1 Departament of Nutrition, School of Public Health, University of São Paulo, Brazil. 2 Diabetes and Nutritional Sciences Division, King’s College London, United Kingdom. 3 School of Arts, Sciences and Humanities, University of São Paulo, Brazil.
Introduction. Indicators on nutritional quality of meals are predefined summary measures of overall meal quality that may be used to evaluate adherence to dietary guidelines and to monitor overall dietary changes. A meal quality indicator could be used as a simple and quick instrument for the assessment of nutritional quality. Objective. To perform a systematic review on indicators developed to evaluate nutritional quality of meals. Methods. A systematic search on bibliographic databases was performed using keywords related to indexes for assessment of meal quality. Literature search retrieved 22,963 citations. After applying inclusion/exclusion criteria, this resulted in seven different indicators of meal quality. The main characteristics (study design; populations; meal type; dietary questionnaire applied; characteristics evaluated; score; components; guidelines; correlations performed and validation) were used for a qualitative assessment of the meal quality indicators. Results. Among the seven indicators, three analysed the meal quality using qualitative method, three used quantitative method and one applied both methods. In relation to the meals evaluated, two studies developed an instrument to assess the quality of breakfast, three analysed lunch, one evaluated dinner and one was applied to all types of meals as well as snacks. None investigated the relationship between meal quality and health outcomes. Three items were included as components for evaluation in most of the indicators reviewed: total fat or some specific type of fat; fruits and vegetables; and cereals or whole grains. Other items usually prevalent were dairy products and calcium; diversity of food items and food groups; and added sugar. Three studies evaluated the ability of the indicator to assess dietary quality and one evaluated the internal consistency of its components. It is noteworthy that all indicators still need to be internally validated. Conclusion. The development and application of meal quality indexes is still relatively new and requires further investigation.