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Open Access Research

Associations of dietary indices with biomarkers of dietary exposure and cardiovascular status among adolescents in Germany

Julia Truthmann1*, Almut Richter1, Silke Thiele2, Larissa Drescher3, Jutta Roosen3 and Gert BM Mensink1

Author Affiliations

1 Robert Koch Institute Berlin, Department of Epidemiology and Health Reporting, Postbox 65 02 61, D-13302, Berlin, Germany

2 Christian-Albrechts-University of Kiel, Department of Food Economics and Consumption Studies, Olshausenstraße 40, D-24098, Kiel, Germany

3 TU München, School of Management, Marketing and Consumer Research, Alte Akademie 16, D-85350, Freising, Germany

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Nutrition & Metabolism 2012, 9:92  doi:10.1186/1743-7075-9-92

Published: 24 October 2012



Adolescence is an important life stage for the development of dietary preferences and health behaviour. Longitudinal studies indicated that cardiovascular status in adolescence predicts cardiovascular risk marker values in adulthood. Several diet quality indices for adolescents have been developed in the past, but literature concerning associations between indices and biomarkers of dietary exposure and cardiovascular status is rather sparse. Hence, the aim of this study was to analyse associations of dietary indices with biomarkers of dietary exposure and cardiovascular status.


For the present analysis, data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS 2003–2006) were used. The analysis included 5,198 adolescents, aged 12 to 17 years. The Healthy Food Diversity Index (HFD), the Healthy Nutrition Score for Kids and Youth (HuSKY), the Indicator Food Index (IFI) and a simple fruit/vegetable intake index were derived from food frequency questionnaire information to indicate a healthy diet. Adjusted mean values for homocysteine, uric acid, CRP, total cholesterol, HDL-C, ferritin, HbA1c, folate, vitamin B12 and BMI were calculated using complex-samples general linear models for quintiles of the different indices. Furthermore, the agreement in ranking between the different indices was calculated by weighted kappa. All statistical analyses were conducted for boys and girls separately, and were adjusted for potential confounders.


Folate was positively associated with the HFD, the HuSKY, and fruit/vegetable intake for both boys and girls and with IFI for boys. Among girls, positive associations were seen between vitamin B12 and the IFI and between diastolic blood pressure and the IFI as well as fruit/vegetable intake. A negative association was found between homocysteine and the HFD, the HuSKY, and the IFI for both boys and girls and with fruit/vegetable intake for boys. Among boys, uric acid and HbA1c were negatively and prevalence of obesity positively associated with the IFI.


Overall, the indices, even the simpler ones, seem to have a similar general capability in predicting biomarkers of dietary exposure. To predict risk of cardiovascular disease dietary indices may have to be more specific.

Dietary indices; Diet quality; Cardiovascular status; Nutritional epidemiology; Adolescents; Germany