Development and validation of a meal quality index with applications to NHANES 2005-2014.

The Meal Balance Index (MBI) assesses the nutritional quality and balance of meals. It is a score between 0 and 100 that takes into account both shortfall and excess nutrients, adjusted for the energy content of the meal. In the present study the score was applied to 147849 meals reported in the National Health and Nutrition Examination Surveys (NHANES) 2005-2014 in order to evaluate its validity and compare against exemplary meals designed as part of 24h diets that meet US dietary guidelines. Meals from exemplary menu plans developed by nutrition experts scored on average 76±14 (mean ± standard deviation) whereas those of NHANES participants scored 45±14. Scores of breakfast, lunch, dinner, snack, considered jointly as independent variables, were moderately but positively and significantly associated with the Healthy Eating Index (Pearson correlation 0.6). MBI scores were significantly associated with the density of positive micronutrients (e.g. Vit A, Vit C) and favorable food groups (e.g. fruits, whole grains) not directly included in the MBI algorithm. The MBI is a valid tool to assess the nutritional quality of meals reported in the US population and if applied to culinary recipe websites could potentially help users to understand which meals are nutritionally balanced. Choice of more balanced individual meals can guide healthier cooking and eating.