ORIGINAL ARTICLE Portuguese households’ diet quality (adherence to Mediterranean food pattern and compliance with WHO population dietary goals): trends, regional disparities and socioeconomic determinants SSP Rodrigues 1 , M Caraher 2 , A Trichopoulou 3 and MDV de Almeida 1 1 Faculty of Nutrition and Food Sciences, Porto University, Porto, Portugal; 2 Centre for Food Policy, City University, London, UK and 3 Department of Hygiene and Epidemiology, School of Medicine, University of Athens, Greece Objective: To evaluate households’ diet-quality trends and regional disparities, as well as to identify the influence of its socioeconomic determinants. Methods/Subjects: Two dietary indexes were applied: a revised Healthy Diet Indicator version (HDIr) and the Mediterranean Adequacy Index (MAI). The socioeconomic differences between households with low-diet quality (if their scoring in HDIr or MAI was below the national median) and the remaining ones were analysed by means of logistic regression. Representative samples of households among each region were analysed. Results: Adherence to a Mediterranean diet was poor in all Portuguese regions; the proportion of households adhering to it has diminished in the North, Centre, Lisbon and Tejo valley. The proportion of households with high HDIr decreased in the North, Centre, Lisbon and Tejo valley and Algarve. In multivariate analysis, households whose head had secondary or higher education, living in semi-urban or urban areas, from the Azores region, within the higher income or outside home food expenditures groups were more likely to be in low-quality diet. Conclusions: The decreasing adherence to a Mediterranean food pattern and the diminishing compliance with World Health Organization dietary goals show that Portuguese households have reduced their diet quality. The observed influence of urbanization and region on diet quality highlights the importance of considering regional nutrition strategies. European Journal of Clinical Nutrition (2008) 62, 1263–1272; doi:10.1038/sj.ejcn.1602852; published online 1 August 2007 Keywords: diet quality; household budget survey; Mediterranean diet; WHO goals; socioeconomic determinants; Portugal Introduction Owing to the multidimensional nature of dietary habits, prevention and treatment of diet-related diseases have evolved to incorporate a more holistic approach than the traditional focus on single dietary components. To evaluate diet quality, researchers have developed a number of compo- site indexes in which dietary behaviour can be analysed as a single factor evaluating at the same time many relevant items (Trichopoulou et al., 1995; Huijbregts et al., 1997; Alberti- Fidanza et al., 1999; Lagiou et al., 1999). Traditionally developed for the study of the relationships between diet and disease, such indexes may also help on the interpretation of dietary trends and disparities (Kant, 1996, 2004). Different perspectives may contribute to the definition and multi-method evaluations of diet quality. The attributes selected for its measurement are based on current scientific knowledge, the population to be assessed, the resources available for dietary analysis and the researcher viewpoint (Kant, 1996, 2004). In the present study, evaluating diet quality by means of conformity with scientific recommenda- tions incorporating both a food-based and a nutrient approach was thought to be relevant. Despite of the recognition that behind the Mediterranean diet concept there is a large heterogeneity; adherence to this food pattern was considered because its major characteristics Received 23 November 2006; revised 18 June 2007; accepted 20 June 2006; published online 1 August 2007 Correspondence: Dr SSP Rodrigues, Faculty of Nutrition and Food Sciences, Porto University, Rua Dr Roberto Frias, Porto, Portugal. E-mail: saraspr@fcna.up.pt European Journal of Clinical Nutrition (2008) 62, 1263–1272 & 2008 Macmillan Publishers Limited All rights reserved 0954-3007/08 $32.00 www.nature.com/ejcn