Stability of the Framingham Nutritional Risk Score and its component nutrients over 8 years: the Framingham Nutrition Studies

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Diet quality indices are increasingly used in nutrition epidemiology as dietary exposures in relation to health outcomes. However, literature on the long-term stability of these indices is limited. We aimed to assess the stability of the validated Framingham Nutritional Risk Score (FNRS) and its component nutrients over 8 years, as well as the validity of the follow-up FNRS.


Framingham Offspring/Spouse Study women and men (n = 1734) aged 22-76 years were evaluated over 8 years. Individuals' nutrient intake and nutritional risk scores were assessed using 3-day dietary records administered at baseline (1984-1988) and at follow-up (1992-1996). Agreement between baseline and follow-up FNRS and nutrient intakes was evaluated by Bland-Altman method; stability was assessed using intra-class correlation (ICC) and weighted Kappa statistics. The effect of diet quality (as assessed by the FNRS) on cardiometabolic risk factors was evaluated using analysis of covariance.


Modest changes from baseline (≤15%) were observed in nutrient intake. The stability coefficients for the FNRS (ICC: women, 0.49; men, 0.46; P< 0.0001) and many nutrients (ICC ≥0.3) were moderate. Over half of the women and men (58%) remained in the same or contiguous baseline and follow-up quartile of the FNRS and few (3-4%) shifted > 1 quartile. The FNRS was directly associated with body mass index in women (P<0.01) and high-density lipoprotein cholesterol among both women (P< 0.001) and men (P<0.01).


The FNRS and its constituent nutrients remained relatively stable over 8 years of follow-up. The stability of diet quality has implications for prospective epidemiological investigations.

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