Background and Objective:
Assessment of diet quality is a major public health concern, considering the impact of nutrition on health status. Nutritional transition, intended as a modification of food preferences from traditional to unhealthier dietary patterns, greatly affects diet quality, especially for younger generations. The aim of this study was to evaluate the overall diet quality in a sample of primary school children using the Mediterranean adaptation of the Diet Quality Index-International (DQI-I).

Methods:
This cross-sectional study was conducted among 112 children (6-10 years) in a primary school in Imola (Italy) in 2019. DQI-I explores four aspects considered necessary for a healthy diet: 1) variety 2) adequacy: the intake of those dietary elements that are required to protect against under-nutrition 3) moderation: the intake of food and nutrients related to chronic diseases which may need restriction 4) overall balance: macronutrients ratio. The analysis of the different categories of the DQI-I helps to identify which aspects of the diet need to be improved.

Results:
The mean total DQI-I score was 59.14 (SD=8.48) on a 0 to 100 scale. Out of the 112 included children, only n=55 (49,1%) had a total score higher than 60 (indicating an intermediate/good diet quality). Adequacy had the highest score (27.13±5.64; min 0-max 40), followed by moderation (18.27±3.21; min 0-max 30) and variety (10.21±3.41; min 0-max 20). Overall balance had the lowest score (3.54±1.34; min 0-max 10). According to the adequacy category, the majority of the sample reported adequate intake (>50% recommendations) for grains, fibers, proteins, iron, calcium and vitamin C. Most children failed to meet the recommended levels of vegetables and fruits intake.

Conclusion:
Health education is necessary to improve the overall quality of childrens nutrition habits, especially about the recommended intake of macronutrients and proper intake of fruits and vegetables.