Adaptation of a Dietary Screener for Asian Americans

No brief dietary screeners are available that capture dietary consumption patterns of Asian Americans. The purpose of this article is to describe the cultural adaptation of the validated Dietary Screener Questionnaire (DSQ) for use by clinicians, researchers, and community-based partners seeking to understand and intervene on dietary behaviors among English-speaking Asian Americans, for the six largest Asian subgroups (Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese) in the United States. This was mainly accomplished by adding culturally specific examples of foods to the questionnaire items via searching online databases and soliciting input from members of our community partner network representing each of the six largest Asian subgroups. Over half of the 26 items on the DSQ were modified to include more culturally specific foods. Developing high-quality tools that reflect the diversity of the U.S. population are critical to implement nutrition interventions that do not inadvertently widen health disparities.

Relative Validity and Reproducibility of a Dietary Screener Adapted for Use Among Pregnant Women in Dhulikhel, Nepal

Objectives Culturally appropriate dietary assessments are lacking in many low-income countries including Nepal. Here we examined the reproducibility and validity of a dietary screener which was translated and adapted to assess diet quality among pregnant Nepalese women. Methods A pilot cohort of singleton pregnant women (N = 101; age 25.9 ± 4.1 years) was recruited from a tertiary, periurban hospital in Nepal. An adapted Nepali version of the PrimeScreen questionnaire, assessing weekly consumption frequency of 12 healthy and 9 unhealthy food groups, was administered twice and a month apart in both the 2nd and 3rd trimester. Up to four inconsecutive 24-hr dietary recalls (24-HDRs) were also completed each trimester and utilized as the reference method for validation. For each trimester, data from multiple 24-HDRs were averaged across days, and items were grouped to match the classification and the three weekly consumption categories (0–1, 2–3 or 4 + servings/week) of the 21 food groups represented on the PrimeScreen. Gwet's agreement coefficients (AC1) were used to evaluate the reproducibility and validity of the adapted PrimeScreen against the 24-HDRs in both 2nd and 3rd trimester. Results In the 2nd trimester, the adapted PrimeScreen demonstrated good to excellent reproducibility (AC1 > 0.6) for majority of the food groups; the reproducibility was moderate for eggs (AC1 = 0.4), and poor (AC1 < 0.4) for citrus fruits and leafy vegetables. In the 3rd trimester, AC1 for reproducibility of the PrimeScreen ranged from 0.4 (moderate agreement) to 1 (excellent agreement), with values ≥0.6 for 90% of the items indicating good to excellent reproducibility for the majority of the food groups. Compared to 24-HDRs, the adapted PrimeScreen showed moderate to excellent validity (AC1 ≥ 0.4) for all food groups except for eggs and leafy vegetables in both the 2nd and 3rd trimester, and additionally citrus fruits and cruciferous vegetables in the 2nd trimester alone. Classification into 3 consumption categories (0–1, 2–3 or 4 + servings/week) were consistent (percentage agreement > 80%) between the PrimeScreen and 24-HDR for 80% of the food groups in both 2nd and 3rd trimester. Conclusions The adapted PrimeScreen questionnaire appears to be a reliable and valid instrument for assessing the dietary intake of most food groups among pregnant women in Nepal. Funding Sources NIH/FIC.

Fruit and Vegetable Intake Assessed by Repeat 24 h Recalls, but Not by A Dietary Screener, Is Associated with Skin Carotenoid Measurements in Children

Accurate measurement of fruit and vegetable (FV) intake is important for nutrition surveillance and evaluation of dietary interventions. We compared two tools for reporting FV intake to objective measurement of skin carotenoids among children. FV cups/day was assessed by repeated 24 h dietary recalls (24H FV) and the National Cancer Institute’s All-Day Fruit and Vegetable Screener (NCI FV). Skin carotenoids were measured by repeated resonance Raman spectroscopy (RRS) of the palm. FV cups were regressed on RRS scores in unadjusted, field-based, and research-setting models with covariates feasible in each scenario. Data were baseline values from children aged 2–12 years in low-income households enrolled in a healthy eating randomized trial in four U.S. states (n = 177). Twenty-four-hour FV cups were associated with skin carotenoids in all models (p < 0.001) but NCI FV cups were not. Predicted RRS scores for discrete 24H FV cups provide a guide to interpretation of RRS in children (2 cups FV intake ~36,000 RRS units), with the research-setting scenario generally providing the narrowest prediction range (+/−1924). When self-reported data are required, 24 h recalls are more accurate than NCI FV screener data; and, when limited time, resources, or literacy must be considered, RRS scores can be quickly obtained and easily interpreted.

Association between hourly wages and dietary intake after the first phase of implementation of the Minneapolis minimum wage ordinance

Objective: In 2018, Minneapolis began phased implementation of an ordinance to increase the local minimum wage to $15/hour. We sought to determine whether the first phase of implementation was associated with changes in frequency of consumption of fruits and vegetables, whole grain-rich foods, and foods high in added sugars among low-wage workers. Design: Natural experiment. Setting: The Wages Study is a prospective cohort study of 974 low-wage workers followed throughout the phased implementation of the ordinance (2018-2022). We used difference-in-difference analysis to compare outcomes among workers in Minneapolis, Minnesota, to those in a comparison city (Raleigh, North Carolina). We assessed wages using participants’ pay stubs and dietary intake using the National Cancer Institute Dietary Screener Questionnaire. Participants: Analyses use the first two waves of Wages data (2018 [baseline], 2019) and includes 267 and 336 low-wage workers in Minneapolis and Raleigh (respectively). Results: After the first phase of implementation, wages increased in both cities, but the increase was $0.82 greater in Minneapolis (p=0.02). However, the first phase of the policy’s implementation was not associated with changes in daily frequency of consumption of fruits and vegetables (IRR=1.03, 95% CI: 0.86-1.24, p=0.73), whole grain-rich foods (IRR=1.23, 95% CI: 0.89-1.70, p=0.20), or foods high in added sugars (IRR=1.13, 95% CI: 0.86-1.47, p=0.38) among workers in Minneapolis compared to Raleigh. Conclusions: The first phase of implementation of the Minneapolis minimum wage policy was associated with increased wages, but not with changes in dietary intake. Future research should examine whether full implementation is associated dietary changes.

Development, Relative Validity and Reproducibility of the Aus-SDS (Australian Short Dietary Screener) in Adults Aged 70 Years and above

The aim of this study was to assess the relative validity and reproducibility of a six-item Australian Short Dietary Screener (Aus-SDS). The Aus-SDS assessed the daily intake of core food groups (vegetables, fruits, legumes and beans, cereals, protein sources and dairy sources) in 100 Australians (52 males and 48 females) aged ≥70 years. Relative validity was assessed by comparing intakes from the Aus-SDS1 with an average of three 24-h recalls (24-HRs), and reproducibility using two administrations of the Aus-SDS (Aus-SDS1 and Aus-SDS2). Cohen’s kappa statistic between the Aus-SDS1 and 24-HRs showed moderate to good agreement, ranging from 0.44 for fruits and dairy to 0.64 for protein. There was poor agreement for legume intake (0.12). Bland–Altman plots demonstrated acceptable limits of agreement between the Aus-SDS1 and 24-HRs for all food groups. Median intakes obtained from Aus-SDS1 and Aus-SDS2 did not differ. For all food groups, Cohen’s kappa statistic ranged from 0.68 to 0.89, indicating acceptable agreement between the Aus-SDS1 and Aus-SDS2. Spearman’s correlation coefficient between Aus-SDS1 and 24-HRs across all food groups ranged from 0.64 for fruit to 0.83 for protein. We found the Aus-SDS to be a useful tool in assessing daily intake of core food groups in this population.

Evaluating the Utility of a Diet Quality Screener in Clinical Practice to Improve Quality of Preventive Care (P07-002-19)

Objectives To assess the impact of an office based dietary screener aimed to improve dietary counseling for the cost effective improvement of patient health. Methods We evaluated the utility of incorporating a 10-item diet quality measure (self-rated diet quality question used in the National Health and Nutrition Examination Survey and a 9-item Mediterranean diet screener recommended by the American Heart Association) prior to the cardiology visit in improving efficiency of dietary assessment, guidance of referrals, and in improving diet quality and health indicators over a 6-month period. To assess provider uptake of the dietary screener, we reviewed a random sample of charts (n = 190) to determine the proportion of notes that referenced the dietary screener and documented specific counseling based on the screener. Results Between December 2017 and August 2018, 865 patients completed the diet screener. Mean age was 59 (SD 16) years, 54% were male, and mean BMI was 27.4 (SD 6.0) kg/m2. 18.5% of participants rated their diet as fair or poor, and mean score on the screener (range 0–9) was 5.6 (SD 1.8). Overall, the diet screener appeared in the chart in 87%, the physician gave specific counseling based on the screener in 11% of the visits. Conclusions Findings from this work demonstrate a dietary screener can facilitate identification of patients who might benefit from specific interventions such as the Diabetes Prevention Program. Since cardiovascular disease is just one diet-influenced disease state, this screener could be implemented in other aspects of the health system to guide referrals to RDs for patients with other diet-related disease states. Funding Sources This work was funded by the Center for Healthcare Innovation and Delivery Sciences at NYU Langone Health. Supporting Tables, Images and/or Graphs