Association of a Single-Item Self-Rated Diet Construct With Diet Quality Measured With the Alternate Healthy Eating Index

Abstract

Background: A single-item self-rated diet measure (SRD) may provide a quick, low-burden screener. However, assessment of its validity is limited. This study aimed to evaluate the association of an SRD construct with measured diet quality among adults in Puerto Rico (PR).Methodology: Participants (30–75 years old; n = 247) of the PR Assessment of Diet, Lifestyle, and Diseases (PRADLAD) cross-sectional study reported SRD with a single question (“How would you describe your current dietary habits and diet quality?”) with a five-point scale: excellent to poor. More complete diet quality was calculated using the Alternate Healthy Eating Index-2010 (AHEI), with 11 food and nutrient components assessed by the food frequency questionnaire. Multivariable general linear models were used to test associations between SRD with AHEI and its components. Associations were also tested between recall SRD in youth and current AHEI.Results: Most participants (35.2%) self-rated diet as “good,” 13.8% as “excellent,” and 4.1% as “poor,” with the remainder split between middle scale points. SRD was not significantly associated with AHEI, although participants with “excellent” vs. “poor” SRD had marginally higher AHEI (P = 0.07). SRD was significantly associated with higher fruit intake (P = 0.02) and marginally associated with intakes of vegetables (P = 0.07) and long-chain fatty acids (P = 0.07). Unexpectedly, AHEI was significantly higher among those reporting “poor” SRD in young adulthood (P = 0.01) or childhood (P = 0.05).Conclusions: SRD may capture current diet quality at extreme intakes. Larger studies should confirm these findings and replicate them in other underrepresented populations. Further research should clarify the inverse associations between adult AHEI and earlier reported SRD.

Lay knowledge of cardiovascular disease and risk factors in three communities in Accra, Ghana: a cross-sectional survey

“…Previous studies have shown that self-rated fat intake is a valid measure for evaluating diet quality at the population and it also provides a simple method for identifying people with worst diet quality. 27 28 …”

Perceiving a need for dietary change in adults living with and beyond cancer: A cross‐sectional study

“…39 The association between older age and a reduced likelihood of perceiving a need to improve diet aligns with previous reports of higher self-ratings of dietary quality in older age groups, 38,39 while the greater likelihood of females perceiving a need to improve diet in the dietary components model diverges from reported similarities across men and women in perceptions of dietary healthfulness. 40,41 This discrepancy may be attributed to the difference in asking participants to consider whether they need to improve their diet, which is distinct from rating the healthfulness of their diet. 38,40 In their study of people LWBC, Xue et al asked participants to rate how healthy their diet was on a scale of one to five, while Batis et al asked participants a closed binary question of whether they considered their diet to be healthy.…”

“…35 In Xue et al's study, each 10-year increase in age was associated with greater odds of being incorrectly optimistic about dietary quality, 38 while different age groups had a differential effect on being incorrectly optimistic in Variyam et al's study of the general population. 36 While there are only few studies examining predictors of misperceptions of dietary quality, 36,38 previous research is inconclusive regarding associations between dietary quality perception (whether correct or not) and demographic factors such as age [38][39][40][41] and sex. 37,38,40 While, Batis et al and Gago et al observed similarities in the mean ages of participants across differing perceptions of dietary quality, 40,41 Sullivan et al reported that adults, who perceive their diet to be of higher quality tend to be older than those who report lower self-ratings of dietary quality.…”

“…39 However, these discrepancies may be attributed to differences in how perceived dietary quality is measured across studies, either dichotomously 40 or using rating scales. 39,41 Further research suggests that individuals with higher education levels tend to self-report better dietary quality, 39 but the accuracy of this is compromised by Xue et al's observation that this group is also more likely to demonstrate an optimism bias. 38 There is more consistent evidence that people with overweight and obesity tend to perceive their dietary quality to be poorer than those in healthier weight categories.…”

“…36 While there are only few studies examining predictors of misperceptions of dietary quality, 36,38 previous research is inconclusive regarding associations between dietary quality perception (whether correct or not) and demographic factors such as age [38][39][40][41] and sex. 37,38,40 While, Batis et al and Gago et al observed similarities in the mean ages of participants across differing perceptions of dietary quality, 40,41 Sullivan et al reported that adults, who perceive their diet to be of higher quality tend to be older than those who report lower self-ratings of dietary quality. 39 However, these discrepancies may be attributed to differences in how perceived dietary quality is measured across studies, either dichotomously 40 or using rating scales.…”