Development of the Penn Healthy Diet screener with reference to adult dietary intake data from the National Health and Nutrition Examination Survey

Abstract

Background There is a need for a feasible, user-friendly tool that can be employed to assess the overall quality of the diet in U.S. clinical settings. Our objectives were to develop the Penn Healthy Diet (PHD) screener, evaluate screener item correlations with Healthy Eating Index (HEI)-2015 components, and develop a simple scoring algorithm. Methods National Health and Nutrition Examination Survey (NHANES) 2017–18 dietary recall data in adults were used to define food examples in screener food groups based on components of the HEI-2015, Diet Approach to Stop Hypertension, and Alternative Mediterranean diet approaches. Instrument Content Validity Index (I-CVI) was used to evaluate the clarity and relevance of the screener. Patient acceptability was evaluated by completion time and response rates. NHANES 2017–18 food recall data were used to simulate responses to the screener items, which were evaluated for association with HEI-2015 components. A scoring algorithm was developed based on screener items moderately or strongly associated with HEI-2015 components. Reproducibility was tested using NHANES 2015–16 data. Results The screener had strong clarity (I-CVI = 0.971) and relevance for nutrition counseling (I-CVI = 0.971). Median (IQR) completion time was 4 (3–5) minutes on paper and 4 (4–8) minutes online, and 73% of patients invited online completed the survey. Based on simulated NHANES participant screener responses, 15 of the 29 screener items were moderately or strongly associated with HEI-2015 components, forming the basis of the scoring algorithm with a range of 0–63 points, where higher score indicates a healthier diet. The median (IQR) screener and HEI-2015 scores were 14.96 (11.99–18.36) and 48.96 (39.51–59.48), respectively. The simulated PHD score was highly correlated with the HEI-2015 score (Spearman rho 0.75) in NHANES 2017–18 and confirmed in NHANES 2015–16 data (Spearman rho 0.75). Conclusions The Penn Healthy Diet screener may be a useful tool for assessing diet quality due to its acceptable content validity, ease of administration, and ability to distinguish between servings of key food groups associated with a healthy versus unhealthy diet according to the HEI-2015. Additional research is needed to further establish the instrument’s validity, and to refine a scoring algorithm.

Penn Healthy Diet survey: pilot validation and scoring

“…Using the simple scoring algorithm recently published (19) , in respondents to both the PHD and the ASA24, the PHD score was 14·5 ± 4·68 and the HEI-2015 score based on ASA24 data was 52·7 ± 16·5. The screener score exhibited a moderate correlation with the HEI-2015 total score ( r = 0·59, P = 0·0034).…”

“…There is substantial need for more efficient and user-friendly methods to gauge diet quality. We developed the PHD screener to help meet this need (19) . In this study, we demonstrated that the patient experience of the PHD screener was generally positive, and the time to completion was in the range expected for a dietary screener.…”

“…A screener score was computed using the simple scoring algorithm previously published (19) with exclusion of the three behavioural variables, using Spearman correlation coefficients to assess associations between screener data and the HEI 2015 total score and subcomponents. Correlation coefficients were interpreted as follows: Values 0-0•2, negligible; 0•2-0•39 weak; 0•4-0•60 moderate; 0•7-0•89 strong and 0•9-1•0 very strong correlation (30) .…”

“…A simple scoring algorithm identified twelve food groups (fruit juice, fruit, green/leafy vegetables, red/orange vegetables, whole grains, milk, seafood, plant proteins, nuts/seeds, sugary beverages, refined grains and cheese) and three behavioural items (full fat dairy, added butter/gravy and added oil) that were moderately or strongly associated with HEI-2015 variables. The simple scoring approach with PHD data correlated strongly (Spearman’s rho = 0·75) with the HEI-2015 score from NHANES diet recall information (19) . However, in the initial study, participant responses to the PHD screener questions were simulated based on their reported food intake in the NHANES 24-h dietary recalls.…”

Review of Validated Methods to Evaluate Diet History in Diet Therapy and Counselling: An Overview and Analysis of Screeners Based on Food-Based Dietary Guidelines

“…Thirteen studies of 11 screeners for assessing diet quality based on FBDGs were included in the review. Four screeners were developed in the USA [74][75][76][77][78], three in Australia [79][80][81][82], three in northern Europe [83][84][85] and one in Switzerland [86]. The studies on the Penn Healthy Diet Screener (PHDS) [74], Picture your Plate (PYP) [75] and the Score d'Alimentation Saine (SCASA) [86] were conducted between 2020 and 2022; the studies on the residential environments dietary guideline index (RDGI) [79], the Short Food Survey (SFS) [80], the Australian Recommended Food Score (ARSF) [81,82], the fifteenitem Food Frequency Questionnaire (15-item FFQ) [83] and the Food-Based Diet Quality Score (FBDQS) [84] were between 2015 and 2019; and the Index of Diet Quality (IDQ) was studied in 2010 [85].…”