The Canadian Food Intake Screener for assessing alignment of adults’ dietary intake with the 2019 Canada’s Food Guide healthy food choices recommendations: Scoring system and construct validity

Abstract

The Canadian Food Intake Screener/Questionnaire court canadien sur les apports alimentaires was developed to rapidly assess alignment of adults' dietary intake over the past month with the 2019 Canada Food Guide's healthy food choices recommendations. From July to December 2021, adults (n=154) aged 18-65 years completed the screener and up to two 24-hour dietary recalls. The screener scoring system was aligned with the Healthy Eating Food Index-2019 (HEFI-2019), to the extent possible. ANOVA compared screener scores among subgroups with known differences in diet quality. Using the recall data, the National Cancer Institute multivariate method was used to model HEFI-2019 components, with the screener score as a covariate, and the correlation coefficient between screener and total HEFI-2019 scores was estimated. The mean screener score was 35 points (SD=4.7; maximum, 65), ranging from 25 (1st percentile) to 45 (99th percentile). Differences in scores in hypothesized directions were evident by gender identity (p=0.06), perceived income adequacy (p=0.07), education (p=0.02), and smoking status (p=0.003). The correlation between screener and HEFI-2019 scores was 0.53 (SE=0.12). The screener's moderate construct validity supports its use for rapid assessment of alignment of adults' intake with the healthy food choices recommendations when comprehensive dietary assessment is not possible.

Development of the Canadian Food Intake Screener to assess alignment of adults’ dietary intake with the 2019 Canada’s Food Guide healthy food choices recommendations

“…Potential uses of the screener are discussed in the accompanying paper (Hutchinson et al 2022). The screener assesses intake over the past month, consistent with other screeners (Centers for Disease Control and Prevention n.d.; England et al 2017;National Cancer Institute 2021;Wijnhoven et al 2018).…”

“…Equivalence or comparability (Frongillo et al 2019) in capturing alignment with the CFG-2019 healthy food choices recommendations across population subgroups was also considered. Additionally, the screener should demonstrate reasonable construct validity, described in the accompanying paper (Hutchinson et al 2022). These principles were discussed with the advisors and informed initial decisions about the format and content of the screener.…”

“…We sought to avoid combining different types of foods (e.g., meats, cheese, and milk) in a single question to the extent possible, while also aiming for a short screener. This approach was deemed useful for minimizing cognitive load and ensuring clarity in the foods to consider in responding to each question, as well as providing flexibility to account for emphases of the guidance, for example, on plant-versus animal-based protein foods, in the screener's scoring system, described in the accompanying paper (Hutchinson et al 2022). The specific wording used in the screener questions differs in some instances from language used in the guidance and the use of wording such as 'sources of' does not imply that the foods or beverages must meet the nutrient criteria for the claim "source of", as defined in the Food and Drug Regulations (Government of .…”

“…The current paper describes the development process, including cognitive testing to assess whether screener questions were understood as intended, and face and content validity with a panel of experts. The screener's scoring system and construct validity are described in the accompanying paper (Hutchinson et al 2022). A separate brief questionnaire, the Canadian Eating Practices Screener, developed to assess adults' alignment with the CFG-2019 healthy eating habits recommendations, is described elsewhere (Haines et al 2022).…”

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“…Fifteen dietary questions, developed and validated by the Canadian government, assessed the intake of various food items. These questions evaluated healthy choices, such as the consumption of fruits and vegetables, and unhealthy choices, including snacks, fried foods, soda, alcohol, and red meat, in alignment with the guidelines set forth in the 2020 Canadian Food Guide [18,19].…”