The validity and reliability of the Dietary Index for a Child's Eating in 2–8‐year old children living in New Zealand

Abstract

This study aimed to examine the validity and reliability of the Dietary Index for a Child's Eating (DICE) in children living in New Zealand (NZ). Caregivers of healthy children aged 2-8 years completed a 4-day estimated food record (4DFR) for their child and completed the DICE online on two separate occasions, 8 weeks apart. Relative validity was assessed by comparing the DICE and 4DFR total score and component subscores using the Wilcoxon test, Spearman rank correlation coefficients, crossclassification, and weighted kappa (ĸ) statistic. For evaluating construct validity, the DICE total score was compared with energy and nutrient intake from the 4DFR using linear contrast analysis. Intraclass correlation coefficients (Cronbach's α) and Bland-Altman plots were used to assess the reliability of DICE. From a possible score of 100, the mean ± standard deviation of DICE was 78.2 ± 11.5 and from the 4DFR, was 73.8 ± 10.8, with a positive correlation (r = 0.72; p < 0.001) and moderate agreement (ĸ = 0.49). Cross-classification showed 61.9% were correctly categorised into the same tertile group from DICE and the 4DFR. Participants in the highest tertile of DICE had higher intakes of fibre, vitamin C, vitamin A, vitamin D, folate, and calcium. Good agreement (α = 0.87) was found for reliability. DICE is a valid and reliable tool for the assessment of children's adherence to a healthy diet, as recommended by the NZ Ministry of Health Food and Nutrition guidelines. a 4-day estimated food record (4DFR), and an online SurveyMonkey link to the DICE questionnaire. Participants completed the online DICE questionnaire and returned their consent and 4DFR booklet in the post by a prepaid envelope. Eight weeks later, participants were asked to complete the DICE a second time (to assess reliability). When determining reliability, it is recommended to have 4 to 8 weeks between the first and second administration of dietary assessment method. This period of time is long enough so that the respondent is not simply remembering his/her answers, but is short enough to minimise real dietary changes in the interval (Block & Hartman, 1989). To assess validity, data from the first administration of DICE was compared with the 4DFR. The study protocol was approved by the Human Ethics Committee of Massey University (Southern A; approval no. MUHECN14/023), and all caregivers provided written informed consent prior to participating. | Dietary assessment tools | Dietary Index for a Child's EatingThe DICE consists of 13 questions. The DICE components, scoring, and cut-off points are based on the NZ MoH Food and Nutrition Guidelines for 2-18 year olds (Ministry of Health, 2012). These guidelines are evidence-based and specific for the NZ population, therefore providing a standard reference for evaluating the quality of children's diets. The DICE was scored from 0 to 100, with a higher score representing greater adherence to these guidelines. The daily servings of main food groups including fruits, vegetables, milk products, meat/meat-alternatives, br...

Diet quality indices and their associations with health-related outcomes in children and adolescents: an updated systematic review

“…Scientific literature on foods that were not consistently reported int these guidelines were also considered (e.g. sugar sweetened beverages, fish and whole milk) [ 186 – 188 ] 10 components, scored 0–10, points awarded and summed Not specified Yes Dietary Index for a Child’s Eating (DICE), Delshad et al (2018) [ 189 ] Nutrient New Zealand 1) 4-d estimated food record Reflects adherence to the recommended NZ Food and Nutrition guidelines [ 190 ] and meeting nutrient reference values for Australia and New Zealand [ 191 ] 13 components, scored 0–100, points awarded & summed Children (2-18y) Yes Diet Quality Index for NZ adolescents (NZDQI-A); Wong et al (2013) [ 192 ] Food & Nutrient New Zealand 1) Food questionnaire 2) 4-day food record Reflecting adherence of adequacy and variety to the New Zealand Food and Nutrition Guidelines for Healthy Adolescents [ 193 ]. 5 components, scored 0–100, calculated from adequacy x variety, points awarded & summed Adolescents (14-18y) Yes Healthy Dietary Habits Score for Adolescents (HDHS-A); Wong et al (2014) [ 194 ] Food & Nutrient New Zealand 1) 24-h recalls 2) DHQ Reflecting adherence for NZ Food and Nutrition Guidelines for Healthy Children and Young People [ 190 ].…”

“…Most indices were scored by considering both food and nutrient intakes ( n = 64 DQIs), while 34% ( n = 44 DQIs) scored by considering food intake alone, and 6% ( n = 7 DQIs [ 111 , 114 , 115 , 117 , 146 , 148 , 189 ]) scored using nutrient intake data alone (Table 2 ). In addition, 10% ( n = 13 DQIs [ 46 , 73 , 75 , 80 , 121 , 128 , 165 , 195 , 214 , 224 , 235 , 248 , 258 ]) assessed a single behaviour (e.g.…”

“…The score was also positively correlated with intake of all of the examined micronutrients. + 15 Dietary Index for a Child’s Eating (DICE) Delshad et al (2018) [ 268 ] • Country: New Zealand • Age: 2-8y • Sex: Not specified • Data collected: dietary scores and nutrient intakes • Data measurement: Validation study • Validity: Relative and construct • Standard references: DICE and 4-day food record scores • Reliability: test-retest • Significant results ( p < 0.05): A significant positive correlation was observed between the total scores for DICE and the 4DFR. The weighted ĸ-statistic demonstrated moderate agreement (ĸ = 0.49) between DICE and the 4DFR.…”

“…Validity was assessed by construct validity ( n = 21), concurrent or convergent validity ( n = 8), relative validity ( n = 8), content validity ( n = 4), predictive validity ( n = 4), or comparative validity ( n = 1), and eight DQIs were assessed for more than one type of validity [ 46 , 107 , 152 , 177 , 192 , 240 , 268 , 272 ]. Reference standards used to evaluate the validity of indices were other validated tools, serum biomarkers ( n = 9) [ 45 , 50 , 74 , 80 , 88 , 130 , 194 , 265 , 266 ], food intake ( n = 18) [ 19 , 33 , 45 , 69 , 73 , 74 , 80 , 87 , 88 , 107 , 121 , 130 , 152 , 172 , 175 , 177 , 178 , 265 , 266 ], nutrient intake ( n = 30) [ 19 , 33 , 43 , 45 , 46 , 53 , 69 , 73 , 74 , 80 , 87 , 88 , 104 , 107 , 121 , 130 , 151 , 152 , 172 , 175 , 177 , 178 , 189 , 192 , …”

“…Only 28% (n = 37) of the DQIs identified were evaluated for validity (n = 35) and/or reliability (n = 11) ( Table 3). Validity was assessed by construct validity (n = 21), concurrent or convergent validity (n = 8), relative validity (n = 8), content validity (n = 4), predictive validity (n = 4), or comparative validity (n = 1), and eight DQIs were assessed for more than one type of validity [46,107,152,177,192,240,268,272]. Reference standards used to evaluate the validity of indices were other validated tools, serum biomarkers (n = 9) [45,50,74,80,88,130,194,265,266], food intake (n = 18) [19,33,45,69,73,74,80,87,88,107,121,130,152,172,175,177,178,265,266], nutrient intake (n = 30) [19,33,43,45,46,53,69,73,…”