Validation of a Dietary Screening Tool in a Middle-Aged Appalachian Population

Abstract

Proactive nutrition screening is an effective public health strategy for identifying and targeting individuals who could benefit from making dietary improvements for primary and secondary prevention of disease. The Dietary Screening Tool (DST) was developed and validated to assess nutritional risk among rural older adults. The purpose of this study was to evaluate the utility and validity of the DST to identify nutritional risk in middle-aged adults. This cross-sectional study in middle-aged adults (45–64 year olds, n = 87) who reside in Appalachia, examined nutritional status using an online health survey, biochemical measures, anthropometry, and three representative 24-h dietary recalls. The Healthy Eating Index (HEI) was calculated to describe overall diet quality. Adults identified by the DST with a nutrition risk had lower HEI scores (50 vs. 64, p < 0.001) and were much more likely to also be considered at dietary risk by the HEI (OR 11.6; 3.2–42.6) when compared to those not at risk. Those at risk had higher energy-adjusted total fat, saturated fat, and added sugar intakes and lower intakes of dietary fiber, and several micronutrients than those classified as not at risk by the DST. Similarly, the at-risk group had significantly lower serum levels of α-carotene, β-carotene, cryptoxanthin, lutein, and zeaxanthin but did not differ in retinol or methylmalonic acid compared with those not at risk. The DST is a valid tool to identify middle-aged adults with nutritional risk.

Self-Reported Diet Quality Differentiates Nutrient Intake, Blood Nutrient Status, Mood, and Cognition: Implications for Identifying Nutritional Neurocognitive Risk Factors in Middle Age

“…This approach offers clinical utility as health care practitioners can easily administer the 20-item screening tool and it does not require the cost and labor associated with more comprehensive methods of dietary assessment (24-h recalls and food frequency questionnaires). The DST has previously been validated in middle-aged adults, demonstrating its ability to discriminate across a range of nutrient intake and biomarkers [29]. However, studies using this tool have focused on general health outcomes [29,30].…”

Nutrition Risk is Associated with Leukocyte Telomere Length in Middle-Aged Men and Women with at Least One Risk Factor for Cardiovascular Disease

“…Nutrition risk was determined based on scores from the DST. In the DST validation study, those classified “at nutrition risk” had lower intakes of several antioxidant nutrients, and lower serum levels of carotenoids than those “not at risk” [30]. Thus, a plausible mechanism for the relationship between DST risk categories and rLTL is that lower intakes of antioxidant nutrients result in higher oxidative stress levels [41], a major cause of DNA damage, which exacerbates telomere shortening [42].…”

“…Unlike the HEI-2015 and aMed index scores which are based on intakes from multiple 24-h recalls, the DST is a survey instrument made up of 24 questions about food intake and behaviors and one question about dietary supplement use [29]. The screening instrument was previously validated in this sample to assess overall diet quality and to detect nutritional risk particularly as it relates to fruit and vegetable intake [30]. For this study, the questions were asked on the online survey and the scoring algorithm was applied based on participant responses.…”

“…The scores were summed for a total DST score ranging from 0–105 points with higher scores indicating better overall diet quality. Participant scores were categorized as being “at nutrition risk” (DST scores < 60) or “not at risk/at potential risk” (DST scores ≥ 60) [30].…”

Self-Selection Bias: An Essential Design Consideration for Nutrition Trials in Healthy Populations

“…The study aimed to recruit a cohort comprising 50% participants with an “optimal” diet and 50% with a “sub-optimal” diet. The dietary screen provided an umbrella view of overall diet quality and has previously been validated as a predictor of nutrient status ( 22 , 23 ). This dietary screen has been described elsewhere ( 24 ).…”