Local Validation Study for NutricheQ Tool in Lebanon

Abstract

Background: Globally, there is a trend towards consumption of energy-dense, nutrient-poor foods leading to dietary imbalances in toddlers. Nutrient deficiencies are associated with the risk of obesity and other health risks. NutricheQ is an 18-item questionnaire that can quickly identify these risks based on dietary patterns in healthy toddlers. Objectives: This study aimed to validate the NutricheQ tool, describe the dietary intake of toddlers and classify them into risk groups. Methods: This was a national, multi-center, observational, validation study conducted at 21 medical centers in Lebanon. Data was collected from NutricheQ administered to the parents of toddlers during a single outpatient visit, and food diary filled by parents during a 4-day follow-up. The validation process of NutricheQ was done using Pearson's and Spearman's correlation, ANOVA and ANCOVA. The accuracy of NutricheQ in the Identifying categories of nutritional risk was evaluated using the receiver operating characteristic (ROC) curves. All analyses were performed using IBM-SPSS version 24 and P value of ≤ 0.05 was considered to be statistically significant. Results: Of the 487 toddlers enrolled, 467 had full data on NutricheQ and food diary data was available for 247 only. Majority of toddlers in Lebanon (80%-88%) were categorized in the moderate or low-risk groups of dietary intake indicating good eating habits. There was a significant positive association between the total NutricheQ score and both, age (r = 0.11, P = 0.021) and BMI Z-score (r = 0.11, P = 0.021). ROC fitting showed a very low discriminatory ability of the scores to correctly classify toddlers into the high-risk group based on their BMI Z-score. Significant positive correlation was obtained between the NutricheQ total score and exchangeable fat and meat with high fat, in the food diaries (R = 0.170, P = 0.045), indicating risk. Also, there was a negative association between the total NutricheQ score and soluble and insoluble fiber (Rs = 0.181, P = 0.004). Conclusions: Results from this study showed that NutricheQ has reasonable validity in the Lebanese context to assess the dietary quality of toddlers in Lebanon and in identifying those at increased nutritional risk.

Lifestyle Screening Tools for Children in the Community Setting: A Systematic Review

“…We included two systematic reviews [ 14 , 17 ], yielding no additional screening tools for inclusion. The other 46 articles [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ] described 41 unique screening tools. The majority of the included articles reported on the development and validation of screening tools, whereas their implementation was rarely addressed.…”

“…Although not always explicitly stated in the tool’s aim, articles mostly described that the tool focused on factors associated with obesity risk. Ten screening tools were distinctively designed for toddlers (1–3 years old) or preschoolers (3–5 years old) [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ] and another nine for school-aged children (6–12 y) [ 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ]. Fourteen tools were described as either designed for children in general or did not specify the children’s target age (0–18 y) [ 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ].…”

“…These visuals included portion sizes and images to make the tool more appealing. The time needed to complete the tool was reported for only thirteen tools [ 18 , 19 , 20 , 30 , 31 , 34 , 37 , 38 , 39 , 40 , 47 , 52 , 60 , 63 ]. From those who reported the time, the time needed ranged from 3 [ 18 , 19 , 20 ] to 90 [ 37 ] minutes; six tools could be completed within 15 min [ 18 , 19 , 20 , 31 , 38 , 40 , 52 ].…”

“…Predictive validity was not assessed for any tool. Specifically, the ‘NutricheQ’ was tested for sensitivity, specificity, associations with food group intake and nutrient intake based on a 4-day weighed food diary, and associations with BMI z-scores [ 18 , 19 , 20 ]. The other screening tools were validated less extensively, usually comprising only one dimension of validity.…”

Evaluation of psychometric properties of NutriCHEQ in Iranian toddlers

“…Aramouny et al . [ 34 ] investigated the validity of the NutriCHEQ questionnaire, defined the dietary intake of Lebanese toddlers, and classified them into risk groups. The analysis of covariance (ANCOVA) test was used for comparisons across the different categories among the different groups.…”