Development and validation testing of a short nutrition questionnaire to identify dietary risk factors in preschoolers aged 12–36 months

BACKGROUND: Although imbalances in dietary intakes can have short and longer term influences on the health of preschool children, few tools exist to quickly and easily identify nutritional risk in otherwise healthy young children. OBJECTIVES: To develop and test the validity of a parent-administered questionnaire (NutricheQ) as a means of evaluating dietary risk in young children (12–36 months). DESIGN: Following a comprehensive development process and internal reliability assessment, the NutricheQ questionnaire was validated in a cohort of 371 Irish preschool children as part of the National Preschool Nutrition Survey. Dietary risk was rated on a scale ranging from 0 to 22 from 11 questions, with a higher score indicating higher risk. RESULTS: Children with higher NutricheQ scores had significantly (p<0.05) lower mean daily intakes of key nutrients such as iron, zinc, vitamin D, riboflavin, niacin, folate, phosphorous, potassium, carotene, retinol, and dietary fibre. They also had lower (p<0.05) intakes of vegetables, fish and fish dishes, meat and infant/toddler milks and higher intakes of processed foods and non-milk beverages, confectionery, sugars and savoury snack foods indicative of poorer dietary quality. Areas under the curve values of 84.7 and 75.6% were achieved for ‘medium’ and ‘high’ dietary risk when compared with expert risk ratings indicating good consistency between the two methods. CONCLUSION: NutricheQ is a valid method of quickly assessing dietary quality in preschoolers and in identifying those at increased nutritional risk. IN CONTEXT: Analysis of data from national food and nutrition surveys typically identifies shortfalls in dietary intakes or quality of young children. This can relate to intakes of micronutrients such as iron or vitamin D as well as to the balance of macronutrients they consume (e.g. fat or sugar). Alongside this lie concerns regarding overweight and obesity and physical inactivity. This combination of risk factors has potential negative effects for both short and longer term health. Hence, screening tools, such as NutricheQ described here, offer an opportunity for early identification and subsequent appropriate timely intervention from 12 months of age. This paper describes the development and validation of NutricheQ, a short user-friendly questionnaire. Designed to be administered by parents or carers, it aims to help healthcare professionals identify children at risk based on known, evidence-based nutritional risk factors. It is hoped in the longer term that this tool can be adapted for use globally and improve child health through early identification, which can be followed up by targeted, cost-effective interventions.