Development and Validation of the Short Healthy Eating Index Survey with a College Population to Assess Dietary Quality and Intake
Abstract
:1. Introduction
- Determine whether the Short Healthy Eating Index (sHEI) could be used to accurately estimate dietary intake of food groups by comparing the newly developed sHEI survey outputs to those of the Dietary Screener Questionnaires (DSQs) [33], 24 h recalls, and carotenoid measurements.
- Determine whether the sHEI could be used to accurately estimate the HEI score calculated from 24 h recall data.
2. Materials and Methods
2.1. Survey Question Development and Refinement
2.2. A Concurrent Criterion Validation Process
2.3. Confirmatory Analysis
3. Results
3.1. DQ Scoring Rules Interpretation
3.2. Food Group Intake Correlation
3.3. Confirmatory Analysis
3.4. Overall Tool
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
Appendix A. The sHEI Survey (The Original Survey Has Pictures with Each Question. That Version Is Available upon Request with the Contact Author.)
Q1 (Fruit)
Q2 (Fruitjuice)
Q3 (Vege)
Q4 (Greenvege)
Q5 (Starchy)
Q6 (Grains)
Q7 (Grains2) If “Less Than 1” is Selected for Q6
Q8 (Wholegrains)
Q9 (Wholegrains2) If “Less Than 1” is Selected for Q8
Q10 (Milk)
Q11 (Milk2) If “Less Than 1” is Selected for Q10
Q12 (Lowfatmilk)
Q13 (Lowfatmilk2) If “Less Than 1” is Selected for Q12
Q14 (Beans)
Q15 (Nutseeds)
Q16 (Seafood)
Q17 (Seafood2) If “Less Than 1” is Selected for Q16
Q18 (Ssb)
Q19 (Ssb2) If “Less Than 1” is Selected for Q18
Q20 (Addedsugars)
Q21 (Satfat)
Q22 (Water)
Appendix B. sHEI Scoring Instructions for Estimating sHEI Total Dietary Quality Score
Total Fruits Component (total_fruits), 0–5 |
IF Q1 (fruit) = 1 THEN total_fruits_Q1 = 0; IF Q1 (fruit) = 2 THEN total_fruits_Q1 = 2; IF Q1 (fruit) = 3 THEN total_fruits_Q1 = 3.5; IF Q1 (fruit) = 4,5,6,7 THEN total_fruits_Q1 = 5. IF Q2 (fruitjuice) = 1 THEN total_fruits_Q2 = 0; IF Q2 (fruitjuice) = 2 THEN total_fruits_Q2 = 2; IF Q2 (fruitjuice) = 3 THEN total_fruits_Q2 = 3.5; IF Q2 (fruitjuice) = 4,5,6,7 THEN total_fruits_Q2 = 5. total_fruits = total_fruits_Q1 + total_fruits_Q2. IF total_fruits > 5 THEN total_fruits = 5. |
Whole Fruits Component (whole_fruits), 0–5 |
IF Q1 (fruit) = 1 THEN whole_fruits = 0; IF Q1 (fruit) = 2 THEN whole_fruits = 2.5; IF Q1 (fruit) = 3,4,5,6,7 THEN whole_fruits = 5. |
Total Vegetables Component (tot_veg), 0–5 |
IF Q4 (greenvege) = 1 THEN tot_veg = 1.60; IF Q5 (startchy) = 2,3,4,5,6,7 AND Q4 (greenvege) = 2 THEN tot_veg = 2.46; IF Q5 (startchy) = 2,3,4,5,6,7 AND Q4 (greenvege) = 3,4,5,6,7 THEN tot_veg = 3.24; IF Q5 (startchy) = 1 AND Q4 (greenvege) = 2,3,4,5,6,7 THEN tot_veg = 3.56. |
Greens and Beans Component (greens_beans), 0–5 |
IF Q4 (greenvege) = 1 THEN greens_beans_Q7 = 0; IF Q4 (greenvege) = 2,3,4,5,6,7 THEN greens_beans_Q7 = 5. IF Q14 (beans) = 1 THEN greens_beans_Q14 = 0; IF Q14 (beans) = 2,3,4,5,6,7 THEN greens_beans_Q14 = 5. greens_beans = greens_beans_Q4 + greens_beans_Q14. IF greens_beans > 5 THEN greens_beans = 5. |
Whole Grains Component (whole_grains), 0–10 |
IF Q8 (wholegrains) = 1 THEN whole_grains = 0.51; IF Gender = M AND Q8 (wholegrains) = 2,3,4,5,6,7 THEN whole_grains = 2.97; IF Gender = F AND Q8 (wholegrains) = 2,3 THEN whole_grains = 5.20; IF Gender = F AND Q8 (wholegrains) = 4,5,6,7 THEN whole_grains = 6.94. |
Dairy Component (Dairy), 0–10 |
IF Gender = M AND Q10 (milk) = 1,2,3 THEN dairy = 3.22; IF Gender = F AND Q10 (milk) = 1,2,3 AND Q12 (lowfatmilk) = 1 THEN dairy = 3.32; IF Gender = F AND Q10 (milk) = 1,2,3 AND Q12 (lowfatmilk) = 2,3,4,5,6,7 THEN dairy = 4.81; IF Q10 (milk) = 4,5,6,7 THEN dairy = 6.51. |
Total Protein Foods Component (tot_proteins), 0–5 |
IF Gender = M AND Q16_17 (seafood_combo) = 1,2,3,4 THEN tot_proteins = 4.11; IF Gender = M AND Q16_17 (seafood_combo) = 5,6,7,8,9,10,11 THEN tot_proteins = 4.98; IF Gender = F THEN tot_proteins = 4.97. |
Seafood and Plant Protein Component (Seafood_Plant), 0–5 |
IF Gender = M AND Q15 (nutseeds) = 1,2 THEN seafood_plant = 0.49; IF Gender = F AND Q15 (nutseeds) = 1,2 THEN seafood_plant = 1.50; IF Q15 (nutseeds) = 3,4,5,6,7 THEN seafood_plant = 4.20. |
Fatty Acid Ratio Component (Fatty_Acid), 0–10 |
IF Q10 (milk) = 4,5,6,7 THEN fatty_acid = 2.56; IF Q21 (satfat) = 2,3 AND Q10_11 (milk_combo) = 1,2,3,4,5,6,7 AND Q12–13 (lowfatmilk_combo) = 1,2 THEN fatty_acid = 2.63; IF Q21 (satfat) = 2,3 AND Q10_11 (milk_combo) = 1,2,3,4,5,6,7 AND Q12_13 (lowfatmilk_combo) = 3,4,5,6,7,8,9,10,11 THEN fatty_acid = 4.54; IF Q21 (satfat) = 1 AND Q10_11 (milk_combo) = 1,2,3,4,5,6,7 THEN fatty_acid = 5.93. |
Refined Grains Component (Refined_Grains), 0–10 |
IF Q4 (greenvege) = 1 THEN refined_grains = 2.13; IF Q6 (grains) = 3,4,5,6,7 AND Q16 (seafood) = 2,3,4,5,6,7 AND Q4 (greenvege) = 2,3,4,5,6,7 THEN refined_grains = 2.27; IF Q6 (grains) = 3,4,5,6,7 AND Q15 (nutseeds) = 1,2 AND Q16 (seafood) = 1 AND Q4 (greenvege) = 2,3,4,5,6,7 THEN refined_grains = 4.73; IF Q6 (grains) = 3,4,5,6,7 AND Q15 (nutseeds) = 3,4,5,6,7 AND Q16 (seafood) = 1 AND Q4 (greenvege) = 2,3,4,5,6,7 THEN refined_grains = 8.45; IF Q6 (grains) = 1,2 AND Q4 (greenvege) = 2,3,4,5,6,7 THEN refined_grains = 9.25. |
Sodium Component (Sodium), 0–10 |
IF Q1 (fruit) = 1,2 AND Q6 (grains) = 3,4,5,6,7 AND Q22 (water) = 3 THEN sodium = 0.70; IF Q1 (fruit) = 3,4,5,6,7 AND Q6 (grains) = 3,4,5,6,7 AND Q22 (water) = 3 THEN sodium = 2.30; IF Q6 (grains) = 3,4,5,6,7 AND Q22 (water) = 1,2 THEN sodium = 4.94; IF Q6 (grains) = 1,2 THEN sodium = 6.07. |
Added Sugars Component (Added_Sugars), 0–10 |
IF Q18 (ssb) = 1 THEN sugar_calories_Q18 = 0; IF Q18 (ssb) = 2 THEN sugar_calories_Q18 = 156; IF Q18 (ssb) = 3 THEN sugar_calories_Q18 = 312; IF Q18 (ssb) = 4 THEN sugar_calories_Q18 = 468; IF Q18 (ssb) = 5 THEN sugar_calories_Q18 = 624; IF Q18 (ssb) = 6 THEN sugar_calories_Q18 = 780; IF Q18 (ssb) = 7 THEN sugar_calories_Q18 = 936. IF Q20 (addedsugars) = 1 THEN sugar_calories_Q20 = 130; IF Q20 (addedsugars) = 2 THEN sugar_calories_Q20 = 260; IF Q20 (addedsugars) = 3 THEN sugar_calories_Q20 = 520. sugar_calories = sugar_calories_Q18 + sugar_calories_Q20. IF sugar_calories < =130 THEN added_sugars = 10; IF sugar_calories > 130 AND sugar_calories < 520 THEN added_sugars = 5; IF sugar_calories > =520 THEN added_sugars = 0. |
Saturated Fats Component (sat_fat), 0–10 |
IF Q18 (ssb) = 3,4,5,6,7 THEN sat_fat = 1.82; IF Q6 (grains) = 1,2 AND Q18 (ssb) = 1,2 THEN sat_fat = 3.20; IF Q6 (grains) = 3,4,5,6,7 AND Q15 (nutseeds) = 1,2 AND Q18 (ssb) = 1,2 THEN sat_fat = 4.64; IF Q6 (grains) = 3,4,5,6,7 AND Q15 (nutseeds) = 3,4,5,6,7 AND Q18 (ssb) = 1,2 THEN sat_fat = 6.56. |
Total DQ Score (0–100) |
tot_score = total_fruits + whole_fruits + tot_veg + greens_beans + whole_grains + dairy + tot_proteins + seafood_plant + fatty_acid + refined_grains + sodium + added_sugars + sat_fat |
Appendix C. sHEI Scoring Instructions for Estimating Food Group Consumption
Total Fruit and Vegetable Servings in Cup Equivalents Including Legumes and French Fries (DSQfvl)
Total Fruit and Vegetable Servings in Cup Equivalents Including Legumes and Excluding French Fries (Dsqfvlnf)
Total Fruit Servings in Cup Equivalents (Dsqfrt)
Total Vegetable Servings in Cup Equivalents Including Legumes and French Fries (Dsqvlall)
Total Vegetable Servings in Cup Equivalents Including Legumes and Excluding French Fries (Dsqvlnf)
Dairy Servings in Cup Equivalents (Dsqdairy)
Added Sugars in Teaspoon Equivalents (Dsqsug)
Added Sugars from Sugar-Sweetened Beverages in Teaspoon Equivalents (DSQssb)
Whole Grains in Ounce Equivalents (DSQwhgr)
Fiber in Grams (DSQfib)
Calcium in Milligrams (DSQcalc)
Green Vegetables in Cup Equivalents
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Dietary Factor and Instrument | 24 h Recall | sHEI | DSQ | |||
---|---|---|---|---|---|---|
Mean | ±sd | Mean | ±sd | Mean | ±sd | |
Total vegetable servings in cup equivalents (including legumes and French fries) | 1.37 | ±0.83 | 1.31 | ±0.59 | 1.55 | ±0.35 |
Total vegetable servings in cup equivalents including legumes and excluding French fries | 1.12 | ±0.82 | 1.04 | ±0.58 | 1.42 | ±0.37 |
Greens and beans servings in cup equivalents | 0.28 | ±0.31 | 0.22 | ±0.15 | N/A | N/A |
Total fruit servings in cup equivalents | 0.68 | ±0.72 | 0.57 | ±0.49 | 1.06 | ±0.45 |
Total fruit and vegetable servings in cup equivalents | 2.05 | ±1.33 | 1.92 | ±0.67 | 2.59 | ±0.74 |
Total fruit and vegetable servings in cup equivalents including legumes and excluding French fries | 1.80 | ±1.34 | 1.66 | ±0.77 | 2.50 | ±0.73 |
Whole fruit servings in cup equivalents | 0.59 | ±0.63 | 0.48 | ±0.37 | N/A | N/A |
Dairy servings in cup equivalents | 1.61 | ±2.18 | 1.35 | ±0.67 | 1.79 | ±0.73 |
Whole grain servings in ounce equivalents | 1.46 | ±1.41 | 1.23 | ±0.77 | 0.80 | ±0.31 |
Total protein servings in ounce equivalents | 6.77 | ±2.79 | 6.60 | ±1.67 | N/A | N/A |
Seafood and plant protein servings in ounce equivalents | 1.37 | ±1.51 | 1.09 | ±0.94 | N/A | N/A |
Refined grains in ounce equivalents | 6.01 | ±6.59 | 5.39 | ±2.86 | N/A | N/A |
Sodium (g) | 3.39 | ±1.88 | 3.30 | ±1.11 | N/A | N/A |
Added sugars in tsp equivalents 1 | 14.10 | ±9.32 | 13.28 | ±5.53 | 17.15 | ±8.18 |
Added sugars from sugar-sweetened beverages in tsp equivalents 2 | 5.81 | ±7.95 | 4.49 | ±4.70 | 7.90 | ±7.02 |
Fiber (g) | 18.02 | ±9.33 | 17.40 | ±5.32 | 16.68 | ±3.48 |
Calcium (mg) | 975.59 | ±657.74 | 936.20 | ±404.77 | 1049.21 | ±242.11 |
HEI Component | Correlation |
---|---|
(1) Total Fruits | 0.64 |
(2) Whole Fruits | 0.57 |
(3) Total Vegetables | 0.53 |
(4) Greens and Beans | 0.49 |
(5) Whole Grains | 0.62 |
(6) Dairy | 0.48 |
(7) Total Protein Foods | 0.51 |
(8) Seafood and Plant Proteins | 0.56 |
(9) Fatty Acids | 0.44 |
(10) Refined Grains | 0.62 |
(11) Sodium | 0.58 |
(12) Added Sugars | 0.47 |
(13) Saturated Fats | 0.51 |
Total Score | 0.79 |
Dietary Factor from the DSQ (Predicted Intake per Day) | (a) Training Sample (n = 50) | (b) Confirmatory Sample (n = 398) |
---|---|---|
Total fruit and vegetable servings in cup equivalents including legumes and French fries (DSQfvl) | 0.74 | 0.49 |
Total fruit and vegetable servings in cup equivalents including legumes and excluding French fries (DSQfvlnf) | 0.73 | 0.49 |
Total fruit servings in cup equivalents (DSQfrt) | 0.85 | 0.49 |
Total vegetable servings in cup equivalents including legumes and French fries (DSQvlall) | 0.63 | 0.60 |
Total vegetable servings in cup equivalents including legumes and excluding French fries (DSQvlnf) | 0.63 | 0.59 |
Dairy servings in cup equivalents (DSQdairy) | 0.69 | 0.49 |
Added sugars in tsp (DSQsug) | 0.70 | 0.49 |
Added sugars from sugar-sweetened beverages in tsp equivalents (DSQssb) | 0.74 | 0.57 |
Whole grains in ounce equivalents (DSQwhgr) | 0.65 | 0.29 |
Fiber in grams (DSQfib) | 0.67 | 0.44 |
Calcium in milligrams (DSQcalc) | 0.78 | 0.66 |
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Colby, S.; Zhou, W.; Allison, C.; Mathews, A.E.; Olfert, M.D.; Morrell, J.S.; Byrd-Bredbenner, C.; Greene, G.; Brown, O.; Kattelmann, K.; et al. Development and Validation of the Short Healthy Eating Index Survey with a College Population to Assess Dietary Quality and Intake. Nutrients 2020, 12, 2611. https://doi.org/10.3390/nu12092611
Colby S, Zhou W, Allison C, Mathews AE, Olfert MD, Morrell JS, Byrd-Bredbenner C, Greene G, Brown O, Kattelmann K, et al. Development and Validation of the Short Healthy Eating Index Survey with a College Population to Assess Dietary Quality and Intake. Nutrients. 2020; 12(9):2611. https://doi.org/10.3390/nu12092611
Chicago/Turabian StyleColby, Sarah, Wenjun Zhou, Chelsea Allison, Anne E. Mathews, Melissa D. Olfert, Jesse Stabile Morrell, Carol Byrd-Bredbenner, Geoffrey Greene, Onikia Brown, Kendra Kattelmann, and et al. 2020. "Development and Validation of the Short Healthy Eating Index Survey with a College Population to Assess Dietary Quality and Intake" Nutrients 12, no. 9: 2611. https://doi.org/10.3390/nu12092611