Development and Evaluation of a Food Choices Assessment Score (FCAS) Measuring the Healthfulness of Dietary Choices According to 2019 Canada's Food Guide/Canada's Dietary Guidelines, using the Canadian Health Measures Survey Food Frequency Questionnaire.

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The objective of this study was to develop and evaluate a Food Choices Assessment Score (FCAS) measuring alignment with 2019 Canada's Food Guide (CFG) and Canada's Dietary Guidelines (CDG) using a non-quantitative food frequency questionnaire (FFQ) data. Cross-sectional data from the Canadian Health Measures Survey (CHMS) (2016 to 2019), including 6,459 participants (≥19 years) and a non-quantitative FFQ (~100 food items) were used. Content and construct validity and assessing reliability were used to evaluate the FCAS, including a comparison of mean FCAS among Canadian subgroups, calculating the FCAS for high quality diet menus, investigating the consistency of the FCAS with the Dietary Approaches to Stop Hypertension (DASH), as a healthy diet linked with lower cardiometabolic risks, and estimating Cronbach's alpha for reliability. The FCAS consisted of nine components for a total of 80 points. The FCAS captured the key recommendations of the 2019 CFG/CDG. Mean (SE) FCAS of the adult Canadian population was 29.3 (0.4) (/80) and was higher in females 32.2 (0.4) and non-smokers 30.3 (0.3) compared to males 26.7 (0.4) and smokers 23.6 (0.9), respectively (p<0.0001). FCAS yielded high scores for healthy menu samples of CDG (80/80) and DASH (70/80) diets. FCAS was correlated with DASH diet score (r=0.83). Cronbach's alpha was found to be moderate (0.5), as expected, which confirmed the multidimensionality of the FCAS components in reflecting different characteristics of diet quality. These analyses suggest adequate validity with multidimensional consistency of the 2019 CFG/CDG FCAS as a new tool for use with non-quantitative FFQ data.