Abstract
BackgroundSuboptimal diet is the leading cause of global morbidity and mortality. Addressing this problem requires context-specific solutions informed by context-specific data collected by context-specific tools. This study aimed to assess the relative validity of a newly developed brief dietary survey to estimate food intake and adherence to the Food Based Dietary Guidelines for Sri Lankans.MethodsBetween December 2018 and February 2019, we interviewed 94 Sri Lankan adults living in Colombo (Western Province), Kalutara (Western Province), and Trincomalee (Eastern Province). We assessed the relative validity of the Sri Lankan Brief Dietary Survey (SLBDS) with Wilcoxon rank-sum tests, Spearman’s Rho correlation coefficients, Bland–Altman plots, and Cohen’s kappa tests using a 24-h Dietary Recall (24DR) as reference.ResultsNinety-four adults (40.7 years ±12.6; 66% female) completed both surveys during the same interview. With the exception of ‘Fish, pulses, meat and eggs’ food group median intake, which was underestimated by the SLBDS compared to the 24DR, there was no strong evidence of difference between median intakes reported by the two methods. Correlation coefficients were highest for ‘Milk and dairy products’ (0.84) at the food group level and for ‘dosa’, ‘hoppers’, ‘milk rice’, and ‘dried fish’ (1.00) among individual food and beverages. Visual exploration of Bland-Altman plots showed acceptable agreement between the SLBDS and 24DR, with the SLBDS tending to overestimate consumption as the number of servings of ‘Rice, bread, other cereals and yams’ and ‘Vegetables’ consumed increased and slightly underestimate consumption as the number of servings of ‘Fish, pulses, meat and eggs’, ‘Milk and dairy products’, and ‘Nuts’ increased. Kappa values ranged from from 0.59 (95% CI: 0.32–0.86) for ‘Vegetables’ to 0.81 (95% CI: 0.66–0.96) for ‘Fruit’ indicating a moderate to strong level of agreement.ConclusionsHaving been developed for and relatively validated with the study population in question, our study shows that the SLBDS can be used as a fit for purpose research tool. Additional research is needed to assess SLBDS test-retest reliability and to validate further the reporting of salt, oil, and coconut intake.
Highlights
Suboptimal diet is the leading cause of global morbidity and mortality
Clarity of survey wording and format was further refined through pre-testing with 25 Sri Lankan adults aged 20 to 65 known to our research network
The calculated k values range from 0.71 for ‘medium size sweets’ to 0.85 for both ‘medium size desserts’ and ‘jaggery’ indicating a strong level of agreement between the number of participants reporting consumption > 0 for the six food items listed above in both the Sri Lankan Brief Dietary Survey (SLBDS) and 24-h Dietary Recall (24DR)
Summary
Suboptimal diet is the leading cause of global morbidity and mortality. Addressing this problem requires context-specific solutions informed by context-specific data collected by context-specific tools. Despite the promising global progress made in preventing and controlling NCDs in the last decades, they remain the world’s leading causes of death This is in part due to a combination of unsustained and ineffective action mounted against key modifiable risk factors and the many ‘data blind spots’ that result from inadequate and infrequent data collection [2]. Substantial reductions in NCD morbidity and mortality require increased investment in evidence-informed healthy diet promotion [3]. This necessitates accurate and timely dietary data collection to identify trends, develop appropriate solutions, prioritise resource allocation, and evaluate intervention effectiveness. Dietary intake is notoriously difficult to capture accurately in populationbased studies, and the complex and burdensome nature of ‘gold standards’ can limit their context suitability and sustainability [4, 5]
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