Self-rated Diet Quality Research Articles

Decoding the misperception: Exploring measurement error in self-rated assessments of diet quality

How much should we trust self-rated diet quality? Measures based on self-perception are often used in diet evaluation, but they can sometimes be subject to diverse biases. Using a unique setting provided by the nationally representative FoodAPS data where questions about diet quality are asked twice with intermediate reminders in between, we first show that the structure of survey questions can help identify inconsistency in the respondents’ self-rated diet quality. Findings reveal that respondents tend to deliver responses that align with their earlier responses. We then validate the respondents’ self-rated diet quality against their household’s healthy eating index, an objective measure of diet quality based on actual food acquisitions. We find no statistically significant association between self-rated diet quality and healthy eating index for respondents who display inconsistency in self-assessing their diet quality. Conversely, that relationship is significant for respondents with no such inconsistency. Our findings suggest an effective question design measuring diet quality, that can be generalized to the design of health survey questions.

Self-Rated Diet Quality and Cardiometabolic Health Among U.S. Adults, 2011–2018

Self-rated health has been extensively studied, but the utility of a similarly structured question to rate diet quality is not well characterized. This study aims to assess the relative validity of self-rated diet quality, compared with that of a validated diet quality measure (Healthy Eating Index-2015) and to examine the associations with cardiometabolic risk factors. Analyses were conducted in 2020-2021 using cross-sectional data from the National Health and Nutrition Examination Survey, 2011-2018. Nonpregnant adults who responded to the question: How healthy is your overall diet? and provided 2 dietary recalls were eligible (n=16,913). Associations between self-rated diet quality (modeled as a 5-point continuous variable, poor=1 to excellent=5) and Healthy Eating Index-2015 scores and cardiometabolic risk factors were assessed by linear regression, accounting for the complex survey design and adjusting for demographic and lifestyle characteristics. Self-rated diet quality was positively associated with total Healthy Eating Index-2015 scores (p < 0.001) and with all components except with Dairy (p=0.94) and Sodium (p=0.66). Higher self-rated diet quality was associated with lower BMI, waist circumference, glucose, insulin, triglycerides, and HbA1c and with higher high-density lipoprotein cholesterol (all p<0.01). Positive associations with total diet quality persisted across all racial/ethnic groups, although the associations with individual dietary components varied. Higher self-ratings were most consistently associated with better-scored diet quality among individuals with BMI <30 kg/m2. Self-rated diet quality was associated with Healthy Eating Index-2015 scores and cardiometabolic disease risk factors. This single-item assessment may be useful in time-limited settings to quickly and easily identify patients in need of dietary counseling to improve cardiometabolic health.

Awareness and Use of Nutrition Information Predict Measured and Self-Rated Diet Quality of Older Adults in the United States - ERRATUM.

Objectives: To examine: (1) diet quality of older adults, using the Healthy Eating Index 2010 (HEI-2010) and self-rated diet quality, (2) characteristics associated with reported awareness and use of nutrition information and (3) factors associated with HEI score and self-rated diet quality. Design: Cross-sectional study. Based on Day 1 and/or Day 2 dietary recalls, the Per-Person method was used to estimate HEI-2010 component and total scores. T-tests and ANOVA were used to compare means. Logistic and linear regressions were used to test for associations with diet quality, controlling for potential confounders. Setting: National Health and Nutrition Examination Survey, 2009–2014. Participants: Three thousand and fifty-six adults, aged 60 years and older, who completed at least one 24-h recall and answered questions on awareness and use of nutrition information. Results: Mean HEI score for men was significantly lower than for women (56·4 ± 0·6 v. 60·2 ± 0·6, P < 0·0001). Compared with men, more women were aware of (44·8 % v. 33·7 %, P < 0·05) and used (13·7 % v. 5·9 %, P < 0·05) nutrition information. In multivariable analyses, awareness and use of nutrition information were significant predictors of both HEI and self-rated diet quality for both women and men. Groups with lower nutrition awareness included men, non-Whites, participants in nutrition assistance programmes and those with lower education and socio-economic status. Conclusions: Nutrition awareness and use of nutrition information are associated with diet quality in adults 60 years and older. Gaps in awareness of dietary guidelines in certain segments of the older adult population suggest that targeted education may improve diet quality for these groups.

Weight self-perception in adolescents: evidence from a population-based study.

To evaluate weight misperception among adolescents and determine associations between self-perceived weight and socio-demographic characteristics, BMI, screen time, self-rated food quantity and diet quality, weekly frequency of breakfast and the consumption of healthy and unhealthy foods. A cross-sectional, two-stage, probabilistic population-based study was conducted in Campinas, Brazil. Multinomial logistic regressions were run to estimate weight self-perception. Data from the Campinas Health Survey (ISACamp) and Campinas Food Consumption Survey (ISACamp-Nutri). A total of 911 adolescents aged 10-19 years. Nearly half (47·7 %) of the adolescents with overweight/obesity did not evaluate their weight properly. Weight self-perception as thin and excess weight was associated with the female gender, overweight/obesity, self-rated diet quality as poor/very poor and eating snacks ≥3 times/week. Adolescents who did not consume breakfast daily were less likely to perceive themselves as thin. Adolescents who ate excessively were more likely and those who consumed cookies/crackers ≥3 times/week were less likely to perceive themselves as having excess weight. Greater weight misperception was found in overweight/obese adolescents. Gender, BMI, self-rated food quantity/diet quality, weekly frequency of breakfast and some unhealthy foods were associated with self-perceived weight. The present findings could contribute to health promotion strategies targeting adolescents.

Awareness and use of nutrition information predict measured and self-rated diet quality of older adults in the USA.

To examine: (1) diet quality of older adults, using the Healthy Eating Index 2010 (HEI-2010) and self-rated diet quality, (2) characteristics associated with reported awareness and use of nutrition information and (3) factors associated with HEI score and self-rated diet quality. Cross-sectional study. Based on Day 1 and/or Day 2 dietary recalls, the Per-Person method was used to estimate HEI-2010 component and total scores. T-tests and ANOVA were used to compare means. Logistic and linear regressions were used to test for associations with diet quality, controlling for potential confounders. National Health and Nutrition Examination Survey, 2009-2014. Three thousand and fifty-six adults, aged 60 years and older, who completed at least one 24-h recall and answered questions on awareness and use of nutrition information. Mean HEI score for men was significantly lower than for women (56·4 ± 0·6 v. 60·2 ± 0·6, P < 0·0001). Compared with men, more women were aware of (44·8 % v. 33·7 %, P < 0·05) and used (13·7 % v. 5·9 %, P < 0·05) nutrition information. In multivariable analyses, awareness and use of nutrition information were significant predictors of both HEI and self-rated diet quality for both women and men. Groups with lower nutrition awareness included men, non-Whites, participants in nutrition assistance programmes and those with lower education and socio-economic status. Nutrition awareness and use of nutrition information are associated with diet quality in adults 60 years and older. Gaps in awareness of dietary guidelines in certain segments of the older adult population suggest that targeted education may improve diet quality for these groups.

Toward a Better Understanding of Listeriosis Risk among Older Adults in the United States: Characterizing Dietary Patterns and the Sociodemographic and Economic Attributes of Consumers with These Patterns

Older adults are at higher risk of invasive listeriosis compared with the general population. Some foods are more likely than others to be contaminated with or to contain high levels of Listeria monocytogenes. The objectives of this study were to (i) determine dietary consumption patterns among older adults in the United States; (ii) evaluate sociodemographic and economic characteristics of older adults associated with each pattern; (iii) determine intake of foods associated with larger relative risk of listeriosis within these patterns; and (iv) rank these patterns based on risk. Data related to older adults (age 60 and older) participating in the cross-sectional National Health and Nutrition Examination Surveys (NHANES) 2009 to 2010, 2011 to 2012, and 2013 to 2014 (n = 4,967) were included in these analyses. Cluster analysis was used to define dietary patterns based on 24-h dietary recalls from day 1 and day 2. Mean intake of foods associated with higher risk of listeriosis was examined within each pattern, and analysis of variance with Dunnett's method of adjustment was used to evaluate significant differences in mean intake of foods. Patterns were ranked based on relative risk of listeriosis, using outbreak illness attribution data. Five distinct dietary patterns were identified. Patterns ranked at highest relative risk of listeriosis, based on U.S. outbreak illness attribution data, were characterized by relatively higher intakes of fruits, vegetables, and cheeses (∼13% respondents) or cereal, milk, and yogurt (∼14% respondents). Individuals consuming these dietary patterns differed in sex, race, food security, self-rated diet quality, and self-rated health. Cluster analysis, despite methodological limitations, provides new information on consumption, sociodemographic, and economic characteristics of subgroups within susceptible populations, which may be used to target educational messages.

Integrating a diet quality screener into a cardiology practice: assessment of nutrition counseling, cardiometabolic risk factors and patient/provider satisfaction

ObjectiveWe assessed factors related to the integration of an office-based diet quality screener: nutrition counselling, cardiometabolic risk factors and patient/physician satisfaction.MethodsWe evaluated the impact of a 10-item diet quality measure...

Validation of Single-Item, Self-Rated Diet Quality Measure Among Adults in Puerto Rico

Abstract Objectives To evaluate the validity of a single-item diet quality measured as a rapid and cost-effective means of dietary assessment among adults living in Puerto Rico (PR), a population with access to and a cultural preference for specific foods. Methods This cross-sectional study used data from the PR Assessment of Diet, Lifestyle, and Diseases (2015). Self-perception of diet quality was reported (n = 247, age = 35–75 y) for the current day, young adulthood, and childhood (five-point scale: excellent to poor). We used a culturally adapted food frequency questionnaire to measure dietary intake, and computed diet quality (range: 0–110) with the Alternate Healthy Eating Index-2010 (AHEI). We conducted multivariable generalized linear models to assess relationships between current AHEI and perception of diet quality at three-time points. Results We categorized current self-rated diet quality into ‘excellent or very good’ (37%), ‘good’ (35%), or ‘fair or poor’ (28%); the overall mean AHEI was 60.1 +/– 11.0. Sensitivity of single-item measure was 60% and specificity was 34%. Current self-rated diet quality was not significantly associated with AHEI score, although adjusted mean scores for fruit and or long-chain fatty acids were significantly lower among participants reporting fair or poor diet, vs. excellent or very good (β = −0.49, 95% CI = −0.97, −0.014; β = −0.52, 95% CI = −0.98, −0.049). In contrast, mean adjusted AHEI score was significantly higher among those rating their diet quality as fair or poor in young adulthood (36%; β = 6.4, 95% CI = 2.4,10.5), and marginally higher among those reporting fair or poor diet quality in childhood (27%; β = 3.99; 95% CI = −0.01,8.04), vs. those rating their diet as excellent or very good, at respective time points. Conclusions A single-item perceived diet measure is not a valid assessment of current diet quality for adults in PR. Interestingly, perception of low diet quality in earlier life stages is associated with higher quality of the actual current diet. Nutrition researchers may use self-rated diet quality in earlier life stages to estimate current diet quality; the mechanisms driving this relationship warrant further investigation. Funding Sources CG is supported by an NIH/NCI training grant. PRADLAD was funded with anonymous donations and an NIH/NHLBI award.

Awareness and Use of Nutrition Information Predict Measured and Self-Rated Diet Quality of Older Adults in the United States (P18-046-19)

ObjectivesThis study aimed to investigate: 1) the diet quality of older adults, using the Healthy Eating Index 2015 (HEI-2015) and self-rated diet quality, 2) characteristics associated with reported awareness and use of nutrition information, 3) factors associated with HEI-2015 score and self-rated diet quality, including the relationship with awareness and use of nutrition information. MethodsA cross-sectional analysis of 24-hour recall and questionnaire data from the National Health and Nutrition Examination Survey 2009–2014, including 4493 subjects, aged 60 years and older. The population ratio method was used in SAS 9.4 to calculate mean HEI scores. Data was stratified by gender, then t-tests and ANOVA were used to compare means and chi-squares were used to compare proportions. Logistic and linear regression were used to test for associations with diet quality, controlling for potential covariates. ResultsThe mean total HEI score for men was significantly lower than for women (63.7 ± 0.8 vs. 66.6 ± 0.8 respectively, P < 0.0001). Compared to men, more women reported nutrition awareness (53.7% vs. 41.1%, P < 0.0001), and use of nutrition information (19.3% vs. 9.2%, P < 0.0001). Nutrition awareness was also associated with race, age, education, socioeconomic status, and food security. In bivariate analyses, nutrition awareness and use of nutrition information were significantly associated with both HEI score and self-rated diet quality in both men and women. In multivariate analyses, nutrition awareness remained a significant predictor of HEI for women but not men, and remained a significant predictor of self-reported diet quality in men but not women. ConclusionsNutrition awareness and use of nutrition information are significantly related to diet quality in older adults, even when controlling for other factors. There are differences in these relationships for older adult men versus women. Gaps in awareness, indicating need for nutrition education, exist in men, non-whites, those participating in nutrition assistance programs, and those with lower education and socioeconomic status. Closing these gaps may lead to improved diet quality in segments of the older adult population. Funding SourcesAgricultural Research Service, United States Department of Agriculture.

Dietary Patterns of Older Adults in the United States and Their Risk of Listeriosis: Characterizing Sociodemographic and Economic Attributes of Consumers by Dietary Patterns (P18-047-19)

Objectives1) Determine dietary consumption patterns, among older adults in the United States; 2) Evaluate sociodemographic and economic characteristics associated with each pattern; 3) Determine intake of foods associated with larger relative risk of listeriosis within these patterns; and 4) Rank these patterns based on risk. MethodsThe study included older adults, age 60 and older, from What We Eat in America, National Health and Nutrition Examination Surveys 2009–2010, 2011–2012 and 2013–2014 (n = 4967). Cluster analysis based on day 1 24-hour dietary recalls was used to define dietary patterns. ANOVA with Dunnett’s method of adjustment used to evaluate significant differences in mean intake of foods associated with higher risk of listeriosis within each pattern. Patterns were ranked based on relative risk of listeriosis using outbreak illness attribution and risk assessment data. ResultsFive distinct dietary patterns were identified -Vegetables, Fruits & Oils; Mixed Dishes; RTE (Ready-To-Eat) Cereal, Milk & Yogurt; Meat & Potatoes; and Cured Meats & Cheese. The patterns ranked at highest relative risk of listeriosis, based on 2013 outbreak illness attribution data, were (1) the Vegetables, Fruits & Oils, characterized by relatively higher intakes of fruits, vegetables, and vegetable oils (∼22% respondents), (2) the RTE (Ready-To-Eat) Cereal, Milk & Yogurt, with relatively higher intakes of cereal, milk, and yogurt (16% respondents); and, based on 2003 risk assessment data, (3) the Cured Meats & Cheese with relatively higher intakes of breads, cheese, and cured meats (∼9.6% respondents). Individuals consuming these dietary patterns differed in sex, race/ethnicity, food security, self-rated diet quality, and self-rated health. ConclusionsCluster analysis, despite methodological limitations, provides new information on consumption, sociodemographic, and economic characteristics of subgroups within susceptible populations that can be used to target educational messages. Funding SourcesAgricultural Research Service, US Department of Agriculture; Food and Drug Administration.

Evaluating the Utility of a Diet Quality Screener in Clinical Practice to Improve Quality of Preventive Care (P07-002-19)

ObjectivesTo assess the impact of an office based dietary screener aimed to improve dietary counseling for the cost effective improvement of patient health. MethodsWe evaluated the utility of incorporating a 10-item diet quality measure (self-rated diet quality question used in the National Health and Nutrition Examination Survey and a 9-item Mediterranean diet screener recommended by the American Heart Association) prior to the cardiology visit in improving efficiency of dietary assessment, guidance of referrals, and in improving diet quality and health indicators over a 6-month period. To assess provider uptake of the dietary screener, we reviewed a random sample of charts (n = 190) to determine the proportion of notes that referenced the dietary screener and documented specific counseling based on the screener. ResultsBetween December 2017 and August 2018, 865 patients completed the diet screener. Mean age was 59 (SD 16) years, 54% were male, and mean BMI was 27.4 (SD 6.0) kg/m2. 18.5% of participants rated their diet as fair or poor, and mean score on the screener (range 0–9) was 5.6 (SD 1.8). Overall, the diet screener appeared in the chart in 87%, the physician gave specific counseling based on the screener in 11% of the visits. ConclusionsFindings from this work demonstrate a dietary screener can facilitate identification of patients who might benefit from specific interventions such as the Diabetes Prevention Program. Since cardiovascular disease is just one diet-influenced disease state, this screener could be implemented in other aspects of the health system to guide referrals to RDs for patients with other diet-related disease states. Funding SourcesThis work was funded by the Center for Healthcare Innovation and Delivery Sciences at NYU Langone Health. Supporting Tables, Images and/or Graphs▪▪▪

Is food security associated with diet and health? A cross-sectional online panel of adults in the UK

BackgroundPrevalence of adult food insecurity is estimated to be 8–10% in the UK, but the impact on population diet and health in unknown. We aimed to investigate the associations between food security and diet and health outcomes in adults in the UK. MethodsWe used cross-sectional UK data from the International Food Policy Study, which recruited 4047 UK adults (aged 18–64 years) through quota sampling from an online panel. 767 participants were excluded for incomplete adult food security status (measured with the USDA Adult Food Security Survey Module). 748 further participants were excluded for incomplete outcome data. Adjusted linear regression models were used to explore associations between food security and frequency of fruit and vegetable intake. Adjusted logistic regression models were used to explore associations between food security and diet quality, health, and stress. Sample weights were used to improve population representativeness and our sample was similar to the UK population in terms of sex, age, and region of residence. Findings2551 participants were included in our analysis. When weighted, 24·3% of participants were food insecure. Food insecure and food secure adults did not differ in their fruit or vegetable intake frequency, but food insecure adults drank fruit juice 0·35 times more per day (95% CI 0·20–0·49) than food secure adults. Odds of poor self-rated diet quality were higher in food insecure than in food secure adults (odds ratio 1·65, 95% CI 1·31–2·09), as were odds of poor general health (1·90, 1·50–2·41), poor mental health (2·10, 1·65–2·69), and high stress levels (3·15, 2·42–4·11). InterpretationThis study is the first, to our knowledge, to examine associations between food security and diet and health in the general adult population in the UK. Food insecurity was associated with some markers of poor diet and health. Strong associations with mental health and stress, especially, point to possible psychological consequences of food insecurity. This study was cross-sectional, so further research into these associations is needed. Self-reported data are subject to social desirability bias. Quota sampling from an online panel may have introduced selection bias. Exclusions from the initial sample could limit representativeness. FundingCentre for Diet and Activity Research (CEDAR) (for AY via a CEDAR PhD studentship, JA, MW), University of Cambridge

Are French Canadians able to accurately self-rate the quality of their diet? Insights from the PREDISE study.

The main objective of this study was to compare self-rated diet quality with a more comprehensive score of diet quality and to assess the ability of self-rated diet quality to predict adherence to healthy eating guidelines. This study also aimed to evaluate the influence of individual characteristics on the association between self-rated diet quality and the overall diet quality score. As part of the PRédicteurs Individuels, Sociaux et Environnementaux (PREDISE) study, 1045 participants (51% women) from the Province of Québec, Canada, self-rated their diet quality ("In general, would you say that your dietary habits are excellent, very good, good, fair, or poor?"). Three Web-based 24-h food recalls were completed, generating data for the calculation of the Canadian Healthy Eating Index (C-HEI) score, an overall diet quality indicator. Participants rated their diet quality as excellent (2.4%), very good (22.7%), good (49.5%), fair (20.3%), or poor (5.1%). C-HEI scores differed significantly between diet ratings, in the expected direction (p < 0.0001). Self-rated diet quality predicted adherence to healthy eating guidelines (i.e., C-HEI > 68) with a sensitivity of 44.5% and a specificity of 81.5% (C-statistic = 0.63). Sex significantly modified the association between self-rated diet quality and C-HEI score (p interaction = 0.0131); women had higher C-HEI scores than did men in the "good" and "fair" ratings. Self-rated diet quality can be useful in obtaining an overview of the diet quality of a population, but the results of this study suggest that such data should be used with caution given their poor ability to predict adherence to healthy eating guidelines. Individual characteristics may influence one's ability to appropriately self-evaluate diet quality.

Do adolescents accurately evaluate their diet quality? The HELENA study

The aim of this study was to assess the diet quality awareness and associated factors in a large sample of European adolescents. The study included 3389 healthy adolescents, aged 12.5-17.5 years, who participated in the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) Study. The adolescents' diet quality was based on repeated 24h recalls and scored into a Diet Quality Index for Adolescents (DQI-A) considering four components: meal, equilibrium, diversity and quality. A self-rated diet quality questionnaire was administered to adolescents to assess their dietary awareness. The association of DQI-A with dietary awareness was studied using a linear mixed model including the center as the random effect and dietary awareness as the fixed effect. There was a positive association between DQI-A scores and diet quality perception levels (p<0.0001). The mean DQI-A was 59.0 (SD=14.8) in adolescents with a low dietary awareness compared with 65.4 (SD=12.6) in adolescents with high dietary awareness (p<0.0001). Similar results were found for all the DQI components. When analyses were stratified, we found a significant heterogeneity across the nutritional status, with no significant association between DQI-A and dietary awareness level in obese adolescents, but a positive association in overweight, normal and undernourished groups. We found also a significant heterogeneity associated with the lunch location (school or home). No other factor affected dietary awareness (gender, pubertal status and maternal educational level). European adolescents evaluate well their food quality whatever their pubertal status, gender and parental educational level, except for the obese who are not able to assess their diet quality. Improving the dietary awareness in obese adolescents might help to induce behavioral changes.

Validation of self-rated overall diet quality by Healthy Eating Index-2010 score among New York City adults, 2013

Objective: Chronic conditions such as cardiovascular disease and cancer can result from a number of diet-related environmental and behavioral factors. Screening for poor diet is helpful in developing interventions to prevent chronic disease, but measuring dietary behavior can be costly and time-consuming. The purpose of this study was to test the ability of a self-rated, single-item measure for evaluating diet quality among individuals and populations. Methods: A 24-h dietary recall and single-item self-rated diet quality measure were collected for 485 adults. From dietary recalls, Healthy Eating Index-2010 (HEI) scores were computed and compared with self-rated diet quality. Data were collected in 2013 among adult (18 years and older) New York City residents. Results: The study sample was 57% female, 47% white, 56% college educated, and 45% in the highest income tertile. The mean HEI score was 56.5 out of a possible 100. Women averaged higher HEI scores compared to men (58.1 vs 54.3, p = .01). There was a modest yet significant correlation between HEI scores and self-rated diet quality (ρ = 0.29, p < .01). Overall, mean HEI score increased as self-rated diet quality improved (from 48.2 for “poor” to 63.0 for “excellent”). Conclusions: The single-item measure of self-rated diet quality may provide a simple method of identifying those with the worst diet quality. Further investigation of this measure's validity is needed with alternative measures of dietary intake and with health outcomes.

Associations Between Self‐Rated Diet Quality and Type 2 Diabetes Indicators: Results from the National Health and Nutrition Examination Survey (NHANES 2009‐2010)

ObjectiveTo examine associations between self‐rated diet quality and key health indicators within a nationally representative sample (NHANES 2009‐2010).Methods: Self‐rated diet quality was assessed as “In general, how healthy is your overall diet?; with five response levels – ‘excellent,’ ‘very good,’ ‘good,’ ‘fair,’ or ‘poor’ among adults in the NHANES 2009‐2010. Mean values of chronic disease health indicators were compared by category of self‐rated diet quality using analysis of variance.Results: Nearly one third (31.4%) report overall diet quality was ‘excellent’ or ‘very good’, 42.8% reported ‘good’, and 24.8% rated their diet quality as ‘fair’ or ‘poor’. Lower self‐rated diet quality was significantly associated with higher body mass index, waist circumference, hemoglobin A1c, and fasting blood glucose (Table 1).ConclusionsSelf‐rated diet quality may be a quick, inexpensive tool for identifying individuals at risk for diet‐related health conditions, detect broad changes in perceived diet quality among cohorts over time, and targeting interventions towards those most likely to participate in and benefit from diet‐related changes.Table 1. Self‐rated diet quality by type 2 diabetes indicators, NHANES 2009‐2010, mean (SE). Risk Factor Excellent Very Good Good Fair Poor Body Mass Index, kg/m2 26.1 (0.4) 27.1 (0.3)* 28.8 (0.2)* 30.0 (0.2)* 31.8 (0.4)* Waist Circumference, cm 92.1 (0.7) 94.0 (0.8)* 97.9 (0.4)* 101.1 (0.6)* 104.8 (0.8)* Hemogobin A1c, % 5.5 (0.0) 5.5 (0.0) 5.6 (0.0)* 5.7 (0.0)* 5.8 (0.1)* Fasting Blood Glucose, mg/dL 100.0 (1.6) 100.5 (1.4) 103.1 (0.9) 105.0 (0.8)* 109.9 (2.7)* *P&lt;0.05 by analysis of variance.

Construct Validity of a Single-Item, Self-Rated Question of Diet Quality

ObjectiveTo provide evidence of the construct validity of a single-item overall diet question with a nomological network of self-rated and biometric measures of dietary intake and outcomes. MethodsThe authors conducted a secondary analysis of survey and biometric data from a cross-sectional sample of urban-dwelling adults. In addition to self-rated diet quality, they examined dietary behaviors, biomarkers of intake, and related outcomes. Self-rated diet quality was treated as a continuous variable to calculate P for trend using regression analysis. ResultsSelf-rated diet quality was significantly associated with variation in both subjective and objective measures of dietary intake (fruit and vegetable intake, P < .001; sugar-sweetened beverage intake, P < .001; sodium to potassium ratio, P < .001), behavior (frequency of fast-food dining, P < .001), and related outcomes (systolic blood pressure, P = .010; diastolic blood pressure, P < .001; and body mass index, P < .001). Conclusions and ImplicationsEvidence supports the construct validity of a single-item measure of diet quality. This single-item question may be a useful proxy for more burdensome measures of overall diet quality.

Confidence in the efficacy and safety of dietary supplements among United States active duty army personnel

BackgroundUnited States Army Soldiers regularly use dietary supplements (DS) to promote general health, enhance muscle strength, and increase energy, but limited scientific evidence supports the use of many DS for these benefits. This study investigated factors associated with Soldiers’ confidence in the efficacy and safety of DS, and assessed Soldiers’ knowledge of federal DS regulatory requirements.MethodsBetween 2006 and 2007, 990 Soldiers were surveyed at 11 Army bases world-wide to assess their confidence in the effectiveness and safety of DS, knowledge of federal DS regulations, demographic characteristics, lifestyle-behaviors and DS use.ResultsA majority of Soldiers were at least somewhat confident that DS work as advertised (67%) and thought they are safe to consume (71%). Confidence in both attributes was higher among regular DS users than non-users. Among users, confidence in both attributes was positively associated with rank, self-rated diet quality and fitness level, education, and having never experienced an apparent DS-related adverse event. Fewer than half of Soldiers knew the government does not require manufacturers to demonstrate efficacy, and almost a third incorrectly believed there are effective pre-market federal safety requirements for DS.ConclusionsDespite limited scientific evidence supporting the purported benefits and safety of many popular DS, most Soldiers were confident that DS are effective and safe. The positive associations between confidence and DS use should be considered when developing DS-related interventions or policies. Additionally, education to clarify Soldiers’ misperceptions about federal DS safety and efficacy regulations is warranted.