Brief Dietary Assessment Tool Validated in Clinical Setting

Emma Hitt, PhD

January 05, 2011

January 5, 2011 — An 8-item brief dietary assessment may prove efficient for learning about a patient's current diet and has been validated in the clinical setting, a new report suggests.

The food frequency instrument, called "Starting The Conversation (STC)" is an 8-item simplified tool designed for use in primary care and health-promotion settings.

Amy E. Paxton, MPH, with the Center for Health Promotion and Disease Prevention, at the University of North Carolina at Chapel Hill, and colleagues reported their findings in the January 2011 issue of the American Journal of Preventive Medicine.

According to researchers, prevention and management of chronic diseases, including type 2 diabetes, is dependent on measurement of the diet, but this is difficult and is costly to measure.

"Food diaries are burdensome and can influence behavior, diet histories are time consuming, and 24-hour dietary recalls are expensive," the study authors note.

Paxton and colleagues used data available from a diabetes self-management intervention study in the primary care setting to investigate the feasibility of the 8-question STC dietary assessment.

The STC questions are designed to be answered by the patient with answers organized into 3 categories. The first category identifies the healthiest dietary habits, followed by less healthy dietary habits and then the least healthy dietary habits.

The assessment is scored by tallying the number of answers in each category (range, 1 - 16), with high numbers representing a less healthy diet and low numbers representing a healthier diet.

To test the validity of the assessment, researchers compared the score provided by STC in randomly assigned adult patients with type 2 diabetes (mean age, 58 years; mean body mass index [BMI], 34.8 kg/m2) vs the fat intake measured by the previously validated National Cancer Institute (NCI) fat screener at baseline and at 4 months after the initial intervention.

The STC summary score from the sample population correlated with the NCI fat screener (r = 0.39 - 0.59; P < .05) at baseline and after a 4-month intervention aimed at reducing the intake of fat calories (r = 0.22; P < .05), supporting the validity of the STC assessment.

The summary score remained unchanged at 4 months in individuals who did not undergo an intervention (r = 0.66; P < .05), indicating that the assessment is consistent with time. Conversely, the assessment was determined to be sensitive, given that the intervention group had a significant reduction in summary score vs the control group (M = 1.16 vs 0.46; P < .05).

"The brief eight-item STC tool identified healthful and unhealthful dietary behaviors in a diverse sample," both with and without intervention, the study authors conclude.

They add that the assessment was "robust across a variety of participant characteristics, was stable over time in the absence of treatment, was sensitive to treatment, and was a reasonably valid measure" against a previously validated dietary fat screener.

According to the researchers, the STC assessment has yet to be validated against a known standard of dietary intake in a large trial, and the conclusions drawn from these data are from a single site; however, the STC is "the shortest instrument available designed specifically to help clinic staff identify atherogenic dietary patterns and guide counseling."

This study was funded by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases. The study authors have disclosed no relevant financial relationships.

Am J Prev Med. 2011;40:67-71. Abstract

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