Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
RESEARCH ARTICLE

Development and validation of the Diet Quality Tool for use in cardiovascular disease prevention settings

S. L. O’Reilly A C and L. R. McCann B
+ Author Affiliations
- Author Affiliations

A Centre for Physical Activity and Nutrition Research, Deakin University, Burwood, Vic. 3125, Australia.

B School of Exercise and Nutrition Sciences, Deakin University, Burwood, Vic. 3125, Australia.

C Corresponding author. Email: sharleen.oreilly@deakin.edu.au

Australian Journal of Primary Health 18(2) 138-147 https://doi.org/10.1071/PY11005
Submitted: 19 January 2011  Accepted: 5 July 2011   Published: 7 November 2011

Abstract

The aim of this study was to develop and evaluate a dietary screening tool for use in a secondary cardiovascular disease (CVD) prevention setting to identify an individual’s overall dietary quality. The Diet Quality Tool (DQT) was validated against a 4-day food diary for 37 individuals with established CVD attending cardiac rehabilitation. Construct validity was demonstrated for % energy from saturated fat (P = 0.002, r = –0.500), dietary fibre (P < 0.001, r = 0.559) and omega-3 fatty acids (P = 0.048, r = 0.327). Criterion validity was established with a significant difference found between mean (95% CI) dietary intakes of fibre (28.2 g, 4.4 to 17.3) and % total energy from saturated fat (10.6%, –4.8 to –0.8) for those with better DQT scores (>60%) versus those with poorer scores (≤60%) when compared with 4-day food diary nutrient values. The usefulness of the DQT was confirmed by both patients (n = 25) and cardiac rehabilitation health professionals (n = 8). The DQT was found to be a valid and useful dietary assessment tool with potential for use in a secondary CVD prevention setting. The tool has the capacity to be used in a wider variety of settings and further refinement of the tool would enable a greater amount of nutrients to be reliably screened.

Additional keywords: dietary assessment, health professionals.


References

Anderson CAM, Appel LJ, Okuda N, Brown IJ, Chan Q, Zhao L, Ueshima H, Kesteloot H, Miura K, Curb JD, Yoshita K, Elliott P, Yamamoto ME, Stamler J (2010) Dietary sources of sodium in China, Japan, the United Kingdom, and the United States, women and men aged 40 to 59 years: the INTERMAP study. Journal of the American Dietetic Association 110, 736–745.
Dietary sources of sodium in China, Japan, the United Kingdom, and the United States, women and men aged 40 to 59 years: the INTERMAP study.CrossRef | 1:CAS:528:DC%2BC3cXnt1aku78%3D&md5=d4d7cc09490c28967d4573732e60d248CAS | open url image1

Artinian NT, Fletcher GF, Mozaffarian D, Kris-Etherton P, Van Horn L, Lichtenstein AH, Kumanyika S, Kraus WE, Fleg JL, Redeker NS, Meininger JC, Banks J, Stuart-Shor EM, Fletcher BJ, Miller TD, Hughes S, Braun LT, Kopin LA, Berra K, Hayman LL, Ewing LJ, Ades PA, Durstine JL, Houston-Miller N, Burke LE (2010) Interventions to promote physical activity and dietary lifestyle changes for cardiovascular risk factor reduction in adults: a scientific statement from the American Heart Association. Circulation 122, 406–441.
Interventions to promote physical activity and dietary lifestyle changes for cardiovascular risk factor reduction in adults: a scientific statement from the American Heart Association.CrossRef | open url image1

Australian Bureau of Statistics, Department of Health and Ageing (1998) ‘National nutrition survey: nutrient intakes and physical measurements, Australia, 1995.’ (Australian Bureau of Statistics: Canberra)

Australian Institute of Health and Welfare (2006) ‘Chronic diseases and associated risk factors in Australia, 2006.’ Cat. no. PHE 81. (AIHW: Canberra)

Begg SJ, Vos T, Barker B, Stanley L, Lopez AD (2008) Burden of disease and injury in Australia in the new millennium: measuring health loss from diseases, injuries and risk factors. The Medical Journal of Australia 188, 36–40.

Calfas KJ, Zabinski MF, Rupp J (2000) Practical nutrition assessment in primary care settings: A review. American Journal of Preventive Medicine 18, 289–299.
Practical nutrition assessment in primary care settings: A review.CrossRef | 1:STN:280:DC%2BD3c3ltVOgtw%3D%3D&md5=282f063ed8e175c99623bcd2cee57df4CAS | open url image1

Department of Health and Ageing, National Health and Medical Research Council (2006) ‘Nutrient reference values for Australia and New Zealand, including recommended dietary intakes.’ (Commonwealth of Australia: Canberra)

Everett B, Salamonson Y, Davidson PM (2009) Bandura’s exercise self-efficacy scale: Validation in an Australian cardiac rehabilitation setting. International Journal of Nursing Studies 46, 824–829.
Bandura’s exercise self-efficacy scale: Validation in an Australian cardiac rehabilitation setting.CrossRef | open url image1

Gans KM, Ross E, Barner CW, Wylie-Rosett J, McMurray J, Eaton C (2003) REAP and WAVE: new tools to rapidly assess/discuss nutrition with patients. The Journal of Nutrition 133, 556S–562S.

Hartwell DL, Henry CJK (2001) Comparison of a self-administered quantitative food amount frequency questionnaire with 4-day estimated food records. International Journal of Food Sciences and Nutrition 52, 151–159.
Comparison of a self-administered quantitative food amount frequency questionnaire with 4-day estimated food records.CrossRef | 1:CAS:528:DC%2BD3MXjtVWntL4%3D&md5=8eef139e15e94ffa8784fa61eea9f205CAS | open url image1

Hodge A, Patterson AJ, Brown WJ, Ireland P, Giles G (2000) The Anti Cancer Council of Victoria FFQ: relative validity of nutrient intakes compared with weighed food records in young to middle-aged women in a study of iron supplementation. Australian and New Zealand Journal of Public Health 24, 576–583.
The Anti Cancer Council of Victoria FFQ: relative validity of nutrient intakes compared with weighed food records in young to middle-aged women in a study of iron supplementation.CrossRef | 1:STN:280:DC%2BD3M7kt1aisA%3D%3D&md5=512a52763c1458d2a485c1152ce532c0CAS | open url image1

Holmes AL, Sanderson B, Maisiak R, Brown A, Bittner V (2005) Dietitian services are associated with improved patient outcomes and the MEDFICTS dietary assessment questionnaire is a suitable outcome measure in cardiac rehabilitation. Journal of the American Dietetic Association 105, 1533–1540.
Dietitian services are associated with improved patient outcomes and the MEDFICTS dietary assessment questionnaire is a suitable outcome measure in cardiac rehabilitation.CrossRef | open url image1

Jilcott SB, Keyserling TC, Samuel-Hodge CD, Johnston LF, Gross MD, Ammerman AS (2007) Validation of a brief dietary assessment to guide counseling for cardiovascular disease risk reduction in an underserved population. Journal of the American Dietetic Association 107, 246–255.
Validation of a brief dietary assessment to guide counseling for cardiovascular disease risk reduction in an underserved population.CrossRef | 1:CAS:528:DC%2BD2sXitV2murY%3D&md5=9bef2152dcaf19764803c92a08c51487CAS | open url image1

Laws RA, Kemp LA, Harris MF, Davies GP, Williams AM, Eames-Brown R (2009) An exploration of how clinician attitudes and beliefs influence the implementation of lifestyle risk factor management in primary healthcare: a grounded theory study. Implementation Science; IS 4, 66
An exploration of how clinician attitudes and beliefs influence the implementation of lifestyle risk factor management in primary healthcare: a grounded theory study.CrossRef | open url image1

McKellar S, Horsley P, Chambers R, Pullen M, Vendersee P, Clarke C, Callum H, Bauer JD (2008) Development of the diet habits questionnaire for use in cardiac rehabilitation. Australian Journal of Primary Health 14, 43–47.
Development of the diet habits questionnaire for use in cardiac rehabilitation.CrossRef | open url image1

McNamara KP, George J, O’Reilly SL, Jackson SL, Peterson GM, Howarth H, Bailey MJ, Duncan G, Trinder P, Morabito E, Finch J, Bunker S, Janus E, Emery J, Dunbar JA (2010) Engaging community pharmacists in the primary prevention of cardiovascular disease: protocol for the Pharmacist Assessment of Adherence, Risk and Treatment in Cardiovascular Disease (PAART CVD) pilot study. BMC Health Services Research 10, 264
Engaging community pharmacists in the primary prevention of cardiovascular disease: protocol for the Pharmacist Assessment of Adherence, Risk and Treatment in Cardiovascular Disease (PAART CVD) pilot study.CrossRef | open url image1

McNaughton SA, Ball K, Crawford D, Mishra GD (2008) An index of diet and eating patterns is a valid measure of diet quality in an Australian population. The Journal of Nutrition 138, 86–93.

Mensink RP, Zock PL, Kester AD, Katan MB (2003) Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. The American Journal of Clinical Nutrition 77, 1146–1155.

National Heart Foundation of Australia, Cardiac Society of Australia and New Zealand (2008) ‘Reducing Risk in Heart Disease 2007: Guidelines for preventing cardiovascular events in people with coronary heart disease.’ (National Heart Foundation of Australia)

Passey M, Fanaian M, Lyle D, Harris MF (2010) Assessment and management of lifestyle risk factors in rural and urban general practices in Australia. Australian Journal of Primary Health 16, 81–86.
Assessment and management of lifestyle risk factors in rural and urban general practices in Australia.CrossRef | open url image1

Prochaska JJ, Sallis JF, Rupp J (2001) Screening measure for assessing dietary fat intake among adolescents. Preventive Medicine 33, 699–706.
Screening measure for assessing dietary fat intake among adolescents.CrossRef | 1:STN:280:DC%2BD3MnntFOrsg%3D%3D&md5=6a0668055d04c23705d6530dc9ec0ecaCAS | open url image1

Productivity Commission (2005) ‘Economic implications of an ageing Australia.’ (Productivity Commission: Canberra)

Rifas-Shiman SL, Willett W, Lobb R, Kotch J, Dart C, Gillman M (2001) PrimeScreen, a brief dietary screening tool: reproducibility and comparability with both a longer food frequency questionnaire and biomarkers. Public Health Nutrition 4, 249–254.
PrimeScreen, a brief dietary screening tool: reproducibility and comparability with both a longer food frequency questionnaire and biomarkers.CrossRef | 1:STN:280:DC%2BD3M3htVOluw%3D%3D&md5=152937c3680cd5e9efecfc6901ef9feaCAS | open url image1

Svilaas A, Ström E, Svilaas T, Borgejordet A, Thoresen M, Ose L (2002) Reproducibility and validity of a short food questionnaire for the assessment of dietary habits. Nutrition, Metabolism, and Cardiovascular Diseases 12, 60–70.

Toft U, Kristoffersen LH, Lau C, Borch-Johnsen K, Jorgensen T (2007) The Dietary Quality Score: validation and association with cardiovascular risk factors: the Inter99 study. European Journal of Clinical Nutrition 61, 270–278.
The Dietary Quality Score: validation and association with cardiovascular risk factors: the Inter99 study.CrossRef | 1:STN:280:DC%2BD2s%2FmtlGjsw%3D%3D&md5=061f4b603d0c9bdc3a14b1b8f8433c79CAS | open url image1

van Achterberg T, Huisman-de Waal GGJ, Ketelaar NABM, Oostendorp RA, Jacobs JE, Wollersheim HCH (2011) How to promote healthy behaviours in patients? An overview of evidence for behaviour change techniques. Health Promotion International 26, 148–162.
How to promote healthy behaviours in patients? An overview of evidence for behaviour change techniques.CrossRef | open url image1

van Keulen HM, Mesters I, Ausems M, van Breukelen G, Campbell M, Resnicow K, Brug J, de Vries H (2011) Tailored print communication and telephone motivational interviewing are equally successful in improving multiple lifestyle behaviors in a randomized controlled trial. Annals of Behavioral Medicine 41, 104–118.
Tailored print communication and telephone motivational interviewing are equally successful in improving multiple lifestyle behaviors in a randomized controlled trial.CrossRef | open url image1

Waijers PM, Feskers EJ, Ocke MC (2007) A critical review of predefined diet quality scores. The British Journal of Nutrition 97, 219–231.
A critical review of predefined diet quality scores.CrossRef | 1:CAS:528:DC%2BD2sXhtV2qu7nK&md5=868536fb8b7d481b37043f8224e33c1bCAS | open url image1

Watson S, Webster IV WA, Feigenbaum MS, Jupp R, Senn M, Wracker C, Blackhurst D, Hendricks M, Durstine JL (2002) Assessing dietary fat intake in chronic disease rehabilitation programs. Journal of Cardiopulmonary Rehabilitation and Prevention 22, 161–167.
Assessing dietary fat intake in chronic disease rehabilitation programs.CrossRef | open url image1

Wiens L, Schulzer M, Chen C, Parinas K (2010) Reliability and validity of the SmartDiet Canadian version questionnaire. Journal of the American Dietetic Association 110, 101–105.
Reliability and validity of the SmartDiet Canadian version questionnaire.CrossRef | open url image1

Wirt A, Collins CE (2009) Diet quality–what is it and does it matter? Public Health Nutrition 12, 2473–2492.
Diet quality–what is it and does it matter?CrossRef | open url image1



Export Citation Cited By (7)