Assessing Overall Diet Quality: Development and Evaluation of the Performance of a Short Self-Administrated...

Several tools assessing diet quality have been developed over the last decades, but their use in public health and clinical practice is limited because they necessitate detailed quantitative assessment of food intake. Our goal was to develop and validate a score (Score d'Alimentation Saine, SCASA) based on a short self-administrated online questionnaire to assess overall diet quality. SCASA targets the adult population in French-speaking Switzerland, but it was designed in a way enabling its adaptation for other regions. The choice of the items involved experts and lay volunteers. Construct validation and inter-method reliability were assessed by screening meal plans and by comparing the self-rated scores with food-record derived scores (kappa and Bland-Altman). SCASA (17 components) discriminated adequately balanced from imbalanced meal plans (93-95% and 44-46% of maximal score). Agreement between self-assessed and food record-based scores ranged between >90% (3 items), 80-89% (3 items), 70-79% (4 items), and <70% (5 items). The Bland-Altman plot showed a mean difference of -1.60 (95% CI -2.36 to -0.84), indicating a slight overestimation of the self-assessed diet quality compared to the food record. SCASA offers a reliable way to assess overall diet quality without requiring burdensome data collection or nutrient calculations.