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Reliability and Validity of a Parent-Reported Diet Quality Screener for Young Children: The Rapid Prime Diet Quality
Nour M Hammad1, Meghan Zimmer1, Rebecca S Mozaffarian1
1Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Insights
The rapid Prime Diet Quality Score for Kids (rPDQS-Kids) is a promising, low-burden tool for assessing young children's overall diet quality. It demonstrated moderate reliability and validity, aiding pediatric nutrition research.
Area of Science:
- Pediatric Nutrition
- Dietary Assessment Methods
- Public Health Nutrition
Background:
- Assessing pediatric diet quality is challenging due to young children's inability to self-report accurately.
- Existing dietary assessment tools can be burdensome for proxy reporters (parents).
- Brief screeners often lack a comprehensive measure of total diet quality.
Purpose of the Study:
- To develop and evaluate the rapid Prime Diet Quality Score for Kids (rPDQS-Kids), a brief parent-reported screener.
- To assess the reliability and validity of rPDQS-Kids against detailed dietary recalls in young children.
- To determine if rPDQS-Kids can effectively measure overall diet quality in children aged 1-4 years.
Main Methods:
- A cross-sectional study evaluated the psychometric properties of the 16-item rPDQS-Kids.
- Parents of 175 children (aged 1-4 years) from the WIC program in Massachusetts participated.
- Diet quality was assessed using rPDQS-Kids and two 24-hour recalls (ASA24), with validity compared against the Healthy Eating Index (HEI).
Main Results:
- The rPDQS-Kids demonstrated moderate test-retest reliability (ICC=0.69).
- Internal consistency reliability was low (ordinal alpha=0.27-0.34).
- A significant correlation was found between rPDQS-Kids and HEI-2020 for children aged 2-4 years (r=0.32), but not for younger children (1 to <2 years).
Conclusions:
- The parent-reported rPDQS-Kids shows potential as a low-burden tool for assessing young children's diet quality.
- Further validation may be needed, particularly for younger age groups.
- This screener could facilitate pediatric nutrition research and surveillance.
Background:
Pediatric dietary assessment is challenging, particularly for young children who cannot accurately report their own intake. Many existing measures are burdensome for proxy-reporters, and briefer dietary screeners focus on specific dietary components but not total diet quality.
Objective:
The objective of this study was to develop and evaluate the reliability and validity of an adapted brief parent-reported diet quality screener; that is, the rapid Prime Diet Quality Score for Kids (rPDQS-Kids), in relation to food groups and overall diet quality estimated from repeated Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24) diet recalls for young children.
Design:
This was a cross-sectional study that evaluated the psychometric properties of the 16-item rPDQS-Kids.
Participants/Setting:
Participants of this study included parents of children aged 1 to 4 years participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (N = 175) in the state of Massachusetts from January 2024 to February 2025.
Main Outcome Measures:
Information about consumption frequencies was reported by parents using the rPDQS-Kids screener. Mean intake and overall diet quality were also assessed using 2 24-hour recalls.
Statistical Analyses Performed:
Test-retest reliability and internal consistency of the rPDQS-Kids were evaluated. Criterion validity was assessed by comparing the rPDQS-Kids diet quality score with the Healthy Eating Index (HEI) score (HEI-2020 for children aged 2 to 4 years or HEI-Toddlers-2020 for children aged 1 up to 2 years).
Results:
The rPDQS-Kids showed moderate test-retest reliability (intraclass correlation coefficient for total score 0.69; 95% CI, 0.62 to 0.75). Consistent with a priori hypotheses, internal consistency reliability was low, with ordinal α = .27 and ordinal α = .34 for the healthy and unhealthy subscores, respectively. Further, a significant correlation was observed between the rPDQS-Kids traffic light diet quality score and HEI-2020 total score among children aged 2 to 4 years (r = 0.32) (P < .001) (n = 127). Among children aged 1 to 2 years (n = 48), rPDQS-Kids was not significantly correlated with the HEI-Toddlers-2020 (P > .05).
Conclusions:
The parent-reported rPDQS-Kids shows potential as a low-burden tool for measuring young children's dietary quality.
