Local validation study for NutricheQ tool in Lebanon

Abstract

Background: Globally, there is a trend towards consumption of energy-dense, nutrient-poor foods leading to dietary imbalances in toddlers. Nutrient deficiencies are associated with the risk of obesity and other health risks. NutricheQ is an 18-item questionnaire that can quickly identify these risks based on dietary patterns in healthy toddlers. Objectives: This study aimed to validate the NutricheQ tool, describe the dietary intake of toddlers and classify them into risk groups. Methods: This was a national, multi-center, observational, validation study conducted at 21 medical centers in Lebanon. Data was collected from NutricheQ administered to the parents of toddlers during a single outpatient visit, and food diary filled by parents during a 4-day follow-up. The validation process of NutricheQ was done using Pearson's and Spearman's correlation, ANOVA and ANCOVA. The accuracy of NutricheQ in the Identifying categories of nutritional risk was evaluated using the receiver operating characteristic (ROC) curves. All analyses were performed using IBM-SPSS version 24 and P value of ≤ 0.05 was considered to be statistically significant. Results: Of the 487 toddlers enrolled, 467 had full data on NutricheQ and food diary data was available for 247 only. Majority of toddlers in Lebanon (80% - 88%) were categorized in the moderate or low-risk groups of dietary intake indicating good eating habits. There was a significant positive association between the total NutricheQ score and both, age (r = 0.11, P = 0.021) and BMI Z-score (r = 0.11, P = 0.021). ROC fitting showed a very low discriminatory ability of the scores to correctly classify toddlers into the high-risk group basedontheir BMI Z-score. Significant positive correlation was obtained between the NutricheQ total score and exchangeable fat and meat with high fat, in the food diaries (R = 0.170, P = 0.045), indicating risk. Also, there was a negative association between the total NutricheQ score and soluble and insoluble fiber (Rs = 0.181, P = 0.004). Conclusions: Results from this study showed that NutricheQ has reasonable validity in the Lebanese context to assess the dietary quality of toddlers in Lebanon and in identifying those at increased nutritional risk.