Development of the Penn Healthy Diet screener with reference to adult dietary intake data from the National Health and Nutrition Examination Survey

Charlene W Compher, Ryan Quinn, Frances Burke, Doris Piccinin, Linda Sartor, James D Lewis, Gary D Wu, Charlene W Compher, Ryan Quinn, Frances Burke, Doris Piccinin, Linda Sartor, James D Lewis, Gary D Wu

Abstract

Background: There is a need for a feasible, user-friendly tool that can be employed to assess the overall quality of the diet in U.S.

Clinical settings: Our objectives were to develop the Penn Healthy Diet (PHD) screener, evaluate screener item correlations with Healthy Eating Index (HEI)-2015 components, and develop a simple scoring algorithm.

Methods: National Health and Nutrition Examination Survey (NHANES) 2017-18 dietary recall data in adults were used to define food examples in screener food groups based on components of the HEI-2015, Diet Approach to Stop Hypertension, and Alternative Mediterranean diet approaches. Instrument Content Validity Index (I-CVI) was used to evaluate the clarity and relevance of the screener. Patient acceptability was evaluated by completion time and response rates. NHANES 2017-18 food recall data were used to simulate responses to the screener items, which were evaluated for association with HEI-2015 components. A scoring algorithm was developed based on screener items moderately or strongly associated with HEI-2015 components. Reproducibility was tested using NHANES 2015-16 data.

Results: The screener had strong clarity (I-CVI = 0.971) and relevance for nutrition counseling (I-CVI = 0.971). Median (IQR) completion time was 4 (3-5) minutes on paper and 4 (4-8) minutes online, and 73% of patients invited online completed the survey. Based on simulated NHANES participant screener responses, 15 of the 29 screener items were moderately or strongly associated with HEI-2015 components, forming the basis of the scoring algorithm with a range of 0-63 points, where higher score indicates a healthier diet. The median (IQR) screener and HEI-2015 scores were 14.96 (11.99-18.36) and 48.96 (39.51-59.48), respectively. The simulated PHD score was highly correlated with the HEI-2015 score (Spearman rho 0.75) in NHANES 2017-18 and confirmed in NHANES 2015-16 data (Spearman rho 0.75).

Conclusions: The Penn Healthy Diet screener may be a useful tool for assessing diet quality due to its acceptable content validity, ease of administration, and ability to distinguish between servings of key food groups associated with a healthy versus unhealthy diet according to the HEI-2015. Additional research is needed to further establish the instrument's validity, and to refine a scoring algorithm.

Keywords: Adult; Food pattern; HEI-2015; Healthy diet; NHANES; Screener.

Conflict of interest statement

The authors have no competing interests with regard to this publication.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Heat map of Spearman correlations between individual simulated Penn Healthy Diet Screener items (y axis) to Healthy Eating Index (HEI)-2015 components (x axis). Data from adult respondents to the National Health and Nutrition Examination Survey 2015–16 are in the left panel and from the 2017–18 sample are in the right panel. Correlations colored green are positively and red are negatively associated. Abbreviations: HEI = Healthy Eating Index-2015
Fig. 2
Fig. 2
Scatter plot and regression line comparing the simulated Penn Healthy Diet screener score (x-axis) and the Healthy Eating Index (HEI)-2015 score (y-axis) based on 2017–18 National Health and Nutrition Examination Survey (NHANES) in adult participants. The Spearman rho is 0.75
Fig. 3
Fig. 3
Scatter plots comparing the simulated Penn Healthy Diet screener score on the x-axis and the total Healthy Eating Index (HEI)-2015 score on the y-axis based on 2017–18 National Health and Nutrition Examination Survey (NHANES) in adult participants stratified by self-reported racial/ethnic group. The Spearman rho correlations are listed in each plot

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