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OverviewThe CDQ is a 28-item semi-quantitative food frequency questionnaire that has beendesigned to be self-completed by parent or caregiver (with or without researcherassistance). It calculates four different food-group scores, which include:• a fruit and vegetable score;• a fat from dairy products score;• a non-core foods h score; and• a sweetened beverages score.A variety of different response-scales are used including Likert scales and frequencyscales.Items were included in the questionnaire based on their perceived impact on thehealthfulness of a diet, and whether their intake is generally ‘recommende’ or‘discouraged’. Secondary analysis of nationally representative children’s intake datawas undertaken to identify food patterns that distinguish higher and lower qualitydiets. To ensure that inclusion of all types of relevant foods were included in thequestionnaire and to optimise content validity, a panel of four paediatric dietaryexperts reviewed all items.Validation and reliabilityParents were asked to complete a 7-day checklist alongside the CDQ to check if the toolwas providing an accurate account of dietary intake. Items on the checklist mirroredthe food and drink items contained in the CDQ. This process found that that thequestionnaire was not able to accurately distinguish positive or negative dietary riskbased on CDQ scores at an individual child level. This suggests that the CDQ has validityas a tool to assess dietary patterns at a group or population level (for which it wasdesigned) but not as an assessment of dietary intake in clinical one-to-one settings. Thereadability of the questionnaire was assessed by pilot testing a draft form with fourparents.The questionnaire was used in five different studies using different population groupsto examine different parameters of the questionnaire. The intra-class correlationcoefficient (ICC) between the first and second administrations of the questionnaire wasused to examine reliability. Test-retest reliability values were significant for allsubscales: 0.75 for fruit and vegetables; 0.51 for fat from dairy products; 0.55 forsweetened beverages; and 0.90 for non-core foods.In one study, children were recruited onto a weight management programme thatencouraged a change in eating patterns closer to those recommended by Australiandietary guidelines. Significant differences were reported for all sub-scales betweenbaseline and at six months in the expected direction, i.e. an increase in fruit andvegetable score and decreases in fat from dairy, sweetened beverages and non-corefoods scores. This outcome suggests that the questionnaire can be used to detectdietary change, but further testing is needed to confirm its ability to detect bothdirection and magnitude of change.hPeanut butter or Nutella, pre‐sugared cereals, sweet biscuits/cakes/muffins/doughnuts/fruit pies, potatochips/crisps or savoury biscuits, confectionery/ muesli or fruit bars, chocolate, soft drink/cordial, icecream/Ice‐blocks,pie/pasty/sausage roll, pizza, hot chips/French fries, hot dog/processed meats, takeawayNOO | Review of dietary assessment methods in public health 25
Internal consistency was assessed through item to total correlation which is a directmeasure of how closely each item is associated with the subscale total score. A commonrecommendation is that item to total correlations should be above 0.221. This was thecase for all items except for those in the sweetened beverages subscale, and three itemsin the non-core foods subscales. The fruit and vegetable and the non-core foodssubscales were found to have relatively high measures of internal consistency (α=0.76and 0.56 respectively). The fat from dairy and the sweetened beverages subscales hadlower measures of internal consistency (α=0.44 and 0.13 respectively). This may be dueto the fewer items (three and two, respectively) and the restricted range of responsesfor these two subscales, resulting from relatively low intakes of full fat dairy andsweetened beverages in the study subjects.UsageThe questionnaire is available for public use. There are no costs associated with its usebut appropriate citation would be expected. Information on the questions included inthe CDQ along with information on the response scales is provided in the referencepaper. While there is adequate information in the reference paper on how to analyseand interpret the questionnaire, the principal author is also willing to work withindividuals who wish to use the questionnaire.The questionnaire is based on Australian nutritional guidelines. It is likely to be validfor use in the UK, but further review and testing would be required to confirm this. Notesting has been carried out on its suitability for use with black and minority ethnicgroups.Reference paperMargarey A, Golley R, Spurrier N, et al. Reliability and validity of the Children's DietaryQuestionnaire; a new tool to measure children's dietary patterns. International Journalof Pediatric Obesity. 2009; 4(4): 257–65.The Dietary Quality ScoreThe Dietary Quality Score (DQS) 15 questionnaire was developed in Denmark. It assessesthe quality of adult diets based on certain nutritional risk factors for cardiovasculardisease. It then categorises people into one of three groups – low, average or highdietary quality. It has been designed for use with adults.OverviewThe foods included in the DQS questionnaire were based on those most likely to beindicative of an overall healthy diet, and matched Danish dietary guidelines. Questionsare included about frequency of consumption of vegetables, vegetarian dishes, fruit,fish, and the type of fats used in spreading and cooking. Each answer had an assignedscore which was then used to calculate an overall dietary score, giving a broadindication of the quality of the diet. This provides an assessment of overall dietaryquality and also allows identification of specific dietary elements that are of lowquality.NOO | Review of dietary assessment methods in public health 26
Page 1 and 2: Review of dietary assessmentmethods
Page 3 and 4: IntroductionAccurate and consistent
Page 5 and 6: and bias as self-report instruments
Page 7 and 8: DietaryAssessmentToolWhat does itme
Page 9 and 10: DietaryAssessmentToolWhat does itme
Page 11 and 12: The CADET is reported to be a relia
Page 13 and 14: The questionnaire was found to show
Page 15 and 16: Five-a-day Community Evaluation Too
Page 17 and 18: categorised as low, medium or high
Page 19 and 20: The authors suggest that the SFFQ m
Page 21 and 22: The Cappuccio dietary questionnaire
Page 23 and 24: initially provided to a group of ch
Page 25: normal weight children, illustratin
Page 29 and 30: ConclusionWhen evaluating dietary o
Page 31 and 32: Appendix AA literature search was u
Page 33: Reader informationTitleReview of di

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