Article Text

Relative validity and reliability of a diet risk score (DRS) for clinical practice
  1. Emily A Johnston1,
  2. Kristina S Petersen1,
  3. Jeannette M Beasley2,
  4. Tobias Krussig3,
  5. Diane C Mitchell1,
  6. Linda V Van Horn4,
  7. Rick Weiss5 and
  8. Penny M Kris-Etherton1
  1. 1 Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania, USA
  2. 2 Department of Medicine, NYU Langone Medical Center, New York City, New York, USA
  3. 3 Penn State College of Medicine, University Park, Pennsylvania, USA
  4. 4 Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  5. 5 Viocare Inc, Princeton, New Jersey, USA
  1. Correspondence to Emily A Johnston, Nutritional Sciences, Pennsylvania State University, University Park, PA 16801, USA; eajohnst{at}


Introduction Adherence to cardioprotective dietary patterns can reduce risk for developing cardiometabolic disease. Rates of diet assessment and counselling by physicians are low. Use of a diet screener that rapidly identifies individuals at higher risk due to suboptimal dietary choices could increase diet assessment and brief counselling in clinical care.

Methods We evaluated the relative validity and reliability of a 9-item diet risk score (DRS) based on the Healthy Eating Index (HEI)-2015, a comprehensive measure of diet quality calculated from a 160-item, validated food frequency questionnaire (FFQ). We hypothesised that DRS (0 (low risk) to 27 (high risk)) would inversely correlate with HEI-2015 score. Adults aged 35 to 75 years were recruited from a national research volunteer registry ( and completed the DRS and FFQ in random order on one occasion. To measure reliability, participants repeated the DRS within 3 months.

Results In total, 126 adults (87% female) completed the study. Mean HEI-2015 score was 63.3 (95% CI: 61.1 to 65.4); mean DRS was 11.8 (95% CI: 10.8 to 12.8). DRS and HEI-2015 scores were inversely correlated (r=−0.6, p<0.001; R2=0.36). The DRS ranked 37% (n=47) of subjects in the same quintile, 41% (n=52) within ±1 quintile of the HEI-2015 (weighted κ: 0.28). The DRS had high reliability (n=102, ICC: 0.83). DRS mean completion time was 2 min.

Conclusions The DRS is a brief diet assessment tool, validated against a FFQ, that can reliably identify patients with reported suboptimal intake. Future studies should evaluate the effectiveness of DRS-guided diet assessment in clinical care.

Trial registration details (NCT03805373).

  • nutrition assessment
  • preventive counselling
  • nutritional treatment
  • dietary patterns

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  • Contributors All authors contributed substantively to this project and manuscript. EAJ: Conceptualisation, funding acquisition, methodology and original draft preparation. KSP: Methodology, data curation, supervision, reviewing and editing. JMB: Funding acquisition, methodology, supervision, reviewing and editing. TK: Methodology, writing and reviewing. DCM: Funding acquisition, validation, reviewing and editing. LVV: Funding acquisition, methodology, reviewing and editing. RW: Resources, software and reviewing. PMKE: Funding acquisition, resources, supervision, reviewing and editing.

  • Funding This work was supported by AMERICAN HEART ASSOCIATION GRANT #19PRE34450165 (Emily A. Johnston). The project described was supported by the Penn State Survey Research Center, through the Social Science Research Institute. Special thanks to Thomas Gates who created the randomisation scheme and coding for this project for all his help and support. The project described was supported by the National Center for Advancing Translational Sciences, Grant TL1 TR002016 and Grant UL1 TR002014. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Review and approval for all procedures was obtained from the Penn State Institutional Review Board (Study 00008321).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.