Reproducibility and Relative Validity of a Dietary Screener Adapted for Use among Pregnant Women in Dhulikhel, Nepal

Objectives: Here we examined the reproducibility and validity of a dietary screener which was translated and adapted to assess diet quality among pregnant Nepalese women.

Methods: A pilot cohort of singleton pregnant women (N = 101; age 25.9 ± 4.1 years) was recruited from a tertiary, periurban hospital in Nepal. An adapted Nepali version of the PrimeScreen questionnaire, a brief 21-item dietary screener that assesses weekly consumption of 12 healthy and 9 unhealthy food groups, was administered twice, and a month apart, in both the 2nd and 3rd trimesters. Up to four inconsecutive 24-h dietary recalls (24-HDRs) were completed each trimester and utilized as the reference method for validation. For each trimester, data from multiple 24-HDRs were averaged across days, and items were grouped to match the classification and three weekly consumption categories (0-1, 2-3, or 4 + servings/week) of the 21 food groups represented on the PrimeScreen.

Results: Gwet's agreement coefficients (AC1) were used to evaluate the reproducibility and validity of the adapted PrimeScreen against the 24-HDRs in both the 2nd and 3rd trimester. AC₁ indicated good to excellent (≥ 0.6) reproducibility for the majority (85%) of food groups across trimesters. There was moderate to excellent validity (AC₁ ≥ 0.4) for all food groups except for fruits and vegetables in the 2nd trimester, and green leafy vegetables and eggs in both the 2nd and 3rd trimesters.

Conclusions: The modified PrimeScreen questionnaire appears to be a reasonably valid and reliable instrument for assessing the dietary intake of most food groups among pregnant women in Nepal.