Characterising whole-of-diet patterns of Australian toddlers to inform the development of a short dietary risk assessment tool

Author: Lucinda Kate Bell

Bell, Lucinda Kate, 2015 Characterising whole-of-diet patterns of Australian toddlers to inform the development of a short dietary risk assessment tool, Flinders University, School of Health Sciences

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Toddlerhood is an important period of life when nutritional experiences shape children's growth, health and development. Exposure to foods during this period influences the development of food preferences and thus current and future eating patterns. Yet toddlers begin to exert their independence in food choices and demonstrate fussy eating behaviours, placing them at risk of poor nutrition. Current dietary intakes of toddlers fall short of dietary recommendations, suggesting many are at 'dietary risk', a term used to describe 'inappropriate dietary patterns' that may impair health. As poor dietary behaviours may persist over time and influence short- and long-term health, early risk identification is important so that intervention can be initiated. Traditional dietary assessment methods are associated with limitations, such as being costly, time-intensive and burdensome on researchers and responders. Short questionnaires are an attractive alternative to assess dietary intake. The literature review presented in chapter one highlights that there are no short (<50 item) valid and reliable dietary assessment tools to measure diet of Australian toddlers. Thus, the primary aim of this thesis was to develop and validate a short dietary assessment tool for measuring dietary risk in Australian toddlers aged 12 - 36 months. Dietary patterns of Australian toddlers were characterised by applying principal components analysis to food intake data collected for two Australian studies. This analysis guided selection of tool items and is described in chapter two. Patterns were similar at two ages, 14 and 24 months, representing 'core' (items recommended to be consumed every day, such as fruit, vegetables, lean meat, dairy, high-fibre bread and water) and 'non-core'(high-fat, -sugar and/or -salt items not included in the 'core' food groups such as spreads, snacks, chocolate, processed meat and sweetened beverages) intake. Based on extracted patterns and the Australian Dietary Guidelines a 19-item Toddler Dietary Questionnaire (TDQ) that assesses the previous week's food-group intake was developed, and is described in chapter three. Intake is evaluated using a scoring system to determine dietary risk (0 - 100; higher score = higher risk) and stratified into four risk categories (low, moderate, high, very high). Evaluation of the TDQ psychometric properties, detailed in chapter three, showed that risk scores were highly correlated and not significantly different between administrations or compared with a valid and reliable FFQ. Further, all participants were classified into the same or adjacent risk category (low - very high). However, analyses were conducted on data collected from a relatively advantaged sample of Australian toddlers. Thus, the TDQ has reliability and comparative validity as a short toddler dietary risk assessment tool for Australian toddlers from relatively advantaged backgrounds. Further testing was undertaken to determine the convergent validity of the dietary risk construct, and is presented in chapter four. Risk scores were associated with nutrient intakes in expected directions; lower and higher risk scores reflect better and poorer nutrient intakes, respectively. Risk scores were positively associated with socio-demographic factors but not BMI z-scores. These findings demonstrate that dietary risk scores measure intake that may impair health but currently do not specifically assess obesity risk. The key findings, strengths and limitations, the implications for practice, and areas for further research are summarised in chapter five. In conclusion, the newly developed TDQ is a valid and reliable screening tool for assessing dietary risk of relatively advantaged populations of toddlers, and may therefore be useful in early childhood nutrition promotion

Keywords: toddler,child,dietary patterns,dietary risk,dietary assessment,questionnaire

Subject: Health Sciences thesis, Nutrition and Dietetics thesis

Thesis type: Doctor of Philosophy
Completed: 2015
School: School of Health Sciences
Supervisor: A/Prof Anthea Magarey