Kelly Martin, Krupali Shah, Abha Shrestha, Emily Barrett, Archana Shrestha, & Shristi Rawal

Objective: Culturally appropriate dietary assessments are lacking in many low-income countries including Nepal. 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, assessing weekly consumption frequency of 12 healthy and 9 unhealthy food groups, was administered twice and a month apart in both the 2nd and 3rd trimester. Up to four inconsecutive 24-hr dietary recalls (24-HDRs) were also 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 the three weekly consumption categories (0-1, 2-3 or 4+ servings/week) of the 21 food groups represented on the PrimeScreen. Gwet’s agreement coefficients (AC1) were used to evaluate the reproducibility and validity of the adapted PrimeScreen against the 24-HDRs in both 2nd and 3rd trimester. 

Results: In the 2nd trimester, the adapted PrimeScreen demonstrated good to excellent reproducibility (AC1 > 0.6) for majority of the food groups; the reproducibility was moderate for eggs (AC1 = 0.4), and poor (AC1 < 0.4) for citrus fruits and leafy vegetables. In the 3rd trimester, AC1 for reproducibility of the PrimeScreen ranged from 0.4 (moderate agreement) to 1 (excellent agreement), with values ≥ 0.6 for 90% of the items indicating good to excellent reproducibility for the majority of the food groups. Compared to 24-HDRs, the adapted PrimeScreen showed moderate to excellent validity (AC1 ≥ 0.4) for all food groups except for eggs and leafy vegetables in both the 2nd and 3rd trimester, and additionally citrus fruits and cruciferous vegetables in the 2nd trimester alone. Classification into 3 consumption categories (0-1, 2-3 or 4+ servings/week) were consistent (percentage agreement >80%) between the PrimeScreen and 24-HDR for 80% of the food groups in both 2nd and 3rd trimester. 

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

Funding Sources: NIH/FIC