Validation of the rapid Prime Dietary Quality Screener (rPDQS), a brief dietary assessment tool with simple traffic light scoring

Background and objectives: The 2021 American Heart Association dietary guidance emphasized dietary pattern as a determinant of chronic disease. We aimed to validate a brief dietary screener utilizing simple traffic light scoring that could help guide clinical dietary assessment and counseling. Methods: We surveyed adults (18 years and over) recruited via CloudResearch online platform and sampled to be representative of the U.S. population. The survey included a 13item rapid Prime Dietary Quality Screener (rPDQS) and demographic information. All participants also completed an Automated Self-Administered 24-hour (ASA24) Dietary Assessment. Responses to rPDQS items were coded using both traffic light and numeric scoring methods and were compared to food groups, Healthy Eating Index 2015 (HEI-2015) scores and usual nutrient intakes estimated from ASA24s. We calculated deattenuated Pearson's correlation coefficients to account for within-person variation in 24-hour diet recalls. Results: 482 adults completed one ASA24 and rPDQS. Of these, 190 completed a second ASA24 and rPDQS. 50% were female aged 35 years and over, 66% were non-Latino White, 13% non-Latino Black, 16% Latino, and 5% Asian. Positive, statistically significant correlations, ranging from r=0.46 for vegetables to r=0.62 for whole fruits, as well as gradients in mean food group intakes were found for all rPDQS responses relating to food groups that should be encouraged, while negative statistically significant associations, ranging from r=0.26 for red meats to r=0.50 for processed meats, as well as gradients in mean intakes, were found for all rPDQS responses for food groups that should be limited. Total rPDQS scores correlated with total HEI-2015 (r=0.75). Positive, statistically significant correlations were observed between the rPDQS values and the majority of energy-adjusted nutrients including fiber (r =0.72), polyunsaturated-to-saturated fat ratio (r=0.47), magnesium (r=0.69), potassium (r=0.62), vitamin E (r=0.64), folate (r=0.67), vitamin C (r=0.53) and selected carotenoids, including β-carotene (r=0.72), lutein&zeaxanthin (r=0.62), and β-cryptoxanthin (r=0.52). Finally, we found an inverse correlation with total SFAs (r= -0.38). Conclusions: The rPDQS is a valid, brief dietary screener that identifies clinically relevant patterns of food intake. The simple traffic light scoring system could help clinicians provide brief, actionable dietary counseling during a visit.