Development of nutrition quotient for Korean preschoolers (NQ-P): Item selection and validation of factor structure

Jung-Sug Lee; Myung-Hee Kang; Tong-Kyung Kwak; Hae Rang Chung; Sehyug Kwon; Hye-Young Kim; Ji-Yun Hwang; Young-Sun Choi

doi:10.4163/jnh.2016.49.5.378

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Lee, Kang, Kwak, Chung, Kwon, Kim, Hwang, and Choi: Development of nutrition quotient for Korean preschoolers (NQ-P): Item selection and validation of factor structure

Research Article

Journal of Nutrition and Health 2016; 49(5): 378-394.

Published online: 31 October 2016

DOI: https://doi.org/10.4163/jnh.2016.49.5.378

Development of nutrition quotient for Korean preschoolers (NQ-P): Item selection and validation of factor structure

Jung-Sug Lee¹, Myung-Hee Kang², Tong-Kyung Kwak³, Hae Rang Chung⁴, Sehyug Kwon⁵, Hye-Young Kim⁶, Ji-Yun Hwang⁷, Young-Sun Choi⁸

¹Department of Food & Nutrition, Kookmin University, Seoul 02707, Korea.

²Department of Food & Nutrition, Hannam University, Daejeon 34430, Korea.

³Department of Food & Nutrition, Yonsei University, Seoul 03722, Korea.

⁴Nutrition for the Future Inc., Seoul 08788, Korea.

⁵Department of Statistics, Hannam University, Daejeon 34430, Korea.

⁶Department of Food & Nutrition, Yongin University, Yongin 17092, Korea.

⁷Department of Foodservice Management and Nutrition, Sangmyung University, Seoul 03016, Korea.

⁸Department of Food & Nutrition, Daegu University, Gyeongsan 38453, Korea.

To whom correspondence should be addressed. tel: +82-53-850-6833, yschoi@daegu.ac.kr

Received 19 August 2016 Revised 2 September 2016 Accepted 23 September 2016

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Screening of preschool-age children for nutrition programs to improve dietary intake and behaviors requires cost-effective and easily administered validated assessment tools. The purpose of this study was to develop a parent/caregiver-administered instrument for measuring diet quality and behaviors of preschoolers as a nutrition quotient for preschoolers (NQ-P).

Methods

Development of NQ-P was carried out in three steps: item generation, item reduction, and validation. The 24-h dietary record was selected as the gold standard reference tool. The 38 items of the NQ-P checklist were derived from a systematic literature review, expert in-depth interviews, statistical analysis of the fifth Korean National Health and Nutrition Examination Survey data, and national nutrition policies and recommendations. Self-administered questionnaires were delivered to parents who recorded 24-h dietary intakes of 100 responders aged 3~5 yr. Pearson's correlation was used to measure the level of agreement between questionnaires. Item reduction was performed, and 20 items were selected based on survey results, expert reviews, and priorities of national nutrition policy and recommendations. The 412 nationwide subjects sampled through daycare centers completed the 20-item checklist questionnaire. The construct validity of the NQ-P was assessed using confirmatory factor analysis, LISREL.

Results

After analyses of exploratory factors, NQ-P items identified three dimensions of diet (balance, moderation, and environment). The three-factor structure accounted for 49.28% of the total variance. Standardized path coefficients were used as weights of the items. The NQ-P and three-factor scores of the subjects were calculated by the obtained weights of the questionnaire items.

Conclusion

A food behavior checklist for preschoolers' NQ would be a useful and suitable instrument for evaluating nutrition adequacy and dietary quality of Korean preschoolers.

Keywords: preschoolers' nutrition quotient (NQ-P), food behavior, dietary quality, checklist

Figures and Tables

Fig. 1

Process of NQ-P development. 1) FBC, food behavior checklist; 2) DR, dietary record

Fig. 2

Comparison of percentage of nutrient intake of the children to recommended nutrient intake (RNI) or adequate intake (AI) according to NQ-P score four-grade criterion of samples from the pilot survey. a b : Different alphabets indicate significant differences by Duncan's multiple test (p < 0.05).

Table 1

Checklist items selected for pilot survey

Table 2

Items selected for a nationwide survey checklist and selection rationales

1) Showed data is p < 0.05. Nonsignificant data are not shown. 2) BMI, body mass index 3) DDS, dietary diversity score

Table 3

Results of exploratory factor analysis of the 14 items selected by LISREL analysis (n = 412)

Factor loading in shaded box is greater than 0.4.

Table 4

Weights and path coefficients of three-factor structure model

Table 5

NQ-P score and group score calculation using response point of the checklist

^*Calculation method of NQ-P score = Σ (B × D) of all 14 items

^*Calculation method of each group score = Σ (B × C) in each group item

Table 6

Nutrition quotient checklist for preschoolers

Table 7

NQ-P score range by the four-grade criterion

1) High : 75% ≤ NQ-P percentile ≤ 100%, Medium-high : 50% ≤ NQ-P percentile < 75%, Medium-low : 25% ≤ NQ-P percentile < 50%, Low : 0% ≤ NQ-P percentile < 25% 2) Mean ± SD

Notes

This research was supported by a grant (14162MFDS126) from Ministry of Food and Drug Safety in 2014.

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