Novel Questionnaire Rapidly & Reliably Screens Diet Quality

High-quality nutrition and diet are important factors when managing patients with or at risk for cardiovascular disease (CVD). “Physicians have limited time during patient visits to discuss symptoms, medications, diagnoses, and treatment plans,” explains Kyla Lara-Breitinger, MD, MS. “Diet plays an integral role in health and chronic diseases, but there is not enough time to have patients complete lengthy dietary questionnaires, such as a food frequency questionnaire (FFQ), or to have long discussions about diet during office visits.”

Brief counseling interventions have been developed to help improve dietary quality and cardiometabolic risk factors, but the above-mentioned time and workflow restraints, as well as lack of nutrition education and survey fatigue have been identified as barriers to implementing dietary assessments. There continues to be an important unmet need for an abbreviated dietary assessment tool so healthcare professionals can improve the frequency of nutrition assessments. By providing rapid and efficient dietary assessments, clinicians can prioritize actionable management plans to reduce CVD risks and improve overall health during the same visit.

Validating a Rapid, Easy Tool to Start Dietary Conversations

For a study published in the Journal of the American Heart Association, Dr. Lara-Breitinger and colleagues compared and validated a 19-item dietary questionnaire called EAT (Eating Assessment Tool) against a reference FFQ. They also sought to reduce the number of EAT questions without significantly affecting correlations or validity so that a shorter, more simplified tool—the Mini-EAT—could be validated. “We wanted to develop a quick and easy tool that healthcare professionals can use to start conversations with patients about diet,” Dr. Lara-Breitinger says. “Based on the answers, clinicians can identify actionable and achievable dietary goals.”

For the study, the investigational 19-item EAT was developed as a shortened FFQ by expert consensus using focus groups composed of dieticians and cardiologists. A survey was then given to 661 adults at a preventive cardiology clinic, in cardiac rehabilitation, or in healthy volunteers. Participants first completed an online 156-item FFQ, which was used to calculate the Healthy Eating Index (HEI) score.

Mini-EAT Sheds Light on Diet Quality

Results from the study demonstrated that reducing the 19-item EAT questionnaire to the nine-item Mini-EAT test maintained very good predictive power when compared with the reference standard FFQ. The final nine-item model of Mini-EAT was validated by fivefold cross validation. The 19-item EAT had a strong correlation with the HEI score. This was subsequently reduced to nine items, which included fruits, vegetables, whole grains, refined grains, fish or seafood, legumes/nuts/seeds, low-fat dairy, high fat dairy, and sweets consumption, without affecting the tool’s predictive ability (Table).

“With the Mini-EAT, we can get a good sense of a patient’s quality of diet from nine questions without burdening them with a lengthy FFQ,” says Dr. Lara-Breitinger. “This is important because time is the most critical factor when considering how to integrate dietary discussions into medical visits. In short, the Mini-EAT is a brief intervention that allows healthcare professionals to use scores to help guide conversations on a few small changes that patients can make to improve their health.”

A First Step Toward Improving Discussions on Diet

According to the study team, the nine-item Mini-EAT can be integrated into clinical practice to rapidly screen patients about diet quality. “The Mini-EAT takes only a few minutes to complete, and patients can answer questions while waiting for their visit to begin or by filling it out prior to a visit via patient portals in electronic health records,” Dr. Lara-Breitinger says. “The Mini-EAT is the first step toward standardizing dietary data in the clinical setting to improve discussions about diet.” Beyond improving dietary quality, implementing the Mini-EAT may also help efforts to prevent CVD.

The researchers plan to investigate the Mini EAT in more diverse populations to ensure that the validation is reproducible, according to Dr. Lara-Breitinger. “We’re optimistic that by integrating the Mini-EAT into electronic health records, we can finally have a standardized method to capture dietary data and initiate a variety of nutrition interventions,” she says. “We’re also hopeful the Mini-EAT will help assess how improvements in diet relate to vital signs, weight, BMI, and cardiac biomarkers.”