Relative validity of a Diet Risk Score (DRS) for Chinese American adults

Emily A. Johnston, Agnes Park, Lu Hu, Stella S. Yi, Lorna E. Thorpe, Pasquale E. Rummo, Jeannette M. Beasley

Research output: Contribution to journalArticlepeer-review


Objective The objective of this study was to evaluate the relative validity of the nine-item Diet Risk Score (DRS) among Chinese American adults using Healthy Eating Index (HEI)-2015 scores. We provide insights into the application of the Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24) for this population, and report on lessons learned from carrying out participant recruitment during the COVID-19 pandemic. Methods Thirty-three Chinese American adults (mean age=40; 36% male) were recruited from the community and through ResearchMatch. Participants completed the DRS and two 24-hour food records, which were entered into the ASA 24-Hour Dietary Assessment Tool (ASA24) by community health workers (CHWs). HEI-2015 scores were calculated from each food record and an average score was obtained for each participant. One-way analysis of variance and Spearman correlations were used to compare total and component scores between the DRS and HEI-2015. Results Mean HEI-2015 score was 56.7/100 (SD 10.6) and mean DRS score was 11.8/27 (SD 4.7), with higher scores reflecting better and worse diets, respectively. HEI-2015 and DRS scores were inversely correlated (r=-0.43, p<0.05). The strongest correlations were between HEI-2015 Total Vegetables and DRS Vegetables (r=-0.5, p<0.01), HEI-2015 Total Vegetables and Green Vegetables (r=-0.43, p=0.01) and HEI-2015 Seafood/Plant Protein and DRS Fish (r=-0.47, p<0.01). The inability to advertise and recruit for the study in person at community centres due to pandemic restrictions impeded the recruitment of less-acculturated individuals. A lack of cultural food items in the ASA24 database made it difficult to record dietary intake as reported by participants. Conclusion The DRS can be a valuable tool for physicians to identify and reach Chinese Americans at risk of cardiometabolic disease.

Original languageEnglish (US)
Pages (from-to)76-82
Number of pages7
JournalBMJ Nutrition, Prevention and Health
Issue number1
StatePublished - Jun 1 2023


  • Nutrition assessment

ASJC Scopus subject areas

  • Health(social science)
  • Medicine (miscellaneous)
  • Nutrition and Dietetics


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