An instrument to assess quality of life in relation to nutrition: item generation, item reduction and initial validation

Measures of nutrition status and health for weight-inclusive patient care: A narrative review

In healthcare, weight is often equated to and used as a marker for health. In examining nutrition and health status, there are many more effective markers independent of weight. In this article, we review practical and emerging clinical applications of technologies and tools used to collect non-weight-related data in nutrition assessment, monitoring, and evaluation in the outpatient setting. The aim is to provide clinicians with new ideas about various types of data to evaluate and track in nutrition care.

Development and validation of the osteoporosis scale among the system of quality of life instruments for chronic diseases QLICD-OS (V2.0)

BACKGROUND

Quality of life of osteoporosis patients had caused widespread concern, due to high incidence and difficulty to cure. Scale specifics for osteoporosis and suitable for Chinese cultural background lacked. This study aimed to develop an osteoporosis scale in Quality of Life Instruments for Chronic Diseases system, namely QLICD-OS (V2.0).

METHODS

Procedural decision-making approach of nominal group, focus group and modular approach were adopted. Our scale was developed based on experience of establishing scales at home and abroad. In this study, Quality of life measurements were performed on 127 osteoporosis patients before and after treatment to evaluate the psychometric properties. Validity was evaluated by qualitative analysis, item-domain correlation analysis, multi-scaling analysis and factor analysis; the SF-36 scale was used as criterion to carry out correlation analysis for criterion-related validity. The reliability was evaluated by the internal consistency coefficients Cronbach's α, test-retest reliability Pearson correlation r. Paired t-tests were performed on data of ​​the scale before and after treatment, with Standardized Response Mean (SRM) being calculated to evaluate the responsiveness.

RESULTS

The QLICD-OS, composed of a general module (28 items) and an osteoporosis-specific module (14 items), had good content validity. Correlation analysis and factor analysis confirmed the construct, with the item having a strong correlation (most > 0.40) with its own domains/principle components, and a weak correlation (< 0.40) with other domains/principle components. Correlation coefficient between the similar domains of QLICD-OS and SF-36 showed reasonable criterion-related validity, with all coefficients r being greater than 0.40 exception of physical function of SF-36 and physical domain of QLICD-OS (0.24). Internal consistency reliability of QLICD-OS in all domains was greater than 0.7 except the specific module. The test-retest reliability coefficients (Pearson r) in all domains and overall score are higher than 0.80. Score changes after treatment were statistically significant, with SRM ranging from 0.35 to 0.79, indicating that QLICD-OS could be rated as medium responsiveness.

CONCLUSION

As the first osteoporosis-specific quality of life scale developed by the modular approach in China, the QLICD-OS showed good reliability, validity and medium responsiveness, and could be used to measure quality of life in osteoporosis patients.

How quality of life is measured in studies of nutritional intervention: a systematic review

BACKGROUND

Nutrition care can positively affect multiple aspects of patient's health; outcomes are commonly evaluated on the basis of their impact on a patient's (i) illness-specific conditions and (ii) health-related quality of life (HRQoL). Our systematic review examined how HRQoL was measured in studies of nutritional interventions. To help future researchers select appropriate Quality of Life Questionnaires (QoLQ), we identified commonly-used instruments and their uses across populations in different regions, of different ages, and with different diseases.

METHODS

We searched EMCare, EMBASE, and Medline databases for studies that had HRQoL and nutrition intervention terms in the title, the abstract, or the MeSH term classifications "quality of life" and any of "nutrition therapy", "diet therapy", or "dietary supplements" and identified 1,113 studies for possible inclusion.We then reviewed titles, abstracts, and full texts to identify studies for final inclusion.

RESULTS

Our review of titles, abstracts, and full texts resulted in the inclusion of 116 relevant studies in our final analysis. Our review identified 14 general and 25 disease-specific QoLQ. The most-used general QoLQ were the Short-Form 36-Item Health Survey (SF-36) in 27 studies and EuroQol 5-Dimension, (EQ-5D) in 26 studies. The European Organization for Research and Treatment of Cancer Quality of life Questionnaire (EORTC-QLQ), a cancer-specific QoLQ, was the most frequently used disease-specific QoLQ (28 studies). Disease-specific QoLQ were also identified for nutrition-related diseases such as diabetes, obesity, and dysphagia. Sixteen studies used multiple QoLQ, of which eight studies included both general and disease-specific measures of HRQoL. The most studied diseases were cancer (36 studies) and malnutrition (24 studies). There were few studies focused on specific age-group populations, with only 38 studies (33%) focused on adults 65 years and older and only 4 studies focused on pediatric patients. Regional variation in QoLQ use was observed, with EQ-5D used more frequently in Europe and SF-36 more commonly used in North America.

CONCLUSIONS

Use of QoLQ to measure HRQoL is well established in the literature; both general and disease-specific instruments are now available for use. We advise further studies to examine potential benefits of using both general and disease-specific QoLQ to better understand the impact of nutritional interventions on HRQoL.

Quality of Life and the Role of Food and Eating as Described by Community-Dwelling Older Adults

While food and eating are important determinants of health, there is limited information on how they affect quality of life (QOL). This study aimed to understand (1) the factors that impact QOL, (2) the effect of food and eating on QOL, from the perspective of community-dwelling older adults. Twenty-five older adults completed semi-structured interviews. The constant comparative method was used to assign codes to participant's responses and organize them into categories, which were used to form a conceptual framework. Five main themes emerged showing factors affecting QOL: health and vitality; independence; mental and emotional well-being; socialization and support; and activities. Four themes were identified demonstrating how food and eating affect QOL: food access and choice; food preparation; health and vitality; and food enjoyment. Relationships between themes suggest food and eating have a broad effect on factors impacting QOL. To develop and tailor community interventions to improve older adults' QOL, measurement tools should include these effects.

Evaluation on the Nutrition Quotient Scores of Elderly People Living Alone in Korea

As the Korean society is aging rapidly, the issues on physical, social, economic, and mental disabilities of single-person households aged 65 years or older has also increased. This study aimed to investigate the nutrition-related dietary conditions of elderly people living alone and determine their dietary behavior by calculating the nutrition quotient for elderly (NQ-E). One hundred and three elderly people living alone who were basic living recipients were recruited from six senior welfare centers in Seoul, and the data were collected using a questionnaire from 19 July 2016 to 17 August 2016, with a 1:1 in-depth interview using the modified version of the NQ-E questionnaire. The data were analyzed using SPSS 27.0 for Mac (IBM Corp., Armonk, NY, USA); a p value of <0.05 was considered significant. The nutrition-related dietary conditions of the elderly living alone were limited, and many of them received support from the government, which helped improve their diet. The nutrition quotient score of the elderly living alone was 50.14, which was lower than the NQ-E mean score (57.6) of the Korean elderly and the NQ-E (62 points), which is the top 25% of the national survey subjects according to the criteria value presented by the Korean Nutrition Society. Elderly people living alone often have poor dietary habits and nutritional status. The NQ-E presented in this study can be used to evaluate the dietary conditions of the elderly and is expected to be used as an indicator for developing community programs for health promotion and evaluating their effectiveness.

Development and validation of a disease-specific quality of life measure QLICD-HY (V2.0) for patients with hypertension

The purpose of the present study is to develop and validate the hypertension scale of the Quality of Life Instruments (QoL) for Chronic Diseases system, QLICD-HY (V2.0). The QLICD-HY (V2.0) was developed via a programmed decision method with several focus groups, nominal discussions and pilot testing. The data was collected from 370 hypertensive inpatients and measured their QoL three times before and after treatment. Using correlation, factor analyses, as well as t-tests, the psychometric properties of the scale were assessed with regard to validity, reliability and responsiveness. Correlation and factor analysis supported good construct validity and criterion-related validity when using Short Form 36 as a criterion. Test-retest reliability coefficients for the overall scale score and all domains, with the exception of the psychological and social domain (0.77, 0.78), were greater than 0.80, with a range of 0.77-0.92. The internal consistency for all domains was higher than 0.70. With the exception of the psychological domain and social domain, the overall score and scores for the majority of aspects within each domain underwent statistically significant changes (t-tests) after the treatment. The QLICD-HY (V2.0) has good validity, reliability and responsiveness and can be used as a QoL measure for hypertensive patients.

Adaptation and Validation of the Well-Being Related to Food Questionnaire (Well-BFQ©) for the French-Speaking General Adult Population of Québec, Canada

Efforts to develop effective strategies that improve dietary intake are needed; however, this improvement in diet quality must not be at the expense of well-being. The Well-Being related to Food Questionnaire (Well-BFQ©) is a tool that has been developed in France to comprehensively measure food well-being. Even though the same language is spoken in France and in Québec, cultural and linguistic differences are present, which supports the importance of adapting and validating this tool before its use in the Québec population. This study aimed to adapt and validate the Well-BFQ© for the French-speaking general adult population of Québec, Canada. The Well-BFQ© underwent a full linguistic adaptation process, including an expert panel adaptation step, a pretest among 30 French-speaking adult (18-65 years) Quebecers, and a final proofreading. The questionnaire was thereafter administered to 203 French-speaking adult Quebecers (49.3% females, M_AGE = 34.9, SD = 13.5; 88.2% Caucasians; 54.2% with a university degree). The exploratory factor analysis showed a two-factor structure: (1) food well-being related to physical and psychological health (27 items) and (2) food well-being related to symbolic/pleasure of food (32 items). Internal consistency was adequate, with a Cronbach's α of 0.92 and 0.93, respectively, for the subscales, and 0.94 for the total scale. The total food well-being score, as well as the two subscale scores, were associated with psychological and eating-related variables in expected directions. Overall, the adapted version of the Well-BFQ© was found to be a valid instrument to measure food well-being in the French-speaking general adult population of Québec, Canada.

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Introduction

Development and validation of the psoriasis scale among the system of quality of life instruments for chronic diseases QLICD-PS (V2.0)

Background and purpose

Psoriasis (PS) is difficult to cure with a high incidence. Therefore, the quality of life (QOL) of people with Psoriasis has caused widespread concern. Universal scales respond poorly to subtle changes caused by specific diseases, which makes it challenging to fully understand the impact of QOL in patients with psoriasis. In view of the deficiencies of the universal scale and the lack of a specific scale suitable for Chinese cultural background, this study aims to develop the psoriasis scale among the system of QOL instruments for chronic diseases QLICD-PS (V2.0).

Methods

The scale QLICD-PS (V2.0) was developed based on the procedural decision-making approach and the experience of establishing scales at home and abroad. 122 patients with psoriasis were participated in measuring QOL 3 times before and after treatments. The reliability was assessed by test–retest reliability (Pearson’s correlation coefficients) and also internal consistency (Cronbach’s alpha coefficients). Qualitative analysis was adopted to evaluate content validity; item-domain correlation analysis, multi-dimensional scaling analysis, and factor analysis were adopted to evaluate the construct validity; the SF-36 scale was used as the criterion to evaluate the criterion-related validity due to lack of gold standard. Paired t tests were performed to evaluate the responsiveness on each domain/facet as well as the total of the scale, with Standardized Response Mean (SRM) being calculated.

Results

The QLICD-PS was composed of the general module including 3 domains (28 items) and the psoriasis specific module (13 items). The Cronbach's α of the specific module, the general module and the total scale of the QLICD-PS was 0.78, 0.87 and 0.74 respectively, the split-half reliability of the specific module, the general module and the total scale was 0.81, 0.91 and 0.81, respectively, both indicating high reliability. Correlation and factor analysis confirmed good construct validity and criterion-related validity. After treatments, the score changes in the total scale were statistically significant with SRM being 0.5, showing moderate responsiveness.

Conclusion

As the first psoriasis-specific QOL scale developed by the modular approach in Chinese, the QLICD-PS showed good reliability, validity and responsiveness, and could be used to measure the QOL of Patients with psoriasis specifically and sufficiently.

Development and Validation of the Yonsei Lifestyle Profile-Satisfaction (YLP-S) Using the Rasch Measurement Model

Lifestyle plays an important role in determining health and vitality among older adults. However, there is limited evidence regarding lifestyle assessment. This study examined the psychometric properties of the Yonsei Lifestyle Profile-Satisfaction (YLP-S). The participants in the study included 156 older adults. Rasch analysis was used to test unidimensionality, fit statistics, and the precision of the YLP-S. The YLP-S demonstrated a unidimensional measurement construct, and 18 items fit the Rasch model. The YLP-S illustrated reasonable precision (person strata = 5.37). Only 4 items showed differential item functioning by sex or age groups. The findings indicate that the YLP-S demonstrated sound internal validity and can be used by health professionals to measure the multifaceted lifestyle of older adults.

Change in nutritional status among women of childbearing age in India (1998-2016)

Introduction

In absolute numbers, India has more undernourished people than all the countries in sub‐Saharan Africa combined. In parallel with the high rates of hunger and undernutrition, the country has been undergoing rapid demographic and dietary transition marked by an increased prevalence of overweight/obesity, particularly among women.

Objective

To measure the changing prevalence of overnutrition during last two decades, as well as to identify the associated sociodemographic correlates among pregnant and non‐pregnant women in India.

Methods

This was a cross‐sectional study based on data from the latest round of National Family Health Survey (2015–2016) conducted among urban and rural women. Participants were 687,876 women (655,850 non‐pregnant and 32,026 pregnant) aged between 15 and 49 years. Nutritional status was assessed in terms of body mass index (BMI) using the cut‐off for Asian population.

Results

Since 1998–1999, the prevalence of underweight has decreased by 9.2%, while that of overweight (BMI = 23–27.4 kg/m²) and obesity (BMI ≥ 27.5 kg/m²) has increased by 6.7% and 3.4%, respectively. Results of multivariable regression analysis revealed significant association between nutritional status and age, parity residency, educational level, religious affiliation, household wealth quintile, and TV watching behaviour. Of those, age and wealth status appeared to be the strongest predictors among both pregnant and non‐pregnant women.

Conclusion

Since 1998, there has been a considerable drop in the prevalence of underweight and rise in the prevalence of overweight and obesity. Significant sociodemographic variations exist in nutritional status, notably age and financial situation, which should be highlighted in national nutrition policymaking and intervention programmes.

Applications of nutritional functional units in commodity-level life cycle assessment (LCA) of agri-food systems

PURPOSE

The nutritional quality of final products is attracting an increased level of attention within life cycle assessment (LCA) literature of agri-food systems. The majority of these studies, however, are based on comparisons at the dietary level and, therefore, are unable to offer immediate implications for farmers as to how best to produce food. This article evaluates recent literature examining the nutrition-environment nexus at the commodity level, with the aim to identify potential pathways towards sustainability analysis that can inform both consumers and producers.

METHODS

A systematic search of literature was carried out to produce a shortlist of studies, and strict exclusion criteria were applied to them afterwards to eliminate irrelevant material. The studies thus selected were classified into one of three tiers based on the level of complexity with regard to their functional units: (1) based on single nutrients, (2) based on composite indicators derived from multiple nutrients and (3) based on commodity-level analysis in a dietary context.

RESULTS AND DISCUSSION

Sixteen papers were identified for inclusion in the review. All of them accounted for climate change either directly or indirectly, whilst only five addressed different impact categories at the same time. Nine studies estimated environmental impacts under functional units associated with nutrient density scores, and the others utilised alternative approaches to account for nutritional value such as linear programming and end-point modelling combined with epidemiological data. A recently developed method to calculate the marginal contribution of a commodity to the overall nutritional value of a specific diet was considered to be a successful first step in bridging the aforementioned knowledge gap.

CONCLUSIONS

The LCA community should continue the ongoing effort to link farm management decisions to diet-level environmental impacts through an enhanced focus on human nutrition across the entire value chain. Future research comparing environmental performances of multiple food groups or multiple production systems should acknowledge differences in nutritional composition and bioavailability between the final products and, ideally, the effects of these nutrients on overall dietary quality.

Perspective: Improving Nutritional Guidelines for Sustainable Health Policies: Current Status and Perspectives

A large body of evidence supports the notion that incorrect or insufficient nutrition contributes to disease development. A pivotal goal is thus to understand what exactly is appropriate and what is inappropriate in food ingestion and the consequent nutritional status and health. The effective application of these concepts requires the translation of scientific information into practical approaches that have a tangible and measurable impact at both individual and population levels. The agenda for the future is expected to support available methodology in nutrition research to personalize guideline recommendations, properly grading the quality of the available evidence, promoting adherence to the well-established evidence hierarchy in nutrition, and enhancing strategies for appropriate vetting and transparent reporting that will solidify the recommendations for health promotion. The final goal is to build a constructive coalition among scientists, policy makers, and communication professionals for sustainable health and nutritional policies. Currently, a strong rationale and available data support a personalized dietary approach according to personal variables, including sex and age, circulating metabolic biomarkers, food quality and intake frequency, lifestyle variables such as physical activity, and environmental variables including one's microbiome profile. There is a strong and urgent need to develop a successful commitment among all the stakeholders to define novel and sustainable approaches toward the management of the health value of nutrition at individual and population levels. Moving forward requires adherence to well-established principles of evidence evaluation as well as identification of effective tools to obtain better quality evidence. Much remains to be done in the near future.

Original article. Work-related quality of life scale among Singaporean nurses

Background: The Work-Related Quality of Life Scale (WRQLS) was developed for health-care workers in England but might be useful, if valid, in other parts of the world or for other professions.

Objective: We test the construct validity and reliability of the WRQLS as applied to nurses in Singapore.

Methods: A descriptive study was undertaken in 2009 on a sample of 811 nurses at the National University Hospital (NUH) of Singapore who had at least one year’s work experience. The WRQLS was used in order to test its construct validity. Exploratory factor analysis was performed to reduce the factors used to determine WRQLS variance. The Pearson’s correlation was used to evaluate the relationship between the WRQLS and the 12-item short form health survey (SF-12) in order to substantiate conclusions regarding construct validity while Cronbach’s alpha was calculated to test WRQLS reliability.

Results: The median age of the respondents was 31 (IQR=12) and the majority were female (96.9%). The median duration of work experience was seven years (IQR=10). Following the exploratory factor analysis, a five-factor model with 22 items was selected, including; 1) job and career satisfaction, 2) general well-being, 3) home-work interface, 4) stress at work, and 5) working conditions. The correlation coefficient showed a moderate relationship between the WRQLS and mental component scale (MCS-12) (r=0.495); and a weak relationship between the WRQLS and physical component scale (PCS-12) (r=0.149). The Cronbach’s alpha revealed good reliability (r=0.92).

Conclusion: The WRQLS test among nurses in Singapore showed good construct validity and reliability. It could be useful in a working environment in Asia but further testing might be warranted.

Improving the psychological evaluation of exercise referral: Psychometric properties of the Exercise Referral Quality of Life Scale

There is a growing need to assess the psychological outcomes of exercise referral and the National Institute of Health and Care Excellence has called for the routine assessment of life-quality. However, a quality of life scale specific to the requirements of exercise referral is currently unavailable. Therefore, the aim of this study was to produce a quality of life measure for this purpose. The Exercise Referral Quality of Life Scale is a 22-item measure comprising three domains: mental and physical health, injury pain and illness and physical activity facilitators. Exploratory factor analysis determined the initial factor structure and was subsequently confirmed by confirmatory factor analysis. Additional scale properties were also assessed. The scale contributes to the global need for improved consistent psychological outcome assessment of exercise referral.

Assessing the impact of dietary habits on health-related quality of life requires contextual measurement tools

The increase of non-communicable diseases at all ages has fostered the general concern for sustaining population health worldwide. Unhealthy lifestyles and dietary habits impacting physical and psycho-social health are well known risk factors for developing life threatening diseases. Identifying the determinants of quality of life is an important task from a Public Health perspective. Consumer-Reported Outcome measures of health-related quality of life (HRQoL) are becoming increasingly necessary and relevant in the field of nutrition. However, quality of life questionnaires are seldom used in the nutrition field. We conducted a scientific literature search to find out the questionnaires used to determine the association between dietary habits and quality of life. A total of 13 studies were eligible for inclusion. Across these studies the short form-36, a generic (non-disease specific) HRQoL measurement instrument was the most widely used. However, generic measures may have limited content validity in the context of dietary habits interventions. We recommend additional contextual diet-specific HRQoL measures are also needed for evaluating the impact of diet habits on daily life functioning and well-being.

Dietary interventions and quality of life: a systematic review of the literature

OBJECTIVE

To systematically review the literature to examine whether there has been adequate assessment of the effects of dietary intervention on quality of life (QOL) independent of weight loss, assess which instruments are being used to measure nutrition-related QOL, identify gaps in the literature, and suggest future directions.

DESIGN

Systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement.

RESULTS

A total of 24 studies were eligible for inclusion. The Short Form-36 Health Survey was the most widely used instrument to assess QOL. Other disease-specific instruments were used. Several different dietary approaches (eg, low carbohydrate, low calorie, low fat, combinations) were recommended. Across studies, QOL generally improved after participating in behavioral weight loss interventions, but findings revealed a lack of evidence to definitively determine whether reported changes in QOL were a result of weight loss or independent of it.

CONCLUSIONS AND IMPLICATIONS

It is important to consider how making broad dietary recommendations for all individuals might affect overall QOL in both positive and negative directions when considering factors other than weight loss and health improvement. If dietary interventions are adversely affecting QOL in other domains (eg, social, economic) and this relationship is not being detected or reported by current research practices, barriers for successful and sustainable dietary changes may not be fully understood.

Relationships between Pathological Patterns and Quality of Life: Pathway Analysis

Purpose. The purpose of our study was to examine the relationships between pathological patterns and self-rated quality of life (QoL). Methods. A total of 426 Korean subjects participated in this study (male : female = 154 : 272). The subjects were asked to complete Yin Deficiency (YD), Qi Deficiency (QD), Food Stagnation (FS), Blood Stasis (BS), Phlegm, and Seven Emotions Impairment (SEI) pattern Questionnaires and the General Health Questionnaire (GHQ). We formed a pathway model consisting of pathological patterns and QoL questionnaire scores and examined which pathological patterns resulted in decreased QoL using path analysis. Results. Our pathway model had satisfactory fitness levels (GFI = 0.975, NFI = 0.984, and CFI = 0.984) and showed that Phlegm and SEI patterns directly resulted in decreased QoL, whereas QD, YD, FD, and BS indirectly resulted in decreased QoL. The pathway model suggested that the severity or stage of decreased QoL may be estimated by pathological patterns: QD and YD patterns are associated with the early stage; FS and BS patterns are associated with the middle stage; Phlegm and SEI are associated with the later stage of decreased QoL. Conclusion. Our results suggest that pathological patterns directly or indirectly affect decreases in QoL.

Lifestyle and health-related quality of life: a cross-sectional study among civil servants in China

Background

Health-related quality of life (HRQoL) has been increasingly acknowledged as a valid and appropriate indicator of public health and chronic morbidity. However, limited research was conducted among Chinese civil servants owing to the different lifestyle. The aim of the study was to evaluate the HRQoL among Chinese civil servants and to identify factors might be associated with their HRQoL.

Methods

A cross-sectional study was conducted to investigate HRQoL of 15,000 civil servants in China using stratified random sampling methods. Independent-Samples t-Test, one-way ANOVA, and multiple stepwise regression were used to analyse the influencing factors and the HRQoL of the civil servants.

Results

A univariate analysis showed that there were significant differences among physical component summary (PCS), mental component summary (MCS), and TS between lifestyle factors, such as smoking, drinking alcohol, having breakfast, sleep time, physical exercise, work time, operating computers, and sedentariness (P < 0.05). Multiple stepwise regressions showed that there were significant differences among TS between lifestyle factors, such as breakfast, sleep time, physical exercise, operating computers, sedentariness, work time, and drinking (P < 0.05).

Conclusion

In this study, using Short Form 36 items (SF-36), we assessed the association of HRQoL with lifestyle factors, including smoking, drinking alcohol, having breakfast, sleep time, physical exercise, work time, operating computers, and sedentariness in China. The performance of the questionnaire in the large-scale survey is satisfactory and provides a large picture of the HRQoL status in Chinese civil servants. Our results indicate that lifestyle factors such as smoking, drinking alcohol, having breakfast, sleep time, physical exercise, work time, operating computers, and sedentariness affect the HRQoL of civil servants in China.