Background: Globally, there is a trend towards consumption of energy-dense, nutrient-poor foods leading to dietary imbalances in toddlers. Nutrient deficiencies are associated with the risk of obesity and other health risks. NutricheQ is an 18-item questionnaire that can quickly identify these risks based on dietary patterns in healthy toddlers. Objectives: This study aimed to validate the NutricheQ tool, describe the dietary intake of toddlers and classify them into risk groups. Methods: This was a national, multi-center, observational, validation study conducted at 21 medical centers in Lebanon. Data was collected from NutricheQ administered to the parents of toddlers during a single outpatient visit, and food diary filled by parents during a 4-day follow-up. The validation process of NutricheQ was done using Pearson’ s and Spearman’ s correlation, ANOVA and ANCOVA. The accuracy of NutricheQ in the Identifying categories of nutritional risk was evaluated using the receiver operating characteristic (ROC) curves. All analyses were performed using IBM-SPSS version 24 and P value of  0. 05 was considered to be statistically significant. Results: Of the 487 toddlers enrolled, 467 had full data on NutricheQ and food diary data was available for 247 only. Majority of toddlers in Lebanon (80%-88%) were categorized in the moderate or low-risk groups of dietary intake indicating good eating habits. There was a significant positive association between the total NutricheQ score and both, age (r = 0. 11, P = 0. 021) and BMI Z-score (r = 0. 11, P = 0. 021). ROC fitting showed a very low discriminatory ability of the scores to correctly classify toddlers into the high-risk group basedontheir BMI Z-score. Significant positive correlation was obtained between the NutricheQ total score and exchangeable fat and meat with high fat, in the food diaries (R = 0. 170, P = 0. 045), indicating risk. Also, there was a negative association between the total NutricheQ score and soluble and insoluble fiber (Rs = 0. 181, P = 0. 004). Conclusions: Results from this study showed that NutricheQ has reasonable validity in the Lebanese context to assess the dietary quality of toddlers in Lebanon and in identifying those at increased nutritional risk.

Background :Toddlers are consuming more energy-dense, nutrient-poor foodstuffs in discordance with international dietary guidelines. Limited data are available on the dietary habits of children in Jordan. Objectives :This study aimed primarily at assessing the local validity of the NutricheQ tool in reflecting the nutritional risk status of 12- to 36-month-old toddlers in Jordan. Methods :This national, multicentre, observational validation study analyzed the data of healthy 12- to 36-month-old toddlers who were identified and prospectively enrolled during a routine clinic visit. After providing written informed consent, the parents or legal guardians of toddlers were asked to (a) complete a food intake diary form (FIDF) over three days (two weekdays and one weekend day); and (b) to answer the NutricheQ questionnaire completed by the physician during a single outpatient visit, as part of the case report form (CRF). Results :Out of 213 Jordanian toddlers, 31 (14.6%) were at low nutritional risk; 145 (68.1%) (95% confidential interval (CI): 61.5 - 74.0) were at moderate nutritional risk, and 37 (17.4%) (95% CI: 12.8 - 23.1) were at an increased nutritional risk. The average nutritional intake of the toddlers did not meet the daily intake of the main nutrients recommended across all food categories, with a default daily intake of vitamin A, vitamin D, fiber, and iodine and an excess daily intake of protein and iron. NutricheQ-predicted risk categories significantly correlated with meat intake and the number of weekly servings of fruits and cooked vegetables. Conclusions :NutricheQ is a valid tool to predict nutritional risk among toddlers in Jordan.

Background: Although poor dietary habits have a great effect on the health status of children, especially in toddlers, a few questionnaires exist for the assessment of dietary imbalances. This study aims to assess the validity and reliability of the NutricheQ in Iranian healthy toddlers. Methods: In this cross‑, sectional study, first, the NutricheQ was translated to Persian and culturally adapted by the forward–, backward translation technique. In order to assess the face validity, we used a cognitive interviewing technique of 25 parents/caretakers of healthy toddlers. In the next step, experts assessed content validity, respectively. One item was removed during the content validity process. Then, a blueprint of NutricheQ was distributed among 156 parents/caretakers of healthy toddlers in different focal points in Tehran for assessing construct validity by nonlinear principal components analysis. In addition, the anthropometric indices checklist and Food Frequency Questionnaire (FFQ) were filled out for toddlers. Then, construct validity was assessed. The Varimax rotation ran for two sections separately. The four‑, factor structure was confirmed. Results: The model showed a good fit, and all the extracted variance of four factors were satisfactory (F1 = 20. 77,F2 = 22. 30,F3 = 14. 75,and F4 = 13. 71). All of the extracted items of the NutricheQ in two parts showed 71. 53% cumulative variance. For criterion‑, related validity, there was a statistically significant positive correlation between the NutricheQ and Z‑, score (rho = 0. 632, P < 0. 001). The Bland‑, Altman result indicates 95% limits of agreement between the NutricheQ questionnaire and Z‑, score. Conclusions: Therefore, we concluded that NutricheQ is a valid, reliable, and convenient instrument to identify the Iranian toddlers’,nutritional status. Therefore, it can be used for research and clinical settings.