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Measuring nutritional knowledge using Item Response Theory and its validity in European adolescents

  • Thanise Sabrina Souza Santos (a1), Cristina Julian (a2), Dalton Francisco de Andrade (a3), Betzabeth Slater Villar (a1), Raffaela Piccinelli (a4), Marcela González-Gross (a5), Fréderic Gottrand (a6), Odysseas Androutsos (a7), Mathilde Kersting (a8), Nathalie Michels (a9), Inge Huybrechts (a10), Kurt Widhalm (a11), Dénes Molnár (a12), Ascensión Marcos (a13), Manuel J Castillo-Garzón (a14) and Luis A Moreno (a2)...

To analyse the Nutritional Knowledge Test (NKT) using Item Response Theory (ITR) analysis and to assess the construct validity of the Nutritional Knowledge Scale (NKTS) and its associations with adolescent food group consumption and nutritional biomarkers.


Cross-sectional study.


Multicentre investigation conducted in ten European cities.


Adolescents aged 12·5–17·5 years (n 3215) who completed over 75 % of the NKT.


Factor analysis indicated that the NKT can be analysed with a one-dimensional model. Eleven out of twenty-three items from the NKT presented adequate parameters and were selected to be included in the NKTS. Nutrition knowledge was positively associated with consumption of fruits, cereals, dairy products, pulses, meat and eggs, and fish, as well as with blood concentrations of vitamin C, β-carotene, n-3 fatty acids, holo-transcobalamin, cobalamin and folate; nutrition knowledge was negatively associated with intake of olives and avocado, alcohol and savoury snacks.


The NKTS assessed nutritional knowledge adequately and it is proposed as a new tool to investigate this subject in future studies.

Corresponding author
*Corresponding author: Email
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Members of the HELENA Study Group are listed in the Appendix.

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1. Robertson, A, Tirado, C, Lobstein, T et al. (editors) (2004) Food and Health in Europe: A New Basis for Action. WHO Regional Publications, European Series no. 96. Copenhagen: WHO Regional Office for Europe.
2. Parmenter, K & Wardle, J (2000) Evaluation and design of nutritional knowledge measures. J Nutr Educ 32, 269277.
3. Sichert-Hellert, W, Beghin, L, De Henauw, S et al. (2011) Nutritional knowledge in European adolescents: results from the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study. Public Health Nutr 14, 20832091.
4. Dickson-Spillmann, M, Siegrist, M & Keller, C (2011) Development and validation of a short, consumer-oriented nutrition knowledge questionnaire. Appetite 56, 617620.
5. Whati, LH, Senekal, M, Steyn, NP et al. (2005) Development of a reliable and valid nutritional knowledge questionnaire for urban South African adolescents. Nutrition 21, 7685.
6. Nguyen, TH, Han, HR, Kim, MT et al. (2014) An introduction to Item Response Theory for patient-reported outcome measurement. Patient 7, 2335.
7. Moreno, LA, De Henauw, S, Gonzalez-Gross, M et al. (2008) Design and implementation of the Healthy Lifestyle in Europe by Nutritional in Adolescence Cross-Sectional Study. Int J Obes (Lond) 32, Suppl. 5, S4S11.
8. Goldberg, GR, Black, AF, Jebb, SA et al. (1991) Critical evaluation of energy intake data using fundamental principles of energy physiology: 1. Derivation of cut-off limits to identify under-recording. Eur J Clin Nutr 45, 569581.
9. Black, AF (2000) Critical evaluation of energy intake using the Goldberg cut-off for energy intake:basal metabolic rate. A practical guide to its calculation, use and limitations. Int J Obes Relat Metab Disord 24, 11191130.
10. Beghin, L, Castera, M, Manios, Y et al. (2009) Quality assurance of ethical issues and regulatory aspects relating to good clinical practices in the HELENA Cross-Sectional Study. Int J Obes (Lond) 32, Suppl. 5, S12S18.
11. Iliescu, C, Beghin, L, Maes, L et al. (2008) Socioeconomic questionnaire and clinical assessment in the HELENA Cross-Sectional Study: methodology. Int J Obes (Lond) 32, Suppl. 5, S19S25.
12. Julian, C, Mouratidou, T, Vicente-Rodrigues, G et al. (2017) Dietary sources and sociodemographic and lifestyle factors affecting vitamin D and calcium intakes in European adolescents: the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) Study. Public Health Nutr 20, 15931601.
13. Vandevijvere, S, Geelen, A, Gonzalez-Gross, M et al. (2013) Evaluation of food and nutrient intake assessment using concentration biomarkers in European adolescents from the Healthy Lifestyle in Europe by Nutrition in Adolescence study. Br J Nutr 109, 736747.
14. Vereecken, CA, Covents, M, Sichert-Hellert, W et al. (2008) Development and evaluation of a self-administered computerized 24h dietary recall method for adolescents in Europe. Int J Obes (Lond) 32, Suppl. 5, S26S34.
15. Currie, C (editor) (1998) Health Behavior in School-aged Children: A WHO Cross-National Survey (HBC) Research Protocol for the 1997/1998 Survey. Edinburgh: University of Edinburgh, Research Unit in Health and Behavioural Change.
16. Nagy, E, Vicente-Rodriguez, G, Manios, Y et al. (2008) Harmonization process and reliability assessment of anthropometric measurements in a multicenter study in adolescents. Int J Obes (Lond) 32, Suppl. 5, S58S65.
17. Cole, TJ, Flegal, KM, Nicholls, D et al. (2007) Body mass index cut offs to define thinness in children and adolescents: international survey. BMJ 335, 194202.
18. Cole, TJ, Bellizzi, MC, Flegal, KM et al. (2000) Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 320, 12401243.
19. González-Gross, M, Breidenasel, C, Gomez-Martinez, S et al. (2008) Sampling and processing of fresh blood samples within a European multicenter nutritional study: evaluation of biomarker stability during transport and storage. Int J Obes (Lond) 32, Suppl. 5, S66S75.
20. Wang, Q, Inamura, F, Lemaitre, RN et al. (2014) Plasma phospholipid trans-fatty acids levels, cardiovascular diseases, and total mortality: the Cardiovascular Health Study. J Am Heart Assoc 3, e000914.
21. Diehl, JM (1999) Ernährungswissen von Kindern und Jugendlichen. Verbraucherdienst 44, 282287.
22. Kersting, M, Sichert-Hellert, W, Vereecken, CA et al. (2008) Food and nutrient intake, nutritional knowledge and diet-related attitudes in European adolescents. Int J Obes (Lond) 32, Suppl. 5, S35S41.
23. Reckase, MD (1979) Unifactor latent trait models applied to multifactor tests: results and implications. J Educ Behav Stat 4, 207230.
24. Andrade, DF, Tavares, HR & Valle, RC (2000) Teoria de Resposta ao Item: Conceitos e Aplicações. In 4º Simpósio Nacional de Probabilidade e Estatística – SINAPE 2000, Caxambu, Minas Gerais, Brazil. São Paulo: Associação Brasileira de Estatística.
25. Chernyshenko, O, Stark, S, Chan, K et al. (2001) Fitting Item Response Theory models to two personality inventories: issues and insights. Multivariate Behav Res 36, 523562.
26. StataCorp, (2015) Stata Statistical Software: Release 14. College Station, TX: StataCorp LP.
27. Zimowski, MF, Muraki, E, Mislevy, RJ et al. (2003) BILOG-MG 3. Chicago, IL: Scientific Software.
28. Wilson, M, Allen, DD & Li, JC (2006) Improving measurement in health education and health behavior research using item response modeling: comparison with the classical test theory approach. Health Educ Res 21, Suppl. 1, i19i32.
29. Primi, R (2004) Advances in scale interpretation with the application of Item Response Theory. Aval Psicol 3, 5358.
30. Burns, KEA, Duffett, M, Kho, ME et al. (2008) A guide for the design and conduct of self-administered surveys of clinicians. CMAJ 179, 245252.
31. Asakura, K, Todoriki, K & Sasaki, S (2017) Relationship between nutrition knowledge and dietary intake among primary school children in Japan: combined effect of children’s and their guardians’ knowledge. J Epidemiol 27, 483491.
32. Augustine, LF, Vazir, S, Rao, SF et al. (2012) Psychometric validation of a knowledge questionnaire on micronutrients among adolescents and its relationship to micronutrient status of 15–19-year-old adolescent boys, Hyderabad, India. Public Health Nutr 15, 11821189.
33. Oldewage-Theron, W, Egal, A & Moroka, T (2014) Nutrition knowledge and dietary intake of adolescents in Cofimvaba, Eastern Cape, South Africa. Ecol Food Nutr 54, 138156.
34. Heshmat, R, Salehi, F, Qorbani, M et al. (2016) Economic inequality in nutritional knowledge, attitude and practice of Iranian households: the NUTRI-KAP study. Med J Islam Repub Iran 30, 915922.
35. Brien, GO & Davies, M (2005) Nutrition knowledge and body mass index. Health Educ Res 22, 571575.
36. Meseri, R, Mermer, G, Ergin, I et al. (2015) Evaluation of obesity prevalence and nutritional knowledge in adolescents in semi urban area of Turkey. Prog Nutr 17, 5867.
37. Cella, D, Riley, W, Stone, A et al. (2010) The patient-reported outcomes measurement information system (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005–2008. J Clin Epidemiol 63, 11791194.
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Table S1-S3 and Figure S1

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