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Item The link between dietary diversity and body composition in New Zealand European, Māori and Pacific women : the women's EXPLORE study : a thesis presented in partial fulfilment of the requirements for the degree Master of Science in Nutrition and Dietetics, Massey University, Albany, New Zealand(Massey university, 2019) Bell, Catherine AnneEating a diverse diet improves diet quality and nutritional adequacy, but may be higher in energy and discretionary foods, which are associated with obesity. We aimed to utilise a newly validated dietary diversity questionnaire (DDQ) to explore the dietary diversity and food variety of New Zealand European, Māori and Pacific women and how dietary diversity and food variety may link to different body composition profiles (BCPs). Women’s (n=235) waist circumference, body mass index and body fat percentage (BF%) was used to categorise them into one of three BCP groups (normal-fat, hidden-fat, apparent- fat). Dietary intake was assessed using a Food Frequency Questionnaire (energy and nutrients), alongside a validated DDQ, which assessed participants dietary diversity and food variety scores (DDS and FVS). Dietary diversity was high (88%, 22/25) whilst food variety was comparatively low (31%, 78/237), especially within carbohydrates, fruits, vegetables and seafood. Overall, DDS and nutritious-DDS was lower for Pacific participants (P<0.005), whilst discretionary-FVS was higher for Māori and Pacific participants (both P<0.001). Regarding obesity, nutritious-DDS was higher in participants with a non-obese BMI (P=0.024) and BF% (P=0.029), compared to obese participants. Both DDS and N-DDS negatively correlated to WC and BF% (P<0.005). Participants in the highest tertile of DDS and nutritious-DDS had a lower WC (P=0.015, P<0.001), BMI (P=0.048, P=0.004), and BF% (P=0.002, P=0.011), despite consuming more energy (P=0.016). We were unable to demonstrate any significant anthropometric differences between tertiles of discretionary DDS nor discretionary FVS. Our results support previous prospective studies, showing that consuming an increased variety of nutritious foods may be associated with reduced female obesity, possibly more so than omitting discretionary foods. Health promotion should encourage exchanging rather than excluding, discretionary foods.Item Determining the relative validity and reproducibility of a food frequency questionnaire (FFQ) to assess nutrient intake in older adults living in New Zealand : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Nutrition and Dietetics at Massey University, Albany, New Zealand(Massey University, 2019) Yu, Angela DawnBackground: New Zealand’s population is ageing. Dietary intakes in older adults and physiological changes through ageing are important predictors of health and disease outcomes. However, it is challenging to capture the typical diet of older adults. Among different types of dietary assessment tools, a food frequency questionnaire (FFQ) is easy to administer and causes less burden to participants. To the best of our knowledge, the latest FFQ validation study in older adults was undertaken nearly 30 years ago. A valid and reproducible FFQ to measure multiple nutrients intake in older New Zealanders is warranted. Aim: This study aims to assess the validity and reproducibility of an FFQ designed to measure a range of relative nutrient intakes in older adults aged 65 to 74 years in New Zealand. Methods: As part of the Researching Eating, Activity and Cognitive Health (REACH) study, a convenience sample of community-dwelling older adults 65 to 74 years were recruited for a cross-sectional observational study. Participants (n = 166) who completed a 109-item FFQ to assess dietary intakes over the past month and a four-day food record (4DFR) were included in the validity analysis; participants (n = 319) who completed the FFQ and re-administered FFQ four weeks later were included in the reproducibility analysis. Energy intake was adjusted for nutrients in the statistical methods. Relative validity and reproducibility of the FFQ were assessed using paired t-tests, Pearson’ or Spearman’s correlation coefficients, cross-classification with weighted kappa statistics, Bland-Altman plots, and linear regression analysis for energy and 28 nutrients. Results: Energy adjustment caused moderate improvements on both validity and reproducibility. The validity correlations for energy adjusted nutrient intakes ranged from 0.05 (selenium) to 0.76 (alcohol), with a mean of 0.35. Validity correlations above 0.40 were observed for 12 nutrients after energy adjustment, including carbohydrate, sugar, dietary fibre, total fat, monounsaturated fat, polyunsaturated fat, cholesterol, vitamin E, calcium, and magnesium. At least 50% of participants were correctly classified into the same tertiles for nine nutrients. Less than 10% of participants were grossly misclassified into the opposite tertiles for seven nutrients. Weighted kappa values for validity demonstrated fair agreement (ĸ 0.21-0.40) for 19 nutrients and good agreement (ĸ >0.61) for alcohol intake. Reproducibility correlations for energy adjusted nutrients ranged from 0.30 (vitamin A) to 0.91 (alcohol), with most nutrients (n = 25) falling between 0.60 and 0.80. For reproducibility, the mean correct classification was 60%, ranged between 53 and 78%. Gross misclassification for energy adjusted nutrients ranged from 0.6 to 7.8%. Weighted kappa values for reproducibility demonstrated moderate agreements (ĸ 0.41-0.60) for 25 energy adjusted nutrients and good agreement (ĸ >0.61) for alcohol. Conclusion: The FFQ showed reasonable relative validity for ranking nutrient intakes in older New Zealanders 65-74 years old. The FFQ appears to have good reproducibility for assessing energy and nutrient intakes. The FFQ could be used in future research for relative nutrient assessments in older adults but is not suitable for measuring absolute nutrient intakes.Item An adaption of the NutriSTEP screening tool to be suitable for nutrition risk factor identification in New Zealand preschool children aged two to five years old; adaptation of NutriSTEP as a parent administered questionnaire : a thesis presented in partial fulfilment of requirements for the degree of Master of Science in Nutrition and Dietetics at Massey University, Albany, New Zealand(Massey University, 2019) Edge, Breanna JadeBackground: Risk factors of poor nutrition status in childhood may continue into adulthood and determine development of chronic disease. To reduce likelihood of chronic disease in adulthood, nutrition risk factors should be identified in childhood. Nutrition screening tools (NSTs) have been developed to identify increased nutrition risk and guide appropriate nutrition intervention. There is currently no reliable paediatric NST for use in the community setting in New Zealand (NZ). However, NutriSTEP, a validated parent-administered NST developed in Canada has been shown to identify preschool aged children at increased nutrition risk. Aim: To adapt the Canadian NutriSTEP to be suitable for use in the NZ setting, and to test its reliability, as a means to identify nutrition risk in preschool children aged between two and five years, as a parent administered questionnaire. Methods: New Zealand Registered Dietitians (NZRDs) (n=3) reviewed the wording of the Canadian NutriSTEP and suggested adaptions suitable for the NZ setting. Intercept interviews with parents of preschoolers (n=26) provided non-expert reviews of the Canadian NutriSTEP. NZRDs participated in a second review to evaluate suggested wording adaptions from the parent intercept interviews. Appropriate wording amendments were confirmed and the adapted NutriSTEP was finalised for online reliability testing. Parents of preschoolers (n=79) completed online administrations of the Canadian NutriSTEP and the adapted NutriSTEP four weeks apart in a blinded manner. Intraclass Correlation Coefficient (ICC) was then used to verify test-retest reliability between administrations of the NutriSTEP. Individual questionnaire items were verified for reliability between administrations through Cohen’s Kappa statistic (κ), Pearson’s chi-square value and Fisher’s exact test. Descriptive statistics identified preschoolers at increased (medium to high) nutrition risk and individual questionnaire items with the highest percentage of nutritional risk. Results: The Canadian NutriSTEP and adapted NutriSTEP were reliable between online administrations (ICC=0.91; 95% confidence interval 0.86, 0.94; F=11.4; P<0.000). Most (13 out of 17) questionnaire items had adequate (κ>0.5) agreement between administrations, one item had excellent agreement (κ>0.75). All individual questionnaire items had a p-value p<0.05 indicating a significant relationship between administrations. The Canadian NutriSTEP identified that 20.3% of preschoolers were at increased nutrition risk, whereas the adapted NutriSTEP identified that 31.6% were at increased nutrition risk. Individual questionnaire items with the highest percentage of nutritional risk included; low intake of breads and cereals (58.2%), milk and milk products (51.9%), meat and meat alternatives (40.5%), child sometimes not controlling the amount consumed (35.4%) and low vegetable intake (34.2%). Conclusions: The Canadian NutriSTEP and the adapted NutriSTEP were reliable between online administrations when verified for test-retest reliability in the NZ community setting. The adapted NutriSTEP identified more preschoolers at increased nutrition risk than the Canadian NutriSTEP. This demonstrates the adapted NutriSTEP has increased sensitivity in the NZ setting in comparison to the Canadian NutriSTEP. To identify increased nutrition risk in NZ preschoolers and reduce likelihood of chronic disease, the adapted NutriSTEP should be considered for future use in the community setting and to guide appropriate nutrition intervention by a NZRD.Item Validation of a food frequency questionnaire to assess nutrient intakes in women participating in the PRedictors linking Obesity and gut MIcrobiomE (PROMIsE) study : a thesis presented in partial fulfilment of the requirements for the degree of Masters of Science in Nutrition and Dietetics, Massey University, Albany, New Zealand(Massey University, 2019) Drury, BeatriceBackground: Diet is a modifiable risk factor for a range of chronic diseases. Food frequency questionnaires (FFQ) are commonly used in epidemiological studies to investigate this relationship due to their ease of administration, low cost and ability to assess nutrient intake over an extended period of time. Like all dietary assessment tools FFQ’s are not free of error and need to be validated for use in their intended population. There is currently no FFQ that has been independently validated for use in the Pacific and New Zealand (NZ) European women in New Zealand. Aim To validate a semi-quantitative food frequency questionnaire in 18-45-year-old pre-menopausal adult NZ European and Pacific women participating in the PROMIsE study, living in the greater Auckland area. Methods Participants included 287 premenopausal women living in New Zealand of NZ European (n=161) and Pacific (n=126) ethnicity. Women completed an FFQ (NZWFFQ) designed to assess the dietary intake of 31 nutrients over the previous month and a five-day estimated food record (5d-FR). Relative validity was assessed by comparing the nutrient intakes of the NZWFFQ and 5d-FR using Wilcoxon signed rank test, Spearman’s correlation coefficients, cross-classification, weighted kappa statistic and Bland-Altman analysis. Validity was evaluated for crude and energy adjusted data for the total group and separately for NZ European and Pacific ethnicity. Results The nutrient intake of the NZWFFQ was higher than the 5d-FR overall for all nutrients (range: 6%-113% difference) except iodine (-16%). Correlation coefficients ranged from 0.07 for iodine in the unadjusted total group to 0.63 for alcohol. The highest energy correlation coefficients were for energy adjusted NZ European data (0.17-0.73) and were lowest for the unadjusted Pacific data (-0.02-0.47). Classification into same and adjacent quartiles of intake, and gross misclassification into opposite quartiles, were respectively 77.5% and 5.41% for the total group, 81% and 3.6% for the NZ European group, and 71.2% and 7.6% for the Pacific group for energy adjusted data. The weighted kappa showed slight to moderate agreement for the total group (0.12-0.47), slight to moderate agreement (0.16-0.54) for NZ European, and slight to fair agreement (-0.10-0.28) for the Pacific group. Bland-Altman analysis showed wide limits of agreement for nutrients in each group, with wider limits of agreement and larger mean differences for the Pacific group. Conclusion: The NZWFFQ gives good validity for ranking NZ European women by nutrient intake however did not compare well for ranking Pacific women by nutrient intake. As most nutrients were overestimated by the NZWFFQ it is not a suitable tool to use for estimating absolute nutrient intake.Item Determining the relative validity and reproducibility of a food frequency questionnaire to assess food group intake in high performing athletes : a thesis presented in partial fulfilment of the requirements for the degree of Masters of Science in Nutrition and Dietetics, Massey University, Albany, New Zealand(Massey University, 2018) Stockley, DaynaBackground: Optimal nutrition is essential for high performing athletes in order to train effectively, optimise recovery and improve their performance. Given the differences in dietary requirements and practices that exist between athletes and the general population, dietary assessment tools designed specifically for athletes are required. Food frequency questionnaires (FFQs) are commonly used to assess habitual dietary intake as they are inexpensive, quick and easy to administer. Currently there are no athlete-specific, up-to-date, valid and reproducible FFQs to assess food group intake of athletes. This study aims to determine the relative validity and reproducibility of an athlete-specific FFQ against an estimated four day food record (4DFR) to assess food group intake in high performing athletes. Methods: Data from 66 athletes (24 males, 42 females) representing their main sport at regional level or higher and aged 16 years and over, was collected as part of a validation study in 2016. Athletes completed the athlete-specific FFQ at baseline (FFQ1) and four weeks later (FFQ2) to assess reproducibility. An estimated 4DFR was completed between these assessments to determine the relative validity of the FFQ1. Foods appearing in the 4DFR were classified into the same 129 food groups as the FFQ, and then further classified into 28 food groups in gram amounts. Agreement between the two methods for intake of food group and core food group intake was assessed using Wilcoxon signed rank tests, Spearmans correlation coefficients, cross classification with tertiles, the weighted kappa statistic and Bland-Altman analysis. Results: The FFQ overestimated intake for 17 of 28 food groups compared with the 4DFR (p<0.05). Correlations ranged from 0.11 (processed foods) to 0.78 (tea, coffee & hot chocolate), with a mean of 0.41. Correct classification of food groups into the same tertile ranged from 35.4% (starchy vegetables) to 55.5% (fats & oils). Misclassification into the opposite tertile ranged from 4.6% (legumes) to 15.4% (starchy vegetables; sauces & condiments). The weighted kappa demonstrated fair to moderate agreement (k=0.21-0.60) for food groups. Bland-Altman plots suggested that for most of food groups, the difference between FFQ1 and the 4DFR increased as the amount of each food group consumed increased. Intake from FFQ1 was significantly higher than from FFQ2 for 13 of 28 food groups. All effect sizes were small (r=0.1). Reproducibility correlations ranged from 0.49 (potato chips; fats & oils) to 1.00 (tea, coffee & hot chocolate), with a mean of 0.65. For the 23 food groups classified into tertile, 20 had >50% of participants correctly classified, <10% grossly misclassified, and 20 demonstrated moderate to good agreement (k=0.61-0.80). The exceptions were dairy; fats & oils; and processed foods & drinks which presented fair agreement (k=0.21-0.40). Conclusions: The FFQ showed reasonable validity and good reproducibility for assessing food group intake in high performance athletes in New Zealand. The FFQ could be used in future research as a convenient, cost-effective and simple way to obtain athletes’ food group intake, and identify those who could benefit from interventions to improve their nutritional adequacy and potentially their athletic performance.Item Investigating eating behaviours as predictors of body composition and dietary intake in New Zealand European, Māori and Pacific women - the women's EXPLORE study : a thesis presented in partial fulfilment of the requirements for the degree Master of Science in Nutrition and Dietetics, Massey University, Albany, New Zealand(Massey University, 2018) Shepherd, Katrina JadeBackground/Aim: Internationally, eating behaviour has been linked with an optimal and adverse body composition in women. However no study to date has examined eating behaviour in female New Zealand ethnic groups. Therefore, the aim of this study was to investigate eating behaviours as predictors of different body composition factors and dietary intake in New Zealand European (NZE), Māori and Pacific women, aged 16-45 years, participating in the women’s EXPLORE study. Methods: Women (N=368) were assessed for basic anthropometry, total adiposity, regional adipose distribution and lean mass using height, weight, circumferences, dual x-ray absorptiometry and air-displacement plethysmography. Body composition profiles (normal-fat, hidden-fat and apparent-fat) were established using parameters of body mass indices and body fat percentages. The validated Three-Factor Eating Questionnaire (TFEQ) and New Zealand Women’s Food Frequency Questionnaire were both used to examine eating behaviour and dietary intake, respectively. The TFEQ examined Restraint (Flexible and Rigid), Disinhibition (Habitual, Emotional and Situational) and Hunger (Internal and External). Combinations of behaviour (sub-groups) were established from the main categories and also examined. Results: Restraint was significantly higher in NZE than Pacific women (p = 0.015). Disinhibition was significantly higher in the apparent-fat profile than normal-fat profile (p < 0.001). Likewise, Hunger was significantly higher in Pacific (p < 0.001) and the apparent-fat profile (p = 0.034) than NZE women and women with normal-fat profile, respectively. Adverse tendencies of Habitual Disinhibition, and External Hunger were more prominent in Pacific and the apparent-fat profile than NZE women and normal-fat profile, respectively (all p < 0.05). External Hunger was more prominent in the hidden-fat profile than normal-fat profile (p = 0.001). When accounting for age and ethnicity the most significant predictors of BMI and BF % were Restraint (p = 0.007 and p = 0.005 respectively), Disinhibition (both p < 0.001), Habitual Disinhibition (both p < 0.001) and Emotional Disinhibition (both p < 0.001). Non-ideal behaviour combinations (Low Restraint High Disinhibition and High Hunger High Disinhibition) generally corresponded to significantly higher body composition markers and dietary intake (p < 0.05). Pacific women were three times more likely to have High Hunger High Disinhibition than NZE women (p = 0.004). Low Restraint High Disinhibition and High Hunger High Disinhibition increased by 12% and 11%, respectively from the normal-fat profile to hidden-fat profile (both p < 0.001). Conclusions: The TFEQ eating behaviour categories, sub-categories and sub-groups can significantly vary between ethnicities and body composition groups. Tailored interventions to promote Restraint (particularly Flexible Restraint) and counteract Disinhibition (particularly Habitual Disinhibition and Emotional Disinhibition), Hunger (particularly External Hunger), Low Restraint High Disinhibition and High Hunger High Disinhibition could enhance eating behaviour and dietary intake and help optimise weight management in young New Zealand women.Item Dietary fibre intake : validity of a short-term food frequency questionnaire : association with gastrointestinal health and public perceptions : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Nutrition and Dietetics, Massey University, Albany, New Zealand(Massey University, 2018) Micah, JohnIntroduction: Dietary fibre is an important constituent of the diet as it plays a key role in reducing the risk of certain diseases. There are several validated dietary assessment tools that measure current fibre intakes; however these are lengthy, cannot be self-administered or classify dietary fibre intakes. The beneficial effects of fibre consumption have led to dietary recommendations that encourage adequate intake, yet there are a limited number of studies that have investigated the effect fibre has on gut symptoms or examined the perceived benefits versus barriers to eating fibre containing foods. Objectives: This study aimed to validate a tool that measures short term dietary fibre intake against a 4-day food record, and compare dietary fibre intake to gastrointestinal symptoms. The study also aimed to survey perceived benefits and barriers to dietary fibre intake. Methods: One hundred and five healthy male and female participants aged 19-65 years completed the study. All eligible participants completed a 4-day diet record, a food frequency questionnaire based 9-item dietary fibre intake tool (DFiT), a daily gastrointestinal symptom diary and a 15-item dietary fibre perceptions survey. Agreement between the 4-day diet record and DFiT was analysed using a paired t-test, correlation coefficient, cross-classification, weighted k statistic and Bland Altman analysis. Results: The DFiT was accurate in classifying but not estimating total dietary fibre intakes. When different levels of dietary fibre intakes were compared to markers of gastrointestinal health, there were no associations found for occurrence or severity for gastrointestinal symptoms. However, high fibre consumers pass one additional bowel motion per day and had softer stool than low fibre consumers. The survey of perceptions showed that the majority of participants agreed with the health benefits, however just over half of participants identified with barriers. There were some differences in responses between genders, levels of dietary fibre intake and socioeconomic status. Conclusion: The DFiT is a valid, simple, short and easy to use questionnaire for classifying but not estimating total short term dietary fibre intakes. In the context of sustainability and shift towards a higher consumption of dietary fibre, it is important to further investigate the effect of dietary fibre on gastrointestinal symptoms and perceptions of barriers.Item Fortified foods with Sangkap Pinoy Seal and the micronutrient intake among selected households in Punta, Sta. Ana, Manila, Philippines : a thesis presented in partial fulfillment of the requirements for the degree of Master of Science in Nutritional Science, Institute of Food, Nutrition and Human Health, Massey University(Massey University, 2001) Sta. Ines, Helena DThis study evaluated the food fortification program (Sangkap Pinoy Seal Program-SPS) in the Philippines in terms of determining the rate of awareness, attitude and considerations and the factors associated with purchase of fortified foods with SPS among women in a poor urban area in Manila. This study also determined the contribution of SPS foods to total iron and vitamin A intake of their preschool children. A survey was conducted through personal interviews among 134 mothers who were randomly selected from all villages of Punta, Sta. Ana, Manila. Descriptive data showed that around 60% of the participants were aware of SPS foods. In general, a positive perception on SPS foods was demonstrated by the women as reflected in their comments. Majority of these comments associated SPS foods as foods accepted/recommended by the Department of Health, foods with added nutrients and nutritious and safe food to eat. Around 89% of those who were aware exhibited a positive attitude towards fortified foods. Awareness of fortified foods and foods with SPS were significant predictors of purchase of SPS foods. However, even if income was the stronger determinant of purchase than awareness, awareness still had some effect. Around 3% and 6% of the variation in purchase of SPS foods could be attributed to the effects of attitude to fortified foods and total opinion to food and health, respectively. The results of this study also showed that preference of the family and taste were major considerations in purchasing SPS foods among more than half of the sample. These findings suggest that the participants purchased SPS foods not mainly because of added nutrients. Intakes of energy and vitamin A among the respondents' preschooler children were considered adequate. However, their iron intake was found to be less adequate. A remarkable finding of this research study was the significant contributions of SPS foods to iron and vitamin A intakes of the children in achieving the RDA. There was 53% increase on the number of children whose vitamin A intake was less than 50% of the RDA if SPS foods were taken out from the diet. SPS foods contributed around 27.6% to total vitamin A intake of the children. Without, the contribution of iron from SPS foods, there was 44% decrease on the number of children whose iron intake was greater than 75% of the RDA and 100% increase on the number of children whose iron intake was less than 50% of the RDA. Hence, iron and vitamin A from SPS foods did have an impact in the nutritional status of the children. The findings of the study may provide vital information to the food fortification program and pose a challenge to nutrition educators. The results are discussed in relation to the previous literature and recommendations are presented with particular emphasis on the implications for future research. In conclusion, SPS foods may have a good potential to improve the nutritional status of the children.Item Dietary intakes and body composition of Māori and Pacific women in the women's EXPLORE study : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Nutrition and Dietetics, Massey University, Albany, New Zealand(Massey University, 2017) Lawn, Alexandra Leita GailThe most thorough record of dietary intake among New Zealand (NZ) Māori and Pacific women was undertaken in the 2008 NZ Adult Nutrition Survey, but it did not consider the relationship with body composition. The aim of this study was to investigate the relationship between dietary intake and body composition (particularly body mass index (BMI) and body fat (BF) percentage) of all Māori (n=79) and Pacific (n=75) women (16-45 years old) recruited in the women’s EXPLORE study. Anthropometric data was measured using weight, height, and air displacement plethysmography (BodPod), while dietary data was assessed using a validated, 220-item, semi-quantitative food frequency questionnaire. On average, the BMI (28.2 kg/m2) and BF (34.6%) of Māori women classified them as overweight, while the average BMI (31.9 kg/m2) and BF (37.8%) of Pacific women classified them as obese. There were significant positive correlations between the BMI and BF percentage of Māori (r=0.86) and Pacific women (r=0.87), which suggests BMI is a good indicator of BF percentage in these populations. The percentage of Māori and Pacific women who exceeded their estimated energy requirement was similar and identical to the percentage of women found in the obese BF percentage groups, respectively. Dietary intake was compared with NZ guidelines, revealing that both groups of women consumed inadequate carbohydrate. In contrast, both groups consumed excess total and saturated fat, and sodium in excess of the upper level, mostly due to high intakes of takeaways. Takeaways were also the top contributor of total energy (13.4%), protein (13.4%) and fat (17.7%) in Pacific women. Obese Māori women consumed more takeaways (42.7%) than non-obese. Obese Pacific women consumed more discretionary breads, cereals and starchy foods (e.g. iced buns, croissants and paraoa parai (fry bread)) (210%) than non-obese. Recommendations include reducing takeaways, fats (e.g. butter), and sugar-sweetened beverages. Instead, opt for more complex carbohydrates and leafy green vegetables. Further research should investigate relationships between dietary intake and waist circumference, as well as other factors influencing body composition, such as physical activity and level of deprivation.Item Validity and reliability of a Dietary Index for a Child's Eating (DICE) to assess diet quality of children living in New Zealand : a thesis presented in partial fulfillment of the requirement for the degree of Master Science in Human Nutrition at Massey University, Albany, New Zealand(Massey University, 2016) Delshad Siyahkaly, MaryamBackground: At present, in New Zealand, there is no valid and reliable dietary index, which can assess the adherence of children to the ‘New Zealand Food and Nutrition Guidelines for Healthy Children and Young People (Aged 2 -18 years)’. Aim: To examine the validity and reliability of the Dietary Index for a Child’s Eating (DICE) in children aged 2 to 8 years living in Auckland, New Zealand. Methods: Caregivers of healthy children (2-8 years) living in NZ were recruited by email and print advertising. Caregivers completed a four day estimated food record (4DFR) for their child, and completed the DICE online on 2 separate occasions, eight weeks apart. The DICE consists of 17 questions that refer to current statements in the ‘New Zealand Food and Nutrition Guidelines for Healthy Children and Young People (Aged 2-18 years)’, with greater adherence to guidelines indicated by a higher score (maximum 100). The 4DFR was the reference method for assessing validity of the DICE, and the repeated completion of the DICE questionnaire for assessing its reliability. Relative validity was assessed by comparing the DICE total score and component sub-scores with 4DFR total score and the same 4DFR component sub-scores from the questionnaire using Wilcoxon signed rank test, Spearman correlation coefficients, cross-classification, and weighted kappa (ĸ) statistic. For evaluating construct validity, the DICE (total score and individual components) were compared with energy and nutrient intake extracted from the 4DFR using Pearson’s rank correlation coefficient and linear contrast analysis. Intra-class correlation coefficients (Cronbach's α) were used to assess the reliability of DICE. Results: From a possible score of 100, the mean ± SD of DICE was 78.2 ± 11.5 (range from 47 to 100) and the 4DFR was 73.8 ± 10.8. Pearson’s correlation coefficient showed a significant, high correlation between the total scores for DICE and 4DFR (r = 0.72; P < 0.001). Results from the weighted ĸ-statistic also showed that the DICE total score and 4DFR total score had very good agreement (ĸ = 0.94). There was a significant positive relationship between the DICE total score and vitamin C (r = 0.53), folate (r = 0.45), and calcium (r = 0.44) (P < 0.001). Results from linear contrast analysis showed that higher intake of fibre, vitamin C, vitamin , vitamin D, folate (P 0.0 ), and calcium (P 0.001) were associated with increasing tertile of the DICE total score. Almost perfect agreement (0.87) was found through the Intra-class correlation coefficient for reliability test (P < 0.001). Discussion and Conclusion: Results from this study demonstrated that DICE is a valid and reliable tool for the assessment of children’s adherences to a health-promoting diet, as suggested in the ‘New Zealand Food and Nutrition Guidelines for Healthy Children and Young People (Aged 2 -18 years)’.