The development and pilot testing of a Cholesterol Saturated Fat Index (CSI) scorecard for dietary self-monitoring

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Virginia Tech

The National Cholesterol Education Program Adult Treatment Panel guidelines specify that dietary intervention is the cornerstone of treatment for hypercholesterolemia. Self-monitoring is a strategy used to achieve self-direction in adopting and maintaining a cholesterol-lowering dietary pattern. The Cholesterol Saturated Fat Index (CSI) illustrates the atherogenic potential of food. Given that saturated fat and dietary cholesterol are the two major dietary components known to raise serum cholesterol, a CSI Scorecard was developed and pilot tested as a dietary self-monitoring tool. Twelve nutritionists scored the same five food records with known CSI scores, the reference data. The food records represented CSI scores from the 10th, 25th, 50th, 75th, and 90th percentiles from a pool of 400 usual diet food records. Two-tailed, one-sample t-tests demonstrated that the CSI Scorecard scores were not statistically significant at only the 25th and 75th percentiles. Therefore, in three of five food record percentiles, nutritionists’ CSI scores differed from the corresponding reference CSI scores. Small sample size and years of experience may have been factors influencing the results. Comments from the nutritionists’ critique forms were incorporated into the revision of the CSI Scorecard.

Twelve participants scored their four-day food records using the booklet. The Spearman’s rho correlation of the CSI Scorecard derived CSI scores to the reference CSI scores was rS=.8 (p<.05). These preliminary results and comments from the formative evaluation meetings suggested that the CSI Scorecard deserves further validity testing with a larger sample of subjects. The CSI Scorecard appeared to show promise as a dietary self-monitoring tool that would facilitate increased self-direction in the adoption of a cholesterol-lowering diet.