• Nur Hana Hamzaid Dietetic Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Selangor
  • Adlina Zainal Abidin Dietetic Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Selangor
  • Woan Yin Tan Centre for Rehabilitation and Special Needs Studies (iCaRehab), Faculty of Health Sciences, Universiti Kebangsaan Malaysia
  • Mohd Shah Kamarudin Centre for Rehabilitation and Special Needs Studies (iCaRehab), Faculty of Health Sciences, Universiti Kebangsaan Malaysia



Dietary Assessment Tool, Children with Intellectual Disabilities, Validity Test, Reliability Test


Nutritional status of people with intellectual disability (PWID) is always at risk and developing a dietary assessment tool is important. This study aims to test reliability (inter-rater reliability and test-retest reliability) and comparable validity (limit of agreement against a multiple pass 24-hour diet recall recorded by a professional dietitian) of a recently developed dietary assessment kit, CIDDIE Kit©, that specialised for a more dependent group of PWID, focusing on preschool aged children. The CIDDIE Kit© was given to 26 parents or caretakers of children with intellectual disabilities (ID) registered with three selected Community Based Rehabilitation Centre in the Klang Valley area. Each subject was asked to complete two sets of CIDDIE Kit© in a two-week interval session. Meanwhile, a certified dietitian conducted a 24-Hour Diet Recall among the same 26 subjects. The validity and reliability of CIDDIE Kit© were analysed using Bland-Altman method, percentage of correctly classified quartile, Intra-class Correlation Coefficient (ICC) value and Pearson’s correlation coefficient. For comparable validity test, the estimated intake from CIDDIE Kit© and Multiple Pass 24-Hour Diet Recall were considerably in agreement to each other. The test-retest reliability analysis showed significant high similarity (p < 0.001) between the estimated intake from both phases of CIDDIE Kit© where the ICC value ranged approximately 0.9 (R = 0.889 - 0.930). The inter-rater reliability analysis was significantly positive (p < 0.001) and strong correlation (indicating internal consistency), r (0.706 – 0.853). The specially designed CIDDIE Kit© can provide a considerably valid and reliable assessment. 


Amo-Setién F, Abajas-Bustillo R, Sarabia-Cobo C, Parás-Bravo P, Leal-Costa C, Redondo-Figuero C, et al. Prevalence and factors associated with overweight and obesity among Spanish students attending special education schools. J Appl Res Intellect Disabil. 2020 May 1;33(3):364–72.

Flygare Wallén E, Ljunggren G, Carlsson AC, Pettersson D, Wändell P. High prevalence of diabetes mellitus, hypertension and obesity among persons with a recorded diagnosis of intellectual disability or autism spectrum disorder. J Intellect Disabil Res. 2018 Apr 1;62(4):269–80.

Savage A, Emerson E. Overweight and obesity among children at risk of intellectual disability in 20 low and middle income countries. J Intellect Disabil Res. 2016 Nov 1;60(11):1128–35.

Wang J, Gao Y, Kwok HHM, Huang WYJ, Li S, Li L. Children with Intellectual Disability Are Vulnerable to Overweight and Obesity: A Cross-Sectional Study among Chinese Children. Childhood Obesity. 2018 Jul 1;14(5):316–26.

Yuan YQ, Liu Y, Wang MJ, Hou X, Zhang SH, Wang XL, et al. Prevalence of overweight and obesity in children and adolescents with intellectual disabilities in China. J Intellect Disabil Res. 2021 Jul 1;65(7):655–65.

Robertson J, Chadwick D, Baines S, Emerson E, Hatton C. Prevalence of dysphagia in people with intellectual disability: A systematic review. Intellectual Dev Disabil. 2017 Dec 1;55(6):377–91.

Segal M, Eliasziw M, Phillips S, Bandini L, Curtin C, Kral TVE, et al. Intellectual disability is associated with increased risk for obesity in a nationally representative sample of U.S. children. In: Disabil Health J. Elsevier Inc.; 2016. p. 392–8.

Magenis ML, Machado AG, Bongiolo AM, Silva MA da, Castro K, Perry IDS. Dietary practices of children and adolescents with Down syndrome. J Intellect Disabil. 2018 Jun 1;22(2):125–34.

Ptomey LT, Willis EA, Goetz JR, Lee J, Sullivan DK, Donnelly JE. Digital photography improves estimates of dietary intake in adolescents with intellectual and developmental disabilities. Disabil Health J. 2015 Jan 1;8(1):146–50.

C M, J B, AJ M, JM G, G N. Construct validity of the Nutrition and Activity Knowledge Scale in a French sample of adolescents with mild to moderate intellectual disability. Res Dev Disabil. 2010 Jan;31(1):232–42.

Bathgate KE, Sherriff JL, Leonard H, Dhaliwal SS, Delp EJ, Boushey CJ, et al. Feasibility of assessing diet with a mobile food record for adolescents and young adults with down syndrome. Nutrients. 2017 Mar 13;9(3).

Polfuss M, Moosreiner A, Boushey CJ, Delp EJ, Zhu F. Technology-based dietary assessment in youth with and without developmental disabilities. Nutrients. 2018 Oct 11;10(10).

Che Nur Azira Liyana CR. Pembentukan dan kebolehgunaan kit penilaian pengambilan makanan dalam kalangan kanak-kanak ketidakupayaan intelek. Thesis submitted in fulfilment for Degree of Master,UKM. 2017.

Wrieden W, Peace H, Mph JA, Barton Bsc K. A short review of dietary assessment methods used in National and Scottish Research Studies. 2003.

Htet MK, Fahmida U, Do TT, Dibley MJ, Ferguson E. The use of tablet-based multiple-pass 24-hour dietary recall application (MP24diet) to collect dietary intake of children under two years old in the prospective cohort study in Indonesia. Nutrients. 2019 Dec 1;11(12).

Nightingale H, Walsh KJ, Olupot-Olupot P, Engoru C, Ssenyondo T, Nteziyaremye J, et al. Validation of triple pass 24-hour dietary recall in Ugandan children by simultaneous weighed food assessment. BMC Nutr. 2016 Sep 20;2(1).

Thompson FE, Subar AF. Dietary assessment methodology. In: Nutrition in the Prevention and Treatment of Disease. Elsevier; 2017. p. 5–48.

Reilly JJ, Montgomery C, Jackson D, MacRitchie J, Armstrong J. Energy intake by multiple pass 24 h recall and total energy expenditure: a comparison in a representative sample of 3–4-year-olds. Br J Nutr. 2001 Nov;86(5):601–5.

Doğan NÖ. Bland-Altman analysis: A paradigm to understand correlation and agreement. Vol. 18, Turk J Emerg Med. Emergency Medicine Association of Turkey; 2018. p. 139–41.

Giavarina D. Understanding Bland Altman analysis. Biochem Med. 2015;25(2):141–51.

JM B, DG A. Agreed statistics: measurement method comparison. Anesthesiology. 2012 Jan;116(1):182–5.

Bawadi H, Akasheh RT, Kerkadi A, Haydar S, Tayyem R, Shi Z. Validity and reproducibility of a food frequency questionnaire to assess macro and micro-nutrient intake among a convenience cohort of healthy adult qataris. Nutrients. 2021 Jun 1;13(6).

Zang J, Luo B, Chang S, Jin S, Shan C, Ma L, et al. Validity and reliability of a food frequency questionnaire for assessing dietary intake among Shanghai residents. Nutrition Journal. 2019 May 23;18(1).

Toorang F, Sasanfar B, Esmaillzadeh A, Ebrahimpour-Koujan S, Zendehdel K. Comparison of validity of the food frequency questionnaire and the diet history questionnaire for assessment of energy and nutrients intakes in an Iranian population. East Mediterr Health J. 2020 Sep 1;26(9):1062–9.

Emerson E, Robertson J, Baines S, Hatton C. Obesity in British children with and without intellectual disability: Cohort study. BMC Public Health. 2016 Jul 27;16(1).

Rajikan R, Zakaria NM, Manaf ZA, Yusoff NAM, Shahar S. The effect of feeding problems on the growth of children and adolescents with cerebral palsy. Journal of Fundamental and Applied Sciences. 2018 Feb 1;9(6S):787–804.

Al-Ozairi E, AlAwadhi MM, al Kandari J, Taghadom E, Abdullah M, le Roux CW. Photo-Assisted Dietary Method Improves Estimates of Dietary Intake Among People with Sleeve Gastrectomy. Obes Surg. 2019 May 15;29(5):1602–6.

Aoun C, Daher RB, Osta N el, Papazian T, Khabbaz LR. Reproducibility and relative validity of a food frequency questionnaire to assess dietary intake of adults living in a Mediterranean country. PLoS ONE. 2019 Jun 1;14(6).

Koleilat M, Whaley SE. Reliability and Validity of Food Frequency Questions to Assess Beverage and Food Group Intakes among Low-Income 2- to 4-Year-Old Children. J Acad Nutr Diet. 2016 Jun 1;116(6):931–9.

Mouratidou T, Mesana Graffe MI, Huybrechts I, de Decker E, de Craemer M, Androutsos O, et al. Reproducibility and relative validity of a semiquantitative food frequency questionnaire in European preschoolers: The ToyBox study. Nutrition. 2019 Sep 1;65:60–7.

Saeedi P, Skeaff SA, Wong JE, Skidmore PML. Reproducibility and relative validity of a short food frequency questionnaire in 9–10 year-old children. Nutrients. 2016 May 7;8(5).

R B, A A, JM A, DS G-T, J M, JE A. Validity and Reliability of General Nutrition Knowledge Questionnaire for Adults in Uganda. Nutrients. 2017 Feb 21;9(2).

G T, E A, M DP, A B, M J, C M. Validation and reproducibility of dietary assessment methods in adolescents: a systematic literature review. Public Health Nutr. 2014 Sep 6;17(12):2700–14.




How to Cite

Hamzaid, N. H. ., Zainal Abidin, A. ., Tan, W. Y., & Kamarudin , M. S. . (2022). VALIDITY AND RELIABILITY OF CIDDIE KIT©, A DIETARY ASSESSMENT TOOL FOR CHILDREN WITH INTELLECTUAL DISABILITY. Malaysian Journal of Public Health Medicine, 22(3), 160–169.