The profession of dietitian in Romania is relatively new, having been officially recognized only in 2015. Before this, nutritional guidance was primarily provided by physicians in various specialties. Studies have shown a correlation between higher nutrition knowledge and healthier lifestyles, although this link remains somewhat debated, with socioeconomic factors, traditions, taste preferences, and genetics also significantly influencing dietary habits. Romanian food choices are largely influenced by economic factors. This study aimed to address the lack of validated nutrition knowledge questionnaires for the Romanian adult population by assessing the reliability and validity of a translated and adapted version of a well-established questionnaire.

The study utilizes Kleimann’s updated version of Parmenter's General Nutrition Knowledge Questionnaire, a widely used instrument in various countries. The authors cite several studies that used adapted versions of this questionnaire in different populations (UK, Australia, Turkey, Uganda, Japan) and highlight its established reliability and validity in other contexts. The introduction notes the existing literature linking nutrition knowledge to healthier lifestyles and notes the controversial and/or limited value of such associations given the importance of other social and economic factors influencing dietary behaviors. The authors further cite previous research that highlighted how economic factors strongly influenced the food choices of Romanians.

The researchers employed a multi-step process to adapt the questionnaire: translation and back-translation, expert review for cultural appropriateness (replacing some specific English foods with Romanian equivalents), and pretesting with volunteers to refine wording. The study used four components: 1) Internal reliability assessment using Cronbach's alpha on a sample of 412 adults; 2) External reliability (test-retest) on a subsample of 46 adults retested after at least 30 days; 3) Construct validity using the 'known groups' method comparing specialists (dietetics students and professionals) and non-specialists (mathematics/informatics students); 4) Convergent validity exploring associations between knowledge scores and sociodemographic characteristics (age, gender, education, marital status, health perception, etc.) in a sample of 508 adults. Two scoring systems were used: Type A (correct answer = 1 point) and Type B (correct answer = 1 point, incorrect answer = -1 point). Type B was used for Component 4 to identify individuals prone to guessing. Statistical analyses included chi-square tests, t-tests, Mann-Whitney tests, Kruskal-Wallis tests, Bonferroni correction, Wilcoxon signed-ranks tests, and linear regression.

The Romanian version of the questionnaire demonstrated good reliability. Internal reliability (Cronbach's alpha) was 0.879 overall, although some sections had lower alphas. External reliability (interclass correlation coefficient) was above 0.85 for all sections and overall. Construct validity was supported by significantly higher scores among specialists compared to non-specialists (very large effect size). Convergent validity analysis revealed that females, middle-aged and older adults, and those with higher education levels scored higher. Linear regression showed that males, individuals with high school or less education, and those without nutrition training were significantly more likely to select incorrect answers. Type B scoring consistently yielded lower median scores than Type A, which was expected given the penalty for incorrect answers.

The findings support the reliability and validity of the Romanian version of the General Nutrition Knowledge Questionnaire. The questionnaire's performance aligns with similar questionnaires used in other populations, demonstrating its adaptability across cultural contexts. The identification of demographic factors associated with higher or lower scores provides valuable insights for future research and targeted interventions, especially focusing on males, individuals with lower education, and those lacking nutrition training. The consistent differences between Type A and Type B scoring highlight the importance of considering response patterns when analyzing nutrition knowledge data.

The study successfully validated a Romanian version of the General Nutrition Knowledge Questionnaire, providing a reliable and valid tool for assessing nutrition knowledge in the Romanian adult population. Future research could investigate the questionnaire's effectiveness in diverse subgroups and its predictive value for dietary behaviors and health outcomes. Further adaptations might be needed to better capture the nuances of specific dietary habits and knowledge related to traditional Romanian foods.

The study relied on self-reported data for certain demographic and health information, which is subject to potential bias. The sample might not be fully representative of the entire Romanian adult population, limiting the generalizability of the findings. The study did not explicitly assess the impact of cultural differences on question interpretation beyond the adaptations made during the translation and expert review process.