Nutrition knowledge and bone health: Development and validation of the 'NutriBone' questionnaire for Italian adult women

Objective: This study aimed to develop and validate a questionnaire assessing the nutrition knowledge (NK) of Italian adult women regarding the relationship between diet, lifestyle and bone health. Design: A thirty-item questionnaire in Italian was developed by experts based on a literature review. Participants completed the questionnaire twice, with a 2-4 week gap between the two administrations. During the initial administration, weight and height were recorded using a mechanical scale and a stadiometer, while bone mineral density (BMD) of the lumbar spine (L1-L4), femoral neck and total femur were assessed via dual-energy X-ray absorptiometry (DXA). Setting: Centre for Metabolic Bone Diseases at the Parma University Hospital, from January 2022 to June 2024. Participants: Women aged 45-75 years old, native Italian speakers, undergoing DXA at the Centre participated. Results: The sample included 295 women with a median age of 63 years (interquartile range 11·5). The questionnaire demonstrated good internal consistency (Cronbach's alpha = 0·698) and high temporal stability (R = 0·810, P = 0·002), effectively differentiating between individuals with and without a nutritional background. Regression analysis indicated negative associations between NK score and age (β1 = -0·130, P < 0·001) and BMI (β1 = -0·193, P < 0·001). Conclusions: The NutriBone questionnaire is a valid and reliable tool for evaluating NK related to bone health in Italian adult women undergoing DXA, with potential for future research applications.