Food-frequency questionnaires: a review of their design, validation and utilisation (original) (raw)
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Development, validation and utilisation of food-frequency questionnaires -a review
Objective: The purpose of this review is to provide guidance on the development, validation and use of food-frequency questionnaires (FFQs) for different study designs. It does not include any recommendations about the most appropriate method for dietary assessment (e.g. food-frequency questionnaire versus weighed record). Methods: A comprehensive search of electronic databases was carried out for publications from 1980 to 1999. Findings from the review were then commented upon and added to by a group of international experts. Results: Recommendations have been developed to aid in the design, validation and use of FFQs. Specific details of each of these areas are discussed in the text. Conclusions: FFQs are being used in a variety of ways and different study designs. There is no gold standard for directly assessing the validity of FFQs. Nevertheless, the outcome of this review should help those wishing to develop or adapt an FFQ to validate it for its intended use. Keywords Food-frequency questionnaire Review Validation Method development q The Authors 2002
Development and Validation: of a Food Frequency Questionnaire
Canadian Journal of Dietetic Practice and Research, 2005
Regular diet monitoring requires a tool validated in the target population. A 73-item, semiquantitative, self-administered food frequency questionnaire (FFQ), was adapted in French and English from the Block National Cancer Institute Health Habits and History Questionnaire. The FFQ was used to capture usual long-term food consumption among adults living in Quebec. A representative sample of adults aged 18 to 82 (57% female) was recruited by random digit dialling in the Montreal region. Approximately 64% of recruits completed and returned the instrument by mail (n=248). The FFQ was validated in a subsample (n=94, 61% female) using four nonconsecutive food records (FRs). Median energy intakes (in kcal) for men and women, respectively, were FFQ (total sample) 2,112 and 1,823, FFQ (subsample) 2,137 and 1,752, and FR (subsample) 2,510 and 1,830. Spearman correlation analyses between FFQ and FR nutrients were positive (with r ranging from 0.32 for folate to 0.58 for saturated fatty acids)...
https://www.ijhsr.org/IJHSR\_Vol.7\_Issue.9\_Sep2017/IJHSR\_Abstract.038.html, 2017
Food frequency questionnaires (FFQs) have been widely used in various studies assessing dietary intake. Application of technological advancements in FFQs is increasing with the aim of enhancing accuracy and decreasing the respondent and researcher burden. The objective of this review was to explore the validity of various electronic FFQs (eFFQs) as a dietary intake assessment method. A total of 23 studies were finalised for qualitative data analysis after screening of various electronic databases and hand searching. The results showed that most of the eFFQs were self-administered, web-based, used food photographs for food portion size estimation and assessed intake of both macro-and micronutrients. Validity of eFFQs was assessed by comparing nutrient intake with reference methods in terms of association (correlation coefficients) and agreement at group level (paired t-test or Wilcoxon signed rank test). Overall, the association of nutrient intake with the reference method was observed to be acceptable in most studies especially with food records. Only few studies showed good agreement of nutrient intake with the reference method. In case of micronutrients, correlation coefficients >0.20 for all vitamins and minerals were observed in nine studies. The findings highlighted some advantages of eFFQs such as less missing data, convenience, automated data entry and analysis, additional features (audio, photographs, prompts etc.) and less cost than paper. Hence, it can be concluded that eFFQs could be an ideal choice for studies assessing usual dietary intake especially with large sample size and limited resources.
Calcified Tissue International, 2009
This study aimed to explore how possible it would be to reduce the length of a food-frequency questionnaire (FFQ) while maintaining adequate accuracy. This FFQ was validated in women in a previous study by our group, whereas the validation in men was one of the aims of the present study. A 15-item FFQ was administered to 136 men and 211 women (age range 25-75 years) recruited by proportional age-stratified sampling, who agreed to fill in a 14-day diet diary. For the intermediate version of the FFQ we considered only eight items in women and 10 in men. For the very short version we considered only three items. The positive likelihood ratio was markedly lower for the very short version (men = 1.2 and women = 1.5) with respect to the intermediate version (men = 6 and women = 6.3) and the 15-item version (men = 19.6 and women = 19.9). The specificity of the very short version was low (22.2% for men and 35.2% for women). The area under ROC curve of the three-item FFQ was significantly lower with respect to the other two versions. In conclusion, our study suggests that the shortest version of the FFQ could be usefully employed only in those clinical settings where the main objective is the identification of individuals who do not have a low calcium intake. ROC analysis and posttest probability calculated by positive likelihood ratio may represent an optimal method for assessing the accuracy of FFQs.
Relative validity and reproducibility of a Food Frequency Questionnaire designed for French adults
Annals of Nutrition …, 2010
It is widely recognized that one of the main causes of uncertainty regarding the role of diet in the process of cancer causation is the intrinsic lack of accuracy of the method of assessing dietary intake. Food frequency questionnaires are often the preferred method for use in large prospective studies assessing the relationship between diet and disease outcome. This type of study involves the enrolment of thousands of volunteers and normal dietary intake needs to be estimated at the individual level, therefore financial and logistic constraints are particularly serious. It is therefore mandatory to reach an optimum compromise between the inaccuracy of the method used, unavoidable to some extent, and feasibility. Moreover, quantitative knowledge of the method's limitations will facilitate the interpretation of the study results and the inferences to be derived from them.
British Journal of Nutrition, 2010
The authors automated the selection of foods in a computer system that compiles and processes tailored FFQ. For the selection of food items, several methods are available. The aim of the present study was to compare food lists made by MOM2, which identifies food items with highest between-person variance in intake of the nutrients of interest without taking other items into account, with food lists made by forward regression. The name MOM2 refers to the variance, which is the second moment of the nutrient intake distribution. Food items were selected for the nutrients of interest from 2 d of recorded intake in 3524 adults aged 25–65 years. Food lists by 80 % MOM2 were compared to those by 80 % explained variance for regression on differences between the number and type of food items, and were evaluated on (1) the percentage of explained variance and (2) percentage contribution to population intake computed for the selected items on the food list. MOM2 selected the same food items fo...
Development and simulated validation of a food-frequency questionnaire for the Colombian population
Public Health Nutrition, 2005
Objective: To develop a food-frequency questionnaire (FFQ) useful for ranking of nutrient intakes. Design: Subjects consuming their regular diet completed 7 days of weighed intake registry (7-WIR). Foods for the FFQ were selected by stepwise multiple regression. The FFQ was then completed for each subject using data on individual food consumption from the 7-WIR. The correlation and agreement between the extrapolated FFQ and the 7-WIR data were assessed using Spearman's rank correlation coefficients (r S ) and Bland and Altman's limits of agreement (LOA). Setting: Bucaramanga, Colombia. Subjects: We studied 97 randomly selected 20 -40-year-old subjects. Results: Sixty foods were selected for the FFQ. The 7-WIR and the extrapolated FFQ intake estimates correlated well. r S was 0.58 for energy, 0.53 for carbohydrate, 0.50 for total fat, and 0.48 for protein. For micronutrients, r S varied from 0.46 (manganese) to 0.71 (vitamin B 12 ). FFQ average intake estimates were 83%, 80%, 86.2% and 86.4% of 7-WIR estimates for energy, carbohydrate, total fat and protein, respectively. LOA for these nutrients ranged between 45% and 165%. FFQ micronutrient intakes were on average 96% (median) of those from the 7-WIR, and the median lower and upper LOA were 50% and 203%. However, there was no indication that the degree of agreement varied with the level of intake. Conclusions: According to our simulated validation, this FFQ may be useful to rank subjects by nutrient intake. Its validity against standard independent measurements and its applicability to other subsets of the Colombian population should be carefully considered.
Development and Validation of a Food Frequency Questionnaire in Spain
International Journal of Epidemiology, 1993
A quantitative food-frequency questionnaire (FFQ) was developed to determine antioxidant intake in athletes. The questionnaire will be valuable for researchers wishing to standardize antioxidant intake or simply document habitual intake during an intervention trial. One hundred thirteen athletes participated in the validity study, of whom 96 completed the questionnaire and blood test, 81 completed the 7-d food diary and questionnaire, and 63 completed the 7-d food diary and blood test. Validity was investigated by comparing total and food-group antioxidant intakes from the questionnaire with those from a subsequent 7-d food diary. Measures of construct validity were determined by comparing a biomarker of antioxidant capacity (ferric-reducing ability of plasma) in a blood sample with antioxidant intakes from the questionnaire and diary. The correlation between the diary and questionnaire energy-adjusted estimates of total antioxidant intake was modest (.38; 90% confidence limits, ± .14); the correlation was highest for antioxidants from cereals (.55; ± .11), which contributed the greatest proportion (31%) of the total antioxidant intake. Correlations were also high for coffee and tea (.51; ± .15) and moderate for vegetables (.34; ± .16) and fruit (.31; ± .16). The correlation of the plasma biomarker with the questionnaire estimate was small (.28; ± .15), but the correlation with the diary estimate was inconsequential (-.03; ± .15). One-week test-retest reliability of the questionnaire's estimates of antioxidant intake in 20 participants was high (.83; ± .16). In conclusion, the FFQ is less labor intensive for participants and researchers than a 7-d diary and appears to be at least as trustworthy for estimating antioxidant intake.
Selection of food items for inclusion in a newly developed food-frequency questionnaire
Public Health Nutrition, 2004
Objectives: To highlight the differences between the food list required in a foodfrequency questionnaire (FFQ) to rank people by their intake and the food items that contribute to absolute intake, and to discuss possible applications. Methods: We conducted a nutritional survey among 1173 adults using an adapted 24hour recall questionnaire. Statistical analysis: To develop an FFQ, we analysed the 24-hour recall survey data by performing a stepwise multiple regression after grouping conceptually similar food items into 175 food groups. Results: In total, 126 food groups were included in the developed FFQ in order to explain at least 80% of the variance in the consumption of each of 27 nutrients. The nutrients that were explained by a few food groups were vitamin A (one food group), alcohol (two), b-carotene (two), vitamin E (three) and cholesterol (five). Nutrients that were explained by a large number of food groups were energy (37 food groups), potassium (31), magnesium (31), dietary fibre (30), phosphorus (31) and sodium (29). Using energy intake as an example, soft drinks were the best between-person energy classifiers, while providing only 2.4% of the total energy intake. Wine, seeds and nuts, which contributed highly to the variance, were minor energy contributors. In contrast, milk, sugar, fried chicken/turkey breast or whole chicken/turkey, which explained little of the variation in the population, were major energy contributors. Conclusions: Developing an FFQ on the basis of common foods may not explain the between-person variation required for ranking individual intake in diet-disease studies. Producing lists of 'discriminating items' can be a useful application in developing mini-FFQs for selected nutrients.
Development, validation and reproducibility of a Swiss food frequency questionnaire
Aktuelle Ernährungsmedizin, 2005
Aim: To develop and assess the validity and reproducibility of a food frequency questionnaire (FFQ) to measure total flavonoid intake, and individual flavonoid subclasses, in older adults. Methods: Retrospective analysis of flavonoid intake in older adults informed the development of a FFQ to measure flavonoid intake and determine the flavonoid subclasses consumed (anthocyanins, flavan-3-ols, flavones, flavonols and flavanones). Older adults (n = 42, mean age 75.3 AE 8.6 years) attended two interviews 1 month apart where anthropometrics (height and weight), blood pressure (BP), demographic data and a 93-item self-administered FFQ were collected. A 4-day food record (FR) was randomly administered between the two interview dates, and each food item was assigned a flavonoid and flavonoid subclass content using the United States Department of Agriculture flavonoid database. The criterion validity and reproducibility of the FFQ was assessed against a 4-day FR using the Wilcoxon signed-rank sum test, Spearman's correlation coefficient (r), Bland-Altman Plots and Cohen's kappa. Results: Total flavonoid intake was determined (median intake FFQ = 919.3 mg/day, FR = 781.4 mg/day). Tests of validity indicated that the FFQ consistently overestimated total flavonoid intake compared with the 4day FR. There was a significant difference in estimates between the FFQ and the 4-day FR for total flavonoid intake (Wilcoxon signed-rank sum P < 0.001; Bland-Altman plots indicated large bias and wide limits of agreement), but they were well correlated (Spearman's r 0.93, P < 0.001; Cohen's kappa κ = 0.619, P < 0.001). For individual flavonoid subclasses, the tests of validity indicated greater discrepancy compared with 4-day FR. The FFQ showed high reproducibility for estimating total flavonoid intake (FFQ1vsFFQ2: Wilcoxon signed-rank sum test, P > 0.05; Spearman's r 0.91, P < 0.001; Bland-Altman plots visually showed small, non-significant bias and wide limits of agreement; and Cohen's kappa κ = 0.619, P < 0.001), with a small mean percentage difference (6.7%). For individual flavonoid subclasses, the tests of reproducibility between FFQ1 and FFQ2 showed similarly high reproducibility. Conclusions: The developed FFQ appears suitable for satisfactorily ranking individuals according to total flavonoid intake. The FFQ shows limitations for estimating absolute total flavonoid intake and intake of flavonoid subclasses in comparison to a 4-day FR in terms of overestimating intake. Refinement and further validation of this tool may be required.