Relative validation of a food frequency questionnaire to estimate food intake in an adult population

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ABSTRACT

Background: Scientifically valid descriptions of dietary intake at population level are crucial for investigating diet effects on health and disease. Food frequency questionnaires (FFQs) are the most common dietary tools used in large epidemiological studies.

Objective: To examine the relative validity of a newly developed FFQ to be used as dietary assessment tool in epidemiological studies.

Design: Validity was evaluated by comparing the FFQ and a 4-day weighed food record (4-d FR) at nutrient and food group levels, Spearman’s correlations, Bland–Altman analysis and Wilcoxon rank sum tests were used. Fifty-six participants completed a paper format FFQ and a 4-d FR within 4 weeks.

Results: Corrected correlations between the two instruments ranged from 0.27 (carbohydrates) to 0.55 (protein), and at food group level from 0.09 (soup) to 0.92 (alcohol). Nine out of 25 food groups showed correlations > 0.5, indicating moderate validity. More than half the food groups were overestimated in the FFQ, especially vegetables (82.8%) and fruits (56.3%). Water, tea and coffee were underestimated (–14.0%).

Conclusions: The FFQ showed moderate relative validity for protein and the food groups fruits, egg, meat, sausage, nuts, salty snacks and beverages. This study supports the use of the FFQ as an acceptable tool for assessing nutrition as a health determinant in large epidemiological studies.

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Most cited references 36

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Development, validation and utilisation of food-frequency questionnaires - a review.

Janet Cade, Rachel Thompson, Victoria Burley … (2002)

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). 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. 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. 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.

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Assessing dietary intake: Who, what and why of under-reporting.

J MacDiarmid, J Blundell (1998)

Under-reporting of food intake is one of the fundamental obstacles preventing the collection of accurate habitual dietary intake data. The prevalence of under-reporting in large nutritional surveys ranges from 18 to 54% of the whole sample, but can be as high as 70% in particular subgroups. This wide variation between studies is partly due to different criteria used to identify under-reporters and also to non-uniformity of under-reporting across populations. The most consistent differences found are between men and women and between groups differing in body mass index. Women are more likely to under-report than men, and under-reporting is more common among overweight and obese individuals. Other associated characteristics, for which there is less consistent evidence, include age, smoking habits, level of education, social class, physical activity and dietary restraint. Determining whether under-reporting is specific to macronutrients or food is problematic, as most methods identify only low energy intakes. Studies that have attempted to measure under-reporting specific to macronutrients express nutrients as percentage of energy and have tended to find carbohydrate under-reported and protein over-reported. However, care must be taken when interpreting these results, especially when data are expressed as percentages. A logical conclusion is that food items with a negative health image (e.g. cakes, sweets, confectionery) are more likely to be under-reported, whereas those with a positive health image are more likely to be over-reported (e.g. fruits and vegetables). This also suggests that dietary fat is likely to be under-reported. However, it is necessary to distinguish between under-reporting and genuine under-eating for the duration of data collection. The key to understanding this problem, but one that has been widely neglected, concerns the processes that cause people to under-report their food intakes. The little work that has been done has simply confirmed the complexity of this issue. The importance of obtaining accurate estimates of habitual dietary intakes so as to assess health correlates of food consumption can be contrasted with the poor quality of data collected. This phenomenon should be considered a priority research area. Moreover, misreporting is not simply a nutritionist's problem, but requires a multidisciplinary approach (including psychology, sociology and physiology) to advance the understanding of under-reporting in dietary intake studies.

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Statistical approaches for assessing the relative validity of a food-frequency questionnaire: use of correlation coefficients and the kappa statistic.

G McNeill, J Tomany, K. Simpson … (2003)

To compare different statistical methods for assessing the relative validity of a self-administered, 150-item, semi-quantitative food-frequency questionnaire (FFQ) with 4-day weighed diet records (WR). Subjects completed the Scottish Collaborative Group FFQ and carried out a 4-day WR. Relative agreement between the FFQ and WR for energy-adjusted nutrient intakes was assessed by Pearson and Spearman rank correlation coefficients, the percentages of subjects classified into the same and opposite thirds of intake, and Cohen's weighted kappa. Forty-one men, mean age 36 (range 21-56) years, and 40 women, mean age 33 (range 19-58) years, recruited from different locations in Aberdeen, Scotland. Spearman correlation coefficients tended to be lower than Pearson correlation coefficients, and were above 0.5 for 10 of the 27 nutrients in men and 17 of the 27 nutrients in women. For nutrients with Spearman correlation coefficients above 0.5, the percentage of subjects correctly classified into thirds ranged from 39 to 78%, and weighted kappa values ranged from 0.23 to 0.66. Both Spearman correlation coefficients and weighted kappa values are useful in assessing the relative validity of estimates of nutrient intake by FFQs. Spearman correlation coefficients above 0.5, more than 50% of subjects correctly classified and less than 10% of subjects grossly misclassified into thirds, and weighted kappa values above 0.4 are recommended for nutrients of interest in epidemiological studies.

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Author and article information

Journal

Journal ID (nlm-ta): Food Nutr Res

Journal ID (iso-abbrev): Food Nutr Res

Journal ID (archive): ZFNR

Journal ID (publisher-id): zfnr20

Title: Food & Nutrition Research

Publisher: Taylor & Francis

ISSN (Electronic): 1654-661X

Publication date Collection: 2017

Publication date (Electronic): 29 March 2017

Volume: 61

Issue: 1

Electronic Location Identifier: 1305193

Affiliations

[ ^a ]Institute of Food and Beverage Innovation, Zurich University of Applied Sciences, Life Sciences and Facility Management , Waedenswil, Switzerland

[ ^b ]Epidemiology, Biostatistics and Prevention Institute, University of Zurich , Zurich, Switzerland

[ ^c ]Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute , Basel, Switzerland

[ ^d ]University of Basel , Basel, Switzerland

[ ^e ]Institute of Applied Simulation, Zurich University of Applied Sciences, Life Sciences and Facility Management , Waedenswil, Switzerland

[ ^f ]PrognosiX AG , Richterswil, Switzerland

Author notes

CONTACT Nina Steinemann nina.steinemann@ 123456uzh.ch ; Christine Brombach christine.brombach@ 123456zhaw.ch ZHAW Life Sciences and Facility Management, Institute of Food and Beverage Innovation, Centre for Nutrition , Einsiedlerstrasse 34, CH-8820 Waedenswil, Switzerland

Article

Publisher ID: 1305193

DOI: 10.1080/16546628.2017.1305193

PMC ID: 5404419

PubMed ID: 28469546

SO-VID: bf836d44-bed9-4e2b-82be-b2d821f2dc91

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 8 January 2017

Date accepted : 7 March 2017

Page count

Figures: 2, Tables: 3, References: 40, Pages: 17

Funding

Funded by: Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung 10.13039/501100001711

Award ID: 32 65896.01

Award ID: NF 32 59302.99

Award ID: NF 32 47BO 104283

Award ID: NF3247BO 104288

The study was funded by the Schweizerischer Nationalfonds (SNF) [Grant no. 32 65896.01, NF 32 59302.99, NF 32 47BO 104283, NF3247BO 104288]. This institution had no role in the design, analysis or writing of this article;Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung.

Relative validation of a food frequency questionnaire to estimate food intake in an adult population

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Karger: Nutrition and Dietetics

Most cited references 36

Development, validation and utilisation of food-frequency questionnaires - a review.

Assessing dietary intake: Who, what and why of under-reporting.

Statistical approaches for assessing the relative validity of a food-frequency questionnaire: use of correlation coefficients and the kappa statistic.

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