Objective: The present work is aimed at meta-analysing validity studies of FFQ for adolescents, to investigate their overall accuracy and variables that can affect it negatively. Design: A meta-analysis of sixteen original articles was performed within the ASSO Project (Adolescents and Surveillance System in the Obesity prevention). Setting: The articles assessed the validity of FFQ for adolescents, compared with food records or 24 h recalls, with regard to energy and nutrient intakes. Subjects: Pearson's or Spearman's correlation coefficients, means/standard deviations, kappa agreement, percentiles and mean differences/limits of agreement (Bland-Altman method) were extracted. Pooled estimates were calculated and heterogeneity tested for correlation coefficients and means/standard deviations. A subgroup analysis assessed variables influencing FFQ accuracy. Results: An overall fair/high correlation between FFQ and reference method was found; a good agreement, measured through the intake mean comparison for all nutrients except sugar, carotene and K, was observed. Kappa values showed fair/ moderate agreement; an overall good ability to rank adolescents according to energy and nutrient intakes was evidenced by data of percentiles; absolute validity was not confirmed by mean differences/limits of agreement. Interviewer administration mode, consumption interval of the previous year/6 months and high number of food items are major contributors to heterogeneity and thus can reduce FFQ accuracy. Conclusions:The meta-analysis shows that FFQ are accurate tools for collecting data and could be used for ranking adolescents in terms of energy and nutrient intakes. It suggests how the design and the validation of a new FFQ should be addressed. Keywords Meta-analysis Validity FFQ AdolescentSemi-quantitative FFQ are valid and reliable dietary assessment methods used worldwide on adolescents and are suggested as appropriate tools for the collection of dietary intake data in large-scale surveys (1,2) , since they have the advantages of ease of administration, saving of economic resources and ability to assess dietary intake over an extended period of time (3) . Among all the used FFQ, large variations in design characteristics have been highlighted (4) , such as number of food items or consumption interval.Our recent systematic literature review (5) identified the FFQ used in adolescents and validated during the last decade throughout the world. One of the aspects emphasized by the review is that there is an ongoing need for the refinement of existing approaches, especially ones that can be used in large epidemiological studies.When preparing the tools for dietary data collection, the specific design and validation issues of the data collecting instrument have to be taken into account. There are many factors that may affect the accuracy of a dietary questionnaire such as respondent characteristics, questionnaire design and quantification, adequacy of the reference data, quality control and data management (6) , including ...
BackgroundA new web-based food frequency questionnaire (the ASSO–FFQ) was developed within the ASSO Project funded by the Italian Ministry of Health.ObjectiveThe aim of the present study is to assess the validity of the ASSO–FFQ at food groups, energy, and nutrients level.Design and subjectsThe validation study compared the ASSO–FFQ against a weighted food record (WFR) measuring foods, beverages and supplements intake, compiled during the week following the ASSO–FFQ administration. Ninety-two subjects aged 14–17, recruited from secondary schools in Palermo (Italy), completed the ASSO–FFQ and WFR. The intake of 24 food groups, energy, and 52 nutrients were taken as main outcomes. Tests for paired observations, Spearman and Pearson’s correlation coefficients (cc), kappa statistics and classification in quintiles, Bland–Altman plots and multiple regressions, on untransformed and transformed data were used for the statistical analysis.ResultsHigh cc (≥0.40) were found for soft drinks, milk, tea/coffee, vegetables, and lactose; fair energy-adjusted cc (0.25–0.40) for water, alcoholic drinks, breakfast cereals, fishery products, savory food, fruit juice, eggs, and 19 nutrients. The subjects classified in the same or adjacent quintile for food groups ranged from 40% (alcoholic drinks) to 100% (dried fruit); for energy and nutrients from 43% (phosphorus, thiamin, niacin) to 77% (lactose). Mean differences were not significant for water, soft drinks, meat, sweets, animal fats, milk and white bread, and vitamin B12 and folate. Limits of Agreement were broad for all food groups and nutrients. School, gender, alcohol consumption and between meals mainly affected most food groups’ intake differences. Gender stratification showed females had increased Pearson’s cc for energy and 28 nutrients, such as almost all fats, carbohydrates, vitamins and minerals.ConclusionsThe ASSO–FFQ could be applied in epidemiological studies for the assessment of dietary consumption in adolescents to adequately rank food, energy and nutrient intakes at a group level.
BackgroundA new food frequency questionnaire (FFQ) has been recently developed within the Italian Adolescents and Surveillance System for the Obesity prevention (ASSO) Project; it was found to be appropriate for ranking adolescents in food and nutrient levels of intake. The aim of this study was to assess the relative and absolute reproducibility of the ASSO-FFQ for 24 food groups, energy and 52 nutrients.MethodsA test-retest study was performed on two ASSO-FFQs administered one month apart of each other to 185 adolescents, aged 14–17 and attending secondary schools in Palermo (Italy). Wilcoxon test assessed differences in median daily intakes between the two FFQs. Agreement was evaluated by quintiles comparison and weighted kappa. Intraclass Correlation Coefficients (ICC) and Bland-Altman method assessed the relative and absolute reliability respectively.ResultsSignificant difference (p < 0.05) in median intakes was found only for bread substitutes, savoury food, water, soft drinks, carbohydrates and sugar. The subjects classified into the same or adjacent quintiles for food groups ranged from 62% (white bread) to 91% (soft drinks); for energy and nutrients from 64% (polyunsaturated fatty acids) to 90% (ethanol). Mean values of weighted kappa were 0.47 and 0.48, respectively for food groups and nutrients. Fair to good ICC values (>0.40) were assessed for thirteen food groups, energy and forty-three nutrients. Limits of Agreement were narrow for almost all food groups and all nutrients.ConclusionsThe ASSO-FFQ is a reliable instrument for estimating food groups, energy and nutrients intake in adolescents.Electronic supplementary materialThe online version of this article (doi:10.1186/1475-2891-13-119) contains supplementary material, which is available to authorized users.
The Adolescents Surveillance System for Obesity prevention (ASSO) Project aimed at developing standardized and web-based tools for collecting data on adolescents’ obesity and its potential determinants. This has been implemented and piloted in the local area of Palermo city, Italy. The aim of the present study is to provide an overview of the Project's design, implementation, and evaluation, highlighting all the aspects for a potential scale-up of the surveillance system on the whole national territory and abroad, as a sustainable and effective source of data.The overall structure and management, the ASSO-toolkit, the ASSO-NutFit software, and all developed and used procedures for recruiting, training, and data collecting/analyzing are addressed. An interim evaluation has been performed through a feasibility study; a final Project evaluation has been performed reporting the Strengths, Weaknesses, Opportunities, and Threats (SWOT) and the attributes that a surveillance system should have.This article provides a detailed overview of the Project and highlights that ASSO can be considered a valid, logical, coherent, efficient, and sustainable surveillance system that is consistent with countries’ needs and priorities.The system developed by the ASSO Project provides high-quality data and complies with several characteristics typical of a suitable surveillance system. It has a potential of being adopted within the National Health Service and other countries’ Health Services for monitoring adolescents’ obesity and its determinants, such as food intakes, behaviors, physical activity, and fitness profiles.
Objectives. Subjective health complaints (e.g. headache and feeling low) are common among adolescents. The objective of this study was to identify the factors associated with the subjective health of adolescents from a population-based point of view. Material and methods. A sample of 712 students was recruited within the web-based Project ASSO (Adolescents and Surveillance System for the Obesity prevention), funded by the Italian Ministry of Health and piloted in Palermo. A 0-100 quantitative score (arbitrarily named "psychosomatic malaise index") based on the frequency of occurrence of seven subjective health complaints was created and used as outcome; socio-demographic characteristics, medical items and lifestyle data were collected as potential explanatory variables. Associations were evaluated through a bivariate analysis first, and a multiple linear regression model afterwards by correcting for confounders. Results. The psychosomatic malaise index averaged 49.0 within the girls and 36.8 within the boys. After adjustment, the psychosomatic malaise index was confirmed to be significantly higher in the females, subjects with a diagnosed disease, smokers and alcohol consumers. Conclusions. Beyond the female gender, incorrect lifestyles such smoking and drinking alcohol may play an important role in the quality of life of adolescents, and thus preventive
Background The observed increase in body weight and cardiometabolic risk (CR) in youth from developed countries contributes to the global burden of chronic diseases in adult age. The aim of this work is to provide a patterning of the associations between different factors and the weight status and CR of the subjects involved in the Italian ministerial ASSO project. Methods This study involved 919 students from high schools in Palermo. Weight, height and waist circumference were collected by trained teachers; weight status was estimated by the BMI cut-offs for adolescents and CR through the waist-to-height ratio. Questionnaires were administered through the web-based ASSO-NutFit software. Chi-square test investigated the variables significantly associated with the outcomes, which were then included in a Multiple Correspondence Analysis (MCA), to explore their dimensional relationship to weight status and CR. Poisson regressions were conducted separately for the two outcomes, reporting raw and adjusted prevalence ratios (PRs) and Bootstrap Method was used to determine confidence intervals (CIs), to assessing the degree of effect of the explanatory variables over the outcomes. Results Two main dimensions were evidenced, with the overweight/obese group and the group at CR characterized by the following strongly associated factors: male gender, overweight/obese parents, following a slimming regime, caesarean birth, sedentariness, being under/overweight at birth, presence of metabolic risk, going to school by car/scooter, not using supplements. Conclusions This study contributed to identifying those adolescents that should be prioritized in interventions aiming at reducing overweight/obesity and CR in this age group. Electronic supplementary material The online version of this article (10.1186/s13052-019-0619-9) contains supplementary material, which is available to authorized users.
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