Development of a Food Frequency Questionnaire for Assessing Habitual Intake of Free Sugar Among Children in Saudi Arabia

Abstract

The World Health Organization emphasizes the urgency to assess and limit the intake of free sugar (FS) among individuals in order to prevent several non-communicable diseases. However, data regarding intake of FS are lacking in Saudi Arabia and in the Middle East. A reliable valid tool is needed to assess children's habitual intake of FS. Thus, we aimed to develop and validate a food frequency questionnaire (FFQ) that assesses children's habitual intake of FS in Saudi Arabia. In this cross-sectional study, 424 healthy Saudi children ages 6–12 years were included using river sampling method. Sociodemographic data and contact information were collected from mothers using an online survey. Dietary data were collected using 24-h dietary recalls (reference method) and a semi-quantitative FFQ through phone interviews. Items and food groups included in the initial draft of the FFQ were adopted from previous work. Content validity was done to the FFQ with total of 12 food groups and 41 food items. Next, a pilot study was conducted to estimate the sample size needed for the study and to ensure that all items reported in the 24-h dietary recalls were included in the final draft of the FFQ. Finally, data were collected to assess the validity and reliability of the FFQ at the population level. Mean intake of FS assessed by the FFQ was significantly higher than that assessed by the 24-h dietary recalls. Spearman's correlation between total FS assessed by the FFQ and 24-h dietary recall was positively low (rs = 0.30, p < 0.001). The coefficient alpha indicated an acceptable level of internal consistency (α = 0.74, p < 0.001). Test-retest reliability for total FS intake assessed by the FFQ was positively high (rs = 0.82). A slight agreement between FS intake assessed by the FFQ and the 24-h dietary recall was seen among the study sample (κ = 0.21, p < 0.001). The newly developed FFQ was found to be reasonably valid in assessing children's habitual intake of FS in Saudi Arabia. Validating the instrument among older population in Saudi Arabia is warranted.

Evaluation of a Food Frequency Questionnaire for Capturing Free Sugars Intake in Australian Young Children: The InFANT FFQ

“…Consistent with findings from the present analysis of the InFANT FFQ, the 41-item FFQ developed by Hunsberger et al revealed that free sugars intakes estimated from the FFQ and 24-h recalls were highly correlated, but the FFQ underestimated free sugars intake [ 26 ]. In contrast, Mumena et al [ 25 ] found that their FFQ overestimated free sugars intakes relative to the 24-h recalls, and there was a low correlation between free sugars intakes estimated from the two methods. The overestimation in Mumena et al [ 25 ] was likely due to the inclusion of a comprehensive list of free-sugars-containing food sources (12 food groups and 41 food items) as the FFQ was purpose-designed to capture free sugars intake.…”

“…In contrast, Mumena et al [ 25 ] found that their FFQ overestimated free sugars intakes relative to the 24-h recalls, and there was a low correlation between free sugars intakes estimated from the two methods. The overestimation in Mumena et al [ 25 ] was likely due to the inclusion of a comprehensive list of free-sugars-containing food sources (12 food groups and 41 food items) as the FFQ was purpose-designed to capture free sugars intake. It is worth noting that the overestimation of dietary intakes is a well-known phenomenon in FFQ development [ 18 ].…”

“…Internationally, there are two other existing tools that have been used to assess free sugars intake. Mumena et al [ 25 ] and Hunsberger et al [ 26 ] developed and validated a FFQ to assess free sugars intake in 424 Saudi children aged 6–12 years and 99 Polish children aged 10–17 years, respectively. Consistent with findings from the present analysis of the InFANT FFQ, the 41-item FFQ developed by Hunsberger et al revealed that free sugars intakes estimated from the FFQ and 24-h recalls were highly correlated, but the FFQ underestimated free sugars intake [ 26 ].…”

Development and validation of a quantitative food frequency questionnaire to assess free sugar intake among Sri Lankan preschool children

“…This FFQ consists of 67 food items and according to Cade et al [15], less than 100 items per FFQ would be optimal, thus this number can consider as su cient to obtain accurate data. Previous studies which develop FFQ to assess sugar intake has identi ed an almost close number of items as 64 [10] and 78 [22].…”

Sources of free sugar in the diet of Saudi children

“…A food guide as well as a table of frequency response options were shared with mothers via WhatsApp to help in accurately estimating the portion size of foods consumed. A validated FFQ that has been designed to evaluate FS intake among Saudi children was used to investigate the top sources of FS ( 26 ). The FFQ includes 40 food items classified in 12 food groups as follows: (1) “sweetened beverages (fruit drink, soft drink, flavored milk, smoothie)”; (2) “ready to eat cereals (ready to eat cereals: lower sugar [≤ 21.2 g/100 g], ready to eat cereals: higher sugar [> 21.2 g/100 g])”; (3) “breads and rolls (yeast breads, rolls and buns)”; (4) “sweet bakery products (cake, fruit pie or cheesecake, cookies, brownies, doughnuts, biscuit, muffins, French toast, pancakes/waffles, sweet pastries)”; (5) “quick breads and bread products (croissant, pastries)”; (6) “candy (candy not containing chocolate; candy containing chocolate)”; (7) “other desserts (ice-cream, popsicle, gelatin, pudding)”; (8) “sugars (sugars in tea and coffee, honey, jam, chocolate spread, peanut butter, syrups)”; (9) “yogurt (yogurt, flavored yogurt)”; (10) “mixed dishes (pizza or burger, all varieties, Chinese food, all varieties)”; (11) “condiments and sauces (ketchup, salad dressing [ranch, blue cheese, and Italian], salad dressing: [French, BBQ, and thousand island])”; (12) “fruits (canned fruits).” Frequency of consumption were as follows: “per day (once, 2–3 times, 4–5 times, or 6 times or more)”, “per week (once, 2–4 times, or 5–6 times)”, “per month (< once or 1–3 times)”.…”