Objectives: We describe the methods used to develop and score a 17-item 'screener' designed to estimate intake of fruit and vegetables, percentage energy from fat and fibre. The ability of this screener and a food-frequency questionnaire (FFQ) to measure these exposures is evaluated. Design: Using US national food consumption data, stepwise multiple regression was used to identify the foods to be included on the instrument; multiple regression analysis was used to develop scoring algorithms. The performance of the screener was evaluated in three different studies. Estimates of intakes measured by the screener and the FFQ were compared with true usual intake based on a measurement error model. Setting: US adult population. Subjects: For development of instrument, n Œ 9323 adults. For testing of instrument, adult men and women in three studies completing multiple 24-hour dietary recalls, FFQ and screeners, n Œ 484, 462 and 416, respectively. Results: Median recalled intakes for examined exposures were generally estimated closely by the screener. In the various validation studies, the correlations between screener estimates and estimated true intake were 0.5 -0.8. In general, the performances of the screener and the full FFQ were similar; estimates of attenuation were lower for screeners than for full FFQs. Conclusions: When coupled with appropriate reference data, the screener approach described may yield useful estimates of intake, for both surveillance and epidemiological purposes.
Keywords
Diet Epidemiological methods Surveillance Validation study Data collection QuestionnairesIn 1998, the US National Cancer Institute (NCI) had the opportunity to develop a supplement to the National Health Interview Survey 2000, a survey of 40 000 adults aged 20 years and above. The supplement, called the Cancer Control Module (CCM), could average no more than 20 min. Areas of interest included cancer-related behaviours, such as participation in cancer screening, smoking, sunlight avoidance, physical activity and diet. The challenge in developing the dietary component was to provide meaningful information about diet in no more than 20 questions. This paper describes our efforts to develop and evaluate a short dietary assessment tool, a 'screener' to estimate usual dietary intake of fruits and vegetables, percentage energy from fat and fibre. We describe the approach used to develop the instrument and analytical scoring procedures and how the new instrument was evaluated in community samples of adults, and report the instrument's ability to estimate mean intakes and its estimated correlation with true intake.
Methods
Development of instrument
Identification of foodsWe were primarily interested in assessing intakes of servings of fruits and vegetables, percentage energy from fat and grams of fibre. To identify which foods best predicted these dietary factors, we analysed dietary intake data (two non-consecutive 24-hour dietary recalls) collected from a nationally representative US sample of the US Department of Agricultur...