Food-frequency questionnaires: a review of their design, validation and utilisation

Cade, Janet; Burley, Victoria J.; Warm, Daniel; Thompson, Rachel; Margetts, Barrie

doi:10.1079/nrr200370

Cited by 397 publications

(518 citation statements)

References 175 publications

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“…In the present study, the mean intake of energy and all macronutrients derived from food diaries was the same or higher compared with the QFFQ. Although a review of 227 validation studies by Cade et al (20) reported total fat as having the highest mean correlation coefficient among all nutrients, the present validation study indicated the highest correlation for carbohydrates (ICC 5 0?63, r 5 0?56).…”

Section: Discussioncontrasting

confidence: 72%

Validation of a quantitative FFQ for the Barbados National Cancer Study

Pakseresht

Sharma

Cao

et al. 2010

Public Health Nutr.

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Objective: To assess the validity of a 148-item quantitative FFQ (QFFQ) that was developed for the Barbados National Cancer Study (BNCS) to determine dietary intake over 12 months and examine the dietary risk factors. Design: A cross-sectional validation study of the QFFQ against 4 d food diaries. Spearman's rank correlations (r), intra-class correlation coefficients (ICC) and weighted k were computed as measures of concordance, adjusting for daily variations in the food diaries. Cross-classification tables and Bland-Altman plots were created for further assessment. Setting: BNCS is a case-control study of environmental risk factors for breast and prostate cancer in a predominantly African-origin population in Barbados. Subjects: Fifty-four individuals (21 years and older) were recruited among controls in the BNCS who were frequency-matched on sex and age group to breast and prostate cancer cases. Results: Similar mean daily energy intake was derived from the food diary (8201 kJ (1960 kcal)) and QFFQ (7774 kJ (1858 kcal)). Rho for energy and macronutrients ranged from 0?66 (energy) to 0?17 (dietary fibre). The percentage of energy from carbohydrates and protein showed the highest and lowest ICC among macronutrients (0?63 and 0?27, respectively). The highest weighted k was observed for energy (0?45). When the nutrient intake was divided into quartiles, approximately 34 % of the observations were in the same quartile. Conclusions: This investigation supports the validity of the QFFQ as a method for assessing long-term dietary intake except for dietary fibre, folate, vitamins A, E and B 12 . The instrument will be a useful tool in the analysis of diet-cancer associations in the BNCS. Keywords Quantitative FFQ Food diary Validity Barbados National Cancer StudyThe Barbados National Cancer Study (BNCS) is a populationbased case-control study designed to examine the genetic and environmental risk factors for breast and prostate cancer in a predominantly African-origin population. The importance of nutrition-related factors and growing interest in the role of nutrient-gene interactions in cancer aetiology necessitates the development of a valid method for assessing long-term dietary intake. Studies on the association between diet and cancer have not been performed in Barbados, West Indies, likely due, in part, to the lack of a validated method to assess long-term dietary intake.To fill this gap, a 148-item quantitative FFQ (QFFQ) was developed to determine dietary intake and to examine hypotheses related to diet and its interaction with genes and cancer in African-Barbadians (1) . QFFQ is commonly used in large-scale epidemiological studies and provides a feasible approach to assess the usual long-term dietary intake of a population (2) . Only valid instruments provide correct estimates of diet and diet-cancer associations. Although a gold standard to validate QFFQ currently does not exist, its validity is evaluated by comparing the results of these instruments to those using other dietary assessment methods or ...

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Section: Discussioncontrasting

confidence: 72%

Validation of a quantitative FFQ for the Barbados National Cancer Study

Pakseresht

Sharma

Cao

et al. 2010

Public Health Nutr.

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“…Finally, Bland-Altman plots enable assessment of the extent of variance in agreement and bias. Even though Bland-Altman plots are considered a gold standard in studies of methodical comparisons (18) , validation studies in nutritional epidemiology have only started to use this method during the past few years (27) . Finally, some limitations of our study need to be mentioned.…”

Section: Discussionmentioning

confidence: 99%

Validation of protein intake assessed from weighed dietary records against protein estimated from 24 h urine samples in children, adolescents and young adults participating in the Dortmund Nutritional and Longitudinally Designed (DONALD) Study

Bokhof

Günther

Berg‐Beckhoff

et al. 2010

Public Health Nutr.

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Objective: To date, only a few nutritional assessment methods have been validated against the biomarker of urinary-N excretion for use in children and adolescents. The aim of the present study was to validate protein intake from one day of a weighed dietary record against protein intake estimated from a simultaneously collected 24 h urine sample. Design: Cross-sectional analyses including 439 participants of the Dortmund Nutritional and Longitudinally Designed (DONALD) Study from four age groups (3-4, 7-8, 11-13 and 18-23 years). Mean differences, Pearson correlation coefficients (r), cross-classifications and Bland-Altman plots were used to assess agreement between methods. Results: Weighed dietary records significantly underestimated mean protein intake by 26?4 (95 % CI 28?2, 24?7) g/d or -11 %, with the difference increasing across the age groups from 20?6 (95 % CI 22?7, 1?5) g/d at age 3-4 years to -13?5 (95 % CI -18?7, -8?3) g/d at age 18-23 years. Correlation coefficients were r 5 0?7 for the total study sample and ranged from r 5 0?5 to 0?6 in the different age groups. Both methods classified 85 % into the same/adjacent quartile for the whole study group (83-86 % for the different age groups) and 2?5 % into the opposite quartile (1?9-3?1 % for the different age groups). Bland-Altman plots for the total sample indicated that differences in protein intake increased across the range of protein intake, while this bias was not obvious within the age groups. Conclusions: Protein intake in children and adolescents can be estimated with acceptable validity by weighed dietary records. In this age-heterogeneous sample, validity was lower among adolescents and young adults.

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“…FFQ are cost-effective tools to assess the usual current and past patterns of food intake over an extended period of time (37) . Estimates of the validity of our FFQ data, for Germany at least, were good, being in the same range as those reviewed by Willett (38) .…”

Section: Discussionmentioning

confidence: 99%

Dietary patterns and risk of asthma: results from three countries in European Community Respiratory Health Survey-II

et al. 2009

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Dietary patterns offer an alternative to the analysis of individual foods or nutrients in nutritional epidemiological studies. The aim of the present study was to identify dietary patterns common to different European countries and examine their associations with asthma. In five study centres (two in Germany, two in the UK and one in Norway), 1174 adults aged 29–55 years completed a FFQ and respiratory symptoms questionnaire. A meta-analytic approach was used to identify the dietary patterns and analyse them in relation to current asthma, asthma symptoms and bronchial responsiveness (BHR). Two patterns emerged, generally correlating with the same foods at different centres: one associated with intake of meats and potatoes; the other with fish, fruits and vegetables. There was no evidence that the fish, fruits and vegetables pattern was associated with asthma (OR 1·11 (95 % CI 0·93, 1·33)), symptom score (ratio of means 1·07 (0·98, 1·17)) or BHR (regression coefficient − 0·01 ( − 0·12, 0·10)), though these CI appeared to rule out large protective effects of consuming these foods. There was no overall evidence that the meat and potato pattern was associated with asthma (OR 1·02 (0·79, 1·31)), symptom score (ratio of means 1·07 (0·84, 1·36)) or BHR (regression coefficient − 0·08 ( − 0·27, 0·10)), but there was heterogeneity between centres in the association with symptom score: a negative association at the two German centres; a positive association at the others. Heterogeneity in a multi-centre observational study of diet could suggest alternative explanations for apparent effects of diet, such as uncontrolled confounding.

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Food-frequency questionnaires: a review of their design, validation and utilisation

Cited by 397 publications

References 175 publications

Validation of a quantitative FFQ for the Barbados National Cancer Study

Validation of a quantitative FFQ for the Barbados National Cancer Study

Validation of protein intake assessed from weighed dietary records against protein estimated from 24 h urine samples in children, adolescents and young adults participating in the Dortmund Nutritional and Longitudinally Designed (DONALD) Study

Dietary patterns and risk of asthma: results from three countries in European Community Respiratory Health Survey-II

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