Relative validity of a semi-quantitative food frequency questionnaire for Singaporean toddlers aged 15–36 months

Abstract

Background: There is presently no simple tool for use in large epidemiological studies to understand the food and nutrient intakes of Asian toddlers. This study aimed to assess the relative validity of a semi-quantitative food frequency questionnaire (sqFFQ) developed for multi-ethnic Singaporean toddlers aged 15-36 months. Methods: Ninety-one parents completed the sqFFQ and a 2-day weighed food record as the reference method. Intake of energy and 25 nutrients were determined for each method and compared using Pearson correlations corrected for attenuation, Bland-Altman plots, and weighted kappa according to quartiles; sqFFQ calibration was performed using multivariable linear regression. Results: Deattenuated correlations for energy and all nutrients were acceptable (r = ≥0.30, p < 0.001). The sqFFQ was highly reproducible, but significantly overestimated intake of energy and all nutrients except vitamin A. Bland-Altman plots showed wide limits of agreement for energy and all nutrients. Weighted kappa ranged from 0.12 (slight) to 0.53 (moderate). After calibration, deattenuated correlations improved for energy and 10/25 nutrients, with no change or a slight decline for the remainder, including one falling to r = 0.27. Limits of agreement narrowed for energy and all nutrients, and except for DHA, median intakes were not significantly different except for vitamin A, enabling population estimates of absolute intakes. Weighted kappa improved overall; energy and 16 nutrients now had moderate agreement (0.41-0.60), while 9 nutrients had fair agreement (0.21-0.40). Conclusions: The Singaporean toddler semi-quantitative food frequency questionnaire is suitable for ranking nutrient intakes of Singaporean toddlers in larger epidemiological studies. However, for population estimates of absolute nutrient intakes, it is recommended that a subsample within a cohort complete weighed food records for calibration purposes. Trial registration: This study was registered retrospectively on clinicaltrials.gov on 3rd May 2017 (identifier code: NCT03138330).

Total Fat and Fatty Acid Intake among 1–7-Year-Old Children from 33 Countries: Comparison with International Recommendations

“…ALA intake was below the AI of 0.5%E in 42% of studies. Daily DHA intake ranged between 19.5 to 120 mg and was below the recommendation of 100 mg per day in all of the recovered studies that assessed DHA intake except in one study done in Singapore [69]. Among this age group, two studies, one in China [61] and one in France [78] reported intakes of total fat, LA, ALA and DHA which were all outside (below) the recommendations.…”

“…N-3 LC-PUFA are highly important for brain maturation and development [3], therefore, this finding is a concern. The exceptions to this were for younger children (1-3 years) in three small studies from coastal areas (Singapore, [69], Vancouver, Canada [49,52]) and for children 3-5 years in five studies (two local (Vancouver [49], Tokyo [63], one subnational (urban areas in Spain) [89] and two national studies (France [79], Sweden [91]), where EPA + DHA intakes were within the FAO/WHO recommendations, but lower than EFSA recommendations.…”

Young Children Display Diurnal Patterns of Salivary IgA and Alpha-Amylase Expression Which Are Independent of Food Intake and Demographic Factors

“…Parents were asked to keep a weighed food record to capture the food and drink intake of their toddler over two nonconsecutive days (one weekday and one weekend day). The full methodology is described in Allan et al [40]. Briefly, participants were given verbal and written instructions on how to complete detailed food records.…”

“…This software linked several national databases available in Australia and allowed new foods to be added (38 generic food items and 19 follow-on and young child formulas were added). For foods specific to Singapore, the Singaporean Health Promotion Board nutrient database [40, 41] was used to create and add new foods to the system (27 items in total). The Composition of Foods Integrated dataset by McCance and Widdowson (revised version) was also consulted [40, 42].…”

“…For foods specific to Singapore, the Singaporean Health Promotion Board nutrient database [40, 41] was used to create and add new foods to the system (27 items in total). The Composition of Foods Integrated dataset by McCance and Widdowson (revised version) was also consulted [40, 42]. The following macro- and micronutrients were used in the analyses for correlation with sAA and sIgA expression and diurnal patters: total energy (kJ), total protein (g), total fat (g), saturated fat (g), total fibre (g), total sugars (g), and total carbohydrates (g); minerals: calcium (mg), iodine (ug), iron (mg), magnesium (mg), phosphorus (mg), potassium (mg), selenium (ug), sodium (mg), and zinc (mg); and vitamins: beta-carotene (ug), total folate (ug), niacin (mg), retinol (ug), riboflavin (mg), thiamine (mg), total vitamin A (ug), vitamin B12 (ug), vitamin B6 (mg), vitamin C (mg), and vitamin E (mg) [40].…”