Validation of a food frequency questionnaire specific for salt intake in Saudi Arabian adults using urinary biomarker and repeated multiple pass 24-hour dietary recall

Abstract

Socioeconomic status and lifestyle (including dietary habits) have dramatically changed in Saudi Arabia (SA) over the last few decades. SA suffers from a high burden of non-communicable diseases (NCDs) such as cardiovascular diseases and hypertension. There is no data on habitual salt intake in SA apart from one study in the Eastern region 8·1 g/day, not representative for the general population. Food frequency questionnaires (FFQ) are practical for epidemiological studies, but need to be developed and validated for specific populations because foods are culture-dependent (1) . To our knowledge, there is no validated Saudi specific FFQ, apart from one semi-quantitative FFQ for the assessment of vitamin A intake only (2) . We aimed to develop a culture-specific FFQ and evaluate its validity in estimating the intake of salt in Saudi Arabian population.A quantitative FFQ was developed using a food list of common foods and composite dishes consumed by Saudi adults from previously collected 24-hour dietary recall (3) . The FFQ was pretested and finalized with 133 food items. A specific question was included regarding table salt use. The FFQ was validated against repeated multiple pass 24-Hour dietary recalls (MP24-HR) and urinary biomarkers for a sub-sample of the population. Participants (aged 19-60) were recruited from the community in Riyadh City, Kingdom of Saudi Arabia in 2013. Informed consent was collected and blood pressure and anthropometrics measurements taken. Participants received verbal and written instructions on how to collect the urine samples for 24 hours. The mean daily intake of salt (NaCl), were estimated from measured urinary sodium (Na) using WHO equation (1 g of NaCl = 393·4 mg of Na).A total of 601 participants were recruited (265 males, 336 females, median age 29, IQR 24-38). All completed the FFQ and repeated MP24-HR. A sub-sample of 71 subjects (24 males, 47 females, median age 38, IQR 25-45) provided urine samples, 49 of which (18 males, 31 females) provided complete 24-h urine collections (creatinine index falling inside the range of 11-20 and 14-26 mg/ kg body weight/day for women and men respectively). The median urinary sodium output was 3457 mg/24 h (IQR 2298-4696), equivalent to 8·7 g salt/24 h (IQR 5·8-11·9), higher than the recommended level of <5 g/d for salt (4) . Around 60 % of the population always adding salt while cooking and 73 % never add it while eating The correlation between FFQ and food recall was weak (r s = 0·376, p < 0·001), and moderate for FFQ and urinary excretion (r s = 0·502, p < 0·001). The biases between FFQ and food recall, and FFQ and urinary excretion were relatively small (3·4 and 2·3 g salt/day, respectively, Fig.1&2), although with wide limits of agreement (−5·4 and 12·2 g salt/day, and −10·1 and 5·5 g salt/day, respectively). Therefore, we can conclude that the newly developed FFQ deemed a valid and practical tool to assess sodium and salt intake in the Saudi adult population.

Knowledge and Practices Related to Salt Intake among Saudi Adults

“…In this study, sodium intake was assessed by the FFQ. Despite the fact that the estimate of sodium intake that is obtained via a 24-h urine sample is considered the gold standard, the FFQ can provide a good estimate of the sodium intake of a group [ 21 ]. In addition, data concerning awareness regarding the food sources of sodium and the ability to read nutrition labels were not collected in this study.…”

“…Dietary sodium intake was assessed using a semi-validated food frequency questionnaire (FFQ) [ 21 ]. The FFQ was used to evaluate the quantity of sodium naturally present in food and the quantity added during cooking, but not sodium coming from table salt.…”

Prevalence and Predictors of Emotional Eating among Healthy Young Saudi Women during the COVID-19 Pandemic

“…Questions related to the mandatory quarantine period included weight change because of lockdown (increase/decrease/no change), following a weight loss diet (yes/no), number of meals and snacks per day, fast food intake and its frequency, and the frequency of eating or the urge to eat sweets (Likert-type scale [hereafter “Likert scale”]), urge to drink coffee and tea (Likert scale), and amount of water intake. Additionally, food frequency questionnaire was conducted to assess macronutrients intake including energy intake (kcal/day), fat intake (gm/day), carbohydrate intake (gm/day) and protein intake (gm/day) [ 31 ].…”

Low Serum Vitamin B12 Levels Are Associated with Adverse Lipid Profiles in Apparently Healthy Young Saudi Women

“…The Saudi Food and Drug Administration's food frequency questionnaire was used to measure vitamin B12 intake over the past year [41]. The official Arabic language version of the questionnaire was used to interview individuals.…”

“…In addition, the questionnaire included open-ended questions, at the end, to gather information about other food items that were not listed. It also included questions regarding the types of cooking fat used, visible fat consumption, and salt and vitamin consumption [41].…”