Development and Validation of FFQ for Assessing SugarSweetened Beverages (SSB) and High-Energy Dense Foods Intake among Malaysian Adolescents

@#Introduction: Increased consumption of sugar-sweetened beverages (SSBs) is strongly associated with weight gain, dental cavities, and a higher risk of chronic diseases among adolescents. However, there is no available FFQ for the Malaysian population individually to evaluate and assess the consumption of SSBs and high-energy dense (HED) foods among adolescents. Method: A 24-hour diet recall with 30 adolescents were performed via Google Meet to identify the most common and frequent types of SSBs and HEDs foods consumed nowadays. The food checklist of SSBs and HED foods from literature review search was also provided to the participants. Experts critically reviewed each food item and provide a score for its relevancy and essentiality. Face validity were conducted among 10 adolescents to validate the developed FFQ. Results: The final FFQ consisted of 63 food items with ten categories. This FFQ showed high content validity for individual items with I-CVI ranging from 0.67 to 1.00 and overall questionnaires with S-CVI/Ave valued at 0.97. The calculation of Kappa statistic showed that this newly developed FFQ has excellent inter-rater reliability at the item level with K > 0.74 for 55 items and K = 0.57 only for 4 items. Most of the items were marked as relevant with a CVR score of 1.00. Conclusion: The findings of this study imply that the newly developed FFQ could be utilised to estimate the intake of SSB and HED foods of Malaysian adolescents.

Analysis of dietary intake in the residents aged 15 years and above in Shanghai / 上海预防医学

ObjectiveTo provide basic data of daily dietary intake from various food categories as well as in different regions， seasons， genders， and age groups in Shanghai residents aged 15 and over. MethodsMultistage stratified proportional probability sampling （PPS） was used to extract the samples， and food frequency questionnaire （FFQ） was used to investigate the dietary intake of the subjects in four seasons from 2012 to 2013. The weighted statistical analysis of the samples comprehensively considered the sampling design weights， the stratified adjustment weights， and the non-response adjustment weights. ResultsThe total daily dietary intake （excluding drinking water） of residents aged 15 years and above was 1 174.71 g， and the highest three daily dietary intake categories were cereals （252.31 g）， vegetables （205.36 g） and fruits （141.00 g）. The total daily dietary intake of the residents in the urban area， the suburban area and the rural area was 1 209.15 g，1 172.27 g and 948.50 g， respectively， and the total daily dietary intake in the outer suburb area was significantly lower than that in other areas （F=74.12，P<0.001）. The total daily dietary intake in different seasons was 1 232.47 g in spring， 1 166.80 g in summer， 1 241.15 g in autumn and 1 088.83 g in winter， respectively. The total daily dietary intake in winter was lower than that in other seasons （F=15.96，P<0.001）. Fruits and beverages intake showed apparent seasonality. The total daily dietary intake in male and female residents was 1 234.03 g and 1 112.32 g， respectively， and the total daily dietary intake of male was higher than that of female （F=78.59，P<0.001）. The total daily dietary intake of residents in different age groups was 1 218.64 g for 15‒44 years old， 1 141.27 g for 45‒59 years old， and 1 064.54 g for 60 years old and above （F=20.28，P<0.001）. ConclusionThe daily intake of cereals， livestock and poultry meat， aquatic products， eggs and edible oil is relatively balanced， but the daily intake of vegetables， fruits and milk is relatively insufficient for the residents aged 15 years and above in Shanghai. The daily intake of different food types shows distinguishable characteristics in urban and rural areas， seasons， age groups and genders.

Cuestionario de frecuencia de consumo de alimentos para niños de zonas rurales costeras del Ecuador: Construcción, validez relativa y calibración

RESUMEN Los Cuestionarios de Frecuencia de Consumo de Alimentos son herramientas de investigación ampliamente utilizadas a nivel poblacional para evaluar la ingesta alimentaria, especialmente en niños. Los objetivos de este estudio fueron construir y determinar la validez relativa del Cuestionario de Frecuencia de Consumo de Alimentos (CFCA) para la evaluación de la ingesta entre niños ecuatorianos en edad escolar. Fueron incluidos 100 niños entre 6 y 8 años de edad de zonas costeras rurales del Ecuador. Las madres completaron 1 CFCA y 2 Recordatorios de 24 horas (R24h, estándar oro). Se utilizaron correlaciones de Pearson, Kappa ponderado y el método de Bland Altman para evaluar su validez. Se aplicaron modelos de regresión lineal incluyendo el R24h como variable dependiente y CFCA como variable independiente para derivar factores de calibración. Los coeficientes de Pearson oscilaron entre -0,03 y 0,24. Los valores de Kappa variaron entre -0,05 y 0,24, los gráficos de Bland-Altman se encuentran entre los límites cerca de la línea media y los factores de calibración oscilaron entre -0,01 a 0,16. Después de aplicar los factores de calibración, las ingestas medias de energía, macro y micro nutrientes fueron similares a las obtenidas en el R24h. El CFCA fue considerado apropiado para evaluar consumo de energía y nutrientes, sin embargo, debido a su concordancia débil a moderada este debe ser corregido mediante los valores de calibración. Asimismo, este CFCA es una herramienta útil para la evaluación de la dieta y la relación entre la dieta y la enfermedad en este grupo poblacional.

ABSTRACT Food frequency questionnaires are research tools widely used at the population level to assess food intake, especially in childhood. The objectives of this study were to develop and determine the relative validity of the Food Frequency Questionnaire (FFQ) for the evaluation of food intake among Ecuadorian schoolchildren. One hundred children from rural coastal areas of Ecuador, aged 6 to 8 years, were included. Mothers completed 1 FFQ frequency and two 24-hour recalls (R24h gold standard). Pearson correlation, weighted Kappa and the Bland Altman method were used to assess validity. Linear regression models were used including R24h as a dependent variable and FFQ as an independent variable to derive calibration factors. The Pearson coefficients ranged between -0.03 and 0.24. The Kappa values varied between -0.05 and 0.24, the Bland-Altman plots were between the limits near the midline and the calibration factors ranged from -0.01 to 0.16. The FFQ was considered appropriate to evaluate energy and nutrient consumption, however, due to its weak to moderate agreement this must be corrected using calibration values. This FFQ is a useful tool for evaluating diet and the relationship between diet and disease in this population group.

Design and Validation of Web-Based or Online Food Frequency Questionnaire for Adults: A Scoping Review

@#This article aimed to review the design features of web-based or online FFQ developed for adults and statistical analysis used in the validation, comparison, or reproducibility studies. The search identified 863 articles, and 29 studies met the criteria. The number of food list ranges from 12 to 279 items. The food portion size was estimated using images or a standard portion size using household measurement. Web-based FFQ was validated with other dietary assessment tools, Block FFQ and biomarker. Comparison study of web-based FFQ was done using paper-based FFQ and interviewed-administered FFQ. Two studies conducted validation and comparison study using other dietary assessment methods, biomarker and paper-based FFQ. Seven studies conducted reproducibility studies. Overall, webbased FFQs showed acceptable validity with the respective reference method and good reproducibility. Strategies to improve the application of current evidence on best practices in designing and validating a web-based FFQ can improve nutritional epidemiology studies.

Reproducibility and validity of food group intake in a short food frequency questionnaire for the middle-aged Japanese population

PURPOSE@#The purpose of this study was to evaluate the reproducibility and validity of a short food frequency questionnaire (FFQ) for food group intake in Japan, the reproducibility and partial validity of which were previously confirmed for nutrients.@*METHODS@#A total of 288 middle-aged healthy volunteers from 11 different areas of Japan provided nonconsecutive 3-day weighed dietary records (DRs) at 3-month intervals over four seasons. We evaluated reproducibility based on the first (FFQ1) and second (FFQ2) questionnaires and their validity against the DRs by comparing the intake of 20 food groups. Spearman's rank correlation coefficients (SRs) were calculated between energy-adjusted intake from the FFQs and that from the DRs.@*RESULTS@#The intake of 20 food groups estimated from the two FFQs was mostly equivalent. The median energy-adjusted SRs between the FFQ1 and FFQ2 were 0.61 (range 0.38-0.86) for men and 0.66 (0.45-0.84) for women. For validity, the median de-attenuated SRs between DRs and the FFQ1 were 0.51 (0.17-0.76) for men and 0.47 (0.23-0.77) for women. Compared with the DRs, the proportion of cross-classification into exact plus adjacent quintiles with the FFQ1 ranged from 58 to 86% in men and from 57 to 86% in women. According to the robust Z scores and the Bland-Altman plot graphs, the underestimation errors in the FFQ1 tended to be greater in individuals with high mean levels of consumption for meat for men and for other vegetables for both men and women.@*CONCLUSION@#The FFQ demonstrated high reproducibility and reasonable validity for food group intake. This questionnaire is short and remains appropriate for identifying associations between diet and health/disease among adults in Japan.

Relative validation of a food frequency questionnaire to assess dietary fatty acid intake / Validación relativa de un cuestionario de frecuencia de alimentos para evaluar la ingesta dietaria de ácido graso

OBJECTIVES: This study aimed to develop and validate a Food Frequency Questionnaire (FFQ) for assessing consumption of fatty acids among pregnant women. METHODS: Two lists of foods were created according to percent contribution of each nutrient estimated by three 24-hour recalls: a long and short version FFQ to estimate long-chain polyunsaturated fatty acids (LCPUFAs). Student paired t-test and Pearson correlation coefficients were used to verify the differences in mean consumption of nutrients from the FFQ and 24-hour recall. The concordance between the consumption values of the two methods was assessed using the Bland-Altman method and quartiles concordance. RESULTS: For the FFQ - long version, correlation values ranged from 0.33 (<0.05) to 0.62 (<0.01) for docosahexaenoic acid (DHA) and linoleic acid (LA), respectively. Eicosapentaenoic acid (EPA) and docosapentaenoic acid (DPA) were not correlated. Exact concordance ranged from 49.0% (energy) to 22.4% (EPA), and discordance ranged from 14.3% (DPA) to 2.0% (Saturated). The FFQ - short version had high correlations for LCPUFAs. Exact concordance ranged from 36.7% (n-3 LCPUFA) to 16.3% (DHA); and discordance from 12.2% (DPA) to 2.0% (arachidonic acid). Bland-Altman analysis showed good concordance for both versions. CONCLUSION: This nutrient-specific FFQ is a valid instrument to be used to estimate the level of consumption of fatty acids among pregnant women.

OBJETIVO: Este estudio tuvo como objetivo desarrollar y validar un cuestionario de frecuencia de consumo de alimentos para evaluar el consumo de ácidos grasos en gestantes. MÉTODOS: Dos listas de alimentos fueron creadas de acuerdo con la contribución porcentual de cada nutriente estimado por 3 recordatorios de 24 horas: CFC - versión larga y CFC - versión corta para estimar ácidos grasos poliinsaturados de cadena larga (AGPICL). La prueba de t pareada de Student y el coeficiente de correlación de Pearson se utilizaron para verificar las diferencias entre el consumo medio de nutrientes de del CFC y el recordatorio de 24 horas. La concordancia entre los valores de consumo de los dos métodos se evaluó mediante el método de Bland-Altman y la concordancia de cuartiles. RESULTADOS: En CFC - versión larga, los valores de correlación oscilaron entre 0.33 (<0.05) y 0.62 (<0.01) para ácido docosahexaenoico (DHA) y ácido linoleico (LA), respectivamente. Ácido eicosapentaenoico (EPA) y ácido docosapentaenoico (DPA) no presentaron correlación. La concordancia exacta varió de 49,0% (energía) a 22,4% (EPA), y la discordancia varió de 14,3% (DPA) a 2,0% (saturado). CFC: la versión corta mostró los mejores valores de correlaciones para los AGPICL. La concordancia exacta varió de 36,7 (n-3 LCPUFA) a 16,3% (DHA); y discordancia de 12,2% (DPA) a 2,0% (ácido araquidónico). El análisis de Bland-Altman mostró una buena concordancia para ambas versiones. CONCLUSIÓN: Este método CFC específico de nutrientes es un instrumento válido que se utiliza para estimar el nivel de consumo de ácidos grasos en mujeres gestantes.

A correlation of per day calorie intake with resting energy expenditure in healthy young adults

Background: The energy requirement of an individual can be defined as the level of energy intake from food that will balance the energy expenditure. Dietary intakes lower or higher than the body requirements can lead to undernutrition (deficiency diseases) or overnutrition (diseases of affluence), respectively. Per day calorie intake influences various daily energy utilizing activities. The imbalance between intake and expenditure continues over long periods, changes in body weight or body composition will occur and may adversely affect health. The resting energy expenditure (REE), the largest portion (50–75%) of total energy expenditure, is the energy required to maintain the basic metabolic activities including maintaining the body temperature and keeping the functioning of vital organs such as brain, kidneys, heart, and lungs. Hence, REE plays the most important role in body functioning. Objective: The aim and objective of the present study were to access the effect of per day calorie intake on REE. Materials and Methods: One hundred subjects (age 18–25 years) were assessed for data collection. All the data were collected in the early morning hours. The study was approved by the Institutional Ethical Committee (EC/P-47/2018) of Rajasthan University of Health Sciences College of Medical Sciences, Jaipur. Demographic data including the anthropometric measurement of the participants such as weight, height, and body mass index (BMI). Calories intake (kcal) in 24 h was measured using food frequency questionnaire. Moreover, REE was measured using the gold standard method indirect calorimetry. Pearson correlation was calculated to seen correlation between per day calorie intake and REE. Results: A total of 75 males and 25 females with mean age of males and females were 19.97 ± 1.81 years and 19.32 ± 1.75 years, respectively. The mean BMI was 21.77 ± 4 kg/m² of males and 22.68 kg/m² of females. The mean calorie intake was 2532.082 ± 830.970 kcal in males and 1991.176 ± 783.291 kcal in females. The mean REE of male subjects was 2081.470 ± 587.661 kcal and of females was 1827.895 ± 469.671 kcal. The present study results showed the positive poor correlation (r = +0.1572) between calorie intake and REE in male subjects and negative poor correlation (r = −0.1484) in female subjects. Conclusion: The present study results concluded that there was a poor association between per day calorie intake and REE. Moreover, on the basis of the present study results, we can also say that most of our energy intake was expended to maintain body functioning at rest.

Validade e reprodutibilidade do questionário de frequência alimentar online com suporte de imagens da coorte de universidades mineiras ( PROJETO CUME) / Validity and reproducibility of the online food frequency questionnaire supported by images from the cohort of universities in Minas Gerais (PROJETO CUME)

A avaliação do consumo alimentar tem sido comumente utilizada em estudos epidemiológicos uma vez que se correlaciona com determinantes da saúde e doenças crônicas não transmissíveis. No entanto, inúmeros são os desafios referentes a este processo, incluindo a acurácia dos instrumentos de coleta de dados, como o questionário de frequência alimentar (QFA). Objetivos: Descrever a construção do Questionário de Frequência Alimentar (QFA) online utilizado na Coorte de Universidades Mineiras (CUME) e avaliar a sua validade e reprodutibilidade. Métodos: A construção do QFA foi baseada em versão original previamente validada para população brasileira, adicionado de um álbum fotográfico. O QFA foi respondido duas vezes em um ano (março a agosto de 2018; março a abril de 2019; n = 108 participantes - reprodutibilidade) e dois recordatórios alimentares de 24 horas (R24h) foram aplicados em duas estações do hemisfério sul em 2018 (outono e inverno; n = 150 participantes - validade), totalizando quatro R24h por participante. Para avaliação da validade e reprodutibilidade foi aplicado o teste de correlação intraclasse (CCI) e calculados percentuais de concordância dos consumos energético total, de nutrientes e de grupos alimentares (similaridade nutricional e grau de processamento industrial) após categorização por tercis. Resultados: O QFA elaborado possui 144 itens alimentares, separados em oito grupos (lácteos; carnes e peixes; cereais e leguminosas; frutas; hortaliças e legumes; gorduras e óleos; bebidas; outros alimentos), 96 fotografias de alimentos e 5 fotografias de utensílios. Na avaliação da validade, CCI de energia e de macronutrientes foram considerados moderados, variando de 0,41 (energia) a 0,59 (proteína); para os demais itens avaliados, CCI foram considerados baixos a moderados, variando de 0,25 (fibras) a 0,65 (vitamina B6). Todos os percentuais de concordância exata + adjacente foram superiores a 80%. Na avaliação da reprodutibilidade, CCI de energia e de todos itens avaliados foram considerados moderados a excelentes, variando de 0,60 (hortaliças e legumes) a 0,91 (vitamina E e retinol), com percentual médio de concordância exata + adjacente de 92,5%. Conclusão: O QFA online e autopreenchido do projeto CUME possui validade e reprodutibilidade satisfatórias, podendo ser usado para analisar a associação entre o consumo alimentar e doenças crônicas não transmissíveis em adultos com elevado nível de escolaridade.

Food consumption evaluation has been commonly used in epidemiological studies since it correlates with health and chronic non-communicable diseases. Objectives: To describe the construction of the online Food Frequency Questionnaire (FFQ) used at CUME (Cohort of Universities of Minas Gerais, Brazil) and evaluate its validity and reproducibility. Methods: FFQ construction was based on an original version previously validated for the Brazilian population, together with a photographic album. The FFQ was answered twice in one year (March/August 2018 ­ March/April 2019; n = 108 participants ­ reproducibility) and two 24-hour dietary recall (24hR) were applied in two seasons of the southern hemisphere in 2018 (autumn and winter; n = 150 participants ­ validity), totaling four 24hR per participant. To assess the validity and reproducibility, the intraclass correlation test (ICC) was applied and agreement percentages of total energy consumption, nutrients and food groups (nutritional similarity and industrial processing degree) were calculated after categorization by tertiles. Results: The elaborated FFQ had 144 food items separated into eight groups (dairy products; meat and fish; cereals and legumes; fruits; vegetables; fats and oils; drinks; other foods), 96 photographs of food and 5 photographs of utensils. In assessing validity, ICCs for energy and macronutrients were considered moderate, ranging from 0.41 (energy) to 0.59 (protein); for the other items evaluated, ICCs were considered low to moderate, ranging from 0.25 (fibers) to 0.65 (vitamin B6). All percentages of exact + adjacent agreement were greater than 80%. In assessing reproducibility, ICCs for energy and all assessed items were considered moderate to excellent, ranging from 0.60 (vegetables) to 0.91 (vitamin E and retinol), with an average exact + adjacent agreement percentage of 92.5%. Conclusion: CUME project's online and selfcompleted FFQ had satisfactory validity and reproducibility, and can be used to analyze the association between food consumption and chronic non-communicable diseases in adults with a high level of education.

Comparison of 24-hour Recalls with a Food Frequency Questionnaire in Assessing Coffee Consumption: The Health Examinees (HEXA) Study / 대한지역사회영양학회지

OBJECTIVES: Most cohort studies used food frequency questionnaires (FFQ) to evaluate coffee consumption as it assesses habitual dietary patterns, whereas some studies have used the 24-hour recalls (24HR) as it elicits in-depth description of foods and the amount eaten. The aim of this study was to compare FFQs and 24HR to assess the consumption of various types of coffee.METHODS: We included 25,904 participants aged 40 years or older from the Health Examinees (HEXA) Study of the Korean Genome and Epidemiologic Study (KoGES). Each participant completed one FFQ and one-day (n=11,280) or two-day 24HR (n=14,624). We classified coffee types into: black coffee, coffee with sugar and cream, and coffee with sugar alone or cream alone. We compared the proportions of nondrinkers, black coffee, and coffee with sugar and cream through FFQ and 24HR.RESULTS: Among those who completed one FFQ and one-day 24HR, 39.4% of “nondrinkers” on one-day 24HR reported that they did not drink coffee on their FFQs. Whereas among those who complete two-day 24HR, 71.2% of “nondrinkers” on two-day 24HR said that they did not drink coffee on their FFQs. Among those who completed one FFQ and oneday 24HR, 58.3% marked “black coffee” on one-day 24HR said that they drank black coffee on their FFQs. Among those who complete two-day 24HR, 58.8% marked “black coffee” on two-day 24HR said that they drank black coffee on their FFQs. The kappa coefficients and percent agreements were 0.4 and 59.6%, respectively, for the comparison of coffee intake between FFQ and one-day 24HR, and 0.6 and 72.8%, respectively, for the comparison of coffee intake between FFQ and two-day 24HR.CONCLUSIONS: We found discrepancies between FFQs and 24HR in the types of coffee consumed. Such limitations should be considered when using the 24HR data to examine the effect of coffee consumption on disease development.

Associations between the dietary patterns of pregnant Malaysian women and ethnicity, education, and early pregnancy waist circumference: A prospective cohort study

BACKGROUND/OBJECTIVES: Little is known about the dietary patterns (DPs) of women during pregnancy. The present study aimed to identify the DPs of pregnant Malaysian women and their associations with socio-demographic, obstetric, and anthropometric characteristics. SUBJECTS AND METHODS: This prospective cohort study included 737 participants enrolled in Seremban Cohort Study between 2013 and 2015. Food consumption was assessed using a validated 126-food item semi-quantitative food frequency questionnaire (SFFQ) at four time-points, namely, pre-pregnancy and at each trimester (first, second, and third). Principal component analysis (PCA) was used to identify DPs. RESULTS: Three DPs were identified at each time point and designated DP 1–3 (pre-pregnancy), DP 4–6 (first trimester), DP 7–9 (second trimester) and DP 10–12 (third trimester). DP 1, 4, and 7 appeared to be more prudent diets, characterized by higher intakes of nuts, seeds & legumes, green leafy vegetables, other vegetables, eggs, fruits, and milk & dairy products. DP 2, 5, 8, and 11 had greater loadings of condiments & spices, sugar, spreads & creamer, though DP 2 had additional sweet foods, DP 5 and 8 had additional oils & fats, and DP 11 had additional tea & coffee, respectively. DP 3 and 6 were characterized by high protein (poultry, meat, processed, dairy, eggs, and fish), sugars (mainly as beverages and sweet foods), and energy (bread, cereal & cereal products, rice, noodles & pasta) intakes. DP 9 had additional fruits. However, DP 12 had greater loadings of energy foods (bread, cereal & cereal products, rice, noodles & pasta), sugars (mainly as beverages, and sweet foods), and good protein sources (eggs, nuts, seeds & legumes). Malays were more likely to have lower adherence (LA) for DP 1 and 10 than non-Malays. DP 2, 8, and 11 were more prevalent among Malays than non-Malays. Women with a higher education were more likely to have LA for DP 10, and women with a greater waist circumference at first prenatal visit were more likely to show LA for DP 11. CONCLUSIONS: DPs observed in the present study were substantially different from those reported in Western populations. Information concerning associations between ethnicity, waist circumference and education with specific DPs before and throughout pregnancy could facilitate efforts to promote healthy dietary behavior and the overall health and well-being of pregnant women.

Food Frequency Questionnaire for Chinese Children Aged 12-17 Years: Validity and Reliability / 生物医学与环境科学（英文）

OBJECTIVE@#The primary objective of this study was to examine the validity and reliability of a semi-quantitative food frequency questionnaire (FFQ) among Chinese children aged 12-17 years.@*METHODS@#A semi-quantitative 72-food item FFQ was developed for children aged 12-17 years. The reliability and validity of this FFQ were evaluated against 24-h dietary recalls (24 h DRs) to measure the consumption of foods and nutrients. We administered two FFQs and three DRs to children (N = 160) over a period of 1 month to evaluate the reliability and validity. Reliability was examined by quartile agreement and intraclass correlation coefficients (ICCs), and validity was examined by quartile agreement, Bland-Altman plots and correlation with DRs.@*RESULTS@#For reliability, the ICCs between the two FFQs ranged from 0.21 to 0.76 for foods and nutrients, and the quartile agreement ranged from 70.0% to 95.0% in the same or adjacent quartiles. Spearman's correlation coefficients of foods and nutrients between the second FFQ and the 24 h DRs ranged from -0.04 to 0.59. The Bland-Altman plots demonstrated good agreement across the range of intakes among nutrients. The quartile agreement ranged from 50.0% to 100.0%, with infrequent misclassification.@*CONCLUSION@#The FFQ assessment of dietary intakes demonstrated acceptable relative validity and high reproducibility for Chinese children aged 12-17 years.

Validation of a semi-quantitative food frequency questionnaire for estimating dietary omega-3 fatty acids intake among urban Indonesian pregnant women

@# Introduction: Studies on the development and validation of semi-quantitative food frequency questionnaires (SQ-FFQ) for assessing omega-3 (Ω-3) long-chain polyunsaturated fatty acids (LC-PUFAs) intake by pregnant women are few. This study aimed to determine the validity of a newly developed SQ-FFQ for assessing the LC-PUFA intake among Indonesian urban pregnant women. Methods: A cross- sectional study was carried out in 2015 on 100 Indonesian pregnant women who were in their late 3rd trimester, living in the urban setting of Jakarta. As a test tool, the SQ-FFQ was administered before the trained nutritionists executed the reference tool of non-consecutive two-day 24-hour dietary recalls (2DRs). The nutrients of interest were a total of Ω-3, eicosapentanoic acid (EPA), docosahexaenoic acid (DHA), alpha-linolenic acid (ALA), total Ω-6, linoleic acid (LA), arachidonic acid (AA), and LC-PUFAs. Statistical correlation, cross-classification and the Bland-Altman plot analysis were done to determine the agreement between tools. Results: Energy-adjusted correlation coefficients between SQ-FFQ and 2DRs were 0.385, 0.349, 0.352, 0.380, 0.338, 0.408, 0.409, 0.331, 0.341 and 0.341 for fat, total Ω-3, ALA, EPA, DHA, total Ω-6, LA, AA and LC-PUFAs, respectively and were statistically significant (p<0.05). Misclassification of these nutrients from SQ-FFQ and 2DRs was <6%. The Bland-Altman plots showed most of the points fell within the 95% limits of acceptable agreement for DHA, EPA, and LA. Conclusion: The newly developed SQ-FFQ of this study is a valid instrument for assessing of Ω-3 LC-PUFAs intake among Indonesian pregnant women living in urban area. Its further validation with relevant biomarkers is recommended.

Validity and Reproducibility of an Interviewer-administered Food Frequency Questionnaire for the Assessment of Riboflavin Intake in Malaysian Women in Selangor

@#Introduction: The aim of this study was to assess the validity and reproducibility of a food frequency questionnaire (FFQ) specifically developed for the assessment of riboflavin intake among Malaysian women in Selangor. Methods: The study was carried out in Universiti Putra Malaysia (UPM), which consisted of 204 healthy women (102 Chinese and 102 Malay) aged between 19 and 45 years. The FFQs were interviewer-administered, which were completed twice; at the beginning of the study (FFQ-1) and two weeks thereafter (FFQ-2). A two-day 24-hour dietary recall (24DR) was interviewer-administered as the standard criteria method. Data were analyzed using Wilcoxon signed ranks test, Spearman correlation coefficient (SCC), intra-class correlation coefficient (ICC) and Bland-Altman plots to determine the validity and reproducibility. Results: Median riboflavin intake derived from 24DRs was significantly higher than FFQ-2 (p<0.01). Both FFQ-1 and FFQ-2 correlated significantly (p<0.01) with 24DRs with r-value of 0.264 and 0.227, respectively. As for reproducibility between FFQs, SCC value was statistically significant (p<0.01) at 0.545 whereby ICC value was 0.752, which considered as good. Most data points fell between the limits of agreements and were found closer to the horizontal line in the middle. However, the plots showed no linear trend existed between FFQ and 24DR over the range of mean riboflavin intake. Conclusion: The newly developed FFQ were found to be valid and relatively reproducible in the assessment of riboflavin intake among Malaysian women in Selangor.

Dietary Factors Associated with Attention Deficit Hyperactivity Disorder (ADHD) in School-aged Children / 대한지역사회영양학회지

OBJECTIVES: An association between dietary patterns and mental health in children has been suggested in a series of studies, yet detailed analyses of dietary patterns and their effects on ADHD (attention deficit hyperactivity disorder) are limited. METHODS: We included 4569 children who had dietary intake data as part of the CHEER (Children's Health and Environmental Research) study conducted nationwide from 2005 to 2010. We assessed ADHD (Attention Deficit Hyperactivity Disorder) by the DuPaul's ADHD Rating Scales and dietary intake by a semi-quantitative food frequency questionnaire. Using intake data, we constructed five dietary patterns: “Plant foods & fish,” “Sweets,” “Meat & fish,” “Fruits & dairy products,” and “Wheat based.” RESULTS: The overall proportion of ADHD was 12.3%. Boys (17.8%) showed a higher rate of ADHD than girls (6.5%). The total intake of calories (85 kcal) and plant fat (2g) in the ADHD group was significantly higher than that of the normal group. ADHD was significantly negatively associated with dietary habits such as having breakfast and meal frequency, and positively associated with eating speed, unbalanced diet, overeating, and rice consumption. Regarding dietary patterns, the “Sweets” category was relevant to high ADHD risk (OR 1.59, 95% CI: 1.18, 2.15 for Q5 vs. Q1) in a linear relationship. An inverse, non-linear association was found between “Fruits & dairy products” and ADHD (OR 0.55, 95% CI: 0.39, 0.76 for Q4 vs. Q1). CONCLUSIONS: Our study confirms both positive and negative associations between diet and ADHD in elementary school age children. Moreover, linear or nonlinear associations between diet and ADHD draw attention to the possible threshold role of nutrients. Further studies may consider characteristics of diet in more detail to develop better intervention or management in terms of diet and health.

Dietary Factors Associated with Attention Deficit Hyperactivity Disorder (ADHD) in School-aged Children / 대한지역사회영양학회지

OBJECTIVES: An association between dietary patterns and mental health in children has been suggested in a series of studies, yet detailed analyses of dietary patterns and their effects on ADHD (attention deficit hyperactivity disorder) are limited. METHODS: We included 4569 children who had dietary intake data as part of the CHEER (Children's Health and Environmental Research) study conducted nationwide from 2005 to 2010. We assessed ADHD (Attention Deficit Hyperactivity Disorder) by the DuPaul's ADHD Rating Scales and dietary intake by a semi-quantitative food frequency questionnaire. Using intake data, we constructed five dietary patterns: “Plant foods & fish,” “Sweets,” “Meat & fish,” “Fruits & dairy products,” and “Wheat based.” RESULTS: The overall proportion of ADHD was 12.3%. Boys (17.8%) showed a higher rate of ADHD than girls (6.5%). The total intake of calories (85 kcal) and plant fat (2g) in the ADHD group was significantly higher than that of the normal group. ADHD was significantly negatively associated with dietary habits such as having breakfast and meal frequency, and positively associated with eating speed, unbalanced diet, overeating, and rice consumption. Regarding dietary patterns, the “Sweets” category was relevant to high ADHD risk (OR 1.59, 95% CI: 1.18, 2.15 for Q5 vs. Q1) in a linear relationship. An inverse, non-linear association was found between “Fruits & dairy products” and ADHD (OR 0.55, 95% CI: 0.39, 0.76 for Q4 vs. Q1). CONCLUSIONS: Our study confirms both positive and negative associations between diet and ADHD in elementary school age children. Moreover, linear or nonlinear associations between diet and ADHD draw attention to the possible threshold role of nutrients. Further studies may consider characteristics of diet in more detail to develop better intervention or management in terms of diet and health.

Development and relative validity of semi-quantitative food frequency questionnaire for Korean adults / 한국영양학회지

PURPOSE: This study was implemented to develop and validate the semi-quantitative food frequency questionnaire (SQ-FFQ) to assess energy, carbohydrates, fat, protein, minerals, and vitamins as well as fatty acids and alcohol in Korean adults. METHODS: The SQ-FFQ consisted of 88 food items, and 12 food groups were selected based on information of frequently consumed foods from the Korean Health and Nutrition Examination survey. Each portion size was categorized as one of three amounts: small (0.5 times), medium (1 time), and large (1.5 times). A total of 111 subjects finished 3-day diet records and the SQ-FFQ. The relative validity of SQ-FFQ was assessed by comparison with the 3-day diet records. RESULTS: The mean nutrient intakes obtained from the SQ-FFQ were estimated to be greater than those of the two 3-day dietary records. Spearman's correlation coefficient between the two methods was the highest for energy (r = 0.583; p < 0.001) and lowest for saturated fatty acid (r = 0.121). Correlation coefficients were energy (r = 0.583; p < 0.001), carbohydrates (r = 0.500; p < 0.001), protein (r = 0.466; p < 0.001), fat (r = 0.411; p < 0.001), dietary fiber (r = 0.467; p < 0.001), alcohol (r = 0.527; p < 0.001), calcium (r = 0.409; p < 0.001), phosphorus (r = 0.499; p < 0.001), potassium (r = 0.418; p < 0.001), magnesium (r = 0.427; p < 0.001), and zinc (r = 0.464; p < 0.001), respectively, for all subjects. CONCLUSION: The developed SQ-FFQ in this study seems to be useful for estimating nutritional status, particularly energy, carbohydrates, protein, fat, dietary fiber, alcohol, calcium, phosphorus, potassium, magnesium, and zinc of Korean adults.

Dietary Intake Among Breast Cancer Survivors In East Coast Of Peninsular Malaysia

A balanced dietary intake plays an important role in the prognosis of breast cancer and is one of the modifiable factors in preventing cancer recurrence. This study aims to determine the dietary intake among breast cancer survivors in East Coast of Peninsular Malaysia. A total of 125 breast cancer survivors, aged 37 to 72 years, with mean duration of survivorship of 6.1 ± 3.9 years were recruited from two main referral hospitals in Terengganu and Kelantan. Majority of the respondents were Malay (94.4%) with a mean BMI of 27.7 ± 5.07 kg/m², and were diagnosed with stage II cancer (66.0%). Dietary intake was estimated using a semi-quantitative food frequency questionnaire (FFQ). The results show that the mean daily intake of energy was 1764 ± 378 kcal/day, protein was 72.38 ± 33.6 g/day (16.5% of energy), carbohydrate was 243.0 ± 62.2 g/day (55% of energy) and fat was 55.8 ± 15.6 g/day (28% of energy). Overall, breast cancer survivors in this study had an adequate daily intake of vitamins and minerals according to Malaysian Recommended Nutrient Intakes (RNI) except for dietary fibre (10.6 ± 4.2 g/day), monounsaturated fatty acids (20.7 ± 5.7 g/day), polyunsaturated fatty acids (8.0 ± 2.2 g/day), calcium (561.0 ± 257.1 mg/day), iron (18.3 ± 7.2 mg/day) and potassium (1813.4 ± 531.1 mg/day) which was lower than the recommendation. Meanwhile, intake of sodium (2592 ± 1697 mg/day), protein (80.4 ± 33.6 g/day), saturated fatty acids (26.9 ± 14.2 g/day), vitamin B2 (1.9 ± 1.1 mg/day) and vitamin C (151.1 ± 149.3 mg/day) exceeded the recommendation by 135.0%, 139.0%, 166.9%, 154.6% and 152.0%, respectively. There was no significant difference in dietary intake between cancer survivors who were diagnosed in the past five years and those who were diagnosed more than five years ago (p>0.05) except for fat (p<0.001), saturated fatty acid (p=0.006), monounsaturated fatty acid (p=0.005) and polyunsaturated fatty acid (p=0.003). As a conclusion, breast cancer survivors in East Coast of Peninsular Malaysia had an adequate intake of most nutrients except for dietary fibre, monounsaturated fatty acids, polyunsaturated fatty acids, calcium, iron and potassium which was below the recommendation and sodium, protein, saturated fatty acids, vitamin B2, vitamin C which was above the recommendation. The intakes between long-term and short-term survivors were also comparable showing sustained dietary intake throughout survivorship.

Dietary Intake Among Breast Cancer Survivors In East Coast Of Peninsular Malaysia

@#A balanced dietary intake plays an important role in the prognosis of breast cancer and is one of the modifiable factors in preventing cancer recurrence. This study aims to determine the dietary intake among breast cancer survivors in East Coast of Peninsular Malaysia. A total of 125 breast cancer survivors, aged 37 to 72 years, with mean duration of survivorship of 6.1 ± 3.9 years were recruited from two main referral hospitals in Terengganu and Kelantan. Majority ofthe respondents were Malay (94.4%) with a mean BMI of 27.7 ± 5.07 kg/m², and were diagnosed with stage II cancer (66.0%). Dietary intake was estimated using a semi-quantitative food frequency questionnaire (FFQ). The results show that the mean daily intake of energy was 1764 ± 378 kcal/day, protein was 72.38 ± 33.6 g/day (16.5% of energy), carbohydrate was 243.0 ± 62.2 g/day (55% of energy) and fat was 55.8 ± 15.6 g/day (28% of energy). Overall, breast cancer survivors in this study had an adequate daily intake of vitamins and minerals according to Malaysian Recommended Nutrient Intakes (RNI) except for dietary fibre (10.6 ± 4.2 g/day), monounsaturated fatty acids (20.7 ± 5.7 g/day), polyunsaturated fatty acids (8.0 ± 2.2 g/day), calcium (561.0 ± 257.1 mg/day), iron (18.3 ± 7.2 mg/day) and potassium (1813.4 ± 531.1 mg/day) which was lower than the recommendation. Meanwhile, intake of sodium (2592 ± 1697 mg/day), protein (80.4 ± 33.6 g/day), saturated fatty acids (26.9 ± 14.2 g/day), vitamin B2 (1.9 ± 1.1 mg/day) and vitamin C (151.1 ± 149.3 mg/day) exceeded the recommendation by 135.0%, 139.0%, 166.9%, 154.6% and 152.0%, respectively. There was no significant difference in dietary intake between cancer survivors who were diagnosed in the past five years and those who were diagnosed more than five years ago (p>0.05) except for fat (p<0.001), saturated fatty acid (p=0.006), monounsaturated fatty acid (p=0.005) and polyunsaturated fatty acid (p=0.003). As a conclusion, breast cancer survivors in East Coast of Peninsular Malaysia had an adequate intake of most nutrients except for dietary fibre, monounsaturated fatty acids, polyunsaturated fatty acids, calcium, iron and potassium which was below the recommendation and sodium, protein, saturated fatty acids, vitamin B2, vitamin C which was above the recommendation. The intakes between long-term and short-term survivors were also comparable showing sustained dietary intake throughout survivorship.

Validity of a food frequency questionnaire to assess food intake in Mexican adolescent and adult population / Validación de un cuestionario de frecuencia de alimentos para evaluar la ingesta alimentaria en adolescentes y adultos de México

Abstract: Objective: To assess the validity of a 140-item semiquantitative food frequency questionnaire (SFFQ), in Mexican adolescents and adults. Materials and methods: Dietary intakes using a SFFQ and two 24-hour dietary recalls (24DRs), in nonconsecutive days during the same week were measured from 178 adolescents and 230 adults participating in the Mexican National Health and Nutrition Survey-2012.Validity was evaluated using correlation coefficients (CC),deattenuated CC, linear regression models, cross-classification analysis, and the Bland-Altman method. Results: In adults, deattenuated correlation coefficients between the SFFQ and the 24DRs ranged from 0.30 for folate to 0.61 for saturated fat. In addition, 63% adults and 62% adolescents were classified in the same and adjacent quartile of nutrient intake when comparing data from SFFQ and 24DRs. Conclusions: The SFFQ had moderate validity for energy, macronutrients and micronutrients. It also had good validity to rank individuals according to their dietary intake of different nutrients.

Resumen: Objetivo: Evaluar la validez de un cuestionario de frecuencia de consumo de alimentos semicuantitativo (CFA), en adolescentes y adultos mexicanos. Material y métodos: Se evaluó la ingesta de alimentos de 178 adolescentes y 230 adultos que participaron en la Encuesta Nacional de Salud y Nutrición-2012, de México, mediante un CFA y el promedio de dos recordatorios de 24-horas (24DRs). La validez se evaluó utilizando coeficientes de correlación, coeficientes de correlación corregidos (CCC) y análisis de clasificación. Resultados: En adultos, los CCC entre el CFA y el promedio de los 24DRs estuvieron entre 0.30 para folatos y 0.61 para grasas saturadas. Adicionalmente, 63% de los adultos y 62% de los adolescentes fueron clasificados en el mismo o adyacente cuartil cuando fueron comparados los datos del CFA y el 24DR. Conclusión: El CFA mostró una validez moderada para energía, macronutrimentos y micronutrimentos. Además, mostró buena validez para clasificar a los individuos de acuerdo con su ingesta dietética.

Validity and Reliability of a Self-administered Food Frequency Questionnaire to Assess Vitamin K Intake in Korean Adults

This study was conducted to validate a food frequency questionnaire (FFQ) to assess vitamin K intake in clinical and research settings based on data from the Fifth Korea National Health and Nutrition Examination Survey (KNHANES V). We collected a subset of data on informative food items using the 24-hour recall method from adults aged 19 to 64 years from KNHANES V. The cumulative percent contribution and cumulative multiple regression coefficients for vitamin K intake from each food were computed. Twenty-five foods items were selected for the FFQ to assess vitamin K intake. The FFQ was validated against intakes derived from a 5-day food record (5DR) (n = 48). To assess the reliability of the FFQ, participants completed the self-administered FFQ (FFQ1) and a second FFQ (FFQ2) after a 6-month period (n = 54). Data were analyzed using Pearson's correlation coefficients, the cross-classification method, and Bland-Altman plots. Mean intakes were similar for vitamin K between the FFQ and dietary records, with significant correlations observed (r = 0.652), and cross-classification analyses demonstrated no major misclassification of participants into intake quartiles. Bland-Altman plots showed no serious systematic bias between the administrations of the two dietary assessment methods over the range of mean intakes. FFQ reliability was high, with a Pearson's correlation coefficient of 0.560. This pilot study shows promising validation and reliability evidence for the use of this FFQ, which is focused on vitamin K intake in adults, as an efficient screening tool in clinical and research settings.