The HELENA online food frequency questionnaire: reproducibility and comparison with four 24-h recalls in Belgian-Flemish adolescents.

OBJECTIVES: To investigate the reproducibility of the HELENA Food Frequency Questionnaire (FFQ) developed as a basis for an online tailored intervention and to compare the FFQ with four computerized 24-h recalls. SUBJECTS/METHODS: A convenience sample of 48 Belgian-Flemish adolescents completed four computerized 24-h recalls, the FFQ and a retest 1-2 weeks later. Correlations, the Wilcoxon's signed rank test and Bland and Altman's plots were used to compare the intakes of 22 food groups, energy (kcal), fibre (g, g/1000 kcal), vitamin C (mg, mg/1000 kcal), calcium (mg, mg/1000 kcal), iron (mg, mg/1000 kcal) and fat (g, % from total energy). RESULTS: Reproducibility correlations were good (0.46-0.90). De-attenuated correlations between both methods were high (> or =0.51) for all nutrients and nutrient densities, except for fibre (g), vitamin C (mg) and percent energy from fat (respectively 0.23, 0.40 and 0.30). On a food group level correlations were significant (r(unadjusted)>0.3) for most (17/22) food groups. No systematic differences were found between test and retest; comparison with the recalls resulted in a significantly higher intake of bread, breakfast cereals, other snacks, vegetables, potatoes, coffee and tea, alcoholic beverages, energy, and most nutrients. No significant difference was found for calcium, whereas an underestimation was found for nutrient density of calcium and fat. CONCLUSIONS: The overestimation in seven food groups, resulting in an overestimation of energy, fibre, iron and vitamin C, and underestimation of percentage energy from fat, needs to be considered when the estimated intakes are used for tailored feedback.

[A longitudinal study on dietary habits and the primary socialization of these habits in young children]. / Een longitudinale studie rond voedingsgewoontes en de primaire socialisatie van voedingsgewoontes bij jonge kinderen.

The Family Influences on Food Intake study (FIFI), is a longitudinal study on dietary habits of young children and the primary socialization of these habits during childhood and during the transition into adolescence. Special attention is paid to the development, validation and feasibility of instruments measuring as well dependent as independent variables useful for large scale surveys. Parents of preschool children from the first year (+/-3 years of age) of 56 school departments were asked to complete a self-administered questionnaire biennially. Data of 862 children was available for the first measurement (2008). A web based dietary record tool was developed to investigate the relative validity of the Food Frequency Questionnaire (FFQ) used in the study. Two hundred and seventeen parents completed the online tool for three non-consecutive days. The feasibility of the online data collection is investigated and the reported intake is compared with the FFQ estimates. Associations between nutritional knowledge and attitudes of the children's mothers and dietary patterns of the children (FFQ) are investigated as well as relations between parent and child characteristics and fruit and vegetable intake. Additionally, 70 teachers completed a questionnaire on their attitudes towards the school food policy. The teachers' responses are compared with responses of parents from a previous study. Finally, the feasibility of an animated web based fruit and vegetables preferences tool, to be used in the follow up surveys, has been investigated in 4-6 years old (n=139 for fruit and n=135 for vegetables). The findings are summarized in the present paper.

Development and evaluation of a self-administered computerized 24-h dietary recall method for adolescents in Europe.

OBJECTIVE: To describe the development of a European computerized 24-h dietary recall method for adolescents, and to investigate the feasibility of self-administration (self report) by comparison with administration by a dietician (interview). METHODS: Two hundred and thirty-six adolescents (mean age 14.6 years (s.d.=1.7)) of eight European cities completed the 24-h recall (Young Adolescents Nutrition Assessment on Computer (YANA-C)) twice (once by self-report and once by interview). RESULTS: A small but significant underestimate in energy (61 (s.e.=31) kcal) and fat (4.2 (s.e.=1.7) g) intake was found in the self-reports in comparison with the interviews; no significant differences were found for the intake of carbohydrates, proteins, fibre, calcium, iron and ascorbic acid. Spearman's correlations were highly significant for all nutrients and energy ranging between 0.86 and 0.91. Agreement in categorizing the respondents as consumers and non-consumers for the 29 food groups was high (kappa statistics >or=0.73). Percentage omissions were on average 3.7%; percentage intrusions: 2.0%. Spearman's correlations between both modes were high for all food groups, for the total sample (>or=0.76) as well as for the consumers only (>or=0.72). Analysing the consumer only, on an average 54% of the consumed amounts were exactly the same; nevertheless, only for one group 'rice and pasta' a significant difference in consumption was found. CONCLUSION: Adaptation, translation and standardization of YANA-C make it possible to assess the dietary intake of adolescents in a broad international context. In general, good agreement between the administration modes was found, the latter offering significant potential for large-scale surveys where the amount of resources to gather data is limited.

Food and nutrient intake, nutritional knowledge and diet-related attitudes in European adolescents.

BACKGROUND AND OBJECTIVE: To provide an overview of methods used to assess food and nutrient intake, nutritional knowledge and diet-related attitudes in the Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study (HELENA-CSS), with selected results from the feasibility study. MATERIAL AND METHODS: To assess food intake in 13- to 16-year-old adolescents, a previously developed computer-assisted and self-administered 24-h recall was adapted for international use. Food consumption data were linked to national food composition databases to calculate energy and nutrient intakes. To assess nutritional knowledge in pupils not having any special (trained) education concerning 'nutrition', a 23-item validated multiple choice questionnaire was adapted. To assess eating attitudes, behaviour and/or putative problems with body weight in adolescents, a validated inventory covering 60 questions or statements was adapted for the study. In a feasibility study, instruments, data collection and processing were tested in one school class in each of the 10 participating European cities. RESULTS AND CONCLUSIONS: The feasibility study provided plausible results, quite consistent between countries. Against this background and for the first time, standardized and uniform methodology was made available for the main study to assess and characterize dietary intake, nutritional knowledge and eating attitudes.

A feasibility study of using a diet optimization approach in a web-based computer-tailoring intervention for adolescents.

OBJECTIVE: Adolescents are an interesting but neglected target group in obesity prevention. We assessed the feasibility of using a diet optimization approach for computer-tailored nutrition interventions for adolescents. METHOD: Development of an optimization model based on the public health approach to diet optimization. On the basis of food frequency questionnaires (FFQ) of 48 adolescents (14-17 years) optimized diets were calculated. RESULTS: The optimization calculations for all cases resulted in individual advice. On a total of 137 items included in the FFQ, the individualized advice included changes in a minimum of 36 and a maximum of 88 items (mean: 61 items), recommendations for changes in the food items ranged from less than 1 g day(-1) up to 1660 g day(-1). In almost all cases a higher intake of fruit and vegetables was recommended; some unexpected advice was also generated (for example, to decrease the consumption of brown bread and to increase the consumption of pizza). The strengths and weaknesses of the optimized diets are discussed. CONCLUSION: Using the optimization approach is a step forward in nutrition tailoring interventions but the model used in the present feasibility study still needs to be refined.

Young adolescents' nutrition assessment on computer (YANA-C).

OBJECTIVE: To assess the relative validity and acceptability of the computerised 24-h recall 'Young Adolescent's Nutrition Assessment on Computer (YANA-C)'. DESIGN: Food and nutrient intakes assessed with YANA-C were compared with food records (study 1) and 24-h dietary recall interviews (study 2). MAIN OUTCOME MEASURES: Intakes of food groups (fruit, fruit juice, vegetables, potatoes, bread, cereals, milk, cheese, other milk products, soft drinks, diet soft drinks, sugar/sweets, pastry/cookies, savoury snacks, butter/sauces, eggs, fish, meat) and nutrients (energy, carbohydrates, protein, fat, fiber, calcium, vitamin C and iron). SUBJECTS AND SETTING: A total of 237 pupils (11-14 y) from two primary and four secondary schools (study 1: n = 136; study 2: n = 101) in Belgium-Flanders. RESULTS: YANA-C proved to agree well with both standard methods in categorizing subjects in consumers and nonconsumers (kappa(study 1) = 0.48-0.92; kappa(study 2) = 0.38-0.90). Spearman's correlations for energy and nutrient intakes ranged between 0.44 and 0.79 for study 1 and between 0.44 and 0.86 for study 2. Nutrient and energy intakes were in general (excluding calcium) significantly higher in YANA-C in comparison with the food record, but not in comparison with the interview (only fiber). Statistics used to investigate whether YANA-C agreed with the other methods in ranking portions/amounts in consumers only were fair to moderate for most of the food groups (weighted kappa study 1 = 0.11-0.55; study 2 = 0.04-0.73); amounts in consumers only, were significantly lower in YANA-C against both standards for cereals; amounts were significantly higher in YANA-C against the food record for milk, soft drinks, sugar/sweets and savoury snacks and against the interview for potatoes. Only a few pupils evaluated the program negatively. CONCLUSION: YANA-C is a promising method to collect detailed dietary information from young adolescents with relatively low staff resources, useful in many nutrition research applications.

School food policy at primary and secondary schools in Belgium-Flanders: does it influence young people's food habits?

OBJECTIVE: To describe the availability of food items at primary and secondary schools in Belgium-Flanders and to examine the influence of school food policy (availability of food items, school food rules, nutrition education programmes) and aggregated school socioeconomical status (AGG SES) on the consumption of fruit, soft drinks, crisps and sweets, using multilevel modelling. DESIGN, SETTING AND SUBJECTS: In spring 2002, 360 schools were invited to participate in the Health Behaviour in School-aged Children survey. In January 2003, the same schools were asked to complete a short school policy questionnaire. Pupils of 197 schools participated in the pupil survey (n=16560); 247 school principals completed the school questionnaire; for 157 schools data were available for both (n=12 360). RESULTS: Mineral water, fruit juice, chocolate milk, and soup were available in most schools. Whole fat milk was available in most primary schools; soft drinks, diet soft drinks and biscuits were available in most secondary schools. Fruit was available in 14% of primary and 26% of secondary schools. Assessment of the variation in the outcome variables revealed no significant between-school variation in primary schools, but considerable variation between secondary schools in the consumption of soft drinks, sweets and crisps (but not fruit). School characteristics explaining some of this school variance independent of pupil level characteristics were: for soft drinks: availability at the school, rules regarding the consumption of sweets and AGG SES; for sweets: AGG SES; and for crisps: rules regarding the consumption of savoury snacks and AGG SES. CONCLUSION: The results indicate that school food policy can have an impact on adolescents' food habits.