Relative validity of a food frequency questionnaire for obesity surveillance in school-aged children – The Childhood Obesity Surveillance Initiative in Ireland

AbstractIntroductionValidation studies are indispensable to test the appropriateness of dietary assessment methods used within epidemiological surveys to accurately assess food intake in young populations. The aim of this study was to examine the relative validity of the food group frequency questionnaire (FGFQ) used to assess dietary intake in the Childhood Obesity Surveillance Initiative.Materials and MethodsThis study was undertaken in a convenience sample of 33 Irish children aged 7–9 years old from urban Dublin-based primary schools. Food group intake estimates were collected with the FGFQand compared with those obtained with a 7-day semi-weighed food diary. Agreement between frequencies of intake between the two instruments were examined using Spearman's correlation coefficient, cross-classification analyses and weighted kappa.ResultsThe FGFQ over-estimated the number of portions for most of the food groups as compared with the reference method. Spearman correlation coefficients ranged from 0.75 (cheese) to 0.03 (flavoured milk). Level of agreement was moderate with an average correlation coefficient of 0.45. The proportion of children classified in the same category ranged from 96.9% (sweet treats) to 60.6% (vegetables). Misclassification was less than 15% for fruit, soft drinks, low fat milk, fish, savoury snacks and sweet treats and above 30% for vegetables, dairy products and pastries & biscuits. Weighted kappa statistic values ranged from 0.84 (sweet treats) to 0.10 (vegetables). Mean level of agreement was moderate (0.39). No agreement (< 0.0) was found for soft drinks.DiscussionAlthough the strength of association estimates varied by food group, strong to moderate levels of relative validity were observed. Our results show that the FGFQ gives acceptable estimates of food group intakes among Irish school-aged children and that the tool can be used for ranking subjects according to food group intakes.

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A Belgian study on the reliability and relative validity of the Health Behaviour in School-Aged Children food-frequency questionnaire

Public Health Nutrition ◽

10.1079/phn2003466 ◽

2003 ◽

Vol 6 (6) ◽

pp. 581-588 ◽

Cited By ~ 164

Author(s):

Carine A Vereecken ◽

Lea Maes

Keyword(s):

Health Behaviour ◽

Food Frequency Questionnaire ◽

Weighted Kappa ◽

Study Data ◽

Soft Drinks ◽

Food Diary ◽

Food Frequency ◽

Relative Validity ◽

School Aged Children ◽

Food Items

AbstractObjective:In the Health Behaviour in School-Aged Children (HBSC) survey, the frequency of consumption of a limited number of food items – focusing on fibre, calcium and less healthy items – is queried using a 15-item food-frequency questionnaire (FFQ). The present study was conducted to assess the reliability and relative validity of the HBSC FFQ among school pupils in Belgium.Design and subjects:To assess the reliability of the FFQ, 207 pupils aged 11–12 years and 560 pupils aged 13–14 years completed the questionnaire twice, with a test–retest interval of 6 to 15 days. To assess the relative validity of the FFQ, in a first study data were collected as part of the Flemish HBSC 2000 survey: 7072 pupils (11–18 years) completed the FFQ and a 24-hour food behaviour checklist (FBC). In a second study, 101 pupils (11–12 years) completed the FFQ and a 7-day food diary (FD).Results:Reliability – weighted kappa values between test and retest ranged from 0.43 to 0.70, percentage agreement from 37 to 87%, and Spearman correlations from 0.52 to 0.82. Relative validity – comparison of the FBC with the percentage of respondents who should have consumed the food items on a random day, computed from the FFQ, showed good agreement between the FFQ and the FBC for most items. Only for cereals, diet soft drinks and other milk products were considerably higher food frequencies than expected found from the FBC. Comparison of the FFQ with the FD showed overestimation for all but three food items (cheese, soft drinks and chips). Spearman correlations ranged between 0.10 for crisps and 0.65 for semi-skimmed milk.Conclusion:The HBSC FFQ is a reliable questionnaire that can be used for ranking subjects for most food items, although one must consider the overestimation when the FFQ is used for estimating prevalences.

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Development and Relative Validity of a Semiquantitative Food Frequency Questionnaire to Estimate Dietary Intake among a Multi-Ethnic Population in the Malaysian Cohort Project

Nutrients ◽

10.3390/nu13041163 ◽

2021 ◽

Vol 13 (4) ◽

pp. 1163

Author(s):

Suzana Shahar ◽

Mohd Razif Shahril ◽

Noraidatulakma Abdullah ◽

Boekhtiar Borhanuddin ◽

Mohd Arman Kamaruddin ◽

...

Keyword(s):

Vitamin C ◽

Correlation Coefficient ◽

Food Frequency Questionnaire ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Weighted Kappa ◽

Dietary Intakes ◽

Food Frequency ◽

Relative Validity ◽

Spearman’S Correlation

Measuring dietary intakes in a multi-ethnic and multicultural setting, such as Malaysia, remains a challenge due to its diversity. This study aims to develop and evaluate the relative validity of an interviewer-administered food frequency questionnaire (FFQ) in assessing the habitual dietary exposure of The Malaysian Cohort (TMC) participants. We developed a nutrient database (with 203 items) based on various food consumption tables, and 803 participants were involved in this study. The output of the FFQ was then validated against three-day 24-h dietary recalls (n = 64). We assessed the relative validity and its agreement using various methods, such as Spearman’s correlation, weighed Kappa, intraclass correlation coefficient (ICC), and Bland–Altman analysis. Spearman’s correlation coefficient ranged from 0.24 (vitamin C) to 0.46 (carbohydrate), and almost all nutrients had correlation coefficients above 0.3, except for vitamin C and sodium. Intraclass correlation coefficients ranged from −0.01 (calcium) to 0.59 (carbohydrates), and weighted Kappa exceeded 0.4 for 50% of nutrients. In short, TMC’s FFQ appears to have good relative validity for the assessment of nutrient intake among its participants, as compared to the three-day 24-h dietary recalls. However, estimates for iron, vitamin A, and vitamin C should be interpreted with caution.

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Assessing the relative validity of the Scottish Collaborative Group FFQ for measuring dietary intake in adults

Public Health Nutrition ◽

10.1017/s1368980016002421 ◽

2016 ◽

Vol 20 (3) ◽

pp. 449-455 ◽

Cited By ~ 9

Author(s):

Jenna L Hollis ◽

Leone CA Craig ◽

Stephen Whybrow ◽

Heather Clark ◽

Janet AM Kyle ◽

...

Keyword(s):

Validation Study ◽

Large Scale ◽

Weighted Kappa ◽

Collaborative Group ◽

Altman Analysis ◽

Food Diary ◽

Cross Sectional ◽

Relative Validity ◽

Bland Altman Analysis ◽

Spearman’S Correlation

AbstractObjectiveTo assess the relative validity of the latest version of the Scottish Collaborative Group (SCG) FFQ (version 6.6) in adults living in Scotland.DesignA cross-sectional validation study. Participants completed the self-administered, 169-item SCG FFQ followed by a 7 d, non-weighed food diary. Energy and energy-adjusted macronutrients and micronutrients were examined for relative validity through Spearman’s correlation, the percentage of classification into thirds of intake, Cohen’s weighted kappa (κw) and Bland–Altman analysis.SettingGeneral population living in Scotland.SubjectsNinety-six adults aged 18–65 years.ResultsSpearman’s correlation coefficients ranged from 0·21 (retinol) to 0·71 (Mg). A median of 52 % of adults were correctly classified into thirds of intake (range: 42 % (PUFA, MUFA and Fe) to 64 % (percentage energy from carbohydrates)) and 8 % were grossly misclassified into opposite thirds of intake (range: 3 % (carbohydrates, percentage energy from carbohydrates) to 19 % (thiamin)). Values of κw ranged between 0·20 (PUFA, β-carotene) to 0·55 (percentage energy from carbohydrates). In the Bland–Altman analysis, the smallest limits of agreement, when expressed as a percentage of the mean intake from the FFQ and food diary, were seen for the main macronutrients carbohydrates, fat and protein.ConclusionsAs in the previous validation study more than 10 years ago, the FFQ gave higher estimates of energy and most nutrients than the food diary, but after adjustment for energy intake the FFQ could be used in place of non-weighed food diaries for most macronutrients and many micronutrients in large-scale epidemiological studies.

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The quality of school lunch consumed reflects overall eating patterns in 11–16-year-old schoolchildren in Finland

Public Health Nutrition ◽

10.1017/s1368980011001388 ◽

2011 ◽

Vol 14 (12) ◽

pp. 2092-2098 ◽

Cited By ~ 20

Author(s):

Tanja Tilles-Tirkkonen ◽

Saara Pentikäinen ◽

Jenni Lappi ◽

Leila Karhunen ◽

Kaisa Poutanen ◽

...

Keyword(s):

Primary Schools ◽

Dairy Products ◽

School Lunch ◽

Soft Drinks ◽

Eating Patterns ◽

School Aged Children ◽

Family Dinner ◽

Eastern Finland ◽

At Home

AbstractObjectiveTo explore how the quality of school lunch consumed reflected overall eating patterns in school-aged children.DesignChildren filled in an Internet-based questionnaire about their eating patterns. The children were then divided into balanced and imbalanced school lunch eaters on the basis of their responses in the questionnaire. A balanced school lunch consisted of, by the definition used in the present study, a main dish, salad and bread.SettingEleven primary schools and one middle school in eastern Finland.SubjectsA total of 531 schoolchildren (247 boys and 284 girls) aged 11–16 years.ResultsThe school lunch was balanced in 46·5 % of children. Eating a balanced school lunch was associated with overall healthier eating patterns outside school. Children who ate a balanced school lunch had more regular meal times and consumed healthier snacks. They ate fruit or berries and vegetables, dairy products and wholegrain foods more often, consumed fewer salty snacks, pizzas, meat pies and drank fewer soft drinks and energy drinks. Their eating patterns at home were also healthier, with vegetables being offered at every family dinner and fruit being offered daily, whereas soft drinks were offered seldom.ConclusionsThe choices made by children in their school lunch reflect the overall eating patterns among school-aged children. Eating a balanced school lunch is associated with more regular meal patterns, the availability of healthier foods at home and an overall healthier diet, suggesting that healthy eating patterns are learnt at home.

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Relative validity of an FFQ for pre-school children in the mother–child ‘Rhea’ birth cohort in Crete, Greece

Public Health Nutrition ◽

10.1017/s1368980014000445 ◽

2014 ◽

Vol 18 (3) ◽

pp. 421-427 ◽

Cited By ~ 11

Author(s):

Vasiliki Leventakou ◽

Vaggelis Georgiou ◽

Leda Chatzi ◽

Katerina Sarri

Keyword(s):

Birth Cohort ◽

School Children ◽

Correlation Coefficients ◽

Weighted Kappa ◽

Food Group ◽

Kappa Statistics ◽

Nutrient Intakes ◽

Relative Validity ◽

Food Records ◽

The Mean

AbstractObjectiveTo examine the relative validity of an FFQ based on parental report for pre-school children in the mother–child ‘Rhea’ birth cohort.DesignThe children’s mothers completed an FFQ that referred to the children’s dietary intake for the previous year by telephone interview. Mothers completed also three food records, two on weekdays and one on a weekend day. Spearman correlation coefficients were calculated for the energy-adjusted values. Weighted kappa statistics (κw) and the Bland–Altman technique were used to test the degree of agreement between the two dietary methods.SettingHeraklion, Crete, Greece, 2011–2012.SubjectsA total of ninety-nine mothers (corresponding to fifty-one boys and forty-eight girls) participated in the validation study.ResultsThe mean and median values of all food group and nutrient intakes did not differ significantly between the two dietary methods. Overall, fair agreement was observed between the FFQ and the food records for ranking participants based on their intake, with κw ranging from 0·21 to 0·40 for most foods and nutrients. On average, 88 % of participants were classified into the same or adjacent tertiles for nutrient and food group intakes by both dietary methods. The degree of agreement was also confirmed by the visual examination of the Bland–Altman plots.ConclusionsThe study indicates that the Rhea 4 years FFQ is a relatively accurate tool for assessing habitual food group and nutrient intakes among pre-school children in Crete, Greece.

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FFQ for the adult population of the capital of Ecuador (FFQ-Quito): development, reliability and validity

Public Health Nutrition ◽

10.1017/s1368980014003346 ◽

2015 ◽

Vol 18 (14) ◽

pp. 2540-2549 ◽

Cited By ~ 7

Author(s):

Katherine M Silva-Jaramillo ◽

Marilda B Neutzling ◽

Michele Drehmer

Keyword(s):

Correlation Coefficient ◽

Nutrient Intake ◽

Communicable Disease ◽

Pearson Correlation ◽

Adult Population ◽

Reliability And Validity ◽

Correlation Coefficients ◽

Weighted Kappa ◽

Nutrient Intakes ◽

Relative Validity

AbstractObjectiveTo assess the reliability and validity of a semi-quantitative FFQ designed to evaluate the usual nutrient intake of adults in Quito, Ecuador.DesignDietary data using 24 h recalls (24hR) were used to design a list of commonly consumed foods. The relative validity of a 111-item FFQ was evaluated by comparing nutrient intakes against three non-consecutive 24hR. All nutrients were energy-adjusted. Reliability was assessed using two FFQ (FFQ1 and FFQ2) and assessed by the intra-class correlation coefficient. The comparisons between the FFQ and the 24hR were assessed by the de-attenuated Pearson correlation coefficient, weighted kappa and by Bland–Altman plots.SettingQuito, Ecuador.SubjectsOverall, 345 adults were enrolled in the present study. Two hundred and fifty participated in FFQ development and ninety-five participated in the FFQ validity and reliability.ResultsThe FFQ produced higher energy and nutrient intakes. Reliability correlation coefficients after adjusting for energy ranged from 0·62 to 0·88 for protein and Ca, respectively. For the validity study, energy-adjusted and de-attenuated correlation coefficients between the questionnaire and the 24hR ranged from 0·21 for fat to 0·65 for Ca. Only 4 % of the participants were grossly misclassified and 46 % had weighted kappa higher than 0·42. The Bland–Altman plot showed a constant bias with a tendency to increase according to the intake level.ConclusionsThe FFQ showed reasonably good relative validity and reliable measurements, especially for nutrients considered protective and risk markers of non-communicable disease, and can be used to assess usual nutrient intake in this population.

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Validity and reproducibility of two semi-quantitative alcohol frequency questionnaires for the Colombian population

Public Health Nutrition ◽

10.1079/phn2005880 ◽

2006 ◽

Vol 9 (6) ◽

pp. 763-770 ◽

Cited By ~ 7

Author(s):

Oscar F Herrán ◽

María F Ardila

Keyword(s):

Correlation Coefficient ◽

Alcohol Intake ◽

Rank Correlation ◽

Kappa Statistic ◽

Cost Effective ◽

Weighted Kappa ◽

Relative Validity ◽

Spearman’S Rank Correlation ◽

Spearman’S Rank Correlation Coefficient ◽

Alcoholic Drinks

AbstractObjectiveTo determine the relative validity and reproducibility of two alcohol intake frequency questionnaires (AFQ-A; AFQ-B), designed to classify subjects according to their alcohol intake level, in Bucaramanga, Colombia.MethodOne hundred and nine randomly selected subjects, aged between 20 and 60 years, completed three 30-day semi-quantitative alcohol intake records (30-DR). The AFQs were applied three months after the last 30-DR. AFQ-A contained 53 items; AFQ-B contained five items, with the alcoholic drinks for AFQ-B selected by Max_r. The correlation and agreement between alcohol intake assessed with the AFQs and the 30-DR were obtained using Pearson's correlation coefficient (r), Lin's concordance correlation coefficient (pC), Spearman's rank correlation coefficient(rS), Bland and Altman's limits of agreement (LOA) and Cohen's weighted kappa statistic (Kw).ResultsThe reproducibility of the 30-DR was poor; rS ranged from 0.33 to 0.41. The reproducibility of the AFQs was higher, with rS between 0.50 and 0.73. The agreement(Kw) of the 30-DR and the AFQs was 0.40. The lower and upper LOA were between 56.4% and 11.0%. The AFQs and 30-DR were well correlated. Assessment of relative validity between the two methods yielded r values for alcohol between 0.52 Alcohol consumption and 0.60, which reduced to 0.20–0.29 after energy adjustment.ConclusionsThese AFQs may be useful to rank subjects according to their alcohol Max_r intake. The AFQ-B is easy and quick to apply, and is also highly cost-effective.

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Relative validity of the pre-coded food diary used in the Danish National Survey of Diet and Physical Activity

Public Health Nutrition ◽

10.1017/s1368980011001650 ◽

2011 ◽

Vol 14 (12) ◽

pp. 2110-2116 ◽

Cited By ~ 14

Author(s):

Vibeke K Knudsen ◽

Maj-Britt Gille ◽

Trine H Nielsen ◽

Tue Christensen ◽

Sisse Fagt ◽

...

Keyword(s):

Physical Activity ◽

National Survey ◽

Dietary Habits ◽

Weighted Kappa ◽

Portion Size ◽

Food Record ◽

Food Diary ◽

Nutrient Intakes ◽

Relative Validity ◽

Weighed Food Record

AbstractObjectiveTo determine the relative validity of the pre-coded food diary applied in the Danish National Survey of Dietary Habits and Physical Activity.DesignA cross-over study among seventy-two adults (aged 20 to 69 years) recording diet by means of a pre-coded food diary over 4 d and a 4 d weighed food record. Intakes of foods and drinks were estimated, and nutrient intakes were calculated. Means and medians of intake were compared, and cross-classification of individuals according to intake was performed. To assess agreement between the two methods, Pearson and Spearman's correlation coefficients and weighted kappa coefficients were calculated.SettingValidation study of the pre-coded food diary against a 4 d weighed food record.SubjectsSeventy-two volunteer, healthy free-living adults (thirty-five males, thirty-seven females).ResultsIntakes of cereals and vegetables were higher, and intakes of fruit, coffee and tea were lower, in the weighed food record compared with the food diary. Intakes of nutrients were grossly the same in the two methods, except for protein, where a higher intake was recorded in the weighed record. In general, moderate agreement between the two methods was found.ConclusionsParticipants were classified moderately correct according to food and nutrient intakes assessed in the pre-coded food diary; however values of absolute food intakes should be used and interpreted with caution. Improvement of the methods to estimate portion size may increase the accuracy of the dietary intake estimates.

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Relative validity of a semi-quantitative FFQ in 3-year-old Polish children

Public Health Nutrition ◽

10.1017/s1368980013002292 ◽

2013 ◽

Vol 17 (8) ◽

pp. 1738-1744 ◽

Cited By ~ 9

Author(s):

Elżbieta Sochacka-Tatara ◽

Agnieszka Pac

Keyword(s):

Dietary Intake ◽

Correlation Coefficient ◽

Rank Correlation ◽

Reference Method ◽

Rank Test ◽

Dietary Intakes ◽

Nutrient Intakes ◽

Relative Validity ◽

Bland Altman Method ◽

Level Of Agreement

AbstractObjectivesThe aim of the study was to assess the relative validity of a semi-quantitative FFQ (SFFQ) which measures the usual dietary intake of 3-year-old children.DesignThe children's daily dietary intake was measured using the SFFQ. The average intake of three 24 h dietary recalls (24hDR) was calculated as a reference method. Wilcoxon's rank test and Spearman's rank-correlation coefficient were used to compare nutrient intakes assessed by both methods. The level of agreement between the SFFQ and the repeated 24hDR was determined by the Bland–Altman method. To assess the agreement in quartile distribution, the weighted kappa coefficient (κw) was used.SettingKrakow, Poland.SubjectsOne hundred and forty-three 3-year-old children and their mothers, participants of a prospective cohort study.ResultsOverall, the SFFQ overestimated energy and nutrient intakes compared with the repeated 24hDR. The median correlation coefficient for energy and nutrient intakes was 0·456, with higher results for Ca, P and riboflavin. Although theκwvalue showed only slight to fair agreement between the two methods, about 75 % of the children were classified into the same or adjacent quartile and the level of agreement assessed by the Bland–Altman method for most of the nutrients investigated was good.ConclusionsThe study indicated that the SFFQ might be a useful tool to assess dietary intakes of nutrients by small children, especially for ranking them according their nutrient intake.

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Sugar-Sweetened Beverage Consumption Status and Its Association with Childhood Obesity among Chinese Children Aged 6–17 Years

Nutrients ◽

10.3390/nu13072211 ◽

2021 ◽

Vol 13 (7) ◽

pp. 2211

Author(s):

Qian Gan ◽

Peipei Xu ◽

Titi Yang ◽

Wei Cao ◽

Juan Xu ◽

...

Keyword(s):

Childhood Obesity ◽

Urban Areas ◽

Study Data ◽

Chinese Children ◽

Obesity Prevalence ◽

Older Children ◽

Sugar Sweetened Beverage ◽

School Aged Children ◽

Chinese School ◽

And Control

Objective: There is a remarkable growth in sugar-sweetened (SSB) production and obesity prevalence among school-aged children in China. This paper describes SSB consumption and its association with obesity among Chinese children aged 6–17 years in 2012. Methods: in total, 25,553 children aged 6~17 years enrolled in the China Nutrition and Health Surveillance 2010–2013 were included in this study. Data of SSB consumption frequency and quantity were obtained from a food frequency questionnaire, and the children’s nutritional status was assessed. Multivariate logistic regression was used to evaluate the association between SSB consumption and obesity status. Results: SSB intake was estimated as 181.0 g/day, occurring 2.2 times/week. Older children, males, children from urban areas, and children with higher socioeconomic status were more likely to consume SSBs. Children who consumed SSBs 1~<5 times/week (11.7%) and >5 times/week (12.9%) were more likely to be overweight/obesity than those who consumed SSBs less than once/week. Conclusion: SSB consumption was common among Chinese school-aged children, especially among males, older children, and children from urban areas. High consumption of SSBs was associated with a higher prevalence of overweight/obesity. Actions and plans are required to reduce SSB consumption and control childhood obesity in China.

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