Elsevier

Clinical Nutrition

Volume 33, Issue 5, October 2014, Pages 906-914
Clinical Nutrition

Original article
Reproducibility and comparative validity of a food frequency questionnaire for Australian adults

https://doi.org/10.1016/j.clnu.2013.09.015Get rights and content

Summary

Background

Food frequency questionnaires (FFQ) are used in epidemiological studies to investigate the relationship between diet and disease. There is a need for a valid and reliable adult FFQ with a contemporary food list in Australia.

Aims

To evaluate the reproducibility and comparative validity of the Australian Eating Survey (AES) FFQ in adults compared to weighed food records (WFRs).

Methods

Two rounds of AES and three-day WFRs were conducted in 97 adults (31 males, median age and BMI for males of 44.9 years, 26.2 kg/m2, females 41.3 years, 24.0 kg/m2. Reproducibility was assessed over six months using Wilcoxon signed-rank tests and comparative validity was assessed by intraclass correlation coefficients (ICC) estimated by fitting a mixed effects model for each nutrient to account for age, sex and BMI to allow estimation of between and within person variance.

Results

Reproducibility was found to be good for both WFR and FFQ since there were no significant differences between round 1 and 2 administrations. For comparative validity, FFQ ICCs were at least as large as those for WFR. The ICC of the WFR-FFQ difference for total energy intake was 0.6 (95% CI 0.43, 0.77) and the median ICC for all nutrients was 0.47, with all ICCs between 0.15 (%E from saturated fat) and 0.7 (g/day sugars).

Conclusions

Compared to WFR the AES FFQ is suitable for reliably estimating the dietary intakes of Australian adults across a wide range of nutrients.

Introduction

Accurate assessment of dietary intake is critical to examining associations between food intake, obesity and risk of chronic disease mortality.1 The prevalence of obesity has almost doubled in men (4.8%–9.8%) and women (7.9%–13.8%) over the past 30 years.2 Given that obesity precedes development of many chronic conditions, it is important to examine current food patterns, using current and valid tools to assist in monitoring intake.

A number of methods have been used to measure usual dietary intake at the population level, however the accurate assessment of diet still presents on-going challenges, including substantial burden for both individuals and researchers, particularly in large population samples.3 Although 24-h recalls and weighed food records (WFRs) have been used successfully, the resource burden and economic constraints of these methods make them unsuitable for most large scale studies.4 Food frequency questionnaires (FFQs) have a lower respondent burden, are relatively inexpensive, do not require trained interviewers and can be semi-automated using technological administration, rendering them practical for large epidemiologic studies.5 Frequency data can explain much of the variation in dietary intake and FFQs can provide sufficient accuracy to rank individuals in terms of risk for subsequent health outcomes.6 FFQs have been used in adults to predict associations between dietary intake and disease specific mortality and morbidity including, colon cancer, heart disease and diabetes.7

In Australia, the Commonwealth Scientific Industrial Research Organisation (CSIRO) developed a FFQ in the early 1980s8 and the Australian Cancer Council of Victoria (ACCV) developed a FFQ for adults in the late 1980s.9 However, evaluation of the performance of the CSIRO FFQ showed it had limited validity and the ACCV FFQ, also known as the dietary questionnaire for epidemiological studies (DQES) was designed for a specific population of 40–69 year old men and women living in Australia but born in Greece, Italy or Australia.9 Both of these instruments are now over 25 years old and the Australian food supply has changed significantly over that period. While an Australian study reported the reproducibility, of a FFQ in adults with a mean age of 60 years,10 it did not evaluate validity, nor did it consider nutrient intakes. The Australian Eating Survey (AES) was developed in response to these gaps. Therefore the aim was to assess the reproducibility and comparative validity of nutrient intakes derived from a semi-quantitative, self-completed FFQ designed for adults residing in Australia.

Section snippets

Participants and recruitment

The population of interest was healthy adults living full-time with at least one child aged 8–10 years, living in the Hunter and Great Lakes regions of New South Wales, Australia, so as to potentially extend the age range and use of a previous FFQ validated for use in children aged 9–16 years.11 Potential participants were recruited through a range of avenues, including newspapers, community notice boards and school newsletters.

Study design

Participants completed the test measure AES FFQ and the reference

Results

A total of 98 participants were recruited to the study, with one excluded as neither FFQ nor WFR data was completed. All 97 participants completed a FFQ at the initial assessment session and of these, 68 completed a second FFQ in round 2. Ninety one of the 97 participants returned completed WFRs in round 1 and 66 in round 2, 65 of whom had completed a round 1 WFR.

Table 1 reports round 1, round 2 and change in demographic and anthropometric variables of the study participants, by sex. Thirty one

Discussion

The reproducibility and comparative validity of the AES FFQ were assessed in the current study using intra-class correlation coefficients (ICC) estimated by comparing nutrient data generated from three-day WFRs with the AES FFQ data over two administration rounds. The analysis methods utilized all collected data and accommodates for probable correlation of observations within the same family.

The reproducibility of the AES FFQ was confirmed as shown by the ICCs for each nutrient assessed as

Statement of authorship

CEC, JW, TB and MG designed the study. CEC and TB oversaw the study. KD, KP, CEC and TB, collected the data. JW, CEC and MB drafted the manuscript. MMB and MG undertook the statistical analysis. All authors contributed to critically reviewing, interpreting the results and approved the final manuscript. CEC had primary responsibility for the final content.

Funding sources

This research project was funded by Meat and Livestock Australia Human Nutrition Research Program grant. CE Collins is supported by a National Health and Medical Research Council, Career Development Fellowship.

Conflict of interest statement

No authors declare a conflict of interest. CE Collins was a member of the Meat and Livestock Australia Dietary Petterns Advisory group 2008--2009. A scannable version of the AES FFQ available for research applications from the University of Newcastle, Australia.

Acknowledgements

This research project was funded by a competitive grant from Meat and Livestock Australia Human Nutrition Research Program (G1000577). The views expressed in this manuscript are those of the authors. CEC is funded by a National Health and Medical Research Council Career Development Fellowship. The authors acknowledge the families who participated in the study as well as the student research assistants for data collection and data entry.

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