September 2012, 11:65,
Open Access This content is freely available online to anyone, anywhere at any time.
Date: 05 Sep 2012
Reliability and relative validity of a food frequency questionnaire to assess food group intakes in New Zealand adolescents
Due to the absence of a current and validated food frequency questionnaire (FFQ) for use in New Zealand adolescents, there is a need to develop one as a cost-effective way to assess adolescents’ food patterns. This study aims to examine the test-retest reliability and relative validity of the New Zealand Adolescent FFQ (NZAFFQ) to assess food group intake in adolescents aged 14 to 18 years.
A non-quantitative (without portion size), 72-item FFQ was developed and pretested. Fifty-two participants (aged 14.9 ± 0.8 years) completed the NZAFFQ twice within a two-week period for test-retest reliability. Forty-one participants (aged 15.1 ± 0.9 years) completed a four-day estimated food record (4DFR) in addition to the FFQs to enable assessment of validity. Spearman’s correlations and cross-classification analyses were used to examine relative validity while intra-class correlations were additionally used for test-retest reliability.
Weekly intakes were estimated for each food item and aggregated into 34 food groups. The median Spearman’s correlation coefficient (SCC) between FFQ administrations was 0.71. SCCs ranged from 0.46 for fruit juice or cordial to 0.87 for non-standard milk. The median intra-class correlation coefficient (ICC) between FFQ administrations was 0.69. The median SCC between food groups from the FFQ and the 4DFR was 0.40 with the highest SCC seen for standard milk (0.70). The exact agreement between the methods in ranking participants into thirds was highest for meat alternatives (78%), but lowest for red or yellow vegetables and potatoes (27%). The mean percent of participants misclassified into extreme thirds for food group intake was 12%.
Despite a small sample size, the NZAFFQ exhibited good to excellent short-term test-retest reliability and reasonable validity in ranking the majority of the food group intakes among adolescents aged 14 to 18 years. The comparability of the validity to that in the current literature suggests that the NZAFFQ may be used among adolescent New Zealanders to identify dietary patterns and rank them according to food group intake.
Ministry of Health: Food and Nutrition Guidelines for Healthy Children and Young People (Aged 2–18 Years): A background paper: Draft for Consultation. Wellington; 2010.
Kavey RE, Daniels SR, Lauer RM, Atkins DL, Hayman LL, Taubert K, American Heart A: American Heart Association guidelines for primary prevention of atherosclerotic cardiovascular disease beginning in childhood. Circulation 2003, 107:1562–1566.CrossRef
Linos E, Willett WC, Cho E, Frazier L: Adolescent diet in relation to breast cancer risk among premenopausal women. Cancer Epidemiol Biomarkers Prev 2010, 19:689–696.CrossRef
Neumark-Sztainer D, Story M, Hannan PJ, Croll J: Overweight status and eating patterns among adolescents: where do youths stand in comparison with the healthy people 2010 objectives? Am J Public Health 2002, 92:844.CrossRef
Nicklas TA, Baranowski T, Cullen KW, Berenson G: Eating patterns, dietary quality and obesity. J Am Coll Nutr 2001, 20:599–608.
Vereecken CA, De Henauw S, Maes L: Adolescents' food habits: results of the Health Behaviour in School-aged Children survey. Br J Nutr 2005, 94:423–431.CrossRef
Rockell JE, Skidmore PM, Parnell WR, Wilson N: What children eat during afternoons and evenings: is it important? Public Health Nutr 2011, 14:557–562.CrossRef
Diethelm K, Jankovic N, Moreno LA, Huybrechts I, De Henauw S, De Vriendt T, Gonzalez-Gross M, Leclercq C, Gottrand F, Gilbert CC, et al.: Food intake of European adolescents in the light of different food-based dietary guidelines: results of the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study. Public Health Nutr 2012, 15:386–398.CrossRef
Parnell E, Scragg R, Wilson N, Schaaf D, Fitzgerald E: NZ Food NZ Children: Key results of the 2002 National Children's Nutrition Survey. Wellington; 2003.
Livingstone MB, Robson PJ: Measurement of dietary intake in children. Proc Nutr Soc 2000, 59:279–293.CrossRef
Livingstone MB, Robson PJ, Wallace JM: Issues in dietary intake assessment of children and adolescents. Br J Nutr 2004,92(Suppl 2):S213-S222.CrossRef
Thompson FE, Subar AF: Dietary assessment methodology. In Nutrition in the Prevention and Treatment of Disease. 2. Edited by: Coulston AM, Boushey CJ. San Diego: Academic Press; 2008:1–38.
Magarey A, Watson J, Golley RK, Burrows T, Sutherland R, McNaughton SA, Denney-Wilson E, Campbell K, Collins C: Assessing dietary intake in children and adolescents: Considerations and recommendations for obesity research. Int J Pediatr Obes 2011, 6:2–11.CrossRef
Moreno LA, Kersting M, de Henauw S, Gonzalez-Gross M, Sichert-Hellert W, Matthys C, Mesana MI, Ross N: How to measure dietary intake and food habits in adolescence: the European perspective. Int J Obes 2005, 29:S66-S77.CrossRef
Rockett HR, Berkey CS, Colditz GA: Evaluation of dietary assessment instruments in adolescents. Curr Opin Clin Nutr Metab Care 2003, 6:557–562.CrossRef
Berkey CS, Rockett HR, Field AE, Gillman MW, Frazier AL, Camargo CA Jr, Colditz GA: Activity, dietary intake, and weight changes in a longitudinal study of preadolescent and adolescent boys and girls. Pediatrics 2000, 105:E56.CrossRef
Frank GC, Nicklas TA, Webber LS, Major C, Miller JF, Berenson GS: A food frequency questionnaire for adolescents: defining eating patterns. J Am Diet Assoc 1992, 92:313–318.
Rockett HR, Breitenbach M, Frazier AL, Witschi J, Wolf AM, Field AE, Colditz GA: Validation of a youth/adolescent food frequency questionnaire. Prev Med 1997, 26:808–816.CrossRef
Watanabe M, Yamaoka K, Yokotsuka M, Adachi M, Tango T: Validity and reproducibility of the FFQ (FFQW82) for dietary assessment in female adolescents. Public Health Nutr 2011, 14:297–305.CrossRef
Lillegaard ITL, Overby NC, Andersen LF: Can children and adolescents use photographs of food to estimate portion sizes? Eur J Clin Nutr 2005, 59:611–617.CrossRef
Foster E, Matthews JN, Nelson M, Harris JM, Mathers JC, Adamson AJ: Accuracy of estimates of food portion size using food photographs–the importance of using age-appropriate tools. Public Health Nutr 2006, 9:509–514.CrossRef
Buzzard IM, Stanton CA, Figueiredo M, Fries EA, Nicholson R, Hogan CJ, Danish SJ: Development and reproducibility of a brief food frequency questionnaire for assessing the fat, fiber, and fruit and vegetable intakes of rural adolescents. J Am Diet Assoc 2001, 101:1438–1446.CrossRef
Schlundt DG, Buchowski MS, Hargreaves MK, Hankin JH, Signorello LB, Blot WJ: Separate estimates of portion size were not essential for energy and nutrient estimation: results from the Southern Community Cohort food-frequency questionnaire pilot study. Public Health Nutr 2007, 10:245–251.CrossRef
Vereecken CA, Maes L: A Belgian study on the reliability and relative validity of the Health Behaviour in School-Aged Children food-frequency questionnaire. Public Health Nutr 2003, 6:581–588.CrossRef
Lazarou C, Panagiotakos DB, Matalas AL: Foods E-KINDEX: a dietary index associated with reduced blood pressure levels among young children: the CYKIDS study. J Am Diet Assoc 2009, 109:1070–1075.CrossRef
Magarey A, Golley R, Spurrier N, Goodwin E, Ong F: Reliability and validity of the Children's Dietary Questionnaire; a new tool to measure children's dietary patterns. Int J Pediatr Obes 2009, 4:257–265.CrossRef
Cade J, Thompson R, Burley V, Warm D: Development, validation and utilisation of food-frequency questionnaires - a review. Public Health Nutr 2002, 5:567–587.CrossRef
Watson JF, Collins CE, Sibbritt DW, Dibley MJ, Garg ML: Reproducibility and comparative validity of a food frequency questionnaire for Australian children and adolescents. Int J Behav Nutr Phys Act 2009, 6:62.CrossRef
United States Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, World Health Organization: Health Behavior in School-Aged Children (2008), 2001–2002. 2008. [Health Behavior in School-Aged Children, 2001–2002] http://dx.doi.org/10.3886/ICPSR04372.v2
University of Otago, Ministry of Health: A Focus on Nutrition: Key findings of the 2008/09 New Zealand Adult Nutrition Survey. Wellington; 2011.
Vereecken CA, Rossi S, Giacchi MV, Maes L: Comparison of a short food-frequency questionnaire and derived indices with a seven-day diet record in Belgian and Italian children. Int J Public Health 2008, 53:297–305.
Yannakoulia M, Karayiannis D, Terzidou M, Kokkevi A, Sidossis LS: Nutrition-related habits of Greek adolescents. Eur J Clin Nutr 2004, 58:580–586.CrossRef
Subar AF, Thompson FE, Smith AF, Jobe JB, Ziegler RG, Potischman N, Schatzkin A, Hartman A, Swanson C, Kruse L, et al.: Improving food frequency questionnaires: a qualitative approach using cognitive interviewing. J Am Diet Assoc 1995, 95:781–788.CrossRef
Ambrosini GL, O'Sullivan TA, de Klerk NH, Mori TA, Beilin LJ, Oddy WH: Relative validity of adolescent dietary patterns: a comparison of a FFQ and 3 d food record. Br J Nutr 2011, 105:625–633.CrossRef
Bradlee ML, Singer MR, Qureshi MM, Moore LL: Food group intake and central obesity among children and adolescents in the Third National Health and Nutrition Examination Survey (NHANES III). Public Health Nutr 2010, 13:797–805.CrossRef
Departmant of Human Nutrition: Diet Assessment Photos. Dunedin; 2000.
Metcalf PA, Scragg RK, Sharpe S, Fitzgerald ED, Schaaf D, Watts C: Short-term repeatability of a food frequency questionnaire in New Zealand children aged 1–14 y. Eur J Clin Nutr 2003, 57:1498–1503.CrossRef
Cullen KW, Watson K, Zakeri I: Relative reliability and validity of the Block Kids Questionnaire among youth aged 10 to 17 years. J Am Diet Assoc 2008, 108:862–866.CrossRef
Deschamps V, de Lauzon-Guillain B, Lafay L, Borys JM, Charles MA, Romon M: Reproducibility and relative validity of a food-frequency questionnaire among French adults and adolescents. Eur J Clin Nutr 2009, 63:282–291.CrossRef
Xia W, Sun C, Zhang L, Zhang X, Wang J, Wang H, Wu L: Reproducibility and relative validity of a food frequency questionnaire developed for female adolescents in Suihua, North China. PLoS ONE 2011, 6:e19656.CrossRef
Willett W, Lenart E: Reproducibility and validity of food-frequency questionnaires. In Nutritional Epidemiology. Edited by: Willett W. Oxford: Oxford University Pres; 1998.CrossRef
Lanfer A, Hebestreit A, Ahrens W, Krogh V, Sieri S, Lissner L, Eiben G, Siani A, Huybrechts I, Loit HM, et al.: Reproducibility of food consumption frequencies derived from the Children's Eating Habits Questionnaire used in the IDEFICS study. Int J Obes 2011,35(Suppl 1):S61-S68.CrossRef
Speck BJ, Bradley CB, Harrell JS, Belyea MJ: A food frequency questionnaire for youth: psychometric analysis and summary of eating habits in adolescents. J Adolesc Health 2001, 28:16–25.CrossRef
Field AE, Peterson KE, Gortmaker SL, Cheung L, Rockett H, Fox MK, Colditz GA: Reproducibility and validity of a food frequency questionnaire among fourth to seventh grade inner-city school children: implications of age and day-to-day variation in dietary intake. Public Health Nutr 1999, 2:293–300.CrossRef
Tooze JA, Midthune D, Dodd KW, Freedman LS, Krebs-Smith SM, Subar AF, Guenther PM, Carroll RJ, Kipnis V: A new statistical method for estimating the usual intake of episodically consumed foods with application to their distribution. J Am Diet Assoc 2006, 106:1575–1587.CrossRef
Haftenberger M, Heuer T, Heidemann C, Kube F, Krems C, Mensink GB: Relative validation of a food frequency questionnaire for national health and nutrition monitoring. Nutr J 2010, 9:36.CrossRef
Kobayashi T, Kamimura M, Imai S, Toji C, Okamoto N, Fukui M, Date C: Reproducibility and validity of the food frequency questionnaire for estimating habitual dietary intake in children and adolescents. Nutr J 2011, 10:27.CrossRef
Rockett HR, Berkey CS, Colditz GA: Comparison of a short food frequency questionnaire with the Youth/Adolescent Questionnaire in the Growing Up Today Study. Int J Pediatr Obes 2007, 2:31–39.CrossRef
Rodríguez G, Sjöberg A, Lissner L, Moreno LA: Food Patterns and Nutrient Intake in Relation to Childhood Obesity. In Epidemiology of Obesity in Children and Adolescents. Edited by: Moreno LA, Pigeot I, Ahrens W. New York: Springer; 2011:329–346.CrossRef
Matthys C, Pynaert I, De Keyzer W, De Henauw S: Validity and reproducibility of an adolescent web-based food frequency questionnaire. J Am Diet Assoc 2007, 107:605–610.CrossRef
Robinson S, Skelton R, Barker M, Wilman C: Assessing the diet of adolescent girls in the UK. Public Health Nutr 1999, 2:571–577.CrossRef
Willett W: Nutritional Epidemiology. 2nd edition. New York: Oxford University Press; 1998.CrossRef
Araujo MC, Yokoo EM, Pereira RA: Validation and calibration of a semiquantitative food frequency questionnaire designed for adolescents. J Am Diet Assoc 2010, 110:1170–1177.CrossRef
Truthmann J, Mensink GB, Richter A: Relative validation of the KiGGS Food Frequency Questionnaire among adolescents in Germany. Nutr J 2011, 10:133.CrossRef
Subar AF, Dodd KW, Guenther PM, Kipnis V, Midthune D, McDowell M, Tooze JA, Freedman LS, Krebs-Smith SM: The food propensity questionnaire: concept, development, and validation for use as a covariate in a model to estimate usual food intake. J Am Diet Assoc 2006, 106:1556–1563.CrossRef
- Reliability and relative validity of a food frequency questionnaire to assess food group intakes in New Zealand adolescents
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
- Online Date
- September 2012
- Online ISSN
- BioMed Central
- Additional Links
- Food frequency questionnaire (FFQ)
- New Zealand
- Author Affiliations
- 1. Department of Human Nutrition, University of Otago, Dunedin, 9054, New Zealand
- 2. School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, 50300, Malaysia