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Development and validation of a food frequency questionnaire for assessing dietary calcium intake in the general population

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The aim of this study was to develop and evaluate a food frequency questionnaire (FFQ) for assessing dietary calcium intake in the general population, since all available questionnaires at present are age- and/or gender-specific. A total of 1001 individuals (including children, adults, and elderly people of both genders) were randomly recruited throughout Greece. Estimates of calcium intake from the 30-item FFQ were compared with those from a multi-pass 24-h recall. The FFQ underestimated mean calcium intake compared to the 24-h recall by (mean±SD) –133±333 mg/day or –5.4±47.6% (P<0.001). The two methods were strongly correlated (r=0.639, P<0.001), but the 95% limits of agreement for individual assessment were rather wide, as the FFQ could provide estimates of calcium intake from 533 mg/day above to 799 mg/day below the 24-h recall. Actual values for surrogate FFQ quartiles manifested a progressive increase, with significant differences between mean calcium intakes (P<0.001). The FFQ could identify individuals who consumed less calcium than 800 mg/day or less than the age-specific adequate intake with a relatively high sensitivity (82.8 and 95.5%, respectively), but low specificity (54.9 and 34.1%, respectively). Cross-classification analysis indicated that only 17 subjects (1.7%) were grossly misclassified (lowest quartile for one method and highest quartile for the other), while 827 subjects (82.6%) were correctly classified (into the same or adjacent quartiles). The FFQ could be used in population-based epidemiological studies or screening programs involving individuals of all ages and both genders, where the discrimination of subjects with relatively low (<500 mg/day) and relatively high (>1000 mg/day) calcium intakes is of primary interest. Results, however, do not support its use for the quantitative assessment of individual calcium intakes.

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This study was part of a nationwide project on osteoporosis, supported by Friesland Hellas. The authors would like to thank Maria Bletsa, Maria Rammata, and Anastasia Doulgeri, dietitians, Silia Sidossis, research assistant, and Antigoni Tsiafitsa, technician, for their valuable help in data collection and processing.

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Correspondence to Labros S. Sidossis.

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Magkos, F., Manios, Y., Babaroutsi, E. et al. Development and validation of a food frequency questionnaire for assessing dietary calcium intake in the general population. Osteoporos Int 17, 304–312 (2006).

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