Cade J, Thompson R, Burley V, Warm D. Development, validation and utilization of food-frequency questionnaires-a review. Public Health Nutr 5, 567-587

Nutrition Epidemiology Group, Division of Public Health, Nuffield Institute for Health, 71-75 Clarendon Road, University of Leeds, UK.
Public Health Nutrition (Impact Factor: 2.48). 09/2002; 5(4):567-87. DOI: 10.1079/PHN2001318
Source: PubMed

ABSTRACT The purpose of this review is to provide guidance on the development, validation and use of food-frequency questionnaires (FFQs) for different study designs. It does not include any recommendations about the most appropriate method for dietary assessment (e.g. food-frequency questionnaire versus weighed record).
A comprehensive search of electronic databases was carried out for publications from 1980 to 1999. Findings from the review were then commented upon and added to by a group of international experts.
Recommendations have been developed to aid in the design, validation and use of FFQs. Specific details of each of these areas are discussed in the text.
FFQs are being used in a variety of ways and different study designs. There is no gold standard for directly assessing the validity of FFQs. Nevertheless, the outcome of this review should help those wishing to develop or adapt an FFQ to validate it for its intended use.

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Available from: Janet Elizabeth Cade, Dec 17, 2013
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    • "They are easy to implement, demanding little resources or analytical power. It is however important to validate FFQs against accepted methods of dietary exposure, for a specific population and setting, in order to be able to draw conclusions from the use of the FFQ (Cade et al., 2002). "
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    ABSTRACT: Background Widespread subclinical iodine insufficiency has recently been reported in Europe, based on urinary iodine using World Health Organization/Food and Agriculture Organization criteria, in particular among young women. Although urinary iodine concentration (UIC) is a useful measurement of the iodine status in a population, it does not provide an insight into the habitual iodine intake of this population. This is compounded by the fact that very few iodine-specific food frequency questionnaires (FFQ) have been validated so far. The present study aimed to develop and validate a new, simple, rapid survey tool to assess dietary iodine exposure in females of childbearing age. Methods Iodine was measured in a duplicate 24-h urine collection. Iodine intake was measured with duplicate 4-day semi-quantitative food diaries and the FFQ. Correlation, cross-classification and Bland–Altman analyses were used to estimate agreement, bias and the reliability of the method. The triangular (triad) method was used to calculate validity coefficients. Results Forty-three women, aged 19–49 years, took part in the validation of the 17-items FFQ. Median (interquartile range) UIC was 74 (47–92) μg L−1, which is indicative of mild iodine insufficiency. The FFQ showed good agreement with food diaries with respect to classifying iodine intake (82% of subjects were classified in the same or adjacent quartile). The FFQ was moderately correlated with the food diaries (rs = 0.45, P = 0.002) and urinary excretion in μg L−1 (rs = 0.34, P = 0.025) but not in μg day−1 (P = 0.316). The validity coefficients were 0.69, 0.66 and 0.52 for the food diaries, FFQ and urinary iodine excretion, respectively. Conclusions The FFQ provides a rapid and reliable estimate of dietary iodine exposure to identify those population subgroups at risk of iodine deficiency.
    Journal of Human Nutrition and Dietetics 03/2014; DOI:10.1111/jhn.12219 · 2.07 Impact Factor
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    • "Dietary intake can be determined by a variety of methods, including 24-h recalls, food frequency questionnaires (FFQs), food diaries and measurement of dietary diversity (Cade et al., 2002; Torheim et al. 2004). "
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    ABSTRACT: South Africa is experiencing a dietary and lifestyle transition as well as increased rates of noncommunicable chronic diseases. Limited information is available on the diets of rural populations. The present study aimed to characterise the diets of men and women from rural KwaZulu-Natal (KZN) and develop a quantitative food-frequency questionnaire (QFFQ) specific for this population. A cross-sectional study was carried out by collecting single 24-h dietary recalls from 81 adults and developing a QFFQ in Empangeni, KZN, South Africa. The diet of this population was limited in variety, high in plant-based foods (especially cereals and beans), and low in animal products, vegetables and fruits. Amaize meal staple (Phutu) was consumed by over 80% of subjects and accounted for almost 45% of energy intake, as well as making an important contribution to fat and protein intake. Most of the protein consumed by the study population was plant-based protein, with almost 40% being obtained from the consumption of phutu and beans. A culturally appropriate QFFQ was developed that includes 71 food and drink items, of which 16 are composite dishes unique to this population. Once validated, this QFFQ can be used to monitor diet-disease associations, evaluate nutritional interventions and investigate dietary changes in this population.
    Journal of Human Nutrition and Dietetics 10/2013; 27(5). DOI:10.1111/jhn.12166 · 2.07 Impact Factor
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    • "All food and drinks reported were listed and local nutritionists added any foods that had not been reported during the recalls but were thought to be consumed by the study population. In order to help respondents to conceptualise the child's diet (Cade et al. 2002), the FFQ foods were then divided into 15 categories (beverages ; fruit; dried fruit and nuts; rice foods; wheat foods; finger millet (ragi) foods; cooked vegetable dishes; salad; meat/poultry and eggs; jam/chutney; sugar added to foods; savoury snacks; sweet snacks; fast food; milk/ milk products). The reference time period for the FFQ was a typical month and the response categories were daily, weekly or monthly with participants stating on how many occasions per day, week or month they consumed the food item. "
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    ABSTRACT: The burden of non-communicable chronic disease (NCD) in India is increasing. Diet and body composition 'track' from childhood into adult life and contribute to the development of risk factors for NCD. Little is known about the diet patterns of Indian children. We aimed to identify diet patterns and study associations with body composition and socio-demographic factors in the Mysore Parthenon Study cohort. We collected anthropometric and demographic data from children aged 9.5 years (n = 538). We also administered a food frequency questionnaire and measured fasting blood concentrations of folate and vitamin B12. Using principal component analysis, we identified two diet patterns. The 'snack and fruit' pattern was characterised by frequent intakes of snacks, fruit, sweetened drinks, rice and meat dishes and leavened breads. The 'lacto-vegetarian' pattern was characterised by frequent intakes of finger millet, vegetarian rice dishes, yoghurt, vegetable dishes and infrequent meat consumption. Adherence to the 'snack and fruit' pattern was associated with season, being Muslim and urban dwelling. Adherence to the lacto-vegetarian pattern was associated with being Hindu, rural dwelling and a lower maternal body mass index. The 'snack and fruit' pattern was negatively associated with the child's adiposity. The lacto-vegetarian pattern was positively associated with blood folate concentration and negatively with vitamin B12 concentration. This study provides new information on correlates of diet patterns in Indian children and how diet relates to nutritional status. Follow-up of these children will be important to determine the role of these differences in diet in the development of risk factors for NCD including body composition.
    Maternal and Child Nutrition 07/2013; 10(1). DOI:10.1111/mcn.12046 · 2.97 Impact Factor
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