Food frequency questionnaire

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Food frequency questionnaire (FFQ) is a dietary assessment tool delivered as a questionnaire to estimate frequency and, in some cases, portion size information about food and beverage consumption over a specified period of time, typically the past month, three months, or year. [1] FFQs are a common dietary assessment tool used in large epidemiologic studies of nutrition and health. [2] [3] Examples of usage include assessment of intake of vitamins and other nutrients, [4] [5] [6] assessment of the intake of toxins, [7] [8] and estimating the prevalence of dietary patterns such as vegetarianism. [3]

Contents

Structure and data collected

Questions

A FFQ includes questions on a set of food and beverage items. For each food or beverage item, there may be questions asking about the following: [1] [9]

In addition to foods and beverages, FFQs often ask about the frequency of intake and dosages of commonly consumed dietary supplements.

Length and administration format

A FFQ that aims to capture total dietary intake includes questions on 80 to 120 food and beverage items, and takes 30 to 60 minutes to complete. [1]

FFQs may be interviewer-administered in case of low literacy [1] as well as when being conducted on children. [6]

FFQs are intended for individual rather than household use (i.e., they need to be answered for each individual food consumer). For very young children, the FFQ may be answered by a parent or guardian instead.[ citation needed ]

Types of FFQs

FFQs are classified as: [11] [10]

Relation with other assessment tools

Similar diet assessment tools

FFQ is a common method for dietary assessment, i.e., for constructing the respondent's diet history. Some other methods include: [6]

Advantages and disadvantages relative to weighted food records

FFQs, as well as other retrospective diet assessment methods (such as the 24-hour diet recall and other diet history methods) have the advantage that they do not directly affect the behavior of the respondent. In contrast, weighted food records may influence the participant's eating behavior. Weighted food records also carry a high respondent burden. [10]

One disadvantage of FFQs and other retrospective methods is that they may be less accurate because participants are relying on memory rather than information recorded in real time.[ citation needed ]

Advantages and disadvantages relative to the 24-hour diet recall

FFQs have the following advantages:

FFQs have many disadvantages:

Validation of FFQs using other methods

Due to some of the concerns surrounding the validity and reliability of FFQs, research using a FFQ generally also tests the validity of the FFQ. In a typical research design, the FFQ is validated against another dietary assessment technique (such as 24-hour diet recall or weighted food records) on a small population. [1] [4] [5] [6] [17] Once validated, the FFQ can be distributed to a wider population with the same characteristics. The need to validate FFQs against diet recalls or other more reliable methods is a recurrent theme in research and guidance on FFQs. [18]

Food frequency questionnaires in use

Specificity to populations

Since FFQs list specific food and beverage items, a FFQ designed for and validated against one population is not valid for other populations. Therefore, FFQs must be appropriately modified and revalidated against new populations. [19] A few key challenges include:

A number of standard FFQs are available for adults in the United States. [11] There is also research based on FFQs in the United Kingdom, [10] although weighted food records are more common there. [16] FFQs have also been developed in Sweden and other Northern and Western European countries. [17] There has been some research on FFQs in other regions, such as the Middle East and Mediterranean, [6] [4] Sri Lanka, [19] and Shanghai, China. [21]

Common FFQs in the United States

The list below is drawn from existing lists of food frequency questionnaires. All questionnaires in the list below are validated through multiple research studies. [11] [22] [23]

Questionnaire nameDeveloperFormat of administrationType of FFQLength
Harvard FFQ, also known as the Harvard Service FFQ (HSFFQ) and the Willett FFQ [24] Walter Willett, M.D., and his colleagues at Harvard University (existed before 2001; [23] most recent version created 2007 [24] )Pen and paper version only; booklet plus analysis cost roughly $15.00-20.00 per questionnaireSemi-quantitativeThe booklet has 19 pages and 18 questions, with some of the questions having a large number of parts. [25]
Diet History Questionnaire (DHQ) [26] [27] National Cancer Institute's Risk Factor Assessment Branch. The first version, DHQ I, was developed by a team including Fran Thompson and Amy Subar and described in a paper published in 2001. [23] DHQ I had a single version and was paper-and-pencil-only. DHQ II has four versions, each of which can be taken online or using paper-and-pencil. [27] A Canadian version (C-DHQ-II) is also available. [20] Sample PDFs for paper versions are freely available. Other languages supported are Spanish (for DHQ I) [28] and French (for the Canadian DHQ II, not available online). [20] Semi-quantitativeDHQ I had 124 questions and took an hour to complete. DHQ II has 134 questions in each of its four versions. [27]
Block FFQ [29] National Cancer Institute, under the direction of Gladys Block. The questionnaire design was described in a 1986 paper [30] and the first research paper validating the questionnaire was published in 1990. [31] The FFQ was subsequently modified and a web version was created. [32] Pen-and-paper and web version, both available at cost. Cost is $2 per respondent for pen-and-paper version, with a minimum of $100.Semi-quantitativeThe 2014 questionnaire has questions of 127 food and beverage items, plus additional questions to adjust for fat, protein, carbohydrate, sugar, and whole grain content. [33]
NHANES [9] National Cancer InstitutePen-and-paper version mailed to large numbers of respondents periodically. Results are used as comparison baselines for other FFQs. Sample is available online.Non-quantitative (mostly; a few questions asked about quantities)The 2003/2004 booklet has 139 questions and 24 pages.

Analysis of data

Calculation of nutrient intake (for semi-quantitative FFQs)

Calculations for nutrient intake can be estimated via computerized software programs that multiply the reported frequency of each food by the amount of nutrient in a serving of that food. References databases commonly used for this purpose are listed below. Note that to estimate total nutrient intake, it is necessary to include dietary supplements in the FFQ and add the nutrient intake from these, particularly when dealing with populations where the consumption of dietary supplements is common. [34]

For non-quantitative FFQs, nutrient intake cannot be calculated as accurately, but the FFQ can still be used to get a rough idea of nutrient consumption. [1]

Calculation of food groups consumed

A related use of FFQs is to determine how much people consume broad groups of foods. Examples of such food groups are fruits, vegetables, and added sugars. A useful database for this purpose is the USDA's Food Patterns Equivalents Database (FPED). [35]

Comparison data

In the United States, data from NHANES is used to provide nationwide comparison data. [11]

Population-level analyses

FFQs can be used for a variety of population-level analyses:

Criticism

The low validity of FFQs has made them a subject of criticism. Walter Willett, developer of the Harvard FFQ, estimated a correlation of 0.60 to 0.70 between standard FFQs and diet recalls. [38]

Alan R. Kristal, Ulrike Peters and John D. Potter wrote in their article "Is It Time to Abandon the Food Frequency Questionnaire?" that there was not much scope to learn more from FFQs, and that a more curious and exploratory approach was needed to uncover new insights on diet and its correlation with health status. [39]

The National Cancer Institute has argued that through careful bias correction, some of the limitations of FFQs can be overcome, and they can be very useful. [18]

Related Research Articles

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References

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  2. ↑ "Food Frequency Questionnaires". Fred Hutch. Retrieved September 20, 2016.
  3. 1 2 "Food Frequency Questionnaires". Animal Charity Evaluators . Retrieved October 21, 2016.
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  7. ↑ Smedts HP, de Vries JH, Rakhshandehroo M, et al. (February 2009). "High maternal vitamin E intake by diet or supplements is associated with congenital heart defects in the offspring". BJOG. 116 (3): 416–23. doi:10.1111/j.1471-0528.2008.01957.x. PMID   19187374. S2CID   22276050.
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  10. 1 2 3 4 5 6 7 Wrieden, Wendy; Peace, Heather; Armstrong, Julie; Barton, Karen. "A short review of dietary assessment methods used in National and Scottish Research Studies" (PDF).
  11. 1 2 3 4 5 6 7 "Food Frequency Questionnaires" (PDF). University of Colorado Denver . Retrieved September 20, 2016.
  12. ↑ "24-hour Dietary Recall (24HR) At a Glance". National Cancer Institute . Retrieved October 21, 2016.
  13. ↑ "24-hour diet recall". Medanth. Retrieved October 21, 2016.
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  15. ↑ Tapsell, Linda Clare; Brenninger, Vanessa; Barnard, Janelle (2000). "Applying Conversation Analysis to Foster Accurate Reporting in the Diet History Interview". Journal of the American Dietetic Association. 100 (7): 818–824. doi:10.1016/S0002-8223(00)00237-6. PMID   10916521.
  16. 1 2 "Dietary assessment - Weighed food diary". Medical Research Council. Retrieved October 21, 2016.
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  18. 1 2 "Principles and recommendations from NCI". NIH . Retrieved 6 October 2016.
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  22. ↑ "Register of validated short dietary instruments (restricted to FFQs)". National Cancer Institute.
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  24. 1 2 "Harvard Food Frequency Questionnaire". Harvard University . Retrieved September 20, 2016.
  25. ↑ "Dietary Assessment, Harvard University" (PDF). Retrieved October 23, 2016.
  26. ↑ "Background of the Diet History Questionnaire". National Cancer Institute . Retrieved October 23, 2016.
  27. 1 2 3 "Diet History Questionnaire (DHQ-II) and Canadian Diet History Questionnaire (C-DHQ II)". National Cancer Institute . Retrieved October 23, 2016.
  28. ↑ "Diet History Questionnaire Paper-based Forms" . Retrieved October 23, 2016.
  29. ↑ "Assessment Tools and Analysis Services". NutritionQuest. Retrieved September 20, 2016.
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  31. ↑ Block, Gladys; Wood, M; Potosky, A; Clifford, C (1990). "Validation of a self-administered diet history questionnaire using multiple diet records". Journal of Clinical Epidemiology . 43 (12): 1327–1335. doi:10.1016/0895-4356(90)90099-B. PMID   2254769.
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  33. ↑ "Questionnaires and Screeners". NutritionQuest. October 23, 2016.
  34. ↑ "Learn More about Food Composition Databases for Food Frequency Questionnaires and Screeners | Dietary Assessment Primer". dietassessmentprimer.cancer.gov.
  35. 1 2 Ahuja, Jaspreet; Moshfegh, Alanna; Holden, Joanne; Harris, Ellen. "USDA Food and Nutrient Databases Provide the Infrastructure for Food and Nutrient Research, Policy, and Practice" (PDF).
  36. ↑ "Food and Nutrient Database". Nutrition Coordinating Center, University of Minnesota . Retrieved October 21, 2016.
  37. ↑ Khazen W, Jeanne JF, Demaretz L, Schäfer F, Fagherazzi G. Rethinking the Use of Mobile Apps for Dietary Assessment in Medical Research. J Med Internet Res. 2020 Jun 18;22(6):e15619. doi: 10.2196/15619. PMID: 32554383; PMCID: PMC7333076.
  38. ↑ Willett, Walter (2001). "Invited Commentary: A Further Look at Dietary Questionnaire Validation". American Journal of Epidemiology . 154 (12): 1100–1102. doi: 10.1093/aje/154.12.1100 . PMID   11744512.
  39. ↑ Kristal, Alan R.; Peters, Ulrike; Potter, John D. (December 1, 2005). "Is It Time to Abandon the Food Frequency Questionnaire?". Cancer Epidemiology, Biomarkers & Prevention. 14 (12): 2826–2828. doi:10.1158/1055-9965.EPI-12-ED1. PMID   16364996. S2CID   6662480.
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