Validation of a food frequency questionnaire for food and nutrient intake of adults in Butajira, Southern Ethiopia.
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Date
2019-10
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Addis Abeba University
Abstract
Background: Food frequency questionnaires (FFQ) is the most commonly used dietary
assessment tool in epidemiological studies, due to ease of administration and feasibility. However,
the information collected by FFQ is associated with lower accuracy. For accurate interpretation of
the food frequency results that arise from epidemiological studies, it needs to be compared with a
more accurate dietary assessment method. To date, there is no culture-specific and validated FFQ
available in Ethiopia.
Objective: This study aims to evaluate the validatiy of a locally developed FFQ for estimating
food and nutrient intakes of adults in Butajira, southern Ethiopia.
Methodology: We employed a community-based cross-sectional study and included a total of one
hundred fifteen adults aged 20-65 years. FFQ was developed using two sources of data; focus
group discussion and previous two days 24-Hour diet recall. The relative validity of the FFQ was
assessed against the average of two interactive 24-hour dietary recalls. Intakes of macronutrients
(energy, protein, carbohydrate, fat), micro-nutrients (calcium, iron, vitamin, vitamin B1, vitamin
B2) and food groups were measured by the two methods. The validity of the FFQ was evaluated
by comparing estimates of specific nutrients and food groups derived from the FFQ against the
24-hour dietary recalls by calculating the mean or median difference, correlation coefficients,
cross-classification, and Bland Altman test.
Result: Mean energy and macronutrient intakes obtained from the FFQ were significantly higher
than those obtained from the mean of 24-hour dietary recalls. The correlation between energy and
macro-nutrients measured by the two methods varies from 0.05 (Total fat) to 0.32 (carbohydrate)
and from 0.1(calcium) to 0.49 (vitamin B1) for micronutrients. FFQ did not adequately classify
subjects with respect to energy, macro-nutrients and most of the micro-nutrients. A systematic
mean difference was observed in vitamin A and iron intake in the bland–Altman agreement test.
For the majority of the food groups, median differences in the intake of foods and nutrients
between 24-hour dietary recall and FFQ were, overall, small and statist ically insignificant.
Correlation coefficients ranged from 0.12 for an egg to 0.78 for legumes. We found that the The
FFQ showed a fair classification agreement with the 24-hour recall for intakes of cereals, legumes,
and roots and tubers. A systematic mean difference was observed in roots and tubers and beverage
intake in the bland–Altman agreement test.
Conclusion: The FFQ provided a good validity to assess and rank individuals in terms of intakes
of most food groups according to high and low intake categories. Its validity could be acceptable
for estimating energy and macro-nutrient intakes at individual basis. However, estimates of
minerals and vitamins should be interpreted with caution.
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Keywords
Food frequency ,food and nutrient