Validity of short food questionnaire items to measure intake in children and adolescents: a systematic review

The Association Between Periconceptual Maternal Dietary Patterns and Miscarriage Risk in Women With Recurrent Miscarriages: A Multicentre Cohort Study

OBJECTIVE

To examine the association between periconceptual maternal diet and miscarriage risk among women with recurrent miscarriages.

DESIGN

Prospective multicentre cohort study (Tommy's Net).

SETTING

Three university hospital research centres in the United Kingdom.

POPULATION

1035 women with a baseline history of two or more miscarriages.

METHODS

We analysed baseline dietary data from a 10-item Food Frequency Questionnaire (FFQ). For individual food category analyses, we used multivariable Poisson regression following adjustment for maternal confounders and paternal dietary patterns. For whole diet analyses, ordinal principal component analysis (PCA) was used to identify common dietary patterns. Results were presented as relative risks (RR) with 95% confidence intervals (CI) and accompanying p-values.

MAIN OUTCOME MEASURES

Miscarriage rate, defined as the rate of spontaneous pregnancy loss (< 24 weeks of gestation) relative to the total number of pregnancies (miscarriages and live births).

RESULTS

High consumption of fruit and nuts (almonds and walnuts) was associated with lower miscarriage risk (fruit 226/662 (34.1%) vs. 38/77 (49.4%), RR 0.66, 95% CI 0.51 to 0.85, p = 0.001; nuts 47/152 (30.9%) vs. 220/613 (35.9%), RR 0.73, 95% CI 0.54 to 0.98, p = 0.039). High red meat intake was associated with a possible increase in miscarriage risk (6/12 (50.0%) vs. 165/469 (35.2%), RR 1.86, 95% CI 1.10 to 3.16, p = 0.022). The association with miscarriage risk was unclear for other food groups, including fresh vegetables, white meat, fish, dairy, eggs, soya and chocolate, due to imprecise point estimates. Through PCA, we identified three data-derived dietary patterns. Yet, no distinct relationship emerged between these dietary patterns and miscarriage risk.

CONCLUSIONS

A maternal diet rich in fresh fruits and nuts is associated with a lower miscarriage risk among women with a history of recurrent miscarriage.

TRAIL REGISTRATION

Tommy's Net (ISRCTN17732518) https://www.isrctn.com/ISRCTN17732518. Analysis plan (OSF zp7cs) https://osf.io/zp7cs.

Pacific Islands Families Study: Serum Uric Acid in Pacific Youth and the Associations with Free-Sugar Intake and Appendicular Skeletal Muscle Mass

BACKGROUND

Fructose (50% of sucrose/sugar) is one component of free-sugars and is metabolized to uric acid, which is a known risk factor for gout and metabolic syndrome. Pacific peoples in New Zealand experience a higher prevalence of gout, type 2 diabetes, and overweight/obesity than other ethnic groups. Interestingly, despite having a similar body mass index (BMI), they tend to have a higher proportion of appendicular skeletal muscle mass (ASMM) and less fat than other ethnic groups. Given this context, this study aimed to evaluate the associations between serum uric acid (SUA), free-sugar intake, and ASMM.

METHODS

In a nested sub-study from the Pacific Islands Families birth-cohort study, 101 boys and 99 girls (all aged 14 and 15 years) self-reported how often they had consumed foods containing sugar in the past month. Anthropometry, body fatness, and ASMM by dual-energy X-ray absorptiometry and metabolic risk factors, including SUA were measured.

RESULTS

Overall, 43% of girls and 57% of boys consumed 'sugary drinks' twice or more a day. When analyzed by group, ASMM was positively related to SUA for both boys and girls (r = 0.593, p < 0.0001). The effect of the intake of 'sugary drinks' on SUA (r = 0.176, p = 0.013) was reduced when ASMM was considered in the relationships.

CONCLUSIONS

This study shows high SUA levels in Pacific adolescents, with a positive association between ASMM and SUA in both genders. Sugary drink intake was positively associated with SUA in both boys and girls. High ASMM in Pacific people and an increased risk for raised SUA make it important to work with Pacific communities to reduce added sugar intake and adopt integrated, family-based, culturally centered, and life-course approaches to prevent chronic diseases, including gout.

Development and validation of a short dietary questionnaire for assessing obesity-related dietary behaviours in young children

There are few short, validated tools to assess young children's obesity-related dietary behaviours, limiting the rapid screening of dietary behaviours in research and practice-based early obesity prevention. This study aimed to develop and assess the reliability and validity of a caregiver-reported short dietary questionnaire to rapidly assess obesity-related dietary behaviours in children aged 6 months to 5 years. The Early Prevention of Obesity in Childhood Dietary Questionnaire (EPOCH-DQ) was developed using a rigorous process to determine content and structural validity. Three age-appropriate versions were developed for (1) infants, aged 6-12 months, (2) toddlers, aged 1-2.9 years and (3) pre-schoolers, aged 3-5 years. The questionnaire (7-15 items) measures dietary behaviours, including diet risk from non-core food and beverage intake, diet quality from vegetable frequency, bread type and infant feeding practices. Test-retest reliability was assessed from repeated administrations 1 week apart (n = 126). Internal consistency, concurrent validity (against a comparison questionnaire, the InFANT Food Frequency Questionnaire), construct validity and interpretability were assessed (n = 209). Most scores were highly correlated and significantly associated (p < 0.05) for validity (rs: 0.45-0.89, percentage agreement 68%-100%) and reliability (intraclass correlation coefficient: 0.61-0.99) for diet risk, diet quality and feeding practice items. The EPOCH-DQ shows acceptable validity and reliability for screening of obesity-related behaviours of children under 5 years of age. The short length and, thus, low participant burden of the EPOCH-DQ allows for potential applications in various settings. Future testing of the EPOCH-DQ should evaluate culturally and socio-economically diverse populations and establish the predictive validity and sensitivity to detect change.

Development and internal validation of the SMILE-FSS: a Free Sugars Screener for Australian children aged 2 and 5 years

OBJECTIVE

To develop and internally validate a Free Sugars Screener (FSS) for Australian children aged 2 and 5 years.

DESIGN

Using data collected from a ninety-nine-item (2-year-olds) and ninety-eight-item (5-year-olds) FFQ in the Study of Mothers' and Infants' Life Events affecting oral health (SMILE-FFQ), a regression-based prediction modelling approach was employed to identify a subset of items that accurately estimate total free sugars intake (FSI). The predictors were grams of free sugars (FSg) for individual items in the SMILE-FFQ and child's age and sex. The outcome variable was total FSI per person. To internally validate the SMILE-FSS items, the estimated FSg was converted to percent energy from free sugars (%EFS) for comparison to the WHO free sugars guideline categories (< 5 %, 5-< 10 % and ≥ 10 %EFS) using cross-classification analysis.

SETTING

Australia.

PARTICIPANTS

858 and 652 2- and 5-year-old children, respectively, with complete dietary (< 5 % missing) and sociodemographic data.

RESULTS

Twenty-two and twenty-six items were important in predicting FSI at 2 and 5 years, respectively. Items were similar between ages with more discretionary beverage items (e.g. sugar-sweetened beverages) at 5 years. %EFS was overestimated by 4·4 % and 2·6 %. Most children (75 % and 82 %) were categorised into the same WHO free sugars category with most (87 % and 95 %) correctly identified as having < 10 %EFS in line with the WHO recommendation.

CONCLUSIONS

The SMILE-FSS has good internal validity and can be used in research and practice to estimate young Australian children's FSI and compare to the WHO free sugars guidelines to identify those 'at risk'.

Food frequency questionnaires developed and validated for pregnant women: Systematic review

OBJECTIVES

Assessing food intake of pregnant women is extremely important, because maternal dietary patterns can influence fetal development as well as have either positive or negative effects on both the mother and fetus. Thus, the aim of the present study was to carry out a systematic review of the literature on food frequency questionnaires developed and validated for pregnant women, in order to assess their methodological quality and validation process.

METHODS

A systematic review of studies focused on validating food frequency questionnaires for pregnant women was carried out in the PubMed, Embase, Scopus, LILACS, and OpenGrey databases. The selected studies were assessed based on their correlation coefficient in validation and reproducibility analyses, whereas their methodological quality was assessed based on the scoring system proposed by the EURopean micronutrient RECommendations Aligned Network of Excellence.

RESULTS

In total, 10 965 articles were identified in these databases; among them, 14 studies, with sample sizes ranging from 46 to 221 participants, and with participants (pregnant women) at a mean age of 28.68 ± 4.34 y, were selected. Most of the included studies used the 24-h food recall as the method for developing the food list (n = 6), with composition ranging from 46 to 255 items. With respect to the methodological assessment of the selected articles, half of the assessed tools were classified as having excellent methodological quality; their validation and reproducibility correlation coefficients were classified as moderate and high (r ≥ 0.40).

CONCLUSIONS

Food frequency questionnaires developed for pregnant women appear to be reliable tools to assess food intake by this group. Overall, they had good methodological quality and adequate correlation coefficients compared with reference methods.

Development and Validation of the Vietnamese Children’s Short Dietary Questionnaire to Evaluate Food Groups Intakes and Dietary Practices among 9–11-Year-Olds Children in Urban Vietnam

This study aims to develop and assess the reproducibility and validity of the Vietnamese Children’s Short Dietary Questionnaire (VCSDQ) in evaluating food groups intakes and dietary practices among school-aged children 9–11 years old in urban Vietnam. A 26-item questionnaire covering frequency intakes of five core food groups, five non-core food groups, five dietary practices over a week, and daily intakes of fruits, vegetables, and water was developed. Children (n = 144) from four primary schools in four areas of Ho Chi Minh City, Vietnam completed the VCSDQ twice, as well as three consecutive 24 h recalls over a week. Intra-class correlation, Spearman correlation, weighted kappa, cross-classification, and Bland–Altman plots were used to evaluate the reproducibility and validity. The direct validity of food groups from VCSDQ against the 24 h recalls was examined using Wilcoxon-test for trend. The VCSDQ had good reproducibility in 12 out of 15 group items; the ICC ranged from 0.33 (grains) to 0.84 (eating while watching screens). This VCSDQ had low relative validity, two items (instant noodles, eating while watching screens) had a moderate to good agreement (k = 0.43, k = 0.84). There was good direct validity in three core-food groups (fruits, vegetables, dairy) and three non-core food groups (sweetened beverages, instant noodles, processed meat). In addition, the VCSDQ can also be used to classify daily intakes of fruits and vegetables from low to high.

Relative validity and reproducibility of a semi-quantitative food frequency questionnaire to assess fruit and vegetable consumption in school-aged children

Background

Since the beneficial effects of fruit and vegetable (FV) consumption on health are well known due to the synergy of their nutrients and non-nutrients, it is crucial to have good tools to assess the FV intake. A food frequency questionnaire (FFQ) is an adequate method to estimate FV consumption, but it is necessary to relate this dietary method to the geographic and cultural environment. Therefore, this study presented the development of a semi-quantitative FFQ to estimate the FV intake in school-aged children who usually consume cooked homemade and school meals. It also aimed to evaluate the relative validity and reproducibility of the FFQ.

Methods

School-aged children (baseline age 8 years) from 14 primary schools in the city of Zagreb participated in the study during the 2019/2020 school year. Parents/caregivers, together with the children, completed the FFQs and 3-day dietary records (3DDRs). The FFQ was designed to assess the consumption of eight food categories. The FFQ was validated using the 3DDR of 141 children (51.4% of boys), whereas the reproducibility test included the FFQ of 161 children (53.4% of boys).

Results

Of the eight food categories, FFQ overestimates the consumption of three and underestimates the consumption of three food categories (p &lt; 0.05; Wilcoxon signed rank test) compared to the 3DDR. De-attenuated correlation coefficients estimated a significant relationship (0.217–0.384) between the FFQ and 3DDR. Cross-classification analysis revealed that overall, 28–41% of children were classified in the same quartile, whereas less than 10% of children were extremely misclassified for all food categories obtained from 3DDR and FFQ1. κw values showed fair agreement for all food categories. The Bland–Altman analysis results showed a relatively small bias for all food categories (median between -11.7 and -54.8 g), with no systematic patterns between the FFQ and 3DDR. No differences were found between food categories estimated with the FFQs on both occasions, and Spearman’s correlation coefficients ranged from 0.664 to 0.712 (p &lt; 0.01). Cronbach’s alpha values (α &gt; 0.700) indicate good internal consistency, and ICCs (range 0.724–0.826; p &lt; 0.01) indicate good reproducibility of the FFQ.

Conclusion

The results indicate reasonable relative validity and acceptable reproducibility of the FFQ for estimating FV consumption among school-aged children.

Mealtime TV Use Is Associated with Higher Discretionary Food Intakes in Young Australian Children: A Two-Year Prospective Study

Background: Mealtime television use has been cross-sectionally associated with suboptimal diets in children. This study aimed to assess the two-year prospective association between baseline mealtime television use and subsequent diets in young children, and identify socioeconomic differences. Methods: Parents reported their child’s television use at meals, and fruit, vegetable, and discretionary food intakes. Multivariable linear and logistic regression analyses assessed the association between baseline mealtime television use and follow-up diet outcomes. Differences were assessed by socioeconomic position. Results: Participants were 352 Australian parents of children aged six months to six years. Daily mealtime television use (average frequency/day) was associated with higher daily frequency of discretionary food intakes (β 0.2, 95% confidence interval (CI) 0.07–0.67) at the 2-year follow-up. Individually, television use during breakfast and dinner (1–2 days/week compared to never) predicted higher daily intake frequency of discretionary food, β 0.36 (95% CI 0.12–0.60) and β 0.19 (95% CI 0.00–0.39), respectively. Similarly, 3–7 days/week of television use during breakfast and lunch predicted higher frequency of discretionary food intake, β 0.18 (95% CI 0.02–0.37) and β 0.31 (95% CI 0.07–0.55), respectively. Associations were not socioeconomically patterned. Conclusions: Investigating mealtime television use motivators across the socioeconomic spectrum could inform interventions targeting the high consumption of discretionary foods in children.

Comparison of Discretionary Food and Drink Intake Based on a Short Web-Based Sugar-Rich Food Screener and a Validated Web-Based 7-Day Dietary Record

A high consumption of discretionary foods and drinks has been associated with increased risk of multiple adverse health outcomes, including risk of overweight and dental caries. The family-based cluster randomized intervention study “Are you too sweet?” aimed at reducing the intake of discretionary foods and drinks in a population of children starting pre-school. As part of the intervention a new short web-based sugar-rich food screener (SRFS), was developed to make the parents and the school health nurses aware of the children’s intake of discretionary foods and drinks. In addition to the short assessment tool the parents also completed a validated web-based 7-day dietary record for the children. In the present study, estimates for intake of discretionary foods and drinks from the two assessment tools were compared (n = 80). There was significant correlation between estimates from the two assessment tools, but the SRFS provided lower estimates for intake of discretionary foods and drinks compared to the 7-day dietary record. The correlation coefficient between the two assessment tools was 0.49 (p < 0.001) and Kappa coefficient was 0.33. It is concluded that the SRFS can provide a fairly ranking of participants according to their intake of discretionary foods and drinks when compared to a validated 7-day dietary record. The screener may be a useful tool in practical settings, such as school health nurse consultations, in order to gain insight into the child’s sweet intake habits.

Development and validation of a food frequency questionnaire for children aged 7 to 10 years

ABSTRACT Objective Food and nutritional evaluation of children can support public policies to combat early overweight and obesity. This study developed and validated a quantitative food frequency questionnaire for assessing the dietary intake of children. Methods This is a cross-sectional study of the development of a food frequency questionnaire for 130 children of both genders aged 7 to 10 years old. For the food frequency questionnaire list, 81 food items were selected. The validity of the food frequency questionnaire was evaluated by comparison with 24-hour recalls and reproducibility was performed by comparing two food frequency questionnaires. Results Most of the foods with 95% relative contribution were ultra-processed, such as packaged snacks and powdered juice. In validation, correlation coefficients were found between 0.45 (p<0.000) for lipids and 0.37 (p<0.000) for carbohydrates. An adjustment for energy reduced the correlations, but there was an increase in the correlation in calcium (r=0.75) and retinol (r=0.20). In terms of reproducibility, all macronutrients and calcium showed a satisfactory intraclass correlation coefficient (>0.400) and moderate correlations [proteins (0.54; p<0.000) and lipids (0.41; p<0.000)]. Conclusion The food frequency questionnaire developed was valid and able to assess the local food consumption by children from northeastern Brazil.

Impact of Reduced School Exposure on Adolescent Health Behaviors and Food Security: Evidence From 4-Day School Weeks

BACKGROUND

Four-day school week (FDSW) use has increased substantially among US districts in recent years, but limited data exist on health impacts of this school schedule. This study examined associations of reduced school exposure via FDSWs with adolescent health and risk behaviors, obesity, and food security.

METHODS

Self-report data from 8th- and 11th-grade students from the Oregon Healthy Teens survey across 5 survey years (odd years 2007-2015, total N = 91,860-104,108 respondents depending on the survey question) were linked to a FDSW indicator. Regression analyses controlling for student and school characteristics compared outcomes between students in 4- and 5-day schools overall (without school fixed effects) and outcomes associated with switching to a FDSW (with school fixed effects).

RESULTS

When controlling for multiple student- and school-level factors, we observed adolescents in FDSW schools report they consume sugar sweetened beverages more frequently and water less frequently, have access to fewer days of physical education, are more likely to be food insecure, and are more likely to report the use of any drugs and specifically marijuana than 5-day school week students.

CONCLUSIONS

Limiting exposure to the school environment via FDSWs may impact adolescent health behaviors, including diet, physical activity, and drug use.

Effectiveness of a kindergarten-based intervention to increase vegetable intake and reduce food neophobia amongst 1-year-old children: a cluster randomised controlled trial

Background

Children's first years of life are crucial to their future health. Studies show that a varied diet with a high intake of vegetables is positive in several domains of health. The present low vegetable intake amongst children is, therefore, a concern. Food neophobia is a common barrier to vegetable intake in children. As most Norwegian children attend kindergarten from an early age, kindergartens could contribute to the prevention of food neophobia and the promotion of vegetable intake.

Objective

The aim of this study was to assess the effect of a cluster randomised trial amongst 1-year-old children in kindergarten to reduce food neophobia and promote healthy eating.

Methods

Kindergartens were randomly allocated to either a control group or one of two intervention groups. Both intervention groups (diet and diet + Sapere-method) were served a warm lunch meal including three alternating intervention vegetables, whilst the intervention group 2 (diet + Sapere) in addition received tools for weekly sensory lessons. The intervention was digitally administered via information and recipes on a study website. The control group did not receive any information. Parents completed digitally distributed questionnaires addressing food neophobia and food habits at baseline and post-intervention.

Results

The parents of 144 1-year-old children in 46 kindergartens completed the questionnaires, which were included in the main analysis. The results suggested a higher intake of the intervention vegetables in group 2 (diet + Sapere) compared to the control group. The effect on total vegetable intake was inconclusive. No effect was observed on the level of food neophobia in either of the intervention group.

Conclusion

This digitally delivered dietary and sensory intervention promoted the intake of intervention-targeted vegetables with inconclusive effect on total vegetable intake due to large loss to follow-up. No effect on the level of food neophobia was detected.

Dietary Patterns, Eating Behavior, and Nutrient Intakes of Spanish Preschool Children with Autism Spectrum Disorders

Eating behavior problems are characteristic of children with autism spectrum disorders (ASD) with a highly restricted range of food choices, which may pose an associated risk of nutritional problems. Hence, detailed knowledge of the dietary patterns (DPs) and nutrient intakes of ASD patients is necessary to carry out intervention strategies if required. The present study aimed to determine the DPs and macro-and micronutrient intakes in a sample of Spanish preschool children with ASD compared to typically developing control children. Fifty-four children with ASD (two to six years of age) diagnosed with ASD according to the Diagnostic Manual-5 criteria), and a control group of 57 typically developing children of similar ages were recruited. A validated food frequency questionnaire was used, and the intake of energy and nutrients was estimated through three non-consecutive 24-h dietary registrations. DPs were assessed using principal component analysis and hierarchical clustering analysis. Children with ASD exhibited a DP characterized by high energy and fat intakes and a low intake of vegetables and fruits. Likewise, meat intake of any type, both lean and fatty, was associated with higher consumption of fish and dietary fat. Furthermore, the increased consumption of dairy products was associated with increased consumption of cereals and pasta. In addition, they had frequent consumption of manufactured products with poor nutritional quality, e.g., beverages, sweets, snacks and bakery products. The percentages of children with ASD complying with the adequacy of nutrient intakes were higher for energy, saturated fat, calcium, and vitamin C, and lower for iron, iodine, and vitamins of group B when compared with control children. In conclusion, this study emphasizes the need to assess the DPs and nutrient intakes of children with ASD to correct their alterations and discard some potential nutritional diseases.

Development of a Food-Based Diet Quality Scale for Brazilian Schoolchildren Using Item Response Theory

Item response theory (IRT) is a psychometric method that provides probabilistic model-based measurements. Its use is relatively recent in the assessment of food consumption, especially through dietary assessment tools. This study aims (1) to develop a food-based diet quality scale for Brazilian schoolchildren using IRT, and (2) to apply the scale to a representative sample of schoolchildren from a Southern Brazilian city. The scale was developed with daily consumption frequency of foods from 835 students who completed the Food Intake and Physical Activity of Schoolchildren questionnaire. Questionnaire foods were grouped into 10 items according to their nutritional similarities and were evaluated by full-information factor analysis that indicated a dominant factor explaining 28% of the variance. Psychometric item analysis was performed using Samejima’s model. The scale covered all levels of diet quality, from “very poor” (scores < 95) to “very good” (scores ≥ 130). Children who had higher diet quality scores consumed beans, meat, fish, eggs, fruits, vegetables, dairy products, and water more frequently, while reducing the consumption of ultraprocessed sugary foods, ultraprocessed savoury snacks and sausages, and sugary drinks. Of 6323 children, an average of less than 10% consumed the highest diet quality scores (good or very good diet quality) and about 60% of children consumed low diet quality scores. The scale can be applied to other schoolchildren with the same measure precision.

Developed and validated food frequency questionnaires in Iran: A systematic literature review

Background:

Food frequency questionnaires (FFQs) are inexpensive, easy to administer, and practical tools for dietary assessment in epidemiological studies. Several studies have investigated the validity and reproducibility of FFQs for the Iranian population. This systematic review aimed to assess the developed and validated FFQs for use in the Iranian population and compare their features and the validation studies in this regard.

Materials and Methods:

A comprehensive search was conducted in ISI Web of Knowledge, PubMed, Scopus, and Iranian databases without time constraints to retrieve the relevant English and non-English publications. Studies would be included if they were focused on the design and validation of FFQs in Iran.

Results:

In total, 782 articles were found, 22 of which met the eligibility criteria and evaluated 18 FFQs. Validation studies had been conducted on 18 out of 20 FFQs. The median of the correlation coefficients for the comparison of the FFQ intakes and the dietary reference method by nutrients varied within the range of 0.19–0.65, indicating reasonable validity. The median of the correlation coefficients for the comparison of two FFQs by nutrients was 0.28–0.85, showing appropriate reproducibility. However, low validity was observed in some nutrients and food groups, such as egg, legumes, iron, folate, and α-tocopherol. In seven studies, biomarkers were used for the assessment of nutrient intake using an FFQ with the median correlation coefficient of −0.07–0.42. In addition, the quality of methodology was evaluated in the FFQ validation studies, with 18 out of 20 studies reporting good and excellent quality.

Conclusion:

Although the FFQs used to assess the dietary intake of the Iranian population have different features, they have acceptable validity and reproducibility. Nevertheless, some food groups and nutrients have poor validity and must be considered attentively.

Social networking sites: a new source of child feeding information for parents in Thailand

Social networking sites (SNSs) provide opportunities for health and nutrition communication. Data are lacking on whether these SNSs influence Thai parent's food provisioning to young children. In the current study, we examined the prevalence and characteristics of Thai parents who reported participating in child food and nutrition-SNSs and investigated the association between participation in these sites and parents' perceptions and feeding practices. A sample of 379 Thai parents completed a survey about the use of child food and nutrition-SNSs, and feeding practices and child eating behavior. Around 70% of participants, especially female millennials with their first child, have participated in SNSs that provide information about children's diets. High engagement was more common among younger and less educated participants, as well as rural dwellers and those with abnormal body mass index. Among these SNSs' participants, those with higher engagement had higher levels of trust in the nutritional information shared on SNSs. Further analyses showed that parents who have joined these sites had positive associations with not only providing children with more fresh fruits and vegetable but also more processed meats. Further investigations are needed to explore the information these SNSs provided and what influences they have on parents' perceptions around feeding children.

Validity and reproducibility of a semi-quantitative food frequency questionnaire in Spanish preschoolers - The SENDO project

Introduction

Introduction: currently, it is important to determine whether food frequency questionnaires (FFQ) are valid tools to collect information on usual diet in children. Objective: we evaluated the reproducibility and validity of the semi-quantitative FFQ used in a Spanish cohort of children aged 4-7 years. Methods: to explore its reproducibility, parents filled a 138-item FFQ at baseline (FFQ-0) and then one year later (FFQ-1). To explore its validity, the FFQ-1 was compared with four weighed 3-day dietary records (DRs) that were used as standard of reference. To estimate associations we calculated deattenuated Pearson's correlation coefficients to correct for season-to-season variability, and the Bland-Altman index. We also calculated the weighted kappa index and assessed participant's gross misclassification across quintiles. We analyzed data from 67 (for reproducibility) and 37 (for validity) children aged 4-7 years old, recruited by the pilot study of the SENDO project. Results: regarding reproducibility, we found mean Bland-Altman indexes of 0-10.45 % for nutrients and 1.49 %-10.45 % for foods. The adjusted r ranged between 0.29 and 0.71, and between 0.27 and 0.74 for nutrients and foods, respectively. Regarding validity, we found mean Bland-Altman indexes of 0 %-16.22 % and 0 %-10.81 % for nutrients and for food groups, respectively. The deattenuated r ranged between 0.38 and 0.81 for nutrients, and between 0.53 and 0.68 for foods. The weighted kappa index for agreement across quintiles ranged from 54.1 to 85.1 for nutrients, and from 55.4 to 78.4 for food groups. Conclusions: our results showed acceptable levels of both reproducibility and validity, and that the ad-hoc developed FFQ is a valid tool for assessing usual diet in Spanish preschoolers.

Reproducibility and Validity of a Food Frequency Questionnaire for Dietary Assessment in Adolescents in a Self-Reported Way

Tools to assess diet in a reliable and efficient way are needed, particularly in children and adolescents. In this study, we assess the reproducibility and validity of a semiquantitative food frequency questionnaire (FFQ) among adolescents in Spain. We analyzed data of 51 male adolescents aged 15-17 years from a prospective birth cohort study. Participants answered the FFQ twice in a self-administered way over a 12-month period. Reproducibility was assessed by comparing nutrient and food intakes from the FFQs, and validity by comparing nutrient intakes from the average of two FFQs and the average of two 24-Hour Dietary Recalls obtained in the period. Pearson correlation coefficients were calculated. The average of reproducibility correlation coefficients for food group intakes was 0.33, with the highest correlation for vegetable intake (r = 0.81); and the average for nutrient intake was 0.32, with the highest coefficients for α- and β-carotene (r = 0.65). Validity correlation coefficients ranged from 0.07 for carbohydrates to 0.53 for dietary fiber. The average of the validity correlation coefficients was r = 0.32. This study suggests that our FFQ may be a useful tool for assessing dietary intake of most nutrient and food groups among Spanish male adolescents in a self-administered way, despite reproducibility and, particularly validity, being low for some nutrients and food groups.

Associations between feeding practices in infancy and fruit and vegetable consumption in childhood

A diet rich in fruits and vegetables may reduce the risk of chronic diseases. However, in many countries, the majority of children do not eat the recommended quantities of fruits and vegetables. The present study aimed to understand associations between feeding practices in infancy (breast-feeding and first complementary food) and fruit and vegetable consumption in childhood (frequency and variety). Data were from the national, observational, cross-sectional Mothers and their Children’s Health study conducted in 2016/2017, a sub-study of the national Australian Longitudinal Study on Women’s Health. Mothers completed a written survey on feeding practices in infancy (breast-feeding duration, use of formula, first complementary food) and children’s fruit and vegetable frequency (number of times eaten) and variety (number of different types eaten) in the past 24 h, using the Children’s Dietary Questionnaire. Children (n 4981, mean 7·36 (sd 2·90) years) ate vegetables 2·10 (sd 1·11) times and fruits 2·35 (sd 1·14) times and ate 3·21 (sd 1·35) different vegetables and 2·40 (sd 1·18) different fruits, on average. Compared with breast-feeding for <6 months, breast-feeding for ≥6 months was associated with higher vegetable variety. Compared with cereal as the first complementary food, fruits or vegetables were associated with higher vegetable frequency and variety, and higher fruit frequency. Overall, infancy is a window of opportunity for dietary intervention. Guidance to parents should encourage the use of fruits and vegetables at the beginning of complementary feeding.

Improving the Reporting of Young Children's Food Intake: Insights from a Cognitive Interviewing Study with Mothers of 3-7-Year Old Children

Short food questions (SFQ) allow for rapid reporting of food intake across a variety of settings but are limited by poor validity and reliability. Understanding the recall process used by parents to report children’s food intake can improve question design and psychometric performance. This study aimed to improve understanding of how parents report children’s dietary intake using SFQ. Semi-structured, cognitive interviews were conducted with 21 mothers of 3–7-year-old children. Mothers were asked to ‘think-aloud’ while answering SFQ about their child’s food intake. Thematic analysis identified themes relating to parent’s question and answer process and barriers to recall. Information retrieval strategies focused on ‘use-of-time’ and ‘sphere of food provision’ and differed for core versus unhealthy foods. Recall of routine and home food provision were used to report core food intake, whereas recall of special occasions and food provision outside the home guided recall of discretionary foods. Mothers utilize different recall strategies for core and discretionary foods based on use of time and the sphere of food provision. The ease of reporting children’s dietary intake may be improved by utilizing a shorter recall time frame, clear and direct question wording, and use of food examples and recall prompts.

Development and evaluation of a food frequency questionnaire for use among young children

Background/Objectives

This study described the development of a parent food frequency questionnaire (FFQ) for measuring diets of young children over the past month and the validation of this FFQ against three non-consecutive 24 hour recalls.

Subjects/Methods

Food and nutrient intakes from a 68-item FFQ were compared with three non-consecutive 24 hour recalls in a follow-up cohort of children aged 1.5, 3.5 and 5.0 years old. Data from both methods were available for 231, 172 and 187 participants at ages 1.5, 3.5 and 5.0 years, respectively.

Results

Out of 11 nutrients, four (protein, fat, fibre, iron), two (Vitamin C, folate) and three (protein, vitamin C and folate) nutrients showed good-acceptable outcome for 2 out of 3 group-level validation tests at ages 1.5, 3.5 and 5.0 years, respectively. Of 26 food groups, good-acceptable outcome for 2 out of 3 group-level validation tests was revealed for two, four and six food groups at ages 1.5, 3.5 and 5.0 years, respectively. For individual-level validation tests, all nutrients showed good-acceptable outcome for 2 out of 3 individual level tests across three time points, except for folate at age 1.5 years and energy intake at age 3.5 years. Most food groups (22 out of 26) at age 1.5 years and all food groups at both ages 3.5 and 5.0 years showed good-acceptable outcome for 2 out of 3 individual-level validation tests.

Conclusions

At all three time points, the FFQ demonstrated good-acceptable validity for some nutrients and food groups at group-level, and good-acceptable validity for most nutrients and food groups at individual-level. This quantitative FFQ is a valid and robust tool for assessing total diet of young children and ranking individuals according to nutrient and food intakes.

Adaptation, acceptability and feasibility of a Short Food Survey to assess the dietary intake of children during attendance at childcare

Objective:

To (i) describe the adaptation of the Short Food Survey (SFS) for assessing the dietary intake of children (2–5 years) during attendance at Early Childhood Education and Care (SFS-ECEC); (ii) determine the acceptability and feasibility of the SFS-ECEC; and (iii) compare the SFS-ECEC to direct observations for assessing dietary intake of children in care.

Design:

The adapted forty-seven-item SFS-ECEC was completed by childcare educators to capture individual child’s usual intake over the past month. Acceptability and feasibility were assessed via educator self-report and completion rates. Mean servings of food groups consumed in accordance with dietary guidelines reported in the SFS-ECEC were compared to those obtained by a single-day direct observation via visual estimation conducted by trained personnel. Mean differences, intra-class correlations, Bland–Altman plots, percentage agreement and Cohen’s κ were examined.

Setting:

Early Childhood Education and Care, NSW, Australia.

Participants:

Educators and children.

Results:

213 (98·61 %) SFS-ECECs were returned. Acceptability was high with 86·54 % of educators reporting the tool as easy to understand. Mean differences in servings of food groups between the SFS-ECEC and direct observation were statistically significantly different for five out of six foods and ranged 0·08–1·07, with intra-class correlations ranging 0·00–0·21. Agreement between the methods in the classification of children meeting or not meeting dietary guidelines ranged 42·78–93·01 %, with Cohen’s κ ranging −0·03 to 0·14.

Conclusions:

The SFS-ECEC is acceptable and feasible for completion by childcare educators. While tool refinement and further validation is warranted, small mean differences suggest the tool may be useful in estimating group-level intakes.

[Validation of a short food frequency questionnaire in small children]

Introduction

Introduction: validated food frequency questionnaires in children are scarce, mostly long, and only provide data about food consumption. Objectives: the aim of this study was to evaluate the reproducibility and validity of a short food frequency questionnaire that estimates energy, nutritional intake, and the frequency of food consumption in children aged between 3 and 6 years. Material and methods: in 49 children (57% boys), the reproducibility and validity of a frequency questionnaire with 41 items was assessed using Spearman's and intraclass correlations, both adjusted and not adjusted for energy. A 6-day record was used as a reference method. Results: reproducibility was high in food groups with correlations > 0.70 for most of them and between 0.5 and 0.7 for meat, fish, potatoes, sweets/soft drinks, and oil. For energy and nutrients correlations were > 0.9 and > 0.7, respectively. Validity was strong to moderate for foods with correlations > 0.7 (dairy and milk) and between 0.4 and 0.7 (sausages, eggs, yogur/cheese, vegetables and oil), and for nutrients with correlations > 0.5 (lipids, AGS, AGP, phosphorus, calcium, vitamin E and vitamin C) and between 0.3 and 0.5 (energy, starches, fiber, MUFA, cholesterol, sodium, magnesium, potassium, retinol, riboflavin, niacin, pantothenic acid, vitamin B6 and folates). All correlations were significant and increased after they had been adjusted for energy. Conclusions: the short food frequency questionnaire for children between 3 and 6 years old has high reproducibility and good validity with results that are as good as those of long food frequency questionnaires.

Reproducibility of a Short-Form, Multicomponent Dietary Questionnaire to Assess Food Frequency Consumption, Nutrition Knowledge, and Lifestyle (SF-FFQ4PolishChildren) in Polish Children and Adolescents

The aim of the study was to assess the reproducibility of a short-form, multicomponent dietary questionnaire (SF-FFQ4PolishChildren) in Polish children and adolescents. The study involved 437 children (6–10 years old) and 630 adolescents (11–15 years old) from rural and urban areas of Poland. The self-administered questionnaire was related to nutrition knowledge, dietary habits, active/sedentary lifestyle, self-reported weight and height, and socioeconomic data. The questionnaire was completed with a two-week interval—twice by parents for their children (test and retest for children), twice by adolescents themselves (adolescent’s test and retest) and once by adolescents’ parents (parent’s test). The strength of agreement measured using the kappa statistic was interpreted as follows: 0–0.20 slight, 0.21–0.40 fair, 0.41–0.60 moderate, 0.61–0.80 good, and 0.81–1.00 excellent. Regarding the frequency of consumption of food items and meals, kappa statistics were 0.46–0.81 (the lowest: fruit/mixed fruit and vegetable juices; the highest: Energy drinks) in test–retest for children, 0.30–0.54 (fruit/mixed fruit and vegetable juices; breakfast, respectively) in adolescent’s test–retest, 0.27–0.56 (the lowest: Sweets, fruit, dairy products; the highest: Breakfast) in adolescent’s test and parent’s test. Lower kappa statistics were found for more frequently consumed foods (juices, fruit, vegetables), higher kappa statistics were found for rarely consumed foods (energy drinks, fast food). Across study groups, kappa statistics for diet quality scores were 0.31–0.55 (pro-healthy diet index, pHDI) and 0.26–0.45 (non-healthy diet index, nHDI), for active/sedentary lifestyle items they were 0.31–0.72, for components of the Family Affluence Scale (FAS) they were 0.55–0.93, for BMI categories (based on self-reported weight and height) they were 0.64–0.67, for the nutrition knowledge (NK) of adolescents the kappa was 0.36, for the nutrition knowledge of children’s parents it was 0.62. The Spearman’s correlations for diet quality scores were 0.52–0.76 (pHDI) and 0.53–0.83 (nHDI), for screen time score they were 0.45–0.78, for physical activity score they were 0.51–0.77, for the FAS score they were 0.90–0.93, and for the NK score they were 0.68–0.80. The questionnaire can be recommended to evaluate dietary and lifestyle behaviors among children and adolescents.

Global Patterns of Adolescent Fruit, Vegetable, Carbonated Soft Drink, and Fast-Food Consumption: A Meta-Analysis of Global School-Based Student Health Surveys

BACKGROUND

Adolescence presents an opportunity to influence diet, which impacts present and future health outcomes, yet adolescent diets globally are poorly understood.

OBJECTIVE

We generate evidence on adolescent diets globally and explore patterns and trends by subpopulation.

METHODS

We estimated mean frequency of consumption and prevalence of less-than-daily fruit and vegetable consumption, at-least-daily carbonated beverage consumption, and at-least-weekly fast-food consumption among school-going adolescents aged primarily 12 to 17 years from the Global School-based Student Health Surveys in Africa, Asia, Oceania, and Latin America between 2008 and 2015. Random-effects meta-analysis was used to pool estimates globally and by subgroup.

RESULTS

On average, adolescents consumed fruit 1.43 (95% confidence interval [CI] 1.26-1.60) times per day, vegetables 1.75 (1.58-1.92) times per day, carbonated soft drinks 0.99 (0.77-1.22) times per day, and fast food 1.05 (0.78-1.32) times per week. Overall, 34.5% (95% CI 29.4-39.7) consumed fruit less than once per day, 20.6% (15.8-25.9) consumed vegetables less than once per day, 42.8% (35.2-50.7) drank carbonated soft drinks at least once per day, and 46.1% (38.6-53.7) consumed fast food at least once per week. Mean daily frequency of fruit consumption was particularly low in South and East Asia (1.30 [1.02-1.58]); carbonated soft drink consumption high in Latin America (1.54 [1.31-1.78]), high-income countries (1.66 [1.29-2.03]), and modern food system typologies (1.44 [0.75-2.12]); and mean weekly fast food consumption high in mixed food system typologies (1.29 [0.88-1.71]).

CONCLUSIONS

School-going adolescents infrequently consume fruits and vegetables and frequently consume carbonated soft drinks, but there is wide variability by subpopulation.

Reproducibility and validity of an FFQ in the Henan Rural Cohort Study

OBJECTIVE

The present study aimed to evaluate the validity and reproducibility of a thirteen-item FFQ regarding identification of dietary conditions in a rural population in China.

DESIGN

A reproducibility study repeated the first FFQ (FFQ1) approximately 4 weeks later (FFQ2). A validity study evaluated the mean of three consecutive 24 h diet recalls as the reference measure.

SETTING

Cross-sectional study.

PARTICIPANTS

Residents of a rural area in Henan Province, which is located in the central region of China.

RESULTS

A total of 295 individuals participated in the reproducibility study. In addition, 123 people agreed to participate in the validity study. Spearman's correlation coefficients between the two FFQ ranged from 0·06 (vegetables) to 0·58 (eggs). Spearman's correlation coefficients between the two methods of collection ranged from 0·01 for cereal to 0·49 for staple foods. The mean of the intraclass correlation coefficients of the two FFQ (FFQ1 v. FFQ2) was 0·19. Bland-Altman analysis indicated good agreement for most food groups across the range of intake for the two studies.

CONCLUSIONS

The study demonstrated that our FFQ design could be used as a representative tool to conduct a dietary evaluation of a rural population.

Diet and Neurodevelopmental Score in a Sample of One-Year-Old Children-A Cross-Sectional Study

Environmental factors in the first years of life are crucial for a child’s neurodevelopment. Research on the association between breastfeeding and neurodevelopment is inconclusive, while research on the possible association between other dietary factors and neurodevelopment is inadequate in children as young as one year of age. The aim of the present study was to investigate associations between both breastfeeding and other dietary factors and the neurodevelopment of one-year-old children in Norway. Methods: Participants were recruited from kindergartens in four Norwegian counties in 2017. A questionnaire including questions about dietary factors and breastfeeding, and a standardised age-related questionnaire on neurodevelopment (the Ages and Stages Questionnaire), were completed by parents of one-year-olds. Linear regressions adjusting for relevant covariates were conducted to explore the associations. Results: In our sample of 212 one-year-old children, a longer duration of breastfeeding was associated with higher neurodevelopmental scores. Dietary intake of fish, fruits and vegetables was also strongly associated with higher neurodevelopmental scores, even after adjustment for breastfeeding and maternal education. Conclusion: Our results indicate that healthy dietary factors are important for neurodevelopment in young children, with measurable effects already at the age of one year.

The Impact of a Childcare Food Service Intervention on Child Dietary Intake in Care: An Exploratory Cluster Randomized Controlled Trial

PURPOSE

To assess the efficacy of a food service implementation intervention designed to increase provision of foods consistent with nutrition guidelines on child consumption of fruit, vegetables, breads/cereals, meat/alternatives, dairy, and diet quality in care.

DESIGN

Exploratory cluster randomized controlled trial.

SETTING

Twenty-five childcare centers in New South Wales, Australia.

SAMPLE

Three hundred ninety-five children aged 2 to 5 years.

INTERVENTION

Centers were randomized to the intervention or control group. Intervention development was guided by the Theoretical Domains Framework and included securing executive support, provision of group training, resources, audit and feedback, and one-on-one support. The intervention was delivered across six months and the study was conducted between March and December 2016.

MEASURES

Child diet was assessed by educators using a validated questionnaire modified for completion in childcare center.

ANALYSIS

Data were analyzed in SAS using generalized linear mixed models adjusted for clustering.

RESULTS

Children in the intervention group consumed significantly higher number of serves of vegetables (0.4 serves; P < .001), wholegrain cereals (0.7 serves; P = .02), and meat/alternatives (0.5 serves; P < .001), and had higher diet quality scores (10.3; P < .001).

CONCLUSIONS

A food service intervention targeting the provision of food significantly improved child dietary intake in care. Such findings are relevant to health promotion practitioners responsible for supporting improvements in child diet.

Brief tools to measure obesity-related behaviours in children under 5 years of age: A systematic review

INTRODUCTION

Valid and reliable tools for measuring obesity-related behaviours in young children that are brief and can be administered quickly and cost-effectively in large-scale population studies are needed. The objectives of this systematic review were to describe brief tools that measure dietary intake, physical activity, sedentary behaviour, and sleep in young children.

METHODS

A systematic review of studies published in English in six databases (CINAHL, Medline, Embase, PsycINFO, HaPI, and Cochrane) prior to April 2018 was undertaken using the PROSPERO protocol and PRISMA guidelines. Included studies were those reporting the psychometric properties of brief (≤15 items) tools that measure dietary, activity, or sleep-related behaviours, alone or in combination, in children birth to 4.9 years of age.

RESULTS

The search identified 11 379 papers, 200 full-text articles were screened for eligibility, and 12 met the inclusion criteria. Three studies measured two behavioural domains, while most assessed a single behaviour (three diet, five physical activity, one sleep, and none sedentary behaviour). Only two (one diet, one sleep) focused on the under 2 age group. Few studies assessed reliability, and validity and findings were mixed.

CONCLUSIONS

There is a need to develop brief tools to measure early life obesity-related behaviours, particularly those assessing sedentary behaviour and sleep and tools that cover multiple domains.

Data Mapping From Food Diaries to Augment the Amount and Frequency of Foods Measured Using Short Food Questionnaires

Collecting accurate and detailed dietary intake data is costly at a national level. Accordingly, limited dietary assessment tools such as Short Food Questionnaires (SFQs) are increasingly used in large surveys. This paper describes a novel method linking matched datasets to improve the quality of dietary data collected. Growing Up in Ireland (GUI) is a nationally representative longitudinal study of infants in the Republic of Ireland which used a SFQ (with no portion sizes) to assess the intake of “healthy” and “unhealthy” food and drink by 3 years old preschool children. The National Preschool Nutrition Survey (NPNS) provides the most accurate estimates available for dietary intake of young children in Ireland using a detailed 4 days weighed food diary. A mapping algorithm was applied using food name, cooking method, and food description to fill all GUI food groups with information from the NPNS food datafile which included the target variables, frequency, and amount. The augmented data were analyzed to examine all food groups described in NPNS and GUI and what proportion of foods were covered, non-covered, or partially-covered by GUI food groups, as a percentage of the total number of consumptions. The term non-covered indicated a specific food consumption that could not be mapped using a GUI food group. “High sugar” food items that were non-covered included ready-to-eat breakfast cereals, fruit juice, sugars, syrups, preserves and sweeteners, and ice-cream. The average proportion of consumption frequency and amount of foods not covered by GUI was 44 and 34%, respectively. Through mapping food codes in this manner, it was possible, using density plots, to visualize the relative performance of the brief dietary instrument (SFQ) compared to the more detailed food diary (FD). The SFQ did not capture a substantial portion of habitual foods consumed by 3-year olds in Ireland. Researchers interested in focussing on specific foods, could use this approach to assess the proportion of foods covered, non-covered, or partially-covered by reference to the mapped food database. These results can be used to improve SFQs for future studies and improve the capacity to identify diet-disease relationships.

Review of Short-Form Questions for the Evaluation of a Diet, Physical Activity, and Sedentary Behaviour Intervention in a Community Program Targeting Vulnerable Australian Children

Childhood obesity is associated with low socioeconomic status in developed countries, and community programs can deliver cost-effective obesity interventions to vulnerable children and adolescents at scale. Evaluating these programs in a low-cost, time-efficient, and culturally appropriate way with valid and reliable measures is essential to determining their effectiveness. We aimed to identify existing valid and reliable short-form instruments (≤50 items for diet, ≤15 items for physical activity) suitable for the assessment of change in diet, physical activity, and sedentary behaviour in an Australian obesity intervention program for children and adolescents aged 7⁻13 years from low socioeconomic groups, with a focus on Aboriginal and Torres Strait Islander children. Relevant electronic databases were searched, with a focus on Australian literature. Validity and/or reliability studies using diet instruments (5), physical activity/sedentary behaviour instruments (12), and diet and physical activity/sedentary behaviour instruments used with Aboriginal and Torres Strait Islander (3) children were identified. Seven questions on diet, one question on physical activity, and no questions on sedentary behaviour were recommended. These questions can be used for evaluation in community-based obesity programs among Australian children and adolescents, including those from low socioeconomic groups and Aboriginal and Torres Strait Islander children.

The Relative Validity of the Menzies Remote Short-Item Dietary Assessment Tool (MRSDAT) in Aboriginal Australian Children Aged 6⁻36 Months

The Menzies Remote Short-item Dietary Assessment Tool (MRSDAT) can be used to derive a dietary index score, which measures the degree of compliance with the Australian Dietary Guidelines. This study aimed to determine the relative validity of a dietary index score for children aged 6⁻24 months, living in a Remote Aboriginal Community (RAC), derived using MRSDAT. This validation study compared dietary index scores derived using MRSDAT with those derived from the average of three 24-h recalls. Participants were aged 6⁻36 months at the first dietary assessment and were living in a RAC. The level of agreement between the two methods was explored using Lin’s concordance correlation coefficient (CCC), Bland-Altman plots, weighted Cohen’s kappa, and Fischer’s exact and paired t-tests. Forty participants were recruited. The CCC was poor between methods (R = 0.35, 95% CI 0.06, 0.58), with MRSDAT estimating higher dietary intake scores for all food groups except fruit, and higher dietary quality scores by an average of 4.78 points/100. Community-based Aboriginal researchers were central to this validation study. MRSDAT was within the performance range of other short-item dietary assessment tools developed for young children, and shows promise for use with very young children in RACs.

Adjustment Factors Can Improve Estimates of Food Group Intake Assessed Using a Short Dietary Assessment Instrument

BACKGROUND

Methods to address misreporting associated with short dietary assessment instruments are needed.

OBJECTIVE

Our objective was to develop and evaluate the direct and indirect validity of adjustment factors applied to a short dietary assessment instrument to improve estimates of usual consumption of core and discretionary food and beverage intake.

DESIGN

Validation of the Short Food Survey relative to 24-hour recalls was performed. The Short Food Survey requires individuals to report their usual intake of fruit, vegetables, grains, meat, dairy, and discretionary choices in multiples of standard servings. Adjustment factors were developed based on a ratio (usual portion size estimated from national data to standard serving size). The estimates of food group intakes (unadjusted and adjusted) were compared to 24-hour recalls.

PARTICIPANTS/SETTING

Three population samples were used in this study. The direct validation used data from 61 Australian adults (collected 2013-2014). The indirect validation compared data from the 2011-2013 Australian National Nutrition and Physical Activity Survey (n=9,435) to a sample of 145,975 who completed the Short Food Survey in a format that is freely available online (2015-2016).

MAIN OUTCOME MEASURES

Food group intake (in servings) was measured.

STATISTICAL ANALYSES PERFORMED

Descriptive and inferential statistical analyses were conducted.

RESULTS

Direct validation showed the adjustment factors improved the survey-derived estimates of intake for all food groups except grain foods. For grains, the mean difference went from -0.6 servings to +1.2 to 1.5 servings. The absolute difference in food group intake between the adjusted Short Food Survey and recalls remained statistically significant for fruit, meat, dairy, and grains, but was not different for vegetables and discretionary foods. The indirect validation showed that the adjusted estimates of intake from the online Short Food Survey were closer to the population estimates reported by 24-hour recall for all food groups except meat.

CONCLUSIONS

Adjustment factors can improve estimates of food group intake assessed using a short dietary assessment instrument for some but not all food groups.

Longitudinal association between eating frequency and hemoglobin A1c and serum lipids in diabetes in the SEARCH for Diabetes in Youth study

BACKGROUND

Few studies have evaluated the prospective association of eating frequency with HbA1c levels and cardiovascular disease risk markers among youth with diabetes.

OBJECTIVE

To examine the 5-year longitudinal association of eating frequency with HbA1c and serum lipid levels among youth with type 1 diabetes (T1D) or type 2 diabetes (T2D).

METHODS

One-thousand and forty-nine youth (≥10-year old) with incident T1D (n = 821) or T2D (n = 228) who participated in the SEARCH for Diabetes in Youth study were included. Eating frequency (≤3, 4-5, or 6-10 times/d) measured at baseline and follow-up visits was related to HbA1c and serum lipid levels measured repeatedly over 5 years.

RESULTS

Increased eating frequency was associated with larger increases in HbA1c among youth T1D. For example, for youth with T1D who ate ≤3 times/d at the outset and ate 6-10 times/d 5 years later, the longitudinal model predicted greater absolute increases in HbA1c (2.77%); whereas for youth with T1D who ate 6-10 times/d at the outset and ate ≤3 times/d 5 years later, the model predicted lesser absolute increases in HbA1c (1.33%). Eating frequency was not associated with changes in serum lipid levels among youth with T1D or T2D.

CONCLUSIONS

Youth with T1D who increased their eating frequency vs those who decreased it had larger increases in HbA1c over 5 years.

Relative validity of a short food frequency questionnaire assessing adherence to the Norwegian dietary guidelines among colorectal cancer patients

Background

The Norwegian food-based dietary guidelines (FBDG) aim at reducing the risk of developing chronic diseases and promote overall health. We studied the effect of the Norwegian FBDG in colorectal cancer (CRC) patients. There is a need for a time-efficient dietary assessment tool measuring adherence to these guidelines in patients treated for dietary dependent cancer, such as CRC patients.

Objective

To evaluate a new short food frequency questionnaire (NORDIET-FFQ), developed to estimate adherence to the Norwegian FBDG among CRC patients.

Design

Eighty-one CRC patients from both study groups in the Norwegian Dietary Guidelines and Colorectal Cancer Survival study, an ongoing dietary intervention, completed both the short 63-item NORDIET-FFQ and a 7-day weighed food record.

Results

The NORDIET-FFQ was on group level able to estimate intakes of fruits, vegetables, unsalted nuts, fish, fatty fish, high fat dairy products, unprocessed meat, processed meat, red meat, water, sugar-rich beverages, alcoholic drinks, and sugar- and fat-rich foods. Ranking of individuals according to intake was good (r = 0.31–0.74) for fruits and vegetables, fruits, unsalted nuts, whole grain products, sugar-rich cereals, fish, fatty fish, dairy products, red meat, water, sugar-rich beverages, alcoholic beverages, and sugar- and fat-rich foods. The NORDIET-FFQ was able to identify the individuals who did not fulfil the recommendations of fruits, vegetables, unsalted nuts, whole grains, low-fat dairy products, processed meat, water, alcoholic beverages, and sugar- and fat-rich foods (sensitivity: 67–93%).

Conclusions

The NORDIET-FFQ showed good ability in to estimate intakes of plant-based foods, fish, dairy products, meat, and energy-dense foods; adequate ranking of individuals according to intake of most recommendations except for unprocessed meat, processed meat, and vegetables; and importantly a good ability to identify those patients in need of dietary counselling for foods that are known to modulate the risk of CRC.

Trial registration

National Institutes of Health ClinicalTrials.gov; Identifier: NCT01570010.

Test-Retest Reliability and Convergent Validity of Two Brief Fruit and Vegetable Intake Questionnaires among School-Aged Children

Reliable, valid, and easy-to-implement tools are required to assess children's fruit and vegetable intake as part of behavior change-focused nutrition education programs; however, the availability of such instruments is limited. The purpose of this study was to examine the reproducibility and accuracy of two brief fruit and vegetable intake questionnaires among 8- to 12-year-old children. A total of 109 participants from diverse racial/ethnic groups were recruited from urban afterschool programs. The results of two short questionnaires (food web and plate activity) were reproducible between two repeated measures conducted one week apart. Compared to a reference 24-h dietary recall, the food web questionnaire had acceptable convergent validity for assessing children's fruit intake (kappa: 0.51; r = 0.53, p < 0.001), but limited validity for assessing children's vegetable intake (kappa: 0.43; r = 0.33, p < 0.003). Children tended to overestimate intake when visualizing fruit and vegetable consumption via the plate activity questionnaire, indicating that this questionnaire was not a valid tool to assess children's fruit and vegetable consumption at dinner meals. Children's report of fruit intake via the food web questionnaire may be a useful indicator of program success in improving fruit intake.

The CSIRO Healthy Diet Score: An Online Survey to Estimate Compliance with the Australian Dietary Guidelines

There are few dietary assessment tools that are scientifically developed and freely available online. The Commonwealth Scientific and Industrial Research Organisation (CSIRO) Healthy Diet Score survey asks questions about the quantity, quality, and variety of foods consumed. On completion, individuals receive a personalised Diet Score—reflecting their overall compliance with the Australian Dietary Guidelines. Over 145,000 Australians have completed the survey since it was launched in May 2015. The average Diet Score was 58.8 out of a possible 100 (SD = 12.9). Women scored higher than men; older adults higher than younger adults; and normal weight adults higher than obese adults. It was most common to receive feedback about discretionary foods (73.8% of the sample), followed by dairy foods (55.5%) and healthy fats (47.0%). Results suggest that Australians’ diets are not consistent with the recommendations in the guidelines. The combination of using technology and providing the tool free of charge has attracted a lot of traffic to the website, providing valuable insights into what Australians’ report to be eating. The use of technology has also enhanced the user experience, with individuals receiving immediate and personalised feedback. This survey tool will be useful to monitor population diet quality and understand the degree to Australians’ diets comply with dietary guidelines.