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Validation Information: FFQ (Women)

Martin-Moreno 1993

Development and Validation of a Food Frequency Questionnaire in Spain

To create a suitable instrument to estimate intakes of total calories, protein, carbohydrate, fats (saturated, mono and polyunsaturated), alcohol, cholesterol, fibre, vitamin A and vitamin C in epidemiological studies conducted in Spain, a food frequency questionnaire was developed and tested. In particular, the questionnaire was designed to be used in a large population-based case-control study of dietary factors in relation to breast and colorectal cancer among women from different Spanish regions. After identifying the most important food sources of the relevant nutrients in the study population, the final version of the questionnaire asked about consumption of 118 food items. Its reproducibility and validity were tested among 147 Spanish women aged 18–74 years. These subjects were asked to complete the questionnaire before and after completing four 4-day food records. The records were obtained at 3-month intervals designed to represent daily and seasonal changes (between 1990 and 1991). Using the information available from standard Spanish food composition tables, an ad hoc computer program was created to translate food consumption into nutrient intake. The reproducibility of the questionnaire was assessed by means of estimating correlations between nutrient scores measured with the same instrument twice, with a period of 1 year between estimates. Pearson correlation coefficients ranged from 0.51 for saturated fat to 0.88 for alcohol. In the validity study, correlation coefficients between diet records and the first and second questionnaires ranged between r=0.20 for vitamin A and r=0.88 for alcohol. Simple adjustment for total energy intake did not increase these estimates, but the energy-adjusted correlations improved after considering the attenuation derived from within-person variation. The de-attenuated correlation coefficients between the second questionnaire and diet records ranged from 0.45 for vitamin A to 0.91 for alcohol. With regard to gross misclassification, on the average 3% of subjects classified in the highest or lowest quintile by food record were assigned to the lowest or highest quintile by the food frequency questionnaire. These results indicate that our Spanish questionnaire is fairly reproducible and provides a potentially reliable scale for categorizing individuals by level of past nutrient intake. It seems to be an impossible puzzle but it's easy to solve a Rubik' Cube using a few algorithms.

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Validation Information

Year of Publication

Tool Information

Dietary Exposure Measured
Energy, Macronutrient, Micronutrient, Food Groups
Tool Type
Food Frequency Questionnaire
Timeframe Tool Measures info
Portion Size Measures info
Standard reference measures (portion, weight, size or volume) were identified for each item considering previously administered 24-hour recalls.
Reporting Method info
Usual; Retrospective
Format info
Supplements Measured
Administration Method info

Study Information

Study Location
Associated Nutrient Database
Tablas de Composición de Alimentos. Madrid CSIC (1980 & 1990) and Tabla de Composición de Alimentos. Barcelona (1988)
Comparator Validated Against
Food Diary Estimated


Sample Size
Adults, Elderly
Age of Population

Range: 18-74 years

Female Only
Other Notable Characteristics
Subjects were drawn from the controls of a population-based case-control study on breast and colorectal cancer (Martin-Moreno et al. 1991). The results displayed are taken from Questionnaire 2.

Total number of nutrients validated: 11 info

Not all of the nutrients validated in the validation studies are included in the table below, as statistical data was only selected to be displayed for a number of nutrients, this included:

  • Energy
  • Fat
  • Saturated Fat
  • Mono-unsaturated Fat
  • Poly-unsaturated Fat
  • Carbohydrates
  • Protein
  • Sugar
  • Non‐starch polysaccharides(NSP)
  • Sodium
  • Calcium
  • Iron
  • Zinc
  • Retinol
  • Folate
  • Folic Acid
  • Vitamin B12
  • Vitamin C
  • Fruit & Vegetables
  • Urinary Nitrogen

To find information on the other validated nutrients please read the validation study.

  • Energy
  • Macronutrients: 8
  • Micronutrients: 2
Comparator Lifestage Sex Nutrient Measured info Mean Difference Standard Deviation info Correlation Coefficient info Cohen's Kappa Coefficient Percentage Agreement Percentage Agreement Categories info Lower Limits of Agreement Upper Limits of Agreement
Estimated Food Diary Adults, Elderly Female Only Energy (kcal) -60 347 0.54 (P) 71^ 5 -739 619
Protein (g) -6 21 0.52 (P) 69^ 5 -47 35
Fat (g) -2 27 0.41 (P) 53^ 5 -55 51
Saturated Fat (g) -2 9 0.47 (P) 64^ 5 -19 15
MUFA (g) -1 13 0.40 (P) 65^ 5 -27 25
PUFA (g) -3 6 0.45 (P) 65^ 5 -15 9
Carbohydrates (g) -6 59 0.44 (P) 69^ 5 -121 109
Fibre (NSP) (g) -1 7 0.51 (P) 69^ 5 -15 13
Retinol Eq (µg) 172.8 2036.4 0.35 (P) 65^ 5 -13119.8 13465.4
Vitamin C (mg) -26.4 63.6 0.63 (P) 78^ 5 -151 98.2

Some results have been calculated using statistical techniques based on the published data.

For further information on statistical terms click on Statistical tests used in validation studies

All correlations coefficients in the table are unadjusted unless stated otherwise. For adjusted correlation coefficients and other statistical methods used in the study e.g. paired t-tests, please read the validation articles.

  • # Adjusted
  • † Energy adjusted.
  • ‡ For loge-transformed, energy-adjusted nutrient intakes.
  • ^ Adjacent included.
  • ᵟ Participants provided identical responses.
  • (w) = Weighted.

Martin-Moreno JM, Boyle P, Gorgojo L, Maisonneuve P, Fernandez-Rodriguez JC, Salvini S, et al. Development and validation of a food frequency questionnaire in Spain. International journal of epidemiology. 1993;22(3):512-9