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Validation Information: FFQ (4-5 years old)

Vioque 2016

Reproducibility and Validity of a Food Frequency Quetionnaire Designed to Assess Diet in Children Aged 4-5 Years

Background: The food frequency questionnaire (FFQ) is the most efficient and cost-effective method to investigate the relationship between usual diet and disease in epidemiologic studies. Although FFQs have been validated in many adult populations worldwide, the number of valid FFQ in preschool children is very scarce. The aim of this study was to evaluate the reproducibility and validity of a semi-quantitative FFQ designed for children aged 4 to 5 years.

Materials and methods: In this study, we have included 169 children aged 4–5 years from the INMA project in Valencia, a population-based prospective cohort study of mothers and children in Spain. The 105-items FFQ was administered twice to the parents or care-givers of children over a 9-month period. Reproducibility was explored by comparing intake of nutrients by the FFQs, while validity was examined by comparing the nutrient values from the FFQs with the average nutrient values of three 24 hour dietary recall (24hDR) taken in the period, and also, with the concentration in blood specimens for several vitamins (carotenoids, folate, vitamin B12, vitamin C and α-tocopherol). Pearson correlation coefficients and de-attenuated correlation coefficients were calculated and we also evaluated misclassification by quintile distribution.

Results: All correlation coefficients for reproducibility for nutrients and major food groups were statistically significant; the average correlation coefficients for daily intake were 0.43 for food groups and 0.41 for nutrients. The average correlation coefficients for validity for daily intakes against 24hDR was r = 0.30, and the average for de-attenuated correlation coefficients was r = 0.44. When evaluating validity against the blood concentration of vitamins, statistically significant correlations were observed for vitamin C (0.35), lycopene (0.31), β-Cryptoxantin (0.40), and vitamin E (0.29); the average of correlation coefficients was r = 0.21.

Conclusion: Despite some low to moderate correlations for reproducibility and validity, overall this study suggests that the FFQ may be a good method for assessing a wide range of food groups and nutrients intake in children aged 4–5 years.

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Validation Information

Year of Publication

Tool Information

Dietary Exposure Measured
Full Nutrient, Food Groups
Tool Type
Food Frequency Questionnaire
Timeframe Tool Measures info
1 Year
Portion Size Measures info
Portions and serving sizes were estimated by using household measures and detailed descriptions of the food, method of preparation and brands.
Reporting Method info
Usual; Retrospective
Format info
Supplements Measured
Administration Method info
Recommend interview-administered questionnaire by Nutritionist. Alternatively by proxy: parents or care-givers with instructions and illustrative examples

Study Information

Study Location
Valencia, Spain
Associated Nutrient Database
U.S. Department of Agriculture: Agricultural Research Service, USDA National Nutrient Database for Standard Reference & Tablas de Composicion Españolas
Comparator Validated Against
24hr Recall, Biomarkers


Sample Size
169 (24hr Recall), 169 (Biomarkers)
Age of Population

Range: 4-5 years

Mean(SD): 4.34(0.1) years

Other Notable Characteristics
Healthy Children enrolled in the Spanish Childhood and Environment Project of Valencia (INMA study)

Total number of nutrients validated: 30 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: 11
  • Micronutrients: 18
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
24hr Recall Children Both Energy (Kcal) 355 345 0.29 (P) 64.5^ 5 -321 1031
Protein (g) 17 16 0.30 (P) 62.7^ 5 -14 48
Fat (g) 19 16 0.26 (P) 60.9^ 5 -13 51
Saturated Fat (g) 5 6 0.39 (P) 63.3^ 5 -6 16
MUFA (g) 8 8 0.21 (P) 62.7^ 5 -7 23
PUFA (g) 4 3 0.11 (P) 57.4^ 5 -2 10
Carbohydrates (g) 33 48 0.30 (P) 60.4^ 5 -61 127
Sodium (mg) 474 598.6 0.19 (P) 57.4^ 5 -699.3 1647.3
Calcium (mg) 270 262.9 0.54 (P) 70.4^ 5 -245.2 785.2
Iron (mg) 1.7 4.8 0.49 (P) 70.4^ 5 -7.8 11.1
Zinc (mg) 2.5 2.1 0.32 (P) 59.8^ 5 -1.7 6.7
Retinol (µg) 236 335.5 0.26 (P) 57.4^ 5 -421.5 893.5
Folate (µg) 68 66.5 0.23 (P) 55.0^ 5 -62.3 198.3
Vitamin B12 (µg) 2.7 2.7 0.29 (P) 62.1^ 5 -2.6 8
Vitamin C (mg) 34 55.1 0.36 (P) 62.1^ 5 -74.0 142
Biomarkers Children Both Retinol (µmol/dl) 474 332.2 0.14 (P) 55.8^ 5 -179.1 1123.1
Vitamin C (µmol/dl) 9 44.4 0.33 (P) 61.1^ 5 -78.1 96.1
Fruit and Vegetables (g) 118 142 0.14 (P) 58.2^ 5 -160 396

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.

Vioque J, Gimenez-Monzo D, Navarrete-Munoz EM, Garcia-de-la-Hera M, Gonzalez-Palacios S, Rebagliato M, et al. Reproducibility and Validity of a Food Frequency Questionnaire Designed to Assess Diet in Children Aged 4-5 Years. PloS one. 2016;11(11):e0167338.