Validation Information: FFQ (FODMAPs)
Barrett 2011
Development and Validation of a Comprehensive Semi-Quantitative Food Frequency Questionnaire that Includes FODMAP Intake and Glycemic Index
Background Fermentable, short chain carbohydrates (FODMAPs) have been identified as triggers for functional gastrointestinal symptoms. In addition, excess FODMAP consumption has been implicated in the onset of Crohn’s disease, and animal studies suggest that a low glycemic index diet can impair absorption of fructose, a major dietary FODMAP. Such hypotheses cannot be tested without the ability to quantify FODMAP ingestion with a validated dietary assessment tool.
Objective To assess the validity and reproducibility of a 297- item comprehensive, semi-quantitative food frequency questionnaire (FFQ) in estimating intake of macro- and micronutrients, FODMAPs, and glycemic index/load.
Subjects/setting One hundred healthy participants were recruited to complete the FFQ on two occasions, plus four 1-week food diaries kept during a 12-month period. Participants exhibiting major dietary change during the study period or low energy reporting on the FFQ were excluded.
Main outcome measures Validation and reproducibility of the semi-quantitative FFQ by comparison with the mean of four 1-week food diaries.
Statistical analyses performed Validation was assessed using Wilcoxon signed rank test, Spearman’s correlation, Bland-Altman, and weighted K statistics. Reproducibility was examined using Shrout-Fleiss intraclass correlation coefficient.
Results Seventy-two participants fulfilled inclusion and exclusion criteria. Demographics of the participants were comparable with 2006 Australian Census data. Consistent with other reported FFQs, the FFQ overestimated nutrient intake by a mean 140% (range=95% to 249%). However, based on the other analyses performed, it demonstrated validity for intake of sugars, fiber, alcohol, glycemic index, glucose, FODMAPs, calcium, folate, phosphate, potassium, iron, and magnesium; moderate validation for energy, total fat, saturated fat, carbohydrates, sodium, thiamin, sucrose, and retinol; poor validation for protein, mono/polyunsaturated fat, starch, glycemic load, niacin, and zinc. Riboflavin intake was not validated. Intraclass correlation coefficients for reproducibility ranged from 0.352 to 0.928.
Conclusions The FFQ was validated for assessment of a wide range of nutrients, including the new class of carbohydrates, FODMAPs, and glycemic index. This provides a useful tool for dietary research, particularly in the area of gastroenterological disorders.
Total number of nutrients validated: 36
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: 21
- Micronutrients: 13
| Comparator | Lifestage | Sex | Nutrient Measured | Mean Difference | Standard Deviation | Correlation Coefficient | Cohen's Kappa Coefficient | Percentage Agreement | Percentage Agreement Categories | Lower Limits of Agreement | Upper Limits of Agreement |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Estimated Food Diary | Adults, Elderly | Both | Energy (kJ) | 1441† | 1832.6† | 0.55 (S)†; 0.72 (ICC)† | 0.35 (W)† | 44† | 3 | -2224.12† | 5106.12† |
| Protein (g) | 14.8† | 15.0† | 0.49 (S)†; 0.61 (ICC)† | 0.27 (W)† | 46† | 3 | -15.16† | 44.76† | |||
| Fat (g) | 2.6† | 12.6† | 0.58 (S)†; 0.81 (ICC)† | 0.33 (W)† | 46† | 3 | -22.51† | 27.71† | |||
| Saturated Fat (g) | -0.9† | 6.4† | 0.44(S)†; 0.82 (ICC)† | 0.34(W)† | 51† | 3 | -13.75† | 11.95† | |||
| MUFA (g) | 5.3† | 7.7† | 0.39(S)†; 0.78 (ICC)† | 0.22 (W)† | 44† | 3 | -10.14† | 20.74† | |||
| PUFA (g) | 0.7† | 3.7† | 0.38(S)†; 0.83 (ICC)† | 0.28 (W)† | 47† | 3 | -6.68† | 8.08† | |||
| Carbohydrates (g) | 62.4† | 28.8† | 0.54(S)†; 0.76 (ICC)† | 0.31(W)† | 47† | 3 | 4.90† | 119.90† | |||
| Total Sugar (g) | 40.8† | 30.4† | 0.55(S)†; 0.77 (ICC)† | 0.39(W)† | 58† | 3 | -19.95† | 101.55† | |||
| Fibre (g) | 9.8† | 6.2† | 0.59(S)†; 0.73 (ICC)† | 0.44(W)† | 54† | 3 | -2.55† | 22.15† | |||
| Sodium (mg) | 425† | 861.0† | 0.52(S)†; 0.77 (ICC)† | 0.34(W)† | 49† | 3 | -1297.03† | 2147.03† | |||
| Calcium (mg) | 265.5† | 292.7† | 0.56(S)†; 0.64 (ICC)† | 0.41(W)† | 56† | 3 | -319.80† | 850.80† | |||
| Iron (mg) | 3.4† | 1.9† | 0.67(S)†; 0.69 (ICC)† | 0.45(W)† | 56† | 3 | -0.36† | 7.16† | |||
| Zinc (mg) | 3.1† | 2.5† | 0.46(S)†; 0.72 (ICC)† | 0.28(W)† | 49† | 3 | -1.90† | 8.10† | |||
| Retinol (µg) | -24.3† | 194.6† | 0.48(S)†; 0.66 (ICC)† | 0.38(W)† | 54† | 3 | -413.45† | 364.85† | |||
| Folate (µg) | 191.3† | 144.9† | 0.50(S)†0.68 (ICC)† | 0.38(W)† | 51† | 3 | -98.49† | 481.09† | |||
| Vitamin C | 105.2† | 80.7† | 0.63(S)†; 0.536 (ICC)† | 0.38(W)† | 48† | 3 | -56.20† | 266.60† |
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.
Barrett JS, Gibson PR. Development and validation of a comprehensive semi-quantitative food frequency questionnaire that includes FODMAP intake and glycemic index. Journal of the American Dietetic Association. 2010;110(10):1469-76.