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Validation Information: FFQ (MetaCardis France)

Verger 2016

Dietary Assessment in the MetaCardis Study: Development and Relative Validity of an Online Food Frequency Questionnaire

Background The European study MetaCardis aims to investigate the role of the gut microbiota in health and cardiometabolic diseases in France, Germany, and Denmark. To evaluate long-term dietedisease relationships, a food frequency questionnaire (FFQ) was found to be the most relevant dietary assessment method for the MetaCardis study. Objective The objectives of this study were to describe the development of three semiquantitative online FFQs used in the MetaCardis study—one FFQ per country—and to assess the relative validity of the French MetaCardis FFQ. Design The layout and format of the MetaCardis FFQ was based on the European Prospective Investigation of Cancer (EPIC)-Norfolk FFQ and the content was based on relevant European FFQs. Portion size and nutrient composition were derived from national food consumption surveys and food composition databases. To assess the validity of the French MetaCardis FFQ, a cross-sectional study design was utilized. Participants/setting The validation study included 324 adults recruited between September 2013 and June 2015 from different hospitals in Paris, France. Main outcome measures Food intakes were measured with both the French MetaCardis FFQ and 3 consecutive self-administered web-based 24-hour dietary recalls (DRs). Statistical analyses performed Several measures of validity of the French MetaCardis FFQ were evaluated: estimations of food groups, energy, and nutrient intakes from the DRs and the FFQ, Spearman and Pearson correlations, cross-classification, and BlandAltman analyses. Results The French MetaCardis FFQ tended to report higher food, energy, and nutrient intakes compared with the DRs. Mean correlation coefficient was 0.429 for food, 0.460 for energy, 0.544 for macronutrients, 0.640 for alcohol, and 0.503 for micronutrient intakes. Almost half of participants (44.4%) were correctly classified within tertiles of consumption, whereas 12.9% were misclassified in the opposite tertile. Performance of the FFQ was relatively similar after stratification by sex. Conclusions The French MetaCardis FFQ was found to have an acceptable level of validity and may be a useful instrument to rank individuals based on their food and nutrient intakes.

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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
Relevant national survey data were used for common portions (e.g. 1 apple) by calculating the portion size based on the weighted mean. If national survey data was missing or household measures were used, the portion sizes were described and standardised (when possible). Manufacturers' websites were also used if manufacturer weights were used (e.g. a yoghurt container)
Reporting Method info
Retrospective; Usual
Format info
Supplements Measured
Administration Method info

Study Information

Study Location
Paris, France
Associated Nutrient Database
SU.VI.MAX food composition database
Comparator Validated Against
24hr Recall


Sample Size
Adults, Elderly
Age of Population

Mean (SD): 53.5 (11.5) years

Other Notable Characteristics
All following results relate to the French FFQ only. Participants were recruited from hospitals. The design of the relative validity study is not optimal.

Total number of nutrients validated: 27 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: 10
  • Micronutrients: 17
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 Adults, Elderly Both Energy (kcal) 219 0.28 (P) 41 3 -1239 1678
Protein (g) 12.9 0.30 (P) 50 3 -54 80
Fat (g) -0.3 0.22 (P) 39 3 -72 71
Saturated Fat (g) -0.6 0.30 (P) 45 3 -33 31.8
MUFA (g) -1.1 0.19 (P) 40 3 -28 25.8
PUFA (g) 1.3 0.17 (P) 40 3 -12 14.6
Carbohydrates (g) 44 0.37 (P) 43 3 -127 215
Sugar (g) 25.8 0.38 (P) 44 3 -73 124
Fibre (g) 6.4 0.34 (P) 50 3 -14.7 27.5
Sodium (mg) -85 0.26 (P) 45 3 -2851 2681
Calcium (mg) 206 0.30 (P) 48 3 -785 1197
Iron (mg) 1.7 0.29 (P) 47 3 -9.5 12.8
Zinc (mg) 2.1 0.26 (P) 44 3 -7.2 11.4
Vitamin B12 (µg) 0.9 0.27 (P) 43 3 -10.1 12.0
Vitamin C (mg) 57.6 0.38 (P) 48 3 -131 246

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.

Verger EO, Armstrong P, Nielsen T, Chakaroun R, Aron-Wisnewsky J, Gøbel RJ, Schütz T, Delaere F, Gausseres N, Clément K, Holmes BA. Dietary assessment in the MetaCardis Study: development and relative validity of an online food frequency questionnaire. Journal of the Academy of Nutrition and Dietetics. 2017 Jun 30;117(6):878-88.