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Validation Information: FFQ (Bangladesh)
Validation of a food frequency questionnaire as a tool for assessing dietary intake in cardiovascular disease research and surveillance in Bangladesh
Background: Cardiovascular disease (CVD) has emerged as a major public health concern in Bangladesh. Diet is an established risk factor for CVD but a tool to assess dietary intake in Bangladesh is lacking. This study aimed to validate a food frequency questionnaire (FFQ) using the 24-h dietary recall method and corresponding nutritional biological markers among rural and urban populations of Bangladesh.
Method: Participants of both genders aged 18–60 years were included in the analysis (total n = 146, rural n = 94 and urban n = 52). Two FFQs of 166 items were administered three-months apart, during which time three 24-h dietary recalls were also completed. Participants were asked to recall their frequency of consumption over the preceding 3 months. Urine and blood samples were collected for comparison between FFQ-estimates of nutrients and their corresponding biomarkers. Methods were compared using unadjusted, energy-adjusted, de-attenuated correlation coefficients, 95% limits of agreement (LOA) and quartile classification.
Results: Fair to moderate agreement for ranking energy, macro and micronutrients into quartiles was observed (weighted k value ranged from 0.22 to 0.58; p < 0.001 for unadjusted data) except for vitamin D (weighted k − 0.05) and zinc (weighted k 0.09). Correlation coefficients of crude energy, macronutrients and common micronutrients including vitamin E, thiamine, riboflavin, niacin, pyridoxine, folate, iron, magnesium, phosphorus, potassium, and sodium were moderately good, ranging from 0.42 to 0.78; p < 0.001 but only fair for vitamin A, β carotene and calcium (0.31 to 0.38; p < 0.001) and poor for vitamin D and zinc (0.02 and 0.16; p = ns, respectively). Energy-adjusted correlations were generally lower except for fat and vitamin E, and in range of − 0.017 (for calcium) to 0.686 (for fat). De-attenuated correlations were higher than unadjusted and energy- adjusted, and significant for all nutrients except for vitamin D (0.017) to 0.801 (for carbohydrate). The Bland Altman tests demonstrated that most of the coefficients were positive which indicated that FFQ provided a greater overestimation at higher intakes. More than one in three participants appeared to overestimate their food consumption based on the ratio of energy intake to basal metabolic rate cut points suggested by Goldberg. Absolute intake of macronutrients was 1.5 times higher and for micronutrients it ranged from 1.07 (sodium) to 26 times (Zinc). FFQ estimates correlated well for sodium (0.32; p < 0.001), and vitamin D (0.20; p = 0.017) with their corresponding biomarkers and iron (0.25; p = 0.003) with serum ferritin for unadjusted data. Folate, iron (with haemoglobin) and total protein showed inverse association; and fat and potassium showed poor correlation with their corresponding biomarkers for unadjusted data. However, folate showed significant positive correlation (0.189; p = 0.025) with biomarker after energy adjustment.
Conclusion: Although FFQ showed overestimation for absolute intake in comparison with 24-h recalls, the validation study demonstrated acceptable agreement for ranking dietary intakes from FFQ with 24-h recall methods and some biomarkers and therefore could be considered as a tool to measure dietary intake for research and CVD risk factors surveillance in Bangladesh. The instrument may not be appropriate for monitoring population adherence to recommended intakes because of the overestimation.
Total number of nutrients validated: 20
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:
- Saturated Fat
- Mono-unsaturated Fat
- Poly-unsaturated Fat
- Non‐starch polysaccharides(NSP)
- Folic Acid
- Vitamin B12
- Vitamin C
- Fruit & Vegetables
- Urinary Nitrogen
To find information on the other validated nutrients please read the validation study.
- Macronutrients: 3
- Micronutrients: 17
|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|
|24hr Recall||Adults||Both||Energy (kcal)||1135||1135.0||-1135||3405|
|Sodium (mg)||341 (Median)|
|Calcium (mg)||402 (Median)|
|Iron (mg)||7.9 (Median)|
|Zinc (mg)||253 (Median)|
|Folate (μg)||475 (Median)|
|Vitamin C (mg)||223 (Median)|
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.
Mumu SJ, Merom D, Ali L, Fahey PP, Hossain I, Rahman A, et al. Validation of a food frequency questionnaire as a tool for assessing dietary intake in cardiovascular disease research and surveillance in Bangladesh. Nutrition Journal. 2020;19(1):42.