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Validation Information: FFQ Malaysia)

Shahar 2021

Development and Relative Validity of a Semiquantitative Food Frequency Questionnaire to Estimate Dietary Intake among a Multi-Ethnic Population in the Malaysian Cohort Project

Measuring dietary intakes in a multi-ethnic and multicultural setting, such as Malaysia, remains a challenge due to its diversity. This study aims to develop and evaluate the relative validity of an interviewer-administered food frequency questionnaire (FFQ) in assessing the habitual dietary exposure of The Malaysian Cohort (TMC) participants. We developed a nutrient database (with 203 items) based on various food consumption tables, and 803 participants were involved in this study. The output of the FFQ was then validated against three-day 24-h dietary recalls (n = 64). We assessed the relative validity and its agreement using various methods, such as Spearman’s correlation, weighed Kappa, intraclass correlation coefficient (ICC), and Bland–Altman analysis. Spearman’s correlation coefficient ranged from 0.24 (vitamin C) to 0.46 (carbohydrate), and almost all nutrients had correlation coefficients above 0.3, except for vitamin C and sodium. Intraclass correlation coefficients ranged from −0.01 (calcium) to 0.59 (carbohydrates), and weighted Kappa exceeded 0.4 for 50% of nutrients. In short, TMC’s FFQ appears to have good relative validity for the assessment of nutrient intake among its participants, as compared to the three-day 24-h dietary recalls. However, estimates for iron, vitamin A, and vitamin C should be interpreted with caution.

Web Link

Validation Information

Year of Publication

Tool Information

Dietary Exposure Measured
Energy, Macronutrient, Micronutrient
Tool Type
Food Frequency Questionnaire
Timeframe Tool Measures info
3 Days
Portion Size Measures info
A tablet personal computer with touch-screen features is used to show a data dictionary and a digital diet album, to assist both the enumerators and the participants to estimate their food portion sizes.
Reporting Method info
Format info
Supplements Measured
Not Reported
Administration Method info

Study Information

Study Location
Associated Nutrient Database
The Malaysian Food Composition Table, the Singapore Food Database, and the United States Department of Agriculture nutrient database
Comparator Validated Against
24hr Recall


Sample Size
Adults and Elderly
Age of Population

Range:35-70 years

Other Notable Characteristics
The inclusion criteria included being a Malaysian citizen, possession of a valid nationality identification card, not suffering from any acute illness at the time of study, and those who gave written informed consent to the study. Those with debilitating illnesses, including cancers, and those who refused consent were excluded.

Total number of nutrients validated: 10 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: 3
  • Micronutrients: 7
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
3-day diet recall  Adults and Elderly Both Energy (kcal) 26% (Median) 0.364 (S); 0.53 (ICC)
Protein (g) 16% (Median) 0.329 (S); 0.52 (ICC)
Fat (g) 36% (Median) 0.316 (S); 0.44 (ICC)
Carbohydrates (g) 18% (Median) 0.456 (S); 0.59 (ICC)
Sodium (mg) -6.3 (Median) 0.291 (S); 0.48 (ICC)
Calcium (mg) 22% (Median) 0.312 (S); -0.01 (ICC)
Iron (mg) 19% (Median) 0.425 (S); 0.38 (ICC)
Vitamin C (mg) 47% (Median) 0.239 (S); 0.40 (ICC)

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.

Shahar S, Shahril MR, Abdullah N, Borhanuddin B, Kamaruddin MA, Yusuf NAM, et al. Development and Relative Validity of a Semiquantitative Food Frequency Questionnaire to Estimate Dietary Intake among a Multi-Ethnic Population in the Malaysian Cohort Project. Nutrients. 2021;13(4):01.