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Validation Information: FFQ (Italy)

Zanini 2020

A new self-administered semi-quantitative food frequency questionnaire to estimate nutrient intake among Italian adults: development design and validation process

Food Frequency Questionnaires (FFQs) are valuable research tools in nutritional epidemiology. This study aimed to develop and validate a new semi-quantitative FFQ, specifically designed for the Italian population and best fitted for self-administration. During the development process, we adapted to Italian needs the validated FFQ proposed by the Fred Hutchinson Cancer Research Center, revising food items, food frequency scale, portion sizes, and time frame. To assess the validity of the proposed FFQ, we compared the estimated daily intake using FFQ with the mean of 3-day food diaries and one 24-hour recall (considered as reference method). The validation process was conducted among a cohort of 51 healthy subjects enrolled in a clinical trial. Four statistical tests were applied on 23 estimated nutrient intakes. Spearman's coefficients ranged from 0.223 (sodium) to 0.748 (alcohol) and were good (≥0.50) and acceptable (0.20-0.49) for 7 and 16 nutrients, respectively. Cross classification showed a good agreement (≥50% in the same tertile or ≤10% in the opposite tertile) for 7 nutrients. The weighted Cohen's kappa values indicated an acceptable outcome (0.20-0.60) for 13 nutrients. Bland Altman plots did not show heteroscedasticity in the error terms, despite the presence of a bias. Our study provided a new Italian semi-quantitative FFQ for self-administration with an acceptable validation level. Its definitive release requires additional refinements and efforts.

Web Link

Validation Information

Year of Publication

Tool Information

Dietary Exposure Measured
Full Nutrient
Tool Type
Food Frequency Questionnaire
Timeframe Tool Measures info
3 months
Portion Size Measures info
Next to frequencies' columns, the medium or standard serving size of each food item is reported followed by the serving size scale graded in 3 categories: “S” (small, about one half the medium service size), “M” (about medium service size) and “L” (large, about one and half times the M).
Reporting Method info
Usual; Retrospective
Format info
Supplements Measured
Not Reported
Administration Method info

Study Information

Study Location
Associated Nutrient Database
Comparator Validated Against
24hr Recall, Food Diary Estimated


Sample Size
Age of Population

Range:20-59 years

Other Notable Characteristics
The study protocol of the SEELN project involved the selection of two cohorts of subjects: subjects with liver steatosis and healthy subjects (i.e., without liver steatosis). Excluded subjects with evidence of other causes of liver disease (as viral or autoimmune hepatitis, alcohol consumption, drug-induced liver steatosis), serious clinical illness, pregnancy, or breast-feeding, and ongoing treatment potentially affecting development and/or progression of NAFLD.

Total number of nutrients validated: 21 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: 9
  • Micronutrients: 12
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
mean of 3-day food diaries and one 24-hour recall Adults Both Energy (kcal) 31% (Median) 0.524 (S) 0.265 49% 3 −548 1751
Protein (g) 24% (Median) 0.514 (S) 0.353 43% 3 -31 72
Fat (g) 56% (Median) 0.502 (S) 0.118 41% 3 -18 102
Saturated Fat (g) 46% (Median) 0.366 (S) 0.5 51% 3 -9 35
MUFA (g) 59% (Median) 0.475 (S) -0.029 27% 3 -7 46
PUFA (g) 86% (Median) 0.534 (S) 0.353 43% 3 -3 24
Carbohydrate (g) 11% (Median) 0.574 (S) 0.441 49% 3 -126 170
Total Sugar (g) 21% (Median) 0.340 (S) 0.412 51% 3 -53 73
Fibre (g) 10% (Median) 0.552 (S) -0.029 27% 3 -25 29
Sodium (mg) 77% (Median) 0.233 (S) 0.235 39% 3 -1031 6243
Calcium (mg) 62% (Median) 0.271 (S) 0.294 41% 3 -270 1333
Iron (mg) 52% (Median) 0.395 (S) 0.059 29% 3 -6 20
Zinc (mg) 48% (Median) 0.271 (S) 0.206 35% 3 -4 14
Folate (µg) 42% (Median) 0.486 (S) 0.059 33% 3 -129 414
Vitamin C (mg) 48% (Median) 0.298 (S) -0.147 29% 3 -95 208

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.

Zanini B, Simonetto A, Bertolotti P, Marullo M, Marconi S, Becchetti C, et al. A new self-administered semi-quantitative food frequency questionnaire to estimate nutrient intake among Italian adults: development design and validation process. Nutrition Research. 2020;80:18-27.