Fitting portion sizes in a self-administered food frequency questionnaire

For epidemiological studies, a simple semiquantitative FFQ was developed to assess the frequency of intake of food items demonstrated with graphically displayed portion sizes. As a validation study, a random sample of 393 participants in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study completed 2 unannounced 24-h dietary recalls (24HDR) and the FFQ during 1 y. To calculate food and nutrient intakes, we compared the use of fitted portion sizes with the use of predefined portion sizes. Fitted portion sizes were calculated by summing food intakes over the 2 24HDR and dividing the sum by the frequency of intake reported in the FFQ for each FFQ food item, leading to similar mean intakes for FFQ and 24HDR. As predefined portion sizes, amounts that had been used in previous dietary assessments in EPIC-Potsdam were used. Mean intake of 12 food groups was 102% for men or women with fitted portion sizes and 79% for men and 95% for women with predefined portion sizes of intake measured with 2 24HDR. However, deattenuated, energy-adjusted correlation coefficients between FFQ and 24HDR were not better for 19 nutrients by the use of fitted portion sizes, with a mean correlation coefficient of 0.53 for men and 0.56 for women. Mean correlation coefficients for food groups also were similar for fitted and predefined portion sizes. Fitting portion sizes using recent reference data from a random sample of study participants improved the quantitative assessment of food and nutrient intake, but not ranking of study participants, compared with predefining portion sizes based on prior knowledge.     

Do we need information about portion sizes to rank individuals by their nutrient intakes?

Nutrient intakes calculated from 7-day weighed intake records for a community sample of 99 men and women were compared with those estimated from the same records, but with mean portion weights substituted for the actual weights. For many nutrients, approximately half of the mean portion records yielded intakes within 10% of the weighed record values. Correlation coefficients between the two estimates of intakes were high (0.64-0.97). Between 58 and 74 subjects were classified in the same third of the nutrient distributions and only between zero and four classified in opposite thirds. Using estimated portion weights is likely to reduce the degree of misclassification only slightly. It is therefore concluded that for most nutrients a diary with standard portion weights may be as likely to detect diet-disease relationships in population studies as a diary with estimated weights and only slightly less likely to detect such associations than a weighed intake survey.     

Inadequate nutrient intakes among homebound elderly and their correlation with individual characteristics and health-related factors

BACKGROUND: The prevalence of inadequate nutrient intakes among the homebound elderly and their correlation with individual characteristics and health-related factors remain poorly understood. OBJECTIVE: We assessed the extent of inadequate dietary intakes of key nutrients among the homebound elderly by using the newly released dietary reference intakes and examined the associations of individual characteristics and health-related factors with low nutrient intakes. DESIGN: This was a cross-sectional examination of data collected during the baseline assessment of a prospective study of nutrition and function among a randomly recruited sample of cognitively eligible recipients of home-delivered meals who completed a home visit and three 24-h dietary recalls (n = 345). Nutrient analysis was performed with the NUTRITION DATA SYSTEM software, and associations were identified through multiple regression models. RESULTS: In multiple regression models, lower intakes of specific nutrients were associated with subjects who were women, who were black, who reported a low income and limited education, and who did not usually eat breakfast. On the basis of the estimated average requirement standard for nutrient inadequacy, the intake of >/= 6 nutrients was inadequate in 27% of subjects, of 3-5 nutrients in 40% of subjects, and of 1-2 nutrients in 29% of subjects. On the basis of the adequate intake standard, a less than adequate intake of calcium was reported by 96% of subjects and of vitamin D by 99% of subjects. CONCLUSIONS: The findings suggest that home-delivered meals programs should target specific subgroups of participants with interventions, such as a breakfast meal or more-nutrient-dense meals, tailored to increase nutrient intakes and reduce the prevalence of nutrient inadequacy.     

The validity of a telephone-administered 24-hour dietary recall methodology

This study assesses the operational feasibility and validity of a unique telephone-administered 24-h dietary recall methodology. Dietary interviews were conducted by telephone with 204 low-income elderly subjects. Food portion size estimation was done using a two-dimensional food portion visual aid the that was mailed to respondents' homes. The mean intakes and distributions of nine nutrients among males and females in the research sample were compared with those reported in the 1971 to 1974 Health and Nutrition Examination Survey. After correcting for time trends in nutrient intake, the mean intake values found in the survey were very similar to those reported by the Health and Nutrition Examination Survey. In testing the frequency distributions of intakes, only two nutrients for women and one for men had statistically significant differences. The telephone-administered dietary methodology thus produced acceptable estimates of the means and distributions of nutrient intakes among groups of individuals and has the potential of markedly reducing the cost, time, logistical, and personnel constraints associated with nutrition surveys.     

基于在校大学生在线24小时膳食问卷调查数据有效性研究

目的 在接受高等教育的人群中验证在线24h膳食调查问卷(ODQ)相较于面对面24h膳食调查(FDR)膳食数据的有效性。方法 采用整群随机抽样的方法,抽取四川大学142名在校大学生,在同一天之内分别进行ODQ及FDR调查。通过计算ODQ与FDR间膳食摄入的个体平均差异、Spearman相关系数、交叉表一致性检验,Bland-Altman图等方法,评价两种方法之间膳食能量及常见营养素摄入量的相关性和一致性。结果 ODQ法估计的膳食能量及营养素摄入量均低于FDR(P<0.05)。 两方法各膳食摄入量间的秩相关系数在0.54~0.74之间(P<0.05),两方法间膳食能量及营养素摄入被分类到相同或相邻的四分位数组的比例从维生素A的82.4%到维生素PP的93%,而被错误分类的比例均在5%以下,加权kappa系数分布在0.41~0.64间,呈现中度到高度的一致性。Bland-Altman图表明两方法间膳食能量及各营养素摄入呈现良好的一致性。结论 本研究表明在线24h膳食问卷在群体水平上调查大学生膳食能量和营养素摄入时具有良好的有效性。     

Use of quantified and frequency indices of vitamin A intake in a case-control study of lung cancer

Recent publications have examined the extent of food frequency data needed to estimate nutrient intakes in epidemiological studies. The need for amount (usual portion size) data to supplement information on average frequency of intake has been questioned. In a case-control study of risk factors for lung cancer, we have collected data on frequency, amount and past pattern of intake for common or rich sources of vitamin A. These data have been combined with standard content information to calculate three different types of indices: one based on frequency alone, a quantitative index that included both frequency and amount, and a past-weighted index that combined the frequency, amount and data on relative consumption in the past. Odds ratios by tercile of carotene, retinol and total vitamin A intake varied little between the frequency index and the quantified and past-weighted indices. Higher intakes of carotene and total vitamin A were associated with a lower risk for lung cancer regardless of index type. This consistency of results is explained by a stability of relative intakes regardless of index type. Spearman rank order correlation coefficients between the frequency and quantitative indices exceeded 0.90 for total vitamin A, carotene, and retinol. This stability is attributable to parallel trends of increased frequency of consumption and portion size at higher levels of nutrient intake. Because similar trends were observed in five main food groups included in these analyses, these findings may be generalizable to other nutrients.     

The effect of missing data in the supplements to McCance and Widdowson's food tables on calculated nutrient intakes

OBJECTIVE: To assess the degree of underestimation of nutrient intakes caused by missing data in McCance and Widdowson's food tables and supplements, the standard food tables used in the UK. SUBJECTS: 1026 children aged 18 months. SETTING: A research clinic in Bristol. INTERVENTIONS: A 3-day dietary diary was completed for each child. These were coded and analysed using a database consisting of the unedited information in the food tables, to produce a set of 'uncorrected' nutrient intakes. 'Guesstimated' values for nutrient content were then added to our nutrient database in place of the missing values in the food tables, and the daily nutrient intakes were recalculated. MAIN OUTCOME MEASURES: Calculated daily nutrient intakes before and after substituting missing data in the food tables for guesstimated values. RESULTS: Of the 1027 foods used in the analysis, 540 had missing data for one or more nutrient content. For several of the nutrients examined adding guesstimated values altered the calculated nutrient intake of more than 90% of the subjects. However, for nutrients such as the B vitamins and the major minerals the mean percentage underestimate was very small. We calculated the underestimation of nutrient intake to be largest for vitamins E and D (13.8% and 14.7%, respectively). The effect of missing data on calculated nutrient intakes was proportionately greater at the bottom end of the nutrient intake distribution. CONCLUSION: Missing data has a fairly small effect on calculated mean daily intakes. However, it can result in some individuals being misranked within a nutrient intake distribution. The availability of a standard set of 'guesstimates' to use in place of missing data would reduce this problem, and would improve comparability between dietary surveys.     

Nutrient Intakes and Adequacy Among an Older Population on the Eastern Shore of Maryland: The Salisbury Eye Evaluation

OBJECTIVE: To describe the reported usual dietary intakes of the participants in the Salisbury Eye Evaluation (SEE) project and to estimate the prevalence of inadequate nutrient intakes using the probability approach. SUBJECTS/SETTING: A representative sample of elderly residents (aged 65 to 85 years) of Salisbury, Md. DESIGN: Cross-sectional survey, using a food frequency questionnaire to obtain nutrient intakes. We estimated energy and protein; percent of energy intake from carbohydrates, fat, and protein; as well as usual intakes of cholesterol, vitamin A, carotenoids, vitamin C, thiamin, riboflavin, vitamin B-6, vitamin E, niacin, iron, calcium, zinc, and folate. Estimates of prevalence of inadequate nutrient intakes were calculated using the probability approach among the 2,655 participants with complete nutrient intake information. STATISTICAL ANALYSES PERFORMED: The chi 2 test for independence and analysis of variance. A P < .05 was considered significant in a 2-sided test. RESULT: On average, white participants of both genders reported higher mean energy and nutrient intakes than did black participants. Zinc had the highest estimated prevalences of inadequacy across all gender and race categories, followed by calcium, vitamin E, and vitamin B-6. Vitamin C, with estimated prevalences of inadequacy lower than 13%, and folate, with prevalences lower than 17%, had the lowest estimated prevalences of inadequacy across all gender, race, and age categories. CONCLUSIONS: In this population, there are race differences in estimated prevalences of inadequate nutrient intake. According to the current nutrient requirements for adults aged 51 years and older, many elderly persons have inadequate dietary intakes of key nutrients.     

Validation of a food frequency questionnaire for assessing dietary nutrients in Brazilian children 5 to 10 years of age

OBJECTIVE: This study aimed to assess the relative validity of a food frequency questionnaire (FFQ), previously validated to measure usual intakes in adults, for measuring dietary intakes in children 5 to 10 y of age. METHODS: Dietary intakes were measured using an FFQ and a 3-d dietary record. Healthy children, 5 to 10 y old (n = 151), were recruited from public schools and asked to answer the questions in the FFQ and to provide non-consecutive 3-d dietary records based on reported estimated portion sizes. Paired sample t tests and Pearson's correlation coefficients were conducted to determine whether the two instruments reported similar values for energy and nutrients. The agreement of quartile categorization between the two instruments was also examined. RESULTS: Estimated energy and nutrient intakes derived from the FFQ were significantly higher than those derived from 3-d dietary records. As expected, Pearson's correlations increased after adjusting for residual measurement error, presumably due to exclusion of the high within-person variability in intake of these nutrients. Moderate to high (r > 0.50) correlation coefficients were verified for some nutrients such as calcium, folate, vitamin B2, vitamin A, and vitamin C. CONCLUSION: This FFQ, originally developed for use in adults, appears to overestimate usual energy and nutrient intakes in children 5 to 10 y of age. Further work is necessary to conduct a calibration study to establish adequate portion sizes before instrument adoption in this population.     

Allowing for variations in multivitamin supplement composition improves nutrient intake estimates for epidemiologic studies

Collecting detailed data on dietary supplement use is time-consuming for study participants and investigators, and this is particularly difficult for multivitamin use because of the many different formulations available. Therefore, many studies simply ask about the frequency of multivitamin use and assign default nutrient composition values to obtain nutrient intakes. Multivitamin supplements are important contributors to total nutrient intakes, but it is not known how default values affect the accuracy of intake estimation. In this study, nutrient intakes were calculated from multivitamins consumed by 26,735 multivitamin users who provided detailed information like product name(s) and frequency of use on a mailed questionnaire. We then recalculated the intakes, using 2 different assumptions about the composition of the multivitamin supplements: 1) a single default composition for all products; and 2) four default compositions, 1 for each subtype of multivitamin, i.e., one-a-day with minerals, one-a-day without minerals, B-complex or stress multivitamins, and antioxidant combinations. A total of 1246 different brands of multivitamins were reported and nutrient composition varied widely. Spearman correlation coefficient analyses, using the 4 default nutrient profiles compared with actual nutrient intakes, were >0.5 (P < 0.001) for 12 of 15 nutrients examined. However, correlations using the single default were lower, with only 5 correlations >0.5. Our findings suggest that a questionnaire designed to assess the composition profiles for 4 types of multivitamin products substantially improves the accuracy of nutrient-intake estimates over one that uses a single default nutrient profile for all multivitamin products.     

Contribution of the Title III Meals Program to Nutrient Intake of Participants

This study was conducted to determine the contribution of the Title III meal program to the overall nutrient intake of participants. There were 69 participants in the study with a mean age of 74 years. Overall nutrient intake of the participants was adequate with mean intakes of all nutrients exceek 67% of the RDA. Black subjects consumed more carbohydrates, fiber, calcium, iron, thiamine, niacin, riboflavin, and vitamin C at lunch than did white subjects; however, these differences were due to different consumption patterns reported for "home" lunches rather than differences in lunches eaten at the meal site. Lunches supplied at least 33% of the total daily nutrient intake regardless of whether it was a meal program lunch or a home lunch.     

Influence of individually estimated portion size on the assessment of nutritional risk in colorectal cancer in Portugal

We evaluated the influence of individually estimated portion sizes on the estimate of nutrient related risk of colorectal cancer, using data from a Portuguese hospital based case-control study on diet and colorectal cancer. A total of 100 patients with colorectal adenocarcinoma (aged 15-92 years) and 211 controls (aged 36-89 years) were included. Two data sets were created for nutrient analysis, the first one allowed estimates of food intake using data on portion size as collected with visual aids during the interview. The second estimate substituted respondents' estimate with a standard portion size, as used in the semi-quantitative (SQ) food frequency approach. The two analytic approaches yielded similar energy and nutrient intakes in cases and controls. The percent range of concordance is acceptable, in the same quartile varying from 44 to 82% (mean: 56%) and very good in the same or adjacent (+/-1) quartile (mean: 91%, range: 85-97%). The two estimates lead to a similar pattern of multivariate odd's ratio, however the SQ estimates resulted in more significant findings. We conclude that little extra information is gained by including individual portion size information when assessing diet-related risk of colorectal cancer.     

Agreement on nutrient intake between the databases of the First National Health and Nutrition Examination Survey and the ESHA Food Processor

The objective of this study was to assess agreement on nutrient intake between the nutrient database of the First National Health and Nutrition Examination Survey (NHANES I) and an up-to-date (December 1998) nutrient database, the ESHA Food Processor. Analysis was conducted among 11,303 NHANES I participants aged 25-74 years in 1971-1975 who had undergone dietary assessment. A list of all unique foods consumed was obtained from a single 24-hour dietary recall questionnaire administered during the baseline NHANES I visit. Foods on the list were matched to foods in the ESHA Food Processor software. Agreement between participants' nutrient intakes as calculated with the NHANES I and ESHA nutrient databases was assessed using intraclass correlation analysis, linear regression analysis, and graphic methods. Intraclass correlation analysis demonstrated excellent concordance between most nutrient intakes, with coefficients above 0.95 for intakes of energy, carbohydrates, protein, cholesterol, and calcium; coefficients between 0.90 and 0.95 for intakes of total fat, saturated fat, potassium, and vitamin C; and coefficients of approximately 0.85 for intakes of sodium and vitamin A. Graphic methods and regression analyses also showed good-to-excellent correspondence for most nutrients. These findings support the validity of expanding existing nutrient intake databases to explore current hypotheses, provided that food formulation, enrichment, and fortification practices have not changed substantially over time.     

Nutrient intake and food consumption among pregnant women from an agricultural region of Morocco

This study aimed to assess dietary intake and nutrient adequacy in pregnant women selected from an agricultural region of Morocco. On a sample of 172 pregnant women from rural and urban area, data on socio-demographic characteristics and dietary habits by a quantified food frequency were collected using questionnaires. Mean daily intakes of energy and nutrients were estimated and compared to reference nutrient intakes (RNI). The results show that the mean daily intakes of energy (3110.9 kcal in urban; 2707.5 kcal in rural) and some nutrients were adequate. However, iron, folate, zinc and calcium intakes were inadequate for the majority of women and more markedly in rural area. Education level appeared to affect nutrient intakes while no differences were registered across pregnancy stages or according to household size. The study suggests that an education program should be conducted to improve dietary intakes in order to prevent risks for pregnancy outcome in this population.     

Validation of a food frequency questionnaire for assessment of calcium and bone-related nutrient intake in rural populations

OBJECTIVE: To assess the ability of a semiquantitative food frequency questionnaire (FFQ) to measure calcium and bone-related nutrient intakes in a rural South Dakota population. DESIGN: Intake estimates from FFQ were compared with four 24-hour recalls obtained quarterly during the preceding year. SUBJECTS: Convenience sample of 100 participants of the South Dakota Rural Bone Health Study were recruited, with 81 completing the FFQ. MAIN OUTCOME MEASURES: Calcium and bone-related nutrient intakes were expressed as milligrams per day, milligrams per 1,000 kcal, or quartiles. STATISTICAL ANALYSES PERFORMED: Intakes by FFQ and 24-hour recalls were compared using paired t test and quartiles were formed to examine cross-classification. RESULTS: Calcium intakes from FFQ and recalls were 1,287 and 1,141 mg/day (P=0.01), but calcium per 1,000 kcal did not differ. Calcium intake by FFQ correlated with intake by recall when expressed as milligrams per day (r=0.49, P<0.001) or milligrams per 1,000 kcal (r=0.59, P<0.001). Bland-Altman graphs indicated fairly good agreement between methods. Seventy-eight percent of subjects fell into the same or within one quartile category when calcium intake was expressed as milligrams per day and 83% when expressed as milligrams per 1,000 kcal. Gross misclassification occurred in 0% to 4% of the nutrients. CONCLUSIONS: Although FFQ may not be a valid indicator of an individual's intake, it does adequately classify rural populations into quartiles of calcium and bone-related nutrient intakes, making it a useful tool for assessing dietary calcium and bone related intake in rural populations.     

Dietary intake in human immunodeficiency virus-infected adults: a comparison of dietary assessment methods

OBJECTIVE: The objective of this study was to compare estimated nutrient intakes from 3-day food records vs Food Frequency Questionnaire (FFQ) in a large cohort of individuals living with human immunodeficiency virus (HIV) infection. DESIGN: Dietary data from 315 HIV-positive participants enrolled in a longitudinal cohort study were collected. Nutrient intake data estimated from the Block FFQ were compared with multiple 3-day food records done over the same time period. SUBJECTS/SETTING: Participants enrolled in Nutrition for Healthy Living, an ongoing cohort study based in Boston, MA, were studied. STATISTICAL ANALYSES PERFORMED: Using 3-day food records as the gold standard, we compared estimated nutrient intakes between the two assessment methods by (a) median of individual differences in intake, (b) correlation coefficients, (c) quintile ranking, and (d) intakes less than the Dietary Reference Intakes. Nutrient intake estimates between the two methods were compared using Spearman, Pearson, and deattenuated correlation coefficients. RESULTS: Median reported intakes of all macronutrients and most micronutrients were significantly less on the FFQ for both men and women. Deattenuated correlations were less than 0.5 for 86% of the men and for 68% of the women. Mean percent agreement for quintile ranking was 30%. CONCLUSIONS: In this large cohort of HIV-infected adults, we found significant differences between FFQs and food records in estimates of absolute dietary intakes, correlation coefficients, quintile rankings, and proportions of subjects consuming less than the Dietary Reference Intakes. These findings have implications for the interpretation and application of dietary intake data from FFQs in specialized populations.     

Association of Household Income Level with Vitamin and Mineral Intake

Appropriate nutrient intake is essential for maintaining health and resisting disease. The current study investigated the association between household income quintile and nutrient intake using data from KNHANES 2019. A total of 5088 South Korean adults were analyzed. The estimated average requirement cut-point method, extended to handle participants with intakes higher than the tolerable upper level, was utilized to determine the need for dietary modification. The suitability of overall vitamin, overall mineral, and individual nutrient intake was evaluated by logistic regression analysis. Subgroup analysis was performed on overall mineral intake suitability. None of the individual nutrients had an intake ratio of over 70%, with the ratio being under 30% for some nutrients. The intake of iron, phosphorus, vitamin B9, and vitamin C had a significant upward trend as household income rose. A subgroup analysis revealed sex differences in the trends of overall mineral intake. The results revealed that some nutrients are not consumed appropriately in the Korean population. Furthermore, they suggest that household income is significantly associated with the intake of overall minerals and several individual nutrients. These results suggest that nutritional assistance is required for certain vulnerable groups, and provide supplementary data for appropriate interventions or further research.     

Nutrient intake and food consumption among pregnant women from an agricultural region of Morocco

This study aimed to assess dietary intake and nutrient adequacy in pregnant women selected from an agricultural region of Morocco. On a sample of 172 pregnant women from rural and urban area, data on socio-demographic characteristics and dietary habits by a quantified food frequency were collected using questionnaires. Mean daily intakes of energy and nutrients were estimated and compared to reference nutrient intakes (RNI).

The results show that the mean daily intakes of energy (3110.9?kcal in urban; 2707.5?kcal in rural) and some nutrients were adequate. However, iron, folate, zinc and calcium intakes were inadequate for the majority of women and more markedly in rural area. Education level appeared to affect nutrient intakes while no differences were registered across pregnancy stages or according to household size. The study suggests that an education program should be conducted to improve dietary intakes in order to prevent risks for pregnancy outcome in this population.     

Older pregnant women and adolescents: nutrition data after enrollment in WIC

Although there has been an increase in pregnancy in women over 35 years of age, the literature contains no information on dietary intakes of older pregnant women. Several studies have reported the nutritional status of pregnant adolescents who are considered to be at nutritional risk. This study investigated the energy, nutrient, and food intake patterns of 63 low-income pregnant women over 35 compared with 526 pregnant adolescents. Nutrient intake was assessed using a standardized 24-hour dietary recall protocol. Energy values for both groups were below recommended levels, and neither group gained the recommended amount of weight. Obesity may have been the reason for the lack of weight gain by the older pregnant women, since more than 50% of the older pregnant women were calculated to be obese prior to pregnancy. The younger women reported consuming less milk but more snack foods with lower nutrient densities, which significantly increased their energy values over those of the older group. In comparison with diets reported in other studies, the diets of the older pregnant women were more nutrient dense for most nutrients. Although all participants were enrolled in WIC, an equal number of women from both groups stated that they did not have the supplemental foods in their households at the time of interview.     

Multivitamin-multimineral supplements' effect on total nutrient intake

Use of multivitamin-multimineral supplements is widespread and can contribute substantially to total nutrient intakes. In the Hawaii-Los Angeles Multiethnic Cohort (MEC), 48% of men and 56% of women without chronic diseases reported use of multivitamin supplements at least weekly over the past year. We calculated the prevalence of nutrient adequacy for 17 nutrients based on responses to a self-administered quantitative food-frequency questionnaire administered to MEC participants at baseline in 1993-1996. Although the prevalence of nutrient adequacy from food only was higher for multivitamin supplement users (n = 21,056) than for nonusers (n = 69,715), differences averaged only 2 percentage points. For multivitamin users, the prevalence of adequacy improved by an average of 8 percentage points for both men and women when intake from supplements was included. Users were also more likely to have potentially excessive intakes, particularly for iron, zinc, vitamin A, and niacin. The 26,735 MEC participants in Hawaii who answered an open-ended question about multivitamin use in 1999-2001 reported using 1246 different products. The nutrient profile of these products varied widely, and the composition of products at the 90th percentile was 10-fold greater than the composition at the median for some nutrients. We conclude that analyses of nutrient adequacy and excess for supplement users should be extended to national samples and that composition data on actual supplements used are preferable to assuming a default nutrient profile for multivitamin supplements. Multivitamin products could be better formulated to reduce the prevalence of inadequacy and also to reduce the risk of excessive intakes.