Reasonable estimates of serum vitamin E, vitamin C, and beta-cryptoxanthin are obtained with a food frequency questionnaire in older black and white adults. The validity of questionnaire-based micronutrient intake estimates is increased by including dietary supplement use in Swedish men. Dietary intake estimated using different methods in two Italian older populations. Validity and reproducibility of a food frequency questionnaire by cognition in an older biracial sample. Comparison of diet history interview and self completed questionnaire in assessment of diet in an elderly population. Comparative validation of standard, picture-sort and meal-based food-frequency questionnaires adapted for an elderly population of low socio-economic status. Comparison of a picture-sort food-frequency questionnaire with 24-hour dietary recalls in an elderly Utah population. Dietary assessment in the elderly: validation of a semiquantitative food frequency questionnaire Validation and reproducibility of a semi-quantitative Food Frequency Questionnaire for use in elderly Swiss women. A dietary study of the elderly in the city of Roskilde 1988/89. Methodological aspects of the relative validity of the dietary history method. Validation of a food frequency questionnaire for nutritional calcium intake assessment in Italian women Evaluation of two food frequency methods of measuring dietary calcium intake. The Dutch EPIC food frequency questionnaire. II. Relative validity and reproducibility for nutrients.
Few studies provide correlations between different indicators of the dietary intakes of older ( > or= 65 y ) black and white adults . This study compared the usual intakes of vitamin E , vitamin C , and selected carotenoids estimated by a modified Harvard food frequency question naire ( FFQ ) to those estimated by multiple 24-h recalls , and to blood concentrations of components in a r and omly selected sample of participants in the Chicago Health and Aging Project ( CHAP ) . Subjects ( n = 59 ) were interviewed to complete multiple 24-h recalls over a year 's time , then completed an FFQ and subsequently provided a fasting blood specimen within 2 mo . Dietary estimates were energy-adjusted separately for men and women . Significant ( P < 0.05 ) correlations between total ( diet and supplement ) FFQ estimates and serum measures of vitamin E and vitamin C were as follows : 0.49 and 0.39 for blacks , and 0.42 and 0.29 for whites , respectively . The highest correlations between serum and FFQ indicators were for dietary beta-cryptoxanthin ( 0.46 ) , total alpha-tocopherol ( 0.46 ) and total beta-carotene ( 0.44 ) among whites ; among blacks , the highest correlations were for dietary alpha-carotene ( 0.81 ) , total alpha-tocopherol ( 0.53 ) and total beta-cryptoxanthin ( 0.50 ) ; all were significant ( P < 0.05 ) . Further adjustment for age , gender , BMI , and educational level minimally altered these coefficients . These findings indicate that the modified Harvard FFQ provides reasonable estimates of serum levels of vitamin E , vitamin C and beta-cryptoxanthin among CHAP participants Although many validation studies of FFQ have been reported , only a few addressed the effect of inclusion of dietary supplement use on the validity of micronutrient estimates . The purpose of the present study was to assess reproducibility and validity of a self-administered FFQ , intended to measure total nutrient intake from diet and from  dietary supplements  , in a r and om population -based sample of 248 middle-aged and elderly men ( 40 - 74 y old ) in central Sweden . Fourteen 24-h recall interviews were used as the reference method . Participants were telephoned about once a month for 1 y , covering every day of the week , twice in r and om order . Spearman correlation coefficients increased 13 % ( from 0.49 to 0.62 ) , between FFQ-based micronutrient estimates and the fourteen 24-h recall interviews ( reference method ) when supplement use was included . Correct classification into highest quintiles was also improved by 14 % ( from 37 to 51 % ) . There were no differences in mean intraclass correlation coefficients for 1-y reproducibility between total micronutrient intake and micronutrients from foods only . The increase in the validity of micronutrient estimates due to inclusion of supplements in nutrient intake assessment has important implication s for sample size in epidemiologic studies . Because a dramatic increase in dietary supplement use has occurred in recent decades in many countries , the issue of including supplements in dietary assessment should be of highest priority in nutritional epidemiologic studies of chronic diseases Most of the tools used to assess nutritional intake in large epidemiological studies were originally developed to be used in young and middle-aged subjects and , therefore , their validity and reliability when employed in older subjects remain uncertain . We conducted this study to verify whether the question naire developed in the context of the European Prospect i ve Investigation into Cancer and nutrition ( EPIC ) could be used to assess dietary intake in the participants of InCHIANTI , an epidemiological study of risk factors for disability in late life , performed in 633 men ( 78 % aged , > or = 65 years ) and 802 women ( 81 % aged , > or = 65 years ) r and omly sample d from the general population . In particular , the aim of this project was to collect preliminary information that could support a future study of concurrent validity . Data on food consumption assessed using the EPIC question naire from the InCHIANTI participants were compared with those collected using a 7-day diary in the National Nutritional Investigation into Dietary Behavior ( INN-CA ) , a study conducted in 15 Italian centres aim ed at assessing Italian households ' and individuals ' dietary intake . In spite of different population s and different methods used in data collection , the distributions of dietary intake from the two studies were remarkably similar for most macro- and micro-nutrients , both in men and women and according to age groups . At a population level , a food frequency question naire and a costly and time-consuming objective method provided similar estimates of dietary intake . Future study should attempt to generalize these findings at an individual level by collecting data with both instruments in the same subjects It is not currently known how dietary assessment in older persons is affected by cognition . In a 1997 - 2000 study , the authors assessed the validity and reproducibility of a modified Harvard self-administered food frequency question naire ( SFFQ ) among 118 Black and 114 White r and omly selected participants , aged 68 - 99 years , of the Chicago Health and Aging Project . Participants completed multiple 24-hour dietary recall interviews ( mean=3.6 ) over 12 months and two SFFQs in the first and 12th months . The average energy-adjusted intraclass correlation coefficient for 15 nutrients was 0.59 for 1-year reproducibility in nutrient intake levels assessed by the SFFQ . The average energy-adjusted Pearson correlation coefficient was 0.46 for comparative validity between nutrient intake levels on the SFFQ and the dietary recalls . SFFQ reproducibility was higher among men , and comparative validity with the dietary recalls was higher among women . There were no remarkable differences in the correlations by age , race , educational level , presence of chronic conditions , or cognitive ability . The modified Harvard SFFQ is a reasonable method of dietary assessment even in a population of older persons , some of whom are at advanced age , have chronic health conditions , and have cognitive impairment STUDY OBJECTIVE --The aim of the study was to determine the reliability of a diet history interview with a short self completed question naire of a basic design used in other studies in the United Kingdom . DESIGN --The study used a cohort of elderly people r and omly divided into two groups after stratification for sex . Members of one group completed the question naire first and were interviewed later ; the procedure was reversed for the other group . SETTING -- Participants were drawn from registers of two general practitioners at a Nottingham health centre . PARTICIPANTS --All non-Asian men aged 65 - 74 years and women aged 59 - 65 years registered with the practice s were identified ( n = 152 ) ; 20 could not be traced and two were too ill , leaving 130 possible participants . Of these , 80 took part in the study . MEASUREMENTS AND RESULTS --Ranking of subjects in terms of estimated fat , fibre , and calcium intakes was compared in the history interview and in the self completed question naire . Agreement in tertile ranking was 58 % for fibre , 53 % for fat , and 49 % for calcium . Corresponding correlation coefficients for estimated nutrient intakes were 0.49 , 0.45 , and 0.41 respectively . The differences in nutrient intakes estimated by the two methods were not affected by age , sex , marital status , or smoking patterns . Subjects in the group asked to complete the question naire before being interviewed showed greater percentage concordance for tertile ranking , but this reached significance only for fat intake . CONCLUSIONS --The two methods provide estimates of intakes similar to those found in other studies in the United Kingdom , and the agreement between them in terms of tertile ranking is also similar to previous studies . The incidence of gross misclassification was low OBJECTIVE To compare the validity of a modified Block food-frequency question naire ( FFQ ) , a picture-sort administration of the FFQ ( PSFFQ ) and a meal pattern-based question naire ( MPQ ) in a multi-ethnic population of low socio-economic status ( SES ) . DESIGN Participants completed six 24-hour dietary recalls ( 24HR ) over six months ; the FFQ , PSFFQ and MPQ were completed in r and om order in the subsequent month . Instruments were interviewer-administered . The PSFFQ and MPQ were developed in formative research concerning difficulties for older adults in responding to st and ard food-frequency instruments . SETTING Rural North Carolina , USA . Subjects One hundred and twenty-two African American , Native American and white adults aged > or = 65 years , with approximately one-third in each ethnic group . Inclusion criteria included education < or = 12 years and income < or = 150 % of national poverty level or Medicaid recipient . RESULTS Comparing median intakes from the average of the 24HR with the three diet assessment instruments , the MPQ tended to overestimate intakes compared with the FFQ and PSFFQ . Correlations among nutrients obtained by the 24HR and the other three instruments were generally statistically significant and positive . Across nutrients , the PSFFQ was most highly correlated with the 24HR for women , while the FFQ was most highly correlated with the 24HR for men . CONCLUSIONS Dietary assessment s using 24HR and FFQ were similar to results reported elsewhere , although correlations between 24HR and FFQ were somewhat lower . Interviewer-administered dietary assessment s should be used with caution to evaluate dietary intake among older adults with low SES . Gender differences and the lower correlations should be investigated more thoroughly to assist in choosing dietary assessment instruments for this population OBJECTIVE To evaluate the 137-item  Utah Picture-sort Food-frequency Question naire ( FFQ ) in the measurement of usual dietary intake in older adults . DESIGN The picture-sort FFQ was administered at baseline and again one year later . Three seasonal 24-hour dietary recall interviews were collected during the year between the two FFQs . Mean nutrient intakes were compared between methods and between administrations of the FFQ . SETTING The FFQ interviews were administered in respondents ' homes or care-centres . The 24-hour diet recalls were conducted by telephone interview on r and om days of the week . SUBJECTS Two-hundred- and -eight men and women aged 55 - 84 years were recruited by r and om sample of controls from a case-control study of nutrition and bone health in Utah . RESULTS After adjustment for total energy intake , median Spearman rank correlation coefficients between the two picture-sort FFQs were 0.69 for men aged < or = 69 years , 0.66 for men aged > 69 years ; and 0.68 for women aged < or = 69 years , 0.67 for women aged > 69 years . Median correlation coefficients between methods were 0.50 for men < or = 69 years old , 0.52 for men > 69 years old ; 0.55 for women < or = 69 years old , 0.46 for women > 69 years old . CONCLUSIONS We report intake correlations between methods and administrations comparable to those reported in the literature for traditional paper- and -pencil FFQs and one other picture-sort method of FFQ . This dietary assessment method may improve ease and accuracy of response in this and other population s with low literacy levels , poor memory skill , impaired hearing , or poor vision Objective : The study was conducted to assess the relative validity of a 170-item semiquantitative food frequency question naire ( SFFQ ) adapted for use in the elderly . Design and subjects : The study was carried out in a sample of 80 men and women aged 55–75 y participating in a community based prospect i ve cohort study in Rotterdam , The Netherl and s. The two-step dietary assessment comprised a simple self-administered question naire ( 20 min ) followed by a structured interview with trained dietitians ( 20 min ) based on the completed question naire . Multiple food records ( FR ) collected over a one year period served as reference method . 24 h urine urea was used as indirect marker for protein intake . Results : Compared with FR , the SFFQ generally overestimated nutrient intake as reflected by difference in means and the ratio of SFFQ to FR . Energy adjustment reduced the observed overestimation . Pearson ’s correlation coefficients varied from close to 0.5 to about 0.9 for crude data , and after adjustment for age , sex , total energy intake , and for within-person variability in daily intake for 0.4–0.8 . Cross-classification into quintiles result ed in correct classification into the same or adjacent quintile of 75.8 % for crude and 76.8 % for energy-adjusted data . Validation of protein intake estimated by SFFQ with protein excretion from 24 h urine urea indicated overestimation of protein intake by SFFQ . Spearman correlation coefficient between protein intake estimated from urea excretion and SFFQ was 0.67 . Conclusions : Adaptation of a SFFQ for use in the elderly result ed in a valid and time-efficient dietary assessment instrument . Its ability to adequately rank study subjects according to their dietary intake support its application in epidemiological studies in the elderly . Sponsorship : ROMERES and Akzo Nobel , the Netherl and s ; K. Klipstein-Grobusch was supported by the Ministry of Research , Culture , and Science of the Federal State of Br and enburg , Germany OBJECTIVE The principal aim of this study was to develop a Swiss Food Frequency Question naire ( FFQ ) for the elderly population for use in a study to investigate the influence of nutritional factors on bone health . The secondary aim was to assess its validity and both short-term and long-term reproducibility . DESIGN A 4-day weighed record ( 4 d WR ) was applied to 51 r and omly selected women of a mean age of 80.3 years . Subsequently , a detailed FFQ was developed , cross-vali date d against a further 44 4-d WR , and the short- ( 1 month , n = 15 ) and long-term ( 12 months , n = 14 ) reproducibility examined . SETTING French speaking part of Switzerl and . SUBJECTS The subjects were r and omly selected women recruited from the Swiss Evaluation of the Methods of Measurement of Osteoporotic Fracture cohort study . RESULTS Mean energy intakes by 4-d WR and FFQ showed no significant difference [ 1564.9 kcal ( SD 351.1 ) ; 1641.3 kcal ( SD 523.2 ) respectively ] . Mean crude nutrient intakes were also similar ( with nonsignifcant P-values examining the differences in intake ) and ranged from 0.13 ( potassium ) to 0.48 ( magnesium ) . Similar results were found in the reproducibility studies . CONCLUSION These findings provide evidence that this FFQ adequately estimates nutrient intakes and can be used to rank individuals within distributions of intake in specific population In winter 1988/89 , 194 elderly adults ( 96 men and 98 women , aged 70 - 75 years ) were interviewed , using the dietary history method . The relative validity of a dietary history method used in this elderly population was assessed . The record of intake of energy and nutrients from the dietary history method was compared with that obtained in the same group by means of a 3-day food record completed during the same period . For daily intake of energy and nutrients , the differences in mean intake were generally below 15 % . But mean differences were significant for energy , fat , dietary fiber , and calcium . The two dietary methods correlated well for energy and nutrients . Pearson 's correlation coefficient varied from 0.80 ( dietary fiber ) to 0.24 ( vitamin A ) . The two methods classified about half of the subjects similarly into tertiles for energy and most nutrients . Gross misclassification occurred for 2 - 17 % of the subject . Agreement between the two methods were poorest for vitamin A. The results suggest that the dietary history method may be inadequate for determining the exact level of mean and distribution of dietary intake in a group or the precise intake of an individual . But the method could be used to test differences in means between groups and to rank subjects as to their dietary intake within the study Objective : To evaluate a food frequency question naire assessing calcium intake in women . Design : Estimates of calcium intake from the food frequency question naire were compared with those from 14 day records from 206 Caucasian women aged 25–75 y in Siena , Italy . Subjects : Subjects were r and omly recruited from the residents list of the city of Siena , Italy . Of the 250 initially recruited , 39 did not meet the inclusion criteria or failed to complete the diet record and five outliers were excluded before the statistical analysis on the basis that their diet record was unlikely to represent habitual intake . Results : Mean dietary calcium intakes were 829±255 ( s.d . ) mg/day from the question naire and 818±260 ( s.d . ) mg/day from the diet record . The mean difference in intake by the two methods ( −11.3±116.4 mg/day ) did not differ significantly from zero . Specificity in classifying women consuming less than 800 mg/day calcium was 86.6 % , and sensibility in classifying women consuming more than 800 mg/day calcium was 89.4 % . Conclusions : The food frequency question naire could be used in epidemiological studies to assess calcium intake in young to elderly women . The specificity in identifying low calcium intake subjects makes it useful also as an educational tool in diet counselling and for prescribing calcium supplementation . Sponsorship : None To assess the ability of food frequency methods to measure current dietary calcium intake in elderly women , the authors administered two types of food frequency instruments to 37 r and omly selected women who attended two senior citizens centers in San Francisco , and they compared those responses to seven-day food records . A 34-item food frequency instrument ( with portion sizes rated as small , medium , or large ) correlated well ( r = 0.76 ) with the estimated calcium intake from seven-day records . Limiting the instrument to the top 15 , 10 , or five foods that contribute to dietary calcium intake had little effect on this correlation ( r = 076 , 0.75 , and 0.67 , respectively ) . Rating all portions as " medium " reduced these correlations somewhat . An 18-item instrument , which asks respondents to rate portion sizes in ounces or cups , did not correlate as well with the seven-day records ( r = 0.49 ) . The authors conclude that brief food frequency instruments which rate portion sizes on a simple qualitative scale may be suitable for many clinical uses and adequate for some types of epidemiologic studies of calcium intake in elderly women BACKGROUND A self-administered semi-quantitative food frequency question naire ( FFQ ) was developed for the Dutch cohort of the European Prospect i ve Investigation into Cancer and Nutrition ( EPIC ) . METHODS The reproducibility and relative validity of  nutrient intake  as assessed by this question naire were investigated in a population of 121 men and women . To assess the relative validity , 12 monthly 24-hour recalls served as reference method , together with four determinations of 24-hour urinary nitrogen excretion , predicted basal metabolic rate , and serum beta-carotene and alpha-tocopherol levels . RESULTS Protein and among women , energy intake were underestimated by the question naire compared to urinary nitrogen excretion and the basal metabolic rate , respectively . The underestimation for protein decreased with increasing protein intake . Pearson correlation coefficients between nutrient intakes assessed by repeated question naires ranged from 0.70 to 0.94 among men and from 0.59 to 0.94 among women . Correlation coefficients between nutrient intakes assessed by the question naire and 24-hour recalls ranged from 0.26 to 0.83 for men and from 0.35 to 0.90 for women , with medians of 0.59 and 0.58 , respectively . Correlation coefficients between 0.2 and 0.5 were observed for beta-carotene and vitamin C for men and for beta-carotene and vitamin E for women . Associations with serum beta-carotene ( r = -0.16 for men ; 0.13 for women ) and alpha-tocopherol ( 0.23 and 0.15 , respectively ) were much poorer than those obtained with 24-hour recalls . Correlations between protein intake and 24-hour urinary nitrogen excretion were 0.47 and 0.53 , respectively . CONCLUSIONS The FFQ seems adequate for ranking subjects according to intake of energy , macronutrients , dietary fibre and retinol , but it does not yield such good results for beta-carotene , vitamin C for men , vitamin E for women
The European micronutrient recommendations aligned ( EURRECA ) Network of Excellence seeks to establish clear guidelines for assessing the validity of reported micronutrient intakes among vulnerable population groups .