Comparison of dietary intake measured by a web-based FFQ and repeated 24-hour dietary recalls: the Hordaland Health Study

Validation of a digital food frequency questionnaire for the Northern Sweden Diet Database

BACKGROUND

Dietary habits strongly influence health, with poor diets contributing to numerous deaths annually. Addressing this requires improved dietary habits and consistent monitoring thereof. In northern Sweden, a validated food frequency questionnaire (FFQ) has been used for decades, but trends show that its ability to accurately measure intake has diminished. With changing eating habits and food supply, updating the FFQ was crucial, leading to the development of FFQ2020. This study assessed FFQ2020's relative validity using 24-hour recalls and evaluated its reproducibility.

METHODS

Participants were recruited from one of the northern-Sweden population-based health screenings and by advertising. Food intake was registered in an electronic food frequency questionnaire (FFQ2020) (test instrument) and reference data were obtained by six repeated electronic 24-hour dietary recalls (24HDR). Intakes of single foods were aggregated into food groups and healthy diet index scores, and daily energy and nutrient intakes were estimated. Results from the two methods were described and tested in univariate analyses and correlation tests, Bland Altman plots, cross-classification validity, and intra-class correlation analyses.

RESULTS

Totally, 628 adults were invited to participate in the study. Of these, 320 joined, and 244 completed at least four 24HDRs. The median intakes in food groups, as well as the mean index scores and estimated nutrient intakes, were largely similar between the FFQ2020 and 24HDR recordings. The correlation coefficients between the two assessments ranged from 0.253 to 0.693 for food groups, 0.520 to 0.614 for diet indices, and 0.340 to 0.629 for energy and nutrients. Intra-class correlation coefficients indicated at least good reproducibility for intakes of food groups, diet index scores, and nutrients. Generally, Bland-Altman plots did not reveal any gross systematic disagreement between the two methods for any of the assessments. However, there were single observations located outside the upper or lower 95% confidence interval (CI) limits for the difference between FFQ2020 and the 24HDR recordings.

CONCLUSION

In concert, the results suggest that the relative validity and reproducibility of FFQ2020 are acceptable for trend analyses and group comparisons in large-scale studies but also that extended reference periods would improve the precision of less frequently consumed foods.

A validation study comparing energy and nutrient intake between a web-based food frequency questionnaire and a 4-d dietary record

OBJECTIVE

Reliable assessments of dietary intake is crucial when examining associations between dietary factors and different outcomes. Today, web-based instead of paper-based food frequency questionnaires (FFQs) are common. A web-based FFQ implies a different experience (including design differences, the possibility only to show relevant questions, and automatic checks for completeness) and may capture dietary intake differently. The aim of this study was to validate a well-used paper-based FFQ transferred to a web-based version against a 4-d dietary record.

METHODS

Baseline data from a dietary intervention study comprising women and men with type 2 diabetes were used. Diet was assessed with the web-based FFQ and a 4-d dietary record. Energy intake and energy-adjusted nutrient intakes were assessed and compared using Spearman's rank correlation and Bland-Altman analysis. The analysis included 101 participants.

RESULTS

The average energy intake with the FFQ was 2068 kcal, 157 kcal higher than the average from the dietary record. Significant deattenuated correlations were found for intake of energy (r = 0.37; 95% confidence interval [CI],0.19-0.53), carbohydrates (r = 0.85; 95% CI, 0.78-0.89), protein (r = 0.53; 95% CI, 0.38-0.66) and fat (r = 0.59; 95% CI, 0.44-0.70). Significant deattenuated correlations (ranging r = 0.26-0.73) were found for intake of alcohol, whole grain, fiber, saturated fat, monounsaturated fat, polyunsaturated fat, cholesterol, vitamins A, B12, C, D, and E, folate, iron, potassium, magnesium, and calcium. Bland-Altman analyses showed no clear trends but wide limits of agreement.

CONCLUSION

Overall, the web-based FFQ performed well and is similar to the paper-based version. It can be a useful tool for dietary assessments.

The Association of Isocaloric Substitution of Dietary Protein in Middle Age with Muscle Mass and Strength in Old Age: The Hordaland Health Study

Background

Age-associated loss of muscle mass and strength is an important predictor of disability in older persons. Although several mechanisms contribute to the decline in muscle mass and function seen with aging, the process is thought to be accelerated by an inadequate protein intake. However, the optimal amount and source of protein and the role of dietary protein intake over the life course remain uncertain.

Objectives

In a sample of community-dwelling adults in Western Norway, the current study examined both cross-sectional and longitudinal associations over 20 y of dietary protein intake with appendicular skeletal muscle mass (ASMM) and muscle strength measured by handgrip strength (HGS) in older age.

Methods

Dietary intake was assessed using food frequency questionnaires (FFQs) in middle age (46-49 y) and older age (67-70 y) within the community-based Hordaland Health Study.

Results

Adjusted, multivariate linear regression analyses revealed a negative cross-sectional association between the substitution of total protein (TP) and animal protein (AP), with fat and carbohydrates, on ASMM in women but not in men. No longitudinal associations were found between substitution of dietary protein intake and ASMM in either sex in adjusted models. Similarly, no cross-sectional or longitudinal associations were evident between substitution of dietary protein intake and HGS in either sex in adjusted models.

Conclusion

The findings in the current study highlight the need to clarify the role of dietary protein intake in the maintenance of muscle mass and muscle strength in healthy older adults.

The association of dietary patterns with muscle mass and strength in old age: The Hordaland Health Study

PURPOSE

The single nutrient approach in nutrition research lacks the ability to account for synergistic relationships between dietary components. Current evidence suggests that diet quality, reflecting overall dietary intake, may influence muscle health. In a community-based observational study in Western Norway, we examined dietary patterns in relation to muscle mass and strength at age 67-70.

METHODS

The current analysis was conducted in men and women of The Hordaland Health Study (HUSK), who participated in both the second (HUSK2) and third study wave (HUSK3). Dietary patterns were extracted by principal component analysis (PCA) on food frequency questionnaire (FFQ) data. Individual dietary pattern scores (DPS) for HUSK2 (age 46-49) and HUSK3 (age 67-70), and overall DPS (oDPS) were calculated. Outcome variables were appendicular skeletal muscle mass (ASMM) and handgrip strength (HGS) measured in HUSK3. The relationships of HUSK3 DPS and oDPS with ASMM and HGS were assessed by multivariate linear regression analysis adjusted for potential confounding factors.

RESULTS

We identified three distinct dietary patterns, labelled 'Western', 'Healthy', and 'Sweets-focused'. A significant positive association was observed between the oDPS for the 'Healthy' dietary pattern and ASMM in both men and women at age 67-70. No significant associations were found between HUSK3 DPS or oDPS for any of the identified dietary patterns and HGS in our population.

CONCLUSION

Higher oDPS on a dietary pattern predominantly rich in fish, vegetables, nuts and seeds, fruit and berries, and eggs was associated with better ASMM at age 67-70. To establish the influence of diet quality on muscle health, further long-term studies with repeated dietary assessments are warranted.