Assessing the diet of adolescent girls in the UK

Influence of income on diet quality and daily iron and zinc intake: analysis of the National Diet and Nutrition Survey of British females aged 11-14 and 15-18 years

PURPOSE

A negative socio-economic gradient exists for diet and health outcomes. Since cheaper diets are associated with increased energy and lower nutrient density, we investigated the influence of income on iron and zinc intakes and overall diet quality for adolescent (DQI-A) females aged 11-18 years.

METHODS

National Diet and Nutrition Survey (NDNS years 7 and 8) data for iron and zinc intake and overall diet quality was assessed by household income quintile across females aged 11-18 years.

RESULTS

Equivalised household income positively correlated with Diet quality index for adolescents (DQI-A) (P < 0.001) Females aged 15-18 years in income quintiles (IQs) I and 2, had a greater proportion of respondents with low to intermediate DQI-A score compared to higher IQs (P = 0.002). NDNS data showed intake was negatively influenced by income amongst females aged 11-14 years for iron (P = 0.009) and zinc (P = 0.001) with those from the lowest incomes consistently consuming significantly less than those from the highest. DQI-A was positively correlated with iron intakes for 11-14 (P = 0.001) and 15-18 years (P < 0.001). Forty-one percent of 15-18-year-olds plasma ferritin stores were below the 15 µg L^-1 and 21% had some form of anaemia. Cereal and cereal products were the greatest contributors to iron in all groups.

CONCLUSION

Females in the lowest income groups are at greater risk of lower overall diet quality and inadequate iron and zinc intakes. Amongst older adolescents, there is evidence of iron stores being depleted and an increased prevalence of anaemia.

Relative validity of FFQ to assess food items, energy, macronutrient and micronutrient intake in children and adolescents: a systematic review with meta-analysis

FFQ are one of the most widely used tools of research into nutritional epidemiology, and many studies have been conducted in several countries using this dietary assessment method. The present study aimed to evaluate the relative validity of FFQ, in comparison with other methods, in assessing dietary intake of children and adolescents, through a systematic review. Four electronic databases (Embase, PubMed, Scopus and Web of Science) found sixty-seven articles, which met the inclusion criteria (healthy children and adolescents from 3 to 18 years of age; journal articles written in English, Spanish and Portuguese between 1988 and March 2019; results showing the comparison between the FFQ with other methods of assessment of dietary intake). The articles were analysed by two independent reviewers. A meta-analysis was conducted using correlation coefficients as estimate effects between the FFQ and the reference standard method. Subgroup analysis and meta-regression were performed to identify the probable source of heterogeneity. In fifty-five of the sixty-seven studies, a single dietary assessment method was used to evaluate the FFQ; nine combined the two methods and three used three reference methods. The most widely used reference method was the 24-h recall, followed by the food record. The overall relative validity of the FFQ to estimate energy, macronutrient, certain micronutrient and certain food item intakes in children and adolescents may be considered weak. The study protocol was registered in PROSPERO under number CRD42016038706.

Relative validity and reproducibility of a quantitative food frequency questionnaire for adolescents with type 1 diabetes: validity of a food frequency questionnaire

Background. Food frequency questionnaires are used to assess dietary intake in epidemiological studies. Objective. The aim of the study was to assess the relative validity and reproducibility of a quantitative food frequency questionnaire (QFFQ) for adolescents with type 1 diabetes.

METHODS

Validity was evaluated by comparing the data generated by QFFQs to those of 24-hour recalls (24 hrs). QFFQs were applied twice per patient to assess reproducibility. Statistical analysis included performing t-tests, obtaining Pearson correlation coefficients when necessary, correcting measurements for randomness by the weighted kappa method, calculating intraclass correlation coefficients, and generating Bland-Altman plots (P < 0,05). Results. The total energy and nutrient intake as estimated by the QFFQs were significantly higher than those from 24 hrs. Pearson correlation coefficients for energy-adjusted, deattenuated data ranged from 0.32 (protein) to 0.75 (lipid, unsaturated fat and calcium). Weighted kappa values ranged from 0.15 (vitamin C) to 0.45 (calcium). Bland-Altman plots indicated acceptable validity. As for reproducibility, intraclass correlation coefficients ranged from 0.24 (calcium) to 0.65 (lipid), and the Bland-Altman plots showed good agreement between the two questionnaires.

CONCLUSION

The QFFQ presented an acceptable ability to classify correctly and with good reproducibility, adolescents with type 1 diabetes according to their levels of dietary intake.

Reliability and relative validity of a food frequency questionnaire to assess food group intakes in New Zealand adolescents

Background

Due to the absence of a current and validated food frequency questionnaire (FFQ) for use in New Zealand adolescents, there is a need to develop one as a cost-effective way to assess adolescents’ food patterns. This study aims to examine the test-retest reliability and relative validity of the New Zealand Adolescent FFQ (NZAFFQ) to assess food group intake in adolescents aged 14 to 18 years.

Methods

A non-quantitative (without portion size), 72-item FFQ was developed and pretested. Fifty-two participants (aged 14.9 ± 0.8 years) completed the NZAFFQ twice within a two-week period for test-retest reliability. Forty-one participants (aged 15.1 ± 0.9 years) completed a four-day estimated food record (4DFR) in addition to the FFQs to enable assessment of validity. Spearman’s correlations and cross-classification analyses were used to examine relative validity while intra-class correlations were additionally used for test-retest reliability.

Results

Weekly intakes were estimated for each food item and aggregated into 34 food groups. The median Spearman’s correlation coefficient (SCC) between FFQ administrations was 0.71. SCCs ranged from 0.46 for fruit juice or cordial to 0.87 for non-standard milk. The median intra-class correlation coefficient (ICC) between FFQ administrations was 0.69. The median SCC between food groups from the FFQ and the 4DFR was 0.40 with the highest SCC seen for standard milk (0.70). The exact agreement between the methods in ranking participants into thirds was highest for meat alternatives (78%), but lowest for red or yellow vegetables and potatoes (27%). The mean percent of participants misclassified into extreme thirds for food group intake was 12%.

Conclusions

Despite a small sample size, the NZAFFQ exhibited good to excellent short-term test-retest reliability and reasonable validity in ranking the majority of the food group intakes among adolescents aged 14 to 18 years. The comparability of the validity to that in the current literature suggests that the NZAFFQ may be used among adolescent New Zealanders to identify dietary patterns and rank them according to food group intake.

Reproducibility and validity of a food frequency questionnaire in assessing dietary intakes of low-income Caucasian postpartum women living in Sheffield, United Kingdom

The aim of this study was to examine the reproducibility and validity of a semi-quantitative food frequency questionnaire (FFQ) for assessing dietary intakes of low-income, Caucasian, English-speaking, postpartum women living in Sheffield, United Kingdom. Data was obtained from a cross-sectional sample of the 'Healthy Start' study; a population-based survey of mothers and infants. Participants completed two FFQs at 4 and 8 weeks postpartum. Measures from 24-hour dietary recalls (24HDRs) were collected at 4, 6, 8 and 12 weeks postpartum. In the reproducibility study, crude Pearson's correlation coefficients ranged from 0.40 (riboflavin) to 0.73 (thiamine), mean value 0.54. In the validation study, crude Pearson correlation coefficients between the FFQ and the measures from the 24HDRs ranged from 0.10 (B12) to 0.55 (manganese), mean value 0.34. Energy-adjustments and corrections for attenuation had no significant effect on the strength of the correlation both observed in the reproducibility and validity study. On average, 68% of the participants were classified correctly, and 3% were misclassified into the extreme opposite quintile of the distribution. The authors conclude that the questionnaire performed well for the majority of nutrients examined and that is a valid tool for ranking individuals according to nutrient distribution.

Reproducibility and comparative validity of a food frequency questionnaire for Australian children and adolescents

BACKGROUND

Dietary intake during childhood and adolescence is of increasing interest due to its influence on adult health, particularly obesity, cardiovascular disease and diabetes. There is a need to develop and validate dietary assessment methods suitable for large epidemiologic studies of children and adolescents. Limited large scale dietary studies of youth have been undertaken in Australia, due partly to the lack of a suitable dietary intake tool. A self-administered, semi-quantitative food-frequency questionnaire (FFQ), the 'Australian Child and Adolescent Eating Survey' (ACAES), was developed for youth aged 9-16 years. This study evaluated reproducibility and comparative validity of the ACAES FFQ using assisted food records (FRs) as the reference method.

METHODS

The ACAES FFQ was completed twice (FFQ1 and FFQ2) at an interval of 5 months, along with four one-day assisted FRs. Validity was evaluated by comparing the average of the FRs with FFQ2 (n = 113) as well as with the average of FFQ1 and FFQ2 (n = 101). Reproducibility was evaluated by comparing FFQ1 and FFQ2 (n = 101). The two methods were compared using correlations, Kappa statistics and Bland-Altman plots.

RESULTS

Correlation coefficients for comparative validity ranged from 0.03 for retinol to 0.56 for magnesium for transformed, energy-adjusted, deattenuated nutrient data, with correlation coefficients greater than 0.40 for total fat, saturated fat, monounsaturated fat, carbohydrate, sugars, riboflavin, vitamin C, folate, beta-carotene, magnesium, calcium and iron. Correlation coefficients for reproducibility ranged from 0.18 for vitamin A to 0.50 for calcium for transformed, energy-adjusted, deattenuated nutrient data. The ACAES FFQ ranked individuals reasonably accurately, with the comparative validity analysis showing that over 50% of participants were classified within one quintile for all nutrients, with only a small percentage grossly misclassified (0-7%).

CONCLUSION

The ACAES FFQ is the first child and adolescent specific FFQ available for ranking the dietary intakes of Australian children and adolescents for a range of nutrients in epidemiologic research and public health interventions.

Sociodemographic correlates of food habits among school adolescents (12-15 year) in North Gaza Strip

BACKGROUND

There is little information about meal patterns and food consumption of adolescents in Palestine. The objective of this study was to describe the association between sociodemographic factors and food intake, and meal patterns among Palestinian school adolescents (12-15 year) in North Gaza Strip.

METHODS

A cross-sectional study was conducted in 2002 comprising 944 subjects in 10 schools in Gaza city, Jabalia village and Jabalia refugee camp. Self-administered questionnaires were filled in by students and parents to obtain data on frequency of meals, food intake and sociodemographic characteristics.

RESULTS

High household socioeconomic status (SES) was associated with the increased number of meals and the increased intakes of many nutritious foods such as; animal food items, fruits and vegetables and dairy foods. The percentage of adolescents having breakfast daily of high and low SES was 74.5% vs 55% in boys and 65.6% vs 45% in girls. The percentage of girls with refugee status who had lunch was higher (90.2%) compared to the local citizen girls (83.9%), (p = 0.03). Girls were less likely to skip daily lunch (OR = 0.55, 95% CI = 0.36-0.87, p = 0.01) compared to boys. Risk of skipping lunch was three times higher among adolescents living in the village compared to Gaza well-off area (OR = 3.3, 95% CI = 1.72-6.31, p < 0.001). Adolescents who were having lunch daily were less likely to skip breakfast or dinner. Only 11.6% of boys and 16.2% of girls consumed fruits daily. In multivariate analysis, SES was positively associated with food frequency intake scores in both genders. Boys from the refugee camp and the village had a significant higher consumption of fruits and vegetables than boys from high and low income area in Gaza City, while it was the opposite in girls.

CONCLUSION

Meal skipping is common, particularly among those of low SES and the intakes of many nutritious foods such as animal food items, fruits and vegetables and dairy foods seem to be low among adolescents of low SES. The results of this study could be used as an important base-line for future monitoring of the nutritional situation of adolescents.

Studying a population undergoing nutrition transition: a practical case study of dietary assessment in urban South African adolescents

The South African Medical Research Council food frequency questionnaire (FFQ) and protocol was used to determine food intake in 83 adolescents from the Birth To Twenty study. The FFQ was piloted on a small group (n=8). Specific problems which resulted in overestimation of energy intake were identified. The protocol was modified and administered to the remainder of the adolescents and their caregivers. Reasonable energy intakes were obtained, and time spent completing the FFQ was reduced. The modified protocol was more successful in determining habitual food intake although it would benefit from validation against other dietary intake techniques.

Reprodutibilidade de questionário semiquantitativo de freqüência alimentar elaborado para adolescentes da Região Metropolitana do Rio de Janeiro, Brasil

A reprodutibilidade de questionário semiquantitativo de freqüência alimentar (QSFA) para adolescentes do Rio de Janeiro, Brasil, foi analisada entre 108 adolescentes. O intervalo médio entre as duas aplicações do QSFA foi de vinte dias. A lista de alimentos e as porções de referência do QSFA basearam-se em dados de registros alimentares de 430 adolescentes. Estimaram-se coeficientes de correlação intraclasse para itens alimentares e coeficientes de correlação de Pearson para nutrientes. A concordância da classificação em quartis para nutrientes foi estimada pelo kappa ponderado. O método de Bland-Altman avaliou a concordância para nutrientes. Apresentaram-se dados brutos e ajustados pela energia. Para os itens alimentares, a média dos coeficientes de correlação intraclasse foi 0,54. Para dados ajustados, a concordância para o mesmo quartil e quartis adjacentes variou de 72% a 86%. Segundo o método de Bland-Altman, a concordância média variou de 77% a 104% e foram independentes da magnitude do consumo, exceto para vitamina A. Os coeficientes de correlação de Pearson variaram de 0,40 a 0,61. O QSFA demonstrou confiabilidade aceitável para as estimativas de alimentos e nutrientes de adolescentes da área considerada.

Reproducibility of a food frequency questionnaire for adolescents

To assess the reproducibility of a validated 76-item food frequency questionnaire designed to estimate diet in adolescents (Adolescent Food Frequency Questionnaire--AFFQ) in the city of Sao Paulo, Brazil, a test-retest study was conducted (n = 49). Intraclass correlation coefficient (ICC), weighted kappa, and percentage of agreement were used in both crude and energy-adjusted nutrient intakes. Bland Altman plots were used to examine the limits of agreement for energy and macronutrients. The ICC ranged from 0.48 (carbohydrates) to 0.65 (vitamin C) in crude values and from 0.25 (total fat) to 0.58 (vitamin C) in adjusted values. Kappa values ranged from 0.28 (protein and fiber) to 0.56 (unsaturated fat). Bland Altman showed a trend towards larger difference in energy according to increased intake values and a bias towards extreme values for fat intake. The percent of individuals classified in the same category on the two occasions was on average 54.2%. By conclusion, the Adolescent Food Frequency Questionnaire showed reasonable reproducibility and can be used in studies that aim to classify groups into intake categories.

Sugar snack consumption in Ugandan schoolchildren: validity and reliability of a food frequency questionnaire

OBJECTIVES

This study assessed the reproducibility and relative validity of an eight-item self-administered food frequency questionnaire (FFQ) on intake of sugared snacks in Ugandan schoolchildren. A 5-day precoded food behaviour checklist (FBC) was used as validation criteria. Sociodemographic correlates of a sum frequency sugar score were explored.

METHODS

The study was conducted in Kampala, Uganda, in 2004. Six hundred and fourteen schoolchildren (mean age 12.4 years) completed the FFQ on cakes/biscuits, chocolate, ice sticks, soft drinks, coffee, tea, sugared desserts and sweets/candies at school. They were examined clinically for dental caries. Forty students completed the FFQ twice, 1 week apart and 325 students completed the 5 day FBC at school.

RESULTS

The mean decayed, missing and filled tooth index score was 0.98 (SD 1.6, range 0-15). Reproducibility scores (Cohen's kappa) for the sugar items ranged from 0.17 (ice sticks) to 0.55 (biscuits). No differences were seen between the average intakes at test and retest. Higher intake was reported in FFQ than in FBC across all sugar items. Crude agreement between students reporting intake at least 3-5 times a week/less than three times a week ranged from 50% to 55% (e.g. biscuits, chocolate) to 87% (tea). Spearman's correlation coefficients ranged from 0.14 (desserts) to 0.27 (sweets). anova revealed significant increase (P = 0.001) in the mean FBC sum scores by increasing quartiles of the FFQ sum scores. The average sum FFQ sugar scores were higher in girls than in boys and higher in older than in younger students.

CONCLUSION

Fair reproducibility was established for the FFQ sugar items. The FFQ was acceptable in classifying individuals into broad categories of low and high sugar consumption.

Evaluation of dietary assessment instruments in adolescents

PURPOSE OF REVIEW

The obesity epidemic, the increasing occurrence of adult diseases in childhood, and the growing awareness of a connection between adult diseases and the diet of children and adolescents have led to increased interest in what our youth are eating. Designing an instrument to evaluate adolescents' eating habits requires addressing not only the typical requirements for a diet assessment tool but also the unique concerns of the adolescent population. We reviewed current dietary instruments for adolescents.

RECENT FINDINGS

New nutrient assessment methods fall into one of two groups: instruments limited to a specific nutrient/food or those designed for a specific population. The new tools range from Food Intake Recording Software System, a computer program to assist individuals under 10 years of age in reporting their diets, to short food-frequency questionnaires specifically designed to assess fruits and vegetables or fat. Another new instrument uses picture cards to evaluate the entire diet of low-income, overweight African-Americans. The Youth Adolescent Questionnaire, although not a new tool, has been evaluated in new populations (multi-ethnic, multi-income, and multi-education) and with doubly labeled water.

SUMMARY

A limited number of dietary assessment instruments that are specifically designed for adolescents have been found to be reproducible and validated. There is a demand for a short, easily administered, inexpensive, accurate instrument that can be used in a broad range of adolescent subpopulations. Future tools will need to meet these criteria and evaluate the 'new' nutrients, foods, and other factors that lead our youth to eat the foods they do.

Can the EPIC food-frequency questionnaire be used in adolescent populations?

OBJECTIVE

To assess the validity of the food-frequency questionnaire used in the European Prospective Investigation of Cancer (EPIC FFQ) for estimating nutrient intake in an adolescent population.

DESIGN

Sixty-seven schoolchildren (mean age: 12.3 +/- 0.3 years) were recruited to complete a 7-day weighed dietary record (7-day WDR), the EPIC FFQ and supply one 24-hour urine collection.

SETTING

Harris Academy in Dundee (UK).

RESULTS

Fifty subjects completed both dietary assessment methods. Thirteen of these were classified as underreporters with energy intake/basal metabolic rate < 1.14. The EPIC FFQ showed higher estimates than the 7-day WDR for all nutrients. The median Spearman correlation coefficient for the nutrients examined was found to be 0.31 and increased to 0.48 after adjustment for total energy. The limits of agreement were as far apart as 13.4 MJ, 120 g, 270 g, 120 g and 1170 mg for energy, fat, sugar, protein and calcium, respectively. Correlations between urine and 7-day WDR dietary nitrogen and potassium were found to be statistically significant with r = 0.45 (P < 0.05) and r = 0.78 (P < 0.001) respectively. The median proportion of subjects that appeared in the same and opposite third of intake was found to be 45.9% and 10.8%, respectively.

CONCLUSIONS

The EPIC FFQ seems adequate to correctly classify low, medium and high consumers and might therefore be used to identify adolescent population groups at risk or for differences between populations. However, agreement between the EPIC FFQ and the 7-day WDR was very poor on both a group and an individual basis, and demonstrates that the EPIC FFQ is not an appropriate method for estimating absolute intakes in this age group.

Behaviour, body composition and diet in adolescent girls

The purpose of the study was to examine the relationships between patterns of behaviour, body composition and diet in adolescent girls. A group of 328 14 to 16-year-old girls at school in Southampton, U. K. completed a questionnaire about their behaviour and lifestyle, and had their heights, weights and skinfold thicknesses measured. Of these girls, 286 also provided dietary information. Socially independent girls were more likely to smoke, and less likely to eat breakfast and meals with family. They consumed more snacks, chocolate and soft drinks. Girls who were dissatisfied with their weight dieted and exercised, watched less television and spent less of their money on food. Dissatisfaction with weight was strongly related to body mass index. The odds of being a dieter, an indication of dissatisfaction with weight, increased with every unit increase in body mass index, so that girls with a body mass index of 24 kg/m(2)and over were 19 times more likely to diet than those with a body mass index of 19 kg/m(2)or less. Girls who were less satisfied with their weight reported lower energy intakes but ate more green vegetables and brown bread than other girls. The eating habits of the girls were therefore influenced by the extent of their social lives and by their satisfaction with their weight.