Reproducibility and Relative Validity of a Short Food Frequency Questionnaire in 9-10 Year-Old Children

Validity and Reliability of a Questionnaire Assessing Changes in Dietary Behaviors Among School Children Amid the COVID-19 Pandemic in Jordan

OBJECTIVE

This study aimed to develop and validate a questionnaire to assess changes in dietary behaviors among school children in Jordan during the COVID-19 pandemic.

METHODS

A cross-sectional study used a convenience sample of 253 school-aged children from public schools across Jordan. The dietary and lifestyle behavior inventory (DLBI) was developed, incorporating cultural and regional dietary preferences. The questionnaire's validity and reliability were assessed using the content validity index (CVI) and Cronbach's alpha for internal consistency. Exploratory factor analysis (EFA) was conducted to evaluate the underlying factor structure.

RESULTS

The DLBI demonstrated excellent content validity with a scale content validity index (S-CVI) of 0.997 and a high level of agreement among expert reviewers (total agreement = 116). Reliability analysis showed high internal consistency for dietary behavior scales, with Cronbach's alpha values exceeding 0.9 for fruit (0.869) and vegetable (0.916) consumption scales. Factor analysis revealed strong associations between dietary behavior variables, with factor loadings ranging from 0.688 to 0.889. The study identified significant reductions in physical activity levels among children, with an average Cronbach's alpha of 0.835 for physical activity-related items. The average time to complete the questionnaire was 15 minutes (SD = 5 minutes), with a completion rate of 45.6%.

CONCLUSIONS

The validated DLBI is a robust tool for assessing changes in dietary behaviors among school-aged children in Jordan during the COVID-19 pandemic. The findings highlight significant dietary patterns and physical activity shifts, emphasizing the need for targeted nutritional interventions.

Increasing the frequency of plant-based food intake in daily diets reduces the risk of cardiovascular disease among elderly Chinese: a cohort study

Objective

There is limited research on the relationship between the frequency of plant-based food intake and the risk of cardiovascular disease (CVD) among elderly Chinese. This study aims to evaluate the association between plant-based dietary index (PDI) and CVD risks, providing evidence for elderly Chinese to reduce CVD risks by increasing the frequency of plant-based food consumption.

Methods

This study analyzed data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) 2011-2018, employing a multivariate modified Poisson regression model, trend tests, and restricted cubic spline (RCS) analysis to assess the linear and non-linear relationship between the PDI and CVD risks. Subgroup analyses and interaction tests were conducted to evaluate the robustness and population-specificity of the results.

Results

This study included a total of 1,414 elderly Chinese, and at the end of follow-up, 487 participants had developed CVD. The multivariate modified Poisson regression model revealed a negative association between PDI and CVD risks [RR = 0.983, 95%CI = (0.970, 0.997)]. Similarly, the multivariate trend test (p = 0.031) and RCS analysis (P for nonlinear = 0.600) indicated a linear relationship between PDI and CVD risks. Subgroup analyses showed that the relationship between PDI and CVD risk was not influenced by gender, BMI, smoking, alcohol use, or exercise.

Conclusion

The PDI was negatively correlated with CVD risks, indicating that increasing the frequency of plant-based food intake in the diet may reduce CVD risks among elderly Chinese.

Association of plant-based dietary patterns with depression and anxiety symptoms in Chinese older adults: A nationwide study

BACKGROUND

The associations of plant-based dietary patterns with depression and anxiety symptoms among older adults have not been extensively studied. Therefore, the purpose of this study was to examine these associations in Chinese older adults.

METHODS

Data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) was employed in the present study. The simplified food frequency questionnaire was used to assess the overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI). The Center for Epidemiologic Studies Depression Scale-10 (CES-D-10) was used to evaluate depression symptoms, and the Generalized Anxiety Disorder Scale-7 (GAD-7) was used to assess anxiety symptoms. This study employed logistic regression and linear regression to examine the associations between plant-based dietary patterns and symptoms of depression and anxiety.

RESULTS

This study included 11,971 older adults, with a mean age of 83.23 ± 11.10 years. The results indicated that PDI and hPDI were negative associated with depression symptoms (adjusted β -0.09, 95 % CI -0.11, -0.07) (adjusted β -0.09, 95 % CI -0.11, -0.07) and anxiety symptoms (adjusted β -0.03, 95 % CI -0.04, -0.02) (adjusted β -0.04, 95 % CI -0.05, -0.02), while uPDI was positive associated with depression symptoms (adjusted β 0.09, 95 % CI 0.07, 0.11) and anxiety symptoms (adjusted β 0.04, 95 % CI 0.03, 0.05).

CONCLUSIONS

The findings from this study have the potential to promote healthy dietary patterns in older adults, and may have implications for the prevention and management of depression and anxiety in this population.

Plant-based dietary patterns and risk of esophageal cancer: A prospective cohort study spanning 17 years

Objective

Plant-based diets have multiple health benefits for cancers; however, little is known about the association between plant-based dietary patterns and esophageal cancer (EC).This study presents an investigation of the prospective associations among three predefined indices of plant-based dietary patterns and the risk of EC.

Methods

We performed endoscopic screening for 15,709 participants aged 40-69 years from two high-risk areas of China from January 2005 to December 2009 and followed the cohort until December 31, 2022. The overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI), were calculated using survey responses to assess dietary patterns. We applied Cox proportional hazard regression to estimate the multivariable hazard ratios (HRs) and 95% confidence intervals (95% CIs) of EC across 3 plant-based diet indices and further stratified the analysis by subgroups.

Results

The final study sample included 15,184 participants in the cohort. During a follow-up of 219,365 person-years, 176 patients with EC were identified. When the highest quartile was compared with the lowest quartile, the pooled multivariable-adjusted HR of EC was 0.50 (95% CI, 0.32-0.77) for hPDI. In addition, the HR per 10-point increase in the hPDI score was 0.42 (95% CI, 0.27-0.66) for ECs. Conversely, uPDI was positively associated with the risk of EC, and the HR was 1.80 (95% CI, 1.16-2.82). The HR per 10-point increase in the uPDI score was 1.90 (95% CI, 1.26-2.88) for ECs. The associations between these scores and the risk of EC were consistent in most subgroups. These results remained robust in sensitivity analyses.

Conclusions

A healthy plant-based dietary pattern was associated with a reduced risk of EC. Emphasizing the healthiness and quality of plant-based diets may be important for preventing the development of EC.

Association between plant-based dietary pattern and biological aging trajectory in a large prospective cohort

BACKGROUND

Aging is a dynamic and heterogeneous process that may better be captured by trajectories of aging biomarkers. Biological age has been advocated as a better biomarker of aging than chronological age, and plant-based dietary patterns have been found to be linked to aging. However, the associations of biological age trajectories with mortality and plant-based dietary patterns remained unclear.

METHODS

Using group-based trajectory modeling approach, we identified distinctive aging trajectory groups among 12,784 participants based on a recently developed biological aging measure acquired at four-time points within an 8-year period. We then examined associations between aging trajectories and quintiles of plant-based dietary patterns assessed by overall plant-based diet index (PDI), healthful PDI (hPDI), and unhealthful PDI (uPDI) among 10,191 participants who had complete data on dietary intake, using multivariable multinomial logistics regression adjusting for sociodemographic and lifestyles factors. Cox proportional hazards regression models were applied to investigate the association between aging trajectories and all-cause mortality.

RESULTS

We identified three latent classes of accelerated aging trajectories: slow aging, medium-degree, and high-degree accelerated aging trajectories. Participants who had higher PDI or hPDI had lower odds of being in medium-degree (OR = 0.75, 95% CI: 0.65, 0.86 for PDI; OR = 0.73, 95% CI: 0.62, 0.85 for hPDI) or high-degree (OR = 0.63, 95% CI: 0.46, 0.86 for PDI; OR = 0.62, 95% CI: 0.44, 0.88 for hPDI) accelerated aging trajectories. Participants in the highest quintile of uPDI were more likely to be in medium-degree (OR = 1.72, 95% CI: 1.48, 1.99) or high-degree (OR = 1.70, 95% CI: 1.21, 2.38) accelerated aging trajectories. With a mean follow-up time of 8.40 years and 803 (6.28%) participants died by the end of follow-up, we found that participants in medium-degree (HR = 1.56, 95% CI: 1.29, 1.89) or high-degree (HR = 3.72, 95% CI: 2.73, 5.08) accelerated aging trajectory groups had higher risks of death than those in the slow aging trajectory.

CONCLUSIONS

We identified three distinctive aging trajectories in a large Asian cohort and found that adopting a plant-based dietary pattern, especially when rich in healthful plant foods, was associated with substantially lowered pace of aging.

Dietary profile of pediatric obstructive sleep apnea patients, effects of routine educational counseling, and predictors for outcomes

Background

Dietary behavior is a main contributing yet modifiable factor to the body weight status of children and may be involved in the pathophysiology of childhood obstructive sleep apnea (OSA). This study aimed to investigate the dietary profile of pediatric OSA patients, effects of educational counseling after adenotonsillectomy, and predictor for disease resolution.

Methods

This observational study included 50 pediatric OSA patients undergoing adenotonsillectomy with routine educational counseling (Group 1), 50 pediatric OSA patients undergoing adenotonsillectomy without formal educational counseling (Group 2), and 303 healthy children without OSA (Control). The three groups were matched by age. The consumption frequency of 25 food items/groups was assessed by the Short Food Frequency Questionnaire. Quality of life was evaluated by the OSA-18 questionnaire. Sleep architecture and OSA severity were measured by standard polysomnography. Between- and within-group comparisons were analyzed by non-parametric approaches and generalized estimating equations. Prediction of disease recovery was performed by multivariable logistic regression models.

Results

Group 1 children consumed fruit drinks with sugar, vegetables, sweets, chocolate, rice, and noodles more frequently than Control Group children. At baseline, the distributions of sex, weight status, OSA-18 scores, and polysomnographic variables were comparable between Group 1 and Group 2. After a 12-month follow-up, Group 1 had better improvements in physical suffering, caregiver concerns, sleep architecture, and mean peripheral oxygen saturation compared to Group 2. Furthermore, Group 1 no longer had excessive consumption of fruit drinks with sugar, chocolate, and noodles; however, food consumption frequencies did not change significantly. Notably, younger age and reduced intake of butter/margarine on bread and noodles were independent predictors of cured OSA in Group 1.

Conclusion

The present study preliminarily characterized an unhealthy dietary profile among pediatric OSA patients and suggested that routine educational counseling in addition to adenotonsillectomy yielded some clinical benefits. Certain items/groups of food frequencies may be associated with disease recovery and further investigations are warranted.

Interaction between the animal-based dietary pattern and green space on cognitive function among Chinese older adults: A prospective cohort study

Green space is associated with better cognition, while the animal-based dietary pattern can be a risk factor. We aimed to verify the associations and explore their interaction among the elderly. The China Longitudinal Healthy Longevity Survey (CLHLS) cohort including 17,827 participants was used. The average green space coverage rate was used to measure green space exposure. The animal-based diet index (ADI) was scored based on the non-quantitative frequency questionnaire of ten types of food intake (three types of animal foods and seven types of plant foods). We used the Mini-Mental State Examination (MMSE) to assess cognitive function. The Cox proportional hazard regression was applied to explore the correlations and interactions. In the models, we gradually adjusted for the potential risk factors. Compared with participants living in the area with the lowest green space, those living with the highest were associated with a 20% decrease in the risk of cognitive impairment (hazard ratio (HR): 0.80, 95% CI: 0.73, 0.89). As for ADI, the highest group was related to a 64% increase in the risk of cognitive impairment (HR: 1.64, 95% CI: 1.38, 1.95). The protective effect of the highest green space group on cognitive impairment was more evident among participants with low ADI (HR = 0.72, 95% CI: 0.62, 0.83), compared to those with high ADI. Green space was positively associated with cognition, while the animal-based dietary pattern was a cognitive disadvantage. The animal-based dietary pattern may mitigate the beneficial effects of green space on cognition.

cMIND Diet, Indoor Air Pollution, and Depression: A Cohort Study Based on the CLHLS from 2011 to 2018

This study aims to explore the interaction between a Chinese version of the Mediterranean-DASH intervention for neurodegenerative delay (cMIND) diet and indoor air pollution and its effect on depression among older adults. This cohort study used 2011-2018 data from the Chinese Longitudinal Healthy Longevity Survey. Participants included 2724 adults aged 65 and older without depression. The Chinese version of the Mediterranean-DASH intervention for neurodegenerative delay (cMIND) diet scores ranged from 0 to 12 based on validated food frequency questionnaire responses. Depression was measured using the Phenotypes and eXposures Toolkit. Cox proportional hazards regression models were used to explore the associations, and the analysis was stratified using the cMIND diet scores. A total of 2724 participants (54.3% males and 45.9% 80 years and older) at baseline were included. Living with severe indoor pollution was associated with a 40% increase in the risk of depression (HR: 1.40, 95% CI: 1.07, 1.82) compared to living without indoor pollution. Indoor air pollution exposure was significantly associated with cMIND diet scores. Participants with a lower cMIND diet score (HR: 1.72, 95% CI: 1.24, 2.38) had a greater association with severe pollution than those with a higher cMIND diet score. The cMIND diet may alleviate depression caused by indoor pollution among older adults.

A Cross-Sectional Investigation of Preadolescent Cardiometabolic Health: Associations with Fitness, Physical Activity, Sedentary Behavior, Nutrition, and Sleep

BACKGROUND

Cardiometabolic disease (CMD) risk often begins early in life. Healthy lifestyle behaviors can mitigate risk, but the optimal combination of behaviors has not been determined. This cross-sectional study simultaneously examined the associations between lifestyle factors (fitness, activity behaviors, and dietary patterns) and CMD risk in preadolescent children.

METHODS

1480 New Zealand children aged 8-10 years were recruited. Participants included 316 preadolescents (50% female, age: 9.5 ± 1.1 years, BMI: 17.9 ± 3.3 kg/m²). Fitness (cardiorespiratory fitness [CRF], muscular fitness), activity behaviors (physical activity, sedentary, sleep), and dietary patterns were measured. Factor analysis was used to derive a CMD risk score from 13 variables (adiposity, peripheral and central hemodynamics, glycemic control, and blood lipids).

RESULTS

Only CRF (β = -0.45, p < 0.001) and sedentary time (β = 0.12, p = 0.019) were associated with the CMD risk score in the adjusted multivariable analysis. CRF was found to be nonlinear (VO₂ max ≤ ≈42 mL/kg/min associated with higher CMD risk score), and thus a CRF polynomial term was added, which was also associated (β = 0.19, p < 0.001) with the CMD risk score. Significant associations were not found with sleep or dietary variables.

CONCLUSION

The findings indicate that increasing CRF and decreasing sedentary behavior may be important public health targets in preadolescent children.

Is It Feasible to Predict Cardiovascular Risk among Healthy Vegans, Lacto-/Ovo-Vegetarians, Pescatarians, and Omnivores under Forty?

Guidelines for cardiovascular (CV) risk assessment among young adults are uncertain. Researchers are still looking for new tools for earlier diagnosis of cardiovascular diseases (CVD), the leading cause of mortality in the modern world. This study aimed to assess whether CV risk estimation is possible in groups of healthy individuals under the age of 40 on different dietary patterns (vegans-VEGAN (n = 48), lacto-/ovo-vegetarians-VEGE (n = 49), pescatarians-PESCA (n = 23), and omnivores-OMN (n = 35)) during the pandemic period. Four metrics containing selected risk classifiers were created, and participants were assessed using them. Groups including meat consumption showed increased CV risk predictions in the metrics assessment. The next analyzes showed statistically significant relationships between the results from the created metrics and selected non-basic biomarkers for ApoA1 (OMN group, p = 0.028), IL-6 (PESCA group, p = 0.048), HCY (VEGAN group, p = 0.05), and hsCRP (OMN + PESCA groups, p = 0.025). We found that predicting CV risk among healthy people under 40 adhering to different dietary patterns, taking into account basic and non-basic laboratory assessments and created metrics, is challenging but feasible. Furthermore, the OMN group appeared to be at the highest risk of increased CV risk in the future, while risk tended to be the lowest in the VEGAN group.

Nutritional Status and Habits among People on Vegan, Lacto/Ovo-Vegetarian, Pescatarian and Traditional Diets

Background: This study assessed the possible dependencies between nutritional habits and body composition among subjects with different dietary habits. Materials: A total of 196 healthy (aged 18−50 yrs) participants were enrolled in the study and divided into 4 groups according to their diet: vegans-VEGAN (n = 53), lacto/ovo-vegetarians—VEGE (n = 52), pescatarians-PESCA (n = 28), and omnivores-OMN (n = 43). Methods: The Food Frequency Questionnaire (FFQ) was used, and body composition was assessed on the In-Body120 analyzer. Results: Our result revealed in OMN + PESCA groups a higher average consumption frequency of sweets (p = 0.024), cheese/plant cheese (p < 0.001), eggs and egg dishes/egg substitutes (p < 0.001), butter, margarine/plant margarine (p < 0.001), cream /plant cream (p = 0.018), wine and cocktails (p = 0.028), vodka (p = 0.039) and lower of natural cottage cheese/tofu/tempeh (p < 0.001), vegetable oils (p = 0.036), legumes (p < 0.001) and nuts and seeds(p < 0.001) compared to the VEGAN + VEGE groups. The body composition analysis showed significant differences in skeletal muscle mass (SMM) (p = 0.019) and the content of minerals (p = 0.048) between groups. VEGAN disclosed the lowest average values of body fat mass (BFM), percentage body fat (PBF), and visceral adipose tissue (VAT) than other studied groups. Conclusions: The body composition analysis showed mean values within normal ranges in all of the groups, but some average results of OMN, PESCA, and VEGE compared to VEGAN were not highly satisfactory (in addition to eating behavior outcomes).

Evaluation of paper-based and web-based food frequency questionnaires for 7-year-old children in Singapore

Advances in technology enabled the development of a web-based, pictorial FFQ to collect parent-report dietary intakes of 7-year-old children in the Growing Up in Singapore Towards healthy Outcomes study. This study aimed to compare intakes estimated from a paper-FFQ and a web-FFQ and examine the relative validity of both FFQ against 3-d diet records (3DDR). Ninety-two mothers reported food intakes of their 7-year-old child on a paper-FFQ, a web-FFQ and a 3DDR. A usability questionnaire collected participants' feedback on the web-FFQ. Correlations and agreement in energy, nutrients and food groups intakes between the dietary assessments were evaluated using Pearson's correlation, Lin's concordance, Bland-Altman plots, Cohen's κ and tertile classification. The paper- and web-FFQ had good correlations (≥ 0·50) and acceptable-good agreement (Lin's concordance ≥ 0·30; Cohen's κ ≥ 0·41; ≥ 50 % correct and ≤ 10 % misclassification into same or extreme tertiles). Compared with 3DDR, both FFQ showed poor agreement (< 0·30) in assessing absolute intakes except micronutrients (web-FFQ had acceptable-good agreement), but showed acceptable-good ability to classify children into tertiles (κ ≥ 0·21; ≥ 40 % and ≤ 15 % correct or misclassification). Bland-Altman plots suggest good agreement between web-FFQ and 3DDR in assessing micronutrients and several food groups. The web-FFQ was well-received, and majority (81 %) preferred the web-FFQ over the paper-FFQ. The newly developed web-FFQ produced intake estimates comparable to the paper-FFQ, has acceptable-good agreement with 3DDR in assessing absolute micronutrients intakes and has acceptable-good ability to classify children according to categories of intakes. The positive acceptance of the web-FFQ makes it a feasible tool for future dietary data collection.

Adiposity in preadolescent children: Associations with cardiorespiratory fitness

Lifestyle factors contribute to childhood obesity risk, however it is unclear which lifestyle factors are most strongly associated with childhood obesity. The purpose of this cross-sectional study was to simultaneously investigate the associations among dietary patterns, activity behaviors, and physical fitness with adiposity (body fat %, fat mass, body mass index [BMI], and waist to hip ratio) in preadolescent children. Preadolescent children (N = 392, 50% female, age: 9.5 ± 1.1year, BMI: 17.9 ± 3.3 kg/m2) were recruited. Body fat (%) and fat mass (kg) were measured with bioelectrical impedance analysis. Cardiorespiratory fitness (VO2 max), muscular strength (hand-grip strength), activity, sleep, and dietary pattern was assessed. Multivariable analysis revealed that cardiorespiratory fitness associated most strongly with all four indicators of adiposity (body fat (%) (β = -0.2; p < .001), fat mass (β = -0.2; p < .001), BMI (β = -0.1; p < .001) and waist to hip ratio (β = -0.2; p < .001). Additionally, fruit and vegetable consumption patterns were associated with body fat percentage, but the association was negligible (β = 0.1; p = 0.015). Therefore, future interventions should aim to promote the use of cardiorespiratory fitness as a means of reducing the obesity epidemic in children.

Development and Validation of the Vietnamese Children’s Short Dietary Questionnaire to Evaluate Food Groups Intakes and Dietary Practices among 9–11-Year-Olds Children in Urban Vietnam

This study aims to develop and assess the reproducibility and validity of the Vietnamese Children’s Short Dietary Questionnaire (VCSDQ) in evaluating food groups intakes and dietary practices among school-aged children 9–11 years old in urban Vietnam. A 26-item questionnaire covering frequency intakes of five core food groups, five non-core food groups, five dietary practices over a week, and daily intakes of fruits, vegetables, and water was developed. Children (n = 144) from four primary schools in four areas of Ho Chi Minh City, Vietnam completed the VCSDQ twice, as well as three consecutive 24 h recalls over a week. Intra-class correlation, Spearman correlation, weighted kappa, cross-classification, and Bland–Altman plots were used to evaluate the reproducibility and validity. The direct validity of food groups from VCSDQ against the 24 h recalls was examined using Wilcoxon-test for trend. The VCSDQ had good reproducibility in 12 out of 15 group items; the ICC ranged from 0.33 (grains) to 0.84 (eating while watching screens). This VCSDQ had low relative validity, two items (instant noodles, eating while watching screens) had a moderate to good agreement (k = 0.43, k = 0.84). There was good direct validity in three core-food groups (fruits, vegetables, dairy) and three non-core food groups (sweetened beverages, instant noodles, processed meat). In addition, the VCSDQ can also be used to classify daily intakes of fruits and vegetables from low to high.

Reproducibility and Validity of a Semi-Quantitative Food Frequency Questionnaire for Assessing Dietary Intake of Vegetarians and Omnivores in Harbin, China

This study aims to evaluate the reproducibility and validity of a semi-quantitative food frequency questionnaire (SQFFQ) developed for vegetarians and omnivores in Harbin, China. Participants (36 vegetarians and 64 omnivores) administered SQFFQ at baseline (SQFFQ1) and six months later (SQFFQ2) to assess the reproducibility. The 24 h recalls (24 HRs) for three consecutive days were completed between the administrations of two SQFFQs to determine the validity. For reproducibility, Pearson correlation coefficients between SQFFQ1 and SQFFQ2 for vegetarians and omnivores were 0.45~0.88 and 0.44~0.84, respectively. For validity, unadjusted Pearson correlation coefficients were 0.46~0.83 with an average of 0.63 and 0.43~0.86 with an average of 0.61, respectively; energy-adjusted Pearson correlation coefficients were 0.43~0.82 with an average of 0.61 and 0.40~0.85 with an average of 0.59, respectively. Majority of the correlation coefficients for food groups and macronutrients decreased or remained unchanged after energy adjustment. Furthermore, all correlations were statistically significant (p < 0.05). Bland−Altman plots also showed reasonably acceptable agreement between the two methods. In conclusion, the SQFFQ developed in this study has reasonably acceptable reproducibility and validity.

Plant-based dietary patterns and cognitive function: A prospective cohort analysis of elderly individuals in China (2008-2018)

INTRODUCTION

Plant-based diets confer health benefits, especially on the prevention of noncommunicable diseases. The relationship between plant-based dietary patterns on cognitive function as a neurological outcome needs more evidence. We aimed to assess the associations between plant-based dietary patterns and cognitive function among Chinese older adults.

METHODS

We used four waves (2008-2018) of the Chinese Longitudinal Healthy Longevity Survey. We included 6136 participants aged 65 years and older with normal cognition at baseline. We constructed an overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI) from questionnaires. We used the Mini-Mental State Examination (MMSE) to assess cognitive function. We used the multivariable-adjusted generalized estimating equation to explore the corresponding associations.

RESULTS

The multivariable-adjusted models showed inverse associations between plant-based dietary patterns and cognitive function. The highest quartiles of PDI and hPDI were associated with a 55% (odds ratio [OR] = 0.45, 95% CI: 0.39, 0.52) decrease and a 39% (OR = 0.61, 95% CI: 0.54, 0.70) decrease in the odds of cognitive impairment (MMSE < 24), compared with the lowest quartile. In contrast, the highest quartile of uPDI was associated with an increased risk (OR = 2.03, 95% CI: 1.79, 2.31) of cognitive impairment. We did not observe pronounced differences by selected socioeconomic status, physical activity, residential greenness, and APOE ε4 status.

CONCLUSIONS

Our findings suggested that adherence to healthy plant-based dietary patterns was associated with lower risks of cognitive impairment among older adults, and unhealthy plant-based dietary patterns were related to higher risks of cognitive impairment.

Interaction between plant-based dietary pattern and air pollution on cognitive function: a prospective cohort analysis of Chinese older adults

BACKGROUND

Air pollution is a risk factor for poor cognitive function, while a plant-based dietary pattern is associated with better cognitive function. We aimed to explore their interaction with cognitive function among older adults.

METHODS

We used a prospective cohort of old individuals, including 6525 participants of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), aged 65-110 years and with normal cognition at baseline. Air pollution measurement was derived using satellite-derived annual average fine particulate matter (PM2.5) concentrations based on residential locations. Plant-based diet index (PDI) was calculated using survey responses to assess the dietary pattern. Repeated measures of the Mini-Mental State Examination (MMSE) were utilized to assess cognitive function. We applied the Cox proportional hazard regression to explore the associations and further stratified the analysis by PDI.

FINDINGS

During a median of 5·6-year follow-up, 1537 (23·6%) out of 6525 participants with normal cognition at baseline developed poor cognitive function (MMSE <18). Living in areas with the highest quintile of cumulative PM2.5 was associated with a 46% increase in the risk of developing poor cognitive function (hazard ratio (HR): 1·46, 95% confidence interval (CI): 1·20, 1·77), compared to those living in areas with the lowest quintile. We observed a significant interaction between cumulative PM2.5 and PDI (p-interaction: 0·04), with the corresponding associations of cumulative PM2.5 being more pronounced among participants with lower PDI (HR: 1·68, 95% CI: 1·26, 2·24) than those with higher PDI (HR: 1·28, 95% CI: 0·98, 1·68).

INTERPRETATION

Plant-based dietary pattern may attenuate detrimental impacts of PM2.5 on cognitive function among older adults. Adherence to the plant-based dietary pattern could be used to prevent adverse neurological effects caused by air pollution, especially in developing regions.

Social jetlag is associated with obesity-related outcomes in 9-11-year-old children, independent of other sleep characteristics

INTRODUCTION

Social jetlag has been reported to predict obesity-related indices, independent of sleep duration, with associations in female adolescents but not males. However, such sex-specific relationships have not been investigated in pre-adolescents.

OBJECTIVES

To examine: (i) the relationships between sleep characteristics, including social jetlag, and obesity-related outcomes during childhood, and (ii) whether these relationships are moderated by sex.

METHODS

This cross-sectional study included 381 children aged 9-11 years (49.6% female). Average sleep duration, social jetlag, and physical activity were assessed via wrist-worn accelerometry. Sleep disturbances were quantified from the Children's Sleep Habits Questionnaire. Obesity-related outcomes included age-specific body mass index Z-scores (zBMI) and waist-to-height ratio. Additionally % fat, total fat mass, and fat mass index were assessed via bioelectrical impedance analysis. Linear mixed models that nested children within schools were used to identify relationships among sleep characteristics and obesity-related outcomes.

RESULTS

Positive associations between social jetlag with zBMI, % fat, and fat mass index were seen in univariable and unadjusted multivariable analyses. Following adjustments for known confounders, social jetlag remained significantly associated with zBMI (β = 0.12, p = 0.013). Simple slopes suggested a positive association in girls (β = 0.19, p = 0.006) but not in boys (β = 0.03, p = 0.703).

CONCLUSIONS

Obesity prevention efforts, particularly in girls, may benefit from targeted approaches to improving the consistency of sleep timing in youth.

Relative validity and reproducibility of a food frequency questionnaire to evaluate food group intakes among Jordanian children and adolescents

INTRODUCTION

studies of the impact of diet on the prevention and occurrence of diseases in all life stages require a reliable and valid dietary assessment tool for assessing dietary intake.

OBJECTIVES

this study aimed to develop and evaluate the relative validity and reproducibility of a culturally sensitive quantitative food frequency questionnaire (FFQ) to assess food group intake among Jordanian children and adolescents.

METHODS

the validation study was carried out on 136 children and adolescents aged between 6 and 18 years who enrolled from selected public and private schools. Fifty of these children and adolescents participated in the reproducibility phase. Food group intake from a quantitative FFQ was compared with food group intake from 24-hour dietary recalls (24h-DRs). Four 24-HRs were collected weekly for one month.

RESULTS

intraclass correlation coefficients between the two FFQs ranged from 0.18 for nuts to 0.98 for tea. De-attenuated and energy-adjusted correlations ranged from 0.08 for nuts to 0.95 for vegetable oils. On average, 46.6 % and 43.6 % of participants were ranked by the FFQ-1 and the 24h-DRs into the same quartile based on their crude and energy-adjusted food group intake, respectively. Bland-Altman plots showed a satisfactory agreement between the two methods for milk and milk products and vegetables.

CONCLUSIONS

the findings of this study suggested that the developed FFQ has excellent reproducibility and good relative validity for most food groups.

Reproducibility and relative validity of a semi-quantitative food frequency questionnaire for the Chinese lactating mothers

Background

The dietary nutritional status of the lactating mothers is related to maternal health and has a significant impact on the growth and development of infants through the secretion of breast milk. The food frequency questionnaire (FFQ) is the most cost-effective dietary assessment method that can help obtain information on the usual dietary pattern of participants. Until now, the FFQs have been used for different populations in China, but there are few FFQs available for the lactating mothers. We aimed to develop a semi-quantitative, 156-item FFQ for the Chinese lactating mothers, and evaluate its reproducibility and relative validity.

Methods

A total of 112 lactating mothers completed two FFQs and one 3-d dietary record (3DR). The first FFQ (FFQ1) was conducted during postpartum at 60–65 days and the second FFQ (FFQ2) during subsequent follow-up at 5 weeks. The 3DR was completed with portion sizes assessed using photographs taken by the respondent before and after eating (instant photography) 1 week after FFQ1.

Results

For reproducibility, the Spearman’s correlation coefficients for food ranged from 0.34 to 0.68, and for nutrients from 0.25 to 0.61. Meanwhile, the intra-class correlation coefficients for food ranged from 0.48 to 0.87, and for nutrients from 0.27 to 0.70. For relative validity, the Spearman’s correlation coefficients for food ranged from 0.32 to 0.56, and for nutrients from 0.23 to 0.72. The energy-adjusted coefficients for food ranged from 0.26 to 0.55, and for nutrients from 0.22 to 0.47. Moreover, the de-attenuation coefficients for food ranged from 0.34 to 0.67, and for nutrients from 0.28 to 0.77. The Bland-Altman plots also showed reasonably acceptable agreement between the two methods.

Conclusions

This FFQ is a reasonably reproducible and a relative valid tool for assessing dietary intake of the Chinese lactating mothers.

The associations between meeting 24-hour movement guidelines and adiposity in Asian Adolescents: The Asia-Fit Study

Less is known about how compliance with 24-hour movement guidelines for physical activity (PA), sedentary behavior, and sleep affects adiposity in young people. The purposes of this study were to compare compliance with 24-hour movement guidelines in Asian adolescents and to examine the associations between compliance with 24-hour movement guidelines and body fat percentage. A sample of 12 590 adolescents aged 13.63 (± 1.01) years from eight Asian metropolitan cities including Bangkok (Thailand), Hong Kong SAR, Kuala Lumpur (Malaysia), Seoul (South Korea), Shanghai (China), Singapore, Taipei (Taiwan), and Tokyo (Japan) completed interviewer-administered questionnaires to assess moderate-to-vigorous PA, recreational screen time, sleep duration, and covariates. Body fat percentage was measured using bioelectrical impedance analysis. We found that compliance with 24-hour movement guidelines differed in Asian adolescents across the eight cities. Adjusting for covariates, there was a negative association between number of the guidelines being met and body fat percentage in Asian adolescents. In addition, meeting only the sleep guideline and both the PA and sleep guidelines had negative associations with body fat percentage compared with no guidelines being met. Our findings improve the understanding about how compliance with 24-hour movement guidelines benefit a healthy body weight in adolescents, as well as contribute to development of evidence-based 24-hour movement guidelines for Asian young people. Future research is needed to gain better insights into the directionality of the associations between compliance with 24-hour movement guidelines and adiposity, as well as the mechanisms underlying the associations in Asian adolescents.

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.

Adaptation, validation and reproducibility of a short FFQ to assess food group intake in the population resident in the Basque country (Spain)

OBJECTIVE

To adapt a short FFQ (SFFQ) and evaluate its relative validity and reproducibility to assess food group intake in a population resident in the Basque Country. Moreover, the possible influence of associated variables (such as education level) on its validity and reproducibility was determined.

DESIGN

Nine-day 24-h recalls (24HR) were used as a reference to explore validity over the course of 1 year. The degree of misclassification in the SFFQ was evaluated by a contingency table of quartiles and by Bland-Altman plots comparing SFFQ2 and 24HR. SFFQ was administered twice to explore reproducibility at 1 year.

SETTING

Basque Autonomous Community.

PARTICIPANTS

Adults aged ≥21 years (n 99). The sample was randomly selected and representative of the target population.

RESULTS

For validity, statistically significant correlations were observed for more than half of the food groups, with the lowest correlations (r or ρ) for fat (-0·008) and the highest for other foods (0·963). The mean percentage of the subjects' food intake that was classified into the same or adjacent quartile in both methods was 75·2 %. Reproducibility was explored by the correlation coefficient and ranged from 0·201 to 0·809, and 82·6 % of participants were in the same or adjacent quartile in both SFFQ. The associated variables did not seem to influence the validity and reproducibility of the SFFQ.

CONCLUSIONS

An adapted SFFQ presented good reproducibility and validity for measuring most food groups in the target population, and these results did not seem to be influenced by the associated variables.

Development, validity and reproducibility of a whole grain food frequency questionnaire in Malaysian children

Background

To date, there is no validated whole grain assessment tool for children in any Southeast Asian countries. Hence, there is a need for a valid tool to assess whole grain intake among Malaysian children. This study aimed to develop, validate and test the reproducibility of a food frequency questionnaire (FFQ) in estimating whole grain intake among Malaysian children.

Methods

A total of 392 children participated in the FFQ development and 112 children aged 9–12 years participated in the validation phase; with a subsample of 50 children participating in the reproducibility phase. Three-day diet record (3DR) as the reference method in validation phase. Spearman correlations, mean difference, Bland-Altman plot and cross-classification analyses were used to assess validity. The reproducibility was tested through a repeat administration of the FFQ, with 1 month time interval. Reproducibility analyses involved intra-class correlation coefficient (ICC), Cronbach’s alpha and cross-classification analyses.

Results

The FFQ consisted of 156 whole grain food items from six food groups. Mean intake of whole grain in FFQ1 and 3DR were correlated well (r = 0.732), demonstrated good acceptance of the FFQ. Bland Altman plots showed relatively good agreement for both the dietary methods. Cross-classification of whole grain intake between the two methods showed that < 9.9% of children were grossly misclassified. Outcomes from ICC (0.989) and Cronbach’s alpha (0.995) demonstrated excellent reliability. All the children were classified in the same or adjacent quartile of whole grain intake.

Conclusions

Overall, the findings support the validity of the developed FFQ to appropriately estimate the whole grain intake in Malaysian children. This validated FFQ will be a valuable tool for future studies, to analyses the impact of whole grain consumption with disease relationship among Malaysian schoolchildren.

Relationships between Dietary Patterns and Indices of Arterial Stiffness and Central Arterial Wave Reflection in 9-11-Year-Old Children

Arterial stiffness is an important marker of vascular damage and a strong predictor of cardiovascular diseases (CVD). Given that pathophysiological processes leading to an increased arterial stiffness begin during childhood, the aim of this clustered observational study was to determine the relationship between modifiable factors including dietary patterns and indices of aortic arterial stiffness and wave reflection in 9–11-year-old children. Data collection was conducted between April and December 2015 in 17 primary schools in Dunedin, New Zealand. Dietary data were collected using a previously validated food frequency questionnaire and identified using principal component analysis method. Arterial stiffness (carotid-femoral pulse wave velocity, PWV) and central arterial wave reflection (augmentation index, AIx) were measured using the SphygmoCor XCEL system (Atcor Medical, Sydney, Australia). Complete data for PWV and AIx analyses were available for 389 and 337 children, respectively. The mean age of children was 9.7 ± 0.7 years, 49.0% were girls and 76.0% were classified as “normal weight”. The two identified dietary patterns were “Snacks” and “Fruit and Vegetables”. Mean PWV and AIx were 5.8 ± 0.8 m/s and −2.1 ± 14.1%, respectively. There were no clinically meaningful relationships between the identified dietary pattern scores and either PWV or AIx in 9–11-year-old children.

Reproducibility of a Short-Form, Multicomponent Dietary Questionnaire to Assess Food Frequency Consumption, Nutrition Knowledge, and Lifestyle (SF-FFQ4PolishChildren) in Polish Children and Adolescents

The aim of the study was to assess the reproducibility of a short-form, multicomponent dietary questionnaire (SF-FFQ4PolishChildren) in Polish children and adolescents. The study involved 437 children (6–10 years old) and 630 adolescents (11–15 years old) from rural and urban areas of Poland. The self-administered questionnaire was related to nutrition knowledge, dietary habits, active/sedentary lifestyle, self-reported weight and height, and socioeconomic data. The questionnaire was completed with a two-week interval—twice by parents for their children (test and retest for children), twice by adolescents themselves (adolescent’s test and retest) and once by adolescents’ parents (parent’s test). The strength of agreement measured using the kappa statistic was interpreted as follows: 0–0.20 slight, 0.21–0.40 fair, 0.41–0.60 moderate, 0.61–0.80 good, and 0.81–1.00 excellent. Regarding the frequency of consumption of food items and meals, kappa statistics were 0.46–0.81 (the lowest: fruit/mixed fruit and vegetable juices; the highest: Energy drinks) in test–retest for children, 0.30–0.54 (fruit/mixed fruit and vegetable juices; breakfast, respectively) in adolescent’s test–retest, 0.27–0.56 (the lowest: Sweets, fruit, dairy products; the highest: Breakfast) in adolescent’s test and parent’s test. Lower kappa statistics were found for more frequently consumed foods (juices, fruit, vegetables), higher kappa statistics were found for rarely consumed foods (energy drinks, fast food). Across study groups, kappa statistics for diet quality scores were 0.31–0.55 (pro-healthy diet index, pHDI) and 0.26–0.45 (non-healthy diet index, nHDI), for active/sedentary lifestyle items they were 0.31–0.72, for components of the Family Affluence Scale (FAS) they were 0.55–0.93, for BMI categories (based on self-reported weight and height) they were 0.64–0.67, for the nutrition knowledge (NK) of adolescents the kappa was 0.36, for the nutrition knowledge of children’s parents it was 0.62. The Spearman’s correlations for diet quality scores were 0.52–0.76 (pHDI) and 0.53–0.83 (nHDI), for screen time score they were 0.45–0.78, for physical activity score they were 0.51–0.77, for the FAS score they were 0.90–0.93, and for the NK score they were 0.68–0.80. The questionnaire can be recommended to evaluate dietary and lifestyle behaviors among children and adolescents.

Reliability and validity of an FFQ for South American children and adolescents from the SAYCARE study

Objective:

The purpose of this study was to analyse the reliability and validity of a semi-quantitative FFQ to assess food group consumption in South American children and adolescents.

Design:

The SAYCARE (South American Youth/Child cARdiovascular and Environmental) study is an observational, multicentre, feasibility study performed in a sample of 3- to 18-year-old children and adolescents attending private and public schools from six South American countries. Participants answered the FFQ twice with a two-week interval and three 24-h dietary recalls. Intraclass and Spearman’s correlations, weighted Cohen’s kappa (κw), percentage of agreement and energy-adjusted Pearson’s correlation coefficients were calculated.

Setting:

Seven cities in South America (Buenos Aires, Lima, Medelin, Montevideo, Santiago, Sao Paulo and Teresina).

Subjects:

A sample of 200 children and 244 adolescents for reliability analyses and 252 children and 244 adolescents for validity analyses were included.

Results:

Depending on the food group, for children and adolescents, reliability analyses resulted in Spearman’s coefficients from 0·47 to 0·73, intraclass correlation coefficients from 0·66 to 0·99, κw coefficients from 0·35 to 0·63, and percentage of agreement between 72·75 and 83·52 %. In the same way, validity analyses resulted in Spearman’s coefficients from 0·17 to 0·37, energy-adjusted Pearson’s coefficients from 0·17 to 0·61, κw coefficients from 0·09 to 0·24, and percentages of agreement between 45·79 and 67·06 %.

Conclusion:

The SAYCARE FFQ achieved reasonable reliability and slight-moderate validity for almost all food groups intakes. Accordingly, it can be used for the purpose of ranking the intake of individuals within a population.

Reproducibility of A Non-Quantitative Food Frequency Questionnaire (62-Item FFQ-6) and PCA-Driven Dietary Pattern Identification in 13-21-Year-Old Females

The aim of this study was to evaluate the test-retest reproducibility of a non-quantitative food frequency questionnaire (acronym: 62-item FFQ-6) and the possibility of identifying dietary patterns (DPs) in 13-21-year-old females. The study involved 97 females within three age groups: 13-15, 16-18, and 19-21 years, including 31, 38, and 28 subjects, respectively. The questionnaire was completed twice with a two-week interval (test and retest). For the total sample, using a principal component analysis (PCA), two similar PCA-driven DPs (DP1 and DP2) were identified separately from test data and retest data, considering two sets of input variables. 60-item-DP1 and 60-item-DP2 were identified after excluding two items-vegetables and fruits in general-due to including single items of various kinds of vegetables and fruits. After an aggregation of some items of the questionnaire, 25-item-DP1 and 25-item-DP2 were identified. The kappa statistic (test vs. retest) in the total sample averaged at 0.52 (0.32-0.72 for food items), while within age groups, it averaged at 0.41, 0.53, and 0.65, respectively. The percentage of subjects classified into the same food frequency category (test vs. retest) in the total sample averaged at 68% (51%-89% for food items), while within age groups, it averaged at 60%, 68%, and 77%, respectively. The Spearman correlations between dietary pattern scores (test vs. retest) in the total sample were: 0.84 (within age groups 0.83, 0.81, and 0.78, respectively) for 60-item-DP1, 0.68 (within age groups 0.24, 0.79, and 0.76, respectively) for 60-item-DP2, 0.76 (within age groups 0.56, 0.82, and 0.89, respectively) for 25-item-DP1, and 0.48 (within age groups 0.40, 0.57, and 0.53, respectively) for 25-item-DP2 (p < 0.05 for all). In conclusion, the test-retest reproducibility of the 62-item FFQ-6 was good or very good for most food items, with a tendency to be higher in older age groups of females under study. Due to the acceptable-to-good reproducibility of dietary pattern identification, the use of a 62-item FFQ-6 to describe the overall diet of young Polish females can be recommended.

Reproducibility and validity of an FFQ in the Henan Rural Cohort Study

OBJECTIVE

The present study aimed to evaluate the validity and reproducibility of a thirteen-item FFQ regarding identification of dietary conditions in a rural population in China.

DESIGN

A reproducibility study repeated the first FFQ (FFQ1) approximately 4 weeks later (FFQ2). A validity study evaluated the mean of three consecutive 24 h diet recalls as the reference measure.

SETTING

Cross-sectional study.

PARTICIPANTS

Residents of a rural area in Henan Province, which is located in the central region of China.

RESULTS

A total of 295 individuals participated in the reproducibility study. In addition, 123 people agreed to participate in the validity study. Spearman's correlation coefficients between the two FFQ ranged from 0·06 (vegetables) to 0·58 (eggs). Spearman's correlation coefficients between the two methods of collection ranged from 0·01 for cereal to 0·49 for staple foods. The mean of the intraclass correlation coefficients of the two FFQ (FFQ1 v. FFQ2) was 0·19. Bland-Altman analysis indicated good agreement for most food groups across the range of intake for the two studies.

CONCLUSIONS

The study demonstrated that our FFQ design could be used as a representative tool to conduct a dietary evaluation of a rural population.

Food Consumption Patterns and Body Composition in Children: Moderating Effects of Prop Taster Status

This cross-sectional study determined whether 6-n-propylthiouracil (PROP) taster status moderates the relationship between food consumption patterns and body composition in children. Children were recruited (n = 342, 50% female, 8-10 y) from across New Zealand. Using a food frequency questionnaire, these food consumption patterns were derived: Processed Foods, Fruit and Vegetables, and Breakfast Foods. Body composition variables included: body fat (%), fat mass (kg), fat mass index (FMI, kg/m²), body mass index (kg/m²) and waist to height ratio (W:Ht). Following adjustment for confounders, Processed Foods were positively associated with %fat (p = 0.015), fat mass (p = 0.004) and FMI (p = 0.016). Taste test strips determined PROP status. For Breakfast Foods, there were small negative associations with all body composition variables (p ≤ 0.001 to 0.037). The population sample was also stratified by PROP taster status. For the non-tasters, there were small to moderate negative associations between Breakfast Foods and each body composition variable (p = 0.003-0.045) except W:Ht (p = 0.112), and these relationships were stronger for girls compared to boys. For the tasters, there were small to moderate positive associations between Processed Foods with %fat (p = 0.030), fat mass (p ≤ 0.001) and FMI (p = 0.014). In conclusion, sensitivity to bitterness may moderate the relationship between food consumption patterns and body composition in children.

Validity and Reliability of an Expanded Vegetable Questionnaire Among Elementary School Children

BACKGROUND

The purpose of this study was to expand the School Physical Activity and Nutrition questionnaire to include a greater variety of vegetables and to evaluate the relative validity and reliability of these revised items.

OBJECTIVES

This study utilized 2 convenience samples of third to fifth graders for an analysis: validity (n = 70) and reliability (n = 76). Validity was assessed by comparing questionnaire items with vegetable intake reported from a 24-hour dietary recall covering the same reference period. Reliability estimates were assessed via same-day test-retest.

RESULTS

Agreement correlations ranged from 0.35 to 0.71. Kappa statistics varied from 0.16 to 0.66. Percentage agreements ranged from 57% to 87%. Test-retest Spearman coefficients were greater than 0.50 for 6 items, weighted Kappa values were greater than 0.40 for all 7 items, and percentage agreement exceeded 75% for 5 items.

CONCLUSIONS

Results suggest that the questionnaire is a valid and reliable measure of the previous day's vegetable intake in third- to fifth-grade students. This trial was registered at ClinicalTrials.gov as NCT02668744.

Reproducibility and Validity of a Short Food Frequency Questionnaire for Dietary Assessment in Children Aged 7⁻9 Years in Spain

The purpose of this study was to examine if the short semi-quantitative food frequency questionnaire (FFQ) is a reliable and valid tool to assess the diet of Spanish children aged 7-9 years. We collected data from 156 children of the birth cohort INMA (Infancia y Medio Ambiente (Environment and Childhood)). Children's parents or care-givers completed a 46-item FFQ on two occasions over a 9-12-month period about the children's diet. To explore the reproducibility of the FFQ, the nutrient and food group intake collected from the both FFQs were compared, while validity was examined by contrasting the nutrient values from the FFQs and the average of three 24-hour dietary recalls (24hDRs) taken in this period, and also with the concentration of several vitamins in the blood (carotenoids, vitamin D and α-tocopherol). Pearson and de-attenuated correlation coefficients were calculated. The average correlation coefficients for nutrient intake's reproducibility was 0.41, ranging from 0.25 (calcium) to 0.65 (β-carotene), and for food group intake was 0.45, ranging from 0.18 (cereals) to 0.68 (sweetened beverages). Correlation coefficients slightly improved when we compared energy-adjusted intakes. The average correlation coefficients for validity against 24hDRs was 0.34 for energy-adjusted intakes, and 0.39 when de-attenuation coefficients were used. The validity coefficients against the blood concentrations of vitamins were 0.38 for β-cryptoxanthin, 0.26 for lycopene, 0,23 for α-carotene and 0.15 for β-carotene, all of them statistically significant (p < 0.05). This study suggests that our brief FFQ is a suitable tool for the dietary assessment of a wide range of nutrients and food groups in children 7-9 years, despite the low to moderate reproducibility and validity observed for some nutrients.

Relative Validity of a Method Based on a Smartphone App (Electronic 12-Hour Dietary Recall) to Estimate Habitual Dietary Intake in Adults

BACKGROUND

Accurate dietary assessment is key to understanding nutrition-related outcomes and for estimating the dietary change in nutrition-based interventions. When researching the habitual consumption of selected food groups, it is essential to be aware of factors that could possibly affect reporting accuracy.

OBJECTIVE

This study aimed to evaluate the relative validity of the current-day dietary recall, a method based on a smartphone app called electronic 12-hour dietary recall (e-12HR), to categorize individuals according to habitual intake, in the whole sample of adults and in different strata thereof.

METHODS

University students and employees over 18 years recorded the consumption of 10 selected groups of food using e-12HR during 28 consecutive days. During this period, they also completed 4 dietary records. Once the period was finished, the subjects then completed a food frequency questionnaire (FFQ) and a usability-rating questionnaire for e-12HR. The food group intakes estimated by the e-12HR app, the dietary records, and the FFQ were categorized into sextiles: less than once a week, once or twice a week, 3-4 times a week, 5-6 times a week, once or twice a day, and 3 or more times a day. The 10 selected groups with e-12HR were compared with 4 dietary records and an FFQ reference method, in the whole sample and in different strata thereof: age (years): <25 and ≥25; gender: females and males; occupation: students and employees; smoking: no and yes; physical activity (minutes/week): ≥150 and <150; and body mass index (kg/m²): <25 and ≥25. The association between the different methods was assessed using Spearman correlation coefficient (SCC). Cross-classification and kappa statistic were used as a measure of agreement between the different methods.

RESULTS

In total, 203 participants completed the study (56.7% [115/203] women, and 43.3% [88/203] men). For all food groups and all participants, the mean SCC for e-12HR versus FFQ was 0.67 (≥0.62 for all strata). On average, 50.7% of participants were classified into the same category (≥47.0% for all strata) and 90.2% within the nearest category (≥88.6% for all strata). Mean weighted kappa was 0.49 (≥0.44 for all strata). For e-12HR versus RDs, mean SCC was 0.65 (≥0.57 for all strata). On average, 50.0% of participants were classified into the same category (≥47.0% for all strata) and 88.2% within the nearest category (≥86.1% for all strata). Mean weighted kappa was 0.50 (≥0.44 for all strata).

CONCLUSIONS

The results indicate that e-12HR generated categories of dietary intake highly comparable with the 2 reference methods in the whole sample and in different strata thereof. The inclusion of photographs to facilitate estimation of the servings consumed generated correlation/agreement data between e-12HR and the FFQ that were similar to a previous study using an older version of the app, which did not include photographs.

Relative Validity and Reproducibility of a Food Frequency Questionnaire to Assess Nutrients and Food Groups of Relevance to the Gut Microbiota in Young Children

Dietary fiber is an important nutrient for the gut microbiota, with different fiber fractions having different effects. The aim of this study was to determine the relative validity and reproducibility of a food frequency questionnaire (EAT5 FFQ) for measuring intake of fiber, and low and high fiber foods, in studies examining diet and gut microbiota in young children. One hundred parents of 5-year old children completed the 123-item EAT5 FFQ on two occasions four weeks apart. A 3-day weighed diet record (WDR) was completed on non-consecutive days between FFQ appointments. Mean correlations between the (randomly chosen) FFQ and WDR were acceptable for nutrient and food group intakes (r = 0.34 and r = 0.41 respectively). Gross misclassification was below chance (12.5%) for quartiles of nutrient (mean 5.7%) and food group (mean 5.1%) intake. ‘Absolute values for surrogate categories’ suggested the FFQ clearly differentiated between highest and lowest quartiles for all nutrients and food groups tested. Mean correlations between repeat administrations of the FFQ suggested very good reproducibility for nutrients (r = 0.83) and food groups (r = 0.80). The EAT5 FFQ appears to be an appropriate tool for investigating the intake of nutrients and food groups of relevance to the gut microbiota, and is the first FFQ validated to measure total, soluble and insoluble non-starch polysaccharide intakes in young children.

Reproducibility of Preschool Personnel and Guardian Reports on Energy Balance-Related Behaviors and Their Correlates in Finnish Preschool Children

Valid and reliable non-objective assessments of guardian and preschool personnel reports are necessary when estimating young children’s health behaviors. This study examines the test-retest reproducibility of (a) guardian and preschool personnel questionnaires about correlates of preschool-aged children’s energy balance-related behaviors (EBRBs), (b) a screen time diary, and (c) a food frequency questionnaire (FFQ) reported by a guardian. A sample of guardians having preschool-aged children (N = 69) and preschool personnel (N = 61) completed questionnaires twice within a five-week time interval during April–May 2018 in Finland. Intra-class correlations (ICC), kappas, and percentage agreement were calculated to test the test-retest-reproducibility. The guardian questionnaire for correlates of the children’s EBRBs demonstrated mainly moderate to good reproducibility whereas the preschool personnel questionnaire of preschool correlates for children’s EBRBs was mostly good. The reproducibility of the screen time diary was good and FFQ food items showed mostly moderate reproducibility. The reproducibility of the FFQ foods items for vegetables, fruit, and berries was slightly better for the amount consumed than for the frequency of consumption. To conclude, all the instruments are acceptable for use in future studies.

Dietary Patterns, Cardiorespiratory and Muscular Fitness in 9⁻11-Year-Old Children from Dunedin, New Zealand

Research shows that cardiorespiratory (CRF) and muscular fitness in childhood are associated with a healthier cardiovascular profile in adulthood. Identifying factors associated with measures of fitness in childhood could allow for strategies to optimize cardiovascular health throughout the lifecourse. The aim of this study was to examine the association between dietary patterns and both CRF and muscular fitness in 9⁻11-year-olds. In this study of 398 children, CRF and muscular fitness were assessed using a 20-m shuttle run test and digital hand dynamometer, respectively. Dietary patterns were derived using principal component analysis. Mixed effects linear regression models were used to assess associations between dietary patterns and CRF and muscular fitness. Most children had healthy CRF (99%, FITNESSGRAM) and mean ± SD muscular fitness was 15.2 ± 3.3 kg. Two dietary patterns were identified; &ldquo;Snacks&rdquo; and &ldquo;Fruit and Vegetables&rdquo;. There were no significant associations between either of the dietary patterns and CRF. Statistically significant but not clinically meaningful associations were seen between dietary patterns and muscular fitness. In an almost exclusively fit cohort, food choice is not meaningfully related to measures of fitness. Further research to investigate diet-fitness relationships in children with lower fitness levels can identify key populations for potential investments in health-promoting behaviors.

Electronic 12-Hour Dietary Recall (e-12HR): Comparison of a Mobile Phone App for Dietary Intake Assessment With a Food Frequency Questionnaire and Four Dietary Records

BACKGROUND

One of the greatest challenges in nutritional epidemiology is improving upon traditional self-reporting methods for the assessment of habitual dietary intake.

OBJECTIVE

The aim of this study was to evaluate the relative validity of a new method known as the current-day dietary recall (or current-day recall), based on a smartphone app called 12-hour dietary recall, for determining the habitual intake of a series of key food and drink groups using a food frequency questionnaire (FFQ) and four dietary records as reference methods.

METHODS

University students over the age of 18 years recorded their consumption of certain groups of food and drink using 12-hour dietary recall for 28 consecutive days. During this 28-day period, they also completed four dietary records on randomly selected days. Once the monitoring period was over, subjects then completed an FFQ. The two methods were compared using the Spearman correlation coefficient (SCC), a cross-classification analysis, and weighted kappa.

RESULTS

A total of 87 participants completed the study (64% women, 56/87; 36% men, 31/87). For e-12HR versus FFQ, for all food and drink groups, the average SCC was 0.70. Cross-classification analysis revealed that the average percentage of individuals classified in the exact agreement category was 51.5%; exact agreement + adjacent was 91.8%, and no participant (0%) was classified in the extreme disagreement category. The average weighted kappa was 0.51. For e-12HR versus the four dietary records, for all food and drink groups, the average SCC was 0.63. Cross-classification analysis revealed that the average percentage of individuals classified in the exact agreement category was 47.1%; exact agreement + adjacent was 89.2%; and no participant (0%) was classified in the extreme disagreement category. The average weighted kappa was 0.47.

CONCLUSIONS

Current-day recall, based on the 12-hour dietary recall app, was found to be in good agreement with the two reference methods (FFQ & four dietary records), demonstrating its potential usefulness for categorizing individuals according to their habitual dietary intake of certain food and drink groups.

Reproducible and reliable general semiquantitative food frequency questionnaire for evaluating iodine intake in Chinese children

Iodine deficiency is a global issue that is correlated with a variety of diseases and can affect individuals of all ages. We hypothesized that a general, semiquantitative food frequency questionnaire (FFQ) could be a valuable tool to evaluate iodine intake in children. Study participants comprised 687 healthy children between the ages of 7 and 13 years. The FFQ was developed to assess habitual iodine intake over a 6-month period (FFQ1). A 3-day estimated food diary (3DEFD) and the habitual daily iodine intake, calculated from 2-repeated 24-hour urine iodine excretion, tested the intermethod relative validity of the FFQ. There were 92 children who also repeated the FFQ (FFQ2) 3 weeks later to assess for FFQ reproducibility. Iodine intake estimated by FFQ1 + water was significantly higher than that indicated by the 3DEFD + water (204 μg/d vs 156 μg/d, P < .001), whereas there were no differences between habitual daily iodine intake and FFQ1 + water (185 μg/d vs 204 μg/d, P = .223). The interclass correlation coefficients of iodine intake estimated by the FFQ1 and FFQ2 were 0.72 (P < .001). The FFQ1 + water was moderately correlated with the 3DEFD + water (Spearman correlation coefficient = 0.57, P < .001) as well as habitual daily iodine intake (SCC = 0.34, P < .001). The subjects classified into the same or adjacent quartiles ranged from 32% to 93%. The κ value α was 0.46 for FFQ1 and FFQ2 (P < .001) 0.27 for FFQ1 + water and 3DEFD + water (P < .001), and 0.09 for FFQ1 + water and habitual daily iodine intake (P < .001). The results showed this FFQ is a reliable and reproducible tool in evaluating iodine intake in Chinese children.

Relative validity of a short food frequency questionnaire assessing adherence to the Norwegian dietary guidelines among colorectal cancer patients

Background

The Norwegian food-based dietary guidelines (FBDG) aim at reducing the risk of developing chronic diseases and promote overall health. We studied the effect of the Norwegian FBDG in colorectal cancer (CRC) patients. There is a need for a time-efficient dietary assessment tool measuring adherence to these guidelines in patients treated for dietary dependent cancer, such as CRC patients.

Objective

To evaluate a new short food frequency questionnaire (NORDIET-FFQ), developed to estimate adherence to the Norwegian FBDG among CRC patients.

Design

Eighty-one CRC patients from both study groups in the Norwegian Dietary Guidelines and Colorectal Cancer Survival study, an ongoing dietary intervention, completed both the short 63-item NORDIET-FFQ and a 7-day weighed food record.

Results

The NORDIET-FFQ was on group level able to estimate intakes of fruits, vegetables, unsalted nuts, fish, fatty fish, high fat dairy products, unprocessed meat, processed meat, red meat, water, sugar-rich beverages, alcoholic drinks, and sugar- and fat-rich foods. Ranking of individuals according to intake was good (r = 0.31–0.74) for fruits and vegetables, fruits, unsalted nuts, whole grain products, sugar-rich cereals, fish, fatty fish, dairy products, red meat, water, sugar-rich beverages, alcoholic beverages, and sugar- and fat-rich foods. The NORDIET-FFQ was able to identify the individuals who did not fulfil the recommendations of fruits, vegetables, unsalted nuts, whole grains, low-fat dairy products, processed meat, water, alcoholic beverages, and sugar- and fat-rich foods (sensitivity: 67–93%).

Conclusions

The NORDIET-FFQ showed good ability in to estimate intakes of plant-based foods, fish, dairy products, meat, and energy-dense foods; adequate ranking of individuals according to intake of most recommendations except for unprocessed meat, processed meat, and vegetables; and importantly a good ability to identify those patients in need of dietary counselling for foods that are known to modulate the risk of CRC.

Trial registration

National Institutes of Health ClinicalTrials.gov; Identifier: NCT01570010.

Dietary quality and household food insecurity among Mexican children and adolescents

Seventy percent of Mexican households experience some level of food insecurity (FI). Studies have shown positive associations between FI and poor dietary quality. As far as it is known, this is the first time the Healthy Eating Index (HEI-2010) has been used to assess dietary quality of children and adolescents in Mexico, and to examine if FI is related to it. The objective of this research is to assess dietary quality and its association with FI among Mexican children and adolescents from a nationally representative cross-sectional sample. We analyzed data from 4635 2-19-year-old Mexican children and adolescents participating in the Mexican National Health and Nutrition Survey (Ensanut 2012). FI was measured using the Latin American and Caribbean Household Food Security Scale (ELCSA) and dietary quality with the HEI-2010. We examined the association between FI and dietary quality using multivariate linear regressions. Dietary quality was worst as FI became more severe among children and adolescents compared with their counterparts living in households with food security. Specifically, FI had a negative association with fruits, vegetables, and protein foods, and a positive association with refined grains consumption. Dairy intake was negatively associated with FI among older children and adolescents. Added sugars were not associated with FI, but intake was excessive across the population at 15% of total daily energy intake. Decreasing FI may help improve dietary quality of Mexican children and adolescents.

First evaluation steps of a new method for dietary intake estimation regarding a list of key food groups in adults and in different sociodemographic and health-related behaviour strata

OBJECTIVE

A new method known as 'current-day dietary recall' (current-day recall) is based on an application for mobile phones called 'electronic 12 h dietary recall' (e-12HR). This new method was designed to rank participants into categories of habitual intake regarding a series of key food groups. The present study compared current-day recall against a previously validated short paper FFQ.

DESIGN

Participants recorded the consumption of selected food groups using e-12HR during twenty-eight consecutive days and then filled out a short paper FFQ at the end of the study period. To evaluate the association and agreement between both methods, Spearman's correlation coefficients (SCC), cross-classification analysis and weighted kappa statistics (κ w) were used.

SETTING

Andalusia, Spain, Southern Europe.

SUBJECTS

University students and employees over the age of 18 years.

RESULTS

One hundred and eighty-seven participants completed the study (64·2 % female, 35·8 % male). For all particpants, for all food group intakes, the mean SCC was 0·70 (SCC≥0·62 were observed for all strata); the mean percentage of participants cross-classified into categories of 'exact agreement+adjacent' was 90·1 % (percentages≥87·8 % were observed for all strata); and the mean κ w was 0·55 (κ w≥0·53 in ten of the twelve strata).

CONCLUSIONS

For the whole sample and for all strata thereof, the current-day recall has good agreement with the previously validated short paper FFQ for assessing food group intakes, rendering it a useful method for ranking individuals.

The Association between Parent Diet Quality and Child Dietary Patterns in Nine- to Eleven-Year-Old Children from Dunedin, New Zealand

Previous research investigating the relationship between parents’ and children’s diets has focused on single foods or nutrients, and not on global diet, which may be more important for good health. The aim of the study was to investigate the relationship between parental diet quality and child dietary patterns. A cross-sectional survey was conducted in 17 primary schools in Dunedin, New Zealand. Information on food consumption and related factors in children and their primary caregiver/parent were collected. Principal component analysis (PCA) was used to investigate dietary patterns in children and diet quality index (DQI) scores were calculated in parents. Relationships between parental DQI and child dietary patterns were examined in 401 child-parent pairs using mixed regression models. PCA generated two patterns; ‘Fruit and Vegetables’ and ‘Snacks’. A one unit higher parental DQI score was associated with a 0.03SD (CI: 0.02, 0.04) lower child ‘Snacks’ score. There was no significant relationship between ‘Fruit and Vegetables’ score and parental diet quality. Higher parental diet quality was associated with a lower dietary pattern score in children that was characterised by a lower consumption frequency of confectionery, chocolate, cakes, biscuits and savoury snacks. These results highlight the importance of parental modelling, in terms of their dietary choices, on the diet of children.

Reliability of a Kid's Activity and Nutrition Questionnaire for School-Based SNAP-Ed Interventions as Part of a Tiered Development Process

OBJECTIVE

To assess the reliability of the Kids' Activity and Nutrition Questionnaire (KAN-Q) as part of a tiered process for developing Supplemental Nutrition Assistance Program-Education tools.

METHODS

The KAN-Q was administered at 2 time points to assess internal consistency using standardized values of Cronbach α and test-retest reliability using the intraclass correlation coefficient for continuous variables, Cohen's kappa (κ) statistic for categorical variables, and the weighted κ statistic for ordinal data.

RESULTS

Data were collected from 119 fourth graders. Cronbach α was adequate for behavior (.71) and knowledge (.72) scales and nutrition behavior (.78) and nutrition knowledge (.75) subscales. Test-retest reliability was generally acceptable, with intraclass correlation coefficients from 0.40 to 0.75 and κ coefficients showing fair to substantial agreement (0.30 to 0.72).

CONCLUSIONS AND IMPLICATIONS

The KAN-Q is a practical and reliable questionnaire for school-based administration that aligns directly with Supplemental Nutrition Assistance Program-Education evaluation priorities.