Dietary Assessment in Rwanda - Food Frequency Questionnaire (FFQ Rwanda)

Development and Evaluation of a Semi-quantitative Food Frequency Questionnaire for Use in Urban and Rural Communities of Rwanda

The burden of non-communicable diseases (NCDs) in Rwanda is adding to the health burden in the country which is facing the nutritional transition and the double burden of malnutrition. Diet is an established risk factor in NCDs, hence the importance to assess accurately the changes in dietary habits occurring in the population. The objective is to develop and validate a food frequency questionnaire in Rwanda.

Study Overview

• Status: Completed
• Conditions: Dietary Assessment
• Intervention / Treatment: Other: Food Frequency Questionnaire; Other: 24 Hour food recall

Detailed Description

In many developing countries, including Rwanda, the lack of developed and validated questionnaires is among major challenges for dietary assessment in nutritional surveys. Questionnaires are mostly borrowed from other communities. This can increase the error range due to low adaptation to local context, especially when they are not validated and may not have similar objectives. One Food Frequency Questionnaire (FFQ) does not capture dietary history in two different countries or regions, unless their diets are similar. Besides, the diet changes with time, where new foods are introduced in diet and others may disappear. In Rwanda, one FFQ has been developed to cover only the eastern part of the country, but none for the entire country (Cade et al., 2001; FAO, 2018). It is then very important to develop and validate an update and general FFQ that can be used across the country to measure the dietary intake to have a better interpretation of the study findings from the Rwandan context.

The overall objective is to develop and validate a semi-quantitative FFQ that can be used to assess the food and nutrient intake in urban and rural communities of Rwanda.

Specific objectives include:

1. To collect data on diet intake of selected participants by using a 24-H recall questionnaire that includes pictures on the approximate quantities consumed in each occasion.
2. To develop a list of food items from commonly consumed food by study participants using the compiled 24-h recall questionnaire to use for an FFQ development. Additionally, an open question format to collect information on foods consumed during social gathering and festivals will be used to include unreported foods. FFQ shall include additionally the food portion size, and the frequency of intake over a reference period of one year.
3. To assess the accuracy of the developed FFQ in estimating energy and nutrient intake using the 24-H dietary recall as a benchmark of accuracy.

• Study Type: Observational
• Enrollment (Actual): 200

Contacts and Locations

Study Locations

• Rwanda
  • Kigali, Rwanda
    • University of Rwanda

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 49 years (Adult)
• Accepts Healthy Volunteers: N/A
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

In total, 100 participants will be selected from 100 households (one per household) in urban villages (mainly in Kigali) and the same number of participants from rural communities of Rwanda will be recruited in the validation study.

Description

Inclusion Criteria:

• Permanent residence of the selected urban or rural villages
• Holding a valid health insurance card
• Aged between 18 and 49 years
• Signing informed consent form
• Familiar with the diet and cooking practices
• Registration in city demographic system, since study participants will be selected from population registration cards at village level,
• Accept enumerators for home visit and data collection for one year

Exclusion Criteria:

• Mental disorders such as clinically diagnosed depression, anxiety disorders, eating disorders and addictive behaviors

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Urban; Men and women between 18 and 49 years of age living in the selected urban communities in Rwanda and who are familiar with the diet. Participants in this study should be acquainted with cooking practices to be able to cite all the ingredients that are used in the preparation of the dishes/ meals	Other: Food Frequency Questionnaire; Food frequency questionnaires (FFQs) are a common method for measuring dietary intake in large epidemiological studies, in particular in low literacy settings were diaries and food history would not be viable.; Other: 24 Hour food recall; Standardized and validated approach of collecting all foods, beverages, and supplements consumed during the past 24 hours
Rural; Men and women between 18 and 49 years of age living in the selected urban communities in Rwanda and who are familiar with the diet. Participants in this study should be acquainted with cooking practices to be able to cite all the ingredients that are used in the preparation of the dishes/ meals	Other: Food Frequency Questionnaire; Food frequency questionnaires (FFQs) are a common method for measuring dietary intake in large epidemiological studies, in particular in low literacy settings were diaries and food history would not be viable.; Other: 24 Hour food recall; Standardized and validated approach of collecting all foods, beverages, and supplements consumed during the past 24 hours

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Median proportion of energy intake from carbohydrates assessed by the 24 hour recalls	Median proportion of energy intake from carbohydrates (starch from grains and tubers such as corn, pasta, rice, potatoes, breads), natural sugars from fruits and juices, and added sugars found in soft drinks, candy, fruit drinks, and desserts) assessed by the 24 hour recalls Adults should get 45 percent to 65 percent of their calories from carbohydrates	One year
Median proportion of energy intake from carbohydrates assessed by the Food Frequency Questionnaire	Median proportion of energy intake from carbohydrates (starch from grains and tubers such as corn, pasta, rice, potatoes, breads), natural sugars from fruits and juices, and added sugars found in soft drinks, candy, fruit drinks, and desserts) assessed by the Food Frequency Questionnaire. Adults should get 45 percent to 65 percent of their calories from carbohydrates	One year
Median proportion of energy intake from fat assessed by the 24 hour recalls	Median proportion of energy intake from fat (Butter, margarine, vegetable oils, whole milk, visible fat on meat and poultry products, invisible fat in fish, shellfish, some plant products such as seeds and nuts, and bakery products) assessed by the 24 hour recalls. Adults should get 20 percent to 35 percent of their calories from fat	One year
Median proportion of energy intake from fat assessed by the Food Frequency Questionnaire	Median proportion of energy intake from fat (Butter, margarine, vegetable oils, whole milk, visible fat on meat and poultry products, invisible fat in fish, shellfish, some plant products such as seeds and nuts, and bakery products) assessed by the Food Frequency Questionnaire. Adults should get 20 percent to 35 percent of their calories from fat	One year
Median proportion of energy intake from proteins assessed by the 24 hour recalls	Median proportion of energy intake from proteins (from animal sources, such as meat, poultry, fish, eggs, milk, cheese, and yogurt; and proteins from plants, legumes, grains, nuts, seeds, and vegetables) assessed by the 24 hour recalls. Adults should get 10 to 35 percent of their calories from protein	One year
Median proportion of energy intake from proteins assessed by the Food Frequency Questionnaire	Median proportion of energy intake from proteins (from animal sources, such as meat, poultry, fish, eggs, milk, cheese, and yogurt; and proteins from plants, legumes, grains, nuts, seeds, and vegetables) assessed by the Food Frequency Questionnaire. Adults should get 10 to 35 percent of their calories from protein	One year
Median daily intake of fibers assessed by the 24 hour recalls	Median daily intake of fibers (in gram; Includes dietary fiber naturally present in grains, such as found in oats, wheat, or unmilled rice; and functional fiber synthesized or isolated from plants or animals) assessed by the 24 hour recalls. The recommended intake for total fiber for adults 50 years and younger is set at 38 grams for men and 25 grams for women	One year
Median daily intake of fibers assessed by the Food Frequency Questionnaire	Median daily intake of fibers (in gram; Includes dietary fiber naturally present in grains, such as found in oats, wheat, or unmilled rice; and functional fiber synthesized or isolated from plants or animals) assessed by the Food Frequency Questionnaire. The recommended intake for total fiber for adults 50 years and younger is set at 38 grams for men and 25 grams for women	One year

Collaborators and Investigators

• Sponsor: University Ghent
• Collaborators: University of Rwanda; Institut de Recherche en Sciences de la Sante, Burkina Faso
• Investigators: Principal Investigator: Hilda Vasanthakaalam, PhD, University of Rwanda; Principal Investigator: Jerome Some, Md. PhD, Institut de Recherche en Sciences de la Sante, Ouagadougou, Burkina Faso; Principal Investigator: Souheila Abbeddou, MSc. PhD, UGent

Publications and helpful links

General Publications

• Bowen L, Bharathi AV, Kinra S, Destavola B, Ness A, Ebrahim S. Development and evaluation of a semi-quantitative food frequency questionnaire for use in urban and rural India. Asia Pac J Clin Nutr. 2012;21(3):355-60.
• Cade J, Thompson R, Burley V, Warm D. Development, validation and utilisation of food-frequency questionnaires - a review. Public Health Nutr. 2002 Aug;5(4):567-87. doi: 10.1079/PHN2001318.
• Aglago EK, Landais E, Nicolas G, Margetts B, Leclercq C, Allemand P, Aderibigbe O, Agueh VD, Amuna P, Annor GA, El Ati J, Coates J, Colaiezzi B, Compaore E, Delisle H, Faber M, Fungo R, Gouado I, El Hamdouchi A, Hounkpatin WA, Konan AG, Labzizi S, Ledo J, Mahachi C, Maruapula SD, Mathe N, Mbabazi M, Mirembe MW, Mizehoun-Adissoda C, Nzi CD, Pisa PT, El Rhazi K, Zotor F, Slimani N. Evaluation of the international standardized 24-h dietary recall methodology (GloboDiet) for potential application in research and surveillance within African settings. Global Health. 2017 Jun 19;13(1):35. doi: 10.1186/s12992-017-0260-6.
• Shridhar K, Satija A, Dhillon PK, Agrawal S, Gupta R, Bowen L, Kinra S, Bharathi AV, Prabhakaran D, Srinath Reddy K, Ebrahim S; Indian Migration Study group. Association between empirically derived dietary patterns with blood lipids, fasting blood glucose and blood pressure in adults - the India migration study. Nutr J. 2018 Feb 8;17(1):15. doi: 10.1186/s12937-018-0327-0.

Helpful Links

• The International Dietary Data Expansion (INDDEX) Project

Study record dates

Study Major Dates

• Study Start (Actual): January 30, 2020
• Primary Completion (Actual): December 31, 2021
• Study Completion (Actual): December 31, 2021

Study Registration Dates

• First Submitted: November 27, 2019
• First Submitted That Met QC Criteria: December 16, 2019
• First Posted (Actual): December 17, 2019

Study Record Updates

• Last Update Posted (Actual): November 15, 2022
• Last Update Submitted That Met QC Criteria: November 14, 2022
• Last Verified: November 1, 2022

More Information

Terms related to this study

• Keywords: Food Frequency Questionnaire; Dietary assessment; multi-pass 24 hour food recall; semi-quantitative
• Other Study ID Numbers: EC/2019/1578

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No