Relative validity of a semi-quantitative food frequency questionnaire for Singaporean toddlers aged 15-36 months

Cameron Allan, Ummi Hani Abdul Kader, Jowynn Yu Ying Ang, Leilani Muhardi, Smita Nambiar, Cameron Allan, Ummi Hani Abdul Kader, Jowynn Yu Ying Ang, Leilani Muhardi, Smita Nambiar

Abstract

Background: There is presently no simple tool for use in large epidemiological studies to understand the food and nutrient intakes of Asian toddlers. This study aimed to assess the relative validity of a semi-quantitative food frequency questionnaire (sqFFQ) developed for multi-ethnic Singaporean toddlers aged 15-36 months.

Methods: Ninety-one parents completed the sqFFQ and a 2-day weighed food record as the reference method. Intake of energy and 25 nutrients were determined for each method and compared using Pearson correlations corrected for attenuation, Bland-Altman plots, and weighted kappa according to quartiles; sqFFQ calibration was performed using multivariable linear regression.

Results: Deattenuated correlations for energy and all nutrients were acceptable (r = ≥0.30, p < 0.001). The sqFFQ was highly reproducible, but significantly overestimated intake of energy and all nutrients except vitamin A. Bland-Altman plots showed wide limits of agreement for energy and all nutrients. Weighted kappa ranged from 0.12 (slight) to 0.53 (moderate). After calibration, deattenuated correlations improved for energy and 10/25 nutrients, with no change or a slight decline for the remainder, including one falling to r = 0.27. Limits of agreement narrowed for energy and all nutrients, and except for DHA, median intakes were not significantly different except for vitamin A, enabling population estimates of absolute intakes. Weighted kappa improved overall; energy and 16 nutrients now had moderate agreement (0.41-0.60), while 9 nutrients had fair agreement (0.21-0.40).

Conclusions: The Singaporean toddler semi-quantitative food frequency questionnaire is suitable for ranking nutrient intakes of Singaporean toddlers in larger epidemiological studies. However, for population estimates of absolute nutrient intakes, it is recommended that a subsample within a cohort complete weighed food records for calibration purposes.

Trial registration: This study was registered retrospectively on clinicaltrials.gov on 3rd May 2017 (identifier code: NCT03138330).

Keywords: Food frequency questionnaire; Nutrient intake; Singapore; Toddler; Validation.

Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

© The Author(s). 2018.

Figures

Fig. 1
Fig. 1
Bland Altman plot for energy before calibration. Indicates mean difference (mid line) and Limits of Agreement (+ 2 standard deviations and − 2 standard deviations); values on the axes are kilojoules transformed to the cube root
Fig. 2
Fig. 2
Bland Altman plot for energy after calibration. Indicates mean difference (mid line) and Limits of Agreement (+ 2 standard deviations and − 2 standard deviations); values on the axes are kilojoules transformed to the cube root

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