Validation and calibration of the Food Consumption Frequency Questionnaire for pregnant women
Keywords:
Eating, Validation studies [publication type], Pregnancy, Prenatal care, Dietary patterns, Food consumption frequency questionnaire, CalibrationAbstract
BACKGROUND: Few food frequency questionnaires (FFQ) have been validated for pregnant women, particularly those in small- and medium-sized cities in different regions of Brazil.
OBJECTIVES: To validate and calibrate a semiquantitative FFQ for pregnant women. DESIGN AND SETTING: The study was validated with a sample of 50 pregnant women (≥ 18 years) enrolled in Brazilian prenatal services.
METHODS: An FFQ and a 24-hour recall were used to evaluate dietary intake. Dietary variables were tested for normality and log-converted when asymmetrical. Pearson’s Correlation Coefficient was used to validate the questionnaire. Linear regression was applied to extract calibration factors. All variables underlying the consumption analysis were adjusted for energy.
RESULTS: The mean age of the pregnant women was 26 years ± 6.2 years; 58% were in their first trimester, and 30% were identified as overweight/obese. The Pearson correlation analysis results indicated that the FFQ overestimated energy and nutrient intake, whose coefficients ranged from -0.15 (monounsaturated fat) to 0.50 (carbohydrate). Adjusting for energy reduced the mean values of intake coefficients, which now ranged from -0.33 (sodium) to 0.96 (folate). The calibration analysis results indicated variation in the coefficients from -0.23 (sodium) to 1.00 (folate). Calibration produced satisfactory coefficients for the FFQ compared with the reference standard for energy, macronutrients, monounsaturated fat, cholesterol, vitamins B12/C, folate, sodium, iron, and calcium.
CONCLUSIONS: After validating and calibrating tests, we observed that the FFQ was adequately accurate for assessing the food consumption of the pregnant women in this study.
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References
Willett W. Nutritional Epidemiology. Oxford: Oxford University Press; 2012.
Mello APQ, Lima PA, Verde SMML, Damasceno NRT. Estudo de calibração de um questionário quantitativo de freqüência alimentar aplicado à população com diferentes níveis de risco cardiovascular. Nutrire. 2008;33(2):13-28. Available from: http://sban.cloudpainel.com.br/files/ revistas_publicacoes/191.pdf. Accessed in 2023 (May 30).
Voci SM, Slater B, da Silva MV, Marchioni DML, Latorre MRDO. Estudo de calibração do Questionário de Frequência Alimentar para Adolescentes (QFAA) [Calibration study of the food frequency questionnaire for adolescents (AFFQ)]. Cienc Saude Colet. 2011;16(4):2335-43. PMID: 21584475; https://doi.org/10.1590/s1413-81232011000400033.
Silva TA, Vasconcelos SML. Procedimentos metodológicos empregados em questionários de frequência alimentar elaborados no Brasil: uma revisão sistemática. Rev Nutr. 2012;25(6):785-97. https://doi.org/10.1590/ S1415-52732012000600010.
Cardoso MA. Development, validation and applications of a Food Frequency Questionnaire in Epidemiological Studies. In: Kac G, Sichieri R, Gigante DP, orgs. Nutritional Epidemiology. Rio de Janeiro: Editora Fiocruz/Atheneu; 2009. p. 201-11. Available from: https://static.scielo.org/scielobooks/rrw5w/ pdf/kac-9788575413203.pdf. Accessed in 2023 (Feb 28).
Slater B, Philippi ST, Marchioni DML, Fisberg RM. Validação de Questionários de Freqüência Alimentar - QFA: considerações metodológicas. Rev Bras Epidemiol. 2003;6(3):200-8. https://doi. org/10.1590/S1415-790X2003000300003.
Mota JF, Rinaldi AEM, Pereira AF, et al. Adaptação do índice de alimentação saudável ao guia alimentar da população brasileira. Rev Nutr. 2008;21(5):545-52. https://doi.org/10.1590/S1415-52732008000500007.
Giacomello A, Schmidt MI, Nunes MAA, et al. Validação relativa de Questionário de Freqüência Alimentar em gestantes usuárias de serviços do Sistema Único de Saúde em dois municípios no Rio Grande do Sul, Brasil. Rev Bras Saude Matern Infant. 2008;8(4):445-54. https://doi. org/10.1590/S1519-38292008000400010.
Oliveira T, Marquitti FD, Carvalhaes MABL, Sartorelli DS. Development of a quantitative food frequency questionnaire for pregnant women attending primary care in Ribeirão Preto, São Paulo State, Brazil. Cad Saude Publica. 2010;26(12):2296-306. PMID: 21243224; https://doi. org/10.1590/s0102-311x2010001200008.
Bonatto S, Henn RL, Olinto MTA, et al. Reproducibility, relative validity, and calibration of a food-frequency questionnaire for adults in Greater Metropolitan Porto Alegre, Rio Grande do Sul State, Brazil.
Cad Saude Publica. 2014;30(9):1837-48. PMID: 25317513; https://doi. org/10.1590/0102-311x00151313.
Furlan-Viebig R, Pastor-Valero M. Development of a food frequency questionnaire to study diet and non-communicable diseases in adult population. Rev Saude Publica. 2004;38(4):581-4. PMID: 15311301.
https://doi.org/10.1590/s0034-89102004000400016.
Fawzi WW, Rifas-Shiman SL, Rich-Edwards JW, Willett WC, Gillman MW. Calibration of a semi-quantitative food frequency questionnaire in early pregnancy. Ann Epidemiol. 2004;14(10):754-62. PMID: 15519898. https://doi.org/10.1016/j.annepidem.2004.03.001.
Barker DJP. Developmental origins of adult health and disease. J Epidemiol Community Health. 2004;58(2):114-5. PMID: 14729887; https://doi.org/10.1136/jech.58.2.114.
Crispim SP, Ribeiro RCL, Panato E, et al. Validade relativa de um questionário de freqüência alimentar para utilização em adultos. Rev Nutr. 2009;22(1):81-95. https://doi.org/10.1590/S1415-52732009000100008.
Cade J, Thompson R, Burley V, Warm D. Development, validation and utilisation of food-frequency questionnaires - a review. Public Health Nutr. 2002;5(4):567-87. PMID: 12186666; https://doi.org/10.1079/ phn2001318.
Andrade RG, Pereira RA, Sichieri R. Food intake in overweight and normal-weight adolescents in the city of Rio de Janeiro. Cad Saude Publica. 2003;19(5):1485-95. PMID: 14666230; https://doi.org/10.1590/ s0102-311x2003000500027.
Fraser GE, Shavlik DJ. Correlations between estimated and true dietary intakes. Ann Epidemiol. 2004;14(4):287-95. PMID: 15066609; https:// doi.org/10.1016/j.annepidem.2003.08.008.
Ferreira MG, Silva NF, Schmidt FD, et al. Development of a food frequency questionnaire for adults in a population-based sample in Cuiabá, MidWestern Region of Brazil. Rev Bras Epidemiol. 2010;13(3):413-24. PMID: 20857028; https://doi.org/10.1590/s1415-790x2010000300005.
Vasconcelos IAL, Côrtes MH, Coitinho DC. Alimentos sujeitos à fortificação compulsória com ferro: um estudo com gestantes. Rev Nutr. 2008;21(2):149-60. http://doi.org/10.1590/S1415-52732008000200003.
Fisberg RM, Slater Villar B. Manual de receitas e medidas caseiras para cálculo de inquéritos alimentares: manual elaborado para auxiliar o processamento de dados de inquéritos alimentares. São Paulo: Signus; 2022.
Universidade Estadual de Campinas. Tabela Brasileira de Composição de Alimentos – TACO. Campinas: NEPA-UNICAMP; 2011. Available from: https://www.nepa.unicamp.br/taco/tabela.php?ativo=tabela. Accessed in 2023 (May 30).
Kaaks R, Riboli E, van Staveren W. Calibration of dietary intake measurements in prospective cohort studies. Am J Epidemiol. 1995;142(5):548-56. PMID: 7677134; https://doi.org/10.1093/ oxfordjournals.aje.a117673.
Slater B, Marchioni DML, Voci SM. Use of linear regression for correction of dietary data. Rev Saude Publica. 2007;41(2):190-6. PMID: 17384792; https://doi.org/10.1590/s0034-89102007000200004.
Freedman LS, Commins JM, Willett W, et al. Evaluation of the 24hour recall as a reference instrument for calibrating other self-report
instruments in nutritional cohort studies: evidence from the validation studies pooling project. Am J Epidemiol. 2017;186(1):73-82. PMID: 28402488; https://doi.org/10.1093/aje/kwx039.
Araujo MC, Yokoo EM, Pereira RA. Validation and calibration of a semiquantitative food frequency questionnaire designed for adolescents. J Am Diet Assoc. 2010;110(8):1170-7. PMID: 20656092; https://doi.org/10.1016/j.jada.2010.05.008.
Hinojosa-Nogueira D, Romero-Molina D, Giménez-Asensio MJ, et al. Validity and reproducibility of a Food Frequency Questionnaire to assess nutrients intake of pregnant women in the south-east of Spain. Nutrients. 2021;13(9):3032. PMID: 34578909; https://doi.org/10.3390/ nu13093032.
Tenório MCS, Wanderley TM, Macedo IA, et al. Validation and reproducibility of a FFQ focused on pregnant women living in Northeastern Brazil. Public Health Nutr. 2021;24(17):5769-76. PMID: 33563352; https://doi.org/10.1017/s1368980021000549.
Apostolopoulou A, Magriplis E, Tsekitsidi E, et al. Development and validation of a short culture-specific food frequency questionnaire for Greek pregnant women and their adherence to the Mediterranean diet.
Nutrition. 2021;90:111357. PMID: 34218120; https://doi.org/10.1016/j. nut.2021.111357.
Voortman T, Steegers-Theunissen RPM, Bergen NE, et al. Validation of a Semi-Quantitative Food-Frequency Questionnaire for Dutch Pregnant Women from the General Population Using the Method or Triads. Nutrients. 2020;12(5):1341. PMID: 32397149; https://doi.org/10.3390/ nu12051341.
Gibson RS, Charrondiere UR, Bell W. Measurement errors in dietary assessment using self-reported 24-hour recalls in low-income countries and strategies for their prevention. Adv Nutr. 2017;8(6):980-91 PMID: 29141979; https://doi.org/10.3945/an.117.016980.
Kipnis V, Midthune D, Freedman L, et al. Bias in dietary-report instruments and its implications for nutritional epidemiology. Public Health Nutr. 2002;5(6A):915-23. PMID: 12633516; https://doi.org/10.1079/ phn2002383.
Bezerra AR, Tenório MCS, de Souza BG, et al. Food Frequency Questionnaires developed and validated for pregnant women: systematic review. Nutrition. 2023;111979; https://doi.org/10.1016/j. nut.2023.111979.
Hartman TJ, Elliott AJ, Angal J, et al. Relative validation of a short questionnaire to assess the dietary habits of pregnant American Indian women. Food Sci Nutr. 2016;5(3):625-32. PMID: 28572950; https://doi. org/10.1002/fsn3.440.
Cabigas CKC, Bongga DC, Gabriel AA. Relative validity of a food frequency questionnaire for pregnancy in a low-income urban community in the Philippines. Nutrition. 2020;70S:100012. PMID: 34301369; https://doi. org/10.1016/j.nutx.2020.100012.
Brunst KJ, Kannan S, Ni YM, et al. Validation of a food frequency questionnaire for estimating micronutrient intakes in an urban US sample of multi-ethnic pregnant women. Matern Child Health J.
Sao Paulo Med J. 2024;142(2);e2023059
;20(2):250-60. PMID: 26511128; https://doi.org/10.1007/s10995015-1824-9.
Barbieri P, Nishimura RY, Crivellenti LC, Sartorelli DS. Relative validation of a quantitative FFQ for use in Brazilian pregnant women. Public Health Nutr. 2013;16(8):1419-26. PMID: 22895030; https://doi.org/10.1017/ s1368980012003783.
Tayyem R, Allehdan S, Mustafa L, Thekraallah F, Al-Asali F. Validity and reproducibility of a Food Frequency Questionnaire for estimating macro- and micronutrient intakes among pregnant women in Jordan. J Am Coll Nutr. 2020;39(1):29-38. PMID: 30951436; https://doi.org/10.1 080/07315724.2019.1570878.
Queiroz CG, Pereira M, Santana JM, Louro ID, Santos DB. Relative validation of a food frequency questionnaire to assess dietary fatty acid intake. Rev Chil Nutr. 2020;47(3):396-405. http://dx.doi.org/10.4067/ S0717-75182020000300396.
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