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American Journal of Epidemiology Advance Access originally published online on September 18, 2007
American Journal of Epidemiology 2007 166(12):1468-1478; doi:10.1093/aje/kwm236
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American Journal of Epidemiology © The Author 2007. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

PRACTICE OF EPIDEMIOLOGY

Design Characteristics of Food Frequency Questionnaires in Relation to Their Validity

Marja L. Molag1, Jeanne H. M. de Vries1, Marga C. Ocké2, Pieter C. Dagnelie3, Piet A. van den Brandt3, Margje C. J. F. Jansen4, Wija A. van Staveren1 and Pieter van't Veer1

1 Department of Human Nutrition, Wageningen University, Wageningen, The Netherlands
2 National Institute of Public Health and the Environment, Bilthoven, The Netherlands
3 Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
4 TNO Quality of Life, Zeist, The Netherlands

Correspondence to Dr. J. H. M. de Vries, Department of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV Wageningen, The Netherlands (e-mail: Jeanne.deVries{at}wur.nl).

Received for publication March 12, 2007. Accepted for publication July 27, 2007.

The authors investigated the role of food frequency questionnaire (FFQ) design, including length, use of portion-size questions, and FFQ origin, in ranking subjects according to their nutrient intake. They also studied the ability of the FFQ to detect differences in energy intake between subgroups and to assess energy and protein intake. In a meta-analysis of 40 validation studies, FFQs with longer food lists (200 items) were better than shorter FFQs at ranking subjects for most nutrients; results were statistically significant for protein, energy-adjusted total fat, and energy-adjusted vitamin C. The authors found that FFQs that included standard portions had higher correlation coefficients for energy-adjusted vitamin C (0.80 vs. 0.60, p < 0.0001) and protein (0.69 vs. 0.61, p = 0.03) than FFQs with portion-size questions. However, it remained difficult from this review to analyze the effects of using portion-size questions. FFQs slightly underestimated gender differences in energy intake, although level of energy intake was underreported by 23% and level of protein intake by 17%. The authors concluded that FFQs with more items are better able to rank people according to their intake and that they are able to distinguish between subpopulations, even though they underestimated the magnitude of these differences.

diet; methods; nutrition assessment; questionnaires; review; validation studies

Abbreviations: EPIC, European Prospective Investigation into Cancer and Nutrition; FFQ, food frequency questionnaire; SE, standard error


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