PRACTICE OF EPIDEMIOLOGY |
Measurement of Fruit and Vegetable Consumption with Diet Questionnaires and Implications for Analyses and Interpretation
1 Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
2 Department of Epidemiology, Harvard School of Public Health, Boston, MA
3 Strangeways Research Laboratory, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
4 Medical Research Council Dunn Human Nutrition Unit, Cambridge, United Kingdom
Correspondence to Dr. Karin Michels at the Strangeways Research Laboratory, Institute of Public Health, University of Cambridge, Worts Causeway, Cambridge CB1 8RN, United Kingdom, or the Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115 (kmichels{at}rics.bwh.harvard.edu).
Measurement error can have an important impact on the estimation of the true relation between diet and disease. The authors examined the performance of models regressing plasma vitamin C level on fruit and vegetable consumption and the effect of categorization of fruit and vegetable consumption on the association with plasma vitamin C. They used diet information reported by 4,487 participants in the Norfolk, United Kingdom, portion of the European Prospective Investigation into Cancer and Nutrition by means of a 7-day diet diary and a food frequency questionnaire (FFQ) (1993–1998). The authors found substantial differences in mean fruit and vegetable consumption assessed by the two diet instruments. Consumption estimated with the FFQ was about twice as high as that obtained with the 7-day diary, and the ranking of individuals according to estimates of fruit and vegetable consumption from the 7-day diary and the FFQ differed substantially. When fruit and vegetable consumption were categorized into quintiles, the two questionnaires produced similar associations of relative intake with plasma vitamin C, but estimation of the association of absolute intake with plasma vitamin C differed.
bias (epidemiology); data collection; diet; food; nutrition assessment; questionnaires; regression analysis
Abbreviations: EPIC, European Prospective Investigation into Cancer and Nutrition; FFQ, food frequency questionnaire
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