Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2024

Open Access 01-12-2024 | Research

Development and validation of a food frequency questionnaire in adult Saudi subjects in Jeddah city

Authors: Sarah M. Ajabnoor, Hanan Jambi, Suhad Bahijri

Published in: BMC Public Health | Issue 1/2024

Login to get access

Abstract

Background and aims

In Saudi Arabia, very limited studies have been conducted to evaluate the validity of culturally appropriate food frequency questionnaire (FFQ). The aim of this study was to validate a newly designed FFQ against two reference methods in Saudi adults.

Methods

A new FFQ adapted from the Block FFQ was completed via interview and validated against three-day food records (3DFRs; n = 126) and 24-hour urinary urea nitrogen (UUN)-based protein intake estimates (n = 118) in adult Saudis living in Jeddah. FFQ-estimated nutrient intake was compared to the 3DFR and UUN methods using Pearson’s correlations (r), Bland–Altman plots, and weighted kappa (κw) statistics.

Results

This study included 126 participants (80 females and 46 males). The FFQ generally overreported nutrient intakes compared to the reference methods. The FFQ was strongly correlated with 3DFRs for energy, protein, carbohydrate, and total fat (r > 0.7); moderately correlated with cholesterol (r = 0.55) and iron (r = 0.44); and weakly correlated with the other micronutrients (r = 0.1–0.3). A moderate positive correlation for protein intake was found (r = 0.62) between the FFQ and 24-hour UUN method. The Bland–Altman analysis indicated the FFQ had an acceptable level of agreement with no significant proportional bias (P > 0.05) with the 3DFRs for energy, protein, total fat, and iron and with protein intake. Similarly, an acceptable level of agreement was found between the FFQ and the 24-hour UUN method for estimating protein intake. Cross-classification analysis showed that ≥ 50% of participants were ranked within the same quartile for energy, protein, and total fat. The FFQ showed good agreement with the 3DFRs for energy and protein (κw ≥ 0.61) and acceptable agreement with protein intake. An acceptable agreement was reported between the FFQ and 24-hour UUN method (κw = 0.56). Separate analyses of females and males showed stronger correlations and agreements between the FFQ and the two reference methods only in females.

Conclusion

The developed FFQ is an effective and valid tool for assessing dietary intake in Saudi adults. However, it still requires future optimization to improve its validity.
Appendix
Available only for authorised users
Literature
1.
Nishida C, Uauy R, Kumanyika S, Shetty P. The joint WHO/FAO expert consultation on diet, nutrition and the prevention of chronic Diseases: process, product and policy implications. Public Health Nutr. 2004;7(1a):245–50.PubMedCrossRef
2.
Cade JE, Burley VJ, Warm DL, Thompson RL, Margetts BM. Food-frequency questionnaires: a review of their design, validation and utilisation. Nutr Res Rev. 2004;17(1):5–22.PubMedCrossRef
3.
Willett W. Nutritional epidemiology. Oxford University Press; 2012.
4.
Magarey A, Watson J, Golley RK, Burrows T, Sutherland R, McNaughton SA, Denney-Wilson E, Campbell K, Collins C. Assessing dietary intake in children and adolescents: considerations and recommendations for obesity research. Int J Pediatr Obes. 2011;6(1):2–11.PubMedCrossRef
5.
Food and Agriculture Organization of the United Nations. : Dietary assessment: a resource guide to method selection and application in low resource settings. In.: FAO Rome, Italy; 2018.
6.
7.
Bharathi AV, Kurpad AV, Thomas T, Yusuf S, Saraswathi G, Vaz M. Development of food frequency questionnaires and a nutrient database for the Prospective Urban and Rural Epidemiological (PURE) pilot study in South India: methodological issues. Asia Pac J Clin Nutr. 2008;17(1):178–85.PubMed
8.
Marks GC, Hughes MC, van der Pols JC. The effect of personal characteristics on the validity of nutrient intake estimates using a food-frequency questionnaire. Public Health Nutr. 2006;9(3):394–402.PubMedCrossRef
9.
Block G, Wakimoto P, Jensen C, Mandel S, Green RR. Validation of a food frequency questionnaire for hispanics. Prev Chronic Dis. 2006;3(3):A77.PubMedPubMedCentral
10.
El Sayed Ahmad R, Baroudi M, Shatila H, Nasreddine L, Chokor FAZ, Chehab RF, Forman MR, Naja F. Validity and reproducibility of a culture-specific food frequency questionnaire in Lebanon. Nutrients 2020, 12(11).
11.
Gunes FE, Imeryuz N, Akalin A, Bekiroglu N, Alphan E, Oguz A, Dehghan M. Development and validation of a semi-quantitative food frequency questionnaire to assess dietary intake in Turkish adults. J Pak Med Assoc. 2015;65(7):756–63.PubMed
12.
Regassa IF, Endris BS, Habtemariam E, Hassen HY, Ghebreyesus SH. Development and validation of food frequency questionnaire for food and nutrient intakes of adults in Butajira, Southern Ethiopia. J Nutr Sci. 2021;10:e98.PubMedPubMedCentralCrossRef
13.
Westerterp KR, Goris AH. Validity of the assessment of dietary intake: problems of misreporting. Curr Opin Clin Nutr Metab Care. 2002;5(5):489–93.PubMedCrossRef
14.
Poslusna K, Ruprich J, de Vries JH, Jakubikova M, van’t Veer P. Misreporting of energy and micronutrient intake estimated by food records and 24 hour recalls, control and adjustment methods in practice. Br J Nutr. 2009;101(Suppl 2):73–85.CrossRef
15.
Dao MC, Subar AF, Warthon-Medina M, Cade JE, Burrows T, Golley RK, Forouhi NG, Pearce M, Holmes BA. Dietary assessment toolkits: an overview. Public Health Nutr. 2019;22(3):404–18.PubMedCrossRef
16.
Ravelli MN, Schoeller DA. Traditional self-reported Dietary instruments are Prone to inaccuracies and New approaches are needed. Front Nutr. 2020;7:90.PubMedPubMedCentralCrossRef
17.
Price GM, Paul AA, Cole TJ, Wadsworth ME. Characteristics of the low-energy reporters in a longitudinal national dietary survey. Br J Nutr. 1997;77(6):833–51.PubMedCrossRef
18.
Okubo H, Sasaki S. Underreporting of energy intake among Japanese women aged 18–20 years and its association with reported nutrient and food group intakes. Public Health Nutr. 2004;7(7):911–7.PubMedCrossRef
19.
Bedard D, Shatenstein B, Nadon S. Underreporting of energy intake from a self-administered food-frequency questionnaire completed by adults in Montreal. Public Health Nutr. 2004;7(5):675–81.PubMedCrossRef
20.
Klingberg S, Hallenberg E, Lorentzon M, Mellström D, Ohlsson C, Hulthén L. Characteristics of under- and over-reporters of energy intake among 18-20-year-old males: the Gothenburg Osteoporosis and Obesity Determinants (GOOD) study. Public Health Nutr. 2008;11(11):1117–23.PubMedCrossRef
21.
Banna JC, McCrory MA, Fialkowski MK, Boushey C. Examining plausibility of self-reported Energy Intake Data: considerations for Method Selection. Front Nutr. 2017;4:45.PubMedPubMedCentralCrossRef
22.
Kroke A, Klipstein-Grobusch K, Voss S, Möseneder J, Thielecke F, Noack R, Boeing H. Validation of a self-administered food-frequency questionnaire administered in the European prospective investigation into Cancer and Nutrition (EPIC) study: comparison of energy, protein, and macronutrient intakes estimated with the doubly labeled water, urinary nitrogen, and repeated 24-h dietary recall methods. Am J Clin Nutr. 1999;70(4):439–47.PubMedCrossRef
23.
Subar AF, Kipnis V, Troiano RP, Midthune D, Schoeller DA, Bingham S, Sharbaugh CO, Trabulsi J, Runswick S, Ballard-Barbash R, et al. Using intake biomarkers to evaluate the extent of dietary misreporting in a large sample of adults: the OPEN study. Am J Epidemiol. 2003;158(1):1–13.PubMedCrossRef
24.
Bingham SA. Urine nitrogen as a biomarker for the validation of dietary protein intake. J Nutr. 2003;133(Suppl 3):921s–4.PubMedCrossRef
25.
Pufulete M, Emery PW, Nelson M, Sanders TA. Validation of a short food frequency questionnaire to assess folate intake. Br J Nutr. 2002;87(4):383–90.PubMedCrossRef
26.
Bingham SA, Williams R, Cole TJ, Price CP, Cummings JH. Reference values for analytes of 24-h urine collections known to be complete. Ann Clin Biochem. 1988;25(Pt 6):610–9.PubMedCrossRef
27.
Olveira G, Olveira C, Casado-Miranda E, Padilla A, Dorado A, Rojo-Martinez G, Porras N, Garcia-Escobar E, Soriguer F. Markers for the validation of reported dietary intake in adults with cystic fibrosis. J Am Diet Assoc. 2009;109(10):1704–11.PubMedCrossRef
28.
Block G, Woods M, Potosky A, Clifford C. Validation of a self-administered diet history questionnaire using multiple diet records. J Clin Epidemiol. 1990;43(12):1327–35.PubMedCrossRef
29.
Marks GC, Hughes MC, van der Pols JC. Relative validity of food intake estimates using a food frequency questionnaire is associated with sex, age, and other personal characteristics. J Nutr. 2006;136(2):459–65.PubMedCrossRef
30.
Rosenthal HL. Determination of Urea in blood and urine with Diacetyl Monoxime. Anal Chem. 1955;27(12):1980–2.CrossRef
31.
Wybenga DR, Di Giorgio J, Pileggi VJ. Manual and automated methods for urea nitrogen measurement in whole serum. Clin Chem. 1971;17(9):891–5.PubMedCrossRef
32.
Toora BD, Rajagopal G. Measurement of creatinine by Jaffe’s reaction–determination of concentration of sodium hydroxide required for maximum color development in standard, urine and protein free filtrate of serum. Indian J Exp Biol. 2002;40(3):352–4.PubMed
33.
Forni Ogna V, Ogna A, Vuistiner P, Pruijm M, Ponte B, Ackermann D, Gabutti L, Vakilzadeh N, Mohaupt M, Martin PY, et al. New anthropometry-based age- and sex-specific reference values for urinary 24-hour creatinine excretion based on the adult Swiss population. BMC Med. 2015;13:40.PubMedPubMedCentralCrossRef
34.
Hayter JE, Henry CJ. A re-examination of basal metabolic rate predictive equations: the importance of geographic origin of subjects in sample selection. Eur J Clin Nutr. 1994;48(10):702–7.PubMed
35.
Piers LS, Diffey B, Soares MJ, Frandsen SL, McCormack LM, Lutschini MJ, O’Dea K. The validity of predicting the basal metabolic rate of young Australian men and women. Eur J Clin Nutr. 1997;51(5):333–7.PubMedCrossRef
36.
Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1(8476):307–10.PubMedCrossRef
37.
Lombard MJ, Steyn NP, Charlton KE, Senekal M. Application and interpretation of multiple statistical tests to evaluate validity of dietary intake assessment methods. Nutr J. 2015;14(1):1–11.CrossRef
38.
Morel S, Portolese O, Chertouk Y, Leahy J, Bertout L, Laverdière C, Krajinovic M, Sinnett D, Levy E, Marcil V. Development and relative validation of a food frequency questionnaire for french-canadian adolescent and young adult survivors of acute lymphoblastic Leukemia. Nutr J. 2018;17:1–12.CrossRef
39.
Cui Q, Xia Y, Wu Q, Chang Q, Niu K, Zhao Y. Validity of the food frequency questionnaire for adults in nutritional epidemiological studies: a systematic review and meta-analysis. Crit Rev Food Sci Nutr. 2023;63(12):1670–88.PubMedCrossRef
40.
Jackson MD, Motswagole BS, Kwape LD, Kobue-Lekalake RI, Rakgantswana TB, Mongwaketse T, Mokotedi M, Jackson-Malete J. Validation and reproducibility of an FFQ for use among adults in Botswana. Public Health Nutr. 2013;16(11):1995–2004.PubMedCrossRef
41.
El Kinany K, Garcia-Larsen V, Khalis M, Deoula MMS, Benslimane A, Ibrahim A, Benjelloun MC, El Rhazi K. Adaptation and validation of a food frequency questionnaire (FFQ) to assess dietary intake in Moroccan adults. Nutr J. 2018;17(1):1–12.CrossRef
42.
Henriquez-Sanchez P, Sánchez-Villegas A, Doreste-Alonso J, Ortiz-Andrellucchi A, Pfrimer K, Serra-Majem L. Dietary assessment methods for micronutrient intake: a systematic review on vitamins. Br J Nutr. 2009;102(S1):10–S37.CrossRef
43.
Tayyem RF, Abu-Mweis SS, Bawadi HA, Agraib L, Bani-Hani K. Validation of a food frequency questionnaire to assess macronutrient and micronutrient intake among jordanians. J Acad Nutr Dietetics. 2014;114(7):1046–52.CrossRef
44.
Ocke MC, Bueno-de-Mesquita HB, Pols MA, Smit HA, van Staveren WA, Kromhout D. The Dutch EPIC food frequency questionnaire. II. Relative validity and reproducibility for nutrients. Int J Epidemiol. 1997;26(suppl1):49.CrossRef
45.
Katsouyanni K, Rimm EB, Gnardellis C, Trichopoulos D, Polychronopoulos E, Trichopoulou A. Reproducibility and relative validity of an extensive semi-quantitative food frequency questionnaire using dietary records and biochemical markers among Greek schoolteachers. Int J Epidemiol. 1997;26(suppl1):118.CrossRef
46.
Pijls LT, Vries Hd, Donker AJ, Eijk JTM. Reproducibility and biomarker-based validity and responsiveness of a food frequency questionnaire to estimate protein intake. Am J Epidemiol. 1999;150(9):987–95.PubMedCrossRef
47.
Malekshah A, Kimiagar M, Saadatian-Elahi M, Pourshams A, Nouraie M, Goglani G, Hoshiarrad A, Sadatsafavi M, Golestan B, Yoonesi A. Validity and reliability of a new food frequency questionnaire compared to 24 h recalls and biochemical measurements: pilot phase of Golestan cohort study of Esophageal cancer. Eur J Clin Nutr. 2006;60(8):971–7.PubMedCrossRef
48.
Sarmento RA, Antonio JP, Riboldi BP, Montenegro KR, Friedman R, de Azevedo MJ, de Almeida JC. Reproducibility and validity of a quantitative FFQ designed for patients with type 2 Diabetes Mellitus from southern Brazil. Public Health Nutr. 2014;17(10):2237–45.PubMedCrossRef
49.
McKenzie BL, Coyle DH, Santos JA, Burrows T, Rosewarne E, Peters SAE, Carcel C, Jaacks LM, Norton R, Collins CE, et al. Investigating sex differences in the accuracy of dietary assessment methods to measure energy intake in adults: a systematic review and meta-analysis. Am J Clin Nutr. 2021;113(5):1241–55.PubMedPubMedCentralCrossRef
50.
Al Moraie N. Dietary patterns in Saudi Arabian adults residing in different geographical locations in Saudi Arabia and in the UK in relation to heart disease risk. Doctoral Thesis Newcastle University; 2014.
51.
52.
Bawazeer NM, Al-Qahtani SJ, Alzaben AS. The association between dietary patterns and socio-demographic and lifestyle characteristics: a sample of Saudi Arabia. Curr Res Nutr Food Sci J. 2021;9(3):1046–57.CrossRef
53.
Almutairi OM, Alhomaid TA, Alshuaibi AM, Ahmad Alahmad RM, Al Mardhamah NH, Alamri T. The influence of eating habits on type 2 Diabetes in Saudi Arabia: a systematic review. Cureus. 2023;15(7):e42638.PubMedPubMedCentral
54.
Gosadi IM, Alatar AA, Otayf MM, AlJahani DM, Ghabbani HM, AlRajban WA, Alrsheed AM, Al-Nasser KA. Development of a Saudi food frequency questionnaire and testing its reliability and validity. Saudi Med J. 2017;38(6):636–41.PubMedPubMedCentralCrossRef
55.
Almajwal A, Al-zahrani S, Abulmeaty M, Alam I, Razzak S, Alqahtani A. Development of food frequency questionnaire (FFQ) for the assessment of dietary intake among overweight and obese Saudi young children. Nutrire. 2018;43(1):29.CrossRef
56.
Lee H, Kang M, Song WO, Shim JE, Paik HY. Gender analysis in the development and validation of FFQ: a systematic review. Br J Nutr. 2016;115(4):666–71.PubMedCrossRef
Metadata
Title
Development and validation of a food frequency questionnaire in adult Saudi subjects in Jeddah city
Authors
Sarah M. Ajabnoor
Hanan Jambi
Suhad Bahijri
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2024
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-023-17511-9

Other articles of this Issue 1/2024

BMC Public Health 1/2024 Go to the issue

Research

“So that’s why I found PrEP to be safest way to protect yourself”: exploring IPV experiences and impact on HIV prevention among pregnant and postpartum women in Cape Town, South Africa

Research

Postpartum depression symptoms: prevalence, risk factors, and childbirth experiences in Palestine

Research

Changes in disease burden and global inequalities in bladder, kidney and prostate cancers from 1990 to 2019: a comparative analysis based on the global burden of disease study 2019

Research

Association between area-level walkability and glycated haemoglobin: a Portuguese population-based study

Research

A natural experiment to assess recess frequency on children’s physical activity in Arizona (U.S.) elementary schools

Research

COVID-19 vaccine intentions and attitudes in Black American emerging adults with asthma