Abstract
Background: Dental research into early childhood caries is hindered by a lack of suitable dietary assessment tools that have been developed and validated for the population and outcomes of interest. The aim of this study was to develop and investigate the relative validity and reproducibility of the Study of Mothers’ and Infants’ Life Events Food Frequency Questionnaire (SMILE-FFQ), to assess the total and free sugars intakes of Australian toddlers. Methods: The SMILE-FFQ was designed to capture the leading dietary contributors to dental caries risk in toddlers aged 18–30 months via a proxy report. Ninety-five parents of Australian toddlers completed the questionnaire online before and after providing three 24-h recalls (24HR), collected on non-consecutive days using the multipass method. Total and free sugars were compared between the two SMILE-FFQ administrations and between each SMILE-FFQ and the 24HR using multiple statistical tests and standardised validity criteria. Correlation (Pearson), mean difference (Wilcoxon rank test) and Bland Altman analyses were conducted to compare absolute values, with cross-classification (Chi-Square and Weighted Kappa) used to compare agreement across tertiles. Results: All reproducibility tests showed good agreement except weighted kappa, which showed acceptable agreement. Relative validity tests revealed a mix of good and acceptable agreement, with total sugars performing better at the individual level than free sugars. Compared to the 24HR, the SMILE-FFQ tended to underestimate absolute values at lower levels and overestimate them at higher levels. Conclusions: The combined findings of the various tests indicate that the SMILE-FFQ performs comparably to the 24HR for assessing both total and free sugars among individuals, is most effective for ranking participants rather than determining absolute intakes, and is therefore suitable for use in observational studies of Australian toddlers.
Highlights
Dental diseases are the most prevalent non-communicable disease globally [1] and the leading cause of preventable hospitalisations among children in Australia [2]
Development of the SMILE-Food Frequency Questionnaire (FFQ) occurred in four stages, following the methods described by Willett [11] and Coulston et al [20]
Linear regression verified that the slope of bias was significantly different from zero for all four measures (p < 0.001), indicating that proportional bias was present. These results suggest that agreement between the SMILE-FFQ and
Summary
Dental diseases are the most prevalent non-communicable disease globally [1] and the leading cause of preventable hospitalisations among children in Australia [2]. The relationship between free sugar intakes and dental caries is well established, the lower level of the effect is less clear [1,5,6,7]. The aim of this study was to develop and investigate the relative validity and reproducibility of the Study of Mothers’ and Infants’ Life Events Food Frequency Questionnaire (SMILE-FFQ), to assess the total and free sugars intakes of Australian toddlers. Relative validity tests revealed a mix of good and acceptable agreement, with total sugars performing better at the individual level than free sugars. Conclusions: The combined findings of the various tests indicate that the SMILE-FFQ performs comparably to the 24HR for assessing both total and free sugars among individuals, is most effective for ranking participants rather than determining absolute intakes, and is suitable for use in observational studies of Australian toddlers
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