Abstract
The World Health Organization emphasizes the urgency to assess and limit the intake of free sugar (FS) among individuals in order to prevent several non-communicable diseases. However, data regarding intake of FS are lacking in Saudi Arabia and in the Middle East. A reliable valid tool is needed to assess children's habitual intake of FS. Thus, we aimed to develop and validate a food frequency questionnaire (FFQ) that assesses children's habitual intake of FS in Saudi Arabia. In this cross-sectional study, 424 healthy Saudi children ages 6–12 years were included using river sampling method. Sociodemographic data and contact information were collected from mothers using an online survey. Dietary data were collected using 24-h dietary recalls (reference method) and a semi-quantitative FFQ through phone interviews. Items and food groups included in the initial draft of the FFQ were adopted from previous work. Content validity was done to the FFQ with total of 12 food groups and 41 food items. Next, a pilot study was conducted to estimate the sample size needed for the study and to ensure that all items reported in the 24-h dietary recalls were included in the final draft of the FFQ. Finally, data were collected to assess the validity and reliability of the FFQ at the population level. Mean intake of FS assessed by the FFQ was significantly higher than that assessed by the 24-h dietary recalls. Spearman's correlation between total FS assessed by the FFQ and 24-h dietary recall was positively low (rs = 0.30, p < 0.001). The coefficient alpha indicated an acceptable level of internal consistency (α = 0.74, p < 0.001). Test-retest reliability for total FS intake assessed by the FFQ was positively high (rs = 0.82). A slight agreement between FS intake assessed by the FFQ and the 24-h dietary recall was seen among the study sample (κ = 0.21, p < 0.001). The newly developed FFQ was found to be reasonably valid in assessing children's habitual intake of FS in Saudi Arabia. Validating the instrument among older population in Saudi Arabia is warranted.
Highlights
The global increase in non-communicable disease epidemics and the documented association with excessive free sugar (FS) consumption had led many countries to establish fiscal policy interventions to limit intake of sugary foods, and it became a global health agenda [1, 2]
Mean intake of FS assessed by the food frequency questionnaire (FFQ) was significantly higher than mean intake of FS assessed by the 24-h dietary recall (94.5 ± 52.8 g/day vs. 44.9 ± 25.7 g/day, respectively, p < 0.05)
Mean intake of FS assessed by the FFQ was 110% higher than the mean intake of FS assessed by the 24-h dietary recall
Summary
The global increase in non-communicable disease epidemics and the documented association with excessive free sugar (FS) consumption had led many countries to establish fiscal policy interventions to limit intake of sugary foods, and it became a global health agenda [1, 2]. The impact of excessive free/added sugar intake on health was supported by abundant studies that linked high sugar consumption with overweight [3], dental caries [4], poor dietary quality/intake [5,6,7], cardiovascular diseases [8], and mortality [9]. Previous studies that attempted to evaluate consumption of FS in Saudi Arabia focused only on certain food items, e.g., sugar sweetened beverages or candies [14,15,16]. Data obtained from such tools cannot provide data regarding total amount of free sugar
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