Abstract
BackgroundThere is presently no simple tool for use in large epidemiological studies to understand the food and nutrient intakes of Asian toddlers. This study aimed to assess the relative validity of a semi-quantitative food frequency questionnaire (sqFFQ) developed for multi-ethnic Singaporean toddlers aged 15–36 months.MethodsNinety-one parents completed the sqFFQ and a 2-day weighed food record as the reference method. Intake of energy and 25 nutrients were determined for each method and compared using Pearson correlations corrected for attenuation, Bland-Altman plots, and weighted kappa according to quartiles; sqFFQ calibration was performed using multivariable linear regression.ResultsDeattenuated correlations for energy and all nutrients were acceptable (r = ≥0.30, p < 0.001). The sqFFQ was highly reproducible, but significantly overestimated intake of energy and all nutrients except vitamin A. Bland-Altman plots showed wide limits of agreement for energy and all nutrients. Weighted kappa ranged from 0.12 (slight) to 0.53 (moderate). After calibration, deattenuated correlations improved for energy and 10/25 nutrients, with no change or a slight decline for the remainder, including one falling to r = 0.27. Limits of agreement narrowed for energy and all nutrients, and except for DHA, median intakes were not significantly different except for vitamin A, enabling population estimates of absolute intakes. Weighted kappa improved overall; energy and 16 nutrients now had moderate agreement (0.41–0.60), while 9 nutrients had fair agreement (0.21–0.40).ConclusionsThe Singaporean toddler semi-quantitative food frequency questionnaire is suitable for ranking nutrient intakes of Singaporean toddlers in larger epidemiological studies. However, for population estimates of absolute nutrient intakes, it is recommended that a subsample within a cohort complete weighed food records for calibration purposes.Trial registrationThis study was registered retrospectively on clinicaltrials.gov on 3rd May 2017 (identifier code: NCT03138330).
Highlights
There is presently no simple tool for use in large epidemiological studies to understand the food and nutrient intakes of Asian toddlers
Recruitment was from 15 months of age because the semi-quantitative food frequency questionnaire (sqFFQ) asks about habitual food intake over the last three months and only information from 12 months onwards was of interest
The initial impression of the results indicated that the sqFFQ in its current form may not be suitable for ranking intake of all nutrients, as total fat, saturated fat (SFA), monounsaturated fat (MUFA) and vitamin A only had slight agreement
Summary
There is presently no simple tool for use in large epidemiological studies to understand the food and nutrient intakes of Asian toddlers. Defined here as children aged 12–36 months, this phase is marked by rapid growth, maturation of organs and increasing levels of physical activity [1]. Relative to their body size, toddlers have high nutritional requirements [1]. There are several different methods for collecting dietary information. These methods are similar in adults and children, with the exception of nutritional biomarkers, dietary information is obtained from a proxy (parent or guardian), especially if the child is under ten years of age [4]. The food record (FR) and FFQ are two examples of dietary assessment methods commonly used in epidemiological studies involving children [4]
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