Abstract
Background: Estimation of usual dietary intake poses a challenge in epidemiological studies. We applied a blended approach that combines the strengths provided by repeated 24-h food lists (24HFLs) and a food frequency questionnaire (FFQ).Methods: At least two web-based 24HFLs and one FFQ were completed by 821 participants in the KORA FF4 study. Consumption probabilities were estimated using logistic mixed models, adjusting for covariates and the FFQ data on consumption frequency. Intake amount of a consumed food item was predicted for each participant based on the results of the second Bavarian Food Consumption Survey (BVS II). By combining consumption probability and estimated consumption amount, the usual food intake for each participant was estimated. These results were compared to results obtained without considering FFQ information for consumption probability estimation, as well as to conventional FFQ data.Results: The results of the blended approach for food group intake were often higher than the FFQ-based results. Intraclass correlation coefficients between both methods ranged between 0.21 and 0.86. Comparison of both methods resulted in weighted kappa values based on quintiles ranging from fair (0.34) to excellent agreement (0.84). Omission of FFQ information in the consumption probability models distinctly affected the results at the group level, though individual intake data were slightly affected, for the most part.Conclusions: Usual dietary intake data based on the blended approach differs from the FFQ-based results both in absolute terms and in classification according to quintiles. The application of the blended approach has been demonstrated as a possible tool in nutritional epidemiology, as a comparison with published studies showed that the blended approach yields reasonable estimates. The inclusion of the FFQ information is valuable especially with regard to irregularly consumed foods. A validation study including biomarkers of dietary intake is warranted.
Highlights
Estimation of usual dietary intake poses a challenge in epidemiological studies
Several biomarker studies have cast doubt on whether the food frequency questionnaire (FFQ) has sufficient precision to allow detection of moderate but important diet-disease associations [9,10,11,12]. de Boer et al [13] recommend applying 24 h dietary recalls (24 h-DR) on at least two non-consecutive days per participant in combination with a food propensity questionnaire in order to derive appropriate estimates to rank individuals according to their intakes
Omission of FFQ information as adjustment variable in the estimation of the consumption probability led to distinct alterations in food group and subgroup intake data at the group level, especially regarding the tailes of the intake distributions
Summary
Estimation of usual dietary intake poses a challenge in epidemiological studies. We applied a blended approach that combines the strengths provided by repeated 24-h food lists (24HFLs) and a food frequency questionnaire (FFQ). Dietary intake assessment methods are substantially affected by measurement errors and other challenges [1,2,3]. Questions persist regarding the most appropriate instrument to measure dietary intake at the individual level in large cohort studies. Food frequency questionnaires (FFQs) have long been the instrument of choice in epidemiologic studies, FFQs assesses dietary intake with both systematic and random error that may affect estimates of dietdisease associations [5,6,7,8]. De Boer et al [13] recommend applying 24 h dietary recalls (24 h-DR) on at least two non-consecutive days per participant in combination with a food propensity questionnaire in order to derive appropriate estimates to rank individuals according to their intakes. As the consumption of rarely consumed foods might be missed by collecting only a small number of recalls [15], including a FFQ improves the accuracy of the assessment [8, 13, 16,17,18,19]
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