Validation of a quantitative web-based food frequency questionnaire to assess dietary intake in the adult Emirati population.

Najoua El Mesmoudi,Habiba I Ali,Jack Feehan,Lily Stojanovska,Ayesha S Al Dhaheri,Walid Elfalleh

doi:10.1371/journal.pone.0262150

Abstract

Background and objectiveA culture-specific web-based food frequency questionnaire (FFQ) to assess dietary intake in the United Arab Emirates (UAE) adult population was developed using data from the 2009–2010 national nutrition survey. The objective of this study was to assess the relative validity of the newly developed FFQ for use in the adult Emirati population (AE-FFQ), which contained a list of 139 food lines.MethodsA convenient sample of 60 (36 females and 24 males) adult Emiratis completed 3 non-consecutive 24HRs over a period of one month, followed by the AE-FFQ, which assessed the intake over the previous month. Relative validity was evaluated by comparing nutrient and food group intakes from the AE-FFQ with the average three 24HRs using Wilcoxon signed-rank tests, Spearman’s correlation coefficients (CC), Bland-Altman analysis, and cross-classification.ResultsThe AE-FFQ overestimated energy and most nutrients and food groups. Bland–Altman analysis showed significant proportional bias between the 2 methods. Deattenuated energy-adjusted Spearman correlation coefficients were poor to good ranging from 0.06 (iron) to 0.62 (fiber) for nutrients, 0.39 median value, and from –0.01 (cruciferous vegetables) to 0.64 (eggs) for food groups, 0.41 median value. A fairly acceptable agreement was obtained, with correct classification into the same or adjacent quartile ranging from 34% (vitamin B12) to 78% (pyridoxine), median 69% for nutrients and from 55% (diet soft drinks) to 87% (soft drinks), median 67% for food groups.ConclusionsThe AE-FFQ is an acceptable tool for ranking UAE adults (aged 18 to 50) according to their dietary intake to investigate the role of Emirati dietary patterns on health and disease. Caution is needed for assessing absolute intake, however, given the bias observed in assessing group-level agreement.

Highlights

Suboptimal diet is well established as one of the most important modifiable risk factors of noncommunicable disease, including obesity, cardiovascular disease (CVD), type 2 diabetes, and certain cancers [1]
A fairly acceptable agreement was obtained, with correct classification into the same or adjacent quartile ranging from 34% to 78%, median 69% for nutrients and from 55% to 87%, median 67% for food groups
The Adult Emirati food frequency questionnaire (AE-food frequency questionnaire (FFQ)) is an acceptable tool for ranking United Arab Emirates (UAE) adults according to their dietary intake to investigate the role of Emirati dietary patterns on health and disease

Summary

Introduction

Suboptimal diet (i.e., high in sodium and low in whole grains, fruits, nuts & seeds, vegetables and omega-3 fatty acids) is well established as one of the most important modifiable risk factors of noncommunicable disease, including obesity, cardiovascular disease (CVD), type 2 diabetes, and certain cancers [1]. The choice of an appropriate DAT to determine dietary risk factors depends on its ability to assess diet over a time period sufficient to reveal long-term behaviors and patterns [3]. Both diet history and FFQ can measure mid- to long term habitual food intake, in contrast to more short-term measures such as 24-hour recall (24HR) or dietary record (DR), both of which focus only on recent dietary intake [3]. FFQs are easier to administer and require less resources, making them the instrument of choice for the measure of long-term dietary intake in large epidemiologic studies [3]. They are preferred to print-FFQs by users as reported by numerous usability studies [8,9,10]

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