Abstract
BackgroundNutritional status during childhood is critical given its effect on growth and development as well as its association with disease risk later in life. The Middle East and North Africa (MENA) region is experiencing alarming rates of childhood malnutrition, both over- and under-nutrition. Hence, there is a need for valid tools to assess dietary intake for children in this region. To date, there are no validated dietary assessment tools for children in any country of the MENA region. The main objective of this study was to examine the validity and reliability of a Food Frequency Questionnaire (FFQ) for the assessment of dietary intake among Lebanese children.MethodsChildren, aged 5 to 10 years (n = 111), were recruited from public and private schools of Beirut, Lebanon. Mothers (proxies to report their children’s dietary intake) completed two FFQs, four weeks apart. Four 24-hour recalls (24-HRs) were collected weekly during the duration of the study. Spearman correlations and Bland-Altman plots were used to assess validity. Linear regression models were used to derive calibration factors for boys and girls. Reproducibility statistics included Intraclass Correlation Coefficient (ICC) and percent agreement.ResultsCorrelation coefficients between dietary intake estimates derived from FFQ and 24-HRs were significant at p < 0.001 with the highest correlation observed for energy (0.54) and the lowest for monounsaturated fatty acids (0.26). The majority of data points in the Bland-Altman plots lied between the limits of agreement, closer to the middle horizontal line. After applying the calibration factors for boys and girls, the mean energy and nutrient intakes estimated by the FFQ were similar to those obtained by the mean 24-HRs. As for reproducibility, ICC ranged between 0.31 for trans-fatty acids and 0.73 for calcium intakes. Over 80 % of study participants were classified in the same or adjacent quartile of energy and nutrients intake.ConclusionsFindings of this study showed that the developed FFQ is reliable and is also valid, when used with calibration factors. This FFQ is a useful tool in dietary assessment and evaluation of diet-disease relationship in this age group.Electronic supplementary materialThe online version of this article (doi:10.1186/s12937-015-0121-1) contains supplementary material, which is available to authorized users.
Highlights
Nutritional status during childhood is critical given its effect on growth and development as well as its association with disease risk later in life
The objectives of this study are to 1) develop an Food Frequency Questionnaire (FFQ) with a culturally appropriate list of foods commonly consumed among Lebanese children, 2) determine the relative validity of the developed FFQ in measuring energy and nutrient intakes as compared to the means obtained by repeated 24-hour recalls (24-HRs) 3) calibrate the FFQ using linear calibration factors and 4) evaluate the reproducibility of this FFQ
The energy intake cut offs used for detection of outliers were calculated using mean ± 2.5 standard deviations (SD), using data derived from the mean 24-HRs
Summary
Nutritional status during childhood is critical given its effect on growth and development as well as its association with disease risk later in life. There is a need for valid tools to assess dietary intake for children in this region. There are no validated dietary assessment tools for children in any country of the MENA region. Nutritional status during childhood has been shown to have profound effects on overall health and chronic disease development [1, 2]. Validated tools to assess dietary intake among children are essential to provide reliable data on their nutritional status and to develop effective evidencebased strategies and programs to address diet-related problems in this young age group
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