Abstract
BackgroundThe web-based EatWellQ8 food frequency questionnaire (FFQ) was developed as a dietary assessment tool for healthy adults in Kuwait. Validation against reliable instruments and assessment of its reproducibility are required to ensure the accuracy of the EatWellQ8 FFQ in computing nutrient intake.ObjectiveThis study aims to assess the reproducibility and relative validity of the EatWellQ8 146-item FFQ, which included images of food portion sizes based on The Composition of Foods by McCance and Widdowson and food composition tables from Kuwait and the Kingdom of Bahrain, against a paper-based FFQ (PFFQ) and a 4-day weighed food record (WFR).MethodsReproducibility of the EatWellQ8 FFQ was assessed using a test-retest methodology. Participants were required to complete the FFQ at 2 time points, 4 weeks apart. To assess the relative validity of the EatWellQ8 FFQ, a subset of the participants were asked to complete a PFFQ or a 4-day WFR 1 week after the administration of the EatWellQ8 FFQ. The level of agreement between nutrient and food group intakes was estimated by repeated EatWellQ8 FFQ administration. The EatWellQ8 FFQ, PFFQ, and 4-day WFR were also evaluated using the Bland-Altman methodology and classified into quartiles of daily intake. Crude unadjusted correlation coefficients were also calculated for nutrients and food groups.ResultsA total of 99 Kuwaiti participants (64/99, 65% female and 35/99, 35% male) completed the study—53 participated in the reproducibility study and the 4-day WFR validity study (mean age 37.1 years, SD 9.9) and 46 participated in the PFFQ validity study (mean age 36.2 years, SD 8.3). Crude unadjusted correlations for repeated EatWellQ8 FFQs ranged from 0.37 to 0.93 (mean r=0.67, SD 0.14; 95% CI 0.11-0.95) for nutrients and food groups (P=.01). Mean cross-classification into exact agreement plus adjacent was 88% for nutrient intakes and 86% for food groups, and Bland-Altman plots showed good agreement for energy-adjusted macronutrient intakes. The association between the EatWellQ8 FFQ and PFFQ varied, with crude unadjusted correlations ranging from 0.42 to 0.73 (mean r=0.46, SD 0.12; 95% CI −0.02 to 0.84; P=.046). Mean cross-classification into exact agreement plus adjacent was 84% for nutrient intake and 74% for food groups. Bland-Altman plots showed moderate agreement for both energy and energy-controlled nutrient intakes. Crude unadjusted correlations for the EatWellQ8 FFQ and the 4-day WFR ranged from 0.40 to 0.88 (mean r=0.58, SD 0.13; 95% CI 0.01-0.58; P=.01). Mean cross-classification into exact agreement plus adjacent was 85% for nutrient intake and 83% for food groups. Bland-Altman plots showed moderate agreement for energy-adjusted macronutrient intakes.ConclusionsThe results indicate that the web-based EatWellQ8 FFQ is reproducible for assessing nutrient and food group intake and has moderate agreement compared with a PFFQ and a 4-day WFR for measuring energy and nutrient intakes.
Highlights
The results indicate that the web-based EatWellQ8 food frequency questionnaire (FFQ) is reproducible for assessing nutrient and food group intake and has moderate agreement compared with a paper-based FFQ (PFFQ) and a 4-day weighed food record (WFR) for measuring energy and nutrient intakes
This study aimed to evaluate the reproducibility of the EatWellQ8 FFQ and to test its relative validity against a semiquantitative Kuwaiti PFFQ and a four-day WFR
The results of this study indicated that the EatWellQ8 FFQ is a suitable tool with moderate validity for the assessment of nutrient and food intake in a sample of healthy adults living in Kuwait
Summary
The web-based EatWellQ8 food frequency questionnaire (FFQ) was developed as a dietary assessment tool for healthy adults in Kuwait. Several dietary assessment methods are available, including the food frequency questionnaire (FFQ), diet history, weighed food record (WFR), and 24-hour dietary recall [5]. FFQs require respondents to state the frequency of intake of a predefined list of foods over a specified period and are one of the most commonly used tools to assess the relationship between diet, health, and disease [6]. With the widespread availability of the internet, there has been a growing interest in using the web to assess dietary intake and deliver health-related messages. Web-based dietary assessment methods may be more cost-effective and can include photographs of food portion sizes, increasing the ease of use for respondents, and can be designed to be user-friendly and tailored toward a specific target group [9,10]
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