Does nutritionist review of a self-administered food frequency questionnaire improve data quality?

This study sought to evaluate the benefit of utilizing a nutritionist review of a self-administered food frequency questionnaire (FFQ), to determine whether accuracy could be improved beyond that produced by the self-administered questionnaire alone.

Participants randomized into a dietary intervention trial completed both a FFQ and a 4-day food record (FR) at baseline before entry into the intervention. The FFQ was self-administered, photocopied and then reviewed by a nutritionist who used additional probes to help complete the questionnaire. Both the versions before nutritionist review and after nutritionist review - were individually compared on specific nutrients to the FR by means, correlations and per cent agreement into quintiles.

Three hundred and twenty-four people, a subset of participants from the Polyp Prevention Trial - a randomized controlled trial examining the effect of a low-fat, high-fibre, high fruit and vegetable dietary pattern on the recurrence of adenomatous polyps - were recruited from clinical centres at the University of Utah, University of Buffalo, Memorial Sloan Kettering Cancer Center in New York and Kaiser Permanente Medical Program in Oakland.

Reviewing the FFQ increased correlations with the FR for every nutrient, and per cent agreement into quintiles for all nutrients except calcium. Energy was underestimated in both versions of the FFQ but to a lesser degree in the version with review.

One must further evaluate whether the increases seen with nutritionist review of the FFQ will enhance our ability to predict diet-disease relationships and whether it is cost-effective when participant burden and money spent utilizing trained personnel are considered.