Quantifying calcium intake in school age children: development and validation of the Calcium Counts! food frequency...

Quantifying dietary behavior is difficult and can be intrusive. Calcium, an essential mineral for skeletal development during childhood, is difficult to assess. Few studies have examined the use of food frequency questionnaires (FFQs) for assessing calcium intake in school-age children. This study evaluated the validity and reliability of the Calcium Counts! FFQ (CCFFQ) for estimating calcium intake in school children in the US. Healthy children, aged 7-10 years (n = 139) completed the CCFFQ and 7-day weighed food records. A subset of subjects completed a second CCFFQ within 3.6 months. Concurrent validity was determined using Pearson correlations between the CCFFQ and food record estimates of calcium intake, and the relationship between quintiles for the two measures. Predictive validity was determined using generalized linear regression models to explore the effects of age, race, and gender. Inter- and intra-individual variability in calcium intake was high (>300 mg/day). Calcium intake was approximately 300 mg/day higher by CCFFQ compared to food records. Concurrent validity was moderate (r = 0.61) for the entire cohort and higher for selected subgroups. Predictive validity estimates yielded significant relationships between CCFFQ and food record estimates of calcium intake alone and in the presence of such potential effect modifiers as age group, race, and gender. Test-retest reliability was high (r = 0.74). Although calcium intake estimated by the CCFFQ was greater than that measured by food records, the CCFFQ provides valid and reliable estimates of calcium intake in children. The CCFFQ is especially well-suited as a tool to identify children with low calcium intakes.