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Validation of an FFQ and options for data processing using the doubly labelled water method in children
Alice E Dutman1, Annette Stafleu, Astrid Kruizinga
1TNO Quality of Life, Postbus 360, 3700 AJ Zeist, The Netherlands. ellen.dutman@tno.nl
Insights
This study validates a food frequency questionnaire (FFQ) for estimating children's energy intake. The FFQ accurately assesses group energy intake and ranks individuals, proving useful for nutritional surveys.
Area of Science:
- Pediatric Nutrition
- Dietary Assessment Methods
- Nutritional Epidemiology
Background:
- Accurate estimation of children's energy intake is crucial for nutritional assessment and public health.
- Food Frequency Questionnaires (FFQs) are commonly used but require validation against objective measures.
- Doubly Labeled Water (DLW) is the gold standard for measuring total energy expenditure (TEE).
Purpose of the Study:
- To validate a newly developed FFQ for estimating energy intake (EI) in children aged 4-6 years.
- To compare FFQ-derived EI with TEE measured by DLW.
- To assess the impact of quality control and standard portion sizes on FFQ validity.
Main Methods:
- A validation study was conducted in The Netherlands with 30 healthy children (4-6 years old).
- Total energy expenditure (TEE) was measured using the DLW method over 15 days.
- Parents completed the FFQ assessing habitual EI over the preceding four weeks.
Main Results:
- The FFQ showed a mean EI:TEE ratio of 0.98, indicating good agreement between estimated intake and expenditure.
- A strong Pearson correlation coefficient (0.62) was observed between EI and TEE.
- Bland-Altman analysis revealed no systematic bias, and less intensive quality control minimally impacted validity.
Conclusions:
- The developed FFQ is a valid tool for estimating mean energy intake in 4-6-year-old children.
- The FFQ demonstrates good performance in ranking subjects by energy intake.
- This FFQ is suitable for use in surveys and epidemiological studies in The Netherlands.
Objective:
To validate an FFQ designed to estimate energy intake in children against doubly labelled water (DLW). To investigate how quality control and standard beverage portion sizes affect the validity of the FFQ.
Design:
Thirty healthy children, aged 4-6 years, participated. Total energy expenditure (EE) was measured by the DLW method during an observation period of 15 d. At the end of this period parents filled out an FFQ designed to assess the child's habitual energy intake (EI) of the preceding four weeks.
Setting:
Validation study in The Netherlands.
Subjects:
Thirty healthy children (fifteen boys and fifteen girls), aged 4-6 years.
Results:
Mean EI (6117 (sd 1025) kJ/d) did not differ significantly from mean EE (6286 (sd 971) kJ/d; P = 0·15); the mean EI:EE ratio was 0·98. The Pearson correlation coefficient between EI and EE was 0·62. The Bland-Altman plot showed no systematic bias and a constant bias close to zero. Less intensive quality control of the FFQ maintained the mean EI:EE ratio and decreased the correlation slightly. Using standard instead of individually measured beverage portion sizes decreased the mean EI:EE ratio, but maintained the correlation.
Conclusions:
It can be concluded that the developed FFQ is a valid instrument to estimate mean energy intake in a group of 4- to 6-year-old children and performs reasonably well to rank the subjects with respect to energy intake. It is therefore a useful instrument to estimate energy intake in children in surveys and epidemiological studies in The Netherlands.
