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The first semi-quantitative toddler's food frequency questionnaire (T-FFQ) in Iran
Maryam Bahreynian1,2, Awat Feizi3, Roya Kelishadi4
1Department of Nutrition, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
Insights
A new food frequency questionnaire (FFQ) was developed and validated for Iranian toddlers. This tool accurately assesses toddlers' usual dietary intake, showing good reliability and validity compared to dietary records.
Area of Science:
- Nutritional Science
- Pediatric Nutrition
- Dietary Assessment Methods
Background:
- Limited availability of validated food frequency questionnaires (FFQs) for toddlers globally.
- Absence of a reliable instrument for assessing the usual dietary intake of Iranian toddlers.
- Need for a culturally appropriate and validated tool to evaluate toddler nutrition.
Purpose of the Study:
- To develop a semi-quantitative food frequency questionnaire (FFQ) specifically for Iranian toddlers.
- To rigorously assess the validity and reliability of the developed toddler FFQ (T-FFQ).
- To establish a dependable method for evaluating the dietary habits of young children in Iran.
Main Methods:
- Cross-sectional study involving 100 toddlers and their mothers in Iran (2019).
- Development of a 99-item semi-quantitative FFQ and comparison with three non-consecutive 24-hour dietary records.
- Assessment of relative validity via correlation coefficients and reliability using intra-class correlation coefficients and weighted kappa.
Main Results:
- The T-FFQ demonstrated acceptable validity, with significant correlation coefficients for energy (0.82), fats (0.81), carbohydrates (0.60), calcium (0.96), and iron (0.39).
- High reliability was observed, with correlation coefficients ranging from 0.77 (vitamin C) to 0.99 (calcium, potassium, phosphorus, zinc, B vitamins, vitamin E, D).
- Cronbach's Alpha of 0.91 indicated excellent internal consistency, and Bland-Altman plots showed good agreement between repeated FFQ administrations.
Conclusions:
- The developed T-FFQ is a valid and reliable tool for assessing the usual dietary intake of Iranian toddlers.
- This FFQ provides a practical and accurate method for nutritional assessment in pediatric populations.
- The T-FFQ can be instrumental in future research and public health initiatives focused on toddler nutrition in Iran.
Abstract:
Background: Only few food frequency questionnaires (FFQs) have been specifically designed and validated for toddlers. There is no valid instrument to assess usual intakes of Iranian toddlers. The present study was designed to develop a FFQ, and to examine its validity and reliability among toddlers. Material and methods: This cross-sectional study was conducted in 2019 in Iran. Mothers of 100 toddlers completed a semi-quantitative FFQ with 99 items as well as three non-consecutive dietary records. Data on maternal age, education, toddler gender, birth order, birth weight, current weight and height, and the age of beginning complementary foods were collected. By comparing the results obtained from dietary records and the FFQ, we assessed the relative validity. Reliability was evaluated by intra-class correlation coefficients between results of two FFQs administered with four weeks intervals to the same participants (n=20), as well as weighted kappa. The Bland-Altman plots were used to assess the level of agreement between two FFQs. Results: Mean and standard deviation (SD) of age was 32.71 (4.76) years and 22.42 (3.52) months, for mothers and toddlers, respectively. The FFQ showed acceptable validity and reliability. The correlation coefficients for the first FFQ were 0.82 (energy), 0.81 (fats), 0.60 (carbohydrate), 0.96 (calcium), 0.39 (iron) and 0.24 (vitamin C), all P-values were <0.001, except for vitamin C (P: 0.02). Reliability coefficients were between 0.77 (vitamin C) and 0.99 (calcium, potassium, phosphorus, zinc, riboflavin, vitamin B12, vitamin E and D). The Cronbach's Alpha was 0.91, showing high reliability. Conclusion: The present study provided a thorough assessment of both validity and reliability of T-FFQ, and indicated acceptable validity as compared with three-day dietary records and good reliability. Therefore, this FFQ could be a useful tool to evaluate usual dietary intake of toddlers.
