Evaluation of the Reliability and Validity of a Food Frequency Questionnaire Using Three-Day 24-Hour Dietary Recalls:...

Objective: This study aimed to evaluate the reliability and validity of a Food Frequency Questionnaire (FFQ) designed for use in epidemiological studies among populations in Fujian, China. Methods: From September to December 2023, adults aged 18 years and above residing in Fujian Province, southeastern China, were recruited via online survey promotion. Participants completed the FFQ twice with a one-month interval and also completed a 3-day 24 h dietary recall (3d-24HDR), covering two weekdays and one weekend day, during the same period. The reliability of the FFQ was assessed by comparing the average intake of food groups and nutrients between the two FFQs, using Spearman correlation coefficients, intraclass correlation coefficients (ICCs), and weighted Kappa coefficients based on tertile classification. Validity was evaluated by comparing the average intake values from the FFQs and the 3d-24HDR using similar methods, including Spearman correlation, weighted Kappa statistics, and Bland-Altman analysis. Results: A total of 152 participants completed two FFQs (for reliability assessment), and 142 participants completed the 3d-24HDR (for validity assessment). Spearman correlation coefficients for food group intake between the two FFQs ranged from 0.60 to 0.80, with ICCs ranging from 0.53 to 0.91. For energy and nutrient intake, Spearman coefficients ranged from 0.66 to 0.96, and ICCs ranged from 0.57 to 0.97. After tertile classification, less than 15% of participants were misclassified into distant categories. The weighted Kappa coefficients for food groups and nutrients ranged from 0.37 to 0.71 and 0.43 to 0.88, respectively. In comparison with the 3d-24HDR, Spearman correlations for food groups and nutrients ranged from 0.41 to 0.72 and 0.40 to 0.70, respectively. The proportion of participants classified into the same or adjacent tertile was 78.8-95.1%. Weighted Kappa coefficients and Bland-Altman plots indicated acceptable agreement between the FFQ and 3d-24HDR for most nutrients. Conclusions: The FFQ used in this study demonstrated good reliability and moderate-to-good validity. It is suitable for use in dietary assessment in gastric cancer epidemiological studies in Fujian, China.