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A Modular Digital FFQ for Tibetan Highlanders in Agricultural and Pastoral Communities: Development and Rigorous
Zhuoning Tang1,2,3, Yunhan Zhou1,2,3, Yi Huang1,2,3
1Key Laboratory of Eco-Environment and Population Health of Xizang Autonomous Region, Xizang University, Lhasa 850000, China.
Nutrients
|August 13, 2026
Summary
A new digital Tibetan Food Frequency Questionnaire (T-FFQ) was developed for high-altitude populations. This tool accurately assesses dietary intake in Tibetan agricultural and pastoral communities, aiding nutritional research.
Area of Science:
- Nutritional Epidemiology
- High-Altitude Physiology
- Dietary Assessment Technology
Background:
- Limited validated dietary assessment tools exist for high-altitude Tibetan populations.
- Unique nutritional challenges are faced by agricultural and pastoral communities on the Qinghai-Tibetan Plateau (QTP).
- A digital, offline-capable Food Frequency Questionnaire (T-FFQ) was needed for resource-limited settings.
Purpose of the Study:
- To develop and validate a digital Tibetan Food Frequency Questionnaire (T-FFQ).
- To assess dietary intake heterogeneity across agricultural and pastoral Tibetan communities.
- To enable real-time, culturally adapted dietary data capture in high-altitude environments.
Main Methods:
- Developed a region-specific, offline-capable digital T-FFQ.
- Validated the T-FFQ against a full-length FFQ and three 24-hour dietary recalls (24HDRs) in 200 Tibetan residents (agricultural and pastoral).
- Assessed reproducibility and relative validity of the T-FFQ across different altitudes (3650-4900 m).
Main Results:
- The T-FFQ demonstrated good reproducibility (ICCs up to 0.990) and relative validity (correlations up to 0.948) for nutrients and food groups.
- Mean classification into same/adjacent quartiles was 82.3%, with a low extreme misclassification rate of 3.9%.
- The T-FFQ performed well for macronutrients, sodium, vitamin E, and common foods, suitable for population-level dietary ranking.
Conclusions:
- The digital T-FFQ is a practical, semi-quantitative, and culturally appropriate tool for assessing habitual dietary intake in high-altitude Tibetan populations.
- The T-FFQ facilitates population-level dietary ranking and stratification for nutritional research.
- The tool's offline capability supports data collection in remote, resource-limited high-altitude settings.