Development and Validation of a Food Frequency Questionnaire for Preschool Children Using Multiple Methods

Background: The ability to determine the relationship between diet and health outcomes in children requires reproducible and validated long-term dietary assessment tools such as food frequency questionnaire (FFQ).Objective: To test the reproducibility and relative validity of a FFQ for young children using 24-hour food recalls (24HRs), anthropometric measurements, and a comprehensive feeding practices questionnaire (CFPQ).Methods: Children (aged 5-6) and their mothers were recruited during one school-year (2008) from preschools. Children's anthropometric measurements were obtained. Mothers provided during a personal interview on three occasions a 110-item semiquantitative FFQ, 24HRs and CFPQ. Pearson-correlation coefficients were calculated between the results of the FFQ and 3*24HR. Validity coefficients between the FFQ and the different measurements were calculated. Scores of the 12 factors of the CFPQ were calculated and related to dietary intake.Results: Sixty-six healthy children (47% boys) were recruited. Pearson's correlations between the average of the FFQs and 3*24HRs ranged from 0.3-0.6 (P<0.05). The highest correlation coefficients were 0.59 for total fat intake and 0.56 for energy. Dietary intake of energy and carbohydrates differed significantly (P=0.05, 0.001 respectively) across the three BMI z-score levels (normal-weight, overweight, obese) and the three waist circumference tertiles (0.019, 0.006 respectively). Obesogenic factors from the CFPQ correlated with consumption of empty calories like sweets, snacks, junk foods and sweet drinks.Conclusions: The modified FFQ is a relatively valid instrument to estimate mean energy intake in preschool children. The questionnaire performs reasonably well to rank children with respect to macronutrients intake as well as obesogenic food groups

Effect of a School-Based Intervention on Nutritional Knowledge and Habits of Low-Socioeconomic School Children in Israel: A Cluster-Randomized Controlled Trial

Early social and economic deprivation, associated with poor nutrition and physical inactivity, may lead to adverse health trajectories. A cluster-randomized controlled-trial examining the effect of a school-based comprehensive intervention on nutrition knowledge, eating habits, and behaviors among low socioeconomic status (LSES) school-aged children was performed. LSES school-aged children (4–7 years) and their mothers were recruited from 11 schools, located in one town. The intervention was implemented on three levels: children, mothers, and teachers. The intervention (IArm) included nutrition classes for children, mothers, and teachers and physical activity (PA) classes for children; the control (CArm) received PA only. Interventions were conducted by professional personnel, who were trained during in a two-day session to deliver the specific program in schools. Family data were obtained by parental interviews. Food knowledge observations, packed lunch records, and anthropometric measurements were obtained in school at baseline, six months, and at the end of the school year. Of 258 children enrolled, 220 (87.6%) completed the six-month program. Only children in the IArm improved their nutrition knowledge and eating-habits and increased food variety and fruit and vegetable consumption, quality score of packed lunches (p < 0.001 for all), habitual water drinking increased (p = 0.02), and decreased sweet-drink consumption (p = 0.05). A school-based comprehensive nutrition intervention targeting LSES population improved eating habits, nutritional knowledge, and healthier packed lunches

Clinical and metabolic characteristics of the Diabetes Intervention Accentuating Diet and Enhancing Metabolism (DIADEM-I) randomised clinical trial cohort

Objectives Diabetes Intervention Accentuating Diet and Enhancing Metabolism-I (DIADEM-I) is the first randomised controlled trial (RCT) in the Middle East and North Africa (MENA) region testing the effectiveness of an intensive lifestyle intervention (ILI) for weight loss and diabetes remission. We report on the recruitment process and baseline characteristics of the DIADEM-I cohort based on origin (Middle East vs North Africa), and waist circumference.Design DIADEM-I is an open-label randomised, controlled, parallel group RCT recruiting young individuals (18–50 years) with early type 2 diabetes (≤3 years since diagnosis) originating from MENA. Individuals from primary care were randomised to usual medical care or ILI (total dietary replacement phase using meal replacement products, followed by staged food reintroduction and physical activity support). The primary outcome is weight loss at 12 months. Other outcomes are glycaemic control and diabetes remission.Setting Primary care, Qatar.Participants 147 (73% men) randomised within DIADEM-I who were included in the final trial data analysis.Outcome measures Recruitment metrics, and baseline clinical and metabolic characteristics.Results Of 1498 people prescreened, 267 (18%) were invited for screening and 209 (78%) consented. 173 (83%) were eligible. 15 (7%) withdrew before randomisation and the remaining 158 were randomised. Mean age was 42.1 (SD 5.6) years and mean body mass index was: 36.3 (5.5) kg/m2 (women) and 34.4 (5.4) kg/m2 (men). Mean diabetes duration was 1.8 (1.0) years and mean glycosylated haemoglobin (HbA1c) was 7.0% (1.30) (52.5 mmol/mol (SD 14.3)). Participants originated from 13 countries. Those from North Africa reported greater physical activity and had lower family history of diabetes. 90% of subjects were taking diabetes medications and 31% antihypertensives. Those with greater waist circumference had significantly higher insulin resistance and lower quality of life.Conclusion Recruitment of participants originating from the MENA region into the RCT was successful, and study participation was readily accepted. While DIADEM-I participants originated from 13 countries, there were few baseline differences amongst participants from Middle East versus North Africa, supporting generalisability of RCT results.Trial registration number ISRCTN20754766; NCT0322533