Online dietary intake estimation : The food4me food frequency questionnaire

Copyright ©Hannah Forster, Rosalind Fallaize, Caroline Gallagher, Clare B O’Donovan, Clara Woolhead, Marianne C Walsh, Anna L Macready, Julie A Lovegrove, John C Mathers, Michael J Gibney, Lorraine Brennan, Eileen R Gibney. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 09.06.2014. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.Dietary assessment methods are important tools for nutrition research. Online dietary assessment tools have the potential to become invaluable methods of assessing dietary intake because, compared with traditional methods, they have many advantages including the automatic storage of input data and the immediate generation of nutritional outputs. Objective: The aim of this study was to develop an online food frequency questionnaire (FFQ) for dietary data collection in the Food4Me study and to compare this with the validated European Prospective Investigation of Cancer (EPIC) Norfolk printed FFQ. Methods: The Food4Me FFQ used in this analysis was developed to consist of 157 food items. Standardized color photographs were incorporated in the development of the Food4Me FFQ to facilitate accurate quantification of the portion size of each food item. Participants were recruited in two centers (Dublin, Ireland and Reading, United Kingdom) and each received the online Food4Me FFQ and the printed EPIC-Norfolk FFQ in random order. Participants completed the Food4Me FFQ online and, for most food items, participants were requested to choose their usual serving size among seven possibilities from a range of portion size pictures. The level of agreement between the two methods was evaluated for both nutrient and food group intakes using the Bland and Altman method and classification into quartiles of daily intake. Correlations were calculated for nutrient and food group intakes. Results: A total of 113 participants were recruited with a mean age of 30 (SD 10) years (40.7% male, 46/113; 59.3%, 67/113 female). Cross-classification into exact plus adjacent quartiles ranged from 77% to 97% at the nutrient level and 77% to 99% at the food group level. Agreement at the nutrient level was highest for alcohol (97%) and lowest for percent energy from polyunsaturated fatty acids (77%). Crude unadjusted correlations for nutrients ranged between .43 and .86. Agreement at the food group level was highest for other fruits (eg, apples, pears, oranges) and lowest for cakes, pastries, and buns. For food groups, correlations ranged between .41 and .90. Conclusions: The results demonstrate that the online Food4Me FFQ has good agreement with the validated printed EPIC-Norfolk FFQ for assessing both nutrient and food group intakes, rendering it a useful tool for ranking individuals based on nutrient and food group intakes.Peer reviewedFinal Published versio

Determinants of dietary diversity among pregnant women in Laikipia County, Kenya: a cross-sectional study

BACKGROUND: Dietary diversity has continued to gain widespread attention among the population since it has evidently been associated with nutrient adequacy. A diverse diet has been shown to reflect nutrient adequacy since no one food can meet the nutritional requirement of a person. Pregnant women have been considered vulnerable to malnutrition due to their increased nutrient requirement and therefore a variety of foods in their diet is considered imperative in ensuring adequate nutrient intake. To promote dietary diversity, it is important to understand the factors associated with it. This paper therefore assessed the determinants of dietary diversity among pregnant women in Laikipia County, Kenya. METHODS: The study was a cross-sectional analytical study consisting of 254 pregnant women attending antenatal clinic at Nanyuki Teaching and Referral Hospital in Laikipia County, Kenya. RESULTS: The mean Dietary Diversity Score (DDS) was 6.84 ± 1.46 Standard Deviation (SD), with cereals being the most (99%) commonly consumed food group. Adjusted Logistic Regression (AOR) analyses revealed education level (AOR = 2.78; (95% Confidence Interval (CI) 1.06, 5.32; p < 0.001), employment status (AOR = 2.29; CI 1.18, 4.14; p = 0.003), monthly income (AOR = 2.08; CI 1.32, 3.03; p < 0.001), household assets (AOR = 1.93; CI 0.73, 6.90; p = 0.030), land ownership (AOR = 0.64; CI 0.44, 2.25; p = 0.040), and morbidity (AOR = 0.78; CI 0.36, 2.34; p = 0.010) among the pregnant women as the variables that influenced their dietary diversity. CONCLUSION: Socioeconomic factors (education level, employment status, monthly income, household assets and land ownership) have been shown to influence dietary diversity in this study. New policies and intervention programmes targeting these determinants of dietary diversity should therefore be enacted, while the existing ones should be supported and monitored particularly among the vulnerable populations. Such policies and programmes among pregnant women will ensure improved dietary diversity and adequate nutrient intake. Similarly, since morbidity incidence among pregnant women have been shown to significantly influence dietary diversity, public health awareness campaign on the importance of early detection and timely treatment of diseases among pregnant women should be launched by the relevant stakeholders

Policy implementation and priorities to create healthy food environments using the Healthy Food Environment Policy Index (Food-EPI): A pooled level analysis across eleven European countries

Background: Food environments have been recognised as highly influential on population diets. Government policies have great potential to create healthy food environments to promote healthy diets. This study aimed to evaluate food environment policy implementation in European countries and identify priority actions for governments to create healthy food environments. Methods: The Healthy Food Environment Policy Index (Food-EPI) was used to evaluate the level of food environment policy and infrastructure support implementation in Estonia, Finland, Germany, Ireland, Italy, the Netherlands, Norway, Poland, Portugal, Slovenia, and Spain in 20192021. Evidence of implementation of food environment policies was compiled in each country and validated by government officials. National experts evaluated the implementation of policies and identified priority recommendations. Findings: Finland had the highest proportion (32%, n = 7/22) of policies shaping food environments with a high level of implementation. Slovenia and Poland had the highest proportion of policies rated at very low implementation (42%, n = 10/24 and 36%, n = 9/25 respectively). Policies regarding food provision, promotion, retail, funding, monitoring, and health in all policies were identified as the most important gaps across the European countries. Experts recommended immediate action on setting standards for nutrients of concern in processed foods, improvement of school food environments, fruit and vegetable subsidies, unhealthy food and beverage taxation, and restrictions on unhealthy food marketing to children. Interpretation: Immediate implementation of policies and infrastructure support that prioritize action towards healthy food environments is urgently required to tackle the burden of obesity and diet-related non-communicable diseases in Europe. Funding: This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 774548 and from the Joint Programming Initiative A Healthy Diet for a Healthy Life. (c) 2022 The Author(s

High dietary diversity is associated with obesity in Sri Lankan adults: An evaluation of three dietary scores.

Background: Dietary diversity is recognized as a key element of a high quality diet. However, diets that offer a greater variety of energy-dense foods could increase food intake and body weight. The aim of this study was to explore association of diet diversity with obesity in Sri Lankan adults. Methods: Six hundred adults aged > 18 years were randomly selected by using multi-stage stratified sample. Dietary intake assessment was undertaken by a 24 hour dietary recall. Three dietary scores, Dietary Diversity Score (DDS), Dietary Diversity Score with Portions (DDSP) and Food Variety Score (FVS) were calculated. Body mass index (BMI) ≥ 25 kg.m−2 is defined as obese and Asian waist circumference cut-offs were used diagnosed abdominal obesity. Results: Mean of DDS for men and women were 6.23 and 6.50 (p=0.06), while DDSP was 3.26 and 3.17 respectively (p=0.24). FVS values were significantly different between men and women 9.55 and 10.24 (p=0.002). Dietary diversity among Sri Lankan adults was significantly associated with gender, residency, ethnicity, education level but not with diabetes status. As dietary scores increased, the percentage consumption was increased in most of food groups except starches. Obese and abdominal obese adults had the highest DDS compared to non-obese groups (p<0.05). With increased dietary diversity the level of BMI, waist circumference and energy consumption was significantly increased in this population. Conclusion: Our data suggests that dietary diversity is positively associated with several socio-demographic characteristics and obesity among Sri Lankan adults. Although high dietary diversity is widely recommended, public health messages should emphasize to improve dietary diversity in selective food items

Validity and reproducibility of an interviewer-administered food frequency questionnaire for healthy French-Canadian men and women

OBJECTIVE: To evaluate the validity (study 1) and the reproducibility (study 2) of an interviewer-administered food frequency questionnaire (FFQ). METHOD: The FFQ was designed at Laval University and contains 91 items and 33 subquestions. Study 1: The FFQ was compared against a 3-day food record (2 week-days and 1 weekend-day), at week 0, 6 and 12 of a nutritional intervention. Study 2: In order to evaluate the reproducibility of the FFQ, 2 registered dietitians administered the FFQ 4-weeks apart among subjects who were not part of the nutritional intervention. RESULTS: Study 1: Mean values for intake of most nutrients assessed by the FFQ and by the 3-day food record were not statistically different. Energy-adjusted correlation coefficients for major macronutrients ranged from 0.36 for proteins to 0.60 for carbohydrates (p ≤ 0.01). Agreement analysis revealed that on average, 35% of the subjects were classified in the same quartile when nutrients were assessed by either the 3-day food record or the FFQ. Study 2: Significant associations were observed between dietary measurements derived from the two FFQs administered 4 weeks apart. Correlation coefficients for the reproducibility of macronutrients ranged from 0.66 for carbohydrates to 0.83 for lipids after energy adjustment. On average, 46% of the subjects were classified in the same quartile when nutrient intakes were assessed by either FFQ. CONCLUSION: These data indicated that the FFQ developed has a good validity and is reproducible

Nutrient intakes of rural Tibetan mothers: a cross-sectional survey

<p>Abstract</p> <p>Background</p> <p>Tibetan food intake is influenced by the region's high altitude and unique culture. Few published studies of nutrient intakes among Tibetan women are available. The present study of Tibetan mothers with young children explores dietary patterns, nutrient intakes, and differences between socio-demographic groups.</p> <p>Methods</p> <p>A cross-sectional survey of 386 women with a child aged less than 24 months was conducted in rural areas surrounding Lhasa, Tibet. All participants were recruited using simple random sampling and were interviewed face-to-face by trained investigators. Dietary information was collected via a food frequency questionnaire. Nutrient intakes were calculated using food composition tables. Non-parametric tests were used to compare nutrient intakes according to socio-demographic variables, and to compare results with the <it>2002 Chinese National Nutrition and Health Survey </it>(2002 NNHS) and dietary reference intakes (DRIs).</p> <p>Results</p> <p>Median intakes of energy (<it>p </it>< 0.001), protein (<it>p </it>< 0.001), fat (<it>p </it>< 0.001), vitamin A (<it>p </it>< 0.001), vitamin B1 (<it>p </it>< 0.001), vitamin B2 (<it>p </it>< 0.001), vitamin C (<it>p </it>< 0.001), and vitamin E (<it>p </it>< 0.001) were lower than the average levels reported in 2002 NNHS. The median intakes of calcium (517 mg/d, <it>p </it>< 0.001), iron (35 mg/d, <it>p </it>< 0.001), and zinc (17.3 mg/d, <it>p </it>< 0.001) were higher than the average levels in 2002 NNHS. The highest education subgroup had significantly higher intakes of vitamins A and C than the lowest education subgroup.</p> <p>Conclusion</p> <p>Although the diet of Tibetan mothers with young children has been partially influenced by other factors, their dietary patterns are still mostly composed of Tibetan traditional foods. Compared with the 2002 NNHS, Tibetan women with young children appear to have insufficient intakes of many nutrients, which will affect their nutritional status.</p

Does crop diversity contribute to dietary diversity? Evidence from integration of vegetables into maize-based farming systems

Background: Maize is the most important staple crop for food security and livelihood of smallholder farmers in many parts of sub-Saharan Africa, but it alone cannot ensure food security. Cropping patterns must be diversified to ensure an adequate supply and economic access to greater variety of foods for smallholder farm households. This study measured the effect of crop diversification on household dietary diversity in a selected study locale using a survey of 300 randomly stratified farm households in 10 villages located in the Babati, Kongwa and Kiteto districts of Tanzania. Results: Based on multiple regression analysis, the study found that simply increasing Simpson’s Index does not influence dietary diversity of farm households due to the presence of interaction effect between Simpson’s Index and crop income. It is much more critical and significant to increase the revenue generated from diversified crops along with other socioeconomic endowment and behavioral characteristics of farm households. This is particularly applicable to poorer smallholder farmers who receive crop income less than US$85 per sales transaction and per season. Particularly, marginal and smallholders might be exposed to the effects of crop diversification and crop income toward increasing in their household dietary diversity score. Conclusion: Under average crop income scenarios, households that diversify their crop production tend to increase their dietary diversity from their existing dietary diversity score at a decreasing rate. However, under below average crop income threshold scenarios, farmers tend to increase their dietary diversity score from their existing score at an increasing rate when they diversify into high-value crops that attract relatively high farm gate values and accrue higher net revenues from the market. Monthly food expenditure also tends to positively influence household dietary diversity, indicating that farm households that spend more on market-purchased food have consistent increases in their dietary diversity scores at the household level. This study concludes that improving economic access to variety of foods at the smallholder household level by diversifying diets through increased crop diversification should be encouraged within maize-based farming systems of the study locale, through integration of micronutrient-rich foods such as vegetables

A Biodiverse Rich Environment Does Not Contribute to a Better Diet: A Case Study from DR Congo

The potential of biodiversity to increase and sustain nutrition security is increasingly recognized by the international research community. To date however, dietary assessment studies that have assessed how biodiversity actually contributes to human diets are virtually absent. This study measured the contribution of wild edible plants (WEP) to the dietary quality in the high biodiverse context of DR Congo. The habitual dietary intake was estimated from 2 multiple-pass 24 h dietary recalls for 363 urban and 129 rural women. All WEP were collected during previous ethnobotanical investigations and identified and deposited in the National Botanical Garden of Belgium (BR). Results showed that in a high biodiverse region with precarious food security, WEP are insufficiently consumed to increase nutrition security or dietary adequacy. The highest contribution came from Dacryodes edulis in the village sample contributing 4.8% of total energy intake. Considering the nutrient composition of the many WEP available in the region and known by the indigenous populations, the potential to increase nutrition security is vast. Additional research regarding the dietary contribution of agricultural biodiversity and the nutrient composition of WEP would allow to integrate them into appropriate dietary guidelines for the region and pave the way to domesticate the most interesting WEP

Food access and diet quality are associated with quality of life outcomes among HIV-infected individuals in Uganda.

BACKGROUND: Food insecurity is associated with poor nutritional and clinical outcomes among people living with HIV/AIDS. Few studies investigate the link between food insecurity, dietary diversity and health-related quality of life among people living with HIV/AIDS. OBJECTIVE: We investigated whether household food access and individual dietary diversity are associated with health-related quality of life among people living with HIV/AIDS in Uganda. METHODS: We surveyed 902 people living with HIV/AIDS and their households from two clinics in Northern Uganda. Health-related quality of life outcomes were assessed using the Medical Outcomes Study (MOS)-HIV Survey. We performed multivariate regressions to investigate the relationship between health-related quality of life, household food insecurity and individual dietary diversity. RESULTS: People living with HIV/AIDS from severe food insecurity households have mean mental health status scores that are 1.7 points lower (p<.001) and physical health status scores that are 1.5 points lower (p<.01). Individuals with high dietary diversity have mean mental health status scores that were 3.6 points higher (p<.001) and physical health status scores that were 2.8 points higher (p<.05). CONCLUSIONS: Food access and diet quality are associated with health-related quality of life and may be considered as part of comprehensive interventions designed to mitigate psychosocial consequences of HIV

Addressing constraints in promoting wild edible plants’ utilization in household nutrition: case of the Congo Basin forest area

It is worth raising the question, why are wild edible plants (WEPs) which are rich in diverse nutrients and widely abundant underutilized despite the increasing rate of undernourishment in poor regions? One reason is that their culinary uses are not quantified and standardized in nutrition surveys, and therefore, they are not properly included in household diet intensification and diversification across regions and cultures. Active steps are needed to bridge this gap. This paper outlines the constraints to including WEPs in nutritional surveys as the lack of standard ways of food identification of diverse WEPs, lack of specific food categorization and therefore difficult dissemination across regions and cultures. As a way forward, a functional categorization of 11 subgroups for WEPs is introduced and discussed. In labeling these sub-food groups, the paper advocates that more WEPs food items and culinary uses should be enlisted during household nutrition surveys. Food researchers could then capitalize these enlisted species and disseminate them to promote diverse food use of WEPs in other regions where they exist but are not utilized as food