Repeatability of food frequency assessment tools in relation to the number of items and response categories included

Background: Accuracy of a measurement is a cornerstone in research in order to make robust conclusions about the research hypothesis. Objective: To examine whether the number of items (questions) and the number of responses of consumption included in nutritional assessment tools influence their repeatability. Methods: During 2009, 400 participants (250 from Greece, 37±13 yrs, 34% males and 150 participants from Spain, 39±17 yrs, 41% males) completed a diet index with 11-items and binary (yes/no) responses, a diet-index with 11-items and 6-scale responses, a 36-item and a 76-item food frequency questionnaire (FFQ) with 6-scale responses. Participants completed these tools, twice, within 15-days period. Spearman-Brown (rsb), Kendall’s tau coefficients and the Bland-Altman method were applied to answer the research hypothesis. Results: The highest repeatability coefficient was observed for the 11-items with binary responses index (rsb=0.948, p<0.001), followed by the 11-items with 6-scale responses index (rsb=0.943, p<0.001), the 36-item (rsb=0.936, p<0.001) and the 76-item FFQs (rsb=0.878, p<0.001). Statistical comparisons revealed no significant differences between repeatability coefficients of the first three tools (p>0.23); whereas the aforementioned tools had significantly higher repeatability coefficients as compared with the 76-item FFQ (p=0.002). Sub-group analyses by gender, education, smoking and clinical status, confirmed the aforementioned results. Conclusion: Repeatability has been revealed for all food frequency assessment tools used, irrespective of the number of items or the number of responses included

Dietary and other lifestyle characteristics of Cypriot school children: results from the nationwide CYKIDS study

Dietary and lifestyle behaviors at young ages have been associated with the development of various chronic diseases. Schools are regarded as an excellent setting for lifestyle modification; there is a lack, however, of published dietary data in Cypriot school children. Thus, the objective of this work was to describe lifestyle characteristics of a representative segment of Cypriot school children and provide implications for school health education. Methods. The CYKIDS (Cyprus Kids Study) is a national, cross-sectional study conducted among 1140 school children (10.7 0.98 years). Sampling was stratified and multistage in 24 primary schools of Cyprus. Dietary assessment was based on a 154-item semi-quantitative food-frequency questionnaire and three supplementary questionnaires, assessing dietary patterns and behaviors. Adherence to the Mediterranean diet was evaluated by the KIDMED index (Mediterranean Diet Quality Index for children and adolescents). Physical activity was assessed by a 32-item, semi-quantitative questionnaire. Results. Analysis revealed that 6.7% of the children were classified as high adherers, whereas 37% as low adherers to the Mediterranean diet. About 20% of boys and 25% of girls reported "not having breakfast on most days of the week", while more than 80% of the children reported having meals with the family at least 5 times/week. Some food-related behaviors, such as intake of breakfast, were associated with socio-demographic factors, mostly with gender and the geomorphological characteristics of the living milieu. With respect to physical activity, boys reported higher levels compared to girls, however, one fourth of children did not report any kind of physical activity. Conclusion. A large percentage of Cypriot school children have a diet of low quality and inadequate physical activity. Public health policy makers should urgently focus their attention to primary school children and design school health education programs that target the areas that need attention in order to reduce the future burden of metabolic disorders and chronic diseases

Adherence to a DASH-style diet and cardiovascular disease risk: The 10-year follow-up of the ATTICA study

Background: Recent findings suggest a protective role of the DASH dietary pattern on cardiovascular disease (CVD) incidence and mortality. Aim: In this direction, we aimed at investigating the relationship between adherence to a DASH-style diet and CVD risk in a Greek cohort. Methods: This sub-sample from the ATTICA epidemiological study consisted of 669 adults with a complete dietary profile at baseline, adequate to calculate DASH-diet score, and complete 10-year follow-up (2002–2012). Demographic, clinical and lifestyle parameters were thoroughly assessed at baseline and CVD incidence was recorded upon medical records at follow-up. Adherence to the DASH-style diet was assessed by a DASH-style diet score developed for the study (range 9–45). Results: Mean value (SD) of the DASH-diet score was 27.1 (5.1) (range 13–41). Adherence to a DASH-style diet was associated neither with the 10-year CVD risk nor with baseline clinical parameters. Multiple regression analysis revealed that, after appropriate adjustments, only age (46% increase per 5-life-years) and BMI (9.7% increase per unit of BMI) were associated with 10-year CVD events. Conclusions: In this small cohort of a Mediterranean population, a cardioprotective effect of a DASH-style diet was not detected. © The Author(s) 2019

Low energy reporting related to lifestyle, clinical, and psychosocial factors in a randomly selected population sample of greek adults: The attica study

Objective: Aim of the present study was to identify potential dietary, lifestyle, psychosocial and clinical correlates of underreporting in a population-based sample. Methods: Following a random multistage sampling, 1514 men (46±13 years old) and 1528 women (45±13 years old) from the Attica area, in Greece, participated in this study. All participants underwent a standard assessment procedure that included clinical, psychosocial and lifestyle parameters. Food consumption was assessed through a validated semi-quantitative food frequency questionnaire. The ratio of energy intake to estimated basal metabolic rate (EI/BMR) and the Goldberg cut-off points were used for the classification of subjects as low energy reporters (LERs) and non-LERs. Results: LERs represented 12.2% of the sample. This percentage was higher in obese subjects compared to overweight or normal weight (20.6 % vs. 9.9 % vs. 10.6 %, p = 0.05), as well as in women compared to men (14.6% vs. 9.9%, p&lt;0.001). Data analysis was stratified by gender, since a significant interaction was observed between gender and LER group on several dietary parameters. Female LERs had higher Med Diet Score compared to non-LERs (30.6 ± 8.2, 95%CI 30.2–31.04 vs. 26.9 ± 6.3, 95%CI 26.05–27.7, p&lt;0.001). Multiple regression analysis revealed that lower EI/BMR values were associated with younger age (p&lt;0.001), higher BMI (p&lt;0.001), presence of diabetes mellitus (p=0.012) and lower depression score (p=0.056) in women, whereas with younger age (p&lt;0.001), higher BMI (p&lt;0.001), higher education level (p=0.046) and higher anxiety score (p=0.08) in men. Conclusion: Several psychosocial and clinical characteristics operate in low energy reporting in both genders. Nutrition-related professionals should be aware of these gender-specific trends in dietary assessment procedures. © 2007 American College of Nutrition