Validation of a Food-Frequency Questionnaire for the Assessment of Calcium Intake in Schoolchildren Aged 9–10 Years

Abstract

Bone mass increases steadily until age 20-30 years, when peak bone mass (PBM) is acquired. Nutrition plays a critical role in achievement of the optimal genetically programmed PBM, with reduction in the risk of osteoporosis later in life. Intake of nutrients can be estimated through the use of various tools; typically, food-frequency questionnaires (FFQs) are used in epidemiologic studies. The aim of this study was to validate a 21-item, semiquantitative FFQ to assess important nutrient intakes for bone health in Italian schoolchildren 9-10 years of age. Relative validation was accomplished through comparison of the 7-days weighed food record (7D records) with an FFQ developed ad hoc, completed by a group of 75 Italian schoolchildren (36 females, 39 males). Agreement between the two methods was evaluated by Spearman's correlation test and Bland-Altman analysis applied on the data on intake of energy, macronutrients, and micronutrients. Particular attention was devoted to nutrients relevant for bone health. Good correlations between the two methods (FFQ and 7D records) were observed for all nutrients. In particular, mean dietary calcium intakes were 725.6 mg/day (95 % CI 683.2-768.1) from 7D records and 892.4 mg/day (95 % CI 844.6-940.2) from the FFQ. These results indicate that our FFQ for schoolchildren aged 9-10 years is highly acceptable as it is an accurate method that can be used in large-scale or epidemiological studies for the evaluation of nutrient intakes important for the prevention of osteoporosis in a similar population.

Rapid assessment of dietary calcium intake

“…While most studies have found FFQ to be reliable in dietary Ca assessment, it is however not possible to compare these studies as FFQs used are different and so are the methods of assessment through food diaries. Previous studies, which have used FFQ to estimate dietary Ca intake, have tended to overestimate the daily dietary Ca 5 6. In contrast, the results of our study showed that FFQ underestimated the daily dietary Ca intake in children.…”

“…Validation of other FFQs for dietary Ca intake in children have previously been performed, albeit, in different populations 5 6. While most studies have found FFQ to be reliable in dietary Ca assessment, it is however not possible to compare these studies as FFQs used are different and so are the methods of assessment through food diaries.…”

“…However, this method is laborious and time-consuming for the patient, parent and the dietician. While validated food frequency questionnaire (FFQ) exists in medical literature,5 6 they are too cumbersome for rapid assessment in the clinic setting and not suitable for British children. We have therefore been using a simple FFQ (table 1), devised by one of the investigators (MZM), for rapid assessment of dietary Ca intake in children attending our metabolic bone disease clinics, for more than 10 years.…”

Development and validation of a food frequency questionnaire to assess omega‐3 long chain polyunsaturated fatty acid intake in Australian children aged 9–13 years

“…In general, it has been reported that FFQs tend to overestimate actual intake, compared to other dietary assessments such as two 24-h food recall (45,46) , 2-day food diary (47) and 3-day food record (48) , as well as 7-day weighed records (49) . In context of the present study, only a single study of Belgian school-aged children (12-15 years) has compared a FFQ with a 7-day food diary (50) .…”

The dietary management of calcium and phosphate in children with CKD stages 2-5 and on dialysis—clinical practice recommendation from the Pediatric Renal Nutrition Taskforce

“…The 3-day prospective diet diary/food intake record is considered "gold standard" against which other dietary assessment methods are compared, but can be time consuming to administer and assess. FFQs tend to overestimate daily dietary nutrient intake, although this depends on the number of food categories included in the tool [53][54][55]. Supplemental Table 3 lists the relative advantages and disadvantages of the different methods of dietary assessment.…”