1. Validation and reproducibility of a food frequency questionnaire to assess energy and fat intake in affluent north Indians
D Pandey, V Bhatia, R Boddula, HK Singh and E Bhatia
Department of Endocrinology, Sanjay Gandhi
Post-Graduate Institute of Medical sciences, Lucknow.

2. Introduction Increasing prevalence India Change in food habits Obesity
Type II diabetes mellitus
Hypertension
Cardiovascular disease
Increased intake
Energy
Fat (especially
saturated fat)
Cholesterol
Food frequency questionnaires (FFQ): A simple method
of diet assessment for use in epidemiological studies.
There are very few validated FFQ in India.

3. Aim
Develop and validate a Food Frequency Questionnaire (FFQ) as a simple and reproducible epidemiological tool for assessing energy and fat intake in affluent population in north India.

4. Methods:Subjects FFQ validation study
Urban high income group population
Consecutive subjects: first 30 volunteers over 3 weeks
n = 30, 16 males, 14 females; mean ages years
Diet record (DR)
and FFQ
(n =30)
Reproducibility study
re-administered< 3 m
FFQ II (n = 23)

5. Methods 1 + Diet record: 5 non-consecutive days: 1-2 weekend and
remaining weekdays.
Major festivals and brief illnesses excluded.
In terms of standardized cups, spoons, 3 D
food models, definite weight and /or brand.
Food eaten at home
Food eaten outside +

6. Methods 2 Semi-quantitative food frequency questionnaire:
Designed to assess energy, total and saturated fat
cholesterol and cholesterol-saturated fat index (CSI)#
Interviewer administered (> 20 minutes).
Food list: 102 food items divided into 10 groups.
Portion size: Standardized cups and spoons, definite
brand and/or weight and 3 D food models.
Frequency: Open ended, reference period 1 year.
# CSI = 1.01 X saturated fat (gm) X cholesterol (mg) Connor et al.1986

7. Data (log transformed)
Statistical Analysis
Data (log transformed)
Mean + S.D
Paired t-test
Adjusted for calories by regression analysis
Pearson’s correlation
Regression coefficient
Quartile categorization

8. Paired t-test: Only total fat significantly different (p<0.05)
Results:Validation
Mean values of DR and FFQ and percentage overestimation by FFQ
Nutrient DR
FFQ
% over-estimation
Energy (Kcal)
1726
1838 6
Total fat (gm)
42.6
50.5 17
Saturated fat (gm)
12.4
14.4 16
Cholesterol (mg)
91.5
104.5 14
CSI
17.0
19.9
Paired t-test: Only total fat significantly different (p<0.05)

9. DR vs. FFQ: Pearson’s correlation (r) and Regression coefficient (b)
Results: Validation
DR vs. FFQ: Pearson’s correlation (r) and Regression coefficient (b)
Nutrient r
(crude)
r (adjusted) b
Energy (Kcal)
0.80† -
Total fat (gm)
0.55‡
0.45
0.42
Saturated fat (gm)
0.63†
0.66†
0.85
Cholesterol (mg)
0.69†
0.64†
0.64
CSI
0.68†
0.90
† p < 0.01
‡ p < 0.05

10. Results:Validation DR vs. FFQ: Quartile Categorization
for Energy and energy adjusted nutrients

11. Results: Reproducibility
Mean, Energy adjusted:Pearson’s correlation(r) and Regression coefficient (b)
Nutrient
FFQ
FFQ II r b
Energy (Kcal)
1838
1912 -
Total fat (gm)
50.5
55.4
0.49
0.42
Saturated fat (gm)
14.4
14.7
0.66‡
0.59
Cholesterol (mg)
104.5
100.1
0.86†
0.85
CSI
19.9
20.1
0.77†
0.65
† p < 0.005
‡p = 0.05

12. Conclusions Diet record vs. FFQ: Validation
Correlations: Moderate for fat and good for all
other nutrients.
Quartiles: Mostly good agreement.
FFQ vs. FFQ II: Reproducibility
Correlations: Moderate to strong correlations.
The FFQ developed for an affluent north Indian population
was easy to administer, showed moderate to good correlation
with the diet record and was reproducible.