Lagarteja, Regrine B.

2013-88648
PHN 208

Critique of a Validation Study of a Dietary Assessment

Method
JOURNAL ARTICLE:
Haftenberger, M., Heuer, T., Heidemann, C., Kube, F., Krems, C., & Mensink, G.
(2010). Relative validation of a food frequency questionnaire for national health
and nutrition monitoring. Nutrition Journal , 9 (36).

Introduction
1. Has the author correctly represented the results from previous research?

the author has not stated if this type of validation study has been done in

other countries.
It only emphasized the advantages and disadvantages of performing a

food frequency questionnaire

It stressed out the need for validating newly formulated FFQs

2. Does the author clearly state the purposes of the study and the nature of the
problem under study?

No. The researchers just wanted to find out if the FFQ results is
comparable to 2 24 hour recall for national health and nutrition monitoring.
The nature of the problem was not stated in the study.

3. Do the hypotheses logically follow from the discussion in the introduction?

It was not stated in the background but it was implied at the snippet/

abstract that they want to validate the FFQ that they have created.
Direct admission of their hypothesis was not included in the introduction
since the introduction only talked about FFQ but not with the reference
method that they are to use.

4. Are the hypotheses clearly stated and, more important, are they testable?

No. Their hypothesis was only implied and not directly stated. However, it
was testable since they will be comparing the results of the FFQ with 2 24
hour dietary recall.

Method
1. Who served as participants in the study? How were the participants selected
(randomly, through a subject pool, etc.)?

2000 participants aged 18-79 years old were recruited from the German

National Nutrition Survey

They were chosen because they were already recruited and interviewed

by trained interviewers using the 24 h-recall method

487 of the participants completed both 24-hour recalls, and 209 of them

completed at least one recall from Jan 9 to Feb 16

After they completed the 24 hour recall, they were asked to come back for
the Food Frequency Questionnaire. They were given compensation in the
form of gift vouchers to encourage them to participate in the FFQ. In total,

161 participants were included in the data analysis.

51 % of the participants were men, with a mean age of 51 years old
Socioeconomic status, and geographic data not stated

exclusion criteria not stated

2. Are there any flaws in materials or procedures used that might affect the
validity of the study?
Process/Material
Flaw
Participants were chosen because The study involved volunteers and are
they were already recruited and too

heterogeneous.

No

exclusion

interviewed by trained interviewers criteria were given

using the 24 h-recall method
High dropout rate despite of the fact
that they were recruited

No specific geographic data of the

participants in the study
The FFQ used is for a revision of the The population that they

studied

questionnaire used in the German included subjects aged 18 to 79,

Health Interview and Examination therefore, the usability for older age
Survey

for

Children

and groups is questionable

Adolescents
After they completed the 24 hour Giving compensation may have altered
recall, they were asked to come the response behavior of those who
back

for

the

Questionnaire.

Food
They

Frequency have participated in FFQ

were

given

compensation in the form of gift

vouchers to encourage them to

Process/Material
participate in the FFQ. In total, 161

Flaw

participants were included in the

data analysis.
The FFQ developed used pictures to No
illustrate
standard

standard
use

of

consideration

of

age-specific

portions, photographs to estimate portion size

10

frequency

categories
The FFQ was pre-tested and showed Details
good usability

on

pre-testing

were

not

included in the paper (where it was pretested, number of subjects, when it was

pre-tested)
Final list of 53 food items were The list may be too short to be
included in the FFQ, 33 of which representative of commonly consumed
have

photographs

to

estimate foods by the participants

portion sizes
Not all food items present in the list
have photographs to estimate portion
sizes
No information was given as to the
24 hour recall was done using comprehensiveness
telephone

interview.

participants

to

To

of

the

assist photographed portion size given to the

indicate

the participants (are all foods included in

consumed amount of a food, a the photograph?)

picture booklet providing different
photographed

portion

sizes

for Age-appropriateness

of

the

food

Process/Material
various foods and dishes was used

Flaw
photographs used was not stated

Accuracy of estimation of portion sizes

for foods without photographed are
questionable since the interviewer will
find it difficult to ask for portion sizes
since
Discrepancy

in

number

the

recall

telephone interview
of This may have

was
an

done

using

impact

on

participants because 23 of them reproducibility of the FFQ since 23 of

have missing values from the FFQ

the participants failed to properly fill out

the FFQ

Results
1. Which effects are statistically significant?

The results are nonnormally distributed so they used Wilcoxon signed

rank test for the analysis of results. There was a nonsignificant correlation
for cooked vegetables and pizza. High correlation coefficients ( 0.70)
were observed for tea, coffee and butter/margarine. The correlation
coefficients were moderate (0.40 to 0.69) for sweet spreads, milk,
breakfast cereals, alcoholic and non-alcoholic beverages, meat products,
fresh fruits, water, bread, sweets, cream cheese, cheese and curd
cheese/soured milk/yoghurt.

After exclusion of participants who recalled their food consumption of at

least one day of special consumption, the spearman correlation

coefficients were similar or higher for most food groups.

o Data were not shown on food items with insignificant correlation
Correlation coefficients for processed fruits, fast food and cooked

vegetables were only significant in women

The spearman correlation coefficients for alcoholic beverages and sweets

increased with age

The mean intake of legumes, rice, potatoes, raw vegetables, cheese, curd
cheese/soured milk/yoghurt, fresh fruits, non-alcoholic beverages and milk
estimated from the FFQ was significantly higher than the intake assessed

by the 24-hour recalls.

intake of coffee, meat products, sweets, butter and margarine, sweet
spreads, fish, processed fruits, cream cheese and pizza obtained by the
FFQ were lower as compared to the 24-hour dietary recalls.

Discussion
1. Does the author offer speculations concerning the results?

The author offered some reasons as to the results of the paper.

o Disagreement of food intake estimates was expected because of
the different reference time of both methods, also for food
consumed rarely
o The authors have considered using multiple day-weighted food
record to be a reference method for the FFQ that they have
developed. However, it was logistically not feasible for the

researchers. They cannot use diet history because of similarity in

the sources of error.
o They have realized that FFQ is relied on long term memory while
the 24 hour recall relies on short term memory and this may have
impacted the results of their study
o They have also stated that there was a tight time schedule in doing
both the dietary assessment methods.
o Small representation of adults aged >64 years old
o FFQ inquired the frequency and amount consumed of single food
items but not mixed dishes
2. How well do the findings of the study mesh with previous research and existing
theory? Are the results consistent with previous research, or are they unique?

For fats, it is surprising that there was no underestimation even though

there are obese in the study population, and even though the subjects
generally had normal BMI, it is common for people to underestimate oil

and fat intake. But in this study, there was a good correlation for fat
Alcohol and sweets showed the same trend as fats, though it was pointed
out that alcohol intakes have good correlation because maybe it is
Christmas season, in which drinking habits may differ from their usual
intake.

3. Does the author point the way to directions for future research in the area?

For future development of FFQs, it should be considered to inquire

vegetable consumption by multiple detailed questions to increase the level
of precision, since there was a low correlation for this group in the study

In future, a separate question for milk in coffee and milk as a beverage

would make sense since it was observed that there was a large difference

in means for milk

Better handling of mixed dishes rather than quantifying the food items in a
mixed dish