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Validation of Three Food Frequency Questionnaires to Assess Dietary Calcium Intake in Adults

https://doi.org/10.1016/j.jada.2007.02.007Get rights and content

Abstract

Objective

To assess the accuracy of three self-administered food frequency questionnaires (FFQs) to measure dietary calcium intake in healthy adults.

Design

Estimates of dietary calcium intake from one previously validated and two recently developed FFQs were compared with those from 7-day food records.

Subjects/setting

Healthy adults enrolled in an outpatient study of calcium supplementation completed the 36-page Dietary History Questionnaire (DHQ), a 3-page Calcium Questionnaire, and a 1-page Short Calcium Questionnaire. Subjects then completed a 7-day food record.

Main outcome measures

Differences between calcium intake reported on FFQs and calcium intake from food records were compared.

Statistical analyses

Spearman correlations were used to measure associations among variables; Bland-Altman pairwise comparisons were conducted to assess systematic and magnitude biases.

Results

We studied 341 subjects, 74.5% female, mean (±standard deviation) age of 38±11 years and body mass index (calculated as kg/m2) of 31.8±7.1. Mean (±standard deviation) food record calcium intake was 896±380 mg/day; data from all three FFQs were positively related to food record calcium intake, but accounted for <40% of the variance in food record dietary calcium intake (DHQ: r2=0.21; Calcium Questionnaire: r2=0.33; Short Calcium Questionnaire: r2=0.37; all P<0.001). The DHQ underestimated daily calcium intake (systematic bias: −94 mg/day, P<0.001; magnitude bias r=−0.40; P<0.001), whereas the Calcium Questionnaire overestimated calcium intake (systematic bias +177 mg/day, P<0.001), but had no significant magnitude bias (r=−0.09; P=0.11). The Short Calcium Questionnaire showed minimal systematic bias (+34 mg/day, P=0.09), but had magnitude bias (r=−0.33; P<0.001).

Conclusions

All three FFQs performed reasonably well at estimating dietary calcium intake compared to food records; each may be appropriate for use in select clinical and research settings.

Section snippets

Subjects

This validation study was conducted as part of a baseline assessment for a randomized clinical trial examining the effects of calcium supplementation on body weight, body composition, and comorbid conditions (28). We recruited both healthy overweight adults, with body mass index (BMI; calculated as kg/m2) ≥25, and healthy normal-weight adult control subjects (BMI range of 18 to 24.9). These studies were carried out in accordance with the Declaration of Helsinki, and were approved by the

Results

Preliminary telephone screening of 1,843 potential subjects was performed. Of those meeting preliminary criteria by self-report and expressing interest in enrollment, 485 subjects underwent additional screening at the initial clinic visit, with 398 subjects eventually qualifying for enrollment in the larger study. Of these, 57 subjects were excluded from the dietary validation analysis: 54 subjects were excluded because their food records were not complete or were determined to be inaccurate

Discussion

All three FFQs performed reasonably well, although not perfectly, to estimate dietary calcium intake obtained from 7-day food records. Mean calcium intakes from food records and all three FFQs were similar to mean calcium intake from food (892 mg/day) reported for a national sample (NHANES 2001-2002), based on two 24-hour recalls (38). Although the DHQ showed some systematic bias resulting in underestimation of calcium intake, it was relatively small. The DHQ also had a greater magnitude bias

Conclusions

In summary, the DHQ, Calcium Questionnaire, and Short Calcium Questionnaire all reflect calcium intake estimated from food records, but none are perfect tools for measuring calcium intake in adults. The DHQ may be a good choice when the intake of several nutrients is being assessed. The Calcium Questionnaire would seem to be a good choice for assessing usual calcium intake in a research setting where relative intake is of primary interest. The Short Calcium Questionnaire appears to work well as

N. G. Sebring and B. I. Denkinger are clinical research dietitians, Clinical Nutrition Services, Unit on Growth and Obesity, Developmental Endocrinology Branch, National Institute of Child Health and Human Development, all at the National Institutes of Health, Bethesda, MD.

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    N. G. Sebring and B. I. Denkinger are clinical research dietitians, Clinical Nutrition Services, Unit on Growth and Obesity, Developmental Endocrinology Branch, National Institute of Child Health and Human Development, all at the National Institutes of Health, Bethesda, MD.

    C. M. Menzie is a research associate, Unit on Growth and Obesity, Developmental Endocrinology Branch, National Institute of Child Health and Human Development, all at the National Institutes of Health, Bethesda, MD.

    L. B. Yanoff is a fellow in endocrinology, Unit on Growth and Obesity, Developmental Endocrinology Branch, National Institute of Child Health and Human Development, all at the National Institutes of Health, Bethesda, MD.

    J. A. Yanovski is head, Unit on Growth and Obesity, Developmental Endocrinology Branch, National Institute of Child Health and Human Development, all at the National Institutes of Health, Bethesda, MD.

    S. J. Parikh is director of clinical research cardiovascular, AstraZeneca LP, Wilmington, DE; at the time of the study, he was a fellow in endocrinology, Unit on Growth and Obesity, Developmental Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.

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