Dietary quality varies according to data collection instrument: a comparison between a food frequency questionnaire and 24-hour recall

Rodrigues, Paulo Rogério Melo; Souza, Rita Adriana Gomes de; Cnop, Mara Lima De; Monteiro, Luana Silva; Coura, Camila Pinheiro; Brito, Alessandra Page; Pereira, Rosangela Alves

doi:10.1590/0102-311X00047215

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ARTICLE • Cad. Saúde Pública 32 (2) • 2016 • https://doi.org/10.1590/0102-311X00047215 copy

Dietary quality varies according to data collection instrument: a comparison between a food frequency questionnaire and 24-hour recall

A qualidade da dieta varia de acordo com o instrumento de obtenção de dados: comparação entre questionário de frequência alimentar e recordatório de 24 horas

La calidad de la dieta varía de acuerdo a lo instrumento de obtención de datos: comparación de cuestionario de frecuencia alimentaria y recordatorio de 24 horas

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The objective of this study was to assess the agreement between the Brazilian Healthy Eating Index – Revised (BHEI-R), estimated by a food frequency questionnaire (FFQ) and multiple 24-hour recalls (24h-R). The Wilcoxon paired test, partial correlations (PC), intraclass correlation coefficient (ICC), and Bland-Altman method were used. The total BHEI-R scores and its components (“total fruits”, “whole fruits”, “total vegetables”, “integral cereals”, “saturated fat”, “sodium”, and “energy intake derived from solid fat, added sugar, and alcoholic beverages”) were statistically different, with the ICC and PC indicating poor concordance and correlation. The mean concordance estimated for the total BHEI-R and its components varied from 68% for “integral cereals” to 147% for “whole fruits”. The suitable concordance limits were violated for most of the components of the BHEI-R. Poor concordance was observed between the BHEI-R estimated by the FFQ and by multiple 24h-R, which indicated a strong reliability of the BHEI-R on the instrument used to collect information on food consumption.

Diet; Validation Studies; Adolescent

Components	Maximum score	FFQ		Multiple 24h-R		p-value *
Components	Maximum score	Mean	95%CI	Mean	95%CI	p-value *
BHEI-R total	100	76.5	75.2; 77.7	68.4	67.1; 69.7	< 0.01
Total fruits	5	3.5	3.1; 3.8	2.8	2.4; 3.2	0.01
Whole fruits	5	2.8	2.5; 3.1	1.5	1.1; 1.8	< 0.01
Total vegetables	5	3.7	3.4; 4.0	4.2	4.0; 4.5	< 0.01
Dark green and orange vegetables & legumes	5	3.1	2.7; 3.5	3.5	3.1; 3.9	0.10
Total grains	5	4.9	4.9; 5.0	4.9	4.8; 5.0	0.15
Whole cereals	5	0.07	0.05; 0.10	0.06	0.01; 0.10	< 0.01
Meat, eggs & legumes **	10	9.9	9.9; 10.0	10.0	10.0; 10.0	0.11
Milk & dairy	10	5.4	4.9; 5.8	3.1	2.7; 3.5	< 0.01
Oils ^, *	10	10.0	10.0; 10.0	10.0	10.0; 10.0	1.00
Saturated fat	10	6.8	6.3; 7.2	7.3	6.7; 7.8	0.02
Sodium	10	7.1	6.5; 7.8	4.3	3.8; 4.7	< 0.01
SoFAS	20	19.2	18.9; 19.5	17.0	16.3; 17.6	< 0.01

	Difference between FFQ and Multiple 24h-R		ICC		Correlation
	Mean	95%CI	Value	95%CI	r ^#	p-value

BHEI-R total	8.05	6.45; 9.65	0.35	0.04; 0.56	0.21	0.03
Total fruits	0.68	0.23; 1.13	0.23	-0.13; 0.48	0.14	0.17
Whole fruits	1.35	0.92; 1.78	0.27	-0.07; 0.50	0.16	0.11
Total vegetables	-0.52	-0.84; -0.20	0.39	0.11; 0.59	0.24	0.01
Dark green and orange vegetables & legumes	-0.45	-0.95; 0.07	0.29	-0.04; 0.52	0.16	0.11
Total grains	0.08	-0.03; 0.18	0.08	-0.36; 0.37	0.05	0.61
Whole cereals	0.02	-0.03; 0.07	0.20	-0.18; 0.45	0.14	0.16
Meat, eggs & legumes **	-0.07	-0.15; 0.02	0.00	-0.47; 0.32	1.00	-
Milk & dairy	2.31	1.84; 2.78	0.54	0.32; 0.68	0.37	< 0.01
Oils ^, *	-	-	-	-	1.00	-
Saturated fat	-0.51	-1.17; 0.16	0.15	-0.26; 0.42	0.08	0.43
Sodium	2.89	2.10; 3.67	0.11	-0.32; 0.39	0.06	0.57
SoFAS	2.27	1.55; 2.98	0.05	-0.55; 0.28	-0.03	0.77

Components *	Mean agreement (%)	LOA **	β ***	p-value ^#
BHEI-R total	105	95; 116	-0.20	0.21
Total fruits	113	34; 381	-1.08	< 0.01
Whole fruits	147	24; 901	-1.49	< 0.01
Total vegetables	93	58; 152	0.18	0.24
Dark green and orange vegetables & legumes	96	13; 707	-0.55	0.01
Total grains	101	87; 118	-1.66	< 0.01
Whole cereals	68	19; 239	-0.36	0.92
Meat, eggs & legumes	100	95; 104	1.00	-
Milk & dairy	132	64; 274	-0.61	< 0.01
Oils ^##	100	100; 100	-	-
Saturated fat	98	42; 229	-0.73	< 0.01
Sodium	122	50; 299	0.54	< 0.01
SoFAS	107	85; 133	-1.47	< 0.01

Components	Sex [mean (SD)]		Weight status [mean (SD)]
Components	Girls (n = 60)	Boys (n = 46)	Normal weight * (n = 80)	Excess weight ** (n = 26)
BHEI-R total
FFQ	75.5 (7.2)	77.8 (5.4)	76.5 (6.4)	76.3 (7.2)
24h-R	68.8 (6.6)	68.0 (6.8)	68.7 (6.3)	67.8 (7.8)
Difference between FFQ and 24h-R	6.7 (8.2)	9.8 (8.1)	7.9 (8.1)	8.5 (8.9)
p-value ***	< 0.01	< 0.01	< 0.01	< 0.01
Total fruits
FFQ	3.5 (1.6)	3.4 (1.6)	3.4 (1.6)	3.7 (1.6)
24h-R	3.1 (2.1)	2.4 (1.7)	2.7 (2.0)	3.0 (2.0)
Difference between FFQ and 24h-R	0.4 (2.5)	1.1 (2.2)	0.7 (2.3)	0.7 (2.6)
p-value	0.30	< 0.01	0.01	0.26
Whole fruits
FFQ	2.9 (1.7)	2.6 (1.4)	2.7 (1.5)	3.2 (1.8)
24h-R	1.7 (2.0)	1.2 (1.6)	1.4 (1.8)	1.7 (2.0)
Difference between FFQ and 24h-R	1.3 (2.4)	1.5 (2.1)	1.3 (2.0)	1.6 (2.8)
p-value	< 0.01	< 0.01	< 0.01	0.02
Total vegetables
FFQ	3.5 (1.5)	4.0 (1.3)	3.8 (1.4)	3.6 (1.5)
24h-R	4.1 (1.3)	4.4 (1.2)	4.2 (1.3)	4.3 (1.3)
Difference between FFQ and 24h-R	-0.6 (1.8)	-0.5 (1.5)	-0.5 (1.7)	-0.7 (1.5)
p-value	0.02	0.04	0.02	0.03
Dark green and orange vegetables & legumes
FFQ	2.8 (2.1)	3.4 (1.8)	3.2 (1.9)	2.7 (2.1)
24h-R	3.3 (2.2)	3.8 (1.9)	3.5 (2.1)	3.7 (2.1)
Difference between FFQ and 24h-R	-0.5 (2.9)	-0.4 (2.3)	-0.3 (2.6)	-1.0 (2.6)
p-value	0.30	0.21	0.38	0.10
Total grains
FFQ	5.0 (0.2)	4.9 (0.3)	4.9 (0.2)	4.9 (0.2)
24h-R	4.8 (0.6)	5.0 (0.1)	4.9 (0.3)	4.7 (0.9)
Difference between FFQ and 24h-R	0.2 (0.6)	-0.1 (0.3)	0.01 (0.3)	0.3 (0.9)
p-value	0.02	0.25	0.46	0.16
Whole cereals
FFQ	0.1 (0.1)	0.1 (0.1)	0.1 (0.1)	0.1 (0.2)
24h-R	0.1 (0.3)	0.02 (0.1)	0.1 (0.2)	0.1 (0.4)
Difference between FFQ and 24h-R	-0.01 (0.3)	0.1 (0.1)	0.02 (0.2)	0.0 (0.4)
p-value	0.11	< 0.01	0.01	0.06
Meat, eggs & legumes
FFQ	9.9 (0.6)	10.0 (0.2)	9.9 (0.6)	9.9 (0.4)
24h-R	10.0 (0.0)	10.0 (0.0)	10.0 (0.0)	10.0 (0.0)
Difference between FFQ and 24h-R	-0.1 (0.6)	-0.03 (0.2)	-0.1 (0.5)	-0.1 (0.4)
p-value	0.18	0.32	0.18	0.32
Milk & dairy
FFQ	5.5 (2.5)	5.2 (2.1)	5.4 (2.2)	5.3 (2.7)
24h-R	3.0 (1.9)	3.2 (2.1)	3.1 (1.9)	2.9 (2.2)
Difference between FFQ and 24h-R	2.6 (2.7)	2.0 (2.1)	2.3 (2.2)	2.4 (3.2)
p-value	< 0.01	< 0.01	< 0.01	< 0.01
Oils ^#
FFQ	10.0 (0.0)	10.0 (0.0)	10.0 (0.0)	10.0 (0.0)
24h-R	10.0 (0.0)	10.0 (0.0)	10.0 (0.0)	10.0 (0.0)
Difference between FFQ and 24h-R	0.0 (0.0)	0.0 (0.0)	0.0 (0.0)	0.0 (0.0)
p-value ^##	-	-	-	-
Saturated fat
FFQ	6.3 (2.4)	7.4 (1.7)	6.9 (2.1)	6.3 (2.4)
24h-R	7.2 (2.8)	7.3 (2.9)	7.4 (2.8)	7.0 (3.1)
Difference between FFQ and 24h-R	-1.0 (3.5)	0.1 (3.3)	-0.4 (3.4)	-0.7 (3.7)
p-value	0.02	0.31	0.03	0.30
Sodium
FFQ	7.0 (3.4)	7.3 (3.2)	6.9 (3.4)	7.8 (3.1)
24h-R	4.8 (2.8)	3.5 (2.0)	4.1 (2.7)	4.7 (2.3)
Difference between FFQ and 24h-R	2.2 (4.2)	3.8 (3.7)	2.8 (4.3)	3.1 (3.4)
p-value	< 0.01	< 0.01	< 0.01	< 0.01
SoFAS
FFQ	19.1 (1.9)	19.4 (1.3)	19.4 (1.3)	18.8 (2.5)
24h-R	16.8 (3.4)	17.1 (3.2)	17.3 (2.9)	15.9 (4.2)
Difference between FFQ and 24h-R	2.2 (4.1)	2.3 (3.2)	2.1 (3.1)	2.9 (5.3)
p-value	< 0.01	< 0.01	< 0.01	0.01

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[1] Correspondence
P. R. M. Rodrigues Departamento de Nutrição Social e Aplicada, Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro. Av. Carlos Chagas Filho 373, Centro de Ciências da Saúde, Bloco J, 2º andar, Rio de Janeiro, RJ 21941-590, Brasil. prmr84@gmail.com