Development and evaluation of cultural food frequency questionnaires for South Asians, Chinese, and Europeans in North America

doi:10.1016/S0002-8223(03)00985-4

Journal of the American Dietetic Association

Volume 103, Issue 9, September 2003, Pages 1178-1184

https://doi.org/10.1016/S0002-8223(03)00985-4 Get rights and content

Abstract

We developed three ethnic food frequency questionnaires (FFQs) to characterize the diets of South Asian, Chinese, and European immigrants. FFQs were developed from foods reported in the diet records and recalls of 29 South Asians, 25 Chinese, and 20 Europeans participating in a pilot study from 1995–1996 in Hamilton, Ontario, Canada. The FFQ and a seven-day diet record were then administered to 342 South Asians, 317 Chinese, and 346 Europeans participating in the Study of Health Assessment and Risk in Ethnic groups (SHARE) in three Canadian centers from 1996–1998. For FFQ validation, a subset of these participants completed a second seven-day diet record and second FFQ 8 to 10 months later. The FFQ generally underestimated macronutrient and overestimated micronutrient intake compared with the records. Consumption of most macronutrients was lower among South Asians. Energy-adjusted deattenuated correlation coefficients between the records and second FFQ ranged from 0.32 to 0.73 (South Asians), 0.17 to 0.84 (Chinese), and 0.30 to 0.83 (Europeans). The FFQs generally performed well and will be used to investigate diet-disease relations in SHARE. Lower correlations for dietary fats among Chinese persons (0.17 to 0.31) may be improved with more direct questions on the FFQ regarding brand, type, and amount of oil consumed in stirfry servings.

Section snippets

Pilot study

In 1995 and 1996 we conducted pilot studies in Hamilton, Ontario, Canada, to develop questionnaires and assess recruitment feasibility for a national study. A letter of introduction to the study was mailed to 522 randomly selected households followed by telephone contact, in the native language if required, to assess eligibility. Details of the recruitment method and response rates have been described elsewhere (8). Sampling frames for South Asian and Chinese participants were compiled by the

Statistical analyses

The mean nutrient intake of participants from the FFQ was calculated by summing across all food items the product of the frequency of consumption of each food, the portion size, and the nutrient composition of that item. Nutrient distributions were positively skewed; therefore variables were logarithmically transformed. Nutrients were further adjusted for total energy using the residual method (21). Means and standard deviations were calculated for total nutrient intakes from the diet records

Results

Table 1 shows the response rate for completion of the diet record and FFQs. Of those persons participating in the validation substudy, everyone’s first seven-day diet record was used in addition to the second seven-day diet record from those participants who completed them. Therefore we analyzed a combination of 7- and 14-day diet records from 58 South Asians, 64 Chinese, and 85 Europeans.

Table 2 displays the daily nutrient intakes estimated by the diet records and the FFQ2, adjusted for total

Discussion

We evaluated the performance of our ethnic FFQs by comparing nutrient values from these questionnaires with those derived from 7- to 14-day diet records collected during the period covered by the FFQ. The majority of energy-adjusted deattenuated correlation coefficients for both the validity and reliability analyses were within the range of 0.5 to 0.7 and are comparable with those reported in the literature (26). The FFQ tended to overestimate the intake of many vitamins with supplements; this

Applications

■ Although the ethnic FFQs appeared to measure nutrient intake with reasonable validity and reliability, the measurement error associated with dietary fat assessment among Chinese may produce biased results. Dietary fat assessment among Chinese may be improved with inclusion of detailed questions on the FFQ regarding brand, type, and amount of oil consumed in a stirfry serving.

■ For epidemiologic research, the FFQs are a useful tool to characterize population mean intakes or to rank persons

Acknowledgements

The authors thank Meera Jain, PhD, for sharing the CSDLH FFQ, for guidance with dietary assessments in the pilot and main studies, and assistance with the ethnic food item compilation; Jean Hankin, RD, DrPH, and Gladys Block, PhD, for guidance with questionnaire and database development; Walter Willett, MD, for guidance with questionnaire development and assistance with data interpretation; Bernard Rosner, PhD, for sharing the pairwise statistical program; Meir Stampfer, MD, for critical review

L. E. Kelemen is a research associate in the Department of Health Sciences Research, Mayo Clinic, Rochester, MN. At the time the study was conducted, she was a research nutritionist with the Population Health Research Institute and Department of Medicine, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada.

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S. S. Anand is an assistant professor in the Population Health Research Institute and Department of Medicine, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada. At the time the study was conducted, she was a research fellow in the Population Health Research Institute and Department of Medicine, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada.

S. Yusuf is the director of the Population Health Research Institute and a professor in the Department of Medicine, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada.

V. Vuksan is an associate professor with the Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, Ontario, Canada and the Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

Q. Yi is a biostatistician with Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada. At the time the study was conducted, he was a statistician with the Population Health Research Institute and Department of Medicine, McMaster University, Hamilton, Ontario, Canada.

K. K. Teo is a professor with the Population Health Research Institute and Department of Medicine, McMaster University Medical Centre, Hamilton, Ontario, Canada. At the time the study was conducted, he was an associate professor of medicine and director of the Cardiac Clinical Trials and Epicore Centre, Department of Medicine, University of Alberta Hospitals, Edmonton, Alberta, Canada.

S. Devanesen is an associate professor with the Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

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Perspectives in practiceDevelopment and evaluation of cultural food frequency questionnaires for South Asians, Chinese, and Europeans in North America

Abstract

Section snippets

Pilot study

Statistical analyses

Results

Discussion

Applications

Acknowledgements

Lancet

Lancet

Public Health

J Am Diet Assoc

Ann Epidemiol

Am J Clin Nutr

Am J Clin Nutr

Am J Clin Nutr

Global health statisticsa compendium of incidence, prevalence, and mortality estimates for over 200 conditions

The World Development Indicators

1996 Census Directory

An analysis of state and county population changes by characteristics1990–1999

Cardiovascular and cancer mortality among Canadians of European, South Asian and Chinese origin from 1979 to 1993an analysis of 1.22 million deaths

Can Med Assoc J

Risk factors for cardiovascular disease in Canadians of South Asian and European origina pilot study of the Study of Heart Assessment and Risk in Ethnic Groups (SHARE)

Clin Invest Med

Perspectives in practice
Development and evaluation of cultural food frequency questionnaires for South Asians, Chinese, and Europeans in North America