A comparison of a food frequency questionnaire with a 24-hour recall for use in an epidemiological cohort study: results from the biomarker-based Observing Protein and Energy Nutrition (OPEN) study.

BACKGROUND Most large cohort studies have used a food frequency questionnaire (FFQ) for assessing dietary intake. Several biomarker studies, however, have cast doubt on whether the FFQ has sufficient precision to allow detection of moderate but important diet-disease associations. We use data from the Observing Protein and Energy Nutrition (OPEN) study to compare the performance of a FFQ with that of a 24-hour recall (24HR). METHODS The OPEN study included 484 healthy volunteer participants (261 men, 223 women) from Montgomery County, Maryland, aged 40-69. Each participant was asked to complete a FFQ and 24HR on two occasions 3 months apart, and a doubly labelled water (DLW) assessment and two 24-hour urine collections during the 2 weeks after the first FFQ and 24HR assessment. For both the FFQ and 24HR and for both men and women, we calculated attenuation factors for absolute energy, absolute protein, and protein density. RESULTS For absolute energy and protein, a single FFQ's attenuation factor is 0.04-0.16. Repeat administrations lead to little improvement (0.08-0.19). Attenuation factors for a single 24HR are 0.10-0.20, but four repeats would yield attenuations of 0.20-0.37. For protein density a single FFQ has an attenuation of 0.3-0.4; for a single 24HR the attenuation factor is 0.15-0.25 but would increase to 0.35-0.50 with four repeats. CONCLUSIONS Because of severe attenuation, the FFQ cannot be recommended as an instrument for evaluating relations between absolute intake of energy or protein and disease. Although this attenuation is lessened in analyses of energy-adjusted protein, it remains substantial for both FFQ and multiple 24HR. The utility of either of these instruments for detecting important but moderate relative risks (between 1.5 and 2.0), even for energy-adjusted dietary factors, is questionable.

[1]  D. Midthune,et al.  Comparative validation of the Block, Willett, and National Cancer Institute food frequency questionnaires : the Eating at America's Table Study. , 2001, American journal of epidemiology.

[2]  A F Subar,et al.  Is shorter always better? Relative importance of questionnaire length and cognitive ease on response rates and data quality for two dietary questionnaires. , 2001, American journal of epidemiology.

[3]  R J Carroll,et al.  Empirical evidence of correlated biases in dietary assessment instruments and its implications. , 2001, American journal of epidemiology.

[4]  D A Schoeller,et al.  Measurement of energy expenditure in free-living humans by using doubly labeled water. , 1988, The Journal of nutrition.

[5]  A F Subar,et al.  Improving food frequency questionnaires: a qualitative approach using cognitive interviewing. , 1995, Journal of the American Dietetic Association.

[6]  J. Jobe,et al.  Cognitive research enhances accuracy of food frequency questionnaire reports: results of an experimental validation study. , 2002, Journal of the American Dietetic Association.

[7]  S A Bingham,et al.  Urine nitrogen as an independent validatory measure of dietary intake: a study of nitrogen balance in individuals consuming their normal diet. , 1985, The American journal of clinical nutrition.

[8]  M. Wong,et al.  Epidemiological assessment of diet: a comparison of a 7-day diary with a food frequency questionnaire using urinary markers of nitrogen, potassium and sodium. , 2001, International journal of epidemiology.

[9]  R J Carroll,et al.  Implications of a new dietary measurement error model for estimation of relative risk: application to four calibration studies. , 1999, American journal of epidemiology.

[10]  E Riboli,et al.  Calibration of dietary intake measurements in prospective cohort studies. , 1995, American journal of epidemiology.

[11]  N E Day,et al.  Validation of dietary assessment methods in the UK arm of EPIC using weighed records, and 24-hour urinary nitrogen and potassium and serum vitamin C and carotenoids as biomarkers. , 1997, International journal of epidemiology.

[12]  D. Schoeller,et al.  Relative dilution spaces of 2H- and 18O-labeled water in humans. , 1994, The American journal of physiology.

[13]  Raymond J Carroll,et al.  Bias in dietary-report instruments and its implications for nutritional epidemiology , 2002, Public Health Nutrition.

[14]  W. Willett.  Commentary: Dietary diaries versus food frequency questionnaires-a case of undigestible data. , 2001, International journal of epidemiology.

[15]  L. Ovesen,et al.  para-aminobenzoic acid used as a marker for completeness of 24 hour urine: assessment of control limits for a specific HPLC method , 1997, European Journal of Clinical Nutrition.

[16]  D. Schoeller,et al.  Use of an automated chromium reduction system for hydrogen isotope ratio analysis of physiological fluids applied to doubly labeled water analysis. , 2000, Journal of mass spectrometry : JMS.

[17]  Raymond J Carroll,et al.  Structure of dietary measurement error: results of the OPEN biomarker study. , 2003, American journal of epidemiology.

[18]  A F Subar,et al.  Evaluation of alternative approaches to assign nutrient values to food groups in food frequency questionnaires. , 2000, American journal of epidemiology.

[19]  J. D. Berg,et al.  Practical Assessment of the NBT-PABA Pancreatic Function Test Using High Performance Liquid Chromatography Determination of P-Aminobenzoic Acid in Urine , 1985, Annals of clinical biochemistry.

[20]  D. Clayton,et al.  Measurement error in dietary assessment: an investigation using covariance structure models. Part II. , 1993, Statistics in medicine.

[21]  W. Willett.  Invited Commentary: OPEN Questions , 2003 .

[22]  D A Schoeller,et al.  Rapid 18O analysis of CO2 samples by continuous-flow isotope ratio mass spectrometry. , 1997, Journal of mass spectrometry : JMS.

[23]  Kipnis et al. Respond to “OPEN Questions” , 2003 .

[24]  D. Midthune,et al.  Using intake biomarkers to evaluate the extent of dietary misreporting in a large sample of adults: the OPEN study. , 2003, American journal of epidemiology.

[25]  D Clayton,et al.  Measurement error in dietary assessment: an investigation using covariance structure models. Part I. , 1993, Statistics in medicine.

[26]  H Boeing,et al.  Validation of a self-administered food-frequency questionnaire administered in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study: comparison of energy, protein, and macronutrient intakes estimated with the doubly labeled water, urinary nitrogen, and repeated 24-h dietary , 1999, The American journal of clinical nutrition.