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Original Research
Development and Validation of a Comprehensive Semi-Quantitative Food Frequency Questionnaire that Includes FODMAP Intake and Glycemic Index

https://doi.org/10.1016/j.jada.2010.07.011Get rights and content

Abstract

Background

Fermentable, short chain carbohydrates (FODMAPs) have been identified as triggers for functional gastrointestinal symptoms. In addition, excess FODMAP consumption has been implicated in the onset of Crohn's disease, and animal studies suggest that a low glycemic index diet can impair absorption of fructose, a major dietary FODMAP. Such hypotheses cannot be tested without the ability to quantify FODMAP ingestion with a validated dietary assessment tool.

Objective

To assess the validity and reproducibility of a 297-item comprehensive, semi-quantitative food frequency questionnaire (FFQ) in estimating intake of macro- and micronutrients, FODMAPs, and glycemic index/load.

Subjects/setting

One hundred healthy participants were recruited to complete the FFQ on two occasions, plus four 1-week food diaries kept during a 12-month period. Participants exhibiting major dietary change during the study period or low energy reporting on the FFQ were excluded.

Main outcome measures

Validation and reproducibility of the semi-quantitative FFQ by comparison with the mean of four 1-week food diaries.

Statistical analyses performed

Validation was assessed using Wilcoxon signed rank test, Spearman's correlation, Bland-Altman, and weighted κ statistics. Reproducibility was examined using Shrout-Fleiss intraclass correlation coefficient.

Results

Seventy-two participants fulfilled inclusion and exclusion criteria. Demographics of the participants were comparable with 2006 Australian Census data. Consistent with other reported FFQs, the FFQ overestimated nutrient intake by a mean 140% (range=95% to 249%). However, based on the other analyses performed, it demonstrated validity for intake of sugars, fiber, alcohol, glycemic index, glucose, FODMAPs, calcium, folate, phosphate, potassium, iron, and magnesium; moderate validation for energy, total fat, saturated fat, carbohydrates, sodium, thiamin, sucrose, and retinol; poor validation for protein, mono/polyunsaturated fat, starch, glycemic load, niacin, and zinc. Riboflavin intake was not validated. Intraclass correlation coefficients for reproducibility ranged from 0.352 to 0.928.

Conclusions

The FFQ was validated for assessment of a wide range of nutrients, including the new class of carbohydrates, FODMAPs, and glycemic index. This provides a useful tool for dietary research, particularly in the area of gastroenterological disorders.

Section snippets

Methods

A 297-item comprehensive FFQ was designed to assess macronutrient and micronutrient intake, FODMAPs, fiber, starch, glycemic index, and glycemic load. The questionnaire was based on the Harvard FFQ (13), with sections divided into individual food groups. The FFQ included initial questions on vitamin/mineral supplementation, and then covered all food groups. Food lists were considerably expanded compared with existing FFQs because of the variability of FODMAP intake between similar foods (eg,

Subjects

Of 100 subjects who completed the FFQ and four 1-week food records, 72 were included in the analysis. Twelve subjects acknowledged that during the study they changed their diet substantially or had a substantial change in health; these included a new diagnosis of diabetes (n=1), a relapse of ulcerative colitis (n=2), commencement of a low FODMAP diet for irritable bowel syndrome (n=2), trial of dietary strategies to manage psoriasis (n=1), carbohydrate loading for a marathon (n=1), and major

Discussion

The importance of being able to simply and accurately assess FODMAP intake in individuals and specific populations, such as disease groups, has been highlighted by the impact that dietary modification of FODMAPs has had on functional gut symptoms and the putative role that FODMAPs might have on disease pathogenesis in gastrointestinal conditions. FFQs are the method of choice in this regard. The current study has shown that the 297-item semi-quantitative FFQ is a valid, reproducible tool to

Conclusions

A semi-quantitative FFQ has been developed and validated in an Australian population relevant to its intended use. It accurately and reproducibly assesses dietary intake of FODMAPs, a new class of carbohydrates emerging as important dietary components in the management of gastrointestinal symptoms. In addition, the comprehensive FFQ demonstrated good validation for assessment of total sugars, fiber, alcohol, average glycemic index, glucose, calcium, folate, phosphate, potassium, iron and

J. S. Barrett is an accredited practicing dietitian and lecturer, Monash University, Eastern Health Clinical School, Victoria, Australia.

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    J. S. Barrett is an accredited practicing dietitian and lecturer, Monash University, Eastern Health Clinical School, Victoria, Australia.

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