International Journal of Epidemiology 2003;32:1054-1062
© International Epidemiological Association 2003
Theory and Methods |
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
1 Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
2 Biometry Research Group, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA.
3 Department of Statistics, Texas A&M University, College Station, TX, USA.
4 Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA.
5 Medical Research Council, Dunn Human Nutrition Unit, Cambridge, UK.
6 University of Wisconsin, Madison, WI, USA.
7 Department of Mathematics, Statistics and Computer Science, Bar Ilan University, Ramat Gan, Israel, and Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel.
Correspondence: Dr Arthur Schatzkin, Nutritional Epidemiology Branch, National Cancer Institute, 6120 Executive Blvd–EPS 3040, Bethesda,MD 20892–7232, USA. E-mail: schatzka{at}mail.nih.gov
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.
Keywords Attenuation factor, cohort study, dietary measurement error, doubly labelled water, energy intake, food frequency questionnaire, nutritional epidemiology, protein intake, 24-hour recall, urinary nitrogen
Accepted 12 June 2003
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