New technologies applied to food frequency questionnaires: a current perspective

Nuevas tecnologías aplicadas a los cuestionarios de frecuencia de consumo de alimentos: una perspectiva actual

P. García-Segovia¹, R. González-Carrascosa¹, J. Martínez-Monzó¹, J. Ngo² and L. Serra-Majem^2,3

¹CUINA group. Food Technology Department. Universidad Politécnica de Valencia. Valencia. Spain.
²Community Nutrition Research Centre of the Nutrition Research Foundation. University of Barcelona Science Park. Barcelona. Spain.
³University of Las Palmas de Gran Canaria. Las Palmas de Gran Canaria. Spain.

ABSTRACT

The food frequency questionnaires are widely used in epidemiological researches like dietary assessment method. Traditionally, they have been self-administered in paper but the use of information and communication technologies has led to develop Internet and computerized food frequency questionnaires. It is the objective of this article to offer a global perspective of the new technologies applied to FFQ. It will be presented the purpose of the food frequency questionnaire, the number of strengths of the web-based surveys versus print-surveys and finally, a description of the manuscripts that have used web-based and computerized FFQ.

Key words: Internet. Computers. Questionnaires. Diet surveys.

RESUMEN

Los cuestionarios de frecuencia de consumo de alimentos son muy utilizados en investigaciones epidemiológicas como método para evaluar la dieta. Tradicionalmente, han sido autoadministrados en papel, pero el uso de las tecnologías de la información y la comunicación (TICs) ha permitido desarrollar cuestionarios de frecuencia de consumo de alimentos computerizados y a través de Internet. El objetivo de este artículo es ofrecer una perspectiva actual del uso de las nuevas tecnologías aplicadas al diseño e interpretación de los cuestionarios de frecuencia de consumo de alimentos. En el presente trabajo se resumen los objetivos de los cuestionarios de frecuencia de consumo de alimentos, las ventajas de los cuestionarios autoadministrados por Internet frente a los administrados en papel y finalmente, se describirán diferentes estudios que han usado cuestionarios de frecuencia de consumo de alimentos autoadministrados mediante el uso de ordenador o a través de Internet.

Palabras clave: Internet. Ordenadores. Cuestionarios. Encuestas dietéticas.

Abbreviations ]]> FFQ: Food frequency questionnaire.
ICT: Information and Communication Technology.

Introduction

There are different types of dietary assessment instruments like food frequency questionnaires (FFQs), 24-hour dietary recall and so on. At this moment, food frequency questionnaires are usually used in epidemiologic studies when one works with large samples sizes, thanks to their ease of administration, minimal burden to respondents and low cost. In earlier years, the usual way of administration of the FFQs has been in-person by paper. Nowadays, the progress of the information and communication technologies (ICT) has allowed using another ways of administration like web-based. Today, World Wide Web is being used in everyday life by an ever wider, more diverse public and it is one of the most preferred sources of nutrition information. Nowadays, computers and Internet are very accessible; data indicates that in 2008 more than the half of the Spanish homes had already personal computer and the access to Internet. In light of these considerations, web-based and computerized FFQs have been developed.

Food Frequency Questionnaire (FFQ)

Food frequency questionnaires are designed to measure "habitual" dietary intake, over a defined period of time. At present, in epidemiologic studies dietary intake is still assessed by means of food frequency questionnaires. The primary aim in these studies is often to classify individuals into groups by estimated intake and the FFQs have the ability to assign individuals correctly by nutrient intake. The FFQ includes a defined list of foods which are sometimes grouped into categories. In general, all questionnaires present a gene ral question (Do you eat bread?) and subjects have to respond yes or no, and if confirmed, they indicate the frequency of consumption ("how often?"). In this way, the questionnaire only provides qualitative information and they are called "non-quantitative" FFQs because they do not collect information on portion size. It is possible to obtain quantitative information by asking the quantity consumed ("How much?").

The advantages of the web-based surveys versus print-surveys

Conventional survey administration modes such as mail, in-person, telephone and central site have been practically replaced by the use of e-mail and webbased surveys. In the literature, many studies have exposed that Web-based surveys have a number of advantages over traditional mail methods. The webbased survey allows collecting data continuously, regardless of the time of day and day of week, and without geographical limitations. Furthermore, these surveys are less expensive and can be conducted in large samples. Another advantage of web-based surveys is the speed and exactness of data collection because responses from online questionnaires can be automatically stored on databases or statistical packages, saving time of data entry as well as reducing coding errors and the risk of lost data. But, they also have some disadvantages. The most cited disadvantages are sample frame and non-response bias. Another important disadvantage is that the researcher often has no way of knowing whether there is more than one respondent at one computer address, or if one respondent is completing a questionnaire from a varie ty of computers.

Some authors have worked in new technologies applied to food frequency questionnaires. In total, nine studies were selected and they were divided into two groups depend of the purpose of the study: the first group included those papers whose principal aim was validity and reproducibility of a FFQ and the second group incorporate papers whose objective was to present and describe the tool FFQ. The main characteristics, the most important results and conclusions of the studies of the first and the second group can be seen in the table I and II, respectively.

Discussion

Chronic diseases, especially cardiovascular diseases, are increasing rapidly in the western world, resulting in the inevitable rise in health expenditures. FFQs can classify individuals into groups by estimating their intake and can thus identify those who may be at nutritional risk. Recently, conventional FFQ administration modes such as mail, in-person and telephone have started to be replaced by the use of e-mail and webbased FFQ. This paper has identified studies that have developed FFQ applying new technologies showing that they can be as valid as the methods standard for certain aims and population. Moreover, self-administered web-based or computerized FFQs present more advantages than disadvantages as compared with printed-FFQs.

These reviewed manuscripts, which included partici pants with a wide age ranging between 16 and 72 years, show that self-administered web-based and/or computerized FFQ can be appropriate to assess dietary intake of a wide range of ages. The participants with older ages and those who had never used a computer did not have problems in completing the questionnaires. Furthermore, it is possible to develop this type of questionnaires for different target population.

The number of food items listed on reviewed FFQ ranged from 69 to 206 and they are generally classified in groups to facilitate dietary reporting. The food items were based on the common dietary habits of the study population. The participants were asked to indicate frequency of consumption, on average, for each food. Sometimes, they also had to indicate the quantity consumed to obtained semi-quantitative information. It is not easy to obtain semi-quantitative trustworthy information, we agree with authors who consider that it is necessary to include colour photographs of food items showing different portion sizes per food. The photographs can make the questionnaire more attractive, to prevent the monotony and to help the participant to select the portion size category that best fit their daily portion.

FFQs are designed to assess "habitual" intake, over a defined period of time. The time periods used in the selected studies were the previous year, previous three months and the previous month. In the litera ture there are other studies that have used other periods of time like the previous six. It is not prudent to use a very short period of time, for example, the previous day because it has the disadvantage of not capturing the seasonal variation of foods available. For the other hand, when a longer period of time is used, participants have more difficult to remember their dietary intake.

The principal aim of these studies was to evaluate validity and the reproducibility by means of a testretest design. Although the validity is estimated by comparison with food records, 24-hour recalls and diet history, some authors like Engle and Cade are agreeing on there is no accepted "gold standard" for assessing dietary individual intake by which to judge the validity of other methods.

FFQs are the dietary assessment method most used in epidemiologic research. For this type of researches it would be very important to have a set of web-based and computerized FFQs, among which there could select those more adapted to every research. This would suppose an important saving of time and money because web-based or computerized FFQs present more advantages than printed FFQs. But there are not many studies about the applications of ICT in FFQ, for this reason, it is necessary to develop new computerized and web-based FFQs and to improve the FFQs already developed to be able to obtain more and better information.

Acknowledgements

González-Carrascosa, R. has a predoctoral scholarship from Generalitat Valenciana (Spain).

References

1. Engle A, Lynn LL, Koury K et al. Reproducibility and comparability of a computerized, self-administered food frequency questionnaire. Lawrence Erlbaum Associates, Inc. 1990; 13: 281-92.         [ Links ]

2. Smith BA, Morgan SL, Vaughn WH, et al. Comparison of a computer-based food frequency questionnaire for calcium intake with 2 other assessment tools. J Am Diet Assoc 1999; 99:1579-81.         [ Links ]

3. Health A-LM, Skeaff CM, Gibson RS. The relative validity of a computer food frequency questionnaire for estimating intake of dietary iron and its absorption modifiers. Eur J Clin Nutr 2000; 54: 592-9.         [ Links ]

4. Vandelanotte C, Matthys C, De Bourdeaudhuij I. Reliability and validity of a computerized questionnaire to measure fat intake in Belgium. Nutr Res 2004; 24: 621-31.         [ Links ]

5. Matthys C, Pynaert I, De Keyzer W, et al. Validity and reproducibility of an Adolescent Web-Based Food Frequency Questionnaire. J Am Diet Assoc 2007; 107: 605-10.         [ Links ]

6. Slattery ML, Murtaugh MA, Schumacher MC et al. Development, Implementation and Evaluation of a Computerized selfadministered diet history Questionnaire for Use in studies of American Indian and Alaskan Native People. J Am Diet Assoc 2008; 108: 101-09.         [ Links ]

7. Wrong SS, Boushey CJ, Novotny R, Gustafson DR. Evaluation of a Computerized Food Frequency Questionnaire to Estimate Calcium Intake of Asian, Hispanic, and Non-Hispanic White Youth. J Am Diet Assoc 2008; 108: 539-43.         [ Links ]

8. Domingo JL, Bocio A, Martí-Cid R et al. Benefits and risks of fish consumption Part II. RIBEPEIX, a computer program to optimize the balance between the intake of omega-3 fatty acids and chemical contaminants. Toxicology 2007; 230: 227-33.         [ Links ]

9. Martí-Cid R, Bocio A, Llobet JM et al. Balancing health benefits and chemical risks associated to dietary habits: RIBEFOOD, a new Internet resource. Toxicology 2008; 244: 242-48.         [ Links ]

Correspondence:
Purificación García Segovia.
Politechnic University of Valencia (UPV) Science Park.
Building 8E. Stairs F. Floor 0 Office. 0.2. ]]> Camino de Vera, s/n.
46022 Valencia. Spain.
E-mail: pugarse@tal.upv.es

Recibido: 25-XI-2010.
Aceptado: 28-XI-2010.