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. 2020 Mar;59(2):571-580.
doi: 10.1007/s00394-019-01926-5. Epub 2019 Feb 25.

Development and relative validation of a short food frequency questionnaire for assessing dietary intakes of non-alcoholic fatty liver disease patients

Carla Bredin  1 , Sara Naimimohasses  2   3 , Suzanne Norris  2   3 , Ciara Wright  4 , Neil Hancock  5 , Kathryn Hart  1 , J Bernadette Moore  6   7
Affiliations

Development and relative validation of a short food frequency questionnaire for assessing dietary intakes of non-alcoholic fatty liver disease patients

Carla Bredin et al. Eur J Nutr. 2020 Mar.

Abstract

Purpose: This work aimed to design and validate a novel short food frequency questionnaire (SFFQ) to assess habitual intakes of food items related to non-alcoholic fatty liver disease (NAFLD) in a cohort of European patients.

Methods: A 48-item SFFQ was created, with questions from existing FFQs and expert knowledge, emphasizing foods and nutrients implicated in NAFLD pathogenesis. Consenting, fibroscan-diagnosed, NAFLD patients completed the SFFQ during a short interview and were asked to complete a 4-day diet diary (4DDD) at home for return by mail. Nutritional intakes were assessed utilizing the myfood24™ food composition dataset and estimated energy requirements (EER) were calculated using sex-, age- and weight-specific equations. Agreement between the dietary instruments was assessed by Spearman correlations and Bland Altman analysis.

Results: Fifty-five patients completed both the SFFQ and the 4DDD within 30 weeks; 42 (76%) were diagnosed with simple steatosis, whereas 13 (24%) had biopsy-proven steatohepatitis; the majority were overweight or obese, with a median (25th; 75th percentile) BMI of 33.2 kg/m2 (29.3; 36.0). Reported energy intakes were well below EER with a median intake of 73% of requirements, suggesting widespread under-reporting. Significant correlations were observed between sugar (r = 0.408, P = 0.002), fat (r = 0.44, P = 0.001), fruits (r = 0.51, P = 0.0001) and vegetables (r = 0.40, P = 0.0024) measurements by the SFFQ and 4DDD. Bland Altman plots with regression analysis demonstrated broad comparability with the 4DDD for intakes of fat (bias - 13.8 g/day) and sugar (bias + 12.9 g/day).

Conclusions: A novel SFFQ designed to be minimally burdensome to participants was effective at assessing dietary intakes in NAFLD patients.

Keywords: Diet; Non-alcoholic fatty liver disease; Nutrition; Short food frequency questionnaire.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Bland Altman plots showing difference vs mean for the SFFQ and 4DDD measurements of: a sugar; b fat; c fruit; and d vegetable intakes. Bias and 95% limits of agreement shown in dotted horizontal lines. Linear regression and 95% confidence intervals are solid line and dashed lines, respectively
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