Daniel Gimenez-Monzo

Reproducibility and validity of a food frequency questionnaire among pregnant women in a Mediterranean area

BackgroundStudies exploring the role of diet during pregnancy are still scarce, in part due to the complexity of measuring diet and to the lack of valid instruments. The aim of this study was to examine the reproducibility and validity (against biochemical biomarkers) of a semi-quantitative food frequency questionnaire (FFQ) in pregnant women.MethodsParticipants were 740 pregnant women from a population-based birth cohort study in Valencia (INMA Study). We compared nutrient and food intakes from FFQs estimated for two periods of pregnancy (reproducibility), and compared energy-adjusted intake of several carotenoids, folate, vitamin B12, vitamin C and α-tocopherol of the FFQ in the first trimester with their concentration in blood specimens (validity).ResultsSignificant correlations for reproducibility were found for major food groups and nutrients but not for lycopene (r=0.06); the average correlation coefficients for daily intake were 0.51 for food groups and 0.61 for nutrients. For validity, statistically significant correlations were observed for vitamin C (0.18), α-carotene (0.32), β-carotene (0.22), lutein-zeaxantin (0.29) and β-cryptoxantin(0.26); non-significant correlations were observed for retinol, lycopene, α-tocopherol, vitamin B12 and folate (r≤0.12). When dietary supplement use was considered, correlations were substantially improved for folate (0.53) and to a lesser extent for vitamin B12 (0.12) and vitamin C (0.20).ConclusionThis study supports that the FFQ has a good reproducibility for nutrient and food intake, and can provide a valid estimate of several important nutrients during pregnancy.

Use of high doses of folic acid supplements in pregnant women in Spain: an INMA cohort study

Objectives We examined the use of low (<400 μg/day, including no use) and high folic acid supplement (FAS) dosages (≥1000 μg/day) among pregnant women in Spain, and explored factors associated with the use of these non-recommended dosages. Design Population-based cohort study. Setting Spain. Participants We analysed data from 2332 pregnant women of the INMA study, a prospective mother-child cohort study in Spain. Main outcome measures We assessed usual dietary folate and the use of FAS from preconception to the 3rd month (first period) and from the 4th to the 7th month (second period), using a validated food frequency questionnaire. We used multinomial logistic regression to estimate relative risk ratios (RRRs). Results Over a half of the women used low dosages of FAS in the first and second period while 29% and 17% took high dosages of FAS, respectively. In the first period, tobacco smoking (RRR=1.63), alcohol intake (RRR=1.40), multiparous (RRR=1.44), unplanned pregnancy (RRR=4.20) and previous spontaneous abortion (RRR=0.58, lower use of high FAS dosages among those with previous abortions) were significantly associated with low FAS dosages. Alcohol consumption (RRR=1.42), unplanned pregnancy (RRR=2.66) and previous spontaneous abortion (RRR=0.68) were associated with high dosage use. In the second period, only tobacco smoking was significantly associated with high FAS dosage use (RRR=0.67). Conclusions A high proportion of pregnant women did not reach the recommended dosages of FAS in periconception and a considerable proportion also used FAS dosages ≥1000 μg/day. Action should be planned by the Health Care System and health professionals to improve the appropriate periconceptional use of FAS, taking into consideration the associated factors.

Validez del peso y talla auto-referido en población universitaria y factores asociados a las discrepancias entre valores declarados y medidos

INTRODUCTION Obesity is an important public health problem related to a higher risk of death from chronic degenerative diseases such as diabetes, cardiovascular diseases and several types of cancer. In epidemiological studies of big sample size, only self-reported weight and height can be collected for feasibility reasons and body mass index (BMI) estimates may be questioned. OBJECTIVES In this study we compare self-reported and measured weight, height and BMI in a mostly young population of university students, and explore factors associated with discrepancies between self-reported and measured data. METHODS In the period 2006-2012, 628 University students (476 women) from health sciences subject gave consent to participate in this study. Self-reported weight and height were collected by questionnaire and compared with weight and height measured afterward in health exams wearing light clothes and using standardized protocols. The validity of self-reported anthropometric estimates was explored by correlation coefficients and sensitivity, specificity, predictive values and kappa to detect measured overweight/obesity (BMI ≥ 25 kg/m²). Multiple linear regression was used to explore the factors related to the discrepancies between self-reported and measured data. RESULTS The mean of self-reported weight, height and BMI was 62.5 kg, 167.6 cm and 22.1 kg/m² and the mean of measured data was 62.6 kg, 167.4 cm y 22.2 kg/m² respectively. Correlations between self-reported and measured data were r = 0.97 for weight, 0.96 for height and 0.95 for BMI. The sensitivity to detect overweight (IMC ≥ 25 kg/m²) using self-reported data was 81.0%, the specificity was 98.5%, the predictive value was 90.6% and the kappa index was 0.75. The discrepancy between measured and self-reported weight, height and BMI was associated with a higher age, and a higher sleeping time was also associated to discrepancies in self-reported and measured height. CONCLUSIONS Despite the self-reported weight and BMI may underestimate the true weight and BMI, and self-reported height overestimate, the validity of self-reported anthropometric measures is adequate to use be used in epidemiological studies among young people with a high educational level.

Reproducibility and Validity of a Food Frequency Questionnaire Designed to Assess Diet in Children Aged 4-5 Years

Background The food frequency questionnaire (FFQ) is the most efficient and cost-effective method to investigate the relationship between usual diet and disease in epidemiologic studies. Although FFQs have been validated in many adult populations worldwide, the number of valid FFQ in preschool children is very scarce. The aim of this study was to evaluate the reproducibility and validity of a semi-quantitative FFQ designed for children aged 4 to 5 years. Materials and methods In this study, we have included 169 children aged 4–5 years from the INMA project in Valencia, a population-based prospective cohort study of mothers and children in Spain. The 105-items FFQ was administered twice to the parents or care-givers of children over a 9-month period. Reproducibility was explored by comparing intake of nutrients by the FFQs, while validity was examined by comparing the nutrient values from the FFQs with the average nutrient values of three 24 hour dietary recall (24hDR) taken in the period, and also, with the concentration in blood specimens for several vitamins (carotenoids, folate, vitamin B12, vitamin C and α-tocopherol). Pearson correlation coefficients and de-attenuated correlation coefficients were calculated and we also evaluated misclassification by quintile distribution. Results All correlation coefficients for reproducibility for nutrients and major food groups were statistically significant; the average correlation coefficients for daily intake were 0.43 for food groups and 0.41 for nutrients. The average correlation coefficients for validity for daily intakes against 24hDR was r = 0.30, and the average for de-attenuated correlation coefficients was r = 0.44. When evaluating validity against the blood concentration of vitamins, statistically significant correlations were observed for vitamin C (0.35), lycopene (0.31), β-Cryptoxantin (0.40), and vitamin E (0.29); the average of correlation coefficients was r = 0.21. Conclusion Despite some low to moderate correlations for reproducibility and validity, overall this study suggests that the FFQ may be a good method for assessing a wide range of food groups and nutrients intake in children aged 4–5 years.

El Estudio DiSA-UMH: Estudio de cohorte prospectivo en estudiantes de ciencias de la salud de la Universidad Miguel Hernández

Introduction: Young adulthood is an important stage to establish dietary habits and lifestyle behaviors that could be linked to the long-term development of chronic diseases in later life. The 3 years follow-up prospective cohort DiSA-UMH study was set up with the main objectives of determining the nutritional status, lifestyle behaviors and health status, assessing the possible changes during the follow-up, and estimating their influence on the occurrence and development of chronic diseases. Material and Methods: Baseline information of 1204 health science students from Universidad Miguel Hernández (UMH) aged between 17 and 35 years was collected during the period from 2006 to 2012. All the participants completed a general questionnaire divided into separate sections that included a food frequency questionnaire, specific questions on physical activity, tobacco consumption, nutritional labelling use, weight, height, health status, and questions about the diagnosis of several diseases. In order to validate self-reported data, several reliability/validity investigations with different subsamples were specifically conducted. After baseline questionnaire, students were asked to obtain anthropometric measurements and fasting blood samples. To evaluate our assessment of dietary intake, between three and nine 24-hour recalls administered by telephone were conducted over one year. Results: The first follow-up period of 3-years finished in 2015 and the second 3-year follow-up period is still ongoing. Although the retention rates during these assessment periods were 59.2% and 52.2% respectively, the losses of follow-up happened in a random way because of characteristics of participants and non-participants during follow-up were similar. KEYWORDS

Dietary intake of trans fatty acids in children aged 4–5 in Spain: The INMA cohort study

Trans fatty acid (TFA) intake has been identified as a health hazard in adults, but data on preschool children are scarce. We analyzed the data from the Spanish INMA Project to determine the intake of total, industrial and natural TFA, their main sources and the associated socio-demographic and lifestyle factors in children aged 4–5 (n = 1793). TFA intake was estimated using a validated Food Frequency Questionnaire, and multiple linear regression was used to explore associated factors. The mean daily intakes of total, industrial and natural TFA were 1.36, 0.60, and 0.71 g/day, respectively. Ten percent of the children obtained >1% of their energy intake from TFA. The main sources of industrial TFA were fast food, white bread and processed baked goods. Milk, red and processed meat and processed baked goods were the main sources of natural TFA. Having parents from countries other than Spain was significantly associated with higher natural TFA (in mg/day) intake (β 45.5) and television viewing was significantly associated with higher industrial TFA intake (β 18.3). Higher fruits and vegetables intake was significantly associated with lower intakes of all TFAs, whereas higher sweetened beverages intake was significantly associated with lower total and natural TFA intake. Thus, total and industrial TFA intake was associated with less healthy food patterns and lifestyles in Spanish preschool children.