Maternal and Child Health Journal

, Volume 18, Issue 1, pp 268–285 | Cite as

Validation of a Food Frequency Questionnaire for Retrospective Estimation of Diet During the First 2 Years of Life

  • Fabiola Mejía-RodríguezEmail author
  • Lynnette M. Neufeld
  • Armando García-Guerra
  • Amado D. Quezada-Sanchez
  • Manuela A. Orjuela


This study aims to validate a Food Frequency Questionnaire (FFQ), specifically designed to retrospectively estimate dietary intake and supplement consumption during the first 2 years of life in children from resource poor households in semi-rural Mexico. The FFQ querying about diet during the first 2 years of life was administered to mothers of children (N = 84), who participated in a prospective study 3–5 years earlier, in which complementary feeding practice questionnaires and 24-h recall (24hrR) were collected at several time points during the first 2 years of life to evaluate dietary and vitamin supplement intake. The resulting FFQ data were compared to intake data collected during the original study using Spearman correlations, deattenuated correlations and Wilcoxon signed-rank tests. Total energy intake, as estimated by the retrospective and original instruments, did not differ in the second year (Yr2); correlations between the measures were significant (r = 0.40, p < 0.001). The 24hrR and FFQ-Yr2 were significantly correlated for dietary intake of vitamins B6, B12 (p < 0.001) and folate (p < 0.01); however, after including vitamin supplement intake, the two dietary instruments were correlated only for vitamins A and B12 (p < 0.05). The FFQ provides a reasonable estimate of a child’s dietary intake of energy and key micronutrients during the second year of life, and permits accurate ranking of intake 3–5 years after birth.


Validation Children Micronutrients Dietary supplements Food frequency questionnaire 24 hr recalls 



This study was Funded by NCI Grant CA98180 & CA167833 (MAO) and support from ES009089 (MAO). The original RCT was founded by the Thrasher Research Fund, UNICEF, CONACyT Mexico, the Department of International Health, Rollins School of Public Health, Emory University and the Mexican National Institute of Public Health. We are grateful to Dr. Usha Ramakrishnan principal investigator of the RCT for allowing us to use the data for this validation. The authors also thank Ida Suen, Silvia Diaz and Natasha Chiofalo for critical assistance with editing and manuscript preparation.


  1. 1.
    Investing in the future: A united call to action on vitamin and mineral deficiency, Global report (2009) Ontario, Canada: flour fortification initiative, the global alliance for improved nutrition, micronutrient initiative, The United Nations Children’s Fund, United States Agency for International Development, World Bank, World Health Organization 2009 Contract No.: 978-1-894217-31-6.Google Scholar
  2. 2.
    UNICEF. Tracking progress on child and maternal nutrition: A survival and development priority. New York UNICEF; 2009.Google Scholar
  3. 3.
    Rivera, J. A., et al. (2003). The effect of micronutrient deficiencies on child growth: A review of results from community-based supplementation trials. Journal of Nutrition, 133(11 Suppl 2), 4010S–4020S.CrossRefGoogle Scholar
  4. 4.
    Eckhardt CL. (2006) Micronutrient malnutrition, obesity, and chronic disease in countries undergoing the nutrition transition: Potential links and program/policy implications: International food policy research institute (IFPRI).Google Scholar
  5. 5.
    Lande, B., et al. (2003). Infant feeding practices and associated factors in the first 6 months of life: the Norwegian infant nutrition survey. Acta Paediatrica, 92(2), 152–161.CrossRefGoogle Scholar
  6. 6.
    Wilkins, J. R, 3rd, & Bunn, J. Y. (1997). Comparing dietary recall data for mothers and children obtained on two occasions in a case-control study of environmental factors and childhood brain tumours. International Journal of Epidemiology, 26(5), 953–963.CrossRefGoogle Scholar
  7. 7.
    Willett, W. C., & Hu, F. B. (2006). Not the time to abandon the food frequency questionnaire: Point. Cancer Epidemiology Biomarkers and Prevention, 15(10), 1757–1758. doi: 10.1158/1055-9965.EPI-06-0388.CrossRefGoogle Scholar
  8. 8.
    Burrows, T. L., et al. (2010). A systematic review of the validity of dietary assessment methods in children when compared with the method of doubly labeled water. Journal of the American Dietetic Association, 110(10), 1501–1510. doi: 10.1016/j.jada.2010.07.008.CrossRefGoogle Scholar
  9. 9.
    Roman-Viñas B, et al. (2010) Is the food frequency questionnaire suitable to assess micronutrient intake adequacy for infants, children and adolescents? Maternal and child nutrition. 6(s2):112–21. doi: 10.1111/j.1740-8709.2010.00268.x.CrossRefGoogle Scholar
  10. 10.
    Friedenreich, C. M., et al. (1992). Measurement of past diet: Review of previous and proposed methods. Epidemiologic Reviews, 14, 177–196.CrossRefGoogle Scholar
  11. 11.
    Sempos, C. T. (1992). Invited commentary: Some limitations of semiquantitative food frequency questionnaires. American Journal of Epidemiology, 135(10), 1127–1132.CrossRefGoogle Scholar
  12. 12.
    de Lourdes, Flores M., et al. (2007). Multiple micronutrient supplementation and dietary energy intake in pregnant women. Salud Publica de Mexico, 49(3), 190–198.Google Scholar
  13. 13.
    Ramakrishnan, U., et al. (2003). Multiple micronutrient supplementation during pregnancy does not lead to greater infant birth size than does iron-only supplementation: A randomized controlled trial in a semirural community in Mexico. American Journal of Clinical Nutrition, 77(3), 720–725.CrossRefGoogle Scholar
  14. 14.
    Ramakrishnan, U., et al. (2005). Effect of prenatal multiple micronutrient supplements on maternal weight and skinfold changes: A randomized double-blind clinical trial in Mexico. Food and Nutrition Bulletin, 26(3), 273–280.CrossRefGoogle Scholar
  15. 15.
    Ramakrishnan, U., et al. (2004). Multiple micronutrient supplements during pregnancy do not reduce anemia or improve iron status compared to iron-only supplements in Semirural Mexico. Journal of Nutrition, 134(4), 898–903.CrossRefGoogle Scholar
  16. 16.
    Lopez Flores JF. Factores asociados al cumplimiento del tratamiento con micronutrimentos en niños de 3 a 24 meses de edad de una localidad semi-rural de México: Escuela de Salud Pública de México, Instituto Nacional de Salud Pública.Google Scholar
  17. 17.
    Mejia-Rodriguez, F., et al. (2011). Validation of a novel method for retrospectively estimating nutrient intake during pregnancy using a semi-quantitative food frequency questionnaire. Maternal and Child Health Journal,. doi: 10.1007/s10995-011-0912-8.CrossRefGoogle Scholar
  18. 18.
    Mgrsg, W. H. O. (2006). WHO child growth standards: Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: Methods and development. Geneva: World Health Organization.Google Scholar
  19. 19.
    Bronfman, M., et al. (1988). Strategies for improving the therapeutic patterns used in acute diarrhea in primary medical care units. II. The measurement of inequality: A methodologic strategy, analysis of the socioeconomic features of the sample. Archivos de investigacion medica, 19(4), 351–360.PubMedGoogle Scholar
  20. 20.
    Rivera Dommarco, J., et al. (2001). Encuesta nacional de nutricion 1999. Estado nutricio en niños y mujeres en México. Morelos: Cuernavaca.Google Scholar
  21. 21.
    Rodriguez-Ramirez, S., et al. (2009). Methodology for the analysis of dietary data from the Mexican National Health and Nutrition Survey 2006. Salud Publica de Mexico, 51(Suppl 4), S523–S529.PubMedGoogle Scholar
  22. 22.
    Bases de datos de valor nutritivo de los alimentos. Complied by Instituto Nacional de Salud Pública. Cuernavaca, Morelos: Instituto Nacional de Salud Pública [database on the Internet] 2004.Google Scholar
  23. 23.
    Mejia-Rodriguez, F., et al. (2007). Use of nutritional supplements among Mexican women and the estimated impact on dietary intakes below the EAR and above the UL. Journal of the American College of Nutrition, 26(1), 16–23.CrossRefGoogle Scholar
  24. 24.
    Zar, J. H. (1972). Significance testing of the Spearman rank correlation coefficient. Journal of the American Statistical Association, 67(339), 578–580.CrossRefGoogle Scholar
  25. 25.
    Willett, W. C., et al. (1997). Adjustment for total energy intake in epidemiologic studies. The American journal of clinical nutrition, 65(4 Suppl), 1220S–1228S. discussion 9S-31S.CrossRefGoogle Scholar
  26. 26.
    Bland, J. M., & Altman, D. G. (1999). Measuring agreement in method comparison studies. Statistical Methods in Medical Research, 8(2), 135–160.CrossRefGoogle Scholar
  27. 27.
    Bland, J. M., & Altman, D. G. (1986). Statistical methods for assessing agreement between two methods of clinical measurement. Lancet, 1(8476), 307–310.CrossRefGoogle Scholar
  28. 28.
    Rosner, B., & Willett, W. C. (1988). Interval estimates for correlation coefficients corrected for within-person variation: implications for study design and hypothesis testing. American Journal of Epidemiology, 127(2), 377–386.CrossRefGoogle Scholar
  29. 29.
    Zar, J. H. (1972). Significance testing of the Spearman Rank Correlation Coefficient. Journal of the American Statistical Association, 67(339), 578–580.CrossRefGoogle Scholar
  30. 30.
    Andersen, L. F., et al. (2003). Validation of a semi-quantitative food-frequency questionnaire used among 12-month-old Norwegian infants. European Journal of Clinical Nutrition, 57(8), 881–888. doi: 10.1038/sj.ejcn.1601621.CrossRefGoogle Scholar
  31. 31.
    Marriott, L. D., et al. (2009). What do babies eat? Evaluation of a food frequency questionnaire to assess the diets of infants aged 12 months. Public health nutrition, 12(7), 967–972. doi: 10.1017/S1368980008003388.CrossRefGoogle Scholar
  32. 32.
    Marriott, L. D., et al. (2008). What do babies eat? Evaluation of a food frequency questionnaire to assess the diets of infants aged 6 months. Public health nutrition, 11(7), 751–756. doi: 10.1017/S1368980007001292.CrossRefGoogle Scholar
  33. 33.
    Andersen, L. F., et al. (2004). Validation of a semi-quantitative food-frequency questionnaire used among 2-year-old Norwegian children. Public health nutrition, 7(6), 757–764.CrossRefGoogle Scholar
  34. 34.
    Blum, R. E., et al. (1999). Validation of a food frequency questionnaire in Native American and Caucasian children 1–5 years of age. Maternal and Child Health Journal, 3(3), 167–172.CrossRefGoogle Scholar
  35. 35.
    Greeley, S., et al. (1992). Use of a modified food frequency questionnaire during pregnancy. Journal of the American College of Nutrition, 11(6), 728–734.CrossRefGoogle Scholar
  36. 36.
    Ocke, M. C., et al. (1997). The Dutch EPIC food frequency questionnaire. II. Relative validity and reproducibility for nutrients. International Journal of Epidemiology, 26(Suppl 1), S49–S58.CrossRefGoogle Scholar
  37. 37.
    Kabagambe, E. K., et al. (2001). Application of the method of triads to evaluate the performance of food frequency questionnaires and biomarkers as indicators of long-term dietary intake. American Journal of Epidemiology, 154(12), 1126–1135.CrossRefGoogle Scholar
  38. 38.
    Block, G., et al. (2006). Validation of a food frequency questionnaire for Hispanics. Preventing chronic disease, 3(3), A77.PubMedPubMedCentralGoogle Scholar
  39. 39.
    Willett, W. (1990). Nutritional Epidimiology. Oxford: Oxford Univeristy Press.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Fabiola Mejía-Rodríguez
    • 1
    Email author
  • Lynnette M. Neufeld
    • 3
  • Armando García-Guerra
    • 1
  • Amado D. Quezada-Sanchez
    • 1
  • Manuela A. Orjuela
    • 2
  1. 1.Centro de Investigación en Nutrición y SaludInstituto Nacional de Salud Pública (INSP)CuernavacaMexico
  2. 2.Department of Pediatrics (Oncology), and in Environmental Health Sciences, Mailman School of Public HealthColumbia UniversityNew YorkUSA
  3. 3.Micronutrient InitiativeOttawaCanada

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