European Journal of Epidemiology

, Volume 21, Issue 6, pp 417–426 | Cite as

Estimating dietary intakes from a brief questionnaire: A simulation study of reliability in a molecular epidemiologic study of pancreatic and biliary diseases

  • Michelle A. Mendez
  • Jesús Vioque
  • Miquel Porta
  • Eva Morales
  • Tomàs López
  • Núria Malats
  • Marta Crous
  • Luis I. Gómez
  • for the PANKRAS II Study Group*



Brief dietary questionnaires may be useful in research or clinical settings where in-depth assessments are inefficient or impractical. We conducted a simulation study to assess the reliability of a brief food frequency questionnaire (bFFQ) for capturing dietary intakes relative to a detailed survey.

Subjects and methods

The bFFQ was used in a study of patients with pancreatic and biliary diseases in eastern Spain (n = 605). The structured interview included a section probing the frequency of intakes of 14 food groups, using 4 response categories. Data from a 93-item semi-quantitative food frequency questionnaire (SFFQ) with 9 response categories (n = 1337) was used to: (1) develop estimates of nutrient intakes for each food group, and (2) to simulate how intakes would have been estimated using the bFFQ. The simulation allowed to assess effects of aggregating foods and using abbreviated frequency categories.


Correlations between actual and simulated intake frequencies exceeded 0.70 for 10 food groups; modest correlations (0.43–0.56) were observed for groups assessed less well using abbreviated frequency categories. Correlations exceeded 0.60 for most nutrients. Concordance was lower for several nutrients, notably retinol, for which substantial proportions were contributed by groups combining foods with highly variable levels of these compounds.


Intake estimates from the bFFQ may be useful in exploratory analyses of the role of diet in bilio-pancreatic diseases and related etiopathogenic events. Estimates for some nutrients may be less reliable, and should be interpreted with particular caution.


Dietary assessment Nutritional epidemiology Food-frequency questionnaires Validation Pancreatic neoplasms/epidemiology Epidemiologic methods 



food frequency questionnaire


semi-quantitative food frequency questionnaire


brief food frequency questionnaire


’Encuesta de Nutrición y Salud de la Comunidad Valenciana’ (Nutrition and Health Survey of the Valencian Community); PANKRAS II Study and PANKRAS = Multicentre prospective study on the role of K-ras and other genetic alterations in the diagnosis, prognosis and etiology of pancreatic and biliary diseases; FCT = food composition table; RE = Retinol Equivalents (1 RE = 1 mcg = 5 IU of vitamin A)


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Supported by research grants from Ministerio de Ciencia y Tecnología (CICYT SAF 2000–0097), Fondo de Investigación Sanitaria (95/0017), Madrid, Spain; Generalitat de Catalunya (CIRIT SGR 0241, SGR 0078 and 1998/BEAi 400011); ‚Red temática de investigación cooperativa de centros en Cáncer’ (C03/10); ‚Red temática de investigación cooperativa de centros en Epidemiología y salud pública’ (C03/09), Instituto de Salud Carlos III; and Oficina de Ciencia␣y Tecnología, Generalitat Valenciana (Grupos 03/136). The authors gratefully acknowledge technical and scientific assistance provided by José Pumarega, Esteve Fernandez, David J. MacFarlane, Joy Ngo and Isabel Egea.


  1. 1.
    Porta M, Malats N, Jariod M et al. Serum concentrations of organochlorine compounds and K-ras mutations in exocrine pancreatic cancer. Lancet 1999; 354: 2125–2129PubMedCrossRefGoogle Scholar
  2. 2.
    Porta M, Malats N, Corominas JM et al. Generalizing molecular results arising from incomplete biological samples: expected bias and unexpected findings. Ann Epidemiol 2002; 12: 7–14PubMedCrossRefGoogle Scholar
  3. 3.
    Porta M, Malats N, Vioque J et al. Incomplete overlapping of biological, clinical and environmental information in molecular epidemiologic studies: A variety of causes and a cascade of consequences. J Epidemiol Commun Health 2002; 56: 734–738CrossRefGoogle Scholar
  4. 4.
    Porta M. Commentary on Chapter 7. In: Von Hoff DD, Evans DB, Hruban RH (eds), Pancreatic cancer. Boston: Jones and Bartlett Publishers, 2005: 113–117Google Scholar
  5. 5.
    Neuhouser ML, Kristal AR, McLerran D, Patterson RE, Atkinson J Validity of short food frequency questionnaires used in cancer chemoprevention trials: Results from the Prostate Cancer Prevention Trial. Cancer Epidemiol Biomarkers Prev 1999; 8: 721–725PubMedGoogle Scholar
  6. 6.
    Brink M, Weijenberg MP, de Goeij AF et al. Dietary folate intake and k-ras mutations in sporadic colon and rectal cancer in The Netherlands Cohort Study. Int J Cancer 2005; 114: 824–830PubMedCrossRefGoogle Scholar
  7. 7.
    Wark PA, Van der Kuil W, Ploemacher J, et al. Diet, lifestyle and risk of K-ras mutation-positive and negative colorectal adenomas. Int J Cancer 2006 (in press)Google Scholar
  8. 8.
    Slattery ML, Curtin K, Anderson K et al. Associations between dietary intake and Ki-ras mutations in colon tumors: A population-based study. Cancer Res 2000; 60: 6935–6941PubMedGoogle Scholar
  9. 9.
    Little P, Barnett J, Margetts B et al. The validity of dietary assessment in general practice. J Epidemiol Commun Health 1999; 53: 165–172Google Scholar
  10. 10.
    Kim DJ, Holowaty EJ Brief, validated survey instruments for the measurement of fruit and vegetable intakes in adults: A review. Prev Med 2003; 36: 440–447PubMedCrossRefGoogle Scholar
  11. 11.
    Gans KM, Ross E, Barner CW, Wylie-Rosett J, McMurray J, Eaton C REAP, WAVE: New tools to rapidly assess/discuss nutrition with patients. J Nutr 2003; 133: 556S–562SPubMedGoogle Scholar
  12. 12.
    Rifas-Shiman SL, Willett WC, Lobb R, Kotch J, Dart C, Gillman MW. PrimeScreen, a brief dietary screening tool: Reproducibility and comparability with both a longer food frequency questionnaire and biomarkers. Public Health Nutr 2001; 4: 249–254PubMedCrossRefGoogle Scholar
  13. 13.
    Block G, Gillespie C, Rosenbaum EH, Jenson C. A rapid food screener to assess fat and fruit and vegetable intake. Am J Prev Med 2000; 18: 284–288PubMedCrossRefGoogle Scholar
  14. 14.
    Snyder DC, Sloane R, Lobach D et al. Agreement between a brief mailed screener and an in-depth telephone survey: Observations from the Fresh Start study. J Am Diet Assoc 2004;104: 1593–1596PubMedCrossRefGoogle Scholar
  15. 15.
    Martínez-González MA, Fernández-Jarne E, Serrano-Martínez M, Wright M, Gómez-Gracia E Development of a short dietary intake questionnaire for the quantitative estimation of adherence to a cardioprotective Mediterranean diet. Eur J Clin Nutr 2004; 58: 1550–1552PubMedCrossRefGoogle Scholar
  16. 16.
    Andersen LF, Johansson L, Solvoll K Usefulness of a short food frequency questionnaire for screening of low intake of fruit and vegetable and for intake of fat. Eur J Public Health 2002; 2: 208–213CrossRefGoogle Scholar
  17. 17.
    Thompson FE, Midthune D, Subar AF, Kahle LL, Schatzkin A, Kipnis V Performance of a short tool to assess dietary intakes of fruits and vegetables, percentage energy from fat and fibre. Public Health Nutr 2004; 7: 1097–1105PubMedCrossRefGoogle Scholar
  18. 18.
    Vioque J, Quiles J. Encuesta de Nutrición y Salud de la Comunidad Valenciana. Alicante: Universidad Miguel Hernández, 2003; [accessed 31 January 2006]Google Scholar
  19. 19.
    Porta M, Malats N, Guarner L et al. Association between coffee drinking and K-ras mutations in exocrine pancreatic cancer. J Epidemiol Commun Health 1999; 53: 702–709CrossRefGoogle Scholar
  20. 20.
    Malats N, Casals T, Porta M, Guarner L, Estivill X, Real FX The cystic fibrosis transmembrane regulator (CFTR) ΔF508 mutation and 5T allele in patients with chronic pancreatitis and exocrine pancreas cancer. Gut 2001; 48: 70–74PubMedCrossRefGoogle Scholar
  21. 21.
    Real FX, Malats N, Lesca G et al. Family history of cancer and germline BRCA2 mutations in sporadic exocrine pancreas cancer. Gut 2002; 50: 653–657PubMedCrossRefGoogle Scholar
  22. 22.
    Alguacil J, Porta M, Malats N et al. Occupational exposure to organic solvents and K-ras mutations in exocrine pancreatic cancer. Carcinogenesis 2002; 23: 101–106PubMedCrossRefGoogle Scholar
  23. 23.
    Alguacil J, Porta M, Kauppinen T, Malats N, Kogevinas M, Carrato A Occupational exposure to dyes, metals, polycyclic aromatic hydrocarbons and other agents and K-ras activation in human exocrine pancreatic cancer. Int J Cancer 2003; 107: 635–641PubMedCrossRefGoogle Scholar
  24. 24.
    Warneke CL, Davis M, De Moor C, Baranowski T A 7-item versus 31-item food frequency questionnaire for measuring fruit, juice, and vegetable intake among a predominantly African-American population. J Am Diet Assoc 2001; 101: 774–779PubMedCrossRefGoogle Scholar
  25. 25.
    Feskanich D, Marshall J, Rimm EB, Litin LB, Willett WC Simulated validation of a brief food frequency questionnaire. Ann Epidemiol 1994; 4: 181–187PubMedCrossRefGoogle Scholar
  26. 26.
    Porta M, Fabregat X, Malats N et al. Exocrine pancreatic cancer: Symptoms at presentation and their relation to tumour site and stage. Clin Translat Oncol 2005; 7:189–197CrossRefGoogle Scholar
  27. 27.
    Gavaldà L, Porta M, Malats N et al. Agreement between information supplied by the patient and a family member on medical history, consumption of tobacco, alcohol and coffee, and diet in cancer of the exocrine pancreas and extrahepatic biliary system. Gac Sanit 1995; 9: 334–342PubMedGoogle Scholar
  28. 28.
    Porta M, Costafreda S, Malats N et al. Validity of the hospital discharge diagnosis in epidemiologic studies of biliopancreatic pathology. Eur J Epidemiol 2000; 16: 533–541PubMedCrossRefGoogle Scholar
  29. 29.
    Soler M, Malats N, Porta M et al. Medical conditions in patients with pancreatic and biliary diseases: Validity and agreement between data from questionnaires and medical records. Dig Dis Sci 1999; 44: 2469–2477PubMedCrossRefGoogle Scholar
  30. 30.
    Valero MP, Fletcher AE, De Stavola BL, Vioque J, Alepuz VC Vitamin C is associated with reduced risk of cataract in a Mediterranean population. J Nutr 2002; 132: 1299–1306PubMedGoogle Scholar
  31. 31.
    Vioque J, Gonzalez L Validity of a food frequency questionnaire. Preliminary results. Eur J Cancer Prev1991; 1: 19–20CrossRefGoogle Scholar
  32. 32.
    Vioque J. Validez de la evaluación de la ingesta dietética. In: Serra L, Aranceta J (eds), Nutrición y salud pública. Métodos, bases científicas y aplicaciones. Barcelona: Masson, 1995Google Scholar
  33. 33.
    Willett W Nutritional Epidemiology. 2 Oxford: Oxford University Press; 1998Google Scholar
  34. 34.
    Friedenreich CM, Slimani N, Riboli E. Measurement of past diet: Review of previous and proposed methods. Epidemiol Rev 1992; 14: 177–196PubMedGoogle Scholar
  35. 35.
    U.S. Department of Agriculture, Agricultural Research Service. USDA National Nutrient Database for Standard Reference, Release 18. Washington, 2005; [Retrieved in January 2006 from the Nutrient Data Laboratory Home Page,]Google Scholar
  36. 36.
    Food Processor SQL. Quality Nutrition Software for the Health & Food Industries (Version 9.1). Salem, OR: ESHA Research, 2002Google Scholar
  37. 37.
    Svilaas A, Strom EC, Svilaas T, Borgejordet A, Thoresen M, Ose L Reproducibility and validity of a short food questionnaire for the assessment of dietary habits. Nutr Metab Cardiovasc Dis 2002; 12: 60–70PubMedGoogle Scholar
  38. 38.
    Schatzkin A, Kipnis V Could exposure assessment problems give us wrong answers to nutrition and cancer questions? J Natl Cancer Inst 2004; 96: 1564–1565PubMedCrossRefGoogle Scholar
  39. 39.
    Salleras L, Tresserras R (eds) General Directorate of Public Health, Generalitat de Catalunya. Evaluation of the targets of the Health Plan for Catalonia for the Year 2000. Barcelona: Doyma; 2005Google Scholar
  40. 40.
    Serra-Majem L, Ribas L, Salvador G et al. Estat nutricional de la població catalana. Tendències del consum d’aliments i nutrients a Catalunya. Butll Epidemiol Catalunya 2005; 26: 113–117Google Scholar
  41. 41.
    Serra-Majem L, Aranceta Bartrina J, Mataix Verdú J, eds. Nutrición y salud pública: métodos, bases científicas y aplicaciones. Barcelona : Masson; 1995Google Scholar
  42. 42.
    Bingham SA, Luben R, Welch A, Wareham N, Khaw KT, Day N Are imprecise methods obscuring a relation between fat and breast cancer? Lancet. 2003; 362: 212–214PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2006

Authors and Affiliations

  • Michelle A. Mendez
    • 1
    • 2
  • Jesús Vioque
    • 3
  • Miquel Porta
    • 2
    • 4
  • Eva Morales
    • 2
  • Tomàs López
    • 2
  • Núria Malats
    • 2
  • Marta Crous
    • 2
  • Luis I. Gómez
    • 4
    • 5
  • for the PANKRAS II Study Group*
  1. 1.Institut Català d’OncologiaBarcelonaSpain
  2. 2.Institut Municipal d’Investigació MèdicaBarcelonaSpain
  3. 3.Department of Public HealthUniversidad Miguel HernándezAlacantSpain
  4. 4.Universitat Autònoma de BarcelonaBarcelonaSpain
  5. 5.Department of Preventive Medicine & Public HealthUniversity of ZaragozaZaragozaSpain

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