Skip to main content
Log in

Validation of a Food-Frequency Questionnaire for the Assessment of Calcium Intake in Schoolchildren Aged 9–10 Years

  • Original Research
  • Published:
Calcified Tissue International Aims and scope Submit manuscript

Abstract

Bone mass increases steadily until age 20–30 years, when peak bone mass (PBM) is acquired. Nutrition plays a critical role in achievement of the optimal genetically programmed PBM, with reduction in the risk of osteoporosis later in life. Intake of nutrients can be estimated through the use of various tools; typically, food-frequency questionnaires (FFQs) are used in epidemiologic studies. The aim of this study was to validate a 21-item, semiquantitative FFQ to assess important nutrient intakes for bone health in Italian schoolchildren 9–10 years of age. Relative validation was accomplished through comparison of the 7-days weighed food record (7D records) with an FFQ developed ad hoc, completed by a group of 75 Italian schoolchildren (36 females, 39 males). Agreement between the two methods was evaluated by Spearman’s correlation test and Bland–Altman analysis applied on the data on intake of energy, macronutrients, and micronutrients. Particular attention was devoted to nutrients relevant for bone health. Good correlations between the two methods (FFQ and 7D records) were observed for all nutrients. In particular, mean dietary calcium intakes were 725.6 mg/day (95 % CI 683.2–768.1) from 7D records and 892.4 mg/day (95 % CI 844.6–940.2) from the FFQ. These results indicate that our FFQ for schoolchildren aged 9–10 years is highly acceptable as it is an accurate method that can be used in large-scale or epidemiological studies for the evaluation of nutrient intakes important for the prevention of osteoporosis in a similar population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Plawecki K, Chapman-Novakofski K (2010) Bone health nutrition issues in aging. Nutrients 2:1086–1105

    Article  PubMed  CAS  Google Scholar 

  2. Heaney RP (2009) Dairy and bone health. J Am Coll Nutr 28:82S–90S

    Article  PubMed  CAS  Google Scholar 

  3. Rizzoli R (2008) Nutrition: its role in bone health. Best Pract Res Clin Endocrinol Metab 22(5):813–829

    Article  PubMed  CAS  Google Scholar 

  4. Zhu K, Prince RL (2012) Calcium and bone. Clin Biochem 45(12):936–942

    Article  PubMed  CAS  Google Scholar 

  5. Wosje KS, Specker BL (2000) Role of calcium in bone health during childhood. Nutr Rev 58:253–268

    Article  PubMed  CAS  Google Scholar 

  6. Greer FR, Krebs NF, Committee on Nutrition (2006) Optimizing bone health and calcium intakes of infants, children, and adolescents. Pediatrics 117:578–585

    Article  PubMed  Google Scholar 

  7. Yin J, Zhang Q, Liu A, Du W, Wang X, Hu X, Ma G (2010) Calcium supplementation for 2 years improves bone mineral accretion and lean body mass in Chinese adolescents. Asia Pac J Clin Nutr 19(2):152–160

    PubMed  CAS  Google Scholar 

  8. Jensen JK, Gustafson D, Boushey CJ, Auld G, Bock MA, Bruhn CM, Gabel K, Misner S, Novotny R, Peck L, Read M (2004) Development of a food frequency questionnaire to estimate calcium intake of Asian, Hispanic, and white youth. J Am Diet Assoc 104:762–769

    Article  PubMed  Google Scholar 

  9. Mesías M, Seiquer I, Navarro MP (2011) Calcium nutrition in adolescence. Crit Rev Food Sci Nutr 51(3):195–209

    Article  PubMed  Google Scholar 

  10. Bonjour JP, Guéguen L, Palacios C, Shearer MJ, Weaver CM (2009) Minerals and vitamins in bone health: the potential value of dietary enhancement. Br J Nutr 101:1581–1596

    Article  PubMed  CAS  Google Scholar 

  11. Bonjour JP (2005) Dietary protein: an essential nutrient for bone health. J Am Coll Nutr 24:526S–536S

    Article  PubMed  CAS  Google Scholar 

  12. Jesudason D, Clifton P (2011) The interaction between dietary protein and bone health. J Bone Miner Metab 29(1):1–14

    Article  PubMed  CAS  Google Scholar 

  13. Zhu K, Du X, Cowell CT, Greenfield H, Blades B, Dobbins TA, Zhang Q, Fraser DR (2005) Effects of school milk intervention on cortical bone accretion and indicators relevant to bone metabolism in Chinese girls aged 10–12 y in Beijing. Am J Clin Nutr 81(5):1168–1175

    PubMed  CAS  Google Scholar 

  14. Uenishi K, Ishida H, Toba Y, Aoe S, Itabashi A, Takada Y (2007) Milk basic protein increases bone mineral density and improves bone metabolism in healthy young women. Osteoporos Int 18(3):385–390

    Article  PubMed  CAS  Google Scholar 

  15. Caroli A, Poli A, Ricotta D, Banfi G, Cocchi D (2011) Dairy intake and bone health: a viewpoint from the state of the art. J Dairy Sci 94(11):5249–5262

    Article  PubMed  CAS  Google Scholar 

  16. Pampaloni B, Bartolini E, Brandi ML (2011) Parmigiano Reggiano cheese and bone health. Clin Cases Miner Bone Metab 8(3):33–36

    PubMed  Google Scholar 

  17. Story M, Neumark-Sztainer D, French S (2002) Individual and environmental influences on adolescent eating behaviours. J Am Diet Assoc 102:S40–S51

    Article  PubMed  Google Scholar 

  18. Institute of Medicine Nutrition (2007) Standards for foods in schools: leading the way toward healthier youth. National Academies Press, Washington, DC

    Google Scholar 

  19. Cassidy CM (1994) Walk a mile in my shoes: culturally sensitive food-habit research. Am J Clin Nutr 59:190S–190S7

    PubMed  CAS  Google Scholar 

  20. Torheim LE, Barikmo I, Hatloy A, Diakité M, Solvoll K, Diarra M, Oshaug A (2001) Validation of a quantitative food frequency questionnaire for use in western Mali. Public Health Nutr 4:1267–1277

    Article  PubMed  CAS  Google Scholar 

  21. Fumagalli F, Pontes Monteiro J, Sartorelli DS, Vieira MN, de Lourdes Pires Bianchi M (2008) Validation of a food frequency questionnaire for assessing dietary nutrients in Brazilian children 5 to 10 years of age. Nutrition 24(5):427–432

    Article  PubMed  Google Scholar 

  22. Magkos F, Manios Y, Babaroutsi E, Sidossis LS (2006) Development and validation of a food frequency questionnaire for assessing dietary calcium intake in the general population. Osteoporos Int 17(2):304–312

    Article  PubMed  Google Scholar 

  23. Zemel BS, Carey LB, Paulhamus DR, Stallings VA, Ittenbach RF (2010) Quantifying calcium intake in school age children: development and validation of the calcium counts! food frequency questionnaire. Am J Hum Biol 22(2):180–186

    PubMed  Google Scholar 

  24. Lillegaard IT, Overby NC, Andersen LF (2005) Can children and adolescents use photographs of food to estimate portion sizes? Eur J Clin Nutr 59(4):611–617

    Article  PubMed  CAS  Google Scholar 

  25. Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310

    Article  PubMed  CAS  Google Scholar 

  26. Leclercq C, Piccinelli R, Arcella D, Le Donne C (2004) Food consumption and nutrient intake in a sample of Italian secondary school students: results from the INRAN-RM-2001 food survey. Int J Food Sci Nutr 55(4):265–277

    Article  PubMed  CAS  Google Scholar 

  27. Dehghan M, Del Cerro S, Zhang X, Cuneo JM, Linetzky B, Diaz R, Merchant AT (2012) Validation of a semi-quantitative food frequency questionnaire for Argentinean adults. PLoS ONE 7(5):e37958

    Article  PubMed  CAS  Google Scholar 

  28. Roumelioti M, Leotsinidis M (2009) Relative validity of a semiquantitative food frequency questionnaire designed for schoolchildren in western Greece. Nutr J 8:8

    Article  PubMed  Google Scholar 

  29. Sebring NG, Denkinger BI, Menzie CM, Yanoff LB, Parikh SJ, Yanovski JA (2007) Validation of three food frequency questionnaires to assess dietary calcium intake in adults. J Am Diet Assoc 107:752–759

    Article  PubMed  Google Scholar 

  30. Hacker-Thompson A, Robertson TP, Sellmeyer DE (2009) Validation of two food frequency questionnaires for dietary calcium assessment. J Am Diet Assoc 109:1237–1240

    Article  PubMed  Google Scholar 

  31. Osowski JM, Beare T, Specker B (2007) Validation of a food frequency questionnaire for assessment of calcium and bone-related nutrient intake in rural populations. J Am Diet Assoc 107:1349–1355

    Article  PubMed  CAS  Google Scholar 

  32. Bertoli S, Petroni ML, Pagliato E, Mora S, Weber G, Chiumello G, Testolin G (2005) Validation of food frequency questionnaire for assessing dietary macronutrients and calcium intake in Italian children and adolescents. J Pediatr Gastroenterol Nutr 40(5):555–560

    Article  PubMed  Google Scholar 

  33. Lombardi-Boccia G, Aguzzi A, Cappelloni M, Di Lullo G, Lucarini M (2003) Total-diet study: dietary intakes of macro elements and trace elements in Italy. Br J Nutr 90:1117–1121

    Article  PubMed  CAS  Google Scholar 

  34. World Health Organization (1996) Trace elements in human health and nutrition. WHO, Geneva

    Google Scholar 

  35. Società Italiana di Nutrizione Umana (2012) Livelli di Assunzione Raccomandati di Energia e Nutrienti per la Popolazione Italiana (LARN). SINU, Rome

    Google Scholar 

  36. Sonneville KR, Gordon CM, Kocher MS, Pierce LM, Ramappa A, Field AE (2012) Vitamin D, calcium, and dairy intakes and stress fractures among female adolescents. Arch Pediatr Adolesc Med 166(7):595–600

    Article  PubMed  Google Scholar 

  37. Cheng S, Tylavsky F, Kröger H, Kärkkäinen M, Lyytikäinen A, Koistinen A, Mahonen A, Alen M, Halleen J, Väänänen K, Lamberg-Allardt C (2003) Association of low 25-hydroxyvitamin D concentrations with elevated parathyroid hormone concentrations and low cortical bone density in early pubertal and prepubertal Finnish girls. Am J Clin Nutr 78:485–492

    PubMed  CAS  Google Scholar 

  38. Ginty F, Cavadini C, Michaud PA, Burckhardt P, Baumgartner M, Mishra GD, Barclay DV (2004) Effects of usual nutrient intake and vitamin D status on markers of bone turnover in Swiss adolescents. Eur J Clin Nutr 58:1257–1265

    Article  PubMed  CAS  Google Scholar 

  39. Hill TR, Cotter AA, Mitchell S, Boreham CA, Dubitzky W, Murray L, Strain JJ, Flynn A, Robson PJ, Wallace JM, Kiely M, Cashman KD (2008) Vitamin D status and its determinants in adolescents from the Northern Ireland Young Hearts 2000 cohort. Br J Nutr 99:1061–1067

    Article  PubMed  CAS  Google Scholar 

  40. Gordon C, DePeter K, Feldman H, Grace E, Emans SJ (2004) Prevalence of vitamin D deficiency among healthy adolescents. Arch Pediatr Adolesc Med 158:531–537

    Article  PubMed  Google Scholar 

  41. Sullivan S, Rosen C, Halteman W, Chen TC, Holick MF (2005) Adolescent girls in Maine are at risk for vitamin D insufficiency. J Am Diet Assoc 105:971–974

    Article  PubMed  CAS  Google Scholar 

  42. Rockell JE, Green TJ, Skeaff CM, Whiting SJ, Taylor RW, Williams SM, Parnell WR, Scragg R, Wilson N, Schaaf D, Fitzgerald ED, Wohlers MW (2005) Season and ethnicity are determinants of serum 25-hydroxyvitamin D concentrations in New Zealand children aged 5–14 y. J Nutr 135:2602–2608

    PubMed  CAS  Google Scholar 

  43. Greer RM, Rogers MA, Bowling FG, Buntain HM, Harris M, Leong GM, Cotterill AM (2007) Australian children and adolescents with type 1 diabetes have low vitamin D levels. Med J Aust 187:59–60

    PubMed  Google Scholar 

  44. Holick MF (2004) Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr 80:1678S

    PubMed  CAS  Google Scholar 

  45. Peters BS, Verly E Jr, Marchioni DM, Fisberg M, Martini LA (2012) The influence of breakfast and dairy products on dietary calcium and vitamin D intake in postpubertal adolescents and young adults. J Hum Nutr Diet 25(1):69–74

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This work was supported by F.I.R.M.O, Fondazione Raffaella Becagli (to MLB).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to M. L. Brandi.

Additional information

The authors have stated that they have no conflict of interest.

Appendix

Appendix

Att. 1

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pampaloni, B., Bartolini, E., Barbieri, M. et al. Validation of a Food-Frequency Questionnaire for the Assessment of Calcium Intake in Schoolchildren Aged 9–10 Years. Calcif Tissue Int 93, 23–38 (2013). https://doi.org/10.1007/s00223-013-9721-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00223-013-9721-y

Keywords

Navigation