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Development of a Saudi Food Frequency Questionnaire and Testing Its Reliability and Validity

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Development of a Saudi Food Frequency Questionnaire and Testing Its Reliability and Validity Development of a Saudi Food Frequency Questionnaire and testing its reliability and validity Ibrahim M. Gosadi, MPH, PhD, Abdullah A. Alatar, MBBS, Mojahed M. Otayf, MBBS, Dhaherah M. AlJahani, MBBS, Hisham M. Ghabbani, MBBS, Waleed A. AlRajban, MBBS, Abdullah M. Alrsheed, MBBS, Khalid A. Al-Nasser, MBBS. ABSTRACT year food frequency consumption and 24 hours dietary recall, body weight and height were collected. Internal consistency, test-retest reliability, completeness تطوير استبانة ذات مصداقية و معولية لقياس تكرار .of the food list, and criterion validity were assessed اﻷهداف: استهﻻك الطعام في املجتمع السعودي. Results: One-hundred and thirty eight participants were interviewed to complete the 24 hours dietary recall and الطرق: هذه دراسة استقدامية مع إعادة اﻻختبار اُجريت في جامعة the constructed questionnaire. Approximately 85% of the امللك سعود، الرياض، اململكة العربية السعودية بني ديسمبر 2015 و 140 2016 food items reported in the dietary recall were covered in the food frequency questionnaire. The association of body مارس شملت ًنوعا من اﻷغذية في هذه اﻻستبانة بحيث mass index with meats )regression coefficients: 2.28( and مت استخدام أسلوبي اﻷسئلة املفتوحة و املغلقة. مت جمع بيانات عن dairy products consumption frequency was statistically تكرار استهﻻك اﻷطعمة للسنة املاضية و تذكر استهﻻك الطعام خﻻل significant )regression coefficients: 2.31(. A high overall اﻷربعة و العشرين ساعة املاضية و الطول و الوزن. مت اختبار التجانس reproducibility rate of the questionnaire was detected الداخلي و معولية إعادة اﻻختبار و كذلك مت اختبار اكتمال قائمة .)Pearsons’ correlation coefficient: 0.78 p<0.001( اﻷطعمة و مصداقية اخلاصية. Conclusion: The developed questionnaire has a high reliability and reasonable validity, and suitable for use النتائج:مت إجراء مقابﻻت لـ 138 ً مشاركافي هذا البحث بحيث مت in nutritional epidemiological investigations in Saudi جمع املعلومات عن طريق اﻻستبانة املطورة و تذكر استهﻻك الطعام .Arabia خﻻل اﻷربعة و العشرين ساعة املاضية. تبني أنه مت تغطية ما يقارب %85 من اﻷطعمة املذكورة في تذكر استهﻻك الطعام في اﻻستبانة Saudi Med J 2017; Vol. 38 (6): 636-641 املطورة لقياس تكرار استهﻻك الطعام. كذلك ُوجدت عﻻقة ذات doi:10.15537/smj.2017.6.20055 دﻻلة إحصائية بني مؤشر كتلة اجلسم و تكرار استهﻻك اللحوم و 2.28 From the Prince Sattam Chair for Epidemiology and Public Health مشتقات احلليب )قيمة املعامل اﻹنحداري للحوم: قيمة Research, Department of Family and Community Medicine, College of املعامل اﻻنحداري ملشتقات احلليب: 2.31-(. و كذلك يوجد .Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia معدل إعادة انتاج عالي لﻻستبانة املطورة ذات دﻻلة إحصائية )0.78 .)p <0.001 Received 7th February 2017. Accepted 2nd March 2017. .Address correspondence and reprint request to: Dr. Ibrahim M اﻻستبانة التي مت تطويرها ذات معولية عالية و مصداقية Gosadi, Prince Sattam Chair for Epidemiology and Public Health اخلامتة: Research, Department of Family and Community Medicine, College مقبولة و مناسبة لﻻستعمال في التحقيقات الوبائية الغذائية في .of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia اململكة العربية السعودية. E-mail: [email protected] Objectives: To create a food frequency questionnaire ORCID: http://orcid.org/0000-0002-1275-3953 specifically designed to capture the dietary habits of Saudis and test its validity and reliability. Disclosure. Authors have no conflict of interest, and the Methods: This investigation is a longitudinal, test- retest study conducted in King Saud University, work was not supported or funded by any drug company. Riyadh, Kingdom of Saudi Arabia between December This study was funded by the Deanship of Scientific 2015 and March 2016. A list of 140 food items was Research, King Saud University, Riyadh, Kingdom included in the questionnaire where a closed-ended of Saudi Arabia through Vice Deanship of Scientific and open-ended approach was used. Regarding past Research Chairs. 636 Saudi Med J 2017; Vol. 38 )6( www.smj.org.sa OPEN ACCESS Saudi food frequency questionnaire ... Gosadi et al ingdom of Saudi Arabia )KSA( witnessed a Methods. Study context and participants. This Kdramatic increase in the prevalence of obesity, investigation is a longitudinal, test-retest study, which diabetes, and metabolic syndrome during the involved students from King Saud University )KSU(, past 2 decades.1,2 According to the World Health Riyadh, KSA. The study was conducted between Organization, cardiovascular diseases and diabetes December 2015 and March 2016 and involved are responsible for half the deaths among the Saudi university students of both genders and different population.3 This epidemic is partially explained by colleges in the university. Ethical approval to conduct the unhealthy eating behaviors of the Saudis, leading the study was provided by the Ethics Committee in to a higher prevalence of obesity and overweight people Department of Family and Community Medicine, and subsequent chronic non-communicable diseases.4-7 College of Medicine, KSU. A sample of 130 subjects was Several nutritional investigations were conducted in estimated to detect a Pearsons’s correlation coefficient KSA to measure the eating behavior of Saudis, methods of 0.25 assuming probability of 5% type 1 error and of measuring dietary habits varied between the use of 90% study power to detect the effect. Providing the 24-hours dietary recall,8 food records,6 and limited longitudinal nature of this study, an attempt to recruit questionnaires measuring consumption of selected food larger sample was made to avoid reduction of sample items.9 A study conducted among male school children size caused by attrition. Participants were requested to in Al-Hasa, KSA utilized the Youth and Adolescent Food sign a consent form for approval to participate in the Frequency Questionnaire to measure eating behavior.5 study. Subjects were excluded from this investigation However, several food items listed in this questionnaire if any prior medical history of conditions that might are not permitted in KSA or are not usually consumed interfere with average eating behavior was present. in the country.10,11 Several methods are used to measure These conditions involved Bulimia nervosa, Anorexia dietary habits. Dietary recall depends on the ability of nervosa, Binge eating, inflammatory bowel disease, individuals to recall food and beverages consumed in a peptic diseases, intestinal motility disorders, cancer, hyperthyroidism and hypothyroidism. specific period of time, usually the previous 24 hours.12 Construction of the food frequency questionnaire. When using food records, participants are asked to The design of the food frequency questionnaire was record their food intake on a daily basis. It does not rely adopted from the food frequency questionnaire on memory and participants can proactively record their developed by the European Prospective Investigation intake of the day.13 Food Frequency Questionnaires ask into Cancer and Nutrition study )EPIC(.23 This design the participants how frequently they consume several was selected as its validity and reliability was previously food items over a fixed time period) usually a year(. This tested24 and it seemed more convenient to complete method can be self-administered or completed during compared with other observed questionnaires. Similarly, interviews. This method is more suitable for large-scale portion sizes were adopted from the EPIC food epidemiological studies compared with 24-hour food 14 frequency questionnaire. The constructed questionnaire recall or food diaries. Cultural variations exhibited was developed in the Arabic language. A list of 140 between geographical areas mandated development food items was included in the questionnaire where of food frequency questionnaires suitable for a a closed-ended approach was used. Nine answering particular region. For example, there are different food options were provided for each closed-ended question 15,16 frequency questionnaires developed for European, where consumption frequency choices were stated 17-19 20 Asian and American populations. Food frequency as the following: never or less than a month, 1-3 per questionnaires developed for Arab nations are month, once a week, 2-4 per week, 5-6 per week, once limited. Two questionnaires, developed for Lebanese a day, 2-3 per day, 4-5 per day, 6+ per day. Open-ended population21 and Kuwaiti and Emirati populations,22 questions were added at the end of the questionnaire were detected. However, there is no validated and reliable to gather information regarding other food items not food frequency questionnaire specifically created for the listed. Questions regarding type of cooking fat, visible Saudi population. The Use of a questionnaire specifically fat consumption, consumption of salt and vitamins designed for Saudis is necessary to ensure consistency of were added. nutritional epidemiological investigations performed Validity and reliability assessment. Validity of the in this population. This study aims to create a food questionnaire was tested on several levels. Pilot testing frequency questionnaire specifically designed to capture of the questionnaire was performed to test the initially the nutritional habits of Saudis and to test its validity compiled food list where 10 male and 10 female and reliability. participants were recruited to investigate the ability www.smj.org.sa Saudi Med J 2017; Vol. 38 )6( 637 Saudi food frequency questionnaire ... Gosadi et al of the respondents to complete the questionnaire, consistency of the questionnaire. A p-value of 0.05 or assess clarity of the questionnaire and the need
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