United Arab Emirates University Scholarworks@UAEU Dissertations Electronic Theses and Dissertations 11-2020 DEVELOPMENT AND VALIDATION OF A FOOD FREQUENCY QUESTIONNAIRE FOR THE ADULT EMIRATI POPULATION FOR USE IN EPIDEMIOLOGICAL STUDIES Najoua El Mesmoudi Follow this and additional works at: https://scholarworks.uaeu.ac.ae/all_dissertations Part of the Medicine and Health Sciences Commons Recommended Citation Mesmoudi, Najoua El, "DEVELOPMENT AND VALIDATION OF A FOOD FREQUENCY QUESTIONNAIRE FOR THE ADULT EMIRATI POPULATION FOR USE IN EPIDEMIOLOGICAL STUDIES" (2020). Dissertations. 120. https://scholarworks.uaeu.ac.ae/all_dissertations/120 This Dissertation is brought to you for free and open access by the Electronic Theses and Dissertations at Scholarworks@UAEU. It has been accepted for inclusion in Dissertations by an authorized administrator of Scholarworks@UAEU. For more information, please contact [email protected]. ii Declaration of Original Work I, Najoua El Mesmoudi, the undersigned, a graduate student at the United Arab Emirates University (UAEU), and the author of this dissertation entitled “Development and Validation of a Food Frequency Questionnaire for the Adult Emirati National Population for Use in Epidemiological Studies”, hereby, solemnly declare that this dissertation is my own original research work that has been done and prepared by me under the supervision of Dr. Habiba I. Ali, in the College of Medicine and Health Sciences at UAEU. This work has not previously been presented or published or formed the basis for the award of any academic degree, diploma or a similar title at this or any other university. Any materials borrowed from other sources (whether published or unpublished) and relied upon or included in my dissertation have been properly cited and acknowledged in accordance with appropriate academic conventions. I further declare that there is no potential conflict of interest with respect to the research, data collection, authorship, presentation and/or publication of this dissertation. Student’s Signature: Date: ______20___-09-__________20 iii Copyright Copyright © 2020 Najoua El Mesmoudi All Rights Reserved iv Advisory Committee 1) Advisor: Habiba I. Ali Title: Associate Professor Department of Nutrition and Health College of Medicine and Health Sciences 2) Co-advisor: Ayesha S. Al Dhaheri Title: Professor Department of Nutrition and Health College of Medicine and Health Sciences 3) Member (External): Haleama Al Sabbah Title: Associate Professor College of Natural and Health Sciences Zayed University, Dubai, UAE 4) Member (External): Jeannette M. Beasley Title: Assistant Professor Division of General Internal Medicine and Clinical Innovation NYU Langone Health New York University, New York, USA v Approval of the Doctorate Dissertation This Doctorate Dissertation is approved by the following Examining Committee Members: 1) Advisor (Committee Chair): Habiba I. Ali Title: Associate Professor Department of Nutrition and Health College of Medicine and Health Sciences Signature Date 17 - 11 - 2020 2) Member: Liliana Stojanovska 27- 11 - 2020 Title: Professor Department of Nutrition and Health College of Medicine and Health Sciences Signature Date 17 - 11 - 2020 3) Member: Syed Shah 17- 11 - 2020 Title: Professor Public Health Institute College of Medicine and Health Sciences Signature Date 17 - 11 - 2020 17- 11 - 2020 4) Member (External Examiner): Paul F. Jacques Title: Professor Department: Friedman School of Nutrition Science and Policy Institution: Tufts University, Boston, USA Signature Date 17 - 11 - 2020 17- 11 - 2020 vi This Doctorate Dissertation is accepted by: Acting Dean of the College of Medicine and Health Sciences: Professor Juma Al Kaabi Signature Date 11 January 2021 Dean of the College of Graduate Studies: Professor Ali Al-Marzouqi Signature Date 11 January 2021 Copy ____ of ____ vii Abstract The United Arab Emirates (UAE) has been undergoing a nutritional transition in the last few decades, making diet-related Non communicable diseases (dr-NCDs) a critical health problem in the country. Food frequency questionnaire (FFQ) is the most frequently used method in epidemiological studies to investigate dietary exposures in relation to NCDs. At present, a designated FFQ for the UAE national population is lacking. To develop a culturally appropriate quantitative Web-based FFQ for the adult Emirati population (the AE-FFQ) and to assess its relative validity against three 24- hour recalls. A convenient sample of 60 (36 females and 24 males) adult Emiratis completed 3 consecutive 24HRs over a period of one month, followed by the AE-FFQ which assessed the intake over the previous month. Relative validity was evaluated by comparing nutrient and food group intakes from the AE-FFQ with the average three 24 HRs using Wilcoxon signed-rank tests, Spearman’s correlation coefficients (CC), Bland-Altman analysis, and cross-classification. The AE-FFQ was composed of 139 food items and 12 food groups. Energy, most nutrient and food groups intakes were significantly higher in the AE-FFQ compared to the reference method. Bland-Altman analysis further characterized higher estimates by the AE-FFQ and the presence of significant proportional bias between the 2 methods. The de-attenuated energy- adjusted Spearman CCs were positive and statistically significant for most nutrients and food groups and ranged from 0.06 (iron) to 0.62 (fiber) for nutrients with a 0.39 median value and from 0.01(cruciferous vegetables) to 0.64 (eggs) for food groups, with a 0.41 median value. A fairly acceptable agreement was obtained, with correct classification into the same or adjacent quartile ranging from 34% (vitamin B12) to 78% (pyridoxine), median 69% for nutrients and from 55% (diet soft drinks) to 87% (soft drinks), median 67% for food groups. The AE-FFQ is an acceptable tool for ranking UAE individuals according to their dietary intake to investigate the role of Emirati dietary patterns on health and disease. Caution is needed for assessing absolute intake, however, given the bias observed in assessing group-level agreement. Keywords: Food Frequency Questionnaire, 24-hour recall, United Arab Emirates, web-based, online, validity, diet, noncommunicable diseases. viii Title and Abstract (in Arabic) تطوير والتحقق من صحة استبيان تردد الغذاء للمواطنين اﻹماراتيين البالغين ﻻستخدامه في الدراسات الوبائية الملخص الخلفية: تمر دولة اﻹمارات العربية المتحدة بمرحلة انتقال غذائي في العقود القليلة الماضية مما يجعل اﻷمراض غير المعدية المتعلقة بالنظام الغذائي مشكلة صحية خطيرة في الدولة. استبيان تردد الغذاء )FFQ( هو الطريقة اﻷكثر استخدا ًما في الدراسات الوبائية للتحقيق في التعرض الغذائي المتعلق باﻷمراض غير المعدية. في الوقت الحاضر، ﻻ يوجد FFQ مخص ص للمواطنين اﻹماراتيين. الهدف: تطوير استبيان تردد غذاء كمي ومناسب ثقافيًا لﻻماراتيين البالغين على شبكة اﻹنترنت )AE- FFQ( وتقييم صﻻحيته النسبية ضد ثﻻث مقابﻻت استذكار غذائي على مدار 24 سا عة. الطري قة: أكملت عينة مﻻ ئمة من 60 إماراتيين بالغين )36 أنثى و 24 ذك ًرا( 3 مقابﻻت استذكار غذائي على مدار شهر واحد، تﻻها استبي ان AE-FFQ الذي قيم تناول الطعام خﻻل الشهر السابق. تم تقييم الصﻻحية النسبية من خﻻل مقارنة تناول المغذيات ومجموعات اﻻطعمة من AE-FFQ ومن معدل اﻻستذكار الغذائي باستخدام اختبارات تصنيف موقع ويلكوكسون، ومعامﻻت ارتباط سبيرمان، وتحليل بﻻن د-ألتمان، والتصنيف المتقاطع. النتائج: يتكون AE-FFQ من 139 عنص ًرا غذائيًا و 12 مجموعة غذائية. كانت الطاقة ومعظم مآخذ المغذيات ومآخذ المجموعات الغذائية أعلى بكثير ف ي AE-FFQ مقارنة بالطريقة المرجعية. تميز تحليل بﻻن د-ألتمان أي ًضا بتقديرات أعلى بواسطة AE-FFQ ووجود تحيز نسبي كبير بين الطريقتين. كانت معامﻻت ارتباط سبيرمان المعدلة للطاقة إيجابية وذات دﻻلة إحصائية لمعظم مآخذ المغذيات ومجموعات الطعام وتراوحت من 0.06 )حديد( إلى 0.62 )ألياف( لمآخذ المغذيات ومن 0.01 )خضروات صليبية( إلى 0.64 )بيض( للمجموعات الغذائية. التصنيف الربعي الصحيح للمشاركين في الربع نفسه والمجاور لتقديرات الطاقة المعدلة تراوحت من ٪34 )فيتامين ب 12( إلى 78٪ )بيريدوكسين( لمآخذ المغذيات ومن 55٪ )مشروبات غازية دايت( إلى 87٪ )مشروبات غازية( للمجموعات غذا ئية. ix الخﻻصة: استبيان AE-FFQ أداة مقبولة لترتيب اﻷفراد وف ًقا ﻻستهﻻكهم لمآخذ الطاقة ومآخذ المغذيات والمجموعات الغذائية لغاية التحقيق في دور اﻷنماط الغذائية اﻹماراتية في اﻷمراض غري المعدية المتصلة بالنظام الغذائي. ومع ذلك، يجب أن يتم استخدامه بحذر لتقييم المدخول المطلق نظ ًرا للتحيز الملحوظ عند تقييم اﻻتفاق بتحليل بﻻن د- ألتمان. مفاهيم البحث الرئيسية: استبيان تردد الغذاء، استذكار غذائي على مدار 24 ساعة، عبر اﻹنترنت ، دراسة تحقق من صحة استبيان، اﻷمراض غير المعدية ، اﻹمارات العربية المتحدة. x Acknowledgments I would like to express my sincere heartfelt gratitude to my supervisor, Dr. Habiba Issa Ali, for her generous guidance and support throughout the time of my PhD study. I am extremely thankful to my co-supervisor, Prof. Ayesha Salem Al Dhaheri and the rest of my thesis advisory committee members, Dr. Jeannette M. Beasley and Dr. Haleama Al Sabbah for their valuable feedback on my research progress and constant encouragement. I would also like to express my gratitude for the United Arab Emirates University for the funding provided for this study and my sincere appreciation to the study participants for their kindness and willingness to give their time for this study. My special thanks to Dr. Tom Loney, Mr. Nasser and Mr. Ashok Prasad for making the food images project possible. My deepest everlasting gratitude to my family for their support and unconditional love. Above all, thank you God for giving me strength to keep going! xi Dedication To the memory of my father Mohamed El Mesmoudi, and my aunt Zoubida El Mesmoudi, who taught me to