Evaluation of a short food frequency questionnaire for dietary intake assessment among children



The objective of this study was to evaluate the performance of a short food frequency questionnaire (FFQ) to assess dietary intake at 4 and 7 years of age, against 3d food diaries (FD) and serum biomarkers, using two methods to convert the FFQ to daily intake in grams and nutrients (standard and z-score method).


The present analysis comprises data from 2482 4-year-old children and 3511 7-year-old children, from the birth cohort Generation XXI (Porto, Portugal). To estimate daily consumption from the FFQ, the frequency response was multiplied by a standard mean portion (standard method) or adjusted with data from the FD (z-score method). The dietary intake obtained from the FFQ was compared with the FD and serum biomarkers, using Intra-Class Correlation Coefficients (ICC), de-attenuated Pearson’s correlation coefficients and Bland Altman analysis.


In general, the mean daily food intake estimated by the z-score method had a higher agreement with the FD, than the standard method. The highest ICC was obtained for “vegetable soup” (ICC = 0.536), using the z-score method, compared to an ICC of 0.373 using the standard method. Significant correlation coefficients were observed for all nutrients; the average of correlation coefficients was 0.39 at 4 years and 0.42 at 7 years of age. For the majority of nutrients, the correlation between mean and mean difference was lower using the z-score method, in comparison with the standard method.


The results suggest that the FFQ is a reasonably good instrument to estimate dietary intake in children. Moreover, adjusting the FFQ portion size, by using a z-score method, seems to increase the accuracy of dietary data in children.

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The authors gratefully acknowledge the families enrolled in Generation XXI for their kindness, all members of the research team for their enthusiasm and perseverance and the participating hospitals and their staff for their help and support. The authors acknowledge the support from the Epidemiology Research Unit (EPI-Unit: UID-DTP/04750/2013). We gratefully acknowledge Dr Tiago Guimarães and Dr Isaac Barroso from the Department of Clinical Pathology of São João Hospital Center (Porto), and Daniela Ferreira from the Institute of Public Health of the University of Porto, for analyzing the serum biomarkers.

Author contributions

SV contributed to the design of study, performed statistical analyses and interpretation of the data and wrote the first draft of the paper. MS contributed the statistical analysis and to the interpretation of data. TM and ER contributed to the design of data collection instruments and contributed to the interpretation of data. CL contributed to the design of study, coordinated the design of data collection instruments and contributed to the discussion of results. All the authors critically reviewed the manuscript and approved the final version as submitted.


Generation XXI was funded by the Health Operational Programme—Saúde XXI, Community Support Framework III and the Regional Department of Ministry of Health. It was supported by the Calouste Gulbenkian Foundation, by FEDER from the Operational Programme Factors of Competitiveness—COMPETE and through national funding from the Foundation for Science and Technology – FCT (Portuguese Ministry of Education and Science) under the project PTDC/SAU-EPI/121532/2010 (FEDER-Operational Programme Factors of Competitiveness—COMPETE—FCOMP-01–0124-FEDER-021177), and the PhD Grant SFRH/BD/92389/2013 (SV).

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Correspondence to Sofia Vilela.

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Vilela, S., Severo, M., Moreira, T. et al. Evaluation of a short food frequency questionnaire for dietary intake assessment among children. Eur J Clin Nutr 73, 679–691 (2019). https://doi.org/10.1038/s41430-018-0200-4

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