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Clinical nutrition

Development and validation of processed foods questionnaire (PFQ) in adult inflammatory bowel diseases patients

European Journal of Clinical Nutrition volume 74, pages 1653–1660 (2020)Cite this article

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Abstract

Background

Processed foods have been implicated in the pathogenesis of inflammatory bowel diseases (IBD). Our goal was to develop a validated processed foods frequency questionnaire (PFQ) and assess its reliability and validity.

Methods

We recruited adult IBD patients to fill-in a PFQ in this prospective single-center study. Food intake was categorized into three groups of processed food levels: unprocessed, processed, and ultra-processed. Reliability was assessed by comparing the PFQ results of each patient at 2 time points. Validity was assessed by comparing the PFQ results to a 3–7 day food diary (FD), and by comparing urine sodium as a biomarker for the high intake of sodium that is mostly present in processed food.

Results

Eighty-six IBD patients were enrolled. Good test–retest reliability was indicated by intraclass correlation of 0.75–0.88 for the different food processing levels. Validity was fair-to-strong as assessed by correlations for different levels of processed food intake between FDs and PFQ, ranging between 0.43 and 0.64 (Pearsonr, P < 0.001), and further supported by higher mean urine sodium levels in patients with high processed foods consumption compared with low consumption (104.57 ± 53.26 vs. 78.62 ± 39.08 mmol/L, respectively, P = 0.022). Agreement between PFQ and the FD in categorizing patients to high and low processed food consumption groups was fair (Kappa 0.23–0.35).

Conclusions

The PFQ is a reliable and valid tool for the assessment of processed foods consumption in IBD patients and can be utilized for studying the association between processed food consumption and IBD etiopathogenesis.

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Fig. 1: Distribution of unprocessed/processed/ultra-processed daily food consumption according to food diary across high and low levels of consumption of unprocessed/processed/ultra-processed foods according to the PFQ.
Fig. 2: Correlation between the PFQ and food diary for the number of daily portions of unprocessed/processed/ultra-processed foods.
Fig. 3: Distribution of urine sodium levels (mmol/l) across the high and low processed food consumption groups.

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Authors and Affiliations

  1. IBD Center, Department of Gastroenterology and Liver Diseases, Tel-Aviv Medical Center, Tel-Aviv, Israel

    Chen Sarbagili-Shabat, Shira Zelber-Sagi, Naomi Fliss Isakov, Yulia Ron, Ayal Hirsch & Nitsan Maharshak

  2. The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    Chen Sarbagili-Shabat & Nitsan Maharshak

  3. School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel

    Shira Zelber-Sagi

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  1. Chen Sarbagili-Shabat
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Contributions

The authors’ responsibilities were as follows—CSS: conceived and designed the study, did the data collection, performed the statistical analysis, and wrote the paper; SZS: conceived and designed the study, provided statistical input, helped with interpretation of the results, and reviewed the paper for important intellectual content; NFI, YR, and AH: contributed to data collection; NM: conceived and designed the study, supervised on data collection, helped with interpretation of the results, and reviewed the paper for important intellectual content; all the authors read and approved the final paper.

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Correspondence to Chen Sarbagili-Shabat.

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Sarbagili-Shabat, C., Zelber-Sagi, S., Fliss Isakov, N. et al. Development and validation of processed foods questionnaire (PFQ) in adult inflammatory bowel diseases patients. Eur J Clin Nutr 74, 1653–1660 (2020). https://doi.org/10.1038/s41430-020-0632-5

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