Skip to main content Accessibility help
×
Home

Assessment of dietary fish consumption in pregnancy: comparing one-, four- and thirty-six-item questionnaires

  • Emily Oken (a1), Lauren B Guthrie (a1), Arienne Bloomingdale (a1), Matthew W Gillman (a1) (a2), Sjurdur F Olsen (a2), Chitra J Amarasiriwardena (a3), Deborah N Platek (a4), David C Bellinger (a5) and Robert O Wright (a5) (a6)...

Abstract

Objective

Fish consumption influences a number of health outcomes. Few studies have directly compared dietary assessment methods to determine the best approach to estimating intakes of fish and its component nutrients, including DHA, and toxicants, including methylmercury. Our objective was to compare three methods of assessing fish intake.

Design

We assessed 30 d fish intake using three approaches: (i) a single question on total fish consumption; (ii) a brief comprehensive FFQ that included four questions about fish; and (iii) a focused FFQ with thirty-six questions about different finfish and shellfish.

Setting

Obstetrics practices in Boston, MA, USA.

Subjects

Fifty-nine pregnant women who consumed ≤2 monthly fish servings.

Results

Estimated intakes of fish, DHA and Hg were lowest with the one-question screener and highest with the thirty-six-item fish questionnaire. Estimated intake of DHA with the thirty-six-item questionnaire was 4·4-fold higher (97 v. 22 mg/d), and intake of Hg was 3·8-fold higher (1·6 v. 0·42 μg/d), compared with the one-question screener. Plasma DHA concentration was correlated with fish intake assessed with the one-question screener (Spearman r = 0·27, P = 0·04), but not with the four-item FFQ (r = 0·08, P = 0·54) or the thirty-six-item fish questionnaire (r = 0·01, P = 0·93). In contrast, blood and hair Hg concentrations were similarly correlated with fish and Hg intakes regardless of the assessment method (r = 0·35 to 0·52).

Conclusions

A longer questionnaire provides no advantage over shorter questionnaires in ranking intakes of fish, DHA and Hg compared with biomarkers, but estimates of absolute intakes can vary by as much as fourfold across methods.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Assessment of dietary fish consumption in pregnancy: comparing one-, four- and thirty-six-item questionnaires
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Assessment of dietary fish consumption in pregnancy: comparing one-, four- and thirty-six-item questionnaires
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Assessment of dietary fish consumption in pregnancy: comparing one-, four- and thirty-six-item questionnaires
      Available formats
      ×

Copyright

Corresponding author

*Corresponding author: Email emily_oken@hphc.org

References

Hide All
1. Nesheim, M & Yaktine, A (2007) Seafood Choices: Balancing Benefits and Risks. Washington, DC: The National Academies Press.
2. Mahaffey, KR, Clickner, RP & Jeffries, RA (2008) Methylmercury and omega-3 fatty acids: co-occurrence of dietary sources with emphasis on fish and shellfish. Environ Res 107, 2029.
3. Debes, F, Budtz-Jorgensen, E, Weihe, P et al. (2006) Impact of prenatal methylmercury exposure on neurobehavioral function at age 14 years. Neurotoxicol Teratol 28, 536547.
4. Myers, GJ, Davidson, PW, Cox, C et al. (2003) Prenatal methylmercury exposure from ocean fish consumption in the Seychelles child development study. Lancet 361, 16861692.
5. Stern, AH & Korn, LR (2011) An approach for quantitatively balancing methylmercury risk and omega-3 benefit in fish consumption advisories. Environ Health Perspect 119, 10431046.
6. Oken, E & Bellinger, DC (2008) Fish consumption, methylmercury and child neurodevelopment. Curr Opin Pediatr 20, 178183.
7. Oken, E, Radesky, JS, Wright, RO et al. (2008) Maternal fish intake during pregnancy, blood mercury levels, and child cognition at age 3 years in a US cohort. Am J Epidemiol 167, 11711181.
8. Oken, E, Wright, RO, Kleinman, KP et al. (2005) Maternal fish consumption, hair mercury, and infant cognition in a US cohort. Environ Health Perspect 113, 13761380.
9. Lynch, ML, Huang, LS, Cox, C et al. (2010) Varying coefficient function models to explore interactions between maternal nutritional status and prenatal methylmercury toxicity in the Seychelles Child Development Nutrition Study. Environ Res 111, 7580.
10. Budtz-Jorgensen, E, Grandjean, P & Weihe, P (2007) Separation of risks and benefits of seafood intake. Environ Health Perspect 115, 323327.
11. Koletzko, B, Cetin, I & Thomas Brenna, J (2007) Dietary fat intakes for pregnant and lactating women. Br J Nutr 98, 873877.
12. Goyer, R, Aposhian, V, Arab, L et al. (2000) Toxicological Effects of Methylmercury. Washington, DC: National Academy Press.
13. Mahaffey, KR, Clickner, RP & Jeffries, RA (2009) Adult women's blood mercury concentrations vary regionally in the United States: association with patterns of fish consumption (NHANES 1999–2004). Environ Health Perspect 117, 4753.
14. Mahaffey, KR, Clickner, RP & Bodurow, CC (2004) Blood organic mercury and dietary mercury intake: National Health and Nutrition Examination Survey, 1999 and 2000. Environ Health Perspect 112, 562570.
15. Strom, S, Helmfrid, I, Glynn, A et al. (2011) Nutritional and toxicological aspects of seafood consumption – an integrated exposure and risk assessment of methylmercury and polyunsaturated fatty acids. Environ Res 111, 274280.
16. Gump, BB, MacKenzie, JA, Dumas, AK et al. (2011) Fish consumption, low-level mercury, lipids, and inflammatory markers in children. Environ Res 112, 204211.
17. Fillion, M, Mergler, D, Sousa Passos, CJ et al. (2006) A preliminary study of mercury exposure and blood pressure in the Brazilian Amazon. Environ Health 5, 29.
18. Turunen, AW, Mannisto, S, Kiviranta, H et al. (2010) Dioxins, polychlorinated biphenyls, methyl mercury and omega-3 polyunsaturated fatty acids as biomarkers of fish consumption. Eur J Clin Nutr 64, 313323.
19. Rees, JR, Sturup, S, Chen, C et al. (2007) Toenail mercury and dietary fish consumption. J Expo Sci Environ Epidemiol 17, 2530.
20. Olsen, SF, Hansen, HS, Sandstrom, B et al. (1995) Erythrocyte levels compared with reported dietary intake of marine n-3 fatty acids in pregnant women. Br J Nutr 73, 387395.
21. Oken, E, Guthrie, LB, Bloomingdale, A et al. (2013) A pilot randomized controlled trial to promote healthful fish consumption during pregnancy: the Food for Thought Study. Nutr J 12, 33.
22. Rifas-Shiman, SL, Willett, WC, Lobb, R et al. (2001) PrimeScreen, a brief dietary screening tool: reproducibility and comparability with both a longer food frequency questionnaire and biomarkers. Public Health Nutr 4, 249254.
23. Oken, E, Kleinman, KP, Olsen, SF et al. (2004) Associations of seafood and elongated n-3 fatty acid intake with fetal growth and length of gestation: results from a US pregnancy cohort. Am J Epidemiol 160, 774783.
24. Oken, E, Ning, Y, Rifas-Shiman, SL et al. (2007) Diet during pregnancy and risk of preeclampsia or gestational hypertension. Ann Epidemiol 17, 663668.
25. Iso, H, Rexrode, KM, Stampfer, MJ et al. (2001) Intake of fish and omega-3 fatty acids and risk of stroke in women. JAMA 285, 304312.
26. Hu, FB, Bronner, L, Willett, WC et al. (2002) Fish and omega-3 fatty acid intake and risk of coronary heart disease in women. JAMA 287, 18151821.
27. Rifas-Shiman, SL, Rich-Edwards, JW, Kleinman, KP et al. (2009) Dietary quality during pregnancy varies by maternal characteristics in Project Viva: a US cohort. J Am Diet Assoc 109, 10041011.
28. Schober, SE, Sinks, TH, Jones, RL et al. (2003) Blood mercury levels in US children and women of childbearing age, 1999–2000. JAMA 289, 16671674.
29. Bloomingdale, A, Guthrie, LB, Price, S et al. (2010) A qualitative study of fish consumption during pregnancy. Am J Clin Nutr 92, 12341240.
30. US Department of Agriculture (2011) USDA National Nutrient Database for Standard Reference, Release 24. http://www.ars.usda.gov/services/docs.htm?docid=8964 (accessed January 2013).
31. Food and Drug Administration (2011) Mercury Levels in Commercial Fish and Shellfish (1990–2010). http://www.fda.gov/food/foodsafety/product-specificinformation/seafood/foodbornepathogenscontaminants/methylmercury/ucm115644.htm (accessed January 2013).
32. Groth, E 3rd (2010) Ranking the contributions of commercial fish and shellfish varieties to mercury exposure in the United States: implications for risk communication. Environ Res 110, 226236.
33. Hu, FB, Rimm, E, Smith-Warner, SA et al. (1999) Reproducibility and validity of dietary patterns assessed with a food-frequency questionnaire. Am J Clin Nutr 69, 243249.
34. Rifas-Shiman, SL, Fawzi, W, Rich-Edwards, JW et al. (2000) Validity of a semi-quantitative food frequency questionnaire (SFFQ) during early pregnancy. Paediatr Perinatal Epidemiol 14, A25A26.
35. Donahue, SM, Rifas-Shiman, SL, Olsen, SF et al. (2009) Associations of maternal prenatal dietary intake of n-3 and n-6 fatty acids with maternal and umbilical cord blood levels. Prostaglandins Leukot Essent Fatty Acids 80, 289296.
36. National Research Council (2000) Toxicological Effects of Methylmercury. Washington, DC: National Academy Press.
37. Morrissette, J, Takser, L, St-Amour, G et al. (2004) Temporal variation of blood and hair mercury levels in pregnancy in relation to fish consumption history in a population living along the St. Lawrence River. Environ Res 95, 363374.
38. Baylin, A, Kabagambe, EK, Siles, X et al. (2002) Adipose tissue biomarkers of fatty acid intake. Am J Clin Nutr 76, 750757.
39. Bland, JM & Altman, DG (1999) Measuring agreement in method comparison studies. Stat Methods Med Res 8, 135160.
40. Food and Drug Administration (2004) What You Need to Know About Mercury in Fish and Shellfish (Brochure). http://www.fda.gov/downloads/Food/ResourcesForYou/Consumers/UCM182158.pdf (accessed November 2011).
41. Sunderland, EM (2007) Mercury exposure from domestic and imported estuarine and marine fish in the US seafood market. Environ Health Perspect 115, 235242.
42. Food and Drug Administration (2012) Total Diet Study. April 2001; Updated July 2008, January 2011, February 2012. http://www.fda.gov/Food/FoodSafety/FoodContaminantsAdulteration/TotalDietStudy/ucm184293.htm (accessed March 2012).
43. Wall, R, Ross, RP, Fitzgerald, GF et al. (2010) Fatty acids from fish: the anti-inflammatory potential of long-chain omega-3 fatty acids. Nutr Rev 68, 280289.
44. Baylin, A, Kim, MK, Donovan-Palmer, A et al. (2005) Fasting whole blood as a biomarker of essential fatty acid intake in epidemiologic studies: comparison with adipose tissue and plasma. Am J Epidemiol 162, 373381.
45. Willett, W (1998) Nutritional Epidemiology. New York: Oxford University Press.
46. Willett, WC, Sampson, L, Stampfer, MJ et al. (1985) Reproducibility and validity of a semiquantitative food frequency questionnaire. Am J Epidemiol 122, 5165.
47. Hibbeln, JR, Davis, JM, Steer, C et al. (2007) Maternal seafood consumption in pregnancy and neurodevelopmental outcomes in childhood (ALSPAC study): an observational cohort study. Lancet 369, 578585.
48. Tamburlini, G & Barbone, F (2007) Maternal fish consumption and children's development. Lancet 369, 11661167.
49. Stern, AH & Rice, DC (2007) Maternal seafood consumption and children's development. Lancet 370, 217218.
50. Groth, E 3rd (2008) Re: ‘Maternal fish intake during pregnancy, blood mercury levels, and child cognition at age 3 years in a US cohort’. Am J Epidemiol 168, 236.

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed