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Development and evaluation of a Nutrition Transition-FFQ for adolescents in South India

  • Nida I Shaikh (a1), Jennifer K Frediani (a2), Usha Ramakrishnan (a1) (a3), Shailaja S Patil (a4), Kathryn M Yount (a3) (a5), Reynaldo Martorell (a1) (a3), KM Venkat Narayan (a1) (a3) and Solveig A Cunningham (a1) (a3) (a5)...



To develop and evaluate a Nutrition Transition-FFQ (NT-FFQ) to measure nutrition transition among adolescents in South India.


We developed an interviewer-administered NT-FFQ comprising a 125-item semi-quantitative FFQ and a twenty-seven-item eating behaviour survey. The reproducibility and validity of the NT-FFQ were assessed using Spearman correlations, intra-class correlation coefficients (ICC), and levels of agreement using Bland–Altman and cross-classification over 2 months (NT-FFQ1 and NT-FFQ2). Validity of foods was evaluated against three 24-h dietary recalls (24-HR). Face validity of eating behaviours was evaluated through semi-structured cognitive interviews. The reproducibility of eating behaviours was assessed using weighted kappa (κ w) and cross-classification analyses.


Vijayapura, India.


A representative sample of 198 adolescents aged 14–18 years.


Reproducibility of NT-FFQ: Spearman correlations ranged from 0·33 (pulses) to 0·80 (red meat) and ICC from 0·05 (fruits) to 1·00 (tea). On average, concordance (agreement) was 60 % and discordance was 7 % for food groups. For eating behaviours, κ w ranged from 0·24 (eating snacks while watching television) to 0·67 (eating lunch at home) with a mean of 0·40. Validity of NT-FFQ: Spearman correlations ranged from 0·11 (fried traditional foods) to 0·70 (tea) and ICC ranged from 0·02 (healthy global foods) to 1·00 (grains). The concordance and discordance were 48 % and 8 %, respectively. Bland–Altman plots showed acceptable agreement between NT-FFQ2 and 24-HR. The eating behaviours had acceptable face validity.


The NT-FFQ has good reproducibility and acceptable validity for food intake and eating behaviours. The NT-FFQ can quantify the nutrition transition among Indian adolescents.

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1. Popkin, BM, Horton, S, Kim, S et al. (2001) Trends in diet, nutritional status, and diet-related noncommunicable diseases in China and India: the economic costs of the nutrition transition. Nutr Rev 59, 379390.
2. Popkin, BM (1994) The nutrition transition in low-income countries: an emerging crisis. Nutr Rev 52, 285298.
3. Drewnowski, A & Popkin, BM (1997) The nutrition transition: new trends in the global diet. Nutr Rev 55, 3143.
4. Satia, JA (2010) Dietary acculturation and the nutrition transition: an overview. Appl Physiol Nutr Metab 35, 219223.
5. Popkin, BM & Gordon-Larsen, P (2004) The nutrition transition: worldwide obesity dynamics and their determinants. Int J Obes Relat Metab Disord 28, Suppl. 3, S2S9.
6. Zingoni, C, Norris, SA, Griffiths, PL et al. (2009) Studying a population undergoing nutrition transition: a practical case study of dietary assessment in urban South African adolescents. Ecol Food Nutr 48, 178198.
7. Singhal, S, Goyle, A & Gupta, R (1998) Quantitative food frequency questionnaire and assessment of dietary intake. Natl Med J India 11, 268275.
8. Adair, LS & Popkin, BM (2005) Are child eating patterns being transformed globally? Obes Res 13, 12811299.
9. Kuriyan, R, Bhat, S, Thomas, T et al. (2007) Television viewing and sleep are associated with overweight among urban and semi-urban South Indian children. Nutr J 6, 25.
10. Dasen, P (2000) Rapid social change and the turmoil of adolescence: a cross-cultural perspective. Int J Group Tensions 29, 1749.
11. UNICEF (2011) The State of the World’s Children 2011. Adolescence: An Age of Opportunity. New York: UNICEF.
12. Patel, SA, Narayan, KM & Cunningham, SA (2015) Unhealthy weight among children and adults in India: urbanicity and the crossover in underweight and overweight. Ann Epidemiol 25, 336341.e2.
13. Swaminathan, S, Thomas, T, Kurpad, AV et al. (2007) Dietary patterns in urban school children in South India. Indian Pediatr 44, 593596.
14. Vijayapushpam, T, Menon, KK, Raghunatha Rao, D et al. (2003) A qualitative assessment of nutrition knowledge levels and dietary intake of schoolchildren in Hyderabad. Public Health Nutr 6, 683688.
15. Raghunatha Rao, D, Antony, GM, Sarma, KVR et al. (2007) Dietary habits and effect of two different educational tools on nutrition knowledge of school going adolescent girls in Hyderabad, India. Eur J Clin Nutr 61, 10811085.
16. National Institute of Nutrition (2000) Diet and nutritional status of adolescents. In National Nutrition Monitoring Bureau, Special Report. NNMB Technical Report no. 20, pp. 1–25. Hyderabad: NIN.
17. Rockett, HR, Berkey, CS & Colditz, GA (2003) Evaluation of dietary assessment instruments in adolescents. Curr Opin Clin Nutr Metab Care 6, 557562.
18. Slater, B, Enes, CC, Lopez, RV et al. (2010) Validation of a food frequency questionnaire to assess the consumption of carotenoids, fruits and vegetables among adolescents: the method of triads. Cad Saude Publica 26, 20902100.
19. Jayawardena, R, Swaminathan, S, Byrne, NM et al. (2012) Development of a food frequency questionnaire for Sri Lankan adults. Nutr J 11, 63.
20. Government of India, Ministry of Micro Small and Medium Enterprises (2011) Brief Industrial Profile of Bijapur District. Bijapur: Government of Karnataka.
21. Shaikh, NI, Patil, SS, Halli, S et al. (2016) Going global: Indian adolescents’ eating patterns. Public Health Nutr 19, 27992807.
22. Borgatti, S (1999) Elicitation techniques for cultural domain analysis. In Ethnographer’s Toolkit. vol. 3: Enhanced Ethnographic Methods: Audiovisual Techniques, Focused Group Interviews, and Elicitation Techniques, pp. 115151 [JJ Schensul, MD LeCompte, BK Natasi et al., editors]. Walnut Creek, CA: AltaMira.
23. Wang, Z, Zhai, F, Du, S et al. (2008) Dynamic shifts in Chinese eating behaviors. Asia Pac J Clin Nutr 17, 123130.
24. Salvini, S, Hunter, DJ, Sampson, L et al. (1989) Food-based validation of a dietary questionnaire: the effects of week-to-week variation in food consumption. Int J Epidemiol 18, 858867.
25. National Insitute of Nutrition, Indian Council of Medical Research (2011) Dietary Guildelines for Indians, 2011 edition. Hyderabad: NIN.
26. Cade, JE, Burley, VJ, Warm, DL et al. (2004) Food-frequency questionnaires: a review of their design, validation and utilisation. Nutr Res Rev 17, 522.
27. Subar, AF, Thompson, FE, Smith, AF et al. (1995) Improving food frequency questionnaires: a qualitative approach using cognitive interviewing. J Am Diet Assoc 95, 781788.
28. Thompson, FE, Subar, AF, Brown, CC et al. (2002) Cognitive research enhances accuracy of food frequency questionnaire reports: results of an experimental validation study. J Am Diet Assoc 102, 212225.
29. Staab, EM, Cunningham, SA, Thorpe, S et al. (2006) A ‘snapshot’ of nutrition and physical activity among private school adolescents in rural India. Childhood 23, 537–553.
30. Millen, AE, Midthune, D, Thompson, FE et al. (2006) The National Cancer Institute diet history questionnaire: validation of pyramid food servings. Am J Epidemiol 163, 279288.
31. Bohlscheid-Thomas, S, Hoting, I, Boeing, H et al. (1997) Reproducibility and relative validity of food group intake in a food frequency questionnaire developed for the German part of the EPIC project. European Prospective Investigation into Cancer and Nutrition. Int J Epidemiol 26, Suppl. 1, S59S70.
32. Midthune, D, Schatzkin, A, Subar, AF et al. (2011) Validating an FFQ for intake of episodically consumed foods: application to the National Institutes of Health–AARP Diet and Health Study. Public Health Nutr 14, 12121221.
33. Huybrechts, I, De Backer, G, De Bacquer, D et al. (2009) Relative validity and reproducibility of a food-frequency questionnaire for estimating food intakes among Flemish preschoolers. Int J Environ Res Public Health 6, 382399.
34. Ocke, MC, Bueno-de-Mesquita, HB, Goddijn, HE et al. (1997) The Dutch EPIC food frequency questionnaire. I. Description of the questionnaire, and relative validity and reproducibility for food groups. Int J Epidemiol 26, Suppl. 1, S37S48.
35. Haftenberger, M, Heuer, T, Heidemann, C et al. (2010) Relative validation of a food frequency questionnaire for national health and nutrition monitoring. Nutr J 9, 36.
36. Zhuang, M, Yuan, Z, Lin, L et al. (2012) Reproducibility and relative validity of a food frequency questionnaire developed for adults in Taizhou, China. PLoS One 7, e48341.
37. Bowen, L, Bharathi, AV, Kinra, S et al. (2012) Development and evaluation of a semi-quantitative food frequency questionnaire for use in urban and rural India. Asia Pac J Clin Nutr 21, 355360.
38. Mahajan, R, Malik, M, Bharathi, AV et al. (2013) Reproducibility and validity of a quantitative food frequency questionnaire in an urban and rural area of northern India. Natl Med J India 26, 266272.
39. Araujo, MC, Yokoo, EM & Pereira, RA (2010) Validation and calibration of a semiquantitative food frequency questionnaire designed for adolescents. J Am Diet Assoc 110, 11701177.
40. Tabacchi, G, Filippi, AR, Breda, J et al. (2015) Comparative validity of the ASSO-Food Frequency Questionnaire for the web-based assessment of food and nutrients intake in adolescents. Food Nutr Res 59, 26216.
41. Willett, W (2013) Nutritional Epidemiology , 3rd ed. Oxford: Oxford University Press.
42. Colditz, GA, Willett, WC, Stampfer, MJ et al. (1987) The influence of age, relative weight, smoking, and alcohol intake on the reproducibility of a dietary questionnaire. Int J Epidemiol 16, 392398.
43. Wiecha, JM, Hebert, JR & Lim, M (1994) Diet measurement in Vietnamese youth: concurrent reliability of a self-administered food frequency questionnaire. J Community Health 19, 181188.
44. Graham, S, Lilienfeld, AM & Tidings, JE (1967) Dietary and purgation factors in the epidemiology of gastric cancer. Cancer 20, 22242234.
45. Acheson, ED & Doll, R (1964) Dietary factors in carcinoma of the stomach: a study of 100 cases and 200 controls. Gut 5, 126131.
46. Samaras, K, Kelly, PJ, Chiano, MN et al. (1998) Genes versus environment. The relationship between dietary fat and total and central abdominal fat. Diabetes Care 21, 20692076.
47. Bland, JM & Altman, DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1, 307310.
48. Rockett, HR, Breitenbach, M, Frazier, AL et al. (1997) Validation of a youth/adolescent food frequency questionnaire. Prev Med 26, 808816.
49. Livingstone, MB, Robson, PJ & Wallace, JM (2004) Issues in dietary intake assessment of children and adolescents. Br J Nutr 92, Suppl. 2, S213S222.
50. Hebert, JR, Gupta, PC, Bhonsle, RB et al. (2002) Dietary exposures and oral precancerous lesions in Srikakulam District, Andhra Pradesh, India. Public Health Nutr 5, 303312.
51. Emmons, L & Hayes, M (1973) Accuracy of 24-hr. recalls of young children. J Am Diet Assoc 62, 409415.
52. Jenner, DA, Neylon, K, Croft, S et al. (1989) A comparison of methods of dietary assessment in Australian children aged 11–12 years. Eur J Clin Nutr 43, 663673.
53. Cade, J, Thompson, R, Burley, V et al. (2002) Development, validation and utilisation of food-frequency questionnaires – a review. Public Health Nutr 5, 567587.


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