Public Health Nutrition

Research Article

Adaptation and evaluation of the National Cancer Institute's Diet History Questionnaire and nutrient database for Canadian populations

Ilona Csizmadia1 c1, Lisa Kahlea2, Ruth Ullmana1, Ursula Dawea1, Thea Palmer Zimmermana3, Christine M Friedenreicha1, Heather Bryanta1 and Amy F Subara4

a1 Division of Population Health and Information, Alberta Cancer Board, 1331–29 Street NW, Calgary, Alberta, Canada, T2N 4N2

a2 Information Management Services, Inc., Bethesda, MD, USA

a3 Westat, Rockville, MD, USA

a4 National Cancer Institute, Bethesda, MD, USA


Background and objective Despite assumed similarities in Canadian and US dietary habits, some differences in food availability and nutrient fortification exist. Food-frequency questionnaires designed for the USA may therefore not provide the most accurate estimates of dietary intake in Canadian populations. Hence, we undertook to evaluate and modify the National Cancer Institute's Diet History Questionnaire (DHQ) and nutrient database.

Methods Of the foods queried on the DHQ, those most likely to differ in nutrient composition were identified. Where possible these foods were matched to comparable foods in the Canadian Nutrient File. Nutrient values were examined and modified to reflect the Canadian content of minerals (calcium, iron, zinc) and vitamins (A, C, D, thiamin, riboflavin, niacin, B6, folate and B12). DHQs completed by 13 181 Alberta Cohort Study participants aged 35–69 years were analysed to estimate nutrient intakes using the original US and modified versions of the DHQ databases. Misclassification of intake for meeting the Dietary Reference Intake (DRI) was determined following analysis with the US nutrient database.

Results Twenty-five per cent of 2411 foods deemed most likely to differ in nutrient profile were subsequently modified for folate, 11% for vitamin D, 10% for calcium and riboflavin, and between 7 and 10% for the remaining nutrients of interest. Misclassification with respect to meeting the DRI varied but was highest for folate (7%) and vitamin A (7%) among men, and for vitamin D (7%) among women over 50 years of age.

Conclusion Errors in nutrient intake estimates owing to differences in food fortification between the USA and Canada can be reduced in Canadian populations by using nutrient databases that reflect Canadian fortification practices.

(Received April 26 2005)

(Accepted January 25 2006)


c1 * Corresponding author: Email