Public Health Nutrition

Research Paper

Reliability and validity of a semi-quantitative FFQ for sodium intake in low-income and low-literacy Brazilian hypertensive subjects

Maria-Carolina S Ferreira-Saea1, Maria-Cecilia BJ Gallania1 c1, Wilson Nadruz Jra2, Roberta CM Rodriguesa1, Kleber G Franchinia2, Poliana C Cabrala3 and Maria Lilian Salesa2

a1 Department of Nursing, Faculty of Medical Sciences, University of Campinas, Cidade Universitária ‘Zeferino Vaz’, 13081-970 Campinas, SP, Brazil

a2 Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil

a3 Nutrition Department of the Health Sciences, Federal University of Pernambuco, Recife, Brazil


Objective To assess the reliability and validity of an FFQ to evaluate dietary patterns of Na consumption among low-income and low-literacy Brazilian hypertensive subjects.

Design The initial FFQ was submitted to content analysis with the pre-test administered to fifteen subjects. Reliability was evaluated according to the reproducibility criterion, with interviewer administration of the FFQ twice within a 15 d interval. Validity was assessed against a 24 h recall (132 subjects), a 3 d diet record (121 subjects) and a biomarker (24 h urinary Na; 121 subjects). To test the correlation with the biomarker, discretionary salt was added to the FFQ Na values.

Setting A large urban teaching hospital in south-eastern Brazil.

Subjects The study was based on 132 randomly selected subjects (eighty-three women and forty-nine men) aged 18 to 85 years.

Results Kappa coefficients ranged from 0·79 to 0·98, confirming the reproducibility of the FFQ. There was no correlation between urinary Na excretion, the FFQ and the 24 h recall for the general sample, although significant correlations had been observed when methods were summed up (24 h recall + discretionary salt + FFQ; 0·32, P = 0·01). The addition of discretionary salt significantly improved the biomarker-based FFQ validity, with correlation coefficients varying from 0·19 (general sample) to 0·31 (female sub-sample).

Conclusions The developed FFQ demonstrated satisfactory evidence of validity and reliability and can be used as an important complementary tool for the evaluation of Na intake among Brazilian hypertensive subjects.

(Received April 15 2008)

(Accepted March 23 2009)

(Online publication May 28 2009)


c1 Corresponding author: Email