Public Health Nutrition

Assessment and methodology

Validating an FFQ for intake of episodically consumed foods: application to the National Institutes of Health–AARP Diet and Health Study

Douglas Midthunea1 c1, Arthur Schatzkina2, Amy F Subara3, Frances E Thompsona3, Laurence S Freedmana4, Raymond J Carrolla5, Marina A Shumakovicha1 and Victor Kipnisa1

a1 Biometry Research Group, Division of Cancer Prevention, National Cancer Institute, Executive Plaza North – Suite 3131, 6130 Executive Blvd – MSC 7354, Bethesda, MD 20892-7354, USA

a2 Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA

a3 Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA

a4 Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel

a5 Department of Statistics, Texas A&M University, College Station, TX, USA


Objective To develop a method to validate an FFQ for reported intake of episodically consumed foods when the reference instrument measures short-term intake, and to apply the method in a large prospective cohort.

Design The FFQ was evaluated in a sub-study of cohort participants who, in addition to the questionnaire, were asked to complete two non-consecutive 24 h dietary recalls (24HR). FFQ-reported intakes of twenty-nine food groups were analysed using a two-part measurement error model that allows for non-consumption on a given day, using 24HR as a reference instrument under the assumption that 24HR is unbiased for true intake at the individual level.

Setting The National Institutes of Health–AARP Diet and Health Study, a cohort of 567 169 participants living in the USA and aged 50–71 years at baseline in 1995.

Subjects A sub-study of the cohort consisting of 2055 participants.

Results Estimated correlations of true and FFQ-reported energy-adjusted intakes were 0·5 or greater for most of the twenty-nine food groups evaluated, and estimated attenuation factors (a measure of bias in estimated diet–disease associations) were 0·4 or greater for most food groups.

Conclusions The proposed methodology extends the class of foods and nutrients for which an FFQ can be evaluated in studies with short-term reference instruments. Although violations of the assumption that the 24HR is unbiased could be inflating some of the observed correlations and attenuation factors, results suggest that the FFQ is suitable for testing many, but not all, diet–disease hypotheses in a cohort of this size.

(Received October 10 2010)

(Accepted February 20 2011)

(Online publication April 13 2011)


c1 Corresponding author: Email