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Evaluation of a screener to assess diet quality in the Netherlands

  • Linde van Lee (a1), Edith J. M. Feskens (a1), Saskia Meijboom (a1), Eveline J. C. Hooft van Huysduynen (a1), Pieter van’t Veer (a1), Jeanne H. M. de Vries (a1) and Anouk Geelen (a1)...

Generally, there is a need for short questionnaires to estimate diet quality in the Netherlands. We developed a thirty-four-item FFQ – the Dutch Healthy Diet FFQ (DHD-FFQ) – to estimate adherence to the most recent Dutch guidelines for a healthy diet of 2006 using the DHD-index. The objectives of the present study were to evaluate the DHD-index derived from the DHD-FFQ by comparing it with the index based on a reference method and to examine associations with participant characteristics, nutrient intakes and levels of cardiometabolic risk factors. Data of 1235 Dutch men and women, aged between 20 and 70 years, participating in the Nutrition Questionnaires plus study were used. The DHD-index was calculated from the DHD-FFQ and from a reference method consisting of a 180-item FFQ combined with a 24-h urinary Na excretion value. Ranking was studied using Spearman’s correlations, and absolute agreement was studied using a Bland–Altman plot. Nutrient intakes derived from the 180-item FFQ were studied according to quintiles of the DHD-index using DHD-FFQ data. The correlation between the DHD-index derived from the DHD-FFQ and the reference method was 0·56 (95 % CI 0·52, 0·60). The Bland–Altman plot showed a small mean overestimation of the DHD-index derived from the DHD-FFQ compared with the reference method. The DHD-index score was in the favourable direction associated with most macronutrient and micronutrient intakes when adjusted for energy intake. No associations between the DHD-index score and cardiometabolic risk factors were observed. In conclusion, the DHD-index derived from the DHD-FFQ was considered acceptable in ranking but relatively poor in individual assessment of diet quality.

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* Corresponding author: A. Geelen, email
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1. WHO Regional Office for Europe (2008) WHO European Action Plan for Food and Nutrition Policy 2007–2012. Copenhagen: WHO.
2. Health Council of the Netherlands (2006) Guidelines for a Healthy Diet 2006. Publication no. 2006/21. The Hague: Health Council of the Netherlands.
3. van Lee, L, Geelen, A, van Huysduynen, EJ, et al. (2012) The Dutch Healthy Diet index (DHD-index): an instrument to measure adherence to the Dutch guidelines for a healthy diet. Nutr J 11, 19.
4. van Lee, L, Feskens, EJ, Hooft van Huysduynen, EJ, et al. (2014) The Dutch Healthy Diet index as assessed by 24 h recalls and FFQ: associations with biomarkers from a cross-sectional study. J Nutr Sci 2, e40.
5. Paxton, AE, Strycker, LA, Toobert, DJ, et al. (2011) Starting the conversation performance of a brief dietary assessment and intervention tool for health professionals. Am J Prev Med 40, 6771.
6. Schröder, H, Fitó, M, Estruch, R, et al. (2011) A short screener is valid for assessing Mediterranean diet adherence among older Spanish men and women. J Nutr 141, 11401145.
7. Mochari, H, Gao, Q & Mosca, L (2008) Validation of the MEDFICTS dietary assessment questionnaire in a diverse population. J Am Diet Assoc 108, 817822.
8. 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.
9. Apovian, CM, Murphy, MC, Cullum-Dugan, D, et al. (2010) Validation of a web-based dietary questionnaire designed for the DASH (Dietary Approaches to Stop Hypertension) diet: the DASH online questionnaire. Public Health Nutr 13, 615622.
10. Schröder, H, Benitez Arciniega, A, Soler, C, et al. (2012) Validity of two short screeners for diet quality in time-limited settings. Public Health Nutr 15, 618626.
11. Siebelink, E, Geelen, A & de Vries, JHM (2011) Self-reported energy intake by FFQ compared with actual energy intake to maintain body weight in 516 adults. Br J Nutr 106, 274281.
12. Feunekes, GI, Van Staveren, WA, De Vries, JH, et al. (1993) Relative and biomarker-based validity of a food-frequency questionnaire estimating intake of fats and cholesterol. Am J Clin Nutr 58, 489496.
13. Streppel, MT, De Vries, JH, Meijboom, S, et al. (2013) Relative validity of the food frequency questionnaire used to assess dietary intake in the Leiden Longevity Study. Nutr J 12, 18.
14. Wendel-Vos, GCW, Schuit, AJ, Saris, WHM, et al. (2003) Reproducibility and relative validity of the short questionnaire to assess health-enhancing physical activity. J Clin Epidemiol 56, 11631169.
15. Molag, ML (2010) Towards transparent development of food frequency questionnaires. Scientific basis of the Dutch FFQ-TOOLTM: a computer system to generate, apply and process FFQs. Thesis, Wageningen University, Wageningen.
16. van Rossum, CTM, Fransen, HP, Verkaik-Kloosterman, J, et al. (2011) Dutch National Food Consumption Survey 2007–2010, RIVM Report 350050006/2011. Bilthoven, the Netherlands: National Institute for Public Health and the Environment.
17. Block, G, Dresser, CM, Hartman, AM, et al. (1985) Nutrient sources in the American diet: quantitative data from the NHANES II survey. I. Vitamins and minerals. Am J Epidemiol 122, 2740.
18. Block, G, Hartman, AM, Dresser, CM, et al. (1986) A data-based approach to diet questionnaire design and testing. Am J Epidemiol 124, 453469.
19. Mark, SD, Thomas, DG & Decarli, A (1996) Measurement of exposure to nutrients: an approach to the selection of informative foods. Am J Epidemiol 143, 514521.
20. NEVO-tabel (2011) Dutch Food Composition Table 2011/version 3. Bilthoven, the Netherlands: RIVM/Dutch Nutrition Centre.
21. Anonymous (1998) Basisrapportage en tabellen voedselconsumptiepeiling 1997-1998 en gegevens op het niveau van voedingsmiddelen en voedingsstoffen over een periode van tien jaar (Report and Tables of the Food Consumption Survey 1997–1998 and Information on Foods and Nutrients Over a Period of 10 Years). Zeist: TNO Voeding.
22. Brown, IJ, Tzoulaki, I, Candeias, V, et al. (2009) Salt intakes around the world: implications for public health. Int J Epidemiol 38, 791813.
23. Jakobsen, J, Ovesen, L, Fagt, S, et al. (1997) Para-aminobenzoic acid used as a marker for completeness of 24 hour urine: assessment of control limits for a specific HPLC method. Eur J Clin Nutr 51, 514519.
24. Johansson, G, Bingham, S & Vahter, M (1999) A method to compensate for incomplete 24-hour urine collections in nutritional epidemiology studies. Public Health Nutr 2, 587591.
25. Hagfors, L, Westerterp, K, Skoldstam, L, et al. (2005) Validity of reported energy expenditure and reported intake of energy, protein, sodium and potassium in rheumatoid arthritis patients in a dietary intervention study. Eur J Clin Nutr 59, 238245.
26. Holbrook, JT, Patterson, KY & Bodner, JE (1984) Sodium and potassium intake and balance in adults consuming self-selected diets. Am J Clin Nutr 40, 786793.
27. Mulder, M (2013) Zware drinkers 2012 (Heavy drinkers 2012). In Volksgezondheid Toekomst Verkenning, Nationale Atlas Volksgezondheid. Bilthoven: RIVM.
28. Health Council of the Netherlands (2001) Dietary Reference Intakes: Energy, Proteins, Fats and Digestible Carbohydrates. Publication no. 2001/19R. The Hague: Health Council of the Netherlands.
29. Mattes, RD & Donnelly, D (1991) Relative contributions of dietary sodium sources. J Am Coll Nutr 10, 383393.
30. Health Council of the Netherlands (2000) Salt and Blood Pressure. Publication no. 2000/13. The Hague: Health Council of the Netherlands.
31. Allain, CC, Poon, LS, Chan, CSG, et al. (1974) Enzymatic determination of total serum cholesterol. Clin Chem 20, 470475.
32. Bland, JM & Altman, DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet i, 307310.
33. Newby, PK, Hu, FB, Rimm, EB, et al. (2003) Reproducibility and validity of the diet quality index revised as assessed by use of a food-frequency questionnaire. Am J Clin Nutr 78, 941949.
34. Bingham, SA, Williams, R, Cole, TJ, et al. (1988) Reference values for analytes of 24-h urine collections known to be complete. Ann Clin Biochem 25, 610619.
35. Struijk, EA, May, AM, Beulens, JW, et al. (2014) Adherence to the Dutch guidelines for a healthy diet and cancer risk in the European Prospective Investigation into Cancer and Nutrition-Netherlands (EPIC-NL) cohort. Public Health Nutr 17, 25462553.
36. Molag, ML, De Vries, JHM, Ocké, MC, et al. (2007) Design characteristics of food frequency questionnaires in relation to their validity. Am J Epidemiol 166, 14681478.
37. Bondia-Pons, I, Mayneris-Perxachs, J, Serra-Majem, L, et al. (2010) Diet quality of a population sample from coastal north-east Spain evaluated by a Mediterranean adaptation of the diet quality index (DQI). Public Health Nutr 13, 1224.
38. Hashimoto, T, Yagami, F, Owada, M, et al. (2008) Salt preference according to a questionnaire vs. dietary salt intake estimated by a spot urine method in participants at a health check-up center. Intern Med 47, 399403.
39. Charlton, KE, Steyn, K, Levitt, NS, et al. (2008) Development and validation of a short questionnaire to assess sodium intake. Public Health Nutr 11, 8394.
40. van Gelder, MM, Bretveld, RW & Roeleveld, N (2010) Web-based questionnaires: the future in epidemiology? Am J Epidemiol 172, 12921298.
41. Beasley, JM, Davis, A & Riley, WT (2009) Evaluation of a web-based, pictorial diet history questionnaire. Public Health Nutr 12, 651659.
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