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Food Frequency Questionnaires: Are they appropriate for foods that are consumed irregularly, such as eggs?
- Emmy van den Heuvel, Jane L. Murphy, Katherine M. Appleton
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- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E515
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- Article
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Eggs tend to be eaten irregularly, e.g. they are often eaten as a standby for unplanned meals, and have been reported to be eaten as a treat or on special occasions. This intrapersonal variation may impact the accuracy of measuring the habitual intake of eggs. Food frequency questionnaires (FFQs) are often validated for nutrients but not foods, and may not be suitable for measuring the consumption of individual foods. The validity of measuring the consumption of specific foods can be particularly affected for foods with a greater within-person variation. Moreover, FFQs rarely include a detailed intake measure of eggs, and often do not include eggs in mixed dishes. With epidemiological studies focussing on individual foods to assess associations between foods and diseases, it is important to consider the accuracy of dietary assessment methods in measuring intake of individual foods.
In the current study we compare egg intake data from a validated FFQ and egg intake data from an FFQ specifically designed to measure egg intake. Both questionnaires were completed by a sample of 100 community-dwelling healthy older adults, which included 54 females and 46 males, with mean age 70 (SD = 7) years. Both FFQs had a similar layout, but the validated FFQ section on egg intake consisted of three questions on egg intake, while the egg FFQ included 18 preparations of eggs, including mixed dishes.
Mean monthly egg consumption for the validated FFQ was 16 (SD = 13) eggs, while the egg FFQ showed an egg intake of 22 (SD = 16) eggs per month, suggesting under- or over-reporting on one or both measures. Although the mean values are noticeably different, validated FFQ egg intake correlates strongly with egg FFQ intake (r = .773, p < .001).
National Diet and Nutrition Survey data indicates that British older adults (65 years + ) consume 33 g of eggs/egg dishes per day, the equivalent of 16–17 eggs per month. This means that the validated FFQ egg intake of 16 eggs per month is more similar to the NDNS data. However, FFQs generally tend to overestimate food intake compared to diet records and the validated FFQ is validated for the total nutrient intake, not for individual foods. With only three questions and without including mixed dishes, the validated FFQ may under-estimate intake of eggs, while the egg FFQ may be more comprehensive. More research is needed to explore the most appropriate methods for measuring intakes of foods that are irregularly consumed, such as eggs.
Evaluating individual differences in a food based approach to increase egg and protein intake in older adults.
- Emmy van den Heuvel, Jane L. Murphy, Katherine M Appleton
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- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E225
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- Article
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A randomized controlled intervention study was undertaken to increase egg and protein intake in community-dwelling adults over 55 years old. During a 12 week intervention, recipes for protein-rich egg-based meals and single-use herbs/spice packets were provided to 53 individuals in the intervention group to promote the addition of flavour and variety to the diet. Egg intakes increased by 20%, and this increase was sustained up to 12 weeks after the end of the intervention. Exploratory analyses however revealed some individual differences within the intervention group, where some participants increased their egg intake and others did not.
We compared the participants who increased their egg intake to those who did not on several demographic characteristics and baseline outcomes, and explored the qualitative feedback related to recipe use collected after the intervention.
Results show that the participants who increased their egg intake during the intervention (n = 27) had a significantly higher BMI (U = 402, p = .035), a lower health-related quality of life (U = 198, p = .047), and take external reports and recommendations about eggs and health from media and health professionals more seriously (U = 399, p = .038) than those who did not increase egg intake. Those who increased their egg intake during the 12 week follow up period (n = 19) reported a lower availability of eggs during their upbringing (U = 371, p = .041), with no other differences between the groups.
Feedback from the whole group showed that reasons for choosing to use or not use the recipes were based on preferences, culinary skills, time/effort to prepare the meal, having ingredients already in the cupboard, the importance of variety, habits and familiarity, and the portion sizes, which were generally considered too large. The recipes used most often included ingredients that are more traditionally combined with eggs in the English diet (e.g. cheese/ham), while the recipes used least often were more unfamiliar (e.g. Turkish eggs with yoghurt).
Our study used recipes that specifically focus on eggs, but our findings suggest that recipe based interventions in this age group may be particularly beneficial for those with a higher BMI, those who may feel their health could be improved, those who are more likely to respect external advice, and those who have less early experience with the included foods. Greater future benefit may also be obtained from recipes that are for smaller dishes, using familiar ingredients, and that cater to a range of culinary skills and preferences.