Sains Malaysiana 42(11)(2013): 1625–1632

Validation of a Food Frequency Questionnaire in Assessing the

Omega-3 Polyunsaturated Fatty Acids Intake for Malays and Chinese Elderly in Malaysia

(Pengesahan Soal-selidik Kekerapan Makanan untuk Menilai Pengambilan Asid Lemak

Omega-3 Poli-tak-tepu untuk Warga Tua Melayu dan Cina di Malaysia)

LAI KUAN LEE¹, SUZANA SHAHAR²*, NOOR AINI MOHAMAD YUSOFF³& AI-VYRN CHIN⁴

¹Nutrition Programme, School of Health Sciences, Health Campus, University of Science Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia

²Dietetics Program, School of Health Care Sciences, Faculty of Health Sciences,

Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia

³Masterskill University College of Health Sciences, G-8, Jalan Kemacahaya 11 Taman Kemacahaya, Batu 9, 43200 Cheras, Selangor D.E. Malaysia

⁴Division of Geriatrics, Department of Medicine, Faculty of Medicine, Universiti Malaya

50603 Kuala Lumpur, Malaysia

Received: 3 April 2012/Accepted: 8 June 2013

ABSTRACT

Omega-3 polyunsaturated fatty acids (PUFAs) is crucial to prevent a wide range of chronic diseases from a global view point. However, no suitable dietary assessment tool is available for usage among Malaysian population. The present study aimed to evaluate the validity of interviewer-administered semi-quantitative Food Frequency Questionnaire (FFQ) for assessing the omega-3 PUFAs intake among the Malays and Chinese elderly individuals in Klang Valley, Malaysia. Thirty-seven elderly people (54.1% women and 45.9% men), aged 60 years and above, were recruited from a community setting. Omega-3 PUFAs intake for the past one month was assessed using a 45-food item FFQ and validated against 3 days Food Record (FR). Wilcoxon signed rank test indicated no significant mean intake difference between two assessment methods. Significant correlation was found for total omega-3 PUFAs (r=0.926), α-linolenic acid (ALA) (r=0.745), eicosapentaenoic acid (EPA) (r=0.579) and docosahexaenoic acid (DHA) (r=0.912). Bland-Altman analysis exhibited no apparent systematic bias between the two methods for total omega-3 PUFAs intake, while quartile analysis classified 73% subjects assigned into the same quartile. Conclusively, the newly-developed FFQ yielded a reasonable validity in the tested population and provided a convenient means to estimate omega-3 PUFAs intake within healthy Malays and Chinese elderly individuals. Further study to evaluate its validity and reproducibility for different age groups is required.

Keywords: Elderly; food frequency questionnaire; food record; omega-3 PUFAs; validity

ABSTRAK

Asid lemak omega-3 poli-tak-tepu (PUFAs) adalah penting untuk mencegah pelbagai penyakit kronik mengikut pandangan global. Namun, tiada alat penilaian dietari yang bersesuaian untuk kegunaan populasi di Malaysia. Kajian ini bertujuan untuk menilai kesahihan soal-selidik kekerapan makanan (FFQ) untuk menilai pengambilan omega-3 PUFAs bagi warga tua Melayu dan Cina di Lembah Klang, Malaysia. Tiga puluh tujuh orang warga tua (54.1% perempuan dan 45.9% lelaki), berumur 60 tahun dan ke atas telah direkrut daripada satu komuniti. Pengambilan omega-3 PUFAs bagi sebulan lepas dinilai menggunakan FFQ yang mengandungi 45 item dan kesahihannya dibandingkan dengan Rekod Makanan (FR) 3 hari. Ujian Wilcoxon signed rank menunjukkan bahawa tiada perbezaan min yang signifikan antara kedua-dua kaedah penilaian. Korelasi yang signifikan didapati untuk jumlah omega-3 PUFAs (r=0.926), asid linolenik alfa (ALA) (r=0.745), asid eikosapentanoik (EPA) (r=0.579) dan asid dokosaheksanoik (DHA) (r=0.912). Analisis Bland-Altman menunjukkan tiada bias sistematik yang ketara antara dua kaedah bagi jumlah pengambilan omega-3 PUFA, manakala analisis kuartil mengklasifikasikan 73% subjek ke dalam kuartil yang sama. Sebagai kesimpulannyai, FFQ yang baru dibina menunjukkan kesahihan yang munasabah bagi populasi kajian dan memberikan satu cara mudah untuk menganggar pengambilan omega-3 PUFAs bagi warga tua Melayu dan Cina yang sihat. Kajian lanjut bagi menilai kebolehulangan dan kesahihannya bagi kumpulan umur yang berbeza adalah amat diperlukan.

Kata kunci: Kesahihan; omega-3 PUFAs; rekod makanan; soal-selidik kekerapan makanan; warga tua

REFERENCES

Bingham, S.A., Gill, C., Welch, A., Day, K., Cassidy, A., Khaw, K.T., Sneyd, S.J., Key, T.J., Roe, I. & Day, N.E. 1994. Comparison of dietary assessment methods in nutritional epidemiology: Weighed records v. 24h recalls, food-frequency questionnaires and estimated-diet records. British Journal of Nutrition 72: 619-643.

Bland, L.M. & Altman, D.G. 1986. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1: 307-310.

Broadfield, E., McKeever, T., Fogarty, A. & Britton, J. 2003. Measuring dietary fatty acid intake: Validation of a food-frequency questionnaire against 7 d weighed records. British Journal of Nutrition 90: 215-220.

Cantwell, M.M., Gibney, M.J., Cronin, D., Younger, K.M., O’Neill, J.P., Hogan, L., Flynn, M.A.T. 2005. Development and validation of a food-frequency questionnaire for the determination of detailed fatty acid intakes. Public Health Nutrition 8(1): 97-107.

Cleland, L., James, M. & Proudman, S. 2003. The role of fish oils in the treatment of rheumatoid arthritis. Drugs 63: 845-853.

Dangour, A.D. & Uauy, R. 2008. n-3 long-chain polyunsaturated fatty acids for optimal function during brain development and ageing. Asia Pacific Journal of Clinical Nutrition 17 (suppl 1): 185-188.

De Vriesea, S.R., De Henauwb, S., De Backerb, G., Dhontc, M. & Christophe, A.B. 2001. Estimation of dietary fat intake of Belgian pregnant women. Annals of Nutrition and Metabolism 45: 273-278.

Erber, E., Beck, L., Hopping, B.N., Sheehy, T., De Roose, E. & Sharma, S. 2010. Food patterns and socioeconomic indicators of food consumption amongst Inuvialuit in the Canadian Arctic. Journal of Human Nutrition and Dietetics 23 (Suppl. 1): 59-66.

Foo, K.Y. & Hameed, B.H. V2009. alue-added utilization of oil palm ash: A superior recycling of the industrial agricultural waste. Journal of Hazardous Material 172: 523-531.

Freund-Levi, Y., Erikstodder-Jӧnhagen, M., Cerdeholm, T., Basun, H., Faxén-Irving, G., Garlind, A., Vedin, I., Vessby, B., Wahlund, L.O. & Palmblad, J. 2006. ω-3 fatty acid treatment in 174 patients with mild to moderate Alzheimer Disease: OmegaAD study. Archieves of Neurology 63: 1402-1408.

Howe, P.R.C., Meyer, B.J., Record, S. & Baghurst, K. 2006. Dietary intake of long-chain n-3 polyunsaturated fatty acids: Contribution of meat sources. Nutrition 22: 47-53.

Institute of Medicine. 2002. Dietary Reference Intakes for Energy, Carbohydrates, Fiber, Fat, Protein and Amino Acids (Macronutrients). Washington, DC, USA: The National Academies Press.

Logan, K.J., Woodside, J.V., Young, I.S., McKinley, M.C., Perkins-Porras, L. & McKeown, P.P. 2009. Adoption and maintenance of a Mediterranean diet in patients with coronary heart disease from a Northern European population: A pilot randomised trial of different methods of delivering Mediterranean diet advice. Journal of Human Nutrition and Dietetics 23: 30-37.

Lucas, M., Asseslin, G., Mérette, C., Poulin, M.J. & Dodin, S. 2008. Validation of an FFQ for evaluation of EPA and DHA intake. Public Health Nutrition 12: 1783-1790.

McNaughton, S.A., Hughes, M.C. & Marks, G.C. 2007. Validation of a FFQ to estimate the intake of PUFA using plasma phospholipids fatty acids and weighed foods records. British Journal of Nutrition 97: 561-568.

McNutt, S., Zimmerman, T.P. & Hull, S.G. 2008. Development of food composition databases for food frequency questionnaires (FFQ). Journal of Food Composition and Analysis 21: S20- 26.

NCCFN. 2005. Recommended Nutrient Intakes for Malaysia. A report of the working group on nutritional guidelines. pp. 32-40.

Orton, H.D., Szabo, N.J., Clare-Salzler, M. & Norris, J.M. 2008. Comparison between omega-3 and omega-6 polyunsaturated fatty acid intakes as assessed by a food frequency questionnaire and erythrocyte membrane fatty acid composition in young children. European Journal of Clinical Nutrition 62: 733-738.

Panagiotakos, D., Kalogeropoulos, N., Pitsavos, C., Roussinou, G., Palliou, K., Chrysohoou, C. & Stefanadis, C. 2009. Validation of the MedDietScore via the determination of plasma fatty acids. International Journal of Food Sciences and Nutrition 60(S5): 168-180.

Parka,Y., Parka, S., Yi, H., Kim, H.Y., Kang, S.J., Kim, J. & Ahn, H. 2009. Low level of n-3 polyunsaturated fatty acids in erythrocytes is a risk factor for both acute ischemic and hemorrhagic stroke in Koreans. Nutrition Research 29: 825-830.

Ritter-Gooder, P.K., Lewis, N.M., Heidal, K.B. & Eskridge, K.M. 2006. Validity and reliability of a quantitative food frequency questionnaire measuring n-3 fatty acid intakes in cardiac patients in the midwest: A validation pilot study. Journal of American Dietetic Association 106: 1251-1255.

Rohrmann, S. & Klein, G. 2003. Development and validation of a short food list to assess the intake of total fat, saturated, mono-unsaturated, polyunsaturated fatty acids and cholesterol. European Journal of Public Health 13: 262-268.

Rohrmann, S. & Klein, G. 2003. Validation of a short questionnaire to qualitatively assess the intake of total fat, saturated, monounsaturated, polyunsaturated fatty acids, and cholesterol. Journal of Human Nutrition and Dietetics 16: 111-117.

Stiegler, P., Sausenthaler, S., Buyken, A.E., Rzehak, P., Czech, D., Linseisen, J., Kroke, A., Gedrich, K., Robertson, C. & Heinrich, J. 2009. A new FFQ designed to measure the intake of fatty acids and antioxidants in children. Public Health Nutrition 13(1): 38-46.

Su, K.P. 2008. Mind-body interface: The role of n-3 fatty acids in psychoneuroimmunology, somatic presentation, and medical illness comorbidity of depression. Asia Pacific Journal of Clinical Nutrition 17(suppl 1): 151-157.

Sullivan, B.L., Williams, P.G. & Meyer, B.J. 2006 Biomarker validation of a Long-Chain Omega-3 Polyunsaturated Fatty Acid Food Frequency Questionnaire. Lipids 41: 845-850.

Sullivan, B.L., Brown, J., Williams, P.G. & Meyer, B.J. 2008. Dietary validation of a new Australian food-frequency questionnaire that estimates long-chain n-3 polyunsaturated fatty acids. British Journal of Nutrition 99: 660-666.

Tee, E.S., Ismail, M.N., Nasir, M.A. & Khatijah, I. 1997. Nutrient Composition of Malaysian Foods. Institute of Medical Research, Kuala Lumpur, Malaysia: MDC Publishers.

U.S. Department of Agriculture, Agricultural Research Service (2007) USDA National Nutrient Database for Standard Reference, Release 18. Available from http://www.nal.usda. gov/fnic/foodcomp/search/.pdf (accessed on 30 August 2010).

Wennberg, M., Vessby, B. & Johansson, I. 2009. Evaluation of relative intake of fatty acids according to the Northern Sweden FFQ with fatty acid levels in erythrocyte membranes as biomarkers. Public Health Nutrition 12: 1477-1484.

Willett, W.C. 1998. Nutritional Epidemiology. New York, USA: Oxford University Press.

Woods, R.K., Stoney, R.M., Ireland, P.D., Bailey, M.J., Raven, J.M., Thien, F.C., Walters, E.H. & Abramson, M.J. 2002. A valid food frequency questionnaire for measuring dietary fish intake. Asia Pacific Journal of Clinical Nutrition 11: 56-61.

World Health Organization. 2003. Diet, Nutrition and the Prevention of Chronic Diseases. Joint WHO/FAO Expert Consultation. WHO Technical Report Series no. 916. Geneva;

Zhang, B., Wang, P., Chen, C.G., He, Q.Q., Zhuo, S.Y., Chen, Y.M. & Su, Y.X. 2009. Validation of an FFQ to estimate the intake of fatty acids using erythrocyte membrane fatty acids and multiple 3 d dietary records. Public Health Nutrition 17: 1-7.

*Corresponding author; email: suzana.shahar@gmail.com