Development and validation of a short food-frequency questionnaire for screening women of childbearing age for vitamin A status in northwestern Iran

A high percentage of women in their childbearing years suffer from subclinical vitamin A deficiency; 10% to 20% of pregnant women worldwide are vitamin A deficient. This study aimed to design and validate a short food-frequency questionnaire to serve as a simple screening tool for vitamin A status in women of childbearing age. The sample consisted of 187 healthy, nonpregnant, nonlactating women 15 to 49 years of age, from urban and rural areas of Marand district in East Azerbaijan. Dietary intake was evaluated by a face-to-face interview using a 24-hour dietary recall for two consecutive days and a 41-item qualitative food frequency questionnaire. Height, weight, and serum retinol were measured. Serum retinol values were less than 20 micrograms/dl for three subjects, while an additional 34 subjects (18%) had values between 21 and 30 micrograms/dl. Principal-component analysis performed on the food-frequency questionnaire identified five components that together defined 34.4% of the variance in estimated vitamin A intake and were used to derive a 20-item short food-frequency questionnaire. Internal consistency of the short instrument was acceptable (Cronbach's alpha = .59). Serum retinol was significantly correlated with total vitamin A intake and with intake of vitamin A from plant sources, as estimated by the short food-frequency questionnaire. Important sources of provitamin A in these women's diets included some not typical of other populations: nuts and green leaves of types used elsewhere in small quantities as herbs, but important in Iran because the amount and frequency of consumption are relatively high. We conclude that the questionnaire is relatively valid and potentially useful in identifying women at risk for vitamin A deficiency in this population.     

Household food insecurity in Timor-Leste

Timor-Leste is among the world’s youngest and poorest countries. It suffers from seasonal food insecurity and has the third-highest stunting rate globally. Previously inadequately documented, this paper summarises recent advances in understanding household food security in Timor-Leste and the multifaceted approaches being used to overcome it. Information comes from the extensive annual surveys of the Seeds of Life (SoL) program in Timor-Leste. The hungry season prior to maize and rice harvests is the key issue in household food security in Timor-Leste. Farm households cope with the problem through crop diversification with tubers playing a lead role as grain stocks dwindle. Foraging for wild food resources, selling animals and other assets, and social networks are other coping strategies. To address seasonal food insecurity, the government has focused on rice importation and the improvement of agricultural productivity within a multi-dimensional program. Information on storage by households of the key staple, maize, indicates an improving trend in food security at the household level from 2006/2007 to 2010/2011 through a significant reduction in the percentage of ‘at risk’ households—those who grow insufficient maize for storage during the year. The current emphasis on the widespread dissemination of the new high-yielding SoL cultivars has the potential to augment these improving trends. Nevertheless this picture remains vulnerable to weather shocks—such as drought—which are anticipated to increase with climate change and it is important to build further resilience into the agricultural systems of Timor-Leste.     

Female-headed households and food insecurity in Brazil

The National Household Survey carried out in 2009 by Brazil??s bureau of the census contains information on a representative sample of 121,708 households. The questionnaire includes items that enable us to identify households that experience moderate and severe degrees of food insecurity. The results of logistic regression analyses support the hypothesis that the odds of food insecurity are higher among female-headed households compared to male-headed households. Net of statistical controls for region, urban residence, age, monthly per capita household income, and five indicators of the internal composition of the household, the odds of moderate and severe food insecurity are, respectively, 32?% and 16?% higher among households headed by women compared to households headed by men. Further analyses show that the likelihood of food insecurity increases with presence of young children 0?C10?years of age and older children 11?C18?years of age. The importance of intra-household characteristics is confirmed by results that show that the odds of both moderate and severe food insecurity increase with additional adult males but decrease with additional adult females. Evidence that the presence of adult females reduces food insecurity is consistent with studies of gender differences in household decision making which show that, compared to men, women??s spending patterns have a greater positive effect on the welfare of children and other members of the household. The conclusions are discussed in the context of the poverty and hunger alleviation initiatives in Brazil??s new social policy agenda.     

Market information and food insecurity response analysis

Food aid is no longer the only, or even the dominant, response to widespread food insecurity. Donors, governments, NGOs and recipient communities exhibit rapidly growing interest in and experimentation with cash-based alternatives, both in the form of direct cash distribution to food insecure persons, and of local or regional purchase of food using cash provided to operational agencies by donors. But humanitarian assistance and development communities lack a systematic, field-tested framework for choosing among food- and/or cash-based responses to food insecurity. This paper outlines the rationale for “response analysis” and introduces a new, field-tested, systematic approach to this emergent activity. The Market Information and Food Insecurity Response Analysis (MIFIRA) framework provides a logically sequenced set of questions, and corresponding analytical tools to help operational agencies anticipate the likely impact of alternative (food- and/or cash-based) responses and thereby identify the response that best fits a given food insecurity context.

Development and validation of a food frequency questionnaire.

Regular diet monitoring requires a tool validated in the target population. A 73-item, semiquantitative, self-administered food frequency questionnaire (FFQ), was adapted in French and English from the Block National Cancer Institute Health Habits and History Questionnaire. The FFQ was used to capture usual long-term food consumption among adults living in Quebec. A representative sample of adults aged 18 to 82 (57% female) was recruited by random digit dialling in the Montreal region. Approximately 64% of recruits completed and returned the instrument by mail (n=248). The FFQ was validated in a subsample (n=94, 61% female) using four nonconsecutive food records (FRs). Median energy intakes (in kcal) for men and women, respectively, were FFQ (total sample) 2,112 and 1,823, FFQ (subsample) 2,137 and 1,752, and FR (subsample) 2,510 and 1,830. Spearman correlation analyses between FFQ and FR nutrients were positive (with r ranging from 0.32 for folate to 0.58 for saturated fatty acids) and statistically significant (p<0.001), with better results among women. On average, cross-classification of energy and 24 nutrients from the FFQ and means of four FRs placed 39% into identical quartiles and 78% into identical and contiguous quartiles, with only 4% frankly misclassified. These results suggest that the FFQ is a relatively valid instrument for determining usual diet in Quebec adults.     

Sensitivity and specificity of a tail-activity measuring device for calving prediction in dairy cattle

Efficient calving surveillance is essential for avoiding stillbirth due to unattended dystocia. Calving sensors can help detect the onset of parturition and thus ensure timely calving assistance if necessary. Tail-raising is an indicator of imminent calving. The objective of this study was to evaluate a tail-mounted inclinometer sensor (Moocall Ltd., Dublin, Ireland) and to monitor skin integrity after sensor attachment. Cows (n = 157) and heifers (n = 23) were enrolled at 275 d post insemination, and a sensor was attached to each cow's tail. Investigators checked for signs indicating the onset of stage II of parturition, verified the position of the sensor, and evaluated the skin integrity of the tail above and below the sensor hourly for 24 h/d. We used 5 different intervals (i.e., 1, 2, 4, 12, and 24 h until calving) to calculate sensitivity and specificity. Sensors continuously remained on the tail (i.e., within 3 cm of the initial attachment position) after initial attachment until the onset of calving in only 13.9% of animals (n = 25). Sensors were reattached until a calving event occurred (51.6%) or the animal was excluded for other reasons (34.4%). In 31 animals the sensor was removed because the tail was swollen or painful. Heifers were significantly less likely than cows to lose a sensor but more likely to experience tail swelling or pain. Depending on the interval preceding the onset of parturition, sensitivity varied from 19 to 75% and specificity from 63 to 96%.     

Household food insecurity in small municipalities in Northeastern Brazil: a validation study

The State of Paraiba in Northeastern Brazil ranks as the fourth poorest state in the country. The objectives of this study are to conduct the psychometric validation of the Brazilian Household Food Insecurity Scale (EBIA), to assess the household food insecurity (HFI) prevalence, and to identify the association between HFI, poverty and dietary intake in a representative sample of Paraiba’s 14 poorest municipalities (N = 4533). All municipalities included had fewer than 50,000 inhabitants. EBIA had strong internal consistency (Cronbach’s alpha = 0.93 and 0.90 in households with and without children, respectively). The percentage of affirmative responses for each item was inversely associated with household income and the item curves were parallel across socio-economic strata. Rasch modeling indicated that: a) scale items severities followed theoretical expectations, b) all items had an adequate fit to the scale confirming its unidimensionality, and c) items ‘functioned’ similarly across key subpopulation characteristics including: urban/rural; men/women; younger/older; poor/less poor; Bolsa Familia enrollment (yes/no). HFI prevalence was higher in rural than in urban areas (55.5 % vs. 49.9 %, p < 0.0005) and severe food insecurity was substantially higher in rural areas (14.0 % vs. 9.0 %, p < 0.0005). HFI severity was inversely associated with household income, positively associated with daily sugar consumption and inversely associated with daily consumption of bread and nutrient dense foods (fruits, vegetables, and dairy). In conclusion, EBIA had strong internal and external validity at the municipal level. Findings are particularly relevant for Brazil where 89.1 % of municipalities (4,957 out of 5,565 municipalities) have less than 50,000 inhabitants.     

Enhancing the capacity of food consumption surveys of short duration to estimate long term consumer-only intakes by combination with a qualitative food frequency questionnaire

In principle, a proper risk assessment for a food chemical requires that the time-frame for food chemical intake estimates matches the time-frame for the toxicological assessments upon which the safety statements (ADI, PTW I, etc.) are based. For food additives, the toxicological assessments are based on exposure over a lifetime. While food consumption data cannot be collected over the lifetimes of individuals, the information should reflect habitual intakes as closely as possible. This study investigated the possibility of combining a 3-day food diary with a food frequency questionnaire to estimate mean consumer-only food intakes comparable to estimates based on a 14-day diary. The study population consisted of 948 teenagers and analysis was based on 32 clearly defined foods. For 47% of the foods, the difference was ≤ 1g/day. When expressed as portion sizes, 56% of the foods showed differences representing 14% of an average portion. When between-method differences (portions/day) were plotted against the mean of the methods, the mean between-method difference was 0.02 (± 0.06) portions/ day with limits of agreement of -0.10 to 0.14. This preliminary investigation suggests that the combined 3-day diary and FFQ method provides comparable estimates of mean consumer only intakes to a 14-day diary. Therefore, a qualitative FFQ may be a useful adjunct to a food consumption survey of short duration if estimates of longer term food intakes are required.     

Algal biorefinery-based industry: an approach to address fuel and food insecurity for a carbon-smart world

Food and fuel production are intricately interconnected. In a carbon-smart society, it is imperative to produce both food and fuel sustainably. Integration of the emerging biorefinery concept with other industries can bring many environmental deliverables while mitigating several sustainability-related issues with respect to greenhouse gas emissions, fossil fuel usage, land use change for fuel production and future food insufficiency. A new biorefinery-based integrated industrial ecology encompasses the different value chain of products, coproducts, and services from the biorefinery industries. This paper discusses a framework to integrate the algal biofuel-based biorefinery, a booming biofuel sector, with other industries such as livestock, lignocellulosic and aquaculture. Using the USA as an example, this paper also illustrates the benefits associated with sustainable production of fuel and food. Policy and regulatory initiatives for synergistic development of the algal biofuel sector with other industries can bring many sustainable solutions for the future existence of mankind.     

Development of a food frequency questionnaire module and databases for compounds in cooked and processed meats

There is ample evidence from basic research and animal carcinogenicity studies that heterocyclic amines (HCAs) and polycyclic aromatic hydrocarbons (PAHs) are mutagens and carcinogens. However, there was a paucity of human data due to a lack of appropriate investigative tools. We developed the first validated cooked meat module within a food frequency questionnaire (FFQ) in the United States of America and created databases to be used in conjunction with this FFQ to estimate intake of HCAs and benzo[a]pyrene, a marker of PAHs. It became clear that other aspects of meat may also contribute to carcinogenesis; in particular, we are pursuing two additional areas: processed meat and iron exposure in relation to cancer risk. To investigate these hypotheses, we have expanded the cooked meat module to include detailed information on processed meats and fish. In addition, we are developing two databases, one for total iron and heme iron in cooked meat and the other for nitrite, nitrate, and N-nitroso compounds in processed meats. In this report, we will outline the methods used to develop the meat questionnaires, the databases, a software package for generating the intake values, and the methods used to generate nutritional data from nationally representative samples.     

Cultural relevance of a fruit and vegetable food frequency questionnaire.

PURPOSE: Canada's multicultural population poses challenges for culturally competent nutrition research and practice. In this qualitative study, the cultural relevance of a widely used semi-quantitative fruit and vegetable food frequency questionnaire (FFQ) was examined among convenience samples of adults from Toronto's Cantonese-, Mandarin-, Portuguese-, and Vietnamese-speaking communities. METHODS: Eighty-nine participants were recruited through community-based organizations, programs, and advertisements to participate in semi-structured interviews moderated in their native language. Data from the interviews were translated into English and transcribed for analysis using the constant comparative approach. RESULTS: Four main themes emerged from the analysis: the cultural relevance of the foods listed on the FFQ, words with multiple meanings, the need for culturally appropriate portion-size prompts, and the telephone survey as a Western concept. CONCLUSIONS: This research highlights the importance of investing resources to develop culturally relevant dietary assessment tools that ensure dietary assessment accuracy and, more important, reduce ethnocentric biases in food and nutrition research and practice. The transferability of findings must be established through further research.     

Vulnerability of smallholder rural households to food insecurity in Eastern Ethiopia

Although several empirical methodologies as to how best assess vulnerability to food insecurity have been proposed in the literature, none of these has evolved into a unanimously accepted approach. This article contributes to this literature by adapting the Vulnerability as Expected Poverty approach from poverty analysis methodology with the aim of scrutinizing factors determining household level vulnerability to food insecurity based on cross-section data collected from 277 randomly selected households in eastern Ethiopia. Vulnerability to food insecurity was strongly associated with several factors which included family size, size of cultivated landholding, soil fertility status of plots, access to irrigation, number of extension visits, use of fertilizer and improved seed. The probability that any given household??s food consumption expenditure would fall below a specified cut-off level has also been computed and vulnerable households identified. The total number of vulnerable households (111) was found to be greater than those who are currently food insecure (103). This implies that design and implementation of food security policies and strategies need to focus not only on those who are observed to be currently food insecure, but also on setting up social protection mechanisms to help prevent households from falling more deeply into food insecurity in the future.     

Food insecurity and dietary intake of immigrant food bank users.

PURPOSE: The degree of food insecurity and dietary intake was examined in adult Colombians who are new immigrants to Canada and use a food bank. METHODS: In-person surveys were conducted on a convenience sample of 77 adult Colombian immigrant food bank users in London, Ontario. Degree of food insecurity was measured by the Radimer/Cornell questionnaire, food intakes by 24-hour recall, sociodemographics, and questionnaires about changes in dietary patterns before and after immigration. RESULTS: Thirty-six men and 41 women participated in the study. Despite being highly educated, all respondents had experienced some form of food insecurity within the previous 30 days. The degree of food insecurity seems to be inversely associated with income and length of residency in Canada. Total daily energy intake was low, with a mean value of 1,568.3 +/- 606.0 kcal (6,217.5 +/- 2,336.4 kJ). In particular, a large proportion of participants consumed a diet low in fruits and vegetables (73%) and milk and dairy products (58%). CONCLUSIONS: Colombian immigrant food bank users new to Canada experience various degrees of food insecurity, which is associated with inadequate food intake. Interventions are needed to assist this population with adapting to society while concurrently sustaining healthy eating patterns.     

Validation of a Turkish version of the food choice questionnaire

The purpose of this study was to test the validity and reliability of the food choice questionnaire (FCQ) for Turkish consumers. A total of 963 voluntary consumers participated in this study. Confirmatory factor analysis (CFA) with a diagonally weighted least squares estimation method was used to assess the construct validity. Results showed that factor loadings were similar to the original FCQ. CFA results indicated an acceptable fit. Test-retest reliability was tested with intraclass correlation coefficient (ICC) and the ICC values ranged from 0.89 to 0.95. Results show that the Turkish version of FCQ was validated and it appears to be a reliable research instrument.     

Household resilience to food insecurity: evidence from Tanzania and Uganda

Resilience—the capacity that ensures adverse stressors and shocks do not have long-lasting adverse consequences—has become a key topic in both scholarly and policy debates. More recently some international organizations have proposed the use of resilience to analyze food and nutrition security. The objective of the paper is twofold: (i) analyze what the determinants of household resilience to food insecurity are and (ii) assess the role played by household resilience capacity on food security outcomes. The dataset employed in the analysis is a panel of three waves of household surveys recently collected in Tanzania and Uganda. First, we estimated the FAO’s Resilience Capacity Index (RCI), combining factor analysis and structural equation modeling. Then probit models were estimated to test whether the resilience is positively related to future food security outcomes and recovery capacity after a shock occurs. In both countries, the most important dimension contributing to household resilience was adaptive capacity, which in turn depended on the level of education and on the proportion of income earners to total household members. Furthermore, household resilience was significantly and positively related to future household food security status. Finally, households featuring a higher resilience capacity index were better equipped to absorb and adapt to shocks.     

Experiential household food insecurity in an urban underserved slum of North India

One-third of India’s urban population resides in extreme poverty, in slums and squatters. Food insecurity remains a visible reality among this segment. Yet, it is scarcely documented. This paper describes levels and determinants of experiential household food insecurity (HFI) in an underserved urban slum of Delhi (India) and reports the internal validity and reliability of the measure used to assess experiential HFI. A four-item scale was adapted from the U.S. six-item short-form food security scale and was administered in Hindi through household interviews with 410 female adults. Association of HFI with household economic and socio-demographic characteristics were examined using multiple logistic regression. Cronbach’s alpha and Rasch-model-based item fit statistics were used to assess reliability and internal validity. Fifty-one percent of households were food insecure. Significant HFI predictors were unemployed to employed family members’ ratio of > 3:1 (Odds Ratio 2.1, Confidence Interval 1.2 – 3.4) and low household standard of living (OR 4.9, C.I. 2.7 – 8.9). Cronbach’s alpha was 0.8. Item severities as estimated under Rasch model assumptions spanned 9.7 logits. Item infit statistics (0.77 – 1.07) indicated that the Rasch model fit the data well. Item outfit statistics suggested that one item was inconsistently understood by a small proportion of respondents. For improving HFI among the urban poor, in addition to improving behaviors/entitlement access, programs should consider linkage of urban poor to existing employment schemes, upgrading of their skills and linkage to potential employers. The adapted scale was reliable and easy to administer. However, being a subjective assessment, its sensitivity to social expectation and its association with nutrition security require examination.     

Sensitivity and specificity of a reagent-impregnated test strip in identifying smokeless tobacco users.

This study was designed to determine the sensitivity and specificity of a reagent-impregnated test strip in identifying habitual snuff users and tobacco chewers. Urine specimens were obtained from smokeless tobacco users and controls and blind tested on-site using a reagent-impregnated test strip. Samples also were sent to our university hospital lab for cotinine and nicotine analysis by gas chromatography (GC). The test strip results were compared with GC results and self-reported use of snuff and chewing tobacco. A total of 61 subjects enrolled in the study: 26 snuff users, 25 tobacco chewers, and 10 nonconsumers of nicotine. Using GC assessment of nicotine and cotinine (>or=200 ng/ml) as the standard, we found the sensitivity of the test strip to be 96% (25/26) for snuff users and 96% (24/25) for tobacco chewers. When compared with self-report, the sensitivity of the test strip was 92.3% (24/26) for snuff users and 84% (21/25) for tobacco chewers. The specificity for nonusers of nicotine was 100% (10/10) for both the self-report and GC conditions. These results suggest that a reagent-impregnated test strip is a rapid, valid, and user-friendly means of differentiating smokeless tobacco users from nonconsumers of tobacco. The intensity of the pink color on the test strip is proportional to the amount of nicotine or its metabolites present in urine and therefore offers a semiquantitative measure of nicotine consumption.     

Observation versus self-report: validation of a consumer food behavior questionnaire

A reliable and validated set of food safety behavior questions that could be used with confidence when evaluating food safety education programs was identified in this study. A list of 29 food-handling and consumption behaviors rank-ordered within five pathogen control factors by nationally recognized food safety experts was the basis for the development of the behavior questions. Questions were evaluated for reliability and several forms of validity. During a kitchen activity session, 70 graduates of a nutrition education program completed four food preparation tasks while being observed and videotaped. The individuals also participated in an in-depth interview to validate behaviors that could not be observed during the food preparation activity, e.g., refraining from preparing food for others when experiencing diarrhea. Criterion validity was established by comparing questionnaire responses to observed behavior and interview responses. Twenty-eight questions met the validity criterion (> or = 70% agreement between observed and interviewed responses and self-reported responses), with three or more questions from each of five pathogen control factor areas. Observation assessments revealed that hand washing was more likely to be performed prior to beginning food preparation than between working with raw meats and fresh produce. Errors in methods of washing hands, utensils, and preparation surfaces between food preparation tasks were common. Most participants did not use thermometers to evaluate doneness but still cooked to safe internal temperatures. The results provide a tool that educators can use to evaluate food safety programs and will help guide the development of more effective food safety education programs targeting needed improvements in behavioral skills.     

Energy and nutrient supply according to food insecurity severity among Mexican households

Studies from Latin America have shown that food insecurity reduces dietary diversity. However, dietary diversity measures do not account for the energy and nutrient supply in households. The objective of our study was to know whether there are differences in food, energy and nutrients supplies in Mexican households according to their food insecurity level. We analyzed the database of the National Household Income and Expenditure Survey performed in Mexico in 2014. The modified Latin-American and Caribbean Food Security Scale was used to determine the existence of household food security or insecurity. Participants registered foods and beverages available at their homes during the previous week. The supply of energy and nutrients was estimated using Mexican and American food composition references. Mexican food secure households had greater supply of healthy (e.g., fresh fruits and vegetables, fish and seafood, and fresh meats) and unhealthy (e.g., processed meats, fries, sugar-sweetened beverages, desserts, and alcoholic beverages) foods. By contrast, food insecure households rely on cheap staple food (e.g. maize, rice, pulses, eggs, and sugar). There was a linear relationship between the energy density and severity of food insecurity. Households with mild and moderate food insecurity had greater total energy supplies than households with food security and severe food insecurity. Food insecure households had greater supplies of carbohydrates, cholesterol, iron, and magnesium, but lower supplies of protein, fat, vitamin C, vitamin A, potassium, calcium, and sodium. Most of the results suggest that food insecure households are exposed mostly to negative aspects of the nutrition transition because they have greater access to energy and lower availability of some micronutrients.