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Original Research: Brief
Evaluation of a Modified Italian European Prospective Investigation into Cancer and Nutrition Food Frequency Questionnaire for Individuals with Celiac Disease

https://doi.org/10.1016/j.jand.2016.04.013Get rights and content

Abstract

Background

To date, it is unclear whether individuals with celiac disease following a gluten-free (GF) diet for several years have adequate intake of all recommended nutrients. Lack of a food frequency questionnaire (FFQ) for individuals with celiac disease could be partly responsible for this still-debated issue.

Objective

The aim of the study is to evaluate the performance of a modified European Prospective Investigation into Cancer and Nutrition (EPIC) FFQ in estimating nutrient and food intake in a celiac population.

Design

In a cross-sectional study, the dietary habits of individuals with celiac disease were reported using a modified Italian EPIC FFQ and were compared to a 7-day weighed food record as a reference method.

Participants/setting

A total of 200 individuals with histologically confirmed celiac disease were enrolled in the study between October 2012 and August 2014 at the Center for Prevention and Diagnosis of Celiac Disease (Milan, Italy).

Main outcome measures

Nutrient and food category intake were calculated by 7-day weighed food record using an Italian food database integrated with the nutrient composition of 60 GF foods and the modified EPIC FFQ, in which 24 foods were substituted with GF foods comparable for energy and carbohydrate content.

Statistical analyses performed

An evaluation of the modified FFQ compared to 7-day weighed food record in assessing the reported intake of nutrient and food groups was conducted using Spearman’s correlation coefficients and weighted κ.

Results

One hundred individuals completed the study. The Spearman's correlation coefficients of FFQ and 7-day weighed food record ranged from .13 to .73 for nutrients and from .23 to .75 for food groups. A moderate agreement, which was defined as a weighted κ value of .40 to .60, was obtained for 30% of the analyzed nutrients, and 40% of the nutrients showed values between .30 and .40. The weighted κ exceeded .40 for 60% of the 15 analyzed food groups.

Conclusions

The modified EPIC FFQ demonstrated moderate congruence with a weighed food record in ranking individuals by dietary intakes, particularly food groups.

Section snippets

Participants and Study Design

Participants were recruited from among the patients referred to the Center of Prevention and Diagnosis of Celiac Disease at the IRCCS Cà Granda Foundation, Policlinico Hospital, Milan. The exclusion criteria were diagnosis of CD <2 years before, age younger than 18 years or older than 70 years, metabolic or chronic disease (eg, diabetes mellitus, Crohn's disease, cardiovascular and neurovascular diseases, cancer, neurodegenerative diseases, and rheumatoid arthritis), pregnancy or lactation, or

Results

Of the 200 participants enrolled in the study, 66 communicated to study investigators either orally or in writing that they no longer wanted to participate. Twenty-seven of the remaining 134 participants did not mail back their food records, and 107 completed both the FFQ and the 7-day weighed food record. Of these, seven were excluded from the study because of reported implausible extreme values of the ratio of total energy intake to basal metabolic rate.

The final dataset included 100

Discussion

In the present study, the ability of the modified EPIC FFQ to assess the dietary habits of individuals with CD was evaluated relative to a 7-day weighed food record. Based on the correlation coefficients, the modified EPIC FFQ correctly classified individuals with CD according to the distribution of intake of some nutrients and most food groups. The coefficient values observed in the present study were comparable to those observed in the previous validation study evaluating the FFQ performance

Conclusions

The EPIC FFQ, primarily designed for general populations and then revised with specific products, demonstrated moderate congruence with a weighed food record in ranking individuals by dietary intakes, particularly food groups. Consequently, this modified EPIC FFQ might be a useful instrument for assessing the dietary intake in the Italian population with CD. The present evaluation of this tool will allow for extending research on the dietary habits of individuals with CD from nutritional

T. Mazzeo is a postdoctoral researcher, Human Nutrition Unit, Department of Food Science, University of Parma, Parma, Italy.

References (29)

  • R.K. Johnson

    Dietary intake—How do we measure what people are really eating?

    Obes Res

    (2002)
  • G. Biró et al.

    Selection of methodology to assess food intake

    Eur J Clin Nutr

    (2002)
  • G. Tabacchi et al.

    Comparative validity of the Asso food frequency questionnaire for the web based assessment of food and nutrients intake in adolescents

    Food Nutr Res

    (2015)
  • P.G. Persson et al.

    Food frequency questionnaire versus 7-day weighed dietary record information on dietary fibre and fat intake in middle-aged Swedish men

    Scand J Soc Med

    (1998)
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    T. Mazzeo is a postdoctoral researcher, Human Nutrition Unit, Department of Food Science, University of Parma, Parma, Italy.

    F. Brighenti is a full professor, Human Nutrition Unit, Department of Food Science, University of Parma, Parma, Italy.

    N. Pellegrini is an associate professor, Human Nutrition Unit, Department of Food Science, University of Parma, Parma, Italy.

    L. Roncoroni is a researcher and nutritionist, Center for Prevention and Diagnosis of Celiac Disease, IRCCS Cà Granda Foundation, Ospedale Maggiore Policlinico, Milan, Italy, and Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.

    V. Lombardo is a scholarship holder, Center for Prevention and Diagnosis of Celiac Disease, University of Milan, Fondazione IRCCS Cà Granda Foundation, Ospedale Maggiore Policlinico, Milan, Italy.

    C. Tomba is a researcher in gastroenterology, Center for Prevention and Diagnosis of Celiac Disease, University of Milan, Fondazione IRCCS Cà Granda Foundation, Ospedale Maggiore Policlinico, Milan, Italy.

    L. Elli is a gastroenterologist, Center for Prevention and Diagnosis of Celiac Disease, University of Milan, Fondazione IRCCS Cà Granda Foundation, Ospedale Maggiore Policlinico, Milan, Italy.

    C. Agostoni is a full professor of pediatrics, Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Cà Granda Foundation, Ospedale Maggiore Policlinico, Milan, Italy.

    S. Sieri is a senior researcher in nutritional epidemiology, Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.

    S. Grioni is a research associate in nutritional epidemiology, Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.

    M. T. Bardella is a consultant gastroenterologist, Center for Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, IRCCS Cà Granda Foundation, Ospedale Maggiore Policlinico, Milan, Italy.

    L. Doneda is an associate professor in applied biology, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.

    STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.

    FUNDING/SUPPORT This work has been partly supported by Dr. Schär GmbH/Srl. Dr. Schär GmbH/Srl had no role in the design, analysis, and writing of this article.

    The study was registered at ClinicalTrials.gov (ID NCT01975155).

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