Practice of Epidemiology Validation of a Food Frequency Questionnaire by Direct Measurement of Habitual ad Libitum Food Intake

Food frequency questionnaires are commonly used to assess habitual food intake. Although food frequency questionnaires are known to produce measurement error, the amount of error and effectiveness of correction methods are poorly understood. Twelve men from the Baltimore, MD/Washington, DC, area consumed an ad libitum diet for 16 weeks during the spring of 2001. At the end of the study period, subjects reported their food intakes with a food frequency questionnaire (Block 98). During weeks 8 and 16, subjects were dosed with doubly labeled water and maintained physical activity logs. Absolute and relative macronutrient intakes were poorly predicted by the food frequency questionnaire. The application of a single, group mean energy adjustment (using doubly labeled water or physical activity) reduced the variance of carbohydrate intake and increased the variance of fat and protein intakes, but none significantly (p > 0.05). Subject-specific energy adjustments reduced the variance for carbohydrate and protein intakes (p< 0.05). Including a body weight adjustment reduced the variance in fat intake (p < 0.05) when doubly labeled water was used to first correct energy intake. The application of correction methods based on energy expenditure and body weight can be used to reduce measurement error, improving the ability of the food frequency questionnaire to measure food intake.