Comparison of Energy Intake in Toddlers Assessed by Food Frequency Questionnaire and Total Energy Expenditure Measured by the Doubly Labeled Water Method

The ability of parents to accurately report energy intake in toddlers has rarely been validated using the gold-standard doubly labeled water (DLW) method to assess total energy expenditure (TEE). The aim of the study was to evaluate the accuracy of toddler energy intake (El), estimated using the Australian Child and Adolescent Eating Survey (ACAES) food frequency questionnaire (FFQ) by parent report compared with a weighed food record (WFR) and TEE measured by DLW. Twelve toddlers had TEE assessed over 10 days using DLW. Usual energy intake was estimated by the primary caregiver, using standard toddler portions in ACAES-FFQ and a 4-day WFR and daily El (in kilocalories) derived using national nutrient databases. Accuracy of reporting was calculated from absolute (El-TEE) and percentage (EI/TEEx100) differences between El and TEE and Pearson correlations and limits of agreement from Bland-Altman plots. Toddlers (n=12, 7 boys) had a mean age of 3.2 +/- 0.5 years, body mass index 16.2 +/- 0.9 kg, body mass index z score 0.1 +/- 0.8, El from ACAES-FFQ 1,183 +/- 281 kcal/day, and WFR 1,179 +/- 278 kcal/day and DLW TEE 1,251 +/- 149 kcal/day. The mean difference and limits of agreement (+/- 2 standard deviations) compared with DLW was -68 (-623, 488) kcal/day for the FFQ and for the WFR -72 (-499, 354) kcal/day. Although both a semiquantitative FFQ and WFR can adequately estimate toddler energy intake at the group level in this population, toddler-specific portion size estimates should be assigned to foods listed in the FFQ. Choice of method is likely to depend on practical issues, including cost and burden. J Acad Nutr Diet. 2013;113:459-463.