Issues in assessing the validity of nutrient data obtained from a food-frequency questionnaire:: folate and vitamin B12 examples

Objective: To compare methods used to assess the validity of nutrient intake data obtained from a food-frequency questionnaire (FFQ), using folate and vitamin B-12 as nutrient examples. Design: Cross-sectional sample from a population cohort. Setting: Two postcode areas west of Sydney, Australia. Subjects: In total, 2895 people aged 49 years and older provided dietary data using a semi-quantitative FFQ (79% of 3654 subjects examined). The validity of the FFQ was assessed against three 4-day weighed food records (WFRs) completed by 78 people (mean age 70 years). Results: Folate and vitamin B-12 validity data were assessed using different methods. The Spearman ranked correlations (energy-adjusted) were 0.66 for folate and 0.38 for vitamin B-12. Using the Bland-Altman method, following log(e) transformation, no linear trend existed between the differences and means for folate and vitamin B-12. Large differences existed between the FFQ and WFR in individual cases, particularly for vitamin B-12. Finally, data were divided into quintile categories for the test and reference method: 79% classified folate within one quintile, 65% classified vitamin B 12 within one quintile; there was no gross misclassification for folate and only 3% misclassification for vitamin B-12. Conclusions: Different methods of analysis provided different information about the validity of the FFQ. Correlation coefficients should not be used alone to assess the validity of nutrient data, but should be used in conjunction with Bland-Altman analyses. Depending on the use of the data, additional assessment of classification categories is recommended. This worked example demonstrates that absolute intakes of folate and vitamin B-12 should be used with caution.