Validation of a semi-quantitative FFQ for 18-month-old toddlers: the Growing Up in Singapore Towards Healthy Outcomes (GUSTO) study

ObjectiveDietary intake of toddlers has been of growing interest due to its long-term consequences on health. However, previous works have focused largely on Caucasian populations and less is known about Asian toddlers. We aimed to validate a semi-quantitative FFQ designed to assess dietary intakes of 18-month-old toddlers in a multi-ethnic Asian cohort.DesignAn FFQ of ninety-four food items, identified based on food records of 12-month-old GUSTO children, the Southampton Women's Survey 12 Month Infancy Questionnaire and inputs from paediatric dietitians, was filled out two weeks before the 18th-month clinic visit. As the reference method, two non-consecutive 24 h recalls (24HR) were administered during and two weeks after the clinic visit. FFQ nutrient intakes were validated against averaged 24HR nutrient intakes, using the Wilcoxon signed-rank test, Spearman's rank-order correlation, cross-classification and the Bland-Altman method.SettingData from the Singapore Growing Up in Singapore Towards Healthy Outcomes (GUSTO) mother-offspring birth cohort.ParticipantsToddlers (n 188) aged 18 months.ResultsAbsolute nutrient intakes from the FFQ were significantly higher than from the 24HR, except for vitamin A. After energy adjustments, r range was 056-078 (macronutrients) and 040-054 (micronutrients). De-attenuation increased r to 058-096 and 045-065 for macro- and micronutrients, respectively. Of participants, >= 824 % (macronutrients) and >= 777 % (micronutrients) were classified in the same and adjacent quartiles. No clear systematic increase in intake differences with increasing mean intake was observed in Bland-Altman plots.ConclusionsThis FFQ can provide a satisfactory assessment of toddlers' energy-adjusted nutrient intakes, as well as accurately rank them in a group.