title: Validity and reliability of a food frequency questionnaire to estimate dietary intake among Lebanese children.
abstract: BACKGROUND
  Nutritional status during childhood is critical given its effect on growth and development as well as its association with disease risk later in life. The Middle East and North Africa (MENA) region is experiencing alarming rates of childhood malnutrition, both over- and under-nutrition. Hence, there is a need for valid tools to assess dietary intake for children in this region. To date, there are no validated dietary assessment tools for children in any country of the MENA region. The main objective of this study was to examine the validity and reliability of a Food Frequency Questionnaire (FFQ) for the assessment of dietary intake among Lebanese children.
  
  
  METHODS
  Children, aged 5 to 10 years (n = 111), were recruited from public and private schools of Beirut, Lebanon. Mothers (proxies to report their children's dietary intake) completed two FFQs, four weeks apart. Four 24-hour recalls (24-HRs) were collected weekly during the duration of the study. Spearman correlations and Bland-Altman plots were used to assess validity. Linear regression models were used to derive calibration factors for boys and girls. Reproducibility statistics included Intraclass Correlation Coefficient (ICC) and percent agreement.
  
  
  RESULTS
  Correlation coefficients between dietary intake estimates derived from FFQ and 24-HRs were significant at p < 0.001 with the highest correlation observed for energy (0.54) and the lowest for monounsaturated fatty acids (0.26). The majority of data points in the Bland-Altman plots lied between the limits of agreement, closer to the middle horizontal line. After applying the calibration factors for boys and girls, the mean energy and nutrient intakes estimated by the FFQ were similar to those obtained by the mean 24-HRs. As for reproducibility, ICC ranged between 0.31 for trans-fatty acids and 0.73 for calcium intakes. Over 80 % of study participants were classified in the same or adjacent quartile of energy and nutrients intake.
  
  
  CONCLUSIONS
  Findings of this study showed that the developed FFQ is reliable and is also valid, when used with calibration factors. This FFQ is a useful tool in dietary assessment and evaluation of diet-disease relationship in this age group.
authors.affiliation: Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Lebanon, 11-0236 Riad El Solh, 1107-2020, Beirut, Lebanon. patriciamoghames@gmail.com.
authors.forename: Patricia
authors.initials: P
authors.lastname: Moghames
authors.affiliation: School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada. nour.hammami@uwaterloo.ca.
authors.forename: Nour
authors.initials: N
authors.lastname: Hammami
authors.affiliation: Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Lebanon, 11-0236 Riad El Solh, 1107-2020, Beirut, Lebanon. nahla@aub.edu.lb.
authors.forename: Nahla
authors.initials: N
authors.lastname: Hwalla
authors.affiliation: Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Lebanon, 11-0236 Riad El Solh, 1107-2020, Beirut, Lebanon. ny12@aub.edu.lb.
authors.forename: Nadine
authors.initials: N
authors.lastname: Yazbeck
authors.affiliation: Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Lebanon, 11-0236 Riad El Solh, 1107-2020, Beirut, Lebanon. shoaib.hikma@gmail.com.
authors.forename: Hikma
authors.initials: H
authors.lastname: Shoaib
authors.affiliation: Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Lebanon, 11-0236 Riad El Solh, 1107-2020, Beirut, Lebanon. ln10@aub.edu.lb.
authors.forename: Lara
authors.initials: L
authors.lastname: Nasreddine
authors.affiliation: Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Lebanon, 11-0236 Riad El Solh, 1107-2020, Beirut, Lebanon. fn14@aub.edu.lb.
authors.forename: Farah
authors.initials: F
authors.lastname: Naja
mesh_terms: D015992:Body Mass Index; D002136:Calcium, Dietary / Q000008:administration & dosage / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D004032:Diet; D004034:Diet Surveys; D004040:Dietary Carbohydrates / Q000008:administration & dosage / Q000032:analysis; D004041:Dietary Fats / Q000008:administration & dosage / Q000032:analysis; D004044:Dietary Proteins / Q000008:administration & dosage / Q000032:analysis; D002149:Energy Intake; D005227:Fatty Acids / Q000008:administration & dosage / Q000032:analysis; D005260:Female; D006801:Humans; D007861:Lebanon; D016014:Linear Models; D008297:Male; D011939:Mental Recall; D018977:Micronutrients / Q000008:administration & dosage / Q000032:analysis; D015203:Reproducibility of Results; D012959:Socioeconomic Factors; D044242:Trans Fatty Acids / Q000008:administration & dosage / Q000032:analysis
chemical_list: D002136:Calcium, Dietary; D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004044:Dietary Proteins; D005227:Fatty Acids; D018977:Micronutrients; D044242:Trans Fatty Acids