Relative validity of a short food frequency questionnaire assessing adherence to the Norwegian dietary guidelines among colorectal cancer patients

  • Hege Berg Henriksen
  • Monica Hauger Carlsen
  • Ingvild Paur
  • Sveinung Berntsen
  • Siv Kjølsrud Bøhn
  • Anne Juul Skjetne
  • Ane Sørlie Kværner
  • Christine Henriksen
  • Lene Frost Andersen
  • Sigbjørn Smeland
  • Rune Blomhoff
Keywords: dietary assessment tool, weighed food records, validity, dietary intake, food based dietary guidelines, cancer


Background: The Norwegian food-based dietary guidelines (FBDG) aim at reducing the risk of developing chronic diseases and promote overall health. We studied the effect of the Norwegian FBDG in colorectal cancer (CRC) patients. There is a need for a time-efficient dietary assessment tool measuring adherence to these guidelines in patients treated for dietary dependent cancer, such as CRC patients.

Objective: To evaluate a new short food frequency questionnaire (NORDIET-FFQ), developed to estimate adherence to the Norwegian FBDG among CRC patients.

Design: Eighty-one CRC patients from both study groups in the Norwegian Dietary Guidelines and Colorectal Cancer Survival study, an ongoing dietary intervention, completed both the short 63-item NORDIET-FFQ and a 7-day weighed food record.

Results: The NORDIET-FFQ was on group level able to estimate intakes of fruits, vegetables, unsalted nuts, fish, fatty fish, high fat dairy products, unprocessed meat, processed meat, red meat, water, sugar-rich beverages, alcoholic drinks, and sugar- and fat-rich foods. Ranking of individuals according to intake was good ( r = 0.31–0.74) for fruits and vegetables, fruits, unsalted nuts, whole grain products, sugar-rich cereals, fish, fatty fish, dairy products, red meat, water, sugar-rich beverages, alcoholic beverages, and sugar- and fat-rich foods. The NORDIET-FFQ was able to identify the individuals who did not fulfil the recommendations of fruits, vegetables, unsalted nuts, whole grains, low-fat dairy products, processed meat, water, alcoholic beverages, and sugar- and fat-rich foods (sensitivity: 67–93%).

Conclusions: The NORDIET-FFQ showed good ability in to estimate intakes of plant-based foods, fish, dairy products, meat, and energy-dense foods; adequate ranking of individuals according to intake of most recommendations except for unprocessed meat, processed meat, and vegetables; and importantly a good ability to identify those patients in need of dietary counselling for foods that are known to modulate the risk of CRC.

Trial registration: National Institutes of Health; Identifier: NCT01570010.



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  1. Diet, nutrition and the prevention of chronic diseases: report of Joint WHO/FAO expert consultation on Diet, Nutrition and the Prevention of Chronic Diseases (2002, Geneva, Switzerland). Diet, Nutrition and the Prevention of Chronic Diseases: report of a joint WHO/FAO expert consultation, Geneva, 28 January - 1 February 2002.

  2. World Cancer Research Fund/American Institute for Cancer Research (2007). Food, nutrition, physical activity, and the prevention of cancer: a global perspective. Washington, DC: American Institute for Cancer Research.

  3. Kostråd for å fremme folkehelsen og forebygge kroniske sykdommer: metodologi og vitenskapelig kunnskapsgrunnlag. Oslo: Nasjonalt råd for ernæring, Helsedirektoratet; 2011. Directorate of Health Oslo, Norway.

  4. Diet, nutrition, physical activity and colorectal cancer. Continuous Update Project Report World Cancer Research Fund/American Institute for Cancer Research. 2017.

  5. Food and Agriculture Organization of the United Nations (FAO). Food-based dietary guidelines. Available from: [cited 1 January 2016].

  6. Cancer in Norway 2016 (2017). Cancer incidence, mortality and prevalence in Norway. Oslo: Cancer registry of Norway.

  7. Henriksen HB, Ræder H, Bohn SK, Paur I, Kværner AS, Billington SÅW, et al. The Norwegian dietary guidelines and colorectal cancer survival (CRC-NORDIET) study: a food-based multicenter randomized controlled trial. BMC Cancer 2017; 17: 83.

  8. Willett W. Nutritional epidemiology. Oxford: Oxford University Press; 2013.

  9. Jia X, Craig LC, Aucott LS, Milne AC, McNeill G. Repeatability and validity of a food frequency questionnaire in free-living older people in relation to cognitive function. J Nutr Health Aging 2008; 12: 735–41.

  10. Dumartheray EW, Krieg MA, Cornuz J, Whittamore DR, Lovell DP, Burckhardt P, et al. Validation and reproducibility of a semi-quantitative Food Frequency Questionnaire for use in elderly Swiss women. J Hum Nutr Diet 2006; 19: 321–30.

  11. Eysteinsdottir T, Thorsdottir I, Gunnarsdottir I, Steingrimsdottir L. Assessing validity of a short food frequency questionnaire on present dietary intake of elderly Icelanders. Nutr J 2012; 11: 12.

  12. Kristjansdottir AG, Andersen LF, Haraldsdottir J, de Almeida MD, Thorsdottir I. Validity of a questionnaire to assess fruit and vegetable intake in adults. Eur J Clin Nutr 2006; 60: 408–15.

  13. Lillegaard IT, Overby NC, Andersen LF. Evaluation of a short food frequency questionnaire used among Norwegian children. Food Nutr Res 2012; 56. 6399 - DOI:10.3402/fnr.v56i0.6399

  14. Margetts BM, Nelson,M. Design concepts in nutritional epidemiology. New York: Oxford University Press; 1997.

  15. Thompson FE, Byers T. Dietary assessment resource manual. J Nutr 1994; 124: 2245s–317s.

  16. Willett WC, Sampson L, Stampfer MJ, Rosner B, Bain C, Witschi J, et al. Reproducibility and validity of a semiquantitative food frequency questionnaire. Am J Epidemiol 1985; 122: 51–65.

  17. Yokoyama Y, Takachi R, Ishihara J, Ishii Y, Sasazuki S, Sawada N, et al. Validity of short and long self-administered food frequency questionnaires in ranking dietary intake in middle-aged and elderly Japanese in the Japan Public Health Center – based prospective study for the next generation (JPHC-NEXT) protocol area. J Epidemiol 2016; 26: 12.

  18. Osler M, Heitmann BL. The validity of a short food frequency questionnaire and its ability to measure changes in food intake: a longitudinal study. Int J Epidemiol 1996; 25: 1023–9.

  19. Xinying PX, Noakes M, Keogh J. Can a food frequency questionnaire be used to capture dietary intake data in a 4 week clinical intervention trial? Asia Pac J Clin Nutr 2004; 13: 318–23.

  20. England CY, Andrews RC, Jago R, Thompson JL. A systematic review of brief dietary questionnaires suitable for clinical use in the prevention and management of obesity, cardiovascular disease and type 2 diabetes. Eur J Clin Nutr 2015; 69: 977–1003.

  21. Asaad G, Sadegian M, Lau R, Xu Y, Soria-Contreras DC, Bell RC, et al. The reliability and validity of the perceived dietary adherence questionnaire for people with type 2 diabetes. Nutrients 2015; 7: 5484–96.

  22. Bell LK, Golley RK, Magarey AM. A short food-group-based dietary questionnaire is reliable and valid for assessing toddlers’ dietary risk in relatively advantaged samples. Br J Nutr 2014; 112: 627–37.

  23. Cade J, Thompson R, Burley V, Warm D. Development, validation and utilisation of food-frequency questionnaires – a review. Public Health Nutr 2002; 5: 567–87.

  24. Golley RK, Bell LK, Hendrie GA, Rangan AM, Spence A, Mc-Naughton SA, et al. Validity of short food questionnaire items to measure intake in children and adolescents: a systematic review. J Hum Nutr Diet 2017; 30: 36–50.

  25. Kupek E, de Assis MA, Bellisle F, Lobo AS. Validity of WebCAAFE questionnaire for assessment of schoolchildren’s dietary compliance with Brazilian Food Guidelines. Public Health Nutr 2016; 19: 2347–56.

  26. Perez Rodrigo C, Moran Fagundez LJ, Riobo Servan P, Aranceta Bartrina J. Screeners and brief assessment methods. Nutr Hosp 2015; 31(Suppl 3): 91–8.

  27. Randall Simpson J, Gumbley J, Whyte K, Lac J, Morra C, Rysdale L, et al. Development, reliability, and validity testing of Toddler NutriSTEP: a nutrition risk screening questionnaire for children 18–35 months of age. Appl Physiol Nutr Metab 2015; 40: 877–86.

  28. Edge SB. AJCC cancer staging handbook: from the AJCC cancer staging manual. New York: Springer; 2009.

  29. Rimestad AL, Løken EB, Nordbotten A. The Norwegian food composition table and the database for nutrient calculations at the Institute for Nutrition Research. Norwegian J Epidemiol 2000; 10: 16.

  30. The Keyhole symbole Oslo, Norway. Available from: [cited 1 December 2015].

  31. Brødskalaen Norwegian Directorate of Health Oslo, Norway. Available from: [cited 1 January 2016].

  32. Glasson C, Chapman K, James E. Fruit and vegetables should be targeted separately in health promotion programmes: differences in consumption levels, barriers, knowledge and stages of readiness for change. Public Health Nutr 2011; 14: 694–701.

  33. Totland TH. Norkost 3: en landsomfattende kostholdsundersøkelse blant menn og kvinner i Norge i alderen 18–70 år, 2010–11. Oslo: Helsedirektoratet; 2012.

  34. Bland M. An introduction to medical statistics. 3rd ed. Oxford: Oxford University Press; 2000.

  35. Hankin JH, Wilkens LR, Kolonel LN, Yoshizawa CN. Validation of a quantitative diet history method in Hawaii. Am J Epidemiol 1991; 133: 616–28.

  36. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: 307–10.

  37. Schmidt ME, Steindorf K. Statistical methods for the validation of questionnaires – discrepancy between theory and practice. Methods Inf Med 2006; 45: 409–13.

  38. Kipnis V, Midthune D, Freedman LS, Bingham S, Schatzkin A, Subar A, et al. Empirical evidence of correlated biases in dietary assessment instruments and its implications. Am J Epidemiol 2001; 153: 394–403.

  39. Tooze JA, Freedman LS, Carroll RJ, Midthune D, Kipnis V. The impact of stratification by implausible energy reporting status on estimates of diet-health relationships. Biom J 2016; 58: 1538–51.

  40. Willett WC. Diet and cancer: an evolving picture. JAMA 2005; 293: 233–4.

  41. Lee H, Kang M, Song WO, Shim JE, Paik HY. Gender analysis in the development and validation of FFQ: a systematic review. Br J Nutr. 2016;115:666–71.

  42. Carlsen MH, Lillegaard IT, Karlsen A, Blomhoff R, Drevon CA, Andersen LF. Evaluation of energy and dietary intake estimates from a food frequency questionnaire using independent energy expenditure measurement and weighed food records. Nutr J 2010; 9: 37.

  43. Carlsen MH, Karlsen A, Lillegaard IT, Gran JM, Drevon CA, Blomhoff R, et al. Relative validity of fruit and vegetable intake estimated from an FFQ, using carotenoid and flavonoid biomarkers and the method of triads. Br J Nutr 2011; 105: 1530–8.

  44. Continuous Update Project Report (2011). Food, nutrition, physical activity, and the prevention of colorectal cancer. Washington, DC: World Cancer Research Fund/American Institute for Cancer Research.

  45. Andersen LF, Johansson L, Solvoll K. Usefulness of a short food frequency questionnaire for screening of low intake of fruit and vegetable and for intake of fat. Eur J Public Health 2002; 12: 208–13.

  46. Saeedi P, Skeaff SA, Wong JE, Skidmore PM. Reproducibility and relative validity of a short food frequency questionnaire in 9–10 year-old children. Nutrients 2016; 8. 271 - DOI:10.3390/nu8050271

  47. Saloheimo T, Gonzalez SA, Erkkola M, Milauskas DM, Meisel JD, Champagne CM, et al. The reliability and validity of a short food frequency questionnaire among 9–11-year olds: a multinational study on three middle-income and high-income countries. Int J Obes Suppl 2015; 5: S22–8.

  48. Schroder H, Benitez Arciniega A, Soler C, Covas MI, Baena-Diez JM, Marrugat J. Validity of two short screeners for diet quality in time-limited settings. Public Health Nutr 2012; 15: 618–26.

How to Cite
Berg Henriksen H., Hauger Carlsen M., Paur I., Berntsen S., Kjølsrud Bøhn S., Juul Skjetne A., Sørlie Kværner A., Henriksen C., Frost Andersen L., Smeland S., & Blomhoff R. (2018). Relative validity of a short food frequency questionnaire assessing adherence to the Norwegian dietary guidelines among colorectal cancer patients. Food & Nutrition Research, 62.
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