Relative validity of a semi-quantitative food frequency questionnaire to estimate the intake of iron and its absorption modifiers in young Saudi females

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Merfat Almaghrabi
Salwa Albar
Hadeil Alsufiani
Ranim Zamkah
Sarah Alyafie
Abrar Houssien


food frequency questionnaire; validity; iron intake; anemia; young females; Saudi Arabia.


Background and aim: To date, there is a lack of published data regarding validated food frequency questionnaire (FFQ) design specifically for Saudi populations. Therefore, the purpose of this study was to investigate for the first time the relative validity of a semi-quantitative FFQ to estimate the intake of iron and its absorption modifiers in young Saudi females. 

Methods: A convenience sample of 101 apparently healthy young Saudi females aged 18- 24 from Jeddah, Saudi Arabia participated in the study. All participants completed the FFQ and three non-consecutive days of food records (FR) to determine validity. Pearson’s correlation was used to investigate the correlation between nutrients intake obtained from the FFQ and FR. The agreement between the two methods was compared using a Bland-Altman analysis and the Cohen’s kappa statistic. For the analysis, the significance level was set at p <0.05.

Results: There were no significant differences between the estimates of iron and calcium intake obtained by the two methods. However, the FFQ yielded higher estimates of vitamin A, vitamin C, and fiber. The differences in iron was equivalent to 4%, with agreement ranging from an underestimation of 1.2% to an overestimation of 1.3%. For vitamin A, vitamin C, and fiber, the difference between the two methods increased with increasing mean intake. The agreement on ranking showed that participants were correctly classified in the same or adjacent quantile of nutrient intake.

Conclusions: The semi-quantitative FFQ appears to be a reasonably valid method of estimating the intake of iron and its absorption modifiers in young Saudi females. The present findings are of interest for public health and could be applied in epidemiological studies. 


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1. Al-Jamea L, Woodman A, Elnagi EA, et al. Prevalence of iron-deficiency anemia and its associated risk factors in female undergraduate students at Prince Sultan Military College of Health Sciences. J Appl Hematol 2019; 10: 126.
2. Stoltzfus RJ, Mullany L, Black RE. Iron deficiency anaemia. In Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors, Ezzati M, Rodgers A, Murray CJL, Editors. 2004, Geneva, Switzerland: World Health Organization. pp. 163-209.
3. World Health Organization. Iron deficiency anaemia. 2001 [Accessed 1 July 2021]. Available from:
4. Schümann K, Ettle T, Szegner B, Elsenhans B, Solomons NW. On risks and benefits of iron supplementation recommendations for iron intake revisited. J Trace Elem Med Biol 2007; 21: 147-68.
5. Khaskheli M-N, Baloch S, Sheeba A, Baloch S, Khaskheli FK. Iron deficiency anaemia is still a major killer of pregnant women. Pak J Med Sci 2016; 32: 630.
6. de Andrade Cairo RC, Silva LR, Bustani NC, Marques CDF. Iron deficiency anemia in adolescents; a literature review. Nutrición Hospitalaria 2014; 29: 1240-9.
7. Fayet-Moore F, Petocz P, Samman S. Micronutrient status in female university students: iron, zinc, copper, selenium, vitamin B12 and folate. Nutrients 2014; 6: 5103-16.
8. Israeli E, Merkel D, Constantini N, et al. Iron deficiency and the role of nutrition among female military recruits. Med Sci Sports Exerc 2008; 40: S685-90.
9. Young I, Parker H, Rangan A, et al. Association between haem and non-haem iron intake and serum ferritin in healthy young women. Nutrients 2018; 10: 81.
10. Kapur D, Agarwal KN, Agarwal DK. Nutritional anemia and its control. Indian J Pediatr 2002; 69: 607-16.
11. National Research Council. Diet and health: implications for reducing chronic disease risk. 1989, Washington, DC: National Academies Press.
12. Hu FB, Rimm E, Smith-Warner SA, et al. Reproducibility and validity of dietary patterns assessed with a food-frequency questionnaire. Am J Clin Nutr 1999; 69: 243-9.
13. Owaidah T, Al-Numair N, Al-Suliman A, et al. Iron deficiency and iron deficiency anemia are common epidemiological conditions in Saudi Arabia: Report of the National Epidemiological Survey. Anemia 2020: 1-8.
14. Dehghan M, Al Hamad N, Yusufali A, Nusrath F, Yusuf S, Merchant AT. Development of a semi-quantitative food frequency questionnaire for use in United Arab Emirates and Kuwait based on local foods. Nutrition J 2005; 4: 1-7.
15. Willett W. Nutritional Epidemiology (3rd ed.) 2013, Oxford University Press: United Kingdom. pp. 70-95.
16. Barbosa K, de Lima Rosado L, Priore S. Dietary records used for food consumption evaluation in adolescents: Comparison among methods. Archivos Latinoamericanos de Nutricion 2007; 57: 43-50.
17. Ambrosini GL, O'Sullivan TA, De Klerk NH, Mori TA, Beilin LJ, Oddy WH. Relative validity of adolescent dietary patterns: a comparison of a FFQ and 3 d food record. BJN 2011; 105: 625-33.
18. Beck KL, Kruger R, Conlon CA, et al. The relative validity and reproducibility of an iron food frequency questionnaire for identifying iron-related dietary patterns in young women. J Acad Nutr Diet 2012; 112: 1177-87.
19. Carroll R, Pee D, Freedman L, Brown C. Statistical design of calibration studies. Am J Clin Nutr 1997; 65: 1187S-9S.
20. Altman DG. Practical Statistics for Medical Research. 1990, London: CRC Press.
21. 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.
22. Alsufiani HM, Yamani F, Kumosani TA, Ford D, Mathers JC. The relative validity and repeatability of an FFQ for estimating intake of zinc and its absorption modifiers in young and older Saudi adults. Public Health Nutr 2015; 18: 968-76.
23. Barrett JS, Gibson PR. Development and validation of a comprehensive semi-quantitative food frequency questionnaire that includes FODMAP intake and glycemic index. J Am Diet Assoc 2010; 110: 1469-76.
24. Pakseresht M, Sharma S. Validation of a culturally appropriate quantitative food frequency questionnaire for Inuvialuit population in the Northwest Territories, Canada. J Human Nutr Diet 2010; 23: 75-82.
25. Segovia-Siapco G, Singh P, Jaceldo-Siegl K, Sabaté J. Validation of a food-frequency questionnaire for measurement of nutrient intake in a dietary intervention study. Public Health Nutr 2007; 10: 177-84.
26. Sauvageot N, Alkerwi A, Albert A, Guillaume M. Use of food frequency questionnaire to assess relationships between dietary habits and cardiovascular risk factors in NESCAV study: validation with biomarkers. Nutr J 2013; 12: 1-11.
27. Araujo MC, Yokoo EM, Pereira RA. Validation and calibration of a semiquantitative food frequency questionnaire designed for adolescents. J Am Diet Assoc 2010; 110: 1170-7.
28. Molag ML, de Vries JH, Ocké MC, et al. Design characteristics of food frequency questionnaires in relation to their validity. Am J Epidemiol 2007; 166: 1468-78.
29. Bland JM, Altman D. Statistical methods for assessing agreement between two methods of clinical measurement. The Lancet 1986; 327: 307-10.
30. Lombard MJ, Steyn NP, Charlton KE, Senekal M. Application and interpretation of multiple statistical tests to evaluate validity of dietary intake assessment methods. Nutr J 2015; 14: 1-11.
31. Regassa IF, Endris BS, Habtemariam E, Hassen HY, Ghebreyesus SH. Development and validation of food frequency questionnaire for food and nutrient intakes of adults in Butajira, southern Ethiopia. J Nutr Sci 2021; 10.
32. Masson LF, McNeill G, Tomany J, et al. Statistical approaches for assessing the relative validity of a food-frequency questionnaire: use of correlation coefficients and the kappa statistic. Public Health Nutr 2003; 6: 313-21.
33. Al-Jawaldeh A, Taktouk M, Doggui R, et al. Are countries of the Eastern Mediterranean region on track towards meeting the world health assembly target for anemia? A review of evidence. Int J Environ Res Public Health 2021; 18: 2449.