Nutrition Assessment

Trained and certified NASR staff conduct recalls over the telephone and enter data directly into the University of Minnesota’s Nutrition Data System for Research (NDSR) software. This interactive software prompts the interviewer to probe for detailed information about specific quantities, brand names and cooking methods for each food. The accuracy of the recall is highly dependent upon participant memory and the communication skills of both the participant and the interviewer. For this reason, NASR interviewers are specially trained to effectively probe for information using neutral and non-leading questions. All participants receive a serving size booklet prior to the call.

_{NASR's serving size booklet is available for purchase.}

Prior to completing the documented food record, the participant meets with trained study staff to receive detailed instruction on food recording procedures. After completing the food record, the participant meets with study staff again to review and document the information reported in the food record. Study staff then send the reviewed and documented food record to NASR for coding and analysis using the University of Minnesota’s Nutrition Data System for Research (NDSR).

For an undocumented food record, the participant receives less instruction on food recording procedures and does not meet with study staff to review and document the completed food record. Study staff send the food record, as completed by the participant, to NASR for coding and analysis using NDSR.

Two studies evaluated a self-administered 3-day food record protocol where the dietary intake data were analyzed both before (undocumented) and after (documented) additional information was obtained from the study participant. Results of these studies suggest that the use of undocumented food records is feasible for use in large cohort studies.

_{NASR's undocumented multiple-day food record booklet is available for purchase.}

For more information:

Kolar AS, Patterson RE, White E, Neuhouser ML, Frank LL, Standley J, Potter JD, Kristal AR. A practical method for collecting 3-day food records in a large cohort. Epidemiology. 2005; 16:579-583.

Kwan ML, Kushi LH, Song J, Timperi AW, Boynton AM, Johnson KM, Standley J, Kristal AR.  A Practical Method for Collecting Food Record Data in a Prospective Cohort Study of Breast Cancer Survivors.  J Am Diet Assoc. 2010; 172 (11): 1315-1323.

NASR offers training for study staff on the appropriate and accurate completion of the Multiple-Day Food Record. Trainings for study staff include:

• How to instruct a participant to complete a Multiple-Day Food Record (undocumented)
• How to instruct a participant to complete a Multiple-Day Food Record (documented)
• How to document a completed Multiple-Day Food Record (documented)

Trainings can be done individually or in group format. Customized training options are available, pending study needs.

The paper format of the FFQ is a 12-page scannable booklet. The booklets are purchased from NASR. Completed booklets are sent back to NASR to be scanned (i.e., read by an optical scanner) and processed (to generate nutrient output). Processed FFQ output files are posted to the secure NASR Portal for download. 

Process At A Glance

• Email nasr@fredhutch.org to set up your study & purchase paper booklets
• Review & implement QA Guidelines
• Distribute booklets to participants
• Collect completed booklets
• Send completed booklets to NASR for scanning and processing (use Batch Cover Sheet)
• NASR will notify you when your datasets are ready to download from our secure Portal
• Cite NASR in your publications

For information about how FFQ data are processed, see the Technical Documentation.

View sample data dictionaries for information about the variables included in standard output datasets for the Online FFQ and the Paper FFQ.

Custom services are available. For example:

• Customization of FFQs.
• Customized datasets (e.g., additional variables on Healthy Eating Index [HEI] scoring).
• Individualized Participant Feedback (called the Nutrient Analysis Report or NAR) — a printable report giving the estimated dietary intake of specific nutrients for each study participant.

NASR periodically updates its standard FFQ to reflect U.S. food consumption patterns and major changes in the marketplace.

The previous version of the standard FFQ was the GSEL (and its counterpart, the MSEL). The GSEL/MSEL was designed in 2001 under the direction of Fred Hutch nutritional scientists and epidemiologists and was based on the questionnaires used in two large NIH-funded studies, the Selenium and Vitamin E Cancer Prevention Trial (SELECT) and the VITamins and Lifestyle study (VITAL). The GSEL/MSEL was updated in late 2010 to become the GNA/MNA.

The validation study by Patterson et al, using the WHI FFQ, is an excellent approximation of the inter-method reliability of the standard FFQ. The questionnaires use the same format and analysis algorithms. There are some differences in FFQ items. The nutrient database systems are the same; however, the standard FFQ nutrient database is updated regularly as new nutrients/food components are added to NDSR and improved analytic methods result in updated nutrient composition data.

Reference: Patterson RE, Kristal AR, Carter RA, Fels-Tinker L, Bolton MP, Agurs-Collins T. Measurement characteristics of the Women's Health Initiative food frequency questionnaire. Annals of Epidemiology. 9: 178-187, 1999.

BSQ

The Beverage and Snack Questionnaire (BSQ) is a 19-item questionnaire used to assess frequency of consumption of beverages such as soft drinks, energy drinks, juice, fruit drinks and milk, plus consumption of salty and sweet snacks such as cookies and candy. The response options inquire whether the food or beverage was consumed at school or away from school. The questionnaire was developed for use with youth (ages 10-18 years).

Reference: Neuhouser ML, Lilley S, Lund A, and Johnson DB. Development and validation of a beverage and snack questionnaire for use in evaluation of school nutrition policies. J Am Diet Assoc 2009; 109 (9): 1587-1592.

BSQ2

A second Beverage and Snack Questionnaire (BSQ2) is also available. The BSQ2 was developed in conjunction with the Network for a Healthy California. It differs slightly from the validated version in that a) the milk questions have been changed in order to separate flavored milks from regular milks, for investigators interested in overall sweetened beverage consumption and b) sweetened coffee and tea beverages and plain water have also been added.

The Caffeine Questionnaire (Supplemental Beverage Questions) is a list of 13 caffeine-containing beverages available to supplement the general Food Frequency Questionnaire on the dietary intake of caffeine. It can also be used independently of the general FFQ.

Reference: Song YJ, Kristal AR, Wicklund KG, Cushing-Haugen KL, Rossing MA.  Coffee, tea, colas, and risk of epithelial ovarian cancer. Cancer Epidemiol Biomarkers Prev 2008; 17(3): 712-6.

The Fat-Related Diet Habits Questionnaire was designed to assess eating behaviors associated with a low-fat diet.

There are five fat-related dietary patterns (factors): substitute specially manufactured low-fat foods; modify meats to be low in fat; avoid frying foods; replace high-fat foods with lower-fat foods such as fruits and vegetables; and avoid fat as a spread or flavoring.

Responses are on a four-point scale (1=usually or always, 2=often, 3=sometimes, 4=rarely or never), which are coded 1 through 4 to correlate positively with fat intake. Scoring the questionnaire will give a general idea about respondents' low-fat eating patterns; the lower the score, the lower the dietary fat intake.

References:

Kristal AR, Shattuck AL, Henry HJ. Patterns of dietary behavior associated with selecting diets low in fat: reliability and validity of a behavioral approach to dietary assessment. J Am Diet Assoc 1990; 90: 214-20.

Shannon J, Kristal AR, Curry SJ, Beresford SA. Application of a behavioral approach to measuring dietary change: the fat- and fiber-related diet behavior questionnaire. Cancer Epidemiol Biomarkers Prev 1997; 6(5): 355-61.

The Mindful Eating Questionnaire (MEQ) is a 28-item scale developed to measure the construct of mindful eating, a nonjudgmental awareness of the physical and emotional sensations associated with eating. 

Reference: Framson C, Kristal AR, Schenk JM, Littman AJ, Zeliadt S, Benitez D. Development and validation of the Mindful Eating Questionnaire. J Am Diet Assoc 2009; 109:1439-1444.

The Soy Questionnaire was developed to assess the patterns and correlates of soy consumption among postmenopausal women in the United States. It asks questions about the consumption of 20 soy foods and supplements.

Reference: Frankenfeld CL, Patterson RE, Horner NK, Neuhouser ML, Skor HE, Kalhorn TF, Howald WN, Lampe JW. Validation of a soy food frequency questionnaire and evaluation of correlates of plasma isoflavone concentrations in postmenopausal women. Am J Clin Nutr 2003; 77:674-80.