A Semi-Quantitative Food Frequency Questionnaire Validated in Hispanic Infants and Toddlers Aged 0 to 24 Months

Published:February 07, 2017DOI:https://doi.org/10.1016/j.jand.2016.12.010



      There are limited validated food frequency questionnaires (FFQs) for infants and toddlers, most of which were evaluated in Europe or Oceania, and the ones available for use in the United States have important limitations.


      Our aim was to assess the validity of an FFQ developed for infants and toddlers.


      A semi-quantitative FFQ was developed that included 52 food items, their sources, and portion sizes. The FFQ inquired about diets over the previous 7 days. Its validity was assessed in a cross-sectional study. Participants completed the FFQ, followed by a 24-hour recall on two occasions with 1 week between data collection.


      A total of 296 caregivers of infants and toddlers aged 0 to 24 months enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children, Puerto Rico.

      Main outcome measures

      Intake of nutrients and food groups were averaged for the two FFQs and the two 24-hour food recalls, and adjusted for energy intake.

      Statistical analyses performed

      Spearman correlations were performed for intakes of energy, nutrients, and foods between administrations and between instruments. Correlation coefficients were de-attenuated to account for variation in the 24-hour recalls.


      A total of 241 participants completed the study. Intake of all nutrients and foods were significantly correlated between FFQs and 24-hour recalls and between the means of FFQs and 24-hour food recalls. The de-attenuated correlation for nutrients between the FFQs and 24-hour recalls ranged from 0.26 (folate) to 0.77 (energy), with a mean correlation of 0.53. The de-attenuated correlation for food groups between the FFQs and 24-hour recalls ranged from 0.28 (sweets) to 0.80 (breast milk), with a mean correlation of 0.55. When analyses were restricted to those consuming foods other than breast milk or formula (n=186), results were similar.


      This semi-quantitative FFQ is a tool that offers reasonably valid rankings for intake of energy, nutrients, foods, and food groups in this sample of infants and toddlers.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Adair L.S.
        Long-term consequences of nutrition and growth in early childhood and possible preventive interventions.
        Nestle Nutr Inst Workshop Ser. 2014; 78: 111-120
        • Polhamus B.
        • Dalenius K.
        • Thompson D.
        • et al.
        Pediatric nutrition surveillance.
        Nutr Clin Care. 2003; 6: 132-134
        • Young B.E.
        • Johnson S.L.
        • Krebs N.F.
        Biological determinants linking infant weight gain and child obesity: Current knowledge and future directions.
        Adv Nutr. 2012; 3: 675-686
        • Dattilo A.M.
        • Birch L.
        • Krebs N.F.
        • Lake A.
        • Taveras E.M.
        • Saavedra J.M.
        Need for early interventions in the prevention of pediatric overweight: A review and upcoming directions.
        J Obes. 2012; 2012: 123023
        • Gaffney K.F.
        • Kitsantas P.
        • Cheema J.
        Clinical practice guidelines for feeding behaviors and weight-for-age at 12 months: A secondary analysis of the Infant Feeding Practices Study II.
        Worldviews Evidence-Based Nurs. 2012; 9: 234-242
        • Mihrshahi S.
        • Battistutta D.
        • Magarey A.
        • Daniels L.A.
        Determinants of rapid weight gain during infancy: Baseline results from the NOURISH randomised controlled trial.
        BMC Pediatr. 2011; 11: 99
        • Fox M.K.
        • Pac S.
        • Devaney B.
        • Jankowski L.
        Feeding infants and toddlers study: What foods are infants and toddlers eating?.
        J Am Diet Assoc. 2004; 104: S22-S30
        • Picciano M.F.
        • Smiciklas-Wright H.
        • Birch L.L.
        • Mitchell D.C.
        • Murray-Kolb L.
        • McConahy K.L.
        Nutritional guidance is needed during dietary transition in early childhood.
        Pediatrics. 2000; 106: 109-114
        • Birch L.L.
        Development of food acceptance patterns in the first years of life.
        Proc Nutr Soc. 1998; 57: 617-624
        • Marriott L.D.
        • Inskip H.M.
        • Borland S.E.
        • Godfrey K.M.
        • Law C.M.
        • Robinson S.M.
        What do babies eat? Evaluation of a food frequency questionnaire to assess the diets of infants aged 12 months.
        Public Health Nutr. 2009; 12: 967-972
        • D’Ambrosio A.
        • Tiessen A.
        • Simpson J.R.
        Development of a food frequency questionnaire for toddlers of Low-German-Speaking Mennonites from Mexico.
        Can J Diet Pract Res. 2012; 73: 40-44
        • Collins C.E.
        • Burrows T.L.
        • Truby H.
        • et al.
        Comparison of energy intake in toddlers assessed by food frequency questionnaire and total energy expenditure measured by the doubly labeled water method.
        J Acad Nutr Diet. 2013; 113: 459-463
        • Bell L.K.
        • Golley R.K.
        • Magarey A.M.
        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: 627-637
        • Mills V.C.
        • Skidmore P.M.L.
        • Watson E.O.
        • Taylor R.W.
        • Fleming E.A.
        • Heath A.-L.M.
        Relative validity and reproducibility of a food frequency questionnaire for identifying the dietary patterns of toddlers in New Zealand.
        J Acad Nutr Diet. 2015; 115: 551-558
        • Watson E.O.
        • Heath A.-L.M.
        • Taylor R.W.
        • Mills V.C.
        • Barris A.C.
        • Skidmore P.M.
        Relative validity and reproducibility of an FFQ to determine nutrient intakes of New Zealand toddlers aged 12-24 months.
        Public Health Nutr. 2015; 18: 3265-3271
        • Andersen L.F.
        • Lande B.
        • Arsky G.H.
        • Trygg K.
        Validation of a semi-quantitative food-frequency questionnaire used among 12-month-old Norwegian infants.
        Eur J Clin Nutr. 2003; 57: 881-888
        • Blum R.E.
        • Wei E.K.
        • Rockett H.R.
        • et al.
        Validation of a food frequency questionnaire in Native American and Caucasian children 1-5 years of age.
        Matern Child Health J. 1999; 3: 167-172
        • Klohe D.M.
        • Clarke K.K.
        • George G.C.
        • Milani T.J.
        • Hanss-Nuss H.
        • Freeland-Graves J.
        Relative validity and reliability of a food frequency questionnaire for a triethnic population of 1-year-old to 3-year-old children from low-income families.
        J Am Diet Assoc. 2005; 105: 727-734
        • Marshall T.A.
        • Eichenberger Gilmore J.M.
        • Broffitt B.
        • Levy S.M.
        • Stumbo P.J.
        Relative validation of a beverage frequency questionnaire in children ages 6 months through 5 years using 3-day food and beverage diaries.
        J Am Diet Assoc. 2003; 103: 714-720
        • Lora K.R.
        • Davy B.
        • Hedrick V.
        • et al.
        Assessing initial validity and reliability of a beverage intake questionnaire in Hispanic preschool-aged children.
        J Acad Nutr Diet. 2016; 116: 1951-1960
        • Willett W.C.
        Nutritional Epidemiology. Vol 3. Oxford University Press, New York, NY2013
        • Cade J.E.
        • Burley V.J.
        • Warm D.L.
        • Thompson R.L.
        • Margetts B.M.
        Food-frequency questionnaires: A review of their design, validation and utilisation.
        Nutr Res Rev. 2004; 17: 5-22
      1. World Health Organization. Child growth standards, training course and other tools. http://www.who.int/childgrowth/training/en/. Accessed December 11, 2015.

      2. Center for Disease Control and Prevention (CDC). Infant Feeding Practices Study II and its year six follow-up. http://www.cdc.gov/ifps/. Published 2014. Accessed December 20, 2015.

        • Briefel R.
        • Ziegler P.
        • Novak T.
        • Ponza M.
        Feeding Infants and Toddlers Study: Characteristics and usual nutrient intake of Hispanic and non-Hispanic infants and toddlers.
        J Am Diet Assoc. 2006; 106: S84-S95
        • Mennella J.A.
        • Ziegler P.
        • Briefel R.
        • Novak T.
        Feeding Infants and Toddlers Study: The types of foods fed to Hispanic infants and toddlers.
        J Am Diet Assoc. 2006; 106: S96-S106
        • Palacios C.
        • Torres R.
        • Trak M.A.
        • Joshipura K.J.
        • Willett W.C.
        Assessing an infant food frequency questionnaire: A pilot study.
        FASEB J. 2014; 28: 36.2
        • Neville M.C.
        • Keller R.
        • Seacat J.
        • et al.
        Studies in human lactation: Milk volumes in lactating women during the onset of lactation and full lactation.
        Am J Clin Nutr. 1988; 48: 1375-1386
        • Dewey K.G.
        • Finley D.A.
        • Lönnerdal B.
        Breast milk volume and composition during late lactation (7-20 months).
        J Pediatr Gastroenterol Nutr. 1984; 3: 713-720
      3. Butte NF, Lopez-Alarcon MG, Garza C. Nutrient adequacy of exclusive breastfeeding for the term infant during the first six months of life. Expert consultation on the optimal duration of exclusive breastfeeding. Geneva, Switzerland: World Health Organization (WHO); 2002. http://www.who.int/iris/handle/10665/42519. Accessed May 1, 2016.

      4. Nutrition Data System for Research [computer program]. Version 25, program 2.8. Minneapolis, MN: Nutrition Coordinating Center, University of Minnesota; 2014.

        • Feskanich D.
        • Sielaff B.H.
        • Chong K.
        • Buzzard I.M.
        Computerized collection and analysis of dietary intake information.
        Comput Methods Programs Biomed. 1989; 30: 47-57
        • Buzzard M.
        • Feskanich D.
        Maintaining a food composition data base for multiple research studies: The NCC food table.
        in: Rand W. Windham C. Wyse B. Young V. Food Composition Data: A User’s Perspective. United Nations University Press, New York, NY1987: 226
      5. Nutrition Coordinating Center, University of Minnesota. Foods, Nutrients and food groups. http://www.ncc.umn.edu/about-ncc/foods-nutrients-and-food-groups/. Published 2016. Accessed May 1, 2016.

        • Willett W.C.
        • Howe G.R.
        • Kushi L.H.
        Adjustment for total energy intake in epidemiologic studies.
        Am J Clin Nutr. 1997; 65 (discussion 1229S-1231S): 1220S-1228S
        • Rosner B.
        • Glynn R.J.
        Interval estimation for rank correlation coefficients based on the probit transformation with extension to measurement error correction of correlated ranked data.
        Stat Med. 2007; 26: 633-646
        • Freedman L.S.
        • Commins J.M.
        • Moler J.E.
        • et al.
        Pooled results from 5 validation studies of dietary self-report instruments using recovery biomarkers for energy and protein intake.
        Am J Epidemiol. 2014; 180: 172-188
        • Betson D.
        • Martinez-Schiferl M.
        • Giannarelli L.
        • Zedlewski S.
        National- and State-Level Estimates of WIC Eligibles and Program Reach, 2000-2009.
        Urban Institute, Washington, DC2011


      C. Palacios is an associate professor, Nutrition Program, School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan.


      O. Sinigaglia is a graduate student, Nutrition Program, School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan.


      E. M. Ríos is a graduate student, Nutrition Program, School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan.


      S. Rivas-Tumanyan is an assistant professor in epidemiology and assistant deanship of research, School of Dental Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan.


      M. Campos is an associate professor, Center for Clinical Research and Health Promotion, School of Dental Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan.


      B. Diaz is an assistant professor, Undergraduate Department, School of Nursing, Medical Sciences Campus, University of Puerto Rico, San Juan.


      E. J. Santiago-Rodríguez is a biostatistician, Retrovirus Research Center, Internal Medicine Department, School of Medicine, Universidad Central del Caribe, Bayamon, Puerto Rico.


      W. Willett is Fredrick John Stare Professor of Epidemiology and Nutrition, and chair of the Department of Nutrition, Department of Epidemiology, School of Public Health, Harvard University, Boston, MA.