Development and validation of a food frequency questionnaire for assessing dietary vitamin D intake in young adults of Pakistan
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Abstract
Objective: To develop and validate a culturally adapted food frequency questionnaire (FFQ) for assessing vitamin D (VD) intake among young Pakistani adults, using multiple 24-hour dietary recalls (24HDRs) as the reference method.
Methods: This cross-sectional study was conducted at Dow University of Health Sciences (DUHS) between August and October 2022. A VD-focused FFQ was developed using international food composition databases and adapted to Pakistani dietary practices, excluding culturally inappropriate or unavailable items. The final tool contained 53 items grouped into major food categories. Participants aged 18–30 years (n=99) were recruited through convenience sampling. Three interviewer-administered 24HDRs and two FFQs (FFQ1, FFQ2) were collected. Validity was assessed by comparing FFQ1 and FFQ2 with the mean 24HDRs using paired t-tests, Spearman’s correlation, and Bland-Altman analysis, while reproducibility was evaluated by comparing FFQ1 and FFQ2.
Results: Mean VD intake was higher when estimated from FFQs (FFQ1: 5.96 µg; FFQ2: 6.39 µg) compared to 24HDRs (4.33 µg), reflecting overestimation common to FFQs. Adequate VD intake (>2.5 µg/day) was reported in >55% of participants across all methods. Spearman’s correlation showed strong validity for FFQ1 vs. 24HDRs (r=0.693, p<0.001) and moderate validity for FFQ2 vs. 24HDRs (r=0.538, p<0.001). Reproducibility between FFQ1 and FFQ2 was strong (r=0.700, p<0.001). Bland-Altman indices were within acceptable ranges (3–5%), confirming agreement.
Conclusion: The culturally adapted VD-FFQ demonstrated moderate-to-strong validity and strong reproducibility, making it a reliable tool for estimating VD intake in young Pakistani adults. Its use may facilitate future research on dietary determinants of VD deficiency in this high-risk population.
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