EFSA/EU Menu Guidance Appendix 5.3.5

Transcription

1 EFSA/EU Menu Guidance Appendix Example of a protocol for application of the Food Propensity Questionnaire (FPQ) based on the PANCAKE and the PILOT-PANEU projects 1 TABLE OF CONTENTS 1. Introduction Standardization of procedures Responsibilities of the study Coordinator Procedures Before the interview starts Data collection The Questionnaire Example sets of FPQ questions... 6 REFERENCES The content of this Appendix is used with mission of the PILOT PANEU project (Ambrus et al., 2012) and PANCAKE consortium (Ocké et al., 2013).

2 1. Introduction Twenty four-hour recalls have traditionally been used for nutrition monitoring purposes (USDA; Tippett and Cypel, 1997; De Vriese S et al., 2005; Sekula et al., 2005). Also the European Food Safety Authority (EFSA) in the Guidance on the EU Menu methodology recommends that surveys should use a dietary assessment method (24h-recall in age groups years and a combined diary and a completion interview in children up to 9 years old) covering two non-consecutive complemented by a short food propensity questionnaire (EFSA, 2014). The 24-hour recalls capture a son s occasional food consumption in substantial detail. Nonetheless, the day-to-day variation in intakes, which is present in single or few short-term measurements, affects the estimation of habitual intake distributions and thus the centages of individuals below or above a particular intake (Buzzard M, 1998; Carriquiry, 2003). In addition, when the data are used to assess diet-disease associations, the presence of within-son variability is expected to affect the magnitude of associations leading generally to attenuation of the effect. A question therefore arises as to whether a single or two 24-hours recalls participant are adequate to describe the distribution of usual intakes and to identify population groups at risk because of higher or lower exposure. In order to address this limitation, researchers have recommended the use of supplementary data on frequency of consumption collected from a short, non-quantitative food frequency questionnaire, which aims to record the frequency of intake, but not to collect information on amounts consumed. This type of food frequency questionnaire is often described as Food Propensity Questionnaire (FPQ) (Subar et al., 2006; Tooze et al., 2006). The rationale for using this questionnaire is to assess the probability of consumption separately from the amount consumed and subsequently combine the two estimates to describe the distribution of usual intake (Haubrock et al., 2011; Orfanos et al., 2013). When data are analysed the FPQ-derived information is used as covariates when modeling the data collected through at least two repeated short-term measurements in order to estimate usual intake. In the recently concluded project European Tool Usual Intake (ETUI) commissioned by EFSA, the usual intake models were reviewed and the optimal model was selected (van Klaveren et al., 2012). Based on the results of the ETUI project (van Klaveren et al., 2012) and the EU Menu pilot projects PANCAKE (Ocké et al., 2012) and PILOT-PANEU (Ambrus et al., 2013), in the current EFSA Guidance on the EU Menu methodology it is recommended that for all age groups, except infants and toddlers, information on the frequency of consumption of some less frequently eaten foods and food supplements should be collected using an additional modified food propensity questionnaire (FPQ) covering all seasons of the past year (EFSA 2014). In the case of infants, the reference iod to be used is recommended to be one. In this guidance document it is highlighted that the FPQ should be as short as possible to lower the participation burden. In the case of food supplements, it is recommended that only frequency of use of different groups of food supplements (e.g. multivitamins and minerals, vitamin C or iron supplements) be recorded. Based on the above, the items/food groups to be prioritised in the EU Menu FPQ fall into one of the following categories: a. Specific foods and beverages expected of being consumed at varying frequency in European countries and with importance for risk assessment purposes (e.g. types of fresh vegetables, cereals, meats, molluscs and energy drinks). These questionnaire entries are common to all countries. b. Food supplements. c. In special cases, foods and beverages selected to address country-specific public health priorities (to be decided by the national survey team and to keep the list of foods as short as possible). 2

3 2. Standardisation of procedures In an attempt to ensure the collection of harmonised data among countries, when recording data through the FPQ, it is important to achieve uniformity. The focus is therefore set on applying unchanged processes and procedures and documenting deviations, when the latter are deemed necessary. It is recommended to use the EFSA FoodEx2 food classification system as much as possible and map the foods of the FPQ against the FoodEx2 system prior starting to use the FPQ. The well-prepared training of the survey sonnel is essential in the compilation and use of the FPQ. Before proceeding to the data collection, field workers need to understand the scope of the FPQ and practice its application. The PILOT-PANEU study (Ambrus et al., 2013) showed that respondents generally needed assistance in: (a) understanding the food items included in questions on aggregated categories and (b) estimating the average frequency of consumption. Specific attention needs to be given during the sonnel s training in order to address these issues. The FPQ training material should include country-specific examples of items included in each food group, as well as ways to average the yearly frequency of consumption. If the fieldwork is expected to last for more than few s, re-training sessions that will reinforce the use of the standard procedures need to be foreseen. Another issue that emerged during the pilot-testing of the questionnaire was that the respondents had difficulties in estimating the average consumption of items which are usually consumed on a seasonal basis. The PILOT-PANEU project noted that the addition of questions addressing the seasonality in the consumption of certain items will provide better applicability of the FPQ and suggested two options for doing so (rf. the project s final report). 3. Responsibilities of the study Coordinator The study Coordinator ensures that: 4. Procedures all the documents needed (FPQ and protocol) are translated to the local language, in accordance to accepted translation procedures (i.e. translation followed by back-translation) interviewers are appropriately trained before being involved in the fieldwork work is carried out according to the provisions of the protocol interviewers record all collected information, according to guidelines set; in case of a pa-administered questionnaire, data are entered from pa FPQ into the central database Before the interview starts The following guidelines refer to the interviewers: After creating a comfortable and friendly atmosphere, explain to the study participant that the aim of this questionnaire is to record the frequency of consuming certain foods and beverages. Some questions refer to major food groups (e.g. green leafy vegetables), whereas other refers to specific items (e.g. lettuce). In order to answer the questions, kindly ask the years old participant to think of a usual in the last 12 s and try to reply to the question: How often did you eat/drink the following.? You need to also clarify that the question remains the same throughout the questionnaire. In case of children (subject under 10 years old), the reference iod is one and the help of parents and care takers are often needed. You may repeat the question every 3-4 items, to assist the participant in recalling it. Explain to the participant that the frequency options include never, sometimes and sometimes and indicate that if sometimes or sometimes is the reply, you may ask him/her to specify the number of times. 3

4 Lastly, emphasise that attention is needed with respect to items consumed sporadically or on a seasonal basis and kindly ask the participant to inform you if the question refers to such an item, so as to assist him/her in estimating the usual frequency over the year. If only one face-to-face interview will take place, the FPQ should be sent to the participant prior to the visit and checked by the interviewer together with the study participant during the visit for completeness. Responsibilities of the interviewers Before being engaged for the fieldwork, all interviewers need to: Carefully study the questionnaire and the protocol and discuss questions with the study coordinator; Obtain routine and know the common problems with the FPQ checks if the interviewer has to check a self-administered FPQs during study visits; receive appropriate practical training in interviewing or checking FPQs including e.g. roleplay exercises Data collection The following two issues need to be particularly addressed during the training and fieldwork: (a) Items consumed seasonally: In its current format the questionnaire does not include questions that specifically capture any seasonality in consumption. In this format, the interviewers need to assist the respondent in estimating his/her frequency of consumption. In particular, the respondent can be asked: (a) to think of a usual during which the item is consumed, (b) to indicate how often she/he eats the foods in each season (c), to report how long is the season for this particular item and in the end the interviewer will average the consumption frequency over the whole year. Examples: 1. If strawberries are only consumed in the three summer s 2-3, the interviewer will indicate 1 day (over the year). 2. If the respondent reports consuming 3 portions of specific fish of interest from June to September and 1 portion of the same type of fish for the rest of the year, the interviewer can indicate 2 portions of the fish of interest (over the year). Items consumed seasonally may also be asked through a separate set of questions (a) during a season, e.g. during summer s, and b) during the rest of the year) and two alternatives are provided for doing so. (b) Examples of items classified in groups In the case of questionnaire entries that refer to aggregated food categories, examples of items included in the category need to be provided, particularly if the questionnaire is planned to be selfadministered. Examples need to be carefully selected so as to adequately reflect national food consumption patterns. In addition, it is generally recommended that you use descriptions of the food groups that will be understandable by the lay respondent. Whenever this is not possible, scientific terms can be used followed by a detailed list of items in this group to facilitate the response. During their training, the interviewers will be asked to review and discuss these examples so that uniformity in providing clarifications is achieved and maintained. Additional and more detailed examples are needed if the questionnaire addresses adolescents. When the interview is completed: Check for incorrect or missing data; Store the pa-based questionnaire appropriately (keeping a scanned copy is often advised); 4

5 Enter the data following the coding instructions (at the study centre); Inform the study Coordinator on any deviations during the data collection. The study coordinator needs to organise regular staff meetings to take notice about problems encountered, deviations made and remedies applied. The coordinating centre needs to be informed on the outcome of these meetings. 5. The Questionnaire Examples of possible FPQ questions to be used in an EU Menu survey are included at the end of this document. These sets of questions are from different countries from both the PANCAKE (Ocké et al., 2012) and PILOT-PANEU (Ambrus et al., 2013) pilot studies. The questionnaire has been structured to allow collection of consumption data food group. Survey coordinators are advised to enrich the questionnaire with entries that are of particular interest according to their country s priorities. The new entries on specific items have to be added in the relevant section before the questions about aggregated categories. The questions on aggregated food categories always appear at the end of each food group section. It is important to clearly explain to the respondent that the questions about the aggregated groups aim to capture the frequency of consumption of all the remaining items in the group. For example, questions on dairy products are asked in the following sequence: (a) cheese; (b) yoghurt and (c) other milk products (asking the respondent to report the frequency of consuming of all other milk products, with the exception of cheese and yoghurt). Once the questionnaire is completed, a short test of its feasibility is strongly advised in order to address issues related to the new country-specific entries. 5

6 6. Example sets of FPQ questions (The questions are directly from or modified from the EU Menu pilot studies, PANCAKE and PILOT- PANEU (Ocké et al 2012; Ambrus et al. 2013). Examples of food propensity questions for children Specific dietary habits of the child Respondent number of the child Date (ddmmyyyy) 1. Who is answering the general questions of this questionnaire? Mother/female caretaker of the participating child -1 Father/male caretaker of the participating child -2 Other caretaker of the child, nl. -3 A caretaker is a son (mostly a relative or friend) who provides unpaid daily care by looking after the child. 2. Is your child a boy or a girl? Boy Girl What is the date of birth of the participating child? (ddmmyyyy) 6

7 4. How often did your child eat/drink the following specific foods this preceding : Please note that specific food items may seem strange to consume for small children. We still want to ask the questions, to know the frequency of consumption. When the specific food is not consumed tick never. a. Muesli, cornflakes, other breakfast cereal b. Dried fruits (e.g. prunes, figs, raisins, dates) Never <1 / 1-3 / 1 day/ 2-3 / 4-5 / 6-7 / Unknown c. Nuts (salted, fresh, e.g. peanuts,hazelnuts,walnuts, d. Nut spread (e.g. peanut butter) e. Smoked sausage (e.g. *) f. Smoked cheese g. Smoked fish (e.g smoked mackerel, smoked eel) h. Kidney i. Liver i. Meat products with liver (e.g. liver sausage, liverpate) k. Fatty fish (sardines, anchovis, herring, mackerel, salmon, eel) l. Clams$ m. Mussels$ n. Oysters$ o. Scallops$ p. Gastropods (snails, whelks *) $ q. Roe$ r. Pep s. Nutmeg t. Mint u. Salt added at the table v. Home prepared foods with salt added during preparation w. Endives x. Spinach y. Lettuce * example from a country, $ see Wikipedia description. 7

8 5. Has your child taken vitamin tablets, minerals or any other supplements (e.g. beer yeast) in this preceding? No continue with question 8 Yes What did your child use? Never <1 / 1-3 / 1 day/ 2-3 / 4-5 / 6-7 / Unknown a. Vitamin A b. Vitamin D c. Vitamin A/D d. Vitamin K e. Vitamin B f. Vitamin C g. Beer yeast h. Multivitamins (without minerals) i. Multivitamins/-minerals j. Iron k. Calcium l. Fluor m. Omega-3 fatty acids n. Fish oil o. Other,nl.:

9 Examples of food propensity questions for adults For answering the questions that follow, please think of a usual in the last 12 s. How often did you eat/drink the following items? Please select the most suitable frequency of consumption and circle the respective number in the row. For items consumed seasonally (e.g. freshwater fish): Please think of a usual in the season the food item is commonly consumed. How often did you eat the foods in each season? How long is the season for this item? Please try to average your consumption frequency over the whole year. Example: If from June to August, you eat freshwater fish [the choice of the item can be countryspecific] 2-3, please indicate 1 day. How often did you eat/drink the following items the last 12 s? Please give an answer on each row and circle the number indicating your reply. Fish, seafood 1. Fatty fish of marine origin, fresh (sardines, anchovy, herring, mackerel, salmon, eel, tuna) 2. Other marine fish, fresh (e.g. cod) 3. Freshwater fish, fresh (e.g. trout, ch, carp, bighead carp catfish) 4. Smoked fish (e.g. smoked salmon) 5. Cephalopods (incl. octopus, squids, cuttlefish) Never Less than 1 day day (nearly every day) Not answer ed 6. Prawns and shrimps 7. Mussels, clams, oysters, bivalve molluscs, scallops 9

10 How often did you take any of the vitamins, minerals or other dietary supplements listed below the last 12 s? Never Less than 1 day day (nearly every day) Not answer ed 1. Vitamin C supplement 2. Vitamin D supplement 3. Folate supplement 4. Multivitamin supplement without minerals 5. Multivitamin supplement with minerals 6. Calcium supplement 7. Iron supplement 8. Magnesium supplement 9. Fatty acid supplement (e.g. fish oil, primrose oil) 10. Herb or plant supplements 11. Probiotic or prebiotic preparations 12. Algae preparations 13. Supplements for body building (carnitin, creatin, amino acids, protein, etc) 14. Supplements for weight control and slimming 15. Other Please indicate: This is the end of the questionnaire, thank you for participating! 10

11 REFERENCES Buzzard M, hour dietary recall and food record methods. In: Nutritional epidemiology, 2nd ed. W. Willet, Ed. New York: Oxford University Press; p Carriquiry AL, Estimation of usual intake distributions of nutrients and foods. The Journal of Nutrition, 133(2), 601S-608S. De Vriese S, De Backer G, De Henauw S & et al., The Belgian food consumption survey : aims, design and methods. Archives of Public Health, 63(1), EFSA (European Food Safety Authority), General principles for the collection of national food consumption data in the view of a pan-european dietary survey. EFSA Journal 2009; 7(12):1435. doi: /j.efsa Available online: EFSA (European Food Safety Authority), Guidance on the EU Menu methodology. EFSA Journal 2014;12(12):3944, 81 pp. doi: /j.efsa Haubrock J, Nothlings U, Volatier JL & et al., Estimating usual food intake distributions by using the multiple source method in the EPIC-Potsdam Calibration Study. The Journal of Nutrition, 141(5), Ocké M, de Boer E, Brants H, van der Laan J, Niekerk M, van Rossum C, Temme L, Freisling H, Nicolas G, Casagrande C, Slimani N, Trolle E, Ege M, Christensen T, Vandevijvere S, Bellemans M, De Maeyer M, Defourny S, Rupich J, Dofkova M, Rehurkova I, Jakubikova M, Blahova J, Piskackova Z and Maly M, PANCAKE Pilot study for the assessment of nutrient intake and food consumption among kids in Europe. Supporting Publications 2012, EN-339, 120 pp. Available online: Orfanos P, Knuppel S, Naska A & et al., Evaluating the effect of measurement error when using one or two 24 h dietary recalls to assess eating out: a study in the context of the HECTOR project. The British Journal of Nutrition, Sekula W, Nelson M, Figurska K & et al., Comparison between household budget survey and 24-hour recall data in a nationally representative sample of Polish households. Public Health Nutrition, 8(4), Subar AF, Dodd KW, Guenther PM & et al., The food propensity questionnaire: concept, development, and validation for use as a covariate in a model to estimate usual food intake. Journal of the American Dietetic Association, 106(10), Tippett KS and Cypel YS, Eds., Design and Oation of the Continuing Survey of Food Intakes by Individuals and the Diet and Health Knowledge Survey, Washington, DC, US Department of Agriculture, Agricultural Research Service. NFS Report No Tooze JA, Midthune D, Dodd KW & et al., A new statistical method for estimating the usual intake of episodically consumed foods with application to their distribution. Journal of the American Dietetic Association, 106(10), USDA (United States Department of Agriculture). What we eat in America, NHANES , Available online: Van Klaveren JD, Goedhart PW, Wapom D and Voet Hvd, A European tool for usual intake distribution estimation in relation to data collection by EFSA. Supporting Publications 2012:EN