Development and external validation of the "flower-FFQ": A food frequency questionnaire designed for the Lifelines Cohort Study

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14 Citations (Scopus)


Objective: Food frequency questionnaires (FFQs) assess habitual dietary intake and are relatively inexpensive to process, but may take up to 60 minutes to complete. This article describes the validation of the Flower-FFQ, which consists of four short FFQs measuring the intake of energy and macronutrients or specific (micro)nutrients/foods that can be merged into one complete daily assessment using predefined algorithms. Design: Participants completed the Flower-FFQ and validated regular-FFQ (n=401). Urinary nitrogen (n=242) and potassium excretions (n=361) were measured. We evaluated: 1) group-level bias, 2) correlations, and 3) cross-classification. Setting: Observational study. Participants: Dutch adults, 54±11(mean±SD) years. Results: Flower-FFQ1, Flower-FFQ2, Flower-FFQ3, and Flower-FFQ4 were completed in ±24, 9, 8 and 9 minutes (±50 minutes total), respectively. The regular-FFQ was completed in ±43 minutes. Mean energy (flower vs. regular: 7953 vs. 8718 kJ/day) and macronutrient intakes (carbohydrates: 204 vs. 222 g/day; protein: 75 vs. 76 g/day; fat: 74 vs. 83 g/day; ethanol: 8 vs. 12 g/day) were comparatively similar. Spearman correlations between Flower-FFQ and regular-FFQ ranged from 0.60-0.80 for macronutrients and from 0.40-0.80 for micronutrients and foods. For all micronutrients and foods, ≥78% of the participants classified in the same/adjacent quartile. The flower-FFQ underestimated urinary nitrogen and potassium excretions by 24% and 18%; 75% and 73% of the participants ranked in the same/adjacent quartile. Conclusion: Completing the Flower-FFQ required 50 minutes with a maximum of 25 minutes per short FFQ. The Flower-FFQ has a moderate to good ranking ability for most nutrients and foods and performs sufficiently to study diet-disease associations.

Original languageEnglish
Pages (from-to)225-236
JournalPublic Health Nutrition
Issue number2
Early online date14 May 2021
Publication statusPublished - 14 Feb 2022


  • Dietary assessment
  • FFQ
  • Food Frequency Questionnaire
  • validation


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