Skip to main content
. 2016 Sep 14;20(3):417–448. doi: 10.1017/S1368980016002366

Table 2.

Summary of the included studies: design, population studied, dietary assessment instruments used and details of validation and/or reproducibility. Studies selected according to the two criteria are shaded. Where validation or reliability data was not available for fruit and vegetables specifically, this is highlighted in bold font

Study Design Population Countries Instrument(s) Validation Reproducibility
Adults
Baldini et al. ( 54 ) Cross-sectional Adults/students (n 210) Age range NR 2 (Italy, Spain) FFQ Based on the Willett FFQ Validated against diet records( 124 ) No validation data for F&V No details
Baltic project( 55 ) Cross-sectional Adults (n 4571) 19–65 years 3 (Latvia, Lithuania, Estonia) 24-HDR Standardised questionnaire No details No details
Behanova et al. ( 56 ) Cross-sectional Adults (n 210) 19–64 years 2 (Slovakia, Netherlands) FFQ No details No details
CNSHS( 57 , 58 ) Cross-sectional Adults/students (n 2651) Age range NR 4 (Germany, Denmark, Poland, Bulgaria) FFQ No test of validity was performed, but the questionnaire was similar to other FFQ that have been validated
ECRHS( 59 ) Cross-sectional Adults (n 1174) 30–70 years 3 (Germany, UK, Norway) FFQ (based on EPIC-UK and EPIC-Germany FFQ) German and UK FFQ validated against 24-HDR( 125 , 141 ) The Norwegian FFQ was not assessed for repeatability or validity Reproducibility of German FFQ obtained by a repeated administration of the FFQ at a 6-month interval( 125 ). Repeatability of the UK FFQ using two assessments separated by an interval of 5–23 months( 59 )
EHBS( 60 ) Cross-sectional Adults/students (n 7115) 17–30 years 21 in total 17 European countries (Austria, Denmark, England, Finland, France, Germany, Greece, Iceland, Ireland, Netherlands, Norway, Poland, Portugal, Scotland, Spain, Sweden, Switzerland) FFQ No details Reliability of the measures are described( 142 ) but no reliability data on F&V
ENERGY( 27 ) Cross-sectional Adults/parents or guardians (n 6002) Age range NR 7 (Belgium, Greece, Hungary, Netherlands, Norway, Slovenia, Spain) FFQ No details The reliability and content validity of the parent questionnaires were tested separately in all participating countries, in five schools per country using approximately fifty parents per country for the reliability study and twenty parents for the construct validity study (unpublished results)
EPIC( 18 , 28 , 29 , 61 63 ) Cohort Adults (n 519 978) 30–70 years 10 (Italy, Spain, Netherlands, Germany, Sweden (Malmo)/Sweden (Umea), Denmark, France, Greece, Norway, England) FFQ, 24-HDR (EPIC-SOFT) EPIC-SOFT was validated against biomarkers for F&V consumption( 63 ) Assessed by crude correlations Weak to moderate association between biomarkers and F&V intake No details
ESCAREL( 64 ) Cross-sectional Adults (n 3187) 18–35 years 7 (France, Spain, Italy, UK, Finland, Latvia, Estonia) FFQ Bartlett et al.( 64 ) report that all questionnaires were validated in pilot studies No reference or data available
Esteve et al. ( 65 ) Case–control Adults/controls (n 3057) Age range NR 4 (Spain, Italy, Switzerland, France) Dietary questionnaire No details No details
Finbalt Health Monitor( 66 ) Cross-sectional Adults (n 25 044) 20–64 years 4 (Estonia, Finland, Latvia, Lithuania) FFQ No details No details
Finnish and Russian Karelia study( 67 ) (2002 study) Cross-sectional Adults (n 1201) 25–64 years 2 (Russia, Finland) FFQ No details No details
‘Food in later life project’( 68 ) Cross-sectional Adults (n 644) 65–98 years 8 (Denmark, Germany, Italy, Poland, Portugal, Spain, Sweden, UK) 7 d non-weighed food diaries No details No details
Food4Me( 51 53 ) Randomised controlled trial Adults (n 5562) 17–79 years 7 (Ireland, Netherlands, Spain, Greece, UK, Poland, Germany) FFQ (web-based) Validated against 4 d non-consecutive weighed records( 53 ) and by comparing with the validated EPIC-Norfolk FFQ( 52 ) Assessed by crude correlations, energy-adjusted correlations, and mean or median differences in F&V consumption Moderate agreement with 4 d weighed food record Interval: 4 weeks( 53 ) Assessed by correlations Reproducible for nutrient and food group intake
Galanti et al. ( 69 ) Cross-sectional Adults (n 440) 2 (Sweden, Norway) FFQ No details No details
HAPIEE( 70 )* Cross-sectional Adults (n 28 947) 3 (Russia, Poland, Czech Republic) FFQ Based on the Whitehall II questionnaire. Validated against a 7 d diet diary and biomarkers of nutrient intake by Brunner et al. ( 126 ). Whitehall II questionnaire was originally developed by Willett et al. ( 127 ) Assessed by energy-adjusted correlations, mean or median differences, and exact level of agreement. Good correlation of intakes estimated by FFQ with biomarkers Overestimation of vitamin C and carotenes by FFQ relative to 7 d diet diary No details
HTT( 71 ) Cross-sectional Adults (n 18 000) 9 (Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, Ukraine) FFQ No details No details
Hupkens et al. ( 72 ) Cross-sectional Adults/women (n 849) 3 (Belgium, Netherlands, Germany) FFQ (based on Netherlands Cohort Study FFQ) Validated using diet records( 128 ) Assessed by crude correlations, mean or median differences FFQ can rank individuals according to food groups and nutrient intake No details
I.Family Project( 50 , 73 , 74 ) Prospective cohort study (successor of IDEFICS study) Adults/parents (n>7000) 8 (Belgium, Cyprus, Estonia, Germany Hungary, Italy, Spain, Sweden) Diet questionnaire as part of the parent questionnaire Online 24-HDR (SACANA) Similar to validated instruments used in the IDEFICS project No details
IHBS( 75 ) Cross-national Adults (n 17 246) 17 (Austria, Denmark, England, Finland, France, Germany, Greece, Iceland, Ireland, Netherlands, Norway, Poland, Portugal, Scotland, Spain, Sweden, Switzerland) FFQ No details No details
IMMIDIET( 76 ) Cross-sectional Adults (n 802) 3 (Italy, Belgium, England) EPIC-Italian FFQ EPIC-UK FFQ Specifically developed Belgian FFQ Based on EPIC UK and Italian FFQ which have been validated using weighed diet records( 141 ), biomarkers( 141 , 143 ) and 24-HDR( 143 ). Belgian FFQ validated using 7 d diet records and 24-HDR( 39 , 129 ) Assessed by energy-adjusted correlations, de-attenuated correlation coefficients, and mean or median differences Generally good correlation between FFQ and diet records No details
Kolarzyk et al. ( 48 ) Cross-sectional Adults/students (n 1517) 4 (Poland, Belarus, Russia, Lithuania) FFQ Validated and recommended by the National Food and Nutrition Institute in Warsaw, Poland( 49 ) No details
LiVicordia( 77 ) Cross-sectional Adults/men (n 150) 2 (Lithuania, Sweden) 24-HDR No details No details
LLH( 71 ) Cross-sectional Adults (n 18 428) 8 (Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, Ukraine) FFQ No details No details
MEDIS( 78 ) Cross-sectional Adults/elderly (n 1190) 2 (Cyprus, Greece) FFQ Validated using diet records( 138 ) Assessed by crude correlations, mean or median differences and exact level of agreement Moderate agreement for fruit and low agreement for vegetables Interval: 10–30 d( 138 ) Reproducibility of FFQ is fair
MGSD( 79 ) Cross-sectional Adults (n 4254) Non-diabetics (n 1833) 6 (Greece, Italy, Algeria, Bulgaria, Egypt, Yugoslavia (only diabetics in Yugoslavia)) Dietary history method using questionnaire Validated using diet records( 79 ) No details
NORBAGREEN( 41 , 80 ) Cross-sectional Adults and adolescents (n 8397) 8 (Norway, Denmark, Sweden, Finland, Latvia, Lithuania, Estonia, Iceland) FFQ Validated using 3 d diet records in Finland and four 24-HDR in Lithuania( 80 ) Assessed by crude correlations, mean or median differences, and exact level of agreement FFQ is valid to rank individuals according to F&V intake Interval: 6–8 months( 80 ) Provides reproducible estimates of food group intake
North/South Food Consumption Survey( 45 , 81 ) Cross-sectional Adults (n 1379) 2 (Northern Ireland, Republic of Ireland) 7 d record No details No details
O’Neill et al. ( 82 ) Cross-sectional Adults (n 400) 5 (UK, Republic of Ireland, Spain, France, Netherlands) FFQ No details No details
Parfitt et al. ( 83 ) Cross-sectional Adults/students (n 48) 2 (England, Italy) 5–7 d record No details No details
PRIME( 84 ) Cohort Adults (n 8087 used for present study) 2 (Northern Ireland, France) FFQ Not validated against another dietary assessment method. A correlation analysis between the frequency of fruit and/or vegetable intake and plasma vitamins was performed in 100 men to assess the ability of the questionnaire to discriminate large v. small consumers of fruits and vegetables( 84 ) No details
PRO GREENS( 85 ) Cross-sectional Adults/parents 10 (Austria, Belgium, Denmark, Iceland, Netherlands, Norway, Portugal, Spain, Sweden, Finland) A pre-coded 24-HDR, FFQ No details No details
Pro-Children study( 42 , 86 , 87 ) Cross-sectional Adults/parents Number NR 9 (Austria, Belgium, Denmark, Iceland, Netherlands, Norway Portugal, Spain, Sweden) A pre-coded 24-HDR, FFQ Validated using 7 d diet records (1 d weighed record and 6 d record using household measures)( 130 ) Assessed by crude correlations, mean or median differences, and exact level of agreement FFQ valid for ranking adults according to usual intake No details
Rylander et al. ( 88 ) Cross-sectional Adults/women (n 6785) 2 (Sweden, Switzerland) FFQ No details No details
SENECA( 43 , 44 , 89 , 90 ) Mixed design (longitudinal and cross-sectional) Adults/elderly (n≈2600) 70–75 years 12 (Belgium, Denmark, France, Greece, Hungary, Italy, Netherlands, Norway, Poland, Portugal, Spain, Switzerland) Modified dietary history method comprising a 3 d estimated record and meal-based frequency checklist Validated against a 3 d weighed record( 89 ) No validation data for F&V No details
Seven Countries Study( 4 , 91 , 92 ) Cross-sectional Adults/men (n 12 763 (enrolled)) 40–59 years (at enrolment) 7 (Netherlands, Finland, Yugoslavia, Japan, Italy, Greece, USA) Cross-check dietary history method European cohorts (n 14) used 7 d records at baseline No details Interval: 3 and 12 months after the initial surveys( 104 ) Small differences in reproducibility estimates
Terry et al. ( 93 ) Case–control Adults/controls (n 2486) 20–82 years 6 (Germany, France, Canada, Sweden, Australia, USA) FFQ No details No details
Tessier et al. ( 94 ) Cross-sectional Adults/women (n 123 mother/daughter pairs) 50–91 years 22–60 years 2 (Malta, Italy) Open-ended qualitative questionnaire No details No details
ToyBox( 95 106 ) Intervention multifactorial study Adults/parents Number NR Age range NR 6 (Belgium, Bulgaria, Germany, Greece, Poland, Spain) Primary caregiver’s FFQ (PCQ) No details Test–retest reliability of the PCQ was assessed after 2-week interval( 112 ) No data for F&V
Van Diepen et al.( 107 ) Cross-sectional Adults/students (n 185) Age range NR 2 (Greece, Netherlands) 2×consecutive 24-HDR No details No details
WHO-MONICA EC/MONICA Project optional nutrition study( 46 , 108 , 123 ) Cross-sectional Adults (n 7226) 45–64 years 9 (Northern Ireland, UK (Cardiff), Denmark, Finland, Belgium, Germany, France, Italy, Spain) 3 d record and 7 d record One centre used 3×24-HDR No details No details
Adolescents
Gerrits et al. ( 109 ) Cross-sectional Adolescents (n 537) 14–19 years 3 (Netherlands, Hungary, USA) FFQ No details No details
HBSC( 31 , 110 ) Cross-sectional Adolescents (n 209 320) 11-, 13- and 15-year-olds 37 (England, Norway, Macedonia, Iceland, Netherlands, Portugal, Wales, Italy, Sweden, Latvia, Switzerland, Denmark, Estonia, Scotland, Slovenia, Ukraine, Belgium, Finland, Greece, Croatia, Hungary, Lithuania, Poland, Germany, Greenland, Russia, Armenia, Austria, Belgium, Spain, France, Romania, Turkey, Czech Republic, Ireland, Luxembourg, Slovakia) FFQ Validated using 24 h food behaviour checklist and a 7 d food diary( 132 ) Assessed by crude correlations, energy-adjusted correlations, and mean or median differences in F&V consumption Good agreement but overestimation of intakes by FFQ v. 7 d diary Interval: 7–15 d( 123 ) Provides reproducible estimates of food group intake
HELENA( 32 36 , 50 , 111 , 112 ) Cross-sectional Adolescents (n 3000) 13–17 years 9 (Greece, Germany, Belgium, France, Hungary, Italy, Sweden, Austria, Spain) 8 countries included for 24-HDR (as above, except Hungary) Only Belgium tested the online FFQ 5 (Austria, Belgium, Greece, Sweden, Germany) pilot-tested the online FFQ 24-HDR HELENA-DIAT (Dietary Assessment Tool)Online FFQ YANA-C validated using food records and 24 h dietary recall interviews( 35 )Assessed by crude correlations and median or mean differences Good agreement between intakes assessed by 24-HDR administered by self-report and interview Validated using four computerised 24-HDR( 35 , 121 ) Overestimation for vegetables Interval: 1–2 weeksHELENA FFQ has adequate reliability
Larsson et al. ( 113 ) Cross-sectional Adolescents (n 2041) Age range NR 2 (Sweden, Norway) FFQ No details No details
Szczepanska et al. ( 114 ) Cross-sectional Adolescents (n 404) Age range NR 2 (Poland, Czech Republic) FFQ No details No details
TEMPEST( 115 ) Cross-sectional Adolescents (n 2764) 12–17 years 4 (Netherlands, Poland, UK, Portugal) FFQ No details No details
I.Family Project( 50 , 73 , 74 ) Prospective cohort study (successor of IDEFICS study) Adolescents (n >9000 children of IDEFICs study and their siblings) 12–17 years 8 (Belgium, Cyprus, Estonia, Germany Hungary, Italy, Spain, Sweden) Diet questionnaire as part of the parent questionnaire Online 24-HDR (SACANA) Instruments are similar to validated instruments used in the IDEFICS project No details
Children
Antova et al. ( 116 ) Cross-sectional Children (n 20 271) 7–11 years 6 (Bulgaria, Czech Republic, Hungary, Poland, Romania, Slovakia) FFQ No details No details
ENERGY( 27 ) Cross-sectional Children (n 7234) 10–12 years 7 (Belgium, Greece, Hungary, Netherlands, Norway, Slovenia, Spain) Questionnaire with FFQ and 24-HDR No details The reliability and content validity of the child questionnaires were tested separately in all participating countries( 143 ) Reliability tested using a test–retest design was used by comparing data from two completions of the questionnaire conducted 1 week apart( 130 ) No reliability data for F&V
EYHS( 30 , 117 ) Cross-sectional Children (n≈4000) 9 and 15 years 4 (Denmark, Portugal, Estonia, Norway) (sourced study involves only Sweden) 24-HDR, qualitative food record Children’s ability to recall what they consumed during a 24 h period was compared with observational data collected during the same period( 144 ) Not conducted among European population No details
IDEFICS( 37 , 38 , 118 , 119 ) Prospective cohort study with an embedded intervention Children (n 16 224) 2–9 years 8 (Belgium, Cyprus, Estonia, Germany Hungary, Italy, Spain, Sweden) CEHQ-FFQ SACINA 24-HDR ( 50 ) Validity was assessed using biomarkers( 140 ) and 24-HDR( 38 ). No biomarker validation data for F&V Assessed against 24-HDR by crude correlations, de-attenuated correlation coefficients, mean or median differences, and exact level of agreement Association between FFQ and 24-HDR varied by food group and age. Low agreement of FFQ with 24-HDR High relative validity between FFQ and 24-HDR. FFQ can reliably estimate food group intake among Spanish children SACINA is based on the YANA-C instrument validated as part of the HELENA study( 35 , 135 ). SACINA was validated using the doubly labelled water technique( 134 ). No validation data on F&V Interval: 0–354 d (no fixed time period)( 145 ) CEHQ-FFQ provides reproducible estimates of food group intake
I.Family Project( 50 , 73 , 74 ) Prospective cohort study (successor of IDEFICS study) Children (n >9000 children of IDEFICS study and their siblings) 2–11 years 8 (Belgium, Cyprus, Estonia, Germany Hungary, Italy, Spain, Sweden) Diet Questionnaire (FFQ) as part of the children’s questionnaire Online 24-HDR (SACANA) Instruments are similar to validated instruments used as part of the IDEFICS project No details
ISAAC Phase II( 40 , 120 ) Cross-sectional Children (n ≈63 000 including international countries) 8–12 years 15 (Albania, France, Estonia, Germany, Georgia, Greece, Iceland, Italy, Latvia, Netherlands, Norway, Spain, Sweden, Turkey, UK) FFQ No details No details
PRO GREENS( 85 ) Cross-sectional Children (n 8159) 11 years 10 (Austria, Belgium, Denmark, Iceland, Netherlands, Norway, Portugal, Spain, Sweden, Finland) A pre-coded 24-HDR, FFQ Validity of 24-HDR and FFQ was tested in 4 countries (Denmark, Iceland, Norway, Portugal) using a 1 d weighed food record and 7 d food records Assessed by crude correlations, mean or median differences, and exact level of agreement FFQ: Moderately good ranking of F&V food groups in 4 countries 24-HDR: Valid estimates for fruit in 3 countries (exception Portugal) Valid estimates for vegetables in 2 countries (exception Iceland and Norway) Assessed in 6 countries (Belgium, Denmark, Iceland, Norway, Portugal, Spain) Interval: 7–12 d( 42 ) Good reproducibility for FFQ Test–retest reliability carried out in 5 countries (Norway, Spain, Denmark, Portugal, Belgium) with a 1-week interval( 136 ) No information on F&V intake
Pro-Children study( 42 , 86 , 87 ) Cross-sectional Children (n 15 404) 11 years 9 (Austria, Belgium, Denmark, Iceland, Netherlands, Norway Portugal, Spain, Sweden) A pre-coded 24-HDR, FFQ As per PRO-GREENS( 42 , 136 ) As per PRO-GREENS( 42 , 136 )
ToyBox( 95 106 ) Intervention multifactorial study Children (n 5472) 3·5–5·5 years 6 (Belgium, Bulgaria, Germany, Greece, Poland, Spain) Children’s FFQ Validated using estimated 3 d diet records( 137 ) Assessed by crude correlations, de-attenuated correlation coefficients, mean or median differences, and exact level of agreement Moderate relative validity between FFQ and diet records Interval: at least 5 weeks( 137 ) FFQ provides reproducible estimates of food group intake

CNSHS, Cross National Student Health Survey; ECRHS, European Community Respiratory Health Survey; EHBS, European Health and Behaviour Survey; ENERGY, EuropeaN Energy balance Research to prevent excessive weight Gain among Youth; EPIC, European Prospective Investigation into Cancer and Nutrition; ESCAREL, European Study in Non Carious Cervical Lesions; HAPIEE, Health, Alcohol and Psychosocial factors in Eastern Europe; HTT, Health in Times of Transition; IHBS, International Health and Behaviour Survey; LLH, Living Conditions, Lifestyles and Health; MEDIS, MEDiterranean Islands Study; MGSD, Mediterranean Group for the Study of Diabetes; SENECA, Survey in Europe on Nutrition and the Elderly; a Concerted Action; MONICA, Multinational MONItoring of trends and determinants in CArdiovascular disease; HBSC, Health Behaviour in School-aged Children; HELENA, Healthy Lifestyle in Europe by Nutrition in Adolescence; TEMPEST, ‘Temptations to Eat Moderated by Personal and Environmental Self-regulatory Tools’; EYHS, European Youth Heart Study; IDEFICS, Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS; ISAAC, International Study of Asthma and Allergies in Childhood; NR, not reported; 24-HDR, 24 h recall; PCQ, Primary Caregiver’s Questionnaire; F&V, fruit and vegetables; YANA-C, Young Adolescents’ Nutrition Assessment on Computer; CEHQ, Children’s Eating Habits Questionnaire.

*

Funded by the Wellcome Trust programme grant entitled ‘Determinants of Cardiovascular Diseases in Eastern Europe: A multi-centre cohort study’ (reference number 064947/Z/01/Z) and developed by Martin Bobak, Anne Peasey, Hynek Pikhart (UCL), Ruzena Kubinova, Lubomíra Milla Novosibirsk, Sofia Malyutina, Oksana Bragina (Prague), Andrzej Pajak, Aleksandra Gilis-Januszewska (Krakow).

Original instrument obtained for review.

Validation or reproducibility of the instrument was not reported in the article and no reference to validation or reproducibility studies were provided.