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.