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. 2013 Aug 9;13:740. doi: 10.1186/1471-2458-13-740

Development of a quantitative food frequency questionnaire for Brazilian patients with type 2 diabetes

Roberta Aguiar Sarmento 1, Bárbara Pelicioli Riboldi 2, Ticiana da Costa Rodrigues 1,3, Mirela Jobim de Azevedo 1,3, Jussara Carnevale de Almeida 1,2,3,✉
PMCID: PMC3751547  PMID: 23938026

Abstract

Background

To investigate the association between dietary components and development of chronic diabetic complications, the dietary evaluation should include a long period, months or years. The present manuscript aims to develop a quantitative food frequency questionnaire (FFQ) and a portfolio with food photos to assess the usual intake pattern of Brazilian patients with type 2 diabetes to be used in future studies.

Methods

Dietary data using 3-day weighed diet records (WDR) from 188 outpatients with type 2 diabetes were used to construct the list of usually consumed foods. Foods were initially clustered into eight groups: “cereals, tubers, roots, and derivatives”; “vegetables and legumes”; “fruits”; “beans”; “meat and eggs”; “milk and dairy products”; “oils and fats”, and “sugars and sweets”. The frequency of food intake and the relative contribution of each food item to the total energy and nutrient intakes were calculated. Portion sizes were determined according to the 25th, 50th, 75th, and 95th percentiles of intake for each food item.

Results

A total of 62 food items were selected based on the 3-day WDR and another 27 foods or how they are prepared and nine beverages were included after the expert examination. Also, a portfolio with food photos of each included food item and portion sizes was made to assist the patients in identifying the consumed portion.

Conclusions

We developed a practical quantitative FFQ and portfolio with photos of 98 food items covering those most commonly consumed in the past 12 months, to assess the usual diet pattern of patients with type 2 diabetes in Southern Brazil.

Keywords: Food frequency questionnaire, Type 2 diabetes mellitus, Food record, Epidemiologic methods

Background

The field of nutritional epidemiology has been developed because of an interest in the concept that aspects of diet may influence the occurrence of human disease [1]. In the case of patients with diabetes, dietary advice and assessment of compliance with these recommendations are important for achieving metabolic goals, especially glycemic control [2].

There are several methods for the assessment of food and nutrient consumption as well as energy intake, including 24-hour recall, food records, food frequency questionnaire (FFQ), and biomarkers [3]. To investigate the association between dietary components and development of chronic diabetic complications, the dietary evaluation should include a long period, months or years, as is the case of FFQ. To date, four FFQs involving patients with diabetes have been validated and published in specific populations: Australian [4], Japanese [5], Malian [6], and Korean [7]; however, none was made for the Brazilian population. In fact, the FFQ should represent regional habits and the accuracy of such data needs to take this into account [8].

In drawing up an FFQ, careful attention must be given to the choice of foods, the clearness of the questions, and the format of the frequency response section. In addition, the choice of foods, especially if the FFQ is constructed to also include quantitative or semi-quantitative dietary evaluation, should be based on an accurate dietary tool [9]. In this way, the present manuscript aims to create an FFQ and a portfolio with food photos to assess the usual intake pattern of Brazilian patients with diabetes to be used in future studies.

Methods

Study population

Patients were identified belonged to the Group of Nutrition in Endocrinology (GNE), a cohort of outpatients with type 2 diabetes in southern Brazil [10]. The GNE study was designed to evaluate possible associations of dietary factors with chronic complications of diabetes. From a previously constructed database of patients with type 2 diabetes [11] data from consecutive registered patients who reported a plausible ratio of protein intake estimated from the 3-day weighed diet records (WDR) to protein intake from urinary nitrogen [12] were selected. The acceptable ratio between the two protein intake estimates ranged from 0.79 to 1.26 [12]. An equal seasonal distribution (1:1:1:1 spring, summer, autumn, and winter) and the same gender proportion (1:1 males and females) between each season were also considered inclusion criteria. Therefore, records from 188 patients with type 2 diabetes were analyzed.

This study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving patients were approved by the Hospital Ethics Committee. Written informed consent was obtained from all patients.

The new instrument: food frequency questionnaire

The most frequently consumed foods and their respective portion sizes were extracted from 3-day WDR (two nonconsecutive weekdays and one-weekend day) to create the FFQ and the food portfolio photo. All registered foods and preparation methods were listed and clustered into eight groups as proposed by the Food Guide for the Brazilian Population [13]: “cereals, tubers, roots, and derivatives”; “vegetables and legumes”; “fruits”; “beans”; “meat and eggs”; “milk and dairy products”; “oils and fats” and “sugars and sweets”. The caloric and non caloric beverages were added into a new group, according to the WDR description (“beverages group”).

Data analyses

A food item was classified according to its relative contribution, at least 80%, for daily energy or intake of a selected relevant nutrient (K nutrient) in its respective food group. The relative contribution was calculated by the equation proposed by Block et al. [14] [% K nutrient contribution by food = (amount of the K nutrient provided by food × 100) / amount of the K nutrient provided by all foods]. The most relevant nutrients in each food group were selected considering their influence on glucose metabolism [15-18] and/or diabetic complications [15,19-22] and are described in Table 1. Information about the nutritional composition of each food and regional ingredients used in their preparation was based on NutriBase Clinical® software (1986-2013 CyberSoft, Inc. an Arizona corporation). This software used the USDA Nutrient Database for Standard Reference [23]. Nutrient data on frequently consumed foods were complemented if necessary with data obtained from local manufacturers of specific industrialized foods.

Table 1.

The most relevant nutrients in each food group considering their influence on glucose metabolism and/or diabetic complications

Food group Nutrients
Cereals, tubers, roots and derivatives
 Carbohydrate
Vegetables and legumes
 Fiber, iron, calcium, and potassium
Fruits
 Carbohydrate, fiber, and potassium
Beans
 Protein, fibers, and iron
Meat and eggs
 Protein, lipids, and iron
Milk and dairy products
 Protein, lipids, and calcium
Oils and fats
 Lipids
Sugars and sweets Carbohydrate
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The size of servings of each food item was classified according to its respective weight distribution as registered in the WDR: small = 25th percentile, medium = 50th percentile, large = 75th percentile, and extra large = 95th percentile [24]. Figure 1 shows an example of food portions as illustrated in the food portfolio photo. The amount of each portion in grams or milliliters was transformed into household measures using the Table for Assessment of Food Intake in Household Measures [25]. The FFQ also included open questions about the frequency of food consumption and an option to include new foods according to personal eating habits. The frequency was described as the number of times the food was consumed and also if the intake occurred daily, weekly, monthly, or yearly.

Figure 1.

Figure 1

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Illustration of four portions of the same food (chayote cooked) photographed and included on the food portfolio.

In order to obtain an expert examination, the constructed FFQ was submitted to health researchers used to dealing with diabetes care: endocrinologists, nutritionists, and researchers from the GNE [10]. After the experts’ meeting, changes were made in the food list and definition of portion sizes. Regional dishes and seasonal foods were also included according to suggestions.

Portfolio with food photos

The construction of the portfolio with food photos was based on the methodology suggested by Monteiro et al. [26]. Digital photographs were taken of each portion of food from the FFQ and organized in the order in which they were mentioned, considering the four portion sizes and food groups (Figure 1). A numerical legend was also created to explain details about the each portion (amount in grams or milliliters) and keep patients blinded to serving sizes. The food portions were determined with an analytical scale (Marte ®, from 0.01 to 2000 g) and measuring cup (50-250 mL; Marinex, Brazil). The solid foods were arranged in the same plate meal size to perform the pictures, in order to help the patients acquire a perspective of size.

Results

The main features of 188 patients with type 2 diabetes were: 61.1 ± 10.1 years of age (range 34-80 years), males 50.0%, 12 years (6-18 years) of diabetes duration, BMI of 28.8 ± 4.3 kg/m2; HbA1c of 7.5 ± 1.4%, 42.5% from lower middle class, and 84.4% self-identified as whites. The patients performed 3-day WDR, totaling 564 WDR during all seasons: 25% (n = 141) in winter, 25% (n = 141) in spring, 25% (n = 141) in summer, and 25% (n = 141) in autumn.

Initially, a list of 177 different food items was compiled based on data from the WDR and the number of food items in each food cluster was as follows: “cereals, tubers, roots, and derivatives” - 39 food items; “vegetables and legumes” - 34 food items; “fruits”- 22 food items; “beans” - 5 food items; “meat and eggs” - 27 food items; “milk and dairy products” - 14 food items; “oils and fats” - 7 food items; “sugars and sweets”- 16 food items; “beverages” - 13 food items. Subsequently, only 62 food types were included in the FFQ, considering the 80% cutoff contribution in its respective food group. The reported frequency of each included food item with respective relevant nutrient is shown in Table 2. The most frequently consumed foods by patients with diabetes included white rice (94.1%), papaya (87.2%), beans (78.2%), French or Vienna bread (75.5%), banana (71.8%), and tomato (71.3%). Furthermore, another four food items (lettuce, beef, chicken, and margarine) were reported by more than 50% of this patient sample. After expert examination, 21 regional foods (fruits, vegetables, sweets, and fats), six different types of food preparations, and nine beverages were included in the food list.

Table 2.

Food list from food frequency questionnaire for diabetes: registered consumption frequency of 188 patients with type 2 diabetes and nutrient contribution

 
  
 Nutrient contribution*
Foods Subjects consuming this food
 Calories Carbohydrate Protein Lipid Fiber Iron Calcium Potassium
n %
Cereals, tubers, roots and derivatives
  
  
  
  
  
  
  
  
  
  
  White rice
 177
 94.1
 yes
 yes
 yes
 no
 yes
 yes
 no
 yes
  French or Vienna bread
 142
 75.5
 yes
 yes
 yes
 yes
 yes
 yes
 yes
 yes
  Spaghetti pasta
 76
 40.4
 yes
 yes
 yes
 no
 yes
 yes
 no
 yes
  Wheat cracker
 82
 43.6
 yes
 yes
 yes
 yes
 yes
 yes
 yes
 yes
  Whole bread
 78
 41.4
 yes
 yes
 yes
 yes
 yes
 yes
 yes
 yes
  Cassava, boiled
 41
 21.8
 yes
 yes
 no
 no
 yes
 no
 no
 yes
  Cake
 35
 18.6
 yes
 yes
 no
 yes
 yes
 yes
 no
 yes
  Maize porridge
 23
 12.2
 yes
 yes
 no
 no
 yes
 yes
 no
 yes
  Potato, boiled/baked
 82
 43.6
 yes
 yes
 no
 no
 yes
 no
 no
 yes
  Homemade bread
 24
 12.7
 yes
 yes
 no
 no
 no
 yes
 no
 no
  White bread
 35
 18.6
 yes
 yes
 no
 no
 no
 yes
 yes
 no
  Milk cracker
 27
 14.3
 yes
 yes
 no
 yes
 no
 yes
 yes
 no
Vegetables and legumes
  
  
  
  
  
  
  
  
  
  
  Carrot
 77
 40.9
 no
 no
 no
 no
 yes
 no
 yes
 yes
  Cabbage
 56
 29.7
 no
 no
 no
 no
 yes
 yes
 yes
 yes
  Tomato
 134
 71.2
 no
 no
 no
 no
 yes
 no
 no
 yes
  Chayote
 34
 18.0
 no
 no
 no
 no
 yes
 no
 no
 yes
  Lettuce
 112
 59.5
 no
 no
 no
 no
 no
 yes
 yes
 yes
  Kale
 37
 19.6
 no
 yes
 no
 no
 no
 yes
 yes
 yes
  Broccoli
 22
 11.7
 no
 no
 no
 no
 no
 no
 no
 yes
  Pumpkin
 17
 9.0
 no
 no
 no
 no
 no
 no
 no
 yes
  Beet
 20
 10.6
 no
 no
 no
 no
 no
 no
 no
 yes
Fruits
  
  
  
  
  
  
  
  
  
  
  Banana
 135
 71.8
 yes
 no
 no
 no
 yes
 yes
 no
 yes
  Apple
 92
 48.9
 yes
 yes
 no
 no
 yes
 no
 no
 yes
  Orange
 58
 30.8
 yes
 yes
 no
 no
 yes
 no
 yes
 yes
  Tangerine
 51
 27.1
 yes
 yes
 no
 no
 yes
 no
 yes
 yes
  Papaya
 164
 87.2
 yes
 yes
 no
 no
 yes
 no
 yes
 yes
  Mango
 16
 8.5
 no
 no
 yes
 no
 no
 no
 no
 no
  Pear
 19
 10.1
 no
 no
 no
 no
 yes
 no
 no
 no
Beans
  
  
  
  
  
  
  
  
  
  
  Beans (all types)
 147
 78.1
 yes
 yes
 yes
 no
 yes
 yes
 yes
 yes
  Lentil
 16
 8.5
 yes
 yes
 no
 no
 yes
 yes
 no
 yes
Meat and eggs
  
  
  
  
  
  
  
  
  
  
  Beef, boiled/baked
 122
 64.8
 yes
 no
 yes
 yes
 no
 yes
 yes
 yes
  Chicken, boiled/baked
 123
 65.4
 yes
 no
 yes
 yes
 no
 yes
 yes
 yes
  Ground beef
 63
 33.5
 yes
 no
 yes
 yes
 no
 yes
 yes
 yes
  Beef steak
 64
 34.0
 yes
 no
 yes
 yes
 no
 yes
 no
 yes
  Luncheon/bologna
 43
 22.8
 yes
 no
 yes
 yes
 no
 yes
 no
 yes
  Fish, boiled/baked
 21
 11.1
 yes
 no
 yes
 yes
 no
 no
 no
 yes
  Pork
 28
 14.8
 yes
 no
 yes
 yes
 no
 yes
 no
 yes
  Fish, fried
 9
 4.7
 yes
 no
 no
 yes
 no
 no
 no
 yes
  Chicken, fried
 14
 7.4
 yes
 no
 yes
 no
 no
 no
 no
 yes
  Frankfurter wiener, hot dog
 15
 7.9
 no
 no
 no
 yes
 no
 no
 no
 no
  Mortadella
 35
 18.6
 no
 no
 no
 yes
 no
 no
 no
 no
  Salami
 23
 12.2
 no
 no
 no
 yes
 no
 no
 no
 no
  Beef, fried
 8
 4.2
 no
 no
 no
 yes
 no
 no
 no
 no
  Egg, boiled/fried
 22
 11.7
 no
 no
 no
 yes
 no
 no
 no
 no
  Beef liver
 6
 3.1
 no
 no
 no
 no
 no
 yes
 no
 no
  Ham
 48
 25.5
 no
 no
 no
 no
 no
 no
 no
 yes
Milk and dairy products
  
  
  
  
  
  
  
  
  
  
  Muenster cheese
 76
 40.4
 yes
 no
 yes
 yes
 no
 no
 yes
 no
  Milk, fluid, 3.25% fat
 73
 38.8
 yes
 yes
 yes
 yes
 no
 no
 yes
 yes
  Milk, fluid, nonfat
 78
 41.4
 yes
 yes
 yes
 no
 no
 no
 yes
 yes
  Goat cheese, soft type
 32
 17.0
 no
 no
 no
 yes
 no
 no
 yes
 no
  Muenster cheese
 12
 6.3
 no
 no
 no
 yes
 no
 no
 yes
 no
  Milk, fluid, 2% fat
 19
 10.1
 no
 no
 no
 no
 no
 no
 yes
 yes
  Yogurt, plain
 10
 5.3
 no
 no
 no
 no
 no
 no
 yes
 no
  Milk type C
 10
 5.3
 no
 no
 no
 no
 no
 no
 yes
 no
  Yogurt, plan, skim
 8
 4.2
 no
 no
 no
 no
 no
 no
 yes
 no
  Milk, dry, whole
 10
 5.3
 no
 no
 no
 no
 no
 no
 yes
 no
  Yogurt, fruit
 6
 3.1
 no
 no
 no
 no
 no
 no
 yes
 no
  American cheese
 11
 5.8
 no
 no
 no
 no
 no
 no
 yes
 no
Oils and fats
  
  
  
  
  
  
  
  
  
  
  Margarine
 101
 53.7
 yes
 no
 no
 yes
 no
 no
 no
 no
  Goose pate
 23
 12.3
 no
 no
 no
 yes
 no
 no
 no
 no
  Mayonnaise
 19
 10.1
 no
 no
 no
 yes
 no
 no
 no
 no
Sugars and sweets
  
  
  
  
  
  
  
  
  
  
  Flan and/or pudding diet 8 4.2 no no no no no no yes no
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*Nutrient contribution defined as contribution of at least 80% of total energy or relevant nutrient intake in the respective food group.

The final version of the FFQ consisted of 98 food items and beverages distributed into nine groups: eight food groups and one of beverages. The preparation options (fried, boiled, cooked or roasted) were considered in food items of the “cereals, tubers, roots, and derivatives” and “meats and eggs” groups. The FFQ is shown in Additional file 1. All included food items contributed 95% of the total energy and nutrient intake as follows: total energy (94.2%), protein (96.8%), carbohydrate (92.8%), fat (94.6%), fiber (90.3%), iron (93.4%), calcium (95.3%), and potassium (92.2%). The portions of each food in grams or milliliters and its respective number of portions in household measures are shown in Table 3.

Table 3.

Final food list in the food frequency questionnaire: portions in grams or milliliters and household measures

Food group Small (25th) Medium (50th) Large (75th) Extra large (95th)
Cereals, tubers, roots, and derivatives
  
  
  
  
  
  
  
  
  White rice
 2 full tablespoon
 50 g
 4 full tablespoon
 100 g
 5 full tablespoon
 125 g
 8 full tablespoon
 200 g
  Spaghetti pasta
 3 full tablespoon
 75 g
 4 full tablespoon
 100 g
 1 paten
 200 g
 1 full paten
 320 g
  Cassava, boiled/fried
 2 pieces
 60 g
 3 pieces
 90 g
 4 pieces
 120 g
 6 pieces
 240 g
  Potato, boiled/baked/fried
 2 full tablespoon
 60 g
 3 full tablespoon
 90 g
 4 full tablespoon
 120 g
 6 full tablespoon
 180 g
  Maize porridge, boiled/fried
 1 serving spoon
 60 g
 2 full tablespoon
 90 g
 3 full tablespoon
 150 g
 1 paten
 325 g
  French or Vienna bread
 ½ unit
 25 g
 1 unit
 50 g
 1 and ½ unit
 75 g
 2 units
 100 g
  White bread
 1 slice
 25 g
 2 slice
 50 g
 2 and ½ slices
 62.5 g
 3 and ½ slices
 87.5 g
  Whole bread
 ½ slice
 15 g
 1 slice
 30 g
 2 slices
 60 g
 3 slices
 90 g
  Homemade bread
 2/3 slice
 60 g
 1 slice
 68 g
 1 and ½ slice
 86 g
 2 and ½ slices
 145 g
  Cake
 1 small slice
 50 g
 1 medium slice
 70 g
 1 large slice
 90 g
 2 medium slices
 140 g
  Wheat cracker
 4 units
 20 g
 6 units
 30 g
 9 units
 45 g
 20 units
 100 g
  Milk cracker
 5 units
 25 g
 8 units
 40 g
 11 units
 55 g
 32 units
 160 g
Vegetables and legumes
  
  
  
  
  
  
  
  
  Carrot
 2 full tablespoon
 24 g
 3 full tablespoon
 36 g
 5 full tablespoon
 60 g
 10 full tablespoon l
 120 g
  Tomato
 3 small slices
 30 g
 5 small slices
 50 g
 7 small slices
 70 g
 7 medium slices
 100 g
  Chayote
 1 full tablespoon
 30 g
 2 full tablespoon
 60 g
 3 and ½ full tablespoon
 100 g
 5 full tablespoon
 145 g
  Cabbage
 4 full tablespoon
 40 g
 7 full tablespoon
 70 g
 10 full tablespoon
 100 g
 6 full medium skimmer
 150 g
  Lettuce
 1 tagger
 20 g
 2 taggers
 30 g
 5 medium leaf
 50 g
 1 full paten
 80 g
  Watercress
 1 full dessert plate
 20 g
 2 taggers
 30 g
 1 full paten
 80 g
 2 full patens
 160 g
  Kale, spinach
 2 full tablespoon
 40 g
 3 full tablespoon
 60 g
 5 full tablespoon
 100 g
 9 full tablespoon
 180 g
  Broccoli, cauliflower
 1 small bunch
 30 g
 1 medium bunch
 60 g
 1 large bunch
 100 g
 2 medium bunches
 130 g
  Snap bean
 2 level tablespoon
 30 g
 2 full tablespoon
 40 g
 5 full tablespoon
 100 g
 15 full tablespoon l
 300 g
  Pumpkin
 1 medium piece
 50 g
 2 medium pieces
 100 g
 2 and ½ medium pieces
 125 g
 6 medium pieces
 300 g
  Beet
 2 medium slices
 30 g
 5 medium slices
 60 g
 8 medium slices
 90 g
 12 medium slices
 140 g
Fruits
  
  
  
  
  
  
  
  
  Banana
 1 small unit
 40 g
 1 medium unit
 70 g
 1 large unit
 90 g
 2 medium units
 140 g
  Apple, pear
 1 small unit
 90 g
 1 and ½ small unit
 135 g
 1 medium unit
 150 g
 1 large unit
 230 g
  Orange, tangerine
 1 small unit
 90 g
 1 and ½ small unit
 135 g
 1 large unit
 180 g
 2 medium units
 225 g
  Papaya
 ½ small slice
 80 g
 1 medium slice
 100 g
 ¼ unit
 135 g
 ½ unit
 270 g
  Mango
 1 small piece
 60 g
 2 small pieces
 120 g
 1 medium pieces
 140 g
 6 small pieces
 360 g
  Grape
 8 units
 64 g
 14 units
 112 g
 1 small bunch
 170 g
 1 medium bunch
 350 g
  Persimmon
 1 small unit
 85 g
 1 large unit
 150 g
 2 medium units
 220 g
 3 small units
 255 g
  Casaba melon
 ½ small slice
 78 g
 1 small slice
 125 g
 1 medium slice
 200 g
 1 large slice
 300 g
  Watermelon
 1 small slice
 143 g
 1 medium slice
 200 g
 1 large slice
 282 g
 2 medium slices
 350 g
Beans
  
  
  
  
  
  
  
  
  Beans (all types)
 1 small full scoop
 65 g
 1 level medium scoop
 80 g
 2 small full scoop
 130 g
 2 level medium scoop
 160 g
  Lentil
 1 level medium scoop
 100 g
 1 medium full scoop
 160 g
 2 level medium scoop
 200 g
 2 medium full scoop
 320 g
Meat and eggs
  
  
  
  
  
  
  
  
  Beef, boiled/baked/fried
 1 small slice
 70 g
 4 small pieces
 80 g
 1 large slice
 135 g
 2 large slices
 270 g
  Ground beef
 2 full tablespoon
 50 g
 3 full tablespoon
 75 g
 4 full tablespoon
 100 g
 8 full tablespoon
 200 g
  Beef steak
 ½ small unit
 40 g
 1 small unit
 80 g
 1 medium unit
 100 g
 2 medium units
 200 g
  Beef liver
 ½ large unit
 75 g
 1 small unit
 80 g
 1 medium unit
 100 g
 1 large unit
 150 g
  Chicken thigh, boiled/baked/fried
 1 medium piece
 60 g
 1 large piece
 95 g
 2 medium pieces
 110 g
 3 medium pieces
 180 g
  Chicken breast, boiled/baked/fried
 1 medium piece
 60 g
 1 large piece
 95 g
 2 medium pieces
 110 g
 3 medium pieces
 180 g
  Fish, boiled/baked/fried
 ½ small piece
 60 g
 1 small piece
 100 g
 1 large piece
 155 g
 2 large pieces
 310 g
  Pork, boiled/baked/fried
 1 small slice
 60 g
 1 medium slice
 90 g
 1 large slice
 120 g
 2 medium slices
 180 g
  Luncheon/bologna
 ½ unit
 30 g
 1 unit
 60 g
 1 and ½ units
 90 g
 2 and ½ units
 150 g
  Frankfurter wiener, hot dog
 1 unit
 42 g
 1 and ½ unit
 63 g
 2 units
 84 g
 3 and ½ units
 147 g
  Mortadella, ham, salami
 1 medium slice
 15 g
 1 large slice
 25 g
 2 medium slices
 30 g
 2 large slices
 50 g
  Egg, boiled/fried
 ½ unit
 25 g
 1 unit
 50 g
 1 and ½ unit
 75 g
 3 units
 150 g
Milk and dairy products
  
  
  
  
  
  
  
  
  Milk, fluid, 3.25% fat
 ½ cup
 100 ml
 ¾ cup
 150 ml
 1 cup
 200 ml
 1 mug
 300 ml
  Milk, fluid, 2% fat
 ½ cup
 100 ml
 ¾ cup
 150 ml
 1 cup
 200 ml
 1 mug
 300 ml
  Milk, fluid, nonfat
 ¾ cup
 150 ml
 1 cup
 200 ml
 1 glass
 240 ml
 1 and ½ cups
 250 ml
  Milk, dry
 1 full tablespoon
 16 g
 2 full dessert spoon
 18 g
 2 full tablespoon
 32 g
 4 full tablespoon
 36 g
  Mozzarella cheese
 1 slice
 20 g
 1 and ½ slice
 30 g
 2 slices
 40 g
 3 slices
 60 g
  Ricotta cheese
 1 small slice
 15 g
 1 medium slice
 35 g
 1 large slice
 45 g
 2 large slices
 90 g
  Muenster cheese
 1 small slice
 25 g
 1 medium slice
 35 g
 1 large slice
 50 g
 2 medium large slices
 70 g
  Sour cultured, Cream half-half
 1 teaspoon
 10 g
 1 level tablespoon
 15 g
 1 full tablespoon
 25 g
 4 level tablespoon
 60 g
  American cheese
 1 level dessert spoon
 10 g
 1 level tablespoon
 15 g
 1 full tablespoon
 30 g
 2 full tablespoon
 60 g
  Yogurt, plan
 ½ pot
 100 g
 1 pot
 200 g
 1 and ½ pots
 300 g
 2 pots
 400 g
  Yogurt, fruit
 1 pot
 100 g
 1 and ½ pots
 150 g
 2 pots
 200 g
 3 pots
 300 g
Oils and fats
  
  
  
  
  
  
  
  
  Margarine
 1 level teaspoon
 4 g
 1 full teaspoon
 8 g
 1 level dessert spoon
 13 g
 1 full dessert spoon
 23 g
  Butter
 1 level teaspoon
 4 g
 1 full teaspoon
 8 g
 1 level dessert spoon
 13 g
 1 full dessert spoon
 23 g
  Mayonnaise
 1 full teaspoon
 6 g
 2 full teaspoon
 12 g
 1 full dessert spoon
 17 g
 2 full dessert spoon
 34 g
  Goose pate
 1 full teaspoon
 8 g
 2 full teaspoon
 16 g
 1 full dessert spoon
 21 g
 3 full dessert spoon
 63 g
  Oil, add
 1 teaspoon
 2 ml
 2 teaspoon
 4 ml
 1 dessert spoon
 5 ml
 1 tablespoon
 8 ml
Sugars and sweets
  
  
  
  
  
  
  
  
  Sago
 3 full tablespoon
 90 g
 4 full tablespoon
 120 g
 5 full tablespoon
 150 g
 6 full tablespoon
 180 g
  Chocolate
 2 pieces
 15 g
 3 pieces
 30 g
 4 pieces
 40 g
 8 pieces
 80 g
  Flan, pudding
 1 full tablespoon
 50 g
 2 full tablespoon
 90 g
 3 full tablespoon
 130 g
 5 full tablespoon
 220 g
  Ice cream
 1 full tablespoon
 55 g
 1 ball
 75 g
 1 cup
 100 g
 2 balls
 150 g
  Gelatin
 2 full tablespoon
 50 g
 3 full tablespoon
 75 g
 5 full tablespoon
 125 g
 12 full tablespoon
 300 g
  Condensed milk
 1 level teaspoon
 10 g
 1 level dessert spoon
 15 g
 1 full tablespoon
 40 g
 2 full dessert spoon
 50 g
  Jelly
 1 full teaspoon
 10 g
 2 full teaspoon
 20 g
 1 full tablespoon
 34 g
 2 full tablespoon
 68 g
  Honey
 1 dessert spoon
 10 g
 1 tablespoon
 15 g
 2 dessert spoon
 20 g
 2 tablespoon
 30 g
  Chocolate, dry
 1 level dessert spoon
 7 g
 1 level tablespoon
 11 g
 1 full tablespoon
 16 g
 2 full tablespoon
 32 g
Beverages
  
  
  
  
  
  
  
  
  Coffee, brewed
 ¼ cup
 50 ml
 ½ cup
 100 ml
 ¾ cup
 150 ml
 1 cup
 200 ml
  Coffee, instant
 1 teaspoon
 1.5 g
 2 teaspoon
 3 g
 4 teaspoon
 6 g
 6 teaspoon
 9 g
  Tea
 ¾ cup
 150 ml
 1 cup
 200 ml
 1 and ¼ cups
 250 ml
 1 mug
 300 ml
  Soft drink
 1 cup
 200 ml
 1 full glass
 250 ml
 1 can
 350 ml
 2 full glass
 500 ml
  Fruit juice raw
 ¾ cup
 150 ml
 1 cup
 200 ml
 1 full glass
 250 ml
 2 cups
 400 ml
  Fruit juice artificial
 ¾ cup
 150 ml
 1 cup
 200 ml
 1 full glass
 250 ml
 2 full glass
 500 ml
  Soymilk
 ¾ cup
 150 ml
 ½ glass
 175 ml
 1 cup
 200 ml
 1 full glass
 250 ml
  Beer
 1 glass
 300 ml
 1 bottle
 600 ml
 1 and ½ bottles
 900 ml
 6 bottles
 3600 ml
  Wine ½ glass 75 ml ¾ glass 115 ml 1 glass 150 ml 2 glass 300 ml
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The FFQ also included open questions about frequency of food consumption and eight queries about food preferences and usual dietary practices: number of meals per day, type of sweetener added in beverages, type and amount of fat used in food preparation, if intake of visible fat from meats, the habit of salt added in prepared foods and salads, and other foods and/or seasonings not listed but regularly consumed.

Discussion

Patients with diabetes are encouraged to comply with specific dietary recommendations to achieve optimal glucose, lipid, and blood pressure control as well as a healthy body weight [2]. These aspects can modify the food intake of patients with diabetes as compared to the general population. We constructed a quantitative FFQ and a portfolio with photos of 98 food items distributed into nine food groups and based on WDR performed by patients with type 2 diabetes. This is the first FFQ for Brazilian type 2 diabetes patients.

The development of an FFQ should take into account some important aspects such as drawing up the food list, definition of portion intake [8], and how representative of the dietary habits of a population-based sample is the food list [1]. Our FFQ took into account the foods most commonly consumed by patients with type 2 diabetes and, as recommended, represents the regional dietary habits [1] in Southern Brazil. In addition, the cultural and clinical appropriateness of food items included in our FFQ was assured by using as reference the 3-day WDRs, a dietary instrument previously standardized, validated [12,27], and widely used in diabetic patients by our research group [11,28-30]. It is also important to keep in mind that these WDR were performed throughout the year because it is known that portion sizes and food types can vary according to season [31] and the gender distribution was equal, since gender also influences food intake [31].

The final food list was drawn up considering the contribution criteria of each relevant nutrient to minimize the omission of usually consumed food [14]. It should be noted that nutrients known to influence glucose, lipid, or blood pressure control, or that have been associated with chronic diabetic complications were considered to choose the relevant nutrients for the food list. The number of food items in the final version of the FFQ is appropriate according to suggestions found in the literature [32] and similar to other FFQs for diabetes around the world [5-7]. Small food lists (less than 50 items) may underestimate food intake, and very long lists (more than 100 items) may tire respondents and overestimate food intake [32].

The FFQ in the present study also includes a quantitative evaluation of food intake. The size of portions (quartiles of intake) was based on the weight of consumed foods assessed by 3-day WDR. These portions, specific for each food item, were shown as photos and as household measures in the food portfolio and can be easily used for respondents to select their own portion size [8]. Finally, the FFQ structure including open questions provides greater freedom to choose the actual frequency of food intake and reduces the error of consumption categories by the patients [32]. The frequency of food consumption was considered in this FFQ (day, week, month, or year). However, care should be taken when assessing the consumption of a particular food per year. The diary conversion of intake is necessary to minimize the contribution of the foods scarcely consumed in evaluating the eating habits of the individual [8].

Conclusions

In conclusion, we developed a practical quantitative FFQ and a portfolio with 98 food items covering the past 12 months and representing the usual food intake of patients with type 2 diabetes in Southern Brazil. This relatively long-term evaluation of food intake can be particularly relevant for prospective studies that evaluate associations of diet with chronic diabetic complications. However, this dietary instrument should be validated in other samples of patients.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

RAS was responsible for the study design, collection, analysis and interpretation of data, as well as the preparation of the manuscript. BPR contributed the construction of the portfolio with food photos. TCR contributed the initial idea. MJA contributed to the interpretation of results and final version of the manuscript. JCA contributed to the study design and each step of the FFQ construction as well as proof-reading the manuscript. The final paper version was approved by all authors.

Pre-publication history

The pre-publication history for this paper can be accessed here:

http://www.biomedcentral.com/1471-2458/13/740/prepub

Supplementary Material

Additional file 1

Food frequency questionnaire developed for Brazilian patients with type 2 Diabetes.

Click here for file (251.5KB, doc)

Contributor Information

Roberta Aguiar Sarmento, Email: roberta.sarmento@gmail.com.

Bárbara Pelicioli Riboldi, Email: barbara.riboldi@gmail.com.

Ticiana da Costa Rodrigues, Email: ticianacr@yahoo.com.br.

Mirela Jobim de Azevedo, Email: mirelajobimazevedo@gmail.com.

Jussara Carnevale de Almeida, Email: jussara.carnevale@gmail.com.

Acknowledgments

This study was partially supported by Fundo de Incentivo à Pesquisa e Eventos – Hospital de Clínicas de Porto Alegre and Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul (ARD-FAPERGS 01/2010). RAS received scholarships from Fundação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), and BPR from Programa Institucional de Bolsas de Iniciação Científica - Conselho Nacional de Desenvolvimento Científico e Tecnológico.

References

  1. Willett WC. Nutritional epidemiology. Oxford: Oxford University Press; 1998. [Google Scholar]
  2. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. 2012;35:11–63. [Google Scholar]
  3. Pereira RA, Sichieri R. In: Fiocruz e Atheneu. Kac G, Sichieri R, Gigante DP, editor. Rio de Janeiro: Epidemiologia Nutricional; 2007. Métodos de avaliação do consumo alimentar; pp. 120–200. [Google Scholar]
  4. Riley MD, Blizzard L. Comparative validity of a food frequency questionnaire for adults with IDDM. Diabetes Care. 1995;18(9):1249–1254. doi: 10.2337/diacare.18.9.1249. [DOI] [PubMed] [Google Scholar]
  5. Yamaoka K, Tango T, Watanabe M, Yokotsuka M. Validity and reproducibility of a semi-quantitative food frequency questionnaire for nutritional education of patients of diabetes mellitus (FFQW65) Nihon Koshu Eisei Zasshi. 2000;47(3):230–244. [PubMed] [Google Scholar]
  6. Coulibaly A, Turgeon O’Brien H, Galibois I. Validation of an FFQ to assess dietary protein intake in type 2 diabetic subjects attending primary health-care services in Mali. Public Health Nutr. 2008;12(5):644–650. doi: 10.1017/S1368980008002620. [DOI] [PubMed] [Google Scholar]
  7. Hong S. et al. Development and validation of a semi-quantitative food frequency questionnaire to assess diets of Korean type 2 diabetic patients. Korean Diabetes J. 2010;34(1):32–39. doi: 10.4093/kdj.2010.34.1.32. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Cade J, Thompson R, Burley V, Warm D. Development, validation and utilization of food-frequency questionnaires – a review. Public Health Nutr. 2002;5(4):567–587. doi: 10.1079/PHN2001318. [DOI] [PubMed] [Google Scholar]
  9. Lopes ACS, Caiaffa WT, Mingoti SA, Lima-Costa MFF. Ingestão Alimentar em Estudos Epidemiológicos. Rev Bras Epidemiol. 2003;6(3):209–219. doi: 10.1590/S1415-790X2003000300004. [DOI] [Google Scholar]
  10. Conselho Nacional de Desenvolvimento Científico e Tecnológico. Diretório de Grupos de Pesquisa no Brasil. Grupo de Nutrição em Endocrinologia (GNE); 2012. http://dgp.cnpq.br/buscaoperacional/detalhegrupo.jsp?grupo=01924053KT5EMV#identificacao Accessed in June 26, 2012. [Google Scholar]
  11. De Paula TP, Steemburgo T, De Almeida JC, Dall'alba V, Gross JL, De Azevedo MJ. The role of Dietary Approaches to Stop Hypertension (DASH) diet food groups in blood pressure in type 2 diabetes. Br J Nutr. 2011;6:1–8. doi: 10.1017/S0007114511005381. [DOI] [PubMed] [Google Scholar]
  12. Vaz JS, Bittencourt M, Almeida JC, Gross JL, Azevedo MJ, Zelmanovitz T. Protein intake estimated by weighed diet records in type 2 diabetic patients: misreporting and intra-individual variability using 24-hour nitrogen output as criterion standart. J Am Diet Assoc. 2008;108(5):867–872. doi: 10.1016/j.jada.2008.03.022. [DOI] [PubMed] [Google Scholar]
  13. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Coordenação Geral da Política de Alimentação e Nutrição. Guia Alimentar para a População Brasileira. Brasília: promovendo a alimentação saudável; 2006. [Google Scholar]
  14. Block G, Dresser CM, Hartman AM, Carroll MD. Nutrient sources in the American diet: quantitative data from the NHANES II survey. Am J Epidemiol. 1985;122:13–26. doi: 10.1093/oxfordjournals.aje.a114072. [DOI] [PubMed] [Google Scholar]
  15. Bantle JP, Wylie-Rosett J, Albright AL, Apovian CM, Clark NG, Franz MJ, Hoogwerf BJ, Lichtenstein AH, Mayer-Davis E, Mooradian AD, Wheeler ML. Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2008;31(Suppl. 1):S61–S78. doi: 10.2337/dc08-S061. [DOI] [PubMed] [Google Scholar]
  16. Pittas AG, Lau J, Hu FB, Dawson-Hughes B. The role of vitamin D and Calcium in type 2 diabetes. A systematic review and meta-analysis. J Clin Endocrinol Metab. 2007;92:2017–2029. doi: 10.1210/jc.2007-0298. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Zillich AJ, Garg J, Basu J, Barkis GL, Carter BL. Thiazide diuretics, potassium, and the development of diabetes: a quantitative review. Hypertension. 2006;48:219–224. doi: 10.1161/01.HYP.0000231552.10054.aa. [DOI] [PubMed] [Google Scholar]
  18. Mello VD, Laaksonen DE. Dietary fibers: current trends and health benefits in the metabolic syndrome and type 2 diabetes. Arq Bras Endocrinol Metabol. 2009;53:509–518. doi: 10.1590/S0004-27302009000500004. [DOI] [PubMed] [Google Scholar]
  19. Robertson L, Waugh N, Robertson A. Protein restriction for diabetic renal disease. Cochrane Database Syst Rev. 2007;17(4) doi: 10.1002/14651858.CD002181.pub2. CD002181. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. De Mello VD, Zelmanovitz T, Perassolo MS, Azevedo MJ, Gross JL. Withdrawal of red meat from the usual diet reduces albuminuria and improves serum fatty acid profile in type 2 diabetes patients with macroalbuminuria. Am J Clin Nutr. 2006;83(5):1032–1038. doi: 10.1093/ajcn/83.5.1032. [DOI] [PubMed] [Google Scholar]
  21. De Mello VD, Zelmanovitz T, Azevedo MJ, De Paula TP, Gross JL. Long-term effect of a chicken-based diet versus enalapril on albuminuria in type 2 diabetic patients with microalbuminuria. J Ren Nutr. 2008;18(5):440–447. doi: 10.1053/j.jrn.2008.04.010. [DOI] [PubMed] [Google Scholar]
  22. Liu Q, Sun L, Tan Y, Wang G, Lin X, Cai L. Role of iron deficiency and overload in the pathogenesis of diabetes and diabetic complications. Curr Med Chem. 2009;16:113–129. doi: 10.2174/092986709787002862. [DOI] [PubMed] [Google Scholar]
  23. USDA SR 17 Research Quality Nutrient Data. The Agricultural Research Service: Composition of Foods. DC, US Department of Agriculture: Agricultural Handbook no 8 Washington; 2006. [Google Scholar]
  24. Cardoso MA, Stocco PR. Desenvolvimento de um questionário quantitativo de freqüência alimentar em imigrantes japoneses e seus descendentes residentes em São Paulo. Brasil Cad Saúde Pública. 2000;16(1):107–114. doi: 10.1590/s0102-311x2000000100011. [DOI] [PubMed] [Google Scholar]
  25. Pinheiro ABV, Lacerda EMA, Benzecry EH, Gomes MCS, Costa VM. Tabela para avaliação de consumo alimentar em medidas caseiras. 3ª Ed. Rio de. Editora Atheneu: Janeiro; 2004. [Google Scholar]
  26. Monteiro JP. Nutrição e Metabolismo: Consumo Alimentar: Visualizando Porções. 1 ed. Rio de. Guanabara Koogan: Janeiro; 2007. [Google Scholar]
  27. Moulin CC, Tiskievicz F, Zelmanovitz T, De Oliveira J, Azevedo MJ, Gross JL. Use of weighed diet records in the evaluation of diets with different protein contents in patients with type 2 diabetes. Am J Clin Nutr. 1998;67(5):853–857. doi: 10.1093/ajcn/67.5.853. [DOI] [PubMed] [Google Scholar]
  28. Almeida JC, Zelmanovitz T, Vaz JS, Steemburgo T, Perassolo MS, Gross JL, Azevedo MJ. Sources of protein and polyunsaturated fatty acids of the diet and microalbuminuria in type 2 diabetes mellitus. J Am Coll Nutr. 2008;27(5):528–537. doi: 10.1080/07315724.2008.10719735. [DOI] [PubMed] [Google Scholar]
  29. Steemburgo T, Dall'Alba V, Almeida JC, Zelmanovitz T, Gross JL, De Azevedo MJ. Intake of soluble fibers has a protective role for the presence of metabolic syndrome in patients with type 2 diabetes. Eur J Clin Nutr. 2009;63(1):127–133. doi: 10.1038/sj.ejcn.1602902. [DOI] [PubMed] [Google Scholar]
  30. Silva FM, Steemburgo T, De Mello VD, Tonding SF, Gross JL, Azevedo MJ. High dietary glycemic index and low fiber content are associated with metabolic syndrome in patients with type 2 diabetes. J Am Coll Nutr. 2011;30(2):141–148. doi: 10.1080/07315724.2011.10719953. [DOI] [PubMed] [Google Scholar]
  31. Slater B, Philippi ST, Marchioni DML, Fisberg RM. Validação de Questionários de Freqüência Alimentar - QFA: considerações metodológicas. Rev Bras Epidemiol. 2003;6(3):200–208. doi: 10.1590/S1415-790X2003000300003. [DOI] [Google Scholar]
  32. Fisberg RM, Slater B, Marchioni DML, Martini LA. Inquéritos Alimentares: métodos e bases científicos. São Paulo: Manole; 2005. [Google Scholar]

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Supplementary Materials

Additional file 1

Food frequency questionnaire developed for Brazilian patients with type 2 Diabetes.

Click here for file (251.5KB, doc)

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