Reliability and Validity of Food Frequency Questions to Assess Beverage and Food Group Intakes Among Low-Income 2- to 4-Year-Old Children

Background: Fruits, vegetables, sweetened foods, and beverages have been found to have positive and negative associations with obesity in early childhood, yet no rapid assessment tools are available to measure intake of these foods among preschoolers.

Objective: This study examines the test-retest reliability and validity of a 10-item Child Food and Beverage Intake Questionnaire designed to assess fruits, vegetables, and sweetened foods and beverages intake among 2- to 4-year-old children.

Methods: The Child Food and Beverage Intake Questionnaire was developed for use in periodic phone surveys conducted with low-income families with preschool-aged children. Seventy primary caregivers of 2- to 4-year-old children completed two Child Food and Beverage Intake Questionnaires within a 2-week period for test-retest reliability. Participants also completed three 24-hour recalls to allow assessment of validity. Intraclass correlations were used to examine test-retest reliability. Spearman rank correlation coefficients, Bland-Altman plots, and linear regression analyses were used to examine validity of the Child Food and Beverage Intake Questionnaire compared with three 24-hour recalls.

Results: Intraclass correlations between Child Food and Beverage Intake Questionnaire administrations ranged from 0.48 for sweetened drinks to 0.87 for regular sodas. Intraclass correlations for fruits, vegetables, and sweetened food were 0.56, 0.49, and 0.56, respectively. Spearman rank correlation coefficients ranged from 0.15 to 0.59 for beverages, with 0.46 for sugar-sweetened beverages. Spearman rank correlation coefficients for fruits, vegetables, and sweetened food were 0.30, 0.33, and 0.30, respectively. Although observation of the Bland-Altman plots and linear regression analyses showed a slight upward trend in mean differences, with increasing mean intake for five beverage groups, at least 90% of data plots fell within the limits of agreement for all food/beverage groups.

Conclusions: The Child Food and Beverage Intake Questionnaire exhibited fair to substantial test-retest reliability and moderate to strong validity in ranking fruits, vegetables, sweetened food, and the majority of beverages consumed by children aged 2 to 4 years old. Although the Child Food and Beverage Intake Questionnaire might not be able to assess the absolute intake of foods and beverages, given the scarcity of an easily administered, valid, and reliable questionnaire to assess nutritional intake among 2- to 4-year-old low-income children, this tool is a useful means for measuring trends in dietary intake among low-income preschoolers.