Korean Journal of Health Promotion

Kang, Lee, Shim, and Paik: Gender Analysis of Food Items Selection for Food Frequency Questionnaire Development

Original Article

Published online: January 10, 2018

DOI: https://doi.org/10.15384/kjhp.2018.18.2.96

Gender Analysis of Food Items Selection for Food Frequency Questionnaire Development

Minji Kang¹, Jung Eun Lee^2,³, Jae Eun Shim^4,⁵, Hee-Young Paik^1,^2,

¹Center for Gendered Innovations in Science and Technology Research (GISTeR), Korea Federation of Women's Science & Technology Associations, Seoul, Korea

²Department of Food and Nutrition, Seoul National University, Seoul, Korea

³Research Institute of Human Ecology, Seoul National University, Seoul, Korea

⁴Department of Food and Nutrition, Daejeon University, Daejeon, Korea

⁵Daejeon Dong-gu Center for Children's Food Service Management, Daejeon, Korea

￭ Corresponding author: Hee-Young Paik, ScD Center for Gendered Innovations in Science and Technology Research (GISTeR), Korea Federation of Women's Science & Technology Associations, 22 Teheran-ro 7-gil, Gangnam-gu, Seoul 06130, Korea
Tel: +82-2-565-3701, Fax: +82-2-3452-2912 E-mail: hypaik@kofwst.org

Received June 06, 2018 Accepted June 25, 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: The aims of this study were 1) to compare foods between men and women with high contributions to absolute intake and the variability in energy and nutrient intakes, which are common criteria of selecting foods for food frequency questionnaire (FFQ), 2) to analyze possible inaccuracies due to not taking gender into consideration.

Methods: The study used 1-day 24 hour recall data of 7,952 participants (n=3,250 men, n=4,702 women) aged 19–64 years who participated in the 2013–2014 Korea National Health and Nutrition Examination Survey. Foods which have high possibility of being included in FFQ items, called candidate foods, were selected by analyzing their contribution to absolute intake and variability in the intakes of energy and 15 nutrients in total participants, men and women.

Results: The number of candidate foods selected was 133 for total participants, 126 for men, and 153 for women. Intakes of candidate foods for total participants were significantly higher in energy and six nutrients out of selected 16 nutrients than those of candidate foods for men only. On the contrary, all nutrient intakes of candidate foods for total participants were significantly lower than those of candidate foods for women only.

Conclusions: Differences were revealed between men and women not only in the total numbers, but also in the selected food items from the candidate foods for FFQ. Thus, developing FFQs without considering gender may produce systematic errors in dietary assessment, possibly in different directions for men and women.

Key words: Gender; Food selection; FFQ development; Dietary assessment; KNHANES

Figure 1.

Selection of candidate foods for the food frequency questionnaire (FFQ).^a

Figure 2.

Ratios of energy and nutrient intakes for the selected candidate foods.^a-c

Table 1.

Descriptions of 6th (2013–2014) Korea National Health and Nutrition Examination Survey whose dietary intake data were included in the present study

Characteristic	Total (n=7,952)	Men (n=3,250)	Women (n=4,702)	P^a
Age, y	43.4±12.4	43.3±12.5	43.5±12.3	0.3736
Age group
19–29 years	1,237 (15.6)	523 (16.1)	714 (15.2)	0.4030
30–49 years	3,830 (48.2)	1,571 (48.3)	2,259 (48.0)
50–64 years	2,885 (36.3)	1,156 (35.6)	1,729 (36.8)
Residential area^b
Rural	1,385 (17.4)	616 (19.0)	769 (16.4)	0.0005
City	2,980 (37.5)	1,244 (38.3)	1,736 (36.9)
Metropolitan	3,587 (45.1)	1,390 (42.8)	2,197 (46.7)
Household income, monthly, won
≤2,000,000	1,939 (24.5)	717 (22.2)	1,222 (26.1)	0.0009
2,000,000–3,500,000	2,227 (28.1)	944 (29.2)	1,283 (27.4)
3,500,000–5,000,000	1,762 (22.3)	733 (22.6)	1,029 (22.0)
>5,000,000	1,988 (25.1)	843 (26.0)	1,145 (24.5)
Education
Middle school or less	1,445 (21.1)	461 (17.2)	984 (23.6)	<0.0001
High school	2,722 (39.7)	1,081 (40.2)	1,641 (39.4)
College or more	2,685 (39.2)	1,144 (42.6)	1,541 (37.0)

Values are mean±standard deviation or number (%).

^aDifferences between men and women were analyzed by t-test for continuous variable and by χ² test for categorical variables.

^bResidential area was categorized as rural area (Eup-Myeon area of the administrative district in Korea), city (Dong area in non-metropolitan cities, such as Gyeonggi-do), and metropolitan area (Dong area in metropolitan cities such as Seoul).

Table 2.

Number of candidate foods selected among total participants, men, and women in the 2013–2014 Korea National Health and Nutrition Examination Survey^a

Group	Total participants (n=7,952)	Men (n=3,250)	Women (n=4,702)
Cooked rice	13	11	14
Breads and baked products	7	9	11
Noodles and dumplings	9	7	11
Porridges	1	1	2
Soups	4	4	6
Stews	6	6	7
Steamed food	3	3	3
Grilled food	10	10	10
Pan-fried food	3	3	3
Stir-fried food	5	6	8
Braised food	4	3	2
Fried food	4	4	4
Cooked and seasoned vegetables	4	4	5
Seasoned fresh vegetables of other food	4	5	4
Kimchi	5	5	8
Pickled or preserved food	4	3	4
Seasoning	4	7	3
Milk and milk products	5	4	5
Beverages and tea	10	8	12
Alcoholic beverages	3	3	2
Fruits	11	11	11
Grain, starch and grain products	7	2	9
Legumes, nuts, and seeds	3	2	4
Vegetables and seaweeds	3	3	3
Meat, poultry, and fish	1	2	2
Total	133	126	153

^aCandidate foods: foods which have high possibility of being included in food frequency questionnaire items, which were identified as foods with high contribution to total energy and major nutrient intakes as well as foods of major sources of between-person variation in energy and nutrient intakes.

Table 3.

Energy and nutrient intakes from the selected candidate foods^a^b

Nutrient	Men (n=3,249)		Women (n=4,699)
Nutrient	From candidate foods of total participants^c	From candidate foods of men^d	From candidate foods of total participants^e	From candidate foods of women^f
Macro nutrients
Energy, kcal	1934.4±929.9	1915.6±921.6^g	1343.5±649.7	1399.4±660.4^g
Protein, g	59.4±40.7	59.4±41.3	42.3±27.6	44.2±28.1^g
Fat, g	39.2±37.3	38.8±36.8^h	28.0±26.9	29.8±27.5^g
Saturated fatty acid, g	12.2±12.7	12.0±12.4 ^g	8.6±9.4	9.1±9.6^g ^g
Polyunsaturated fatty acid, g	g 9.2±9.3	9.0±9.1^g ^g	6.8±7.4	7.1±7.4^g ^g
Carbohydrate, g	284.7±124.7	280.6±122.3^g	219.8±105.6	228.4±107.2^g
Minerals		^g		^g
Calcium, mg	392.7±276.7	389.3±275.1^g	322.4±253.1	332.4±247.4^g
Phosphorous, mg	918.7±499.6	917.8±503.1	703.8±426	730.0±429.8^g
Iron, mg	14.1±63.5	13.7±63.5^g	10.0±6.6	11.0±7.1^g
Sodium, mg	3240.2±2757.3	3303.2±2742.2^g	2187.6±1915	2329.4±1950.5^g
Potassium, mg	2520.1±1421.7	2521.3±1405.3	2120.2±1360.4	2186.7±1380.1^g
Vitamins
Vitamin A, μgRE	550.2±642.2	526.1±598.2^g	457.8±565.8	479.2±579.2^g
Thiamin, mg Riboflavin, mg	1.9±1.1 1.2±0.8	1.9±1.1 1.2±0.8	1.4±0.8 0.9±0.6	1.4±0.8^g 0.9±0.6^g
Niacin, mg	13.6±8.8	13.5±9.1	10.2±6.5	10.7±6.6^g
Vitamin C, mg	68.2±97.5	71.3±99.6^g	79.9±122.3	81.1±122.6^g

Values are mean±standard deviation or number (%).

^bAmong the participants (men, n=3,250; women, n=4,702), those who did not consume the candidate foods (men, n=1; women, n=3) were excluded from the nutrient intake comparison.

^cNutrient intakes among men calculated from candidate foods of total participants.

^dNutrient intakes among men calculated from candidate foods of only men.

^eNutrient intakes among women calculated from candidate foods of total participants.

^fNutrient intakes among women calculated from candidate foods of only women.

^gNutrient intakes from candidate foods selected for total participants, and for each gender, were compared by paired t-test (<0.001).

^hNutrient intakes from candidate foods selected for total participants, and for each gender, were compared by paired t-test (<0.05).

REFERENCES

REFERENCES: References

1. Block G, Dresser CM, Hartman AM, Carroll MD. Nutrient sources in the American diet: quantitative data from the NHANES II survey. I. Vitamins and minerals. Am J Epidemiol 1985;122(1):13-26.
[PubMed]

2. Block G, Dresser CM, Hartman AM, Carroll MD. Nutrient sources in the American diet: quantitative data from the NHANES II survey. II. Macronutrients and fats. Am J Epidemiol 1985;122(1):27-40.
[PubMed]

3. Block G, Hartman AM, Dresser CM, Carroll MD, Gannon J, Gardner L. A databased approach to diet questionnaire design and testing. Am J Epidemiol 1986;124(3):453-69.
[Article] [PubMed]

4. Stryker WS, Salvini S, Stampfer MJ, Sampson L, Colditz GA, Willett WC. Contributions of specific foods to absolute intake and between-person variation of nutrient consumption. J Am Diet Assoc 1991;91(2):172-8.
[Article] [PubMed]

5. Beaton GH, Milner J, Corey P, McGuire V, Cousins M, Stewart E, et al. Sources of variance in 24-hour dietary recall data: implications for nutrition study design and interpretation. Am J Clin Nutr 1979;32(12):2546-59.
[Article] [PubMed]

6. Ireland P, Jolley D, Giles G, O'Dea K, Powles J, Rutishauser I, et al. Development of the Melbourne FFQ: a food frequency questionnaire for use in an Australian prospective study involving an ethnically diverse cohort. Asia Pac J Clin Nutr 1994;3(1):19-31.
[PubMed]

7. Park MK, Kim DW, Kim J, Park S, Joung H, Song WO, et al. Development of a dish-based, semiquantitative FFQ for the Korean diet and cancer research using a database approach. Br J Nutr 2011;105(7):1065-72.
[Article] [PubMed]

8. Hebden L, Kostan E, O'Leary F, Hodge A, Allman-Farinelli M. Validity and reproducibility of a food frequency questionnaire as a measure of recent dietary intake in young adults. PLoS One 2013;8(9):e75156.
[Article] [PubMed] [PMC]

9. Lee H, Kang M, Song WO, Shim JE, Paik HY. Gender analysis in the development and validation of FFQ: a systematic review. Br J Nutr 2016;115(4):666-71.
[Article] [PubMed]

10. Korea Centers for Disease Control and Prevention. The sixth Korea National Health and Nutrition Examination Survey (KNHANES VI). [Internet]. Sejong: Ministry of Health and Welfare; 2015. [Accessed June 5, 2018]. Available from:. https://knhanes.cdc.go.kr/knhanes/sub02/sub02_03.do.

11. Overvad K, Tjønneland A, Haraldsdóttir J, Ewertz M, Jensen OM. Development of a semiquantitative food frequency questionnaire to assess food, energy and nutrient intake in Denmark. Int J Epidemiol 1991;20(4):900-5.
[Article] [PubMed]

12. Yum J, Lee S. Development and evaluation of a dish-based semiquantitative food frequency questionnaire for Korean adolescents. Nutr Res Pract 2016;10(4):433-41.
[Article] [PubMed] [PMC]

13. Yun SH, Shim JS, Kweon S, Oh K. Development of a food frequency questionnaire for the Korea National Health and Nutrition Examination Survey: data from the fourth Korea National Health and Nutrition Examination Survey (KNHANES IV). Korean J Nutr 2013;46(2):186-96.
[Article]

14. Kang M, Jung HJ, Joung H, Shim JE, Lee SE, Park YH, et al. Development of Han-sik database utilizing an expert focus group and assessment of Han-sik effects on diet quality. Korean J Food culture 2014;29(1):9-17.
[Article]

15. Cade J, Thompson R, Burley V, Warm D. Development, validation and utilisation of food-frequency questionnaires – a review. Public Health Nutr 2002;5(4):567-87.
[Article] [PubMed]

16. Block G, Hartman AM, Naughton D. A reduced dietary questionnaire: development and validation. Epidemiology 1990;1(1):58-64.
[Article] [PubMed]

17. Drewnowski A, Henderson SA, Shore AB, Fischler C, Preziosi P, Hercberg S. Diet quality and dietary diversity in France: implications for the French paradox. J Am Diet Assoc 1996;96(7):663-9.
[PubMed]

18. Jayawardena R, Byrne NM, Soares MJ, Katulanda P, Yadav B, Hills AP. High dietary diversity is associated with obesity in Sri Lankan adults: an evaluation of three dietary scores. BMC Public Health 2013;13:314-21.
[Article] [PubMed] [PMC]

19. Kim CW, Kim TH. Study on the food selection by analyzing the correlates of perceptions and consumptions frequency of foods. Korean J Food Culture 2004;19(5):524-31.

20. Hong YH. A study of dietary pattern and food preference of unversity students in Gwangju and Chonnam province. Korean J Food Culture 2008;23(3):318-27.

21. Blanck HM, Gillespie C, Kimmons JE, Seymour JD, Serdula MK. Trends in fruit and vegetable consumption among U.S. men and women, 1994–2005. Prev Chronic Dis 2008;5(2):1-10.

22. Fagerli RA, Wandel M. Gender differences in opinions and practices with regard to a "healthy diet". Appetite 1999;32(2):171-90.
[Article] [PubMed]

23. Bates CJ, Prentice A, Finch S. Gender differences in food and nutrient intakes and status indices from the National Diet and Nutrition Survey of people aged 65 years and over. Eur J Clin Nutr 1999;53(9):694-9.
[Article] [PubMed]

24. Noh H, Park MK, Lee H, Kim J, Joung H, Paik HY. Reanalyzing sex/gender specific portion sizes of dish items for a dish-based, semiquantitative FFQ for Korean adults. Gender Summit 4 in Europe;. 2014;June 30 – July 01; Brussels..

25. Nishi N, Horikawa C, Murayama N. Characteristics of food group intake by household income in the National Health and Nutrition Survey, Japan. Asia Pac J Clin Nutr 2017;26(1):156-9.
[PubMed]

Gender Analysis of Food Items Selection for Food Frequency Questionnaire Development

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References