Assessing food consumption patterns of young children on Guam through the development of a culturally appropriate food frequency questionnaire (FFQ)

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2023

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ABSTRACT Food frequency questionnaires (FFQ) can assess usual dietary intake, be tailored to the population of interest, are fairly inexpensive to administer, are cost effective, and have low participation burden. To our knowledge, there is no FFQ to assess usual diet of young children in Guam. This dissertation encompasses three manuscripts whose respective objectives were to: 1) understand the food intake of young children living on Guam, 2) create a diet assessment tool that will help monitor diets of young children in Guam, and 3) pilot and test the newly created diet assessment tool. The first manuscript is an analysis of existing data utilizing cross-sectional data collected on children ages 2-8 yrs. who participated in the Children’s Healthy Living Program (CHL) baseline study. Parents/caregivers completed food records of everything their children ate and drank for two randomly assigned days. Results show high intakes of added sugar, non-whole grains, meat, total energy intake, protein, total carbohydrates, total fat, iron, and sodium. CHamoru children had a statistically higher mean (233.35g) carbohydrate intake per day compared to Other PI (218.53g) and Filipino (225.50g) children in the study. Other PI children had a statistically higher mean (2671.76mg) sodium intake per day compared to CHamoru ((2593.54 mg) and Filipino (2463.05mg) children. Higher intake of dietary fat was found among CHamoru children with Overweight and Obesity (OWOB) compared to CHamoru children with Healthy Weight, also reveals an area for dietary improvement. Overall, intakes were low in fruit, vegetables, milk, and calcium compared to MyPlate recommendations and Dietary Reference Intakes, respectively. The second manuscript used the dietary data collected in the first manuscript to help create a food list for developing a Guam Child FFQ. A food list with frequently consumed foods is the first step to creating an FFQ. Data from all CHL Guam children contributed to the development of the FFQ. A semi-quantitative food frequency questionnaire which included culturally appropriate food items was created. For the third manuscript, the objective was to test the Guam Child FFQ created in the second manuscript. There were a total of 82 children participating in completion of FFQ1and a subsample of 59 participating in the reproducibility (test-retest) and 43 participating in the validation study, which compared results from the FFQ with results from 2 days of records obtained from the Pacific Islands Cohort on Cardiometabolic Health (PICCAH) study. The reproducibility of the FFQ was assessed by Pearson’s correlation coefficient which ranged from 0.60 for cholesterol to 0.74 for sodium. The results of the validation study did not demonstrate good validity of the FFQ, with correlations ranging from 0.17 for iron to 0.50 for calcium using nutrient densities. Although these findings indicate that further modifications and testing to the Guam Child FFQ are needed to improve the validity of the FFQ, reliability of the tool was good. A future goal is to further modify and test the FFQ for future studies to capture usual dietary intake of children in Guam and find ways to monitor and improve diet and health in this population.

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Nutrition, Children, Diet Assessment, Food Frequency Questionnaire, Guam, Pacific

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