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Jpn J Clin OncoI1998;28(11)679-687 Development of Data-based Semi-quantitative Food Frequency Questionnaire for Dietary Studies in Middle-aged Japanese Shinkan Iokudome', Masato Ikeda2, Yuko Tokudome3, Nahomi Imaeda4, Ikumi Kitagawa 5 and Nakako Fujiwara 1 1Department of Public Health, Nagoya City University Medical School, Nagoya, 2Department of Occupational Health Economics, University of Occupational and Environmental Health, Kitakyushu, 3Nagoya Bunri College, Nagoya, 4Nagoya City Personnel Health Management Center, Nagoya and 5Nagoya Seirei Junior College, Seto, Japan Background: We designed a data-based semi-quantitative food frequency questionnaire to clarify the relationship between food intake and lifestyle-related diseases among middle-aged Japanese. Methods: A total of 351 middle-aged individuals were recruited to a one-day weighed diet record survey in 1994. In all, 586 foods were consumed. Intakeof 31 nutrients including energy, protein, fat, carbohydrate, vitamins, minerals and dietary fiber by food was computed by multiplying the weight of food consumed by its nutrient content. First, 252 foods with up to 90 cumulative 0/0 contribution to nutrientintakewere selected. Of these, foods having apparently the same/similar nutrient content were combined into 206 foods by research dietitians. Next, 183 foods with up to 0.90 cumulative multiple regression coefficient and 90 cumulative % contribution were chosen. At this stage an additional food grouping was made. Results: Finally, 102 foods/recipes were included in the questionnaire: rice (2 items), bread and noodles (11), eggs, milkand dairyproducts (10), soybean, soybean products andotherbeans (7), meat including beef, pork and chicken (12), fish (5), other fish, shellfish and fish products (10), green-yellow vegetables (8), other vegetables and mushrooms (7), edible roots (2), seaweeds (3), seeds (2), fruits (8), beverages (7) and confectioneries (8). The frequencies were classified intoeight categories. Portion size was calculated for the respective foodslargelyfrom the one-day weighed diet record. Conclusions: The developed semi-quantitative food frequency questionnaire substantially coveredthe intakeof 31 nutrients andmaybecompetentto rankmiddle-aged Japanese efficiently. Key words: weigheddiet record - contribution analysis - multipleregression analysis - semi-quantitative food frequency questionnaire INTRODUCTION As is well known, the Japanese enjoy the longest life expectancy in the world, which may be accounted for by genetic predisposition, modest lifestyle, improvements in sanitary environment and a well-organized health care/medical/welfare system. Three- Received February 2,1998; accepted August 10, 1998 For reprints and all correspondence: Shinkan Tokudome, Department of Public Health, Nagoya City University Medical School, Mizuho-ku, Nagoya 467-8601, Japan. E-mail: [email protected] Abbreviations: SQFFQ, semi-quantitative food frequency questionnaire; WDR, weighed diet record; MRA, multiple regression analysis; CA, contribution analysis; TDF, total dietary fiber; SDF, soluble dietary fiber; lDF, insoluble dietary fiber; SFA, saturated fatty acid; MUFA, mono-unsaturated fatty acids; PUFA, polyunsaturated fatty acid; EPA, eicosapentaenoic acid; DHA, docosahexaenoic acid; RDA, Recommended Dietary Allowances fifths of deaths are due to chronic diseases, such as cancer, heart disease and cerebrovascular disease. Among lifestyle factors, smoking, diet and exercise may be the top three. As with smoking and physical exercise, food intake is controllable. However, unlike either smoking, which is always harmful, or physical exercise, which is beneficial if done moderately, diet has two profiles. Food is primarily requisite and favorable, but excessive or imbalanced intake may be deleterious. Thus, further research is needed to elucidate the association between food intake and health/disease, including cancer, on the basis of a dietary questionnaire specifically and systematically developed in Japan. Recently, we designed an evidence-based semi-quantitative food frequency questionnaire (SQFFQ) (1-3) on the basis of a one-day weighed diet record (WDR) according to multiple regression analysis (MRA) and also contribution analysis (CA). Although calibration/validation and reproducibility studies in terms of food list, intake frequency and portion size are currently in progress, it seemed informative to report the procedures 680 Development of data-basedSQFFQ undertaken for preparing this SQFFQ and the foods largely contributing to nutrient intake of interest and serving to classify individuals efficiently into a tertile/quartile/quintile categorization. SUBJECTS AND METHODS SUBJECTS A total of351 (171 males and 180 females) middle-aged Japanese living in Aichi, Mie and Gifu Prefectures, in Central Japan, parents of student dietitians attending a Junior College and majoring in nutrition, participated in a one-day WDR survey during October-November 1994. The mean ages ± standard deviations for males and females were 50.2 ± 5.2 and 46.9 ± 4.4, respectively. WEIGHED DIET RECORD The WDR was carried out on a weekday. Weight measurement was done before cooking if food was prepared at home, otherwise after cooking. Foods were weighed individually; while foods such as soup were divided by the number of household members. Not only completeness but also accuracy ofWDR were reviewed by the respective students and research nutritionists. NUTRIENTS OF INTEREST The following 31 nutrients were selected: energy, protein, fat, carbohydrate, total dietary fiber (TDF) [including soluble dietary fiber (SDF) and insoluble dietary fiber (IDF)], minerals (including potassium, calcium, magnesium, phosphorus, iron, zinc and copper) and vitamins (including carotene and vitamins A, C, D and E). Fat was divided into saturated fatty acids (SFA), mono-unsaturated fatty acids (MUFA) (including oleic acid), polyunsaturated fatty acids (PUFA), n-6 PUFA, n-3 PUFA and cholesterol. n-6 PUFA was subdivided into linoleic acid (l8:2n-6) and arachidonic acid (18:3n-6) and n-3 PUPA was divided into a-linolenic acid (18:3n-3), eicosapentaenoic acid (EPA, 20:5n-3) and docosahexaenoic acid (DHA, 22:6n-3). SELECTION OF FOODS/RECIPES In all, 586 foods were consumed by the subjects. The nutrient intake by food was computed by multiplying the food intake (in grams) or serving size by the nutrient content per gram of food as listed in the Standard Tables of Food Composition, Version 4 and the Follow-up of the Standard Tables of Food Composition, Version 4 (4,5). First, modified CA was applied to nutrients of interest as follows (6,7). We defined the percentage contribution of nutrient k by food i as the arithmetic mean of the individual % contribution of nutrient k by food (lPCjik), which was estimated by 586 ire; = QjiD ik/ I Q;iDik x 100, i=1 586 if I i=l Q;iD ik = 0 then Il'C, = 0 was assumed. 351 Percentage contribution of nutrient k by food i = I IPC jik/ 351, j=l wherej=l, ... ,351 subjects,i= 1, ... ,586foods,k= 1, ... ,31 nutrient factors, Q = grams of foods consumed and D = nutrient content per gram of food. We selected 252 foods with up to 90 cumulative % contribution, except for 80% for potassium and calcium. Those foods having apparently the same/similar nutrient contents were combined into 206 foods by research nutritionists, irrespective of the different cooking processes or appearances: cooked bread (e.g. pre-cooked bread, sandwich, pizza); beef (e.g. steak, grilled beef, Sukiyaki, Shabu-shabu); blue-skinned fish (e.g. mackerel, sardines, horse mackerel, yellowtail, Spanish mackerel); bone-edible small fish (e.g. Wakasagi, Shishamo, Mezashi, Shirasuboshiy; other green-yellow vegetables (e.g. Komatsuna, green pepper, garland chrysanthemum, leek, okra); other vegetables (e.g. cucumber, lettuce, bean sprouts, onion, eggplant, Chinese cabbage); edible roots (e.g. potato, sweet potato, taro, yam) and so on. Next, not only CA but also forward MRA (8) were performed by adopting total intake of a specific nutrient as the dependent variable and overall amounts of nutrient from 206 foods as the independent variables for the 351 individuals (9-11). We chose 183 foods with up to 90 cumulative % contribution and 0.90 cumulative multiple regression coefficient/cumulative R2. However, seasonings, such as salt and Shoyu (soy sauce), were excluded from the questionnaire and some foods, such as brown rice, kiwi fruit, strawberries, potato chips and milk powder, were intentionally included. At this phase we did additional food grouping. Finally, 102 foods/recipes were included in the SQFFQ. Rice is a Japanese staple food and substantially provided most nutrients. Rice intake was inquired into in a special manner, that is, the intake frequency and portion size according to the size of rice bowl for breakfast, lunch, supper and meal/snack between meals, respectively. Supplementary questions regarding fat and oil intake were also prepared. Intake frequency of vegetable oil, mayonnaise, dressing, butter, margarine, lard, etc. and foods/recipes cooked with such fat and oil were asked about separately by dish. The brand names of fat and oil consumed at home were further surveyed to assess fatty acids intake. Sea foods such as fish, shellfish and seaweeds are also part of the typical Japanese diet and they are major sources of n-3 PUFA such as EPA and DHA; therefore, food grouping was left rather loose in order to ascertain the intake of such nutrients. Other information was collected on the type of breakfast (e.g. Japanese or Western type), the intake frequencies of fish and meat, lean and fatty meat, and chicken skin, the frequency of eating out and the type of food (e.g. Japanese, Chinese or Western) along with sweetness and saltiness. In addition, a separate lifestyle questionnaire included smoking, physical exercise and sleeping hours, inquiries with regard to intake of alcohol, vitamin and mineral supplements, and functional (or designer) foods. The proportion of individuals taking vitamin and mineral supplements, however, was very small in this study population, and intake of vitamin and mineral supplements was not taken into consideration. Jpn J Clin OncoI1998;28( 11) Table 1. Intake of macro-nutrients by the 351 subjects Table 2. Number of foods contributing to 31 nutrients with up to 90 cumulative % contribution and 0.90 cumulative R2 by the 351 subjects Male (171) Female (180) Mean (min-max) Mean (min-max) Energy 2163 kcal (1045-3619) 1785 kcal (956-3169) Energy Protein 83.5 g (33.1-149.1) 70.4 g (35.5-123.4) Fat 62.0 g (22.4-146.2) Cumulative % contribution Cumulative R2 78 45 Protein 82 59 57.7 g (17.2-118.8) Fat 61 41 35 18 50 25 Animal origin 24.7 g (0-84.1) 22.2 g (0-83.5) Carbohydrate Vegetable origin 30.5 g (4.2-84.1) 30.6 g (4.5-76.5) SFA 6.8 g (0-31.7) 4.8 g (0-33.5) Marine origin Carbohydrate 281.6 g (112.3-606.2) 681 239.3 g (109.0-470.6) INTAKE FREQUENCY Intake frequencies were classified into eight categories: never or seldom, 1-3 times per month, 1-2 times per week, 3-4 times per week, 5-6 times per week, once a day, twice a day and three or more times a day. For beverages, including coffee, green tea, black tea and oolong tea, questions on intake frequency were left open-ended when the answer was more than 5-6 times per week. PORTION SIZE The meanportion size (or average serving size) was calculatedfor the respectivefoods from the one-day WDR and typical/standard values and/or natural units from the literature were also taken into account.Portion size was questioned whether the size was half as much, the same, 1.5times larger or twice the averageserving size. An open-ended response was also prepared. RESULTS STUDY SUBJECTS Table 1 shows the intake of energy, protein, fat and carbohydrate by study subjects. More macro-nutrients were consumed by males than females. These nutrients were slightly less than the national average in the respective age groups (12). Energy intake was somewhat less than the Recommended Dietary Allowances (RDA) in either sex (13). Protein intake was, however, slightly higher than the RDA. Approximately 60 g of fat on average or 25% of the fat-energy ratio was consumed, which was slightly above the RDA. MUFA 47 30 PUFA 43 20 Cholesterol 35 8 Oleic acid 40 23 16 n-6 PUFA 30 Linoleic acid 33 16 Arachidonic acid 29 19 n-3 PUFA 42 16 a-Linolenic acid 29 9 EPA 50* 10 DHA 28 11 Vitamin C 27 10 Carotene 18 2 Vitamin A 29 5 Vitamin E 62 24 Vitamin D 25 6 Potassium (K) 90 42 Calcium (Ca) 76 24 Magnesium (Mg) 49 27 Phosphorus (P) 94 54 Iron (Fe) 90 37 Zinc (Zn) 38 Copper (Cu) 40 TDF 36 SDF 29 16 IDF 32 27 29 *Stopped at 85% partly because 51 subjects did not consume foods/recipes providing EPA. SELECTION OF FOODS/RECIPES As mentioned,586 foods were initially consumed by the subjects. Firstly, CA was used and 252 foods with up to 90 cumulative % contribution were chosen for 31 nutrients. Those foods having apparentlythe same/similarnutrient contents were combined into 206 foods by the research nutritionists. Next, 183foods satisfying not only the 90 cumulative % contribution but also 0.90 cumulative R2 were selected. The mean number of foods by CA was 46.7 with a range of 18 for carotene to 94 for phosphorus, which was significantly greater than the mean by MRA of 21.6 with a range of 1 for zinc and copper to 59 for protein (Table 2). LIST OF FOODS/RECIPES According to the categorizationscheme of the Standard Tablesof Food Composition (4,5), 102 foods/recipes were included in the SQFFQ as follows: rice (2 items), bread and noodles (11), eggs, milk and dairy products (10), soybean, soybean products and other beans (7), meat including beef, pork and chicken (12), fish (5), other fish, shellfish and fish products (10), green-yellow vegetables (8), other vegetables and mushrooms (7), edible roots (2), seaweeds (3), seeds (2), fruits (8), beverages (7) and confectioneries (8) (see Appendix). Developmentofdata-based SQFFQ 682 Table3. Percentage contribution, cumulative % contribution and cumulative R2 of the top 20 foods for energy Rank Food Cumulative Rank Food % contribution Cumulative R2 Well-milled rice 31.0 0.35 % contribution Well-milled rice 31.0 2 White bread 35.6 2 Beer 2.0 0.43 3 Chicken egg 39.9 3 White bread 4.6 0.49 4 Milk (whole) 42.4 4 Beef (chuck loin) 0.8 0.52 5 Salad oil (mixed) 44.7 5 Chinese noodles 1.2 0.55 6 Udon/Soba (Japanese noodles) 46.8 6 Sake l.l 0.58 7 Beer 48.8 7 Arare (rice cake cubes) 0.4 0.61 8 White sugar 50.4 8 Wheat flour 1.4 0.64 9 Tofu (soybean curd) 52,1 9 Milk (whole) 2.4 0,66 10 Wheat flour 53.4 10 Mayonnaise (egg yolk type) 1.2 0.68 II Vegetable oil (mixed) 54,7 II Pork (ground meat) 0.6 0,70 12 Pork (Boston butt) 56,0 12 Chicken egg 4.4 0.71 13 Mayonnaise (egg yolk type) 57,2 13 Mayonnaise(whole egg type) 0.6 0.73 0,3 0,74 14 Koji-miso (soybean paste) 58.5 14 Dorayaki (bean-jam pancake) 15 Chinese noodles 59.7 15 Mirin (sweet Sake used for seasoning) 0.4 0.75 16 Sake 60,8 16 Bread crumbs 0.4 0,76 17 Salmon 61.8 17 Udon/Soba (Japanese noodles) 2.1 0.77 18 Potatoes 62,8 18 Salad oil (mixed) 2.3 0.78 19 Beef (chuck loin) 63.6 19 Beef (sirloin) 0,2 0,79 20 Abura-age (fried soybean curd) 64,S 20 Under-milled rice 0,2 0.79 Table4. Percentage contribution, cumulative % contribution and cumulative R2 of the top 20 foods for protein Rank Food Cumulative Rank Food % contribution Cumulative R2 Well-milled rice 14.7 0.16 % contribution Well-milled rice 14,7 2 Chicken egg 23,2 2 Round herring (salted and dried, round) 0,3 0.21 3 White bread 27,2 3 Chicken egg 8.6 0.26 4 Tofu (soybean curd) 30.8 4 Yellowfin tuna 1.0 0,31 5 Salmon 34,0 5 Shoyu (soy sauce) 2,3 0,35 6 Milk (whole) 37,1 6 Dried squid 0,2 0.39 7 Koji-miso (soybean paste) 39,6 7 Pork (ground meat) 1.0 0.43 8 Coffee drink (canned) 0,2 0.47 Koji-miso (soybean paste) 2,5 0.50 Chicken (breast) 0.5 0,52 8 Shoyu (soy sauce) 9 Mushi-Kamaboko (steamed fish paste) 43,8 9 Pork (Boston butt) 45.7 10 10 41.9 11 Pacific saury 47.4 II Milk (whole) 3.1 0,54 12 Beef (chuck loin) 48,8 12 Chinese noodles l.l 0,56 13 Udon/Soba (Japanese noodles) 50.2 13 White bread 3.9 0,58 14 Shiba-shrimp (prawn) 51.4 14 Under-milled rice 0.1 0,60 IS Beef (flank) 52,5 15 Chicken (breast), sasami (fillet) 0,7 0.61 16 Chicken (wing) 53.5 16 Chicken (wing) l.l 0.63 17 Chinese noodles 54,6 17 Salmon 3,2 0.64 18 Beef (inside round) 55.6 18 Lettuce 0.1 0.65 19 Chicken (thigh) 56.7 19 Squid 0.8 0,66 20 Abura-age (fried soybean curd) 57.7 20 Beef (sirloin) 0.4 0,67 Jpn J Clin OncoI1998;28( 11) Table5. Percentage contribution, cumulative % contribution and cumulative R2 of the top 20 foods for fat Rank Food Cumulative Rank Food % contribution Cumulative R2 % contribution Chicken egg 10.3 Pork (ground meat) 1.2 0.10 2 Salad oil (mixed) 18.0 2 Mayonnaise (egg yolk type) 4.0 0.18 3 Vegetable oil (mixed) 22.5 3 Pork (Boston butt) 3.0 0.25 4 Milk (whole) 26.8 4 Chicken egg 10.3 0.31 5 Mayonnaise (egg yolk type) 30.8 5 Salad oil (mixed) 7.7 0.36 6 Well-milled rice 34.7 6 Beef (sirloin) 0.5 0.41 7 Tofu (soybean curd) 38.3 7 Safflower oil 1.8 0.45 8 Pork (Boston butt) 41.3 8 Vegetable oil (mixed) 4.5 0.48 9 Abura-age (fried soybean curd) 43.8 9 Beef (chuck loin) 2.2 0.53 10 Margarine 46.2 10 Milk (whole) 4.3 0.56 11 White bread 48.5 11 Mayonnaise (whole egg type) 1.9 0.59 12 Beef (chuck loin) 50.7 12 Margarine 2.3 0.61 13 Koji-miso (soybean paste) 52.7 13 Sausage (Vienna) 1.5 0.64 14 Mayonnaise (whole egg type) 54.6 14 Butter 1.2 0.66 15 Safflower oil 56.4 15 Butter peanuts 0.4 0.67 16 Pacific saury 58.1 16 Beef (ground meat) 1.1 0.69 17 Salmon 59.6 17 Pork (belly) 1.1 0.70 18 Sausage (Vienna) 61.1 18 Peanuts (dried) 0.2 0.72 19 Beef (flank) 62.6 19 Bacon 0.7 0.73 20 Corn oil 63.9 20 Beef (flank) 1.4 0.75 Table 6. Percentage contribution, cumulative % contribution and cumulative R2 of the top 20 foods for carbohydrate Rank Food Cumulative Rank Food % contribution Well-milled rice 50.5 0.45 Udon/Soba (Japanese noodles) 3.1 0.51 Cumulative R2 % contribution Well-milled rice 50.5 2 White bread 57.1 3 White sugar 60.2 3 Chinese noodles 1.8 0.57 4 UdonrSoba (Japanese noodles) 63.3 4 White bread 6.6 0.62 2 5 Wheat flour 65.5 5 Coffee drink (canned) 0.9 0.67 6 Chinese noodles 67.3 6 Wheat flour 2.2 0.70 7 Potatoes 68.9 7 Arare (rice cake cubes) 0.6 0.74 8 Milk (whole) 70.4 8 Mandarin orange 1.4 0.77 9 Kaki (Japanese persimmon) 71.9 9 Dorayaki (bean-jam pancake) 0.5 0.78 10 Mandarin orange 73.3 10 An-pan (bean-jam bun) 0.7 0.80 11 Apple 74.6 11 Macaroni 1.0 0.82 12 Beer 75.9 12 Short cake 0.6 0.83 13 Macaroni 77.0 13 Kaki (Japanese persimmon) 1.5 0.84 14 Banana 77.9 14 Under-milled rice 0.3 0.86 15 Coffee drink (canned) 78.8 15 Sweet potatoes 0.6 0.87 16 Onion 79.5 16 Manju (steamed bun with bean-jam filling) 0.4 0.88 17 An-pan (bean-jam bun) 80.2 17 Buckwheat flour 0.5 0.90 18 Pre-cooked Chinese noodles 80.9 18 Pre-cooked Chinese noodles 0.7 0.91 19 Shoyu (soy sauce) 81.6 19 Potatoes 1.6 0.91 20 Bread crumbs 82.2 20 Pumpkin 0.5 0.92 683 684 Development of data-based SQFFQ FOODS/RECIPES FOR MACRONUTRIENTS The percentage contribution, cumulative % contribution and cumulative R2 of the top 20 foods/recipesfor energy, protein, fat and carbohydrate are shown in Table 3-6, respectively. One-third of the energy was contributed by well-milled rice, followed by white bread, chicken egg, milk (whole) and salad oil (mixed) according to CA (Table 3). Well-milledrice, beer, white bread, beef (chuck loin) and Chinesenoodles were selectedin that order by MRA. CA revealed that approximately 15% of total protein was derived from well-milled rice, followed by chicken egg, white bread, tofu (soybean curd) and salmon(Table4). Well-milledrice, round herring (salted and dried, round), chicken egg, yellowfin tuna and Shoyu (soy sauce) were chosen by MRA. For fat, chicken egg was ranked at the top based on CA, followed by salad oil (mixed), vegetable oil (mixed), milk (whole) and mayonnaise (egg yolk type) (Table 5). Pork (ground meat), mayonnaise (egg yolk type), pork (Boston butt), chicken egg and salad oil (mixed) were selected by MRA. More than half the carbohydrate was supplied by well-milled rice, followed by white bread, white sugar, Udon/Soba (Japanese noodles) and wheat flour on the basis of CA (Table 6). Well-milled rice, Udon/Soba, Chinese noodles, white bread and coffee drink (canned) were chosen by MRA. efficientin categorizingindividuals,but unsuitablefor computing the absolute nutrient level. Substantial foods selected by MRA were covered by those chosen by CA; rather, specific foods were only chosen by MRA. The ranking was very different by each type of analysis. Well-milled rice, a Japanese staple food, is an exception; it was not only the greatest source of variance contribution but also the largest source of absolute contribution to energy, protein and carbohydrate. Chicken egg, for example, was ranked third in energy by CA but twelfth by MRA. On the other hand, Chinese noodles were a minor source of absolute contribution to energy but a major source of variance contribution. It appeared odd that Shoyu (soy sauce) was chosen as a major provider of protein according to CA and MRA. Shoyu, however, is often used for seasoningof foods, including meat and fish, and seemed to have contributed substantially to absolute intake and variance in intake of protein. We know of an analogous observation where popcorn, cholesterol-freein itself, was picked as a major contributor to cholesterol, which may be plausibly explained by the fact that popcorn is ordinarily seasoned with butter in the USA (1). Table 7. Percentage coverage of 31 nutrients by the Energy PERCENTAGE COVERAGE OF NUTRIENTS BY SQFFQ The percentage coverage of 31 nutrients by the SQFFQ was computed assuming all 586 foods as unity (Table 7). As mentioned, fat and oil intake in supplementary items in the SQFFQ and alcohol intake in a lifestyle questionnaire were taken into account. The average was 94% with a range from 85% for iron to 99% for a-linolenic acid. DISCUSSION Admittedly, the sample size was not largeenough and the one-day WDR was done in a specific seasonand in a selected area in Japan. We were naturally unableto estimate within-individual variation on the basis of a one-day WDR. The present data therefore were not necessarily accurate or complete in terms of quality and quantity. The averageintakeof macro-nutrients, however, was somewhat less than the national data published (12) and slightly greater than the RnA (13); hence the profiles of study subjects were unlikely to be very different from those of the general population. In choosing foods/recipes, there are two contrasting methods (14-15): one is based on CA (6,7) and the other on MRA (9-11). Each method has its particular advantagesand disadvantages.The former approach is based on absolute intake and is useful for making energy adjustments. Hence this procedure is especially suitable for studies to clarify the association with absolute nutrient intake but often inappropriate for categorizing individuals. The latter is based on the variance of nutrient intake. The cumulative R 2 was explained by a significantly smaller number of foods than cumulative % contribution, that is, MRA may be 91 Protein 89 Fat 93 Carbohydrate 91 SFA 96 MUFA 97 PUFA 98 Cholesterol 97 Oleic acid 96 n-6 PUFA 98 Linoleic acid 98 Arachidonic acid 97 n-3 PUFA 98 a-Linolenic acid 99 EPA 96 DHA 96 Vitamin C 93 Carotene 95 Vitamin A 95 VitaminE 96 Vitamin D 96 Potassium (K) 87 Calcium (Ca) 91 Magnesium (Mg) 86 Phosphorus (P) 89 Iron (Fe) 8S Zinc (Zn) 93 Copper (Cu) 94 TDF 93 SDF 92 IDF 93 SQFFQ Jpn J Clin OncoI1998;28(11) Seasonings, such as salt and Shoyu, were selected by CA and MRA for certain minerals including sodium and magnesium. However, they were excluded from the SQFFQ because it is difficult to weigh seasonings accurately and measure actual intake. On the other hand, brown rice, kiwi fruit, strawberries, potato chips and powdered milk were not consumed by the subjects because some of them have seasonal variations, but they were included because they are important sources of vitamins, minerals and fat. The percentage coverage of selected nutrients by the SQFFQ was 94% on average with a range from 85% for iron to 99% for a-linolenic acid. The coverage of certain nutrients may be overestimated, owing in part to the incompleteness of the composition table. The values were more than 81 %, mathematically computed by multiplying 0.90 by 0.90 (that is, we selected foods according to 90 cumulative % contribution twice), substantially because foods chosen for other nutrients have covered a specific nutrient and supplementary questions in terms of fat and oil intake eventually attained a high coverage of fat, fatty acids and related nutrients. Consequently, the SQFFQ developed seemed efficient not only in estimating the absolute intake of nutrients, except for certain minerals, but also in categorizing individuals by variance in intake. Although the reproducibility of dietary questionnaires has often been evaluated in Japan (16-18), few validation studies have been carried out (19-22). To our knowledge, few data-based Japanese SQFFQs have been developed. Questionnaires were frequently prepared by selecting foods on the basis of the nutrient content from the food composition tables according to researchers' interest, by citing historical questionnaires or by referring to National Nutritional Surveys. Such questionnaires appeared unsatisfactory for elucidating specific hypotheses. They were mostly designed to ask only about frequency and seemed inefficient in calculating nutrient intake and values adjusted for energy intake. Japanese dietitians have been concerned about calculating food and nutrient intake and giving advice on whether a client's nutrient intake is deficient or excessive. Epidemiologists, nutritionists and biostatisticians should collaborate to prepare a valid and reliable SQFFQ to be applied to a particular population under a specific hypothesis. APPENDIX LIST OF FOODS/RECIPES INCLUDED IN A SEMI-QUANTITATIVE FOOD FREQUENCY QUESTIONNAIRE RICE 1. Well-milled rice 2. Brown rice, under-milled rice with embryo, rice boiled with barley 685 6. Pre-cooked bread, sandwiches, pizza 7. Japanese noodle [Udon (wheat noodle)] 8. Japanese noodle [Soba (buckwheat noodle)] 9. Spaghetti, macaroni au gratin 10. Pre-cooked noodles (dried snack noodle) 11. Chinese noodles [Ramen (Chinese noodle), fried noodle, Champon (Chinese-style hotchpotch with noodle), etc.] 12. Okonomiyaki (Japanese pancake, a thin, flat, unsweetened oil fried with bits of vegetables, meat or shellfish) 13. Mochi (Japanese rice cake) EGGS. MILK AND DAIRY PRODUCTS 14. Eggs 15. Milk (whole) 16. Milk (condensed) 17. Milk (low fat) 18. Milk powder 19. Lactic acid beverage 20. Yogurt 21. Cheese 22. Ice cream (>8% milk fat) 23. Other ice cream SOYBEAN, SOYBEAN PRODUCTS AND OTHER BEANS 24. Tofu (soybean curd) for Miso soup 25. Tofu, Yakko tofu (tofu cut in cubes), tofu steak, Mabo-dofu 26. Nama-age (fried tofu), Agedashi-dofu (lightly fried tofu), Ganmodoki (fried tofu paste) 27. Abura-age (fried tofu) 28. Natto (fermented soybean), soybean 29. Koji-miso (soybean paste) (Miso soup, vinegar Miso) 30. Koya-dofu (frozen and dried tofu) MEAT 31. Ground chicken [e.g. meatball, Soboro (powdered chicken)] 32. Beef and pork ground together (e.g. hamburger, rolled cabbage) 33. Ground beef (e.g. hamburger, meat sauce) 34. Ground pork (e.g. dumpling) 35. Chicken 36. Beef (e.g. steak, grilled beef, Sukiyaki, Shabu-Shabuy 37. Other beef (e.g. fried with vegetables, cooked with vegetables) 38. Pork 39. Ham 40. Sausage (except fish sausage) 41. Bacon 42. Liver FISH BREAD AND NOODLES 3. White bread, soft rolls 4. Croissant 5. Bun, bean-jam bun 43. Salmon, trout 44. Eel 45. Blue-skinned fish (e.g. mackerel, sardines, horse mackerel, yellowtail, Spanish mackerel) 686 Development ofdata-based SQFFQ 46. Red-meat fish (e.g. tuna, bonito) 47. White-meat fish (e.g. red bream, sea bream, cod, flatfish) OTHER FISH AND SHELLFISH 48. Bone-edible small fish [e.g. Wakasagi (fresh-water smelt), Shishamo (smelt), Mezashi (salted and semi-dried sardines), Shirasuboshi (boiled and semi-dried whitebait)] 49. Cod roe, salmon roe 50. Canned tuna 51. Oyster 52. Shellfish (e.g. short-necked clam, corbicula) 53. Dried cuttlefish/squid 54. Cuttlefish, squid, octopus 55. Shrimp, Crab 56. Fried fish paste products (e.g. Satsuma-age, Agemono) 57. Fish paste products (e.g. Kamaboko, Chikuwa) GREEN-YELLOW VEGETABLES 58. 59. 60. 61. 62. 63. 64. Spinach Pumpkin/squash Carrot Broccoli Tomato Vegetable juice, tomato juice Other green-yellow vegetables (e.g. Komatsuna, green pepper, garland chrysanthemum, leek, okra) 65. Pickles (e.g. pickled green-yellow vegetables, Takuan) FRUITS 80. 81. 82. 83. 84. 85. 86. 87. Citrus fruits (e.g. orange, tangerine, mandarin orange) Fruit juice Kaki (Japanese persimmon) Banana Apples Strawberries Kiwi fruit Other fruits BEVERAGES 88. 89. 90. 91. 92. 93. 94. Coffee drink (canned) Coffee (regular, instant) Black tea Sugar for coffee and black tea Green tea Oolong tea, Chinese tea Other refreshments CONFECTIONERIES 95. 96. 97. 98. 99. 100. 101. 102. Kasutera (sponge cake) Sembei (rice crackers), Arare (rice cake cubes) Japanese style confectioneries (Manju, etc.) Potato chips Doughnut Chocolate, chocolate cake Cookie Cake (e.g. short cake, cream puff) OTHER VEGETABLES 66. 67. 68. 69. Cabbage Daikon (Japanese radish), turnip Burdock, bamboo shoot Other vegetables (e.g. cucumber, lettuce, bean sprouts, onion, eggplant, Chinese cabbage) 70. Kiriboshi-daikon (dry strips Japanese radish) MUSHROOMS 71. Shiitake (mushroom) (dried) 72. Shiitake (raw), Shimeji (champignon), etc. EDIBLE ROOTS 73. Potatoes (e.g. potato, sweet-potato, taro, yam) 74. Kon-nyaku (devil's tongue) SEAWEEDS 75. Toasted laver, toasted and seasoned laver 76. Hijiki (brown algae), Kombu (kelop) 77. Wakame (seaweed) SEEDS 78. Sesame 79. 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