SEMI-QUANTITATIVE FOOD FREQUENCY QUESTIONNAIRES

Three different versions of our semi-quantitative food frequency questionnaire have been developed at Harvard University and are available for research purposes. It is the result of over thirty years of continued development, evaluation, refinement and re-evaluation. It was originally created to be used as a self-administered, mailed questionnaire. At every step we have attempted to examine the reproducibility and validity of the questionnaire by comparing its estimates with those of diet records or multiple 24-hour recalls and with relevant biochemical indicators of nutrient intakes.  Such studies have been conducted among adults of all ages and both sexes, and among a variety of socio-economic groups; many of these validation studies have been published. The results of the validation studies have indicated that the method is remarkably robust; similarly valid results have been obtained from virtually all the groups that we have studied. Obviously, the process of continued refinement of the questionnaire can not stop, in part because the nature of the food supply and the distribution of dietary intakes is in constant change.

Although the semi-quantitative food frequency questionnaire was developed for our own research purposes, we are happy to share it with other investigators. This extended use has obvious advantages in better defining the useful scope and limits of the methodology, and, sometimes, providing direct information on the degree of validity in different populations and with various methods of administration.

Although we are not organized as a service group, we have tried to accommodate the wide variety of requests from different investigators as efficiently as possible and within the limited constraints of research budgets. For routine questionnaire processing, this operates quite smoothly at present. We have not always been able to meet special requests as quickly as desired, but do have a professional team available to do their best in meeting such requests. Most importantly, we have strived to maintain the same level of data quality for external users, as we want for our own research.

 We have developed this website for those interested in obtaining copies of the food frequency questionnaires. There is also a general information file containing a list of published validation studies, a list of nutrients analyzed, a sample hard copy output and a pricing list. Due to the volume of investigators interested in receiving the questionnaires, we ask you to please review the information on our website to answer general questions.  

PLEASE NOTE: ANY SALE OR COMMERCIAL USE OF THE QUESTIONNAIRE REQUIRES WRITTEN PERMISSION OF OUR INSTITUTION.

TO: Investigators using the semiquantitative food frequency questionnaires (SFFQ)

FROM: Laura Sampson, Walter Willet

RE: Coding Instructions

An optical scanner is used to read the bar codes and the “skunk marks” along the border of the SFFQ, as well as the coding bubbles within the body of the SFFQ. Users of the SFFQ must use only a NO. 2 PENCIL or a NO.1 PENCIL to mark the questionnaire. The scanner will not recognize ink whether black or blue ink. If the respondent completes the questionnaire in ink, the responses must be shaded over with pencil.

When the machine reads a page, it reads both sides of the page simultaneously. For this reason, care must be taken to avoid writing text on top of any bubble or black rectangle on any page. The scanner sees double responses if writing over bubbles exist. If lead covers the black rectangles or is present in between the black rectangles, the questionnaire will not scan. Studies will be responsible for “cleaning up” these errors by transcribing the SFFQ over onto new forms. To best avoid this possibility, writing, whether in ink or pencil, is only allowed in blank white margins found on any questionnaire.

Additionally, NEVER WRITE OR PLACE LABELS above the solid bar at the top of each page. This will interfere with the bar code. If labels must be added onto the questionnaires, keep them very small and carefully place them only on the top center of page 1, where it reads “dietary assessment” without covering any coding bubbles (the box that is shaded blue). If the label is placed too high on the SFFQ, the questionnaire will eject out of the side of the scanner. IF the label crosses the box outlining question 2 on the SFFQ the scanner will pick up 6+ per day responses on the fruit and vegetable section on page 2.

Do not add scotch tape, staples, or punch holes to any part of the SFFQ, or submit questionnaires that are damaged (either wrinkled or torn). All scenarios often cause the questionnaire to enter the scanner at an incorrect angle or become jammed and torn within the scanner, further damaging the questionnaire. Again, Studies will be responsible for correcting these errors which may entail copying SFFQs over to blank forms.

Finally, if self-coded, the SFFQ needs to be “scanner ready”. Please separate each booklet along their perforation before mailing them in for analysis. Also, please bundle the SFFQs together in an elastic band. Do NOT paper clip individual questionnaires. You may clip the SFFQ batch depending on the size of the batch..

If you have any questions concerning the completion of the SFFQ, please contact Laura Sampson at nhlas@channing.harvard.edu. We suggest that you send a copy of your questionnaires to Laura Sampson for approval if you make any written changes or label additions to the questionnaire before utilizing in your study. If adherence to the above guidelines is not followed correctly, investigators need to expect addition processing fees.

BILLING FORM

Please use the Billing form for all requests. Please see Billing Form 2017 on the website.

Dominique S. Michaud, Edward L. Giovannucci, Alberto Ascherio, Eric B. Rimm, Michelle R. Forman, Laura Sampson, and Walter C. WillettAssociations of Plasma Carotenoid Concentrations and Dietary Intake of Specific Carotenoids in Samples of Two Prospective Cohort Studies Using a New Carotenoid Database. Cancer Epidemiology, Biomarkers & Prevention. Vol.7, 283-290, April 1998.

Dietary Assessment Your Average Recommended Intake

For ID [ID] Daily Intake

Age 4-8 9-13 14-18 Adult

Total Calories [calor] See Diet Assessment

Percentage of TotalCalories From:

Protein [prot]% See Diet Assessment

Fats [tfat]% See Diet Assessment

-Saturated [satfat]% -Polyunsaturated [poly]% -Monounsaturated [monfat]%

Carbohydrates [carbo]% See Diet Assessment

-Sucrose [sucr]%

Total Protein [prot]GM 0.95 0.95 0.85 0.80 (M) GM/KG0.95 0.95 0.85 0.80 (F) Of WGT

Total Carbohydrates [carbo] GM See Diet Assessment

Total Fat [tfat] GM See Diet Assessment

Total Cholesterol [chol] MG Less Than 300 Mg

Dietary Fiber [aofib] GM See Diet Assessment

Vitamin A [vita] mcg 400 600 900 900 (M)400 600 700 700 (F)

Vitamin C [vitc] MG 25 45 75 90 (M)25 45 65 75 (F)

Vitamin B6 [b6] MG 0.6 1.0 1.3 1.3-1.7 (M)0.6 1.0 1.2 1.3-1.5 (F)

Vitamin D [vitd] IU 600 600 600 600-800 (M)600 600 600 600-800 (F)

Iron [iron] MG 10 8 11 8 (M)10 8 15 8-18 (F)

Calcium [calc] MG 1000 1300 1300 1000-1200 (M)

1000 1300 1300 1000-1200 (F)

Vitamin B1, Thiamin [b1] MG 0.6 0.9 1.2 1.2 (M)0.6 0.9 1.0 1.1 (F)

Vitamin B2, Riboflavin [b2] MG 0.6 0.9 1.3 1.3 (M)0.6 0.9 1.0 1.1 (F)

Niacin [niacin]MG 8 12 16 16 (M)8 12 14 14 (F)

Vitamin B12 [b12] MCG 1.2 1.8 2.4 2.4 (M)1.2 1.8 2.4 2.4 (F)

Vitamin E [vite] MG 7 11 15 15 (M)7 11 15 15 (F)

Dietary Assessment

Your dietary assessment consists of values we obtained from the food frequency questionnaire you completed. This assessment includes the percentage of total calories you obtain from protein, various types of fat, carbohydrates, and sucrose. The assessment also includes your daily intake of protein, carbohydrates, fats, cholesterol, iron, folic acid, thiamin, riboflavin, niacin, calcium, and vitamins A, C, D, E, B6, and B12. Please keep in mind that the totals are calculated from the foods reported on your questionnaire and these are thus estimates of your usual intake rather than exact numbers.

For each of the nutrients that we have reported, we have included a recommended daily intake. Most of these values are based on the current dietary reference intakes or DRI’s. These values include the Recommended Dietary Allowance (RDA), the Adequate Intake (AI), the Tolerable Upper Intake Level (UL), and the Estimated Average Requirement (EAR). RDA’s are the average daily dietary intake that meets the nutrient requirements of almost all healthy individuals in a particular gender and age. The EAR is the daily intake value that is estimated to meet the requirements of half the healthy individuals of a particular age and gender. However, when there is not enough scientific evidence to calculate an EAR, an AI is provided. It is a value based on experimentally derived intake levels from assessing a group of healthy individuals. The UL is the highest level of daily nutrient intake that is likely to pose no risk of adverse health effects in most individuals in a specified age group. These values together create the reference values called the DRI’s. (1)

There are nutrients for which no DRI’s exist. For those nutrients RDA’s will be provided instead. However, none of these recommendations should be confused with your own individual requirements, which can vary according to age, body size, state of health, and lifestyle.

Calories

Calories are derived from the protein, fats, and carbohydrates in food and are required for everyday bodily activities. Alcohol can also contribute to caloric consumption. The amount of calories required for an individual varies depending on their age, gender, height, weight and level of physical activity. The calories consumed will depend on the need to lose, maintain, or gain weight. (1) A body weight range from underweight, healthy weight, overweight, to obese can be determined through a tool called BMI or Body Mass Index. This tool measures weight in kilograms with height in meters squared and can give a range of high or low from what is considered healthy weight. Useful charts and BMI tools can be found at mypyramid.gov (1)

The most common form of malnutrition in the US is obesity. It can lead to many health problems including type-2 diabetes, heart disease, and some forms of cancer. If your body weight is higher than what is considered healthy weight, you are probably consuming more calories than your body needs. If you would like to lose weight, it should be done gradually. Achieving your weight goal depends on acquiring healthy eating and exercise habits.

To achieve or maintain healthy weight:- Avoid soda and other sugar-sweetened beverages- Limit fruit juices.- limit consumption of trans fatty acids as much as possible, by avoiding

ingredients containing “partially hydrogenated” shortening or oils and limit other solid fats

- consume smaller portions- limit intake of potatoes and refined grains, such as white bread and white rice- increase dietary fiber by consuming foods such as whole grains, bran, vegetables,

fruits, beans and legumes- limit added sugar and added sodium in foods- limit red and processed meats- limit alcohol intake to a moderate amount- be physically active everyday

Carbohydrates, Protein and Fats

The Harvard School of Public Health maintains a website, http://www.hsph.harvard.edu/nutritionsource/, designed to provide timely information on diet and nutrition for clinicians, allied health professionals, and the public. Please refer to this website for the latest suggestions and information on carbohydrates, protein and fats.

Cholesterol

Cholesterol is not used for energy even though it is grouped with fats. However, cholesterol does have some important uses. Cholesterol is needed to make bile salts and steroid hormones. It also is needed for the synthesis of hormones. Our bodies can produce enough cholesterol even if it is not consumed daily. Excessive consumption of cholesterol is correlated with an increase risk of cardiovascular disease. The American Heart Association recommends that healthy adults consume less than 300 mg of cholesterol per day. However, adults living with heart disease should consume no more then 200 mg of cholesterol per day. (1) To achieve this goal, practice the following recommendations:

- Pick nuts, fish, poultry, dried beans as your protein sources- Moderate your intake of eggs and liver (1 egg yolk = 200mg of

cholesterol)- Limit use of red meat, cheese, butter and cream--Use liquid vegetable oils as the main source of fat (including olive, canola, soy, corn, safflower oils)- Lower your intake of hydrogenated margarine, shortenings, and

coconut oils (These products do not contain cholesterol, but they tend to raise blood cholesterol levels)

- Trim off excess fat

Important Sources: organ meats (liver), egg yolks, fish roe, all types of meat, butter, cheese, other dairy products

Vitamin A

Vitamin A is a fat-soluble vitamin that occurs in two forms. One form is retinol, which is found in animal sources and the other is carotene, which is found in vegetable sources. This vitamin is required for maintaining healthy vision, gene expression, reproduction, embryonic development, growth, immune function, and for maintaining healthy skin. Vitamin A is also an important antioxidant. An antioxidant prevents cancer and hardening of the arteries. The RDA for Vitamin A is 900 mcg retinol activity equivalents (RAE)/day for men and 700 mcg RAE/day for women. Intake of more then 3,000 mcg/day of preformed vitamin A can be toxic to your body.

Important Sources: retinol: liver, fish liver oils, egg yolk, red meats, and fortified foods

carotene: deep-yellow and deep-green leafy vegetables, carrots, cantaloupe, apricots

Vitamin C

Vitamin C is a water-soluble vitamin. It is also referred to as ascorbic acid. Vitamin C is another important antioxidant that can also enhance iron absorption in the body. The vitamin is essential for building strong cells and blood vessels, as well as healing wounds and broken bones. The current DRI for vitamin C is 90mg for men and 75 mg for women. It is recommended that smokers should have an extra 35mg everyday.(1) Excess vitamin C is excreted in urine and not considered harmful, but large doses of 600mg or more can result in diarrhea. Please refer to the DRI chart at the end of the handout for age and gender specific recommendations.

Important Sources: fruits (citrus, cantaloupe, strawberries, tomatoes) and vegetables (fresh potatoes and leafy green vegetables), supplemented cereals

Vitamin D

Vitamin D is a fat-soluble vitamin essential for building and maintaining bone health and increasing evidence shows vitamin D may play a vital role in heart health and

immune support. Studies have reported associations between low levels of vitamin D and possible increased risk of certain cancers, type 1 diabetes, multiple sclerosis, and the decreased ability to fight infectious disease such as flu and tuberculosis. (2) Vitamin D sources are either naturally occurring or supplemented in the foods we eat, as well as synthesized by the body when the skin is exposed to sunlight, but how much is produced through the skin depends on many factors. The DRI recommends 600 IU of vitamin D a day for both men and women. It has been argued by many that this is a very conservative estimate based on emerging studies. Tolerable Upper Level Intakes have been set at 4,000 IUs for adults. Vitamin D intakes much higher than 10,000 IU per day have caused toxicity, including neurologic damage.

Important Sources: fatty fish, liver oils, egg yolk, fortified milk, supplemented cereals

Vitamin E

Vitamin E is a fat-soluble vitamin and an antioxidant. It helps prevent oxidation of unsaturated fatty acids and cholesterol, as well as prevent damage to cell membranes and atherosclerosis (hardening of the arties). The DRI recommends 15mg for both men and women. (1) Please look at the end of the handout for age and gender specific recommendations. The Tolerable Upper Intake level for adults has been set at 1,000mg/day of any form of supplemental alpha tocopherol based on the adverse effect of increased tendency to hemorrhage.(1)

Important Sources: wheat germ, vegetable oils, nuts, whole grains, dark green leafy vegetables, supplemented cereals

Vitamin B6

Vitamin B6 is a water-soluble vitamin that is also called pyridoxine. This vitamin is essential for amino acid or protein metabolism and necessary for the conversion of the amino acid tryptophan to the vitamin called niacin. It is also needed for the formation of antibodies and hemogloblin and helps maintain a healthy nervous system. The DRI for both males and females is 1.3mg. Please look at the DRI chart for specific age and gender recommendations. The Tolerable Upper Level for adults is 100mg/day. An adverse effect from high intake of Vitamin B6 is sensory neuropathy. (1)

Important Sources: meat, poultry, and fish (less important sources: potatoes, sweet potatoes, tomatoes, spinach), supplemented cereal

Vitamin B1

Vitamin B1 is also known as thiamin. This water-soluble vitamin is essential because it is needed for metabolism of carbohydrates and branch-chain amino acids. The DRI recommends 1.2 mg for males and 1.1 mg for females. If you would like age and gender specific values, please refer to the DRI chart at the end of the handout. Data is

insufficient concerning adverse effects and therefore no Tolerable Upper Intake Level has been set for Vitamin B1. (1)

Important Sources: lean meats, liver, fish, eggs, whole grains, leafy green vegetables, legumes, supplemented cereal

Vitamin B2

Vitamin B2 is also called riboflavin. This essential water-soluble vitamin forms two coenzymes that work together to help metabolize sugars, fats, and proteins. The DRI recommends 1.3 mg of B2 for men and 1.1 mg for women. Specific recommendations for age and gender can be found on the DRI chart at the end of the handout. Data is insufficient concerning adverse effects and therefore no Tolerable Upper Intake Level has been set for Vitamin B2. (1)

Important Sources: liver, yeast, egg white, whole grains, meat, poultry, fish, legumes; major source is milk, supplemented cereal

Vitamin B12

Vitamin B12 is a water-soluble vitamin that is also called cyanocobalamin. It acts in the synthesis of DNA and when absent from the diet red blood cells do not divide properly. B12 is also essential for synthesis of some amino acids. The DRI recommends that men and women consume 2.4 ug per day. (1) Look at the end of the handout for the DRI chart for specific recommendations based on age and gender. Data is insufficient concerning adverse effects and therefore no Tolerable Upper Intake Level has been set for Vitamin B12. (1)

Important Sources: liver, meat, poultry, fish, dairy foods except butter, eggs,not found in plant foods, supplemented cereal

Niacin

Niacin is a water-soluble vitamin that is involved in glycolosis, oxidative phosphorylation, and fat breakdown. It also inhibits cholesterol synthesis. The DRI recommends that men consume 16 mg and women 14 mg per day. (1) Excessive intake of niacin can lead to hyperglycemia, flushed skin, tingling sensations and possible liver damage. The Tolerable Upper Intake Level for niacin in adults is 35mg/day. (1) Specific recommendations for age and gender are on the DRI chart at the end of the handout.

Important Sources: poultry, meat, fish. Less important sources are liver, yeast, peanuts, potatoes, leafy green vegetables

Iron

Iron is an essential mineral necessary for healthy red blood cells, synthesis of collagen, and as a mediator of oxidative processes. It also helps bind oxygen for transportation in the blood. The DRI for men is 8 mg and women 18 mg a day of iron. (1)The Tolerable Upper Intake Level for adults is 45mg/day. (1) Excess iron intake can cause damage to the liver, heart, and pancreas. Look at the DRI chart at the end of the handout for age and gender specific recommendations.

Important Sources: meat, liver, shellfish, egg yolk, dried fruit, nuts, legumes, molasses, supplemented cereals

Calcium

Calcium is a mineral that is essential for bone health. The DRI for calcium varies considerably depending on age and gender. Look for the recommendation most appropriate for you on the DRI chart at the end of the handout. However, these levels are high compared to other review groups; for example the World Health Organization has concluded that 500 mg per day is adequate intake for adults. An excessive intake of calcium is not recommended because it can cause depressed neural function, confusion, weakness, and kidney stones.

Important Sources: Milk, milk products, leafy green vegetables, fortified orange juice, supplemented cereal

References

1. “Dietary Reference Intakes”. The National Academies. Retrieved April 22, 2011 from the World Wide Web: http://iom.edu/Activities/Nutrition/SummaryDRIs/~/media/Files/Activity

%20Files/Nutrition/DRIs/RDA%20and%20AIs_Vitamin%20and%20Elements.pdf.

2. Nutrition Source. Harvard School of Public Health. Retrieved May 11, 2011 from the World Wide Web:http://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/vitamin-d/index.html#vitamin-d-references

DRI Chart

Category Age Vit C Vit D Vit E Vit B1 Vit B2 Niacin Vit B6 Vit A Calicum

Infants 0-6 mo 40 mg 400 IU 4 mg .2 mg .3 mg 2 mg .1 mg 400 mcg 200 mg

Infants 7-12 mo 50mg 400 IU 5 mg .3 mg .4 mg 4 mg .3 mg 500 mcg 260 mg

Children 1-3 yr 15 mg 600 IU 6 mg .5 mg .5 mg 6 mg .5 mg 300 mcg 700 mg

Children 4-8 yr 25 mg 600 IU 7 mg .6 mg .6 mg 8 mg .6 mg 400 mcg 1,000 mg

Males 9-13 yr 45 mg 600 IU 11 mg .9 mg .9 mg 12 mg 1.0 mg 600 mcg 1,300 mg

Males 14-18 yr 75 mg 600 IU 15 mg 1.2 mg 1.3 mg 16 mg 1.3 mg 900 mcg 1,300 mg

Males 19-30 yr 90 mg 600 IU 15 mg 1.2 mg 1.3 mg 16 mg 1.3 mg 900 mcg 1,000 mg

Males 31-50 yr 90 mg 600 IU 15 mg 1.2 mg 1.3 mg 16 mg 1.3 mg 900 mcg 1,000 mg

Males 51-70 yr 90 mg 600 IU 15 mg 1.2 mg 1.3 mg 16 mg 1.7 mg 900 mcg 1,000 mg

Males > 70 yr 90 mg 800 IU 15 mg 1.2 mg 1.3 mg 16 mg 1.7 mg 900 mcg 1,200 mg

Females 9-13 yr 45 mg 600 IU 11 mg .9 mg .9 mg 12 mg 1.0 mg 600 mcg 1,300 mg

Females 14-18 yr 65 mg 600 IU 15 mg 1.0 mg 1.0 mg 14 mg 1.2 mg 700 mcg 1,300 mg

Females 19-30 yr 75 mg 600 IU 15 mg 1.1 mg 1.1 mg 14 mg 1.3 mg 700 mcg 1,000 mg

Females 31-50 yr 75 mg 600 IU 15 mg 1.1 mg 1.1 mg 14 mg 1.3 mg 700 mcg 1,000 mg

Females 51-70 yr 75 mg 600 IU 15 mg 1.1 mg 1.1 mg 14 mg 1.5 mg 700 mcg 1,200 mg

Females > 70 yr 75 mg 800 IU 15 mg 1.1 mg 1.1 mg 14 mg 1.5 mg 700 mcg 1,200 mg

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RDA Chart

Category Age Iron ProteinCarbohydrate

Infants 0-6 mo .27 mg 9.1 g 60 gInfants 7-12 mo 11 mg 11.0g 95 g

Children 1-3 yr 7 mg 13 g 130 gChildren 4-8 yr 10 mg 19 g 130 g

Male 9-13 yr 8 mg 34 g 130 gMale 14-19 yr 11 mg 52 g 130 gMale 19-30 yr 8 mg 56 g 130 gMale 31-50 yr 8 mg 56 g 130 gMale 50-70 yr 8 mg 56 g 130 gMale >70 yr 8 mg 56 g 130 g

Female 9-13 yr 8 mg 34 g 130 gFemale 14-19 yr 15 mg 46 g 130 gFemale 19-30 yr 18 mg 46 g 130 gFemale 31-50 yr 18 mg 46 g 130 gFemale 50-70 yr 8 mg 46 g 130 gFemale >70 yr 8 mg 46 g 130 g

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