Dietary Assessment in Rwanda - Food Frequency Questionnaire

Study Overview
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Brief Summary
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The burden of non-communicable diseases (NCDs) in Rwanda is adding to the health burden in the country which is facing the nutritional transition and the double burden of malnutrition. Diet is an established risk factor in NCDs, hence the importance to assess accurately the changes in dietary habits occurring in the population. The objective is to develop and validate a food frequency questionnaire in Rwanda.

Detailed Description
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In many developing countries, including Rwanda, the lack of developed and validated questionnaires is among major challenges for dietary assessment in nutritional surveys. Questionnaires are mostly borrowed from other communities. This can increase the error range due to low adaptation to local context, especially when they are not validated and may not have similar objectives. One Food Frequency Questionnaire (FFQ) does not capture dietary history in two different countries or regions, unless their diets are similar. Besides, the diet changes with time, where new foods are introduced in diet and others may disappear. In Rwanda, one FFQ has been developed to cover only the eastern part of the country, but none for the entire country (Cade et al., 2001; FAO, 2018). It is then very important to develop and validate an update and general FFQ that can be used across the country to measure the dietary intake to have a better interpretation of the study findings from the Rwandan context. The overall objective is to develop and validate a semi-quantitative FFQ that can be used to assess the food and nutrient intake in urban and rural communities of Rwanda. Specific objectives include: To collect data on diet intake of selected participants by using a 24-H recall questionnaire that includes pictures on the approximate quantities consumed in each occasion. To develop a list of food items from commonly consumed food by study participants using the compiled 24-h recall questionnaire to use for an FFQ development. Additionally, an open question format to collect information on foods consumed during social gathering and festivals will be used to include unreported foods. FFQ shall include additionally the food portion size, and the frequency of intake over a reference period of one year. To assess the accuracy of the developed FFQ in estimating energy and nutrient intake using the 24-H dietary recall as a benchmark of accuracy.

Official Title
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Development and Evaluation of a Semi-quantitative Food Frequency Questionnaire for Use in Urban and Rural Communities of Rwanda

Conditions
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Dietary Assessment

Intervention / Treatment
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* Other: Food Frequency Questionnaire
* Other: 24 Hour food recall


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Permanent residence of the selected urban or rural villages Holding a valid health insurance card Aged between 18 and 49 years Signing informed consent form Familiar with the diet and cooking practices Registration in city demographic system, since study participants will be selected from population registration cards at village level, Accept enumerators for home visit and data collection for one year Exclusion Criteria: Mental disorders such as clinically diagnosed depression, anxiety disorders, eating disorders and addictive behaviors

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 49 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Urban<br>Men and women between 18 and 49 years of age living in the selected urban communities in Rwanda and who are familiar with the diet. Participants in this study should be acquainted with cooking practices to be able to cite all the ingredients that are used in the preparation of the dishes/ meals | Other: Food Frequency Questionnaire<br>* Food frequency questionnaires (FFQs) are a common method for measuring dietary intake in large epidemiological studies, in particular in low literacy settings were diaries and food history would not be viable.<br>Other: 24 Hour food recall<br>* Standardized and validated approach of collecting all foods, beverages, and supplements consumed during the past 24 hours<br>|
| Rural<br>Men and women between 18 and 49 years of age living in the selected urban communities in Rwanda and who are familiar with the diet. Participants in this study should be acquainted with cooking practices to be able to cite all the ingredients that are used in the preparation of the dishes/ meals | Other: Food Frequency Questionnaire<br>* Food frequency questionnaires (FFQs) are a common method for measuring dietary intake in large epidemiological studies, in particular in low literacy settings were diaries and food history would not be viable.<br>Other: 24 Hour food recall<br>* Standardized and validated approach of collecting all foods, beverages, and supplements consumed during the past 24 hours<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Median proportion of energy intake from carbohydrates assessed by the 24 hour recalls | Median proportion of energy intake from carbohydrates (starch from grains and tubers such as corn, pasta, rice, potatoes, breads), natural sugars from fruits and juices, and added sugars found in soft drinks, candy, fruit drinks, and desserts) assessed by the 24 hour recalls Adults should get 45 percent to 65 percent of their calories from carbohydrates | One year | 
| Median proportion of energy intake from carbohydrates assessed by the Food Frequency Questionnaire | Median proportion of energy intake from carbohydrates (starch from grains and tubers such as corn, pasta, rice, potatoes, breads), natural sugars from fruits and juices, and added sugars found in soft drinks, candy, fruit drinks, and desserts) assessed by the Food Frequency Questionnaire. Adults should get 45 percent to 65 percent of their calories from carbohydrates | One year | 
| Median proportion of energy intake from fat assessed by the 24 hour recalls | Median proportion of energy intake from fat (Butter, margarine, vegetable oils, whole milk, visible fat on meat and poultry products, invisible fat in fish, shellfish, some plant products such as seeds and nuts, and bakery products) assessed by the 24 hour recalls. Adults should get 20 percent to 35 percent of their calories from fat | One year | 
| Median proportion of energy intake from fat assessed by the Food Frequency Questionnaire | Median proportion of energy intake from fat (Butter, margarine, vegetable oils, whole milk, visible fat on meat and poultry products, invisible fat in fish, shellfish, some plant products such as seeds and nuts, and bakery products) assessed by the Food Frequency Questionnaire. Adults should get 20 percent to 35 percent of their calories from fat | One year | 
| Median proportion of energy intake from proteins assessed by the 24 hour recalls | Median proportion of energy intake from proteins (from animal sources, such as meat, poultry, fish, eggs, milk, cheese, and yogurt; and proteins from plants, legumes, grains, nuts, seeds, and vegetables) assessed by the 24 hour recalls. Adults should get 10 to 35 percent of their calories from protein | One year | 
| Median proportion of energy intake from proteins assessed by the Food Frequency Questionnaire | Median proportion of energy intake from proteins (from animal sources, such as meat, poultry, fish, eggs, milk, cheese, and yogurt; and proteins from plants, legumes, grains, nuts, seeds, and vegetables) assessed by the Food Frequency Questionnaire. Adults should get 10 to 35 percent of their calories from protein | One year | 
| Median daily intake of fibers assessed by the 24 hour recalls | Median daily intake of fibers (in gram; Includes dietary fiber naturally present in grains, such as found in oats, wheat, or unmilled rice; and functional fiber synthesized or isolated from plants or animals) assessed by the 24 hour recalls. The recommended intake for total fiber for adults 50 years and younger is set at 38 grams for men and 25 grams for women | One year | 
| Median daily intake of fibers assessed by the Food Frequency Questionnaire | Median daily intake of fibers (in gram; Includes dietary fiber naturally present in grains, such as found in oats, wheat, or unmilled rice; and functional fiber synthesized or isolated from plants or animals) assessed by the Food Frequency Questionnaire. The recommended intake for total fiber for adults 50 years and younger is set at 38 grams for men and 25 grams for women | One year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Dietary assessment, Food Frequency Questionnaire, multi-pass 24 hour food recall, semi-quantitative