Miriam Abouelnasr, Carrie Asher, Erin Buehler, Holly Cheek, Andrea Penix, Lauryn Whitfield

1. Validation of a Food Frequency Questionnaire to Assess Folate Status among Georgia State University Students Miriam Abouelnasr, Carrie Asher, Erin Buehler, Holly Cheek, Andrea Penix, Lauryn Whitfield

2. Why Folate? Percentage of people with low folate has decreased since the early 90s with the United States’ fortification of grain products, but folate status is still low in some populations. In 2000, 5.1% of US women of childbearing age were deficient in folate.

3. The Facts About Folate • Many dietary sources • Leafy greens, cereals and grains • Egg yolks and liver • Need about 400 μg folate/day • Essential for • synthesis of DNA and RNA • methylation of DNA • conversion of homocysteine to methionine • Erythrocyte synthesis

4. Population’s Problems Cooking foods such as grains and leafy greens may reduce the amount of folate that is bioavailable. In a study of collage aged women only ~1/3 took folic acid supplements.

5. Folate Deficiency Consequences About 1/ 1000 births in the US is complicated by a NTD High levels of homocysteine are implicated in cardiovascular disease Inadequate biosynthesis of DNA/RNA can cause megaloblastic anemia

6. Materials and Methods • Subjects • 15 college age women (ages 18-30) • 14 college age men (ages 18-30) • Location: Georgia State University campus • Purpose: • To validate a food frequency questionnaire (FFQ) that is likely to assess the intake of folate in the Georgia State University community • Two FFQ’s administered: • 1. Gold Standard FFQ obtained from National Health and Nutrition Examination Survey (NHANES) • 2. Coordinated program FFQ (CPFFQ)

7. Gold Standard FFQ • Administered first • Frequency of consumption of various folate-containing foods assessed for the past 12 months • Foods asked in each question: • Oatmeal, grits or other cooked cereal • Cold cereal • Whole grain cereal such as shredded wheat, Wheaties, Cheerios, Raisin Bran or other bran, oat, or whole wheat cereal • Cooked greens such as spinach, turnip, collard, mustard, chard, or kale • Raw greens such as spinach, turnip, collard, mustard, chard or kale • Coleslaw • Sauerkraut or cabbage (other than coleslaw) • Carrots (fresh, canned, or frozen) • String beans or green beans (fresh, canned or frozen) • Corn (fresh, canned, or frozen) • Broccoli (fresh or frozen) • Cauliflower or Brussels sprouts (fresh or frozen)

8. Mixed vegetables • Sweet or hot peppers (green, red, or yellow) • Fresh tomatoes (including those in salads) • Summer squash (include yellow or green squash) • Lettuce salads (with or without other vegetables) • Sweet potatoes or yams • Tortillas or tacos • Cooked dried beans (such as baked beans, pintos, kidney, black-eyed peas, lima, lentils, soybeans, or refried beans) • Rice or other cooked grains (such as bulgur, cracked wheat, or millet) • Pancakes, waffles, or French Toast • Lasagna, stuffed shells, stuffed manicotti, ravioli, or tortellini • Macaroni and cheese • Pasta salad or macaroni salad • Bagels or English muffins • Breads or rolls as part of sandwiches (including burger and hot dog rolls) • Breads or dinner rolls not as part of sandwiches

9. Example of GSFFQ

10. Coordinated Program FFQ • Administered second • Frequency of consumption per week of various folate-containing foods • Foods asked in each question: • Beans, lentils, and chickpeas/garbonzos (include kidney, pinto, refried, black, and baked beans) • Peanuts, peanut butter, or other types of nuts and seeds • All-Bran, All-Bran Extra Fiber, 100% Bran, Fiber One, or Total Cereals • Cereals such as corn flakes, cheerios, rice krispies, or presweetened cereals • Hot cereals such as oatmeal, cream of wheat, cream of rice, and grits • White bread, rolls, bagels, biscuits, English muffins, or crackers • Dark breads and rolls, including whole wheat, rye, and pumpernickel • Corn bread, corn muffins, or corn tortillas • Flour tortillas

11. Rice • Salted snacks such as potato chips, taco chips, corn chips, and salted pretzels and popcorn • Vegetables • Cooked greens such as mustard, turnip, or collard • Okra or asparagus • Broccoli or Brussel sprouts • Corn • Raw spinach • Raw onions • Multi-vitamins

12. Example of CPFFQ

13. Analysis of Data • The nutrient content of the CPFFQ and GSFFQ was analyzed using the nutrient data base at MyPyramid.gov • The validity of the CPFFQ was determined by using standard statistical methodology such as: • Sensitivity • Specificity • PPV • NPV • Accuracy • Likelihood Ratio • Odds Ratio • Relative Risk • Mean • Standard Deviation • Median • 95% Confidence Interval

14. Results

15. Sensitivity= 0; the CPFFQ picks up 0% of people who don't meet the DRI for folate • Specificity= 0.285714; 29% of the time the CPFFQ correctly excludes people that do meet the DRI • PPV= 0; If a person meets the DRI according to the CPFFW there is a 0% chance that that he or she actually meets the DRI • NPV= 0.952381; If a person does not meet the DRI according to the CPFFQ there is a 95% chance that he or she does not meet the DRI • Accuracy= 0.689655; 69% of all tests have given the correct result • Likelihood ratio= 0 It is 0% likely that a positive test will be found in a person meeting the DRI, as compared to one not meeting the DRI

16. Association between the Surveys • Relative Risk: 0, which is <1 so the likelihood of people not meeting the DRI for folate occurred more in the GSFFQ. • Odds Ratio: 0, which is <1, so the likelihood of picking up people who do not meet the DRI for folate occurred more in the experimental group.

17. Correlation coefficient r = 0.32; this represents a positive, low correlation between the two surveys

18. Survey Differences • The CPFFQ assesses supplement use, whereas the GSFFQ does not. • Therefore, the percentage of people that met the DRI according to the CPFFQ did not meet the DRI according to the GSFFQ.

19. Questions?