The FFQ, originally developed for the TLGS, was a Willett-format questionnaire modified based on Iranian food items25 and contains questions about average consumption and frequency for 168 food items during the past year.7 The food items were chosen according to the most frequently consumed items in the national food consumption survey in Iran.25 Because different recipes are used for food preparation, the FFQ was based on food items rather than dishes, eg, beans, different meats and oils, and rice. Subjects indicated their food consumption frequencies on a daily basis (eg, for bread), weekly basis (eg, for rice and meat), monthly basis (eg, for fish), yearly basis (eg, for organ meats), or a never/seldom basis according to portion sizes that were provided in the FFQ. For each food item on the FFQ, a portion size was specified using USDA serving sizes (eg, bread, 1 slice; apple, 1 medium; dairy, 1 cup) whenever possible; if this was not possible, household measures (eg, beans, 1 tablespoon; chicken meat, 1 leg, breast, or wing; rice, 1 large, medium, or small plate) were chosen. Table 1 shows food items and portion sizes used in the FFQ. Trained dietary interviewers with at least 3 of experience in the Nationwide Food Consumption Survey project25 or TLGS26 (link) administered the FFQs and 24-hour DRs during face-to-face interviews. The interviewer read out the food items on the FFQ, and recorded their serving size and frequency. The interview session took about 45 minutes. The interviewer for FFQ1 and FFQ2 was the same for each participant. Daily intakes of each food item were determined based on the consumption frequency multiplied by the portion size or household measure for each food item.27 The weight of seasonal foods, like some fruits, was estimated according to the number of seasons when each food was available.
Dietary data were also collected monthly by means of twelve 24-hour DRs that lasted for 20 minutes on average. For all subjects, 2 formal weekend day (Thursday and Friday in Iran) and 10 weekdays were recalled. All recall interviews were performed at subjects’ homes to better estimate the commonly used household measures and to limit the number of missing subjects. Detailed information about food preparation methods and recipe ingredients were considered by interviewers. To prevent subjects from intentionally altering their regular diets, participants were informed of the recall meetings with dietitians during the evening before the interview. All recalls were checked by investigators, and ambiguities were resolved with the subjects. Mixed dishes in 24-hour DRs were converted into their ingredients according to the subjects’ report on the amount of the food item consumed, thus taking into account variations in meal preparation recipes. For instance, broth or soup ingredients—usually vegetables (carrot or green beans), noodles, barley, etc.—differed according to subjects’ meal preparation. Because the only available Iranian food composition table (FCT)28 analyzes a very limited number of raw food items and nutrients, we used the USDA FCT29 as the main FCT; the Iranian FCT was used as an alternative for traditional Iranian food items, like kashk, which are not included in the USDA FCT.
The food items on the FFQ and DR were grouped according to their nutrient contents, based on other studies,30 (link) and modified according to our dietary patterns. Seventeen food groups were thus obtained, as follows: 1) whole grains, 2) refined grains, 3) potatoes, 4) dairy products, 5) vegetables, 6) fruits, 7) legumes, 8) meats, 9) nuts and seeds, 10) solid fat, 11) liquid oil, 12) tea and coffee, 13) salty snacks, 14) simple sugars, 15) honey and jams, 16) soft drinks, and 17) desserts and snacks (Table1 ). The 168 food items on the FFQ were allocated to these 17 food groups, and the amounts in grams of each item were summed to obtain the daily intake of each food group.
Dietary data were also collected monthly by means of twelve 24-hour DRs that lasted for 20 minutes on average. For all subjects, 2 formal weekend day (Thursday and Friday in Iran) and 10 weekdays were recalled. All recall interviews were performed at subjects’ homes to better estimate the commonly used household measures and to limit the number of missing subjects. Detailed information about food preparation methods and recipe ingredients were considered by interviewers. To prevent subjects from intentionally altering their regular diets, participants were informed of the recall meetings with dietitians during the evening before the interview. All recalls were checked by investigators, and ambiguities were resolved with the subjects. Mixed dishes in 24-hour DRs were converted into their ingredients according to the subjects’ report on the amount of the food item consumed, thus taking into account variations in meal preparation recipes. For instance, broth or soup ingredients—usually vegetables (carrot or green beans), noodles, barley, etc.—differed according to subjects’ meal preparation. Because the only available Iranian food composition table (FCT)28 analyzes a very limited number of raw food items and nutrients, we used the USDA FCT29 as the main FCT; the Iranian FCT was used as an alternative for traditional Iranian food items, like kashk, which are not included in the USDA FCT.
The food items on the FFQ and DR were grouped according to their nutrient contents, based on other studies,30 (link) and modified according to our dietary patterns. Seventeen food groups were thus obtained, as follows: 1) whole grains, 2) refined grains, 3) potatoes, 4) dairy products, 5) vegetables, 6) fruits, 7) legumes, 8) meats, 9) nuts and seeds, 10) solid fat, 11) liquid oil, 12) tea and coffee, 13) salty snacks, 14) simple sugars, 15) honey and jams, 16) soft drinks, and 17) desserts and snacks (Table
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