The dietary intake of each subject was assessed using a semi-quantitative food frequency questionnaire (FFQ), which was an adapted version of the FFQ used in the National Health and Morbidity Survey (NHMS) 2014 [35 ]. The NHMS was a nationally representative food consumption survey conducted in both Peninsular Malaysia and East Malaysia. The FFQ applied in this study was modified to include food sources associated with CRC development. Details on the validation and reliability study of this FFQ are provided elsewhere [36 (link)]. The finalised FFQ used in this study includes 142 food items from 13 food groups: cereal products, meats, fish and seafood, eggs, vegetables, nuts and legumes, milk and dairy products, condiments, bread spread, fruits, confectionaries, fast food, and sugar-sweetened drinks.
The FFQ was administered through a face-to-face interview in which subjects were requested to provide the type of normally consumed food items, the frequency of intake of each food item based on the standard serving size, and the number of serving sizes consumed in the preceding year prior to diagnosis/interview using five response categories (“never,” “per day,” “per week,” “per month,” or “per year”), guided by a trained dietitian. Each food item in the FFQ was assigned a portion size using common household units, such as spoons, bowls, cups, bowls, matchbox sizes, glasses, and plates, to estimate the serving size of the food eaten. To minimise errors while assessing the dietary intake of subjects, the interview process was started by asking the subject to recall all the food items that were typically consumed daily, and the recall process was built up over weeks and months. Further, the completed FFQs were cross-checked by a dietitian for completeness and accuracy in terms of portion size and ingredients recorded.
Based on the FFQ data, reported food intakes in grams (g) per day were calculated for each subject. Nutrient and total energy intakes per day were estimated using the Nutrient Composition of Malaysian Foods, Malaysian Atlas of Food Exchanges and Portion Sizes, Album Makanan Malaysia, and Malaysian Food Composition Database (MyFCD, 2020) [37 ,38 ,39 ,40 ]. For food items that were not available in the published literature mentioned above, nutritional food labels and recipes from websites were used as references. The amount of daily food intake was calculated from the FFQ according to the following formula: {frequency of intake (the conversion factor) × serving size × total number of servings × weight of food in one serving (g)} [41 (link)]. From the values of the amount of food consumed per day, the detailed analysis of the intake of nutrients was calculated using the Nutritionist Pro™ Diet Analysis Software version 7.8.0 (Axxya Systems, version 2020, Redmond, WA, USA) to obtain energy and nutrient values for each subject.
The FFQ was administered through a face-to-face interview in which subjects were requested to provide the type of normally consumed food items, the frequency of intake of each food item based on the standard serving size, and the number of serving sizes consumed in the preceding year prior to diagnosis/interview using five response categories (“never,” “per day,” “per week,” “per month,” or “per year”), guided by a trained dietitian. Each food item in the FFQ was assigned a portion size using common household units, such as spoons, bowls, cups, bowls, matchbox sizes, glasses, and plates, to estimate the serving size of the food eaten. To minimise errors while assessing the dietary intake of subjects, the interview process was started by asking the subject to recall all the food items that were typically consumed daily, and the recall process was built up over weeks and months. Further, the completed FFQs were cross-checked by a dietitian for completeness and accuracy in terms of portion size and ingredients recorded.
Based on the FFQ data, reported food intakes in grams (g) per day were calculated for each subject. Nutrient and total energy intakes per day were estimated using the Nutrient Composition of Malaysian Foods, Malaysian Atlas of Food Exchanges and Portion Sizes, Album Makanan Malaysia, and Malaysian Food Composition Database (MyFCD, 2020) [37 ,38 ,39 ,40 ]. For food items that were not available in the published literature mentioned above, nutritional food labels and recipes from websites were used as references. The amount of daily food intake was calculated from the FFQ according to the following formula: {frequency of intake (the conversion factor) × serving size × total number of servings × weight of food in one serving (g)} [41 (link)]. From the values of the amount of food consumed per day, the detailed analysis of the intake of nutrients was calculated using the Nutritionist Pro™ Diet Analysis Software version 7.8.0 (Axxya Systems, version 2020, Redmond, WA, USA) to obtain energy and nutrient values for each subject.
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