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====== FFQ Sum scores ======

Researchers from [[https://www.wur.nl/en/Persons/Corine-CWM-Corine-Perenboom.htm|Wageningen University & Research (WUR)]] developed sum scores for the [[ffq|Food Frequency Questionnaire (FFQ)]] from adult participants. The FFQ consists of one basic questionnaire covering the macronutrient intake (heart of the flower) which has been assessed at [[1A]] and three shorter questionnaires (the petals) covering (micro)nutrients assessed at [[1B]], [[1C]], and [[2A]]. ([[sections]]: [[nutrition]] ([[ffq|Flower FFQ]]) and [[secondary & linked variables]]))\\
Using the FFQ Sum scores from [[1A]], an [[upf_categorization|ultra-processed food categorization]] has been generated and is available for use as well.

The FFQ sum scores can be requested in the [[https://data-catalogue.lifelines.nl/|Lifelines catalogue]]. When this data has been used in your research, you will have to include a reference to the following paper: \\ 
  * [[https://doi.org/10.1017/S0007114511000067|Siebelink, E., Geelen, A., & de Vries, J. H. (2011). Self-reported energy intake by FFQ compared with actual energy intake to maintain body weight in 516 adults. British journal of nutrition, 106(2), 274-281.]]

Optional paper for complete FFQ questionnaire:
  * [[https://doi.org/10.3390/nu14010048|Baart, A. M., Brouwer-Brolsma, E. M., Perenboom, C. W., de Vries, J. H., & Feskens, E. J. (2022). Dietary Intake in the Lifelines Cohort Study: Baseline Results from the Flower Food Frequency Questionnaire among 59,982 Participants. Nutrients, 14(1), 48.]]

\\
===== FFQ questionnaire =====
A Food Frequency Questionnaire consists of a foodlist with a frequency response section for subjects to report how often each item was consumed over a specified period of time (in this case: one month). Data collection is therefore retrospective. From the answers given in a FFQ, nutrient intake can be estimated by calculations made with computerized software programs that multiply the reported frequency of each food item by the amount of nutrient in a serving of that food. A reference database is used to establish the nutrient content of each food item. FFQ data are assumed to be representative of habitual intake and can be used to rank individuals according to intake.

Lifelines participants aged 18 years and older complete four questionnaires on their food intake: one main questionnaire at baseline to estimate energy and macronutrient intake and three questionnaires on specific (micro)nutrients, i.e. a questionnaire on b-vitamins (questionnaire A), one on fatty acids (questionnaire B), and a vitamin ACE questionnaire (questionnaire C). The information from the questionnaires on specific nutrients can only be interpreted by combining this information with the information from the main questionnaire at baseline. 

\\
===== Creating the FFQ sum scores =====
From the food intake as reported in the total FFQ, the following information was calculated:
  - The intake in grams of all foods included in the FFQ per person per day.
  - The energy, macronutrients and micronutrients delivered by these foods.
  - The total energy, macronutrient and micronutrients intake per person per day.

=== 1. Intake in grams per person per day ===
The questions on the intake of a certain food group generally consist of three parts: 
  - The frequency of consumption is reported in days per week
  - The number of servings per day on days that the specific food was eaten is specified 
  - The types of the food consumed are reported (for example: white chocolate, milk chocolate and dark chocolate)\\

To calculate the absolute intake of foods in grams per day the following formula was used:
**frequency of consumption * number of servings * serving size (* food item * correction factor serving size)**

Preprocessing:
  * //Frequency of consumption:// it is assumed that a month includes 28 days (reference periode is 4 weeks). The frequency 'one day per week' will therefore receive the value 0.14 (4/28)
  * //Food items eaten within a food group// are assigned a value according to the frequency of their consumption: never = 0, sometimes = 0.33, often = 0.67, always = 1.
  * //Contributions of every food item// to the total consumption within the food group are recalculated so that they add up to 1, in order to make them evenly distributed. 
  * //Serving size// and //correction factor serving size// are based on external sources (NEVO table 2011).
\\
=== 2. Energy, macronutrients and micronutrients deliverd by food ===
When the consumption of each food item as included in the FFQ was calculated in grams per day, the consumed amount in grams was multiplied by the nutrient content of that food item as reported in the NEVO table 2011, in order to calculate the nutrient intake for each participant on a food level.\\
\\
=== 3. Total energy, macronutrient and micronutrient intake per person per day ===
The total energy, macronutrient and micronutrient intake per person per day is calculated by adding up the energy and nutrient intake through all separate food items included in the FFQ for each participant.\\
\\

===== Remarks from WUR researchers =====
The WUR researchers listed the following points of attention:
  * **Extreme values have not been corrected:** Answers given to general questions on the diet as included in each FFQ questionnaire may be used to explain extreme values, but they have not been used to correct for extreme values in any way. It is up to individual researchers to include or exclude participants with extreme values in their analyses.
  * **Not all missing values are treated equally:** When __frequency of consumption__ is missing, the whole question cannot be interpreted and data for this food are not included in the calculations of total nutrient intake. Resulting in the possibility of underestimation of total daily intake of some nutrients for this participants. When __the number of servings and/or the food items consumed__ are missing, standard answers are used for calculations (according to the Dutch National Food Consumption Survey 1998). Because these are standard answers established for the whole population, the consumption of the food in grams per day and the intake of certain nutrients may be over- or underestmiated.

\\
===== Related papers =====
  * [[https://doi.org/10.1017/s1368980021002111|Brouwer-Brolsma, E. M., Perenboom, C., Sluik, D., van de Wiel, A., Geelen, A., Feskens, E. J., & de Vries, J. H. (2021). Development and external validation of the ‘Flower-FFQ’: a FFQ designed for the Lifelines Cohort Study. Public Health Nutrition, 1-12.]]
  * [[https://doi.org/10.3390/nu9101136|Brouwer-Brolsma, E. M., Streppel, M. T., Van Lee, L., Geelen, A., Sluik, D., Van de Wiel, A. M., ... & Feskens, E. J. (2017). A National Dietary Assessment Reference Database (NDARD) for the Dutch population: rationale behind the design. Nutrients, 9(10), 1136.]]

\\
===== Variables =====
Below the total intake per person per day for different energy/macronutrient/micronutrient variables are listed. 
| **Label English**                                                              | **Label Dutch**                                                                                  | **Code**                      | **Variable**       | **Assessment**  | **Age**  |
| total added sugar delivered by all food items in g/day (ffq heart)             | totaal aan sucrose geleverd door alle voedingsitems in g/dag (ffq hart)                          | addedsugar_intake_adu_c_1     | sumofadd_sug       | sec *           | 18+      |
| total alcohol intake in g/day (ffq heart)                                      | totale inname van alcohol in g/dag (ffq hart)                                                    | alcohol_intake_adu_c_1        | sumofalcohol       | sec *           | 18+      |
| total alcohol intake in g/day (ffq heart + petals)                             | totale inname van alcohol in g/dag (ffq hart + bloemblaadjes)                                    | alcohol_intake_adu_c_2        | alcohol            | sec *           | 18+      |
| total animal protein intake in g/day (ffq heart)                               | totale inname van dierlijke eiwitten in g/dag (ffq hart)                                         | animalprotein_intake_adu_c_1  | sumofeiwitdier     | sec *           | 18+      |
| total animal protein intake in g/day (ffq heart + petals)                      | totale inname van dierlijke eiwitten in g/dag (ffq hart + bloemblaadjes)                         | animalprotein_intake_adu_c_2  | eiwitdier          | sec *           | 18+      |
| total calcium intake in mg/day (ffq heart + petals)                            | totale inname van calcium in mg/dag (ffq hart + bloemblaadjes)                                   | calcium_intake_adu_c_1        | calcium            | sec *           | 18+      |
| total carbohydrate intake in g/day (ffq heart + petals)                        | totale inname van koolhydraten in g/dag (ffq hart + bloemblaadjes)                               | carbohydrate_intake_adu_c_2   | khtot              | sec *           | 18+      |
| total carbohydrate intake in g/day (ffq heart)                                 | totale inname van koolhydraten in g/dag (ffq hart)                                               | carbohydrates_intake_adu_c_1  | sumofkhtot         | sec *           | 18+      |
| total omega-3 fatty acid dha intake in g/day (ffq heart + petals)              | totale inname van omega-3 vetzuur (dha) in g/dag (ffq hart + bloemblaadjes)                      | dha_intake_adu_c_1            | dha                | sec *           | 18+      |
| total omega-3 fatty acid epa intake in g/day (ffq heart + petals)              | totale inname van omega-3 vetzuur (epa) in g/dag (ffq hart + bloemblaadjes)                      | epa_intake_adu_c_1            | epa                | sec *           | 18+      |
| total fat intake in g/day (ffq heart) (ffq heart)                              | totale inname van vet in g/dag (ffq hart)                                                        | fat_intake_adu_c_1            | sumofvettot        | sec *           | 18+      |
| total fat intake in g/day (ffq heart + petals)                                 | totale inname van vetten in g/dag (ffq hart + bloemblaadjes)                                     | fat_intake_adu_c_2            | vettot             | sec *           | 18+      |
| reliability of the results                                                     | betrouwbaarheid van de waarden                                                                   | ffq_reliability_adu_c_1       | betrouwbaarheid    | sec *           | 18+      |
| reliability of the results (ffq heart + petals)                                | betrouwbaarheid van de waarden (ffq hart + bloemblaadjes)                                        | ffq_reliability_adu_c_2       | betrouwbaarheid_2  | sec *           | 18+      |
| total dietary fiber intake in g/day (ffq heart + petals)                       | totale inname van voedingsvezel in g/dag (ffq hart + bloemblaadjes)                              | fiber_intake_adu_c_1          | vezel              | sec *           | 18+      |
| total folate (natural folic acid) intake in mcg/day (ffq heart + petals)       | totale inname van folaat (van nature aanwezig foliumzuur) in mcg/dag (ffq hart + bloemblaadjes)  | folate_intake_adu_c_1         | folaat             | sec *           | 18+      |
| total folic acid equivalent intake in mcg/day (ffq heart + petals)             | totale inname van foliumzuur equivalent in mcg/dag (ffq hart + bloemblaadjes)                    | folicacid_intake_adu_c_1      | foleq              | sec *           | 18+      |
| total free sugar delivered by all food items in g/day (ffq heart)              | totaal aan vrije suikers geleverd door alle voedingsitems in g/dag (ffq hart)                    | freesugar_intake_adu_c_1      | sumoffree_sug      | sec *           | 18+      |
| total fructose delivered by all food items in g/day (ffq heart)                | totaal aan fructose geleverd door alle voedingsitems in g/dag (ffq hart)                         | fructose_intake_adu_c_1       | sumoffructose      | sec *           | 18+      |
| total glucose intake in g/day (ffq heart)                                      | totaal aan glucose geleverd door alle voedingsitems in g/dag (ffq hart)                          | glucose_intake_adu_c_1        | sumofglucose       | sec *           | 18+      |
| total glycemic index delivered by all food items per day (ffq heart)           | totale glycemic index geleverd door alle voedingsitems per dag (ffq hart)                        | glycindex_intake_adu_c_1      | sumofglyc_ind      | sec *           | 18+      |
| total glycemic load delivered by all food items per day (ffq heart)            | totale glycemic load geleverd door alle voedingsitems per dag (ffq hart)                         | glycload_intake_adu_c_1       | sumofglyc_load     | sec *           | 18+      |
| total energy intake per day expressed in kcal (ffq heart)                      | totale inname van energie per dag, uitgedrukt in kcal (ffq hart)                                 | kcal_intake_adu_c_1           | sumofkcal          | sec *           | 18+      |
| total energy intake per day expressed in kcal (ffq heart + petals)             | totale inname van energie per dag, uitgedrukt in kcal (ffq hart + bloemblaadjes)                 | kcal_intake_adu_c_2           | kcal               | sec *           | 18+      |
| total energy intake per day expressed in kj (ffq heart)                        | totale inname van energie per dag, uitgedrukt in kj (ffq hart)                                   | kjoule_intake_adu_c_1         | sumofkj            | sec *           | 18+      |
| total energy intake per day expressed in kj (ffq heart + petals)               | totale inname van energie per dag, uitgedrukt in kj (ffq hart + bloemblaadjes)                   | kjoule_intake_adu_c_2         | kj                 | sec *           | 18+      |
| total lactose delivered by all food items in g/day (ffq heart)                 | totaal aan lactose geleverd door alle voedingsitems in g/dag (ffq hart)                          | lactose_intake_adu_c_1        | sumoflactose       | sec *           | 18+      |
| total maltose delivered by all food items in g/day (ffq heart)                 | totaal aan maltose geleverd door alle voedingsitems in g/dag (ffq hart)                          | maltose_intake_adu_c_1        | sumofmaltose       | sec *           | 18+      |
| total mono- and disaccharide delivered by all food items in g/day (ffq heart)  | totaal aan mono- en disacchariden geleverd door alle voedingsitems in g/dag (ffq hart)           | modisacch_intake_adu_c_1      | sumofmodis         | sec *           | 18+      |
| total mono- and disaccharide intake in g/day (ffq heart + petals)              | totale inname van mono-en disacchariden in g/dag (ffq hart + bloemblaadjes)                      | modisacch_intake_adu_c_2      | monodisacch        | sec *           | 18+      |
| total monounsaturated fatty acid intake in g/day (ffq heart + petals)          | totale inname van enkelvoudige onverzadigde vetzuren in g/dag (ffq hart + bloemblaadjes)         | mufa_intake_adu_c_1           | eovz               | sec *           | 18+      |
| total plant protein intake in g/day (ffq heart)                                | totale inname van plantaardige eiwitten in g/dag (ffq hart)                                      | plantprotein_intake_adu_c_1   | sumofeiwitplant    | sec *           | 18+      |
| total plant protein intake in g/day (ffq heart + petals)                       | totale inname van plantaardige eiwitten in g/dag (ffq hart + bloemblaadjes)                      | plantprotein_intake_adu_c_2   | eiwitplant         | sec *           | 18+      |
| total polysaccharide delivered by all food items in g/day (ffq heart)          | totaal aan polysacchariden geleverd door alle voedingsitems in g/dag (ffq hart)                  | polysacch_intake_adu_c_1      | sumofpolys         | sec *           | 18+      |
| total polysaccharide intake in g/day (ffq heart + petals)                      | totale inname van polysacchariden in g/dag (ffq hart + bloemblaadjes)                            | polysacch_intake_adu_c_2      | polysacch          | sec *           | 18+      |
| total protein intake in g/day (ffq heart)                                      | totale inname van eiwitten in g/dag (ffq hart)                                                   | protein_intake_adu_c_1        | sumofeiwittot      | sec *           | 18+      |
| total protein intake in g/day (ffq heart + petals)                             | totale inname van eiwitten in g/dag (ffq hart + bloemblaadjes)                                   | protein_intake_adu_c_2        | eiwittot           | sec *           | 18+      |
| total polyunsaturated fatty acid intake in g/day (ffq heart + petals)          | totale inname van meervoudige onverzadigde vetzuren in g/dag (ffq hart + bloemblaadjes)          | pufa_intake_adu_c_1           | movz               | sec *           | 18+      |
| total retinol activity equivalent intake in mcg/day (ffq heart + petals)       | totale inname van retinol activiteit equivalent in mcg/dag (ffq hart + bloemblaadjes)            | rae_intake_adu_c_1            | rae                | sec *           | 18+      |
| total retinol equivalents intake in mcg/day (ffq heart + petals)               | totale inname van retinol equivalenten in mcg/dag (ffq hart + bloemblaadjes)                     | retinoleq_intake_adu_c_1      | reteq              | sec *           | 18+      |
| total saturated fatty acid intake in g/day (ffq heart + petals)                | totale inname van verzadigde vetzuren in g/dag (ffq hart + bloemblaadjes)                        | sfa_intake_adu_c_1            | vetverz            | sec *           | 18+      |
| total sucrose delivered by all food items in g/day (ffq heart)                 | totaal aan sucrose geleverd door alle voedingsitems in g/dag (ffq hart)                          | sucrose_intake_adu_c_1        | sumofsucrose       | sec *           | 18+      |
| total vitamin b12 intake in mcg/day (ffq heart + petals)                       | totale inname van vitamine b12 in mcg/dag (ffq hart + bloemblaadjes)                             | vitb12_intake_adu_c_1         | vitb12             | sec *           | 18+      |
| total vitamin b2 intake in mg/day (ffq heart + petals)                         | totale inname van vitamine b2 in mg/dag (ffq hart + bloemblaadjes)                               | vitb2_intake_adu_c_1          | vitb2              | sec *           | 18+      |
| total vitamin b6 intake in mg/day (ffq heart + petals)                         | totale inname van vitamine b6 in mg/dag (ffq hart + bloemblaadjes)                               | vitb6_intake_adu_c_1          | vitb6              | sec *           | 18+      |
| total vitamin c intake in mg/day (ffq heart + petals)                          | totale inname van vitamine c in mg/dag (ffq hart + bloemblaadjes)                                | vitc_intake_adu_c_1           | vitc               | sec *           | 18+      |
| total vitamin e intake in mg/day (ffq heart + petals)                          | totale inname van vitamine e in mg/dag (ffq hart + bloemblaadjes)                                | vite_intake_adu_c_1           | vite               | sec *           | 18+      |
| total haem iron intake in mg/day (ffq heart + petals)                          | totale inname van heemijzer in mg/dag (ffq hart + bloemblaadjes)                                 | ironhaem_intake_adu_c_1       | ijzerhaem          | sec *           | 18+      |
| total non-haem iron intake in mg/day (ffq heart + petals)                      | totale inname van non-heemijzer in mg/dag (ffq hart + bloemblaadjes)                             | ironnonhaem_intake_adu_c_1    | ijzernonhaem       | sec *           | 18+      |
| total iron intake in mg/day (ffq heart + petals)                               | totale inname van ijzer in mg/dag (ffq hart + bloemblaadjes)                                     | irontot_intake_adu_c_1        | ijzertot           | sec *           | 18+      |

* All FFQ sum scores included as assessment 'sec' as the sum scores include several assessments.
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