# Validation of the fermented food frequency questionnaire to assess consumption across four European regions: a study within the promoting innovation of fermented foods cost action

## TL;DR

A new questionnaire was tested to accurately measure fermented food consumption across four European regions, showing it is reliable and valid for most food groups.

## Contribution

The study introduces and validates a Fermented Food Frequency Questionnaire (3FQ) for assessing fermented food intake in European populations.

## Key findings

- The 3FQ showed high repeatability for most fermented food groups with ICC values ranging from 0.4 to 1.0.
- Bland-Altman plots confirmed strong agreement between the 3FQ and 24-h dietary recalls for most food groups.
- Fermented dairy, coffee, and bread categories showed the strongest agreement (>95%) between the 3FQ and 24-h recalls.

## Abstract

Fermented foods are an integral part of diets worldwide, and emerging epidemiological data suggest their significant beneficial health effects. However, assessing their intake is challenging since many of these foods are sporadically and/or locally consumed, hence current traditional nutritional assessment tools lack the specificity to capture this variability. To address this gap, the Fermented Food Frequency Questionnaire (3FQ) was developed and this study aimed to evaluate its relative validity and repeatability across European regions.

In the validation study of the 3FQ, 12,646 adult participants were recruited across four European regions to assess consumption of sixteen major fermented food groups. Repeatability was assessed by administering the 3FQ twice, ~6 weeks apart, to a subset of participants (n = 2,315). Validity was evaluated using 24-h dietary recalls (24 h). Statistical analyses included Spearman's rank correlation coefficients and Intra-Class Correlation coefficients (ICC) for repeatability, and Bland-Altman plots for validity.

Results showed high repeatability, overall and by region, for estimated quantities and frequencies of consumption for most of the fermented food groups (from 0.4 to 1.0), with a few exceptions for infrequently consumed items (e.g., fermented fish). Validity assessment via Bland-Altman plots revealed excellent agreement between the 3FQ and 24 h for most of the food groups, with over 90% of values falling within the agreement interval. Notably, fermented dairy products, coffee, and bread categories showed the strongest agreement (>95%).

The 3FQ is a robust and reliable tool for estimating the consumption of diverse fermented food groups across four European regions and provides valid estimates of the frequency and quantity of intake for specific fermented foods. The 3FQ could be a valuable instrument for epidemiological research aiming to elucidate associations between certain fermented foods and health parameters in European diets.