We examined the effect of seasonality on the ability of the DHQ to estimate the mean nutrient intake of a population and to rank individuals according to nutrient intake, using DRs collected over a total of 16 days as reference. Mean nutrient intake estimated by the DHQ varied according to season, indicating that any consideration of nutrient intake estimated by the DHQ as a yearly average intake may be problematic. The DHQ is a questionnaire which assesses the previous month’s dietary intake, and seasonal variance in mean values estimated by it may therefore represent the true seasonal variance of nutrient intake. On the other hand, the correlation coefficients between the DR and each of the questionnaires showed significant differences for some nutrients, suggesting that seasonality affected the ranking ability of the DHQ for a limited number of nutrients.
Several previous studies in Japan reported that the mean intake of some nutrients varied by season [2–4]. Specifically, Tokudome et al. observed remarkable seasonal differences for carotenes, vitamin A, vitamin C, iron, zinc, arachidonic acid, n-3 polyunsaturated fat, eicosapentaenoic acid, docosahexaenoic acid , soluble dietary fiber, insoluble dietary fiber, and total dietary fiber . Mori et al. reported significant seasonal differences for protein, fat, calcium, iron, vitamin A, thiamine, riboflavin, niacin, and vitamin C . Also, Owaki et al. reported significant seasonal differences for water, vegetable protein, vegetable fat, potassium, vitamin C, vitamin E, sodium, monounsaturated fat, polyunsaturated fat, α-linolenic acid, insoluble dietary fiber, total dietary fiber, and magnesium in men and women, fat and iron in men, and soluble dietary fiber in women . These results imply that the seasonality of nutrition intake can affect mean nutrient intake estimated by dietary questionnaires in epidemiological studies. However, few studies have investigated how the season of dietary questionnaire administration influences the ranking ability of dietary questionnaires. In the present study, we examined seasonal influence on both the estimated mean values and ranking ability of a dietary questionnaire using 16-day dietary records conducted in each season as the reference. To our knowledge, this is the first study to examine the impact of seasonality on the validity (the ability to estimate mean intake and ranking ability) of a dietary questionnaire using dietary records as reference.
In this study, the mean intake for energy and most of the 42 nutrients estimated by the DHQ differed significantly from those estimated by the DR, and varied according to season. Kobayashi et al. reported significant differences between mean intakes estimated by the DHQ and by the DR for energy and many energy-adjusted nutrients . Our present results are consistent with these findings as well as those of other studies of the effect of seasonality [11–13]. This result implies that regarding the mean value of a nutrient’s intake estimated by the DHQ as the yearly average intake is problematic. However, the DHQ assesses dietary intake for the previous month, and the seasonal variance in mean values estimated by it might therefore represent the true seasonal variance of nutrient intake.
We also found a significant difference in correlation coefficients between fall and the other seasons in 11 nutrients for men and 13 for women. This implies that seasonality can affect the ability to rank individuals according to their intake of these nutrients. Most of the significant differences in correlation coefficients were shown in spring and summer for both sexes. It is not clear why most of the significant differences in correlation coefficients were observed in spring and summer. We examined how many food and beverage items appeared in the DR of the participants in each season and how many food and beverage items were used in the DHQ’s computer algorithm, which also appeared in the DR (data not shown). There was no significant seasonal difference in the number of food and beverage items appeared in the DR and the DHQ. Thus the seasonal difference observed in this study might have been mainly caused by the difference of intake amount in foods and beverages contained in the DHQ. However, we also found the number of vegetables, fish, and shellfishes included in the DHQ’s computer algorithm was considerably smaller compared with that appeared in the DR. Since intake of vegetables and fish tended to be affected by season, it is possible that the number of vegetables and fish included in the DHQ’s nutritional value calculation is not enough to reflect the seasonal change of intake for these foods. Our results indicate that there may be no particular season which is unsuitable for ranking the individual’s habitual intake of nutrients by dietary questionnaire, except for a limited number of nutrients. For example, summer might not be suitable for dietary assessment in studies examining the relationship between thiamin intake and health outcomes for women, because the correlation coefficient of thiamine for women in summer was extremely low (0.02).
These results imply the need for caution in administering epidemiological studies which extend over two or more seasons. Although seasonal effects on the correlation coefficients between seasons were relatively small, absolute nutrient intake varies according to season. Thus, the combination and analysis of data collected in different seasons can be problematic. If the purpose of using a questionnaire is to rank individuals according to nutrient intake, we recommend that the questionnaire be administered in a single season.
We acknowledge several limitations of this study. First, we may have not discriminated between “seasonal change in nutrient intake” and the possible influence of repetition of the dietary questionnaire. Repeated experience with dietary questionnaires and dietary records might change participants’ attention to food consumption and improve the precision of assessment by DHQ 2–4. On this basis, subjects’ attention to food consumption might be misinterpreted as ‘seasonal difference’. However, the limitations of dietary questionnaires largely relate to the simplification of dietary intake into a modest number of multiple choice questions, rather than to subject recognition and recall of food . Moreover, our present study found no significant improvement in correlation coefficient between DHQ1 and DHQ 2–4, except for zinc and vitamin K for men, and calcium and manganese for women. We therefore consider that the effect of repetition, if present, is not large. Second, the DHQ asks about the consumption frequency and portion size of selected foods during the preceding month and is likely more vulnerable to seasonality. Consequently, the results of this study are applicable to similar questionnaires that ask about food intake for a preceding month, and might not be generalizable to questionnaires that ask about the yearly intake of foods. This means that the effect of seasonality observed in our study is likely larger than that seen in other studies using other dietary questionnaires. Third, although we used mean values of energy and nutrient intake derived from the 16-day DR as reference, DRs are susceptible to day-to-day variability in nutrient intake. A DR collection period of 16 days and our sample size (92 men and 92 women) might therefore be too short and small for consideration as usual individual intake, particularly for micronutrients. Finally, our subjects were volunteers, and may therefore have been more nutritionally conscious than others who did not participate in the study. Accordingly, they might not be representative of the general Japanese population, and our results might thus not be generalizable to the Japanese population.