ArticleEuropean journal of nutrition2026
Validation and reproducibility of a novel flavonoid food frequency dietary assessment tool (Flav-Q) against multiple 24-h recalls across 12 months.
Article in European journal of nutrition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeMeasurement of dietary flavonoid intake requires a reliable tool. This study validated and evaluated the reproducibility of a 23-item shortened flavonoid food frequency questionnaire (FLAV-Q), derived from the 96-item Kent & Charlton Flavonoid specific-FFQ.
methodsThe FLAV-Q was validated against an average of repeated 24-h dietary recalls using Intake-24 completed quarterly over the period of a year that were adjusted to represent habitual intake by applying the multiple source method (MSM) in 80 Australian adults. FLAV-Q validity was estimated using the Wilcoxon signed-rank test, Spearman's correlation coefficient, Bland-Altman plots, and Cohen's kappa (κ). Reproducibility was assessed by comparing the FLAV-Qs at four timepoints.
resultsFLAV-Q overestimated total flavonoid intake against habitual intake (443.2 mg/day versus 234.4 mg/day, p < 0.001) and all subclasses except for flavanones. Moderate agreement was detected for total flavonoids (r = 0.66, p < 0.001; κ = 0.45, p < 0.001), flavan-3-ols (r = 0.72, p < 0.001; κ = 0.53, p < 0.001), flavonols (r = 0.55, p < 0.001; κ = 0.40, p < 0.001), flavanones (r = 0.50, p < 0.001; κ = 0.30, p = 0.007) and fair but non-significant agreement for anthocyanins (r = 0.38, p < 0.001; κ = 0.15, p = 0.18) and flavones (r = 0.34, p < 0.001; κ = 0.20, p = 0.07). Bland-Altman plots showed a large bias (Bland-Altman index: 7.5%) for total flavonoid intake. FLAV-Q demonstrated moderate reproducibility across timepoints with mean percentage differences for total flavonoid intake ranging from 22% to 37%. Bland-Altman plots indicated moderate to small bias for reproducibility (Bland-Altman index: 2.5-3.8%).
conclusionsFLAV-Q demonstrates moderate to low validity and reproducibility for total flavonoids and the subclasses. Further validation for absolute intake values is necessary to understand and address the overestimation.
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