The Cardio-Med survey tool: development and pilot validation of a FFQ in a multicultural cardiology cohort

In Australia, CVD is the second largest contributor to death despite advancements made in cardiovascular health and mortality reduction over the last few decades⁽¹⁾. The prevention of CVD at both primary and secondary level is strongly influenced through modification of lifestyle-based risk factors including smoking, physical activity and diet. In relation to diet, adherence to the Mediterranean dietary pattern (MDP) has been inversely associated with CVD risk factors⁽²⁾ and mortality^(3–5). The MDP is primarily plant based, characterised by a high intake of fruits, vegetables, legumes, wholegrains, nuts and extra virgin olive oil. Dairy products and fish are consumed in moderate amounts as is alcohol, predominantly red wine consumed with meals. Meat and meat products are consumed in small portions and less frequently⁽⁶⁾. Plant-based traditional diets from other cultures, including Asian populations⁽⁷⁾, have many similarities to the MDP and have been associated with low CVD risk^(8,9).

Accurate measurement of habitual diets in individuals and populations is inherently complicated due to recall bias and the impact of measurement on modifying intake. Epidemiological studies frequently employ the use of FFQ as their preferred dietary assessment method because of their enhanced ability to estimate habitual intake^(10,11), ease of administration and low-cost burden compared with other methods, such as weighed food records and 24-h diet recalls^(11,12). Numerous FFQ exist in Australia; however, they have a limited capacity to capture culturally specific dietary behaviours including food preparation methods that may influence adherence to the MDP. Australia is a multicultural population; with nearly half of Australians being overseas born or have at least one parent born overseas⁽¹³⁾ comes with a broad range of food cultures and differing food consumption patterns compared with other populations⁽¹⁴⁾. This then limits the applicability for international FFQ to be utilised in Australia due to being culture specific with the inclusion of unfamiliar foods.

The Cardio-Med survey tool (CMST) was specifically designed in response to the limitations of currently available FFQ coupled with the knowledge that CVD poses a significant health burden in Australia, and the MDP is associated with a reduction in CVD. It was important that the CMST had multiple utilities including the ability to capture CVD risk...