The JPFCS is a population-based cross-sectional study on household food consumption patterns that was conducted within all regions of the Hashemite Kingdom of Jordan between October 2021 and March 2022. Jordanians aged ≥8 years were defined as children, adolescents, adults, and older adults in the JPFCS study. Obtaining 24-h DR for children aged <8 years is difficult, especially out-of-home food intake (food eaten in schools, kindergarten, and daycare centers). Therefore, the data reliability is higher among children aged ≥8 years [22].

This study included 4 phases. The first phase included survey planning, questionnaire preparation, interviewer selection and training, and obtaining ethical approval. The second phase involved conducting a pilot study and selecting households. The third phase included data collection from eligible household members on demographics, health, anthropometrics, and food consumption. The final phase will involve data management and analysis. The study protocol flowchart is presented in Figure 1.

Jordan covers 89,342 km², with 10.8 million people in 2020 [25]. Geographically, the governorates of Jordan are located in 1 of 3 regions: the Central Region (Amman, Madaba, Balqa, and Zarqa), the Northern Region (Irbid, Mafraq, Ajloun, and Jarash), and the Southern Region (Aqaba, Karak, Ma’an, and Tafila). Each region has 4 governorates, including several districts and subdistricts, as shown in Figure 2. About 4.5 million people live in the Amman Governorate, almost half the country’s population.

As a sampling frame, a sample of Jordanian households was selected using the Estimated Population of the Kingdom by Governorate, Locality, Sex, and Households, 2020 [25]. The sample size was calculated using the following formula:

n=N*X / (X + N – 1)

where N is the population size and

X=Z_α/2² × p × (1 – p) / MOE²

where Z_α/2 is the critical value of the normal distribution at α/2 (eg, for a confidence level of 95%, α is .05, and the critical value is 1.96), MOE is the margin of error, p is the sample proportion.

A minimum sample size of 664 households was required. The number of governorate-selected households was calculated using the percentage of each region’s households in the overall number of Jordanian households, as shown in Table 1.

Individuals who agreed to participate in the survey received detailed information about the survey objectives and what was expected from them; a disclosure of the survey’s requirements to preserve confidentiality, risks, and benefits; and a clear description of their decision to participate freely or not in the survey. After being presented with a detailed survey description, parents were asked for oral approval for their children to participate. No incentive money was offered for taking part in the survey. All data were recorded anonymously. Therefore, participants cannot be identified directly or through identifiers linked to the participants. At the start of the first home visit, participants or parents of children aged <12 years provided written informed consent.

The Institutional Board Review committee at The Hashemite University reviewed and approved the survey protocol (No.7/13/2020/2021).

During the project’s development, an expert group of professors and research assistants was formed, which appointed a primary coordinator, 3 co-coordinators, and a data entry specialist. The group was responsible for planning this survey domain, determining and developing the instruments, conducting the training, monitoring data collection, and planning the cleaning and organization processing of the data.

In all, 14 interviewers with nutrition backgrounds joined the group because of the need for a thorough knowledge of the available foods on the market and the recipes usually prepared within the study population. The population density determined the number of interviewers assigned to each region: 9 were assigned to the Central Region, 3 to the Northern Region, and 2 to the Southern Region.

The following quality control steps were taken before, during, and after data collection:

Data analysis was performed using SPSS software (version 22.0; IBM Corp). The normality of the distributions will be assessed through the Kolmogorov-Smirnov test and kurtosis and skewness values. Continuous variables will be presented as mean values and standard deviations, percentages for numerical variables, and frequencies (n and %) for categorical variables. This analysis will be stratified by sex and age.

Inferential statistics such as the Student t test (2-tailed), chi-square test, and independent samples t test (2-tailed) will be used based on the sample distribution and test statistics. Statistical significance will be accepted at P<.05, with a 95% confidence level.

A representative sample of 701 households was randomly invited, and 632 households were included in the study, with a 90.2% response rate. A total of 2721 household members were approached, with a response rate of 78.8% (n=2145). Female subjects who were pregnant or lactating and children aged <8 years in the selected households were excluded from the study. The overall refusal rate of the included household members was 7.7% (210/2721). The hierarchical chart for household sampling, participant distribution, the number of excluded individuals, response rates, and refusals by region is shown in Figure 3.

The age groups for eligible male and female household members were as follows: 8-12, 13-19, 20-64, and ≥65 years. Table 2 summarizes the number of subjects interviewed for each sex of children, adolescents, adults, and older adults.

The 2145 subjects were divided into 4 age groups: 11.3% (n=243) were children (8-12 years), 17.4% (n=374) were adolescents (13-19 years), 66.6% (n=1428) were adults (20-64 years), and 4.6% (n=99) were older adults (≥65 years; Table 2).

The data collected included weight, height, and waist circumference measurements; the response rate for those measurements was high, with the lowest response rate (117/119, 98.3%) for waist circumference in girls aged 8-12 years. The collection of the second 24-h DR for dietary assessment revealed the lowest response rate (114/124, 91.9%) in boys aged 8-12 years (Table 3).

Before estimating nutrient and food group intakes, participants will be divided into 3 groups based on energy intake: underreporters, plausible reporters, and overreporters; plausible reporters will only be considered when estimating nutrient and food group intakes. The survey results will be disseminated in national and international scientific journals.

The study aimed to describe the design and methodology of a population-based food consumption survey to evaluate energy, nutrient, and food group intake in various age groups and the relationship with the prevalence of overweight and obesity.

Food consumption patterns in Jordan have not been studied at the population level. The published studies focused on specific age groups, such as food consumption among university students [33,34] and food and nutrient consumption in certain disease cases [35,36]. These studies used a food frequency questionnaire to focus on food group consumption, whereas 24-h DR was rarely used. Some of the studies mentioned above were pilot studies or had small sample sizes. Furthermore, food consumption data for various age groups and households are still scarce in many Middle Eastern countries.

The total number of respondents in this study was 2145, divided into 4 age groups: children, adolescents, adults, and older adults. The findings of this study will concentrate on food consumption patterns, food group consumption, macronutrient consumption, and some micronutrient consumption, as well as anthropometric indices of obesity such as BMI and weight-to-height ratio in the studied age groups. In line with this protocol, Bel and de Ridder [37] completed a national survey on the Belgian national food consumption data collection in 2200 individuals (aged 10-64 years). Food intake data were collected with 2 nonconsecutive 24-h DRs.

Data from national studies will assist governments and international organizations in supplying statistical elements that will eventually advise national social security and health policies [38]. Additionally, this population-based survey will shed light on the whole population’s energy intake, risk assessment, and nutritional status studies, with essential suggestions for developing policies [37,38].

Among study limitations, the household sample size was smaller than recommended; biochemical data, blood pressure measurements, food safety, hygiene, and lifestyle pattern were not included. Moreover, it was challenging to collect data about food consumption for children aged <8 years. However, among the study’s strengths is that the protocol was similar to other population-based dietary surveys. Participants in the survey were from both sexes and were distributed in all representative age groups in Jordan. Additionally, the distribution of interviews on weekdays and seasonality was confirmed. The core strength of this protocol is that the dietary assessment was completed following the standards of the Jordanian diet and Arabic regions that covers food and nutrient intake, nutritional status, and eating habits. Furthermore, precise and comprehensive food consumption data are crucial for the food consumption assessment based on the food atlas prepared and introduced by the team workers.

As the first population-based household survey, it will provide updated information about dietary habits and food consumption patterns for various age groups, especially because it was conducted following the COVID-19 pandemic. The findings serve as a descriptive baseline for future follow-up and a critical starting point for future food consumption pattern studies of some Jordanian age groups.

This population-based food consumption survey aims to collect data on the food consumption of a sample representing various age groups. It will provide the most comprehensive evaluation of food consumption, identify the components of consumed food and their nutrient contents, examine energy and nutrient intakes, and identify the prevalence of overweight and obesity in the Jordanian community. It will serve as a solid nutritional background for future studies, help assess dietary patterns changes, develop and evaluate nutrition policies, and serve as a solid foundation for developing a future national surveillance system on food consumption patterns.