**Background:** Non-communicable diseases (NCDs) cause 41 million deaths annually (71% of all deaths globally). In the Middle East and North Africa (MENA) region, obesity prevalence has reached 55% in adult females and 30% in adult males. Beverage consumption, particularly sugar-sweetened beverages, is associated with obesity, diabetes, hypertension, and coronary heart disease. Despite the importance of accurate beverage intake assessment for research and clinical practice, no validated beverage frequency questionnaire existed for Arabic-speaking populations. This study aimed to develop and validate the first online Arabic Beverage Frequency Questionnaire (ABFQ) to assess total beverage intake among Arabic-speaking adults.
**Methods:** A cross-sectional validation study was conducted between January 30 and March 23, 2021, in Riyadh, Saudi Arabia. A convenience sample of 49 healthy adults (aged 18–55 years) was recruited from the Saudi Food and Drug Authority community. Participants completed a 24-item online ABFQ on two occasions (ABFQ1 and ABFQ2, separated by 7–17 days; median 7 days) and provided one 24-hour urine sample. The ABFQ assessed consumption frequency (10 response options from 'never' to '3 times a day') and portion size using pictorial guides of common serving sizes with volume in ml. Beverage categories included water, fruit juices, milk and dairy beverages, soft drinks, teas, coffees, energy drinks, sports drinks, and malt drinks. Validity was assessed by correlating total beverage consumption from ABFQ1 with 24-hour urine osmolality using Spearman's correlation. Reliability was assessed by comparing ABFQ1 and ABFQ2 responses using Spearman's correlation and paired sample t-tests. Urine osmolality was measured using an OSMO STATION OM-6060 automatic osmometer (freezing point depression method).
**Key Results:** The mean age of participants was 32 ± 8 years (range 18–54), mean BMI was 25.6 ± 4.3 kg/m² (55.1% normal weight), 71.4% were male, 53% held a bachelor's degree, and 65.3% were unmarried. The average daily beverage consumption based on ABFQ1 was 1504 ml/day (SD 769, range 463–4198), and mean urine osmolality was 614 mOsm/kg (SD 234.1, range 200–1068). The correlation between ABFQ1 total beverage intake and urine osmolality was negative but weak and not statistically significant (r_s = -0.2, p = 0.12). For test-retest reliability, the correlation for total beverage intake between ABFQ1 and ABFQ2 was r_s = 0.7 (p < 0.001). Most individual beverage categories showed positive and acceptable correlations (r_s = 0.4–0.9; all p ≤ 0.05), with the highest correlations for sports drinks (r_s = 0.9998), sweetened energy drinks (r_s = 0.8775), and soft drinks (r_s = 0.8437). Two categories showed non-significant or weak correlations: flavored milk (r_s = 0.2, p = 0.181) and sweetened Arabic/Turkish coffee (r_s = 0.3, p = 0.022). The mean difference in total daily beverage intake between ABFQ1 and ABFQ2 was 11 ml, and the paired t-test showed no significant difference (p = 0.86).
**Clinical Implications:** The ABFQ is the first online beverage frequency questionnaire developed specifically for Arabic-speaking populations, incorporating culturally relevant beverages (e.g., Laban, Arabic coffee, herbal drinks) and traditional serving vessels with pictorial portion size guides. The tool demonstrated strong test-retest reliability, making it suitable for assessing habitual beverage consumption patterns and monitoring changes over time in clinical and research settings. However, the weak and non-significant validity correlation with 24-hour urine osmolality highlights important limitations. The authors note that urine osmolality reflects only 24-hour hydration status, while the ABFQ assessed average intake over 30 days, and that food moisture contribution to total fluid intake (estimated at 19–40% in other populations) could not be accounted for due to lack of local food composition data. The small sample size (n = 49) and homogeneous sample (primarily well-educated, normal-weight adults from one institution) limit generalizability. For clinical practice, the ABFQ can be used to identify high consumers of sugar-sweetened beverages and monitor dietary interventions, but clinicians should be aware that absolute volume estimates may not precisely reflect actual intake. Future validation should incorporate multiple 24-hour dietary recalls and larger, more diverse samples across MENA countries.