Food photography II: use of food photographs for estimating portion size and the nutrient content of meals

Development and validation of two food portion photograph books to assess dietary intake among adults and children in Central Africa

Owing to nutritional transition in Cameroon, one in two adults is overweight and one in five is obese, and 8·1 % of children are overweight and 2·1 % are obese. Given this phenomenon, dietary intake assessment is needed to establish appropriate preventive nutrition-sensitive strategies. Our aim was to develop and test the validity of two food portion photograph books (FPPB) to be used as visual aids for adults and children taking part in a 24-h dietary recall. To design FPPB, interviews and focus group discussions were undertaken with women to obtain consensus on the local categorisation of foods. For each cooked and weighed food, three photographs of the average small, medium and large serving portion sizes were taken, and four intermediary portion sizes were calculated. To validate the FPPB, a sample of adults (361) and children (224) were asked, at meal times, to self-serve a food portion prepared in the household and the portion sizes were weighed; 24 h after the measurement, the same subjects were shown the appropriate FPPB and were asked to indicate the food and the portion they consumed. In adults, of the 821 portions tested, 77 % were accurately estimated, whereas in children 74 % of the 556 portions tested were accurately estimated. For both groups, the small- and medium-sized portions were frequently selected and accurately estimated (>70 %). Our findings suggest that the adult and children’s FPPB can be used in Cameroon to estimate food portion sizes, and thus nutritional intake in the frame of the 24-h dietary recall.

Development and Applicability of an Internet-Based Diet and Lifestyle Questionnaire for College Students in China: A Cross-Sectional Study

Diet contributes to the increasing incidence of chronic diseases. Thus, fast, accurate, and convenient dietary assessment tools are in demand. We designed an internet-based diet and lifestyle questionnaire for Chinese (IDQC). The objective of this study was to validate its applicability and assess the dietary habits of Chinese college students.Six hundred forty-four college students from northern China were recruited and asked to complete the IDQC for the last 4 months (135 food items) and 3-day diet records (3DDRs). Food and nutrient intakes recorded in the IDQC were validated against those in the 3DDRs using the Wilcoxon matched-pairs t test, correlation analysis, and cross-classification. The Student t and χ tests were used in the dietary assessment.There were significantly positive correlations in the dietary intakes of 9 food groups and 23 nutrients between the IDQC and 3DDRs. All participants consumed low levels of fruits, vegetables, legumes, dairy, and certain micronutrients (ie, vitamin A, vitamin B1, vitamin B2, folic acid, vitamin C, calcium, selenium, and iodine), and high levels of iron and manganese. Male students consumed higher intakes of the food groups and nutrients than female students.The IDQC represents an accurate and convenient dietary assessment tool that can be used in large populations. Inadequate and excessive nutrition co-existed in college students, and more fruits, vegetables, legumes, dairy, and various vitamins and minerals were needed in this population's daily diet. The IDQC is free of access at www.yyjy365.org/diet.

The factors affecting on estimation of carbohydrate content of meals in carbohydrate counting

The objective of this study was to identify factors affecting on errors in carbohydrate (CHO) content estimation during CHO counting. Thirty-seven type 1 diabetes patients and 22 of their parents and 28 physicians/dieticians were enrolled in this study. CHO counting was counted in "Carb", with 1 Carb defined as 10 g of CHO. To evaluate the accuracy of CHO counting, 80 real-size photographs of cooked meals were presented to the subjects for Carb estimation. Carbs tended to be overestimated for foods containing relatively small amounts of Carbs. On the other hands, Carbs tended to be underestimated for foods with higher than 6 Carbs. Accurate estimation of the Carbs in food containing a large amount of rice was particularly difficult even in the subjects having the CHO counting experience. The Carb contents of high-calorie foods such as meats, fried foods, and desserts tended to be overestimated. This error was smaller in subjects having the CHO counting experience. In conclusion, misunderstanding of high-calorie dishes containing high amounts of CHO was observed in inexperienced subjects, indicating the efficacy of the current methodology of CHO counting. On the other hand it was difficult even for experienced subjects to assess the amount of seasoned rice, suggesting the need for a new methodology for accurate estimation.

The gender-related differences of nutrient intakes in a group of Italian obese patients display the ongoing transition from Mediterranean to western dietary patterns

BACKGROUND

The purpose of this study was to compare nutrients and energy intakes between obese women and men and the variation rates over or below the recommended dietary allowances.

METHODS

A retrospective survey was conducted on the records of obese patients, categorized into gender-related groups (36 women, 36 men). Total energy and nutrient intakes were determined.

RESULTS

The highest variation rates were found for animal protein, averaging 225 % over the recommended dietary allowance, without significant differences between women and men. The simple carbohydrate intake was quite elevated in women with variations almost 80% over the RDA, significantly higher than in men (22%).

CONCLUSION

The consumption of high-protein foods in both sexes, and even more the association with high-simple carbohydrate foods in women, display the Westernization of traditional eating habits.

Evaluation of a Mobile Phone Image-Based Dietary Assessment Method in Adults with Type 2 Diabetes

Image-based dietary records have limited evidence evaluating their performance and use among adults with a chronic disease. This study evaluated the performance of a 3-day mobile phone image-based dietary record, the Nutricam Dietary Assessment Method (NuDAM), in adults with type 2 diabetes mellitus (T2DM). Criterion validity was determined by comparing energy intake (EI) with total energy expenditure (TEE) measured by the doubly-labelled water technique. Relative validity was established by comparison to a weighed food record (WFR). Inter-rater reliability was assessed by comparing estimates of intake from three dietitians. Ten adults (6 males, age: 61.2 ± 6.9 years old, BMI: 31.0 ± 4.5 kg/m²) participated. Compared to TEE, mean EI (MJ/day) was significantly under-reported using both methods, with a mean ratio of EI:TEE 0.76 ± 0.20 for the NuDAM and 0.76 ± 0.17 for the WFR. Correlations between the NuDAM and WFR were mostly moderate for energy (r = 0.57), carbohydrate (g/day) (r = 0.63, p < 0.05), protein (g/day) (r = 0.78, p < 0.01) and alcohol (g/day) (r_s = 0.85, p < 0.01), with a weaker relationship for fat (g/day) (r = 0.24). Agreement between dietitians for nutrient intake for the 3-day NuDAM (Intra-class Correlation Coefficient (ICC) = 0.77–0.99) was lower when compared with the 3-day WFR (ICC = 0.82–0.99). These findings demonstrate the performance and feasibility of the NuDAM to assess energy and macronutrient intake in a small sample. Some modifications to the NuDAM could improve efficiency and an evaluation in a larger group of adults with T2DM is required.

Congenital Malformations and Consequential Epidemiology

A call for a shift in the discipline of epidemiology, away from those aimed at identifying risk factors and toward those aimed at more directly improving health - so called consequential epidemiology. This call for epidemiologists to engage in solving the biggest public health problems has been heralded for decades by Cates and more recently by Galea [Am J Epidemiol 2013; 178; 1185-94]. In consideration of the consequential epidemiology perspective, the impacts of epidemiologic research of birth defects over the recent decades are evaluated and directions for the field are proposed. While many causal factors have been identified, the causes of the majority of birth defects remain unknown. Folic acid intake notwithstanding, primary prevention of birth defects is elusive. Meanwhile, research that identifies what improves the lives of individuals born with a birth defect and how to ensure those factors are available to all affected would have great impact. In summary, a consequentialist approach to birth defects epidemiology requires a shift in research agendas and teams, but the opportunities are wide open.

The ANIBES Study on Energy Balance in Spain: design, protocol and methodology

Energy Balance (EB) is an important topic to understand how an imbalance in its main determinants (energy intake and consumption) may lead to inappropriate weight gain, considered to be "dynamic" and not "static". There are no studies to evaluate EB in Spain, and new technologies reveal themselves as key tools to solve common problems to precisely quantify energy consumption and expenditure at population level. The overall purpose of the ANIBES ("Anthropometry, Intake and Energy Balance") Study was to carry out an accurate updating of food and beverage intake, dietary habits/behaviour and anthropometric data of the Spanish population (9-75 years, n=2009), as well as the energy expenditure and physical activity patterns. Anthropometry measurements (weight, height, body mass index, waist circumference, % body fat, % body water) were obtained; diet was evaluated throughout a three-day dietary record (tablet device) accompanied by a 24 h-dietary recall; physical activity was quantified by questionnaire and accelerometers were also employed. Finally, information about perception and understanding of several issues related to EB was also obtained. The ANIBES study will contribute to provide valuable useful data to inform food policy planning, food based dietary guidelines development and other health oriented actions in Spain.

Usability of a smartphone food picture app for assisting 24-hour dietary recall: a pilot study

BACKGROUND/OBJECTIVES

The Recaller app was developed to help individuals record their food intakes. This pilot study evaluated the usability of this new food picture application (app), which operates on a smartphone with an embedded camera and Internet capability.

SUBJECTS/METHODS

Adults aged 19 to 28 years (23 males and 22 females) were assigned to use the Recaller app on six designated, nonconsecutive days in order to capture an image of each meal and snack before and after eating. The images were automatically time-stamped and uploaded by the app to the Recaller website. A trained nutritionist administered a 24-hour dietary recall interview 1 day after food images were taken. Participants' opinions of the Recaller app and its usability were determined by a follow-up survey. As an evaluation indicator of usability, the number of images taken was analyzed and multivariate Poisson regression used to model the factors determining the number of images sent.

RESULTS

A total of 3,315 food images were uploaded throughout the study period. The median number of images taken per day was nine for males and 13 for females. The survey showed that the Recaller app was easy to use, and 50% of the participants would consider using the app daily. Predictors of a higher number of images were as follows: greater interval (hours) between the first and last food images sent, weekend, and female.

CONCLUSIONS

The results of this pilot study provide valuable information for understanding the usability of the Recaller smartphone food picture app as well as other similarly designed apps. This study provides a model for assisting nutrition educators in their collection of food intake information by using tools available on smartphones. This innovative approach has the potential to improve recall of foods eaten and monitoring of dietary intake in nutritional studies.

Meeting challenges related to the dietary assessment of ethnic minority populations

BACKGROUND

Migrants from the Indian subcontinent comprise the largest minority group in the UK. With the process of migration come alterations in lifestyle and eating habits. The present study aimed to disseminate the valuable information, experiences and challenges faced by researchers who conduct studies with ethnic minority groups in the area of diet and nutritional surveys, with an emphasis on migrant South Asians.

METHODS

The findings reported are the result of research carried out during 2008-2012, involving 1100 face-to-face dietary recalls conducted in the UK among South Asian children (aged 1.5-11 years; n = 300) and adults (≥30 years; n = 100).

RESULTS

Factors to consider when planning and carrying out diet and nutrition survey studies among migrant South Asians were identified and include the employment of culture-specific tools, visual aid reinforcement and the involvement of key community members and translators to facilitate recruitment and data collection. One of the best practices found when working with minority groups was the use of incentives and tangible benefits to reward study participants. It was also found that constant communication and follow-up of the study participants improved the quality of the data and the likelihood of maintaining links with community members for future studies.

CONCLUSIONS

From the results of in-house studies and a revision of practices reported in earlier literature, two 24-h face-to-face dietary recalls are recommended as the optimal method for the dietary assessment of migrant South Asians. To complement this assessment, ethnic-specific food frequency questionnaires such as that developed and successfully implemented among South Asians in the present study must be employed.

A food photograph series for identifying portion sizes of culturally specific dishes in rural areas with high incidence of oesophageal cancer

Rural areas of the Eastern Cape (EC) Province, South Africa have a high incidence of squamous cell oesophageal cancer (OC) and exposure to mycotoxin fumonisin has been associated with increased OC risk. However, to assess exposure to fumonisin in Xhosas—having maize as a staple food—it is necessary to determine the amount of maize consumed per day. A maize-specific food frequency questionnaire (M-FFQ) has recently been developed. This study developed a food photograph (FP) series to improve portion size estimation of maize dishes. Two sets of photographs were developed to be used alongside the validated M-FFQ. The photographs were designed to assist quantification of intakes (portion size photographs) and to facilitate estimation of maize amounts in various combined dishes (ratio photographs) using data from 24 h recalls (n = 159), dishing-up sessions (n = 35), focus group discussions (FGD) (n = 56) and published literature. Five villages in two rural isiXhosa-speaking areas of the EC Province, known to have a high incidence of OC, were randomly selected. Women between the ages of 18–55 years were recruited by snowball sampling and invited to participate. The FP series comprised three portion size photographs (S, M, L) of 21 maize dishes and three ratio photographs of nine combined maize-based dishes. A culturally specific FP series was designed to improve portion size estimation when reporting dietary intake using a newly developed M-FFQ.

Comparison of a full food-frequency questionnaire with the three-day unweighted food records in young Polish adult women: implications for dietary assessment

The food frequency questionnaire (FFQ) and the food record (FR) are among the most common methods used in dietary research. It is important to know that is it possible to use both methods simultaneously in dietary assessment and prepare a single, comprehensive interpretation. The aim of this study was to compare the energy and nutritional value of diets, determined by the FFQ and by the three-day food records of young women. The study involved 84 female students aged 21-26 years (mean of 22.2 ± 0.8 years). Completing the FFQ was preceded by obtaining unweighted food records covering three consecutive days. Energy and nutritional value of diets was assessed for both methods (FFQ-crude, FR-crude). Data obtained for FFQ-crude were adjusted with beta-coefficient equaling 0.5915 (FFQ-adjusted) and regression analysis (FFQ-regressive). The FFQ-adjusted was calculated as FR-crude/FFQ-crude ratio of mean daily energy intake. FFQ-regressive was calculated for energy and each nutrient separately using regression equation, including FFQ-crude and FR-crude as covariates. For FR-crude and FFQ-crude the energy value of diets was standardized to 2000 kcal (FR-standardized, FFQ-standardized). Methods of statistical comparison included a dependent samples t-test, a chi-square test, and the Bland-Altman method. The mean energy intake in FFQ-crude was significantly higher than FR-crude (2740.5 kcal vs. 1621.0 kcal, respectively). For FR-standardized and FFQ-standardized, significance differences were found in the mean intake of 18 out of 31 nutrients, for FR-crude and FFQ-adjusted in 13 out of 31 nutrients and FR-crude and FFQ-regressive in 11 out of 31 nutrients. The Bland-Altman method showed an overestimation of energy and nutrient intake by FFQ-crude in comparison to FR-crude, e.g., total protein was overestimated by 34.7 g/day (95% Confidence Interval, CI: -29.6, 99.0 g/day) and fat by 48.6 g/day (95% CI: -36.4, 133.6 g/day). After regressive transformation of FFQ, the absolute difference between FFQ-regressive and FR-crude equaled 0.0 g/day and 95% CI were much better (e.g., for total protein 95% CI: -32.7, 32.7 g/day, for fat 95% CI: -49.6, 49.6 g/day). In conclusion, differences in nutritional value of diets resulted from overestimating energy intake by the FFQ in comparison to the three-day unweighted food records. Adjustment of energy and nutrient intake applied for the FFQ using various methods, particularly regression equations, significantly improved the agreement between results obtained by both methods and dietary assessment. To obtain the most accurate results in future studies using this FFQ, energy and nutrient intake should be adjusted by the regression equations presented in this paper.

New technology in dietary assessment: a review of digital methods in improving food record accuracy

Methods for conducting dietary assessment in the United States date back to the early twentieth century. Methods of assessment encompassed dietary records, written and spoken dietary recalls, FFQ using pencil and paper and more recently computer and internet applications. Emerging innovations involve camera and mobile telephone technology to capture food and meal images. This paper describes six projects sponsored by the United States National Institutes of Health that use digital methods to improve food records and two mobile phone applications using crowdsourcing. The techniques under development show promise for improving accuracy of food records.

Validation of a food quantification picture book targeting children of 0-10 years of age for pan-European and national dietary surveys

The aim of the present study was to validate thirty-eight picture series of six pictures each developed within the PANCAKE (Pilot study for the Assessment of Nutrient intake and food Consumption Among Kids in Europe) project for portion size estimation of foods consumed by infants, toddlers and children for future pan-European and national dietary surveys. Identical validation sessions were conducted in three European countries. In each country, forty-five foods were evaluated; thirty-eight foods were the same as the depicted foods, and seven foods were different, but meant to be quantified by the use of one of the thirty-eight picture series. Each single picture within a picture series was evaluated six times by means of predefined portions. Therefore, thirty-six pre-weighed portions of each food were evaluated by convenience samples of parents having children aged from 3 months to 10 years. The percentages of participants choosing the correct picture, the picture adjacent to the correct picture or a distant picture were calculated, and the performance of individual pictures within the series was assessed. For twenty foods, the picture series performed acceptably (mean difference between the estimated portion number and the served portion number less than 0.4 (SD < 1.1)). In addition, twelve foods were rated acceptable after adjustment for density differences. Some other series became acceptable after analyses at the country level. In conclusion, all picture series were acceptable for inclusion in the PANCAKE picture book. However, the picture series of baby food, salads and cakes either can only be used for foods that are very similar to those depicted or need to be substituted by another quantification tool.

Dietary assessment and self-monitoring with nutrition applications for mobile devices

Nutrition applications for mobile devices (e.g., personal digital assistants, smartphones) are becoming increasingly accessible and can assist with the difficult task of intake recording for dietary assessment and self-monitoring. This review is a compilation and discussion of research on this tool for dietary intake documentation in healthy populations and those trying to lose weight. The purpose is to compare this tool with conventional methods (e.g., 24-hour recall interviews, paper-based food records). Research databases were searched from January 2000 to April 2011, with the following criteria: healthy or weight loss populations, use of a mobile device nutrition application, and inclusion of at least one of three measures, which were the ability to capture dietary intake in comparison with conventional methods, dietary self-monitoring adherence, and changes in anthropometrics and/or dietary intake. Eighteen studies are discussed. Two application categories were identified: those with which users select food and portion size from databases and those with which users photograph their food. Overall, positive feedback was reported with applications. Both application types had moderate to good correlations for assessing energy and nutrient intakes in comparison with conventional methods. For self-monitoring, applications versus conventional techniques (often paper records) frequently resulted in better self-monitoring adherence, and changes in dietary intake and/or anthropometrics. Nutrition applications for mobile devices have an exciting potential for use in dietetic practice.

Estimated portion sizes in a school-aged population

OBJECTIVE

To produce study-specific portion sizes for 11-year-old children in a population-based birth cohort and to compare these study-specific portion sizes with previously published children's portion sizes, to assess their relevance today.

DESIGN

Two multiple-pass 24 h dietary recalls were taken. The Food Standard Agency's photographic food atlas was used to quantify intakes. Study-specific food portion sizes were calculated for each food group. Portion sizes were calculated for all children and separately for boys and girls. The nutrient intake from the 24 h dietary recalls was analysed using study-specific and published portion sizes for individual participants. Agreement was assessed using Pearson's correlation, intra-class correlation coefficients and the Bland-Altman method.

SETTING

Birth cohort study, UK.

SUBJECTS

Children (mean age 11.3 years, n 264) and parents/guardians.

RESULTS

A total of 124 food portion sizes were calculated. Differences in portion weights between boys and girls were seen only for seven food items. There was a significant positive relationship (P < 0.001) between intakes of each nutrient as determined by the two sets of portion sizes. Correlation coefficients ranged from 0.77 (protein) to 0.98 (β-carotene). The intra-class correlation coefficients showed good agreement between nutrient intakes determined by the study-specific and published portion sizes (P < 0.001).

CONCLUSIONS

Nutrient intakes calculated using portion sizes from our population were similar to those calculated from portion size data collected in a national survey, despite being collected over a decade later. The present study adds to the small amount of evidence regarding portion sizes in UK children and shows agreement with previously published paediatric portion sizes.

Validation of digital photographs, as a tool in 24-h recall, for the improvement of dietary assessment among rural populations in developing countries

BACKGROUND

Improvement of traditional methods for dietary assessment is necessary, especially in rural areas where it is more difficult to succeed with self-reporting methods. This study presents and validates a method for improving accuracy when measuring food and nutrient intake of individuals in rural areas. It is called the "Food photography 24-h recall method" (FP 24-hR) and is a modified 24-h recall with the addition of a digital food photography record and a photo atlas.

METHODS

The study was carried out in a rural area in the tropical region of Bolivia; 45 women participated. Validation of the method was made by comparing it with a reference method, the Weighed Food Record (WFR). During the FP 24-hR, digital photographs were taken by the subjects of all food consumed during a day and a 24-h recall questionnaire was conducted by an interviewer. An estimate of the amount of food consumed was made using a photo atlas and the photographs taken by the subjects. For validation, comparison was made between the calculations, by both methods, of the levels of food, and nutrient, intake.

RESULTS

The comparison was made in 10 food categories; most of which were somewhat underestimated from -2.3% (cassava) to -6.8% (rice), except for beverages (+1.6%) and leafy vegetables (+8.7%), which were overestimated. Spearman's correlation coefficients were highly significant (r from 0.75 for eggs to 0.98 for potato and cassava). Nutrient intakes calculated with data from both methods showed small differences from -0.90% (vitamin C) to -5.98% (fat). Although all nutrients were somewhat underestimated, Pearson's coefficients are high (>0.93 for all) and statistically significant. Bland Altman analysis showed that differences between both methods were random and did not exhibit any systematic bias over levels of food and nutrient intake, with acceptable 95% limits of agreement.

CONCLUSION

The FP 24-hR exhibits acceptable differences when compared with a WFR, digital photos are useful as a memory aid for the subjects during 24-h recall and as an estimation tool. The method is suitable for assessing dietary intake among rural populations in developing countries.

Food photographs in portion size estimation among adolescent Mozambican girls

OBJECTIVE

To assess the validity of food photographs in portion size estimation among adolescent girls in Mozambique. The study was carried out in preparation for the larger ZANE study, which used the 24 h dietary recall method.

DESIGN

Life-sized photographs of three portion sizes of two staple foods and three sauces were produced. Participants ate weighed portions of one staple food and one sauce. After the meal, they were asked to estimate the amount of food with the aid of the food photographs.

SETTING

Zambezia Province, Mozambique.

SUBJECTS

Ninety-nine girls aged 13–18 years.

RESULTS

The mean differences between estimated and actual portion sizes relative to the actual portion size ranged from 219% to 8% for different foods. The respective mean difference for all foods combined was 25% (95% CI 212, 2 %). Especially larger portions of the staple foods were often underestimated. For the staple foods, between 62% and 64% of the participants were classified into the same thirds of the distribution of estimated and actual food consumption and for sauces, the percentages ranged from 38% to 63%. Bland–Altman plots showed wide limits of agreement.

CONCLUSIONS

Using life-sized food photographs among adolescent Mozambican girls resulted in a rather large variation in the accuracy of individuals’ estimates. The ability to rank individuals according to their consumption was, however, satisfactory for most foods. There seems to be a need to further develop and test food photographs used in different populations in Sub-Saharan Africa to improve the accuracy of portion size estimates.

Validation of a Mexican food photograph album as a tool to visually estimate food amounts in adolescents

The aim of the present study was to validate a food photograph album (FPA) as a tool to visually estimate food amounts, and to compare this estimation with that attained through the use of measuring cups (MC) and food models (FM). We tested 163 foods over fifteen sessions (thirty subjects/session; 10-12 foods presented in two portion sizes, 20-24 plates/session). In each session, subjects estimated food amounts with the assistance of FPA, MC and FM. We compared (by portion and method) the mean estimated weight and the mean real weight. We also compared the percentage error estimation for each portion, and the mean food percentage error estimation between methods. In addition, we determined the percentage error estimation of each method. We included 463 adolescents from three public high schools (mean age 17·1 (sd 1·2) years, 61·8 % females). All foods were assessed using FPA, 53·4 % of foods were assessed using MC, and FM was used for 18·4 % of foods. The mean estimated weight with all methods was statistically different compared with the mean real weight for almost all foods. However, a lower percentage error estimation was observed using FPA (2·3 v. 56·9 % for MC and 325 % for FM, P< 0·001). Also, when analysing error rate ranges between methods, there were more observations (P< 0·001) with estimation errors higher than 40 % with the MC (56·1 %), than with the FPA (27·5 %) and FM (44·9 %). In conclusion, although differences between estimated and real weight were statistically significant for almost all foods, comparisons between methods showed FPA to be the most accurate tool for estimating food amounts.

Portion size estimation aids for Asian foods

BACKGROUND

Portion size estimation is fundamental to the accuracy of dietary recall, as well as interventions in obesity. Data on portion size estimation aids (PSEA) for Asian foods are limited. PSEA for Asian foods were developed and their accuracy and precision were tested for inclusion in a food atlas.

METHODS

Sixteen food items were selected to represent all food groups. Small and life size photographs were developed, and line diagrams were drawn. These, together with household utensils, were tested among a random sample of 80 schoolchildren (aged 10-16 years). A total of 3180 estimations were made: 876 for small photographs (n = 11 foods), 558 for life size photographs (n = 7 foods), 1271 for line diagrams (n = 16 foods) and 475 for household utensils (n = 6 foods).

RESULTS

Line diagrams had a high percentage (63.9%) of correct estimations and a low percentage of over estimations (18.0%) and under estimations (18.1%), whereas household utensils performed poorly with 0.6% correct estimations. Greater accuracy and precision were obtained for amorphous foods with small photographs and for non-amorphous foods with line diagrams. The combination of small photographs (for vegetables) and line diagrams (for other foods) achieved a high correlation (r = 0.959, P ≤ 0.001), percentage correct estimations (68.3%) and low under estimations (19.9%) and over estimations (11.8%). Food texture, but not age or sex, was associated with correct estimations in all of the PSEA, except household utensils.

CONCLUSIONS

Accuracy and precision of a combination PSEA is convincing, enabling inclusion into an Asian food atlas for dietary assessment and intervention.

Development and evaluation of a photographic atlas as a tool for dietary assessment studies in Middle East cultures

OBJECTIVE

To assess the errors between estimates of amounts based on photographs and actual quantities of food presented to adults or eaten on the previous day.

DESIGN

A photographic atlas was constructed by taking digital photographs of three pre-weighed portion sizes of 212 traditional Lebanese dishes. In a first approach, ten portions of real pre-weighed foods were assessed using the photographic atlas. In a second approach, the participants weighed all foods consumed at one meal and recalled the amount of food that was eaten the previous day using the photographic atlas. Differences between actual quantities and estimation were assessed using a signed rank test (P < 0·05). Spearman's correlation coefficients and bias (Bland-Altman plot) between the methods were calculated.

SETTING

Lebanese university canteen and Lebanese homes.

SUBJECTS

Forty adults (twenty males, twenty females) completed the first protocol and fifty adults (twenty-five males, twenty-five females) completed the second protocol; all were volunteers aged 21 to 62 years.

RESULTS

Mean differences between actual and estimated portion sizes by photographs were between -13·1 % and +24·5 % when pre-weighed foods were presented, and between -10·4 % and +3·8 % when foods were consumed the day before. No significant differences were found between actual and estimated portion sizes except for three dishes (loubieh bil zeit, tabbouleh and yachnet bazella). Bland-Altman plots showed good agreement for all dishes with a negligible bias of -0·2 g between estimated and presented portions, and -6·3 g between estimated and eaten portions.

CONCLUSIONS

In the Lebanese diet, food photographs seem a reliable tool for quantification of food portion sizes.

Effect of α-lipoic acid and exercise training on cardiovascular disease risk in obesity with impaired glucose tolerance

Obese subjects with impaired glucose tolerance (IGT) are more susceptible than healthy individuals to oxidative stress and cardiovascular disease. This randomised controlled investigation was designed to test the hypothesis that α-lipoic acid supplementation and exercise training may elicit favourable clinical changes in obese subjects with IGT. All data were collected from 24 obese (BMI ≥ 30 kg/m²) IGT patients. Following participant randomisation into two groups, fasting venous blood samples were obtained at baseline, and before and following intervention. The first group consisted of 12 participants who completed a 12 week control phase followed by 12 weeks of chronic exercise at 65% HR_max for 30 minutes a day, 5 days per week, while ingesting 1 gram per day of α-lipoic acid for 12 weeks. The second group consisted of 12 participants who completed the same 12 week control phase, but this was followed by 12 weeks of 1 gram per day of α-lipoic acid supplementation only (no exercise). The main findings show a comparatively greater rate of low density lipoprotein (LDL) oxidation in the group consisting of α-lipoic acid only (p < 0.05 vs. pre intervention), although total oxidant status was lower post intervention (p < 0.05 vs. baseline) in this group. However, exercise and α-lipoic acid in combination attenuates LDL oxidation. Furthermore, in the α-lipoic acid supplement plus exercise training group, total antioxidant capacity was significantly increased (p < 0.05 vs. baseline and pre intervention). Body fat percentage and waist and hip circumference decreased following exercise training (p < 0.05 vs. post intervention). There were no selective treatment differences for a range of other clinical outcomes including glycaemic regulation (p > 0.05). These findings report that α-lipoic acid ingestion may increase the atherogenicity of LDL when ingested in isolation of exercise, suggesting that in IGT the use of this antioxidant treatment does not ameliorate metabolic disturbances, but instead may detrimentally contribute to the pathogenesis of atherosclerosis and development of CVD. However, when α-lipoic acid is combined with exercise, this atherogenic effect is abolished.

Glycemic index and glycemic load used in combination to characterize metabolic responses of mixed meals in healthy lean young adults

BACKGROUND

Glycemic index (GI) and glycemic load (GL) have been independently assessed with regard to their metabolic effects and their associations with disease risk. Because a low-GI high-carbohydrate and a high-GI low-carbohydrate food/meal can produce the same GL, we propose that these 2 concepts should be used in conjunction to characterize the carbohydrate quality of mixed meals.

OBJECTIVE

The aim of this study was to measure postprandial glucose, insulin, and cortisol responses of meals differing in both GI and GL over a period of 3 hours (every 15 minutes for the first hour, and every 30 minutes subsequently), and to investigate the validity of methods of calculating GI and GL by measuring the cumulative incremental area under the curve (iAUC) for glucose and insulin (0-2 hours and 2-3 hours postprandially).

METHODS

A total of 10 healthy lean young adults (5 males, 5 females) participated. Breakfast meals were designed to differ in terms of GI and GL based on a 2 × 2 grid with a single elaboration: low-GI high-GL (M1); high-GI high-GL (M2a) of similar GL to M1; high-GI high-GL (M2b) of similar macronutrient composition to M1 (the elaboration); low-GI low-GL (M3); and high-GI low-GL (M4). The 5 breakfast meals were administered in a double-blind randomized crossover design. Repeated measures analysis of variance was performed to investigate differences in metabolic response between low- versus high-GI and between low- versus high-GL breakfast meals (and GI × GL interactions), with GI and GL used as within-subject factors.

RESULTS

High-GL meals increased glucose iAUC and insulin iAUC in both immediate (0-2 hours) (p < 0.01, p < 0.001, respectively) and middle postabsorptive periods (2-3 hours) (p = 0.04, p = 0.02, respectively) compared with low-GL meals. GI meals were not associated with glucose iAUC 0 to 2 hours (p = 0.37) and 2 to 3 hours (p = 0.81) postprandially. GI meals were not associated with insulin iAUC 0 to 2 hours postprandially (p = 0.81); in contrast, high-GI meals increased insulin iAUC 2 to 3 hours postprandially (p = 0.03) compared with low-GI meals. No significant differences were noted in cortisol responses, GI × GL interactions, or effect modification by gender.

CONCLUSIONS

These findings highlight the need for further investigation of meals/diets differing in both GI and GL to characterize metabolic responses and potential health effects.

Computerized portion-size estimation compared to multiple 24-hour dietary recalls for measurement of fat, fruit, and vegetable intake in overweight adults

Validated self-report methods of dietary assessment exist and might be improved in terms of both accuracy and cost-efficiency with computer technology. The objectives of this preliminary study were to develop an initial version of an interactive CD-ROM program to estimate fruit, vegetable, and fat intake, and to compare it to multiple 24-hour dietary recalls (averaged over 3 days). In 2009, overweight male and female adults (n=205) from Lane County, OR, completed computerized and paper versions of fruit, vegetable, and fat screening instruments, and multiple 24-hour dietary recalls. Summary scores from the 10-item National Cancer Institute Fruit and Vegetable Scan and the 18-item Block Fat Screener were compared to multiple 24-hour dietary recall-derived fruit/vegetable and fat intake estimates (criterion measures). Measurement models were used to derive deattenuated correlations with multiple 24-hour dietary recalls of paper and CD-ROM administrations of Fruit and Vegetable Scan fruit intake, vegetable intake, and fruit and vegetable intake, and Block Fat Screener fat intake. The computerized assessment and paper surveys were related to multiple 24-hour dietary recall-derived fruit/vegetable and fat intake. Deattenuated correlation coefficients ranged from 0.50 to 0.73 (all P≤0.0001). The CD-ROM-derived estimate of fruit intake was more closely associated with 24-hour dietary recall (r=0.73) than the paper-derived estimate (r=0.54; P<0.05), but the other comparisons did not differ significantly. Findings from this preliminary study with overweight adults indicate the need for additional enhancements to the CD-ROM assessment and more extensive validation studies.

Uso de imagens de alimentos na avaliação do consumo alimentar

Discutem-se, neste estudo, abordagens metodológicas que utilizam tecnologias de informação e comunicação para a avaliação do consumo alimentar por meio de fotografias ou filmagem dos alimentos. Foram pesquisados artigos nas bases de dados ScienceDirect, Scopus, SciELO e MedLine/PubMed, utilizando-se, sem limitação temporal, em português e inglês, as palavras-chave: "foto/fotografia" ou "filmagem" conjugadas a "digital", "alimento", "tamanho da porção", "refeição" e/ou "ingestão alimentar", bem como a associação desses ter-mos com: "precisão", "validade" e "validação". Das referências consultadas, foram analisados 21 artigos que atenderam ao critério estabelecido. Pelo resultado da pesquisa, é possível afirmar que o método fotográfico pode ser aplicado mediante registro das porções de referência, servidas e rejeitadas, com posterior transmissão ao computador. Assim, os observadores treinados não precisam, necessariamente, acompanhar o momento da refeição. Tal método apresenta validação e acurácia aceitáveis para a estimativa do tamanho das porções quando comparado ao método de estimativa visual direta e de pesagem de alimentos. Outra abordagem emprega computador portátil com câmera fotográfica e celular integrados, contendo programa dietético projetado para registro e automonitoração da ingestão alimentar. Esse instrumento possibilita a transmissão de informações diárias sobre a ingestão de alimentos e bebidas em locais variados, auxiliando a coleta de dados em estudos populacionais. A abordagem em desenvolvimento inclui a utilização de dispositivo de com-putação móvel para registro fotográfico das refeições, com determinação automática dos alimentos consumidos. Também se discutem tentativas para investigar o comportamento espontâneo de comensais por meio de filmagem, reconhecimento facial e informações obtidas nas caixas registradoras em um restaurante modelo.

Uncertainty in intake due to portion size estimation in 24-hour recalls varies between food groups

Portion size estimation is expected to be one of the largest sources of uncertainty in dietary assessment of the individual. Therefore, we demonstrated a method to quantify uncertainty due to portion size estimation in the usual intake distributions of vegetables, fruit, bread, protein, and potassium. Dutch participants of the European Food Consumption Validation study completed 2 nonconsecutive 24-h recall interviews. In short, the uncertainty analysis consists of Monte Carlo simulations drawing values for portion size from lognormal uncertainty distributions. The uncertainty of the usual intake distribution and accompanying parameters (IQR and the shrinkage factor) were estimated. For the food groups, portion size uncertainty had the greatest effect for vegetables and the least for fruit: the relative 95% uncertainty interval (UI) of the IQR of the usual intake distribution was 0.61-1.35 for vegetables, 0.77-1.24 for bread, and 0.99-1.10 for fruit. For protein and potassium, the resulting relative width of the UI of the IQR for portion size uncertainty are similar: 0.88-1.14 for protein and 0.86-1.14 for potassium. Furthermore, a sensitivity analysis illustrated the importance of the specified uncertainty distributions. The examples show that uncertainty in portion sizes may be more important for some foods such as vegetables. This may reflect differential quantification errors by food groups that deserve further consideration. In conclusion, the presented methodology allows the important quantification of portion size uncertainty and extensions to include other sources of uncertainty is straightforward.

Glycaemic index and glycaemic load of breakfast predict cognitive function and mood in school children: a randomised controlled trial

The macronutrient composition of a breakfast that could facilitate performance after an overnight fast remains unclear. As glucose is the brain's major energy source, the interest is in investigating meals differing in their blood glucose-raising potential. Findings vary due to unaccounted differences in glucoregulation, arousal and cortisol secretion. We investigated the effects of meals differing in glycaemic index (GI) and glycaemic load (GL) on cognition and mood in school children. A total of seventy-four school children were matched and randomly allocated either to the high-GL or low-GL group. Within each GL group, children received high-GI and low-GI breakfasts. Cognitive function (CF) and mood were measured 95–140 min after breakfast. Blood glucose and salivary cortisol were measured at baseline, before and after the CF tests. Repeated-measures ANOVA was used to identify differences in CF, mood, glucose and cortisol levels between the breakfasts. Low-GI meals predicted feeling more alert and happy, and less nervous and thirsty (P < 0·05 for each); high-GL meals predicted feeling more confident, and less sluggish, hungry and thirsty (P < 0·05 for each). High-GL (P < 0·001) and high-GI (P = 0·05) meals increased glucose levels 90 min after breakfast, and high-GI meals increased cortisol levels (P < 0·01). When baseline mood, glucose and cortisol levels were considered, low-GI meals predicted better declarative-verbal memory (P = 0·03), and high-GI meals better vigilance (P < 0·03); observed GI effects were valid across GL groups. GI effects on cognition appear to be domain specific. On balance, it would appear that the low-GI high-GL breakfast may help to improve learning, and of potential value in informing government education policies relating to dietary recommendations and implementation concerning breakfast.

Food photographs in nutritional surveillance: errors in portion size estimation using drawings of bread and photographs of margarine and beverages consumption

Food photographs are widely used as instruments to estimate portion sizes of consumed foods. Several food atlases are available, all developed to be used in a specific context and for a given study population. Frequently, food photographs are adopted for use in other studies with a different context or another study population. In the present study, errors in portion size estimation of bread, margarine on bread and beverages by two-dimensional models used in the context of a Belgian food consumption survey are investigated. A sample of 111 men and women (age 45-65 years) were invited for breakfast; two test groups were created. One group was asked to estimate portion sizes of consumed foods using photographs 1-2 d after consumption, and a second group was asked the same after 4 d. Also, real-time assessment of portion sizes using photographs was performed. At the group level, large overestimation of margarine, acceptable underestimation of bread and only small estimation errors for beverages were found. Women tended to have smaller estimation errors for bread and margarine compared with men, while the opposite was found for beverages. Surprisingly, no major difference in estimation error was found after 4 d compared with 1-2 d. Individual estimation errors were large for all foods. The results from the present study suggest that the use of food photographs for portion size estimation of bread and beverages is acceptable for use in nutrition surveys. For photographs of margarine on bread, further validation using smaller amounts corresponding to actual consumption is recommended.

Children's accuracy of portion size estimation using digital food images: effects of interface design and size of image on computer screen

OBJECTIVE

To test the effect of image size and presence of size cues on the accuracy of portion size estimation by children.

DESIGN

Children were randomly assigned to seeing images with or without food size cues (utensils and checked tablecloth) and were presented with sixteen food models (foods commonly eaten by children) in varying portion sizes, one at a time. They estimated each food model's portion size by selecting a digital food image. The same food images were presented in two ways: (i) as small, graduated portion size images all on one screen or (ii) by scrolling across large, graduated portion size images, one per sequential screen.

SETTING

Laboratory-based with computer and food models.

SUBJECTS

Volunteer multi-ethnic sample of 120 children, equally distributed by gender and ages (8 to 13 years) in 2008-2009.

RESULTS

Average percentage of correctly classified foods was 60·3 %. There were no differences in accuracy by any design factor or demographic characteristic. Multiple small pictures on the screen at once took half the time to estimate portion size compared with scrolling through large pictures. Larger pictures had more overestimation of size.

CONCLUSIONS

Multiple images of successively larger portion sizes of a food on one computer screen facilitated quicker portion size responses with no decrease in accuracy. This is the method of choice for portion size estimation on a computer.

Assessment of the accuracy of portion size reports using computer-based food photographs aids in the development of an automated self-administered 24-hour recall

OBJECTIVE

To assess the accuracy of portion-size estimates and participant preferences using various presentations of digital images.

DESIGN

Two observational feeding studies were conducted. In both, each participant selected and consumed foods for breakfast and lunch, buffet style, serving themselves portions of nine foods representing five forms (eg, amorphous, pieces). Serving containers were weighed unobtrusively before and after selection as was plate waste. The next day, participants used a computer software program to select photographs representing portion sizes of foods consumed the previous day. Preference information was also collected. In Study 1 (n=29), participants were presented with four different types of images (aerial photographs, angled photographs, images of mounds, and household measures) and two types of screen presentations (simultaneous images vs an empty plate that filled with images of food portions when clicked). In Study 2 (n=20), images were presented in two ways that varied by size (large vs small) and number (4 vs 8).

SUBJECTS/SETTING

Convenience sample of volunteers of varying background in an office setting.

STATISTICAL ANALYSES PERFORMED

Repeated-measures analysis of variance of absolute differences between actual and reported portions sizes by presentation methods.

RESULTS

Accuracy results were largely not statistically significant, indicating that no one image type was most accurate. Accuracy results indicated the use of eight vs four images was more accurate. Strong participant preferences supported presenting simultaneous vs sequential images.

CONCLUSIONS

These findings support the use of aerial photographs in the automated self-administered 24-hour recall. For some food forms, images of mounds or household measures are as accurate as images of food and, therefore, are a cost-effective alternative to photographs of foods.

Validity and Reliability of Photographic Diet Diaries for Assessing Dietary Intake Among Young Children

Obtaining valid, reliable dietary intake data for young children is challenging. The objective of this study was to assess the validity, reliability, and acceptability of the addition of photography to traditional written diet diaries for recording young children's dietary intake. Twenty-two parents of preschoolers enrolled to complete a 2-day photographic diet diary for their child. Diaries were coded by a trained nursing student for food weight, calories, and macronutrients. A random sample of diaries was evaluated by an independent nutritionist to determine interrater reliability. Convergent validity was tested by comparing visual estimates and actual values of photos of 24 researcher-created meals/snacks. Acceptability was assessed through participants' feedback, completion rates for the project, project costs, and quality of the data obtained. Reliability was assessed by computing intraclass correlations between caloric and macronutrient data from 2 independent diary evaluators. Convergent validity was assessed by calculating intraclass correlations between visually estimated photo diary evaluations and actual premeasured researcher-created meals/snacks. Medium to large correlations between the 2 independent evaluators (.51-.63) were found for caloric and macronutrient values, with the exception of protein (r = –.21). Strong correlations (food served, r = .69-.96; food consumed, r = .66-.83) were obtained between visual estimates and actual values of calories and macronutrients for the premeasured foods. Preliminary results indicate the addition of photographs to a traditional diet diary may enhance the validity and reliability of prospective dietary intake recording. Parents and children indicated the activity was fun, and quality data resulted, indicating that this method is acceptable.

Maternal fish consumption in the nutrition transition of the Amazon Basin: growth of exclusively breastfed infants during the first 5 years

BACKGROUND

Changes in fish-eating habits due to rapid urbanization in Western Amazon was used as model to investigate whether maternal fish-intake rate impacts on children's weight and height during the first 5 years.

AIM

The study examined the growth of 82 breastfed children, and maternal fish consumption (hair mercury concentrations, HHg) during pregnancy and lactation.

SUBJECTS AND METHODS

Fish consumption in mothers and children was estimated through HHg. The children were measured and weighed at birth and at 6 (exclusive breastfeeding), 36 and 60 months.

RESULTS

Fish consumption rate (HHg) had no significant impact on children's growth at the specified ages (p = 0.35). After 6 months of exclusive breastfeeding, children had the highest proportion of Z-scores <-1 SD; however, weaning (with extended breastfeeding) had a substantial impact in moving up the attained growth at 3 years. The duration of breastfeeding was significantly correlated with attained Z-scores for weight-for-age (r = 0.26; p = 0.02) and weight-for-height (r = 0.22; p = 0.04) but not for height-for-age. At 3 years most children had improved Z-scores (>-1 SD) for height-for-age (70/82), weight-for-age (74/82) and weight-for-height (74/82). At 5 years, all but one child attained Z-scores >-1.

CONCLUSION

The apparently good nutritional status of subjects is more likely due to a well balanced diet composition than to only one dietary protein source--fish.

Validity of photographs for food portion estimation in a rural West African setting

Objective

To validate food photographs for food portion size estimation of frequently consumed dishes, to be used in a 24-hour recall food consumption study of pregnant women in a rural environment in Burkina Faso. This food intake study is part of an intervention evaluating the efficacy of prenatal micronutrient supplementation on birth outcomes.

Subjects

Women of childbearing age (15–45 years).

Design

A food photograph album containing four photographs of food portions per food item was compiled for eight selected food items. Subjects were presented two food items each in the morning and two in the afternoon. These foods were weighed to the exact weight of a food depicted in one of the photographs and were in the same receptacles. The next day another fieldworker presented the food photographs to the subjects to test their ability to choose the correct photograph.

Results

The correct photograph out of the four proposed was chosen in 55% of 1028 estimations. For each food, proportions of underestimating and overestimating participants were balanced, except for rice and couscous. On a group level, mean differences between served and estimated portion sizes were between −8.4% and 6.3%. Subjects who attended school were almost twice as likely to choose the correct photograph. The portion size served (small vs. largest sizes) had a significant influence on the portion estimation ability.

Conclusions

The results from this study indicate that in a West African rural setting, food photographs can be a valuable tool for the quantification of food portion size on group level.

Alteration of dietary fat intake to prevent weight gain: Jayhawk Observed Eating Trial

OBJECTIVE

To examine the effects of ad libitum diets with three distinct levels of fat intake for the prevention of weight gain in sedentary, normal-weight and overweight men and women.

METHODS AND PROCEDURES

Three hundred and five participants were randomized to one of three diets. The diets targeted <25% of energy from fat (low fat (LF)), between 28 and 32% of energy from fat (moderate fat (MF)), or >35% of energy from fat (high fat (HF)). Participants consumed two meals per day on weekdays and one meal per day on weekends in a university cafeteria over a 12-week period. Energy and nutrient content of cafeteria foods were measured by digital photography. All meals and snacks consumed outside the cafeteria were measured by dietary recall. All analysis of energy and nutrient content was completed using Nutrition Data System for Research (NDS-R) version 2005.

RESULTS

Two hundred and sixty participants completed the study. LF gained 0.1 +/- 3.1 kg, MF gained 0.8 +/- 2.5 kg, and HF gained 1.0 +/- 2.2 kg and there was no gender or age effect. Longitudinal mixed modeling indicated a significant difference among the groups in weight over time (P = 0.0366). When adjusting for total energy intake, which was a significant predictor of weight over time, the global effect for the group was eliminated. Thus, increasing weight was a function of increasing energy but not increasing percentage of fat intake.

DISCUSSION

Energy intake, but not percentage of energy from fat, appears responsible for the observed weight gain. LF diets may contribute to weight maintenance and HF diets may promote weight gain due to the influence of fat intake on total energy intake.

Children's estimates of food portion size: the development and evaluation of three portion size assessment tools for use with children

A number of methods have been developed to assist subjects in providing an estimate of portion size but their application in improving portion size estimation by children has not been investigated systematically. The aim was to develop portion size assessment tools for use with children and to assess the accuracy of children's estimates of portion size using the tools. The tools were food photographs, food models and an interactive portion size assessment system (IPSAS). Children (n 201), aged 4–16 years, were supplied with known quantities of food to eat, in school. Food leftovers were weighed. Children estimated the amount of each food using each tool, 24 h after consuming the food. The age-specific portion sizes represented were based on portion sizes consumed by children in a national survey. Significant differences were found between the accuracy of estimates using the three tools. Children of all ages performed well using the IPSAS and food photographs. The accuracy and precision of estimates made using the food models were poor. For all tools, estimates of the amount of food served were more accurate than estimates of the amount consumed. Issues relating to reporting of foods left over which impact on estimates of the amounts of foods actually consumed require further study. The IPSAS has shown potential for assessment of dietary intake with children. Before practical application in assessment of dietary intake of children the tool would need to be expanded to cover a wider range of foods and to be validated in a ‘real-life’ situation.

Children’s Preference for Large Portions: Prevalence, Determinants, and Consequences

BACKGROUND

Proliferation of large portions of snack and fast foods parallels dramatic increases in childhood obesity. This study investigates the prevalence, determinants, and consequences of large portions in children's diets.

METHODS

As part of the 2003 Children's Lifestyle and School-performance Study, we surveyed 4,966 children in Nova Scotia regarding their usual portion sizes of french fries, meats, vegetables, and potato chips using three-dimensional graduated food models. We measured heights and weights and assessed dietary intake with the Harvard Youth Adolescent Food Frequency Questionnaire. Diet quality was summarized using the Diet Quality Index International (DQI-I). Parents were surveyed on food habits and socioeconomic background.

STATISTICAL ANALYSIS

We used multilevel regression methods to examine determinants of children's large portion size choice and to evaluate the effect of this selection on energy intake, diet quality, and overweight.

RESULTS

Children reported preference for portions of french fries, meats, and potato chips that are larger and vegetable portions that are smaller than what is recommended. Children from socioeconomically disadvantaged families or who frequently eat while watching television and in fast-food restaurants preferred larger portions of french fries and potato chips. Consequences of consuming large portions of these foods included poor diet quality and increased energy intake. Consuming large portions of vegetables was associated with lower energy intake and better diet quality.

CONCLUSIONS

Successful marketing of large portions of french fries and potato chips may be at the expense of diet quality and appropriate energy intake. Policy regulations and nutrition education emphasizing appropriate portion sizes provide opportunities to prevent overweight and improve future health.

Validity and Reproducibility of an Adolescent Web-Based Food Frequency Questionnaire

OBJECTIVE

To assess the validity and reproducibility of a newly developed, cost-effective, and easy to administer, Web-based food frequency questionnaire (FFQ) for the dietary assessment of adolescents.

DESIGN

Cross-sectional validation of a Web-based FFQ, which contained 15 food groups (water; soft drinks, including fruit juice and diet soft drinks; alcoholic beverages; soup; milk and milk products; fruit; sweet and savory snacks/fillings; sauces and fat spreads; breakfast cereals; bread; cheese, fish/eggs/meat; pasta/rice; vegetables; and potatoes). Reference data for validation were 3-day estimated food records. Analyses were done for all participants and for consumers only (consumer in both Web-based FFQ and food record).

SUBJECTS/SETTING

A selected group of adolescents (12 to 18 years of age, n=104) from participating secondary schools in Ghent, Belgium.

RESULTS

For all participants, the measured intakes of water, fruit, breakfast cereals, fish/eggs/meat, pasta/rice, and potatoes were not significantly different between the two methods. The Spearman correlation for all foods was on average 0.38 (ranging from 0.20 for pasta/rice to 0.64 for breakfast cereals). When analyzed for consumers only, the Web-based FFQ showed significantly lower estimates for soft drinks, sweet and savory snacks/fillings, sauces and fat spreads, cheese, pasta/rice, and vegetables. The average Spearman correlation for all foods collectively was 0.30. When reproducibility of the Web-based FFQ was assessed, the average Spearman correlation coefficient for all foods collectively was 0.62.

CONCLUSIONS

Most questions on the 15 food groups had acceptable reproducibility, whereas validation only showed reliable intakes for water, fruit, bread, and fish/eggs/meat. This Web-based FFQ could be a start for development of dietary assessment methods in public health nutrition contexts.