A Systematic Review of Ecological Momentary Assessment of Diet: Implications and Perspectives for Nutritional Epidemiology

Future Directions for Integrative Objective Assessment of Eating Using Wearable Sensing Technology

Established methods for nutritional assessment suffer from a number of important limitations. Diaries are burdensome to complete, food frequency questionnaires only capture average food intake, and both suffer from difficulties in self estimation of portion size and biases resulting from misreporting. Online and app versions of these methods have been developed, but issues with misreporting and portion size estimation remain. New methods utilizing passive data capture are required that address reporting bias, extend timescales for data collection, and transform what is possible for measuring habitual intakes. Digital and sensing technologies are enabling the development of innovative and transformative new methods in this area that will provide a better understanding of eating behavior and associations with health. In this article we describe how wrist-worn wearables, on-body cameras, and body-mounted biosensors can be used to capture data about when, what, and how much people eat and drink. We illustrate how these new techniques can be integrated to provide complete solutions for the passive, objective assessment of a wide range of traditional dietary factors, as well as novel measures of eating architecture, within person variation in intakes, and food/nutrient combinations within meals. We also discuss some of the challenges these new approaches will bring.

"Everyone can take photos." Feasibility and relative validity of phone photography-based assessment of children's diets - a mixed methods study

Background

Dietary assessment methods that are user-friendly, simple, yet valid are of interest to both researchers and participants, particularly for use in disadvantaged settings, where language barriers and low levels of education are often present. We tested if parents taking photos of what children ate, using mobile phones, would be a feasible, acceptable method that could still provide information with adequate relative validity.

Methods

We used a mixed-methods design, with parents of 21 5- to 7-year-olds from disadvantaged areas in Sweden. Parents reported all dietary intake, during non-school hours, on three days (two weekdays) using a photo method (PM). The PM consisted of simple instructions and a fiduciary card, but no training, equipment or software. Text messages could be sent if necessary. As a reference method, parents completed three 24-h recalls (24HRs) with an interviewer each following day. The next week, parents completed a 9-item semi-FFQ regarding the preceding week. The outcomes were intakes (in dl) of 9 food groups, categorised as fruits and vegetables, energy-dense sweet/salty foods, and sweet drinks. Agreement with the reference 24HRs was assessed using correlations, median differences and Bland-Altman plots. Parents completed an open-ended questionnaire on barriers and facilitators. Data collectors provided complementary information. Qualitative data was analysed using qualitative manifest analysis.

Results

Nineteen parents (90%) provided complete data. The majority (n = 13) spoke Swedish as a second language, few (n = 4) were proficient. Compared to 24HRs, intakes measured by PM correlated well for all categories (Spearman’s rho = 0.609–0.845). However, intakes were underreported, significantly so for fruits and vegetables; Bland-Altman plots indicated that the underestimation was fairly constant across intake levels. When the FFQ was compared to the 24HRs, parameters of agreement were generally inferior than for the PM. Parents found the PM a positive experience, primarily facilitated by its simplicity and familiarity. Barriers, mainly related to time and logistics, can inform further methodological refinements.

Conclusions

The PM was an acceptable and feasible way to measure children’s diet outside of school hours in this population of parents from disadvantaged areas. While the absolute validity should be evaluated further, this relatively simple method has potential for assessing intakes of well-defined foods at group level.

Momentary Physical Activity Co-Occurs with Healthy and Unhealthy Dietary Intake in African American College Freshmen

Background: Research investigating interrelations between physical activity and dietary intake has primarily used retrospective, summary-based measures of behavior subject to increased recall bias. This study used ecological momentary assessment (EMA) methods with accelerometry to determine within-day, momentary associations between physical activity and dietary intake behaviors in African American college freshmen. Methods: Participants (N = 50) completed a dietary EMA protocol that assessed food/fluids consumed over the past 2 h at five random times per day and wore an activPAL accelerometer for 7 days to measure physical activity. Physical activity was operationalized as step counts in the 2 h prior to the EMA prompt (matching the EMA recall window). Results: On occasions when participants took more steps than was typical for them in the 2 h prior to the EMA prompt, they were more likely to consume sugar-sweetened beverages (OR = 1.37, p < 0.001), water (OR = 1.28, p < 0.001), fruit (OR = 1.44, p < 0.001), vegetables (OR = 1.19, p = 0.02), and fried fast food (OR = 1.21, p = 0.04) over that same time. Conclusion: Momentary physical activity co-occurred with momentary consumption of both healthy and unhealthy dietary intake. These behavioral interrelations suggest potential implications for obesity risk and multiple health behavior change interventions in young adult African Americans.