A comparison of the remote food photography method and the automated self-administered 24-h dietary assessment tool for measuring full-day dietary intake among school-age children

Opportunities for Examining Child Health Impacts of Early-Life Nutrition in the ECHO Program: Maternal and Child Dietary Intake Data from Pregnancy to Adolescence

Background

Longitudinal measures of diet spanning pregnancy through adolescence are needed from a large, diverse sample to advance research on the effect of early-life nutrition on child health. The Environmental influences on Child Health Outcomes (ECHO) Program, which includes 69 cohorts, >33,000 pregnancies, and >31,000 children in its first 7-y cycle, provides such data, now publicly available.

Objectives

This study aimed to describe dietary intake data available in the ECHO Program as of 31 August, 2022 (end of year 6 of Cycle 1) from pregnancy through adolescence, including estimated sample sizes, and to highlight the potential for future analyses of nutrition and child health.

Methods

We identified and categorized ECHO Program dietary intake data, by assessment method, participant (pregnant person or child), and life stage of data collection. We calculated the number of maternal-child dyads with dietary data and the number of participants with repeated measures. We identified diet-related variables derived from raw dietary intake data and nutrient biomarkers measured from biospecimens.

Results

Overall, 66 cohorts (26,941 pregnancies, 27,103 children, including 22,712 dyads) across 34 US states/territories provided dietary intake data. Dietary intake assessments included 24-h recalls (1548 pregnancies and 1457 children), food frequency questionnaires (4902 and 4117), dietary screeners (8816 and 23,626), and dietary supplement use questionnaires (24,798 and 26,513). Repeated measures were available for ∼70%, ∼30%, and ∼15% of participants with 24-h recalls, food frequency questionnaires, and dietary screeners, respectively. The available diet-related variables describe nutrient and food intake, diet patterns, and breastfeeding practices. Overall, 17% of participants with dietary intake data had measured nutrient biomarkers.

Conclusions

ECHO cohorts have collected longitudinal dietary intake data spanning pregnancy through adolescence from a geographically, socioeconomically, and ethnically diverse US sample. As data collection continues in Cycle 2, these data present an opportunity to advance the field of nutrition and child health.

A Multimethod Evaluation of the Futuros Fuertes Intervention to Promote Healthy Feeding, Screen Time, and Sleep Practices

OBJECTIVE

1) To evaluate the impact of the Futuros Fuertes intervention on infant feeding, screen time, and sleep practices and 2) To use qualitative methods to explore mechanisms of action.

METHODS

Low-income Latino infant-parent dyads were recruited from birth to 1 month and randomized to Futuros Fuertes or a financial coaching control. Parents received health education sessions from a lay health educator at well-child visits in the first year of life. Parents received two text messages per week that reinforced intervention content. We assessed infant feeding, screen time, and sleep practices via surveys. body mass index z-score (BMI-z) was measured at 6 and 12 months. Seventeen parents from the intervention arm participated in a semi-structured interview that explored parental experiences with the intervention.

RESULTS

There were n = 96 infant-parent dyads randomized. Fruit intake was higher in the intervention group at 15 months (1.1 vs 0.86 cups p = 0.05). Breastfeeding rates were higher in intervention participants at 6 months (84% vs 59% p = 0.02) and 9 months (81% vs 51% p = 0.008). Mean daily screen time was lower among intervention participants at 6 months (7 vs 22 min p = 0.003), 12 months (35 vs 52 min p = 0.03), and 15 months (60 vs 73 min p = 0.03). Major qualitative themes include 1) parental trust in intervention messaging 2) changes in feeding and screen time parenting practices, 3) text messages supported behavior change for parents and family members, and 4) varying effectiveness of intervention on different health behaviors.

CONCLUSIONS

Low-income Latino infants participating in the Futuros Fuertes intervention had modestly healthier feeding and screen time practices compared to control participants.

CA, Catellier D, Cordero JF, Croen L, Dabelea D, Deoni S, D’Sa V, Duarte CS, Dunlop AL, Elliott AJ, Farzan SF, Ferrara A, Ganiban JM, Gern JE, Giardino AP, Towe-Goodman NR, Gold DR, Habre R, Hamra GB, Hartert T, Herbstman JB, Hertz-Picciotto I, Hipwell AE, Karagas MR, Karr CJ, Keenan K, Kerver JM, Koinis-Mitchell D, Lau B, Lester BM, Leve LD, Leventhal B, LeWinn KZ, Lewis J, Litonjua AA, Lyall K, Madan JC, McEvoy CT, McGrath M, Meeker JD, Miller RL, Morello-Frosch R, Neiderhiser JM, O’Connor TG, Oken E, O’Shea M, Paneth N, Porucznik CA, Sathyanarayana S, Schantz SL, Spindel ER, Stanford JB, Stroustrup A, Teitelbaum SL, Trasande L, Volk H, Wadhwa PD, Weiss ST, Woodruff TJ, Wright RJ, Zhao Q, Jacobson LP, Influences on Child Health Outcomes ,OBOPCFE. The Environmental Influences on Child Health Outcomes (ECHO)-Wide Cohort

The Environmental Influences on Child Health Outcomes (ECHO)-Wide Cohort Study (EWC), a collaborative research design comprising 69 cohorts in 31 consortia, was funded by the National Institutes of Health (NIH) in 2016 to improve children's health in the United States. The EWC harmonizes extant data and collects new data using a standardized protocol, the ECHO-Wide Cohort Data Collection Protocol (EWCP). EWCP visits occur at least once per life stage, but the frequency and timing of the visits vary across cohorts. As of March 4, 2022, the EWC cohorts contributed data from 60,553 children and consented 29,622 children for new EWCP data and biospecimen collection. The median (interquartile range) age of EWCP-enrolled children was 7.5 years (3.7-11.1). Surveys, interviews, standardized examinations, laboratory analyses, and medical record abstraction are used to obtain information in 5 main outcome areas: pre-, peri-, and postnatal outcomes; neurodevelopment; obesity; airways; and positive health. Exposures include factors at the level of place (e.g., air pollution, neighborhood socioeconomic status), family (e.g., parental mental health), and individuals (e.g., diet, genomics).

Dietary Behavior Assessments in Children-A Mixed-Method Research Exploring the Perspective of Pediatric Dieticians on Innovative Technologies

Background

Assessing dietary intake and eating behavior in children is challenging, owing to children's undeveloped food knowledge and perception of portion sizes. Additionally, caregivers cannot always provide complete surrogate information. Consequently, validated dietary behavior assessment methods for children are limited, but technological innovations offer opportunities for the development of new tools. One of the first steps in the developmental process of a newly developed pediatric dietary assessment tool includes an alignment of the needs and preferences of pediatric dieticians (PDs) as potential users.

Objectives

To explore opinions of Dutch PDs about traditional dietary behavior assessment methods for children and potential technological innovations to replace or support traditional methods.

Methods

Ten PDs participated in semistructured interviews (total of 7.5 h) based on 2 theoretical frameworks, and data saturation was reached after the seventh interview. Interview transcripts were inductively coded in an iterative process, and overarching themes and domains were identified. Interview data were then used as input for an extensive online survey completed by 31 PDs who were not involved in the initial interview rounds.

Results

PDs discussed their perspective on dietary behavior assessments in 4 domains: traditional methods, technological methods, future methods, and external influences on these methods. Generally, PDs felt that traditional methods supported them in reaching their desired goals. However, the time needed to obtain a comprehensive overview of dietary intake behavior and the reliability of conventional methods were mentioned as limitations. For future technologies, PDs mention the ease of use and engaging in children as opportunities.

Conclusions

PDs have a positive attitude toward the use of technology for dietary behavior assessments. Further development of assessment technologies should be tailored to the needs of children in different care situations and age categories to increase its usability among children, their caregivers, and dietician. Curr Dev Nutr 2023;xx:xx.

A Novel Approach to Dining Bowl Reconstruction for Image-Based Food Volume Estimation

Knowing the amounts of energy and nutrients in an individual's diet is important for maintaining health and preventing chronic diseases. As electronic and AI technologies advance rapidly, dietary assessment can now be performed using food images obtained from a smartphone or a wearable device. One of the challenges in this approach is to computationally measure the volume of food in a bowl from an image. This problem has not been studied systematically despite the bowl being the most utilized food container in many parts of the world, especially in Asia and Africa. In this paper, we present a new method to measure the size and shape of a bowl by adhering a paper ruler centrally across the bottom and sides of the bowl and then taking an image. When observed from the image, the distortions in the width of the paper ruler and the spacings between ruler markers completely encode the size and shape of the bowl. A computational algorithm is developed to reconstruct the three-dimensional bowl interior using the observed distortions. Our experiments using nine bowls, colored liquids, and amorphous foods demonstrate high accuracy of our method for food volume estimation involving round bowls as containers. A total of 228 images of amorphous foods were also used in a comparative experiment between our algorithm and an independent human estimator. The results showed that our algorithm overperformed the human estimator who utilized different types of reference information and two estimation methods, including direct volume estimation and indirect estimation through the fullness of the bowl.

A Qualitative Analysis of the Remote Food Photography Method and the Automated Self-Administered 24-hour Dietary Assessment Tool for Assessing Children's Food Intake Reported by Parent Proxy

BACKGROUND

Accuracy and participant burden are two key considerations in the selection of a dietary assessment tool for assessing children's full-day dietary intake.

OBJECTIVE

The aim of this study was to identify barriers experienced by parents and burden when using two technology-based measures of dietary intake to report their child's intake: the Remote Food Photography Method (RFPM) and the Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24).

DESIGN

Qualitative, semistructured, focus groups were conducted with parents who served as proxy reporters of their child's dietary intake using the two different dietary assessment methods (ie, RFPM and ASA24) 1 week apart.

PARTICIPANTS/SETTING

This study was conducted in 2019 and included 32 parents of children aged 7 to 8 years in Colorado and Louisiana.

MAIN OUTCOME MEASURES

Barriers adhering to the protocol and burden with the RFPM and ASA24.

QUALITATIVE ANALYSES

Qualitative content analysis and Atlas.ti software were used to analyze and interpret focus group data.

RESULTS

For the RFPM, parents described missing photos due to unobserved intake, forgetting to capture images, disruption of mealtimes, and child embarrassment when meals were photographed at school. For the ASA24, parents described the time commitment as the main source of burden and the need to expand the food database to include additional ethnic foods and restaurant items. The main strengths were ease of use for the RFPM and the consolidated workload for the ASA24.

CONCLUSIONS

The barriers experienced by parents and burden differed by method, highlighting the importance of considering the unique characteristics of each assessment tool when designing a pediatric dietary assessment study and interpreting findings.