Validation of photographic food records in children: are pictures really worth a thousand words?

Reliability of a frequency method for assessing vegetable intake using photos among college students: a smart phone approach

OBJECTIVE

To measure the interrater reliability of assessing the frequency of vegetable intake using mobile photos and descriptions.

DESIGN

Repeated measures design.

SETTING

A Midwestern university.

PARTICIPANTS

Undergraduate students (N = 165).

MEASURABLE OUTCOME/ANALYSIS

Number of times each of these vegetable subgroups were consumed daily: dark green vegetables, beans and peas, starchy vegetables, and other vegetables. Analysis: Two raters independently coded meals using mobile photos and descriptions of meals. Cohen κ was calculated to determine interrater reliability.

RESULTS

A value of κ = 0.9 (p < .001) was obtained, indicating an almost perfect agreement between the two raters. Nearly 92% of participants complied with providing photos along with descriptions of their meals.

CONCLUSIONS AND IMPLICATIONS

A frequency method using mobile photos and descriptions of meals is a reliable strategy to assess vegetable consumption. This frequency method can improve data quality, reduce participant burden, and minimize recall bias in college nutrition programs.

Design and Development of 'Diet DQ Tracker': A Smartphone Application for Augmenting Dietary Assessment

The purpose of the current study was to describe the design, development, and validation of the 'Diet DQ Tracker'. The 'Diet DQ Tracker' is the first self-administered smartphone app designed to collect dietary data for diet diversity indicators. The main objective of the app was to replace the traditional methods of dietary data collection, such as in-person or telephone 24 h recall via pen and paper questionnaire or tablets. The real-time meal recording, extensive food database, and automatic score calculations and visualizations for MDD-W, IYCF-MDD, and HDDS have the potential to overcome the drawbacks of 24 h recalls. Recall depends on respondent memory, food expertise, and time consumption and demands skilled interviewers. Further, SAIN, LIM recommendations in the app prompt users to diversify diets with healthy foods. The pilot study determined the acceptability, feasibility, and relative validity of the 'Diet DQ Tracker' with a 24 h dietary recall. The results demonstrated minimal differences in dietary scores by both methodologies. The app, being convenient, easy to use, less time-consuming, and enjoyable, was preferred by the entire study sample over 24 h recall. The app will be continually updated with foods from different cultures for validating in large-scale studies. The future studies will help to improve the subsequent versions of the app.

Validation of Dietary Intake Estimated by Web-Based Dietary Assessment Methods and Usability Using Dietary Records or 24-h Dietary Recalls: A Scoping Review

The goal was to summarize studies comparing the accuracy of web-based dietary assessments with those of conventional face-to-face or paper-based assessments using 24-h dietary recall or dietary record methods in the general population. Using two databases, mean differences and correlation coefficients (CCs) for intakes of energy, macronutrients, sodium, vegetables, and fruits were extracted from each study independently by the authors. We also collected information regarding usability from articles reporting this. From 17 articles included in this review, the mean dietary intake differences in the web-based dietary assessment compared to conventional methods, were -11.5-16.1% for energy, -12.1-14.9% for protein, -16.7-17.6% for fat, -10.8-8.0% for carbohydrates, -11.2-9.6% for sodium, -27.4-3.9% for vegetables, and -5.1-47.6% for fruits. The CC was 0.17-0.88 for energy, protein, fat, carbohydrates, and sodium, and 0.23-0.85 for vegetables and fruits. In three out of four studies reporting usability, more than half of the participants preferred the web-based dietary assessment. In conclusion, % difference and CC of dietary intake were acceptable in both web-based dietary records and 24-h dietary recalls. The findings from this review highlight the possibility of wide-spread application of the web-based dietary assessment in the future.

Development and Validation of the Vietnamese Children’s Short Dietary Questionnaire to Evaluate Food Groups Intakes and Dietary Practices among 9–11-Year-Olds Children in Urban Vietnam

This study aims to develop and assess the reproducibility and validity of the Vietnamese Children’s Short Dietary Questionnaire (VCSDQ) in evaluating food groups intakes and dietary practices among school-aged children 9–11 years old in urban Vietnam. A 26-item questionnaire covering frequency intakes of five core food groups, five non-core food groups, five dietary practices over a week, and daily intakes of fruits, vegetables, and water was developed. Children (n = 144) from four primary schools in four areas of Ho Chi Minh City, Vietnam completed the VCSDQ twice, as well as three consecutive 24 h recalls over a week. Intra-class correlation, Spearman correlation, weighted kappa, cross-classification, and Bland–Altman plots were used to evaluate the reproducibility and validity. The direct validity of food groups from VCSDQ against the 24 h recalls was examined using Wilcoxon-test for trend. The VCSDQ had good reproducibility in 12 out of 15 group items; the ICC ranged from 0.33 (grains) to 0.84 (eating while watching screens). This VCSDQ had low relative validity, two items (instant noodles, eating while watching screens) had a moderate to good agreement (k = 0.43, k = 0.84). There was good direct validity in three core-food groups (fruits, vegetables, dairy) and three non-core food groups (sweetened beverages, instant noodles, processed meat). In addition, the VCSDQ can also be used to classify daily intakes of fruits and vegetables from low to high.

Improvement of Methodology for Manual Energy Intake Estimation From Passive Capture Devices

Objective

To describe best practices for manual nutritional analyses of data from passive capture wearable devices in free-living conditions.

Method

18 participants (10 female) with a mean age of 45 ± 10 years and mean BMI of 34.2 ± 4.6 kg/m² consumed usual diet for 3 days in a free-living environment while wearing an automated passive capture device. This wearable device facilitates capture of images without manual input from the user. Data from the first nine participants were used by two trained nutritionists to identify sources contributing to inter-nutritionist variance in nutritional analyses. The nutritionists implemented best practices to mitigate these sources of variance in the next nine participants. The three best practices to reduce variance in analysis of energy intake (EI) estimation were: (1) a priori standardized food selection, (2) standardized nutrient database selection, and (3) increased number of images captured around eating episodes.

Results

Inter-rater repeatability for EI, using intraclass correlation coefficient (ICC), improved by 0.39 from pre-best practices to post-best practices (0.14 vs 0.85, 95% CI, respectively), Bland–Altman analysis indicated strongly improved agreement between nutritionists for limits of agreement (LOA) post-best practices.

Conclusion

Significant improvement of ICC and LOA for estimation of EI following implementation of best practices demonstrates that these practices improve the reproducibility of dietary analysis from passive capture device images in free-living environments.

Patient-Generated Health Photos and Videos Across Health and Well-being Contexts: Scoping Review

Background

Patient-generated health data are increasingly used to record health and well-being concerns and engage patients in clinical care. Patient-generated photographs and videos are accessible and meaningful to patients, making them especially relevant during the current COVID-19 pandemic. However, a systematic review of photos and videos used by patients across different areas of health and well-being is lacking.

Objective

This review aims to synthesize the existing literature on the health and well-being contexts in which patient-generated photos and videos are used, the value gained by patients and health professionals, and the challenges experienced.

Methods

Guided by a framework for scoping reviews, we searched eight health databases (CINAHL, Cochrane Library, Embase, PsycINFO, PubMed, MEDLINE, Scopus, and Web of Science) and one computing database (ACM), returning a total of 28,567 studies. After removing duplicates and screening based on the predefined inclusion criteria, we identified 110 relevant articles. Data were charted and articles were analyzed following an iterative thematic approach with the assistance of NVivo software (version 12; QSR International).

Results

Patient-generated photos and videos are used across a wide range of health care services (39/110, 35.5% articles), for example, to diagnose skin lesions, assess dietary intake, and reflect on personal experiences during therapy. In addition, patients use them to self-manage health and well-being concerns (33/110, 30%) and to share personal health experiences via social media (36/110, 32.7%). Photos and videos create significant value for health care (59/110, 53.6%), where images support diagnosis, explanation, and treatment (functional value). They also provide value directly to patients through enhanced self-determination (39/110, 35.4%), social (33/110, 30%), and emotional support (21/110, 19.1%). However, several challenges emerge when patients create, share, and examine photos and videos, such as limited accessibility (16/110, 14.5%), incomplete image sets (23/110, 20.9%), and misinformation through photos and videos shared on social media (17/110, 15.5%).

Conclusions

This review shows that photos and videos engage patients in meaningful ways across different health care activities (eg, diagnosis, treatment, and self-care) for various health conditions. Although photos and videos require effort to capture and involve challenges when patients want to use them in health care, they also engage and empower patients, generating unique value. This review highlights areas for future research and strategies for addressing these challenges.

Agreement between an Image-Based Dietary Assessment Method and a Written Food Diary among Adolescents with Type 1 Diabetes

Valid and useful dietary assessment methods for adolescents with type 1 diabetes (T1D) are needed. In this study, we compared an image-based method with a written food diary for dietary intake estimation among adolescents with T1D and evaluated the adolescents’ experiences of the methods. Adolescents with T1D aged 13 to 18 years (n = 13) photographed their meals (n = 264) with a mobile phone camera and simultaneously kept a written food diary for four consecutive days. The participants filled out electronic background and feedback questionnaires. The agreement between the methods was evaluated using intraclass correlation coefficients (ICCs) and Bland–Altman plot analyses. The agreement between the methods was moderate to excellent for the energy intake (ICC = 0.91, 95% confidence interval (CI): 0.66 to 0.97, p < 0.001) and good to excellent for total carbohydrate intake (ICC = 0.95, 95% CI: 0.84 to 0.99, p < 0.001). The adolescents considered photographing easier and faster than keeping a food diary. In conclusion, the image-based method appeared comparable to the food diary for dietary intake estimation among adolescents with T1D. The photographing of meals may become a useful dietary assessment tool for adolescents with T1D, but must be further developed and validated.

Reproducibility of Dietary Intake Measurement From Diet Diaries, Photographic Food Records, and a Novel Sensor Method

Objective: No data currently exist on the reproducibility of photographic food records compared to diet diaries, two commonly used methods to measure dietary intake. Our aim was to examine the reproducibility of diet diaries, photographic food records, and a novel electronic sensor, consisting of counts of chews and swallows using wearable sensors and video analysis, for estimating energy intake. Method: This was a retrospective analysis of data from a previous study, in which 30 participants (15 female), aged 29 ± 12 y and having a BMI of 27.9 ± 5.5, consumed three identical meals on different days. Four different methods were used to estimate total mass and energy intake on each day: (1) weighed food record; (2) photographic food record; (3) diet diary; and (4) novel mathematical model based on counts of chews and swallows (CCS models) obtained via the use of electronic sensors and video monitoring system. The study staff conducted weighed food records for all meals, took pre- and post-meal photographs, and ensured that diet diaries were completed by participants at the end of each meal. All methods were compared against the weighed food record, which was used as the reference method. Results: Reproducibility was significantly different between the diet diary and photographic food record for total energy intake (p = 0.004). The photographic record had greater reproducibility vs. the diet diary for all parameters measured. For total energy intake, the novel sensor method exhibited good reproducibility (repeatability coefficient (RC) of 59.9 (45.9, 70.4), which was better than that for the diet diary [RC = 79.6 (55.5, 103.3)] but not as repeatable as the photographic method [RC = 43.4 (32.1, 53.9)]. Conclusion: Photographic food records offer superior precision to the diet diary and, therefore, would be valuable for longitudinal studies with repeated measures of dietary intake. A novel electronic sensor also shows promise for the collection of longitudinal dietary intake data.

Development of a Smartphone Application for Dietary Self-Monitoring

This article describes the key features of the Well-D, a mobile dietary self-monitoring application developed to assess and track dietary intake. To test the acceptability of the app, 102 adults aged 18 years or older were asked to use Well-D for 3 days or more. After using the app, they recorded their likes/dislikes and recommendations regarding ways to improve Well-D. A mobile application for dietary assessment and monitoring may have the potential to help individuals and groups to engage in healthy behaviors.

A systematic review of mobile health interventions in China: Identifying gaps in care

INTRODUCTION

Mobile health has a promising future in the healthcare system in most developed countries. China's rapidly developing mobile technology infrastructure offers an unprecedented opportunity for wide adoption of mobile health interventions in the delivery of effective and timely healthcare services. However, there is little data on the current extent of the mobile health landscape in China. The aim of this study was to systematically review the existing mobile health initiatives in China, characterise the technology used, disease categories targeted, location of the end user (urban versus rural), and examine the potential effects of mobile health on health system strengthening in China. Furthermore, we identified gaps in development and evaluation of the effectiveness of mobile health interventions.

METHODS

A systematic review of the literature published from 18 December 2015 - 3 April 2019 was conducted and yielded 2863 articles from English and Chinese retrieval database and trial registries, including PubMed, EMBASE, China National Knowledge of Infrastructure and World Health Organization International Clinical Trials Registry Platform. Studies were included if they used mobile health to support patient healthcare outcomes.

RESULTS

A total of 1129 full-text articles were assessed and 338 were included in this study. The review found that most studies targeted client education and behaviour change via applications (apps) (65.4%), including WeChat, and text messaging (short text messages) (19.8%) to improve patient medical treatment outcomes such as compliance and appointment reminders. The most common disease-specific mobile health interventions focused primarily on chronic disease management and behaviour change in cardiology (13.3%), endocrinology/diabetes (12.1%), behavioural health (11.8%), oncology (11.2%) and neurology (6.8%). The mobile health interventions related to nutrition (0.6%) and chronic respiratory diseases (1.6%) are underrepresented in mobile health in comparison to the burden of disease in China. The majority (90.0%) of the mobile health interventions were conducted exclusively in urban areas, with few opportunities reaching rural populations.

CONCLUSIONS

Overall, mobile health has a promising future in China, with recent rapid growth in initiatives. The majority are focused on education and behaviour change in the realm of chronic diseases and target patients in urban areas. The imbalance in mobile health between the urban and rural areas, as well as between population disease spectrum and health service delivery, pose substantial dilemmas. However, mobile health may be redirected to correct this imbalance, possibly improving access to healthcare services, and filling the gaps in order to improve health equity for the underserved populations in China.

A Systematic Review of Technology-Driven Methodologies for Estimation of Energy Intake

Accurate measurement of energy intake (EI) is important for estimation of energy balance, and, correspondingly, body weight dynamics. Traditional measurements of EI rely on self-report, which may be inaccurate and underestimate EI. The imperfections in traditional methodologies such as 24-hour dietary recall, dietary record, and food frequency questionnaire stipulate development of technology-driven methods that rely on wearable sensors and imaging devices to achieve an objective and accurate assessment of EI. The aim of this research was to systematically review and examine peer-reviewed papers that cover the estimation of EI in humans, with the focus on emerging technology-driven methodologies. Five major electronic databases were searched for articles published from January 2005 to August 2017: Pubmed, Science Direct, IEEE Xplore, ACM library, and Google Scholar. Twenty-six eligible studies were retrieved that met the inclusion criteria. The review identified that while the current methods of estimating EI show promise, accurate estimation of EI in free-living individuals presents many challenges and opportunities. The most accurate result identified for EI (kcal) estimation had an average accuracy of 94%. However, collectively, the results were obtained from a limited number of food items (i.e., 19), small sample sizes (i.e., 45 meal images), and primarily controlled conditions. Therefore, new methods that accurately estimate EI over long time periods in free-living conditions are needed.

An Assessment of the Validity of an Audio-Video Method of Food Journaling for Dietary Quantity and Quality

Objective

To validate an audio-video (AV) method of food journaling, in a free-living scenario, compared to direct, weighed food assessment.

Design and Setting

Data were collected in a cafeteria. Meals, selected by participants (n=30), were documented using the AV method: participants video-recorded their tray while audio-recording a description of their selected meal, after which the research team digitally weighed each food item and created an itemized diary record of the food.

Variables Measured

Data from the AV method and from the weighed food diaries were transcribed and entered into a nutrition software analysis program (Nutribase Pro 10.0). Nutrient outputs were compared between the two methods including kilocalories, macronutrients, and selected micronutrients.

Analyses

Using mean scores for each variable, Wilcoxon signed-rank test and Spearman's correlation coefficients were conducted. Interclass correlation coefficient (ICC) was calculated for absolute agreement between the two methods to assess interrater reliability.

Results

With the exception of Vitamin E and total weight, nutrient values were highly correlated between methods and were statistically significant given alpha = 0.05, power = 0.95, and effect size of 0.70.

Conclusions

The AV method may be a meaningful alternative to diary recording in a free-living setting.

Statistical models for meal-level estimation of mass and energy intake using features derived from video observation and a chewing sensor

Accurate and objective assessment of energy intake remains an ongoing problem. We used features derived from annotated video observation and a chewing sensor to predict mass and energy intake during a meal without participant self-report. 30 participants each consumed 4 different meals in a laboratory setting and wore a chewing sensor while being videotaped. Subject-independent models were derived from bite, chew, and swallow features obtained from either video observation or information extracted from the chewing sensor. With multiple regression analysis, a forward selection procedure was used to choose the best model. The best estimates of meal mass and energy intake had (mean ± standard deviation) absolute percentage errors of 25.2% ± 18.9% and 30.1% ± 33.8%, respectively, and mean ± standard deviation estimation errors of −17.7 ± 226.9 g and −6.1 ± 273.8 kcal using features derived from both video observations and sensor data. Both video annotation and sensor-derived features may be utilized to objectively quantify energy intake.

The use of social media in nutrition interventions for adolescents and young adults-A systematic review

OBJECTIVE

Social media is a potentially engaging way to support adolescents and young adults in maintaining healthy diets and learning about nutrition. This review identifies interventions that use social media to promote nutrition, examines their content and features, and evaluates the evidence for the use of such platforms among these groups.

MATERIAL AND METHODS

We conducted a systematic search of 5 databases (PubMed, CINAHL, EMBASE, PsycINFO, and ACM Digital Library) for studies that included: 1) adolescents and/or young adults (ages 10-19; ages 18-25); 2) a nutrition education or behavior change intervention component, or outcomes related to nutrition knowledge or dietary changes; and 3) a social media component that allowed users to communicate or share information with peers.

RESULTS

16 articles were identified that included a social media component in a nutrition-related intervention for adolescents or young adults. Interventions included features in 7 categories: social media; communication; tracking health; education; tailoring; social support; and gamification. 11 out of the 16 studies had at least one significant nutrition-related clinical or behavioral outcome.

CONCLUSION

Social media is a promising feature for nutrition interventions for adolescents and young adults. A limited number of studies were identified that included social media. A majority of the identified studies had positive outcomes. We found that most studies utilized only basic social media features, did not evaluate the efficacy of social media components, and did not differentiate between the efficacy of social media compared to other delivery mechanisms.

Digital Food Records in Community-Based Interventions: Mixed-Methods Pilot Study

BACKGROUND

A pressing need exists to understand and optimize the use of dietary assessment tools that can be used in community-based participatory research (CBPR) interventions. A digital food record, which uses a mobile device to capture the dietary intake through text and photography inputs, is a particularly promising mobile assessment method. However, little is understood about the acceptability and feasibility of digital food records in CBPR and how to best tailor dietary assessment tools to the needs of a community.

OBJECTIVE

The objective of our study was to evaluate the acceptability and feasibility of digital food records among church-based populations in resource-limited wards of Washington, DC, USA, using a mixed-methods approach.

METHODS

This community-based pilot study was conducted as part of the Washington, DC Cardiovascular Health and Needs Assessment. Participants (n=17) received a mobile device (iPod Touch) to photodocument their dietary intake for a 3-day digital food record using a mobile app, FitNinja (Vibrent Health). The acceptability of the digital food record was explored through the thematic analysis of verbatim transcripts from a moderated focus group (n=8). In addition, the feasibility was evaluated by the percentage of participants complying with instructions (ie, capturing both before and after meal photos for at least 2 meals/day for 3 days).

RESULTS

Qualitative themes identified were related to (1) the feasibility and acceptability of the mobile device and app, including issues in recording the dietary information and difficulty with photodocumentation; (2) suggestions for additional support and training experiences; and (3) comparisons with other mobile apps. Overall, the participants accepted the digital food record by demonstrating satisfaction with the tool and intent to continue the use (eg, participants recorded an average of 5.2, SD 7, consecutive days). Furthermore, of the 17 participants, 15 photodocumented at least 1 meal during the study period and 3 fully complied with the digital food record instructions.

CONCLUSIONS

This study demonstrated digital food records as an acceptable tool in CBPR and identified contributors and barriers to the feasibility of digital food records for future research. Engaging community members in the implementation of novel assessment methods allows for the tailoring of technology to the needs of the community and optimizing community-based interventions.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01927783; https://www.clinicaltrials.gov/ct2/show/NCT01927783 (Archived by WebCite at http://www.webcitation.org/70WzaFWb6).

Validation of a photographic seafood portion guide to assess fish and shrimp intakes

Objective

To validate a novel photographic portion guide as a tool to estimate consumption of fish and shrimp. Application of such a validated tool can facilitate accurate individual and community seafood intake assessments and provide meaningful data relative to health benefits and hazard assessment, particularly in response to environmental contamination and disasters.

Design

A photographic fish and shrimp portion guide presenting a stepped range of cooked portion sizes was used by participants to estimate their typical portion sizes. Participants selected their typical portion size from the photographic guide and also from a selection of freshly cooked reference meals. Photographic portions selections were compared with plated reference portions for each participant.

Setting

Academic sensory testing laboratory in the USA.

Subjects

Separate groups of adults (25–64 years) contributed to fish (n 54) and shrimp (n 53) portion size comparison studies.

Results

In the fish study, there was no difference between photographic portion selections (6·59 (sd 2·65) oz (186·8 (sd 75·1) g)) and reference plate selections (7·04 (sd 2·63) oz (199·6 (sd 74·6) g); P=0·384). Similarly in the shrimp study, there was no difference between photographic portion selections (6·88 (sd 3·40) oz (195·0 (sd 96·4) g)) and reference plate selections (6·06 (sd 2·65) oz (171·8 (sd 75·1) g); P=0·159). Photographic portions predicted plated reference portions for both fish and shrimp based on linear regression (P<0·001). Bland–Altman plot analyses showed good agreement between the two methods, <1 oz (<28·3 g) bias, in both fish and shrimp studies.

Conclusions

This validated photographic seafood portion guide provides a utilitarian tool for accurately assessing fish and shrimp intake in a community setting.

Evaluation of food photographs assessing the dietary intake of children up to 10 years old

OBJECTIVE

Young children lack basic skills related to recognizing the types of foods they consume and dietary surveys often rely on parents' response. The present study aimed to evaluate how well parents of children aged from 3 months to 10 years perceive images of portions of foods commonly consumed by young children.

DESIGN

Pre-weighed, actual food portions (n 2314) were shown to the study participants who were asked to indicate the picture that corresponded to the food in view. Mean differences between picture numbers selected and shown were estimated and compared using unpaired t tests or Tukey-Cramer pairwise comparisons.

SETTING

Real-time testing of parents' perception of food images presenting portion sizes consumed by children up to 10 years old.

SUBJECTS

A convenience sample of 138 parents/caregivers of young children (69 % females).

RESULTS

Individuals selected the correct or adjacent image in about 97 % of the assessments. Images presenting amorphous solids (i.e. pies and pastries with a filling), liquid or semi-liquid dishes (i.e. soups, porridges, fruit and vegetable purées) were more prone to bias. There was no indication that personal characteristics (gender, age, educational background, age, number of offspring) were associated with differences in the way parents/caregivers perceived the food pictures.

CONCLUSIONS

Food pictures may not be appropriate to quantify the intake of liquid, semi-liquid or amorphous solid foods in surveys addressing young children and studies evaluating their performance as food portion anchors should ensure the inclusion of several and various amorphous foods in the assessment.

Adherence to self-monitoring healthy lifestyle behaviours through mobile phone-based ecological momentary assessments and photographic food records over 6 months in mostly ethnic minority mothers

OBJECTIVE

Mobile phones can replace traditional self-monitoring tools through cell phone-based ecological momentary assessment (CEMA) of lifestyle behaviours and camera phone-based images of meals, i.e. photographic food records (PFR). Adherence to mobile self-monitoring needs to be evaluated in real-world treatment settings. Towards this goal, we examine CEMA and PFR adherence to the use of a mobile app designed to help mothers self-monitor lifestyle behaviours and stress. Design/Setting In 2012, forty-two mothers recorded CEMA of diet quality, exercise, sleep, stress and mood four times daily and PFR during meals over 6 months in Los Angeles, California, USA.

SUBJECTS

A purposive sample of mothers from mixed ethnicities.

RESULTS

Adherence to recording CEMA at least once daily was higher compared with recording PFR at least once daily over the study period (74 v. 11 %); adherence to both types of reports decreased over time. Participants who recorded PFR for more than a day (n 31) were more likely to be obese v. normal- to overweight and to have higher blood pressure, on average (all P<0·05). Based on random-effects regression, CEMA and PFR adherence was highest during weekdays (both P<0·01). Additionally, PFR adherence was associated with older age (P=0·04). CEMA adherence was highest in the morning (P<0·01). PFR recordings occurred throughout the day.

CONCLUSIONS

Variations in population and temporal characteristics should be considered for mobile assessment schedules. Neither CEMA nor PFR alone is ideal over extended periods.

Do Image-Assisted Mobile Applications Improve Dietary Habits, Knowledge, and Behaviours in Elite Athletes? A Pilot Study

To date, there has been a paucity of research on optimal ways to educate and promote dietary behavioural change within athletes. Optimising athlete nutrition is fundamental to reaching peak performance and maintaining athlete wellbeing. MealLogger^® is a smartphone application that incorporates the use of an image-based food record and social-media functionality to provide in-application personalised feedback to individuals or groups, peer-support, and a platform to deliver nutrition education material. This study measured the feasibility of MealLogger^® within New Zealand elite male field hockey players (n = 17) aged 18–20 to increase athlete knowledge and nutrition promoting behaviours. During a six-week intervention, participants were instructed to log images of their meals three days per week and they received individualised dietetic feedback on logged meals. Weekly nutrition-education fact-sheets and videos were delivered through the application. Nutrition knowledge increased moderately from baseline (%Pre 54.7 ± 14.3; %Post 61.1 ± 11.45, p = 0.01). Participants report a highly positive experience of application use (8/10) with 82.3% attempting to make positive changes in dietary behaviours based on in-app education. All participants preferred this method to traditional methods of dietary analysis. Using image-based applications such as MealLogger^® is an effective approach to monitor dietary intake and deliver education to optimise the nutritional behaviours of elite athletes.

Novel Online or Mobile Methods to Assess Eating Patterns

Purpose of Review

Recent developments in technology-based dietary assessment allow real-time data collection of eating occasions, yet their application to assessing eating pattern constructs has not been evaluated. The purpose of this review was to examine existing electronic and mobile food diary methods in relation to their ability to assess eating patterns constructs (e.g. patterning, format and context of eating occasions).

Recent Findings

A systematic search of electronic databases identified 18 dietary assessment methods. Multiple methods with diverse technological capabilities have been developed, yet few studies report on their ability to assess all eating pattern constructs, particularly eating occasion context. Validity of the methods to assess overall dietary intake was found to be similar to traditional dietary assessment methods.

Summary

A diverse range of methods are available for examining the patterning and format/content, but not context, of eating occasions. Further consideration of eating pattern constructs is required when developing dietary assessment methods.

A feasibility study with process evaluation of a preschool intervention to improve child and family lifestyle behaviours

Background

Around a fifth of children starting school in England are now overweight/obese. There is a paucity of interventions with the aim of obesity prevention in preschool-age children in the UK. Previous research has demonstrated some positive results in changing specific health behaviours, however, positive trends in overall obesity rates are lacking. Preschool settings may provide valuable opportunities to access children and their families not only for promoting healthy lifestyles, but also to develop and evaluate behaviour-change interventions.

Methods

This paper presents a cluster randomised feasibility study of a theory based behaviour-change preschool practitioner-led intervention tested in four preschool centres in the North East of England. The primary outcome measures were to test the acceptability and feasibility of the data collection measures and intervention. Secondary measures were collected and reported for extra information. At baseline and post intervention, children’s anthropometric, dietary and physical activity measures as well as family ‘active’ time data were collected. The preschool practitioner-led intervention included family intervention tasks such as ‘family goal-setting activities’ and ‘cooking challenges’. Preschool activities included increasing physical activity and providing activities with the potential to change behaviour with increased knowledge of and acceptance of healthy eating. The process evaluation was an on-going monthly process and was collected in multiple forms such as questionnaires, photographs and verbal feedback.

Results

‘Gatekeeper’ permission and lower-hierarchal adherence were initially a problem for recruitment and methods acceptance. However, at intervention end the preschool teachers and parents stated they found most intervention methods and activities acceptable, and some positive changes in family health behaviours were reported. However, the preschool centres appeared to have difficulties with enforcing everyday school healthy eating policies.

Conclusions

The findings from the current study may have implications for nursery practitioners, nursery settings, Local Educational Authorities and policy makers, and contributes to the body of literature. However, further work with preschool practitioners is required to determine how personal attitudes and school policy application can be supported to implement successfully such an intervention.

Trial registration

ISRCTN12345678 (16/02/17) retrospectively registered.

Development and Validation of a Photographic Method to Use for Dietary Assessment in School Settings

OBJECTIVE

To develop and validate a photographic method aimed at making assessment of dietary intake in school canteens non-obstrusive, practical and feasible.

METHODS

The study was conducted in two elementary schools representing two different school canteen systems; main dish being served by canteen staff (Iceland), and complete self-serving (Sweden). Food items in serving and leftovers were weighed and photographed. Trained researchers estimated weights of food items by viewing the photographs and comparing them with pictures of half and full reference portions with known weights. Plates of servings and leftovers from 48 children during five school days (n = 448 plates) and a total of 5967 food items were estimated. The researchers' estimates were then compared with the true weight of the foods and the energy content calculated.

RESULTS

Weighed and estimated amounts correlated across meals both in grams and as total energy (0.853-0.977, p<0.001). The agreement between estimated energy content in school meals was close to the true measurement from weighed records; on average 4-19 kcal below true values. Organisation of meal service impacted the efficacy of the method as seen in the difference between countries; with Iceland (served by canteen staff) having higher rate of acceptable estimates than Sweden (self-serving), being 95% vs 73% for total amount (g) in serving. Iceland more often had serving size between or above the half and full reference plates compared with Sweden.

CONCLUSIONS

The photographic method provides acceptable estimates of food and energy intake in school canteens. However, greater accuracy can be expected when foods are served by canteen staff compared with self-serving.

Using Personal Mobile Phones to Assess Dietary Intake in Free-Living Adolescents: Comparison of Face-to-Face Versus Telephone Training

Background

Traditional paper-based methods to assess food intake can be cumbersome for adolescents; use of mobile phones to track and photograph what they eat may be a more convenient, reliable, and compelling way to collect data.

Objective

Our aims were to determine (1) the feasibility of using personal mobile phones to send food records with digital images (FRDIs) among free-living adolescents and (2) whether the quality of food records differed between a high-level intervention group (ie, face-to-face training plus real-time support) and a low-level intervention group (ie, telephone training plus next-day follow-up).

Methods

Adolescents (N=42, 11 males and 31 females) aged 12-18 years who had a mobile phone with camera enrolled in the study via consecutive sampling. The first group (n=21) received face-to-face training while the second group (n=21) was trained via telephone. Participants received a fiducial marker (FM) and completed a 1-day FRDI using their mobile phones. At every eating occasion, participants were to (1) take clear images of their meals/food with a correctly placed fiducial marker before eating, (2) send the image immediately to a designated email address, (3) right after completing a meal, send a text message listing the time and name of the meal, foods eaten, and amounts eaten, and (4) before sleep, send an “end” text message to indicate completion of food recording. Those who received face-to-face training received real-time support during reporting; those trained by telephone received next-day follow-up. Descriptive statistics and comparison tests were used to determine performance of the groups.

Results

All participants (N=42) who underwent training completed their 1-day FRDI. A significantly greater proportion of the low-level intervention group compared to the high-level intervention group placed their FM correctly in the image (95% vs 43%, P<.001), had complete information for each meal in their food record (95% vs 71%, P=.04), and had a higher overall score in meeting the criteria for food recording (4.3 vs 3.4 out of 5 points). Both groups had energy intake values that moderately correlated with their estimated energy requirements: low-intervention r=.55; high-intervention r=.51.

Conclusions

Using personal mobile phones to report dietary intake via texting and digital images is feasible among free-living adolescents. Real-time support or high-level intervention does not guarantee better food recording quality among adolescents.

A mobile phone food record app to digitally capture dietary intake for adolescents in a free-living environment: usability study

Background

Mobile technologies are emerging as valuable tools to collect and assess dietary intake. Adolescents readily accept and adopt new technologies; thus, a food record app (FRapp) may be a useful tool to better understand adolescents’ dietary intake and eating patterns.

Objective

We sought to determine the amenability of adolescents, in a free-living environment with minimal parental input, to use the FRapp to record their dietary intake.

Methods

Eighteen community-dwelling adolescents (11-14 years) received detailed instructions to record their dietary intake for 3-7 days using the FRapp. Participants were instructed to capture before and after images of all foods and beverages consumed and to include a fiducial marker in the image. Participants were also asked to provide text descriptors including amount and type of all foods and beverages consumed.

Results

Eight of 18 participants were able to follow all instructions: included pre- and post-meal images, a fiducial marker, and a text descriptor and collected diet records on 2 weekdays and 1 weekend day. Dietary intake was recorded on average for 3.2 (SD 1.3 days; 68% weekdays and 32% weekend days) with an average of 2.2 (SD 1.1) eating events per day per participant. A total of 143 eating events were recorded, of which 109 had at least one associated image and 34 were recorded with text only. Of the 109 eating events with images, 66 included all foods, beverages and a fiducial marker and 44 included both a pre- and post-meal image. Text was included with 78 of the captured images. Of the meals recorded, 36, 33, 35, and 39 were breakfasts, lunches, dinners, and snacks, respectively.

Conclusions

These data suggest that mobile devices equipped with an app to record dietary intake will be used by adolescents in a free-living environment; however, a minority of participants followed all directions. User-friendly mobile food record apps may increase participant amenability, increasing our understanding of adolescent dietary intake and eating patterns. To improve data collection, the FRapp should deliver prompts for tasks, such as capturing images before and after each eating event, including the fiducial marker in the image, providing complete and accurate text information, and ensuring all eating events are recorded and should be customizable to individuals and to different situations.

Trial Registration

Clinicaltrials.gov NCT01803997. http://clinicaltrials.gov/ct2/show/NCT01803997 (Archived at: http://www.webcitation.org/6WiV1vxoR).

Image-assisted dietary assessment: a systematic review of the evidence

Images captured during eating episodes provide objective information to assist in the assessment of dietary intake. Images are captured using handheld devices or wearable cameras, and can support traditional self-report or provide the primary record of dietary intake. A diverse range of image-assisted methods have been developed and evaluated but have not been previously examined together. Therefore, a review was undertaken to examine all studies that have evaluated or validated image-assisted methods of dietary assessment for assessing dietary energy intake. Identified image-assisted methods that employ similar methodologies were grouped for comparison. English-language full-text research articles published between January 1998 and November 2013 were searched using five electronic databases. A search of reference lists and associated websites was also conducted. Thirteen studies that evaluated 10 unique image-assisted methods among adults aged 18 to 70 years were included. Ten studies used handheld devices and three studies used wearable cameras. Eight studies evaluated image-based food records, two studies explored the use of images to enhance written food records, and three studies evaluated image-assisted 24-hour dietary recalls. Results indicate images enhance self-report by revealing unreported foods and identify misreporting errors not captured by traditional methods alone. Moreover, when used as the primary record of dietary intake, images can provide valid estimates of energy intake. However, image-assisted methods that rely on image analysis can be prone to underestimation if users do not capture images of satisfactory quality before all foods are consumed. Further validation studies using criterion measures are warranted. The validity among children, adolescents, and elderly persons as well as the feasibility of using image-assisted methods in large samples needs to be examined. Additional research is also needed to better understand the potential applications and pitfalls of wearable cameras.

Energy intake estimation from counts of chews and swallows

Current, validated methods for dietary assessment rely on self-report, which tends to be inaccurate, time-consuming, and burdensome. The objective of this work was to demonstrate the suitability of estimating energy intake using individually-calibrated models based on Counts of Chews and Swallows (CCS models). In a laboratory setting, subjects consumed three identical meals (training meals) and a fourth meal with different content (validation meal). Energy intake was estimated by four different methods: weighed food records (gold standard), diet diaries, photographic food records, and CCS models. Counts of chews and swallows were measured using wearable sensors and video analysis. Results for the training meals demonstrated that CCS models presented the lowest reporting bias and a lower error as compared to diet diaries. For the validation meal, CCS models showed reporting errors that were not different from the diary or the photographic method. The increase in error for the validation meal may be attributed to differences in the physical properties of foods consumed during training and validation meals. However, this may be potentially compensated for by including correction factors into the models. This study suggests that estimation of energy intake from CCS may offer a promising alternative to overcome limitations of self-report.

Considering the value of dietary assessment data in informing nutrition-related health policy

Dietary assessment has long been known to be challenged by measurement error. A substantial amount of literature on methods for determining the effects of error on causal inference has accumulated over the past decades. These methods have unrealized potential for improving the validity of data collected for research studies and national nutritional surveillance, primarily through the NHANES. Recently, the validity of dietary data has been called into question. Arguments against using dietary data to assess diet-health relations or to inform the nutrition policy debate are subject to flaws that fall into 2 broad areas: 1) ignorance or misunderstanding of methodologic issues; and 2) faulty logic in drawing inferences. Nine specific issues are identified in these arguments, indicating insufficient grasp of the methods used for assessing diet and designing nutritional epidemiologic studies. These include a narrow operationalization of validity, failure to properly account for sources of error, and large, unsubstantiated jumps to policy implications. Recent attacks on the inadequacy of 24-h recall-derived data from the NHANES are uninformative regarding effects on estimating risk of health outcomes and on inferences to inform the diet-related health policy debate. Despite errors, for many purposes and in many contexts, these dietary data have proven to be useful in addressing important research and policy questions. Similarly, structured instruments, such as the food frequency questionnaire, which is the mainstay of epidemiologic literature, can provide useful data when errors are measured and considered in analyses.

Evaluation of photographs supporting an FFQ developed for adolescents

OBJECTIVE

To evaluate the validity of food photographs used to support the reporting of food intake with an FFQ designed for adolescents from Rio de Janeiro, Brazil.

DESIGN

A set of ninety-five food photographs was elaborated. The photographs' evaluation process included the acknowledgement of foods and portions in the pictures. In the identification of foods (ninety-five photographs) and typical portions (twelve photographs), the adolescents were requested to answer a structured questionnaire related to the food photographs. The identification of the portion size of amorphous foods (forty-three photographs) was performed using three different portion sizes of actual preparations. The proportions (and 95% confidence intervals) of adolescents who correctly identified foods and portion size in each photograph were estimated.

SETTING

A public school in Niterói, Rio de Janeiro State, Brazil.

SUBJECTS

Sixty-two adolescents between 11·0 and 18·9 years old, randomly selected.

RESULTS

At least 90% of adolescents correctly identified the food in ninety-two photographs and the food in the three remaining photographs was recognized by 80-89% of the adolescents. At least 98% of the adolescents correctly identified eleven typical or natural portions in the food photographs. For amorphous foods, at least 70% of teenagers correctly identified the portion size in the photograph of thirty-one foods; for the other photographs, the portion size was correctly recognized by 50-69% of the adolescents for eight foods and by less than 50% of adolescents for four foods.

CONCLUSIONS

The analysed photographs are appropriate visual aids to the reporting of food consumption by adolescents.

Digital photography as an educational food logging tool in obese patients with type 2 diabetes: lessons learned from a randomized, crossover pilot trial

PURPOSE

The purpose of this pilot study is to investigate the utility of, and areas of refinement for, digital photography as an educational tool for food logging in obese patients with type 2 diabetes (T2DM).

METHODS

Thirty-three patients aged 18 to 70 with T2DM, body mass index at least 30 kg/m(2), and A1C 7.5% to 9% were recruited from an endocrinology clinic and randomized to a week of food logging using a digital camera (DC) or paper diary (PD), crossing over for week 2. Patients then viewed a presentation about dietary effects on blood glucose, using patient DC and blood glucose entries. Outcomes of adherence (based on number of weekly entries), changes in mean blood glucose and frequency of blood glucose checks, and patient satisfaction were compared between methods. Patient feedback on the DC intervention and presentation was also analyzed.

RESULTS

Thirty patients completed the study. Adherence was identical across methods. The mean difference in number of entries was not significant between methods. This difference increased and neared statistical significance (favoring DC) among patients who were adherent for at least 1 week (21 entries, with 2 entries per day for 5 of 7 days, n = 25). Mean blood glucose did not significantly decrease in either method. Patient satisfaction was similar between interventions. Feedback indicated concerns over photograph accuracy, forgetting to use the cameras, and embarrassment using them in public.

CONCLUSION

Although the DC method was comparable to PD in adherence, blood glucose changes, and patient satisfaction in this pilot trial, patient feedback suggested specific areas of refinement to maximize utility of DC-based food logging as an educational tool in T2DM.

Photo-assisted recall increases estimates of energy and macronutrient intake in adults with intellectual and developmental disabilities

Diet assessment of adults with intellectual and developmental disabilities is challenging because of their limited cognitive abilities. The objective of this study was to examine the feasibility and outcomes of combining photos with 24-hour dietary recalls for the assessment of energy and macronutrient intakes in adults with intellectual and developmental disabilities. Participants used an iPad 2 tablet computer (Apple) to take photos of all food and beverages consumed before a standard, multiple-pass, 24-hour dietary recall. After the standard 24-hour diet recall, the photos were reviewed with the participant for clarification details (eg, portion size) and differences were recorded. The standard 24-hour recall and photo-assisted recall were entered separately into the Nutrition Data System for Research for computerized dietary analysis. Sixty-four eating occasions were entered from 23 participants (48% female; mean age 26.4±9.7 years). Participants captured photos for 66.5%±30.4% of all recorded eating occasions. Greater energy intake per eating occasion was reported with the photo-assisted recalls than the standard recalls (625.6±85.7 kcal vs 497.2±86.6 kcal; P=0.002) and a greater intake of grams of fat (P=0.006), protein (P=0.029), and carbohydrates (P=0.003). Photo-assisted 24-hour recalls provided a significant increase in total calories and macronutrient content compared with a standard 24-hour recall and may be a feasible method to enhance dietary assessment in adults with intellectual and developmental disabilities.

Feasibility of a SenseCam-assisted 24-h recall to reduce under-reporting of energy intake

BACKGROUND/OBJECTIVES

The SenseCam is a camera worn on a lanyard around the neck that automatically captures point-of-view images in response to movement, heat and light (every 20-30 s). This device may enhance the accuracy of self-reported dietary intake by assisting participants' recall of food and beverage consumption. It was the objective of this study to evaluate if the wearable camera, SenseCam, can enhance the 24-h dietary recall by providing visual prompts to improve recall of food and beverage consumption.

SUBJECT/METHODS

Thirteen volunteer adults in Oxford, United Kingdom, were recruited. Participants wore the SenseCam for 2 days while continuing their usual daily activities. On day 3, participants' diets were assessed using an interviewer-administered 24-h recall. SenseCam images were then shown to the participants and any additional dietary information that participants provided after viewing the images was recorded. Energy and macronutrient intakes were compared between the 24-h recall and 24-h recall+SenseCam.

RESULTS

Data from 10 participants were included in the final analysis (8 males and 2 females), mean age 33 ± 11 years, mean BMI 25.9 ± 5.1 kg/m(2). Viewing the SenseCam images increased self-reported energy intake by approximately 1432 ± 1564 kJ or 12.5% compared with the 24-h recall alone (P=0.02). The increase was predominantly due to reporting of 41 additional foods (241 vs 282 total foods) across a range of food groups. Eight changes in portion size were made, which resulted in a negligible change to energy intake.

CONCLUSIONS

Wearable cameras are promising method to enhance the accuracy of self-reported dietary assessment methods.

Validation of a digital photographic method for assessment of dietary quality of school lunch sandwiches brought from home

Background

It is a challenge to assess children's dietary intake. The digital photographic method (DPM) may be an objective method that can overcome some of these challenges.

Objective

The aim of this study was to evaluate the validity and reliability of a DPM to assess the quality of dietary intake from school lunch sandwiches brought from home among children aged 7–13 years.

Design

School lunch sandwiches (n=191) were prepared to represent randomly selected school lunch sandwiches from a large database. All components were weighed to provide an objective measure of the composition. The lunches were photographed using a standardised DPM. From the digital images, the dietary components were estimated by a trained image analyst using weights or household measures and the dietary quality was assessed using a validated Meal Index of Dietary Quality (Meal IQ). The dietary components and the Meal IQ obtained from the digital images were validated against the objective weighed foods of the school lunch sandwiches. To determine interrater reliability, the digital images were evaluated by a second image analyst.

Results

Correlation coefficients between the DPM and the weighed foods ranged from 0.89 to 0.97. The proportion of meals classified in the same or an adjacent quartile ranged from 98% (starch) to 100% (fruits, vegetables, fish, whole grain, and Meal IQ). There was no statistical difference between fish, fat, starch, whole grains, and Meal IQ using the two methods. Differences were found for fruits and vegetables; Bland–Altman analyses showed a tendency to underestimate high amounts of these variables using the DPM. For interrater reliability, kappa statistics ranged from 0.59 to 0.82 across the dietary components and Meal IQ.

Conclusions

The standardised DPM is a valid and reliable method for assessing the dietary quality of school lunch sandwiches brought from home.

Using a wearable camera to increase the accuracy of dietary analysis

BACKGROUND

Food diaries are commonly used to assess individual dietary intake in both the general and sporting populations. Despite the widespread use of such diaries, evidence suggests that individuals' self-reported energy intake frequently and substantially underestimate true energy intake.

PURPOSE

To examine the use of the Microsoft SenseCam wearable camera to help more accurately report dietary intake within various sporting populations.

METHODS

In 2011, a total of 47 participants were recruited to take part in this study (17 trainee jockeys, 15 elite Gaelic footballers, and 15 healthy physically active university students). Participants wore a SenseCam for 1 day (from morning until night) while simultaneously keeping a 1-day food diary. Comparisons were made between the energy intake reported in the food diary alone and the food diary in conjunction with information gathered from the SenseCam. Data analysis was conducted in 2012.

RESULTS

Mean total calorie intake using diary alone and diary and SenseCam were 2349±827.9 kcals vs 2631±893.4 kcal for the trainee jockeys; 2600±521.9 kcal vs 3191±770.2 kcal for the Gaelic footballers, and 2237±318.5 kcal vs 2487±404.6 kcal for the university students. This represented a difference of 10.7% (p≤0.001); 17.7% (p≤0.001); and 10.1% (p≤0.01) among measurement methods for trainee jockeys, Gaelic footballers, and university students, respectively.

CONCLUSIONS

Results from this first-generation study suggest that a more accurate estimate of total energy intake is provided when combining the use of a conventional food diary and a SenseCam. Additional information on portion size, forgotten foods, leftovers, and brand names can be obtained by using this novel sensing technology in conjunction with the diary, with improved dietary assessment a potential outcome.

A randomised study on the effectiveness of therapist-led v. self-help parental intervention for treating childhood obesity

A strategy is needed on how to treat the growing number of obese children with the limited resources available. We compared the long-term (24 months) effectiveness of therapist-led groups (TLG) v. self-help groups (SHG) for parents on changes in children's adiposity and dietary intake. The study included ninety-nine children (forty-eight girls) who were referred to obesity treatment (7–12 years, BMI z-scores ≥ 2, attendance of at least one parent). Parents (ninety-one mothers, fifty-four fathers) were randomised to TLG aimed at increasing parents' competence to accomplish lifestyle changes (n 47), or SHG (n 52), both with fifteen sessions. All children participated in children's groups, and all families attended individual counselling by a clinical dietitian and physiotherapist. Percentage of body fat (BF) was measured by dual-energy X-ray absorptiometry, BMI z-score was calculated by international reference values and dietary intake was calculated from 4 d estimated food records at baseline and after 6 and 24 months. No significant between-group differences were detected in the children's changes in adiposity or dietary intake after 6 and 24 months. BF, BMI z-scores and energy intake were significantly decreased after 6 months (P< 0·05) in both intervention groups, and this persisted throughout 24 months without compromising the diet macronutrient composition. In conclusion, the TLG and SHG intervention groups appear to be equally effective in improving long-term adiposity and dietary intake in obese children. Further research should be performed to clarify whether the SHG should be preferred to parental group treatment for similar children with obesity.

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.

Overweight and Obese Children's Ability to Report Energy Intake Using Digital Camera Food Records during a 2-Year Study

The objective was to evaluate overweight and obese children's ability to report reproducible and valid estimates of energy intake (EI) by using digital camera food records (FR) during a 2-year study, compared with objectively measured total energy expenditure (TEE). Seventy-three overweight/obese children, aged 8-12 years at inclusion, kept FR with the help of digital cameras for 16 days in total, on 7 occasions during a 2-year period. On the same days, their TEE was registered with SenseWear Armband (SWA). The children underestimated their EI by -2.8 (2.4) MJ/d on the first assessment occasion (95% CI: -3.3, -2.3). Reporting accuracy did not differ between the 7 assessment occasions (P = 0.15). Variables negatively associated with reporting accuracy relative to TEE were increased age (95% CI: -0.07, -0.01) and BMI z-score (95% CI: -0.18, -0.06). Further, reporting accuracy relative to TEE was lower for girls than boys (95% CI: -0.14, -0.01) and on weekdays compared with weekend days (95% CI: -0.08, -0.001). In conclusion, overweight and obese children were able to report their EI using a digital camera FR with good reproducibility over a 2-year period, even though their EI was underestimated compared with objectively measured TEE.

Validity of the Remote Food Photography Method (RFPM) for estimating energy and nutrient intake in near real-time

Two studies are reported; a pilot study to demonstrate feasibility followed by a larger validity study. Study 1's objective was to test the effect of two ecological momentary assessment (EMA) approaches that varied in intensity on the validity/accuracy of estimating energy intake (EI) with the Remote Food Photography Method (RFPM) over 6 days in free-living conditions. When using the RFPM, Smartphones are used to capture images of food selection and plate waste and to send the images to a server for food intake estimation. Consistent with EMA, prompts are sent to the Smartphones reminding participants to capture food images. During Study 1, EI estimated with the RFPM and the gold standard, doubly labeled water (DLW), were compared. Participants were assigned to receive Standard EMA Prompts (n = 24) or Customized Prompts (n = 16) (the latter received more reminders delivered at personalized meal times). The RFPM differed significantly from DLW at estimating EI when Standard (mean ± s.d. = -895 ± 770 kcal/day, P < 0.0001), but not Customized Prompts (-270 ± 748 kcal/day, P = 0.22) were used. Error (EI from the RFPM minus that from DLW) was significantly smaller with Customized vs. Standard Prompts. The objectives of Study 2 included testing the RFPM's ability to accurately estimate EI in free-living adults (N = 50) over 6 days, and energy and nutrient intake in laboratory-based meals. The RFPM did not differ significantly from DLW at estimating free-living EI (-152 ± 694 kcal/day, P = 0.16). During laboratory-based meals, estimating energy and macronutrient intake with the RFPM did not differ significantly compared to directly weighed intake.

Validation of personal digital photography to assess dietary quality among people with intellectual disabilities

BACKGROUND

Dietary assessment is a challenge in general, and specifically in individuals with intellectual disabilities (ID). This study aimed to evaluate personal digital photography as a method of assessing different aspects of dietary quality in this target group.

METHOD

Eighteen adults with ID were recruited from community residences and activity centres in Stockholm County. Participants were instructed to photograph all foods and beverages consumed during 1 day, while observed. Photographs were coded by two raters. Observations and photographs of meal frequency, intake occasions of four specific food and beverage items, meal quality and dietary diversity were compared. Evaluation of inter-rater reliability and validity of the method was performed by intra-class correlation analysis.

RESULTS

With reminders from staff, 85% of all observed eating or drinking occasions were photographed. The inter-rater reliability was excellent for all assessed variables (ICC ≥ 0.88), except for meal quality where ICC was 0.66. The correlations between items assessed in photos and observations were strong to almost perfect with ICC values ranging from 0.71 to 0.92 and all were statistically significant.

CONCLUSION

Personal digital photography appears to be a feasible, reliable and valid method for assessing dietary quality in people with mild to moderate ID, who have daily staff support.

Trial of a mobile phone method for recording dietary intake in adults with type 2 diabetes: evaluation and implications for future applications

We evaluated a mobile phone application (Nutricam) for recording dietary intake. It allowed users to capture a photograph of food items before consumption and store a voice recording to explain the contents of the photograph. This information was then sent to a website where it was analysed by a dietitian. Ten adults with type 2 diabetes (BMI 24.1-47.9 kg/m(2)) recorded their intake over a three-day period using both Nutricam and a written food diary. Compared to the food diary, energy intake was under-recorded by 649 kJ (SD 810) using the mobile phone method. However, there was no trend in the difference between dietary assessment methods at levels of low or high energy intake. All subjects reported that the mobile phone system was easy to use. Six subjects found that the time taken to record using Nutricam was shorter than recording using the written diary, while two reported that it was about the same. The level of detail provided in the voice recording and food items obscured in photographs reduced the quality of the mobile phone records. Although some modifications to the mobile phone method will be necessary to improve the accuracy of self-reported intake, the system was considered an acceptable alternative to written records and has the potential to be used by adults with type 2 diabetes for monitoring dietary intake by a dietitian.

Convergent validity of a digital image-based food record to assess food group intake in youth

Current methods to assess the dietary behavior of youth have many limitations that reduce accuracy. Previous research has examined use of food images to assess nutrient intake. The objectives for this study are to validate the use of a novel digital image-based food record (DIFR) method to assess food group intake in youth and examine inter-analyst reliability. In 2009, a convenience sample of youth aged 9 to 12 years were recruited in Davis, CA, and asked to take images of the food they ate between 5 pm and bedtime for 7 days. To examine convergent validity, 1-day and average weekly food group intakes assessed by DIFR were compared to food group estimates derived from 24-hour dietary recalls. To examine interanalyst reliability, estimates of food group intakes made by two independent nutrition students were compared, using Spearman correlation coefficients. Data from 26 youth showed that each participant's 1-day food group intakes assessed by the DIFR and recall methods were significantly correlated (P<0.001) for both analysts for all food groups. Estimated average daily intake amounts determined by the DIFR method and recall methods were also significantly correlated for all food groups except grains (n=28). Interanalyst reliability was very good; estimates of food group intakes, provided by the two students, were significantly correlated (n=28, P<0.001). These results show great potential for use of DIFR to assess 1 day's intake of food groups, but more research is needed to determine how well the method performs in capturing usual intake and changes in intake.

Evaluation of a digital method to assess evening meal intake in a free-living adult population

BACKGROUND

In recent years new applications of technologies, including digital images, to capture dietary behaviour in real time have been explored.

OBJECTIVES

To validate a digital method for estimating evening meal intake in a free-living adult population, and to examine the feasibility of the method for recording evening meal intake over a prolonged period of time.

DESIGN

The digital method was compared against weighed records of 19 participants' usual evening meals for five consecutive days. Two trained image analysts independently estimated the weight of individual foods within the meals into major food categories, and the nutrient content was calculated. A second study included interviews with 28 participants recording their evening meals on weekdays for three consecutive weeks to get their perspective on the feasibility of the method.

RESULTS

High correlation coefficients between the digital method and weighed records were found for all measured food categories and nutrients. Comparable means and acceptable limits of agreement (mean difference +/- 2 SD) were found with regard to macronutrient distribution (e.g. fat content -5 to 6 E%), energy density (-75 to 91 kJ/100 g), and energy-adjusted foods (e.g. fruit and vegetable content -241 to 236 g/10 MJ). The majority of the participants expressed satisfaction with the method and were willing to record their evening meals for 1 month or more using the digital method.

CONCLUSION

The digital method is valid and feasible for evening meal estimation in real-time where a prolonged recording period of participants' meals is needed.