Reducing the cost of dietary assessment: self-completed recall and analysis of nutrition for use with children (SCRAN24)

AI nutritionist: Intelligent software as the next generation pioneer of precision nutrition

With the rapid development of information technology and artificial intelligence (AI), people have acquired the abilities and are encouraged to develop intelligent tools and software, which begins to shed light on intelligent and precise food nutrition. Despite the rapid development of such software, disparities still exist in terms of methodology, contents, and implementation strategies. Hence, a set of panoramic profiles is urgently needed to elucidate their values and guide their future development. Here a comprehensive review was conducted aiming to summarize and compare the objects, contents, intelligent algorithms, and functions realized by the already released software in current research. Consequently, 177 AI nutritionists in recent years were collected and analyzed. The advantages, limitations, and trends concerning their application scenarios were analyzed. It was found that AI nutritionists have been gradually advancing the production modes and efficiency of food recognition, dietary recording/monitoring, nutritional assessment, and nutrient/recipe recommendation. Most AI nutritionists have a relatively low level of intelligence. However, new trends combining advanced AI algorithms, intelligent sensors and big data are coming with new applications in real-time and precision nutrition. AI models concerning molecular-level behaviors are becoming the new focus to drive AI nutritionists. Multi-center and multi-level studies have also gradually been realized to be necessary.

Self-completed online dietary recalls as an alternative method of dietary assessment for dietetic outpatient appointments: A feasibility study

BACKGROUND

Integrating digital dietary assessment within dietetic care could save time and reduce costs, at the same time as increasing patient engagement. The present study explores the feasibility of implementing a web-based dietary assessment tool, myfood24 (https://www.myfood24.org), into routine healthcare.

METHODS

This mixed methods feasibility study recruited dietitians and patients from a National Health Service (NHS) hospital outpatient setting. Patients completed and shared three online 24-h dietary recalls in advance, which were used as a dietary assessment by dietitians. Recruitment data were collected and questionnaires on technology, usability, and acceptability were completed. Patient interviews and focus groups with dietitians were conducted.

RESULTS

Eleven dietitians working in allergy, bariatrics, diabetes, oncology, general, renal, infectious diseases, and coeliac services took part with 39 patients. Recruitment rates were highest in bariatrics and lowest in renal and oncology. Compared to other studies, completion rates were good, with 29 (74.4%) completing three recalls despite lower technology readiness and software usability scores than in similar studies. Illness and difficulty with technology were reasons for non-completion. Opportunity to receive nutritional feedback from the tool and share this with a dietitian motivated patients to complete the record accurately. Consultation times were shortened in approximately one-third of appointments and a higher proportion of time was spent on nutritional education compared to usual practice. However, mean preparation time increased by 13 min per appointment because dietitians found nutritional analysis reports difficult to interpret.

CONCLUSIONS

It is feasible to introduce a digital dietary assessment tool into NHS dietetic practice. However, further development is needed to ensure that the tool is suitable for healthcare.

Potential of existing online 24-h dietary recall tools for national dietary surveys

OBJECTIVE

To describe existing online, 24-h dietary recall (24-h DR) tools in terms of functionalities and ability to tackle challenges encountered during national dietary surveys, such as maximising response rates and collecting high-quality data from a representative sample of the population, while minimising the cost and response burden.

DESIGN

A search (from 2000 to 2019) was conducted in peer-reviewed and grey literature. For each tool, information on functionalities, validation and user usability studies, and potential adaptability for integration into a new context was collected.

SETTING

Not country-specific.

PARTICIPANTS

General population.

RESULTS

Eighteen online 24-h DR tools were identified. Most were developed in Europe, for children ≥10 years old and/or for adults. Eight followed the five multiple-pass steps but used various methodologies and features. Almost all tools (except three) validated their nutrient intake estimates, but with high heterogeneity in methodologies. User usability was not always assessed, and rarely by applying real-time methods. For researchers, eight tools developed a web platform to manage the survey and five appeared to be easily adaptable to a new context.

CONCLUSIONS

Among the eighteen online 24-h DR tools identified, the best candidates to be used in national dietary surveys should be those that were validated for their intake estimates, had confirmed user and researcher usability, and seemed sufficiently flexible to be adapted to new contexts. Regardless of the tool, adaptation to another context will still require time and funding, and this is probably the most challenging step.

Acceptability and Feasibility of a 13-Week Pilot Randomised Controlled Trial Testing the Effects of Incremental Doses of Beetroot Juice in Overweight and Obese Older Adults

Nitrate-rich food can increase nitric oxide production and improve vascular and brain functions. This study examines the feasibility of a randomised controlled trial (RCT) testing the effects of prolonged consumption of different doses of dietary nitrate (NO3-) in the form of beetroot juice (BJ) in overweight and obese older participants. A single-blind, four-arm parallel pilot RCT was conducted in 62 overweight and obese (30.4 ± 4 kg/m2) older participants (mean ± standard deviation (SD), 66 ± 4 years). Participants were randomized to: (1) high-NO3- (HN: 2 × 70 mL BJ/day) (2) medium-NO3- (MN: 70 mL BJ/day), (3) low-NO3- (LN: 70 mL BJ on alternate days) or (4) Placebo (PL: 70 mL of NO3--depleted BJ on alternate days), for 13 weeks. Compliance was checked by a daily log of consumed BJ, NO3- intake, and by measuring NO3- and NO2- concentrations in plasma, saliva, and urine samples. Fifty participants completed the study. Self-reported compliance to the interventions was >90%. There were significant positive linear relationships between NO3- dose and the increase in plasma and urinary NO3- concentration (R2 = 0.71, P < 0.001 and R2 = 0.46 P < 0.001, respectively), but relationships between NO3- dose and changes in salivary NO3- and NO2- were non-linear (R2 = 0.35, P = 0.002 and R2 = 0.23, P = 0.007, respectively). The results confirm the feasibility of prolonged BJ supplementation in older overweight and obese adults.

Evaluation of New Technology-Based Tools for Dietary Intake Assessment-An ILSI Europe Dietary Intake and Exposure Task Force Evaluation

BACKGROUND

New technology-based dietary assessment tools, including Web-based programs, mobile applications, and wearable devices, may improve accuracy and reduce costs of dietary data collection and processing. The International Life Sciences Institute (ILSI) Europe Dietary Intake and Exposure Task Force launched this project to evaluate new tools in order to recommend general quality standards for future applications.

METHODS

A comprehensive literature search identified technology-based dietary assessment tools, including those published in English from 01/2011 to 09/2017, and providing details on tool features, functions and uses. Each of the 43 tools identified (33 for research and 10 designed for consumer use) was rated on 25 attributes.

RESULTS

Most of the tools identified (79%) relied on self-reported dietary intakes. Most (91%) used text entry and 33% used digital images to help identify foods. Only 65% had integrated databases for estimating energy or nutrients. Fewer than 50% contained any features of customization and about half generated automatic reports. Most tools reported on usability or reported validity compared with another assessment method (77%). A set of Best Practice Guidelines was developed for reporting dietary assessment tools using new technology.

CONCLUSIONS

Dietary assessment methods that utilize technology offer many advantages for research and are often preferable to consumers over more traditional methods. In order to meet general quality standards, new technology tools require detailed publications describing tool development, food identification and quantification, customization, outputs, food composition tables used, and usability/validity testing.

Bidirectional associations between diet and body composition measures from 2 to 15 years: Longitudinal Study of Australian Children

This study investigates how dietary patterns and scores are associated with subsequent BMI and waist:height ratio (WHtR), and how BMI and WHtR are associated with subsequent dietary patterns or scores, from 2-3 to 10-11 and 4-5 to 14-15 years of age. In the Longitudinal Study of Australian Children, height, weight and waist circumference were measured biennially in children, yielding BMI z-score and WHtR. Parents, latterly children, reported frequency of child consumption of 12-16 food/drink items during the previous 24 h. At each wave, we empirically derived dietary patterns using factor analyses, and dietary scores based on the 2013 Australian Dietary Guidelines. We used structural-equation modelling to investigate cross-lagged associations (n 1972-2882) between diet and body composition measures in univariable and multivariable analyses. Dietary scores/patterns did not consistently predict WHtR and BMI z-score in the next wave, nor did BMI z-score and WHtR consistently predict diet in the next wave. The few associations seen were weak and often in the opposite direction to that hypothesised. The largest effect, associated with each standard deviation increase in BMI in wave 5 of the K cohort (age 12-13 years), was a 0·06 standard deviation estimated mean increase in dietary score (higher quality diet) in the subsequent wave (95 % CI 0·02, 0·11, P=0·003). Associations between dietary patterns/scores and body composition were not strongly evident in either direction. Better quantitative childhood dietary tools feasible for large-scale administration are needed to quantify how dietary patterns, energy intake and anthropometry co-develop.

Does Providing Assistance to Children and Adolescents Increase Repeatability and Plausibility of Self-Reporting Using a Web-Based Dietary Recall Instrument?

BACKGROUND

It is important to find ways to minimize errors when children self-report food consumption.

OBJECTIVE

The objective of this study was to investigate whether assistance given to children completing a self-administered 24-hour dietary recall instrument called SACANA (Self-Administered Child, Adolescent and Adult Nutrition Assessment) increased the repeatability and plausibility of energy intake (EI) estimates.

PARTICIPANTS/SETTING

The study was conducted between October 2013 and March 2016 in a convenience sample of 395 children, aged 8 to 17 years, from eight European countries participating in the I.Family study.

DESIGN

SACANA was used to recall the previous day's food intake, twice in a day, once with and once without assistance.

MAIN OUTCOME MEASURES

The difference in EI between the first and second recalls was the main repeatability measure; the ratio of EI to basal metabolic rate was the plausibility measure.

STATISTICAL METHODS

Generalized linear mixed models, adjusted for sex, age, and body mass index z-score, were used to assess whether assistance during the first vs second recall influenced repeatability and plausibility.

RESULTS

The difference in estimated EI (EI from second recall minus EI from first recall) was significantly lower (P<0.001) in those assisted at first (median=-76 kcal) than those assisted at second recall (median=282 kcal). Modeling showed that EI at assisted first recall was 19% higher (95% CI 1.13 to 1.24) than in assisted second recall. Overall, 60% of recalls had a plausible EI. Modeling to estimate the simultaneous effects of second vs first recall and assistance vs no assistance on plausibility showed that those assisted at first recall had significantly higher odds of a plausible recall than those unassisted (odds ratio 3.64, 95% CI 2.20 to 6.01), with no significant difference in plausibility of second recall compared to the first (odds ratio 1.48, 95% CI 0.92 to 2.35).

CONCLUSIONS

When children are assisted at first recall, the plausibility and repeatability of the later unassisted recall improve. This improvement was evident for all ages. A future, adequately powered study is required to investigate the age range for which assistance is advisable.

Exploring the Feasibility of Use of An Online Dietary Assessment Tool (myfood24) in Women with Gestational Diabetes

myfood24 is an online 24 hr dietary recall tool developed for nutritional epidemiological research. Its clinical application has been unexplored. This mixed methods study explores the feasibility and usability of myfood24 as a food record in a clinical population, women with gestational diabetes (GDM). Women were asked to complete five myfood24 food records, followed by a user questionnaire (including the System Usability Scale (SUS), a measure of usability), and were invited to participate in a semi-structured interview. Of the 199 participants, the mean age was 33 years, mean booking body mass index (BMI) 29.7 kg/m², 36% primiparous, 57% White, 33% Asian. Of these, 121 (61%) completed myfood24 at least once and 73 (37%) completed the user questionnaire; 15 were interviewed. The SUS was found to be good (mean 70.9, 95% CI 67.1, 74.6). Interviews identified areas for improvement, including optimisation for mobile devices, and as a clinical management tool. This study demonstrates that myfood24 can be used as an online food record in a clinical population, and has the potential to support self-management in women with GDM. However, results should be interpreted cautiously given the responders’ demographic characteristics. Further research to explore the barriers and facilitators of uptake in people from ethnic minority and lower socioeconomic backgrounds is recommended.

Parental health behaviour predictors of childhood and adolescent dietary trajectories

OBJECTIVE

To determine which parental health behaviours early in childhood most strongly predict whole-of-childhood dietary trajectories.

DESIGN

Population-based Longitudinal Study of Australian Children (LSAC, waves 1-6; 2004-2014). Exposures were parents' fruit/vegetable consumption, alcohol, smoking and physical activity at child age 0-1 years (B Cohort) or 4-5 years (K Cohort). Outcomes, from repeated biennial short diet diaries, were group-based trajectories of (i) dietary scores and empirically derived patterns of (ii) healthful and (iii) unhealthful foods consumed, spanning ages 2-3 to 10-11 years (B Cohort) and 4-5 to 14-15 years (K Cohort). We investigated associations of baseline parental health behaviours with child dietary trajectories using multinomial logistic regression.

SETTING

Australian homes.

SUBJECTS

Of children, 4443 (87·0 %) from the B Cohort and 4620 (92·7 %) from the K Cohort were included in all trajectories. Multivariable analyses included 2719 to 2905 children and both parents.

RESULTS

Children whose primary caregiver reported the lowest fruit/vegetable consumption had markedly higher odds of belonging to the least healthy score and pattern trajectories (K Cohort: OR=8·7, 95 % CI 5·0, 15·1 and OR=8·4, 95 % CI 4·8, 14·7, respectively); associations were weaker (K Cohort: OR=2·3, 95 % CI 1·0, 5·2) for the unhealthiest pattern trajectory. Secondary caregiver fruit/vegetable associations were smaller and inconsistent. Parental alcohol, smoking and physical activity were not predictive in multivariable analyses. Results were largely replicated for the B Cohort.

CONCLUSIONS

Low primary caregiver fruit/vegetable consumption increased nearly ninefold the odds of children being in the lowest intake of healthy, but only weakly predicted unhealthy, food trajectories. Healthy and unhealthy food intake may have different determinants.

Consistency evaluation of values of weight, height, and body mass index in Food Intake and Physical Activity of School Children: the quality control of data entry in the computerized system

INTRODUCTION

The quality control of data entry in computerized questionnaires is an important step in the validation of new instruments. The study assessed the consistency of recorded weight and height on the Food Intake and Physical Activity of School Children (Web-CAAFE) between repeated measures and against directly measured data.

METHODS

Students from the 2nd to the 5th grade (n = 390) had their weight and height directly measured and then filled out the Web-CAAFE. A subsample (n = 92) filled out the Web-CAAFE twice, three hours apart. The analysis included hierarchical linear regression, mixed linear regression model, to evaluate the bias, and intraclass correlation coefficient (ICC), to assess consistency. Univariate linear regression assessed the effect of gender, reading/writing performance, and computer/internet use and possession on residuals of fixed and random effects.

RESULTS

The Web-CAAFE showed high values of ICC between repeated measures (body weight = 0.996, height = 0.937, body mass index - BMI = 0.972), and regarding the checked measures (body weight = 0.962, height = 0.882, BMI = 0.828). The difference between means of body weight, height, and BMI directly measured and recorded was 208 g, -2 mm, and 0.238 kg/m², respectively, indicating slight BMI underestimation due to underestimation of weight and overestimation of height. This trend was related to body weight and age.

CONCLUSION

Height and weight data entered in the Web-CAAFE by children were highly correlated with direct measurements and with the repeated entry. The bias found was similar to validation studies of self-reported weight and height in comparison to direct measurements.

Iterative Development of an Online Dietary Recall Tool: INTAKE24

Collecting large-scale population data on dietary intake is challenging, particularly when resources and funding are constrained. Technology offers the potential to develop novel ways of collecting large amounts of dietary information while making it easier, more convenient, intuitive, and engaging for users. INTAKE24 is an online multiple pass 24 h dietary recall tool developed for use in national food and nutrition surveys. The development of INTAKE24 was a four-stage iterative process of user interaction and evaluation with the intended end users, 11–24 years old. A total of 80 11–24 years old took part in the evaluation, 20 at each stage. Several methods were used to elicit feedback from the users including, ‘think aloud’, ‘eye tracking’, semi-structured interviews, and a system usability scale. Each participant completed an interviewer led recall post system completion. Key system developments generated from the user feedback included a ‘flat’ interface, which uses only a single interface screen shared between all of the various activities (e.g., free text entry, looking up foods in the database, portion size estimation). Improvements to the text entry, search functionality, and navigation around the system were also influenced through feedback from users at each stage. The time to complete a recall using INTAKE24 almost halved from the initial prototype to the end system, while the agreement with an interviewer led recall improved. Further developments include testing the use of INTAKE24 with older adults and translation into other languages for international use. Our future aim is to validate the system with recovery biomarkers.

Development of a Web-Based 24-h Dietary Recall for a French-Canadian Population

Twenty-four-hour dietary recalls can provide high-quality dietary intake data, but are considered expensive, as they rely on trained professionals for both their administration and coding. The objective of this study was to develop an automated, self-administered web-based 24-h recall (R24W) for a French-Canadian population. The development of R24W was inspired by the United States Department of Agriculture (USDA) Automated Multiple-Pass Method. Questions about the context of meals/snacks were included. Toppings, sauces and spices frequently added to each food/dish were suggested systematically. A list of frequently forgotten food was also suggested. An interactive summary allows the respondent to track the progress of the questionnaire and to modify or remove food as needed. The R24W prototype was pre-tested for usability and functionality in a convenience sample of 29 subjects between the ages of 23 and 65 years, who had to complete one recall, as well as a satisfaction questionnaire. R24W includes a list of 2865 food items, distributed into 16 categories and 98 subcategories. A total of 687 recipes were created for mixed dishes, including 336 ethnic recipes. Pictures of food items illustrate up to eight servings per food item. The pre-test demonstrated that R24W is easy to complete and to understand. This new dietary assessment tool is a simple and inexpensive tool that will facilitate diet assessment of individuals in large-scale studies, but validation studies are needed prior to the utilization of the R24W.

Validity of WebCAAFE questionnaire for assessment of schoolchildren's dietary compliance with Brazilian Food Guidelines

OBJECTIVE

To estimate reporting bias of WebCAAFE, a web-based questionnaire for the assessment of food intake (recall of frequency of intake of thirty-two food items the day before) and physical activity in schoolchildren.

DESIGN

Cross-sectional study. Self-reported food intake on WebCAAFE was compared with direct observation of school meals in five public schools. Additional data included school grade, sex, BMI, socio-economic status and access to Internet at home. Poisson regression was used to calculate the reporting bias (WebCAAFE v. direct observation) and the sample size necessary to detect a statistically significant difference between WebCAAFE reports and at least 75 % compliance with the recommendations for a healthy diet.

SETTING

Intentional sample of five elementary public schools in Florianopolis, Brazil.

SUBJECTS

Schoolchildren (n 629) from 2nd to 5th grades.

RESULTS

Moderate bias magnitude was found for most food groups of interest. Frequency of consumption was not related to the bias. Sample sizes necessary to detect the compliance with dietary recommendations varied between four and seventy-four individuals for the different groups investigated.

CONCLUSIONS

After adjusting for moderate bias, WebCAAFE may be used as a food questionnaire for evaluation of schoolchildren's food compliance on a group level, even with a relatively small sample size.

Evaluation of a Web-Based Food Record for Children Using Direct Unobtrusive Lunch Observations: A Validation Study

Background

High-quality, Web-based dietary assessment tools for children are needed to reduce cost and improve user-friendliness when studying children’s dietary practices.

Objective

To evaluate the first Web-based dietary assessment tool for children in Norway, the Web-based Food Record (WebFR), by comparing children’s true school lunch intake with recordings in the WebFR, using direct unobtrusive observation as the reference method.

Methods

A total of 117 children, 8-9 years, from Bærum, Norway, were recruited from September to December 2013. Children completed 4 days of recordings in the WebFR, with parental assistance, and were observed during school lunch in the same period by 3 observers. Interobserver reliability assessments were satisfactory. Match, omission, and intrusion rates were calculated to assess the quality of the recordings in the WebFR for different food categories, and for all foods combined. Logistic regression analyses were used to investigate whether body mass index (BMI), parental educational level, parental ethnicity or family structure were associated with having a “low match rate” (≤70%).

Results

Bread and milk were recorded with less bias than spreads, fruits, and vegetables. Mean (SD) for match, omission, and intrusion rates for all foods combined were 73% (27%), 27% (27%), and 19% (26%), respectively. Match rates were statistically significantly associated with parental educational level (low education 52% [32%] versus high 77% [24%], P=.008) and parental ethnicity (non-Norwegian 57% [28%] versus others 75% [26%], P=.04). Only parental ethnicity remained statistically significant in the logistic regression model, showing an adjusted odds ratio of 6.9 and a 95% confidence interval between 1.3 and 36.4.

Conclusions

Compared with other similar studies, our results indicate that the WebFR is in line with, or better than most of other similar tools, yet enhancements could further improve the WebFR.

A changing landscape: web-based methods for dietary assessment in adolescents

PURPOSE OF REVIEW

Adolescents' dietary intake is an important determinant of health and well-being and is influenced by a complex interaction of environmental, social, psychological, and physiological factors. The complexity of the adolescent diet makes its assessment prone to error, which has prompted researchers and clinicians to turn to technology to reduce this error. Previous reviews have been conducted regarding the use of technology in dietary assessment for adults; however, there are no known reviews for adolescents. Therefore, the purpose of this review is to describe the practical considerations for web-based dietary assessment methods and to evaluate recent evidence on their validity and implications.

RECENT FINDINGS

There are numerous web-based dietary assessment methods that are available, valid, and reliable for use in the adolescent population. Web-based methods include both native and web-based applications (or 'apps'), and have been developed for use as food records, 24-h dietary recalls, and food frequency questionnaires.

SUMMARY

Web-based methods provide an efficient, cost-effective and practical solution to assess dietary intake; they are less burdensome to respondents and reduce errors and bias. Furthermore, adolescents are technologically savvy and often prefer the use of technology. Web-based methods should be considered when assessing adolescents' dietary intake.

Personalised nutrition: the role of new dietary assessment methods

Food records or diaries, dietary recalls and FFQ are methods traditionally used to measure dietary intake; however, advancing technologies and growing awareness in personalised health have heightened interest in the application of new technologies to assess dietary intake. Dietary intake data can be used in epidemiology, dietary interventions and in the delivery of personalised nutrition advice. Compared with traditional dietary assessment methods, new technologies have many advantages, including their ability to automatically process data and provide personalised dietary feedback advice. This review examines the new technologies presently under development for the assessment of dietary intakes, and their utilisation and efficacy for personalising dietary advice. New technology-based methods of dietary assessment can broadly be categorised into three key areas: online (web-based) methods, mobile methods and sensor technologies. Several studies have demonstrated that utilising new technologies to provide tailored advice can result in positive dietary changes and have a significant impact on selected nutrient and food group intakes. However, comparison across studies indicates that the magnitude of change is variable and may be influenced by several factors, including the frequency and type of feedback provided. Future work should establish the most effective combinations of these factors in facilitating dietary changes across different population groups.

Development of a UK Online 24-h Dietary Assessment Tool: myfood24

Assessment of diet in large epidemiological studies can be costly and time consuming. An automated dietary assessment system could potentially reduce researcher burden by automatically coding food records. myfood24 (Measure Your Food on One Day) an online 24-h dietary assessment tool (with the flexibility to be used for multiple 24 h-dietary recalls or as a food diary), has been developed for use in the UK population. Development of myfood24 was a multi-stage process. Focus groups conducted with three age groups, adolescents (11–18 years) (n = 28), adults (19–64 years) (n = 24) and older adults (≥65 years) (n = 5) informed the development of the tool, and usability testing was conducted with beta (adolescents n = 14, adults n = 8, older adults n = 1) and live (adolescents n = 70, adults n = 20, older adults n = 4) versions. Median system usability scale (SUS) scores (measured on a scale of 0–100) in adolescents and adults were marginal for the beta version (adolescents median SUS = 66, interquartile range (IQR) = 20; adults median SUS = 68, IQR = 40) and good for the live version (adolescents median SUS = 73, IQR = 22; adults median SUS = 80, IQR = 25). Myfood24 is the first online 24-h dietary recall tool for use with different age groups in the UK. Usability testing indicates that myfood24 is suitable for use in UK adolescents and adults.

The validation of a computer-based food record for older adults: the Novel Assessment of Nutrition and Ageing (NANA) method

Dietary assessment in older adults can be challenging. The Novel Assessment of Nutrition and Ageing (NANA) method is a touch-screen computer-based food record that enables older adults to record their dietary intakes. The objective of the present study was to assess the relative validity of the NANA method for dietary assessment in older adults. For this purpose, three studies were conducted in which a total of ninety-four older adults (aged 65–89 years) used the NANA method of dietary assessment. On a separate occasion, participants completed a 4 d estimated food diary. Blood and 24 h urine samples were also collected from seventy-six of the volunteers for the analysis of biomarkers of nutrient intake. The results from all the three studies were combined, and nutrient intake data collected using the NANA method were compared against the 4 d estimated food diary and biomarkers of nutrient intake. Bland–Altman analysis showed a reasonable agreement between the dietary assessment methods for energy and macronutrient intake; however, there were small, but significant, differences for energy and protein intake, reflecting the tendency for the NANA method to record marginally lower energy intakes. Significant positive correlations were observed between urinary urea and dietary protein intake using both the NANA and the 4 d estimated food diary methods, and between plasma ascorbic acid and dietary vitamin C intake using the NANA method. The results demonstrate the feasibility of computer-based dietary assessment in older adults, and suggest that the NANA method is comparable to the 4 d estimated food diary, and could be used as an alternative to the food diary for the short-term assessment of an individual's dietary intake.

Validation of a web-based questionnaire to assess the dietary intake of Brazilian children aged 7-10 years

BACKGROUND

The Food Intake and Physical Activity of School Children (CAAFE) comprises an online questionnaire to self-report diet and physical activity of Brazilian schoolchildren.

BACKGROUND

The present study aimed to assess the validity (matches, omissions and intrusions) and moderating factors of the CAAFE.

METHODS

Direct observation was made of foods consumed (five public schools) and child self-reporting on the CAAFE. Additional data included school grade, gender, body mass index, completion of food diary, socioeconomic status and access to computer. Data were analysed using regression.

RESULTS

In total, 602 children participated in the study [mean (SD) age 9.5 (1.24) years; 53.6% boys]. On average, there were 43% matches, 29% intrusions and 28% omissions. Matches doubled in third grade compared to the second grade (P = 0.004); matches almost tripled for afternoon snack compared to morning snack (P < 0.001); and matches were 69% higher for children with access to a computer at home (P < 0.01). Intrusions decreased by almost one-half in fifth compared to fourth grades (P = 0.004). Omissions declined significantly in the third and fourth grades but increased in the fifth grade. Omissions were 47% lower for children in the highest income and lower among children who completed the food diary. No differences were found for gender or body mass index.

CONCLUSIONS

Children older than 8 years old, who owned a computer and completed a food diary, performed better in the CAAFE. A high incidence of disagreement was found in relation to the schools and the type of meal. Overall matches (43%), intrusions (29%) and omissions (28%) indicate that further studies are required to improve the validity of the CAAFE.

Growth and metabolic outcome in adolescents born preterm (GROWMORE): follow-up protocol for the Newcastle Preterm Birth GRowth study (PTBGS)

Background

Preterm infants represent up to 10% of births worldwide and have an increased risk of adverse metabolic outcomes in later life. Early life exposures are key factors in determining later health but current lifestyle factors such as diet and physical activity are also extremely important and provide an opportunity for targeted intervention.

Methods/Design

This current study, GROWMORE, is the fourth phase of the Newcastle Preterm Birth Growth Study (PTBGS), which was formed from two randomised controlled trials of nutrition in early life in preterm (24–34 weeks gestation) and low birthweight infants. 247 infants were recruited prior to hospital discharge. Infant follow-up included detailed measures of growth, nutritional intake, morbidities and body composition (Dual X Ray Absorptiometry, DXA) along with demographic data until 2 years corrected age. Developmental assessment was performed at 18 months corrected age, and cognitive assessment at 9–10 years of age. Growth, body composition (DXA), blood pressure and metabolic function (insulin resistance and lipid profile) were assessed at 9–13 years of age, and samples obtained for epigenetic analysis. In GROWMORE, we will follow up a representative cohort using established techniques and novel metabolic biomarkers and correlate these with current lifestyle factors including physical activity and dietary intake. We will assess auxology, body composition (BODPOD™), insulin resistance, daily activity levels using Actigraph™ software and use ³¹P and ¹H magnetic resonance spectroscopy to assess mitochondrial function and intra-hepatic lipid content.

Discussion

The Newcastle PTBGS is a unique cohort of children born preterm in the late 1990’s. The major strengths are the high level of detail of early nutritional and growth exposures, and the comprehensive assessment over time. This study aims to examine the associations between early life exposures in preterm infants and metabolic outcomes in adolescence, which represents an area of major translational importance.