The Development, Validation, and User Evaluation of Foodbook24: A Web-Based Dietary Assessment Tool Developed for the Irish Adult Population

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.

Dietary Intake Assessment Using a Novel, Generic Meal-Based Recall and a 24-Hour Recall: Comparison Study

BACKGROUND

Dietary intake assessment is an integral part of addressing suboptimal dietary intakes. Existing food-based methods are time-consuming and burdensome for users to report the individual foods consumed at each meal. However, ease of use is the most important feature for individuals choosing a nutrition or diet app. Intakes of whole meals can be reported in a manner that is less burdensome than reporting individual foods. No study has developed a method of dietary intake assessment where individuals report their dietary intakes as whole meals rather than individual foods.

OBJECTIVE

This study aims to develop a novel, meal-based method of dietary intake assessment and test its ability to estimate nutrient intakes compared with that of a web-based, 24-hour recall (24HR).

METHODS

Participants completed a web-based, generic meal-based recall. This involved, for each meal type (breakfast, light meal, main meal, snack, and beverage), choosing from a selection of meal images those that most represented their intakes during the previous day. Meal images were based on generic meals from a previous study that were representative of the actual meal intakes in Ireland. Participants also completed a web-based 24HR. Both methods were completed on the same day, 3 hours apart. In a crossover design, participants were randomized in terms of which method they completed first. Then, 2 weeks after the first dietary assessments, participants repeated the process in the reverse order. Estimates of mean daily nutrient intakes and the categorization of individuals according to nutrient-based guidelines (eg, low, adequate, and high) were compared between the 2 methods. P values of less than .05 were considered statistically significant.

RESULTS

In total, 161 participants completed the study. For the 23 nutrient variables compared, the median percentage difference between the 2 methods was 7.6% (IQR 2.6%-13.2%), with P values ranging from <.001 to .97, and out of 23 variables, effect sizes for the differences were small for 19 (83%) variables, moderate for 2 (9%) variables, and large for 2 (9%) variables. Correlation coefficients were statistically significant (P<.05) for 18 (78%) of the 23 variables. Statistically significant correlations ranged from 0.16 to 0.45, with median correlation of 0.32 (IQR 0.25-0.40). When participants were classified according to nutrient-based guidelines, the proportion of individuals who were classified into the same category ranged from 52.8% (85/161) to 84.5% (136/161).

CONCLUSIONS

A generic meal-based method of dietary intake assessment provides estimates of nutrient intake comparable with those provided by a web-based 24HR but with varying levels of agreement among nutrients. Further studies are required to refine and improve the generic recall across a range of nutrients. Future studies will consider user experience including the potential feasibility of incorporating image recognition of whole meals into the generic recall.

Teaching Health Literacy and Digital Literacy Together at University Level: The FLOURISH Module

Many universities have wellness programs to promote overall health and well-being. Using students' own personal data as part of improving their own wellness would seem to be a natural fit given that most university students are already data and information literate. In this work, we aim to show how the interplay between health literacy and data literacy can be used and taught together. The method we use is the development and delivery of the FLOURISH module, an accredited, online-only but extra-curricular course that delivers practical tips in the areas that impact students' everyday wellness including sleep, nutrition, work habits, procrastination, relationships with others, physical activity, positive psychology, critical thinking, and more. For most of these topics, students gather personal data related to the topic and submit an analysis of their data for assessment thus demonstrating how students can use their personal data for their benefit. More than 350 students have taken the module and an analysis of the use of online resources, as well as feedback on the module experience, are presented. The contributions of this article are to further endorse the need for health literacy and digital literacy for students, and we demonstrate that these can be taught together making each literacy more appealing to the digital natives of Generation Z who make up the majority of students. The implications for public health research and practice are that two student literacies, health and digital, are not independent and for our students, they should be taught together.

Web-Based 24-Hour Dietary Recall Tool for Russian Adults and School-Aged Children: Validation Study

BACKGROUND

Data on dietary intakes in Russian adults and children are assessed very infrequently primarily due to the time, cost, and burden to the participants for assessing dietary patterns. To overcome some of those challenges, the use of web-based 24-hour recall methods can be successfully used.

OBJECTIVE

The study objective is to assess the extent of agreement between a self-administered and an interviewer-administered 24-hour dietary recall in Russian adults and school-aged children using an adaptation of a web-based 24-hour recall tool.

METHODS

This web-based dietary assessment tool is based on a previously validated tool, which has been adapted to the Russian diet and language. A randomized 50% (n=97) of 194 participants initially completed a self-administered web-based dietary recall, followed by an interviewer-administered 24-hour dietary recall later that same day, and vice versa for the other 50% (n=97) of participants. Following at least 1 week wash-out period, during visit 2, participant groups completed the 2 dietary recalls in the opposite order. Statistical analysis was carried out on the intake results from both methods for the 2 recalls. Finally, an evaluation questionnaire on ease-of-use of the tool was also completed.

RESULTS

In total, intakes of 28 nutrients and energy were analyzed in this study. The Bland-Altman analysis showed that between 98.4% and 90.5% of data points were within the limits of agreement among all age groups and nutrients analyzed. A "moderate to excellent" reliability between the 2 methods was observed in younger children. In older children, a "moderate to good" reliability was observed, with the exception of sodium. In adults, "moderate to excellent" reliability between both methods was observed with the exception of vitamins B1, B2, and B6, and pantothenic acid. The level of agreement between the categorization of estimates into thirds of the intake distribution for the average of the 2 days was satisfactory, since the percentages of participants categorized into the same tertile of intake were ˃50%, and the percentages of participants categorized into the opposite tertile of intake were <10%. The majority of respondents were very positive in their evaluation of the web-based dietary assessment tool.

CONCLUSIONS

Overall, the web-based dietary assessment tool performs well when compared with a face-to-face, interviewer-administered 24-hour dietary recall and provides comparable estimates of energy and nutrient intakes in Russian adults and children.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04372160; https://clinicaltrials.gov/ct2/show/NCT04372160.

Relative Validity and Reliability of the Remind App as an Image-Based Method to Assess Dietary Intake and Meal Timing in Young Adults

Image-based dietary records have been validated as tools to evaluate dietary intake. However, to determine meal timing, previous studies have relied primarily on image-based smartphone applications without validation. Noteworthy, the validation process is necessary to determine how accurately a test method measures meal timing compared with a reference method over the same time period. Thus, we aimed to assess the relative validity and reliability of the Remind^® app as an image-based method to assess dietary intake and meal timing. For this purpose, 71 young adults (aged 20-33 years, 81.7% women) were recruited for a 3-day cross-sectional study, where they completed a 3-day image-based record using the Remind app (test method) and a 3-day handwritten food record (reference method). The relative validity of the test method versus the reference method was assessed using multiple tests including Bland-Altman, % difference, paired t-test/Wilcoxon signed-rank test, Pearson/Spearman correlation coefficients, and cross-classification. We also evaluated the reliability of the test method using an intra-class correlation (ICC) coefficient. The results showed that, compared to the reference method, the relative validity of the test method was good for assessing energy and macronutrient intake, as well as meal timing. Meanwhile, the relative validity of the test method to assess micronutrient intake was poor (p < 0.05) for some micronutrients (iron, phosphorus, potassium, zinc, vitamins B1, B2, B3, B6, C, and E, and folates) and some food groups (cereals and grains, legumes, tubers, oils, and fats). Regarding the reliability of an image-based method to assess dietary intake and meal timing, results ranged from moderate to excellent (ICC 95% confidence interval [95% CI]: 0.50-1.00) for all nutrients, food groups (except oils and fats, which had low to moderate reliability), and meal timings. Thus, the results obtained in this study provide evidence of the relative validity and reliability of image-based methods to assess dietary intake (energy, macronutrients, and most food groups) and meal timing. These results open up a new framework for chrononutrition, as these methods improve the quality of the data collected and also reduce the burden on users to accurately estimate portion size and the timing of meals.

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.

Pilot Study of the Applicability, Usability, and Accuracy of the Nutricate© Online Application, a New Dietary Intake Assessment Tool for Managing Infant Cow's Milk Allergy

BACKGROUND/OBJECTIVES

The mainstay treatment of cow's milk allergy (CMA) is to remove cow's milk proteins from children's dietary intake. In this context, dietary intake of children with CMA should be particularly checked and monitored. The objective of this study was to assess the applicability, usability, and accuracy of a new dietary intake (DI) assessment online tool (Nutricate© online application) for managing CMA in children.

SUBJECTS/METHODS

This study used a pre-existing database of DI from the Nutricate© online application. DIs from 30 CMA children were used to compare micro/macronutrients (energy, protein, calcium, and iron intakes) calculated by Nutricate© and NutriLog© as the reference method. Comparisons were performed using the Pearson correlation analysis and the Bland-Altman plot. The Nutricate© tool usability was assessed via a System Usability Scale questionnaire (SUSq).

RESULTS

Correlation coefficient between the levels of micro/macronutrients obtained by Nutrilog© and Nutricate© software were highly significant (p = 0.0001) and were well-correlated (R coefficient > 0.6), indicating a very good concordance between the two methods. This observation was reinforced by the Bland-Altman plot, indicating the absence of proportional or fixed bias for energy, protein, calcium, and iron intakes. The mean SUSq score obtained was 81 ± 14, which is considered to be an excellent score.

CONCLUSIONS

Nutricate© online application is a reliable method to assess micro/macronutrient (energy, protein, calcium, and iron intakes) intake in CMA children. Applicability and usability of this new dietary intake assessment online tool is excellent.

A Clustering Approach to Meal-Based Analysis of Dietary Intakes Applied to Population and Individual Data

BACKGROUND

Examination of meal intakes can elucidate the role of individual meals or meal patterns in health not evident by examining nutrient and food intakes. To date, meal-based research has been limited to focus on population rather than individual intakes, without considering portions or nutrient content when characterizing meals.

OBJECTIVES

We aimed to characterize meals commonly consumed, incorporating portions and nutritional content, and to determine the accuracy of nutrient intake estimates using these meals at both population and individual levels.

METHODS

The 2008-2010 Irish National Adult Nutrition Survey (NANS) data were used. A total of 1500 participants, with a mean ± SD age of 44.5 ± 17.0 y and BMI of 27.1 ± 5.0 kg/m2, recorded their intake using a 4-d weighed food diary. Food groups were identified using k-means clustering. Partitioning around the medoids clustering was used to categorize similar meals into groups (generic meals) based on their Nutrient Rich Foods Index (NRF9.3) score and the food groups that they contained. The nutrient content for each generic meal was defined as the mean content of the grouped meals. Seven standard portion sizes were defined for each generic meal. Mean daily nutrient intakes were estimated using the original and the generic data.

RESULTS

The 27,336 meals consumed were aggregated to 63 generic meals. Effect sizes from the comparisons of mean daily nutrient intakes (from the original compared with generic meals) were negligible or small, with P values ranging from <0.001 to 0.941. When participants were classified according to nutrient-based guidelines (high, adequate, or low), the proportion of individuals who were classified into the same category ranged from 55.3% to 91.5%.

CONCLUSIONS

A generic meal-based method can estimate nutrient intakes based on meal rather than food intake at the sample population and individual levels. Future work will focus on incorporating this concept into a meal-based dietary intake assessment tool.

Feasibility of wearable camera use to improve the accuracy of dietary assessment among adults

Traditional methods of dietary assessment are prone to measurement error, with energy intake often under-reported. The 24-h recall is widely used in dietary assessment, however, its reliance on self-report without verification of consumption can result in inaccuracies in true nutrient intake. Wearable cameras may provide a complementary approach to improve self-report accuracy by providing an objective and passive measure of food consumption. The purpose of the present study was to determine whether a wearable camera improves the accuracy of a 24-h recall compared with a 24-h recall alone in twenty adults aged 18-65 years. The study also explored limitations associated with wearable cameras. Participants wore the camera for 1 d and a 24-h recall was then conducted the following day, before and after viewing the camera images. Dietary data were analysed using Nutritics dietary analysis software, while eating habits were assessed by a self-report questionnaire. Energy and nutrient intakes were compared between the recall alone and the camera-assisted recall. Results showed a significant increase in mean energy intake with the camera-assisted recall compared with the recall alone (9677⋅8 ± 2708⋅0 kJ/d v. 9304⋅6 ± 2588⋅5 kJ/d, respectively, P = 0⋅003). Intakes of carbohydrates, total sugars and saturated fats were also significantly higher with the camera-assisted recall. In terms of challenges, there were occasionally technological issues such as proper positioning of the camera by the participants. In conclusion, reporting of energy and nutrient intake may be enhanced when a traditional method of dietary assessment, the 24-h recall, is assisted by a wearable camera.

Telehealth Delivery of a Multi-Disciplinary Rehabilitation Programme for Upper Gastro-Intestinal Cancer: ReStOre@Home Feasibility Study

Simple Summary

Throughout the COVID-19 pandemic, many cancer care services have safely been delivered via telehealth. Multi-disciplinary rehabilitation programmes can help address the complex physical, nutritional and quality of life needs of upper gastrointestinal (UGI) cancer survivors, but it is unknown how well these multi-component programmes translate to a telehealth model of delivery. Therefore, we assessed the feasibility of running a 12-week exercise and nutrition rehabilitation programme for UGI cancer via telehealth. Participants found the telehealth model safe, convenient and highly satisfactory. Lower levels of technology skills were a barrier to recruitment, and some participants needed help with using the technology. Some adaptations to how the exercise programme was delivered were required. Participants recommended that future versions of the programme would have some element of in-person contact. Cancer survivors should receive all possible supports to enable their participation in telehealth programmes.

Abstract

Background: Telehealth has enabled access to rehabilitation throughout the pandemic. We assessed the feasibility of delivering a multi-disciplinary, multi-component rehabilitation programme (ReStOre@Home) to cancer survivors via telehealth. Methods: This single-arm mixed methods feasibility study recruited participants who had completed curative treatment for oesophago-gastric cancer for a 12-week telehealth rehabilitation programme, involving group resistance training, remotely monitored aerobic training, one-to-one dietetic counselling, one-to-one support calls and group education. The primary outcome was feasibility, measured by recruitment rates, attendance, retention, incidents, acceptability, Telehealth Usability Questionnaire (TUQ) and analysis of semi-structured interviews. Results: Characteristics of the twelve participants were: 65.42 ± 7.24 years; 11 male; 10.8 ± 3.9 months post-op; BMI 25.61 ± 4.37; received neoadjuvant chemotherapy 7/12; received adjuvant chemotherapy 4/12; hospital length of stay 16 days (median). Recruitment rate was 32.4%, and retention rate was 75%. Mean attendance was: education 90%; dietetics 90%; support calls 84%; resistance training 78%. Mean TUQ score was 4.69/5. Adaptations to the planned resistance training programme were required. Participants reported that ReStOre@Home enhanced physical and psychological wellbeing, and online delivery was convenient. Some reported a preference for in-person contact but felt that the online group sessions provided adequate peer support. Conclusion: Telehealth delivery of ReStOre@Home was most feasible in individuals with moderate to high levels of digital skills. Low level of digitals skills was a barrier to recruitment and retention. Participants reported high levels of programme adherence and participant satisfaction. Adaptations to future programmes, including introducing elements of in-person contact, are required.

Precision Nutrient Management Using Artificial Intelligence Based on Digital Data Collection Framework

(1) Background: Nutritional intake is fundamental to human growth and health, and the intake of different types of nutrients and micronutrients can affect health. The content of the diet affects the occurrence of disease, with the incidence of many diseases increasing each year while the age group at which they occur is gradually decreasing. (2) Methods: An artificial intelligence model for precision nutritional analysis allows the user to enter the name and serving size of a dish to assess a total of 24 nutrients. A total of two AI models, including semantic and nutritional analysis models, were integrated into the Precision Nutritional Analysis. A total of five different algorithms were used to identify the most similar recipes and to determine differences in text using cosine similarity. (3) Results: This study developed two models to form a precision nutrient analysis model. The 2013–2016 Taiwan National Nutrition Health Status Change Survey (NNHS) was used for model verification. The model’s accuracy was determined by comparing the results of the model with the NNHS. The results show that the AI model has very little error and can significantly improve the efficiency of the analysis. (4) Conclusions: This study proposed an Intelligence Precision Nutrient Analysis Model based on a digital data collection framework, where the nutrient intake was analyzed by entering dietary recall data. The AI model can be used as a reference for nutrition surveys and personal nutrition analysis.

Digital Assessment Tools Using Animation Features to Quantify Alcohol Consumption: Systematic App Store and Literature Review

Background

Accurate and user-friendly assessment tools for quantifying alcohol consumption are a prerequisite for effective interventions to reduce alcohol-related harm. Digital assessment tools (DATs) that allow the description of consumed alcoholic drinks through animation features may facilitate more accurate reporting than conventional approaches.

Objective

This review aims to identify and characterize freely available DATs in English or Russian that use animation features to support the quantitative assessment of alcohol consumption (alcohol DATs) and determine the extent to which such tools have been scientifically evaluated in terms of feasibility, acceptability, and validity.

Methods

Systematic English and Russian searches were conducted in iOS and Android app stores and via the Google search engine. Information on the background and content of eligible DATs was obtained from app store descriptions, websites, and test completions. A systematic literature review was conducted in Embase, MEDLINE, PsycINFO, and Web of Science to identify English-language studies reporting the feasibility, acceptability, and validity of animation-using alcohol DATs. Where possible, the evaluated DATs were accessed and assessed. Owing to the high heterogeneity of study designs, results were synthesized narratively.

Results

We identified 22 eligible alcohol DATs in English, 3 (14%) of which were also available in Russian. More than 95% (21/22) of tools allowed the choice of a beverage type from a visually displayed selection. In addition, 36% (8/22) of tools enabled the choice of a drinking vessel. Only 9% (2/22) of tools allowed the simulated interactive pouring of a drink. For none of the tools published evaluation studies were identified in the literature review. The systematic literature review identified 5 exploratory studies evaluating the feasibility, acceptability, and validity of 4 animation-using alcohol DATs, 1 (25%) of which was available in the searched app stores. The evaluated tools reached moderate to high scores on user rating scales and showed fair to high convergent validity when compared with established assessment methods.

Conclusions

Animation-using alcohol DATs are available in app stores and on the web. However, they often use nondynamic features and lack scientific background information. Explorative study data suggest that such tools might enable the user-friendly and valid assessment of alcohol consumption and could thus serve as a building block in the reduction of alcohol-attributable health burden worldwide.

Trial Registration

PROSPERO International Prospective Register of Systematic Reviews CRD42020172825; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020172825

DIetary ASSessment (DIASS) Study: Design of an Evaluation Study to Assess Validity, Usability and Perceived Burden of an Innovative Dietary Assessment Methodology

During recent years, the integration of technology has substantially improved self-reported dietary assessment methods, such as food frequency questionnaires (FFQ), food records, and 24-h recalls. To further reduce measurement error, additional innovations are urgently needed. Memory-related measurement error is one of the aspects that warrants attention, which is where new smartphone technologies and ecological momentary assessment (EMA) approaches provide a unique opportunity. In this article, we describe the DIASS study, which was designed to evaluate an innovative 2-h recall (2hR) smartphone-based methodology, against traditional 24-h recalls, FFQ, and biomarkers, to assess both actual and habitual dietary intake. It is hypothesized that a 2-h reporting window decreases reliance on memory and reporting burden, and increases data accuracy. We included 215 men (28%) and women (72%), with a mean ± SD age of 39 ± 19 years and a mean ± SD BMI of 23.8 ± 4.0. Most participants were highly educated (58%). Response rates for the various dietary assessment methods were >90%. Besides the evaluation of the accuracy, usability, and perceived burden of the 2hR methodology, the study set-up also allows for (further) evaluation of the other administrated dietary assessment tools.

Comparison of Three Dietary Assessment Methods to Estimate Meat Intake as Part of a Meat Reduction Intervention among Adults in the UK

Food diaries are used to estimate meat intake at an individual level but it is unclear whether simpler methods would provide similar results. This study assessed the agreement between 7 day food diaries in which composite dishes were disaggregated to assess meat content (reference method), and two simpler methods: (1) frequency meal counts from 7 day food diaries; and (2) 7 day dietary recalls, each using standard estimated portion sizes. We compared data from a randomized controlled trial testing a meat reduction intervention. We used Bland-Altman plots to assess the level of agreement between methods at baseline and linear mixed-effects models to compare estimates of intervention effectiveness. At baseline, participants consumed 132 g/d (±75) of total meat; frequency meal counts and dietary recalls underestimated this by an average of 30 and 34 g/day, respectively. This was partially explained by an underestimation of the assumed portion size. The two simpler methods also underestimated the effect of the intervention, relative to control, though the significant effect of the intervention was unchanged. Simpler methods underestimated absolute meat intake but may be suitable for use in studies to measure the change in meat intake in individuals over time.

A Mixed-Method Study Exploring Experiences and Perceptions of Nutritionists Regarding Use of an Image-Based Dietary Assessment System in Tanzania

Due to global advances in technology, image-based food record methods have emerged as an alternative to traditional assessment methods. The use of image-based food records in low and lower-middle income countries such as Tanzania is limited, with countries still using traditional methods. The current study aimed to determine the feasibility of using a new voice and image-based dietary assessment system (VISIDA) in Dar es Salaam, Tanzania. This mixed-method study recruited 18 nutritionists as participants who collected image-based records of food and drinks they consumed using the VISIDA smartphone app. Participants viewed an online demonstration of the VISIDA web platform and the analysis process for intake data collected using the VISIDA app. Then, participants completed an online survey and were interviewed about the VISIDA app and web platform for food and nutrient intake analysis. The method was reported as being acceptable and was found to be easy to use, although technical challenges were experienced by some participants. Most participants indicated a willingness to use the VISIDA app again for one week or longer and were interested in using the VISIDA system in their current role. Participants acknowledged that the VISIDA web platform would simplify some aspects of their current job. Image-based food records could potentially be used in Tanzania to improve the assessment of dietary intake by nutritionists in urban areas. Participants recommended adding sound-on notifications, using the VISIDA app in both Apple and Android phones, enabling installation from the app store, and improving the quality of the fiducial markers.

Validation of the web-based self-administered 24-h dietary recall myfood24-Germany: comparison with a weighed dietary record and biomarkers

PURPOSE

We aimed to validate myfood24-Germany, a web-based 24-h dietary recall (24HDR), by comparing its performance with a weighed dietary record (WDR) and biomarkers.

METHODS

97 adults (77% female) completed a 3-day WDR with a 24-h urine collection on day 3, followed by at least one 24HDR with myfood24-Germany (corresponding to day 3 of the WDR). Intake of energy and 32 nutrients assessed by myfood24-Germany and the WDR for the same day were compared (method comparison). Intakes of protein and potassium assessed by myfood24-Germany/WDR were compared with intake estimated from urinary biomarkers for protein and potassium (biomarker comparison).

RESULTS

In the method comparison, significant correlations were found for energy and all tested nutrients (range 0.45-0.87). There was no significant difference between both methods in the assessed mean energy and macronutrient intake. However, myfood24-Germany underestimated mean intake of 15 nutrients. In the biomarker comparison, protein intake reported by myfood24-Germany/WDR was on average 10%/8% lower than estimated by biomarker. There was no significant difference in mean potassium intake assessed by myfood24-Germany/WDR and biomarker. However, a shared bias in the assessment of potassium intake was observed for both instruments. Concordance correlation coefficients (p_c) and weighted Kappa coefficients (κ) confirmed good agreement with the biomarker estimates for myfood24-Germany/WDR in case of protein (p_c = 0.58/0.66, κ = 0.51/0.53) and moderate agreement in case of potassium (p_c = 0.44/0.51; κ = 0.30/0.33).

CONCLUSION

Our results suggest that myfood24-Germany is of comparable validity to traditional dietary assessment methods.

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.

Using Wearable Cameras to Assess Foods and Beverages Omitted in 24 Hour Dietary Recalls and a Text Entry Food Record App

Technology-enhanced methods of dietary assessment may still face common limitations of self-report. This study aimed to assess foods and beverages omitted when both a 24 h recall and a smartphone app were used to assess dietary intake compared with camera images. For three consecutive days, young adults (18–30 years) wore an Autographer camera that took point-of-view images every 30 seconds. Over the same period, participants reported their diet in the app and completed daily 24 h recalls. Camera images were reviewed for food and beverages, then matched to the items reported in the 24 h recall and app. ANOVA (with post hoc analysis using Tukey Honest Significant Difference) and paired t-test were conducted. Discretionary snacks were frequently omitted by both methods (p < 0.001). Water was omitted more frequently in the app than in the camera images (p < 0.001) and 24 h recall (p < 0.001). Dairy and alternatives (p = 0.001), sugar-based products (p = 0.007), savoury sauces and condiments (p < 0.001), fats and oils (p < 0.001) and alcohol (p = 0.002) were more frequently omitted in the app than in the 24 h recall. The use of traditional self-report methods of assessing diet remains problematic even with the addition of technology and finding new objective methods that are not intrusive and are of low burden to participants remains a challenge.

ReStOre@Home: Feasibility study of a virtually delivered 12-week multidisciplinary rehabilitation programme for survivors of upper gastrointestinal (UGI) cancer - study protocol

Background: Exercise rehabilitation programmes, traditionally involving supervised exercise sessions, have had to rapidly adapt to virtual delivery in response to the coronavirus disease 2019 (COVID-19) pandemic to minimise patient contacts. In the absence of an effective vaccine, the pandemic is likely to persist in the medium term and during this time it is important that the feasibility and effectiveness of remote solutions is considered.  We have previously established the feasibility of the Rehabilitation Strategies following Oesophago-gastric Cancer (ReStOre) intervention - a face to face multidisciplinary rehabilitation programme for upper gastrointestinal (UGI) cancer survivors. This study will examine the feasibility of a virtually delivered 12-week multi-component ReStOre@Home programme. Methods: This single arm feasibility study will recruit 12 patients who have completed curative treatment for oesophago-gastric cancer. Participants will complete the 12-week ReStOre@Home programme consisting of exercise (aerobic and resistance training), 1:1 dietary counselling and group education sessions through virtual delivery. Underpinned by the Medical Research Council (MRC) Framework, feasibility will be determined by recruitment rates, adherence, retention, incidents, and acceptability. Acceptability will be assessed qualitatively through post-intervention interview and the Telehealth Usability Questionnaire. Secondary outcomes will be assessed pre and post-intervention and will include measures of physical performance (cardiopulmonary exercise test, short physical performance battery, hand grip strength, Godin Leisure Time Questionnaire, and body composition), health related quality of life (European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC-QLQ-C30) and oesophago-gastric cancer specific subscale (EORTC-QLQ-OG25), fatigue (Multidimensional Fatigue Inventory (MFI-20), and venous blood samples will be collected for the UGI Cancer Survivorship Biobank. Discussion: The ReStOre@Home feasibility study will provide important data regarding the amenability of a multidisciplinary programme designed for UGI cancer survivors to virtual delivery. Trial registration: ClinicalTrials.gov NCT04603339 (26/10/2020).

Respondent Characteristics and Dietary Intake Data Collected Using Web-Based and Traditional Nutrition Surveillance Approaches: Comparison and Usability Study

Background

There are many constraints to conducting national food consumption surveys for national nutrition surveillance, including cost, time, and participant burden. Validated web-based dietary assessment technologies offer a potential solution to many of these constraints.

Objective

This study aims to investigate the feasibility of using a previously validated, web-based, 24-hour recall dietary assessment tool (Foodbook24) for nutrition surveillance by comparing the demographic characteristics and the quality of dietary intake data collected from a web-based cohort of participants in Ireland to those collected from the most recent Irish National Adult Nutrition Survey (NANS).

Methods

Irish adult participants (aged ≥18 years) were recruited to use Foodbook24 (a web-based tool) between March and October 2016. Demographic and dietary intake (assessed by means of 2 nonconsecutive, self-administered, 24-hour recalls) data were collected using Foodbook24. Following the completion of the study, the dietary intake data collected from the web-based study were statistically weighted to represent the age-gender distribution of intakes reported in the NANS (2008-2010) to facilitate the controlled comparison of intake data. The demographic characteristics of the survey respondents were investigated using descriptive statistics. The controlled comparison of weighted mean daily nutrient intake data collected from the Foodbook24 web-based study (329 plausible reporters of a total of 545 reporters) and the mean daily nutrient intake data collected from the NANS (1051 plausible reporters from 1500 reporters) was completed using the Wilcoxon–Mann-Whitney U test in Creme Nutrition software.

Results

Differences between the demographic characteristics of the survey participants across the 2 surveys were observed. Notable differences included a lower proportion of adults aged ≥65 years and a higher proportion of females who participated in the web-based Foodbook24 study relative to the NANS study (P<.001). Similar ranges of mean daily intake for the majority of nutrients and food groups were observed (eg, energy [kilocalorie per day] and carbohydrate [gram per day]), although significant differences for some nutrients (eg, riboflavin [mg/10 MJ], P<.001 and vitamin B12 [µg/10 MJ], P<.001) and food groups were identified. A high proportion of participants (200/425, 47.1%) reported a willingness to continue using Foodbook24 for an additional 6 months.

Conclusions

These findings suggest that by using targeted recruitment strategies in the future to ensure the recruitment of a more representative sample, there is potential for web-based methodologies such as Foodbook24 to be used for nutrition surveillance efforts in Ireland.

Evaluation of PIQNIQ, a Novel Mobile Application for Capturing Dietary Intake

BACKGROUND

Accurate measurement of dietary intake is vital for providing nutrition interventions and understanding the complex role of diet in health. Traditional dietary assessment methods are very resource intensive and burdensome to participants. Technology may help mitigate these limitations and improve dietary data capture.

OBJECTIVE

Our objective was to evaluate the accuracy of a novel mobile application (PIQNIQ) in capturing dietary intake by self-report. Our secondary objective was to assess whether food capture using PIQNIQ was comparable with an interviewer-assisted 24-h recall (24HR).

METHODS

This study was a single-center randomized clinical trial enrolling 132 adults aged 18 to 65 y from the general population. Under a provided-food protocol with 3 menus designed to include a variety of foods, participants were randomly assigned to 1 of 3 food capture methods: simultaneous entry using PIQNIQ, photo-assisted recall using PIQNIQ, and 24HR. Primary outcomes were energy and nutrient content (calories, total fat, carbohydrates, protein, added sugars, calcium, dietary fiber, folate, iron, magnesium, potassium, saturated fat, sodium, and vitamins A, C, D, and E) captured by the 3 methods.

RESULTS

The majority of nutrients reported were within 30% of consumed intake in all 3 food capture methods (n = 129 completers). Reported intake was highly (>30%) overestimated for added sugars in both PIQNIQ groups and underestimated for calcium in the photo-assisted recall group only (P < 0.001 for all). However, in general, both PIQNIQ methods had similar levels of accuracy and were comparable to the 24HR except in their overestimation (>30%) of added sugars and total fat (P < 0.001 for both).

CONCLUSIONS

Our results suggest that intuitive, technology-based methods of dietary data capture are well suited to modern users and, with proper execution, can provide data that are comparable to data obtained with traditional methods. This trial was registered at clinicaltrials.gov as NCT03578458.

Web-Based Dietary Intake Estimation to Assess the Reproducibility and Relative Validity of the EatWellQ8 Food Frequency Questionnaire: Validation Study

BACKGROUND

The web-based EatWellQ8 food frequency questionnaire (FFQ) was developed as a dietary assessment tool for healthy adults in Kuwait. Validation against reliable instruments and assessment of its reproducibility are required to ensure the accuracy of the EatWellQ8 FFQ in computing nutrient intake.

OBJECTIVE

This study aims to assess the reproducibility and relative validity of the EatWellQ8 146-item FFQ, which included images of food portion sizes based on The Composition of Foods by McCance and Widdowson and food composition tables from Kuwait and the Kingdom of Bahrain, against a paper-based FFQ (PFFQ) and a 4-day weighed food record (WFR).

METHODS

Reproducibility of the EatWellQ8 FFQ was assessed using a test-retest methodology. Participants were required to complete the FFQ at 2 time points, 4 weeks apart. To assess the relative validity of the EatWellQ8 FFQ, a subset of the participants were asked to complete a PFFQ or a 4-day WFR 1 week after the administration of the EatWellQ8 FFQ. The level of agreement between nutrient and food group intakes was estimated by repeated EatWellQ8 FFQ administration. The EatWellQ8 FFQ, PFFQ, and 4-day WFR were also evaluated using the Bland-Altman methodology and classified into quartiles of daily intake. Crude unadjusted correlation coefficients were also calculated for nutrients and food groups.

RESULTS

A total of 99 Kuwaiti participants (64/99, 65% female and 35/99, 35% male) completed the study-53 participated in the reproducibility study and the 4-day WFR validity study (mean age 37.1 years, SD 9.9) and 46 participated in the PFFQ validity study (mean age 36.2 years, SD 8.3). Crude unadjusted correlations for repeated EatWellQ8 FFQs ranged from 0.37 to 0.93 (mean r=0.67, SD 0.14; 95% CI 0.11-0.95) for nutrients and food groups (P=.01). Mean cross-classification into exact agreement plus adjacent was 88% for nutrient intakes and 86% for food groups, and Bland-Altman plots showed good agreement for energy-adjusted macronutrient intakes. The association between the EatWellQ8 FFQ and PFFQ varied, with crude unadjusted correlations ranging from 0.42 to 0.73 (mean r=0.46, SD 0.12; 95% CI -0.02 to 0.84; P=.046). Mean cross-classification into exact agreement plus adjacent was 84% for nutrient intake and 74% for food groups. Bland-Altman plots showed moderate agreement for both energy and energy-controlled nutrient intakes. Crude unadjusted correlations for the EatWellQ8 FFQ and the 4-day WFR ranged from 0.40 to 0.88 (mean r=0.58, SD 0.13; 95% CI 0.01-0.58; P=.01). Mean cross-classification into exact agreement plus adjacent was 85% for nutrient intake and 83% for food groups. Bland-Altman plots showed moderate agreement for energy-adjusted macronutrient intakes.

CONCLUSIONS

The results indicate that the web-based EatWellQ8 FFQ is reproducible for assessing nutrient and food group intake and has moderate agreement compared with a PFFQ and a 4-day WFR for measuring energy and nutrient intakes.

ReStOre@Home: Feasibility study of a virtually delivered 12-week multidisciplinary rehabilitation programme for survivors of upper gastrointestinal (UGI) cancer - study protocol

Background: Exercise rehabilitation programmes, traditionally involving supervised exercise sessions, have had to rapidly adapt to virtual delivery in response to the coronavirus disease 2019 (COVID-19) pandemic to minimise patient contacts. In the absence of an effective vaccine, the pandemic is likely to persist in the medium term and during this time it is important that the feasibility and effectiveness of remote solutions is considered.  We have previously established the feasibility of the Rehabilitation Strategies following Oesophago-gastric Cancer (ReStOre) intervention - a face to face multidisciplinary rehabilitation programme for upper gastrointestinal (UGI) cancer survivors. This study will examine the feasibility of a virtually delivered 12-week multi-component ReStOre@Home programme. Methods: This single arm feasibility study will recruit 12 patients who have completed curative treatment for oesophago-gastric cancer. Participants will complete the 12-week ReStOre@Home programme consisting of exercise (aerobic and resistance training), 1:1 dietary counselling and group education sessions through virtual delivery. Underpinned by the Medical Research Council (MRC) Framework, feasibility will be determined by recruitment rates, adherence, retention, incidents, and acceptability. Acceptability will be assessed qualitatively through post-intervention interview and the Telehealth Usability Questionnaire. Secondary outcomes will be assessed pre and post-intervention and will include measures of physical performance (cardiopulmonary exercise test, short physical performance battery, hand grip strength, Godin Leisure Time Questionnaire, and body composition), health related quality of life (European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC-QLQ-C30) and oesophago-gastric cancer specific subscale (EORTC-QLQ-OG25), fatigue (Multidimensional Fatigue Inventory (MFI-20), and venous blood samples will be collected for the UGI Cancer Survivorship Biobank. Discussion: The ReStOre@Home feasibility study will provide important data regarding the amenability of a multidisciplinary programme designed for UGI cancer survivors to virtual delivery. Trial registration: ClinicalTrials.gov NCT04603339 (26/10/2020).

Rehabilitation strategies following oesophagogastric and Hepatopancreaticobiliary cancer (ReStOre II): a protocol for a randomized controlled trial

BACKGROUND

Curative treatment for upper gastrointestinal (UGI) and hepatopancreaticobiliary (HPB) cancers, involves complex surgical resection often in combination with neoadjuvant/adjuvant chemo/chemoradiotherapy. With advancing survival rates, there is an emergent cohort of UGI and HPB cancer survivors with physical and nutritional deficits, resultant from both the cancer and its treatments. Therefore, rehabilitation to counteract these impairments is required to maximise health related quality of life (HRQOL) in survivorship. The initial feasibility of a multidisciplinary rehabilitation programme for UGI survivors was established in the Rehabilitation Strategies following Oesophago-gastric Cancer (ReStOre) feasibility study and pilot randomised controlled trial (RCT). ReStOre II will now further investigate the efficacy of that programme as it applies to a wider cohort of UGI and HPB cancer survivors, namely survivors of cancer of the oesophagus, stomach, pancreas, and liver.

METHODS

The ReStOre II RCT will compare a 12-week multidisciplinary rehabilitation programme of supervised and self-managed exercise, dietary counselling, and education to standard survivorship care in a cohort of UGI and HPB cancer survivors who are > 3-months post-oesophagectomy/ gastrectomy/ pancreaticoduodenectomy, or major liver resection. One hundred twenty participants (60 per study arm) will be recruited to establish a mean increase in the primary outcome (cardiorespiratory fitness) of 3.5 ml/min/kg with 90% power, 5% significance allowing for 20% drop out. Study outcomes of physical function, body composition, nutritional status, HRQOL, and fatigue will be measured at baseline (T0), post-intervention (T1), and 3-months follow-up (T2). At 1-year follow-up (T3), HRQOL alone will be measured. The impact of ReStOre II on well-being will be examined qualitatively with focus groups/interviews (T1, T2). Bio-samples will be collected from T0-T2 to establish a national UGI and HPB cancer survivorship biobank. The cost effectiveness of ReStOre II will also be analysed.

DISCUSSION

This RCT will investigate the efficacy of a 12-week multidisciplinary rehabilitation programme for survivors of UGI and HPB cancer compared to standard survivorship care. If effective, ReStOre II will provide an exemplar model of rehabilitation for UGI and HPB cancer survivors.

TRIAL REGISTRATION

The study is registered with ClinicalTrials.gov, registration number: NCT03958019, date registered: 21/05/2019.

Use of a Web-Based Dietary Assessment Tool (RiksmatenFlex) in Swedish Adolescents: Comparison and Validation Study

Background

A Web-based dietary assessment tool—RiksmatenFlex—was developed for the national dietary survey of adolescents in Sweden.

Objective

This study aimed to describe the Web-based method RiksmatenFlex and to test the validity of the reported dietary intake by comparing dietary intake with 24-hour dietary recalls (recall interviews), estimated energy expenditure, and biomarkers.

Methods

Adolescents aged 11-12, 14-15, and 17-18 years were recruited through schools. In total, 78 students had complete dietary information and were included in the study. Diet was reported a few weeks apart with either RiksmatenFlexDiet (the day before and a random later day) or recall interviews (face-to-face, a random day later by phone) in a cross-over, randomized design. At a school visit, weight and height were measured and blood samples were drawn for biomarker analyses. Students wore an accelerometer for 7 days for physical activity measurements. Dietary intake captured by both dietary methods was compared, and energy intake captured by both methods was compared with the accelerometer-estimated energy expenditure (EEest). Intake of whole grain wheat and rye and fruit and vegetables by both methods was compared with alkylresorcinol and carotenoid concentrations in plasma, respectively.

Results

The mean of the reported energy intake was 8.92 (SD 2.77) MJ by RiksmatenFlexDiet and 8.04 (SD 2.67) MJ by the recall interviews (P=.01). Intake of fruit and vegetables was 224 (169) g and 227 (150) g, and whole grain wheat and rye intake was 12.4 (SD 13.2) g and 12.0 (SD 13.1) g, respectively; the intakes of fruit and vegetables as well as whole grain wheat and rye did not differ between methods. Intraclass correlation coefficients ranged from 0.57 for protein and carbohydrates to 0.23 for vegetables. Energy intake by RiksmatenFlexDiet was overreported by 8% (P=.03) but not by the recall interviews (P=.53) compared with EEest. The Spearman correlation coefficient between reported energy intake and EEest was 0.34 (P=.008) for RiksmatenFlexDiet and 0.16 (P=.21) for the recall interviews. Spearman correlation coefficient between whole grain wheat and rye and plasma total alkylresorcinol homologs was 0.36 (P=.002) for RiksmatenFlexDiet and 0.29 (P=.02) for the recall interviews. Spearman correlations between intake of fruit and vegetables and plasma carotenoids were weak for both dietary tools. The strongest correlations were observed between fruit and vegetable intake and lutein/zeaxanthin for RiksmatenFlexDiet (0.46; P<.001) and for recall interviews (0.28; P=.02).

Conclusions

RiksmatenFlexDiet provides information on energy, fruit, vegetables, and whole grain wheat and rye intake, which is comparable with intake obtained from recall interviews in Swedish adolescents. The results are promising for cost-effective dietary data collection in upcoming national dietary surveys and other studies in Sweden. Future research should focus on how, and if, new technological solutions could reduce dietary reporting biases.

Protein Intake Estimated from Brief-Type Self-Administered Diet History Questionnaire and Urinary Urea Nitrogen Level in Adolescents

Our aim was to assess the validity of the brief-type self-administered diet history questionnaire (BDHQ15y) to estimate the protein intake in 248 Japanese secondary school students (mean age = 14.2 years), using urinary biomarkers as references. Participants provided three samples of overnight urine for measurement of urea nitrogen and creatinine levels, underwent anthropometric measurements, and answered the questionnaires. Additionally, 58 students provided 24-h urine specimens. A significant correlation was observed between excretion of urea nitrogen in overnight and 24-h urine specimens (ρ = 0.527; p < 0.001), with biases ≤5.8%. The mean daily protein intake estimated from urinary biomarkers was 76.4 ± 20.4 g/d in males and 65.4 ± 16.9 g/d in females, and the mean protein intake estimated from the BDHQ15y (PRTbdhq) was 89.3 ± 33.7 g/d in males and 79.6 ± 24.6 g/d in females. Crude and energy-adjusted coefficients of correlation between PRTbdhq and protein intake estimated from urinary biomarkers were 0.205 (p = 0.001; 0.247 for males and 0.124 for females), and 0.204 (p = 0.001; 0.302 for males and 0.109 for females), respectively. The BDHQ15y is a low-cost tool to assess protein intake of a large population, instead of a weakness of overestimation.

Reliability and validity of assessing energy and nutrient intake with the Vienna food record: a cross-over randomised study

BACKGROUND

The Vienna Food Record was developed as a simple paper-based pre-coded food record for use in Austrian adults, which can be completed over a flexible period of time. The present study aimed at evaluating test-retest reliability of the Vienna Food Record and its concurrent validity against a weighed food record.

METHODS

A randomised cross-over study served to compare outcomes of the Vienna Food Record with those of the weighed food record. The Vienna Food Record was completed for a second time, in order to assess test-retest reliability. Three assessment phases were interrupted by two-week wash-out phases. Sixty-seven free living Austrians aged 18-64 years, without (self-) diagnosed food allergies or intolerances, not at any medication, and not nutrition experts, were randomly assigned to one of two study arms. After drop-outs and exclusion of under-reporters, data of 35 participants has been analysed. Paired t-tests were performed for comparisons, regarding test-retest reliability and criterion validity, where mean differences were calculated as effect sizes. Consistency between repeated assessments with the Vienna Food Record was expressed by intra-class-correlation coefficients (ICC), while Pearson's r was used for agreement regarding validity. Bland-Altman Plots with 95% limits of agreement were created for energy and macronutrients. Validity metrics for macronutrients were analysed additionally separated by gender, taking an adjustment of energy intake into account. Total energy intakes as well as intakes of macro- and selected micronutrients, expressed as daily means, were defined as 34 primary outcomes.

RESULTS

ICCs for energy and intake of preselected nutrients, expressing the consistency of the Vienna Food Record, ranged from not significant to 0.95. Pearson's correlation coefficients, expressing the agreement of the Vienna Food Record with the weighed food record ranged from not significant to 0.80.

CONCLUSIONS

This study demonstrates acceptable reliability and validity of the Vienna Food Record as an instrument for the assessment of energy and nutrient intake, comparable to the results of similar studies.

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.

Strategies for online personalised nutrition advice employed in the development of the eNutri web app

The internet has considerable potential to improve health-related food choice at low-cost. Online solutions in this field can be deployed quickly and at very low cost, especially if they are not dependent on bespoke devices or offline processes such as the provision and analysis of biological samples. One key challenge is the automated delivery of personalised dietary advice in a replicable, scalable and inexpensive way, using valid nutrition assessment methods and effective recommendations. We have developed a web-based personalised nutrition system (eNutri) which assesses dietary intake using a validated graphical FFQ and provides personalised food-based dietary advice automatically. Its effectiveness was evaluated during an online randomised controlled trial dietary intervention (EatWellUK study) in which personalised dietary advice was compared with general population recommendations (control) delivered online. The present paper presents a review of literature relevant to this work, and describes the strategies used during the development of the eNutri app. Its design and source code have been made publicly available under a permissive open source license, so that other researchers and organisations can benefit from this work. In a context where personalised diet advice has great potential for health promotion and disease prevention at-scale and yet is not currently being offered in the most popular mobile apps, the strategies and approaches described in the present paper can help to inform and advance the design and development of technologies for personalised nutrition.

A Dietary Assessment App for Hospitalized Patients at Nutritional Risk: Development and Evaluation of the MyFood App

Background

Disease-related malnutrition is a common challenge among hospitalized patients. There seems to be a lack of an effective system to follow-up nutritional monitoring and treatment of patients at nutritional risk after risk assessment. We identify a need for a more standardized system to prevent and treat disease-related malnutrition.

Objective

We aimed to develop a dietary assessment app for tablets for use in a hospital setting and to evaluate the app’s ability to measure individual intake of energy, protein, liquid, and food and beverage items among hospitalized patients for two days. We also aimed to measure patients’ experiences using the app.

Methods

We have developed the MyFood app, which consists of three modules: 1) collection of information about the patient, 2) dietary assessment function, and 3) evaluation of recorded intake compared to individual needs. We used observations from digital photography of the meals, combined with partial weighing of the meal components, as a reference method to evaluate the app’s dietary assessment system for two days. Differences in the intake estimations of energy, protein, liquid, and food and beverage items between MyFood and the photograph method were analyzed on both group and individual level.

Results

Thirty-two patients hospitalized at Oslo University Hospital were included in the study. The data collection period ran from March to May 2017. About half of the patients had ≥90% agreement between MyFood and the photograph method for energy, protein, and liquid intake on both recording days. Dinner was the meal with the lowest percent agreement between methods. MyFood overestimated patients’ intake of bread and cereals and underestimated fruit consumption. Agreement between methods increased from day 1 to day 2 for bread and cereals, spreads, egg, yogurt, soup, hot dishes, and desserts. Ninety percent of participants reported that MyFood was easy to use, and 97% found the app easy to navigate.

Conclusions

We developed the MyFood app as a tool to monitor dietary intake among hospitalized patients at nutritional risk. The recorded intake of energy, protein, and liquid using MyFood showed good agreement with the photograph method for the majority of participants. The app’s ability to estimate intake within food groups was good, except for bread and cereals which were overestimated and fruits which were underestimated. The app was well accepted among study participants and has the potential to be a dietary assessment tool for use among patients in clinical practice.

New approaches in assessing food intake in epidemiology

PURPOSE OF REVIEW

A promising direction for improving dietary intake measurement in epidemiologic studies is the combination of short-term and long-term dietary assessment methods using statistical methods. Thereby, web-based instruments are particularly interesting as their application offers several potential advantages such as self-administration and a shorter completion time. The objective of this review is to provide an overview of new web-based short-term instruments and to describe their features.

RECENT FINDINGS

A number of web-based short-term dietary assessment tools for application in different countries and age-groups have been developed so far. Particular attention should be paid to the underlying database and the search function of the tool. Moreover, web-based instruments can improve the estimation of portion sizes by offering several options to the user.

SUMMARY

Web-based dietary assessment methods are associated with lower costs and reduced burden for participants and researchers, and show a comparable validity with traditional instruments. When there is a need for a web-based tool researcher should consider the adaptation of existing tools rather than developing new instruments. The combination of short-term and long-term instruments seems more feasible with the use of new technology.

Online dietary intake assessment using a graphical food frequency app (eNutri): Usability metrics from the EatWellUK study

Background

With widespread use of the internet, lifestyle and dietary data collection can now be facilitated using online questionnaires as opposed to paper versions. We have developed a graphical food frequency assessment app (eNutri), which is able to assess dietary intake using a validated food frequency questionnaire (FFQ) and provide personalised nutrition advice. FFQ user acceptance and evaluation have not been investigated extensively and only a few studies involving user acceptance of nutrition assessment and advice apps by older adults are published.

Methods

A formative study with 20 participants (including n = 10 ≥60 years) assessed the suitability of this app for adults and investigated improvements to its usability. The outcomes of this formative study were applied to the final version of the application, which was deployed in an online study (EatWellUK) with 324 participants (including n = 53 ≥60 years) in the UK, using different devices (smartphones, tablets and laptops/desktops). Completion times were based on browser timestamps and usability was measured using the System Usability Scale (SUS), scoring between 0 and 100. Products with a SUS score higher than 70 are considered to be good.

Results

In the EatWellUK study, SUS score median (n = 322) was 77.5 (IQR 15.0). Out of the 322 SUS questionnaire completions, 321 device screen sizes were detected by the app. Grouped by device screen size, small (n = 92), medium (n = 38) and large (n = 191) screens received median SUS scores of 77.5 (IQR 15.0), 75.0 (IQR 19.4) and 77.5 (IQR 16.25), respectively. The median SUS scores from younger (n = 268) and older participants (n = 53) were the same. The FFQ contained 157 food items, and the mean completion time was 13.1 minutes (95% CI 12.6–13.7 minutes). Small, medium and large screen devices resulted in completion times of 11.7 minutes (95% CI 10.9–12.6 minutes), 14.4 minutes (95% CI 12.9–15.9 minutes) and 13.6 minutes (95% CI 12.8–14.3 minutes), respectively.

Conclusions

The overall median SUS score of 77.5 and overall mean completion time of 13.3 minutes indicate good overall usability, and equally, comparable SUS scores and completion times across small, medium and large screen sizes indicates good usability across devices. This work is a step toward the promotion of wider uptake of online apps that can provide online dietary intake assessment at-scale, with the aim of addressing pressing epidemiological challenges.

Feasibility of an estimated method using graduated utensils to estimate food portion size in infants aged 4 to 18 months

The Diet and Nutrition Survey of Infants and Young Children (DNSIYC) was carried out in 2011 to assess the nutrient intakes of 4 to 18 month old infants in the UK. Prior to the main stage of DNSIYC, pilot work was undertaken to determine the impact of using graduated utensils to estimate portion sizes. The aims were to assess whether the provision of graduated utensils altered either the foods given to infants or the amount consumed by comparing estimated intakes to weighed intakes. Parents completed two 4-day food diaries over a two week period; an estimated diary using graduated utensils and a weighed diary. Two estimated diary formats were tested; half the participants completed estimated diaries in which they recorded the amount of food/drink served and the amount left over, and the other half recorded the amount of food/drink consumed only. Median daily food intake for the estimated and the weighed method were similar; 980g and 928g respectively. There was a small (6.6%) but statistically significant difference in energy intake reported by the estimated and the weighed method; 3189kJ and 2978kJ respectively. There were no statistically significant differences between estimated intakes from the served and left over diaries and weighed intakes (p>0.05). Estimated intakes from the amount consumed diaries were significantly different to weighed intakes (food weight (g) p = 0.02; energy (kJ) p = 0.01). There were no differences in intakes of amorphous (foods which take the shape of the container, e.g. pureed foods, porridge) and discrete food items (individual pieces of food e.g. biscuits, rice cakes) between the two methods. The results suggest that the household measures approach to reporting portion size, with the combined use of the graduated utensils, and recording the amount served and the amount left over in the food diaries, may provide a feasible alternative to weighed intakes.

Validation of a self-administered web-based 24-hour dietary recall among pregnant women

Background

The use of valid dietary assessment methods is crucial to analyse adherence to dietary recommendations among pregnant women. This study aims to assess the relative validity of a self-administered Web-based 24-h dietary recall, the R24W, against a pen-paper 3-day food record (FR) among pregnant women.

Methods

Sixty (60) pregnant women recruited at 9.3 ± 0.7 weeks of pregnancy in Quebec City completed, at each trimester, 3 R24W and a 3-day FR. Mean energy and nutrient intakes reported by both tools were compared using paired Student T-Tests. Pearson correlations were used to analyze the association between both methods. Agreement between the two methods was evaluated using cross-classification analyses, weighted kappa coefficients and Bland-Altman analyses.

Results

Pearson correlation coefficients were all significant, except for vitamin B₁₂ (r = 0.03; p = 0.83) and ranged from 0.27 to 0.76 (p < 0.05). Differences between mean intakes assessed by the R24W and the FR did not exceed 10% in 19 variables and were not significant for 16 out of 26 variables. In cross-classification analyses, the R24W ranked, on average, 79.1% of participants in the same or adjacent quartiles as the FR.

Conclusions

Compared to a 3-day FR, the R24W is a valid method to assess intakes of energy and most nutrients but may be less accurate in the evaluation of intakes of fat (as a proportion of energy intake), vitamin D, zinc and folic acid. During pregnancy, the R24W was a more accurate tool at a group-level than at an individual-level and should, therefore, be used in an epidemiological rather than a clinical setting. The R24W may be particularly valuable as a tool used in cohort studies to provide valid information on pregnant women’s dietary intakes and facilitate evaluation of associations between diet and adverse pregnancy outcomes.

Electronic supplementary material

The online version of this article (10.1186/s12884-018-1741-1) contains supplementary material, which is available to authorized users.

Comparison of a Web-Based 24-h Dietary Recall Tool (Foodbook24) to an Interviewer-Led 24-h Dietary Recall

Web-based tools have the potential to reduce the cost of dietary assessment; however, it is necessary to establish their performance compared to traditional dietary assessment methods. This study aims to compare nutrient and food intakes derived from Foodbook24 to those obtained from an interview-led 24-h dietary recall (24HDR). Seventy-nine adult participants completed one self-administered 24HDR using Foodbook24 and one interviewer-led 24HDR on the same day. Following a 10 days wash-out period the same process was completed again in opposite order to the previous study visit. Statistical analysis including Spearman’s rank order correlation, Mann-Whitney U tests, cross-classification analysis, and “Match”, “Omission”, and “Intrusion” rates were used to investigate the relationship between both methods. Strong, positive correlations of nutrient intake estimated using both methods was observed (r_s = 0.6–1.0; p < 0.001). The percentage of participants classified into the same tertile of nutrient intake distribution using both methods ranged from 58% (energy) to 82% (vitamin D). The overall match rate for food intake between both methods was 85%, while rates for omissions and intrusions were 11.5% and 3.5%, respectively. These results, alongside the reduced cost and participant burden associated with Foodbook24, highlight the tool’s potential as a viable alternative to the interviewer-led 24HDR.