Dietary assessment and prevention of hypertension in Nigeria: Protocol for a retrospective cross-sectional study for the development and validation of a food frequency questionnaire for clinical use

Contrary to North America and Europe, the prevalence of hypertension is rising in West Africa. With a transition from whole foods to processed foods in Nigeria, diet plays a key driver of hypertension. To combat this, the national nutritional guidelines in Nigeria were implemented, but their translation into actionable tools for clinicians remains a challenge. Currently, there are no simple dietary assessment tools that are concise and suitable to be incorporated into clinical care without requiring extensive data analysis while still providing personalised dietary support to their patients. This study aims to deliver a clinically tested and validated short dietary assessment tool for clinicians, patients, and researchers across Nigeria to provide personalised dietary advice for patients with hypertension. The study will be conducted in two phases: Phase 1 (n = 75) will investigate the feasibility of the short FFQ and its agreement with 24-hour dietary recalls (3x) in a clinical setting in Nigeria. During the analysis of Phase 1 data, a scoring system will be developed based on the associations between individual food items in the FFQ and measures of hypertension. Phase 2 (n = 50) will assess the acceptability of the FFQ and validate the association between the FFQ score and hypertension. Expected outcomes: The development of a clinically tested and validated short food frequency questionnaire that will be ready to use by clinicians, patients, and researchers across Nigeria to support the prevention and management of hypertension. This study will contribute to knowledge on dietary assessment and hypertension prevention by developing a validated and acceptable FFQ, which will be valuable for clinicians and researchers for personalised dietary recommendations to combat hypertension in Nigeria.

Development and validation of the MY-VEG-FFQ: A modular web-based food-frequency questionnaire for vegetarians and vegans

BACKGROUND AND OBJECTIVE

The adoption of plant-based diets in recent years has increased the need for accurate assessments of dietary intake among vegans, vegetarians, semi-vegetarians, and omnivores. This study aimed at developing and validating a modular web-based food-frequency questionnaire (FFQ), the MY-VEG-FFQ. This FFQ was based on the original FFQ (O-FFQ) designed for the Israeli population and incorporates a skip algorithm tailored for different dietary patterns.

METHODS

A convenience sample of 101 participants, recruited via social media, completed the MY-VEG FFQ, as well as a three-day food records, which served as the gold standard for this research. Relative validity of the new FFQ was evaluated by comparing nutrients with those in the three-day food records, using Pearson correlation coefficients, Bland-Altman plots, and cross-classification. The results were compared with 90 O-FFQs that previously had been completed by vegans.

RESULTS

The validation analysis showed that nutrient-intake estimates were generally higher for the MY-VEG-FFQ than those of the three-day food records. Pearson correlation coefficients ranged between 0.25-0.63, indicating an acceptable agreement between the two tools. The proportion of participants with exact or adjacent quartile agreement was between 73%-82%. The Bland-Altman analysis revealed overestimation of nutrient intake via the MY-VEG-FFQ. Compared to the O-FFQ, vegans who completed the MY-VEG-FFQ reported consumption of more food items. Additionally, the MY-VEG-FFQ showed a significantly higher intake of most macro- and micronutrients.

CONCLUSIONS

The My-VEG-FFQ demonstrated reasonable validity in assessing dietary intake among people who followed a plant-based diet. However, it tended to overestimate nutrient intake compared to the three-day food records. The development of a modular web-based FFQ with a skip algorithm tailored for specific dietary patterns, fills a crucial gap in accurately assessing the dietary intake of these populations. The MY-VEG-FFQ offers a practical and cost-effective tool for evaluating long-term dietary consumption among people who follow different dietary patterns.

Cohort profile update-overview of over 35 years of research in the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study

PURPOSE

To provide an update on the cohort profile of the DOrtmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study, including objectives, study design, methods and description of the comprehensive data pool, as well as to summarize the most important research findings of recent years.

METHODS

In 1985, the open (dynamic) cohort started to collect information on diet, growth, development, and metabolism of healthy children and adolescents in Dortmund, Germany. Detailed data are collected annually during infancy, childhood, and adolescence of the participants, including a 3-day weighed dietary record, a 24-h urine sample, anthropometric and medical examinations as well as interviews on lifestyle.

RESULTS

Even if the basic examination modules have not changed since the start over 35 years ago, the DONALD study has been continuously further developed by introducing new modules. As such, participants are also invited for follow-up examinations during adulthood since 2005, including an additional fasting blood withdrawal. Overall, 2375 (♂: 1177; ♀: 1198) participants were recruited in the DONALD study between 1985 and 2022. Data from ~ 30,700 anthropometric measurements, ~ 19,200 dietary records, ~ 10,600 24-h urine and ~ 1300 blood samples are available from an observation period of over 35 years.

CONCLUSION

The DONALD study provides a large data pool for longitudinal studies on nutrition, growth, and health in childhood and adolescence, its impact on the development of diseases in early adult life as well as dietary intake trends over more than three decades.

A validation study comparing energy and nutrient intake between a web-based food frequency questionnaire and a 4-d dietary record

OBJECTIVE

Reliable assessments of dietary intake is crucial when examining associations between dietary factors and different outcomes. Today, web-based instead of paper-based food frequency questionnaires (FFQs) are common. A web-based FFQ implies a different experience (including design differences, the possibility only to show relevant questions, and automatic checks for completeness) and may capture dietary intake differently. The aim of this study was to validate a well-used paper-based FFQ transferred to a web-based version against a 4-d dietary record.

METHODS

Baseline data from a dietary intervention study comprising women and men with type 2 diabetes were used. Diet was assessed with the web-based FFQ and a 4-d dietary record. Energy intake and energy-adjusted nutrient intakes were assessed and compared using Spearman's rank correlation and Bland-Altman analysis. The analysis included 101 participants.

RESULTS

The average energy intake with the FFQ was 2068 kcal, 157 kcal higher than the average from the dietary record. Significant deattenuated correlations were found for intake of energy (r = 0.37; 95% confidence interval [CI],0.19-0.53), carbohydrates (r = 0.85; 95% CI, 0.78-0.89), protein (r = 0.53; 95% CI, 0.38-0.66) and fat (r = 0.59; 95% CI, 0.44-0.70). Significant deattenuated correlations (ranging r = 0.26-0.73) were found for intake of alcohol, whole grain, fiber, saturated fat, monounsaturated fat, polyunsaturated fat, cholesterol, vitamins A, B12, C, D, and E, folate, iron, potassium, magnesium, and calcium. Bland-Altman analyses showed no clear trends but wide limits of agreement.

CONCLUSION

Overall, the web-based FFQ performed well and is similar to the paper-based version. It can be a useful tool for dietary assessments.

Development and validation of an eight-item calcium screener to assess daily calcium intake of patients with osteoporosis in clinical practice

OBJECTIVE

To validate a short food frequency questionnaire (screener) estimating daily average calcium intake from dietary sources to guide calcium supplementation of patients with osteoporosis in clinical practice.

METHODS

An eight-item calcium screener was developed based on existing literature, food consumption data and expert opinion. Convergent validity was determined by comparison with 3-day food records using mean difference, Spearman's correlation coefficients (SCC) and Bland-Altman analysis. Test-retest reliability was assessed by SCC and intraclass correlation coefficients (ICC). We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) to identify patients requiring calcium supplementation (<1200 mg dietary calcium intake/day).

RESULTS

Fifty-two patients filled out the eight-item calcium screener and the 3-day Food record (mean age of 66.8 ± 12.9 (SD)) and 38 patients filled out the screener twice for reliability analysis (mean age of 65.8 ± 12.8 (SD)). Dietary calcium intake between the calcium screener and food records showed a strong correlation (N = 52 patients, SCC = 0.53, p ≤ 0.001) and mean difference of 21 mg (p = 0.70). Bland-Altman analysis showed agreement within 95% confidence intervals for 49/52 comparisons (94%). Test-retest reliability of the calcium screener was excellent (SCC = 0.96, p ≤ 0.001; ICC = 0.99, p ≤ 0.001).

CONCLUSION

The calcium screener shows good convergent validity, reliability and feasibility to estimate daily calcium intake of patients with osteoporosis in routine clinical practice.

The Use of Three-Dimensional Images and Food Descriptions from a Smartphone Device Is Feasible and Accurate for Dietary Assessment

Technology-assisted dietary assessment has the potential to improve the accuracy of self-reported dietary intake. This study evaluates MealScan3D (MS3D), a mobile device-based food recording system, which uses three-dimensional images to obtain food volumes and an application to capture algorithm-driven food intake data. Participants (n = 179) were randomly assigned and trained to record three meals using either MS3D or a written food record (WFR). Generous amounts of standardized meals were provided, and participants self-selected portions for each food. The weights of provided and uneaten/leftover foods were used to determine true intake. For total energy intake (three meals combined), validity (Pearson correlation) was significantly higher for MS3D vs. the WFR (p < 0.001); when interpreted as the percentage of variance in energy intake explained, MS3D explained 84.6% of true variance, a 25.3% absolute and 42.6% relative increase over the 59.3% explained by the WFR. For 9 of 15 individual foods, the Pearson correlations between true and reported portion size estimates were significantly larger for MS3D than the WFR. Bias was smaller (intercepts were closer to the means) for 9 of 15 foods and the regression coefficients for 10 of 15 foods were significantly closer to 1.0 in the MS3D arm. MS3D is feasible for dietary assessment and may provide improvements in accuracy compared to WFRs.

Validity and reproducibility of the PERSIAN Cohort food frequency questionnaire: assessment of major dietary patterns

BACKGROUND

Dietary patterns, encompassing an overall view of individuals' dietary intake, are suggested as a suitable means of assessing nutrition's role in chronic disease development. The aim of this study was to evaluate the validity and reproducibility of a food frequency questionnaire (FFQ) designed for use in the Prospective Epidemiological Research Studies in IrAN (PERSIAN), by comparing major dietary patterns assessed by the FFQ with a reference method.

METHODS

Study participants included men and women who enrolled in the PERSIAN Cohort Study at seven of the eighteen centers. These centers were chosen to include dietary variations observed among the different Iranian ethnic populations. Two FFQ were completed for each participant over a one-year study period (FFQ1 upon enrollment and FFQ2 at the end of the study), with 24 interviewer-administered 24-hour dietary recalls (24 h) being completed monthly in between. Spearman correlation coefficients (SCC) were used comparing FFQs 1 and 2 to the 24 h to assess validity, while FFQ1 was compared to FFQ2 to assess reproducibility of the questionnaire.

RESULTS

Three major dietary patterns-Healthy, Low Protein/High Carb and Unhealthy-were identified, accounting for 70% of variance in the study population. Corrected SCC ranged from 0.31 to 0.61 in the validity and from 0.34 to 0.57 in reproducibility analyses, with the first two patterns, which accounted for over 50% of population variance, correlated at above 0.5 in both parameters, showing acceptable findings.

CONCLUSIONS

The PERSIAN Cohort FFQ is suitable for identification of major dietary patterns in the populations it is used for, in order to assess diet-disease relationships.

The impact of body composition on the degree of misreporting of food diaries

BACKGROUND/OBJECTIVES

Accurate assessments of energy intake (EI) are needed in lifestyle interventions to guarantee a negative energy balance (EB), thereby losing weight. This study aimed (1) to compare objectively measured and self-reported EI and (2) to determine the predictors of underreporting divided by sex, adiposity and BMI category.

METHODS

Seventy-three participants [mean (SD): 43.7 (9.2) years, BMI = 31.5 (4.5) kg/m2, 37% females] of the Champ4Life intervention were included in this study. EI was measured using the "intake-balance method" and self-reported through 3-day food records. Fat mass (FM) and fat-free mass (FFM) were measured by dual-energy X-ray absorptiometry. Bland-Altman analysis was performed to compare both EI assessments.

RESULTS

Self-reported EI was lower than measured EI during both neutral (-355 kcal/d) and negative EB (-570 kal/day). While no significant trends were observed for EI evaluation in either neutral (p = 0.315) or negative EB (p = 0.611), limits of agreement were wide (-1720 to 1010 and -1920 to 779 kcal/day, respectively). In females, the degree of misreporting (kcal/day and %) was predicted by weight (p = 0.032 and p = 0.039, respectively) and FM (p = 0.029 and p = 0.037, respectively). In males, only BMI (p = 0.036) was a predictor of misreporting (kcal/day).

CONCLUSION

Self-reported EI did not agree with measured EI. Our results show that larger body size was associated with higher levels of underestimation for EI (females only). Nevertheless, misreporting EI is a complex issue involving more associations than merely body composition. A deeper understanding could inform counseling for participants filling out food records in other to reduce misreporting and improve validity.

Assessment of the Dutch Healthy Diet index 2015 in the Lifelines cohort study at baseline

BACKGROUND

Dietary indices are useful measures to investigate associations between dietary intake and disease development. The Dutch Healthy Diet index 2015 (DHD2015-index), a measure of diet quality, assesses adherence to the 2015 Dutch dietary guidelines. We assessed the DHD2015-index in the Lifelines cohort study, and compared calculations from basic and detailed dietary intake data. This article replaces the retracted article that was published on 16 May 2022 [1].

METHODS

Dietary intake was assessed with a specially developed Food Frequency Questionnaire (FFQ) called Flower-FFQ, which consists of one main questionnaire (heart-FFQ), which asks for intakes of major food groups, and three complementary questionnaires (petal-FFQs), which ask for detailed information on food types within major food groups of the heart-FFQ. The DHD2015-index was assessed using data from the total Flower-FFQ (for 56,982 participants), and using data from the heart-FFQ only (for 129,030 participants). Agreement between the two indices was assessed with correlation and cross-classification.

RESULTS

The median (25th-75th percentile) DHD2015-index score was 75 (65-85) for men and 81 (70-91) for women based on the Flower-FFQ, and 68 (58-77) for men and 73 (63-82) for women based on the heart-FFQ. The Kendall's tau-b correlation coefficient between the two scores was 0.67 for men and 0.66 for women. Cross-classification into quartiles of the DHD2015-index showed that 59-60% of participants were classified in the same quartile, 36-37% in the adjacent, and 4% in the non-adjacent.

CONCLUSION

Dietary data from the Flower-FFQ provide the most optimal information to assess the DHD2015-index. However, the DHD2015-index from the heart-FFQ showed good agreement with the index from the Flower-FFQ of ranking participants according to diet quality, and can be used when the DHD2015 index from the Flower-FFQ is not available.

Evaluation of a digital FFQ using 24 h recalls as reference method, for assessment of habitual diet in women with South Asian origin in Norway

OBJECTIVE

Dietary assessment tools should be designed for the target population. We developed an FFQ designed to assess diet in South Asian women in Norway. The study objective was to evaluate this FFQ using 24-h dietary recalls as reference method.

DESIGN

Approximately 3 weeks after the participants (n 40) had filled in the FFQ, the first of three non-consecutive 24-h dietary recalls was completed. The recalls were telephone-based, unannounced and performed by a trained dietitian, with 2-3 weeks between each interview.

SETTING

The DIASA 1 study, in Oslo, Norway.

PARTICIPANTS

Women of South Asian ethnic origin participating in the DIASA 1 study were invited to participate in the evaluation study.

RESULTS

The WebFFQasia significantly overestimated the absolute intake of energy, protein, fat and carbohydrates compared with the 24-h dietary recalls. Absolute intakes of sugar, starch and fibre did not differ significantly between the methods. For energy percentages (E%), there were no significant differences, except for monounsaturated fat. Correlations were strong for E% from sugar and saturated fat and moderate for E% from fibre, carbohydrate, total fat and protein. Fourteen food groups out of twenty three were not significantly different compared with the reference method, and sixteen groups showed strong to moderate correlations.

CONCLUSION

The WebFFQasia may be used to assess E% from habitual diet and can adequately estimate intakes and rank participants according to nutrient intake and main food categories at group level.

Empirically derived portion sizes from the DOrtmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study for 4- to 18-year-old children and adolescents to simplify analysis of dietary data using FFQ

OBJECTIVE

To apply FFQ, knowledge about portion sizes is relevant. According to increased energy and nutrient requirements, average portion sizes of foods are supposed to increase during growth. We provide empirically derived portion sizes for 4- to 18-year-olds in different age groups to facilitate analyses of FFQ data in children and adolescents.

DESIGN

Using data from the dynamic DOrtmund Nutritional and Anthropometric Longitudinally Designed cohort study, quantile regression for smoothing percentiles was used to derive portion sizes as a function of age from which age- and food group-specific portion sizes were calculated as median food group intake (g).

SETTING

Dortmund, Germany.

PARTICIPANTS

Data from 3-day weighed dietary records (WDR) of 1,325 participants (♀: 653) were analysed. Participants provided in total 9,828 WDR (on average 7·5 per participant) between 1985 and 2022. WDR were grouped into five age groups, whereby each age group covered 3 years of age.

RESULTS

In total, 11 955 food items were reported and categorised into sixteen major food groups with seventy-one sub-groups. Portion sizes tended to increase with age, except for milk- and plant-based alternatives. Comparing 4- to 6-year-olds to 16- to 18-year-olds, portion size increased between 22·2 % (processed meat: 18 g v. 22 g) and 173·3 % (savoury snacks: 15 g v. 41 g).

CONCLUSION

We provide empirically derived portion sizes for children and adolescents. These data are useful to establish dietary assessment methods based on estimates of portion sizes, such as FFQ, for children and adolescents.

Validity and Reproducibility of a Semiquantitative Food Frequency Questionnaire for Measuring Intakes of Foods and Food Groups

We evaluated the validity and reproducibility of a semiquantitative food frequency questionnaire (FFQ) for measuring intakes of 149 foods and 25 food groups among 736 participants of the Women's Lifestyle Validation Study (WLVS, 2010-2012) and 649 participants of the Men's Lifestyle Validation Study (MLVS, 2011-2013). Validity of the FFQ compared with two 7-day dietary records measured 6 months apart and the reproducibility between 2 FFQs administered 1 year apart (FFQ1 and FFQ2) were assessed using Spearman correlations and intraclass correlation coefficients. The average 1-year reproducibility of FFQ-measured foods was 0.64 in both the WLVS and MLVS. Reproducibility of the food groups (mean = 0.71 among women and 0.72 among men) was generally higher than that for individual foods. Among women, the average validity correlation for individual foods was 0.59 when comparing FFQ2 with the 7-day dietary records. Among men, the corresponding average validity correlation was 0.61. Compared with individual foods, food groups had slightly higher validity correlations in both women (range, 0.45-0.92; mean = 0.61) and men (range, 0.46-0.88; mean = 0.65). This study reaffirms that the FFQ performs well in measuring most foods and food groups and provides data to adjust for measurement errors in epidemiologic studies of foods and food groups.

Development and validation of a food frequency questionnaire in adult Saudi subjects in Jeddah city

BACKGROUND AND AIMS

In Saudi Arabia, very limited studies have been conducted to evaluate the validity of culturally appropriate food frequency questionnaire (FFQ). The aim of this study was to validate a newly designed FFQ against two reference methods in Saudi adults.

METHODS

A new FFQ adapted from the Block FFQ was completed via interview and validated against three-day food records (3DFRs; n = 126) and 24-hour urinary urea nitrogen (UUN)-based protein intake estimates (n = 118) in adult Saudis living in Jeddah. FFQ-estimated nutrient intake was compared to the 3DFR and UUN methods using Pearson's correlations (r), Bland-Altman plots, and weighted kappa (κw) statistics.

RESULTS

This study included 126 participants (80 females and 46 males). The FFQ generally overreported nutrient intakes compared to the reference methods. The FFQ was strongly correlated with 3DFRs for energy, protein, carbohydrate, and total fat (r > 0.7); moderately correlated with cholesterol (r = 0.55) and iron (r = 0.44); and weakly correlated with the other micronutrients (r = 0.1-0.3). A moderate positive correlation for protein intake was found (r = 0.62) between the FFQ and 24-hour UUN method. The Bland-Altman analysis indicated the FFQ had an acceptable level of agreement with no significant proportional bias (P > 0.05) with the 3DFRs for energy, protein, total fat, and iron and with protein intake. Similarly, an acceptable level of agreement was found between the FFQ and the 24-hour UUN method for estimating protein intake. Cross-classification analysis showed that ≥ 50% of participants were ranked within the same quartile for energy, protein, and total fat. The FFQ showed good agreement with the 3DFRs for energy and protein (κw ≥ 0.61) and acceptable agreement with protein intake. An acceptable agreement was reported between the FFQ and 24-hour UUN method (κw = 0.56). Separate analyses of females and males showed stronger correlations and agreements between the FFQ and the two reference methods only in females.

CONCLUSION

The developed FFQ is an effective and valid tool for assessing dietary intake in Saudi adults. However, it still requires future optimization to improve its validity.

Dietary Patterns of iTaukei (indigenous) Fijians: Preliminary Findings From a Five-Day Dietary Record in Rural Communities

This article presents the preliminary findings from a five-day dietary record of 105 iTaukei (indigenous) Fijians in seven rural communities on remote islands, Fiji. Although the literature on noncommunicable diseases (NCDs) has discussed the potential reasons for the NCD increase in Fiji, research has relied on secondary data on the consumption patterns of limited food items. Hence, this research is one of the first in the country to analyze detailed dietary patterns. A high body mass index rate in the case study communities is observed. We also find that carbohydrate sources dominate the diet of the participants, while the consumption of protein sources (including canned products) and vegetables/fruits is limited. In addition, the diversity of food items is limited. Meanwhile, the major carbohydrate sources are locally produced cassava, although rice and flour products are also consumed. We suggest integrating these factors into the determination of the cause of the NCD increase.

Usual Nutrient Intake Distribution and Prevalence of Nutrient Intake Inadequacy among Japanese Children and Adults: A Nationwide Study Based on 8-Day Dietary Records

In this cross-sectional study, we evaluated nutrient intake adequacy in 4450 Japanese people aged 1-79 years. Dietary data was collected through non-consecutive 8-day weighed dietary records. Usual nutrient intakes from foods and beverages were estimated using the Multiple Source Method. Participant proportions with intakes below and above the Japanese Dietary Reference Intakes (2020) were calculated. Usual intakes of most nutrients were below the Estimated Average Requirement; calcium showed a high percentage of inadequacy across all sex and age groups (29-88%), and iron showed a high inadequacy among females aged 12-64 years (79-95%). The percentages of energy from protein and carbohydrates, dietary fibre, and potassium were typically below the lower limit of the Tentative Dietary Goal for Preventing Lifestyle-related Diseases (DG). Furthermore, over 20% of the participants exceeded the upper limit of the DG for the percentages of energy from total and saturated fats, and over 88% exceeded the upper limit of the DG for sodium. Japanese children and adults could improve their nutrient intake by increasing calcium, iron, dietary fibre, and potassium and reducing total and saturated fats and sodium. These findings can inform policies and interventions to improve nutrient intake in Japan.

[Design and validation of a self-reported dietary polyphenol intake frequency questionnaire.]

Introduction

Introduction: although there is evidence linking polyphenol consumption with better health outcomes, information on consumption patterns, particularly in Latin American countries, is scarce. Objective: to design and evaluate the validity of an online self-reported food frequency questionnaire to measure dietary total polyphenol intake in the Chilean adult population. Methods: the designed questionnaire (FFQ-P) was submitted to expert opinion for content validity coefficient estimation; then a pilot study was conducted in 47 adults who completed FFQ-P, in addition to a six-day food record as a reference method. Wilcoxon was applied in related samples, Spearman's correlation to determine the strength of association and Bland-Altman diagrams to examine the difference between methods. Results: content validity reflected concordant values for adequacy (0.94 ± 0.04) and relevance (0.93 ± 0.05). The percentage difference between both methods was 1.2 %, with greater variability observed in fruits (9 %) and alcoholic beverages (4 %). The Wilcoxon test showed no significant differences between food groups. Medium reliability was observed for vegetables, fruits, tea, and coffee (0.26 to 0.5) and moderate reliability for alcoholic beverages (0.5 to 0.75). The mean value of the difference was 9.8, being within a short distance of zero. Conclusion: FFQ-P is reliable for estimating polyphenol intake from fruits, vegetables, alcoholic beverages, tea, and coffee; however, the intake of non-alcoholic beverages, nuts and olives should be interpreted with reservation.

Using a Patient-Completed Food Frequency Questionnaire to Determine Mediterranean Diet Score in People with Inflammatory Bowel Disease

Purpose: To examine the level of agreement between a patient-completed food frequency questionnaire (FFQ) and assessment of usual intake by a registered dietitian (RD) to score adherence to a Mediterranean diet (MedD) in patients with inflammatory bowel disease (IBD).Methods: Patients with IBD completed a short FFQ and were subsequently interviewed by an RD. A 12-item MedD score (MDS), adapted from the Mediterranean Diet Adherence Screener (MEDAS), was calculated from the FFQ and RD assessments. To determine agreement between individual items, Cohen's kappa coefficients were calculated. Absolute agreement between assessment methods was quantified using a one-way random intra-class correlation coefficient for a single measure.Results: Forty-six patients with IBD participated. The mean FFQ-MDS was 4.59 (standard deviation [SD] = 1.65), and mean RD-MDS was 4.83 (SD = 1.53). Kappa coefficients for individual MEDAS items ranged from 0.41 to 0.78 (p < 0.01) between the FFQ- and RD-MDS. Most items demonstrated moderate to substantial agreement. The intra-class correlation coefficient for absolute agreement between the summed FFQ-MDS and RD-MDS was 0.71 (95% confidence interval: 0.52-0.83, p < 0.001), indicating moderate reliability.Conclusions: This patient-completed FFQ may be a promising tool in clinical practice and research and would benefit from additional evaluation to validate its use in patients with IBD.

Mitigating errors in mobile-based dietary assessments: Effects of a data modification process on the validity of an image-assisted food and nutrition app

OBJECTIVE

Mobile nutrition applications (apps) provide a simple way for individuals to record their diet, but the validity and inherent errors need to be carefully evaluated. The aim of this study was to assess the validity and clarify the sources of measurement errors of image-assisted mobile nutrition apps.

METHODS

This was a cross-sectional study with 98 students recruited from School of Nutrition and Health Sciences, Taipei Medical University. A 3-d nutrient intake record by Formosa Food and Nutrient Recording App (FoodApp) was compared with a 24-h dietary recall (24-HDR). A two-stage data modification process, manual data cleaning, and reanalyzing of prepackaged foods were employed to address inherent errors. Nutrient intake levels obtained by the two methods were compared with the recommended daily intake (DRI), Taiwan. Paired t test, Spearman's correlation coefficients, and Bland-Altman plots were used to assess agreement between the FoodApp and 24-HDR.

RESULTS

Manual data cleaning identified 166 food coding errors (12%; stage 1), and 426 food codes with missing micronutrients (32%) were reanalyzed (stage 2). Positive linear trends were observed for total energy and micronutrient intake (all Ptrend < 0.05) after the two stages of data modification, but not for dietary fat, carbohydrates, or vitamin D. There were no statistical differences in mean energy and macronutrient intake between the FoodApp and 24-HDR, and this agreement was confirmed by Bland-Altman plots. Spearman's correlation analyses showed strong to moderate correlations (r = 0.834 ∼ 0.386) between the two methods. Participants' nutrient intake tended to be lower than the DRI, but no differences in proportions of adequacy/inadequacy for DRI values were observed between the two methods.

CONCLUSIONS

Mitigating errors significantly improved the accuracy of the Formosa FoodApp, indicating its validity and reliability as a self-reporting mobile-based dietary assessment tool. Dietitians and health professionals should be mindful of potential errors associated with self-reporting nutrition apps, and manual data cleaning is vital to obtain reliable nutrient intake data.

Reproducibility and relative validity of a semi-quantitative food and beverage frequency questionnaire for Spanish children aged 3 to 11 years: the COME-Kids F&B-FQ

A reliable food and beverage frequency questionnaire (F&B-FQ) to measure dietary intakes for children across Spain is currently unavailable. Thus, we designed and assessed the reproducibility and relative validity of a new F&B-FQ in 210 Spanish children aged 3-11 years. COME-Kids F&B-FQ contained 125 items to assess the usual diet intake in the past year among children. To explore the reproducibility, caregivers answered COME-Kids F&B-FQ twice over a 15-day period (± 1 week). To evaluate the relative validity, estimates from a third COME-Kids F&B-FQ administered at 1 year of follow-up were compared with the mean estimates from 3-day dietary records (3d-DR) collected at baseline, 6 months, and after 1 year of follow-up. Reproducibility and relative validity of the COME-Kids F&B-FQ in estimating food groups and nutrients were assessed using Pearson (r) and intra-class (ICC) correlation coefficients. We used the kappa index to evaluate the agreement in repeat administrations or with the 3d-DR. We used Bland-Altman plots to identify bias across levels of intake. A total of 195 children (105 boys, 90 girls) completed the study. The reproducibility of data estimated from COME-Kids F&B-FQ was substantial with mean r and ICC being 0.65 and 0.64 for food groups and 0.63 and 0.62 for nutrients, respectively. Validation assessments comparing the FFQ and 3d-DRs showed r = 0.36 and ICC = 0.30 for food groups and r = 0.29 and ICC = 0.24 for nutrients. The mean agreement for food group reproducibility and relative validity was 86% and 65%, respectively. These estimates were 85% for reproducibility and 64% for relative validity in the case of nutrients. For reproducibility and relative validity, the overall mean kappa index was 63% and 37% for all food groups and 52% and 27% for nutrients, respectively. Bland-Altman plots showed no specific bias relating to the level of intake of nutrients and several food groups.

CONCLUSION

COME-Kids F&B-FQ showed substantial reproducibility and acceptable relative validity to assess food and beverage intake in Spanish children aged 3 to 11 years. Most children were correctly classified in relation to the intake of food groups and nutrients, and misclassification was unlikely with reference to 3d-DR.

WHAT IS KNOWN

• The estimation of dietary intake in children is complex, especially in large cohorts. • The food frequency questionnaire is a well-recognized and the most frequently used method for assessing food consumption.

WHAT IS NEW

• A new food and beverage frequency questionnaire including a beverage section and novel plant-based food items has been validated in Spanish children aged 3-11 years.

Developing and validating a version of the food frequency questionnaire for young adults in a public university in Malaysia

BACKGROUND AND OBJECTIVES

Epidemiological studies often use the food frequency questionnaire (FFQ) to predict the food consumption habits of a target group and subsequently promote healthy eating in the group. In the present study, a version of the FFQ for Malaysian young adults aged 18-24 years was designed and validated.

METHODS AND STUDY DESIGN

This study comprised development and validation phases. In the development phase, 129 young adults from a public university in Klang Valley completed a 3-day food record (3DFR), and the data were used to create a food list for the FFQ. Two weeks later, in the validation phase, another 100 participants recruited from the same university completed the 3DFR and a newly developed FFQ for assessing consumption of 38 food items. Finally, the data obtained from the FFQ and 3DFR were used to analyze the nutrient intake of each participant, and the developed FFQ was validated using Spearman correla-tion coefficients (r) and Bland-Altman methods.

RESULTS

For the development phase, 38 food items were determined to contribute to 90% of the participants' total energy and macronutrient intake, and these items were included on the FFQ. For the validation phase, the average Spearman correlation coefficient for energy and all nutrients was 0.43, which indicated good agreement between the 3DFR and FFQ. Cross-classification analysis of the 3DFR and FFQ results revealed that 79% of the young adults were classified into similar or neighboring quartiles when each set of results was used. The Bland-Altman plots revealed that the results obtained using the two methods were parallel.

CONCLUSIONS

The FFQ is a simple and validated tool that can be self-administered to young adults to assess their energy and nutrient consumption.

Surveying Nutrient Assessment with Photographs of Meals (SNAPMe): A Benchmark Dataset of Food Photos for Dietary Assessment

Photo-based dietary assessment is becoming more feasible as artificial intelligence methods improve. However, advancement of these methods for dietary assessment in research settings has been hindered by the lack of an appropriate dataset against which to benchmark algorithm performance. We conducted the Surveying Nutrient Assessment with Photographs of Meals (SNAPMe) study (ClinicalTrials ID: NCT05008653) to pair meal photographs with traditional food records. Participants were recruited nationally, and 110 enrollment meetings were completed via web-based video conferencing. Participants uploaded and annotated their meal photos using a mobile phone app called Bitesnap and completed food records using the Automated Self-Administered 24-h Dietary Assessment Tool (ASA24®) version 2020. Participants included photos before and after eating non-packaged and multi-serving packaged meals, as well as photos of the front and ingredient labels for single-serving packaged foods. The SNAPMe Database (DB) contains 3311 unique food photos linked with 275 ASA24 food records from 95 participants who photographed all foods consumed and recorded food records in parallel for up to 3 study days each. The use of the SNAPMe DB to evaluate ingredient prediction demonstrated that the publicly available algorithms FB Inverse Cooking and Im2Recipe performed poorly, especially for single-ingredient foods and beverages. Correlations between nutrient estimates common to the Bitesnap and ASA24 dietary assessment tools indicated a range in predictive capacity across nutrients (cholesterol, adjusted R2 = 0.85, p < 0.0001; food folate, adjusted R2 = 0.21, p < 0.05). SNAPMe DB is a publicly available benchmark for photo-based dietary assessment in nutrition research. Its demonstrated utility suggested areas of needed improvement, especially the prediction of single-ingredient foods and beverages.

National Nutrition Surveys Applying Dietary Records or 24-h Dietary Recalls with Questionnaires: A Scoping Review

Development of an accurate and efficient dietary method is required for national nutrition surveys. Some countries conduct dietary surveys and combine 24-h dietary records or 24-h dietary recalls with dietary questionnaires. This scoping review aimed to summarize studies that used results from national surveys that combined detailed dietary surveys (dietary records or 24-h dietary recall) and dietary questionnaires and identify the purpose of combining the two methods. The PubMed database and manual searches were used for the literature review. We extracted 58 articles from 16 national nutrition surveys from 14 countries. Most studies used 24-h dietary recall for detailed dietary surveys and the food frequency questionnaire (FFQ) or food propensity questionnaire (FPQ) for questionnaire surveys. Among 37 studies from eight countries, the purpose of combining the two dietary survey methods was to estimate energy and nutrient intakes from detailed dietary surveys and habitual food intake from questionnaires. These findings are useful as a reference when introducing new dietary survey methods in future national nutrition surveys.

Validation of the 2 × 24 h recall method and a 7-d web-based food diary against doubly labelled water in Danish adults

The European Food Safety Authority has suggested that EU countries implement the 2 × 24 h diet recall (2 × 24 h DR) method and physical activity (PA) measurements for national dietary surveys. Since 2000, Denmark has used 7 d food diaries (7 d FD) with PA questionnaires and measurements. The accuracy of the reported energy intakes (EI) from the two diet methods, pedometer-determined step counts and self-reported time spent in moderate-to-vigorous PA (MVPA) were compared with total energy expenditure measured by the doubly labelled water (TEEDLW) technique and with PA energy expenditure (PAEE), respectively. The study involved fifty-two male and sixty-eight female volunteers aged 18-60 years who were randomly assigned to start with either the 24 h DR or the web-based 7 d FD, and wore a pedometer for the first 7 d and filled in a step diary. The mean TEEDLW (11·5 MJ/d) was greater than the mean reported EI for the 7 d FD (9·5 MJ/d (P < 0·01)) but the same as the 2 × 24 h DR (11·5 MJ/d). The proportion of under-reporters was 34 % (7 d FD) and 4 % (2 × 24 h DR). Most participants preferred the 7 d DR as it was more flexible, despite altering their eating habits. Pearson's correlation between steps corrected for cycling and PAEE was r = 0·44, P < 0·01. Spearman's correlation for self-reported hours spent in MVPA and PAEE was r = 0·58, P < 0·01. The 2 × 24 h DR performs better than the existing 7 d FD method. Pedometer-determined steps and self-reported MVPA are good predictors of PAEE in adult Danes.

Reliability and validity of a semi-quantitative food frequency questionnaire: dietary intake assessment among multi-ethnic populations in Northwest China

BACKGROUND

Few multi-ethnic dietary culture-sensitive food frequency questionnaires (FFQ) have been developed due to the complexity and diversity of cooking methods and styles. This study aimed to develop and validate a specific FFQ among multi-ethnic groups in Northwest China.

METHODS

In the reliability study, 139 participants aged 20-65 completed two identical FFQs separated by 3 months. The relative validation of the FFQ was assessed by three 24-h recalls (24HR) employed in the interval of two FFQs, as a reference. Stratified analyses were also conducted by the major ethnic groups (Han nationality or Ethnic minority).

RESULTS

For reproducibility, the median (range) of Spearman's correlation coefficients (SCC) was 0.71 (0.43-0.84) for nutrients. The intra-class correlation coefficients (ICC) covered a spectrum from 0.39 to 0.78 (median: 0.64). Meanwhile, the weighted kappa values ranged from 0.11 to 0.64. For validity, the median (range) of Pearson's correlation coefficients derived from the energy unadjusted and the adjusted values between FFQ and 24HR were 0.61 (0.12-0.79) and 0.56 (0.12-0.77), respectively. The results of correlation coefficients were similar between the two ethnic groups. Moreover, the Bland-Altman plots likewise demonstrated a satisfactory level of agreement between the two methods.

CONCLUSIONS

The FFQ showed acceptable reproducibility and moderate relative validity for evaluating dietary intake among multi-ethnic groups in northwest China. It could be a credible nutritional screening tool for forthcoming epidemiological surveys of these populations.

Dietary amino acid intake and sleep duration are additively involved in future cognitive decline in Japanese adults aged 60 years or over: a community-based longitudinal study

BACKGROUND

Sleep duration and amino acid intake are independently associated with cognitive decline. This study aimed to determine the longitudinal association between sleep duration and cognitive impairment incidence and to examine the involvement of diet, particularly amino acid intake, in these associations in community dwellers.

METHODS

In this longitudinal study in a community-based setting, we analyzed data from 623 adults aged 60-83 years without cognitive impairment at baseline. Sleep duration was assessed using a self-report questionnaire. Amino acid intake was assessed using 3-day dietary records. Cognitive impairment was defined as a Mini-Mental State Examination score ≤ 27. Participants were classified into short-, moderate-, and long-sleep groups according to baseline sleep duration (≤ 6, 7-8, and > 8 h, respectively). Using moderate sleep as a reference, odds ratios (ORs) and 95% confidence intervals (CIs) of short- and long-sleep for cognitive-impairment incidence were estimated using the generalized estimating equation. Participants were classified according to sex-stratified quartiles (Q) of 19 amino acid intake: Q1 and Q2-Q4 were low- and middle to high-intake groups, respectively. Using middle- to high-intake as a reference, ORs and 95% CIs of low intake for cognitive impairment incidence were estimated using the generalized estimating equation in each sleep-duration group. Follow-up period, sex, age, body mass index, depressive symptoms, education, smoking status, employment status, sleep aids use, physical activity, medical history, and Mini-Mental State Examination score at baseline were covariates.

RESULTS

Mean follow-up period was 6.9 ± 2.1 years. Adjusted ORs (95% CIs) for cognitive impairment in short- and long-sleep groups were 0.81 (0.49-1.35, P = 0.423) and 1.41 (1.05-1.87, P = 0.020), respectively. Particularly in long sleepers (i.e., > 8 h), cognitive impairment was significantly associated with low cystine, proline, and serine intake [adjusted ORs (95% CIs) for cognitive impairment were 2.17 (1.15-4.11, P = 0.017), 1.86 (1.07-3.23, P = 0.027), and 2.21 (1.14-4.29, P = 0.019), respectively].

CONCLUSIONS

Community-dwelling adults aged ≥ 60 years who sleep longer are more likely to have cognitive decline, and attention should be paid to the low cystine, proline, and serine intake.

Validation and calibration of the Food Consumption Frequency Questionnaire for pregnant women

BACKGROUND

Few food frequency questionnaires (FFQ) have been validated for pregnant women, particularly those in small- and medium-sized cities in different regions of Brazil.

OBJECTIVES

To validate and calibrate a semiquantitative FFQ for pregnant women.

DESIGN AND SETTING

The study was validated with a sample of 50 pregnant women (≥ 18 years) enrolled in Brazilian prenatal services.

METHODS

An FFQ and a 24-hour recall were used to evaluate dietary intake. Dietary variables were tested for normality and log-converted when asymmetrical. Pearson's Correlation Coefficient was used to validate the questionnaire. Linear regression was applied to extract calibration factors. All variables underlying the consumption analysis were adjusted for energy.

RESULTS

The mean age of the pregnant women was 26 years ± 6.2 years; 58% were in their first trimester, and 30% were identified as overweight/obese. The Pearson correlation analysis results indicated that the FFQ overestimated energy and nutrient intake, whose coefficients ranged from -0.15 (monounsaturated fat) to 0.50 (carbohydrate). Adjusting for energy reduced the mean values of intake coefficients, which now ranged from -0.33 (sodium) to 0.96 (folate). The calibration analysis results indicated variation in the coefficients from -0.23 (sodium) to 1.00 (folate). Calibration produced satisfactory coefficients for the FFQ compared with the reference standard for energy, macronutrients, monounsaturated fat, cholesterol, vitamins B12/C, folate, sodium, iron, and calcium.

CONCLUSIONS

After validating and calibrating tests, we observed that the FFQ was adequately accurate for assessing the food consumption of the pregnant women in this study.

"More2Eat" in patients at nutritional risk during hospital stay lowers the risk of three-month mortality

BACKGROUND & AIMS

Malnutrition is a common problem among hospitalized patients due to increased nutrient requirements and reduced food intake or uptake of nutrients. The aim of this prospective cohort study was to investigate the association of nutritional risk status (at or not at risk by NRS-2002) as well as energy and protein intake, use of oral nutritional supplements (ONS) and snack meals in at risk patients during hospitalization and adverse outcomes (length of stay (LOS), readmissions and mortality) at three-months follow-up.

METHODS

Data were collected at baseline and at three-months follow-up in patients hospitalized at 31 units at a Danish University Hospital. Diet records were performed at baseline by using the nurses' quartile nutrition recording methods. Data about disease and clinical outcomes were collected from electronic medical records at baseline and three-months follow-up.

RESULTS

A total of 318 patients were included. Patients at nutritional risk (n = 149, 47%) had higher risk of longer LOS (≥20 days (OR = 4.24 [1.81;9.95] and ≥30 days OR = 2.50 [1.22;5.14])), having one readmission (OR = 1.86 [1.15;3.01]) and death (OR = 2.56 [1.27;5.20]) compared to patients not at nutritional risk (n = 169, 53%). A longer LOS was associated with patients who achieved ≥75% of energy and protein requirements, consumed snack meals incl. and excl. oral nutritional supplements. Readmissions in patients at nutritional risk during the three-months were not associated with food intake during the index hospitalization. Mortality was observed in 43 of the 318 (13.5%) hospitalized patients. A lower mortality was associated with increased energy and protein intake in patients at nutritional risk.

CONCLUSIONS

The results of this study indicate a longer LOS, higher readmission rate and increased mortality in patients at nutritional risk compared to patients not at risk. Patients at nutritional risk had lower risk of three-month mortality and longer LOS during index hospitalization with increased energy and protein intake. Readmissions in patients at nutritional risk were not affected by food intake. The association of nutritional risk with poorer outcomes indicates that good nutritional care including constant attention to food-intake during hospitalization can be beneficial regarding mortality.

Iodine-specific food frequency questionnaire can evaluate iodine intakes of Chinese pregnant women

Iodine is an essential trace element for the synthesis of thyroid hormones, which play an important role in growth and development, metabolism, and body organ function. There is no iodine-specific food frequency questionnaire (I-FFQ) for pregnant women in China. This study aimed to validate and optimize an I-FFQ. A total of 1802 pregnant women were included in this study. The iodine nutrition survey was performed using I-FFQ and 3-day estimated food diary (3DEFD). Seventy-one women of reproductive age repeated the I-FFQ twice to assess for FFQ reproducibility. Further optimization of the I-FFQ was accomplished by integrating iodine contributions to simplified questionnaire items. Correlation and Bland-Altman analyses were used to verify the consistency of I-FFQ with 3DEFD, as well as the stability and feasibility of I-FFQ optimization. The I-FFQ and 3DEFD had a strong correlation (R = 0.76, P < .001) and agreement (Kappa = 0.731, P < .001). A Bland-Altman plot showed that 5.1% of participants exceeded the limit of agreement. Nonpregnant women of reproductive age completed the I-FFQ twice, and the results had a strong correlation (R = 0.72, P < .001). A Bland-Altman analysis showed that 5.6% of individuals were located outside the limit of agreement. The consistency of I-FFQ before and after optimization was good (Kappa = 0.982, P < .001). Therefore, I-FFQ could be used as a valid tool to estimate iodine intake among Chinese pregnant women. The optimized I-FFQ could shorten survey time without affecting its accuracy.

24-h glucose level and variability in response to carbohydrate overfeeding assessed using continuous glucose monitoring system are associated with daily carbohydrate intake

BACKGROUND & AIMS

The quantity gap between daily and loaded carbohydrates may affects blood glucose response to carbohydrate intake; however, no study has investigated the difference in 24-h span. This study aimed to determine differences in the 24-h glucose levels and variability in response to single-day carbohydrate overfeeding based on daily carbohydrate intake in healthy Japanese men.

METHODS

Twenty male college students completed a 3-day dietary record and were divided into two groups based on whether their daily carbohydrate intake exceeded the median intake (H-CHO) or not (L-CHO). Thereafter, the participants consumed a high-carbohydrate diet (carbohydrate 8.1 g/kg/d) for 1 day. The 24-h glucose levels and glucose variability (CONGA1) were measured using a continuous glucose monitoring system.

RESULTS

The mean daily carbohydrate intakes in the L-CHO and H-CHO groups were 3.9 ± 0.5 and 5.8 ± 0.6 g/kg/d, respectively (p < 0.001). The peak 24-h glucose level was not differ between the L-CHO group and the H-CHO group (8.0 ± 0.8 vs. 8.0 ± 1.0; p = 0.886). The mean 24-h glucose level was higher in the L-CHO group than in the H-CHO group (6.0 ± 0.3 vs. 5.6 ± 0.3 mmol/L; p = 0.010). The CONGA1 was higher in the L-CHO group than in the H-CHO group (5.40 ± 0.41 vs. 4.95 ± 0.25; p = 0.008).

CONCLUSIONS

Mean glucose level and glucose variability in response to carbohydrate overfeeding were high in the individuals with small daily carbohydrate intake. These findings suggest that the large quantity gap between daily and loaded carbohydrates cause worse glucose control during carbohydrate overfeeding.

Validation of Total Water Intake from the Automated Self-Administered 24-h Recall, 4-d Food Records, and a Food Frequency Questionnaire Using Doubly Labeled Water

BACKGROUND

Although prior evidence indicates that water intake is important for health, the ability to accurately measure community-dwelling intake is limited. Only a few studies have evaluated self-reported water intake against an objective recovery biomarker.

OBJECTIVES

The aim was to compare preformed water intakes (all sources including food) by multiple Automated Self-Administered 24-h recalls (ASA24s), food frequency questionnaires (FFQs), and 4-d food records (4DFRs) against a recovery biomarker, doubly labeled water (DLW), to assess measurement error.

METHODS

Over 1 y, 1082 women and men (50%), aged 50 to 74 y, were asked to complete 6 ASA24s, 2 FFQs, 2 unweighted 4DFRs, and an administration of DLW (n = 686). Geometric means of water intake by self-report tools were compared with DLW. Attenuation factors and correlation coefficients between self-reported and the recovery biomarker (DLW) were estimated.

RESULTS

Mean water intakes by DLW were 2777 mL/d (interquartile range, 2350 to 3331) in women and 3243 mL/d (interquartile range, 2720 to 3838) in men. Compared with DLW, water intake was underestimated by 18% to 31% on ASA24s and 43% to 44% on 4DFRs. Estimated geometric means from FFQs differed from DLW by -1% to +13%. For a single ASA24, FFQ, and 4DFR, attenuation factors were 0.28, 0.27, and 0.32 and correlation coefficients were 0.46, 0.48, and 0.49, respectively. Repeated use of 6 ASA24s, 2 FFQs, and 2 4DFRs improved attenuation factors to 0.43, 0.32, and 0.39 and correlation coefficients to 0.58, 0.53, and 0.54, respectively.

CONCLUSIONS

FFQs may better estimate population means for usual water intake compared with ASA24 and 4DFR. Similar attenuation factors and correlation coefficients across all self-report tools indicate that researchers have 3 feasible options if the goal is understanding intake-disease relationships. The findings are useful for planning future nutrition studies that set policy priorities for populations and to understand the health impact of water. This trial was registered at clinicaltrials.gov as NCT03268577.

Calorie Compensation Patterns Observed in App-Based Food Diaries

Self-regulation of food intake is necessary for maintaining a healthy body weight. One of the characteristics of self-regulation is calorie compensation. Calorie compensation refers to adjusting the current meal's energy content based on the energy content of the previous meal(s). Preload test studies measure a single instance of compensation in a controlled setting. The measurement of calorie compensation in free-living conditions has largely remained unexplored. This paper proposes a methodology that leverages extensive app-based observational food diary data to measure an individual's calorie compensation profile in free-living conditions. Instead of a single compensation index followed in preload-test studies, we present the compensation profile as a distribution of days a user exhibits under-compensation, overcompensation, non-compensation, and precise compensation. We applied our methodology to the public food diary data of 1622 MyFitnessPal users. We empirically established that four weeks of food diaries were sufficient to characterize a user's compensation profile accurately. We observed that meal compensation was more likely than day compensation. Dinner compensation had a higher likelihood than lunch compensation. Precise compensation was the least likely. Users were more likely to overcompensate for missing calories than for additional calories. The consequences of poor compensatory behavior were reflected in their adherence to their daily calorie goal. Our methodology could be applied to food diaries to discover behavioral phenotypes of poor compensatory behavior toward forming an early behavioral marker for weight gain.

Seasonal and Regional Differences in Eating Times in a Representative Sample of the Brazilian Population

Human food intake and its timing are a complex behavior that can be influenced by a variety of factors, some of which may vary from season to season or from region to region. In this study, our aim was to investigate the seasonal variation in food intake times, with a particular focus on how these may vary across different regions of a country. We conducted an analysis of data from 20,622 adults from the National Household Budget Survey (POF-IBGE), encompassing complete food diaries collected from individuals residing in Brazil, and thereby ensuring representation across different latitudes. Each participant's daily food intake was reported for two non-consecutive days at different times in the same week using food diaries. An ANOVA revealed a later food intake time in the evening in high-latitude regions compared to low-latitude regions. The Sidak post-hoc test showed a significant interaction effect between region and season, demonstrating a pattern of early First Intake Time and Eating Midpoint in the Northeast region during spring/summer. Additionally, we observed an independent effect of the region, as early food intake times were found in low-latitude regions. These findings offer a basis for discussing food intake times among individuals living in different regions located on distinct latitudes.

Validity and reproducibility of the intake of trans-fatty acids estimated using a FFQ and characteristics of trans-fatty acid intake of the Japanese population: the JPHC FFQ Validation Study

We aimed to validate a method for assessing trans-fatty acid (TFA) intake in the Japanese population using the FFQ developed in the 1990s from a prospective study that was based on the Japan Public Health Center-based Prospective Cohort Study. For FFQ validation, we included 565 participants (Cohort I: n 215, Cohort II: n 350) aged 40-69 years. We used a 28-d dietary record (DR) over 1 year and two FFQ administered before and after DR assessment. We calculated total TFA intake, TFA from industrial oils (i-TFA) and TFA from ruminants (r-TFA) considering a database of measurements obtained mainly from Japan. Spearman's rank correlation coefficients (CC) were computed for validity and reproducibility. Energy adjustments were applied using two methods considering the TFA measurement: density method for TFA % of total energy and residual method for TFA g/d. The total TFA intake (% of the total energy intake) was 0·08-0·76 % (median, 0·27-0·37 %) in DR of both cohorts and was 0·00-1·13 % (median, 0·30-0·40 %) in FFQ. The i-TFA accounted for approximately 50 % of the total TFA intake in DR and approximately 40 % in FFQ. For total TFA (% of the total energy intake), CC were 0·54-0·69, and weighted κ coefficients were 0·88-0·92 for both cohorts. The de-attenuated CC was 0·46-0·62 for i-TFA (g/d) and 0·57-0·68 for r-TFA (g/d). Our study showed that the validity and reproducibility of TFA intake estimation using the FFQ were reasonable, suggesting its suitability among the Japanese population with low-TFA intake.

Validation of Mobile Artificial Intelligence Technology-Assisted Dietary Assessment Tool Against Weighed Records and 24-Hour Recall in Adolescent Females in Ghana

BACKGROUND

Important gaps exist in the dietary intake of adolescents in low- and middle-income countries (LMICs), partly due to expensive assessment methods and inaccuracy in portion-size estimation. Dietary assessment tools leveraging mobile technologies exist but only a few have been validated in LMICs.

OBJECTIVE

We validated Food Recognition Assistance and Nudging Insights (FRANI), a mobile artificial intelligence (AI) dietary assessment application in adolescent females aged 12-18 y (n = 36) in Ghana, against weighed records (WR), and multipass 24-hour recalls (24HR).

METHODS

Dietary intake was assessed during 3 nonconsecutive days using FRANI, WRs, and 24HRs. Equivalence of nutrient intake was tested using mixed-effect models adjusted for repeated measures, by comparing ratios (FRANI/WR and 24HR/WR) with equivalence margins at 10%, 15%, and 20% error bounds. Agreement between methods was assessed using the concordance correlation coefficient (CCC).

RESULTS

Equivalence for FRANI and WR was determined at the 10% bound for energy intake, 15% for 5 nutrients (iron, zinc, folate, niacin, and vitamin B6), and 20% for protein, calcium, riboflavin, and thiamine intakes. Comparisons between 24HR and WR estimated equivalence at the 20% bound for energy, carbohydrate, fiber, calcium, thiamine, and vitamin A intakes. The CCCs by nutrient between FRANI and WR ranged between 0.30 and 0.68, which was similar for CCC between 24HR and WR (ranging between 0.38 and 0.67). Comparisons of food consumption episodes from FRANI and WR found 31% omission and 16% intrusion errors. Omission and intrusion errors were lower when comparing 24HR with WR (21% and 13%, respectively).

CONCLUSIONS

FRANI AI-assisted dietary assessment could accurately estimate nutrient intake in adolescent females compared with WR in urban Ghana. FRANI estimates were at least as accurate as those provided through 24HR. Further improvements in food recognition and portion estimation in FRANI could reduce errors and improve overall nutrient intake estimations.

Validating a semi-quantitative food frequency questionnaire to assess regional diet in a study of cancer in South West Nigeria

PURPOSE

Cancer burden is rising rapidly in Nigeria, the most populous country in sub-Saharan Africa; this trend may in part be attributable to diet. We developed and validated a semi-quantitative food frequency questionnaire (FFQ) to assess regional diet in Nigeria.

METHODS

We recruited 68 adult participants from rural and urban settings in South West Nigeria. We developed an FFQ administered at baseline and assessed its validity using 3 dietary recalls (baseline, 7 days post baseline, 3 months post baseline). We calculated Spearman's rank correlation coefficients and energy-adjusted de-attenuated correlation coefficients for food items and macronutrients. We evaluated cross-classification using quartiles of macronutrient intake.

RESULTS

Energy-adjusted de-attenuated food item correlations between the FFQ and dietary recalls ranged from -0.08 (smoked beef/goat) to 0.73 (fried snacks) for the average intake from the first 2 recalls (2DR) and from -0.05 (smoked beef/goat) to 0.75 (smoked fish) for the average of all 3 recalls (3DR). Macronutrient correlations ranged from 0.15 (fat) to 0.37 (fiber) for the 2DR and from 0.08 (fat) to 0.41 (carbohydrates) for the 3DR. The percent of participants classified in the same quartile ranged from 16.4% (fat) to 32.8% (fiber, protein) for the 2DR and from 25.6% (fat) to 34.9% (carbohydrates) for the 3DR. Agreement improved when including adjacent quartiles, from 65.5% (carbohydrates) to 70.5% (fat, fiber) for the 2DR and from 62.8% (protein) to 76.8% (carbohydrate) for the 3DR.

CONCLUSION

Our semi-quantitative FFQ was reasonably valid for ranking intake of certain foods and macronutrients in adults in South West Nigeria.

Highly Processed Food Consumption and Its Association with Anthropometric, Sociodemographic, and Behavioral Characteristics in a Nationwide Sample of 2742 Japanese Adults: An Analysis Based on 8-Day Weighed Dietary Records

This cross-sectional study assessed highly processed food (HPF) consumption and its association with individual characteristics in a nationwide sample of Japanese adults. Eight-day weighed dietary records were obtained from 2742 free-living adults aged 18-79 years across Japan. HPFs were identified based on a classification method developed by researchers at the University of North Carolina at Chapel Hill. The basic characteristics of the participants were assessed using a questionnaire. On average, HPF contributed to 27.9% of daily energy intake. The contribution of HPF to the daily intake of 31 nutrients ranged from 5.7% for vitamin C to 99.8% for alcohol (median, 19.9%). Cereals and starchy foods were the main food groups that contributed to the total energy intake of HPF. Multiple regression analysis showed that the older group (60-79 years) had a lower HPF energy contribution than the younger group (18-39 y) (regression coefficient (β) = -3.55, p < 0.0001). Compared to current smokers, past and never-smokers had lower HPF energy contributions (β = -1.41, p < 0.02; and -4.20, p < 0.0001, respectively). In conclusion, HPFs account for approximately one-third of energy intake in Japan. Younger age and current smoking status should be considered in future intervention strategies to reduce HPF consumption.

Validation of a Thai semiquantitative food frequency questionnaire (semi-FFQ) for people at risk of metabolic syndrome

BACKGROUND

Food frequency questionnaires (FFQ) are a useful dietary assessment tool to determine relationships between diet and non-communicable diseases (NCDs). Our purpose was to validate a semiquantitative FFQ (semi-FFQ) for Thais at risk of metabolic syndrome (MS).

METHODS

The researchers identified 345 men and women aged 30-65 years who were eligible for the study. Ninety-four participants were finally enrolled (54 in a "urine-collection not-required" group and 40 in a "urine collection" group). They were asked to maintain a 4-day food record for 4 weeks and partook in a semi-FFQ interview during week 4. Urine samples and biochemical results related to MS were collected. Validation results were associated with three primary nutrients for MS (sugar, fat, and sodium) and biochemical results (blood glucose, lipid profiles, blood pressure, and 24-h urine sodium).

RESULTS

The biomarker level of each key MS nutrient significantly increased commensurate with rises in semi-FFQ estimated intakes. Correlation coefficients (r) were as follows: fasting blood glucose, r = 0.221 (fruits) and r = 0.229 (desserts); triglycerides, r = 0.112 (a la carte-dishes); low-density lipoprotein cholesterol, r = 0.205 (rice-with-topping dishes); systolic blood pressure, r = 0.272 (snacks) and r = 0.190 (a la carte dishes). Fasting blood glucose was a significant biomarker associated with the development of metabolic syndrome (OR 1.42, 95% CI 1.12-1.81). We also found that fat (OR 1.28, 95% CI 1.09-1.89), sodium (OR 1.98, 95% CI 1.05-1.95) and energy (OR 1.09, 95% CI 1.01-1.17) from an a la carte meal were significantly associated with the development of metabolic syndrome.

CONCLUSIONS

Thai food has a unique characteristic since it often pairs various ingredients and seasoning in one menu. This semi-FFQ is a tool that offers relatively valid ranking for intake of energy, nutrients, single foods, and mixed dishes based on Thai menus associated with a risk for developing metabolic syndrome and NCDs. Using this tool could help identify unhealthy dietary patterns and help develop recommendations for people at risk with the goal of preventing NCDs.

Development and Validation of a Food Frequency Questionnaire for Evaluating the Nutritional Status of Patients with Cancer

Patients with cancer need to maintain proper nutritional status to overcome cancer, alleviate the side effects of chemotherapy, and prevent a recurrence. As such, it is necessary to manage nutritional status. This study aimed to develop a dish-based semi-quantitative food frequency questionnaire (FFQ) to evaluate the nutritional status of patients with cancer and assess the validity of the FFQ. A total of 109 dish items were selected through contribution and variability analyses using the 2016-2018 Korea National Health and Nutrition Examination Survey data. The FFQ was validated against the average 3-day dietary records of 100 patients with cancer. Pearson correlation coefficients and quartile agreements between FFQ and 3-day dietary records were calculated for intake of energy, macronutrients, and micronutrients. Age and energy-adjusted Pearson correlation coefficients ranged from 0.20 (iron) to 0.54 (potassium). The percentage of participants who were classified into the same or adjacent quartile between the FFQ and the 3-day dietary record ranged from 68% (protein) to 81% (energy, dietary fiber). The results suggest that the FFQ is an appropriate tool for assessing nutritional status in Korean cancer patients.

Development and Validation of Vitamin D- Food Frequency Questionnaire for Moroccan Women of Reproductive Age: Use of the Sun Exposure Score and the Method of Triad's Model

This cross-sectional study aimed to develop and validate a vitamin D food frequency questionnaire (VitD-FFQ) to assess vitamin D intake in Moroccan women of reproductive age. Using the method of triads, the VitD-FFQ was validated against seven-day dietary records (7d-FR) and 25-hydroxyvitamin D (25(OH)D) as a biomarker of vitamin D status in 152 women (aged 18-45 years). Participants' sun exposure scores (SES) were assessed using a specific questionnaire (SEQ). Predictors of vitamin D status were identified via linear regression models. Several statistical tests were applied to evaluate the criterion validity of the FFQ against two references methods (7d-FR and the biomarker-serum 25(OH)D). Median (Interquartile range) intakes were 7.10 ± 6.95 µg /day and 6.33 ± 5.02 µg/ day, respectively, for VitD-FFQ and 7d-FR. Vitamin D status was mainly determined by SES (R = 0.47) and vitamin D absolute food intakes derived by the VitD-FFQ (R = 0.56), which demonstrated a more significant prediction ability compared to 7d-FR (R = 0.36). An agreement was observed between the VitD-FFQ and 7d-FR (BA index of 3.29%) with no proportional bias (R² = 0.002, p = 0.54). <10% of participants were incorrectly classified, and weighted kappa statistics showed that VitD-FFQ had an acceptable ranking ability compared to the 7d-FR and the biomarker. The validity coefficient for the VitD-FFQ was high: ρQR = 0.90 (95%CI: 0.89-0.92), and a range from 0.46 to 0.90. Adjustment for the participants' SES and BMI (body mass index) improved the biomarker's validity coefficient (ρRB 0.63 (95% CI 0.39-0.82). Our results indicate that the VitD-FFQ is valid for estimating absolute vitamin D intake in Moroccan women of reproductive age.

Estimating nitrate intake in the Australian diet: Design and validation of a food frequency questionnaire

BACKGROUND

Dietary nitrates may play a role in mediating several key physiological processes impacting health and/or exercise performance. However, current methods for assessing dietary nitrate (NO3 - ) consumption are inadequate. The present study aimed to examine the dietary nitrate intake in a sample of 50 healthy adults, as well as test the validity of a purposefully developed food frequency questionnaire (FFQ).

METHODS

Dietary nitrate intake was estimated over a week using (i) three 24-h dietary recalls; (ii) a short-term (7-day) FFQ; and (iii) a biomarker (urinary nitrate), in conjunction with a nitrate reference database.

RESULTS

Daily dietary nitrate intake estimates were 130.94 mg (average of three 24-h recalls) and 180.62 mg (FFQ). The mean urinary NO3 - excretion was 1974.79 µmol day-1 (or 917.9 µmol L-1 ). Despite the difference between the two dietary assessment methods, there was a moderate positive correlation (r = 0.736, ρ < 0.001) between the two tools. There was also a positive correlation between urinary NO3 - and 24-h recall data (r = 0.632, ρ < 0.001), as well as between urinary NO3 - and FFQ (r = 0.579, ρ < 0.001).

CONCLUSIONS

The ability to accurately estimate nitrate intakes depends on having suitable reference methods to estimate the concentrations of nitrate in the food supply, coupled with valid and reliable dietary assessment tools. Based on the findings from the present study, at an individual level, dietary recalls or records may be more accurate in estimating intakes of NO3 - . However, given the lower cost and time needed for administration relative to recalls, the FFQ has merit for estimating NO3 - intakes in health interventions, dietary surveys and surveillance programs.

Relative Validity and Reproducibility of Dietary Measurements Assessed by a Semiquantitative Food Frequency Questionnaire among Chinese Healthy Adults

This study aimed to evaluate the relative validity and reproducibility of a semiquantitative food frequency questionnaire (SFFQ) in adult populations in China. Among the 49 recruited healthy participants (age range: 20-60 years), the relative validity of a 79-item SFFQ was assessed in two ways: (1) by comparing its dietary intake estimates with those from the average measurements of three inconsecutive 24 h dietary records (24-HDRs); and (2) by comparing its estimates of dietary fatty acids with the measured plasma levels of fatty acids. The reproducibility of the SFFQ was evaluated by a comparison of two SFFQ measurements from the same participants collected one year apart. In the relative validity study, the average Spearman correlation coefficient (r) was 0.27 among 18 prespecified food group intakes estimated from the SFFQ and the 24-HDRs; nevertheless, that of five food group intakes (e.g., red meat and seafood) was higher (all r_s > 0.40, p < 0.05). In addition, a moderate correlation between the SFFQ estimate of polyunsaturated fatty acid intakes (energy-adjusted percentage of total fatty acids) and its plasma level was observed (r = 0.42, p < 0.05). Regarding the one-year reproducibility of the SFFQ-assessed intakes, the average rank intraclass correlation coefficient (ICC) was 0.35 for the 18 food group estimates. In particular, moderately reproducible estimates of seven food group intakes (e.g., refined grains and red meat, all ICCs ≥ 0.40, p < 0.05) were observed. In conclusion, the SFFQ provides valid and reproducible estimates of dietary intakes for various food groups in general and performs well as a potential tool for estimating habitual dietary intakes of some unsaturated fatty acids.

Evaluation of a Food Frequency Questionnaire for Capturing Free Sugars Intake in Australian Young Children: The InFANT FFQ

Excess free sugars intake contributes to dental caries and obesity in children. Food frequency questionnaires (FFQ) that assess free sugars intake in young children are limited. This study evaluated the utility of a 68-item FFQ to assess free sugars intake in Australian young children against three 24-h recalls at ages 1.5, 3.5, and 5.0 years. Free sugars intakes estimated from two methods were compared using group- and individual-level validation tests. Group-level tests revealed that mean free sugars intakes estimated from two methods were similar and Bland-Altman tests revealed no presence of proportional bias at age 1.5 years. For ages 3.5 and 5.0 years, the FFQ underestimated the free sugars intake compared to the recalls, and Bland-Altman tests revealed proportional bias. For individual-level tests, the deattenuated correlation (R) between free sugars intakes estimated from two methods exhibited good agreement across three time-points (R: 0.54-0.62), as were the percentage agreement (68.5-73.6%) and weighted kappa (Kw: 0.26-0.39). The FFQ showed good validity at age 1.5 years. For ages 3.5 and 5.0 years, the FFQ showed good validity for individual-level tests only. The FFQ provided stronger validity in the ranking of individuals according to free sugars intake than comparing absolute free sugars intake at group level.

Reliability and Validity Estimate of the Pro-Inflammatory/Anti-Inflammatory Food Intake Score in South American Pediatric Population: SAYCARE Study

Chronic low-grade inflammation may be associated with the development of chronic non-communicable diseases in young populations, often lasting to adulthood. Studies show that the diet is related to chronic inflammation. The Pro-inflammatory/Anti-inflammatory Food Intake Score (PAIFIS) is an indicator that measures the inflammatory potential of the diet, with the help of validated tools that assess food consumption. The validation of tools that assess inflammatory dietary patterns in young populations to produce valid and reliable results is essential to guide disease prevention strategies for adulthood.

METHODS

This study aimed to estimate the Pro-inflammatory/Anti-inflammatory Food Intake Score (PAIFIS) in children and adolescents in South America and to test its reliability and validity using a food frequency questionnaire (FFQ) and an inflammatory biomarker. This work consists of a validation study in a sample of children and adolescents conducted in South America (SAYCARE Study). The habitual consumption of food contributing to calculating the PAIFIS was obtained through an FFQ and 24 h Dietary Recall (24HDR). Reliability was tested using the FFQ (FFQ1 × FFQ2), using Spearman's correlation coefficient to estimate the agreement between measurements. The validity of the PAIFIS was tested using 24HDR and the inflammatory biomarker C-reactive protein (CRP) using Spearman's correlation and multilevel linear regression.

RESULTS

For children and adolescents, pro- and anti-inflammatory food groups showed Spearman's correlation coefficients ranging from 0.31 to 0.66, convergent validity ranging from 0.09 to 0.40, and criterion validity for a reliability range from -0.03 to 0.18. The PAIFIS showed Spearman's correlation coefficients for reliability ranging from 0.61 to 0.69, convergent validity from 0.16 to 0.23, and criterion validity from -0.03 to 0.24.

CONCLUSION

The PAIFIS showed acceptable reliability, weak convergent validity, and weak criterion validity in children and adolescents.

Association between the intake of animal offal and depressive symptoms: the TCLSIH Cohort Study

Background: Prospective cohort studies linking animal offal intake and depressive symptoms are limited. This study aimed to prospectively investigate the association between animal offal consumption and the risk of depressive...

The simplified iodine-specific food frequency questionnaire can evaluate iodine intake in Chinese adults

We hypothesized that an effective iodine-specific food frequency questionnaire (I-FFQ) simplification method could expand the application of the I-FFQ in evaluating long-term iodine intake. An adult I-FFQ was developed and was simplified by deleting food items with iodine contribution rates ≤0.1%, combining food items with similar species and iodine contribution rates, and calculating the iodine content of combined food by a weighted calculation method. A 3-day (3-d) diet diary tested the validity of the I-FFQ. We evaluated the relationship between iodine intake estimated using the I-FFQ and the urinary iodine to creatinine ratio, thyroid volume (Tvol), and thyroid function. The Kappa value was 0.62 for the original I-FFQ and the 3-d diet diary (P < .001), 0.78 for the short-version I-FFQ and the 3-d diet diary (P < .001), and 0.76 for the original I-FFQ and the short-version I-FFQ (P < .001). The mean difference before and after simplification was 27.1 µg/d. The Tvol was different between the I-FFQ groups and showed an upward trend (P for trend = .01). Tvol was higher in the 284 <I-FFQ <347 µg/d (β = 0.55; 95% CI, 0.06-1.03; P = .03) and I-FFQ >347 µg/d (β = 0.72; 95% CI, 0.16-1.28; P = .01) groups after simplification. The I-FFQ is an effective method for evaluating iodine nutritional status in adults. After streamlining, the food items were reduced from 58 to 15, which shortened the investigation time while retaining evaluation efficiency; it is also easier to get the cooperation of the subjects and improve the availability of I-FFQ.

Dietary Intakes of Elite Male Professional Rugby Union Players in Catered and Non-Catered Environments

In professional rugby union, it is common for players to switch between catered and non-catered dietary environments throughout a season. However, little is known about the difference in dietary intake between these two settings. Twelve elite male professional rugby union players (28.3 ± 2.9 y, 188.9 ± 9.5 cm, 104.1 ± 13.3 kg) from the New Zealand Super Rugby Championship completed seven-day photographic food diaries with two-way communication during two seven-day competition weeks in both catered and non-catered environments. While no significant differences were observed in relative carbohydrate intake, mean seven-day absolute energy intakes (5210 ± 674 vs. 4341 ± 654 kcal·day^-1), relative protein (2.8 ± 0.3 vs. 2.3 ± 0.3 g·kgBM·day^-1) and relative fat (2.1 ± 0.3 vs. 1.5 ± 0.3 g·kgBM·day^-1) intakes were significantly higher in the catered compared to the non-catered environment (respectively) among forwards (n = 6). Backs (n = 6) presented non-significantly higher energy and macronutrient intakes within a catered compared to a non-catered environment. More similar dietary intakes were observed among backs regardless of the catering environment. Forwards may require more support and/or attention when transitioning between catered and non-catered environments to ensure that recommended dietary intakes are being achieved.

Effect of Different Nutritional Education Based on Healthy Eating Index for HemoDialysis Patients on Dietary Quality and Muscle Mass

BACKGROUND

Hemodialysis patients are at high risk of muscle loss as a result of aging and disease, and combined with inadequate dietary intake. The Healthy Eating Index for HemoDialysis patients (HEI-HD) was developed to assess the dietary quality of hemodialysis patients. The purposes of this study were to examine the effects of different nutritional education models using HEI-HD-based education on dietary quality and muscle mass in hemodialysis patients.

METHODS

A quasi-experimental study was conducted from May 2019 to April 2021, with four groups, including no course for patients and nurses (Non-C), course for nurses (CN), course for patients (CP), and course for patients and nurses (CPN). The courses were delivered by registered dietitians. The data of 94 patients were collected and analyzed at baseline, after 2 months of intervention, and 2 months follow-up, including demographics, body composition, 3-day dietary records, and hemodialysis dietary knowledge. The HEI-HD index score was calculated.

RESULTS

Patients aged 58.3 ± 10.1 years. The dietary quality change in the CPN group was improved as compared with the Non-C group (-3.4 ± 9.5 vs. 3.0 ± 5.5, 0.04). The skeletal muscle mass of the Non-C group at intervention was also significantly lower than baseline, but the CPN group was not.

CONCLUSIONS

The HEI-HD-based nutritional education for both patients and nurses showed a positive effect on improving the dietary quality and maintaining muscle mass in hemodialysis patients.

Wearable Cameras Reveal Large Intra-Individual Variability in Timing of Eating among Young Adults

Studies have shown that young adults follow less structured eating patterns compared with older cohorts. This may have implications for dietary assessment methods which rely on memory and structured meal patterns. Our aim was to describe the intra-individual variation of eating times in young adults aged 18−30 years. Participants (n = 41) wore an Autographer camera that captured first-person perspective images every 30 s for three consecutive days. All images were timestamped and those showing food consumption were used to extract data such as the timing of the first and last eating occasions (EOs), number of EOs per day, and length of eating window. Intra-individual variability was calculated from these data using composite phase deviation (CPD) and coefficient of variation (CV). The number of individuals with high or very high variability was 28 and 18 for timing of first and last EOs, respectively (CPD > 1.70), and 27 and 17 for number of EOs and eating window, respectively (CV > 20%). In this sample of young adults, the lack of regularity in eating patterns should be considered when selecting a dietary assessment method.