Rethinking the Use of Mobile Apps for Dietary Assessment in Medical Research

Food intake and usual dietary intake are among the key determinants of health to be assessed in medical research and important confounding factors to be accounted for in clinical studies. Although various methods are available for gathering dietary data, those based on innovative technologies are particularly promising. With combined cost-effectiveness and ease of use, it is safe to assume that mobile technologies can now optimize tracking of eating occasions and dietary behaviors. Yet, choosing a dietary assessment tool that meets research objectives and data quality standards remains challenging. In this paper, we describe the purposes of collecting dietary data in medical research and outline the main considerations for using mobile dietary assessment tools based on participant and researcher expectations.

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Rethinking the Use of Mobile Apps for Dietary Assessment in Medical Research (Preprint)

10.2196/preprints.15619 ◽

2019 ◽

Author(s):

Wael Khazen ◽

Jean-François Jeanne ◽

Laëtitia Demaretz ◽

Florent Schäfer ◽

Guy Fagherazzi

Keyword(s):

Medical Research ◽

Assessment Tool ◽

Mobile Apps ◽

Dietary Assessment ◽

Ease Of Use ◽

Assessment Tools ◽

Dietary Behaviors ◽

Mobile Technologies ◽

Eating Occasions ◽

Dietary Data

UNSTRUCTURED Food intake and usual dietary intake are among the key determinants of health to be assessed in medical research and important confounding factors to be accounted for in clinical studies. Although various methods are available for gathering dietary data, those based on innovative technologies are particularly promising. With combined cost-effectiveness and ease of use, it is safe to assume that mobile technologies can now optimize tracking of eating occasions and dietary behaviors. Yet, choosing a dietary assessment tool that meets research objectives and data quality standards remains challenging. In this paper, we describe the purposes of collecting dietary data in medical research and outline the main considerations for using mobile dietary assessment tools based on participant and researcher expectations.

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Accuracy of Parental Reporting of Preschoolers’ Dietary Intake Using an Online Self-Administered 24-h Recall

Nutrients ◽

10.3390/nu10080987 ◽

2018 ◽

Vol 10 (8) ◽

pp. 987 ◽

Cited By ~ 4

Author(s):

Angela Wallace ◽

Sharon Kirkpatrick ◽

Gerarda Darlington ◽

Jess Haines

Keyword(s):

Dietary Intake ◽

Assessment Tool ◽

Dietary Assessment ◽

Portion Size ◽

Assessment Tools ◽

Web Based ◽

Plate Waste ◽

Daycare Centre ◽

Parental Reports ◽

Eating Occasions

Parents are typically relied upon to report young children’s dietary intake. However, there has been limited research assessing the accuracy of such reports captured using novel dietary assessment tools. The purpose of the current study was to assess the validity of the web-based Automated Self-Administered 24-h Dietary Assessment Tool (ASA24-Canada) for capturing dietary intake among children aged two-five years (n = 40), using parental proxy reporting. The study was conducted in a daycare setting, allowing for standardization of foods and drinks offered and direct observation of intake. Parental-reported intake was compared to true intake for lunch and dinner, as well as an afternoon snack, on a single day. Each eating occasion, including plate waste, was unobtrusively documented. Parents were not present for lunch or the afternoon snack, but joined their children at the daycare centre for the dinner meal. The following day, parents reported their children’s intake from the previous 24-h period using ASA24-Canada. For the eating occasions assessed, parents reported exact or close matches for 79.2% (82.3% for lunch, 81.2% for the snack, and 77.4% for dinner) of the foods and beverages truly consumed by children. Estimates of intake for energy and macronutrients examined (carbohydrates, fat, and protein) based on parental reports were higher than those based on true (observed) intake. Our findings suggest that parents are able to report what their preschool children eat and drink relatively accurately. However, the accuracy of portion size estimates is low. Strategies to enhance portion size reporting are needed to improve parental proxy reporting.

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A comparison of the Remote Food Photography Method and the Automated Self-Administered 24-hour Dietary Assessment Tool for measuring full day dietary intake among school-aged children

British Journal Of Nutrition ◽

10.1017/s0007114521001951 ◽

2021 ◽

pp. 1-26

Author(s):

Traci A. Bekelman ◽

Corby K. Martin ◽

Susan L. Johnson ◽

Deborah H. Glueck ◽

Katherine A. Sauder ◽

...

Keyword(s):

Dietary Intake ◽

Energy Intake ◽

Mixed Model ◽

Linear Mixed Model ◽

Assessment Tool ◽

Dietary Assessment ◽

Ease Of Use ◽

Self Report ◽

Food Photography ◽

Photography Method

Abstract The limitations of self-report measures of dietary intake are well known. Novel, technology-based measures of dietary intake may provide a more accurate, less burdensome alternative to existing tools. The first objective of this study was to compare participant burden for two technology-based measures of dietary intake among school-age children: the Automated-Self Administered 24-hour Dietary Assessment Tool-2018 (ASA24-2018) and the Remote Food Photography Method (RFPM). The second objective was to compare reported energy intake for each method to the Estimated Energy Requirement for each child, as a benchmark for actual intake. Forty parent-child dyads participated in 2, 3-day dietary assessments: a parent proxy-reported version of the ASA24 and the RFPM. A parent survey was subsequently administered to compare satisfaction, ease of use and burden with each method. A linear mixed model examined differences in total daily energy intake (TDEI) between assessments, and between each assessment method and the EER. Reported energy intake was 379 kcal higher with the ASA24 than the RFPM (p=0.0002). Reported energy intake with the ASA24 was 231 kcal higher than the EER (p = 0.008). Reported energy intake with the RFPM did not differ significantly from the EER (difference in predicted means = −148 kcal, p = 0.09). Median satisfaction and ease of use scores were 5 out of 6 for both methods. A higher proportion of parents reported that the ASA24 was more time consuming than the RFPM (74.4% vs. 25.6%, p = 0.002). Utilization of both methods is warranted given their high satisfaction among parents.

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Effect of Manual Data Cleaning on Nutrient Intakes using the Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24)

Current Developments in Nutrition ◽

10.1093/cdn/nzab005 ◽

2021 ◽

Author(s):

Yasmine Y Bouzid ◽

Joanne E Arsenault ◽

Ellen L Bonnel ◽

Eduardo Cervantes ◽

Annie Kan ◽

...

Keyword(s):

Energy Intake ◽

Assessment Tool ◽

Data Cleaning ◽

Dietary Assessment ◽

Assessment Tools ◽

Energy Requirements ◽

Nutrient Intakes ◽

Significant Difference ◽

Before And After ◽

Total Fat

Abstract Background Automated dietary assessment tools such as ASA24® are useful for collecting 24-hour recall data in large-scale studies. Modifications made during manual data cleaning may affect nutrient intakes. Objectives We evaluated the effects of modifications made during manual data cleaning on nutrients intakes of interest: energy, carbohydrate, total fat, protein, and fiber. Methods Differences in mean intake before and after data cleaning modifications for all recalls and average intakes per subject were analyzed by paired t-tests. Chi-squared test was used to determine whether unsupervised recalls had more open-ended text responses that required modification than supervised recalls. We characterized food types of text response modifications. Correlations between predictive energy requirements, measured total energy expenditure (TEE), and mean energy intake from raw and modified data were examined. Results After excluding 11 recalls with invalidating technical errors, 1499 valid recalls completed by 393 subjects were included in this analysis. We found significant differences before and after modifications for energy, carbohydrate, total fat, and protein intakes for all recalls (p < 0.05). Limiting to modified recalls, there were significant differences for all nutrients of interest, including fiber (p < 0.02). There was not a significantly greater proportion of text responses requiring modification for home compared to supervised recalls (p = 0.271). Predicted energy requirements correlated highly with TEE. There was no significant difference in correlation of mean energy intake with TEE for modified compared to raw data. Mean intake for individual subjects was significantly different for energy, protein, and fat intakes following cleaning modifications (p < 0.001). Conclusions Manual modifications can change mean nutrient intakes for an entire cohort and individuals. However, modifications did not significantly affect correlation of energy intake with predictive requirements and measured expenditure. Investigators can consider their research question and nutrients of interest when deciding to make cleaning modifications.

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A cross-sectional assessment of food- and nutrient-based standards applied to British schoolchildren’s packed lunches

Public Health Nutrition ◽

10.1017/s1368980016002251 ◽

2016 ◽

Vol 20 (3) ◽

pp. 565-570 ◽

Cited By ~ 4

Author(s):

Charlotte EL Evans ◽

Janet E Cade

Keyword(s):

Primary Schools ◽

Assessment Tool ◽

Dietary Assessment ◽

Quality Score ◽

Food Groups ◽

Multilevel Regression ◽

Optimal Model ◽

Cross Sectional ◽

The Uk ◽

Dietary Data

AbstractObjectiveIn England, standards for school meals included both foods and nutrients until 2015. School policies for packed lunches are generally food based; research is needed to determine whether these are adequate or whether a small number of nutrients would potentially improve their quality.DesignFrom dietary data obtained using a weighed dietary assessment tool, a diet quality score (DQS) for packed lunches was calculated using the number of standards met out of twenty-one (eight foods and thirteen nutrients). Multilevel regression analysis determined the foods and nutrients contributing to variation in the DQS.SettingEighty-nine primary schools across the four regions of the UK (England, Wales, Scotland and Northern Ireland).SubjectsBritish schoolchildren (n 1294), aged 8–9 years, taking a packed lunch.ResultsThe optimal model included all eight foods and seven of the thirteen nutrients, explaining 72 % of the variance in DQS. Folate, Fe and vitamin C, together with the eight food groups, explained 70 % of DQS variation.ConclusionsIdeally, policies for school packed lunches should include food-based standards plus recommendations based on a small number of nutrients.

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INDDEX24: An Innovative Global Dietary Assessment Platform to Scale Up the Availability, Access, and Use of Dietary Data

Current Developments in Nutrition ◽

10.1093/cdn/nzaa056_027 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1180-1180

Author(s):

Sarah Wafa ◽

Brooke Colaiezzi ◽

Jerome Some ◽

Winnie Bell ◽

Cathleen Prata ◽

...

Keyword(s):

Burkina Faso ◽

Dietary Assessment ◽

Technical Specification ◽

Mobile App ◽

Assessment Tools ◽

Dietary Recall ◽

Technical Specifications ◽

Web App ◽

Dietary Data ◽

The Web

Abstract Objectives Regular collection and use of dietary data, particularly in low- and middle-income countries (LMICs), is hindered by the lack of available and accessible dietary data research infrastructure (e.g., accessible food composition tables (FCT), portion conversions, and standard recipes; electronic dietary assessment tools). INDDEX24 is a global dietary assessment platform that addresses these bottlenecks. Methods Priority technical specification were drafted and reviewed by experts with extensive dietary assessment experience in LMICs. Specifications included use of the multiple pass 24-hour dietary recall method, offline data collection capability, contextual adaptability, and an interviewer-administered format. Existing dietary assessment platforms were evaluated against the technical specifications via a structured literature review and key informant interviews. An initial version of INDDEX24 was developed and tested through feasibility studies in Vietnam and Burkina Faso. Feedback from potential users of the platform was gathered during webinars. The platform was subsequently revised, and its relative validity, time, and cost compared to use of paper-based 24-hour dietary recalls were then evaluated in Vietnam and Burkina Faso. Results INDDEX24 is comprised of a mobile application (app) that is linked with a web app. The web app is used by researchers to manage the dietary data inputs for their survey context (i.e., FCT data, recipes, food descriptors, and portion conversions). Users can search the web app for dietary data inputs and integrate them into their workspace or upload their own inputs. The INDDEX24 mobile app is a 24-hour dietary recall app that has been built using CommCare mobile platform technology. Users can adapt mobile app questionnaire text to their survey language and context, add survey modules, conduct data monitoring, and basic food matching. To maximize the time and cost saving benefits of the platform, a concerted effort will be needed to populate the web app with dietary data inputs from LMICs. Conclusions The extensive consultative process and evidence driven design has produced a high-quality platform that balances flexibility of adaptation to a range of contexts with quality control and standardization. Funding Sources Bill and Melinda Gates Foundation.

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Applying a meal coding system to 16-d weighed dietary record data in the Japanese context: towards the development of simple meal-based dietary assessment tools

Journal of Nutritional Science ◽

10.1017/jns.2018.21 ◽

2018 ◽

Vol 7 ◽

Cited By ~ 7

Author(s):

Kentaro Murakami ◽

M. Barbara E. Livingstone ◽

Satoshi Sasaki ◽

Naoko Hirota ◽

Akiko Notsu ◽

...

Keyword(s):

Dietary Intake ◽

Dietary Assessment ◽

Food Group ◽

Scientific Basis ◽

Food Composition ◽

Assessment Tools ◽

Coding System ◽

Nutrient Intakes ◽

Dietary Record ◽

Eating Occasions

AbstractData on the combination of foods consumed simultaneously at specific eating occasions are scarce, primarily due to a lack of assessment tools. We applied a recently developed meal coding system to multiple-day dietary intake data for assessing its ability to estimate food and nutrient intakes and characterise meal-based dietary patterns in the Japanese context. A total of 242 Japanese adults completed sixteen non-consecutive-day weighed dietary records, including 14 734 eating occasions (3788 breakfasts, 3823 lunches, 3856 dinners and 3267 snacks). Common food group combinations were identified by meal type to identify a range of generic meals. Dietary intake was calculated on the basis of not only the standard food composition database but also the substituted generic meal database. In total, eighty generic meals (twenty-three breakfasts, twenty-one lunches, twenty-four dinners and twelve snacks) were identified. The Spearman correlation coefficients between food group intakes calculated based on the standard food composition database and the substituted generic meal database ranged from 0·26 to 0·85 (median 0·69). The corresponding correlations for nutrient intakes ranged from 0·17 to 0·82 (median 0·61). A total of eleven meal patterns were established using principal components analysis, and these accounted for 39·1 % of total meal variance. Considerable variation in patterns was seen in meal type inclusion and choice of staple foods (bread, rice and noodles) and drinks, and also in meal constituents. In conclusion, this study demonstrated the usefulness of a meal coding system for assessing habitual diet, providing a scientific basis towards the development of simple meal-based dietary assessment tools.

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Development of a Sleep Assessment Module in the Automated Self-Administered 24-Hour (ASA24) Dietary Assessment Tool: New Research Opportunities

Current Developments in Nutrition ◽

10.1093/cdn/nzab039_010 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 474-474

Author(s):

Marissa Shams-White ◽

Lauren O'Connor ◽

Sydney O'Connor ◽

Amy Miller ◽

Beth Mittl ◽

...

Keyword(s):

Sleep Quality ◽

Assessment Tool ◽

Dietary Assessment ◽

Assessment Tools ◽

Sleep Diary ◽

Plain Language ◽

Wake Time ◽

Time In Bed ◽

Sleep Assessment ◽

The Impact

Abstract Objectives To develop a sleep assessment module in ASA24 to capture self-reported sleep behavior as an optional enhancement to the ASA24 Dietary Assessment Tool for adults. Methods Multiple self-reported sleep assessment tools were considered in module development, including the National Sleep Foundation Sleep Diary, the Activities Completed over Time in 24-hours (ACT24), Munich Chronotype Questionnaire (MCTQ), and the Consensus Sleep Diary (CSD) Core. Priority was given to minimal need for adaptation, questionnaire length to reduce survey fatigue, incorporating plain language, and optimizing for implementation in 24 hour recalls (24HR) and food records. Researchers with expertise in meal timing and sleep were consulted for feedback on content and utility and programmers with expertise in survey design were consulted on implementation. Lastly, the online data collection process and ASA24 System's output data files were tested for accuracy. Results The ASA24 sleep module contains ten questions and can be administered immediately following dietary assessment. Eight CSD Core questions were adapted to assess time in bed, time trying to go to sleep, and length of time to fall asleep; number and duration of nocturnal awakenings; wake time and time out of bed for the day; and perceived sleep quality. Two questions were added to capture sleep quality and comparability of reported sleep to a usual night's sleep. For users completing a 24HR, the module includes two questions on time of awakening and sleep quality immediately preceding the first reported meal; all 10 sleep questions are asked for the sleep period immediately following the last meal (i.e., 12 questions total), allowing for assessment of the impact of diet on sleep. In contrast, a food record is completed on the same day users consume the food, and thus all sleep questions address the sleep window prior to the first meal; a single record can be used to assess the impact of sleep on diet. Consecutive days of records can also be collected to capture sleep pre- and post-eating windows. Conclusions The ASA24 sleep module can assess sleep timing and quality and will be available in Fall 2021. Researchers can soon leverage this novel resource to examine the association of sleep with timing of eating and other chrononutrition variables. Funding Sources This project has been funded by the NIH.

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Validating dietary assessment tools with energy expenditure measurement methods: Is this accurate?

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000744 ◽

2022 ◽

Author(s):

Jalal Hejazi

Keyword(s):

Energy Expenditure ◽

Assessment Tool ◽

Complete Solution ◽

Dietary Assessment ◽

Energy Balance Equation ◽

Measurement Methods ◽

Metabolizable Energy ◽

Assessment Tools ◽

Dietary Intakes ◽

Nutritional Studies

Abstract. Having an accurate dietary assessment tool is a necessity for most nutritional studies. As a result, many validation studies have been carried out to assess the validity of commonly used dietary assessment tools. Since based on the energy balance equation, among individuals with a stable weight, Energy Intake (EI) is equal to Energy Expenditure (EE) and there are precise methods for measurement of EE (e.g. doubly labeled water method), numerous studies have used this technique for validating dietary assessment tools. If there was a discrepancy between measured EI and EE, the researchers have concluded that self-reported dietary assessment tools are not valid or participants misreport their dietary intakes. However, the calculation of EI with common dietary assessment tools such as food frequency questionnaires (FFQs), 24-hour dietary recalls, or weighed food records, is based on fixed factors that were introduced by Atwater and the accuracy of these factors are under question. Moreover, the amount of energy absorption, and utilization from a diet, depends on various factors and there are considerable interindividual differences in this regard, for example in gut microbiota composition. As a result, the EI which is calculated using dietary assessment tools is likely not representative of real metabolizable energy which is equal to EE in individuals with stable weight, thus validating dietary assessment tools with EE measurement methods may not be accurate. We aim to address this issue briefly and propose a feasible elucidation, albeit not a complete solution.

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Evaluation of Dietary Assessment Tools Used in Bariatric Population

Nutrients ◽

10.3390/nu13072250 ◽

2021 ◽

Vol 13 (7) ◽

pp. 2250

Author(s):

Marianne Legault ◽

Vicky Leblanc ◽

Geneviève B. Marchand ◽

Sylvain Iceta ◽

Virginie Drolet-Labelle ◽

...

Keyword(s):

Bariatric Surgery ◽

Assessment Tool ◽

Dietary Assessment ◽

Assessment Tools ◽

Dietary Intakes ◽

Health Issues ◽

Loss Assessment ◽

Bariatric Patients ◽

Per Se ◽

Nutritional Studies

Severe obesity is associated with major health issues and bariatric surgery is still the only treatment to offer significant and durable weight loss. Assessment of dietary intakes is an important component of the bariatric surgery process. Objective: To document the dietary assessment tools that have been used with patients targeted for bariatric surgery and patients who had bariatric surgery and explore the extent to which these tools have been validated. Methods: A literature search was conducted to identify studies that used a dietary assessment tool with patients targeted for bariatric surgery or who had bariatric surgery. Results: 108 studies were included. Among all studies included, 27 used a dietary assessment tool that had been validated either as part of the study per se (n = 11) or in a previous study (n = 16). Every tool validated per se in the cited studies was validated among a bariatric population, while none of the tools validated in previous studies were validated in this population. Conclusion: Few studies in bariatric populations used a dietary assessment tool that had been validated in this population. Additional studies are needed to develop valid and robust dietary assessment tools to improve the quality of nutritional studies among bariatric patients.

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