Development of a Screening Tool to Estimate Vitamin A Intake and Comparison with Detailed Dietary Assessment Methods

Objectives We aimed to develop and validate a tool to estimate vitamin A (VA) intake and identify children at risk of intake above the tolerable upper intake level (UL). Methods We developed, pilot-tested, and refined a screening tool to estimate VA intake among Filipino children 12–18 mo of age. Data were entered into tablets with pre-loaded food composition data to calculate VA intake immediately. The screening tool was used to identify children likely to have “adequate” (one group: 200–500 µg retinol activity equivalents, RAE/d) or “high” (two groups: >600 µg retinol/d) intake. Interviewers administered four 24-h recalls, one 12-h observed weighed record with 12-h recall, and a 30-d supplement questionnaire. Breastmilk intake and VA concentration were measured among breastfeeding children. We compared the screening tool and detailed dietary assessment (DDA) results for primary VA sources, group mean usual intake, and prevalence of intakes above the UL. Results Major VA sources were similar between methods: fortified milk powders, multivitamin supplements, and breastmilk; contributions from intervention programs (e.g., micronutrient powders, fortified staple foods) were low. Mean usual retinol intakes for the high groups (n = 47 and 39, respectively) were 1218 and 1313 µg/d by screening tool vs. 1096 and 931 by DDA; 70 and 77% had usual intake above 600 µg/d. In the adequate group (n = 37), mean total VA intake was 375 and 559 µg RAE/d by screening and DDA, respectively. Conclusions This screening tool provides a reasonably good rapid estimate of VA intake among Filipino children and can be useful for identifying groups with adequate to excessive intakes. Funding Sources Bill & Melinda Gates Foundation.

Feasibility and relative validity of a digital photo-based dietary assessment: results from the Nutris-Phone study

Objective For dietary assessment, mobile devices with a camera can be used as an alternative to hand-written paper records. The Nutritional Tracking Information Smartphone (Nutris-Phone) study aimed to examine relative validity and feasibility of a photo-based dietary record in everyday life. Design Parallel to the photo-based technique, a weighed record was performed. Participant satisfaction was assessed by questionnaire. A trained nutrition scientist evaluated portion sizes and nutrient content was calculated (DGExpert). Spearman correlation and Bland–Altman analyses were applied. Setting Healthy, non-pregnant volunteers (≥18 years) without intent to lose weight recruited at Ulm University, Germany. Subjects Sixty-six participants (36 % males, median age 22·0 (interquartile range 20·0–25·0) years) took pictures of foods and beverages consumed with a commercially available mobile phone. Results Significant correlation between the photo-based and weighed record was observed: energy (r=0·991), carbohydrate (r=0·980), fat (r=0·972), protein (r=0·988), fibre (r=0·941). Bland–Altman analyses indicated comparable means and acceptable 95 % limits of agreement (energy: −345·2 to 302·9 kJ (−82·5 to 72·4 kcal); carbohydrate: −15·2 to 13·1 g; fat: −6·4 to 6·4 g; protein: −5·9 to 5·6 g; fibre: −2·7 to 2·5 g). However, with increasing intake level, underestimation by the digital method was present (except for fat, all P<0·01). Over 80 % of participants were satisfied with the photo-based record. In nearly 90 %, technical implementation was without major problems. Conclusions Compared with a weighed record, the photo-based dietary record seems to be valid, feasible and user-friendly to estimate energy, macronutrient and fibre intakes, although a systematic bias with increasing levels of intake should be kept in mind.

Food portion sizes and dietary quality in Irish children and adolescents

ObjectiveTo describe relationships between the portion sizes of a range of foods commonly consumed by Irish children and adolescents and key indicators of dietary quality on the days they were consumed.DesignCross-sectional data from the Irish National Children’s Food Survey (2003–2004; 7 d weighed record) and National Teens’ Food Survey (2005–2006; 7 d semi-weighed record) were used to compare mean values for a number of dietary quality indicators (e.g. energy-adjusted intakes of saturated fat, dietary fibre and Na) across portion size tertiles for a range of foods, on the days the foods were consumed.SettingThe Republic of Ireland.SubjectsNationally representative samples of children aged 5–12 years (n594) and adolescents aged 13–17 years (n441).ResultsRelationships between food portion sizes and indicators of dietary quality on the days the foods were consumed were similar in both children and adolescents. Lower dietary energy density and saturated fat intakes, and higher dietary fibre intakes, were observed on the days larger portions of fruit and boiled potatoes were consumed. Higher dietary energy density and lower micronutrient intakes were observed on the days larger portions of sugar-sweetened beverages were consumed. Higher Na intakes were observed on the days larger portions of frying meats were consumed.ConclusionsThe current work identifies foods for which larger portion sizes may be associated with positive dietary attributes, as well as the opposite. Findings will form an evidence base from which more specific dietary guidance relating to portion size may be developed for Irish children and adolescents.

Validation of the second version of a quantitative food-frequency questionnaire for use in Western Mali

Objective:To assess the relative validity of the second version of a quantitative food-frequency questionnaire (QFFQ), designed to measure the habitual food and nutrient intake in one season in rural populations in Western Mali, West Africa.Design:The dietary intake during the previous week was assessed with the 164-item QFFQ administered by interview. This was compared with the intake from a 2-day weighed record (WR) with weighed recipes.Setting:The village of Ouassala in the Kayes region, Western Mali.Subjects:Thirty-four women and 36 men aged 15–45 years, from 29 households.Results:The QFFQ gave a lower intake of lunch and dinner and a higher intake of snacks than the WR. The discrepancies were larger for women than for men. The median proportion of subjects classified in the same quartile of intake was 29% for food groups and 36% for energy and nutrients. For classification into extreme opposite quartiles, the median proportion was 6% for food groups and 7% for energy and nutrients. Spearman's rank correlation for energy and nutrients ranged from 0.16 (% energy from protein) to 0.62 (retinol equivalents).Conclusions:The second version of the QFFQ tends to underestimate total food weight. The methods used for estimating food portion size should therefore be applied with caution. The changes made from the first version had little effect. The ability to rank subjects according to dietary intake is similar with both versions. The improved layout of the new QFFQ makes it a more user-friendly tool for comparing dietary intake between population groups and for measuring changes over time.

The SENECA study: potentials and problems in relating diet to survival over 10 years

Objective:To give an overview of the evaluation of the modified diet history applied in the SENECA study (Survey in Europe on Nutrition and the Elderly; a Concerted Action).Design:Nineteen centres in 12 countries participated at baseline. Nine of these SENECA centres conducted a repeat measurement scheme in elderly people born between 1913 and 1918. These longitudinal centres included 100 subjects per sex per site.Methods:The relative validity of the method was tested by comparing results of the modified diet history with results obtained from a weighed record in 82 subjects. In the follow-up we compared changes in energy intake with changes in body weight and calculated the physical activity ratio in all longitudinal centres. In SENECA's finale we examined the predictive value of dietary patterns observed at baseline for survival 10 years later, making use of the original and an adapted Mediterranean Diet Score.Results:The modified diet history overestimated intake, compared with the weighed record. However, the physical activity ratio and an in-depth study in a metabolic room indicated that the diet history rather underestimated energy intake. We did not find a relationship between changes in energy intake and changes in body weight, but this could be explained by the fact that most likely we did not measure intake in the dynamic phase of body weight change. Based on the adapted Mediterranean Diet Score, the study results showed a positive relation between a healthy diet and survival.Conclusion:We conclude that the modified diet history has given sufficiently reliable results for the purposes of the study

Development, validation and utilisation of food-frequency questionnaires – a review

Objective:The purpose of this review is to provide guidance on the development, validation and use of food-frequency questionnaires (FFQs) for different study designs. It does not include any recommendations about the most appropriate method for dietary assessment (e.g. food-frequency questionnaire versus weighed record).Methods:A comprehensive search of electronic databases was carried out for publications from 1980 to 1999. Findings from the review were then commented upon and added to by a group of international experts.Results:Recommendations have been developed to aid in the design, validation and use of FFQs. Specific details of each of these areas are discussed in the text.Conclusions:FFQs are being used in a variety of ways and different study designs. There is no gold standard for directly assessing the validity of FFQs. Nevertheless, the outcome of this review should help those wishing to develop or adapt an FFQ to validate it for its intended use.

A computerized diet questionnaire for use in diet health education

A diet questionnaire was developed in association with a computer program to provide rapid nutritional feedback to the general public. The questionnaire was validated against 16 d of weighed diet records and biochemical variables in blood and urine. The highest Pearson correlation coefficients obtained between the questionnaire and the weighed records were for alcohol, fibre, iron, riboflavin (r 0.74, 0.67, 0.66, 0.66 respectively). Striking sex differences were shown in the results; the trend for higher correlations persisted in females. At least 65% of subjects were classified by questionnaire to within one quintile of the classification by weighed record for the majority of nutrients.

Dietary behaviours and sociocultural demographics in Northern Ireland

Subjects aged 16–64 years (592; 258 men and 334 women), randomly selected from the population of Northern Ireland, kept a 7 d weighed record of all food and drink consumed. Social, personal and anthropometric data were also collected. From the weighed records food consumption was described in terms of forty-one food groups. Using principal components analysis, four distinct dietary patterns were generated which were identified as a traditional diet, a cosmopolitan diet, a convenience diet and a ‘meat and two veg’ diet. These dietary patterns were then correlated with sociocultural, lifestyle and anthropometric variables. It is clear that dietary behaviour is influenced by a number of inter-related sociocultural demographics and that identifiable population groups in Northern Ireland have different dietary behaviours.