Validation of the INDDEX24 mobile app vs. a pen-and-paper 24-hour dietary recall using the weighed food record as a benchmark in Burkina Faso

Effective nutrition policies require timely, accurate individual dietary consumption data; collection of such information has been hampered by cost and complexity of dietary surveys and lag in producing results. The objective of this work was to assess accuracy and cost-effectiveness of a streamlined, tablet-based dietary data collection platform for 24-hour individual dietary recalls (24HR) administered using INDDEX24 platform vs. a pen-and-paper (PAPI) questionnaire, with weighed food record (WFR) as a benchmark. This cross-sectional comparative study included women 18-49 years old from rural Burkina Faso (n=116 INDDEX24; n=115 PAPI). A weighed food record was conducted; the following day, a 24HR was administered by different interviewers. Food consumption data were converted into nutrient intakes. Validity of 24HR estimates of nutrient and food group consumption was based on comparison with WFR using equivalence tests (group level) and percentages of participants within ranges of percent error (individual level). Both modalities performed comparably estimating consumption of macro- and micronutrients, food groups, and quantities (modalities’ divergence from WFR not significantly different). Accuracy of both modalities was acceptable (equivalence to WFR significant at p <.05) at group level for macronutrients, less so for micronutrients and individual-level consumption (percent within +/-20% of WFR 17%-45% for macronutrients; 5%-17% for micronutrients). INDDEX24 was more cost-effective than PAPI based on superior accuracy of a composite nutrient intake measure (but not gram amount or item count) due to lower time and personnel costs. INDDEX24 for 24HR dietary surveys linked to dietary reference data shows comparable accuracy to PAPI at lower cost.

Omissions, Intrusions, and Use of Standard Recipes in Computer Assisted and Pen and Paper 24-hour Dietary Recalls Compared With Weighed Food Record: Results From Burkina Faso

Objectives A validation study in Burkina Faso compared accuracy of two modes of administration of a 24-hour individual dietary recall (24HR), pen-and-paper (PAPI) and tablet (computer-assisted, CAPI), using weighed food record (WFR) as a benchmark. Sources of divergence between the WFR and each 24HR mode were explored, including number of times items in the WFR were omitted from the 24HR (omissions), and number of times items appeared in the 24HR but not the WFR (intrusions). Methods Subjects were 231 rural women aged 18–49 years. For the WFR an enumerator visited the household and recorded all food consumed from early morning until after the evening meal, at home and away. Food prepared at home was weighed before and after cooking; amount taken by the respondent was weighed; leftovers subtracted. For mixed dishes, the enumerator weighed all ingredients prior to cooking, the finished dish, and the amount consumed by the respondent, assuming equal distribution of ingredients. The following day a different enumerator administered a multiple pass 24HR of the previous day. Mixed dishes were recorded in two ways: if the dish was similar to a standard recipe (SR) obtained from previous surveys, the quantity was recorded assuming the ingredients and proportions matched the SR. If the dish was not similar, it was considered a non-standard recipe (NSR), and the enumerator recorded the quantity of each ingredient, the final dish, and amount consumed. Results In both modes, omissions outnumbered intrusions. About 1/4 of foods in the WFR were omitted from the 24HR: 26.5% (PAPI); 25.1% (CAPI); about 10% of foods in both 24HR did not match the WFR. For NSRs, omissions and intrusions were less frequent: 15.1% (PAPI) and 16.5% (CAPI) omissions; 2.5% (PAPI) and 5.1% (CAPI) intrusions. SRs were recorded less frequently than individual foods or NSRs. PAPI, 400 foods, 404 NSRs, 91 SRs; CAPI, 386 foods, 411 NSRs, 100 SRs. SRs were more frequently omitted in CAPI (30%) than PAPI (18.7%); and added: CAPI (15.0%); PAPI (7.7%). Conclusions Respondents to both 24HR modes were more likely to forget items than recall them erroneously. SRs are intended to reduce respondent burden but were infrequently used. The time saved using SRs should be balanced against possible loss of accuracy. Sources of divergence between 24HR and the WFR need investigation. Funding Sources Bill and Melinda Gates Foundation.

The INDDEX24 Dietary Assessment Platform Is As Accurate as Pen-and-Paper 24-Hour Dietary Recall When Compared to a Weighed Food Record Benchmark in Viet Nam

Objectives The study assessed the relative accuracy of INDDEX24, a computer-assisted personal interview (CAPI) approach to conducting a 24-hour dietary recall (24HR), compared to the pen-and-paper interview (PAPI) approach against a full-day observed weighed food record (WFR) in northern Viet Nam where the diet is diverse and complex. Methods Women aged 18–49 from northern Viet Nam were randomly assigned to be interviewed with the CAPI or PAPI 24HR the day after other enumerators conducted a WFR. The Two One Sided T-test (TOST) assessed equivalence of each recall-benchmark method comparison using a 10% bound. A difference-in-differences approach compared the significance of differences between the CAPI vs. WFR and PAPI vs. WFR modalities. Nutrient intakes were logged to achieve a normal distribution. Results Both the PAPI and the CAPI were statistically equivalent to the WFR across indicators of average total food items, total grams of intake, energy intake, all macro- and micronutrients tested (except Vitamin A for both CAPI and PAPI). The difference-in-difference analysis showed that the CAPI diverged significantly less than PAPI from the WFR for iron (0.9 v. −1.3 mg) and PAPI diverged less from the WFR than CAPI for protein (−3.7 v. 7.9 grams). There were no other statistically significant differences and, for both PAPI and CAPI, average deviations from the WFR were small. Individual-level comparisons showed 56% of PAPI and 59% of CAPI respondents were within +/−20% of the WFR intakes, while 26% of respondents in the PAPI group and 32% of the CAPI group had energy intakes by 24HR within +/- 10% of the WFR intakes. Conclusions INDDEX24 was an accurate method for assessing food and nutrient intake among women of reproductive age in northern Viet Nam, when compared to a WFR. INDDEX24 performed at least as well as the PAPI 24HR modality across several different group and individual level measures for energy and nutrients of interest. Digital data collection platforms facilitate standardization of data collection and may reduce survey time and costs. Given these advantages, the INDDEX24 Dietary Assessment Platform should be considered for implementing high quality, individual-level, quantitative dietary surveys in low- and middle-income countries. Funding Sources Bill and Melinda Gates Foundation.

Energy, Macronutrients, Dietary Fibre and Salt Intakes in Older Adults in Ireland: Key Sources and Compliance with Recommendations

The global population is rapidly ageing. Adequate nutritional status can play a key role in preventing or delaying the progression of age-related diseases. The aim of this study was to estimate the usual intake of energy, macronutrients, dietary fibre and salt in order to determine compliance with recommendations and to identify the sources of these nutrients in older adults (≥65 years) in Ireland. This study is based on data from the cohort of older adults aged ≥65 years (n = 226) in the Irish National Adult Nutrition Survey (NANS) (2008–2010) which estimated food and nutrient intakes in a representative sample of adults 18–90 years using a 4 day weighed food record. This study found that while intakes of macronutrients are generally sufficient in this population group, older adults in Ireland have high intakes of total fat, saturated fat, sugar and salt and low intakes of dietary fibre. Future strategies to address the nutritional issues identified in older adults could include the promotion of healthy food choices together with improvements of the food supply including reformulation (fat, sugar and salt) to support successful ageing of our population.

Higher egg consumption associated with increased risk of diabetes in Chinese adults – China Health and Nutrition Survey

The association between egg consumption and diabetes is inconclusive. We aimed to examine the association between long-term egg consumption and its trajectory with diabetes in Chinese adults. A total of 8545 adults aged ≥18 years old who attended the China Health and Nutrition Survey from 1991 to 2009 were included in this analysis. Egg consumption at each survey was assessed by a 3-d 24-h recall and weighed food record methods. The consumption trajectories of eggs were modelled with the latent class group approach. Diabetes was diagnosed based on fasting blood glucose in 2009. Logistic regression was used to examine the association. The mean age of the study population was 50·9 (sd 15·1) years. About 11·1 % had diabetes in 2009. Egg consumption nearly doubled in 2009 from 16 g/d in 1991. Compared with the first quartile of egg consumption (0–9·0 g/d), the adjusted OR of diabetes for the second (9·1–20·6 g/d), third (20·7–37·5 g/d) and fourth (≥37·6 g/d) quartiles were 1·29 (95 % CI 1·03, 1·62), 1·37 (95 % CI 1·09, 1·72) and 1·25 (95 % CI 1·04, 1·64), respectively (Pfor trend = 0·029). Three trajectory groups of egg consumption were identified. Compared with group 1 (30·7 %, low baseline intake and slight increase), both group 2 (62·2 %, medium baseline intake and increase) and group 3 (7·1 %, high baseline intake and decrease) were associated with an increased OR for diabetes. The results suggested that higher egg consumption was positively associated with the risk of diabetes in Chinese adults.

Validation of a life-logging wearable camera method and the 24-h diet recall method for assessing maternal and child dietary diversity

Accurate and timely data are essential for identifying populations at risk for undernutrition due to poor-quality diets, for implementing appropriate interventions and for evaluating change. Life-logging wearable cameras (LLWC) have been used to prospectively capture food/beverage consumed by adults in high-income countries. This study aimed to evaluate the concurrent criterion validity, for assessing maternal and child dietary diversity scores (DDS), of a LLWC-based image-assisted recall (IAR) and 24-h recall (24HR). Direct observation was the criterion method. Food/beverage consumption of rural Eastern Ugandan mothers and their 12–23-month-old child (n 211) was assessed, for the same day for each method, and the IAR and 24HR DDS were compared with the weighed food record DDS using the Bland–Altman limits of agreement (LOA) method of analysis and Cohen’s κ. The relative bias was low for the 24HR (–0·1801 for mothers; –0·1358 for children) and the IAR (0·1227 for mothers; 0·1104 for children), but the LOA were wide (–1·6615 to 1·3012 and –1·6883 to 1·4167 for mothers and children via 24HR, respectively; –2·1322 to 1·8868 and –1·7130 to 1·4921 for mothers and children via IAR, respectively). Cohen’s κ, for DDS via 24HR and IAR, was 0·68 and 0·59, respectively, for mothers, and 0·60 and 0·59, respectively, for children. Both the 24HR and IAR provide an accurate estimate of median dietary diversity, for mothers and their young child, but non-differential measurement error would attenuate associations between DDS and outcomes, thereby under-estimating the true associations between DDS – where estimated via 24HR or IAR – and outcomes measured.

Impact of FODMAP Content Restrictions on the Quality of Diet for Patients with Celiac Disease on a Gluten-Free Diet

Restrictive diets as gluten-free (GFD) or reduced in Fermentable, Oligosaccharides, Disaccharides, Monosaccharides, and Polyols (FODMAP) are used to improve gastrointestinal (GI) symptoms in sensitive individuals. Aiming at comparing the nutritional quality and effects of a regular GFD regimen (R-GFD) and a low-FODMAP GFD (LF-GFD), in 46 celiac patients with persistent GI symptoms we conducted a randomized, double-blind intervention-controlled study. Patients received a personalized diet, either a strict GFD (n = 21) or a LF-GFD (n = 25) for 21 days. A validated food-frequency questionnaire before intervention and a 7-day weighed-food record after the intervention assessed the diets. Patients were 41.1 ± 10.1 years (mean ± SD), 94% women, with mean BMI 21.8 ± 2.9 kg/m2. On day 21, patients on R-GFD still showed poor nutritional adequacy compared to dietary recommendations, with decreased energy intake, even though an improvement in carbohydrates and folates was observed (all p < 0.025). In both groups, intake of iron, calcium, vitamin D, sodium and folates did not meet daily recommendations. As expected, consumption of legumes and grains was lower and that of fruits was higher in the LF-GFD group than in the R-GFD one (all p < 0.05). The nutritional quality of both diets was not different. When restrictive diets are useful to improve the persistent GI symptoms, careful nutritional surveillance and counseling is mandatory.