Digital photography: a new method for estimating food intake in cafeteria settings

Comparison of Food Selection with the National School Lunch Program Meal Pattern Guidelines and Assessment of Children's Food Intake and Waste Using Digital Photography in a School Cafeteria

Background: School lunch is an important nutritious food source for children. The National School Lunch Program (NSLP) meal patterns guidelines have been established to promote healthier school lunches. This pilot study compared food selection during lunch in a school cafeteria with the NSLP meal pattern guidelines. Food intake and waste were also examined in relation to food selection. Methods: In a cross-sectional design, data were collected from children in the 1st, 6th, and 10th grades from a school in the United States. The digital photography of foods method was used to assess children's food selection, intake, and waste at lunch over 3 weeks. Results were presented as percentage, frequency, and mean ± standard deviation. Results: About 48 children from 1st grade, 47 from 6th grade, and 50 from 10th grade participated each day. Food selection in these grades consistently fell below the NSLP guidelines, with 69%, 79.8%, and 86.9% of children selecting less than the guidelines for energy, respectively. On average, only 10.4% of children selected vegetables at or above the guidelines. About 41% of the selected energy, 43% of fruits, 43% of vegetables, and 56% of milk were discarded as plate waste across all grades. Conclusions: Selection of energy and vegetables was consistently below the NSLP guidelines, yet almost half of the selected fruits, vegetables, and milk were wasted by children. Initiatives to enhance meal quality and variety, along with nutrition education interventions and school policies, are needed to improve food selection and intake and reduce food waste.

Evaluating the Validity of the PortionSize Smartphone Application for Estimating Dietary Intake in Free-Living Conditions: A Pilot Study

OBJECTIVE

Evaluate the validity of the PortionSize application.

METHODS

In this pilot study, 14 adults used PortionSize to record their free-living food intake over 3 consecutive days. Digital photography was the criterion measure, and the main outcomes were estimated intake of food (grams), energy (kilocalories), and food groups. Equivalence tests with ±25% equivalence bounds and Bland-Altman analysis were performed.

RESULTS

Estimated gram intake from PortionSize was equivalent (P < 0.001) to digital photography estimates. PortionSize and digital photography estimated energy intake, however, were not equivalent (P = 0.08), with larger estimates from PortionSize. In addition, PortionSize and digital photography were equivalent for vegetable intake (P = 0.01), but PortionSize had larger estimates of fruits, grains, dairy, and protein intake (P >0.07; error range 11% to 23%).

CONCLUSIONS AND IMPLICATIONS

Compared with digital photography, PortionSize accurately estimated food intake and had reasonable error rates for other nutrients; however, it overestimated energy intake, indicating further application improvements are needed for free-living conditions.

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.

Selecting foods from FNDDS when calculating food intake: Does the reference matter?

To estimate food intake, the nutrient content of food must be known or inferred by matching it to a nutrient database. This study evaluated how different procedures for matching foods to the Food and Nutrient Database for Dietary Studies (FNDDS) affect food intake estimates. Adult participants estimated a meal with the PortionSize app, which contains a subset of FNDDS codes (PortionSize FNDDS). Meals were covertly weighed (weigh back), and intake was estimated by referencing the FNDDS dataset. Combination foods were evaluated by 1) a composite generated by summing the nutrient values (from FNDDS) from single food items and 2) using the single composite food code from FNDDS. Raters analyzed food images from the PortionSize app to estimate intake with the digital photography of foods (DPF) method. Raters estimated intake from: 1) PortionSize FNDDS and 2) full FNDDS. Using PortionSize's FNDDS database, participants' energy intake estimates were equivalent to rater estimated energy intake. Raters estimated almost identical energy intake when they used PortionSize vs. full FNDDS. Using the full FNDDS, the DPF's energy estimates were similar to weigh back. Estimation of energy intake with a single FNDDS code was not equivalent to estimations from summing the nutrient values for combination foods.

Reliability of a frequency method for assessing vegetable intake using photos among college students: a smart phone approach

OBJECTIVE

To measure the interrater reliability of assessing the frequency of vegetable intake using mobile photos and descriptions.

DESIGN

Repeated measures design.

SETTING

A Midwestern university.

PARTICIPANTS

Undergraduate students (N = 165).

MEASURABLE OUTCOME/ANALYSIS

Number of times each of these vegetable subgroups were consumed daily: dark green vegetables, beans and peas, starchy vegetables, and other vegetables. Analysis: Two raters independently coded meals using mobile photos and descriptions of meals. Cohen κ was calculated to determine interrater reliability.

RESULTS

A value of κ = 0.9 (p < .001) was obtained, indicating an almost perfect agreement between the two raters. Nearly 92% of participants complied with providing photos along with descriptions of their meals.

CONCLUSIONS AND IMPLICATIONS

A frequency method using mobile photos and descriptions of meals is a reliable strategy to assess vegetable consumption. This frequency method can improve data quality, reduce participant burden, and minimize recall bias in college nutrition programs.

Using Crowdsourced Food Image Data for Assessing Restaurant Nutrition Environment: A Validation Study

Crowdsourced online food images, when combined with food image recognition technologies, have the potential to offer a cost-effective and scalable solution for the assessment of the restaurant nutrition environment. While previous research has explored this approach and validated the accuracy of food image recognition technologies, much remains unknown about the validity of crowdsourced food images as the primary data source for large-scale assessments. In this paper, we collect data from multiple sources and comprehensively examine the validity of using crowdsourced food images for assessing the restaurant nutrition environment in the Greater Hartford region. Our results indicate that while crowdsourced food images are useful in terms of the initial assessment of restaurant nutrition quality and the identification of popular food items, they are subject to selection bias on multiple levels and do not fully represent the restaurant nutrition quality or customers' dietary behaviors. If employed, the food image data must be supplemented with alternative data sources, such as field surveys, store audits, and commercial data, to offer a more representative assessment of the restaurant nutrition environment.

Students' consumption of high and low nutrition foods and reduced plate waste by schools' wellness-related policies and garden program participation

BACKGROUND

Participation in school-based programs that may support children's nutritious dietary behaviours varies across schools. We examined school participation in wellness-related policies, school-based garden programs and students' dietary behaviours.

METHODS

Among matching schools who did and did not participate in school-based garden programs, we analysed the lunches of 80 Pittsburgh Public Schools (PPS) students in 1st, 2nd, 6th and 7th grades during Autumn 2019 using digital food photography. We also acquired school wellness policy data. Using cross-sectional linear regression, we estimated the association between school-based garden programming, wellness-related policies and dietary outcomes, adjusting for grade.

RESULTS

School's implementation of nutrition services policies was negatively associated with energy wasted from lunch (β = - 44.7 , p = 0.01 ${\rm{\beta }}=-44.7,{p}=0.01$ ). The number of semesters the students' school had participated in the garden program was positively associated with students' whole grain consumption (β = 0.07 , p < 0.001 ${\rm{\beta }}=0.07,{p}\lt 0.001$ ).

CONCLUSIONS

Cross-sectional associations suggest that schools that are more engaged in wellness policies and garden programs may provide environments that are more supportive of students' nutrition than in other schools.

Reliability and Validity of Digital Images to Assess Child Dietary Intake in a Quick-Service Restaurant Setting

BACKGROUND

Development of methods to accurately measure dietary intake in free-living situations-restaurants or otherwise-is critically needed to understand overall dietary patterns.

OBJECTIVE

This study aimed to develop and test reliability and validity of digital images (DI) for measuring children's dietary intake in quick-service restaurants (QSRs), validating against weighed plate waste (PW) and bomb calorimetry (BC).

DESIGN

In 2016, cross-sectional data were collected at two time points within a randomized controlled trial assessing children's leftovers in QSRs from parents of 4- to 12-year-old children.

PARTICIPANTS/SETTING

Parents (n = 640; mean age = 35.9 y; 70.8% female) consented and agreed to provide their child's PW for digital imaging, across 11 QSRs in Massachusetts in areas with low socioeconomic status and ethnically diverse populations.

OUTCOME MEASURES

Outcome measures were interrater reliability for DIs, correspondence between methods for energy consumed and left over, and correspondence between methods across varying quantities of PW.

ANALYSES PERFORMED

Intraclass correlations, percent agreement, Spearman correlations, Wilcoxon signed rank tests, and Bland-Altman plots were used.

RESULTS

Interrater reliability ratings for DIs had substantial intraclass correlations (ICC = 0.94) but not acceptable exact percent agreement (80.2%); DI and PW energy consumed were significantly correlated (r = 0.96, P < 0.001); DI slightly underestimated energy consumed compared with PW (Mdiff = -1.61 kcals, P < 0.001). Bland-Altman plots showed high DI-PW correspondence across various energy amounts and revealed few outliers. Energy left over by BC was highly correlated with DI (r = 0.87, P < 0.001) and PW (r = 0.90, P < 0.001); and mean differences were not significantly different from DI (Mdiff = 9.77 kcal, P = 0.06) or PW (Mdiff = -2.84 kcal, P = 0.20).

CONCLUSIONS

Correspondence was high between PW and DI assessments of energy consumed, and high with BC energy left over. Results demonstrate reliability and practical validity of digital images for assessing child meal consumption in QSR settings.

Accuracy of dietary intake assessments using food records based on photographic images captured by visually impaired people

Traditional methods to assess dietary intake have limited and questionable application in visually impaired people since the lack of vision and low leading role in their diet make it difficult to quantify and detail the food consumed throughout the day. Thus, this study investigated whether it is possible to accurately identify foods and estimate their quantities using food records based on photographic images captured by visually impaired people. A panel of experts composed of nutritionists (n = 20) assessed these records comprising three standardized meals (breakfast; lunch/dinner; snack) from visually impaired people (n = 40) using two different protocols (frontal photo; aerial photo). Each nutritionist reported an estimated food record for each photographic image, which was compared to its respective weighed food record. For both frontal and aerial photos, experts were frequently correct for the number of food items in the meal (95.0% or over for breakfast, 100% for lunch/dinner, and 100% for snacks). All experts identified at least 11 of the 13 food items, but the majority correctly estimated the food amount only for 23% of the items. Compared to the weighed food record, the photographic records underestimated the amount of 61.5% of food items based on frontal photos, and of 76.9% of food items based on aerial photos. While most foods could be identified by photographic images captured by visually impaired people enabling a qualitative assessment of the diet, they could not be quantified accurately by nutritionists.

A Qualitative Analysis of the Remote Food Photography Method and the Automated Self-Administered 24-hour Dietary Assessment Tool for Assessing Children's Food Intake Reported by Parent Proxy

BACKGROUND

Accuracy and participant burden are two key considerations in the selection of a dietary assessment tool for assessing children's full-day dietary intake.

OBJECTIVE

The aim of this study was to identify barriers experienced by parents and burden when using two technology-based measures of dietary intake to report their child's intake: the Remote Food Photography Method (RFPM) and the Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24).

DESIGN

Qualitative, semistructured, focus groups were conducted with parents who served as proxy reporters of their child's dietary intake using the two different dietary assessment methods (ie, RFPM and ASA24) 1 week apart.

PARTICIPANTS/SETTING

This study was conducted in 2019 and included 32 parents of children aged 7 to 8 years in Colorado and Louisiana.

MAIN OUTCOME MEASURES

Barriers adhering to the protocol and burden with the RFPM and ASA24.

QUALITATIVE ANALYSES

Qualitative content analysis and Atlas.ti software were used to analyze and interpret focus group data.

RESULTS

For the RFPM, parents described missing photos due to unobserved intake, forgetting to capture images, disruption of mealtimes, and child embarrassment when meals were photographed at school. For the ASA24, parents described the time commitment as the main source of burden and the need to expand the food database to include additional ethnic foods and restaurant items. The main strengths were ease of use for the RFPM and the consolidated workload for the ASA24.

CONCLUSIONS

The barriers experienced by parents and burden differed by method, highlighting the importance of considering the unique characteristics of each assessment tool when designing a pediatric dietary assessment study and interpreting findings.

A comparison of the remote food photography method and the automated self-administered 24-h dietary assessment tool for measuring full-day dietary intake among school-age children

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 two, 3-d 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 between assessments, and between each assessment method and the Estimated Energy Requirement (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 five out of six for both methods. A higher proportion of parents reported that the ASA24 was more time-consuming than the RFPM (74·4 % v. 25·6 %, P = 0·002). Utilisation of both methods is warranted given their high satisfaction among parents.

How Does the University Food Environment Impact Student Dietary Behaviors? A Systematic Review

The food environment has been implicated in creating an obesogenic generation; and while previous research has focused on population-wide initiatives, the university population resides in a research gap. To explore detailed components of the university food environment and what shaped dietary behaviors, we retrieved literature from the following databases: ScienceDirect, Scopus, PubMed, Medline, and EMBASE. Eleven studies were identified for qualitative content analysis and study quality assessment identified most of the studies as of good quality (n 8) and some as of fair quality (n 3). The certainty of evidence remained at a low level for all (n 11) studies due to the cross-sectional, observational nature of studies. Three major themes emerged: (1) food environment, (2) student perceptions (SPs), and (3) dietary outcome (DO). In a university food environment, the taste of food was paramount for the food choices of students, followed by the availability of food and the price of food. When university students perceive and choose foods and beverages, they sometimes regard unhealthy foods and beverages as healthy options. The diet quality of university students is more susceptible to living arrangements and socioeconomic status, but higher salt, fat, and added sugar consumption generally resulted in poorer quality of diet on campus. Future research could use novel methods to explore a wider range and deeper level of students' dietary behavior determinants in university food environments.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, identifier: CRD42021283562.

Comparison of the Diet Photograph Record to Weighed Dietary Record and 24 h Dietary Recall for Estimating Energy and Nutrient Intakes Among Chinese Preschoolers

This study aimed to assess the relative validity of the diet photograph record (DP) for measuring the energy and nutrient intakes against the weighed dietary record (WD) and the 24 h dietary recall (HR) in the Chinese preschoolers. In this study, 40 preschool children aged 4–6 years and their parents were recruited from a kindergarten in southwest China. Dietary intake of the preschoolers on a same day, as estimated by the DP and the HR were compared with the WD. These three methods were administered by the three group of investigators independently. The mean differences, correlation coefficients, cross-classifications, and weighted κ, as well as the Bland–Altman plots were performed to assess the differences and agreements among the estimates from the DP, the HR, and the WD. For the DP and the HR, the estimates of energy and nutrient intakes were moderate to high correlated with the WD, with the higher coefficients ranging from 0.73 to 0.94 for the DP. Both the methods tended to underestimate the dietary intake, but the differences from the known weights using the DP were significantly smaller than those using the HR. The weighed κ values ranking the preschoolers ranged from 0.48 to 0.80 for the DP and ranged from 0.28 to 0.64 for the HR. Furthermore, the Bland–Altman plots indicated a better agreement between the DP and the WD for estimating energy and nutrient intakes. This DP is a valid tool for measuring energy and nutrient intakes among the preschoolers.

An Exploratory Approach to Deriving Nutrition Information of Restaurant Food from Crowdsourced Food Images: Case of Hartford

Deep learning models can recognize the food item in an image and derive their nutrition information, including calories, macronutrients (carbohydrates, fats, and proteins), and micronutrients (vitamins and minerals). This technology has yet to be implemented for the nutrition assessment of restaurant food. In this paper, we crowdsource 15,908 food images of 470 restaurants in the Greater Hartford region on Tripadvisor and Google Place. These food images are loaded into a proprietary deep learning model (Calorie Mama) for nutrition assessment. We employ manual coding to validate the model accuracy based on the Food and Nutrient Database for Dietary Studies. The derived nutrition information is visualized at both the restaurant level and the census tract level. The deep learning model achieves 75.1% accuracy when compared with manual coding. It has more accurate labels for ethnic foods but cannot identify portion sizes, certain food items (e.g., specialty burgers and salads), and multiple food items in an image. The restaurant nutrition (RN) index is further proposed based on the derived nutrition information. By identifying the nutrition information of restaurant food through crowdsourced food images and a deep learning model, the study provides a pilot approach for large-scale nutrition assessment of the community food environment.

A pilot study of a school lunchroom intervention in a predominately Latinx sample

OBJECTIVE

The purpose of the study was to assess the feasibility of an environmental school lunchroom intervention ('Smarter Lunchrooms') and test initial efficacy within a predominately Latinx population.

DESIGN

We collected baseline and intervention lunchroom food consumption and waste data in a pre-post, single group design. Meal consumption data was analyzed using Nutrition Data System for Research software to obtain estimates of nutritional content.

MAIN OUTCOME MEASURES

Feasibility.

SECONDARY MEASURES

Plate Waste, Nutrient Intake.

RESULTS

Participants were 88 1st-4th graders (51% female; 77% Latinx). Our recruitment rate was 45%, we were able to implement 8 Smarter Lunchroom strategies, and we were able to collect 82 baseline plate photos (93%) and 80 intervention photos (90%) of school lunches. On average, students threw away more than half of their meals on both days. Fruit consumption and fiber per 1000 kcal were significantly poorer at intervention compared to baseline.

CONCLUSIONS

Our findings highlight challenges in collecting consumption data in a real-world setting. We describe directions for future research taking into consideration our "lessons learned" from this formative work.

Assessing Mealtime Macronutrient Content: Patient Perceptions Versus Expert Analyses via a Novel Phone App

Background: People with type 1 diabetes estimate meal carbohydrate content to accurately dose insulin, yet, protein and fat content of meals also influences postprandial glycemia. We examined accuracy of macronutrient content estimation via a novel phone app. Participant estimates were compared with expert nutrition analyses performed via the Remote Food Photography Method© (RFPM©). Methods: Data were collected through a novel phone app. Participants were asked to take photos of meals/snacks on the day of and day after scheduled exercise, enter carbohydrate estimates, and categorize meals as low, typical, or high protein and fat. Glycemia was measured via continuous glucose monitoring. Results: Participants (n = 48) were 15-68 years (34 ± 14 years); 40% were female. The phone app plus RFPM© analysis captured 88% ± 29% of participants' estimated total energy expenditure. The majority (70%) of both low-protein and low-fat meals were accurately classified. Only 22% of high-protein meals and 17% of high-fat meals were accurately classified. Forty-nine percent of meals with <30 g of carbohydrates were overestimated by an average of 25.7 ± 17.2 g. The majority (64%) of large carbohydrate meals (≥60 g) were underestimated by an average of 53.6 ± 33.8 g. Glycemic response to large carbohydrate meals was similar between participants who underestimated or overestimated carbohydrate content, suggesting that factors beyond carbohydrate counting may impact postprandial glycemic response. Conclusions: Accurate estimation of total macronutrients in meals could be leveraged to improve insulin decision support tools and closed loop insulin delivery systems; development of tools to improve macronutrient estimation skills should be considered.

Development and validation of protocols for photographed food record by visually impaired people

OBJECTIVE

To develop and validate protocols for photographed food record directed to visually impaired people.

DESIGN

Photographic techniques were established for capturing food images using a smartphone, and written protocols were defined. Thereafter, visually impaired people made photographic records of three standardised meals (breakfast, lunch/dinner, and snack) following the previously developed protocols. These photographs were then evaluated by a panel of experts (nutritionists and photographer) to indicate whether the framing, focus and angle were suitable to identify the food type, food amount and portion size. Agreement between the experts was assessed using Fleiss' Kappa.

SETTING

Natal, the capital of Rio Grande do Norte, Brazil.

PARTICIPANTS

Visually impaired people (n 40); nutritionists (n 2); professional photographer (n 1).

RESULTS

Both protocols obtained a high proportion of satisfactory photos for all the items in the three dimensions investigated. When overall quality was assessed, the experts' agreement was a substantial that through the images it would be possible to identify the food type and portion size, both for Frontal Photos (k = 0·70 and k = 0·62, respectively) and Aerial Photos (k = 0·68 and k = 0·70, respectively). The degree of agreement that the photos presented a satisfactory global quality was moderate for the Frontal Photo (k = 0·43) and substantial for the Aerial Photo (k = 0·64). Participants who frequently used smartphone-type cell phones obtained better quality images for all these attributes for both protocols.

CONCLUSIONS

The protocols for photographed food record developed for visually impaired people in this study are feasible and present themselves as an alternative strategy to qualitatively assess their dietary intake.

Review of the validity and feasibility of image-assisted methods for dietary assessment

Accurately quantifying dietary intake is essential to understanding the effect of diet on health and evaluating the efficacy of dietary interventions. Self-report methods (e.g., food records) are frequently utilized despite evident inaccuracy of these methods at assessing energy and nutrient intake. Methods that assess food intake via images of foods have overcome many of the limitations of traditional self-report. In cafeteria settings, digital photography has proven to be unobtrusive and accurate and is the method of choice for assessing food provision, plate waste, and food intake. In free-living conditions, image capture of food selection and plate waste via the user's smartphone, is promising and can produce accurate energy intake estimates, though accuracy is not guaranteed. These methods foster (near) real-time transfer of data and eliminate the need for portion size estimation by the user since the food images are analyzed by trained raters. A limitation that remains, similar to self-report methods where participants must truthfully record all consumed foods, is intentional and/or unintentional underreporting of foods due to social desirability or forgetfulness. Methods that rely on passive image capture via wearable cameras are promising and aim to reduce user burden; however, only pilot data with limited validity are currently available and these methods remain obtrusive and cumbersome. To reduce analysis-related staff burden and to allow real-time feedback to the user, recent approaches have aimed to automate the analysis of food images. The technology to support automatic food recognition and portion size estimation is, however, still in its infancy and fully automated food intake assessment with acceptable precision not yet a reality. This review further evaluates the benefits and challenges of current image-assisted methods of food intake assessment and concludes that less burdensome methods are less accurate and that no current method is adequate in all settings.

Development and validation of nutrient estimates based on a food-photographic record in Japan

Background

Previous studies have reported that estimates of portion size, energy, and macronutrients such as carbohydrates, proteins, and fat based on the food-photographic record closely correlate with directly weighed values. However, the correlation based on a large sample of the test meal with the evidence of many nutrients is yet to be determined. We conducted this study to assess the correlation and difference between the food-photographic record and weighed results for 44 nutrients based on a larger number of test meals than those in previous studies.

Methods

We assessed the nutrients of test meals using a food-photographic record and direct weighing and compared the results of the two methods. Twenty participants prepared a total of 1163 test meals. Each participant cooked 28–29 different kinds of dishes. Five participants cooked the same dish with their own recipes. For the most commonly consumed 41 dishes, 20 participants served a meal with their usual portion size. For the remaining 73 dishes, five participants served a meal with their usual portion size. An independent researcher weighed each ingredient and calculated the nutrients of the test meals. The participants took photographs of the test meals using a digital camera. Two independent, trained analysts measured the longitudinal and transverse diameters of the food area on the photographs of the test meals, compared the portion size with the reference photographs, and calculated the nutrients based on a database that contained reference photographs.

Results

Rank correlation coefficients between estimates from the food-photographic record of each test meal and weighed results were high for portion size (r = 0.93), energy (r = 0.93), protein (r = 0.90), fat (r = 0.92), and carbohydrate (r = 0.94), and those for the 44 nutrients ranged from 0.78 to 0.94. We found high reproducibility between the two analysts for all the nutrients (r > 0.90).

Conclusions

We found a high correlation and small difference between the food-photographic record method and weighed results of a large number of nutrients in many test meals.

Selection, intake, and plate waste patterns of leftover food items among U.S. consumers: A pilot study

Many campaigns promote the preservation and consumption of leftover food items as a critical household strategy to accomplish national consumer food waste reduction goals. We fill a gap in knowledge about the consumption and creation of leftovers in the United States by analyzing data from a pilot study in which 18 subjects tracked food selection, intake, and plate waste across all eating occasions for about one week. Subjects noted which items selected for consumption were leftovers, i.e., previously prepared but uneaten items that were stored for future consumption, and which unfinished items were saved to become leftovers. We found that 12% of items selected for consumption were leftovers while 24% of selected items that were not fully consumed were kept to become a leftover. Leftovers were most frequently vegetables, cheeses, and meats, and most frequently selected on Mondays and for lunch. Regression analyses isolate significant dining patterns with respect to leftovers, including evidence that leftovers were less likely to be fully consumed than non-leftover items, and that larger meals led to more uneaten food. This suggests that strategies to reduce meal size may be most effective in reducing food waste by limiting the creation of leftovers in the first place. Strategies to make leftovers more attractive and appealing may also reduce food waste.

The Validity, Time Burden, and User Satisfaction of the FoodImage™ Smartphone App for Food Waste Measurement Versus Diaries: A Randomized Crossover Trial

The FoodImage™ smartphone app transmits to researchers users' photographs of food selection and food waste, and includes user-tagged information about waste reasons and destination. Twenty-four participants were trained to record food waste using FoodImage, food waste diaries requiring visual estimation of waste quantities, and diaries requiring scale weights. Participants used each method during three staged food-waste scenarios (food preparation, eating, and clean-out) in a randomized crossover trial. Two participants had extreme values for the weighed diary method; therefore, accuracy results are reported with and without these two participants' data. Error was calculated as waste estimated with the experimental method minus directly weighed waste. Mean absolute error from FoodImage was significantly smaller than or equal to the error from both diary methods in each scenario. Furthermore, the mean values from FoodImage were equivalent to directly weighed values in two out of the three tasks; while weighed diaries were equivalent in two tasks only when the two participants with extreme values were removed. Visually estimated diaries were equivalent for only one task. All 24 participants preferred FoodImage to diaries and all rated FoodImage as less time consuming. Over one week, FoodImage would require ~24 fewer minutes of users' time to record all data. Unlike food waste diaries, FoodImage also transmits data to researchers in real-time and provides detailed data on food selection and intake. ClinicalTrials.gov Identifier: NCT03309306.

Photo-Assisted Dietary Method Improves Estimates of Dietary Intake Among People with Sleeve Gastrectomy

INTRODUCTION

Bariatric operations are effective obesity treatments because of the significant reductions in food intake after surgery, but weight regain remains a problem in a small group of patients after surgery. Estimating food intake is difficult due to dieting status, weight, gender, and challenges with estimating portion size. We aimed to evaluate the use of digital food photography in comparison to conventional methods among patients after sleeve gastrectomy.

METHODS

Participants used a mobile device (mHealth) to photo-document their dietary intake of all food and beverages consumed before and after eating. They also completed a 24 h food recall interview with a dietician.

RESULTS

Data from 383 eating occasions were analyzed. Food intake using 24 h recall was reported as 972.5 ± 77 kcal and estimates from photographs were 802.9 ± 63.4 kcal, with a difference of 169.6 ± 451.4 kcal (95% confidence interval (CI) of 41.4 to 297.9 kcal, p = 0.005). There was no difference for protein intake, but carbohydrate intake reported during the 24 h recall was 541.2 ± 298 kcal and estimates from photographs were 395.2 ± 219.6 kcal, with a difference of 145.8 ± 256.3 kcal (95% CI of 73.2 to 218.8 kcal, p = 0.0001).

CONCLUSION

After sleeve gastrectomy, patients reported eating more total calories and calories from carbohydrates compared to estimations using photographs. The implication for patients are that tools such as mHealth might be useful to optimize food intake and calories after sleeve gastrectomy, especially for those patients that may struggle with weight regain after surgery.

Measuring lunchtime consumption in school cafeterias: a validation study of the use of digital photography

OBJECTIVE

The present study tested the validity of a digital image-capture measure of food consumption suitable for use in busy school cafeterias.

DESIGN

Lunches were photographed pre- and post-consumption, and food items were weighed pre- and post-consumption for comparison.

SETTING

A small research team recorded children's lunchtime consumption in one primary and one secondary school over seven working days.ParticipantsA primary-school sample of 121 children from North Wales and a secondary-school sample of 124 children from the West Midlands, UK, were utilised. Nineteen children were excluded because of incomplete data, leaving a final sample of 239 participants.

RESULTS

Results indicated that (i) consumption estimates based on images were accurate, yielding only small differences between the weight- and image-based judgements (median bias=0·15-1·64 g, equating to 0·45-3·42 % of consumed weight) and (ii) good levels of inter-rater agreement were achieved, ranging from moderate to near perfect (Cohen's κ=0·535-0·819). This confirmed that consumption estimates derived from digital images were accurate and could be used in lieu of objective weighed measures.

CONCLUSIONS

Our protocol minimised disruption to daily lunchtime routine, kept the attrition low, and enabled better agreement between measures and raters than was the case in the existing literature. Accurate measurements are a necessary tool for all those engaged in nutrition research, intervention evaluation, prevention and public health work. We conclude that our simple and practical method of assessment could be used with children across a range of settings, ages and lunch types.

An Assessment of the Validity of an Audio-Video Method of Food Journaling for Dietary Quantity and Quality

Objective

To validate an audio-video (AV) method of food journaling, in a free-living scenario, compared to direct, weighed food assessment.

Design and Setting

Data were collected in a cafeteria. Meals, selected by participants (n=30), were documented using the AV method: participants video-recorded their tray while audio-recording a description of their selected meal, after which the research team digitally weighed each food item and created an itemized diary record of the food.

Variables Measured

Data from the AV method and from the weighed food diaries were transcribed and entered into a nutrition software analysis program (Nutribase Pro 10.0). Nutrient outputs were compared between the two methods including kilocalories, macronutrients, and selected micronutrients.

Analyses

Using mean scores for each variable, Wilcoxon signed-rank test and Spearman's correlation coefficients were conducted. Interclass correlation coefficient (ICC) was calculated for absolute agreement between the two methods to assess interrater reliability.

Results

With the exception of Vitamin E and total weight, nutrient values were highly correlated between methods and were statistically significant given alpha = 0.05, power = 0.95, and effect size of 0.70.

Conclusions

The AV method may be a meaningful alternative to diary recording in a free-living setting.

Calorie Estimation From Pictures of Food: Crowdsourcing Study

Background

Software designed to accurately estimate food calories from still images could help users and health professionals identify dietary patterns and food choices associated with health and health risks more effectively. However, calorie estimation from images is difficult, and no publicly available software can do so accurately while minimizing the burden associated with data collection and analysis.

Objective

The aim of this study was to determine the accuracy of crowdsourced annotations of calorie content in food images and to identify and quantify sources of bias and noise as a function of respondent characteristics and food qualities (eg, energy density).

Methods

We invited adult social media users to provide calorie estimates for 20 food images (for which ground truth calorie data were known) using a custom-built webpage that administers an online quiz. The images were selected to provide a range of food types and energy density. Participants optionally provided age range, gender, and their height and weight. In addition, 5 nutrition experts provided annotations for the same data to form a basis of comparison. We examined estimated accuracy on the basis of expertise, demographic data, and food qualities using linear mixed-effects models with participant and image index as random variables. We also analyzed the advantage of aggregating nonexpert estimates.

Results

A total of 2028 respondents agreed to participate in the study (males: 770/2028, 37.97%, mean body mass index: 27.5 kg/m²). Average accuracy was 5 out of 20 correct guesses, where “correct” was defined as a number within 20% of the ground truth. Even a small crowd of 10 individuals achieved an accuracy of 7, exceeding the average individual and expert annotator’s accuracy of 5. Women were more accurate than men (P<.001), and younger people were more accurate than older people (P<.001). The calorie content of energy-dense foods was overestimated (P=.02). Participants performed worse when images contained reference objects, such as credit cards, for scale (P=.01).

Conclusions

Our findings provide new information about how calories are estimated from food images, which can inform the design of related software and analyses.

Performance Nutrition Dining Facility Intervention Improves Special Operations Soldiers' Diet Quality and Meal Satisfaction

OBJECTIVE

To assess the impact of the Special Operations Forces Human Performance Program dining facility (DFAC) intervention on patron diet quality and meal satisfaction.

DESIGN

Nonrandomized, controlled time series study using digital food photography and surveys pre-post intervention (0, 4, 8, and 12 months).

SETTING

Two Fort Bragg, NC military installation DFACs.

PARTICIPANTS

Volunteers (n = 688 total; n = 573 complete dataset) were US Army active duty soldiers.

INTERVENTION

The DFAC intervention included food choice architecture, new performance-optimizing food recipes to increase nutrient density, revised menus to offer more performance foods daily, and nutrition labeling to influence food choice.

MAIN OUTCOME MEASURES

Daily DFAC nutrient intake and Healthy Eating Index (HEI) 2010 scores.

ANALYSIS

Descriptive and ANOVA statistical analyses were performed between control and intervention groups and from baseline to 4, 8, and 12 months postintervention (α = .05; 80% power).

RESULTS

The intervention resulted in a higher posttest HEI score (60.1 ± 8.8 points; +3.4%; P = .005) and DFAC satisfaction compared with control (49.0 ± 10.4 points; P > .05). Improved intervention HEI scores were attributed to changes in citrus and melon fruit (+46%), red and orange vegetables (+35%), whole grains (+181%), legumes (65%), yogurt (+45%), oils (-26%), and solid fat (-18%) consumption (all P < .05).

CONCLUSIONS AND IMPLICATIONS

These data illustrate that the Special Operations Forces Human Performance Program military DFAC nutrition intervention was feasible to implement and was associated with diet quality improvements. Access to high-quality ingredients and recipes may improve soldier meal quality and acceptance in other settings and warrants further investigation.

Efficacy of a school-based obesity prevention intervention at reducing added sugar and sodium in children's school lunches: the LA Health randomized controlled trial

BACKGROUND

Decreasing selection and consumption of sodium and added sugars in the school cafeteria setting is important to provide optimal nutrition to children.

OBJECTIVE

The ofjective of this study is to determine whether Louisiana (LA) Health, a school-based obesity prevention intervention, could successfully reduce children's selection and consumption of sodium and added sugars during school lunches vs. the control group.

DESIGN

Food selection, consumption, and plate waste from student lunches (3 consecutive days) in 33 public schools in rural Louisiana were collected and analyzed using the digital photography of foods method at baseline and after a 28-month obesity prevention intervention (LA Health) beginning in 4th-6th grade (87% of children received free or reduced cost lunch). Selection and consumption of energy, added sugar, and sodium was objectively measured using digital photography of foods. Mixed models, including Race and BMI, were used to determine whether change in selection and consumption differed by group.

RESULTS

Sodium decreased for selection (- 233.1 ± 89.4 mg/lunch, p = 0.04) and consumption (- 206.3 ± 65.9, mg/lunch) in the intervention (vs. control) by month 18, and in consumption by month 28 (- 153.5 ± 66.9 mg/lunch, p = 0.03). Change in added sugar consumption decreased in the intervention (vs. control) at month 18 (- 3.7 ± 1.6, p = 0.05) and at month 28 (- 3.5 ± 1.6 tsp/lunch, p = 0.05).

CONCLUSIONS

LA Health decreased the amount of added sugar and sodium selected and consumed, but not plate waste, by month 28. Results highlight the importance of long-term interventions and policies targeting provision and selection to improve dietary patterns in children, with less focus on plate waste.

The Feasibility and Acceptability of Two Methods of Snack Portion Control in United Kingdom (UK) Preschool Children: Reduction and Replacement

Large portions of high energy dense (HED) snacks are offered to children from a young age and are pervasive in our food environment. This study aimed to explore the feasibility, acceptability, and preliminary efficacy of two strategies of snack portion control: reduction and replacement. Forty-six mother-child dyads aged 22⁻56 months (36.6 ± 9.5 m, 48% female) completed a three-week intervention. In week 1 (baseline) no changes were made to the child's diet; week 2 (acclimation) children received a standardised selection of HED snacks, and in week 3 (intervention) participants were randomly assigned to snack replacement (n = 24) or snack reduction (n = 22). Snack replacement involved swapping HED snacks for fruits and vegetables, whilst snack reduction involved reducing the size of HED snacks by 50%. Food and energy intake were measured using a weighed food diary for four consecutive days. Snack replacement resulted in more positive changes to children's diets; vegetable intake increased (p < 0.01), and total daily energy intake decreased when compared to snack reduction (p < 0.05). Mothers expressed a more favourable attitude to snack replacement, although snack reduction was also well received by mothers. Despite increased preliminary efficacy of snack replacement on dietary intake, both strategies were feasible and acceptable. The current pilot study provides the necessary information to inform the design of future interventions.

The Remote Food Photography Method and SmartIntake App for the Assessment of Alcohol Use in Young Adults: Feasibility Study and Comparison to Standard Assessment Methodology

BACKGROUND

Heavy drinking is prevalent among young adults and may contribute to obesity. However, measurement tools for assessing caloric intake from alcohol are limited and rely on self-report, which is prone to bias.

OBJECTIVE

The purpose of our study was to conduct feasibility testing of the Remote Food Photography Method and the SmartIntake app to assess alcohol use in young adults. Aims consisted of (1) quantifying the ability of SmartIntake to capture drinking behavior, (2) assessing app usability with the Computer System Usability Questionnaire (CSUQ), (3) conducting a qualitative interview, and (4) comparing preference, usage, and alcohol use estimates (calories, grams per drinking episode) between SmartIntake and online diet recalls that participants completed for a parent study.

METHODS

College students (N=15) who endorsed a pattern of heavy drinking were recruited from a parent study. Participants used SmartIntake to send photographs of all alcohol and food intake over a 3-day period and then completed a follow-up interview and the CSUQ. CSUQ items range from 1-7, with lower scores indicating greater usability. Total drinking occasions were determined by adding the number of drinking occasions captured by SmartIntake plus the number of drinking occasions participants reported that they missed capturing. Usage was defined by the number of days participants provided food/beverage photos through the app, or the number of diet recalls completed.

RESULTS

SmartIntake captured 87% (13/15) of total reported drinking occasions. Participants rated the app as highly usable in the CSUQ (mean 2.28, SD 1.23). Most participants (14/15, 93%) preferred using SmartIntake versus recalls, and usage was significantly higher with SmartIntake than recalls (42/45, 93% vs 35/45, 78%; P=.04). Triple the number of participants submitted alcohol reports with SmartIntake compared to the recalls (SmartIntake 9/15, 60% vs recalls 3/15, 20%; P=.06), and 60% (9/15) of participants reported drinking during the study.

CONCLUSIONS

SmartIntake was acceptable to college students who drank heavily and captured most drinking occasions. Participants had higher usage of SmartIntake compared to recalls, suggesting SmartIntake may be well suited to measuring alcohol consumption in young adults. However, 40% (6/15) did not drink during the brief testing period and, although findings are promising, a longer trial is needed.

Christian Orthodox fasting in practice: A comparative evaluation between Greek Orthodox general population fasters and Athonian monks

OBJECTIVES

Christian Orthodox fasting (COF), a periodical vegetarian subset of the Mediterranean diet, has been proven to exert beneficial effects on human health. Athonian fasting is a pescetarian COF variation, where red meat is strictly restricted throughout the year. Previous studies have examined the COF nutritional synthesis and health effects in general population fasters (GF) and Athonian monks (AM), separately. The aim of this study is to comparatively evaluate the characteristics and effects of this nutritional advocacy between the two populations.

METHODS

The study included 43 male GFs (20-45 y of age) and 57 age-matched male AMs following COF. Dietary intake data were collected in both groups during a restrictive (RD) and a nonrestrictive (NRD) day. Nutritional, cardiometabolic, and anthropometric parameters were compared between the two cohorts.

RESULTS

AM presented lower daily total caloric intake for both RD (1362.42 ± 84.52 versus 1575.47 ± 285.96 kcal, P < 0.001) and NRD (1571.55 ± 81.07 versus 2137.80 ± 470.84 kcal, P < 0.001) than GF.They also demonstrated lower body mass index (23.77 ± 3.91 versus 28.92 ± 4.50 kg/m², P <0.001), body fat mass (14.57 ± 8.98 versus 24.61 ± 11.18 kg, P = 0.001), and homeostatic model assessment for insulin resistance values (0.98 ± 0.72 versus 2.67 ± 2.19 mmol/L, P < .001) than GF. Secondary hyperparathyroidism (parathyroid hormone concentrations: 116.08 ± 49.74 pg/mL), as a result of profound hypovitaminosis D [25(OH)D: 9.27 ± 5.81 ng/mL], was evident in the AM group.

CONCLUSIONS

The results of the present study highlight the unique characteristics of Athonian fasting and its value as a health-promoting diet. The effects of limitation of specific vitamins and minerals during fasting warrants further investigation.

Preliminary Feasibility and Acceptability of the Remote Food Photography Method for Assessing Nutrition in Young Children with Type 1 Diabetes

Background

Nutrition is a critical component of diabetes and other chronic diseases for young children. However, nutritional intake is burdensome to measure accurately and easily, making it difficult to evaluate in research or clinical contexts.

Objective

This pilot study examined the feasibility and acceptability of having parents of young children with T1D use the Remote Food Photography Method (RFPM) to measure breakfast nutrition.

Methods

Participants were 9 mothers of children ages 2-5 years (M_age=4.2), with a T1D duration of at least 1 year (M_age=2.4 years at diagnosis), representing diverse backgrounds (55.6% Caucasian; 44.4% African American; 55.6% married). During baseline and follow-up of a healthy eating and physical activity intervention for children with T1D, parents used the RFPM to capture before and after images of their children's breakfast. Feasibility and acceptability were assessed by adherence to taking photos, percent of usable photos, and participant satisfaction.

Results

The RFPM was feasible across participants with high adherence rates (100% at baseline and 87% at follow-up) for sending usable photographs. Most participants reported satisfaction with the method.

Conclusions

Using the RFPM to assess nutrition in a small sample of young children with T1D was feasible and acceptable. Given the importance of assessing nutrition in young children with T1D as well as other chronic illnesses (e.g., cystic fibrosis, obesity), the RFPM may be a useful tool for both research and clinical data collection in lieu of other methods. More research is needed to evaluate reliability and validity of RFPM in pediatric populations.

Bite count rates in free-living individuals: new insights from a portable sensor

Background

Conclusions regarding bite count rates and body mass index (BMI) in free-living populations have primarily relied on self-report. The objective of this exploratory study was to compare the relationship between BMI and bite counts measured by a portable sensor called the Bite Counter in free-living populations and participants eating in residence.

Methods

Two previously conducted studies were analyzed for relationships between BMI and sensor evaluated bite count/min, and meal duration. Participants from the first study (N = 77) wore the bite counter in a free-living environment for a continuous period of 14 days. The second study (N = 214) collected bite count/min, meal duration, and total energy intake in participants who consumed one meal in a cafeteria. Linear regression was applied to examine relationships between BMI and bite count/min.

Results

There was no significant correlation in the free-living participants average bite counts per second and BMI (R² = 0.03, p = 0.14) and a significant negative correlation in the cafeteria participants (R² = 0.04, p = 0.03) with higher bite count rates observed in lean versus obese participants. There was a significant correlation between average meal duration and BMI in the free-living participants (R² = 0.08, p = 0.01). Total energy intake in the cafeteria participants was also significantly correlated to meal duration (R² = 0.31, p < 0.001).

Conclusions

With additional novel applications of the Bite Counter, insights into free-living eating behavior may provide avenues for future interventions that are sustainable for long term application.

Using digital photography in a clinical setting: a valid, accurate, and applicable method to assess food intake

BACKGROUND/OBJECTIVES

Regular monitoring of food intake is hardly integrated in clinical routine. Therefore, the aim was to examine the validity, accuracy, and applicability of an appropriate and also quick and easy-to-use tool for recording food intake in a clinical setting.

SUBJECTS/METHODS

Two digital photography methods, the postMeal method with a picture after the meal, the pre-postMeal method with a picture before and after the meal, and the visual estimation method (plate diagram; PD) were compared against the reference method (weighed food records; WFR). A total of 420 dishes from lunch (7 weeks) were estimated with both photography methods and the visual method. Validity, applicability, accuracy, and precision of the estimation methods, and additionally food waste, macronutrient composition, and energy content were examined.

RESULTS

Tests of validity revealed stronger correlations for photography methods (postMeal: r = 0.971, p < 0.001; pre-postMeal: r = 0.995, p < 0.001) compared to the visual estimation method (r = 0.810; p < 0.001). The pre-postMeal method showed smaller variability (bias < 1 g) and also smaller overestimation and underestimation. This method accurately and precisely estimated portion sizes in all food items. Furthermore, the total food waste was 22% for lunch over the study period. The highest food waste was observed in salads and the lowest in desserts.

CONCLUSIONS

The pre-postMeal digital photography method is valid, accurate, and applicable in monitoring food intake in clinical setting, which enables a quantitative and qualitative dietary assessment. Thus, nutritional care might be initiated earlier. This method might be also advantageous for quantitative and qualitative evaluation of food waste, with a resultantly reduction in costs.

Plate waste of adults in the United States measured in free-living conditions

We analyze food-item level data collected from 50 adults from the United States using the Remote Food Photography Method® to provide the first estimates of plate waste gathered from adults across multiple consecutive meals and days in free-living conditions, and during laboratory-based meals with fixed food items and quantities. We find average plate waste in free-living conditions is 5.6 grams (7.7 kcals) per item and that 3.3% of all food selected is returned as plate waste, where the percent waste figure is substantially lower than previously published plate waste estimates gathered primarily from dine-out settings in the United States such as buffets and institutional settings with limited-choice meals (e.g., school cafeterias). Plate waste from the same participants during the laboratory-based meals is significantly higher with an average of 203.2 grams of solid plate waste per meal (531.3 kcals) or 39.1% of the food provided, which is similar to the plate waste percentages found reported in some school cafeteria settings. The amount of plate waste generated in free-living conditions is significantly positively associated with portion size selected for an item. In a multivariate analysis that controls for macronutrient profile, items selected from the vegetables, fats/oils/dressings, and grains categories are associated with significantly greater amounts of plate waste per item. We find no significant associations between free-living plate waste and gender, age, race or body mass index but find that women leave more plate waste in the lab meal where portion sizes are pre-determined by the researcher and similar for all respondents. We discuss possible implications of these findings for programs focused on reducing plate waste and food waste among consumers.

The opportunity of tracking food waste in school canteens: Guidelines for self-assessment

Reducing food waste is one of the key challenges of the food system and addressing it in the institutional catering industry can be a quick win. In particular, school canteens are a significant source of food waste and therefore embody a great opportunity to address food waste. The goal of our research is the development of guidelines for audit and self-assessment in measuring and managing food waste produced at school canteens. The purpose of the tool is to standardise food waste audits to be executed either by scholars, school staff or by catering companies with the objective of measuring and reducing food waste at schools. We performed a research among public and private schools and catering companies from which we obtained the key performance indicators to be measured and then pilot-tested the resulting tool in four schools with over 2900 pupil participants, measuring plate waste from over 10,000 trays. This tool will help managers in their efforts towards more sustainable organisations at the same time as the standardisation of food waste audits will provide researchers with comparable data. The study suggests that although there is low awareness on the amount of food wasted at school canteens, managers and staff are highly interested in the topic and would be willing to implement audits and reduction measures. The case study also showed that our tool is easy to implement and not disruptive.

Wearable Devices for Caloric Intake Assessment: State of Art and Future Developments

Background:

The self-monitoring of caloric intake is becoming necessary as the number of pathologies related to eating increases. New wearable devices may help people to automatically record energy assumed in their meals.

Objective:

The present review collects the released articles about wearable devices or method for automatic caloric assessments.

Method:

A literature research has been performed with PubMed, Google Scholar, Scopus and ClinicalTrials.gov search engines, considering released articles regarding applications of wearable devices in eating environment, from 2005 onwards.

Results:

Several tools allow caloric assessment and food registration: wearable devices counting the number of bites ingested by the user, instruments detecting swallows and chewings, methods that analyse food with digital photography. All of them still require more validation and improvement.

Conclusion:

Automatic recording of caloric intake through wearable devices is a promising method to monitor body weight and eating habits in clinical and non-clinical settings, and the research is still going on.

Validity of the Remote Food Photography Method Against Doubly Labeled Water Among Minority Preschoolers

OBJECTIVE

The aim of this study was to determine the validity of energy intake (EI) estimations made using the remote food photography method (RFPM) compared to the doubly labeled water (DLW) method in minority preschool children in a free-living environment.

METHODS

Seven days of food intake and spot urine samples excluding first void collections for DLW analysis were obtained on thirty-nine 3- to 5-year-old Hispanic and African American children. Using an iPhone, caregivers captured before and after pictures of each child's intake, pictures were wirelessly transmitted to trained raters who estimated portion size using existing visual estimation procedures, and energy and macronutrients were calculated. Paired t tests, mean differences, and Bland-Altman limits of agreement were performed.

RESULTS

The mean EI was 1,191 ± 256 kcal/d using the RFPM and 1,412 ± 220 kcal/d using the DLW method, resulting in a mean underestimate of 222 kcal/d (-15.6%; P < 0.0001) that was consistent regardless of intake. The RFPM underestimated EI by -28.5% in 34 children and overestimated EI by 15.6% in 5 children.

CONCLUSIONS

The RFPM underestimated total EI when compared to the DLW method among preschoolers. Further refinement of the RFPM is needed for assessing the EI of young children.

Health benefits and consequences of the Eastern Orthodox fasting in monks of Mount Athos: a cross-sectional study

BACKGROUND/OBJECTIVES

Greek Orthodox fasting (OF), which involves 180-200 days of fasting per year, is dictated by the Christian Orthodox religion. For the first time, this cross-sectional study examines the characteristics and the effects of OF on anthropometry, cardiometabolic markers and calcium homeostasis in Athonian monks (AMs).

SUBJECTS/METHODS

Daily intakes of energy, macro- and micronutrients of a day during a weekend of Nativity Fast, defined as non-restrictive day (NRD), and a weekday during Great Lent, labeled as restrictive day (RD) were recorded.

RESULTS

The daily energy intake of 70 AM (age=38.8±9.7 years) was low during both RD and NRD (1265.9±84.5 vs 1660±81 kcal, respectively, P<0.001). Paired samples t-test showed statistically significant difference between daily intakes in RD and NRD: carbohydrates (159.6±21.8 vs 294.3±23.4 g, P<0.0001) and saturated fat (12.7±0.0 vs 16.4±0.0 g, P<0.0001) were lower, whereas protein (89.2±1.3 vs 72.35±1.3 g, P<0.001) was higher during RD. A subsample of 50 monks (age=38.7±10.6 years) formed a study cohort for cardiometabolic and calcium homeostasis assessment. Body weight (74.3±12.9 kg) and body mass index (BMI; 23.8±4.1 kg/m2) were independent of level of physical activity. Optimal profiles for lipid and glucose parameters (total cholesterol: 183.4±41.7 mg/dl, LDL: 120.6±37.6 mg/dl, triglycerides: 72.2±31.3 mg/dl, HDL: 48.5±14.2 mg/dl and homeostasis model assessment of insulin resistance (HOMA-IR) 1.02±0.40) were found. Profound hypovitaminosis D (8.8±6.2 ng/ml), high parathyroid hormone (PTH): 115.5±48.0 pg/ml with normal serum calcium levels (8.9±3.2 mg/dl) was observed.

CONCLUSIONS

Unaffected by variation in lifestyle factors, the results of this unique study offers clear evidence for the health benefits of the strict Athonian OF through optimal lipid and glucose homeostasis.

Developing a digital photography-based method for dietary analysis in self-serve dining settings

Current population-based methods for assessing dietary intake, including food frequency questionnaires, food diaries, and 24-h dietary recall, are limited in their ability to objectively measure food intake. Digital photography has been identified as a promising addition to these techniques but has rarely been assessed in self-serve settings. We utilized digital photography to examine university students' food choices and consumption in a self-serve dining hall setting. Research assistants took pre- and post-photos of students' plates during lunch and dinner to assess selection (presence), servings, and consumption of MyPlate food groups. Four coders rated the same set of approximately 180 meals for inter-rater reliability analyses; approximately 50 additional meals were coded twice by each coder to assess intra-rater agreement. Inter-rater agreement on the selection, servings, and consumption of food groups was high at 93.5%; intra-rater agreement was similarly high with an average of 95.6% agreement. Coders achieved the highest rates of agreement in assessing if a food group was present on the plate (95-99% inter-rater agreement, depending on food group) and estimating the servings of food selected (81-98% inter-rater agreement). Estimating consumption, particularly for items such as beans and cheese that were often in mixed dishes, was more challenging (77-94% inter-rater agreement). Results suggest that the digital photography method presented is feasible for large studies in real-world environments and can provide an objective measure of food selection, servings, and consumption with a high degree of agreement between coders; however, to make accurate claims about the state of dietary intake in all-you-can-eat, self-serve settings, researchers will need to account for the possibility of diners taking multiple trips through the serving line.

Design and Evaluation of a Training Protocol for a Photographic Method of Visual Estimation of Fruit and Vegetable Intake among Kindergarten Through Second-Grade Students

OBJECTIVE

To design a replicable training protocol for visual estimation of fruit and vegetable (FV) intake of kindergarten through second-grade students through digital photography of lunch trays that results in reliable data for FV served and consumed.

METHODS

Protocol development through literature and researcher input was followed by 3 laboratory-based trainings of 3 trainees. Lunchroom data collection sessions were done at 2 elementary schools for kindergarten through second-graders. Intraclass correlation coefficients (ICCs) were used.

RESULTS

By training 3, ICC was substantial for amount of FV served and consumed (0.86 and 0.95, respectively; P < .05). The ICC was moderate for percentage of fruits consumed (0.67; P = .06). In-school estimates for ICCs were all significant for amounts served at school 1 and percentage of FV consumed at both schools.

CONCLUSIONS AND IMPLICATIONS

The protocol resulted in reliable estimation of combined FV served and consumed using digital photography. The ability to estimate FV intake accurately will benefit intervention development and evaluation.

A Cross-Sectional Study of the Relationship between Nutrition Label Use and Food Selection, Servings, and Consumption in a University Dining Setting

BACKGROUND

Nutrition labels at the point of purchase are recommended to improve food choice, yet food choice does not always translate into food consumption. It is important to understand the relationship between label use, food selection, servings, and consumption. Previous research, which has relied on self-reported intake or inferred label use or intake based on sales data, has not adequately answered this question.

OBJECTIVE

To combine survey and meal photographic data to compare food selection, servings, and consumption between label users and nonusers.

DESIGN

Diners were surveyed in two cross-sectional waves during the fall 2014 semester. Food selections were recorded, and pre- and postmeal photographs were taken of diners' plate. Photographs were coded to identify the selection, servings, and consumption of MyPlate food categories.

PARTICIPANTS/SETTING

Convenience sample of 1,069 diners (39% women, 53% freshman) in two university dining halls. Students had to be older than age 18 years and just beginning their meal to participate.

MAIN OUTCOME MEASURES

Selection, servings, and consumption of MyPlate food categories for label users and nonusers.

STATISTICAL ANALYSES PERFORMED

Differences in food selection were tested via χ² tests, and differences in adjusted least squares means for servings and consumption were tested via t tests.

RESULTS

A greater proportion of nutrition label users selected fruits, vegetables, and beans and fewer selected potatoes compared with nonusers. In addition, fewer label users selected fried foods and foods with added sugars (all P values <0.05). Label users served themselves and consumed more vegetables and fewer potatoes and refined grains compared with nonusers (all P values <0.05).

CONCLUSIONS

Our results suggest label users behave differently compared with nonusers. Based on the meals observed, these differences appear more qualitative in nature (selecting different foods) than quantitative (selecting more or less food).

Development and Validation of a Photographic Method to Use for Dietary Assessment in School Settings

OBJECTIVE

To develop and validate a photographic method aimed at making assessment of dietary intake in school canteens non-obstrusive, practical and feasible.

METHODS

The study was conducted in two elementary schools representing two different school canteen systems; main dish being served by canteen staff (Iceland), and complete self-serving (Sweden). Food items in serving and leftovers were weighed and photographed. Trained researchers estimated weights of food items by viewing the photographs and comparing them with pictures of half and full reference portions with known weights. Plates of servings and leftovers from 48 children during five school days (n = 448 plates) and a total of 5967 food items were estimated. The researchers' estimates were then compared with the true weight of the foods and the energy content calculated.

RESULTS

Weighed and estimated amounts correlated across meals both in grams and as total energy (0.853-0.977, p<0.001). The agreement between estimated energy content in school meals was close to the true measurement from weighed records; on average 4-19 kcal below true values. Organisation of meal service impacted the efficacy of the method as seen in the difference between countries; with Iceland (served by canteen staff) having higher rate of acceptable estimates than Sweden (self-serving), being 95% vs 73% for total amount (g) in serving. Iceland more often had serving size between or above the half and full reference plates compared with Sweden.

CONCLUSIONS

The photographic method provides acceptable estimates of food and energy intake in school canteens. However, greater accuracy can be expected when foods are served by canteen staff compared with self-serving.

Innovations in Calculating Precise Nutrient Intake of Hospitalized Patients

Obtaining a detailed assessment of a hospitalized patient's nutrient intake is often critically important to ensuring the patient's successful recovery. However, this process is often laborious and prone to error. Inaccurate nutrient intake assessments result in the inability of the healthcare team to recognize patients with developing nutritional deficits that contribute to delayed recovery and prolonged lengths of stay. This paper describes an innovative, easy to use system designed to increase the precision of calorie count reports by using a combination of photography, direct observation, and a specially developed computer program. Although the system was designed specifically for use in a Department of Veterans Affairs Hospital, it has the potential to be adapted for use in other hospital environments.

Validação de fotografias de alimentos para estimativa do consumo alimentar

RESUMO Objetivo Validar fotografias de um guia fotográfico de alimentos para estimativa do consumo alimentar. Métodos As fotografias de 12 alimentos (bolo simples, macarrão ao sugo, mamão formosa, melancia, repolho roxo ralado, quiabo refogado, churrasco em tiras, filé de frango grelhado, pudim de leite condensado, pizza, amendoim cru e queijo tipo minas), retratadas em três tamanhos de porções (pequena, média e grande), foram avaliadas por 90 indivíduos adultos. Foram também investigados o peso, a estatura e o sexo dos participantes. Para análise de concordância entre o tamanho da porção do alimento retratado nas fotos e o tamanho real do alimento, utilizou-se o teste Kappa. Os dados foram analisados no software Stata, considerando-se p <0,05. Resultados A maior prevalência de acerto foi para as preparações pizza (87,8%), churrasco (80,0%), filé de frango e pudim (75,5%). Já os alimentos com menor percentual de acertos foram a melancia (52,2%), o mamão formosa e o bolo (57,8%). A concordância geral entre a percepção do tamanho da porção do alimento e o tamanho real do alimento foi de 0,622 ( p <0,001). A percepção não foi influenciada pelo sexo e pelo estado nutricional dos participantes ( p >0,05). Conclusão As 12 fotografias apresentaram uma boa concordância com as porções dos alimentos e podem ser um instrumento útil para aumentar a acurácia dos relatos do consumo alimentar.

A picture's worth a thousand words: a food-selection observational method

Issue addressed: Methods are needed to accurately measure and describe behaviour so that social marketers and other behaviour change researchers can gain consumer insights before designing behaviour change strategies and so, in time, they can measure the impact of strategies or interventions when implemented. This paper describes a photographic method developed to meet these needs.Methods: Direct observation and photographic methods were developed and used to capture food-selection behaviour and examine those selections according to their healthfulness. Four meals (two lunches and two dinners) were observed at a workplace buffet-style cafeteria over a 1-week period. The healthfulness of individual meals was assessed using a classification scheme developed for the present study and based on the Australian Dietary Guidelines.Results: Approximately 27% of meals (n = 168) were photographed. Agreement was high between raters classifying dishes using the scheme, as well as between researchers when coding photographs. The subset of photographs was representative of patterns observed in the entire dining room. Diners chose main dishes in line with the proportions presented, but in opposition to the proportions presented for side dishes.Conclusions: The present study developed a rigorous observational method to investigate food choice behaviour. The comprehensive food classification scheme produced consistent classifications of foods. The photographic data collection method was found to be robust and accurate. Combining the two observation methods allows researchers and/or practitioners to accurately measure and interpret food selections. Consumer insights gained suggest that, in this setting, increasing the availability of green (healthful) offerings for main dishes would assist in improving healthfulness, whereas other strategies (e.g. promotion) may be needed for side dishes.So what?: Visual observation methods that accurately measure and interpret food-selection behaviour provide both insight for those developing healthy eating interventions and a means to evaluate the effect of implemented interventions on food selection.