Assessing dinner meals offered at home among preschoolers from low-income families with the Remote Food Photography Method

Preschool teachers display a flexible pattern of pedagogical actions in promoting healthy habits in children

The school represents the optimal setting for promoting the physical, emotional, and social health of children, especially during the first years of life. Understanding the pedagogical actions of teachers to address health education is an important first step in promoting healthy behaviors in children. We inhere analyzed the pedagogical action patterns in the preschool teaching of healthy habits from a holistic health perspective. We used photography as a strategy for data collection and applied a Chi-square automatic interaction detection (CHAID) classification tree, a data mining procedure, to generate a pattern model. We found that the school space and the learning playfulness strategies for the development of executive functions, classified according to the exercise, symbolic, assembly, rules (ESAR) model, were the main factors that influence the pedagogical actions fostering healthy habits. By contrast, the school and the pedagogical resources of the classroom are factors with a much smaller impact on working with healthy habits. This pedagogical action pattern is flexible, since teachers conduct a multiplicity of pedagogical actions through different strategies, in different school spaces, at any time. In conclusion, our results unmask the interdependent relationships between the different factors that determine the teacher's actions at the preschool. It also contributes to the understanding of the teacher's practices in fostering healthy habits in a healthy learning environment.

A Narrative Review of Dietary Assessment Tools for Preschool-Aged Children in the Home Environment

Preschool-aged children in the U.S. have suboptimal diets. Interventions to improve child nutrition focus on parents and their role in shaping social and physical home environments, which influence children's eating behaviors. Dietary assessment tools selected to measure intervention objectives, and how results are interpreted in key findings, are essential when examining children's diets. The objectives of this review were to (1) describe dietary assessment tools used in intervention studies in young children focused within the home environment; and (2) examine how the application of these dietary assessment tools addressed intervention objectives. PubMed and Web of Science were searched for English-language nutrition intervention studies that included children aged 2-5 years, had a home environment component, used a dietary assessment tool, and reported on diet-related outcomes. Seventeen studies were included. Intervention objectives focused on overall diet, specific food groups, eating occasions, and obesity prevention/treatment. Concordance of key findings with intervention objectives, type of tool used, and multiple tools within the same study varied with 8 studies aligning in objective and tool, 1 discordant in both, and 8 partially concordant or too broad to determine. This review highlights current challenges in measuring dietary intake in preschoolers and provides recommendations for alternative applications and strategies.

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.

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.

Food Photography as a Tool to Assess Type, Quantity, and Quality of Foods in Parent-Packed Lunches for Preschoolers

OBJECTIVE

Explore using food photography to assess packed lunches in a university-based Early Childhood Center and contextualize these photographs through parent interviews.

METHODS

An explanatory sequential design was used. Packed lunches were photographed to assess the type and quantity of foods offered and consumed by Child and Adult Food Care Program components (fruit, vegetable, grain, and protein) and quality of foods offered using the Healthy Meal Index. Parent interviews aimed to understand motivations and behaviors related to packing lunch.

RESULTS

Data were collected on 401 lunches. Only 16.2% of lunches met all Child and Adult Food Care Program requirements. Most lunches included fruit (84%) and grains (82%), whereas fewer included vegetables (44%). Portion sizes were large, especially for grains (2.7 ± 1.5 servings). In interviews (n = 24), parents expressed tension between offering healthful items and foods they knew their child would eat, as well as concern about children going hungry.

CONCLUSIONS AND IMPLICATIONS

Food photography is a feasible methodology to capture parent-packed lunches for preschoolers and may have utility in nutrition education, particularly related to age-appropriate portion sizes.

Obesity Risk Assessment Tool for Low-Income Spanish Speaking Immigrant Parents with Young Children: Validity with BMI and Biomarkers of Obesity

Children of Hispanic origin bear a high risk of obesity. Child weight gain trajectories are influenced by the family environment, including parent feeding practices. Excessive body fat can result in unhealthful metabolic and lipid profiles and increased risk of metabolic diseases. The objective was to estimate criterion validity of an obesity risk assessment tool targeting Spanish-speaking families of Mexican origin using anthropometric measures and blood values of their young children. A cross-sectional study design with five data collection sessions was conducted over an eight-week period and involved 206 parent/child dyads recruited at Head Start and the Special Supplemental Nutrition Program for Women, Infants and Children in Northern California. Main outcome measures were criterion validity of Niños Sanos, a pediatric obesity risk assessment tool, using anthropometric measures and blood biomarkers. Niños Sanos scores were inversely related to child BMI-for-age percentiles (p = 0.02), waist-for-height ratios (p = 0.05) and inversely related to blood biomarkers for the metabolic index (p = 0.03) and lipid index (p = 0.05) and positively related to anti-inflammatory index (p = 0.047). Overall, children with higher Niños Sanos scores had more healthful lipid, metabolic and inflammatory profiles, as well as lower BMI-for-age percentiles and waist-to height ratios, providing evidence for the criterion validity of the tool. Niños Sanos can be used by child obesity researchers, by counselors and medical professionals during clinic visits as a screening tool and by educators as a tool to set goals for behavior change.

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.

"Everyone can take photos." Feasibility and relative validity of phone photography-based assessment of children's diets - a mixed methods study

Background

Dietary assessment methods that are user-friendly, simple, yet valid are of interest to both researchers and participants, particularly for use in disadvantaged settings, where language barriers and low levels of education are often present. We tested if parents taking photos of what children ate, using mobile phones, would be a feasible, acceptable method that could still provide information with adequate relative validity.

Methods

We used a mixed-methods design, with parents of 21 5- to 7-year-olds from disadvantaged areas in Sweden. Parents reported all dietary intake, during non-school hours, on three days (two weekdays) using a photo method (PM). The PM consisted of simple instructions and a fiduciary card, but no training, equipment or software. Text messages could be sent if necessary. As a reference method, parents completed three 24-h recalls (24HRs) with an interviewer each following day. The next week, parents completed a 9-item semi-FFQ regarding the preceding week. The outcomes were intakes (in dl) of 9 food groups, categorised as fruits and vegetables, energy-dense sweet/salty foods, and sweet drinks. Agreement with the reference 24HRs was assessed using correlations, median differences and Bland-Altman plots. Parents completed an open-ended questionnaire on barriers and facilitators. Data collectors provided complementary information. Qualitative data was analysed using qualitative manifest analysis.

Results

Nineteen parents (90%) provided complete data. The majority (n = 13) spoke Swedish as a second language, few (n = 4) were proficient. Compared to 24HRs, intakes measured by PM correlated well for all categories (Spearman’s rho = 0.609–0.845). However, intakes were underreported, significantly so for fruits and vegetables; Bland-Altman plots indicated that the underestimation was fairly constant across intake levels. When the FFQ was compared to the 24HRs, parameters of agreement were generally inferior than for the PM. Parents found the PM a positive experience, primarily facilitated by its simplicity and familiarity. Barriers, mainly related to time and logistics, can inform further methodological refinements.

Conclusions

The PM was an acceptable and feasible way to measure children’s diet outside of school hours in this population of parents from disadvantaged areas. While the absolute validity should be evaluated further, this relatively simple method has potential for assessing intakes of well-defined foods at group level.