Dietary assessment is a critical element of health research - Perspective from the Partnership for Advancing Nutritional and Dietary Assessment in Canada

Comparing the web-based and traditional self-reported 24-hour dietary recall data in the PakNutriStudy

BACKGROUND

The flaws in dietary assessment methods can generate misleading information and thus may impact on the interventions planned based on that information. Context specific digitalization of dietary assessment tools is a potential way forward to reduce biases and resources involved in data handling.

METHODS

Two versions of Twenty-Four Hour Recall (24HR) (traditional [24HR Ver-01] and digital [24HR Ver-02]) were tested for data agreement and feasibility by gathering cross sectional paired data on both the versions from 102 participants (18-25 years age). The web based 24HR was setup using the system of Intake24 (New Castle University) with incorporation of South Asian food data base for beverages.

RESULTS

The data sets obtained from 24HR Ver-01 and 24HR Ver-02 on beverage consumption (food items as well as portion sizes) were compared for agreement. The highest percentage of agreement of food item reporting between 24HR Ver-01 and 24HR Ver-01 was during the lunch time. The average kappa value (κ =0.375833) for all the meals indicated a fair agreement betweenVer-01 and 24HR Ver-02 The correlation of portion sizes reported using 24HR Ver-01 and 24 HR Ver-02 was statisticallysignificant for morning snack, lunch and dinner (r = 0.465; r = 0.324; r = 0.407 respectively). According to Bland Altman plot, least agreement between the two versions was found in the portion sizes reported for morning snacks. Data collectors found 24 HR Ver-02 easier in terms of data processing but it was regarded time taking and less convenient by the participants.

CONCLUSION

The Intake 24 (digital version of 24HR) can be a preferred tool of data collection as the data collected through it may reach fairly good levels of accuracy. Future directions for research like conducting a follow up study with cross over design, expanding the study using food items other than beverages, and testing the digital dietary assessment tool against an objective gold standard of dietary intake can be helpful in reaching more conclusive evidence.

The Influence of Increased Dairy Product Consumption, as Part of a Lifestyle Modification Intervention, on Diet Quality and Eating Patterns in Female Adolescents with Overweight/Obesity

Our study examined how increased dairy consumption versus habitually low dairy consumption, against a background of healthy eating (and exercise), influenced diet quality, nutrient intake, and snacking in Canadian female adolescents (14.8 ± 2.2 years) with overweight/obesity (OW/OB). We also explored dairy consumption patterns in the group consuming dairy products. Participants were randomized into two groups: higher/recommended dairy (RDa; 4 svg/d; n = 24) or low dairy (LDa; 0−2 svg/d; n = 23). Both groups participated in a 12-week, eucaloric, lifestyle modification intervention consisting of exercise training and nutritional counseling. The intervention increased the total Canadian Healthy Eating Index score (p < 0.001) with no differences between groups. The “other food” sub-score improved more in RDa than LDa (p = 0.02), and the “saturated fat” sub-score increased more in LDa than RDa (p = 0.02). The intervention significantly increased the consumption of dairy-related nutrients more in RDa than LDa (p < 0.05). The intervention also decreased snack size in both groups (p = 0.01) and improved percentage of healthy snack energy intake more in RDa than LDa (p = 0.04). More servings of dairy products were consumed as snacks than at breakfast, lunch, or dinner (p < 0.05). Thus, our study improved diet quality, and dairy product consumption improved intakes of key related nutrients and snack consumption in adolescents with OW/OB.

Poor quality of dietary assessment in randomized controlled trials of nutritional interventions for type 2 diabetes may affect outcome conclusions: A systematic review and meta-analysis

OBJECTIVES

The aim of this study was to evaluate the quality of dietary assessment methods in randomized controlled trials focusing on individuals with type 2 diabetes (T2DM), and its impact on the favorability of conclusions.

METHODS

MEDLINE, EMBASE, CINAHL, and CENTRAL were searched, from inception until September 2019 for RCTs of dietary interventions in individuals with T2DM. Investigators assessed risk of bias and quality of the dietary measurements using the Cochrane Risk of Bias Assessment Tool 2.0 and the redeveloped EURICA tool, respectively. Random-effects meta-analysis assessed mean changes in hemoglobin (Hb)A1c. The study was conducted in accordance with the Preferred Reporting in Systematic Reviews and Meta-analyses. PROSPERO registration number: CRD42019146471.

RESULTS

Of 2552 records retrieved, 23 studies met the inclusion criteria. Two studies were rated as good, 6 as medium, and 15 as poor in the quality assessment of the dietary measurement tool. All eight studies with higher quality of dietary assessment were associated with favorable conclusions. Among the 15 studies with poor quality, 5 failed to draw favorable conclusions. Among studies that sought to produce a reduction in HbA1c, 3 of 6 with better dietary assessment quality produced a significant difference of -0.38% (-0.67% to -0.08%), and 4 of 12 of poorer quality produced a significant difference of -0.26% (-0.37% to -0.14%).

CONCLUSIONS

The poor quality of dietary assessment in clinical trials casts uncertainty on the dietary outcomes and the validity of possible causal mechanisms. Attention to the accuracy and reliability of dietary assessment methods is indicated.

Differences in Population-Based Dietary Intake Estimates Obtained From an Interviewer-Administered and a Self-Administered Web-Based 24-h Recall

Web-based instruments are being increasingly used in nutrition epidemiology and surveillance. However, the extent to which dietary intake estimates derived from web-based 24-h recalls such as the R24W are consistent with data derived from more traditional interviewer-administered 24-h recalls (TRAD) remains uncertain. Our objective was to compare dietary intake estimates obtained using the R24W and a TRAD instrument in population-based samples from the province of Québec in Canada. This comparison of dietary assessment methods was based on data from two sample survey studies in adults (18–65 years). The R24W was used in a sample of 1,147 French-speaking adults from five regions of Québec as part of the PREDISE (PRÉDicteurs Individuels, Sociaux et Environnementaux) study. The TRAD was used in a sample of 875 French-speaking adults from the Canadian Community Health Survey 2015 located in the same five regions. Characteristics of both samples were matched through selection and weighting (language, sex, age, region, education, body mass index, weekend day, and season of survey). Mean and usual intake data of each sample were compared. The plausibility of reported energy intakes was compared using predictive equations of the Institute of Medicine. Mean servings/day from the R24W were higher than with TRAD for vegetables and fruit (+11%, P = 0.003), grain products (+7%, P = 0.06), milk and alternatives (+21%, P < 0.001), and meat and alternatives (+18%, P = 0.001). Intake of low nutritive value foods was also 28% higher with the R24W than with TRAD (mean difference +164 kcal; 95% CI, 107–222). As a result, total energy intakes from the R24W compared with TRAD were 18% higher in women (mean difference +325 kcal; 95% CI, 243–407) and 15% higher in men (mean difference +361 kcal; 95% CI 232–490). The prevalence of underreporting of energy intakes was 10% lower with the R24W than with TRAD (prevalence ratio 0.90; 95% CI, 0.86–0.94). In conclusion, differences between dietary assessment methods in the context of population-based surveys on nutrition have potentially important consequences on the quality of the data and should be carefully considered in future surveys and surveillance strategies.

Technology in Health: Brazilian version of the GloboDiet program for dietary intake assessment in epidemiological studies

The 24-hour recall (R24h) has been the method for dietary assessment in surveys. Technological advances have allowed the development of a program for the collection of R24h data. International Agency for Research on Cancer-World Health Organization (IARC-WHO) developed a standardized interview and computer-based 24-hour dietary recall program called GloboDiet, aimed at using it in research and nutrition surveillance. Brazil was included in a project for the global expansion of this methodology for developing and adapting a version for national use. The adaptation followed the procedures established by the IARC-WHO that considered the translation and adaptation of approximately 70 databases. For the development of the food list, national databases of food consumption from national surveys were consulted obtaining a final list of 2113 foods and recipes. GloboDiet program guides an interview in five steps: general information of the participant; quick list of foods and recipes; details of food / recipes and quantities consumed using mainly a picture book; control of the amount of food and nutrients; and information on dietary supplements. The Brazilian version of the GloboDiet program will provide a more accurate assessment of food intake based on a standardized method for nutrition surveillance and investigation of the relationship between diet and health outcomes, as well as comparisons of dietary intakes within and between countries.

Consumption of low nutritive value foods and cardiometabolic risk factors among French-speaking adults from Quebec, Canada: the PREDISE study

BACKGROUND

There is very limited knowledge on the magnitude to which foods with low nutritive value constitute the diet of adults from the province of Quebec. The extent to which these foods impact cardiometabolic risk is also poorly documented. The objective was to assess the contribution of low nutritive value foods to total energy intake (E) and to examine associations with cardiometabolic risk factors among French-speaking adults from 5 administrative regions of the Province of Quebec.

METHODS

As part of the cross-sectional PREDISE Study, 1147 adults (50.2% women; mean [SD] age, 43.2 [4.6] years) participated in a web-based investigation. Dietary intake data were obtained using a validated web-based self-administered 24-h recall, the R24W, completed on three occasions. Foods with low nutritive value were defined as foods exceeding predetermined thresholds for the following nutrients: saturated fat, sugar or sodium as well as beverages and ingredients not recommended in Canada's Food Guide 2019. A total of 1019 participants underwent on-site clinical assessment of cardiometabolic risk factors.

RESULTS

Participants consumed on average 29.0%E (95%CI, 28.2-29.7) as low nutritive value foods, to which pastries (18%), alcohol (15%), sweets (13%), chips/popcorn (6%) and sugar-sweetened beverages (6%) contributed the most. Low nutritive value foods contributed more to total E in men than in women (30.7%E vs. 27.5%E, respectively; P < 0.0001). In fully-adjusted linear regression models, increments of 250 kcal/d from low nutritive value foods were associated with higher body mass index (+ 1.7 kg/m2; 95%CI 1.2 to 2.2), higher waist circumference (+ 0.6 cm; 95%CI, 0.1 to 1.1), cholesterol: HDL cholesterol ratio (+ 0.12 mmol/L; 95%CI, 0.01 to 0.24 and triglycerides (+ 7.8%; 95%CI, 3.0 to 12.8).

CONCLUSIONS

Low nutritive value foods contribute near 30% of total daily energy intake of French-speaking adults of the Province of Quebec and are associated with increased waist circumference and an unfavourable lipid profile. Addressing consumption of low nutritive value foods at the population level is a potential strategy to attenuate the burden of chronic diseases.

Pediatric-Adapted Liking Survey (PALS): A Diet and Activity Screener in Pediatric Care

Clinical settings need rapid yet useful methods to screen for diet and activity behaviors for brief interventions and to guide obesity prevention efforts. In an urban pediatric emergency department, these behaviors were screened in children and parents with the 33-item Pediatric-Adapted Liking Survey (PALS) to assess the reliability and validity of a Healthy Behavior Index (HBI) generated from the PALS responses. The PALS was completed by 925 children (average age = 11 ± 4 years, 55% publicly insured, 37% overweight/obese by Body Mass Index Percentile, BMI-P) and 925 parents. Child–parent dyads differed most in liking of vegetables, sweets, sweet drinks, and screen time. Across the sample, child and parent HBIs were variable, normally distributed with adequate internal reliability and construct validity, revealing two dimensions (less healthy—sweet drinks, sweets, sedentary behaviors; healthy—vegetables, fruits, proteins). The HBI showed criterion validity, detecting healthier indexes in parents vs. children, females vs. males, privately- vs. publicly-health insured, and residence in higher- vs. lower-income communities. Parent’s HBI explained some variability in child BMI percentile. Greater liking of sweets/carbohydrates partially mediated the association between low family income and higher BMI percentile. These findings support the utility of PALS as a dietary behavior and activity screener for children and their parents in a clinical setting.

School-Age Children Can Recall Some Foods and Beverages Consumed the Prior Day Using the Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24) without Assistance

BACKGROUND

Technological innovations allow for collection of 24-h recalls (24HRs) in a broader range of studies than previously possible. The web-based Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24) has been shown to be feasible and to perform well in capturing true intake among adults. However, data to inform use with children are limited.

OBJECTIVE

This observational feeding study was conducted to evaluate children's ability to accurately report a lunchtime meal using ASA24 without assistance.

METHODS

The study was conducted among children (n = 100) aged 10-13 y within a school setting. Students were served an individual cheese pizza, baby carrots, ranch dip, yogurt, a cookie, and 1 choice of water, juice, or milk. Plate waste was collected and weighed. The next day, participants completed ASA24 and a sociodemographic questionnaire. Descriptive statistics were generated to determine match rates by food item and age, and linear regression analyses were conducted to examine associations between sociodemographic characteristics and accuracy of reported energy and nutrient intake. Associations between true and reported energy and nutrient intakes and portion sizes were assessed with use of t tests.

RESULTS

Just under half (49%) of children fully completed ASA24 (median time, 41 min). Children reported an exact, close, or far match for 58% of all foods and beverages consumed, ranging from 29% for dip to 76% for pizza, but also reported some items not consumed as part of the study meal. Older children completed the recall in a shorter time than younger children (mean 31 among 13 y compared with 52 min among 10 y). Intakes of energy (39%), protein (33%), and sodium (78%) were significantly overestimated, whereas portion sizes for cookies (53%) and juice (69%) were underestimated.

CONCLUSIONS

Children can report some foods and drinks consumed using ASA24, but our findings suggest challenges with independent completion, necessitating research to examine strategies, such as training and resources, to support data quality.

Examining the Advantages of Using Multiple Web-Based Dietary Assessment Instruments to Measure Population Dietary Intake: The PREDISE Study

BACKGROUND

Combining traditional dietary assessment instruments has been suggested to improve precision of dietary intake estimates. However, this has not been investigated using web-based 24-h recall (R24W) or a web-based food-frequency questionnaire (wFFQ).

OBJECTIVE

The aim of this study was to compare different combinations of web-based instruments to assess population-level dietary intake estimates (means and percentiles) and their precision, either with or without statistical modeling of within-person day-to-day variations.

METHODS

As part of the cross-sectional PREDISE study, 1025 French-speaking adults completed 3 randomly allocated R24W and 1 wFFQ within 21 d. Crude estimates of intake were generated from either 1 or 3 repeated R24W. The National Cancer Institute (NCI) method was used to account for within-person variation. Usual intakes were modeled from 1 R24W repeated in a subsample (40%) and from 3 R24W, with or without consideration of data from the wFFQ.

RESULTS

Using crude data from 3 R24W increased precision of estimates and modified distribution of intakes compared with using data from only 1 R24W. Using NCI-modeled data from 3 repeated R24W had no impact on the precision around mean intakes but increased precision of low and high percentiles intake estimates compared with NCI-modeled data from a partially repeated R24W. Considering data from a wFFQ in combination with data derived from 3 R24W did not influence the precision of intake estimates of most foods and nutrients.

CONCLUSIONS

The data suggest that relying on repeated measures of food and nutrient intake through R24W is preferable to single assessment when within-person variation is not considered. Data also suggest that when NCI modeling is applied, using 3 R24W only improves the precision of low and high percentiles intake estimates compared with using a partially repeated web-based recall.

Behavioral, contextual and biological factors associated with obesity during adolescence: A systematic review

INTRODUCTION/OBJECTIVE

Adolescence is a critical period for the development of obesity. Obesity arises from a complex interaction between several factors, which are not yet fully understood. Therefore, the purpose of this review was to identify and assess the peer-reviewed scientific literature on the behavioral, contextual and biological factors associated with obesity in adolescents.

METHODS

PubMed and Scopus were systematically searched to identify prospective cohort studies concerning the relation between behavioral, contextual and biological factors and obesity in adolescents aged 10 to 18 years.

RESULTS

40 studies published between the year 2000 and 2018 were included. A positive consistent association between genetic factors and obesity during adolescence was found. Also, there is evidence to support the association between socioeconomic status and obesity. There was conflicting evidence for the contribution of dietary intake, physical activity, sedentary behavior, sleep, food store environment, school food environment. For the remaining factors no associations were found, or no conclusions could be drawn due to the limited number of studies identified.

CONCLUSIONS

Further prospective studies that assess multiple obesity determinants simultaneously and use state-of-art measures are warranted to aid in the development of effective strategies and interventions to prevent obesity during adolescence.

Comparing Interviewer-Administered and Web-Based Food Frequency Questionnaires to Predict Energy Requirements in Adults

Traditional food frequency questionnaires (FFQs) are influenced by systematic error, but web-based FFQ (WEB-FFQs) may mitigate this source of error. The objective of this study was to compare the accuracy of interview-based and web-based FFQs to assess energy requirements (mERs). The mER was measured in a series of controlled feeding trials in which participants daily received all foods and caloric drinks to maintain stable body weight over 4 to 6 weeks. FFQs assessing dietary intakes and hence mean energy intake were either interviewer-administered by a registered dietitian (IA-FFQ, n = 127; control method) or self-administered using a web-based platform (WEB-FFQ, n = 200; test method), on a single occasion. Comparison between self-reported energy intake and mER revealed significant under-reporting with the IA-FFQ (-9.5%; 95% CI, -12.7 to -6.1) and with the WEB-FFQ (-11.0%; 95% CI, -15.4 to -6.4), but to a similar extent between FFQs (p = 0.62). However, a greater proportion of individuals were considered as accurate reporters of energy intake using the IA-FFQ compared with the WEB-FFQ (67.7% vs. 48.0%, respectively), while the prevalence of over-reporting was lower with the IA-FFQ than with the WEB-FFQ (6.3% vs. 17.5%, respectively). These results suggest less accurate prediction of true energy intake by a self-administered WEB-FFQ than with an IA-FFQ.

Genetic and Common Environmental Contributions to Familial Resemblances in Plasma Carotenoid Concentrations in Healthy Families

Carotenoids have shown an interindividual variability that may be due to genetic factors. The only study that has reported heritability of serum α- and β-carotene has not considered the environmental component. This study aimed to estimate the contribution of both genetic and common environmental effects to the variance of carotenoid concentrations and to test whether their phenotypic correlations with cardiometabolic risk factors are explained by shared genetic and environmental effects. Plasma carotenoid concentrations (α-carotene, β-carotene, β-cryptoxanthin, lutein, lycopene, zeaxanthin, and total carotenoids) of 48 healthy subjects were measured. Heritability estimates of carotenoid concentrations were calculated using the variance component method. Lutein and lycopene showed a significant familial effect (p = 6 × 10^-6 and 0.0043, respectively). Maximal heritability, genetic heritability, and common environmental effect were computed for lutein (88.3%, 43.8%, and 44.5%, respectively) and lycopene (45.2%, 0%, and 45.2%, respectively). Significant phenotypic correlations between carotenoid concentrations and cardiometabolic risk factors were obtained for β-cryptoxanthin, lycopene, and zeaxanthin. Familial resemblances in lycopene concentrations were mainly attributable to common environmental effects, while for lutein concentrations they were attributable to genetic and common environmental effects. Common genetic and environmental factors may influence carotenoids and cardiometabolic risk factors, but further studies are needed to better understand the potential impact on disease development.

The validity of dietary assessment methods to accurately measure energy intake in children and adolescents who are overweight or obese: a systematic review

The accurate assessment of energy intake in children and adolescents is an important outcome measure for clinical and population-based research. This systematic review aimed to determine the validity of dietary assessment methods to measure energy intake in children and adolescents who are classified as overweight or obese by comparison with doubly labelled water. Five electronic databases were searched using keywords. Of the 5263 papers identified, seven papers describing six studies met the inclusion criteria. Studies were included in the review if participants were classified as overweight or obese, aged 0-18 years old, if they estimated energy intake via a dietary assessment method and if they compared this to total energy expenditure measured via the doubly labelled water method. All studies were cross-sectional in nature, and each used one dietary assessment method, including 14-day-food record (FR; n = 1), 24 h dietary recall (n = 1), 8-day FR (n = 1), 9-day FR (n = 1), 3-day FR (n = 1) and diet history interview (n = 1). Sample sizes ranged from 9 to 59 participants, with the majority of studies including less than 30 participants (n = 4). Mis-reporting was evident in all of the studies, with under-reporting (n = 5) more frequent than over-reporting (n = 1). Findings from this review suggest that a 24-h dietary recall and diet history interview were the most accurate methods at the group level for children aged 4-14 years, where the parent or combined child and parent were the reporters.

Feasibility of Assessing Diet with a Mobile Food Record for Adolescents and Young Adults with Down Syndrome

Technology-based methods for assessing diet in those with disability remains largely unexplored. The aim was to assess the feasibility of assessing diet with an image-based mobile food record application (mFR) in 51 adolescents and young adults with Down syndrome (PANDs). Adherence was also assessed with the instruction to include a fiducial marker object in the before and after eating images. The PANDs sample completed a four-day mFR and results were compared with a sample of young adults from the Connecting Health and Technology study (CHAT, n = 244). Compared to the CHAT sample, PANDs participants reported more fruit (2.2 ± 1.8 versus 1.0 ± 0.9 serves respectively) and vegetables (2.4 ± 1.3 versus 1.9 ± 1.0 serves, respectively), but no differences in energy-dense nutrient-poor (EDNP) foods and beverages were observed. Compared to CHAT, PANDs participants captured fewer images with the mFR (4.9 ± 2.3 versus 4.0 ± 1.5 images, respectively). Adherence to the instruction to include the fiducial marker in images was lower for PANDs compared with the CHAT sample (90.3% versus 96.5%). Due to the quality of information captured in images and the high acceptability of the fiducial marker, the mFR shows great promise as a feasible method of assessing diet in adolescents and young adults with Down syndrome.

Self-Report Dietary Assessment Tools Used in Canadian Research: A Scoping Review

Choosing the most appropriate dietary assessment tool for a study can be a challenge. Through a scoping review, we characterized self-report tools used to assess diet in Canada to identify patterns in tool use and to inform strategies to strengthen nutrition research. The research databases Medline, PubMed, PsycINFO, and CINAHL were used to identify Canadian studies published from 2009 to 2014 that included a self-report assessment of dietary intake. The search elicited 2358 records that were screened to identify those that reported on self-report dietary intake among nonclinical, non-Aboriginal adult populations. A pool of 189 articles (reflecting 92 studies) was examined in-depth to assess the dietary assessment tools used. Food-frequency questionnaires (FFQs) and screeners were used in 64% of studies, whereas food records and 24-h recalls were used in 18% and 14% of studies, respectively. Three studies (3%) used a single question to assess diet, and for 3 studies the tool used was not clear. A variety of distinct FFQs and screeners, including those developed and/or adapted for use in Canada and those developed elsewhere, were used. Some tools were reported to have been evaluated previously in terms of validity or reliability, but details of psychometric testing were often lacking. Energy and fat were the most commonly studied, reported by 42% and 39% of studies, respectively. For ∼20% of studies, dietary data were used to assess dietary quality or patterns, whereas close to half assessed ≤5 dietary components. A variety of dietary assessment tools are used in Canadian research. Strategies to improve the application of current evidence on best practices in dietary assessment have the potential to support a stronger and more cohesive literature on diet and health. Such strategies could benefit from national and global collaboration.