Tablet‐based dietary assessment of nutritional intake for rural women with HIV/AIDS living in Andhra Pradesh, India
Authors: Carpenter Catherine L , Nyamathi Adeline , Kapur Kavita , Hariharan Sriram , Padma RK , Ekstrand Maria , Sinha Sanjeev , Sinha Rashmi 
Published: November 2023

Background and ObjectivesAccurate measurement of dietary intake is essential to characterizing nutrition and disease associations. The considerable international variation in disease incidence and dietary practice necessitate assessment tools that measure indigenous foods and cooking practices within individual countries, especially those who sizably differ from other countries. The foods and cooking practices of India are sufficiently distinct from other countries and yet within India there is sizeable variation in food and nutrients according to geographic region. We are currently conducting a cluster randomized nutrition intervention trial among rural women living with HIV/AIDS (WLH/A) and their children who reside in Andhra Pradesh, India. We extended the NINA‐DISH (New Interactive Nutrition Assistant – Diet in India Study of Health), a laptop based dietary assessment tool, to operate on an Android® tablet‐based format, in order to measure the baseline diets of our study participants, and to assess for dietary compensation. The NINA‐DISH, previously designed to measure foods in other regions of India, (New Delhi, Mumbai, Kerala and Trivandrum), was further modified by introducing unique foods found in Andhra Pradesh. The present study is a validation of the NINA‐DISH.MethodsWe interviewed a small pilot sample of participants (n=16) from a previous nutritional intervention study who provided us with all foods consumed over a three day period. The foods were checked against the pre‐existing database of Indian foods already available in the NINA‐DISH. Foods unique to the study site in Andhra Pradesh were incorporated into the NINA‐DISH. During the baseline phase of our intervention trial, we conducted a simultaneous validation among 22 participants by collecting three day food records using a paper and pencil assessment and the NINA‐DISH. Data from the NINA‐DISH was uploaded into a cloud server located at the University of California, Los Angeles. Paper and pencil assessment data were entered into Microsoft EXCEL®. Both datasets were read into SAS 9.4®. Food items were match‐merged to the nutrient database associated with the NINA‐DISH. Intra‐class correlations and agreement plots were generated to assess agreement.ResultsIntra‐class correlation coefficients (ICC) ranged from 67% for total carbohydrates to 96% for calcium. Total calories had an ICC of 92%. Bland‐Altman plots of log of total calories showed that almost all points fell within the 95% confidence interval. Logarithmic plots of other nutrients showed a similar pattern.Summary and ConclusionWe broadened the NINA‐Dish dietary assessment to include measurement of foods consumed by WLH/A in Andhra Pradesh, India, modified the software to operate on a tablet, and validated the NINA‐DISH against a paper‐and‐pencil dietary assessment. We demonstrated the NINA‐DISH to be a valid tool for measuring food indigenous to Andhra Pradesh, India.Support or Funding InformationMH098728‐01A1