A review of the design and validation of web- and computer-based 24-h dietary recall tools

Technology-based dietary assessment offers solutions to many of the limitations of traditional dietary assessment methodologies including cost, participation rates and the accuracy of data collected. The 24-h dietary recall (24HDR) method is currently the most utilised method for the collection of dietary intake data at a national level. Recently there have been many developments using web-based platforms to collect food intake data using the principles of the 24HDR method. This review identifies web- and computer-based 24HDR tools that have been developed for both children and adult population groups, and examines common design features and the methods used to investigate the performance and validity of these tools. Overall, there is generally good to strong agreement between web-based 24HDR and respective reference measures for intakes of macro- and micronutrients.

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title: Assessment of Nutrient Intakes: Introduction to the Special Issue
abstract: Accurately measuring consumption of food, drinks and supplements is fundamental to nutrition and health research, including surveillance, epidemiology and intervention studies. However, assessing food intake is an area that is fraught with challenges .[...]

title: Promising approaches of computer-supported dietary assessment and management - Current research status and available applications
abstract: The aim of this review was to analyze computer-based tools for dietary management (including web-based and mobile devices) from both scientific and applied perspectives, presenting advantages and disadvantages as well as the state of validation.



For this cross-sectional analysis, scientific results from 41 articles retrieved via a medline search as well as 29 applications from online markets were identified and analyzed.



Results show that many approaches computerize well-established existing nutritional concepts for dietary assessment, e.g., food frequency questionnaires (FFQ) or dietary recalls (DR). Both food records and barcode scanning are less prominent in research but are frequently offered by commercial applications. Integration with a personal health record (PHR) or a health care workflow is suggested in the literature but is rarely found in mobile applications.



It is expected that employing food records for dietary assessment in research settings will be increasingly used when simpler interfaces, e.g., barcode scanning techniques, and comprehensive food databases are applied, which can also support user adherence to dietary interventions and follow-up phases of nutritional studies.

title: Evidence-based development of a mobile telephone food record.
abstract: Mobile telephones with an integrated camera can provide a unique mechanism for collecting dietary information that reduces burden on record-keepers. Objectives for this study were to test whether participant's proficiency with the mobile telephone food record improved after training and repeated use and to measure changes in perceptions regarding use of the mobile telephone food record after training and repeated use. Seventy-eight adolescents (26 males, 52 females) ages 11 to 18 years were recruited to use the mobile telephone food record for one or two meals. Proficiency with the mobile telephone food record was defined as capturing a useful image for image analysis and self-reported ease of use. Positive changes in perceptions regarding use of the mobile telephone food record were assumed to equate to potentially improved proficiency with the mobile telephone food record. Participants received instruction for using the mobile telephone food record prior to their first meal, and captured an image of their meals before and after eating. Following the first meal, participants took part in an interactive session where they received additional training on capturing images in various snacking situations and responded to questions about user preferences. Changes in the participants' abilities to capture useful images and perceptions about the usability of the mobile telephone food record were examined using McNemar, Wilcoxon rank-sum test, and paired t test. After using the mobile telephone food record, the majority of participants (79%) agreed that the software was easy to use. Eleven percent of participants agreed taking images before snacking would be easy. After additional training, the percent increased significantly to 32% (P<0.0001). For taking images after snacking, there was also improvement (21% before training and 43% after; P<0.0001). Adolescents readily adopt new technologies; however, the mobile telephone food record design needs to accommodate the lifestyles of its users to ensure useful images and continuous use. Further, these results suggest that additional training in using a new technology may improve the accuracy among users.

title: Validity and reliability of a dietary assessment method: the application of a digital camera with a mobile phone card attachment.
abstract: This study was aimed at evaluation of the validity and reliability of an alternative dietary measurement method that assists epidemiologic studies. We validated a handheld personal digital assistant with camera and mobile phone card, called Wellnavi, in which a 1-d weighed diet record was employed as a reference method. Twenty college students majoring in food and nutrition participated in this study. They were asked to keep a diet record and to take digital photos of all these recorded food at the same time, then send them to the dietitians by the mobile phone card. In the reliability study, other twenty students from the same college were asked to take digital photos of the same meal during a day by two same instruments under the same circumstances and to send these photos to the different dietitians electronically. With respect to validity, median nutrient intakes estimated by the Wellnavi method and the diet record method are comparable. Correlation coefficients between the median nutrient intakes estimated from these two methods ranged from 0.46 for monounsaturated fatty acid to 0.93 for vitamin B12 and copper (median r = 0.77). With respect to reliability, our data show a good agreement between two Wellnavi instruments for most of the nutrients. Correlation coefficients between the nutrient intakes estimated from 2 instruments ranged from 0.55 for vitamin B1 and water-insoluble dietary fiber to 0.92 for vitamin B12 (median r = 0.78). In conclusion, the results indicate this dietary assessment instrument can usefully measure individual dietary intakes for a variety of nutrients in an epidemiologic study.

title: Formative evaluation of the dietary assessment component of Children's and Adolescents' Nutrition Assessment and Advice on the Web (CANAA-W).
abstract: The increased availability of computers and the efficiency and user-acceptability of computer-assisted questioning have increased the attractiveness of computer-administered querying for large-scale population nutrition research during the last decade. The Young Adolescents' Nutrition Assessment on Computer (YANA-C), a computer-based 24-h dietary recall, was originally developed to collect dietary data among Belgian-Flemish adolescents. A web-based version was created to collect parentally reported dietary data of preschoolers, called Young Children's Nutrition Assessment on the Web (YCNA-W), which has been improved and adapted for use in young adolescents: Children and Adolescents' Nutrition Assessment and Advice on the Web (CANAA-W). The present study describes recent developments and the formative evaluation of the dietary assessment component.



A feasibility questionnaire was completed by 131 children [mean (SD) age: 11.3 (0.7) years] and 53 parents. Eight focus groups were held with children (n = 65) and three with parents (n = 17).



Children (C) and parents (P) found the instrument clear (C: 97%; P: 94%), comprehensible (C: 92%; P: 100%), attractive (C: 84%; P: 85%), fun (C: 93%; P: 83%) and easy to complete (C: 91%; P: 83%). There was ample explanation (C: 95%; P: 94%); the pictures were clear (C: 97%; P: 96%); and most respondents found the food items easy to find (C: 71%, P: 85%). The results helped to refine the lay out and structure of the instrument and the list of food items included.



Children and parents were enthusiastic. The major challenge will be to convince parents who are less interested in dietary intake and less computer literate to participate in this type of study. Children in this age group (11-12 years) should complete the instrument with assistance from an adult.

title: eButton: A wearable computer for health monitoring and personal assistance
abstract: Recent advances in mobile devices have made profound changes in people's daily lives. In particular, the impact of easy access of information by the smartphone has been tremendous. However, the impact of mobile devices on healthcare has been limited. Diagnosis and treatment of diseases are still initiated by occurrences of symptoms, and technologies and devices that emphasize on disease prevention and early detection outside hospitals are under-developed. Besides healthcare, mobile devices have not yet been designed to fully benefit people with special needs, such as the elderly and those suffering from certain disabilities, such blindness. In this paper, an overview of our research on a new wearable computer called eButton is presented. The concepts of its design and electronic implementation are described. Several applications of the eButton are described, including evaluating diet and physical activity, studying sedentary behavior, assisting the blind and visually impaired people, and monitoring older adults suffering from dementia.

title: Comparison of Known Food Weights with Image-Based Portion-Size Automated Estimation and Adolescents' Self-Reported Portion Size
abstract: Diet is a critical element of diabetes self-management. An emerging area of research is the use of images for dietary records using mobile telephones with embedded cameras. These tools are being designed to reduce user burden and to improve accuracy of portion-size estimation through automation. The objectives of this study were to (1) assess the error of automatically determined portion weights compared to known portion weights of foods and (2) to compare the error between automation and human.  Adolescents (n = 15) captured images of their eating occasions over a 24 h period. All foods and beverages served were weighed. Adolescents self-reported portion sizes for one meal. Image analysis was used to estimate portion weights. Data analysis compared known weights, automated weights, and self-reported portions.  For the 19 foods, the mean ratio of automated weight estimate to known weight ranged from 0.89 to 4.61, and 9 foods were within 0.80 to 1.20. The largest error was for lettuce and the most accurate was strawberry jam. The children were fairly accurate with portion estimates for two foods (sausage links, toast) using one type of estimation aid and two foods (sausage links, scrambled eggs) using another aid. The automated method was fairly accurate for two foods (sausage links, jam); however, the 95% confidence intervals for the automated estimates were consistently narrower than human estimates.  The ability of humans to estimate portion sizes of foods remains a problem and a perceived burden. Errors in automated portion-size estimation can be systematically addressed while minimizing the burden on people. Future applications that take over the burden of these processes may translate to better diabetes self-management.

title: Review and evaluation of innovative technologies for measuring diet in nutritional epidemiology.
abstract: The use of innovative technologies is deemed to improve dietary assessment in various research settings. However, their relative merits in nutritional epidemiological studies, which require accurate quantitative estimates of the usual intake at individual level, still need to be evaluated.



To report on the inventory of available innovative technologies for dietary assessment and to critically evaluate their strengths and weaknesses as compared with the conventional methodologies (i.e. Food Frequency Questionnaires, food records, 24-hour dietary recalls) used in epidemiological studies.



A list of currently available technologies was identified from English-language journals, using PubMed and Web of Science. The search criteria were principally based on the date of publication (between 1995 and 2011) and pre-defined search keywords.



Six main groups of innovative technologies were identified ('Personal Digital Assistant-', 'Mobile-phone-', 'Interactive computer-', 'Web-', 'Camera- and tape-recorder-' and 'Scan- and sensor-based' technologies). Compared with the conventional food records, Personal Digital Assistant and mobile phone devices seem to improve the recording through the possibility for 'real-time' recording at eating events, but their validity to estimate individual dietary intakes was low to moderate. In 24-hour dietary recalls, there is still limited knowledge regarding the accuracy of fully automated approaches; and methodological problems, such as the inaccuracy in self-reported portion sizes might be more critical than in interview-based applications. In contrast, measurement errors in innovative web-based and in conventional paper-based Food Frequency Questionnaires are most likely similar, suggesting that the underlying methodology is unchanged by the technology.



Most of the new technologies in dietary assessment were seen to have overlapping methodological features with the conventional methods predominantly used for nutritional epidemiology. Their main potential to enhance dietary assessment is through more cost- and time-effective, less laborious ways of data collection and higher subject acceptance, though their integration in epidemiological studies would need additional considerations, such as the study objectives, the target population and the financial resources available. However, even in innovative technologies, the inherent individual bias related to self-reported dietary intake will not be resolved. More research is therefore crucial to investigate the validity of innovative dietary assessment technologies.

title: Validity and reproducibility of a web-based, self-administered food frequency questionnaire
abstract: To assess the validity and the reproducibility of a newly developed web-based, self-administered food frequency questionnaire (web-FFQ).SubjectsA total of 74 healthy subjects (34 men and 40 women) from the Québec City metropolitan area were asked to complete, in random order, the web-FFQ, a validated interviewer-administered FFQ (IA-FFQ) and a 3-day food record (3-day FR).Results:Mean intakes of 17/22 nutrients assessed between the web-FFQ and the 3-day FR were not significantly different (differences <10%, P⩾0.11). Sex and energy-adjusted de-attenuated Pearson correlation coefficients for each nutrient varied from 0.12–0.98 (mean R=0.55, 95% confidence interval 0.46; 0.63) between the web-FFQ and the 3-day FR. All correlations were significant (P⩽0.01) and above 0.34 (mean R=0.59, 95% confidence interval 0.54; 0.65) between the web-FFQ and the IA-FFQ, except for sodium (R=0.17, P=0.14). Cross-classification analysis revealed that on average, 77% of subjects were classified in the same or adjacent quartile of nutrient intake between the web-FFQ and the 3-day FR. Correlation coefficients for reproducibility of the web-FFQ tested 4–6 weeks apart in the same individuals were all equal or above 0.48 (P⩽0.0001; mean R=0.72, 95% confidence interval 0.68; 0.76). More than 90% of the subjects were classified in the same or adjacent quartile between the two administrations of the web-FFQ, while only 0.8% was misclassified.These data demonstrate that the newly developed web-based FFQ appears to have reasonable validity and good reproducibility for assessing nutrient intakes at the group and individual levels in a population of healthy adults.

title: Validity and reproducibility of an adolescent web-based food frequency questionnaire.
abstract: To assess the validity and reproducibility of a newly developed, cost-effective, and easy to administer, Web-based food frequency questionnaire (FFQ) for the dietary assessment of adolescents.



Cross-sectional validation of a Web-based FFQ, which contained 15 food groups (water; soft drinks, including fruit juice and diet soft drinks; alcoholic beverages; soup; milk and milk products; fruit; sweet and savory snacks/fillings; sauces and fat spreads; breakfast cereals; bread; cheese, fish/eggs/meat; pasta/rice; vegetables; and potatoes). Reference data for validation were 3-day estimated food records. Analyses were done for all participants and for consumers only (consumer in both Web-based FFQ and food record).



A selected group of adolescents (12 to 18 years of age, n=104) from participating secondary schools in Ghent, Belgium.



For all participants, the measured intakes of water, fruit, breakfast cereals, fish/eggs/meat, pasta/rice, and potatoes were not significantly different between the two methods. The Spearman correlation for all foods was on average 0.38 (ranging from 0.20 for pasta/rice to 0.64 for breakfast cereals). When analyzed for consumers only, the Web-based FFQ showed significantly lower estimates for soft drinks, sweet and savory snacks/fillings, sauces and fat spreads, cheese, pasta/rice, and vegetables. The average Spearman correlation for all foods collectively was 0.30. When reproducibility of the Web-based FFQ was assessed, the average Spearman correlation coefficient for all foods collectively was 0.62.



Most questions on the 15 food groups had acceptable reproducibility, whereas validation only showed reliable intakes for water, fruit, bread, and fish/eggs/meat. This Web-based FFQ could be a start for development of dietary assessment methods in public health nutrition contexts.

title: Evaluation of web-based, self-administered, graphical food frequency questionnaire.
abstract: Computer-administered food frequency questionnaires (FFQs) can address limitations inherent in paper questionnaires by allowing very complex skip patterns, portion size estimation based on food pictures, and real-time error checking. We evaluated a web-based FFQ, the Graphical Food Frequency System (GraFFS). Participants completed the GraFFS, six telephone-administered 24-hour dietary recalls over the next 12 weeks, followed by a second GraFFS. Participants were 40 men and 34 women, aged 18 to 69 years, living in the Columbus, OH, area. Intakes of energy, macronutrients, and 17 micronutrients/food components were estimated from the GraFFS and the mean of all recalls. Bias (second GraFFS minus recalls) was -9%, -5%, +4%, and -4% for energy and percentages of energy from fat, carbohydrate, and protein, respectively. De-attenuated, energy-adjusted correlations (intermethod reliability) between the recalls and the second GraFFS for fat, carbohydrate, protein, and alcohol were 0.82, 0.79, 0.67, and 0.90, respectively; for micronutrients/food components the median was 0.61 and ranged from 0.40 for zinc to 0.92 for beta carotene. The correlations between the two administrations of the GraFFS (test-retest reliability) for fat, carbohydrate, protein, and alcohol were 0.60, 0.63, 0.73, and 0.87, respectively; among micronutrients/food components the median was 0.67 and ranged from 0.49 for vitamin B-12 to 0.82 for fiber. The measurement characteristics of the GraFFS were at least as good as those reported for most paper FFQs, and its high intermethod reliability suggests that further development of computer-administered FFQs is warranted.

title: Comparison between an interactive web-based self-administered 24 h dietary record and an interview by a dietitian for large-scale epidemiological studies
abstract: Online self-administered data collection, by reducing the logistic burden and cost, could advantageously replace classical methods based on dietitian's interviews when assessing dietary intake in large epidemiological studies. Studies comparing such new instruments with traditional methods are necessary. Our objective was to compare one NutriNet-Santé web-based self-administered 24 h dietary record with one 24 h recall carried out by a dietitian. Subjects completed the web-based record, which was followed the next day by a dietitian-conducted 24 h recall by telephone (corresponding to the same day and using the same computerised interface for data entry). The subjects were 147 volunteers aged 48–75 years (women 59·2 %). The study was conducted in February 2009 in France. Agreement was assessed by intraclass correlation coefficients (ICC) for foods and energy-adjusted Pearson's correlations for nutrients. Agreement between the two methods was high, although it may have been overestimated because the two assessments were consecutive to one another. Among consumers only, the median of ICC for foods was 0·8 in men and 0·7 in women (range 0·5–0·9). The median of energy-adjusted Pearson's correlations for nutrients was 0·8 in both sexes (range 0·6–0·9). The mean Pearson correlation was higher in subjects ≤ 60 years (P = 0·02) and in those who declared being ‘experienced/expert’ with computers (P = 0·0003), but no difference was observed according to educational level (P = 0·12). The mean completion time was similar between the two methods (median for both methods: 25 min). The web-based method was preferred by 66·1 % of users. Our web-based dietary assessment, permitting considerable logistic simplification and cost savings, may be highly advantageous for large population-based surveys.

title: Developing an interactive portion size assessment system (IPSAS) for use with children.
abstract: Novel methods of assessing dietary intake are required to reduce the participant burden in dietary surveys, improve participation rates and thereby improve the representativeness of the sample and minimise the impact of measuring dietary intake on a subject's food intake during the recording period. One method of reducing the burden placed on participants in recording dietary intake is to replace weighing of foods with estimation of portion size using tools such as food photographs. The interactive portion size assessment system (IPSAS) is an interactive portion size assessment system for use in assessing portion sizes of foods consumed by children aged 18 months to 16 years. The system is computer-based and is designed to be administered during an interview for a food diary or 24-h recall. The portion sizes depicted are age-specific and based on the weights of foods served to children during the UK National Diet and Nutrition Surveys. The system displays digital images of food used to estimate the amount of each food served to the child and the amount of any food left over. Foods are categorised within the system using a three-tier structure. Twenty-seven food group icons are used with two further drop-down menus to select first the food group, then the food category and, finally, the actual food product. Each food is linked to UK food composition codes and all photographs are linked to the weight of the food depicted. Nutritional output is via a companion database. The present study describes the development of the IPSAS and the structure of the system.

title: The food intake recording software system is valid among fourth-grade children.
abstract: To assess the validity of the Food Intake Recording Software System (FIRSSt) against observation of school lunch and a 24-hour dietary recall (24hDR); and to test the effects of sequencing, observation and a hair sample as a bogus pipeline on accuracy of dietary report.



Six-group design systematically varying sequence of self-report (FIRSSt vs 24hDR), observation of school lunch and hair sample as a bogus pipeline manipulation, with random assignment of participants.



138 fourth-grade students in 2 elementary schools.



Accuracy of reported food consumption was measured in terms of matches, intrusions, and omissions among the FIRSSt, 24hDR, and as observed at school lunch. Students also completed self-report of performance with FIRSSt.



t tests, Pearson correlations, analysis of variance, factor analysis.



When compared with school lunch observation for one meal, FIRSSt attained 46% match, 24% intrusion and 30% omission rates, while a dietitian-conducted 24hDR obtained 59% match, 17% intrusion, and 24% omission rates. FIRSSt attained 60% match, 15% intrusion, and 24% omission rates against 24hDR for all meals in the previous day. There was no evidence of sequence of assessment affecting accuracy indicators, but there was a weak effect of school lunch observation on percent intrusions. Obtaining a hair sample reduced the omission rate for FIRSSt vs 24hDR and increased the match rate for 24hDR vs observation, thereby enhancing this as a bogus pipeline procedure. Children generally enjoyed completing FIRSSt. Hispanic children were more likely to report problems using FIRSSt.



FIRSSt is somewhat less accurate than a dietitian-conducted 24hDR. However, this lower-cost procedure provides a promising method for assessing diet among children. Observation of consumption at school lunch may be reactive and artificially increase agreement. Obtaining a hair sample as a bogus pipeline may be a valuable technique for enhancing the accuracy of dietary assessment among children.

title: The development and evaluation of a novel computer program to assess previous-day dietary and physical activity behaviours in school children: the Synchronised Nutrition and Activity Program (SNAP).
abstract: Self-report recall questionnaires used to measure physical activity and dietary intake in children can be labour intensive and monotonous and tend to focus on either dietary intake or physical activity. The web-based software, Synchronised Nutrition and Activity Program (SNAP), was developed to produce a novel, simple, quick and engaging method of assessing energy balance-related behaviours at a population level, combining principles from new and existing 24 h recall methodologies, set within a user-friendly interface. Dietary intake was measured using counts for twenty-one food groups and physical activity levels were measured in min of moderate to vigorous physical activity (MVPA). A combination of the mean difference between methods, type II regression and non-parametric limits of agreement techniques were used to examine the accuracy and precision of SNAP. Method comparison analyses demonstrated a good agreement for both dietary intake and physical activity behaviours. For dietary variables, accuracy of SNAP (mean difference) was within +/- 1 count for the majority of food groups. The proportion of the sample with between-method agreement within +/- 1 count ranged from 0.40 to 0.99. For min of MVPA, there was no substantial fixed or proportional bias, and a mean difference between methods (SNAP - accelerometry) of -9 min. SNAP provides a quick, accurate, low-burden, cost-effective and engaging method of assessing energy balance behaviours at a population level. Tools such as SNAP, which exploit the popularity, privacy and engagement of the computer interface, and linkages with other datasets, could make a substantial contribution to future public health monitoring and research.

title: Validation of the Portuguese self-administered computerised 24-hour dietary recall among second-, third- and fourth-grade children.
abstract: Current methods for assessing children's dietary intake, such as interviewer-administered 24-h dietary recall (24-h DR), are time consuming and resource intensive. Self-administered instruments offer a low-cost diet assessment method for use with children. The present study assessed the validity of the Portuguese self-administered, computerised, 24-h DR (PAC24) against the observation of school lunch.



Forty-one, 7-10-year-old children from two elementary schools, in Lisbon, were observed during school lunch followed by completion of the PAC24 the next day. Accuracy for reporting items was measured in terms of matches, intrusions and omissions; accuracy for reporting amounts was measured in terms of arithmetic and absolute differences for matches and amounts for omissions and intrusions; and accuracy for reporting items and amounts combined was measured in terms of total inaccuracy. The ratio of the estimated weight of food consumed with the actual weight consumed was calculated along with the limits of agreement using the method of Bland and Altman.



Comparison of PAC24 against observations at the food level resulted in values of 67.0% for matches, 11.5% for intrusions and 21.5% for omissions. The mean for total inaccuracy was 3.44 servings. For amounts, accuracy was high for matches (-0.17 and 0.23 servings for arithmetic and absolute differences, respectively) and lower for omissions (0.61 servings) and intrusions (0.55 servings). PAC24 was found to under-estimate the weight of food on average by 32% of actual intake.



PAC24 is a lower-burden procedure for both respondents and researchers and, with slight modification, comprises a promising method for assessing diet among children.

title: Reliability and validity of Web-SPAN, a web-based method for assessing weight status, diet and physical activity in youth.
abstract: Web-based surveys are becoming increasing popular. The present study aimed to assess the reliability and validity of the Web-Survey of Physical Activity and Nutrition (Web-SPAN) for self-report of height and weight, diet and physical activity by youth.



School children aged 11-15years (grades 7-9; n=459) participated in the school-based research (boys, n=225; girls, n=233; mean age, 12.8years). Students completed Web-SPAN (self-administered) twice and participated in on-site school assessments [height, weight, 3-day food/pedometer record, Physical Activity Questionnaire for Older Children (PAQ-C), shuttle run]. Intraclass (ICC) and Pearson's correlation coefficients and paired samples t-tests were used to assess the test-retest reliability of Web-SPAN and to compare Web-SPAN with the on-site assessments.



Test-retest reliability for height (ICC=0.90), weight (ICC=0.98) and the PAQ-C (ICC=0.79) were highly correlated, whereas correlations for nutrients were not as strong (ICC=0.37-0.64). There were no differences between Web-SPAN times 1 and 2 for height and weight, although there were differences for the PAQ-C and most nutrients. Web-SPAN was strongly correlated with the on-site assessments, including height (ICC=0.88), weight (ICC=0.93) and the PAQ-C (ICC=0.70). Mean differences for height and the PAQ-C were not significant, whereas mean differences for weight were significant resulting in an underestimation of being overweight/obesity prevalence (84% agreement). Correlations for nutrients were in the range 0.24-0.40; mean differences were small but generally significantly different. Correlations were weak between the web-based PAQ-C and 3-day pedometer record (r=0.28) and 20-m shuttle run (r=0.28).



Web-SPAN is a time- and cost-effective method that can be used to assess the diet and physical activity status of youth in large cross-sectional studies and to assess group trends (weight status).

title: Formative research of a quick list for an automated self-administered 24-hour dietary recall.
abstract: Twenty-four-hour dietary recalls are used to collect high-quality dietary data. Because they require highly trained interviewers, recalls are expensive and impractical for large-scale nutrition research, leading to the use of food frequency questionnaires. We are developing a computer-based, self-administered 24-hour dietary recall for use by adults. Our goal is an easy-to-use, low-cost, publicly available, Web-enabled instrument that will include elements of the Automated Multiple Pass Method developed by the US Department of Agriculture, which uses five passes to enhance recall. The initial pass is called the "quick list" and allows respondents to report foods consumed the previous day freely, in any order, and without detail. Using a crossover design, we conducted initial formative pilot testing among 18 adults in a self-administered computer environment. We tested two versions of a "quick list" (the first Automated Multiple Pass Method pass) for remembering foods consumed the previous day: "unstructured" and "meal-based." Respondents showed a strong preference for the meal-based version (13 of 18), although positive features of both were identified. Chronological reporting was most common, although many foods were sporadically reported out of order. Versions did not appreciably differ in number of foods reported, moved, or deleted. Usability issues and preferences were also identified. If these developmental efforts prove successful, the use of affordable automated recalls could be valuable in clarifying diet-disease associations in observational epidemiologic studies and measuring dietary compliance in clinical trials. This pilot work illustrates the usefulness of formative cognitive and usability testing for questionnaire and software development.

title: Eight self-administered 24-hour dietary recalls using the Internet are feasible in African Americans and Whites: the energetics study.
abstract: To support research and to provide food and nutrition practitioners with a strong foundation for nutrient-based counseling, there is a need for affordable automated 24-hour dietary recalls. Multiple days of intake, along with repeated reports over time, are needed to achieve stable indicators of individual intakes and to support evaluation of success in meeting dietary goals because of intraindividual intake variability. Little information has been published on subject responses, participation rates, and the perceived subject burden of repeated 24-hour recalls. Our aim was to determine the willingness of subjects to conduct eight 24-hour recalls via the Internet.



A study to validate a Web-based, automated, self-administered 24-hour recall (DietDay, Centrax Corporation, Chicago, IL).



Two-hundred and sixty-one white and African-American subjects within 50 miles of the University of California-Los Angeles participated in the study. Subjects completed 3 DietDays at the study visits and another 5 days on their own. The last 2 DietDays were completed 1 and 2 months after the final clinic visit. Subjects were notified by automatic e-mail of the need for DietDay completion, and nonresponders were followed up with personalized e-mails and phone calls.



The perceived subject burden was minimal and, even after completing six recalls, 92% were willing to continue reporting their daily diets 1 and 2 months later. White subjects had a slightly higher rate of return, with 94% completing all eight recalls, compared to 91% of African-American subjects. Participants were able to access the Internet in their homes, offices, library, or homes of friends or family. It is also of interest that 82% of subjects believed the 24-hour recall was superior to a diet history in reflecting their normal diet.



These results open up new opportunities for food and nutrition practitioners to strengthen their nutritional counseling in an efficient and affordable manner without additional time investment.

title: The standardized computerized 24-h dietary recall method EPIC-Soft adapted for pan-European dietary monitoring
abstract: The EPIC-Soft program (the software initially developed to conduct 24-h dietary recalls (24-HDRs) in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study) was recommended as the best way to standardize 24-HDRs for future pan-European dietary monitoring. Within European Food Consumption Validation (EFCOVAL), EPIC-Soft was adapted and further developed on various aspects that were required to optimize its use. In this paper, we present the structure and main interview steps of the EPIC-Soft program, after implementation of a series of new specifications deemed to satisfy specific requirements of pan-European monitoring surveys and other international studies.Updates to optimize the EPIC-Soft program were ascertained according to the following stepwise approach: (1) identification of requested specifications to be potentially implemented through an ad hoc ‘EPIC-Soft specifications questionnaire’ sent to past, current and possible future users of the software; (2) evaluation of the specifications in collaboration with two ad hoc task force groups and through a workshop; (3) development of a technical solution for each retained specification; (4) implementation of the specifications by software developers; (5) testing and amendment of bugs.A number of new specifications and facilities were implemented to EPIC-Soft program. In addition, the software underwent a full reprogramming and migration to a modern Windows environment, including changes in its internal architecture and user interface. Although the overall concept and structure of the initial software were not changed substantially, these improvements ease the current and future use of EPIC-Soft and increase further its adaptation to other countries and study contexts.EPIC-Soft is enriched with further functions and facilities expected to fulfil specific needs of pan-European dietary monitoring and risk assessment purposes. The validity, feasibility and relevance of this software for different national and international study designs, and the logistical aspects related to its implementation are reported elsewhere.

title: A novel online Food Recall Checklist for use in an undergraduate student population: a comparison with diet diaries
abstract: BackgroundUniversity students are commonly overlooked when diet of populations is measured and there is a lack of comprehensive dietary assessment in whole university student populations. To measure diet of undergraduate students, a new online 121-item Food Recall Checklist (FoRC) was designed as an alternative to a non-weighed record (food diary). This article reports the comparison between the new dietary assessment method (FoRC) and the food diary as a measure of energy (kJ), fat (g), Non-Starch Polysaccharide (NSP) (g), fruit and vegetables (g), breakfast cereal (g) and bread (g) and alcohol (units) intake.MethodsFifty-three students at the University of Aberdeen completed four days of FoRC then four days food diary. Median agreement and correlation between the two methods was assessed for foods and nutrients using the Spearman's rank correlation co-efficient and the Wilcoxon signed ranks test. Agreement between FoRC and food diary was assessed using the Bland-Altman method.ResultsThe mean time taken to complete FoRC for one day was 7.4 minutes. Intakes of fat (g and % food energy), NSP and bread were similar between FoRC and the food diary. Median energy intake was 8185 kJ in the food diary and 8007 kJ in FoRC. However, FoRC recorded significantly lower intakes of energy and alcohol and significantly higher intakes of fruit and vegetables and breakfast cereal compared with the food diary. There was considerable variation in agreement between methods at the individual level. For all variables except alcohol and percentage energy from fat, correlation co-efficients were statistically significant and greater than 0.5.ConclusionAt the group level, four days of FoRC showed good median agreement with the food diary and there was high correlation between methods for most foods and nutrients. This suggests that this novel method of assessing diet can provide a useful alternative for assessing group mean intakes but that individual intakes may need to be interpreted with care.

title: Development and Evaluation of a Web-based Computer-Assisted Personal Interview System (CAPIS) for Open-ended Dietary Assessments among Koreans
abstract: The accuracy of dietary assessments has emerged as a major concern in nutritional epidemiology and new dietary assessment tools using computer technology to increase accuracy have been developed in many countries. The purpose of this study was to develop a web-based computer-assisted personal interview system (CAPIS) for conducting dietary assessment and to evaluate its practical utilization among Koreans. The client software was developed using Microsoft's ClickOnce technology, which allows communication with a database system via an http server to add or retrieve data. The system consists of a tracking system for the subject and researcher, a data-input system during the interview, a calculation system for estimating food and nutrient intake, a data-output system for presenting the results, and an evaluation system for assessing the adequacy of nutrient and food intake. Databases of the nutrient composition of common food (n = 3,642), recipes for common dishes (n = 1,886), and photos of serving sizes for food and dishes (n = 4,152) were constructed, and logical processes for data collection, calculation, and output were developed. The functionality, on-site applicability, and efficiency of CAPIS were evaluated in a convenience sample of 181 participants (61 males, 120 females; aged 24 to 85) by comparing with manual 24 hour recall method with paper questionnaire. The CAPIS was functioned adequately in the field survey in terms of completeness of function, security, and compliance of researcher and subjects. Regarding on-site applicability, 23.2%, 32.6%, 35.4%, and 43.7% of subjects reported that CAPIS was easier to recall their diet, to estimate the amount consumed, to communicate with the interviewer, and to concentrate on the interview than the manual method with paper questionnaire, respectively. Although CAPIS required more interview time (9 min 42 sec) compared to the manual method (7 min 30 sec), it saved time and cost for data coding and entry (15 min 35 sec) and gave high satisfaction from the prompt feedback after interview to the subjects, which increase efficiency to apply on the field survey. Our results suggest that the newly developed CAPIS is suitable for conducting personal interviews for dietary assessment in Korean population.

title: Development and evaluation of the Oxford WebQ, a low-cost, web-based method for assessment of previous 24 h dietary intakes in large-scale prospective studies
abstract: To describe the development of the Oxford WebQ, a web-based 24 h dietary assessment tool developed for repeated administration in large prospective studies; and to report the preliminary assessment of its performance for estimating nutrient intakes.  We developed the Oxford WebQ by repeated testing until it was sufficiently comprehensive and easy to use. For the latest version, we compared nutrient intakes from volunteers who completed both the Oxford WebQ and an interviewer-administered 24 h dietary recall on the same day.  Subjects A total of 116 men and women.  The WebQ took a median of 12·5 (interquartile range: 10·8–16·3) min to self-complete and nutrient intakes were estimated automatically. By contrast, the interviewer-administered 24 h dietary recall took 30 min to complete and 30 min to code. Compared with the 24 h dietary recall, the mean Spearman's correlation for the 21 nutrients obtained from the WebQ was 0·6, with the majority between 0·5 and 0·9. The mean differences in intake were less than ±10 % for all nutrients except for carotene and vitamins B12 and D. On rare occasions a food item was reported in only one assessment method, but this was not more frequent or systematically different between the methods.  Compared with an interviewer-based 24 h dietary recall, the WebQ captures similar food items and estimates similar nutrient intakes for a single day's dietary intake. The WebQ is self-administered and nutrients are estimated automatically, providing a low-cost method for measuring dietary intake in large-scale studies.

title: Development of a UK Online 24-h Dietary Assessment Tool: myfood24
abstract: Assessment of diet in large epidemiological studies can be costly and time consuming. An automated dietary assessment system could potentially reduce researcher burden by automatically coding food records. myfood24 (Measure Your Food on One Day) an online 24-h dietary assessment tool (with the flexibility to be used for multiple 24 h-dietary recalls or as a food diary), has been developed for use in the UK population. Development of myfood24 was a multi-stage process. Focus groups conducted with three age groups, adolescents (11–18 years) (n = 28), adults (19–64 years) (n = 24) and older adults (≥65 years) (n = 5) informed the development of the tool, and usability testing was conducted with beta (adolescents n = 14, adults n = 8, older adults n = 1) and live (adolescents n = 70, adults n = 20, older adults n = 4) versions. Median system usability scale (SUS) scores (measured on a scale of 0–100) in adolescents and adults were marginal for the beta version (adolescents median SUS = 66, interquartile range (IQR) = 20; adults median SUS = 68, IQR = 40) and good for the live version (adolescents median SUS = 73, IQR = 22; adults median SUS = 80, IQR = 25). Myfood24 is the first online 24-h dietary recall tool for use with different age groups in the UK. Usability testing indicates that myfood24 is suitable for use in UK adolescents and adults.

title: The Automated Self-Administered 24-hour dietary recall (ASA24): a resource for researchers, clinicians, and educators from the National Cancer Institute.
abstract: Extensive evidence has demonstrated that 24-hour dietary recalls (24HDRs) provide high-quality dietary intake data with minimal bias, making them the preferred tool for monitoring the diets of populations and, increasingly, for studying diet and disease associations (1-3). Traditional 24HDRs, however, are expensive and impractical for large-scale research because they rely on trained interviewers, and multiple administrations are needed to estimate usual intakes. To address these challenges, the National Cancer Institute (NCI), in collaboration with the research firm Westat (Rockville, MD), and with the support of other institutes and offices at the National Institutes of Health, developed the Automated Self-Administered 24-hour dietary recall (ASA24) (4-6). ASA24 is a public-access, freely available, web-based tool for researchers, clinicians and educators, modeled on the Automated Multiple Pass Method (AMPM) (7). Development of an automated self-administered 24HDR for adults began in 2006 and was informed by input from stakeholders participating in an External Working Group and small-scale cognitive and usability testing (4,5). A Beta version released in August 2009 has been used by over 175 researchers to collect over 40,000 recalls; Version 1, which offers improved usability and new features, was released in September 2011 (8). A modified version intended for self-administration by children is under development by researchers at the Baylor College of Medicine (Houston, TX) and is expected to be available mid-2012 (9,10). This paper describes the features of ASA24 and planned evaluations.

title: Validity of a multipass, web-based, 24-hour self-administered recall for assessment of total energy intake in blacks and whites.
abstract: To date, Web-based 24-hour recalls have not been validated using objective biomarkers. From 2006 to 2009, the validity of 6 Web-based DietDay 24-hour recalls was tested among 115 black and 118 white healthy adults from Los Angeles, California, by using the doubly labeled water method, and the results were compared with the results of the Diet History Questionnaire, a food frequency questionnaire developed by the National Cancer Institute. The authors performed repeated measurements in a subset of 53 subjects approximately 6 months later to estimate the stability of the doubly labeled water measurement. The attenuation factors for the DietDay recall were 0.30 for blacks and 0.26 for whites. For the Diet History Questionnaire, the attenuation factors were 0.15 and 0.17 for blacks and whites, respectively. Adjusted correlations between true energy intake and the recalls were 0.50 and 0.47 for blacks and whites, respectively, for the DietDay recall. For the Diet History Questionnaire, they were 0.34 and 0.36 for blacks and whites, respectively. The rate of underreporting of more than 30% of calories was lower with the recalls than with the questionnaire (25% and 41% vs. 34% and 52% for blacks and whites, respectively). These findings suggest that Web-based DietDay dietary recalls offer an inexpensive and widely accessible dietary assessment alternative, the validity of which is equally strong among black and white adults. The validity of the Web-administered recall was superior to that of the paper food frequency questionnaire.

title: Development of a field-friendly automated dietary assessment tool and nutrient database for India
abstract: Studies of diet and disease risk in India and among other Asian-Indian populations are hindered by the need for a comprehensive dietary assessment tool to capture data on the wide variety of food and nutrient intakes across different regions and ethnic groups. The nutritional component of the India Health Study, a multicentre pilot cohort study, included 3908 men and women, aged 35–69 years, residing in three regions of India (New Delhi in the north, Mumbai in the west and Trivandrum in the south). We developed a computer-based, interviewer-administered dietary assessment software known as the ‘NINA-DISH (New Interactive Nutrition Assistant – Diet in India Study of Health)’, which consisted of four sections: (1) a diet history questionnaire with defined questions on frequency and portion size; (2) an open-ended section for each mealtime; (3) a food-preparer questionnaire; (4) a 24 h dietary recall. Using the preferred meal-based approach, frequency of intake and portion size were recorded and linked to a nutrient database that we developed and modified from a set of existing international databases containing data on Indian foods and recipes. The NINA-DISH software was designed to be easily adaptable and was well accepted by the interviewers and participants in the field. A predominant three-meal eating pattern emerged; however, patterns in the number of foods reported and the primary contributors to macro- and micronutrient intakes differed by region and demographic factors. The newly developed NINA-DISH software provides a much-needed tool for measuring diet and nutrient profiles across the diverse populations of India with the potential for application in other South Asian populations living throughout the world.

title: Application and interpretation of multiple statistical tests to evaluate validity of dietary intake assessment methods
abstract: BackgroundSeveral statistical tests are currently applied to evaluate validity of dietary intake assessment methods. However, they provide information on different facets of validity. There is also no consensus on types and combinations of tests that should be applied to reflect acceptable validity for intakes. We aimed to 1) conduct a review to identify the tests and interpretation criteria used where dietary assessment methods was validated against a reference method and 2) illustrate the value of and challenges that arise in interpretation of outcomes of multiple statistical tests in assessment of validity using a test data set.MethodsAn in-depth literature review was undertaken to identify the range of statistical tests used in the validation of quantitative food frequency questionnaires (QFFQs). Four databases were accessed to search for statistical methods and interpretation criteria used in papers focusing on relative validity. The identified tests and interpretation criteria were applied to a data set obtained using a QFFQ and four repeated 24-hour recalls from 47 adults (18–65 years) residing in rural Eastern Cape, South Africa.Results102 studies were screened and 60 were included. Six statistical tests were identified; five with one set of interpretation criteria and one with two sets of criteria, resulting in seven possible validity interpretation outcomes. Twenty-one different combinations of these tests were identified, with the majority including three or less tests. Coefficient of correlation was the most commonly used (as a single test or in combination with one or more tests). Results of our application and interpretation of multiple statistical tests to assess validity of energy, macronutrients and selected micronutrients estimates illustrate that for most of the nutrients considered, some outcomes support validity, while others do not.ConclusionsOne to three statistical tests may not be sufficient to provide comprehensive insights into various facets of validity. Results of our application and interpretation of multiple statistical tests support the value of such an approach in gaining comprehensive insights in different facets of validity. These insights should be considered in the formulation of conclusions regarding validity to answer a particular dietary intake related research question.

title: Validity of Electronic Diet Recording Nutrient Estimates Compared to Dietitian Analysis of Diet Records: Randomized Controlled Trial
abstract: Dietary intake assessment with diet records (DR) is a standard research and practice tool in nutrition. Manual entry and analysis of DR is time-consuming and expensive. New electronic tools for diet entry by clients and research participants may reduce the cost and effort of nutrient intake estimation.  To determine the validity of electronic diet recording, we compared responses to 3-day DR kept by Tap & Track software for the Apple iPod Touch and records kept on the Nutrihand website to DR coded and analyzed by a research dietitian into a customized US Department of Agriculture (USDA) nutrient analysis program, entitled GRAND (Grand Forks Research Analysis of Nutrient Data).  Adult participants (n=19) enrolled in a crossover-designed clinical trial. During each of two washout periods, participants kept a written 3-day DR. In addition, they were randomly assigned to enter their DR in a Web-based dietary analysis program (Nutrihand) or a handheld electronic device (Tap & Track). They completed an additional 3-day DR and the alternate electronic diet recording methods during the second washout. Entries resulted in 228 daily diet records or 12 for each of 19 participants. Means of nutrient intake were calculated for each method. Concordance of the intake estimates were determined by Bland-Altman plots. Coefficients of determination (R 2) were calculated for each comparison to assess the strength of the linear relationship between methods.  No significant differences were observed between the mean nutrient values for energy, carbohydrate, protein, fat, saturated fatty acids, total fiber, or sodium between the recorded DR analyzed in GRAND and either Nutrihand or Tap & Track, or for total sugars comparing GRAND and Tap & Track. Reported values for total sugars were significantly reduced (P<.05) comparing Nutrihand to GRAND. Coefficients of determination (R 2) for Nutrihand and Tap & Track compared to DR entries into GRAND, respectively, were energy .56, .01; carbohydrate .58, .08; total fiber .65, .37; sugar .78, .41; protein .44, .03; fat .36, .03; saturated fatty acids .23, .03; sodium .20, .00; and for Nutrihand only for cholesterol .88; vitamin A .02; vitamin C .37; calcium .05; and iron .77. Bland-Altman analysis demonstrates high variability in individual responses for both electronic capture programs with higher 95% limits of agreement for dietary intake recorded on Tap & Track.  In comparison to dietitian-entered 3-day DR, electronic methods resulted in no significant difference in mean nutrient estimates but exhibited larger variability, particularly the Tap & Track program. However, electronic DR provided mean estimates of energy, macronutrients, and some micronutrients, which approximated those of the dietitian-analyzed DR and may be appropriate for dietary monitoring of groups. Electronic diet assessment methods have the potential to reduce the cost and burden of DR analysis for nutrition research and clinical practice.

title: General principles for the collection of national food consumption data in the view of a pan-European dietary survey 1 European Food Safety Authority
abstract: The availability of detailed, harmonised and high quality food consumption data at European level is a primary long term objective for EFSA which has been recognised as a top priority for collaboration with the EU Member States. This Guideline has been developed by the EFSA Expert Group on Food Consumption Data. It issues general principles to collect dietary information that can be used to estimate the nutrient intake and to assess exposure to biological agents and chemical substances considered by EFSA‟s Scientific Panels. It is recommended that surveys cover two non-consecutive days and use the dietary record method for infants and children and the 24-hour recall method for adults. It is further recommended to use a food propensity questionnaire and that supplementary information, in particular on brand name, physical characteristics of the packaging, cooking procedures and other specific information, such as fortification should be collected. Detailed information on the use of nutritional supplements by respondents should also be covered as well as physical measures of the survey participants (weight and height) along with an estimate of their physical activity level.

title: A bivariate measurement error model for nitrogen and potassium intakes to evaluate the performance of regression calibration in the European Prospective Investigation into Cancer and Nutrition study
abstract: Within the European Prospective Investigation into Cancer and Nutrition (EPIC) study, the performance of 24-h dietary recall (24-HDR) measurements as reference measurements in a linear regression calibration model is evaluated critically at the individual (within-centre) and aggregate (between-centre) levels by using unbiased estimates of urinary measurements of nitrogen and potassium intakes.Between 1995 and 1999, 1072 study subjects (59% women) from 12 EPIC centres volunteered to collect 24-h urine samples. Log-transformed questionnaire, 24-HDR and urinary measurements of nitrogen and potassium intakes were analysed in a multivariate measurement error model to estimate the validity of coefficients and error correlations in self-reported dietary measurements. In parallel, correlations between means of 24-HDR and urinary measurements were computed. Linear regression calibration models were used to estimate the regression dilution (attenuation) factors.After adjustment for sex, centre, age, body mass index and height, the validity coefficients for 24-HDRs were 0.285 (95% confidence interval: 0.194, 0.367) and 0.371 (0.291, 0.446) for nitrogen and potassium intakes, respectively. The attenuation factors estimated in a linear regression calibration model were 0.368 (0.228, 0.508) for nitrogen and 0.500 (0.361, 0.639) for potassium intakes; only the former was different from the estimate obtained using urinary measurements in the measurement error model. The aggregate-level correlation coefficients between means of urinary and 24-HDR measurements were 0.838 (0.637, 0.932) and 0.756 (0.481, 0.895) for nitrogen and potassium intakes, respectively.This study suggests that 24-HDRs can be used as reference measurements at the individual and aggregate levels for potassium intake, whereas, for nitrogen intake, good performance is observed for between-centre calibration, but some limitations are apparent at the individual level.

title: Image-assisted dietary assessment: a systematic review of the evidence.
abstract: Images captured during eating episodes provide objective information to assist in the assessment of dietary intake. Images are captured using handheld devices or wearable cameras, and can support traditional self-report or provide the primary record of dietary intake. A diverse range of image-assisted methods have been developed and evaluated but have not been previously examined together. Therefore, a review was undertaken to examine all studies that have evaluated or validated image-assisted methods of dietary assessment for assessing dietary energy intake. Identified image-assisted methods that employ similar methodologies were grouped for comparison. English-language full-text research articles published between January 1998 and November 2013 were searched using five electronic databases. A search of reference lists and associated websites was also conducted. Thirteen studies that evaluated 10 unique image-assisted methods among adults aged 18 to 70 years were included. Ten studies used handheld devices and three studies used wearable cameras. Eight studies evaluated image-based food records, two studies explored the use of images to enhance written food records, and three studies evaluated image-assisted 24-hour dietary recalls. Results indicate images enhance self-report by revealing unreported foods and identify misreporting errors not captured by traditional methods alone. Moreover, when used as the primary record of dietary intake, images can provide valid estimates of energy intake. However, image-assisted methods that rely on image analysis can be prone to underestimation if users do not capture images of satisfactory quality before all foods are consumed. Further validation studies using criterion measures are warranted. The validity among children, adolescents, and elderly persons as well as the feasibility of using image-assisted methods in large samples needs to be examined. Additional research is also needed to better understand the potential applications and pitfalls of wearable cameras.

title: Technology-based dietary assessment: development of the Synchronised Nutrition and Activity Program (SNAP).
abstract: Accurate, reliable and feasible methods of dietary intake and physical activity assessment are required to improve our understanding of the associations between energy balance-related behaviours and health.



The Synchronised Nutrition and Activity Program (SNAP) was developed to enhance recall in children by integrating new and established methods of dietary intake and physical activity recall. A list of commonly consumed foods (n = 40), drinks (n = 9) and physical activities (n = 29) was used in SNAP. All foods and drinks were analysed by count (i.e., the number of times a particular food was selected), as a proxy indicator of dietary behaviours. All reported physical activities were assigned an intensity code [in metabolic equivalents (METs)] to determine minutes of moderate-vigorous activity (MVPA; ≥3 METs).



Most participants completed a whole day's recall (both dietary intake and physical activities) in less than 25 min. SNAP was compared against 24-h multiple pass questionnaire and accelerometry in 121 children (aged 7-15 years old). For dietary variables, the accuracy of SNAP(™) (mean difference) was within ±1 count for the majority of food groups. The proportion of the sample with a between-method agreement within ±1 count ranged from 0.40 to 0.99. For MVPA, there was no substantial fixed or proportional bias, with a mean difference between methods (SNAP) - accelerometry) of -9 min of MVPA. Qualitatively, participants have indicated that they find SNAP easy and fun to use.



SNAP was developed to be a simple, quick and engaging method of assessing energy balance-related behaviours at a group or population level and succeeded because it can collect a whole day's recall (dietary intake and physical activities) in less than 25 min to a reasonable and acceptable degree of accuracy.

title: Development and evaluation of a short 24-h food list as part of a blended dietary assessment strategy in large-scale cohort studies
abstract: The validity of dietary assessment in large-scale cohort studies has been questioned. Combining data sources for the estimation of usual intake in a blended approach may enhance the validity of dietary measurement. Our objective was to develop a web-based 24-h food list for Germany to identify foods consumed during the previous 24 h and to evaluate the performance of the new questionnaire in a feasibility study.Available data from the German National Nutrition Survey II were used to develop a finite list of food items. A total of 508 individuals were invited to fill in the 24-h food list via the Internet up to three times during a 3–6-month time period. In addition, participants were asked to evaluate the questionnaire using a brief online evaluation form.In total, 246 food items were identified for the 24-h food list, reflecting >75% variation in intake of 27 nutrients and four major food groups. Among the individuals invited, 64% participated in the feasibility study. Of these, 100%, 85% and 68% of participants completed the 24-h food list one, two or three times, respectively. The average time needed to complete the questionnaire was 9 min, and its acceptability by participants was rated as high.The 24-h food list represents a promising new dietary assessment tool that can be used as part of a blended approach combining multiple data sources for valid estimation of usual dietary intake in large-scale cohort studies.

title: Performance of the Automated Self-Administered 24-hour Recall relative to a measure of true intakes and to an interviewer-administered 24-h recall.
abstract: The Automated Self-Administered 24-hour Recall (ASA24), a freely available Web-based tool, was developed to enhance the feasibility of collecting high-quality dietary intake data from large samples.



The purpose of this study was to assess the criterion validity of ASA24 through a feeding study in which the true intake for 3 meals was known.



True intake and plate waste from 3 meals were ascertained for 81 adults by inconspicuously weighing foods and beverages offered at a buffet before and after each participant served him- or herself. Participants were randomly assigned to complete an ASA24 or an interviewer-administered Automated Multiple-Pass Method (AMPM) recall the following day. With the use of linear and Poisson regression analysis, we examined the associations between recall mode and 1) the proportions of items consumed for which a match was reported and that were excluded, 2) the number of intrusions (items reported but not consumed), and 3) differences between energy, nutrient, food group, and portion size estimates based on true and reported intakes.



Respondents completing ASA24 reported 80% of items truly consumed compared with 83% in AMPM (P = 0.07). For both ASA24 and AMPM, additions to or ingredients in multicomponent foods and drinks were more frequently omitted than were main foods or drinks. The number of intrusions was higher in ASA24 (P < 0.01). Little evidence of differences by recall mode was found in the gap between true and reported energy, nutrient, and food group intakes or portion sizes.



Although the interviewer-administered AMPM performed somewhat better relative to true intakes for matches, exclusions, and intrusions, ASA24 performed well. Given the substantial cost savings that ASA24 offers, it has the potential to make important contributions to research aimed at describing the diets of populations, assessing the effect of interventions on diet, and elucidating diet and health relations.

title: Feasibility of the Young Children's Nutrition Assessment on the Web.
abstract: Methods to assess detailed dietary data are cumbersome, expensive, and difficult to implement with large samples. The purpose of the present article was to evaluate the feasibility of collecting data from parents about their child's diet using an online dietary assessment tool. The Young Children's Nutrition Assessment on the Web was developed as part of a longitudinal study of familial influences on food intake of preschool children. A sample of 862 parents from 56 nursery schools completed a paper-and-pencil questionnaire containing sociodemographic variables and a food frequency questionnaire about their child's diet and psychosocial variables. Subsequently, a subset of parents was asked to either complete a paper-and-pencil food diary or the Young Children's Nutrition Assessment on the Web (n=88); those remaining who provided e-mail addresses were asked to complete the Young Children's Nutrition Assessment on the Web (n=467) and a user-acceptability questionnaire. This resulted in 39 useful paper-and-pencil diaries, 217 useful Young Children's Nutrition Assessments on the Web, and 164 user-acceptability questionnaires. Mann-Whitney U tests comparing nutrient (macronutrients, vitamin C, calcium, and fiber) and food group intakes from data collected with the Young Children's Nutrition Assessment on the Web vs paper-and-pencil diaries resulted in no substantial differences except for water. Attrition analyses indicated that dropout for the online assessment was associated with the sex of the respondent (father completing the questionnaire), lower social status, being a smoker, and lower nutrition knowledge. The online measure was well-received by respondents. The majority found it user-friendly (79%), attractive (68%), and clear (93%). The Young Children's Nutrition Assessment on the Web is a promising tool to collect online dietary data in large-scale surveys.

title: Repeated 24-hour recalls versus dietary records for estimating nutrient intakes in a national food consumption survey
abstract: The methodology used in the first Belgian food consumption survey followed to a large extent the instructions of the European Food Consumption (EFCOSUM) reports, where repeated 24-hour recalls (24HR) using EPIC-SOFT were recommended.  To evaluate the relative validity of two non-consecutive 24HR using EPIC-SOFT by comparison with 5-day estimated dietary records (EDR). To assess misreporting in energy for both methods by comparing energy intake with energy expenditure from accelerometery in a subsample.  A total of 175 subjects (aged 15 and over) were recruited to participate in the study. Repeated 24HR were performed with an interval of 2–8 weeks. After completion of the second interview, subjects were instructed to keep an EDR. Dietary intakes were adjusted for within-person variability to reflect usual intakes. A Student's t-test was calculated to assess differences between both methods. Spearman and Kappa correlation coefficients were used to investigate agreement.  In total, 127 subjects completed the required repeated 24HR, as well as the five record days. From 76 participants, accelerometer data were available. In both methods, about 35% of participants had ratios of Energy Intake/Total Energy Expenditure (EI/TEE) above or below 95% confidence intervals for EI/TEE, suggesting misreporting of energy. Significant differences between the two dietary intake methods were found for total energy, total fat, fatty acids, cholesterol, alcohol, vitamin C, thiamine, riboflavin and iron. In general, intakes from 24HR were higher compared to EDR. Correlation coefficients for all nutrients ranged from 0.16 for thiamine to 0.70 for water.  The results from this study show that in the context of nutritional surveillance, duplicate 24HR can be used to asses intakes of protein, carbohydrates, starch, sugar, water, potassium and calcium.

title: STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT
abstract: In clinical measurement comparison of a new measurement technique with an established one is often needed to see whether they agree sufficiently for the new to replace the old. Such investigations are often analysed inappropriately, notably by using correlation coefficients. The use of correlation is misleading. An alternative approach, based on graphical techniques and simple calculations, is described, together with the relation between this analysis and the assessment of repeatability.

title: Validation of web-based, multiple 24-h recalls combined with nutritional supplement intake questionnaires against nitrogen excretions to determine protein intake in Dutch elite athletes.
abstract: Information on dietary composition is vitally important for elite athletes to optimise their performance and recovery, which requires valid tools. The aim of the present study was to investigate the validity of assessing protein intake using three web-based 24-h recalls and questionnaires, by comparing these with three urinary N excretions on the same day. A total of forty-seven Dutch elite top athletes, both disabled and non-disabled, aged between 18 and 35 years, with a BMI of 17·5-31 kg/m2, exercising >12 h/week were recruited. Estimated mean dietary protein intake was 109·6 (sd 33·0) g/d by recalls and questionnaires v. 141·3 (sd 38·2) g/d based on N excretions in urine; the difference was 25·5 (sd 21·3) % between the methods (P<0·05). We found a reasonably good association between methods for protein intake of 0·65 (95 % CI 0·45, 0·79). On an individual level, under-reporting was larger with higher protein intakes than with lower intakes. No significant differences were found in reporting absolute differences between subcategories (sex, under-reporting, BMI, collection of recalls within a certain amount of time and using protein supplements or not). In conclusion, combined, multiple, 24-h recalls and questionnaires underestimated protein intake in these young elite athletes more than that reported for non-athlete populations. The method proved to be suitable for ranking athletes according to their protein intake as needed in epidemiological studies. On an individual level, the magnitude of underestimation was about equal for all athletes except for those with very high protein intakes.

title: Agreement between an online dietary assessment tool (myfood24) and an interviewer-administered 24-h dietary recall in British adolescents aged 11–18 years
abstract: Is an online 24-h dietary assessment tool developed for use among British adolescents and adults. Limited information is available regarding the validity of using new technology in assessing nutritional intake among adolescents. Thus, a relative validation of myfood24 against a face-to-face interviewer-administered 24-h multiple-pass recall (MPR) was conducted among seventy-five British adolescents aged 11–18 years. Participants were asked to complete myfood24 and an interviewer-administered MPR on the same day for 2 non-consecutive days at school. Total energy intake (EI) and nutrients recorded by the two methods were compared using intraclass correlation coefficients (ICC), Bland–Altman plots (using between and within-individual information) and weighted κ to assess the agreement. Energy, macronutrients and other reported nutrients from myfood24 demonstrated strong agreement with the interview MPR data, and ICC ranged from 0·46 for Na to 0·88 for EI. There was no significant bias between the two methods for EI, macronutrients and most reported nutrients. The mean difference between myfood24 and the interviewer-administered MPR for EI was −230 kJ (−55 kcal) (95 % CI −490, 30 kJ (−117, 7 kcal); P=0·4) with limits of agreement ranging between 39 % (3336 kJ (−797 kcal)) lower and 34 % (2874 kJ (687 kcal)) higher than the interviewer-administered MPR. There was good agreement in terms of classifying adolescents into tertiles of EI (κ w =0·64). The agreement between day 1 and day 2 was as good for myfood24 as for the interviewer-administered MPR, reflecting the reliability of myfood24. myfood24 Has the potential to collect dietary data of comparable quality with that of an interviewer-administered MPR.

title: Precision of the doubly labeled water method in a large-scale application: evaluation of a streamlined-dosing protocol in the Observing Protein and Energy Nutrition (OPEN) study
abstract: To evaluate whether the doubly labeled water (DLW) method is precise under conditions required for a large-scale evaluation of dietary intake instruments. Energy expenditure was measured in 484 subjects (main study). Subjects received one of five different weight DLW dose bottles prepared in advance of the study. A repeat energy expenditure measure was obtained in a subset of 24 subjects (substudy). DLW measures of energy expenditure were performed over a 2-week interval with urine collection at the beginning and end. Free-living environment with three clinic visits in the Maryland suburban area of Washington,  A total of 484 subjects (261 men and 223 women) aged 40–69 y, 24 of whom (13 men and 11 women) participated in a substudy in which DLW was administered a second time. The coefficient of variation of the DLW energy expenditure measurement was 5.1%. This included a 2.9% analytical and a 4.2% physiologic variation. Based on observed initial isotopic enrichment, the preweighed dosages were optimal in 70% of the main study subjects, and 9% received a dose that was less than optimal. Only six subjects (1%) were excluded because the final isotopic enrichment was too low to conduct precise measurement. Use of preweighed DLW dosages did not compromise the precision of the DLW method. The DLW method is a reliable measure of energy expenditure for large-scale evaluations of dietary intake instruments. The National Cancer Institute.

title: WebDASC: a web-based dietary assessment software for 8-11-year-old Danish children.
abstract: The present study describes the development and formative evaluation of the Web-based Dietary Assessment Software for Children (WebDASC). WebDASC is part of the OPUS project ('Optimal well-being, development and health for Danish children through a healthy New Nordic Diet') and was intended to measure dietary change resulting from a school-based intervention.


WebDASC was developed as a self-administered tool that could be used by 8-11-year-old children with or without parent's aid. The development of WebDASC followed a prototyping approach: focus groups, informal interviews, literature review, and usability tests preceded its release. Special consideration was given to age-appropriate design issues.


In WebDASC an animated armadillo guides respondents through six daily eating occasions and helps them report foods and beverages previously consumed. A database of 1300 food items is available either through category browse or free text search, aided by a spell check application. A type-in format is available for foods not otherwise found through category browse or text search. Amount consumed is estimated by selecting the closest portion size among four different digital images. WebDASC includes internal checks for frequently forgotten foods, and the following features to create motivation: a food-meter displaying cumulative weight of foods reported, a most popular food ranking, and a computer game with a high score list.


WebDASC was developed as an intuitive, cost-effective, and engaging method to collect detailed dietary data from 8- to 11-year-old children. Preliminary testing demonstrated that it was well accepted among children.

title: Food Intake Recording Software System, version 4 (FIRSSt4): a self-completed 24-h dietary recall for children.
abstract: The Food Intake Recording Software System, version 4 (firsst4), is a web-based 24-h dietary recall (24 hdr) self-administered by children based on the Automated Self-Administered 24-h recall (ASA24) (a self-administered 24 hdr for adults). The food choices in firsst4 are abbreviated to include only those reported by children in US national surveys; and detailed food probe questions are simplified to exclude those that children could not be expected to answer (e.g. questions regarding food preparation and added fats). ASA24 and firsst4 incorporate 10 000+ food images, with up to eight images per food, to assist in portion size estimation. We review the formative research conducted during the development of firsst4. When completed, firsst4 will be hosted and maintained for investigator use on the National Cancer Institute's ASA24 website.

title: Simulated Adaptations to an Adult Dietary Self-Report Tool to Accommodate Children: Impact on Nutrient Estimates
abstract: To simulate the effect of child-friendly (CF) adaptations of the National Cancer Institute's Automated Self-Administered 24-Hour Dietary Recall (ASA24) on estimates of nutrient intake.  One hundred twenty children, 8–13 years old, entered their previous day's intake using the ASA24 and completed an interviewer-administered recall using the Nutrition Data System for Research (NDSR). Based on a hypothesis that proposed adaptations to the ASA24 will not significantly affect mean nutrient estimates, ASA24 data were manipulated postadministration to simulate a CF version in which 2 categories of data collection were removed: (1) foods not likely to be consumed by children (45%) based on previous analyses of national dietary data and (2) food detail questions (probes) to which children are unlikely to know the answers (46%), based on our experience.  Mean estimates of select nutrients between the beta version of ASA24 and the simulated CF recall showed no significant differences, indicating that the food and probe elimination did not significantly affect results. However, a comparison of total sugar and vitamin C assessments between the original ASA24, the CF version, and NDSR showed that the daily nutrient totals for both nutrients were significantly higher in the self-administered methods (both ASA24 and CF version) than in NDSR (interviewer-administered), which warrants a review of different methods for obtaining information about foods that are sources of these nutrients.  The simulation of CF adaptations showed that it is feasible to implement, thereby reducing CF response burden without significantly affecting the results.

title: Comparison of a Web-based versus traditional diet recall among children.
abstract: Self-administered instruments offer a low-cost diet assessment method for use in adult and pediatric populations. This study tested whether 8- to 13-year-old children could complete an early version of the Automated Self Administered 24-hour diet recall (ASA24) and how this compared to an interviewer-administered 24-hour diet recall. One-hundred twenty 8- to 13-year-old children were recruited in Houston from June through August 2009 and randomly assigned to complete either the ASA24 or an interviewer-administered 24-hour diet recall, followed by the other recall mode covering the same time interval. Multivariate analysis of variance, testing for differences by age, sex, and ethnic/racial group, were applied to percentages of food matches, intrusions, and omissions between reports on the ASA24 and the interviewer-administered 24-hour diet recall. For the ASA24, qualitative findings were reported regarding ease of use. Overall matches between interviewer-administered and ASA24 self-administered 24-hour diet recall was 47.8%. Matches were significantly lower among younger (8- to 9-year-old) compared with older (10- to 13-year-old) children. Omissions on ASA24 (18.9% overall) were most common among 8-year-olds and intermediate among 9-year-olds. Eight- and 9-year-olds had substantial difficulties and often required aid in completing ASA24. Findings from this study suggest that a simpler version of an Internet-based diet recall program would be easier for children to use.

title: Comparative validation of a bilingual interactive multimedia dietary assessment tool.
abstract: To perform comparative validity testing for a bilingual interactive multimedia (IMM) dietary assessment tool that mimics a dietary recall against an interview-administered dietary recall.



This was a two-period crossover design study. First, participants were randomly assigned to complete an IMM recall or interview-administered 24-hour recall. The IMM recall generated a nutrient profile that included 20 dietary constituents. The interview-administered recall was analyzed using the Food Intake Analysis System (FIAS) and the Expanded Food and Nutrition Education Program (EFNEP) Evaluating/Reporting System. The effect of substituting standardized portion sizes for reported portion sizes was examined.



Of 80 adult participants, 71 (91%) were female, 45 (56%) had 12th grade or less education, 65 (81%) had an annual income of dollar 15,000 or less, and 21 (26%) completed the IMM recall in Spanish.


STATISTICAL ANALYSES PERFORMED
Analysis of variance and unadjusted and energy-adjusted correlations were used.



No significant group differences were found for order of administration or demographic characteristics. There was only one significant (P=.025) method effect, whereby vitamin C intake was higher in the IMM recall than the FIAS. The unadjusted correlations between the IMM recalls and interview-administered recalls analyzed using both FIAS and EFNEP Evaluating/Reporting System were generally approximately 0.6. Energy-adjusted correlations were consistently lower. Substituting standardized portion sizes resulted in significant differences for six nutrients and caused all correlations to decrease.



The IMM dietary recall is a valid method for assessing dietary intake within the tested group. The results of comparative validity testing and positive reactions received from participants and nutrition educators indicate that diet assessment using IMM has tremendous potential.

title: Diet Assessment in Children and Adolescents
abstract: Although increases in obesity prevalence over the last few decades have been dramatic in all age groups, trends among youths have been particularly alarming. The prevalence of childhood overweight has almost doubled in the past two decades in the United States (CDC, National Center for Health Statistics [NCHS, 2004]). The emergence of childhood obesity as a serious public health problem underscores the need for dietary assessment tools that are not only reliable and valid but also feasible to administer across multiple settings and age ranges and with diverse populations. Accurate dietary assessment is critical for monitoring the nutritional status of children, examining associations between diet and health, and identifying dietary intake patterns and eating behaviors that are associated with unhealthy weight and weight gain over time. Such information is critical for developing intervention messages and behavioral targets for obesity prevention and treatment programs and for evaluating their effectiveness. As others have documented, there is no “one-size-fits-all” dietary assessment tool appropriate for all research and clinical applications, and there is always a trade-off with the choice of any diet assessment methodology (Goran, 1998; Rockett, Wolf, & Colditz, 1995). Moreover, the measurement of energy and nutrient intake in children and adolescents is further complicated by a variety of factors, including reliance on a third person (e.g., adult caregiver, teacher) to report a child’s intake during the preschool years, cognitive abilities, motivation, and reporting biases (e.g., underreporting and overreporting) influenced by developmental stage and other factors (e.g., weight status). The goal of this chapter is to review the variety of dietary assessment methods available,

title: Comparison of Interviewer-Administered and Automated Self-Administered 24-Hour Dietary Recalls in 3 Diverse Integrated Health Systems.
abstract: Twenty-four-hour dietary recalls provide high-quality intake data but have been prohibitively expensive for large epidemiologic studies. This study's goal was to assess whether the web-based Automated Self-Administered 24-Hour Recall (ASA24) performs similarly enough to the standard interviewer-administered, Automated Multiple-Pass Method (AMPM) 24-hour dietary recall to be considered a viable alternative. In 2010-2011, 1,081 adults from 3 integrated health systems in Detroit, Michigan; Marshfield, Wisconsin; and Kaiser-Permanente Northern California participated in a field trial. A quota design ensured a diverse sample by sex, age, and race/ethnicity. Each participant was asked to complete 2 recalls and was randomly assigned to 1 of 4 protocols differing by type of recall and administration order. For energy, the mean intakes were 2,425 versus 2,374 kcal for men and 1,876 versus 1,906 kcal for women by AMPM and ASA24, respectively. Of 20 nutrients/food groups analyzed and controlling for false discovery rate, 87% were judged equivalent at the 20% bound. ASA24 was preferred over AMPM by 70% of the respondents. Attrition was lower in the ASA24/AMPM study group than in the AMPM/ASA24 group, and it was lower in the ASA24/ASA24 group than in the AMPM/AMPM group. ASA24 offers the potential to collect high-quality dietary intake information at low cost with less attrition.

title: Design concepts in nutritional epidemiology
abstract: Part A The scientific concepts underlying study design overview of the principles of nutritional epidemiology design, planning and evaluation of nutritional epidemiological studies sampling, study size and power covariate measurement errors in nutritional epidemiology - effects and remedies. Part B The measurement of exposure and outcome food consumption, nutrient intake and the use of food composition tables assessment of food consumption and nutrient intake biochemical markers of nutrient intake the validation of dietary assessment socio-demographic and psycho-social variables anthropometric measures gene-nutrient interactions in epidemiological studies. Part C The design of nutritional epidemiological studies ecological studies cross-sectional studies cohort studies case-control studies experimental studies: clinical trials, field trials, community trials and intervention studies.

title: Use of biological markers to validate self-reported dietary intake in a random sample of the European Prospective Investigation into Cancer United Kingdom Norfolk cohort.
abstract: The validity of dietary assessment methods should be established before diet-disease associations are reported.



Our objective was to validate a 7-d food diary and a food-frequency questionnaire (FFQ) against independent biomarkers of intake in urine (nitrogen, potassium, and sodium) and blood (plasma ascorbic acid).



A total of 146 healthy middle-aged men and women were recruited from the European Prospective Investigation into Cancer UK Norfolk cohort, a free-living cohort of approximately 25000 persons. Over a 9-mo period, urinary nitrogen, potassium, and sodium were estimated from 2-6 complete 24-h urine collections in 134 subjects and plasma ascorbic acid was estimated from 2-3 fasting blood samples in 118 subjects. Subjects completed 2 FFQs and two 7-d food diaries.



In men and women combined, correlations between 24-h urinary nitrogen excretion and dietary intake from the 7-d food diary were high (r = 0.57-0.67) compared with those for the FFQ (r = 0.21-0.29). Similarly, correlations between urinary potassium and dietary potassium were higher for the 7-d food diary (r = 0.51-0.55) than for the FFQ (r = 0.32-0.34). There was no overall difference in correlations between plasma ascorbic acid and dietary vitamin C between the 7-d food diary (r = 0.40-0.52) and the FFQ (r = 0.44-0.45).



These data indicate that, despite increased subject burden, the 7-d food diary provided a better estimate of nitrogen and potassium intakes than did the FFQ in this study population. However, with respect to plasma ascorbic acid, both the FFQ and 7-d food diary provided a similar ranking of subjects according to vitamin C intake.

title: Validation of dietary assessment methods in the UK arm of EPIC using weighed records, and 24-hour urinary nitrogen and potassium and serum vitamin C and carotenoids as biomarkers.
abstract: In the UK EPIC validation studies, the accuracy of several methods was assessed by comparison with to-day weighed records and the biomarkers, 24-hour urine nitrogen (N) and potassium (K), plasma carotenoids and plasma vitamin C.



Comparisons between methods were made on 156 women, studied over 1 year at 3-monthly intervals at home. On each of four occasions, volunteers completed 4 days of weighed records and provided two 24-hour urine collections and a fasting blood sample.



In comparison with the 16 days of weighed records, a food frequency questionnaire (FFQ) yielded higher values mainly due to greater reported consumption of milk and of vegetables. A 24-hour recall was as good as the FFQ in placing individuals in the distribution of habitual diet from weighed records. Results obtained from a 7-day estimated record were closest to those obtained from the weighed record. Correlations between 24-hour urine excretion and dietary N intake from weighed records were high (0.78-0.87) as were those with estimated food diaries (0.60-0.70). Correlations between urine N and the FFQ and 24-hour recall were lower (0.10 to 0.27), but improved by energy adjustment using residuals for N and K which are correlated with total energy intake. Comparisons between dietary estimates and urinary K and serum carotenoids and vitamin C showed broadly similar results. Limited biomarker information amongst 200 UK EPIC participants supported the findings of the validation study.



UK EPIC uses three methods (the 7-day diary, an improved FFQ, and the 24-hour recall) to assess diet. 93% of first food diaries are returned completed by participants. Repeated diaries are the main dietary assessment method for nested case-control analyses.

title: Urinary potassium is as reliable as urinary nitrogen for use as a recovery biomarker in dietary studies of free living individuals.
abstract: Twenty-four-hour urinary nitrogen (UN) is commonly used to validate dietary assessment methods. Potassium is more widespread in food than nitrogen, but the role of 24-h urinary potassium (UK) as a biomarker has been less studied and characterized. To investigate the performance of UK as a recovery biomarker compared with UN in subjects consuming their normal diet, 7 males and 6 females consumed known amounts of food based on their habitual varying diet (assessed beforehand from 4 consecutive 7-d food diaries) for 30 d in a metabolic suite. All daily urine samples and dietary duplicates were collected, and N and K were measured. Stool K was determined in 5-d pooled samples. Thirty-day mean analyzed K intake was 121.3 +/- 25.1 (mean +/- SD) mmol/d. Overall, 77 +/- 6.7% of K in the diet was excreted in urine and 18 +/- 5% in stool. Dietary K was correlated with UK (r = 0.89; P < 0.001). UN was 77.7 +/- 6.6% of N intake and was correlated with N in the diet (r = 0.87; P < 0.001). When 16 d of intake and 8 d of urine-collection measurements were randomly selected from the 30-d measurements, correlations were significant for both K (r = 0.86; P < 0.001) and N (r = 0.92; P < 0.001). The high correlations between UK and K in the diet show that UK is a reliable recovery biomarker for use in studies of dietary measurement error. Factors for use of urinary N as a recovery biomarker are also confirmed.

title: Biomarker and dietary validation of a Canadian food frequency questionnaire to measure eicosapentaenoic and docosahexaenoic acid intakes from whole food, functional food, and nutraceutical sources.
abstract: Canadian dietary sources of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) include marine and non-marine whole foods, functional foods, and nutraceuticals.



In the present study, these sources were incorporated into a nutrient-specific, semi-quantitative food frequency questionnaire (FFQ) and the ability to measure the EPA and DHA intakes of Canadian adults was assessed. Specifically, the EPA and DHA intakes estimated by FFQ of 78 men and women, 20 to 60 years of age, were compared with EPA and DHA measurements from 3-day food records and measures of EPA and DHA in fasting whole blood.



Mean (±standard deviation) and median intakes of EPA+DHA were 0.34±0.34 and 0.21 g/day by FFQ and 0.47±0.71 and 0.13 g/day by food record, with no significant differences between mean intakes (P=0.93). The FFQ provided higher estimates than the food record at low intakes of EPA and DHA and lower estimates at high intakes based on Bland-Altman plots. The FFQ was moderately correlated with food record (r=0.31 to 0.49) and with blood biomarker measures of EPA and DHA (r=0.31 to 0.51). Agreement analysis revealed that 42% of participants were classified in the same and 77% into same or adjacent quartile when EPA and DHA intake was assessed by food record and by FFQ. Similar quartile agreement was found for EPA and DHA intakes by FFQ with blood biomarker EPA and DHA. The range of the validity coefficients, calculated using the method of triads, was 0.43 to 0.71 for FFQ measurement of EPA+DHA.



The FFQ is an adequate tool for estimating usual EPA and DHA intakes and ranking Canadian adults by their intakes.

title: The validation of a computer-based food record for older adults: the Novel Assessment of Nutrition and Ageing (NANA) method
abstract: Dietary assessment in older adults can be challenging. The Novel Assessment of Nutrition and Ageing (NANA) method is a touch-screen computer-based food record that enables older adults to record their dietary intakes. The objective of the present study was to assess the relative validity of the NANA method for dietary assessment in older adults. For this purpose, three studies were conducted in which a total of ninety-four older adults (aged 65–89 years) used the NANA method of dietary assessment. On a separate occasion, participants completed a 4 d estimated food diary. Blood and 24 h urine samples were also collected from seventy-six of the volunteers for the analysis of biomarkers of nutrient intake. The results from all the three studies were combined, and nutrient intake data collected using the NANA method were compared against the 4 d estimated food diary and biomarkers of nutrient intake. Bland–Altman analysis showed a reasonable agreement between the dietary assessment methods for energy and macronutrient intake; however, there were small, but significant, differences for energy and protein intake, reflecting the tendency for the NANA method to record marginally lower energy intakes. Significant positive correlations were observed between urinary urea and dietary protein intake using both the NANA and the 4 d estimated food diary methods, and between plasma ascorbic acid and dietary vitamin C intake using the NANA method. The results demonstrate the feasibility of computer-based dietary assessment in older adults, and suggest that the NANA method is comparable to the 4 d estimated food diary, and could be used as an alternative to the food diary for the short-term assessment of an individual's dietary intake.