New and Innovative Dietary Assessment Methods

German Institute for Human Nutrition, Potsdam-Rehbruecke

Dr. Karen Wagner/Anne-Kathrin Illner

Literature search

• Criteria for inclusion

– Studies published in English between 2002 and later

– Studies using an instrument to assess foods

– Studies with target populations relevant to the characteristics of

cohorts of IDAMES partners

– Studies identified in Pubmed

Overview

New Method Number of Studies

Validation Studies Feasibility Studies and other

PDA 7 5 2

Picture-sort FFQ

2 2

Smart-card 3 3Bar code scanner

2 2

Computer-tools 3 3

Web-FFQ 5 2 3

Web-24 HDR 2 2

Statistical

method2 2

PDA (1)

Wellnavi

handheld personal digital assistant with camera and mobile phone card

• real time dietary data assessment possible

• digital photos of foods and drinks consumed

• display to specify the ingredients of the meal

• electronic data transfer to a dietician

Fig. 1: „Wellnavi“-Instrument

Wang, D.H., et al., Validity and reliability of a dietary assessment method: the application of a digital camera with a mobile phone card attachment. J Nutr Sci

Vitaminol (Tokyo), 2002. 48(6): p. 498-504.

“Wellnavi” – Studies

Author Methods Subjects Results for nutrient intake

Wang et al, 2006

Wellnavi vs. 1d-WFR1

28 ♀

19.3 ± 0.5 y

r = 0.21-0.81

+ less burden & time consuming (57%)

Kikunaga et al, 2007

Wellnavi vs.

5d-WFR1

75 ♂ & ♀

48.8 ± 10.2 y

r = 0.34-0.78

+ underestimation

Wang, D.H., M. Kogashiwa, and S. Kira, Development of a new instrument for evaluating individuals' dietary intakes. J Am Diet Assoc, 2006. 106(10): p. 1588-93.

Kikunaga, S., et al., The application of a handheld personal digital assistant with camera and mobile phone card (Wellnavi) to the general population in a dietary

survey. J Nutr Sci Vitaminol (Tokyo), 2007. 53(2): p. 109-16.

1WFR: weighted food record

Beasley, J., W.T. Riley, and J. Jean-Mary, Accuracy of a PDA-based dietary assessment program. Nutrition, 2005. 21(6): p. 672-7.

DietMatePro

PDA with integrated Web-based technology

• real time dietary assessment possible • selection of foods from the USDA-database and specification of portion sizes

• immediate web-based transfer form dietary data, date and time of consumption

• individualization of database

PDA (2)

Fig. 2: „DietMatePro“-Display

„DietMatePro“ – Studies

Beasley, J., W.T. Riley, and J. Jean-Mary, Accuracy of a PDA-based dietary assessment program. Nutrition, 2005. 21(6): p. 672-7.

Beasley JM, Riley WT, Davis A, Singh J. Evaluation of a PDA-based dietary assessment and intervention program: a randomized controlled trial. J Am Coll Nutr.

2008 Apr;27(2):280-6.

Author Methods Subjects Results for nutrient intake

Beasley et al, 2005

DietMatePro vs:

1) 24HDR1

2) Weighed meal

39 ♂ & ♀

53 ± 1,7 y

1) r = 0.51-0.80

2) r = 0.42-0.79

+ training essential

Beasley et al, 2008

DietMatePro vs:

1) 24HDR1

2) Paper-diary

174 ♂ & ♀

1) r = 0.41-0.71

2) r = 0.63-0.83

+ training essential

1HDR: 24 Hour dietary recall

Weaknesses Benefits

• high technical and staff

requirements → expensive

• training required

• inaccurate estimation of portion

size

• low correlation coefficient

• usefully measure of

individual dietary intake for a

variety of nutrients

• immediate data transfer

• facilitated data coding

• useful to reach low-literacy

groups, e.g. children, elderly

PDAs

Alternatives to measure self-reported food

intake in large-scale studies?

Web-based FFQs

Author Methods Subjects Results

Beasley et al, 2008

Web-DHQ1 vs:

1) PDHQ2

2) 24 HDR3

3) 4d-FR4

218 ♂ & ♀

54.9 ± 14.4 y

1) r = 0.82

2) r = 0.31

3) r = 0.41(for nutrient intake)

Matthys et al, 2007

Web-based FFQ

vs 3d-WFR5

104 ♂ & ♀ r = 0.20 to 0.64 (for food intake)

Beasley, J. M., Davis, A., and Riley, W. T. Evaluation of a web-based, pictorial diet history questionnaire. Public Health Nutr: 1-9, 2008.

Matthys, C., Pynaert, I., De Keyzer, W., and De Henauw, S. Validity and reproducibility of an adolescent web-based food frequency questionnaire. J Am Diet Assoc, 107: 605-10, 2007

1DHQ: Diet History Questionnaire 2PDHQ: Paper-Diet History Questionnaire3HDR: 24 Hour dietary recall4FR: food record5WFR: weighted food record

Weaknesses Benefits

• finite food list with often closed

ended response categories

• measurement error (no

quantification)

• burden & selection bias - cognitive difficult

- computer literacy

• higher data quality - immediate data check

• less costs - no costs for printing, postage

• less organisational constraints - no manual checks of incomplete or

implausible answers, no transfer of data to

an electronic format

• higher compliance of participants - completion any time & location, reminder

messages, personalized feed-

back, interactive help features

Hanning, R. M., Woodruff, S. J., Lambraki, I., Jessup, L., Driezen, P., and Murphy, C. C. Nutrient intakes and food consumption patterns among Ontario students in grades six, seven, and eight. Can J Public Health, 98: 12-6, 2007;

Bälter, K., Bälter, O., Fondell, E. and Lagerros, Y. Web-based and mailed questionnaires: a comparison of response rates and compliance. Epidemiology, 16:4 S577-590, 2005.

Web-based FFQs

• More specific contributions of new methods to epidemiologic approaches have to be evaluated in feasibility research.

• Some are of high interest large-scale epidemiologic studies, web-based FFQs, 24 HDR today preferred

• High potential for a historically new period of research?

Outlook

Thank you for your attention!

Wellnavi – Validity I

Wang, D.H., et al., Validity and reliability of a dietary assessment method: the application of a digital camera with a mobile

phone card attachment. J Nutr Sci Vitaminol (Tokyo), 2002. 48(6): p. 498-504.

Wellnavi vs. 1-d weighed record

Subjects: College students (n = 20)

Results: r = 0.46 to 0.93 (median r = 0.77).

Conclusion:

Wellnavi can usefully measure individual dietary intakes for a variety of nutrients

in an epidemiologic study

Wellnavi – Validation II

Wang, D.H., M. Kogashiwa, and S. Kira, Development of a new instrument for evaluating individuals' dietary intakes. J Am Diet

Assoc, 2006. 106(10): p. 1588-93.

Wellnavi vs. 1-d weighed record and 24 hr recall

Design: cross-sectional study design

Subjects: College students (n = 28)

Results: no significant differences between the methods

Practicability evaluations participants burden by using a questionnaire

• least burdensome (57% participants)

Conclusion: • may be a valid and convenient instrument for evaluating dietary intake.

New / innovative methods

• Personal Digital Assistant (PDA)– Wellnavi (Wang 2002, Wang 2006, Kikunaga 2007)

– DietMatePro (Beasley 2005 and 2008)

• Web-based and computer based tools

• New statistical analysis

Application Wellnavi

Kikunaga, S., et al., The application of a handheld personal digital assistant with camera and mobile phone card (Wellnavi) to the

general population in a dietary survey. J Nutr Sci Vitaminol (Tokyo), 2007. 53(2): p. 109-16.

Wellnavi vs. 1-d weighed record

Subjects: healthy adults n = 75

Results: significant correlation for energy intake [kcal]:

r = 0.602; p < 0,001

significant lower values for the Energy intake [kcal]:

Wellnavi: 1718 ± 361 vs record: 1977 ± 405

Conclusion:

• could become a useful new dietary assessment method to get accurate

dietary information from people of a wide range of age and occupation

DietMatePro – Validation

Validated in two on-site studies:

(1) 39-person trial with weighed intake of a meal

(2) 174 person randomized, controlled trial comparing

DietMatePro vs 24 hr recall

Beasley, J., W.T. Riley, and J. Jean-Mary, Accuracy of a PDA-based dietary assessment program. Nutrition, 2005. 21(6): p.

672-7.

DietMatePro – Validation

Beasley, J., W.T. Riley, and J. Jean-Mary, Accuracy of a PDA-based dietary assessment program. Nutrition, 2005. 21(6): p.

672-7.

(1) DietMatePro vs. 24 hr recall and weighed meal

Design: Randomized controlled trial

Subjects: 39 participants

Results: r = 0.51 to 0.80 for DietMatePro vs. 24 hr recall

r = 0.42 to 0.79 for DietMatePro vs weighed meal

Conclusion: • provides a method of assessing energy and macronutrient intakes comparable

to the 24-h recall

DietMatePro – Validation

(2) DieMatePro or paper food diary vs 24 hr recall

Design: Randomized controlled trial

Subjects: 174 overweight/obese participants (BMI 25 – 40 kg/m²)

Results: r = 0.41 to 0.71 for the DietMatePro vs 24 hr recall

r = 0.63 to 0.83 for the paper-based diary vs 24 hr recall

Conclusion:

• does not produce more valid data than paper-based approaches

• may improve adherence compared to paper-based methods

Beasley JM, Riley WT, Davis A, Singh J. Evaluation of a PDA-based dietary assessment and intervention program: a

randomized controlled trial. J Am Coll Nutr. 2008 Apr;27(2):280-6.

Web-based version of the NCI diet history questionnaire(web-PDHQ) – Beasley et al, 2008

Design: comparing web-PDHQ vs original paper DHQ

4day food record and 24 hr recall as reference

Subjects: 218 subjects

Results: r = 0.82 between web-PDHQ/original paper DHQ

web-based questionnaires

Beasley, J. M., Davis, A., and Riley, W. T. Evaluation of a web-based, pictorial diet history questionnaire. Public Health Nutr : 1-9, 2008.

Web-based food frequency questionnaire (web-FFQ)Mathyss et al, 2007

Design: comparing web-FFQ vs diary

Subjects: 104 adolescents (12 to 18 years)

Results: r = 0. 20 to 0.64

acceptable validity only for:

water , fruit, bread, and fish/eggs/meat

web-based questionnaires

Matthys, C., Pynaert, I., De Keyzer, W., and De Henauw, S. Validity and reproducibility of an adolescent web-based food frequency questionnaire. J Am Diet Assoc, 107: 605-10, 2007

MyPyramid Tracker, Juan et al, 2006

Design: comparing web-FFQ vs diary

Subjects: 104 adolescents (12 to 18 years)

Results: r = 0. 20 to 0.64

acceptable validity only for:

water , fruit, bread, and fish/eggs/meat

Web-based tool

Juan, W., Gerrior, S., and Hiza, H. MyPyramid Tracker assesses food consumption, physical activity, and energy balance status interactively. J Nutr Educ Behav, 38: S155-7, 2006.

Advanced metods

Lu et al, 2006; Moore et al, 2007; Hanning et al, 2007;

Edwards et al, 2007, Subar et al, 2007

Application:

• web-based questionnaires, web-based software, computer-based recalls

Experiences in application:

• Time-saving, accurate, low burden, cost-effective, well-accepted

• Publicly available