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Validation of a novel dietary assessment method in older adults
Claire Timon, Human Nutrition Unit, The University of Sheffield, UK
Supervisors: Dr Liz Williams and Dr Margo Barker
• Heterogeneity
• Memory
• Cognition
• Physiological changes
• Involvement in food preparation
Challenges of dietary assessment in Older Adults
Aim : To investigate the application of technology to
improve dietary assessment in older adults
Novel Assessment of Nutrition and Ageing - The NANA Project
• Focus groups with nutritionists, older adults, healthcare professionals to inform the conceptual and physical design
• User centred designed
• Technology exploration with older adults
- Digital cameras, mobile phones, laptops.
• Touchscreen computer was the most appropriate
Development of the NANA system
The “NANA homestation”
Web camera
“Eeetop” touch screen
computer
Speaker for voice recording
Plate guide mat
Software
Select meal
Select choose a food or drink
Select food/ drink category
Select food/ drink item
Cranberry juice
Cranberry juice
Select another food / drink category
Select another food/ drink item
Selected items
Photograph food/ drink item
Photograph food/ drink item
Enjoy your meal
Clinician tool
The validation
Hypothesis : There is no difference between the NANA homestation and an estimated 4 day food diary in reported
dietary intake.
Method
Bland-Altman
Older adult groups, volunteer email, leaflet drop n = 40
Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week 10
• 44 older adults (65 years+) were recruited
• Recorded diet using :
- NANA homestation - 3 weeks
- Estimated food diary - 4 days
- 24 hour Multiple Pass Recalls - 3 days
• Fasted blood and 24 hour urine samples for the analysis of biomarkers of nutrient status
4 days from 2nd week of NANA
4 days of estimated food diary
Average of 24 hour MPRs
• Statistical analysis in SPSS
- Correlation - Pearson and Spearman correlation coefficients
- Difference of mean - Paired t test and Wilcoxon Signed Rank
- Bland Altman analysis
Method
Windiets nutritional software
Study demographics, n = 40
Gender
Female 23 (57.5%)
Male
Age (Mean, SD)
17 (42.5%)
72 years (5.21)
BMI
Mean (SD) 26.38 (4.27)
Underweight 1 (2%)
Normal weight 14 (35%)
Over weight 17 (43%)
Obese 8 (20%)
Results
Demographic characteristics of participants
Nutrient NANA (Mean,
SD)
Estimated Food Diary
(Mean, SD)
Correlation
Coefficients (r)
Significance
Energy (KJ) ‡
7965 (1455.6)
8252 (1774.9)
0.867***
0.022*
Fat (g) †
75.5 (21.28)
79.5 (22.14)
0.849***
0.024*
Carbohydrate (g) ‡
224 (44.6)
227 (44.9)
0.815***
0.495
Protein (g) †
76.0 (13.74)
78.9 (15.14)
0.719***
0.179
Folate (µg) †
278 (82.9)
289 (87.8)
0.456**
0.262
Vitamin C (mg) †
78.8 (37.56)
84.9 (39.05)
0.543***
0.297
Vitamin E (mg) ‡
8.49 (3.459)
8.77 (4.187)
0.359*
0.909
Calcium (mg) ‡
967 (248.9)
988 (253.2)
0.355*
0.973
Iron (mg) ‡
11.6 (3.29)
12.6 (3.22)
0.394*
0.591
Results Correlation coefficients and mean difference test to compare mean daily nutrient intakes recorded by the “NANA homestation” and the food diary.
*= significant at the 0.05 level; ** = significant at the 0.01 level ; *** = significant at the <0.001 level key: †= Pearson correlation coefficient and Paired t test; ‡= Spearman’s correlation coefficient and Wilcoxon signed rank
Energy
• Intakes recorded using the “NANA homestation” were 287 KJ lower than the average reported energy intake reported by the food diary.
Bland-Altman plot for Energy (KJ) Scatterplot for Energy intakes as recorded by the
estimated food diary and the “NANA homestation”
Protein
• Values for protein intake were on average 2.80 grams lower than the protein values
recorded from the food diary.
Scatterplot for protein intakes as recorded by the
estimated food diary and the “NANA homestation”
Bland-Altman plot for Protein (g)
Vitamin C
• Vitamin C intakes recorded by the “NANA homestation” were on average 6.12 grams lower than Vitamin C intakes recorded by the food diary.
Scatterplot for Vitamin C intakes as recorded by the
estimated food diary and the “NANA homestation”
Bland-Altman plot for Vitamin C (mg)
• The “NANA homestation” consistently reported lower intakes than food diary
• Majority of nutrients – no significant differences between 2 methodologies
• The “NANA homestation” is comparable with estimated food diary
• Need to validate against biomarkers of nutrient intake
Conclusion
Acknowledgements
All Participants
Funders Economic & Social Research Council
The NANA team
Liz Williams Faustina Hwang Tim Adlam
Sarah Forster Arlene Astell Lin Maclean
Laura Brown Tom Smith Hassane Khadra
Simon Halsey Daynor Spurr Alan Godfrey
Rebecca Rowland-Jones Sarah Smith
