New and Innovative Dietary Assessment Methods. German Institute for Human Nutrition, Potsdam- Rehbruecke Dr. Karen Wagner/Anne-Kathrin Illner

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1 New and Innovative Dietary Assessment Methods German Institute for Human Nutrition, Potsdam- Rehbruecke Dr. Karen Wagner/Anne-Kathrin Illner

2 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

3 Overview New Method Number of Studies Validation Studies Feasibility Studies and other PDA Picture-sort FFQ 2 2 Smart-card 3 3 Bar code scanner 2 2 Computer-tools 3 3 Web-FFQ Web-24 HDR 2 2 Statistical method 2 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

4 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), (6): p

5 Wellnavi Studies Author Methods Subjects Results for nutrient intake Wang et al, 2006 Wellnavi vs. 1d- WFR ± 0.5 y r = less burden & time consuming (57%) Kikunaga et al, 2007 Wellnavi vs. 5d-WFR 1 75 & 48.8 ± 10.2 y r = underestimation 1 WFR: weighted food record Wang, D.H., M. Kogashiwa, and S. Kira, Development of a new instrument for evaluating individuals' dietary intakes. J Am Diet Assoc, (10): p 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), (2): p

PDA (2) 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

6 PDA (2) 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 Fig. 2: DietMatePro -Display Beasley, J., W.T. Riley, and J. Jean-Mary, Accuracy of a PDA-based dietary assessment program. Nutrition, (6): p

7 DietMatePro Studies Author Methods Subjects Results for nutrient intake Beasley et al, 2005 DietMatePro vs: 1) 24HDR 1 39 & 53 ± 1,7 y 1) r = ) r = ) Weighed meal + training essential Beasley et al, 2008 DietMatePro vs: 1) 24HDR 1 2) Paper-diary 174 & 1) r = ) r = training essential 1 HDR: 24 Hour dietary recall Beasley, J., W.T. Riley, and J. Jean-Mary, Accuracy of a PDA-based dietary assessment program. Nutrition, (6): p 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 Apr;27(2):280-6.

8 PDAs Weaknesses high technical and staff requirements expensive training required inaccurate estimation of portion size Benefits usefully measure of individual dietary intake for a variety of nutrients immediate data transfer facilitated data coding low correlation coefficient useful to reach low-literacy groups, e.g. children, elderly

9 Alternatives to measure self-reported food intake in large-scale studies?

10 Web-based FFQs Author Methods Subjects Results Beasley et al, 2008 Matthys et al, 2007 Web-DHQ 1 vs: 1) PDHQ 2 2) 24 HDR 3 3) 4d-FR & 54.9 ± 14.4 y 1) r = ) r = ) r = 0.41 (for nutrient intake) Web-based FFQ 104 & r = 0.20 to 0.64 vs 3d-WFR 5 (for food intake) 1 DHQ: Diet History Questionnaire 2 PDHQ: Paper-Diet History Questionnaire 3 HDR: 24 Hour dietary recall 4 FR: food record 5 WFR: weighted food record Beasley, J. M., Davis, A., and Riley, W. T. Evaluation of a web-based, pictorial diet history questionnaire. Public Health Nutr: 1-9, 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: , 2007

11 Web-based FFQs Weaknesses finite food list with often closed ended response categories measurement error (no quantification) burden & selection bias - cognitive difficult - computer literacy Benefits 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 feedback, 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 S , 2005.

12 Outlook 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?

13 Thank you for your attention!

15 Wellnavi Validity I 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 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), (6): p

16 Wellnavi Validation II 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. Wang, D.H., M. Kogashiwa, and S. Kira, Development of a new instrument for evaluating individuals' dietary intakes. J Am Diet Assoc, (10): p

17 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

18 Application Wellnavi 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 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), (2): p

19 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, (6): p

20 DietMatePro Validation (1) DietMatePro vs. 24 hr recall and weighed meal Design: Subjects: Results: Randomized controlled trial 39 participants 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 Beasley, J., W.T. Riley, and J. Jean-Mary, Accuracy of a PDA-based dietary assessment program. Nutrition, (6): p

21 DietMatePro Validation (2) DieMatePro or paper food diary vs 24 hr recall Design: Subjects: Results: Randomized controlled trial 174 overweight/obese participants (BMI kg/m²) 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 Apr;27(2):280-6.

22 web-based questionnaires Web-based version of the NCI diet history questionnaire (web-pdhq) Beasley et al, 2008 Design: Subjects: Results: comparing web-pdhq vs original paper DHQ 4day food record and 24 hr recall as reference 218 subjects r = 0.82 between web-pdhq/original paper DHQ Beasley, J. M., Davis, A., and Riley, W. T. Evaluation of a web-based, pictorial diet history questionnaire. Public Health Nutr: 1-9, 2008.

23 web-based questionnaires 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 = to 0.64 acceptable validity only for: water, fruit, bread, and fish/eggs/meat 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: , 2007

24 Web-based tool MyPyramid Tracker, Juan et al, 2006 Design: comparing web-ffq vs diary Subjects: 104 adolescents (12 to 18 years) Results: r = to 0.64 acceptable validity only for: water, fruit, bread, and fish/eggs/meat 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.

25 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

Evaluation of new technology-based tools for dietary intake assessment

Evaluation of new technology-based tools for dietary intake assessment Alison Eldridge, PhD, RD Nestlé Research Center, Lausanne On behalf of the ILSI Europe Expert Group Evaluation of new methods for