Methodological Approaches for Dietary Intake Assessment in Formula-fed Infants

Background and Objective: The estimation of dietary intake remains a challenge in human nutritional studies. In infants, the use of food diaries (FDs) is a suitable method already validated; however, this method is not exempt from error. In formula-fed infants, dilution of powdered formulas may produce errors. Our aim was to develop and validate standard operating procedures (SOPs) for the assessment of dietary intake in formula-fed infants, attending potential sources of error. Methods: We analysed sources of error in a random subsample of 3-day FDs from 100 infants enrolled in the European Childhood Obesity Project. Calculations to estimate intakes were standardised and included in a software tool (SOPsystem). An evaluation of a simulated FD was performed by 9 trained nutritionists and 23 nutrition students (n = 225 and n = 575 bottle evaluations, respectively) to compare the results obtained when using or not the SOPsystem. Correct answers (%), coefficients of variation, and the time spent (minutes) to assess the simulated FD were analysed. Results: Overall, 60% of the FDs contained reports of incorrect volumes, and 37% reported incorrect formula dilutions. When the SOPsystem was used, correct answers in the simulated FD were more frequent (P < 0.001) and the mean coefficient of variation and the time spent were lower (P < 0.005 and P < 0.01, respectively). Conclusions: The development and implementation of SOPs with a software tool that identifies specific sources of error in record-keeping achieved a harmonised and improved process for assessing dietary intakes in formula-fed infants, minimising errors in calculations and reducing the work time invested

Implementing experiential learning activities in a large enrollment introductory food science and human nutrition course

Experiential learning activities are often viewed as impractical, and potentially unfeasible, instructional tools to employ in a large class. Research has shown, though, that the metacognitive skills that students utilize while participating in experiential learning activities enable students to assess their true level of understanding and mastery for the subject matter. The objective of this study was to evaluate whether students in a large (~660 person) Introduction to Food Science and Human Nutrition (FSHN 101) course improved their understanding of dietary intake and food safety after participating in two experiential learning activities developed for these course topics. The first activity, completed during class, asked students to select one day???s worth of food from a list of menu choices, calculate the nutritional value of their food choices, and then compare their daily nutritional intake to the dietary reference intakes for their gender, age category and health status. The second activity, completed via the course website, asked students to complete one food safety survey prior to the commencement of the course???s food microbiology section to assess the students' personal food safety behaviors and a second survey upon completion of the section to assess students' knowledge of recommended food safety practices. Students were asked to evaluate both the cognitive and affective aspects of the experiential learning activities by completing a reflective questionnaire after participating in each activity. Overall, students' responses revealed that the activities were effective learning tools and that the students liked engaging with the material on a personal application level. A Poster version of this article can be found in the IDEALS SoTL Presentations and Posters folder.published or submitted for publicationis peer reviewe

UK Nutrition Research Partnership (NRP) workshop:Forum on advancing dietary intake assessment

The development of better and more robust measures of dietary intake in free living situations was identified as a priority for advancing nutrition research by the Office of Strategic Coordination for Health Research (OSCHR) Review of Nutrition and Human Health Research in 2017. The UK Nutrition Research Partnership (NRP) sponsored a workshop on Dietary Intake Assessment methodology alongside its series of ‘Hot Topic’ workshops designed to accelerate progress in nutrition research by bringing together people from a range of different disciplines. The workshop on Dietary Intake Assessment methodology took place via Zoom over two half‐days in January 2021 and included 50 scientists from a wide range of disciplines. The problems with current methods of dietary assessment and how emerging technologies might address them were set out in pre‐recorded presentations and explored in panel discussions. Participants then worked in breakout groups to discuss and prioritise the research questions that should be addressed to best further the field and lead to improvements in dietary assessment methodology. Five priority research questions were selected. Participants were asked to brainstorm potential approaches for addressing them and were then asked to focus on one approach and develop it further. At the end of these sessions, participants presented their project ideas to the rest of the workshop and these will be reported back to the Medical Research Council. It is hoped that potential collaborative projects arising from these discussions will be taken forward in response to future funding calls

Energy Expenditure, Availability, and Dietary Intake Assessment in Competitive Female Dragon Boat Athletes

Dragon boat racing requires high physical activity levels during competition and training. The female athletic triad refers to a number of negative health consequences (e.g., amenorrhoea, low bone mineral density, and low energy availability) that may result from high physical activity in female athletes in parallel with inadequate dietary intake. This study aimed to estimate energy expenditure and dietary adequacy in female competitive dragon boat athletes. Following ethical approval, energy expenditure was assessed by use of SensewearTM armbands (which measure movement as well as galvanic heat loss) on nine dragon boat athletes preparing for the Southeast Asian Games 2013. The mean estimated energy expenditure for the athletes was 2226 ± 711 kJ/day. Mean total energy, recorded using three-day food diaries (6715 ± 2518 kJ/day) and energy availability (99 ± 56 kJ/kg/day), were low. Estimated micronutrient intake (calcium 699.3 ± 328.7 mg/day and iron 10.6 ± 4.7 mg/day) did not meet recommended daily allowances of 800 mg/day and 19 mg/day, respectively. The low intake of energy, calcium, and iron noted within this study could have negative effects on performance and short- and long-term health in female dragon boat athletes

Online dietary intake assessment using a graphical food frequency app (eNutri): usability metrics from the EatWellUK study

With widespread use of the internet, lifestyle and dietary data collection can now be facilitated using online questionnaires as opposed to paper versions. We have developed a graphical food frequency assessment app (eNutri), which is able to assess dietary intake using a validated food frequency questionnaire (FFQ) and provide personalised nutrition advice. FFQ user acceptance and evaluation have not been investigated extensively and only a few studies involving user acceptance of nutrition assessment and advice apps by older adults are published.A formative study with 20 participants (including n = 10 ≥60 years) assessed the suitability of this app for adults and investigated improvements to its usability. The outcomes of this formative study were applied to the final version of the application, which was deployed in an online study (EatWellUK) with 324 participants (including n = 53 ≥60 years) in the UK, using different devices (smartphones, tablets and laptops/desktops). Completion times were based on browser timestamps and usability was measured using the System Usability Scale (SUS), scoring between 0 and 100. Products with a SUS score higher than 70 are considered to be good.In the EatWellUK study, SUS score median (n = 322) was 77.5 (IQR 15.0). Out of the 322 SUS questionnaire completions, 321 device screen sizes were detected by the app. Grouped by device screen size, small (n = 92), medium (n = 38) and large (n = 191) screens received median SUS scores of 77.5 (IQR 15.0), 75.0 (IQR 19.4) and 77.5 (IQR 16.25), respectively. The median SUS scores from younger (n = 268) and older participants (n = 53) were the same. The FFQ contained 157 food items, and the mean completion time was 13.1 minutes (95% CI 12.6-13.7 minutes). Small, medium and large screen devices resulted in completion times of 11.7 minutes (95% CI 10.9-12.6 minutes), 14.4 minutes (95% CI 12.9-15.9 minutes) and 13.6 minutes (95% CI 12.8-14.3 minutes), respectively.The overall median SUS score of 77.5 and overall mean completion time of 13.3 minutes indicate good overall usability, and equally, comparable SUS scores and completion times across small, medium and large screen sizes indicates good usability across devices. This work is a step toward the promotion of wider uptake of online apps that can provide online dietary intake assessment at-scale, with the aim of addressing pressing epidemiological challenges

A review of the use of information and communication technologies for dietary assessment

Presently used dietary-assessment methods often present difficulties for researchers and respondents, and misreporting errors are common. Methods using information and communication technologies (ICT) may improve quality and accuracy. The present paper presents a systematic literature review describing studies applying ICT to dietary assessment. Eligible papers published between January 1995 and February 2008 were classified into four assessment categories: computerised assessment; personal digital assistants (PDA); digital photography; smart cards. Computerised assessments comprise frequency questionnaires, 24 h recalls (24HR) and diet history assessments. Self-administered computerised assessments, which can include audio support, may reduce literacy problems, be translated and are useful for younger age groups, but less so for those unfamiliar with computers. Self-administered 24HR utilising computers yielded comparable results as standard methods, but needed supervision if used in children. Computer-assisted interviewer-administered recall results were similar to conventional recalls, and reduced inter-interviewer variability. PDA showed some advantages but did not reduce underreporting. Mobile phone meal photos did not improve PDA accuracy. Digital photography for assessing individual food intake in dining facilities was accurate for adults and children, although validity was slightly higher with direct visual observation. Smart cards in dining facilities were useful for measuring food choice but not total dietary intake. In conclusion, computerised assessments and PDA are promising, and could improve dietary assessment quality in some vulnerable groups and decrease researcher workload. Both still need comprehensive evaluation for micronutrient intake assessment. Further work is necessary for improving ICT tools in established and new methods and for their rigorous evaluatio

Gap analysis of nickel bioaccessibility and bioavailability in different food matrices and its impact on the nickel exposure assessment

The metal nickel is well known to cause nickel allergy in sensitive humans by prolonged dermal contact to materials releasing (high) amounts of nickel. Oral nickel exposure via water and food intake is of potential concern. Nickel is essential to plants and animals and can be naturally found in food products or contamination may occur across the agro-food chain. This gap analysis is an evaluation of nickel as a potential food safety hazard causing a risk for human health. In the first step, the available data regarding the occurrence of nickel and its contamination in food and drinks have been collected through literature review. Subsequently, a discussion is held on the potential risks associated with this contamination. Elevated nickel concentrations were mostly found in plant-based foods, e.g. legumes and nuts in which nickel of natural origin is expected. However, it was observed that dedicated and systematic screening of foodstuffs for the presence of nickel is currently still lacking. In a next step, published studies on exposure of humans to nickel via foods and drinks were critically evaluated. Not including bioaccessibility and/or bioavailability of the metal may lead to an overestimation of the exposure of the body to nickel via food and drinks. This overestimation may be problematic when the measured nickel level in foods is high and bioaccessibility and/or bioavailability of nickel in these products is low. Therefore, this paper analyzes the outcomes of the existing dietary intake and bioaccessibility/bioavailability studies conducted for nickel. Besides, the available gaps in nickel bioaccessibility and/or bioavailability studies have been clarified in this paper. The reported bioaccessibility and bioavailability percentages for different food and drinks were found to vary between < LOD and 83% and between 0 and 30% respectively. This indicates that of the total nickel contained in the foodstuffs only a fraction can be absorbed by the intestinal epithelium cells. This paper provides a unique critical overview on nickel in the human diet starting from factors affecting its occurrence in food until its absorption by the body

The potential health benefits of seaweed and seaweed extract

Edible seaweeds have historically been consumed by coastal populations across the globe. Today, seaweed is still part of the habitual diet in many Asian countries. Seaweed consumption also appears to be growing in popularity in Western cultures, due both to the influx of Asian cuisine as well as notional health benefits associated with consumption. Isolates of seaweeds (particularly viscous polysaccharides) are used in an increasing number of food applications in order to improve product acceptability and extend shelf-life. Epidemiological evidence suggests regular seaweed consumption may protect against a range of diseases of modernity. The addition of seaweed and seaweed isolates to foods has already shown potential to enhance satiety and reduce the postprandial absorption rates of glucose and lipids in acute human feeding studies, highlighting their potential use in the development of anti-obesity foods. As seaweeds and seaweed isolates have the potential to both benefit health and improve food acceptability, seaweeds and seaweed isolates offer exciting potential as ingredients in the development of new food products. This review will outline the evidence from human and experimental studies that suggests consumption of seaweeds and seaweed isolates may impact on health (both positively and negatively). Finally, this review will highlight current gaps in knowledge in this area and what future strategies should be adopted for maximising seaweed's potential food uses

Evaluation of acceptability, functionality, and validity of a passive image-based dietary intake assessment method in adults and children of Ghanaian and Kenyan origin living in London, UK

BACKGROUND: Accurate estimation of dietary intake is challenging. However, whilst some progress has been made in high-income countries, low- and middle-income countries (LMICs) remain behind, contributing to critical nutritional data gaps. This study aimed to validate an objective, passive image-based dietary intake assessment method against weighed food records in London, UK, for onward deployment to LMICs. METHODS: Wearable camera devices were used to capture food intake on eating occasions in 18 adults and 17 children of Ghanaian and Kenyan origin living in London. Participants were provided pre-weighed meals of Ghanaian and Kenyan cuisine and camera devices to automatically capture images of the eating occasions. Food images were assessed for portion size, energy, nutrient intake, and the relative validity of the method compared to the weighed food records. RESULTS: The Pearson and Intraclass correlation coefficients of estimates of intakes of food, energy, and 19 nutrients ranged from 0.60 to 0.95 and 0.67 to 0.90, respectively. Bland-Altman analysis showed good agreement between the image-based method and the weighed food record. Under-estimation of dietary intake by the image-based method ranged from 4 to 23%. CONCLUSIONS: Passive food image capture and analysis provides an objective assessment of dietary intake comparable to weighed food records

Dietary intake and nutritional status of Korean migrants in New Zealand : a thesis presented in partial fulfillment of the requirements for the degree of Master of Science in Nutritional Science at Massey University

Migration to a new country presents many lifestyle challenges that may influence future health outcomes. In particular, eating patterns may be altered due to the expense or lack of availability of foods typical of the immigrant's usual diet and the relative abundance of unfamiliar, locally produced foods. Studies of migrants carried out in host countries have shown that the change of living environment is associated with changes in food choices, activity patterns and other lifestyle factors. This may then be reflected by changes in health indicators: e.g., body measurements, and consequently morbidity and mortality. The latest census indicates that Koreans are the fastest growing ethnic group and the third largest Asian ethnic group in New Zealand after Chinese and Indians. Nonetheless, to date no studies have examined the nutritional outcomes resulting from the migration of Koreans to New Zealand. Hence, a study is needed to determine the dietary habits and the possible impact of the diet on risk factors for health and disease among Korean migrants. As a pilot study, the purpose of this study was to assess dietary intake and other health related measures in a sample of 50 middle-aged (40-55 years) Korean females who have lived in New Zealand for at least 5 years. The study assessed sociodemographic characteristics, activity level, dietary intake, factors related to the dietary intake and anthropometric and biochemical measurements by questionnaires, 24-hour dietary recall and appropriate body measurements. The body measurements included weight, height, triceps and subscapular skinfolds, waist, hip, and upper arm circumference, elbow breadth, body fat using Bioelectrical Impedance Analysis, blood pressure and blood glucose level. The nutrient intakes of subjects were found to be generally adequate and the proportions of energy derived from macronutrients (Carbohydrate:Protein:Fat =55:17:26) were also considered to be in the adequate range. However, low intakes of calcium (596mg) and zinc (8mg) and high intake of sodium (3749mg) were identified as the main nutritional problems in this population. The nutrient intakes of Korean immigrants to New Zealand with longer residences (≥8.8 years) did not differ from those with shorter residences (<8.8 years). This suggests that the dietary acculturation of migrant Koreans may have taken place during the early years of residence in New Zealand (<5 years). The findings from this study further indicate that Korean migrants have not changed their traditional dietary habit to any great extent and that rice and kimchi still hold a prominent place in their diet. While the intakes of the study participants were generally similar to reported intakes from Korean and New Zealand national surveys, the intakes of some nutrients were intermediate in the study participants (Korean immigrants) between those of native Koreans and New Zealanders; intakes of calcium in migrant Koreans were lower than those of New Zealand women, but higher than native Koreans because of a significantly greater intake of dairy products. The risk associated with BMI is difficult to evaluate in this population group because of differences between Korean and New Zealand standards. The subjects had a much lower prevalence of obesity, measured by the BMI, according to the New Zealand (2%) compared to the Korean classification (24%) (p=0.005). Similarly, the subjects had a lower prevalence of increased disease risk, measured by waist circumference, according to the global classification (8%) compared to the Asian classification (24%) (p=0.029). However, almost half of all subjects fell into the 'at risk' group for WHR, suggesting that subjects may have more body fat in the upper body in relation to their body size. These findings suggest that appropriate ethnic-specific obesity indicators need to be developed to monitor anthropometric changes in migrant populations. The majority of subjects fell into the normal blood pressure range with only two hypertensive women in the study group. The findings from this study identified the areas of concern in nutrition and indicated the need for further research into this population. Furthermore, these results may be used to develop culturally appropriate nutrition education materials and programmes