Automated Self-Administered 24-H Dietary Assessment Tool (ASA24) recalls for parent proxy-reporting of children's intake (> 4 years of age): a feasibility study

Background: Robust measurement of dietary intake in population studies of children is critical to better understand the diet-health nexus. It is unknown whether parent proxy-report of children's dietary intake through online 24-h recalls is feasible in large cohort studies. Objectives: The primary objective of this study was to describe the feasibility of the Automated Self-Administered 24-h Dietary Assessment Tool (ASA24) to measure parent proxy-reported child dietary intake. A secondary objective was to compare intake estimates with those from national surveillance. Methods: Parents of children aged 4-15 years participating in the TARGet Kids! research network in Toronto, Canada were invited by email to complete an online ASA24-Canada-2016 recall for their child, with a subsample prompted to complete a second recall about 2 weeks later. Descriptive statistics were reported for ASA24 completion characteristics and intake of several nutrients. Comparisons were made to the 2015 Canadian Community Health Survey (CCHS) 24-h recall data. Results: A total of 163 parents completed the first recall, and 46 completed the second, reflecting response rates of 35% and 59%, respectively. Seven (4%) first recalls and one (2%) second recall were excluded for ineligibility, missing data, or inadvertent parental self-report. The median number of foods reported on the first recall was 18.0 (interquartile range (IQR) 6.0) and median time to complete was 29.5 min (IQR 17.0). Nutrient intakes for energy, total fat, protein, carbohydrates, fiber, sodium, total sugars, and added sugars were similar across the two recalls and the CCHS. Conclusions: The ASA24 was found to be feasible for parent proxy-reporting of children's intake and to yield intake estimates comparable to those from national surveillance, but strategies are needed to increase response rate and support completion to enhance generalizability.</p

Validation of a parent proxy-reported beverage screener compared to a 24-hour dietary recall for the measurement of sugar-containing beverage intake among young children

Measures that can provide reasonably accurate estimates of sugar-containing beverage (SCB) intake among children are needed. The primary objective of this study was to evaluate the relative validity of a short beverage screener (Nutrition and Health Questionnaire, NHQ) compared to a 24-hour recall (Automated Self-Administered 24-h (ASA24) Dietary Assessment Tool-Canada) for assessing parent proxy-reported daily SCB intake among children aged 4-14 years from the TARGet Kids! research network in Toronto, Canada. Children for whom a NHQ completed between March 2018 and June 2019 and an ASA24 completed within one year were included. A total of 471 parents who completed the NHQ beverage screener were also asked to complete the ASA24. One-hundred sixty-three completed the ASA24 and of this group, 109 were analyzed. Estimates of daily intake of 100% juices, sweetened drinks and soda, and total SCBs from the two measures were compared. The mean difference in beverage intake, Spearman correlations, and Bland-Altman plots were estimated for continuous measures. The kappa coefficient, sensitivity, and specificity were calculated for dichotomous measures of any daily intake versus none. The mean difference in total SCB intake between the NHQ and ASA24 was 0.14 cups/day (95% CI 0.01, 0.29) and the correlation was 0.43 (95% CI 0.26, 0.57). Sensitivity and specificity for any daily SCB intake were 0.63 and 0.76, respectively. Overall, parent proxy-reporting of children's total SCB intake from a beverage screener can provide reasonable estimates of SCB intake when detailed dietary assessment is not feasible.</p

Descriptive characteristics of study sample of N = 109 children participating in the validation of a parent proxy-reported short beverage screener against a 24-hour recall.

Descriptive characteristics of study sample of N = 109 children participating in the validation of a parent proxy-reported short beverage screener against a 24-hour recall.</p

Mean difference and correlation between beverage volumes for a sub-sample of N = 101 children participating in the validation of a parent proxy-reported short beverage screener (Nutrition and Health Questionnaire; NHQ) against a 24-hour recall (Automated Self-Administered 24-h Dietary Assessment Tool-Canada; ASA24).

Sub-sample contained those children whose parents indicated that their 24-hour recall represented typical intake. Beverage volumes are reported as mean (SD). Mean difference and Spearman correlation are reported with the 95% confidence interval (CI). (DOCX)</p

Kappa coefficient, sensitivity, and specificity for any daily SCB intake (>0 cups/day) compared to none (0 cups/day) for the N = 109 children participating in the validation of a parent proxy-reported short beverage screener (Nutrition and Health Questionnaire; NHQ) against a 24-hour recall (Automated Self-Administered 24-h Dietary Assessment Tool-Canada; ASA24).

Kappa coefficient, sensitivity, and specificity for any daily SCB intake (>0 cups/day) compared to none (0 cups/day) for the N = 109 children participating in the validation of a parent proxy-reported short beverage screener (Nutrition and Health Questionnaire; NHQ) against a 24-hour recall (Automated Self-Administered 24-h Dietary Assessment Tool-Canada; ASA24).</p

Bland-Altman plot.

Describes the agreement between a parent proxy-reported short beverage screener (Nutrition and Health Questionnaire; NHQ) and a 24-hour recall (Automated Self-Administered 24-h Dietary Assessment Tool-Canada; ASA24) for total sugar-containing beverages (SCBs) among N = 109 children. The solid red line represents the mean of the difference between the two measures (-0.14 cups/day). The dashed red lines represent +/- 2 standard deviations of this difference (1.43 cups/day, -1.72 cups/day).</p

Question number 28 on the <i>TARGet Kids</i>! Nutrition and Health Questionnaire (NHQ).

This was the short beverage screener used in this study for comparison with the 24-hour dietary recall. (TIF)</p

Descriptive characteristics of a sub-sample of N = 101 children participating in the validation of a parent proxy-reported short beverage screener against a 24-hour recall.

Sub-sample contained those children whose parents indicated that their 24-hour recall represented typical intake. Values are reported as Mean (SD) or n (%) where appropriate. (DOCX)</p

Nutritional Risk in Early Childhood and School Readiness

Background Nutrition in early childhood is important for healthy growth and development. Achieving school readiness is considered one of the most important developmental milestones for young children. Objectives The purpose of this study is to determine if nutritional risk in early childhood is associated with school readiness in kindergarten. Methods A prospective cohort study was conducted through The Applied Research Group for Kids (TARGet Kids!) primary care research network in Toronto, Canada, 2015–2020. Nutritional risk was measured (18 mo to 5 y) using validated parent-completed questionnaires called Nutrition Screening for Toddlers and Preschoolers (NutriSTEP). High nutritional risk was categorized as scores ≥21. School readiness was measured using the validated teacher-completed Early Developmental Instrument (EDI), which measures 5 developmental domains in kindergarten (2 y of schooling, ages 4–6 y, before they enter grade 1). Vulnerability indicates scores lower than a population-based cutoff at the 10th percentile on at least 1 domain. Multiple logistic and linear regression models were conducted adjusting for relevant confounders. Results The study included 896 children: 53% were male, 9% had high nutritional risk, and 17% were vulnerable on the EDI. A 1-SD increase in NutriSTEP total score was associated with 1.54 times increased odds of being vulnerable on the EDI among children in year 2 of kindergarten (P = 0.001). High nutritional risk cutoff was associated with 4.28 times increased odds of being vulnerable on the EDI among children in year 2 of kindergarten (P Conclusions Higher nutritional risk in early childhood is associated with lower school readiness in year 2 of kindergarten. Nutritional interventions early in life may offer opportunities to enhance school readiness. This trial was registered http://www.clinicaltrials.gov as NCT01869530.</p

Mean difference and correlation between beverage volumes for the N = 109 children participating in the validation of a parent proxy-reported short beverage screener (Nutrition and Health Questionnaire; NHQ) against a 24-hour recall (Automated Self-Administered 24-h Dietary Assessment Tool-Canada; ASA24).

Mean difference and correlation between beverage volumes for the N = 109 children participating in the validation of a parent proxy-reported short beverage screener (Nutrition and Health Questionnaire; NHQ) against a 24-hour recall (Automated Self-Administered 24-h Dietary Assessment Tool-Canada; ASA24).</p