Abstract
Overreporting of dietary intake in infants is a problem when using food records (FR), distorting possible relationships between diet and health outcomes. Image-assisted dietary assessment may improve the accuracy, but to date, evaluation in the pediatric setting is limited. The aim of the study was to compare macronutrient and energy intake by using an active image-assisted five-day FR against a regular five-day FR, and to validate image-assistance with total energy expenditure (TEE), was measured using doubly labeled water. Participants in this validation study were 22 healthy infants randomly selected from the control group of a larger, randomized intervention trial. The parents reported the infants’ dietary intake, and supplied images of main course meals taken from standardized flat-surfaced plates before and after eating episodes. Energy and nutrient intakes were calculated separately using regular FR and image-assisted FRs. The mean (± standard deviations) energy intake (EI) was 3902 ± 476 kJ/day from the regular FR, and 3905 ± 476 kJ/day from the FR using active image-assistance. The mean EI from main-course meals when image-assistance was used did not differ (1.7 ± 55 kJ, p = 0.89) compared to regular FRs nor did the intake of macronutrients. Compared to TEE, image-assisted FR overestimated EI by 10%. Without validation, commercially available software to aid in the volume estimations, food item identification, and automation of the image processing, image-assisted methods remain a more costly and burdensome alternative to regular FRs in infants. The image-assisted method did, however, identify leftovers better than did regular FR, where such information is usually not readily available.
Highlights
Dietary assessments from food records (FR) are commonly used to assess children’s food and nutrient intake, and possible relationships between dietary intake and health outcomes [1]
When comparing the food records with and without image assistance, we found that 23 meals (29%) had to be adjusted, since the meal images contained additional information to correctly estimate the intake from the meals, and 22 of the 23 adjusted meals were overestimations, i.e., the parents had omitted to exclude foods left over or spilled on or around the plate
energy intake (EI) from the main course meals were a mix of equal numbers of over- and underestimated meals (Table 3) and the errors were balanced out and had no effect on the average energy or macronutrient intake (Table 2)
Summary
Dietary assessments from food records (FR) are commonly used to assess children’s food and nutrient intake, and possible relationships between dietary intake and health outcomes [1]. In infants and young children, parents are asked to record everything that the child has eaten and drunk during a predefined time period [2]. Meals with complex content, such as main course meals with several ingredients, are challenging to remember, record, and to determine the amounts of the various ingredients [5]. Food records tend to overestimate energy intake, e.g., parents may misreport the child’s intake by failing to omit food leftovers and spillage from the FRs [4,5,6]. In order to better understand the complex
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