Development and Validation of an Expedited 10 g Protein Counter (EP-10) for Dietary Protein Intake Quantification

Abstract

Precise protein quantification is essential in clinical dietetics, particularly in the management of renal, burn, and malnourished patients. The expedited 10 g protein counter (EP-10) was developed to expedite the estimation of dietary protein for nutritional assessment and recommendation. The main objective of this study was to compare the validity and efficacy of the EP-10 with the American Dietetic Association's "Exchange List for Meal Planning" (ADA-7 g) in quantifying dietary protein intake, against computerized nutrient analysis (CNA). Protein intake of 197 food records kept by healthy adult subjects in Singapore was determined thrice using 3 different methods: (1) EP-10, (2) ADA-7 g, and (3) CNA using SERVE program (Version 4.0). Assessments using the EP-10 and ADA-7 g were performed by 2 assessors in a blind crossover manner while a third assessor performed the CNA. All assessors were blind to each other's results. Time taken to assess a subsample (n = 165) using the EP-10 and ADA-7 g was also recorded. Mean difference in protein intake quantification when compared with the CNA was statistically nonsignificant for the EP-10 (1.4 ± 16.3 g, P = .239) and statistically significant for the ADA-7 g (-2.2 ± 15.6 g, P = .046). Both the EP-10 and ADA-7 g had clinically acceptable agreement with the CNA, as determined via Bland-Altman plots, although it was found that EP-10 had a tendency to overestimate with protein intakes above 150 g. The EP-10 required significantly less time for protein intake quantification than the ADA-7 g (mean time of 65 ± 36 seconds vs. 111 ± 40 seconds, P < .001). The EP-10 and ADA-7 g are valid clinical tools for protein intake quantification in an Asian context, with EP-10 being more time efficient. However, a dietician's discretion is needed when the EP-10 is used on protein intakes above 150 g.