Abstract
Image-based dietary records have limited evidence evaluating their performance and use among adults with a chronic disease. This study evaluated the performance of a 3-day mobile phone image-based dietary record, the Nutricam Dietary Assessment Method (NuDAM), in adults with type 2 diabetes mellitus (T2DM). Criterion validity was determined by comparing energy intake (EI) with total energy expenditure (TEE) measured by the doubly-labelled water technique. Relative validity was established by comparison to a weighed food record (WFR). Inter-rater reliability was assessed by comparing estimates of intake from three dietitians. Ten adults (6 males, age: 61.2 ± 6.9 years old, BMI: 31.0 ± 4.5 kg/m2) participated. Compared to TEE, mean EI (MJ/day) was significantly under-reported using both methods, with a mean ratio of EI:TEE 0.76 ± 0.20 for the NuDAM and 0.76 ± 0.17 for the WFR. Correlations between the NuDAM and WFR were mostly moderate for energy (r = 0.57), carbohydrate (g/day) (r = 0.63, p < 0.05), protein (g/day) (r = 0.78, p < 0.01) and alcohol (g/day) (rs = 0.85, p < 0.01), with a weaker relationship for fat (g/day) (r = 0.24). Agreement between dietitians for nutrient intake for the 3-day NuDAM (Intra-class Correlation Coefficient (ICC) = 0.77–0.99) was lower when compared with the 3-day WFR (ICC = 0.82–0.99). These findings demonstrate the performance and feasibility of the NuDAM to assess energy and macronutrient intake in a small sample. Some modifications to the NuDAM could improve efficiency and an evaluation in a larger group of adults with T2DM is required.
Highlights
Nutrition therapy provided by a dietitian and self-management education and support are important strategies for the effective long-term management of type 2 diabetes mellitus (T2DM) [1]
The overall mean energy intake (EI) was 8.8 ± 2.0 MJ/day from the Nutricam Dietary Assessment Method (NuDAM) and 8.8 ± 1.8 MJ/day from the weighed food record (WFR); both were significantly lower than mean total energy expenditure (TEE) of 11.8 ± 2.3MJ/day (p < 0.01)
Three males and four males were classified as under-reporters for the NuDAM and WFR, respectively
Summary
Nutrition therapy provided by a dietitian and self-management education and support are important strategies for the effective long-term management of type 2 diabetes mellitus (T2DM) [1]. The measurement of dietary intake is necessary to inform, support and evaluate these interventions. Image-based dietary records continue to show promise in alleviating the issues associated with subject burden relating to the collection of dietary intake information among adults [6,7], including those with T2DM [8]. Evaluation of the performance of image-based dietary records as an independent prospective method to estimate nutrient intake in adults has predominantly been limited to relative validity [9,10,11,12,13] and inter-rater reliability [11,13,14]. One study [7] has determined criterion validity of self-reported energy intake (EI) derived from image-based dietary records
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