Abstract
BackgroundA Web-based dietary assessment tool—RiksmatenFlex—was developed for the national dietary survey of adolescents in Sweden.ObjectiveThis study aimed to describe the Web-based method RiksmatenFlex and to test the validity of the reported dietary intake by comparing dietary intake with 24-hour dietary recalls (recall interviews), estimated energy expenditure, and biomarkers.MethodsAdolescents aged 11-12, 14-15, and 17-18 years were recruited through schools. In total, 78 students had complete dietary information and were included in the study. Diet was reported a few weeks apart with either RiksmatenFlexDiet (the day before and a random later day) or recall interviews (face-to-face, a random day later by phone) in a cross-over, randomized design. At a school visit, weight and height were measured and blood samples were drawn for biomarker analyses. Students wore an accelerometer for 7 days for physical activity measurements. Dietary intake captured by both dietary methods was compared, and energy intake captured by both methods was compared with the accelerometer-estimated energy expenditure (EEest). Intake of whole grain wheat and rye and fruit and vegetables by both methods was compared with alkylresorcinol and carotenoid concentrations in plasma, respectively.ResultsThe mean of the reported energy intake was 8.92 (SD 2.77) MJ by RiksmatenFlexDiet and 8.04 (SD 2.67) MJ by the recall interviews (P=.01). Intake of fruit and vegetables was 224 (169) g and 227 (150) g, and whole grain wheat and rye intake was 12.4 (SD 13.2) g and 12.0 (SD 13.1) g, respectively; the intakes of fruit and vegetables as well as whole grain wheat and rye did not differ between methods. Intraclass correlation coefficients ranged from 0.57 for protein and carbohydrates to 0.23 for vegetables. Energy intake by RiksmatenFlexDiet was overreported by 8% (P=.03) but not by the recall interviews (P=.53) compared with EEest. The Spearman correlation coefficient between reported energy intake and EEest was 0.34 (P=.008) for RiksmatenFlexDiet and 0.16 (P=.21) for the recall interviews. Spearman correlation coefficient between whole grain wheat and rye and plasma total alkylresorcinol homologs was 0.36 (P=.002) for RiksmatenFlexDiet and 0.29 (P=.02) for the recall interviews. Spearman correlations between intake of fruit and vegetables and plasma carotenoids were weak for both dietary tools. The strongest correlations were observed between fruit and vegetable intake and lutein/zeaxanthin for RiksmatenFlexDiet (0.46; P<.001) and for recall interviews (0.28; P=.02).ConclusionsRiksmatenFlexDiet provides information on energy, fruit, vegetables, and whole grain wheat and rye intake, which is comparable with intake obtained from recall interviews in Swedish adolescents. The results are promising for cost-effective dietary data collection in upcoming national dietary surveys and other studies in Sweden. Future research should focus on how, and if, new technological solutions could reduce dietary reporting biases.
Highlights
There is a need for cost-effective dietary assessment methods that provide data of high quality to enable studies on diet and health
231 (54%) participated in at least one part of the study, 205 participants completed the first day by both methods (113 started with RiksmatenFlexDiet and 118 started with recall interviews), and 78 participants completed 2 days by both methods (36 started with RiksmatenFlexDiet and 42 started with recall interviews)
The results of this study suggest that RiksmatenFlexDiet provides dietary intake estimates comparable to recall interviews in adolescents
Summary
There is a need for cost-effective dietary assessment methods that provide data of high quality to enable studies on diet and health. FFQs, are less accurate than open-ended dietary assessment methods [1,2]. They provide less detail on the type and amounts of foods eaten and no information on meal patterns. The European Food Safety Authority (EFSA) recommends two 24-hour dietary recall interviews with at least one face-to-face interview for national dietary surveys of adults and children from the age of 10 years [3]. A Web-based dietary assessment tool—RiksmatenFlex—was developed for the national dietary survey of adolescents in Sweden Educational levels of both parents were reported in RiksmatenFlexQ [36]. Height and weight were measured and nonfasting blood was collected from all participants at visit 2. Height and weight were used to estimate energy expenditure (see below)
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