Abstract
Undernutrition remains highly prevalent in African children, highlighting the need for accurately assessing dietary intake. In order to do so, the assessment method must be validated in the target population. A triple pass 24 hour dietary recall with volumetric portion size estimation has been described but not previously validated in African children. This study aimed to establish the relative validity of 24-hour dietary recalls of daily food consumption in healthy African children living in Mbale and Soroti, eastern Uganda compared to simultaneous weighed food records. Quantitative assessment of daily food consumption by weighed food records followed by two independent assessments using triple pass 24-hour dietary recall on the following day. In conjunction with household measures and standard food sizes, volumes of liquid, dry rice, or play dough were used to aid portion size estimation. Inter-assessor agreement, and agreement with weighed food records was conducted primarily by Bland-Altman analysis and secondly by intraclass correlation coefficients and quartile cross-classification. 19 healthy children aged 6 months to 12 years were included in the study. Bland-Altman analysis showed 24-hour recall only marginally under-estimated energy (mean difference of 149kJ or 2.8%; limits of agreement -1618 to 1321kJ), protein (2.9g or 9.4%; -12.6 to 6.7g), and iron (0.43mg or 8.3%; -3.1 to 2.3mg). Quartile cross-classification was correct in 79% of cases for energy intake, and 89% for both protein and iron. The intraclass correlation coefficient between the separate dietary recalls for energy was 0.801 (95% CI, 0.429-0.933), indicating acceptable inter-observer agreement. Dietary assessment using 24-hour dietary recall with volumetric portion size estimation resulted in similar and acceptable estimates of dietary intake compared with weighed food records and thus is considered a valid method for daily dietary intake assessment of children in communities with similar diets. The method will be utilised in a sub-study of a large randomised controlled trial addressing treatment in severe childhood anaemia. This study was approved by the Mbale Research Ethics committee (Reference: 2013-050). Transfusion and Treatment of severe Anaemia in African Children: a randomized controlled Trial (TRACT) registration: ISRCTN84086586.
Highlights
Undernutrition remains highly prevalent in African children, highlighting the need for accurately assessing dietary intake
The over- and underestimation of energy and nutrients may be reduced by the modifying the triple pass method for 24-h dietary recall (24hDR), which has been shown to maximise recall accuracy for quantitation [16,17,18] by including volumetric portion size estimation, but this has yet to be evaluated in African children
Three children were moderately or severely underweight defined as Weight-for-age z-scores (WAZ) scores ≤ −2.0
Summary
Undernutrition remains highly prevalent in African children, highlighting the need for accurately assessing dietary intake. Interactive dietary recall is a potential substitute for a weighed food record This has been investigated in Ghanaian children [14] and in Malawian children [15] in studies using a single 24hDR the day following independent weighed food assessment. This method of dietary recall could only be considered partially validated in the study groups due to some biases and imprecision. The over- and underestimation of energy and nutrients may be reduced by the modifying the triple pass method for 24hDR, which has been shown to maximise recall accuracy for quantitation [16,17,18] by including volumetric portion size estimation, but this has yet to be evaluated in African children
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