Validity of a Digital Diet Estimation Method for Use with Preschool Children

Abstract

BackgroundThe validity of using the Remote Food Photography Method (RFPM) for measuring food intake of minority preschool children’s intake is not well documented. ObjectiveOur aim was to determine the validity of intake estimations made by human raters using the RFPM compared with those obtained by weighing all foods and beverages consumed by 3- to 5-year-old children (weighed method). DesignWe conducted a cross-sectional observational study. Participants/settingsA convenience sample of 54 3- to 5-year-old Hispanic and African-American children were observed during a 12-hour period at Baylor Metabolic Research Unit between June 2013 and January 2014. Main outcome measuresAll foods/beverages consumed by the children were provided by Baylor research coordinators who took and wirelessly transmitted before-and-after pictures of the trays to trained human raters at the Pennington Biomedical Research Center who estimated grams consumed. Energy and macronutrients were calculated using the Food and Nutrient Database for Dietary Studies or food facts data provided by manufacturers. Statistical analysesPaired t test, mean differences, and Bland-Altman limits of agreement were performed. ResultsCompared to the weighed method, the rater method significantly overestimated total intake by 34±71 g (P<0.0001), with a mean percent error of 2.9% (root mean square error=7.1%), and total energy intake by 75±102 kcal (P<0.0001), with a mean percent error of 7.5% (root mean square error=12.3%). The standard error for the macronutrient intakes ranged from 11.0% to 20.2%. The Bland-Altman approach demonstrated a positive slope for the rater method relative to the weighed method for total intake in grams (P=0.006), carbohydrate (P=0.01), and protein (P=0.01) (ie, magnitude of the bias increased with increasing intakes). ConclusionsThe rater method overestimated total intake in grams and energy in kilocalories in minority preschool children in a well-controlled condition and needs to be further tested in a free-living environment.