Automated Multiple-Pass Method Research Articles

The Use of Digital Images in 24-Hour Recalls May Lead to Less Misestimation of Portion Size Compared with Traditional Interviewer-Administered Recalls

Background: The Automated Self-Administered 24-hour (ASA24) dietary recall system enhances the feasibility of collecting high-quality intake data in population-based studies.Objective: The aim of this study was to assess the accuracy of portion size reporting in the ASA24 compared with interviewer-administered recalls.Methods: True intake for 3 meals was ascertained in 81 adults aged 20–70 y from the Washington, DC area. Participants were randomly assigned to complete an unannounced ASA24 or an interviewer-administered Automated Multiple-Pass Method (AMPM) recall the following day. An adapted Bland-Altman approach was used to assess agreement between true and reported portion sizes. Linear regression was used to assess log-scale differences between true and reported portion sizes by recall mode. The proportions of reported portion sizes within 10% and 25% of truth were estimated. Analyses were conducted for all foods and drinks and predetermined categories.Results: Mean differences between true and reported portion sizes were 3.7 g for the ASA24 and 11.8 g for the AMPM. According to the Bland-Altman-type plots, between 92% and 100% (depending on food or drink category and recall mode) of observations fell within the limits of agreement. After adjustment for multiple testing, the mean ratio of reported to true portion sizes was significantly >1 for the categories of all foods and drinks, all foods excluding liquids, amorphous or soft foods, and small pieces among AMPM respondents. Misestimation in the AMPM was significantly different from that in the ASA24 for all foods and drinks and for all foods excluding liquids. Small proportions of reported portions fell within 10% (16.2% for the ASA24 and 14.9% for the AMPM) and 25% (37.5% for the ASA24 and 33.2% for the AMPM) of truth.Conclusions: The results raise the possibility that digital images tailored to different types and formats of foods may facilitate improved estimation of amounts eaten but highlight the need for continued work in this aspect of dietary assessment. This trial was registered at clinicaltrials.gov as NCT00978406.

Consumption of Milk and alternatives decreased among Canadians from 2004 to 2015: evidence from the Canadian community health surveys

BackgroundMilk and milk products make important contributions to the diet of Canadians. The aim of this study was to examine trends in Milk & Alternatives consumption among Canadians (≥2 years) from 2004 to 2015.MethodsWe used nutrition data from 2 nationally representative cross-sectional surveys conducted in 2004 and 2015 [Canadian Community Health Survey (CCHS) 2004 Cycle 2.2 and CCHS-Nutrition 2015] to compare Milk & Alternatives consumption between 2004 and 2015. Data from 24-h dietary recalls were collected using the Automated Multiple-Pass Method (AMPM).ResultFrom 2004 to 2015, the proportion of Canadians consuming Milk & Alternatives food group significantly decreased from 89.5 to 87.7% and the number of servings consumed per day dropped from 1.9 to 1.7. Despite their low energy contribution (12.3% of energy), Milk & Alternatives contributed 45.8% of calcium, 39.9% of vitamin D, and 36.0% of vitamin B12 to the diet of the Canadian population in 2015. Milk & Alternatives were among the top sources of vitamin A, phosphorus and riboflavin. Milk & Alternatives food group was a major contributor to saturated fat intake in both 2004 (31.2%) and 2015 (28.6%). In 2015, dietary intakes of calcium and vitamin D among Milk & Alternatives consumers were 137.8, and 59.4% higher, respectively, than those of non-consumers.ConclusionDaily intake of Milk & Alternatives has decreased in the Canadian population over time, which may adversely affect the nutritional profile of the diet.

Development and Usability Study of an Open-Access Interviewer-Administered Automated 24-h Dietary Recall Tool in Argentina: MAR24

Background: Latin American countries show a fast-growing rate of non-communicable diseases (NCDs) and diet is a critical risk factor that must be properly assessed. Automated dietary assessment tools to collect 24-h dietary recalls (24HR) are lacking in Argentina.Objective: This study aimed to develop an open-access automated tool (MAR24) for collecting 24HR using a multiple pass method and a database containing foods and recipes commonly consumed in Argentina.Methods: MAR24 was developed based on data from 1,285 24HR provided by male and female participants aged 18 to 68 years from the six Argentinian geographical regions. The main structure and interface of the tool were designed using Visual Basic for Applications programming language in Excel Microsoft Office 365, integrating the five steps of the United States Department of Agriculture (USDA) Automated Multiple-Pass Method (AMPM) for the application of 24HR in Spanish. The tool underwent alpha testing and expert assessment to address structural and usability issues. Critical feedback and face validation from researchers and experienced dietitians, and repeated testing to collect 24HR were used to adjust and improve the tool.Results: A total of 968 food items and 100 standard Argentinian recipes were added to its database. MAR24 allows the estimation of the nutrient profile of dietary intake. The analytic food composition includes energy and 50 nutrients including water, macronutrients, total dietary fiber, total sugar, 10 minerals, 19 vitamins, eight fatty acids, cholesterol, ethyl alcohol, caffeine, and theobromine. MAR24 includes a user manual and technical manual to guide users to apply changes (e.g., add foods or recipes, or change food designation according to local terms) to fit different research and clinical applications.Conclusions: MAR24 is the first tool that uses the AMPM methodology for 24HR applications in Argentina. The tool may be used in clinical practice and clinical trials for monitoring purposes, and in validation of food frequency questionnaires (FFQ) for nutritional epidemiology studies addressing dietary-associated risk factors for NCDs.

Eating Behaviors and Dietary Intakes of Older Adults: What We Eat in America, NHANES 2015–2016 (FS02-07-19)

Abstract Objectives It is estimated that the number of older individuals in the U.S. will nearly double between 2020 and 2050 to over 80 million. This research examines eating behaviors and dietary intakes of older adults. Methods Nationally representative day 1 dietary data from 1684 adults ages 60+ participating in What We Eat in America (WWEIA), NHANES 2015–2016 were analyzed to estimate eating pattern behaviors and dietary intakes. The interviewer-administered 5-step USDA Automated Multiple-Pass Method (AMPM) was used to collect the 24-hour dietary recall. The WWEIA Food Categories were used to estimate the percentage who consumed vegetables or fruits. The Food Patterns Equivalents Database (FPED) was used to calculate added sugars intake. Results On any given day, almost all older adults reported eating breakfast (92%) and dinner (94%) and fewer ate lunch (78%); two-thirds reported all three meals. Snacks were consumed by 94%, most commonly 3 to 4 times per day, and provided 20% of daily mean energy intake. In relation to energy, snacks provided more of the daily intakes of caffeine (33%), total sugar (32%), carbohydrates (23%), and calcium (21%). More than 2/3 of older adults consumed a vegetable, 1/3 of which were white potatoes, such as French fried, mashed, or baked potatoes. A fruit was reported by just over half of older adults, the most common being bananas (16%), followed by apples (12%), berries (11%), citrus (9%), melons (8%), and grapes (5%). Four out of ten older adults consumed at least one food or beverage from a restaurant and among these individuals, intake at restaurants provided 42% of their daily energy intake and about half of daily intakes of fat, saturated fat, cholesterol, and sodium. Mean daily intakes of added sugars and saturated fat each provided 12% of daily energy intake, exceeding the Dietary Guidelines for Americans recommendations of less than 10% of calories per day from each, as did sodium with mean daily intake of 3091 mg, exceeding the recommendation of less than 2300 mg. Conclusions With the number and proportion of older adults increasing in the U.S., understanding their eating behaviors and dietary intakes can inform strategies for well-being during this life stage. Funding Sources USDA, Agricultural Research Service.

Examining food intake and eating out of home patterns among university students.

Eating out of home (OH) is increasingly popular in Balkan countries, among them Albania. To date there is only anecdotal evidence regarding nutritional quality of food consumed OH and the contribution to diet. This study assessed intake of foods and drinks consumed OH and at home (AH), as well as their nutritional contribution to the daily diet of university students in Tirana, Albania. Using a single day Automated Multiple Pass Method (AMPM) 24-hour dietary recall, we examined food intake among 289 students aged 18–24 years old, from three major universities in Albania. Contribution of eating OH to total energy intake per day, as well as to daily consumption of macronutrients by eating OH intensity tertiles were assessed. Foods and drinks consumed OH contributed 46.9% [95%CI:41.4–52.8] of total daily energy intake, representing, on average, 1169.1kcal [95%CI:1088.3–1249.9]. Sweets, soft drinks and meat products were more frequently consumed OH, while fruits and vegetables consumption was extremely low. The average quantity of sugars and dietary fats per day was higher AH, 76.9g [95%CI:70.3–83.5] and 173.7g [95%CI:163.2–184.2] respectively, compared to OH, 33.7g [95%CI:30.4–37.0] and 142.0g [95%CI:131.5–152.5] respectively. Dietary composition of AH intake was richer in sugars, total fats and proteins, while OH intake was richer in saturated fats. The overall diet appeared unhealthy, when nutrients were assessed as energy percentage against WHO proposed nutrient standards for sugar and saturated fats. Eating OH, even though was associated with lower fruits and vegetables intake, was not clearly associated with poor diet quality, as AH foods were also characterized by increased saturated fats and sugars intake as energy percentage. This study provides data on the first assessment of current dietary patterns of the studied population and can be used as baseline for designing and conducting future studies and interventions targeting malnutrition in all its forms.

Comparing Reported Dietary Supplement Intakes between Two 24-Hour Recall Methods: The Automated Self-Administered 24-Hour Dietary Assessment Tool and the Interview-Administered Automated Multiple Pass Method

BackgroundThe Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24) includes a highly standardized multipass web-based recall that, like the Automated Multiple Pass Method (AMPM), captures detailed information about dietary intake using multiple probes and reminders to enhance recall of intakes. The primary distinction between ASA24 and AMPM is that the ASA24 user interface guides participants, thus removing the need for interviewers. ObjectiveThe objective of this study was to compare dietary supplement use reported on self-administered (ASA24-2011) vs interviewer-administered (AMPM) 24-hour recalls. DesignThe Food Reporting Comparison Study was an evaluation study designed to compare self-reported intakes captured using the self-administered ASA24 vs data collected via interviewer-administered AMPM recalls. Between 2010 and 2011, 1081 women and men were enrolled from three integrated health care systems that belong to the National Cancer Institute–funded Cancer Research Network: Security Health Plan Marshfield Clinic, Wisconsin; Henry Ford Health System, Michigan; and Kaiser Permanente Northern California, California. Quota sampling was used to ensure a balance of age, sex, and race/ethnicity. Participants were randomly assigned to four groups, and each group was asked to complete two dietary recalls: group 1, two ASA24s; group 2, two AMPMs; group 3, ASA24 first and AMPM second; and group 4, AMPM first and ASA24 second. Dietary supplements were coded using the 2007-2008 National Health and Nutrition Examination Survey Dietary Supplement Database. Analyses used the two one-sided tests, known as TOST, to assess equivalence of reported supplement use between methods. ResultsComplete 24-hour dietary recalls that included both dietary and supplement intake data were available for 1076 participants (507 men and 569 women). The proportions reporting supplement use via ASA24 and AMPM were 46% and 43%, respectively. These proportions were equivalent, with a small effect size of less than 20%. There were two exceptions in subgroup analyses: reported use among those 40 to 59 years of age and reported use by non-Hispanic black subjects were higher for ASA24 than AMPM. ConclusionsThis study provides evidence that there is little difference in reported supplement use by mode of administration (ie, interview-administered vs self-administered recall).

The Use of Digital Images in 24-Hour Recalls May Lead to Less Misestimation of Portion Size Compared with Traditional Interviewer-Administered Recalls.

The Automated Self-Administered 24-hour (ASA24) dietary recall system enhances the feasibility of collecting high-quality intake data in population-based studies. The aim of this study was to assess the accuracy of portion size reporting in the ASA24 compared with interviewer-administered recalls. True intake for 3 meals was ascertained in 81 adults aged 20-70 y from the Washington, DC area. Participants were randomly assigned to complete an unannounced ASA24 or an interviewer-administered Automated Multiple-Pass Method (AMPM) recall the following day. An adapted Bland-Altman approach was used to assess agreement between true and reported portion sizes. Linear regression was used to assess log-scale differences between true and reported portion sizes by recall mode. The proportions of reported portion sizes within 10% and 25% of truth were estimated. Analyses were conducted for all foods and drinks and predetermined categories. Mean differences between true and reported portion sizes were 3.7 g for the ASA24 and 11.8 g for the AMPM. According to the Bland-Altman-type plots, between 92% and 100% (depending on food or drink category and recall mode) of observations fell within the limits of agreement. After adjustment for multiple testing, the mean ratio of reported to true portion sizes was significantly >1 for the categories of all foods and drinks, all foods excluding liquids, amorphous or soft foods, and small pieces among AMPM respondents. Misestimation in the AMPM was significantly different from that in the ASA24 for all foods and drinks and for all foods excluding liquids. Small proportions of reported portions fell within 10% (16.2% for the ASA24 and 14.9% for the AMPM) and 25% (37.5% for the ASA24 and 33.2% for the AMPM) of truth. The results raise the possibility that digital images tailored to different types and formats of foods may facilitate improved estimation of amounts eaten but highlight the need for continued work in this aspect of dietary assessment. This trial was registered at clinicaltrials.gov as NCT00978406.

Collecting Brand and Product Names in the USDA Automated Multiple Pass Method (AMPM) 24‐hour Dietary Recall

Brand and product names collected from respondents in dietary surveys often provide specific characteristics of foods/beverages which can assist in assigning nutrient profiles to those foods/beverages. They can also be used to create direct links between a food/beverage reported by a respondent and a product specific nutrient profile in a food composition database. Using brand and product names reported by respondents can result in reduced processing time and effort and can increase the specificity and amount of detail about foods available from dietary surveys. In order to accomplish this, both the dietary survey collection system and the food composition database need to include brand and product names and respondents need to know the brand and product name of items they report. USDA/ARS is working to obtain branded food product label data in electronic format that can be made available in the USDA food composition database. The Partnership for Public Health: Branded Food Products Database, composed of USDA/ARS, the International Life Sciences Institute North America and the Agricultural Technology Innovation Partnership Foundation was established to increase the knowledge of the nutritional content of the nation's food supply by obtaining comprehensive food composition data from food manufacturers. USDA/ARS included the collection of selected brand and product names in the design and development of the AMPM. The USDA AMPM collects 24‐hour dietary recalls for the What We Eat in America (WWEIA), National Health and Nutrition Examination Survey (NHANES). AMPM uses a research‐based, multiple‐pass approach which has 5 steps designed to encourage complete and accurate dietary recall and reduce respondent burden. The purpose of this research is to describe the use of AMPM brand and product name questions. AMPM questions and responses were analyzed for 15,885 complete and reliable dietary recall interviews in the 2011–2012 WWEIA, NHANES. AMPM questions were identified as asking for brand or product specific responses based on the text of the question. In 88% of the 2011–2012 AMPM dietary recall interviews, respondents were asked at least one question about the brand name of a reported food/beverage. Both days for both males and females averaged three questions about brand names per interview. There were no differences in the percentages (p < .05) between the day 1 and day 2 interviews or between males and females. Overall, 70% of the brand name responses matched a description in the AMPM, 10% of the brand name responses did not match an AMPM description, and 20% of the responses recorded that the respondent did not know. Collection of brand and product names in dietary recalls is becoming more important for producing comprehensive dietary survey data. Their collection in the AMPM interview demonstrates that respondents are able to provide this information.Support or Funding InformationARS, USDA

A Unique Harmonization Approach to the Construction of a Database Assessing Prenatal Consumption of Total Flavonoids and Flavonoid Classes in U.S. Multiethnic Pregnant Women

Flavonoids with established antioxidant activities and anti‐inflammatory effects may influence epigenetic mechanisms which may have implications for fetal development. Data on flavonoid intakes in pregnant women are sparse. Utilizing the (2014) Expanded USDA Flavonoids Database, and based on PRISM (Programming of Intergenerational Stress Mechanisms), a prospective multiethnic pregnancy cohort (n= 492; 36% White, 26% Blacks, 30% Hispanic, 8% other/mixed), total flavonoid intakes and specific sub‐classes were ascertained using Block98 FFQ. In addition, two 24‐hr dietary recalls (24hrDR) with the USDA Automated Multiple Pass Method (AMPM) were collected. A Block98 FFQ tailored flavonoid database was constructed quantifying six classes (anthocyanidins, flavan‐3‐ols, flavanones, flavones, flavonols, and isoflavones) in fresh fruits and vegetables, and juices. Specifically, appropriate data (food/beverage item, description, processing) were retrieved from 24hrDR (n=42×2 days). Multiple foods within single line items on the FFQ were disaggregated, study‐specific food item weights were generated, matched to the item description in the recall, and supplemented with FNDDS population weights, literature values and market research data. Appropriate nutrient databank (NDB) codes were assigned, analytical values for corresponding food items were extracted from the USDA Database, and the PRISM database with total flavonoids and the six classes was finalized for validation, and modeling and applications assessing maternal and child health endpoints. We constructed a unique culturally relevant flavonoids database by harmonizing with study‐population‐specific weights as compared to general‐population‐weighting in other studies, thereby enabling the use of this database in epidemiological studies examining health outcomes in diverse multi‐ethnic prenatal populations.Support or Funding InformationThis work was supported by the National Institute of Environmental Health Sciences (NIEHS) under Grant R21ES021318‐02; and the National Heart, Lung, and Blood Institute under Grant R01HL095606‐04.

Prevalence and characteristics of misreporting of energy intake in US children and adolescents: National Health and Nutrition Examination Survey (NHANES) 2003-2012.

Using data from the National Health and Nutrition Examination Survey (NHANES) 2003-2012, we investigated the prevalence and characteristics of under- and over-reporting of energy intake (EI) among 14 044 US children and adolescents aged 2-19 years. For the assessment of EI, two 24-h dietary recalls were conducted with the use of the US Department of Agriculture Automated Multiple-Pass Method. Under-, plausible and over-reporters of EI were identified using two methods: based on the 95 % confidence limits (1) for agreement between the ratio of EI:BMR and a physical activity level for sedentary lifestyle (1·55) and (2) of the expected ratio of EI:estimated energy requirement (EER) of 1·0. BMR was calculated using Schofield's equations. EER was calculated using equations from the US Dietary Reference Intakes, assuming 'low active' level of physical activity. The risk of being an under- or over-reporter compared with a plausible reporter was analysed using multiple logistic regression. Percentages of under-, plausible and over-reporters were 13·1, 81·5 and 5·4 %, respectively, based on EI:BMR and 18·8, 72·3 and 8·8 %, respectively, based on EI:EER. Under-reporting was associated with older age, non-Hispanic blacks (compared with non-Hispanic whites) and overweight and obesity (compared with normal weight). Over-reporting was associated with younger age, lower family poverty income ratio, normal weight and the first survey cycle. Similar findings were obtained when analysing only the first 24-h recall data from NHANES 1999-2012 (n 22 949). In conclusion, we found that EI misreporting remains prevalent and differential in US children and adolescents.

Prevalence and characteristics of misreporting of energy intake in US adults: NHANES 2003-2012.

Using data from the National Health and Nutrition Examination Survey (NHANES) 2003-2012, we investigated the prevalence and characteristics of under-reporting and over-reporting of energy intake (EI) among 19 693 US adults ≥20 years of age. For the assessment of EI, two 24-h dietary recalls were conducted using the US Department of Agriculture Automated Multiple-Pass Method. Under-reporters, acceptable reporters and over-reporters of EI were identified by two methods based on the 95 % confidence limits: (1) for agreement between the ratio of EI to BMR and a physical activity level for sedentary lifestyle (1·55) and (2) of the expected ratio of EI to estimated energy requirement (EER) of 1·0. BMR was calculated using Schofield's equations. EER was calculated using equations from the US Dietary Reference Intakes, assuming 'low active' level of physical activity. The risk of being an under-reporter or over-reporter compared with an acceptable reporter was analysed using multiple logistic regression. Percentages of under-reporters, acceptable reporters and over-reporters were 25·1, 73·5 and 1·4 %, respectively, based on EI:BMR, and 25·7, 71·8 and 2·5 %, respectively, based on EI:EER. Under-reporting was associated with female sex, older age, non-Hispanic blacks (compared with non-Hispanic whites), lower education, lower family poverty income ratio and overweight and obesity. Over-reporting was associated with male sex, younger age, lower family poverty income ratio, current smoking (compared with never smoking) and underweight. Similar findings were obtained when analysing only the first 24-h recall data from NHANES 1999-2012 (n 28 794). In conclusion, we found that misreporting of EI, particularly under-reporting, remains prevalent and differential in US adults.

Performance of the Automated Self-Administered 24-hour Recall relative to a measure of true intakes and to an interviewer-administered 24-h recall

The Automated Self-Administered 24-hour Recall (ASA24), a freely available Web-based tool, was developed to enhance the feasibility of collecting high-quality dietary intake data from large samples. The purpose of this study was to assess the criterion validity of ASA24 through a feeding study in which the true intake for 3 meals was known. True intake and plate waste from 3 meals were ascertained for 81 adults by inconspicuously weighing foods and beverages offered at a buffet before and after each participant served him- or herself. Participants were randomly assigned to complete an ASA24 or an interviewer-administered Automated Multiple-Pass Method (AMPM) recall the following day. With the use of linear and Poisson regression analysis, we examined the associations between recall mode and 1) the proportions of items consumed for which a match was reported and that were excluded, 2) the number of intrusions (items reported but not consumed), and 3) differences between energy, nutrient, food group, and portion size estimates based on true and reported intakes. Respondents completing ASA24 reported 80% of items truly consumed compared with 83% in AMPM (P = 0.07). For both ASA24 and AMPM, additions to or ingredients in multicomponent foods and drinks were more frequently omitted than were main foods or drinks. The number of intrusions was higher in ASA24 (P < 0.01). Little evidence of differences by recall mode was found in the gap between true and reported energy, nutrient, and food group intakes or portion sizes. Although the interviewer-administered AMPM performed somewhat better relative to true intakes for matches, exclusions, and intrusions, ASA24 performed well. Given the substantial cost savings that ASA24 offers, it has the potential to make important contributions to research aimed at describing the diets of populations, assessing the effect of interventions on diet, and elucidating diet and health relations. This trial was registered at clinicaltrials.gov as NCT00978406.

Comparison of dietary supplement intake reporting between the Automated Self‐Administered 24‐Hour Recall (ASA24) and Automated Multiple Pass Method (AMPM) recalls (245.2)

Objective: To compare dietary supplement use reported on self‐administered (ASA24) versus interviewer‐administered (AMPM) 24‐hour recalls.Methods: About 1200 women and men were recruited from three integrated health systems using quota sampling to capture a range of ages and racial/ethnic backgrounds. Participants were randomized into four groups and asked to complete two recalls: 1) two ASA24s; 2) two AMPMs; 3) ASA24 first, AMPM second; 4) AMPM first, ASA24 second. Dietary supplements were coded using the 2007‐2008 NHANES Dietary Supplement Database. Difference in prevalence of reported supplement use was tested using a Chi‐square test.Results: Food and supplement data were complete for 1089 participants. Prevalence of use of any dietary supplement on either day was not significantly different by recall mode overall (47.8% for AMPM (n=1022) vs.48.5% for ASA24 (n=1012); p=0.82) or within sex, age, or race/ethnicity groups. Among supplement users, the prevalence of reported multivitamin use was significantly higher on AMPM compared to ASA24 (65.9% vs. 57.2%; p &lt;0.01). In ASA24, 50 participants reported 114 supplements as “unknown”, meaning they were unable to find their supplement in the ASA24 database.Discussion: The ASA24 performs similarly to AMPM for estimating overall prevalence of dietary supplement use. Significant differences found in the reporting of multivitamins specifically could be related to the number of unknown supplements reported in ASA24. Coding of text entered for supplements not found in ASA24 may be necessary to obtain accurate prevalence of supplement type and nutrient estimates. Based on these findings, future versions of ASA24 will include questions when unknown supplements are reported for the purpose of assigning reasonable default supplement codes.

Accuracy of portion size reporting in the Automated Self‐Administered 24‐hour recall (ASA24) compared to interviewer‐administered recalls (36.6)

Objective: To assess accuracy of portion size reporting in ASA24 compared to interviewer‐administered recalls.Methods: True intake for three meals was ascertained among 81 adults by inconspicuously weighing foods and beverages offered at a buffet before and after each participant served him/herself, as well as plate waste. Participants were randomly assigned to complete ASA24 or an interviewer‐administered Automated Multiple‐Pass Method (AMPM) recall the following day. Differences between true and reported gram weights were calculated for each consumed item for which a match was reported by respondents and averaged.Results: For foods and drinks truly consumed for which respondents reported a match (80% for ASA24 and 83% for AMPM), mean differences between true and reported portion sizes were ‐3.7 grams for ASA24 and ‐11.8 grams for AMPM (absolute differences: 40.5 grams for ASA24 and 39.8 grams for AMPM (p=0.44)). Differences for primary foods and drinks were ‐5.1 grams for ASA24 and ‐14.4 grams for AMPM, and for additions to or ingredients in multi‐component items, 0.60 grams for ASA24 and ‐6.2 grams for AMPM.Discussion: Previous analyses indicate similar match rates (i.e., the proportion of items consumed for which a corresponding food or drink was reported) and energy, nutrient and food group estimates between ASA24 and AMPM. The current results suggest that the accuracy of portion size reporting is also similar, providing further evidence that ASA24 performs well relative to interviewer‐administered recalls.

Capturing sodium reduction efforts in What We Eat in America, NHANES (384.6)

The Institute of Medicine report, Strategies to Reduce Sodium Intake in the United States, recommended that Federal agencies should ensure and enhance monitoring and surveillance relative to sodium (Na) intake measurement and Na content of foods. This presentation highlights initiatives undertaken to assure that the Na reduction efforts are reflected in dietary intake data collected in What We Eat in America, NHANES. A comprehensive review of the USDA Automated Multiple‐Pass Method (AMPM) began in 2008. Questions to elicit specific details for 2/3 of the foods/beverages reported by respondents have been updated as necessary with attention to Na. The survey database of foods/beverages has expanded by 20 % (&gt;1300 items) since 2009‐10 with increased specificity about foods that impact Na content. Identification of ~125 “sentinel foods”, select foods being monitored as primary indicators for assessing potential change in Na content, was completed in collaboration with other government agencies. Results from the AMPM Validation Study demonstrated the competence of AMPM to capture accurate estimates of dietary Na intake. Each of these initiatives enhances Na intake measurement in national surveillance.Grant Funding Source: Supported by the Food Surveys Research Group

Abstract MP31: The Web-based Automated Self-administered 24-hour Dietary Recall Performs Similarly to a Traditional Interviewer-administered 24-hour Dietary Recall

Introduction: Two studies were conducted to evaluate the National Cancer Institute (NCI)’s web-based Automated Self-Administered 24-hour Recall (ASA24) system, which was developed to facilitate the collection of 24-hour dietary recalls in large-scale research. Hypothesis: Energy, nutrient and food group estimates, response rates, and preferences are comparable between ASA24 and USDA’s interviewer-administered Automated Multiple-Pass Method (AMPM). Methods: Study 1 assessed the response rates and data collected using ASA24 compared to AMPM. About 1200 participants were recruited from three integrated health systems using quota sampling to ensure representation of a range of ages and race/ethnicity groups. Participants were asked to complete two 24HRs, 4-7 weeks apart, and randomized into four study groups: 1) two ASA24s; 2) two AMPMs; 3) ASA24 first and AMPM second; and 4) AMPM first and ASA24 second. Study 2 assessed the validity of ASA24 compared to AMPM in a one-day feeding study. Eighty-one participants visited a study center to consume three meals from a buffet. All containers were unobtrusively weighed before and after each participant served him/herself; plate waste was also weighed. The next day, participants returned to the center to complete either ASA24 or AMPM. Results: Study 1: Almost all enrolled participants (95%) completed at least one recall and 80% completed two; response rates did not differ by recall mode. Estimated intakes of energy, nutrients and food groups were comparable for ASA24 and AMPM; for example, energy, 2132 vs. 2126 kcal; fat, 84.9 vs. 82.8 g; saturated fatty acids, 27.9 vs. 26.9 g; fiber, 18.4 vs. 18.4 g; and fruits and vegetables, 3.0 vs. 3.1 cup equivalents. Of participants randomized to complete one ASA24 and one AMPM, a greater percentage preferred ASA24. Study 2: The examination of foods and drinks reported showed that exact or close matches were recalled for 76.9% of items truly consumed among ASA24 respondents compared to 82.5% among AMPM respondents. Far matches were reported for 3.1% of items consumed among ASA24 respondents compared to 0.7% for AMPM. The proportions of foods or drinks consumed but not reported (exclusions) were 20.4% and 16.8% for ASA24 and AMPM, respectively. Median differences between reported and true intakes for energy, nutrient and most food groups were not significantly different between ASA24 and AMPM. Conclusion: ASA24 performs well relative to traditional interviewer-administered recalls and is feasible for use in large-scale research. The tool, which offers significant savings over interviewer-administered recalls, is publicly available from NCI and has been used in over 800 studies to collect over 113,000 dietary recalls. The tool is currently being updated to run on mobile applications.

The USDA Automated Multiple-Pass Method accurately assesses population sodium intakes

Given current sodium-reduction strategies, accurate and practical methods to monitor sodium intake in the US population are critical. Although the gold standard for estimating sodium intake is the 24-h urine collection, few studies have used this biomarker to evaluate the accuracy of a dietary instrument. Our objective was to compare self-reported dietary intake of sodium with 24-h urinary excretion obtained in the USDA Automated Multiple-Pass Method (AMPM) Validation Study. Subjects were healthy, weight-stable volunteers aged 30-69 y recruited from the Washington, DC, area. Data from 465 subjects who completed at least one 24-h recall and collected a complete 24-h urine sample during the same period were used to assess the validity of sodium intake. Reporting accuracy was calculated as the ratio of reported sodium intake to that estimated from the urinary biomarker (24-h urinary sodium/0.86). Estimations of sodium intake included salt added in cooking but did not include salt added at the table. Overall, the mean (95% CI) reporting accuracy was 0.93 (0.89, 0.97) for men (n = 232) and 0.90 (0.87, 0.94) for women (n = 233). Reporting accuracy was highest for subjects classified as normal weight [body mass index (in kg/m(2)) <25]: 1.06 (1.00, 1.12) for men (n = 84) and 0.99 (0.94, 1.04) for women (n = 115). For women only, reporting accuracy was higher in those aged 50-69 y than in those who were younger. Findings from this study suggest that the USDA AMPM is a valid measure for estimating sodium intake in adults at the population or group level.

Validity of the National Cancer Institute's Automated Self‐ Administered 24‐hour Recall (ASA24): Results of a Feeding Study

The Automated Self‐administered 24‐hour dietary recall (ASA24) is a web‐based tool that enables the collection of multiple recalls in large studies at minimal cost. To assess the validity of ASA24, we studied 83 adults, aged 20–70 years, who ate three meals at a study center. True intake was ascertained by inconspicuously weighing foods and beverages offered at a buffet before and after each participant served him/herself, as well as plate waste. Participants were randomly assigned to complete ASA24 or an interviewer‐administered recall using the Automated Multiple‐Pass Method (AMPM) on the following day, and the degree to which reported and true intake matched was examined. Data for one ASA24 participant was excluded because reported intake did not correspond to the previous day. For study center meals, average true energy intake of ASA24 participants (n=40) was 2329 calories compared to an average reported intake of 2138 calories (−191). On average, exact or close matches were reported for 72% of items consumed. Among AMPM participants (n=42), average true energy intake was 2268 calories compared to an average reported intake of 2425 calories (+157). On average, exact or close matches were reported for 78% of items consumed. The average number of items consumed but not reported was 7 for ASA24 and 6 for AMPM. The results support the use of ASA24 as a cost‐effective means of collecting high‐quality dietary data.Grant Funding Source: n/a

Avocado consumption is associated with better diet quality and nutrient intake, and lower metabolic syndrome risk in US adults: results from the National Health and Nutrition Examination Survey (NHANES) 2001-2008.

BackgroundAvocados contain monounsaturated fatty acids (MUFA) dietary fiber, essential nutrients and phytochemicals. However, no epidemiologic data exist on their effects on diet quality, weight management and other metabolic disease risk factors. The objective of this research was to investigate the relationships between avocado consumption and overall diet quality, energy and nutrient intakes, physiological indicators of health, and risk of metabolic syndrome.MethodsAvocado consumption and nutrition data were based on 24-hour dietary recalls collected by trained NHANES interviewers using the USDA Automated Multiple Pass Method (AMPM). Physiological data were collected from physical examinations conducted in NHANES Mobile Examination Centers. Diet quality was calculated using the USDA’s Healthy Eating Index-2005. Subjects included 17,567 US adults ≥ 19 years of age (49% female), including 347 avocado consumers (50% female), examined in NHANES 2001–2008. Least square means, standard errors, and ANOVA were determined using appropriate sample weights, with adjustments for age, gender, ethnicity, and other covariates depending on dependent variable of interest.ResultsAvocado consumers had significantly higher intakes of vegetables (p < 0.05); fruit, diet quality, total fat, monounsaturated and polyunsaturated fats, dietary fiber, vitamins E, K, magnesium, and potassium (p < 0.0001); vitamin K (p = 0.0013); and lower intakes of added sugars (p < 0.0001). No significant differences were seen in calorie or sodium intakes. Body weight, BMI, and waist circumference were significantly lower (p < 0.01), and HDL-C was higher (p < 0.01) in avocado consumers. The odds ratio for metabolic syndrome was 50% (95th CI: 0.32-0.72) lower in avocado consumers vs. non-consumers.ConclusionsAvocado consumption is associated with improved overall diet quality, nutrient intake, and reduced risk of metabolic syndrome. Dietitians should be aware of the beneficial associations between avocado intake, diet and health when making dietary recommendations.

Food Reporting Patterns in the USDA Automated Multiple-Pass Method

Complete and accurate 24-hour dietary recalls are essential for nutrition monitoring in the United States. The USDA Automated Multiple-Pass Method (AMPM) uses a five-step multiple-pass approach to collect dietary data. The first step is an unstructured, uninterrupted listing of all foods and beverages consumed. The next 3 steps use a structured approach to data collection including memory cues. The Final Probe step is an unstructured question for any other foods recalled and includes several additional memory cues. The objective of this analysis is to describe patterns of food reporting in the AMPM in a nationally representative sample. This analysis uses data from the 2007-2008 What We Eat in America, National Health and Nutrition Examination Survey for males and females ages 12 and older. The step in the AMPM interview where a food is first recalled and reported is determined and assigned a value. These values are summed to create an AMPM reporting score which reflects the use of the five steps in AMPM in the 24- hour dietary intake recall. There are signficant differences in the AMPM reporting score by day of interview, gender, age and race/ethnicity. The patterns described in this analysis demonstrate the importance of the multiple-pass method in obtaining complete 24-hour dietary recalls.