Mobile Food Record Research Articles

Improving Diet Quality of People Living With Obesity by Building Effective Dietetic Service Delivery Using Technology in a Primary Health Care Setting: Protocol for a Randomized Controlled Trial.

Almost a third of Australian adults are living with obesity, yet most cannot access medical nutrition therapy from dietitians, that is, the health professionals trained in dietary weight management services. Across the health system, primary care doctors readily identify people who may benefit from weight management services, but there are limited referral options in the community. Dietitians are trained to provide evidence-informed dietary treatment of overweight and obesity but are underutilized and underresourced. The chat2 (Connecting Health and Technology 2) trial will test combining new technologies for dietary assessment with behavior change techniques to improve outcomes for people living with obesity. This study aimed to compare the effectiveness of a 1-year digital dietary intervention, with standard care on body weight reduction and improved diet quality, in adults living with obesity delivered by dietitians in a primary care setting. This randomized controlled trial will compare a 1-year, digitally tailored, feedback dietary intervention with a control group in 430 adults living with obesity (BMI≥30 to ≤45 kg/m2). Participants will be recruited by letters sent to individuals randomly selected from the electoral roll and supplemented by hospital site posters, newsletters, and unaddressed mailbox delivery postcards sent to residential street points. The primary outcome is change in body weight, measured face-to-face at a baseline, 6 months, and 12 months. A 4-day, image-based dietary assessment tool (mobile Food Record) will be used to measure diet quality score. Secondary outcomes include diet quality score; dual-energy absorptiometry body composition; and total cholesterol, triglyceride, low-density lipoprotein, high-density lipoprotein, glycated hemoglobin, and fasting glucose levels. The intervention group will receive 8 video counseling sessions with a trained dietitian delivered over 12 months to support dietary behavior change and relapse prevention. The trial is unblinded. Both groups will receive feedback on their clinical chemistry and dual-energy absorptiometry scans at each time point. Participant recruitment commenced in July 2023 and ended in August 2024. Data analysis will commence in 2025, with the anticipated publication of results in 2026. If found to be effective, the results of this randomized controlled trial will support the delivery of effective, evidence-based weight management advice using new technologies. Improving community access to high-quality dietetic services will ensure more effective use of the dietetic workforce to improve outcomes for people living with obesity. Australian New Zealand Clinical Trials Registry ACTRN12622000803796; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=383838. DERR1-10.2196/64735.

Accuracy of energy and nutrient intake estimation versus observed intake using 4 technology-assisted dietary assessment methods: a randomized crossover feeding study

BackgroundTechnology-assisted 24-h dietary recalls (24HRs) have been widely adopted in population nutrition surveillance. Evaluations of 24HRs inform improvements, but direct comparisons of 24HR methods for accuracy in reference to a measure of true intake are rarely undertaken in a single study population. ObjectivesTo compare the accuracy of energy and nutrient intake estimation of 4 technology-assisted dietary assessment methods relative to true intake across breakfast, lunch, and dinner. MethodsIn a controlled feeding study with a crossover design, 152 participants [55% women; mean age 32 y, standard deviation (SD) 11; mean body mass index 26 kg/m2, SD 5] were randomized to 1 of 3 separate feeding days to consume breakfast, lunch, and dinner, with unobtrusive weighing of foods and beverages consumed. Participants undertook a 24HR the following day [Automated Self-Administered Dietary Assessment Tool-Australia (ASA24); Intake24-Australia; mobile Food Record-Trained Analyst (mFR-TA); or Image-Assisted Interviewer-Administered 24-hour recall (IA-24HR)]. When assigned to IA-24HR, participants referred to images captured of their meals using the mobile Food Record (mFR) app. True and estimated energy and nutrient intakes were compared, and differences among methods were assessed using linear mixed models. ResultsThe mean difference between true and estimated energy intake as a percentage of true intake was 5.4% (95% CI: 0.6, 10.2%) using ASA24, 1.7% (95% CI: −2.9, 6.3%) using Intake24, 1.3% (95% CI: −1.1, 3.8%) using mFR-TA, and 15.0% (95% CI: 11.6, 18.3%) using IA-24HR. The variances of estimated and true energy intakes were statistically significantly different for all methods (P < 0.01) except Intake24 (P = 0.1). Differential accuracy in nutrient estimation was present among the methods. ConclusionsUnder controlled conditions, Intake24, ASA24, and mFR-TA estimated average energy and nutrient intakes with reasonable validity, but intake distributions were estimated accurately by Intake24 only (energy and protein). This study may inform considerations regarding instruments of choice in future population surveillance.This trial was registered at Australian New Zealand Clinical Trials Registry as ACTRN12621000209897.

OR09-02-23 Pilot Evaluation of Whether an Interviewer Administered Dietary Recall Method Augmented With a Photo-Based Mobile Food Record Improves Reporting of Food Intake

OR09-02-23 Pilot Evaluation of Whether an Interviewer Administered Dietary Recall Method Augmented With a Photo-Based Mobile Food Record Improves Reporting of Food Intake

Evaluation of the implementation and practicality of a novel approach to 24-hour dietary recall interviews using the image-assisted Mobile Food Record 24-hour dietary recall

An abstract is not available for this content. As you have access to this content, full HTML content is provided on this page. A PDF of this content is also available in through the ‘Save PDF’ action button.

Mobile Food Record 24 Hour Recall (mFR24) Was “Easy” and an Acceptable Mobile Health Dietary Assessment Method

Mobile Food Record 24 Hour Recall (mFR24) Was “Easy” and an Acceptable Mobile Health Dietary Assessment Method

Demographic and psychosocial correlates of measurement error and reactivity bias in a four-day image-based mobile food record among adults with overweight and obesity.

Improving dietary reporting among people living with obesity is challenging as many factors influence reporting accuracy. Reactive reporting may occur in response to dietary recording but little is known about how image-based methods influence this process. Using a 4-day image-based mobile food record (mFRTM), this study aimed to identify demographic and psychosocial correlates of measurement error and reactivity bias, among adults with BMI 25-40kg/m2. Participants (n=155, aged 18-65y) completed psychosocial questionnaires, and kept a 4-day mFRTM. Energy expenditure (EE) was estimated using ≥4 days of hip-worn accelerometer data, and energy intake (EI) was measured using mFRTM. Energy intake: energy expenditure ratios were calculated, and participants in the highest tertile were considered to have Plausible Intakes. Negative changes in EI according to regression slopes indicated Reactive Reporting. Mean EI was 72% (SD=21) of estimated EE. Among participants with Plausible Intakes, mean EI was 96% (SD=13) of estimated EE. Higher BMI (OR 0.81, 95%CI 0.72-0.92) and greater need for social approval (OR 0.31, 95% CI 0.10-0.96), were associated with lower likelihood of Plausible Intakes. Estimated EI decreased by 3% per day of recording (IQR -14%,6%) among all participants. The EI of Reactive Reporters (n=52) decreased by 17%/day (IQR -23%,-13%). A history of weight loss (>10kg) (OR 3.4, 95% CI 1.5-7.8), and higher percentage of daily energy from protein (OR 1.1, 95%CI 1.0-1.2) were associated with greater odds of Reactive Reporting. Identification of reactivity to measurement, as well as Plausible Intakes, is recommended in community-dwelling studies to highlight and address sources of bias.

PEGASO e-Diary: User Engagement and Dietary Behavior Change of a Mobile Food Record for Adolescents

BackgroundObesity amongst children and adolescents is becoming a major health problem globally and mobile food records can play a crucial role in promoting healthy dietary habits.ObjectiveTo describe the methodology for the implementation of the e-Diary mobile food record, to assess its capability in promoting healthy eating habits, to evaluate the factors associated with its usage and engagement.MethodsThis is a descriptive study that compared the characteristics of participants engaged in the e-Diary, which was part of the PEGASO project in which an app to provide proactive health promotion was given to 365 students at 4 European sites enrolled during October to December 2016: England (UK), Scotland (UK), Lombardy (Italy), and Catalonia (Spain). The e-Diary tracked the users' dietary habits in terms of food groups, dietary indexes, and 6 dietary target behaviors relating to consumption of: fruit; vegetable; breakfast; sugar-sweetened beverages; fast-food; and snacks. The e-Diary provided also personalized suggestions for the next meal and gamification.ResultsThe e-Diary was used for 6 months by 357 adolescents (53.8% females). The study showed that females used the e-Diary much more than males (aOR 3.8, 95% CI 1.6–8.8). Participants aged 14 years were more engaged in the e-Diary than older age groups (aOR 5.1, 95% CI 1.4–18.8) as were those with a very good/excellent self-perceived health status compared to their peers with fair/poor health perception (aOR 4.2, 95% CI 1.3–13.3). Compared to the intervention sites, those living in Catalonia (aOR 13.2 95% CI 2.5–68.8) were more engaged. In terms of behavior change, a significant positive correlation between fruit (p < 0.0001) and vegetables (p = 0.0087) intake was observed in association with increased engagement in the e-Diary. Similarly, adolescents who used the app for more than 2 weeks had significantly higher odds of not skipping breakfast over the study period (aOR 2.5, 95% CI 1.0–6.3).ConclusionsThe users highly engaged with the e-Diary were associated with improved dietary behaviors: increased consumption of fruit and vegetables and reduced skipping of breakfast. Although the overall usage of the e-Diary was high during the first weeks, it declined thereafter. Future applications should foster user engagement, particularly targeting adolescents at high risk.Clinical Trial Registrationhttps://www.clinicaltrials.gov/, identifier: NCT02930148.

An Active Image-Based Mobile Food Record Is Feasible for Capturing Eating Occasions among Infants Ages 3-12 Months Old in Hawai'i.

The ability to comprehensively assess the diet of infants is essential for monitoring adequate growth; however, it is challenging to assess dietary intake with a high level of accuracy. Infants rely on surrogate reporting by caregivers. This study aimed to determine if surrogate reporters (e.g., caregivers) could use an image-based mobile food record adapted (baby mFR) to record infants’ eating occasions, and via caregiver feedback, could assess the usability and feasibility of the baby mFR in recording infants’ diets. This was a cross-sectional study in which surrogate reporters (e.g., caregivers) recorded all food and beverage intake (including human milk) of the infant over a 4-day period. Trained research staff evaluated all images submitted during data collection for different indicators of quality. All surrogate reporters were asked to complete a usability questionnaire at the end of the 4-day data collection period. Basic descriptive analyses were performed on the infants 3–12 months of age (n = 70). A total of 91% (n = 64) of surrogate reporters used the baby mFR to record their infants’ eating occasions. The mean number of images submitted daily per participant via the mFR was 4.2 (SD 0.2). A majority of submitted images contained the fiducial marker and the food and/or beverage was completely visible. The mFR was found to be easy to use; however, suggestions were provided to increase utility of the application such as the inclusion of a bottle button and reminders. An image-based dietary assessment method using a mobile app was found to be feasible for surrogate reporters to record an infant’s food and beverage intake throughout the day.

Associations between Cultural Identity, Household Membership and Diet Quality among Native Hawaiian, Pacific Islander, and Filipino Infants in Hawaiʻi

Public health efforts to reduce diet-related health disparities experienced by indigenous peoples could be enhanced by efforts to improve complementary infant feeding practices. The latter is possible through interventions informed by cultural determinants. This cross-sectional secondary analysis explored possible determinants of the complementary feeding practices of Native Hawaiian, Pacific Islander, and/or Filipino infants (NHPIF) in Hawaiʻi, ages 3–12 months. The objective was to determine the association between caregiver cultural identity and infant household membership with indicators of infant diet healthfulness. The cultural identities, infant household memberships, early infant feeding practices and additional demographic information (infant age and sex, household income) were assessed via an online questionnaire. Surrogate reporting of the infants’ diets over four days was evaluated using an image-based mobile food record (mFR). Data collected by the mFR were evaluated to derive the World Health Organization’s minimum dietary diversity (MDD) indicator and food group consumption. Data were summarized by descriptive statistics and analyzed using multivariate linear and logistic regressions. Seventy infant participants, ages 3–12 months, and their primary caregivers completed the study. Of these, there were 56 infant participants between the age of 6–12 months. Approximately 10% of infants, ages 6–12 months, met MDD for all four days. Meeting MDD and the number of food groups consumed were significantly associated with age. Caregiver cultural identity, infant household membership and infant sex had non-significant associations with indicators of infant diet quality. Findings inform the influences shaping dietary patterns of Native Hawaiian, Pacific Islander and Filipino infants in Hawaiʻi.

Temporal patterns of eating by mode of data collection from the baseline dietary intakes of participants in the Healthy Diet and Lifestyle Study

Temporal patterns of eating by mode of data collection from the baseline dietary intakes of participants in the Healthy Diet and Lifestyle Study

Accuracy and Cost-effectiveness of Technology-Assisted Dietary Assessment Comparing the Automated Self-administered Dietary Assessment Tool, Intake24, and an Image-Assisted Mobile Food Record 24-Hour Recall Relative to Observed Intake: Protocol for a Randomized Crossover Feeding Study

BackgroundThe assessment of dietary intake underpins population nutrition surveillance and nutritional epidemiology and is essential to inform effective public health policies and programs. Technological advances in dietary assessment that use images and automated methods have the potential to improve accuracy, respondent burden, and cost; however, they need to be evaluated to inform large-scale use.ObjectiveThe aim of this study is to compare the accuracy, acceptability, and cost-effectiveness of 3 technology-assisted 24-hour dietary recall (24HR) methods relative to observed intake across 3 meals.MethodsUsing a controlled feeding study design, 24HR data collected using 3 methods will be obtained for comparison with observed intake. A total of 150 healthy adults, aged 18 to 70 years, will be recruited and will complete web-based demographic and psychosocial questionnaires and cognitive tests. Participants will attend a university study center on 3 separate days to consume breakfast, lunch, and dinner, with unobtrusive documentation of the foods and beverages consumed and their amounts. Following each feeding day, participants will complete a 24HR process using 1 of 3 methods: the Automated Self-Administered Dietary Assessment Tool, Intake24, or the Image-Assisted mobile Food Record 24-Hour Recall. The sequence of the 3 methods will be randomized, with each participant exposed to each method approximately 1 week apart. Acceptability and the preferred 24HR method will be assessed using a questionnaire. Estimates of energy, nutrient, and food group intake and portion sizes from each 24HR method will be compared with the observed intake for each day. Linear mixed models will be used, with 24HR method and method order as fixed effects, to assess differences in the 24HR methods. Reporting bias will be assessed by examining the ratios of reported 24HR intake to observed intake. Food and beverage omission and intrusion rates will be calculated, and differences by 24HR method will be assessed using chi-square tests. Psychosocial, demographic, and cognitive factors associated with energy misestimation will be evaluated using chi-square tests and multivariable logistic regression. The financial costs, time costs, and cost-effectiveness of each 24HR method will be assessed and compared using repeated measures analysis of variance tests.ResultsParticipant recruitment commenced in March 2021 and is planned to be completed by the end of 2021.ConclusionsThis protocol outlines the methodology of a study that will evaluate the accuracy, acceptability, and cost-effectiveness of 3 technology-enabled dietary assessment methods. This will inform the selection of dietary assessment methods in future studies on nutrition surveillance and epidemiology.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12621000209897; https://tinyurl.com/2p9fpf2sInternational Registered Report Identifier (IRRID)DERR1-10.2196/32891

A Novel to Method to Measure Food Waste: The Mobile Food Record

The mobile food record™ (mFR™) is a novel app that allows for the tracking of individual food waste and addresses the limitations of current methods to accurately quantify food waste. Extension educators may use data from the mFR™ to create educational initiatives for food waste prevention and education that may be implemented in settings such as schools and universities. The mFR is an innovative application that simplifies the process of collecting food-based data and accurately quantifying food waste for use in Extension.

Development and Validation of a Sustainable Diet Index among Malaysian Adults: Protocol

Adopting a sustainable diet is an alternative to address the pandemics of obesity, undernutrition and climate change that are threatening human health. Sustainable diet considers the health aspect as well as the environmental impact of diets. There is a scarcity of research on sustainable diet and lack validated tools for its measurement. This article aimed to describe the protocol on the development and validation of a Sustainable Diet Index (SDI) among Malaysian adults. A Sustainable Diet Index (SDI) was developed based on previous studies and available dietary guidelines on sustainable diet. Five indicators (rice, animal-based food, plant-based food, food waste and packaging) were included in the SDI. The index will be validated among Malaysian adults using mobile food record as the dietary assessment tool. The index has the potential to measure the level of healthy and sustainable diet behaviour of an individual. The use of mobile food record provides images of each eating occasion for the evaluation of serving size and the information on waste management. Health and environmental impacts from the diet can be evaluated through the integration of all indicators in the SDI. The index developed is novel and expected to provide a feasible measurement to assess the level of sustainable diet of an individual.

Design and Development of a Digital Weight Management Intervention (ToDAy): Qualitative Study.

BackgroundThe Tailored Diet and Activity (ToDAy) study aims to build on the campaign by adding a digital intervention with the potential to provide wide-reaching, cost-effective weight management support.ObjectiveThe ToDAy study aims to build a tailored intervention using mobile technology to improve diet and physical activity behaviours in adults with overweight and obesity. The main objectives were to identify behavior change techniques for diet and physical activity (PA) change for weight loss and explore preferences for digital intervention features that would be effective in changing diet and PA behaviors.MethodsThis qualitative study uses the principles of a person-based approach to intervention development; the behavioral intervention technology framework; and the capability, opportunity, motivation, and behavior (COM-B) framework. Focus groups and telephone interviews were conducted with 56 adults in Western Australia. Open-ended questions and example intervention features were used to explore the usability and acceptability of the self-monitoring tools, knowledge about effective weight-loss strategies, and acceptability of tailored feedback. Findings from the focus groups and interviews were analyzed using thematic analysis.ResultsQualitative findings revealed an awareness of key public health messages but a lack of confidence in how to perform these behaviors to help manage their weight. A total of 4 major themes were identified and mapped to the domains of the COM-B framework: (1) misinformation, (2) environmental support, (3) social norms, and (4) confidence.ConclusionsThis study explores users’ capability, opportunity, and motivation to perform the target behaviors for weight loss. The findings suggested that a digital weight management intervention using a mobile food record and activity trackers to inform tailored feedback may be acceptable and feasible. Participants expressed a preference for simple expert advice, digital self-monitoring tools, and visual feedback.International Registered Report Identifier (IRRID)RR2-10.2196/12782

Examining the Influence of Cultural Immersion on Willingness to Try Fruits and Vegetables among Children in Guam: The Traditions Pilot Study.

This pilot study examined the influence of cultural immersion on willingness to try fruits and vegetables (FV) among children 3–12 years old in three summer camps in Guam with different cultural exposure levels: cultural immersion camp (CIC), high exposure; university day camp (UDC), moderate exposure; and recreational sports camp (RSC), zero exposure. Children, ages 3–12 years old for CIC and UDC and 5–12 years old for RSC, participated: CIC (n = 47), UDC (n = 23), and RSC (n = 33). Children’s willingness to try FV was assessed with the Adapted WillTry tool before and after each program. Whole FV intakes were assessed concurrently using the mobile food record in CIC and UDC. Using multivariate regression, WillTry post-assessment outcomes were modeled adjusting for pre-assessment, child characteristics, exposure, and parent cultural affiliation. Unique to the Adapted WillTry tool are three FV scales, local novel, local common, and imported, which are classified by source (local or imported) and/or familiarity (novel or common). WillTry adjusted mean FV post-scores by highest exposure camp to lowest were 2.2, 2.3, and 2.2 for local novel and 2.6, 2.6, and 2.6 for local common. No differences among camps were significant; however, there was an increase in the willingness to try scores for all FV score types and camps. The Traditions pilot study demonstrated: (1) feasibility of a multi-arm parallel design using existing community programs in limited-resource environments and (2) further examination of nutrition education components and contexts are needed to understand diet behaviors of indigenous populations.

First Feeding Behaviors of Native Hawaiian, Pacific Islander, and Filipino Infants (P11-063-19)

First Feeding Behaviors of Native Hawaiian, Pacific Islander, and Filipino Infants (P11-063-19)

An End-to-End Image-Based Automatic Food Energy Estimation Technique Based on Learned Energy Distribution Images: Protocol and Methodology

Obtaining accurate food portion estimation automatically is challenging since the processes of food preparation and consumption impose large variations on food shapes and appearances. The aim of this paper was to estimate the food energy numeric value from eating occasion images captured using the mobile food record. To model the characteristics of food energy distribution in an eating scene, a new concept of “food energy distribution” was introduced. The mapping of a food image to its energy distribution was learned using Generative Adversarial Network (GAN) architecture. Food energy was estimated from the image based on the energy distribution image predicted by GAN. The proposed method was validated on a set of food images collected from a 7-day dietary study among 45 community-dwelling men and women between 21–65 years. The ground truth food energy was obtained from pre-weighed foods provided to the participants. The predicted food energy values using our end-to-end energy estimation system was compared to the ground truth food energy values. The average error in the estimated energy was 209 kcal per eating occasion. These results show promise for improving accuracy of image-based dietary assessment.

Improving Nutrition and Activity Behaviors Using Digital Technology and Tailored Feedback: Protocol for the Tailored Diet and Activity (ToDAy) Randomized Controlled Trial.

BackgroundExcess weight is a major risk factor for chronic diseases. In Australia, over 60% of adults are overweight or obese. The overconsumption of energy-dense nutrient-poor (EDNP) foods and low physical activity (PA) levels are key factors contributing to population obesity. New cost-effective approaches to improve population diet and PA behaviors are needed.ObjectiveThis 1-year randomized controlled trial (6-month intervention and 6-month follow-up) aims to investigate whether a tailored intervention using mobile technology can improve diet and PA behaviors leading to weight loss in adults (aged 18-65 years) who are overweight or obese and recruited through a social marketing campaign (LiveLighter).MethodsAll eligible participants will provide data on demographics and lifestyle behaviors online at baseline, 6 months, and 12 months. Using two-stage randomization, participants will be allocated into one of three conditions (n=200 per group): tailored feedback delivered via email at seven time points, informed by objective dietary (mobile food record app) and activity (wearable activity monitor) assessment; active control receiving no tailored feedback, but undergoing the same objective assessments as tailored feedback; and online control receiving no tailored feedback or objective assessments. Primary outcome measures at 6 and 12 months are changes in body mass, EDNP food and beverage consumption, and daily moderate-to-vigorous PA (measured via accelerometry). Secondary outcomes include change in fruit and vegetable consumption, daily sedentary behaviors, and cost effectiveness.ResultsEnrolment commenced in August 2017. Primary outcomes at 12 months will be available for analysis from September 2019.ConclusionsTailored email feedback provided to individuals may deliver a cost-effective strategy to overcome existing barriers to improving diet and PA. If found to be successful and cost effective, upscaling this intervention for inclusion in larger-scale interventions is highly feasible.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12617000554369; https://www.anzctr.org.au /Trial/Registration/TrialReview.aspx?id=371325&isReview=trueInternational Registered Report Identifier (IRRID)DERR1-10.2196/12782

THE USE OF CO-OCCURRENCE PATTERNS IN SINGLE IMAGE BASED FOOD PORTION ESTIMATION.

Measuring accurate dietary intake is considered to be an open research problem in the nutrition and health fields. Food portions estimation is a challenging problem as food preparation and consumption process pose large variations on food shapes and appearances. We use geometric model based technique to estimate food portions and further improve estimation accuracy using co-occurrence patterns. We estimate the food portion co-occurrence patterns from food images we collected from dietary studies using the mobile Food Record (mFR) system we developed. Co-occurrence patterns is used as prior knowledge to refine portion estimation results. We show that the portion estimation accuracy has been improved when incorporating the co-occurrence patterns as contextual information.

Feasibility of Assessing Diet with a Mobile Food Record for Adolescents and Young Adults with Down Syndrome

Technology-based methods for assessing diet in those with disability remains largely unexplored. The aim was to assess the feasibility of assessing diet with an image-based mobile food record application (mFR) in 51 adolescents and young adults with Down syndrome (PANDs). Adherence was also assessed with the instruction to include a fiducial marker object in the before and after eating images. The PANDs sample completed a four-day mFR and results were compared with a sample of young adults from the Connecting Health and Technology study (CHAT, n = 244). Compared to the CHAT sample, PANDs participants reported more fruit (2.2 ± 1.8 versus 1.0 ± 0.9 serves respectively) and vegetables (2.4 ± 1.3 versus 1.9 ± 1.0 serves, respectively), but no differences in energy-dense nutrient-poor (EDNP) foods and beverages were observed. Compared to CHAT, PANDs participants captured fewer images with the mFR (4.9 ± 2.3 versus 4.0 ± 1.5 images, respectively). Adherence to the instruction to include the fiducial marker in images was lower for PANDs compared with the CHAT sample (90.3% versus 96.5%). Due to the quality of information captured in images and the high acceptability of the fiducial marker, the mFR shows great promise as a feasible method of assessing diet in adolescents and young adults with Down syndrome.