Remote Food Photography Method Research Articles

Assessing dinner meals offered at home among preschoolers from low-income families with the Remote Food Photography Method.

The high prevalence of obesity among preschoolers may be partially explained by the type and quantity of foods offered by parents and left unconsumed by preschoolers. (a) To compare foods offered and consumed at dinner to the Dietary Guidelines for Americans (DGAs) and the Child and Adult Care Food Program (CACFP) standards and (b) to examine the types, quantities, and nutrient composition of foods offered to and consumed by preschoolers and their plate waste. Participants were recruited from six Head Start/preschool centres. The Remote Food Photography Method was used to document dinner meals over 1 week (n = 153 meals). Energy and nutrients for foods offered, consumed, and plate waste were calculated. Foods offered and consumed were compared with the DGAs and CACFP standards. Foods and beverages offered at dinner equaled 506 kcal, which is 36% of the DGA-recommended total daily energy intake. Meals offered and consumed were high in fat and sodium and low in fibre. Adherence to CACFP standards was low for fruits (25%) and milk (2%) and moderate for vegetables (63%). Mean plate waste (29%) was similar across food types. Opportunities exist to improve preschoolers' adherence to the DGAs and CACFP standards by enhancing the quality of dinner meals offered to them.

No Association Between Consumption of Eggs with Energy or Macronutrient Intake: Objective Evidence from the Remote Food Photography Method (P08-025-19)

ObjectivesStudies using subjective assessment of food intake have reported associations of egg consumption with the intake of various food groups and nutrients, including positive associations with the intake of cholesterol, macronutrients, saturated fat, and total energy. Considering the substantial misreporting linked with subjective measures of food intake, we aimed to examine such associations of egg consumption in a setting with objectively measured food intake. MethodsWe assessed dietary intake using an ecological momentary assessment approach (i.e., Remote Food Photography Method, RFPM). Forty-eight healthy subjects (age 19–58 years; BMI 20.05–38.03 kg/m2; consume ≥1 egg per week) took ‘before’ and ‘after’ photographs of all food they consumed during consecutive 7 days using a smartphone app called SmartIntake®. Images were analyzed for nutrient content. Linear correlations between egg consumption and the intake of cholesterol, total energy, saturated fat, carbohydrate, protein, and that with Body Mass Index (BMI), were determined using R software. ResultsEgg consumption was positively related with cholesterol intake (r = 0.84, P < 0.001). Egg consumption was not significantly associated with the intake of total energy, saturated fat, carbohydrate, or protein. The association between egg consumption and BMI was also not significant (r = 0.25, P = 0.09). ConclusionsConsidering the higher cholesterol content in eggs, the positive association of egg consumption with cholesterol was expected. However, our objectively assessed findings contradict many of the other prevailing associations of egg consumption derived from subjective assessment of food intake. Our results showed that in this setting, egg consumption was not associated with greater intake of energy, saturated fat or other macronutrients. Funding SourcesAmerican Egg Board/Egg Nutrition Center

333-OR: Assessing Mealtime Macronutrient Content: Patient Perceptions vs. Expert Analyses via a Novel Phone App

People with type 1 diabetes (T1D) estimate the carbohydrate (CHO) content of meals to enable accurate insulin dosing, yet protein and fat content of meals also influences post-prandial glycemia. As part of an observational study examining the impact of exercise and nutrient consumption on glycemia, we examined accuracy in estimating macronutrient content of free-living meals via a novel phone app. Participant estimates of nutrient content were compared to expert nutrition analyses performed via the Remote Food Photography Method (RFPM). We report results from 30 of 33 randomized with analyzable food photos. Participants were 15-65 years (32±14 years); 27% identified as female. Participants were asked to take photos before and after meals/snacks on up to 16 days over a 28-day period, enter CHO estimates and estimate if meals were low (&amp;lt;13%), typical (13-&amp;lt;18%), or high (≥18%) protein and if meals were low (&amp;lt;26%), medium (26-&amp;lt;32%), or high (≥32%) fat. The phone app plus RFPM captured 92±27% of estimated energy needs. Of 1,292 food photos analyzed, 429 contained &amp;lt; 25 g (small), 641 contained 25-75 g (medium), and 222 contained &amp;gt; 75 g (large) amounts of CHO. Participants estimated CHO in small or medium meals within 10 g of the expert analyses. They were less accurate estimating CHO for larger meals (-56 ± 46 g). Likewise, most correctly categorized low and typical protein (63%, 50%) as well as low and typical fat (62%, 67%) meals. Few correctly categorized meals high in protein (17%) or fat (16%). Participants’ estimation accuracy for larger meals did not differ by T1D duration. The phone app successfully collected individuals’ food intake and estimated macronutrient intake, but showed that participants consistently underestimated nutrient intake for large meals. Accurate estimation of total macronutrients in meals could be leveraged to improve insulin decision support tools and closed loop systems; development of tools to improve macronutrient estimation skills should be considered. Disclosure M.B. Gillingham: None. C.K. Martin: Advisory Panel; Self; EHE. Consultant; Self; ACAP Health, Florida Hospital, WW, Zafgen, Inc. Other Relationship; Self; Academy of Nutrition and Dietetics. S.R. Patton: None. Z. Li: None. P.G. Jacobs: Stock/Shareholder; Self; Pacific Diabetes Technologies. M. Riddell: Advisory Panel; Self; Xeris Pharmaceuticals, Inc. Research Support; Self; Dexcom, Inc. Speaker's Bureau; Self; Insulet Corporation, Medtronic MiniMed, Inc. Stock/Shareholder; Self; Zucara Therapeutics Inc. M.R. Rickels: None. J.R. Castle: Advisory Panel; Self; Novo Nordisk Inc., Zealand Pharma A/S. Consultant; Self; Dexcom, Inc. Research Support; Self; Dexcom, Inc., Xeris Pharmaceuticals, Inc. M.A. Clements: Advisory Panel; Self; Glooko, Inc. Consultant; Self; Eli Lilly and Company. Speaker's Bureau; Self; Medtronic. E. Dassau: Consultant; Self; Eli Lilly and Company, Insulet Corporation. Research Support; Self; Dexcom, Inc., DreaMed Diabetes, Ltd., Insulet Corporation, Roche Diabetes Care, Tandem Diabetes Care, Xeris Pharmaceuticals, Inc. Speaker's Bureau; Self; Roche Diabetes Care. Other Relationship; Self; ModAGC. F.J. Doyle: Consultant; Self; ModeAGC. Other Relationship; Self; Insulet Corporation. P. Calhoun: Stock/Shareholder; Self; Dexcom, Inc. R.L. Gal: None. R. Beck: Other Relationship; Self; Abbott Laboratories, Ascensia Diabetes Care, Bigfoot Biomedical, Dexcom, Inc., Insulet Corporation, Lilly Diabetes, Roche Diabetes Care, Tandem Diabetes Care. Funding The Leona M. and Harry B. Helmsley Charitable Trust

Using Photography to Assess Foods Offered to Preschoolers in Parent Packed Lunches (P11-069-19)

ObjectivesTo examine the quality of meals offered to children ages 3–5 years in parent packed lunches at a university-based early childhood center. MethodsUsing a protocol based on the Remote Food Photography Method, trained research staff used iPads to take before and after photos of preschoolers’ packed lunches over 1 week. Meal quality was assessed using the Healthy Meal Index (HMI) and Child and Adult Food Care Program (CACFP) standards. Photos were independently coded by 2 researchers for key meal details, including availability and type of fruits, vegetables, grains, proteins and dairy, which fed into established scoring criteria to generate a HMI adequacy score. The mean HMI adequacy score for all lunches and percentages of lunches containing each adequacy food group were calculated to assess total meal quality. Photos were also reviewed using CACFP standards for availability, type, and amount of foods offered. Researchers coded photos (k = .86) for the inclusion of 4 food groups (fruits, vegetables, grains, and protein; milk was not served), and serving sizes were visually estimated and compared with recommended CACFP serving sizes: 1.5 oz of protein and 0.25 c each of fruits, vegetables, and grains. Mean standardized servings offered to children were calculated from these standards. ResultsLunches (n = 301) from 79 children were photographed (2-5 days/child). The mean HMI adequacy score was x̄ = 37.7 11.0 (out of 65), with a range of 15.0 to 65.0. For all meals, 89% contained a grain, 86% contained fruit, 75% contained dairy (non-milk), 60% contained protein, and 48% contained a vegetable. Compared to CACFP standards, lunches had an average of 2.77 0.78 food groups present out of 4. Standardized servings offered for grains (x̄ = 2.60 ± 1.49), fruits (x̄ = 1.89 ± 1.09), protein (x̄ = 1.42 ± .68), and vegetables (x̄ = 1.35 ± .74) were high when calculated based on recommended CACFP serving sizes. ConclusionsIn this study, parent packed lunches fell short of meeting CACFP guidelines by offering less than 3 of the recommended 4 food groups, with a large percentage of lunches containing grains, fruits, and dairy. Children were provided with larger amounts than recommended for all food groups, particularly for grains. Funding SourcesColorado State University Health Behaviors Lab.

Beyond Nutrient Intake: Use of Digital Food Photography Methodology to Examine Family Dinnertime

To explore the feasibility of using an image-based food photography methodology (Remote Food Photography Method) in a rural, low-resource audience and use the photos to examine the context of family dinner. Parents used the SmartIntake app on study-issued tablets to take before and after photos of their and their child's dinner for about 7 nights and participated in a mini-focus group to discuss their experience with the Remote Food Photography Method. Six Head Start/preschool centers in rural Colorado. Mother-child dyads (n = 31). Number and quality of photos received, participant feedback, meal timing, concordance, location, preparation, and quality. The researchers assessed feasibility via practicality (percent photos received) and acceptability (general inductive approach used to analyze mini-focus group transcripts for participant feedback); time stamps, meal quality, and food preparation scales were used to analyze dinner photos. The majority of photographs (738 of 864) were received. Participants reacted favorably to the methodology; for some, it led to greater self-reflection about mealtime. Mother-child dyads usually ate dinner at the same time and often ate the same food. Children were frequently served protein and refined grains and were rarely served whole grains or fruit. Many families relied on convenience foods. Digital food photography was feasible in this audience. Photos yielded a holistic picture of family dinnertime: meal timing, location, concordance in parent-child meals, level of preparation, and meal quality.

The Remote Food Photography Method and SmartIntake App for the Assessment of Alcohol Use in Young Adults: Feasibility Study and Comparison to Standard Assessment Methodology.

BackgroundHeavy drinking is prevalent among young adults and may contribute to obesity. However, measurement tools for assessing caloric intake from alcohol are limited and rely on self-report, which is prone to bias.ObjectiveThe purpose of our study was to conduct feasibility testing of the Remote Food Photography Method and the SmartIntake app to assess alcohol use in young adults. Aims consisted of (1) quantifying the ability of SmartIntake to capture drinking behavior, (2) assessing app usability with the Computer System Usability Questionnaire (CSUQ), (3) conducting a qualitative interview, and (4) comparing preference, usage, and alcohol use estimates (calories, grams per drinking episode) between SmartIntake and online diet recalls that participants completed for a parent study.MethodsCollege students (N=15) who endorsed a pattern of heavy drinking were recruited from a parent study. Participants used SmartIntake to send photographs of all alcohol and food intake over a 3-day period and then completed a follow-up interview and the CSUQ. CSUQ items range from 1-7, with lower scores indicating greater usability. Total drinking occasions were determined by adding the number of drinking occasions captured by SmartIntake plus the number of drinking occasions participants reported that they missed capturing. Usage was defined by the number of days participants provided food/beverage photos through the app, or the number of diet recalls completed.ResultsSmartIntake captured 87% (13/15) of total reported drinking occasions. Participants rated the app as highly usable in the CSUQ (mean 2.28, SD 1.23). Most participants (14/15, 93%) preferred using SmartIntake versus recalls, and usage was significantly higher with SmartIntake than recalls (42/45, 93% vs 35/45, 78%; P=.04). Triple the number of participants submitted alcohol reports with SmartIntake compared to the recalls (SmartIntake 9/15, 60% vs recalls 3/15, 20%; P=.06), and 60% (9/15) of participants reported drinking during the study.ConclusionsSmartIntake was acceptable to college students who drank heavily and captured most drinking occasions. Participants had higher usage of SmartIntake compared to recalls, suggesting SmartIntake may be well suited to measuring alcohol consumption in young adults. However, 40% (6/15) did not drink during the brief testing period and, although findings are promising, a longer trial is needed.

Preliminary Feasibility and Acceptability of the Remote Food Photography Method for Assessing Nutrition in Young Children with Type 1 Diabetes.

Nutrition is a critical component of diabetes and other chronic diseases for young children. However, nutritional intake is burdensome to measure accurately and easily, making it difficult to evaluate in research or clinical contexts. This pilot study examined the feasibility and acceptability of having parents of young children with T1D use the Remote Food Photography Method (RFPM) to measure breakfast nutrition. Participants were 9 mothers of children ages 2-5 years (Mage=4.2), with a T1D duration of at least 1 year (Mage=2.4 years at diagnosis), representing diverse backgrounds (55.6% Caucasian; 44.4% African American; 55.6% married). During baseline and follow-up of a healthy eating and physical activity intervention for children with T1D, parents used the RFPM to capture before and after images of their children's breakfast. Feasibility and acceptability were assessed by adherence to taking photos, percent of usable photos, and participant satisfaction. The RFPM was feasible across participants with high adherence rates (100% at baseline and 87% at follow-up) for sending usable photographs. Most participants reported satisfaction with the method. Using the RFPM to assess nutrition in a small sample of young children with T1D was feasible and acceptable. Given the importance of assessing nutrition in young children with T1D as well as other chronic illnesses (e.g., cystic fibrosis, obesity), the RFPM may be a useful tool for both research and clinical data collection in lieu of other methods. More research is needed to evaluate reliability and validity of RFPM in pediatric populations.

Subjective social status is associated with compensation for large meals – A prospective pilot study

ObjectivesSubjective social status (SSS) is known to be inversely associated with obesity. Our objective was to determine if SSS is associated with eating behaviors that would predispose to weight gain, specifically, with inadequate compensation for excess energy consumed during a single large meal. Therefore, we conducted a pilot study to determine the association of SSS with 24-h energy balance, 24-h and post-lunch energy intake, changes in body composition and changes in adjusted resting energy expenditure on days when a high-energy lunch was consumed in free-living human subjects. MethodFemale participants (7 normal weight and 10 overweight) consumed 60% of’ estimated 24-h energy requirements as a lunchtime meal in the laboratory for 14 days. Subjective social status was measured at baseline using the MacArthur Scale. Remote Food Photography Method was used to record food intake outside of the lab on days 1–2, 7–8, and 12–13. Associations of 24-h energy balance, 24-h and post-lunch energy intake, changes in adjusted resting energy expenditure and changes in percent body fat (measured by dual x-ray absorptiometry) with SSS were studied. ResultsMean (standard deviation) age and BMI were 36.29 (8.25) years and 26.43 (2.32) kg/m2, respectively. Lower SSS was significantly associated with positive energy balance (p for trend 0.002), and higher post-lunch energy intake (p = 0.02) when controlled for age and initial body mass index. ConclusionsOur pilot data show that lower SSS is associated with higher post-lunch energy intake, which is indicative of poor energy compensation following a large meal. Over a longer time period, this could result in fat mass gain. Studies that are of longer duration and well-powered are warranted to confirm our findings.

NP34 - The HEROs Study Year 3: Engaging Families to Promote Healthy Eating and Activity Behaviors in Early Childhood

Objective: The objective of the HEROs Study (HEalthy EnviROnments Study) is to develop a technology-based, interactive family intervention to promote healthy lifestyles and weight outcomes for young children in the family setting. Description: The project aims to improve family routines and parent-child eating and physical activity (PA) interactions. Research activities will be conducted through four key objectives: formative research; intervention design; intervention testing; and education. Evaluation: Year 3 focused on completion of the formative research and initialization of intervention design and plans for intervention testing. Parents and caregivers provided input on four key topic areas: food behaviors and environments (mealtime environment survey, n = 120; remote food photography method, n = 31 parent-child dyads; parent focus group, n = 7 groups, 29 participants); physical activity behaviors and environments (parent interview and parent practices survey; n = 31); mobile device use (results reported in Year 2); and daily life (ecocultural family interview; n = 30). A mixed methods approach is being utilized to synthesize findings from quantitative and qualitative assessments to provide a holistic understanding of participant behaviors, beliefs, attitudes and values related to each topic area. Intervention mapping is being employed as a framework to integrate formative research findings alongside theory, findings from the literature and previous research outcomes to design the HEROs intervention. Year 3 also included the development and testing of prototypes of nutrition and physical activity mobile applications that will serve as key intervention components. Conclusions and Implications: The HEROs intervention map will be used as a framework for intervention development. Subsequently in Year 4, an implementation study will be conducted utilizing the Plan-Do-Study-Act (PDSA) framework to test intervention components with a subset of families. Intervention module cycles will be studied to understand which of the key intervention components resonates with and drives participants towards behavior change. Funding: 2015-68001-23240. The following is the supplementary data to this article: Download .pdf (.91 MB) Help with pdf files Poster

HEROs: Design of a Mixed-Methods Formative Research Phase for an Ecocultural Intervention to Promote Healthy Eating and Activity Behaviors in Rural Families With Preschoolers

ObjectiveTo describe the mixed-methods formative research phase in the development of the Healthy Environments Study (HEROs), a technology-based, interactive family intervention to promote healthy eating and activity behaviors for young children in the home environment. DesignA mixed-method iterative approach, using ecocultural theory as a framework, will guide the development of both quantitative and qualitative formative research assessments. SettingRural eastern Colorado. ParticipantsLow-income families (n = 200) with preschool-aged children enrolled at 6 Head Start/preschool centers. Main Outcome MeasuresQuantitative and qualitative methodologies will garner insights into 4 key topic areas: (1) food behaviors and environments (Remote Food Photography Method, parent focus group, and survey), (2) physical activity behaviors and environments (parent interview and survey), (3) mobile device use (parent survey and interview), and (4) daily life (ecocultural family interview and teacher/staff group discussions). AnalysisResults will be interpreted in combination to allow for a holistic understanding of participant behaviors, beliefs, attitudes and values related to each of the 4 topic areas. Collectively, outcomes will provide a comprehensive picture of preschoolers' daily life and inform intervention design and strategies to enhance preschoolers' eating and activity behaviors in the home environment.

Plate waste of adults in the United States measured in free-living conditions.

We analyze food-item level data collected from 50 adults from the United States using the Remote Food Photography Method® to provide the first estimates of plate waste gathered from adults across multiple consecutive meals and days in free-living conditions, and during laboratory-based meals with fixed food items and quantities. We find average plate waste in free-living conditions is 5.6 grams (7.7 kcals) per item and that 3.3% of all food selected is returned as plate waste, where the percent waste figure is substantially lower than previously published plate waste estimates gathered primarily from dine-out settings in the United States such as buffets and institutional settings with limited-choice meals (e.g., school cafeterias). Plate waste from the same participants during the laboratory-based meals is significantly higher with an average of 203.2 grams of solid plate waste per meal (531.3 kcals) or 39.1% of the food provided, which is similar to the plate waste percentages found reported in some school cafeteria settings. The amount of plate waste generated in free-living conditions is significantly positively associated with portion size selected for an item. In a multivariate analysis that controls for macronutrient profile, items selected from the vegetables, fats/oils/dressings, and grains categories are associated with significantly greater amounts of plate waste per item. We find no significant associations between free-living plate waste and gender, age, race or body mass index but find that women leave more plate waste in the lab meal where portion sizes are pre-determined by the researcher and similar for all respondents. We discuss possible implications of these findings for programs focused on reducing plate waste and food waste among consumers.

Validity of the Remote Food Photography Method Against Doubly Labeled Water Among Minority Preschoolers.

ObjectiveTo determine the validity of energy intake (EI) estimations made using the Remote Food Photography Method (RFPM) compared to the doubly-labeled water (DLW) method in minority preschool children in a free-living environment.MethodsSeven days of food intake and spot urine samples excluding first void collections for DLW analysis were obtained on 39 3-to-5 year old Hispanic and African American children. Using an iPhone, caregivers captured before and after pictures of the child’s intake and pictures were wirelessly transmitted to trained raters who estimated portion size using existing visual estimation procedures and energy and macronutrients were calculated. Paired t-test, mean differences and Bland-Altman limits of agreement were performed.ResultsThe mean EI using the RFPM was 1,191 ± 256 kcal/d and 1,412 ± 220 kcal/d by the DLW method, resulting in a mean underestimate of 222 kcal/d (−15.6%) (p<0.0001) that was consistent regardless of intake. The RFPM underestimated EI by −28.5% in 34 children and overestimated EI by 15.6% in 5 children.ConclusionsThe RFPM underestimated total EI when compared to the DLW method among preschoolers. Further refinement of the RFPM is needed for assessing EI of young children.

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

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.

An Exploratory Study Examining the Impact of Participating in a Nutrition‐Education and Culinary Skill‐Building Program on Adolescents' Dietary Intake Using the Remote Food Photography Method

It is important for adolescents to develop healthy eating habits, yet many youth lack adequate cooking skills and frequently purchase and consume foods away from home. Away‐from‐home meals tend to be low in fruits and vegetables, and a lack of these foods can contribute to a lower quality diet. Nutrition‐education and culinary skill‐building programs have been found to improve adolescents' motivation and competence to follow the 2010 Dietary Guidelines for Americans recommendations, yet it is not known if such interventions improve dietary intake. The purpose of this study was to assess the impact of participating in a summer nutrition‐education and culinary skill‐building program on high school students' consumption of fruits, vegetables, and overall dietary quality. Three‐day diet records were gathered before and after participating in a six‐week summer enrichment program using the Remote Food Photography Method. Participants sent photographs of foods and beverages consumed to investigators, and dietary information was analyzed by researchers at Pennington Biomedical Research Center. Normally distributed data were analyzed using t‐tests and data not normally distributed were examined with Wilcoxon Signed Rank Tests. Twenty adolescents were invited to participate, and eight enrolled (40%). Four participants were male (50%) and all were African American. The adolescents' mean age was 16 ± 1.1 years. Wilcoxon Signed Rank Tests indicated that the adolescents' 3‐day‐average servings of fruit significantly increased from baseline (Mdn = 0.00) to post‐program (Mdn = 0.69), Z = −2.02, p &lt; 0.05, r = 0.71, but consumption of vegetables and overall diet quality estimated from Healthy Eating Index (HEI) Score did not change as a result of participating in the program. For the eight participants, the number of vegetable servings pre‐program was Mdn = 0.00, and the number of servings post‐program was Mdn = 0.00. The HEI pre‐program mean score was M = 61.50, SE = 0.54 and the post‐program score was M = 64.58, SE = 2.16. The results from this study suggest that behavioral interventions promoting nutrition education and cooking competence can improve older adolescents' consumption of fruit.Support or Funding InformationPartially funded by Hatch Project 94127, and NIH grants P30DK072476 and U54 GM104940.

Assessing the Validity of Measuring Energy Intake by Remote Food Photography Method as Compared to Doubly Labeled Water in Pregnant Women

To improve weight management of pregnant women, there is a need to deliver specific, data‐based recommendations on energy intake or physical activity. This study investigated how to use an electronic reporting method of energy intake in pregnant women and evaluated its validity compared to total daily energy expenditure (TDEE).23 obese (BMI: 36.9±1.3 kg/m2) pregnant women (28.3±1.1 years) used a Smartphone application to capture images of their food selection and plate waste in free‐living conditions for at least 6 days in early (13–16 weeks) and late (35–37 weeks) pregnancy. Energy intake by Remote Food Photography Method (RFPM) was evaluated compared to TDEE obtained by doubly labeled water over the same 7‐day period.During 45 observation periods (n=23 × 2 visits, one abnormal TDEE excluded), pictures were captured on 290 (99%) days (6.4±0.1 days captured per observation, 9.0±0.4 pictures*d−1). Average energy intake reported by the RFPM was 1755±59 kcal*d−1 (range: 804 to 2729 kcal*d−1) which equals a 37%±2% (−68 to −11%) underestimate compared to TDEE (2807±51 kcal*d−1), consistent with earlier data from non‐pregnant adults where non‐personalized ecological momentary assessment (EMA) prompts were utilized. Meals (breakfast, lunch, dinner) were reported on 82% (reported meals vs total days) of possible occasions and accounted for 83±2% of total energy intake, while energy intake from snacks was 17±2%.To investigate which factors contribute to compliance, we differentiated reported energy intake by days of the week (week vs weekend), type of phone (own vs study‐provided) and meal type (meals vs snacks). While we found no significant difference in the reported energy intake between week and weekend days, participants that captured pictures on their own phone compared to the study‐provided phone had significantly more pictures (P=.04) and consequently a higher energy intake (P=.13). Reported energy intake as snacks (%energy snack/total) was significantly associated with % reporting (% RFPM/DLW, R2=0.19, P=.03), indicating that reporting of snacks increased accuracy.To understand how to improve data quality, we excluded days of likely underreporting by three criteria: &lt;1000 kcal*d−1, &lt;2 main meals*d−1 or &lt;60% of TDEE. The accuracy of energy intake in comparison to TDEE increased significantly (+7±2%, +5±3% and +24±4%), yet 9, 9 and 45% of the days were excluded by these criteria, respectively. Despite these improvements none of the criteria increased the RFPM to an accuracy within 10% bounds (Two One‐Sided Test for Equivalence, −33±2%, −34±2% and −22±1%, all: P=1.00).In summary, using an electronic reporting method (RFPM), energy intake in obese pregnant women does not accurately estimate energy intake as compared to DLW. However, data quality improves when participants use their own phones and by applying criteria to eliminate unrealistic data. Further evaluation of EMA prompting in this population is needed to improve compliance, specifically for snacks and frequent small meals.Support or Funding InformationNIH R01DK099175, LaCats U54GM104940 and NORC P30DK094418

Effects of intermittent fasting on health markers in those with type 2 diabetes: A pilot study.

AIMTo determine the short-term biochemical effects and clinical tolerability of intermittent fasting (IF) in adults with type 2 diabetes mellitus (T2DM).METHODSWe describe a three-phase observational study (baseline 2 wk, intervention 2 wk, follow-up 2 wk) designed to determine the clinical, biochemical, and tolerability of IF in community-dwelling volunteer adults with T2DM. Biochemical, anthropometric, and physical activity measurements (using the Yale Physical Activity Survey) were taken at the end of each phase. Participants reported morning, afternoon and evening self-monitored blood glucose (SMBG) and fasting duration on a daily basis throughout all study stages, in addition to completing a remote food photography diary three times within each study phase. Fasting blood samples were collected on the final days of each study phase.RESULTSAt baseline, the ten participants had a confirmed diagnosis of T2DM and were all taking metformin, and on average were obese [mean body mass index (BMI) 36.90 kg/m2]. We report here that a short-term period of IF in a small group of individuals with T2DM led to significant group decreases in weight (-1.395 kg, P = 0.009), BMI (-0.517, P = 0.013), and at-target morning glucose (SMBG). Although not a study requirement, all participants preferentially chose eating hours starting in the midafternoon. There was a significant increase (P < 0.001) in daily hours fasted in the IF phase (+5.22 h), although few attained the 18-20 h fasting goal (mean 16.82 ± 1.18). The increased fasting duration improved at-goal (< 7.0 mmol/L) morning SMBG to 34.1%, from a baseline of 13.8%. Ordinal Logistic Regression models revealed a positive relationship between the increase in hours fasted and fasting glucose reaching target values (χ2 likelihood ratio = 8.36, P = 0.004) but not for afternoon or evening SMBG (all P > 0.1). Postprandial SMBGs were also improved during the IF phase, with 60.5% readings below 9.05 mmol/L, compared to 52.6% at baseline, and with less glucose variation. Neither insulin resistance (HOMA-IR), nor inflammatory markers (C-reactive protein) normalized during the IF phase. IF led to an overall spontaneous decrease in caloric intake as measured by food photography (Remote Food Photography Method). The data demonstrated discernable trends during IF for lower energy, carbohydrate, and fat intake when compared to baseline. Physical activity, collected by a standardized measurement tool (Yale Physical Activity Survey), increased during the intervention phase and subsequently decreased in the follow-up phase. IF was well tolerated in the majority of individuals with 6/10 participants stating they would continue with the IF regimen after the completion of the study, in a full or modified capacity (i.e., every other day or reduced fasting hours).CONCLUSIONThe results from this pilot study indicate that short-term daily IF may be a safe, tolerable, dietary intervention in T2DM patients that may improve key outcomes including body weight, fasting glucose and postprandial variability. These findings should be viewed as exploratory, and a larger, longer study is necessary to corroborate these findings.

Development and Application of the Remote Food Photography Method to Measure Food Intake in Exclusively Milk Fed Infants: A Laboratory-Based Study.

BackgroundAccurate methods of assessing food intake in infants are needed to assess the relationship between infant feeding practices and risk of childhood obesity. Current methods are either subjective or have limited ability for use beyond clinical research settings.ObjectiveTo assess the accuracy of the RFPM to evaluate simulated milk intake including energy, macronutrient, and micronutrient intake compared to direct weighing within a controlled study.MethodsIndividuals were recruited to prepare three 2 fl oz, 4 fl oz, 6 fl oz, and 8 fl oz servings of infant formula and to capture photographs at different stages of preparation (dry powdered formula, prepared formula, and liquid waste) using the SmartIntake® application. Gram weights of the bottles were obtained by the RFPM and direct weighing. Using the United States Department of Agriculture National Nutrient Database for Standard Reference, energy, macronutrient, and micronutrient values were generated from gram weights.ResultsIntake of formula prepared from powder measured by the RFPM was equivalent to weighed intake within 7.5% equivalence bounds among all servings and each serving size. The mean difference between methods varied among servings sizes with the RFPM underestimating intake by 1.6 ± 0.4 kcals in 2 fl oz servings, 4.8 ± 0.6 kcals in 4 fl oz servings, and 6.2 ± 1.0 kcals in 6 fl oz servings, and overestimating intake by 0.1 ± 1.2 kcals in 8 fl oz servings. Bland-Altman analysis showed that the RFPM overestimated intake at lower levels food intake and underestimated intake at higher levels. Considering photographs of only the prepared formula bottle and the bottle with formula waste to simulate ready-to-feed formula and human breast milk, intake estimated by the RFPM was equivalent to the directly weighed intake within 7.5% for all servings.ConclusionsThe RFPM has higher accuracy than subjective methods and similar accuracy as compared to the objective methods in estimating simulated intake of milk and formula with lower burden to caregivers. The RFPM is a viable method for measuring intake in exclusively milk fed infants by caregivers in a controlled environment with potential for widespread use in research and clinical practice.

Validation of the Remote Food Photography Method among Preschool Children

Validation of the Remote Food Photography Method among Preschool Children

The Remote Food Photography Method Accurately Estimates Dry Powdered Foods—The Source of Calories for Many Infants

BackgroundInfant formula is a major source of nutrition for infants, with more than half of all infants in the United States consuming infant formula exclusively or in combination with breast milk. The energy in infant powdered formula is derived from the powder and not the water, making it necessary to develop methods that can accurately estimate the amount of powder used before reconstitution. ObjectiveOur aim was to assess the use of the Remote Food Photography Method to accurately estimate the weight of infant powdered formula before reconstitution among the standard serving sizes. MethodsFor each serving size (1 scoop, 2 scoops, 3 scoops, and 4 scoops), a set of seven test bottles and photographs were prepared as follow: recommended gram weight of powdered formula of the respective serving size by the manufacturer; three bottles and photographs containing 15%, 10%, and 5% less powdered formula than recommended; and three bottles and photographs containing 5%, 10%, and 15% more powdered formula than recommended (n=28). Ratio estimates of the test photographs as compared to standard photographs were obtained using standard Remote Food Photography Method analysis procedures. The ratio estimates and the US Department of Agriculture data tables were used to generate food and nutrient information to provide the Remote Food Photography Method estimates. Statistical analyses performedEquivalence testing using the two one-sided t tests approach was used to determine equivalence between the actual gram weights and the Remote Food Photography Method estimated weights for all samples, within each serving size, and within underprepared and overprepared bottles. ResultsFor all bottles, the gram weights estimated by the Remote Food Photography Method were within 5% equivalence bounds with a slight underestimation of 0.05 g (90% CI −0.49 to 0.40; P<0.001) and mean percent error ranging between 0.32% and 1.58% among the four serving sizes. ConclusionsThe maximum observed mean error was an overestimation of 1.58% of powdered formula by the Remote Food Photography Method under controlled laboratory conditions, indicating that the Remote Food Photography Method accurately estimated infant powdered formula.

Use of the Remote Food Photography Method by young pregnant women: a feasibility study

Use of the Remote Food Photography Method by young pregnant women: a feasibility study