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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Approaches to Assessing Intake of Food and Dietary Supplements in Pregnant Women and Children 2 to 11 Years of Age: Proceedings of a Workshop Series. Washington, DC: The National Academies Press. doi: 10.17226/26374.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Approaches to Assessing Intake of Food and Dietary Supplements in Pregnant Women and Children 2 to 11 Years of Age: Proceedings of a Workshop Series. Washington, DC: The National Academies Press. doi: 10.17226/26374.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Approaches to Assessing Intake of Food and Dietary Supplements in Pregnant Women and Children 2 to 11 Years of Age: Proceedings of a Workshop Series. Washington, DC: The National Academies Press. doi: 10.17226/26374.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Approaches to Assessing Intake of Food and Dietary Supplements in Pregnant Women and Children 2 to 11 Years of Age: Proceedings of a Workshop Series. Washington, DC: The National Academies Press. doi: 10.17226/26374.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Approaches to Assessing Intake of Food and Dietary Supplements in Pregnant Women and Children 2 to 11 Years of Age: Proceedings of a Workshop Series. Washington, DC: The National Academies Press. doi: 10.17226/26374.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Approaches to Assessing Intake of Food and Dietary Supplements in Pregnant Women and Children 2 to 11 Years of Age: Proceedings of a Workshop Series. Washington, DC: The National Academies Press. doi: 10.17226/26374.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Approaches to Assessing Intake of Food and Dietary Supplements in Pregnant Women and Children 2 to 11 Years of Age: Proceedings of a Workshop Series. Washington, DC: The National Academies Press. doi: 10.17226/26374.
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Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Approaches to Assessing Intake of Food and Dietary Supplements in Pregnant Women and Children 2 to 11 Years of Age: Proceedings of a Workshop Series. Washington, DC: The National Academies Press. doi: 10.17226/26374.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Approaches to Assessing Intake of Food and Dietary Supplements in Pregnant Women and Children 2 to 11 Years of Age: Proceedings of a Workshop Series. Washington, DC: The National Academies Press. doi: 10.17226/26374.
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Page R9
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Approaches to Assessing Intake of Food and Dietary Supplements in Pregnant Women and Children 2 to 11 Years of Age: Proceedings of a Workshop Series. Washington, DC: The National Academies Press. doi: 10.17226/26374.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Approaches to Assessing Intake of Food and Dietary Supplements in Pregnant Women and Children 2 to 11 Years of Age: Proceedings of a Workshop Series. Washington, DC: The National Academies Press. doi: 10.17226/26374.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Approaches to Assessing Intake of Food and Dietary Supplements in Pregnant Women and Children 2 to 11 Years of Age: Proceedings of a Workshop Series. Washington, DC: The National Academies Press. doi: 10.17226/26374.
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Emily A. Callahan, Rapporteur Food and Nutrition Board Health and Medicine Division

THE NATIONAL ACADEMIES PRESS   500 Fifth Street, NW   Washington, DC 20001 This activity was supported by the Academy of Nutrition and Dietetics and the U.S. Department of Health and Human Services. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Number-13: 978-0-309-27160-8 International Standard Book Number-10: 0-309-27160-6 Digital Object Identifier: https://doi.org/10.17226/26374 Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2022 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2022. Approaches to assessing intake of food and dietary supplements in p ­ regnant women and children 2 to 11 years of age: Proceedings of a workshop series. ­Washington, DC: The National Academies Press. https://doi.org/10.17226/26374.

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the char- ter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president. The National Academy of Medicine (formerly the Institute of Medicine) was estab- lished in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org.

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PLANNING COMMITTEE ON APPROACHES TO ASSESSING INTAKE OF FOOD AND DIETARY SUPPLEMENTS IN PREGNANT WOMEN AND CHILDREN 2 TO 11 YEARS OF AGE1 CHERYL A. ANDERSON (Chair), Professor and Dean, San Diego Herbert Wertheim School of Public Health and Human Longevity Science, University of California DANA DABELEA, Professor of Epidemiology and Pediatrics and Director, Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus STEPHEN R. DANIELS, Professor and Chair, Department of Pediatrics, University of Colorado School of Medicine, and Pediatrician-in-Chief and L. Joseph Butterfield Chair in Pediatrics, Children’s Hospital Colorado ESA M. DAVIS, Associate Professor of Medicine, Clinical and Translational Science, University of Pittsburgh School of Medicine ERICA P. GUNDERSON, Epidemiologist and Research Scientist III, Division of Research, Kaiser Permanente Northern California LISA J. HARNACK, Professor, School of Public Health; Director, Nutrition Coordinating Center; and Co-Director, Healthy Weight Research Center, University of Minnesota AMY H. HERRING, Sara and Charles Ayres Distinguished Professor of Statistical Science, Duke University ANNA MARIA SIEGA-RIZ, Dean and Professor, Department of Nutrition and Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst Health and Medicine Division Staff MARIA ORIA, Senior Program Officer ALICE VOROSMARTI, Associate Program Officer ZARIA FYFFE, Senior Program Assistant ANN L. YAKTINE, Director, Food and Nutrition Board 1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop Series rests with the workshop rapporteur and the institution. v

Reviewers This Proceedings of a Workshop Series was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical com- ments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evi- dence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We thank the following individuals for their review of this proceedings: DAVID B. ALLISON, Indiana University Bloomington REGAN L. BAILEY, Purdue University I. DIANA FERNANDEZ, University of Rochester School of Medicine Although the reviewers listed above provided many constructive com- ments and suggestions, they were not asked to endorse the content of the proceedings, nor did they see the final draft before its release. The review of this proceedings was overseen by HUGH TILSON, University of North Carolina Gillings School of Global Public Health. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteur and the National Academies. vii

Contents 1 INTRODUCTION 1 Introductory Remarks, 2 Organization of This Proceedings, 4 2 METHODS FOR DIETARY ASSESSMENT DURING PREGNANCY 5 Challenges to Estimating Diet During Pregnancy, 6 Estimating Intake of Dietary Supplements During Pregnancy, 8 Dietary Assessment During Pregnancy: Perspective from a Nutritional Phenotyping Cohort, 10 A French-Canadian Perspective on Dietary Assessment During Pregnancy, 14 Analytical Methods to Estimate Dietary Intake During Pregnancy, 17 Q & A Session, 20 Panel Discussion, 24 3 METHODS FOR DIETARY ASSESSMENT IN CHILDREN 2 TO 5 YEARS OF AGE 27 Methods for Dietary Assessment in Young Children, 29 Choosing an Appropriate Dietary Assessment Method for Research Conducted in Early Childhood, 31 Lessons from the Feeding Infants and Toddlers Study, 34 Lessons from Other Disciplines: Analysis of Data Recorded from Multiple Informants, 37 ix

x CONTENTS Q & A Session, 40 Panel Discussion, 43 4 METHODS FOR DIETARY ASSESSMENT IN CHILDREN 6 TO 11 YEARS OF AGE 47 Methods for Dietary Assessment in Children 6 to 11 Years of Age, 50 A Comparison of Two Technology-Based Methods for Measuring School-Aged Children’s Dietary Intake, 52 Objective Passive Methods to Assess Dietary Intake in Later Childhood, 55 Exploring Best Practices for Measuring Dietary Intake in Children 6 to 11 Years of Age, 57 Q & A Session, 63 Panel Discussion, 67 5 INNOVATIONS AND SPECIAL CONSIDERATIONS IN ASSESSING DIETARY INTAKE DURING PREGNANCY AND IN CHILDREN 2 TO 11 YEARS OF AGE 71 Considerations for Developing and Implementing Dietary Assessment Methods, 73 Emerging Technologies as Opportunities to Measure Dietary Intake, 75 Potential for Ecological Momentary Assessment in Dietary Intake Research, 78 Harmonization of Methods for Dietary Assessment, 80 Matching the Research Question to the Appropriate Dietary Assessment Method and Statistical Analyses, 82 Q & A Session, 85 Final Workshop Panel Discussion: Challenges and Opportunities to Strengthen Dietary Intake Data from Pregnant Women and Children, 88 Highlights, 92 REFERENCES 95 APPENDIXES A WORKSHOP AGENDAS 103 B ACRONYMS AND ABBREVIATIONS 109 C BIOGRAPHICAL SKETCHES OF SPEAKERS AND PLANNING COMMITTEE MEMBERS 111

Box, Figures, and Tables BOX 1-1 Workshop Statement of Task, 2 FIGURES 2-1 Schedule of prenatal measurements in the Mother and Infant Nutri- tion Study, 11 2-2 Schedule of measurements in the Apports Nutritionnels Durant la Grossesse (ANGE) study, 15 2-3 Hypothetical effect of different types of measurement error on estimates of population prevalence (%) of meeting or exceeding the Dietary ­Reference Intake guidelines, 18 3-1 Daily food and activity tracker used in the KIDFIT study, 33 4-1 Nutritional epidemiology road map highlighting the timing of dietary assessment in the research process, 58 4-2 Factors influencing the ideal choice of dietary assessment instrument, 59 5-1 Example of a reference illumination for a fiducial marker, 76 5-2 Shape analysis-derived constellations representing high-quality dietary patterns illustrated using radar graphs, 84 xi

xii BOX, FIGURES, AND TABLES TABLES 4-1 Parent Perceptions of the Remote Food Photography Method (RFPM) Assessed via Focus Groups, 54 4-2 Parent Perceptions of the Automated Self-Administered 24-Hour (ASA24) Dietary Assessment Tool Assessed via Focus Groups, 54 4-3 Comparison of Instruments for Dietary Assessment in Children 6 to 11 Years of Age, 60

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A virtual workshop series titled Approaches to Assessing Intake of Food and Dietary Supplements in Pregnant Women and Children 2 to 11 Years of Age was convened in May, 2021 by the Food and Nutrition Board of the National Academies of Sciences, Engineering, and Medicine. The four-day workshop series explored the evidence on methodological approaches to assessing intake of food and dietary supplements in pregnant women and children 2 to 11 years of age.

Obtaining reliable and valid dietary intake information for these population groups is particularly difficult - in pregnancy, rapid changes in nutrient needs and dietary intakes occur, and in young children, much of dietary intake is consumed outside the home and is often misreported by the children or their proxy reporters. To advance the quality of the science in these areas, the workshop had four goals: identify the suite of current methods used in dietary assessments, including food and dietary supplements, in pregnant women and children 2 to 11 years of age; identify the methodological challenges and opportunities in improving current methods; explore methodologies in other disciplines and their application in dietary assessments in those populations; and discuss factors to consider when implementing dietary assessment tools in those populations. This publication summarizes the presentations and discussions of the workshop series.

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