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 (2022) / Chapter Skim
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4 Methods for Dietary Assessment in Children 6 to 11 Years of Age
4 Methods for Dietary Assessment in Children 6 to 11 Years of Age
Pages 47-70
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From page 47... ...
• Objective passive methods to assess dietary intake are relatively emergent and preliminary, although they hold considerable potential to mitigate or overcome some limitations of tradi tional methods. It is unclear whether the groups willing to use such methods are representative of broader populations, 47
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From page 48... ...
Presentation topics included methods to collect dietary intake data in children 6 to 11 years of age, a comparison of two technology-based methods -- the remote food photography method and the Automated SelfAdministered 24-Hour (ASA24) Dietary Assessment tool -- for measuring school-aged children's dietary intake, objective passive ways to improve assessment of dietary intake in later childhood, and best practices for measuring dietary intake during this life stage.
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observational cohort study to illustrate how the challenges of dietary intake reporting can bias observed associations between intake and health outcomes. She reported that her team observed an inverse relationship between sugar intakes at approximately 10 years of age (measured with a validated food frequency questionnaire)
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Foster next presented methods that she and her colleagues at N ewcastle University used and developed to assess children's dietary intakes. In a school-based fruit and vegetable intervention that aimed to increase intake among children 4 to 11 years of age, Foster recounted how parents reported the foods consumed at home and observers collected data on intakes that
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From page 51... ...
to gather the intake data; respondents selected from a checklist of foods commonly consumed among the study population and wrote in consumed foods that were not on the list. The reported foods were linked to a database of age- and gender-specific portion sizes, Foster continued, enabling the team to compare participants' intakes with weighted intakes.
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From page 52... ...
A COMPARISON OF TWO TECHNOLOGY-BASED METHODS FOR MEASURING SCHOOL-AGED CHILDREN'S DIETARY INTAKE Traci Bekelman, research assistant professor in the Lifecourse Epidemiology of Adiposity and Diabetes Center and the Department of Epidemiology at the University of Colorado Anschutz Medical Campus, discussed a study that compared two methods for measuring dietary intake among schoolage children 7 to 8 years of age, and was conducted as part of the National Institutes of Health's Environmental influences on Child Health Outcomes (ECHO) program.
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From page 53... ...
From Bekelman's perspective, strengths of the RFPM include real-time data collection, which reduces misreporting owing to poor recall (memory) ; portion size estimation by study staff, which may be more accurate than participants' estimation; and customized text reminders to submit images at participants' usual meal and snack times, which helps reduce missing data.
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Dietary Assessment Tool Assessed via Focus Groups Perceived Strengths of ASA24 Opportunities to Improve ASA24 Minimize • Consolidated workload (once/ • Minimize time commitment burden day) • Minimize parent embarrassment • Structured data entry • Expand database options for restaurant and ethnic foods to avoid recipe creation Maximize • Food images to help estimate • Expand options for restaurant and accuracy portion size ethnic foods in the database • Improve portion size estimation • Improve documentation of unobserved intake SOURCE: Presented by Traci Bekelman, May 19, 2021.
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Therefore, she contended that continued efforts to minimize the challenges parents face in documenting intake for both the RFPM and the ASA24 are justified, based on high acceptability among her study's parent respondents. OBJECTIVE PASSIVE METHODS TO ASSESS DIETARY INTAKE IN LATER CHILDHOOD Tom Baranowski, distinguished emeritus professor at the Baylor C ollege of Medicine, reviewed objective passive ways to improve assessment of dietary intake.
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Baranowski elaborated on a passive objective dietary assessment method called the eButton, which he described as a relatively small, chestworn device that has been in development for nearly 15 years. The eButton incorporates multiple sensors, such as a camera, motion sensor, b arometer, thermometer, and light sensor, which he said work together to detect and classify dietary intake.
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EXPLORING BEST PRACTICES FOR MEASURING DIETARY INTAKE IN CHILDREN 6 TO 11 YEARS OF AGE Wei Perng, assistant professor in the Department of Epidemiology at the Colorado School of Public Health and assistant director of omics research at the Lifecourse Epidemiology of Adiposity and Diabetes Center at the Colorado University Denver Anschutz Medical Campus, discussed best practices for measuring dietary intake in children 6 to 11 years of age. She prefaced her presentation by acknowledging that the determination of a "best practice" hinges on the perceived goal of dietary assessment.
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Accuracy is the proximity of a measured value of dietary intake to the true measure, she explained, offering the analogy of the ability to place a dart in a bullseye. Reliability, she continued, refers to the consistency of results for an instrument when it is implemented repeatedly over time in the same population.
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Perng moved into a summary of six conventional, validated instruments for measuring children's dietary intakes: FFQ, 24-hour dietary recall, and weighed food record, which she said are the most commonly used instruments in epidemiological studies of children; as well as meal observations, biomarkers, and anthropometry. She briefly described each method, the type of data it collects, and its strengths and limitations.
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Strengths • Relevance to chronic • Detailed intake data • Detailed and exact disease • Low respondent intake data • Cost-effective; burden • No interviewer suitable for large • No literacy required • No recall bias studies for the participant • Ideal data for deriving dietary patterns Limitations • Specific to cultural • Requires multiple • Large respondent habits of sample passes and staff burden • Difficult to quantify • May not capture • Multiple days to absolute intake episodically assess usual intake • Recall bias consumed foods • Expensive (e.g., fish) • Recording diet • Interviewer training may cause dietary • Recall and changes interviewer bias Key points • Long-term intake • Short-term intake • Short-term intake • Reliable and valid for • Reliable, fairly • Accurate, reliable, specific populations accurate, and valid and valid • Low accuracy Overall Low burden Medium burden High burden burden level NOTE: ADP = air displacement plethysmography; BIA = bioelectrical impedance analysis; DXA = dual-energy X-ray absorptiometry; FFQ = food frequency questionnaire.
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expensive to observation • Expensive for collecting, • Not ideal for meals storing, and shipping eaten outside of samples and assaying home biomarkers • Short-term intake • Short- or long-term intake • Long-term energy intake • Accurate and reliable • Reliable and valid for some • Crude but reliable and nutrients valid for energy intake High (staff) burden Low/medium burden Low/medium burden
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, she explained that incorporating total energy intake in the analysis controls for confounding and strengthens causal inference by simulating an isocaloric dietary intervention. Another best practice, she continued, is based on the recognition that children underestimate intake of foods typically enjoyed during childhood (cookies, juice, and possibly milk)
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The topics covered were assessing children's dietary supplement use, the misreporting of sex differences in energy intake, choosing an optimal method to assess children's dietary intake, using dietary assessment methods to assess diet quality, and advancing novel technologies for dietary assessment. Assessing Children's Dietary Supplement Use Cheryl Anderson, professor and dean of the Herbert Wertheim School of Public Health and Human Longevity Science at the University of California San Diego, asked about best practices for assessing children's dietary supplement use.
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Dabelea asked if Bekelman's data indicated that either the ASA24 or the RFPM is better for assessing children's dietary intakes or whether the choice of method depends on the study context. Bekelman's response emphasized the importance of matching the assessment method and tool to the research question.
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Dietary Assessment Across Life Stages and Settings Dabelea asked Perng if her advice on best practices for assessing children's dietary intake is also relevant for other age groups and life stages, and whether any age- or stage-specific considerations exist. Perng underscored that the designation of a best practice depends on the research question.
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He suggested more substantial investment in development of measures themselves, noting that previous funding from the National Cancer Institute for methods development helped to advance some of the novel technologies discussed during the workshop series. Huge advances are occurring in artificial intelligence, he pointed out, that could accelerate improvements in the accuracy of dietary assessment methods.
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PANEL DISCUSSION Following the questions from the workshop series planning committee, audience members had an opportunity to submit questions for the speakers. Question topics included the timing of dietary intake assessments, conducting dietary assessment in developing countries, and measuring intake of unprocessed foods.
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electricity, while portion size estimation is complicated by cultural practices such as eating foods by hand, often directly from a common bowl. Foster echoed those challenges, drawing on her previous efforts to measure dietary intakes in Tanzania.
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From page 69... ...
Echoing other panelists' comments about the value of forming multidisciplinary teams to advance dietary assessment methods, she suggested that anthropologists would be a helpful addition and could advise on the types of foods to include in FFQs for use with diverse cultures. Measuring Intake of Unprocessed Foods An attendee mentioned the difficulty characterizing intake of whole unprocessed foods, particularly those consumed in away-from-home settings.
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