Mobile Ecological Momentary Diet Assessment Methods for Behavioral Research: Systematic Review

BackgroundAccurate and feasible assessment of dietary intake remains challenging for research and healthcare. Experience Sampling Methodology (ESM) is a real-time real-life data capturing method with low burden and good feasibility not yet fully explored as alternative dietary assessment method.MethodsThis scoping review is the first to explore the implementation of ESM as an alternative to traditional dietary assessment methods by mapping the methodological considerations to apply ESM and formulating recommendations to develop an Experience Sampling-based Dietary Assessment Method (ESDAM). The scoping review methodology framework was followed by searching PubMed (including OVID) and Web of Science from 2012 until 2024.ResultsScreening of 646 articles resulted in 39 included articles describing 24 studies. ESM was mostly applied for qualitative dietary assessment (i.e. type of consumed foods) (n = 12), next to semi-quantitative dietary assessment (i.e. frequency of consumption, no portion size) (n = 7), and quantitative dietary assessment (i.e. type and portion size of consumed foods) (n = 5). Most studies used ESM to assess the intake of selected foods. Two studies applied ESM as an alternative to traditional dietary assessment methods assessing total dietary intake quantitatively (i.e. all food groups). ESM duration ranged from 4 to 30 days and most studies applied ESM for 7 days (n = 15). Sampling schedules were mostly semi-random (n = 12) or fixed (n = 9) with prompts starting at 8–10 AM and ending at 8–12 PM. ESM questionnaires were adapted from existing questionnaires, based on food consumption data or focus group discussions, and respond options were mostly presented as multiple-choice. Recall period to report dietary intake in ESM prompts varied from 15 min to 3.5 h.ConclusionsMost studies used ESM for 7 days with fixed or semi-random sampling during waking hours and 2-h recall periods. An ESDAM can be developed starting from a food record approach (actual intake) or a validated food frequency questionnaire (long-term or habitual intake). Actual dietary intake can be measured by ESM through short intensive fixed sampling schedules while habitual dietary intake measurement by ESM allows for longer less frequent semi-random sampling schedules. ESM sampling protocols should be developed carefully to optimize feasibility and accuracy of dietary data.

Reliable dietary data for adolescents in low- and middle-income countries (LMICs) are limited due to high costs and estimation errors in traditional dietary assessment methods. Although technology-assisted dietary assessment tools are becoming popular, few have been validated in LMICs. This study validated the PlantVillage Food Recognition Assistance and Nudging Insights (FRANI), an artificial intelligence-assisted mobile application for dietary assessment, against weighed food records (WFR) and multipass 24-h recalls (24HR) among adolescent girls aged 14‒18 y (n = 60) in urban/semi-urban communities in Sri Lanka. Dietary intake was assessed over 2 non-consecutive days using 3 methods: FRANI, WFR, and 24HR. The equivalence of nutrient intake was evaluated using mixed-effect models accounting for repeated measures by comparing intake ratios (FRANI/WFR and 24HR/WFR) with 10%, 15%, and 20% equivalence bounds. The concordance correlation coefficient was utilized to assess the agreement between methods. FRANI demonstrated equivalence with WFR at the 10% bound for energy and vitamin A; 15% for protein, fiber, iron, and zinc; and 20% for fat, niacin, and folate intakes. Comparisons between 24HR and WFR found that no nutrients fell within the 10% bound. Energy, protein, fat, iron, niacin, and vitamin A intakes were equivalent at 15% bound, whereas fiber, calcium, folate, and vitamin C intakes were equivalent at 20% bound. Concordance correlation coefficient ranged from 0.49 to 0.89 for FRANI compared to WFR, and 0.44 to 0.84 for 24HR compared with WFR. Omission errors were 2% for FRANI and 12% for 24HR, and intrusion errors were 7% and 9%, respectively. PlantVillage FRANI application accurately estimated nutrient intakes of adolescent girls in Sri Lanka compared to the WFR. Its performance was at least comparable to the traditional 24HR method, supporting its potential as a scalable alternative for dietary assessment in similar LMIC populations.

BackgroundDietary assessment is a fundamental component of nutrition research and plays a pivotal role in managing chronic diseases. Traditional dietary assessment methods, particularly in the context of Thai cuisine, often require extensive training and may lead to estimation errors. ObjectivesTo address these challenges, Institute of Nutrition, Mahidol University (INMU) iFood, an innovative artificial intelligence–based Thai food dietary assessment system, allows for estimating the nutritive values of dishes from food images. MethodsINMU iFood leverages state-of-the-art technology and integrates a validated automated Thai food analysis system. Users can use 3 distinct input methods: food image recognition, manual input, and a convenient barcode scanner. This versatility simplifies the tracking of dietary intake while maximizing data quality at the individual level. The core improvement in INMU iFood can be attributed to 2 key factors, namely, the replacement of Yolov4-tiny with Yolov7 and the expansion of noncarbohydrate source foods in the training image data set. ResultsThis combination significantly enhances the system’s ability to identify food items, especially in scenarios with closely packed food images, thus improving accuracy. Validation results showcase the superior performance of the INMU iFood integrated V7-based system over its predecessor, V4-based, with notable improvements in protein and fat estimation. Furthermore, INMU iFood addresses limitations by offering users the option to import additional food products via a barcode scanner, thus providing access to a vast database of nutritional information through Open Food Facts. This integration ensures users can track their dietary intake effectively, with expanded access to over 3000 food items added to or updated in the Open Food Facts database covering a wide variety of dietary choices. ConclusionsINMU iFood is a promising tool for researchers, health care professionals, and individuals seeking to monitor their dietary intake within the context of Thai cuisine and for ultimately promoting better health outcomes and facilitating nutrition-related research.

The aim of the present paper is to summarise current and future applications of dietary assessment technologies in nutrition surveys in developed countries. It includes the discussion of key points and highlights of subsequent developments from a panel discussion to address strengths and weaknesses of traditional dietary assessment methods (food records, FFQ, 24h recalls, diet history with interviewer-assisted data collection) v. new technology-based dietary assessment methods (web-based and mobile device applications). The panel discussion 'Traditional methods v. new technologies: dilemmas for dietary assessment in population surveys', was held at the 9th International Conference on Diet and Activity Methods (ICDAM9), Brisbane, September 2015. Despite respondent and researcher burden, traditional methods have been most commonly used in nutrition surveys. However, dietary assessment technologies offer potential advantages including faster data processing and better data quality. This is a fast-moving field and there is evidence of increasing demand for the use of new technologies amongst the general public and researchers. There is a need for research and investment to support efforts being made to facilitate the inclusion of new technologies for rapid, accurate and representative data.

Different methods of dietary intake assessment are frequently used to assess a population's diet. In this study, we aimed to compare the adherence to Swiss food-based dietary guidelines as depicted in two Swiss population-based surveys using different methods of dietary assessment. Two population-based, cross-sectional surveys were compared. In the Swiss Health Survey (SHS), diet was assessed via a short set of questions on specific food groups, while in menuCH by two non-consecutive 24-h dietary recall interviews. To compare the diet depicted in these surveys, we used the Swiss food-based dietary guidelines on vegetable, fruit, dairy product, meat and meat product, fish and alcohol. The weighted proportion of responders meeting these guidelines was calculated for both surveys and was compared overall and by selected characteristics. Residents of Switzerland, selected from a stratified random sample of the non-institutionalised residents, who agreed to participate in the respective survey. To ensure comparability between the surveys, the age of the study populations was restricted to 18-75 years. In menuCH, approximately 2 % of responders met ≥4 of the selected Swiss food-based dietary guidelines. In the SHS, using a cruder dietary assessment, the corresponding percentage was 20 %. In both surveys, more women and never smokers were meeting ≥4 food-based dietary guidelines compared to men and current or former smokers, respectively. Our study comparing the diet in two population-based, representative surveys detected large variations in guideline adherence depending on the dietary assessment method used.

A comparative study of vision-language models for food ingredient recognition and nutrient estimation.

The effectiveness of the tailored feedback in digital interventions may be limited by the quality of the dietary assessment (DA) upon which it is based. The present study systematically reviewed studies reporting the protocols for DA methods used to inform tailored feedback in digital weight loss interventions. The search included: PubMed-National Library of Medicine database, MEDLINE, Cochrane Library of Systematic Reviews, Web of Science and ProQuest. Search terms were related to five groups: dietary assessment, weight loss, clinical trials, technology and tailoring. Thirteen articles were eligible for inclusion. The most common DA method was a digital dietary record linked to a food database that provided instant feedback on daily energy intake. Only four studies provided feedback on overall diet quality and intake of fruit, vegetables and fibre. Dietary feedback was provided using text messages, email, mobile applications and online intervention websites. Most digital dietary feedback focused on reducing energy intake without providing feedback to enhance diet quality. This review highlighted the heterogeneity in DA methods used in tailored weight loss interventions, which may account for the range of outcome results reported. Future interventions should publish the protocols describing how dietary data was collected and used to inform dietary feedback.

The potential of salivary biomarkers of nutritional status and dietary intake: A Systematic Review

BackgroundThe quest towards more feasible, low-cost yet accurate dietary assessment methods has led to the development of the new Experience Sampling-based Dietary Assessment Method (ESDAM). ESDAM is an app-based quantitative dietary assessment method to assess habitual dietary intake over a period of 2 weeks. ESDAM prompts three 2-hour recalls daily requesting to provide dietary intake on meal and food group level. The ESDAM allows to measure dietary intake near real-time in a rapid, low-cost and feasible manner. Following the user experience evaluation of the ESDAM, the validity of the ESDAM will now be assessed against objective biomarkers.MethodsThis protocol describes the validation of the ESDAM against three 24-hour dietary recalls (24-HDR), doubly labeled water, urinary nitrogen, serum carotenoids, and erythrocyte membrane fatty acids. The primary outcomes include energy intake and protein intake measured by the ESDAM in relation to energy expenditure measured by the doubly labeled water method and protein intake derived from urinary nitrogen analysis respectively. Secondary outcomes include nutrient and food group consumption derived from ESDAM and repeated 24-HDR’s, beta-carotenoids as biomarker of fruit and vegetable consumption and erythrocyte membrane fatty acid composition as biomarker of dietary fatty acid composition. Blinded continuous glucose monitoring will serve as method to assess compliance to ESDAM prompts. A target sample of 115 healthy volunteers will be recruited. Validity will be evaluated by mean differences and spearman correlations between nutrient and biomarker reference values. Bland-Altman plots will be developed to assess agreement. Method of triads will allow quantifying measurement error of the ESDAM, 24-HDR’s and biomarkers in relation to the (unknown) ‘true dietary intake’.DiscussionThis protocol describes an extensive validation study of a newly developed Experience Sampling-based Dietary Assessment Method against both self-reported and objective reference methods. The main strength is the use of the state-of-the-art validation techniques using doubly labeled water, urinary nitrogen, carotenoids and erythrocyte membrane fatty acids as biomarkers for dietary intake. A limitation of the study is that the evaluation of reproducibility of the ESDAM is not included.RegistrationThis study is registered at ClinicalTrials.gov on (NCT06485960, date: 07/02/2024).

Mobile device-assisted dietary ecological momentary assessments (EMAs) have emerged as a new tool allowing the evaluation of dietary intake in real time, in a real-world setting and in a continuous manner. They have the potential to minimize recall bias, participant, and investigator burden, and decrease economic and time investment while maximizing ecological validity. We developed a set of EMAs aimed at evaluating continuous adherence to the MedDiet. Four multiple-choice EMAs are sent daily in a randomized manner from a total of eight questions. The EMAs enquire about the consumption of 11 key food groups of the Mediterranean diet in the last 24-48 h in a semi-quantitative way. EMAs capture the daily frequency of consumption of fruits, vegetables, and extra virgin olive oil on different days of the week. Additionally, EMAs capture the weekly frequency of consumption of whole grain products, sugary drinks, nuts, legumes, sweets, fish and seafood, and red and processed meats. A designed scoring system behind the EMAs extracts the percentage of adherence to the MedDiet recommendations and calculates a quality index of the diet every week. Individualized reports are sent periodically to the volunteers highlighting the strengths and weaknesses of their diet. EMAs are also expected to have a behavioral effect, reinforcing the choice of Mediterranean foods.

Children are vulnerable to developing iron deficiency anemia, especially in resource-limited settings. Information on habitual dietary intake informs dietary interventions aimed at improving iron deficiency. Dietary assessment in school-aged children is challenging and requires concerted efforts to mitigate the pitfalls of long complex methods. Nested within an intervention trial, we aimed to obtain dietary intake information to assess iron nutrition in 8 to 13-year-old children from resource-limited settings in Cape Town, South Africa. Following careful consideration of the study objective, participant characteristics, research setting, available resources, and features of the different dietary intake assessment methods, we identified an iron quantified food frequency questionnaire (QFFQ) as the best method to obtain the information. The QFFQ reflected the study population’s habitual intake and the nutrients of interest (protein, iron, vitamin A, vitamin C, calcium, zinc, and fiber). In addition, strategies such as interview-administration of the QFFQ, interviewing the child participant and caregiver together, simplifying frequency reporting, a strategic food list order and a variety of interesting portion size estimation aids collectively supported dietary intake assessment in this young study population. Using a methodical, multiphase approach and strategies that promote participant engagement, we developed the QFFQ, achieved interview success, and obtained comparable data.

Understanding the dietary intake of people with kidney disease is fundamental to addressing their treatment or for the prevention or progression of disease. Several recent guidelines on chronic kidney disease (CKD) vary on recommendations for assessing the dietary intake of patients (Table 3.1) [1–8]. Whether the approach to assessing dietary intake is considered warranted is not discussed in these guidelines, so perhaps it is not an issue of the reliability of dietary intake assessment methods but rather one of the origin of the guidelines. For example, the guidelines from the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI) on nutrition [1] are written to be multidisciplinary and include guidelines for dietitians. The guidelines for CKD that were produced by the Academy of Nutrition and Dietetics are written specifically for dietitians [4]. However, many of the other guidelines for CKD are physician specific, and obtaining the dietary record is not included in their guidelines, perhaps because physicians do not normally collect this information. In contrast, assessment of dietary intake is a significant practice of dietetics, and they routinely evaluate dietary intake in assessing the nutritional status of patients.

Background: Micronutrient deficiency, including iron, vitamin A, B-12 and folic acid, can cause anemia and harm adolescent health. Accurate dietary assessment methods is crucial to detect micronutrient deficiencies, but existing methods, have limitations, necessitating a review to identify the accurate methods for assessing micronutrient intake in adolescents. Objectives: To determine the accuracy of dietary assessment methods as suitable option for measuring micronutrient intake in adolescents. Methods: This study utilized the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Review (PRISMA-ScR) flowchart approach. Article were identified from ScienceDirect, PubMed, Scopus, Google Scholar. Articles were included if participants aged 10-19 years, published between 2014-2024, written in English/Indonesian, original research articles and studies related to validation of dietary assessment methods for micronutrient intake. The keywords were "micronutrient intake" OR "dietary intake" AND "dietary assessment" OR "validity" AND "adolescent". Discussions: 1157 articles were identified, 7 met the eligibility criteria, including 50 to 1081 adolescent. The Semi-Quantitative Food Frequency Questionnaire (SQ-FFQ) method was valid for sodium, niacin, folate, thiamine, calcium, phosphorus and reproducible for vitamin A, vitamin C, thiamine, riboflavin, niacin, iron, calcium, phosphorus, potassium, β-carotene. The Food Frequency Questionnaire (FFQ) method was valid for riboflavin, vitamin C, calcium, serum iron biomarkers, and reproducible for retinol, thiamine, riboflavin, vitamin C, vitamin D, iron, calcium. The 24-hour Dietary Recall (24hDR) method showed acceptable validity for serum iron biomarkers. Conclusions: The SQ-FFQ, completed by adolescents with instruction of nutritionist, using a shorter food list and time intervals, has higher relative validity and reproducibility.

PurposeComparison of food consumption, nutrient intake and underreporting of diet history interviews, 24-h recalls and weighed food records to gain further insight into specific strength and limitations of each method and to support the choice of the adequate dietary assessment method.MethodsFor 677 participants (14–80 years) of the German National Nutrition Survey II confidence intervals for food consumption and nutrient intake were calculated on basis of bootstrapping samples, Cohen’s d for the relevance of differences, and intraclass correlation coefficients for the degree of agreement of dietary assessment methods. Low energy reporters were identified with Goldberg cut-offs.ResultsIn 7 of 18 food groups diet history interviews showed higher consumption means than 24-h recalls and weighed food records. Especially mean values of food groups perceived as socially desirable, such as fruit and vegetables, were highest for diet history interviews. For “raw” and “cooked vegetables”, the diet history interviews showed a mean consumption of 144 and 109 g/day in comparison with 68 and 70 g/day in 24-h recalls and 76 and 75 g/day in weighed food records, respectively. For “fruit”, diet history interviews showed a mean consumption of 256 g/day in comparison with 164 g/day in 24-h recalls and 147 g/day in weighed food records. No major differences regarding underreporting of energy intake were found between dietary assessment methods.ConclusionsWith regard to estimating food consumption and nutrient intake, 24-h recalls and weighed food records showed smaller differences and better agreement than pairwise comparisons with diet history interviews.

Novel strategies for improving dietary exposure assessment: Multiple-data fusion is a more accurate measure than the traditional single-biomarker approach