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Reliability and Validity of Digital Images to Assess Child Dietary Intake in a Quick-Service Restaurant Setting

Published:August 09, 2022DOI:https://doi.org/10.1016/j.jand.2022.08.116

      Abstract

      Background

      Development of methods to accurately measure dietary intake in free-living situations—restaurants or otherwise—is critically needed to understand overall dietary patterns.

      Objective

      This study aimed to develop and test reliability and validity of digital images (DI) for measuring children’s dietary intake in quick-service restaurants (QSRs), validating against weighed plate waste (PW) and bomb calorimetry (BC).

      Design

      In 2016, cross-sectional data were collected at two time points within a randomized controlled trial assessing children’s leftovers in QSRs from parents of 4- to 12-year-old children.

      Participants/setting

      Parents (n = 640; mean age = 35.9 y; 70.8% female) consented and agreed to provide their child’s PW for digital imaging, across 11 QSRs in Massachusetts in areas with low socioeconomic status and ethnically diverse populations.

      Outcome measures

      Outcome measures were interrater reliability for DIs, correspondence between methods for energy consumed and left over, and correspondence between methods across varying quantities of PW.

      Analyses performed

      Intraclass correlations, percent agreement, Spearman correlations, Wilcoxon signed rank tests, and Bland-Altman plots were used.

      Results

      Interrater reliability ratings for DIs had substantial intraclass correlations (ICC = 0.94) but not acceptable exact percent agreement (80.2%); DI and PW energy consumed were significantly correlated (r = 0.96, P < 0.001); DI slightly underestimated energy consumed compared with PW (Mdiff = −1.61 kcals, P < 0.001). Bland-Altman plots showed high DI–PW correspondence across various energy amounts and revealed few outliers. Energy left over by BC was highly correlated with DI (r = 0.87, P < 0.001) and PW (r = 0.90, P < 0.001); and mean differences were not significantly different from DI (Mdiff = 9.77 kcal, P = 0.06) or PW (Mdiff = −2.84 kcal, P = 0.20).

      Conclusions

      Correspondence was high between PW and DI assessments of energy consumed, and high with BC energy left over. Results demonstrate reliability and practical validity of digital images for assessing child meal consumption in QSR settings.

      Keywords

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      Biography

      E. T. S. is an assistant clinical professor at Merrimack College, North Andover, MA. At the time of the research, she was a postdoctoral scholar at the Friedman School of Nutrition, Tufts University, Boston.

      Biography

      E. H. is an assistant professor, Friedman School of Nutrition, Tufts University, Boston, MA.

      Biography

      K. C. is an assistant professor of public health and community medicine, Tufts University, Boston, MA.

      Biography

      M.A.J. is a PhD Candidate, Friedman School of Nutrition, Tufts University, Boston, MA.

      Biography

      E. M. is data manager and program administrator, Social & Scientific Systems, Inc. At the time of the research, she was Friedman School of Nutrition, Tufts University, Boston, MA.

      Biography

      S. A. is an assistant professor, University of Rhode Island, at the time of research, she was a postdoctoral scholar at Friedman School of Nutrition, Tufts University, Boston, MA.

      Biography

      P. B. is a statistical manager, Friedman School of Nutrition, Tufts University, Boston, MA.

      Biography

      S. B. R. is a professor, Friedman School of Nutrition, Tufts University, Boston, MA.

      Biography

      M. B. is a senior clinical data associate research assistant, Syneos Health, at the time of research she was a research assistant at Friedman School of Nutrition, Tufts University, Boston, MA.

      Biography

      J. M.is a clinical research dietitian at Massachusetts General Hospital , Friedman School of Nutrition, Tufts University, Boston, MA.

      Biography

      C. D. E. is a professor, at the time of research she was a research assistant at Friedman School of Nutrition, Tufts University, Boston, MA.