Performance and Feasibility of Recalls Completed Using the Automated Self-Administered 24-Hour Dietary Assessment Tool in Relation to Other Self-Report Tools and Biomarkers in the Interactive Diet and Activity Tracking in AARP (IDATA) Study.

BACKGROUND: Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24) is a self-administered web-based tool designed to collect detailed dietary data at low cost in observational studies. OBJECTIVE: The objectives of this study were to describe, overall and by demographic groups, the performance and feasibility of ASA24-2011 recalls and compare Healthy Eating Index-2015 (HEI-2015) total and component scores to 4-day food records (4DFRs) and food frequency questionnaires (FFQs). DESIGN: Over 12 months, participants completed up to 6 ASA24 recalls, 2 web-based FFQs, and 2 unweighed paper-and-pencil 4DFRs. Up to 3 attempts were made to obtain each ASA24 recall. Participants were administered doubly-labeled water to provide a measure of total energy expenditure and collected two 24-hour urine samples to assess concentrations of nitrogen, sodium, and potassium. PARTICIPANTS/SETTING: From January through September 2012, 1,110 adult members of AARP, 50 to 74 years of age, were recruited from the Pittsburgh, PA, area to participate in the Interactive Diet and Activity Tracking in AARP (IDATA) study. After excluding 33 participants who had not completed any dietary assessments, 531 men and 546 women remained. MAIN OUTCOME MEASURES: Response rates, nutrient intakes compared to recovery biomarkers across each ASA24 administration day, and HEI-2015 total and component scores were measured. STATISTICAL ANALYSES PERFORMED: Means, medians, standard deviations, interquartile ranges, and HEI-2015 total and component scores computed using a multivariate measurement error model are presented. RESULTS: Ninety-one percent of men and 86% of women completed 3 ASA24 recalls. Approximately three-quarters completed 5 or more, higher than the completion rates for 2 4DFRs and 2 FFQs. Approximately, three-quarters of men and 70% of women completed ASA24 on the first attempt; 1 in 5 completed it on the second. Completion rates varied slightly by age and body mass index. Median time to complete ASA24-2011 (current version: ASA24-2020) declined with subsequent recalls from 55 to 41 minutes in men and from 58 to 42 minutes in women and was lowest in those younger than 60 years. Mean nutrient intakes were similar across recalls. For each recording day, energy intakes estimated by ASA24 were lower than energy expenditure. Reported intakes for protein, potassium, and sodium were closer to recovery biomarkers for women, but not for men. Geometric means of reported intakes of these nutrients did not systematically vary across ASA24 administrations, but differences between reported intakes and biomarkers differed by nutrient. Of 100 possible points, HEI-2015 total scores were nearly identical for 4DFRs and ASA24 recalls and higher for FFQs (men: 61, 60, and 68; women: 64, 64, and 72, respectively). CONCLUSIONS: ASA24, a freely available dietary assessment tool for use in large-scale nutrition research, was found to be highly feasible. Similar to previously reported data for nutrient intakes, HEI-2015 total and component scores for ASA24 recalls were comparable to those for 4DFRs, but not FFQs. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03268577 (http://www.clinicaltrials.gov).

Comparison of recruitment and retention among demographic subgroups in a large diverse population study of diet.

OBJECTIVE: We examined the feasibility of conducting a longitudinal study of diet among diverse populations by comparing rates of response throughout recruitment and retention phases by demographic and other characteristics. METHODS: Using quota sampling, participants were recruited from 3 geographically and demographically diverse integrated health systems in the United States. Overall, 12,860 adults, ages 20-70, were invited to participate via mail. Participation first required accessing the study's website and later meeting eligibility criteria via telephone interview. Enrollees were asked to provide two 24-hour dietary recalls, either interviewer-administered or self-administered on the web, over 6 weeks. Stepped monetary incentives were provided. RESULTS: Rates for accessing the study website ranged from 6% to 23% (9% overall) across sites. Site differences may reflect differences in recruitment strategy or target samples. Of those accessing the website, enrollment was high (≥ 87%). Of the 1185 enrollees, 42% were non-Hispanic white, 34% were non-Hispanic black, and 24% were Hispanic. Men and minorities had lower enrollment rates than women and non-Hispanic whites, partially due to less successful telephone contact for eligibility screening. Once enrolled, 90% provided 1 recall and 80% provided both. Women had higher retention rates than men, as did older compared to younger participants. Retention rates were similar across race/ethnicity groups. CONCLUSIONS: While study recruitment remains challenging, once recruited most participants, regardless of race/ethnicity, completed two 24-hour dietary recalls, both interviewer-administered and self-administered on the web. This study demonstrates the feasibility of collecting multiple 24-hour recalls including less expensive automated self-administered recalls among diverse populations.

Dietary Flavonoid Intake Reduces the Risk of Head and Neck but Not Esophageal or Gastric Cancer in US Men and Women.

Background: Flavonoids are bioactive polyphenolic compounds found in fruits, vegetables, and beverages of plant origin. Previous studies have shown that flavonoid intake reduces the risk of certain cancers; however, few studies to date have examined associations of flavonoids with upper gastrointestinal cancers or used prospective cohorts.Objective: Our study examined the association between intake of flavonoids (anthocyanidins, flavan-3-ols, flavanones, flavones, flavonols, and isoflavones) and risk of head and neck, esophageal, and gastric cancers.Methods: The NIH-AARP Diet and Health Study is a prospective cohort study that consists of 469,008 participants. Over a mean 12-y follow-up, 2453 head and neck (including 1078 oral cavity, 424 pharyngeal, and 817 laryngeal), 1165 esophageal (890 adenocarcinoma and 275 squamous cell carcinoma), and 1297 gastric (625 cardia and 672 noncardia) cancer cases were identified. We used Cox proportional hazards regression models to estimate HRs and CIs for the associations between flavonoid intake assessed at study baseline and cancer outcomes. For 56 hypotheses examined, P-trend values were adjusted using the Benjamini-Hochberg (BH) procedure for false discovery rate control.Results: The highest quintile of total flavonoid intake was associated with a 24% lower risk of head and neck cancer (HR: 0.76; 95% CI: 0.66, 0.86; BH-adjusted 95% CI: 0.63, 0.91; P-trend = 0.02) compared with the lowest quintile. Notably, anthocyanidins were associated with a 28% lower risk of head and neck cancer (HR: 0.72; 95% CI: 0.62, 0.82; BH-adjusted 95% CI: 0.59, 0.87; P-trend = 0.0005), and flavanones were associated with a 22% lower risk of head and neck cancer (HR: 0.78; 95% CI: 0.68, 0.89; BH-adjusted 95% CI: 0.64, 0.94; P-trend: 0.02). No associations between flavonoid intake and risk of esophageal or gastric cancers were found.Conclusions: Our results indicate that flavonoid intake is associated with lower head and neck cancer risk. These associations suggest a protective effect of dietary flavonoids on head and neck cancer risk, and thus potential as a risk reduction strategy.

The Use of Digital Images in 24-Hour Recalls May Lead to Less Misestimation of Portion Size Compared with Traditional Interviewer-Administered Recalls.

BACKGROUND: The Automated Self-Administered 24-hour (ASA24) dietary recall system enhances the feasibility of collecting high-quality intake data in population-based studies. OBJECTIVE: The aim of this study was to assess the accuracy of portion size reporting in the ASA24 compared with interviewer-administered recalls. METHODS: True intake for 3 meals was ascertained in 81 adults aged 20-70 y from the Washington, DC area. Participants were randomly assigned to complete an unannounced ASA24 or an interviewer-administered Automated Multiple-Pass Method (AMPM) recall the following day. An adapted Bland-Altman approach was used to assess agreement between true and reported portion sizes. Linear regression was used to assess log-scale differences between true and reported portion sizes by recall mode. The proportions of reported portion sizes within 10% and 25% of truth were estimated. Analyses were conducted for all foods and drinks and predetermined categories. RESULTS: Mean differences between true and reported portion sizes were 3.7 g for the ASA24 and 11.8 g for the AMPM. According to the Bland-Altman-type plots, between 92% and 100% (depending on food or drink category and recall mode) of observations fell within the limits of agreement. After adjustment for multiple testing, the mean ratio of reported to true portion sizes was significantly >1 for the categories of all foods and drinks, all foods excluding liquids, amorphous or soft foods, and small pieces among AMPM respondents. Misestimation in the AMPM was significantly different from that in the ASA24 for all foods and drinks and for all foods excluding liquids. Small proportions of reported portions fell within 10% (16.2% for the ASA24 and 14.9% for the AMPM) and 25% (37.5% for the ASA24 and 33.2% for the AMPM) of truth. CONCLUSIONS: The results raise the possibility that digital images tailored to different types and formats of foods may facilitate improved estimation of amounts eaten but highlight the need for continued work in this aspect of dietary assessment. This trial was registered at clinicaltrials.gov as NCT00978406.

Comparison of 2 methods for estimating the prevalences of inadequate and excessive iodine intakes.

BACKGROUND: Prevalences of iodine inadequacy and excess are usually evaluated by comparing the population distribution of urinary iodine concentration (UIC) in spot samples with established UIC cutoffs. To our knowledge, until now, dietary intake data have not been assessed for this purpose. OBJECTIVE: Our objective was to compare 2 methods for evaluating the prevalence of iodine inadequacy and excess in sex- and life stage-specific subgroups of the US population: one that uses UIC cutoffs, and one that uses iodine intake cutoffs. DESIGN: By using the iodine concentrations of foods measured in the US Food and Drug Administration's Total Diet Study (TDS), dietary intake data from the NHANES 2003-2010, and a file that maps each NHANES food to a TDS food with similar ingredients, we estimated each NHANES participant's iodine intake from each NHANES food as the mean iodine concentration of the corresponding TDS food in samples gathered over the same 2-y period. We calculated prevalences of iodine inadequacy and excess in each sex- and life stage-specific subgroup by both the UIC cutoff method and the iodine intake cutoff method-using the UIC values and dietary intakes reported for NHANES participants who provided both types of data-and compared the prevalences across methods. RESULTS: We found lower prevalences of iodine inadequacy across all sex- and life stage-specific subgroups with the iodine intake cutoff method than with the UIC cutoff method; for pregnant females, the respective prevalences were 5.0% and 37.9%. For children aged ≤8 y, the prevalence of excessive iodine intake was high by either method. CONCLUSIONS: The consideration of dietary iodine intake from all sources may provide a more complete understanding of population prevalences of iodine inadequacy and excess and thus better inform dietary guidance than consideration of UIC alone. Methods of adjusting UIC for within-person variation are needed to improve the accuracy of prevalence assessments based on UIC.

Comparison of Interviewer-Administered and Automated Self-Administered 24-Hour Dietary Recalls in 3 Diverse Integrated Health Systems.

Twenty-four-hour dietary recalls provide high-quality intake data but have been prohibitively expensive for large epidemiologic studies. This study's goal was to assess whether the web-based Automated Self-Administered 24-Hour Recall (ASA24) performs similarly enough to the standard interviewer-administered, Automated Multiple-Pass Method (AMPM) 24-hour dietary recall to be considered a viable alternative. In 2010-2011, 1,081 adults from 3 integrated health systems in Detroit, Michigan; Marshfield, Wisconsin; and Kaiser-Permanente Northern California participated in a field trial. A quota design ensured a diverse sample by sex, age, and race/ethnicity. Each participant was asked to complete 2 recalls and was randomly assigned to 1 of 4 protocols differing by type of recall and administration order. For energy, the mean intakes were 2,425 versus 2,374 kcal for men and 1,876 versus 1,906 kcal for women by AMPM and ASA24, respectively. Of 20 nutrients/food groups analyzed and controlling for false discovery rate, 87% were judged equivalent at the 20% bound. ASA24 was preferred over AMPM by 70% of the respondents. Attrition was lower in the ASA24/AMPM study group than in the AMPM/ASA24 group, and it was lower in the ASA24/ASA24 group than in the AMPM/AMPM group. ASA24 offers the potential to collect high-quality dietary intake information at low cost with less attrition.

Performance of the Automated Self-Administered 24-hour Recall relative to a measure of true intakes and to an interviewer-administered 24-h recall.

BACKGROUND: The Automated Self-Administered 24-hour Recall (ASA24), a freely available Web-based tool, was developed to enhance the feasibility of collecting high-quality dietary intake data from large samples. OBJECTIVE: The purpose of this study was to assess the criterion validity of ASA24 through a feeding study in which the true intake for 3 meals was known. DESIGN: True intake and plate waste from 3 meals were ascertained for 81 adults by inconspicuously weighing foods and beverages offered at a buffet before and after each participant served him- or herself. Participants were randomly assigned to complete an ASA24 or an interviewer-administered Automated Multiple-Pass Method (AMPM) recall the following day. With the use of linear and Poisson regression analysis, we examined the associations between recall mode and 1) the proportions of items consumed for which a match was reported and that were excluded, 2) the number of intrusions (items reported but not consumed), and 3) differences between energy, nutrient, food group, and portion size estimates based on true and reported intakes. RESULTS: Respondents completing ASA24 reported 80% of items truly consumed compared with 83% in AMPM (P = 0.07). For both ASA24 and AMPM, additions to or ingredients in multicomponent foods and drinks were more frequently omitted than were main foods or drinks. The number of intrusions was higher in ASA24 (P < 0.01). Little evidence of differences by recall mode was found in the gap between true and reported energy, nutrient, and food group intakes or portion sizes. CONCLUSIONS: Although the interviewer-administered AMPM performed somewhat better relative to true intakes for matches, exclusions, and intrusions, ASA24 performed well. Given the substantial cost savings that ASA24 offers, it has the potential to make important contributions to research aimed at describing the diets of populations, assessing the effect of interventions on diet, and elucidating diet and health relations. This trial was registered at clinicaltrials.gov as NCT00978406.