Formative evaluation of the dietary assessment component of Children's and Adolescents' Nutrition Assessment and Advice on the Web (CANAA-W).

BACKGROUND: The increased availability of computers and the efficiency and user-acceptability of computer-assisted questioning have increased the attractiveness of computer-administered querying for large-scale population nutrition research during the last decade. The Young Adolescents' Nutrition Assessment on Computer (YANA-C), a computer-based 24-h dietary recall, was originally developed to collect dietary data among Belgian-Flemish adolescents. A web-based version was created to collect parentally reported dietary data of preschoolers, called Young Children's Nutrition Assessment on the Web (YCNA-W), which has been improved and adapted for use in young adolescents: Children and Adolescents' Nutrition Assessment and Advice on the Web (CANAA-W). The present study describes recent developments and the formative evaluation of the dietary assessment component. METHODS: A feasibility questionnaire was completed by 131 children [mean (SD) age: 11.3 (0.7) years] and 53 parents. Eight focus groups were held with children (n = 65) and three with parents (n = 17). RESULTS: Children (C) and parents (P) found the instrument clear (C: 97%; P: 94%), comprehensible (C: 92%; P: 100%), attractive (C: 84%; P: 85%), fun (C: 93%; P: 83%) and easy to complete (C: 91%; P: 83%). There was ample explanation (C: 95%; P: 94%); the pictures were clear (C: 97%; P: 96%); and most respondents found the food items easy to find (C: 71%, P: 85%). The results helped to refine the lay out and structure of the instrument and the list of food items included. CONCLUSIONS: Children and parents were enthusiastic. The major challenge will be to convince parents who are less interested in dietary intake and less computer literate to participate in this type of study. Children in this age group (11-12 years) should complete the instrument with assistance from an adult.

Comparison of a food frequency questionnaire with an online dietary assessment tool for assessing preschool children's dietary intake.

BACKGROUND: It is important to assess the dietary habits of children as they progress from early childhood to adolescence. However, there are few validated tools available to assess the diet of this group of children. The present study aimed to investigate the relative validity of a food frequency questionnaire (FFQ) developed for use in a biennial longitudinal study. METHODS: The parents of 216 Belgian-Flemish preschool children completed a FFQ (including questions on 77 food groups) and an online dietary assessment tool for three nonconsecutive days on their child's diet. Intakes of energy, macronutrients, fibre, calcium and 20 food groups recorded by both methods were compared using Spearman's correlations, Wilcoxon's signed rank test and Bland and Altman analyses. RESULTS: At the group level, good agreement was found for energy, fat and protein intake, an overestimation was found for carbohydrates (5.6%) and fibre (13.3%), and an underestimation was found for calcium (9%). For the food groups, overestimation as well as underestimation and good agreement were found, although overestimation was most common. Good agreement was found in ranking the children's fruit (r = 0.53), beverages (r = 0.58-0.76), soup (r = 0.51), breakfast cereals (r = 0.55) and calcium (r = 0.59) intake according to both methods. CONCLUSION: The results obtained revealed that the FFQ was a useful alternative for estimating energy and macronutrient intake at a group level; however, when used to estimate fibre and calcium intake, respectively, over- and underestimation need to be considered. The short reference period (3 days) may have compromised agreement in ranking and agreement at the individual level.

Development and evaluation of a self-administered computerized 24-h dietary recall method for adolescents in Europe.

OBJECTIVE: To describe the development of a European computerized 24-h dietary recall method for adolescents, and to investigate the feasibility of self-administration (self report) by comparison with administration by a dietician (interview). METHODS: Two hundred and thirty-six adolescents (mean age 14.6 years (s.d.=1.7)) of eight European cities completed the 24-h recall (Young Adolescents Nutrition Assessment on Computer (YANA-C)) twice (once by self-report and once by interview). RESULTS: A small but significant underestimate in energy (61 (s.e.=31) kcal) and fat (4.2 (s.e.=1.7) g) intake was found in the self-reports in comparison with the interviews; no significant differences were found for the intake of carbohydrates, proteins, fibre, calcium, iron and ascorbic acid. Spearman's correlations were highly significant for all nutrients and energy ranging between 0.86 and 0.91. Agreement in categorizing the respondents as consumers and non-consumers for the 29 food groups was high (kappa statistics >or=0.73). Percentage omissions were on average 3.7%; percentage intrusions: 2.0%. Spearman's correlations between both modes were high for all food groups, for the total sample (>or=0.76) as well as for the consumers only (>or=0.72). Analysing the consumer only, on an average 54% of the consumed amounts were exactly the same; nevertheless, only for one group 'rice and pasta' a significant difference in consumption was found. CONCLUSION: Adaptation, translation and standardization of YANA-C make it possible to assess the dietary intake of adolescents in a broad international context. In general, good agreement between the administration modes was found, the latter offering significant potential for large-scale surveys where the amount of resources to gather data is limited.

Young adolescents' nutrition assessment on computer (YANA-C).

OBJECTIVE: To assess the relative validity and acceptability of the computerised 24-h recall 'Young Adolescent's Nutrition Assessment on Computer (YANA-C)'. DESIGN: Food and nutrient intakes assessed with YANA-C were compared with food records (study 1) and 24-h dietary recall interviews (study 2). MAIN OUTCOME MEASURES: Intakes of food groups (fruit, fruit juice, vegetables, potatoes, bread, cereals, milk, cheese, other milk products, soft drinks, diet soft drinks, sugar/sweets, pastry/cookies, savoury snacks, butter/sauces, eggs, fish, meat) and nutrients (energy, carbohydrates, protein, fat, fiber, calcium, vitamin C and iron). SUBJECTS AND SETTING: A total of 237 pupils (11-14 y) from two primary and four secondary schools (study 1: n = 136; study 2: n = 101) in Belgium-Flanders. RESULTS: YANA-C proved to agree well with both standard methods in categorizing subjects in consumers and nonconsumers (kappa(study 1) = 0.48-0.92; kappa(study 2) = 0.38-0.90). Spearman's correlations for energy and nutrient intakes ranged between 0.44 and 0.79 for study 1 and between 0.44 and 0.86 for study 2. Nutrient and energy intakes were in general (excluding calcium) significantly higher in YANA-C in comparison with the food record, but not in comparison with the interview (only fiber). Statistics used to investigate whether YANA-C agreed with the other methods in ranking portions/amounts in consumers only were fair to moderate for most of the food groups (weighted kappa study 1 = 0.11-0.55; study 2 = 0.04-0.73); amounts in consumers only, were significantly lower in YANA-C against both standards for cereals; amounts were significantly higher in YANA-C against the food record for milk, soft drinks, sugar/sweets and savoury snacks and against the interview for potatoes. Only a few pupils evaluated the program negatively. CONCLUSION: YANA-C is a promising method to collect detailed dietary information from young adolescents with relatively low staff resources, useful in many nutrition research applications.