Accuracy of energy and nutrient intake estimation versus observed intake using 4 technology-assisted dietary assessment methods: a randomized crossover feeding study.

BACKGROUND: Technology-assisted 24-h dietary recalls (24HRs) have been widely adopted in population nutrition surveillance. Evaluations of 24HRs inform improvements, but direct comparisons of 24HR methods for accuracy in reference to a measure of true intake are rarely undertaken in a single study population. OBJECTIVES: To compare the accuracy of energy and nutrient intake estimation of 4 technology-assisted dietary assessment methods relative to true intake across breakfast, lunch, and dinner. METHODS: In a controlled feeding study with a crossover design, 152 participants [55% women; mean age 32 y, standard deviation (SD) 11; mean body mass index 26 kg/m2, SD 5] were randomized to 1 of 3 separate feeding days to consume breakfast, lunch, and dinner, with unobtrusive weighing of foods and beverages consumed. Participants undertook a 24HR the following day [Automated Self-Administered Dietary Assessment Tool-Australia (ASA24); Intake24-Australia; mobile Food Record-Trained Analyst (mFR-TA); or Image-Assisted Interviewer-Administered 24-hour recall (IA-24HR)]. When assigned to IA-24HR, participants referred to images captured of their meals using the mobile Food Record (mFR) app. True and estimated energy and nutrient intakes were compared, and differences among methods were assessed using linear mixed models. RESULTS: The mean difference between true and estimated energy intake as a percentage of true intake was 5.4% (95% CI: 0.6, 10.2%) using ASA24, 1.7% (95% CI: -2.9, 6.3%) using Intake24, 1.3% (95% CI: -1.1, 3.8%) using mFR-TA, and 15.0% (95% CI: 11.6, 18.3%) using IA-24HR. The variances of estimated and true energy intakes were statistically significantly different for all methods (P < 0.01) except Intake24 (P = 0.1). Differential accuracy in nutrient estimation was present among the methods. CONCLUSIONS: Under controlled conditions, Intake24, ASA24, and mFR-TA estimated average energy and nutrient intakes with reasonable validity, but intake distributions were estimated accurately by Intake24 only (energy and protein). This study may inform considerations regarding instruments of choice in future population surveillance. This trial was registered at Australian New Zealand Clinical Trials Registry as ACTRN12621000209897.

HealthyRHearts - reducing cholesterol in rural adults via telehealth-based medical nutrition therapy: protocol for a cluster randomised controlled trial.

BACKGROUND: Few randomised controlled trials specifically focus on prevention in rural populations. Cardiovascular disease (CVD) contributes to approximately one quarter of deaths in Australia. Nutrition is a key component affecting many risk factors associated with CVD, including hypercholesterolaemia. However, access to medical nutrition therapy (MNT) is limited for people living in rural areas, potentially exacerbating inequities related to health outcomes. Telehealth services present an opportunity to improve MNT access and address healthcare disparities for rural populations. The present study aims to evaluate feasibility, acceptability, and cost-effectiveness of a telehealth MNT CVD intervention program in lowering CVD risk over 12-months in regional and rural primary health care settings. METHODS/DESIGN: A cluster randomised controlled trial set in rural and regional general practices in NSW, Australia, and their consenting patients (n = 300 participants). Practices will be randomised to either control (usual care from their General Practitioner (GP) + low level individualised dietetic feedback) or intervention groups (usual care from their GP + low level individualised dietetic feedback + telehealth MNT intervention). Telehealth consultations will be delivered by an Accredited Practising Dietitian (APD), with each intervention participant scheduled to receive five consultations over a 6-month period. System-generated generic personalised nutrition feedback reports are provided based on completion of the Australian Eating Survey - Heart version (AES-Heart), a food frequency questionnaire. Eligible participants must be assessed by their GP as at moderate (≥ 10%) to high (> 15%) risk of a CVD event within the next five years using the CVD Check calculator and reside in a regional or rural area within the Hunter New England Central Coast Primary Health Network (HNECC PHN) to be eligible for inclusion. Outcome measures are assessed at baseline, 3, 6 and 12 months. The primary outcome is reduction in total serum cholesterol. Evaluation of the intervention feasibility, acceptability and cost-effective will incorporate quantitative, economic and qualitative methodologies. DISCUSSION: Research outcomes will provide knowledge on effectiveness of MNT provision in reducing serum cholesterol, and feasibility, acceptability, and cost-effectiveness of delivering MNT via telehealth to address CVD risk in rural regions. Results will inform translation to health policy and practice for improving access to clinical care in rural Australia. TRIAL REGISTRATION: This trial is registered at anzctr.org.au under the acronym HealthyRHearts (Healthy Rural Hearts), registration number ACTRN12621001495819.

Efficacy of technology-based personalised feedback on diet quality in young Australian adults: results for the advice, ideas and motivation for my eating (Aim4Me) randomised controlled trial.

OBJECTIVE: Web-based dietary interventions could support healthy eating. The Advice, Ideas and Motivation for My Eating (Aim4Me) trial investigated the impact of three levels of personalised web-based dietary feedback on diet quality in young adults. Secondary aims were to investigate participant retention, engagement and satisfaction. DESIGN: Randomised controlled trial. SETTING: Web-based intervention for young adults living in Australia. PARTICIPANTS: 18-24-year-olds recruited across Australia were randomised to Group 1 (control: brief diet quality feedback), Group 2 (comprehensive feedback on nutritional adequacy + website nutrition resources) or Group 3 (30-min dietitian consultation + Group 2 elements). Australian Recommended Food Score (ARFS) was the primary outcome. The ARFS subscales and percentage energy from nutrient-rich foods (secondary outcomes) were analysed at 3, 6 and 12 months using generalised linear mixed models. Engagement was measured with usage statistics and satisfaction with a process evaluation questionnaire. RESULTS: Participants (n 1005, 85 % female, mean age 21·7 ± 2·0 years) were randomised to Group 1 (n 343), Group 2 (n 325) and Group 3 (n 337). Overall, 32 (3 %), 88 (9 %) and 141 (14 %) participants were retained at 3, 6 and 12 months, respectively. Only fifty-two participants (15 % of Group 3) completed the dietitian consultation. No significant group-by-time interactions were observed (P > 0·05). The proportion of participants who visited the thirteen website pages ranged from 0·6 % to 75 %. Half (Group 2 = 53 %, Group 3 = 52 %) of participants who completed the process evaluation (Group 2, n 111; Group 3, n 90) were satisfied with the programme. CONCLUSION: Recruiting and retaining young adults in web-based dietary interventions are challenging. Future research should consider ways to optimise these interventions, including co-design methods.

A Systematic Review Examining Contributors to Misestimation of Food and Beverage Intake Based on Short-Term Self-Report Dietary Assessment Instruments Administered to Adults.

Error in self-reported food and beverage intake affects the accuracy of dietary intake data. Systematically synthesizing available data on contributors to error within and between food groups has not been conducted but may help inform error mitigation strategies. In this review we aimed to systematically identify, quantify, and compare contributors to error in estimated intake of foods and beverages, based on short-term self-report dietary assessment instruments, such as 24-h dietary recalls and dietary records. Seven research databases were searched for studies including self-reported dietary assessment and a comparator measure of observed intake (e.g., direct observation or controlled feeding studies) in healthy adults up until December 2021. Two reviewers independently screened and extracted data from included studies, recording quantitative data on omissions, intrusions, misclassifications, and/or portion misestimations. Risk of bias was assessed using the QualSyst tool. A narrative synthesis focused on patterns of error within and between food groups. Of 2328 articles identified, 29 met inclusion criteria and were included, corresponding to 2964 participants across 15 countries. Most frequently reported contributors to error were omissions and portion size misestimations of food/beverage items. Although few consistent patterns were seen in omission of consumed items, beverages were omitted less frequently (0-32% of the time), whereas vegetables (2-85%) and condiments (1-80%) were omitted more frequently than other items. Both under- and overestimation of portion size was seen for most single food/beverage items within study samples and most food groups. Studies considered and reported error in different ways, impeding the interpretation of how error contributors interact to impact overall misestimation. We recommend that future studies report 1) all error contributors for each food/beverage item evaluated (i.e., omission, intrusion, misclassification, and portion misestimation), and 2) measures of variation of the error. The protocol of this review was registered in PROSPERO as CRD42020202752 (https://www.crd.york.ac.uk/prospero/).

Review of dietary assessment studies conducted among Khmer populations living in Cambodia.

BACKGROUND: Despite economic growth, Cambodia continues to have high rates of malnutrition, anaemia and nutrition-related deficiencies. Government policies promote nutrition strategies, although dietary intake data is limited. A detailed synthesis of existing intake data is needed to inform nutrition policy and practice change. This review aims to characterise and assess quality of dietary assessment methods and outcomes from individual-level 'whole diet' studies of Khmer people living in Cambodia. METHODS: Searches were conducted using PRISMA-ScR guidelines. Included papers reported dietary intake at an individual level for 'whole diet'. Studies using secondary data or lacking dietary assessment details were excluded. Extracted data included dietary assessment features, nutrient/food group intakes and database. RESULTS: Nineteen publications (15 studies) were included, with nine carried out among children under 5 years and six among women. Eleven studies reported intake by food groups and four by nutrients, prominently energy, protein, vitamin A, iron, calcium and zinc. Inconsistent intakes, food groupings and reporting of study characteristics limited data synthesis. All but one study used 24-h recalls. Trained local fieldworkers used traditional interview-administered data collection and varied portion estimation tools. Food composition databases for analysis were not tailored to the Cambodian diet. Overall quality was rated as 'good'. CONCLUSIONS: We recommend the development of a best-practice protocol for conducting dietary assessment, a Cambodia-specific food composition database and a competent trained workforce of nutrition professionals, with global support of expertise and funding for future dietary assessment studies conducted in Cambodia.

A Mixed-Method Study Exploring Experiences and Perceptions of Nutritionists Regarding Use of an Image-Based Dietary Assessment System in Tanzania.

Due to global advances in technology, image-based food record methods have emerged as an alternative to traditional assessment methods. The use of image-based food records in low and lower-middle income countries such as Tanzania is limited, with countries still using traditional methods. The current study aimed to determine the feasibility of using a new voice and image-based dietary assessment system (VISIDA) in Dar es Salaam, Tanzania. This mixed-method study recruited 18 nutritionists as participants who collected image-based records of food and drinks they consumed using the VISIDA smartphone app. Participants viewed an online demonstration of the VISIDA web platform and the analysis process for intake data collected using the VISIDA app. Then, participants completed an online survey and were interviewed about the VISIDA app and web platform for food and nutrient intake analysis. The method was reported as being acceptable and was found to be easy to use, although technical challenges were experienced by some participants. Most participants indicated a willingness to use the VISIDA app again for one week or longer and were interested in using the VISIDA system in their current role. Participants acknowledged that the VISIDA web platform would simplify some aspects of their current job. Image-based food records could potentially be used in Tanzania to improve the assessment of dietary intake by nutritionists in urban areas. Participants recommended adding sound-on notifications, using the VISIDA app in both Apple and Android phones, enabling installation from the app store, and improving the quality of the fiducial markers.

Accuracy and Cost-effectiveness of Technology-Assisted Dietary Assessment Comparing the Automated Self-administered Dietary Assessment Tool, Intake24, and an Image-Assisted Mobile Food Record 24-Hour Recall Relative to Observed Intake: Protocol for a Randomized Crossover Feeding Study.

BACKGROUND: The assessment of dietary intake underpins population nutrition surveillance and nutritional epidemiology and is essential to inform effective public health policies and programs. Technological advances in dietary assessment that use images and automated methods have the potential to improve accuracy, respondent burden, and cost; however, they need to be evaluated to inform large-scale use. OBJECTIVE: The aim of this study is to compare the accuracy, acceptability, and cost-effectiveness of 3 technology-assisted 24-hour dietary recall (24HR) methods relative to observed intake across 3 meals. METHODS: Using a controlled feeding study design, 24HR data collected using 3 methods will be obtained for comparison with observed intake. A total of 150 healthy adults, aged 18 to 70 years, will be recruited and will complete web-based demographic and psychosocial questionnaires and cognitive tests. Participants will attend a university study center on 3 separate days to consume breakfast, lunch, and dinner, with unobtrusive documentation of the foods and beverages consumed and their amounts. Following each feeding day, participants will complete a 24HR process using 1 of 3 methods: the Automated Self-Administered Dietary Assessment Tool, Intake24, or the Image-Assisted mobile Food Record 24-Hour Recall. The sequence of the 3 methods will be randomized, with each participant exposed to each method approximately 1 week apart. Acceptability and the preferred 24HR method will be assessed using a questionnaire. Estimates of energy, nutrient, and food group intake and portion sizes from each 24HR method will be compared with the observed intake for each day. Linear mixed models will be used, with 24HR method and method order as fixed effects, to assess differences in the 24HR methods. Reporting bias will be assessed by examining the ratios of reported 24HR intake to observed intake. Food and beverage omission and intrusion rates will be calculated, and differences by 24HR method will be assessed using chi-square tests. Psychosocial, demographic, and cognitive factors associated with energy misestimation will be evaluated using chi-square tests and multivariable logistic regression. The financial costs, time costs, and cost-effectiveness of each 24HR method will be assessed and compared using repeated measures analysis of variance tests. RESULTS: Participant recruitment commenced in March 2021 and is planned to be completed by the end of 2021. CONCLUSIONS: This protocol outlines the methodology of a study that will evaluate the accuracy, acceptability, and cost-effectiveness of 3 technology-enabled dietary assessment methods. This will inform the selection of dietary assessment methods in future studies on nutrition surveillance and epidemiology. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12621000209897; https://tinyurl.com/2p9fpf2s. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/32891.

The Effectiveness of Randomized Controlled Trials to Improve Dietary Intake in the Context of Cardiovascular Disease Prevention and Management in Rural Communities: A Systematic Review.

BACKGROUND: Dietary intake is an important modifiable risk factor for cardiovascular disease. However, to our knowledge, there are no systematic reviews of nutrition interventions in the context of cardiovascular disease prevention and management within rural communities. This is important to investigate, given the unique geographic, social, and contextual factors associated with rurality. OBJECTIVE: Our primary objective was to systematically assess evidence on the effectiveness of randomized controlled trials to improve dietary intake in the context of cardiovascular disease prevention and management in rural communities. METHODS: Nine electronic databases were searched from inception to June 2020, including MEDLINE, The Cochrane Library, Embase, Emcare, PsycINFO, Scopus, Rural and Remote Health, CINAHL, and AMED. Randomized controlled trials that reported results of interventions with adult, rural populations and measured change in dietary intake compared to usual care, alternative intervention, or no intervention controls were included. Included randomized controlled trials were also assessed according to the TIDieR (Template for Intervention Description and Reporting) checklist and RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework. RESULTS: Thirteen articles reporting results of randomized controlled trials were identified. Included articles reported a range of nutrition interventions and measured 18 dietary intake outcomes. Most studies (n = 10) demonstrated effectiveness in altering at least 1 dietary intake outcome, including fruit and/or vegetable (n = 9), fiber (n = 2), Dietary Risk Assessment score (n = 2), energy, dairy, carotene, vitamin C and sodium (all n = 1). However, there was wide variation in the reporting of intervention components (according to the TIDieR checklist) and impact (according to RE-AIM framework), resulting in difficulty interpreting the "real-world" implications of these results. CONCLUSIONS: Through this systematic review, we found limited evidence of improvement in dietary intakes due to nutrition interventions in the context of cardiovascular disease prevention and management in rural communities. Fruit and/or vegetable intakes were the most frequently reported dietary intake outcomes, and most likely to be improved across the included studies. Included studies were generally not well reported, which may hinder replication by clinicians and consolidation of the evidence base by other researchers. Given the substantial burden of cardiovascular disease experienced by those living in rural areas of developed countries, additional high-quality nutrition research that acknowledges the complexities of rural health is required.

Scoping review of nutrition intervention and dietary assessment studies in Khmer populations living in Cambodia.

BACKGROUND: This scoping review aims to describe the body of nutrition intervention and dietary assessment research undertaken with Khmer populations in Cambodia, as well as summarise the nutrition knowledge base and highlight priority areas for future research. METHODS: Five databases and the grey literature were searched, following PRISMA-ScR guidelines. Studies involving dietary assessment or nutrition interventions published after 1992 were identified using specific search terms and extracted to a customised data extraction table for categorisation and analysis. Study participants were Khmer people of any age and gender, living in rural or urban Cambodia. RESULTS: Of the 100 included studies, 58 were dietary assessment only studies, 24 were nutrition interventions only, and 18 studies involved both assessment of intake and an intervention. Sixty-eight percent of study populations were mothers and young children, of which 52 studies focused on children aged under 5 years. Nineteen interventions involved supplementation and six trialled fortification of rice or fish sauce. Anaemia was the most common nutrition condition studied (n = 17), followed by malnutrition (n = 15) and malnutrition risk factors (n = 11). General nutrition status was explored in 25 studies, and individual micronutrients that were studied included iron (n = 27), zinc (n = 6), vitamin A (n = 4) and thiamine (n = 3). CONCLUSIONS: Diet-related research in Khmer populations in Cambodia has predominantly focused on dietary assessment or evaluation of interventions aimed at reducing malnutrition and resolving micronutrient deficiencies. Areas identified as emerging needs included non-communicable diseases, the ageing population and non-iron deficiency anaemia.

Informing telehealth service delivery for cardiovascular disease management: exploring the perceptions of rural health professionals.

Objective To explore the perceptions of rural health professionals who use telehealth services for cardiovascular health care, including the potential role of telehealth in enhancing services for this patient group. Methods Semi-structured interviews were conducted with ten rural health professionals across a range of disciplines, including medicine, nursing and allied health. All study participants were based in the same rural region in New South Wales, Australia. Results Participant responses emphasised the importance of including rural communities in ongoing dialogue to enhance telehealth services for cardiovascular care. Divergent expectations about the purpose of telehealth and unresolved technology issues were identified as factors to be addressed. Rural health professionals highlighted the importance of all stakeholders coming together to overcome barriers and enhance telehealth services in a collaborative manner. Conclusion This study contributes to an evolving understanding of how health professionals based in regional Australia experience telehealth services. Future telehealth research should proceed in collaboration with rural communities, supported by policy that actively facilitates the meaningful inclusion of rural stakeholders in telehealth dialogue. What is known about the topic? Telehealth is frequently discussed as a potential solution to overcome aspects of rural health, such as poor outcomes and limited access to services compared with metropolitan areas. In the context of telehealth and cardiovascular disease (CVD), research that focuses on rural communities is limited, particularly regarding the experiences of these communities with telehealth. What does this paper add? This paper offers insight into how telehealth is experienced by rural health professionals. The paper highlights divergent expectations of telehealth's purpose and unresolved technological issues as barriers to telehealth service delivery. It suggests telehealth services may be enhanced by collaborative approaches that engage multiple stakeholder groups. What are the implications for practitioners? The use and development of telehealth in rural communities requires a collaborative approach that considers the views of rural stakeholders in their specific contexts. To improve telehealth services for people living with CVD in rural communities, it is important that rural stakeholders have opportunities to engage with non-rural clinicians, telehealth developers and policy makers.

Maternal Diet Quality, Body Mass Index and Resource Use in the Perinatal Period: An Observational Study.

The impact of pre-pregnancy obesity and maternal diet quality on the use of healthcare resources during the perinatal period is underexplored. We assessed the effects of body mass index (BMI) and diet quality on the use of healthcare resources, to identify whether maternal diet quality may be effectively targeted to reduce antenatal heath care resource use, independent of women's BMI. Cross-sectional data and inpatient medical records were gathered from pregnant women attending publicly funded antenatal outpatient clinics in Newcastle, Australia. Dietary intake was self-reported, using the Australian Eating Survey (AES) food frequency questionnaire, and diet quality was quantified from the AES subscale, the Australian Recommended Food Score (ARFS). Mean pre-pregnancy BMI was 28.8 kg/m2 (range: 14.7 kg/m2-64 kg/m2). Mean ARFS was 28.8 (SD = 13.1). Higher BMI was associated with increased odds of caesarean delivery; women in obese class II (35.0-39.9 kg/m2) had significantly higher odds of caesarean delivery compared to women of normal weight, (OR = 2.13, 95% CI 1.03 to 4.39; p = 0.04). Using Australian Refined Diagnosis Related Group categories for birth admission, the average cost of the birth admission was $1348 more for women in the obese class II, and $1952 more for women in the obese class III, compared to women in a normal BMI weight class. Higher ARFS was associated with a small statistically significant reduction in maternal length of stay (RR = 1.24, 95% CI 1.00, 1.54; p = 0.05). There was no evidence of an association between ARFS and mode of delivery or "midwifery-in-the-home-visits".

Exploring core food accessibility in Tamworth, NSW, Australia.

INTRODUCTION: A lack of core food accessibility negatively affects diet quality, potentially increasing the prevalence of health risk factors such as obesity. The purpose of this study was to investigate core food access in an Australian regional center through the use of data visualization techniques. METHODS: Supermarkets were used as a proxy for core food accessibility and were identified and mapped by town region with a combination of Google Maps and Stata/IC 15.1 software. A statistical analysis comparing the demographics of each town region was also completed using Stata. RESULTS: The maps generated suggest that there may be a disparity in core food accessibility between town regions. The analysis of demographics demonstrated that one town region had a greater proportion of disadvantaged residents, with statistically significant variation between regions. CONCLUSION: Data visualization and analysis may be a useful tool for clinicians to communicate accessibility information experienced by local residents. This need not be limited to food accessibility and extended to health services.

Investigating the Efficacy and Cost-Effectiveness of Technology-Delivered Personalized Feedback on Dietary Patterns in Young Australian Adults in the Advice, Ideas, and Motivation for My Eating (Aim4Me) Study: Protocol for a Randomized Controlled Trial.

BACKGROUND: Web-based health interventions may be easier to access and time efficient relative to face-to-face interventions and therefore may be the most appropriate mode to engage young adults. OBJECTIVE: This study aims to investigate the impact of 3 different levels of personalized web-based dietary feedback and support on changes in diet quality. METHODS: The Advice, Ideas, and Motivation for My Eating (Aim4Me) study is a 12-month assessor-blinded, parallel-group randomized controlled trial evaluating the impact of 3 levels of web-based feedback on diet quality, measured using the Australian Recommended Food Score (ARFS). Participants (N=2570) will primarily be recruited via web-based methods and randomized to 1 of 3 groups. Group 1 (control) will receive the Healthy Eating Quiz, a web-based dietary assessment tool that generates a brief feedback report on diet quality. Individuals randomized to this group can use the brief feedback report to make positive dietary changes. Group 2 will receive the Australian Eating Survey, a web-based dietary assessment tool that generates a comprehensive feedback report on diet quality as well as macro- and micronutrient intake. Group 2 will use the comprehensive feedback report to assist in making positive dietary changes. They will also have access to the Aim4Me website with resources on healthy eating and tools to set goals and self-monitor progress. Group 3 will receive the same intervention as Group 2 (ie, the comprehensive feedback report) in addition to a tailored 30-min video consultation with an accredited practicing dietitian who will use the comprehensive feedback report to assist individuals in making positive dietary changes. The self-determination theory was used as the framework for selecting appropriate website features, including goal setting and self-monitoring. The primary outcome measure is change in diet quality. The completion of questionnaires at baseline and 3, 6, and 12 months will be incentivized with a monetary prize draw. RESULTS: As of December 2019, 1277 participants have been randomized. CONCLUSIONS: The web-based delivery of nutrition interventions has the potential to improve dietary intake of young adults. However, the level of support required to improve intake is unknown. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12618000325202; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374420. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/15999.

Dietary Assessment Methods in Military and Veteran Populations: A Scoping Review.

Optimal dietary intake is important for the health and physical performance of military personnel. For military veterans, the complex nature of transition into civilian life and sub-optimal dietary intake is a leading contributor to the increased burden of disease. A scoping review was undertaken to determine what is known about the assessment and reporting of dietary intakes within both military and veteran populations. In addition, this review determines if studies reporting on the dietary intake of military personnel or veterans include comparisons with dietary guidelines. Six databases were searched to identify papers published from the database inception to April 2019. Observational and intervention studies were searched to identify if they assessed and reported whole dietary intake data, reported data exclusively for a military or veteran population, and included only healthy populations. A total of 89 studies were included. The majority of studies used one dietary assessment method (n = 76, 85%) with fewer using multiple methods (n = 13, 15%). The most frequent methodology used was food frequency questionnaires (FFQ) (n = 40, 45%) followed by 24-hour recalls (n = 8, 9%) and food records (n = 8, 9%). The main dietary outcomes reported were macronutrients: carbohydrate, protein, fat, and alcohol (n = 66, 74%) with total energy intake reported in n = 59 (66%). Fifty four (61%) studies reported a comparison with country-specific dietary guidelines and 14 (16%) reported a comparison with the country-specific military guidelines. In conclusion, dietary intake in military settings is most commonly assessed via FFQs and 24-hour recalls. Dietary intake reporting is mainly focused around intakes of energy and macronutrients. Most studies compare against dietary guidelines, however, comparison to specific military dietary guidelines is minimal.

Diet quality is more strongly related to food skills rather than cooking skills confidence: Results from a national cross-sectional survey.

AIM: While diet quality has declined globally, the promotion of cooking skills as a potential target to counter the decline has been proposed. The aim of the current study was to investigate the relationship between food and cooking skills and diet quality in Australian adults. METHODS: A sample of 910 Australian adults completed an online cross-sectional survey to evaluate their level of cooking and food skills confidence, food related psychological variables, diet quality using the Australian Recommended Food Score (ARFS) and sociodemographic characteristics. Analysis of variance with post hoc analysis, Pearson's correlations and hierarchical multiple regressions were conducted using IBM SPSS V25, with statistical significance set at P < .05. RESULTS: Older respondents and females reported higher levels of both cooking and food skills confidence compared to younger and male participants, all P < .001. Cooking and food skills confidence scores were highly correlated (r = .70, P < .001), but weakly correlated with ARFS (r = .22, P < .001; r = .31, P < .001, respectively). Participants with higher diet quality scores had greater cooking and food skills confidence and they consumed less takeaway food (P < .001 and P = .006, respectively). Sixteen percent of the variance in ARFS was accounted for, with age, sex, food creativity and food skills confidence contributing the most variability. CONCLUSIONS: Strategies to improve food skills confidence could potentially enhance diet quality and variety to a greater degree than focusing on cooking skills alone. However, development of both skills sets should be encouraged within education programs and targeted to differing aspects of diet quality. Tailoring interventions to specific population groups with low confidence in their skills, including younger adults and males, may facilitate individuals in making healthy food choices.

Advancement in Dietary Assessment and Self-Monitoring Using Technology.

On the surface, some methods to assess and self-monitor dietary intake may be considered similar; however, the intended function of each is quite distinct [...].

Dietary Assessment of Shared Plate Eating: A Missing Link.

Shared plate eating is a defining feature of the way food is consumed in some countries and cultures. Food may be portioned to another serving vessel or directly consumed into the mouth from a centralised dish rather than served individually onto a discrete plate for each person. Shared plate eating is common in some low- and lower-middle income countries (LLMIC). The aim of this narrative review was to synthesise research that has reported on the assessment of dietary intake from shared plate eating, investigate specific aspects such as individual portion size or consumption from shared plates and use of technology in order to guide future development work in this area. Variations of shared plate eating that were identified in this review included foods consumed directly from a central dish or shared plate food, served onto additional plates shared by two or more people. In some settings, a hierarchical sharing structure was reported whereby different family members eat in turn from the shared plate. A range of dietary assessment methods have been used in studies assessing shared plate eating with the most common being 24-h recalls. The tools reported as being used to assist in the quantification of food intake from shared plate eating included food photographs, portion size images, line drawings, and the carrying capacity of bread, which is often used rather than utensils. Overall few studies were identified that have assessed and reported on methods to assess shared plate eating, highlighting the identified gap in an area of research that is important in improving understanding of, and redressing dietary inadequacies in LLMIC.

Image-Based Dietary Assessment and Tailored Feedback Using Mobile Technology: Mediating Behavior Change in Young Adults.

Assessing the implementation of nutrition interventions is important to identify characteristics and dietary patterns of individuals who benefit most. The aim was to report on young adults' experiences of receiving dietary feedback text messaging intervention. Diet was captured using an image-based 4-day mobile food recordTM application (mFRTM) and assessed to formulate two tailored feedback text messages on fruit and vegetables and energy-dense nutrient-poor (EDNP) foods and beverages. At 6-months 143 participants completed a second mFRTM and a questionnaire evaluating the dietary feedback. Participants who agreed the text messages made them think about how much vegetables they ate were more likely to increase their intake by at least half a serve than those who disagreed [odds ratio (OR) = 4.28, 95% Confidence Interval (CI): 1.76 to 10.39]. Those who agreed the text messages made them think about how much EDNP foods they ate, were twice as likely to decrease their intake by over half a serve (OR = 2.39, 95%CI: 1.12 to 5.25) than those who disagreed. Undertaking detailed dietary assessment ensured the tailored feedback was constructive and relevant. Personal contemplation about vegetable and EDNP food intake appears to be a mediator of dietary change in young adults.

Validity of Dietary Assessment Methods When Compared to the Method of Doubly Labeled Water: A Systematic Review in Adults.

Accuracy in quantifying energy intake (EI) using common dietary assessment methods is crucial for interpreting the relationship between diet and chronic disease. The aim of this systematic review was to evaluate the validity of dietary assessment methods used to estimate the EI of adults in comparison to total energy expenditure (TEE) measured by doubly labeled water (DLW). Articles in English across nine electronic databases, published between 1973 and February 2019 were retrieved. Studies were included if participants were adults (≥18 years) and used the DLW technique to measure TEE compared to self-reported EI. A total of 59 studies were included, with a total of 6,298 free living adults and a mean of 107 participants per study. The majority of studies including 16 studies that included a technology based method reported significant (P < 0.05) under-reporting of EI when compared to TEE, with few over-reporting EI. Misreporting was more frequent among females compared to males within recall based dietary assessment methods. The degree of under-reporting was highly variable within studies using the same method, with 24 h recalls having less variation and degree of under-reporting compared to other methods.

Cost evaluation of providing evidence-based dietetic services for weight management in adults: In-person versus eHealth delivery.

AIM: To compare the theoretical costs of best-practice weight management delivered by dietitians in a traditional, in-person setting compared to remote consultations delivered using eHealth technologies. METHODS: Using national guidelines, a framework was developed outlining dietitian-delivered weight management for in-person and eHealth delivery modes. This framework mapped one-on-one patient-dietitian consultations for an adult requiring active management (BMI ≥ 30 kg/m2 ) over a one-year period using both delivery modes. Resources required for both the dietitian and patient to implement each treatment mode were identified, with costs attributed for material, fixed, travel and personnel components. The resource costs were categorised as either establishment or recurring costs associated with the treatment of one patient. RESULTS: Establishment costs were higher for eHealth compared to in-person costs ($1394.21 vs $90.05). Excluding establishment costs, the total (combined dietitian and patient) cost for one patient receiving best-practice weight management for 12 months was $560.59 for in-person delivery, compared to $389.78 for eHealth delivery. Compared to the eHealth mode, a higher proportion of the overall recurring delivery costs was attributed to the patient for the in-person mode (46.4% and 33.9%, respectively). CONCLUSIONS: Although it is initially more expensive to establish an eHealth service mode, the overall reoccurring costs per patient for delivery of best-practice weight management were lower compared to the in-person mode. This theoretical cost evaluation establishes preliminary evidence to support alternative obesity management service models using eHealth technologies. Further research is required to determine the feasibility, efficacy and cost-effectiveness of these models within dietetic practice.