1. New and Innovative Dietary Assessment Methods German Institute for Human Nutrition, Potsdam- Rehbruecke Dr. Karen Wagner/Anne-Kathrin Illner

2. Literature search Criteria for inclusion –Studies published in English between 2002 and later –Studies using an instrument to assess foods –Studies with target populations relevant to the characteristics of cohorts of IDAMES partners –Studies identified in Pubmed

3. Overview New MethodNumber of Studies Validation StudiesFeasibility Studies and other PDA 752 Picture-sort FFQ 22 Smart-card 33 Bar code scanner 22 Computer-tools 33 Web-FFQ 523 Web-24 HDR 22 Statistical method 22

4. PDA (1) Wellnavi handheld personal digital assistant with camera and mobile phone card real time dietary data assessment possible digital photos of foods and drinks consumed display to specify the ingredients of the meal electronic data transfer to a dietician Fig. 1: Wellnavi-Instrument Wang, D.H., et al., Validity and reliability of a dietary assessment method: the application of a digital camera with a mobile phone card attachment. J Nutr Sci Vitaminol (Tokyo), 2002. 48(6): p. 498-504.

5. Wellnavi – Studies AuthorMethodsSubjectsResults for nutrient intake Wang et al, 2006 Wellnavi vs. 1d- WFR 1 28 19.3 ± 0.5 y r = 0.21-0.81 + less burden & time consuming (57%) Kikunaga et al, 2007 Wellnavi vs. 5d-WFR 1 75 & 48.8 ± 10.2 y r = 0.34-0.78 + underestimation Wang, D.H., M. Kogashiwa, and S. Kira, Development of a new instrument for evaluating individuals' dietary intakes. J Am Diet Assoc, 2006. 106(10): p. 1588-93. Kikunaga, S., et al., The application of a handheld personal digital assistant with camera and mobile phone card (Wellnavi) to the general population in a dietary survey. J Nutr Sci Vitaminol (Tokyo), 2007. 53(2): p. 109-16. 1 WFR: weighted food record

6. Beasley, J., W.T. Riley, and J. Jean-Mary, Accuracy of a PDA-based dietary assessment program. Nutrition, 2005. 21(6): p. 672-7. DietMatePro PDA with integrated Web-based technology real time dietary assessment possible selection of foods from the USDA-database and specification of portion sizes immediate web-based transfer form dietary data, date and time of consumption individualization of database PDA (2) Fig. 2: DietMatePro-Display

7. DietMatePro – Studies Beasley, J., W.T. Riley, and J. Jean-Mary, Accuracy of a PDA-based dietary assessment program. Nutrition, 2005. 21(6): p. 672-7. Beasley JM, Riley WT, Davis A, Singh J. Evaluation of a PDA-based dietary assessment and intervention program: a randomized controlled trial. J Am Coll Nutr. 2008 Apr;27(2):280-6. AuthorMethodsSubjectsResults for nutrient intake Beasley et al, 2005 DietMatePro vs: 1)24HDR 1 2)Weighed meal 39 & 53 ± 1,7 y 1)r = 0.51-0.80 2)r = 0.42-0.79 + training essential Beasley et al, 2008 DietMatePro vs: 1)24HDR 1 2)Paper-diary 174 & 1)r = 0.41-0.71 2)r = 0.63-0.83 + training essential 1 HDR: 24 Hour dietary recall

8. WeaknessesBenefits high technical and staff requirements expensive training required inaccurate estimation of portion size low correlation coefficient usefully measure of individual dietary intake for a variety of nutrients immediate data transfer facilitated data coding useful to reach low-literacy groups, e.g. children, elderly PDAs

9. Alternatives to measure self-reported food intake in large-scale studies?

10. Web-based FFQs AuthorMethodsSubjectsResults Beasley et al, 2008 Web-DHQ 1 vs: 1)PDHQ 2 2)24 HDR 3 3)4d-FR 4 218 & 54.9 ± 14.4 y 1)r = 0.82 2)r = 0.31 3)r = 0.41 (for nutrient intake) Matthys et al, 2007 Web-based FFQ vs 3d-WFR 5 104 & r = 0.20 to 0.64 (for food intake) Beasley, J. M., Davis, A., and Riley, W. T. Evaluation of a web-based, pictorial diet history questionnaire. Public Health Nutr: 1-9, 2008. Matthys, C., Pynaert, I., De Keyzer, W., and De Henauw, S. Validity and reproducibility of an adolescent web-based food frequency questionnaire. J Am Diet Assoc, 107: 605-10, 2007 1 DHQ: Diet History Questionnaire 2 PDHQ: Paper-Diet History Questionnaire 3 HDR: 24 Hour dietary recall 4 FR: food record 5 WFR: weighted food record

11. WeaknessesBenefits finite food list with often closed ended response categories measurement error (no quantification) burden & selection bias - cognitive difficult - computer literacy higher data quality - immediate data check less costs - no costs for printing, postage less organisational constraints - no manual checks of incomplete or implausible answers, no transfer of data to an electronic format higher compliance of participants - completion any time & location, reminder messages, personalized feed- back, interactive help features Hanning, R. M., Woodruff, S. J., Lambraki, I., Jessup, L., Driezen, P., and Murphy, C. C. Nutrient intakes and food consumption patterns among Ontario students in grades six, seven, and eight. Can J Public Health, 98: 12-6, 2007; Bälter, K., Bälter, O., Fondell, E. and Lagerros, Y. Web-based and mailed questionnaires: a comparison of response rates and compliance. Epidemiology, 16:4 S577-590, 2005. Web-based FFQs

12. More specific contributions of new methods to epidemiologic approaches have to be evaluated in feasibility research. Some are of high interest large-scale epidemiologic studies, web-based FFQs, 24 HDR today preferred High potential for a historically new period of research? Outlook

13. Thank you for your attention!

15. Wellnavi – Validity I Wang, D.H., et al., Validity and reliability of a dietary assessment method: the application of a digital camera with a mobile phone card attachment. J Nutr Sci Vitaminol (Tokyo), 2002. 48(6): p. 498-504. Wellnavi vs. 1-d weighed record Subjects: College students (n = 20) Results: r = 0.46 to 0.93 (median r = 0.77). Conclusion: Wellnavi can usefully measure individual dietary intakes for a variety of nutrients in an epidemiologic study

16. Wellnavi – Validation II Wang, D.H., M. Kogashiwa, and S. Kira, Development of a new instrument for evaluating individuals' dietary intakes. J Am Diet Assoc, 2006. 106(10): p. 1588-93. Wellnavi vs. 1-d weighed record and 24 hr recall Design: cross-sectional study design Subjects: College students (n = 28) Results: no significant differences between the methods Practicability evaluations participants burden by using a questionnaire least burdensome (57% participants) Conclusion: may be a valid and convenient instrument for evaluating dietary intake.

17. New / innovative methods Personal Digital Assistant (PDA) –Wellnavi (Wang 2002, Wang 2006, Kikunaga 2007) –DietMatePro (Beasley 2005 and 2008) Web-based and computer based tools New statistical analysis

18. Application Wellnavi Kikunaga, S., et al., The application of a handheld personal digital assistant with camera and mobile phone card (Wellnavi) to the general population in a dietary survey. J Nutr Sci Vitaminol (Tokyo), 2007. 53(2): p. 109-16. Wellnavi vs. 1-d weighed record Subjects: healthy adults n = 75 Results: significant correlation for energy intake [kcal]: r = 0.602; p < 0,001 significant lower values for the Energy intake [kcal]: Wellnavi: 1718 ± 361 vs record: 1977 ± 405 Conclusion: could become a useful new dietary assessment method to get accurate dietary information from people of a wide range of age and occupation

19. DietMatePro – Validation Validated in two on-site studies: (1) 39-person trial with weighed intake of a meal (2) 174 person randomized, controlled trial comparing DietMatePro vs 24 hr recall Beasley, J., W.T. Riley, and J. Jean-Mary, Accuracy of a PDA-based dietary assessment program. Nutrition, 2005. 21(6): p. 672-7.

20. DietMatePro – Validation Beasley, J., W.T. Riley, and J. Jean-Mary, Accuracy of a PDA-based dietary assessment program. Nutrition, 2005. 21(6): p. 672-7. (1) DietMatePro vs. 24 hr recall and weighed meal Design: Randomized controlled trial Subjects: 39 participants Results: r = 0.51 to 0.80 for DietMatePro vs. 24 hr recall r = 0.42 to 0.79 for DietMatePro vs weighed meal Conclusion: provides a method of assessing energy and macronutrient intakes comparable to the 24-h recall

21. DietMatePro – Validation (2) DieMatePro or paper food diary vs 24 hr recall Design: Randomized controlled trial Subjects: 174 overweight/obese participants (BMI 25 – 40 kg/m²) Results: r = 0.41 to 0.71 for the DietMatePro vs 24 hr recall r = 0.63 to 0.83 for the paper-based diary vs 24 hr recall Conclusion: does not produce more valid data than paper-based approaches may improve adherence compared to paper-based methods Beasley JM, Riley WT, Davis A, Singh J. Evaluation of a PDA-based dietary assessment and intervention program: a randomized controlled trial. J Am Coll Nutr. 2008 Apr;27(2):280-6.

22. Web-based version of the NCI diet history questionnaire (web-PDHQ) – Beasley et al, 2008 Design: comparing web-PDHQ vs original paper DHQ 4day food record and 24 hr recall as reference Subjects: 218 subjects Results: r = 0.82 between web-PDHQ/original paper DHQ web-based questionnaires Beasley, J. M., Davis, A., and Riley, W. T. Evaluation of a web-based, pictorial diet history questionnaire. Public Health Nutr: 1-9, 2008.

23. Web-based food frequency questionnaire (web-FFQ) Mathyss et al, 2007 Design: comparing web-FFQ vs diary Subjects: 104 adolescents (12 to 18 years) Results: r = 0. 20 to 0.64 acceptable validity only for: water, fruit, bread, and fish/eggs/meat web-based questionnaires Matthys, C., Pynaert, I., De Keyzer, W., and De Henauw, S. Validity and reproducibility of an adolescent web-based food frequency questionnaire. J Am Diet Assoc, 107: 605-10, 2007

24. MyPyramid Tracker, Juan et al, 2006 Design: comparing web-FFQ vs diary Subjects: 104 adolescents (12 to 18 years) Results: r = 0. 20 to 0.64 acceptable validity only for: water, fruit, bread, and fish/eggs/meat Web-based tool Juan, W., Gerrior, S., and Hiza, H. MyPyramid Tracker assesses food consumption, physical activity, and energy balance status interactively. J Nutr Educ Behav, 38: S155-7, 2006.

25. Advanced metods Lu et al, 2006; Moore et al, 2007; Hanning et al, 2007; Edwards et al, 2007, Subar et al, 2007 Application: web-based questionnaires, web-based software, computer-based recalls Experiences in application: Time-saving, accurate, low burden, cost-effective, well-accepted Publicly available