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Title: Validity of the remote food photography method against doubly labeled water among minority preschoolers

Author
item Nicklas, Theresa - Children'S Nutrition Research Center (CNRC)
item Saab, Rabab - Children'S Nutrition Research Center (CNRC)
item Islam, Noemi - Children'S Nutrition Research Center (CNRC)
item Wong, William - Children'S Nutrition Research Center (CNRC)
item Butte, Nancy - Children'S Nutrition Research Center (CNRC)
item Schulin, Rebecca - Pennington Biomedical Research Center
item Liu, Yan - Children'S Nutrition Research Center (CNRC)
item Apolzan, John - Pennington Biomedical Research Center
item Myers, Candice - Pennington Biomedical Research Center
item Martin, Corby - Pennington Biomedical Research Center

Submitted to: Obesity
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 6/19/2017
Publication Date: 8/28/2017
Citation: Nicklas, T.A., Saab, R., Islam, N.G., Wong, W., Butte, N., Schulin, R., Liu, Y., Apolzan, J.W., Myers, C.A., Martin, C.K. 2017. Validity of the remote food photography method against doubly labeled water among minority preschoolers. Obesity. 25(9):1633-1638.

Interpretive Summary: Dietary assessment methods in children entail a high participant response burden and are impractical for young children who have multiple caregivers and eating occasions in different settings outside of the home (e.g., daycare centers, preschool). In Houston, Texas, researchers at the Children's Nutrition Research Center conducted a study that aimed at validating the remote food photography method (RFPM) in estimating energy intake (EI) in comparison to the doubly labeled water (DLW) method. Caregivers and teachers of thirty-nine African Americans and Hispanic 3 to 5 year old children who attended Head Start took pictures using an iPhone of what children ate and drank for a period of seven consecutive days. At home caregivers also collected and froze one urine sample from the child each of the seven days. The RFPM underestimated EI among minority preschoolers when compared to the DLW method. Further refinement of the RFPM is needed for assessing EI of young children, particularly those with multiple caregivers.

Technical Abstract: The aim of this study was to determine the validity of energy intake (EI) estimations made using the remote food photography method (RFPM) compared to the doubly labeled water (DLW) method in minority preschool children in a free-living environment. Seven days of food intake and spot urine samples excluding first void collections for DLW analysis were obtained on thirty-nine 3- to 5-year-old Hispanic and African American children. Using an iPhone, caregivers captured before and after pictures of each child's intake, pictures were wirelessly transmitted to trained raters who estimated portion size using existing visual estimation procedures, and energy and macronutrients were calculated. Paired t tests, mean differences, and Bland-Altman limits of agreement were performed. The mean EI was 1,191 +/- 256 kcal/d using the RFPM and 1,412 +/- 220 kcal/d using the DLW method, resulting in a mean underestimate of 222 kcal/d (-15.6%; P <0.0001) that was consistent regardless of intake. The RFPM underestimated EI by -28.5% in 34 children and overestimated EI by 15.6% in 5 children. The RFPM underestimated total EI when compared to the DLW method among preschoolers. Further refinement of the RFPM is needed for assessing the EI of young children.