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The science and tools of measuring energy intake and output in humans have rapidly advanced in the last decade. Engineered devices such as wearables and sensors, software applications, and Web-based tools are now ubiquitous in both research and consumer environments. The assessment of energy expenditure in particular has progressed from reliance on self-report instruments to advanced technologies requiring collaboration across multiple disciplines, from optics to accelerometry. In contrast, assessing energy intake still heavily relies on self-report mechanisms. Although these tools have improved, moving from paper-based to online reporting, considerable room for refinement remains in existing tools, and great opportunities exist for novel, transformational tools, including those using spectroscopy and chemo-sensing. This report reviews the state of the science, and the opportunities and challenges in existing and emerging technologies, from the perspectives of 3 key stakeholders: researchers, users, and developers. Each stakeholder approaches these tools with unique requirements: researchers are concerned with validity, accuracy, data detail and abundance, and ethical use; users with ease of use and privacy; and developers with high adherence and utilization, intellectual property, licensing rights, and monetization. Cross-cutting concerns include frequent updating and integration of the food and nutrient databases on which assessments rely, improving accessibility and reducing disparities in use, and maintaining reliable technical assistance. These contextual challenges are discussed in terms of opportunities and further steps in the direction of personalized health.

Image-based dietary records have been validated as tools to evaluate dietary intake. However, to determine meal timing, previous studies have relied primarily on image-based smartphone applications without validation. Noteworthy, the validation process is necessary to determine how accurately a test method measures meal timing compared with a reference method over the same time period. Thus, we aimed to assess the relative validity and reliability of the Remind® app as an image-based method to assess dietary intake and meal timing. For this purpose, 71 young adults (aged 20–33 years, 81.7% women) were recruited for a 3-day cross-sectional study, where they completed a 3-day image-based record using the Remind app (test method) and a 3-day handwritten food record (reference method). The relative validity of the test method versus the reference method was assessed using multiple tests including Bland–Altman, % difference, paired t-test/Wilcoxon signed-rank test, Pearson/Spearman correlation coefficients, and cross-classification. We also evaluated the reliability of the test method using an intra-class correlation (ICC) coefficient. The results showed that, compared to the reference method, the relative validity of the test method was good for assessing energy and macronutrient intake, as well as meal timing. Meanwhile, the relative validity of the test method to assess micronutrient intake was poor (p < 0.05) for some micronutrients (iron, phosphorus, potassium, zinc, vitamins B1, B2, B3, B6, C, and E, and folates) and some food groups (cereals and grains, legumes, tubers, oils, and fats). Regarding the reliability of an image-based method to assess dietary intake and meal timing, results ranged from moderate to excellent (ICC 95% confidence interval [95% CI]: 0.50–1.00) for all nutrients, food groups (except oils and fats, which had low to moderate reliability), and meal timings. Thus, the results obtained in this study provide evidence of the relative validity and reliability of image-based methods to assess dietary intake (energy, macronutrients, and most food groups) and meal timing. These results open up a new framework for chrononutrition, as these methods improve the quality of the data collected and also reduce the burden on users to accurately estimate portion size and the timing of meals. [ABSTRACT FROM AUTHOR]

Image-based dietary assessment (IBDA) may improve the accuracy of dietary assessments, but no formalized training currently exists for skills relating to IBDA. This study investigated nutrition and dietetics students' and interns' IBDA abilities, the training and experience factors that may contribute to food identification and quantification accuracy, and the perceived challenges to performing IBDA. An online survey containing images of known foods and serving sizes representing common American foods was used to assess the ability to identify foods and serving sizes. Nutrition and dietetics students and interns from the United States and Australia (n = 114) accurately identified foods 79.5% of the time. Quantification accuracy was lower, with only 38% of estimates within ±10% of the actual weight. Foods of amorphous shape or higher energy density had the highest percent error. Students expressed general difficulty with perceiving serving sizes, making IBDA food quantification more difficult. Experience cooking at home from a recipe, frequent measuring of portions, and having a food preparation or cooking laboratory class were associated with enhanced accuracy in IBDA. Future training of dietetics students should incorporate more food-based serving size training to improve quantification accuracy while performing IBDA, while advances in IBDA technology are also needed. [ABSTRACT FROM AUTHOR]

Image-based dietary records could lower participant burden associated with traditional prospective methods of dietary assessment. They have been used in children, adolescents and adults, but have not been evaluated in pregnant women. The current study evaluated relative validity of the DietBytes image-based dietary assessment method for assessing energy and nutrient intakes. Pregnant women collected image-based dietary records (via a smartphone application) of all food, drinks and supplements consumed over three non-consecutive days. Intakes from the image-based method were compared to intakes collected from three 24-h recalls, taken on random days; once per week, in the weeks following the image-based record. Data were analyzed using nutrient analysis software. Agreement between methods was ascertained using Pearson correlations and Bland-Altman plots. Twenty-five women (27 recruited, one withdrew, one incomplete), median age 29 years, 15 primiparas, eight Aboriginal Australians, completed image-based records for analysis. Significant correlations between the two methods were observed for energy, macronutrients and fiber (r = 0.58-0.84, all p < 0.05), and for micronutrients both including (r = 0.47-0.94, all p < 0.05) and excluding (r = 0.40-0.85, all p < 0.05) supplements in the analysis. Bland-Altman plots confirmed acceptable agreement with no systematic bias. The DietBytes method demonstrated acceptable relative validity for assessment of nutrient intakes of pregnant women. [ABSTRACT FROM AUTHOR]

Image-based dietary records could lower participant burden associated with traditional prospective methods of dietary assessment. They have been used in children, adolescents and adults, but have not been evaluated in pregnant women. The current study evaluated relative validity of the DietBytes image-based dietary assessment method for assessing energy and nutrient intakes. Pregnant women collected image-based dietary records (via a smartphone application) of all food, drinks and supplements consumed over three non-consecutive days. Intakes from the image-based method were compared to intakes collected from three 24-h recalls, taken on random days; once per week, in the weeks following the image-based record. Data were analyzed using nutrient analysis software. Agreement between methods was ascertained using Pearson correlations and Bland-Altman plots. Twenty-five women (27 recruited, one withdrew, one incomplete), median age 29 years, 15 primiparas, eight Aboriginal Australians, completed image-based records for analysis. Significant correlations between the two methods were observed for energy, macronutrients and fiber ( r = 0.58-0.84, all p < 0.05), and for micronutrients both including ( r = 0.47-0.94, all p < 0.05) and excluding ( r = 0.40-0.85, all p < 0.05) supplements in the analysis. Bland-Altman plots confirmed acceptable agreement with no systematic bias. The DietBytes method demonstrated acceptable relative validity for assessment of nutrient intakes of pregnant women., Competing Interests: The authors declare no conflict of interest.

Background: Dietitians ideally should provide personally tailored nutrition advice to pregnant women. Provision is hampered by a lack of appropriate tools for nutrition assessment and counselling in practice settings. Smartphone technology, through the use of image-based dietary records, can address limitations of traditional methods of recording dietary intake. Feedback on these records can then be provided by the dietitian via smartphone. Efficacy and validity of these methods requires examination., Objective: The aims of the Australian Diet Bytes and Baby Bumps study, which used image-based dietary records and a purpose-built brief Selected Nutrient and Diet Quality (SNaQ) tool to provide tailored nutrition advice to pregnant women, were to assess relative validity of the SNaQ tool for analyzing dietary intake compared with nutrient analysis software, to describe the nutritional intake adequacy of pregnant participants, and to assess acceptability of dietary feedback via smartphone., Methods: Eligible women used a smartphone app to record everything they consumed over 3 nonconsecutive days. Records consisted of an image of the food or drink item placed next to a fiducial marker, with a voice or text description, or both, providing additional detail. We used the SNaQ tool to analyze participants' intake of daily food group servings and selected key micronutrients for pregnancy relative to Australian guideline recommendations. A visual reference guide consisting of images of foods and drinks in standard serving sizes assisted the dietitian with quantification. Feedback on participants' diets was provided via 2 methods: (1) a short video summary sent to participants' smartphones, and (2) a follow-up telephone consultation with a dietitian. Agreement between dietary intake assessment using the SNaQ tool and nutrient analysis software was evaluated using Spearman rank correlation and Cohen kappa., Results: We enrolled 27 women (median age 28.8 years, 8 Indigenous Australians, 15 primiparas), of whom 25 completed the image-based dietary record. Median intakes of grains, vegetables, fruit, meat, and dairy were below recommendations. Median (interquartile range) intake of energy-dense, nutrient-poor foods was 3.5 (2.4-3.9) servings/day and exceeded recommendations (0-2.5 servings/day). Positive correlations between the SNaQ tool and nutrient analysis software were observed for energy (ρ=.898, P<.001) and all selected micronutrients (iron, calcium, zinc, folate, and iodine, ρ range .510-.955, all P<.05), both with and without vitamin and mineral supplements included in the analysis. Cohen kappa showed moderate to substantial agreement for selected micronutrients when supplements were included (kappa range .488-.803, all P ≤.001) and for calcium, iodine, and zinc when excluded (kappa range .554-.632, all P<.001). A total of 17 women reported changing their diet as a result of the personalized nutrition advice., Conclusions: The SNaQ tool demonstrated acceptable validity for assessing adequacy of key pregnancy nutrient intakes and preliminary evidence of utility to support dietitians in providing women with personalized advice to optimize nutrition during pregnancy., Competing Interests: Conflicts of Interest: None declared., (©Amy M Ashman, Clare E Collins, Leanne J Brown, Kym M Rae, Megan E Rollo. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 04.11.2016.)