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Assessment of dietary intake in young populations using new approaches and technologies
Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Abstract

Background There is a great need for improved dietary assessment methods that give valid intake data and are more user friendly than traditional methods.

Objectives The aim of this thesis was to develop, implement, and evaluate dietary assessment methods using new approaches and technologies in young populations, and to investigate variables that are important for reporting accuracy. Another aim was to investigate day-of-the-week effects on assessed energy and sugar intakes among children and adolescents.

Methods This thesis is based on data collected as part of four different studies on the implementation of the following dietary assessment methods: the short dietary questionnaire (SDQ), a food record (FR) with either a digital camera or smartphone, and a computer-based 24-hour recall. Young pregnant and non-pregnant women with different weight statuses completed the SDQ. Children with overweight and obesity used digital cameras to complete FRs, and adolescents used the smartphone application FR. Parents of 2‒9-year-old European children completed the computer-based 24-hour recall and the results of sugar intake of the children on weekdays and weekends were analysed. The SDQ was evaluated against doubly labelled water (DLW) and a more extensive food frequency questionnaire (FFQ). The two FRs were evaluated against data from a SenseWear Armband (SWA), and the smartphone FR was further compared to a web-based FR.

Results The new approaches and technologies used in the dietary assessment methods in this thesis captured between 70% and 79% of the energy intake (EI) of children, adolescents and young women, and the ranking according to EI was generally low with all methods. The negative effect on reporting accuracy with increasing BMI/weight status that has been observed previously was confirmed in our studies. In children and adolescents, a weekend day in the FR emerged as a factor that was positively associated with reporting accuracy. Assessed sugar intake in children and adolescents was high in general and highest on weekends, although EI did not differ between weekdays and weekends.

Conclusions FRs using technology should focus on simplifying the recording of consumed foods and amounts to a greater extent, for example, by automatizing these steps as much as possible. The SDQ could be further adapted for testing among other groups than young women, and could be adapted for specific objectives. Factors influencing reporting accuracy need to be taken into consideration and further explored when assessing dietary intake. In order to make it possible to evaluate sugar intake in relation to nutritional recommendations, information about added sugar in foods needs to be incorporated into food composition databases. Further development and research is needed to obtain dietary assessment methods with improved accuracy and user friendliness.

Abstract [sv]

Sammanfattning

Bakgrund Traditionella kostundersökningsmetoder är krävande och har flera felkällor, vilket ofta leder till att energiintaget (EI) från insamlade kostdata är lägre än individens uppmätta totala energiförbrukning (TEE). Det finns ett stort behov av kostundersökningsmetoder som ger valida resultat och är användarvänliga.

Syfte Syftet med avhandlingen var att vidareutveckla kostundersökningsmetoder och att im plementera och utvärdera dem bland barn, ungdomar och unga kvinnor. Syftet var också att undersöka faktorer med betydelse för en korrekt rapportering av kostintaget. Vidare var syftet att undersöka skillnader i EI och intag av socker under vardagar och helger bland barn och ungdomar.

Metod Avhandlingen baseras på data från fyra olika studier där olika nyutvecklade kostundersökningsmetoder användes. I en studie användes en kort kostenkät (SDQ) på unga gravida och icke-gravida kvinnor med olika viktstatus. Rapporterat EI jämförde s med TEE uppmätt med dubbelmärkt vatten-metoden, och rapporterat intag av näringsämnen och livsmedel jämfördes med en mer omfattande kostenkät (FFQ). I en annan studie samlades kostdata in för 2 ‒ 9-åringar från åtta europeiska länder med hjälp av en datoriserad 24-timmars recall som besvarades av föräldrarna. Barnens socker- och energiintag jämfördes mellan måndag ‒ torsdag, fredag och helg. I en tredje studie genomförde 8 ‒ 12-åringar med övervikt eller fetma en kostregistrering med hjälp av digitalkamera vid upprepade tillfällen. I en fjärde studie utvecklades och anvä ndes en smartphoneapplikation för kostregistrering bland 15-åringar, som också använde en webb-baserad kostregistrering. Rapporterat EI med kostregistreringarna utvärderades i jämförelse med TEE mätt med SenseWear Armband, och EI och sockerintag under vardagar och helger undersöktes.

Resultat SDQ underskattade EI med 30 % bland de icke-gravida kvinnorna och en signifikant högre underskattning skedde bland kvinnorna med övervikt eller fetma. SDQ underskattade EI med 21 % bland de gravida kvinnorna. SDQ kunde dock rangordna EI bland kvinnorna med övervikt eller fetma och gav ett högre estimerat intag av flera näringsämnen och de flesta livsmedel jämfört med FFQ bland de icke-gravida kvinnorna. De nyutvecklade kostregistreringsmetoderna underskattade EI bland barn med 24 % och bland ungdomar med 29 %. Digitalkamerametoden visade god reproducerbarhet för de olika mättillfällena bland barn. Smartphoneapplikationen kunde uppskatta ungdomars TEE och pojkars fysiska aktivitetsnivå med en fråga om den dagliga fysiska aktiviteten. Underskattning av EI ökade med BMI och var lägre när en helgdag fanns med i kostregistreringen för både barn och ungdomar. Bland barnen iv underskattades EI mer bland flickor än pojkar och underskattningen ökade med åldern. Det fanns ingen signifikant skillnad i intagsmängd av näringsämnen och livsmedel när de mättes med smartphoneapplikationen jämfört med den webb-baserade kostregistreringen, och flera näringsämnen och livsmedel var signifikant korrelerade mellan de båda metoderna. EI hos barn i Europa skilde sig inte åt mellan vardagar och helger, men det totala intaget av mono- och disackarider och/eller livsmedel med hög andel tillsatt socker eller sackaros var generellt högre på helgerna. Sockerintaget på fredagar var ett mellanting mellan intaget under vardagar och helger hos de europeiska barnen.

Konklusion De nyutvecklade kostundersökningsmetoderna fångade i genomsnitt mellan 70 % och 79 % av EI bland barn, ungdomar och unga kvinnor, och förmågan att rangordna EI var generellt låg med metoderna. Liksom i tidigare studier underskattades EI i högre grad hos de med övervikt/fetma eller högre BMI i alla grupperna, och bland barn och ungdomar framkom att validiteten ökade med en helgdag i kostregistreringen som en ny påverkande faktor. Barns och ungdomars sockerintag var generellt högt och som högst under helgen. Det finns ett stort behov av fortsatt forskning för att förbättra kostundersökningsmetoders validitet och användarvänlighet. För kostregistreringsmetoder som använder sig av teknik bör fokus i vidareutvecklingen vara på att göra det enklare för användaren att registrera konsumerade livsmedel och portionsstorlekar, till exempel genom att automatisera dessa steg i så hög grad som möjligt. SDQ kan anpassas och utvärderas även i andra grupper och för olika syften. Faktorer med betydelse för en korrekt rapportering av kost intaget bör tas i beaktande även fortsättningsvis samt undersökas vidare. För att göra det möjligt att utvärdera intaget av socker i jämförelse med näringsrekommendationer bör information om mängden tillsatt socker i livsmedel inkluderas i livsmedelsdatabaser.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2014. , 72 p.
Keyword [en]
dietary intake, energy, assessment, validity, reproducibility, children, adolescents, women, pregnant, overweight, technology
National Category
Other Social Sciences not elsewhere specified
Research subject
Food and Nutrition
Identifiers
URN: urn:nbn:se:umu:diva-97356ISBN: 978-91-7601-188-1 (print)OAI: oai:DiVA.org:umu-97356DiVA: diva2:772360
Public defence
2015-01-23, Samhällsvetarhuset, Hörsal B, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2014-12-18 Created: 2014-12-16 Last updated: 2015-01-22Bibliographically approved
List of papers
1. Dietary intake assessment in women with different weight and pregnancy status using a short questionnaire
Open this publication in new window or tab >>Dietary intake assessment in women with different weight and pregnancy status using a short questionnaire
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2014 (English)In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 17, no 9, 1939-1948 p.Article in journal (Refereed) Published
Abstract [en]

Objective: First, to evaluate the ability of a short dietary questionnaire (SDQ) to estimate energy intake (EI) on group and individual levels compared with total energy expenditure (TEE) measured by the doubly labelled water method. Second, to compare the SDQ's performance in estimating energy, nutrient and food intakes with a sixty-six-item FFQ used in large-scale Swedish epidemiological research. Design: Cross-sectional. Setting: Umea, Sweden. Subjects: In total, sixty-five non-pregnant women, of whom thirty-one were overweight or obese, and twenty-five pregnant, normal-weight women completed the protocol. Results: On average, the SDQ captured 78% and 79% of absolute TEE in the non-pregnant and pregnant normal-weight women, respectively. Furthermore, the SDQ captured an average of 57% of TEE in the overweight/obese nonpregnant women. The Spearman correlation of EI and TEE was significant in the overweight and obese women only (rho=0.37, 95% CI 0.02, 0.64). There was no significant difference between the SDQ and the more extensive FFQ in the ability to assess EI when compared with TEE. Intakes of most nutrients and foods were significantly higher when assessed with the SDQ compared with the FFQ. Conclusions: A new short dietary questionnaire with an alternative design underestimated EI of non-pregnant and pregnant, overweight and obese women on a group level but was able to rank the overweight/obese women according to EI. Furthermore, the short questionnaire captured as much or more of the energy, nutrient and food intakes of non-pregnant normal-weight and overweight/obese women on the group level as a traditional, more extensive FFQ.

Place, publisher, year, edition, pages
Cambridge University Press, 2014
Keyword
Body weight, Dietary intake, Doubly labelled water, FFQ, Non-pregnant and pregnant women, Validity
National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:umu:diva-92904 (URN)10.1017/S1368980013003042 (DOI)000340166800005 ()
Available from: 2014-09-18 Created: 2014-09-09 Last updated: 2017-12-05Bibliographically approved
2. European children's sugar intake on weekdays versus weekends: the IDEFICS study
Open this publication in new window or tab >>European children's sugar intake on weekdays versus weekends: the IDEFICS study
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2014 (English)In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 68, no 7, 822-828 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To compare the intake of total sugars, foods and drinks rich in added sugar, and energy in children on weekdays (Monday Thursday), Fridays and weekends.

METHODS: Dietary intake (g, kJ, energy %) was assessed using a computerized 24-h recall method in a sample of 2- to 9-year-old children from Belgium, Cyprus, Estonia, Germany, Hungary, Italy, Spain and Sweden who were participating in the IDEFICS baseline study (2007-2008). Analyses were performed in 9497 children by selecting one 24-h recall per child (for comparison of weekdays vs weekends, and Fridays vs weekdays and weekends). Selected stratified analyses were performed by country and age group.

RESULTS: Intake of total sugars exceeded 20 energy % in all countries but one. In the non-stratified analyses, the intakes of total sugars and foods and drinks rich in added sugar were found to be higher on weekends compared with weekdays (both P < 0.001), and intakes on Fridays were a mix between intakes on weekdays and weekends. Energy intake did not differ between weekdays and weekends. Results were somewhat heterogeneous, both across countries and age groups.

CONCLUSIONS: High intake of sugar remains an important nutritional problem in children of many European countries. Interventions aiming to prevent this diet pattern may optimize their impact by targeting dietary habits on Fridays and weekends. Furthermore, when conducting dietary assessment in children, data from weekends and Fridays in combination with a selection of Mondays to Thursdays are needed to capture habitual sugar intake. Age and dietary cultures should also be considered in dietary intervention and assessment as effect modifications were seen for both age and country.

Place, publisher, year, edition, pages
Nature Publishing Group, 2014
Keyword
preschool-children; childhood obesity; nutrient intake; food; determinants; adolescents; overweight; nutrition; cohort; diet
National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:umu:diva-91755 (URN)10.1038/ejcn.2014.87 (DOI)000338598600011 ()
Available from: 2014-08-19 Created: 2014-08-15 Last updated: 2017-12-05Bibliographically approved
3. Overweight and obese children´s ability to report energy intake using digital camera food records during a 2-year study
Open this publication in new window or tab >>Overweight and obese children´s ability to report energy intake using digital camera food records during a 2-year study
2012 (English)In: Journal of Nutrition and Metabolism, ISSN 2090-0724, E-ISSN 2090-0732, no 247389Article in journal (Refereed) Published
National Category
Nutrition and Dietetics
Research subject
Food and Nutrition
Identifiers
urn:nbn:se:umu:diva-43682 (URN)10.1155/2012/247389 (DOI)
Available from: 2011-05-05 Created: 2011-05-05 Last updated: 2017-12-11Bibliographically approved
4. Evaluation of a smartphone application for dietary intake assessment in adolescents
Open this publication in new window or tab >>Evaluation of a smartphone application for dietary intake assessment in adolescents
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Abstract

Objective To develop a smartphone application and evaluate its ability to assess energy intake (EI) and total energy expenditure (TEE) compared with objectively measured TEE. Furthermore, to investigate the impact of factors on reporting accuracy of EI, and to compare dietary intake with a web-based method.

Methods Participants were recruited from year nine in schools in Västra Götaland, Sweden. In total, 81 adolescents used the smartphone application over 1‒6 days. TEE was measured with SenseWear Armband (SWA) during the same or proximate days. Individual factors were assessed with a questionnaire. Fifteen participants also recorded dietary intake using a web-based method.

Results The smartphone application underestimated EI by 29% on group level (P < 0.001), and there was no significant correlation between EI and objectively measured TEE. Accuracy of EI relative to TEE increased with a weekend day in the record (P = 0.007) and lower BMI-z (P = 0.001). TEE assessed with the smartphone application was 1.19 times TEE measured by SWA on group level (P < 0.001), and the correlation between the methods was 0.66 (P < 0.001). Analysis of TEE stratified by gender showed that accuracy of the smartphone application was higher among boys. EI, nutrients and food groups assessed with the smartphone application and web-based method were not significantly different and several were significantly correlated.

Conclusions Using a smartphone dietary assessment application, 71% of EI in adolescents was captured, and BMI-z and a weekend day in the record influenced reporting accuracy. A daily question about physical activity could accurately rank participants according to TEE.

Keyword
adolescents, dietary assessment, smartphone application, energy, SenseWear armband
National Category
Other Social Sciences not elsewhere specified
Research subject
Food and Nutrition
Identifiers
urn:nbn:se:umu:diva-97355 (URN)
Available from: 2014-12-16 Created: 2014-12-16 Last updated: 2014-12-17Bibliographically approved

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