Validity of the Remote Food Photography Method Against Doubly Labeled Water Among Minority Preschoolers

Theresa Nicklas, Rabab Saab, Noemi G Islam, William Wong, Nancy Butte, Rebecca Schulin, Yan Liu, John W Apolzan, Candice A Myers, Corby K Martin, Theresa Nicklas, Rabab Saab, Noemi G Islam, William Wong, Nancy Butte, Rebecca Schulin, Yan Liu, John W Apolzan, Candice A Myers, Corby K Martin

Abstract

Objective: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Trial registration: ClinicalTrials.gov NCT01725347.

© 2017 The Obesity Society.

Figures

Figure 1
Figure 1
Mean percent error for the 34 participants whose intake was underestimated by the RFPM when compared to the reference doubly labeled water (DLW) method and mean percent error for the 5 participants whose intake was overestimated by the RFPM when compared to the DLW method. †Mean percent error= (RFPM-DLW)/DLW RFPM: Remote Food Photography Method DLW: Double Labeled Water ††Mean Percent Error ± Standard Deviation
Figure 2
Figure 2
A Bland-Altman plot comparing energy intake using the Remote Food Photography Method (RFPM) and total energy expenditure (TEE) measured using the double labeled water (DLW) method in 39 preschool children. The mean difference between the methods was −222 kcal/d with limits of agreement (2 SD) of 316 kcal/d. The regression was: Difference in energy intake (RFPM-DLW) = −517.91+ 0.23 × Mean of (RFPM and DLW), R2= 2.6%, p-value=0.33. RFPM: Remote Food Photography Method DLW: Double Labeled Water UCL: Upper Confidence Limit LCL: Lower Confidence Limit

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