Anthropometry involves the external measurement of morphological traits of human beings. It has a widespread and important place in nutritional assessment, and while the literature on anthropometric measurement and its interpretation is enormous, the extent to which measurement error can influence both measurement and interpretation of nutritional status is little considered. In this article, different types of anthropometric measurement error are reviewed, ways of estimating measurement error are critically evaluated, guidelines for acceptable error presented, and ways in which measures of error can be used to improve the interpretation of anthropometric nutritional status discussed. Possible errors are of two sorts; those that are associated with: (1) repeated measures giving the same value (unreliability, imprecision, undependability); and (2) measurements departing from true values (inaccuracy, bias). Imprecision is due largely to observer error, and is the most commonly used measure of anthropometric measurement error. This can be estimated by carrying out repeated anthropometric measures on the same subjects and calculating one or more of the following: technical error of measurement (TEM); percentage TEM, coefficient of reliability (R), and intraclass correlation coefficient. The first three of these measures are mathematically interrelated. Targets for training in anthropometry are at present far from perfect, and further work is needed in developing appropriate protocols for nutritional anthropometry training. Acceptable levels of measurement error are difficult to ascertain because TEM is age dependent, and the value is also related to the anthropometric characteristics of the group or population under investigation. R > 0·95 should be sought where possible, and reference values of maximum acceptable TEM at set levels of R using published data from the combined National Health and Nutrition Examination Surveys I and II (Frisancho, 1990) are given. There is a clear hierarchy in the precision of different nutritional anthropometric measures, with weight and height being most precise. Waist and hip circumference show strong between-observer differences, and should, where possible, be carried out by one observer. Skinfolds can be associated with such large measurement error that interpretation is problematic. Ways are described in which measurement error can be used to assess the probability that differences in anthropometric measures across time within individuals are due to factors other than imprecision. Anthropometry is an important tool for nutritional assessment, and the techniques reported here should allow increased precision of measurement, and improved interpretation of anthropometric data.

Background: Information on dietary intake provides some of the most valuable insights for mounting intervention programmes for the prevention of chronic diseases. With the growing concern about adolescent overweight, the need to accurately measure diet becomes imperative. Assessment among adolescents is problematic as this group has irregular eating patterns and they have less enthusiasm for recording food intake. Subjects/Methods: We used qualitative and quantitative techniques among adolescents to assess their preferences for dietary assessment methods. Results: Dietary assessment methods using technology, for example, a personal digital assistant (PDA) or a disposable camera, were preferred over the pen and paper food record. Conclusions: There was a strong preference for using methods that incorporate technology such as capturing images of food. This suggests that for adolescents, dietary methods that incorporate technology may improve cooperation and accuracy. Current computing technology includes higher resolution images, improved memory capacity and faster processors that allow small mobile devices to process information not previously possible. Our goal is to develop, implement and evaluate a mobile device (for example, PDA, mobile phone) food record that will translate to an accurate account of daily food and nutrient intake among adolescents. This mobile computing device will include digital images, a nutrient database and image analysis for identification and quantification of food consumption. Mobile computing devices provide a unique vehicle for collecting dietary information that reduces the burden on record keepers. Images of food can be marked with a variety of input methods that link the item for image processing and analysis to estimate the amount of food. Images before and after the foods are eaten can estimate the amount of food consumed. The initial stages and potential of this project will be described.

BackgroundEarly adulthood represents the transition to independent living which is a period when changes in diet and body weight are likely to occur. This presents an ideal time for health interventions to reduce the effect of health problems and risk factors for chronic disease in later life. As young adults are high users of mobile devices, interventions that use this technology may improve engagement. The Connecting Health and Technology study aimed to evaluate the effectiveness of tailored dietary feedback and weekly text messaging to improve dietary intake of fruit, vegetables and junk food over 6 months among a population-based sample of men and women (aged 18–30 years).MethodsA three-arm, parallel, randomized control trial was conducted. After baseline assessments, participants were randomized to one of three groups: A) dietary feedback and weekly text messages, B) dietary feedback only or C) control group. Dietary intake was assessed using a mobile food record App (mFR) where participants captured images of foods and beverages consumed over 4-days at baseline and post-intervention. The primary outcomes were changes in serves of fruits, vegetables, energy-dense nutrient-poor (EDNP) foods and sugar-sweetened beverages (SSB). The intervention effects were assessed using linear mixed effect models for change in food group serves.ResultsYoung adults (n = 247) were randomized to group A (n = 82), group B (n = 83), or group C (n = 82). Overall, no changes in food group serves for either intervention groups were observed. An unanticipated outcome was a mean weight reduction of 1.7 kg (P = .02) among the dietary feedback only. Men who received dietary feedback only, significantly reduced their serves of EDNP foods by a mean of 1.4 serves/day (P = .02). Women who received dietary feedback only significantly reduced their intake of SSB (P = .04) by an average of 0.2 serves/day compared with controls.ConclusionsTailored dietary feedback only resulted in a decrease in EDNP foods in men and SSB in women, together with a reduction in body weight. Using a mobile food record for dietary assessment and tailored feedback has great potential for future health promotion interventions targeting diet and weight in young adults.Trial RegistrationAustralian Clinical Trials Registry Registration number: ACTRN12612000250831.

For nutrition practitioners and researchers, assessing dietary intake of children and adults with a high level of accuracy continues to be a challenge. Developments in mobile technologies have created a role for images in the assessment of dietary intake. The objective of this review was to examine peer-reviewed published papers covering development, evaluation and/or validation of image-assisted or image-based dietary assessment methods from December 2013 to January 2016. Images taken with handheld devices or wearable cameras have been used to assist traditional dietary assessment methods for portion size estimations made by dietitians (image-assisted methods). Image-assisted approaches can supplement either dietary records or 24-h dietary recalls. In recent years, image-based approaches integrating application technology for mobile devices have been developed (image-based methods). Image-based approaches aim at capturing all eating occasions by images as the primary record of dietary intake, and therefore follow the methodology of food records. The present paper reviews several image-assisted and image-based methods, their benefits and challenges; followed by details on an image-based mobile food record. Mobile technology offers a wide range of feasible options for dietary assessment, which are easier to incorporate into daily routines. The presented studies illustrate that image-assisted methods can improve the accuracy of conventional dietary assessment methods by adding eating occasion detail via pictures captured by an individual (dynamic images). All of the studies reduced underreporting with the help of images compared with results with traditional assessment methods. Studies with larger sample sizes are needed to better delineate attributes with regards to age of user, degree of error and cost.

It is considered that skeletal mass in humans may respond to loading or the number of loading cycles. The aim of this study was to examine the effect of a 1 year progressive resistance training program on the bone mass of 56 postmenopausal women. Assignment was by block randomization to one of two resistance training groups: a strength trained group (3 x 8 repetition maximum) or an endurance group (3 x 20 repetition maximum). The resistance exercises were selected to stress the ipsilateral forearm and hip region. The exercising side was randomly assigned with one side exercised while the alternate side acted as the nonexercise control. Bone mineral density (BMD) was measured every 3 months at the radial forearm and four hip sites using the Hologic QDR 2000 bone densitometer. A linear regression function was fitted for each individual's bone density results, and the slope was compared for the exercise and control side using paired t-tests. The bone mass increase with the strength regimen was significantly greater at the trochanteric hip site (control -0.6 +/- 2.2%, exercise 1.7 +/- 4.1%, p < 0.01), at the intertrochanteric hip site (control -0.1 +/- 2.1%, exercise 1.5 +/- 3.0%, p < 0.05), Ward's triangle (control 0.8 +/- 5.2%, exercise 2.3 +/- 4.0%, p < 0.05), and at the ultradistal radial site (control -1.4 +/- 2.3%, exercise 2.4 +/- 4.3%, p < 0.01). There was no significant increase in BMD with the endurance regimen except at the radius midsite (control -1.0 +/- 2.3%, exercise 0.1 +/- 1.4%, p < 0.01). In both the endurance and the strength group, muscle strength, tested by a one-repetition maximum (1RM) test, increased significantly for all 10 exercises (p < 0.01) and to a similar degree in the two groups. In the strength group but not the endurance group there were significant correlations between the slope of the change in BMD and the percentage increase in strength as follows: trochanter with leg press; intertrochanter with leg press (p < 0.05); and Ward's triangle with hip extension and hip adduction (p < 0.05). Thus these results support the notion of a site-specific response of bone to maximal loading from resistance exercise in that although the trochanter and intertrochanter bone density was elevated by the resistance exercises undertaken, there was no effect on the femoral neck value. Postmenopausal bone mass can be significantly increased by a strength regimen that uses high-load low repetitions but not by an endurance regimen that uses low-load high repetitions. We conclude that the peak load is more important than the number of loading cycles in increasing bone mass in early postmenopausal women.

Mobile telephones with an integrated camera can provide a unique mechanism for collecting dietary information that reduces burden on record keepers. Objectives for this study were: (1) to test whether participant's proficiency with the mobile telephone food record (mpFR) improved after training and repeated use, and (2) to measure changes in perceptions regarding use of the mpFR after training and repeated use. Seventy-eight adolescents (26 males, 52 females) ages 11–18 y were recruited to use the mpFR for one or two meals. Proficiency with the mpFR was defined as capturing a useful image for image analysis and self-reported ease of use. Positive changes in perceptions regarding use of the mpFR were assumed to equate to potentially improved proficiency with the mpFR. Participants received instruction for using the mpFR prior to their first meal, and captured an image of their meals before and after eating. Following the first meal, participants took part in an interactive session where they received additional training on capturing images in various snacking situations and responded to questions about user preferences. Changes in the participants' abilities to capture useful images and perceptions about the usability of the mpFR were examined using McNemar, Wilcoxon rank-sum test, and paired t-test. After using the mpFR, the majority of participants (79%) agreed that the software was easy to use. Eleven percent of participants agreed taking images before snacking would be easy. After additional training, the percent increased significantly to 32% (p<.0001). For taking images after snacking, there was also improvement (21% before training and 43% after, p<.0001). Adolescents readily adopt new technologies; however the mpFR design needs to accommodate the lifestyles of its users to ensure useful images and continuous use. Further, these results suggest that additional training in using a new technology may improve the accuracy among users.

The influence of urinary sodium excretion and dietary calcium intake was examined in a 2-y longitudinal study of bone density in 124 women postmenopausal for > 10 y. Analysis of bone density changes showed that urinary sodium excretion was negatively correlated with changes in bone density at the intertrochanteric and total hip sites. Multiple-regression analysis of dietary calcium intake and urine sodium excretion on the change in bone density showed that both dietary calcium and urinary sodium excretion were significant determinants of the change in bone mass over 2 y at the hip and ankle sites. These data suggest that an effect of reducing bone loss equivalent to that achieved by a daily dietary increase of 891 mg (22 mmol) Ca can also be achieved by halving daily sodium excretion. No bone loss occurred at the total hip site at a calcium intake of 1768 mg/d (44 mmol/d) or a urine sodium excretion of 2110 mg/d (92 mmol/d). We report a significant effect of sodium excretion on bone loss in this population.

BackgroundThe development of a mobile telephone food record has the potential to ameliorate much of the burden associated with current methods of dietary assessment. When using the mobile telephone food record, respondents capture an image of their foods and beverages before and after eating. Methods of image analysis and volume estimation allow for automatic identification and volume estimation of foods. To obtain a suitable image, all foods and beverages and a fiducial marker must be included in the image.ObjectiveTo evaluate a defined set of skills among adolescents and adults when using the mobile telephone food record to capture images and to compare the perceptions and preferences between adults and adolescents regarding their use of the mobile telephone food record.MethodsWe recruited 135 volunteers (78 adolescents, 57 adults) to use the mobile telephone food record for one or two meals under controlled conditions. Volunteers received instruction for using the mobile telephone food record prior to their first meal, captured images of foods and beverages before and after eating, and participated in a feedback session. We used chi-square for comparisons of the set of skills, preferences, and perceptions between the adults and adolescents, and McNemar test for comparisons within the adolescents and adults.ResultsAdults were more likely than adolescents to include all foods and beverages in the before and after images, but both age groups had difficulty including the entire fiducial marker. Compared with adolescents, significantly more adults had to capture more than one image before (38% vs 58%, P = .03) and after (25% vs 50%, P = .008) meal session 1 to obtain a suitable image. Despite being less efficient when using the mobile telephone food record, adults were more likely than adolescents to perceive remembering to capture images as easy (P < .001).ConclusionsA majority of both age groups were able to follow the defined set of skills; however, adults were less efficient when using the mobile telephone food record. Additional interactive training will likely be necessary for all users to provide extra practice in capturing images before entering a free-living situation. These results will inform age-specific development of the mobile telephone food record that may translate to a more accurate method of dietary assessment.