Assessing the Initial Validity of the PortionSize App to Estimate Dietary Intake Among Adults: Pilot and Feasibility App Validation Study

Abstract

Background Accurately assessing dietary intake can promote improved nutrition. The PortionSize app (Pennington Biomedical Research Center) was designed to quantify and provide real-time feedback on the intake of energy, food groups, saturated fat, and added sugar. Objective This study aimed to assess the preliminary feasibility and validity of estimating food intake via the PortionSize app among adults. Methods A total of 15 adults (aged 18-65 years) were recruited and trained to quantify the food intake from a simulated meal by using PortionSize. Trained personnel prepared 15 simulated meals and covertly weighed (weigh back) the amount of food provided to participants as well as food waste. Equivalence tests (±25% bounds) were performed to compare PortionSize to the weigh back method. Results Participants were aged a mean of 28 (SD 12) years, and 11 were female. The mean energy intake estimated with PortionSize was 742.9 (SD 328.2) kcal, and that estimated via weigh back was 659.3 (SD 190.7) kcal (energy intake difference: mean 83.5, SD 287.5 kcal). The methods were not equivalent in estimating energy intake (P=.18), and PortionSize overestimated energy intake by 83.5 kcal (12.7%) at the meal level. Estimates of portion sizes (gram weight; P=.01), total sugar (P=.049), fruit servings (P=.01), and dairy servings (P=.047) from PortionSize were equivalent to those estimated via weigh back. PortionSize was not equivalent to weigh back with regard to estimates for carbohydrate (P=.10), fat (P=.32), vegetable (P=.37), grain (P=.31), and protein servings (P=.87). Conclusions Due to power limitations, the equivalence tests had large equivalence bounds. Though preliminary, the results of this small pilot study warrant the further adaptation, development, and validation of PortionSize as a means to estimate energy intake and provide users with real-time and actionable dietary feedback.

An Overview of Traditional and Novel Tools to Assess Diet

“…Therefore, technology-assisted methods still rely on the user or a trained reviewer to complete the food record. For example, using a mobile app, like the PortionSize app, 11 an individual can capture images of their food and then the individual can identify the food and estimate the food volume, or the images can be sent to a trained reviewer for further analysis using a validated method like the Remote Food Photography Method (RFPM). 11,12 The Automated Self-Administered 24-Hour (ASA24®) Dietary Assessment Tool is another technology-assisted food record which is freely available online and is a web-based tool.…”

“…For example, using a mobile app, like the PortionSize app, 11 an individual can capture images of their food and then the individual can identify the food and estimate the food volume, or the images can be sent to a trained reviewer for further analysis using a validated method like the Remote Food Photography Method (RFPM). 11,12 The Automated Self-Administered 24-Hour (ASA24®) Dietary Assessment Tool is another technology-assisted food record which is freely available online and is a web-based tool. 13 Strengths of technology-based and technology-assisted food records are they may help to reduce the costs of collecting food records, reduce the user and researcher burden for completing and analyzing foods records, and may improve the efficiency and accuracy of dietary assessment.…”