The use of multiple imputation method for the validation of 24-h food recalls by part-time observation of dietary intake in school

Abstract

External validation of food recall over 24 h in schoolchildren is often restricted to eating events in schools and is based on direct observation as the reference method. The aim of this study was to estimate the dietary intake out of school, and consequently the bias in such research design based on only part-time validated food recall, using multiple imputation (MI) conditioned on the information on child age, sex, BMI, family income, parental education and the school attended. The previous-day, web-based questionnaire WebCAAFE, structured as six meals/snacks and thirty-two foods/beverage, was answered by a sample of 7-11-year-old Brazilian schoolchildren (n 602) from five public schools. Food/beverage intake recalled by children was compared with the records provided by trained observers during school meals. Sensitivity analysis was performed with artificial data emulating those recalled by children on WebCAAFE in order to evaluate the impact of both differential and non-differential bias. Estimated bias was within ±30 % interval for 84·4 % of the thirty-two foods/beverages evaluated in WebCAAFE, and half of the latter reached statistical significance (P < 0·05). Rarely (<3 %) consumed dietary items were often under-reported (fish/seafood, vegetable soup, cheese bread, French fries), whereas some of those most frequently reported (meat, bread/biscuits, fruits) showed large overestimation. Compared with the analysis restricted to fully validated data, MI reduced differential bias in sensitivity analysis but the bias still remained large in most cases. MI provided a suitable statistical framework for part-time validation design of dietary intake over six daily eating events.

Validade e reprodutibilidade de questionário baseado na Internet (Web-CAAFE) para avaliação do consumo alimentar de escolares de 7 a 15 anos

“…Essa é uma limitação típica em validações de questionários para escolares que utilizaram a observação direta dos alimentos consumidos na escola como método de referência 2,3,4,5,7,10 . A técnica estatística da imputação múltipla de dados, condicionada a informações de sexo, idade, índice de massa corporal e dados sociodemográficos, é uma alternativa promissora para a estimativa da validade de todas as refeições de recordatórios de 24 horas 19 .…”

Validation of the Online version of the Previous Day Food Questionnaire for schoolchildren

“…The use of multiple imputations, conditioned on information on gender, age, BMI and sociodemographic data, is a promising alternative to estimating the validity of all meals in 24-hour food recalls [22].…”

Development of a mobile application to assess Brazilian schoolchildren's diet: CADE – food consumption at home and at school

“…Systematic reviews published in the last 5 years on the development or validation of technologies (21,23,24) identified twelve studies on the development of technologies to investigate schoolchildren's diet (16,(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39) . Web-based 24-HR is the most frequently applied technology in this age group (27,(30)(31)(32)(33)35,37) , but tools have also been developed that are based on mobile devices such as smartphones and tablets (26,36,38,39) .…”

“…Most of these technologies were developed for North American and European schoolchildren (16,(25)(26)(27)(30)(31)(32)(33)(34)(37)(38)(39) . These systematic reviews found only one technology that was developed and validated in Brazilian schoolchildren, consisting of a qualitative dietary assessment of children aged 7-10 years through a web-based questionnaire on the previous day's diet (28,29) , hindering the accurate estimation of food amount and energy and nutrient intake. We also found an offline mobile app for tablets used in the 2019 Brazilian National Survey on Child Nutrition (ENANI), which investigated dietary intake in children under 5 years of age (40) .…”

“…However, older children are known to have more autonomy over their food intake. So, the children's participation in food intake assessment in the school environment is essential, aspects that have not been investigated in other Brazilian technologies (28,29,(40)(41)(42)(43)(44) . Furthermore, the use of technologies developed for different age groups (41,44) to school-age children is limited.…”