The validation of a computer-based food record for older adults: the Novel Assessment of Nutrition and Ageing (NANA) method

Abstract

Dietary assessment in older adults can be challenging. The Novel Assessment of Nutrition and Ageing (NANA) method is a touch-screen computer-based food record that enables older adults to record their dietary intakes. The objective of the present study was to assess the relative validity of the NANA method for dietary assessment in older adults. For this purpose, three studies were conducted in which a total of ninety-four older adults (aged 65 -89 years) used the NANA method of dietary assessment. On a separate occasion, participants completed a 4 d estimated food diary. Blood and 24 h urine samples were also collected from seventy-six of the volunteers for the analysis of biomarkers of nutrient intake. The results from all the three studies were combined, and nutrient intake data collected using the NANA method were compared against the 4 d estimated food diary and biomarkers of nutrient intake. Bland-Altman analysis showed a reasonable agreement between the dietary assessment methods for energy and macronutrient intake; however, there were small, but significant, differences for energy and protein intake, reflecting the tendency for the NANA method to record marginally lower energy intakes. Significant positive correlations were observed between urinary urea and dietary protein intake using both the NANA and the 4 d estimated food diary methods, and between plasma ascorbic acid and dietary vitamin C intake using the NANA method. The results demonstrate the feasibility of computer-based dietary assessment in older adults, and suggest that the NANA method is comparable to the 4 d estimated food diary, and could be used as an alternative to the food diary for the short-term assessment of an individual's dietary intake.

Validation of a Tablet Application for Assessing Dietary Intakes Compared with the Measured Food Intake/Food Waste Method in Military Personnel Consuming Field Rations

“…This indicates that the tablet app is suitable for accurately estimating intakes at an individual level. Our finding of narrow LOA is consistent with the results by Timon et al [26] but in contrast to studies comparing either a smartphone app or a Personal Digital Assistant (PDA) with 24-h recall [15,19,29]. As suggested by the authors of these latter studies, this could be possibly due to measurement errors found in the reference measure (24-h recall), which itself is not a measure of absolute intakes as it is not representative of habitual intakes and is prone to recall bias and misreporting [19], whereas we were able to measure absolute food intake with our use of the current gold standard (measured food intake/food waste method).…”

“…These correlations compared favourably with results from other validation studies of technology-assisted dietary assessment methodologies [13,15,19,26,27]. Carter et al [19] compared a smartphone app with 24-h recalls and found correlations ranging from 0.63 to 0.83, which are quite a bit lower than those seen in our study.…”

A comparison of food portion size estimation by older adults, young adults and nutritionists

“…This study also suggests that nutritionists may provide more accurate estimates of portion size with less variance in the estimates by nutritionists compared to younger and older adults. In terms of the development of the NANA system, it was concluded that higher accuracy would be achieved by a nutritionist making portion size assessment from a photograph of a meal and this was incorporated into the design of the system (17,18). These results support the recent developments in dietary assessment and technology which have shown that taking the onus of portion size estimation off the individual and putting it on a trained researcher yields accurate results compared to weighed methods of dietary assessment (13,14).…”

“…The results of this project were used to inform the development of the dietary component of a computer based assessment tool for older adults, i.e. the "NANA" (Novel Assessment of Nutrition and Ageing) system (17,18). In terms of the portion size assessment component of the NANA system, two possible strategies for assessing portion size were considered.…”

Popular Nutrition-Related Mobile Apps: An Agreement Assessment Against a UK Reference Method (Preprint)

“…Whereas previous studies have compared user with professional entry of the same record [9], or user with professional entry of records taken on separate occasions [17], this study eliminated the biases associated with user entry, (e.g. selection of appropriate food item, estimation of portion size [13]).…”