Title:
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A novel method of nutritional assessment in school age children : its design, development and performance relative to a more established technique
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Background: Obesity and overweight are increasing problems to the health of
Western populations, both in adults and children. Overweight or obesity in childhood are
predictors of obesity and various chronic diseases in adulthood. Constituents of the diet,
in particular dietary energy intake, are at least part of the reason for this, so the
measurement of childhood diet has considerable public health importance. However, the
assessment of children's diets is usually costly and often inaccurate.
Aims: This PhD involved the design, development and testing of a novel website
method of assessment of dietary energy and macronutrient intake for school-age
children, with the aim of maximising participation and completion rates, while keeping
costs lower than those associated with paper-and-ink survey techniques, such as food
diaries. The results from this new method were tested for their agreement with the
results obtained from a 5-day food diary used in the same subjects.
Methods: Participants were 164 children aged 9-10 years from a range of schools in
the North East of England. The website's content was based on recent evidence of
important sources of energy in this age group, and its design was informed by research
into children's memory and reporting of foods and drinks. Colour photographs of a
range of foods were provided on a website, selected from keyage-specific references
and refined during a pilot study, along with time-cued questions regarding their usual
diet. A computer database automatically compiled and coded each child's responses, in
order to produce an estimate of mean daily energy and macronutrient intakes. The food
diary was adapted from an existing tool which has been used previously in similar
participants, and mean daily nutrient intake calculations were made using the same
database as the website. The two methods were compared in their calculated mean daily
energy and macronutrient intakes, and their relative cost of use.
Results: 154 children completed both the website and the diary in full. Significant
correlations were found between the two methods' ranking of mean daily energy and
macro nutrients intakes (r=0.193 p<0.05, to r=0.230 p<0.01). However, this did not reach
the levels of correlation identified as adequate to make the new tool useful in public
health research, i.e. correlation above r=0.5, more than 50% agreement on tertiles of
intake, and weighted kappa greater than k=O.4. The mean daily energy intakes reported
to the website and the diary were 14.46MJ and 6.04MJ respectively. Bland-Altman
(difference) plots and limits of agreement modelling revealed systematic under-reporting
to the website at lower levels of intake of all nutrients, and over-reporting at high levels,
when compared with the diary. Analysis of sources of energy showed closer correlation
between the two techniques (r=0.245 to 0.351, all p
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