Measuring energy, macro and micronutrient intake in UK children and adolescents: a comparison of validated dietary assessment tools

Linda A Bush; Jayne Hutchinson; Jozef Hooson; Marisol Warthon-Medina; Neil Hancock; Katharine Greathead; Bethany Knowles; Elisa J Vargas-Garcia; Lauren E Gibson; Barrie Margetts; Sian Robinson; Andy Ness; Nisreen A Alwan; Petra A Wark; Mark Roe; Paul Finglas; Toni Steer; Polly Page; Laura Johnson; Katharine Roberts; Birdem Amoutzopoulos; Darren C Greenwood; Janet E Cade

doi:10.1186/s40795-019-0312-9

Measuring energy, macro and micronutrient intake in UK children and adolescents: a comparison of validated dietary assessment tools

BMC Nutr. 2019 Nov 21:5:53. doi: 10.1186/s40795-019-0312-9. eCollection 2019.

Authors

Linda A Bush¹, Jayne Hutchinson¹, Jozef Hooson¹, Marisol Warthon-Medina^{1

2

3}, Neil Hancock¹, Katharine Greathead¹, Bethany Knowles¹, Elisa J Vargas-Garcia¹, Lauren E Gibson¹, Barrie Margetts⁴, Sian Robinson^{5

6}, Andy Ness⁷, Nisreen A Alwan^{4

8}, Petra A Wark^{9

10}, Mark Roe^{2

3}, Paul Finglas^{2

3}, Toni Steer¹¹, Polly Page¹¹, Laura Johnson^{12

11}, Katharine Roberts^{13

14}, Birdem Amoutzopoulos¹¹, Darren C Greenwood¹⁵, Janet E Cade¹

Affiliations

¹ 1Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, LS2, 9JT, Leeds, UK.
² 2Quadram Institute Bioscience, Norwich, NR4 7UA UK.
³ 3EuroFIR AISBL, 40 Rue Washington, 1050 Brussels, Belgium.
⁴ School of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD UK.
⁵ 5NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK.
⁶ 6National Institute of Health (NIHR) Bristol Biomedical Research Centre, Nutrition Theme, University, Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, BS2 8AE UK.
⁷ 7NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital, Southampton NHS Foundation Trust, Southampton, UK.
⁸ 8Centre for Innovative Research Across the Life Course (CIRAL), Faculty of Health and Life Sciences, Coventry University, Coventry, CV1 5FB UK.
⁹ 9Global eHealth Unit, Department of Primary Care and Public Health, Imperial College London, London, SW7 2AZ UK.
¹⁰ 10AGE Research Group, Newcastle University, Newcastle, UK.
¹¹ 11MRC Elsie Widdowson Laboratory, Cambridge, CB1 9NL UK.
¹² 12Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, BS8 1TH UK.
¹³ 13Public Health Section, School of Health and Related Research (ScHARR), University of Sheffield, S10 2TN, Sheffield, UK.
¹⁴ 14Public Health England, London, SE1 8UG UK.
¹⁵ 15Faculty of Medicine and Health, Division of Biostatistics, University of Leeds, Leeds, LS2 9JT UK.

Abstract

Background: Measuring dietary intake in children and adolescents can be challenging due to misreporting, difficulties in establishing portion size and reliance on recording dietary data via proxy reporters. The aim of this review was to present results from a recent systematic review of reviews reporting and comparing validated dietary assessment tools used in younger populations in the UK.

Methods: Validation data for dietary assessment tools used in younger populations (≤18 years) were extracted and summarised using results from a systematic review of reviews of validated dietary assessment tools. Mean differences and Bland-Altman limits of agreement (LOA) between the test and reference tool were extracted or calculated and compared for energy, macronutrients and micronutrients.

Results: Seventeen studies which reported validation of 14 dietary assessment tools (DATs) were identified with relevant nutrition information. The most commonly validated nutrients were energy, carbohydrate, protein, fat, calcium, iron, folate and vitamin C. There were no validated DATs reporting assessment of zinc, iodine or selenium intake. The most frequently used reference method was the weighed food diary, followed by doubly labelled water and 24 h recall. Summary plots were created to facilitate comparison between tools. On average, the test tools reported higher mean intakes than the reference methods with some studies consistently reporting wide LOA. Out of the 14 DATs, absolute values for LOA and mean difference were obtained for 11 DATs for EI. From the 24 validation results assessing EI, 16 (67%) reported higher mean intakes than the reference. Of the seven (29%) validation studies using doubly labelled water (DLW) as the reference, results for the test DATs were not substantially better or worse than those using other reference measures. Further information on the studies from this review is available on the www.nutritools.org website.

Conclusions: Validated dietary assessment tools for use with children and adolescents in the UK have been identified and compared. Whilst tools are generally validated for macronutrient intakes, micronutrients are poorly evaluated. Validation studies that include estimates of zinc, selenium, dietary fibre, sugars and sodium are needed.

Keywords: Dietary assessment; Macronutrients; Mean difference, limits of agreement; Micronutrients; Validation.

Grants and funding

MR/L02019X/1/MRC_/Medical Research Council/United Kingdom