The validation of a novel dietary assessment method in ... · Validation of a novel dietary...

Validation of a novel dietary assessment method in older adults

Claire Timon, Human Nutrition Unit, The University of Sheffield, UK

Supervisors: Dr Liz Williams and Dr Margo Barker

• Heterogeneity

• Memory

• Cognition

• Physiological changes

• Involvement in food preparation

Challenges of dietary assessment in Older Adults

Aim : To investigate the application of technology to

improve dietary assessment in older adults

Novel Assessment of Nutrition and Ageing - The NANA Project

• Focus groups with nutritionists, older adults, healthcare professionals to inform the conceptual and physical design

• User centred designed

• Technology exploration with older adults

- Digital cameras, mobile phones, laptops.

• Touchscreen computer was the most appropriate

Development of the NANA system

The “NANA homestation”

Web camera

“Eeetop” touch screen

computer

Speaker for voice recording

Plate guide mat

Software

Select meal

Select choose a food or drink

Select food/ drink category

Select food/ drink item

Cranberry juice

Cranberry juice

Select another food / drink category

Select another food/ drink item

Selected items

Photograph food/ drink item

Photograph food/ drink item

Enjoy your meal

Clinician tool

The validation

Hypothesis : There is no difference between the NANA homestation and an estimated 4 day food diary in reported

dietary intake.

Method

Bland-Altman

Older adult groups, volunteer email, leaflet drop n = 40

Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week 10

• 44 older adults (65 years+) were recruited

• Recorded diet using :

- NANA homestation - 3 weeks

- Estimated food diary - 4 days

- 24 hour Multiple Pass Recalls - 3 days

• Fasted blood and 24 hour urine samples for the analysis of biomarkers of nutrient status

4 days from 2nd week of NANA

4 days of estimated food diary

Average of 24 hour MPRs

• Statistical analysis in SPSS

- Correlation - Pearson and Spearman correlation coefficients

- Difference of mean - Paired t test and Wilcoxon Signed Rank

- Bland Altman analysis

Method

Windiets nutritional software

Study demographics, n = 40

Gender

Female 23 (57.5%)

Male

Age (Mean, SD)

17 (42.5%)

72 years (5.21)

BMI

Mean (SD) 26.38 (4.27)

Underweight 1 (2%)

Normal weight 14 (35%)

Over weight 17 (43%)

Obese 8 (20%)

Results

Demographic characteristics of participants

Nutrient NANA (Mean,

SD)

Estimated Food Diary

(Mean, SD)

Correlation

Coefficients (r)

Significance

Energy (KJ) ‡

7965 (1455.6)

8252 (1774.9)

0.867***

0.022*

Fat (g) †

75.5 (21.28)

79.5 (22.14)

0.849***

0.024*

Carbohydrate (g) ‡

224 (44.6)

227 (44.9)

0.815***

0.495

Protein (g) †

76.0 (13.74)

78.9 (15.14)

0.719***

0.179

Folate (µg) †

278 (82.9)

289 (87.8)

0.456**

0.262

Vitamin C (mg) †

78.8 (37.56)

84.9 (39.05)

0.543***

0.297

Vitamin E (mg) ‡

8.49 (3.459)

8.77 (4.187)

0.359*

0.909

Calcium (mg) ‡

967 (248.9)

988 (253.2)

0.355*

0.973

Iron (mg) ‡

11.6 (3.29)

12.6 (3.22)

0.394*

0.591

Results Correlation coefficients and mean difference test to compare mean daily nutrient intakes recorded by the “NANA homestation” and the food diary.

*= significant at the 0.05 level; ** = significant at the 0.01 level ; *** = significant at the <0.001 level key: †= Pearson correlation coefficient and Paired t test; ‡= Spearman’s correlation coefficient and Wilcoxon signed rank

Energy

• Intakes recorded using the “NANA homestation” were 287 KJ lower than the average reported energy intake reported by the food diary.

Bland-Altman plot for Energy (KJ) Scatterplot for Energy intakes as recorded by the

estimated food diary and the “NANA homestation”

Protein

• Values for protein intake were on average 2.80 grams lower than the protein values

recorded from the food diary.

Scatterplot for protein intakes as recorded by the

estimated food diary and the “NANA homestation”

Bland-Altman plot for Protein (g)

Vitamin C

• Vitamin C intakes recorded by the “NANA homestation” were on average 6.12 grams lower than Vitamin C intakes recorded by the food diary.

Scatterplot for Vitamin C intakes as recorded by the

estimated food diary and the “NANA homestation”

Bland-Altman plot for Vitamin C (mg)

• The “NANA homestation” consistently reported lower intakes than food diary

• Majority of nutrients – no significant differences between 2 methodologies

• The “NANA homestation” is comparable with estimated food diary

• Need to validate against biomarkers of nutrient intake

Conclusion

Acknowledgements

All Participants

Funders Economic & Social Research Council

The NANA team

Liz Williams Faustina Hwang Tim Adlam

Sarah Forster Arlene Astell Lin Maclean

Laura Brown Tom Smith Hassane Khadra

Simon Halsey Daynor Spurr Alan Godfrey

Rebecca Rowland-Jones Sarah Smith

Contact for further information

Dr Liz Williams e.a.williams@sheffield.ac.uk

Claire Timon mdp08ct@sheffield.ac.uk