• Energy Research

Image-based dietary records have limited evidence evaluating their performance and use among adults with a chronic disease. This study evaluated the performance of a 3-day mobile phone image-based dietary record, the Nutricam Dietary Assessment Method (NuDAM), in adults with type 2 diabetes mellitus (T2DM). Criterion validity was determined by comparing energy intake (EI) with total energy expenditure (TEE) measured by the doubly-labelled water technique. Relative validity was established by comparison to a weighed food record (WFR). Inter-rater reliability was assessed by comparing estimates of intake from three dietitians. Ten adults (6 males, age: 61.2 ± 6.9 years old, BMI: 31.0 ± 4.5 kg/m2) participated. Compared to TEE, mean EI (MJ/day) was significantly under-reported using both methods, with a mean ratio of EI:TEE 0.76 ± 0.20 for the NuDAM and 0.76 ± 0.17 for the WFR. Correlations between the NuDAM and WFR were mostly moderate for energy (r = 0.57), carbohydrate (g/day) (r = 0.63, p < 0.05), protein (g/day) (r = 0.78, p < 0.01) and alcohol (g/day) (rs = 0.85, p < 0.01), with a weaker relationship for fat (g/day) (r = 0.24). Agreement between dietitians for nutrient intake for the 3-day NuDAM (Intra-class Correlation Coefficient (ICC) = 0.77–0.99) was lower when compared with the 3-day WFR (ICC = 0.82–0.99). These findings demonstrate the performance and feasibility of the NuDAM to assess energy and macronutrient intake in a small sample. Some modifications to the NuDAM could improve efficiency and an evaluation in a larger group of adults with T2DM is required.

AbstractBackgroundPrimary healthcare dietitians have a vital role to play in the prevention and management of chronic disease. Working in primary care requires efficient and effective management of practice to ensure client and practitioner needs are met. The present study aimed to explore the way in which primary care dietitians in Australia view the constructs of efficiency and effectiveness within the context of their practice.MethodsThe study used an exploratory qualitative design within a pragmatist framework. Individual semi‐structured telephone interviews were conducted with Australian primary care dietitians. All interviews were audio‐recorded, transcribed verbatim and analysed using an inductive thematic approach.ResultsTwenty dietitians (17 females) working as private practitioners in primary care from three Australian states participated in the present study. Three themes emerged from the data. The first theme revealed that seeking efficiency and especially effectiveness were important to primary care dietitians and that there was a tension between the two. The second theme identified that efficiency and effectiveness are influenced by personal and structural factors. The final theme explored how dietitians are actively seeking ways to be more efficient and effective, including supportive networks, as well as the utilisation of technology.ConclusionsAchieving a balance between efficiency and effectiveness in primary care dietetics is challenging to practitioners, who may require further training and support to enhance productivity, time management and resource utilisation. Structured issues exist for the workface. Further studies are required to quantify these findings and to explore whether it is possible to optimise efficiency and effectiveness and achieve sustainability of the dietetic workforce in primary care.

Assessing energy intake (EI) in children and adolescents is essential for monitoring population nutrition trends and interpreting clinical outcomes. The aim of this review was to examine the validity of dietary assessment methods for estimating EI in children and adolescents when compared with total energy expenditure (TEE) measured using doubly labelled water (DLW). Six online databases were searched to identify articles published in English. Studies were included if they were conducted in participants aged ≤18 years, if they estimated EI via a dietary assessment method, and if they compared this estimate to TEE measured using the DLW method. The search strategy identified 345 articles, of which 13 articles (12 studies) (n = 306 children) met the selection criteria. Five studies were carried out in children aged 5-11 years with dietary intake of children reported by parents/caregivers. The most common dietary assessment methods used were food frequency questionnaires (n = 5) and weighed food records (n = 4). All methods were found to have some level of misreporting. Child characteristics including weight status, age, and sex were not found to consistently influence the accuracy of reported EI. Five studies employing technology-assisted approaches for assessing dietary intake in children were identified and reported mixed findings. Validity studies using DLW remain sparse in the literature. Studies including participants less than 5 years or older than 11 years, and from diverse ethnicities and socioeconomic backgrounds are warranted to explore other demographic differences that may affect the accuracy of dietary assessment methods. While reported in few studies, technology-assisted methods were found to perform equally well in estimating intakes when compared to DLW and other traditional forms of dietary assessment.