Validity of Energy Intake Estimated by Digital Photography Plus Recall in Overweight and Obese Young Adults

BackgroundRecent reports have questioned the adequacy of self-report measures of dietary intake as the basis for scientific conclusions regarding the associations of dietary intake and health, and reports have recommended the development and evaluation of better methods for the assessment of dietary intake in free-living individuals. We developed a procedure that used pre- and post-meal digital photographs in combination with dietary recalls (DP+R) to assess energy intake during ad libitum eating in a cafeteria setting.ObjectiveTo compare mean daily energy intake of overweight and obese young adults assessed by a DP+R method with mean total daily energy expenditure assessed by doubly labeled water (TDEEDLW).MethodsEnergy intake was assessed using the DP+R method in 91 overweight and obese young adults (age = 22.9±3.2 years, body mass index [BMI; calculated as kg/m2]=31.2±5.6, female=49%) over 7 days of ad libitum eating in a university cafeteria. Foods consumed outside the cafeteria (ie, snacks, non-cafeteria meals) were assessed using multiple-pass recall procedures, using food models and standardized, neutral probing questions. TDEEDLW was assessed in all participants over the 14-day period.ResultsThe mean energy intakes estimated by DP+R and TDEEDLW were not significantly different (DP+R=2912±661 kcal/d; TDEEDLW=2849±748 kcal/d, P=0.42). The DP+R method overestimated TDEEDLW by 63±750 kcal/d (6.8±28%).ConclusionResults suggest that the DP+R method provides estimates of energy intake comparable to those obtained by TDEEDLW.