Development and validation of objective, passive, dietary assessment method for estimating food and nutrient intake in households in low and middle-income countries (LMICs): a study protocol

Abstract

BACKGROUND: Undernutrition is a major concern in low- and middle-income countries (LMICs), but the full extent of the problem remains unknown largely due to the lack of accurate assessment methods. OBJECTIVE: This study seeks to develop and validate an objective, passive method of estimating food and nutrient intake in households in Ghana and Uganda, to increase the understanding of the extent of undernutrition. METHODS: A combination of camera devices are used to capture image and sensor data around food intake and related activities. Foodcam, a fixed camera device, is mounted in a household’s cooking area to take images of food preparation. Household members (including under-5s and adolescents) are assigned a wearable camera device to capture images of food acquisition and consumption during waking hours. Depending on the circumstance (e.g. breast/spoon-fed infants) and preference of the individual, the devices used are: eHAT – a hat with a camera attached to its visor, AIM (Automatic Ingestion Monitor) – an eyeglass with a camera attached to its frame, eButton – a button-like device with a front facing camera, or an ear-worn device with a frontal camera worn on the ear. Using custom software, images captured by the devices are time-stamped, annotated for activities such as shopping, cooking and eating, and assessed for food and nutrient (protein, fat, carbohydrate, energy and micronutrients) intake. The devices are assessed for functionality, acceptability, and relative validity compared to weighed food records in studies in London, Ghana and Uganda. DISCUSSION: Passive food image capture and assessment provides an objective measure of food and nutrient intake in real-time, minimizing some of the limitations associated with self-24 reported methods. Its use in LMICs could potentially increase the understanding of population’s nutritional status, and the contribution of household food intake to the malnutrition burden.