REVIEW

CURRENT
OPINION New approaches in assessing food intake
in epidemiology
Johanna Conrad, Stefanie A.J. Koch, and Ute Nöthlings

Purpose of review
A promising direction for improving dietary intake measurement in epidemiologic studies is the
combination of short-term and long-term dietary assessment methods using statistical methods. Thereby,
web-based instruments are particularly interesting as their application offers several potential advantages
such as self-administration and a shorter completion time. The objective of this review is to provide an
overview of new web-based short-term instruments and to describe their features.
Recent findings
A number of web-based short-term dietary assessment tools for application in different countries and age-
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groups have been developed so far. Particular attention should be paid to the underlying database and the
search function of the tool. Moreover, web-based instruments can improve the estimation of portion sizes by
offering several options to the user.
Summary
Web-based dietary assessment methods are associated with lower costs and reduced burden for
participants and researchers, and show a comparable validity with traditional instruments. When there
is a need for a web-based tool researcher should consider the adaptation of existing tools rather than
developing new instruments. The combination of short-term and long-term instruments seems more feasible
with the use of new technology.
Keywords
24-h dietary recall, dietary assessment, food record, usual dietary intake, web-based methods

INTRODUCTION
A promising direction for improving the estimation
of individual usual dietary intake in epidemiologic
studies is the combination of short-term dietary
assessment methods such as the 24-h dietary recall
(24HDR) and long-term instruments such as the food
frequency questionnaire (FFQ) using statistical meth-
& &&
ods [1,2 ,3 ]. The usual intake of an individual is
derived by multiplying the probability of consuming
a food on a given day with the average amount of
&&
and time expenditure [3 ]. Technological progress
and a significant increase in Internet usage in the past
years have resulted in the development of a number of
innovative technologies for dietary assessment. Web-
based instruments have been developed to mitigate
the challenges faced in dietary assessment. They are of
particular relevance for epidemiologic studies as their
application offers several potential advantages includ-
ing automated data coding, cost-effectiveness associ-
ated with self-administration and reduced participant
& &&

intake of that food on a typical consumption day [4].
Repeated 24HDRs provide information on both the
probability of consumption and the amount con-
sumed, whereas the FFQ can add information on
rarely consumed foods. By applying statistical meth-
ods such as the National Cancer Institute (NCI)
method, the day-to-day variability of an individual’s
intake can be considered by removing the so-called
&
within-person variation from the total variation [5 ].
With traditional interviewer-administered 24HDR
or food records, multiple administrations are rarely
feasible in epidemiologic studies due to high costs
burden [2 ,3 ]. On the one hand, numerous efforts
have been made to transfer 24HDRs or food records to
self-administered online tools [6]. On the other hand,
Department of Nutrition and Food Sciences, Nutritional Epidemiology,
University of Bonn, Bonn, Germany
Correspondence to Dr Johanna Conrad, Department of Nutrition and
Food Sciences, Nutritional Epidemiology, University of Bonn, Endenicher
Allee 11-13, 53115 Bonn, Germany. Tel: +49 228 732068;
fax: +49 228 7360492; e-mail: jconrad@uni-bonn.de
Curr Opin Clin Nutr Metab Care 2018, 21:343–351
DOI:10.1097/MCO.0000000000000497

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Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

Assessment of nutritional and metabolic status
KEY POINTS
 Numerous web-based short-term dietary assessment
instruments including 24-h dietary recalls, food records
and hybrid tools exist to be used in
epidemiologic studies.
 Web-based tools are associated with lower costs and
reduced burden for participants and researchers, and
show a comparable validity with traditional instruments.
 Researchers should consider using existing tools rather
than developing new instruments as most of the tools
can easily be adapted and/or translated to
other databases.
 The recommended combination of repeated
administrations of a short-term instrument and a long-
term instrument seems more feasible with the use of
new technology.
simple online questionnaires with a finite list of food
items have been developed that assess the food intake
&
of the previous 24 h [7,8 ,9]. The latter tools are often
referred to as hybrids due to their similarities with both
FFQs and 24HDRs.
The integration of statistical methods and new
technologies seems feasible as online instruments
can easily be used instead of traditional methods to
estimate the probability of consumption and con-
sumption-day amounts [1]. For example, in the
cross-sectional I.Family study, individual usual die-
tary intakes of various food groups were estimated
based on repeated administrations of the Self-
Administered Children, Adolescents and Adult
Nutrition Assessment system, a web-based 24HDR,
using the NCI method [10,11]. Information from a
FFQ was used as a covariate in all models.
The objective of this article is to review web-
based short-term instruments as being especially
promising for measuring usual dietary intake in
epidemiologic studies, and to describe their features.
Technology-assisted instruments can facilitate the
implementation of a combined use of short-term
and long-term instruments in large-scale studies.
WEB-BASED SYSTEMS TO MEASURE
DIETARY INTAKE
General and specific characteristics of web-based
dietary assessment tools that have been developed
or implemented within the review period are sum-
marized in Tables 1 and 2 ordered by assessment
method. To obtain an overview of the different
instruments, general characteristics were investi-
gated such as the country and language that the
tool has been developed for, available adaptations,
344 www.co-clinicalnutrition.com
Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
target groups and the average completion time
(Table 1). For a detailed description, specific aspects
were compared across instruments including the
database development, options for portion size esti-
mation and validity (Table 2).
General characteristics
Overall, this review identified seven 24HDR
& & &
tools [10,12,14 ,15 ,18,19 ,21], three food records
& &
[22,25,27 ] and two hybrid tools [7,8 ]. All tools
were initially developed for application in Western
countries (nine developed in Europe, one in the USA
and one in Canada). In the United Kingdom, avail-
ability of tools was most diverse. Significantly, a
number of tools were applied in different countries
by adapting the respective language and/or the food
and nutrient database. For example, our group is
currently evaluating and validating the German
adaptation of myfood24 (S.A.J.K., J.C., U.N., unpub-
lished data). This is a desirable development as it
might lead to a more standardized dietary assess-
ment across countries in the future. Seven instru-
ments were developed specifically for adult
populations, one instrument for children and four
instruments for dietary assessment from childhood
to adulthood. For the Riksmaten method, a tool
specifically tailored for adolescents was developed
in addition [26]. The average completion time for
the different tools ranged from 9 min for the 24-h
food list to 45 min for the Compl-eat (iDesign,
Deventer, The Netherlands); of note, latter repre-
sented total login time [9,18]. However, not all
authors reported this information.
All of the tools were developed for self-adminis-
tered application. The myfood24 can also be con-
ducted as interviewer-administered 24HDR [12]. To
mimic the interviewer, all online 24HDR tools fol-
low aspects of the detailed Automated Multiple-Pass
Method (AMPM). Whereas the myfood24 focused
on selected steps of the AMPM (i.e. an optional
quick list, detailed food search, prompts for com-
monly forgotten foods and final review) to reduce
completion time [13], the other tools follow the full
pass. Prompts for commonly forgotten food items
were overall included. Some systems such as the
INTAKE24 or automated self-administered 24-h
(ASA24) dietary recall system also recognize large
time gaps in which no items have been entered
& &
[15 ,19 ]. The INTAKE24 tool in addition imple-
mented a so-called sandwich and salad wizard to
&
assist recording [15 ]. Sandwiches and salads were
found to be often reported incompletely. To reduce
the risk of omissions, the user is asked a series of
questions regarding the single components of the
sandwich or the salad. The NutriNet-Santé tool and
Volume 21  Number 5  September 2018
 Table 1. General characteristics of web-based dietary assessment tools available for use in epidemiologic studiesa

Average
Region Adaptation/ Administration completion Demo
Tool name (language) translation Target group and approach time (min) version References

24-h DR
myfood24 UK (English) Germany, Australia Adolescents and SA or IA; some 19 Available [6,12,13]
adults aspects of the
AMPM included
&
Foodbook24 Ireland (English) None Adults SA; follows AMPM N/A N/A [14 ]
&
INTAKE24 UK (English) New Zealand, Adolescents and SA; follows AMPM 20 Available [15 ,16,17]
Portugal, adults (11–24
Denmark, the years old)
UAE, Australia
Compl-eat The Netherlands None Adults SA; follows AMPM 40–45 N/A [18]
(Dutch)
&
ASA24-2016 USA (English, Canada, Australia Children, SA; follows AMPM 24 Available [19 ,20]
Spanish) adolescents and
adults
R24W Canada (French) None Adults SA; follows AMPM, N/A N/A [21]
but meal-based
approach
SACANA N/A N/A Children, SA N/A N/A [10]
adolescents and

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adults
Food record
NutriNet-Santé tool France (French) Belgium, Adults SA; prompts for 25 N/A [22–24]
Switzerland, frequently
Spain, Mexico, forgotten foods
Canada and food details
Riksmaten method Sweden (Swedish) RiksmatenFlex for Adults SA N/A N/A [25,26]
adolescents
&
WebDASC Denmark (Danish) Norway (WebFR) Children SA; prompts for 15 (35 at first N/A [27 ,28–30]
frequently usage)
forgotten foods
Hybrid
Oxford WebQ UK (English) None Adults SA; food-frequency 12.5 Available [7,31]
approach
&

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

24-h food list Germany (German) None Adults SA; food-frequency 9 Available [8 ,9]
approach

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AMPM, Automated Multiple-Pass Method; ASA24, automated self-administered 24-h dietary recall; DR, dietary recall; IA, interviewer-administered; R24W, automated self-administered web-based 24-h recall; SA, self-
administered; SACANA, Self-Administered Children, Adolescents and Adult Nutrition Assessment; WebDASC, Web-based Dietary Assessment Software for Children; WebFR, web-based food record.
a
We only included information available in scientific articles or published online.
New approaches in assessing food intake in epidemiology Conrad et al.

345
 Table 2. Specific aspects of web-based dietary assessment tools available for use in epidemiologic studiesa

346
Tool name Database Search function Portion size estimation Additional features Validation

myfood24 N ¼ 40 274 generic and Free text search; filter option; N ¼ 5669 items with portion Customisation of projects possible Compared with an IA 24HDR in
&
[6,12,32 ] branded items; UK food common synonyms and images with the option to select (project-specific text and logos, adolescents aged 11–18 years;
composition tables as potential misspellings added to from seven portion size image; tailored invitation and reminder mean difference in EI between
underlying FCDB the database (N ¼ 30 733 standard pack sizes; average emails, supplementary myfood24 and comparison:
synonyms and misspellings); serving size; enter own amounts questions); can be used for 230 kJ (55 kcal)
recently used items to allow multiple 24HDR or as FR;
quick entry of repeated foods automated calculation of food
and nutrient intakes (i.e. 120
macronutrient and micronutrient
data); recipe module
Foodbook24 N ¼ 751 generic food items Free text search; common Photographs (N ¼ 174) Automated calculation of food Compared with an IA 24HDR;
& &
[14 ,33 ,34] based on the Irish National misspellings and multiple representing small, medium and nutrient intakes; database mean difference in EI between

www.co-clinicalnutrition.com
Adult Nutrition Survey; UK
food composition tables and
The Irish Food Composition
names (incl. brands) of and large portions (user can of N ¼ 542 branded nutritional Foodbook24 and comparison:
various food items addressed also select ‘less than this’, supplements; a screening and 1008 kJ (241 kcal);
with food tags ‘exactly this size’ or ‘greater consent stage, demographic compared with a 4-day
Assessment of nutritional and metabolic status

Database as underlying FCDB than this’); average portions questionnaire, food frequency semiweighed FR; mean
sizes (N ¼ 195) and food choice questionnaires difference in EI between
and a tool evaluation Foodbook24 and comparison:
questionnaire can be optionally 540 kJ (129 kcal)
included
INTAKE24 More than N ¼ 2500 food items; Free text search; custom search Over N ¼ 3000 photographs; Automatic coding and creation of Compared with an IA 24HDR in
&
[15 ,16,17] UK National Diet and Nutrition algorithms highly tolerant to two different types of images a nutrient and food group two age groups (G1: 11–16
Surveys Nutrient Databank as spelling mistakes (as served/guide), sliding output; tool is optimized for use and G2: 17–24 years old);
underlying FCDB scales for drinks and standard on tablet and mobile devices; mean difference in EI between
portion description sandwich and salad wizard to INTAKE24 and comparison:
assist recording 142 kJ (34 kcal) (G1) and
107 kJ (26 kcal) (G2)
Compl-eat Food list based on the Dutch Includes synonyms; recently used Household measures, standard Computation module (data-entry Compared with an IA 24HDR;
[18] Food Composition Database items to allow quick entry of portions, weight in grams or part for researchers and food mean difference in EI between
(NEVO-database, 2011) and repeated foods; participants volume in litres calculation system); recipe Compl-eat and comparison:
foods and recipes derived from can optionally include notes for module; yield and retention 714 kJ (171 kcal)
self-reports in previous research clarification (processed by factors are automatically taken
trained dieticians) into account; Compl-eat recalls
are checked for completeness
and unusual portion sizes
ASA24 N ¼ 7200 food items; Food and Free text search; filter option; Over N ¼ 17 000 portion size Can be used for multiple 24HDRs ASA24-2011 validated against
&& &

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[3 ,19 ,20, Nutrient Database for Dietary includes >17 500 misspellings images ranging from small to or as a FR; automatic coding; DLW; mean difference in EI
& &
35 ,36 ] Studies as underlying FCDB and synonyms in the US large portions (units, foods on output for 65 nutrients and 37 between ASA24 and
version; includes an open- plates or bowls, household food groups and food pyramid comparison: 1975 kJ
ended text field measures) equivalents; can be used on (472 kcal) (men), 1318 kJ
mobile devices; optional (315 kcal) (women)
modules (context of meals, food
source, dietary supplement
intake); respondent nutrition

Volume 21  Number 5  September 2018

report
 Table 2 (Continued)

Tool name Database Search function Portion size estimation Additional features Validation

R24W [21] N ¼ 2865 food items sorted into Foods can be searched by
16 main categories; based on
the Canadian Nutrient File
database (version 2010) and
other existing web-based
24HDRs
SACANA N/A
[10,37]
NutriNet-Santé SU.VI.MAX Food Composition
tool [22,23,38] Table as underlying FCDB
browsing categories or using
a search function; food items
linked to a list of common
synonyms, misspellings and
trademarks
N/A
Free text search, classification
tree or open-ended type-in
format; spelling errors
accepted
Portion size images (N ¼ 1491,
up to eight photographs per
item); standard units
Standardized photographs
Photographs (N ¼ 250)
corresponding to >2000 food
items presented in seven
increasing portion sizes; entry
Automatic calculation of nutrient None
intakes, food group servings
according to the Canadian
Food Guide and diet quality
scores (Mediterranean score,
C-HEI); computation of the
probability of meeting
individual nutrient
recommendations;
supplementary questionnaire
(sex, age, smoking habits,
pregnancy/lactation, dietary
supplements)
N/A Self-reported sugar intake
validated against urinary
sucrose and fructose; moderate
correlations between sugar
intake and biomarkers
Socio-demographic and lifestyle Compared with urinary
questionnaires (e.g. on health, biomarkers (reported vs. true
anthropometrics and physical intakes of protein, K and Na;
activity); recording module for men: r ¼ .61,.78 and .47,

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of exact quantity; household salt intake and recipes; detailed women: r ¼ .64, .42 and .37);
measures instructions in several forms F/V, fish and micronutrient
(e.g. PDF user’s guide and intakes compared with plasma
videos) biomarkers (low-to-moderate
correlations); compared with an
IA 24HDR (mean difference in
EI between tool and
comparison: 145 kJ
(35 kcal) (men), 23 kJ (5 kcal)
(women)
Riksmaten N ¼ 1909 food items and N/A Portions size guide consisting of Automated calculation of food Validated against DLW; mean
method dishes; Swedish food 24 food categories with four to (group) and nutrient intakes; difference in EI between
[25,39,40] composition database as eight reference sizes in each questions regarding dietary Riksmaten method and
underlying FCDB category; household measures; supplements and physical comparison: 2500 kJ
numbers of portions (cups, activity level included (598 kcal)
pieces, slices); grams

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WebFR N ¼ 550 food items; based Free text search, drop-down-lists Photo series with two to four Structured by meals; Compared with TEE from
[28,41] on the Norwegian national with different categories or photos illustrating different voice-assisted cartoon accelerometer outputs; mean
dietary survey and products type-in format portion sizes; new photos taken character difference in EI between

www.co-clinicalnutrition.com
designed for children based specifically for the purpose of WebFR and comparison:
on Norwegian sales statistics the development of the WebFR 1830 kJ (437 kcal)
and selected photo series from
New approaches in assessing food intake in epidemiology Conrad et al.

347
the WebDASC
 348
Table 2 (Continued)

Tool name Database Search function Portion size estimation Additional features Validation

WebDASC N ¼ 1300 food items based on Five search strategies: category Photograph series (N ¼ 320), Features for motivation, e.g. a Self-reported whole-grain intake
&
[27 ,29, the Danish National Survey of browse, ‘copy meal’ function, selecting the closest portion computer game and a food validated against plasma
30,42] Diet and Physical Activity free text search, ‘starts with’ size among four different meter; child appealing alkylresorcinol concentrations in
2003–2008, the Danish search or type-in format; digital images interface, e.g. an avatar a RCT; Spearman correlations
Household Panel and trademark customised spell check function guiding through eating between estimated whole-grain
items from the Danish Food occasions (animated armadillo); wheat þ rye intake and plasma

www.co-clinicalnutrition.com
Composition Databank; individual modifications alkylresorcinol showed
includes foods commonly eaten possible (e.g. number of correlations of 0.40 and 0.37
by ethnic minorities living in records, food list terms, portions for different diets
Denmark size photos, add-on questions)
Assessment of nutritional and metabolic status

Oxford N ¼ 238 generic food items;
WebQ based on major foods
[7,31] consumed in the United
Kingdom according to
population dietary surveys and
pilot studies; McCance and
Widdowson’s The Composition
of Foods as underlying FCDB
24-h food N ¼ 246 food items; based on the N/A
&
list [8 ,9] German National Nutrition
Survey II
Free text boxes when listed
options do not fit
Standard (e.g. slice, bottle) Automated calculation of energy Compared with an IA 24HDR;
and average portion sizes and nutrient intakes mean difference in EI between
(servings) Oxford WebQ and
comparison: þ11 kJ (þ3 kcal)
N/A Estimation of consumption None
probability for computation of
usual dietary intake; closed-
ended food list; intended for
use in a combined approach

24HDR, 24-h dietary recall; AMPM, Automated Multiple-Pass Method; ASA24, automated self-administered 24-h dietary recall; C-HEI, Canadian Healthy Eating Index; DLW, doubly labelled water; EI, energy intake; F/
V, fruits and vegetables; FCDB, Food Composition Database; FR, food record; G, group; IA, interviewer administered; R24W, automated self-administered web-based 24-h recall; SA, self-administered; SACANA, Self-
Administered Children, Adolescents and Adult Nutrition Assessment; TEE, total energy expenditure; WebDASC, Web-based Dietary Assessment Software for Children; WebFR, web-based food record.
a
We only included information available in scientific articles or published online.

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Volume 21  Number 5  September 2018
 New approaches in assessing food intake in epidemiology Conrad et al.
the Web-based Dietary Assessment Software for
Children (WebDASC; The Opus Project, Copenha-
gen, Denmark) also implemented prompts for fre-
quently forgotten foods, although this was not
&
traditionally part of food records [22,27 ].
Database
Particular attention should be paid to the underly-
ing list of foods and drinks, and the respective
nutrient database of the tool. Self-administered
and automated tools place the responsibility to
correctly identify and choose the appropriate food
&
item consumed on the user [32 ]. Therefore, food
descriptions need to be well defined, easy to under-
stand and presented in a user-friendly way. For the
development of web-based dietary assessment tools,
different approaches were chosen. On the one hand,
very extensive databases were implemented to pro-
vide the study participant with a high level of detail
&
such as in the myfood24 system [32 ]. Therefore, the
myfood24 team followed a new approach to develop
a food composition table by mapping back of pack
nutrient information from branded UK food prod-
ucts to generic food items. The final database com-
prised 40 274 generic and branded food items. Of
course, with this approach, it is challenging to
maintain an up-to-date database [6]. In contrast,
other researchers try to keep the list of foods and
drinks as concise as possible to limit participant
&
burden [33 ]. The database of Foodbook24 was
derived from the Irish National Adult Nutrition
Survey data based on the most frequently used food
codes within a food type. The final database con-
sisted of 751 food items. The authors showed that
only small difference in nutrient intakes was
observed between this concise item list and the
original extensive item list (N ¼ 2319 items). Over-
all, the web-based tools differ a lot with respect to
the number of food items included in the database;
still, most of the tools were based on the respective
country-specific food and nutrient database and
included both generic and branded food items.
Automated calculation of nutrient and food
group intakes was described for seven tools
&& & &
[3 ,7,13,14 ,15 ,21,25]. For example, the ASA24
output covers 65 nutrients and 37 food groups
&
[19 ]. Moreover, the ASA24 and the automated
self-administered web-based 24-h recall can addi-
tionally calculate food pyramid equivalents and
food group servings according to diet quality scores,
&
respectively [19 ,21]. The Compl-eat tool included a
computation module, but no automated feature
[18]. The module consists of a data-entry part for
researchers and a food calculation system. Outputs
for different purposes can be generated. For the 24-h
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Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
food list, also no automated computation has been
&
implemented [8 ]. Here, the focus was on the short
completion time and the simple structure to reduce
participants’ burden. The 24-h food list is intended
to be used in a combined approach with a FFQ
applying statistical modelling to estimate usual
dietary intake.
Search function
It is important that participants can easily find the
foods and drinks that they consumed. We found that
the free text search was the most common search
method. Some systems additionally implemented
food categories to aid searching, either as filter option
& &
or as classification tree [13,19 ,21, 22,27 ,28]. More-
over, synonyms and misspellings were added to the
database to enhance the probability of finding a
& & &
specific food item [14 ,16,19 , 21,29,32 ]. Little
research is available on the search function of self-
administered tools. Kirkpatrick et al. (2017) reported
that some students completing the ASA24 did not
understand how to use the search function. They
entered multiple items (e.g. ‘banana cereal orange
juice’) at a time and not one after another, which did
&&
not return the desired results [43 ]. In a feasibility
study of adults using ASA24, some participants
reported difficulties finding a particular food when
searching for generic items such as bread. This could
result in a long list of suitable matches to consider.
Overall, older adults were observed to have more
problems with the search function and navigation
but to be more patient with completing the ASA24
compared with younger adults.
Most of the web-based 24HDRs are implemented
in principle closed-ended food lists meaning that the
user cannot add a food or drink item, which is not
available in the database. In contrast, the ASA24
system offers the option to enter open-ended text
&
for unfound food items [35 ]. The system subse-
quently assigns default food codes after asking a series
of questions to better identify the food. An analysis of
the implications of checking and when indicated
correcting the assigned food codes by nutritionists
indicated that such editing does not have a large
impact on nutrient and food group estimates in
large-scale studies [44]. However, it might be neces-
sary in smaller settings in which a small number of
errors may have a greater impact. In the Compl-eat
system, users can optionally include notes for clarifi-
cation, which are subsequently processed by trained
dieticians [18]. This effort, however, might be pro-
hibitively expensive for most large-scale studies.
From the food records, the NutriNet-Santé tool, the
web-based food record and the WebDASC included
an option to add a food or drink that was not found in
www.co-clinicalnutrition.com 349
Assessment of nutritional and metabolic status
the database using type-in formats [23,29,45]. This
was also possible in the Oxford WebQ (University of
Oxford, Oxford, UK) [7].
Portion size estimation
Web-based tools can support portion size assess-
ment by presenting multiple options for portion
selection to the user [6]. The options available for
a specific food may depend upon the food selected.
The reviewed tools included different options for
portion size estimation such as food photographs,
average portion size or entry of actual weights.
Regarding food photographs, technological advan-
ces allow to provide multiple images for a specific
food item. This gives the opportunity to present
more realistic ranges of amounts of foods and drinks
&
compared with traditional options [35 ]. For exam-
ple, the myfood24 system included portion images
for 5669 food items with the option to select from
seven images for each food item [13]. The ASA24
&
tool has over 17 000 portion size images [19 ]. It was
suggested that the use of multiple digital images
may enhance the estimation of amounts consumed
compared with interviewer-administered 24HDRs
&
that rely on traditional portion-size aids [35 ].
Validity
Another issue is the validity of web-based, self-
administered tools. One has to keep in mind that
new technologies do not negate the methodological
issues related to dietary assessment. To date, few
tools have been validated against recovery biomark-
ers such as doubly labelled water or urinary nitrogen
representing the gold standard. Five tools were vali-
dated relatively against either interviewer-adminis-
& There are no conflicts of interest.
tered 24HDR or food records [7,12,14 ,17,18,34].
The mean difference in energy intake ranged from
þ3 kcal for the comparison of the Oxford WebQ
with an interviewer-administered 24HDR [31] to
241 kcal for the comparison of Foodbook24 with
& been highlighted as:
a 4-day semiweighed food record [14 ]. The ASA24
tool and the Riksmaten method were compared
with doubly labelled water. Mean differences in
energy intake were 394 and 598 kcal, respectively
&&
[3 ,25]. This difference in energy intake for online
tools validated against recovery biomarkers can be
expected to some extent as self-report dietary assess-
ment instruments are always prone to error related
to memory, reactivity and portion size estimation
&&
[3 ]. The magnitude of energy underestimation
with online tools lies in the range of underestima-
tion with traditional 24HDRs and food records
&&
[3 ,46]. The overall lower energy intakes assessed
with online tools might be explained by a lower
350 www.co-clinicalnutrition.com
Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
number of foods reported as indicated by Meijboom
et al. [18]. A more detailed overview of the validity of
web-based 24HDRs can be found in a recent review
&
by Timon et al. [36 ].
CONCLUSION
Web-based methods are promising to meet the chal-
lenges regarding dietary assessment in epidemio-
logic studies. The tools are associated with lower
costs and reduced burden for participants and
researchers, and show a comparable validity with
traditional instruments. Researchers should con-
sider using existing tools rather than developing
new instruments. Most of the tools can easily be
adapted and/or translated to other databases. In our
opinion, more evidence is needed on how users
search for food items considering different age
groups, and if extensive databases including branded
food products help to get more detailed or correct
information on food consumption or if it is rather
confusing for the user. The impact of open-ended text
responses also needs further investigation.
Acknowledgements
None.
Financial support and sponsorship
The current work was supported by the ‘Diet-Body-Brain
(DietBB) Competence Cluster in Nutrition Research’
funded by the Federal Ministry of Education and
Research, Germany (grant number 01EA1410A). The
German Federal Ministry of Education and Research had
no role in the design, analysis or writing of this article.
Conflicts of interest
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