Accuracy of food photographs for quantifying food servings in a lunch meal setting among Danish children and adults.

BACKGROUND: Visual aids, such as food photographs, are widely used in estimating food quantities in dietary surveys. The present study aimed to assess how accurately Danish adults and children can estimate food portion sizes using 37 series of photographs illustrating four to six different portion sizes under real-life conditions; determine whether adults were more accurate than children; and estimate the error caused by using portion size photographs to estimate weights of foods consumed in macronutrient calculation. METHODS: Six hundred and twenty-two adults and 109 children were recruited in three workplace canteens and in two schools, respectively, to estimate their lunchtime portions based on photographs. Participants were instructed to keep the foods separated on their plate when taking lunch. Participants thereafter estimated their own portions by looking at the relevant series of photographs. The actual food portions were then weighed. RESULTS: The proportion of correct estimations was 42% overall (range 19-77%). The mean difference (%) between estimated and actual weight was 17% (range 1-111%). Small portion size photographs were more often used correctly compared to larger portion photographs. Children had as many correct estimations as adults, although they overestimated portions more. Participants using fractions of (or more than) one photograph to estimate the portion of a food had significantly larger errors. When calculating the macronutrient content of a weekly menu using the estimated portion sizes, protein had the largest error (29%). CONCLUSIONS: When used in a real-life situation, the portion size photographs validated in the present study showed a certain inaccuracy compared to the actual weights.

Identifying dietary patterns and associated health-related lifestyle factors in the adult Danish population.

BACKGROUND/OBJECTIVES: To identify and describe dietary patterns in Danish adults and to examine which demographic and health-related lifestyle factors are associated with dietary patterns. SUBJECTS/METHODS: Data derived from the Danish national survey of diet and physical activity collected in 2003-2008 and included 1569 men and 1785 women. Diet was assessed by a 7-day pre-coded food diary. Information on age, gender, weight, height, physical activity, smoking habits, educational level and attitudes towards healthy eating habits was derived from face-to-face interviews. Principal component analysis was applied to explore dietary patterns. Associations with lifestyle factors were examined by means of multiple regression analyses. RESULTS: Three major dietary patterns were identified: a 'traditional' pattern correlated with intake of rye bread, white bread, fat on bread, cheese, jam, cold meat, minced meat, potatoes and gravy, and cake and biscuits; a 'health-conscious' pattern correlated with coarse bread, fruit, vegetables, low-fat dairy, nuts, water and tea; and a 'fast food' pattern correlated with pizza, hamburger/spring rolls, crisps, rice and pasta, sugar-sweetened soft drinks and sweets. The 'traditional' pattern was positively associated with male gender and age, whereas the 'health-conscious' pattern was positively associated with being female, increasing age and educational level. The 'fast food' pattern was inversely associated with age and smoking. CONCLUSIONS: Three distinct dietary patterns were identified, and associated lifestyle and demographic factors were characterised. The findings are valuable in targeting future nutrition education and will enable more focused strategies in communicating food-based dietary guidelines.

WebDASC: a web-based dietary assessment software for 8-11-year-old Danish children.

BACKGROUND: The present study describes the development and formative evaluation of the Web-based Dietary Assessment Software for Children (WebDASC). WebDASC is part of the OPUS project ('Optimal well-being, development and health for Danish children through a healthy New Nordic Diet') and was intended to measure dietary change resulting from a school-based intervention. METHODS: WebDASC was developed as a self-administered tool that could be used by 8-11-year-old children with or without parent's aid. The development of WebDASC followed a prototyping approach: focus groups, informal interviews, literature review, and usability tests preceded its release. Special consideration was given to age-appropriate design issues. RESULTS: In WebDASC an animated armadillo guides respondents through six daily eating occasions and helps them report foods and beverages previously consumed. A database of 1300 food items is available either through category browse or free text search, aided by a spell check application. A type-in format is available for foods not otherwise found through category browse or text search. Amount consumed is estimated by selecting the closest portion size among four different digital images. WebDASC includes internal checks for frequently forgotten foods, and the following features to create motivation: a food-meter displaying cumulative weight of foods reported, a most popular food ranking, and a computer game with a high score list. CONCLUSIONS: WebDASC was developed as an intuitive, cost-effective, and engaging method to collect detailed dietary data from 8- to 11-year-old children. Preliminary testing demonstrated that it was well accepted among children.

Dimensions of socioeconomic position related to body mass index and obesity among Danish women and men.

AIMS: The aim of this study was to examine the association between different dimensions of socioeconomic position, body mass index (BMI) and obesity in the Danish population. Possible interactions between the different dimensions and gender differences were also investigated. METHODS: This was a cross-sectional survey conducted in 2000-2002 including a simple random sample from the civil registration system, comprising 1953 males and 2167 females aged 4-75 years. Information about different dimensions of socioeconomic position, height and weight was obtained by face-to-face interview. Associations between dimensions of socioeconomic position and weight status were examined by use of linear multiple regression analysis and logistic regression analysis. RESULTS: BMI and prevalence of obesity were significantly associated with education for both men and women. Odds ratios (ORs) for obesity were 2.9 (95% confidence interval (CI) 1.4-5.9) and 6.5 (95% CI 2.3-18.7) for those with basic school as compared with those with long higher education for men and women, respectively. Women outside the labour market had higher BMIs and a greater prevalence of obesity (OR 2.5 (95% CI 1.6-3.9)) after adjustment for educational level. CONCLUSIONS: Education was the dimension most consistently associated with BMI and obesity, indicating the importance of cultural capital for weight status. The gender-specific pattern showed a stronger social gradient for women, and indicated that a high relative body weight was associated with less favourable social and material conditions for women, but not for men. A public health strategy to prevent and reduce obesity should be gender-specific, focus on groups with short education, and incorporate cultural norms.

Development of a recommended food intake pattern for healthy Danish adolescents consistent with the Danish dietary guidelines, nutrient recommendations and national food preferences.

BACKGROUND: Danish adolescents have poor dietary habits compared to current recommendations. The present study aimed to develop a recommended food intake pattern for adolescents consistent with Danish Dietary Guidelines (DDG), Nordic Nutrition Recommendations (NNR) and dietary preferences. METHODS: The nutrient content of a food intake pattern consistent with DDG was calculated using dietary intake data from a random sample of 11-15-year-old boys (n = 85) and girls (n = 70). A recommended food intake pattern was modelled to meet NNR. The discretionary energy allowance was calculated as the difference between the total energy level and the energy needed to meet recommended nutrient needs. The flexibility of the recommended food intake pattern was tested against various energy requirements and with the inclusion of basic foods with higher sugar and/or fat content. RESULTS: The developed food intake pattern meets all nutrient goals except for vitamin D. At low energy requirements, the intake of iron and selenium is of concern. To fulfil nutrient recommendations, half of the bread/cereals and vegetables consumed should be fibre-rich, and fats should be of plant origin. CONCLUSIONS: The recommended food intake pattern meets most nutrient recommendations and makes it possible to advise on discretionary energy.