Validation of a novel image-weighed technique for monitoring food intake and estimation of portion size in hospital settings: a pilot study.

OBJECTIVE: Optimal nutrition for hospital patients is crucial and routine monitoring of patients' nutrient intake is imperative. However, personalised monitoring and customised intervention using traditional methods is challenging and labour-intensive, consequently it is often neglected in hospital settings. The present pilot study aimed to examine the reliability and validity of the Dietary Intake Monitoring System (DIMS) against the weighed food method (WFM). DESIGN: The DIMS 2.0 is composed of an integrated digital camera, weighing scale, radio-frequency identification sensor and WIFI connection for real-time image and weight dietary data acquisition and analysis. The DIMS equipment was used to collect data for a paired set of meals both before and after meal consumption at lunchtime. SETTING: Odense University Hospital, Denmark. SUBJECTS: Photos and weights of seventeen patient meals were captured. RESULTS: The results showed a significant correlation between DIMS and WFM for energy (r=0·99, P<0·01) and protein intake (r=0·98, P<0·01). Intraclass correlation coefficients (ICC) revealed a high degree of agreement among the four non-trained assessors for estimates of portion size of each food item before (0·88, P<0·01) and after consumption (0·99, P<0·01). The ICC for energy and protein intake were 0·99 (P<0·01) and 0·99 (P<0·01), respectively. Bland-Altman plots revealed no systematic bias. CONCLUSIONS: Considering the huge benefits associated with routine monitoring, technological advances have made it possible to develop a novel, easy-to-use DIMS that, according to the findings, is a valid alternative for use in hospital settings.

How to measure energy and protein intake in a geriatric department - A comparison of three visual methods.

BACKGROUND & AIMS: Sufficient energy and protein intake are essential to treatment and recovery of hospitalized older adults. The food intake should be assessed in order to detect patients in need of nutritional intervention. The aim of this study was to compare the accuracy of three visual methods for assessing energy and protein intake as compared to weighing food items. METHODS: We conducted assessment of 103 lunch meals served to geriatric inpatients. Lunch meals were assessed by the nursing staff using three visual methods: 1. Meal Portions (MP): Consumption of each meat/fish, vegetables, potatoes, and sauce 2. Plate Method (PM): Consumption of 100%, 75%, 50%, 25%, or 0% 3. Reduced Plate Method (RPM): All, half, quarter, or nothing Separate weighing of all food items pre- and post-serving was used as reference method. Wilcoxon Signed Rank Test was used comparing the accuracy of the three visual methods. Bland-Altman analysis was used to test the degree of agreement. Results are given as median estimates [25%>, 75%> percentiles]. The Alpha level was set to 0.05. RESULTS: The total energy served pr. lunch meal was 893.6 kJ [830.4, 1034.3] and the weighed intake 676.6 kJ [421.4, 870.0]. The median intake was 663.0 kJ [389.0, 873.0] (p = 0.044), 636.0 kJ [436.5, 873.0] (p < 0.001), and 487.8 kJ [316.5, 873.0] (p < 0.001) assessed by MP, PM, and RPM respectively. The weighted protein content pr. served meal was 13.0 g [11.4, 15.4] with a weighted intake of 10.3 g [5.3, 13.1]. The median intake was 10.7 g [5.3, 11.7] (P = 0.045), 9.3 g [5.8, 11.7] (p < 0.001), and 8.0 g [4.8, 11.7] (p < 0.001) assessed by MP, PM, and RPM respectively. CONCLUSIONS: All visual methods underestimated energy intake. PM and RPM underestimated protein intake whereas MP overestimated protein intake. However, visual assessment by MP was found to be most accurate.