Making the best use of new technologies in the National Diet and Nutrition Survey: a review

<p>.BackgroundDietary assessment is of paramount importance for public health monitoring. Currently in theUK, the population’s diets are examined by the National Diet and Nutrition Survey RollingProgramme (NDNS RP). In the survey, diet is assessed by a four-day paper-based dietarydiary, with accompanying interviews, anthropometric measurements and blood and urinesampling. However, there is growing interest worldwide in the potential for new technologiesto assist in data collection for assessment of dietary intake.Published literature reviews have identified the potential of new technologies to improveaccuracy, reduce costs, and reduce respondent and researcher burden by automating datacapture and the nutritional coding process. However, this is a fast-moving field of research,with technologies developing at a rapid pace, and an updated review of the potentialapplication of new technologies in dietary assessment is warranted. This review wascommissioned to identify the new technologies employed in dietary assessment and criticallyappraise their strengths and limitations in order to recommend which technologies, if any,might be suitable to develop for use in the NDNS RP and other UK population surveys.ObjectivesThe overall aim of the project was to inform the Department of Health of the range of newtechnologies currently available and in development internationally that have potential toimprove, complement or replace the methods used in the NDNS RP. The specific aims were:to generate an itinerary of new and emerging technologies that may be suitable; tosystematically review the literature and critically appraise new technologies; and torecommend which of these new technologies, if any, would be appropriate for future use inthe NDNS RP. To meet these aims, the project comprised two main facets, a literaturereview and qualitative research.Literature review data sourcesThe literature review incorporated an extensive search of peer-reviewed and grey literature.The following sources were searched: Cochrane Database of Systematic Reviews (CDSR),Database of Abstracts of Reviews of Effectiveness (DARE), Web of Science Core Collection,Ovid MEDLINE, Ovid MEDLINE In-Process, Embase, NHS EED (Economic EvaluationDatabase), National Cancer Institute (NCI) Dietary Assessment Calibration/ValidationRegister, OpenGrey, EPPI Centre (TRoPHI), conference proceedings (ICDAM 2012,ISBNPA 2013, IEEE Xplore, Nutrition Society Irish Section and Summer Meetings 2014),recent issues of journals (Journal of Medical Internet Research, International Journal ofMedical Informatics), grants registries (ClinicalTrials.gov, BBSRC, report), national surveys,and mobile phone application stores. In addition, hand-searching of relevant citations wasperformed. The search also included solicitation of key authors in the field to enquire about Making the best use of new technologies in the NDNS: a review4as-yet unpublished articles or reports, and a Bristol Online Survey publicised via socialmedia, society newsletters and meetings.Literature review eligibility criteriaRecords were screened for eligibility using a three-stage process. Firstly, keyword searchesidentified obviously irrelevant titles. Secondly, titles and abstracts were screened against theeligibility criteria, following which full-text copies of papers were obtained and, in the thirdstage of screening, examined against the criteria. Two independent reviewers screenedeach record at each stage, with discrepancies referred to a third reviewer.Eligibility criteria were pre-specified and agreed by the project Steering Group (Section 1.6).Eligible records included: studies involving technologies, new to the NDNS RP, which can beused to automate or assist the collection of food consumption data and the coding of foodsand portion sizes, currently available or beta versions, public domain or commercial; studiesthat address the development, features, or evaluation of new technology; technologiesappropriate for the requirements of the NDNS RP in terms of nutritional analysis, withcapacity to collect quantifiable consumption data at the food level; primary sources ofinformation on a particular technology; and journal articles published since the year 2000 orgrey literature available from 2011 onwards. The literature search was not limited to Englishlanguagepublications, which are included in the itinerary, although data were not extractedfrom non-English studies.Literature synthesis and appraisalNew technologies were categorised into eleven types of technology, and an itinerary wasgenerated of tools falling under each category type. Due to the volume of eligible studiesidentified by the literature searches, data extraction was limited to the literature focussing onselected exemplar tools of five technology categories (web-based diet diary, web-based 24-hour recall, handheld devices (personal digital assistants and mobile phones), nonautomatedcameras to complement traditional methods, and non-automated cameras toreplace traditional methods). For each category, at least two exemplars were chosen, and allstudies involving the exemplar were included in data extraction and synthesis. Exemplarswere selected on the basis of breadth of evidence available, using pre-specified criteriaagreed by the Steering Group.Data were extracted by a single reviewer and an evidence summary collated for eachexemplar. A quality appraisal checklist was developed to assess the quality of validationstudies. The checklist was piloted and applied by two independent reviewers. Studies werenot excluded on the basis of quality, but study quality was taken into account when judgingthe strength of evidence. Due to the heterogeneity of the literature, meta-analyses were notperformed.References were managed and screened using the EPPI Reviewer 4 systematic reviewsoftware. EPPI Reviewer was also used to extract data.</p>