title: An evaluation of a colour food photography atlas as a tool for quantifying food portion size in epidemiological dietary surveys.
abstract: OBJECTIVE
  To test the validity of a colour food photography atlas for quantifying portion size eaten compared with weighed foods.
  
  
  METHODS
  The colour food photography atlas was prepared by cooking, weighing and taking digital photographs of three portion sizes of 434 foods and beverages typical of the Italian diet.
  
  
  METHODS
  In all, 448 male and female volunteers aged 6-60 y from a wide variety of social backgrounds completed 9075 assessments of food portions eaten at lunch and dinner in relation to a set of colour food photographs during 8 weeks of investigation. The amounts of foods eaten by individuals in five different cafeterias in Pavia, Northern Italy, were weighed by trained investigators at the time of serving and, within 5-10 min of the end of the meal, each subject was asked to quantify all foods consumed with reference to one of the three food photographs or in terms of virtual portions among those shown in the photographs.
  
  
  RESULTS
  Multiple regression analysis shows that weights of portion sizes chosen from the set of photographs are significantly associated (P<0.05) to weights of eaten portions (beta=0.81; R(2)=0.70) and are independent of age, gender and BMI. The differences between mean weights of the portions chosen by individuals from photographs and mean weights of eaten foods are significant for all food categories (P<0.05), except for bread. However, because of the very large number of observations, the mean differences are very small (range: from +23.2 g (+11.2%) for first courses to -1.3 g (-2.7%) for bread). Bland-Altman plots show that first courses limits of agreement are wide because the dispersion is increasing while weights are rising.
  
  
  CONCLUSIONS
  The use of a series of three photographs and virtual portion sizes being associated with relatively small errors, our findings support the validity of using this colour food photography atlas as a tool for quantifying food portion size in epidemiological dietary surveys on different age groups of Italian subjects.
authors.affiliation: Department of Applied Health Sciences, Section of Human Nutrition and Dietetics, Faculty of Medicine, University of Pavia, Italy. gturconi@unipv.it
authors.forename: G
authors.initials: G
authors.lastname: Turconi
authors.forename: M
authors.initials: M
authors.lastname: Guarcello
authors.forename: F Gigli
authors.initials: FG
authors.lastname: Berzolari
authors.forename: A
authors.initials: A
authors.lastname: Carolei
authors.forename: R
authors.initials: R
authors.lastname: Bazzano
authors.forename: C
authors.initials: C
authors.lastname: Roggi
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D002648:Child; D003116:Color; D004034:Diet Surveys; D002149:Energy Intake; D016021:Epidemiologic Studies; D005260:Female; D005502:Food / Q000145:classification; D005504:Food Analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010781:Photography; D012044:Regression Analysis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012858:Size Perception