title: Validation of a digital photographic method for assessment of dietary quality of school lunch sandwiches brought from home.
abstract: BACKGROUND
  It is a challenge to assess children's dietary intake. The digital photographic method (DPM) may be an objective method that can overcome some of these challenges.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the validity and reliability of a DPM to assess the quality of dietary intake from school lunch sandwiches brought from home among children aged 7-13 years.
  
  
  METHODS
  School lunch sandwiches (n=191) were prepared to represent randomly selected school lunch sandwiches from a large database. All components were weighed to provide an objective measure of the composition. The lunches were photographed using a standardised DPM. From the digital images, the dietary components were estimated by a trained image analyst using weights or household measures and the dietary quality was assessed using a validated Meal Index of Dietary Quality (Meal IQ). The dietary components and the Meal IQ obtained from the digital images were validated against the objective weighed foods of the school lunch sandwiches. To determine interrater reliability, the digital images were evaluated by a second image analyst.
  
  
  RESULTS
  Correlation coefficients between the DPM and the weighed foods ranged from 0.89 to 0.97. The proportion of meals classified in the same or an adjacent quartile ranged from 98% (starch) to 100% (fruits, vegetables, fish, whole grain, and Meal IQ). There was no statistical difference between fish, fat, starch, whole grains, and Meal IQ using the two methods. Differences were found for fruits and vegetables; Bland-Altman analyses showed a tendency to underestimate high amounts of these variables using the DPM. For interrater reliability, kappa statistics ranged from 0.59 to 0.82 across the dietary components and Meal IQ.
  
  
  CONCLUSIONS
  The standardised DPM is a valid and reliable method for assessing the dietary quality of school lunch sandwiches brought from home.
authors.affiliation: Division of Nutrition, National Food Institute, Technical University of Denmark, Søborg Denmark.
authors.forename: Marianne S
authors.initials: MS
authors.lastname: Sabinsky
authors.forename: Ulla
authors.initials: U
authors.lastname: Toft
authors.forename: Klaus K
authors.initials: KK
authors.lastname: Andersen
authors.forename: Inge
authors.initials: I
authors.lastname: Tetens
keywords: children; diet assessment; food intake; packed lunches