title: A new mobile phone-based tool for assessing energy and certain food intakes in young children: a validation study.
abstract: BACKGROUND
  Childhood obesity is an increasing health problem globally. Obesity may be established already at pre-school age. Further research in this area requires accurate and easy-to-use methods for assessing the intake of energy and foods. Traditional methods have limited accuracy, and place large demands on the study participants and researchers. Mobile phones offer possibilities for methodological advancements in this area since they are readily available, enable instant digitalization of collected data, and also contain a camera to photograph pre- and post-meal food items. We have recently developed a new tool for assessing energy and food intake in children using mobile phones called the Tool for Energy Balance in Children (TECH).
  
  
  OBJECTIVE
  The main aims of our study are to (1) compare energy intake by means of TECH with total energy expenditure (TEE) measured using a criterion method, the doubly labeled water (DLW) method, and (2) to compare intakes of fruits and berries, vegetables, juice, and sweetened beverages assessed by means of TECH with intakes obtained using a Web-based food frequency questionnaire (KidMeal-Q) in 3 year olds.
  
  
  METHODS
  In this study, 30 Swedish 3 year olds were included. Energy intake using TECH was compared to TEE measured using the DLW method. Intakes of vegetables, fruits and berries, juice, as well as sweetened beverages were assessed using TECH and compared to the corresponding intakes assessed using KidMeal-Q. Wilcoxon matched pairs test, Spearman rank order correlations, and the Bland-Altman procedure were applied.
  
  
  RESULTS
  The mean energy intake, assessed by TECH, was 5400 kJ/24h (SD 1500). This value was not significantly different (P=.23) from TEE (5070 kJ/24h, SD 600). However, the limits of agreement (2 standard deviations) in the Bland-Altman plot for energy intake estimated using TECH compared to TEE were wide (2990 kJ/24h), and TECH overestimated high and underestimated low energy intakes. The Bland-Altman plots for foods showed similar patterns. The mean intakes of vegetables, fruits and berries, juice, and sweetened beverages estimated using TECH were not significantly different from the corresponding intakes estimated using KidMeal-Q. Moderate but statistically significant correlations (ρ=.42-.46, P=.01-.02) between TECH and KidMeal-Q were observed for intakes of vegetables, fruits and berries, and juice, but not for sweetened beverages.
  
  
  CONCLUSIONS
  We found that one day of recordings using TECH was not able to accurately estimate intakes of energy or certain foods in 3 year old children.
authors.affiliation: Linköping University, Department of Clinical and Experimental Medicine, Linköping, Sweden.
authors.forename: Hanna
authors.identifier: http://orcid.org/0000-0003-3571-1497
authors.initials: H
authors.lastname: Henriksson
authors.forename: Stephanie E
authors.identifier: http://orcid.org/0000-0002-2219-7970
authors.initials: SE
authors.lastname: Bonn
authors.forename: Anna
authors.identifier: http://orcid.org/0000-0002-7981-6314
authors.initials: A
authors.lastname: Bergström
authors.forename: Katarina
authors.identifier: http://orcid.org/0000-0003-2046-5641
authors.initials: K
authors.lastname: Bälter
authors.forename: Olle
authors.identifier: http://orcid.org/0000-0001-5626-1187
authors.initials: O
authors.lastname: Bälter
authors.forename: Christine
authors.identifier: http://orcid.org/0000-0003-3496-8266
authors.initials: C
authors.lastname: Delisle
authors.forename: Elisabet
authors.identifier: http://orcid.org/0000-0001-9060-0066
authors.initials: E
authors.lastname: Forsum
authors.forename: Marie
authors.identifier: http://orcid.org/0000-0002-2273-4430
authors.initials: M
authors.lastname: Löf
keywords: DLW; FFQ; cell phone; child; digital camera; energy intake; food intake