title: Development and validation of a photographic food atlas for portion size assessment in the southern plains of Nepal.
abstract: To develop and validate a photographic food atlas of common foods for dietary assessment in southern Nepal.
  
  
  
  We created a life-sized photographic atlas of forty locally prepared foods. Between March and June 2014, data collectors weighed portion sizes that respondents consumed during one mealtime and then a different data collector revisited the household the next day to record respondents' estimations of their previous day's intakes using the atlas. Validity was assessed by percentage error, Cohen's weighted kappa (κ w) and Bland-Altman limits of agreement.
  
  
  
  Dhanusha and Mahottari districts in southern Nepal.
  
  
  
  A random sample of ninety-five adults in forty-eight rural households with a pregnant woman.
  
  
  
  Overall, respondents underestimated their intakes (mean error =-4·5 %). Rice and dal (spiced lentil soup) intakes were underestimated (-14·1 % and -34·5 %, respectively), but vegetable curry intake was overestimated (+20·8 %). Rice and vegetable curry portion size images were significantly reliably selected (Cohen's κ w (se): rice=0·391 (0·105); vegetable curry=0·430 (0·139)), whereas dal images were not. Energy intake over one mealtime was under-reported by an average of 569 kJ (136 kcal; 4·5 % error) using recall compared with the weighing method.
  
  
  
  The photographic atlas is a useful tool for field estimation of dietary intake. Average errors were low, and there was 'modest' agreement between weighed and recalled portion size image selection of rice and vegetable curry food items. Error in energy estimation was low but with wide limits of agreement, suggesting that there is scope for future work to reduce error further.
authors.affiliation: 1Institute for Global Health,University College London,30 Guilford Street,London WC1N 1EH,UK.
authors.forename: Helen
authors.identifier: 0000-0003-2367-908X
authors.initials: H
authors.lastname: Harris-Fry
authors.affiliation: 3Mother and Infant Research Activities (MIRA),Behind Siddhartha Finance,Kathmandu,Nepal.
authors.forename: Puskar
authors.initials: P
authors.lastname: Paudel
authors.affiliation: 3Mother and Infant Research Activities (MIRA),Behind Siddhartha Finance,Kathmandu,Nepal.
authors.forename: Manorama
authors.initials: M
authors.lastname: Karn
authors.affiliation: 3Mother and Infant Research Activities (MIRA),Behind Siddhartha Finance,Kathmandu,Nepal.
authors.forename: Nisha
authors.initials: N
authors.lastname: Mishra
authors.affiliation: 3Mother and Infant Research Activities (MIRA),Behind Siddhartha Finance,Kathmandu,Nepal.
authors.forename: Juhi
authors.initials: J
authors.lastname: Thakur
authors.affiliation: 3Mother and Infant Research Activities (MIRA),Behind Siddhartha Finance,Kathmandu,Nepal.
authors.forename: Vikas
authors.initials: V
authors.lastname: Paudel
authors.affiliation: 1Institute for Global Health,University College London,30 Guilford Street,London WC1N 1EH,UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Harrisson
authors.affiliation: 3Mother and Infant Research Activities (MIRA),Behind Siddhartha Finance,Kathmandu,Nepal.
authors.forename: Bhim
authors.initials: B
authors.lastname: Shrestha
authors.affiliation: 3Mother and Infant Research Activities (MIRA),Behind Siddhartha Finance,Kathmandu,Nepal.
authors.forename: Dharma S
authors.initials: DS
authors.lastname: Manandhar
authors.affiliation: 1Institute for Global Health,University College London,30 Guilford Street,London WC1N 1EH,UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Costello
authors.affiliation: 2Institute of Child Health,University College London,London,UK.
authors.forename: Mario
authors.initials: M
authors.lastname: Cortina-Borja
authors.affiliation: 1Institute for Global Health,University College London,30 Guilford Street,London WC1N 1EH,UK.
authors.forename: Naomi
authors.initials: N
authors.lastname: Saville
mesh_terms: D000328:Adult; D004034:Diet Surveys; D002149:Energy Intake; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009390:Nepal; D010781:Photography; D064787:Portion Size; D011247:Pregnancy; D015203:Reproducibility of Results; D055815:Young Adult
keywords: Dietary intake; Food atlas; Portion size; Validation