Browsing by Subject "food photographs"
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(2020)Introduction Kenya has recently acquired lower-middle income country status and is facing the triple burden of malnutrition. There is a shortage of data on food intake habits of children and adolescents especially in the rapidly changing urban environments. To be able to reliably measure food intake, one must be able to accurately estimate food portion sizes. Children’s ability to recall portion sizes consumed can vary widely. When a photographic food atlas designed for children with applicable portions is used, it can improve children’s estimation of food portions. Objectives The aim of this study was to develop a photographic food atlas to be used in assessing portion sizes among Kenyan adolescents aged 9-14 years living in urban areas, to support a quantitative 7-day food frequency questionnaire. The second aim was to assess the usability of the atlas amongst 9-14-year-olds and professionals working in the field of nutrition. Methodology A steering group of Finnish and Kenyan nutritionists was formed to oversee the development of the atlas. Literature and other official documents were reviewed to identify the most commonly consumed foods among 9-14-year-old Kenyans. To obtain weighed portion size data, participants were recruited in Nairobi sub-counties Embakasi Central and Langata to represent low- and middle-socioeconomic status respectively. Twenty-one participants aged 9-14 years participated in the weighing of portion sizes, food portions from street markets were also weighed. Three portion sizes (A, B, C) were calculated for most of the 88 food items in the photographic food atlas. Portion B was the average of all weighed portion sizes, portion A was half of B, and portion C was one and half times B. Cooking demonstrations were arranged with the families of participants and the food portions were weighed out and photographed. A photographic food atlas was compiled, and its usability was tested amongst eight adolescents and four nutrition professionals. The usability survey consisted of Likert scale and open-end questions to ascertain acceptability of the atlas. Verbal feedback and observations were also recorded. Results Based on the usability survey, the photographic food atlas received the Usability Score of “OK” and “Good” from adolescents and nutrition professionals respectively. All eight adolescents agreed that the atlas helped them recall portion sizes, but half disagreed and one was unsure whether they could use the atlas on their own. All four professionals agreed they would use the atlas in their work, but all found the quality of photographs poor. Two adolescents disagreed when asked if the portion sizes were small enough and one disagreed when asked if the portion sizes were large enough. However, all professionals agreed that portion sizes were reasonable for the age group. Professionals gave verbal suggestions on improvements, for example, which foods were missing, how to adjust layout as well as the shapes of portion sizes. Conclusion An atlas consisting of 88 most commonly consumed Kenyan foods was developed based on weighed portion sizes of 9-14-year-old Kenyans. The shapes of portion sizes as well as range of portion sizes were crucial for its usability. Poor picture quality hampered recognition of pictures. Clear instructions and explanation of the purpose of the atlas were crucial. A second version of the atlas was developed based on the feedback. The updated atlas, including 173 food items, was used in a cross-sectional study in Nairobi. Further research is recommended to validate the photographic food atlas in order to identify the possible bias it may introduce to portion size estimation.
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Validity of food photographs for portion size estimation among Nairobian women of reproductive age (2022)Introduction The coexistence of obesity and undernutrition referred to as the double burden of malnutrition (DBM), has been reported in low- and middle-income countries, including Kenya. Women are especially vulnerable to malnutrition due to their nutritional needs during pregnancy and lactation, highlighting the importance of assessing their dietary intake to address their food and nutrition security. However, accurate portion size estimation has been found to be challenging during dietary surveys. Food photographs are useful for estimating portion sizes and are easy to use in dietary surveys. Objectives To assess the validity of food photographs in portion size estimation of commonly consumed foods among women of reproductive age (13-45 years) in Nairobi. The second aim was to examine the association of sociodemographic characteristics such as age and educational level on the accuracy of portion size estimations. Methodology A validation study was carried out among 206 women of reproductive age (13-45 years) in Kahawa West, Nairobi County. Eleven commonly consumed Kenyan foods (ugali, chapati, rice, beans, beef, sukuma wiki, tilapia, sweet banana, orange, pawpaw and watermelon) were chosen to be tested from the Photographic Food Atlas for Kenyan Adolescents (9-14 years). The participants were randomly served pre-weighed food portions based on those in the Food Atlas (in most cases there were three different portion sizes). In most cases, the food portions were similar in weight to those depicted in the food photographs. After the meal, participants were asked to estimate the amount of food consumed using food photographs from the Food Atlas. Any leftover food was recorded and the amount of food consumed was calculated as the difference between the amount weighed and the amount left. Validity was assessed by calculating the mean percent difference between estimated and consumed portions, percentage of estimates within -10 to 10% of consumed portion size, Spearman’s correlation coefficients and Bland–Altman limits of agreement. Pearson’s Chi-square test was used to examine the associations between the accuracy of estimations and participants’ age and educational level. Results Correlations between consumed and estimated portions were significant for all food items except for watermelon (p=0.380). The proportion of participants with estimates within ± 10% of the consumed portion size was above 50% for four of the food items including chapati, sukuma wiki, rice and beef; four other food items, including ugali, pawpaw, orange and tilapia, correct estimates ranged from 43-47%; and for the remaining three food items, including beans, sweet banana and watermelon, correct estimates ranged from 15-34%. Extreme mean differences between the consumed and estimated portion sizes by photograph were between -45% for beans to 563% for pawpaw. In most of the food items, small portions were overestimated while large portions were underestimated. Bland–Altman plots showed wide limits of agreement. The accuracy of estimations was not associated with participants’ age or educational level. Conclusion The food photographs for chapati, sukuma wiki, rice and beef from the Food Atlas for Kenyan adolescents seem to be a valid tool for quantification of portion sizes for women of reproductive age in Nairobi. However, the findings of this study suggest that further improvements are needed to the Food Atlas for wider use in Kenya.
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