dietary assessment tool network (diet@net) mrc … · dietary assessment. the delphi techniques...

DIETary Assessment Tool NETwork(DIET@NET) MRC Partnership Grant. Nutritools (www.nutritools.org)

Dr Marisol Warthon-Medina, QIB

Paul Finglas, Mark Roe, Janet Cade, Barrie Margetts, Sian

Robinson, Andy Ness, Nisreen Alwan, Neil Hancock on

behalf of the DIET@NET Consortium. Tunisia 8th November, 2018.

Outline

• DIET@NET project (Nutritools)

• Best Practice Guidelines (BPG)

• Tool library development – Systematic Review of Reviews

• Nutritools website overview

Partnership Expertise

MWM

Aim

Improve the quality, consistency and comparability of dietary data

collected in epidemiological & clinical studies by:

Producing best practice guidelines (BPG) around the collection and analysis of dietary intake data to help raise standards;

Providing access to high-quality, online tools to measure food and nutrient intakes.

DIET@NET Partnership Structure - Groups and Group Chairs

DIET@NET members - Acknowledgements

Steering Group (SG): Janet Cade, Barrie Margetts, Sian Robinson, Nisreen Alwan,

Andrew Ness, Petra Wark, Toni Steer, Polly Page, Paul Finglas,

Tim Key.

Advisory Group (AG): Barrie Margetts, Amy Subar, Gilliam

Swan, Andrea de Silva Sanigorski, Nadia Slimani, Mark

Lawrence, Simon Wheeler.

Working Groups: Laura Johnson, Linda Harvey, Mark Roe,

Katharine Roberts, Victoria Burley, Darren Greenwood,

Birdem Amoutzopoulous, Darren Cole, Hermione Lawson,

‘SG’.

Project team: Janet Cade, Marisol Warthon-Medina, Neil

Hancock, Jayne Hutchinson, Lauren Gibson, Linda Bush, Elisa

Vargas-Garcia, Jozef Hooson.

DIET@NET – Strands of work

IBest Practice

Guidelines for dietary assessment

II

DAT-eLibrary(interactive website)

III

Online interface between food tables

and tools

Nutritools website work strands

The Nutritools website (www.nutritools.org)

Introduction

➢ Accurate assessment of dietary intake is important for: • Planning and implementation of health promotion

• Evaluating the effectiveness of public health interventions

• Research into links between diet and health.

➢ Measuring dietary intake is one of the most challenging aspects of public health research as no dietary method can measure dietary intake without error.

➢ Strategies which support researchers to choose the most appropriate dietary assessment method are needed.

Aim: Using expert consensus, we aimed to develop Best Practice Guidelines (BPG) to aid researchers carrying out dietary assessment.

Steps for the development of the Best Practice Guidelines (BPG) for dietary assessment

Best Practice Guidelines for dietary assessment

43 Guidelines: Essential (E) & Desirable (D)

Best Practice Guidelines

Cade, J. E., M. Warthon-Medina, S. Albar, N. A. Alwan, A. Ness, M. Roe, P. A. Wark, K. Greathead, V. J. Burley, P. Finglas, L. Johnson, P. Page, K. Roberts, T. Steer, J. Hooson, D. C. Greenwood and S. Robinson (2017). "DIET@NET: Best Practice Guidelines for dietary assessment in health research." BMC Medicine 15(1): 202.https://doi.org/10.1186/s12916

-017-0962-x

131 experts invited.

57 experts were involved in Delphi process

Best Practice Guidelines (BPG) Key message:

➢Using the Best Practice Guidelines will help selection, standardization and quality of dietary assessment.

➢The Delphi techniques allowed us to synthesise experts’ consensus on best practice in choosing a potential Dietary Assessment Tool (DAT) & think through its implementation.

➢The BPG will help researchers to select the most appropriate DAT.

➢These guidelines are included on the Nutritools website (www.nutritools.org).

Best Practice Guidelines Example

Dietary Assessment Tools (DATs) – Strengths and Weaknesses

FFQ – Strengths and Weaknesses

Tool library• The DATe-library provides information on:

-63 UK dietary assessment tools and -64 worldwide tools and validation study characteristics.

• Visual presentation of DATs using:-bubble charts and -summary plots, allows easy comparison between the DATs.

MWM

Systematic Review of Systematic Reviews

7 scientific databases

searched for reviews post

2000

51 reviews identified after

full screening

97 UK + 845 non-UK tool

development and

validation papers located

DAT data extraction

Phase 1 – 63 UK DATs

Phase 2 – >400 non-UK

DAT access secured from tool

owner and

inclusion in e-library

Databases Searched

Systematic Review – Search Terms Domain 1 (what DATs are assessing)

1 exp diet/ 2 Nutritional status.mp. 3 diet* adj2 intake*.mp 4 diet* adj2 qualit*.mp. 5 food adj2 intake*.mp. 6 nutri* adj2 intake*.mp. 7 diet* adj2 habit*.mp. 8 food adj2 habit.mp. 9 diet* pattern* or meal pattern*.mp. 10 food group*.mp. 11 nutrient*.mp. 12 macro-nutrient* or macronutrient.mp. 13 micro-nutrient or micronutrient.mp. 14 energy intake*.mp. 15 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14

Domain 2 (different types of DATs)

16 diet* adj2 (method* or tool* or survey* or record* or assess*).mp. 17 diet* adj2 (recall* or questionnaire* or histor* or instrument*).mp. 18 nutrition* adj2 (survey* or assess* or instrument*).mp. (27252) 19 food adj2 (questionnaire* or record* or recall* or diar* or checklist* or screener*).mp 20 24* adj2 recall.mp. 21 multiple pass.mp 22 FFQ*.mp 23 diet* adj2 (measure* or analys*).mp 24 nutri* adj2 measur*.mp 25 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23 or 24

Domain 3 (the quality of the DATs)

26 valid*.mp. 27 reliab*.mp. 28 reproduc*.mp. 29 calibrat*.mp. 30 repeatab*.mp 31 feasib*.mp 32 evaluat*.mp 33 26 or 27 or 28 or 29 or 30 or 31

Domain 4 (limiting the results to reviews)

34 review*.mp 35 meta-analy*.mp. 36 search*.mp. 37 systematic* adj2 (approach or analys*).mp. 38 33 or 34 or 35 or 36

Domain 1, 2 ,3 and 4 39 15 and 25 and 32 and 37

Domain 1 (what DATs are assessing)

1 exp diet/ 2 Nutritional status.mp. 3 diet* adj2 intake*.mp 4 diet* adj2 qualit*.mp. 5 food adj2 intake*.mp. 6 nutri* adj2 intake*.mp. 7 diet* adj2 habit*.mp. 8 food adj2 habit.mp. 9 diet* pattern* or meal pattern*.mp. 10 food group*.mp. 11 nutrient*.mp. 12 macro-nutrient* or macronutrient.mp. 13 micro-nutrient or micronutrient.mp. 14 energy intake*.mp. 15 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14

Domain 2 (different types of DATs)

16 diet* adj2 (method* or tool* or survey* or record* or assess*).mp. 17 diet* adj2 (recall* or questionnaire* or histor* or instrument*).mp. 18 nutrition* adj2 (survey* or assess* or instrument*).mp. (27252) 19 food adj2 (questionnaire* or record* or recall* or diar* or checklist* or screener*).mp 20 24* adj2 recall.mp. 21 multiple pass.mp 22 FFQ*.mp 23 diet* adj2 (measure* or analys*).mp 24 nutri* adj2 measur*.mp 25 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23 or 24

Domain 3 (the quality of the DATs)

26 valid*.mp. 27 reliab*.mp. 28 reproduc*.mp. 29 calibrat*.mp. 30 repeatab*.mp 31 feasib*.mp 32 evaluat*.mp 33 26 or 27 or 28 or 29 or 30 or 31

Domain 4 (limiting the results to reviews)

34 review*.mp 35 meta-analy*.mp. 36 search*.mp. 37 systematic* adj2 (approach or analys*).mp. 38 33 or 34 or 35 or 36

Domain 1, 2 ,3 and 4 39 15 and 25 and 32 and 37

Domain 1 (what DATs are assessing)

1 exp diet/ 2 Nutritional status.mp. 3 diet* adj2 intake*.mp 4 diet* adj2 qualit*.mp. 5 food adj2 intake*.mp. 6 nutri* adj2 intake*.mp. 7 diet* adj2 habit*.mp. 8 food adj2 habit.mp. 9 diet* pattern* or meal pattern*.mp. 10 food group*.mp. 11 nutrient*.mp. 12 macro-nutrient* or macronutrient.mp. 13 micro-nutrient or micronutrient.mp. 14 energy intake*.mp. 15 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14

Domain 2 (different types of DATs)

16 diet* adj2 (method* or tool* or survey* or record* or assess*).mp. 17 diet* adj2 (recall* or questionnaire* or histor* or instrument*).mp. 18 nutrition* adj2 (survey* or assess* or instrument*).mp. (27252) 19 food adj2 (questionnaire* or record* or recall* or diar* or checklist* or screener*).mp 20 24* adj2 recall.mp. 21 multiple pass.mp 22 FFQ*.mp 23 diet* adj2 (measure* or analys*).mp 24 nutri* adj2 measur*.mp 25 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23 or 24

Domain 3 (the quality of the DATs)

26 valid*.mp. 27 reliab*.mp. 28 reproduc*.mp. 29 calibrat*.mp. 30 repeatab*.mp 31 feasib*.mp 32 evaluat*.mp 33 26 or 27 or 28 or 29 or 30 or 31

Domain 4 (limiting the results to reviews)

34 review*.mp 35 meta-analy*.mp. 36 search*.mp. 37 systematic* adj2 (approach or analys*).mp. 38 33 or 34 or 35 or 36

Domain 1, 2 ,3 and 4 39 15 and 25 and 32 and 37

Domain 1 (what DATs are assessing)

1 exp diet/ 2 Nutritional status.mp. 3 diet* adj2 intake*.mp 4 diet* adj2 qualit*.mp. 5 food adj2 intake*.mp. 6 nutri* adj2 intake*.mp. 7 diet* adj2 habit*.mp. 8 food adj2 habit.mp. 9 diet* pattern* or meal pattern*.mp. 10 food group*.mp. 11 nutrient*.mp. 12 macro-nutrient* or macronutrient.mp. 13 micro-nutrient or micronutrient.mp. 14 energy intake*.mp. 15 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14

Domain 2 (different types of DATs)

16 diet* adj2 (method* or tool* or survey* or record* or assess*).mp. 17 diet* adj2 (recall* or questionnaire* or histor* or instrument*).mp. 18 nutrition* adj2 (survey* or assess* or instrument*).mp. (27252) 19 food adj2 (questionnaire* or record* or recall* or diar* or checklist* or screener*).mp 20 24* adj2 recall.mp. 21 multiple pass.mp 22 FFQ*.mp 23 diet* adj2 (measure* or analys*).mp 24 nutri* adj2 measur*.mp 25 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23 or 24

Domain 3 (the quality of the DATs)

26 valid*.mp. 27 reliab*.mp. 28 reproduc*.mp. 29 calibrat*.mp. 30 repeatab*.mp 31 feasib*.mp 32 evaluat*.mp 33 26 or 27 or 28 or 29 or 30 or 31

Domain 4 (limiting the results to reviews)

34 review*.mp 35 meta-analy*.mp. 36 search*.mp. 37 systematic* adj2 (approach or analys*).mp. 38 33 or 34 or 35 or 36

Domain 1, 2 ,3 and 4 39 15 and 25 and 32 and 37

Domain 1 (What are the DATs measuring)

Domain 2 (Different type of DATs)

Domain 3 (Quality of the DATs)

Domain 4 (Limiting results to reviews)

• Reviews which evaluate/complete a comparative analysis on validated DATs which measure full nutrient intake, macro or micro nutrient intake, food groups, or non-nutrients e.g. flavonoids.

• Reviews which include DATs validated against a biomarker or another self-reported measure of dietary intake.

• Reviews that include DATs which have been validated in any population.

Inclusion Criteria

Exclusion Criteria

• Only assess DATS which measures:

➢ Eating Behaviour

➢ Food Preference

➢ Feeding Practices

➢ Eating Disorders

➢ Malnutrition

• Only assess DATS which cannot be implemented on Nutritools.org - e.g. PDAs.

• Only assess lifestyle questionnaires (diet plus physical activity) where diet questions are minimal.

• All of the DATs and papers identified from the systematic reviews were downloaded and reviewed to determine eligibility for the Nutritools website.

• To be eligible for inclusion the DATs had to be valid, measure dietary intake and be able to be added onto the website.

• No date restrictions was imposed on the selection of DATs

• DATs were split up into UK and non-UK, as UK DATs would only be added onto the website.

Identifying DATs from the Systematic Reviews

Library of validated DATs

DAT in the UK: Child and Diet Evaluation Tool (CADET) - Food checklist

DAT in the UK: Myfood24 (https://www.myfood24.org)spinout company : Dietary Assessment Ltd

DAT in France

DATs for African countries• Tool available from Botswana:

FFQ1 year

• Tool available from South Africa:

Tool visualisation

Bubble chart Summary plot

Food Questionnaire Creator

FQC – CADET example of finalised questionnaire

Links to useful resources

Nutritools glossary

Help / FAQ

References• Lachat C, Hawwash D, Ocké MC, Berg C, Forsum E, et al. (2016) Strengthening the Reporting of

Observational Studies in Epidemiology—Nutritional Epidemiology (STROBE-nut): An Extension of the STROBE Statement. PLoS Med 13: e1002036.

• Bland JM, Altman DG (1995) Comparing methods of measurement: why plotting difference against standard method is misleading. The Lancet 346: 1085-1087.

• Moher D, Schulz KF, Simera I, Altman DG (2010) Guidance for developers of health research reporting guidelines. PLoS medicine 7: e1000217.

• Carter MC, Albar SA, Morris MA, Mulla UZ, Hancock N, et al. (2015) Development of a UK Online 24-h Dietary Assessment Tool: myfood24. Nutrients 7: 4016-4032.

• Diet, Anthropometry and Physical Activity (DAPA) Measurement Toolkit:http://dapa-toolkit.mrc.ac.uk/

• National Cancer institute Dietary Assessment Primer:https://dietassessmentprimer.cancer.gov/concepts/

Principle Investigator: Prof Janet Cade

Project Manager: Dr Marisol Warthon-Medina

Research Support Assistant: Mr. Jozef Hooson

Database Manager: Mr. Neil Hancock

Dr Salwa Albar Dr Nisreen Alwan Prof Andy Ness Mr Mark Roe Prof Petra Wark Dr Katharine GreatheadDr Victoria Burley Mr Paul Finglas

Dr Laura Johnson Ms Polly Page Dr Katharine Roberts

Dr Toni SteerDr Darren Greenwood Prof Sian Robinson

Contact Nutritools –nutritools@leeds.ac.uk

www.nutritools.ac.uk

@Nutritools_org

Acknowledgements: DIET@NET Consortium –Project team

Acknowledgements:

• Paul Finglas, Head of FDNC paul.finglas@quadram.ac.uk

• Mark Roe mr@eurofir.org

• Dr Marisol Warthon-Medina marisol.warthon-medina@quadram.ac.uk

• Jenny Plumb jenny.plumb@quadram.ac.uk

• Hannah Pinchen Hannah.Pinchen@quadram.ac.uk

• Rachel Berry Rachel.Berry@quadram.ac.uk

• Olivia Shaw Olivia.Shaw@quadram.ac.uk

• Daniela Segovia-Lizano Daniela.Segovia-Lizano@quadram.ac.uk

• Pete Metcalf peter.metcalf@quadram.ac.uk

Food Databanks National Capability (FDNC) https://fdnc.quadram.ac.uk/Quadram Institute Bioscience (QIB) & EuroFIRhttp://www.eurofir.org/:

Feedback from Nutritools website users: – Agreed Quotations

“The website looks great and easy to use and such a resource was long

overdue.” Dr Angeliki Papadaki, Senior Lecturer in Nutrition, School for Policy Studies, University of Bristol.

“I think that it is an excellent site and could be very useful to people

wishing to conduct dietary surveys. It is very intuitive to navigate” Dr Helen

Moore, Knowledge Exchange Manager (EPSRC IAA) in the Research and Innovation Services, Durham University.

“Nutritools is an exciting and very worthwhile initiative” Associate Professor Anne-

Louise Heath in the Department of Human Nutrition at the University of Otago, New Zealand.