School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, QC, Canada.
Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
J Med Internet Res. 2022 Nov 21;24(11):e40449. doi: 10.2196/40449.
Thorough dietary assessment is essential to obtain accurate food and nutrient intake data yet challenging because of the limitations of current methods. Image-based methods may decrease energy underreporting and increase the validity of self-reported dietary intake. Keenoa is an image-assisted food diary that integrates artificial intelligence food recognition. We hypothesized that Keenoa is as valid for dietary assessment as the automated self-administered 24-hour recall (ASA24)-Canada and better appreciated by users.
We aimed to evaluate the relative validity of Keenoa against a 24-hour validated web-based food recall platform (ASA24) in both healthy individuals and those living with diabetes. Secondary objectives were to compare the proportion of under- and overreporters between tools and to assess the user's appreciation of the tools.
We used a randomized crossover design, and participants completed 4 days of Keenoa food tracking and 4 days of ASA24 food recalls. The System Usability Scale was used to assess perceived ease of use. Differences in reported intakes were analyzed using 2-tailed paired t tests or Wilcoxon signed-rank test and deattenuated correlations by Spearman coefficient. Agreement and bias were determined using the Bland-Altman test. Weighted Cohen κ was used for cross-classification analysis. Energy underreporting was defined as a ratio of reported energy intake to estimated resting energy expenditure <0.9.
A total of 136 participants were included (mean 46.1, SD 14.6 years; 49/136, 36% men; 31/136, 22.8% with diabetes). The average reported energy intakes (kcal/d) were 2171 (SD 553) in men with Keenoa and 2118 (SD 566) in men with ASA24 (P=.38) and, in women, 1804 (SD 404) with Keenoa and 1784 (SD 389) with ASA24 (P=.61). The overall mean difference (kcal/d) was -32 (95% CI -97 to 33), with limits of agreement of -789 to 725, indicating acceptable agreement between tools without bias. Mean reported macronutrient, calcium, potassium, and folate intakes did not significantly differ between tools. Reported fiber and iron intakes were higher, and sodium intake lower, with Keenoa than ASA24. Intakes in all macronutrients (r=0.48-0.73) and micronutrients analyzed (r=0.40-0.74) were correlated (all P<.05) between tools. Weighted Cohen κ scores ranged from 0.30 to 0.52 (all P<.001). The underreporting rate was 8.8% (12/136) with both tools. Mean System Usability Scale scores were higher for Keenoa than ASA24 (77/100, 77% vs 53/100, 53%; P<.001); 74.8% (101/135) of participants preferred Keenoa.
The Keenoa app showed moderate to strong relative validity against ASA24 for energy, macronutrient, and most micronutrient intakes analyzed in healthy adults and those with diabetes. Keenoa is a new, alternative tool that may facilitate the work of dietitians and nutrition researchers. The perceived ease of use may improve food-tracking adherence over longer periods.
彻底的饮食评估对于获得准确的食物和营养摄入量数据至关重要，但由于当前方法的局限性，这具有一定挑战性。基于图像的方法可能会减少能量低报，并提高自我报告的饮食摄入量的有效性。Keenoa 是一种集成人工智能食物识别功能的图像辅助饮食日记。我们假设 Keenoa 在饮食评估方面与自动化自我管理 24 小时回忆（ASA24）一样有效，并且比用户更喜欢。
我们旨在评估 Keenoa 与基于网络的 24 小时验证食物回忆平台（ASA24）在健康个体和糖尿病患者中的相对有效性。次要目标是比较工具之间的低报和高报比例，并评估工具的用户满意度。
我们使用随机交叉设计，参与者完成了 4 天的 Keenoa 食物跟踪和 4 天的 ASA24 食物回忆。使用系统可用性量表评估感知易用性。使用 2 尾配对 t 检验或 Wilcoxon 符号秩检验分析报告摄入量的差异，并使用 Spearman 系数进行去衰减相关性分析。使用 Bland-Altman 检验确定一致性和偏差。使用加权 Cohen κ 进行交叉分类分析。能量低报定义为报告的能量摄入量与估计的静息能量消耗的比值<0.9。
共纳入 136 名参与者（平均年龄 46.1±14.6 岁；49/136，36%为男性；31/136，22.8%患有糖尿病）。男性中，使用 Keenoa 的平均报告能量摄入量（kcal/d）为 2171（SD 553），使用 ASA24 的为 2118（SD 566）（P=.38），女性中，使用 Keenoa 的为 1804（SD 404），使用 ASA24 的为 1784（SD 389）（P=.61）。总体平均差异（kcal/d）为-32（95%CI -97 至 33），一致性界限为-789 至 725，表明两种工具之间具有可接受的一致性，没有偏差。报告的宏观营养素、钙、钾和叶酸摄入量之间没有显著差异。与 ASA24 相比，使用 Keenoa 时报告的纤维和铁摄入量较高，而钠摄入量较低。所有分析的宏观营养素（r=0.48-0.73）和微量营养素（r=0.40-0.74）之间的摄入量都具有相关性（所有 P<.05）。加权 Cohen κ 得分范围为 0.30 至 0.52（所有 P<.001）。两种工具的低报率均为 8.8%（12/136）。Keenoa 的系统可用性量表平均得分高于 ASA24（77/100，77%比 53/100，53%；P<.001）；74.8%（101/135）的参与者更喜欢 Keenoa。
在健康成年人和糖尿病患者中，Keenoa 应用程序在能量、宏观营养素和大多数微量营养素摄入方面与 ASA24 具有中等至较强的相对有效性。Keenoa 是一种新的替代工具，可能会促进营养师和营养研究人员的工作。感知易用性可能会提高食物跟踪的长期依从性。
