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      Mobile Ecological Momentary Diet Assessment Methods for Behavioral Research: Systematic Review

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          Abstract

          Background

          New methods for assessing diet in research are being developed to address the limitations of traditional dietary assessment methods. Mobile device–assisted ecological momentary diet assessment (mEMDA) is a new dietary assessment method that has not yet been optimized and has the potential to minimize recall biases and participant burden while maximizing ecological validity. There have been limited efforts to characterize the use of mEMDA in behavioral research settings.

          Objective

          The aims of this study were to summarize mEMDA protocols used in research to date, to characterize key aspects of these assessment approaches, and to discuss the advantages and disadvantages of mEMDA compared with the traditional dietary assessment methods as well as implications for future mEMDA research.

          Methods

          Studies that used mobile devices and described mEMDA protocols to assess dietary intake were included. Data were extracted according to Preferred Reporting of Systematic Reviews and Meta-Analyses and Cochrane guidelines and then synthesized narratively.

          Results

          The review included 20 studies with unique mEMDA protocols. Of these, 50% (10/20) used participant-initiated reports of intake at eating events (event-contingent mEMDA), and 50% (10/20) used researcher-initiated prompts requesting that participants report recent dietary intake (signal-contingent mEMDA). A majority of the study protocols (60%, 12/20) enabled participants to use mobile phones to report dietary data. Event-contingent mEMDA protocols most commonly assessed diet in real time, used dietary records for data collection (60%, 6/10), and provided estimates of energy and nutrient intake (60%, 6/10). All signal-contingent mEMDA protocols used a near real-time recall approach with unannounced (ie, random) abbreviated diet surveys. Most signal-contingent protocols (70%, 7/10) assessed the frequency with which (targeted) foods or food groups were consumed. Relatively few (30%, 6/20) studies compared mEMDA with the traditional dietary assessment methods.

          Conclusions

          This review demonstrates that mEMDA has the potential to reduce participant burden and recall bias, thus advancing the field beyond current dietary assessment methods while maximizing ecological validity.

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          Most cited references66

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          Ecological momentary assessment.

          Assessment in clinical psychology typically relies on global retrospective self-reports collected at research or clinic visits, which are limited by recall bias and are not well suited to address how behavior changes over time and across contexts. Ecological momentary assessment (EMA) involves repeated sampling of subjects' current behaviors and experiences in real time, in subjects' natural environments. EMA aims to minimize recall bias, maximize ecological validity, and allow study of microprocesses that influence behavior in real-world contexts. EMA studies assess particular events in subjects' lives or assess subjects at periodic intervals, often by random time sampling, using technologies ranging from written diaries and telephones to electronic diaries and physiological sensors. We discuss the rationale for EMA, EMA designs, methodological and practical issues, and comparisons of EMA and recall data. EMA holds unique promise to advance the science and practice of clinical psychology by shedding light on the dynamics of behavior in real-world settings.
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            Using intake biomarkers to evaluate the extent of dietary misreporting in a large sample of adults: the OPEN study.

            This paper describes the Observing Protein and Energy Nutrition (OPEN) Study, conducted from September 1999 to March 2000. The purpose of the study was to assess dietary measurement error using two self-reported dietary instruments-the food frequency questionnaire (FFQ) and the 24-hour dietary recall (24HR)-and unbiased biomarkers of energy and protein intakes: doubly labeled water and urinary nitrogen. Participants were 484 men and women aged 40-69 years from Montgomery County, Maryland. Nine percent of men and 7% of women were defined as underreporters of both energy and protein intake on 24HRs; for FFQs, the comparable values were 35% for men and 23% for women. On average, men underreported energy intake compared with total energy expenditure by 12-14% on 24HRs and 31-36% on FFQs and underreported protein intake compared with a protein biomarker by 11-12% on 24HRs and 30-34% on FFQs. Women underreported energy intake on 24HRs by 16-20% and on FFQs by 34-38% and underreported protein intake by 11-15% on 24HRs and 27-32% on FFQs. There was little underreporting of the percentage of energy from protein for men or women. These findings have important implications for nutritional epidemiology and dietary surveillance.
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              Need for technological innovation in dietary assessment.

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                Author and article information

                Contributors
                Journal
                JMIR Mhealth Uhealth
                JMIR Mhealth Uhealth
                JMU
                JMIR mHealth and uHealth
                JMIR Publications (Toronto, Canada )
                2291-5222
                November 2018
                20 November 2018
                : 6
                : 11
                : e11170
                Affiliations
                [1 ] Department of Behavioral Science Division of Cancer Control and Population Sciences The University of Texas MD Anderson Cancer Center Houston, TX United States
                [2 ] Department of Family and Community Medicine College of Medicine-Tucson University of Arizona Tucson, AZ United States
                [3 ] Institute for Health Promotion & Disease Prevention Department of Preventive Medicine University of Southern California Los Angeles, CA United States
                [4 ] Department of Nutritional Sciences College of Agriculture & Life Sciences University of Arizona Tucson, AZ United States
                [5 ] Department of Kinesiology Wiess School of Natural Sciences Rice University Houston, TX United States
                [6 ] Department of Health and Human Performance College of Liberal Arts and Social Sciences University of Houston Houston, TX United States
                [7 ] Viocare, Inc Princeton, NJ United States
                [8 ] Department of Health Promotion Sciences Mel and Enid Zuckerman College of Public Health University of Arizona Tucson, AZ United States
                [9 ] Epidemiology Program University of Hawaii Cancer Center Honolulu, HI United States
                Author notes
                Corresponding Author: Susan M Schembre sschembre@ 123456email.arizona.edu
                Author information
                http://orcid.org/0000-0002-9945-7136
                http://orcid.org/0000-0002-9384-336X
                http://orcid.org/0000-0003-0146-562X
                http://orcid.org/0000-0002-6696-5601
                http://orcid.org/0000-0002-7578-5397
                http://orcid.org/0000-0001-5286-0430
                http://orcid.org/0000-0002-2727-5966
                http://orcid.org/0000-0002-4129-3829
                http://orcid.org/0000-0003-2308-9864
                http://orcid.org/0000-0003-3645-7048
                http://orcid.org/0000-0001-7517-787X
                Article
                v6i11e11170
                10.2196/11170
                6280032
                30459148
                293ca016-8413-4612-b25c-24deb32f8d0a
                ©Susan M Schembre, Yue Liao, Sydney G O'Connor, Melanie D Hingle, Shu-En Shen, Katarina G Hamoy, Jimi Huh, Genevieve F Dunton, Rick Weiss, Cynthia A Thomson, Carol J Boushey. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 20.11.2018.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mhealth and uhealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/.as well as this copyright and license information must be included.

                History
                : 31 May 2018
                : 9 July 2018
                : 3 October 2018
                : 10 October 2018
                Categories
                Review
                Review

                diet surveys,diet records,mobile phone,mobile apps,ecological momentary assessment

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