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Methodological Approaches for Dietary Intake Assessment in Formula-fed Infants

Luque, Veronica*; Escribano, Joaquin*; Mendez-Riera, Georgina*; Schiess, Sonia; Koletzko, Berthold; Verduci, Elvira; Stolarczyk, Anna§; Martin, Françoise||; Closa-Monasterolo, Ricardo*

Journal of Pediatric Gastroenterology & Nutrition: March 2013 - Volume 56 - Issue 3 - p 320–327
doi: 10.1097/MPG.0b013e3182779a60
Original Articles: Hepatology and Nutrition

Background and Objective: The estimation of dietary intake remains a challenge in human nutritional studies. In infants, the use of food diaries (FDs) is a suitable method already validated; however, this method is not exempt from error. In formula-fed infants, dilution of powdered formulas may produce errors. Our aim was to develop and validate standard operating procedures (SOPs) for the assessment of dietary intake in formula-fed infants, attending potential sources of error.

Methods: We analysed sources of error in a random subsample of 3-day FDs from 100 infants enrolled in the European Childhood Obesity Project. Calculations to estimate intakes were standardised and included in a software tool (SOPsystem). An evaluation of a simulated FD was performed by 9 trained nutritionists and 23 nutrition students (n = 225 and n = 575 bottle evaluations, respectively) to compare the results obtained when using or not the SOPsystem. Correct answers (%), coefficients of variation, and the time spent (minutes) to assess the simulated FD were analysed.

Results: Overall, 60% of the FDs contained reports of incorrect volumes, and 37% reported incorrect formula dilutions. When the SOPsystem was used, correct answers in the simulated FD were more frequent (P < 0.001) and the mean coefficient of variation and the time spent were lower (P < 0.005 and P < 0.01, respectively).

Conclusions: The development and implementation of SOPs with a software tool that identifies specific sources of error in record-keeping achieved a harmonised and improved process for assessing dietary intakes in formula-fed infants, minimising errors in calculations and reducing the work time invested.

*Universitat Rovira i Virgili, IISPV, Reus, Spain

Hauner Children's Hospital, University of Munich Medical Centre, Munich, Germany

Department of Pediatrics, University of Milan, San Paolo Hospital, Milan, Italy

§Children's Memorial Health Institute, Warsaw, Poland

||CHC St Vincent Liège, Belgium.

Address correspondence and reprint requests to Ricardo Closa-Monasterolo, Paediatrics Unit, Universitat Rovira i Virgili, IISPV, C/Sant Llorenç 21, 43201 Reus, Spain (e-mail:

Received 5 July, 2012

Accepted 23 September, 2012 registration number: NCT00338689.

European Childhood Obesity Project Study Group members: Grote V, Koletzko B, Beyer J, Demmelmair H, Fritsch M, Haile G, Handel U, Hannibal I, Pawellek I, Schiess S, Verwied-Jorky S, von Kries R, Weber M (Children's University Hospital, University of Munich Medical Centre, Munich, Germany), Escribano J, Closa R, Luque V, Ferre N, Zaragoza-Jordana M, Mendez-Riera G (Pediatrics Unit, Universitat Rovira i Virgili, IISPV, Reus, Spain), Gruszfeld D, Socha P, Socha J, Dobrzańska A, Janas R, Wierzbicka A (Children's Memorial Health Institute, Warsaw, Poland), Carlier C, Dain E, Goyens P, Hoyos J, Poncelet P (ULB, Bruxelles, Belgium), Xhonneux A, Van Hees JN, Langhendries J-P (CHC St Vincent Liege, Belgium), Perrin E (Danone Research Centre for Specialized Nutrition, Schiphol, The Netherlands), Agostoni C, Giovannini M, Re Dionigi A, Riva E, Scaglioni S, Vecchi F, Verducci E (University of Milan).

The European Childhood Obesity Project was carried out with the financial support of the European Community, under the 5th Framework Programme for Research, Technology & Demonstration “Quality of Life and Management of Living Resources,” Key Action 1 (Food, Nutrition & Health), contract number QLK1-CT2002-389. B.K. is the recipient of a Freedom to Discover Award from the Bristol-Myers Squibb Foundation, New York, NY. This article does not necessarily reflect the views of the Commission and in no way anticipates its future policy in this area.

The authors report no conflicts of interest.

Copyright 2013 by ESPGHAN and NASPGHAN