Relative validity of a 3 d estimated food record in German toddlers

Objective: To determine the relative validity of a 3 d estimated food record (EFR) used to assess energy and nutrient intakes in toddlers, using a 3 d weighed food record (WDR) as the reference method. Design: Parents reported the food and beverage intakes of their children using an EFR concurrently with a WDR over three consecutive days. Estimation of mean differences, Spearman correlation coefficients, cross-classifications and Bland-Altman plots were used to assess the agreement between the intakes of energy and fourteen nutrients obtained from the EFR and the WDR. Setting: Data obtained from a representative sample of infants or toddlers in Germany. Subjects: Sixty-seven toddlers aged 10-36 months who had completed an EFR for a 3 d recording period that corresponded to the WDR were included in the present analysis. Results: Energy and nutrient intakes did not differ between the EFR and the WDR, except for linoleic acid and retinol. For all dietary intakes, Spearman rank correlation coefficients between the EFR and the WDR ranged from 0.35 to 0.80 (P <= 0.004). The proportion of participants correctly classified into quartiles ranged from 75% for ascorbic acid intake to 96% for Fe intake, and the percentage of misclassification was 9% or less. The weighed kappa values ranking the participants ranged from 0.23 for ascorbic acid intake to 0.59 for Fe intake. The Bland-Altman plots indicated a good agreement for all dietary intakes estimated from the EFR. Conclusions: Our study suggests that this EFR is a valid assessment instrument for estimating the energy and nutrient intakes among toddlers at the group level.