Whether it’s a nutritious meat dish or a bowl of high-fat nuts, food intake is a key determinant for physical growth and cognitive development. The assimilation of nutrients plays a crucial role in human metabolism and the prevention of chronic illnesses. Given the prevalence of nutrition-related diseases, such as obesity, diabetes, cardiovascular disease, and dental problems; food intake assessments become fundamental in health care research and practice. Such evaluations can include dietary consumption data on foods, beverages, and supplements. Note that as food intake is not a static quality, eating assessments must be conducted in real-life settings to reflect the variety of food consumption, both in the short and the long-term.
Hence, ecological momentary assessments (EMAs), which are among the most reliable methods to assess a patient’s daily activities, can be employed as comprehensive and structured food diaries with high ecological validity and minimal recall bias. Interestingly, food diaries are defined as records of foods, portion sizes, eating schedules, nutrition statistics, environmental factors, and feelings. Digital ecological momentary assessment tools, in particular, can erase discrepancies in methodological heterogeneities in research and help users explore the pathways between dietary intake and health outcomes.
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Dietary intake is a multifaceted phenomenon which lacks constant qualities. As consumption varies between meals and populations, ecological momentary assessments can improve the monitoring of food intake and provide high-quality data in real-life settings. Ecological momentary assessment methods are empirically validated structured diary techniques. Depending on the study design, ecological momentary assessments can be additionally divided into interval-contingent schedules, signal-contingent reports, event-contingent captures, and continuous reporting. Note that other common terms used to define ecological momentary assessment include experience sampling methods, ambulatory assessment, daily diary studies, real-time data capture studies, intensive longitudinal methods, and beeper studies. With high ecological validity and minimal recall bias, ecological momentary assessments reveal numerous benefits and applications:
Note that appetite is a vital patient-reported outcome, such as mood and pain experiences, as it affects eating behaviors and varies from moment to moment. Appetite is also a sensory response to food presentation, smell, previous experience, and even social pressure.
Interestingly, evidence shows that dietary lapses are associated with reduced coping strategies, both cognitive and behavioral. Carels and colleagues (2004) assessed 37 postmenopausal women via ecological momentary assessment diaries and found that coping strategies, mood, and abstinence-violation effects play a crucial role in weight-loss programs and relapse crises. Thus, ecological momentary assessment methods can be used to improve self-awareness and adaptive coping regarding temptations and dietary lapses.
Additionally, Liao and colleagues (2018) examined high-fat/high-sugar food intake and food and vegetable consumption in 202 women via an electronic ecological momentary assessment. The team found that vegetable and fruit intake was associated with positive feelings. Interestingly, stress was a strong predictor for high-fat/high-sugar foods consumption, particularly in obese patients.
Note that perceived social support can promote healthy behaviors. Given the fact that cultural differences also impact dietary intake, interventions must focus on traditional foods, family support, and religious beliefs.
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Given the active role of patients in health care decision-making, patient-reported outcomes and ecological momentary assessments, in particular, are becoming more and more popular in practice. Subjective measures provide vital information known only to the patients, improving nutrition surveillance studies, dietary guidance, and self-awareness. When it comes to self-reported methods, two categories exist: methods of real-time recording and methods of recall (Naska et al., 2017). Real-time records consist of food diaries (with or without weighing of foods) and the duplicate portion method (which includes chemical analysis of portions). Methods of recall include dietary histories, food frequency questionnaires (FFQs), and single or multiple daily recalls (24-hour dietary recalls).
Interestingly, subjective data can be supported by the analysis of biomarkers or biological specimen, which may correlate with dietary intake, metabolism, and personal characteristics (e.g.. smoking habits). Note that there are four categories of biomarkers: recovery, concentration, replacement, and predictive biomarkers. In addition, biomarkers can be categorized into short-term (measured in urine, plasma or serum), medium-term (measured in red blood cells or adipose tissue), and long-term biomarkers (measured in hair, nails, or teeth). The list of reliable nutrition biomarkers is increasing to improve dietary pattern analyses and food composition tables.
When it comes to subjective measures, it’s crucial to mention that food intake ability is associated with oral health-related quality of life and mental health. Choi and colleagues (2016) found that reduced subjective food intake ability due to poor oral health can lead to depression, self-esteem, and anxiety. Participants (n=72) completed subjective food intake ability tests, the Oral Health Impact Profile-14 scale, and three questionnaires about anxiety, self-esteem, and depression. Thus, research findings on self-reported masticatory ability are essential to improve both orthodontic treatment and dietary intake.
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With the rapid implementation of digital health technologies, electronic assessments have become reliable instruments to reduce respondent burden and reporting bias. While paper diaries were originally used in combination with pagers or watches, now personal digital assistants, wearable devices, and health applications facilitate the evaluation and monitoring of sampled experiences and eating behaviors. The use of digital platforms allows the integration of databases and pictures of foods, packaging material, and seasonal variations in intake. Electronic assessments also support data management and interoperability.
In fact, with high ecological validity and attractive design, digital dietary assessments reveal numerous benefits in the field of foods and diet patterns research:
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Since effective strategies to measure and improve diet and chronic diseases are a major focus of research, ecological momentary assessment studies are growing in popularity. Ecological momentary assessment can be employed as empirically validated and structured food diaries to help researchers explore behaviors, symptoms, and triggers, which vary between and within individuals. Ecological momentary assessments usually constitute of short questionnaires, and beep prompts. Questionnaires can include open-ended questions, visual analog scales or checklists to assess energy intake, food consumption, physical activity, environmental factors, emotional well-being, and social support. Interestingly, rating scales such as the visual analog scale are valid indices of temporal sensations (e.g., satiety, hunger, appetite) (Merrill et al., 2002). Most of all, evidence shows that self-assessments and daily logs improve patient outcomes related to physical activity and weight management (Burke et al., 2012).
Food diaries can help patients track aspects, such as:
When designing an ecological momentary assessment (EMA) food diary, researchers must decide either on a schedule (interval-contingent, signal-contingent, event-contingent, or continuous reporting) or a combined approach. Prompts and interface designs should be attractive and non-invasive. Interestingly, dietary self-monitoring can be influenced by daily and seasonal aspects (e.g., the beginning of the intervention, the day of the week, and month of the year). Note that Pellegrini and colleagues (2018) examined within-person differences in self-monitoring during a 6-month technology-supported weight loss trial, and found that lower adherence was recorded as the study progressed as well as on the weekends.
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Measuring diet is a challenging task. Food intake depends on various factors, such as body mass, appetite, social support, age, sex, and education. Therefore, only self-reports and food diaries can help health professionals assess dietary intake and its underlying mechanisms. Ecological momentary assessments, in particular, can be employed as effective diary techniques. Such measurements have high ecological validity, sensitivity, and accuracy. As these repeated assessments are conducted in real-life situations, the memory strains and burden to participants are reduced. Food diaries provide rich data on emotions, quality of life, social support, physical activity, and energy intake. Most of all, subjective measures empower patients, which is a leading goal in digital health practices worldwide. By becoming active participants in decision-making, patients can grasp a better understanding of their diet and eating behaviors.
After all, diet is defined as the main pathway between food environments and health outcomes, including in children. Interestingly, Campbell et al. (2018) found that factors in the family environment (e.g., eating alone or in front of the TV) influence eating behaviors in toddlers. The research team asked low-income mothers (n=277) to assess their home environment, and toddler’s eating habits through ecological momentary assessment, and performed multilevel logistic mixed-effects regression models to analyze the data. Note in the US alone; obesity rates are increasing, affecting 13.7 million children (aged 2-18 years). Thus, the adaptation of early healthy eating habits is vital to prevent chronic diseases and disabilities later in life.
In fact, digital ecological momentary assessment methods can benefit both interventions and informing policy. Understanding dietary intake among individuals can improve nutrition initiatives (e.g., school lunch initiatives) on local and national levels. Note that demographic factors and cultural differences influence people’s perceptions of obesity and dietary intake, so interventions should consider the integration of traditional foods and beliefs. Research findings can also improve food retail access, calorie labeling, food restrictions, and healthy choices.
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