The relative validity of nutrition assessment methods for estimating infant carotenoid intake differs by assessment tool, nutrient database, and milk carotenoid adjustment method

Authors: JUNEJA, SHIVANKI - Children'S Nutrition Research Center (CNRC); CHANG, JOCELYN - Children'S Nutrition Research Center (CNRC); NGUYEN, THUY - Children'S Nutrition Research Center (CNRC); CASTANEDA, ROBERT - Children'S Nutrition Research Center (CNRC); O'CONNOR, TERESIA - Children'S Nutrition Research Center (CNRC); MUSAAD, SALMA - Children'S Nutrition Research Center (CNRC); MORAN, NANCY - Children'S Nutrition Research Center (CNRC)

Submitted to: Nutrition Research
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 6/3/2024
Publication Date: 6/13/2024
Citation: Juneja, S., Chang, J., Nguyen, T., Castaneda, R., O'Connor, T., Musaad, S., Moran, N.E. 2024. The relative validity of nutrition assessment methods for estimating infant carotenoid intake differs by assessment tool, nutrient database, and milk carotenoid adjustment method. Nutrition Research. https://doi.org/10.1016/j.nutres.2024.06.003.
DOI: https://doi.org/10.1016/j.nutres.2024.06.003

Interpretive Summary: Health researchers need rigorous methods to determine what children eat in order to understand children’s dietary patterns. There are different standardized methods to find out what children eat, including food frequency questionnaires, 24 hour recalls, and food diaries. There are also different databases that can be used to convert food survey data into nutrient intake data. When it comes to studying how an infant’s intake of carotenoids, the red, orange, and yellow antioxidant pigments in fruits, vegetables, and milk, impact their health, it can be hard to find out what infants are actually consuming. This study set out to determine how different infant carotenoid intake assessment approaches compared with the rigorous method of 7 days of food diaries, analyzed with a comprehensive nutrient database, and with personalized adjustments for breastmilk and formula carotenoid concentrations. This study found that FFQs with personalized milk carotenoid adjustment were good for determining carotenoid intake of 4 month olds, while carotenoid intake estimates for 6 and 8 month olds differed between approaches. A minimum of 3 food diary days agreed well with the 7 food diary days, offering a less burdensome, but rigorous approach for assessing infant carotenoid intake across age groups.

Technical Abstract: Validated carotenoid assessment methods are needed to study infant carotenoid nutrition. This is a secondary analysis of repeated diet assessments of healthy participants collected at 4- (n=21), 6- (n=12), and 8- (n=9) months of age in Houston, TX between April 2019-June 2020. Intake was assessed with 3 assessment tools, analyzed with 3 nutrient databases, and underwent 3 adjustments to account for milk composition variability. We hypothesized that manual adjustment of milk carotenoid intake based on laboratory measurements would improve the validity of all assessment approaches and that using a database with greater coverage of carotenoid composition of infant foods would improve accuracy. Generalized linear mixed models assessed associations between tool, nutrient database, age, and milk carotenoid adjustment variables with carotenoid, energy, fruit, and vegetable intakes. The effect of the number of food diary days on intake estimate precision was evaluated by testing the correlation between intake estimates derived from 1, 3, or 5, vs. 7 days. Visit age influenced energy intake estimates (p=0.029), along with assessment tool (p=0.020). Estimates of vegetable intake were influenced by tool (p=0.009). Combined fruit and vegetable intake differed by nutrient database (p=0.007). Carotenoid intake differed by age (p=<0.0001), tool (p=0.002), and nutrient database (p=0.004). A minimum of 3 food diary days strongly correlated (rho=0.79-1) with reference estimates across ages. Milk carotenoid adjustment was most influential in estimating 4-month olds’ carotenoid intake, while nutrient database and tool were important for 6- and 8-month-olds’, highlighting the dynamic nature of infant diet assessment validity across feeding stages.