JMIR Publications

ABSTRACT

Background:

Childhood and adolescent malnutrition, encompassing undernutrition and overnutrition, poses significant global health challenges, necessitating comprehensive dietary assessment tools. Existing dietary assessment methods, such as 24-hour dietary recalls, often fail to capture eating behaviors and food preferences.

Objective:

This study developed a gamified dietary assessment tool (GDA) to address the limitations of existing dietary assessment methods.

Methods:

A two-phase study was designed including validation and application of GDA. The validation study included 30 participants aged 6–18 years, comparing GDA with the 3-day 24-hour dietary recall (24HR). Nutrient and food intakes were analyzed using Pearson or Spearman correlation coefficients and Bland-Altman plots, showing moderate agreement for energy, carbohydrate, and micronutrient intakes, though GDA overestimated protein intake. The application study, conducted among 1,541 adolescents (11–18 years), assessed dietary intake and eating behaviors tendencies, with differences analyzed using Kruskal-Wallis rank sum test and multiple linear regression models.

Results:

In the validation study (n=30), GDA demonstrated moderate agreement with 24HR for energy (r=0.46, p=0.010) and carbohydrates (r=0.50, p=0.005). Bland-Altman plots indicated good agreement for energy, fat, and carbohydrate intake between methods (mean differences around 0), but GDA overestimated protein intake (mean difference around 25g). In the application study (n=1,541), higher emotional eating scores were associated with increased snack consumption (β=0.438; 95% CI: 0.035, 0.840), while reduced protein (β=-0.159; 95% CI: -0.267, -0.052), fruit (β=-0.464; 95% CI: -0.854, -0.073) and nut intake (β=-0.183; 95% CI: -0.304, -0.062). Participants who chose to "eat alone" consumed significantly more carbohydrates than those opting for "eat with peers" (β=4.2; 95% CI: 1.2, 7.1).

Conclusions:

These findings highlight GDA’s ability to capture both dietary intake and contextual behaviors, overcoming some of the limitations of existing methods. By engaging young participants in an interactive, behavior-focused approach, GDA provides valuable insights into food preferences and eating behavior tendencies.