Methodological aspects of the assessment of dietary intake in the Brazilian National Survey on Child Nutrition (ENANI-2019): a population-based household survey

Abstract

This manuscript aims to describe the methodological, operational, and quality control aspects of the assessment of dietary intake in children under five years of age participating in the Brazilian National Survey on Child Nutrition (ENANI-2019), a household survey in a probability sample of Brazilian households. Two instruments were developed to assess child feeding practices - a structured, current status-type questionnaire and a 24-hour dietary recall (24HR), both installed in a mobile data collection device used by previously trained interviewers. A Photographic Manual for Quantification of Children’s Dietary Intake was specifically developed for and used in the survey as a support aid to identify and quantify foods reported in the 24HR. During the fieldwork, continuous quality control of the records was performed. Data errors or incomplete data in the system were corrected, and the fieldwork team was systematically contacted and informed on their performance, with reiterated orientation on data collection. All children in the sample were evaluated with the two instruments, but data were obtained from the structured questionnaire on all children in the sample (n = 14,558) and 24HR on 14,541 children. ENANI-2019 developed innovative methods and materials based on the Brazilian and international literature to address knowledge gaps on under-five children’s dietary intake. Unprecedented results will be produced, which will allow updating food and nutrition guidelines for children under five years of age in Brazil.

Development of a mobile application to assess Brazilian schoolchildren's diet: CADE – food consumption at home and at school

“…The CADE app's database contains 2125 food items, of which approximately 84 % were foods in the INA survey 2017-18 (45) , 11 % from the database contained in the ENANI mobile app (40) , 5 % from the menus of the National School Meals Program and less than 1 % from the databases of Brazilian regional surveys. The list includes foods commonly consumed by the Brazilian population, with an emphasis on Brazilian schoolchildren's eating habits, including regional foods.…”

“…We believed that underreporting can be minimised with this design, considering the resources that facilitate the amount consumed report and complete child's diet evaluation by investigating different consumption places (59) . Some new technological features compared to usual Brazilian technologies (28,29,(40)(41)(42)(43)(44) , such as taking digital photos of food or meals and sending notifications in real time are only possible using online mobile devices.…”

“…Selection of food database, household measurements and photos of food portions. The CADE database consisted of food items ranging from simple foods and beverages to complex recipes from the 2017-18 Brazilian National Dietary Survey (INAa national survey that assessed food consumption through two 24-HR in a probabilistic sample of individuals 10 years and older) (45) ; the 2019 National Survey on Child Nutrition (ENANIa nationwide survey that assessed diet through one 24-HR in a probabilistic sample of children under 5 years of age) (40) ; menus offered in public schools across the country prepared by the technical team of the National School Feeding Program (PNAE); and the food and beverage databases of Brazilian regional surveys that assessed schoolchildren's dietary intake (46)(47)(48)(49)(50) .…”

“…Functionalities. The dietary assessment method and the app's technological tools were chosen based on a literature review of existing tools (15,25,27,40,52) and created with the collaboration of two software developers as detailed below.…”

“…However, older children are known to have more autonomy over their food intake. So, the children's participation in food intake assessment in the school environment is essential, aspects that have not been investigated in other Brazilian technologies (28,29,(40)(41)(42)(43)(44) . Furthermore, the use of technologies developed for different age groups (41,44) to school-age children is limited.…”