Development and validation of an electronic application (FoodEapp) to assess the dietary intake of adults in Karachi, Pakistan

Background: Under and over-nutrition-related health conditions are highly prevalent in Pakistan. Dietary data are required to understand the challenges of over and undernutrition in Pakistan. Objective: The purpose of the study was to develop and validate a FoodEapp application (FoodEapp) for field staff with no formal education in nutrition (unskilled) to accurately collect 24-hour (24HR) dietary recall (DR) data to assess the dietary intake of adults in Karachi, Pakistan. Method: We designed a novel FoodEapp application for unskilled data collectors to collect 24HR DR data. We validated the FoodEapp against the conventional 24HR DR method in rural and urban Karachi. We compared the mean intake of total energy (kcal), macronutrients, and micronutrients, reported through both methods using Pearson Correlation and Intraclass Correlation (ICC). We also used Bland Altman analysis to assess the agreement between the methods. Results: We found a high correlation between the two methods for total energy (ρ = 0.88, p-value < 0.001), protein (g) (ρ = 0.81, p-value < 0.001), total lipids (g) (ρ = 0.74, p-value < 0.001), and carbohydrates (g) (ρ = 0.68, p-value < 0.001). Bland Altman's analysis showed good agreement in all the nutrients between the two methods. Conclusions: FoodEapp has good validity and can be used to assess the dietary intake of the adult population in Karachi by non-nutritionists. This study may help overcome the limitation of dietary data collection and facilitate the researchers to conduct larger dietary surveys in Pakistan.