The Validity of Measuring Energy and Nutrient Intake with the Remote Food Photography Method (RFPM) in Adolescents.

Authors

Christoph Höchsmann, Hanim E Diktas, Candice A Myers, James L Dorling, Jennifer C Rood, Frank Greenway, Catherine M Champagne, John W Apolzan, Corby K Martin

Published in

The American journal of clinical nutrition. Pages 101452. Jul 25, 2026. Epub Jul 25, 2026.

Abstract

The Remote Food Photography Method (RFPM) accurately estimates energy intake in adults, but its validity in adolescents has yet to be tested. Given the low accuracy of self-reported dietary intake in adolescents, evaluating the validity of the RFPM in both controlled and free-living settings is crucial.
To examine the validity of the RFPM in estimating adolescents' energy intake (EI) in controlled and free-living settings.
In Study 1, adolescents (n=45) used the RFPM/SmartIntake app during: 1) a laboratory test meal, 2) a cafeteria meal, and 3) 7-days of free-living intake, with EI estimations validated against weighed food intake, Digital Photography of Foods Method, and doubly labeled water (DLW), respectively. EI was measured under the same three settings with pen-and-paper food records. After refining the app and training, Study 2 (n=22) repeated the protocol with a 3-day free-living period. For both studies, equivalence was evaluated using two one-sided t-tests (±10% bounds), and linear mixed models assessed RFPM error by participant characteristics.
In Study 1, RFPM estimates of EI were equivalent to the criterion measure during cafeteria meals (mean [SD] error: 4.1 [120.8] kcal; p=0.005), but were not equivalent for the lab test meal (mean [SD] error: 61.1 [112.7] kcal; p=0.675) and 7-days of free-living intake (-887.9 [554.8] kcal/day; p>0.99). In Study 2, RFPM EI estimates were equivalent to the criterion measure in the controlled setting (-2.2 [86.5] kcal; p=0.007), but not in free-living settings (-782.8 [947.0] kcal/day; p=0.99). In both studies, higher BMI percentile was associated with greater underestimation of EI (both R²>0.19 and p<0.05).
The RFPM can accurately estimate the meal-level EI of adolescents in controlled settings; however, significant underestimation occurred in free-living settings in both studies. Previous studies demonstrated the inability to accurately assess adolescents' free-living intake, and the current results extend these findings to the RFPM.
GOV ID STUDY 1: NCT01719445, https://clinicaltrials.gov/study/NCT01719445 CLINICALTRIALS.GOV ID STUDY 2: NCT04148560, https://clinicaltrials.gov/study/NCT04148560.

PMID:
42501948
Bibliographic data and abstract were imported from PubMed on 26 Jul 2026.

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