The feasibility, validity and reliability of a modified 24-hour multiple pass dietary recall to assess fruit and vegetable intake in New Zealand children : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Nutrition and Dietetics at Massey University, Albany, New Zealand
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Date
2025
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Massey University
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Abstract
Background Adequate intake of fruits and vegetables (F/V) is crucial for children’s growth, development, and health. Despite this, many New Zealand children do not meet recommended F/V intake levels. The validity and reliability of a modified 24-hour multiple pass recall (MPR) and alternative tools such as the Veggie Meter® (VM®) for measuring skin-carotenoid scores (SCS) as a biomarker of F/V intake in children remain unexplored. Aims To establish the feasibility, validity and reliability of the modified 24-hour MPR for the evaluation of carotenoid and fruit and vegetable intake against weighed food diaries in 9 to 13–year–old school children living in Auckland. To estimate the reliability of the VM as a tool to measure chronic skin carotenoid levels. Methods Thirty-two children (20 boys, 12 girls) participated in this study. Over a one-to-three week period, F/V intake was assessed using a modified 24-hour MPR (child-reported, weighed food diaries (parent-reported), and SCS measured by the VM®. Validity was evaluated by comparing the modified 24-hour MPR to weighed food diaries as the criterion. Reliability of the modified 24-hour MPR F/V servings were determined from raw arithmetic difference, while reliability of the modified 24-hour MPR carotenoid intake (μg/d) was expressed as a ratio. Inter-day reliability of the modified 24-hour MPR and the VM SCS reliability were estimated using various metrics. Results Children did not meet recommended F/V intake levels based on both the modified 24-hour MPR (1.31 fruit serves; 2.00 vegetable serves) and weighed food diaries (1.26 fruit serves; 1.87 vegetable serves). Boys had higher F/V and carotenoid intakes, while girls had slightly higher SCS. The modified 24-hour MPR demonstrated significant bias and poor reliability for estimating F/V and carotenoid intake. In contrast, the VM® showed good reliability with low variability and excellent intraclass correlation coefficient (ICC). Conclusions The modified 24-hour MPR was valid but unreliable for measuring F/V intake in New Zealand children. The VM was found to provide a reliable measure of carotenoid intake over a chronic time.
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Dietary intake assessment, 24-hour MPR, 24-hour dietary recall, weighed food diary, fruit and vegetable, Veggie Meter®, validity, reliability, carotenoid, children