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Protein, malnutrition and wasting disorders

Using digital photography in a clinical setting: a valid, accurate, and applicable method to assess food intake

European Journal of Clinical Nutritionvolume 72pages879887 (2018) | Download Citation



Regular monitoring of food intake is hardly integrated in clinical routine. Therefore, the aim was to examine the validity, accuracy, and applicability of an appropriate and also quick and easy-to-use tool for recording food intake in a clinical setting.


Two digital photography methods, the postMeal method with a picture after the meal, the pre–postMeal method with a picture before and after the meal, and the visual estimation method (plate diagram; PD) were compared against the reference method (weighed food records; WFR). A total of 420 dishes from lunch (7 weeks) were estimated with both photography methods and the visual method. Validity, applicability, accuracy, and precision of the estimation methods, and additionally food waste, macronutrient composition, and energy content were examined.


Tests of validity revealed stronger correlations for photography methods (postMeal: r = 0.971, p < 0.001; pre–postMeal: r = 0.995, p < 0.001) compared to the visual estimation method (r = 0.810; p < 0.001). The pre–postMeal method showed smaller variability (bias < 1 g) and also smaller overestimation and underestimation. This method accurately and precisely estimated portion sizes in all food items. Furthermore, the total food waste was 22% for lunch over the study period. The highest food waste was observed in salads and the lowest in desserts.


The pre–postMeal digital photography method is valid, accurate, and applicable in monitoring food intake in clinical setting, which enables a quantitative and qualitative dietary assessment. Thus, nutritional care might be initiated earlier. This method might be also advantageous for quantitative and qualitative evaluation of food waste, with a resultantly reduction in costs.

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We would like to thank all participants for taking part at the study and all colleagues from the ward for their help during the study.

Author contributions

EW, ML, and KS were responsible for conception and study design. EW was responsible for recruitment, study visits, collected the data, and conducted the statistical analyses. EW, ML, and KS undertook data interpretation. EW and ML wrote the first draft with contributions from KS. Finally, all authors reviewed and commented on subsequent drafts of the manuscript.


This research received no specific grant from any funding agency, commercial, or not-for-profit sectors.

Author information


  1. Center for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria

    • Eva Winzer
    •  & Maria Luger
  2. Special Institute for Preventive Cardiology And Nutrition – SIPCAN, Rabenfleckweg 8, 5061, Elsbethen, Salzburg, Austria

    • Eva Winzer
    •  & Maria Luger
  3. Department of Internal Medicine III, Division of Endocrinology & Metabolism, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria

    • Karin Schindler


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Conflict of interest

The authors declare that they have no conflict of interest.

Corresponding author

Correspondence to Maria Luger.

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