The development of a valid measure of school children's fruit and vegetable consumption

As interventions aim to increase schoolchildren's fruit and vegetable (F/V) consumption, accurate dietary assessment methods not subject to self‐report errors are needed. We tested the validity of three methods in schoolchildren (grades 3–5). F/V consumption was assessed using direct observation (DO)(n=101), digital imaging (DI)(n=165), and digital imaging plus observation (DI+O)(n=167) over four days at two school sites and tested against weighed plate waste (WPW). Validity was tested using Pearson correlations, paired t‐tests, and Bland‐Altman plots. DO ( r ≥0.92), DI ( r ≥0.91), and DI+O ( r ≥0.95) were strongly correlated with WPW for consumption of fruits, vegetables, and F/V combined ( p <0.01). Pearson correlations for DI versus DI+O increased for lasagna, soup and whole fruit. Mean biases for total F/V consumption/tray did not differ from WPW when using DO ( p =0.39), DI ( p =0.56), or DI+O ( p =0.38). DO underestimated mean fruit consumption/tray by 3.0 gm ( p <0.05), and DI+O overestimated mean vegetable consumption/tray by 2.8 gm ( p <0.05). Bland‐Altman limits of agreement for individual F/V consumption were within ~one oz for DO (−35.9 to 38.9 gm), DI (−31.3 to 32.9), and DI+O (−26.8 to 25.0). DO, DI, and DI+O were all valid for assessing mean consumption. DI may be especially promising for assessing mean consumption of fruits, vegetables and F/V combined as excluding observations reduces labor and time. Grant Funding Source : USDA ‐ Vermont Agricultural Experiment Station and the Bickford Scholar Research Fund