ORIGINAL RESEARCH Tele-Dietetics with Food Images as Dietary Intake Record in Nutrition Assessment Lousia Ming Yan Chung, R.Nutr., B.Sc., M.B.A., D.H.Sc., 1 and Joanne Wai Yee Chung, R.N., R.N.T., B.App.Sc. (Nursing), B.A. (Hons) Ed., M.H.A., Ph.D. 2 1 School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong. 2 Department of Health and Physical Education, The Institute of Education, Hong Kong, Hong Kong. Abstract Rationale: Tele-dietetic is not common in current practice. To pro- mote this, food images as dietary intake records should be validated before application. Two-dimensional (2D) digital images are reliable and have been validated in previous studies. However, the depth is virtual with a 2D image. And ingredient types, sauce types, cooking methods, and amount of oil added have not been researched for accurate food analysis. Aim: This study was designed to compare the reliability and accuracy of these parameters estimated using 2D and three-dimensional (3D) food images. Methods: Ten nutritionists evaluated 10 selected food items between January 2008 and June 2008. Ten 2D food images and ten 3D images of the same food items were captured for the observers’ evaluation. The actual weightings or volume of the food items were measured as the gold standard for comparisons. Intraclass correlations (ICCs), percentage agreement, and one-sample t-tests were analyzed to compare the reliability and accuracy of each type of images. Results: Both images showed high reliability among observers with 3D images giving less variance (2D: ICC ¼ 0.916, F ¼ 17.001, p < 0.001; 3D: ICC ¼ 0.846, F ¼ 6.501, p < 0.001). Both images resulted in good ingredient and cooking method identification, but 3D was better in identifying sauce type. 2D images provided better volume and oil estimation when compared with 3D images. Conclusions: The research findings confirmed the application of 2D and 3D food images as reliable and accurate dietary records for nutritionists to evaluate clients’ dietary habits. This implied the feasibility of tele-dietetics that one’s nutrition status could be assessed over the Internet. Key words: e-health, home health monitoring, telecommunications Introduction D ietary advice plays an important role in the healthcare system, for both disease prevention and management. 1,2 Before providing dietary advice, nutritionists need to re- view the dietary intake records of clients to assess their nutritional status. Currently, nutritionists conduct face-to-face consultations with clients to obtain accurate dietary intake in- formation. This practice, however, can be improved through the use of new technology. For example, the type of food and number of servings of each food item can be electronically input to a Web site. After a nutritionist has reviewed the information, dietary comments can be given through e-mail or online reporting. If necessary, a teleconference can be arranged to provide a detailed consultation. The term ‘‘tele-dietetics’’ has been suggested to de- scribe this new process, which complements telemedicine and e-health in a holistic healthcare system (Fig. 1). Such a process can enhance efficiency, break down distance-related barriers, and maximize the accessibility of dietetic services to an expanded population. To make tele-dietetics more user friendly, image die- tary records are preferable to textual ones. Digital photography is increasingly popular for recording dietary intake. Previous studies examining the validity and reliability of various assessment modes have found fair agreement in estimated nutrient intake between digital food photos and food weightings 3 and in portion size DOI: 10.1089/tmj.2009.0174 ª MARY ANN LIEBERT, INC. . VOL. 16 NO. 6 . JULY/AUGUST 2010 TELEMEDICINE and e-HEALTH 691