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Evaluation of the international standardized 24-h dietary recall methodology
(GloboDiet) for potential application in research and surveillance within
African settings
Article  in  Globalization and Health · June 2017
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Aglago et al. Globalization and Health  (2017) 13:35 
DOI 10.1186/s12992-017-0260-6
RESEARCH Open Access
Evaluation of the international standardized
24-h dietary recall methodology
(GloboDiet) for potential application in
research and surveillance within African
settings
Elom Kouassivi Aglago1* , Edwige Landais2, Geneviève Nicolas1, Barrie Margetts3, Catherine Leclercq4,
Pauline Allemand4, Olaide Aderibigbe5, Victoire Damienne Agueh6, Paul Amuna7, George Amponsah Annor8,
Jalila El Ati9, Jennifer Coates10, Brooke Colaiezzi10, Ella Compaore11, Hélène Delisle12, Mieke Faber13,
Robert Fungo14, Inocent Gouado15, Asmaa El Hamdouchi16, Waliou Amoussa Hounkpatin17,
Amoin Georgette Konan18, Saloua Labzizi16,19, James Ledo20, Carol Mahachi21, Segametsi Ditshebo Maruapula22,
Nonsikelelo Mathe23, Muniirah Mbabazi24, Mandy Wilja Mirembe25, Carmelle Mizéhoun-Adissoda26,
Clement Diby Nzi27, Pedro Terrence Pisa28, Karima El Rhazi29, Francis Zotor30 and Nadia Slimani1
Abstract
Background: Collection of reliable and comparable individual food consumption data is of primary importance to
better understand, control and monitor malnutrition and its related comorbidities in low- and middle-income countries
(LMICs), including in Africa. The lack of standardised dietary tools and their related research support infrastructure
remains a major obstacle to implement concerted and region-specific research and action plans worldwide. Citing the
magnitude and importance of this challenge, the International Agency for Research on Cancer (IARC/WHO) launched
the “Global Nutrition Surveillance initiative” to pilot test the use of a standardized 24-h dietary recall research tool
(GloboDiet), validated in Europe, in other regions. In this regard, the development of the GloboDiet-Africa can be
optimised by better understanding of the local specific methodological needs, barriers and opportunities. The study
aimed to evaluate the standardized 24-h dietary recall research tool (GloboDiet) as a possible common methodology
for research and surveillance across Africa.
Methods: A consultative panel of African and international experts in dietary assessment participated in six e-workshop
sessions. They completed an in-depth e-questionnaire to evaluate the GloboDiet dietary methodology before and after
participating in the e-workshop.
(Continued on next page)
* Correspondence: aglagoe@fellows.iarc.fr
1Nutrition and Metabolism Section (NME), International Agency for Research
on Cancer (IARC/WHO), 150 Cours Albert Thomas, 69372 Lyon, France
Full list of author information is available at the end of the article
© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Aglago et al. Globalization and Health  (2017) 13:35 Page 2 of 12
(Continued from previous page)
Results: The 29 experts expressed their satisfaction on the potential of the software to address local specific needs
when evaluating the main structure of the software, the stepwise approach for data collection and standardisation
concept. Nevertheless, additional information to better describe local foods and recipes, as well as particular culinary
patterns (e.g. mortar pounding), were proposed. Furthermore, food quantification in shared-plates and -bowls eating
situations and interviewing of populations with low literacy skills, especially in rural settings, were acknowledged as
requiring further specific considerations and appropriate solutions.
Conclusions: An overall positive evaluation of the GloboDiet methodology by both African and international experts,
supports the flexibility and potential applicability of this tool in diverse African settings and sets a positive platform for
improved dietary monitoring and surveillance. Following this evaluation, prerequisite for future implementation and/or
adaptation of GloboDiet in Africa, rigorous and robust capacity building as well as knowledge transfer will be required
to roadmap a stepwise approach to implement this methodology across pilot African countries/regions.
Keywords: GloboDiet, Africa, 24-h dietary recall, Dietary assessment, Standardisation
Background predominantly for surveillance and research purposes
The global nutrition transition associated with an increas- [12]. Amongst these methodologies are the 24-h dietary
ing prevalence of overweight and obesity is a real health recalls, food frequency questionnaires (FFQ), dietary
and societal challenge affecting particularly low- and records and dietary history. The 24-h dietary recall is an
middle-income countries (LMICs) worldwide, including open-ended method intended to report detailed informa-
those in Africa [1–3]. This transition is characterized by tion about all foods and beverages consumed by a
rapid changes in diets shifting from a traditional and pru- respondent, in the preceding 24 h or over the previous
dent high fibre, low-fat diet to a diet rich in saturated fat, day [13, 14]. The interview can be paper-and-pencil-
animal source foods, salt, processed foods, added sugar, based, computer-assisted or rarely self-administrated.
lower intake of fruits and vegetables, fibre and complex The method relies on short memories and allows the
carbohydrates and increased consumption of meals eaten quantification of all the foods and beverages consumed
out-of-home, especially from fast foods chains [4–6]. In over the period concerned.
addition, physical activity has substantially decreased, Although only few of the used methodologies were re-
especially in urban areas with increased sedentary ported to have been validated, their reported scientific
behaviour in the secondary and tertiary economic sectors outcomes have shaped the understanding of the food con-
activities, as compared to primary sector activities which sumption landscape in Africa. However, in practice, there
are more prevalent in rural areas [7]. This tangled is a need to appraise the validity of the methodologies
situation has resulted in the steady increase in non- used and strengthen individual food consumption data
communicable diseases (NCDs) such as cardiovascular collection and comparability throughout Africa. The
diseases, respiratory diseases, diabetes, and certain types optimal way to achieve this goal is to build on pre-existing
of cancer in the LMICs [8, 9]. Concernedly, micronutrient experience and accelerate transfer of knowledge and
deficiency is still tremendously prevalent within these capacity building among researchers and countries,
populations, leading to a double burden of malnutrition considering the specific scientific, social, cultural and
difficult to be subdued by the fragile economy of the ethical African context. Diverse initiatives have already
concerned countries [10, 11]. been launched on the continent to cover this gap.
Accurate assessment and monitoring of malnutrition Although these initiatives do not strictly embed the same
in LMICs, especially early detection of changes in the objectives, they act as fundamental components to cover
nutritional status of the populations, might require the the food consumption collection field in Africa. For more
collection of high-quality dietary data because individual than six decades, dietary intakes activities in Africa have
food consumption is intimately related to the nutritional been pioneered by diverse institutions including the Food
status. Dietary data can be collected for several purposes and Agriculture Organization of the United Nations
including setting of nutritional recommendations, expos- (FAO), Harvard University, Wageningen University and
ure and safety assessment as well as overall nutritional the French National Research Institute for Sustainable
surveillance. Development (IRD) through the development of country-
We have previously illustrated from an inventory or region-specific food composition tables (http://
conducted in 18 African countries that various dietary www.fao.org/infoods/infoods/tables-and-databases/africa/
assessment methodologies are used across the continent, en/), the training of local research teams, as well as the
Aglago et al. Globalization and Health  (2017) 13:35 Page 3 of 12
designing of studies on dietary assessment methods use in quantification, (v) probing questions, (vi) final controls, (vii)
epidemiologic studies [15, 16]. The International Network and information on the dietary supplements consumed
of Food Data Systems (INFOODS, http://www.fao.org/ [21]. The chronological description of the GloboDiet
infoods/infoods/en/) benefitted from these experiences, interview sections is presented in Table 1.
and through its regional data centre AFROFOODS
published the West-African food composition table Preparatory phase of the e-workshop
([17])and developed relevant courses [15]. Besides this, the The experts who participated in the Africa’s Study on
FAO/WHO Global Individual Food consumption data Tool Physical activity and Dietary Assessment Methods
(FAO/WHO GIFT, http://www.fao.org/nutrition/assess- (AS-PADAM) coordinated by IARC [12], served as pre-
ment/food-consumption-database/en/) aimed at increasing liminary list. This preliminary list was constituted as a
the harmonization and availability of existing data. The team of food and nutrition experts who were selected
International Dietary Data Expansion (INDDEX, www.ind- based on accomplished knowledge in their areas of
dex.nutrition.tufts.edu) project led by Tufts University was excellence. International institutions (WHO, FAO) and
designed to increase the availability, access, and use of the African Nutrition Society (ANS) proposed experts
household and individual food consumption data in low- from their networks using a snowball sampling method
income countries by developing open source and open ac- to reach a total of 48 African and international experts
cess tools for dietary data collection, processing, analysis, from universities and research institutes. The invitation
and policy application. of the experts did not foresee any statistical representa-
The International Agency for Research on Cancer tiveness by country or region, but was rather constituted
(IARC), the affiliated specialised institute of the WHO as a consultative panel of African and international
on cancer research, has developed a 24-h dietary recall experts with expertise in dietary assessment, and eventu-
software for the collection of standardised dietary data ally surveillance or implementation of diet-related
for epidemiological, surveillance and monitoring pur- programs at country- or regional level. Nonetheless, it
poses [18]. A series of quality control measures are uti- was empirically decided to include at least one African
lized from the preparation of the databases to data expert from each UN sub-region as dietary habits and
collection and management [19]. The software based on research issues might differ between these regions.
the GloboDiet (previously EPIC-Soft) methodology, has Figure 1 summarizes the diagram flow of how the
already been used in 19 European countries for both experts identified were invited for the evaluation of
research and surveillance purposes. In addition, the GloboDiet.
GloboDiet methodology has successfully been adapted in
Latin America (Brazil) and in the Republic of Korea. The Pre-workshop phase
specific adaptations needed for this first Asian country The identified experts were invited through email and
were recently published [20]. three dates with sessions scheduled in the morning and
The implementation of GloboDiet in Africa will re- the afternoon of each date were proposed for the evalu-
quire adaptation based on prior in-depth understanding ation. Core documents including a (i) scientific paper
of the specific context of the African continent, with its presenting the GloboDiet software [18], (ii) a presentation
diverse populations, languages, food sources and habits. on the methodology and (iii) 30 min video simulating
Through a consultation panel consisting of both African interaction between an interviewer and an interviewee
and international experts with known and recognised were provided to each participating expert to get
experience in the field of dietary assessment, this paper acquainted with the methodology. An additional folder
reports on the evaluation findings of GloboDiet’s inter- consisting of poster presentations and published papers
view steps and other various aspects towards a feasible on the structure, evaluation, standardization, validation,
platform to be used for surveillance, monitoring and re- quality insurance and other GloboDiet components was
search purposes in diverse African settings. assembled and uploaded online for participants to study
in preparation of the workshop [18–27].
Methods In parallel, an e-questionnaire was developed using
The GloboDiet interview Wepi™, a simplified online questionnaire authoring and
The evaluation sessions covered all the sections of an publishing application for health professionals
interview conducted using the 24-h dietary recall (EpiConcept, www.wepi.org). The e-questionnaire con-
GloboDiet application. The main sections of the dietary sisted of nine parts that covered all the aspects of the
interview comprise (i) the general information on the GloboDiet interview. The first three parts focused on
interviewee, (ii) a quick list of the foods and recipes geographical, institutional, and socio-demographic infor-
consumed the preceding day, (iii) the description using mation on the experts as well as pre-workshop questions
facets (questions) and descriptors (answers), (iv) the and comments that the participants might have on
Aglago et al. Globalization and Health  (2017) 13:35 Page 4 of 12
Table 1 Structure of an interview by GloboDiet
Section Description Featuresa
General Non-dietary information for the identification of the participant Name, code, birth date, sex, anthropometric data, date of
information and information on the recalled day interview and wakeup time
Special diets and special daysb(e.g. gluten free, veganism, energy
restricted) and (e.g. feast day, travel, illness, holidays)
Quick list Open list to collect foods and beverages consumed at each Consumption occasionsb (e.g. before breakfast, breakfast, during
occasion (cognitive approach, qualitative information) the morning, lunch, dinner, after dinner, during the evening)
Consumption time (hour with/without minutes)
Places of consumptionb: (e.g. home, work place, catering, fast
food, bar, café, pub, street)
Description of Search and detailed description of the foods and recipes e.g. Facets (and descriptors)b
foods and recipes consumed using facets and descriptors
Food preparation and purchase (prepared at home, commercial,
restaurant, vending machine, fast food)
Cooking method (raw, fried, battered and fried, baked, sautéed,
stewed, boiled, barbecued, steamed)
Physical state (liquid, powdered, reconstitution from powdered)
Fat content (whole, fat reduced, light)
Quantification of Quantification of the described foods and recipes using Quantification methods with possibility to select a fraction or
foods and recipes photos, shapes, HHMs, SU, reported weight or volume, a multipleb
standard portions
Photos (e.g photos of a salad)
Shape (e.g portion of a pie)
HHMs (e.g. photos of graduated spoons, bowls, plates, glasses)
SU (an apple, a can)
Mass or volume method (in g, ml)
Standard portions (e.g. melted cheese on a dish)
Unkwownc (fats, sauces and sweeteners)
Probing Checklist during the quick list step and after quantification e.g. Food (and probing)b
questions of items to recall the interviewer of easily forgettable foods
in link with other consumed foods Tea (sugar)
Bread (topping)
Recall on non-filled quick list items and daily energy and e.g. Daily calories intake (too low or too high)
macronutrients aberrant values
Warning maximum exceed e.g. Volume of milk > 600 ml
Note enteringd e.g. Volume of 1000 ml of milk have been confirmed by the
subject
Dietary Recall on dietary supplements taken: search, description Vitamins, minerals or oligoelements capsules
supplements and information on quantification
HHM household measure, SU standard unit
anon exhaustive list
bad hoc, to be adapted for each local situation/project
cStandard percentages of fats, sauces, sweeteners
dAutomatic or manual
reading the documentation that was sent to them. The interviews? It is convenient to use? Strongly agree/
fourth to sixth parts were dedicated to the evaluation of Agree/Neither agree nor disagree/Disagree/Strongly dis-
the different GloboDiet interview sections. The last three agree), contingency questions (e.g. If you think the
parts evaluated the overall controls, probing questions, pictures of foods are not applicable for use in Africa,
dietary supplements and a general evaluation of the could you specify why?), and open questions (e.g. Which
software. Four types of questions were included in the adaptations of the pictures of household measures could
questionnaire: dichotomous (e.g: Is there any missing you think of to make it more suitable for African
food description that would be relevant in the African settings?). An individual link as well as an ID code to
context? - Yes/No), Likert scale types (e.g. How do you keep anonymity was sent to each expert. The experts
evaluate the pictures of foods for the face-to-face were encouraged to fill the first three parts of the e-
Aglago et al. Globalization and Health  (2017) 13:35 Page 5 of 12
Fig. 1 Flow chart for the participation in the evaluation. A total of 48 identified experts from various networks were invited, amongst whom 32 were
available to participate in a session of the e-workshop. During the e-workshop sessions, the experts disconnected [5] were re-invited to watch online
uploaded video and comments afterwards. A total of 29 experts completed the final questionnaire
questionnaire to facilitate the preparation of the e-work- University and FAO (two from each) completed one
shop session they would participate in. questionnaire per institution.
E-workshop sessions Data analysis
Six identical e-workshop sessions of 3 hours each were Quantitative data collected through the e-questionnaires
conducted: four in English and two in French to comply were analysed using statistical distribution. Qualitative
with adequate language proficiency for all the experts. The information from the e-questionnaires and sessions reports
sessions were conducted through Citrix GoToMeeting were summarized into general ideas, and the core informa-
(Citrix, CA, USA), an online conference platform. Four to tion was assorted to other responses provided by the
six experts participated in each session. Sessions proceeded experts for the same topics. The results of the analysis were
as follows: brief introduction of each participant, presenta- drafted in a paper to the writing group to distil redundant
tion of the GloboDiet initiative and the GloboDiet software, and irrelevant information. The Likert scale plot was
followed by an open discussion. During the presentation of performed using R 3.0.1 (R Foundation for Statistical
the interview procedure, participants were invited to ask Computing, Vienna, Austria).
questions, add comments and suggestions through the inset
“Chat” windows of the GoToMeeting. Questions and Results
comments were gathered and addressed during the open Participants
discussion. General characteristics of the experts that were invited to
take part in the evaluation are reported in Table 2. Of the
Post-workshop phase After the workshop, the experts 48 African and international experts invited, 29 experts
were invited to complete all the parts of the e-question- participated in the sessions and completed the e-
naire, if not already done or/and add further comments. questionnaire. Eighteen experts participated in the four
Some of the participants who initially agreed to take part sessions in English while 11 participated in the two
in the e-workshop sessions and who were finally unable sessions in French. A total of 19 experts were unable to
to participate were invited to watch an online uploaded participate in the e-workshop sessions: 11 did not reply to
video of a session, and ultimately completed the online the two invitation emails, five were unable to participate
questionnaire afterwards. Four experts from Tufts due to their personal unavailability to attend one of the
Aglago et al. Globalization and Health  (2017) 13:35 Page 6 of 12
Table 2 General characteristics of the panel of experts the countries that adopted the GloboDiet methodology
Number but new specifications or adaptations could be developed
Gender if necessary.
Male 9
General information
Female 20
Comments on the general information focused on its
All 29 easiness with most experts reporting its relative complete-
Age group ness. A few comments pointed out the need to include
20–29 1 more information on the socio-economic and physiological
30–39 13 status of the interviewee. Self-reporting of birth and
40–49 4 anthropometric measures was questioned, especially in the
context of low literacy. To note, the general information
50–59 8
available in GloboDiet is flexible and can allow addition
>60 3 and removal of specific data. The general information can
Education be retrievable in the personal sheet of participants in a re-
Master 7 search study. Therefore, it was explained that the general
PhD or MD 22 information section does not intend to be exhaustive but
Affiliation rather to give information on the interviewee. Nevertheless,
minimal data (age and sex) are needed for final controls
Academic institution 20
that are based on energy requirement.
Global institution 4
Research centres 3 Quick list
Ministry of Health 1 As individual food consumption occasions must comply
Not knowna 1 with the activities undertaken in a day, some experts
Type of dietary methodology expertise proposed to capture the daily activities of the inter-
viewee and then construct foods consumption around it.
24-h dietary recall 29
This approach may reveal at the beginning of the inter-
Food frequency questionnaire 25 view, times and places of consumption. To the experts
Dietary record 18 panel, the chronological approach for the quick list in
Dietary history 9 GloboDiet reinforces the intuitiveness to capture foods
aMissing data consumed by day, and is a validated approach to screen
a whole day and track all possible foods consumed. In
proposed sessions, five were unable to connect during the the case this approach is not adapted to spot all food
e-workshop sessions, or disconnected during the presen- consumption occasions in specific settings, this can be
tations, amongst whom two further became participants addressed by training of the interviewers to exhaustively
after watching the presentation uploaded online and filling collect foods consumed, place of consumption, time and
the questionnaires. occasion.
African participant experts were from 13 countries:
three from Eastern Africa (Uganda), one from Middle Description of foods and recipes
Africa (Cameroon), four from Northern Africa There was consensus among the experts that the facet/
(Morocco, Tunisia), five from Southern Africa descriptor approach (i.e. systematic predefined food−/re-
(Botswana, South Africa, Zimbabwe), and nine from cipe-questions asked and their related answers) was an
Western Africa (Benin, Burkina Faso, Côte d’Ivoire, appropriate and detailed way to standardize food item
Ghana, Nigeria). Seven experts were from international descriptions. In the African context, there was consensus
institutions (WHO, FAO) and universities outside Africa that the contrast between urban and rural areas requires
(Tufts University, USA; University of Alberta, Canada; slightly different facets and descriptors of foods and
University of Southampton, UK). recipes. There was an agreement to retain some facets
Table 3 summarizes the opinions and recommenda- already present in GloboDiet because they describe
tions regarding all the different sections of the individual food consumption patterns in urban areas.
GloboDiet 24-h recall interview, and the possibility of The situation is quite different in rural areas where new
addressing or adapting them into the software in the descriptors such as sun drying, smoking, mortar pound-
future. In order to keep the methodology standardized ing and grinding would be relevant. Descriptors “dried”,
at the international level, the African GloboDiet version “smoked” are already available in GloboDiet in the facet
should align with common rules already endorsed in all preservation method. Likewise, the descriptor “pureed/
Aglago et al. Globalization and Health  (2017) 13:35 Page 7 of 12
Table 3 Experts evaluation of GloboDiet sections and response address
Section Overall evaluationa More specific suggestions Response approach in GloboDiet
General Adequate, useful, applicable, Additional: dwelling place, marital status, Actually handled by additional questionnaire(s)
information comprehensive, easily number of children, education, physical (non-dietary data to be merged with dietary data)
understandable, complete, excellent, activity, breastfeeding status,
simple, concise and relevant employment status
Adaptation: delete participant name, Local interview training issue
measure weight and height instead of
self-reporting
Ask age instead of birth date, These requests can be addressed in GloboDiet
non-consideration of sickness and travel
days as special days, ask for diet-related
diseases directly
Quick list Easy, comprehensive, good, useful Adaptation: ask for daily activities of the Adaptation of food consumption occasions list
features, clear, appropriate, interviewee to capture food and local training issue
detail-focused, intuitive, interesting consumption occasions
Description of Relevant aspects covered, detailed, - Adaptation of the foods and recipes lists
foods and comprehensive, clear
recipes
Necessity to contextualize Additional: sun drying, smoking, mortar Study how to link to existing GloboDiet facets/
and peddle pounding, stone grounding, descriptors
sifting, gifts, home production
Possibility to add new descriptors and facets.
Adaptation: possibility to delete Adaptation of the facets and descriptors databases
packaging, all the facets related to to local situations
canned fruits and vegetables
Quantification Satisfactory (see Fig. 2) Adaptation: Clear distinction between Adaptation of the quantification methods to
of foods and urban and rural areas local settings
recipes
Have pictures of local foods without Create local picture books with local HHMs,
fork and knife, local HHMs foods/recipes,
Use local standard units
SU (be sure about the cultivars), real Quantification method to be linked to volume
foods, handful and soft food scoping
Food models, salted replicas, Weight method
Onsite weighing New quantification approach to be defined.
Shared plate Study/validation of method “shared plate”.
Probing Important, relevant Additional: wild foods and fruits picking Actually handled at the quick list step
questions
Training issue
Quality controls Needed, important - Well-grounded in GloboDiet
Dietary Relevant, adapted, necessary, good, Definition of dietary supplements is not There is need to clearly define dietary
supplements helpful, appropriate clear in Africa supplements before inclusion in Globodiet
databases (as food, dietary supplements, or both)
Additional: “tonic” and “energy-booster”
plant by-products
HHM household measure, SU standard unit
aAs commented by the experts in the online questionnaire
mashed” is present in the facet physical state. Adding highlighted which are part of the general customisation
and/or removing facets and descriptors is feasible in procedure to be followed for the preparation of any
GloboDiet. Concretely, an agreement on necessary facets GloboDiet version. Firstly, selected local foods and
and descriptors will have to be found for the African recipes need to be photographied and composed as
setting for incorporation into the software. pictures books which would be tested and validated as
portion size estimation aids in rural contexts where
Quantification of foods and recipes pictoral literacy is likely to be low. In addition, these
The panel of experts acknowledged overall that the pictures could be used to identify the items consumed in
quantification methods used in GloboDiet, notably the low literacy settings. Secondly, specific African house-
household measures, the pictures, the standard units, hold measures (HHMs) should be inventoried and
and the food shapes, are suitable for African settings included in the database for quantification. Thirdly,
(Fig. 2). In this regard, some adaptations were shape/volume quantification from a pictures book was
Aglago et al. Globalization and Health  (2017) 13:35 Page 8 of 12
Fig. 2 Appreciation of quantification methods used in GloboDiet. The comments of the experts on the quantification methods available in GloboDiet
were satisfactory. Standards units were evaluated as the most convenient method followed by picture books and household measures. Likewise, the three
methods were considered as the most applicable in the African context. Overall, shape quantification was considered as the least applicable in Africa
identified as the least convenient method and would interviewer’s attention for some accompanying foods and
require specific attention for more adaptation. Lastly, toppings. As already in GloboDiet, experts acknowledged
standard units (SU) should consider the different that a probing should be neutral. The African version of
cultivars of fruits for example or be matched with GloboDiet should consider probing about easily forgettable
photos showing sizes/shapes for both identification and items such as wild foods and fruits picking when complet-
quantification. It is indeed a usual prerequisite to include ing check list or during the inventory of food consumption
local SU in GloboDiet databases. In addition, the experts occasions. Overall controls are flexible, and energy and
have proposed other methods of quantification which macronutrients cut-offs can be adapted according to a
have been tested and used in African rural areas: real population of interest or for a study.
foods, food models or salted replicas as spatial models
might facilitate the quantification step in rural areas. Dietary supplements
The general impression of the experts on the dietary
Probing and overall controls supplements section was positive. Approximately half
There was unanimity among the experts regarding the (n = 14) of the experts estimated that the proposed
importance of the probing section in the 24-h recall separation of the dietary supplements from foods and
methodology, as embeded in GloboDiet. Reasons provided recipes is important in order to repertoriate, describe
were the need to check the interviewee’s responses as well and quantify them properly. The rest of the experts
as the necessity to provide pop ups to bring to the (n = 15) suggested, based on the potential confusion
Aglago et al. Globalization and Health  (2017) 13:35 Page 9 of 12
between supplements and some medications in Africa, injera may require at least the facets: food production/
to conduct in advance an extensive search to identify, purchase location, salt content). The use of facets and
describe and classify dietary supplements before further descriptors privileged in GloboDiet is also used in food
decisions for use and inclusion in dietary assessement in description worldwide by organisations such as the
general, and in GloboDiet in particular. Therefore, there European Food Safety Authority [31]. Through the con-
is first a need of clarification for what should be consid- sultation of the experts, it was confirmed that most of
ered as dietary supplements in Africa. Thereafter, there the facets/descriptors available in GloboDiet European
will also be a need to cover specific African supplements versions are also suitable for the description of foods
used as “tonic” or “energy-booster” which are prepared and recipes consumed in urban areas in Africa. However,
from plant by-products. These suggestions were retained as in any preparation of a GloboDiet version, typical
as specific requirements to dapt the GloboDiet and its African foods will need to be included in GloboDiet
databases in the African context. databases and combined implicit and explicit descrip-
tions will be applied to each food and recipe during data
Discussion collection. Additional descriptive pieces of information
The GloboDiet methodology designed for nutritional that may be deemed necessary to collect are sources of
research and surveillance based on the 24-h dietary recall is drinking water [32, 33] and water treatment methods
a tool that has, initially, been used to collect dietary [34, 35] because drinking water is still a vector of micro-
consumption data in the EPIC study. The cumulative bial infections and chemical hazards in Africa. Other ex-
experience that went into the development, testing, valid- amples of description consideration details that might be
ation and implementation of this international software interesting to consider are application of treatments to
enables the establishment of strong science-based evidence decrease cyanogenic agents in cassava [36], or the cover-
on its reliability, detailed information, robustness and flexi- ing of street-vended foods. It is also important to
bility that made it possible to be adapted amongst other consider food fortification status in the description of
countries and contexts [23, 27]. Likewise, the main feature the foods available in Africa since several foods and
of the GloboDiet 24-h dietary recall software is its design staples are now subjects to mandatory or voluntary food
that ensures a high level of standardisation of data fortification programs in Africa [37]. Food fortification
collection, management and analyses within and between should be included in African databases if interviewees
countries. Therefore, the consultation of the panel of are likely to recall the food items and/or if fortified foods
African and other experts was an efficient way to share could be recalled during the interview and dealt a priori.
information on the methodology and receive feedback on The major challenge in food quantification that was
the potential of the existing version and additional adapta- raised unanimously by the experts is the individual
tions needed for Africa. consumption quantification from a shared plate, consid-
Within the GloboDiet software, the general informa- ered as a notable issue in studies using the 24-h recall
tion on the interviewee (e.g. age, sex, height and weight) [38, 39]. To address this issue, some researchers
is important for final controls on the reported total en- reported the distribution of HHMs beforehand by field
ergy and macronutrient intakes vs. recommendations, as enumerators, and asked the participants to serve individ-
well as for individual identification information (e.g. ual portions [40, 41]. However, Kigutha [42] hypothe-
interviewee’s identification code). It should be recom- sized that this might affect eating habits of the subjects,
mended that in the context of low-literacy, anthropo- and therefore introduce biases in individual intake
metric measures be entered from a participant sheet to estimation. Asobayire [43] quantified individual intake
avoid self-declared information, which is a plausible by weighing participants before and after eating and
source of errors [28, 29]. The “special days” within the adjusting for beverages volume consumed in separate
general information might also concern local market bowls. This approach, besides weight measurement
days in rural Africa, because foods available in house- constraints and errors, is only valid to estimate the
holds and consumed on that day are more diverse, and consumption of a single food and recipe, without accur-
do not reflect routine consumption [30]. In addition, ate quantification of diverse item consumed. In the
these foods available and then consumed that day fluctu- Gambia, an algorithm has been applied to approximate
ate with the purchasing power of the households. individual portion consumed from a shared bowl
To fully describe a consumed item, a combination of considering body weight, sex and age [44]. The
two food description pathways is used in GloboDiet. The formula used in this algorithm has not been tested in
implicit pathway uses the name of the foods as self- other settings, suggesting that, if an algorithm is the
standing (e.g. injera uniquely could refer to the chosen approach to solve the shared plate issue, there
Ethiopian sourdough bread made of teff ), whereas the is a need to find a systematic and reliable algorithm
explicit description requires facets and descriptors (e.g. to estimate individual intake from shared-plate.
Aglago et al. Globalization and Health  (2017) 13:35 Page 10 of 12
Besides the consumption from a shared plate, food international experts in dietary assessment through
quantification methods usually applied in GloboDiet have Internet. Despite the low Internet penetration in Africa,
been acknowledged by the panel of experts as valid for this study overcame the shortage through beforehand
quantification of African foods and recipes. Pictures have steady preparation and special assistance that guided the
been extensively used for quantification in Africa [45] and experts throughout the whole process of e-workshop
validation studies have been carried out [46, 47]. Picture with direct phone calls when needed. Furthermore, the
atlas in GloboDiet is a series of a minimum of four high- possibility to conduct sessions in French permitted to
quality unpixellated coloured photos at incremental food include a larger number of French-speaking experts who
sizes. Adaptation of the existing GloboDiet photos to the might have been impeded with probable English profi-
African context will require updating of the foods and rec- ciency issues. Although, we failed to recruit Spanish-
ipes to be photographed and the deletion of the cutlery and Portuguese-speaking experts in addition, we assume
not in use in African settings. Food grids developed and that this has a little impact on the consultation reported
validated by GAIN for the Food Assessment Coverage in this study because their regions are covered.
Toolkit (FACT) could be utilized as a primary tool [48] One of the limitations of this study was the difficulty
and used a complement to validated picture of foods for to align the agenda of all the experts invited to the work-
the quantification of individual intake. Likewise, previous shop. Despite the fact that it would have been preferable
studies suggest that HHMs including cups, mugs, spoons to have more experts participating in the e-workshop
and plates are extensively used for quantification in Africa sessions, the e-workshop successfully gathered experts
[49–53]. Adaptation of the HHMs booklet will include from all the African five United Nations sub-regions,
photos of local HHMs, but also having these onsite during suggesting that the necessary adaptations required for
the interviews to ease quantification. However, in contrast GloboDiet are compiled; In-depths national or local
to foods pictures and HHMs, shape/volume quantification requests could be addressed during implementation.
appears to be laborious because misrepresentation of the
actual size of the foods may occur in relation to the visual Conclusion
perception of the subjects. Shapes are predominantly used The contributions of the experts were constructive and
in GloboDiet to quantify breads and wedge-shaped por- will serve as the foundation for the possible future im-
tions and have not been extensively used in Africa, which plementation of the GloboDiet methodology in Africa. It
imply a thorough analysis of applicability and adaptability. can be summarized that successful and standardised as-
Overall, there is a necessity to validate the combination of sessment of individual food consumption across Africa
methods of quantification proposed by Willett [13] com- is possible but would need the inclusion and combin-
prising household measures, photographs, geometric ation of description and quantification methods available
shapes, standard units, and other innovative methods in GloboDiet, as well as the specific propositions drawn
likely to be developed in the very context of LMICs. In from this consultation. Furthermore, particular attention
addition to individual portion size estimation, memory should be given to the shared plate consumption, to im-
lapses have been reported as substantial sources of errors prove quantification of individual intake. Also, a clear
in food intake assessment in Africa [54]. Therefore prob- definition of dietary supplements will be necessary to
ing and various controls are important to capture all the handle the African specific situation.
foods consumed, their description and quantification in The possible implementation of the GloboDiet
order to prevent misreporting. GloboDiet contains a series methodology in the African context will be an opportun-
of probing and control steps from database preparation, ity for public health, nutrition, food safety and cancer
data collection, calculation and data cleaning in order to researchers to collect and analyse high-standard quality
decrease these errors [19]. Apart from usual probing such food consumption data. Preliminary work to assess the
as sugar for tea and topping for breads, African-specific needs and gaps to adapt the GloboDiet methodology is a
probing can be included according to specific behaviours prerequisite before any roadmap for implementation.
in some African regions. For example, condiments such as Africa is a heterogeneous continent constituted of more
the stock cubes which are ubiquitously found in African than 50 countries with various dietary cultures and the
countries can be candidate for probing. Another import- most efficient approach will be to develop several
ant issue in Africa would be the need to extensively train versions of GloboDiet-Africa either by country or by
field enumerators for the collection of individual food region, with few pilot countries as starting point. Further
consumption data, considering the local environment. steps will therefore include, but not exclusively:
collection of foods and recipes from African surveys,
Strengths and limitations of the study detailing of appropriate facets and descriptors,
To our knowledge, this study is the first to conduct an exploration of suitable quantification pathways and their
e-workshop gathering a panel of African and other validation in pilot studies.
Aglago et al. Globalization and Health  (2017) 13:35 Page 11 of 12
Africa needs to collect regular data on nutrition and its Author details
1
determinants, as a starting point of ingrained nutrition Nutrition and Metabolism Section (NME), International Agency for Research
on Cancer (IARC/WHO), 150 Cours Albert Thomas, 69372 Lyon, France. 2UMR
surveillance programs capable to support the continent in 204 ‘Nutripass’ IRD/UM/SupAgro, Montpellier, France. 3Institute of Human
the process of fulfilling the Sustainable Development Nutrition, University of Southampton, Southampton, UK. 4Food and
Goals (SDGs). Overall, concerted actions will be needed Agriculture Organization of the United Nations (FAO), Rome, Italy.
5National
Horticultural Research Institute, Ibadan, Nigeria. 6Regional Institute of Public
and collaboration between and with African networks will Health (IRSP), University of Abomey-Calavi, Cotonou, Benin. 7Research
be the key to successful implementation. Section, Primary Health Care Corporation, Doha, Qatar. 8Department of
Nutrition and Food Science, University of Ghana, Accra, Ghana. 9INNTA, Tunis,
Tunisia. 10Gerald J. and Dorothy R. Friedman School of Nutrition Science and
Additional files Policy, Tufts University, Boston, USA. 11Department of
Biochemistry-Microbiology, UFR-SVT, CRSBAN/University of Ouagadougou I
Additional file 1: Answers of the e-questionnaire by the experts panel. Joseph Ki-Zerbo, Ouagadougou, Burkina Faso.
12TRANSNUT, Centre
(XLSX 46 kb) Collaborateur OMS sur la transition nutritionnelle et le développement,
Département de Nutrition, Faculté of Médecine, Université de Montréal,
Additional file 2: Evaluation questionnaire in English. (PDF 505 kb) Montréal, Canada. 13Non-Communicable Diseases Research Unit, South
Additional file 3: Evaluation questionnaire in French. (PDF 145 kb) African Medical Research Council, Tygerberg, South Africa. 14School of Food
Technology, Nutrition & Bio-Engineering, Makerere University, Kampala,
Uganda. 15Faculty of Science, University of Douala, Douala, Cameroon.
Abbreviations 16Unité mixte de recherche en Nutrition et alimentation; URAC 39;
ANS: African nutrition society; AS-PADAM: Africa’s study on physical activity RDC-Nutrition associé à l’AFRA/AIEA (CNESTEN-Université Ibn Tofail), Rabat,
and dietary assessment methods; FAO: Food and agriculture organization of Morocco. 17Department of Food Science and Nutrition, Faculty of
the United States; FFQ: Food frequency questionnaire; HHM: Household Agricultural Science, University of Abomey-Calavi, Cotonou, Benin.
measure; IARC: International agency for research on cancer; 18Université Félix Houphouët Boigny, Abidjan, Côte d’Ivoire. 19Ministry of
INDDEX: International dietary data expansion; INFOODS: International Health, Rabat, Morocco. 20DietPlus Ghana, Accra, Ghana. 21Department of
network of food data systems; LMIC: Low- and middle-income countries; Physiology, University of Zimbabwe, Harare, Zimbabwe. 22Department of
NCD: Non-communicable diseases; SDG: Sustainable development goals; Family and Consumer Sciences, University of Botswana, Gaborone, Botswana.
SU: Standard unit; WHO: World health organization 23Faculty of Health Disciplines, Athabasca University, School of Public Health,
University of Alberta, Edmonton, Canada. 24Division of Nutritional Sciences,
Acknowledgements School of Biosciences, University of Nottingham, Nottingham, UK.
25Faculty
This work was undertaken during the tenure of a postdoctoral fellowship of Epidemiology and Population Health, London School of Hygiene and
26
from the IARC, partially supported by the European Commission FP7 Marie Tropical Medicine, London, UK. Faculty of Health Sciences, University of
27
Curie Actions–People–Cofounding of Regional, National and International Abomey-Calavi, Cotonou, Benin. Food and Agriculture Organization (FAO),
Abidjan, Côte d’Ivoire. 28Programmes (COFUND). We would like to thank all the members of the Wits RHI, University of Witwatersrand, Johannesburg,
29
Dietary Exposure Assessment (DEX) group at IARC for logistical and scientific South Africa. Department of Epidemiology and Public Health, Faculty of
30
support. We also want to thank Sam Bodjrenou, the assistant of Dr. Waliou Medicine of Fez, Fez, Morocco. University of Health and Allied Sciences, Ho,
Hounkpatin for his logistical support during one of the sessions of the Volta Region, Ghana.
e-workshop.
Received: 15 November 2016 Accepted: 11 June 2017
Funding
This research project received no specific grant from any funding agency,
commercial or not-for-profit sectors. References
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