Dental Diet Diary: Development and Validation of a Mobile Application for Assessing Sugar Exposures in Children

Background: Early childhood caries (ECC) is a health problem in developed and developing countries. Dietary sugars-added sugars and natural sugars, play important role in the etiology of ECC. Increased frequency of sugar exposures increases the caries risk in children. Primary prevention of ECC includes dietary modifications along with other measures. Assessment of child’s diet requires recording it with ease and comfort. Conventional method like recording using pen and paper burdens the parent. Increase in the use of smartphones among the general population has opened many avenues to medical professionals. User-friendly mobile applications are used in medical settings to render information and obtain records from patients.

Aim: To develop and validate a mobile application (Dental Diet Diary) for assessing sugar exposures in children.

Methods: A mobile application (Dental Diet Diary, D3) for android smartphones was developed for recording and analysing cariogenicity of the diet. For validation, a total of 124 mother-child dyads, where child was between age 4-7 years, were included in the study. Mothers were asked to record the child’s diet for a typical 1 day using D3. They were recalled on the next day and the child’s diet was recorded by an assessor, who was blinded to data obtained from D3, using 24-hour diet recall (DR) based on Multi-pass method. Sugar exposures were calculated from the data obtained from both the methods and statistical analysis was done.

Results: Mean of sugar exposures was found to be 5.0(1.36) for D3 and 5.1(1.33) for DR. Significant correlation was seen between the 2 methods (r=0.94, p<0.0001). Absolute agreement between the two methods was seen by Intra-class coefficient(0.94). Bland-Altman plots also showed good agreement between the two methods.

Conclusion: The mobile application method was as effective as the 24 hour dietary recall in recording child’s diet and calculating sugar exposures from recorded diet.