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A Digital Dietary Assessment Tool for a Multicultural Population (Intake24 Malaysia): Protocol for a Development and
Nik Nur Izzati Nik Mohd Fakhruddin1, Shaleen Tho Rajasegaram1, Nurul Natasha Osman1
1Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Jalan Lagoon Selatan, Subang Jaya, Selangor, 47500, Malaysia, 60 5146000.
Background:
Malaysia is a multicultural country with the main ethnic groups being Malays, Chinese, and Indians. This diversity creates a rich food culture with distinct dishes, cooking styles, and portion sizes, making dietary assessment challenging. Intake24 is a web-based 24-hour dietary recall (24hDR) system that automates data collection, reduces recall bias, and saves time. It supports self-reporting of the previous day's food and beverage intake using structured prompts, searchable food lists, portion-size images, and linked food composition data. As it was originally developed in the United Kingdom, adaptation for Malaysia is needed to address differences in language, food culture, mixed dishes, portion sizes, terminology, and local food composition data.
Objective:
This paper aims to describe a protocol for the development and relative validation of Intake24 Malaysia (Intake24-MY) for the Malaysian population.
Methods:
This paper describes 2 phases in adapting Intake24-MY: (1) the development process and (2) the validation study. Phase 1 consists of the following components: (1a) system translation, which will involve machine translation tools and bilingual translators; (1b) food list development, which includes Malaysian and globally familiar foods; (1c) 4 options for portion-size estimation and a photograph validation study; (1d) food composition data and recipe calculation; (1e) small-scale testing, which will involve 10 adults identifying the foods and technical issues, with pilot testing conducted among 100 adults to compare 2 days of dietary intake using Intake24-MY against an interviewer-led 24hDR; and (1f) user guide development. Phase 2 consists of the following components: (2a) a single-meal validation study that will be conducted among 100 adults, comparing Intake24-MY with observed intake and (2b) a cross-sectional study that will be conducted among 482 Malaysian adults, comparing 4 days of dietary intake using Intake24-MY against an interviewer-led 24hDR. A structured questionnaire will be used to assess the feedback on the usability of Intake24-MY. The Bland-Altman method will be used to determine the agreement between these methods.
Results:
The study was funded in December 2023, with data collection starting in June 2024 and continuing. Data analysis is set to begin in August 2026, with results expected by 2027. This study has received approval from the Monash University Human Research Ethics Committee (MUHREC ID 41337).
Conclusions:
Intake24-MY is being developed as a multilingual digital dietary assessment tool for Malaysia. The planned validation study will determine its agreement with interviewer-led 24hDRs and assess its usability among Malaysian adults. If shown to be valid and acceptable, Intake24-MY can support more efficient dietary data collection in Malaysia's multicultural population.
