OBJECTIVES: Photographic food diaries (PFD) are a useful and valid measure for nutritional intake in both observational and interventional research, and a good choice for populations where limited literacy creates a barrier to the use of written diaries. Findings from a small observational cohort study are presented to highlight the method’s flexibility and potential for capturing a variety of relevant concepts other than caloric intake, including meal formats, timing, and composition. PFDs were also compared with findings from questionnaires and interviews to evaluate the relationship between nutritional knowledge and actual consumption.

METHODS: As part of a larger study on the health of pre-adolescent girls in an economically deprived area in northern England, 21 participants were recruited to keep 24-hour PFDs. Participants were trained to use disposable film cameras, and instructed to take photographs before and after eating, using a small plastic toy of known dimensions as a scale. Diary content and portion size were then assessed using the Young Person’s Food Atlas (UK).

RESULTS: Despite all participants displaying age-appropriate levels of nutritional knowledge, only one participant met the ‘5-a-day’ recommended minimum intake of fruits and vegetables and 6 participants consumed no fruits or vegetables during the PFD period. Median intake of sweets/desserts was 3 servings, while median intake of both sugar-sweetened drinks and deep fried food items were 2 servings. Consumption of school-provided dinners was not an indicator of higher quality diet, despite the fact that encouraging school meal uptake was, at the time of the study, considered a vital health intervention for children in the UK.

CONCLUSIONS: PFD data exposed a disconnect between nutritional knowledge and real world eating habits in the study population. This highlights the PFD’s potential to add nuance and context to health research with children, eliminating the potential for reporting bias due to social pressure.