British Journal of Nutrition

Dietary Surveys and Nutritional Epidemiology

Food photographs in nutritional surveillance: errors in portion size estimation using drawings of bread and photographs of margarine and beverages consumption

Willem De Keyzera1a2 c1, Inge Huybrechtsa2, Mieke De Maeyera2, Marga Ockéa3, Nadia Slimania4, Pieter van 't Veera5 and Stefaan De Henauwa1a2

a1 Department of Nutrition and Dietetics, Faculty of Health Care Vesalius, University College Ghent, Keramiekstraat 80, B-9000 Ghent, Belgium

a2 Department of Public Health, Ghent University, University Hospital, 2 Blok A, De Pintelaan, 185, B-9000 Ghent, Belgium

a3 National Institute for Public Health and the Environment (RIVM), PO Box 1, Bilthoven, 3720 BA Utrecht, The Netherlands

a4 International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France

a5 Division of Human Nutrition, Wageningen University, Bomenweg 2, Wageningen 6703 HD, The Netherlands


Food photographs are widely used as instruments to estimate portion sizes of consumed foods. Several food atlases are available, all developed to be used in a specific context and for a given study population. Frequently, food photographs are adopted for use in other studies with a different context or another study population. In the present study, errors in portion size estimation of bread, margarine on bread and beverages by two-dimensional models used in the context of a Belgian food consumption survey are investigated. A sample of 111 men and women (age 45–65 years) were invited for breakfast; two test groups were created. One group was asked to estimate portion sizes of consumed foods using photographs 1–2 d after consumption, and a second group was asked the same after 4 d. Also, real-time assessment of portion sizes using photographs was performed. At the group level, large overestimation of margarine, acceptable underestimation of bread and only small estimation errors for beverages were found. Women tended to have smaller estimation errors for bread and margarine compared with men, while the opposite was found for beverages. Surprisingly, no major difference in estimation error was found after 4 d compared with 1–2 d. Individual estimation errors were large for all foods. The results from the present study suggest that the use of food photographs for portion size estimation of bread and beverages is acceptable for use in nutrition surveys. For photographs of margarine on bread, further validation using smaller amounts corresponding to actual consumption is recommended.

(Received June 07 2010)

(Revised August 30 2010)

(Accepted October 03 2010)

(Online publication November 24 2010)


c1 Corresponding author: W. De Keyzer, fax +32 9 220 17 26, email


Abbreviations: EPIC, European Prospective Investigation into Cancer and Nutrition