Limited validity of an AI-powered app for dietary assessment in females with obesity.

Serra, Michele; Alceste, Daniela; Jucker, Nicole; Haupt, Lotta; Elben, Sebastian; Müller, Samuel; Hulshof, Paul J M; Meijer, Harro A J et al. · NPJ Digit Med · 2026

cross_sectional · Level IV

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Abstract

Artificial intelligence (AI) is transforming dietary assessment, yet few tools have been clinically validated against physiological reference methods. This cross-sectional observational validation study conducted under free-living conditions evaluated the validity of SNAQ, an AI-powered image-based dietary assessment app, against doubly labelled water (DLW) in females with obesity. Twenty participants completed a 7-day protocol, including DLW-based measurement of total daily energy expenditure (TDEE) and estimation of total daily energy intake using SNAQ and 24-h dietary recall (24HR). Compared with DLW-derived TDEE (3004 ± 481 kcal/day), SNAQ underestimated energy intake by 25% (bias -817 kcal/day; limits of agreement -3707 to 2073 kcal/day), while 24HR underestimated intake by 50%. Individual-level agreement had negligible within-subject reliability (ICC = 0.00). Despite advanced AI architecture, SNAQ showed systematic group-level underestimation and poor individual-level agreement, underscoring the translational gap between algorithmic performance and clinical feasibility and the need for standardised clinical validation before implementation.