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.
Serra et al. (2026) studied this question.