Geometry-Enhanced Portion Estimation for Multimodal LLMs

Multimodal Large Language Models (MLLMs) are increasingly used for dietary assessment from meal images, where retrieval-augmented grounding was shown to sharpen nutrition estimates. However, we find this premise no longer holds for current MLLMs. A modern MLLM's direct estimate now matches or surpasses the full retrieval pipeline. This raises a question: if retrieval no longer improves the overall estimate, can it still deliver the two things clinicians value, accurate portions and a traceable, item-by-item record? We pursue this while preserving what matters for clinical adoption: minimal user burden (a single, unannotated meal image), explainability (an auditable record), and privacy (locally hosted inference). We introduce Open-KNEAD, a knowledge-grounded agentic framework for meal nutrition estimation that is training-free and locally deployable. Each decomposed food item is grounded to a Food and Nutrient Database for Dietary Studies (FNDDS) code via selective, nutrient-aware retrieval, composing an auditable per-item record. Across two open MLLM families and three cuisines, Open-KNEAD improves portion estimates over both prior grounding methods and direct estimation in most backbone-dataset settings. An agent-internal recipe-prior step further recovers the invisible cooking-added energy that biases estimates on non-US cuisine. The advantage is largest on the dietitian-verified ACETADA dataset, where the local open agent surpasses the direct portion estimates of two frontier closed models by roughly $30\%$ and $53\%$, all while keeping every meal image on local hardware. We release the Open-KNEAD framework and its agent-ready FNDDS knowledge base.

Image based dietary assessment offers a scalable alternative to self reported food diaries, yet fine-grained food recognition remains challenging due to high intra-class variability and visually similar dishes. This study presents OliveGemma, a vision language model for recognising and reasoning about Mediterranean and European cuisine. Built on the open-weight PaliGemma-2-3B architecture, OliveGemma is fine-tuned with LoRA on a unified corpus of 17,340 images from three European research project datasets (MedGR, ODIN, and VIPPSTAR), reconciled into a vocabulary of 216 composed dish categories and paired with 102,642 instruction style question-answer items covering dish recognition, likely and visible ingredients, class boundary discrimination, visual evidence and overall visual food understanding. Under a 3-fold cross-validation scheme, OliveGemma achieves a top-1 accuracy of 92.96% +/- 0.91%, exceeding the strongest CNN baseline (DenseNet-121) by 7.31% and outperforming zero-shot frontier models with exact instructions and bounded classes including Gemini Flash 3 and 3.5, GPT-5.4 Mini, and Claude Haiku 4.6 by 8%, 46%, and 64% respectively. Furthermore, OliveGemma demonstrates competitive performance on Top-3 and Top-5 accuracy, being second best across CNNs and frontier models, surpassed only by DenseNet-121. In addition, OliveGemma achieves 90.79% +/- 1.3% Exact-Set on the likely ingredients of the food categories. These results demonstrate that PEFT adaptation of a small VLM can surpass substantially larger proprietary models on specialised food recognition. The model is publicly available at https://huggingface.co/JamesZar/OliveGemma-3B and the experiments and results can be found at https://github.com/tsiokris/OliveGemma.

Comprehensive estimation of dietary micronutrients from food images could improve clinical nutrition care, but training such models requires large multimodal datasets linking diverse foods to complete nutrient profiles. We first show that existing multimodal large language models (MLLMs), including leading proprietary models, are unreliable for this task. Across five model families and four independent evaluation benchmarks (ASA24, SNAPMe, FNDDS, and NutriBench), models frequently abstained or returned statistically implausible values. To address this gap without costly expert annotation, we repurposed a decade of population-scale 24-hour dietary recalls as structured prompts for text-to-image generation. This pipeline produced a synthetic corpus of about 1.1 million image-description-nutrient triplets, each pairing a generated food image with a complete 65-nutrient label. To our knowledge, this is the largest synthetic food-image corpus with comprehensive micronutrient annotation planned for public release upon publication. Fine-tuning Qwen3-VL (2B/4B/8B/30B) and GLM-4.6V-Flash on this corpus yielded NutriMLLM, the first family of vision-language models specialized for comprehensive dietary micronutrient estimation. We evaluate these models with a four-component framework that separately measures abstention, hallucination, overall usability, and per-nutrient numerical accuracy. On real food images, every NutriMLLM variant achieved near-complete coverage across all 65 nutrients, and the largest variant matched or exceeded proprietary baselines (GPT-5, Gemini 3, and Claude Sonnet 4.5) in accuracy on most nutrients. These results show that recall-driven synthetic supervision can make image-based comprehensive micronutrient estimation a tractable engineering problem and support dietary assessment, personalized nutrition guidance, and population-scale micronutrient surveillance.