A Primer for the Evaluation and Integration of Dietary Intake and Physical Activity Digital Measurement Tools into Nutrition and Dietetics Practice

Digital Health Solutions for Weight Loss and Obesity: A Narrative Review

Personal exercise programmes have long been used and prescribed for weight loss and the improvement of quality of life in obese patients. While individualised programmes are usually the preferred option, they can be more costly and challenging to deliver in person. A move to digital programmes with a wider reach has commenced, and demand has increased due to the SARS-CoV-2 pandemic. In this review, we evaluate the current status of digital exercise programme delivery and its evolution over the past decade, with a focus on personalisation. We used specific keywords to search for articles that met our predetermined inclusion and exclusion criteria in order to provide valuable evidence and insights for future research. We identified 55 studies in total in four key areas of focus, from the more recent development of apps and personal digital assistants to web-based programmes and text or phone call interventions. In summary, we observed that apps may be useful for a low-intensity approach and can improve adherence to programmes through self-monitoring, but they are not always developed in an evidence-based manner. Engagement and adherence are important determinants of weight loss and subsequent weight maintenance. Generally, professional support is required to achieve weight loss goals.

Research at the Academy of Nutrition and Dietetics: What, How, and Why?

Research is essential to further advance our understanding of the role of nutrition and dietetics in maintenance and improvement of health. Research is also essential for nutrition and dietetics professionals to create and provide evidence-based interventions, including medical nutrition therapy (MNT) provided by registered dietitian nutritionists (RDNs). Given this critical role of research, the Academy of Nutrition and Dietetics (Academy) has a variety of resources to assist its members in accessing, understanding, participating in, conducting, and disseminating nutrition research. These resources are comprehensive and include opportunities to participate in research (e.g., Nutrition Research Network (NRN) and Data Science Center (DSC)), tools to aggregate practice data (Nutrition Care Process and Terminology (NCPT) and the Academy of Nutrition and Dietetics Informatics Infrastructure (ANDHII)), funding opportunities to support primary research (e.g., Academy Foundation), resources to understand the latest research informing evidence-based practice (EBP) (e.g., Evidence Analysis Center (EAC)), and avenues for sharing research findings (e.g., Food and Nutrition Conference and Expo (FNCE)). The aim of this paper is to encourage members to get involved in research by describing Academy-based research resources and opportunities to contribute to nutrition and dietetics research, as well as describe specific examples of research conducted at Academy. The information presented can serve as a framework to guide members in engaging in research through the Academy.

mHealth Applications to Monitor Lifestyle Behaviors and Circadian Rhythm in Clinical Settings: Current Perspective and Future Directions

Metabolic diseases are a global rising health burden, mainly due to the deleterious interaction of current lifestyles with the underlying biology of these diseases. Daily habits and behaviors, such as diet, sleep, and physical exercise impact the whole-body circadian system through the synchronization of the peripheral body clocks that contribute to metabolic homeostasis. The disruption of this system may promote the development of metabolic diseases, including obesity and diabetes, emphasizing the importance of assessing and monitoring variables that affect circadian rhythms. Advances in technology are generating innovative resources and tools for health care management and patient monitoring, particularly important for chronic conditions. The use of mobile health technologies, known as mHealth, is increasing and these approaches are contributing to aiding both patients and healthcare professionals in disease management and education. The mHealth solutions allow continuous monitoring of patients, sharing relevant information and data with physicians and other healthcare professionals and accessing education resources to support informed decisions. Thus, if properly used, these tools empower patients and help them to adopt healthier lifestyles. This article aims to give an overview of the influence of circadian rhythms disruption and lifestyle habits in the progression of metabolic diseases while also reviewing some of the mobile applications available to monitor lifestyle behaviors and individual chronobiology. Herein is also described the design and development of the NutriClock system, an mHealth solution developed by our team to monitor these variables.

Perspectives of Dietary Assessment in Human Health and Disease

Diet and human health have a complex set of relationships, so it is crucial to identify the cause-effects paths and their management. Diet is crucial for maintaining health (prevention) and unhealthy diets or diet components can cause disease in the long term (non-communicable disease) but also in the short term (foodborne diseases). The present paper aims to provide a synthesis of current research in the field of dietary assessment in health and disease as an introduction to the special issue on "Dietary Assessment and Human Health and Disease". Dietary assessment, continuously evolving in terms of methodology and tools, provides the core information basis for all the studies where it is necessary to disentangle the relationship between diet and human health and disease. Estimating dietary patterns allows for assessing dietary quality, adequacy, exposure, and environmental impact in nutritional surveillance so on the one hand, providing information for further clinical studies and on another hand, helping the policy to design tailored interventions considering individual and planetary health, considering that planetary health is crucial for individual health too, as the SARS-CoV-2 (COVID-19) pandemic has taught. Overall, dietary assessment should be a core component in One-Health-based initiatives to tackle public health nutrition issues.

Piloting a training program in computed tomography (CT) skeletal muscle assessment for Registered Dietitians

BACKGROUND

Consensus definitions for disease-associated malnutrition and sarcopenia include reduced skeletal muscle mass as a diagnostic criterion. There is a need to develop and validate techniques to assess skeletal muscle in clinical practice. Skeletal muscle mass can be precisely quantified from computed tomography (CT) images. This pilot study aimed to train Registered Dietitians (RD) to complete precise skeletal muscle measurements using CT.

METHODS

Purposive sampling identified RDs employed in clinical areas where CT scans are routinely performed. CT training included: 1) a 3-day training session focused on manual segmentation of skeletal muscle cross-sectional areas (cm² ) from abdominal CT images at the third lumber (L3) vertebra, using SliceOmatic® software, and 2) a precision assessment to quantify the intra- and inter-observer precision error of repeated skeletal muscle measurements (30 images in duplicate). Precision error is reported as the root mean standard deviation (cm² ) and % coefficient of variation (%CV), our primary performance indicator was defined as a precision error <2%.

RESULTS

Five RDs completed CT training. RDs were from three clinical areas (cancer care (N=1), surgery (N=2), and critical care (N=1). RDs precision error was low and below the minimal acceptable error of <2%; intra-observer error was ≤1.8 cm² (range 0.8 - 1.8 cm² ) or ≤1.5% (range 0.8 - 1.5%) and inter-observer error was 1.2 cm² or 1.1%.

CONCLUSION

RDs can be trained to perform precise CT skeletal muscle measurements. Increasing capacity to assess skeletal muscle is a first step toward developing this technique for use in clinical practice.

CLINICAL RELEVANCE STATEMENT

There is significant interest from both researchers and clinicians to undertake the measurement of skeletal muscle. Reduced skeletal muscle mass places individuals at risk of experiencing adverse outcomes and is a diagnostic criterion for disease-associated malnutrition and sarcopenia. In this study we piloted a training program in computed tomography (CT)-skeletal muscle assessments for RDs, and demonstrated after completion of the program RDs were able to perform CT skeletal muscle measurements with high precision. The addition of new tools to the comprehensive nutrition assessment tool box may benefit clinical practice in multiple ways including improved identification of patients with reduced skeletal muscle mass, individualization of interventions, and monitoring effectiveness of interventions over time. Other clinicians may also benefit from knowing about their patients' skeletal muscle mass to help identify risk and make treatment decisions. This article is protected by copyright. All rights reserved.