Comparison of an electronic versus traditional food diary for assessing dietary intake-A validation study

The test-retest reliability and validity of food photography and food diary analyses

AIMS

To assess test-retest reliability of both food photography and food diary methods and validity of these data against known values derived from food labels.

METHODS

Test-retest reliability analyses of food diary and food photography were compared using single foodstuffs using intra-class correlation coefficients, coefficients of variation, and limits of agreement. For food diaries, 24-h test-retest reliability was also examined. Validity was assessed against weighed analyses. As part of habitual intake, a single foodstuff (randomly allocated from 14 common foods) was consumed by 26 participants over 24-h. On two occasions (14 days apart), single-blind dietary analyses allowed estimation of foodstuff-specific energy and macronutrient content and 24-h intakes.

RESULTS

For food diaries, test-retest reliability was acceptable (weight, energy, carbohydrate, protein, and fat: all intra-class correlation coefficients: >0.990, coefficient of variation percentage: <0.1%, limits of agreements: <0.1 to <0.1, p > 0.05, and effect size: <0.01). For food photography, test-retest reliability was acceptable for weight, energy, carbohydrate, and protein (all intra-class correlation coefficients: >0.898, coefficient of variation percentage: 3.6%-6.2%, limits of agreements: 1.1 to - 44.9, and effect size: 0.01-0.12). Food photography validity was worse than food diaries for all variables (percentage difference: 8.8%-15.3%, coefficient of variation percentage: 7.5%-13.8%, all p ≤ 0.05, and effect size: 0.001-0.11).

CONCLUSIONS

Greater reliability and validity occurred in food diaries versus food photography. These findings suggest that using food photography may lead to an underestimation of energy and macronutrient content, which may have implications for dietary interventions and nutritional strategies.

Plant-based alternative proteins-are they nutritionally more advantageous?

BACKGROUND

The transition towards sustainable nutrition as well as the exploration of alternative sources of protein have been at the forefront of thinking in the 21st century. However, further research is required to ascertain if a diet composed of alternative plant-based proteins has similar nutritional advantages to a plant-based diet. This study aims to model the replacement of a diet consisting of animal-based proteins with plant-based alternatives (PBA), in a group of Asians.

METHODS

A 4-day food record was collected from 50 individuals residing in Singapore and nutrient profiles were generated for each individual. Food records were analysed, and meat, dairy, and seafood ingredients were substituted gram-for-gram with their PBA. The original and replaced nutrient profiles were compared against each other and the differences in macro and micronutrients were analysed.

RESULTS

A significant increase in carbohydrates, dietary fibre, as well as in micronutrients such as sodium and calcium was observed. Conversely, there was a significant decreased intake in overall energy, protein and fat (p < 0.005).

CONCLUSIONS

The significant nutritional impact of substituting animal-based proteins for PBA may present benefits for bone health and individuals on a caloric restriction diet. However, higher sodium levels may be undesirable for individuals with cardiovascular conditions and hypertension, and the low bioavailability of iron in plant-based sources may present issues for iron deficient populations. Bearing some of these key findings in mind, researchers and manufacturers need to consider these when developing alternative protein products to meet consumer demands for palatable and nutritious plant-based products.

Assessment of Frailty by the French Version of the Vulnerable Elders Survey-13 on Digital Tablet: Validation Study

BACKGROUND

Frailty assessment is a major issue in geriatric medicine. The Vulnerable Elders Survey-13 (VES-13) is a simple and practical tool that identifies frailty through a 13-item questionnaire completed by older adults or their family caregivers by self-administration (pencil and paper) or by telephone interview. The VES-13 provides a 10-point score that is also a recognized mortality predictor.

OBJECTIVE

This study aims to design an electronic version of the Echelle de Vulnérabilité des Ainés-13, the French version of the VES-13 (eEVA-13) for use on a digital tablet and validate it.

METHODS

The scale was implemented as a web App in 3 different screens and used on an Android tablet (14.0× 25.6 cm). Participants were patients attending the outpatient clinic of a French geriatric hospital or hospitalized in a rehabilitation ward and family caregivers of geriatric patients. They completed the scale twice, once by a reference method (self-administered questionnaire or telephone interview) and once by eEVA-13 using the digital tablet. Agreement for diagnosis of frailty was assessed with the κ coefficient, and scores were compared by Bland and Altman plots and interclass correlation coefficients. User experience was assessed by a self-administered questionnaire.

RESULTS

In total, 86 participants, including 40 patients and 46 family caregivers, participated in the study. All family caregivers had previously used digital devices, while 13 (32.5%) and 10 (25%) patients had no or infrequent use of them previously. We observed no failure to complete the eEVA-13, and 70% of patients (28/40) and no family caregivers needed support to complete the eEVA-13. The agreement between the eEVA-13 and the reference method for the diagnosis of frailty was excellent (κ=0.92) with agreement in 83 cases and disagreement in 3 cases. The mean difference between the scores provided by the 2 scales was 0.081 (95% CI-1.263 to 1.426). Bland and Altman plots showed a high level of agreement between the eEVA-13 and the reference methods and interclass correlation coefficient value was 0.997 (95% CI 0.994-0.998) for the paper and tablet group and 0.977 (95% CI 0.957-0.988) for the phone and tablet groups. The tablet assessment was found to be easy to use by 77.5% (31/40) of patients and by 96% (44/46) of caregivers. Finally, 85% (39/46) of family caregivers and 50% (20/40) of patients preferred the eEVA-13 to the original version.

CONCLUSIONS

The eEVA-13 is an appropriate digital tool for diagnosing frailty and can be used by older adults and their family caregivers. The scores obtained with eEVA-13 are highly correlated with those obtained with the original version. The use of health questionnaires on digital tablets is feasible in frail and very old patients, although some patients may need help to use them.

Feasibility of wearable camera use to improve the accuracy of dietary assessment among adults

Traditional methods of dietary assessment are prone to measurement error, with energy intake often under-reported. The 24-h recall is widely used in dietary assessment, however, its reliance on self-report without verification of consumption can result in inaccuracies in true nutrient intake. Wearable cameras may provide a complementary approach to improve self-report accuracy by providing an objective and passive measure of food consumption. The purpose of the present study was to determine whether a wearable camera improves the accuracy of a 24-h recall compared with a 24-h recall alone in twenty adults aged 18-65 years. The study also explored limitations associated with wearable cameras. Participants wore the camera for 1 d and a 24-h recall was then conducted the following day, before and after viewing the camera images. Dietary data were analysed using Nutritics dietary analysis software, while eating habits were assessed by a self-report questionnaire. Energy and nutrient intakes were compared between the recall alone and the camera-assisted recall. Results showed a significant increase in mean energy intake with the camera-assisted recall compared with the recall alone (9677⋅8 ± 2708⋅0 kJ/d v. 9304⋅6 ± 2588⋅5 kJ/d, respectively, P = 0⋅003). Intakes of carbohydrates, total sugars and saturated fats were also significantly higher with the camera-assisted recall. In terms of challenges, there were occasionally technological issues such as proper positioning of the camera by the participants. In conclusion, reporting of energy and nutrient intake may be enhanced when a traditional method of dietary assessment, the 24-h recall, is assisted by a wearable camera.

Efficacy of Personalized Diabetes Self-care Using an Electronic Medical Record-Integrated Mobile App in Patients With Type 2 Diabetes: 6-Month Randomized Controlled Trial

Background

A system that combines technology and web-based coaching can help treat chronic conditions such as diabetes. However, the effectiveness of apps in mobile health (mHealth) interventions is inconclusive and unclear due to heterogeneous interventions and varying follow-up durations. In addition, randomized controlled trial data are limited, and long-term follow-up is lacking, especially for apps integrated into electronic medical records.

Objective

We aimed to assess the effect of an electronic medical record–integrated mobile app for personalized diabetes self-care, focusing on the self-monitoring of blood glucose and lifestyle modifications, on glycemic control in patients with type 2 diabetes mellitus.

Methods

In a 26-week, 3-arm, randomized, controlled, open-label, parallel group trial, patients with type 2 diabetes mellitus and a hemoglobin A_1c (HbA_1c) level of ≥7.5% were recruited. The mHealth intervention consisted of self-monitoring of blood glucose with the automatic transfer of glucose, diet, and physical activity counseling data (iCareD system). Participants were randomly assigned to the following three groups: usual care (UC), mobile diabetes self-care (MC), and MC with personalized, bidirectional feedback from physicians (MPC). The primary outcome was the change in HbA_1c levels at 26 weeks. In addition, diabetes-related self-efficacy, self-care activities, and satisfaction with the iCareD system were assessed after the intervention.

Results

A total of 269 participants were enrolled, and 234 patients (86.9%) remained in the study at 26 weeks. At 12 weeks after the intervention, the mean decline in HbA_1c levels was significantly different among the 3 groups (UC vs MC vs MPC: −0.49% vs −0.86% vs −1.04%; P=.02). The HbA_1c level decreased in all groups; however, it did not differ among groups after 26 weeks. In a subgroup analysis, HbA_1c levels showed a statistically significant decrease after the intervention in the MPC group compared with the change in the UC or MC group, especially in patients aged <65 years (P=.02), patients with a diabetes duration of ≥10 years (P=.02), patients with a BMI of ≥25.0 kg/m² (P=.004), patients with a C-peptide level of ≥0.6 ng/mL (P=.008), and patients who did not undergo treatment with insulin (P=.004) at 12 weeks. A total of 87.2% (137/157) of the participants were satisfied with the iCareD system.

Conclusions

The mHealth intervention for diabetes self-care showed short-term efficacy in glycemic control, and the effect decreased over time. The participants were comfortable with using the iCareD system and exhibited high adherence.

Trial Registration

Clinical Research Information Service, Republic of Korea KCT0004128; https://tinyurl.com/bdd6pa9m

From salt to hypertension, what is missed?

Excess salt intake is viewed as a major contributor to hypertension and cardiovascular disease, and dietary salt restriction is broadly recommended by public health guidelines. However, individuals can have widely varying physiological responses to salt intake, and a tailored approach to evaluation and intervention may be needed. The traditional sodium related concepts are challenging to assess clinically for two reasons: (1) spot and 24-hour urine sodium are frequently used to evaluate salt intake, but are more suitable for population study, and (2) some adverse effects of salt may be blood pressure-independent. In recent years, previously unknown mechanisms of sodium absorption and storage have been discovered. This review will outline the limitations of current methods to assess sodium balance and discuss new potential evaluation methods and treatment targets.

Present and Future of Digital Health in Diabetes and Metabolic Disease

The use of information and communication technology (ICT) in medical and healthcare services goes beyond everyday life. Expectations of a new medical environment, not previously experienced by ICT, exist in the near future. In particular, chronic metabolic diseases such as diabetes and obesity, have a high prevalence and high social and economic burden. In addition, the continuous evaluation and monitoring of daily life is important for effective treatment and management. Therefore, the wide use of ICTbased digital health systems is required for the treatment and management of these diseases. In this article, we compiled a variety of digital health technologies introduced to date in the field of diabetes and metabolic diseases.

Healthy Eating, Physical Activity, and Sleep Hygiene (HEPAS) as the Winning Triad for Sustaining Physical and Mental Health in Patients at Risk for or with Neuropsychiatric Disorders: Considerations for Clinical Practice

Neuropsychiatric disorders stem from gene-environment interaction and their development can be, at least in some cases, prevented by the adoption of healthy and protective lifestyles. Once full blown, neuropsychiatric disorders are prevalent conditions that patients live with a great burden of disability. Indeed, the determinants that increase the affliction of neuropsychiatric disorders are various, with unhealthy lifestyles providing a significant contribution in the interplay between genetic, epigenetic, and environmental factors that ultimately represent the pathophysiological basis of these impairing conditions. On one hand, the adoption of Healthy Eating education, Physical Activity programs, and Sleep hygiene promotion (HEPAS) has the potential to become one of the most suitable interventions to reduce the risk to develop neuropsychiatric disorders, while, on the other hand, its integration with pharmacological and psychological therapies seems to be essential in the overall management of neuropsychiatric disorders in order to reduce the disability and improve the quality of life of affected patients. We present an overview of the current evidence in relation to HEPAS components in the prevention and management of neuropsychiatric disorders and provide suggestions for clinical practice.

'Boden Food Plate': Novel Interactive Web-based Method for the Assessment of Dietary Intake

Different methods can be used in research to assess dietary intake, many of which are still paper-based. Written estimated food diaries are often utilized in clinical trials, despite being a burden for both study participants and researchers. This method requires participant literacy, it is time consuming, labor intensive, and can easily lead to under-reporting. With advancements in technology, there is a growing interest in electronic diaries that automate the dietary assessment process. These are focused on improving accuracy, reducing both time and cost and providing users with a visual and more enjoyable experience. The methodology presented here aimed to validate the 'Boden Food Plate', a novel web-based platform for self-recording of food and drink items, compared to a traditional estimated food diary. The application was also rated on a satisfaction scale by study participants using a paper-based questionnaire. Sixty-seven participants completed the dietary measures on both the three-day electronic and paper food diaries. For the analysis, only dietary data completed at both study time points (baseline and week six) was utilized. Despite small mean differences between dietary data collection methods, Bland Altman analysis showed fairly wide 95% limits of agreement between the electronic platform and the written estimated food diary and there were few cases which did not fall within the 95% confidence intervals. Overall, participants found the electronic food diary to be more fun than the paper method and as easy to use as hard copy diaries. The new platform has potential as a self-recording tool for the collection of dietary data, particularly when utilized in clinical trial settings. However, further validation studies are needed to improve the validity of this novel electronic dietary data collection tool.

Dietary Management of Obesity: Cornerstones of Healthy Eating Patterns

Several dietary patterns, both macronutrient and food based, can lead to weight loss. A key strategy for weight management that can be applied across dietary patterns is to reduce energy density. Clinical trials show that reducing energy density is effective for weight loss and weight loss maintenance. A variety of practical strategies and tools can help facilitate successful weight management by reducing energy density, providing portion control, and improving diet quality. The flexibility of energy density gives patients options to tailor and personalize their dietary pattern to reduce energy intake for sustainable weight loss.