Potential Use of Mobile Phone Applications for Self-Monitoring and Increasing Daily Fruit and Vegetable Consumption: A Systematized Review

A single-blinded, randomized, parallel intervention to evaluate genetics and omics-based personalized nutrition in general population via an e-commerce tool: The PREVENTOMICS e-commerce study

BACKGROUND

Personalized nutrition (PN) has been proposed as a strategy to increase the effectiveness of dietary recommendations and ultimately improve health status.

OBJECTIVES

We aimed to assess whether including omics-based PN in an e-commerce tool improves dietary behavior and metabolic profile in general population.

METHODS

A 21-wk parallel, single-blinded, randomized intervention involved 193 adults assigned to a control group following Mediterranean diet recommendations (n = 57, completers = 36), PN (n = 70, completers = 45), or personalized plan (PP, n = 68, completers = 53) integrating a behavioral change program with PN recommendations. The intervention used metabolomics, proteomics, and genetic data to assist participants in creating personalized shopping lists in a simulated e-commerce retailer portal. The primary outcome was the Mediterranean diet adherence screener (MEDAS) score; secondary outcomes included biometric and metabolic markers and dietary habits.

RESULTS

Volunteers were categorized with a scoring system based on biomarkers of lipid, carbohydrate metabolism, inflammation, oxidative stress, and microbiota, and dietary recommendations delivered accordingly in the PN and PP groups. The intervention significantly increased MEDAS scores in all volunteers (control-3 points; 95% confidence interval [CI]: 2.2, 3.8; PN-2.7 points; 95% CI: 2.0, 3.3; and PP-2.8 points; 95% CI: 2.1, 3.4; q < 0.001). No significant differences were observed in dietary habits or health parameters between PN and control groups after adjustment for multiple comparisons. Nevertheless, personalized recommendations significantly (false discovery rate < 0.05) and selectively enhanced the scores calculated with biomarkers of carbohydrate metabolism (β: -0.37; 95% CI: -0.56, -0.18), oxidative stress (β: -0.37; 95% CI: -0.60, -0.15), microbiota (β: -0.38; 95% CI: -0.63, -0.15), and inflammation (β: -0.78; 95% CI: -1.24, -0.31) compared with control diet.

CONCLUSIONS

Integration of personalized strategies within an e-commerce-like tool did not enhance adherence to Mediterranean diet or improved health markers compared with general recommendations. The metabotyping approach showed promising results and more research is guaranteed to further promote its application in PN. This trial was registered at clinicaltrials.gov as NCT04641559 (https://clinicaltrials.gov/study/NCT04641559?cond=NCT04641559&rank=1).

The effect of an app-based dietary intervention on diet-related greenhouse gas emissions - results from a randomized controlled trial

BACKGROUND

Dietary change towards a diet low in greenhouse gas emissions (GHGEs) can reduce climate impact and improve individual-level health. However, there is a lack of understanding if diet interventions can achieve low-GHGE diets.

METHODS

A randomized controlled trial was conducted to assess the effects of an app-based intervention. The intervention was designed to improve dietary intake of people with Type 2 diabetes, and was delivered via an app over 12 weeks, with each week covering one diet-related topic. Dietary intake was assessed at baseline and 3-month follow up by a 95-item food frequency questionnaire and linked to GHGE values. A total of n = 93 participants (n = 46 and n = 47 for the intervention and control group, respectively) were included in the analysis. Changes to GHGEs within and between the groups were analysed with inferential statistics.

RESULTS

The majority (60%) of participants were male, with a mean age of 63.2 years and body mass index of 30 kg/m2. At baseline, diet-related GHGEs were 4.8 and 4.9 kg CO2-eq/day in the intervention and control group, respectively. At 3-month follow up the corresponding GHGEs were 4.7 and 4.9 kg CO2-eq/day. We found no statistically significant changes to diet-related GHGEs within or between groups, or within food categories, from baseline to 3-month follow up.

CONCLUSION

No evidence was found for the effectiveness of the app-based intervention to generate changes to diet-related GHGEs in a population of people with Type 2 diabetes. However, future interventions that target reducing meat consumption specifically may have the potential to result in a reduction of individual-level diet-related GHGEs.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03784612. Registered 24 December 2018. www.

CLINICALTRIALS

gov/ct2/show/NCT03784612 .

Perceptions of adequacy of fruit and vegetable intake as a barrier to increasing consumption

AIM

To investigate New South Wales adults' perceived adequacy of their fruit and vegetable consumption and to identify the barriers to consumption.

METHOD

An online cross-sectional survey of a sample of adults in New South Wales (n = 1603) in February 2019 measured self-reported fruit and vegetable intakes, perception of consumption adequacy and barriers to consumption. Proportions of participants whose reported consumption met the daily recommended serves of fruit and vegetables per day were calculated. Chi-square and Fisher's exact tests were used to explore differences between demographic characteristics and meeting fruit and vegetable recommendations. For those not meeting recommendations, Chi-square and Fisher's exact tests were used to explore perceived adequacy of intake as a potential barrier to consumption.

RESULTS

The sample included 52.7% women, 40.0% aged under 40 years and 28.6% over 59 years, 68.2% lived in a major city, and 32.6% were university educated. Overall, 64.8% of participants reported consuming adequate fruit and 12.4% reported consuming adequate vegetables. Of those consuming less than the guidelines, 21.3% perceived that they were eating enough fruit and 53.7% perceived they were eating enough vegetables. The most common barriers to eating more fruit were preference for other foods (29.6%), fruit spoiling too quickly (28.3%), and habit (27.0%). The most common barriers to eating more vegetables were the perception that they eat enough (26.8%), preference for other foods (21.9%), and habit (19.7%).

CONCLUSIONS

Greater efforts are needed to support the public to eat adequate fruit and vegetables, consistent with dietary guidelines. Public education campaigns specifically targeting increasing vegetable consumption are required to address knowledge gaps, given a large proportion of our study population consumed inadequate levels of vegetables yet perceived their intake to be adequate.

The effect of a school-based fruit and vegetable promotion program on adolescents' fruit and vegetable consumption behavior in Turkey

PURPOSE

The aim of this study was to analyze the effect of a school-based F&V promotion program developed in line with the transtheoretical model (TTM) on the consumption behavior of middle school students.

DESIGN AND METHODS

The study was designed as semi-experimental research with pre-/post- and follow-up tests and a control group. It was conducted at a total of six middle schools in the district of Fethiye/Muğla, Turkey. Three of the schools were selected with the random clustering method as an intervention group and the others as the control group. The F&V promotion program was executed in the intervention group for a period of 24 weeks.

RESULTS

It was found in the 6th and 12th months after the intervention that the daily number of portions of fruits (p<.01) and vegetables (p<.01) consumed by the students in the intervention group was significantly more compared to the control group. The perception of the pros of F&V consumption and self-efficacy in the intervention group were higher than in the controls (p<.01).

CONCLUSIONS

The school-based F&V consumption promotion program was effective in increasing the number of portions of fruits and vegetables students consumed and in improving their behaviors in this regard.

APPLICATION TO PRACTICE

The study indicates that the interventions described may be recommended to school nurses for use in their efforts to increase levels of F&V consumption.

Short-Term Pilot Study to Evaluate the Impact of Salbi Educa Nutrition App in Macronutrients Intake and Adherence to the Mediterranean Diet: Randomized Controlled Trial

Promoting a healthy diet is a relevant strategy for preventing non-communicable diseases. This study aims to evaluate the impact of an innovative tool, the SAlBi educa nutrition app, in primary healthcare dietary counseling to improve dietary profiles as well as adherence to the Mediterranean diet. A multi-center randomized control trial comprising 104 participants was performed. Both control (n = 49) and intervention (n = 55) groups attended four once-weekly sessions focusing on healthy eating habits and physical activity, over one month. As well as attending the meetings, the intervention group used the app, which provides self-monitoring and tailored dietary advice based on the Mediterranean diet model. In a second intervention (one arm trial), the potential of SAlBi educa was evaluated for three months during the COVID-19 pandemic. At 4 weeks, the intervention group had significantly increased their carbohydrate intake (7.7% (95% CI: 0.16 to 15.2)) and decreased their total fat intake (−5.7% (95% CI: −10.4 to −1.15)) compared to the control group. Significant differences were also found for carbohydrates (3.5% (95% CI: −1.0 to 5.8)), total fats (−5.9% (95% CI: −8.9 to −3.0)), fruits and vegetables (266.3 g/day (95% CI: 130.0 to 402.6)), legumes (7.7g/day (95% CI: 0.2 to 15.1)), starchy foods (36.4 g/day (95% CI: 1.1 to 71.7)), red meat (−17.5 g/day (95% CI: −34.0 to −1.1)), and processed meat (−6.6 g/day (95% CI: −13.1 to −0.1)) intakes during the COVID-19 pandemic. SAlBi educa is a useful tool to support nutrition counseling in primary healthcare, including in special situations such as the COVID-19 pandemic. Trial registration: ISRCTN57186362.

Design and evaluation of a mobile-based nutrition education application for infertile women in Iran

Background

The prevalence of infertility in Iran is higher than the world average. Furthermorte, education and nutrition are among the effective factors in improving the quality of life of women with infertility. According to the significant role of smartphones in people's lives as well as health education, the present study aimed to design and evaluate a mobile-based nutrition education application for infertile women.

Methods

This quantitative research was conducted in two stages. Initially, the educational contents were determined based on a review of the literature. Later, the obtained contents were given to 10 nutritionists and five infertility specialists to determine the necessity of each item. In the next stage, the application prototype was designed based on the results of the first stage and distributed among 220 infertile women. After two months, the Questionnaire of User Interface Satisfaction was administrated to assess the usability of the developed application. The results were analyzed via SPSS software version 20.

Results

According to the nutritionists and infertility specialists, the contents determined for the nutrition educational application were categorized under three general sections of user's demographic data, educational contents, required capabilities. The users' mean score of the application usability was calculated as 7.44 out of 9 indicating a good level of satisfaction.

Conclusions

Nutrition education of women with infertility problems can play a significant role in improving their awareness and treatment outcomes. Due to the increasing use of smartphones, designing a mobile-based nutrition educational application can be of great benefit for women with infertility according to the cultural conditions and characteristics of each community.

Validating Accuracy of a Mobile Application against Food Frequency Questionnaire on Key Nutrients with Modern Diets for mHealth Era

In preparation for personalized nutrition, an accurate assessment of dietary intakes on key essential nutrients using smartphones can help promote health and reduce health risks across vulnerable populations. We, therefore, validated the accuracy of a mobile application (app) against Food Frequency Questionnaire (FFQ) using artificial intelligence (AI) machine-learning-based analytics, assessing key macro- and micro-nutrients across various modern diets. We first used Bland and Altman analysis to identify and visualize the differences between the two measures. We then applied AI-based analytics to enhance prediction accuracy, including generalized regression to identify factors that contributed to the differences between the two measures. The mobile app underestimated most macro- and micro-nutrients compared to FFQ (ranges: -5% for total calories, -19% for cobalamin, -33% for vitamin E). The average correlations between the two measures were 0.87 for macro-nutrients and 0.84 for micro-nutrients. Factors that contributed to the differences between the two measures using total calories as an example, included caloric range (1000-2000 versus others), carbohydrate, and protein; for cobalamin, included caloric range, protein, and Chinese diet. Future studies are needed to validate actual intakes and reporting of various diets, and to examine the accuracy of mobile App. Thus, a mobile app can be used to support personalized nutrition in the mHealth era, considering adjustments with sources that could contribute to the inaccurate estimates of nutrients.

Effect of a Multicomponent mHealth Intervention on the Composition of Diet in a Population with Overweight and Obesity-Randomized Clinical Trial EVIDENT 3

A balanced diet can help in the prevention of chronic diseases. The aim of this study was to evaluate the effect of an mHealth intervention on the distribution of macronutrients and the intake of food groups. A total of 650 participants were included in this multi-center, clinical, randomized, controlled trial (Evident 3 study). All participants were given brief advice about diet and exercise. The intervention group received, in addition, an app (Evident 3) for the self-recording of their diet and an activity tracker wristband for 3 months. Follow-up visits were performed at 3 and 12 months to collect the diet composition using the Food Frequency Questionnaire. There were decreases in the intake of total calories, fat, protein and carbohydrates in both groups throughout the study, without significant differences between them. The intervention group reduced the intake of cholesterol (−30.8; 95% CI −59.9, −1.7) and full-fat dairies (−23.3; 95% CI −42.8, −3.8) and increased the intake of wholemeal bread (3.3; 95% CI −6.7, 13.3) and whole-grain cereals (3.4; 95% CI −6.8, 13.7) with respect to the control group. No differences were found in the rest of the nutritional parameters. The brief advice is useful to promote a healthier diet, and the app can be a support tool to obtain changes in relevant foods, such as integral foods, and the intake of cholesterol. Trial registration: ClinicalTrials.gov with identifier NCT03175614.

What drives the use of wearable healthcare devices? A cross-country comparison between the US and Korea

Objective

Given the rapid growth of the wearable healthcare device market, we examined the associations among health-related and technology-related characteristics of using wearable healthcare devices and demonstrated how the associations differ between the US and Korean users.

Methods

Online self-administered surveys were conducted with 4098 participants (3035 in the US and 1063 in Korea) who were recruited through two online survey service providers based on quota sampling. The primary outcome was the use of wearable healthcare devices. Seven health-related, two technology-related, and five socio-demographic factors were included as explanatory variables. Binary logistic regression analyses and a Chow test were conducted.

Results

The health-related characteristics that were significantly associated with using wearable healthcare devices included disease-related worries (β = 0.11**), health information seeking (β = 0.26***), physical activity (β = 0.62***), and health-related expenditures ($50–$199, β = 0.38***; $200 or more, β = 0.56***). Hedonic (β = 0.33***), social (β = 0.31***), and cognitive innovativeness (β = 0.14*) also exhibited positive relationships. Younger, higher earner, and individuals with a child were more likely to use wearable healthcare devices. However, for Korean users, several associations disappeared including health information seeking, hedonic and social innovativeness, age, and household income.

Conclusions

Key drivers of using wearable healthcare devices include greater concern about a specific illness, active engagement in health-promoting behaviors, and hedonic and social motivation to adopt new technologies. However, more country-specific considerations are needed in future studies to identify the main benefits for target markets.

Relationship Between Individual Health Beliefs and Fruit and Vegetable Intake and Physical Activity Among Cancer Survivors: Results from the Health Information National Trends Survey

Purpose: The aim of this study was to describe diet and physical activity (PA) behaviors and health beliefs among cancer survivors and identify potential differences between adolescent and young adult (AYA) and adult/older cancer survivors. Methods: Cancer survivors (n = 1864) participating in the Health Information National Trends Survey (HINTS) provided responses regarding diet and PA and selected health beliefs related to general health and cancer (self-efficacy, attitudinal belief, normative belief, risk belief, intention, and self-regulation). Health belief associations with diet and PA were assessed using adjusted logistic regression models, and multiple linear regression was used for a computed Modified American Cancer Society Adherence score (0-10, higher score indicates higher adherence to recommendations); age at diagnosis was evaluated as a potential effect modifier. Results: Health behaviors between AYA and adult/older were not significantly different; a greater percent of AYA met fruit and resistance PA recommendations. Higher health self-efficacy was associated with meeting aerobic PA recommendations (odds ratio [OR]: 1.71; confidence interval [95% CI]: 1.13-2.60; p = 0.01). Higher intention was inversely related to meeting vegetable recommendation (OR: 0.58; 95% CI: 0.35-0.97; p = 0.04). Self-regulation was associated with higher odds of meeting each recommendation. Self-efficacy and self-regulation were associated with greater adherence (β = 0.52 ± 0.16, p = 0.001; β = 1.21 ± 0.24, p < 0.0001, respectively). Age at diagnosis was not an effect modifier. Conclusion: Health behaviors and beliefs among AYA and adult/older are similar. Self-efficacy and self-regulation through engagement with a mobile app support adoption of diet and PA recommendations among HINTS respondents. Future interventions should consider mechanisms to promote self-efficacy and self-regulation to maximize diet and PA behaviors in cancer survivors.

Investigation of the impact of grapefruit juice, pomegranate juice and tomato juice on pharmacokinetics of brexpiprazole in rats using UHPLC-QTOF-MS

Brexpiprazole (BRX) is approved for the treatment of schizophrenia and major depressive disorders and it is mainly metabolized by CYP3A4 and CYP2D6. Grapefruit juice (GFJ), pomegranate juice (PJ) and tomato juice (TJ) have the potential to inhibit CYP3A4 enzymes in the body. However, fruit juice-drug interactions between BRX and GFJ, PJ and TJ have not been studied extensively. The present study describes the influence of GFJ, PJ and TJ on the pharmacokinetic parameters of BRX in rats. The study samples were analyzed using a mass-accurate and single-step bioanalytical method by ultra-high-performance liquid chromatography-quadrupole time-of-flight mass spectrometry over a wide calibration range of 20-1,500 ng/ml. The results of the pharmacokinetic study denoted that the combined administration of GFJ and PJ could increase systemic exposure of BRX. The area under the curve of BRX increased 3.43- and 1.88-fold with co-administration of GFJ and PJ, respectively, while TJ with BRX had no effect on the area under the curve. Time to peak concentration and half-life were not significantly changed by any juice co-administration. The results show that GFJ and PJ affect the pharmacokinetic profile of BRX and hence advice needs to be given to patients.

Changing parental feeding practices through web-based interventions: A systematic review and meta-analysis

Web-based parent interventions designed to promote children’s healthy eating patterns can enhance parents’ engagement and facilitate behavior change. However, it is still unclear how much the existing programs focus on changing parental feeding practices, and if so, which behavioral methodologies are used and how effective these interventions are in changing these parental behaviors. This systematic review and meta-analysis studied randomized controlled trials of web-based interventions targeting parents of 0-12-year-old children, aiming to promote children’s healthy diet or prevent nutrition-related problems and reporting parental feeding behaviors as one of the outcomes. We conducted an electronic search in four databases from the earliest publication date until February 2020. Of the 1271 records found, we retained twelve studies about nine programs, comprising 1766 parents that completed the baseline evaluation. We found recent interventions, mainly directed to parents of young children, with small, non-clinical samples, and mostly theory-based. The programs were heterogeneous regarding the type of intervention delivered and its duration. The most assessed parental feeding practices were Restriction, Pressure to eat, and Food availability/accessibility. The behavior change techniques Instruction on how to perform the behavior, Demonstration of the behavior, and Identification of self as role model were frequently used. Meta-analytic results indicated that most programs’ effects were small for the evaluated parental practices, except for Food availability/accessibility that benefited the intervention group only when all follow-up measurements were considered. The development of high-quality and controlled trials with larger samples is needed to determine with greater certainty the interventions’ impact on parental feeding behaviors. The more frequent inclusion of measures to evaluate parental practices to support children’s autonomy and of self-regulatory strategies as intervention components should be considered when designing programs.

The importance of knowing and listening to all those involved in the design and use of nutrition mobile apps. Getting to know the Great GApp

Introduction

Almost every country worldwide suffers from one or more types of malnutrition. Mobile technology (mHealth) interventions seem to represent a promising approach to this problem because they help share information about healthy eating patterns, offer motivation for behavioral change, etc. From this perspective we introduce a theoretical model that attempts to explain the gap that currently prevails between the elements involved in the development of nutritional mHealth strategies (which we have called the Great GApp). Evidence tells us that it is necessary to consider all the parts involved to ensure positive outcomes of an mHealth-based nutritional intervention: patients, health care providers, and stakeholders (technological companies). If these elements are not considered in the design of mHealth strategies a Great GApp arises, which may lead to lack of adherence to the proposed change, and decrease the potential for improving the quality of health outcomes.

eHealth Practices in Cancer Survivors With BMI in Overweight or Obese Categories: Latent Class Analysis Study

Background

eHealth technologies have been found to facilitate health-promoting practices among cancer survivors with BMI in overweight or obese categories; however, little is known about their engagement with eHealth to promote weight management and facilitate patient-clinician communication.

Objective

The objective of this study was to determine whether eHealth use was associated with sociodemographic characteristics, as well as medical history and experiences (ie, patient-related factors) among cancer survivors with BMI in overweight or obese categories.

Methods

Data were analyzed from a nationally representative cross-sectional survey (National Cancer Institute’s Health Information National Trends Survey). Latent class analysis was used to derive distinct classes among cancer survivors based on sociodemographic characteristics, medical attributes, and medical experiences. Logistic regression was used to examine whether class membership was associated with different eHealth practices.

Results

Three distinct classes of cancer survivors with BMI in overweight or obese categories emerged: younger with no comorbidities, younger with comorbidities, and older with comorbidities. Compared to the other classes, the younger with comorbidities class had the highest probability of identifying as female (73%) and Hispanic (46%) and feeling that clinicians did not address their concerns (75%). The older with comorbidities class was 6.5 times more likely than the younger with comorbidities class to share eHealth data with a clinician (odds ratio [OR] 6.53, 95% CI 1.08-39.43). In contrast, the younger with no comorbidities class had a higher likelihood of using a computer to look for health information (OR 1.93, 95% CI 1.10-3.38), using an electronic device to track progress toward a health-related goal (OR 2.02, 95% CI 1.08-3.79), and using the internet to watch health-related YouTube videos (OR 2.70, 95% CI 1.52-4.81) than the older with comorbidities class.

Conclusions

Class membership was associated with different patterns of eHealth engagement, indicating the importance of tailored digital strategies for delivering effective care. Future eHealth weight loss interventions should investigate strategies to engage younger cancer survivors with comorbidities and address racial and ethnic disparities in eHealth use.

Cranberry for Bacteriuria in Individuals with Spinal Cord Injury: A Systematic Review and Meta-Analysis

Background

Urinary tract infection (UTI) is common in individuals with spinal cord injury (SCI) and neurogenic lower urinary tract dysfunction (NLUTD) and in veterans with SCI who use antibiotics improperly for asymptomatic bacteriuria. Cranberry (CB) has been suggested for UTI prevention.

Methods

We performed a systematic search up to May 2020 in the following databases: AccessMedicine, BioMed Central, CINAHL, Cochrane Library, ProQuest, and PubMed. Quality assessment was performed using a specifically designed quality score. Risk ratio was calculated with both random effect model analysis (DerSimonian-Laird method) and quality effect model analysis (Doi Thalib method).

Results

Six studies on bacteriuria and SCI were reviewed. From the four studies available for meta-analysis, two of which with individuals taking both CB and control, 477 data from 415 participants were analysed (241 CB and 236 control). No significant differences were detected with meta-analysis. However, bias, limitations, and incompleteness were observed in the reviewed studies.

Conclusion

Although further studies are needed, we suggest an accurate monitoring of diet and fluid intake, the evaluation of risk for potential food or nutraceutical interactions with drugs, and the inclusion of inflammatory markers among the outcomes in addition to UTI.

Digital Support for Healthier Eating Habits Among Patients With Type 2 Diabetes: Protocol for a Randomized Clinical Trial Within Primary Care (HAPPY Trial)

Background

Despite the large impact that dietary habits have in the management of diabetes, few tools for supporting healthy eating habits are available for persons with diabetes.

Objective

The aim of this randomized clinical trial is to evaluate the effect of a 12-week, mobile health (mHealth), app-based intervention promoting healthy eating habits among patients with type 2 diabetes.

Methods

The HAPPY (Healthy eating using APP technologY) trial is a randomized clinical trial with two arms aiming to include 200 patients, 18 years of age or older, with type 2 diabetes. Both women and men are eligible for inclusion. Study participants are randomized 1:1 to an intervention group, where they are instructed to use a smartphone app promoting healthy eating, or to a control group, where they receive standard primary care only, for a period of 12 weeks. Each week a new topic (eg, vegetable intake) is introduced via the app. After an introduction text, the user is given a topic-related activity to perform (eg, eat one additional serving of vegetables per day during that week). The app records daily progress and sends automatic reminders or feedback to the user. Dietary intake, body composition, clinical variables, and biomarkers are measured at baseline and at 3- and 6-month follow-ups. An extensive web-based questionnaire comprising several validated questionnaires assessing a number of lifestyle factors is distributed via email at baseline and at 3-, 6-, and 12-month follow-ups; lifestyle factors include, for example, sleep, physical activity, eating behavior, and health-related quality of life. The effect of the intervention on dietary intake (primary outcome) and on glycated hemoglobin and blood lipid levels, body composition, blood pressure, other lifestyle factors, and overall health (secondary outcomes) will be assessed.

Results

Data collection is ongoing. Recruitment of participants started in January 2019. Findings from the study are expected to be published by the end of 2021.

Conclusions

Technology development provides new ways to promote and support long-term adherence to healthier eating habits. mHealth-based approaches allow for real-time interaction and the delivery of an intervention at any time. Further, focusing on overall diet allows the user to apply new knowledge to current eating patterns, creating an individualized approach. In this study, we evaluate the effect of using a new smartphone app promoting healthy eating habits on dietary intake, clinical markers, and lifestyle factors among patients with type 2 diabetes.

Trial Registration

ClinicalTrials.gov NCT03784612; https://clinicaltrials.gov/ct2/show/NCT03784612

International Registered Report Identifier (IRRID)

DERR1-10.2196/24422

The "Virtual Digital Twins" Concept in Precision Nutrition

Nutritional and lifestyle changes remain at the core of healthy aging and disease prevention. Accumulating evidence underscores the impact of genetic, metabolic, and host gut microbial factors on individual responses to nutrients, paving the way for the stratification of nutritional guidelines. However, technological advances that incorporate biological, nutritional, lifestyle, and health data at an unprecedented scale and depth conceptualize a future where preventative dietary interventions will exceed stratification and will be highly individualized. We herein discuss how genetic information combined with longitudinal metabolomic, immune, behavioral, and gut microbial parameters, and bioclinical variables could define a digital replica of oneself, a "virtual digital twin," which could serve to guide nutrition in a personalized manner. Such a model may revolutionize the management of obesity and its comorbidities, and provide a pillar for healthy aging.

Construal beliefs moderate the usability and effectiveness of a novel healthy eating mobile app

Reduced self-control is a strong predictor of overeating and obesity. Priming a high construal level mind-set has been shown to enhance self-control and reduce snack consumption in the lab but the long-term and real-world effects are not known. The use of digital technology is an efficient way to deliver priming cues in real-world settings. Many mobile apps claim to support healthy eating but few are grounded in psychological theories of self-control. The aim of this study was to test the feasibility and effectiveness of a novel, construal-theory-based mobile app to promote self-control and healthy eating. In an exploratory analysis, the moderating influence of user characteristics was also examined. Using an iterative process involving users at every stage of the process, a prototype mobile app was developed. The final version included a high construal, self-control priming task, sent personalised reminder cues before each eating occasion, provided a just-in time 'crave-buster' for unanticipated eating opportunities and an optional food log. In a longitudinal trial the app was used over an eight-week period (N=71; 51 females; M (SD) Age = 33.34 (11.68) years; M (SD) BMI = 26.22 (4.94)) with pre-post measures of weight, percent body fat and dietary intake. The app received high usability ratings on the System Usability Scale (M=76.55; SD=11.35), however food intake, per cent body fat and weight pre- and post- app use showed no significant change (p>.05). Exploratory analyses showed that baseline construal belief moderated the extent to which engagement with the app predicted dietary changes (p<.05). These findings indicate that this novel app was user-friendly and effective but that this was dependent on the user's characteristics. Future development in this area should consider tailoring apps to the specific characteristics of the user for improved support and effectiveness.

Why Do Lifestyle Recommendations Fail in Most Patients with Nonalcoholic Fatty Liver Disease?

Nonalcoholic fatty liver disease has been recognized as a major health burden. The efficacy and safety profile of pharmacotherapy in the treatment of nonalcoholic fatty liver disease remains uncertain; therefore, lifestyle modification is the first line of treatment. Based on available data, patients should optimally achieve at least a 5% to 10% weight reduction for histologic improvement. There is no clear consensus on the optimal diet or exercise regimen. Sustainability of any intervention is key to success; however, compliance has been a major issue in clinical trials. This finding underscores the importance of multidisciplinary strategies to achieve targeted weigh loss.

An Interactive Mobile Phone App (SMART 5-A-DAY) for Increasing Knowledge of and Adherence to Fruit and Vegetable Recommendations: Development and Pilot Randomized Controlled Trial

Background

Fruit and vegetable consumption is important for health, but many individuals fail to consume adequate amounts for health benefits. Although many individuals are aware of current fruit and vegetable consumption recommendations, research suggests that adherence to these is hampered by low knowledge of the details of these recommendations.

Objective

This paper reports the development and details of a pilot randomized controlled test of a novel interactive mobile phone app for addressing low knowledge of the UK 5-a-day fruit and vegetable recommendations.

Methods

Requirements for the app were first defined by researchers and potential end users and prioritized using the MoSCoW (Must have, Should have, Could have, Won’t have) method. Second, a prototype mobile phone app was developed using an agile approach. Third, the prototype app was tested in a randomized controlled pilot trial for impacts on knowledge and intake of fruit and vegetables. Volunteers were randomized to either receive (n=50) or not receive the app (n=44) for 2 or 4 weeks, and fruit and vegetable knowledge, intake, and behavior were assessed at the beginning of the study and after 1 and 2 weeks or after 2 and 4 weeks, respectively. App usage and qualitative feedback were also investigated. All findings then informed the development of a final app.

Results

Low knowledge of consumption recommendations centered around portion sizes and the need for variety, and an interactive mobile phone app was considered a suitable tool for improving this knowledge in a practical manner that would be available both at time of consumption and outside of these times. The pilot test revealed improved behavior after 2 weeks compared with baseline in volunteers who received the app, but improvements in knowledge on fruit and vegetable recommendations were found in both groups, and no improvements in fruit and vegetable intakes were found in formal measures. Patterns of app usage and qualitative feedback also suggested a number of modifications. The resultant final app incorporates several behavior change techniques (goal-setting, self-monitoring, and personalized feedback) as well as aiming to improve knowledge.

Conclusions

A novel interactive mobile phone app was successfully developed based on requirements, and when tested in a pilot randomized controlled trial, this app was found to have some impacts on fruit and vegetable outcomes. Although benefits from the app were small, impacts will likely increase as a result of recent modifications. The final SMART 5-A-DAY app is available in the Google Play Store and now needs testing in the target population.

Trial Registration

ClinicalTrials.gov NCT02779491; https://www.clinicaltrials.gov/ct2/show/NCT02779491