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

The impact of the COVID-19 pandemic on Mediterranean diet adherence: A narrative systematic review

BACKGROUND

The COVID-19 pandemic upended many aspects of daily life. For some individuals, this was an opportunity to re-evaluate their life and make better choices, while others were overwhelmed with stressors, leading to a deterioration in mental and physical health.

AIM

The aim of this narrative systematic review is to explore the effects of the COVID-19 pandemic on Mediterranean diet adherence.

METHODS

A systematic literature search was carried out on PubMed, Scopus and Web of Science electronic databases utilising the search terms 'Mediterranean diet' AND 'COVID-19'. This yielded 73 articles that fulfilled the inclusion criteria.

RESULTS

The data suggests that a substantial proportion of individuals adhered less to the Mediterranean diet during the COVID-19 lockdown period. However, individuals receiving some form of lifestyle intervention had better adherence to the Mediterranean diet than their unassisted counterparts.

CONCLUSION

This emphasises the importance of professional support during times of crisis to avoid deterioration of a population's health.

Technology-delivered personalized nutrition intervention on dietary outcomes among adults with overweight and obesity: A systematic review, meta-analysis, and meta-regression

The prevalence of overweight and obesity has continued to increase globally, and one-size-fits-all dietary recommendations may not be suitable for different individual characteristics. A personalized nutrition intervention may be a potential solution. This review aims to evaluate the effects of the technology-delivered personalized nutrition intervention on energy, fat, vegetable, and fruit intakes among adults with overweight and obesity. A three-step comprehensive search strategy was performed from 10 databases and seven clinical registries in published and unpublished trials. A total of 46 randomized controlled trials (RCTs) involving 19,670 adults with overweight and obesity from 14 countries are included. Subgroup and meta-regression analyses were conducted. Meta-analyses showed a reduction of energy intake (-128.05, 95% CI: -197.08, -59.01) and fat intake (-1.81% energy/days, 95% CI: -3.38, -0.24, and -0.19 scores, 95% CI: -0.40, 0.02) in the intervention compared with the comparator. Significant improvements in vegetable and fruit intakes with 0.12-0.15 servings/day were observed in the intervention. Combined one- and two-way interactions had a greater effect on energy intake reduction compared with their counterparts. Meta-regression analyses revealed that no significant covariates were found. Given that the certainty of the evidence was rated as low or very low, further well-designed RCTs with long-term follow-up are warranted.

Short-Term Effect of a Health Promotion Intervention Based on the Electronic 12-Hour Dietary Recall (e-12HR) Smartphone App on Adherence to the Mediterranean Diet Among Spanish Primary Care Professionals: Randomized Controlled Clinical Trial

BACKGROUND

The World Health Organization has called for addressing the growing burden of noncommunicable diseases (NCDs) by promoting healthy lifestyles among the population. Regarding patient health, primary care professionals (PCPs) are the first line of care who can positively influence patients' behavior and lifestyle habits. However, a significant percentage of PCPs do not lead a healthy lifestyle. Therefore, addressing their health behaviors may be the key to substantially increasing health promotion advice in general practice. The Mediterranean diet has been extensively studied, and there is strong evidence of it being a dietary pattern for the prevention of NCDs, in addition to its significant environmental, sociocultural, and local economics benefits.

OBJECTIVE

This study focused only on the dietary aspect of the PCPs' lifestyle. The primary objective was to evaluate the effect of using the Electronic 12-Hour Dietary Recall (e-12HR) smartphone app to improve diet, specifically to promote adherence to the Mediterranean diet (AMD), among PCPs. The secondary objectives were to establish the usability of the e-12HR app and to determine AMD among PCPs.

METHODS

An individual-level randomized, controlled, and single-blind clinical trial was conducted with 2 parallel groups: a control group (CG), using the nonfeedback version of the e-12HR app, and an intervention group (IG), using the feedback version of the e-12HR app. The level of human involvement was fully automated through the use of the app. There was a 28-day follow-up period. Participants were PCPs (medicine or nursing) recruited offline at one of the selected primary care centers (Andalusia, Spain, Southern Europe), of both sexes, over 18 years old, possessing a smartphone, and having smartphone literacy.

RESULTS

The study response rate was 73% (71 of 97 PCPs), with 27 (38%) women and 44 (62%) men: 40 (56%) PCPs in the CG and 31 (44%) in the IG. At baseline, AMD was medium (mean Mediterranean Diet Serving Score [MDSS] index 9.45, range 0-24), with 47 (66%) PCPs with a medium/high MDSS index. There were significant statistical improvements (CG vs IG, in favor of the IG) at week 4 (no significant statistical differences at baseline): +25.6% for the MDSS index (P=.002) and +213.1% for the percentage with a medium/high MDSS index (P=.001). In relation to specific food groups, there were significant statistical improvements for fruits (+33.8%, P=.02), vegetables (+352%, P=.001), nuts (+184%, P=.02), and legumes (+75.1%, P=.03). The responses to the usability rating questionnaire were satisfactory.

CONCLUSIONS

The results support recommending the use of the e-12HR app as a tool to contribute to improving diet and preventing NCDs among PCPs, while positively influencing patient dietary behavior and preventing diet-related NCDs among patients.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05532137; https://clinicaltrials.gov/study/NCT05532137.

Effectiveness of a Smartphone App (e-12HR) in Improving Adherence to the Mediterranean Diet in Spanish University Students by Age, Gender, Field of Study, and Body Mass Index: A Randomized Controlled Trial

There is an urgent need to implement intervention programs to promote adherence to the Mediterranean diet (AMD) in university students to prevent non-communicable diseases. A powerful tool for this is smartphone apps. Furthermore, it is necessary to determine the subgroups that are most likely to benefit from these technologies. The objective is to evaluate the effectiveness of an app (e-12HR) at improving AMD in a sample of Spanish university students and different strata. The study method was a controlled and randomized clinical trial over a four-week follow-up period and involving 385 participants (76.9% women). The participants were in two parallel groups: the control group (CG) and the intervention group (IG), with only the IG receiving feedback to improve their AMD. There were significant statistical improvements (with higher values in the IG) at week four, after no significant statistical differences at baseline (Week One): in the whole sample: +25.7% AMD index and +74.5% percentage with moderate/high AMD index. In the subgroups, seven of eight subgroups, ranging in AMD index from +17.8% (≥20 years) to +33.0% (<20 years); and for males, in weeks two (+27.9%) and three (+23.9%), but not at week four. In conclusion, e-12HR could improve AMD among university students (in the total sample and all subgroups, except ≥25 kg/m2).

Effectiveness of a multiple health-behaviour-change intervention in increasing adherence to the Mediterranean Diet in adults (EIRA study): a randomized controlled hybrid trial

Background

The present study describes the effectiveness of a complex intervention that addresses multiple lifestyles to promote healthy behaviours in increasing adherence to the Mediterranean diet (MD). 

Methods

Cluster-randomised, hybrid clinical trial controlled with two parallel groups. The study was carried out in 26 primary Spanish healthcare centres. People aged 45–75 years who presented at least two of the following criteria were included: smoker, low adherence to the MD or insufficient level of physical activity. The intervention group (IG) had three different levels of action: individual, group, and community, with the aim of acting on the behaviours related to smoking, diet and physical activity at the same time. The individual intervention included personalised recommendations and agreements on the objectives to attain. Group sessions were adapted to the context of each healthcare centre. The community intervention was focused on the social prescription of resources and activities performed in the environment of the community of each healthcare centre. Control group (CG) received brief advice given in the usual visits to the doctor’s office. The primary outcome was the change, after 12 months, in the number of participants in each group with good adherence to the MD pattern. Secondary outcomes included the change in the total score of the MD adherence score (MEDAS) and the change in some cardiovascular risk factors.

Results

Three thousand sixty-two participants were included (IG = 1,481, CG = 1,581). Low adherence to the MD was present in 1,384 (93.5%) participants, of whom 1,233 initiated the intervention and conducted at least one individual visit with a healthcare professional. A greater increase (13.7%; 95% CI, 9.9–17.5; p < 0.001) was obtained by IG in the number of participants who reached 9 points or more (good adherence) in the MEDAS at the final visit. Moreover, the effect attributable to the intervention obtained a greater increase (0.50 points; 95% CI, 0.35 to 0.66; p < 0.001) in IG.

Conclusions

A complex intervention modelled and carried out by primary healthcare professionals, within a real clinical healthcare context, achieved a global increase in the adherence to the MD compared to the brief advice.

Trial registration

ClinicalTrials.gov Identifier: NCT03136211. Retrospectively registered on 02/05/2017 https://clinicaltrials.gov/ct2/show/NCT03136211

A feasibility study to assess Mediterranean Diet adherence using an AI-powered system

Mediterranean diet (MD) can play a major role in decreasing the risks of non-communicable diseases and preventing overweight and obesity. In order for a person to follow the MD and assess their adherence to it, proper dietary assessment methods are required. We have developed an Artificial Intelligence-powered system that recognizes the food and drink items from a single meal photo and estimates their respective serving size, and integrated it into a smartphone application that automatically calculates MD adherence score and outputs a weekly feedback report. We compared the MD adherence score of four users as calculated by the system versus an expert dietitian, and the mean difference was 3.5% and statistically not significant. Afterwards, we conducted a feasibility study with 24 participants, to evaluate the system's performance and to gather the users' and dietitians' feedback. The image recognition system achieved 61.8% mean Average Precision for the testing set and 57.3% for the feasibility study images (where the ground truth was taken as the participants' annotations). The feedback from the participants of the feasibility study was also very positive.

Evaluation of an Application for Mobile Telephones (e-12HR) to Increase Adherence to the Mediterranean Diet in University Students: A Controlled, Randomized and Multicentric Study

Mediterranean diet (MD) is potentially one of the best diets regarding health benefits and sustainability. However, it is faced with serious difficulties staying alive, even in traditionally Mediterranean regions. The objective was to evaluate the effectiveness of an application (e-12HR) to improve adherence to the MD (AMD) in university students. This study was a controlled, randomized, and multicentric clinical trial with two parallel groups (control group (CG) and intervention group (IG)), a 28-day follow-up period, and 286 participants (74.1% women). There were two versions of e-12HR: ‘feedback’ e-12HR (IG) and ‘non-feedback’ e-12HR (CG). Only the ‘feedback’ e-12HR had two specific automatic functions: 1. Evaluation of the user’s AMD; 2. Identification of the food groups for which the user has not fulfilled the MD recommendations. Both versions of the application allowed the collection of data on dietary intake in order to calculate the AMD. When comparing CG and IG at 14-, 21-, and 28-days follow-up (no significant statistical differences at baseline), there were significant statistical improvements in favor of IG in AMD index (0.71, 1.56, and 1.43 points, respectively), and in the percentage of participants with medium/high AMD index (14.4%, 20.6%, and 23.7%, respectively). In conclusion, e-12HR could improve AMD among university students.

Food Frequency Questionnaire Personalisation Using Multi-Target Regression

Fondazione Bruno Kessler is developing a mobile app prototype for empowering citizens to improve their health conditions through different lifestyle interventions that will be incorporated into a mobile application for lifestyle promotion of the Province of Trento in the context of the Trentino Salute 4.0 Competence Center. The envisioned interventions are based on promoting behaviour change in various domains such as physical activity, mental health and nutrition. In particular, the nutrition component is a self-monitoring module that collects dietary habits to analyse them and recommend healthier eating behaviours. Dietary assessment is completed using a Food Frequency Questionnaire on the Mediterranean diet that is presented to the user as a grid of images. The questionnaire returns feedback on 11 aspects of nutrition. Although the questionnaire used in the application only consists of 24 questions, it still could be a bit overwhelming and a bit crowded when shown on the screen. In this paper, we tried to find a machine-learning-based solution to reduce the number of questions in the questionnaire. We proposed a method that uses the user’s previous answers as additional information to find the goals that need more attention. We compared this method with a case where the subset of questions is randomly selected and with a case where the subset is chosen using feature selection. We also explored how large the subset should be to obtain good predictions. All the experiments are conducted as a multi-target regression problem, which means several goals are predicted simultaneously. The proposed method adjusts well to the user in question and has the slightest error when predicting the goals.