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Calderón-Pérez L, Escoté X, Companys J, Alcaide-Hidalgo JM, Bosch M, Rabassa M, Crescenti A, Valls RM, Pedret A, Solà R, Mariné R, Gil-Cardoso K, Rodríguez MA, Palacios H, Del Pino A, Guirro M, Canela N, Suñol D, Galofré M, Galmés S, Palou-March A, Serra F, Caimari A, Gutiérrez B, Del Bas JM. 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. Am J Clin Nutr 2024; 120:129-144. [PMID: 38960570 DOI: 10.1016/j.ajcnut.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 03/04/2024] [Accepted: 04/02/2024] [Indexed: 07/05/2024] Open
Abstract
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).
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Affiliation(s)
| | - Xavier Escoté
- Eurecat, Centre Tecnològic de Catalunya, Nutrition and Health Unit, Reus, Spain
| | - Judit Companys
- Eurecat, Centre Tecnològic de Catalunya, Nutrition and Health Unit, Reus, Spain
| | | | - Mireia Bosch
- Eurecat, Centre Tecnològic de Catalunya, Nutrition and Health Unit, Reus, Spain
| | - Montserrat Rabassa
- Eurecat, Centre Tecnològic de Catalunya, Nutrition and Health Unit, Reus, Spain; Departament de Nutrició, Ciències de l'Alimentació i Gastronomia, Nutrition and Food Safety Research Institute (INSA), Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona (UB), Barcelona, Spain
| | - Anna Crescenti
- Eurecat, Centre Tecnològic de Catalunya, Nutrition and Health Unit, Reus, Spain
| | - Rosa M Valls
- Functional Nutrition, Oxidation and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Reus, Spain
| | - Anna Pedret
- Functional Nutrition, Oxidation and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Reus, Spain
| | - Rosa Solà
- Functional Nutrition, Oxidation and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Reus, Spain; Internal Medicine Service, Hospital Universitari Sant Joan de Reus, Reus, Spain
| | - Roger Mariné
- Eurecat, Centre Tecnològic de Catalunya, Nutrition and Health Unit, Reus, Spain
| | | | - Miguel A Rodríguez
- Eurecat, Centre Tecnològic de Catalunya, Centre for Omic Sciences (COS), Joint Unit Universitat Rovira i Virgili-EURECAT, Unique Scientific and Technical Infrastructures (ICTS), Reus, Spain
| | - Héctor Palacios
- Eurecat, Centre Tecnològic de Catalunya, Centre for Omic Sciences (COS), Joint Unit Universitat Rovira i Virgili-EURECAT, Unique Scientific and Technical Infrastructures (ICTS), Reus, Spain
| | - Antoni Del Pino
- Eurecat, Centre Tecnològic de Catalunya, Centre for Omic Sciences (COS), Joint Unit Universitat Rovira i Virgili-EURECAT, Unique Scientific and Technical Infrastructures (ICTS), Reus, Spain
| | - María Guirro
- Eurecat, Centre Tecnològic de Catalunya, Centre for Omic Sciences (COS), Joint Unit Universitat Rovira i Virgili-EURECAT, Unique Scientific and Technical Infrastructures (ICTS), Reus, Spain
| | - Núria Canela
- Eurecat, Centre Tecnològic de Catalunya, Centre for Omic Sciences (COS), Joint Unit Universitat Rovira i Virgili-EURECAT, Unique Scientific and Technical Infrastructures (ICTS), Reus, Spain
| | - David Suñol
- Eurecat, Centre Tecnològic de Catalunya, Digital Health, Barcelona, Spain
| | - Mar Galofré
- Eurecat, Centre Tecnològic de Catalunya, Digital Health, Barcelona, Spain
| | - Sebastià Galmés
- Laboratory of Molecular Biology, Nutrition and Biotechnology (Group of Nutrigenomics, Biomarkers and Risk Evaluation - NuBE), University of the Balearic Islands, Palma, Spain; Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain; Centro de investigación Biomédica en red de Fisiopatología de la obesidad y nutrición, Instituto de Salud Carlos III, Madrid, Spain; Alimentómica S.L. Camí de na Pontons, Campanet, Spain
| | - Andreu Palou-March
- Laboratory of Molecular Biology, Nutrition and Biotechnology (Group of Nutrigenomics, Biomarkers and Risk Evaluation - NuBE), University of the Balearic Islands, Palma, Spain; Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain; Centro de investigación Biomédica en red de Fisiopatología de la obesidad y nutrición, Instituto de Salud Carlos III, Madrid, Spain; Alimentómica S.L. Camí de na Pontons, Campanet, Spain
| | - Francisca Serra
- Laboratory of Molecular Biology, Nutrition and Biotechnology (Group of Nutrigenomics, Biomarkers and Risk Evaluation - NuBE), University of the Balearic Islands, Palma, Spain; Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain; Centro de investigación Biomédica en red de Fisiopatología de la obesidad y nutrición, Instituto de Salud Carlos III, Madrid, Spain; Alimentómica S.L. Camí de na Pontons, Campanet, Spain
| | - Antoni Caimari
- Eurecat, Centre Tecnològic de Catalunya, Biotechnology Area, Reus, Spain
| | - Biotza Gutiérrez
- Eurecat, Centre Tecnològic de Catalunya, Biotechnology Area, Reus, Spain
| | - Josep M Del Bas
- Eurecat, Centre Tecnològic de Catalunya, Biotechnology Area, Reus, Spain.
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AlKasasbeh W, Akroush S. Investigating the interrelationships among food habits, sports nutrition knowledge, and perceived barriers to healthy eating: a study of adolescent swimmers. Front Nutr 2024; 11:1381801. [PMID: 38807642 PMCID: PMC11130493 DOI: 10.3389/fnut.2024.1381801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 04/08/2024] [Indexed: 05/30/2024] Open
Abstract
This cross-sectional study aims to explore the relationships between food habits, perceived barriers to healthy eating, and sports nutrition knowledge among adolescent swimmers. The study focuses on understanding how these factors interact and influence dietary choices in young athletes. A cohort of 52 adolescent swimmers aged 12-18 from Al Hussein Youth Club in Al-Hussein Sport City participated in the study. Data were collected through surveys assessing food habits, perceived barriers to healthy eating, and sports nutrition knowledge. Pearson Correlation analysis was employed to examine associations between variables, and stepwise regression analysis was used to identify predictors of food habits. The analysis revealed a significant positive association between food habits and sports nutrition knowledge (r = 0.393, p = 0.004). Knowledge emerged as a significant positive predictor of food habits (β = 0.393, p = 0.004), highlighting the influential role of sports nutrition knowledge in shaping the dietary choices of adolescent swimmers. However, the introduction of Barriers lacked significance, and individual predictors did not reach statistical significance. These findings underscore the importance of targeted interventions aimed at enhancing nutritional education among adolescent swimmers. Understanding the interplay between knowledge, barriers, and food habits provides valuable insights into the complex dynamics that influence the dietary choices of young athletes. Addressing these factors through tailored educational programs can promote healthier eating habits and optimize performance among adolescent swimmers. This study highlights the critical role of sports nutrition knowledge in shaping the dietary behaviors of adolescent swimmers. By addressing knowledge gaps and overcoming perceived barriers, targeted interventions can help improve food habits and enhance the overall health and performance of young athletes.
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Affiliation(s)
- Walaa AlKasasbeh
- Department of Physical and Health Education, Faculty of Education Sciences, Al-Ahliyya Amman University, Al-Salt, Jordan
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Faessen JPM, Feskens EJM, Brouwer-Brolsma EM. Development and short evaluation of the Dutch healthy diet index for pregnant women; DHD-P. Front Nutr 2024; 11:1386888. [PMID: 38737511 PMCID: PMC11082309 DOI: 10.3389/fnut.2024.1386888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/12/2024] [Indexed: 05/14/2024] Open
Abstract
Introduction Diet quality indices provide a quick indicator of overall diet and are commonly used in research and surveillance. We developed a Dutch Healthy Diet for pregnant women (DHD-P) index, comprising 22 components aligned with the 2021 Dutch food-based dietary guidelines for pregnant women. Our evaluation focused on assessing its performance and sensitivity to change. Methods The DHD-P index was quantified by using a validated Food Frequency Questionnaire (FFQ) and two 24-h recalls at 12 and 24 weeks gestation completed by 24-to-41 year old pregnant women participating in the GLIMP-II study. Strength and direction of associations were evaluated based on de-attenuated correlation coefficients between FFQ and 24-h recall data at 24 weeks gestation (n = 47). Sensitivity to change was evaluated by comparing DHD-P index data assessed by both FFQ and recalls at 12 and 24 weeks gestation using paired t-tests or Wilcoxon Signed Rank Test (n = 27). Results De-attenuated correlation coefficients between FFQ and 24-recall data showed a good correlation for the total DHD-P score (rho = 0.57) and moderate to good correlations for component scores. FFQ as well as recall data showed comparable dietary intake at 12 and 24 weeks, suggesting minimal changes during pregnancy. Correlations over time were moderate-to-good for scores based on FFQ and low to moderate for scores based on 24hRs, indicating better reproducibility of scores based on FFQ data. Conclusion Considering the moderate to good correlations, the DHD-P index appears to be an appropriate index to assess diet quality among pregnant women, and could serve as a foundation to provide dietary feedback toward healthier food choices. Studies including dietary data for all relevant food groups and nutrients are needed to substantiate our findings and further explore the DHD-P sensitivity to change.
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Affiliation(s)
- Janine P. M. Faessen
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, Netherlands
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Schaafsma HN, Jantzi HA, Seabrook JA, McEachern LW, Burke SM, Irwin JD, Gilliland JA. The impact of smartphone app-based interventions on adolescents' dietary intake: a systematic review and evaluation of equity factor reporting in intervention studies. Nutr Rev 2024; 82:467-486. [PMID: 37330675 PMCID: PMC10925905 DOI: 10.1093/nutrit/nuad058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/19/2023] Open
Abstract
CONTEXT Adolescence is a critical stage for improving nutrition. The popularity of smartphones makes them an ideal platform for administering interventions to adolescents. A systematic review has yet to assess the impact of smartphone app-based interventions exclusively on adolescents' dietary intake. Furthermore, despite the impact of equity factors on dietary intake and the claim for mobile health of increased accessibility, there is minimal research on the reporting of equity factors in the evaluation of smartphone app-based nutrition-intervention research. OBJECTIVES This systematic review examines the effectiveness of smartphone app-based interventions on adolescents' dietary intake and the frequency with which equity factors and statistical analyses specific to equity factors are reported in these intervention studies. DATA SOURCES Databases (ie, Scopus, CINAHL, EMBASE, MEDLINE, PsycINFO, ERIC, and Cochrane Central Register for Randomized Control Trials) were searched for studies published from January 2008 to October 2022. Smartphone app-based intervention studies that were nutrition focused, evaluated at least 1 dietary intake variable, and included participants with a mean age between 10 and 19 years were included. All geographic locations were included. DATA EXTRACTION AND ANALYSIS Study characteristics, intervention results, and reported equity factors were extracted. Because of the heterogeneity of dietary outcomes, findings were reported as a narrative synthesis. CONCLUSION In total, 3087 studies were retrieved, 14 of which met the inclusion criteria. Eleven studies reported a statistically significant improvement in at least 1 dietary outcome because of the intervention. Reporting of at least 1 equity factor across articles' Introduction, Methods, Results, and Discussion sections was minimal (n = 5), and statistical analyses specific to equity factors were rare, occurring in only 4 of the 14 included studies. Future interventions should include a measurement of intervention adherence and report the impact of equity factors on the effectiveness and applicability of interventions for equity-deserving groups.
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Affiliation(s)
- Holly N Schaafsma
- Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, Ontario, Canada
- Children’s Health Research Institute, London, Ontario, Canada
| | - Heather A Jantzi
- Children’s Health Research Institute, London, Ontario, Canada
- Department of Geography, Western University, London, Ontario, Canada
| | - Jamie A Seabrook
- Children’s Health Research Institute, London, Ontario, Canada
- School of Food and Nutritional Sciences, Brescia University College at Western University, London, Ontario, Canada
- Department of Pediatrics, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Louise W McEachern
- Children’s Health Research Institute, London, Ontario, Canada
- Department of Geography, Western University, London, Ontario, Canada
| | - Shauna M Burke
- Children’s Health Research Institute, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- School of Health Studies, Western University, London, Ontario, Canada
| | - Jennifer D Irwin
- School of Health Studies, Western University, London, Ontario, Canada
| | - Jason A Gilliland
- Children’s Health Research Institute, London, Ontario, Canada
- Department of Geography, Western University, London, Ontario, Canada
- Department of Pediatrics, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- School of Health Studies, Western University, London, Ontario, Canada
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Han CY, Lim SL, Ong KW, Johal J, Gulyani A. Behavioral Lifestyle Intervention Program Using Mobile Application Improves Diet Quality in Adults With Prediabetes (D'LITE Study): A Randomized Controlled Trial. J Acad Nutr Diet 2024; 124:358-371. [PMID: 37820787 DOI: 10.1016/j.jand.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 09/29/2023] [Accepted: 10/04/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Mobile health applications (mHealth apps) are increasingly being used in weight loss interventions. However, evidence on the effects of such interventions on diet quality and their correlation with weight loss is lacking. OBJECTIVE The objective of this study was to examine whether changes in the diet quality of adults with prediabetes followed the use of an mHealth-enabled lifestyle intervention, compared with those who did not, and whether these changes correlated with weight loss. DESIGN A secondary analysis of a 6-month randomized controlled trial Diabetes Lifestyle Intervention using Technology Empowerment (D'LITE) was conducted, with participants recruited from October 2017 to September 2019. PARTICIPANTS/SETTING Community-dwelling adults (n = 148) in Singapore diagnosed with prediabetes and body mass index (BMI) ≥23 were included in this study. INTERVENTION Participants were randomized to receive either a 6-month mHealth-enabled lifestyle intervention program (diet and physical activity) or standard care dietary advice. MAIN OUTCOME MEASURES Dietary data were collected in the form of 2-day food records at baseline, 3, and 6 months. Changes in Alternate Healthy Eating Index-2010 (AHEI-2010) scores and food groups (servings/day), calculated from the dietary data, and correlation between changes in AHEI-2010 and weight loss at 3 and 6 months, were examined. STATISTICAL ANALYSES Between-group comparisons of continuous variables and within-participants variation were performed using longitudinal mixed-effect models, intention-to-treat principles. The models included treatment groups, time (baseline, 3 months, and 6 months), and covariates (age, sex, and BMI), as well as the group × time interactions, as fixed variables and within-participant variation in outcome values as random variable. The random intercept for participants accounted for the dependence of repeated measures. A likelihood ratio test was also conducted to test random effect variance. Spearman correlation test was used to examine correlation between changes in AHEI-2010 scores and weight loss. RESULTS There was a significant improvement in overall diet quality as ascertained by the AHEI-2010, by 6.2 points (95% confidence interval [CI], 3.8-8.7; P < 0.001) in the intervention group as compared with the control. The participants in the intervention group had a significantly greater reduction in intake of sugar-sweetened beverages (SSB) by 0.5 servings/day (95% CI, -0.8, -0.2; P < 0.001) and sodium by 726 mg/day (95% CI, -983, -468; P < .001), compared with those receiving standard care. At 3 and 6 months, a significant decrease in SSB (0.8 servings/day; 0.7 servings/day, respectively) and sodium (297 mg/day; 296 mg/day, respectively) intakes were reported compared with baseline intakes. Small positive correlations (r = 0.2; P < 0.05) were observed between changes in AHEI-2010 scores from baseline and percentage weight loss at 3 and 6 months. CONCLUSION For adults with prediabetes in Singapore, diet quality can be improved with an mHealth-enabled lifestyle intervention program. A small positive correlation exists between AHEI-2010 scores and weight loss.
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Affiliation(s)
- Chad Yixian Han
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Australia; NOVI Health, Singapore.
| | - Su Lin Lim
- Dietetics Department, National University Hospital, National University Health System, Singapore
| | - Kai Wen Ong
- Dietetics Department, National University Hospital, National University Health System, Singapore
| | - Jolyn Johal
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Australia
| | - Aarti Gulyani
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Australia
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Nunthanawanich P, Wichansawakun S, Luangjinda C, Hudthagosol C. Effectiveness of Web Applications on Improving Nutritional Status of Patients with Colorectal Cancer. Nutrients 2024; 16:408. [PMID: 38337693 PMCID: PMC10857273 DOI: 10.3390/nu16030408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/11/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
The most common cancer in Thailand is colorectal cancer (CRC). A lack of knowledge and misleading information from social media have contributed to cancer deaths from malnutrition. A web application is a tool that provides easy access to scientific nutritional information via an online platform. In this study, our goal was to compare the nutritional status of CRC patients using different nutrition-based educational tools with nutrition counseling, namely the Nutrition Educational Prototype based on Smartphone Web Applications (NEPSA) and standard hospital leaflets. Anthropometric and biochemical analyses and a dietary assessment, especially calories and protein, were measured during three visits. This study finally included 28 CRC patients who were undergoing chemotherapy and malnutrition with a body mass index (BMI) of <20 kg/m2. Thirteen participants received NEPSA while the remaining fifteen participants received a standard hospital leaflet. The results showed that NEPSAs improved nutritional outcomes by encouraging weight gain, increasing BMI, hemoglobin, hematocrit, and albumin levels, and consuming more calories and protein. NEPSA should be implemented to enhance the nutrition outcomes from anthropometric, biochemical, and dietary perspectives from nutrition advice among CRC patients. There could be positive impacts at the national level regarding equal accessibility to Thailand's nutrition information.
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Affiliation(s)
- Pornpimon Nunthanawanich
- Doctor of Public Health (International Program), Faculty of Public Health, Mahidol University, Bangkok 10400, Thailand
| | - Sanit Wichansawakun
- Division of Clinical Nutrition, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand;
| | - Cholrit Luangjinda
- Research and Development Office, Thailand Institute of Occupational Safety and Health, Ministry of Labor, Bangkok 10170, Thailand
| | - Chatrapa Hudthagosol
- Department of Nutrition, Faculty of Public Health, Mahidol University, Bangkok 10400, Thailand
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Shah RR, Dixon CC, Fowler MJ, Driesse TM, Liang X, Summerour CE, Gross DC, Spangler HB, Lynch DH, Batsis JA. Using Voice Assistant Systems to Improve Dietary Recall among Older Adults: Perspectives of Registered Dietitians. J Nutr Gerontol Geriatr 2024; 43:1-13. [PMID: 38287658 PMCID: PMC10922685 DOI: 10.1080/21551197.2024.2302619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
Dietary assessments are important clinical tools used by Registered Dietitians (RDs). Current methods pose barriers to accurately assess the nutritional intake of older adults due to age-related increases in risk for cognitive decline and more complex health histories. Our qualitative study explored whether implementing Voice assistant systems (VAS) could improve current dietary recall from the perspective of 20 RDs. RDs believed the implementing VAS in dietary assessments of older adults could potentially improve patient accuracy in reporting food intake, recalling portion sizes, and increasing patient-provider efficiency during clinic visits. RDs reported that low technology literacy in older adults could be a barrier to implementation. Our study provides a better understanding of how VAS can better meet the needs of both older adults and RDs in managing and assessing dietary intake.
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Affiliation(s)
- Rahi R. Shah
- Division of Geriatric Medicine, University of North Carolina School of Medicine, Chapel Hill NC
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill NC
| | - Claudia C. Dixon
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill NC
| | - Michael J. Fowler
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill NC
| | - Tiffany M. Driesse
- Division of Geriatric Medicine, University of North Carolina School of Medicine, Chapel Hill NC
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill NC
| | - Xiaohui Liang
- Department of Computer Science, University of Massachusetts Boston, Boston, MA
| | - Caroline E. Summerour
- Division of Geriatric Medicine, University of North Carolina School of Medicine, Chapel Hill NC
| | - Danae C. Gross
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill NC
| | - Hillary B. Spangler
- Division of Geriatric Medicine, University of North Carolina School of Medicine, Chapel Hill NC
| | - David H. Lynch
- Division of Geriatric Medicine, University of North Carolina School of Medicine, Chapel Hill NC
| | - John A. Batsis
- Division of Geriatric Medicine, University of North Carolina School of Medicine, Chapel Hill NC
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill NC
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Zheng S, Edney SM, Goh CH, Tai BC, Mair JL, Castro O, Salamanca-Sanabria A, Kowatsch T, van Dam RM, Müller-Riemenschneider F. Effectiveness of holistic mobile health interventions on diet, and physical, and mental health outcomes: a systematic review and meta-analysis. EClinicalMedicine 2023; 66:102309. [PMID: 38053536 PMCID: PMC10694579 DOI: 10.1016/j.eclinm.2023.102309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/16/2023] [Accepted: 10/26/2023] [Indexed: 12/07/2023] Open
Abstract
Background Good physical and mental health are essential for healthy ageing. Holistic mobile health (mHealth) interventions-including at least three components: physical activity, diet, and mental health-could support both physical and mental health and be scaled to the population level. This review aims to describe the characteristics of holistic mHealth interventions and their effects on related behavioural and health outcomes among adults from the general population. Methods In this systematic review and meta-analysis, we searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, Scopus, China National Knowledge Infrastructure, and Google Scholar (first 200 records). The initial search covered January 1, 2011, to April 13, 2022, and an updated search extended from April 13, 2022 to August 30, 2023. Randomised controlled trials (RCTs) and non-randomised studies of interventions (NRSIs) were included if they (i) were delivered via mHealth technologies, (ii) included content on physical activity, diet, and mental health, and (iii) targeted adults (≥18 years old) from the general population or those at risk of non-communicable diseases (NCDs) or mental disorders. Studies were excluded if they targeted pregnant women (due to distinct physiological responses), individuals with pre-existing NCDs or mental disorders (to emphasise prevention), or primarily utilised web, email, or structured phone support (to focus on mobile technologies without exclusive human support). Data (summary data from published reports) extraction and risk-of-bias assessment were completed by two reviewers using a standard template and Cochrane risk-of-bias tools, respectively. Narrative syntheses were conducted for all studies, and random-effects models were used in the meta-analyses to estimate the pooled effect of interventions for outcomes with comparable data in the RCTs. The study was registered in PROSPERO, CRD42022315166. Findings After screening 5488 identified records, 34 studies (25 RCTs and 9 pre-post NRSIs) reported in 43 articles with 5691 participants (mean age 39 years, SD 12.5) were included. Most (91.2%, n = 31/34) were conducted in high-income countries. The median intervention duration was 3 months, and only 23.5% (n = 8/34) of studies reported follow-up data. Mobile applications, short-message services, and mobile device-compatible websites were the most common mHealth delivery modes; 47.1% (n = 16/34) studies used multiple mHealth delivery modes. Of 15 studies reporting on weight change, 9 showed significant reductions (6 targeted on individuals with overweight or obesity), and in 10 studies reporting perceived stress levels, 4 found significant reductions (all targeted on general adults). In the meta-analysis, holistic mHealth interventions were associated with significant weight loss (9 RCTs; mean difference -1.70 kg, 95% CI -2.45 to -0.95; I2 = 89.00%) and a significant reduction in perceived stress levels (6 RCTs; standardised mean difference [SMD] -0.32; 95% CI -0.52 to -0.12; I2 = 14.52%). There were no significant intervention effects on self-reported moderate-to-vigorous physical activity (5 RCTs; SMD 0.21; 95%CI -0.25 to 0.67; I2 = 74.28%) or diet quality scores (5 RCTs; SMD 0.21; 95%CI -0.47 to 0.65; I2 = 62.27%). All NRSIs were labelled as having a serious risk of bias overall; 56% (n = 14/25) of RCTs were classified as having some concerns, and the others as having a high risk of bias. Interpretation Findings from identified studies suggest that holistic mHealth interventions may aid reductions in weight and in perceived stress levels, with small to medium effect sizes. The observed effects on diet quality scores and self-reported moderate-to-vigorous physical activity were less clear and require more research. High-quality RCTs with longer follow-up durations are needed to provide more robust evidence. To promote population health, future research should focus on vulnerable populations and those in middle- and low-income countries. Optimal combinations of delivery modes and components to improve efficacy and sustain long-term effects should also be explored. Funding National Research Foundation, Prime Minister's Office, Singapore, under its Campus for Research Excellence and Technological Enterprise (CREATE) Programme and Physical Activity and Nutrition Determinants in Asia (PANDA) Research Programme.
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Affiliation(s)
- Shenglin Zheng
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
| | - Sarah Martine Edney
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Chin Hao Goh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Jacqueline Louise Mair
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
| | - Oscar Castro
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
| | - Alicia Salamanca-Sanabria
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A∗STAR), Singapore
| | - Tobias Kowatsch
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
- Institute for Implementation Science in Health Care, University of Zürich, Zürich, Switzerland
- School of Medicine, University of St. Gallen, St. Gallen, Switzerland
- Centre for Digital Health Interventions, Department of Management, Technology and Economics ETH Zürich, Zürich, Switzerland
| | - Rob M. van Dam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Departments of Exercise and Nutrition Sciences and Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
- Digital Health Centre, Berlin Institute of Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
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9
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Almeida APD, Ribeiro PVDM, Rocha DMUP, Castro LCV, Hermsdorff HHM. Tools developed in Brazil for the promotion and assessment of adequate and healthy eating habits: A scoping review. CIENCIA & SAUDE COLETIVA 2023; 28:3231-3246. [PMID: 37971006 DOI: 10.1590/1413-812320232811.17192022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/27/2023] [Indexed: 11/19/2023] Open
Abstract
The objective of this study was to identify and discuss the tools for the promotion and evaluation of adequate and healthy eating based on the Food Guide for the Brazilian Population. The scoping review was conducted according to the JBI Manual for Evidence Synthesis via the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist and by searching PubMed/MEDLINE, EMBASE, SciELO and LILACS. Sixteen studies on relevant tools, based on the food guide for individuals of all age groups, were thus included: two descriptive studies, two randomized clinical trial protocols, eleven methodological analyses, and one psychometric paper, aimed at either a focal population (n=12) or health professionals (n=4). Six studies addressed tools for promoting adequate and healthy eating, and ten developed tools for evaluating dietary practices or the knowledge and activities of health professionals. This review can therefore assist health professionals in choosing instruments for the implementation and/or dissemination of food guide recommendations, contributing to the promotion of adequate and healthy eating habits.
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Affiliation(s)
| | | | - Daniela Mayumi Usuda Prado Rocha
- Departamento de Nutrição e Saúde, Universidade Federal de Viçosa (UFV). Viçosa MG Brasil
- Instituto de Políticas Públicas e Desenvolvimento Sustentável, UFV. Av. Peter Henry Rolfs s/n, Campus Universitário. 36570-900 Viçosa MG Brasil.
| | - Luiza Carla Vidigal Castro
- Departamento de Nutrição e Saúde, Universidade Federal de Viçosa (UFV). Viçosa MG Brasil
- Instituto de Políticas Públicas e Desenvolvimento Sustentável, UFV. Av. Peter Henry Rolfs s/n, Campus Universitário. 36570-900 Viçosa MG Brasil.
| | - Helen Hermana Miranda Hermsdorff
- Departamento de Nutrição e Saúde, Universidade Federal de Viçosa (UFV). Viçosa MG Brasil
- Instituto de Políticas Públicas e Desenvolvimento Sustentável, UFV. Av. Peter Henry Rolfs s/n, Campus Universitário. 36570-900 Viçosa MG Brasil.
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10
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Batista SA, Cupertino AFB, Cupertino AP, Botelho RBA, Pimentel J, Cartujano-Barrera F, Ginani VC. Nutrition and Diet Apps: Brazilian Panorama before and during the COVID-19 Pandemic. Nutrients 2023; 15:3606. [PMID: 37630796 PMCID: PMC10459095 DOI: 10.3390/nu15163606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/12/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
In the last decade, we have seen a substantial increase in the development and use of mobile technology to improve diet and healthy eating behaviors. OBJECTIVE To describe the characteristics of nutrition and diet apps before and after the COVID-19 pandemic available in Brazil. METHODS Nutrition and diet apps were identified using the official Apple and Google stores. The search occurred in January 2020 and May 2022 in Brazil. We extracted the nutritional content and standard indicators (e.g., being developed before or after 2020, number of languages, target population, investment, prices, seller, number of reviews and downloads, consumer rating). RESULTS 280 apps were launched before and 411 during the COVID-19 period. Most apps were available in at least ten languages (96.6%), with no indication of age (95.6%) or partial or full cost (59%). As for the contents, 18.9% addressed personal diet suggestions; 73.4%, nutritional education; 48.8%, revenues; 35.9%, physical activity with a nutritional guide; 2.3%, nutritional recommendation for eating out; 23.9%, grocery shopping with a scan code; 32.4%, food diary; 18.9%, water intake; and 4.6%, nutrition/diseases. The data show an evolution that may have been boosted by the pandemic and that reveals a trend towards the development of apps with educational content. CONCLUSION During the pandemic, there was a positive qualitative and quantitative movement in e-health regarding the promotion of education.
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Affiliation(s)
- Sueny Andrade Batista
- Department of Nutrition, University of Brasilia, Brasilia 70910-900, Brazil; (A.F.B.C.); (R.B.A.B.); (J.P.); (V.C.G.)
| | | | - Ana Paula Cupertino
- Department of Surgery, University of Rochester Medical Center, Rochester, NY 14642, USA; (A.P.C.); (F.C.-B.)
| | - Raquel Braz Assunção Botelho
- Department of Nutrition, University of Brasilia, Brasilia 70910-900, Brazil; (A.F.B.C.); (R.B.A.B.); (J.P.); (V.C.G.)
| | - Juliana Pimentel
- Department of Nutrition, University of Brasilia, Brasilia 70910-900, Brazil; (A.F.B.C.); (R.B.A.B.); (J.P.); (V.C.G.)
| | - Francisco Cartujano-Barrera
- Department of Surgery, University of Rochester Medical Center, Rochester, NY 14642, USA; (A.P.C.); (F.C.-B.)
| | - Verônica Cortez Ginani
- Department of Nutrition, University of Brasilia, Brasilia 70910-900, Brazil; (A.F.B.C.); (R.B.A.B.); (J.P.); (V.C.G.)
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11
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Guan V, Zhou C, Wan H, Zhou R, Zhang D, Zhang S, Yang W, Voutharoja BP, Wang L, Win KT, Wang P. A Novel Mobile App for Personalized Dietary Advice Leveraging Persuasive Technology, Computer Vision, and Cloud Computing: Development and Usability Study. JMIR Form Res 2023; 7:e46839. [PMID: 37549000 PMCID: PMC10442736 DOI: 10.2196/46839] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/23/2023] [Accepted: 05/10/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND The Australian Dietary Guidelines (ADG) translate the best available evidence in nutrition into food choice recommendations. However, adherence to the ADG is poor in Australia. Given that following a healthy diet can be a potentially cost-effective strategy for lowering the risk of chronic diseases, there is an urgent need to develop novel technologies for individuals to improve their adherence to the ADG. OBJECTIVE This study describes the development process and design of a prototype mobile app for personalized dietary advice based on the ADG for adults in Australia, with the aim of exploring the usability of the prototype. The goal of the prototype was to provide personalized, evidence-based support for self-managing food choices in real time. METHODS The guidelines of the design science paradigm were applied to guide the design, development, and evaluation of a progressive web app using Amazon Web Services Elastic Compute Cloud services via iterations. The food layer of the Nutrition Care Process, the strategies of cognitive behavioral theory, and the ADG were translated into prototype features guided by the Persuasive Systems Design model. A gain-framed approach was adopted to promote positive behavior changes. A cross-modal image-to-recipe retrieval model under an Apache 2.0 license was deployed for dietary assessment. A survey using the Mobile Application Rating Scale and semistructured in-depth interviews were conducted to explore the usability of the prototype through convenience sampling (N=15). RESULTS The prominent features of the prototype included the use of image-based dietary assessment, food choice tracking with immediate feedback leveraging gamification principles, personal goal setting for food choices, and the provision of recipe ideas and information on the ADG. The overall prototype quality score was "acceptable," with a median of 3.46 (IQR 2.78-3.81) out of 5 points. The median score of the perceived impact of the prototype on healthy eating based on the ADG was 3.83 (IQR 2.75-4.08) out of 5 points. In-depth interviews identified the use of gamification for tracking food choices and innovation in the image-based dietary assessment as the main drivers of the positive user experience of using the prototype. CONCLUSIONS A novel evidence-based prototype mobile app was successfully developed by leveraging a cross-disciplinary collaboration. A detailed description of the development process and design of the prototype enhances its transparency and provides detailed insights into its creation. This study provides a valuable example of the development of a novel, evidence-based app for personalized dietary advice on food choices using recent advancements in computer vision. A revised version of this prototype is currently under development.
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Affiliation(s)
- Vivienne Guan
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Chenghuai Zhou
- School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Hengyi Wan
- School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Rengui Zhou
- School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Dongfa Zhang
- School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Sihan Zhang
- School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Wangli Yang
- School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Bhanu Prakash Voutharoja
- School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Lei Wang
- School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Khin Than Win
- School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Peng Wang
- School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
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12
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Orte S, Migliorelli C, Sistach-Bosch L, Gómez-Martínez M, Boqué N. A Tailored and Engaging mHealth Gamified Framework for Nutritional Behaviour Change. Nutrients 2023; 15:nu15081950. [PMID: 37111168 PMCID: PMC10142076 DOI: 10.3390/nu15081950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/12/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023] Open
Abstract
Mobile health applications (apps) have been shown to be effective for improving eating habits. However, most of the existing apps rely on calorie and nutrient counting which have several limitations including the difficulty in sustaining long-term use, inaccuracy, and the risk of developing eating disorders. We designed and developed a mHealth framework for nutritional behaviour change, integrated into the CarpeDiem app, that focuses on the intake of key food groups which are known to have a higher impact on health indicators instead of the intake of nutrients. This framework is mainly based on a gamified system that delivers personalized dietary missions to the user and provides motivational recommendations that help the user to achieve these missions. Its design was guided by an evidenced-based theory of behavioural change, the HAPA model, and it is also characterized by the personalization of the system and the use of a recommender system based on advanced artificial intelligence techniques. Overall, the approach used in the present app could foster a sustained improvement of eating habits among the general population, which is the main challenge of dietary interventions, decreasing the risk of developing the chronic diseases associated with unhealthy dietary habits.
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Affiliation(s)
- Silvia Orte
- Unitat de Salut Digital, Centre Tecnològic de Catalunya, Eurecat, 08005 Barcelona, Spain
| | - Carolina Migliorelli
- Unitat de Salut Digital, Centre Tecnològic de Catalunya, Eurecat, 08005 Barcelona, Spain
| | - Laura Sistach-Bosch
- Unitat de Salut Digital, Centre Tecnològic de Catalunya, Eurecat, 08005 Barcelona, Spain
| | | | - Noemi Boqué
- Unitat de Nutrició i Salut, Centre Tecnològic de Catalunya, Eurecat, 43204 Reus, Spain
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