The Effects of Personalized Text Messages on Diet Quality and Anthropometric Markers in College Students – A Protocol for a 12-Week Randomized Control Pilot Study

Objectives

Consumption of highly processed foods and beverages, and inadequate fruit and vegetable intake is common among college students. These low diet quality eating patterns may predispose students to excess weight gain, metabolic derangements, and risk for chronic health conditions later in life. It is currently unknown if personalized text messages can improve eating patterns in this population. The objective of the present study is to examine the effects of personalized text messages on diet quality and anthropometric markers in college students attending a public Midwestern university.

Methods

A 12-week randomized, two-arm, parallel design pilot study will examine the effects of personalized text messages (INV) compared to generic text messages (CON) on diet quality and anthropometric markers. Recruitment will be delimited to healthy (i.e., no diagnosis of chronic health conditions), undergraduate students ≥18 years old with normal weight, overweight, or obesity, and a low diet quality score (assessed during the initial screening survey). Students without access to a text-capable mobile phone and those who engage in >420 minutes of physical activity per week will be excluded. One-way short message service (SMS) will be utilized, and text messages will be sent between 7 AM – 7 PM according to a pre-determined schedule (i.e., each participant will receive seven text messages per week during weeks 1–8 and five text messages per week during weeks 9–12). Thirteen areas of focus with five distinct text messages per area were created for the INV group using a validated diet quality screener. Text messages were reviewed by two dietitians and were further refined based on feedback from four virtual focus groups (n = 13 graduate nutrition and/or health majors attending U.S. universities). General, non-nutrition text messages (e.g., handwashing) will be utilized for the CON group, and each area of focus will consist of five distinct text messages.

Results

Study approval has been granted by the University's Institutional Review Board. Recruitment activities have commenced, and data collection is ongoing.

Conclusions

Findings will inform the development of effective and sustainable mobile health initiatives for college students.

Funding Sources

Ball State University.

An Eight-Week Time-Restricted Feeding Study Reduces Body Weight in College Students: A Pilot Study

Objectives

College students’ dietary patterns may predispose them to weight gain and risk for cardiometabolic conditions later in life. Time-restricted feeding (TRF), a type of intermittent fasting, may confer health benefits, including reductions in body weight. Currently, it is unknown if TRF might impact diet quality. The objective of this randomized controlled study was to assess the feasibility of a TRF protocol versus a control (CON) protocol for eight weeks on dietary patterns, anthropometric measures, and cardiometabolic indices in college students. We hypothesized that dietary patterns, anthropometric measures, and cardiometabolic indices would improve for participants in the TRF group.

Methods

Healthy college students were randomly assigned to a TRF intervention group (six-hour daily eating window) or a CON (16-hour daily eating window) for eight weeks. One ‘cheat’ day was permitted each week, and outcomes were measured at weeks zero, four, and eight. Due to COVID-19 restrictions, data collection at week eight was incomplete and these data were not viable; hence, only change data at week four are reported. The Rapid Eating Assessment for Participants [shortened version] questionnaire was used to assess shifts in dietary patterns.

Results

Of the 25 initial participants, 17 completed the study (TRF group; n = 7; CON group; n = 10; age, 23 ± 4 years; BMI, 23.2 ± 2.3 kg/m2). Six TRF participants withdrew from the trial (43%) due to study-related side effects, including excess hunger and poor energy; additionally, in each group, a single participant was lost to follow-up. Change in body weight at week four was significantly different between the TRF group (−1.1 ± 1.6 kg) and the CON group (0.7 ± 1.3 kg); (P = 0.016). There were no between-group differences for change in dietary patterns and cardiometabolic indices (P > 0.05).

Conclusions

Although dietary patterns and cardiometabolic indices were not altered between groups over the course of the trial, body weight was reduced in the TRF participants compared to the CON participants. These preliminary data suggest that an 18-hour TRF protocol may be useful for weight reduction; however, this protocol is difficult to follow. Future studies should identify modifications to make TRF more acceptable to users and focus on diet quality.

Funding Sources

Arizona State University.

Health Biomarkers in Adults Are More Closely Linked to Diet Quality Attributes Than to Plant-Based Diet Categorization

Although plant-based diets are promoted for healthy outcomes, these diets are not synonymous with high-quality diets. Plant-based diets can include highly processed, less healthful foods, including savory snacks, pastries, and sugary fruit drinks. This cross-sectional study examined the diet quality of vegetarian and omnivorous adults, matched for gender, age, and adiposity, and related diet quality to standard health biomarkers. Diet quality was assessed using the Rapid Eating and Activity Assessment for Participants Short Version questionnaire. Participants (17 vegetarians and 16 omnivores; 28.2 ± 8.9 years; 22.5 ± 2.7 kg/m²) were non-smokers and healthy by self-report. The median duration of adherence to the vegetarian diet was 27 months. Physical activity level and diet quality did not differ significantly between diet groups. Moreover, health biomarkers did not differ by diet groups. When participants were regrouped by low versus high diet quality, health biomarkers differed significantly between groups for fasting insulin, HOMA-IR, triglyceride (TG)/HDL ratio, and blood folate, with more favorable levels in the group with high diet quality. These data suggest that health biomarkers more closely align with diet quality attributes than with plant-based diet categorization. Thus, messaging focused on healthy diet attributes may lead to better health outcomes than the simple promotion of plant-based diets.