%0 Journal Article %@ 2291-9694 %I JMIR Publications %V 13 %N %P e57530 %T Prediction of Snacking Behavior Involving Snacks Having High Levels of Saturated Fats, Salt, or Sugar Using Only Information on Previous Instances of Snacking: Survey- and App-Based Study %A Dammas,Shaima %A Weyde,Tillman %A Tapper,Katy %A Spanakis,Gerasimos %A Roefs,Anne %A Pothos,Emmanuel M %+ Department of Health Services and Hospitals Administration, King AbdulAziz University, PO Box 80200, 67 Administration Street, Jeddah, 21589, Saudi Arabia, 966 126952951, smalghamdi2@kau.edu.sa %K high fats, salt, or sugar snacks %K machine learning algorithms %K internet data collection %K just-in-time interventions %D 2025 %7 23.4.2025 %9 Original Paper %J JMIR Med Inform %G English %X Background: Consuming high amounts of foods or beverages with high levels of saturated fats, salt, or sugar (HFSS) can be harmful for health. Many snacks fall into this category (HFSS snacks). However, the palatability of these snacks means that people can sometimes struggle to reduce their intake. Machine learning algorithms could help in predicting the likely occurrence of HFSS snacking so that just-in-time adaptive interventions can be deployed. However, HFSS snacking data have certain characteristics, such as sparseness and incompleteness, which make snacking prediction a challenge for machine learning approaches. Previous attempts have employed several potential predictor variables and have achieved considerable success. Nevertheless, collecting information from several dimensions requires several potentially burdensome user questionnaires, and thus, this approach may be less acceptable for the general public. Objective: Our aim was to consider the capacity of standard (unmodified in any way; to tailor to the specific learning problem) machine learning algorithms to predict HFSS snacking based on the following minimal data that can be collected in a mostly automated way: day of the week, time of the day (divided into time bins), and location (divided into work, home, and other). Methods: A total of 111 participants in the United Kingdom were asked to record HFSS snacking occurrences and the location category over a period of 28 days, and this was considered the UK dataset. Data collection was facilitated by a purpose-specific app (Snack Tracker). Additionally, a similar dataset from the Netherlands was used (Dutch dataset). Both datasets were analyzed using machine learning methods, including random forest regressor, Extreme Gradient Boosting regressor, feed forward neural network, and long short-term memory. We additionally employed 2 baseline statistical models for prediction. In all cases, the prediction problem was the time to the next HFSS snack from the current one, and the evaluation metric was the mean absolute error. Results: The ability of machine learning methods to predict the time of the next HFSS snack was assessed. The quality of the prediction depended on the dataset, temporal resolution, and machine learning algorithm employed. In some cases, predictions were accurate to as low as 17 minutes on average. In general, machine learning methods outperformed the baseline models, but no machine learning method was clearly better than the others. Feed forward neural network showed a very marginal advantage. Conclusions: The prediction of HFSS snacking using sparse data is possible with reasonable accuracy. Our findings offer a foundation for further exploring how machine learning methods can be used in health psychology and provide directions for further research. %M 40267467 %R 10.2196/57530 %U https://medinform.jmir.org/2025/1/e57530 %U https://doi.org/10.2196/57530 %U http://www.ncbi.nlm.nih.gov/pubmed/40267467 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66970 %T The Monthly Cycling of Food Insecurity in Latinas at Risk for Diabetes: Methods, Retention, and Sample Characteristics for a Microlongitudinal Design %A Bermúdez-Millán,Angela %A Pérez-Escamilla,Rafael %A Segura-Pérez,Sofia %A Grady,James %A Feinn VI,Richard S %A Agresta,Hanako %A Kim,Dean %A Wagner,Julie Ann %K food insecurity %K monthly cycling %K type 2 diabetes risk %K quantitative methods %K Latinas %K endocrinology %K nutrition %K nutrition assistance %K micro-longitudinal design %D 2025 %7 28.3.2025 %9 %J JMIR Form Res %G English %X Background: Food insecurity (FI) is a risk factor for type 2 diabetes (T2D) that disproportionately affects Latinas. We conducted a microlongitudinal study to examine the relationship of monthly cycling of FI and diabetes risk factors. Objective: This study aimed to determine the quantitative methodology, recruitment and retention strategies, predictors of retention across time, and baseline sample demographics. Methods: Participants were adult Latinas living in Hartford, Connecticut who were recruited through a community agency, invited to participate if they were receiving Supplementary Nutrition Assistance Program (SNAP) benefits, screened positive for FI using the 2-item Hunger Vital Sign Screener, and had elevated risk factors for T2D using the American Diabetes Association risk factor test. Using a microlongitudinal design, we collected data twice per month for 3 months (week 2, which is a period of food budget adequacy; and week 4, which is a period of food budget inadequacy) to determine if the monthly cycling of FI was associated with near-term diabetes risk (fasting glucose, fructosamine, and glycosylated albumin) and long-term risk (BMI, waist circumference, and glycated hemoglobin) markers. We determined whether household food inventory, psychological distress, and binge eating mediated associations. We examined Health Action Process Approach model constructs. To assess the relationship between monthly cycling of FI with diabetes risk markers, we used repeated measures general linear mixed models. To assess the role of mediators, we performed a causal pathway analysis. Results: Participant enrollment was from April 1, 2021 to February 21, 2023. A total of 87 participants completed 420 assessments or a mean of 4.83 (SD 2.02) assessments. About half (47/87, 54%) of the sample self-identified as Puerto Rican, mean age was 35.1 (SD 5.8) years, with 17.1 (SD 11.6) years in the mainland United States. Just under half (41/87, 47.1%) spoke Spanish only, 69% (60/87) had no formal schooling, and 31% (27/87) had less than eighth grade education. Modal household size was 4 including 2 children; 44.8% (39/87) were not living with a partner. About half (47/87, 54%) were unemployed, 63.2% (55/87) reported a monthly income 30 times per week (approximately >4 times/d) were more likely to lose weight in the first 6 months of the program. Conclusions: This commercial weight loss program was shown to be effective, with 1 in 2 members achieving clinically significant results after 1 year. Greater engagement with the platform was associated with consecutive periods of weight loss and greater weight loss success overall. %R 10.2196/65122 %U https://www.jmir.org/2025/1/e65122 %U https://doi.org/10.2196/65122 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63680 %T Exploring Individuals’ Views and Feedback on a Nutritional Screening Mobile App: Qualitative Focus Group Study %A Jones,Debra %A Sowerbutts,Anne Marie %A Burden,Sorrel %+ School of Health Sciences, University of Manchester, Jean McFarlane Building, 5th Floor, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 1613061508, debra.jones@manchester.ac.uk %K malnutrition %K malnutrition risk %K malnutrition screening %K MUST %K mobile application %K mHealth app %K malnutrition universal screening tool %D 2024 %7 18.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Malnutrition is a major global health challenge. Worldwide, approximately 390 million adults are underweight, while 2.5 billion are overweight. The Malnutrition Universal Screening Tool (MUST) has been implemented successfully in the United Kingdom to assess the nutritional status of patients in health care settings. Currently, MUST is available as a web-based tool or as a paper-based version, However, the paper tool can lead to calculation errors, and web-based tools require internet access, limiting use in some communities. The MUST app uses clear and simple navigation and processes information precisely, so could potentially improve the accuracy and accessibility of malnutrition screening for health care professionals (HCP) in all settings. Objective: This study aimed to explore the views of HCPs on the content, functionality, and usability of a newly developed mobile app for MUST. Methods: We performed a qualitative study using deductive and inductive framework analysis. A series of online focus groups (~1 hour each) were conducted, exploring potential users’ views on the app’s content design, functionality, and usefulness, which was set in demonstration mode and not available for direct use with patients. Each focus group used a semistructured approach and predefined topic guide. Participants were recruited consecutively and United Kingdom–wide using advertisements through emails, newsletters, and on social media across appropriate local and national networks. Participants had the opportunity to look at the app on their phones before giving feedback and an on-screen demonstration of the app was provided during the focus group. Data were analyzed using deductive and inductive framework analysis. Results: In total, 8 online focus groups were conducted between August 2022 and January 2023. Participants (n=32) were dietetic and nutrition HCPs or educators with experience in using MUST in clinical or community settings. Data analysis revealed three broad themes: (1) improving the app for better use in practice, (2) user experience of design, and (3) barriers and facilitators in different settings. Overall feedback for the app was positive with potential users considering it to be very useful for improving routine and accurate screening, particularly in the community, and mainly because of the automatic calculation feature, which may help with improving discrepancies. Participants generally considered the app to be for professional use only, stating that patients may find it too clinical or technical. Participants also made suggestions for app sustainability and improvements, such as incentives to complete the demographics section or the option to skip questions, and the addition of more subjective measures and instructions on measuring ulna length. Conclusions: The MUST app was positively evaluated by potential users, who reported it was user-friendly and an accessible way to screen for malnutrition risk, whilst improving the accuracy of screening and availability in community settings. %M 39693128 %R 10.2196/63680 %U https://formative.jmir.org/2024/1/e63680 %U https://doi.org/10.2196/63680 %U http://www.ncbi.nlm.nih.gov/pubmed/39693128 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54664 %T Developing Components of an Integrated mHealth Dietary Intervention for Mexican Immigrant Farmworkers: Feasibility Usability Study of a Food Photography Protocol for Dietary Assessment %A Fernandez,Isabel Diana %A Yang,Yu-Ching %A Chang,Wonkyung %A Kautz,Amber %A Farchaus Stein,Karen %+ Department of Public Health Sciences, Division of Epidemiology, University of Rochester School of Medicine and Dentistry, 265 Crittenden Blvd., CU 420644, Rochester, NY, 14642-0644, United States, 1 585 275 9554, Diana_fernandez@urmc.rochester.edu %K Mexican immigrant farmworker %K diet-related noncommunicable diseases %K mHealth %K dietary assessment %K image-based %K healthcare disparities %K minority %K feasibility study %K food photography %K rural health %K health literacy %K culutural adaptation %K women %K technology acceptance %K mobile health %D 2024 %7 13.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Rural-urban disparities in access to health services and the burden of diet-related noncommunicable diseases are exacerbated among Mexican immigrant farmworkers due to work demands, social and geographical isolation, literacy issues, and limited access to culturally and language-competent health services. Although mobile health (mHealth) tools have the potential to overcome structural barriers to health services access, efficacious mHealth interventions to promote healthy eating have not considered issues of low literacy and health literacy, and food preferences and norms in the Mexican immigrant farmworker population. To address this critical gap, we conducted a series of preliminary studies among Mexican immigrant farmworkers with the long-term goal of developing a culture- and literacy-specific smartphone app integrating dietary assessment through food photography, diet analyses, and a non–text-based dietary intervention. Objective: This study aimed to report adherence and reactivity to a 14-day food photography dietary assessment protocol, in which Mexican immigrant farmworker women were instructed to take photos of all foods and beverages consumed. Methods: We developed a secure mobile app with an intuitive graphical user interface to collect food images. Adult Mexican immigrant farmworker women were recruited and oriented to the photography protocol. Adherence and reactivity were examined by calculating the mean number of food photos per day over time, differences between the first and second week, and differences between weekdays and weekends. The type of foods and meals photographed were compared with reported intake in three 24-hour dietary recalls. Results: In total, 16 Mexican farmworker women took a total of 1475 photos in 14 days, with a mean of 6.6 (SD 2.3) photos per day per participant. On average, participants took 1 fewer photo per day in week 2 compared with week 1 (mean 7.1, SD 2.5 in week 1 vs mean 6.1, SD 2.6 in week 2; P=.03), and there was a decrease of 0.6 photos on weekdays versus weekends (mean 6.4, SD 2.5 on weekdays vs mean 7, SD 2.7 on weekends; P=.50). Of individual food items, 71% (352/495) of foods in the photos matched foods in the recalls. Of all missing food items (n=138) and meals (n=36) in the photos, beverages (74/138, 54%), tortillas (15/138, 11%), snacks 16/36, 44%), and dinners (10/36, 28%) were the most frequently missed. Most of the meals not photographed (27/36, 75%) were in the second week of the protocol. Conclusions: Dietary assessment through food photography is feasible among Mexican immigrant farmworker women. For future protocols, substantive adjustments will be introduced to reduce the frequency of missing foods and meals. Our preliminary studies are a step in the right direction to extend the benefits of mHealth technologies to a hard-to-reach group and contribute to the prevention and control of diet-related noncommunicable diseases. %M 39671581 %R 10.2196/54664 %U https://formative.jmir.org/2024/1/e54664 %U https://doi.org/10.2196/54664 %U http://www.ncbi.nlm.nih.gov/pubmed/39671581 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54557 %T Artificial Intelligence Applications to Measure Food and Nutrient Intakes: Scoping Review %A Zheng,Jiakun %A Wang,Junjie %A Shen,Jing %A An,Ruopeng %+ School of Economics and Management, Shanghai University of Sport, 399 Changhai Road, Yangpu District, Shanghai, 200438, China, 86 13817507993, zhengjiakun07@163.com %K food %K nutrient %K diet %K artificial intelligence %K machine learning %K deep learning %K neural networks %K computer vision %K natural language processing %K measurement %K AI %K food intake %K systematic literature %K dietary assessments %K AI-based %K disease management %K mobile phone %D 2024 %7 28.11.2024 %9 Review %J J Med Internet Res %G English %X Background: Accurate measurement of food and nutrient intake is crucial for nutrition research, dietary surveillance, and disease management, but traditional methods such as 24-hour dietary recalls, food diaries, and food frequency questionnaires are often prone to recall error and social desirability bias, limiting their reliability. With the advancement of artificial intelligence (AI), there is potential to overcome these limitations through automated, objective, and scalable dietary assessment techniques. However, the effectiveness and challenges of AI applications in this domain remain inadequately explored. Objective: This study aimed to conduct a scoping review to synthesize existing literature on the efficacy, accuracy, and challenges of using AI tools in assessing food and nutrient intakes, offering insights into their current advantages and areas of improvement. Methods: This review followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A comprehensive literature search was conducted in 4 databases—PubMed, Web of Science, Cochrane Library, and EBSCO—covering publications from the databases’ inception to June 30, 2023. Studies were included if they used modern AI approaches to assess food and nutrient intakes in human subjects. Results: The 25 included studies, published between 2010 and 2023, involved sample sizes ranging from 10 to 38,415 participants. These studies used a variety of input data types, including food images (n=10), sound and jaw motion data from wearable devices (n=9), and text data (n=4), with 2 studies combining multiple input types. AI models applied included deep learning (eg, convolutional neural networks), machine learning (eg, support vector machines), and hybrid approaches. Applications were categorized into dietary intake assessment, food detection, nutrient estimation, and food intake prediction. Food detection accuracies ranged from 74% to 99.85%, and nutrient estimation errors varied between 10% and 15%. For instance, the RGB-D (Red, Green, Blue-Depth) fusion network achieved a mean absolute error of 15% in calorie estimation, and a sound-based classification model reached up to 94% accuracy in detecting food intake based on jaw motion and chewing patterns. In addition, AI-based systems provided real-time monitoring capabilities, improving the precision of dietary assessments and demonstrating the potential to reduce recall bias typically associated with traditional self-report methods. Conclusions: While AI demonstrated significant advantages in improving accuracy, reducing labor, and enabling real-time monitoring, challenges remain in adapting to diverse food types, ensuring algorithmic fairness, and addressing data privacy concerns. The findings suggest that AI has transformative potential for dietary assessment at both individual and population levels, supporting precision nutrition and chronic disease management. Future research should focus on enhancing the robustness of AI models across diverse dietary contexts and integrating biological sensors for a holistic dietary assessment approach. %M 39608003 %R 10.2196/54557 %U https://www.jmir.org/2024/1/e54557 %U https://doi.org/10.2196/54557 %U http://www.ncbi.nlm.nih.gov/pubmed/39608003 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60037 %T An Investigation of the Feasibility and Acceptability of Using a Commercial DASH (Dietary Approaches to Stop Hypertension) App in People With High Blood Pressure: Mixed Methods Study %A Alnooh,Ghadah %A AlTamimi,Jozaa Z %A Williams,Elizabeth A %A Hawley,Mark S %+ Centre for Assistive Technology and Connected Healthcare, School of Medicine and Population Health, University of Sheffield, The Innovation Centre, 217 Portobello, Sheffield, S1 4DP, United Kingdom, 44 1142222000, mark.hawley@sheffield.ac.uk %K hypertension %K blood pressure %K Dietary Approaches to Stop Hypertension %K DASH diet %K self-efficacy %K mobile health %K mHealth %K Saudi Arabia %K mobile phone %D 2024 %7 19.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of smartphone apps for dietary self-management among patients with high blood pressure is becoming increasingly common. Few commercially available DASH (Dietary Approaches to Stop Hypertension) diet apps have the potential to be effective, and only a few of these have adequate security and privacy measures. In previous studies, we identified 2 high-quality apps that are likely effective and safe. One of these, the Noom app, was selected as the most suitable app for use in the Saudi Arabian context based on health care professionals’ and patients’ preferences. Objective: This study aims to determine the feasibility and acceptability of using the Noom app to support DASH diet self-management among people with high blood pressure in Saudi Arabia. Methods: This mixed methods study evaluated the feasibility and acceptability of using the Noom app among people with high blood pressure in Riyadh, Saudi Arabia. Fourteen participants with high blood pressure were recruited and asked to use the app for 8 weeks. The quantitative outcome measures were DASH diet adherence and self-efficacy. Feasibility and acceptability were assessed during and after the intervention via the Noom diet-tracking engagement questionnaire, the System Usability Scale, and semistructured interviews. Results: Most participants (8/13, 62%) logged their meals for 3 to 5 days a week; the frequency of logging increased over time. Snacks were the foods they most often forgot to log. The interviews revealed four main themes: (1) acceptance, (2) app usability, (3) technical issues, and (4) suggestions for improvement. Most participants found the Noom app acceptable, and most had no difficulties integrating it into their daily routines. The results of this feasibility study provided insights into the app’s educational content, some of which was deemed unsuitable for Saudi Arabian users. App usability was identified as a critical theme: the app and its database were easy to use, convenient, and valuable to most of the participants. Despite this, some of the participants reported difficulties in identifying some foods because of a lack of local options on the app. Technical issues included the app freezing or responding slowly. Most participants also suggested developing an Arabic version of the app and simplifying the method of food logging. The participants showed some improvement in self-efficacy and adherence to the DASH diet, although these improvements were not statistically significant. The mean self-efficacy score increased from 18 (SD 4.7) to 20 (SD 6.3), and the mean DASH diet score increased from 3.4 (SD 1.4) to 4.3 (SD 1.1). Conclusions: The app was feasible and acceptable among the participants who completed the study. Further studies are needed to examine the potential of smartphone apps in promoting adherence to the DASH diet and their impact on blood pressure among individuals with hypertension in Saudi Arabia. %M 39561360 %R 10.2196/60037 %U https://formative.jmir.org/2024/1/e60037 %U https://doi.org/10.2196/60037 %U http://www.ncbi.nlm.nih.gov/pubmed/39561360 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e57265 %T Knowledge, Attitudes, and Behaviors Toward Salt Consumption and Its Association With 24-Hour Urinary Sodium and Potassium Excretion in Adults Living in Mexico City: Cross-Sectional Study %A Gutiérrez-Salmeán,Gabriela %A Miranda-Alatriste,Paola Vanessa %A Benítez-Alday,Patricio %A Orozco-Rivera,Luis Enrique %A Islas-Vargas,Nurit %A Espinosa-Cuevas,Ángeles %A Correa-Rotter,Ricardo %A Colin-Ramirez,Eloisa %+ Centro de Investigación en Ciencias de la Salud, Facultad de Ciencias de la Salud, Universidad Anáhuac México, Avenida Universidad Anáhuac 46,, Lomas Anáhuac, Huixquilucan, Estado de México, 52786, Mexico, 52 55 5627 0210, eloisa.colinr@incmnsz.mx %K beliefs %K attitudes %K hypertension %K knowledge %K salt consumption %K sodium intake %K potassium intake %K Mexico %D 2024 %7 18.11.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: The World Health Organization recommends a daily sodium intake of less than 2000 mg for adults; however, the Mexican population, like many others globally, consumes more sodium than this recommended amount. Excessive sodium intake is often accompanied by inadequate potassium intake. The association between knowledge, attitudes, and behaviors (KAB) and actual sodium intake has yielded mixed results across various populations. In Mexico, however, salt/sodium-related KAB and its relationship with sodium and potassium intake have not been evaluated. Objective: This study primarily aims to describe salt/sodium-related KAB in a Mexican population and, secondarily, to explore the association between KAB and 24-hour urinary sodium and potassium excretion. Methods: We conducted a cross-sectional study in an adult population from Mexico City and the surrounding metropolitan area. Self-reported KAB related to salt/sodium intake was assessed using a survey developed by the Pan American Health Organization. Anthropometric measurements were taken, and 24-hour urinary sodium and potassium excretion levels were determined. Descriptive statistics were stratified by sex and presented as means (SD) or median (25th-75th percentiles) for continuous variables, and as absolute and relative frequencies for categorical variables. The associations between KAB and sodium and potassium excretion were assessed using analysis of covariance, adjusting for age, sex, BMI, and daily energy intake as covariates, with the Šidák correction applied for multiple comparisons. Results: Overall, 232 participants were recruited (women, n=184, 79.3%). The mean urinary sodium and potassium excretion were estimated to be 2582.5 and 1493.5 mg/day, respectively. A higher proportion of men did not know the amount of sodium they consumed compared with women (12/48, 25%, vs 15/184, 8.2%, P=.01). More women reported knowing that there is a recommended amount for daily sodium intake than men (46/184, 25%, vs 10/48, 20.8%, P=.02). Additionally, more than half of men (30/48, 62.5%) reported never or rarely reading food labels, compared with women (96/184, 52.1%, P=.04). Better salt/sodium-related KAB was associated with higher adjusted mean sodium and potassium excretion. For example, mean sodium excretion was 3011.5 (95% CI 2640.1-3382.9) mg/day among participants who reported knowing the difference between salt and sodium, compared with 2592.8 (95% CI 2417.2-2768.3) mg/day in those who reported not knowing this difference (P=.049). Similarly, potassium excretion was 1864.9 (95% CI 1669.6-2060.3) mg/day for those who knew the difference, compared with 1512.5 (95% CI 1420.1-1604.8) mg/day for those who did not (P=.002). Additionally, higher urinary sodium excretion was observed among participants who reported consuming too much sodium (3216.0 mg/day, 95% CI 2867.1-3565.0 mg/day) compared with those who claimed to eat just the right amount (2584.3 mg/day, 95% CI 2384.9-2783.7 mg/day, P=.01). Conclusions: Salt/sodium-related KAB was poor in this study sample. Moreover, KAB had a greater impact on potassium excretion than on sodium excretion, highlighting the need for more strategies to improve KAB related to salt/sodium intake. Additionally, it is important to consider other strategies aimed at modifying the sodium content of foods. %M 39556832 %R 10.2196/57265 %U https://www.i-jmr.org/2024/1/e57265 %U https://doi.org/10.2196/57265 %U http://www.ncbi.nlm.nih.gov/pubmed/39556832 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55088 %T An Online Multimodal Food Data Exploration Platform for Specific Population Health: Development Study %A Yang,Lin %A Guo,Zhen %A Xu,Xiaowei %A Kang,Hongyu %A Lai,Jianqiang %A Li,Jiao %+ Institute of Medical Information and Library, Chinese Academy of Medical Sciences/Peking Union Medical College, No. 3, Yabao Rd, Chaoyang District, Beijing, 100020, China, 86 18618461596, li.jiao@imicams.ac.cn %K Chinese food data %K multimodal knowledge graph %K online platform %K population health promotion %K health promotion %K nutrients %K diet %K pregnant women %D 2024 %7 15.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Nutrient needs vary over the lifespan. Improving knowledge of both population groups and care providers can help with healthier food choices, thereby promoting population health and preventing diseases. Providing evidence-based food knowledge online is credible, low cost, and easily accessible. Objective: This study aimed to develop an online multimodal food data exploration platform for easy access to evidence-based diet- and nutrition-related data. Methods: We developed an online platform named Food Atlas in collaboration with a multidisciplinary expert group from the National Institute for Nutrition and Health and Peking Union Medical College Hospital in China. To demonstrate its feasibility for Chinese food for pregnant women, a user-friendly and high-quality multimodal food knowledge graph was constructed, and various interactions with graph-structured data were developed for easy access, including graph-based interactive visualizations, natural language retrieval, and image-text retrieval. Subsequently, we evaluated Food Atlas from both the system perspective and the user perspective. Results: The constructed multimodal food knowledge graph contained a total of 2011 entities, 10,410 triplets, and 23,497 images. Its schema consisted of 11 entity types and 26 types of semantic relations. Compared with 5 other online dietary platforms (Foodwake, Boohee, Xiachufang, Allrecipes, and Yummly), Food Atlas offers a distinct and comprehensive set of data content and system functions desired by target populations. Meanwhile, a total of 28 participants representing 4 different user groups were recruited to evaluate its usability: preparing for pregnancy (n=8), pregnant (n=12), clinicians (n=5), and dietitians (n=3). The mean System Usability Scale index of our platform was 82.5 (SD 9.94; range 40.0-82.5). This above-average usability score and the use cases indicated that Food Atlas is tailored to the needs of the target users. Furthermore, 96% (27/28) of the participants stated that the platform had high consistency, illustrating the necessity and effectiveness of health professionals participating in online, evidence-based resource development. Conclusions: This study demonstrates the development of an online multimodal food data exploration platform and its ability to meet the rising demand for accessible, credible, and appropriate evidence-based online dietary resources. Further research and broader implementation of such platforms have the potential to popularize knowledge, thereby helping populations at different life stages make healthier food choices. %M 39547662 %R 10.2196/55088 %U https://formative.jmir.org/2024/1/e55088 %U https://doi.org/10.2196/55088 %U http://www.ncbi.nlm.nih.gov/pubmed/39547662 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51432 %T Advancements in Using AI for Dietary Assessment Based on Food Images: Scoping Review %A Chotwanvirat,Phawinpon %A Prachansuwan,Aree %A Sridonpai,Pimnapanut %A Kriengsinyos,Wantanee %+ Human Nutrition Unit, Food and Nutrition Academic and Research Cluster, Institute of Nutrition, Mahidol University, 999 Phutthamonthon 4 Rd., Salaya, Nakhon Pathom, 73170, Thailand, 66 2 800 2380, wantanee.krieng@mahidol.ac.th %K image-assisted dietary assessment %K artificial intelligence %K dietary assessment %K mobile phone %K food intake %K image recognition %K portion size %D 2024 %7 15.11.2024 %9 Review %J J Med Internet Res %G English %X Background: To accurately capture an individual’s food intake, dietitians are often required to ask clients about their food frequencies and portions, and they have to rely on the client’s memory, which can be burdensome. While taking food photos alongside food records can alleviate user burden and reduce errors in self-reporting, this method still requires trained staff to translate food photos into dietary intake data. Image-assisted dietary assessment (IADA) is an innovative approach that uses computer algorithms to mimic human performance in estimating dietary information from food images. This field has seen continuous improvement through advancements in computer science, particularly in artificial intelligence (AI). However, the technical nature of this field can make it challenging for those without a technical background to understand it completely. Objective: This review aims to fill the gap by providing a current overview of AI’s integration into dietary assessment using food images. The content is organized chronologically and presented in an accessible manner for those unfamiliar with AI terminology. In addition, we discuss the systems’ strengths and weaknesses and propose enhancements to improve IADA’s accuracy and adoption in the nutrition community. Methods: This scoping review used PubMed and Google Scholar databases to identify relevant studies. The review focused on computational techniques used in IADA, specifically AI models, devices, and sensors, or digital methods for food recognition and food volume estimation published between 2008 and 2021. Results: A total of 522 articles were initially identified. On the basis of a rigorous selection process, 84 (16.1%) articles were ultimately included in this review. The selected articles reveal that early systems, developed before 2015, relied on handcrafted machine learning algorithms to manage traditional sequential processes, such as segmentation, food identification, portion estimation, and nutrient calculations. Since 2015, these handcrafted algorithms have been largely replaced by deep learning algorithms for handling the same tasks. More recently, the traditional sequential process has been superseded by advanced algorithms, including multitask convolutional neural networks and generative adversarial networks. Most of the systems were validated for macronutrient and energy estimation, while only a few were capable of estimating micronutrients, such as sodium. Notably, significant advancements have been made in the field of IADA, with efforts focused on replicating humanlike performance. Conclusions: This review highlights the progress made by IADA, particularly in the areas of food identification and portion estimation. Advancements in AI techniques have shown great potential to improve the accuracy and efficiency of this field. However, it is crucial to involve dietitians and nutritionists in the development of these systems to ensure they meet the requirements and trust of professionals in the field. %M 39546777 %R 10.2196/51432 %U https://www.jmir.org/2024/1/e51432 %U https://doi.org/10.2196/51432 %U http://www.ncbi.nlm.nih.gov/pubmed/39546777 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55218 %T A Food Intake Estimation System Using an Artificial Intelligence–Based Model for Estimating Leftover Hospital Liquid Food in Clinical Environments: Development and Validation Study %A Tagi,Masato %A Hamada,Yasuhiro %A Shan,Xiao %A Ozaki,Kazumi %A Kubota,Masanori %A Amano,Sosuke %A Sakaue,Hiroshi %A Suzuki,Yoshiko %A Konishi,Takeshi %A Hirose,Jun %+ Medical Informatics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima, 7708503, Japan, 81 88 633 9178, tagi@tokushima-u.ac.jp %K artificial intelligence %K machine learning %K system development %K food intake %K dietary intake %K dietary assessment %K food consumption %K image visual estimation %K AI estimation %K direct visual estimation %D 2024 %7 5.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Medical staff often conduct assessments, such as food intake and nutrient sufficiency ratios, to accurately evaluate patients’ food consumption. However, visual estimations to measure food intake are difficult to perform with numerous patients. Hence, the clinical environment requires a simple and accurate method to measure dietary intake. Objective: This study aims to develop a food intake estimation system through an artificial intelligence (AI) model to estimate leftover food. The accuracy of the AI’s estimation was compared with that of visual estimation for liquid foods served to hospitalized patients. Methods: The estimations were evaluated by a dietitian who looked at the food photo (image visual estimation) and visual measurement evaluation was carried out by a nurse who looked directly at the food (direct visual estimation) based on actual measurements. In total, 300 dishes of liquid food (100 dishes of thin rice gruel, 100 of vegetable soup, 31 of fermented milk, and 18, 12, 13, and 26 of peach, grape, orange, and mixed juices, respectively) were used. The root-mean-square error (RMSE) and coefficient of determination (R2) were used as metrics to determine the accuracy of the evaluation process. Corresponding t tests and Spearman rank correlation coefficients were used to verify the accuracy of the measurements by each estimation method with the weighing method. Results: The RMSE obtained by the AI estimation approach was 8.12 for energy. This tended to be smaller and larger than that obtained by the image visual estimation approach (8.49) and direct visual estimation approach (4.34), respectively. In addition, the R2 value for the AI estimation tended to be larger and smaller than the image and direct visual estimations, respectively. There was no difference between the AI estimation (mean 71.7, SD 23.9 kcal, P=.82) and actual values with the weighing method. However, the mean nutrient intake from the image visual estimation (mean 75.5, SD 23.2 kcal, P<.001) and direct visual estimation (mean 73.1, SD 26.4 kcal, P=.007) were significantly different from the actual values. Spearman rank correlation coefficients were high for energy (ρ=0.89-0.97), protein (ρ=0.94-0.97), fat (ρ=0.91-0.94), and carbohydrate (ρ=0.89-0.97). Conclusions: The measurement from the food intake estimation system by an AI-based model to estimate leftover liquid food intake in patients showed a high correlation with the actual values with the weighing method. Furthermore, it also showed a higher accuracy than the image visual estimation. The errors of the AI estimation method were within the acceptable range of the weighing method, which indicated that the AI-based food intake estimation system could be applied in clinical environments. However, its lower accuracy than that of direct visual estimation was still an issue. %M 39500491 %R 10.2196/55218 %U https://formative.jmir.org/2024/1/e55218 %U https://doi.org/10.2196/55218 %U http://www.ncbi.nlm.nih.gov/pubmed/39500491 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63823 %T Evaluating User Experiences and Preferred Features of a Web-Based 24-Hour Dietary Assessment Tool: Usability Study %A Follong,Berit %A Haliburton,Caitlin %A Mackay,Sally %A Maiquez,Maria %A Grey,Jacqueline %A Ni Mhurchu,Cliona %+ National Institute for Health Innovation, University of Auckland, 28 Park Avenue, Grafton, Auckland, 1023, New Zealand, 64 93737599, berit.follong@auckland.ac.nz %K public health %K nutrition %K dietary assessment methods %K digital tools %K user experience %K qualitative data %K survey %D 2024 %7 18.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Intake24, a web-based 24-hour dietary recall tool developed in the United Kingdom, was adapted for use in New Zealand (Intake24-NZ) through the addition of a New Zealand food list, portion size images, and food composition database. Owing to the customizations made, a thorough evaluation of the tool’s usability was required. Detailed qualitative usability studies are well suited to investigate any challenges encountered while completing a web-based 24-hour recall and provide meaningful data to inform enhancements to the tool. Objective: This study aims to evaluate the usability of Intake24-NZ and identify improvements to enhance both the user experience and the quality of dietary intake data collected. Methods: We used a mixed methods approach comprising two components: (1) completion of a single 24-hour dietary recall using Intake24-NZ with both screen observation recordings and collation of verbal participant feedback on their experience and (2) a survey. Results: A total of 37 participants aged ≥11 years self-completed the dietary recall and usability survey (men and boys: 14/37, 38% and women and girls: 23/37, 62%; Māori: 10/37, 27% and non-Māori: 27/37, 73%). Although most (31/37, 84%) reported that Intake24-NZ was easy to use and navigate, data from the recorded observations and usability survey revealed challenges related to the correct use of search terms, search results obtained (eg, type and order of foods displayed), portion size estimation, and associated food prompts (eg, did you add milk to your tea?). Conclusions: This comprehensive usability study identified challenges experienced by users in completing a dietary recall in Intake24-NZ. The results informed a series of improvements to enhance user experience and the quality of dietary data collected with Intake24-NZ, including adding new foods to the food list, optimizing the search function and ordering of search results, creating new portion size images, and providing clearer instructions to the users. %M 39422998 %R 10.2196/63823 %U https://formative.jmir.org/2024/1/e63823 %U https://doi.org/10.2196/63823 %U http://www.ncbi.nlm.nih.gov/pubmed/39422998 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51321 %T The Influence of Physical Activity and Diet Mobile Apps on Cardiovascular Disease Risk Factors: Meta-Review %A Bushey,Erica %A Wu,Yin %A Wright,Alexander %A Pescatello,Linda %+ University of Connecticut, 2098 Hillside Rd, Storrs, CT, United States, 1 860 486 0008, erica.bushey@uconn.edu %K physical activity %K diet %K mobile applications %K obesity %K hypertension %K dyslipidemia %K diabetes %K mobile phone %D 2024 %7 9.10.2024 %9 Review %J J Med Internet Res %G English %X Background: The literature on whether physical activity (PA) and PA and diet (PA+Diet) mobile apps improve cardiovascular disease (CVD) risk factors is promising. Objective: The aim of this meta-review is to provide an evidence synthesis of systematic reviews and meta-analyses examining the influence of PA and PA+Diet apps on the major CVD risk factors. Methods: We systematically searched 5 databases until January 12, 2022. Included systematic reviews and meta-analyses (1) reported the CVD risk factor outcomes of BMI, waist circumference, body weight, blood pressure (BP), hemoglobin A1c (HbA1c), fasting blood glucose, blood lipids, or PA; (2) enrolled healthy participants ≥18 years who may or may not have the metabolic syndrome, diabetes mellitus, or preexisting CVD risk factors; (3) reviewed PA or PA+Diet app interventions integrating behavioral change techniques (BCT) to deliver their information; and (4) had a nonapp control. Results: In total, 17 reviews (9 systematic reviews and 8 meta-analyses) published between 2012 and 2021 qualified. Participants were middle-aged, mostly women ranging in number from 10 to 62,219. Interventions lasted from 1 to 24 months, with the most common behavioral strategies being personalized feedback (n=8), self-monitoring (n=7), and goal setting (n=5). Of the PA app systematic reviews (N=4), the following CVD risk factors improved: body weight and BMI (n=2, 50%), BP (n=1, 25%), HbA1c (n=1, 25%), and blood lipids (n=1, 25%) decreased, while PA (n=4, 100%) increased. Of the PA+Diet app systematic reviews (N=5), the following CVD risk factors improved: body weight and BMI (n=3, 60%), BP (n=1, 20%), and HbA1c (n=3, 60%) decreased, while PA (n=3, 60%) increased. Of the PA app meta-analyses (N=1), the following CVD risk factors improved: body weight decreased (–0.73 kg, 95% CI –1.45 to –0.01; P=.05) and PA increased by 25 minutes/week (95% CI 0.58-1.68; P<.001), while BMI (–0.09 kg/m2, 95% CI –0.29 to 0.10; P=.35) and waist circumference (–1.92 cm, 95% CI –3.94 to 0.09; P=.06) tended to decrease. Of the PA+Diet app meta-analyses (n=4), the following CVD risk factors improved: body weight (n=4, 100%; from –1.79 kg 95% CI –3.17 to –0.41; P=.01 to –2.80 kg 95% CI –4.54 to –1.06, P=.002), BMI (n=1, 25%; –0.64 kg/m2, 95% CI –1.09 to –0.18; P=.01), waist circumference (n=1, 25%; –2.46 cm, 95% CI –4.56 to –0.36; P=.02), systolic/diastolic BP (n=1, 25%; –4.22/–2.87 mm Hg, 95% CI –6.54 to –1.91/ –4.44 to –1.29; P<.01), and HbA1c (n=1, 25%; –0.43%, 95% CI –0.68 to –0.19; P<.001) decreased. Conclusions: PA and PA+Diet apps appear to be most consistent in improving PA and anthropometric measures with favorable but less consistent effects on other CVD risk factors. Future studies are needed that directly compare and better quantify the effects of PA and PA+Diet apps on CVD risk factors. Trial Registration: PROSPERO CRD42023392359; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=392359 %M 39382958 %R 10.2196/51321 %U https://www.jmir.org/2024/1/e51321 %U https://doi.org/10.2196/51321 %U http://www.ncbi.nlm.nih.gov/pubmed/39382958 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52170 %T Developing a Personalized Meal Recommendation System for Chinese Older Adults: Observational Cohort Study %A Xu,Zidu %A Gu,Yaowen %A Xu,Xiaowei %A Topaz,Maxim %A Guo,Zhen %A Kang,Hongyu %A Sun,Lianglong %A Li,Jiao %+ Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, No 3. Yabao Road, Beijing, 10020, China, 86 1052328740, li.jiao@imicams.ac.cn %K knowledge graph %K personalized food recommendation %K geriatric nutrition %K community %K ubiquitous computing %D 2024 %7 30.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: China’s older population is facing serious health challenges, including malnutrition and multiple chronic conditions. There is a critical need for tailored food recommendation systems. Knowledge graph–based food recommendations offer considerable promise in delivering personalized nutritional support. However, the integration of disease-based nutritional principles and preference-related requirements needs to be optimized in current recommendation processes. Objective: This study aims to develop a knowledge graph–based personalized meal recommendation system for community-dwelling older adults and to conduct preliminary effectiveness testing. Methods: We developed ElCombo, a personalized meal recommendation system driven by user profiles and food knowledge graphs. User profiles were established from a survey of 96 community-dwelling older adults. Food knowledge graphs were supported by data from websites of Chinese cuisine recipes and eating history, consisting of 5 entity classes: dishes, ingredients, category of ingredients, nutrients, and diseases, along with their attributes and interrelations. A personalized meal recommendation algorithm was then developed to synthesize this information to generate packaged meals as outputs, considering disease-related nutritional constraints and personal dietary preferences. Furthermore, a validation study using a real-world data set collected from 96 community-dwelling older adults was conducted to assess ElCombo’s effectiveness in modifying their dietary habits over a 1-month intervention, using simulated data for impact analysis. Results: Our recommendation system, ElCombo, was evaluated by comparing the dietary diversity and diet quality of its recommended meals with those of the autonomous choices of 96 eligible community-dwelling older adults. Participants were grouped based on whether they had a recorded eating history, with 34 (35%) having and 62 (65%) lacking such data. Simulation experiments based on retrospective data over a 30-day evaluation revealed that ElCombo’s meal recommendations consistently had significantly higher diet quality and dietary diversity compared to the older adults’ own selections (P<.001). In addition, case studies of 2 older adults, 1 with and 1 without prior eating records, showcased ElCombo’s ability to fulfill complex nutritional requirements associated with multiple morbidities, personalized to each individual’s health profile and dietary requirements. Conclusions: ElCombo has shown enhanced potential for improving dietary quality and diversity among community-dwelling older adults in simulation tests. The evaluation metrics suggest that the food choices supported by the personalized meal recommendation system surpass autonomous selections. Future research will focus on validating and refining ElCombo’s performance in real-world settings, emphasizing the robust management of complex health data. The system’s scalability and adaptability pinpoint its potential for making a meaningful impact on the nutritional health of older adults. %M 38814702 %R 10.2196/52170 %U https://formative.jmir.org/2024/1/e52170 %U https://doi.org/10.2196/52170 %U http://www.ncbi.nlm.nih.gov/pubmed/38814702 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53442 %T Digital Food Frequency Questionnaire Assessing Adherence to the Norwegian Food–Based Dietary Guidelines and Other National Lifestyle Recommendations: Instrument Validation Study %A Henriksen,Hege Berg %A Knudsen,Markus Dines %A Hjartåker,Anette %A Blomhoff,Rune %A Carlsen,Monica Hauger %+ Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Sognsvannsveien 9, PO Box 1046, Blindern, Oslo, 0372, Norway, 47 99459673, h.b.henriksen@medisin.uio.no %K digital food frequency questionnaire %K lifestyle assessment tool %K relative validity %K physical activity %K Norwegian food–based dietary guidelines %K Norway %K Norwegian %K food %K foods %K diet %K dietary %K lifestyle %K assessment %K digital questionnaire %K investigation %K food intake %K dietary intake %K dietary intakes %K observation %K monitoring %K youths %K adolescent %K adolescents %K teen %K teens %K teenager %K teenagers %K cross-sectional study %D 2024 %7 30.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Valid assessment tools are needed when investigating adherence to national dietary and lifestyle guidelines. Objective: The relative validity of the new digital food frequency questionnaire, the DIGIKOST-FFQ, against 7-day weighed food records and activity sensors was investigated. Methods: In total, 77 participants were included in the validation study and completed the DIGIKOST-FFQ and the weighed food record, and of these, 56 (73%) also used the activity sensors. The DIGIKOST-FFQ estimates the intake of foods according to the Norwegian food–based dietary guidelines (FBDGs) in addition to lifestyle factors. Results: At the group level, the DIGIKOST-FFQ showed good validity in estimating intakes according to the Norwegian FBDG. The median differences were small and well below portion sizes for all foods except “water” (median difference 230 g/day). The DIGIKOST-FFQ was able to rank individual intakes for all foods (r=0.2-0.7). However, ranking estimates of vegetable intakes should be interpreted with caution. Between 69% and 88% of the participants were classified into the same or adjacent quartile for foods and between 71% and 82% for different activity intensities. The Bland-Altman plots showed acceptable agreements between DIGIKOST-FFQ and the reference methods. The absolute amount of time in “moderate to vigorous intensity” was underestimated with the DIGIKOST-FFQ. However, estimated time in “moderate to vigorous intensity,” “vigorous intensity,” and “sedentary time” showed acceptable correlations and good agreement between the methods. The DIGIKOST-FFQ was able to identify adherence to the Norwegian FBDG and physical activity recommendations. Conclusions: The DIGIKOST-FFQ gave valid estimates of dietary intakes and was able to identify individuals with different degrees of adherence to the Norwegian FBDG and physical activity recommendations. Moderate physical activity was underreported, water was overreported, and vegetables showed poor correlation, which are important to consider when interpreting the data. Good agreement was observed between the methods in estimating dietary intakes and time in “moderate to vigorous physical activity,” “sedentary time,” and “sleep.” %M 38687986 %R 10.2196/53442 %U https://www.jmir.org/2024/1/e53442 %U https://doi.org/10.2196/53442 %U http://www.ncbi.nlm.nih.gov/pubmed/38687986 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55795 %T Examining and Comparing the Validity and Reproducibility of Scales to Determine the Variety of Vegetables Consumed: Validation Study %A Ominami,Kaya %A Kushida,Osamu %+ Department of Nutrition and Life Sciences, School of Food and Nutritional Sciences, University of Shizuoka, 52-1 Yada, Suruga-ku, Shizuoka, 422-8526, Japan, 81 542645832, kushida@u-shizuoka-ken.ac.jp %K vegetable %K variety %K scale %K validity %K reproducibility %K dietary records %K nutrition %D 2024 %7 11.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Previous studies have reported that vegetable variety reduces the risk for noncommunicable diseases independent of the amount consumed. Objective: This study aimed to examine and compare the validity and reproducibility of several scales to determine vegetable variety. Methods: In total, 23 nutrition students in Japan reported their vegetable intake over the past month using a self-administered questionnaire between July and August 2021. Specifically, four scales were used: (1) a single question regarding the number of vegetables consumed (scale A); (2) a scale containing 9 vegetable subgroups included in the brief-type self-administered diet history questionnaire (scale B); (3) a scale containing 19 vegetable items included in a self-administered diet history questionnaire (scale C); and (4) a scale containing 20 vegetable items from the Ranking of Vegetable Consumers in Japan, which was analyzed based on a report on the National Health and Nutrition Survey in Japan (scale D). Scale validity was assessed by correlation with the number of vegetables consumed, which was collected from dietary records for 7 consecutive days. Reproducibility was assessed by test-retest reliability. Results: Regarding the validity of the 4 scales, significant correlations were found between scales C (ρ=0.51) and D (ρ=0.44) with vegetable variety based on dietary records, but scales A (ρ=0.28) and B (ρ=0.22) were not significantly correlated. Reproducibility showed a significant correlation in scale B (ρ=0.45) and strong correlations in scales C (ρ=0.73) and D (ρ=0.75). Conclusions: The scales for vegetable items have acceptable validity and reproducibility compared to the scales that used a single question or vegetable subgroup and, therefore, may determine the variety of vegetables consumed. %M 38603775 %R 10.2196/55795 %U https://formative.jmir.org/2024/1/e55795 %U https://doi.org/10.2196/55795 %U http://www.ncbi.nlm.nih.gov/pubmed/38603775 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51108 %T Long-Term Effectiveness of a Multi-Strategy Choice Architecture Intervention in Increasing Healthy Food Choices of High-School Students From Online Canteens (Click & Crunch High Schools): Cluster Randomized Controlled Trial %A Delaney,Tessa %A Jackson,Jacklyn %A Lecathelinais,Christophe %A Clinton-McHarg,Tara %A Lamont,Hannah %A Yoong,Sze Lin %A Wolfenden,Luke %A Sutherland,Rachel %A Wyse,Rebecca %+ School of Medicine and Public Health, University of Newcastle, Locked Bag 10, Wallsend, 2287, Australia, 61 294617441, Tessa.Delaney@health.nsw.gov.au %K randomized controlled trial %K web-based ordering systems %K ordering %K menu %K menus %K prompt %K prompts %K prompting %K nudge %K nudges %K behavior change %K behaviour change %K digital intervention %K lunch %K school %K menu labelling %K behavioral economics %K secondary school %K meal delivery apps %K public health nutrition %K meal %K meals %K nutrition %K nutritional %K diet %K eating %K food %K schools %K student %K students %K RCT %K randomized %K controlled trial %K controlled trials %K purchase %K purchasing %K canteen %K canteens %K choice %K choices %K architecture %D 2024 %7 19.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: School canteens are a recommended setting to influence adolescent nutrition due to their scope to improve student food choices. Online lunch ordering systems (“online canteens”) are increasingly used and represent attractive infrastructure to implement choice architecture interventions that nudge users toward healthier food choices. A recent cluster randomized controlled trial demonstrated the short-term effectiveness (2-month follow-up) of a choice architecture intervention to increase the healthiness of foods purchased by high school students from online canteens. However, there is little evidence regarding the long-term effectiveness of choice architecture interventions targeting adolescent food purchases, particularly those delivered online. Objective: This study aimed to determine the long-term effectiveness of a multi-strategy choice architecture intervention embedded within online canteen infrastructure in high schools at a 15-month follow-up. Methods: A cluster randomized controlled trial was undertaken with 1331 students (from 9 high schools) in New South Wales, Australia. Schools were randomized to receive the automated choice architecture intervention (including menu labeling, positioning, feedback, and prompting strategies) or the control (standard online ordering). The foods purchased were classified according to the New South Wales Healthy Canteen strategy as either “everyday,” “occasional,” or “should not be sold.” Primary outcomes were the average proportion of “everyday,” “occasional,” and “should not be sold” items purchased per student. Secondary outcomes were the mean energy, saturated fat, sugar, and sodium content of purchases. Outcomes were assessed using routine data collected by the online canteen. Results: From baseline to 15-month follow-up, on average, students in the intervention group ordered significantly more “everyday” items (+11.5%, 95% CI 7.3% to 15.6%; P<.001), and significantly fewer “occasional” (–5.4%, 95% CI –9.4% to –1.5%; P=.007) and “should not be sold” items (–6%, 95% CI –9.1% to –2.9%; P<.001), relative to controls. There were no between-group differences over time in the mean energy, saturated fat, sugar, or sodium content of lunch orders. Conclusions: Given their longer-term effectiveness, choice architecture interventions delivered via online canteens may represent a promising option for policy makers to support healthy eating among high school students. Trial Registration: Australian Clinical Trials ACTRN12620001338954, https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380546 ; Open Science Framework osf.io/h8zfr, https://osf.io/h8zfr/ %M 38502177 %R 10.2196/51108 %U https://www.jmir.org/2024/1/e51108 %U https://doi.org/10.2196/51108 %U http://www.ncbi.nlm.nih.gov/pubmed/38502177 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55193 %T Examining Parent Mood, Feeding Context, and Feeding Goals as Predictors of Feeding Practices Used by Parents of Preschool Children With Avid Eating Behavior: Protocol for an Ecological Momentary Assessment Study %A Edwards,Katie %A Croker,Helen %A Farrow,Claire %A Haycraft,Emma %A Herle,Moritz %A Llewellyn,Clare %A Pickard,Abigail %A Blissett,Jacqueline %+ School of Psychology and Institute of Health and Neurodevelopment, Aston University, Aston Triangle, Birmingham, B4 7ET, United Kingdom, 44 121 204 3784, k.edwards4@aston.ac.uk %K ecological momentary assessment %K avid eating %K children’s eating behavior %K parental feeding practices %K feeding behaviour %K parent %K children %K eating behaviour %K obesity %K environmental factors %K observational study %K feeding %K United Kingdom %D 2024 %7 19.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: An avid eating behavior profile is characterized by a greater interest in food and a tendency to overeat in response to negative emotions. Parents use specific strategies to manage feeding interactions with children with avid eating behavior. While momentary and contextual factors, such as parental mood, have been found to influence parental feeding practices, there is a lack of research examining parents’ daily experiences of feeding children with avid eating behavior. Examining this is important because parental feeding practices are key levers in tailored interventions to support children’s healthy eating behavior. Objective: We aim to describe the ecological momentary assessment methods and procedures used in the APPETItE (Appetite in Preschoolers: Producing Evidence for Tailoring Interventions Effectively) project, which aims to examine how variation in parental mood, feeding goals, and the context of eating occasions affect the parental feeding practices used to manage feeding interactions with children with an avid eating behavior profile. Methods: Participants are primary caregivers from the APPETItE cohort who have a preschool-age child (aged 3-5 years) with an avid eating behavior profile. Caregivers complete a 10-day ecological momentary assessment period using signal- and event-contingent surveys to examine (1) mood and stress, (2) parental feeding goals, and (3) contextual factors as predictors of parental feeding practices. Results: Recruitment and data collection began in October 2023 and is expected to be completed by spring 2024. The data have a 3-level structure: repeated measurements (level 1) nested within days (level 2) nested within an individual (level 3). Thus, lag-dependent models will be conducted to test the main hypotheses. Conclusions: The findings from this study will provide an understanding of caregivers’ daily experiences of feeding preschool children with avid eating behavior, who are at greater risk for the development of obesity. Understanding the predictors of feeding practices at the moment they occur, and across various contexts, will inform the development of tailored resources to support caregivers in managing children’s avid eating behavior. International Registered Report Identifier (IRRID): DERR1-10.2196/55193 %M 38502178 %R 10.2196/55193 %U https://www.researchprotocols.org/2024/1/e55193 %U https://doi.org/10.2196/55193 %U http://www.ncbi.nlm.nih.gov/pubmed/38502178 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e51962 %T The Potential of Exercise on Lifestyle and Skin Function: Narrative Review %A Oizumi,Ryosuke %A Sugimoto,Yoshie %A Aibara,Hiromi %+ Faculty of Nursing, Shijonawate gakuen University, Gakuen-cyo, 6-45, Osaka, Daito-shi, 574-0001, Japan, 81 72 813 2601, r-oizumi@un.shijonawate-gakuen.ac.jp %K skin function %K lifestyle %K exercise %K reviews %K knowledge synthesis %K Review methods %K review methodology %K literature review %K literature reviews %K narrative review %K narrative reviews %K skin %K dermatology %K exercise %K physical activity %K fitness %K lifestyles %K smoking %K diet %K sleep %K sugar intake %K life habits %K skin barrier %D 2024 %7 14.3.2024 %9 Review %J JMIR Dermatol %G English %X Background: The skin is an important organ of the human body and has moisturizing and barrier functions. Factors such as sunlight and lifestyle significantly affect these skin functions, with sunlight being extremely damaging. The effects of lifestyle habits such as smoking, diet, and sleep have been studied extensively. It has been found that smoking increases the risk of wrinkles, while excessive fat and sugar intake leads to skin aging. Lack of sleep and stress are also dangerous for the skin’s barrier function. In recent years, the impact of exercise habits on skin function has been a focus of study. Regular exercise is associated with increased blood flow to the skin, elevated skin temperature, and improved skin moisture. Furthermore, it has been shown to improve skin structure and rejuvenate its appearance, possibly through promoting mitochondrial biosynthesis and affecting hormone secretion. Further research is needed to understand the effects of different amounts and content of exercise on the skin. Objective: This study aims to briefly summarize the relationship between lifestyle and skin function and the mechanisms that have been elucidated so far and introduce the expected effects of exercise on skin function. Methods: We conducted a review of the literature using PubMed and Google Scholar repositories for relevant literature published between 2000 and 2022 with the following keywords: exercise, skin, and life habits. Results: Exercise augments the total spectrum power density of cutaneous blood perfusion by a factor of approximately 8, and vasodilation demonstrates an enhancement of approximately 1.5-fold. Regular exercise can also mitigate age-related skin changes by promoting mitochondrial biosynthesis. However, not all exercise impacts are positive; for instance, swimming in chlorinated pools may harm the skin barrier function. Hence, the exercise environment should be considered for its potential effects on the skin. Conclusions: This review demonstrates that exercise can potentially enhance skin function retention. %M 38483460 %R 10.2196/51962 %U https://derma.jmir.org/2024/1/e51962 %U https://doi.org/10.2196/51962 %U http://www.ncbi.nlm.nih.gov/pubmed/38483460 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48817 %T Dietary Intake Assessment Using a Novel, Generic Meal–Based Recall and a 24-Hour Recall: Comparison Study %A O'Hara,Cathal %A Gibney,Eileen R %+ University College Dublin Institute of Food and Health, Science Centre South, University College Dublin, Belfield, Dublin, D04 N2E5, Ireland, 353 17162819, eileen.gibney@ucd.ie %K meal patterns %K eating behaviors %K eating occasions %K nutrition assessment %K dietary intake assessment %K 24-hour recall %K relative validity %D 2024 %7 14.2.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Dietary intake assessment is an integral part of addressing suboptimal dietary intakes. Existing food-based methods are time-consuming and burdensome for users to report the individual foods consumed at each meal. However, ease of use is the most important feature for individuals choosing a nutrition or diet app. Intakes of whole meals can be reported in a manner that is less burdensome than reporting individual foods. No study has developed a method of dietary intake assessment where individuals report their dietary intakes as whole meals rather than individual foods. Objective: This study aims to develop a novel, meal-based method of dietary intake assessment and test its ability to estimate nutrient intakes compared with that of a web-based, 24-hour recall (24HR). Methods: Participants completed a web-based, generic meal–based recall. This involved, for each meal type (breakfast, light meal, main meal, snack, and beverage), choosing from a selection of meal images those that most represented their intakes during the previous day. Meal images were based on generic meals from a previous study that were representative of the actual meal intakes in Ireland. Participants also completed a web-based 24HR. Both methods were completed on the same day, 3 hours apart. In a crossover design, participants were randomized in terms of which method they completed first. Then, 2 weeks after the first dietary assessments, participants repeated the process in the reverse order. Estimates of mean daily nutrient intakes and the categorization of individuals according to nutrient-based guidelines (eg, low, adequate, and high) were compared between the 2 methods. P values of less than .05 were considered statistically significant. Results: In total, 161 participants completed the study. For the 23 nutrient variables compared, the median percentage difference between the 2 methods was 7.6% (IQR 2.6%-13.2%), with P values ranging from <.001 to .97, and out of 23 variables, effect sizes for the differences were small for 19 (83%) variables, moderate for 2 (9%) variables, and large for 2 (9%) variables. Correlation coefficients were statistically significant (P<.05) for 18 (78%) of the 23 variables. Statistically significant correlations ranged from 0.16 to 0.45, with median correlation of 0.32 (IQR 0.25-0.40). When participants were classified according to nutrient-based guidelines, the proportion of individuals who were classified into the same category ranged from 52.8% (85/161) to 84.5% (136/161). Conclusions: A generic meal–based method of dietary intake assessment provides estimates of nutrient intake comparable with those provided by a web-based 24HR but with varying levels of agreement among nutrients. Further studies are required to refine and improve the generic recall across a range of nutrients. Future studies will consider user experience including the potential feasibility of incorporating image recognition of whole meals into the generic recall. %M 38354039 %R 10.2196/48817 %U https://www.jmir.org/2024/1/e48817 %U https://doi.org/10.2196/48817 %U http://www.ncbi.nlm.nih.gov/pubmed/38354039 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e54805 %T Prevalence and Correlates of Dietary and Nutrition Information Seeking Through Various Web-Based and Offline Media Sources Among Japanese Adults: Web-Based Cross-Sectional Study %A Murakami,Kentaro %A Shinozaki,Nana %A Okuhara,Tsuyoshi %A McCaffrey,Tracy A %A Livingstone,M Barbara E %+ Department of Social and Preventive Epidemiology, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113 0033, Japan, 81 3 5841 7872, kenmrkm@m.u-tokyo.ac.jp %K nutrition %K diet %K information seeking %K health literacy %K food literacy %K diet quality %K Japan %D 2024 %7 14.2.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The advent of the internet has changed the landscape of available nutrition information. However, little is known about people’s information-seeking behavior toward healthy eating and its potential consequences. Objective: We aimed to examine the prevalence and correlates of nutrition information seeking from various web-based and offline media sources. Methods: This cross-sectional study included 5998 Japanese adults aged 20 to 79 years participating in a web-based questionnaire survey (February and March 2023). The dependent variable was the regular use of web-based and offline media as a reliable source of nutrition information. The main independent variables included health literacy, food literacy, and diet quality, which were assessed using validated tools, as well as sociodemographic factors (sex, age, education level, and nutrition- and health-related occupations). Results: The top source of nutrition information was television (1973/5998, 32.89%), followed by web searches (1333/5998, 22.22%), websites of government and medical manufacturers (997/5998, 16.62%), newspapers (901/5998, 15.02%), books and magazines (697/5998, 11.62%), and video sites (eg, YouTube; 634/5998, 10.57%). Multivariable logistic regression showed that higher health literacy was associated with higher odds of using all the individual sources examined; odds ratios (ORs) for 1-point score increase ranged from 1.27 (95% CI 1.09-1.49) to 1.81 (95% CI 1.57-2.09). By contrast, food literacy was inversely associated with the use of television (OR 0.65, 95% CI 0.55-0.77), whereas it was positively associated with the use of websites of government and medical manufacturers (OR 1.98, 95% CI 1.62-2.44), books and magazines (OR 2.09, 95% CI 1.64-2.66), and video sites (OR 1.53, 95% CI 1.19-1.96). Furthermore, diet quality was positively associated with the use of newspapers (OR 1.02, 95% CI 1.01-1.03) and books and magazines (OR 1.03, 95% CI 1.02-1.04). Being female was associated with using television and books and magazines, whereas being male was associated with using websites of government and medical manufacturers, newspapers, and video sites. Age was positively associated with using newspapers and inversely associated with using websites of government and medical manufacturers and video sites. People with higher education were more likely to refer to websites of government and medical manufacturers and newspapers but less likely to use television and video sites. Dietitians were more likely to use websites of government and medical manufacturers and books and magazines than the general public but less likely to use television and video sites. Conclusions: We identified various web-based and offline media sources regularly used by Japanese adults when seeking nutrition information, and their correlates varied widely. A lack of positive associations between the use of the top 2 major sources (television and web searches) and food literacy or diet quality is highlighted. These findings provide useful insights into the potential for developing and disseminating evidence-based health promotion materials. %M 38354021 %R 10.2196/54805 %U https://publichealth.jmir.org/2024/1/e54805 %U https://doi.org/10.2196/54805 %U http://www.ncbi.nlm.nih.gov/pubmed/38354021 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49322 %T The Effect of Web-Based Culinary Medicine to Enhance Protein Intake on Muscle Quality in Older Adults: Randomized Controlled Trial %A Salas-Groves,Emily %A Alcorn,Michelle %A Childress,Allison %A Galyean,Shannon %+ Nutritional Sciences, Texas Tech University, 1301 Akron Avenue, Lubbock, TX, 79409, United States, 1 806 834 2286, shannon.galyean@ttu.edu %K older adults %K culinary medicine %K protein %K muscle mass %K muscle strength %K physical activity %K nutrition intervention %K online %D 2024 %7 13.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The most common age-related musculoskeletal disorder is sarcopenia. Sarcopenia is the progressive and generalized loss of muscle mass, strength, and function. The causes of sarcopenia can include insufficient nutritional status, which may be due to protein-energy malnutrition, anorexia, limited food access and eating ability, or malabsorption. In the United States, 15.51% of older adults have been diagnosed with sarcopenia. Culinary medicine (CM) is a novel evidence-based medical field that combines the science of medicine with food and cooking to prevent and treat potential chronic diseases. CM helps individuals learn and practice culinary skills while tasting new recipes. Therefore, this program could successfully reduce barriers to protein intake, enabling older adults to enhance their diet and muscle quality. Objective: This study aimed to examine how a web-based CM intervention, emphasizing convenient ways to increase lean red meat intake, could improve protein intake with the promotion of physical activity to see how this intervention could affect older adults’ muscle strength and mass. Methods: A 16-week, single-center, parallel-group, randomized controlled trial was conducted to compare a web-based CM intervention group (CMG) with a control group (CG) while monitoring each group’s muscle strength, muscle mass, and physical activity for muscle quality. The CMG received weekly web-based cooking demonstrations and biweekly nutrition education videos about enhancing protein intake, whereas the CG just received the recipe handout. Anthropometrics, muscle mass, muscle strength, dietary habits, physical activity, and cooking effectiveness were established at baseline and measured after the intervention. The final number of participants for the data analysis was 24 in the CMG and 23 in the CG. Results: No between-group difference in muscle mass (P=.88) and strength (dominant P=.92 and nondominant P=.72) change from the prestudy visit was detected. No statistically significant difference in protein intake was seen between the groups (P=.50). A nonsignificant time-by-intervention interaction was observed for daily protein intake (P=.08). However, a statistically significant time effect was observed (P≤.001). Post hoc testing showed that daily protein intake was significantly higher at weeks 1 to 16 versus week 0 (P<.05). At week 16, the intake was 16.9 (95% CI 5.77-27.97) g higher than that at the prestudy visit. Conclusions: This study did not affect protein intake and muscle quality. Insufficient consistent protein intake, low physical activity, intervention adherence, and questionnaire accuracy could explain the results. These studies could include an interdisciplinary staff, different recruitment strategies, and different muscle mass measurements. Future research is needed to determine if this intervention is sustainable in the long term and should incorporate a follow-up to determine program efficacy on several long-term behavioral and health outcomes, including if the participants can sustain their heightened protein intake and how their cooking skills have changed. Trial Registration: ClinicalTrials.gov NCT05593978; https://clinicaltrials.gov/ct2/show/NCT05593978 %M 38349721 %R 10.2196/49322 %U https://formative.jmir.org/2024/1/e49322 %U https://doi.org/10.2196/49322 %U http://www.ncbi.nlm.nih.gov/pubmed/38349721 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e50196 %T A Smartphone Food Record App Developed for the Dutch National Food Consumption Survey: Relative Validity Study %A Ocké,Marga %A Dinnissen,Ceciel Simone %A van den Bogaard,Coline %A Beukers,Marja %A Drijvers,José %A Sanderman-Nawijn,Eline %A van Rossum,Caroline %A Toxopeus,Ido %+ National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, Bilthoven, 3721 MA, Netherlands, 31 088 689 8989, ceciel.dinnissen@rivm.nl %K relative validity %K smartphone food record %K 24-hour dietary recall %K mobile app %K national food consumption surveys %K smartphone %K food %K food consumption %K app %K diet %K dietary intake %K nutrients %K survey %K mobile phone %D 2024 %7 9.2.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In the Dutch National Food Consumption Survey, dietary intake has been assessed since 2003 through 24-hour dietary recalls using the GloboDiet software. A new self-administered smartphone food record app called DitEetIk! was developed for potential use in future surveys. Objective: This study aims to evaluate the data collected using the DitEetIk! app and its relative validity for food group, energy, and nutrient intake compared with the previous dietary assessment method (GloboDiet 24-hour dietary recalls). Methods: A total of 300 participants aged 18 to 79 years were recruited from a consumer panel. Participants were asked to keep a record of their consumption using the DitEetIk! app on 3 nonconsecutive days. Trained dietitians conducted a 24-hour dietary recall interview by telephone using the GloboDiet software (International Agency for Research on Cancer) regarding 1 of 3 DitEetIk! recording days. Nutrient intake was calculated using the NEVO database (version 2021/7.0). Relative validity was studied by comparing data from GloboDiet 24-hour dietary recalls and the DitEetIk app for the same day. Participants with implausible records, defined as days with energy intake of <0.6 or >3.0 basal metabolic rate, were excluded from the analyses. For 19 food groups and 29 nutrients, differences in median intake were assessed using the Wilcoxon signed rank test, and Spearman correlation coefficients were calculated. Bland-Altman plots with mean differences and 95% limits of agreement were created for energy intake and the contribution to energy intake from fat, carbohydrates, and protein. Results: A total of 227 participants completed a combination of a DitEetIk! app recording day and a 24-hour dietary recall interview for the same day. Of this group, 211 participants (n=104, 49.3% men and n=107, 50.7% women) had plausible recording days. Of all recorded food items, 12.8% (114/894) were entered via food barcode scanning, and 18.9% (169/894) were searched at the brand level. For 31% (5/16) of the food groups, the median intake assessed using the DitEetIk! app was >10% lower than that assessed using 24-hour dietary recalls; this was the case for fruit (P=.005), added fats (P=.001), milk and milk products (P=.02), cereal products (P=.01), and sauces (P<.001). This was also the case for 14% (4/29) of the nutrients (all P<.001). Regarding mean intake, differences were generally smaller. Regarding energy intake, the mean difference and 95% limits of agreement were 14 kcal (−1096 to 1124). Spearman correlation coefficients between intake assessed using the DitEetIk! app and 24-hour dietary recalls ranged from 0.48 to 0.88 (median 0.78) for food groups and from 0.58 to 0.90 (median 0.72) for nutrients. Conclusions: Compared with GloboDiet 24-hour dietary recalls, the DitEetIk! app assessed similar mean energy intake levels but somewhat lower median intake levels for several food groups and nutrients. %M 38335009 %R 10.2196/50196 %U https://mhealth.jmir.org/2024/1/e50196 %U https://doi.org/10.2196/50196 %U http://www.ncbi.nlm.nih.gov/pubmed/38335009 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e44993 %T Unveiling Consumer Preferences and Intentions for Cocreated Features of a Combined Diet and Physical Activity App: Cross-Sectional Study in 4 European Countries %A Mahmoodi Kahriz,Bahram %A Snuggs,Sarah %A Sah,Anumeha %A Clot,Sophie %A Lamport,Daniel %A Forrest,Joseph %A Helme-Guizon,Agnes %A Wilhelm,Marie-Claire %A Caldara,Cindy %A Anin,Camille Valentine %A Vogt,Julia %+ Henley Business School, University of Reading, Whiteknights, Reading, RG6 6UD, United Kingdom, 44 01491 571454, bahram.mahmoodikahriz@henley.ac.uk %K mobile apps %K healthy eating and physical activity %K attitude %K BMI and self-efficacy %D 2023 %7 11.12.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Numerous mobile health apps are marketed globally, and these have specific features including physical activity tracking, motivational feedback, and recipe provision. It is important to understand which features individuals prefer and whether these preferences differ between consumer groups. Objective: In this study, we aimed to identify consumers’ most preferred features and rewards for a mobile app that targets healthy eating and physical activity and to reduce the number of individual mobile health app features to a smaller number of key categories as perceived by consumers. In addition, we investigated the impact of differences in consumers’ BMI and self-efficacy on their intention to use and willingness to pay for such an app. Finally, we identified the characteristics of different target groups of consumers and their responses toward app features via cluster analysis. Methods: A total of 212 participants from France, Italy, the United Kingdom, and Germany were recruited via the web to answer questions about app features, motivation, self-efficacy, demographics, and geographic factors. It is important to note that our study included an evenly distributed sample of people in the age range of 23 to 50 years (23-35 and 35-50 years). The app features in question were generated from a 14-day cocreation session by a group of consumers from the United Kingdom and the Republic of Ireland. Results: “Home work out suggestions,” “exercise tips,” and “progress charts” were the most preferred app features, whereas “gift vouchers” and “shopping discounts” were the most preferred rewards. “Connections with other communication apps” was the least preferred feature, and “charitable giving” was the least preferred reward. Importantly, consumers’ positive attitude toward the “social support and connectedness and mindfulness” app feature predicted willingness to pay for such an app (β=.229; P=.004). Differences in consumers’ health status, motivational factors, and basic demographics moderated these results and consumers’ intention to use and willingness to pay for such an app. Notably, younger and more motivated consumers with more experience and knowledge about health apps indicated more positive attitudes and intentions to use and willingness to pay for this type of app. Conclusions: This study indicated that consumers tend to prefer app features that are activity based and demonstrate progress. It also suggested a potential role for monetary rewards in promoting healthy lifestyle behaviors. Moreover, the results highlighted the role of consumers’ health status, motivational factors, and socioeconomic status in predicting their app use. These results provide up-to-date, practical, and pragmatic information for the future design and operation of mobile health apps. %M 38079197 %R 10.2196/44993 %U https://humanfactors.jmir.org/2023/1/e44993 %U https://doi.org/10.2196/44993 %U http://www.ncbi.nlm.nih.gov/pubmed/38079197 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e43936 %T Consumer Willingness to Pay for Food Defense and Food Hygiene in Japan: Cross-Sectional Study %A Matsumoto,Shinya %A Kanagawa,Yoshiyuki %A Nagoshi,Kiwamu %A Akahane,Takemi %A Imamura,Tomoaki %A Akahane,Manabu %+ Department of Environmental Medicine and Public Health, Faculty of Medicine, Shimane University, Enya-cho 89-1, Izumo, 693-8501, Japan, 81 853 20 2162, smatsumo@med.shimane-u.ac.jp %K food defense %K food hygiene %K contingent valuation method %K willingness %K food %K cost %K awareness %K food safety %K questionnaire %K Japan %K prevention %K food poisoning %K safety %D 2023 %7 23.10.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: In Japan, incidents of falsified expiration dates on popular cookie brands and health hazards associated with frozen Chinese dumplings have raised food safety awareness. To prevent the intentional contamination of food by foreign substances, large food manufacturing companies have adopted the concept of food defense. Objective: The aim of this study was to assess people’s willingness to pay for food protection measures. In addition, the impact of participants’ personalities and considerations regarding their purchase choices on how much they were willing to pay when shopping for food and other products were measured. Methods: A questionnaire on willingness to pay for food hygiene and food defense was administered via a web survey and 1414 responses were included in the analysis. Univariate logistic regression analyses were performed with individuals willing and unwilling to pay additional costs as the objective variable and other questionnaire items as explanatory variables. A principal component analysis was performed on 12 questions regarding how much additional money people were willing to pay, and the principal component scores and other questions were examined for implications and other information. Results: Approximately one-third of the respondents stated that they were unwilling to pay additional costs and reported a willingness to consume delivery food even if it contained items that were not part of the original order. The first principal component reflected the extent to which people were willing to pay additional money, and if so, how much. This tendency existed even if the individual foods and amounts varied. The third principal component reflected the amount of extra money that people were willing to pay, which was determined by the amount people had to pay toward food safety measures. Those who answered “zero” were more likely to believe that consumers should not have to pay to ensure food safety. The second principal component reflected an axis separating food defense and food hygiene. Some items not directly related to food were correlated with this axis. Conclusions: In Japan, the concept of food hygiene is well-established and is generally taken for granted. In contrast, the concept of food defense is relatively new and has not yet fully penetrated the Japanese market. Our research shows that people who think that clothing brands provided added value to clothing products may have similar feelings about food defense. In addition, food hygiene efforts to prevent outbreaks of food poisoning are common in Japan and have been established as the basis of food safety. While food defense efforts are spreading, mainly in companies, it is presumed that they are valuable for the general public as supplementary measures to routine (or basic) food hygiene. %M 37870896 %R 10.2196/43936 %U https://www.i-jmr.org/2023/1/e43936 %U https://doi.org/10.2196/43936 %U http://www.ncbi.nlm.nih.gov/pubmed/37870896 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e49092 %T Animated Videos Based on Food Processing for Guidance of Brazilian Adults: Validation Study %A Silva,Maria Fernanda Gomes da %A Nobre,Luciana Neri %A Silva,Edson da %+ Department of Basic Sciences, Federal University of Jequitinhonha and Mucuri Valleys, Edifício DCB-DCBIO, Campus JK, Rodovia MGT 367, Alto da Jacuba, 5000, Diamantina, 39100-000, Brazil, 55 383532 1200, edson.silva@ufvjm.edu.br %K food, processed %K dietary guidelines %K nutrition policy %K instructional films and videos %K validation study %K food classification %K validation %K educational videos %K nutrition %K Brazil %D 2023 %7 11.9.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: Ultraprocessed foods (UPFs) contribute almost one-fifth of the calories consumed by the Brazilian population. This consumption has been favored by aspects such as the ease of acquisition and low cost of this food group. Initiatives focused on supporting and promoting healthy eating practices have been implemented. Among them, the availability of educational resources is an important strategy to maximize the effectiveness of these actions in the field of food and nutrition education (FNE). Objective: This study aims to describe the development and validation process of animated videos based on the NOVA food classification for FNE actions aimed at Brazilian adults. Methods: This methodological study was developed in the following 4 phases: planning, preproduction, production, and postproduction. In the planning phase, a literature review was con-ducted on the topic and to define the content to be covered. The design of the material was based on the cognitive theory of multimedia learning. In the preproduction phase, video scripts were developed and evaluated by 7 content specialists. In the production phase, videos were developed based on the assessed scripts and then assessed by 3 multimedia production specialists. In the postproduction phase, the videos were evaluated by 15 representatives of the target audience. All results obtained in the evaluation phases were analyzed using the content validity index (CVI). Results: We developed 3 animated videos covering the following themes: food processing levels, food categories according to processing levels, and UPFs and their impact on health. In the evaluation by the content specialists, the scripts of videos 1, 2, and 3 obtained CVIs at the scale level and average method equal to 0.96, 0.98, and 0.98, respectively. When the animated videos were evaluated by multimedia production specialists and representatives of the target audience, these indexes were equal to 1.0. These results attest to the videos’ adequacy and quality in communicating the addressed content. Conclusions: The animated videos developed and validated in this study proved to be adequate for their purpose. Thus, it is expected that they will be an important instrument for FNE actions aimed at an adult audience and for disseminating the Dietary Guidelines for the Brazilian Population. %M 37695656 %R 10.2196/49092 %U https://www.i-jmr.org/2023/1/e49092 %U https://doi.org/10.2196/49092 %U http://www.ncbi.nlm.nih.gov/pubmed/37695656 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44150 %T Consumer Awareness of Food Defense Measures at Food Delivery Service Providers and Food Manufacturers: Web-Based Consumer Survey Study %A Akahane,Manabu %A Kanagawa,Yoshiyuki %A Takahata,Yoshihisa %A Nakanishi,Yasuhiro %A Akahane,Takemi %A Imamura,Tomoaki %+ Department of Health and Welfare Services, National Institute of Public Health, 2-3-6 Minami, Wako, 351-0197, Japan, 81 484586347, akahane.m.aa@niph.go.jp %K food defense %K health hazards %K intentional contamination %K foreign substances %K food delivery service %D 2023 %7 24.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Various stages of the food chain, from production to processing to distribution, can impact food safety. The concept of “food defense” has emerged as a countermeasure against intentional contamination of food with foreign substances. Although knowledge of food hygiene is common among consumers, there are currently no reports of consumer surveys on food defense. Objective: This study aims to investigate consumer awareness of food defense and food safety. We analyzed the results focusing on how consumers behave when they find abnormalities in food to further our knowledge on promoting food defense measures. Methods: Participants completed a web-based questionnaire that included items related to awareness of food safety and food defense, as well as actions to be taken in cases of food abnormalities, such as contamination by foreign substances, the presence of a bad smell in purchased food, and the inclusion of extra items not selected by the individual. The participants were asked to indicate their preference among the 5 suggested actions in each case using a 6-point Likert scale. Data analysis involved aggregating responses into binary values. Stepwise linear regression analysis was conducted to examine the relationship between selected actions and questionnaire items, such as sex, age, and personality. Results: A total of 1442 respondents completed the survey, and the majority of participants placed importance on food safety when making food purchases. The recognition of each term was as follows: 95.2% (n=1373) for “food security and safety,” 95.6% (n=1379) for “food hygiene,” and 17.1% (n=247) for “food defense.” The percentages of those who answered that they would “eat without worrying” in the case of “contamination by foreign substances,” “bad smell,” or “including unpurchased product” in the frozen food they purchased were 9.1% (n=131), 4.8% (n=69), and 30.7% (n=443), respectively. The results showed that contacting the manufacturer was the most common action when faced with contaminated food or food with a bad smell. Interestingly, a significant percentage of respondents indicated they would upload the issue on social networking sites. Logistic regression analysis revealed that male participants and the younger generation were more likely to choose the option of eating contaminated food without worrying. Additionally, the tendency to upload the issue on social networking sites was higher among respondents who were sociable and brand-conscious. Conclusions: The findings of this study indicate that if food intentionally contaminated with a foreign substance is sold and delivered to consumers, it is possible consumers may eat it and experience health problems. Therefore, it is crucial for not only food manufacturers but also food delivery service providers to consider food defense measures such as protecting food from intentional contamination. Additionally, promoting consumer education and awareness regarding food defense can contribute to enhancing food safety throughout the food chain. %M 37616047 %R 10.2196/44150 %U https://formative.jmir.org/2023/1/e44150 %U https://doi.org/10.2196/44150 %U http://www.ncbi.nlm.nih.gov/pubmed/37616047 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e46550 %T Microtemporal Dynamics of Dietary Intake, Physical Activity, and Impulsivity in Adult Attention-Deficit/Hyperactivity Disorder: Ecological Momentary Assessment Study Within Nutritional Psychiatry %A Ruf,Alea %A Neubauer,Andreas B %A Koch,Elena D %A Ebner-Priemer,Ulrich %A Reif,Andreas %A Matura,Silke %+ Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Heinrich-Hoffmann-Straße 10, Frankfurt, 60528, Germany, 49 69 6301 83348, alea.ruf@kgu.de %K impulsivity %K nutrition %K macronutrient intake %K physical activity %K ecological momentary assessment %K EMA %K attention-deficit/hyperactivity disorder %K ADHD %K diet %K neurodevelopmental %K hyperactivity %K macronutrient %K psychiatry %K symptoms %K mobile %K impulsivity %K mobile phone %D 2023 %7 17.8.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Increasing attention is being paid to lifestyle factors, such as nutrition and physical activity (PA), as potential complementary treatment options in attention-deficit/hyperactivity disorder (ADHD). Previous research indicates that sugar and saturated fat intake may be linked to increased impulsivity, a core symptom of ADHD, whereas protein intake and PA may be related to reduced impulsivity. However, most studies rely on cross-sectional data that lack microtemporal resolution and ecological validity, wherefore questions of microtemporal dynamics (eg, is the consumption of foods high in sugar associated with increased impulsivity within minutes or hours?) remain largely unanswered. Ecological momentary assessment (EMA) has the potential to bridge this gap. Objective: This study is the first to apply EMA to assess microtemporal associations among macronutrient intake, PA, and state impulsivity in the daily life of adults with and without ADHD. Methods: Over a 3-day period, participants reported state impulsivity 8 times per day (signal-contingent), recorded food and drink intake (event-contingent), and wore an accelerometer. Multilevel 2-part models were used to study the association among macronutrient intake, PA, and the probability to be impulsive as well as the intensity of impulsivity (ADHD: n=36; control: n=137). Results: No association between macronutrient intake and state impulsivity was found. PA was not related to the intensity of impulsivity but to a higher probability to be impulsive (ADHD: β=−.09, 95% CI −0.14 to −0.04; control: β=−.03, 95% CI −0.05 to −0.01). No evidence was found that the combined intake of saturated fat and sugar amplified the increase in state impulsivity and that PA alleviated the positive association between sugar or fat intake and state impulsivity. Conclusions: Important methodological considerations are discussed that can contribute to the optimization of future EMA protocols. EMA research in the emerging field of nutritional psychiatry is still in its infancy; however, EMA is a highly promising and innovative approach as it offers insights into the microtemporal dynamics of psychiatric symptomology, dietary intake, and PA in daily life. %M 37590053 %R 10.2196/46550 %U https://mental.jmir.org/2023/1/e46550 %U https://doi.org/10.2196/46550 %U http://www.ncbi.nlm.nih.gov/pubmed/37590053 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41774 %T Web-Based 24-Hour Dietary Recall Tool for Russian Adults and School-Aged Children: Validation Study %A Pigat,Sandrine %A Soshina,Mariya %A Berezhnaya,Yulia %A Kryzhanovskaya,Ekaterina %+ PepsiCo, Inc, Leningradskii Prospect, 72/4, Moscow, 125315, Russian Federation, 7 495 937 05 50, Mariya.Soshina@pepsico.com %K dietary assessment %K 24-hour dietary recall %K extent of agreement %K energy and nutrient intake %K Russian diet %K interviewer-administered %K web-based self-administered %K diet %K food intake %K dietary recall %K energy intake %K nutrient intake %D 2023 %7 16.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Data on dietary intakes in Russian adults and children are assessed very infrequently primarily due to the time, cost, and burden to the participants for assessing dietary patterns. To overcome some of those challenges, the use of web-based 24-hour recall methods can be successfully used. Objective: The study objective is to assess the extent of agreement between a self-administered and an interviewer-administered 24-hour dietary recall in Russian adults and school-aged children using an adaptation of a web-based 24-hour recall tool. Methods: This web-based dietary assessment tool is based on a previously validated tool, which has been adapted to the Russian diet and language. A randomized 50% (n=97) of 194 participants initially completed a self-administered web-based dietary recall, followed by an interviewer-administered 24-hour dietary recall later that same day, and vice versa for the other 50% (n=97) of participants. Following at least 1 week wash-out period, during visit 2, participant groups completed the 2 dietary recalls in the opposite order. Statistical analysis was carried out on the intake results from both methods for the 2 recalls. Finally, an evaluation questionnaire on ease-of-use of the tool was also completed. Results: In total, intakes of 28 nutrients and energy were analyzed in this study. The Bland-Altman analysis showed that between 98.4% and 90.5% of data points were within the limits of agreement among all age groups and nutrients analyzed. A “moderate to excellent” reliability between the 2 methods was observed in younger children. In older children, a “moderate to good” reliability was observed, with the exception of sodium. In adults, “moderate to excellent” reliability between both methods was observed with the exception of vitamins B1, B2, and B6, and pantothenic acid. The level of agreement between the categorization of estimates into thirds of the intake distribution for the average of the 2 days was satisfactory, since the percentages of participants categorized into the same tertile of intake were ˃50%, and the percentages of participants categorized into the opposite tertile of intake were <10%. The majority of respondents were very positive in their evaluation of the web-based dietary assessment tool. Conclusions: Overall, the web-based dietary assessment tool performs well when compared with a face-to-face, interviewer-administered 24-hour dietary recall and provides comparable estimates of energy and nutrient intakes in Russian adults and children. Trial Registration: ClinicalTrials.gov NCT04372160; https://clinicaltrials.gov/ct2/show/NCT04372160 %M 37585243 %R 10.2196/41774 %U https://formative.jmir.org/2023/1/e41774 %U https://doi.org/10.2196/41774 %U http://www.ncbi.nlm.nih.gov/pubmed/37585243 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e45079 %T The Use of a Decision Support System (MyFood) to Assess Dietary Intake Among Free-Living Older Adults in Norway: Evaluation Study %A Severinsen,Frida %A Andersen,Lene Frost %A Paulsen,Mari Mohn %+ Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Postboks 1046, Blindern, Oslo, 0317, Norway, 47 95772048, m.m.paulsen@medisin.uio.no %K dietary assessment %K malnutrition %K eHealth %K validation study %K older adults %K mobile phone %D 2023 %7 3.8.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The proportion of older adults in the world is constantly increasing, and malnutrition is a common challenge among the older adults aged ≥65 years. This poses a need for better tools to prevent, assess, and treat malnutrition among older adults. MyFood is a decision support system developed with the intention to prevent and treat malnutrition. Objective: This study aimed to evaluate the ability of the MyFood app to estimate the intake of energy, protein, fluids, and food and beverage items among free-living older adults aged ≥65 years, primarily at an individual level and secondarily at a group level. In addition, the aim was to measure the experiences of free-living older adults using the app. Methods: Participants were instructed to record their dietary intake in the MyFood app for 4 consecutive days. In addition, each participant completed two 24-hour recalls, which were used as a reference method to evaluate the dietary assessment function in the MyFood app. Differences in the estimations of energy, protein, fluid, and food groups were analyzed at both the individual and group levels, by comparing the recorded intake in MyFood with the 2 corresponding recalls and by comparing the mean of all 4 recording days with the mean of the 2 recalls, respectively. A short, study-specific questionnaire was used to measure the participants’ experiences with the app. Results: This study included 35 free-living older adults residing in Norway. Approximately half of the participants had ≥80% agreement between MyFood and the 24-hour recalls for energy intake on both days. For protein and fluids, approximately 60% of the participants had ≥80% agreement on the first day of comparison. Dinner was the meal with the lowest agreement between the methods, at both the individual and group levels. MyFood tended to underestimate the intake of energy, protein, fluid, and food items at both the individual and group levels. The food groups that achieved the greatest agreement between the 2 methods were eggs, yogurt, self-composed dinner, and hot beverages. All participants found the app easy to use, and 74% (26/35) of the participants reported that the app was easy to navigate. Conclusions: The results showed that the MyFood app tended to underestimate the participants’ dietary intake compared with the 24-hour recalls at both the individual and group levels. The app’s ability to estimate intake within food groups was greater for eggs, yogurt, and self-composed dinner than for spreads, mixed meals, vegetables, and snacks. The app was well accepted among the study participants and may be a useful tool among free-living older adults, given that the users are provided follow-up and support in how to record their dietary intake. %M 37535420 %R 10.2196/45079 %U https://mhealth.jmir.org/2023/1/e45079 %U https://doi.org/10.2196/45079 %U http://www.ncbi.nlm.nih.gov/pubmed/37535420 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45098 %T Factors Influencing Nutritional Intake and Interests in Educational Content of Athletes and Sport Professionals Toward the Development of a Clinician-Supported Mobile App to Combat Relative Energy Deficiency in Sport: Formative Research and a Description of App Functions %A Mey,Jacob T %A Karpinski,Christine A %A Yang,Shengping %A Madere,Joseph D %A Piattoly,Tavis %A Harper,Ronnie %A Kirwan,John P %+ Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, 70808, United States, 1 2257632644, jacob.mey@pbrc.edu %K dietitian %K malnutrition %K mHealth %K mobile health %K performance %K RED-S %K relative energy deficiency in sport %K sports nutrition %K technology %D 2023 %7 26.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Relative energy deficiency in sport (RED-S) as a consequence of athlete malnutrition remains a prominent issue. However, it remains underrecognized, in part due to the perceived outward health of athletes. The Eat2Win app was designed to combat RED-S and athlete malnutrition by providing education, behavior modification, and direct communication with expert sports dietitians to athletes and sport professionals (professionals who work with athletes, eg, sport coaches and athletic trainers). Objective: The purpose of this formative research was to gain critical insight on motivators and barriers to optimal nutritional intake from both the athletes’ and sport professionals’ perspectives. Additionally, since these 2 groups represent the primary end users of an app aimed at improving athlete nutrition and reducing the risk of RED-S, a secondary objective was to gain insight on the preferences and perceptions of app-based educational content and functionality. Methods: An electronic survey was developed by an interdisciplinary team of experts. Survey questions were established based upon prevailing literature, professional dietetic field experience, and app design considerations to obtain respondent knowledge on key sports nutrition topics along with motivations and barriers to meal choices. Additionally, the survey included questions about the development of an integrative, clinician-support app aimed at addressing RED-S. These questions included preferences for educational content, modes of in-app information, and communication delivery for the target population (app end users: athletes and sport professionals). The survey was distributed through Research Electronic Data Capture (REDCap) to athletes and sport professionals using targeted email, social media, and community engagement campaigns. The electronic survey was available from May 4 to August 2, 2022. Results: Survey respondents (n=1352) included athletes and professionals who work with athletes from a variety of settings, like high school, collegiate, professional, and club sports. Respondents reported high interest in 8 core sports nutrition topics. The preferred modes of information and communication delivery were visual formats (eg, videos and infographics) and in-app alerts (eg, direct messaging and meal reminders). Only athlete respondents were asked about motivators and barriers that influence meal choices. “Health” and “sports performance” were the highest scoring motivators, while the highest scoring barriers were “cost of food,” “easy access to unhealthy food,” and “time to cook or prepare food.” Notably, survey respondents provided positive feedback and interest using a novel function of the app: real-time meal feedback through food photography. Conclusions: The Eat2Win app is designed to combat RED-S and athlete malnutrition. Results from this study provide critical information on end-user opinions and preferences and will be used to further develop the Eat2Win app. Future research will aim to determine whether the Eat2Win app can prevent RED-S and the risk of athlete malnutrition to improve both health and performance. %M 37494083 %R 10.2196/45098 %U https://formative.jmir.org/2023/1/e45098 %U https://doi.org/10.2196/45098 %U http://www.ncbi.nlm.nih.gov/pubmed/37494083 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45908 %T Pulse-Based Nutrition Education Intervention Among High School Students to Enhance Knowledge, Attitudes, and Practices: Pilot for a Formative Survey Study %A Teshome,Getenesh Berhanu %A Haileslassie,Hiwot Abebe %A Shand,Phyllis %A Lin,Yun %A Lieffers,Jessica R L %A Henry,Carol %+ Applied Human Sciences, University of Prince Edward Island, 550 University Ave, Charlottetown, PE, C1A 4P3, Canada, 1 3067153659, hhaileslassie@upei.ca %K adolescents %K food literacy %K high school %K macronutrients %K micronutrients %K pulses %K dietary pattern %K diet %K eating habits %K nutrition %K students %K school-based interventions %D 2023 %7 31.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Promoting pulse consumption in schools could improve students’ healthy food choices. Pulses, described as legumes, are rich in protein and micronutrients and are an important food choice for health and well-being. However, most Canadians consume very little pulse-based food. Objective: This pilot study sought to investigate outcomes of a teacher-led, school-based food literacy intervention focused on the Pulses Make Perfect Sense (PMPS) program in 2 high schools in Saskatoon, Saskatchewan. Methods: Both high schools were selected using a convenience sampling technique and have similar sociodemographic characteristics. The mean age of students was 16 years. The intervention comprised 7 key themes focused on pulses, which included defining pulses; health and nutritional benefits of pulses; incorporating pulses into meals; the role of pulses in reducing environmental stressors, food insecurity, and malnutrition; product development; taste testing and sensory analysis; and pulses around the world. A self-administered questionnaire was used to assess knowledge, attitudes, practices, and barriers regarding pulse consumption in students at baseline and study end. Teachers were interviewed at the end of the intervention. Descriptive statistics and the nonparametric Mann-Whitney U test were used for analysis. Results: In total, 41 and 32 students participated in the baseline and study-end assessments, respectively. At baseline, the median knowledge score was 9, attitude score was 6, and barrier score was 0. At study end, the median knowledge score was 10, attitude score was 7, and barrier score was 1. A lower score for barriers indicated fewer barriers to pulse consumption. There was a significant difference between baseline and study-end scores in knowledge (P<.05). Barriers to pulse consumption included parents not cooking or consuming pulses at home, participants not liking the taste of pulses, and participants often preferring other food choices over pulses. The teachers indicated that the pulse food-literacy teaching resources were informative, locally available, and easy to use. Conclusions: Despite the improvements in knowledge, attitude, and practice, pulse consumption did not change significantly at the end of the intervention. Future studies with larger samples are needed to determine the impact of PMPS on knowledge, attitude, and practice of high school students. %M 37256666 %R 10.2196/45908 %U https://formative.jmir.org/2023/1/e45908 %U https://doi.org/10.2196/45908 %U http://www.ncbi.nlm.nih.gov/pubmed/37256666 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41021 %T Feasibility and Response to the San Diego County, California, Supplemental Nutrition Assistance Program (SNAP) Agency Sending Food and Nutrition Text Messages to All Participants: Quasi-Experimental Web-Based Survey Pilot Study %A Gosliner,Wendi %A Felix,Celeste %A Strochlic,Ron %A Wright,Shana %A Yates-Berg,Allison %A Thompson,Hannah R %A Tang,Hao %A Melendrez,Blanca %+ Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, 1111 Franklin St, 11th Fl, Oakland, CA, 94607, United States, 1 510 612 1552, wgosliner@ucanr.edu %K SNAP %K CalFresh %K text %K SMS text messaging %K nutrition %K fruits %K vegetables %K mHealth %D 2023 %7 19.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The Supplemental Nutrition Assistance Program (SNAP) provides over 40 million Americans with money for food without typically providing participants with food or nutrition information. Educational SMS text messages can reach large numbers of people, and studies suggest SNAP participants appreciate nutrition education and have access to mobile phones. Objective: Using a pre-post intervention design, we assessed the feasibility of, and program satisfaction and outcomes resulting from, the San Diego County, California SNAP agency sending monthly food and nutrition education SMS text messages to all SNAP participants to increase fruit and vegetable purchasing and consumption. Methods: We developed and sent 5 behavioral science–informed SMS text messages with links to a project website in English and Spanish with information about selecting, storing, and preparing seasonal fruits and vegetables. The San Diego County SNAP agency sent monthly texts to ~170,000 SNAP households from October 2020 to February 2021. SNAP participants completed web-based surveys in response to a text invitation from the SNAP agency in September 2020 (baseline, n=12,036) and April 2021 (follow-up, n=4927). Descriptive frequencies were generated, and adjusted multiple linear mixed models were run on a matched data set of participants that completed both baseline and follow-up surveys (n=875) assessing pre- or postattitudes, behaviors, knowledge, and self-efficacy. We used adjusted logistic regression models to assess differences between the matched (n=875) and nonmatched (n=4052) participants related to experiences with the intervention (questions asked only at follow-up). Results: After the intervention, matched participants reported significant increase in knowing where to get information about selecting, storing, and preparing fruits and vegetables (3.76 vs 4.02 on a 5-point Likert scale with 5=strongly agree, P<.001); feeling good about participating in SNAP (4.35 vs 4.43, P=.03); and thinking the CalFresh program helps them eat healthy (4.38 vs 4.48, P=.006). No significant pre- or postdifferences were found in fruit or vegetable consumption, though most participants at follow-up (n=1556, 64%) reported their consumption had increased. Among the sample that completed the follow-up survey only (n=4052, not including 875 participants who completed follow-up and baseline), 1583 (65%) and 1556 (64%) reported purchasing and eating more California-grown fruits and vegetables, respectively. Nearly all respondents appreciated the intervention (n=2203, 90%) and wanted it to continue (n=2037, 83%). Conclusions: SNAP can feasibly provide food and nutrition messages via text to participants. A monthly text campaign was well received by responding participants and improved some measures of their self-reported knowledge, self-efficacy, produce consumption, and perceptions of SNAP participation. Participants expressed interest in continuing to receive texts. While educational messages will not solve the complex food and nutrition challenges confronting SNAP participants, further work should employ rigorous methods to expand and test this intervention in other SNAP programs before considering to implement it at scale. %M 37074786 %R 10.2196/41021 %U https://www.jmir.org/2023/1/e41021 %U https://doi.org/10.2196/41021 %U http://www.ncbi.nlm.nih.gov/pubmed/37074786 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e42529 %T Assessment of Energy and Nutrient Intake and the Intestinal Microbiome (ErNst Study): Protocol and Methods of a Cross-sectional Human Observational Study %A Dötsch,Andreas %A Merz,Benedikt %A Louis,Sandrine %A Krems,Carolin %A Herrmann,Maria %A Dörr,Claudia %A Watzl,Bernhard %A Bub,Achim %A Straßburg,Andrea %A Engelbert,Ann Katrin %+ Department of Physiology and Biochemistry of Nutrition, Max Rubner-Institut-Federal Research Institute of Nutrition and Food, Haid-und-Neu-Str. 9, Karlsruhe, 76131, Germany, 49 721 6625 ext 443, andreas.doetsch@mri.bund.de %K dietary assessment %K human observational study %K nutrient intake %K human intestinal microbiome %K biomarkers %K 24-hour recall %K validity %K nutrition %K diet %K assessment %K food %K behavior %D 2023 %7 7.4.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: On the national level, nutritional monitoring requires the assessment of reliable representative dietary intake data. To achieve this, standardized tools need to be developed, validated, and kept up-to-date with recent developments in food products and the nutritional behavior of the population. Recently, the human intestinal microbiome has been identified as an essential mediator between nutrition and host health. Despite growing interest in this connection, only a few associations between the microbiome, nutrition, and health have been clearly established. Available studies paint an inconsistent picture, partly due to a lack of standardization. Objective: First, we aim to verify if food consumption, as well as energy and nutrient intake of the German population, can be recorded validly by means of the dietary recall software GloboDiet, which will be applied in the German National Nutrition Monitoring. Second, we aim to obtain high-quality data using standard methods on the microbiome, combined with dietary intake data and additional fecal sample material, and to also assess the functional activity of the microbiome by measuring microbial metabolites. Methods: Healthy female and male participants aged between 18 and 79 years were recruited. Anthropometric measurements included body height and weight, BMI, and bioelectrical impedance analysis. For validation of the GloboDiet software, current food consumption was assessed with a 24-hour recall. Nitrogen and potassium concentrations were measured from 24-hour urine collections to enable comparison with the intake of protein and potassium estimated by the GloboDiet software. Physical activity was measured over at least 24 hours using a wearable accelerometer to validate the estimated energy intake. Stool samples were collected in duplicate for a single time point and used for DNA isolation and subsequent amplification and sequencing of the 16S rRNA gene to determine microbiome composition. For the identification of associations between nutrition and the microbiome, the habitual diet was determined using a food frequency questionnaire covering 30 days. Results: In total, 117 participants met the inclusion criteria. The study population was equally distributed between the sexes and 3 age groups (18-39, 40-59, and 60-79 years). Stool samples accompanying habitual diet data (30-day food frequency questionnaire) are available for 106 participants. Current diet data and 24-hour urine samples for the validation of GloboDiet are available for 109 participants, of which 82 cases also include physical activity data. Conclusions: We completed the recruitment and sample collection of the ErNst study with a high degree of standardization. Samples and data will be used to validate the GloboDiet software for the German National Nutrition Monitoring and to compare microbiome composition and nutritional patterns. Trial Registration: German Register of Clinical Studies DRKS00015216; https://drks.de/search/de/trial/DRKS00015216 International Registered Report Identifier (IRRID): DERR1-10.2196/42529 %M 37027187 %R 10.2196/42529 %U https://www.researchprotocols.org/2023/1/e42529 %U https://doi.org/10.2196/42529 %U http://www.ncbi.nlm.nih.gov/pubmed/37027187 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e43160 %T Effects of a Smartphone App on Fruit and Vegetable Consumption Among Saudi Adolescents: Randomized Controlled Trial %A Shatwan,Israa M %A Alhefani,Rabab S %A Bukhari,Mawadah F %A Hanbazazah,Danah A %A Srour,Jumanah K %A Surendran,Shelini %A Aljefree,Najlaa M %A Almoraie,Noha M %+ Food and Nutrition Department, Human Sciences and Design Faculty, King Abdulaziz University, Abdulalah Suliman Street, 3270, Jeddah, 6269, Saudi Arabia, 966 535619144, eshatwan@kau.edu.sa %K smartphone app %K fruit and vegetable consumption %K Saudi Arabia %K adolescents %K nutrition %K health outcome %K digital health intervention %K digital health app %K pediatrics %K youth %D 2023 %7 9.2.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Dietary patterns and nutritional status during adolescence have a direct effect on future health outcomes. Objective: This study aimed to promote fruit and vegetable intake among adolescents using a smartphone app called MyPlate. Methods: This randomized intervention study was conducted in an urban area of Jeddah, Saudi Arabia. We included 104 adolescents aged 13 to 18 years, who were randomized into intervention (n=55) or control (n=49) arms. We examined the effects of MyPlate on fruit and vegetable intake over 6 weeks in the intervention group. Pre- and postintervention questionnaires were used in the intervention and control groups. Results: The control group showed a significant increase in fruit consumption scores between baseline (1.15, SD 0.68) and postintervention (1.64, SD 0.98; P=.01), but no significant difference in vegetable consumption scores was observed before (1.44, SD 0.97) and after intervention (1.55, SD 0.90; P=.54). However, there was no significant difference between scores at baseline and after 6 weeks of using the smartphone app for fruit (1.48, SD 0.99 and 1.70, SD 1.11, respectively; P=.31) or vegetables (1.50, SD 0.97 and 1.43, SD 1.03, respectively; P=.30) in the intervention group. Our findings showed no significant impact of using a smartphone app on fruit and vegetable consumption. Conclusions: These findings suggest that a smartphone app did not significantly improve fruit and vegetable intake among adolescents. Trial Registration: ClinicalTrials.gov NCT05692765; https://clinicaltrials.gov/ct2/show/NCT05692765 %M 36757770 %R 10.2196/43160 %U https://pediatrics.jmir.org/2023/1/e43160 %U https://doi.org/10.2196/43160 %U http://www.ncbi.nlm.nih.gov/pubmed/36757770 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e41262 %T Development of a Digital Behavioral Intervention to Reduce the Consumption of Sugar-Sweetened Beverages Among Rural Appalachian Adults: Multiphased, Human-Centered Design Approach %A Zoellner,Jamie %A Reid,Annie %A Porter,Kathleen %A Frederick,Christina %A Hilgart,Michelle %A Ritterband,Lee %+ Department of Public Health Sciences, School of Medicine, University of Virginia, 16 East Main Street, Suite 101, Christainsburg, VA, 24073, United States, 1 4349624488, jz9q@virginia.edu %K eHealth %K human-centered design %K internet-based intervention %K digital technology %K Model for Internet Interventions %K beverages %K behavioral research %K rural population %K mobile phone %D 2023 %7 1.2.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: To avoid the low engagement and limited efficacy of digital behavioral health interventions, robust human-centered design (HCD) processes are needed. Objective: The primary objective of this study was to describe a flexible, step-by-step HCD process to develop digital behavioral health interventions by illustrating iSIPsmarter as an example. iSIPsmarter is a digital intervention for reducing the consumption of sugar-sweetened beverages (SSBs) that comprises 6 internet-based cores metered out over time to deliver the program content, an integrated SMS text message strategy to engage users in reporting SSB behaviors, and an electronic cellular-enabled scale for in-home weighing. The secondary objective is to illustrate the key components and characteristics of iSIPsmarter that resulted from the HCD process. Methods: The methods were guided by the Model for Internet Interventions and by best practices in HCD and instructional design processes (eg, rapid prototype development and think-aloud protocol). The 3-phased (ie, contextual, prototype testing, end user testing phases) process followed in this study included a series of 13 semistructured one-on-one interviews with 7 advisory team participants from the targeted Appalachian user group. The interviews were content coded by 2 researchers and then deductively coded to the suggested areas of digital behavioral health interventions. Results: The participants provided rich perspectives pertaining to iSIPsmarter’s appearance, behavioral prescriptions, burdens, content, delivery, message, participation, and assessment. These inputs included requests for built-in flexibility to account for varying internet and SMS text message accessibility among users; ideas to resolve the issues and problems encountered when using the prototypes, including those related to navigation and comprehension of content; ideas to enhance personalized feedback to support motivation and goal setting for SSB consumption and weight; and feedback to refine the development of realistic and relatable vignettes. The participants were able to interact with multiple prototype drafts, allowing researchers to capture and incorporate feedback related to the iSIPsmarter dashboard, daily SSB and weight diaries, action planning, core content, interactions, and vignettes. Conclusions: Using scientific models and established processes is critical for building robust and efficacious interventions. By applying an existing model and HCD and instructional design processes, we were able to identify assumptions and address the key areas of the iSIPsmarter intervention that were hypothesized to support users’ engagement and promote behavior change. As evidenced by the rich feedback received from the advisory team members and the resulting iSIPsmarter product, the HCD methodology was instrumental in the development process. Although the final iSIPsmarter content is specific to improving SSB consumption behaviors among adults in rural areas, the intent is that this HCD process will have wide applications in the development of digital behavioral health interventions across multiple geographic and behavioral contexts. %M 36724036 %R 10.2196/41262 %U https://humanfactors.jmir.org/2023/1/e41262 %U https://doi.org/10.2196/41262 %U http://www.ncbi.nlm.nih.gov/pubmed/36724036 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 12 %P e39340 %T A Novel Approach to Characterize State-level Food Environment and Predict Obesity Rate Using Social Media Data: Correlational Study %A Li,Chuqin %A Jordan,Alexis %A Song,Jun %A Ge,Yaorong %A Park,Albert %+ Department of Software and Information Systems, College of Computing and Informatics, University of North Carolina at Charlotte, 9201 University Blvd, Charlotte, NC, 28223, United States, 1 704 687 8668, al.park@uncc.edu %K obesity %K social media %K machine learning %K lifestyle %K environment %K food %K correlation %K modeling %K predict %K rates %K outcome %K category %K dishes %K popular %K mobile phone %D 2022 %7 13.12.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Community obesity outcomes can reflect the food environment to which the community belongs. Recent studies have suggested that the local food environment can be measured by the degree of food accessibility, and survey data are normally used to calculate food accessibility. However, compared with survey data, social media data are organic, continuously updated, and cheaper to collect. Objective: The objective of our study was to use publicly available social media data to learn the relationship between food environment and obesity rates at the state level. Methods: To characterize the caloric information of the local food environment, we used food categories from Yelp and collected caloric information from MyFitnessPal for each category based on their popular dishes. We then calculated the average calories for each category and created a weighted score for each state. We also calculated 2 other dimensions from the concept of access, acceptability and affordability, to build obesity prediction models. Results: The local food environment characterized using only publicly available social media data had a statistically significant correlation with the state obesity rate. We achieved a Pearson correlation of 0.796 between the predicted obesity rate and the reported obesity rate from the Behavioral Risk Factor Surveillance System across US states and the District of Columbia. The model with 3 generated feature sets achieved the best performance. Conclusions: Our study proposed a method for characterizing state-level food environments only using continuously updated social media data. State-level food environments were accurately described using social media data, and the model also showed a disparity in the available food between states with different obesity rates. The proposed method should elastically apply to local food environments of different sizes and predict obesity rates effectively. %M 36512396 %R 10.2196/39340 %U https://www.jmir.org/2022/12/e39340 %U https://doi.org/10.2196/39340 %U http://www.ncbi.nlm.nih.gov/pubmed/36512396 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 4 %P e40123 %T Low– and Medium–Socioeconomic-Status Group Members’ Perceived Challenges and Solutions for Healthy Nutrition: Qualitative Focus Group Study %A Hermsen,Sander %A van Kraaij,Alex %A Camps,Guido %+ OnePlanet Research Center, Bronland 10, Wageningen, 6708 WH, Netherlands, 31 317 791 009, sander.hermsen@imec.nl %K nutrition %K citizen science %K socioeconomic status %K digital technology %D 2022 %7 2.12.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Although digital tools for healthy nutrition have shown great potential, their actual impact remains variable as digital solutions often do not fit users’ needs and barriers. This is especially poignant for priority communities in society. Involving these groups in citizen science may have great benefits even beyond the increase in knowledge of the lives and experiences of these groups. However, this requires specialized skills. Participants from priority groups could benefit from an approach that offers sensitization and discussion to help them voice their needs regarding healthy nutrition and technology to support healthy eating. Objective: This study aimed to gather insights into people’s thoughts on everyday eating practices, self-regulation in healthy eating, and skill acquisition and on applying technological innovations to these domains. Methods: Participants answered 3 daily questionnaires to garner their current practices regarding habits, self-regulation, skills, and technology use surrounding healthy eating and make it easier for them to collect their thoughts and experiences (sensitization). Within a week of filling out the 3 questionnaires, participants took part in a web-based focus group discussion session. All sessions were transcribed and analyzed using a thematic qualitative approach. Results: A total of 42 people took part in 7 focus group interviews of 6 people each. The analysis showed that participants would like to receive support from technology for a broad range of aspects of nutrition, such as measuring the effect their personal nutrition has on their individual health, providing them with reliable product information, giving them practical guidance for healthy eating and snacking, and reducing the burden of registering food intake. Technology should be easy to use, reduce burdens, and be tailored to personal situations. Privacy and cost were major concerns for the participants. Conclusions: This study shows that people from low– and medium–socioeconomic-status groups have a need for specific support in tailoring their knowledge of healthy nutrition to their own situation and see technology as a means to achieve this. %M 36459403 %R 10.2196/40123 %U https://humanfactors.jmir.org/2022/4/e40123 %U https://doi.org/10.2196/40123 %U http://www.ncbi.nlm.nih.gov/pubmed/36459403 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e40449 %T Relative Validation of an Artificial Intelligence–Enhanced, Image-Assisted Mobile App for Dietary Assessment in Adults: Randomized Crossover Study %A Moyen,Audrey %A Rappaport,Aviva Ilysse %A Fleurent-Grégoire,Chloé %A Tessier,Anne-Julie %A Brazeau,Anne-Sophie %A Chevalier,Stéphanie %+ School of Human Nutrition, McGill University, 21111 Lakeshore Rd, Sainte-Anne-de-Bellevue, QC, H9X 3V9, Canada, 1 514 398 8603, Stephanie.chevalier@mcgill.ca %K dietary intake %K dietary assessment %K food diary %K food records %K automated self-administered 24-hour recall %K ASA24 %K Keenoa %D 2022 %7 21.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Thorough dietary assessment is essential to obtain accurate food and nutrient intake data yet challenging because of the limitations of current methods. Image-based methods may decrease energy underreporting and increase the validity of self-reported dietary intake. Keenoa is an image-assisted food diary that integrates artificial intelligence food recognition. We hypothesized that Keenoa is as valid for dietary assessment as the automated self-administered 24-hour recall (ASA24)–Canada and better appreciated by users. Objective: We aimed to evaluate the relative validity of Keenoa against a 24-hour validated web-based food recall platform (ASA24) in both healthy individuals and those living with diabetes. Secondary objectives were to compare the proportion of under- and overreporters between tools and to assess the user’s appreciation of the tools. Methods: We used a randomized crossover design, and participants completed 4 days of Keenoa food tracking and 4 days of ASA24 food recalls. The System Usability Scale was used to assess perceived ease of use. Differences in reported intakes were analyzed using 2-tailed paired t tests or Wilcoxon signed-rank test and deattenuated correlations by Spearman coefficient. Agreement and bias were determined using the Bland-Altman test. Weighted Cohen κ was used for cross-classification analysis. Energy underreporting was defined as a ratio of reported energy intake to estimated resting energy expenditure <0.9. Results: A total of 136 participants were included (mean 46.1, SD 14.6 years; 49/136, 36% men; 31/136, 22.8% with diabetes). The average reported energy intakes (kcal/d) were 2171 (SD 553) in men with Keenoa and 2118 (SD 566) in men with ASA24 (P=.38) and, in women, 1804 (SD 404) with Keenoa and 1784 (SD 389) with ASA24 (P=.61). The overall mean difference (kcal/d) was −32 (95% CI −97 to 33), with limits of agreement of −789 to 725, indicating acceptable agreement between tools without bias. Mean reported macronutrient, calcium, potassium, and folate intakes did not significantly differ between tools. Reported fiber and iron intakes were higher, and sodium intake lower, with Keenoa than ASA24. Intakes in all macronutrients (r=0.48-0.73) and micronutrients analyzed (r=0.40-0.74) were correlated (all P<.05) between tools. Weighted Cohen κ scores ranged from 0.30 to 0.52 (all P<.001). The underreporting rate was 8.8% (12/136) with both tools. Mean System Usability Scale scores were higher for Keenoa than ASA24 (77/100, 77% vs 53/100, 53%; P<.001); 74.8% (101/135) of participants preferred Keenoa. Conclusions: The Keenoa app showed moderate to strong relative validity against ASA24 for energy, macronutrient, and most micronutrient intakes analyzed in healthy adults and those with diabetes. Keenoa is a new, alternative tool that may facilitate the work of dietitians and nutrition researchers. The perceived ease of use may improve food-tracking adherence over longer periods. %M 36409539 %R 10.2196/40449 %U https://www.jmir.org/2022/11/e40449 %U https://doi.org/10.2196/40449 %U http://www.ncbi.nlm.nih.gov/pubmed/36409539 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 4 %P e37590 %T Enhancing Food Intake Tracking in Long-term Care With Automated Food Imaging and Nutrient Intake Tracking (AFINI-T) Technology: Validation and Feasibility Assessment %A Pfisterer,Kaylen %A Amelard,Robert %A Boger,Jennifer %A Keller,Heather %A Chung,Audrey %A Wong,Alexander %+ Department of Systems Design Engineering, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada, 1 519 888 4567, kaylen.pfisterer@uhn.ca %K long-term care %K automated nutrient intake %K convolutional neural network %K food segmentation %K food classification %K depth imaging %K deep learning %K collaborative design %K aging %K food intake %D 2022 %7 17.11.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Half of long-term care (LTC) residents are malnourished, leading to increased hospitalization, mortality, and morbidity, with low quality of life. Current tracking methods are subjective and time-consuming. Objective: This paper presented the automated food imaging and nutrient intake tracking technology designed for LTC. Methods: A needs assessment was conducted with 21 participating staff across 12 LTC and retirement homes. We created 2 simulated LTC intake data sets comprising modified (664/1039, 63.91% plates) and regular (375/1039, 36.09% plates) texture foods. Overhead red-green-blue-depth images of plated foods were acquired, and foods were segmented using a pretrained food segmentation network. We trained a novel convolutional autoencoder food feature extractor network using an augmented UNIMIB2016 food data set. A meal-specific food classifier was appended to the feature extractor and tested on our simulated LTC food intake data sets. Food intake (percentage) was estimated as the differential volume between classified full portion and leftover plates. Results: The needs assessment yielded 13 nutrients of interest, requirement for objectivity and repeatability, and account for real-world environmental constraints. For 12 meal scenarios with up to 15 classes each, the top-1 classification accuracy was 88.9%, with mean intake error of −0.4 (SD 36.7) mL. Nutrient intake estimation by volume was strongly linearly correlated with nutrient estimates from mass (r2=0.92-0.99), with good agreement between methods (σ=−2.7 to −0.01; 0 within each of the limits of agreement). Conclusions: The automated food imaging and nutrient intake tracking approach is a deep learning–powered computational nutrient sensing system that appears to be feasible (validated accuracy against gold-standard weighed food method, positive end user engagement) and may provide a novel means for more accurate and objective tracking of LTC residents’ food intake to support and prevent malnutrition tracking strategies. %M 36394940 %R 10.2196/37590 %U https://aging.jmir.org/2022/4/e37590 %U https://doi.org/10.2196/37590 %U http://www.ncbi.nlm.nih.gov/pubmed/36394940 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e35933 %T A Short Digital Food Frequency Questionnaire (DIGIKOST-FFQ) Assessing Dietary Intake and Other Lifestyle Factors Among Norwegians: Qualitative Evaluation With Focus Group Interviews and Usability Testing %A Henriksen,Hege Berg %A Knudsen,Markus Dines %A Carlsen,Monica Hauger %A Hjartåker,Anette %A Blomhoff,Rune %+ Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Sognsvannsveien 9, Oslo, 0372, Norway, 47 99459673, h.b.henriksen@medisin.uio.no %K digital assessment tool %K assessment tool %K food frequency questionnaire %K food %K diet %K nutrition %K questionnaire %K focus group %K interview %K usability %K physical activity %K lifestyle factor %K dietary intake %K digital health %K chronic disease %K chronic condition %K health promotion %K cancer %K survivor %K usability %K thematic analysis %K research tool %K measurement tool %D 2022 %7 8.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In-person dietary counseling and interventions have shown promising results in changing habits toward healthier lifestyles, but they are costly to implement in large populations. Developing digital tools to assess individual dietary intake and lifestyle with integrated personalized feedback systems may help overcome this challenge. We developed a short digital food frequency questionnaire, known as the DIGIKOST-FFQ, to assess diet and other lifestyle factors based on the Norwegian Food-Based Dietary Guidelines. The DIGIKOST-FFQ includes a personalized feedback system, the DIGIKOST report, that benchmarks diet and lifestyle habits. We used qualitative focus group interviews and usability tests to test the feasibility and usability of the DIGIKOST application. Objective: We aimed to explore attitudes, perceptions, and challenges in completing the DIGIKOST-FFQ. We also investigated perceptions and understanding of the personalized feedback in the DIGIKOST report and the technical flow and usability of the DIGIKOST-FFQ and the DIGIKOST report. Methods: Healthy individuals and cancer survivors were invited to participate in the focus group interviews. The transcripts were analyzed using thematic analysis. Another group of healthy individuals completed the usability testing, which was administered individually by a moderator and 2 observers. The results were analyzed based on predefined assignments and discussion with the participants about the interpretation of the DIGIKOST report and technical flow of the DIGIKOST-FFQ. Results: A total of 20 individuals participated in the focus group interviews, divided into 3 groups of healthy individuals and 3 groups of cancer survivors. Each group consisted of 3 to 4 individuals. Five main themes were investigated: (1) completion time (on average 19.1, SD 8.3, minutes, an acceptable duration), (2) layout (participants reported the DIGIKOST-FFQ was easy to navigate and had clear questions but presented challenges in reporting dietary intake, sedentary time, and physical activity in the last year), (3) questions (the introductory questions on habitual intake worked well), (4) pictures (the pictures were very helpful, but some portion sizes were difficult to differentiate and adding weight in grams would have been helpful), and (5) motivation (users were motivated to obtain personalized feedback). Four individuals participated in the usability testing. The results showed that the users could seamlessly log in, give consent, fill in the DIGIKOST-FFQ, and receive, print, and read the DIGIKOST report. However, parts of the report were perceived as difficult to interpret. Conclusions: The DIGIKOST-FFQ was overall well received by participants, who found it feasible to use; however, some adjustments with regard to reporting dietary intake and lifestyle habits were suggested. The DIGIKOST report with personalized feedback was the main motivation to complete the questionnaire. The results from the usability testing revealed a need for adjustments and updates to make the report easier to read. %M 36346647 %R 10.2196/35933 %U https://formative.jmir.org/2022/11/e35933 %U https://doi.org/10.2196/35933 %U http://www.ncbi.nlm.nih.gov/pubmed/36346647 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e41418 %T Changes in Food Insecurity Among Individuals Using a Telehealth and Nutrition Platform: Longitudinal Study %A Bakre,Shivani %A Shea,Benjamin %A Ortega,Kaylee %A Scharen,Jared %A Langheier,Jason %A Hu,Emily %+ Foodsmart, 595 Pacific Ave. Fl. 4, San Francisco, CA, 94133, United States, 1 650 823 9022, ben.shea@foodsmart.com %K food insecurity %K tele-nutrition %K telehealth %K meal planning %K SNAP %K diet %K nutrition %K COVID-19 %D 2022 %7 25.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Food insecurity is a complex public health problem affecting many individuals in the United States. Digital health interventions that promote behavior change and provide access to affordable and healthy food may help to alleviate food insecurity. Objective: The aim of this study was to characterize food-insecure users of Foodsmart, a telehealth and nutrition platform with meal planning, food ordering, nutrition education, budgeting, and grocery discount features, and to evaluate changes in diet and food insecurity. Methods: We retrospectively analyzed data collected from 4595 adults who used the Foodsmart platform between February and October 2021. Participants self-reported their diet, demographics, biometrics, and food insecurity status in a 56-item questionnaire. Participants were reported to be food insecure if they answered “sometimes” or “often” to the question “How often does the food you buy not last and you don't have money to get more?” from the United States Department of Agriculture’s Household Food Security survey. We examined baseline characteristics of participants by food insecurity status, associations between characteristics and baseline food insecurity, and changes in diet quality and food insecurity status. To evaluate potential causes of reversing food insecurity, the use of 6 Foodsmart features was compared between food-insecure participants who achieved food security versus food-insecure participants who remained food insecure, based on their last response to the food insecurity question. Results: We found that 16% (742/4595) of participants were food insecure at baseline. Participants who were food insecure at baseline were more likely to be obese, to have at least one chronic condition, to have a lower diet quality, to cook less frequently at home, to think healthy food is too expensive, and less likely to order takeout or eat at a restaurant. Among participants who were food insecure at baseline, 61% (451/742) improved their nutrition and 29% (217/742) responded that they were food secure at follow-up, with an increasing percentage achieving food security with longer enrollment time. Using a multivariable logistic regression model, we found that age, diabetes, prediabetes, BMI categories, and diet quality at baseline were statistically significantly associated with the likelihood of being food insecure at baseline. Among those who were food insecure at baseline, there was a higher relative proportion of participants who achieved food security and used the “deals” (28.6% higher), “CookItNow” (36.4% higher), and “telenutrition” (27.5% higher) features compared to those who remained food insecure. Conclusions: This study assesses the characteristics of individuals enrolled on the Foodsmart platform who answered the food insecurity question. We found that a significant number of participants who were food insecure at enrollment achieved food security. This finding shows that telehealth and nutrition platforms may potentially help users improve household food security. %M 36282563 %R 10.2196/41418 %U https://formative.jmir.org/2022/10/e41418 %U https://doi.org/10.2196/41418 %U http://www.ncbi.nlm.nih.gov/pubmed/36282563 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 9 %P e39033 %T Monitoring the Nutrient Composition of Food Prepared Out-of-Home in the United Kingdom: Database Development and Case Study %A Huang,Yuru %A Burgoine,Thomas %A Essman,Michael %A Theis,Dolly R Z %A Bishop,Tom R P %A Adams,Jean %+ Medical Research Council (MRC) Epidemiology Unit, University of Cambridge, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, United Kingdom, 44 01223 330315, Yuru.Huang@mrc-epid.cam.ac.uk %K nutritional database %K web scraping %K food prepared out of the home %K out-of-home %K data science %K chains %D 2022 %7 8.9.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Hand transcribing nutrient composition data from websites requires extensive human resources and is prone to error. As a result, there are limited nutrient composition data on food prepared out of the home in the United Kingdom. Such data are crucial for understanding and monitoring the out-of-home food environment, which aids policy making. Automated data collection from publicly available sources offers a potential low-resource solution to address this gap. Objective: In this paper, we describe the first UK longitudinal nutritional database of food prepared out of the home, MenuTracker. As large chains will be required to display calorie information on their UK menus from April 2022, we also aimed to identify which chains reported their nutritional information online in November 2021. In a case study to demonstrate the utility of MenuTracker, we estimated the proportions of menu items exceeding recommended energy and nutrient intake (eg, >600 kcal per meal). Methods: We have collated nutrient composition data of menu items sold by large chain restaurants quarterly since March 2021. Large chains were defined as those with 250 employees or more (those covered by the new calorie labeling policy) or belonging to the top 100 restaurants based on sales volume. We developed scripts in Python to automate the data collection process from business websites. Various techniques were used to harvest web data and extract data from nutritional tables in PDF format. Results: Automated Python programs reduced approximately 85% of manual work, totaling 500 hours saved for each wave of data collection. As of January 2022, MenuTracker has 76,405 records from 88 large out-of-home food chains at 4 different time points (ie, March, June, September, and December) in 2021. In constructing the database, we found that one-quarter (24.5%, 256/1043) of large chains, which are likely to be subject to the United Kingdom’s calorie menu labeling regulations, provided their nutritional information online in November 2021. Across these chains, 24.7% (16,391/66,295) of menu items exceeded the UK government’s recommendation of a maximum of 600 kcal for a single meal. Comparable figures were 46.4% (29,411/63,416) for saturated fat, 34.7% (21,964/63,388) for total fat, 17.6% (11,260/64,051) for carbohydrates, 17.8% (11,434/64,059) for sugar, and 35.2% (22,588/64,086) for salt. Furthermore, 0.7% to 7.1% of the menu items exceeded the maximum daily recommended intake for these nutrients. Conclusions: MenuTracker is a valuable resource that harnesses the power of data science techniques to use publicly available data online. Researchers, policy makers, and consumers can use MenuTracker to understand and assess foods available from out-of-home food outlets. The methods used in development are available online and can be used to establish similar databases elsewhere. %M 36074559 %R 10.2196/39033 %U https://publichealth.jmir.org/2022/9/e39033 %U https://doi.org/10.2196/39033 %U http://www.ncbi.nlm.nih.gov/pubmed/36074559 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e38326 %T Associations of Maternal and Paternal Parenting Practices With Children’s Fruit and Vegetable Intake and Physical Activity: Preliminary Findings From an Ecological Momentary Study %A Lopez,Nanette Virginia %A Lai,Mark HC %A Yang,Chih-Hsiang %A Dunton,Genevieve Fridlund %A Belcher,Britni Ryan %+ Department of Health Sciences, Northern Arizona University, 1100 S Beaver St, Box 15095, Flagstaff, AZ, 86011, United States, 1 928 523 7913, nanette.lopez@nau.edu %K parenting %K ecological momentary assessment %K fruit and vegetable consumption %K physical activity %K pediatrics %K obesity %D 2022 %7 10.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Childhood obesity prevention interventions routinely focus on changing maternal parenting practices. Failure to assess how fathers’ weight-related (ie, diet and physical activity) parenting practices contribute to children’s energy balance behaviors limits the understanding of their paternal role within the family. Examining the independent and interacting effects of fathers’ and mothers’ weight-related parenting practices on children’s diet and physical activity addresses this important research gap. Objective: This study used ecological momentary assessment (EMA) to investigate the within-subject and between-subject independent and interactive effects of maternal and paternal encouragement to eat and preparation of fruits and vegetables (F/V) and encouragement of and taking their child to be physically active on their child’s self-reported F/V intake and physical activity engagement. Methods: Participants included mother-father-child triads (n=22 triads, n=205-213 prompts/occasions) in the Mothers and Their Children’s Health Study and the University of Southern California Fathers Study. Simultaneously, mothers and fathers (agesmean 44.2 years, SD 5.6, and 45.2 years, SD 8.1, respectively), and their children (agemean 12.0 years, SD 0.7) completed up to 8 randomly prompted EMA surveys per day on separate smartphones for 7 days. At each prompt, mothers and fathers each reported whether they did the following in the past 2 hours: (1) encouraged their child to eat F/V, (2) prepared F/V for their child, (3) encouraged their child to be physically active, or (4) took their child to be physically active. Children self-reported whether they consumed F/V or were physically active in the past 2 hours. Results: Results from Bayesian multilevel logistic models (all in log-odd units) indicated that at the within-subject level, greater maternal encouragement (β=2.28, 95% CI 0.08 to 5.68) of eating F/V was associated with greater child report of eating F/V, but paternal encouragement (β=1.50, 95% CI –0.83 to 4.52) showed no effects above and beyond maternal encouragement. Additionally, greater than usual paternal encouragement (β=2.28, 95% CI 0.08 to 5.54) and maternal encouragement (β=2.94, 95% CI 0.36 to 6.69) of physical activity had significant independent effects and were associated with greater child report of physical activity. No other within-subject or between-subject associations nor interactive effects were significant. Conclusions: Findings from this study suggest that fathers play a role in supporting their children’s physical activity but not their intake of F/V. Future EMA studies should recruit larger samples to evaluate the independent and interacting roles of mothers’ and fathers’ weight-related parenting practices on child’s obesogenic behaviors. %M 35947425 %R 10.2196/38326 %U https://formative.jmir.org/2022/8/e38326 %U https://doi.org/10.2196/38326 %U http://www.ncbi.nlm.nih.gov/pubmed/35947425 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e34497 %T The Assessment of a Personalized Nutrition Tool (eNutri) in Germany: Pilot Study on Usability Metrics and Users’ Experiences %A Kaiser,Birgit %A Stelzl,Tamara %A Finglas,Paul %A Gedrich,Kurt %+ Research Group Public Health Nutrition, ZIEL - Institute for Food & Health, TUM School of Life Sciences, Technical University of Munich, Weihenstephaner Berg 1, Freising, 85354, Germany, 49 8161 71 2483, kgedrich@tum.de %K Food Frequency Questionnaire %K dietary assessment %K Diet Quality Score %K web application %K digital nutrition %K personalized nutrition %K system usability %K internet %K eNutri %K EIT Food Quisper %D 2022 %7 4.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: To address the epidemic burden of diet-related diseases, adequate dietary intake assessments are needed to determine the actual nutrition intake of a population. In this context, the eNutri web app has been developed, providing online automated personalized dietary advice, based on nutritional information recorded via an integrated and validated food frequency questionnaire (FFQ). Originally developed for a British population and their dietary habits, the eNutri tool has specifically been adapted to the German population, taking into account national eating habits and dietary recommendations. Objective: The primary aim of this study is to evaluate the system usability and users’ experience and feedback on the eNutri app in a small-scale preliminary study. The secondary aim is to investigate the efficacy of personalized nutrition (PN) recommendations versus general dietary advice in altering eating habits. Methods: The app was piloted for 4 weeks by 106 participants from across Germany divided into a PN group and a control group. The groups differed according to the degree of personalization of dietary recommendations obtained. Results: An overall System Usability Scale (SUS) score of 78.4 (SD 12.2) was yielded, indicating an above average user experience. Mean completion time of the FFQ was 26.7 minutes (SD 10.6 minutes). Across subgroups (age, sex, device screen sizes) no differences in SUS or completion time were found, indicating an equal performance for all users independent of the assigned experimental group. Participants’ feedback highlighted the need for more personalized dietary advice for controls, while personalized nutritional recommendations improved the awareness of healthy eating behavior. Further improvements to the eNutri app were suggested by the app users. Conclusions: In total, the eNutri app has proven to be a suitable instrument to capture the dietary habits of a German population sample. Regarding functionality, system usability, and handling, direct user feedback was quite positive. Nutritional advice given was rated ambivalent, pointing to several weaknesses in the eNutri app, minimizing the system’s full potential. A higher level of personalization within nutritional advice subjectively improved the app’s usability. The insights gained will be used as a basis to further develop and improve this digital diet assessment tool. %M 35925664 %R 10.2196/34497 %U https://formative.jmir.org/2022/8/e34497 %U https://doi.org/10.2196/34497 %U http://www.ncbi.nlm.nih.gov/pubmed/35925664 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 7 %P e37556 %T Utilizing Technology for Diet and Exercise Change in Complex Chronic Conditions Across Diverse Environments (U-DECIDE): Protocol for a Randomized Controlled Trial %A Brown,Riley C C %A Jegatheesan,Dev K %A Conley,Marguerite M %A Mayr,Hannah L %A Kelly,Jaimon T %A Webb,Lindsey %A Barnett,Amandine %A Staudacher,Heidi M %A Burton,Nicola W %A Isbel,Nicole M %A Macdonald,Graeme A %A Campbell,Katrina L %A Coombes,Jeff S %A Keating,Shelley E %A Hickman,Ingrid J %+ Department of Nutrition and Dietetics, Princess Alexandra Hospital, 199 Ipswich Road Woolloongabba, Brisbane, 4102, Australia, 61 731765588, i.hickman@uq.edu.au %K lifestyle intervention %K telehealth service delivery %K digital disruption %K complex chronic disease %K liver disease %K kidney disease %K transplant %K metabolic syndrome %K metabolism %K diabetes %K obesity %K mobile health %K health technology %K chronic disease %D 2022 %7 28.7.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The metabolic syndrome is common across many complex chronic disease groups. Advances in health technology have provided opportunities to support lifestyle interventions. Objective: The purpose of this study is to test the feasibility of a health technology-assisted lifestyle intervention in a patient-led model of care. Methods: The study is a single-center, 26-week, randomized controlled trial. The setting is specialist kidney and liver disease clinics at a large Australian tertiary hospital. The participants will be adults with a complex chronic condition who are referred for dietetic assessment and display at least one feature of the metabolic syndrome. All participants will receive an individualized assessment and advice on diet quality from a dietitian, a wearable activity monitor, and standard care. Participants randomized to the intervention group will receive access to a suite of health technologies from which to choose, including common base components (text messages) and optional components (online and mobile app–based nutrition information, an online home exercise program, and group-based videoconferencing). Exposure to the optional aspects of the intervention will be patient-led, with participants choosing their preferred level of engagement. The primary outcome will be the feasibility of delivering the program, determined by safety, recruitment rate, retention, exposure uptake, and telehealth adherence. Secondary outcomes will be clinical effectiveness, patient-led goal attainment, treatment fidelity, exposure demand, and participant perceptions. Primary outcome data will be assessed descriptively and secondary outcomes will be assessed using an analysis of covariance. This study will provide evidence on the feasibility of the intervention in a tertiary setting for patients with complex chronic disease exhibiting features of the metabolic syndrome. Results: The study was funded in 2019. Enrollment has commenced and is expected to be completed by June 2022. Data collection and follow up are expected to be completed by December 2022. Results from the analyses based on primary outcomes are expected to be submitted for publication by June 2023. Conclusions: The study will test the implementation of a health technology–assisted lifestyle intervention in a tertiary outpatient setting for a diverse group of patients with complex chronic conditions. It is novel in that it embeds patient choice into intervention exposure and will inform health service decision-makers in regards to the feasibility of scale and spread of technology-assisted access to care for a broader reach of specialist services. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12620001282976; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378337 International Registered Report Identifier (IRRID): DERR1-10.2196/37556 %M 35900834 %R 10.2196/37556 %U https://www.researchprotocols.org/2022/7/e37556 %U https://doi.org/10.2196/37556 %U http://www.ncbi.nlm.nih.gov/pubmed/35900834 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e35553 %T Exploring the Use of a Web-Based Menu Planning Tool in Childcare Services: Qualitative Cross-sectional Survey Study %A Kempler,Jessica V %A Love,Penelope %A Bolton,Kristy A %A Rozman,Margaret %A Spence,Alison C %+ School of Exercise and Nutrition Sciences, Deakin University, 75 Pigdons Road, Geelong, 3216, Australia, 61 3 9246 8651, jkempler@deakin.edu.au %K child care %K preschool %K early childhood services %K child nutrition %K menu planning %K healthy eating %K web-based systems %K web-based tool %K internet-based intervention %K user experience %D 2022 %7 18.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Early childhood is a critical period for supporting the development of healthy eating habits, which may affect lifelong health. Childcare services are important settings for promoting early childhood nutrition; however, food provision in childcare frequently does not align with dietary guidelines. Web-based menu planning tools are well suited to support healthy food provision in childcare, although little is known about their use. Research is needed to understand how web-based menu planning tools are used in the childcare setting and how they can effectively support healthy menu planning and food provision for children in childcare. Objective: We aimed to explore the use of a web-based menu planning tool called FoodChecker, which is available to childcare services in Victoria, Australia. We also aimed to gain insights and perspectives from childcare staff involved in menu planning about their use of the tool to plan healthy menus and guide healthy food provision for children. Methods: We conducted a qualitative descriptive study using a cross-sectional web-based survey completed by the staff involved in menu planning in childcare services. Thematic analysis was performed using NVivo software. Emergent themes were mapped against constructs of the Technology Acceptance Model regarding perceived usefulness, perceived ease of use, and external variables influencing perceptions and use. Results: The participants included 30 cooks and 34 directors from 53 childcare services. Participants perceived the web-based menu planning tool as useful for supporting child nutrition and health, improving organizational processes, and aiding the menu planner role. Perceptions regarding ease of use were mixed. External variables influencing perceptions and use included awareness of the tool, perceived need, time, resources, organizational support, and the food budget. Participants made recommendations to improve the tool, particularly the need to integrate functionality to make it easier and faster to use or to include more links to resources to support healthy menu planning. Conclusions: The web-based menu planning tool was perceived as useful for cooks and directors in childcare services. Areas for improvement were identified; for example, the need for integrated digital features to make the tool easier and faster to use. As the first qualitative study to explore childcare staff experiences with a web-based menu planning tool, these findings inform future research and development of such tools to aid scalable and sustainable support for healthier food provision in the childcare sector. %M 35849438 %R 10.2196/35553 %U https://formative.jmir.org/2022/7/e35553 %U https://doi.org/10.2196/35553 %U http://www.ncbi.nlm.nih.gov/pubmed/35849438 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 7 %P e35898 %T Relationship Between Protein Intake in Each Traditional Meal and Physical Activity: Cross-sectional Study %A Shinto,Takae %A Makino,Saneyuki %A Tahara,Yu %A Nitta,Lyie %A Kuwahara,Mai %A Tada,Ayako %A Abe,Nanako %A Michie,Mikiko %A Shibata,Shigenobu %+ Department of Bioscience and Engineering, Waseda University, Wakamatsu-cho 2-2, Shinjuku-ku, Tokyo, 162-0056, Japan, 81 +81353697318, shibatas@waseda.jp %K protein %K dietary pattern %K physical activity %K chrononutrition %D 2022 %7 12.7.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Protein intake plays an important role in the synthesis and maintenance of skeletal muscles for the prevention of health risks. It is also widely known that physical activity influences muscle function. However, no large-scale studies have examined the relationship between daily dietary habits, especially the timing of protein intake, and daily physical activity. Objective: The purpose of this cross-sectional study was to investigate how protein intake and composition (involving the 3 major nutrients protein, fat, and carbohydrate) in the 3 traditional meals (breakfast, lunch, and dinner) are associated with physical activity. Methods: Using daily dietary data accumulated in the smartphone food log app “Asken” and a web-based cross-sectional survey involving Asken users (N=8458), we analyzed nutrient intake and composition, as well as daily activity levels. As very few individuals skipped breakfast (1102/19,319 responses, 5.7%), we analyzed data for 3 meals per day. Results: Spearman rank correlation analysis revealed that breakfast and lunch protein intakes had higher positive correlations with daily physical activity among the 3 major macronutrients (P<.001). These findings were confirmed by multivariate logistic regression analysis with confounding factors. Moreover, participants with higher protein intake and composition at breakfast or lunch tended to exhibit significantly greater physical activity than those with higher protein intake at dinner (P<.001). Conclusions: Among the 3 macronutrients, protein intake during breakfast and lunch was closely associated with daily physical activity. %M 35819831 %R 10.2196/35898 %U https://publichealth.jmir.org/2022/7/e35898 %U https://doi.org/10.2196/35898 %U http://www.ncbi.nlm.nih.gov/pubmed/35819831 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e38283 %T Assessing the Initial Validity of the PortionSize App to Estimate Dietary Intake Among Adults: Pilot and Feasibility App Validation Study %A Saha,Sanjoy %A Lozano,Chloe Panizza %A Broyles,Stephanie %A Martin,Corby K %A Apolzan,John W %+ Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA, 70808, United States, 1 2257632827, john.apolzan@pbrc.edu %K dietary assessment %K eating %K food intake %K energy intake %K portion size %K mHealth %K digital health %K eHealth %K nutrition %K food groups %D 2022 %7 15.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Accurately assessing dietary intake can promote improved nutrition. The PortionSize app (Pennington Biomedical Research Center) was designed to quantify and provide real-time feedback on the intake of energy, food groups, saturated fat, and added sugar. Objective: This study aimed to assess the preliminary feasibility and validity of estimating food intake via the PortionSize app among adults. Methods: A total of 15 adults (aged 18-65 years) were recruited and trained to quantify the food intake from a simulated meal by using PortionSize. Trained personnel prepared 15 simulated meals and covertly weighed (weigh back) the amount of food provided to participants as well as food waste. Equivalence tests (±25% bounds) were performed to compare PortionSize to the weigh back method. Results: Participants were aged a mean of 28 (SD 12) years, and 11 were female. The mean energy intake estimated with PortionSize was 742.9 (SD 328.2) kcal, and that estimated via weigh back was 659.3 (SD 190.7) kcal (energy intake difference: mean 83.5, SD 287.5 kcal). The methods were not equivalent in estimating energy intake (P=.18), and PortionSize overestimated energy intake by 83.5 kcal (12.7%) at the meal level. Estimates of portion sizes (gram weight; P=.01), total sugar (P=.049), fruit servings (P=.01), and dairy servings (P=.047) from PortionSize were equivalent to those estimated via weigh back. PortionSize was not equivalent to weigh back with regard to estimates for carbohydrate (P=.10), fat (P=.32), vegetable (P=.37), grain (P=.31), and protein servings (P=.87). Conclusions: Due to power limitations, the equivalence tests had large equivalence bounds. Though preliminary, the results of this small pilot study warrant the further adaptation, development, and validation of PortionSize as a means to estimate energy intake and provide users with real-time and actionable dietary feedback. %M 35704355 %R 10.2196/38283 %U https://formative.jmir.org/2022/6/e38283 %U https://doi.org/10.2196/38283 %U http://www.ncbi.nlm.nih.gov/pubmed/35704355 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e35886 %T Testing a Mobile App for Participatory Research to Identify Teen-Targeted Food Marketing: Mixed Methods Study %A Truman,Emily %A Elliott,Charlene %+ Department of Communication, Media and Film, University of Calgary, 2500 University Dr NW, Social Sciences Building, Calgary, AB, T2N 1N4, Canada, 1 403 220 3180, charlene.elliott@ucalgary.ca %K mHealth %K mobile app %K teenager %K adolescent %K monitoring %K participatory research %K feasibility %K usability %K food marketing %K food advertising %D 2022 %7 3.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile apps are not only effective tools for promoting health to teenagers but are also useful for engaging teenagers in participatory research on factors that influence their health. Given the impact of food marketing messages on teenagers’ food attitudes and consumption choices, it is important to develop effective methods for capturing the food advertisements targeted at this population to assess their content. Objective: The aim of this study was to test the feasibility and usability of a mobile app, “GrabFM!” (“Grab Food Marketing!”), designed for teenagers to facilitate monitoring of self-identified targeted food marketing messaging. Methods: A mixed methods approach, including quantitative user response rates and qualitative focus group discussion feedback, was used in the evaluation process. Results: A total of 62 teenagers (ages 13-17) completed GrabFM! app pilot testing over a 7-day data collection period. Teenagers submitted a total of 339 examples of food marketing, suggesting high feasibility for the app. Participants also took part in focus group discussions about their experience, providing positive feedback on usability, including ease of use and design aesthetic appeal. Conclusions: The GrabFM! app had high feasibility and usability, suggesting its efficacy in capturing accurate data relevant to the teenage population’s experience with food marketing messaging. %M 35503652 %R 10.2196/35886 %U https://formative.jmir.org/2022/5/e35886 %U https://doi.org/10.2196/35886 %U http://www.ncbi.nlm.nih.gov/pubmed/35503652 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32302 %T Media Source Characteristics Regarding Food Fraud Misinformation According to the Health Information National Trends Survey (HINTS) in China: Comparative Study %A Chang,Angela %A Schulz,Peter Johannes %A Jiao,Wen %A Yu,Guoming %A Yang,Ya %+ School of Journalism and Communication, Beijing Normal University, #15 Xinjiekouwai Street, Haidian District, Beijing, 100875, China, 86 18810305219, yangya@bnu.edu.cn %K risk assessment %K food rumor %K risk management %K conspiracy narratives %K population health %K food safety %D 2022 %7 16.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Ongoing rumors and fake news regarding food fraud, adulteration, and contamination are highly visible. Health risk information circulating through media and interpersonal communication channels has made health crisis an important research agenda. Objective: This study explored the issue of food fraud and the effect of misinformation. Further, it assessed whether and how these issues have provided evidence-based interventions for food handlers and regulators to mitigate fraud misinformation. Methods: The Health Information National Trends Survey (HINTS) was adopted for a collaborative study in China, after which a cross-sectional survey with door-to-door interviews was performed. Participants from Beijing and Hefei were selected using multistage sampling of adults in May 2017. Based on 4 government surveillance reports on food rumors and safety incidents, a descriptive analysis, correlation analysis, and analysis of variance were performed on the data. Results: A total of 3090 results were gathered and analyzed. Among the respondents, 83.6% (2584/3090) heard at least one food rumor. Learning about food fraud was correlated with interpersonal connections (eg, doctors or health specialists) for accessing food health information. Overall, Chinese citizens with a higher level of interpersonal connection were more likely to be concerned about food incidents with a statistical difference (P<.001). Interpersonal connection was the most frequent communication source (698/1253, 55.7%), followed by traditional media (325/1253, 25.9%) and internet portals (144/1253, 11.5%). There was a significant relationship between media use and media category in Beijing (P<.001) and Hefei (P<.001). Overall, responses to food fraud and incident risks were lower in Beijing than in Hefei (P=.006). The respondents in Beijing were confronted more frequently by food rumors (range 346-1253) than those in Hefei (range 155-946). The urban dwellers in Beijing and their rural counterparts in Hefei also differed in terms of perceiving different levels of food risks from different media sources. The food rumor narratives that examined the conspiracy belief showed that social media played more important roles in influencing attitudes against misinformation for users in Hefei than in Beijing. Conclusions: This study shows that consumers have to be on guard against not only fake food, but also spreading fake information and rumors, as well as conspiracy beliefs involving fake food. This study focused on characterizing media sources, types of food fraud misinformation, and risk perceptions of food safety, which mix urgency and suspicion, and attempted to provide evidence-based interventions for risk management guidance, with the hypothesis of significant correlations between media types and sources, and consumer exposure and perception levels of food rumors and risks. %M 34939565 %R 10.2196/32302 %U https://formative.jmir.org/2022/3/e32302 %U https://doi.org/10.2196/32302 %U http://www.ncbi.nlm.nih.gov/pubmed/34939565 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e35092 %T Evaluation of a Web-Based Dietary Assessment Tool (myfood24) in Norwegian Women and Men Aged 60-74 Years: Usability Study %A Hopstock,Laila Arnesdatter %A Medin,Anine Christine %A Skeie,Guri %A Henriksen,André %A Lundblad,Marie Wasmuth %+ Department of Community Medicine, UiT The Arctic University of Norway, Hansine Hansens vei, Tromsø, 9037, Norway, 47 77644000, laila.hopstock@uit.no %K system usability score %K older adults %K measurements %K nutrition %K dietary intake %K digital health %K web tool %D 2022 %7 11.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: A healthy diet throughout the life course improves health and reduces the risk of disease. There is a need for new knowledge of the relation between diet and health, but existing methods to collect information on food and nutrient intake have their limitations. Evaluations of new tools to assess dietary intake are needed, especially in old people, where the introduction of new technology might impose challenges. Objective: We aimed to examine the usability of a new web-based dietary assessment tool in older adult women and men. Methods: A total of 60 women and men (participation 83%, 57% women) aged 60-74 years recruited by convenience and snowball sampling completed a 24-hour web-based dietary recall using the newly developed Norwegian version of Measure Your Food On One Day (myfood24). Total energy and nutrient intakes were calculated in myfood24, primarily on the basis of the Norwegian Food Composition Table. No guidance or support was provided to complete the recall. Usability was assessed using the system usability scale (SUS), where an SUS score of ≥68 was considered satisfactory. We examined the responses to single SUS items and the mean (SD) SUS score in groups stratified by sex, age, educational level, and device used to complete the recall (smartphone, tablet device, or computer). Results: The mean total energy intake was 5815 (SD 3093) kJ. A total of 14% of participants had an energy intake of <2100 kJ (ie, 500 kilocalories) and none had an intake of >16,800 kJ (ie, 4000 kilocalories). Mean energy proportions from carbohydrates, fat, protein, alcohol, and fiber was within the national recommendations. The mean SUS score was 55.5 (SD 18.6), and 27% of participants had SUS scores above the satisfactory product cut-off. Higher SUS scores were associated with younger age and lower education, but not with the type of device used. Conclusions: We found the overall usability of a new web-based dietary assessment tool to be less than satisfactory in accordance with standard usability criteria in a sample of 60-74–year-old Norwegians. The observed total energy intakes suggest that several of the participants underreported their intake during the completion of the dietary recall. Implementing web-based dietary assessment tools in older adults is feasible, but guidance and support might be needed to ensure valid completion. %M 35275079 %R 10.2196/35092 %U https://formative.jmir.org/2022/3/e35092 %U https://doi.org/10.2196/35092 %U http://www.ncbi.nlm.nih.gov/pubmed/35275079 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e30211 %T Validity and Feasibility of the Monitoring and Modeling Family Eating Dynamics System to Automatically Detect In-field Family Eating Behavior: Observational Study %A Bell,Brooke Marie %A Alam,Ridwan %A Mondol,Abu Sayeed %A Ma,Meiyi %A Emi,Ifat Afrin %A Preum,Sarah Masud %A de la Haye,Kayla %A Stankovic,John A %A Lach,John %A Spruijt-Metz,Donna %+ Department of Chronic Disease Epidemiology, School of Public Health, Yale University, 60 College St, 8th Floor, New Haven, CT, 06520, United States, 1 475 235 0643, brooke.bell@yale.edu %K ecological momentary assessment %K wearable sensors %K automatic dietary assessment %K eating behavior %K eating context %K smartwatch %K mobile phone %D 2022 %7 18.2.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The field of dietary assessment has a long history, marked by both controversies and advances. Emerging technologies may be a potential solution to address the limitations of self-report dietary assessment methods. The Monitoring and Modeling Family Eating Dynamics (M2FED) study uses wrist-worn smartwatches to automatically detect real-time eating activity in the field. The ecological momentary assessment (EMA) methodology was also used to confirm whether eating occurred (ie, ground truth) and to measure other contextual information, including positive and negative affect, hunger, satiety, mindful eating, and social context. Objective: This study aims to report on participant compliance (feasibility) to the 2 distinct EMA protocols of the M2FED study (hourly time-triggered and eating event–triggered assessments) and on the performance (validity) of the smartwatch algorithm in automatically detecting eating events in a family-based study. Methods: In all, 20 families (58 participants) participated in the 2-week, observational, M2FED study. All participants wore a smartwatch on their dominant hand and responded to time-triggered and eating event–triggered mobile questionnaires via EMA while at home. Compliance to EMA was calculated overall, for hourly time-triggered mobile questionnaires, and for eating event–triggered mobile questionnaires. The predictors of compliance were determined using a logistic regression model. The number of true and false positive eating events was calculated, as well as the precision of the smartwatch algorithm. The Mann-Whitney U test, Kruskal-Wallis test, and Spearman rank correlation were used to determine whether there were differences in the detection of eating events by participant age, gender, family role, and height. Results: The overall compliance rate across the 20 deployments was 89.26% (3723/4171) for all EMAs, 89.7% (3328/3710) for time-triggered EMAs, and 85.7% (395/461) for eating event–triggered EMAs. Time of day (afternoon odds ratio [OR] 0.60, 95% CI 0.42-0.85; evening OR 0.53, 95% CI 0.38-0.74) and whether other family members had also answered an EMA (OR 2.07, 95% CI 1.66-2.58) were significant predictors of compliance to time-triggered EMAs. Weekend status (OR 2.40, 95% CI 1.25-4.91) and deployment day (OR 0.92, 95% CI 0.86-0.97) were significant predictors of compliance to eating event–triggered EMAs. Participants confirmed that 76.5% (302/395) of the detected events were true eating events (ie, true positives), and the precision was 0.77. The proportion of correctly detected eating events did not significantly differ by participant age, gender, family role, or height (P>.05). Conclusions: This study demonstrates that EMA is a feasible tool to collect ground-truth eating activity and thus evaluate the performance of wearable sensors in the field. The combination of a wrist-worn smartwatch to automatically detect eating and a mobile device to capture ground-truth eating activity offers key advantages for the user and makes mobile health technologies more accessible to nonengineering behavioral researchers. %M 35179508 %R 10.2196/30211 %U https://mhealth.jmir.org/2022/2/e30211 %U https://doi.org/10.2196/30211 %U http://www.ncbi.nlm.nih.gov/pubmed/35179508 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e27337 %T Measurement Properties of Smartphone Approaches to Assess Diet, Alcohol Use, and Tobacco Use: Systematic Review %A Thornton,Louise %A Osman,Bridie %A Champion,Katrina %A Green,Olivia %A Wescott,Annie B %A Gardner,Lauren A %A Stewart,Courtney %A Visontay,Rachel %A Whife,Jesse %A Parmenter,Belinda %A Birrell,Louise %A Bryant,Zachary %A Chapman,Cath %A Lubans,David %A Slade,Tim %A Torous,John %A Teesson,Maree %A Van de Ven,Pepijn %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russel Building, Camperdown, Sydney, 2006, Australia, 61 0403744089, louise.thornton@sydney.edu.au %K smartphone %K app %K alcohol %K smoking %K diet %K measurement %K mobile phone %D 2022 %7 17.2.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Poor diet, alcohol use, and tobacco smoking have been identified as strong determinants of chronic diseases, such as cardiovascular disease, diabetes, and cancer. Smartphones have the potential to provide a real-time, pervasive, unobtrusive, and cost-effective way to measure these health behaviors and deliver instant feedback to users. Despite this, the validity of using smartphones to measure these behaviors is largely unknown. Objective: The aim of our review is to identify existing smartphone-based approaches to measure these health behaviors and critically appraise the quality of their measurement properties. Methods: We conducted a systematic search of the Ovid MEDLINE, Embase (Elsevier), Cochrane Library (Wiley), PsycINFO (EBSCOhost), CINAHL (EBSCOHost), Web of Science (Clarivate), SPORTDiscus (EBSCOhost), and IEEE Xplore Digital Library databases in March 2020. Articles that were written in English; reported measuring diet, alcohol use, or tobacco use via a smartphone; and reported on at least one measurement property (eg, validity, reliability, and responsiveness) were eligible. The methodological quality of the included studies was assessed using the Consensus-Based Standards for the Selection of Health Measurement Instruments Risk of Bias checklist. Outcomes were summarized in a narrative synthesis. This systematic review was registered with PROSPERO, identifier CRD42019122242. Results: Of 12,261 records, 72 studies describing the measurement properties of smartphone-based approaches to measure diet (48/72, 67%), alcohol use (16/72, 22%), and tobacco use (8/72, 11%) were identified and included in this review. Across the health behaviors, 18 different measurement techniques were used in smartphones. The measurement properties most commonly examined were construct validity, measurement error, and criterion validity. The results varied by behavior and measurement approach, and the methodological quality of the studies varied widely. Most studies investigating the measurement of diet and alcohol received very good or adequate methodological quality ratings, that is, 73% (35/48) and 69% (11/16), respectively, whereas only 13% (1/8) investigating the measurement of tobacco use received a very good or adequate rating. Conclusions: This review is the first to provide evidence regarding the different types of smartphone-based approaches currently used to measure key behavioral risk factors for chronic diseases (diet, alcohol use, and tobacco use) and the quality of their measurement properties. A total of 19 measurement techniques were identified, most of which assessed dietary behaviors (48/72, 67%). Some evidence exists to support the reliability and validity of using smartphones to assess these behaviors; however, the results varied by behavior and measurement approach. The methodological quality of the included studies also varied. Overall, more high-quality studies validating smartphone-based approaches against criterion measures are needed. Further research investigating the use of smartphones to assess alcohol and tobacco use and objective measurement approaches is also needed. International Registered Report Identifier (IRRID): RR2-10.1186/s13643-020-01375-w %M 35175212 %R 10.2196/27337 %U https://mhealth.jmir.org/2022/2/e27337 %U https://doi.org/10.2196/27337 %U http://www.ncbi.nlm.nih.gov/pubmed/35175212 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e31875 %T Nutrient and Food Group Prediction as Orchestrated by an Automated Image Recognition System in a Smartphone App (CALO mama): Validation Study %A Sasaki,Yuki %A Sato,Koryu %A Kobayashi,Satomi %A Asakura,Keiko %+ Link & Communication Inc, Kioicho 4-1, Chiyoda-ku, Tokyo, 102-0094, Japan, 81 3 5210 2721, y.sasaki@linkncom.co.jp %K health app %K image recognition %K automatic calculation %K nutrient and food contents %K validity %K mobile phone %K mHealth %K validation %K nutrition %K diet %K food %D 2022 %7 10.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: A smartphone image recognition app is expected to be a novel tool for measuring nutrients and food intake, but its performance has not been well evaluated. Objective: We assessed the accuracy of the performance of an image recognition app called CALO mama in terms of the nutrient and food group contents automatically estimated by the app. Methods: We prepared 120 meal samples for which the nutrients and food groups were calculated. Next, we predicted the nutrients and food groups included in the meals from their photographs by using (1) automated image recognition only and (2) manual modification after automatic identification. Results: Predictions generated using only image recognition were similar to the actual data on the weight of meals and were accurate for 11 out of 30 nutrients and 4 out of 15 food groups. The app underestimated energy, 19 nutrients, and 9 food groups, while it overestimated dairy products and confectioneries. After manual modification, the predictions were similar for energy, accurately capturing the nutrients for 29 out of 30 of meals and the food groups for 10 out of 15 meals. The app underestimated pulses, fruits, and meats, while it overestimated weight, vitamin C, vegetables, and confectioneries. Conclusions: The results of this study suggest that manual modification after prediction using image recognition improves the performance of the app in assessing the nutrients and food groups of meals. Our findings suggest that image recognition has the potential to achieve a description of the dietary intakes of populations by using “precision nutrition” (a comprehensive and dynamic approach to developing tailored nutritional recommendations) for individuals. %M 35006077 %R 10.2196/31875 %U https://formative.jmir.org/2022/1/e31875 %U https://doi.org/10.2196/31875 %U http://www.ncbi.nlm.nih.gov/pubmed/35006077 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e30909 %T A Modern Flexitarian Dietary Intervention Incorporating Web-Based Nutrition Education in Healthy Young Adults: Protocol for a Randomized Controlled Trial %A Braakhuis,Andrea %A Gillies,Nicola %A Worthington,Anna %A Knowles,Scott %A Conner,Tamlin %A Roy,Rajshri %A Pham,Toan %A Bermingham,Emma %A Cameron-Smith,David %+ Discipline of Nutrition, Faculty of Medical and Health Science, The University of Auckland, 85 Park Road, Grafton, Auckland, 1100, New Zealand, 64 0223502926, a.braakhuis@auckland.ac.nz %K protein %K meat %K vegetarian %K eating patterns %K diet %K nutrition %K dietary restrictions %K biomarkers %K health %K well-being %K macronutrients %K micronutrients %D 2021 %7 21.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The trend of flexitarian eating patterns is on the rise, with young adults among the biggest adopters claiming health and environmental reasons to reduce red meat intake. Nutrient-dense meat and animal products are often the lynchpin of these diets, even when consumed only occasionally and in moderate amounts. Red meat provides forms and concentrations of essential proteins, lipids, and micronutrients that are scarce in exclusively vegetarian regimens. Objective: The aim of this study is to consider the effects of moderate consumption of lean red meat as part of an otherwise vegetarian balanced diet and its impact on biomarkers of sustained health and well-being. Methods: A cohort of healthy, young (20-34 years old, n=80) male and female participants will take part in a 2-arm, parallel randomized controlled trial (RCT) for a duration of 12 weeks, with a 3-month posttrial follow-up. The trial will commence with a 2-week assessment period followed by allocation to the intervention arms. The intervention will include the consumption of red meat or meat alternatives 3 times per week for 10 weeks. Blood samples of the participants will be collected to measure changes in erythrocyte fatty acid distribution, circulating amino acids, neurotransmitters, markers of mineral status, and inflammatory markers. Questionnaires to assess well-being and mental health will be undertaken every 2 weeks. Body composition, physical function, and blood parameters will be assessed at allocation (t0), week 5 into the intervention (t5), and post intervention (t10). Results: The protocol has been developed using the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) checklist and the outcomes will be reported in accordance with the CONSORT (Consolidated Standards of Reporting Trials) guidelines. The trial was approved by the New Zealand Ministry of Health’s Health and Disability Ethics Committees (protocol 20/STH/157). The results of this study will be communicated via publication. Conclusions: To our knowledge, this is the first RCT investigating the overarching health consequences of consuming pasture-fed red meat or no meat as part of a healthy diet. Trial Registration: ClinicalTrials.gov NCT04869163; https://clinicaltrials.gov/ct2/show/NCT04869163 International Registered Report Identifier (IRRID): PRR1-10.2196/30909 %M 34931994 %R 10.2196/30909 %U https://www.researchprotocols.org/2021/12/e30909 %U https://doi.org/10.2196/30909 %U http://www.ncbi.nlm.nih.gov/pubmed/34931994 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e32891 %T Accuracy and Cost-effectiveness of Technology-Assisted Dietary Assessment Comparing the Automated Self-administered Dietary Assessment Tool, Intake24, and an Image-Assisted Mobile Food Record 24-Hour Recall Relative to Observed Intake: Protocol for a Randomized Crossover Feeding Study %A Whitton,Clare %A Healy,Janelle D %A Collins,Clare E %A Mullan,Barbara %A Rollo,Megan E %A Dhaliwal,Satvinder S %A Norman,Richard %A Boushey,Carol J %A Delp,Edward J %A Zhu,Fengqing %A McCaffrey,Tracy A %A Kirkpatrick,Sharon I %A Atyeo,Paul %A Mukhtar,Syed Aqif %A Wright,Janine L %A Ramos-García,César %A Pollard,Christina M %A Kerr,Deborah A %+ School of Population Health, Faculty of Health Sciences, Curtin University, Kent Street, Perth, 6102, Australia, 61 892664122, D.Kerr@curtin.edu.au %K 24-hour recall %K Automated Self-Administered Dietary Assessment Tool %K Intake24 %K mobile food record %K image-assisted dietary assessment %K validation %K controlled feeding %K accuracy %K dietary measurement error %K self-report %K energy intake %K adult %K cost-effectiveness %K acceptability %K mobile technology %K diet surveys %K mobile phone %D 2021 %7 16.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The assessment of dietary intake underpins population nutrition surveillance and nutritional epidemiology and is essential to inform effective public health policies and programs. Technological advances in dietary assessment that use images and automated methods have the potential to improve accuracy, respondent burden, and cost; however, they need to be evaluated to inform large-scale use. Objective: The aim of this study is to compare the accuracy, acceptability, and cost-effectiveness of 3 technology-assisted 24-hour dietary recall (24HR) methods relative to observed intake across 3 meals. Methods: Using a controlled feeding study design, 24HR data collected using 3 methods will be obtained for comparison with observed intake. A total of 150 healthy adults, aged 18 to 70 years, will be recruited and will complete web-based demographic and psychosocial questionnaires and cognitive tests. Participants will attend a university study center on 3 separate days to consume breakfast, lunch, and dinner, with unobtrusive documentation of the foods and beverages consumed and their amounts. Following each feeding day, participants will complete a 24HR process using 1 of 3 methods: the Automated Self-Administered Dietary Assessment Tool, Intake24, or the Image-Assisted mobile Food Record 24-Hour Recall. The sequence of the 3 methods will be randomized, with each participant exposed to each method approximately 1 week apart. Acceptability and the preferred 24HR method will be assessed using a questionnaire. Estimates of energy, nutrient, and food group intake and portion sizes from each 24HR method will be compared with the observed intake for each day. Linear mixed models will be used, with 24HR method and method order as fixed effects, to assess differences in the 24HR methods. Reporting bias will be assessed by examining the ratios of reported 24HR intake to observed intake. Food and beverage omission and intrusion rates will be calculated, and differences by 24HR method will be assessed using chi-square tests. Psychosocial, demographic, and cognitive factors associated with energy misestimation will be evaluated using chi-square tests and multivariable logistic regression. The financial costs, time costs, and cost-effectiveness of each 24HR method will be assessed and compared using repeated measures analysis of variance tests. Results: Participant recruitment commenced in March 2021 and is planned to be completed by the end of 2021. Conclusions: This protocol outlines the methodology of a study that will evaluate the accuracy, acceptability, and cost-effectiveness of 3 technology-enabled dietary assessment methods. This will inform the selection of dietary assessment methods in future studies on nutrition surveillance and epidemiology. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000209897; https://tinyurl.com/2p9fpf2s International Registered Report Identifier (IRRID): DERR1-10.2196/32891 %M 34924357 %R 10.2196/32891 %U https://www.researchprotocols.org/2021/12/e32891 %U https://doi.org/10.2196/32891 %U http://www.ncbi.nlm.nih.gov/pubmed/34924357 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e32441 %T Using Interactive Text Messaging to Improve Diet Quality and Increase Redemption of Foods Approved by the Special Supplemental Nutrition Program for Women, Infants, and Children: Protocol for a Cohort Feasibility Study %A Kay,Melissa C %A Hammad,Nour M %A Herring,Sharon J %A Bennett,Gary G %+ Duke University, 310 Trent Dr., Durham, NC, 27708, United States, 1 7812493062, melissa.kay@duke.edu %K WIC %K diet quality %K digital health %K text messaging %K mothers %K postpartum %K child obesity %K mobile phone %D 2021 %7 15.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Children in the United States eat too few fruits, vegetables, and whole grains and too many energy-dense foods; these dietary behaviors are associated with increased risk of obesity. Maternal diet plays a key role in shaping children's diets; however, many mothers have poor diet quality, especially those living in low-income households. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federal nutrition assistance program that provides mothers and children with nutrient-dense foods, and those who participate have better diet quality. However, many mothers do not redeem all their WIC-approved foods. Thus, there is a need to create effective interventions to improve diet quality, especially among low-income children and families. Objective: This paper aims to describe the development and protocol for a study to evaluate the feasibility, satisfaction, and preliminary efficacy of a fully automated text messaging intervention as a strategy to improve maternal diet quality and the redemption of WIC-approved foods. Methods: We describe the use of the framework developed for the description of nonrandomized feasibility studies. Using an observational, prospective cohort study design, we will recruit mothers enrolled in WIC with a child aged ≤2 years. Participants will receive automated SMS text messages aimed at improving the redemption of WIC-approved foods to improve the participants’ diet quality for 12 weeks. All outcome measures will be analyzed using descriptive and inferential statistics. Qualitative data will be analyzed using thematic analysis. Results: Data collection for this study began in March 2021. We expect the study results to be available within 9 months of study commencement. The results will shed light on the feasibility, acceptability, and effectiveness of using automated text messages as a behavior change strategy for mothers enrolled in WIC. Conclusions: The results of this pilot study will explore whether this digital behavioral intervention, which will deliver nutrition guidance in accordance with the Dietary Guidelines for Americans using interactive self-monitoring and feedback, is feasible and acceptable. This will lay the foundation for a larger evaluation to determine efficacy for improving diet quality in those most at risk for obesity. Trial Registration: ClinicalTrials.gov NCT04098016; https://clinicaltrials.gov/ct2/show/NCT04098016 International Registered Report Identifier (IRRID): DERR1-10.2196/32441 %M 34914616 %R 10.2196/32441 %U https://www.researchprotocols.org/2021/12/e32441 %U https://doi.org/10.2196/32441 %U http://www.ncbi.nlm.nih.gov/pubmed/34914616 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e30291 %T Long-Term Effects of a Web-Based Low-FODMAP Diet Versus Probiotic Treatment for Irritable Bowel Syndrome, Including Shotgun Analyses of Microbiota: Randomized, Double-Crossover Clinical Trial %A Ankersen,Dorit Vedel %A Weimers,Petra %A Bennedsen,Mette %A Haaber,Anne Birgitte %A Fjordside,Eva Lund %A Beber,Moritz Emanuel %A Lieven,Christian %A Saboori,Sanaz %A Vad,Nicolai %A Rannem,Terje %A Marker,Dorte %A Paridaens,Kristine %A Frahm,Suzanne %A Jensen,Lisbeth %A Rosager Hansen,Malte %A Burisch,Johan %A Munkholm,Pia %+ Department of Gastroenterology, North Zealand University Hospital, Frederikssundsvej 30, Frederikssund, 3600, Denmark, 45 48292078, pia.munkholm@regionh.dk %K irritable bowel syndrome %K web-based low-FODMAP diet %K probiotics %K randomized trial %K web-based %K IBS %K symptom management %K treatment outcomes %K outcomes %K treatment %K microbiota %K microbiome %K gastroenterology %K mobile app %K mHealth %K eHealth %D 2021 %7 14.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The long-term management of irritable bowel syndrome (IBS) poses many challenges. In short-term studies, eHealth interventions have been demonstrated to be safe and practical for at-home monitoring of the effects of probiotic treatments and a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs). IBS has been linked to alterations in the microbiota. Objective: The aim of this study was to determine whether a web-based low-FODMAP diet (LFD) intervention and probiotic treatment were equally good at reducing IBS symptoms, and whether the response to treatments could be explained by patients’ microbiota. Methods: Adult IBS patients were enrolled in an open-label, randomized crossover trial (for nonresponders) with 1 year of follow-up using the web application IBS Constant Care (IBS CC). Patients were recruited from the outpatient clinic at the Department of Gastroenterology, North Zealand University Hospital, Denmark. Patients received either VSL#3 for 4 weeks (2 × 450 billion colony-forming units per day) or were placed on an LFD for 4 weeks. Patients responding to the LFD were reintroduced to foods high in FODMAPs, and probiotic responders received treatments whenever they experienced a flare-up of symptoms. Treatment response and symptom flare-ups were defined as a reduction or increase, respectively, of at least 50 points on the IBS Severity Scoring System (IBS-SSS). Web-based ward rounds were performed daily by the study investigator. Fecal microbiota were analyzed by shotgun metagenomic sequencing (at least 10 million 2 × 100 bp paired-end sequencing reads per sample). Results: A total of 34 IBS patients without comorbidities and 6 healthy controls were enrolled in the study. Taken from participating subjects, 180 fecal samples were analyzed for their microbiota composition. Out of 21 IBS patients, 12 (57%) responded to the LFD and 8 (38%) completed the reintroduction of FODMAPs. Out of 21 patients, 13 (62%) responded to their first treatment of VSL#3 and 7 (33%) responded to multiple VSL#3 treatments. A median of 3 (IQR 2.25-3.75) probiotic treatments were needed for sustained symptom control. LFD responders were reintroduced to a median of 14.50 (IQR 7.25-21.75) high-FODMAP items. No significant difference in the median reduction of IBS-SSS for LFD versus probiotic responders was observed, where for LFD it was –126.50 (IQR –196.75 to –76.75) and for VSL#3 it was –130.00 (IQR –211.00 to –70.50; P>.99). Responses to either of the two treatments were not able to be predicted using patients’ microbiota. Conclusions: The web-based LFD intervention and probiotic treatment were equally efficacious in managing IBS symptoms. The response to treatments could not be explained by the composition of the microbiota. The IBS CC web application was shown to be practical, safe, and useful for clinical decision making in the long-term management of IBS. Although this study was underpowered, findings from this study warrant further research in a larger sample of patients with IBS to confirm these long-term outcomes. Trial Registration: ClinicalTrials.gov NCT03586622; https://clinicaltrials.gov/ct2/show/NCT03586622 %M 34904950 %R 10.2196/30291 %U https://www.jmir.org/2021/12/e30291 %U https://doi.org/10.2196/30291 %U http://www.ncbi.nlm.nih.gov/pubmed/34904950 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e26988 %T Use of Natural Spoken Language With Automated Mapping of Self-reported Food Intake to Food Composition Data for Low-Burden Real-time Dietary Assessment: Method Comparison Study %A Taylor,Salima %A Korpusik,Mandy %A Das,Sai %A Gilhooly,Cheryl %A Simpson,Ryan %A Glass,James %A Roberts,Susan %+ Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA, 02111, United States, 1 617 556 3238, susan.roberts@tufts.edu %K energy intake %K macronutrient intakes %K 24-hour recall %K machine learning %K convolutional neural networks %K nutrition %K diet %K app %K natural language processing %D 2021 %7 6.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Self-monitoring food intake is a cornerstone of national recommendations for health, but existing apps for this purpose are burdensome for users and researchers, which limits use. Objective: We developed and pilot tested a new app (COCO Nutritionist) that combines speech understanding technology with technologies for mapping foods to appropriate food composition codes in national databases, for lower-burden and automated nutritional analysis of self-reported dietary intake. Methods: COCO was compared with the multiple-pass, interviewer-administered 24-hour recall method for assessment of energy intake. COCO was used for 5 consecutive days, and 24-hour dietary recalls were obtained for two of the days. Participants were 35 women and men with a mean age of 28 (range 20-58) years and mean BMI of 24 (range 17-48) kg/m2. Results: There was no significant difference in energy intake between values obtained by COCO and 24-hour recall for days when both methods were used (mean 2092, SD 1044 kcal versus mean 2030, SD 687 kcal, P=.70). There were also no significant differences between the methods for percent of energy from protein, carbohydrate, and fat (P=.27-.89), and no trend in energy intake obtained with COCO over the entire 5-day study period (P=.19). Conclusions: This first demonstration of a dietary assessment method using natural spoken language to map reported foods to food composition codes demonstrates a promising new approach to automate assessments of dietary intake. %M 34874885 %R 10.2196/26988 %U https://www.jmir.org/2021/12/e26988 %U https://doi.org/10.2196/26988 %U http://www.ncbi.nlm.nih.gov/pubmed/34874885 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e27512 %T The Use of Food Images and Crowdsourcing to Capture Real-time Eating Behaviors: Acceptability and Usability Study %A Harrington,Katharine %A Zenk,Shannon N %A Van Horn,Linda %A Giurini,Lauren %A Mahakala,Nithya %A Kershaw,Kiarri N %+ Northwestern University Feinberg School of Medicine, 680 N Lake Shore, Suite 1400, Chicago, IL, 60611, United States, 1 312 503 4014, k-kershaw@northwestern.edu %K ecological momentary assessment %K eating behaviors %K crowdsourcing %K food consumption images %K food image processing %K mobile phone %D 2021 %7 2.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: As poor diet quality is a significant risk factor for multiple noncommunicable diseases prevalent in the United States, it is important that methods be developed to accurately capture eating behavior data. There is growing interest in the use of ecological momentary assessments to collect data on health behaviors and their predictors on a micro timescale (at different points within or across days); however, documenting eating behaviors remains a challenge. Objective: This pilot study (N=48) aims to examine the feasibility—usability and acceptability—of using smartphone-captured and crowdsource-labeled images to document eating behaviors in real time. Methods: Participants completed the Block Fat/Sugar/Fruit/Vegetable Screener to provide a measure of their typical eating behavior, then took pictures of their meals and snacks and answered brief survey questions for 7 consecutive days using a commercially available smartphone app. Participant acceptability was determined through a questionnaire regarding their experiences administered at the end of the study. The images of meals and snacks were uploaded to Amazon Mechanical Turk (MTurk), a crowdsourcing distributed human intelligence platform, where 2 Workers assigned a count of food categories to the images (fruits, vegetables, salty snacks, and sweet snacks). The agreement among MTurk Workers was assessed, and weekly food counts were calculated and compared with the Screener responses. Results: Participants reported little difficulty in uploading photographs and remembered to take photographs most of the time. Crowdsource-labeled images (n=1014) showed moderate agreement between the MTurk Worker responses for vegetables (688/1014, 67.85%) and high agreement for all other food categories (871/1014, 85.89% for fruits; 847/1014, 83.53% for salty snacks, and 833/1014, 81.15% for sweet snacks). There were no significant differences in weekly food consumption between the food images and the Block Screener, suggesting that this approach may measure typical eating behaviors as accurately as traditional methods, with lesser burden on participants. Conclusions: Our approach offers a potentially time-efficient and cost-effective strategy for capturing eating events in real time. %M 34860666 %R 10.2196/27512 %U https://formative.jmir.org/2021/12/e27512 %U https://doi.org/10.2196/27512 %U http://www.ncbi.nlm.nih.gov/pubmed/34860666 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e28608 %T Consumption of Ultraprocessed Foods in a Sample of Adolescents With Obesity and Its Association With the Food Educational Style of Their Parent: Observational Study %A Borloz,Sylvie %A Bucher Della Torre,Sophie %A Collet,Tinh-Hai %A Jotterand Chaparro,Corinne %+ Pediatric Service, Department Woman-Mother-Child, Lausanne University Hospital (CHUV), Montetan 14, Lausanne, 1004, Switzerland, 41 795568409, sylvie.borloz@chuv.ch %K adolescent %K obesity %K ultraprocessed foods %K qualitative food intake %K food educational style %K smartphone application %D 2021 %7 15.11.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Both parental education and the food environment influence dietary intake and may therefore contribute to childhood obesity. Objective: We aimed to assess the consumption of ultraprocessed foods (UPFs) in a convenience sample of adolescents with obesity and to determine its association with the food educational style of their parent. Methods: This observational study included 24 participants, 12 adolescents (8 boys and 4 girls) aged from 12 to 14 years and their 12 parents, who were followed in a specialized pediatric obesity clinic in the French-speaking part of Switzerland. The adolescents were asked to take a photograph with a smartphone application of all meals and beverages consumed in their daily routine over 14 consecutive days. They evaluated their parent’s food educational style using the Kids’ Child Feeding Questionnaire. The parent who was present at the study visits also completed the Feeding Style Questionnaire. A dietitian analyzed the pictures to extract food group portions and to identify UPFs using the NOVA classification. A nonparametric statistical test was used to investigate associations between UPF intake and food educational style. Results: Overall, the adolescents had unbalanced dietary habits compared to national recommendations. They consumed an insufficient quantity of vegetables, fruits, dairy products, and starchy foods and an excessive amount of meat portions and sugary and fatty products compared to the current Swiss recommendations. Their consumption of UPFs accounted for 20% of their food intake. All adolescents defined their parent as being restrictive in terms of diet, with a mean parental restriction score of 3.3±SD 0.4 (norm median=2.1). No parent reported a permissive food educational style. A higher intake of UPFs was associated with a lower parental restriction score (P=.04). Conclusions: Despite being followed in a specialized pediatric obesity clinic, this small group of adolescents had an unbalanced diet, which included 20% UPFs. The intake of UPFs was lower in participants whose parent was more restrictive, suggesting the importance of parents as role models and to provide adequate food at home. Trial Registration: ClinicalTrials.gov NCT03241121; https://clinicaltrials.gov/ct2/show/NCT03241121 %M 34779776 %R 10.2196/28608 %U https://pediatrics.jmir.org/2021/4/e28608 %U https://doi.org/10.2196/28608 %U http://www.ncbi.nlm.nih.gov/pubmed/34779776 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 6 %N 4 %P e32298 %T Changes in Glycemic Control Among Individuals With Diabetes Who Used a Personalized Digital Nutrition Platform: Longitudinal Study %A Shea,Benjamin %A Bakre,Shivani %A Carano,Keaton %A Scharen,Jared %A Langheier,Jason %A Hu,Emily A %+ Foodsmart, 595 Pacific Ave, 4th Fl., San Francisco, CA, 94133, United States, 1 7818669200, emily.hu@foodsmart.com %K diabetes %K hyperglycemia %K hemoglobin A1c %K HbA1c %K blood glucose %K digital health %K nutrition %K meal planning %K food environment %K food ordering %K food purchasing %K platform %K longitudinal %K characteristic %K diet %K education %D 2021 %7 18.10.2021 %9 Original Paper %J JMIR Diabetes %G English %X Background: Diabetes-related costs are the highest across all chronic conditions in the United States, with type 2 diabetes accounting for up to 95% of all cases of diabetes. A healthy diet is strongly associated with lowering glycated hemoglobin A1c (HbA1c) levels among individuals with diabetes, which can help curtail other health complications. Digital health platforms can offer critical support for improving diet and glycemic control among individuals with diabetes. Less is known about the characteristics of people with diabetes who use digital health platforms (specifically, a platform that integrates personalized healthy meal plans and food ordering) and changes in their HbA1c levels. Objective: The aim of this study is to characterize Foodsmart users with diabetes and evaluate the longitudinal impact of Foodsmart—a personalized digital nutrition platform with meal planning, food ordering, and nutrition education features—on changes in HbA1c levels. Methods: We retrospectively analyzed data collected from 643 adults with at least two self-reported HbA1c entries in the Foodsmart platform between January 2016 and June 2021. Participants self-reported their HbA1c levels, height, weight, health conditions, and diet in a 53-item food frequency questionnaire. Diabetes was defined as HbA1c ≥6.5%. We analyzed distributions of characteristics by baseline diabetes status and examined the association of characteristics with the likelihood of having diabetes at baseline. To evaluate the change in HbA1c levels among Foodsmart users, we calculated mean changes (absolute and percent) in HbA1c among participants with diabetes and by length of follow-up. We also compared changes in HbA1c and weight between participants with diabetes at baseline who achieved a normal HbA1c level and those who did not. Results: We found that 43.5% (280/643) of the participants with at least two HbA1c level entries had diabetes at baseline. Participants with diabetes at baseline were more likely to be male, have a higher weight and BMI, report high blood pressure, and have a poorer diet in comparison to participants without diabetes. Using a multivariable logistic regression model, we found that being male and obese were statistically significantly associated with baseline diabetes. Among participants with diabetes at baseline, HbA1c was reduced, on average, by 0.46%. In addition, 21.4% (60/280) of participants with diabetes achieved a normal HbA1c level (<6.5%) in their last HbA1c level entry; this percentage increased with longer follow-up time (39% [7/18] at >24 months). In a sensitivity analysis, users with an HbA1c ≥7.0% at baseline had an average absolute change of –0.62% and 31.2% (62/199) of these participants achieved HbA1c levels of less than 7.0%. Conclusions: This study assessed characteristics of individuals enrolled on the Foodsmart platform with HbA1c levels and found that users with diabetes had lower HbA1c levels over time and a sizable percentage of participants were successful in achieving normal levels. %M 34661545 %R 10.2196/32298 %U https://diabetes.jmir.org/2021/4/e32298 %U https://doi.org/10.2196/32298 %U http://www.ncbi.nlm.nih.gov/pubmed/34661545 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e31273 %T Supporting Mental Health During the COVID-19 Pandemic Using a Digital Behavior Change Intervention: An Open-Label, Single-Arm, Pre-Post Intervention Study %A Summers,Charlotte %A Wu,Philip %A Taylor,Alisdair J G %+ DDM Health, Technology House, Science Park, University of Warwick, Coventry, CV4 7EZ, United Kingdom, 44 7969091134, charlotte@ddm.health %K stress %K mental health %K COVID-19 %K digital therapy %K mHealth %K support %K behavior %K intervention %K online intervention %K outcome %K wellbeing %K sleep %K activity %K nutrition %D 2021 %7 6.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic is taking a toll on people’s mental health, particularly as people are advised to adhere to social distancing, self-isolation measures, and government-imposed national lockdowns. Digital health technologies have an important role to play in keeping people connected and in supporting their mental health and well-being. Even before the COVID-19 pandemic, mental health and social services were already strained. Objective: Our objective was to evaluate the 12-week outcomes of the digitally delivered Gro Health intervention, a holistic digital behavior change app designed for self-management of mental well-being, sleep, activity, and nutrition. Methods: The study used a quasi-experimental research design consisting of an open-label, single-arm, pre-post intervention engagement using a convenience sample. Adults who had joined the Gro Health app (intervention) and had a complete baseline dataset (ie, 7-item Generalized Anxiety Disorder scale, Perceived Stress Scale, and 9-item Patient Health Questionnaire) were followed up at 12 weeks (n=273), including 33 (12.1%) app users who reported a positive COVID-19 diagnosis during the study period. User engagement with the Gro Health platform was tracked by measuring total minutes of app engagement. Paired t tests were used to compare pre-post intervention scores. Linear regression analysis was performed to assess the relationship between minutes of active engagement with the Gro Health app and changes in scores across the different mental health measures. Results: Of the 347 study participants, 273 (78.67%) completed both the baseline and follow-up surveys. Changes in scores for anxiety, perceived stress, and depression were predicted by app engagement, with the strongest effect observed for changes in perceived stress score (F1,271=251.397; R2=0.479; P<.001). Conclusions: A digital behavior change platform that provides remote mental well-being support can be effective in managing depression, anxiety, and perceived stress during times of crisis such as the current COVID-19 pandemic. The outcomes of this study may also support the implementation of remote digital health apps supporting behavior change and providing support for low levels of mental health within the community. %M 34459740 %R 10.2196/31273 %U https://formative.jmir.org/2021/10/e31273 %U https://doi.org/10.2196/31273 %U http://www.ncbi.nlm.nih.gov/pubmed/34459740 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e26054 %T Effectiveness of a Multistrategy Behavioral Intervention to Increase the Nutritional Quality of Primary School Students’ Web-Based Canteen Lunch Orders (Click & Crunch): Cluster Randomized Controlled Trial %A Wyse,Rebecca %A Delaney,Tessa %A Stacey,Fiona %A Zoetemeyer,Rachel %A Lecathelinais,Christophe %A Lamont,Hannah %A Ball,Kylie %A Campbell,Karen %A Rissel,Chris %A Attia,John %A Wiggers,John %A Yoong,Sze Lin %A Oldmeadow,Christopher %A Sutherland,Rachel %A Nathan,Nicole %A Reilly,Kathryn %A Wolfenden,Luke %+ School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia, 61 49246310, rebecca.wyse@health.nsw.gov.au %K nudge %K choice architecture %K intervention %K online canteen %K online ordering systems %K digital interventions %K school children %K school food service %K canteens %K menu labeling %D 2021 %7 7.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: School food outlets represent a key setting for public health nutrition intervention. The recent proliferation of web-based food ordering systems provides a unique opportunity to support healthy purchasing from schools. Embedding evidence-based choice architecture strategies within these routinely used systems provides the opportunity to impact the purchasing decisions of many users simultaneously and warrants investigation. Objective: This study aims to assess the effectiveness of a multistrategy behavioral intervention implemented via a web-based school canteen lunch ordering system in reducing the energy, saturated fat, sugar, and sodium content of primary students’ web-based lunch orders. Methods: The study used a parallel-group, cohort, cluster randomized controlled trial design with 2207 students from 17 Australian primary schools. Schools with a web-based canteen lunch ordering system were randomly assigned to receive either a multistrategy behavioral intervention that included choice architecture strategies embedded in the web-based system (n=9 schools) or the standard web-based ordering system only (n=8 control schools). Automatically collected student purchasing data at baseline (term 2, 2018) and 12 months later (term 2, 2019) were used to assess trial outcomes. Primary trial outcomes included the mean energy (kJ), saturated fat (g), sugar (g), and sodium (mg) content of student lunch orders. Secondary outcomes included the proportion of all web-based lunch order items classified as everyday, occasional, and caution (based on the New South Wales Healthy School Canteen Strategy) and canteen revenue. Results: From baseline to follow-up, the intervention lunch orders had significantly lower energy content (−69.4 kJ, 95% CI −119.6 to −19.1; P=.01) and saturated fat content (−0.6 g, 95% CI −0.9 to −0.4; P<.001) than the control lunch orders, but they did not have significantly lower sugar or sodium content. There was also a small significant between-group difference in the percentage of energy from saturated fat (−0.9%, 95% CI −1.4% to −0.5%; P<.001) but not in the percentage of energy from sugar (+1.1%, 95% CI 0.2% to 1.9%; P=.02). Relative to control schools, intervention schools had significantly greater odds of having everyday items purchased (odds ratio [OR] 1.7, 95% CI 1.5-2.0; P<.001), corresponding to a 9.8% increase in everyday items, and lower odds of having occasional items purchased (OR 0.7, 95% CI 0.6-0.8; P<.001), corresponding to a 7.7% decrease in occasional items); however, there was no change in the odds of having caution (least healthy) items purchased (OR 0.8, 95% CI 0.7-1.0; P=.05). Furthermore, there was no change in schools’ revenue between groups. Conclusions: Given the evidence of small statistically significant improvements in the energy and saturated fat content, acceptability, and wide reach, this intervention has the potential to influence dietary choices at a population level, and further research is warranted to determine its impact when implemented at scale. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618000855224; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375075. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-030538 %M 34491207 %R 10.2196/26054 %U https://www.jmir.org/2021/9/e26054 %U https://doi.org/10.2196/26054 %U http://www.ncbi.nlm.nih.gov/pubmed/34491207 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 6 %N 3 %P e28930 %T Abbreviated Dietary Self-monitoring for Type 2 Diabetes Management: Mixed Methods Feasibility Study %A Richardson,Kelli Marie %A Cota Aguirre,Gloria %A Weiss,Rick %A Cinar,Ali %A Liao,Yue %A Marano,Kari %A Bedoya,Arianna R %A Schembre,Susan %+ Department of Family and Community Medicine, College of Medicine, University of Arizona, 3950 S Country Club Rd, Tucson, AZ, 85714, United States, 1 520 626 7864, sschembre@arizona.edu %K diabetes mellitus, type 2 %K diet, diabetic %K feasibility studies %K diet records %K dietary carbohydrates %D 2021 %7 12.8.2021 %9 Original Paper %J JMIR Diabetes %G English %X Background: Type 2 diabetes mellitus (T2D) can be managed through diet and lifestyle changes. The American Diabetes Association acknowledges that knowing what and when to eat is the most challenging aspect of diabetes management. Although current recommendations for self-monitoring of diet and glucose levels aim to improve glycemic stability among people with T2D, tracking all intake is burdensome and unsustainable. Thus, dietary self-monitoring approaches that are equally effective but are less burdensome should be explored. Objective: This study aims to examine the feasibility of an abbreviated dietary self-monitoring approach in patients with T2D, in which only carbohydrate-containing foods are recorded in a diet tracker. Methods: We used a mixed methods approach to quantitatively and qualitatively assess general and diet-related diabetes knowledge and the acceptability of reporting only carbohydrate-containing foods in 30 men and women with T2D. Results: The mean Diabetes Knowledge Test score was 83.9% (SD 14.2%). Only 20% (6/30) of participants correctly categorized 5 commonly consumed carbohydrate-containing foods and 5 noncarbohydrate-containing foods. The mean perceived difficulty of reporting only carbohydrate-containing foods was 5.3 on a 10-point scale. Approximately half of the participants (16/30, 53%) preferred to record all foods. A lack of knowledge about carbohydrate-containing foods was the primary cited barrier to acceptability (12/30, 40%). Conclusions: Abbreviated dietary self-monitoring in which only carbohydrate-containing foods are reported is likely not feasible because of limited carbohydrate-specific knowledge and a preference of most participants to report all foods. Other approaches to reduce the burden of dietary self-monitoring for people with T2D that do not rely on food-specific knowledge could be more feasible. %M 34387551 %R 10.2196/28930 %U https://diabetes.jmir.org/2021/3/e28930 %U https://doi.org/10.2196/28930 %U http://www.ncbi.nlm.nih.gov/pubmed/34387551 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 3 %P e27452 %T Designing Consumer Health Information Technology to Support Biform and Articulation Work: A Qualitative Study of Diet and Nutrition Management as Patient Work %A Rogers,Courtney C %A Moutinho Jr,Thomas J %A Liu,Xiaoyue %A Valdez,Rupa S %+ Department of Public Health Sciences, University of Virginia, PO Box 800717, Hospital West Complex, Charlottesville, VA, 22908, United States, 1 434 982 2510, rsv9d@virginia.edu %K Crohn disease %K inflammatory bowel diseases %K chronic disease %K self-management %K consumer health information technology %K qualitative research %K user-centered design %K patient work %K context %K articulation work %K diet %K nutrition %D 2021 %7 10.8.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Diet and nutrition management is an integral component of Crohn disease (CD) management. This type of management is highly variable and individualized and, thus, requires personalized approaches. Consumer health information technology (CHIT) designed to support CD management has typically supported this task as everyday life work and, not necessarily, as illness work. Moreover, CHIT has rarely supported the ways in which diet and nutrition management requires coordination between multiple forms of patient work. Objective: The purpose of this study was to investigate diet and nutrition management as biform work, identify components of articulation work, and provide guidance on how to design CHIT to support this work. Methods: We performed a qualitative study in which we recruited participants from CD-related Facebook pages and groups. Results: Semistructured interviews with 21 individuals showed that diet and nutrition management strategies were highly individualized and variable. Four themes emerged from the data, emphasizing the interactions of diet and nutrition with physical, emotional, information, and technology-enabled management. Conclusions: This study shows that the extent to which diet and nutrition management is biform work fluctuates over time and that articulation work can be continuous and unplanned. The design guidance specifies the need for patient-facing technologies to support interactions among diet and nutrition and other management activities such as medication intake, stress reduction, and information seeking, as well as to respond to the ways in which diet and nutrition management needs change over time. %M 34383664 %R 10.2196/27452 %U https://humanfactors.jmir.org/2021/3/e27452 %U https://doi.org/10.2196/27452 %U http://www.ncbi.nlm.nih.gov/pubmed/34383664 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e27885 %T Perspectives and Preferences of Adult Smartphone Users Regarding Nutrition and Diet Apps: Web-Based Survey Study %A Vasiloglou,Maria F %A Christodoulidis,Stergios %A Reber,Emilie %A Stathopoulou,Thomai %A Lu,Ya %A Stanga,Zeno %A Mougiakakou,Stavroula %+ ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse 50, 3008, Bern, Switzerland, 41 316327592, stavroula.mougiakakou@artorg.unibe.ch %K dietary assessment %K end-users %K mHealth %K mobile apps %K smartphone %K survey %K apps %K nutrition %K diet %K mobile health %K users %K behavior %K behavior change %D 2021 %7 30.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital technologies have evolved dramatically in recent years, finding applications in a variety of aspects of everyday life. Smartphones and mobile apps are being used for a steadily increasing number of tasks, including health monitoring. A large number of nutrition and diet apps are available, and some of them are very popular in terms of user downloads, highlighting a trend toward diet monitoring and assessment. Objective: We sought to explore the perspectives of end users on the features, current use, and acceptance of nutrition and diet mHealth apps with a survey. We expect that this study can provide user insights to assist researchers and developers in achieving innovative dietary assessments. Methods: A multidisciplinary team designed and compiled the survey. Before its release, it was pilot-tested by 18 end users. A 19-question survey was finally developed and was translated into six languages: English, German, French, Spanish, Italian, and Greek. The participants were mainly recruited via social media platforms and mailing lists of universities, university hospitals, and patient associations. Results: A total of 2382 respondents (1891 female, 79.4%; 474 male, 19.9%; and 17 neither, 0.7%) with a mean age of 27.2 years (SD 8.5) completed the survey. Approximately half of the participants (1227/2382, 51.5%) had used a nutrition and diet app. The primary criteria for selecting such an app were ease of use (1570/2382, 65.9%), free cost (1413/2382, 59.3%), and ability to produce automatic readings of caloric content (1231/2382, 51.7%) and macronutrient content (1117/2382, 46.9%) (ie, food type and portion size are estimated by the system without any contribution from the user). An app was less likely to be selected if it incorrectly estimated portion size, calories, or nutrient content (798/2382, 33.5%). Other important limitations included the use of a database that does not include local foods (655/2382, 27.5%) or that may omit major foods (977/2382, 41%). Conclusions: This comprehensive study in a mostly European population assessed the preferences and perspectives of potential nutrition and diet app users. Understanding user needs will benefit researchers who develop tools for innovative dietary assessment as well as those who assist research on behavioral changes related to nutrition. %M 34328425 %R 10.2196/27885 %U https://mhealth.jmir.org/2021/7/e27885 %U https://doi.org/10.2196/27885 %U http://www.ncbi.nlm.nih.gov/pubmed/34328425 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e26297 %T Development of a Mobile App for Ecological Momentary Assessment of Circadian Data: Design Considerations and Usability Testing %A Woolf,Thomas B %A Goheer,Attia %A Holzhauer,Katherine %A Martinez,Jonathan %A Coughlin,Janelle W %A Martin,Lindsay %A Zhao,Di %A Song,Shanshan %A Ahmad,Yanif %A Sokolinskyi,Kostiantyn %A Remayeva,Tetyana %A Clark,Jeanne M %A Bennett,Wendy %A Lehmann,Harold %+ Department of Physiology, Johns Hopkins University School of Medicine, 725 N Wolfe St, Baltimore, MD, 21205, United States, 1 410 416 2643, twoolf@jhu.edu %K mhealth %K circadian %K sleep %K ecological momentary assessment %K timing of eating %K mobile applications %K habits %K body weight %K surveys and questionnaires %D 2021 %7 23.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Collecting data on daily habits across a population of individuals is challenging. Mobile-based circadian ecological momentary assessment (cEMA) is a powerful frame for observing the impact of daily living on long-term health. Objective: In this paper, we (1) describe the design, testing, and rationale for specifications of a mobile-based cEMA app to collect timing of eating and sleeping data and (2) compare cEMA and survey data collected as part of a 6-month observational cohort study. The ultimate goal of this paper is to summarize our experience and lessons learned with the Daily24 mobile app and to highlight the pros and cons of this data collection modality. Methods: Design specifications for the Daily24 app were drafted by the study team based on the research questions and target audience for the cohort study. The associated backend was optimized to provide real-time data to the study team for participant monitoring and engagement. An external 8-member advisory board was consulted throughout the development process, and additional test users recruited as part of a qualitative study provided feedback through in-depth interviews. Results: After ≥4 days of at-home use, 37 qualitative study participants provided feedback on the app. The app generally received positive feedback from test users for being fast and easy to use. Test users identified several bugs and areas where modifications were necessary to in-app text and instructions and also provided feedback on the engagement strategy. Data collected through the mobile app captured more variability in eating windows than data collected through a one-time survey, though at a significant cost. Conclusions: Researchers should consider the potential uses of a mobile app beyond the initial data collection when deciding whether the time and monetary expenditure are advisable for their situation and goals. %M 34296999 %R 10.2196/26297 %U https://formative.jmir.org/2021/7/e26297 %U https://doi.org/10.2196/26297 %U http://www.ncbi.nlm.nih.gov/pubmed/34296999 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e17780 %T Measuring the Healthiness of Ready-to-Eat Child-Targeted Cereals: Evaluation of the FoodSwitch Platform in Sweden %A Mottas,Antoine %A Lappi,Veli-Matti %A Sundström,Johan %A Neal,Bruce %A Mhurchu,Cliona Ni %A Löf,Marie %A Rådholm,Karin %+ Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, SE-58183, Sweden, 46 13 281756, karin.radholm@liu.se %K breakfast cereals %K child-targeted cereals %K front-of-pack labels %K Keyhole symbol %K Health Star Rating %K FoodSwitch %K diet %K food intake %D 2021 %7 22.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Childhood obesity is a major public health issue. The increase in the consumption of foods with poor nutritional value, such as processed foods, contributes to this. Breakfast cereals are often advertised as a healthy way to start the day, but the healthiness of these products varies greatly. Objective: Our main objective was to gather information about the nutritional characteristics of ready-to-eat breakfast cereals in Sweden and to investigate the healthiness of products targeted at children compared to other cereals by use of the FoodSwitch platform. A secondary objective was to evaluate the alignment between the Keyhole symbol and the Health Star Rating. Methods: The FoodSwitch app is a mobile health (mHealth) tool used to present nutrition data and healthier alternative products to consumers. Ready-to-eat breakfast cereals from the largest Swedish grocery retailers were collected using the FoodSwitch platform. Products were defined as targeting children if they presented features addressing children on the package. Results: Overall, information on 261 ready-to-eat cereals was examined. Of this total, 8% (n=21) were targeted at children. Child-targeted cereals were higher in sugar (22.3 g/100 g vs 12.8 g/100 g, P<.001) and lower in fiber (6.2 g/100 g vs 9.8 g/100 g, P<.001) and protein (8.1 g/100 g vs 10.5 g/100 g, P<.001). Total fat (3 g/100 g vs 10.5 g/100 g, P<.001) and saturated fat (0.8 g/100 g vs 2.6 g/100 g, P<.001) were also lower. No difference was found in salt content (P=.61). Fewer child-targeted breakfast cereals displayed an on-pack Keyhole label (n=1, 5% vs n=53, 22%; P=.06), and the mean Health Star Rating value was 3.5 for child-targeted cereals compared to others (mean 3.8, P=.07). A correlation was found between the Keyhole symbol and the Health Star Rating. Conclusions: Ready-to-eat breakfast cereals targeted at children were less healthy in terms of sugar and fiber content compared to products not targeted at children. There is a need to improve the nutritional quality of child-targeted cereals. %M 34292165 %R 10.2196/17780 %U https://mhealth.jmir.org/2021/7/e17780 %U https://doi.org/10.2196/17780 %U http://www.ncbi.nlm.nih.gov/pubmed/34292165 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e22693 %T Mobile Ecological Momentary Assessment and Intervention and Health Behavior Change Among Adults in Rakai, Uganda: Pilot Randomized Controlled Trial %A Beres,Laura K %A Mbabali,Ismail %A Anok,Aggrey %A Katabalwa,Charles %A Mulamba,Jeremiah %A Thomas,Alvin G %A Bugos,Eva %A Nakigozi,Gertrude %A Grabowski,Mary K %A Chang,Larry W %+ Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E5031, Baltimore, MD, 21205, United States, 1 410 955 7159, laura.beres@jhu.edu %K ecological momentary assessment %K ecological momentary intervention %K mHealth %K digital health %K smartphone %K mobile phone %K randomized trial %K Uganda %K Africa %D 2021 %7 20.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: An extraordinary increase in mobile phone ownership has revolutionized the opportunities to use mobile health approaches in lower- and middle-income countries (LMICs). Ecological momentary assessment and intervention (EMAI) uses mobile technology to gather data and deliver timely, personalized behavior change interventions in an individual’s natural setting. To our knowledge, there have been no previous trials of EMAI in sub-Saharan Africa. Objective: To advance the evidence base for mobile health (mHealth) interventions in LMICs, we conduct a pilot randomized trial to assess the feasibility of EMAI and establish estimates of the potential effect of EMAI on a range of health-related behaviors in Rakai, Uganda. Methods: This prospective, parallel-group, randomized pilot trial compared health behaviors between adult participants submitting ecological momentary assessment (EMA) data and receiving behaviorally responsive interventional health messaging (EMAI) with those submitting EMA data alone. Using a fully automated mobile phone app, participants submitted daily reports on 5 different health behaviors (fruit consumption, vegetable consumption, alcohol intake, cigarette smoking, and condomless sex with a non–long-term partner) during a 30-day period before randomization (P1). Participants were then block randomized to the control arm, continuing EMA reporting through exit, or the intervention arm, EMA reporting and behavioral health messaging receipt. Participants exited after 90 days of follow-up, divided into study periods 2 (P2: randomization + 29 days) and 3 (P3: 30 days postrandomization to exit). We used descriptive statistics to assess the feasibility of EMAI through the completeness of data and differences in reported behaviors between periods and study arms. Results: The study included 48 participants (24 per arm; 23/48, 48% women; median age 31 years). EMA data collection was feasible, with 85.5% (3777/4418) of the combined days reporting behavioral data. There was a decrease in the mean proportion of days when alcohol was consumed in both arms over time (control: P1, 9.6% of days to P2, 4.3% of days; intervention: P1, 7.2% of days to P3, 2.4% of days). Decreases in sex with a non–long-term partner without a condom were also reported in both arms (P1 to P3 control: 1.9% of days to 1% of days; intervention: 6.6% of days to 1.3% of days). An increase in vegetable consumption was found in the intervention (vegetable: 65.6% of days to 76.6% of days) but not in the control arm. Between arms, there was a significant difference in the change in reported vegetable consumption between P1 and P3 (control: 8% decrease in the mean proportion of days vegetables consumed; intervention: 11.1% increase; P=.01). Conclusions: Preliminary estimates suggest that EMAI may be a promising strategy for promoting behavior change across a range of behaviors. Larger trials examining the effectiveness of EMAI in LMICs are warranted. Trial Registration: ClinicalTrials.gov NCT04375423; https://www.clinicaltrials.gov/ct2/show/NCT04375423 %M 34283027 %R 10.2196/22693 %U https://formative.jmir.org/2021/7/e22693 %U https://doi.org/10.2196/22693 %U http://www.ncbi.nlm.nih.gov/pubmed/34283027 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e26739 %T Adolescent Levers for a Diet and Physical Activity Intervention Across Socioecological Levels in Kenya, South Africa, Cameroon, and Jamaica: Mixed Methods Study Protocol %A Odunitan-Wayas,Feyisayo A %A Wadende,Pamela %A Mogo,Ebele R I %A Brugulat-Panés,Anna %A Micklesfield,Lisa K %A Govia,Ishtar %A Mapa-Tassou,Clarisse %A Mukoma,Gudani %A Smith,Joanne A %A Motlhalhedi,Molebogeng %A Wasnyo,Yves %A Were,Vincent %A Assah,Felix %A Okop,Kufre J %A Norris,Shane A %A Obonyo,Charles %A Mbanya,Jean Claude %A Tulloch-Reid,Marshall K %A King,Abby C %A Lambert,Estelle V %A Oni,Tolu %+ Health Through Physical Activity, Lifestyle and Sport Research Centre, Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, 3rd Floor, Sports Science Institute of South Africa, Boundary Road, Newlands, South Africa, Cape Town, 7725, South Africa, 27 843686276, feyi.odunitan-wayas@uct.ac.za %K adolescent %K food intake %K foodways %K physical activity %K noncommunicable diseases %K socioecological levers %K low and middle income countries %K health outcomes %D 2021 %7 13.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The increasing burden of noncommunicable diseases that are prevalent in low- and middle-income countries (LMICs) is largely attributed to modifiable behavioral risk factors such as unhealthy diets and insufficient physical activity (PA). The adolescent stage, defined as 10 to 24 years of age, is an important formative phase of life and offers an opportunity to reduce the risk of noncommunicable diseases across the life course and for future generations. Objective: The aim of this paper is to describe a protocol for a study using a convergent mixed methods design to explore exposures in the household, neighborhood, school, and the journey from home to school that may influence diet and PA behaviors in adolescents from LMICs. Methods: Male and female adolescents (n≥150) aged between 13 and 24 years will be recruited from selected high schools or households in project site countries to ensure the socioeconomic diversity of perspectives and experiences at the individual, home, and neighborhood levels. The project will be conducted at 5 sites in 4 countries: Kenya, Cameroon, Jamaica, and South Africa (Cape Town and Johannesburg). Data on anthropometric measures, food intake, and PA knowledge and behavior will be collected using self-report questionnaires. In addition, a small number of learners (n=30-45) from each site will be selected as citizen scientists to capture data (photographs, audio notes, text, and geolocations) on their lived experiences in relation to food and PA in their homes, the journey to and from school, and the school and neighborhood environments using a mobile app, and for objective PA measurements. In-depth interviews will be conducted with the citizen scientists and their caregivers to explore household experiences and determinants of food intake and foodways, as well as the PA of household members. Results: The study described in this protocol paper was primarily funded through a UK National Institute for Health Research grant in 2017 and approved by the relevant institutional ethics review boards in the country sites (South Africa, Cameroun, and Jamaica in 2019, and Kenya in 2020). As of December 23, 2020, we had completed data collection from adolescents (n≥150) in all the country sites, except Kenya, and data collection for the subgroup (n=30-45) is ongoing. Data analysis is ongoing and the output of findings from the study described in this protocol is expected to be published by 2022. Conclusions: This project protocol contributes to research that focuses on adolescents and the socioecological determinants of food intake and PA in LMIC settings. It includes innovative methodologies to interrogate and map the contexts of these determinants and will generate much-needed data to understand the multilevel system of factors that can be leveraged through upstream and downstream strategies and interventions to improve health outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/26739 %M 34255729 %R 10.2196/26739 %U https://www.researchprotocols.org/2021/7/e26739 %U https://doi.org/10.2196/26739 %U http://www.ncbi.nlm.nih.gov/pubmed/34255729 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e28144 %T Australian Children's Exposure to, and Engagement With, Web-Based Marketing of Food and Drink Brands: Cross-sectional Observational Study %A Kelly,Bridget %A Bosward,Rebecca %A Freeman,Becky %+ Early Start, School of Health & Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Northfields Avenue, Wollongong, 2522, Australia, 61 2 4221 3893, bkelly@uow.edu.au %K food %K beverage %K marketing %K online %K digital %D 2021 %7 12.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Food is one of the most frequently promoted commodities, and promoted foods are overwhelmingly unhealthy. Marketing normalizes unhealthy foods, creates a positive brand image, and encourages overconsumption. Limited research is available to describe the extent of food marketing to children on web-based media, and measuring actual exposure is challenging. Objective: This study aims to monitor the extent of children’s exposure to web-based media food marketing as an essential step in increasing the accountability of industry and governments to protect children. Methods: Children aged 13-17 years were recruited from October 2018 to March 2019. Children recorded their mobile device screen for 2 weekdays and 1 weekend day any time they visited relevant web-based platforms. After each day, the participants uploaded the video files to a secure server. Promoted products were defined using the World Health Organization European Region nutrient profile model. Results: The sample of 95 children uploaded 267.8 hours of video data. Children saw a median of 17.4 food promotions each hour on the internet. Considering the usual time spent on the internet on mobile devices, children would be exposed to a median of 168.4 food promotions on the web on mobile devices per week, 99.5 of which would not be permitted to be marketed based on nutrient profiling criteria. Most promotions (2613/4446, 58.77%) were peer endorsed and derived from third-party sources. Conclusions: Exposure to brand content that is seemingly endorsed by peers or web-based communities likely heightens the effects of marketing on children. Regulations to protect children from this marketing must extend beyond paid advertising to paid content in posts generated through web-based communities and influencers. %M 34255675 %R 10.2196/28144 %U https://www.jmir.org/2021/7/e28144 %U https://doi.org/10.2196/28144 %U http://www.ncbi.nlm.nih.gov/pubmed/34255675 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e25850 %T Studying Microtemporal, Within-Person Processes of Diet, Physical Activity, and Related Factors Using the APPetite-Mobile-App: Feasibility, Usability, and Validation Study %A Ruf,Alea %A Koch,Elena Doris %A Ebner-Priemer,Ulrich %A Knopf,Monika %A Reif,Andreas %A Matura,Silke %+ Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Heinrich-Hoffmann-Straße 10, Frankfurt, 60528, Germany, 49 69 6301 83348, alea.ruf@kgu.de %K diet %K physical activity %K microtemporal processes %K within-person factors %K ecological momentary assessment %K smartphone-app %K mobile phone %K mHealth %K dietary assessment %K feasibility %K usability %K validity %D 2021 %7 5.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Diet and physical activity (PA) have a major impact on physical and mental health. However, there is a lack of effective strategies for sustaining these health-protective behaviors. A shift to a microtemporal, within-person approach is needed to capture dynamic processes underlying eating behavior and PA, as they change rapidly across minutes or hours and differ among individuals. However, a tool that captures these microtemporal, within-person processes in daily life is currently not present. Objective: The APPetite-mobile-app is developed for the ecological momentary assessment of microtemporal, within-person processes of complex dietary intake, objectively recorded PA, and related factors. This study aims to evaluate the feasibility and usability of the APPetite-mobile-app and the validity of the incorporated APPetite-food record. Methods: The APPetite-mobile-app captures dietary intake event-contingently through a food record, captures PA continuously through accelerometers, and captures related factors (eg, stress) signal-contingently through 8 prompts per day. Empirical data on feasibility (n=157), usability (n=84), and validity (n=44) were collected within the Eat2beNICE-APPetite-study. Feasibility and usability were examined in healthy participants and psychiatric patients. The relative validity of the APPetite-food record was assessed with a subgroup of healthy participants by using a counterbalanced crossover design. The reference method was a 24-hour recall. In addition, the energy intake was compared with the total energy expenditure estimated from accelerometry. Results: Good feasibility, with compliance rates above 80% for prompts and the accelerometer, as well as reasonable average response and recording durations (prompt: 2.04 min; food record per day: 17.66 min) and latencies (prompts: 3.16 min; food record: 58.35 min) were found. Usability was rated as moderate, with a score of 61.9 of 100 on the System Usability Scale. The evaluation of validity identified large differences in energy and macronutrient intake between the two methods at the group and individual levels. The APPetite-food record captured higher dietary intakes, indicating a lower level of underreporting, compared with the 24-hour recall. Energy intake was assessed fairly accurately by the APPetite-food record at the group level on 2 of 3 days when compared with total energy expenditure. The comparison with mean total energy expenditure (2417.8 kcal, SD 410) showed that the 24-hour recall (1909.2 kcal, SD 478.8) underestimated habitual energy intake to a larger degree than the APPetite-food record (2146.4 kcal, SD 574.5). Conclusions: The APPetite-mobile-app is a promising tool for capturing microtemporal, within-person processes of diet, PA, and related factors in real time or near real time and is, to the best of our knowledge, the first of its kind. First evidence supports the good feasibility and moderate usability of the APPetite-mobile-app and the validity of the APPetite-food record. Future findings in this context will build the foundation for the development of personalized lifestyle modification interventions, such as just-in-time adaptive interventions. %M 34342268 %R 10.2196/25850 %U https://www.jmir.org/2021/7/e25850 %U https://doi.org/10.2196/25850 %U http://www.ncbi.nlm.nih.gov/pubmed/34342268 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e25256 %T A Multicomponent mHealth-Based Intervention (SWAP IT) to Decrease the Consumption of Discretionary Foods Packed in School Lunchboxes: Type I Effectiveness–Implementation Hybrid Cluster Randomized Controlled Trial %A Sutherland,Rachel %A Brown,Alison %A Nathan,Nicole %A Yoong,Serene %A Janssen,Lisa %A Chooi,Amelia %A Hudson,Nayerra %A Wiggers,John %A Kerr,Nicola %A Evans,Nicole %A Gillham,Karen %A Oldmeadow,Christopher %A Searles,Andrew %A Reeves,Penny %A Davies,Marc %A Reilly,Kathryn %A Cohen,Brad %A Wolfenden,Luke %+ Hunter New England Population Health, Booth Building, Longworth Avenue, Wallsend, Australia, 61 2 4924 6499, rachel.sutherland@health.nsw.gov.au %K childhood obesity %K lunchboxes %K children %K child nutrition %K mHealth %K schools %K hybrid %K randomized controlled trial %K technology %D 2021 %7 24.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: There is significant opportunity to improve the nutritional quality of foods packed in children’s school lunchboxes. Interventions that are effective and scalable targeting the school and home environment are therefore warranted. Objective: This study aimed to assess the effectiveness of a multicomponent, mobile health–based intervention, SWAP IT, in reducing the energy contribution of discretionary (ie, less healthy) foods and drinks packed for children to consume at school. Methods: A type I effectiveness–implementation hybrid cluster randomized controlled trial was conducted in 32 primary schools located across 3 local health districts in New South Wales, Australia, to compare the effects of a 6-month intervention targeting foods packed in children’s lunchboxes with those of a usual care control. Primary schools were eligible if they were not participating in other nutrition studies and used the required school communication app. The Behaviour Change Wheel was used to co-design the multicomponent SWAP IT intervention, which consisted of the following: school lunchbox nutrition guidelines, curriculum lessons, information pushed to parents digitally via an existing school communication app, and additional parent resources to address common barriers to packing healthy lunchboxes. The primary outcome, mean energy (kilojoules) content of discretionary lunchbox foods and drinks packed in lunchboxes, was measured via observation using a validated school food checklist at baseline (May 2019) and at 6-month follow-up (October 2019). Additional secondary outcomes included mean lunchbox energy from discretionary foods consumed, mean total lunchbox energy packed and consumed, mean energy content of core lunchbox foods packed and consumed, and percentage of lunchbox energy from discretionary and core foods, all of which were also measured via observation using a validated school food checklist. Measures of school engagement, consumption of discretionary foods outside of school hours, and lunchbox cost were also collected at baseline and at 6-month follow-up. Data were analyzed via hierarchical linear regression models, with controlling for clustering, socioeconomic status, and remoteness. Results: A total of 3022 (3022/7212, 41.90%) students consented to participate in the evaluation (mean age 7.8 years; 1487/3022, 49.22% girls). There were significant reductions between the intervention and control groups in the primary trial outcome, mean energy (kilojoules) content of discretionary foods packed in lunchboxes (–117.26 kJ; 95% CI –195.59 to –39.83; P=.003). Relative to the control, the intervention also significantly reduced secondary outcomes regarding the mean total lunchbox energy (kilojoules) packed (–88.38 kJ; 95% CI –172.84 to –3.92; P=.04) and consumed (–117.17 kJ; 95% CI –233.72 to –0.62; P=.05). There was no significant difference between groups in measures of student engagement, consumption of discretionary foods outside of school hours, or cost of foods packed in children’s lunchboxes. Conclusions: The SWAP IT intervention was effective in reducing the energy content of foods packed for and consumed by primary school–aged children at school. Dissemination of the SWAP IT program at a population level has the potential to influence a significant proportion of primary school–aged children, impacting weight status and associated health care costs. Trial Registration: Australian Clinical Trials Registry ACTRN12618001731280; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376191&isReview=true International Registered Report Identifier (IRRID): RR2-10.1186/s12889-019-7725-x %M 34185013 %R 10.2196/25256 %U https://www.jmir.org/2021/6/e25256/ %U https://doi.org/10.2196/25256 %U http://www.ncbi.nlm.nih.gov/pubmed/34185013 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e25043 %T Exploring the Potential of Personalized Dietary Advice for Health Improvement in Motivated Individuals With Premetabolic Syndrome: Pretest-Posttest Study %A van der Haar,Sandra %A Hoevenaars,Femke P M %A van den Brink,Willem J %A van den Broek,Tim %A Timmer,Mariëlle %A Boorsma,André %A Doets,Esmée L %+ Wageningen Food & Biobased Research, Wageningen University & Research, Bornse Weilanden 9, Wageningen, 6708 WG, Netherlands, 31 0317 480171, sandra.vanderhaar@wur.nl %K personalized nutrition %K metabolic syndrome %K dietary behavior %K diet %K metabolic %K metabolic health %K dietary advice %K dietary feedback %K digital health %D 2021 %7 24.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Dietary quality plays an essential role in the prevention and management of metabolic syndrome (MetS). Objective: The aim of this pilot study is to organize personalized dietary advice in a real-life setting and to explore the effects on dietary intake, metabolic health, and perceived health. Methods: We followed a one-group pretest-posttest design and included 37 individuals at risk of MetS, who indicated motivation to change dietary behavior. For a period of 16 weeks, participants received personalized advice (t=0 and t=8) and feedback (t=0, t=4, t=8, t=12 and t=16) on dietary quality and metabolic health (ie, waist circumference, BMI, blood pressure, lipid profile, fasting glucose levels, and C-peptide). Personalized advice was generated in a two-stage process. In stage 1, an automated algorithm generated advice per food group, integrating data on individual dietary quality (Dutch Healthy Diet Index; total score 8-80) and metabolic health parameters. Stage 2 included a telephone consultation with a trained dietitian to define a personal dietary behavior change strategy and to discuss individual preferences. Dietary quality and metabolic health markers were assessed at t=0, t=8, and t=16. Self-perceived health was evaluated on 7-point Likert scales at t=0 and t=16. Results: At the end of the study period, dietary quality was significantly improved compared with the baseline (Dutch Healthy Diet Index +4.3; P<.001). In addition, lipid profile (triglycerides, P=.02; total cholesterol, P=.01; high-density lipoprotein, P<.001; and low-density lipoprotein, P<.001), BMI (P<.001), waist circumference (P=.01), and C-peptide (P=.01) were all significantly improved, whereas plasma glucose increased by 0.23 nmol/L (P=.04). In line with these results, self-perceived health scores were higher at t=16 weeks than at baseline (+0.67; P=.005). Conclusions: This exploratory study showed that personalized dietary advice resulted in positive effects on dietary behavior, metabolic health, and self-perceived health in motivated pre-MetS adults. The study was performed in a do-it-yourself setting, highlighting the potential of at-home health improvement through dietary changes. Trial Registration: ClinicalTrials.gov NCT04595669; https://clinicaltrials.gov/ct2/show/NCT04595669 %M 34185002 %R 10.2196/25043 %U https://formative.jmir.org/2021/6/e25043/ %U https://doi.org/10.2196/25043 %U http://www.ncbi.nlm.nih.gov/pubmed/34185002 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 5 %N 1 %P e28392 %T Evaluating the Impact of a Digital Nutrition Platform on Cholesterol Levels in Users With Dyslipidemia: Longitudinal Study %A Hu,Emily A %A Scharen,Jared %A Nguyen,Viet %A Langheier,Jason %+ Zipongo Inc, DBA Foodsmart, 595 Pacific Avenue, Fl 4, San Francisco, CA, 94133, United States, 1 415 800 2311, emily.hu@foodsmart.com %K dyslipidemia %K hyperlipidemia %K lipids %K cholesterol %K digital %K nutrition %K meal planning %K food environment %K food ordering %K food purchasing %D 2021 %7 10.6.2021 %9 Original Paper %J JMIR Cardio %G English %X Background: A strong association exists between consuming a healthy diet and lowering cholesterol levels among individuals with high cholesterol. However, implementing and sustaining a healthy diet in the real world is a major challenge. Digital technologies are at the forefront of changing dietary behavior on a massive scale, as they can reach broad populations. There is a lack of evidence that has examined the benefit of a digital nutrition intervention, especially one that incorporates nutrition education, meal planning, and food ordering, on cholesterol levels among individuals with dyslipidemia. Objective: The aim of this observational longitudinal study was to examine the characteristics of people with dyslipidemia, determine how their status changed over time, and evaluate the changes in total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), non-HDL-C, and triglycerides among individuals with elevated lipids who used Foodsmart, a digital nutrition platform that integrates education, meal planning, and food ordering. Methods: We included 653 adults who used Foodsmart between January 2015 and February 2021, and reported a lipid marker twice. Participants self-reported age, gender, weight, and usual dietary intake in a 53-item food frequency questionnaire, and lipid values could be provided at any time. Dyslipidemia was defined as total cholesterol ≥200 mg/dL, HDL-C ≤40 mg/dL, LDL-C ≥130 mg/dL, or triglycerides ≥150 mg/dL. We retrospectively analyzed distributions of user characteristics and their associations with the likelihood of returning to normal lipid levels. We calculated the mean changes and percent changes in lipid markers among users with elevated lipids. Results: In our total sample, 54.1% (353/653) of participants had dyslipidemia at baseline. Participants with dyslipidemia at baseline were more likely to be older, be male, and have a higher weight and BMI compared with participants who had normal lipid levels. We found that 36.3% (128/353) of participants who had dyslipidemia at baseline improved their lipid levels to normal by the end of follow-up. Using multivariate logistic regression, we found that baseline obesity (odds ratio [OR] 2.57, 95% CI 1.25-5.29; P=.01) and Nutriscore (OR 1.04, 95% CI 1.00-1.09; P=.04) were directly associated with achieving normal lipid levels. Participants with elevated lipid levels saw improvements as follows: HDL-C increased by 38.5%, total cholesterol decreased by 6.8%, cholesterol ratio decreased by 20.9%, LDL-C decreased by 12.9%, non-HDL-C decreased by 7.8%, and triglycerides decreased by 10.8%. Conclusions: This study characterized users of the Foodsmart platform who had dyslipidemia and found that users with elevated lipid levels showed improvements in the levels over time. %M 34110291 %R 10.2196/28392 %U https://cardio.jmir.org/2021/1/e28392 %U https://doi.org/10.2196/28392 %U http://www.ncbi.nlm.nih.gov/pubmed/34110291 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e25343 %T Reactance to Social Authority in Entertainment-Education Media: Protocol for a Web-Based Randomized Controlled Trial %A Vandormael,Alain %A Adam,Maya %A Hachaturyan,Violetta %A Greuel,Merlin %A Favaretti,Caterina %A Gates,Jennifer %A Baernighausen,Till %+ Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130/3, Heidelberg, 69120, Germany, 49 6221 565344, alain.vandormael@uni-heidelberg.de %K entertainment-education %K sugar reduction %K reactance %K animated video %K list experiment %D 2021 %7 28.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Entertainment-education media can be an effective strategy for influencing health behaviors. To improve entertainment-education effectiveness, we seek to investigate whether the social authority of a person delivering a health message arouses the motivation to reject that message—a phenomenon known as reactance. Objective: In this study, using a short animated video, we aim to measure reactance to a sugar reduction message narrated by a child (low social authority), the child’s mother (equivalent social authority to the target audience), and a family physician (high social authority). The aims of the study are to determine the effect of the narrator’s perceived social authority on reactance to the sugar reduction message, establish the effectiveness of the video in improving behavioral intent to reduce the intake of added sugars, and quantify participants’ interest in watching the entertainment-education intervention video. Methods: This is a parallel group, randomized controlled trial comparing an intervention video narrated by a low, equivalent, or high social authority against a content placebo video and a placebo video. Using a web-based recruitment platform, we plan to enroll 4000 participants aged between 18 and 59 years who speak English and reside in the United Kingdom. The primary end points will include measures of the antecedents to reactance (proneness to reactance and threat level of the message), its components (anger and negative cognition), and attitudinal and behavioral intent toward sugar intake. We will measure behavioral intent using list experiments. Participants randomized to the placebo videos will be given a choice to watch one of the sugar-intervention videos at the end of the study to assess participant engagement with the entertainment-education video. Results: The study was approved by the ethics committee of Heidelberg University on March 18, 2020 (S-088/2020). Participant recruitment and data collection were completed in December 2020. The data analysis was completed in April 2021, and the final results are planned to be published by August 2021. Conclusions: In this trial, we will use several randomization procedures, list experimentation methods, and new web-based technologies to investigate the effect of perceived social authority on reactance to a message about reducing sugar intake. Our results will inform the design of future entertainment-education videos for public health promotion needs. Trial Registration: German Clinical Trials Registry DRKS00022340: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00022340. International Registered Report Identifier (IRRID): DERR1-10.2196/25343 %M 34047702 %R 10.2196/25343 %U https://www.researchprotocols.org/2021/5/e25343 %U https://doi.org/10.2196/25343 %U http://www.ncbi.nlm.nih.gov/pubmed/34047702 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e23809 %T Integrating User-Centered Design and Behavioral Science to Design a Mobile Intervention for Obesity and Binge Eating: Mixed Methods Analysis %A Graham,Andrea K %A Munson,Sean A %A Reddy,Madhu %A Neubert,Sarah W %A Green,Emilie A %A Chang,Angela %A Spring,Bonnie %A Mohr,David C %A Wildes,Jennifer E %+ Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, United States, 1 312 503 5266, andrea.graham@northwestern.edu %K obesity %K binge eating %K user-centered design %K mobile intervention %K engagement %K experimental therapeutics %D 2021 %7 10.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Accounting for how end users engage with technologies is imperative for designing an efficacious mobile behavioral intervention. Objective: This mixed methods analysis examined the translational potential of user-centered design and basic behavioral science to inform the design of a new mobile intervention for obesity and binge eating. Methods: A total of 22 adults (7/22, 32% non-Hispanic White; 8/22, 36% male) with self-reported obesity and recurrent binge eating (≥12 episodes in 3 months) who were interested in losing weight and reducing binge eating completed a prototyping design activity over 1 week. Leveraging evidence from behavioral economics on choice architecture, participants chose treatment strategies from 20 options (aligned with treatment targets composing a theoretical model of the relation between binge eating and weight) to demonstrate which strategies and treatment targets are relevant to end users. The process by which participants selected and implemented strategies and their change in outcomes were analyzed. Results: Although prompted to select one strategy, participants selected between 1 and 3 strategies, citing perceived achievability, helpfulness, or relevance as selection reasons. Over the week, all practiced a strategy at least once; 82% (18/22) struggled with implementation, and 23% (5/22) added a new strategy. Several themes emerged on successes and challenges with implementation, yielding design implications for supporting users in behavior change. In postexperiment reflections, 82% (18/22) indicated the strategy was helpful, and 86% (19/22) planned to continue use. One-week average within-subject changes in weight (–2.2 [SD –5.0] pounds) and binge eating (–1.6 [SD –1.8] episodes) indicated small clinical improvement. Conclusions: Applying user-centered design and basic behavioral science yielded design insights to incorporate personalization through user choice with guidance, which may enhance engagement with and potential efficacy of digital health interventions. %M 33970114 %R 10.2196/23809 %U https://formative.jmir.org/2021/5/e23809 %U https://doi.org/10.2196/23809 %U http://www.ncbi.nlm.nih.gov/pubmed/33970114 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e25160 %T User Perspectives of Diet-Tracking Apps: Reviews Content Analysis and Topic Modeling %A Zečević,Mila %A Mijatović,Dejan %A Kos Koklič,Mateja %A Žabkar,Vesna %A Gidaković,Petar %+ School of Economics and Business, University of Ljubljana, Kardeljeva ploscad 17, Ljubljana, 1000, Slovenia, 386 15892429, mila.zecevic@ef.uni-lj.si %K diet-tracking apps %K mobile apps %K user reviews %K topic modeling %K n-grams %K mHealth %K nutrition %K diet %K well-being %D 2021 %7 22.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The availability and use of mobile apps in health and nutrition management are increasing. Ease of access and user friendliness make diet-tracking apps an important ally in their users’ efforts to lose and manage weight. To foster motivation for long-term use and to achieve goals, it is necessary to better understand users’ opinions and needs for dietary self-monitoring. Objective: The aim of this study was to identify the key topics and issues that users highlight in their reviews of diet-tracking apps on Google Play Store. Identifying the topics that users frequently mention in their reviews of these apps, along with the user ratings for each of these apps, allowed us to identify areas where further improvement of the apps could facilitate app use, and support users’ weight loss and intake management efforts. Methods: We collected 72,084 user reviews from Google Play Store for 15 diet-tracking apps that allow users to track and count calories. After a series of text processing operations, two text-mining techniques (topic modeling and topical n-grams) were applied to the corpus of user reviews of diet-tracking apps. Results: Using the topic modeling technique, 11 separate topics were extracted from the pool of user reviews. Most of the users providing feedback were generally satisfied with the apps they use (average rating of 4.4 out of 5 for the 15 apps). Most topics referred to the positive evaluation of the apps and their functions. Negatively rated topics mostly referred to app charges and technical difficulties encountered. We identified the positive and negative topic trigrams (3-word combinations) among the most frequently mentioned topics. Usability and functionality (tracking options) of apps were rated positively on average. Negative ratings were associated with trigrams related to adding new foods, technical issues, and app charges. Conclusions: Motivating users to use an app over time could help them better achieve their nutrition goals. Although user reviews generally showed positive opinions and ratings of the apps, developers should pay more attention to users’ technical problems and inform users about expected payments, along with their refund and cancellation policies, to increase user loyalty. %M 33885375 %R 10.2196/25160 %U https://www.jmir.org/2021/4/e25160 %U https://doi.org/10.2196/25160 %U http://www.ncbi.nlm.nih.gov/pubmed/33885375 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e29048 %T Nutritional Implications of Baby-Led Weaning and Baby Food Pouches as Novel Methods of Infant Feeding: Protocol for an Observational Study %A Taylor,Rachael W %A Conlon,Cathryn A %A Beck,Kathryn L %A von Hurst,Pamela R %A Te Morenga,Lisa A %A Daniels,Lisa %A Haszard,Jill J %A Meldrum,Alison M %A McLean,Neve H %A Cox,Alice M %A Tukuafu,Lesieli %A Casale,Maria %A Brown,Kimberley J %A Jones,Emily A %A Katiforis,Ioanna %A Rowan,Madeleine %A McArthur,Jenny %A Fleming,Elizabeth A %A Wheeler,Ben J %A Houghton,Lisa A %A Diana,Aly %A Heath,Anne-Louise M %+ Department of Human Nutrition, University of Otago, 70 Union St West, Dunedin, 9054, New Zealand, 64 34798379, anne-louise.heath@otago.ac.nz %K infant %K diet %K complementary feeding %K food pouch %K baby-led weaning %K iron %K growth %K eating behavior %K feeding behavior %K dental health %K choking %K breast milk %D 2021 %7 21.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The complementary feeding period is a time of unparalleled dietary change for every human, during which the diet changes from one that is 100% milk to one that resembles the usual diet of the wider family in less than a year. Despite this major dietary shift, we know relatively little about food and nutrient intake in infants worldwide and virtually nothing about the impact of baby food “pouches” and “baby-led weaning” (BLW), which are infant feeding approaches that are becoming increasingly popular. Pouches are squeezable containers with a plastic spout that have great appeal for parents, as evidenced by their extraordinary market share worldwide. BLW is an alternative approach to introducing solids that promotes infant self-feeding of whole foods rather than being fed purées, and is popular and widely advocated on social media. The nutritional and health impacts of these novel methods of infant feeding have not yet been determined. Objective: The aim of the First Foods New Zealand study is to determine the iron status, growth, food and nutrient intakes, breast milk intake, eating and feeding behaviors, dental health, oral motor skills, and choking risk of New Zealand infants in general and those who are using pouches or BLW compared with those who are not. Methods: Dietary intake (two 24-hour recalls supplemented with food photographs), iron status (hemoglobin, plasma ferritin, and soluble transferrin receptor), weight status (BMI), food pouch use and extent of BLW (questionnaire), breast milk intake (deuterium oxide “dose-to-mother” technique), eating and feeding behaviors (questionnaires and video recording of an evening meal), dental health (photographs of upper and lower teeth for counting of caries and developmental defects of enamel), oral motor skills (questionnaires), and choking risk (questionnaire) will be assessed in 625 infants aged 7.0 to 9.9 months. Propensity score matching will be used to address bias caused by differences in demographics between groups so that the results more closely represent a potential causal effect. Results: This observational study has full ethical approval from the Health and Disability Ethics Committees New Zealand (19/STH/151) and was funded in May 2019 by the Health Research Council (HRC) of New Zealand (grant 19/172). Data collection commenced in July 2020, and the first results are expected to be submitted for publication in 2022. Conclusions: This large study will provide much needed data on the implications for nutritional intake and health with the use of baby food pouches and BLW in infancy. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000459921; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379436. International Registered Report Identifier (IRRID): DERR1-10.2196/29048 %M 33881411 %R 10.2196/29048 %U https://www.researchprotocols.org/2021/4/e29048 %U https://doi.org/10.2196/29048 %U http://www.ncbi.nlm.nih.gov/pubmed/33881411 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 4 %P e17503 %T A User-Centered Chatbot (Wakamola) to Collect Linked Data in Population Networks to Support Studies of Overweight and Obesity Causes: Design and Pilot Study %A Asensio-Cuesta,Sabina %A Blanes-Selva,Vicent %A Conejero,J Alberto %A Frigola,Ana %A Portolés,Manuel G %A Merino-Torres,Juan Francisco %A Rubio Almanza,Matilde %A Syed-Abdul,Shabbir %A Li,Yu-Chuan (Jack) %A Vilar-Mateo,Ruth %A Fernandez-Luque,Luis %A García-Gómez,Juan M %+ Instituto de Tecnologías de la Información y Comunicaciones, Universitat Politècnica de València, Camino de Vera s/n, Valencia, 46022, Spain, 34 96 387 70 07 ext 71846, sasensio@dpi.upv.es %K mHealth %K obesity %K overweight %K chatbot %K assessment %K public health %K Telegram %K user-centered design %K Social Network Analysis %D 2021 %7 14.4.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Obesity and overweight are a serious health problem worldwide with multiple and connected causes. Simultaneously, chatbots are becoming increasingly popular as a way to interact with users in mobile health apps. Objective: This study reports the user-centered design and feasibility study of a chatbot to collect linked data to support the study of individual and social overweight and obesity causes in populations. Methods: We first studied the users’ needs and gathered users’ graphical preferences through an open survey on 52 wireframes designed by 150 design students; it also included questions about sociodemographics, diet and activity habits, the need for overweight and obesity apps, and desired functionality. We also interviewed an expert panel. We then designed and developed a chatbot. Finally, we conducted a pilot study to test feasibility. Results: We collected 452 answers to the survey and interviewed 4 specialists. Based on this research, we developed a Telegram chatbot named Wakamola structured in six sections: personal, diet, physical activity, social network, user's status score, and project information. We defined a user's status score as a normalized sum (0-100) of scores about diet (frequency of eating 50 foods), physical activity, BMI, and social network. We performed a pilot to evaluate the chatbot implementation among 85 healthy volunteers. Of 74 participants who completed all sections, we found 8 underweight people (11%), 5 overweight people (7%), and no obesity cases. The mean BMI was 21.4 kg/m2 (normal weight). The most consumed foods were olive oil, milk and derivatives, cereals, vegetables, and fruits. People walked 10 minutes on 5.8 days per week, slept 7.02 hours per day, and were sitting 30.57 hours per week. Moreover, we were able to create a social network with 74 users, 178 relations, and 12 communities. Conclusions: The Telegram chatbot Wakamola is a feasible tool to collect data from a population about sociodemographics, diet patterns, physical activity, BMI, and specific diseases. Besides, the chatbot allows the connection of users in a social network to study overweight and obesity causes from both individual and social perspectives. %M 33851934 %R 10.2196/17503 %U https://medinform.jmir.org/2021/4/e17503 %U https://doi.org/10.2196/17503 %U http://www.ncbi.nlm.nih.gov/pubmed/33851934 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e22759 %T Respondent Characteristics and Dietary Intake Data Collected Using Web-Based and Traditional Nutrition Surveillance Approaches: Comparison and Usability Study %A Timon,Claire M %A Walton,Janette %A Flynn,Albert %A Gibney,Eileen R %+ Institute of Food and Health, University College Dublin, Institute of Food and Health, University College Dublin, Belfield, Dublin, 4, Ireland, 353 17162819, eileen.gibney@ucd.ie %K diet %K survey and questionnaire %K technology %K nutrition surveillance %D 2021 %7 7.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: There are many constraints to conducting national food consumption surveys for national nutrition surveillance, including cost, time, and participant burden. Validated web-based dietary assessment technologies offer a potential solution to many of these constraints. Objective: This study aims to investigate the feasibility of using a previously validated, web-based, 24-hour recall dietary assessment tool (Foodbook24) for nutrition surveillance by comparing the demographic characteristics and the quality of dietary intake data collected from a web-based cohort of participants in Ireland to those collected from the most recent Irish National Adult Nutrition Survey (NANS). Methods: Irish adult participants (aged ≥18 years) were recruited to use Foodbook24 (a web-based tool) between March and October 2016. Demographic and dietary intake (assessed by means of 2 nonconsecutive, self-administered, 24-hour recalls) data were collected using Foodbook24. Following the completion of the study, the dietary intake data collected from the web-based study were statistically weighted to represent the age-gender distribution of intakes reported in the NANS (2008-2010) to facilitate the controlled comparison of intake data. The demographic characteristics of the survey respondents were investigated using descriptive statistics. The controlled comparison of weighted mean daily nutrient intake data collected from the Foodbook24 web-based study (329 plausible reporters of a total of 545 reporters) and the mean daily nutrient intake data collected from the NANS (1051 plausible reporters from 1500 reporters) was completed using the Wilcoxon–Mann-Whitney U test in Creme Nutrition software. Results: Differences between the demographic characteristics of the survey participants across the 2 surveys were observed. Notable differences included a lower proportion of adults aged ≥65 years and a higher proportion of females who participated in the web-based Foodbook24 study relative to the NANS study (P<.001). Similar ranges of mean daily intake for the majority of nutrients and food groups were observed (eg, energy [kilocalorie per day] and carbohydrate [gram per day]), although significant differences for some nutrients (eg, riboflavin [mg/10 MJ], P<.001 and vitamin B12 [µg/10 MJ], P<.001) and food groups were identified. A high proportion of participants (200/425, 47.1%) reported a willingness to continue using Foodbook24 for an additional 6 months. Conclusions: These findings suggest that by using targeted recruitment strategies in the future to ensure the recruitment of a more representative sample, there is potential for web-based methodologies such as Foodbook24 to be used for nutrition surveillance efforts in Ireland. %M 33825694 %R 10.2196/22759 %U https://publichealth.jmir.org/2021/4/e22759 %U https://doi.org/10.2196/22759 %U http://www.ncbi.nlm.nih.gov/pubmed/33825694 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e24249 %T Slip Buddy App for Weight Management: Randomized Feasibility Trial of a Dietary Lapse Tracking App %A Pagoto,Sherry %A Tulu,Bengisu %A Waring,Molly E %A Goetz,Jared %A Bibeau,Jessica %A Divito,Joseph %A Groshon,Laurie %A Schroeder,Matthew %+ University of Connecticut, Department of Allied Health Sciences, 2006 Hillside Road, Unit 1248, Room 22, Storrs, CT, 06269, United States, 1 5084864900, Sherry.Pagoto@uconn.edu %K mobile app %K mHealth %K weight loss %K obesity %K diet %K mobile phone %D 2021 %7 1.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although calorie tracking is one of the strongest predictors of weight loss in behavioral weight loss interventions, low rates of adherence are common. Objective: This study aims to examine the feasibility and acceptability of using the Slip Buddy app during a 12-week web-based weight loss program. Methods: We conducted a randomized pilot trial to evaluate the feasibility and acceptability of using the Slip Buddy app compared with a popular commercial calorie tracking app during a counselor-led, web-based behavioral weight loss intervention. Adults who were overweight or obese were recruited on the web and randomized into a 12-week web-based weight loss intervention that included either the Slip Buddy app or a commercial calorie tracking app. Feasibility outcomes included retention, app use, usability, slips reported, and contextual factors reported at slips. Acceptability outcomes included ratings of how helpful, tedious, taxing, time consuming, and burdensome using the assigned app was. We described weight change from baseline to 12 weeks in both groups as an exploratory outcome. Participants using the Slip Buddy app provided feedback on how to improve it during the postintervention focus groups. Results: A total of 75% (48/64) of the participants were female and, on average, 39.8 (SD 11.0) years old with a mean BMI of 34.2 (SD 4.9) kg/m2. Retention was high in both conditions, with 97% (31/32) retained in the Slip Buddy condition and 94% (30/32) retained in the calorie tracking condition. On average, participants used the Slip Buddy app on 53.8% (SD 31.3%) of days, which was not significantly different from those using the calorie tracking app (mean 57.5%, SD 28.4% of days), and participants who recorded slips (30/32, 94%) logged on average 17.9 (SD 14.4) slips in 12 weeks. The most common slips occurred during snack times (220/538, 40.9%). Slips most often occurred at home (297/538, 55.2%), while working (153/538, 28.4%), while socializing (130/538, 24.2%), or during screen time (123/538, 22.9%). The conditions did not differ in participants’ ratings of how their assigned app was tedious, taxing, or time consuming (all values of P>.05), but the calorie tracking condition gave their app higher helpfulness and usability ratings (all values of P<.05). Technical issues were the most common type of negative feedback, whereas simplicity was the most common type of positive feedback. Weight losses of ≥5% of baseline weight were achieved by 31% (10/32) of Slip Buddy participants and 34% (11/32) of calorie tracking participants. Conclusions: Self-monitoring of dietary lapses and the contextual factors associated with them may be an alternative for people who do not prefer calorie tracking. Future research should examine patient characteristics associated with adherence to different forms of dietary self-monitoring. Trial Registration: ClinicalTrials.gov NCT02615171; https://clinicaltrials.gov/ct2/show/NCT02615171 %M 33792547 %R 10.2196/24249 %U https://mhealth.jmir.org/2021/4/e24249 %U https://doi.org/10.2196/24249 %U http://www.ncbi.nlm.nih.gov/pubmed/33792547 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 1 %P e22541 %T Days Needed to Characterize the Healthfulness of a Typical Dinner Meal in Direct Observational Research: Mixed Methods Study %A Tate,Allan %A Trofholz,Amanda %A Miner,Michael %A Berge,Jerica %+ Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 202 BS Miller Hall, 101 Buck Rd, Health Sciences Campus, Athens, GA, 30602, United States, 1 706 542 6317, allan.tate@uga.edu %K meal healthfulness %K direct observation %K family meals %K well-being %K diet %K food %D 2021 %7 24.3.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Prior research around the home meal environment has demonstrated that family meals are associated with positive health outcomes for children and adolescents. Researchers have begun using direct observational methods to understand key aspects of family meals such as meal healthfulness and family meal frequency to explain the protective nature of family meals. Direct observational research, however, can be resource intensive and also burdensome for participants. Information about the number of days needed to sufficiently characterize typical meal healthfulness using direct observational research methods is needed. Objective: The current study aimed to produce guidance about the number of meals necessary to approximate typical meal healthfulness at the family dinner meal occasion in a direct observational, mixed methods study of the home food environment. Methods: Families were recruited between 2012-2013 from primary care clinics in the Minneapolis–St Paul metropolitan area (N=120). A total of 800 meals were collected as part of the Family Meals LIVE! mixed methods study. The Healthfulness of Meal Index was used to evaluate meal dietary healthfulness of foods served at 8 family meal occasions. Participating families were provided an iPad (Apple Inc) and asked to video-record 8 consecutive days of family dinner meals with a minimum of two weekend meals. After the meal, families completed a meal screener, which is a self-reported, open-ended measure of the foods served at the meal. Results: Weekend and weekday meals differed in their measurement of meal healthfulness, indicating that at least one weekday and one weekend day are necessary to approximate meal healthfulness. Single-day measurement mischaracterized the strength of the relationship between the quality of what was served and intake by almost 50%, and 3 to 4 observation days were sufficient to characterize typical weekly meal healthfulness (r=0.94; P<.001). Conclusions: Relatively few direct observational days of family meals data appear to be needed to approximate the healthfulness of meals across 1 week. Specifically, 1 weekday and 1 weekend observation are needed, including a total of 3 to 4 days of direct observational meal data. These findings may inform future direct observational study designs to reduce both research costs and participant burden in assessing features of the meal environment. %M 33759788 %R 10.2196/22541 %U https://pediatrics.jmir.org/2021/1/e22541 %U https://doi.org/10.2196/22541 %U http://www.ncbi.nlm.nih.gov/pubmed/33759788 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e13591 %T Web-Based Dietary Intake Estimation to Assess the Reproducibility and Relative Validity of the EatWellQ8 Food Frequency Questionnaire: Validation Study %A Alawadhi,Balqees %A Fallaize,Rosalind %A Franco,Rodrigo Zenun %A Hwang,Faustina %A Lovegrove,Julie %+ Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, Department of Food and Nutritional Sciences, University of Reading, Whiteknights, Reading, RG6 6AP, United Kingdom, 44 0118 378 6418, j.a.lovegrove@reading.ac.uk %K web-based %K Kuwait %K weighed food record %K app %K food frequency questionnaire %K validation %K dietary assessment %D 2021 %7 2.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The web-based EatWellQ8 food frequency questionnaire (FFQ) was developed as a dietary assessment tool for healthy adults in Kuwait. Validation against reliable instruments and assessment of its reproducibility are required to ensure the accuracy of the EatWellQ8 FFQ in computing nutrient intake. Objective: This study aims to assess the reproducibility and relative validity of the EatWellQ8 146-item FFQ, which included images of food portion sizes based on The Composition of Foods by McCance and Widdowson and food composition tables from Kuwait and the Kingdom of Bahrain, against a paper-based FFQ (PFFQ) and a 4-day weighed food record (WFR). Methods: Reproducibility of the EatWellQ8 FFQ was assessed using a test-retest methodology. Participants were required to complete the FFQ at 2 time points, 4 weeks apart. To assess the relative validity of the EatWellQ8 FFQ, a subset of the participants were asked to complete a PFFQ or a 4-day WFR 1 week after the administration of the EatWellQ8 FFQ. The level of agreement between nutrient and food group intakes was estimated by repeated EatWellQ8 FFQ administration. The EatWellQ8 FFQ, PFFQ, and 4-day WFR were also evaluated using the Bland-Altman methodology and classified into quartiles of daily intake. Crude unadjusted correlation coefficients were also calculated for nutrients and food groups. Results: A total of 99 Kuwaiti participants (64/99, 65% female and 35/99, 35% male) completed the study—53 participated in the reproducibility study and the 4-day WFR validity study (mean age 37.1 years, SD 9.9) and 46 participated in the PFFQ validity study (mean age 36.2 years, SD 8.3). Crude unadjusted correlations for repeated EatWellQ8 FFQs ranged from 0.37 to 0.93 (mean r=0.67, SD 0.14; 95% CI 0.11-0.95) for nutrients and food groups (P=.01). Mean cross-classification into exact agreement plus adjacent was 88% for nutrient intakes and 86% for food groups, and Bland-Altman plots showed good agreement for energy-adjusted macronutrient intakes. The association between the EatWellQ8 FFQ and PFFQ varied, with crude unadjusted correlations ranging from 0.42 to 0.73 (mean r=0.46, SD 0.12; 95% CI −0.02 to 0.84; P=.046). Mean cross-classification into exact agreement plus adjacent was 84% for nutrient intake and 74% for food groups. Bland-Altman plots showed moderate agreement for both energy and energy-controlled nutrient intakes. Crude unadjusted correlations for the EatWellQ8 FFQ and the 4-day WFR ranged from 0.40 to 0.88 (mean r=0.58, SD 0.13; 95% CI 0.01-0.58; P=.01). Mean cross-classification into exact agreement plus adjacent was 85% for nutrient intake and 83% for food groups. Bland-Altman plots showed moderate agreement for energy-adjusted macronutrient intakes. Conclusions: The results indicate that the web-based EatWellQ8 FFQ is reproducible for assessing nutrient and food group intake and has moderate agreement compared with a PFFQ and a 4-day WFR for measuring energy and nutrient intakes. %M 33650974 %R 10.2196/13591 %U https://formative.jmir.org/2021/3/e13591 %U https://doi.org/10.2196/13591 %U http://www.ncbi.nlm.nih.gov/pubmed/33650974 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e14760 %T A Novel Food Record App for Dietary Assessments Among Older Adults With Type 2 Diabetes: Development and Usability Study %A Jung,Hyunggu %A Demiris,George %A Tarczy-Hornoch,Peter %A Zachry,Mark %+ Department of Computer Science and Engineering, University of Seoul, Information and Technology Building, 163 Seoulsiripdae-ro, Dongdaemun-gu, Seoul, 02504, Republic of Korea, 82 2 6490 2455, hjung@uos.ac.kr %K mobile health %K older adults %K diabetes %K dietary assessment %K smartphone app %K usability test %D 2021 %7 17.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: More than 1 in 4 people in the United States aged 65 years and older have type 2 diabetes. For diabetes care, medical nutrition therapy is recommended as a clinically effective intervention. Previous researchers have developed and validated dietary assessment methods using images of food items to improve the accuracy of self-reporting over traditional methods. Nevertheless, little is known about the usability of image-assisted dietary assessment methods for older adults with diabetes. Objective: The aims of this study were (1) to create a food record app for dietary assessments (FRADA) that would support image-assisted dietary assessments, and (2) to evaluate the usability of FRADA for older adults with diabetes. Methods: For the development of FRADA, we identified design principles that address the needs of older adults and implemented three fundamental tasks required for image-assisted dietary assessments: capturing, viewing, and transmitting images of food based on the design principles. For the usability assessment of FRADA, older adults aged 65 to 80 years (11 females and 3 males) were assigned to interact with FRADA in a lab-based setting. Participants’ opinions of FRADA and its usability were determined by a follow-up survey and interview. As an evaluation indicator of usability, the responses to the survey, including an after-scenario questionnaire, were analyzed. Qualitative data from the interviews confirmed the responses to the survey. Results: We developed a smartphone app that enables older adults with diabetes to capture, view, and transmit images of food items they consumed. The findings of this study showed that FRADA and its instructions for capturing, viewing, and transmitting images of food items were usable for older adults with diabetes. The survey showed that participants found FRADA easy to use and would consider using FRADA daily. The analysis of the qualitative data from interviews revealed multiple categories, such as the usability of FRADA, potential benefits of using FRADA, potential features to be added to FRADA, and concerns of older adults with diabetes regarding interactions with FRADA. Conclusions: This study demonstrates in a lab-based setting not only the usability of FRADA by older adults with diabetes but also potential opportunities using FRADA in real-world settings. The findings suggest implications for creating a smartphone app for an image-assisted dietary assessment. Future work still remains to evaluate the feasibility and validity of FRADA with multiple stakeholders, including older adults with diabetes and dietitians. %M 33493129 %R 10.2196/14760 %U http://formative.jmir.org/2021/2/e14760/ %U https://doi.org/10.2196/14760 %U http://www.ncbi.nlm.nih.gov/pubmed/33493129 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e19234 %T Recruitment of Participants for a 3D Virtual Supermarket: Cross-sectional Observational Study %A Hoenink,Jody C %A Mackenbach,Joreintje D %A van der Laan,Laura Nynke %A Lakerveld,Jeroen %A Waterlander,Wilma %A Beulens,Joline W J %+ Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1117, Amsterdam, Netherlands, 31 204449681, j.c.hoenink@amsterdamumc.nl %K online study %K nudges %K pricing %K recruitment strategies %D 2021 %7 9.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Virtual supermarkets offer a practical and affordable setting to test the efficacy of different pricing and nudging strategies before they are implemented in the real world. Despite the advantages of using virtual supermarkets for this purpose, conducting studies in online settings is challenging with regard to recruitment and retention of sufficient and suitable participants. Objective: To describe cost, time, and retention with regard to participants recruited using various strategies and potential sociodemographic differences between participants recruited via different strategies. Methods: This cross-sectional study used data from a randomized controlled trial in which 455 Dutch adults with low and high educational levels were invited to shop 5 times in a 3D virtual supermarket. Participants were recruited via social media and flyers. A log that tracked the costs of and time spent on the different recruitment strategies was kept by the study team. Outcome measures included the cost of recruitment strategies, the time investment by researchers, and recruitment and attrition rates of participants in the study. Results: The median age of study completers was 31.0 (IQR 25.0) and 157 out of 346 study completers (45.4%) were highly educated. Out of the 455 included participants, 235 (51.6%) were recruited via social media campaigns, 131 (28.8%) via home-delivered flyers, 38 (8.4%) via flyers directly distributed by the study team, and 46 (10.1%) via word-of-mouth. Of all paid recruitment strategies, social media campaigns were the cheapest and least time-consuming, whereas the distribution of flyers by the study team was the most expensive and time-consuming recruitment strategy. Age, sex, overweight status, employment situation, and number of adults within the household varied by recruitment strategy. Conclusions: Using different recruitment strategies resulted in the efficient recruitment of a representative study sample and retention of participants was relatively high. While “word-of-mouth” was the most cost- and time-effective recruitment strategy, using only one type of recruitment strategy could result in a demographically skewed study population. %M 33560230 %R 10.2196/19234 %U http://formative.jmir.org/2021/2/e19234/ %U https://doi.org/10.2196/19234 %U http://www.ncbi.nlm.nih.gov/pubmed/33560230 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e21926 %T Deep Learning–Based Multimodal Data Fusion: Case Study in Food Intake Episodes Detection Using Wearable Sensors %A Bahador,Nooshin %A Ferreira,Denzil %A Tamminen,Satu %A Kortelainen,Jukka %+ Faculty of Information Technology and Electrical Engineering, University of Oulu, Pentti Kaiteran katu 1, Oulu, FIN-90570, Finland, 358 417246274, nooshin.bahador@oulu.fi %K deep learning %K image processing %K data fusion %K covariance distribution %K food intake episode %K wearable sensors %D 2021 %7 28.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Multimodal wearable technologies have brought forward wide possibilities in human activity recognition, and more specifically personalized monitoring of eating habits. The emerging challenge now is the selection of most discriminative information from high-dimensional data collected from multiple sources. The available fusion algorithms with their complex structure are poorly adopted to the computationally constrained environment which requires integrating information directly at the source. As a result, more simple low-level fusion methods are needed. Objective: In the absence of a data combining process, the cost of directly applying high-dimensional raw data to a deep classifier would be computationally expensive with regard to the response time, energy consumption, and memory requirement. Taking this into account, we aimed to develop a data fusion technique in a computationally efficient way to achieve a more comprehensive insight of human activity dynamics in a lower dimension. The major objective was considering statistical dependency of multisensory data and exploring intermodality correlation patterns for different activities. Methods: In this technique, the information in time (regardless of the number of sources) is transformed into a 2D space that facilitates classification of eating episodes from others. This is based on a hypothesis that data captured by various sensors are statistically associated with each other and the covariance matrix of all these signals has a unique distribution correlated with each activity which can be encoded on a contour representation. These representations are then used as input of a deep model to learn specific patterns associated with specific activity. Results: In order to show the generalizability of the proposed fusion algorithm, 2 different scenarios were taken into account. These scenarios were different in terms of temporal segment size, type of activity, wearable device, subjects, and deep learning architecture. The first scenario used a data set in which a single participant performed a limited number of activities while wearing the Empatica E4 wristband. In the second scenario, a data set related to the activities of daily living was used where 10 different participants wore inertial measurement units while performing a more complex set of activities. The precision metric obtained from leave-one-subject-out cross-validation for the second scenario reached 0.803. The impact of missing data on performance degradation was also evaluated. Conclusions: To conclude, the proposed fusion technique provides the possibility of embedding joint variability information over different modalities in just a single 2D representation which results in obtaining a more global view of different aspects of daily human activities at hand, and yet preserving the desired performance level in activity recognition. %M 33507156 %R 10.2196/21926 %U http://mhealth.jmir.org/2021/1/e21926/ %U https://doi.org/10.2196/21926 %U http://www.ncbi.nlm.nih.gov/pubmed/33507156 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e24467 %T The Human Factor in Automated Image-Based Nutrition Apps: Analysis of Common Mistakes Using the goFOOD Lite App %A Vasiloglou,Maria F %A van der Horst,Klazine %A Stathopoulou,Thomai %A Jaeggi,Michael P %A Tedde,Giulia S %A Lu,Ya %A Mougiakakou,Stavroula %+ ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse 50, Bern, 3008, Switzerland, 41 6327592, stavroula.mougiakakou@artorg.unibe.ch %K mHealth %K dietary assessment %K smartphone %K apps %K human mistakes %K mobile phone %D 2021 %7 13.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Technological advancements have enabled nutrient estimation by smartphone apps such as goFOOD. This is an artificial intelligence–based smartphone system, which uses food images or video captured by the user as input and then translates these into estimates of nutrient content. The quality of the data is highly dependent on the images the user records. This can lead to a major loss of data and impaired quality. Instead of removing these data from the study, in-depth analysis is needed to explore common mistakes and to use them for further improvement of automated apps for nutrition assessment. Objective: The aim of this study is to analyze common mistakes made by participants using the goFOOD Lite app, a version of goFOOD, which was designed for food-logging, but without providing results to the users, to improve both the instructions provided and the automated functionalities of the app. Methods: The 48 study participants were given face-to-face instructions for goFOOD Lite and were asked to record 2 pictures (1 recording) before and 2 pictures (1 recording) after the daily consumption of each food or beverage, using a reference card as a fiducial marker. All pictures that were discarded for processing due to mistakes were analyzed to record the main mistakes made by users. Results: Of the 468 recordings of nonpackaged food items captured by the app, 60 (12.8%) had to be discarded due to errors in the capturing procedure. The principal problems were as follows: wrong fiducial marker or improper marker use (19 recordings), plate issues such as a noncompatible or nonvisible plate (8 recordings), a combination of various issues (17 recordings), and other reasons such as obstacles (hand) in front of the camera or matching recording pairs (16 recordings). Conclusions: No other study has focused on the principal problems in the use of automatic apps for assessing nutritional intake. This study shows that it is important to provide study participants with detailed instructions if high-quality data are to be obtained. Future developments could focus on making it easier to recognize food on various plates from its color or shape and on exploring alternatives to using fiducial markers. It is also essential for future studies to understand the training needed by the participants as well as to enhance the app’s user-friendliness and to develop automatic image checks based on participant feedback. %M 33439139 %R 10.2196/24467 %U http://mhealth.jmir.org/2021/1/e24467/ %U https://doi.org/10.2196/24467 %U http://www.ncbi.nlm.nih.gov/pubmed/33439139 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 12 %P e21733 %T Improving Heart Disease Risk Through Quality-Focused Diet Logging: Pre-Post Study of a Diet Quality Tracking App %A Kwon,Bum Chul %A VanDam,Courtland %A Chiuve,Stephanie E %A Choi,Hyung Wook %A Entler,Paul %A Tan,Pang-Ning %A Huh-Yoo,Jina %+ College of Computing and Informatics, Drexel University, 3675 Market St, Philadelphia, PA, 19104, United States, 1 2158952474, jinahuhyoo@drexel.edu %K mHealth %K diet monitoring %K diet tracking %K food tracking %K CVD %K heart disease risk %K health risk communication %K human-computer interaction %K user study %K mobile phone %D 2020 %7 23.12.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Diet-tracking mobile apps have gained increased interest from both academic and clinical fields. However, quantity-focused diet tracking (eg, calorie counting) can be time-consuming and tedious, leading to unsustained adoption. Diet quality—focusing on high-quality dietary patterns rather than quantifying diet into calories—has shown effectiveness in improving heart disease risk. The Healthy Heart Score (HHS) predicts 20-year cardiovascular risks based on the consumption of foods from quality-focused food categories, rather than detailed serving sizes. No studies have examined how mobile health (mHealth) apps focusing on diet quality can bring promising results in health outcomes and ease of adoption. Objective: This study aims to design a mobile app to support the HHS-informed quality-focused dietary approach by enabling users to log simplified diet quality and view its real-time impact on future heart disease risks. Users were asked to log food categories that are the main predictors of the HHS. We measured the app’s feasibility and efficacy in improving individuals’ clinical and behavioral factors that affect future heart disease risks and app use. Methods: We recruited 38 participants who were overweight or obese with high heart disease risk and who used the app for 5 weeks and measured weight, blood sugar, blood pressure, HHS, and diet score (DS)—the measurement for diet quality—at baseline and week 5 of the intervention. Results: Most participants (30/38, 79%) used the app every week and showed significant improvements in DS (baseline: mean 1.31, SD 1.14; week 5: mean 2.36, SD 2.48; 2-tailed t test t29=−2.85; P=.008) and HHS (baseline: mean 22.94, SD 18.86; week 4: mean 22.15, SD 18.58; t29=2.41; P=.02) at week 5, although only 10 participants (10/38, 26%) checked their HHS risk scores more than once. Other outcomes, including weight, blood sugar, and blood pressure, did not show significant changes. Conclusions: Our study showed that our logging tool significantly improved dietary choices. Participants were not interested in seeing the HHS and perceived logging diet categories irrelevant to improving the HHS as important. We discuss the complexities of addressing health risks and quantity- versus quality-based health monitoring and incorporating secondary behavior change goals that matter to users when designing mHealth apps. %M 33355537 %R 10.2196/21733 %U http://mhealth.jmir.org/2020/12/e21733/ %U https://doi.org/10.2196/21733 %U http://www.ncbi.nlm.nih.gov/pubmed/33355537 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 12 %P e20625 %T A Real-Time Eating Detection System for Capturing Eating Moments and Triggering Ecological Momentary Assessments to Obtain Further Context: System Development and Validation Study %A Bin Morshed,Mehrab %A Kulkarni,Samruddhi Shreeram %A Li,Richard %A Saha,Koustuv %A Roper,Leah Galante %A Nachman,Lama %A Lu,Hong %A Mirabella,Lucia %A Srivastava,Sanjeev %A De Choudhury,Munmun %A de Barbaro,Kaya %A Ploetz,Thomas %A Abowd,Gregory D %+ Georgia Institute of Technology, 756 W Peachtree St NW, Atlanta, GA, 30308, United States, 1 4049552729, mehrab.morshed@gatech.edu %K eating detection %K eating behavior %K eating context %K well-being %K smartwatch %K ecological momentary assessment %D 2020 %7 18.12.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Eating behavior has a high impact on the well-being of an individual. Such behavior involves not only when an individual is eating, but also various contextual factors such as with whom and where an individual is eating and what kind of food the individual is eating. Despite the relevance of such factors, most automated eating detection systems are not designed to capture contextual factors. Objective: The aims of this study were to (1) design and build a smartwatch-based eating detection system that can detect meal episodes based on dominant hand movements, (2) design ecological momentary assessment (EMA) questions to capture meal contexts upon detection of a meal by the eating detection system, and (3) validate the meal detection system that triggers EMA questions upon passive detection of meal episodes. Methods: The meal detection system was deployed among 28 college students at a US institution over a period of 3 weeks. The participants reported various contextual data through EMAs triggered when the eating detection system correctly detected a meal episode. The EMA questions were designed after conducting a survey study with 162 students from the same campus. Responses from EMAs were used to define exclusion criteria. Results: Among the total consumed meals, 89.8% (264/294) of breakfast, 99.0% (406/410) of lunch, and 98.0% (589/601) of dinner episodes were detected by our novel meal detection system. The eating detection system showed a high accuracy by capturing 96.48% (1259/1305) of the meals consumed by the participants. The meal detection classifier showed a precision of 80%, recall of 96%, and F1 of 87.3%. We found that over 99% (1248/1259) of the detected meals were consumed with distractions. Such eating behavior is considered “unhealthy” and can lead to overeating and uncontrolled weight gain. A high proportion of meals was consumed alone (680/1259, 54.01%). Our participants self-reported 62.98% (793/1259) of their meals as healthy. Together, these results have implications for designing technologies to encourage healthy eating behavior. Conclusions: The presented eating detection system is the first of its kind to leverage EMAs to capture the eating context, which has strong implications for well-being research. We reflected on the contextual data gathered by our system and discussed how these insights can be used to design individual-specific interventions. %M 33337336 %R 10.2196/20625 %U http://mhealth.jmir.org/2020/12/e20625/ %U https://doi.org/10.2196/20625 %U http://www.ncbi.nlm.nih.gov/pubmed/33337336 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 12 %P e15602 %T Use of Different Food Image Recognition Platforms in Dietary Assessment: Comparison Study %A Van Asbroeck,Stephanie %A Matthys,Christophe %+ Department of Chronic Diseases and Metabolism, Clinical and Experimental Endocrinology, KU Leuven, Herestraat 49, DIEET, Leuven, Belgium, 32 016 34 26 55, christophe.matthys@uzleuven.be %K image recognition %K dietary assessment %K automated food recognition %K accuracy %D 2020 %7 7.12.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: In the domain of dietary assessment, there has been an increasing amount of criticism of memory-based techniques such as food frequency questionnaires or 24 hour recalls. One alternative is logging pictures of consumed food followed by an automatic image recognition analysis that provides information on type and amount of food in the picture. However, it is currently unknown how well commercial image recognition platforms perform and whether they could indeed be used for dietary assessment. Objective: This is a comparative performance study of commercial image recognition platforms. Methods: A variety of foods and beverages were photographed in a range of standardized settings. All pictures (n=185) were uploaded to selected recognition platforms (n=7), and estimates were saved. Accuracy was determined along with totality of the estimate in the case of multiple component dishes. Results: Top 1 accuracies ranged from 63% for the application programming interface (API) of the Calorie Mama app to 9% for the Google Vision API. None of the platforms were capable of estimating the amount of food. These results demonstrate that certain platforms perform poorly while others perform decently. Conclusions: Important obstacles to the accurate estimation of food quantity need to be overcome before these commercial platforms can be used as a real alternative for traditional dietary assessment methods. %M 33284118 %R 10.2196/15602 %U https://formative.jmir.org/2020/12/e15602 %U https://doi.org/10.2196/15602 %U http://www.ncbi.nlm.nih.gov/pubmed/33284118 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e18104 %T Importance of Multiple Reinforcing Comments and Areas for Change in Optimizing Dietary and Exercise Self-Monitoring Feedback in Behavioral Weight Loss Programs: Factorial Design %A Krukowski,Rebecca %A Kim,Hyeonju %A Stansbury,Melissa %A Li,Qian %A Sen,Saunak %A Farage,Gregory %A West,Delia %+ Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, 66 N. Pauline, Memphis, TN, 38163, United States, 1 9014482426, rkrukows@uthsc.edu %K overweight %K obesity %K weight loss %K feedback %K diet records %K compliance %K counselor %D 2020 %7 23.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Individualized dietary and physical activity self-monitoring feedback is a core element of behavioral weight loss interventions and is associated with clinically significant weight loss. To our knowledge, no studies have evaluated individuals’ perspectives on the composition of feedback messages or the effect of feedback composition on the motivation to self-monitor. Objective: This study aims to assess the perceptions of feedback emails as a function of the number of comments that reinforce healthy behavior and the number of areas for change (ie, behavioral changes that the individual might make to have an impact on weight) identified. Methods: Emailed feedback followed a factorial design with 2 factors (ie, reinforcing comments and areas for change), each with 3 levels (ie, 1, 4, or 8 comments). A total of 250 adults with overweight or obesity who were interested in weight loss were recruited from the Qualtrics research panel. Participants read 9 emails presented in a random order. For each email, respondents answered 8 questions about the likelihood to self-monitor in the future, motivation for behavioral change, and perceptions of the counselor and the email. A mixed effects ordinal logistic model was used to compute conditional odds ratios and predictive margins (ie, average predicted probability) on a 5-point Likert response scale to investigate the optimal combination level of the 2 factors. Results: Emails with more reinforcing comments or areas for change were better received, with small incremental benefits for 8 reinforcing comments or areas for change versus 4 reinforcing comments or areas for change. Interactions indicated that the best combination for 3 of 8 outcomes assessed (ie, motivation to make behavioral changes, counselor’s concern for their welfare, and the perception that the counselor likes them) was the email with 8 reinforcing comments and 4 areas for change. Emails with 4 reinforcing comments and 4 areas for change resulted in the highest average probability of individuals who reported being very likely to self-monitor in the future. Conclusions: The study findings suggest how feedback might be optimized for efficacy. Future studies should explore whether the composition of feedback email affects actual self-monitoring performance. %M 33226348 %R 10.2196/18104 %U https://www.jmir.org/2020/11/e18104 %U https://doi.org/10.2196/18104 %U http://www.ncbi.nlm.nih.gov/pubmed/33226348 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e22074 %T Carbohydrate Counting App Using Image Recognition for Youth With Type 1 Diabetes: Pilot Randomized Control Trial %A Alfonsi,Jeffrey E %A Choi,Elizabeth E Y %A Arshad,Taha %A Sammott,Stacie-Ann S %A Pais,Vanita %A Nguyen,Cynthia %A Maguire,Bryan R %A Stinson,Jennifer N %A Palmert,Mark R %+ Department of Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond St, Clinical Skills Building, London, ON, N6A 3K7, Canada, 1 647 938 3669, j.alfonsi@utoronto.ca %K carbohydrate counting %K type 1 diabetes %K image recognition %K youth %K digital health applications (apps) %K mHealth %D 2020 %7 28.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Carbohydrate counting is an important component of diabetes management, but it is challenging, often performed inaccurately, and can be a barrier to optimal diabetes management. iSpy is a novel mobile app that leverages machine learning to allow food identification through images and that was designed to assist youth with type 1 diabetes in counting carbohydrates. Objective: Our objective was to test the app's usability and potential impact on carbohydrate counting accuracy. Methods: Iterative usability testing (3 cycles) was conducted involving a total of 16 individuals aged 8.5-17.0 years with type 1 diabetes. Participants were provided a mobile device and asked to complete tasks using iSpy app features while thinking aloud. Errors were noted, acceptability was assessed, and refinement and retesting were performed across cycles. Subsequently, iSpy was evaluated in a pilot randomized controlled trial with 22 iSpy users and 22 usual care controls aged 10-17 years. Primary outcome was change in carbohydrate counting ability over 3 months. Secondary outcomes included levels of engagement and acceptability. Change in HbA1c level was also assessed. Results: Use of iSpy was associated with improved carbohydrate counting accuracy (total grams per meal, P=.008), reduced frequency of individual counting errors greater than 10 g (P=.047), and lower HbA1c levels (P=.03). Qualitative interviews and acceptability scale scores were positive. No major technical challenges were identified. Moreover, 43% (9/21) of iSpy participants were still engaged, with usage at least once every 2 weeks, at the end of the study. Conclusions: Our results provide evidence of efficacy and high acceptability of a novel carbohydrate counting app, supporting the advancement of digital health apps for diabetes care among youth with type 1 diabetes. Further testing is needed, but iSpy may be a useful adjunct to traditional diabetes management. Trial Registration: ClinicalTrials.gov NCT04354142; https://clinicaltrials.gov/ct2/show/NCT04354142 %M 33112249 %R 10.2196/22074 %U http://mhealth.jmir.org/2020/10/e22074/ %U https://doi.org/10.2196/22074 %U http://www.ncbi.nlm.nih.gov/pubmed/33112249 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e18237 %T Accuracy of Nutrient Calculations Using the Consumer-Focused Online App MyFitnessPal: Validation Study %A Evenepoel,Charlotte %A Clevers,Egbert %A Deroover,Lise %A Van Loo,Wendy %A Matthys,Christophe %A Verbeke,Kristin %+ Translational Research in Gastrointestinal Disorders, Department of Chronic Diseases, Metabolism and Aging, KU Leuven, Herestraat 49, TARGID, O&N1, box 701, Leuven, 3000, Belgium, 32 16330150, kristin.verbeke@kuleuven.be %K dietary assessment %K MyFitnessPal %K Nubel %K nutrition %K online application %K diet %D 2020 %7 21.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital food registration via online platforms that are coupled to large food databases obviates the need for manual processing of dietary data. The reliability of such platforms depends on the quality of the associated food database. Objective: In this study, we validate the database of MyFitnessPal versus the Belgian food composition database, Nubel. Methods: After carefully given instructions, 50 participants used MyFitnessPal to each complete a 4-day dietary record 2 times (T1 and T2), with 1 month in between T1 and T2. Nutrient intake values were calculated either manually, using the food composition database Nubel, or automatically, using the database coupled to MyFitnessPal. First, nutrient values from T1 were used as a training set to develop an algorithm that defined upper limit values for energy intake, carbohydrates, fat, protein, fiber, sugar, cholesterol, and sodium. These limits were applied to the MyFitnessPal dataset extracted at T2 to remove extremely high and likely erroneous values. Original and cleaned T2 values were correlated with the Nubel calculated values. Bias was estimated using Bland-Altman plots. Finally, we simulated the impact of using MyFitnessPal for nutrient analysis instead of Nubel on the power of a study design that correlates nutrient intake to a chosen outcome variable. Results: Per food portion, the following upper limits were defined: 1500 kilocalories for total energy intake, 95 grams (g) for carbohydrates, 92 g for fat, 52 g for protein, 22 g for fiber, 70 g for sugar, 600 mg for cholesterol, and 3600 mg for sodium. Cleaning the dataset extracted at T2 resulted in a 2.8% rejection. Cleaned MyFitnessPal values demonstrated strong correlations with Nubel for energy intake (r=0.96), carbohydrates (r=0.90), fat (r=0.90), protein (r=0.90), fiber (r=0.80), and sugar (r=0.79), but weak correlations for cholesterol (ρ=0.51) and sodium (ρ=0.53); all P values were ≤.001. No bias was found between both methods, except for a fixed bias for fiber and a proportional bias for cholesterol. A 5-10% power loss should be taken into account when correlating energy intake and macronutrients obtained with MyFitnessPal to an outcome variable, compared to Nubel. Conclusions: Dietary analysis with MyFitnessPal is accurate and efficient for total energy intake, macronutrients, sugar, and fiber, but not for cholesterol and sodium. %M 33084583 %R 10.2196/18237 %U http://www.jmir.org/2020/10/e18237/ %U https://doi.org/10.2196/18237 %U http://www.ncbi.nlm.nih.gov/pubmed/33084583 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e15430 %T Occurrence of and Reasons for “Missing Events” in Mobile Dietary Assessments: Results From Three Event-Based Ecological Momentary Assessment Studies %A Ziesemer,Katrin %A König,Laura Maria %A Boushey,Carol Jo %A Villinger,Karoline %A Wahl,Deborah Ronja %A Butscher,Simon %A Müller,Jens %A Reiterer,Harald %A Schupp,Harald Thomas %A Renner,Britta %+ Psychological Assessment & Health Psychology, Department of Psychology, University of Konstanz, PO Box 47, Konstanz, 78457, Germany, 49 7531884679, britta.renner@uni-konstanz.de %K dietary assessment %K diet records %K mobile phone %K mobile applications %K technology %K adherence %K compliance %K missing events %K Ecological Momentary Assessment %K mHealth %D 2020 %7 14.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Establishing a methodology for assessing nutritional behavior comprehensively and accurately poses a great challenge. Mobile technologies such as mobile image-based food recording apps enable eating events to be assessed in the moment in real time, thereby reducing memory biases inherent in retrospective food records. However, users might find it challenging to take images of the food they consume at every eating event over an extended period, which might lead to incomplete records of eating events (missing events). Objective: Analyzing data from 3 studies that used mobile image-based food recording apps and varied in their technical enrichment, this study aims to assess how often eating events (meals and snacks) were missed over a period of 8 days in a naturalistic setting by comparing the number of recorded events with the number of normative expected events, over time, and with recollections of missing events. Methods: Participants in 3 event-based Ecological Momentary Assessment (EMA) studies using mobile image-based dietary assessments were asked to record all eating events (study 1, N=38, 1070 eating events; study 2, N=35, 934 eating events; study 3, N=110, 3469 eating events). Study 1 used a basic app; study 2 included 1 fixed reminder and the possibility to add meals after the actual eating events occurred instead of in the moment (addendum); and study 3 included 2 fixed reminders, an addendum feature, and the option to record skipped meals. The number of recalled missed events and their reasons were assessed by semistructured interviews after the EMA period (studies 1 and 2) and daily questionnaires (study 3). Results: Overall, 183 participants reported 5473 eating events. Although the momentary adherence rate as indexed by a comparison with normative expected events was generally high across all 3 studies, a differential pattern of results emerged with a higher rate of logged meals in the more technically intensive study 3. Multilevel models for the logging trajectories of reported meals in all 3 studies showed a significant, albeit small, decline over time (b=−.11 to −.14, Ps<.001, pseudo-R²=0.04-0.06), mainly because of a drop in reported snacks between days 1 and 2. Intraclass coefficients indicated that 38% or less of the observed variance was because of individual differences. The most common reasons for missing events were competing activities and technical issues, whereas situational barriers were less important. Conclusions: Three different indicators (normative, time stability, and recalled missing events) consistently indicated missing events. However, given the intensive nature of diet EMA protocols, the effect sizes were rather small and the logging trajectories over time were remarkably stable. Moreover, the individual’s actual state and context seemed to exert a greater influence on adherence rates than stable individual differences, which emphasizes the need for a more nuanced understanding of the factors that affect momentary adherence. %M 33052123 %R 10.2196/15430 %U https://mhealth.jmir.org/2020/10/e15430 %U https://doi.org/10.2196/15430 %U http://www.ncbi.nlm.nih.gov/pubmed/33052123 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e20317 %T Design and Usability Evaluation of Mobile Voice-Added Food Reporting for Elderly People: Randomized Controlled Trial %A Liu,Ying-Chieh %A Chen,Chien-Hung %A Lin,Yu-Sheng %A Chen,Hsin-Yun %A Irianti,Denisa %A Jen,Ting-Ni %A Yeh,Jou-Yin %A Chiu,Sherry Yueh-Hsia %+ Department of Health Care Management and Healthy Aging Research Center, College of Management, Chang Gung University, No. 259, Wen-Hwa 1st Road, 333 Kwei-Shan, Taoyuan, Taiwan, 886 3 2118800 ext 5250, sherrychiu@mail.cgu.edu.tw %K voice-added design %K food report %K elderly %K usability evaluation %K automatic speech recognition %K mHealth %K randomized trial %D 2020 %7 28.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Advances in voice technology have raised new possibilities for apps related to daily health maintenance. However, the usability of such technologies for older users remains unclear and requires further investigation. Objective: We designed and evaluated two innovative mobile voice-added apps for food intake reporting, namely voice-only reporting (VOR) and voice-button reporting (VBR). Each app features a unique interactive procedure for reporting food intake. With VOR, users verbally report the main contents of each dish, while VBR provides both voice and existing touch screen inputs for food intake reporting. The relative usability of the two apps was assessed through the metrics of accuracy, efficiency, and user perception. Methods: The two mobile apps were compared in a head-to-head parallel randomized trial evaluation. A group of 57 adults aged 60-90 years (12 male and 45 female participants) was recruited from a retirement community and randomized into two experimental groups, that is, VOR (n=30) and VBR (n=27) groups. Both groups were tested using the same set of 17 food items including dishes and beverages selected and allocated to present distinct breakfast, lunch, and dinner meals. All participants used a 7-inch tablet computer for the test. The resulting data were analyzed to evaluate reporting accuracy and time efficiency, and the system usability scale (SUS) was used to measure user perception. Results: For eight error types identified in the experiment, the VBR group participants were significantly (P<.001) more error prone owing to the required use of button-tapping actions. The highest error rates in the VOR group were related to incomprehensible reporting speech (28/420, 6.7%), while the highest error rates in the VBR group were related to failure to make required button taps (39/378, 10.3%). The VOR group required significantly (P<.001) less time to complete food reporting. The overall subjective reactions of the two groups based on the SUS surpassed the benchmark and were not significantly different (P=.20). Conclusions: Experimental results showed that VOR outperformed VBR, suggesting that voice-only food input reporting is preferable for elderly users. Voice-added apps offer a potential mechanism for the self-management of dietary intake by elderly users. Our study contributes an evidence-based evaluation of prototype design and selection under a user-centered design model. The results provide a useful reference for selecting optimal user interaction design. Trial Registration: International Standard Randomized Controlled Trial Registry ISRCTN17335889; http://www.isrctn.com/ISRCTN17335889. %M 32985999 %R 10.2196/20317 %U http://mhealth.jmir.org/2020/9/e20317/ %U https://doi.org/10.2196/20317 %U http://www.ncbi.nlm.nih.gov/pubmed/32985999 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e17919 %T Design and Development of a Digital Weight Management Intervention (ToDAy): Qualitative Study %A Shoneye,Charlene L %A Mullan,Barbara %A Begley,Andrea %A Pollard,Christina M %A Jancey,Jonine %A Kerr,Deborah A %+ School of Public Health, Curtin University, GPO Box U1987, Perth, Western Australia, Australia, 61 61892664122, D.Kerr@curtin.edu.au %K obesity %K diet %K physical activity %K sedentary behavior %K digital behavioral interventions %K health behavior %K wearable activity monitor %K health %K mobile food record %K clinical trial %K focus group %K qualitative research %K mobile phone %D 2020 %7 9.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The Tailored Diet and Activity (ToDAy) study aims to build on the campaign by adding a digital intervention with the potential to provide wide-reaching, cost-effective weight management support. Objective: The ToDAy study aims to build a tailored intervention using mobile technology to improve diet and physical activity behaviours in adults with overweight and obesity. The main objectives were to identify behavior change techniques for diet and physical activity (PA) change for weight loss and explore preferences for digital intervention features that would be effective in changing diet and PA behaviors. Methods: This qualitative study uses the principles of a person-based approach to intervention development; the behavioral intervention technology framework; and the capability, opportunity, motivation, and behavior (COM-B) framework. Focus groups and telephone interviews were conducted with 56 adults in Western Australia. Open-ended questions and example intervention features were used to explore the usability and acceptability of the self-monitoring tools, knowledge about effective weight-loss strategies, and acceptability of tailored feedback. Findings from the focus groups and interviews were analyzed using thematic analysis. Results: Qualitative findings revealed an awareness of key public health messages but a lack of confidence in how to perform these behaviors to help manage their weight. A total of 4 major themes were identified and mapped to the domains of the COM-B framework: (1) misinformation, (2) environmental support, (3) social norms, and (4) confidence. Conclusions: This study explores users’ capability, opportunity, and motivation to perform the target behaviors for weight loss. The findings suggested that a digital weight management intervention using a mobile food record and activity trackers to inform tailored feedback may be acceptable and feasible. Participants expressed a preference for simple expert advice, digital self-monitoring tools, and visual feedback. International Registered Report Identifier (IRRID): RR2-10.2196/12782 %M 32641284 %R 10.2196/17919 %U https://mhealth.jmir.org/2020/9/e17919 %U https://doi.org/10.2196/17919 %U http://www.ncbi.nlm.nih.gov/pubmed/32641284 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e16953 %T Validity and Usability of a Smartphone Image-Based Dietary Assessment App Compared to 3-Day Food Diaries in Assessing Dietary Intake Among Canadian Adults: Randomized Controlled Trial %A Ji,Yuwei %A Plourde,Hugues %A Bouzo,Valerie %A Kilgour,Robert D %A Cohen,Tamara R %+ Faculty of Land and Food Systems, Food, Nutrition and Health, University of British Columbia, 218-2205 East Mall, Vancouver, BC, V6T 1Z4, Canada, 1 604 827 0362, tamara.cohen@ubc.ca %K mobile food record %K validity %K image-based dietary assessment %K healthy adults %K 3-day food diary %K diet %K application %K nutrition %K mHealth %K Canada %D 2020 %7 9.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Accurate dietary assessment is needed in studies that include analysis of nutritional intake. Image-based dietary assessment apps have gained in popularity for assessing diet, which may ease researcher and participant burden compared to traditional pen-to-paper methods. However, few studies report the validity of these apps for use in research. Keenoa is a smartphone image-based dietary assessment app that recognizes and identifies food items using artificial intelligence and permits real-time editing of food journals. Objective: This study aimed to assess the relative validity of an image-based dietary assessment app — Keenoa — against a 3-day food diary (3DFD) and to test its usability in a sample of healthy Canadian adults. Methods: We recruited 102 participants to complete two 3-day food records. For 2 weeks, on 2 non-consecutive days and 1 weekend day, in random order, participants completed a traditional pen-to-paper 3DFD and the Keenoa app. At the end of the study, participants completed the System Usability Scale. The nutrient analyses of the 3DFD and Keenoa data before (Keenoa-participant) and after they were reviewed by dietitians (Keenoa-dietitian) were analyzed using analysis of variance. Multiple tests, including the Pearson coefficient, cross-classification, kappa score, % difference, paired t test, and Bland-Altman test, were performed to analyze the validity of Keenoa (Keenoa-dietitian). Results: The study was completed by 72 subjects. Most variables were significantly different between Keenoa-participant and Keenoa-dietitian (P<.05) except for energy, protein, carbohydrates, fiber, vitamin B1, vitamin B12, vitamin C, vitamin D, and potassium. Significant differences in total energy, protein, carbohydrates, % fat, saturated fatty acids, iron, and potassium were found between the 3DFD and Keenoa-dietitian data (P<.05). The Pearson correlation coefficients between the Keenoa-dietitian and 3DFD ranged from .04 to .51. Differences between the mean intakes assessed by the 3DFD and Keenoa-dietitian were within 10% except for vitamin D (misclassification rate=33.8%). The majority of nutrients were within an acceptable range of agreement in the Bland-Altman analysis; no agreements were seen for total energy, protein, carbohydrates, fat (%), saturated fatty acids, iron, potassium, and sodium (P<.05). According to the System Usability Scale, 34.2% of the participants preferred using Keenoa, while 9.6% preferred the 3DFD. Conclusions: The Keenoa app provides acceptable relative validity for some nutrients compared to the 3DFD. However, the average intake of some nutrients, including energy, protein, carbohydrates, % fat, saturated fatty acids, and iron, differed from the average obtained using the 3DFD. These findings highlight the importance of verifying data entries of participants before proceeding with nutrient analysis. Overall, Keenoa showed better validity at the group level than the individual level, suggesting it can be used when focusing on the dietary intake of the general population. Further research is recommended with larger sample sizes and objective dietary assessment approaches. %M 32902389 %R 10.2196/16953 %U https://mhealth.jmir.org/2020/9/e16953 %U https://doi.org/10.2196/16953 %U http://www.ncbi.nlm.nih.gov/pubmed/32902389 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e19634 %T Weight Reduction Through a Digital Nutrition and Food Purchasing Platform Among Users With Obesity: Longitudinal Study %A Hu,Emily A %A Nguyen,Viet %A Langheier,Jason %A Shurney,Dexter %+ Zipongo, Inc, DBA Foodsmart, 600 California Street, 11th Floor, San Francisco, CA, 94108, United States, 1 415 604 4122, emily.hu@zipongo.com %K digital %K nutrition %K meal planning %K weight loss %K obese %K food environment %K food ordering %K food purchasing %K behavioral economics %K behavior change %K eating behavior %K mHealth %K app %D 2020 %7 2.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital nutrition apps that monitor or provide recommendations on diet have been found to be effective in behavior change and weight reduction among individuals with obesity. However, there is less evidence on how integration of personalized nutrition recommendations and changing the food purchasing environment through online meal planning and grocery delivery, meal kits, and grocery incentives impacts weight loss among individuals with obesity. Objective: The objective of this observational longitudinal study was to examine weight loss and predictors of weight loss among individuals with obesity who are users of a digital nutrition platform that integrates tools to provide nutrition recommendations and changes in the food purchasing environment grounded in behavioral theory. Methods: We included 8977 adults with obesity who used the digital Foodsmart platform, created by Zipongo, Inc, DBA Foodsmart between January 2013 and April 2020. We retrospectively analyzed user characteristics and their associations with weight loss. Participants reported age, gender, height, at least 2 measures of weight, and usual dietary intake. Healthy Diet Score, a score to measure overall diet quality, was calculated based on responses to a food frequency questionnaire. We used paired t tests to compare differences in baseline and final weights and baseline and final Healthy Diet Scores. We used univariate and multivariate logistic regression models to estimate odds ratios and 95% CI of achieving 5% weight loss by gender, age, baseline BMI, Healthy Diet Score, change in Healthy Diet Score, and duration of enrollment. We conducted stratified analyses to examine mean percent weight change by enrollment duration and gender, age, baseline BMI, and change in Healthy Diet Score. Results: Over a median (IQR) of 9.9 (0.03-54.7) months of enrollment, 59% of participants lost weight. Of the participants who used the Foodsmart platform for at least 24 months, 33.3% achieved 5% weight loss. In the fully adjusted logistic regression model, we found that baseline BMI (OR 1.02, 95% CI 1.02-1.03; P<.001), baseline Healthy Diet Score (OR 1.06, 95% CI 1.05-1.08; P<.001), greater change in Healthy Diet Score (OR 1.12, 95% CI 1.11-1.14; P<.001), and enrollment length (OR 1.28, 95% CI 1.23-1.32; P<.001) were all significantly associated with higher odds of achieving at least 5% weight loss. Conclusions: This study found that a digital app that provides personalized nutrition recommendations and change in one’s food purchasing environment appears to be successful in meaningfully reducing weight among individuals with obesity. %M 32792332 %R 10.2196/19634 %U http://www.jmir.org/2020/9/e19634/ %U https://doi.org/10.2196/19634 %U http://www.ncbi.nlm.nih.gov/pubmed/32792332 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19056 %T The Associations Among Individual Factors, Media Literacy, and Dietary Supplement Use Among College Students: Cross-Sectional Study %A Yang,Shu Ching %A Hsu,Wan-Chen %A Chiang,Chia-Hsun %+ National Sun Yat-Sen University, 70 Lienhai Rd, Kaohsiung, 80424, Taiwan, 886 75251521, d996050002@student.nsysu.edu.tw %K college student %K dietary supplement %K media literacy %K ehealth literacy %D 2020 %7 31.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The mass media have been condemned for encouraging young people to take dietary supplements (DS). Media literacy, which includes authors and audiences (AA), messages and meanings (MM), and representation and reality (RR) domains, is a new approach to teaching young adults to make better informed health decisions. However, it is not clear which domains are the most important for media literacy education. Objective: The purpose of this study is to investigate the associations among individual factors, media literacy, and DS use. Methods: The survey instrument included demographic items, the DS Media Literacy Scale (DSMLS), and DS use items (users or nonusers, types of DS, current use of DS, and intention to use DS in the future). The DSMLS is an 11-item instrument designed to assess college students’ AA, MM, and RR media literacy in relation to DS. A total of 467 Taiwanese college students participated in the study. Descriptive statistical analysis, logistic regression analysis, and multiple regression analysis were conducted. Results: A total of 338/467 (72.4%) participants reported using DS, and 176/467 (37.7%) consumed 3 or more supplements. Moreover, the MM media literacy domain was associated with having been a DS user (odds ratio 0.63, P=.002), current DS use (β=–.10, P=.02), and intention to use DS in the future (β=–.12, P=.011). Finally, perceived importance of health was positively related to current DS use (β=.18, P=.001) and intention to use DS in the future (β=.18, P=.001). Conclusions: This study showed that the majority of Taiwanese college students were DS users and used multiple types of supplements. Moreover, students with lower MM media literacy were more likely to be DS users, to take DS more frequently, and to have higher intentions for future frequent DS use. Finally, those who placed extreme importance on health were more likely to take DS frequently and have higher intentions for future frequent DS use. %M 32865500 %R 10.2196/19056 %U http://www.jmir.org/2020/8/e19056/ %U https://doi.org/10.2196/19056 %U http://www.ncbi.nlm.nih.gov/pubmed/32865500 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e17521 %T Understanding Time Series Patterns of Weight and Meal History Reports in Mobile Weight Loss Intervention Programs: Data-Driven Analysis %A Kim,Junetae %A Kam,Hye Jin %A Kim,Youngin %A Lee,Yura %A Lee,Jae-Ho %+ Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea, 82 3010 3350, rufiji@gmail.com %K weight loss %K self-reporting %K adherence %K mobile weight loss intervention %K diet %D 2020 %7 11.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile apps for weight loss provide users with convenient features for recording lifestyle and health indicators; they have been widely used for weight loss recently. Previous studies in this field generally focused on the relationship between the cumulative nature of self-reported data and the results in weight loss at the end of the diet period. Therefore, we conducted an in-depth study to explore the relationships between adherence to self-reporting and weight loss outcomes during the weight reduction process. Objective: We explored the relationship between adherence to self-reporting and weight loss outcomes during the time series weight reduction process with the following 3 research questions: “How does adherence to self-reporting of body weight and meal history change over time?”, “How do weight loss outcomes depend on weight changes over time?”, and “How does adherence to the weight loss intervention change over time by gender?” Methods: We analyzed self-reported data collected weekly for 16 weeks (January 2017 to March 2018) from 684 Korean men and women who participated in a mobile weight loss intervention program provided by a mobile diet app called Noom. Analysis of variance (ANOVA) and chi-squared tests were employed to determine whether the baseline characteristics among the groups of weight loss results were different. Based on the ANOVA results and slope analysis of the trend indicating participant behavior along the time axis, we explored the relationship between adherence to self-reporting and weight loss results. Results: Adherence to self-reporting levels decreased over time, as previous studies have found. BMI change patterns (ie, absolute BMI values and change in BMI values within a week) changed over time and were characterized in 3 time series periods. The relationships between the weight loss outcome and both meal history and self-reporting patterns were gender-dependent. There was no statistical association between adherence to self-reporting and weight loss outcomes in the male participants. Conclusions: Although mobile technology has increased the convenience of self-reporting when dieting, it should be noted that technology itself is not the essence of weight loss. The in-depth understanding of the relationship between adherence to self-reporting and weight loss outcome found in this study may contribute to the development of better weight loss interventions in mobile environments. %M 32780028 %R 10.2196/17521 %U https://www.jmir.org/2020/8/e17521 %U https://doi.org/10.2196/17521 %U http://www.ncbi.nlm.nih.gov/pubmed/32780028 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e14013 %T Use of a Smartphone App for Weight Loss Versus a Paper-Based Dietary Diary in Overweight Adults: Randomized Controlled Trial %A Ahn,Jeong Sun %A Lee,Heejin %A Kim,Jiae %A Park,Haemin %A Kim,Dong Woo %A Lee,Jung Eun %+ Department of Food and Nutrition, College of Human Ecology, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea, 82 2 880 6834, jungelee@snu.ac.kr %K smartphone app %K mobile phone %K dietary self-monitoring %K randomized controlled trial %K weight loss %D 2020 %7 31.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) tools may be useful platforms for dietary monitoring and assessment. Objective: This study aims to evaluate the effectiveness of a mobile dietary self-monitoring app for weight loss versus a paper-based diary among adults with a BMI of 23 kg/m2 or above. Methods: A total of 33 men and 17 women aged 18-39 years participated in a 6-week randomized controlled trial. We randomly assigned participants to one of two groups: (1) a smartphone app group (n=25) or (2) a paper-based diary group (n=25). The smartphone app group recorded foods and dietary supplements that they consumed and received immediate dietary feedback using Well-D, a dietary self-monitoring app developed by our team. The paper-based diary group was instructed to record foods or supplements that they consumed using a self-recorded diary. The primary outcomes were weight, BMI, waist circumference, body fat mass, and skeletal muscle mass. We also examined changes in nutrient intake, including energy, carbohydrate, protein, fat, dietary fiber, vitamins, and minerals, using 3-day 24-hour recalls. Differences in changes between the two groups were analyzed using independent t tests or Wilcoxon Mann-Whitney tests. All of the data were analyzed using intent-to-treat analysis. Results: The mean number of days recorded was 18.5 (SD 14.1) for the app group and 15.5 (SD 10.1) for the paper-based diary group. The differences in changes in weight, BMI, and waist circumference were not significantly different between the app group and paper-based diary group (P=.33, .34, and .70, respectively). Similarly, changes in body fat mass or skeletal muscle mass did not differ between the two groups (P=.71 and .054, respectively). Although energy intake was reduced in both groups, there was no significant difference in changes in energy intake between the two groups (P=.98). Conclusions: There were no differences in changes in anthropometric measures and nutrient intake between the app group and the paper-based diary group. Both mobile dietary self-monitoring app and paper-based diary may be useful for improving anthropometric measures. Trial Registration: Clinical Research Information Service KCT0003170; https://cris.nih.go.kr/cris/search/search_result_st01_en.jsp?seq=11642<ype=&rtype= %M 32735225 %R 10.2196/14013 %U http://mhealth.jmir.org/2020/7/e14013/ %U https://doi.org/10.2196/14013 %U http://www.ncbi.nlm.nih.gov/pubmed/32735225 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e16405 %T Wearable Technology to Quantify the Nutritional Intake of Adults: Validation Study %A Dimitratos,Sarah M %A German,J Bruce %A Schaefer,Sara E %+ Foods for Health Institute, University of California, 2141 Robert Mondavi Institute, North Building, 1 Shields Ave, Davis, CA, 95616, United States, 1 530 574 0797, seschaefer@ucdavis.edu %K wearable technology %K mobile health %K mobile phone %K food intake %K validation study %D 2020 %7 22.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Wearable and mobile sensor technologies can be useful tools in precision nutrition research and practice, but few are reliable for obtaining accurate and precise measurements of diet and nutrition. Objective: This study aimed to assess the ability of wearable technology to monitor the nutritional intake of adult participants. This paper describes the development of a reference method to validate the wristband’s estimation of daily nutritional intake of 25 free-living study participants and to evaluate the accuracy (kcal/day) and practical utility of the technology. Methods: Participants were asked to use a nutrition tracking wristband and an accompanying mobile app consistently for two 14-day test periods. A reference method was developed to validate the estimation of daily nutritional intake of participants by the wristband. The research team collaborated with a university dining facility to prepare and serve calibrated study meals and record the energy and macronutrient intake of each participant. A continuous glucose monitoring system was used to measure adherence with dietary reporting protocols, but these findings are not reported. Bland-Altman tests were used to compare the reference and test method outputs (kcal/day). Results: A total of 304 input cases were collected of daily dietary intake of participants (kcal/day) measured by both reference and test methods. The Bland-Altman analysis had a mean bias of −105 kcal/day (SD 660), with 95% limits of agreement between −1400 and 1189. The regression equation of the plot was Y=−0.3401X+1963, which was significant (P<.001), indicating a tendency for the wristband to overestimate for lower calorie intake and underestimate for higher intake. Researchers observed transient signal loss from the sensor technology of the wristband to be a major source of error in computing dietary intake among participants. Conclusions: This study documents high variability in the accuracy and utility of a wristband sensor to track nutritional intake, highlighting the need for reliable, effective measurement tools to facilitate accurate, precision-based technologies for personal dietary guidance and intervention. %M 32706729 %R 10.2196/16405 %U https://mhealth.jmir.org/2020/7/e16405 %U https://doi.org/10.2196/16405 %U http://www.ncbi.nlm.nih.gov/pubmed/32706729 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e15948 %T Comparison of Geographic Information System and Subjective Assessments of Momentary Food Environments as Predictors of Food Intake: An Ecological Momentary Assessment Study %A Elliston,Katherine G %A Schüz,Benjamin %A Albion,Tim %A Ferguson,Stuart G %+ College of Health and Medicine, University of Tasmania, 17 Liverpool Street, Hobart, 7000, Australia, 61 362264259, katherine.elliston@utas.edu.au %K ecological momentary assessment %K mHealth %K geographic information systems %K food intake %K mobile phone %D 2020 %7 22.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: It has been observed that eating is influenced by the presence and availability of food. Being aware of the presence of food in the environment may enable mobile health (mHealth) apps to use geofencing techniques to determine the most appropriate time to proactively deliver interventions. To date, however, studies on eating typically rely on self-reports of environmental contexts, which may not be accurate or feasible for issuing mHealth interventions. Objective: This study aimed to compare the subjective and geographic information system (GIS) assessments of the momentary food environment to explore the feasibility of using GIS data to predict eating behavior and inform geofenced interventions. Methods: In total, 72 participants recorded their food intake in real-time for 14 days using an ecological momentary assessment approach. Participants logged their food intake and responded to approximately 5 randomly timed assessments each day. During each assessment, the participants reported the number and type of food outlets nearby. Their electronic diaries simultaneously recorded their GPS coordinates. The GPS data were later overlaid with a GIS map of food outlets to produce an objective count of the number of food outlets within 50 m of the participant. Results: Correlations between self-reported and GIS counts of food outlets within 50 m were only of a small size (r=0.17; P<.001). Logistic regression analyses revealed that the GIS count significantly predicted eating similar to the self-reported counts (area under the curve for the receiver operating characteristic curve [AUC-ROC] self-report=0.53, SE 0.00 versus AUC-ROC 50 m GIS=0.53, SE 0.00; P=.41). However, there was a significant difference between the GIS-derived and self-reported counts of food outlets and the self-reported type of food outlets (AUC-ROC self-reported outlet type=0.56, SE 0.01; P<.001). Conclusions: The subjective food environment appears to predict eating better than objectively measured food environments via GIS. mHealth apps may need to consider the type of food outlets rather than the raw number of outlets in an individual’s environment. %M 32706728 %R 10.2196/15948 %U https://mhealth.jmir.org/2020/7/e15948 %U https://doi.org/10.2196/15948 %U http://www.ncbi.nlm.nih.gov/pubmed/32706728 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17817 %T A Dietary Mobile App for Patients Undergoing Hemodialysis: Prospective Pilot Study to Improve Dietary Intakes %A Fakih El Khoury,Cosette %A Crutzen,Rik %A Schols,Jos M G A %A Halfens,Ruud J G %A Karavetian,Mirey %+ Department of Health Sciences, Zayed University, PO Box 19282, Dubai, United Arab Emirates, 971 562446865, Mirey.Karavetian@zu.ac.ae %K mHealth %K dietary app %K hemodialysis diet %D 2020 %7 20.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile technology has an impact on the health care sector, also within dietetics. Mobile health (mHealth) apps may be used for dietary assessment and self-monitoring, allowing for real-time reporting of food intakes. Changing eating behaviors is quite challenging, and patients undergoing hemodialysis, particularly, struggle to meet the target intakes set by dietary guidelines. Usage of mobile apps that are developed in a person-centered approach and in line with recommendations may support both patients and health care practitioners. Objective: This study is a pilot that aims at estimating the potential efficacy of a dietary intervention using a theory-based, person-centered smartphone app. Results will be used to improve both the app and a planned large-scale trial intended to assess app efficacy thoroughly. Methods: A prospective pilot study was performed at the hemodialysis unit of Al Qassimi Hospital (The Emirate of Sharjah). All patients that fulfilled the study inclusion criteria were considered eligible to be enrolled in the pilot study. Upon successful installation of the app, users met with a dietitian once a week. Outcomes were measured at baseline (T0) and 2 weeks post app usage (T1). This pilot is reported as per guidelines for nonrandomized pilot and feasibility studies and in line with the CONSORT 2010 checklist for reporting pilot or feasibility trials. Results: A total of 23 patients completed the pilot intervention. Mean energy intakes increased from 24.4 kcal/kg/day (SD 8.0) to 29.1 kcal/kg/day (SD 7.8) with a medium effect size (d=0.6, 95% CI 0.0-1.2). Mean protein intakes increased from 0.9 g/kg/day (SD 0.3) to 1.3 g/kg/day (SD 0.5) with a large effect size (d=1.0, 95% CI 0.4-1.6); mean intake of high biological value (%HBV) proteins also increased from 58.6% (SD 10.1) to 70.1% (SD 10.7) with a large effect size (d=1.1, 95% CI 0.5-1.7). Dietary intakes of minerals did not change, apart from sodium which decreased from a mean intake of 2218.8 mg/day (SD 631.6) to 1895.3 mg/day (SD 581.0) with a medium effect size (d=0.5, 95% CI 0.1-1.1). Mean serum phosphorus, potassium, and albumin levels did not change relevantly. Mean serum iron increased from 7.9 mg/dL (SD 2.8) to 11.5 mg/dL (SD 7.9) postintervention with a medium effect size (d=0.6, 95% CI 0.0-1.2). Conclusions: This pilot study showed that the KELA.AE app has the potential to improve dietary intakes. Processes related to procedure, resources, tools, and app improvement for a future trial were assessed. A more extended intervention using a randomized controlled trial is required to estimate parameters concerning app efficacy accurately. %M 32706698 %R 10.2196/17817 %U http://www.jmir.org/2020/7/e17817/ %U https://doi.org/10.2196/17817 %U http://www.ncbi.nlm.nih.gov/pubmed/32706698 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e17845 %T Evaluating Engagement in a Digital and Dietetic Intervention Promoting Healthy Weight Gain in Pregnancy: Mixed Methods Study %A Willcox,Jane C %A Chai,Daniel %A Beilin,Lawrence J %A Prescott,Susan L %A Silva,Desiree %A Neppe,Cliff %A Huang,Rae-Chi %+ Telethon Kids Institute, Hospital Avenue, Nedlands, Perth, 6009, Australia, 61 0402131555, rae-chi.huang@telethonkids.org.au %K pregnancy %K internet-based intervention %K patient participation %K qualitative research %K eHealth %K body weight %K obesity %D 2020 %7 26.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Early excess and inadequate gestational weight gain (GWG) have been associated with negative outcomes for mother and child. The use of digital media to deliver pregnancy lifestyle interventions is increasing, but there is little data on participant engagement. The Pregnancy Lifestyle Activity and Nutrition (PLAN) intervention pilot study was an electronic health and dietetic-delivered intervention program promoting healthy GWG in early pregnancy. Objective: This study aims to explore the interactions of participants with the program and to assess its acceptability. Methods: This study uses both quantitative and qualitative methods using data from parent randomized controlled trial (ACTRN12617000725369). Quantitative data from 22 participants in the intervention arm who completed the study provided measures of the interactions participants had with the digital components of the program and with dietetic consultations. A descriptive qualitative analysis employed semistructured interviews with 9 participants to elicit views on the acceptability of the intervention and its components. Results: The electronic delivery of information and recording of weight from 8 to 20 weeks of gestation were universally accepted. Component (face-to-face dietitian, weight tracker, website information delivery, and SMS goal prompting) acceptability and engagement differed between individuals. A total of 4 key themes emerged from the qualitative analysis: supporting lifestyle change, component acceptability and value, delivery platforms, and engagement barriers. Conclusions: The PLAN intervention and its delivery via a blend of personal dietetic consultations and digital program delivery was found to be acceptable and valuable to pregnant women. Individuals responded differently to various components, emphasizing the importance of including women in the development of lifestyle interventions and allowing participants to choose and tailor programs. Larger randomized controlled trials using these insights in a broader section of the community are needed to inform the iterative development of practical, time-efficient, and cost-effective ways of supporting optimal GWG with the potential to optimize outcomes for pregnant women and their child. %M 32442153 %R 10.2196/17845 %U http://www.jmir.org/2020/6/e17845/ %U https://doi.org/10.2196/17845 %U http://www.ncbi.nlm.nih.gov/pubmed/32442153 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e15619 %T Rethinking the Use of Mobile Apps for Dietary Assessment in Medical Research %A Khazen,Wael %A Jeanne,Jean-François %A Demaretz,Laëtitia %A Schäfer,Florent %A Fagherazzi,Guy %+ Innovation Science and Nutrition, Danone Nutricia Research, RD 128 Avenue de la Vauve, Palaiseau, 91767, France, 33 622256853, florent.schafer@danone.com %K diet %K dietary assessment %K epidemiology %K clinical research %K mobile diet app %K academic apps %K consumer-grade apps %D 2020 %7 18.6.2020 %9 Viewpoint %J J Med Internet Res %G English %X Food intake and usual dietary intake are among the key determinants of health to be assessed in medical research and important confounding factors to be accounted for in clinical studies. Although various methods are available for gathering dietary data, those based on innovative technologies are particularly promising. With combined cost-effectiveness and ease of use, it is safe to assume that mobile technologies can now optimize tracking of eating occasions and dietary behaviors. Yet, choosing a dietary assessment tool that meets research objectives and data quality standards remains challenging. In this paper, we describe the purposes of collecting dietary data in medical research and outline the main considerations for using mobile dietary assessment tools based on participant and researcher expectations. %M 32554383 %R 10.2196/15619 %U https://www.jmir.org/2020/6/e15619 %U https://doi.org/10.2196/15619 %U http://www.ncbi.nlm.nih.gov/pubmed/32554383 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e14543 %T Usability of Food Size Aids in Mobile Dietary Reporting Apps for Young Adults: Randomized Controlled Trial %A Liu,Ying-Chieh %A Wu,Sheng-Tang %A Lin,Shan-Ju %A Chen,Chien-Hung %A Lin,Yu-Sheng %A Chen,Hsin-Yun %+ Department of Industrial Design, College of Management, Chang Gung University, No 259, Wen-Hwa 1st Road, Kwei-Shan, Taoyuan, 333, Taiwan, 886 3 2118800 ext 5250, ycl30@mail.cgu.edu.tw %K portion size measurement %K prototype %K user-centered design %K dietary reporting %K mobile health %K randomized controlled trial %D 2020 %7 29.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Young adults are more likely to use self-managed dietary reporting apps. However, there is scant research examining the user experience of different measurement approaches for mobile dietary reporting apps when dealing with a wide variety of food shapes and container sizes. Objective: Field user experience testing was conducted under actual meal conditions to assess the accuracy, efficiency, and subjective reaction of three food portion measurement methods embedded in a developed mobile app. Key-in–based aid (KBA), commonly used in many current apps, relies on the user’s ability to key in volumes or weights. Photo-based aid (PBA) extends traditional assessment methods, allowing users to scroll, observe, and select a reduced-size image from a set of options. Gesture-based aid (GBA) is a new experimental approach in which the user makes finger movements on the screen to roughly describe food portion boundaries accompanied by a background reference. Methods: A group of 124 young adults aged 19 to 26 years was recruited for a head-to-head randomized comparison and divided into 3 groups: a KBA (n=42) control group and PBA (n=41) and GBA (n=41) experimental groups. In total, 3 meals (ie, breakfast, lunch, and dinner) were served in a university cafeteria. Participants were provided with 25 dishes and beverages for selection, with a variety of food shapes and containers that reflect everyday life conditions. The accuracy of and time spent on realistic interaction during food portion estimation and the subjective reaction of each aid were recorded and analyzed. Results: Participants in the KBA group provided the highest accuracy in terms of hash brown weight (P=.004) and outperformed PBA or GBA for many soft drinks in cups. PBA had the best results for a cylindrical hot dog (P<.001), irregularly shaped pork chop (P<.001), and green tea beverage (660 mL; P<.001). GBA outperformed PBA for most drinks, and GBA outperformed KBA for some vegetables. The GBA group spent significantly more time assessing food items than the KBA and PBA groups. For each aid, the overall subjective reaction based on the score of the System Usability Scale was not significantly different. Conclusions: Experimental results show that each aid had some distinguishing advantages. In terms of user acceptance, participants considered all 3 aids to be usable. Furthermore, users’ subjective opinions regarding measurement accuracy contradicted the empirical findings. Future work will consider the use of each aid based on food or container shape and integrate the various advantages of the 3 different aids for better results. Our findings on the use of portion size aids are based on realistic and diverse food items, providing a useful reference for future app improvement of an effective, evidence-based, and acceptable feature. Trial Registration: International Standard Randomized Controlled Trial Registry ISRCTN36710750; http://www.controlled-trials.com/ISRCTN36710750. %M 32347805 %R 10.2196/14543 %U http://mhealth.jmir.org/2020/4/e14543/ %U https://doi.org/10.2196/14543 %U http://www.ncbi.nlm.nih.gov/pubmed/32347805 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e17816 %T Use of a Smartphone-Based Mobile App for Weight Management in Obese Minority Stroke Survivors: Pilot Randomized Controlled Trial With Open Blinded End Point %A Ifejika,Nneka L %A Bhadane,Minal %A Cai,Chunyan C %A Noser,Elizabeth A %A Grotta,James C %A Savitz,Sean I %+ Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, United States, 1 2146488762, nneka.ifejika@utsouthwestern.edu %K smartphone %K stroke %K obesity %K telemedicine %K minority groups %K cognitive dysfunction %K outcome assessment, health care %D 2020 %7 22.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Minorities have an increased incidence of early-onset, obesity-related cerebrovascular disease. Unfortunately, effective weight management in this vulnerable population has significant barriers. Objective: Our objective was to determine the feasibility and preliminary treatment effects of a smartphone-based weight loss intervention versus food journals to monitor dietary patterns in minority stroke patients. Methods: Swipe out Stroke was a pilot prospective randomized controlled trial with open blinded end point. Minority stroke patients and their caregivers were screened for participation using cluster enrollment. We used adaptive randomization for assignment to a behavior intervention with (1) smartphone-based self-monitoring or (2) food journal self-monitoring. The smartphone group used Lose it! to record meals and communicate with us. Reminder messages (first 30 days), weekly summaries plus reminder messages on missed days (days 31-90), and weekly summaries only (days 91-180) were sent via push notifications. The food journal group used paper diaries. Both groups received 4 in-person visits (baseline and 30, 90, and 180 days), culturally competent counseling, and educational materials. The primary outcome was reduced total body weight. Results: We enrolled 36 stroke patients (n=23, 64% African American; n=13, 36% Hispanic), 17 in the smartphone group, and 19 in the food journal group. Mean age was 54 (SD 9) years; mean body mass index was 35.7 (SD 5.7) kg/m2; education, employment status, and family history of stroke or obesity did not differ between the groups. Baseline rates of depression (Patient Health Questionnaire-9 [PHQ-9] score median 5.5, IQR 3.0-9.5), cognitive impairment (Montreal Cognitive Assessment score median 23.5, IQR 21-26), and inability to ambulate (5/36, 14% with modified Rankin Scale score 3) were similar. In total, 25 (69%) stroke survivors completed Swipe out Stroke (13/17 in the smartphone group, 12/19 in the food journal group); 1 participant in the smartphone group died. Median weight change at 180 days was 5.7 lb (IQR –2.4 to 8.0) in the smartphone group versus 6.4 lb (IQR –2.2 to 12.5; P=.77) in the food journal group. Depression was significantly lower at 30 days in the smartphone group than in the food journal group (PHQ-9 score 2 vs 8; P=.03). Clinically relevant depression rates remained in the zero to minimal range for the smartphone group compared with mild to moderate range in the food journal group at day 90 (PHQ-9 score 3.5 vs 4.5; P=.39) and day 180 (PHQ-9 score 3 vs 6; P=.12). Conclusions: In a population of obese minority stroke survivors, the use of a smartphone did not lead to a significant difference in weight change compared with keeping a food journal. The presence of baseline depression (19/36, 53%) was a confounding variable, which improved with app engagement. Future studies that include treatment of poststroke depression may positively influence intervention efficacy. Trial Registration: ClinicalTrials.gov NCT02531074; https://www.clinicaltrials.gov/ct2/show/NCT02531074 %M 32319963 %R 10.2196/17816 %U http://mhealth.jmir.org/2020/4/e17816/ %U https://doi.org/10.2196/17816 %U http://www.ncbi.nlm.nih.gov/pubmed/32319963 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e17613 %T Promoting Healthy Eating Habits for College Students Through Creating Dietary Diaries via a Smartphone App and Social Media Interaction: Online Survey Study %A Watanabe-Ito,Masako %A Kishi,Emiko %A Shimizu,Yoko %+ Department of Public Health Nursing, School of Nursing, Toho University, 4-16-20 Omori-Nishi, Ota, Tokyo, 143-0015, Japan, 81 3 3762 9881 ext 418, masako.watanabe@med.toho-u.ac.jp %K health promotion %K college students %K eating habits %K social media %K smartphone app %D 2020 %7 31.3.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Youth in developed countries face the contradictory health problems of obesity and an excessive desire for weight loss. Developing a better health attitude for college students is essential as this period of life establishes future lifestyle and habits. Online interaction on social media can help to improve eating habits by creating dietary diaries through a smartphone app; however, the effects of such interactions for college students have not been examined to date. Objective: The aim of this study was to evaluate the potential effectiveness of social media interactions with the use of dietary diaries on a smartphone app to motivate college students in raising self-awareness of their eating habits. Methods: Forty-two college students in the greater Tokyo area of Japan participated in the study by creating dietary diaries online through a smartphone app and then followed/interacted with each other using social media for 7 consecutive days in September to November 2017. Online surveys were administered at baseline, immediately after creating the dietary diaries, and at 1-month follow up. Participants rated their degree of interest and self-evaluation of eating habits using 7-point scales, and answered multiple choice questions related to their thoughts in choosing meals/drinks among 10 topics. Free descriptions about their overall experience throughout the project were also collected in the follow-up survey. Results: Data from 38 participants who completed all processes were analyzed. Over time, the mean score for degree of interest in eating habits increased from 4.6 to 6.2 (P<.001), while the self-evaluation score decreased from 4.5 to 3.6 (P<.001); these significant differences remained after 1 month (5.3, P=.002; 4.1, P=0.04, respectively). A weak negative correlation (P=.009) was observed between scores for degree of interest and self-evaluation. Participants with lower scores for degree of interest at baseline tended to increase their interest level by more than 2 points above the average (P<.001). Participants gradually thought more about their eating habits from various perspectives when choosing a meal/drink, particularly with respect to maintaining well-balanced diets and introducing diverse ingredients. Participants evaluated their experiences as interesting/fun and reported familiarity with using the smartphone app and social media as the preferred method to keep track of their eating. All participants welcomed communication with fellow participants on social media and motivated each other, in addition to monitoring their eating habits through online dietary diaries. Some participants experienced difficulty, especially when they were busy or faced a lack of internet access. Conclusions: Through interactions on social media, college students experienced encouragement and developed an interest and critical thinking with respect to their eating habits. This approach, which embraces peer education and peer support with social media, holds promise for the future of youth health promotion. Further examination will be needed to explore how to sustain this level of heightened awareness. %M 32229468 %R 10.2196/17613 %U http://mhealth.jmir.org/2020/3/e17613/ %U https://doi.org/10.2196/17613 %U http://www.ncbi.nlm.nih.gov/pubmed/32229468 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e15294 %T Volumetric Food Quantification Using Computer Vision on a Depth-Sensing Smartphone: Preclinical Study %A Herzig,David %A Nakas,Christos T %A Stalder,Janine %A Kosinski,Christophe %A Laesser,Céline %A Dehais,Joachim %A Jaeggi,Raphael %A Leichtle,Alexander Benedikt %A Dahlweid,Fried-Michael %A Stettler,Christoph %A Bally,Lia %+ Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, University of Bern, Freiburgstrasse 15, Bern, 3010, Switzerland, 41 31 632 36 77, lia.bally@insel.ch %K depth camera %K computer vision %K dietary assessment %K smartphone %D 2020 %7 25.3.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Quantification of dietary intake is key to the prevention and management of numerous metabolic disorders. Conventional approaches are challenging, laborious, and lack accuracy. The recent advent of depth-sensing smartphones in conjunction with computer vision could facilitate reliable quantification of food intake. Objective: The objective of this study was to evaluate the accuracy of a novel smartphone app combining depth-sensing hardware with computer vision to quantify meal macronutrient content using volumetry. Methods: The app ran on a smartphone with a built-in depth sensor applying structured light (iPhone X). The app estimated weight, macronutrient (carbohydrate, protein, fat), and energy content of 48 randomly chosen meals (breakfasts, cooked meals, snacks) encompassing 128 food items. The reference weight was generated by weighing individual food items using a precision scale. The study endpoints were (1) error of estimated meal weight, (2) error of estimated meal macronutrient content and energy content, (3) segmentation performance, and (4) processing time. Results: In both absolute and relative terms, the mean (SD) absolute errors of the app’s estimates were 35.1 g (42.8 g; relative absolute error: 14.0% [12.2%]) for weight; 5.5 g (5.1 g; relative absolute error: 14.8% [10.9%]) for carbohydrate content; 1.3 g (1.7 g; relative absolute error: 12.3% [12.8%]) for fat content; 2.4 g (5.6 g; relative absolute error: 13.0% [13.8%]) for protein content; and 41.2 kcal (42.5 kcal; relative absolute error: 12.7% [10.8%]) for energy content. Although estimation accuracy was not affected by the viewing angle, the type of meal mattered, with slightly worse performance for cooked meals than for breakfasts and snacks. Segmentation adjustment was required for 7 of the 128 items. Mean (SD) processing time across all meals was 22.9 seconds (8.6 seconds). Conclusions: This study evaluated the accuracy of a novel smartphone app with an integrated depth-sensing camera and found highly accurate volume estimation across a broad range of food items. In addition, the system demonstrated high segmentation performance and low processing time, highlighting its usability. %M 32209531 %R 10.2196/15294 %U http://mhealth.jmir.org/2020/3/e15294/ %U https://doi.org/10.2196/15294 %U http://www.ncbi.nlm.nih.gov/pubmed/32209531 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 2 %P e13266 %T Progressive 24-Hour Recall: Usability Study of Short Retention Intervals in Web-Based Dietary Assessment Surveys %A Osadchiy,Timur %A Poliakov,Ivan %A Olivier,Patrick %A Rowland,Maisie %A Foster,Emma %+ Open Lab, School of Computing, Newcastle University, Floor 1, Urban Sciences Building, Newcastle Helix, Newcastle upon Tyne, NE4 5TG, United Kingdom, 44 1912084642, timurosadchiy@gmail.com %K computer systems %K nutrition surveys %K diet records %K nutrition assessment %K epidemiologic methods %D 2020 %7 3.2.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Under-reporting because of the limitations of human memory is one of the key challenges in dietary assessment surveys that use the multiple-pass 24-hour recall. Research indicates that shortening a retention interval (ie, the time between the eating event and recall) reduces the burden on memory and may increase the accuracy of the assessment. Objective: This study aimed to explore the accuracy and acceptability of Web-based dietary assessment surveys based on a progressive recall, where a respondent is asked to record multiple recalls throughout a 24-hour period using the multiple-pass protocol and portion size estimation methods of the 24-hour recall. Methods: The experiment was conducted with a dietary assessment system, Intake24, that typically implements the multiple-pass 24-hour recall method where respondents record all meals they had for the previous day on a single occasion. We modified the system to allow respondents to add multiple recalls throughout the day using the multiple-pass protocol and portion size estimation methods of the 24-hour recall (progressive recall). We conducted a dietary assessment survey with 33 participants, where they were asked to record dietary intake using both 24-hour and progressive recall methods for weekdays only. We compared mean retention intervals (ie, the time between eating event and recall) for the 2 methods. To examine accuracy, we compared mean energy estimates and the mean number of reported foods. Of these participants, 23 were interviewed to examine the acceptability of the progressive recall. Results: Retention intervals were found to be, on average, 15.2 hours (SD 7.8) shorter during progressive recalls than those during 24-hour recalls. We found that the mean number of foods reported for evening meals for progressive recalls (5.2 foods) was significantly higher (P=.001) than that for 24-hour recalls (4.2 foods). The number of foods and the amount of energy reported for other meals remained similar across the 2 methods. In interviews, 65% (15/23) of participants said that the 24-hour recall is more convenient in terms of fitting in with their daily lifestyles, and 65% (15/23) of respondents indicated that they remembered meal content and portion sizes better with the progressive recall. Conclusions: The analysis of interviews and data from our study indicate that progressive recalls provide minor improvements to the accuracy of dietary assessment in Intake24. Additional work is needed to improve the acceptability of progressive recalls in this system. %M 32012055 %R 10.2196/13266 %U https://www.jmir.org/2020/2/e13266 %U https://doi.org/10.2196/13266 %U http://www.ncbi.nlm.nih.gov/pubmed/32012055 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 1 %P e15283 %T A Smartphone App Combining Global Positioning System Data and Ecological Momentary Assessment to Track Individual Food Environment Exposure, Food Purchases, and Food Consumption: Protocol for the Observational FoodTrack Study %A Poelman,Maartje P %A van Lenthe,Frank J %A Scheider,Simon %A Kamphuis,Carlijn BM %+ Chair Group Consumption and Healthy Lifestyles, Wageningen University and Research, PO Box 8130, Wageningen, 6700 EW, Netherlands, 31 317 483401, maartje.poelman@wur.nl %K ecological momentary assessment %K eating behavior %K environmental exposure %K mobile apps %K smartphone %K geographic information systems %K food preferences %K diet records %D 2020 %7 28.1.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Our understanding of how food choices are affected by exposure to the food environment is limited, and there are important gaps in the literature. Recently developed smartphone-based technologies, including global positioning systems and ecological momentary assessment, enable these gaps to be filled. Objective: We present the FoodTrack study design and methods, as well as participants’ compliance with the study protocol and their experiences with the app. We propose future analyses of the data to examine individual food environmental exposure taking into account the accessible food environment and individual time constraints; to assess people’s food choices in relation to food environmental exposure; and to examine the moderating role of individual and contextual determinants of food purchases and consumption. Methods: We conducted a 7-day observational study among adults (25-45 years of age) living in urban areas in the Netherlands. Participants completed a baseline questionnaire, used an app (incorporating global positioning system tracking and ecological momentary assessment) for 7 days, and then completed a closing survey. The app automatically collected global positioning system tracking data, and participants uploaded information on all food purchases over the 7-day period into the app. Participants also answered questions on contextual or individual purchase-related determinants directly after each purchase. During the final 3 days of the study, the participants also uploaded data on fruit, vegetable, and snack consumption and answered similar ecological momentary assessment questions after each intake. Results: In total, 140 participants completed the study. More than half of the participants said they liked the app (81/140, 57.9%) and found it easy to use (75/140, 53.6%). Of the 140 participants, 126 (90.0%) said that they had collected data on all or almost all purchases and intakes during the 7-day period. Most found the additional ecological momentary assessment questions “easy to answer” (113/140, 80.7%) with “no effort” (99/140, 70.7%). Of 106 participants who explored their trips in the app, 20 (18.8%) had trouble with their smartphone’s global positioning system tracking function. Therefore, we will not be able to include all participants in some of the proposed analyses, as we lack these data. We are analyzing data from the first study aim and we expect to publish the results in the spring of 2020. Conclusions: Participants perceived the FoodTrack app as a user-friendly tool. The app is particularly useful for observational studies that aim to gain insight into daily food environment exposure and food choices. Further analyses of the FoodTrack study data will provide novel insights into individual food environmental exposure, evidence on the individual food environment-diet interaction, and insights into the underlying individual and contextual mechanisms of food purchases and consumption. International Registered Report Identifier (IRRID): DERR1-10.2196/15283 %M 32012100 %R 10.2196/15283 %U http://www.researchprotocols.org/2020/1/e15283/ %U https://doi.org/10.2196/15283 %U http://www.ncbi.nlm.nih.gov/pubmed/32012100 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 12 %P e14904 %T Counting Bites With Bits: Expert Workshop Addressing Calorie and Macronutrient Intake Monitoring %A Alshurafa,Nabil %A Lin,Annie Wen %A Zhu,Fengqing %A Ghaffari,Roozbeh %A Hester,Josiah %A Delp,Edward %A Rogers,John %A Spring,Bonnie %+ Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, , United States, 1 3125034517, nabil@northwestern.edu %K computer vision systems %K computing methodologies %K diet %K energy intake %K eating %K eHealth %K feeding behavior %K mHealth %K nutritional status %K obesity %K wearable technology %D 2019 %7 4.12.2019 %9 Viewpoint %J J Med Internet Res %G English %X Background: Conventional diet assessment approaches such as the 24-hour self-reported recall are burdensome, suffer from recall bias, and are inaccurate in estimating energy intake. Wearable sensor technology, coupled with advanced algorithms, is increasingly showing promise in its ability to capture behaviors that provide useful information for estimating calorie and macronutrient intake. Objective: This paper aimed to summarize current technological approaches to monitoring energy intake on the basis of expert opinion from a workshop panel and to make recommendations to advance technology and algorithms to improve estimation of energy expenditure. Methods: A 1-day invitational workshop sponsored by the National Science Foundation was held at Northwestern University. A total of 30 participants, including population health researchers, engineers, and intervention developers, from 6 universities and the National Institutes of Health participated in a panel discussing the state of evidence with regard to monitoring calorie intake and eating behaviors. Results: Calorie monitoring using technological approaches can be characterized into 3 domains: (1) image-based sensing (eg, wearable and smartphone-based cameras combined with machine learning algorithms); (2) eating action unit (EAU) sensors (eg, to measure feeding gesture and chewing rate); and (3) biochemical measures (eg, serum and plasma metabolite concentrations). We discussed how each domain functions, provided examples of promising solutions, and highlighted potential challenges and opportunities in each domain. Image-based sensor research requires improved ground truth (context and known information about the foods), accurate food image segmentation and recognition algorithms, and reliable methods of estimating portion size. EAU-based domain research is limited by the understanding of when their systems (device and inference algorithm) succeed and fail, need for privacy-protecting methods of capturing ground truth, and uncertainty in food categorization. Although an exciting novel technology, the challenges of biochemical sensing range from a lack of adaptability to environmental effects (eg, temperature change) and mechanical impact, instability of wearable sensor performance over time, and single-use design. Conclusions: Conventional approaches to calorie monitoring rely predominantly on self-reports. These approaches can gain contextual information from image-based and EAU-based domains that can map automatically captured food images to a food database and detect proxies that correlate with food volume and caloric intake. Although the continued development of advanced machine learning techniques will advance the accuracy of such wearables, biochemical sensing provides an electrochemical analysis of sweat using soft bioelectronics on human skin, enabling noninvasive measures of chemical compounds that provide insight into the digestive and endocrine systems. Future computing-based researchers should focus on reducing the burden of wearable sensors, aligning data across multiple devices, automating methods of data annotation, increasing rigor in studying system acceptability, increasing battery lifetime, and rigorously testing validity of the measure. Such research requires moving promising technological solutions from the controlled laboratory setting to the field. %M 31799938 %R 10.2196/14904 %U https://www.jmir.org/2019/12/e14904 %U https://doi.org/10.2196/14904 %U http://www.ncbi.nlm.nih.gov/pubmed/31799938 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 10 %P e12572 %T Use of a Web-Based Dietary Assessment Tool (RiksmatenFlex) in Swedish Adolescents: Comparison and Validation Study %A Lindroos,Anna Karin %A Petrelius Sipinen,Jessica %A Axelsson,Cecilia %A Nyberg,Gisela %A Landberg,Rikard %A Leanderson,Per %A Arnemo,Marianne %A Warensjö Lemming,Eva %+ Swedish National Food Agency, Box 622, Uppsala, 75126, Sweden, 46 18175500, annakarin.lindroos@slv.se %K dietary assessment %K 24-hour hour dietary recalls %K internet %K validity %K biomarkers %K carotenoids %K alkylresorcinols %K adolescents %D 2019 %7 4.10.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: A Web-based dietary assessment tool—RiksmatenFlex—was developed for the national dietary survey of adolescents in Sweden. Objective: This study aimed to describe the Web-based method RiksmatenFlex and to test the validity of the reported dietary intake by comparing dietary intake with 24-hour dietary recalls (recall interviews), estimated energy expenditure, and biomarkers. Methods: Adolescents aged 11-12, 14-15, and 17-18 years were recruited through schools. In total, 78 students had complete dietary information and were included in the study. Diet was reported a few weeks apart with either RiksmatenFlexDiet (the day before and a random later day) or recall interviews (face-to-face, a random day later by phone) in a cross-over, randomized design. At a school visit, weight and height were measured and blood samples were drawn for biomarker analyses. Students wore an accelerometer for 7 days for physical activity measurements. Dietary intake captured by both dietary methods was compared, and energy intake captured by both methods was compared with the accelerometer-estimated energy expenditure (EEest). Intake of whole grain wheat and rye and fruit and vegetables by both methods was compared with alkylresorcinol and carotenoid concentrations in plasma, respectively. Results: The mean of the reported energy intake was 8.92 (SD 2.77) MJ by RiksmatenFlexDiet and 8.04 (SD 2.67) MJ by the recall interviews (P=.01). Intake of fruit and vegetables was 224 (169) g and 227 (150) g, and whole grain wheat and rye intake was 12.4 (SD 13.2) g and 12.0 (SD 13.1) g, respectively; the intakes of fruit and vegetables as well as whole grain wheat and rye did not differ between methods. Intraclass correlation coefficients ranged from 0.57 for protein and carbohydrates to 0.23 for vegetables. Energy intake by RiksmatenFlexDiet was overreported by 8% (P=.03) but not by the recall interviews (P=.53) compared with EEest. The Spearman correlation coefficient between reported energy intake and EEest was 0.34 (P=.008) for RiksmatenFlexDiet and 0.16 (P=.21) for the recall interviews. Spearman correlation coefficient between whole grain wheat and rye and plasma total alkylresorcinol homologs was 0.36 (P=.002) for RiksmatenFlexDiet and 0.29 (P=.02) for the recall interviews. Spearman correlations between intake of fruit and vegetables and plasma carotenoids were weak for both dietary tools. The strongest correlations were observed between fruit and vegetable intake and lutein/zeaxanthin for RiksmatenFlexDiet (0.46; P<.001) and for recall interviews (0.28; P=.02). Conclusions: RiksmatenFlexDiet provides information on energy, fruit, vegetables, and whole grain wheat and rye intake, which is comparable with intake obtained from recall interviews in Swedish adolescents. The results are promising for cost-effective dietary data collection in upcoming national dietary surveys and other studies in Sweden. Future research should focus on how, and if, new technological solutions could reduce dietary reporting biases. %M 31588902 %R 10.2196/12572 %U https://www.jmir.org/2019/10/e12572 %U https://doi.org/10.2196/12572 %U http://www.ncbi.nlm.nih.gov/pubmed/31588902 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 4 %P e11997 %T Paper-Based Versus Web-Based Versions of Self-Administered Questionnaires, Including Food-Frequency Questionnaires: Prospective Cohort Study %A Zazpe,Itziar %A Santiago,Susana %A De la Fuente-Arrillaga,Carmen %A Nuñez-Córdoba,Jorge M %A Bes-Rastrollo,Maira %A Martínez-González,Miguel Angel %+ School of Medicine, Department of Preventive Medicine and Public Health, University of Navarra, C/ Irunlarrea s/n, Pamplona, 31080, Spain, 34 948 42 56 00 ext 806463, mamartinez@unav.es %K epidemiologic studies %K cohort studies %K surveys and questionnaires %D 2019 %7 1.10.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Web-based questionnaires allow collecting data quickly, with minimal costs from large sample groups and through Web-based self-administered forms. Until recently, there has been a lack of evidence from large-scale epidemiological studies and nutrition surveys that have evaluated the comparison between traditional and new technologies to measure dietary intake. Objective: This study aimed to compare results from the general baseline questionnaire (Q_0) and the 10-year follow-up questionnaire (Q_10) in the Seguimiento Universidad de Navarra (SUN) prospective cohort, obtained from different subjects, some of whom used a paper-based version, and others used a Web-based version. Both baseline and 10-year assessments included a validated 136-item semiquantitative food-frequency questionnaire (FFQ), used to collect dietary intake. Methods: The SUN project is a prospective cohort study (with continuous open recruitment and many participants who were recently recruited). All participants were university graduates. Participants who completed the validated FFQ at baseline (FFQ_0, n=22,564) were selected. The variables analyzed were classified into 6 groups of questions: (1) FFQ (136 items), (2) healthy eating attitudes (10 items), (3) alcohol consumption (3 items), (4) physical activity during leisure time (17 items), (5) other activities (24 items), and (6) personality traits (3 items). Multiple linear and logistic regression models were used to assess the adjusted differences between the mean number of missing values and the risk of having apparently incorrect values for FFQ items or mismatches and inconsistencies in dietary variables. Results: Only 1.5% (339/22564) and 60.71% (6765/11144) participants reported their information using the Web-based version for Q_0 and Q_10, respectively, and 51.40 % (11598/22564) and 100.00% (11144/11144) of participants who completed the Q_0 and Q_10, respectively, had the option of choosing the Web-based version. Sociodemographic, lifestyle, health characteristics, food consumption, and energy and nutrient intakes were similar among participants, according to the type of questionnaire used in Q_10. Less than 0.5% of values were missing for items related to healthy eating attitudes, alcohol consumption, and personality traits in the Web-based questionnaires. The proportion of missing data in FFQ, leisure time physical activity, and other activities was higher in paper-based questionnaires than Web-based questionnaires. In Web-based questionnaires, a high degree of internal consistency was found when comparing answers that should not be contradictory, such as the frequency of fruit as dessert versus total fruit consumption and the frequency of fried food consumptions versus oil consumption. Conclusions: Incorporating a Web-based version for a baseline and 10-year questionnaire has not implicated a loss of data quality in this cohort of highly educated adults. Younger participants showed greater preference for Web-based questionnaires. Web-based questionnaires were filled out to a greater extent and with less missing items than paper-based questionnaires. Further research is needed to optimize data collection and response rate in Web-based questionnaires. %M 31573924 %R 10.2196/11997 %U https://publichealth.jmir.org/2019/4/e11997 %U https://doi.org/10.2196/11997 %U http://www.ncbi.nlm.nih.gov/pubmed/31573924 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e11917 %T Weight Loss Following Use of a Smartphone Food Photo Feature: Retrospective Cohort Study %A Ben Neriah,Daniela %A Geliebter,Allan %+ Institute of Human Nutrition, Columbia University, 630 W 168th St #1512, New York, NY, 10032, United States, 1 2125234000, d.benneriah@caa.columbia.edu %K food intake %K digital photography %K app tracking %K dietary assessment %K free-living %D 2019 %7 29.5.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Tracking of dietary intake is key to enhancing weight loss. Mobile apps may be useful for tracking food intake and can provide feedback about calories and nutritional value. Recent technological developments have enabled image recognition to identify foods and track food intake. Objective: We aimed to determine the effectiveness of using photography as a feature of a smartphone weight loss app to track food intake in adults who were overweight or obese. Methods: We analyzed data from individuals (age, 18-65 years; body mass index≥25 kg/m2; ≥4 days of logged food intake; and ≥2 weigh-ins) who used a mobile-based weight loss app. In a retrospective study, we compared those who used the photo feature (n=9871) and those who did not use the feature (n=113,916). Linear regression analyses were used to assess use of the photo feature in relation to percent weight loss. Results: Weight loss was greater in the group using the photo feature (Δ=0.14%; 95% CI 0.06-0.22; P<.001). The photo feature group used the weight loss app for a longer duration (+3.5 days; 95% CI 2.61-4.37; P<.001) and logged their food intake on more days (+6.1 days; 95% CI 5.40-6.77; P<.001) than the nonusers. Mediation analysis showed that the weight loss effect was absent when controlling for either duration or number of logged days in the program. Conclusions: This study was the first to examine the effect of a food photo feature to track food intake on weight loss in a free-living setting. Use of photo recognition was associated with greater weight loss, which was mediated by the duration of app use and number of logged days in the program. %M 31199300 %R 10.2196/11917 %U https://mhealth.jmir.org/2019/6/e11917/ %U https://doi.org/10.2196/11917 %U http://www.ncbi.nlm.nih.gov/pubmed/31199300 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e9232 %T A Focused Review of Smartphone Diet-Tracking Apps: Usability, Functionality, Coherence With Behavior Change Theory, and Comparative Validity of Nutrient Intake and Energy Estimates %A Ferrara,Giannina %A Kim,Jenna %A Lin,Shuhao %A Hua,Jenna %A Seto,Edmund %+ Department of Environmental & Occupational Health Sciences, University of Washington, 1959 NE Pacific Street, Campus Box 357234, Seattle, WA, 98195, United States, 1 206 543 1475, eseto@uw.edu %K diet %K nutrition assessment %K behavior and behavior mechanisms %D 2019 %7 17.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone diet-tracking apps may help individuals lose weight, manage chronic conditions, and understand dietary patterns; however, the usabilities and functionalities of these apps have not been well studied. Objective: The aim of this study was to review the usability of current iPhone operating system (iOS) and Android diet-tracking apps, the degree to which app features align with behavior change constructs, and to assess variations between apps in nutrient coding. Methods: The top 7 diet-tracking apps were identified from the iOS iTunes and Android Play online stores, downloaded and used over a 2-week period. Each app was independently scored by researchers using the System Usability Scale (SUS), and features were compared with the domains in an integrated behavior change theory framework: the Theoretical Domains Framework. An estimated 3-day food diary was completed using each app, and food items were entered into the United States Department of Agriculture (USDA) Food Composition Databases to evaluate their differences in nutrient data against the USDA reference. Results: Of the apps that were reviewed, LifeSum had the highest average SUS score of 89.2, whereas MyDietCoach had the lowest SUS score of 46.7. Some variations in features were noted between Android and iOS versions of the same apps, mainly for MyDietCoach, which affected the SUS score. App features varied considerably, yet all of the apps had features consistent with Beliefs about Capabilities and thus have the potential to promote self-efficacy by helping individuals track their diet and progress toward goals. None of the apps allowed for tracking of emotional factors that may be associated with diet patterns. The presence of behavior change domain features tended to be weakly correlated with greater usability, with R2 ranging from 0 to .396. The exception to this was features related to the Reinforcement domain, which were correlated with less usability. Comparing the apps with the USDA reference for a 3-day diet, the average differences were 1.4% for calories, 1.0% for carbohydrates, 10.4% for protein, and −6.5% for fat. Conclusions: Almost all reviewed diet-tracking apps scored well with respect to usability, used a variety of behavior change constructs, and accurately coded calories and carbohydrates, allowing them to play a potential role in dietary intervention studies. %M 31102369 %R 10.2196/mhealth.9232 %U http://mhealth.jmir.org/2019/5/e9232/ %U https://doi.org/10.2196/mhealth.9232 %U http://www.ncbi.nlm.nih.gov/pubmed/31102369 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e10755 %T Image-Based Mobile System for Dietary Management in an American Cardiology Population: Pilot Randomized Controlled Trial to Assess the Efficacy of Dietary Coaching Delivered via a Smartphone App Versus Traditional Counseling %A Choi,Brian G %A Dhawan,Tania %A Metzger,Kelli %A Marshall,Lorraine %A Akbar,Awdah %A Jain,Tushina %A Young,Heather A %A Katz,Richard J %+ Department of Medicine, School of Medicine & Health Sciences, The George Washington University, 2150 Pennsylvania Ave NW, Suite 4-417, Washington, DC, 20037, United States, 1 2027412323, bchoi@mfa.gwu.edu %K Mediterranean diet %K telemedicine %K cardiovascular disease %K randomized controlled trial %D 2019 %7 23.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Randomized controlled trials conducted in Mediterranean countries have shown that the Mediterranean diet lowers adverse cardiovascular events. In the American population, diet remains the biggest uncontrolled risk factor for cardiovascular disease. Objective: This study aimed to test the hypothesis that asynchronous dietary counseling supplied through a custom smartphone app results in better adherence to a Mediterranean diet in a non-Mediterranean population than traditional standard-of-care (SOC) counseling. Methods: In total, 100 patients presenting to the cardiology clinic of an academic medical center were randomized to either the SOC or smartphone app-based experimental (EXP) Mediterranean diet intervention after informed consent and 1 hour of individual face-to-face dietary counseling with a registered dietitian. Participants in EXP received a custom smartphone app that reinforced the Mediterranean diet, whereas participants in SOC received 2 additional sessions of in-person dietary counseling with the registered dietitian—30 min at 1 month and 30 min at 3 months. Preexisting knowledge of a Mediterranean diet was measured by the validated Mediterranean Diet Score (MDS) instrument. Baseline height, weight, blood pressure (BP), and laboratory biomarkers were collected. At 1, 3, and 6 months, participants presented for a follow-up appointment to assess compliance to the Mediterranean diet using the MDS as well as a patient satisfaction survey, BP, and weight. Repeat laboratory biomarkers were performed at 3 and 6 months. Results: Enrolled participants had a mean age with SE of 56.6 (SD 1.7) for SOC and 57.2 (SD 1.8) for EXP; 65.3% of SOC and 56.9% of EXP were male, and 20.4% of SOC and 35.3% of EXP had coronary artery disease. There were no significant differences between EXP and SOC with regard to BP, lipid parameters, hemoglobin A1c, or C-reactive protein (CRP). Participants in EXP achieved a significantly greater weight loss on average of 3.3 pounds versus 3.1 pounds for participants in SOC, P=.04. Adherence to the Mediterranean diet increased significantly over time for both groups (P<.001), but there was no significant difference between groups (P=.69). Similarly, there was no significant difference in diet satisfaction between EXP and SOC, although diet satisfaction increased significantly over time for both groups. The proportion of participants with high Mediterranean diet compliance (defined as the MDS ≥9) increased significantly over time (P<.001)—from 18.4% to 57.1% for SOC and 27.5% to 64.7% for EXP; however, there was no significant difference between the groups. Conclusions: Both traditional SOC counseling and smartphone-based counseling were effective in getting participants to adhere to a Mediterranean diet, and these dietary changes persisted even after counseling had ended. However, neither method was more effective than the other. This pilot study demonstrates that patients can change to and maintain a Mediterranean diet with either traditional or smartphone app-based nutrition counseling. Trial Registration: ClinicalTrials.gov NCT03897426;https://clinicaltrials.gov/ct2/show/NCT03897426 %M 31012860 %R 10.2196/10755 %U https://mhealth.jmir.org/2019/4/e10755/ %U https://doi.org/10.2196/10755 %U http://www.ncbi.nlm.nih.gov/pubmed/31012860 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e13250 %T Application of Mobile Health Technologies Aimed at Salt Reduction: Systematic Review %A Ali,Shahmir H %A Luo,Rong %A Li,Yuan %A Liu,Xiangjun %A Tang,Chengyao %A Zhang,Puhong %+ The George Institute for Global Health, Peking University Health Science Center, Level 18, Tower B, Horizon Tower, No 6 Zhichun Rd Haidian District, Beijing,, China, 86 10 8280 0577 ext 512, zpuhong@georgeinstitute.org.cn %K mobile health %K sodium %K diet %K cardiovascular diseases %K systematic review %D 2019 %7 17.04.2019 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: High salt consumption has contributed to the rise of noncommunicable diseases around the world. The application of mobile health (mHealth) technologies has witnessed rapid growth in recent years. However, evidence to support mHealth interventions to confront the challenge of salt reduction has not yet been critically reviewed. Objective: The aim of this study was to identify, characterize, and evaluate mHealth interventions aimed at salt reduction across the world. Methods: A systematic search of studies in English or Chinese language published from January 1, 1992 to July 31, 2017 was conducted using 4 English databases (PubMed, MEDLINE, Global Health, and Cochrane) and 3 Chinese databases (Wanfang, China Science and Technology Journal, and China National Knowledge of Infrastructure). All studies directly using mobile technologies in health care with a primary or secondary objective of reducing dietary salt consumption were included. Results: A total of 1609 articles were found using the search strategy, with 11 full articles (8 English and 3 Chinese) being included for data extraction, including 11 interventional studies. Overall, few high-quality interventions were identified. Most interventions were limited by small study population sample sizes, lack of control groups, and short follow-up times, all of which were obstacles in generating long-term scalable approaches. Most interventions employed short message service as a platform for mHealth interventions, whereas some innovative mHealth technologies were also explored. Most interventions had a primary focus of improving awareness of dietary salt consumption. The outcome variables used to measure intervention effectiveness included 24-hour urinary sodium excretion, spot urine sampling, dietary records, and indirect behavior or knowledge indicators targeting salt consumption. Although most interventions displayed positive outcome results, none of them provided reliable evidence to evaluate the effectiveness of salt reduction. Conclusions: Salt reduction in mHealth initiatives remains relatively unexplored; however, studies that did intervene on salt-reduction show the potential of mHealth as an effective intervention method. We provide 3 recommendations for future mHealth interventions in salt reduction—(1) increased use of new, innovative, and interactive mHealth technologies; (2) development of mHealth interventions with primary prevention measures and goals of salt reduction; and (3) large-scale, rigorously designed, and object-targeted clinical trials of mHealth interventions with appropriate quantitative outcome variables, in particular 24-hour urine sodium. %M 30994467 %R 10.2196/13250 %U http://mhealth.jmir.org/2019/4/e13250/ %U https://doi.org/10.2196/13250 %U http://www.ncbi.nlm.nih.gov/pubmed/30994467 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e11531 %T Relative Validity of a Method Based on a Smartphone App (Electronic 12-Hour Dietary Recall) to Estimate Habitual Dietary Intake in Adults %A Béjar,Luis María %A García-Perea,María Dolores %A Reyes,Óscar Adrián %A Vázquez-Limón,Esther %+ Department of Preventive Medicine and Public Health, School of Medicine, University of Seville, Institute of Anatomy, 3rd Floor, Sánchez-Pizjuán Avenue, Seville, 41009, Spain, 34 954551771, lmbprado@us.es %K epidemiologic methods %K diet records %K mobile apps %K nutrition assessment %D 2019 %7 11.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Accurate dietary assessment is key to understanding nutrition-related outcomes and for estimating the dietary change in nutrition-based interventions. When researching the habitual consumption of selected food groups, it is essential to be aware of factors that could possibly affect reporting accuracy. Objective: This study aimed to evaluate the relative validity of the current-day dietary recall, a method based on a smartphone app called electronic 12-hour dietary recall (e-12HR), to categorize individuals according to habitual intake, in the whole sample of adults and in different strata thereof. Methods: University students and employees over 18 years recorded the consumption of 10 selected groups of food using e-12HR during 28 consecutive days. During this period, they also completed 4 dietary records. Once the period was finished, the subjects then completed a food frequency questionnaire (FFQ) and a usability-rating questionnaire for e-12HR. The food group intakes estimated by the e-12HR app, the dietary records, and the FFQ were categorized into sextiles: less than once a week, once or twice a week, 3-4 times a week, 5-6 times a week, once or twice a day, and 3 or more times a day. The 10 selected groups with e-12HR were compared with 4 dietary records and an FFQ reference method, in the whole sample and in different strata thereof: age (years): <25 and ≥25; gender: females and males; occupation: students and employees; smoking: no and yes; physical activity (minutes/week): ≥150 and <150; and body mass index (kg/m2): <25 and ≥25. The association between the different methods was assessed using Spearman correlation coefficient (SCC). Cross-classification and kappa statistic were used as a measure of agreement between the different methods. Results: In total, 203 participants completed the study (56.7% [115/203] women, and 43.3% [88/203] men). For all food groups and all participants, the mean SCC for e-12HR versus FFQ was 0.67 (≥0.62 for all strata). On average, 50.7% of participants were classified into the same category (≥47.0% for all strata) and 90.2% within the nearest category (≥88.6% for all strata). Mean weighted kappa was 0.49 (≥0.44 for all strata). For e-12HR versus RDs, mean SCC was 0.65 (≥0.57 for all strata). On average, 50.0% of participants were classified into the same category (≥47.0% for all strata) and 88.2% within the nearest category (≥86.1% for all strata). Mean weighted kappa was 0.50 (≥0.44 for all strata). Conclusions: The results indicate that e-12HR generated categories of dietary intake highly comparable with the 2 reference methods in the whole sample and in different strata thereof. The inclusion of photographs to facilitate estimation of the servings consumed generated correlation/agreement data between e-12HR and the FFQ that were similar to a previous study using an older version of the app, which did not include photographs. %M 30973343 %R 10.2196/11531 %U https://mhealth.jmir.org/2019/4/e11531/ %U https://doi.org/10.2196/11531 %U http://www.ncbi.nlm.nih.gov/pubmed/30973343 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 4 %P e12047 %T Crowdsourcing for Food Purchase Receipt Annotation via Amazon Mechanical Turk: A Feasibility Study %A Lu,Wenhua %A Guttentag,Alexandra %A Elbel,Brian %A Kiszko,Kamila %A Abrams,Courtney %A Kirchner,Thomas R %+ Department of Childhood Studies, Rutgers, The State University of New Jersey, 329, Cooper Street, Camden, NJ, 08102, United States, 1 856 225 6083, w.lu@rutgers.edu %K Amazon Mechanical Turk %K food purchase receipt %K crowdsourcing %K feasibility %K reliability %K validity %D 2019 %7 05.04.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The decisions that individuals make about the food and beverage products they purchase and consume directly influence their energy intake and dietary quality and may lead to excess weight gain and obesity. However, gathering and interpreting data on food and beverage purchase patterns can be difficult. Leveraging novel sources of data on food and beverage purchase behavior can provide us with a more objective understanding of food consumption behaviors. Objective: Food and beverage purchase receipts often include time-stamped location information, which, when associated with product purchase details, can provide a useful behavioral measurement tool. The purpose of this study was to assess the feasibility, reliability, and validity of processing data from fast-food restaurant receipts using crowdsourcing via Amazon Mechanical Turk (MTurk). Methods: Between 2013 and 2014, receipts (N=12,165) from consumer purchases were collected at 60 different locations of five fast-food restaurant chains in New Jersey and New York City, USA (ie, Burger King, KFC, McDonald’s, Subway, and Wendy’s). Data containing the restaurant name, location, receipt ID, food items purchased, price, and other information were manually entered into an MS Access database and checked for accuracy by a second reviewer; this was considered the gold standard. To assess the feasibility of coding receipt data via MTurk, a prototype set of receipts (N=196) was selected. For each receipt, 5 turkers were asked to (1) identify the receipt identifier and the name of the restaurant and (2) indicate whether a beverage was listed in the receipt; if yes, they were to categorize the beverage as cold (eg, soda or energy drink) or hot (eg, coffee or tea). Interturker agreement for specific questions (eg, restaurant name and beverage inclusion) and agreement between turker consensus responses and the gold standard values in the manually entered dataset were calculated. Results: Among the 196 receipts completed by turkers, the interturker agreement was 100% (196/196) for restaurant names (eg, Burger King, McDonald’s, and Subway), 98.5% (193/196) for beverage inclusion (ie, hot, cold, or none), 92.3% (181/196) for types of hot beverage (eg, hot coffee or hot tea), and 87.2% (171/196) for types of cold beverage (eg, Coke or bottled water). When compared with the gold standard data, the agreement level was 100% (196/196) for restaurant name, 99.5% (195/196) for beverage inclusion, and 99.5% (195/196) for beverage types. Conclusions: Our findings indicated high interrater agreement for questions across difficulty levels (eg, single- vs binary- vs multiple-choice items). Compared with traditional methods for coding receipt data, MTurk can produce excellent-quality data in a lower-cost, more time-efficient manner. %M 30950801 %R 10.2196/12047 %U http://www.jmir.org/2019/4/e12047/ %U https://doi.org/10.2196/12047 %U http://www.ncbi.nlm.nih.gov/pubmed/30950801 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e11490 %T Mobile Phone App for Self-Monitoring of Eating Rhythm: Field Experiment %A Pentikäinen,Saara %A Tanner,Hannu %A Karhunen,Leila %A Kolehmainen,Marjukka %A Poutanen,Kaisa %A Pennanen,Kyösti %+ VTT Technical Research Centre of Finland Ltd, Tietotie 2, PO Box 1000, Espoo, 02044, Finland, 358 401708922, saara.pentikainen@vtt.fi %K mHealth %K behavior observation %K self-regulation %K eating %K ecological momentary assessment %D 2019 %7 27.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Temporal aspects of eating are an integral part of healthy eating, and regular eating has been associated with good diet quality and more successful weight control. Unfortunately, irregular eating is becoming more common. Self-monitoring of behavior has been found to be an efficient behavioral change technique, but the solution should be simple enough to ensure long-lasting adherence. Objective: This study aimed to explore the influence of self-monitoring of daily eating pattern with mobile phone app on eating rhythm, eating behavior tendencies, and the underlying motives and attitudes related to eating. Methods: A mobile phone app, Button, was developed for effortless self-monitoring of eating rhythm. The feasibility of the app was tested in a 30-day intervention. The participants (N=74) recorded their eating occasions during the intervention by pressing a button in the app widget. Results: The average interval between meals increased (96 [SD 24] min during the first 10 days vs 109.1[SD 36.4] during the last 10 days) and the number of daily eating occasions decreased (4.9 [SD 0.9] during the first 10 days vs 4.4 [SD 0.9] during the last 10 days). The tendencies for cognitive restraint, emotional eating, and uncontrolled eating increased. Eating-related attitudes and motives remained largely unchanged. Conclusions: These results indicate that a simple self-monitoring tool is able to draw a user’s attention to eating and is a potential tool to aid people to change their eating rhythm. %M 30916657 %R 10.2196/11490 %U http://mhealth.jmir.org/2019/3/e11490/ %U https://doi.org/10.2196/11490 %U http://www.ncbi.nlm.nih.gov/pubmed/30916657 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 2 %P e9838 %T Popular Nutrition-Related Mobile Apps: An Agreement Assessment Against a UK Reference Method %A Fallaize,Rosalind %A Zenun Franco,Rodrigo %A Pasang,Jennifer %A Hwang,Faustina %A Lovegrove,Julie A %+ Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, Department of Food and Nutritional Sciences, University of Reading, Whiteknights Campus, Reading,, United Kingdom, 44 1183786418, j.a.lovegrove@reading.ac.uk %K weighed food records %K smartphone application %K dietary assessment %K diet apps %K nutrition apps %K diet records %K mobile applications %D 2019 %7 20.02.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Nutrition-related apps are commonly used to provide information about the user’s dietary intake, but limited research has been performed to assess how well their outputs agree with those from standard methods. Objective: The objective of our study was to evaluate the level of agreement of popular nutrition-related apps for the assessment of energy and available macronutrients and micronutrients against a UK reference method. Methods: We compared dietary analysis of 24-hour weighed food records (n=20) between 5 nutrition-related apps (Samsung Health, MyFitnessPal, FatSecret, Noom Coach, and Lose It!) and Dietplan6 (reference method), using app versions available in the United Kingdom. We compared estimates of energy, macronutrients (carbohydrate, protein, fat, saturated fat, and fiber), and micronutrients (sodium, calcium, iron, vitamin A, and vitamin C) using paired t tests and Wilcoxon signed-rank tests, correlation coefficients, and Bland-Altman plots. We obtained 24-hour weighed food records from 20 participants (15 female, 5 male participants; mean age 36.3 years; mean body mass index 22.9 kg/m2) from previous controlled studies conducted at the Hugh Sinclair Unit of Human Nutrition, University of Reading, Reading, UK. Participants had recorded their food consumption over a 24-hour period using standard protocols. Results: The difference in estimation of energy and saturated fat intake between Dietplan6 and the diet apps was not significant. Estimates of protein and sodium intake were significantly lower using Lose It! and FatSecret than using Dietplan6. Lose It! also gave significantly lower estimates for other reported outputs (carbohydrate, fat, fiber, and sodium) than did Dietplan6. Samsung Health and MyFitnessPal significantly underestimated calcium, iron, and vitamin C compared with Dietplan6, although there was no significant difference for vitamin A. We observed no other significant differences between Dietplan6 and the apps. Correlation coefficients ranged from r=–.12 for iron (Samsung Health vs Dietplan6) to r=.91 for protein (FatSecret vs Dietplan6). Noom Coach was limited to energy output, but it had a high correlation with Dietplan6 (r=.91). Samsung Health had the greatest variation of correlation, with energy at r=.79. Bland-Altman analysis revealed potential proportional bias for vitamin A. Conclusions: The findings suggest that the apps provide estimates of energy and saturated fat intake comparable with estimates by Dietplan6. With the exception of Lose It!, the apps also provided comparable estimates of carbohydrate, total fat, and fiber. FatSecret and Lose It! tended to underestimate protein and sodium. Estimates of micronutrient intake (calcium, iron, vitamin A, and vitamin C) by 2 apps (Samsung Health and MyFitnessPal) were inconsistent and less reliable. Lose It! was the app least comparable with Dietplan6. As the use and availability of apps grows, this study helps clinicians and researchers to make better-informed decisions about using these apps in research and practice. %M 30785409 %R 10.2196/mhealth.9838 %U http://mhealth.jmir.org/2019/2/e9838/ %U https://doi.org/10.2196/mhealth.9838 %U http://www.ncbi.nlm.nih.gov/pubmed/30785409 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 2 %P e10931 %T Evaluating Mobile Health Apps for Customized Dietary Recording for Young Adults and Seniors: Randomized Controlled Trial %A Liu,Ying-Chieh %A Chen,Chien-Hung %A Tsou,Ya-Chi %A Lin,Yu-Sheng %A Chen,Hsin-Yun %A Yeh,Jou-Yin %A Chiu,Sherry Yueh-Hsia %+ Department of Health Care Management and Healthy Aging Research Center, College of Management, Chang Gung University, 259, Wen-Hwa 1st Road, Kwei-Shan, Taoyuan, 333, Taiwan, 886 3 2118800 ext 5250, sherrychiu@mail.cgu.edu.tw %K customized dietary recording %K prototypes %K user-centered design %K utilization %K mobile health %K mHealth %K randomized trial %D 2019 %7 15.02.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The role of individual-tailored dietary recording in mobile phone health apps has become increasingly important in management of self-health care and population-based preventive service. The development of such mobile apps for user-centered designing is still challengeable and requires further scientific evidence. Objective: This study aims to conduct a randomized trial to assess the accuracy and time efficiency of two prototypes for dietary recoding utilization related to the input method of food intake. Methods: We first present an innovative combinatorial concept for dietary recording to account for dish variation. One prototype was a self-chosen tab app that featured choosing each food ingredient to synthesize an individual dish, whereas the other was an autonomous exhaustive list app that provided one selection from a comprehensive list of dish items. The concept included commercially available choices that allowed users to more accurately account for their individual food selection. The two mobile apps were compared in a head-to-head parallel randomized trial evaluation. Young adults (n=70, aged 18-29) and older adults (n=35, aged 55-73) were recruited and randomized into two groups for accuracy and response time evaluation based on 12 types of food items in use of the developed self-chosen tab and autonomous exhaustive list apps, respectively. Results: For the trials based on the self-chosen tab (53 participants) and autonomous exhaustive list groups (52 participants), the two prototypes were found to be highly accurate (>98%). The self-chosen tab app was found to be more efficient, requiring significantly less time for input of 11 of 12 items (P<.05). The self-chosen tab users occasionally neglected to select food attributes, an issue which did not occur in the autonomous exhaustive list group. Conclusions: Our study contributes through the scientific evaluation of the transformation step into prototype development to demonstrate that a self-chosen tab app has potentially better opportunity in effectiveness and efficiency. The combinatorial concept offers potential for dietary recording and planning which can account for high food item variability. Our findings on prototype development of diversified dietary recordings provide design consideration and user interaction for related further app development and improvement. Trial Registration: ISRCTN Registry ISRCTN86142301; http://www.isrctn.com/ ISRCTN86142301 (Archived by WebCite at http://www.webcitation.org/74YLEPYnS) %M 30767906 %R 10.2196/10931 %U http://mhealth.jmir.org/2019/2/e10931/ %U https://doi.org/10.2196/10931 %U http://www.ncbi.nlm.nih.gov/pubmed/30767906 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 2 %P e11463 %T EVIDENT Smartphone App, a New Method for the Dietary Record: Comparison With a Food Frequency Questionnaire %A Recio-Rodriguez,Jose I %A Rodriguez-Martin,Carmela %A Gonzalez-Sanchez,Jesus %A Rodriguez-Sanchez,Emiliano %A Martin-Borras,Carme %A Martínez-Vizcaino,Vicente %A Arietaleanizbeaskoa,Maria Soledad %A Magdalena-Gonzalez,Olga %A Fernandez-Alonso,Carmen %A Maderuelo-Fernandez,Jose A %A Gomez-Marcos,Manuel A %A Garcia-Ortiz,Luis %A , %+ Department of Nursing, University of Extremadura, Plasencia Campus, Avda Comuneros 27-31, Salamanca,, Spain, 34 923231859, jesusgonzsan@gmail.com %K technology assessment, biomedical %K telemedicine %K energy intake %K diet records %K surveys and questionnaires %D 2019 %7 08.02.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: More alternatives are needed for recording people’s normal diet in different populations, especially adults or the elderly, as part of the investigation into the effects of nutrition on health. Objective: The aim of this study was to compare the estimated values of energy intake, macro- and micronutrient, and alcohol consumption gathered using the EVIDENT II smartphone app against the data estimated with a food frequency questionnaire (FFQ) in an adult population aged 18 to 70 years. Methods: We included 362 individuals (mean age 52 years, SD 12; 214/362, 59.1% women) who were part of the EVIDENT II study. The participants registered their food intake using the EVIDENT app during a period of 3 months and through an FFQ. Both methods estimate the average nutritional composition, including energy intake, macro- and micronutrients, and alcohol. Through the app, the values of the first week of food recording, the first month, and the entire 3-month period were estimated. The FFQ gathers data regarding the food intake of the year before the moment of interview. Results: The intraclass correlation for the estimation of energy intake with the FFQ and the app shows significant results, with the highest values returned when analyzing the app’s data for the full 3-month period (.304, 95% CI 0.144-0.434; P<.001). For this period, the correlation coefficient for energy intake is .233 (P<.001). The highest value corresponds to alcohol consumption and the lowest to the intake of polyunsaturated fatty acids (r=.676 and r=.155; P<.001), respectively. The estimation of daily intake of energy, macronutrients, and alcohol presents higher values in the FFQ compared with the EVIDENT app data. Considering the values recorded during the 3-month period, the FFQ for energy intake estimation (Kcal) was higher than that of the app (a difference of 408.7, 95% CI 322.7-494.8; P<.001). The same is true for the other macronutrients, with the exception g/day of saturated fatty acids (.4, 95% CI −1.2 to 2.0; P=.62). Conclusions: The EVIDENT app is significantly correlated to FFQ in the estimation of energy intake, macro- and micronutrients, and alcohol consumption. This correlation increases with longer app recording periods. The EVIDENT app can be a good alternative for recording food intake in the context of longitudinal or intervention studies. Trial Registration: ClinicalTrials.gov NCT02016014; http://clinicaltrials.gov/ct2/show/NCT02016014 (Archived by WebCite at http://www.webcitation.org/760i8EL8Q) %M 30735141 %R 10.2196/11463 %U http://mhealth.jmir.org/2019/2/e11463/ %U https://doi.org/10.2196/11463 %U http://www.ncbi.nlm.nih.gov/pubmed/30735141 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e11312 %T Mobile-Based Interventions for Dietary Behavior Change and Health Outcomes: Scoping Review %A Kankanhalli,Atreyi %A Shin,Jieun %A Oh,Hyelim %+ Department of Information Systems and Analytics, National University of Singapore, 13 Computing Drive, Singapore,, Singapore, 65 6516 6732, hyelim.oh@nus.edu.sg %K mHealth %K mobile-based intervention %K dietary behavior %K food intake %K behavior change %K health outcomes %D 2019 %7 21.01.2019 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Mobile apps are being widely used for delivering health interventions, with their ubiquitous access and sensing capabilities. One such use is the delivery of interventions for healthy eating behavior. Objective: The aim of this study was to provide a comprehensive view of the literature on the use of mobile interventions for eating behavior change. We synthesized the studies with such interventions and mapped out their input methods, interventions, and outcomes. Methods: We conducted a scoping literature search in PubMed/MEDLINE, Association for Computing Machinery Digital Library, and PsycINFO databases to identify relevant papers published between January 2013 and April 2018. We also hand-searched relevant themes of journals in the Journal of Medical Internet Research and registered protocols. Studies were included if they provided and assessed mobile-based interventions for dietary behavior changes and/or health outcomes. Results: The search resulted in 30 studies that we classified by 3 main aspects: input methods, mobile-based interventions, and dietary behavior changes and health outcomes. First, regarding input methods, 5 studies allowed photo/voice/video inputs of diet information, whereas text input methods were used in the remaining studies. Other than diet information, the content of the input data in the mobile apps included user’s demographics, medication, health behaviors, and goals. Second, we identified 6 categories of intervention contents, that is, self-monitoring, feedback, gamification, goal reviews, social support, and educational information. Although all 30 studies included self-monitoring as a key component of their intervention, personalized feedback was a component in 18 studies, gamification was used in 10 studies, goal reviews in 5 studies, social support in 3 studies, and educational information in 2 studies. Finally, we found that 13 studies directly examined the effects of interventions on health outcomes and 12 studies examined the effects on dietary behavior changes, whereas only 5 studies observed the effects both on dietary behavior changes and health outcomes. Regarding the type of studies, although two-thirds of the included studies conducted diverse forms of randomized control trials, the other 10 studies used field studies, surveys, protocols, qualitative interviews, propensity score matching method, and test and reference method. Conclusions: This scoping review identified and classified studies on mobile-based interventions for dietary behavior change as per the input methods, nature of intervention, and outcomes examined. Our findings indicated that dietary behavior changes, although playing a mediating role in improving health outcomes, have not been adequately examined in the literature. Dietary behavior change as a mechanism for the relationship between mobile-based intervention and health outcomes needs to be further investigated. Our review provides guidance for future research in this promising mobile health area. %M 30664461 %R 10.2196/11312 %U http://mhealth.jmir.org/2019/1/e11312/ %U https://doi.org/10.2196/11312 %U http://www.ncbi.nlm.nih.gov/pubmed/30664461 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e11170 %T Mobile Ecological Momentary Diet Assessment Methods for Behavioral Research: Systematic Review %A Schembre,Susan M %A Liao,Yue %A O'Connor,Sydney G %A Hingle,Melanie D %A Shen,Shu-En %A Hamoy,Katarina G %A Huh,Jimi %A Dunton,Genevieve F %A Weiss,Rick %A Thomson,Cynthia A %A Boushey,Carol J %+ Department of Family and Community Medicine, College of Medicine-Tucson, University of Arizona, Abrams Building Room 3345E, 3950 South Country Club Road, Tucson, AZ, 85714, United States, 1 520 626 7735, sschembre@email.arizona.edu %K diet surveys %K diet records %K mobile phone %K mobile apps %K ecological momentary assessment %D 2018 %7 20.11.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: New methods for assessing diet in research are being developed to address the limitations of traditional dietary assessment methods. Mobile device–assisted ecological momentary diet assessment (mEMDA) is a new dietary assessment method that has not yet been optimized and has the potential to minimize recall biases and participant burden while maximizing ecological validity. There have been limited efforts to characterize the use of mEMDA in behavioral research settings. Objective: The aims of this study were to summarize mEMDA protocols used in research to date, to characterize key aspects of these assessment approaches, and to discuss the advantages and disadvantages of mEMDA compared with the traditional dietary assessment methods as well as implications for future mEMDA research. Methods: Studies that used mobile devices and described mEMDA protocols to assess dietary intake were included. Data were extracted according to Preferred Reporting of Systematic Reviews and Meta-Analyses and Cochrane guidelines and then synthesized narratively. Results: The review included 20 studies with unique mEMDA protocols. Of these, 50% (10/20) used participant-initiated reports of intake at eating events (event-contingent mEMDA), and 50% (10/20) used researcher-initiated prompts requesting that participants report recent dietary intake (signal-contingent mEMDA). A majority of the study protocols (60%, 12/20) enabled participants to use mobile phones to report dietary data. Event-contingent mEMDA protocols most commonly assessed diet in real time, used dietary records for data collection (60%, 6/10), and provided estimates of energy and nutrient intake (60%, 6/10). All signal-contingent mEMDA protocols used a near real-time recall approach with unannounced (ie, random) abbreviated diet surveys. Most signal-contingent protocols (70%, 7/10) assessed the frequency with which (targeted) foods or food groups were consumed. Relatively few (30%, 6/20) studies compared mEMDA with the traditional dietary assessment methods. Conclusions: This review demonstrates that mEMDA has the potential to reduce participant burden and recall bias, thus advancing the field beyond current dietary assessment methods while maximizing ecological validity. %M 30459148 %R 10.2196/11170 %U http://mhealth.jmir.org/2018/11/e11170/ %U https://doi.org/10.2196/11170 %U http://www.ncbi.nlm.nih.gov/pubmed/30459148 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e12136 %T A Tool to Measure Young Adults’ Food Intake: Design and Development of an Australian Database of Foods for the Eat and Track Smartphone App %A Wellard-Cole,Lyndal %A Potter,Melisa %A Jung,Jisu (Joseph) %A Chen,Juliana %A Kay,Judy %A Allman-Farinelli,Margaret %+ School of Life and Environmental Science, The University of Sydney, Level 4 East, Charles Perkins Centre D17, University of Sydney, 2006, Australia, 61 286274854, lwel3754@uni.sydney.edu.au %K diet surveys %K smartphone %K mobile phone %K young adult %D 2018 %7 07.11.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Dietary assessment is reliant on the collection of accurate food and beverage consumption data. Technology has been harnessed to standardize recording and provide automatic nutritional analysis to reduce cost and researcher burden. Objective: To better assess the diet of young adults, especially relating to the contribution of foods prepared outside the home, a database was needed to support a mobile phone data collection app. The app also required usability testing to assure ease of entry of foods and beverages. This paper describes the development of the Eat and Track app (EaT app) and the database underpinning it. Methods: The Australian Food and Nutrient Database 2011-13, consisting of 5740 food items was modified. Four steps were undertaken: (1) foods not consumed by young adults were removed, (2) nutritionally similar foods were merged, (3) foods available from the 30 largest ready-to-eat food chains in Australia were added, and (4) long generic food names were shortened and simplified. This database was used to underpin the EaT app. Qualitative, iterative usability testing of the EaT app was conducted in three phases using the “Think Aloud” method. Responses were sorted and coded using content analysis. The System Usability Scale (SUS) was administered to measure the EaT app’s perceived usability. Results: In total, 1694 (29.51%) foods were removed from the Australian Food and Nutrient Database, including 608 (35.89%) ingredients, 81 (4.78%) foods already captured in the fast food chain information, 52 (3.07%) indigenous foods, 25 (1.48%) nutrients/dietary supplements, and 16 (0.94%) child-specific foods. The remaining 912 (53.84%) foods removed were not consumed by young adults in previous surveys or were “not defined” in the Australian Food and Nutrient Database. Another 220 (3.83%) nutritionally similar foods were combined. The final database consisted of 6274 foods. Fifteen participants completed usability testing. Issues identified by participants fell under six themes: keywords for searching, history list of entered foods, amounts and units, the keypad, food names, and search function. Suggestions for improvement were collected, incorporated, and tested in each iteration of the app. The SUS of the final version of the EaT app was rated 69. Conclusions: A food and beverage database has been developed to underpin the EaT app, enabling data collection on the eating-out habits of 18- to 30-year-old Australians. The development process has resulted in a database with commonly used food names, extensive coverage of foods from ready-to-eat chains, and commonly eaten portion sizes. Feedback from app usability testing led to enhanced keyword searching and the addition of functions to enhance usability such as adding brief instructional screens. There is potential for the features of the EaT app to facilitate the collection of more accurate dietary intake data. The database and the app will be valuable dietary assessment resources for researchers. %M 30404768 %R 10.2196/12136 %U http://mhealth.jmir.org/2018/11/e12136/ %U https://doi.org/10.2196/12136 %U http://www.ncbi.nlm.nih.gov/pubmed/30404768 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 9 %P e175 %T A Dietary Assessment App for Hospitalized Patients at Nutritional Risk: Development and Evaluation of the MyFood App %A Paulsen,Mari Mohn %A Hagen,Martina Lovise Lindhart %A Frøyen,Marte Hesvik %A Foss-Pedersen,Rikke Julie %A Bergsager,Dagfinn %A Tangvik,Randi Julie %A Andersen,Lene Frost %+ Institute of Basic Medical Sciences, Department of Nutrition, University of Oslo, PO Box 1046, Blindern, Oslo, 0317, Norway, 47 22851103, m.m.paulsen@medisin.uio.no %K decision support system %K disease-related malnutrition %K eHealth %K mHealth %K dietary assessment %K validation study %D 2018 %7 07.09.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Disease-related malnutrition is a common challenge among hospitalized patients. There seems to be a lack of an effective system to follow-up nutritional monitoring and treatment of patients at nutritional risk after risk assessment. We identify a need for a more standardized system to prevent and treat disease-related malnutrition. Objective: We aimed to develop a dietary assessment app for tablets for use in a hospital setting and to evaluate the app’s ability to measure individual intake of energy, protein, liquid, and food and beverage items among hospitalized patients for two days. We also aimed to measure patients’ experiences using the app. Methods: We have developed the MyFood app, which consists of three modules: 1) collection of information about the patient, 2) dietary assessment function, and 3) evaluation of recorded intake compared to individual needs. We used observations from digital photography of the meals, combined with partial weighing of the meal components, as a reference method to evaluate the app’s dietary assessment system for two days. Differences in the intake estimations of energy, protein, liquid, and food and beverage items between MyFood and the photograph method were analyzed on both group and individual level. Results: Thirty-two patients hospitalized at Oslo University Hospital were included in the study. The data collection period ran from March to May 2017. About half of the patients had ≥90% agreement between MyFood and the photograph method for energy, protein, and liquid intake on both recording days. Dinner was the meal with the lowest percent agreement between methods. MyFood overestimated patients’ intake of bread and cereals and underestimated fruit consumption. Agreement between methods increased from day 1 to day 2 for bread and cereals, spreads, egg, yogurt, soup, hot dishes, and desserts. Ninety percent of participants reported that MyFood was easy to use, and 97% found the app easy to navigate. Conclusions: We developed the MyFood app as a tool to monitor dietary intake among hospitalized patients at nutritional risk. The recorded intake of energy, protein, and liquid using MyFood showed good agreement with the photograph method for the majority of participants. The app’s ability to estimate intake within food groups was good, except for bread and cereals which were overestimated and fruits which were underestimated. The app was well accepted among study participants and has the potential to be a dietary assessment tool for use among patients in clinical practice. %M 30194059 %R 10.2196/mhealth.9953 %U http://mhealth.jmir.org/2018/9/e175/ %U https://doi.org/10.2196/mhealth.9953 %U http://www.ncbi.nlm.nih.gov/pubmed/30194059 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 9 %P e170 %T The SPLENDID Eating Detection Sensor: Development and Feasibility Study %A van den Boer,Janet %A van der Lee,Annemiek %A Zhou,Lingchuan %A Papapanagiotou,Vasileios %A Diou,Christos %A Delopoulos,Anastasios %A Mars,Monica %+ Sensory Science and Eating Behaviour Chair Group, Division of Human Nutrition, Wageningen University, Stippeneng 4, Wageningen, 6708WE, Netherlands, 31 317 485 340, monica.mars@wur.nl %K chewing sensor %K weight management %K obesity prevention %K overweight %K PPG sensor %K in-ear microphone %K mobile phone %D 2018 %7 04.09.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The available methods for monitoring food intake—which for a great part rely on self-report—often provide biased and incomplete data. Currently, no good technological solutions are available. Hence, the SPLENDID eating detection sensor (an ear-worn device with an air microphone and a photoplethysmogram [PPG] sensor) was developed to enable complete and objective measurements of eating events. The technical performance of this device has been described before. To date, literature is lacking a description of how such a device is perceived and experienced by potential users. Objective: The objective of our study was to explore how potential users perceive and experience the SPLENDID eating detection sensor. Methods: Potential users evaluated the eating detection sensor at different stages of its development: (1) At the start, 12 health professionals (eg, dieticians, personal trainers) were interviewed and a focus group was held with 5 potential end users to find out their thoughts on the concept of the eating detection sensor. (2) Then, preliminary prototypes of the eating detection sensor were tested in a laboratory setting where 23 young adults reported their experiences. (3) Next, the first wearable version of the eating detection sensor was tested in a semicontrolled study where 22 young, overweight adults used the sensor on 2 separate days (from lunch till dinner) and reported their experiences. (4) The final version of the sensor was tested in a 4-week feasibility study by 20 young, overweight adults who reported their experiences. Results: Throughout all the development stages, most individuals were enthusiastic about the eating detection sensor. However, it was stressed multiple times that it was critical that the device be discreet and comfortable to wear for a longer period. In the final study, the eating detection sensor received an average grade of 3.7 for wearer comfort on a scale of 1 to 10. Moreover, experienced discomfort was the main reason for wearing the eating detection sensor <2 hours a day. The participants reported having used the eating detection sensor on 19/28 instructed days on average. Conclusions: The SPLENDID eating detection sensor, which uses an air microphone and a PPG sensor, is a promising new device that can facilitate the collection of reliable food intake data, as shown by its technical potential. Potential users are enthusiastic, but to be successful wearer comfort and discreetness of the device need to be improved. %M 30181111 %R 10.2196/mhealth.9781 %U http://mhealth.jmir.org/2018/9/e170/ %U https://doi.org/10.2196/mhealth.9781 %U http://www.ncbi.nlm.nih.gov/pubmed/30181111 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 8 %P e166 %T A Dietary Management System Using Radio-Frequency Identification Technology to Collect Information on Chinese Food Consumption: Development and Feasibility Study %A Xu,Xiaowei %A Wang,Ju %A Hou,Li %A Guo,Zhen %A Li,Jiao %+ Institute of Medical Information & Library, Chinese Academy of Medical Sciences, No. 3 Yabao Road, Chaoyang District, Beijing, 100020, China, 86 1052328740, li.jiao@imicams.ac.cn %K diet records %K RFID technology %K radio frequency identification device %K food consumption %K Chinese foods %D 2018 %7 14.08.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Dietary management is important for personal health. However, it is challenging to record quantified food information in an efficient, accurate, and sustainable manner, particularly for the consumption of Chinese food. Objective: The objective of this study was to develop a dietary management system to record information on consumption of Chinese food, which can help in assessing individuals’ dietary intake and maintaining healthy eating behaviors. We proposed to use plates embedded with radio-frequency identification chips to carry Chinese foods and collect food consumption data. Methods: We obtained food composition and nutrient (eg, carbohydrate, fat, fiber) data from the Chinese Recipe Database and China Food Composition Database. To test the feasibility of the dietary management system at a population level, we applied it to collect data on 489 Chinese foods that were consumed at lunchtime across 7 weeks by 10,528 individuals. To test individual-level output, we selected an individual participant with completed 20-day dietary data for analysis. We examined the system’s nutrient calculation performance by comparing the nutrient values of 3 selected Chinese dishes calculated by our method with the results of chemical measurements. Results: We collected the dietary intake for a group of 10,528 individuals aged from 20 to 40 years having lunch in a restaurant across 7 weeks. A total of 489 Chinese dishes were identified. We analyzed a specified customer’s diet recordings and broke his or her 20 lunch diet recordings down to ingredients and then to nutrient intake. We compared the nutrient value of a given Chinese dish (eg, garlic puree cooked pork leg) calculated by our method with the results of chemical measurements. The mean absolute percentage deviation showed that our method enabled collection of dietary intake for Chinese foods. Conclusions: This preliminary study demonstrated the feasibility of radio-frequency identification–based dietary management for Chinese food consumption. In future, we will investigate factors such as preparation method, weight of food consumed, and auxiliary ingredients to improve dietary assessment accuracy. %M 30108037 %R 10.2196/mhealth.7674 %U http://mhealth.jmir.org/2018/8/e166/ %U https://doi.org/10.2196/mhealth.7674 %U http://www.ncbi.nlm.nih.gov/pubmed/30108037 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 7 %P e160 %T Digital Food Records in Community-Based Interventions: Mixed-Methods Pilot Study %A Fowler,Lauren A %A Yingling,Leah R %A Brooks,Alyssa T %A Wallen,Gwenyth R %A Peters-Lawrence,Marlene %A McClurkin,Michael %A Wiley Jr,Kenneth L %A Mitchell,Valerie M %A Johnson,Twanda D %A Curry,Kendrick E %A Johnson,Allan A %A Graham,Avis P %A Graham,Lennox A %A Powell-Wiley,Tiffany M %+ Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, 10-CRC, Room 5-5332, Bethesda, MD, 20892, United States, 1 3015943735, tiffany.powell-wiley@nih.gov %K mHealth %K diet %K community-based participatory research %K qualitative research %K focus group, obesity %D 2018 %7 17.07.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A pressing need exists to understand and optimize the use of dietary assessment tools that can be used in community-based participatory research (CBPR) interventions. A digital food record, which uses a mobile device to capture the dietary intake through text and photography inputs, is a particularly promising mobile assessment method. However, little is understood about the acceptability and feasibility of digital food records in CBPR and how to best tailor dietary assessment tools to the needs of a community. Objective: The objective of our study was to evaluate the acceptability and feasibility of digital food records among church-based populations in resource-limited wards of Washington, DC, USA, using a mixed-methods approach. Methods: This community-based pilot study was conducted as part of the Washington, DC Cardiovascular Health and Needs Assessment. Participants (n=17) received a mobile device (iPod Touch) to photodocument their dietary intake for a 3-day digital food record using a mobile app, FitNinja (Vibrent Health). The acceptability of the digital food record was explored through the thematic analysis of verbatim transcripts from a moderated focus group (n=8). In addition, the feasibility was evaluated by the percentage of participants complying with instructions (ie, capturing both before and after meal photos for at least 2 meals/day for 3 days). Results: Qualitative themes identified were related to (1) the feasibility and acceptability of the mobile device and app, including issues in recording the dietary information and difficulty with photodocumentation; (2) suggestions for additional support and training experiences; and (3) comparisons with other mobile apps. Overall, the participants accepted the digital food record by demonstrating satisfaction with the tool and intent to continue the use (eg, participants recorded an average of 5.2, SD 7, consecutive days). Furthermore, of the 17 participants, 15 photodocumented at least 1 meal during the study period and 3 fully complied with the digital food record instructions. Conclusions: This study demonstrated digital food records as an acceptable tool in CBPR and identified contributors and barriers to the feasibility of digital food records for future research. Engaging community members in the implementation of novel assessment methods allows for the tailoring of technology to the needs of the community and optimizing community-based interventions. Trial Registration: ClinicalTrials.gov NCT01927783; https://www.clinicaltrials.gov/ct2/show/NCT01927783 (Archived by WebCite at http://www.webcitation.org/70WzaFWb6) %M 30021705 %R 10.2196/mhealth.9729 %U http://mhealth.jmir.org/2018/7/e160/ %U https://doi.org/10.2196/mhealth.9729 %U http://www.ncbi.nlm.nih.gov/pubmed/30021705 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 7 %P e227 %T Relative Validity and Reproducibility of a New 44-Item Diet and Food Frequency Questionnaire Among Adults: Online Assessment %A Affret,Aurélie %A El Fatouhi,Douae %A Dow,Courtney %A Correia,Emmanuelle %A Boutron-Ruault,Marie-Christine %A Fagherazzi,Guy %+ Inserm U1018, Center for Research in Epidemiology and Population Health, 114 Rue Edouard Vaillant, Villejuif, 94805, France, 33 33 142116466, marie-christine.boutron@gustaveroussy.fr %K Short Food Frequency e-Questionnaire %K Web-based %K validity %K reproducibility %K online dietary assessment tool %D 2018 %7 05.07.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Dietary questionnaires currently available which can assess the habitual diet are timely, costly, or not adapted well to the modern diet; thus, there is a need for a shorter food frequency e-Questionnaire (FFeQ) adapted to Western diets, in order to properly estimate energy and macronutrient intakes or rank individuals according to food and nutrient intakes. Objective: The aim of this study was to evaluate the relative validity and reproducibility of a 30-minute and 44-item FFeQ in a sample of adults obtained from the general population. Methods: A sample of French adults was recruited through social media and an advertising campaign. A total of 223 volunteers completed the FFeQ twice at one-year intervals and were included in the reproducibility study. During that interval, 92 participants completed three-to-six 24-hour recalls and were included in the validity study. Nutrient and dietary intakes were computed for all validity and reproducibility participants. The level of agreement between the two methods was evaluated for nutrient and food group intakes using classification into quintiles of daily intake, correlation coefficients and Bland-Altman plots. Results: For relative validity, correlation coefficients ranged from 0.09 to 0.88 (unadjusted correlation coefficients, median: 0.48) and 0.02 to 0.68 (deattenuated and energy adjusted correlation coefficients, median: 0.50) for food group and nutrient intakes, respectively. The median proportion of subjects classified into the same or adjacent quintile was 73% and 66% for food and nutrient intakes, respectively. Bland-Altman plots showed good agreement across the range of intakes. Regarding reproducibility, intraclass correlation coefficients ranged from 0.33 to 0.72 (median: 0.60) and 0.55 to 0.73 (median: 0.64), for food and nutrient intakes, respectively. Conclusions: The FFeQ showed acceptable validity and reproducibility in a sample of adults based on their food and nutrient intakes. The FFeQ is a promising and low-cost tool that can be used in large-scale online epidemiological studies or clinical routines and could be integrated into evidence-based smartphone apps for assessing diet components. %M 29980502 %R 10.2196/jmir.9113 %U http://www.jmir.org/2018/7/e227/ %U https://doi.org/10.2196/jmir.9113 %U http://www.ncbi.nlm.nih.gov/pubmed/29980502 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e10253 %T Patient Experiences Using a Self-Monitoring App in Eating Disorder Treatment: Qualitative Study %A Lindgreen,Pil %A Lomborg,Kirsten %A Clausen,Loa %+ Research Unit, Center for Child and Adolescent Psychiatry, Aarhus University Hospital, Skovagervej 2, Entrance 81, Risskov, 8240, Denmark, 45 21511756, pillin@rm.dk %K feeding and eating disorders %K anorexia nervosa %K bulimia nervosa %K mental health %K psychiatry %K mHealth %K mobile applications %K self-monitoring %K blended treatment %K eating disorder treatment %D 2018 %7 22.06.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The Recovery Record smartphone app is a self-monitoring tool for individuals recovering from an eating disorder. Unlike traditional pen-and-paper meal diaries, which are often used in eating disorder treatment, the app holds novel features, such as meal reminders, affirmations, and patient-clinician in-app linkage, the latter allowing for clinicians to continuously monitor patients' app data. Objective: To explore patients' experiences with using Recovery Record as part of outpatient eating disorder treatment. Methods: A total of 41 patients from a Danish eating disorder treatment facility were included in the study. All 41 patients participated in participant observations of individual or group treatment sessions, and 26 were interviewed about their experiences with using the app in treatment. The data material was generated and analyzed concurrently, applying the inductive methodology of Interpretive Description. Results: The patients' experiences with Recovery Record depended on its app features, the impact of these features on patients, and their specific app usage. This patient-app interaction affected and was affected by changeable contexts making patients' experiences dynamic. The patient-app interaction affected patients' placement of specific Recovery Record app features along a continuum from supportive to obstructive of individual everyday life activities including the eating disorder treatment. As an example, some patients found it supportive being notified by their clinician when their logs had been monitored as it gave them a sense of relatedness. Contrarily, other patients felt under surveillance, which was obstructive, as it made them feel uneasy or even dismissing the app. Conclusions: Some patients experienced the app and its features as mostly supportive of their everyday life and the eating disorder treatment, while others experienced it primarily as obstructive. When applying apps in eating disorder treatment, we therefore recommend that patients and clinicians collaborate to determine how the app in question best fits the capacities, preferences, and treatment needs of the individual patient. Thus, we encourage patients and clinicians to discuss how specific features of the applied app affect the individual patient to increase the use of supportive features, while limiting the use of obstructive ones. %M 29934285 %R 10.2196/10253 %U http://mhealth.jmir.org/2018/6/e10253/ %U https://doi.org/10.2196/10253 %U http://www.ncbi.nlm.nih.gov/pubmed/29934285 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e10409 %T Electronic 12-Hour Dietary Recall (e-12HR): Comparison of a Mobile Phone App for Dietary Intake Assessment With a Food Frequency Questionnaire and Four Dietary Records %A Béjar,Luis María %A Reyes,Óscar Adrián %A García-Perea,María Dolores %+ Department of Preventive Medicine and Public Health, School of Medicine, University of Seville, Institute of Anatomy, 3rd Floor, Sánchez-Pizjuán Avenue, Seville, 41009, Spain, 34 954551771, lmbprado@us.es %K dietary assessment %K food frequency questionnaire %K 24-hour dietary recalls %K dietary record %K mobile phone app %D 2018 %7 15.06.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: One of the greatest challenges in nutritional epidemiology is improving upon traditional self-reporting methods for the assessment of habitual dietary intake. Objective: The aim of this study was to evaluate the relative validity of a new method known as the current-day dietary recall (or current-day recall), based on a smartphone app called 12-hour dietary recall, for determining the habitual intake of a series of key food and drink groups using a food frequency questionnaire (FFQ) and four dietary records as reference methods. Methods: University students over the age of 18 years recorded their consumption of certain groups of food and drink using 12-hour dietary recall for 28 consecutive days. During this 28-day period, they also completed four dietary records on randomly selected days. Once the monitoring period was over, subjects then completed an FFQ. The two methods were compared using the Spearman correlation coefficient (SCC), a cross-classification analysis, and weighted kappa. Results: A total of 87 participants completed the study (64% women, 56/87; 36% men, 31/87). For e-12HR versus FFQ, for all food and drink groups, the average SCC was 0.70. Cross-classification analysis revealed that the average percentage of individuals classified in the exact agreement category was 51.5%; exact agreement + adjacent was 91.8%, and no participant (0%) was classified in the extreme disagreement category. The average weighted kappa was 0.51. For e-12HR versus the four dietary records, for all food and drink groups, the average SCC was 0.63. Cross-classification analysis revealed that the average percentage of individuals classified in the exact agreement category was 47.1%; exact agreement + adjacent was 89.2%; and no participant (0%) was classified in the extreme disagreement category. The average weighted kappa was 0.47. Conclusions: Current-day recall, based on the 12-hour dietary recall app, was found to be in good agreement with the two reference methods (FFQ & four dietary records), demonstrating its potential usefulness for categorizing individuals according to their habitual dietary intake of certain food and drink groups. %M 29907555 %R 10.2196/10409 %U http://mhealth.jmir.org/2018/6/e10409/ %U https://doi.org/10.2196/10409 %U http://www.ncbi.nlm.nih.gov/pubmed/29907555 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 2 %P e56 %T Accurately Inferring Compliance to Five Major Food Guidelines Through Simplified Surveys: Applying Data Mining to the UK National Diet and Nutrition Survey %A Rosso,Nicholas %A Giabbanelli,Philippe %+ Data Analytics for Complex Human Behaviors Laboratory, Department of Computer Science, Furman University, 3300 Poinsett Hwy, Greenville, SC, 29613, United States, 1 864 294 2097, giabbanelli@gmail.com %K diet, food, and nutrition %K public health informatics %K supervised machine learning %D 2018 %7 30.05.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: National surveys in public health nutrition commonly record the weight of every food consumed by an individual. However, if the goal is to identify whether individuals are in compliance with the 5 main national nutritional guidelines (sodium, saturated fats, sugars, fruit and vegetables, and fats), much less information may be needed. A previous study showed that tracking only 2.89% of all foods (113/3911) was sufficient to accurately identify compliance. Further reducing the data needs could lower participation burden, thus decreasing the costs for monitoring national compliance with key guidelines. Objective: This study aimed to assess whether national public health nutrition surveys can be further simplified by only recording whether a food was consumed, rather than having to weigh it. Methods: Our dataset came from a generalized sample of inhabitants in the United Kingdom, more specifically from the National Diet and Nutrition Survey 2008-2012. After simplifying food consumptions to a binary value (1 if an individual consumed a food and 0 otherwise), we built and optimized decision trees to find whether the foods could accurately predict compliance with the major 5 nutritional guidelines. Results: When using decision trees of a similar size to previous studies (ie, involving as many foods), we were able to correctly infer compliance for the 5 guidelines with an average accuracy of 80.1%. This is an average increase of 2.5 percentage points over a previous study, showing that further simplifying the surveys can actually yield more robust estimates. When we allowed the new decision trees to use slightly more foods than in previous studies, we were able to optimize the performance with an average increase of 3.1 percentage points. Conclusions: Although one may expect a further simplification of surveys to decrease accuracy, our study found that public health dietary surveys can be simplified (from accurately weighing items to simply checking whether they were consumed) while improving accuracy. One possibility is that the simplification reduced noise and made it easier for patterns to emerge. Using simplified surveys will allow to monitor public health nutrition in a more cost-effective manner and possibly decrease the number of errors as participation burden is reduced. %R 10.2196/publichealth.9536 %U http://publichealth.jmir.org/2018/2/e56/ %U https://doi.org/10.2196/publichealth.9536 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e41 %T Incorporating a Static Versus Supportive Mobile Phone App Into a Partial Meal Replacement Program With Face-to-Face Support: Randomized Controlled Trial %A Brindal,Emily %A Hendrie,Gilly A %A Freyne,Jill %A Noakes,Manny %+ CSIRO Food and Nutrition, Gate 13 Kintore Avenue, Adelaide, 5000, Australia, 61 883050633, emily.brindal@csiro.au %K mHealth %K weight loss %K diet %D 2018 %7 18.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile phone apps may be acceptable to users and could improve retention and adherence over more traditional methods, but there is mixed literature supporting their efficacy. In the weight management space, very little is known about how a mobile phone app integrating features beyond text messaging (short message service) can affect behavior, particularly when combined with face-to-face support. Objective: The objective of this study was to examine the effectiveness of a mobile phone app when combined with a partial meal replacement program including face-to-face support. This paper compares a static versus supportive app over a 6-month randomized trial for effects on weight loss, weight-related biomarkers, and psychological outcomes. Methods: Overweight and obese adults (71.2% female, 104/146; mean 48.11, SD 11.75 years) were recruited to participate in the weight loss study, and they were randomized on a 1:1 basis using a computer algorithm. The supportive app (n=75) provided information, food intake recording, rewards, prompts for regular interaction through reminders, and the opportunity to review personal compliance with the dietary program. The static app (n=71) included only recipes and weight loss information. Both groups recieved equal amounts of face-to-face support in addition to app. Results: The overall reduction in app usage over 24 weeks was lower for the supportive app in comparison with the static app; approximately 39.0% (57/146) of the users were still using the app at week 24. Despite the promising results for app usage, there were no differences in weight loss between groups (F1,128.12=0.83, P=.36). However, it should be noted that almost 60% (49/84) of all participants lost 5% or more of body weight during the trial. No weight-related biomarkers were significantly different between groups. Both groups experienced an increase in positive mood, but this was significantly higher for those who received the static app (F1,118.12=4.93, P=.03). Conclusions: Although the supportive app was well received by users, we found little evidence of the added benefit of this versus the static app in combination with face-to-face support in a community-delivered weight loss program. Future versions of the app may incorporate more unique behavioral techniques beyond those provided by the consultant to improve the potency of the app. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12613000547741; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364187 (Archived by WebCite http://www.webcitation.org/6yivwfMI9) %M 29669704 %R 10.2196/mhealth.7796 %U http://mhealth.jmir.org/2018/4/e41/ %U https://doi.org/10.2196/mhealth.7796 %U http://www.ncbi.nlm.nih.gov/pubmed/29669704 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e83 %T Relationship Between Weekly Patterns of Caloric Intake and Reported Weight Loss Outcomes: Retrospective Cohort Study %A Hill,Christine %A Weir,Brian W %A Fuentes,Laura W %A Garcia-Alvarez,Alicia %A Anouti,Danya P %A Cheskin,Lawrence J %+ Johns Hopkins Bloomberg School of Public Health, Lerner Center for Public Health Promotion, Johns Hopkins University, 624 N Broadway, Room 904B, Baltimore, MD, 21205, United States, 1 410 502 1811, laura.w.fuentes@jhu.edu %K mobile apps %K weight reduction %K caloric restriction %K diet habits %D 2018 %7 16.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although millions of overweight and obese adults use mobile phone apps for weight loss, little is known about the predictors of success. Objective: The objective of this study was to understand the relationship between weight loss outcomes and weekly patterns of caloric intake among overweight and obese adults using a mobile phone app for weight loss. Methods: We examined the relationship between weekly patterns of caloric intake and weight loss outcomes among adults who began using a weight loss app in January 2016 and continued consistent use for at least 5 months (N=7007). Unadjusted and adjusted linear regression analyses were used to evaluate the predictors of percentage of bodyweight lost for women and men separately, including age, body mass index category, weight loss plan, and difference in daily calories consumed on weekend days (Saturday and Sunday) versus Monday. Results: In adjusted linear regression, percentage of bodyweight lost was significantly associated with age (for women), body mass index (for men), weight loss plan, and differences in daily caloric intake on Mondays versus weekend days. Compared with women consuming at least 500 calories more on weekend days than on Mondays, those who consumed 50 to 250 calories more on weekend days or those with balanced consumption (±50 calories) lost 1.64% more and 1.82% more bodyweight, respectively. Women consuming 250 to 500 calories or more than 500 calories more on Mondays than on weekend days lost 1.35% more and 3.58% more bodyweight, respectively. Compared with men consuming at least 500 calories more on weekend days than on Mondays, those consuming 250 to 500 calories or more than 500 calories more on Mondays than on weekend days lost 2.27% and 3.42% less bodyweight, respectively. Conclusions: Consistent caloric intake on weekend days and Mondays or consuming slightly fewer calories per day on Mondays versus weekend days was associated with more successful weight loss. Trial Registration: ClinicalTrials.gov NCT03136692; https://clinicaltrials.gov/ct2/show/NCT03136692 (Archived by WebCite at http://www.webcitation.org/6y9JvHya4) %M 29661750 %R 10.2196/mhealth.8320 %U http://mhealth.jmir.org/2018/4/e83/ %U https://doi.org/10.2196/mhealth.8320 %U http://www.ncbi.nlm.nih.gov/pubmed/29661750 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e67 %T Monitoring Energy Balance in Breast Cancer Survivors Using a Mobile App: Reliability Study %A Lozano-Lozano,Mario %A Galiano-Castillo,Noelia %A Martín-Martín,Lydia %A Pace-Bedetti,Nicolás %A Fernández-Lao,Carolina %A Arroyo-Morales,Manuel %A Cantarero-Villanueva,Irene %+ Department of Physical Therapy, University of Granada, Avenida de la Ilustración, 60, Granada, 18016, Spain, 34 958248765, marroyo@ugr.es %K telemedicine %K breast neoplasms %K survivors %K life style %K exercise %K diet %K mhealth %D 2018 %7 27.03.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The majority of breast cancer survivors do not meet recommendations in terms of diet and physical activity. To address this problem, we developed a mobile health (mHealth) app for assessing and monitoring healthy lifestyles in breast cancer survivors, called the Energy Balance on Cancer (BENECA) mHealth system. The BENECA mHealth system is a novel and interactive mHealth app, which allows breast cancer survivors to engage themselves in their energy balance monitoring. BENECA was designed to facilitate adherence to healthy lifestyles in an easy and intuitive way. Objective: The objective of the study was to assess the concurrent validity and test-retest reliability between the BENECA mHealth system and the gold standard assessment methods for diet and physical activity. Methods: A reliability study was conducted with 20 breast cancer survivors. In the study, tri-axial accelerometers (ActiGraphGT3X+) were used as gold standard for 8 consecutive days, in addition to 2, 24-hour dietary recalls, 4 dietary records, and sociodemographic questionnaires. Two-way random effect intraclass correlation coefficients, a linear regression-analysis, and a Passing-Bablok regression were calculated. Results: The reliability estimates were very high for all variables (alpha≥.90). The lowest reliability was found in fruit and vegetable intakes (alpha=.94). The reliability between the accelerometer and the dietary assessment instruments against the BENECA system was very high (intraclass correlation coefficient=.90). We found a mean match rate of 93.51% between instruments and a mean phantom rate of 3.35%. The Passing-Bablok regression analysis did not show considerable bias in fat percentage, portions of fruits and vegetables, or minutes of moderate to vigorous physical activity. Conclusions: The BENECA mHealth app could be a new tool to measure energy balance in breast cancer survivors in a reliable and simple way. Our results support the use of this technology to not only to encourage changes in breast cancer survivors' lifestyles, but also to remotely monitor energy balance. Trial Registration: ClinicalTrials.gov NCT02817724; https://clinicaltrials.gov/ct2/show/NCT02817724 (Archived by WebCite at http://www.webcitation.org/6xVY1buCc) %M 29588273 %R 10.2196/mhealth.9669 %U http://mhealth.jmir.org/2018/3/e67/ %U https://doi.org/10.2196/mhealth.9669 %U http://www.ncbi.nlm.nih.gov/pubmed/29588273 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 2 %P e42 %T National Food, Nutrition, and Physical Activity Survey of the Portuguese General Population (2015-2016): Protocol for Design and Development %A Lopes,Carla %A Torres,Duarte %A Oliveira,Andreia %A Severo,Milton %A Guiomar,Sofia %A Alarcão,Violeta %A Ramos,Elisabete %A Rodrigues,Sara %A Vilela,Sofia %A Oliveira,Luísa %A Mota,Jorge %A Teixeira,Pedro J %A Nicola,Paulo J %A Soares,Simão %A Andersen,Lene Frost %A , %+ Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, Porto, 4200-319, Portugal, 351 220426640, carlal@med.up.pt %K surveys %K nutritional surveys %K exercise %K public health %K children %K adults %K elderly %D 2018 %7 15.02.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: The assessment of food consumption data using harmonized methodologies at the European level is fundamental to support the development of public policies. Portugal is one of the countries with the most outdated information on individual food consumption. Objective: The objective of this study was to describe the design and methodology of the National Food, Nutrition and Physical Activity Survey, 2015-2016, developed to collect national and regional data on dietary habits, physical activity (PA), and nutritional status, in a representative sample of the Portuguese general population (3 months-84 years). Methods: Participants were selected by multistage sampling, using the National Heath Registry as the sampling frame. Data collection, during 12 months, was harmonized according to European guidelines (EU-MENU, European Food Safety Authority [EFSA]). Computer-assisted personal interviewing (CAPI) was performed on a specific electronic platform synchronized with nutritional composition data and considering the FoodEx2 classification system. Dietary assessment was performed using 24-hour recalls (two nonconsecutive, 8-15 days apart) or food diaries in the case of children aged <10 years, complemented with a food propensity questionnaire; PA data (International Physical Activity Questionnaire [IPAQ], the Activity Choice Index [ACI], and 4-days PA diaries); sociodemographic data, and other health-related data were also collected. Results: A sample of 6553 individuals completed the first interview, and 5811 participants completed two dietary assessments. The participation rate among eligible individuals was 33.38% (6553/19,635), considering the first interview, and 29.60% (5811/19,635) for the participants with two completed interviews (about 40% in children and adolescents and 20% in elderly individuals). Results of the survey will be disseminated in national and international scientific journals during 2018-2019. Conclusions: The survey will assist policy planning and management of national and European health programs on the improvement of nutritional status and risk assessment related to food hazards, and the enhancement of PA. The infrastructures and data driven from this Survey are a solid basis to the development of a future national surveillance system on diet, PA, and other health behaviors reproducible over time. %M 29449204 %R 10.2196/resprot.8990 %U http://www.researchprotocols.org/2018/2/e42/ %U https://doi.org/10.2196/resprot.8990 %U http://www.ncbi.nlm.nih.gov/pubmed/29449204 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 1 %P e24 %T Examining the Frequency and Contribution of Foods Eaten Away From Home in the Diets of 18- to 30-Year-Old Australians Using Smartphone Dietary Assessment (MYMeals): Protocol for a Cross-Sectional Study %A Wellard-Cole,Lyndal %A Jung,Jisu %A Kay,Judy %A Rangan,Anna %A Chapman,Kathy %A Watson,Wendy L %A Hughes,Clare %A Ni Mhurchu,Cliona %A Bauman,Adrian %A Gemming,Luke %A Yacef,Kalina %A Koprinska,Irena %A Allman-Farinelli,Margaret %+ Nutrition and Dietetics Group, School of Life and Environmental Sciences, The University of Sydney, Level 4 East, Charles Perkins Centre, Sydney, 2006, Australia, 61 286274854, lwel3754@uni.sydney.edu.au %K diet %K fast foods %K young adult %K feeding behavior %K nutritional status %K cell phone %D 2018 %7 26.01.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Young Australians aged between 18 and 30 years have experienced the largest increase in the body mass index and spend the largest proportion of their food budget on fast food and eating out. Frequent consumption of foods purchased and eaten away from home has been linked to poorer diet quality and weight gain. There has been no Australian research regarding quantities, type, or the frequency of consumption of food prepared outside the home by young adults and its impact on their energy and nutrient intakes. Objectives: The objective of this study was to determine the relative contributions of different food outlets (eg, fast food chain, independent takeaway food store, coffee shop, etc) to the overall food and beverage intake of young adults; to assess the extent to which food and beverages consumed away from home contribute to young adults’ total energy and deleterious nutrient intakes; and to study social and physical environmental interactions with consumption patterns of young adults. Methods: A cross-sectional study of 1008 young adults will be conducted. Individuals are eligible to participate if they: (1) are aged between 18 and 30 years; (2) reside in New South Wales, Australia; (3) own or have access to a smartphone; (4) are English-literate; and (5) consume at least one meal, snack, or drink purchased outside the home per week. An even spread of gender, age groups (18 to 24 years and 25 to 30 years), metropolitan or regional geographical areas, and high and low socioeconomic status areas will be included. Participants will record all food and drink consumed over 3 consecutive days, together with location purchased and consumed in our customized smartphone app named Eat and Track (EaT). Participants will then complete an extensive demographics questionnaire. Mean intakes of energy, nutrients, and food groups will be calculated along with the relative contribution of foods purchased and eaten away from home. A subsample of 19.84% (200/1008) of the participants will complete three 24-hour recall interviews to compare with the data collected using EaT. Data mining techniques such as clustering, decision trees, neural networks, and support vector machines will be used to build predictive models and identify important patterns. Results: Recruitment is underway, and results will be available in 2018. Conclusions: The contribution of foods prepared away from home, in terms of energy, nutrients, deleterious nutrients, and food groups to young people’s diets will be determined, as will the impact on meeting national recommendations. Foods and consumption behaviors that should be targeted in future health promotion efforts for young adults will be identified. %M 29374002 %R 10.2196/resprot.9038 %U http://www.researchprotocols.org/2018/1/e24/ %U https://doi.org/10.2196/resprot.9038 %U http://www.ncbi.nlm.nih.gov/pubmed/29374002 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 11 %P e360 %T A Fully Automated Web-Based Program Improves Lifestyle Habits and HbA1c in Patients With Type 2 Diabetes and Abdominal Obesity: Randomized Trial of Patient E-Coaching Nutritional Support (The ANODE Study) %A Hansel,Boris %A Giral,Philippe %A Gambotti,Laetitia %A Lafourcade,Alexandre %A Peres,Gilbert %A Filipecki,Claude %A Kadouch,Diana %A Hartemann,Agnes %A Oppert,Jean-Michel %A Bruckert,Eric %A Marre,Michel %A Bruneel,Arnaud %A Duchene,Emilie %A Roussel,Ronan %+ Hôpitaux Universitaires Paris-Nord Val de Seine, Department of Endocrinology, Diabetology, Nutrition, Assistance Publique-Hôpitaux de Paris, 46 Rue Henri Huchard, Paris, 75018, France, 33 0611307469, boris.hansel@aphp.fr %K e-health %K nutrition %K type 2 diabetes %D 2017 %7 08.11.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The prevalence of abdominal obesity and type 2 diabetes mellitus (T2DM) is a public health challenge. New solutions need to be developed to help patients implement lifestyle changes. Objective: The objective of the study was to evaluate a fully automated Web-based intervention designed to help users improve their dietary habits and increase their physical activity. Methods: The Accompagnement Nutritionnel de l’Obésité et du Diabète par E-coaching (ANODE) study was a 16-week, 1:1 parallel-arm, open-label randomized clinical trial. Patients with T2DM and abdominal obesity (n=120, aged 18-75 years) were recruited. Patients in the intervention arm (n=60) had access to a fully automated program (ANODE) to improve their lifestyle. Patients were asked to log on at least once per week. Human contact was limited to hotline support in cases of technical issues. The dietetic tool provided personalized menus and a shopping list for the day or the week. Stepwise physical activity was prescribed. The control arm (n=60) received general nutritional advice. The primary outcome was the change of the dietary score (International Diet Quality Index; DQI-I) between baseline and the end of the study. Secondary endpoints included changes in body weight, waist circumference, hemoglobin A1c (HbA1c) and measured maximum oxygen consumption (VO2 max). Results: The mean age of the participants was 57 years (standard deviation [SD] 9), mean body mass index was 33 kg/m² (SD 4), mean HbA1c was 7.2% (SD 1.1), and 66.7% (80/120) of participants were women. Using an intention-to-treat analysis, the DQI-I score (54.0, SD 5.7 in the ANODE arm; 52.8, SD 6.2 in the control arm; P=.28) increased significantly in the ANODE arm compared to the control arm (+4.55, SD 5.91 vs -1.68, SD 5.18; between arms P<.001). Body weight, waist circumference, and HbA1c changes improved significantly in the intervention. Conclusions: Among patients with T2DM and abdominal obesity, the use of a fully automated Web-based program resulted in a significant improvement in dietary habits and favorable clinical and laboratory changes. The sustainability of these effects remains to be determined. Trial Registration: ClinicalTrials.gov NCT02343107; http://clinicaltrials.gov/ct2/show/NCT02343107 (Archived by WebCite at http://www.webcitation.org/6uVMKPRzs) %M 29117929 %R 10.2196/jmir.7947 %U http://www.jmir.org/2017/11/e360/ %U https://doi.org/10.2196/jmir.7947 %U http://www.ncbi.nlm.nih.gov/pubmed/29117929 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 10 %P e163 %T A New Tool for Nutrition App Quality Evaluation (AQEL): Development, Validation, and Reliability Testing %A DiFilippo,Kristen Nicole %A Huang,Wenhao %A Chapman-Novakofski,Karen M %+ Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, 238 Bevier Hall, 905 S. Goodwin Ave, Urbana, IL, 61801, United States, 1 217 552 5777, kdifilip@illinois.edu %K evaluation %K mobile apps %K dietitians %K health education %K diet, food, and nutrition %D 2017 %7 27.10.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The extensive availability and increasing use of mobile apps for nutrition-based health interventions makes evaluation of the quality of these apps crucial for integration of apps into nutritional counseling. Objective: The goal of this research was the development, validation, and reliability testing of the app quality evaluation (AQEL) tool, an instrument for evaluating apps’ educational quality and technical functionality. Methods: Items for evaluating app quality were adapted from website evaluations, with additional items added to evaluate the specific characteristics of apps, resulting in 79 initial items. Expert panels of nutrition and technology professionals and app users reviewed items for face and content validation. After recommended revisions, nutrition experts completed a second AQEL review to ensure clarity. On the basis of 150 sets of responses using the revised AQEL, principal component analysis was completed, reducing AQEL into 5 factors that underwent reliability testing, including internal consistency, split-half reliability, test-retest reliability, and interrater reliability (IRR). Two additional modifiable constructs for evaluating apps based on the age and needs of the target audience as selected by the evaluator were also tested for construct reliability. IRR testing using intraclass correlations (ICC) with all 7 constructs was conducted, with 15 dietitians evaluating one app. Results: Development and validation resulted in the 51-item AQEL. These were reduced to 25 items in 5 factors after principal component analysis, plus 9 modifiable items in two constructs that were not included in principal component analysis. Internal consistency and split-half reliability of the following constructs derived from principal components analysis was good (Cronbach alpha >.80, Spearman-Brown coefficient >.80): behavior change potential, support of knowledge acquisition, app function, and skill development. App purpose split half-reliability was .65. Test-retest reliability showed no significant change over time (P>.05) for all but skill development (P=.001). Construct reliability was good for items assessing age appropriateness of apps for children, teens, and a general audience. In addition, construct reliability was acceptable for assessing app appropriateness for various target audiences (Cronbach alpha >.70). For the 5 main factors, ICC (1,k) was >.80, with a P value of <.05. When 15 nutrition professionals evaluated one app, ICC (2,15) was .98, with a P value of <.001 for all 7 constructs when the modifiable items were specified for adults seeking weight loss support. Conclusions: Our preliminary effort shows that AQEL is a valid, reliable instrument for evaluating nutrition apps’ qualities for clinical interventions by nutrition clinicians, educators, and researchers. Further efforts in validating AQEL in various contexts are needed. %M 29079554 %R 10.2196/mhealth.7441 %U http://mhealth.jmir.org/2017/10/e163/ %U https://doi.org/10.2196/mhealth.7441 %U http://www.ncbi.nlm.nih.gov/pubmed/29079554 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 10 %P e332 %T Exploring the Potential of a Wearable Camera to Examine the Early Obesogenic Home Environment: Comparison of SenseCam Images to the Home Environment Interview %A Schrempft,Stephanie %A van Jaarsveld,Cornelia HM %A Fisher,Abigail %+ Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London,, United Kingdom, 44 02076791722, abigail.fisher@ucl.ac.uk %K environment and public health %K obesity %K parents %D 2017 %7 12.10.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The obesogenic home environment is usually examined via self-report, and objective measures are required. Objective: This study explored whether the wearable camera SenseCam can be used to examine the early obesogenic home environment and whether it is useful for validation of self-report measures. Methods: A total of 15 primary caregivers of young children (mean age of child 4 years) completed the Home Environment Interview (HEI). Around 12 days after the HEI, participants wore the SenseCam at home for 4 days. A semistructured interview assessed participants’ experience of wearing the SenseCam. Intraclass correlation coefficients (ICCs), percent agreement, and kappa statistics were used as validity estimates for 54 home environment features. Results: Wearing the SenseCam was generally acceptable to those who participated. The SenseCam captured all 54 HEI features but with varying detail; 36 features (67%) had satisfactory validity (ICC or kappa ≥0.40; percent agreement ≥80 where kappa could not be calculated). Validity was good or excellent (ICC or kappa ≥0.60) for fresh fruit and vegetable availability, fresh vegetable variety, display of food and drink (except sweet snacks), family meals, child eating lunch or dinner while watching TV, garden and play equipment, the number of TVs and DVD players, and media equipment in the child’s bedroom. Validity was poor (ICC or kappa <0.40) for tinned and frozen vegetable availability and variety, and sweet snack availability. Conclusions: The SenseCam has the potential to objectively examine and validate multiple aspects of the obesogenic home environment. Further research should aim to replicate the findings in a larger, representative sample. %M 29025695 %R 10.2196/jmir.7748 %U http://www.jmir.org/2017/10/e332/ %U https://doi.org/10.2196/jmir.7748 %U http://www.ncbi.nlm.nih.gov/pubmed/29025695 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 10 %P e343 %T Using a UK Virtual Supermarket to Examine Purchasing Behavior Across Different Income Groups in the United Kingdom: Development and Feasibility Study %A Mizdrak,Anja %A Waterlander,Wilma Elzeline %A Rayner,Mike %A Scarborough,Peter %+ Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme (BODE3), Department of Public Health, University of Otago, Wellington, 23 Mein Street, Newtown, Wellington, 6021, New Zealand, 64 49186192, anja.mizdrak@otago.ac.nz %K food %K diet %K public health %K United Kingdom %K socioeconomic status %D 2017 %7 09.10.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The majority of food in the United Kingdom is purchased in supermarkets, and therefore, supermarket interventions provide an opportunity to improve diets. Randomized controlled trials are costly, time-consuming, and difficult to conduct in real stores. Alternative approaches of assessing the impact of supermarket interventions on food purchases are needed, especially with respect to assessing differential impacts on population subgroups. Objective: The aim of this study was to assess the feasibility of using the United Kingdom Virtual Supermarket (UKVS), a three-dimensional (3D) computer simulation of a supermarket, to measure food purchasing behavior across income groups. Methods: Participants (primary household shoppers in the United Kingdom with computer access) were asked to conduct two shopping tasks using the UKVS and complete questionnaires on demographics, food purchasing habits, and feedback on the UKVS software. Data on recruitment method and rate, completion of study procedure, purchases, and feedback on usability were collected to inform future trial protocols. Results: A total of 98 participants were recruited, and 46 (47%) fully completed the study procedure. Low-income participants were less likely to complete the study (P=.02). Most participants found the UKVS easy to use (38/46, 83%) and reported that UKVS purchases resembled their usual purchases (41/46, 89%). Conclusions: The UKVS is likely to be a useful tool to examine the effects of nutrition interventions using randomized controlled designs. Feedback was positive from participants who completed the study and did not differ by income group. However, retention was low and needs to be addressed in future studies. This study provides purchasing data to establish sample size requirements for full trials using the UKVS. %M 28993301 %R 10.2196/jmir.7982 %U http://www.jmir.org/2017/10/e343/ %U https://doi.org/10.2196/jmir.7982 %U http://www.ncbi.nlm.nih.gov/pubmed/28993301 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 5 %P e105 %T PREventive Care Infrastructure based On Ubiquitous Sensing (PRECIOUS): A Study Protocol %A Castellano-Tejedor,Carmina %A Moreno,Jordi %A Ciudin,Andrea %A Parramón,Gemma %A Lusilla-Palacios,Pilar %+ University Hospital Vall d’Hebron - Vall d'Hebron Research Institute, Department of Psychiatry, CIBERSAM, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, Barcelona, 08035, Spain, 34 934893649 ext 3649, ninacastej@yahoo.es %K mHealth %K motivational interviewing %K physical activity %K diet %K sustained motivation %K adherence %D 2017 %7 31.05.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: mHealth has experienced a huge growth during the last decade. It has been presented as a new and promising pathway to increase self-management of health and chronic conditions in several populations. One of the most prolific areas of mHealth has been healthy lifestyles promotion. However, few mobile apps have succeeded in engaging people and ensuring sustained use. Objective: This paper describes the pilot test protocol of the PReventive Care Infrastructure based on Ubiquitous Sensing (PRECIOUS) project, aimed at validating the PRECIOUS system with end users. This system includes, within a motivational framework, the Bodyguard2 sensor (accelerometer with heart rate monitoring) and the PRECIOUS app. Methods: This is a pilot experimental study targeting morbidly obese prediabetic patients who will be randomized to three conditions: (1) Group 1 - Control group (Treatment as usual with the endocrinologist and the nurse + Bodyguard2), (2) Group 2 - PRECIOUS system (Bodyguard2 + PRECIOUS app), and (3) Group 3 - PRECIOUS system (Bodyguard2 + PRECIOUS app + Motivational Interviewing). The duration of the study will be 3 months with scheduled follow-up appointments within the scope of the project at Weeks 3, 5, 8, and 12. During the study, several measures related to healthy lifestyles, weight management, and health-related quality of life will be collected to explore the effectiveness of PRECIOUS to foster behavior change, as well as user acceptance, usability, and satisfaction with the solution. Results: Because of the encouraging results shown in similar scientific work analyzing health apps acceptance in clinical settings, we expect patients to widely accept and express satisfaction with PRECIOUS. We also expect to find acceptable usability of the preventive health solution. The recruitment of the pilot study has concluded with the inclusion of 31 morbidly obese prediabetic patients. Results are expected to be available in mid-2017. Conclusions: Adopting and maintaining healthy habits may be challenging in people with chronic conditions who usually need regular support to ensure mid/long-term adherence to recommendations and behavior change. Thus, mHealth could become a powerful and efficient tool since it allows continuous communication with users and immediate feedback. The PRECIOUS system is an innovative preventive health care solution aimed at enhancing inner motivation from users to change their lifestyles and adopt healthier habits. PRECIOUS includes ubiquitous sensors and a scientifically grounded app to address three main components of health: physical activity, diet, and stress levels. Trial Registration: Clinicaltrials.gov NCT02818790; https://clinicaltrials.gov/ct2/show/NCT02818790 (Archived by WebCite at http://www.webcitation.org/6qfzdfMoU) %M 28566263 %R 10.2196/resprot.6973 %U http://www.researchprotocols.org/2017/5/e105/ %U https://doi.org/10.2196/resprot.6973 %U http://www.ncbi.nlm.nih.gov/pubmed/28566263 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e160 %T What Matters in Weight Loss? An In-Depth Analysis of Self-Monitoring %A Painter,Stefanie Lynn %A Ahmed,Rezwan %A Hill,James O %A Kushner,Robert F %A Lindquist,Richard %A Brunning,Scott %A Margulies,Amy %+ Retrofit INC, 123 N. Wacker Drive, Suite 1250, Chicago, IL, 60606, United States, 1 8007745962, stefanie@retrofitme.com %K behavior %K body mass index %K fitness trackers %K self-monitoring %K obesity %K overweight %K weight loss %D 2017 %7 12.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Using technology to self-monitor body weight, dietary intake, and physical activity is a common practice used by consumers and health companies to increase awareness of current and desired behaviors in weight loss. Understanding how to best use the information gathered by these relatively new methods needs to be further explored. Objective: The purpose of this study was to analyze the contribution of self-monitoring to weight loss in participants in a 6-month commercial weight-loss intervention administered by Retrofit and to specifically identify the significant contributors to weight loss that are associated with behavior and outcomes. Methods: A retrospective analysis was performed using 2113 participants enrolled from 2011 to 2015 in a Retrofit weight-loss program. Participants were males and females aged 18 years or older with a starting body mass index of ≥25 kg/m2, who also provided a weight measurement at the sixth month of the program. Multiple regression analysis was performed using all measures of self-monitoring behaviors involving weight measurements, dietary intake, and physical activity to predict weight loss at 6 months. Each significant predictor was analyzed in depth to reveal the impact on outcome. Results: Participants in the Retrofit Program lost a mean –5.58% (SE 0.12) of their baseline weight with 51.87% (1096/2113) of participants losing at least 5% of their baseline weight. Multiple regression model (R2=.197, P<0.001) identified the following measures as significant predictors of weight loss at 6 months: number of weigh-ins per week (P<.001), number of steps per day (P=.02), highly active minutes per week (P<.001), number of food log days per week (P<.001), and the percentage of weeks with five or more food logs (P<.001). Weighing in at least three times per week, having a minimum of 60 highly active minutes per week, food logging at least three days per week, and having 64% (16.6/26) or more weeks with at least five food logs were associated with clinically significant weight loss for both male and female participants. Conclusions: The self-monitoring behaviors of self-weigh-in, daily steps, high-intensity activity, and persistent food logging were significant predictors of weight loss during a 6-month intervention. %M 28500022 %R 10.2196/jmir.7457 %U http://www.jmir.org/2017/5/e160/ %U https://doi.org/10.2196/jmir.7457 %U http://www.ncbi.nlm.nih.gov/pubmed/28500022 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e158 %T The Development, Validation, and User Evaluation of Foodbook24: A Web-Based Dietary Assessment Tool Developed for the Irish Adult Population %A Timon,Claire M %A Blain,Richard J %A McNulty,Breige %A Kehoe,Laura %A Evans,Katie %A Walton,Janette %A Flynn,Albert %A Gibney,Eileen R %+ UCD, Institute of Food and Health, University College Dublin, Sceince Centre South, Befield, Dublin, Dublin 4, Ireland, 353 17162819, eileen.gibney@ucd.ie %K diet records %K Internet %K validity %K biomarkers %K method acceptability %K adults %D 2017 %7 11.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The application of technology in the area of dietary assessment has resulted in the development of an array of tools, which are often specifically designed for a particular country or region. Objective: The aim of this study was to describe the development, validation, and user evaluation of a Web-based dietary assessment tool “Foodbook24.” Methods: Foodbook24 is a Web-based, dietary assessment tool consisting of a 24-hour dietary recall (24HDR) and food frequency questionnaire (FFQ) alongside supplementary questionnaires. Validity of the 24HDR component was assessed by 40 participants, who completed 3 nonconsecutive, self-administered 24HDR using Foodbook24 and a 4-day semi-weighed food diary at separate time points. Participants also provided fasted blood samples and 24-hour urine collections for the identification of biomarkers of nutrient and food group intake during each recording period. Statistical analyses on the nutrient and food group intake data derived from each method were performed in SPSS version 20.0 (SPSS Inc). Mean nutrient intakes (and standard deviations) recorded using each method of dietary assessment were calculated. Spearman and Pearson correlations, Wilcoxon Signed Rank and Paired t test were used to investigate the agreement and differences between the nutritional output from Foodbook24 (test method) and the 4-day semi-weighed food diary (reference method). Urinary and plasma biomarkers of nutrient intake were used as an objective validation of Foodbook24. To investigate the user acceptability of Foodbook24, participants from different studies involved with Foodbook24 were asked to complete an evaluation questionnaire. Results: For nutrient intake, correlations between the dietary assessment methods were acceptable to very good in strength and statistically significant (range r=.32 to .75). There were some significant differences between reported mean intakes of micronutrients recorded by both methods; however, with the exception of protein (P=.03), there were no significant differences in the reporting of energy or macronutrient intake. Of the 19 food groups investigated in this analysis, there were significant differences between 6 food groups reported by both methods. Spearman correlations for biomarkers of nutrient and food group intake and reported intake were similar for both methods. A total of 118 participants evaluated the acceptability of Foodbook24. The tool was well-received and the majority, 67.8% (80/118), opted for Foodbook24 as the preferred method for future dietary intake assessment when compared against a traditional interviewer led recall and semi-weighed food diary. Conclusions: The results of this study demonstrate the validity and user acceptability of Foodbook24. The results also highlight the potential of Foodbook24, a Web-based dietary assessment method, and present a viable alternative to nutritional surveillance in Ireland. %M 28495662 %R 10.2196/jmir.6407 %U http://www.jmir.org/2017/5/e158/ %U https://doi.org/10.2196/jmir.6407 %U http://www.ncbi.nlm.nih.gov/pubmed/28495662 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 2 %P e13 %T A Web-Based Graphical Food Frequency Assessment System: Design, Development and Usability Metrics %A Franco,Rodrigo Zenun %A Alawadhi,Balqees %A Fallaize,Rosalind %A Lovegrove,Julie A %A Hwang,Faustina %+ Biomedical Engineering, School of Biological Sciences, University of Reading, Whiteknights Campus, Reading,, United Kingdom, 44 118 378 7668, rodrigo.zenun.franco@pgr.reading.ac.uk %K nutrition assessment %K FFQ %K food frequency questionnaire %K personalized nutrition %K nutrition informatics %K dietary intake %K usability %K SUS %D 2017 %7 08.05.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Food frequency questionnaires (FFQs) are well established in the nutrition field, but there remain important questions around how to develop online tools in a way that can facilitate wider uptake. Also, FFQ user acceptance and evaluation have not been investigated extensively. Objective: This paper presents a Web-based graphical food frequency assessment system that addresses challenges of reproducibility, scalability, mobile friendliness, security, and usability and also presents the utilization metrics and user feedback from a deployment study. Methods: The application design employs a single-page application Web architecture with back-end services (database, authentication, and authorization) provided by Google Firebase’s free plan. Its design and responsiveness take advantage of the Bootstrap framework. The FFQ was deployed in Kuwait as part of the EatWellQ8 study during 2016. The EatWellQ8 FFQ contains 146 food items (including drinks). Participants were recruited in Kuwait without financial incentive. Completion time was based on browser timestamps and usability was measured using the System Usability Scale (SUS), scoring between 0 and 100. Products with a SUS higher than 70 are considered to be good. Results: A total of 235 participants created accounts in the system, and 163 completed the FFQ. Of those 163 participants, 142 reported their gender (93 female, 49 male) and 144 reported their date of birth (mean age of 35 years, range from 18-65 years). The mean completion time for all FFQs (n=163), excluding periods of interruption, was 14.2 minutes (95% CI 13.3-15.1 minutes). Female participants (n=93) completed in 14.1 minutes (95% CI 12.9-15.3 minutes) and male participants (n=49) completed in 14.3 minutes (95% CI 12.6-15.9 minutes). Participants using laptops or desktops (n=69) completed the FFQ in an average of 13.9 minutes (95% CI 12.6-15.1 minutes) and participants using smartphones or tablets (n=91) completed in an average of 14.5 minutes (95% CI 13.2-15.8 minutes). The median SUS score (n=141) was 75.0 (interquartile range [IQR] 12.5), and 84% of the participants who completed the SUS classified the system either “good” (n=50) or “excellent” (n=69). Considering only participants using smartphones or tablets (n=80), the median score was 72.5 (IQR 12.5), slightly below the SUS median for desktops and laptops (n=58), which was 75.0 (IQR 12.5). No significant differences were found between genders or age groups (below and above the median) for the SUS or completion time. Conclusions: Taking into account all the requirements, the deployment used professional cloud computing at no cost, and the resulting system had good user acceptance. The results for smartphones/tablets were comparable with desktops/laptops. This work has potential to promote wider uptake of online tools that can assess dietary intake at scale. %M 28483746 %R 10.2196/humanfactors.7287 %U http://humanfactors.jmir.org/2017/2/e13/ %U https://doi.org/10.2196/humanfactors.7287 %U http://www.ncbi.nlm.nih.gov/pubmed/28483746 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 3 %P e77 %T Ecological Momentary Assessment in Behavioral Research: Addressing Technological and Human Participant Challenges %A Burke,Lora E %A Shiffman,Saul %A Music,Edvin %A Styn,Mindi A %A Kriska,Andrea %A Smailagic,Asim %A Siewiorek,Daniel %A Ewing,Linda J %A Chasens,Eileen %A French,Brian %A Mancino,Juliet %A Mendez,Dara %A Strollo,Patrick %A Rathbun,Stephen L %+ Department of Health & Community Systems, University of Pittsburgh School of Nursing, 415 Victoria Building, 3500 Victoria Street, Pittsburgh, PA, 15261, United States, 1 412 624 2305, lbu100@pitt.edu %K ecological momentary assessment %K relapse %K obesity %K smartphone %K eating behavior %K adherence %D 2017 %7 15.03.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Ecological momentary assessment (EMA) assesses individuals’ current experiences, behaviors, and moods as they occur in real time and in their natural environment. EMA studies, particularly those of longer duration, are complex and require an infrastructure to support the data flow and monitoring of EMA completion. Objective: Our objective is to provide a practical guide to developing and implementing an EMA study, with a focus on the methods and logistics of conducting such a study. Methods: The EMPOWER study was a 12-month study that used EMA to examine the triggers of lapses and relapse following intentional weight loss. We report on several studies that informed the implementation of the EMPOWER study: (1) a series of pilot studies, (2) the EMPOWER study’s infrastructure, (3) training of study participants in use of smartphones and the EMA protocol and, (4) strategies used to enhance adherence to completing EMA surveys. Results: The study enrolled 151 adults and had 87.4% (132/151) retention rate at 12 months. Our learning experiences in the development of the infrastructure to support EMA assessments for the 12-month study spanned several topic areas. Included were the optimal frequency of EMA prompts to maximize data collection without overburdening participants; the timing and scheduling of EMA prompts; technological lessons to support a longitudinal study, such as proper communication between the Android smartphone, the Web server, and the database server; and use of a phone that provided access to the system’s functionality for EMA data collection to avoid loss of data and minimize the impact of loss of network connectivity. These were especially important in a 1-year study with participants who might travel. It also protected the data collection from any server-side failure. Regular monitoring of participants’ response to EMA prompts was critical, so we built in incentives to enhance completion of EMA surveys. During the first 6 months of the 12-month study interval, adherence to completing EMA surveys was high, with 88.3% (66,978/75,888) completion of random assessments and around 90% (23,411/25,929 and 23,343/26,010) completion of time-contingent assessments, despite the duration of EMA data collection and challenges with implementation. Conclusions: This work informed us of the necessary preliminary steps to plan and prepare a longitudinal study using smartphone technology and the critical elements to ensure participant engagement in the potentially burdensome protocol, which spanned 12 months. While this was a technology-supported and -programmed study, it required close oversight to ensure all elements were functioning correctly, particularly once human participants became involved. %M 28298264 %R 10.2196/jmir.7138 %U http://www.jmir.org/2017/3/e77/ %U https://doi.org/10.2196/jmir.7138 %U http://www.ncbi.nlm.nih.gov/pubmed/28298264 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 3 %P e63 %T Online Self-Tracking Groups to Increase Fruit and Vegetable Intake: A Small-Scale Study on Mechanisms of Group Effect on Behavior Change %A Meng,Jingbo %A Peng,Wei %A Shin,Soo Yun %A Chung,Minwoong %+ Michigan State University, Department of Communication, 404 Wilson Road, CAS Building, East Lansing, MI, 48824, United States, 1 517 355 3480, jingbome@msu.edu %K online support group %K quantified self %K fruit and vegetable consumption %K social comparison %K similarity %K social modeling %D 2017 %7 06.03.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based interventions with a self-tracking component have been found to be effective in promoting adults’ fruit and vegetable consumption. However, these interventions primarily focus on individual- rather than group-based self-tracking. The rise of social media technologies enables sharing and comparing self-tracking records in a group context. Therefore, we developed an online group-based self-tracking program to promote fruit and vegetable consumption. Objective: This study aims to examine (1) the effectiveness of online group-based self-tracking on fruit and vegetable consumption and (2) characteristics of online self-tracking groups that make the group more effective in promoting fruit and vegetable consumption in early young adults. Methods: During a 4-week Web-based experiment, 111 college students self-tracked their fruit and vegetable consumption either individually (ie, the control group) or in an online group characterized by a 2 (demographic similarity: demographically similar vs demographically diverse) × 2 (social modeling: incremental change vs ideal change) experimental design. Each online group consisted of one focal participant and three confederates as group members or peers, who had their demographics and fruit and vegetable consumption manipulated to create the four intervention groups. Self-reported fruit and vegetable consumption were assessed using the Food Frequency Questionnaire at baseline and after the 4-week experiment. Results: Participants who self-tracked their fruit and vegetable consumption collectively with other group members consumed more fruits and vegetables than participants who self-tracked individually (P=.01). The results did not show significant main effects of demographic similarity (P=.32) or types of social modeling (P=.48) in making self-tracking groups more effective in promoting fruit and vegetable consumption. However, additional analyses revealed the main effect of performance discrepancy (ie, difference in fruit and vegetable consumption between a focal participant and his/her group members during the experiment), such that participants who had a low performance discrepancy from other group members had greater fruit and vegetable consumption than participants who had a high performance discrepancy from other group members (P=.002). A mediation test showed that low performance discrepancy led to greater downward contrast (b=–0.78, 95% CI –2.44 to –0.15), which in turn led to greater fruit and vegetable consumption. Conclusions: Online self-tracking groups were more effective than self-tracking alone in promoting fruit and vegetable consumption for early young adults. Low performance discrepancy from other group members lead to downward contrast, which in turn increased participants’ fruit and vegetable consumption over time. The study highlighted social comparison processes in online groups that allow for sharing personal health information. Lastly, given the small scale of this study, nonsignificant results with small effect sizes might be subject to bias. %M 28264793 %R 10.2196/jmir.6537 %U http://www.jmir.org/2017/3/e63/ %U https://doi.org/10.2196/jmir.6537 %U http://www.ncbi.nlm.nih.gov/pubmed/28264793 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 2 %N 2 %P e167 %T Qualitative Analysis of Cognitive Interviews With School Children: A Web-Based Food Intake Questionnaire %A Fernandes Davies,Vanessa %A Kupek,Emil %A Faria Di Pietro,Patricia %A Altenburg de Assis,Maria Alice %A GK Vieira,Francilene %A Perucchi,Clarice %A Mafra,Rafaella %A Thompson,Debbe %A Baranowski,Thomas %+ Public Health, Santa Catarina Federal University, R. Delfino Conti, S/N - Trindade, Florianopolis, 88036-020, Brazil, 55 (48) 3721 9394, va.davies@hotmail.co.uk %K dietary assessment %K children %K computer %K questionnaire %D 2016 %7 28.11.2016 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The use of computers to administer dietary assessment questionnaires has shown potential, particularly due to the variety of interactive features that can attract and sustain children’s attention. Cognitive interviews can help researchers to gain insights into how children understand and elaborate their response processes in this type of questionnaire. Objective: To present the cognitive interview results of children who answered the WebCAAFE, a Web-based questionnaire, to obtain an in-depth understanding of children’s response processes. Methods: Cognitive interviews were conducted with children (using a pretested interview script). Analyses were carried out using thematic analysis within a grounded theory framework of inductive coding. Results: A total of 40 children participated in the study, and 4 themes were identified: (1) the meaning of words, (2) understanding instructions, (3) ways to resolve possible problems, and (4) suggestions for improving the questionnaire. Most children understood questions that assessed nutritional intake over the past 24 hours, although the structure of the questionnaire designed to facilitate recall of dietary intake was not always fully understood. Younger children (7 and 8 years old) had more difficulty relating the food images to mixed dishes and foods eaten with bread (eg, jam, cheese). Children were able to provide suggestions for improving future versions of the questionnaire. Conclusions: More attention should be paid to children aged 8 years or below, as they had the greatest difficulty completing the WebCAAFE. %M 27895005 %R 10.2196/publichealth.5024 %U http://publichealth.jmir.org/2016/2/e167/ %U https://doi.org/10.2196/publichealth.5024 %U http://www.ncbi.nlm.nih.gov/pubmed/27895005 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 4 %P e123 %T A Brief Tool to Assess Image-Based Dietary Records and Guide Nutrition Counselling Among Pregnant Women: An Evaluation %A Ashman,Amy M %A Collins,Clare E %A Brown,Leanne J %A Rae,Kym M %A Rollo,Megan E %+ Priority Research Centre in Physical Activity and Nutrition, Faculty of Health and Medicine, School of Health Sciences Office, University of Newcastle, Room HA12, Hunter Building, University Drive, Callaghan, 2308, Australia, 61 (02) 4921 5649, megan.rollo@newcastle.edu.au %K nutrition assessment %K pregnancy %K telehealth %K image-based dietary records %D 2016 %7 04.11.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Dietitians ideally should provide personally tailored nutrition advice to pregnant women. Provision is hampered by a lack of appropriate tools for nutrition assessment and counselling in practice settings. Smartphone technology, through the use of image-based dietary records, can address limitations of traditional methods of recording dietary intake. Feedback on these records can then be provided by the dietitian via smartphone. Efficacy and validity of these methods requires examination. Objective: The aims of the Australian Diet Bytes and Baby Bumps study, which used image-based dietary records and a purpose-built brief Selected Nutrient and Diet Quality (SNaQ) tool to provide tailored nutrition advice to pregnant women, were to assess relative validity of the SNaQ tool for analyzing dietary intake compared with nutrient analysis software, to describe the nutritional intake adequacy of pregnant participants, and to assess acceptability of dietary feedback via smartphone. Methods: Eligible women used a smartphone app to record everything they consumed over 3 nonconsecutive days. Records consisted of an image of the food or drink item placed next to a fiducial marker, with a voice or text description, or both, providing additional detail. We used the SNaQ tool to analyze participants’ intake of daily food group servings and selected key micronutrients for pregnancy relative to Australian guideline recommendations. A visual reference guide consisting of images of foods and drinks in standard serving sizes assisted the dietitian with quantification. Feedback on participants’ diets was provided via 2 methods: (1) a short video summary sent to participants’ smartphones, and (2) a follow-up telephone consultation with a dietitian. Agreement between dietary intake assessment using the SNaQ tool and nutrient analysis software was evaluated using Spearman rank correlation and Cohen kappa. Results: We enrolled 27 women (median age 28.8 years, 8 Indigenous Australians, 15 primiparas), of whom 25 completed the image-based dietary record. Median intakes of grains, vegetables, fruit, meat, and dairy were below recommendations. Median (interquartile range) intake of energy-dense, nutrient-poor foods was 3.5 (2.4-3.9) servings/day and exceeded recommendations (0-2.5 servings/day). Positive correlations between the SNaQ tool and nutrient analysis software were observed for energy (ρ=.898, P<.001) and all selected micronutrients (iron, calcium, zinc, folate, and iodine, ρ range .510-.955, all P<.05), both with and without vitamin and mineral supplements included in the analysis. Cohen kappa showed moderate to substantial agreement for selected micronutrients when supplements were included (kappa range .488-.803, all P ≤.001) and for calcium, iodine, and zinc when excluded (kappa range .554-.632, all P<.001). A total of 17 women reported changing their diet as a result of the personalized nutrition advice. Conclusions: The SNaQ tool demonstrated acceptable validity for assessing adequacy of key pregnancy nutrient intakes and preliminary evidence of utility to support dietitians in providing women with personalized advice to optimize nutrition during pregnancy. %M 27815234 %R 10.2196/mhealth.6469 %U http://mhealth.jmir.org/2016/4/e123/ %U https://doi.org/10.2196/mhealth.6469 %U http://www.ncbi.nlm.nih.gov/pubmed/27815234 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 4 %P e208 %T The e-EPIDEMIOLOGY Mobile Phone App for Dietary Intake Assessment: Comparison with a Food Frequency Questionnaire %A Bejar,Luis Maria %A Sharp,Brett Northrop %A García-Perea,María Dolores %+ Department of Preventive Medicine and Public Health, University of Seville, Institute of Anatomy, 3rd floor, Sánchez-Pizjuán Avenue, Seville, 41009, Spain, 34 954551771, lmbprado@us.es %K dietary assessment %K mobile phone application %K food frequency questionnaire %K epidemiological methods %D 2016 %7 02.11.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: There is a great necessity for new methods of evaluation of dietary intake that overcome the limitations of traditional self-reporting methods. Objective: The objective of this study was to develop a new method, based on an app for mobile phones called e-EPIDEMIOLOGY, which was designed to collect individual consumption data for a series of foods/drinks, and to compare this app with a previously validated paper food frequency questionnaire (FFQ). Methods: University students >18 years of age recorded the consumption of certain foods/drinks using e-EPIDEMIOLOGY during 28 consecutive days and then filled out a paper FFQ at the end of the study period. To evaluate the agreement between the categories of habitual consumption for each of the foods/drinks included in the study, cross-classification analysis and a weighted kappa statistic were used. Results: A total of 119 participants completed the study (71% female, 85/119; 29% male, 34/119). Cross-classification analysis showed that 79.8% of the participants were correctly classified into the same category and just 1.1% were misclassified into opposite categories. The average weighted kappa statistic was good (κ=.64). Conclusions: The results indicate that e-EPIDEMIOLOGY generated ranks of dietary intakes that were highly comparable with the previously validated paper FFQ. However, it was noted that further testing of e-EPIDEMIOLOGY is required to establish its wider utility. %M 27806922 %R 10.2196/resprot.5782 %U http://www.researchprotocols.org/2016/4/e208/ %U https://doi.org/10.2196/resprot.5782 %U http://www.ncbi.nlm.nih.gov/pubmed/27806922 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e85 %T Popular Nutrition-Related Mobile Apps: A Feature Assessment %A Franco,Rodrigo Zenun %A Fallaize,Rosalind %A Lovegrove,Julie A %A Hwang,Faustina %+ School of Systems Engineering, University of Reading, Whiteknights Campus, Reading, RG6 6UR, United Kingdom, 44 1183787668, rodrigo.zenun.franco@pgr.reading.ac.uk %K nutrition apps %K diet apps %K food diary %K nutritional assessment %K mHealth %K eHealth %K mobile phone %K mobile technology %D 2016 %7 01.08.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A key challenge in human nutrition is the assessment of usual food intake. This is of particular interest given recent proposals of eHealth personalized interventions. The adoption of mobile phones has created an opportunity for assessing and improving nutrient intake as they can be used for digitalizing dietary assessments and providing feedback. In the last few years, hundreds of nutrition-related mobile apps have been launched and installed by millions of users. Objective: This study aims to analyze the main features of the most popular nutrition apps and to compare their strategies and technologies for dietary assessment and user feedback. Methods: Apps were selected from the two largest online stores of the most popular mobile operating systems—the Google Play Store for Android and the iTunes App Store for iOS—based on popularity as measured by the number of installs and reviews. The keywords used in the search were as follows: calorie(s), diet, diet tracker, dietician, dietitian, eating, fit, fitness, food, food diary, food tracker, health, lose weight, nutrition, nutritionist, weight, weight loss, weight management, weight watcher, and ww calculator. The inclusion criteria were as follows: English language, minimum number of installs (1 million for Google Play Store) or reviews (7500 for iTunes App Store), relation to nutrition (ie, diet monitoring or recommendation), and independence from any device (eg, wearable) or subscription. Results: A total of 13 apps were classified as popular for inclusion in the analysis. Nine apps offered prospective recording of food intake using a food diary feature. Food selection was available via text search or barcode scanner technologies. Portion size selection was only textual (ie, without images or icons). All nine of these apps were also capable of collecting physical activity (PA) information using self-report, the global positioning system (GPS), or wearable integrations. Their outputs focused predominantly on energy balance between dietary intake and PA. None of these nine apps offered features directly related to diet plans and motivational coaching. In contrast, the remaining four of the 13 apps focused on these opportunities, but without food diaries. One app—FatSecret—also had an innovative feature for connecting users with health professionals, and another—S Health—provided a nutrient balance score. Conclusions: The high number of installs indicates that there is a clear interest and opportunity for diet monitoring and recommendation using mobile apps. All the apps collecting dietary intake used the same nutrition assessment method (ie, food diary record) and technologies for data input (ie, text search and barcode scanner). Emerging technologies, such as image recognition, natural language processing, and artificial intelligence, were not identified. None of the apps had a decision engine capable of providing personalized diet advice. %M 27480144 %R 10.2196/mhealth.5846 %U http://mhealth.jmir.org/2016/3/e85/ %U https://doi.org/10.2196/mhealth.5846 %U http://www.ncbi.nlm.nih.gov/pubmed/27480144 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e92 %T Overcoming Barriers: Adolescents’ Experiences Using a Mobile Phone Dietary Assessment App %A Svensson,Åsa %A Magnusson,Maria %A Larsson,Christel %+ Department of Food and Nutrition, and Sport Science, University of Gothenburg, Box 300, Gothenburg, 40530, Sweden, 46 70 911 65 19, christel.larsson@gu.se %K adolescents %K content analysis %K dietary assessment %K Self Determination Theory %K mobile phone app %D 2016 %7 29.07.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The use of new technology has the potential to increase participation rates in dietary studies and improve the validity of collected dietary data. However, to evaluate the usability of developed dietary methods, qualitative studies of participants’ experiences and perceptions are needed. Objective: To explore adolescents’ experiences using a newly developed mobile phone dietary assessment app, with a focus on factors that could affect their recording of dietary intake. Methods: Focus group interviews were conducted with 75 participants who had used a newly developed mobile phone dietary assessment app in a quantitative evaluation study. The interviews were analyzed using qualitative content analysis and the theoretical framework of Self Determination Theory was applied. Results: The adolescents’ use of the mobile phone dietary assessment app was characterized by their struggle to overcome several perceived barriers. Facilitators that helped adolescents complete the method were also identified. Motivation was found to be an important facilitator, and intrinsically motivated participants completed the method because they found it fun to use. The autonomous extrinsically motivated participants completed the method for the greater good, in order to contribute to the study. The controlled extrinsically motivated participants completed the method to get a reward or avoid punishment. Amotivated participants did not complete the method. More motivated participants were assumed to be more able to overcome barriers and needed less facilitators. Conclusions: Future studies that examine the recording of food intake should include systematic efforts that aim to minimize identified barriers and promote identified facilitators. Further research should specifically aim at studying methods for (and effects of) increasing intrinsic motivation by supporting autonomy, competence, and relatedness among adolescents asked to participate in dietary studies. %M 27473462 %R 10.2196/mhealth.5700 %U http://mhealth.jmir.org/2016/3/e92/ %U https://doi.org/10.2196/mhealth.5700 %U http://www.ncbi.nlm.nih.gov/pubmed/27473462 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e91 %T Using Personal Mobile Phones to Assess Dietary Intake in Free-Living Adolescents: Comparison of Face-to-Face Versus Telephone Training %A Segovia-Siapco,Gina %A Sabaté,Joan %+ Center for Nutrition, Healthy Lifestyle, and Disease Prevention, School of Public Health, Loma Linda University, 24951 No Circle Drive, Nichol Hall 1318, Loma Linda, CA, 92350, United States, 1 909 558 4300 ext 47110, gsiapco@llu.edu %K adolescents %K dietary assessment %K dietary records %K digital images %K follow-up %K mobile phones %K real-time support %K technology %D 2016 %7 29.07.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Traditional paper-based methods to assess food intake can be cumbersome for adolescents; use of mobile phones to track and photograph what they eat may be a more convenient, reliable, and compelling way to collect data. Objective: Our aims were to determine (1) the feasibility of using personal mobile phones to send food records with digital images (FRDIs) among free-living adolescents and (2) whether the quality of food records differed between a high-level intervention group (ie, face-to-face training plus real-time support) and a low-level intervention group (ie, telephone training plus next-day follow-up). Methods: Adolescents (N=42, 11 males and 31 females) aged 12-18 years who had a mobile phone with camera enrolled in the study via consecutive sampling. The first group (n=21) received face-to-face training while the second group (n=21) was trained via telephone. Participants received a fiducial marker (FM) and completed a 1-day FRDI using their mobile phones. At every eating occasion, participants were to (1) take clear images of their meals/food with a correctly placed fiducial marker before eating, (2) send the image immediately to a designated email address, (3) right after completing a meal, send a text message listing the time and name of the meal, foods eaten, and amounts eaten, and (4) before sleep, send an “end” text message to indicate completion of food recording. Those who received face-to-face training received real-time support during reporting; those trained by telephone received next-day follow-up. Descriptive statistics and comparison tests were used to determine performance of the groups. Results: All participants (N=42) who underwent training completed their 1-day FRDI. A significantly greater proportion of the low-level intervention group compared to the high-level intervention group placed their FM correctly in the image (95% vs 43%, P<.001), had complete information for each meal in their food record (95% vs 71%, P=.04), and had a higher overall score in meeting the criteria for food recording (4.3 vs 3.4 out of 5 points). Both groups had energy intake values that moderately correlated with their estimated energy requirements: low-intervention r=.55; high-intervention r=.51. Conclusions: Using personal mobile phones to report dietary intake via texting and digital images is feasible among free-living adolescents. Real-time support or high-level intervention does not guarantee better food recording quality among adolescents. %M 27473291 %R 10.2196/mhealth.5418 %U http://mhealth.jmir.org/2016/3/e91/ %U https://doi.org/10.2196/mhealth.5418 %U http://www.ncbi.nlm.nih.gov/pubmed/27473291 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 12 %P e273 %T Evaluation of a Web-Based Food Record for Children Using Direct Unobtrusive Lunch Observations: A Validation Study %A Medin,Anine Christine %A Astrup,Helene %A Kåsin,Britt Marlene %A Andersen,Lene Frost %+ Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Postboks 1046, Blindern, Oslo, 0317, Norway, 47 22851349, a.c.medin@medisin.uio.no %K children %K dietary records %K Internet %K observation %K validity %D 2015 %7 07.12.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: High-quality, Web-based dietary assessment tools for children are needed to reduce cost and improve user-friendliness when studying children’s dietary practices. Objective: To evaluate the first Web-based dietary assessment tool for children in Norway, the Web-based Food Record (WebFR), by comparing children’s true school lunch intake with recordings in the WebFR, using direct unobtrusive observation as the reference method. Methods: A total of 117 children, 8-9 years, from Bærum, Norway, were recruited from September to December 2013. Children completed 4 days of recordings in the WebFR, with parental assistance, and were observed during school lunch in the same period by 3 observers. Interobserver reliability assessments were satisfactory. Match, omission, and intrusion rates were calculated to assess the quality of the recordings in the WebFR for different food categories, and for all foods combined. Logistic regression analyses were used to investigate whether body mass index (BMI), parental educational level, parental ethnicity or family structure were associated with having a “low match rate” (≤70%). Results: Bread and milk were recorded with less bias than spreads, fruits, and vegetables. Mean (SD) for match, omission, and intrusion rates for all foods combined were 73% (27%), 27% (27%), and 19% (26%), respectively. Match rates were statistically significantly associated with parental educational level (low education 52% [32%] versus high 77% [24%], P=.008) and parental ethnicity (non-Norwegian 57% [28%] versus others 75% [26%], P=.04). Only parental ethnicity remained statistically significant in the logistic regression model, showing an adjusted odds ratio of 6.9 and a 95% confidence interval between 1.3 and 36.4. Conclusions: Compared with other similar studies, our results indicate that the WebFR is in line with, or better than most of other similar tools, yet enhancements could further improve the WebFR. %M 26680744 %R 10.2196/jmir.5031 %U http://www.jmir.org/2015/12/e273/ %U https://doi.org/10.2196/jmir.5031 %U http://www.ncbi.nlm.nih.gov/pubmed/26680744 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 4 %P e98 %T Electronic Dietary Intake Assessment (e-DIA): Comparison of a Mobile Phone Digital Entry App for Dietary Data Collection With 24-Hour Dietary Recalls %A Rangan,Anna M %A O'Connor,Sarah %A Giannelli,Valentina %A Yap,Megan LH %A Tang,Lie Ming %A Roy,Rajshri %A Louie,Jimmy Chun Yu %A Hebden,Lana %A Kay,Judy %A Allman-Farinelli,Margaret %+ School of Molecular Bioscience, Charles Perkins Centre, University of Sydney, Level 4 East, Charles Perkins Centre, University of Sydney, Camperdown, 2006, Australia, 61 2 93513816, anna.rangan@sydney.edu.au %K validity %K dietary assessment %K mobile phone app %K young adult %D 2015 %7 27.10.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: The electronic Dietary Intake Assessment (e-DIA), a digital entry food record mobile phone app, was developed to measure energy and nutrient intake prospectively. This can be used in monitoring population intakes or intervention studies in young adults. Objective: The objective was to assess the relative validity of e-DIA as a dietary assessment tool for energy and nutrient intakes using the 24-hour dietary recall as a reference method. Methods: University students aged 19 to 24 years recorded their food and drink intake on the e-DIA for five days consecutively and completed 24-hour dietary recalls on three random days during this 5-day study period. Mean differences in energy, macro-, and micronutrient intakes were evaluated between the methods using paired t tests or Wilcoxon signed-rank tests, and correlation coefficients were calculated on unadjusted, energy-adjusted, and deattenuated values. Bland-Altman plots and cross-classification into quartiles were used to assess agreement between the two methods. Results: Eighty participants completed the study (38% male). No significant differences were found between the two methods for mean intakes of energy or nutrients. Deattenuated correlation coefficients ranged from 0.55 to 0.79 (mean 0.68). Bland-Altman plots showed wide limits of agreement between the methods but without obvious bias. Cross-classification into same or adjacent quartiles ranged from 75% to 93% (mean 85%). Conclusions: The e-DIA shows potential as a dietary intake assessment tool at a group level with good ranking agreement for energy and all nutrients. %M 26508282 %R 10.2196/mhealth.4613 %U http://mhealth.jmir.org/2015/4/e98/ %U https://doi.org/10.2196/mhealth.4613 %U http://www.ncbi.nlm.nih.gov/pubmed/26508282 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 2 %P e47 %T How Willing Are Adolescents to Record Their Dietary Intake? The Mobile Food Record %A Boushey,Carol Jo %A Harray,Amelia J %A Kerr,Deborah Anne %A Schap,TusaRebecca E %A Paterson,Stacey %A Aflague,Tanisha %A Bosch Ruiz,Marc %A Ahmad,Ziad %A Delp,Edward J %+ University of Hawaii Cancer Center, University of Hawaii, 701 Ilalo Street,, Room 525,, Honolulu, HI, 96813, United States, 1 808 564 5915, cjboushey@cc.hawaii.edu %K adolescents %K children %K dietary assessment %K mobile food record %K novel technology %D 2015 %7 29.05.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Accurately assessing the diets of children and adolescents can be problematic. Use of technologies, such as mobile apps designed to capture food and beverages consumed at eating occasions with images taken using device-embedded cameras, may address many of the barriers to gathering accurate dietary intake data from adolescents. Objective: The objectives of this study were to assess the willingness of adolescents to take images of food and beverages at their eating occasions using a novel mobile food record (mFR) and to evaluate the usability of the user confirmation component of the mFR app, referred to as the “review process.” Methods: Mixed methods combining quantitative and qualitative protocols were used in this study. Adolescents (11-15-year olds) attending a summer camp were recruited to participate in the study. First, the participants were asked to take images of foods and beverages consumed as meals and snacks for 2 consecutive days using the mFR app running on an iPhone and the number of images taken was noted. This was followed by focus group sessions to evaluate usability, which was analyzed by content and themes. After using the mFR, a think-aloud method was used to evaluate the usability of the mFR method for reviewing system-identified foods (ie, the review process). A usability questionnaire was administered at the end of all activities. Results: The mFR was accepted by the majority of the 24 boys and 17 girls (n=41) but varied according to gender and eating occasion. Girls were significantly more likely than boys to capture images of their eating occasions (Fisher exact test, P=.03). Participants were more likely to take images of their breakfasts (90%, 36/40) and lunches (90%, 72/80) and least likely to capture afternoon and evening snacks, 54% (43/80) and 40% (32/80), respectively. The major themes from the focus groups with regard to using the mFR were games, rewards, and the need to know more about why they were using the app. Results of the usability questionnaire indicated that including a game component would be important to increase willingness to use the mFR, and a high majority of the participants indicated a willingness to use the mFR for 7 days or more. The image review process was found to be easy to use except for some confusion with overlapping markers on the screen. Conclusions: The adolescents’ experiences with and feedback about the mFR highlighted the importance of increased training, reminders, entertainment (eg, games), and training with practice in using the device to capture complete dietary intake as part of their active lifestyles. %M 26024996 %R 10.2196/mhealth.4087 %U http://mhealth.jmir.org/2015/2/e47/ %U https://doi.org/10.2196/mhealth.4087 %U http://www.ncbi.nlm.nih.gov/pubmed/26024996 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 4 %P e107 %T Using a 3D Virtual Supermarket to Measure Food Purchase Behavior: A Validation Study %A Waterlander,Wilma Elzeline %A Jiang,Yannan %A Steenhuis,Ingrid Hendrika Margaretha %A Ni Mhurchu,Cliona %+ National Institute for Health Innovation, School of Population Health, University of Auckland, Tamaki Campus, 261 Morrin Road, Auckland, 1072, New Zealand, 64 09 9234612, w.waterlander@auckland.ac.nz %K virtual reality %K user-computer interface %K software validation %K nutrition policy %K food %K behavior %K public health %D 2015 %7 28.04.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: There is increasing recognition that supermarkets are an important environment for health-promoting interventions such as fiscal food policies or front-of-pack nutrition labeling. However, due to the complexities of undertaking such research in the real world, well-designed randomized controlled trials on these kinds of interventions are lacking. The Virtual Supermarket is a 3-dimensional computerized research environment designed to enable experimental studies in a supermarket setting without the complexity or costs normally associated with undertaking such research. Objective: The primary objective was to validate the Virtual Supermarket by comparing virtual and real-life food purchasing behavior. A secondary objective was to obtain participant feedback on perceived sense of “presence” (the subjective experience of being in one place or environment even if physically located in another) in the Virtual Supermarket. Methods: Eligible main household shoppers (New Zealand adults aged ≥18 years) were asked to conduct 3 shopping occasions in the Virtual Supermarket over 3 consecutive weeks, complete the validated Presence Questionnaire Items Stems, and collect their real supermarket grocery till receipts for that same period. Proportional expenditure (NZ$) and the proportion of products purchased over 18 major food groups were compared between the virtual and real supermarkets. Data were analyzed using repeated measures mixed models. Results: A total of 123 participants consented to take part in the study. In total, 69.9% (86/123) completed 1 shop in the Virtual Supermarket, 64.2% (79/123) completed 2 shops, 60.2% (74/123) completed 3 shops, and 48.8% (60/123) returned their real supermarket till receipts. The 4 food groups with the highest relative expenditures were the same for the virtual and real supermarkets: fresh fruit and vegetables (virtual estimate: 14.3%; real: 17.4%), bread and bakery (virtual: 10.0%; real: 8.2%), dairy (virtual: 19.1%; real: 12.6%), and meat and fish (virtual: 16.5%; real: 16.8%). Significant differences in proportional expenditures were observed for 6 food groups, with largest differences (virtual – real) for dairy (in expenditure 6.5%, P<.001; in items 2.2%, P=.04) and fresh fruit and vegetables (in expenditure: –3.1%, P=.04; in items: 5.9%, P=.002). There was no trend of overspending in the Virtual Supermarket and participants experienced a medium-to-high presence (88%, 73/83 scored medium; 8%, 7/83 scored high). Conclusions: Shopping patterns in the Virtual Supermarket were comparable to those in real life. Overall, the Virtual Supermarket is a valid tool to measure food purchasing behavior. Nevertheless, it is important to improve the functionality of some food categories, in particular fruit and vegetables and dairy. The results of this validation will assist in making further improvements to the software and with optimization of the internal and external validity of this innovative methodology. %M 25921185 %R 10.2196/jmir.3774 %U http://www.jmir.org/2015/4/e107/ %U https://doi.org/10.2196/jmir.3774 %U http://www.ncbi.nlm.nih.gov/pubmed/25921185 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 2 %P e38 %T A New Mobile Phone-Based Tool for Assessing Energy and Certain Food Intakes in Young Children: A Validation Study %A Henriksson,Hanna %A Bonn,Stephanie E %A Bergström,Anna %A Bälter,Katarina %A Bälter,Olle %A Delisle,Christine %A Forsum,Elisabet %A Löf,Marie %+ Karolinska Institutet, Department of Biosciences and Nutrition, Novum, Huddinge, 14183, Sweden, 46 734426417, marie.lof@ki.se %K cell phone %K digital camera %K food intake %K energy intake %K child %K DLW %K FFQ %D 2015 %7 24.04.2015 %9 Short Paper %J JMIR mHealth uHealth %G English %X Background: Childhood obesity is an increasing health problem globally. Obesity may be established already at pre-school age. Further research in this area requires accurate and easy-to-use methods for assessing the intake of energy and foods. Traditional methods have limited accuracy, and place large demands on the study participants and researchers. Mobile phones offer possibilities for methodological advancements in this area since they are readily available, enable instant digitalization of collected data, and also contain a camera to photograph pre- and post-meal food items. We have recently developed a new tool for assessing energy and food intake in children using mobile phones called the Tool for Energy Balance in Children (TECH). Objective: The main aims of our study are to (1) compare energy intake by means of TECH with total energy expenditure (TEE) measured using a criterion method, the doubly labeled water (DLW) method, and (2) to compare intakes of fruits and berries, vegetables, juice, and sweetened beverages assessed by means of TECH with intakes obtained using a Web-based food frequency questionnaire (KidMeal-Q) in 3 year olds. Methods: In this study, 30 Swedish 3 year olds were included. Energy intake using TECH was compared to TEE measured using the DLW method. Intakes of vegetables, fruits and berries, juice, as well as sweetened beverages were assessed using TECH and compared to the corresponding intakes assessed using KidMeal-Q. Wilcoxon matched pairs test, Spearman rank order correlations, and the Bland-Altman procedure were applied. Results: The mean energy intake, assessed by TECH, was 5400 kJ/24h (SD 1500). This value was not significantly different (P=.23) from TEE (5070 kJ/24h, SD 600). However, the limits of agreement (2 standard deviations) in the Bland-Altman plot for energy intake estimated using TECH compared to TEE were wide (2990 kJ/24h), and TECH overestimated high and underestimated low energy intakes. The Bland-Altman plots for foods showed similar patterns. The mean intakes of vegetables, fruits and berries, juice, and sweetened beverages estimated using TECH were not significantly different from the corresponding intakes estimated using KidMeal-Q. Moderate but statistically significant correlations (ρ=.42-.46, P=.01-.02) between TECH and KidMeal-Q were observed for intakes of vegetables, fruits and berries, and juice, but not for sweetened beverages. Conclusion: We found that one day of recordings using TECH was not able to accurately estimate intakes of energy or certain foods in 3 year old children. %M 25910494 %R 10.2196/mhealth.3670 %U http://mhealth.jmir.org/2015/2/e38/ %U https://doi.org/10.2196/mhealth.3670 %U http://www.ncbi.nlm.nih.gov/pubmed/25910494 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 1 %P e30 %T A Mobile Phone Food Record App to Digitally Capture Dietary Intake for Adolescents in a Free-Living Environment: Usability Study %A Casperson,Shanon L %A Sieling,Jared %A Moon,Jon %A Johnson,LuAnn %A Roemmich,James N %A Whigham,Leah %+ Grand Forks Human Nutrition Research Center, Agricultural Research Service, United States Department of Agriculture, 2420 2nd Ave N., Grand Forks, ND, , United States, 1 701 795 8497, shanon.casperson@ars.usda.gov %K adolescents %K dietary food records %K smartphone app %K dietary assessment %K food record app %D 2015 %7 13.03.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Mobile technologies are emerging as valuable tools to collect and assess dietary intake. Adolescents readily accept and adopt new technologies; thus, a food record app (FRapp) may be a useful tool to better understand adolescents’ dietary intake and eating patterns. Objective: We sought to determine the amenability of adolescents, in a free-living environment with minimal parental input, to use the FRapp to record their dietary intake. Methods: Eighteen community-dwelling adolescents (11-14 years) received detailed instructions to record their dietary intake for 3-7 days using the FRapp. Participants were instructed to capture before and after images of all foods and beverages consumed and to include a fiducial marker in the image. Participants were also asked to provide text descriptors including amount and type of all foods and beverages consumed. Results: Eight of 18 participants were able to follow all instructions: included pre- and post-meal images, a fiducial marker, and a text descriptor and collected diet records on 2 weekdays and 1 weekend day. Dietary intake was recorded on average for 3.2 (SD 1.3 days; 68% weekdays and 32% weekend days) with an average of 2.2 (SD 1.1) eating events per day per participant. A total of 143 eating events were recorded, of which 109 had at least one associated image and 34 were recorded with text only. Of the 109 eating events with images, 66 included all foods, beverages and a fiducial marker and 44 included both a pre- and post-meal image. Text was included with 78 of the captured images. Of the meals recorded, 36, 33, 35, and 39 were breakfasts, lunches, dinners, and snacks, respectively. Conclusions: These data suggest that mobile devices equipped with an app to record dietary intake will be used by adolescents in a free-living environment; however, a minority of participants followed all directions. User-friendly mobile food record apps may increase participant amenability, increasing our understanding of adolescent dietary intake and eating patterns. To improve data collection, the FRapp should deliver prompts for tasks, such as capturing images before and after each eating event, including the fiducial marker in the image, providing complete and accurate text information, and ensuring all eating events are recorded and should be customizable to individuals and to different situations. Trial Registration: Clinicaltrials.gov NCT01803997. http://clinicaltrials.gov/ct2/show/NCT01803997 (Archived at: http://www.webcitation.org/6WiV1vxoR). %M 25775506 %R 10.2196/mhealth.3324 %U http://mhealth.jmir.org/2015/1/e30/ %U https://doi.org/10.2196/mhealth.3324 %U http://www.ncbi.nlm.nih.gov/pubmed/25775506 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 8 %P e190 %T Online Dietary Intake Estimation: Reproducibility and Validity of the Food4Me Food Frequency Questionnaire Against a 4-Day Weighed Food Record %A Fallaize,Rosalind %A Forster,Hannah %A Macready,Anna L %A Walsh,Marianne C %A Mathers,John C %A Brennan,Lorraine %A Gibney,Eileen R %A Gibney,Michael J %A Lovegrove,Julie A %+ Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, Department of Food and Nutritional Sciences, University of Reading, Whiteknights, PO Box 226, Reading, RG6 6AP, United Kingdom, 44 118 378 6418, j.a.lovegrove@reading.ac.uk %K food frequency questionnaire %K weighed food record %K validity %K reproducibility %K dietary assessment %K Food4Me %K Web-based %D 2014 %7 11.08.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Advances in nutritional assessment are continuing to embrace developments in computer technology. The online Food4Me food frequency questionnaire (FFQ) was created as an electronic system for the collection of nutrient intake data. To ensure its accuracy in assessing both nutrient and food group intake, further validation against data obtained using a reliable, but independent, instrument and assessment of its reproducibility are required. Objective: The aim was to assess the reproducibility and validity of the Food4Me FFQ against a 4-day weighed food record (WFR). Methods: Reproducibility of the Food4Me FFQ was assessed using test-retest methodology by asking participants to complete the FFQ on 2 occasions 4 weeks apart. To assess the validity of the Food4Me FFQ against the 4-day WFR, half the participants were also asked to complete a 4-day WFR 1 week after the first administration of the Food4Me FFQ. Level of agreement between nutrient and food group intakes estimated by the repeated Food4Me FFQ and the Food4Me FFQ and 4-day WFR were evaluated using Bland-Altman methodology and classification into quartiles of daily intake. Crude unadjusted correlation coefficients were also calculated for nutrient and food group intakes. Results: In total, 100 people participated in the assessment of reproducibility (mean age 32, SD 12 years), and 49 of these (mean age 27, SD 8 years) also took part in the assessment of validity. Crude unadjusted correlations for repeated Food4Me FFQ ranged from .65 (vitamin D) to .90 (alcohol). The mean cross-classification into “exact agreement plus adjacent” was 92% for both nutrient and food group intakes, and Bland-Altman plots showed good agreement for energy-adjusted macronutrient intakes. Agreement between the Food4Me FFQ and 4-day WFR varied, with crude unadjusted correlations ranging from .23 (vitamin D) to .65 (protein, % total energy) for nutrient intakes and .11 (soups, sauces and miscellaneous foods) to .73 (yogurts) for food group intake. The mean cross-classification into “exact agreement plus adjacent” was 80% and 78% for nutrient and food group intake, respectively. There were no significant differences between energy intakes estimated using the Food4Me FFQ and 4-day WFR, and Bland-Altman plots showed good agreement for both energy and energy-controlled nutrient intakes. Conclusions: The results demonstrate that the online Food4Me FFQ is reproducible for assessing nutrient and food group intake and has moderate agreement with the 4-day WFR for assessing energy and energy-adjusted nutrient intakes. The Food4Me FFQ is a suitable online tool for assessing dietary intake in healthy adults. %M 25113936 %R 10.2196/jmir.3355 %U http://www.jmir.org/2014/8/e190/ %U https://doi.org/10.2196/jmir.3355 %U http://www.ncbi.nlm.nih.gov/pubmed/25113936 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 6 %P e150 %T Online Dietary Intake Estimation: The Food4Me Food Frequency Questionnaire %A Forster,Hannah %A Fallaize,Rosalind %A Gallagher,Caroline %A O’Donovan,Clare B %A Woolhead,Clara %A Walsh,Marianne C %A Macready,Anna L %A Lovegrove,Julie A %A Mathers,John C %A Gibney,Michael J %A Brennan,Lorraine %A Gibney,Eileen R %+ UCD Institute of Food and Health, University College Dublin, Science Centre South,, Belfield,, Dublin, , Ireland, 353 1 716 2819, eileen.gibney@ucd.ie %K food frequency questionnaire %K online dietary assessment tool %K Food4Me %K dietary assessment %K Web-based %D 2014 %7 09.06.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Dietary assessment methods are important tools for nutrition research. Online dietary assessment tools have the potential to become invaluable methods of assessing dietary intake because, compared with traditional methods, they have many advantages including the automatic storage of input data and the immediate generation of nutritional outputs. Objective: The aim of this study was to develop an online food frequency questionnaire (FFQ) for dietary data collection in the “Food4Me” study and to compare this with the validated European Prospective Investigation of Cancer (EPIC) Norfolk printed FFQ. Methods: The Food4Me FFQ used in this analysis was developed to consist of 157 food items. Standardized color photographs were incorporated in the development of the Food4Me FFQ to facilitate accurate quantification of the portion size of each food item. Participants were recruited in two centers (Dublin, Ireland and Reading, United Kingdom) and each received the online Food4Me FFQ and the printed EPIC-Norfolk FFQ in random order. Participants completed the Food4Me FFQ online and, for most food items, participants were requested to choose their usual serving size among seven possibilities from a range of portion size pictures. The level of agreement between the two methods was evaluated for both nutrient and food group intakes using the Bland and Altman method and classification into quartiles of daily intake. Correlations were calculated for nutrient and food group intakes. Results: A total of 113 participants were recruited with a mean age of 30 (SD 10) years (40.7% male, 46/113; 59.3%, 67/113 female). Cross-classification into exact plus adjacent quartiles ranged from 77% to 97% at the nutrient level and 77% to 99% at the food group level. Agreement at the nutrient level was highest for alcohol (97%) and lowest for percent energy from polyunsaturated fatty acids (77%). Crude unadjusted correlations for nutrients ranged between .43 and .86. Agreement at the food group level was highest for “other fruits” (eg, apples, pears, oranges) and lowest for “cakes, pastries, and buns”. For food groups, correlations ranged between .41 and .90. Conclusions: The results demonstrate that the online Food4Me FFQ has good agreement with the validated printed EPIC-Norfolk FFQ for assessing both nutrient and food group intakes, rendering it a useful tool for ranking individuals based on nutrient and food group intakes. %M 24911957 %R 10.2196/jmir.3105 %U http://www.jmir.org/2014/6/e150/ %U https://doi.org/10.2196/jmir.3105 %U http://www.ncbi.nlm.nih.gov/pubmed/24911957 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 2 %P e59 %T Relative Validity of Micronutrient and Fiber Intake Assessed With Two New Interactive Meal- and Web-Based Food Frequency Questionnaires %A Christensen,Sara E %A Möller,Elisabeth %A Bonn,Stephanie E %A Ploner,Alexander %A Bälter,Olle %A Lissner,Lauren %A Bälter,Katarina %+ Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Nobels väg 12a, Stockholm, SE-171 77, Sweden, 46 8 52482361, sara.christensen@ki.se %K validity %K reproducibility %K FFQ %K micronutrients %K weighed food record %K Internet %K adult %D 2014 %7 21.02.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: The meal- and Web-based food frequency questionnaires, Meal-Q and MiniMeal-Q, were developed for cost-efficient assessment of dietary intake in epidemiological studies. Objective: The objective of this study was to evaluate the relative validity of micronutrient and fiber intake assessed with Meal-Q and MiniMeal-Q. The reproducibility of Meal-Q was also evaluated. Methods: A total of 163 volunteer men and women aged between 20 and 63 years were recruited from Stockholm County, Sweden. Assessment of micronutrient and fiber intake with the 174-item Meal-Q was compared to a Web-based 7-day weighed food record (WFR). Two administered Meal-Q questionnaires were compared for reproducibility. The 126-item MiniMeal-Q, developed after the validation study, was evaluated in a simulated validation by using truncated Meal-Q data. Results: The study population consisted of approximately 80% women (129/163) with a mean age of 33 years (SD 12) who were highly educated (130/163, 80% with >12 years of education) on average. Cross-classification of quartiles with the WFR placed 69% to 90% in the same/adjacent quartile for Meal-Q and 67% to 89% for MiniMeal-Q. Bland-Altman plots with the WFR and the questionnaires showed large variances and a trend of increasing underestimation with increasing intakes. Deattenuated and energy-adjusted Spearman rank correlations between the questionnaires and the WFR were in the range ρ=.25-.69, excluding sodium that was not statistically significant. Cross-classifications of quartiles of the 2 Meal-Q administrations placed 86% to 97% in the same/adjacent quartile. Intraclass correlation coefficients for energy-adjusted intakes were in the range of .50-.76. Conclusions: With the exception of sodium, this validation study demonstrates Meal-Q and MiniMeal-Q to be useful methods for ranking micronutrient and fiber intake in epidemiological studies with Web-based data collection. %M 24565605 %R 10.2196/jmir.2965 %U http://www.jmir.org/2014/2/e59/ %U https://doi.org/10.2196/jmir.2965 %U http://www.ncbi.nlm.nih.gov/pubmed/24565605 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 6 %P e109 %T Two New Meal- and Web-Based Interactive Food Frequency Questionnaires: Validation of Energy and Macronutrient Intake %A Christensen,Sara E %A Möller,Elisabeth %A Bonn,Stephanie E %A Ploner,Alexander %A Wright,Antony %A Sjölander,Arvid %A Bälter,Olle %A Lissner,Lauren %A Bälter,Katarina %+ Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Nobels väg 12a, Stockholm, SE-171 77, Sweden, 46 852482361, sara.christensen@ki.se %K validity %K reproducibility %K food frequency questionnaire %K Internet %K weighed food record %K doubly labeled water %K adult %D 2013 %7 05.06.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Meal-Q and its shorter version, MiniMeal-Q, are 2 new Web-based food frequency questionnaires. Their meal-based and interactive format was designed to promote ease of use and to minimize answering time, desirable improvements in large epidemiological studies. Objective: We evaluated the validity of energy and macronutrient intake assessed with Meal-Q and MiniMeal-Q as well as the reproducibility of Meal-Q. Methods: Healthy volunteers aged 20-63 years recruited from Stockholm County filled out the 174-item Meal-Q. The questionnaire was compared to 7-day weighed food records (WFR; n=163), for energy and macronutrient intake, and to doubly labeled water (DLW; n=39), for total energy expenditure. In addition, the 126-item MiniMeal-Q was evaluated in a simulated validation using truncated Meal-Q data. We also assessed the answering time and ease of use of both questionnaires. Results: Bland-Altman plots showed a varying bias within the intake range for all validity comparisons. Cross-classification of quartiles placed 70%-86% in the same/adjacent quartile with WFR and 77% with DLW. Deattenuated and energy-adjusted Pearson correlation coefficients with the WFR ranged from r=0.33-0.74 for macronutrients and was r=0.18 for energy. Correlations with DLW were r=0.42 for Meal-Q and r=0.38 for MiniMeal-Q. Intraclass correlations for Meal-Q ranged from r=0.57-0.90. Median answering time was 17 minutes for Meal-Q and 7 minutes for MiniMeal-Q, and participants rated both questionnaires as easy to use. Conclusions: Meal-Q and MiniMeal-Q are easy to use and have short answering times. The ranking agreement is good for most of the nutrients for both questionnaires and Meal-Q shows fair reproducibility. %M 23739995 %R 10.2196/jmir.2458 %U http://www.jmir.org/2013/6/e109/ %U https://doi.org/10.2196/jmir.2458 %U http://www.ncbi.nlm.nih.gov/pubmed/23739995 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 15 %N 1 %P e13 %T An Interactive Internet-Based Plate for Assessing Lunchtime Food Intake: A Validation Study on Male Employees %A Svensson,Madeleine %A Bellocco,Rino %A Bakkman,Linda %A Trolle Lagerros,Ylva %+ Karolinska Institutet, Department of Medicine, Unit of Clinical Epidemiology, T2, Stockholm, 171 76, Sweden, 46 8 517 791 73, Madeleine.Svensson@hh.se %K diet %K epidemiology %K Internet %K methods %K nutrition %K validation %K Web %D 2013 %7 18.01.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Misreporting food intake is common because most health screenings rely on self-reports. The more accurate methods (eg, weighing food) are costly, time consuming, and impractical. Objectives: We developed a new instrument for reporting food intake—an Internet-based interactive virtual food plate. The objective of this study was to validate this instrument’s ability to assess lunch intake. Methods: Participants were asked to compose an ordinary lunch meal using both a virtual and a real lunch plate (with real food on a real plate). The participants ate their real lunch meals on-site. Before and after pictures of the composed lunch meals were taken. Both meals included identical food items. Participants were randomized to start with either instrument. The 2 instruments were compared using correlation and concordance measures (total energy intake, nutritional components, quantity of food, and participant characteristics). Results: A total of 55 men (median age: 45 years, median body mass index [BMI]: 25.8 kg/m2) participated. We found an overall overestimation of reported median energy intake using the computer plate (3044 kJ, interquartile range [IQR] 1202 kJ) compared with the real lunch plate (2734 kJ, IQR 1051 kJ, P<.001). Spearman rank correlations and concordance correlations for energy intake and nutritional components ranged between 0.58 to 0.79 and 0.65 to 0.81, respectively. Conclusion: Although it slightly overestimated, our computer plate provides promising results in assessing lunch intake. %M 23335728 %R 10.2196/jmir.2217 %U http://www.jmir.org/2013/1/e13/ %U https://doi.org/10.2196/jmir.2217 %U http://www.ncbi.nlm.nih.gov/pubmed/23335728 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 2 %P e58 %T Novel Technologies for Assessing Dietary Intake: Evaluating the Usability of a Mobile Telephone Food Record Among Adults and Adolescents %A Daugherty,Bethany L %A Schap,TusaRebecca E %A Ettienne-Gittens,Reynolette %A Zhu,Fengqing M %A Bosch,Marc %A Delp,Edward J %A Ebert,David S %A Kerr,Deborah A %A Boushey,Carol J %+ Epidemiology Program, University of Hawaii Cancer Center, 1236 Lauhala Street, Honolulu, HI, 96813, United States, 1 808 564 5915, cjboushey@cc.hawaii.edu %K Mobile telephone food record %K dietary assessment %K technology %K image analysis %K volume estimation %D 2012 %7 13.04.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: The development of a mobile telephone food record has the potential to ameliorate much of the burden associated with current methods of dietary assessment. When using the mobile telephone food record, respondents capture an image of their foods and beverages before and after eating. Methods of image analysis and volume estimation allow for automatic identification and volume estimation of foods. To obtain a suitable image, all foods and beverages and a fiducial marker must be included in the image. Objective: To evaluate a defined set of skills among adolescents and adults when using the mobile telephone food record to capture images and to compare the perceptions and preferences between adults and adolescents regarding their use of the mobile telephone food record. Methods: We recruited 135 volunteers (78 adolescents, 57 adults) to use the mobile telephone food record for one or two meals under controlled conditions. Volunteers received instruction for using the mobile telephone food record prior to their first meal, captured images of foods and beverages before and after eating, and participated in a feedback session. We used chi-square for comparisons of the set of skills, preferences, and perceptions between the adults and adolescents, and McNemar test for comparisons within the adolescents and adults. Results: Adults were more likely than adolescents to include all foods and beverages in the before and after images, but both age groups had difficulty including the entire fiducial marker. Compared with adolescents, significantly more adults had to capture more than one image before (38% vs 58%, P = .03) and after (25% vs 50%, P = .008) meal session 1 to obtain a suitable image. Despite being less efficient when using the mobile telephone food record, adults were more likely than adolescents to perceive remembering to capture images as easy (P < .001). Conclusions: A majority of both age groups were able to follow the defined set of skills; however, adults were less efficient when using the mobile telephone food record. Additional interactive training will likely be necessary for all users to provide extra practice in capturing images before entering a free-living situation. These results will inform age-specific development of the mobile telephone food record that may translate to a more accurate method of dietary assessment. %M 22504018 %R 10.2196/jmir.1967 %U http://www.jmir.org/2012/2/e58/ %U https://doi.org/10.2196/jmir.1967 %U http://www.ncbi.nlm.nih.gov/pubmed/22504018