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Dalakleidi KV, Papadelli M, Kapolos I, Papadimitriou K. Applying Image-Based Food-Recognition Systems on Dietary Assessment: A Systematic Review. Adv Nutr 2022; 13:2590-2619. [PMID: 35803496 PMCID: PMC9776640 DOI: 10.1093/advances/nmac078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/06/2022] [Accepted: 07/06/2022] [Indexed: 01/29/2023] Open
Abstract
Dietary assessment can be crucial for the overall well-being of humans and, at least in some instances, for the prevention and management of chronic, life-threatening diseases. Recall and manual record-keeping methods for food-intake monitoring are available, but often inaccurate when applied for a long period of time. On the other hand, automatic record-keeping approaches that adopt mobile cameras and computer vision methods seem to simplify the process and can improve current human-centric diet-monitoring methods. Here we present an extended critical literature overview of image-based food-recognition systems (IBFRS) combining a camera of the user's mobile device with computer vision methods and publicly available food datasets (PAFDs). In brief, such systems consist of several phases, such as the segmentation of the food items on the plate, the classification of the food items in a specific food category, and the estimation phase of volume, calories, or nutrients of each food item. A total of 159 studies were screened in this systematic review of IBFRS. A detailed overview of the methods adopted in each of the 78 included studies of this systematic review of IBFRS is provided along with their performance on PAFDs. Studies that included IBFRS without presenting their performance in at least 1 of the above-mentioned phases were excluded. Among the included studies, 45 (58%) studies adopted deep learning methods and especially convolutional neural networks (CNNs) in at least 1 phase of the IBFRS with input PAFDs. Among the implemented techniques, CNNs outperform all other approaches on the PAFDs with a large volume of data, since the richness of these datasets provides adequate training resources for such algorithms. We also present evidence for the benefits of application of IBFRS in professional dietetic practice. Furthermore, challenges related to the IBFRS presented here are also thoroughly discussed along with future directions.
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Affiliation(s)
- Kalliopi V Dalakleidi
- Department of Food Science and Technology, University of the Peloponnese, Kalamata, Greece
| | - Marina Papadelli
- Department of Food Science and Technology, University of the Peloponnese, Kalamata, Greece
| | - Ioannis Kapolos
- Department of Food Science and Technology, University of the Peloponnese, Kalamata, Greece
| | - Konstantinos Papadimitriou
- Laboratory of Food Quality Control and Hygiene, Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
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Das SK, Miki AJ, Blanchard CM, Sazonov E, Gilhooly CH, Dey S, Wolk CB, Khoo CSH, Hill JO, Shook RP. Perspective: Opportunities and Challenges of Technology Tools in Dietary and Activity Assessment: Bridging Stakeholder Viewpoints. Adv Nutr 2022; 13:1-15. [PMID: 34545392 PMCID: PMC8803491 DOI: 10.1093/advances/nmab103] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/19/2021] [Accepted: 08/25/2021] [Indexed: 12/23/2022] Open
Abstract
The science and tools of measuring energy intake and output in humans have rapidly advanced in the last decade. Engineered devices such as wearables and sensors, software applications, and Web-based tools are now ubiquitous in both research and consumer environments. The assessment of energy expenditure in particular has progressed from reliance on self-report instruments to advanced technologies requiring collaboration across multiple disciplines, from optics to accelerometry. In contrast, assessing energy intake still heavily relies on self-report mechanisms. Although these tools have improved, moving from paper-based to online reporting, considerable room for refinement remains in existing tools, and great opportunities exist for novel, transformational tools, including those using spectroscopy and chemo-sensing. This report reviews the state of the science, and the opportunities and challenges in existing and emerging technologies, from the perspectives of 3 key stakeholders: researchers, users, and developers. Each stakeholder approaches these tools with unique requirements: researchers are concerned with validity, accuracy, data detail and abundance, and ethical use; users with ease of use and privacy; and developers with high adherence and utilization, intellectual property, licensing rights, and monetization. Cross-cutting concerns include frequent updating and integration of the food and nutrient databases on which assessments rely, improving accessibility and reducing disparities in use, and maintaining reliable technical assistance. These contextual challenges are discussed in terms of opportunities and further steps in the direction of personalized health.
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Affiliation(s)
- Sai Krupa Das
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Akari J Miki
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Caroline M Blanchard
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Edward Sazonov
- Department of Electrical and Computer Engineering, University of Alabama, Tuscaloosa, AL, USA
| | - Cheryl H Gilhooly
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Sujit Dey
- Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, CA, USA
| | - Colton B Wolk
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Chor San H Khoo
- Institute for the Advancement of Food and Nutrition Sciences, Washington, DC, USA
| | - James O Hill
- Department of Nutrition Sciences, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robin P Shook
- Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Kansas City, Kansas City, MO, USA
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
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Coleone JD, Bellei EA, Roman MK, Kirsten VR, De Marchi ACB. Dietary Intake and Health Status of Elderly Patients With Type 2 Diabetes Mellitus: Cross-sectional Study Using a Mobile App in Primary Care. JMIR Form Res 2021; 5:e27454. [PMID: 34448711 PMCID: PMC8433854 DOI: 10.2196/27454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/23/2021] [Accepted: 07/05/2021] [Indexed: 12/15/2022] Open
Abstract
Background Healthy dietary intake reduces the risk of complications of diabetes mellitus. Using assessment methods helps to understand these circumstances, and an electronic application may optimize this practice. Objective In this study, we aimed to (1) assess the dietary intake and health status of elderly patients with type 2 diabetes mellitus (T2DM) in primary care, (2) use a mobile app as a tool for data collection and analysis in the context of primary care, and (3) verify the perceptions of multidisciplinary health professionals regarding app use. Methods First, we developed a mobile app comprised of the questions of the Food and Nutrition Surveillance System (SISVAN) of Brazil, which includes a food frequency questionnaire of food categories with a recall of the previous 7 days. Thereafter, we used the app to collect data on the health status and dietary intake of 154 participants, aged 60-96 years, diagnosed with T2DM, and under treatment in primary care centers in the northern region of Rio Grande do Sul, Brazil. We also collected participants’ demographic, anthropometric, biochemical, and lifestyle variables. The associations between dietary intake and other variables were tested using chi-square tests with a 5% significance level. Regarding the app, we assessed usability and acceptance with 20 health professionals. Results Between August 2018 and December 2018, participants had an intake in line with recommended guidelines for raw salads (57.1%), fruits (76.6%), milk products (68.2%), fried foods (72.7%), savory biscuits (60.4%), cookies or sweets (72.1%), and sugary drinks (92.9%) Meanwhile, the consumption of beans (59.7%), pulses and cooked vegetables (73.4%), and processed meat products (59.7%) was not in line with the guidelines. There were statistically significant differences in meeting the recommended guidelines among participants of different genders (P=.006 and P=.035 for the intake of fried foods and sugary drinks, respectively), place of residence (P=.034 for the intake of cookies and sweets), family history of diabetes (P<.001 for the intake of beans), physical activity engagement (P=.003 for the intake fresh fruits), history of smoking (P=.001 for the intake of raw salads), and presence of coronary disease (P=.050 for the intake of pulses and cooked vegetables). The assessment of usability resulted in a mean score of 71.75 points. Similarly, the assessment of the 15 acceptance questions revealed high scores, and the qualitative questions revealed positive perceptions. Conclusions We identified that most participants complied with recommended intake guidelines for 7 of 10 categories in the SISVAN guidelines. However, most participants were overweight and had nutritional and clinical disorders, which justifies further investigations in this population. The app was well-rated by health professionals and considered a useful and promising tool for collecting and analyzing data in primary care settings.
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Affiliation(s)
- Joane Diomara Coleone
- School of Physical Education and Physiotherapy, University of Passo Fundo, Passo Fundo, RS, Brazil
| | - Ericles Andrei Bellei
- Institute of Exact Sciences and Geosciences, University of Passo Fundo, Passo Fundo, RS, Brazil
| | - Mateus Klein Roman
- Institute of Exact Sciences and Geosciences, University of Passo Fundo, Passo Fundo, RS, Brazil
| | - Vanessa Ramos Kirsten
- Department of Foods and Nutrition, Federal University of Santa Maria, Palmeira das Missões, RS, Brazil.,Graduate Program in Gerontology, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Ana Carolina Bertoletti De Marchi
- School of Physical Education and Physiotherapy, University of Passo Fundo, Passo Fundo, RS, Brazil.,Institute of Exact Sciences and Geosciences, University of Passo Fundo, Passo Fundo, RS, Brazil
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Need and Importance of Nutrition Informatics in India: A Perspective. Nutrients 2021; 13:nu13061836. [PMID: 34072133 PMCID: PMC8230128 DOI: 10.3390/nu13061836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/17/2021] [Accepted: 05/24/2021] [Indexed: 12/04/2022] Open
Abstract
Nutrition informatics (NI) is the effective retrieval, organization, storage, and optimum use of information, data and knowledge for food-and-nutrition-related problem-solving and decision-making. There is a growing opportunity to facilitate technology-enabled behavioral change interventions to support NI research and practice. This paper highlights the changing landscape of food and nutrition practices in India to prepare a NI workforce that could provide some valuable tools to address the double burden of nutrition. Management and interpretation of data could help clarify the relationships and interrelationships of diet and disease in India on both national and regional levels. Individuals with expertise in food and nutrition may receive training in informatics to develop national informatics systems. NI professionals develop tools and techniques, manage various projects and conduct informatics research. These professionals should be well prepared to work in technological settings and communicate data and information effectively. Opportunities for training in NI are very limited in developing countries. Given the current progress in developing platforms and informatics infrastructure, India could serve as an example to other countries to promote NI to support achieving SDGs and other public health initiatives.
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Limketkai BN, Mauldin K, Manitius N, Jalilian L, Salonen BR. The Age of Artificial Intelligence: Use of Digital Technology in Clinical Nutrition. CURRENT SURGERY REPORTS 2021; 9:20. [PMID: 34123579 PMCID: PMC8186363 DOI: 10.1007/s40137-021-00297-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE OF REVIEW Computing advances over the decades have catalyzed the pervasive integration of digital technology in the medical industry, now followed by similar applications for clinical nutrition. This review discusses the implementation of such technologies for nutrition, ranging from the use of mobile apps and wearable technologies to the development of decision support tools for parenteral nutrition and use of telehealth for remote assessment of nutrition. RECENT FINDINGS Mobile applications and wearable technologies have provided opportunities for real-time collection of granular nutrition-related data. Machine learning has allowed for more complex analyses of the increasing volume of data collected. The combination of these tools has also translated into practical clinical applications, such as decision support tools, risk prediction, and diet optimization. SUMMARY The state of digital technology for clinical nutrition is still young, although there is much promise for growth and disruption in the future.
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Affiliation(s)
- Berkeley N. Limketkai
- Vatche & Tamar Manoukian Division of Digestive Diseases, UCLA School of Medicine, 100 UCLA Medical Plaza, Suite 345, Los Angeles, CA 90095 USA
| | - Kasuen Mauldin
- Department of Nutrition, Food Science, and Packaging, San José State University, San José, CA USA
| | - Natalie Manitius
- Vatche & Tamar Manoukian Division of Digestive Diseases, UCLA School of Medicine, 100 UCLA Medical Plaza, Suite 345, Los Angeles, CA 90095 USA
| | - Laleh Jalilian
- Department of Anesthesiology, UCLA School of Medicine, Los Angeles, CA USA
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Evaluation of the Ability of Diet-Tracking Mobile Applications to Estimate Energy and Nutrient Intake in Japan. Nutrients 2020; 12:nu12113327. [PMID: 33138088 PMCID: PMC7694045 DOI: 10.3390/nu12113327] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/26/2020] [Accepted: 10/28/2020] [Indexed: 12/15/2022] Open
Abstract
We evaluated the energy and nutrient intake estimates of popular Japanese diet-tracking mobile applications (apps). We identified five diet-tracking apps in the iTunes store during August 2020. A researcher entered the dietary data from a one-day paper-based dietary record (DR) previously obtained from apparently healthy free-living adults (15 males and 15 females; 22-65 years) into each app. The energy and nutrient intakes estimated by the apps were compared with those calculated using the Standard Tables of Food Composition in Japan based on the paper-based DR (reference method). The number of dietary variables available ranged from one (energy in Mogutan) to 17 (FiNC). Compared to the DR-based estimates, the median energy intake was significantly overestimated by MyFitnessPal, Asken, Calomiru, and Mogutan. Moreover, the intakes of many nutrients were overestimated by Asken and Calomiru and underestimated by MyFitnessPal. For energy intake, the Spearman correlation coefficient between the DR and the apps was lowest for Mogutan (0.76) and highest for FiNC (0.96). The median correlation coefficient for nutrient intakes was lower in MyFitnessPal (0.50) than in the other three apps (0.80 in Asken, 0.87 in FiNC, and 0.88 in Calomiru). These results suggest that intake calculations differ among apps. Further evaluation is needed in free-living settings, where users input their own food intake.
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Evenepoel C, Clevers E, Deroover L, Van Loo W, Matthys C, Verbeke K. Accuracy of Nutrient Calculations Using the Consumer-Focused Online App MyFitnessPal: Validation Study. J Med Internet Res 2020; 22:e18237. [PMID: 33084583 PMCID: PMC7641788 DOI: 10.2196/18237] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 08/12/2020] [Accepted: 09/02/2020] [Indexed: 01/23/2023] Open
Abstract
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.
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Affiliation(s)
- Charlotte Evenepoel
- Translational Research in Gastrointestinal Disorders, Department of Chronic Diseases, Metabolism and Aging, KU Leuven, Leuven, Belgium
| | - Egbert Clevers
- Translational Research in Gastrointestinal Disorders, Department of Chronic Diseases, Metabolism and Aging, KU Leuven, Leuven, Belgium
| | - Lise Deroover
- Translational Research in Gastrointestinal Disorders, Department of Chronic Diseases, Metabolism and Aging, KU Leuven, Leuven, Belgium
| | - Wendy Van Loo
- Translational Research in Gastrointestinal Disorders, Department of Chronic Diseases, Metabolism and Aging, KU Leuven, Leuven, Belgium
| | - Christophe Matthys
- Nutrition & Obesity Unit, Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Aging, KU Leuven, Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
- Leuven Food Science and Nutrition Research Center, KU Leuven, Leuven, Belgium
| | - Kristin Verbeke
- Translational Research in Gastrointestinal Disorders, Department of Chronic Diseases, Metabolism and Aging, KU Leuven, Leuven, Belgium
- Leuven Food Science and Nutrition Research Center, KU Leuven, Leuven, Belgium
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Vasiloglou MF, Christodoulidis S, Reber E, Stathopoulou T, Lu Y, Stanga Z, Mougiakakou S. What Healthcare Professionals Think of "Nutrition & Diet" Apps: An International Survey. Nutrients 2020; 12:nu12082214. [PMID: 32722339 PMCID: PMC7468977 DOI: 10.3390/nu12082214] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/13/2020] [Accepted: 07/21/2020] [Indexed: 12/15/2022] Open
Abstract
Accurate dietary assessment is crucial for both the prevention and treatment of nutrition-related diseases. Since mobile-based dietary assessment solutions are promising, we sought to examine the acceptability of "Nutrition and Diet" (ND) apps by Healthcare Professionals (HCP), explore their preferences on apps' features and identify predictors of acceptance. A 23 question survey was developed by an interdisciplinary team and pilot-tested. The survey was completed by 1001 HCP from 73 countries and 6 continents. The HCP (dietitians: 833, doctors: 75, nurses: 62, other: 31/females: 847, males: 150, neither: 4) had a mean age (SD) of 34.4 (10.2) years and mean job experience in years (SD): 7.7 (8.2). There were 45.5% who have recommended ND apps to their clients/patients. Of those who have not yet recommended an app, 22.5% do not know of their existence. Important criteria for selecting an app were ease of use (87.1%), apps being free of charge (72.6%) and validated (69%). Significant barriers were the use of inaccurate food composition database (52%), lack of local food composition database support (48.2%) and tech-savviness (43.3%). Although the adoption of smartphones is growing and mobile health research is advancing, there is room for improvement in the recommendation of ND apps by HCP.
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Affiliation(s)
- Maria F. Vasiloglou
- ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse 50, 3008 Bern, Switzerland; (M.F.V.); (S.C.); (T.S.); (Y.L.)
| | - Stergios Christodoulidis
- ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse 50, 3008 Bern, Switzerland; (M.F.V.); (S.C.); (T.S.); (Y.L.)
- Institute Gustave Roussy, Inserm Unit, U981 Paris, France
| | - Emilie Reber
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (E.R.); (Z.S.)
| | - Thomai Stathopoulou
- ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse 50, 3008 Bern, Switzerland; (M.F.V.); (S.C.); (T.S.); (Y.L.)
| | - Ya Lu
- ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse 50, 3008 Bern, Switzerland; (M.F.V.); (S.C.); (T.S.); (Y.L.)
| | - Zeno Stanga
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (E.R.); (Z.S.)
| | - Stavroula Mougiakakou
- ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse 50, 3008 Bern, Switzerland; (M.F.V.); (S.C.); (T.S.); (Y.L.)
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
- Correspondence: ; Tel.: +41-31-632-7592
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Fodor I, Man SC, Dumitrascu DL. Low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet in children. World J Clin Cases 2019; 7:2666-2674. [PMID: 31616683 PMCID: PMC6789397 DOI: 10.12998/wjcc.v7.i18.2666] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/26/2019] [Accepted: 08/27/2019] [Indexed: 02/05/2023] Open
Abstract
Irritable bowel syndrome (IBS) is a lifelong condition with a high prevalence among children and adults. As the diet is a frequent factor that triggers the symptoms, it has been assumed that by avoiding the consumption of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP), the symptoms might be improved. Therefore, in the past decade, low FODMAP diet has been intensively investigated in the management of IBS. The capacity of FODMAPs to trigger the symptoms in patients with IBS was related to the stimulation of mechanoreceptors in the small and large intestine. This stimulation appears as a response to a combination of increased luminal water (the osmotic effect) and the release of gases (carbon dioxide and hydrogen) due to the fermentation of oligosaccharides and malabsorption of fructose, lactose and polyols. Numerous studies have been published regarding the efficacy of a low FODMAP diet compared to a traditional diet in releasing the IBS symptoms in adults, but there are only a few studies in the juvenile population. The aim of this review is to analyze the current data on both low FODMAP diet in children with IBS and the effects on their nutritional status and physiological development, given the fact that it is a restrictive diet.
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Affiliation(s)
- Ioana Fodor
- 3rd Pediatric Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca 400006, Romania
| | - Sorin Claudiu Man
- 3rd Pediatric Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca 400006, Romania
| | - Dan L Dumitrascu
- 2nd Medical Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca 400006, Romania
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Chen J, Allman-Farinelli M. Impact of Training and Integration of Apps Into Dietetic Practice on Dietitians' Self-Efficacy With Using Mobile Health Apps and Patient Satisfaction. JMIR Mhealth Uhealth 2019; 7:e12349. [PMID: 30829577 PMCID: PMC6421514 DOI: 10.2196/12349] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/11/2019] [Accepted: 02/17/2019] [Indexed: 11/13/2022] Open
Abstract
Background The use of mobile health (mHealth) apps in dietetic practice could support the delivery of nutrition care in medical nutrition therapy. However, apps are underutilized by dietitians in patient care. Objective This study aimed to determine the feasibility of an intervention consisting of education, training, and integration of apps in improving dietitians’ perceived self-efficacy with using mHealth apps. Methods Private practice Accredited Practising Dietitians who were not regular users or recommenders of mHealth apps were recruited into the intervention. The intervention consisted of 2 phases: (1) a workshop that incorporated an educational lecture and skill-building activities to target self-efficacy, capability, opportunity, and motivation factors and (2) a 12-week intervention phase allowing for the integration of an app into dietetic practice via an app platform. During the 12-week intervention phase, dietitians prescribed an Australian commercial nutrition app to new (intervention) patients receiving nutrition care. Existing (control) patients were also recruited to provide a measure of patient satisfaction before the apps were introduced. New patients completed their patient satisfaction surveys at the end of the 12 weeks. Usability feedback about the app and app platform was gathered from intervention patients and dietitians. Results A total of 5 dietitians participated in the study. On the basis of an analysis of variance with the Tukey post hoc tests, the educational and skills training workshop component of the intervention produced immediate improvements in mean ratings for dietitians’ self-efficacy with using mHealth apps compared with baseline (P=.02), particularly with regard to familiarity with apps factor (P<.001). The self-efficacy factor integration into dietetic work systems achieved significant improvements from baseline to 12 weeks (P=.03). Patient satisfaction with dietetic services did not differ significantly between intervention (n=17) and control patients (n=13). Overall, dietitians and their patients indicated that they would continue using the app platform and app, respectively, and would recommend it to others. To improve usability, enhancing patient-dietitian communication mediums in the app platform and reducing the burden of entering in meals cooked at home should be considered. Conclusions Administering an educational and skills training workshop in conjunction with integrating an app platform into dietetic practice was a feasible method for improving the self-efficacy of dietitians toward using mHealth apps. Further translational research will be required to determine how the broader dietetic profession responds to this intervention.
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Affiliation(s)
- Juliana Chen
- The University of Sydney, Charles Perkins Centre, Discipline of Nutrition and Dietetics, School of Life and Environmental Sciences, Camperdown, Australia
| | - Margaret Allman-Farinelli
- The University of Sydney, Charles Perkins Centre, Discipline of Nutrition and Dietetics, School of Life and Environmental Sciences, Camperdown, Australia
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11
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Mitchell H, Porter J, Gibson PR, Barrett J, Garg M. Review article: implementation of a diet low in FODMAPs for patients with irritable bowel syndrome-directions for future research. Aliment Pharmacol Ther 2019; 49:124-139. [PMID: 30589971 DOI: 10.1111/apt.15079] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 10/27/2018] [Accepted: 11/08/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite the efficacy of a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) for patients with irritable bowel syndrome, many questions remain unanswered with respect to its clinical implementation. AIM To review literature to identify, synthesise, and provide direction for future research in the implementation and evaluation of the low FODMAP diet. METHODS Bibliographical searches were performed in Ovid Medline, CINAHL, Scopus and PubMed from database commencement until September 2018, with search terms focused on the population (irritable bowel syndrome) and intervention of interest (FODMAP). RESULTS Predictors of response to a low FODMAP diet remain under investigation, with preliminary data supporting faecal microbiota or faecal volatile organic compound profiling. Training of clinicians, and standards for the education of patients about the phases of a low FODMAP diet, as well as the role of Apps, require formal evaluation. There are limited data on the longer term efficacy and safety of the low FODMAP diet with respect to sustained symptom control, effect on quality of life and healthcare utilisation, nutritional adequacy, precipitation of disordered eating behaviours, effects on faecal microbiota and metabolomic markers, and subsequent translation to clinical effects. CONCLUSIONS Many gaps in implementation of the low FODMAP diet in clinical practice, as well as long-term safety and efficacy, remain for further investigation.
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Affiliation(s)
- Hannah Mitchell
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Gastroenterology, Eastern Health, Melbourne, Victoria, Australia.,Allied Health, Eastern Health, Melbourne, Victoria, Australia
| | - Judi Porter
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.,Allied Health, Eastern Health, Melbourne, Victoria, Australia
| | - Peter R Gibson
- Department of Gastroenterology, Monash University and Alfred Hospital, Melbourne, Victoria, Australia
| | - Jacqueline Barrett
- Department of Gastroenterology, Monash University and Alfred Hospital, Melbourne, Victoria, Australia
| | - Mayur Garg
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Gastroenterology, Eastern Health, Melbourne, Victoria, Australia
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Chen J, Allman-Farinelli M. Development and Validation of a Tool to Measure Dietitians' Self-Efficacy with Using Mobile Health Apps in Dietetic Practice. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2018; 50:468-475.e1. [PMID: 29456125 DOI: 10.1016/j.jneb.2018.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 12/21/2017] [Accepted: 01/04/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To develop and validate a tool for assessing dietitians' self-efficacy with using mobile health (mHealth) apps in dietetic practice. DESIGN AND PARTICIPANTS A tool for measuring mHealth app self-efficacy among dietitians was constructed based on a literature review, consultation with experts, and Bandura's self-efficacy scales development guide. Senior dietetic students and new graduate dietitians in Australia (n = 100) tested the tool. OUTCOME MEASURES AND ANALYSIS Validation of the tool was conducted using factor analysis. Reliability testing was undertaken to examine internal consistency and repeatability. RESULTS Construct validity was demonstrated through extraction of 4 factors with significant loadings accounting for 68% of variance: efficiency and effectiveness of nutrition care, training and support, integration into dietetic work systems, and familiarity with apps. Internal consistency reliability overall was 0.90; 3 of 4 constructs had Cronbach α > .70. Weighted kappas for test-retest reliability indicated moderate to substantial agreement (0.43-0.76). CONCLUSIONS AND IMPLICATIONS This tool will be useful to researchers and dietetic associations interested in measuring dietitians' levels of mHealth app self-efficacy, developing interventions to enhance self-efficacy, and/or evaluating changes in self-efficacy after professional training. Testing of the tool in a more diverse sample of dietitians and among other health professional groups could enhance the applicability of the tool.
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Affiliation(s)
- Juliana Chen
- Charles Perkins Centre, Discipline of Nutrition and Dietetics, School of Life and Environmental Sciences, University of Sydney, Sydney, New South Wales, Australia.
| | - Margaret Allman-Farinelli
- Charles Perkins Centre, Discipline of Nutrition and Dietetics, School of Life and Environmental Sciences, University of Sydney, Sydney, New South Wales, Australia
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Chen J, Gemming L, Hanning R, Allman-Farinelli M. Smartphone apps and the nutrition care process: Current perspectives and future considerations. PATIENT EDUCATION AND COUNSELING 2018; 101:750-757. [PMID: 29169863 DOI: 10.1016/j.pec.2017.11.011] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 11/02/2017] [Accepted: 11/16/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To provide dietitians with practical guidance on incorporating smartphone applications (apps) in the nutrition care process (NCP) to optimize patient education and counseling. METHODS The current evidence-base for mobile health (mHealth) apps was searched using PubMed and Google Scholar. Where and how apps could be implemented by dietitians across the four steps of the NCP is discussed. RESULTS With functionality to automatically convert patient dietary records into nutrient components, nutrition assessment can be streamlined using nutrition apps, allowing more time for dietitians to deliver education and nutrition counseling. Dietitians could prescribe apps to provide patients with education on nutrition skills and in counseling for better adherence to behavior change. Improved patient-provider communication is also made possible through the opportunity for real-time monitoring and evaluation of patient progress via apps. A practical framework termed the 'Mobile Nutrition Care Process Grid' provides dietitians with best-practice guidance on how to use apps. CONCLUSIONS Including apps into dietetic practice could enhance the efficiency and quality of nutrition care and counseling delivered by dietitians. PRACTICE IMPLICATIONS Apps should be considered an adjunct to enable dietetic counseling and care, rather than to replace the expertise, social support and accountability provided by dietitians.
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Affiliation(s)
- Juliana Chen
- School of Life and Environmental Sciences and Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia.
| | - Luke Gemming
- School of Life and Environmental Sciences and Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Rhona Hanning
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Margaret Allman-Farinelli
- School of Life and Environmental Sciences and Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
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Assessment of the accuracy of nutrient calculations of five popular nutrition tracking applications. Public Health Nutr 2018. [PMID: 29534771 DOI: 10.1017/s1368980018000393] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess the accuracy of nutrient intake calculations from leading nutrition tracking applications (apps). DESIGN Nutrient intake estimates from thirty 24 h dietary recalls collected using Nutrition Data System for Research (NDSR) were compared with intake calculations from these recalls entered by the researcher into five free nutrition tracking apps. Apps were selected from the Apple App Store based on consumer popularity from the list of free 'Health and Fitness' apps classified as a nutrition tracking apps. SUBJECTS Dietary recall data collected from thirty lower-income adults. RESULTS Correlations between nutrient intake calculations from NDSR and the nutrition tracking apps ranged from 0·73 to 0·96 for energy and macronutrients. Correlations for the other nutrients examined (Na, total sugars, fibre, cholesterol, saturated fat) ranged from 0·57 to 0·93. For each app, one or more mean nutrient intake calculations were significantly lower than those from NDSR. These differences included total protein (P=0·03), total fat (P=0·005), Na (P=0·02) and cholesterol (P=0·005) for MyFitnessPal; dietary fibre (P=0·04) for Fitbit; total protein (P=0·0004), total fat (P=0·008), Na (P=0·002), sugars (P=0·007), cholesterol (P=0·0006) and saturated fat (P=0·005) for Lose It!; Na (P=0·03) and dietary fibre (P=0·005) for MyPlate; and total fat (P=0·03) for Lifesum. CONCLUSIONS Findings suggest that nutrient calculations from leading nutrition tracking apps tend to be lower than those from NDSR, a dietary analysis software developed for research purposes. Further research is needed to evaluate the validity of the apps when foods consumed are entered by consumers.
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Karduck J, Chapman-Novakofski K. Results of the Clinician Apps Survey, How Clinicians Working With Patients With Diabetes and Obesity Use Mobile Health Apps. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2018; 50:62-69.e1. [PMID: 29325664 DOI: 10.1016/j.jneb.2017.06.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/06/2017] [Accepted: 06/10/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To develop and administer a questionnaire to determine what factors may be associated with app use (including frequency of use, reasons to recommend to clients/patients, perceived effectiveness on health, health aspects used, features, and types of apps) by clinicians working in diabetes and weight management patient care settings. METHODS The Clinician Apps Survey was developed and contained 3 question domains (smartphone apps use, behavior theory in counseling sessions, and demographics) to explore frequency, types, preferred features, benefits/barriers of using apps, counseling techniques used, and clinician demographics. Clinicians (n = 719) were recruited to complete the online survey through 4 dietetics and diabetes professional groups. Clinician use and preferences for health-related apps for personal reasons and in patient care settings were determined, and comparisons were made between high and non-app users. Descriptive statistics were used with current practices and attitudes about apps. Chi-square test of independence compared those using apps both personally and professionally (app enthusiasts) vs those with no app use. RESULTS There were more app enthusiasts (53%; n = 380) than non-app users (20%; n = 145). Whereas 68% recommended pen/paper methods for diet and physical activity monitoring, 62% recommended apps. Most agreed that apps were superior to traditional methods for patients to track dietary intake (62%) and physical activity (58%), make better food choices (34%), lose weight (45%), and track blood glucose (43%). App enthusiasts used the American Association of Diabetes Educators self-care guidelines (P = .001) and advanced counseling techniques (eg, motivational interviewing) more often than did non-app users (P < .004). Apps most frequently recommended to clients were MyFitnessPal (n = 425), CalorieKing (n = 356), and Fitbit (n = 312). CONCLUSIONS AND IMPLICATIONS Health-related smartphone apps are being widely used and recommended to patients with diabetes and obesity by clinicians for self-monitoring of dietary and physical activity behaviors. Furthermore, many clinicians believe that these types of tracking apps may improve patient outcomes compared with traditional methods of monitoring dietary and physical activity behaviors.
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Affiliation(s)
- Justine Karduck
- Department of Food Science and Human Nutrition, University of Illinois, Urbana, IL.
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Academy of Nutrition and Dietetics: Revised 2017 Scope of Practice for the Registered Dietitian Nutritionist. J Acad Nutr Diet 2017; 118:141-165. [PMID: 29173834 DOI: 10.1016/j.jand.2017.10.002] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Indexed: 01/24/2023]
Abstract
The Academy of Nutrition and Dietetics (Academy) is the world's largest organization of food and nutrition professionals and the association that represents credentialed nutrition and dietetics practitioners-registered dietitian nutritionists (RDNs) and nutrition and dietetics technicians, registered (NDTRs). RDNs integrate research, professional development, and practice to stimulate innovation and discovery; collaborate to solve the greatest food and nutrition challenges now and in the future; focus on systemswide impact across the food, wellness, and health sectors; have a global impact in eliminating all forms of malnutrition; and amplify the contribution of nutrition and dietetics practitioners and expand workforce capacity and capability. The Revised 2017 Scope of Practice for the RDN reflects the position of the Academy on the essential role of the RDN in the direction and delivery of food and nutrition services. The scope of practice for the RDN is composed of education and credentialing, practice resources, Academy Standards of Practice and Professional Performance, codes of ethics, accreditation standards, state and federal regulations, national guidelines, and organizational policy and procedures. The Revised 2017 Scope of Practice for the RDN is used in conjunction with the Revised 2017 Standards of Practice (SOP) in Nutrition Care and the Standards of Professional Performance (SOPP) for RDNs. The SOP address activities related to direct patient and client care. The SOPP address behaviors related to the professional role of RDNs. These standards reflect the minimum competent level of nutrition and dietetics practice and professional performance for RDNs. A companion document addresses the scope of practice for the NDTR.
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Registered Dietitians' Preferred Celiac Disease Resources and Twitter, Facebook, Smartphone App, or Internet Use for Celiac Disease Patient Education. TOP CLIN NUTR 2017. [DOI: 10.1097/tin.0000000000000108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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