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The adoption of poor dietary and lifestyle habits have been associated with the development of non-communicable disease. The majority of strategies implemented to enhance dietary quality of individuals follow a “one size fits all” standardised approach. Results of recent trials have suggested that Personalised Nutrition (PN), tailored to individual requirements, is able to improve dietary intakes, yet limited focus has been given to the effectiveness of face-to-face compared with online methods. The aim of the EatWellQ8 randomised control trial (RCT) was to assess the impact of web-based PN advice, face-to-face PN advice and standardised advice, on adherence to healthy eating in Kuwait.
Materials and Methods
Free living adults aged 21–65 years, were recruited for the 12-week study and randomised to; face-to-face PN, web-based PN or generalised (control) advise groups. Dietary intake and self-reported anthropometric measurements were assessed at baseline, 6 and 12 weeks. A validated food frequency questionnaire (FFQ) modified from the EPIC FFQ was used to assess food and nutrient intake. Diet quality was assessed by a 10-component modified Alternative Healthy Eating Index (m-AHEI) which was used to generate the PN advice. At 0 and 12-weeks post FFQ completion, participants randomised to the PN intervention groups were presented with 3 tailored dietary messages based on the m-AHEI components that received the lowest scores.
320 participants completed the trial. Due to over/underreporting, 100 were included in the analysis (71% female, 29% male) with a mean age of 38.6 years (SD 14.3), and body mass index (BMI) of 25.1 kg/m2 (SD 4.2). After 12-weeks intervention, m-AHEI scores increased significantly in both PN intervention groups (face-to-face PN 19%, web-based 12%) compared to controls (4%) (P < 0.01) and significantly higher intakes of vegetables and fruits, and lower intakes of sugars compared with controls (P < 0.05). The PN intervention groups also significantly increased their intakes of omega 3 fatty acids and total folate compared with the control group (P < 0.05). The Face-to-face PN group significantly reduced weight (-1.9 kg) and BMI (-0.5 kg/m2) compared to web-based PN and control groups(P < 0.01).
In adults living in Kuwait, PN advice, delivered face-to-face or online, was more effective at improving dietary quality than population-based advice. Face-to-face PN was found to be more effective at inducing weight-loss in adults compared to web-based PN and population-based advice.
The internet has considerable potential to improve health-related food choice at low-cost. Online solutions in this field can be deployed quickly and at very low cost, especially if they are not dependent on bespoke devices or offline processes such as the provision and analysis of biological samples. One key challenge is the automated delivery of personalised dietary advice in a replicable, scalable and inexpensive way, using valid nutrition assessment methods and effective recommendations. We have developed a web-based personalised nutrition system (eNutri) which assesses dietary intake using a validated graphical FFQ and provides personalised food-based dietary advice automatically. Its effectiveness was evaluated during an online randomised controlled trial dietary intervention (EatWellUK study) in which personalised dietary advice was compared with general population recommendations (control) delivered online. The present paper presents a review of literature relevant to this work, and describes the strategies used during the development of the eNutri app. Its design and source code have been made publicly available under a permissive open source license, so that other researchers and organisations can benefit from this work. In a context where personalised diet advice has great potential for health promotion and disease prevention at-scale and yet is not currently being offered in the most popular mobile apps, the strategies and approaches described in the present paper can help to inform and advance the design and development of technologies for personalised nutrition.
Nutrition plays a key role in later life health and wellbeing. Older people face a high risk of nutrient deficiencies and malnutrition that can lead to sarcopenia, loss of skeletal muscle mass and strength. A recent review identified that sarcopenia was associated with functional decline, higher rate of falls, higher incidence of hospitalisations and increased mortality (Beaudart et al, 2017). Understandably severe sarcopenia is extremely disabling as it prevents independent living and places an increasing burden on care providers.
Avoiding late life malnutrition is dependent on a number of factors including physical, mental and cognitive health. However, the relative impact of each of these factors and the relationships between them are not well understood. Physical factors, such as problems with chewing, swallowing and impaired mobility, all contribute towards nutritional decline (Hickson, 2006). Mental health status also plays a part, particularly depression, which has been identified as a predictor of poor appetite in older adults (see Engel et al, 2011). Treating depression can be an effective way of increasing appetite and improving nutritional status, but it is commonly under-diagnosed and under-treated among older people (Allan et al, 2014).
There is also growing evidence of associations between diet and cognitive function. Older people with dementia or cognitive decline have a poorer nutritional status than those without (Atti et al, 2008), with increasing dementia severity related to poorer nutritional status (Riccio et al, 2007). The potential for diet to protect against cognitive decline in older people is not currently well understood as much of the epidemiological research has not been supported in trials, and more research is needed to confirm the impact of changing whole diets on cognitive measures (Smith and Blumenthal, 2016).
To explore the associations and interactions between mental and physical health and diet, new intervention and prospective cohort studies are needed (Psaltopoulou et al, 2008). Such research is challenging to complete with older adults, as both ageing itself and the accompanying cognitive and physical decline are progressive and dynamic. Existing tools for measuring diet, cognition and physical activity typically provide snapshots of the situation and cannot identify rate of decline nor readily distinguish cause and effect.
Dietary assessment in older adults can be challenging. The Novel Assessment of Nutrition and Ageing (NANA) method is a touch-screen computer-based food record that enables older adults to record their dietary intakes. The objective of the present study was to assess the relative validity of the NANA method for dietary assessment in older adults. For this purpose, three studies were conducted in which a total of ninety-four older adults (aged 65–89 years) used the NANA method of dietary assessment. On a separate occasion, participants completed a 4 d estimated food diary. Blood and 24 h urine samples were also collected from seventy-six of the volunteers for the analysis of biomarkers of nutrient intake. The results from all the three studies were combined, and nutrient intake data collected using the NANA method were compared against the 4 d estimated food diary and biomarkers of nutrient intake. Bland–Altman analysis showed a reasonable agreement between the dietary assessment methods for energy and macronutrient intake; however, there were small, but significant, differences for energy and protein intake, reflecting the tendency for the NANA method to record marginally lower energy intakes. Significant positive correlations were observed between urinary urea and dietary protein intake using both the NANA and the 4 d estimated food diary methods, and between plasma ascorbic acid and dietary vitamin C intake using the NANA method. The results demonstrate the feasibility of computer-based dietary assessment in older adults, and suggest that the NANA method is comparable to the 4 d estimated food diary, and could be used as an alternative to the food diary for the short-term assessment of an individual's dietary intake.
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