@Article{info:doi/10.2196/68519, author="Peroutka, Markie and Rivero Covelo, Ignacio", title="Effects of Ventral Pallidum--Nucleus Accumbens Shell Neural Pathway Modulation on Sucrose Consumption and Motivation in Female Rats: Chemogenetic Manipulation", journal="JMIRx Bio", year="2025", month="Mar", day="8", volume="3", pages="e68519", keywords="ventral pallidum", keywords="nucleus accumbens shell", keywords="chemogenetics", keywords="sucrose", keywords="feeding behavior", keywords="food motivation", keywords="palatable food", keywords="DREADD", keywords="designer receptors exclusively activated by designer drugs", abstract="Background: The neural control of food intake involves interactions between homeostatic and nonhomeostatic systems. The nucleus accumbens shell (AcbSh) and ventral pallidum (VP) play key roles in regulating ingestive behavior and project to each other. Previous studies have shown that these projections influence food consumption, with sex differences reported in the modulation of sucrose intake by VP projections. Objective: This study aimed to investigate the effects of chemogenetic activation or inhibition of projections from the VP to the AcbSh on sucrose consumption and the motivation to work for sucrose in female rats. Methods: Chemogenetic tools (DREADD [designer receptors exclusively activated by designer drugs]) were used to selectively activate or inhibit VP projections to the AcbSh in female Sprague-Dawley rats (Gi [inhibitory G protein] DREADD: n=11; Gq [excitatory G protein] DREADD: n=10; and no DREADD: n=12). Rats were trained on a progressive ratio operant task to assess motivation to work for sucrose. Additionally, free-access sucrose consumption tests were conducted using a 20\% sucrose solution. The effects of chemogenetic modulation were analyzed using two-way ANOVA. Results: Chemogenetic manipulation of VP projections to the AcbSh did not significantly affect the motivation to work for sucrose in the progressive ratio task (F2,31=1.780; P=.18). However, a significant interaction between DREADD type and drug administration was observed in the sucrose consumption test. Activation of the VP-AcbSh projection (using Gq DREADD) decreased sucrose intake, while inhibition (using Gi DREADD) increased sucrose intake (F2,31=18.891; P=.001). No significant changes in sucrose consumption were observed in the control group without DREADD expression (P=.50). Conclusions: This study shows that projections from the VP to the AcbSh modulate sucrose intake but do not affect the motivation to work for sucrose. Chemogenetic activation reduced sucrose consumption, while inhibition increased it, suggesting that distinct neural circuits within the VP-AcbSh pathway may differentially regulate feeding behaviors. These findings highlight the role of this pathway in the consumption of palatable foods and indicate that future research should consider factors such as sex, food macronutrient composition, and specific neural subpopulations to better understand their role in feeding behavior. ", doi="10.2196/68519", url="https://bio.jmirx.org/2025/1/e68519" } @Article{info:doi/10.2196/57265, author="Guti{\'e}rrez-Salme{\'a}n, Gabriela and Miranda-Alatriste, Vanessa Paola and Ben{\'i}tez-Alday, Patricio and Orozco-Rivera, Enrique Luis and Islas-Vargas, Nurit and Espinosa-Cuevas, {\'A}ngeles and Correa-Rotter, Ricardo and Colin-Ramirez, Eloisa", title="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", journal="Interact J Med Res", year="2024", month="Nov", day="18", volume="13", pages="e57265", keywords="beliefs", keywords="attitudes", keywords="hypertension", keywords="knowledge", keywords="salt consumption", keywords="sodium intake", keywords="potassium intake", keywords="Mexico", abstract="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 {\vS}id{\'a}k 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. ", doi="10.2196/57265", url="https://www.i-jmr.org/2024/1/e57265", url="http://www.ncbi.nlm.nih.gov/pubmed/39556832" } @Article{info:doi/10.2196/56772, author="Wall, R. Clare and Roy, C. Nicole and Mullaney, A. Jane and McNabb, Charles Warren and Gasser, Olivier and Fraser, Karl and Altermann, Eric and Young, Wayne and Cooney, Janine and Lawrence, Robyn and Jiang, Yannan and Galland, C. Barbara and Fu, Xiaoxi and Tonkie, N. Jacqueline and Mahawar, Nisha and Lovell, Luisa Amy", title="Nourishing the Infant Gut Microbiome to Support Immune Health: Protocol of SUN (Seeding Through Feeding) Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="Sep", day="2", volume="13", pages="e56772", keywords="infant", keywords="complementary feeding", keywords="gut microbiota", keywords="immune", keywords="complementary food", keywords="feeding", keywords="gut microbiome", keywords="microbiome", keywords="immune system", keywords="k?mara", keywords="infancy", keywords="immune development", keywords="infant health", keywords="prevalence", keywords="respiratory tract infections", keywords="RTI", abstract="Background: The introduction of complementary foods during the first year of life influences the diversity of the gut microbiome. How this diversity affects immune development and health is unclear. Objective: This study evaluates the effect of consuming k?mara or k?mara with added banana powder (resistant starch) compared to a reference control at 4 months post randomization on the prevalence of respiratory tract infections and the development of the gut microbiome. Methods: This study is a double-blind, randomized controlled trial of mothers and their 6-month-old infants (up to n=300) who have not yet started solids. Infants are randomized into one of 3 groups: control arm (C), standard k?mara intervention (K), and a k?mara intervention with added banana powder product (K+) to be consumed daily for 4 months until the infant is approximately 10 months old. Infants are matched for sex using stratified randomization. Data are collected at baseline (prior to commencing solid food) and at 2 and 4 months after commencing solid food (at around 8 and 10 months of age). Data and samples collected at each timepoint include weight and length, intervention adherence (months 2 and 4), illness and medication history, dietary intake (months 2 and 4), sleep (diary and actigraphy), maternal dietary intake, breast milk, feces (baseline and 4 months), and blood samples (baseline and 4 months). Results: The trial was approved by the Health and Disability Ethics Committee of the Ministry of Health, New Zealand (reference 20/NTA/9). Recruitment and data collection did not commence until January 2022 due to the COVID-19 pandemic. Data collection and analyses are expected to conclude in January 2024 and early 2025, respectively. Results are to be published in 2024 and 2025. Conclusions: The results of this study will help us understand how the introduction of a specific prebiotic complementary food affects the microbiota and relative abundances of the microbial species, the modulation of immune development, and infant health. It will contribute to the expanding body of research that aims to deepen our understanding of the connections between nutrition, gut microbiota, and early-life postnatal health. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000026921; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378654 International Registered Report Identifier (IRRID): DERR1-10.2196/56772 ", doi="10.2196/56772", url="https://www.researchprotocols.org/2024/1/e56772", url="http://www.ncbi.nlm.nih.gov/pubmed/39222346" } @Article{info:doi/10.2196/59227, author="Ng, Min Hwei and Maggo, Jasjot and Wall, Louisa Catherine and Bayer, Brigit Simone and McNabb, C. Warren and Mullaney, Adair Jane and Foster, Meika and Cabrera, L. Diana and Fraser, Karl and Cooney, Janine and Trower, Tania and G{\"u}nther, S. Catrin and Frampton, Chris and Gearry, Blair Richard and Roy, Clemence Nicole", title="Effects of Defatted Rice Bran--Fortified Bread on the Gut Microbiota Composition of Healthy Adults With Low Dietary Fiber Intake: Protocol for a Crossover Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="Aug", day="29", volume="13", pages="e59227", keywords="dietary fiber", keywords="defatted rice bran", keywords="bread", keywords="healthy adults", keywords="gut microbiota", keywords="metabolites", keywords="gut physiome", keywords="randomized controlled trial", keywords="mobile phone", abstract="Background: Inadequate dietary fiber (DF) intake is associated with several human diseases. Bread is commonly consumed, and its DF content can be increased by incorporating defatted rice bran (DRB). Objective: This first human study on DRB-fortified bread primarily aims to assess the effect of DRB-fortified bread on the relative abundance of a composite of key microbial genera and species in fecal samples. Secondary outcomes include clinical (cardiovascular risk profile), patient-reported (daily bread consumption and bowel movement, gut comfort, general well-being, and total DF intake), biological (fecal microbiota gene abundances, and fecal and plasma metabolites), and physiome (whole-gut and regional transit time and gas fermentation profiles) outcomes in healthy adults with low DF intake. Methods: This is a 2-armed, placebo-controlled, double-blinded, crossover randomized controlled trial. The study duration is 14 weeks: 2 weeks of lead-in, 4 weeks of intervention per phase, 2 weeks of washout, and 2 weeks of follow-up. Overall, 60 healthy adults with low DF intake (<18 g [female individuals] or <22 g [male individuals] per day) were recruited in Christchurch, New Zealand, between June and December 2022. Randomly assigned participants consumed 3 (female individuals) or 4 (male individuals) slices of DRB-fortified bread per day and then placebo bread, and vice versa. The DRB-fortified bread provided 8 g (female individuals) or 10.6 g (male individuals) of total DF, whereas the placebo (a matched commercial white toast bread) provided 2.7 g (female individuals) or 3.6 g (male individuals) of total DF. Before and after each intervention phase, participants provided fecal and blood samples to assess biological responses; completed a 3-day food diary to assess usual intakes and web-based questionnaires to assess gut comfort, general and mental well-being, daily bread intake, and bowel movement via an app; underwent anthropometry and blood pressure measurements; and drank blue food dye to assess whole-gut transit time. Additionally, 25\% (15/60) of the participants ingested Atmo gas-sensing capsules to assess colonic gas fermentation profile and whole-gut and regional transit time. Mean differences from baseline will be compared between the DRB and placebo groups, as well as within groups (after the intervention vs baseline). For metabolome analyses, comparisons will be made within and between groups using postintervention values. Results: Preliminary analysis included 56 participants (n=33, 59\% female; n=23, 41\% male). Due to the large dataset, data analysis was planned to be fully completed by the last quarter of 2024, with full results expected to be published in peer-reviewed journals by the end of 2024. Conclusions: This first human study offers insights into the prospect of consuming DRB-fortified bread to effectively modulate health-promoting gut microbes, their metabolism, and DF intake in healthy adults with low DF intake. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12622000884707; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=383814 International Registered Report Identifier (IRRID): DERR1-10.2196/59227 ", doi="10.2196/59227", url="https://www.researchprotocols.org/2024/1/e59227" } @Article{info:doi/10.2196/13642, author="Dogaru, Emanuel Dumitru and Rosu, Serban and Barattini, Franco Dionisio and Guadagna, Simone and Barattini, Luca and Andor, Bogdan", title="Assessment of the Feasibility of Objective Parameters as Primary End Points for Patients Affected by Knee Osteoarthritis: Protocol for a Pilot, Open Noncontrolled Trial (:SMILE:)", journal="JMIR Res Protoc", year="2024", month="Jun", day="28", volume="13", pages="e13642", keywords="pilot trial", keywords="feasibility study", keywords="knee osteoarthritis", keywords="hyaluronic acid", keywords="outcome assessment", keywords="osteoarthritis", keywords="ultrasonography", keywords="knee", keywords="pain", abstract="Background: Osteoarthritis (OA) is a disabling condition that affects more than one-third of people older than 65 years. Currently, 80\% of these patients report movement limitations, 20\% are unable to perform major activities of daily living, and approximately 11\% require personal care. In 2014, the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) recommended, as the first step in the pharmacological treatment of knee osteoarthritis, a background therapy with chronic symptomatic slow-acting osteoarthritic drugs such as glucosamine sulfate, chondroitin sulfate, and hyaluronic acid. The latter has been extensively evaluated in clinical trials as intra-articular and oral administration. Recent reviews have shown that studies on oral hyaluronic acid generally measure symptoms using only subjective parameters, such as visual analog scales or quality of life questionnaires. As a result, objective measures are lacking, and data validity is generally impaired. Objective: The main goal of this pilot study with oral hyaluronic acid is to evaluate the feasibility of using objective tools as outcomes to evaluate improvements in knee mobility. We propose ultrasound and range of motion measurements with a goniometer that could objectively correlate changes in joint mobility with pain reduction, as assessed by the visual analog scale. The secondary objective is to collect data to estimate the time and budget for the main double-blind study randomized trial. These data may be quantitative (such as enrollment rate per month, number of screening failures, and new potential outcomes) and qualitative (such as site logistical issues, patient reluctance to enroll, and interpersonal difficulties for investigators). Methods: This open-label pilot and feasibility study is conducted in an orthopedic clinic (Timisoara, Romania). The study includes male and female participants, aged 50-70 years, who have been diagnosed with symptomatic knee OA and have experienced mild joint discomfort for at least 6 months. Eight patients must be enrolled and treated with Syalox 300 Plus (River Pharma) for 8 weeks. It is a dietary supplement containing high-molecular-weight hyaluronic acid, which has already been marketed in several European countries. Assessments are made at the baseline and final visits. Results: Recruitment and treatment of the 8 patients began on February 15, 2018, and was completed on May 25, 2018. Data analysis was planned to be completed by the end of 2018. The study was funded in February 2019. We expect the results to be published in a peer-reviewed clinical journal in the last quarter of 2024. Conclusions: The data from this pilot study will be used to assess the feasibility of a future randomized clinical trial in OA. In particular, the planned outcomes (eg, ultrasound and range of motion), safety, and quantitative and qualitative data must be evaluated to estimate in advance the time and budget required for the future main study. Finally, the pilot study should provide preliminary information on the efficacy of the investigational product. Trial Registration: ClinicalTrials.gov NCT03421054; https://clinicaltrials.gov/study/NCT03421054 International Registered Report Identifier (IRRID): RR1-10.2196/13642 ", doi="10.2196/13642", url="https://www.researchprotocols.org/2024/1/e13642" } @Article{info:doi/10.2196/50980, author="Spoladore, Daniele and Colombo, Vera and Fumagalli, Alessia and Tosi, Martina and Lorenzini, Cecilia Erna and Sacco, Marco", title="An Ontology-Based Decision Support System for Tailored Clinical Nutrition Recommendations for Patients With Chronic Obstructive Pulmonary Disease: Development and Acceptability Study", journal="JMIR Med Inform", year="2024", month="Jun", day="26", volume="12", pages="e50980", keywords="ontology-based decision support system", keywords="nutritional recommendation", keywords="chronic obstructive pulmonary disease", keywords="clinical decision support system", keywords="pulmonary rehabilitation", abstract="Background: Chronic obstructive pulmonary disease (COPD) is a chronic condition among the main causes of morbidity and mortality worldwide, representing a burden on health care systems. Scientific literature highlights that nutrition is pivotal in respiratory inflammatory processes connected to COPD, including exacerbations. Patients with COPD have an increased risk of developing nutrition-related comorbidities, such as diabetes, cardiovascular diseases, and malnutrition. Moreover, these patients often manifest sarcopenia and cachexia. Therefore, an adequate nutritional assessment and therapy are essential to help individuals with COPD in managing the progress of the disease. However, the role of nutrition in pulmonary rehabilitation (PR) programs is often underestimated due to a lack of resources and dedicated services, mostly because pneumologists may lack the specialized training for such a discipline. Objective: This work proposes a novel knowledge-based decision support system to support pneumologists in considering nutritional aspects in PR. The system provides clinicians with patient-tailored dietary recommendations leveraging expert knowledge. Methods: The expert knowledge---acquired from experts and clinical literature---was formalized in domain ontologies and rules, which were developed leveraging the support of Italian clinicians with expertise in the rehabilitation of patients with COPD. Thus, by following an agile ontology engineering methodology, the relevant formal ontologies were developed to act as a backbone for an application targeted at pneumologists. The recommendations provided by the decision support system were validated by a group of nutrition experts, whereas the acceptability of such an application in the context of PR was evaluated by pneumologists. Results: A total of 7 dieticians (mean age 46.60, SD 13.35 years) were interviewed to assess their level of agreement with the decision support system's recommendations by evaluating 5 patients' health conditions. The preliminary results indicate that the system performed more than adequately (with an overall average score of 4.23, SD 0.52 out of 5 points), providing meaningful and safe recommendations in compliance with clinical practice. With regard to the acceptability of the system by lung specialists (mean age 44.71, SD 11.94 years), the usefulness and relevance of the proposed solution were extremely positive---the scores on each of the perceived usefulness subscales of the technology acceptance model 3 were 4.86 (SD 0.38) out of 5 points, whereas the score on the intention to use subscale was 4.14 (SD 0.38) out of 5 points. Conclusions: Although designed for the Italian clinical context, the proposed system can be adapted for any other national clinical context by modifying the domain ontologies, thus providing a multidisciplinary approach to the management of patients with COPD. ", doi="10.2196/50980", url="https://medinform.jmir.org/2024/1/e50980", url="http://www.ncbi.nlm.nih.gov/pubmed/38922666" } @Article{info:doi/10.2196/52231, author="Lin, Shu-Cheng and Wang, Chien-Yen and Hou, Tien-Hung and Chen, Hong-Ching and Wang, Chia-Chi", title="Impact of Fruit and Vegetable Enzyme Supplementation on Aerobic Performance and Lactate Response in Older Adults Following High-Intensity Interval Exercise Through Exergaming: Randomized Experimental Matched-Pair Study", journal="JMIR Serious Games", year="2024", month="Jun", day="25", volume="12", pages="e52231", keywords="Ring Fit Adventure", keywords="training load", keywords="older adult training", keywords="training impulse", keywords="food supplement", keywords="older adults", keywords="exergames", keywords="exergame", keywords="Taiwan", keywords="female", keywords="fruits", keywords="vegetables", keywords="blood lactate", keywords="exercise", keywords="feasibility", keywords="aerobic", keywords="enzymes", keywords="enzyme", keywords="female older adults", keywords="fitness", keywords="food intake", keywords="diet", keywords="exergaming", keywords="enzyme supplements", keywords="older adults training", keywords="female older adult", keywords="older adult", abstract="Background: Exercise offers substantial health benefits but can induce oxidative stress and inflammation, especially in high-intensity formats such as high-intensity interval exercise (HIIE). Exergaming has become an effective, enjoyable fitness tool for all ages, particularly older adults. Enzyme supplements may enhance exercise performance by improving lactate metabolism and reducing oxidative stress. Objective: This study investigates the efficacy of fruit and vegetable enzyme supplementation in modulating fatigue and enhancing aerobic capacity in older adults following HIIE through exergaming. Methods: The study recruited 16 older adult female participants and allocated them into 2 distinct groups (enzyme and placebo) based on their pretest lactate levels. This division used pairwise grouping to guarantee comparability between the groups, ensuring the integrity of the results. They engaged in HIIE using Nintendo Switch Ring Fit Adventure, performing 8 sets of 20 seconds of maximum effort exercise interspersed with 30 seconds of rest, totaling 370 seconds of exercise. Key metrics assessed included blood lactate levels, heart rate, rating of perceived exertion, and training impulse. Participants in the enzyme group were administered a fruit and vegetable enzyme supplement at a dosage of 30 mL twice daily over a period of 14 days. Results: The enzyme group showed significantly lower blood lactate levels compared to the placebo group, notably after the fourth (mean 4.29, SD 0.67 vs mean 6.34, SD 1.17 mmol/L; P=.001) and eighth (mean 5.84, SD 0.63 vs mean 8.20, SD 1.15 mmol/L; P<.001) exercise sessions. This trend continued at 5 minutes (mean 6.85, SD 0.82 vs mean 8.60, SD 1.13 mmol/L; P=.003) and 10 minutes (mean 5.91, SD 1.16 vs mean 8.21, SD 1.27 mmol/L; P=.002) after exercise. Although both groups exceeded 85\% of their estimated maximum heart rate during the exercise, enzyme supplementation did not markedly affect the perceived intensity or effort. Conclusions: The study indicates that fruit and vegetable enzyme supplementation can significantly reduce blood lactate levels in older adults following HIIE through exergaming. This suggests a potential role for these enzymes in modulating lactate production or clearance during and after high-intensity exercise. These findings have implications for developing targeted interventions to enhance exercise tolerance and recovery in older adults. Trial Registration: ClinicalTrials.gov NCT06466408; https://clinicaltrials.gov/study/NCT06466408 ", doi="10.2196/52231", url="https://games.jmir.org/2024/1/e52231" } @Article{info:doi/10.2196/47826, author="Molenaar, Annika and Lukose, Dickson and Brennan, Linda and Jenkins, L. Eva and McCaffrey, A. Tracy", title="Using Natural Language Processing to Explore Social Media Opinions on Food Security: Sentiment Analysis and Topic Modeling Study", journal="J Med Internet Res", year="2024", month="Mar", day="21", volume="26", pages="e47826", keywords="food security", keywords="food insecurity", keywords="public health", keywords="sentiment analysis", keywords="topic modeling", keywords="natural language processing", keywords="infodemiology", abstract="Background: Social media has the potential to be of great value in understanding patterns in public health using large-scale analysis approaches (eg, data science and natural language processing [NLP]), 2 of which have been used in public health: sentiment analysis and topic modeling; however, their use in the area of food security and public health nutrition is limited. Objective: This study aims to explore the potential use of NLP tools to gather insights from real-world social media data on the public health issue of food security. Methods: A search strategy for obtaining tweets was developed using food security terms. Tweets were collected using the Twitter application programming interface from January 1, 2019, to December 31, 2021, filtered for Australia-based users only. Sentiment analysis of the tweets was performed using the Valence Aware Dictionary and Sentiment Reasoner. Topic modeling exploring the content of tweets was conducted using latent Dirichlet allocation with BigML (BigML, Inc). Sentiment, topic, and engagement (the sum of likes, retweets, quotations, and replies) were compared across years. Results: In total, 38,070 tweets were collected from 14,880 Twitter users. Overall, the sentiment when discussing food security was positive, although this varied across the 3 years. Positive sentiment remained higher during the COVID-19 lockdown periods in Australia. The topic model contained 10 topics (in order from highest to lowest probability in the data set): ``Global production,'' ``Food insecurity and health,'' ``Use of food banks,'' ``Giving to food banks,'' ``Family poverty,'' ``Food relief provision,'' ``Global food insecurity,'' ``Climate change,'' ``Australian food insecurity,'' and ``Human rights.'' The topic ``Giving to food banks,'' which focused on support and donation, had the highest proportion of positive sentiment, and ``Global food insecurity,'' which covered food insecurity prevalence worldwide, had the highest proportion of negative sentiment. When compared with news, there were some events, such as COVID-19 support payment introduction and bushfires across Australia, that were associated with high periods of positive or negative sentiment. Topics related to food insecurity prevalence, poverty, and food relief in Australia were not consistently more prominent during the COVID-19 pandemic than before the pandemic. Negative tweets received substantially higher engagement across 2019 and 2020. There was no clear relationship between topics that were more likely to be positive or negative and have higher or lower engagement, indicating that the identified topics are discrete issues. Conclusions: In this study, we demonstrated the potential use of sentiment analysis and topic modeling to explore evolution in conversations on food security using social media data. Future use of NLP in food security requires the context of and interpretation by public health experts and the use of broader data sets, with the potential to track dimensions or events related to food security to inform evidence-based decision-making in this area. ", doi="10.2196/47826", url="https://www.jmir.org/2024/1/e47826", url="http://www.ncbi.nlm.nih.gov/pubmed/38512326" } @Article{info:doi/10.2196/43936, author="Matsumoto, Shinya and Kanagawa, Yoshiyuki and Nagoshi, Kiwamu and Akahane, Takemi and Imamura, Tomoaki and Akahane, Manabu", title="Consumer Willingness to Pay for Food Defense and Food Hygiene in Japan: Cross-Sectional Study", journal="Interact J Med Res", year="2023", month="Oct", day="23", volume="12", pages="e43936", keywords="food defense", keywords="food hygiene", keywords="contingent valuation method", keywords="willingness", keywords="food", keywords="cost", keywords="awareness", keywords="food safety", keywords="questionnaire", keywords="Japan", keywords="prevention", keywords="food poisoning", keywords="safety", abstract="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. ", doi="10.2196/43936", url="https://www.i-jmr.org/2023/1/e43936", url="http://www.ncbi.nlm.nih.gov/pubmed/37870896" } @Article{info:doi/10.2196/49357, author="Pogrebnoy, Dina and Dennett, M. Amy and Simpson, B. Dawn and MacDonald-Wicks, Lesley and Patterson, J. Amanda and English, Coralie", title="Effects of Using Websites on Physical Activity and Diet Quality for Adults Living With Chronic Health Conditions: Systematic Review and Meta-Analysis", journal="J Med Internet Res", year="2023", month="Oct", day="19", volume="25", pages="e49357", keywords="modifiable risk factors", keywords="secondary prevention", keywords="physical activity", keywords="diet quality", keywords="websites", keywords="chronic health", keywords="chronic illness", abstract="Background: Adults with chronic health conditions need support to manage modifiable risk factors such as physical inactivity and poor diet. Disease-specific websites with health information on physical activity and diet quality may be effective in supporting adults in managing their chronic illnesses. Objective: The primary aim of this review was to determine whether using websites with health information can lead to improvements in physical activity levels or diet quality in adults with chronic health conditions. Methods: Randomized controlled trials evaluating the effectiveness of website use on levels of physical activity or diet quality in adults with chronic health conditions were included. MEDLINE, Embase, CINAHL, and the Physiotherapy Evidence Database were searched from the earliest available record until February 2023. Data for outcomes measuring physical activity levels; diet quality; and, where reported, self-efficacy and quality of life were independently extracted by 2 reviewers. The risk of bias was assessed using the Physiotherapy Evidence Database scale, and the overall certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Where values were presented as the same unit of measure, postintervention scores were pooled for meta-analysis to yield an overall mean difference (MD). A standardized MD (SMD) was calculated for the pooled data in which different units for the same outcome were used. Individual trial data were described in cases where the data of trials could not be pooled. Results: A total of 29 trials (N=6418 participants) across 8 different disease groups with intervention periods ranging from 4 weeks to 12 months were included in the analysis. There was moderate-certainty evidence that using websites with health information increased levels of moderate to vigorous physical activity (MD=39 min/wk, 95\% CI 18.60-58.47), quality of life (SMD=0.36, 95\% CI 0.12-0.59), and self-efficacy (SMD=0.26, 95\% CI 0.05-0.48) and high-certainty evidence for reduction in processed meat consumption (MD=1.1 portions/wk, 95\% CI 0.70-1.58) when compared with usual care. No differences were detected in other measures of diet quality. There was no increased benefit for website users who were offered additional support. Conclusions: The use of websites for risk factor management has the potential to improve physical activity levels, quality of life, and self-efficacy as well as reduce processed meat consumption for adults living with chronic health conditions when compared with usual care. However, it remains unclear whether using websites leads to meaningful and long-lasting behavior change. Trial Registration: PROSPERO CRD42021283168; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=283168 ", doi="10.2196/49357", url="https://www.jmir.org/2023/1/e49357", url="http://www.ncbi.nlm.nih.gov/pubmed/37856187" } @Article{info:doi/10.2196/49092, author="Silva, da Maria Fernanda Gomes and Nobre, Neri Luciana and Silva, da Edson", title="Animated Videos Based on Food Processing for Guidance of Brazilian Adults: Validation Study", journal="Interact J Med Res", year="2023", month="Sep", day="11", volume="12", pages="e49092", keywords="food, processed", keywords="dietary guidelines", keywords="nutrition policy", keywords="instructional films and videos", keywords="validation study", keywords="food classification", keywords="validation", keywords="educational videos", keywords="nutrition", keywords="Brazil", abstract="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. ", doi="10.2196/49092", url="https://www.i-jmr.org/2023/1/e49092", url="http://www.ncbi.nlm.nih.gov/pubmed/37695656" } @Article{info:doi/10.2196/44150, author="Akahane, Manabu and Kanagawa, Yoshiyuki and Takahata, Yoshihisa and Nakanishi, Yasuhiro and Akahane, Takemi and Imamura, Tomoaki", title="Consumer Awareness of Food Defense Measures at Food Delivery Service Providers and Food Manufacturers: Web-Based Consumer Survey Study", journal="JMIR Form Res", year="2023", month="Aug", day="24", volume="7", pages="e44150", keywords="food defense", keywords="health hazards", keywords="intentional contamination", keywords="foreign substances", keywords="food delivery service", abstract="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. ", doi="10.2196/44150", url="https://formative.jmir.org/2023/1/e44150", url="http://www.ncbi.nlm.nih.gov/pubmed/37616047" } @Article{info:doi/10.2196/43501, author="Wang, Lu and Ye, Chen and Zhao, Fanghong and Wu, Hongjing and Wang, Ruoyu and Zhang, Zhaofeng and Li, Jie", title="Association Between the Dietary Inflammatory Index and the Risk of Fracture in Chinese Adults: Longitudinal Study", journal="JMIR Public Health Surveill", year="2023", month="Aug", day="17", volume="9", pages="e43501", keywords="dietary inflammatory index", keywords="fractures", keywords="diet", keywords="risk", abstract="Background: Chronic inflammation plays a crucial role in tissue injury, osteoporosis, and fracture. The dietary inflammatory index (DII) is a tool for assessing the potential for inflammation in the diet. However, the association between the DII and fractures remains controversial from previous studies. Objective: We aimed to explore the correlation between the DII and fracture risk in Chinese adults. Methods: We included 11,999 adults (5519 men and 6480 women) who were a part of the China Health and Nutrition Survey (1997-2015) prospective cohort. A 3-day, 24-hour meal review method was used to calculate the DII score. The fractures were identified using a questionnaire. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95\% CIs for fractures. Subgroup, sensitivity, and restricted cubic spline analyses were performed. Results: During the 18 years of follow-up (median follow-up 9.0 years), 463 men and 439 women developed fractures. The median DII score was 0.64 (IQR ?1.74 to 1.46) for the total sample, 0.75 (IQR ?1.68 to 1.50) for men, and 0.53 (IQR ?1.79 to 1.42) for women. The DII score had a positive correlation with the risk of fracture among women but not among men. For men, after adjusting for covariates, the HRs for quintiles of DII were 1, 0.96 (95\% CI 0.66-1.41), 1.05 (95\% CI 0.74-1.49), 0.89 (95\% CI 0.62-1.26), and 0.94 (95\% CI 0.67-1.34; trend: P=.62). The HRs for women were 1, 1.13 (95\% CI 0.72-1.79), 1.24 (95\% CI 0.83-1.86), 1.51 (95\% CI 1.02-2.22), and 1.62 (95\% CI 1.10-2.39; trend: P=.004). The restricted cubic spline analysis showed a significant association between fracture risk and DII score in women (overall association: P=.01); as the DII scores were >0.53, HRs showed a significant upward trend. Women aged <50 years or who are nonsmokers, who are nondrinkers, or with nonabdominal obesity had a positive association between fracture risk and the DII score. In sensitivity analyses, after excluding people with diabetes or hypertension, there was still a positive association between fracture risk and the DII score in women. Among the DII components, the DII scores of protein (trend: P=.03), niacin (trend: P=.002), and iron (trend: P=.02) showed significant associations with the risk of fracture in women. Conclusions: Proinflammatory diet consumption increased the fracture risk in Chinese women aged <50 years. The high consumption of anti-inflammatory foods and low consumption of proinflammatory foods may be an important strategy to prevent fractures in women. ", doi="10.2196/43501", url="https://publichealth.jmir.org/2023/1/e43501", url="http://www.ncbi.nlm.nih.gov/pubmed/37590048" } @Article{info:doi/10.2196/41021, author="Gosliner, Wendi and Felix, Celeste and Strochlic, Ron and Wright, Shana and Yates-Berg, Allison and Thompson, R. Hannah and Tang, Hao and Melendrez, Blanca", title="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", journal="J Med Internet Res", year="2023", month="Apr", day="19", volume="25", pages="e41021", keywords="SNAP", keywords="CalFresh", keywords="text", keywords="SMS text messaging", keywords="nutrition", keywords="fruits", keywords="vegetables", keywords="mHealth", abstract="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 {\textasciitilde}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. ", doi="10.2196/41021", url="https://www.jmir.org/2023/1/e41021", url="http://www.ncbi.nlm.nih.gov/pubmed/37074786" } @Article{info:doi/10.2196/45332, author="Razavi, Rouzbeh and Xue, Guisen", title="Predicting Unreported Micronutrients From Food Labels: Machine Learning Approach", journal="J Med Internet Res", year="2023", month="Apr", day="12", volume="25", pages="e45332", keywords="micronutrient deficiencies", keywords="micronutrient", keywords="food label", keywords="food", keywords="nutrition", keywords="nutrient", keywords="diet", keywords="machine learning", keywords="algorithm", keywords="predict", keywords="predictive model", keywords="nutrition mobile applications", keywords="mobile app", keywords="health app", keywords="mHealth", keywords="mobile health", abstract="Background: Micronutrient deficiencies represent a major global health issue, with over 2 billion individuals experiencing deficiencies in essential vitamins and minerals. Food labels provide consumers with information regarding the nutritional content of food items and have been identified as a potential tool for improving diets. However, due to governmental regulations and the physical limitations of the labels, food labels often lack comprehensive information about the vitamins and minerals present in foods. As a result, information about most of the micronutrients is absent from existing food labels. Objective: This paper aims to examine the possibility of using machine learning algorithms to predict unreported micronutrients such as vitamin A (retinol), vitamin C, vitamin B1 (thiamin), vitamin B2 (riboflavin), vitamin B3 (niacin), vitamin B6, vitamin B12, vitamin E (alpha-tocopherol), vitamin K, and minerals such as magnesium, zinc, phosphorus, selenium, manganese, and copper from nutrition information provided on existing food labels. If unreported micronutrients can be predicted with acceptable accuracies from existing food labels using machine learning predictive models, such models can be integrated into mobile apps to provide consumers with additional micronutrient information about foods and help them make more informed diet decisions. Methods: Data from the Food and Nutrient Database for Dietary Studies (FNDDS) data set, representing a total of 5624 foods, were used to train a diverse set of machine learning classification and regression algorithms to predict unreported vitamins and minerals from existing food label data. For each model, hyperparameters were adjusted, and the models were evaluated using repeated cross-validation to ensure that the reported results were not subject to overfitting. Results: According to the results, while predicting the exact quantity of vitamins and minerals is shown to be challenging, with regression R2 varying in a wide range from 0.28 (for magnesium) to 0.92 (for manganese), the classification models can accurately predict the category (``low,'' ``medium,'' or ``high'') level of all minerals and vitamins with accuracies exceeding 0.80. The highest classification accuracies for specific micronutrients are achieved for vitamin B12 (0.94) and phosphorus (0.94), while the lowest are for vitamin E (0.81) and selenium (0.83). Conclusions: This study demonstrates the feasibility of predicting unreported micronutrients from existing food labels using machine learning algorithms. The results show that the approach has the potential to significantly improve consumer knowledge about the micronutrient content of the foods they consume. Integrating these predictive models into mobile apps can enhance their accessibility and engagement with consumers. The implications of this research for public health are noteworthy, underscoring the potential of technology to augment consumers' understanding of the micronutrient content of their diets while also facilitating the tracking of food intake and providing personalized recommendations based on the micronutrient content and individual preferences. ", doi="10.2196/45332", url="https://www.jmir.org/2023/1/e45332", url="http://www.ncbi.nlm.nih.gov/pubmed/37043261" } @Article{info:doi/10.2196/37667, author="de Hoogh, M. Iris and Reinders, J. Machiel and Doets, L. Esm{\'e}e and Hoevenaars, M. Femke P. and Top, L. Jan", title="Design Issues in Personalized Nutrition Advice Systems", journal="J Med Internet Res", year="2023", month="Mar", day="29", volume="25", pages="e37667", keywords="personalized nutrition", keywords="eHealth design", keywords="health measurements", keywords="dietary advice", keywords="behavior change support", keywords="knowledge rules", keywords="modeling", keywords="sense", keywords="reason", keywords="act", doi="10.2196/37667", url="https://www.jmir.org/2023/1/e37667", url="http://www.ncbi.nlm.nih.gov/pubmed/36989039" } @Article{info:doi/10.2196/43537, author="Silva, Fl{\'a}via and Rodrigues Amorim Adegboye, Amanda and Lachat, Carl and Curioni, Cintia and Gomes, Fabio and Collins, S. Gary and Kac, Gilberto and de Beyer, Anne Jennifer and Cook, Jonathan and Ismail, Cheikh Leila and Page, Matthew and Khandpur, Neha and Lamb, Sarah and Hopewell, Sally and Kirtley, Shona and Dur{\~a}o, Solange and Vorland, J. Colby and Schlussel, M. Michael", title="Completeness of Reporting in Diet- and Nutrition-Related Randomized Controlled Trials and Systematic Reviews With Meta-Analysis: Protocol for 2 Independent Meta-Research Studies", journal="JMIR Res Protoc", year="2023", month="Mar", day="23", volume="12", pages="e43537", keywords="nutrition", keywords="diet", keywords="randomized controlled trials", keywords="CONSORT", keywords="TIDieR", keywords="PRISMA", keywords="spin", keywords="risk", keywords="bias", keywords="research", keywords="intervention", keywords="literature", keywords="limitations", keywords="PubMed", abstract="Background: Journal articles describing randomized controlled trials (RCTs) and systematic reviews with meta-analysis of RCTs are not optimally reported and often miss crucial details. This poor reporting makes assessing these studies' risk of bias or reproducing their results difficult. However, the reporting quality of diet- and nutrition-related RCTs and meta-analyses has not been explored. Objective: We aimed to assess the reporting completeness and identify the main reporting limitations of diet- and nutrition-related RCTs and meta-analyses of RCTs, estimate the frequency of reproducible research practices among these RCTs, and estimate the frequency of distorted presentation or spin among these meta-analyses. Methods: Two independent meta-research studies will be conducted using articles published in PubMed-indexed journals. The first will include a sample of diet- and nutrition-related RCTs; the second will include a sample of systematic reviews with meta-analysis of diet- and nutrition-related RCTs. A validated search strategy will be used to identify RCTs of nutritional interventions and an adapted strategy to identify meta-analyses in PubMed. We will search for RCTs and meta-analyses indexed in 1 calendar year and randomly select 100 RCTs (June 2021 to June 2022) and 100 meta-analyses (July 2021 to July 2022). Two reviewers will independently screen the titles and abstracts of records yielded by the searches, then read the full texts to confirm their eligibility. The general features of these published RCTs and meta-analyses will be extracted into a research electronic data capture database (REDCap; Vanderbilt University). The completeness of reporting of each RCT will be assessed using the items in the CONSORT (Consolidated Standards of Reporting Trials), its extensions, and the TIDieR (Template for Intervention Description and Replication) statements. Information about practices that promote research transparency and reproducibility, such as the publication of protocols and statistical analysis plans will be collected. There will be an assessment of the completeness of reporting of each meta-analysis using the items in the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statement and collection of information about spin in the abstracts and full-texts. The results will be presented as descriptive statistics in diagrams or tables. These 2 meta-research studies are registered in the Open Science Framework. Results: The literature search for the first meta-research retrieved 20,030 records and 2182 were potentially eligible. The literature search for the second meta-research retrieved 10,918 records and 850 were potentially eligible. Among them, random samples of 100 RCTs and 100 meta-analyses were selected for data extraction. Data extraction is currently in progress, and completion is expected by the beginning of 2023. Conclusions: Our meta-research studies will summarize the main limitation on reporting completeness of nutrition- or diet-related RCTs and meta-analyses and provide comprehensive information regarding the particularities in the reporting of intervention studies in the nutrition field. International Registered Report Identifier (IRRID): DERR1-10.2196/43537 ", doi="10.2196/43537", url="https://www.researchprotocols.org/2023/1/e43537", url="http://www.ncbi.nlm.nih.gov/pubmed/36951931" } @Article{info:doi/10.2196/41436, author="H{\"o}rold, Madlen and Apfelbacher, Christian and Gerhardinger, Katharina and Rohr, Magdalena and Schimmelpfennig, Maria and Weigt, Julia and Brandstetter, Susanne", title="Parents' and Health Care Professionals' Perspectives on Prevention and Prediction of Food Allergies in Children: Protocol for a Qualitative Study", journal="JMIR Res Protoc", year="2023", month="Mar", day="22", volume="12", pages="e41436", keywords="parents", keywords="health care professionals", keywords="content analysis", keywords="grounded theory", keywords="food allergy", keywords="children", keywords="allergic reaction", keywords="information needs", keywords="information seeking", keywords="prevention", keywords="prediction", keywords="risk factors", abstract="Background: Food allergy in children is increasing in prevalence in the western world and appears to become an important health problem. Parents of children at risk of food allergy live with the fear of allergic reaction, especially when the children are very young. The paradigm shift in allergy prevention in the last decade---away from allergen avoidance toward a tolerance induction approach---challenges both parents and health care professionals, as they have to deal with changing information and new evidence that often contradicts previous assumptions. Yet, research on health information--seeking behavior and needs of parents on primary prevention of food allergy in children as well as on prediction and prevention strategies of German health care professionals is lacking. Objective: The aim of the study is to explore and understand parents' and health care professionals' perspectives on the prediction and prevention of food allergies. We are particularly interested in information needs, information seeking, and health care usage and place a special focus on families' experiences when their child is at risk or diagnosed with food allergies. Furthermore, food allergy prediction and prevention strategies of health care professionals will be explored. Methods: This study is part of the NAMIBIO (food allergy biomarker) app consortium, which aims to identify early predictors for the development of food allergy in children and develop apps to guide health care professionals and parents of children with a high risk of food allergy toward prevention and timely tolerance induction. The study uses a qualitative approach with topic-guided interviews and focus groups with parents of children (0-3 years) and health care professionals. Data collection will continue until theoretical saturation is reached. The qualitative content analysis will be used according to Kuckartz to identify overarching themes toward information needs and seeking behavior as well as usage of health care and health care professionals' predictive and preventive strategies. In addition, a constructivist grounded theory approach will be used to explore and understand parents' experiences, interactions, and social processes in families in daily life. Results: Recruitment and data collection started in February 2022 and is still ongoing. Conclusions: The qualitative study will provide insight into parents' information-seeking behavior and needs regarding the prevention of food allergy in children, parents' use of pediatric primary care, and health care professionals strategies for the prediction and prevention of food allergies in children. We assume that our results will highlight the challenges associated with the paradigm shift in allergy prevention for both parents and health care professionals. The results will be used to make practical recommendations from the user's perspective and inform the development of the NAMIBIO apps. International Registered Report Identifier (IRRID): DERR1-10.2196/41436 ", doi="10.2196/41436", url="https://www.researchprotocols.org/2023/1/e41436", url="http://www.ncbi.nlm.nih.gov/pubmed/36947117" } @Article{info:doi/10.2196/41636, author="Al-Shami, Islam and Al Hourani, Huda and Alkhatib, Buthaina and Alboqai, Omar and AlHalaika, Dima and Al-Jawaldeh, Ayoub", title="Jordan's Population-Based Food Consumption Survey: Protocol for Design and Development", journal="JMIR Res Protoc", year="2023", month="Feb", day="17", volume="12", pages="e41636", keywords="household", keywords="food consumption", keywords="24-hour dietary recall", keywords="children", keywords="adolescents", keywords="adults", keywords="older adults", keywords="overweight", keywords="obesity", abstract="Background: One of the factors influencing health and well-being is dietary patterns. Data on food consumption are necessary for evaluating and developing community nutrition policies. Few studies on Jordanians' food consumption and dietary habits at various ages have been conducted, despite the increased prevalence of overweight, obesity, and chronic diseases. This will be the first study focusing on Jordanians' food consumption patterns that includes children, adolescents, adults, and older adults. Objective: This cross-sectional study aims to describe the design and methodology of the Jordan's Population-based Food Consumption Survey, 2021-2022, which was developed to collect data on food consumption, including energy, nutrients, and food group intake, from a representative sample of Jordanians and to determine the prevalence of overweight and obesity and their relationship to food consumption. Methods: Participants were selected by stratified random sampling, using the Estimated Population of the Kingdom by Governorate, Locality, Sex, and Households, 2020 as the sampling frame. The food consumption survey sample was at the population level, representing gender and age classes (8-85 years old). The data collection period was 6 months. Food consumption was assessed using 24-hour dietary recall (2 nonconsecutive days, 1 week apart) interviews representing weekdays and weekends. In addition to data on food consumption, information on the use of food supplements, sociodemographic and socioeconomic status, and health was gathered. Weight, height, and waist circumference were all measured. Results: The survey included 632 households with 2145 participants, of which 243 (11.3\%) were children, 374 (17.4\%) were adolescents, 1428 (66.6\%) were adults, and 99 (4.6\%) were older adults. Three food consumption databases were used to stratify the mean 24-hour dietary recall food consumption into energy intake, carbohydrates, proteins, fats, fiber, vitamins and minerals, and food groups. BMI was calculated and classified as normal, overweight, or obese. Central obesity was classified as normal or abnormal based on the waist-to-height ratio. The survey results will be disseminated based on age, energy, nutrient, and food group consumption. The prevalence of overweight and obesity by age group will be presented, as well as a comparison to the situation in Eastern Mediterranean countries. Conclusions: The survey data will be helpful in nutritional studies, assessing changes in dietary patterns, and developing and evaluating nutrition or health policies. It will be a solid base for developing a future national surveillance system on food consumption patterns with comprehensive food consumption, physical activity, biochemical, and blood pressure data. International Registered Report Identifier (IRRID): DERR1-10.2196/41636 ", doi="10.2196/41636", url="https://www.researchprotocols.org/2023/1/e41636", url="http://www.ncbi.nlm.nih.gov/pubmed/36800239" } @Article{info:doi/10.2196/39340, author="Li, Chuqin and Jordan, Alexis and Song, Jun and Ge, Yaorong and Park, Albert", title="A Novel Approach to Characterize State-level Food Environment and Predict Obesity Rate Using Social Media Data: Correlational Study", journal="J Med Internet Res", year="2022", month="Dec", day="13", volume="24", number="12", pages="e39340", keywords="obesity", keywords="social media", keywords="machine learning", keywords="lifestyle", keywords="environment", keywords="food", keywords="correlation", keywords="modeling", keywords="predict", keywords="rates", keywords="outcome", keywords="category", keywords="dishes", keywords="popular", keywords="mobile phone", abstract="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. ", doi="10.2196/39340", url="https://www.jmir.org/2022/12/e39340", url="http://www.ncbi.nlm.nih.gov/pubmed/36512396" } @Article{info:doi/10.2196/37389, author="Stewart, Cristina and Piernas, Carmen and Frie, Kerstin and Cook, Brian and Jebb, A. Susan", title="Evaluation of OPTIMISE (Online Programme to Tackle Individual's Meat Intake Through Self-regulation): Cohort Study", journal="J Med Internet Res", year="2022", month="Dec", day="12", volume="24", number="12", pages="e37389", keywords="self-regulation", keywords="self-monitoring", keywords="goal setting", keywords="meat intake", keywords="meat reduction", keywords="multi-component intervention", keywords="health", keywords="nutrition", keywords="diet", abstract="Background: There is an urgent need to reduce society's meat consumption to help mitigate climate change and reduce noncommunicable diseases. Objective: This study aimed to investigate changes in meat intake after participation in an online, multicomponent, self-regulation intervention. Methods: We conducted a pre-post observational study among adult meat eaters in the United Kingdom who signed up to a website offering support based on self-regulation theory to reduce meat consumption. The program lasted 9 weeks (including a 1-week baseline phase, a 4-week active intervention phase, and a 4-week maintenance phase), comprising self-monitoring, goal setting, action planning, and health and environmental feedback. Meat intake was estimated during weeks 1, 5, and 9 using a 7-day meat frequency questionnaire. We analyzed the change in mean daily meat intake from baseline to week 5 and week 9 among those reporting data using a hierarchical linear mixed model. We assessed changes in attitudes toward meat consumption by questionnaire and considered the acceptability and feasibility of the intervention. Results: The baseline cohort consisted of 289 participants, of whom 77 were analyzed at week 5 (26.6\% of the baseline sample) and 55 at week 9 (71.4\% of the week 5 sample). We observed large reductions in meat intake at 5 and 9 weeks: --57 (95\% CI --70 to --43) g/day (P<.001) and --49 (95\% CI --64 to --34) g/day (P<.001), respectively. Participants' meat-free self-efficacy increased, meat-eating identities moved toward reduced-meat and non--meat-eating identities, and perceptions of meat consumption as the social norm reduced. Participants who completed the study reported high engagement and satisfaction with the intervention. Conclusions: Among people motivated to engage, this online self-regulation program may lead to large reductions in meat intake for more than 2 months, with promising signs of a change in meat-eating identity toward more plant-based diets. This digital behavior change intervention could be offered to complement population-level interventions to support reduction of meat consumption. ", doi="10.2196/37389", url="https://www.jmir.org/2022/12/e37389", url="http://www.ncbi.nlm.nih.gov/pubmed/36508245" } @Article{info:doi/10.2196/40123, author="Hermsen, Sander and van Kraaij, Alex and Camps, Guido", title="Low-- and Medium--Socioeconomic-Status Group Members' Perceived Challenges and Solutions for Healthy Nutrition: Qualitative Focus Group Study", journal="JMIR Hum Factors", year="2022", month="Dec", day="2", volume="9", number="4", pages="e40123", keywords="nutrition", keywords="citizen science", keywords="socioeconomic status", keywords="digital technology", abstract="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. ", doi="10.2196/40123", url="https://humanfactors.jmir.org/2022/4/e40123", url="http://www.ncbi.nlm.nih.gov/pubmed/36459403" } @Article{info:doi/10.2196/40449, author="Moyen, Audrey and Rappaport, Ilysse Aviva and Fleurent-Gr{\'e}goire, Chlo{\'e} and Tessier, Anne-Julie and Brazeau, Anne-Sophie and Chevalier, St{\'e}phanie", title="Relative Validation of an Artificial Intelligence--Enhanced, Image-Assisted Mobile App for Dietary Assessment in Adults: Randomized Crossover Study", journal="J Med Internet Res", year="2022", month="Nov", day="21", volume="24", number="11", pages="e40449", keywords="dietary intake", keywords="dietary assessment", keywords="food diary", keywords="food records", keywords="automated self-administered 24-hour recall", keywords="ASA24", keywords="Keenoa", abstract="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 $\kappa$ 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 $\kappa$ 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. ", doi="10.2196/40449", url="https://www.jmir.org/2022/11/e40449", url="http://www.ncbi.nlm.nih.gov/pubmed/36409539" } @Article{info:doi/10.2196/37590, author="Pfisterer, Kaylen and Amelard, Robert and Boger, Jennifer and Keller, Heather and Chung, Audrey and Wong, Alexander", title="Enhancing Food Intake Tracking in Long-term Care With Automated Food Imaging and Nutrient Intake Tracking (AFINI-T) Technology: Validation and Feasibility Assessment", journal="JMIR Aging", year="2022", month="Nov", day="17", volume="5", number="4", pages="e37590", keywords="long-term care", keywords="automated nutrient intake", keywords="convolutional neural network", keywords="food segmentation", keywords="food classification", keywords="depth imaging", keywords="deep learning", keywords="collaborative design", keywords="aging", keywords="food intake", abstract="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 ($\sigma$=?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. ", doi="10.2196/37590", url="https://aging.jmir.org/2022/4/e37590", url="http://www.ncbi.nlm.nih.gov/pubmed/36394940" } @Article{info:doi/10.2196/34497, author="Kaiser, Birgit and Stelzl, Tamara and Finglas, Paul and Gedrich, Kurt", title="The Assessment of a Personalized Nutrition Tool (eNutri) in Germany: Pilot Study on Usability Metrics and Users' Experiences", journal="JMIR Form Res", year="2022", month="Aug", day="4", volume="6", number="8", pages="e34497", keywords="Food Frequency Questionnaire", keywords="dietary assessment", keywords="Diet Quality Score", keywords="web application", keywords="digital nutrition", keywords="personalized nutrition", keywords="system usability", keywords="internet", keywords="eNutri", keywords="EIT Food Quisper", abstract="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. ", doi="10.2196/34497", url="https://formative.jmir.org/2022/8/e34497", url="http://www.ncbi.nlm.nih.gov/pubmed/35925664" } @Article{info:doi/10.2196/34285, author="Sigalo, Nekabari and St Jean, Beth and Frias-Martinez, Vanessa", title="Using Social Media to Predict Food Deserts in the United States: Infodemiology Study of Tweets", journal="JMIR Public Health Surveill", year="2022", month="Jul", day="5", volume="8", number="7", pages="e34285", keywords="social media", keywords="Twitter", keywords="food deserts", keywords="food insecurity", abstract="Background: The issue of food insecurity is becoming increasingly important to public health practitioners because of the adverse health outcomes and underlying racial disparities associated with insufficient access to healthy foods. Prior research has used data sources such as surveys, geographic information systems, and food store assessments to identify regions classified as food deserts but perhaps the individuals in these regions unknowingly provide their own accounts of food consumption and food insecurity through social media. Social media data have proved useful in answering questions related to public health; therefore, these data are a rich source for identifying food deserts in the United States. Objective: The aim of this study was to develop, from geotagged Twitter data, a predictive model for the identification of food deserts in the United States using the linguistic constructs found in food-related tweets. Methods: Twitter's streaming application programming interface was used to collect a random 1\% sample of public geolocated tweets across 25 major cities from March 2020 to December 2020. A total of 60,174 geolocated food-related tweets were collected across the 25 cities. Each geolocated tweet was mapped to its respective census tract using point-to-polygon mapping, which allowed us to develop census tract--level features derived from the linguistic constructs found in food-related tweets, such as tweet sentiment and average nutritional value of foods mentioned in the tweets. These features were then used to examine the associations between food desert status and the food ingestion language and sentiment of tweets in a census tract and to determine whether food-related tweets can be used to infer census tract--level food desert status. Results: We found associations between a census tract being classified as a food desert and an increase in the number of tweets in a census tract that mentioned unhealthy foods (P=.03), including foods high in cholesterol (P=.02) or low in key nutrients such as potassium (P=.01). We also found an association between a census tract being classified as a food desert and an increase in the proportion of tweets that mentioned healthy foods (P=.03) and fast-food restaurants (P=.01) with positive sentiment. In addition, we found that including food ingestion language derived from tweets in classification models that predict food desert status improves model performance compared with baseline models that only include socioeconomic characteristics. Conclusions: Social media data have been increasingly used to answer questions related to health and well-being. Using Twitter data, we found that food-related tweets can be used to develop models for predicting census tract food desert status with high accuracy and improve over baseline models. Food ingestion language found in tweets, such as census tract--level measures of food sentiment and healthiness, are associated with census tract--level food desert status. ", doi="10.2196/34285", url="https://publichealth.jmir.org/2022/7/e34285", url="http://www.ncbi.nlm.nih.gov/pubmed/35788108" } @Article{info:doi/10.2196/27760, author="Pearson, Nicole and Finch, Meghan and Sutherland, Rachel and Kingsland, Melanie and Wolfenden, Luke and Wedesweiler, Taya and Herrmann, Vanessa and Yoong, Lin Sze", title="An mHealth Intervention to Reduce the Packing of Discretionary Foods in Children's Lunch Boxes in Early Childhood Education and Care Services: Cluster Randomized Controlled Trial", journal="J Med Internet Res", year="2022", month="Mar", day="17", volume="24", number="3", pages="e27760", keywords="nutrition", keywords="mHealth", keywords="child", keywords="preschool", keywords="parents", abstract="Background: Interventions in early childhood education and care (ECEC) services have the potential to improve children's diet at the population level. Objective: This study aims to test the efficacy of a mobile health intervention in ECEC services to reduce parent packing of foods high in saturated fat, sugar, and sodium (discretionary foods) in children's (aged 3-6 years) lunch boxes. Methods: A cluster randomized controlled trial was undertaken with 355 parent and child dyads recruited by phone and in person from 17 ECEC services (8 [47\%] intervention and 9 [53\%] control services). Parents in the intervention group received a 10-week fully automated program targeting barriers to packing healthy lunch boxes delivered via an existing service communication app. The program included weekly push notifications, within-app messages, and links to further resources, including websites and videos. The control group did not receive any intervention. The primary outcomes were kilojoules from discretionary foods and associated nutrients (saturated fat, free sugars, and sodium) packed in children's lunch boxes. Secondary outcomes included consumption of kilojoules from discretionary foods and related nutrients and the packing and consumption of serves of discretionary foods and core food groups. Photography and weights of foods in children's lunch boxes were recorded by trained researchers before and after the trial to assess primary and secondary outcomes. Outcome assessors were blinded to service allocation. Feasibility, appropriateness, and acceptability were assessed via an ECEC service manager survey and a parent web-based survey. Use of the app was assessed via app analytics. Results: Data on packed lunch box contents were collected for 88.8\% (355/400) of consenting children at baseline and 84.3\% (337/400) of children after the intervention. There was no significant difference between groups in kilojoule from discretionary foods packed (77.84 kJ, 95\% CI ?163.49 to 319.18; P=.53) or the other primary or secondary outcomes. The per-protocol analysis, including only data from children of parents who downloaded the app, also did not find any statistically significant change in primary (?1.98 kJ, 95\% CI ?343.87 to 339.90; P=.86) or secondary outcomes. Approximately 61.8\% (102/165) of parents in the intervention group downloaded the app, and the mean service viewing rate of weekly within-app messages was 26\% (SD 14.9). Parents who responded to the survey and participating services agreed that it was appropriate to receive lunch box information via the app (40/50, 80\% and 6/8, 75\%, respectively). Conclusions: The intervention was unable to demonstrate an impact on kilojoules or associated nutrients from discretionary foods packed in children's lunch boxes. Low app downloads and program message views indicate a need to explore how to improve factors related to implementation before further testing similar mobile health interventions in this setting. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000133235; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374379 ", doi="10.2196/27760", url="https://www.jmir.org/2022/3/e27760", url="http://www.ncbi.nlm.nih.gov/pubmed/35297768" } @Article{info:doi/10.2196/31875, author="Sasaki, Yuki and Sato, Koryu and Kobayashi, Satomi and Asakura, Keiko", title="Nutrient and Food Group Prediction as Orchestrated by an Automated Image Recognition System in a Smartphone App (CALO mama): Validation Study", journal="JMIR Form Res", year="2022", month="Jan", day="10", volume="6", number="1", pages="e31875", keywords="health app", keywords="image recognition", keywords="automatic calculation", keywords="nutrient and food contents", keywords="validity", keywords="mobile phone", keywords="mHealth", keywords="validation", keywords="nutrition", keywords="diet", keywords="food", abstract="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. ", doi="10.2196/31875", url="https://formative.jmir.org/2022/1/e31875", url="http://www.ncbi.nlm.nih.gov/pubmed/35006077" } @Article{info:doi/10.2196/30909, author="Braakhuis, Andrea and Gillies, Nicola and Worthington, Anna and Knowles, Scott and Conner, Tamlin and Roy, Rajshri and Pham, Toan and Bermingham, Emma and Cameron-Smith, David", title="A Modern Flexitarian Dietary Intervention Incorporating Web-Based Nutrition Education in Healthy Young Adults: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Dec", day="21", volume="10", number="12", pages="e30909", keywords="protein", keywords="meat", keywords="vegetarian", keywords="eating patterns", keywords="diet", keywords="nutrition", keywords="dietary restrictions", keywords="biomarkers", keywords="health", keywords="well-being", keywords="macronutrients", keywords="micronutrients", abstract="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 ", doi="10.2196/30909", url="https://www.researchprotocols.org/2021/12/e30909", url="http://www.ncbi.nlm.nih.gov/pubmed/34931994" } @Article{info:doi/10.2196/30131, author="Ilesanmi-Oyelere, Lilian Bolaji and Roy, C. Nicole and Kruger, C. Marlena", title="Modulation of Bone and Joint Biomarkers, Gut Microbiota, and Inflammation Status by Synbiotic Supplementation and Weight-Bearing Exercise: Human Study Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Oct", day="26", volume="10", number="10", pages="e30131", keywords="synbiotic (prebiotic+probiotic)", keywords="weight-bearing exercise", keywords="gut microbiota", keywords="inflammation", keywords="BMD", keywords="cytokines", keywords="bone and joint biomarkers", abstract="Background: There is strong evidence suggesting that prebiotics and probiotics regulate gut microbiota, reducing inflammation and thereby potentially improving bone health status. Similarly, mechanistic evidence suggests that either low-impact or high-impact weight-bearing exercises improve body composition and consequently increase bone mineral density in individuals with osteoporosis and osteoarthritis. Objective: This study aims to investigate the effects of a synbiotic (probiotic+prebiotic) supplementation, an exercise intervention, or a combination of both on gut microbiota, inflammation, and bone biomarkers in postmenopausal women. Methods: A total of 160 postmenopausal women from New Zealand will be recruited and randomized to one of four interventions or treatments for 12 weeks: control, synbiotic supplementation, exercise intervention, or synbiotic supplementation and exercise. The primary outcome measure is the bone and joint biomarkers at baseline and week 12, whereas the gut microbiota profile and inflammatory cytokine measurements will serve as the secondary outcome measures at baseline and week 12. Baseline data and exercise history will be used to assess, allocate, and stratify participants into treatment measures. Results: Recruitment of participants will begin in September 2021, and the anticipated completion date is June 2022. Conclusions: To the best of our knowledge, this will be the first randomized controlled trial to analyze the effects of both a synbiotic supplement and an exercise intervention in postmenopausal women. On the basis of the results obtained, a combination of synbiotic supplements and exercise might serve as a noninvasive approach to manage and/or improve body composition and bone health in postmenopausal women. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000998943p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380336\&isClinicalTrial=False ", doi="10.2196/30131", url="https://www.researchprotocols.org/2021/10/e30131", url="http://www.ncbi.nlm.nih.gov/pubmed/34698648" } @Article{info:doi/10.2196/32298, author="Shea, Benjamin and Bakre, Shivani and Carano, Keaton and Scharen, Jared and Langheier, Jason and Hu, A. Emily", title="Changes in Glycemic Control Among Individuals With Diabetes Who Used a Personalized Digital Nutrition Platform: Longitudinal Study", journal="JMIR Diabetes", year="2021", month="Oct", day="18", volume="6", number="4", pages="e32298", keywords="diabetes", keywords="hyperglycemia", keywords="hemoglobin A1c", keywords="HbA1c", keywords="blood glucose", keywords="digital health", keywords="nutrition", keywords="meal planning", keywords="food environment", keywords="food ordering", keywords="food purchasing", keywords="platform", keywords="longitudinal", keywords="characteristic", keywords="diet", keywords="education", abstract="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. ", doi="10.2196/32298", url="https://diabetes.jmir.org/2021/4/e32298", url="http://www.ncbi.nlm.nih.gov/pubmed/34661545" } @Article{info:doi/10.2196/29046, author="Kinney, A. Gigi and Haddad, N. Eliot and Garrow, S. Linda and Ng, W. Perry K. and Comstock, S. Sarah", title="An Intervention With Michigan-Grown Wheat in Healthy Adult Humans to Determine Effect on Gut Microbiota: Protocol for a Crossover Trial", journal="JMIR Res Protoc", year="2021", month="Oct", day="6", volume="10", number="10", pages="e29046", keywords="fiber", keywords="microbiota", keywords="whole grain", keywords="wheat", keywords="butyrate", keywords="calprotectin", keywords="lipocalin-2", abstract="Background: Daily fiber intake can increase the diversity of the human gut microbiota as well as the abundance of beneficial microbes and their metabolites. Whole-grain wheat is high in fiber. Objective: This manuscript presents a study protocol designed to understand the effects of different types of wheat on gastrointestinal tract microbes. Methods: Human adults will consume crackers made from three types of wheat flour (refined soft white wheat, whole-grain soft white wheat, and whole-grain soft red wheat). In this study, participants will alternate between crackers made from refined soft white wheat flour to those made from whole-grain soft white wheat and whole-grain soft red wheat flour. Survey and stool sample collection will occur after 7-day treatment periods. We will assess how wheat consumption affects gastrointestinal bacteria by sequencing the V4 region of 16S rRNA gene amplicons and the inflammatory state of participants' intestines using enzyme-linked immunosorbent assays. The butyrate production capacity of the gut microbiota will be determined by targeted quantitative real-time polymerase chain reaction. Results: We will report the treatment effects on alpha and beta diversity of the microbiota and taxa-specific differences. Microbiota results will be analyzed using the vegan package in R. Butyrate production capacity and biomarkers of intestinal inflammation will be analyzed using parametric statistical methods such as analysis of variance or linear regression. We expect whole wheat intake to increase butyrate production capacity, bacterial alpha diversity, and abundance of bacterial taxa responsive to phenolic compounds. Soft red wheat is also expected to decrease the concentration of inflammatory biomarkers in the stool of participants. Conclusions: This protocol describes the methods to be used in a study on the impact of wheat types on the human gastrointestinal microbiota and biomarkers of intestinal inflammation. The analysis of intestinal responses to the consumption of two types of whole wheat will expand our understanding of how specific foods affect health-associated outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/29046 ", doi="10.2196/29046", url="https://www.researchprotocols.org/2021/10/e29046", url="http://www.ncbi.nlm.nih.gov/pubmed/34612840" } @Article{info:doi/10.2196/27285, author="Wang, Jin and Pan, Chen and Ma, Xianghua", title="Assessment of the Quality Management System for Clinical Nutrition in Jiangsu: Survey Study", journal="JMIR Form Res", year="2021", month="Sep", day="27", volume="5", number="9", pages="e27285", keywords="quality management system", keywords="human resource management", keywords="artificial intelligence", keywords="online health", keywords="health science", keywords="clinical nutrition", keywords="online platform", keywords="health platform", keywords="nutrition", keywords="patient education", keywords="dietitian", abstract="Background: An electronic system that automatically collects medical information can realize timely monitoring of patient health and improve the effectiveness and accuracy of medical treatment. To our knowledge, the application of artificial intelligence (AI) in medical service quality assessment has been minimally evaluated, especially for clinical nutrition departments in China. From the perspective of medical ethics, patient safety comes before any other factors within health science, and this responsibility belongs to the quality management system (QMS) within medical institutions. Objective: This study aims to evaluate the QMS for clinical nutrition in Jiangsu, monitor its performance in quality assessment and human resource management from a nutrition aspect, and investigate the application and development of AI in medical quality control. Methods: The participants for this study were the staff of 70 clinical nutrition departments of the tertiary hospitals in Jiangsu Province, China. These departments are all members of the Quality Management System of Clinical Nutrition in Jiangsu (QMSNJ). An online survey was conducted on all 341 employees within all clinical nutrition departments based on the staff information from the surveyed medical institutions. The questionnaire contains five sections, and the data analysis and AI evaluation were focused on human resource information. Results: A total of 330 questionnaires were collected, with a response rate of 96.77\% (330/341). A QMS for clinical nutrition was built for clinical nutrition departments in Jiangsu and achieved its target of human resource improvements, especially among dietitians. The growing number of participating departments (an increase of 42.8\% from 2018 to 2020) and the significant growth of dietitians (t93.4=--0.42; P=.02) both show the advancements of the QMSNJ. Conclusions: As the first innovation of an online platform for quality management in Jiangsu, the Jiangsu Province Clinical Nutrition Management Platform was successfully implemented as a QMS for this study. This multidimensional electronic system can help the QMSNJ and clinical nutrition departments achieve quality assessment from various aspects so as to realize the continuous improvement of clinical nutrition. The use of an online platform and AI technology for quality assessment is worth recommending and promoting in the future. ", doi="10.2196/27285", url="https://formative.jmir.org/2021/9/e27285", url="http://www.ncbi.nlm.nih.gov/pubmed/34569942" } @Article{info:doi/10.2196/31389, author="Bhawra, Jasmin and Skinner, Kelly and Favel, Duane and Green, Brenda and Coates, Ken and Katapally, Reddy Tarun", title="The Food Equity and Environmental Data Sovereignty (FEEDS) Project: Protocol for a Quasi-Experimental Study Evaluating a Digital Platform for Climate Change Preparedness", journal="JMIR Res Protoc", year="2021", month="Sep", day="15", volume="10", number="9", pages="e31389", keywords="food security", keywords="food sovereignty", keywords="food equity", keywords="mental health", keywords="solastalgia", keywords="climate change impacts", keywords="climate change preparedness", keywords="digital health", keywords="digital dashboards", keywords="Indigenous health", keywords="mobile phone", abstract="Background: Despite having the tools at our disposal to enable an adequate food supply for all people, inequities in food acquisition, distribution, and most importantly, food sovereignty, worsen food insecurity. The detrimental impact of climate change on food systems and mental health is further exacerbated by a lack of food sovereignty. We urgently require innovative solutions to enable food sovereignty, minimize food insecurity, and address climate change--related mental distress (ie, solastalgia). Indigenous communities have a wealth of Traditional Knowledge for climate change adaptation and preparedness to strengthen food systems. Traditional Knowledge combined with Western methods can revolutionize ethical data collection, engagement, and knowledge mobilization. Objective: The Food Equity and Environmental Data Sovereignty (FEEDS) Project takes a participatory action, citizen science approach for early detection and warning of climate change impacts on food sovereignty, food security, and solastalgia. The aim of this project is to develop and implement a sustainable digital platform that enables real-time decision-making to mitigate climate change--related impacts on food systems and mental well-being. Methods: Citizen science enables citizens to actively contribute to all aspects of the research process. The FEEDS Project is being implemented in five phases: participatory project planning, digital climate change platform customization, community-led evaluation, digital platform and project refinement, and integrated knowledge translation. The project is governed by a Citizen Scientist Advisory Council comprising Elders, Traditional Knowledge Keepers, key community decision makers, youth, and FEEDS Project researchers. The Council governs all phases of the project, including coconceptualizing a climate change platform, which consists of a smartphone app and a digital decision-making dashboard. Apart from capturing environmental and health-related big data (eg, weather, permafrost degradation, fire hazards, and human movement), the custom-built app uses artificial intelligence to engage and enable citizens to report on environmental hazards, changes in biodiversity or wildlife, and related food and mental health issues in their communities. The app provides citizens with valuable information to mitigate health-related risks and relays big data in real time to a digital dashboard. Results: This project is currently in phase 1, with the subarctic M{\'e}tis jurisdiction of {\^I}le-{\`a}-la-Crosse, Saskatchewan, Canada. Conclusions: The FEEDS Project facilitates Indigenous Peoples' self-determination, governance, and data sovereignty. All citizen data are anonymous and encrypted, and communities have ownership, access, control, and possession of their data. The digital dashboard system provides decision makers with real-time data, thereby increasing the capacity to self-govern. The participatory action research approach, combined with digital citizen science, advances the cocreation of knowledge and multidisciplinary collaboration in the digital age. Given the urgency of climate change, leveraging technology provides communities with tools to respond to existing and emerging crises in a timely manner, as well as scientific evidence regarding the urgency of current health and environmental issues. International Registered Report Identifier (IRRID): PRR1-10.2196/31389 ", doi="10.2196/31389", url="https://www.researchprotocols.org/2021/9/e31389", url="http://www.ncbi.nlm.nih.gov/pubmed/34524106" } @Article{info:doi/10.2196/26054, author="Wyse, Rebecca and Delaney, Tessa and Stacey, Fiona and Zoetemeyer, Rachel and Lecathelinais, Christophe and Lamont, Hannah and Ball, Kylie and Campbell, Karen and Rissel, Chris and Attia, John and Wiggers, John and Yoong, Lin Sze and Oldmeadow, Christopher and Sutherland, Rachel and Nathan, Nicole and Reilly, Kathryn and Wolfenden, Luke", title="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", journal="J Med Internet Res", year="2021", month="Sep", day="7", volume="23", number="9", pages="e26054", keywords="nudge", keywords="choice architecture", keywords="intervention", keywords="online canteen", keywords="online ordering systems", keywords="digital interventions", keywords="school children", keywords="school food service", keywords="canteens", keywords="menu labeling", abstract="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 ", doi="10.2196/26054", url="https://www.jmir.org/2021/9/e26054", url="http://www.ncbi.nlm.nih.gov/pubmed/34491207" } @Article{info:doi/10.2196/28229, author="Stojanov, Riste and Popovski, Gorjan and Cenikj, Gjorgjina and Korou{\vs}i{\'c} Seljak, Barbara and Eftimov, Tome", title="A Fine-Tuned Bidirectional Encoder Representations From Transformers Model for Food Named-Entity Recognition: Algorithm Development and Validation", journal="J Med Internet Res", year="2021", month="Aug", day="9", volume="23", number="8", pages="e28229", keywords="food information extraction", keywords="named-entity recognition", keywords="fine-tuning BERT", keywords="semantic annotation", keywords="information extraction", keywords="BERT", keywords="bidirectional encoder representations from transformers", keywords="natural language processing", keywords="machine learning", abstract="Background: Recently, food science has been garnering a lot of attention. There are many open research questions on food interactions, as one of the main environmental factors, with other health-related entities such as diseases, treatments, and drugs. In the last 2 decades, a large amount of work has been done in natural language processing and machine learning to enable biomedical information extraction. However, machine learning in food science domains remains inadequately resourced, which brings to attention the problem of developing methods for food information extraction. There are only few food semantic resources and few rule-based methods for food information extraction, which often depend on some external resources. However, an annotated corpus with food entities along with their normalization was published in 2019 by using several food semantic resources. Objective: In this study, we investigated how the recently published bidirectional encoder representations from transformers (BERT) model, which provides state-of-the-art results in information extraction, can be fine-tuned for food information extraction. Methods: We introduce FoodNER, which is a collection of corpus-based food named-entity recognition methods. It consists of 15 different models obtained by fine-tuning 3 pretrained BERT models on 5 groups of semantic resources: food versus nonfood entity, 2 subsets of Hansard food semantic tags, FoodOn semantic tags, and Systematized Nomenclature of Medicine Clinical Terms food semantic tags. Results: All BERT models provided very promising results with 93.30\% to 94.31\% macro F1 scores in the task of distinguishing food versus nonfood entity, which represents the new state-of-the-art technology in food information extraction. Considering the tasks where semantic tags are predicted, all BERT models obtained very promising results once again, with their macro F1 scores ranging from 73.39\% to 78.96\%. Conclusions: FoodNER can be used to extract and annotate food entities in 5 different tasks: food versus nonfood entities and distinguishing food entities on the level of food groups by using the closest Hansard semantic tags, the parent Hansard semantic tags, the FoodOn semantic tags, or the Systematized Nomenclature of Medicine Clinical Terms semantic tags. ", doi="10.2196/28229", url="https://www.jmir.org/2021/8/e28229", url="http://www.ncbi.nlm.nih.gov/pubmed/34383671" } @Article{info:doi/10.2196/17780, author="Mottas, Antoine and Lappi, Veli-Matti and Sundstr{\"o}m, Johan and Neal, Bruce and Mhurchu, Ni Cliona and L{\"o}f, Marie and R{\aa}dholm, Karin", title="Measuring the Healthiness of Ready-to-Eat Child-Targeted Cereals: Evaluation of the FoodSwitch Platform in Sweden", journal="JMIR Mhealth Uhealth", year="2021", month="Jul", day="22", volume="9", number="7", pages="e17780", keywords="breakfast cereals", keywords="child-targeted cereals", keywords="front-of-pack labels", keywords="Keyhole symbol", keywords="Health Star Rating", keywords="FoodSwitch", keywords="diet", keywords="food intake", abstract="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. ", doi="10.2196/17780", url="https://mhealth.jmir.org/2021/7/e17780", url="http://www.ncbi.nlm.nih.gov/pubmed/34292165" } @Article{info:doi/10.2196/28392, author="Hu, A. Emily and Scharen, Jared and Nguyen, Viet and Langheier, Jason", title="Evaluating the Impact of a Digital Nutrition Platform on Cholesterol Levels in Users With Dyslipidemia: Longitudinal Study", journal="JMIR Cardio", year="2021", month="Jun", day="10", volume="5", number="1", pages="e28392", keywords="dyslipidemia", keywords="hyperlipidemia", keywords="lipids", keywords="cholesterol", keywords="digital", keywords="nutrition", keywords="meal planning", keywords="food environment", keywords="food ordering", keywords="food purchasing", abstract="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. ", doi="10.2196/28392", url="https://cardio.jmir.org/2021/1/e28392", url="http://www.ncbi.nlm.nih.gov/pubmed/34110291" } @Article{info:doi/10.2196/22717, author="Kamyari, Naser and Soltanian, Reza Ali and Mahjub, Hossein and Moghimbeigi, Abbas", title="Diet, Nutrition, Obesity, and Their Implications for COVID-19 Mortality: Development of a Marginalized Two-Part Model for Semicontinuous Data", journal="JMIR Public Health Surveill", year="2021", month="Jan", day="26", volume="7", number="1", pages="e22717", keywords="COVID-19", keywords="diet", keywords="nutrition", keywords="obesity", keywords="marginalized two-part model", keywords="semicontinuous data", abstract="Background: Nutrition is not a treatment for COVID-19, but it is a modifiable contributor to the development of chronic disease, which is highly associated with COVID-19 severe illness and deaths. A well-balanced diet and healthy patterns of eating strengthen the immune system, improve immunometabolism, and reduce the risk of chronic disease and infectious diseases. Objective: This study aims to assess the effect of diet, nutrition, obesity, and their implications for COVID-19 mortality among 188 countries by using new statistical marginalized two-part models. Methods: We globally evaluated the distribution of diet and nutrition at the national level while considering the variations between different World Health Organization regions. The effects of food supply categories and obesity on (as well as associations with) the number of deaths and the number of recoveries were reported globally by estimating coefficients and conducting color maps. Results: The findings show that a 1\% increase in supplementation of pulses reduced the odds of having a zero death by 4-fold (OR 4.12, 95\% CI 11.97-1.42). In addition, a 1\% increase in supplementation of animal products and meat increased the odds of having a zero death by 1.076-fold (OR 1.076, 95\% CI 1.01-1.15) and 1.13-fold (OR 1.13, 95\% CI 1.0-1.28), respectively. Tree nuts reduced the odds of having a zero death, and vegetables increased the number of deaths. Globally, the results also showed that populations (countries) who consume more eggs, cereals excluding beer, spices, and stimulants had the greatest impact on the recovery of patients with COVID-19. In addition, populations that consume more meat, vegetal products, sugar and sweeteners, sugar crops, animal fats, and animal products were associated with more death and less recoveries in patients. The effect of consuming sugar products on mortality was considerable, and obesity has affected increased death rates and reduced recovery rates. Conclusions: Although there are differences in dietary patterns, overall, unbalanced diets are a health threat across the world and not only affect death rates but also the quality of life. To achieve the best results in preventing nutrition-related pandemic diseases, strategies and policies should fully recognize the essential role of both diet and obesity in determining good nutrition and optimal health. Policies and programs must address the need for change at the individual level and make modifications in society and the environment to make healthier choices accessible and preferable. ", doi="10.2196/22717", url="http://publichealth.jmir.org/2021/1/e22717/", url="http://www.ncbi.nlm.nih.gov/pubmed/33439850" } @Article{info:doi/10.2196/23438, author="Tiozzo, Barbara and Ruzza, Mirko and Rizzoli, Valentina and D'Este, Laura and Giaretta, Mos{\`e} and Ravarotto, Licia", title="Biological, Chemical, and Nutritional Food Risks and Food Safety Issues From Italian Online Information Sources: Web Monitoring, Content Analysis, and Data Visualization", journal="J Med Internet Res", year="2020", month="Dec", day="14", volume="22", number="12", pages="e23438", keywords="big data", keywords="online information sources", keywords="web monitoring", keywords="content analysis", keywords="data visualization", keywords="food risks", keywords="risk communication", abstract="Background: With rapid evolution of the internet and web 2.0 apps, online sources have become one of the main channels for most people to seek food risk information. Thus, it would be compelling to analyze the coverage of online information sources related to biological, chemical, and nutritional food risks, and related safety issues, to understand the type of content that online readers are exposed to, possibly influencing their perceptions. Objective: The aim of this study was to identify the types of online sources that are predominantly covering this theme, and the topics that have received the most attention in terms of coverage and engagement on social media. Methods: We performed an analysis of big data related to food risks by combining web monitoring techniques, content analysis, and data visualization of a large amount of unstructured text. Using a dictionary-based approach, a web monitoring app was instructed to automatically collect web content referring to the food risk and safety field. Data were retrieved from March 2017 to February 2018. The validated corpus (N=12,163) was subject to automatic and manual content analysis. Results were combined with descriptive statistics extracted from Web-Live and processed with Qlik Sense. Results: Nutritional risks and news about outbreaks, controls, and alerts were the most widely covered topics. Thematic sources devoted major attention to nutritional topics, whereas national sources covered food risks, especially during food emergencies. Regarding engagement on social media, readers' interest was higher for nutritional topics and animal welfare. Although traditional sources still publish a great amount of content related to food risks and safety, new mediators have emerged as alternative sources for food risk information. Conclusions: This mixed methodological approach was demonstrated to be a useful means for obtaining an accurate characterization of the online discourse on food risks, and can provide insight into how the monitored sources contribute to the process of risk communication. ", doi="10.2196/23438", url="https://www.jmir.org/2020/12/e23438", url="http://www.ncbi.nlm.nih.gov/pubmed/33315018" } @Article{info:doi/10.2196/22074, author="Alfonsi, E. Jeffrey and Choi, Y. Elizabeth E. and Arshad, Taha and Sammott, S. Stacie-Ann and Pais, Vanita and Nguyen, Cynthia and Maguire, R. Bryan and Stinson, N. Jennifer and Palmert, R. Mark", title="Carbohydrate Counting App Using Image Recognition for Youth With Type 1 Diabetes: Pilot Randomized Control Trial", journal="JMIR Mhealth Uhealth", year="2020", month="Oct", day="28", volume="8", number="10", pages="e22074", keywords="carbohydrate counting", keywords="type 1 diabetes", keywords="image recognition", keywords="youth", keywords="digital health applications (apps)", keywords="mHealth", abstract="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 ", doi="10.2196/22074", url="http://mhealth.jmir.org/2020/10/e22074/", url="http://www.ncbi.nlm.nih.gov/pubmed/33112249" } @Article{info:doi/10.2196/18237, author="Evenepoel, Charlotte and Clevers, Egbert and Deroover, Lise and Van Loo, Wendy and Matthys, Christophe and Verbeke, Kristin", title="Accuracy of Nutrient Calculations Using the Consumer-Focused Online App MyFitnessPal: Validation Study", journal="J Med Internet Res", year="2020", month="Oct", day="21", volume="22", number="10", pages="e18237", keywords="dietary assessment", keywords="MyFitnessPal", keywords="Nubel", keywords="nutrition", keywords="online application", keywords="diet", 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 ($\rho$=0.51) and sodium ($\rho$=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. ", doi="10.2196/18237", url="http://www.jmir.org/2020/10/e18237/", url="http://www.ncbi.nlm.nih.gov/pubmed/33084583" } @Article{info:doi/10.2196/16953, author="Ji, Yuwei and Plourde, Hugues and Bouzo, Valerie and Kilgour, D. Robert and Cohen, R. Tamara", title="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", journal="JMIR Mhealth Uhealth", year="2020", month="Sep", day="9", volume="8", number="9", pages="e16953", keywords="mobile food record", keywords="validity", keywords="image-based dietary assessment", keywords="healthy adults", keywords="3-day food diary", keywords="diet", keywords="application", keywords="nutrition", keywords="mHealth", keywords="Canada", abstract="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. ", doi="10.2196/16953", url="https://mhealth.jmir.org/2020/9/e16953", url="http://www.ncbi.nlm.nih.gov/pubmed/32902389" } @Article{info:doi/10.2196/18521, author="Dibley, John Michael and Alam, Ashraful and Fahmida, Umi and Ariawan, Iwan and Titaley, Rialine Christiana and Htet, Kyaw Min and Damayanti, Rita and Li, Mu and Sutrisna, Aang and Ferguson, Elaine", title="Evaluation of a Package of Behaviour Change Interventions (Baduta Program) to Improve Maternal and Child Nutrition in East Java, Indonesia: Protocol for an Impact Study", journal="JMIR Res Protoc", year="2020", month="Sep", day="8", volume="9", number="9", pages="e18521", keywords="infant", keywords="feeding behavior", keywords="diet, food, and nutrition", keywords="growth disorders", keywords="undernutrition", keywords="nutrition during pregnancy", keywords="water treatment", abstract="Background: Over the past decade, the prevalence of stunting has been close to 37\% in children aged <5 years in Indonesia. The Baduta program, a multicomponent package of interventions developed by the Global Alliance for Improved Nutrition, aims to improve maternal and infant nutrition in Indonesia. Objective: This study aims to assess the impact of the Baduta program, a package of health system strengthening and behavior change interventions, compared with the standard village health services on maternal and child nutrition. Methods: The impact evaluation uses a cluster randomized controlled trial design with 2 outcome assessments. The first uses cross-sectional surveys of mothers of children aged 0-23 months and pregnant women before and after the interventions. The second is a cohort study of pregnant women followed until their child is 18 months from a subset of clusters. We will also conduct a process evaluation guided by the program impact pathway to assess coverage, fidelity, and acceptance. The study will be conducted in the Malang and Sidoarjo districts of East Java, Indonesia. The unit of randomization is the subdistricts. As random allocation of interventions to only 6 subdistricts is feasible, we will use constrained randomization to ensure balance of baseline covariates. The first intervention will be health system strengthening, including the Baby-Friendly Hospital Initiative, and training on counseling for appropriate infant and young child feeding (IYCF). The second intervention will be nutrition behavior change that includes Emo-Demos; a national television (TV) advertising campaign; local screening TV spots; a free, text message service; and promotion of low-cost water filters and hygiene practices. The primary study outcome is child stunting (low length-for-age), and secondary outcomes include length-for-age Z scores, wasting (low weight-for-length), anemia, child morbidity, IYCF indicators, and maternal and child nutrient intakes. The sample size for each cross-sectional survey is 1400 mothers and their children aged <2 years and 200 pregnant women in each treatment group. The cohort evaluation requires a sample size of 340 mother-infant pairs in each treatment group. We will seek Gatekeeper consent and written informed consent from the participants. The intention-to-treat principle will guide our data analysis, and we will apply Consolidated Standards of Reporting Trials guidelines for clustered randomized trials in the analysis. Results: In February 2015, we conducted a baseline cross-sectional survey on 2435 women with children aged <2 years and 409 pregnant women. In February 2017, we conducted an end-line survey on 2740 mothers with children aged <2 years and 642 pregnant women. The cohort evaluation began in February 2015, with 729 pregnant women, and was completed in December 2016. Conclusions: The results of the program evaluation will help guide policies to support effective packages of behavior change interventions to prevent child stunting in Indonesia. International Registered Report Identifier (IRRID): RR1-10.2196/18521 ", doi="10.2196/18521", url="https://www.researchprotocols.org/2020/9/e18521", url="http://www.ncbi.nlm.nih.gov/pubmed/32897234" } @Article{info:doi/10.2196/19634, author="Hu, A. Emily and Nguyen, Viet and Langheier, Jason and Shurney, Dexter", title="Weight Reduction Through a Digital Nutrition and Food Purchasing Platform Among Users With Obesity: Longitudinal Study", journal="J Med Internet Res", year="2020", month="Sep", day="2", volume="22", number="9", pages="e19634", keywords="digital", keywords="nutrition", keywords="meal planning", keywords="weight loss", keywords="obese", keywords="food environment", keywords="food ordering", keywords="food purchasing", keywords="behavioral economics", keywords="behavior change", keywords="eating behavior", keywords="mHealth", keywords="app", abstract="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. ", doi="10.2196/19634", url="http://www.jmir.org/2020/9/e19634/", url="http://www.ncbi.nlm.nih.gov/pubmed/32792332" } @Article{info:doi/10.2196/19056, author="Yang, Ching Shu and Hsu, Wan-Chen and Chiang, Chia-Hsun", title="The Associations Among Individual Factors, Media Literacy, and Dietary Supplement Use Among College Students: Cross-Sectional Study", journal="J Med Internet Res", year="2020", month="Aug", day="31", volume="22", number="8", pages="e19056", keywords="college student", keywords="dietary supplement", keywords="media literacy", keywords="ehealth literacy", abstract="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 ($\beta$=--.10, P=.02), and intention to use DS in the future ($\beta$=--.12, P=.011). Finally, perceived importance of health was positively related to current DS use ($\beta$=.18, P=.001) and intention to use DS in the future ($\beta$=.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. ", doi="10.2196/19056", url="http://www.jmir.org/2020/8/e19056/", url="http://www.ncbi.nlm.nih.gov/pubmed/32865500" } @Article{info:doi/10.2196/17296, author="Jenkins, L. Eva and Ilicic, Jasmina and Barklamb, M. Amy and McCaffrey, A. Tracy", title="Assessing the Credibility and Authenticity of Social Media Content for Applications in Health Communication: Scoping Review", journal="J Med Internet Res", year="2020", month="Jul", day="23", volume="22", number="7", pages="e17296", keywords="review", keywords="trust", keywords="social media", keywords="nutrition science", keywords="health", keywords="communication", keywords="health communication", abstract="Background: Nutrition science is currently facing issues regarding the public's perception of its credibility, with social media (SM) influencers increasingly becoming a key source for nutrition-related information with high engagement rates. Source credibility and, to an extent, authenticity have been widely studied in marketing and communications but have not yet been considered in the context of nutrition or health communication. Thus, an investigation into the factors that impact perceived source and message credibility and authenticity is of interest to inform health communication on SM. Objective: This study aims to explore the factors that impact message and source credibility (which includes trustworthiness and expertise) or authenticity judgments on SM platforms to better inform nutrition science SM communication best practices. Methods: A total of 6 databases across a variety of disciplines were searched in March 2019. The inclusion criteria were experimental studies, studies focusing on microblogs, studies focusing on healthy adult populations, and studies focusing on either source credibility or authenticity. Exclusion criteria were studies involving participants aged under 18 years and clinical populations, gray literature, blogs, WeChat conversations, web-based reviews, non-English papers, and studies not involving participants' perceptions. Results: Overall, 22 eligible papers were included, giving a total of 25 research studies. Among these studies, Facebook and Twitter were the most common SM platforms investigated. The most effective communication style differed depending on the SM platform. Factors reported to impact credibility included language used online, expertise heuristics, and bandwagon heuristics. No papers were found that assessed authenticity. Conclusions: Credibility and authenticity are important concepts studied extensively in the marketing and communications disciplines; however, further research is required in a health context. Instagram is a less-researched platform in comparison with Facebook and Twitter. ", doi="10.2196/17296", url="http://www.jmir.org/2020/7/e17296/", url="http://www.ncbi.nlm.nih.gov/pubmed/32706675" } @Article{info:doi/10.2196/16971, author="McMahon, Joy Emma and Jaenke, Rachael and Brimblecombe, Julie", title="A Mobile App to Rapidly Appraise the In-Store Food Environment: Reliability, Utility, and Construct Validity Study", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="22", volume="8", number="7", pages="e16971", keywords="mobile apps", keywords="reliability and validity", keywords="food", keywords="diet", keywords="environment and public health", abstract="Background: Consumer food environments are increasingly being recognized as influential determinants of food purchasing and subsequent intake and health. We developed a tool to enable efficient, but relatively comprehensive, appraisal of the in-store food environment. The Store Scout mobile app facilitates the evaluation of product (availability and range), placement (visibility, accessibility, proximity to high-traffic areas, and location relative to other products), price (price promotion), and promotion (displays and advertising) across 7 categories of food products, with appraisal given immediately as scores (0-100, where a higher score is more in line with best practice). Primary end users are public health nutritionists and nutritionists employed by store organizations; however, store managers and staff are also potential end users. Objective: This study aims to evaluate the reliability (interrater reliability and internal consistency), utility (distribution of scores), and construct validity (score by store type) of measurements using the Store Scout mobile app. Methods: The Store Scout mobile app was used independently by 2 surveyors to evaluate the store environment in 54 stores: 34 metropolitan stores (9 small and 11 large supermarkets, 10 convenience stores, and 4 petrol stations) in Brisbane, Australia, and 20 remote stores (19 small supermarkets and 1 petrol station) in Indigenous Australian communities in Northern Australia. The agreement between surveyors in the overall and category scores was evaluated using intraclass correlation coefficients (ICCs). Interrater reliability of measurement items was assessed using percentage agreement and the Gwet agreement coefficient (AC). Internal consistency was assessed by comparing the responses of items measuring similar aspects of the store environment. We examined the distribution of score values using boxplots and differences by store type using the Kruskal-Wallis test. Results: The median difference in the overall score between surveyors was 4.4 (range 0.0-11.1), with an ICC of 0.954 (95\% CI 0.914-0.975). Most measurement items had very good (n=74/196, 37.8\%) or good (n=81/196, 41.3\%) interrater reliability using the Gwet AC. A minimal inconsistency of measurement was found. Overall scores ranged from 19.2 to 81.6. There was a significant difference in score by store type (P<.001). Large Brisbane supermarkets scored highest (median 77.4, range 53.2-81.6), whereas small Brisbane supermarkets (median 63.9, range 41.0-71.3) and small remote supermarkets (median 63.8, range 56.5-74.9) scored significantly higher than Brisbane petrol stations (median 33.1, range 19.2-37.8) and convenience stores (median 39.0, range 22.4-63.8). Conclusions: These findings suggest good reliability and internal consistency of food environment measurements using the Store Scout mobile app. We identified specific aspects that can be improved to further increase the reliability of this tool. We found a good distribution of score values and evidence that scoring could capture differences by store type in line with previous evidence, which gives an indication of construct validity. The Store Scout mobile app shows promise in its capability to measure and track the health-enabling characteristics of store environments. ", doi="10.2196/16971", url="https://mhealth.jmir.org/2020/7/e16971", url="http://www.ncbi.nlm.nih.gov/pubmed/32706683" } @Article{info:doi/10.2196/13401, author="Grady, Alice and Wolfenden, Luke and Wiggers, John and Rissel, Chris and Finch, Meghan and Flood, Victoria and Salajan, David and O'Rourke, Ruby and Stacey, Fiona and Wyse, Rebecca and Lecathelinais, Christophe and Barnes, Courtney and Green, Sue and Herrmann, Vanessa and Yoong, Lin Sze", title="Effectiveness of a Web-Based Menu-Planning Intervention to Improve Childcare Service Compliance With Dietary Guidelines: Randomized Controlled Trial", journal="J Med Internet Res", year="2020", month="Feb", day="4", volume="22", number="2", pages="e13401", keywords="child care", keywords="child, preschool", keywords="online systems", keywords="menu planning", keywords="nutrition policy", keywords="randomized controlled trial", keywords="internet-based intervention", abstract="Background: Foods provided in childcare services are not consistent with dietary guideline recommendations. Web-based systems offer unique opportunities to support the implementation of such guidelines. Objective: This study aimed to assess the effectiveness of a Web-based menu planning intervention in increasing the mean number of food groups on childcare service menus that comply with dietary guidelines. Secondary aims were to assess the impact of the intervention on the proportion of service menus compliant with recommendations for (1) all food groups; (2) individual food groups; and (3) mean servings of individual food groups. Childcare service use and acceptability of the Web-based program were also assessed. Methods: A single-blind, parallel-group randomized controlled trial was undertaken with 54 childcare services in New South Wales, Australia. Services were randomized to a 12-month intervention or usual care control. Intervention services received access to a Web-based menu planning program linked to their usual childcare management software system. Childcare service compliance with dietary guidelines and servings of food groups were assessed at baseline, 3-month follow-up, and 12-month follow-up. Results: No significant differences in the mean number of food groups compliant with dietary guidelines and the proportion of service menus compliant with recommendations for all food groups, or for individual food groups, were found at 3- or 12-month follow-up between the intervention and control groups. Intervention service menus provided significantly more servings of fruit (P<.001), vegetables (P=.03), dairy (P=.03), and meat (P=.003), and reduced their servings of discretionary foods (P=.02) compared with control group at 3 months. This difference was maintained for fruit (P=.03) and discretionary foods (P=.003) at 12 months. Intervention childcare service staff logged into the Web-based program an average of 40.4 (SD 31.8) times and rated the program as highly acceptable. Conclusions: Although improvements in childcare service overall menu and individual food group compliance with dietary guidelines were not statistically significant, findings indicate that a Web-based menu planning intervention can improve the servings for some healthy food groups and reduce the provision of discretionary foods. Future research exploring the effectiveness of differing strategies in improving the implementation of dietary guidelines in childcare services is warranted. Trial Registration: Australian New Zealand Clinical Trial Registry (ANZCTR): 16000974404; http://www.anzctr.org.au/ACTRN12616000974404.aspx ", doi="10.2196/13401", url="https://www.jmir.org/2020/2/e13401", url="http://www.ncbi.nlm.nih.gov/pubmed/32014843" } @Article{info:doi/10.2196/12580, author="Araujo Almeida, Vanessa and Littlejohn, Paula and Cop, Irene and Brown, Erin and Afroze, Rimi and Davison, M. Karen", title="Comparison of Nutrigenomics Technology Interface Tools for Consumers and Health Professionals: A Sequential Explanatory Mixed Methods Investigation", journal="J Med Internet Res", year="2019", month="Jun", day="28", volume="21", number="6", pages="e12580", keywords="nutrigenomics", keywords="nutrigenetics", keywords="genomics", keywords="epigenomics", keywords="interface, user-computer", abstract="Background: Nutrigenomics forms the basisof personalized nutrition by customizing an individual's dietaryplan based on the integration of life stage, current health status,and genome information. Some common genes that are includedin nutrition-based multigene test panels include CYP1A2 (rateof caffeine break down), MTHFR (folate usage),NOS3 (risk of elevated triglyceride levels related to omega-3fat intake), and ACE (blood pressure response in related tosodium intake). The complexity of gene test--based personalized nutrition presents barriers to its implementation. Objective: This study aimed to compare a self-driven approach to gene test--based nutrition education versus an integrated practitioner-facilitated method to help develop improved interface tools for personalized nutrition practice. Methods: A sequential, explanatory mixed methods investigation of 55 healthy adults (35 to 55 years) was conducted that included (1) a 9-week randomized controlled trial where participants were randomized to receive a standard nutrition-based gene test report (control; n=19) or a practitioner-facilitated personalized nutrition intervention (intervention; n=36) and (2) an interpretative thematic analysis of focus group interview data. Outcome measures included differences in the diet quality score (Healthy Eating Index--Canadian [HEI-C]; proportion [\%] of calories from total fat, saturated fat, and sugar; omega 3 fatty acid intake [grams]; sodium intake [milligrams]); as well as health-related quality of life (HRQoL) scale score. Results: Of the 55 (55/58 enrolled, 95\%) participants who completed the study, most were aged between 40 and 51 years (n=37, 67\%), were female (n=41, 75\%), and earned a high household income (n=32, 58\%). Compared with baseline measures, group differences were found for the percentage of calories from total fat (mean difference [MD]=?5.1\%; Wilks lambda ($\lambda$)=0.817, F1,53=11.68; P=.001; eta-squared [$\eta${\texttwosuperior}]=0.183) and saturated fat (MD=?1.7\%; $\lambda$=0.816; F1,53=11.71; P=.001; $\eta${\texttwosuperior}=0.18) as well as HRQoL scores (MD=8.1 points; $\lambda$=0.914; F1,53=4.92; P=.03; $\eta${\texttwosuperior}=0.086) compared with week 9 postintervention measures. Interactions of time-by-group assignment were found for sodium intakes ($\lambda$=0.846; F1,53=9.47; P=.003; $\eta${\texttwosuperior}=0.15) and HEI-C scores ($\lambda$=0.660; F1,53=27.43; P<.001; $\eta${\texttwosuperior}=0.35). An analysis of phenotypic and genotypic information by group assignment found improved total fat (MD=?5\%; $\lambda$=0.815; F1,51=11.36; P=.001; $\eta${\texttwosuperior}=0.19) and saturated fat (MD=?1.3\%; $\lambda$=0.822; F1,51=10.86; P=.002; $\eta${\texttwosuperior}=0.18) intakes. Time-by-group interactions were found for sodium ($\lambda$=0.844; F3,51=3.09; P=.04; $\eta${\texttwosuperior}=0.16); a post hoc analysis showed pre/post differences for those in the intervention group that did (preintervention mean 3611 mg, 95\% CI 3039-4182; postintervention mean 2135 mg, 95\% CI 1564-2705) and did not have the gene risk variant (preintervention mean 3722 mg, 95\% CI 2949-4496; postintervention mean 2071 mg, 95\% CI 1299-2843). Pre- and postdifferences related to the Dietary Reference Intakes showed increases in the proportion of intervention participants within the acceptable macronutrient distribution ranges for fat (pre/post mean difference=41.2\%; P=.02). Analysis of textual data revealed 3 categories of feedback: (1) translation of nutrition-related gene test information to action; (2) facilitation of eating behavior change, particularly for the macronutrients and sodium; and (3) directives for future personalized nutrition practice. Conclusions: Although improvements were observed in both groups, healthy adults appear to derive more health benefits from practitioner-led personalized nutrition interventions. Further work is needed to better facilitate positive changes in micronutrient intakes. Trial Registration: ClinicalTrials.gov NCT03310814; http://clinicaltrials.gov/ct2/show/NCT03310814 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.9846 ", doi="10.2196/12580", url="http://www.jmir.org/2019/6/e12580/", url="http://www.ncbi.nlm.nih.gov/pubmed/31254340" } @Article{info:doi/10.2196/10812, author="Hamshaw, Thomas Richard James and Barnett, Julie and Gavin, Jeff and Lucas, S. Jane", title="Perceptions of Food Hypersensitivity Expertise on Social Media: Qualitative Study", journal="Interact J Med Res", year="2019", month="Jun", day="28", volume="8", number="2", pages="e10812", keywords="social media", keywords="food allergy", keywords="food hypersensitivity", keywords="celiac disease", keywords="food intolerance", keywords="interviews as topic", keywords="qualitative methods", abstract="Background: Seeking and sharing information are the primary uses of the internet and social media. It is therefore vital to understand the processes individuals go through when engaging with information on these diverse platforms, especially in areas such as health- and risk-related information. One important element of such engagement is evaluating and attributing expertise to others. Objective: This study aimed to explore how meanings around expertise in relation to food allergy and intolerance (food hypersensitivity) were constructed by 2 groups of social media users: (1) those who use platforms for reasons relating to food hypersensitivity and (2) those seen as experts by this community. Methods: Survey participants were asked open-ended questions to identify potential experts in food hypersensitivity issues on social media and to discuss their reasoning for their choices (n=143). Subsequently, 8 adult social media users with experience of managing food hypersensitivity and 5 participants designated as experts by those users took part in email interviews. Survey and interview data were analyzed thematically using Braun and Clarke's approach. Results: Judging expertise on social media is a complex and multifaceted process. Users might be judged as experts through their professional background or their experience living with food hypersensitivities. How users behave on social media and the traces of their Web-based activity can influence how others will see them. Such considerations are both measured and moderated through the social media community itself. Findings highlighted how social media often act as a supportive information tool following a diagnosis, but this also raised concerns regarding the scenario of patients not being able to access suitable vetted information. Conclusions: This work has implications for understanding how users perceive expertise on social media in relation to a health concern and how information assessments are made during the management of risks. Findings provide practical insights to both medical and organizational stakeholders involved in the support of those living with life-changing conditions, such as food hypersensitivities. ", doi="10.2196/10812", url="http://www.i-jmr.org/2019/2/e10812/", url="http://www.ncbi.nlm.nih.gov/pubmed/31254334" } @Article{info:doi/10.2196/12136, author="Wellard-Cole, Lyndal and Potter, Melisa and Jung, (Joseph) Jisu and Chen, Juliana and Kay, Judy and Allman-Farinelli, Margaret", title="A Tool to Measure Young Adults' Food Intake: Design and Development of an Australian Database of Foods for the Eat and Track Smartphone App", journal="JMIR Mhealth Uhealth", year="2018", month="Nov", day="07", volume="6", number="11", pages="e12136", keywords="diet surveys", keywords="smartphone", keywords="mobile phone", keywords="young adult", abstract="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. ", doi="10.2196/12136", url="http://mhealth.jmir.org/2018/11/e12136/", url="http://www.ncbi.nlm.nih.gov/pubmed/30404768" } @Article{info:doi/10.2196/ijmr.9359, author="Zhou, Jun and Bell, Dane and Nusrat, Sabrina and Hingle, Melanie and Surdeanu, Mihai and Kobourov, Stephen", title="Calorie Estimation From Pictures of Food: Crowdsourcing Study", journal="Interact J Med Res", year="2018", month="Nov", day="05", volume="7", number="2", pages="e17", keywords="calorie estimation", keywords="image annotation", keywords="crowdsourcing", keywords="obesity", keywords="public health", abstract="Background: Software designed to accurately estimate food calories from still images could help users and health professionals identify dietary patterns and food choices associated with health and health risks more effectively. However, calorie estimation from images is difficult, and no publicly available software can do so accurately while minimizing the burden associated with data collection and analysis. Objective: The aim of this study was to determine the accuracy of crowdsourced annotations of calorie content in food images and to identify and quantify sources of bias and noise as a function of respondent characteristics and food qualities (eg, energy density). Methods: We invited adult social media users to provide calorie estimates for 20 food images (for which ground truth calorie data were known) using a custom-built webpage that administers an online quiz. The images were selected to provide a range of food types and energy density. Participants optionally provided age range, gender, and their height and weight. In addition, 5 nutrition experts provided annotations for the same data to form a basis of comparison. We examined estimated accuracy on the basis of expertise, demographic data, and food qualities using linear mixed-effects models with participant and image index as random variables. We also analyzed the advantage of aggregating nonexpert estimates. Results: A total of 2028 respondents agreed to participate in the study (males: 770/2028, 37.97\%, mean body mass index: 27.5 kg/m2). Average accuracy was 5 out of 20 correct guesses, where ``correct'' was defined as a number within 20\% of the ground truth. Even a small crowd of 10 individuals achieved an accuracy of 7, exceeding the average individual and expert annotator's accuracy of 5. Women were more accurate than men (P<.001), and younger people were more accurate than older people (P<.001). The calorie content of energy-dense foods was overestimated (P=.02). Participants performed worse when images contained reference objects, such as credit cards, for scale (P=.01). Conclusions: Our findings provide new information about how calories are estimated from food images, which can inform the design of related software and analyses. ", doi="10.2196/ijmr.9359", url="http://www.i-jmr.org/2018/2/e17/", url="http://www.ncbi.nlm.nih.gov/pubmed/30401671" } @Article{info:doi/10.5210/ojphi.v10i2.9306, title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review", journal="Online J Public Health Inform", year="2018", volume="10", number="2", pages="e9306", doi="10.5210/ojphi.v10i2.9306", url="", url="http://www.ncbi.nlm.nih.gov/pubmed/30349631" } @Article{info:doi/10.2196/ijmr.5850, author="Komoto, Keiko and Okamoto, Sawako and Hamada, Miki and Obana, Naoya and Samori, Mami and Imamura, Tomoaki", title="Japanese Consumer Perceptions of Genetically Modified Food: Findings From an International Comparative Study", journal="Interact J Med Res", year="2016", month="Aug", day="29", volume="5", number="3", pages="e23", keywords="genetically modified food", keywords="Japan", keywords="perception", keywords="health", keywords="risk", abstract="Background: Reports of food-related incidents, such as cows infected with bovine spongiform encephalopathy (2001) and the Fukushima nuclear accident (2011), engendered significant fear among Japanese consumers and led to multiple farmer suicides, even when no actual health damage occurred. The growing availability of genetically modified (GM) food is occurring against this backdrop of concern about food safety. Consumers need information to assess risk and make informed purchasing decisions. However, we lack a clear picture of Japanese consumer perceptions of GM food. Objective: This study aims to understand Japanese consumer perceptions of GM food for risk communication. Consumer perceptions of GM food were compared among 4 nations. Methods: A Web-based survey was conducted in Japan, the United States, the United Kingdom, and France. Participants were asked about demographics, fear of health hazards, resistance to GM and breeding-improved products, perception of GM technology and products, and willingness to pay. Multiple linear regression analyses were conducted, as were t tests on dichotomous variables, and 1-way analysis of variance and post hoc tests. Results: Of 1812 individuals who agreed to participate, 1705 (94\%) responded: 457 from Japan and 416 each from France, the United States, and the United Kingdom. The male/female and age group ratios were all about even. Some resistance to GM food was seen in all countries in this study. France showed the strongest resistance (P<.001), followed by Japan, which had stronger resistance than the United States and the United Kingdom (P<.001). Overall, females, people in their 60s and older, and those without higher education showed the greatest resistance to GM food. Japan showed stronger fear of food hazards than other nations (P<.001, odds ratio=2.408, CI: 1.614-3.594); Japanese and French respondents showed the strongest fear of hazards from GM food (P<.001). Regarding perceptions of GM technology and products, consumers in nations other than Japan would accept GM food if it were appropriately explained, they were provided with scientific data supporting its safety, and they understood that all food carries some risk. However, Japanese consumers tended to accept GM technology but rejected its application to food (P<.001). Of those willing to purchase GM food, consumers in Japan required a discount of 30\% compared with about 20\% in other nations. Conclusion: All consumers in our study showed resistance to GM food. Although no health hazards are known, respondents in Japan and France strongly recognized GM food as a health risk. Price discounts of 30\% and GM technology may be communication cues to start discussions about GM food among Japanese consumers. Although education-only risk communication generally is not effective, such an approach may work in Japan to help consumers better understand GM technology and, eventually, GM food. The gap between accepting GM technology and rejecting its application to food should be explored further. ", doi="10.2196/ijmr.5850", url="http://www.i-jmr.org/2016/3/e23/", url="http://www.ncbi.nlm.nih.gov/pubmed/27573588" }