How are innovations in digital technology & dietary intake assessment affecting ease of adoption?

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1 Nutritional Epidemiology Group School of Food Science and Nutrition How are innovations in digital technology & dietary intake assessment affecting ease of adoption? Janet Cade

2 What will I be covering? What new methodologies are available & why do we need them? Web-based tools to measure diet: Eg. myfood24 Smartphone apps for selfmonitoring Ease of adoption

3 As dietary measurement moves to new technologies, how can we avoid this?

4 UK technology 82% UK adults access internet daily 93% owns/uses a mobile phone 76% own a smartphone, 2015 (Deloitte) More time spent using media/communications (8h 41 mins) than sleeping (8h 21 mins) per day! self-monitoring diet on internet is now possible.

5 Measuring diet with new technology Technology category Computer Examples Web based 24h recall/diary/ffq (eg. ASA24, myfood24) Non web based Mobile phone Self monitoring apps (My Meal Mate; My Fitness Pal etc) Tweets geo location Camera Others Non automated cameras Automated cameras (eg. SenseCam, DietCam) Consumer data ( big data) Bar code scanner Wearable sensors (chewing, swallowing)

6 Popular nutrition apps, UK Franco et al. JMIR Mhealth Uhealth 2016;4(3):e85)

7 Nutrition related app outputs Franco et al. JMIR Mhealth Uhealth 2016;4(3):e85)

8 Quality of weight loss apps. 200 weight loss diet assessment apps rated. Usability 13.5/20 Overall most popular apps: sub-optimal Chen et al. JMIR mhealth uhealth 2015;3(4):e104) doi: /mhealth.4334

9 Reliability of diet data from weight loss apps Chen et al, JMIR mhealth uhealth 2015;3(4):e104 App v 3 day diary: E difference App Calorie Counter by FatSecret Calorie Counter Pro My Net Diary Food Diary and Calorie Tracker My Diet Diary Calorie Counter Value Diary Plus Noom Weight Loss Coach Jillian Michaels Slim-Down Diet Watchers Diary Easy Diet Diary Control my weight Calorie Counter & Diet Tracker My Diet Coach Pro MyPlate Calorie Tracker LITE Nutritionist dieting made easy Map My' + apps (walk, run, ride, fitness) Map My' apps (walk, run, ride, fitness) Calorie Counter by Sparkpeople Cronometer Calorie Counter - MyFitnessPal Body tracker body fat tracker Pts plus weight diary Points calculator and weekly weight loss Point tracker weight watchers Mean (95% CI) Energy difference (kj)

10 Functions of 40 apps for diabetes Hoppe et al, JHND. Oct DOI: /jhn Mean: 9/27 functions 4/26 BCTs

11 Self monitoring app: My Meal Mate Food Favourites diary Self monitoring of diet, activity and weight UK food database Photo prompts Improved start-up screen Clearer layout Bar code scanning Social media

12 First trial.. Randomised by Minimisation to 3 groups (n=128) MMM app Online food diary Paper food diary Carter, M. C., Burley, V. J., Nykjaer, C., & Cade, J. E. (2013) Journal of medical Internet research, 15(4). doi: /jmir.2283

13 First RCT of weight loss app: MyMealMate 6 months baseline weight change kg, mean, (95%CI) 99 Chart Title 4.6 ( 6.2, 3.0) 2.9 ( 4.7, 1.1) 1.3 ( 2.7, 0.1) kg MMM Paper diary Website 0 // Baseline 6 wk 6 months Carter, M. C., Burley, V. J., Nykjaer, C., & Cade, J. E. (2013) Journal of medical Internet research, 15(4). doi: /jmir.2283

14 Web tool for diet assessment example: Visit 1 3 diet measures Blood & urine sample Energy expenditure Visit 2 3 diet measures Blood & urine sample Energy expenditure Visit 3 3 diet measures Blood & urine sample Energy expenditure

15

16

17 Preferences for Interviewer AMPM vs. ASA24 Thompson FE, et al. Am J Epidemiol men Age group (y) Education women

18 Can people find foods they have eaten? Mapped on energy, fat, protein, & carbohydrate ~45,000 items 8 nutrients 3,500 items 120 nutrients Over 50% within 10% agreement for energy Largest food groups mapped: cakes, biscuits, etc (6918 items, 18%); alcoholic drinks (5692 items, 15%); sauces & condiments (3635 items, 9%).

19 Difference in estimated nutrient intake Choosing branded items Eg. white bread: 25 generic items v. 225 branded items 6 /100g Kcal Protein CHO Generic (n=25) Branded (n=225) 267 Range: 167 to Range: 83 to Range: 7.6 to Range: 2.1 to Range: 23 to Range: 17 to Energy (kj) Fat (g) Saturated Fat (g) Carbohydrate (g) Protein (g) Fibre (g) Total Veg (g) Total Fruit (g) Cholesterol (mg) -8 Original v Branded Diary Original v Generic Diary Branded v Generic Diary

20 Portion sizes Portion size images mapped foods have images assigned. Users can also estimate portion size: fraction of purchased pack; suggested average portion manually entering amount. Source (with permission): Foster, E, Hawkins, A, Adamson, A. Young Person s Food Atlas. Secondary. Food Standards Agency.

21 Relative validity in adolescents Albar et al. British Journal of Nutrition (2016), 115, n=75: myfood24 v. MPR, 2 non-consecutive days. Strong agreement energy intake, myfood24 MPR in adolescents

22 NHS App Library.. Potential kite mark planned.

23 Challenges of digital technology for diet o o o o o o o o Nutrients reported accuracy, variety Size, scope and accuracy of food database Portion size estimation Searchability of the database Tech readiness ability of user Lack of personalised feedback Need for integration with electronic health records Response rates (further info: Jospe JMIR mhealth uhealth 2015;3(1):e7)

24 Use of big data & social media? Food safety example Food poisoning NHS advice to stay at home and recover Difficult to monitor actual number of food poisoning outbreaks/yr Social media novel way to monitor outbreaks Study language used in a tweet Collect tweets related to food borne illness eg. vomiting, stomach ache rather than food poisoning or salmonella syndromic surveillance nemesis system (Salidek et al, 2013)

25 improving standards Best Practice Guidelines

26 Thanks NPRI

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