Web-based graphical food frequency assessment system: Design, development and usability

The acceptability of an online food frequency questionnaire (FFQ) amongst users participating in the Eat Well Kuwait Project (EatWellQ8) was good, while the results for mobile devices were comparable with computers (Zenun et al., 2017). These conclusions were reached as part of study examining how online tools might be best used to assess food intake.

FFQs used photographs of different portion sizes for each food to make it easier for users to indicate how much they usually eat. In total, volunteers were asked to specify consumption frequency of 146 foods including drinks. Usability scores were good (75) and completion took just over 14 minutes.

EatWellQ8 aims to determine if web-based and face-to-face communication of personalised nutrition are equally effective in Kuwait. These results correspond to the first part of a study related to the design and development of the online FFQs and will help design of a web-based tools and their acceptability.

Popular nutrition-related mobile apps: A feature assessment

Around the same time as the Quisper prototype was launched in late 2015, Rodrigo Zenun Franco and colleagues at the University of Reading (UK) published an analysis of the 13 most popular nutrition apps. They considered the approaches and technologies used as well as user feedback and concluded that none provided personalised nutritional advice and there was still a lot to be done to achieve this goal.

The apps were ranked and selected based on popularity. Nutritional assessment was performed via a food diary tool and the balance between intake and energy expenditure compared. However, none of these apps provided personalised nutrition advice based on this information.

New technologies and devices can be combined to encourage behaviour changes. Although most of the apps reviewed recorded changes in weight and tracked physical activity, the link between users and diet recommendations needs to be improved to have any impact on achieving individuals’ goals.

The development of apps focused on health, based on nutrition advice and physical activity, has the potential to be a powerful tool to combat weight gain and obesity as well as other non-communicable diseases (e.g. diabetes, hypertension), but there is still room for improvement.

Read more here

The science behind healthy lifestyle choices

By sharing information about the health benefits, it is possible to encourage home cooking and reduce unhealthy dietary patterns, and results published in Costa et al. (2018) suggest this new knowledge could contribute to the wider efforts to reduce obesity rates among the population.

We are exposed constantly to offers of calorie-rich, low-price, readily available foods that interfere with efforts to control what we eat. This is described as an obesogenic environment, i.e. our environment actively promotes poor dietary behaviours. As a consequence, it is important to strengthen individuals’ self-regulating powers and promote healthy dietary patterns.

There are three types of responses associated with behavioural modifications:

  1. Motivational - reasons behind a individual’s actions and aimed at increasing willpower
  2. Volitional - when an individual decides on or commits to a course of action
  3. Nudging - where involuntary self-regulating responses are directed

Nudging is known to be more successful at changing behaviours around foods than motivational or volitional responses. Thus, the aim of PRIMEMEAL – funded by the Portuguese Foundation of Science and Technology – was to promote healthier meal choices by first understanding how psychological self-regulating processes work around home cooking, smart meal planning (e.g. using a list to do food shopping) and evaluating restaurant menus.

Read the full article here

Proposed guidelines to evaluate scientific validity and evidence for genotype-based dietary advice

According to Grimaldi et al. (2017) (Eurogenetica Ltd, UK), there is a lack of regulations and guidelines that enable researchers to assess the validity of diet-gene interactions and, thus, companies to commercialise reputable products for consumers. To fill this gap, the authors have created a draft framework that allows scientists, healthcare professionals, and public policy makers to assess the quality of scientific evidence used to support personalised nutrition advice.

Elaborating this framework included review of a variety of documents such as guidelines for medical genetic testing and public health nutritional recommendations. However, the information obtained was not sufficient to assess accurately the evidence for genetics-based personalised nutrition advice. Most did not include the effects of diet-gene interactions on health outcomes, which is essential for evidence-based nutrigenetic advice. Thus, the framework proposes criteria to validate genetic-based dietary advice, including study design and quality, and biological plausibility (diet-gene interaction[s]).

Until now, research has described show some well-defined diet-gene interactions that support the idea that personalised nutrition advice might have a long-term benefit on health. It is important, however, to elaborate individualised advice based on sound evidence to gain trust and acceptance.

Personalised nutrition is impacting public perceptions of healthcare and has the potential to change for the better public health, reducing the incidence of non-communicable diseases (e.g. obesity, diabetes, cardiovascular disease, etc.) and the costs associated with treatment and care.


Read more here: https://genesandnutrition.biomedcentral.com/articles/10.1186/s12263-017-0584-0

Personalised Nutrition and Health

Ordovas et al. (2018) (Tufts University, Boston, MA, USA) have suggested that more research on personalised nutrition is needed to deliver advice based on robust scientific evidence. They advised that studies should be designed in line with clinical research (i.e. randomised controlled trials, RCT) and include a range of “omics” techniques (e.g. metabolomics, microbiomics, etc.), and more guidelines on the use of genotype-based nutritional advice should be developed.

Currently, very little evidence has been published on gene-diet interactions from RCTs; most of the current personalised nutrition advice comes from observational studies using existing risk factors (e.g. cholesterol and cardiovascular disease risk). One exception is the Food4me study, which investigated the impact of personalised dietary advice amongst 1600 individuals and showed personalised information was more effective than generic advice at changing dietary and lifestyle behaviours for the better.

The term “personalised nutrition” can be defined as “an approach that uses information about individual characteristics to develop targeted nutritional advice, products or services”. The goal of personalised nutrition is to generate healthy eating advice using genetic, phenotypic, nutritional and clinical data, in combination with individuals’ goals, to promote healthy eating. The idea behind this concept is that a more personalised nutrition advice has a stronger effect on an individual’s health than more generic public health approaches. This new paradigm for dietary advice has arisen from:

  1. A better understanding of how nutrition affects the health of populations and individuals
  2. Increased availability and uptake of fitness trackers, mobile apps and other devices that allow tracking and or continuous measurement of some biomarkers (e.g. activity).
  3. New analytic tools that translate data into easy-to-understand recommendations.

Read more here (https://doi.org/10.1136/bmj.k2173)

Online dietary intake assessment using a graphical food frequency app (eNutri): Usability metrics from EatWellUK

Providing personalised nutrition advice through apps on mobile devices could be an effective tool to address serious and persistent public health problems (e.g. obesity, cardiovascular disease, diabetes mellitus). This approach has been tested using an app developed by the University of Reading (UoR), one of the leading partners in the Quisper project funded by EIT Food (ID 18064).

Results from an online study (EatWellUK) involving 324 UK participants evaluated the eNutri app using three well-established questionnaires:

  1. Baecke questionnaire for evaluating physical activity
  2. Food4Me food frequency questionnaire (FFQ)
  3. System usability scale (SUS) questionnaire, a tool used for evaluating evaluate a hardware, software, mobile devices, websites and applications (apps)

Volunteers were assigned to one of two groups, based on age (18 – 59 and 60+ years) and screen size (mobile, tablet, laptop/desktop). Suitability for online studies was determined by completion of all questionnaires without assistance across all age groups and a SUS score greater than 70.

Wider use of online and electronic devices would enable healthcare professionals and providers to monitor and affect changes in intake and lifestyle easily and efficiently. However, for apps like eNutri to benefit consumers and healthcare, they must be user-friendly as well as scientifically validated.

eNutri app is being trialled in the UK and Germany as part of the Quisper project - read more