Push Notifications From a Mobile App to Improve the Body Composition of Overweight or Obese Women: Randomized Controlled Trial

Background

Technology—in particular, access to the Internet from a mobile device—has forever changed the way we relate to others and how we behave in our daily life settings. In recent years, studies have been carried out to analyze the effectiveness of different actions via mobile phone in the field of health: telephone calls, short message service (SMS), telemedicine, and, more recently, the use of push notifications. We have continued to explore ways to increase user interaction with mobile apps, one of the pending subjects in the area of mHealth. By analyzing the data produced by subjects during a clinical trial, we were able to extract behavior patterns and, according to them, design effective protocols in weight loss programs.

Objective

A clinical trial was proposed to (1) evaluate the efficacy of push notifications in an intervention aimed at improving the body composition of adult women who are overweight or obese, through a dietary procedure, and (2) analyze the evolution of body composition based on push notifications and prescribed physical activity (PA).

Methods

A two-arm randomized controlled trial was carried out. A sample size of 117 adult obese women attended a face-to-face, 30-minute consultation once a week for 6 months. All patients were supplied with an app designed for this study and a pedometer. The control group did not have access to functionalities related to the self-monitoring of weight at home, gamification, or prescription of PA. The intervention group members were assigned objectives to achieve a degree of compliance with diet and PA through exclusive access to specific functionalities of the app and push notifications. The same diet was prescribed for all patients. Three possible PA scenarios were studied for both the control and intervention groups: light physical activity (LPA), moderate physical activity (MPA), and intense physical activity (IPA). For the analysis of three or more means, the analysis of variance (ANOVA) of repeated means was performed to evaluate the effects of the intervention at baseline and at 3 and 6 months.

Results

Receiving notifications during the intervention increased body fat loss (mean -12.9% [SD 6.7] in the intervention group vs mean -7.0% [SD 5.7] in the control group; P<.001) and helped to maintain muscle mass (mean -0.8% [SD 4.5] in the intervention group vs mean -3.2% [SD 2.8] in the control group; P<.018). These variations between groups led to a nonsignificant difference in weight loss (mean -7.9 kg [SD 3.9] in the intervention group vs mean -7.1 kg [SD 3.4] in the control group; P>.05).

Conclusions

Push notifications have proven effective in the proposed weight loss program, leading women who received them to achieve greater loss of fat mass and a maintenance or increase of muscle mass, specifically among those who followed a program of IPA. Future interventions should include a longer evaluation period; the impact of different message contents, as well as message delivery times and frequency, should also be researched.

Trial Registration

ClinicalTrials.gov NCT03911583; https://www.clinicaltrials.gov/ct2/show/NCT03911583

Design and validation of a food frequency questionnaire (FFQ) for the nutritional evaluation of food intake in the Peruvian Amazon

BACKGROUND

Food frequency questionnaires (FFQs) are dietary surveys widely used in studies of nutritional epidemiology because they are inexpensive, easy to complete and provide significant information on dietary intake over a long period of time. FFQs should be written specifically for each study group since diet may be influenced by ethnicity, culture, economic status and environmental factors. The aim of the authors on this work was to design and validate a food frequency questionnaire for the Peruvian Amazon population.

METHODS

Three hundred three individuals were selected and completed three 24-h recalls (R24). Two FFQs were conducted on two different occasions (FFQ.1 and FFQ.2). The validity of the FFQ was evaluated by comparing the relationship between the average daily nutrient intake estimated by the FFQs and that obtained by the three R24. The reproducibility was measured by comparing the mean nutrient intake of the two FFQs carried out. The correlations were assessed using the Pearson correlation coefficient, the intraclass correlation coefficient (ICC), the Lin correlation coefficient (CCC) and the Bland-Altman plot.

RESULTS

The results obtained to establish the validity showed a high correlation, with an average Pearson's correlation coefficient of 0.70, a CCI of 0.65 and a CCC of 0.60. Approximately 60% of the nutrients had a CCC above 0.60. In terms of reproducibility, better results were obtained, with an average Pearson's correlation coefficient of 0.67, 0.64 for CCI and 0.58 for CCC.

CONCLUSIONS

The correlation coefficients show good validity and reproducibility, and therefore, the FFQ we have developed may be considered a useful and valid tool to estimate the dietary intake of the Peruvian Amazon population.

The FINDRISC questionnaire capacity to predict diabetes mellitus II, arterial hypertension and comorbidity in women from low-and-middle-income countries

The Finnish Diabetes Risk Score (FINDRISC) has been implemented to assess diabetes risk. The authors aimed in this study to determine the prediction capacity of FINDRISC for the early detection of cardiovascular diseases in women. A prevalence study was carried out on 441 women of Pueblo Libre (Peru). Anthropometric variables, blood pressure, blood glucose and comorbidity were measured and entered in FINDRISC. 4.8% of the studied women suffered from DM2, 14.3% from AHT, 33% obesity and 8.6% comorbidity. We found that FINDRISC was the best method to discriminate DM, AHT and comorbidity. FINDRISC is an effective non-invasive tool for women from low-and-middle-income countries.

Ibero⁻American Consensus on Low- and No-Calorie Sweeteners: Safety, Nutritional Aspects and Benefits in Food and Beverages

International scientific experts in food, nutrition, dietetics, endocrinology, physical activity, paediatrics, nursing, toxicology and public health met in Lisbon on 2⁻4 July 2017 to develop a Consensus on the use of low- and no-calorie sweeteners (LNCS) as substitutes for sugars and other caloric sweeteners. LNCS are food additives that are broadly used as sugar substitutes to sweeten foods and beverages with the addition of fewer or no calories. They are also used in medicines, health-care products, such as toothpaste, and food supplements. The goal of this Consensus was to provide a useful, evidence-based, point of reference to assist in efforts to reduce free sugars consumption in line with current international public health recommendations. Participating experts in the Lisbon Consensus analysed and evaluated the evidence in relation to the role of LNCS in food safety, their regulation and the nutritional and dietary aspects of their use in foods and beverages. The conclusions of this Consensus were: (1) LNCS are some of the most extensively evaluated dietary constituents, and their safety has been reviewed and confirmed by regulatory bodies globally including the World Health Organisation, the US Food and Drug Administration and the European Food Safety Authority; (2) Consumer education, which is based on the most robust scientific evidence and regulatory processes, on the use of products containing LNCS should be strengthened in a comprehensive and objective way; (3) The use of LNCS in weight reduction programmes that involve replacing caloric sweeteners with LNCS in the context of structured diet plans may favour sustainable weight reduction. Furthermore, their use in diabetes management programmes may contribute to a better glycaemic control in patients, albeit with modest results. LNCS also provide dental health benefits when used in place of free sugars; (4) It is proposed that foods and beverages with LNCS could be included in dietary guidelines as alternative options to products sweetened with free sugars; (5) Continued education of health professionals is required, since they are a key source of information on issues related to food and health for both the general population and patients. With this in mind, the publication of position statements and consensus documents in the academic literature are extremely desirable.

[FOOD CONSUMPTION PATTERN AT A FAMILY LEVEL OF URBAN AREAS OF ANZOÁTEGUI, VENEZUELA]

In order to assess the qualitative pattern of food consumption in urban families of Anzoátegui, Venezuela, 300 domestic groups that combined a total of 1 163 people were studied. The domestic dietary pattern was addressed by the method of qualitative frequency of food consumption, which applied a structured survey that yielded the usual frequency of intake of a food or food group over a given period. The information was obtained through an interview with the person responsible for the procurement of food in every home, and included basic data for the socioeconomic and nutritional profile of the families studied. The qualitative analysis of the diet was obtained by comparing the different food groups that constitute the actual consumption pattern of the population studied, with official feeding guidelines suggested for the Venezuelan population. The present study showed that the qualitative pattern of food consumption in the urban population evaluated is characterized by slightly adjusted to the promotion of health and control of diet-related diseases. The family food proved to be far from the guidelines established by the dietary guidelines for Venezuela and consumption patterns are fairly homogeneous in the different socioeconomic strata. The foods most consumed daily were salt, coffee, dressing and precooked corn flour as well as beef, chicken and the higher weekly food consumption pastas. 90% of the food consumed daily is technologically processed. The results contribute to increase knowledge about the food situation of the Venezuelan population, and technically could direct the efforts of the authorities to reconcile the development of the productive sector and food supply, whereas a pattern qualitatively inadequate intake directly affects the individual biological functioning, and results in the collective conditioning of unfavorable health states.

[Estimation of the daily nutrients distribution in the Spanish standard diet]

Based on the raw data from the Spanish intake, have made the necessary changes and groupings to establish nutritional content per serving as percentages, regarding the total daily intake of each individual surveyed (n = 3000). Also, it was found the effect of the rating factors (sex, age and location) on the distribution of these percentages. The result indicates that individuals below 25 year should be considered as different groups, front those above that age; and locality effect (treated as random factor rather than fixed) causes differences in the distribution of nutrients between food daily intakes. However, the sex was was not relevant to the anecdotal footage found in statistically significant differences. Percentage distribution of individual nutrients between different food outlets is proposed.

Study on the mortality in Ecuador related to dietary factors

Diet is an important factor related to the development of numerous diseases. In developing countries like Ecuador, this aspect is not considered as priority however, the study of the incidence of certain diet-related diseases could help to assess consumption habits of a country from a Public Health perspective and support national nutrition policies and programs. The objective the present study is to investigate the mortality rate of certain diet-related diseases in Ecuador and its possible relationship with Ecuadorian consumption habits. For that, mortality rates (2001-2008) associated with five different disease groups related to dietary factors (cancer of colon, cerebrovascular diseases, cardiovascular diseases, diabetes mellitus and liver diseases) were collected, analyzed and compared to consumption patterns in Ecuador. According to results, Ecuador has a low level of cancer of colon in comparison with developed countries (e.g. Spain). The group with the highest number of deaths corresponded to cardiovascular diseases followed by cerebrovascular diseases. The mortality study per province revealed that Amazonian provinces showed few deaths in relation to other provinces in Ecuador. This could be due to different factors including fails in the disease surveillance information systems, environmental factors and consumption patterns. In this sense, further investigation on native products consumption such as "chontaduro" might help to find valuable foods contributing to healthier Ecuadorian diet. These results, though preliminary, evidence that a major effort should be made by national and international organisations to collect data on consumption patterns and nutritional aspects of the Ecuadorian population in order to better support the development of effective food security and nutrition policies.

Characterization and prediction by near-infrared reflectance of mineral composition of rocket (Eruca vesicaria subsp. sativa and Eruca vesicaria subsp. vesicaria)

BACKGROUND

Minerals are essential for human nutrition and must be obtained from our diet. Crucifer vegetables are a good source of these nutrients. Our objectives were to determine the genetic variability for mineral content and to evaluate the use of near-infrared reflectance spectroscopy (NIRS) for prediction of ashes and minerals among and within the rocket species Eruca vesicaria subsp. sativa and vesicaria. The minerals studied were iron (Fe), copper (Cu), sodium (Na), potassium (K), calcium (Ca), magnesium (Mg), manganese (Mn) and zinc (Zn).

RESULTS

The maximum mean values obtained for all the accessions (mean ± SE) were 235.5 ± 1.5 mg ashes kg(-1), 273.3 ± 4.2 mg Fe kg(-1), 18.1 ± 0.4 mg Cu kg(-1), 2.8 ± 0.1 g Na kg(-1), 71.6 ± 1.0 g K kg(-1), 64.6 ± 1.2 g Ca kg(-1), 6.8 ± 0.1 g mg kg(-1), 101.6 ± 1.2 mg Mn kg(-1), and 67.1 ± 0.4 mg Zn kg(-1) of dry weight.

CONCLUSION

The statistical analysis showed significant differences for all the minerals, except Ca, for each accession studied individually and for accessions grouped within countries. The results indicate that NIRS can be used as a rapid screening method for determining total mineral, Fe, Na, K, and Zn in rocket.

Mineral content modifications during ripening of asparagus (Asparagus officinalis, L.)

The essential elements: calcium (Ca), magnesium (Mg), sodium (Na) potassium (K) and phosphorus (P) were analyzed in fresh asparagus to determine the effect of the ripening of the asparagus on the mineral content. Asparagus samples were classified in two groups by diameter (< 11 mm and > 14 mm). Asparagus from a sample group with the same diameter were divided into two portions (apical and basal) according to distance from the tip. The concentrations of calcium, magnesium and phosphorus increased with the ripening process of the asparagus while the content of sodium decreased when the white asparagus turned into a green ripening state. No significant differences were established for potassium. The green ripening state was the group with the greater concentration of calcium, magnesium and phosphorus. Statistically significant differences (p < 0.001) were observed between portions of asparagus (tip and rest of stem) in the contents of the five mineral elements analyzed. The levels of mineral elements investigated increased notably in the tip of the asparagus with the exception of sodium and potassium of which the levels in the apical portion decreased or hardly modified. The variance analyses determined statistically significant differences (p < 0.001) in the concentration of magnesium, sodium and phosphorus between asparagus diameters (< 11 and > 14 mm) and no significant differences (p > 0.05) were found for calcium and potassium. The mean element levels were (mg/kg dry weight): Ca = 324 +/- 1186; Mg = 1818 +/- 490; Na = 368 +/- 86; K = 37297 +/- 4167 and P = 6809 +/- 2481.