The connecting health and technology study: a 6-month randomized controlled trial to improve nutrition behaviours using a mobile food record and text messaging support in young adults

International Journal of Behavioral Nutrition and Physical Activity, Apr 2016

Background Early adulthood represents the transition to independent living which is a period when changes in diet and body weight are likely to occur. This presents an ideal time for health interventions to reduce the effect of health problems and risk factors for chronic disease in later life. As young adults are high users of mobile devices, interventions that use this technology may improve engagement. The Connecting Health and Technology study aimed to evaluate the effectiveness of tailored dietary feedback and weekly text messaging to improve dietary intake of fruit, vegetables and junk food over 6 months among a population-based sample of men and women (aged 18–30 years). Methods A three-arm, parallel, randomized control trial was conducted. After baseline assessments, participants were randomized to one of three groups: A) dietary feedback and weekly text messages, B) dietary feedback only or C) control group. Dietary intake was assessed using a mobile food record App (mFR) where participants captured images of foods and beverages consumed over 4-days at baseline and post-intervention. The primary outcomes were changes in serves of fruits, vegetables, energy-dense nutrient-poor (EDNP) foods and sugar-sweetened beverages (SSB). The intervention effects were assessed using linear mixed effect models for change in food group serves. Results Young adults (n = 247) were randomized to group A (n = 82), group B (n = 83), or group C (n = 82). Overall, no changes in food group serves for either intervention groups were observed. An unanticipated outcome was a mean weight reduction of 1.7 kg (P = .02) among the dietary feedback only. Men who received dietary feedback only, significantly reduced their serves of EDNP foods by a mean of 1.4 serves/day (P = .02). Women who received dietary feedback only significantly reduced their intake of SSB (P = .04) by an average of 0.2 serves/day compared with controls. Conclusions Tailored dietary feedback only resulted in a decrease in EDNP foods in men and SSB in women, together with a reduction in body weight. Using a mobile food record for dietary assessment and tailored feedback has great potential for future health promotion interventions targeting diet and weight in young adults. Trial Registration Australian Clinical Trials Registry Registration number: ACTRN12612000250831.

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The connecting health and technology study: a 6-month randomized controlled trial to improve nutrition behaviours using a mobile food record and text messaging support in young adults

Kerr et al. International Journal of Behavioral Nutrition and Physical Activity The connecting health and technology study: a 6-month randomized controlled trial to improve nutrition behaviours using a mobile food record and text messaging support in young adults Deborah A. Kerr 0 Amelia J. Harray 0 Christina M. Pollard 0 2 Satvinder S. Dhaliwal 0 Edward J. Delp 1 Peter A. Howat 0 Mark R. Pickering 6 Ziad Ahmad 1 Xingqiong Meng 5 Iain S. Pratt 4 Janine L. Wright 0 Katherine R. Kerr 0 Carol J. Boushey 3 7 0 School of Public Health, Curtin University , GPO Box U1987, Bentley, Perth, WA 6845 , Australia 1 Video and Image Processing Laboratory, School of Electrical and Computer Engineering, Purdue University , West Lafayette, IN , USA 2 Public Health Division, Department of Health In Western Australia , 189 Royal Street, East Perth 6004WA , Australia 3 Epidemiology Program, University of Hawaii Cancer Center , Honolulu, HI , USA 4 Cancer Council Western Australia , Subiaco, WA , Australia 5 School of Medicine, Flinders University , Bedford Park , Australia 6 School of Engineering and Information Technology, The University of New South Wales at the Australian Defence Force Academy , Canberra , Australia 7 Department of Nutrition Science, Purdue University , West Lafayette, IN , USA Background: Early adulthood represents the transition to independent living which is a period when changes in diet and body weight are likely to occur. This presents an ideal time for health interventions to reduce the effect of health problems and risk factors for chronic disease in later life. As young adults are high users of mobile devices, interventions that use this technology may improve engagement. The Connecting Health and Technology study aimed to evaluate the effectiveness of tailored dietary feedback and weekly text messaging to improve dietary intake of fruit, vegetables and junk food over 6 months among a population-based sample of men and women (aged 18-30 years). Methods: A three-arm, parallel, randomized control trial was conducted. After baseline assessments, participants were randomized to one of three groups: A) dietary feedback and weekly text messages, B) dietary feedback only or C) control group. Dietary intake was assessed using a mobile food record App (mFR) where participants captured images of foods and beverages consumed over 4-days at baseline and post-intervention. The primary outcomes were changes in serves of fruits, vegetables, energy-dense nutrient-poor (EDNP) foods and sugar-sweetened beverages (SSB). The intervention effects were assessed using linear mixed effect models for change in food group serves. Results: Young adults (n = 247) were randomized to group A (n = 82), group B (n = 83), or group C (n = 82). Overall, no changes in food group serves for either intervention groups were observed. An unanticipated outcome was a mean weight reduction of 1.7 kg (P = .02) among the dietary feedback only. Men who received dietary feedback only, significantly reduced their serves of EDNP foods by a mean of 1.4 serves/day (P = .02). Women who received dietary feedback only significantly reduced their intake of SSB (P = .04) by an average of 0.2 serves/day compared with controls. Conclusions: Tailored dietary feedback only resulted in a decrease in EDNP foods in men and SSB in women, together with a reduction in body weight. Using a mobile food record for dietary assessment and tailored feedback has great potential for future health promotion interventions targeting diet and weight in young adults. (Continued on next page) - (Continued from previous page) Trial Registration: Australian Clinical Trials Registry Registration number: ACTRN12612000250831. Background There is convincing evidence of the importance of regularly eating a healthful diet for the prevention of chronic diseases and excessive weight gain in adulthood, particularly a diet high in fruits and vegetables and that limits energy-dense nutrient-poor (EDNP) foods and beverages [ 1 ]. Chronic diseases, such as obesity, cardiovascular disease and some cancers are diet related [ 2 ] and interventions targeting early adulthood may reduce the effect of health problems and risk factors for chronic disease in later life. In 2011, over half of young adults aged 18–24 years and 59 % of 25–34 year olds in Western Australia were classified as either overweight or obese [ 3 ]. Weight gain in early adulthood has been attributed to less physical activity and excess energy intake as well as the obesogenic environment [ 4 ]. In Australia, teenagers and young adults consume more energy dense nutrient poor foods (EDNP) such as fast food, chocolate, chips, meat pies, pizzas and sugar-sweetened beverages (SSB) than other age groups and are less likely than older adults to meet the Australian guidelines of at least two 150 g serves of fruit and five 75 g serves of vegetables a day [ 5 ]. These statistics may result from the challenges of early adultho (...truncated)


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Deborah Kerr, Amelia Harray, Christina Pollard, Satvinder Dhaliwal, Edward Delp, Peter Howat, Mark Pickering, Ziad Ahmad, Xingqiong Meng, Iain Pratt, Janine Wright, Katherine Kerr, Carol Boushey. The connecting health and technology study: a 6-month randomized controlled trial to improve nutrition behaviours using a mobile food record and text messaging support in young adults, International Journal of Behavioral Nutrition and Physical Activity, 2016, pp. 52, 13, DOI: 10.1186/s12966-016-0376-8