Stakeholder perspectives on the barriers and facilitators of engagement in healthy lifestyle behaviours in underrepresented adolescents: a focus group study from the European SEEDS project.

BACKGROUND: Obesity in adolescence has increased in the last decades. Adolescents fail to meet the recommended guidelines for physical activity (PA) and healthy diet. Adolescents with a low socioeconomic status (SES) particularly seem to have fewer healthy lifestyle behaviours. The European Science Engagement to Empower aDolescentS (SEEDS) project used an extreme citizen science approach to develop and implement healthy lifestyle behaviour interventions in high schools. As part of this project, key stakeholders were invited to reflect on the intentions of adolescents to engage in healthy lifestyle behaviours. The aim of this study was to gain stakeholder insights into the barriers and facilitators to healthy lifestyle behaviours of adolescents from low SES areas and on the possible role of these stakeholders in facilitating healthy lifestyle behaviours. METHODS: Six semi-structured focus groups were conducted in four European countries with 28 stakeholders from different settings (schools, community, and government), like teachers, policy advisors and youth workers. The theoretical framework of focus groups was based on the Theory of Planned Behaviour. The main questions of the focus groups were centred on PA and healthy diet. The focus groups were qualitatively analysed in NVivo using thematic analysis to identify topics and themes. RESULTS: According to stakeholders, adolescents have sufficient understanding of the importance of PA and a healthy diet, but nevertheless engage in unhealthy behaviour. Parents were mentioned as important facilitators for engaging adolescents in healthy lifestyle behaviours. Stakeholders listed lack of knowledge, time, and financial resources as barriers for adolescents from low SES families to engage in healthy lifestyle behaviours. The school environment was listed as an important facilitator of adolescents' healthy lifestyle changes, but stakeholders acknowledged that current school days, curriculum and buildings are not designed to promote healthy lifestyle behaviours. External support and collaboration with community and governmental stakeholders was seen as potentially beneficial to improve healthy lifestyle behaviours. CONCLUSIONS: This study shows the variety of barriers adolescents from low SES areas face, and the need for a broader collaboration between key stakeholders to facilitate healthy lifestyle behaviours. Schools are regarded specifically as important facilitators. Currently, the school environment entails various barriers. However, when addressing those, schools can increase opportunities for healthy lifestyle behaviours of adolescents from low SES areas. TRIAL REGISTRATION: This study is registered in ClinicalTrials.gov on 12/08/2021: NCT05002049.

Effectiveness of Participatory Research Interventions on Obesity and Obesity-Related Behaviors in Adolescents: A Systematic Review and Meta-analysis.

CONTEXT: Adolescence is an optimal period to promote healthy lifestyles because behavior patterns are established in this stage. It has been suggested that engaging youth increases the effectiveness of interventions, but an overview is lacking. OBJECTIVE: This study aims to evaluate the effectiveness of participatory research (PR) interventions, where adolescents (11-18 years old) from high-income countries had a significant role in the intervention development and/or delivery, compared with no (PR) intervention control groups on obesity-related outcomes and healthy lifestyle behaviors (HLBs). DATA SOURCES: Eight databases (Embase, Medline ALL, Web of Science Core Collection, PsycINFO, ERIC, CINAHL, Scopus, and Cochrane Central Register of Controlled Trials) and Google Scholar were searched from 1990 to 2024 for randomized controlled trials (RCTs) and non-RCTs (in English). DATA EXTRACTION: Two researchers independently performed the data extraction and risk-of-bias assessment. DATA ANALYSIS: Sixteen studies were included and outcomes have been narratively described. Seven studies evaluated youth-led interventions, 3 studies evaluated co-created interventions, and 6 studies evaluated the combination of both. Six studies focused on physical activity (PA), 2 on nutrition, and 8 on a combination of PA, nutrition, and/or obesity-related outcomes. Ten studies presented at least 1 significant effect on PA, nutrition, or obesity-related outcomes in favor of the intervention group. Additionally, 12 studies were pooled in a meta-analysis. Whereas a small desired effect was found for fruit consumption, a small undesired effect was found for vegetable consumption. The pooled analysis found no significant effects on moderate-vigorous PA, total PA, and PA self-efficacy. CONCLUSION: We found some evidence that youth empowerment in research may have positive effects on obesity-related HLBs, specifically an increased fruit consumption. However, the overall evidence was inconclusive due to limited studies and the heterogeneity of the studies included. This overview may guide future public health interventions that aim to engage and empower adolescents. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration Nº CRD42021254135.

A 16-month follow-up after a youth-led social marketing intervention to encourage healthy lifestyles in children (aged 9 at baseline and 11 at follow-up) from disadvantaged neighbourhoods: the European Youth Tackling Obesity-Kids project.

OBJECTIVES: The objective of this study was to assess the influence of the European Youth Tackling Obesity-Kids (EYTO-Kids) 10-month intervention, based on social marketing and peer-led methodologies, at 16 month of its ending. STUDY DESIGN: Children (aged 9 at baseline and 11 at the follow-up) from disadvantaged neighbourhoods who participated in the 10-month EYTO-Kids parallel-cluster randomised controlled intervention study in Reus (Spain) were included. The number of participants was 252 (retention rate: 67.2%) in the intervention group (7 schools) and 226 (retention rate: 69.1%) in the control one (8 schools). Primary (physical activity and fruit consumption) and secondary (screen time; and vegetables, fast food, and sugary drink consumption) outcomes were assessed. RESULTS: At follow-up, consumption of ≥1 fruit per day increased in girls (odds ratio [OR] (95% confidence interval [CI]) = 2.28 (1.2; 4.2), P = 0.012) and all children (OR (95%CI) = 2.28 (1.0; 2.6), P = 0.044) in the intervention group vs. the control one. Physical activity ≥6 h/week similarly increased in both groups. CONCLUSION: At long-term effectiveness of a 10-month intervention on improving fruit consumption in children was observed. Therefore, peer-led and social marketing methodologies enhance healthy lifestyles by conveying children towards healthy choices.

Changes over time of fruit, vegetable and sweets consumption among European adolescents and associations with sociodemographic characteristics: an HBSC study.

BACKGROUND: European adolescents do not eat enough fruits and vegetables and have a high sweets consumption. This study aims to analyse the changes in time of dietary behaviours related to sociodemographic characteristics, among European adolescents. METHODS: Health Behaviour in School Age Children data (2013/14 to 2017/18), of European adolescents, aged 11- to15-year-old, were used. Family Affluence Scale identified socioeconomic status (SES). Changes in time of dietary behaviours and associations with sociodemographic characteristics were estimated by binary and multilevel logistic regression. RESULTS: 182 719 adolescents were included, and 10/36 European countries showed a significant increase in daily fruit and vegetable consumption and 12/36 countries a significant decrease in sweets consumption over 4 years. The multilevel analysis showed that 13- and 15-year-old adolescents consumed fewer daily fruits and vegetables (P < 0.001) and more daily sweets (P < 0.001) than 11-year-old adolescents. Also, 15-year-old adolescents' sweets consumption change over time was less favourable (P = 0.006). Girls consumed more daily fruits, vegetables and sweets than boys (P < 0.001).Low SES adolescents consumed fewer daily fruits and vegetables than medium/high SES adolescents. Additionally, the low SES adolescents' vegetable consumption change over time was less favourable (P < 0.001). CONCLUSIONS: Dietary behaviour policy recommendations should be adapted for the sex, age and SES of the population.

Impact of an Intervention on Healthy Offerings and Allergenic Food Management in Restaurants: A Parallel Randomized Controlled Study.

The consumption of out-of-home meals is increasing. This study is aimed at assessing the effect of an intervention on healthy offerings and the management of food allergies and intolerances. Ten (control group) and eight restaurants (intervention group) were randomized in a 12-month parallel controlled trial. The outcomes were changes regarding adherence to the Mediterranean diet (AMed) and gluten management (SMAP) criteria, the traffic light rating category, nutrients, and gluten- and allergen-free content of dishes. After 12 months, and compared with baseline, there was an improvement of ≥25% in four items of the AMed criteria in the intervention group, whereas an increase in the offer of dairy desserts without added sugar, and a decrease in the first course offerings of vegetables and/or legumes were observed in the control group (p < 0.05). Also, after 12 months, there was an improvement of ≥50% in four SMAP criteria (p < 0.05) and in the mean average of all SMAP criteria (p = 0.021) compared with baseline in the intervention group, in which intra- and inter-group improvements for desserts in traffic light ratings, nutrients, and allergens were observed (p < 0.05). Therefore, the intervention showed beneficial effects, improving the quality of menus toward the Mediterranean diet pattern and gluten and food allergy/intolerance management.

Citizen Science to improve healthy and active living among adolescents in four European countries: a protocol of the cluster randomised controlled trial of the Science Engagement to Empower aDolescentS (SEEDS) project.

INTRODUCTION: Improving healthy lifestyles of adolescents is challenging. Citizen Science is a way to engage them in the design and delivery of interventions, and may also increase their interest in science, technology, engineering and mathematics (STEM). The Science Engagement to Empower aDolescentS (SEEDS) project aims to use an equity-lens, and engage and empower boys and girls from deprived areas by designing and cocreating interventions to promote healthy lifestyles, and to seed interest in STEM. METHODS AND ANALYSIS: SEEDS is a cluster randomised controlled trial in four countries (Greece, the Netherlands, Spain and the UK). Each country will recruit six to eight high schools from lower socioeconomic neighbourhoods. Adolescents aged 13-15 years are the target population. High schools will be randomised into intervention or control group. Each country will select 15 adolescents from intervention schools called ambassadors, who will be involved throughout the project.In each country, focus groups with ambassadors and stakeholders will focus on physical activity, snacking behaviour and STEM. The input from focus groups will be used to shape Makeathon events, cocreation events where adolescents and stakeholders will develop the interventions. The resultant intervention will be implemented in the intervention schools during 6 months. In total, we aim to recruit 720 adolescents who will complete questionnaires related to healthy lifestyles and STEM outcomes at baseline (November 2021) and after the 6 months (June 2022). ETHICS AND DISSEMINATION: The four countries obtained approval from their corresponding Ethics Committees (Greece: Bioethics Committee of Harokopio University; the Netherlands: The Medical Research Ethics Committee of the Erasmus Medical Center; Spain: The Drug Research Ethics Committee of the Pere Virgili Health Research Institute; UK: Sport and Health Sciences Ethics Committee of the University of Exeter). Informed consent will be collected from adolescents and their parents in line with General Data Protection Regulation legislation. The findings will be disseminated by conference presentations, publications in scientific peer-reviewed journals and during (local) stakeholders and public events. Lessons learnt and the main results will also be used to provide policy recommendations. TRIAL REGISTRATION NUMBER: NCT05002049.

Exploring restaurant and customer needs, barriers, interests, and food choices induced by the COVID-19 pandemic in Tarragona Province (Catalonia, Spain): A cross-sectional study.

Background: COVID-19 has harmed restaurants, but customer preferences remain unknown. This study aims to determine the needs, barriers, interests, and food choice changes in restaurants and customers before and during the COVID-19 pandemic in Tarragona Province (Spain). Methods: An observational cross-sectional study conducted in spring 2021 collected Mediterranean offerings, food safety, and hygiene information about the pandemic through online surveys and focus group interviews with restaurateurs and customers about the changes in their needs and new barriers. Results: Fifty-one restaurateurs (44 survey, 7 focus group) and 138 customers (132 survey, 6 focus group) were included. In relation to the economic, emotional, and uncertainty restaurateurs' barriers detected, they implemented measures to tackle it: buy less and more often, reduce restaurant staff and reduce the restaurants offer, among others. Some customers reported changes in their restaurant orders, specifically increasing their takeaway orders. The Mediterranean diet offer (AMed criteria) remained without noticeable changes in any of the criteria. After lockdown, compared to before lockdown, restaurateurs increased their takeaway offerings by 34.1% (p < 0.001) and their use of digital menus by 27.3% (p < 0.001) because of customer demand. The use of local products in the menus remained high. The cleaning and disinfection tasks increased by 21.1% (p = 0.022), and the use of hydroalcoholic solutions increased by 13.7% (p = 0.031). Conclusion: In restaurants, the first COVID-19 lockdown increased takeaway orders, sanitation, and digital communication. This study provides valuable information for adapting gastronomic offerings during challenging situations.

Occupational Physical Activity and Cardiometabolic Risk Factors: A Cross-Sectional Study.

Contradictory data exist on the impact of occupational physical activity (OPA) on cardiovascular health. We aimed to evaluate the association between OPA and cardiometabolic risk factors. A cross-sectional study was performed in an environmental services company in 2017 (Spain). OPA was classified by work categories as being low (≤3 METs) or moderate-high (>3 METs). Multiple linear and logistic binary regression models were used to assess the associations between OPA and cardiometabolic risk factors related to obesity, blood pressure, blood lipids, and associated medical conditions, adjusted by age, sex, alcohol consumption, and global physical activity. In total, 751 employees were included (547 males and 204 females), and 55.5% (n = 417) had moderate-high OPA. Significant inverse associations were observed between OPA and weight, body mass index, waist circumference, waist-hip ratio, and total cholesterol both overall and in males. OPA was significantly inversely related to dyslipidemia overall and in both sexes, while the overweight plus obesity rate was inversely related only in the total and male populations. OPA was associated with a better cardiometabolic risk factor profile, particularly in males. The fact that our models were also adjusted by global physical activity highlights the associations obtained as being independent of leisure time physical activity effects.

Antioxidant-rich foods, antioxidant supplements, and sarcopenia in old-young adults ≥55 years old: A systematic review and meta-analysis of observational studies and randomized controlled trials.

BACKGROUND & AIMS: Sarcopenia is a disabling muscular multifactorial disease involving the oxidation process in old-young adults. We aimed to evaluate the relationship between antioxidant-rich foods (A-RF) and sarcopenia (muscle mass, strength, and function) based on observational studies (OS), and to assess the effectiveness of antioxidant interventions in ≥55-year-old adults via randomized controlled trials (RCTs). Moreover, to confirm if the OS results were in accordance with the RCTs results. METHODS: We searched in the MEDLINE®/PubMed, Cochrane Library, and CINAHL databases from 2000 to 2020 about sarcopenia and specific nutrients/foods. The risk of bias was assessed and meta-analyses were performed using the Review Manager program. RESULTS: The systematic review included 28 studies (19 OS, 9 RCTs), whereas the meta-analysis included 4 RCTs. Results of the systematic review of OS revealed that higher A-RF consumption was associated with better sarcopenia outcomes. Results of the RCTs meta-analysis indicated that higher fruit/vegetable consumption, supplementation with magnesium, and vitamin E plus vitamin D and protein significantly reduced the time to complete 5 stands (mean difference; 95% CI; -1.11 s; 1.70, -0.51; p < 0.01). Additionally, including tea catechin supplementation significantly increased handgrip strength (1.02 kg; 0.60, 1.44; p < 0.01). CONCLUSIONS: In sum, A-RF or antioxidant supplementation could be effective tools for sarcopenia, especially improving muscle strength and function. The best interventions according to the meta-analysis of the RCTs were supplementation of vitamin E in combination with vitamin D and protein, magnesium, tea catechins, and increasing fruit and vegetable consumption. REGISTRATION NUMBER: PROSPERO (CRD42020183045).

"Som la Pera," a School-Based, Peer-Led Social Marketing Intervention to Engage Spanish Adolescents in a Healthy Lifestyle: A Parallel-Cluster Randomized Controlled Study.

Background: Encouraging adolescents to adopt healthy lifestyles can be challenging. The aim of the "Som la Pera" study was to engage adolescents by applying new strategies to increase both their fruit and vegetable consumption and their physical activity (PA), while reducing their sedentary behavior (screen time per day). Methods: In disadvantaged neighborhoods of Reus (Spain), two high schools were randomly assigned to the intervention (n = 169 adolescents, 13- to 16-year old) and two were assigned to the control group (n = 223 adolescents, 13- to 16-year old). The intervention, which lasted 12 months and spanned two academic years (2013-2015), used social marketing (SM) to improve healthy choices. The peer-led strategy involved 5 adolescents, who designed and implemented 10 activities as challenges for their 169 school-aged peers. The control group received no intervention. To assess self-reported lifestyles in both groups, the Health Behavior in School-aged Children survey was used at baseline and end of study. Results: After 12 months, the weekly PA improved in the intervention group vs. the control one (p = 0.047). When male and female groups were examined separately, the improvement in PA remained with a borderline significance only in the male group (p = 0.050). Conclusions: A school-based, peer-led SM intervention designed and implemented by adolescents attending high schools in low-income neighborhoods promoted an increase in PA, particularly in male adolescents 13 to 16 years of age. No effect on fruit or vegetable consumption or screen time was observed. Clinical Trial Registration number: NCT02157402.

The "Healthy Meals" web app for the assessment of nutritional content and food allergens in restaurant meals: Development, evaluation and validation.

OBJECTIVE: The development and the evaluation of the Healthy Meals web app designed for professionals from different disciplines related to food, aimed to assess the nutritional and food allergen content of restaurant meals, was described. METHODS: App evaluation concerned: (1) usability, scored on a 7-point scale by 6 restaurateurs and 10 nutritionists through the Computer System Usability Questionnaire; (2) quality, scored on a 5-point scale by 10 nutritionists through the Mobile App Rating Scale; (3) validation, by two nutritionists through differences in entered nutrient contents. Ratings reliability was assessed by the interclass correlation coefficient. RESULTS: Users agreed with the web app usability (mean 5.6/7 points, SD 0.9), with moderate reliability among ratings (interclass correlation coefficient = 0.57; 95% CI, 0.18 to 0.82). The web app showed good objective quality (mean 4.0/5 points, SD 0.4), with excellent reliability among nutritionists (interclass correlation coefficient = 0.91; 95% CI, 0.85 to 0.96). For web app validation, no significant differences were observed between the two nutritionists' data, with excellent reliability (interclass correlation coefficient = 0.98; 95% CI, 0.97 to 0.99). App data entry was identified as a point to improve. CONCLUSIONS: The Healthy Meals web app designed for professionals related to food, such as restaurateurs, demonstrated to be usable, of good quality and valid for dishes nutritional assessment and food allergen identification. Points to improve were identified, while app effectiveness should be tested in trials.

Adolescents encouraging healthy lifestyles through a peer-led social marketing intervention: Training and key competencies learned by peer leaders.

BACKGROUND: Adolescents who participate as peer leaders can benefit and acquire competencies from their peer leadership experience. OBJECTIVES: To identify the competencies gained by adolescents who participated as peer leaders in a healthy lifestyle study and to determine whether the training characteristics were related to improvement in competencies. DESIGN: The present study was part of the European Youth Tackling Obesity (EYTO) project, a multicentre social marketing intervention involving four European countries. SETTING AND PARTICIPANTS: Eighteen peer leaders (aged 13-15 years, three or five leaders per country) from disadvantaged neighbourhoods received training in designing and implementing activities for their peers. MEASURES: The peer leaders' confidence, experience and interest in 11 tasks related to lifelong learning competencies were assessed with questions rated on a colour scale at baseline and at the end of the study. RESULTS: The peer leaders demonstrated improvements in experience, confidence and interest in different tasks, such as research, website or logo design, oral presentations, social media use and collaboration with people from other countries. They increased their confidence in management tasks (p = 0.03) and their confidence and experience in communication tasks (p = 0.01). The peer leaders from Spain and Portugal had greater improvements than those from the other countries. CONCLUSION: The peer leaders improved their confidence in management tasks and their confidence and experience in communication tasks. Slight differences were detected in improvement in competencies by country, likely due to the differences in the peer training applied. Recommendations for peer leader training are proposed, although these results should be verified with larger sample size. PATIENT OR PUBLIC CONTRIBUTION: The peer leaders contributed to the design and implementation of the training and intervention.

Evaluating Mediterranean Diet-Adherent, Healthy and Allergen-Free Meals Offered in Tarragona Province Restaurants (Catalonia, Spain): A Cross-Sectional Study.

Restaurant meal consumption has increased substantially, but the ability of restaurants to adhere to guidelines for the Mediterranean diet, healthiness and food allergen management is a challenge. This cross-sectional study aims to assess the Mediterranean diet adherence, healthiness, nutritional quality and food allergen management of meals at restaurants in the Tarragona province (Catalonia, Spain). Primary outcomes included adherence to criteria for the Mediterranean diet (AMed) and gluten management (SMAP), nutritional quality of dishes indicated by a green traffic light rating, meal nutrient content and allergen-free options. Secondary outcomes included restaurant staff knowledge about the Mediterranean diet and food allergens. Forty-four restaurants and 297 dishes were analysed. The restaurants fulfilled an average (mean ± SD) of 5.1 ± 1.6 of 9 compulsory AMed criteria and 12.9 ± 2.8 of 18 SMAP criteria. Dishes were mainly rated green for sugar (n = 178/297; 59.9%) but not for energy (n = 23/297; 7.7%) or total fat (n = 18/297; 6.1%). Waiters and cooks received passing scores for food allergen knowledge (5.8 ± 1.7 and 5.5 ± 1.5 out of 10 points, respectively). Restaurants partially met the AMed and SMAP criteria. Increasing fibre and decreasing saturated fat content are necessary to improve consumers' adherence to healthy diets. For restaurant staff, training courses should be considered to improve their food allergen management.

Study Protocol of a Multicenter Randomized Controlled Trial to Tackle Obesity through a Mediterranean Diet vs. a Traditional Low-Fat Diet in Adolescents: The MED4Youth Study.

Youth obesity is a strong predictor of adult obesity, which has well-known negative health consequences. Thus, addressing adult obesity requires tackling youth obesity. MED4Youth's main objective is to strengthen the link between the Mediterranean Diet (MD) and the health benefits against youth obesity and associated cardiovascular disease (CVD) risk factors, identifying positive effects exerted by an MD including sourdough bread and healthy products from the Mediterranean basis (chickpeas/hummus, nuts, and pomegranate juice). For this purpose, a multicenter randomized controlled trial in which an MD-based intervention will be compared to a traditional low-fat diet intervention will be carried out with 240 overweight and obese adolescents (13-17 years) from Spain, Portugal, and Italy. Both interventions will be combined with an educational web-application addressed to engage the adolescents through a learning-through-playing approach, using both educational materials and games. To assess the interventions, adherence to the MD, dietary records, physical activity, food frequency, sociodemographic, and quality of life questionnaires as well as classical anthropometric and biochemical parameters will be evaluated. Furthermore, an omics approach will be performed to elucidate whether the interventions can shape the gut microbiota and gut-derived metabolites to gain knowledge on the mechanisms through which the MD can exert its beneficial effects.

Interventions to Promote Healthy Meals in Full-Service Restaurants and Canteens: A Systematic Review and Meta-Analysis.

Out-of-home eating is increasing, but evidence about its healthiness is limited. The present systematic review and meta-analysis aimed to elucidate the effectiveness of full-service restaurant and canteen-based interventions in increasing the dietary intake, food availability, and food purchase of healthy meals. Studies from 2000-2020 were searched in Medline, Scopus, and Cochrane Library using the PRISMA checklist. A total of 35 randomized controlled trials (RCTs) and 6 non-RCTs were included in the systematic review and analyzed by outcome, intervention strategies, and settings (school, community, workplace). The meta-analysis included 16 RCTs (excluding non-RCTs for higher quality). For dietary intake, the included RCTs increased healthy foods (+0.20 servings/day; 0.12 to 0.29; p < 0.001) and decreased fat intake (-9.90 g/day; -12.61 to -7.19; p < 0.001), favoring the intervention group. For food availability, intervention schools reduced the risk of offering unhealthy menu items by 47% (RR 0.53; 0.34 to 0.85; p = 0.008). For food purchases, a systematic review showed that interventions could be partially effective in improving healthy foods. Lastly, restaurant- and canteen-based interventions improved the dietary intake of healthy foods, reduced fat intake, and increased the availability of healthy menus, mainly in schools. Higher-quality RCTs are needed to strengthen the results. Moreover, from our results, intervention strategy recommendations are provided.

Mobile Phone Apps for Food Allergies or Intolerances in App Stores: Systematic Search and Quality Assessment Using the Mobile App Rating Scale (MARS).

BACKGROUND: Food allergies and intolerances are increasing worldwide, and mobile phone apps could be a promising tool for self-management of these issues. OBJECTIVE: This study aimed to systemically search and assess food allergy or intolerance apps in app stores using the multidimensional Mobile App Rating Scale (MARS) to rate the objective and subjective quality and to identify critical points for future improvements. METHODS: This systematic search identified apps through the keywords "food allergy," "food intolerance," and "allergens" in English, Spanish, and Italian in the Apple App Store (iOS) and Google Play Store (Android). The inclusion criteria were a user star rating of ≥3 (of 5 stars) to limit the selection to the most highly rated apps; ≥1000 reviews as an indicator of reliability; and the most recent update performed up to 2017. Then, the apps were divided according to their purpose (searching for allergen-free "food products," "restaurants," or recipes in "meal planners") and evaluated on a scale of 1 to 5 points using the MARS in terms of (1) app classification category with a descriptive aim; (2) app subjective and objective quality categories comprised of engagement, functionality, esthetics, and information sections (Medline was searched for eligible apps to check whether they had been tested in trials); and (3) an optional app-specific section. Furthermore, the output and input features were evaluated. Differences between MARS sections and between app purposes and correlations among MARS sections, star ratings, and numbers of reviews were evaluated. RESULTS: Of the 1376 apps identified, 14 were included: 12 related to food allergies and intolerances that detect 2-16 food allergens and 2 related only to gluten intolerance. The mean (SD) MARS scores (maximum 5 points) were 3.8 (SD 0.4) for objective quality, highlighting whether any app had been tested in trials; 3.5 (SD 0.6) for subjective quality; and 3.6 (SD 0.7) for the app-specific section. Therefore, a rating ≥3 points indicated overall acceptable quality. From the between-section comparison, engagement (mean 3.5, SD 0.6) obtained significantly lower scores than functionality (mean 4.1, SD 0.6), esthetics (mean 4, SD 0.5), and information (mean 3.8, SD 0.4). However, when the apps were compared by purpose, critical points were identified: meal planner apps showed significantly higher engagement (mean 4.1, SD 0.4) than food product (mean 3.0, SD 0.6; P=.05) and restaurant (mean 3.2, SD 0.3; P=.02) apps. CONCLUSIONS: In this systematic search of food allergy or intolerance apps, acceptable MARS quality was identified, although the engagement section for food product and restaurant purpose apps should be improved and the included apps should be tested in trials. The critical points identified in this systematic search can help improve the innovativeness and applicability of future food allergy and intolerance apps.

Effectiveness of Workplace Interventions for Improving Absenteeism, Productivity, and Work Ability of Employees: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

To determine the effectiveness of workplace interventions and the most effective methodological design for the improvement of employee productivity, work ability, and absenteeism. A meta-analysis of randomized controlled trials (RCTs) of workplace interventions was conducted (PROSPERO, CRD42018094083). The PubMed, Scopus, PsycINFO, and Cochrane databases were searched. RCTs from 2000 to 2017 and with employees (18-65 years) were selected. Then, intervention characteristics and work-related outcomes data were extracted. A total of 47 RCTs were included in the systematic review, and 19 RCTs (11 absenteeism, 7 productivity, and 5 work ability) were included in the meta-analysis. The meta-analysis showed that the effectiveness of workplace interventions for absenteeism was -1.56 (95% CI, -2.67 to -0.44) and -2.65 (95% CI, -4.49 to -0.81) considering only moderate quality RCTs. In contrast, only a few studies of workplace interventions for productivity and work ability were included, which was insufficient for determining the effectiveness and best design for improving these work outcomes. The workplace is an interesting environment to reduce absenteeism, and individualized and counseling interventions with <10 sessions/total were the most effective workplace intervention methodological design for reducing the absenteeism of employees. Future high-quality RCTs that also consider health risks should be implemented to strengthen the results.

Social and Economic Factors and Malnutrition or the Risk of Malnutrition in the Elderly: A Systematic Review and Meta-Analysis of Observational Studies.

Malnutrition in the elderly could be tackled by addressing socioeconomic factors. This study aimed to determine the magnitude of the relationship between socioeconomic factors and the malnutrition or malnutrition risk (MR) in the elderly. The PubMed and SCOPUS databases were searched for observational studies that included assessment of malnutrition or/and MR and socioeconomic variables (educational level, living alone, marital status, income and occupational level, feeling of loneliness, place of residence, and food expenditure) in ≥60-year-old subjects, published in English among 2000-2018 (PROSPERO: CRD42019137097). The systematic review included 40 observational studies (34 cross-sectional and 4 cohort studies) and 16 cross-sectional studies in the meta-analysis (34,703 individuals) of malnutrition and MR in relation to low educational level (Odds Ratio (OR): 1.48; 95% Confidence Interval (CI): 1.33-1.64; p < 0.001), living alone (OR: 1.92; 95% CI: 1.73-2.14; p < 0.001), being single, widowed, or divorced (OR: 1.73; 95% CI: 1.57-1.90; p < 0.001), and low income level (OR: 2.69; 95% CI: 2.35-3.08; p < 0.001), and considering these four socioeconomic factors, malnutrition and MR is associated with them (OR: 1.83; 95% CI: 1.73-1.93; p < 0.001). Malnutrition and MR could be reduced by increasing economic level, supporting people living alone or being single, widowed, and divorced, and improving lifelong learning.

Potential Use of Mobile Phone Applications for Self-Monitoring and Increasing Daily Fruit and Vegetable Consumption: A Systematized Review.

A wide range of chronic diseases could be prevented through healthy lifestyle choices, such as consuming five portions of fruits and vegetables daily, although the majority of the adult population does not meet this recommendation. The use of mobile phone applications for health purposes has greatly increased; these applications guide users in real time through various phases of behavioural change. This review aimed to assess the potential of self-monitoring mobile phone health (mHealth) applications to increase fruit and vegetable intake. PubMed and Web of Science were used to conduct this systematized review, and the inclusion criteria were: randomized controlled trials evaluating mobile phone applications focused on increasing fruit and/or vegetable intake as a primary or secondary outcome performed from 2008 to 2018. Eight studies were included in the final assessment. The interventions described in six of these studies were effective in increasing fruit and/or vegetable intake. Targeting stratified populations and using long-lasting interventions were identified as key aspects that could influence the effectiveness of these interventions. In conclusion, evidence shows the effectiveness of mHealth application interventions to increase fruit and vegetable consumption. Further research is needed to design effective interventions and to determine their efficacy over the long term.