Randomized trial of a "talking computer" to improve adults' eating habits.

PURPOSE: To assess efficacy of an intervention delivered by an interactive, computer-controlled telephone system to improve individuals' diets. DESIGN: Randomized controlled trial. SETTING: Large multispecialty group practice. SUBJECTS: Two hundred ninety-eight adults who were both sedentary and had suboptimal diet quality. INTERVENTION: Weekly communication for 6 months via a totally automated, computer-based voice system. Among intervention group subjects, the system monitored dietary habits and provided educational feedback, advice, and behavioral counseling. Control group subjects received physical activity promotion counseling. MEASURES: Daily intake of fruits, vegetables, red and processed meats, whole fat dairy foods, and whole grain foods estimated from a food frequency questionnaire. RESULTS: Mean age 45.9 years, 72% women, 45% white, and 45% African-American. Among participants who completed diet assessments, compared with the control group, the intervention raised fruit intake a mean of 1.1 servings per day (95% confidence interval [CI] .4, 1.7). On a 0 to 100 global diet quality score combining all five food groups, intervention participants improved their mean score 9 (95% CI 4, 13) points more than in the control group. The intervention also raised dietary fiber intake 4.0 g/d (95% CI .1, 7.8) and decreased saturated fat, as a proportion of energy intake, by 1.7% (95% CI -2.7, -.7). CONCLUSIONS: This computer-based telecommunications dietary behavior intervention helped improve participants' overall diet.

WebDietAID: an interactive Web-based nutritional counselor.

WebDietAID is a Web-based system aimed at assisting individuals affected by high serum cholesterol. The system tries to reproduce the types of intervention performed by a nutritional counselor. It is structured as a set of advisors, each of which handles a different side of the counseling process. The tasks of the advisors range from monitoring weight, to teaching about healthy nutrition, to assessing motivation and psychological obstacles to behavior change. WebDietAID is based on a development environment for Web-based applications that includes a dynamical Web server, a knowledge base management system, and an interface to a relational database. We describe the architecture of the system, and several of the implemented advisors. Finally, we discuss how the architecture could be generalized to other counseling domains.

Should I take vitamins?...Yes.

AIDS: People with HIV need higher levels of nutrients to remain healthy and fight the virus, but it is often difficult to get adequate amounts of vital nutrients from diet alone. Vitamins and other supplements are recommended. Among them are multivitamins and high-potency B-vitamins, which should be taken daily. Other nutritional supplements, including antioxidants, are listed in their order of importance. These can reduce the symptoms of HIV disease or counteract the side effects of medications taken to control the disease.^ieng

Nutritional risk in New England elders.

BACKGROUND: To better define nutritional risk among older Americans, a cross-sectional study of nutrition and health status was carried out in a probability sample of 1,156 free-living elders, 70 years and older, from 67 communities representing urban and rural areas of the six New England states. METHOD: All participants completed telephone interviews concerning demographic and health characteristics. A subsample of 1,156 individuals underwent in-home assessments of oral health, anthropometrics, and nutritional risk, including a 24-hour dietary recall. RESULTS: Nutrition-related problems were common and diverse among New England elders. Some 41.5% were overweight (BMI > 27 kg/m2), and mean dietary lipid intakes were considerably above recommended levels (Healthy People 2000 (National Health Promotion and Disease Prevention Objectives). Some 16% were underweight (BMI < 22 kg/m2), mean dietary calcium levels were low, and about 28% of older individuals failed to consume adequate levels (> 75% the Recommended Dietary Allowance for persons 51 years and older) for three or more key nutrients. Persons of advanced age or who smoked were more likely to have high dietary lipid intakes or less than adequate nutrient intake. Higher dietary lipid levels were also more common among men and individuals who lived with others. Low nutrient intake was more prevalent in those with lower educational attainment and dental problems. CONCLUSION: Nutrition policies and multidisciplinary interventions for older Americans need to emphasize the spectrum of nutritional problems in the elderly, including dietary excesses and potential nutrient deficiencies. The demographic and life-style characteristics that place older individuals at high nutritional risk need to be considered, particularly advanced age, gender, living situation, smoking, dietary behavior, educational attainment, and dental health.

Comparison of techniques for estimating nutrient intake: the Framingham Study.

We compared estimates of nutrient intake by three diet assessment methods (24-hour recall, 3-day food record, food frequency questionnaire) in a random sample of 73 females and 77 males from the Framingham Offspring/Spouse Study. The results differed according to analytic method. Estimates of group mean intake from the 24-hour recall and 3-day records were similar in both women and men, with differences of less than 10% for most nutrients. The estimates of mean intake calculated from the food frequency questionnaire generally differed from those obtained by the other methods, with higher estimated intakes in women and generally lower estimated intakes in men. Spearman rank correlations between the individuals' nutrient intakes estimated by the three diet assessment methods were modest (r = 0.08-0.68, most below 0.50) and comparable in the comparisons of the 24-hour recall or food frequency questionnaire with the 3-day records. Our data suggest the interchangeability of the recall and record methods and their preference over the food frequency questionnaire for mean estimates of group nutrient intake. The food frequency questionnaire appears to be of some utility in ranking individuals according to the usual intake, although these data are not informative in comparing this method with multiple days of recall or records beyond 3 days. This research underscores the need to develop and evaluate short methods of diet assessment in specific populations of interest.

Dietary characteristics and nutrient intake in an urban homebound population.

The food and nutrient intake of 53 homebound older persons (mean age = 82 years) who receive home medical care in metropolitan Boston was examined, using the 24-hour recall and food frequency methodologies. Demographic data were collected in personal interviews, and systematic analyses were conducted of subjects' medical records. Mean intake of energy, folic acid, and calcium was below the RDAs for both men and women, and intake of thiamin was below the RDA for men. Nutrient intake failed to meet the RDAs for nine leader nutrients in 40% to 80% of the sample. Fewer than 20% of the subjects were able to name the Basic Food Groups or any of their food components. The subjects' age, income, gender, marital and health status, living situation, and educational level did not predict nutrient intake. Poor dietary intake among older, homebound persons, coupled with diverse medical problems, places them at major risk of nutrition problems. The nutrition needs and problems of the homebound elderly should be considered in the delivery of home health care services.