Mitigating errors in mobile-based dietary assessments: Effects of a data modification process on the validity of an image-assisted food and nutrition app.

OBJECTIVE: Mobile nutrition applications (apps) provide a simple way for individuals to record their diet, but the validity and inherent errors need to be carefully evaluated. The aim of this study was to assess the validity and clarify the sources of measurement errors of image-assisted mobile nutrition apps. METHODS: This was a cross-sectional study with 98 students recruited from School of Nutrition and Health Sciences, Taipei Medical University. A 3-d nutrient intake record by Formosa Food and Nutrient Recording App (FoodApp) was compared with a 24-h dietary recall (24-HDR). A two-stage data modification process, manual data cleaning, and reanalyzing of prepackaged foods were employed to address inherent errors. Nutrient intake levels obtained by the two methods were compared with the recommended daily intake (DRI), Taiwan. Paired t test, Spearman's correlation coefficients, and Bland-Altman plots were used to assess agreement between the FoodApp and 24-HDR. RESULTS: Manual data cleaning identified 166 food coding errors (12%; stage 1), and 426 food codes with missing micronutrients (32%) were reanalyzed (stage 2). Positive linear trends were observed for total energy and micronutrient intake (all Ptrend < 0.05) after the two stages of data modification, but not for dietary fat, carbohydrates, or vitamin D. There were no statistical differences in mean energy and macronutrient intake between the FoodApp and 24-HDR, and this agreement was confirmed by Bland-Altman plots. Spearman's correlation analyses showed strong to moderate correlations (r = 0.834 ∼ 0.386) between the two methods. Participants' nutrient intake tended to be lower than the DRI, but no differences in proportions of adequacy/inadequacy for DRI values were observed between the two methods. CONCLUSIONS: Mitigating errors significantly improved the accuracy of the Formosa FoodApp, indicating its validity and reliability as a self-reporting mobile-based dietary assessment tool. Dietitians and health professionals should be mindful of potential errors associated with self-reporting nutrition apps, and manual data cleaning is vital to obtain reliable nutrient intake data.

COVID-19 and Virtual Nutrition: A Pilot Study of Integrating Digital Food Models for Interactive Portion Size Education.

Background and aims: Digital food viewing is a vital skill for connecting dieticians to e-health. The aim of this study was to integrate a novel pedagogical framework that combines interactive three- (3-D) and two-dimensional (2-D) food models into a formal dietetic training course. The level of agreement between the digital food models (first semester) and the effectiveness of educational integration of digital food models during the school closure due to coronavirus disease 2019 (COVID-19) (second semester) were evaluated. Method: In total, 65 second-year undergraduate dietetic students were enrolled in a nutritional practicum course at the School of Nutrition and Health Sciences, Taipei Medical University (Taipei, Taiwan). A 3-D food model was created using Agisoft Metashape. Students' digital food viewing skills and receptiveness towards integrating digital food models were evaluated. Results: In the first semester, no statistical differences were observed between 2-D and 3-D food viewing skills in food identification (2-D: 89% vs. 3-D: 85%) and quantification (within ±10% difference in total calories) (2-D: 19.4% vs. 3-D: 19.3%). A Spearman correlation analysis showed moderate to strong correlations of estimated total calories (0.69~0.93; all p values < 0.05) between the 3-D and 2-D models. Further analysis showed that students who struggled to master both 2-D and 3-D food viewing skills had lower estimation accuracies than those who did not (equal performers: 28% vs. unequal performers:16%, p = 0.041), and interactive 3-D models may help them perform better than 2-D models. In the second semester, the digital food viewing skills significantly improved (food identification: 91.5% and quantification: 42.9%) even for those students who struggled to perform digital food viewing skills equally in the first semester (equal performers: 44% vs. unequal performers: 40%). Conclusion: Although repeated training greatly enhanced students' digital food viewing skills, a tailored training program may be needed to master 2-D and 3-D digital food viewing skills. Future study is needed to evaluate the effectiveness of digital food models for future "eHealth" care.

Integration of an Image-Based Dietary Assessment Paradigm into Dietetic Training Improves Food Portion Estimates by Future Dietitians.

The use of image-based dietary assessments (IBDAs) has rapidly increased; however, there is no formalized training program to enhance the digital viewing skills of dieticians. An IBDA was integrated into a nutritional practicum course in the School of Nutrition and Health Sciences, Taipei Medical University Taiwan. An online IBDA platform was created as an off-campus remedial teaching tool to reinforce the conceptualization of food portion sizes. Dietetic students' receptiveness and response to the IBDA, and their performance in food identification and quantification, were compared between the IBDA and real food visual estimations (RFVEs). No differences were found between the IBDA and RFVE in terms of food identification (67% vs. 71%) or quantification (±10% of estimated calories: 23% vs. 24%). A Spearman correlation analysis showed a moderate to high correlation for calorie estimates between the IBDA and RFVE (r ≥ 0.33~0.75, all p < 0.0001). Repeated IBDA training significantly improved students' image-viewing skills [food identification: first semester: 67%; pretest: 77%; second semester: 84%) and quantification [±10%: first semester: 23%; pretest: 28%; second semester: 32%; and ±20%: first semester: 38%; pretest: 48%; second semester: 59%] and reduced absolute estimated errors from 27% (first semester) to 16% (second semester). Training also greatly improved the identification of omitted foods (e.g., condiments, sugar, cooking oil, and batter coatings) and the accuracy of food portion size estimates. The integration of an IBDA into dietetic courses has the potential to help students develop knowledge and skills related to "e-dietetics".

The Relationship between Food Security Status and Sleep Disturbance among Adults: A Cross-Sectional Study in an Indonesian Population.

BACKGROUND: The relationship between food insecurity and the experience of sleep disturbance has received little attention among researchers, although food insecurity is associated with poor physical and mental health globally. This study aimed to investigate the relationship between food security status and sleep disturbance among adults 20-64 years old. METHODS: The study's population-based sample included 20,212 Indonesian adults who participated in the fifth wave of the Indonesia Family Life Survey (IFLS5) in 2014. Dietary intake data, gathered using a food frequency questionnaire (FFQ), were used to assess the food security status. Sleep disturbance was assessed using the 10-item Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaire. We used multiple linear and logistic regression models to test the study hypothesis. RESULTS: A higher likelihood of experiencing sleep disturbance was recorded in people aged older than 56 years (OR = 1.78, 95% CI: 1.17-2.72, p = 0.007), people with depressive symptoms (OR = 3.57, 95% CI: 2.77-4.61, p < 0.001), and food-insecure people (OR = 1.32, 95% CI: 1.02-1.70, p = 0.036). A lower likelihood of experiencing sleep disturbance was recorded in people with low educational attainment (OR = 0.41, 95% CI: 0.30-0.57, p < 0.001). Sleep disturbance was dependent on the food consumption groups and food security status among men (p = 0.004). CONCLUSIONS: Sleep disturbance may be affected by the food-insecure status of adults, and later, may lead to serious health outcomes.

Infection rate among nutritional therapies for acute pancreatitis: A systematic review with network meta-analysis of randomized controlled trials.

BACKGROUND: Infection in acute pancreatitis (AP) is associated with nutritional therapies including naso-gastric (NG), naso-jejunal (NJ), and total parenteral nutrition (TPN). To examine infections among NG, NJ, TPN, and no nutritional support (NNS) in treating patients with AP. METHODS: The investigators completed comprehensive search in the Cochrane library, EMBASE, PubMed, Web of Science, and ClinicalTrials.gov without restriction on language and publication date before January 21, 2019. They also searched the reference lists of relevant studies for randomized controlled trials (RCTs) comparing NG, NJ, TPN, and NNS among patients with AP. Quantitative synthesis was conducted in a contrast-based network meta-analysis. To clarify effects, a network meta-analysis was conducted to calculate the surface under the cumulative ranking curve (SUCRA). Beside of overall infections, the event rates of infected pancreatic necrosis, bacteremia, line infection, pneumonia, urinary tract infection, and other types of infections were measured. RESULTS: The network meta-analysis of 16 RCTs showed that NJ had significantly lower overall infection rates compared with TPN (risk ratio: 0.59; 95% confidence interval: 0.38, 0.90); and NG had a larger effect size and higher rank probability compared with NJ, TPN, and NNS (mean rank = 1.7; SUCRA = 75.8). TPN was the least preferred (mean rank = 3.2; SUCRA = 26.6). CONCLUSIONS: NG and NJ may be preferred therapies for treating patients with AP. Clinicians may consider NG as a first-line treatment for patients with AP (including severe AP) and even in patients receiving prophylactic antibiotics. In addition, we found that NNS should be avoided when treating patients with severe AP.

Ratio of C-Reactive Protein to Albumin Predicts Muscle Mass in Adult Patients Undergoing Hemodialysis.

Recent studies have indicated that the ratio of C-reactive protein to albumin (CRP-Alb ratio) is associated with clinical outcomes in patients with disease. We examined the predictive value of this ratio in patients undergoing hemodialysis (HD). In this cross-sectional study, 91 eligible adult HD patients were analyzed, and the correlation between the CRP-Alb ratio and skeletal muscle mass normalized for body weight (SMM/wt; estimated using a bioelectrical impedance analyzer) was investigated. The mean age of the study participants was 54.9 ± 6.6 years (ranging from 27 to 64 years); 43 (47.2%) were men. The mean values for the SMM/wt were 39.1% ± 5.4%. The CRP-Alb ratio was found to be negatively correlated with SMM/wt (r = -0.33, P = 0.002) and creatinine (r = -0.20, P = 0.056). All the univariate significant and nonsignificant relevant covariates were selected for multivariable stepwise regression analysis. We determined that the homeostasis model assessment-estimated insulin resistance and CRP-Alb ratio were independent risk determinants for SMM/wt (ßHOMA-IR = -0.18 and ßCRP-Alb ratio = -3.84, adjusted R2 = 0.32). This study indicated that the CRP-Alb ratio may help clinicians in predicting muscle mass in adult patients undergoing HD.

Prevalence and trend of dyslipidaemia from 1996 to 2006 among normal and overweight adolescents in Taiwan.

OBJECTIVES: To evaluate the trend of dyslipidaemia from 1996 to 2006 and examine its relationship with weight status among adolescents in Taiwan. DESIGN: 2 cross-sectional surveys were conducted in 1996 and 2006. SETTING: The junior high schools in Taipei. PARTICIPANTS: After multistage sampling, total of 1500 and 1283 junior high school students were chosen in 1996 and 2006. After excluding missing data, a total of 1353 (676 boys and 677 girls) and 1203 (585 boys and 618 girls) children were included in the final analyses in 1996 and 2006. OUTCOME MEASURES: Anthropometric measures as body height and weight were measured, and body mass index (BMI) was calculated. Blood lipid profiles as total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol were measured. RESULTS: From 1996 to 2006, the prevalence of dyslipidaemia and hypercholesterolaemia significantly increased from 13% (95% CI 11.3% to 15.0%) to 22.3% (95% CI 20.0% to 24.7%) and 6.2% (95% CI 5.0% to 7.6%) to 13.8% (95% CI 11.9% to 15.9%), respectively. The prevalence of hypertriglyceridaemia and low HDL-C dyslipidaemia increased from 3% (95% CI 1.8% to 4.5%) to 4.3% (95% CI 2.8% to 6.2%) and 6.5% (95% CI 4.8% to 8.6%) to 11.6% (95% CI 9.1% to 14.5%), with significance seen only in boys. When compared with normal weight participants, overweight boys and girls faced a 2-fold and 1.6-fold increased risk of dyslipidaemia, respectively, in the 2006 study. The increased risk of low HDL-C dyslipidaemia for overweight participants was 2.6-fold and 7.2-fold in boys and girls, respectively. In 2006, each unit increment of BMI was associated with 28%, 13% and 13% risk of hypertriglyceridaemia, low HDL-C and dyslipidaemia for boys, and 25% risk of low HDL-C dyslipidaemia in girls. CONCLUSIONS: The prevalence of dyslipidaemia had increased significantly for boys and girls in normal weight and overweight adolescents. Early screening of dyslipidaemia and weight intervention programmes in adolescents will be the key to prevent dyslipidaemia and cardiovascular-related comorbidities.

Trends of ABC control 2006-2011: a National Survey of Diabetes Health Promotion Institutes in Taiwan.

AIMS: To understand the trends of ABC control in 5 years interval in Taiwan. METHODS: We compared two waves of nationwide surveys (n=7541 and n=5599, mainly type 2 diabetes) to examine the trends of ABC control across 5 years in accredited Diabetes Health Promotion Institutes in Taiwan. RESULTS: The percentages of subjects who had HbA1c lower than 7% (A), both SBP and DBP lower than 130/80 mmHg (B), and total cholesterol lower than 160 mg/dl or LDL cholesterol lower than 100mg/dl (C) increased by 6.5% (from 32.4% to 34.5%), 22.0% (from 30.9% to 37.7%), and 57.8% (from 35.3% to 55.7%), respectively, with a resulting total ABC attainment rate from 4.1% to 8.6%. A subgroup of 720 diabetic subjects who participated in both surveys showed the same pattern of changes in B and C but had a slight deterioration of glycemic control. Logistic regression analysis revealed that diagnosis of type 1 diabetes, lower BMI and individuals not requiring insulin were independently associated with attainment of ABC goals in 2006 and 2011. An accountabilities examination revealed that annular tests of HbA1c, BP and lipids were all above 90% in both surveys. CONCLUSIONS: We observed an improvement of individual and overall attainments of ABC goals across 5 years in Taiwan owing to recent implementation of several diabetes care models and initiatives. We anticipate that these improvements will translate into reductions of both macrovascular and microvascular complications.

Transculturalization of a diabetes-specific nutrition algorithm: Asian application.

The prevalence of type 2 diabetes (T2D) in Asia is growing at an alarming rate, posing significant clinical and economic risk to health care stakeholders. Commonly, Asian patients with T2D manifest a distinctive combination of characteristics that include earlier disease onset, distinct pathophysiology, syndrome of complications, and shorter life expectancy. Optimizing treatment outcomes for such patients requires a coordinated inclusive care plan and knowledgeable practitioners. Comprehensive management starts with medical nutrition therapy (MNT) in a broader lifestyle modification program. Implementing diabetes-specific MNT in Asia requires high-quality and transparent clinical practice guidelines (CPGs) that are regionally adapted for cultural, ethnic, and socioeconomic factors. Respected CPGs for nutrition and diabetes therapy are available from prestigious medical societies. For cost efficiency and effectiveness, health care authorities can select these CPGs for Asian implementation following abridgement and cultural adaptation that includes: defining nutrition therapy in meaningful ways, selecting lower cutoff values for healthy body mass indices and waist circumferences (WCs), identifying the dietary composition of MNT based on regional availability and preference, and expanding nutrition therapy for concomitant hypertension, dyslipidemia, overweight/obesity, and chronic kidney disease. An international task force of respected health care professionals has contributed to this process. To date, task force members have selected appropriate evidence-based CPGs and simplified them into an algorithm for diabetes-specific nutrition therapy. Following cultural adaptation, Asian and Asian-Indian versions of this algorithmic tool have emerged. The Asian version is presented in this report.

Preprandial single oral dose of sitagliptin does not affect circulating ghrelin and gastrin levels in normal subjects.

AIMS: To determine the effect of an oral dose of sitagliptin on the secretion of ghrelin and gastrin hormones. METHODS: Ten healthy volunteers were recruited in this study. A baseline blood sample was drawn before oral dosing with a 100-mg tablet of sitagliptin. Two blood samples were obtained 0.5 and 1 h after dosing. Three additional postprandial blood samples were drawn at 0.5, 1, and 2 h. Radioimmunoassay was used for determining hormonal levels. A Student's t test, Pearson correlation analysis, and multivariate approach to repeated-measures analysis of variance were used for statistics. RESULTS: After sitagliptin dosing, but before the meal, there was no significant change in circulating ghrelin, gastrin, insulin, and glucose levels. Only after meal loading was there a progressive and persistent decline in ghrelin levels until the end of the study, while a rapid and temporary rise in gastrin, insulin, and glucose levels at 0.5 h was observed. The levels of gastrin, insulin, and glucose then declined progressively. CONCLUSIONS: Preprandial oral dose of sitagliptin does not affect circulating ghrelin, gastrin, insulin, and glucose concentrations in normal subjects. Decreased ghrelin and increased gastrin and insulin levels occurred only after meal loading. These results support the theory that sitagliptin might not cause appetite-enhanced body weight gain and insulin-induced hypoglycemia.

Apnea-hypopnea index in nonobese women with polycystic ovary syndrome.

OBJECTIVE: To assess the influence of polycystic ovary syndrome (PCOS) on respiratory events during sleep in nonobese Taiwanese women. METHOD: Overnight polysomnography was recorded in 18 nonobese women with PCOS who had not received treatment (body mass index [BMI] 21.7+/-0.57, age 29.1+/-1.43 years) and in 10 age- and BMI-matched women without PCOS (BMI 20.9+/-0.58, age 31.6+/-3.87 years). RESULTS: The nonobese women with PCOS had a higher total apnea-hypopnea index (AHI) especially during the non-rapid eye movement stage (AHI(NREM)) than the women who did not have PCOS. The women with PCOS had higher serum levels of high-sensitivity C-reactive protein (hsCRP) and this was positively correlated with AHI(REM). Total testosterone level was positively correlated with AHI(NREM), and androstenedione was negatively correlated with AHI(NREM). CONCLUSION: PCOS was directly linked to increased obstructive respiratory events during sleep in nonobese women in Taiwan.

ABC control of diabetes: survey data from National Diabetes Health Promotion Centers in Taiwan.

We undertook nationwide surveys to evaluate the status of diabetes control in 7541 diabetes subjects among 114 accredited Diabetes Health Promotion Centers in Taiwan in 2006, focusing on characteristics of those who attained the "ABC" goals (n=310). The mean age was 62.8+/-12.4 years (mean+/-SD), BMI 25.9+/-0.4 kg/m(2) and HbA1c levels 7.9+/-1.7%. The percentage of subjects whose HbA1c levels met ADA goals was less than 7% (A), and both SBP and DBP less than 130/80 mmHg (B), total cholesterol less than 160 mg/dl or LDL cholesterol levels less than 100mg/dl (C) were 32.4%, 30.9% and 35.3%, respectively. Overall, the percentage of examined diabetic subjects who fulfilled current recommended ABC goals was 4.1% (95% CI, 3.66-4.56%). Results of logistic regression analysis that indicated factors significantly associated with ABC goals are diagnosis of type 1 diabetes (p=0.025), BMI less than 23 kg/m(2) (p=0.022) and subjects not requiring insulin (p=0.006). In conclusion, only 4.1% of subjects reached all ABC goals. Diabetic individuals with diagnosis of type 1 diabetes, lesser BMI and those not using insulin were more likely to attain all ABC goals.

Prospective evaluation of folic acid supplementation on plasma homocysteine concentrations during weight reduction: a randomized, double-blinded, placebo-controlled study in obese women.

Elevated total homocysteine concentrations and obesity are both associated with an increased risk of cardiovascular disease. However, previous studies of weight reduction on serum homocysteine concentrations have obtained inconsistent reports. We investigated the effect of folic acid supplementation on serum homocysteine concentrations via a randomized, double-blinded, placebo-controlled study. Seventy-four obese women [age (mean +/- SEM) 41 +/- 1 years; body mass index, 29.6 +/- 0.5 kgs/m2] completed a 12 weeks weight reduction program with dietary advice and light exercise. They were also randomized to take either folic acid supplementation (5 mg daily, n = 36) or placebo (n = 38) groups. This program led to a weight reduction of 7.7% and 8.9% of initial weight for folic acid supplementation and placebo groups, respectively. Serum folate concentrations increased for 3 folds (p < 0.001) in the folic acid group. In the folic acid group, there was a trend of lower fasting serum homocysteine concentrations (7.6 +/- 0.2 vs. 7.3 +/- 0.3 micromol/L), but it did not reach statistical significance (p = 0.170). However, we found that serum homocysteine concentrations decreased significantly in those with higher baseline homocysteine concentrations (8.7 +/- 1.3 vs. 7.8 +/- 1.5 micromol/L, p = 0.004), while it did not change in those with lower baseline homocysteine concentrations (6.6 +/- 0.6 vs. 6.8 +/- 1.2 micromol/L, p = 0.334). Reduction of serum homocysteine concentrations did not correlate with elevation of serum folate concentrations (p = 0.646) in obese women with higher baseline homocysteine concentrations. In conclusion, serum homocysteine concentrations can be maintained in obese women during mild to moderate weight loss. Folic acid supplementation decreased serum homocysteine concentrations in those women who had higher serum homocysteine concentrations before participating in the weight reduction program.