Fruit consumption and adiposity status in adults: A systematic review of current evidence.

The aim of this review was to update current understanding of the potential association between fruit consumption and adiposity status in adult populations. Electronic databases were searched from January 1, 1997 to the search date of August 15, 2014, retrieving 4382 abstracts that were reviewed for eligibility: randomized controlled trial (RCT) or prospective cohort (PC), published in English, assessing the effect of whole fruit or fruit juice consumption on adiposity in healthy adult populations. Quality ratings for the 11 included RCTs were either positive (n = 2), neutral (n = 8), or negative (n = 1), while the six included PCs were either positive (n = 4) or neutral (n = 2). Consumption of whole fruit was found to contribute to a reduced risk for long-term weight gain in middle-aged adults. Experimental trials suggest this beneficial effect of whole fruit is mediated by a reduction in total energy intake. Fruit juice, however, had an opposing effect, promoting weight gain over the long term. This review reinforces national food-based dietary guidelines, encouraging the consumption of whole fruits and replacing fruit juices with plain water, as part of a broader set of dietary strategies to reduce total dietary energy intake in adult populations.

Process evaluation of TXT2BFiT: a multi-component mHealth randomised controlled trial to prevent weight gain in young adults.

BACKGROUND: TXT2BFiT was one of the first few innovative mHealth programs designed for young adults (18-35 years) with demonstrated efficacy in weight management. However, research is lacking to understand intervention effectiveness, especially in complex, multi-component mHealth programs. This paper investigates participant perceptions of and engagement with the mHealth program components in the TXT2BFiT to understand program effects. METHODS: Process evaluation data were collected continuously for the study duration. The TXT2BFiT program was a multi-component lifestyle program delivered intensively for 3-month followed by a 6-month maintenance phase. Program components included personalised coaching calls, text messages, emails, smartphone apps and website access. Process evaluation measures included frequency of use of components and frequency for number of components used (online survey data); dose delivered and engagement with program components (researcher logs and web platform reports); frequency, timing and difficulties experienced with program components (online survey data) and overall perceptions of program components (online survey data and semi-structured telephone interviews). Qualitative data analysis was performed using NVivo10. RESULTS: Over 80% of participants completed post-intervention (3-months, intervention, n = 110, control n = 104) and follow-up surveys (9-months, intervention, n = 96, control n = 104). Thirty intervention participants completed semi-structured telephone interviews. Participants reported high use of coaching calls, text messages and emails and no issues in content delivery from these components. These components were described as helping them to achieve their goals. Website and app use and engagement was low for the duration of the program. Participants would prefer incorporation of the self-monitoring apps and website resources into one smartphone application that can be individualised by entry of their personal data. CONCLUSIONS: Our process evaluation has allowed a comprehensive understanding of use and preference for different program components. The high value placed on the coaching calls is consistent with a desire for personalisation of the mHealth program and even further tailoring of text messages and emails. The findings of this study will be used to revise TXT2BFiT for future users. TRIAL REGISTRATION: The trial is registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12612000924853 ).

Electronic Dietary Intake Assessment (e-DIA): relative validity of a mobile phone application to measure intake of food groups.

Automation of dietary assessment can reduce limitations of established methodologies, by alleviating participant and researcher burden. Designed as a research tool, the electronic Dietary Intake Assessment (e-DIA) is a food record in mobile phone application format. The present study aimed to examine the relative validity of the e-DIA with the 24-h recall method to estimate intake of food groups. A sample of eighty university students aged 19-24 years recorded 5 d of e-DIA and 3 d of recall within this 5-d period. The three matching days of dietary data were used for analysis. Food intake data were disaggregated and apportioned to one of eight food groups. Median intakes of food groups were similar between the methods, and strong correlations were found (mean: 0·79, range: 0·69-0·88). Cross-classification by tertiles produced a high level of exact agreement (mean: 71 %, range: 65-75 %), and weighted κ values were moderate to good (range: 0·54-0·71). Although mean differences (e-DIA-recall) were small (range: -13 to 23 g), limits of agreement (LOA) were relatively large (e.g. for vegetables, mean difference: -4 g, LOA: -159 to 151 g). The Bland-Altman plots showed robust agreement, with minimum bias. This analysis supports the use of e-DIA as an alternative to the repeated 24-h recall method for ranking individuals' food group intake.

Children's exposure to food advertising on free-to-air television: an Asia-Pacific perspective.

There is an established link between food promotions and children's food purchase and consumption. Children in developing countries may be more vulnerable to food promotions given the relative novelty of advertising in these markets. This study aimed to determine the scope of television food advertising to children across the Asia-Pacific to inform policies to restrict this marketing. Six sites were sampled, including from China, Indonesia, Malaysia and South Korea. At each site, 192 h of television were recorded (4 days, 16 h/day, three channels) from May to October 2012. Advertised foods were categorized as core/healthy, non-core/unhealthy or miscellaneous, and by product type. Twenty-seven percent of advertisements were for food/beverages, and the most frequently advertised product was sugar-sweetened drinks. Rates of non-core food advertising were highest during viewing times most popular with children, when between 3 (South Korea) and 15 (Indonesia) non-core food advertisements were broadcast each hour. Children in the Asia-Pacific are exposed to high volumes of unhealthy food/beverage television advertising. Different policy arrangements for food advertising are likely to contribute to regional variations in advertising patterns. Cities with the lowest advertising rates can be identified as exemplars of good policy practice.

A fizzy environment: availability and consumption of sugar-sweetened beverages among school students.

OBJECTIVE: Reducing sugar-sweetened beverage (SSB) consumption has been targeted in obesity prevention strategies internationally. This study examined associations between SSB availability at school and in the home, and consumption among Australian school students. METHOD: Secondary analysis of the 2010 New South Wales Schools Physical Activity and Nutrition Survey (n=8058) was conducted. Logistic regression analyses tested the impact of SSB availability at school and in the home on consumption category (low, ≤1 cup/week; moderate, 2-4 cups/week; high, ≥5 cups/week). RESULTS: Students in years K-10 (ages 4-16years) who usually purchased sugar-sweetened soft drinks or sports drinks from their school canteen were almost three times as likely to be high consumers (AOR 2.90; 95%CI 2.26, 3.73). Students in years 6-10 (ages 9-16years) were almost five times as likely to be high consumers if soft drinks were usually available in their home (AOR 4.63; 95%CI 3.48, 6.17), and almost ten times as likely to be high consumers if soft drinks were usually consumed with meals at home (AOR 9.83; 95%CI 6.06, 15.96). CONCLUSION: Limiting the availability of SSBs in the home and school environments is a prudent response to address high SSB consumption among school students, albeit only part of the solution for obesity prevention.

Building the case for independent monitoring of food advertising on Australian television.

OBJECTIVE: To provide an independent monitoring report examining the ongoing impact of Australian self-regulatory pledges on food and drink advertising to children on commercial television. DESIGN: Analysis of food advertisements across comparable sample time periods in April/May 2006, 2007, 2009, 2010 and 2011. The main outcome measure comprised change in the mean rate of non-core food advertisements from 2006 to 2011. SETTING: Sydney free-to-air television channels. SUBJECTS: Televised food advertisements. RESULTS: In 2011 the rate of non-core food advertisements was not significantly different from that in 2006 or 2010 (3·2/h v. 4·1/h and 3·1/h), although there were variations across the intervening years. The rate of fast-food advertising in 2010 was significantly higher than in 2006 (1·8/h v. 1·1/h, P < 0·001), but the same as that in 2011 (1·5/h). CONCLUSIONS: The frequency of non-core food advertising on Sydney television has remained essentially unchanged between 2006 and 2011, despite the implementation of two industry self-regulatory pledges. The current study illustrates the value of independent monitoring as a basic requirement of any responsive regulatory approach.

Advertising of fast food to children on Australian television: the impact of industry self-regulation.

OBJECTIVE: To assess the impact of the quick-service restaurant industry (QSRI) self-regulatory initiative on fast-food advertising to children on Australian commercial television. DESIGN AND SETTING: Analysis of advertisements for foods on the three main free-to-air commercial television channels (channels 7, 9 and 10) in Sydney, Australia, over 4 days in both May 2009 and April 2010 in terms of: number of advertisements; types of food (coded core [healthy] foods, non-core [unhealthy] foods, miscellaneous foods; or fast foods); whether advertised meals were intended for children; whether advertisements were broadcast during children's peak viewing times; and whether the company in question was a signatory to the QSRI initiative. MAIN OUTCOME MEASURES: Change in the mean frequency and rate of food advertisements per hour from 2009 to 2010; change in the types of fast-food meals (healthier alternatives [at least one nutrient-dense, low-energy food considered part of a healthy diet for children], non-core [high in undesirable nutrients and not considered part of a healthy diet for children], and other) being advertised; and proportion of children's energy requirements provided by fast-food meals. RESULTS: From 2009 to 2010, the mean frequency of fast-food advertisements increased from 1.1 to 1.5 per hour. While non-core fast foods comprised a lesser share of fast-food advertising in 2010 than 2009, the mean frequency at which they were advertised during times when the largest numbers of children were watching television remained the same (1.3 per hour in both 2009 and 2010). Family meals advertised for children's consumption in 2010 provided energy far in excess of children's requirements. CONCLUSIONS: Children's exposure to unhealthy fast-food advertising has not changed following the introduction of self-regulation, and some fast foods advertised for children's consumption contain excessive energy. The limited impact of self-regulation suggests that governments should define the policy framework for regulating fast-food advertising to children.

Art of persuasion: an analysis of techniques used to market foods to children.

AIM: Persuasive marketing techniques, such as promotional characters, influence children's food preferences and requests for foods. The aim of this research was to describe the techniques used to market unhealthy foods and beverages to children on Sydney free-to-air television. METHODS: Marketing techniques designed to appeal to children were identified from international literature and summarised into a systematic coding tool. Using this tool, the marketing techniques used in a random sample of 100 unique food advertisements, broadcasted on Sydney free-to-air television, were coded. Frequency of marketing techniques was analysed overall and for use in advertisements marketing unhealthy foods, emotionally or verbally appealing to parents, or featuring child actors. RESULTS: Advertisers' use of persuasive techniques generally did not differ by type of food advertised. Marketing techniques with greater prominence in unhealthy food advertising were palatability (54% of unhealthy food advertisements), convenience (52%), fantasy/imagination (28%), fun/happiness (17%) and cartoon characters (9%). Advertisements emotionally appealing to parents (24%) were significantly more likely to make general health or nutrition statements (38% vs. 17%), and appealed to children concurrently through fun/happiness and fantasy/imagination appeals. Children were depicted in advertisements as eating with friends or family, situated within the home and frequently snacking on less healthy foods. CONCLUSIONS: Food and beverage advertisers use a range of visual, audio and emotive techniques to appeal to children and their parents that do not discriminate by the type of food advertised. The range and complexity of these techniques complicate the restriction of their use in food advertising to children.

Industry self-regulation of food marketing to children: reading the fine print.

ISSUE ADDRESSED: despite the evidence showing the negative influences of food marketing on children's dietary beliefs and behaviours, and risk of adiposity, regulatory action to limit unhealthy food marketing has made little progress within Australia. Our aim was to describe and critically examine the Australian Food and Grocery Council's (AFGC) approach to self-regulate food marketing to Australian children through the Responsible Marketing to Children Initiative (Initiative). METHODS: the Initiative's core principles and the commitments of the 16 signatory companies (as at December 2009) were assessed in terms of their capacity to limit unhealthy food advertising in media accessed by children. All information was publicly available from AFGC and signatory company websites (September- December 2009). RESULTS: limitations of the Initiative included inadequate definitions for when and where food marketing to children can occur, and permissive definitions of foods considered appropriate for advertising. The study also identified numerous examples of ongoing food marketing to children by AFGC companies that illustrate these limitations. CONCLUSIONS: until one reads the fine print, the self-regulatory commitments of companies signed to the AFGC Initiative may appear to be responsible. However, this study shows that the commitments are permissive and allow companies to circumvent the stated intent of the Initiative.

Are products sold in university vending machines nutritionally poor? A food environment audit.

AIM: (i) To audit the nutritional composition, promotion and cost of products available from vending machines available to young adults; and (ii) to examine the relationship between product availability and sales. METHODS: A cross-sectional analysis of snacks and beverages available and purchased at a large urban university was conducted between March and September 2014. Sales were electronically tracked for nine months. RESULTS: A total of 61 vending machines were identified; 95% (n = 864) of the available snacks and 49% of beverages (n = 455) were less-healthy items. The mean (SD) nutrient value of snacks sold was: energy 1173 kJ (437.5), saturated fat 5.36 g (3.6), sodium 251 mg (219), fibre 1.56 g (1.29) and energy density 20.16 kJ/g (2.34) per portion vended. There was a strong correlation between the availability of food and beverages and purchases (R2 = 0.98, P < 0.001). CONCLUSIONS: Vending machines market and sell less-healthy food and beverages to university students. Efforts to improve the nutritional quality are indicated and afford an opportunity to improve the diet quality of young adults, a group at risk of obesity.

Dietary contribution of foods and beverages sold within a university campus and its effect on diet quality of young adults.

OBJECTIVE: Tertiary education institutions have been linked with excessive weight in young adults. However, few data are available on the effect of foods from the university food environment on the diet quality of young adults. The aim of this study was to describe the association of a number of foods and beverages consumed at university food outlets with the diet quality of young adults. METHODS: This was a cross-sectional survey in which the 103 university student participants, aged 19 to 24 y, contributed 5 d of dietary data. A purposely designed, validated smartphone application was used to collect the data. Diet quality was assessed by adherence to the 2013 dietary guidelines for food groups and nutrients, and the validated Healthy Eating Index for Australians (HEIFA-2013) was applied. Individual HEIFA-2013 scores were compared with the frequency of food purchase and consumption from university outlets to assess a dose-response effect of the food environment. Comparisons by tertiles of diet quality for body mass index, waist circumference, and takeaway food consumption (university and other) were computed using a one-way analysis of variance and post hoc Tukey test. RESULTS: There was a statistically significant difference between the number of university foods and beverages consumed in 5 d and the HEIFA-2013 scores: More on-campus purchases resulted in a poor-quality diet (P = 0.001). As the HEIFA-2013 tertile scores increased, there was a significant decrease in the number of university campus and other takeaway foods consumed; body mass index and waist circumference showed a decrease in trend. CONCLUSIONS: Efforts to improve the diet quality of young adults attending university may benefit from approaches to improve the campus food environment.

Weight-Related Goal Setting in a Telephone-Based Preventive Health-Coaching Program: Demonstration of Effectiveness.

PURPOSE: This study investigated whether participants in a 6-month telephone-based coaching program, who set physical activity, nutrition, and weight loss goals had better outcomes in these domains. DESIGN: Quasi-experimental design. SETTING: The Australian Get Healthy Information and Coaching Service (GHS), a free population-wide telephone health-coaching service that includes goal setting as a key component of its coaching program. PARTICIPANTS: Consenting GHS coaching participants who had completed coaching between February 2009 and December 2012 (n = 4108). MEASURES: At baseline, participants select a goal for the coaching program, and sociodemographic variables are collected. Self-reported weight, height, waist circumference, physical activity, and nutrition-related behaviors are assessed at baseline and 6 months. ANALYSIS: Descriptive analysis was performed on key sociodemographic variables, and the relationship between goal type and change in health outcomes was assessed using a series of linear mixed models that modeled change from baseline to 6 months. RESULTS: Participants who set goals in relation to weight management and physical activity achieved better results in these areas than those who set alternate goals, losing more than those who set alternate goals (1.5 kg and 0.9 cm in waist circumference) and increasing walking per week (40 minutes), respectively. There was no difference in food-related outcomes for those that set nutrition-related goals. CONCLUSION: Goal setting for weight management and increasing physical activity in the overweight and obese population, undertaken in a telephone-based coaching program, can be effective.

The development, application, and validation of a Healthy eating index for Australian Adults (HEIFA-2013).

OBJECTIVE: Diet quality indices are used to assess dietary behavior and adherence to dietary guideline recommendations. The aim of this study was to develop, apply, and validate a Healthy Eating Index for Australian Adults (HEIFA-2013) based on the updated Dietary Guidelines for Australians 2013. METHODS: The HEIFA-2013 used an 11-component system of 5 food groups, 4 nutrients, water intake, and a measure of dietary variety. The total possible index score was 100. The HEIFA-2013 was applied to weighed food record (WFR) and food frequency questionnaire (FFQ) data of a sample (n = 100) of young adults. The HEIFA-2013 was assessed using principal components analysis (PCA), Cronbach's coefficient, and correlation coefficient with nutrient intakes. Scores for HEIFA-2013 components were compared between methods using means, frequencies, 95% limits of agreement, Bland and Altman methods, and weighted kappa. RESULTS: PCA indicated that multiple underlying dimensions compose the index, and Cronbach's coefficient α was 0.41. A higher HEIFA-2013 was associated with higher dietary quality, including a low intake of saturated fat and sodium and a high intake of selected vitamins and minerals. Low correlations with energy were observed. The mean HEIFA-2013 score ± standard error (SE) for the WFR was 53.84 ± 1 and for the FFQ was 54.82 ± 0.9. The total mean scores were 54.33 ± 0.1. Young adults had the lowest mean scores for sodium (2.9 ± 0.2), fat (3.0 ± 0.0), vegetables (4.7 ± 0.1), and grains (5.1 ± 0.1). The WFR and FFQ scored individual components differently, but at the group level the differences were not significant. CONCLUSIONS: The HEIFA-2013 will need to be catered for different diet collection methods. It is a useful index of overall diet quality and can be used to monitor changes in dietary intake of adults over time. The findings infer that even a highly educated affluent group of young adults fails to meet recommended dietary guidelines.

A Mobile Health Lifestyle Program for Prevention of Weight Gain in Young Adults (TXT2BFiT): Nine-Month Outcomes of a Randomized Controlled Trial.

BACKGROUND: The unprecedented rise in obesity among young adults, who have limited interaction with health services, has not been successfully abated. OBJECTIVE: The objective of this study was to assess the maintenance outcomes of a 12-week mHealth intervention on prevention of weight gain in young adults and lifestyle behaviors at 9 months from baseline. METHODS: A two-arm, parallel, randomized controlled trial (RCT) with subjects allocated to intervention or control 1:1 was conducted in a community setting in Greater Sydney, Australia. From November 2012 to July 2014, 18- to 35-year-old overweight individuals with a body mass index (BMI) of 25-31.99 kg/m2 and those with a BMI ≥ 23 kg/m2 and a self-reported weight gain of ≥ 2 kg in the past 12 months were recruited. A 12-week mHealth program "TXT2BFiT" was administered to the intervention arm. This included 5 coaching calls, 96 text messages, 12 emails, apps, and downloadable resources from the study website. Lifestyle behaviors addressed were intake of fruits, vegetables, sugar-sweetened beverages (SSBs), take-out meals, and physical activity. The control group received 1 phone call to introduce them to study procedures and 4 text messages over 12 weeks. After 12 weeks, the intervention arm received 2 further coaching calls, 6 text messages, and 6 emails with continued access to the study website during 6-month follow-up. Control arm received no further contact. The primary outcome was weight change (kg) with weight measured at baseline and at 12 weeks and self-report at baseline, 12 weeks, and 9 months. Secondary outcomes were change in physical activity (metabolic equivalent of task, MET-mins) and categories of intake for fruits, vegetables, SSBs, and take-out meals. These were assessed via Web-based surveys. RESULTS: Two hundred and fifty young adults enrolled in the RCT. Intervention participants weighed less at 12 weeks compared with controls (model ß=-3.7, 95% CI -6.1 to -1.3) and after 9 months (model ß=- 4.3, 95% CI - 6.9 to - 1.8). No differences in physical activity were found but all diet behaviors showed that the intervention group, compared with controls at 9 months, had greater odds of meeting recommendations for fruits (OR 3.83, 95% CI 2.10-6.99); for vegetables (OR 2.42, 95% CI 1.32-4.44); for SSB (OR 3.11, 95% CI 1.47-6.59); and for take-out meals (OR 1.88, 95% CI 1.07-3.30). CONCLUSIONS: Delivery of an mHealth intervention for prevention of weight gain resulted in modest weight loss at 12 weeks with further loss at 9 months in 18- to 35-year-olds. Although there was no evidence of change in physical activity, improvements in dietary behaviors occurred, and were maintained at 9 months. Owing to its scalable potential for widespread adoption, replication trials should be conducted in diverse populations of overweight young adults. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12612000924853; (Archived by WebCite at http://www.webcitation.org/6i6iRag55).

Diet Quality of Young Adults Enrolling in TXT2BFiT, a Mobile Phone-Based Healthy Lifestyle Intervention.

BACKGROUND: Young adulthood is associated with poor dietary habits and vulnerability to weight gain. Population studies have revealed that inadequate fruit and vegetable intake, excessive sugar-sweetened beverages, and frequent takeaway food consumption are dietary habits requiring intervention. OBJECTIVE: The aim was to examine the dietary patterns and diet quality of overweight young adults on enrollment into a mobile phone-based healthy lifestyle (mHealth) intervention, TXT2BFiT. METHODS: Baseline diets were analyzed using the online Dietary Questionnaire for Epidemiological Studies version 2. The Healthy Eating Index for Australians (HEIFA) based on the 2013 Dietary Guidelines, was used to rate individual diets according to intake of core foods and deleterious nutrients including sugar, sodium, saturated fat, and alcohol. Findings were compared with the 2011 Australian National Nutrition and Physical Activity Survey (NNPAS). Gender differences were assessed with t tests and chi-square tests. ANOVA models were used to determine linear trends of core and noncore food intake and nutrients across quartiles of HEIFA scores. Associations between HEIFA score, sugar-sweetened beverages, and takeaway food consumption were assessed using linear regression analysis. RESULTS: Diets of 230 participants (females: n=141; males: n=89; body mass index: mean 27.2, SD 2.5 kg/m(2)) were analyzed. The mean diet quality score was 45.4 (SD 8.8, range 21.7-77.0) out of 100 points, with no significant difference between genders. Compared with the NNPAS data for adults aged 19-30 years, this cohort had a lower intake of some core foods and higher intake of alcohol and saturated fat. Better quality diets were associated with higher intakes of fruits, vegetables, and wholegrains (P<.001). Takeaway food (P=.01) and sugar-sweetened beverage consumption (P<.001) were negatively associated with diet quality. CONCLUSIONS: Overweight young adults had poorer diets compared with the reference Australian population within the same age group. This study reinforces that gender-specific interventions are required, as is the current practice in TXT2BFiT, with a need to reduce sodium and alcohol intake in males and sugar intake in females. It also confirms the need to increase fruit and vegetable intake and reduce takeaway food consumption in this population, with additional focus on saturated fat and wholegrain intake.

Effective Strategies to Recruit Young Adults Into the TXT2BFiT mHealth Randomized Controlled Trial for Weight Gain Prevention.

BACKGROUND: Younger adults are difficult to engage in preventive health, yet in Australia they are gaining more weight and increasing in waist circumference faster than middle-to-older adults. A further challenge to engaging 18- to 35-year-olds in interventions is the limited reporting of outcomes of recruitment strategies. OBJECTIVE: This paper describes the outcomes of strategies used to recruit young adults to a randomized controlled trial (RCT), healthy lifestyle mHealth program, TXT2BFiT, for prevention of weight gain. The progression from enquiry through eligibility check to randomization into the trial and the costs of recruitment strategies are reported. Factors associated with nonparticipation are explored. METHODS: Participants were recruited either via letters of invitation from general practitioners (GPs) or via electronic or print advertisements, including Facebook and Google-social media and advertising-university electronic newsletters, printed posters, mailbox drops, and newspapers. Participants recruited from GP invitation letters had an appointment booked with their GP for eligibility screening. Those recruited from other methods were sent an information pack to seek approval to participate from their own GP. The total number and source of enquiries were categorized according to eligibility and subsequent completion of steps to enrolment. Cost data and details of recruitment strategies were recorded. RESULTS: From 1181 enquiries in total from all strategies, 250 (21.17%) participants were randomized. A total of 5311 invitation letters were sent from 12 GP practices-16 participating GPs. A total of 131 patients enquired with 68 participants randomized (68/74 of those eligible, 92%). The other recruitment methods yielded the remaining 182 randomized participants. Enrolment from print media was 26% of enquiries, from electronic media was 20%, and from other methods was 3%. Across all strategies the average cost of recruitment was Australian Dollar (AUD) $139 per person. The least expensive modality was electronic (AUD $37), largely due to a free feature story on one university Web home page, despite Facebook advertising costing AUD $945 per enrolment. The most expensive was print media at AUD $213 and GP letters at AUD $145 per enrolment. CONCLUSIONS: The research indicated that free electronic media was the most cost-effective strategy, with GP letters the least expensive of the paid strategies in comparison to the other strategies. This study is an important contribution for future research into efficacy, translation, and implementation of cost-effective programs for the prevention of weight gain in young adults. Procedural frameworks for recruitment protocols are required, along with systematic reporting of recruitment strategies to reduce unnecessary expenditure and allow for valuable public health prevention programs to go beyond the research setting. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12612000924853; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=362872 (Archived by WebCite at http://www.webcitation.org/6YpNfv1gI).

Effectiveness of a mHealth Lifestyle Program With Telephone Support (TXT2BFiT) to Prevent Unhealthy Weight Gain in Young Adults: Randomized Controlled Trial.

BACKGROUND: Weight gained in young adulthood often persists throughout later life with associated chronic disease risk. Despite this, current population prevention strategies are not specifically designed for young adults. OBJECTIVE: We designed and assessed the efficacy of an mHealth prevention program, TXT2BFiT, in preventing excess weight gain and improving dietary and physical activity behaviors in young adults at increased risk of obesity and unhealthy lifestyle choices. METHODS: A two-arm, parallel-group randomized controlled trial was conducted. Subjects and analyzing researchers were blinded. A total of 250 18- to 35-year-olds with a high risk of weight gain, a body mass index (BMI) of 23.0 to 24.9 kg/m(2) with at least 2 kg of weight gain in the previous 12 months, or a BMI of 25.0 to 31.9 kg/m(2) were randomized to the intervention or control group. In the 12-week intervention period, the intervention group received 8 text messages weekly based on the transtheoretical model of behavior change, 1 email weekly, 5 personalized coaching calls, a diet booklet, and access to resources and mobile phone apps on a website. Control group participants received only 4 text messages and printed dietary and physical activity guidelines. Measured body weight and height were collected at baseline and at 12 weeks. Outcomes were assessed via online surveys at baseline and at 12 weeks, including self-reported weight and dietary and physical activity measures. RESULTS: A total of 214 participants-110 intervention and 104 control-completed the 12-week intervention period. A total of 10 participants out of 250 (4.0%)-10 intervention and 0 control-dropped out, and 26 participants (10.4%)-5 intervention and 21 control-did not complete postintervention online surveys. Adherence to coaching calls and delivery of text messages was over 90%. At 12 weeks, the intervention group were 2.2 kg (95% CI 0.8-3.6) lighter than controls (P=.005). Intervention participants consumed more vegetables (P=.009), fewer sugary soft drinks (P=.002), and fewer energy-dense takeout meals (P=.001) compared to controls. They also increased their total physical activity by 252.5 MET-minutes (95% CI 1.2-503.8, P=.05) and total physical activity by 1.3 days (95% CI 0.5-2.2, P=.003) compared to controls. CONCLUSIONS: The TXT2BFiT low-intensity intervention was successful in preventing weight gain with modest weight loss and improvement in lifestyle behaviors among overweight young adults. The short-term success of the 12-week intervention period shows potential. Maintenance of the behavior change will be monitored at 9 months. TRIAL REGISTRATION: The Australian New Zealand Clinical Trials Registry ACTRN12612000924853; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12612000924853 (Archived by WebCite at http://www.webcitation.org/6Z6w9LlS9).

Electronic Dietary Intake Assessment (e-DIA): Comparison of a Mobile Phone Digital Entry App for Dietary Data Collection With 24-Hour Dietary Recalls.

BACKGROUND: The electronic Dietary Intake Assessment (e-DIA), a digital entry food record mobile phone app, was developed to measure energy and nutrient intake prospectively. This can be used in monitoring population intakes or intervention studies in young adults. OBJECTIVE: The objective was to assess the relative validity of e-DIA as a dietary assessment tool for energy and nutrient intakes using the 24-hour dietary recall as a reference method. METHODS: University students aged 19 to 24 years recorded their food and drink intake on the e-DIA for five days consecutively and completed 24-hour dietary recalls on three random days during this 5-day study period. Mean differences in energy, macro-, and micronutrient intakes were evaluated between the methods using paired t tests or Wilcoxon signed-rank tests, and correlation coefficients were calculated on unadjusted, energy-adjusted, and deattenuated values. Bland-Altman plots and cross-classification into quartiles were used to assess agreement between the two methods. RESULTS: Eighty participants completed the study (38% male). No significant differences were found between the two methods for mean intakes of energy or nutrients. Deattenuated correlation coefficients ranged from 0.55 to 0.79 (mean 0.68). Bland-Altman plots showed wide limits of agreement between the methods but without obvious bias. Cross-classification into same or adjacent quartiles ranged from 75% to 93% (mean 85%). CONCLUSIONS: The e-DIA shows potential as a dietary intake assessment tool at a group level with good ranking agreement for energy and all nutrients.

Validity and reproducibility of a food frequency questionnaire as a measure of recent dietary intake in young adults.

This research assessed the relative validity and reproducibility of the Dietary Questionnaire for Epidemiological Studies (DQESV2) over one month in young adults, given the lack of concise and convenient instruments for assessing recent dietary intake in this population. Participants were recruited from a large Australian university (N = 102; 35% male; age 18-34 years; body mass index 16-37 kg/m(2)). Five one-day weighed food records (WFR) were administered over one month followed by the DQESV2. Estimates for nutrients (energy, protein, total fat, saturated fat, carbohydrate, sugars, dietary fibre, and alcohol) and fruit and vegetable servings were compared between methods using correlation coefficients, 95% limits of agreement, and quintile classifications. One week later, a second DQESV2 was completed by n = 77 of the participants to assess reproducibility using intra-class correlations (ICC) and weighted kappa. Comparing methods, all nutrients and fruit and vegetable servings showed significant positive correlations (P<0.05) except protein intake in males; over 60% of participants were within one quintile classification except total fat and dietary fibre intakes in males (55% and 56%, respectively); and differences in nutrient and food intakes between methods were all within +/-20% of the mean WFR values except alcohol intake in females. Between first and second administrations of the DQESV2 all ICC coefficients were positive (P<0.01) and weighted kappa coefficients ranged from 0.54 for fruit servings (including fruit juice) in males to 0.91 for protein intake in females. Over a one month period, the DQESV2 demonstrated good reproducibility for the studied nutrients and for fruit and vegetable servings and provided a valid measure of the studied nutrients, except alcohol in females, and of fruit servings (including fruit juice) in both genders, at the group level in this young adult population.

'TXT2BFiT' a mobile phone-based healthy lifestyle program for preventing unhealthy weight gain in young adults: study protocol for a randomized controlled trial.

BACKGROUND: Despite international efforts to arrest increasing rates of overweight and obesity, many population strategies have neglected young adults as a target group. Young adults are at high risk for unhealthy weight gain which tends to persist throughout adulthood with associated chronic disease health risks. METHODS/DESIGN: TXT2BFiT is a nine month two-arm parallel-group randomized controlled trial aimed at improving weight management and weight-related dietary and physical activity behaviors among young adults. Participants are recruited via general practice (primary medical care) clinics in Sydney, New South Wales, Australia. All participants receive a mailed resource outlining national physical activity and dietary guidelines and access to the study website. Additional resources accessible to the intervention arm via the study website include Smartphone mobile applications, printable handouts, an interactive healthy weight tracker chart, and a community blog. The study consists of two phases: (1) Intensive phase (weeks 1 to 12): the control arm receives four short message service (SMS) text messages; the intervention arm receives eight SMS messages/week tailored to their baseline stage-of-change, one Email/week, and personalized coaching calls during weeks 0, 2, 5, 8, and 11; and (2) Maintenance phase (weeks 14 to 36): the intervention arm receives one SMS message/month, one Email/month and booster coaching calls during months 5 and 8. A sample of N = 354 (177 per arm) is required to detect differences in primary outcomes: body weight (kg) and body mass index (kg/m2), and secondary outcomes: physical activity, sitting time, intake of specific foods, beverages and nutrients, stage-of-change, self-efficacy and participant well-being, at three and nine months. Program reach, costs, implementation and participant engagement will also be assessed. DISCUSSION: This mobile phone based program addresses an important gap in obesity prevention efforts to date. The method of intervention delivery is via platforms that are highly accessible and appropriate for this population group. If effective, further translational research will be required to assess how this program might operate in the broader community. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12612000924853.