A Scoping Review of Breastfeeding Interventions and Programs Conducted Across Spanish-Speaking Countries.

Breastfeeding is vital to a child's lifelong health and has significant positive benefits to mother's health. World Health Organization recommends beginning exclusively breastfeeding within the first hour after birth and continuing during the first 6 months of infant's life. The purpose of this review is to identify and examine breastfeeding interventions conducted across the Spanish-speaking countries. A scoping review of the literature was conducted across 14 databases for relevant publications published through April 2023 to find studies in Spanish-speaking countries that involved breastfeeding as an intervention component. A total of 46 peer-reviewed articles were included in this review, across 12 Spanish-speaking countries. Participants ranged from pregnant women, mothers, mother-infant pair, and health care professionals. Intervention at the individual level in combination with support from trained health care professionals or peer counselors seemed to have higher improvements in breastfeeding rates. The greatest improvement in exclusively breastfeeding for 6 months was seen in interventions that included prenatal and postnatal intensive lactation education, for a period of 12 months. The most effective interventions that improved rates of any breastfeeding included promotional activities, educations workshop, and training of health care staff along with changes in hospital care. Breastfeeding promotion is an economical and effective intervention to increase breastfeeding behavior and thereby improving breastfeeding adherence across Spanish-speaking countries.

Interventions and Programs to Promote Breastfeeding in Arabic-Speaking Countries: A Scoping Review.

INTRODUCTION: Low prevalence of exclusive breastfeeding in the Arab world is concerning and suboptimal breastfeeding is a leading child health risk factor in several Arab States. Breastfeeding education has the capacity to improve breastfeeding knowledge and practice, thus positively impacting infant and maternal health. The purpose of this review is to identify and examine the impact of breastfeeding promotion interventions across the Arab world. METHOD: A scoping review of the literature was conducted across seventeen databases for relevant publications published through October 2021 to find studies in Arab countries, that involved breastfeeding as an intervention component. Twenty-one articles met inclusion criteria and were reviewed. RESULTS: Individual and community based educational interventions offer the opportunity to positively impact the knowledge, attitudes, and practices of breastfeeding in new mothers in Arab countries. Increased breastfeeding has the potential to lead to improved neonate and maternal health. In addition to significant benefits found across individual and community-based interventions in a variety of Arab countries, there is also evidence that interventions that improve the knowledge of health care professionals and/or the practices of a health care system can contribute to subsequent increases in breastfeeding rates. DISCUSSION: Breastfeeding education is a low-cost and high-impact public health tool that can impact infant and maternal health and potentially increase breastfeeding adherence in the Arab world.

What is already known on this subject? Breastfeeding has major long-term effects on the health and development of children as well as women's health. Combined health systems and community interventions more than double exclusive breastfeeding rates globally. The most cost-effective ways to promote exclusive breastfeeding include counselling and supportive interventions in multiple settings. What this study adds? Multi-component educational and supportive interventions increase breastfeeding initiation and duration among mothers in the Arab world. The most successful interventions among Arab women include education as well as pre- and post-partum support. Education and training for health professionals on the importance of breastfeeding can have broad-reaching impact on improving breastfeeding rates.

Effectiveness of school-based nutrition interventions promoted in the League of Arab States: a systematic review.

Arab countries are doubly burdened with undernutrition as well as overweight and obesity. To provide guidance to those looking to address concerns of obesity and overweight among children in this region, the current review bridges an existing knowledge gap and systematically characterizes and evaluates the available scientific evidence pertaining to school-based nutrition interventions completed to date across the Arab world. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and relevant keywords, terms and phrases, a search of the literature across 14 databases for school-based nutrition interventions implemented in this region was conducted. Out of 1568 articles from 14 databases, 38 full-text articles meeting the inclusion criteria were retrieved. Further assessment for eligibility excluded 23 articles and included one article from hand-searching references, leaving 16 articles in the final analysis. Most articles (n = 7) with the implementation of 5 months or longer found strong positive and significant impacts on limiting sweets consumption, increased dietary knowledge, self-efficacy, breakfast and fruit and vegetable consumption, among others. We also found evidence (n = 5) that teachers trained by experts such as dietitians and pediatricians can effectively implement nutrition interventions that achieve the intended outcomes. Training teachers to implement theory-based nutrition and health promotion curricula serves as a potential solution to improving nutrition knowledge, health behaviors and dietary practices among children living in Arab countries. Appropriately designed and implemented nutrition interventions can positively impact nutrition knowledge, health and diet-related behaviors in children and adolescents in this region.

Translation, validity, and reliability of an Arabic version of the dietary questionnaire on nutrition knowledge, self-efficacy, and practice among Arab young adults.

BACKGROUND AND OBJECTIVES: Assessing knowledge, self-efficacy, and practice among a given population us-ing a validated and reliable questionnaire is crucial. The aim of this study was to translate, validate, and test the reliability of the knowledge, self-efficacy, and practice in the Arabic population. Methods and Study De-sign: A previously published knowledge, self-efficacy, and practice nutrition questionnaire was translated and validated into Arabic. A panel of translation and nutrition experts from Arab countries participated in translation and testing validity. A convenience sampling technique was used to recruit participants across 22 Arab countries. An online self-administered questionnaire was completed twice with an interval of 2 weeks. Tests of validity (face and content) and reliability (consistency and test-retest reliability) were used. RESULTS: A total of 96 participants had a mean age of 21.5 years, 68.7% were female, and 80.2% were students. The mean expert proportional content validity index scale was 0.95, and intra class correlation values ranged from 0.59 to 0.76; all of these values were highly statistically significant at retest. CONCLUSIONS: The Arabic version of the questionnaire provided valid and reliable results for assessing knowledge, self-efficacy, and practice among Arab adolescents and young adults. This tool could assess nutritional education programs in a community setting and educational institutions targeting this population in Arab countries.

Assessment of knowledge and challenges toward the use of subcutaneous self-injecting insulin among diabetes patients during COVID-19 pandemic in Saudi Arabia.

BACKGROUND: The COVID-19 pandemic has revolutionized the delivery of chronic health care. For diabetic patients, maintaining regular contact with healthcare providers and visiting healthcare centers are crucial to patients' overall ability to control their glycemic status. OBJECTIVE: To assess patients' knowledge regarding the use of insulin injection devices and the challenges these patients face in obtaining medical advice, as well as to suggest alternative solutions for addressing these challenges among diabetic patients self-administering their injections during the COVID-19 pandemic. METHODOLOGY: An observational cross-sectional study was conducted among a sample population (N = 178) of diabetic patients attending Security Forces Hospital-Riyadh, Saudi Arabia, from which the Institutional Review Board (IRB) was granted. Data was collected using a self-administered questionnaire, which was distributed from August to September 2020. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) program (version 21). Significant P-value = < 0.05. RESULTS: The majority of patients had good knowledge and practice explained with values 73.6% of total papulation. Sixty-four percent of patients with type 1 diabetes and 59% of patients with type 2 diabetes reported experiencing moderately severe challenges obtaining counseling. There was no correlation between severity of disease and knowledge levels (p-value = 0.36). The most appropriate means of obtaining counseling was determined to be conversations with healthcare providers; this strategy received an overall average score of 4.9 ± 0.4 (p-value < 0.0001). CONCLUSION: Regardless of whether knowledge is high among patients with diabetes, continuous support and counseling from healthcare providers is critical. The creation of innovative approaches to facilitate communication between diabetes patients and healthcare providers is recommended for continued patient care during the COVID-19 pandemic.

Food Labeling Use by Consumers in Arab countries: A Scoping Review.

Non-communicable diseases (NCD) related to inadequate nutrition are prevalent in economically transitioning countries such as the Arab region. The westernized diet is recognized as a leading trend and the UN General Assembly is focused on the prevention and control of NCD. Due to the rapid transitions in diet and physical inactivity occurring in the Arab region, revising public health dietary strategies, guidelines, and policies to reduce the burden of NCD is needed. This article presents existing literature on food label use in the Arab region as a response to the problem. The primary objective was to locate, review, and summarize peer-reviewed studies on how and why consumers use food labels in Arab countries. An integrative review of the related literature was conducted with no delimiting time frames. The authors applied search strategies to eight academic databases which produced 32 peer-reviewed articles. Seventeen were removed due to inconsistent scope and focus. Awareness of and nutrition knowledge about food labeling emerged as a primary theme. Education, household income, and age were secondary themes and predictor variables. Nutrition food labels as a population-based strategy can influence individual behavior change and potentially improve population health. These outcomes depend on the consumer's ability to understand nutrition labels and properly apply information. Themed recommendations included standardization of food labeling policies, consumer education on food labeling, and public health efforts to develop a detailed understanding of regional populations prior to health promotion strategy development. Enabling informed food selection and reinforcing healthy dietary intake can help prevent NCD and support individual and population health.

Probabilistic assessment of the intake of trace elements by consumption of weaning foods in Spain.

A probabilistic model was developed to estimate the intake level for Fe, Zn, Ca, P, Mg, Mn, Cu, Na, and K derived from consumption of weaning foods in Spain. They were pooled into 10 different categories based on the main ingredient used in its formulation (chicken, chicken-veal, hake, ham, varied vegetables, chicken-ham, lamb, veal, sole, and beef-ham). The results reported that trace elements contents were especially low and inadequate according to the Dietary Reference Intake especially to Fe, Zn, and Ca and in less extent for Cu and P. Instead, Na contents were moderately high and near to upper limit of this element.

Stigmatisation of Obesity and its Relation to the Perception of Controllability in Riyadh, Saudi Arabia: A cross-sectional study.

Objectives: This study assessed the stigmatisation of obesity among a sample of the general population in Riyadh and its association with the perception of controllability. Methods: A cross-sectional analytical study was conducted in Riyadh, Saudi Arabia, during January-February 2021. The data were collected through a self-administrated online questionnaire. Statistical analysis was performed using John's Macintosh Project, Version 16.0.0. Results: A total of 525 participants were recruited via convenience sampling. The majority of the participants exhibited a low level of stigma towards obesity (72.8%), and gender and BMI were significantly associated with the level of stigma (P = 0.0023 and 0.0360, respectively). The association between the perception of controllable factors and the level of stigma was also significant (P = 0.0001). Conclusion: A significant association was found between the stigmatisation of obesity and the perception of controllability among the general population in Riyadh. Recommendations should be based on joint international consensus statements for ending obesity stigmatisation in different settings and categories; healthcare service providers and obese patients should be educated on the relationships demonstrated in these findings.

A Scoping Review of Nutrition Education Interventions Applied in Prison Settings.

PURPOSE OF REVIEW: Over 11 million individuals are incarcerated globally, facing health challenges such as obesity, diabetes, and cardiovascular disease, possibly exacerbated by prison diets. The objective of this scoping review is to explore the various available types of nutrition education interventions that currently exist in the literature applied in prison settings. RECENT FINDINGS: Utilizing the PRISMA Extension for Scoping Reviews, 19 databases were searched for studies on nutrition interventions in prisons from 2000 to May 2023, guided by the "PICO" structure. Inclusion criteria encompassed articles in five languages from peer-reviewed journals focusing solely on nutrition education interventions. Rayyan QCRI software was utilized for screening and data extraction. Fifteen international studies were analyzed, covering various countries and targeting different populations in prisons. Interventions varied from nutrition education to comprehensive health programs. The outcomes were inconsistent, with some showing health improvements and others encountering challenges. Few utilized established theoretical frameworks, indicating a research gap. The range of interventions highlights the potential complexity of nutrition education interventions within prisons. Implementing recognized theoretical frameworks may enhance effectiveness. The diverse outcomes highlight the challenges in creating impactful programs, emphasizing foundational issues. Recommendations focus on rigorous research designs and understanding prison-specific complexities. Nutrition education interventions in incarcerated settings present varied results, emphasizing the need for well-structured, theoretically grounded, and carefully evaluated programs. Future strategies should recognize the multifaceted nature of correctional facilities, aiming for holistic approaches to improve health in prisons.

Video clips of the Mediterranean Diet on YouTube TM: A social Media Content Analysis.

PURPOSE: The present study conducted a social media content analysis on videos describing the Mediterranean Diet (MedDiet) posted onYouTube. SETTING: YouTube TM online video sharing and social media platform. METHOD: Three independent content experts evaluated 141 YouTube videos on the MedDiet in August 2020 utilizing standard rubric and protocol. Data abstracted include media source(s) of posted videos, and viewer exposure/engagement metrics. Information quality was measured by each content expert independently through use of the DISCERN instrument, a 16-item tool designed to assess reliability, dependability, and trustworthiness of an online source, scores were then aggregated for analysis. RESULTS: A majority of videos (n = 102, 72.3%) were educational in nature. A third of videos were less clear and less credible on information presented (n = 46, 32.6%). Most videos were posted by an individual (n = 79, 56%), and the majority of videos were rated as medium quality (n = 88, 62.4%). Overall level of user engagement as measured by number of "likes," "dislikes," and user comments varied widely across all sources of media. Exploratory correlation analysis suggests that the number of a video's views, comments, likes, and dislikes are not correlated with quality. CONCLUSION: Study findings suggest that MedDiet health promotion and education via YouTube has the potential to reach and inform clients; however, existing video content and quality varies significantly. Future intervention research focused on MedDiet should further examine possible predictors of high quality MedDiet content utilizing diverse online video sharing platforms.

Adoption of antenatal care conversation mapping among health care providers in Saudi Arabia: Application of the diffusion innovation theory.

AIM: To measure the factors influencing on the adoption of antenatal care conversation mapping among health care providers in Riyadh (Saudi Arabia), using the diffusion innovation theory. METHODS: 88 healthcare providers (Riyadh) were recruited using a non-probability convenient sampling technique were trained on how to use a newly developed antenatal care conversation map. Data was collected by self-administrated questionnaire on health education services, adoption of conversation map and diffusion of innovation variables. The JMP statistical software from SAS version 14 was used to perform data analysis. RESULTS: Printable tools were most common as used by 72.7% of participants and 83.0% of them did not hear about conversation map. The total mean score of diffusion of innovation variables showed was in general high. The total mean score of relative advantage and observability was high in participants aged between 40 to less than 50 years, while the total mean score of compatibility, complexity, and trialability was high in participants aged from 50 years and more. Significant differences were obtained in both compatibility and trialability considering the health educators specialty, p = 0.03 and p = 0.027 respectively. The linear correlations between diffusion of innovation variables was significantly positive (p-value <0.01). CONCLUSION: All of diffusion of innovation variables were positive as per the opinion of the participants. Applying the conversation map on other health topics in Saudi Arabia and other Arabic-speaking countries is warranted. Measuring and evaluating the adoption rate of conversation mapping among health care providers on other health topics should be explored.

Reporting on the Status of Nutrition Programs of Higher Education in the Syrian Arab Republic: A Current Snapshot.

Background: The Syrian Arab Republic (SAR) is experiencing high rates of malnutrition. While many adults experience overweight and obesity, as a direct result of the continuing conflict, SAR is also noted as one of the most food-insecure regions in the Arab world. To combat the health impacts and outcomes related to diet and dietary behaviors, trained nutrition professionals are needed. We aimed to examine current nutrition-affiliated programs offered in post-secondary institutions in the SAR. Methods: The search was conducted between Jan and Feb 2021. An electronic review of universities and colleges' websites, department webpages, and academic programs' homepages and resources of all the private and public universities in SAR was conducted to find programs related to nutrition, nutrition sciences, and dietetics. Results: Only 13%, or 4 out of 30 SAR colleges and universities had bachelor's programs in nutrition or nutrition science, and none had nutrition programs at the graduate or terminal degree levels. Conclusion: A pathway for integration of graduates from nutrition sciences into the healthcare and public health workforce should be defined and an understanding of the value of those with a degree in nutrition should be cultivated in clinical and community care settings. Partnering with existing or creating independent organizations charged with defining the scope of practice and ensuring educational quality and competence of graduating students, as well as readiness to practice as part of a healthcare team or in a public health nutrition role will be integral to moving the nutrition profession forward in the SAR.

Peer-reviewed Nutrition-Affiliated Journals from Sub-Saharan Africa: A Regional Snapshot.

BACKGROUND: Sub-Saharan African (SSA) countries face the multipart burden of nutrition-related disease characterized by a high incidence of undernutrition, overweight, obesity, and associated non-communicable disease. Local and regional research to support a robust public health response is necessary. No evaluation of the availability and scope of nutrition-related journals within SSA has been published. METHODS: An electronic search for peer-reviewed journals was conducted using seven publicly accessible databases. RESULTS: Ten journals were identified including journals from Kenya (4 journals), Nigeria (3 journals), South Africa (2 journals), and Ghana (1 journal) with eight journals in active production. All actively publishing journals are available only as English publications. CONCLUSION: An increased focus on evidence-based research through local and regional journal publications is necessary to develop and maintain public health nutrition programs. Active journals related to nutrition and food sciences are very limited in this comparatively large area and require more support at local, regional, and legislative levels.

Degree-Granting Nutrition Programs in the Republic of Yemen: A Status Report on Postsecondary Education.

Yemen is noted as one of the most food-insecure countries in the Arab world coupled with high rates of malnutrition. To address the public health outcomes related to nutrition, trained nutrition professionals are needed. This report provides a snapshot of current nutrition-affiliated programs offered in postsecondary institutions in Yemen. Partnering with or creating independent organizations responsible for defining the scope of practice is warranted. Additionally, ensuring educational quality, program accreditation, and competence of graduating students and readiness to practice will be central to progressively moving Yemen's dietetics profession forward.

Purification, characterization, and determination of biological activities of water-soluble polysaccharides from Mahonia bealei.

Mahonia bealei is one of the important members of the genus Mahonia and Traditional Chinese Medicine (TCM). Several compounds isolated from this plant have exhibited useful biological activities. Polysaccharides, an important biomacromolecule have been underexplored in case of M. bealei. In this study, hot water extraction and ethanol precipitation were used for the extraction of polysaccharides from the stem of M. bealei, and then extract was purified using ultrafiltration membrane at 50,000 Da cut off value. Characterization of the purified M. bealei polysaccharide (MBP) was performed using Fourier Transform Infrared Spectroscopy (FT-IR), along with Scanning Electron Microscopy (SEM), X-ray crystallography XRD analysis and Thermal gravimetric analysis (TGA). The purified polysaccharide MBP was tested for antioxidant potential by determining its reducing power, besides determining the DPPH, ABTS, superoxide radical, and hydroxyl radical scavenging along with ferrous ion chelating activities. An increased antioxidant activity of the polysaccharide was reported with increase in concentration (0.5 to 5 mg/ml) for all the parameters. Antimicrobial potential was determined against gram positive and gram-negative bacteria. 20 µg/ml MBP was found appropriate with 12 h incubation period against Escherichia coli and Bacillus subtilis bacteria. We conclude that polysaccharides from M. bealei possess potential ability of biological importance; however, more studies are required for elucidation of their structure and useful activities.

Phytochemical Profile and Antioxidant Activity of Sesame Seed (Sesamum indicum) By-Products for Stability and Shelf Life Improvement of Refined Olive Oil.

The by-product of sesame seed coats from the tahini industry was used for the extraction of bioactive compounds as novel antioxidants. This study was designed to evaluate the effect of a natural antioxidant on the quality of refined olive oil (ROO) stored at 60 ± 1 °C for up to 48 days. The lyophilized sesame seed coats extract (LSSCE) was placed into fresh ROO at three levels, i.e., 200, 400, and 600 mg kg-1, and compared with 200 mg kg-1 BHT (reference) and without antioxidant (control). LSSCE exhibited high phenolic (105.9 mg GAE g-1) and lignin (6.3 mg g-1) contents as well as antioxidant activity based on HPLC/DAD. In ROO samples, Including LSSCE, the values of peroxide, p-anisidine, K232, and K270 were remarkably lower than control during storage. The kinetic rate constant (k) of oxidation indicators was the lowest in ROO samples containing BHT and LSSCE 600 mg kg-1compared with other treatments. LSSCE improved the organoleptic acceptability of ROO samples up to 48 days of storage. Moreover, the shelf life (assuming a Q10 value of 2.0 for lipid oxidation) of ROO treated with LSSCE was increased. The findings revealed that LSSCE is a promising natural antioxidant in delaying oxidation, enhancing oil stability, and prolonging the shelf life (~475 days at ambient temperature).

A Continuously Tunable Full-Color Emission Nitrogen-Doped Carbon Dots and for Ultrasensitive and Highly Selective Detection of Ascorbic Acid.

Nitrogen-doped carbon dots exhibiting excitation-dependent full-color emissions (F-NCDs) were prepared via the one-step hydrothermal method with citric acid and phenylenediamine. Specifically, the emission wavelength of the F-NCDs tuned from 452 nm to 602 nm due to the introduction of new energy levels by C=O and C=N functional groups. We exploited its stability in illumination, ionic strength, and pH, as well as its specificity, sensitivity, especially in ascorbic acid (AA) detection. F-NCDs could measure the AA concentration in the linear ranges of 0~0.1 and 0.1~1 mmol/L with the detection limit (LOD, S/N = 3) as low as 2.6 nmol/L. Additionally, we successfully detected AA in bovine serum with our F-NCDs and obtained the result within 1 min. Because of full-color emission features, we believe our F-NCDs have a great potential in fluorescent sensor detection.

Transforming waste into value: pomelo-peel-based nitrogen-doped carbon dots for the highly selective detection of tetracycline.

Tetracycline (TC) is widely used as a veterinary drug, and its residue in livestock products could enter the human body and cause damage. In this study, we developed an eco-friendly approach that utilized pomelo peel as a carbon source to synthesize new water-soluble N-doped carbon dots (P-NCDs) with blue fluorescence, obtaining a high quantum yield of up to 76.47% and achieving the goal of turning waste into value. Our prepared P-NCDs can selectively recognized TC, and their fluorescence was quenched based on the IFE. P-NCDs could measure the TC concentration in the linear range of 0-100 µmol L-1 with a detection limit (LOD, S/N = 3) as low as 0.045 µmol L-1. Furthermore, we have successfully applied our P-NCDs to the detection of TC in milk samples with convincing results within 90 s. Overall, our newly synthesized fluorescent sensor, P-NCDs, demonstrated huge potential to become an alternative way to detect TC in a simple, efficient, sensitive way without using any special instruments.

The use of social media to search for weight reduction information: Assessment of the perception among a sample of Saudi adults.

Objective: To assess the patterns, prevalence, and perceptions of the benefits and risks of using social media as a source of weight loss information among Saudi adults. Methods: In this cross-sectional study, convenient snowball sampling was used to recruit Saudi adults. A self-report questionnaire containing the following five sections was distributed: sociodemographic information, the pattern of social media use, use of social media to obtain weight loss information, perception of benefits, and perception of risks of using social media. A Chi-square test was used to identify differences according to participants' demographics. Results: A total of 420 Saudi adults were included in the study. Most Saudi adults (43.3%) used social media for more than four hours a day, and 88.6% used WhatsApp. The prevalence of social media use for weight loss information was 89.2% among Saudi adults. Significant associations were found between the use of social media for weight loss information and age (<33 years old) and monthly income (<5000 Saudi Arabian Riyal) (p ≤ 0.012). Of the participants, 71.7% believed that social media is "always" or "frequently" an easily acceptable way to obtain weight loss information. Moreover, 36% of Saudi adults believed that weight loss information on social media could be scientifically inaccurate, and 61% believed that it could be posted solely for marketing and financial purposes. Conclusion: The findings of this study show that Saudi adults have a high prevalence of social media use to obtain weight loss information. The benefits and risks of using social media as a source of weight loss information were also perceived to be high among Saudi adults.

Technology-based nutrition interventions using the Mediterranean diet: a systematic review.

CONTEXT: Over the past 2 decades, overweight and obesity rates have increased exponentially, along with related comorbidities including type 2 diabetes, hypertension, cardiovascular disease, and some cancers. The Mediterranean Diet (MDiet) has been suggested as a potential way to mitigate the health burdens related to overweight and obesity. OBJECTIVE: For this review, the literature on MDiet-focused digital interventions was examined to determine efficacy, best practices, and potential limitations. DATA SOURCES: The search was conducted across 15 databases for relevant publications published through April 2020 in English, French, Spanish, Arabic, or Italian. DATA EXTRACTION: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed using a combination of keywords and phrases and evaluated independently for relevance, merit, and inclusion and exclusion criteria. DATA ANALYSIS: The systematic literature review resulted in 15 articles that met the search criteria. Ten interventions were delivered online, and 5 were delivered via smartphone using an app. The majority of online MDiet-focused interventions were effective, particularly when modeled after evidence-based and best-practice online nutrition education interventions. Such interventions also are effective for promoting positive health behaviors and health outcomes, such as increased physical activity, increased levels of high-density lipoprotein cholesterol, and a lower total high-density lipoprotein cholesterol ratio. CONCLUSION: Technology-based interventions to educate and promote adherence to the MDiet are successful in helping individuals achieve the stated outcomes. More research is needed to determine the efficacy of MDiet interventions delivered via smartphone apps.