Multimodal digital phenotyping of diet, physical activity, and glycemia in Hispanic/Latino adults with or at risk of type 2 diabetes.

Digital phenotyping refers to characterizing human bio-behavior through wearables, personal devices, and digital health technologies. Digital phenotyping in populations facing a disproportionate burden of type 2 diabetes (T2D) and health disparities continues to lag compared to other populations. Here, we report our study demonstrating the application of multimodal digital phenotyping, i.e., the simultaneous use of CGM, physical activity monitors, and meal tracking in Hispanic/Latino individuals with or at risk of T2D. For 14 days, 36 Hispanic/Latino adults (28 female, 14 with non-insulin treated T2D) wore a continuous glucose monitor (CGM) and a physical activity monitor (Actigraph) while simultaneously logging meals using the MyFitnessPal app. We model meal events and daily digital biomarkers representing diet, physical activity choices, and corresponding glycemic response. We develop a digital biomarker for meal events that differentiates meal events into normal and elevated categories. We examine the contribution of daily digital biomarkers of elevated meal event count and step count on daily time-in-range 54-140 mg/dL (TIR54-140) and average glucose. After adjusting for step count, a change in elevated meal event count from zero to two decreases TIR54-140 by 4.0% (p = 0.003). An increase in 1000 steps in post-meal step count also reduces the meal event glucose response by 641 min mg/dL (p = 0.0006) and reduces the odds of an elevated meal event by 55% (p < 0.0001). The proposed meal event digital biomarkers may provide an opportunity for non-pharmacologic interventions for Hispanic/Latino adults facing a disproportionate burden of T2D.

Calorie Compensation Patterns Observed in App-Based Food Diaries.

Self-regulation of food intake is necessary for maintaining a healthy body weight. One of the characteristics of self-regulation is calorie compensation. Calorie compensation refers to adjusting the current meal's energy content based on the energy content of the previous meal(s). Preload test studies measure a single instance of compensation in a controlled setting. The measurement of calorie compensation in free-living conditions has largely remained unexplored. This paper proposes a methodology that leverages extensive app-based observational food diary data to measure an individual's calorie compensation profile in free-living conditions. Instead of a single compensation index followed in preload-test studies, we present the compensation profile as a distribution of days a user exhibits under-compensation, overcompensation, non-compensation, and precise compensation. We applied our methodology to the public food diary data of 1622 MyFitnessPal users. We empirically established that four weeks of food diaries were sufficient to characterize a user's compensation profile accurately. We observed that meal compensation was more likely than day compensation. Dinner compensation had a higher likelihood than lunch compensation. Precise compensation was the least likely. Users were more likely to overcompensate for missing calories than for additional calories. The consequences of poor compensatory behavior were reflected in their adherence to their daily calorie goal. Our methodology could be applied to food diaries to discover behavioral phenotypes of poor compensatory behavior toward forming an early behavioral marker for weight gain.

Temporal changes in bio-behavioral and glycemic outcomes following a produce prescription program among predominantly Hispanic/Latino adults with or at risk of type 2 diabetes.

In the United States (U.S.), consumption of fresh vegetables and fruits is below recommended levels. Enhancing access to nutritious food through food prescriptions has been recognized as a promising approach to combat diet-related illnesses. However, the effectiveness of this strategy at a large scale remains untested, particularly in marginalized communities where food insecurity rates and the prevalence of health conditions such as type 2 diabetes (T2D) are higher compared to the background population. This study evaluated the impact of a produce prescription program for predominantly Hispanic/Latino adults living with or at risk of T2D. A total of 303 participants enrolled in a 3-month observational cohort received 21 medically prescribed portions/week of fresh produce. A subgroup of 189 participants used continuous glucose monitoring (CGM) to assess the relationship between CGM profile changes and HbA1c level changes. For 247 participants completing the study (76% female, 84% Hispanic/Latino, 32% with T2D, age 56·6 ± 11·9 years), there was a reduction in weight (-1·1 [-1·6 to -0·6] lbs., p < 0.001), waist circumference (-0·4 [-1·0 to 0·6] cm, p = 0·007) and systolic blood pressure (SBP) for participants with baseline SBP >120 mmHg (-4·2 [-6·8 to -1·8] mmHg, p = 0·001). For participants with an HbA1c ≥ 7·0% at baseline, HbA1c fell significantly (-0·5 [-0·9 to -0·1] %, p = 0·01). There were also improvements in food security (p < 0·0001), self-reported ratings of sleep, mood, pain (all p < 0·001), and measures of depression (p < 0·0001), anxiety (p = 0·045), and stress (p = 0·002) (DASS-21). There was significant correlation (r = 0·8, p = 0·001) between HbA1c change and the change in average glucose for participants with worsening HbA1c, but not for participants with an improvement in HbA1c. In conclusion, medical prescription of fresh produce is associated with significant improvements in cardio-metabolic and psycho-social risk factors for Hispanic/Latino adults with or at risk of T2D.

Food Habits: Insights from Food Diaries via Computational Recurrence Measures.

Humans are creatures of habit, and hence one would expect habitual components in our diet. However, there is scant research characterizing habitual behavior in food consumption quantitatively. Longitudinal food diaries contributed by app users are a promising resource to study habitual behavior in food selection. We developed computational measures that leverage recurrence in food choices to describe the habitual component. The relative frequency and span of individual food choices are computed and used to identify recurrent choices. We proposed metrics to quantify the recurrence at both food-item and meal levels. We obtained the following insights by employing our measures on a public dataset of food diaries from MyFitnessPal users. Food-item recurrence is higher than meal recurrence. While food-item recurrence increases with the average number of food-items chosen per meal, meal recurrence decreases. Recurrence is the strongest at breakfast, weakest at dinner, and higher on weekdays than on weekends. Individuals with relatively high recurrence on weekdays also have relatively high recurrence on weekends. Our quantitatively observed trends are intuitive and aligned with common notions surrounding habitual food consumption. As a potential impact of the research, profiling habitual behaviors using the proposed recurrent consumption measures may reveal unique opportunities for accessible and sustainable dietary interventions.

HRVCam: robust camera-based measurement of heart rate variability.

SIGNIFICANCE: Non-contact, camera-based heart rate variability estimation is desirable in numerous applications, including medical, automotive, and entertainment. Unfortunately, camera-based HRV accuracy and reliability suffer due to two challenges: (a) darker skin tones result in lower SNR and (b) relative motion induces measurement artifacts. AIM: We propose an algorithm HRVCam that provides sufficient robustness to low SNR and motion-induced artifacts commonly present in imaging photoplethysmography (iPPG) signals. APPROACH: HRVCam computes camera-based HRV from the instantaneous frequency of the iPPG signal. HRVCam uses automatic adaptive bandwidth filtering along with discrete energy separation to estimate the instantaneous frequency. The parameters of HRVCam use the observed characteristics of HRV and iPPG signals. RESULTS: We capture a new dataset containing 16 participants with diverse skin tones. We demonstrate that HRVCam reduces the error in camera-based HRV metrics significantly (more than 50% reduction) for videos with dark skin and face motion. CONCLUSION: HRVCam can be used on top of iPPG estimation algorithms to provide robust HRV measurements making camera-based HRV practical.

PPG3D: Does 3D head tracking improve camera-based PPG estimation?

Over the last few years, camera-based estimation of vital signs referred to as imaging photoplethysmography (iPPG) has garnered significant attention due to the relative simplicity, ease, unobtrusiveness and flexibility offered by such measurements. It is expected that iPPG may be integrated into a host of emerging applications in areas as diverse as autonomous cars, neonatal monitoring, and telemedicine. In spite of this potential, the primary challenge of non-contact camera-based measurements is the relative motion between the camera and the subjects. Current techniques employ 2D feature tracking to reduce the effect of subject and camera motion but they are limited to handling translational and in-plane motion. In this paper, we study, for the first-time, the utility of 3D face tracking to allow iPPG to retain robust performance even in presence of out-of-plane and large relative motions. We use a RGB-D camera to obtain 3D information from the subjects and use the spatial and depth information to fit a 3D face model and track the model over the video frames. This allows us to estimate correspondence over the entire video with pixel-level accuracy, even in the presence of out-of-plane or large motions. We then estimate iPPG from the warped video data that ensures per-pixel correspondence over the entire window-length used for estimation. Our experiments demonstrate improvement in robustness when head motion is large.