Background Cardiovascular disease, cancer, diabetes mellitus, and obesity are common chronic diseases, and their prevalence is reaching an epidemic level worldwide. As the impact of chronic diseases continues to increase, finding strategies to improve care, access to care, and patient empowerment becomes increasingly essential. Health care providers use mobile health (mHealth) to access clinical information, collaborate with care teams, communicate over long distances with patients, and facilitate real-time monitoring and interventions. However, these apps focus on improving general health care concerns, with limited apps focusing on specific chronic diseases and the nutrition involved in the disease state. Hence, available evidence on the effectiveness of mHealth apps toward behavior change to improve chronic disease outcomes is limited. Objective The objective of this scoping review was to provide an overview of behavior change effectiveness using mHealth nutrition interventions in people with chronic diseases (ie, cardiovascular disease, diabetes mellitus, cancer, and obesity). We further evaluated the behavior change techniques and theories or models used for behavior change, if any. Methods A scoping review was conducted through a systematic literature search in the MEDLINE, EBSCO, PubMed, ScienceDirect, and Scopus databases. Studies were excluded from the review if they did not involve an app or nutrition intervention, were written in a language other than English, were duplicates from other database searches, or were literature reviews. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines, the systematic review process included 4 steps: identification of records through the database search, screening of duplicate and excluded records, eligibility assessment of full-text records, and final analysis of included records. Results In total, 46 studies comprising 256,430 patients were included. There was diversity in the chronic disease state, study design, number of participants, in-app features, behavior change techniques, and behavior models used in the studies. In addition, our review found that less than half (19/46, 41%) of the studies based their nutrition apps on a behavioral theory or its constructs. Of the 46 studies, 11 (24%) measured maintenance of health behavior change, of which 7 (64%) sustained behavior change for approximately 6 to 12 months and 4 (36%) showed a decline in behavior change or discontinued app use. Conclusions The results suggest that mHealth apps involving nutrition can significantly improve health outcomes in people with chronic diseases. Tailoring nutrition apps to specific populations is recommended for effective behavior change and improvement of health outcomes. In addition, some studies (7/46, 15%) showed sustained health behavior change, and some (4/46, 9%) showed a decline in the use of nutrition apps. These results indicate a need for further investigation on the sustainability of the health behavior change effectiveness of disease-specific nutrition apps.

This scoping review investigates the volume of evidence for home-based exercise and nutrition programs and their effect on muscle quality among senior adults to inform implementation and future research. It aims to answer the research question: What are the evidence, challenges, and needs for research regarding a home-based exercise and nutrition intervention program to improve muscle outcomes in senior adults? This scoping review was conducted following the PRISMA extension for Scoping Review. The following databases were searched: PubMed, Scopus, MEDLINE, CINAHL, EMBASE, and the Cochrane Library. Applied filters were used to help condense the research articles. A total of 13 studies met the inclusion criteria for this scoping review. Most exercise interventions were either resistance or multi-component exercise programs. The nature of the nutrition intervention varied between different supplements, foods, education, or counseling. Muscle outcomes included muscle mass in nine studies, muscle function in all the studies, muscle strength in ten studies, and biochemical analyses in two studies. Two studies found improvements in muscle mass; two studies revealed improvements in all their muscle function tests; and three studies revealed improvements in muscle strength. Muscle biopsy in a study revealed enhanced muscle fibers, but both studies did not reveal any biomarker improvements. The scoping review findings revealed mixed results on the effectiveness of a home-based exercise and nutrition program. However, the current evidence does have many gaps to address before recommending this form of intervention for senior adults as an effective way to prevent and manage sarcopenia. Since this review identified multiple knowledge gaps, strengths, and limitations in this growing field, it can be a starting point to help build future study designs and interventions in this population.

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IntroductionBreast milk contains a wide range of hormones, nutrients, and bioactive compounds. Chrononutrition looks at the interaction between food, both meal timing and meal composition, and circadian rhythms.MethodThis review is a continuation on series on chrononutrition and breast milk. All human studies published in English were included regardless of location or year of publication.ResultsThis review identifies the hormonal circadian variation researched in breast milk to date for melatonin, cortisol, cortisone, leptin, and insulin.ConclusionThe circadian variation observed in some hormones reinforces the superiority of breast milk over formula milk. Melatonin has been the most studied, but more research for all the hormones is needed due to various gaps in the literature and varying levels of study quality. There is insufficient evidence to make recommendations specifically targeting the lactating mother, but we identify and recommend several ideas for future research.

This study aimed to determine the breadth to which obesity education is included in US dietetic internships, how it is prioritized, and the perceived barriers to providing optimal obesity curricula in dietetic internships. A 27-item, cross-sectional survey was emailed to 335 dietetic internship program administrators in the United States and Puerto Rico. Data were analyzed using general descriptive statistics. A total of 83 administrators (25%) participated. Only 26 dietetic internship programs (34%) reported their interns were “very prepared” to manage patients with obesity. Thirty-six percent had no obesity education programs in place, and 65% noted obesity education is not taught as a specific clinical rotation. Forty percent of administrators believed obesity education to be a specific competency for dietetic internships, and 33% viewed expansion of obesity education as a low priority. Lack of room in the current curriculum was the predominant barrier (22%) to integrating obesity education, whereas lack of interest was not (74%). Administrators reported their interns generally had “some to great extent” of knowledge on comorbidities of obesity (60%), but knowledge of obesity etiology and assessment was low (33%). Fifty-eight percent of dietetic internship programs did not provide weight bias training. Despite the expectation that registered dietitian nutritionists are primary educators in obesity management, US dietetic internships may not be adequately preparing their students to manage patients with obesity. Contributing factors to this disconnect should be recognized, and barriers minimized, so that optimal obesity training is provided in dietetic internships.

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Objectives Obesity has been identified as a risk factor for vitamin D deficiency. Those seeking bariatric surgery for obesity treatment have an additional risk for low vitamin D levels post-op due to factors that affect compliance with taking supplemental vitamins and minerals. As personalized nutrition (PN) may change behaviors and have an impact on health outcomes, this study will examine the relationships among genetic variants that predispose individuals to vitamin D deficiency, PN, knowledge of the risk of vitamin D deficiency, and supplemental vitamin adherence in patients who have undergone bariatric surgery. Methods This will be a one year cross-sectional study with approximately 50 participants with severe obesity having bariatric surgery. Inclusion criteria will include subjects aged 18 years and older seeking sleeve gastrectomy at The Advanced Bariatric Surgery Center in Lubbock, Texas. Exclusion criteria will be those who are not candidates for surgery and nicotine, alcohol, and/or drug dependency. The data collected will include buccal swab genetic tests, two assays for vitamin D receptor (VDR) single polymorphisms (SNPs), vitamin D levels, diet and vitamin and mineral adherence, and dual-energy X-ray absorptiometry (DEXA) scans. This information will be analyzed and compared to patients’ outcomes at pre-op and post-op appointments. Results N/A. Conclusions Upon completing this study, we expect to have identified how micronutrient genetic testing can be used in conjunction with PN to improve the bariatric surgery population's vitamin D levels. This outcome can further nutrition education and PN to improve overall health knowledge and interventional outcomes on critical nutritional parameters. Furthermore, the results could potentially produce greater adherence to vitamin and mineral regimens, and improve bone density among individuals who have undergone bariatric surgery. Funding Sources This study was funded by start-up funds from Texas Tech University.