Dietary Intake and Health Status of Elderly Patients With Type 2 Diabetes Mellitus: Cross-sectional Study Using a Mobile App in Primary Care

Abstract

Background Healthy dietary intake reduces the risk of complications of diabetes mellitus. Using assessment methods helps to understand these circumstances, and an electronic application may optimize this practice. Objective In this study, we aimed to (1) assess the dietary intake and health status of elderly patients with type 2 diabetes mellitus (T2DM) in primary care, (2) use a mobile app as a tool for data collection and analysis in the context of primary care, and (3) verify the perceptions of multidisciplinary health professionals regarding app use. Methods First, we developed a mobile app comprised of the questions of the Food and Nutrition Surveillance System (SISVAN) of Brazil, which includes a food frequency questionnaire of food categories with a recall of the previous 7 days. Thereafter, we used the app to collect data on the health status and dietary intake of 154 participants, aged 60-96 years, diagnosed with T2DM, and under treatment in primary care centers in the northern region of Rio Grande do Sul, Brazil. We also collected participants’ demographic, anthropometric, biochemical, and lifestyle variables. The associations between dietary intake and other variables were tested using chi-square tests with a 5% significance level. Regarding the app, we assessed usability and acceptance with 20 health professionals. Results Between August 2018 and December 2018, participants had an intake in line with recommended guidelines for raw salads (57.1%), fruits (76.6%), milk products (68.2%), fried foods (72.7%), savory biscuits (60.4%), cookies or sweets (72.1%), and sugary drinks (92.9%) Meanwhile, the consumption of beans (59.7%), pulses and cooked vegetables (73.4%), and processed meat products (59.7%) was not in line with the guidelines. There were statistically significant differences in meeting the recommended guidelines among participants of different genders (P=.006 and P=.035 for the intake of fried foods and sugary drinks, respectively), place of residence (P=.034 for the intake of cookies and sweets), family history of diabetes (P<.001 for the intake of beans), physical activity engagement (P=.003 for the intake fresh fruits), history of smoking (P=.001 for the intake of raw salads), and presence of coronary disease (P=.050 for the intake of pulses and cooked vegetables). The assessment of usability resulted in a mean score of 71.75 points. Similarly, the assessment of the 15 acceptance questions revealed high scores, and the qualitative questions revealed positive perceptions. Conclusions We identified that most participants complied with recommended intake guidelines for 7 of 10 categories in the SISVAN guidelines. However, most participants were overweight and had nutritional and clinical disorders, which justifies further investigations in this population. The app was well-rated by health professionals and considered a useful and promising tool for collecting and analyzing data in primary care settings.

Evaluation of a Web-Based Dietary Assessment Tool (myfood24) in Norwegian Women and Men Aged 60-74 Years: Usability Study

“…Based on the qualitative feedback from comments provided by the participants in this study, we also believe that adding more foods and more synonyms to the foods list would improve the user experience. Previous usability studies of self-administered dietary assessment apps among older adults, include apps with voice-added reporting [ 23 ] or apps where health personnel can complete the reporting on behalf of the respondent [ 24 ]. For older adults with impairments, such modifications are helpful.…”

“…A potential explanation for this difference could be that the data collection in the German study was performed during a study center visit, where the participants received instructions on how to complete myfood24 as well as on-site assistance [13]. Further, the participants completed 3-4 consecutive recalls (ie, probably resulting in the participant being acquainted with the tool), 11% had previous experience in completing 24-hour dietary recalls, and 21% had a nutritional or food science background [13], of which both are expected to increase the perception of usability. Furthermore, the German version of myfood24 contains a higher number of foods than the Norwegian version, including a large number of branded foods.…”