The Age of Artificial Intelligence: Use of Digital Technology in Clinical Nutrition

Purpose of review Computing advances over the decades have catalyzed the pervasive integration of digital technology in the medical industry, now followed by similar applications for clinical nutrition. This review discusses the implementation of such technologies for nutrition, ranging from the use of mobile apps and wearable technologies to the development of decision support tools for parenteral nutrition and use of telehealth for remote assessment of nutrition. Recent findings Mobile applications and wearable technologies have provided opportunities for real-time collection of granular nutrition-related data. Machine learning has allowed for more complex analyses of the increasing volume of data collected. The combination of these tools has also translated into practical clinical applications, such as decision support tools, risk prediction, and diet optimization. Summary The state of digital technology for clinical nutrition is still young, although there is much promise for growth and disruption in the future

Combining mobile-health (mHealth) and artificial intelligence (AI) methods to avoid suicide attempts: the Smartcrises study protocol

The screening of digital footprint for clinical purposes relies on the capacity of wearable technologies to collect data and extract relevant information’s for patient management. Artificial intelligence (AI) techniques allow processing of real-time observational information and continuously learning from data to build understanding. We designed a system able to get clinical sense from digital footprints based on the smartphone’s native sensors and advanced machine learning and signal processing techniques in order to identify suicide risk. Method/design: The Smartcrisis study is a cross-national comparative study. The study goal is to determine the relationship between suicide risk and changes in sleep quality and disturbed appetite. Outpatients from the Hospital Fundación Jiménez Díaz Psychiatry Department (Madrid, Spain) and the University Hospital of Nimes (France) will be proposed to participate to the study. Two smartphone applications and a wearable armband will be used to capture the data. In the intervention group, a smartphone application (MEmind) will allow for the ecological momentary assessment (EMA) data capture related with sleep, appetite and suicide ideations. Discussion: Some concerns regarding data security might be raised. Our system complies with the highest level of security regarding patients’ data. Several important ethical considerations related to EMA method must also be considered. EMA methods entails a non-negligible time commitment on behalf of the participants. EMA rely on daily, or sometimes more frequent, Smartphone notifications. Furthermore, recording participants’ daily experiences in a continuous manner is an integral part of EMA. This approach may be significantly more than asking a participant to complete a retrospective questionnaire but also more accurate in terms of symptoms monitoring. Overall, we believe that Smartcrises could participate to a paradigm shift from the traditional identification of risks factors to personalized prevention strategies tailored to characteristics for each patientThis study was partly funded by Fundación Jiménez Díaz Hospital, Instituto de Salud Carlos III (PI16/01852), Delegación del Gobierno para el Plan Nacional de Drogas (20151073), American Foundation for Suicide Prevention (AFSP) (LSRG-1-005-16), the Madrid Regional Government (B2017/BMD-3740 AGES-CM 2CM; Y2018/TCS-4705 PRACTICO-CM) and Structural Funds of the European Union. MINECO/FEDER (‘ADVENTURE’, id. TEC2015–69868-C2–1-R) and MCIU Explora Grant ‘aMBITION’ (id. TEC2017–92552-EXP), the French Embassy in Madrid, Spain, The foundation de l’avenir, and the Fondation de France. The work of D. Ramírez and A. Artés-Rodríguez has been partly supported by Ministerio de Economía of Spain under projects: OTOSIS (TEC2013–41718-R), AID (TEC2014–62194-EXP) and the COMONSENS Network (TEC2015–69648-REDC), by the Ministerio de Economía of Spain jointly with the European Commission (ERDF) under projects ADVENTURE (TEC2015– 69868-C2–1-R) and CAIMAN (TEC2017–86921-C2–2-R), and by the Comunidad de Madrid under project CASI-CAM-CM (S2013/ICE-2845). The work of P. Moreno-Muñoz has been supported by FPI grant BES-2016-07762

The use of mHealth solutions in active and healthy ageing promotion: an explorative scoping review

The global population aged 60 years and over is expected to almost double between 2015 and 2050 from 12.0% to 22.0%, which will directly impact countries' labor market composition and increase the economic pressure on their healthcare systems. One way to address these challenges is to promote Active and Healthy Ageing (AHA) using mobile Health (mHealth). This research aims to provide an initial overview of the width and the depth of contemporary preventive mHealth solutions that promote AHA among healthy, independent older adults (individuals aged 60 years and over). To do so, an explorative scoping review was applied to search online databases for recent studies (March 2015 - March 2020) addressing the promotion of mHealth solutions targeting healthy and independent older adults. We identified 31 publications that met the inclusion criteria. Most of them utilized either mobile (n=25) and/or wearable (n=11) devices. mHealth solutions mostly promoted AHA by targeting older adults’ active lifestyles or independence. Most of the studies (n=27) did not apply a theoretical framework on which the mHealth promotion was based. User-experience was positive (n=12) when the solution was easy to use but negative (n=11) when the participants were resistant or faced challenges using the device and/or technology. The review concludes that mHealth offers the opportunity to combat the issues faced by an unhealthy and dependent aging population by promoting AHA through focusing on older adults’ Lifestyle, Daily functioning, and Participation. Future research should use multidisciplinary integrated approaches and strong theoretical and methodological foundations to investigate mHealth solutions' impact on AHA behavioral change

Protocol of the Healthy Brain Study:An accessible resource for understanding the human brain and how it dynamically and individually operates in its bio-social context

The endeavor to understand the human brain has seen more progress in the last few decades than in the previous two millennia. Still, our understanding of how the human brain relates to behavior in the real world and how this link is modulated by biological, social, and environmental factors is limited. To address this, we designed the Healthy Brain Study (HBS), an interdisciplinary, longitudinal, cohort study based on multidimensional, dynamic assessments in both the laboratory and the real world. Here, we describe the rationale and design of the currently ongoing HBS. The HBS is examining a population-based sample of 1,000 healthy participants (age 30–39) who are thoroughly studied across an entire year. Data are collected through cognitive, affective, behavioral, and physiological testing, neuroimaging, bio-sampling, questionnaires, ecological momentary assessment, and real-world assessments using wearable devices. These data will become an accessible resource for the scientific community enabling the next step in understanding the human brain and how it dynamically and individually operates in its bio-social context. An access procedure to the collected data and bio-samples is in place and published on https://www.healthybrainstudy.nl/en/data-and-methods/access. Trail registration: https://www.trialregister.nl/trial/7955

Protocol of the Healthy Brain Study: An accessible resource for understanding the human brain and how it dynamically and individually operates in its bio-social context

The endeavor to understand the human brain has seen more progress in the last few decades than in the previous two millennia. Still, our understanding of how the human brain relates to behavior in the real world and how this link is modulated by biological, social, and environmental factors is limited. To address this, we designed the Healthy Brain Study (HBS), an interdisciplinary, longitudinal, cohort study based on multidimensional, dynamic assessments in both the laboratory and the real world. Here, we describe the rationale and design of the currently ongoing HBS. The HBS is examining a population-based sample of 1,000 healthy participants (age 30-39) who are thoroughly studied across an entire year. Data are collected through cognitive, affective, behavioral, and physiological testing, neuroimaging, bio-sampling, questionnaires, ecological momentary assessment, and real-world assessments using wearable devices. These data will become an accessible resource for the scientific community enabling the next step in understanding the human brain and how it dynamically and individually operates in its bio-social context. An access procedure to the collected data and bio-samples is in place and published on https://www.healthybrainstudy.nl/en/data-and-methods. https://www.trialregister.nl/trial/795

Advancing Dietetic Practice through the Implementation and Integration of Smartphone Apps

As the burden of obesity and its related chronic diseases grows, dietitians have integral roles in providing individualised medical nutrition therapy. Smartphone mobile health (mHealth) applications (apps) have potential to support and extend reach of dietetic services. This thesis examines how mHealth apps could be implemented and integrated by dietitians to advance nutrition care. Based on a narrative review of current evidence, the novel mobile Nutrition Care Process grid was developed, providing dietitians with best-practice guidance for using mHealth apps across the nutrition care process. Surveying dietitians internationally revealed that 62% used mHealth apps in their practice, although primarily as an information resource and for patient self-monitoring rather than as an integral part of the nutrition care process. Similarly, the public used commercial health and fitness apps, such as MyFitnessPal, to track health behaviours. However, individuals performed suboptimally when using MyFitnessPal to track dietary intake, with the app underestimating mean energy intake by -1863kJ (SD=2952kJ, P=0.0002) compared to 24-hour recalls. Qualitative feedback from dietitians, the public and patients are presented to guide app developers in designing quality mHealth apps. A behavioural analysis was conducted using the COM-B model and intervention recommendations were formulated to facilitate uptake of mHealth apps into dietetic practice. These recommendations were incorporated into a two-phase intervention comprising of an educational and training workshop and a 12-week phase where dietitians used an integrated commercial app platform with their patients. The intervention was found to be feasible to deliver and improved dietitians’ mHealth app self-efficacy. There is translational potential for this intervention to equip the profession with greater capability, opportunity, motivation and self-efficacy to use mHealth apps in dietetic practice and in patient nutrition care

Precision medicine in the era of artificial intelligence: implications in chronic disease management.

Aberrant metabolism is the root cause of several serious health issues, creating a huge burden to health and leading to diminished life expectancy. A dysregulated metabolism induces the secretion of several molecules which in turn trigger the inflammatory pathway. Inflammation is the natural reaction of the immune system to a variety of stimuli, such as pathogens, damaged cells, and harmful substances. Metabolically triggered inflammation, also called metaflammation or low-grade chronic inflammation, is the consequence of a synergic interaction between the host and the exposome-a combination of environmental drivers, including diet, lifestyle, pollutants and other factors throughout the life span of an individual. Various levels of chronic inflammation are associated with several lifestyle-related diseases such as diabetes, obesity, metabolic associated fatty liver disease (MAFLD), cancers, cardiovascular disorders (CVDs), autoimmune diseases, and chronic lung diseases. Chronic diseases are a growing concern worldwide, placing a heavy burden on individuals, families, governments, and health-care systems. New strategies are needed to empower communities worldwide to prevent and treat these diseases. Precision medicine provides a model for the next generation of lifestyle modification. This will capitalize on the dynamic interaction between an individual's biology, lifestyle, behavior, and environment. The aim of precision medicine is to design and improve diagnosis, therapeutics and prognostication through the use of large complex datasets that incorporate individual gene, function, and environmental variations. The implementation of high-performance computing (HPC) and artificial intelligence (AI) can predict risks with greater accuracy based on available multidimensional clinical and biological datasets. AI-powered precision medicine provides clinicians with an opportunity to specifically tailor early interventions to each individual. In this article, we discuss the strengths and limitations of existing and evolving recent, data-driven technologies, such as AI, in preventing, treating and reversing lifestyle-related diseases

Advancement in Dietary Assessment and Self-Monitoring Using Technology

Although methods to assess or self-monitor intake may be considered similar, the intended function of each is quite distinct. For the assessment of dietary intake, methods aim to measure food and nutrient intake and/or to derive dietary patterns for determining diet-disease relationships, population surveillance or the effectiveness of interventions. In comparison, dietary self-monitoring primarily aims to create awareness of and reinforce individual eating behaviours, in addition to tracking foods consumed. Advancements in the capabilities of technologies, such as smartphones and wearable devices, have enhanced the collection, analysis and interpretation of dietary intake data in both contexts. This Special Issue invites submissions on the use of novel technology-based approaches for the assessment of food and/or nutrient intake and for self-monitoring eating behaviours. Submissions may document any part of the development and evaluation of the technology-based approaches. Examples may include: web adaption of existing dietary assessment or self-monitoring tools (e.g., food frequency questionnaires, screeners) image-based or image-assisted methods mobile/smartphone applications for capturing intake for assessment or self-monitoring wearable cameras to record dietary intake or eating behaviours body sensors to measure eating behaviours and/or dietary intake use of technology-based methods to complement aspects of traditional dietary assessment or self-monitoring, such as portion size estimation