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• W3155710033 abstract "The rising prevalence of noncommunicable diseases (NCDs) is a global public health concern.1Mozaffarian D. Benjamin E.J. Go A.S. et al.Heart disease and stroke statistics—2015 update: a report from the American Heart Association.Circulation. 2015; 131: e29-e322Crossref PubMed Scopus (5889) Google Scholar,2Pescatello L.S. MacDonald H.V. Lamberti L. Johnson B.T. Exercise for hypertension: a prescription update integrating existing recommendations with emerging research.Curr Hypertens Rep. 2015; 17: 87Crossref PubMed Scopus (234) Google Scholar Unhealthy eating habits and physical inactivity increase the risk or severity of major NCDs such as obesity, coronary heart disease, diabetes mellitus, osteoarthritis, some cancers, and depression.3Dietz W.H. Douglas C.E. Brownson R.C. Chronic disease prevention: tobacco avoidance, physical activity, and nutrition for a healthy start.JAMA. 2016; 316: 1645-1646Crossref PubMed Scopus (65) Google Scholar, 4Penninx B.W. Leveille S. Ferrucci L. van Eijk J.T. Guralnik J.M. Exploring the effect of depression on physical disability: longitudinal evidence from the established populations for epidemiologic studies of the elderly.Am J Public Health. 1999; 89: 1346-1352Crossref PubMed Scopus (461) Google Scholar, 5Scarmeas N. Luchsinger J.A. Schupf N. et al.Physical activity, diet, and risk of Alzheimer disease.JAMA. 2009; 302: 627-637Crossref PubMed Scopus (686) Google Scholar Primary prevention or treatments to combat NCDs include the adoption of a healthy diet without energy excess, routine physical activity, reducing sedentary time, and maintenance of a healthy body weight.6Arena R. Guazzi M. Lianov L. et al.Healthy lifestyle interventions to combat noncommunicable disease: a novel nonhierarchical connectivity model for key stakeholders: a policy statement from the American Heart Association, European Society of Cardiology, European Association for Cardiovascular Prevention and Rehabilitation, and American College of Preventive Medicine.Eur Heart J. 2015; 36: 2097-2109Crossref PubMed Scopus (96) Google Scholar Technological innovations, such as digital measurement of DI and PA, have become widely accepted and are increasingly used to assess and monitor lifestyle behavior. Recently, the need for physical distancing because of the outbreak of the novel coronavirus (COVID-19), has revealed an additional urgent and dynamic use of valid and reliable technology in health care. Providers aspire that digital tools and telehealth platforms will help them to continue to provide health care even when face-to-face interactions with clients are imprudent or impossible. Delivering nutrition care in a framework of telenutrition continues to grow as the health care environment evolves and adapts.7Peregrin T. Telehealth is transforming health care: what you need to know to practice telenutrition.J Acad Nutr Diet. 2019; 119: 1916-1920Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar,8Ventura Marra M. Lilly C.L. Nelson K.R. Woofter D.R. Malone J. A pilot randomized controlled trial of a telenutrition weight loss intervention in middle-aged and older men with multiple risk factors for cardiovascular disease.Nutrients. 2019; 11Crossref Scopus (27) Google Scholar However, whether increased demand for telenutrition will be supported by insurance coverage remains to be determined. Therefore, building a structure for the appropriate use of technology is vital to provide effective nutrition care in the COVID-19 era.9Mehta P. Stahl M.G. Germone M.M. et al.Telehealth and nutrition support during the COVID-19 pandemic.J Acad Nutr Diet. 2020; 120: 1953-1957Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar While taking into account Standards of Practice and Standards of Professional Performance,10Academy of Nutrition and DieteticsRevised 2017 Standards of practice in nutrition care and standards of professional performance for registered dietitian nutritionists.J Acad Nutr Diet. 2018; 118: 132-140Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar,11Academy of Nutrition and DieteticsRevised 2017 standards of practice in nutrition care and standards of professional performance for nutrition and dietetics technicians, registered.J Acad Nutr Diet. 2018; 118: 317-326Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar Registered Dietitians and Nutritionists (RDNs) and Nutrition and Dietetics Technicians, Registered (NDTRs), are uniquely positioned to play an active role in the development, use, and evaluation of DI and PA related technology for Medical Nutrition Therapy (MNT).12Hamideh D. Arellano B. Topol E.J. Steinhubl S.R. Your digital nutritionist.Lancet. 2019; 393: 19Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar This type of work is part of the practice area of nutrition informatics. Today, health care providers can transition from paper to digital-based tools for many measurement tasks. The explosion of mobile applications and wearables allows individual consumers to self-monitor their DI/PA, for their own purposes or for sharing data with their providers for subsequent evaluation and feedback.12Hamideh D. Arellano B. Topol E.J. Steinhubl S.R. Your digital nutritionist.Lancet. 2019; 393: 19Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar In 2018, it was estimated that there were more than 160,000 mobile health applications to track DI/ PA patterns, and over $500 million was spent on these applications.13Grundy Q.H. Wang Z. Bero L.A. Challenges in assessing mobile health app quality: a systematic review of prevalent and innovative methods.Am J Prev Med. 2016; 51: 1051-1059Abstract Full Text Full Text PDF PubMed Scopus (111) Google Scholar The possibilities are endless. Software and application designers are focused on merging the needs of diverse users, providers, and consumers. For clinical researchers, the potential of big data aggregation and data mining hold promise and excitement in generating more accurate DI/PA captures of “point-in-time” and in developing more viable interventions with long-term benefits. In contrast, most consumers’ use of DI/PA technologies is aimed at self-monitoring, related to personal evaluation or awareness to maintain or change their specific behaviors.14Burrows T.L. Rollo M.E. Advancement in dietary assessment and self-monitoring using technology.Nutrients. 2019; 11Crossref Scopus (6) Google Scholar The technology should theoretically improve the efficiency and quality of data collection and facilitate attainment of all of these goals, and yet many questions remain about their use and acceptability. For example, because DI/PA assessment methods are often criticized as being inaccurate and imprecise, are the data from these new tools any more accurate?15McClung H.L. Ptomey L.T. Shook R.P. et al.Dietary intake and physical activity assessment: current tools, techniques, and technologies for use in adult populations.Am J Prev Med. 2018; 55: e93-e104Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar Which tools are well-validated? Are there technologies that are available and appropriate for different populations, such as those of different ages or of different functional or cognitive capacities? Who owns the individual’s or group’s data once aggregated? What are the ethical/regulatory framework and steps needed to ensure anonymity and privacy? It is important to be aware of these factors when evaluating digital tools. A research priority of the Academy’s Research International and Scientific Affairs team is to support utility and application of emerging technologies, information management and knowledge management, processes to inform and advance nutrition and dietetics programming and practice. In this paper, the Academy’s Research International and Scientific Affairs Data Science Center and the International Life Sciences Institute North America’s (now the Institute for the Advancement of Food and Nutrition Sciences) working group on dietary intake and physical activity tools present essential information and perspectives on digital dietary intake (DI)/physical activity (PA) measurement tools. The goal is to provide emerging definitions used to describe digital technology in DI and PA measurement. Second, we describe factors to consider when evaluating DI/PA measurement technology products as part of nutrition care. Finally, we delineate the outlook of digital DI/PA technology. Many terms are used to describe the intersection of health and technology. The World Health Organization has provided a large and detailed taxonomy of intervention terms for Digital Health.16World Health OrganizationClassification of Digital Health Interventions v1. 0: A Shared Language to Describe the Uses of Digital Technology for Health. World Health Organization, 2018Google Scholar Terms and definitions targeted to nutrition and dietetics professionals are provided below and in Figure 1.Figure 1Health care technology measurement definitions. FDA = Food and Drug Administration, RDN = Registered Dietitian Nutritionist.TermDefinitionApplications (apps)Mobile applications used on a smart phone, tablet, or computerConnected products70Trials Transformation Initiative. Digital Health Technologies.https://www.ctti-clinicaltrials.org/projects/digital-health-technologiesGoogle ScholarMobile technologies, wearables, ingestibles, implantables, and portable technologies with sensors for data collectionDevices71U.S. Food and Drug Administrationhttps://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/denovo.cfm?ID=DEN180044Google ScholarA subset of lifestyle technology products with successful FDA approval for safety and effectivenessDigital health18U.S. Food and Drug AdministrationDigital Health. 2020.https://www.fda.gov/medical-devices/digital-healthGoogle ScholarHealth technology products that do not require validity or efficacy or regulatory oversightDigital medicine19Goldsack J. Laying the foundation: defining digital medicine. Medium. 2019.https://medium.com/digital-medicine-society-dime/laying-the-foundation-defining-digital-medicine-49ab7b6ab6efGoogle ScholarHealth technology products used for measurement/intervention that are supported by evidence to demonstrate quality and validityDigital therapeutics20Digital Therapeutics AllianceDigital therapeutics: how they relate to digital health.https://dtxalliance.org/wp-content/uploads/2019/05/DTA_TheDigitalHealthLandscape.pdfGoogle ScholarEvidence-based health technology products that deliver a health intervention and have been reviewed or certified by a regulatory bodyHealth information technology (HIT)72The Office of the National Coordinator for Health Information Technology (ONC). 2017.https://www.healthit.gov/topic/health-it-basics/glossaryGoogle ScholarElectronic medical records and related information systemsImage-based assessment73Gemming L. Utter J. Ni Mhurchu C. Image-assisted dietary assessment: a systematic review of the evidence.J Acad Nutr Diet. 2015; 115: 64-77Abstract Full Text Full Text PDF PubMed Scopus (159) Google ScholarTools that rely solely on images using a camera-enabled smart phone, tablet, or computer to log food or activityImage-assisted assessment73Gemming L. Utter J. Ni Mhurchu C. Image-assisted dietary assessment: a systematic review of the evidence.J Acad Nutr Diet. 2015; 115: 64-77Abstract Full Text Full Text PDF PubMed Scopus (159) Google ScholarUse of images in combination with another assessment method (eg, photos to supplement a written record or to proceed an oral recall in the office)Telehealth or telemedicine74Academy of Nutrition and Dietetics.https://www.eatrightpro.org/practice/practice-resources/telehealth/practicing-telehealthGoogle ScholarUse of electronic information and telecommunication technologies to deliver and support long-distance clinical health care, patient- and professional health-related education, public health, and health administrationTelenutrition74Academy of Nutrition and Dietetics.https://www.eatrightpro.org/practice/practice-resources/telehealth/practicing-telehealthGoogle ScholarThe interactive use, by an RDN, of electronic information and telecommunication technologies to implement the Nutrition Care Process with clients at a remote location (within provisions of their state licensure)Wearable technologyGeneral term for body-worn sensors capable of tracking location, time, environment, motion, and certain body measures (eg, blood glucose, etc.)Web-based assessmentTool requiring internet connection to log food or activity; often “cloud-based” data source Open table in a new tab A good starting point is a consensus framework proposed by four organizations in the field of digital health: the Digital Medicine Society, Digital Therapeutics Alliance, HealthXL, and Health Network of Digital Evidence in Health.17Goldsack J. Coder M. Fitzgerald C. Navar-Mattingly N. Coravos A. Atreja A. Digital health, digital medicine, digital therapeutics (DTx): what’s the difference? 2019. Medium.https://medium.com/digital-medicine-society-dime/digital-health-digital-medicine-digital-therapeutics-dtx-whats-the-difference-92344420c4d5Google Scholar The framework differentiates between products with different levels of clinical evidence, and degree of regulatory oversight. It classifies all types of digital health tools in three major categories: digital health, digital medicine, and digital therapeutics (Figure 2). Digital health is very broad and includes all categories of health technology products such as mobile health (mHealth), health information technology, wearables, telehealth, and personalized health.18U.S. Food and Drug AdministrationDigital Health. 2020.https://www.fda.gov/medical-devices/digital-healthGoogle Scholar This category of products includes all applications that can be found in smart phone “app stores.” Digital health products do not require evidence and do not require regulatory oversight (Figure 2).17Goldsack J. Coder M. Fitzgerald C. Navar-Mattingly N. Coravos A. Atreja A. Digital health, digital medicine, digital therapeutics (DTx): what’s the difference? 2019. Medium.https://medium.com/digital-medicine-society-dime/digital-health-digital-medicine-digital-therapeutics-dtx-whats-the-difference-92344420c4d5Google Scholar Digital medicine is a subset of digital health (Figure 2). The main difference between digital health and digital medicine is that digital medicine products must be backed by clinical evidence.17Goldsack J. Coder M. Fitzgerald C. Navar-Mattingly N. Coravos A. Atreja A. Digital health, digital medicine, digital therapeutics (DTx): what’s the difference? 2019. Medium.https://medium.com/digital-medicine-society-dime/digital-health-digital-medicine-digital-therapeutics-dtx-whats-the-difference-92344420c4d5Google Scholar,19Goldsack J. Laying the foundation: defining digital medicine. Medium. 2019.https://medium.com/digital-medicine-society-dime/laying-the-foundation-defining-digital-medicine-49ab7b6ab6efGoogle Scholar Digital medicine products are used for measurements or interventions aiming at health promotion, disease prevention, treatment, or recovery. Digital therapeutics is a subset of digital medicine (Figure 2), because not all digital medicine products deliver an intervention. Digital therapeutics is defined as an evidence-based health technology product that delivers a health intervention and has been reviewed or certified by a regulatory body (most commonly the Food and Drug Administration [FDA]) for safety.17Goldsack J. Coder M. Fitzgerald C. Navar-Mattingly N. Coravos A. Atreja A. Digital health, digital medicine, digital therapeutics (DTx): what’s the difference? 2019. Medium.https://medium.com/digital-medicine-society-dime/digital-health-digital-medicine-digital-therapeutics-dtx-whats-the-difference-92344420c4d5Google Scholar,20Digital Therapeutics AllianceDigital therapeutics: how they relate to digital health.https://dtxalliance.org/wp-content/uploads/2019/05/DTA_TheDigitalHealthLandscape.pdfGoogle Scholar Clinical evidence is required that demonstrates the products’ high quality and validity, for products to be classified as digital medicine or therapeutics. Thus, it is reasonable to ask: What type, amount, and caliber of evidence is required for a health technology product to qualify as a digital medicine or therapeutic product? There are no established or widely agreed-on criteria. Nutrition and dietetics professionals are encouraged to learn how and what digital tools to use and to conduct research demonstrating how digital tools complement MNT and improve health outcomes. These data are vital to support successful value-based reimbursements, especially as we navigate the COVID-19 era, in which effective use of technology may be integral in positive client outcomes and the future of the dietetics profession. Recently, an easy-to-administer tool on self-efficacy with using mobile health applications in dietetics practice was validated.21Chen J. Allman-Farinelli M. Development and validation of a tool to measure dietitians' self-efficacy with using mobile health apps in dietetic practice.J Nutr Educ Behav. 2018; 50: 468-475Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar This tool may be a good place for the RDN to start a self-assessment exercise.21Chen J. Allman-Farinelli M. Development and validation of a tool to measure dietitians' self-efficacy with using mobile health apps in dietetic practice.J Nutr Educ Behav. 2018; 50: 468-475Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar A later section focuses on choosing the best connected product, to provide guidance and reasoning in the selection process. Digital technologies for DI/PA measurements are frequently described by the technology type used, and these may include online websites, mobile applications, camera-based tools, wearable products, and others (Figure 1). The definitions that follow explain frequently used terms. “Wearable technology” is any electronic product that can be worn as an accessory on the user’s body, embedded in clothes, implanted, or tattooed on the skin, typically to track information related to health and fitness (Figure 1). Common examples include step counters—smart jewelry such as rings, wristbands, watches, or pins. Smaller wearable technology typically connects wirelessly with a smartphone application for display and interaction. This term is not comprehensive because there are other technology products such as portable monitors, ingestibles, and so forth that are not necessarily worn on the body. “Device” is a “term of art,” that is, a word with specific legal meaning used by the FDA. The term device refers to a small subset of lifestyle technology products approved by the FDA for a specific intended function (Figure 1). Whether a product is a “device” depends primarily on the product’s intended function as determined by the FDA’s Center for Drug Evaluation and Research’s review process. A product may be called a device once it has undergone successful FDA approval for safety and effectiveness. The FDA approval process is voluntary for manufacturers, but when it is successful, it works in the manufacturer’s best interest, because then the manufacturer can make claims about the product’s intended use.22U.S. Food and Drug AdministrationDevice Classification Under Section 513(f)(2)(De Novo).https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/denovo.cfm?ID=DEN180044Google Scholar Claims can cover disease treatment (digital therapeutics that deliver a medical intervention to treat a disease), disease management (digital therapeutics that deliver a medical intervention to manage a disease), or improving a health function (digital therapeutics that deliver a medical intervention to improve a health function or prevent a disease). Connected products are those with a real-world function that are connected to the internet to transmit data or are controlled remotely. This comprehensive term includes mobile technologies, wearables, ingestibles, implantables, and portable technologies that have sensors (Internet of Things) for the collection of outcomes data (Figure 1). Connected products can connect with each other and with other systems via the internet, and they can share data about themselves, their environment, and their users. The range of connected products is ever expanding, from cars to medical equipment (such as continuous glucose monitors), industrial machinery, and even packaging that is capable of reporting the location and condition of packaged food or other commodities. Instead of episodic measures collected at client visits, connected products provide the practitioner with longitudinal, and potentially more comprehensive, “real world” datasets for DI/PA, which the Clinical Trials Transformation Initiative and other expert groups consider to be more valuable.23Clinical Trials Transformation Initiative. Recommendations Executive Summary: Advancing the Use of Mobile Technologies for Data Capture & Improved Clinical Trials. In: Clinical Trials Transformation Initiative, ed, 2021. https://www.ctti-clinicaltrials.org/sites/www.ctti-clinicaltrials.org/files/mobile-technologies-executive-summary.pdf. Accessed March 29, 2021.Google Scholar Connected products may create a digital virtual “twin” of the client that captures data that historically have been difficult to collect. Intermittent collection of 24-hour dietary recalls or food records provide single or only a few representations of DI, whereas a connected product may potentially record DI around the clock for long periods. Such around-the-clock monitoring provides a more accurate picture of the targeted behavior in the client’s life and greater awareness of it. Conventional 24-hour dietary recalls and food records are frequently criticized for inaccuracy.24Archer E. The use of implausible data without caveats is misleading.Am J Clin Nutr. 2017; 106: 949-950PubMed Scopus (12) Google Scholar,25Subar A.F. Freedman L.S. Tooze J.A. et al.Addressing current criticism regarding the value of self-report dietary data.J Nutr. 2015; 145: 2639-2645Crossref PubMed Scopus (652) Google Scholar Some studies suggest that data capture by digital means are more complete. For example, an online 24-hour dietary recall (myfood24) for dietary assessment provided higher-quality DI data than standard interviews when compared with biomarkers.26Wark P.A. Hardie L.J. Frost G.S. et al.Validity of an online 24-h recall tool (myfood24) for dietary assessment in population studies: comparison with biomarkers and standard interviews.BMC Med. 2018; 16: 136Crossref PubMed Scopus (61) Google Scholar Furthermore, an electronic 12-hour dietary recall was superior in assessing DI than either a food frequency questionnaire or 4-day food records.27Bejar L.M. Reyes O.A. Garcia-Perea M.D. Electronic 12-hour dietary recall (e-12HR): comparison of a mobile phone app for dietary intake assessment with a food frequency questionnaire and four dietary records.JMIR Mhealth Uhealth. 2018; 6e10409Crossref PubMed Scopus (14) Google Scholar In energy expenditure, the reference standard method is indirect calorimetry, which is not easy to use routinely in clinical care. Also, with inpatient energy estimates using visual estimation of food amounts eaten, there is a high probability for human error. There are different validated connected products that provide a practical alternative to indirect calorimetry and inpatient energy estimates for different populations.28Elbelt U. Haas V. Hofmann T. et al.Evaluation of a portable armband device to assess resting energy expenditure in patients with anorexia nervosa.Nutr Clin Pract. 2016; 31: 362-367Crossref PubMed Scopus (4) Google Scholar, 29Hughes M.J. Harrison E.M. Wigmore S.J. Energy expenditure after liver resection: validation of a mobile device for estimating resting energy expenditure and an investigation of energy expenditure change after liver resection.JPEN J Parenter Enteral Nutr. 2017; 41: 766-775Crossref PubMed Scopus (9) Google Scholar, 30Koehler K. Drenowatz C. Monitoring energy expenditure using a multi-sensor device-applications and limitations of the sensewear armband in athletic populations.Front Physiol. 2017; 8: 983Crossref PubMed Scopus (24) Google Scholar, 31Ofei K.T. Mikkelsen B.E. Scheller R.A. Validation of a novel image-weighed technique for monitoring food intake and estimation of portion size in hospital settings: a pilot study.Public Health Nutr. 2019; 22: 1203-1208PubMed Google Scholar Digital tools may have a beneficial impact on health-related interventions, particularly in the areas of self-monitoring of DI/PA. However, to be effective, these tools must keep track of the user’s progress toward achieving the targeted DI/PA goals, improve adherence to the targeted behavior while minimizing respondent burden. Self-monitoring of DI/PA are important components of lifestyle interventions such as treatment of overweight and obesity. A systematic review on self-monitoring of DI/PA during weight loss interventions described the efficacy of self-monitoring on weight loss (primarily paper-based tools used).32Burke L.E. Wang J. Sevick M.A. Self-monitoring in weight loss: a systematic review of the literature.J Am Diet Assoc. 2011; 111: 92-102Abstract Full Text Full Text PDF PubMed Scopus (805) Google Scholar In that review, 22 studies were included, with 15 reporting on self-monitoring of DI, one reporting on self-monitoring of PA, and six reporting on self-weighing and weight loss. For DI self-monitoring, all 15 studies reported a significant relation between self-monitoring and weight loss. Of the studies examined, four explored the quality of DI self-monitoring that was associated with weight loss. More comprehensive self-monitoring (ie, captured more eating occasions throughout the day) and regular self-monitoring (ie, more days of the week) was related to a greater weight loss.32Burke L.E. Wang J. Sevick M.A. Self-monitoring in weight loss: a systematic review of the literature.J Am Diet Assoc. 2011; 111: 92-102Abstract Full Text Full Text PDF PubMed Scopus (805) Google Scholar Related, Carels et al33Carels R.A. Darby L.A. Rydin S. Douglass O.M. Cacciapaglia H.M. O’Brien W.H. The relationship between self-monitoring, outcome expectancies, difficulties with eating and exercise, and physical activity and weight loss treatment outcomes.Ann Behav Med. 2005; 30: 182-190Crossref PubMed Scopus (95) Google Scholar investigated self-monitoring of PA (paper-based) and also reported that greater self-monitoring was associated with higher frequency of PA (r = 0.52, P < 0.01) and greater weight loss (r = 0.44, P < 0.05).33Carels R.A. Darby L.A. Rydin S. Douglass O.M. Cacciapaglia H.M. O’Brien W.H. The relationship between self-monitoring, outcome expectancies, difficulties with eating and exercise, and physical activity and weight loss treatment outcomes.Ann Behav Med. 2005; 30: 182-190Crossref PubMed Scopus (95) Google Scholar With respect to the integration of technology into lifestyle interventions, the impact on enhancing self-monitoring of DI was directly examined within a 24-month weight loss trial.34Burke L.E. Styn M.A. Sereika S.M. et al.Using mHealth technology to enhance self-monitoring for weight loss: a randomized trial.Am J Prev Med. 2012; 43: 20-26Abstract Full Text Full Text PDF PubMed Scopus (219) Google Scholar Paper-based self-monitoring was compared with self-monitoring on a personal digital assistant (PDA) in 210 adults. Although the PDA was not connected to the internet, the Dietmate Pro software had automated capabilities to calculate DI for energy and nutrients consumed for point-in-time diet self-monitoring. Investigators compared three conditions, paper diary, PDA, and PDA+feedback (FB). In PDA+FB, additional feedback software was used to interact with Dietmate Pro via a custom algorithm to provide tailored daily messages to the participant concerning DI in relation to dietary goals. Although there was no significant difference in weight loss between the conditions at 24 months, those who self-monitored with the PDA (PDA and PDA+FB combined) had significantly better adherence to self-monitoring (defined as the percentage of days that at least 50% of the daily energy goal was recorded) than the paper diary condition. Across all participants, better adherence to self-monitoring was significantly related to greater weight loss (P < 0.001). A weight loss of at least 10% was measured for those with ≥60% self-monitoring adherence regardless of intervention tool used. More technological advances in dietary self-monitoring have occurred since then. However, few researchers have examined the efficacy of technology-based dietary self-monitoring vs paper-based dietary self-monitoring on weight loss outcomes. Because self-monitoring with paper-based systems is known to have flaws, it has often been assumed that real-time technology-based dietary self-monitoring will address some issues by invariably enhancing outcomes compared with paper-based dietary self-monitoring.32Burke L.E. Wang J. Sevick M.A. Self-monitoring in weight loss: a systematic review of the literature.J Am Diet Assoc. 2011; 111: 92-102Abstract Full Text Full Text PDF PubMed Scopus (805) Google Scholar,35Burke L.E. Sereika S.M. Music E. Warziski M. Styn M.A. Stone A. Using instrumented paper diaries to document self-monitoring patterns in weight loss.Contemp Clin Trials. 2008; 29: 182-193Abstract Full Text Full Text PDF PubMed Scopus (104) Google Scholar Therefore, there has been more research on which components of technology-based dietary tools should be used to enhance self-monitoring adherence and weight loss outcomes. Mobile applications provide various electronic forms and interfaces to assist in logging DI (ie, text, photos) with cap" @default.
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• W3155710033 title "A Primer for the Evaluation and Integration of Dietary Intake and Physical Activity Digital Measurement Tools into Nutrition and Dietetics Practice" @default.
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