Behavioral Nutrition Intervention Research Articles

Evaluating feasibility, acceptability, and effectiveness of a digital behavioral nutrition intervention in cystic fibrosis care.

Evaluating feasibility, acceptability, and effectiveness of a digital behavioral nutrition intervention in cystic fibrosis care.

Supplemental Material for Evaluating Feasibility, Acceptability, and Effectiveness of a Digital Behavioral Nutrition Intervention in Cystic Fibrosis Care

Supplemental Material for Evaluating Feasibility, Acceptability, and Effectiveness of a Digital Behavioral Nutrition Intervention in Cystic Fibrosis Care

Differences in dietary acceptability, restraint, disinhibition, and hunger among African American participants randomized to either a vegan or omnivorous soul food diet

The Nutritious Eating with Soul study was a 24-month, randomized behavioral nutrition intervention among African American adults. This present study, which is a secondary analysis of the NEW Soul study, examined changes in dietary acceptability, restraint, disinhibition, and hunger. Participants (n = 159; 79% female, 74% with ≥ college degree, mean age 48.4 y) were randomized to either a soul food vegan (n = 77) or soul food omnivorous (n = 82) diet and participated in a two-year behavioral nutrition intervention. Questionnaires assessing dietary acceptability (Food Acceptability Questionnaire; FAQ) and dietary restraint, disinhibition, and hunger (Three-Factor Eating Questionnaire; TFEQ) were completed at baseline, 3, 6, 12, and 24 months. Mixed models were specified with main effects (group and time) and interaction effects (group by time) to estimate mean differences in FAQ and TFEQ scores using intent-to-treat analysis. After adjusting for employment, education, food security status, sex, and age, there were no differences in any of the FAQ items, total FAQ score, dietary restraint, disinhibition, and hunger at any timepoint except for one item of the FAQ at 12 months. Participants in the vegan group reported a greater increase in satisfaction after eating a meal than the omnivorous group (mean difference 0.80 ± 0.32, 95% CI 0.18, 1.42; P = 0.01). This is one of the first studies to examine differences in dietary acceptability, hunger, and other eating factors among African American adults randomized to either a vegan or omnivorous soul food diet. The findings highlight that plant-based eating styles are equally acceptable to omnivorous eating patterns and have similar changes in hunger, restraint, and disinhibition. These results suggest that plant-based eating styles can be an acceptable dietary pattern to recommend for cardiovascular disease prevention and may result in greater post-meal satisfaction.

Supporting optimal dietary behaviors in women with perinatal depression: A qualitative exploration of experiences, practices, and challenges.

Women with perinatal depression (PD) are at high risk for unhealthy dietary behaviors and suboptimal child feeding practices. Despite evidence supporting the importance of healthful nutrition-related behaviors during and after pregnancy, few behavioral nutrition interventions for women with PD have been developed. The objectives of this study were to identify nutrition-related challenges and needs among women with PD and to elucidate the role that feeding plays in mother-infant interaction, to inform the development of nutrition interventions. Using a qualitative study design, in-depth interviews were conducted with 18 mothers with a history of PD and 10 interdisciplinary healthcare providers with expertise in PD. Data were thematically analyzed using a hybrid inductive and deductive coding approach. Mean age of mothers was 31 ± 6 years, 56% identified as non-Hispanic White, and 33% identified as Black/African American. Eighty percent of healthcare providers practiced for more than five years. Six themes were identified: (a) Time scarcity mindset; (b) Importance of social support; (c) Unrealistic expectations of motherhood; (d) Mom as the last priority; (e) Postpartum body changes and shape ideals; and (f) Contentment associated with infant and young child feeding. Women with PD have several needs pertaining to their nutrition and that of their children. The findings from this study illustrate key considerations and recommendations for addressing these needs.

Diurnal transcriptome landscape of a multi-tissue response to time-restricted feeding in mammals

Time-restricted feeding (TRF) is an emerging behavioral nutrition intervention that involves a daily cycle of feeding and fasting. In both animals and humans, TRF has pleiotropic health benefits that arise from multiple organ systems, yet the molecular basis of TRF-mediated benefits is not well understood. Here, we subjected mice to isocaloric ad libitum feeding (ALF) or TRF of a western diet and examined gene expression changes in samples taken from 22 organs and brain regions collected every 2h over a 24-h period. We discovered that TRF profoundly impacts gene expression. Nearly 80% of all genes show differential expression or rhythmicity under TRF in at least one tissue. Functional annotation of these changes revealed tissue- and pathway-specific impacts of TRF. These findings and resources provide a critical foundation for future mechanistic studies and will help to guide human time-restricted eating (TRE) interventions to treat various disease conditions with or without pharmacotherapies.

Nutrition-Related Challenges and Needs of Women With Perinatal Depression: Perspectives of Women With Perinatal Depression and Healthcare Providers

ObjectivesWomen with perinatal depression (WWPD) are at high risk for unhealthy dietary behaviors and suboptimal child feeding practices. Despite mounting evidence supporting the importance of healthful nutrition-related behaviors during and after pregnancy, few behavioral nutrition interventions for WWPDs have been developed. The objectives of this study were to identify nutrition-related challenges and needs among WWPD, and to elucidate the role that feeding plays in mother-infant interaction.MethodsUsing a qualitative research design, in-depth interviews were conducted with 18 WWPDs and 10 healthcare professionals (HCPs) who work with WWPD. Interviews were audio recorded and transcribed verbatim. Data was thematically analyzed. Transcripts were coded by two research team members and a third member ensured accuracy and resolved discrepancies. Deductive and inductive coding was performed, and codes were refined and subsequently organized into themes.ResultsWWPD had a mean age of 31 ± 6 years and between 2–4 children. 89% reported college-level education, 56% were non-Hispanic white, and 33% were Black/African American. HCPs were in various specialties related to maternal mental health; 80% had practiced for > 5years. Seven themes with up to three subthemes were identified from interviews with HCPs and WWPDs: 1) Prioritizing mom - institutional and personal; 2) Scarce resources; 3) Body changes - body image and appetite; 4) Importance of support - source of affirmation and greater reliance; 5) Sense of fulfilment associated with infant and young child feeding - bonding and pride; 6) Challenges with breastfeeding - difficult experiences and need for liberalizing recommendations; and 7) Great expectations of motherhood - guilt and shame, overwhelm, and high anxiety.ConclusionsWWPD face several barriers to their own healthful nutrition and that of their children, and findings from this study illustrate key considerations for tailoring dietary guidance to meet the unique needs of WWPD. Further, a person-centered approach for breastfeeding guidance is recommended.Funding SourcesDrexel University College of Nursing and Health Professions, Dean's Rapid Response Relevant (R3) Grant.

Personalized Behavioral Nutrition Among Older Asian Americans: Study Protocol.

Metabolomics profiling is an objective assessment of metabolic responses to intricate dietary patterns. However, few studies have investigated the potential benefits associated with personalized behavioral nutrition (PBN) interventions incorporating the metabolomics approach for improving diabetes outcomes for older Asian Americans with Type 2 diabetes. This article describes the protocol for a pilot study testing self-management of a nutrition intervention-provided personalized dietary advice incorporating metabolites phenotypic feedback and digital self-monitoring of diet and blood glucose. A total of 60 older Asian Americans will be randomized into two groups: a PBN group and a control group. Participants in the PBN group will receive personalized dietary advice based on dietary and phenotypic feedback-used metabolic profiles. This study aims to examine the feasibility and preliminary effects of the PBN on diabetes outcomes. The study began in September 2020, with estimated complete data collection by late 2021. Findings from this pilot study will inform future research for developing personalized nutrition interventions for people with Type 2 diabetes.

Dietary Approaches to Stop Hypertension Dietary Intervention Improves Blood Pressure and Vascular Health in Youth With Elevated Blood Pressure.

This randomized control trial assessed the post-intervention and 18-month follow-up effects of a 6-month dietary approaches to stop hypertension (DASH)-focused behavioral nutrition intervention, initiated in clinic with subsequent telephone and mail contact, on blood pressure (BP) and endothelial function in adolescents with elevated BP. Adolescents (n=159) 11 to 18 years of age with newly diagnosed elevated BP or stage 1 hypertension treated at a hospital-based clinic were randomized. DASH participants received a take-home manual plus 2 face-to-face counseling sessions at baseline and 3 months with a dietitian regarding the DASH diet, 6 monthly mailings, and 8 weekly and then 7 biweekly telephone calls focused on behavioral strategies to promote DASH adherence. Routine care participants received nutrition counseling with a dietitian consistent with pediatric guidelines established by the National High Blood Pressure Education Program. Outcomes, measured pre- and post-intervention and at 18-months follow-up, included change in BP, change in brachial artery flow-mediated dilation, and change in DASH score based on 3-day diet recalls. Adolescents in DASH versus routine care had a greater improvement in systolic BP (-2.7 mm Hg, P= 0.03, -0.3 z-score, P=0.03), flow-mediated dilation (2.5%, P=0.05), and DASH score (13.3 points, P<0.0001) from baseline to post-treatment and a greater improvement in flow-mediated dilation (3.1%, P=0.03) and DASH score (7.4 points, P=0.01) to 18 months. The DASH intervention proved more effective than routine care in initial systolic BP improvement and longer term improvement in endothelial function and diet quality in adolescents with elevated BP and hypertension. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00585832.

The Nutritious Eating with Soul (NEW Soul) Study: Study design and methods of a two-year randomized trial comparing culturally adapted soul food vegan vs. omnivorous diets among African American adults at risk for heart disease

BackgroundPrevious research has found that African American (AA) vegetarians/vegans have a significantly lower body mass index and risk of hypertension compared to omnivores. ObjectivesThe Nutritious Eating with Soul (NEW Soul) study partnered with local soul food restaurants/chefs to deliver two behavioral nutrition interventions to AA adults. NEW Soul examines the impact of two different culturally tailored diets (vegan and omnivorous low-fat) on changes in risk factors for cardiovascular disease (CVD). MethodsAA adults with overweight or obesity are recruited from the community in the Midlands of South Carolina. Eligible participants are randomized to follow one of two different culturally-adapted, soul food diets: a vegan diet emphasizing minimally-processed whole foods from plants or a low-fat omnivorous diet. Participants attend weekly group classes for the first six months, bi-weekly for the next six months, and monthly meetings for the last year. In addition to face-to-face content, participants also have access to private Facebook groups for their diet, podcasts, and online newsletters starting at six months. Primary outcomes include changes in body weight and CVD risk factors (lipids, blood pressure, glucose, and insulin) at 12 months. Secondary outcomes include changes in dietary intake. Participants complete assessments at baseline and at months 6, 12, and 24. ConclusionsThe NEW Soul study is an innovative intervention aimed at improving dietary intake while maintaining traditional AA cultural food choices. Primary outcomes are expected by 2021.

Using Ethnographic Data for Tailoring Social and Behavioral Nutrition Interventions

Using Ethnographic Data for Tailoring Social and Behavioral Nutrition Interventions

Interventions for Dietary Sodium Restriction Among Patients with Heart Failure: A Mismatch in the Evidence and Intervention Design (OR22-05-19)

ObjectivesDietary sodium restriction guidelines are controversial due to a lack of studies assessing their effect on heart failure outcomes. An important aspect of this problem is the effectiveness of behavioral nutrition interventions to reduce patients’ sodium intake. We systematically reviewed randomized controlled trials (RCTs) of sodium restricted diets and descriptive studies relating mediators of behavior to successful adherence to sodium restricted diets in patients with heart failure. MethodsWe queried PubMed, CINAHL, and Cochrane databases with relevant search terms for studies published in English January 2000-December 2018. Included were RCTs of interventions for heart failure patients, with sodium restriction as a primary or secondary outcome, and quantitative and qualitative descriptive studies of adherence to sodium restricted diets. Included studies may or may not have reported clinical outcomes (health events, quality of life, etc.). Reviewers noted setting, methods, and outcomes as well as theoretical mediators of dietary behavior change in included studies. We then compared behavioral mediators addressed by the RCTs and behavioral mediators identified in the descriptive studies. ResultsOf 638 studies identified, 445 were excluded by title. 2 reviewers assessed 60 abstracts and included 36 studies in this analysis: 10 RCTs and 26 descriptive studies. 6 of 10 intervention RCTs were successful, but no interventions achieved the recommended 1500 mg/day sodium intake (mean for all studies 3271 mg/day). Interventions that reduced sodium intake were behaviorally focused, were delivered by an RN and/or RD, and included individual feedback and counseling. RCTs intervened only through knowledge, skills, and social support. Behavioral mediators identified in descriptive studies included perceived risk, perceived benefits, outcome expectations, cultural norms, social norms, social support, taste preferences, determinism, self-efficacy, knowledge, skills, and habits. These were not included in the RCTs, which signifies a mismatch between evidence-based moderators of behavior and intervention designs. ConclusionsRCTs have been unable to achieve the recommended goal of 1500 mg/day of sodium. More effective interventions should consider evidence-based mediators, rather than focusing on knowledge and skills. Funding SourcesDr. Burgermaster received funding from NHLBI T32 training grant.

Differential reporting of fruit and vegetable intake among youth in a randomized controlled trial of a behavioral nutrition intervention

BackgroundNutrition interventions typically rely on self-reported intake that may be susceptible to differential reporting bias due to exposure to the intervention. Such differences may result from increased social desirability, increased attention to eating or improved recall accuracy, and may bias estimates of the intervention effect. This study investigated differential reporting bias of fruit and vegetable intake in youth with type 1 diabetes participating in a randomized controlled trial targeting increased whole plant food intake.MethodsParticipants (treatment n = 66, control n = 70) completed 3-day food records at baseline, 6-,12-, and 18-months, from which fruit and vegetable intake (servings/day) was calculated. Serum carotenoids were assessed at these visits using a high-performance liquid chromatography-based assay. Linear regression estimated associations of fruit and vegetable intake with serum carotenoids by treatment assignment. Multiplicative interaction terms tested the interaction of treatment assignment with fruit and vegetable intake on serum carotenoids for each visit and within each group over time.ResultsThe association of fruit and vegetable intake with serum carotenoids was significantly lower in the control versus intervention group at baseline (β = 0.22 Vs 0.46) and 6-month visits (β = 0.37 Vs 0.54), as evidenced by significant interaction effects. However, the association of fruit and vegetable intake with serum carotenoids did not significantly differ over time for either group.ConclusionsWhile the stronger association of fruit and vegetable with carotenoids in the treatment arm suggests greater reporting accuracy, this difference was evident at baseline, and did not change significantly over time in either group. Thus, results indicate greater subject-specific bias in the control arm compared to the treatment, and lack of evidence for reactivity to the intervention by treatment assignment.Clinical trial registry number and websiteNCT00999375

Nutrition Interventions Integrated into an Existing Maternal, Neonatal, and Child Health Program Reduce Food Insecurity Among Recently Delivered and Pregnant Women in Bangladesh

ABSTRACTBackgroundAntenatal care may be a means to reduce food insecurity in pregnancy and postpartum periods.ObjectiveWith the use of a cluster-randomized design, we tested whether participation in nutrition-focused antenatal care intending to improve household knowledge about the importance of nutrition for pregnant and lactating women and encourage allocation of household resources to ensure sufficient quality and quantity of foods, without providing food assistance, would reduce household food insecurity.MethodsAlive & Thrive integrated nutrition interventions into an existing Maternal, Neonatal, and Child Health (MNCH) program in Bangladesh. The nutrition-focused MNCH package was delivered in 10 subdistricts through antenatal care visits with the use of interpersonal communication, community mobilization, and monitoring of weight gain, aiming to improve maternal diet quality, quantity, and micronutrient intake during pregnancy and breastfeeding. The package included components that could reduce food insecurity, measured using the Household Food Insecurity Access Scale. To examine the impact of the nutrition-focused MNCH package compared with the standard MNCH package, we used linear and multinomial logit regression models, adjusted for subdistrict clustering, to test differences at endline in items, domains, and categories of food insecurity, after first confirming no differences at baseline.ResultsAt baseline, nearly half of households were food insecure. At endline, the groups differed in food insecurity, whether expressed as items, domains, or categories, with food insecurity in the nutrition-focused MNCH group 22 percentage points lower than in the standard MNCH group and 20 percentage points lower than at baseline.ConclusionsParticipation in nutrition-focused antenatal care reduced household food insecurity among recently delivered and pregnant women. Integration of social and behavioral nutrition interventions into antenatal care with components that promote food security provides a potentially effective means to reduce food insecurity, without incurring high costs of providing supplemental food, in populations where limited resources can be directed towards accessing adequate and appropriate foods. Registered at clinicaltrials.gov as NCT02745249.

Resemblance of Diet Quality in Families of Youth with Type 1 Diabetes Participating in a Randomized Controlled Behavioral Nutrition Intervention Trial in Boston, MA (2010-2013): A Secondary Data Analysis

BackgroundParent–child diet quality resemblance is unknown in families of youth with type 1 diabetes, for whom nutrition is central to disease management. ObjectiveExamine diet quality resemblance in families of youth with type 1 diabetes participating in a behavioral nutrition intervention trial and investigate whether treatment assignment or family meal frequency modifies resemblance. DesignThis is a secondary data analysis from an 18-month randomized controlled trial conducted August 2010 to May 2013. Participants/settingParent-youth dyads (N=136, child age=12.3±2.5 years) were recruited from a northeast US diabetes center. Main outcome measuresParent and child Healthy Eating Index-2005 (HEI-2005, reflecting adherence to 2005 Dietary Guidelines for Americans) and whole plant food density (WPFD, reflecting intervention target foods) were calculated from 3-day food records collected every 6 months. Statistical analysisLinear random effects models adjusting for demographics and disease characteristics investigated parent–child diet quality resemblance. Separate models examined whether treatment assignment or family meal frequency modified resemblance. Three-way interaction terms examined whether resemblance changed over time by treatment assignment. ResultsTime-varying parent and child HEI-2005 and WPFD were positively associated (P<0.001), and there were no interactions with family meals. Parent–child HEI-2005 resemblance was similar across treatment groups; however, parent–child WPFD resemblance was stronger in the intervention (β±standard error [SE]=.30±.06) vs control families (β±SE=.12±.05). Parent–child HEI-2005 resemblance was similar over time by treatment assignment, whereas parent–child WPFD resemblance increased over time for families in the intervention group (three-way interaction term β±SE=.03±.01). ConclusionsParent and youth diet quality were positively correlated in families of youth with type 1 diabetes. Resemblance was stronger in the intervention group for target foods, but not for a general measure of diet quality. The lack of effect modification by family meal frequency suggests that family diet quality resemblance is not contingent on shared meals.

Greater inflammation and adiposity are associated with lower bone mineral density in youth with type 1 diabetes

AimsThe objectives of this study were to investigate relationships of inflammation and adiposity with bone mineral density (BMD) in youth with type 1 diabetes followed prospectively for 18 months. MethodsParticipants were youth with type 1 diabetes (n = 136, 8–16.9 years) enrolled in an 18-month behavioral nutrition intervention trial. BMD of the total body, subtotal, lumbar spine, pelvis leg, arm and rib, percent body fat and percent trunk fat (by dual energy x-ray absorptiometry) and C-reactive protein (CRP), a marker of inflammation, were assessed at baseline, 12 and 18 months. Linear mixed-effects models estimated associations of time-varying BMD with time-varying CRP, and with percent body and trunk fat. ResultsCRP was inversely associated with BMD of the total body, pelvis and leg (n = 136). Percent body fat was inversely associated with BMD of the total body and pelvis; whereas percent trunk fat was related only to total body BMD. ConclusionsGreater inflammation and adiposity were related to lower BMD in youth with type 1 diabetes. Investigating the impact of inflammation and adiposity on bone turnover markers could provide insights on mechanisms that contribute to this relationship.

P194 - Data-Driven Psychosocial Phenotyping for Precision Behavioral Nutrition

Background (Background, Rationale, Prior Research, and/or Theory): People respond differently to behavior change interventions; therefore, behavioral nutrition interventions often have small effect sizes. Precision Behavioral Nutrition aims to leverage information about individuals to make these interventions more effective via personalization. Psychosocial phenotyping describes variability in psychological and social characteristics in a population, identifying salient mediators of behavior change. Previously, we used psychosocial phenotyping to qualitatively explain results of a behavioral nutrition intervention and noted its potential for designing precision interventions. For this purpose, psychosocial phenotyping must be scalable and identify mediators that can serve as intervention targets along with related moderators and behaviors. Mixed membership models, including Latent Dirichlet Allocation (LDA) and UPhenome, are machine-learning methods used for clinical phenotyping. Whereas LDA treats mediators, moderators, and behaviors as a single data type, UPhenome handles them separately, learning phenotypes that represent each equally. These data-driven models have not yet been applied in behavioral nutrition. Objective: We assessed the utility of LDA and UPhenome for automatic learning of psychosocial phenotypes from survey data. Study Design, Setting, Participants, Intervention: We extracted individual's (n = 5,883) psychosocial characteristics from surveys collected during a cohort study of a predominantly Latino New York City community affected by high levels of chronic disease and health disparity. We conducted a secondary analysis of these data using UPhenome and LDA. Outcome Measures and Analysis: Participant responses were tokenized (n = 4,604) and used as input to LDA and UPhenome to identify phenotypes (k = 10). Domain experts (n = 4) assessed internal consistency among phenotypes resulting from LDA; a heatmap (n = 3,233) depicted dietary patterns for each phenotype. Results: Experts found within-phenotype consistency and between-phenotype discrimination. Differences in dietary patterns were visually detected. UPhenome identified more specific intervention targets than LDA. Conclusions and Implications: LDA and UPhenome can identify psychosocial phenotypes in a large cohort of Latino New Yorkers and could advance Precision Behavioral Nutrition. Future research will assess generalizability of psychosocial phenotypes and integrate psychosocial phenotyping into behavioral nutrition interventions. Funding: NIH Sackler Institute for Nutrition Science at the New York Academy of Sciences.

A Theoretically Based Behavioral Nutrition Intervention for Elderly Women: A Cluster Randomized Controlled Trial

Summary Background Nutritional behavior is one of the main criteria for determining health in the elderly. Health Belief Model (HBM) is most commonly used theory in the interventional programs. This study was aimed to determine efficacy of HBM-based nutritional educational intervention on knowledge, belief and behavior of the elderly women. Methods The sample of this randomized controlled trial study was 100 elderly women who attended to four health care centers of Urmia, Iran. Data were collected using self-administered questionnaire included demographic characteristics and some HBM constructs. The experiment group participated to HBM-based trainings classes twice per week for 12 weeks. The educational strategies were consisted of lecture, focus-group discussion, and video showing. The questionnaire was completed before and after 3 and 6 months intervention. Data were analyzed using two way repeated measure ANOVA at the significant level of α Results The mean scores of benefit, severity, susceptibility, and self-efficacy were not different between the two groups before the educational training (p > 0.05). However, the aforementioned scores changed significantly between two group after 3 months intervention and follow-up (p Conclusion This study confirms the effectiveness of HBM-based nutritional education on healthy nutritional perception, belief and behavior among elderly women.

Parent healthful eating attitudes and motivation are prospectively associated with dietary quality among youth with type 1 diabetes

ABSTRACTA family-based behavioral nutrition intervention grounded in social cognitive and self-determination theories showed an increased intake of whole plant foods. This study examined (1) whether the intervention changed parent diet-related attitudes/beliefs, (2) whether these attitudes/beliefs were associated with youth diet quality, and (3) the moderating roles of youth age and parent nutritional knowledge. Youth with type 1 diabetes and their parents (n = 136, mean ± SD youth age = 12.6 ± 2.8 years) participated in an 18-month trial targeting intake of whole plant foods. Parents reported attitudes/beliefs (self-efficacy, outcome expectations, perceived barriers, autonomous and controlled motivation) for providing healthy food to their families, and type 1 diabetes-specific nutrition knowledge at 6, 12, and 18 months. Whole Plant Food Density (WPFD; cup or ounce equivalents per 1000 kcal of whole grains, fruit, vegetables, legumes, nuts,and seeds) was calculated from 3-day youth food records. Linear mixed models estimated the intervention effect on parent attitudes/beliefs, associations of parent attitudes/beliefs with youth WPFD, and the moderating roles of parent nutrition knowledge and youth age. There was no effect of the intervention on parent attitudes/beliefs. Across groups, higher parent self-efficacy and autonomous motivation were positively associated with youth WPF. Parent-perceived barriers and negative outcome expectations were inversely associated with youth WPFD, especially when parents had higher nutrition knowledge. Youth age did not modify any associations. Parent diet-related attitudes/beliefs were associated with youth diet quality, highlighting the importance of parent psychosocial factors across this age range. Despite a positive effect on youth diet, the intervention did not affect parent attitudes/beliefs, suggesting it worked through a different mechanism.

Innovative Techniques for Evaluating Behavioral Nutrition Interventions.

Assessing outcomes and the impact from behavioral nutrition interventions has remained challenging because of the lack of methods available beyond traditional nutrition assessment tools and techniques. With the current high global obesity and related chronic disease rates, novel methods to evaluate the impact of behavioral nutrition-based interventions are much needed. The objective of this narrative review is to describe and review the current status of knowledge as it relates to 4 different innovative methods or tools to assess behavioral nutrition interventions. Methods reviewed include 1) the assessment of stress and stress responsiveness to enhance the evaluation of nutrition interventions, 2) eye-tracking technology in nutritional interventions, 3) smartphone biosensors to assess nutrition and health-related outcomes, and 4) skin carotenoid measurements to assess fruit and vegetable intake. Specifically, the novel use of functional magnetic resonance imaging, by characterizing the brain's responsiveness to an intervention, can help researchers develop programs with greater efficacy. Similarly, if eye-tracking technology can enable researchers to get a better sense as to how participants view materials, the materials may be better tailored to create an optimal impact. The latter 2 techniques reviewed, smartphone biosensors and methods to detect skin carotenoids, can provide the research community with portable, effective, nonbiased ways to assess dietary intake and quality and more in the field. The information gained from using these types of methodologies can improve the efficacy and assessment of behavior-based nutrition interventions.

Effects of a Group-Based Behavioral Intervention on Dietary Behaviors in Older Adults.

The aim of this study is to examine the effects of a 12-week, behavioral nutrition intervention on dietary behaviors. Inactive older adults ( N = 50) were randomized to a 12-week, behavioral nutrition or physical activity intervention, delivered in a group-based format. Questionnaires assessed fruit and vegetable (FV) consumption, and fat- and fiber-related behaviors at baseline and postintervention. Height and weight were measured. Repeated-measures ANOVAs examined changes in dietary behaviors over time between groups, controlling for age, gender, and education. Participants averaged 64.1 ± 8.4 years of age and had a body mass index (BMI) of 33.3 ± 7.5 kg/m2. Group × Time interactions were significant for FV consumption ( p = .003), and fat- ( p = .02) and fiber-related ( p = .008) behaviors at 12 weeks. At 12 weeks, dietary behaviors improved significantly in the nutrition but not in the physical activity group. Effect sizes were medium to large. A 12-week, behavioral nutrition intervention improved dietary behaviors. Behavioral interventions may be a low-cost way to improve dietary behaviors among older adults, potentially affecting population health significantly.