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Mobile Device-assisted Dietary Ecological Momentary Assessments for the Evaluation of the Adherence to the Mediterranean Diet in a Continuous Manner

Published: September 25th, 2021



1Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital del Mar Medical Research Institute (IMIM), 2Department of Experimental and Health Sciences, University Pompeu Fabra, 3CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, 4Cardiovascular Risk and Nutrition Research Group, Hospital del Mar Medical Research Institute (IMIM), 5CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), 6Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation

Presented here is a study protocol aimed at monitoring continuous adherence to the Mediterranean diet (MedDiet) by means of ecological momentary assessments. The method evaluates the intake of key food groups of the MedDiet and calculates an index of adherence.

Mobile device-assisted dietary ecological momentary assessments (EMAs) have emerged as a new tool allowing the evaluation of dietary intake in real time, in a real-world setting and in a continuous manner. They have the potential to minimize recall bias, participant, and investigator burden, and decrease economic and time investment while maximizing ecological validity.

We developed a set of EMAs aimed at evaluating continuous adherence to the MedDiet. Four multiple-choice EMAs are sent daily in a randomized manner from a total of eight questions. The EMAs enquire about the consumption of 11 key food groups of the Mediterranean diet in the last 24-48 h in a semi-quantitative way. EMAs capture the daily frequency of consumption of fruits, vegetables, and extra virgin olive oil on different days of the week. Additionally, EMAs capture the weekly frequency of consumption of whole grain products, sugary drinks, nuts, legumes, sweets, fish and seafood, and red and processed meats. A designed scoring system behind the EMAs extracts the percentage of adherence to the MedDiet recommendations and calculates a quality index of the diet every week. Individualized reports are sent periodically to the volunteers highlighting the strengths and weaknesses of their diet. EMAs are also expected to have a behavioral effect, reinforcing the choice of Mediterranean foods.

The Mediterranean diet (MedDiet) is a dietary pattern associated with longevity and multiple health benefits. High adherence to the MedDiet has been related to a decreased risk of overall mortality, cardiovascular disease, overall cancer incidence, neurodegenerative disease and diabetes1. In particular, the MedDiet, based on seasonal and local products, is characterized by a high intake of plant-based food (fruit, vegetables, legumes, nuts, and unrefined cereals) and a moderate intake of fish, eggs, dairy, and poultry. Olive oil represents the main source of fat. The consumption of saturated fatty acids is low, with very low consumption of red ....

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This protocol demonstrates how to continuously assess adherence to the MedDiet by means of tailored EMAs. This protocol has been reviewed and approved by the local ethics committee of the Hospital del Mar: CEIm-PSMAR (reference number: 2019/8972).

1. Study design: Sampling protocol

  1. Determine the number of days to assess the dietary intake; a minimum of 1 week is required to obtain the first score and, therefore, ensure that the total number of days is adapted on a 7-days basis (e.g.......

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The present protocol was used in a proof-of-concept study which included a total of 63 subjects with an age range of 22 to 76 years. The aim of the proof-of-concept study was to compare the adherence to the Mediterranean diet obtained with the proposed EMAs approach with the validated MEDAS test. The present study did not intend to validate the EMAs but to compare both instruments as tools to measure the adherence to the MedDiet, to test its feasibility and the adherence of study participants to a two-week EMAs evaluatio.......

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Here we describe a protocol to assess an individual's adherence to the MedDiet via a mobile-based application. This method uses daily EMAs to capture the dietary pattern and by means of an algorithm, calculates a weekly score representing the degree of adherence to the MedDiet. A positive score is given to the high intake of healthy food items which are characteristic of the MedDiet. Conversely, a negative score is given to the intake of unhealthy food groups, in accordance with the recommendations given for the Span.......

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This work was supported by grants from Alzheimer Association (18PTC-R-592192; The PART THE CLOUD to RESCUE (REverse, reStore, Cease and UndErstand) Brain Cell Degeneration in Alzheimer's disease Program), Instituto de Salud Carlos III (FEDERPI17/00223), CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN) and DIUE de la Generalitat de Catalunya (2017 SGR 138) from Agència de Gestió d'Ajuts Universitaris i de Recerca (AGAUR).


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Name Company Catalog Number Comments
Data processing software (excel) MS Office - Others suitable options like R studio
Google forms Google - Free online software that allows the creation of  surveys and questionnaires to be delivered. It's part of Google's web-based apps sui
Limesurvey platofrm ( Limesurvey - A free software application for conducting online surveys

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