Using digital health to improve diet quality among adults at risk for cardiovasclar disease

利用数字健康改善有心血管疾病风险的成年人的饮食质量

• 批准号: 10640300
• 负责人: Gary G Bennett
• 金额: $ 8.77万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10640300
• 关键词: Address; Adherence; Adult; Algorithms; American; Behavior Therapy; Behavioral; Behavioral trial; Blood Pressure; Cardiovascular Diseases; Clinic; Computer software; DASH diet; Data; Databases; Development; Diet; Diet Habits; Dietary Intervention; Dietary Practices; Disease; Effectiveness; Evidence based intervention; Evidence based treatment; Fabaceae; Fasting; Fatty acid glycerol esters; Feasibility Studies; Feedback; Food; Glucose; Goals; Guidelines; Health Technology; Health behavior change; Healthcare; Hour; Hypertension; Incidence; Individual; Institution; Intake; Intervention; Life Style; Lipids; Measures; Meat; Mental Depression; Methods; Morality; Nutrient; Outcome; Participant; Persons; Pharmaceutical Preparations; Physical activity; Physiological; Population; Process; Proteins; Psychosocial Factor; Public Health; Randomized; Randomized Controlled Trials; Research; Risk; Science; Self Efficacy; Technology; Testing; Text Messaging; Thinness; Weight; Woman; application programming interface; arm; attentional control; base; behavior change; blood pressure elevation; blood pressure reduction; blood treatment; cardiovascular disorder risk; clinically relevant; design; dietary; dietary adherence; dietary approach; digital health; digital intervention; efficacious intervention; efficacy evaluation; efficacy testing; evidence base; fasting glucose; feasibility testing; feasibility trial; flexibility; fruits and vegetables; future implementation; hypertension control; implementation trial; improved; innovation; interest; intervention effect; meetings; men; mobile computing; obesity management; premature; primary outcome; recruit; secondary outcome; smartphone Application; theories; tool; treatment arm

ABSTRACT Over 100 million Americans suffer from high blood pressure and thus are at increased risk for cardiovascular disease and premature morality. Evidence supports the DASH (Dietary Approaches to Stop Hypertension) dietary pattern to reduce blood pressure. DASH is rich in fruits and vegetables, legumes, lean protein, and low- fat dairy, and reduced in red meats, sweets and processed foods. In the past 20 years, numerous trials have demonstrated the blood pressure-lowering effects of DASH across a diverse range of populations. As such, DASH is part of national dietary and blood pressure guidelines. Despite this strong evidence, fewer than 1% of U.S. adults with high blood pressure fully meet DASH guidelines. Like most efficacious interventions, the rate- limiting step involves dissemination. Behavioral trials testing DASH have been delivered primarily in-person, an approach that is effective but not accessible to the broader population. Innovative and accessible strategies to disseminate DASH, such as digital health, are critically needed. To address this need, we developed and tested the feasibility of a 3-month digital health intervention called DASH Cloud. The DASH Cloud intervention asked participants to track their diet daily using a commonly-used commercial tracking app with an extensive nutrient database. Our intervention technology platform extracted food and nutrient data from the app using an application programming interface (API). Each day, using this API software, we compared individual participant’s nutrient intake to the recommended levels in the DASH diet. We then processed the data against an algorithm and sent automated text messages to each participant with information on DASH diet adherence and diet tips. Results indicated that we successfully recruited and retained individuals with elevated blood pressure, achieved high engagement with daily diet tracking and saw positive changes in diet quality. Based on the results of the feasibility trial, we will improve upon the personalization of the automated text messages and include a scalable and responsive way of delivering coaching, based on diet data received in the app. The efficacy of this approach will be tested via a fully-powered 12-month randomized controlled trial, DASH Cloud. The trial will examine the effects of the intervention on changes in dietary quality and blood pressure among men and women with high blood pressure, using the new blood pressure guidelines for nonpharmacological treatment. The primary outcome is 6-month change in DASH adherence, as measured by 24-hour recalls. We will also measure DASH adherence at 12-months post-randomization. Secondary outcomes include changes in blood pressure and other physiological outcomes (e.g. weight, lipids, glucose). The scientific premise of this proposal represents establishing the efficacy of a previously-deemed feasible approach for disseminating the DASH diet. With the millions of Americans in dire need of nonpharmacological treatments for blood pressure, the public health impact of disseminating the DASH Cloud intervention could drastically reduce the incidence of cardiovascular disease. The findings from this study prepare us for a future implementation trial, testing the potential to implement DASH Cloud within clinics and other healthcare institutions, yielding a wider dissemination of this evidence-based intervention.

摘要 超过1亿美国人患有高血压，因此心血管疾病的风险增加 疾病和过早的道德。DASH（Dietary Approaches to Stop Hypertension） 饮食模式，以降低血压。DASH富含水果和蔬菜，豆类，瘦肉蛋白质，低- 高脂肪乳制品，减少红肉，糖果和加工食品。在过去的20年里，无数的审判 证明了DASH在不同人群中的降血压作用。因此，在本发明中， DASH是国家饮食和血压指南的一部分。尽管有这些强有力的证据， 美国高血压患者完全符合DASH指南。像大多数有效的干预措施一样，利率- 限制步骤涉及传播。测试DASH的行为试验主要是面对面进行的， 这是一种有效的方法，但不适合更广泛的人群。创新和可获得的战略， 传播DASH，如数字健康，是迫切需要的。为了满足这一需求，我们开发并 测试了为期3个月的名为DASH Cloud的数字健康干预的可行性。DASH云的介入 要求参与者每天使用一个常用的商业跟踪应用程序跟踪他们的饮食， 营养数据库我们的干预技术平台使用 应用程序编程接口（API）。每天，我们使用这个API软件， 参与者的营养摄入量达到DASH饮食的推荐水平。然后我们处理了数据， 算法，并向每个参与者发送自动短信，其中包含DASH饮食依从性的信息 和减肥小贴士结果表明，我们成功地招募和保留了血液浓度升高的个体， 压力，实现了对日常饮食跟踪的高度参与，并看到了饮食质量的积极变化。基于 根据可行性试验的结果，我们将改进自动短信的个性化。 并包括基于应用程序中接收的饮食数据提供指导的可扩展和响应方式。 这种方法的有效性将通过一项为期12个月的完全随机对照试验DASH Cloud进行测试。 该试验将检查干预对饮食质量和血压变化的影响， 男性和女性高血压，使用新的血压指南， 治疗主要结局是DASH依从性的6个月变化，通过24小时召回来衡量。我们 还将在随机化后12个月测量DASH依从性。次要结果包括 血压和其他生理结果（例如体重、血脂、血糖）。科学的前提是 建议是建立一个以前认为可行的方法传播的效力， DASH饮食。随着数百万美国人迫切需要非药物治疗血压， 传播DASH云干预措施的公共卫生影响可以大大降低 心血管疾病这项研究的结果为我们将来的实施试验做好了准备， 在诊所和其他医疗机构内实施DASH云的潜力， 传播这种基于证据的干预措施。