Dietary ecological momentary assessments: validation against food diaries and associations with health biomarkers.
Digital approaches that capture dietary behavior repeatedly in real-world settings may improve the monitoring of long-term lifestyle interventions while reducing participant burden and supporting self-awareness. This study developed and evaluated a low-burden dietary ecological momentary assessment (EMA) protocol to monitor Mediterranean diet adherence during the 12-month PENSA multimodal lifestyle trial in older adults at increased risk of cognitive decline.
A total of 104 participants aged 60-80 years with subjective cognitive decline and APOE-ε4 carrier status were included. Daily mobile EMA prompts assessed key Mediterranean diet food groups through a rotating schedule, and participants received personalized feedback every 4 weeks. EMA-derived adherence indicators were evaluated against the Mediterranean Diet Adherence Screener, 3-day food diaries, nutrient profiles, usability data, and cardiometabolic and dementia-risk markers.
Mediterranean diet adherence improved over the intervention, with EMA scores increasing from 73.6 to 82.3% and capturing dynamic changes in dietary quality across the year. EMA-derived indicators showed increasing convergence with the Mediterranean Diet Adherence Screener over time (ρ = 0.36 at 6 months and ρ = 0.46 at 12 months; both p < 0.001) and were associated with expected nutrient patterns, including higher fiber and monounsaturated fat intake and lower free sugar, saturated fat, and sodium intake. Higher EMA-based adherence was also associated with lower body mass index, visceral adiposity, body fat percentage, insulin resistance, glycated hemoglobin, triglyceride-glucose index, and lifestyle-based dementia risk. The protocol showed high feasibility, with sustained completion rates and positive participant evaluations, although engagement declined modestly over time.
These findings support dietary EMA as a feasible, scalable, and behaviorally meaningful approach for monitoring and promoting Mediterranean diet adherence in real-world lifestyle interventions, with potential value both as an assessment tool and as an active component to reinforce dietary change. The PENSA trial is registered at ClinicalTrials.gov (NCT03978052).
A total of 104 participants aged 60-80 years with subjective cognitive decline and APOE-ε4 carrier status were included. Daily mobile EMA prompts assessed key Mediterranean diet food groups through a rotating schedule, and participants received personalized feedback every 4 weeks. EMA-derived adherence indicators were evaluated against the Mediterranean Diet Adherence Screener, 3-day food diaries, nutrient profiles, usability data, and cardiometabolic and dementia-risk markers.
Mediterranean diet adherence improved over the intervention, with EMA scores increasing from 73.6 to 82.3% and capturing dynamic changes in dietary quality across the year. EMA-derived indicators showed increasing convergence with the Mediterranean Diet Adherence Screener over time (ρ = 0.36 at 6 months and ρ = 0.46 at 12 months; both p < 0.001) and were associated with expected nutrient patterns, including higher fiber and monounsaturated fat intake and lower free sugar, saturated fat, and sodium intake. Higher EMA-based adherence was also associated with lower body mass index, visceral adiposity, body fat percentage, insulin resistance, glycated hemoglobin, triglyceride-glucose index, and lifestyle-based dementia risk. The protocol showed high feasibility, with sustained completion rates and positive participant evaluations, although engagement declined modestly over time.
These findings support dietary EMA as a feasible, scalable, and behaviorally meaningful approach for monitoring and promoting Mediterranean diet adherence in real-world lifestyle interventions, with potential value both as an assessment tool and as an active component to reinforce dietary change. The PENSA trial is registered at ClinicalTrials.gov (NCT03978052).
Authors
Boronat Boronat, Soldevila-Domenech Soldevila-Domenech, Clivillé-Pérez Clivillé-Pérez, Cuenca-Royo Cuenca-Royo, Gomis-González Gomis-González, Lorenzo Lorenzo, Piera Piera, Langohr Langohr, Fitó Fitó, Schröder Schröder, Grau-Rivera Grau-Rivera, Pizarro Pizarro, Forcano Forcano, de la Torre de la Torre
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