The Effectiveness of App-Based Mobile Interventions on Nutrition Behaviors and Nutrition-Related Health Outcomes: A Systematic Review and Meta-Analysis
82 Pages Posted: 30 Jun 2018More...
Background: App-based mobile nutrition interventions offer a promising approach for fighting obesity and nutrition-related diseases in a broad spectrum of the population, but reliable estimates of their effectiveness in changing nutrition behaviors and achieving nutrition-related health outcomes are scarce. We conducted a systematic review and meta-analysis to assess the effectiveness and characteristics of interventions such as behavior change techniques (BCTs) on nutrition behaviors, obesity indices, and clinical metabolic parameters.
Methods: We searched seven databases (MEDLINE, PubMed, PsycINFO, PsycIndex, PsycArticle, SPORTDiscus, and Web of Science) for intervention studies using a smartphone application to promote changes in nutrition behaviors and nutrition-related health outcomes between 2006 and June 2017, including all intervention study designs and populations. Data was extracted following a predefined hierarchy. Independent researchers then reviewed the search results to identify pre-specified outcomes and key characteristics. We assessed the studies' risk of bias in accordance with the Cochrane Handbook for Systematic Reviews of Interventions, and the certainty of evidence using the CONSORT 2010 checklist. Outcomes were changes in nutrition behaviors (primary) and consequent nutrition-related health outcomes (secondary). We estimated pooled effect sizes using meta-analysis with random effects, and conducted separate meta-regressions to identify meaningful moderators.
Findings: Forty-one of the 10 132 interventions identified in the meta-analysis met our selection criteria, comprising 6 348 participants and 373 outcomes from 27 RCTs with sample sizes ranging from 10 to 833 participants. In terms of efficacy, a beneficial effect of app-based mobile interventions was identified for both nutrition behaviors (g = 0·19, CI = 0·06 - 0·32, p = ·004) and nutrition-related health outcomes (g = 0·24, CI = 0·06 - 0·43, p = ·009), including positive effects on obesity indices (g = 0·47, CI = 0·06 - 0·87, p = ·024), blood pressure (g = 0·22, CI = 0·01 - 0·42, p = ·043), and blood fats (g = 0·16, CI = 0·03 - 0·28, p = ·018). Most interventions comprised of four BCTs, namely 'Goals & Planning', 'Feedback & Monitoring', 'Shaping Knowledge', and 'Social Support'. Moderating effects including RCT vs. non-RCT, the type of app, and sample and intervention characteristics were not statistically significant.
Interpretation: Focused app-based mobile interventions are effective in changing nutrition behaviors and nutrition-related health outcomes, which highlights their potential for fighting the obesity epidemic in a broad spectrum of the population. These results should serve evidence-based practice and inform patients, physicians, guideline developers, and policy makers on the relative merits of mobile interventions.
Funding: Federal Ministry of Education and Research and the German Research Foundation (SmartAct, BMBF Grant 01EL1820A; RiskDynamics, DFG Grant FOR 2374).
Competing Financial Interests: The authors declare no competing financial interests.
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