Enabling better nutrition and healthy living through virtual care platforms
Clare Collins
Professor of Nutrition and Dietetics Director of Research, School of Health Sciences Priority Research Centre in Physical Activity and Nutrition NHMRC Senior Research Fellow Faculty of Health and Medicine The University of Newcastle @ProfCCollins
The University of Newcastle | CRICOS Provider 00109J | www.newcastle.edu.au Image from dreamstime.com Getting eHealth innovations to optimise nutrition at key life-stages and health conditions out there
Image from dreamstime.com
The University of Newcastle | Prof Clare Collins | @ProfCollins | CRICOS Provider 00109J | www.newcastle.edu.au Acknowledgements Collaborators and Funding Support
• Tracy Burrows, Melinda Hutchesson, • NHMRC, ARC Megan Rollo, Tamara Bucher, Lesley • nib foundation, Wicks, Amanda Patterson, Tracy • Coal & Allied, Heart Foundation Schumacher, Hannah Lucas, Tracy • DARP, MLA Schumacher, Rebecca Haslam, Lee • University of Newcastle Ashton, Vanessa Shrewsbury & HDR • HMRI / HCRF candidates • Benefactors (HRMI): Thompson Family, • Phil Morgan, Robin Callister, Manohar Kirwina, Gastronomic lunch Garg, Dave Lubans, Ron Plotnikoff , • Newcastle Permanent, The Greater, Amanda Baker, Geoff Skinner, Shamus Medibank Charitable Trust Smith, Roger Smith, Lisa Wood, Kym Rae, • JHH Charitable Trust Loretta Wetherall • Aust Paed Endocrine Society • Helen Truby, Caryl Nowson, Lisa Moran, • Aust Diabetes Educators Society David Sibritt, Julia Lowe, Pete Kelly, Tony • Dietitians Association of Australia Okely, Louise Baur, May Boggess • Lions Club • Wollongong Uni, Sydney Uni, ACAORN, Monash Uni, St Andrew’s Scotland; ETH Zurich, Baylor College of Medicine, University of Vermont, USA. OUTLINE
1. Why Nutrition 2. Getting on the IT path in nutrition & dietetic research 3. Stories from our frontline 4. Opportunities and challenges for N&D and IT 5. Where to from here
The University of Newcastle | Prof Clare Collins | @ProfCollins | CRICOS Provider 00109J | www.newcastle.edu.au OUTLINE
1. Why Nutrition 2. Getting on the IT path in nutrition & dietetic research 3. Stories from our frontline 4. Opportunities and challenges for N&D and IT 5. Where to from here
The University of Newcastle | Prof Clare Collins | @ProfCollins | CRICOS Provider 00109J | www.newcastle.edu.au Poor nutrition contributes to malnutrition in all its forms ▪ High Body Mass Index (BMI) – risks for non-communicable diseases (NCDs) ▪ Dietary Risks – risks for NCDs (eg low grains, F&V, nuts, high sodium, trans fats) ▪ Child & maternal undernutrition – risks for nutrient deficiencies & infectious diseases
DALYs Disability- Adjusted Life years lost
5% 10% 15% 20% 25%
With Permission Prof T Lobstein; Swinburn, et al. The Global Syndemic of Obesity, Undernutrition, and Climate Change: The Lancet Commission report. The Lancet. Jan 27 2019 Graphic by Nico Villarete
www.rappler.com/move- ph/issues/hunger/86284-ending- hunger-malnutrition-effects Poor dietary patterns account for the greatest proportion of Australia’s national burden of disease *
Poor nutrition - 10% Obesity - 8.5% Smoking - 8.2%
* Disability adjusted life years
Institute for Health Metrics and Evaluation. Global burden of diseases, injuries and risk factors study 2010. 2013; Available from: www.healthdata.org
The University of Newcastle | Prof Clare Collins | @ProfCollins | CRICOS Provider 00109J | www.newcastle.edu.au
OUTLINE
1. Why Nutrition 2. Getting on the IT path in nutrition & dietetic research 3. Opportunities and challenges for N&D and telehealth 4. Stories from our frontline 5. Where to from here
The University of Newcastle | Prof Clare Collins | @ProfCollins | CRICOS Provider 00109J | www.newcastle.edu.au Food Amt Pro Fat CHO Fibre Fe Ca Vit B1 Vit B2 Folate
Dietary assessment in the 1980s
The University of Newcastle | Prof Clare Collins | @ProfCollins | CRICOS Provider 00109J | www.newcastle.edu.au Collins, O’Loughlin, Henry, etal. Normal growth in cystic fibrosis associated with attending a specialised CF centre. Archives of Disease in Childhood, 1999; 81 (3): 241-6. IT kinda just happened … …
Measuring diet quality and alignment with Australian Dietary Guidelines www.healthyeatingquiz.com.au OUTLINE
1. Why Nutrition 2. Getting on the IT path in nutrition & dietetic research 3. Stories from our frontline 4. Challenges and opportunities for N&D and IT 5. Where to from here
The University of Newcastle | Prof Clare Collins | @ProfCollins | CRICOS Provider 00109J | www.newcastle.edu.au eHealth innovations to optimise nutrition at key life-stages and health conditions Research-to-Action Cycle
Goal 1 Evidence
Goal 4 Nutrition Science Goal 2 Translation Communication Methods
Goal 3 Interventions Research-to-Action Cycle
Systematic reviews to synthesise evidence on Goal 1 diet-related outcomes Evidence
Translate results to ‘real world’ Develop novel, validated settings in consultation with Goal 4 Nutrition Science Goal 2 tools to measure dietary consumers, health professionals Translation Communication Methods intake using technology and industry partners and provide real-time feedback on intake
Goal 3 Interventions Conduct feasibility and efficacy trials, targeted to life stage (pregnancy) and health risk (CVD, type 2 and gestational diabetes) Systematic reviews of eHealth technologies
▪ To evaluate effectiveness of eHealth interventions for the prevention and treatment of overweight and obesity in adults
Prof Clare Collins @ProfCCollins Systematic reviews of translation
▪ To synthesise knowledge translation studies on dietary evidence for prevention / treatment of CVD into practice in those at high CVD risk
▪ No diet studies with specific aim of KT
Prof Clare Collins @ProfCCollins Research-to-Action Cycle
Systematic reviews to synthesise evidence on Goal 1 diet-related outcomes Evidence
Translate results to ‘real world’ Develop novel, validated settings in consultation with Goal 4 Nutrition Science Goal 2 tools to measure dietary consumers, health professionals Translation Communication Methods intake using technology and industry partners and provide real-time feedback on intake
Goal 3 Interventions Conduct feasibility and efficacy trials, targeted to life stage (pregnancy) and health risk (CVD, type 2 and gestational diabetes) Real-time analysis Personal reports
Optimising nutrition to improve health and well being
Migraine1001storia.polimi.it Diet Australian Eating Survey® Online AES® Nutrition Assessment with real-time feedback compared to national recommendations
E: [email protected] W: www.australianeatingsurvey.com.au Australia Eating Survey® (AES)
▪ Assesses usual food and nutrient intake over the past 3-6 months ▪ Personalised feedback report generated for each user
E: [email protected] W: www.australianeatingsurvey.com.au
24 | The University of Newcastle Biomarkers of dietary intakes
▪ Fat quality, vegetable & fruit intake measured by FFQ ▪ Red blood cell membrane fatty acids measured by gas chromatography ▪ Plasma carotenoids measured by HPLC ▪ Skin carotenoids by spectrophotometry ServAR ▪ An augmented reality (AR) tool for food portion size guidance ServAR ▪ An augmented reality (AR) tool for food portion size guidance Research-to-Action Cycle
Systematic reviews to synthesise evidence on Goal 1 diet-related outcomes Evidence
Translate results to ‘real world’ Develop novel, validated settings in consultation with Goal 4 Nutrition Science Goal 2 tools to measure dietary consumers, health professionals Translation Communication Methods intake using technology and industry partners and provide real-time feedback on intake
Goal 3 Interventions Conduct feasibility and efficacy trials, targeted to life stage (pregnancy) and health risk (CVD, type 2 and gestational diabetes) Real-time analysis Personal reports
Optimising nutrition to improve health and well being
Migraine1001storia.polimi.it Diet Dietitian view
Client view A feasibility study investigating tailored video-coaching for nutrition and exercise care for postpartum women
Lisa Vincze: Accredited Practising Dietitian, Accredited Exercise Physiologist; PhD Candidate Priority Research Centre for Physical Activity and Nutrition, School of Health Sciences, University of Newcastle
▪ Women aged ≥18 years who were 3-12 months postpartum ▪ Weight status: >2kg above self-reported pre-pregnancy weight OR BMI ≥25.0kg/m2 ▪ Cleared for exercise (ESSA pre-exercise screening tool)
…of an exercise and nutrition program for 1. IMPLEMENTATION... women up to 12 months postpartum 2. ACCEPTABILITY... delivered by an Accredited Practising 3. PRELIMINARY EFFICACY... Dietitian (APD) and Accredited Exercise Physiologist (AEP) via video conferencing. 32 The Team • Prof Clare Collins • Dr Tracy Burrows • Dr Chris May • Ms Li Kheng Chai (Supported by a APA & Barker’s family scholarship • Ms Denise Wong See • Mr Ashley Young • Ms Carol Teh Parenting SMS support Remember, your child looks up to you and your choices!
Thinking how to encourage your little chef to help with cooking today? Visit cookingmattersaustralia.com.au/cooking-with-kids! Diet Bytes and Baby Bumps
Evaluating feasibility of tailored smart phone nutrition assessment and support in pregnant indigenous and non-indigenous women
Diet Bytes & Baby Bumps, image-based dietary records, purpose-built brief Selected Nutrient and Diet Quality (SNaQ) tool + tailored nutrition advice + dietary feedback via smartphone 1) Short video summary sent to smartphone; 2) Follow-up telephone consult with dietitian Example Diet Bytes entry Diet Bytes and Baby Bumps
Mobile app
Photo + voice dietary record Short video feedback Analysis of diet … from little things, big things grow … Measuring diet quality and alignment with Australian Dietary Guidelines www.healthyeatingquiz.com.au Diet Quality, Morbidity and Mortality
▪ Majority found inverse relationship between diet quality score and health outcomes ▪ Higher diet quality moderately protective ▪ All-cause mortality risk 17-42% ▪ CVD mortality 18-53% ▪ CVD risk 14-28% ▪ Cancer mortality 13-30% ▪ All-cancer risk 7-35%
Wirt A and Collins CE. Diet Quality - What is it and does it matter? Public Health Nutrition 2009:12(12);2473-92
Higher Scores in those who repeat the HEQ™
Williams RL, Rollo ME, Schumacher T, Collins CE. Diet quality scores of Australian adults who have completed the Healthy Eating Quiz NUTRIENTS 2017, 9(8), 880; doi:10.3390/nu9080880 HEQ™ linked to our programs and external websites ™
www.cookingmattersaustralia.com.au
www.healthydadsandkids.com ™
VISIDA ▪The Voice-Image-Sensor technologies for Individual Dietary Assessment (VISIDA) system ▪Combination of technologies to collect dietary intake data ▪Supported by funding from the Bill & Melinda Gates Foundation
@VISIDAproject Team • Investigators : Dr Megan Rollo, A/Prof Tracy Burrows Dr Marc Adam, Dr Shamus Smith, Prof Clare Collins • Project Manager: Dr Kerith Duncanson • Software Engineers: Josh Crompton, Connor Dodd • Research Dietitians: Janelle Windus (Cambodia), Janelle Skinner, Felicity Steel • PhD candidates: Philipp Rouast (Engineering), Hamid Heydarian (Engineering), Naomi Saronga (Nutrition) Target population and countries
▪ Mothers or other adult women who care for the child (e.g. grandmother, aunt) and children aged ≤5 years ▪ Countries: ▪ Australia, Cambodia and Tanzania ▪ Partner Organisations: ▪ This Life Cambodia (TLC) ▪ Muhimbili University of Health and Allied Science (MUHAS) 1. Collection of dietary 2. Analysis of dietary intake data VISIDA system intake data 49
VISIDA A F B E D C
Hybrid capture consisting of: Active: A. Image-voice food record application Web-based Content Management 3. Interpretation of dietary System (CMS): to capture of recipe/preparation & intake data eating occasion E. speech-to-text and quick search to + facilitate matching to records in food VISIDA Passive: composition databases; B. Wrist-worn sensor to detect hand-to- F. Tools for quantification, including mouth movements wiremesh, reference image and measures databases. Ground truth measures as required: Offline ‘lite’ version C. Time-lapse camera; and D. Spherical video camera*. Included within CMS to facilitate identification of at-risk individuals and prioritise intervention OUTLINE
1. Why Nutrition 2. Getting on the IT path in nutrition & dietetic research 3. Stories from our frontline 4. Challenges and opportunities for N&D and IT 5. Where to from here
The University of Newcastle | Prof Clare Collins | @ProfCollins | CRICOS Provider 00109J | www.newcastle.edu.au Challenges “… I usually eat really healthy! …” Where can you find decent, trustworthy nutrition information? Opportunities
https://theconversation.com/what-is-a-balanced-diet-anyway-72432 Research-to-Action Cycle
Systematic reviews to synthesise evidence on Goal 1 diet-related outcomes Evidence
Translate results to ‘real world’ Develop novel, validated settings in consultation with Goal 4 Nutrition Science Goal 2 tools to measure dietary consumers, health professionals Translation Communication Methods intake using technology and industry partners and provide real-time feedback on intake
Goal 3 Interventions Conduct feasibility and efficacy trials, targeted to life stage (pregnancy) and health risk (CVD, type 2 and gestational diabetes) Prof Clare Collins @ProfCCollins Free - Massive Online Open Course (MOOC)
Next course starts 4th Sept 2019
ATC 2019 Prof Clare Collins @ProfCCollins “I am 42 and have tried every diet going. I finally feel empowered and I am enjoying my food for the first time in years… ...No more ‘specialist’ weight loss programs, no more feeling powerless or depressed. Thank you so so much. The course has been life changing and I will recommend to all of my friends”
“As a 58 year old woman, I found this course to be literally a life saver! ….It really put me on a path to better health. I was able to enjoy weight loss as a benefit of better eating”
The University of Newcastle | Prof Clare Collins | @ProfCollins | CRICOS Provider 00109J | www.newcastle.edu.au The University of Newcastle | Prof Clare Collins | @ProfCollins | CRICOS Provider 00109J | www.newcastle.edu.au Summary ▪ Nutrition is omnipotent ▪ The IT path in clinical nutrition & dietetics needs to move into health services ▪ Seize opportunities and learn from the challenges ▪ Keep moving forward ▪ The future looks interesting
Image from dreamstime.com OUTLINE
1. Why Nutrition 2. Getting on the IT path in nutrition & dietetic research 3. Stories from our frontline 4. Challenges and opportunities for N&D and IT 5. Where to from here ?
The University of Newcastle | Prof Clare Collins | @ProfCollins | CRICOS Provider 00109J | www.newcastle.edu.au The future is now
@ProfCCollins @UONPRCPAN @@Uni_Newcastle @HMRIAustralia
The University of Newcastle | Prof Clare Collins | @ProfCollins | CRICOS Provider 00109J | www.newcastle.edu.au