A randomized controlled study investigating the impact of dietary education and counselling with a smartphone application on secondary prevention of coronary artery disease (TeleDiet Study)

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Daiichi-Sankyo, Inc. Background In secondary prevention of coronary artery disease (CAD), nutritional management is an integral part of lifestyle optimization. While face-to-face nutritional follow-up is part of standard of care in many centres, few studies have investigated the potential of remote follow-up using digital solutions. Purpose We investigated the effectiveness of a smartphone application for nutrition education and feedback with pictures of meals by a dietitian for CAD patients. Methods Sixty patients with CAD were randomized 1:1 to either a TeleDiet group or a Control group. Patients in the TeleDiet group participated in dietary education using a messaging application. The primary outcome was the change of the Mediterranean diet score (MedDietScore). Blood tests (blood lipids, blood glucose and kidney function), body mass index, self-efficacy, medication adherence, and health-related quality of life (HRQoL) and the Nutrition-Score during the observation period were analysed as secondary outcomes. The Nutrition-Score is a modification of the MedDietScore in which parameters about salt and sugar intake are added to the score, and an intake of zero alcohol is considered positive (in contrast to the MedDietScore). Results Sixty patients participated in the study. The difference in the MedDietScore in the TeleDiet group was greater than in the control group, but not significant (2.0 [-1.0, 4.0] vs. 0.0 [-3.0, 1.5], p = 0.066). The difference in the Nutrition-Score in the TeleDiet group from baseline to week 12 was significantly greater than in the control group (3.0 [1.0, 3.5] vs. 0.0 [-3.0, 2.0], p = 0.029). There was a significant difference in the within-group analysis only in the TeleDiet group (32 [30, 38] at baseline vs. 36 [33, 41] at week 12, p = 0.045). Nutrition knowledge of the TeleDiet group improved significantly compared to the control group (1.9 ± 1.7 vs. 0.8 ± 2.1, p = 0.048). The change in HRQoL in the TeleDiet group was greater than in the control group, but not significant (7.4 ± 8.9 vs. 3.2 ± 7.0, p = 0.063). Conclusion A feedback system using a simple messaging application that allows CAD patients to simply send a picture of their food has a positive effect on nutrition knowledge and the implementation of the Mediterranean diet.