Mobile Applications and Artificial Intelligence for Nutrition Education: A Narrative Review
, Lucia Varela Vazquez 1, Aroa Lopez-Santamarina 1, Alicia Mondragon-Portocarrero 1, Sercan Karav 2 and Jose Manuel Miranda 1,*
Round 1
Reviewer 1 Report
Comments and Suggestions for Authors
Dear authors, the idea for the paper is very interesting, but I fear your paper fails to make an adequate narrative review on "Mobile Health and Artificial Intelligence as Nutritional Support for the Population".
So let me start with the title: Mobile Health (mHealth) is a wide field of study, that is not confined in mobile Apps. It comprehends, for example, the use of smart watches and other wearables that may or may not be used in the context of nutritional support. On the same line, "nutritional support for the population" is not a very good expression. I would prefer "providing nutritional information" or "nutrition education". And also, the expression "population" is not adequate, and seldom used in this context, to the best of my knowledge.
Finally, to end my argument in disfavour of the title, there number of mobile apps that use AI and are related to nutrition and / or eating habits is very limited, as this is a very recent area of research, so it came as a surprise that you were able to find 100 papers that complied with your search criteria.
Allow me now to discuss what I believe is one major flaw of your research: you cannot claim that an app is "an health app" if it has not been marked as a medical device wither by the EU CE marking legislation or the USA FDA regulations (or any other major legal framework).
If an app is not CE maked (or etc.), it is not a medical device, and therefore it _cannot_ be called or addressed as an health-related app.
So you need to clearly address this before proceeding to the narrative review, because it may happen that you are analyzing apps that claim to be health apps but in fact are apps that provide false or unsubstantiated results.
On other issues, I have many concerns with the introduction, as folows:
Due to the increase in noncommunicable diseases and the health costs they produce, society is facing a growing interest in the fields of human nutrition and dietetics; however, this is not the only reason, as we should not forget the social perspective, in which image and physical appearance play a very important role [1].
— this sentence is too general and not useful at all. I understand that you are referring to Diabetes, for example, but you need to be concrete
Currently, people's awareness of the need for a healthier lifestyle is on the rise.
— You meed to be able to sustain this claim. Otherwise, this is not true.
This is due to the increased interest in nutrition; in fact, nutritional knowledge is essential for promoting and improving eating habits, as it ensures that the necessary nutrient needs are met to avoid problems resulting from inadequate feeding [2]. Exposing individuals to nutrition education-based interventions is also likely to improve food choices and, consequently, dietary behaviors [3]. Therefore, it is necessary to raise awareness of healthy eating habits and to know which foods to consume to change dietary lifestyles
— how do you explain the pandemic of obesity in many industrialized countries, e.g., the US?
Packaged foods for sale as well as restaurant menus provide nutritional information on the foods they offer [4].
— this is not true for all restaurants, therefore, you cannot write this. Also, reference 4 is inadequate for this claim.
Due to advances in mobile 48 technology, there are a multitude of applications on the market, many of which are free 49 and used to treat health problems [5]
— this is the other way around
Health apps provide an opportunity to mitigate 50 some of the limitations associated with traditional prescriptions, such as cost, patient bur- 51 den, and compliance. Many of these apps offer users additional tools to monitor their 52 health or achieve health-related goals [7].
— one thing is to have apps that claim to be health apps, the other thing is to have apps that are marked as medical devices and therefore, that are really health apps.
Recently, new ideas and concepts, such as electronic health (eHelath) o
— typo
Comments on the Quality of English Language
some sentences are too short. For example "Smartphones and artificial intelligence have become very useful tools for health-related interventions. Because they are very accessible and cost-effective." why is this a single sentence?
Author Response
Reviewer 1:
1) With respect to the comments about “Dear authors, the idea for the paper is very interesting, but I fear your paper fails to make an adequate narrative review on "Mobile Health and Artificial Intelligence as Nutritional Support for the Population".
Response: the authors would like to thank you for your opinion and valuable comments. Indeed, it is possible that the manuscript in its original version may not achieve the ambitious goals we had set ourselves. Therefore, we have tried to redirect the manuscript according to the comments provided by the 4 reviewers who have been involved in the revision of the manuscript. Thanks to their accurate comments, as well as to the English editing service offered by MDPI, we hope that the manuscript in its corrected version has improved sufficiently to improve your opinion of it.
2) With respect to the comments about “So let me start with the title: Mobile Health (mHealth) is a wide field of study, that is not confined in mobile Apps. It comprehends, for example, the use of smart watches and other wearables that may or may not be used in the context of nutritional support. On the same line, "nutritional support for the population" is not a very good expression. I would prefer "providing nutritional information" or "nutrition education". And also, the expression "population" is not adequate, and seldom used in this context, to the best of my knowledge.”
Response: Thank you very much. Throughout the manuscript, according to the comments provided by the reviewer, the term “mHealth” has been modified to “mobile applications”. “nutritional support for the population” was changed to ‘nutritional education’. The term “population” was modified throughout the manuscript and changed to more appropriate terms, including “people”, “users”.
3) With respect to the comments about “Finally, to end my argument in disfavour of the title, there number of mobile apps that use AI and are related to nutrition and / or eating habits is very limited, as this is a very recent area of research, so it came as a surprise that you were able to find 100 papers that complied with your search criteria.”
Response: Thank you for your comment. The title, according to other comments stated previously by the Reviewer, was changed to “Mobile Applications and Artificial Intelligence as Nutritional Education for the People: A Narrative Review” avoiding the terms “Mobile health” and “population”. With respect to the comments about the high number of references, please note that some of the articles cited were included to sustain the affirmations included in the main text. None of the references included are shelf-citations from the authors, that is one of the reasons why the number of references in many scientific articles, especially review articles, is currently inadequately increased. In this case, no self-citation has been included, but all articles can be found in the scientific search engines mentioned in the article using the search criteria employed. There are even more, which in the end have not been included because they were considered less appropriate.
4) With respect to the comments about “Allow me now to discuss what I believe is one major flaw of your research: you cannot claim that an app is "an health app" if it has not been marked as a medical device wither by the EU CE marking legislation or the USA FDA regulations (or any other major legal framework). If an app is not CE maked (or etc.), it is not a medical device, and therefore it _cannot_ be called or addressed as an health-related app.” So you need to clearly address this before proceeding to the narrative review, because it may happen that you are analyzing apps that claim to be health apps but in fact are apps that provide false or unsubstantiated results.
Response: Please note that several of the works included as references use the cited term, even if they do not come from Europe or the USA, nor have they been approved by the health authorities of those territories. It is not our aim to re-evaluate articles published by other authors in terms of the appropriateness of the terms used, which may have erroneously included the term “health app”. Please note that many of the papers included in the review come from countries where our characters are not used (such as Asian countries), so it would be very difficult for us to properly assess the appropriateness of the applications mentioned. However, according to the comment from the reviewer, the term “health app” was removed from the revised version of the manuscript. Instead, it was used other term such as “mobile applications”; “nutrition applications”, “dietetic applications” and in some cases, it was deleted from the revised version of the manuscript.
On other issues, I have many concerns with the introduction, as folows:
5) With respect to the comments about “Due to the increase in noncommunicable diseases and the health costs they produce, society is facing a growing interest in the fields of human nutrition and dietetics; however, this is not the only reason, as we should not forget the social perspective, in which image and physical appearance play a very important role [1].
— this sentence is too general and not useful at all. I understand that you are referring to Diabetes, for example, but you need to be concrete”
Response: According to the suggestions from the reviewer, and taking into account that the cited phrase is too generic, it was deleted from the revised version of the manuscript.
6) With respect to the comments about “Currently, people's awareness of the need for a healthier lifestyle is on the rise.— You meed to be able to sustain this claim. Otherwise, this is not true.
Response: Thank you for your comment. According to the suggestions from the Reviewer, the cited phrase and the corresponding reference was deleted from the revised version of the manuscript
7) With respect to the comments about “This is due to the increased interest in nutrition; in fact, nutritional knowledge is essential for promoting and improving eating habits, as it ensures that the necessary nutrient needs are met to avoid problems resulting from inadequate feeding [2]. Exposing individuals to nutrition education-based interventions is also likely to improve food choices and, consequently, dietary behaviors [3]. Therefore, it is necessary to raise awareness of healthy eating habits and to know which foods to consume to change dietary lifestyles
— how do you explain the pandemic of obesity in many industrialized countries, e.g., the US?”
Response: Response: Thank you for your comment. According to the suggestions from the Reviewer, the cited phrase and the corresponding references (2 and 3) was deleted from the revised version of the manuscript
8) With respect to the comments about “Packaged foods for sale as well as restaurant menus 8) provide nutritional information on the foods they offer [4].
— this is not true for all restaurants, therefore, you cannot write this. Also, reference 4 is inadequate for this claim.”
Response: Thank you for your comment. In the revised version of the manuscript, it was clarified that not in all countries packaged foods offer nutritional information. The reference to restaurants was also deleted, as well as the reference employed.
9) With respect to the comments about “Due to advances in mobile 48 technology, there are a multitude of applications on the market, many of which are free 49 and used to treat health problems [5] — this is the other way around”.
Response: we are not quite sure what the reviewer means by it being the other way around, but in any case, to avoid misinterpretation, the phrase has been deleted from the revised version of the manuscript.
10) With respect to the comments about “Health apps provide an opportunity to mitigate 50 some of the limitations associated with traditional prescriptions, such as cost, patient bur- 51 den, and compliance. Many of these apps offer users additional tools to monitor their 52 health or achieve health-related goals [7].— one thing is to have apps that claim to be health apps, the other thing is to have apps that are marked as medical devices and therefore, that are really health apps.”
Response: Thank you for your comment. According to previous suggestion from the Reviewer, the term health apps were changed to “mobile apps” or other related terms in the revised version of the manuscript.
11) With respect to the comments about “Recently, new ideas and concepts, such as electronic health (eHelath) o— typo”
Response: Thank you for your comment. Typographic miskate was corrected in the revised version of the manuscript.
12) With respect the comments about “Comments on the Quality of English Language: some sentences are too short. For example "Smartphones and artificial intelligence have become very useful tools for health-related interventions. Because they are very accessible and cost-effective." why is this a single sentence?
Response: Yes, it is possible that there may be some editorial errors, since, as you may have noticed, none of the authors are native English speakers. Therefore, we have decided to hire the English editing services of MDPI in order to solve these problems. After this correction by a professional editor, we hope that the format of the article has improved substantially (Certificate english-85753).
Author Response File: 
Author Response.pdf
Reviewer 2 Report
Comments and Suggestions for Authors
This is an example of up-to-date topic which refers to using applications on mobile phones with the help of artificial intelligence in the context of nutritional support for the users. This narrative review is quite well constructed and gives a lot of examples of how applications help to change dietary habits and improve the diet satisfaction as well as physical activity nutrition. At the end authors indicate correctly future trends and conclusions. What I missed in this review is lack of clear aim of this review which should be clearly stated. Besides, if this is a very first review about this topic it should be underlined, if not, it would be worth mention that other reviews have been published already, and consequently what this review gives new.
Line 39-40
Be aware that your paper will be read by international readers. Not all countries expect nutritional information from restaurants so it would be better to write “restaurant menus in some/many countries”
Author Response
Reviewer 2:
1) With respect to the comments about “This is an example of up-to-date topic which refers to using applications on mobile phones with the help of artificial intelligence in the context of nutritional support for the users. This narrative review is quite well constructed and gives a lot of examples of how applications help to change dietary habits and improve the diet satisfaction as well as physical activity nutrition. At the end authors indicate correctly future trends and conclusions.”
Response: The authors are very grateful for the positive and constructive feedback from the reviewer.
2) With respect to the comments about “What I missed in this review is lack of clear aim of this review which should be clearly stated. Besides, if this is a very first review about this topic it should be underlined, if not, it would be worth mention that other reviews have been published already, and consequently what this review gives new.”
Response: Thank you for your comment. Accordingly to the comments from the reviewer, we included in the revised version of the manuscript (end of the Introduction section) a new paragraph to sustain the information required by the reviewer. In concrete, it was added the following paragraph:
“There are other literature reviews involving the usefulness of mobile applications on the adoption of healthy lifestyles [13], improvement of diet for overweight patients [14], for development of healthy habits in the adolescent population [15], or for sustain nutrition for exercise [16]. However, this is the first narrative review about mobile applications for nutritional education and prevention of metabolic diseases, that also compiles the information available from the tools provided by artificial intelligence with direct application in the creation of a personalized dietary plan. In general, the article provides a summary of the present level of knowledge about the subject. Then, a discussion of the results reported in recent research publications helps the reader develop a knowledge of the subject at hand”
In order to sustain the affirmation, four new references were added to the references list, in concrete:
- Pimenta, F.; Lopes, L.; Gonçalves, F.; Campos, P. Designing Positive Behavior Change Experiences: a Systematic Review and Sentiment Analysis based on Online User Reviews of Fitness and Nutrition Mobile Applications. MUM 2020, 2020, 22-25, doi.org/10.1145/3428361.3428403.
- Li, S.J.; You, Z.; Ma, M.H.; Wang, A.Q.; Tang, X.Y.; Pei, R.Y.; Piao, M.H. Effects of Mobile Applications on Weight-Related, Behavior and Metabolic Outcomes for Adults with Overweight and Obesity: A Systematic Review and Meta-Analysis. Stud Health Technol Inform 2024, 325, 386-391, doi.org/10.3233/SHTI240175.
- Arana-Alvarez, C.; Gómez-Asencio, D.; Gago-Valiente, F.J.; Cabrera-Arana, Y.; Merino-Godoy, A.A.; Moreno-Sánchez, E. Virtual Pedagogy and Care: Systematic Review on Educational Innovation with Mobile Applications for the Development of Healthy Habits in the Adolescent Population. Nutrients 2023, 15, 18, doi.org/10.3390/nu15183966.
- Peart, D.J.; Briggs, M.A.; Shaw, M.P. Mobile applications for the sport and exercise nutritionist: a narrative review. BMC Sports Sci. Med. Rehabilitation 2022, 14(1), 30, doi.org/10.1186/s13102-022-00419-z.
3) With respect to the comments about “ Line 39-40: Be aware that your paper will be read by international readers. Not all countries expect nutritional information from restaurants so it would be better to write “restaurant menus in some/many countries”
Response: Thank you very much for your comment. The term “in some countries” was added after “restaurant menus”.
The English Grammar and spelling was corrected by MDPI Editing service (certificate english-85753)
Author Response File: Author Response.pdf
Reviewer 3 Report
Comments and Suggestions for Authors
The article is well written and interesting. Could you add a little bit more at the limitations and future trends chapters?!
Author Response
Reviewer 3:
1) With respect to the comments about “The article is well written and interesting. Could you add a little bit more at the limitations and future trends chapters?”
Response: Thank you very much for your constructive comments. In the corrected version of the manuscript, we have included additional information about the limitations and future implications of the manuscript. In concrete, in the limitations it was included the paragraphs”:
“because it must be considered than health data The lack of safe custody can lead to very significant financial penalties, and in some countries, even criminal consequences.”
“With respect to the applications that assess dietary intake, it should be noted that many of them do not take into account the portion. The databases to which they are connected are not homogeneous in terms of nutritional composition and the estimation of the portion ingested is variable, leading in many cases to an underestimation of intake [16].
For the subheadings of future trends, it was added the following paragraph:
“Given the significant limitations and constraints with respect to security issues in technology, the main barrier and future need when adopting a new technology is the concern for security.
The main barrier and future need when adopting new technology is the concern about the security of data or information that is shared using this new technology, as well as what hands such data can get into and what use can be made of it.
Efficacy in diagnosis and prognosis is another aspect that should be studied, since if these types of applications become widespread, we run the risk of the user developing a sense of false competence that leads them to distance themselves from healthcare professionals and adopt decisions for which the user is not prepared. A future trend should be to adequately regulate that only proven professionals can develop, or at least validate and constantly supervise, such applications.”
Reviewer 4 Report
Comments and Suggestions for Authors
First of all, I would like to mention Thank you for giving the opportunity to review your article, “Mobile Health and Artificial Intelligence as Nutritional Support for the Population: A narrative Review.” The authors has done good job but there’s some corrections that are needed. So I would like to recommend this article for Minor revision.
Please follow this changes, which will be reviewed further,
The paper gives a thorough summary of how artificial intelligence and digital health relate to nutritional assistance, however, it still needs some small edits for readability and clarity. There are a few well-formed but awkwardly constructed sentences, which gives the reading a somewhat jerky feeling. Small grammatical mistakes that break sentences and employ terminology inconsistently take away from the article's polished appearance. Furthermore, certain passages use the same language repeatedly, and other words are not presented or clarified in enough detail. The readability and impact of the document would be greatly increased by addressing these problems by making modest structural changes to the sentences, improving the language, and improving the transition between paragraphs. All things considered, these are small issues that don't compromise the work's main conclusions or contributions.
Final conclusion-
The article requires minor editing to improve clarity and structure, reference and also preparation as per the journals guidelines.
Thank you,
Reviewer
Author Response
Reviewer 4:
1) With respect to the comments about “First of all, I would like to mention Thank you for giving the opportunity to review your article, “Mobile Health and Artificial Intelligence as Nutritional Support for the Population: A narrative Review.” The authors has done good job but there’s some corrections that are needed. So I would like to recommend this article for Minor revision.”
Response: Thank you very much for your constructive comments and for your time reviewing our article. Your help and time are much appreciated and thanked by us
2) With respect to the comments about:
“The paper gives a thorough summary of how artificial intelligence and digital health relate to nutritional assistance, however, it still needs some small edits for readability and clarity. There are a few well-formed but awkwardly constructed sentences, which gives the reading a somewhat jerky feeling. Small grammatical mistakes that break sentences and employ terminology inconsistently take away from the article's polished appearance. Furthermore, certain passages use the same language repeatedly, and other words are not presented or clarified in enough detail. The readability and impact of the document would be greatly increased by addressing these problems by making modest structural changes to the sentences, improving the language, and improving the transition between paragraphs. All things considered, these are small issues that don't compromise the work's main conclusions or contributions.
Final conclusion: The article requires minor editing to improve clarity and structure, reference and also preparation as per the journals guidelines.”
Response: Thank you very much for your constructive comments. Yes, it is possible that there may be some editorial errors, since, as you may have noticed, none of the authors are native English speakers. Therefore, we have decided to hire the English editing services of MDPI in order to solve these problems (Editing-Certificate-85753). After this correction by a professional editor, we hope that the format of the article has improved substantially.
Author Response File: Author Response.pdf
