Application and evaluation of mobile nutrition management service for breast cancer patients

Ji Hee Choi; Seon-Joo Park; Hee Kwon; Hae-Jeung Lee

doi:10.4163/jnh.2020.53.1.83

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Choi, Park, Kwon, and Lee: Application and evaluation of mobile nutrition management service for breast cancer patients

Research Article

J Nutr Health 2020;53(1):83-97.

Published online: 10 February 2020

DOI: https://doi.org/10.4163/jnh.2020.53.1.83

Application and evaluation of mobile nutrition management service for breast cancer patients

Ji Hee Choi¹, Seon-Joo Park¹, Hee Kwon², Hae-Jeung Lee^1,

¹ Department of Food and Nutrition, Gachon University, Seongnam 13120, Korea

² LifeSemantics, Seoul 06138, Korea

Correspondence to Hae-Jeung Lee Department of Food and Nutrition, Gachon University, 1342 Seongnam-daero, Sujeong-gu, Seongnam 13120, Korea. Tel: +82-31-750-5968 Fax: +82-31-750-5974 E-mail: skysea@gachon.ac.kr skysea1010@gmail.com

ORCID iDs Ji Hee Choi https://orcid.org/0000-0001-7801-7513 Seon-Joo Park https://orcid.org/0000-0002-1825-1815 Hee Kwon https://orcid.org/0000-0001-9910-1888 Hae-Jeung Lee https://orcid.org/0000-0001-8353-3619

Funding This work was supported by Republic of Korea and the Creative Industrial Technology Development Program (10053249, Development of Personalized Healthcare System Exploiting User Life-log and Open Government Data for Business Service Model Proof on Whole Life Cycle Care) funded by the Ministry of Trade, Industry & Energy (MOTIE, Korea) and partly supported by Gachon University research fund of 2019 (GCU-2019–0389).

Conflict of Interest There are no financial or other issues that might lead to conflict of interest.

Received 9 January 2020 Revised 14 February 2020 Accepted 14 February 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study evaluated the effects of nutrition management application in a mobile device on obesity management of patients with breast cancer.

Methods

Fifty subjects, who were breast cancer survivors, aged 30 years and older, participated in an obesity management program for four weeks. They were divided randomly into two groups: a control group (n = 25) and a treatment group (n = 25). The treatment group was provided an application for nutrition management and diet consultant, while the control group maintained their ordinary life without any nutrition management.

Results

The weight of the treatment group decreased by 0.8 kg, but the change was not significant. In contrast, the waist-hip ratio of the treatment group decreased significantly from 0.75 to 0.71 (p = 0.012). The Nutrition Quotients of the treatment group increased significantly from 61.3 to 69.6 points (p < 0.001), whereas that of the control group decreased significantly from 61.5 to 59.0 (p = 0.002).

Conclusion

This mobile nutrition management application for breast cancer patients is effective in managing obesity and dietary habits. These results can be used as basic information to prepare an obesity management program for breast cancer patients.

Keywords: breast cancer, mobile application, diet therapy, obesity management

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Fig. 1.

The example of nutrition management application of dietary record.

Fig. 2.

The example of nutrition management application of dietary guide and expert consultant.

Fig. 3.

Comparison of changes in Nutrition Quotients area scores between 2 groups.

Table 1.

Baseline characteristics of participants

Variables	Intervention group (n = 21)	Control group (n = 22)	p-value¹⁾
Age (yrs)	48.6 ± 8.1	49.8 ± 10.0	ns
Height (cm)	161.0 ± 5.2	159.2 ± 5.0	ns
Weight (kg)	63.0 ± 9.0	59.4 ± 8.7	ns
BMI (kg/m²)	24.4 ± 4.1	23.4 ± 3.1	ns
Education			ns
College or higher degree	15 (71.4)	16 (72.7)
High school	6 (28.6)	6 (27.3)
Occupation			ns
Professional	1 (4.8)	3 (13.6)
Office	2 (9.5)	4 (18.2)
Small business owner	2 (9.5)	2 (9.1)
Production, service	2 (9.5)	1 (4.6)
Unemployment	6 (28.6)	7 (31.8)
Others	8 (38.1)	5 (22.7)
Marital status			ns
Single	3 (14.3)	2 (9.1)
Married	18 (85.7)	20 (90.9)
Medication history			ns
Yes	19 (18.2)	18 (81.8)
No	2 (9.5)	4 (90.5)
Family history			ns
Yes	13 (61.9)	18 (81.82)
No	8 (38.1)	4 (18.18)
Smoking			ns
Current smoking	0 (0.0)	0 (0.0)
Past smoking (no current)	1 (4.8)	1 (4.6)
None	20 (95.2)	21 (95.5)
Alcohol intake			ns
More than twice less than 4 times a week	0 (0)	1 (4.6)
Twice less than 4 times a month	0 (0)	2 (9.1)
Below once a month	3 (14.3)	3 (13.6)
None	18 (85.7)	16 (72.7)
Quality of life (SOFA/GP-K)			ns
Normal	14 (70.0)	11 (50.0)
Fatigue	6 (30.0)	11 (50.0)
Physical activity (MET)	1,527.3 ± 999.2	1,663.7 ± 1,054.2	ns
Nutrition Quotient	61.3 ± 9.1	61.5 ± 10.8	ns

Values are presented as mean ± SD or number (%).

ns, not significant; BMI, body mass index; SOFA/GP-K, Korean Version of Schedule of Fatigue and Anergia: General Physician Questionnaire; MET, metabolic equivalent task.

¹⁾ Categorical variables used chi-square test or Fisher's exact test, and continuous variables used Student's t-test.

Table 2.

Comparison of body composition changes between intervention and control groups

Body composition	Intervention group (n = 21)			Control group (n = 22)			p-value²⁾
Body composition	Before	After	p-value¹⁾	Before	After	p-value¹⁾	p-value²⁾
Weight (kg)	63.0 ± 9.1	62.2 ± 8.9	ns	59.3 ± 8.8	59.1 ± 9.2	ns	ns
BMI (kg/m²)	24.4 ± 4.1	24.1 ± 4.1	ns	23.4 ± 3.1	23.4 ± 3.2	ns	ns
WHR	0.75 ± 0.05	0.71 ± 0.04	0.012	0.74 ± 0.04	0.73 ± 0.04	ns	0.015
Percent body fat (%)	26.0 ± 7.5	23.9 ± 7.5	ns	23.1 ± 7.1	24.3 ± 6.9	ns	ns
Fat free mass (kg)	46.2 ± 5.1	46.9 ± 4.4	ns	45.2 ± 5.0	44.6 ± 5.4	ns	ns
Skeletal muscle mass (kg)	25.5 ± 3.3	25.7 ± 2.6	ns	25.0 ± 3.1	24.4 ± 3.3	ns	ns
Soft lean mass (kg)	43.4 ± 4.9	43.9 ± 4.1	ns	42.6 ± 4.7	41.9 ± 5.1	ns	ns
Fat (kg)	16.9 ± 6.6	15.3 ± 6.5	ns	14.1 ± 5.9	14.7 ± 6.1	ns	ns
Total body water (L)	33.7 ± 3.7	34.2 ± 3.2	ns	33.1 ± 3.7	32.6 ± 3.9	ns	ns
Intracellular water (L)	21.1 ± 2.5	21.2 ± 2.0	ns	20.7 ± 2.4	20.3 ± 2.5	ns	ns
Extracellular water (L)	12.7 ± 1.2	12.9 ± 1.2	ns	12.3 ± 1.4	12.3 ± 1.4	ns	ns
Protein (kg)	9.1 ± 1.1	9.2 ± 0.9	ns	9.0 ± 1.0	8.8 ± 1.1	0.037	ns
Mineral (kg)	3.4 ± 0.3	3.5 ± 0.3	0.026	3.2 ± 0.5	3.3 ± 0.4	ns	0.024

Values are mean ± SD.

BMI, body mass index; WHR, waist hip ratio; ns, not significant.

¹⁾ Compared within groups: p-value by paired t-test or Wilcoxon signed rank test.

²⁾ Compared between groups: p-value by student t-test.

Table 3.

Comparison of changes in NQ between intervention and control groups

NQ	Intervention group (n = 21)			Control group (n = 22)			p-value²⁾
NQ	Before	After	p-value¹⁾	Before	After	p-value¹⁾	p-value²⁾
Total score	61.3 ± 9.1	69.6 ± 9.0	< 0.0001	61.5 ± 10.8	59.0 ± 10.0	0.002	< 0.0001
Category
Balance	11.8 ± 5.2	14.2 ± 5.2	< 0.0001	11.6 ± 3.3	10.5 ± 3.0	0.001	< 0.0001
Moderation	23.2 ± 4.2	25.9 ± 3.2	< 0.0001	24.4 ± 3.9	23.5 ± 3.9	0.036	< 0.0001
Diversity	16.1 ± 2.7	18.0 ± 2.2	< 0.0001	14.8 ± 4.4	14.8 ± 4.4	ns	0.005
Dietary behavior	10.2 ± 3.0	11.5 ± 2.8	< 0.0001	10.7 ± 3.2	10.1 ± 3.4	0.041	< 0.0001

Values are mean ± SD.

NQ, Nutrition Quotient; ns, not significant.

¹⁾ Compared within groups: p-value by paired t-test or Wilcoxon signed rank test.

²⁾ Compared between groups: p-value by student t-test.

Table 4.

Comparison of changes in food intake frequency/week between intervention and control groups

Foods	Intervention group (n = 21)			Control group (n = 22)			p-value²⁾
Foods	Before	After	p-value¹⁾	Before	After	p-value¹⁾	p-value²⁾
Vegetables	4.9 ± 4.5	5.7 ± 4.6	ns	5.6 ± 3.8	3.7 ± 1.4	0.016	0.003
Seaweeds	4.2 ± 3.9	4.3 ± 3.9	ns	2.3 ± 1.9	2.0 ± 1.0	ns	ns
Fruits	7.4 ± 4.8	7.9 ± 4.3	0.047	8.4 ± 4.6	6.7 ± 3.8	0.041	0.004
Dairy products	3.5 ± 2.7	4.8 ± 3.9	0.002	3.3 ± 2.6	2.9 ± 2.2	ns	0.002
Beans	4.9 ± 5.0	6.3 ± 5.3	0.008	4.9 ± 4.8	4.5 ± 4.9	ns	0.009
Eggs	4.2 ± 3.4	5.2 ± 4.3	ns	4.2 ± 2.3	3.8 ± 2.2	ns	ns
Fishes and shellfishes	2.1 ± 1.5	3.2 ± 1.7	0.006	2.2 ± 1.2	1.9 ± 1.2	ns	< 0.001
Meats	1.9 ± 1.4	2.9 ± 2.0	0.007	3.2 ± 1.7	2.7 ± 1.4	ns	0.001
Poultry	1.8 ± 1.6	2.4 ± 1.7	0.008	1.4 ± 0.8	1.2 ± 0.5	ns	0.003
Snacks and sweet breads	3.5 ± 3.4	1.8 ± 1.9	0.004	2.3 ± 2.3	2.8 ± 3.2	ns	0.006
Nuts	7.3 ± 5.7	9.0 ± 5.2	0.016	4.5 ± 3.9	4.5 ± 3.9	ns	0.015
Ramen	2.1 ± 1.7	1.4 ± 1.2	0.008	1.8 ± 2.9	1.9 ± 3.0	ns	0.015
Fast foods	1.1 ± 0.9	0.8 ± 0.5	ns	0.8 ± 0.5	0.9 ± 0.7	< 0.0001	0.037
Eating out or food delivery	2.8 ± 2.0	2.2 ± 2.0	0.016	3.0 ± 1.9	3.5 ± 2.7	ns	0.015

Values are mean ± SD. ns, not significant.

ns, not significant.

¹⁾ Compared within groups: p-value by Wilcoxon signed rank test.

²⁾ Compared between groups: p-value by student t-test.

Table 5.

Changes in nutrients intake for intervention group

Nutrients	Intervention group (n = 17)
Nutrients	Before	After	p-value¹⁾
Energy (kcal/day)	1,594.3 ± 310.7	1,581.8 ± 288.1	ns
Carbohydrate (g/day)	227.4 ± 44	224.8 ± 40.2	ns
Fat (g/day)	49.5 ± 16.4	49.3 ± 14.1	ns
Protein (g/day)	66.1 ± 20.9	66.8 ± 19.9	ns
Fiber (g/day)	24.2 ± 9.5	27.2 ± 9.7	ns
Water (g/day)	1,009.6 ± 347.8	967.3 ± 306.9	ns
Vitamin A (ugRE/day)	656.4 ± 375.8	803 ± 613.9	ns
Vitamin D (ug/day)	3.3 ± 4.4	4.3 ± 4.3	ns
Vitamin E (mg/day)	17.5 ± 6	17.4 ± 6.9	ns
Vitamin K (ug/day)	212 ± 271.6	316.1 ± 286.8	ns
Vitamin C (mg/day)	102.3 ± 77	167.9 ± 114.1	0.002
Thiamin (mg/day)	1.4 ± 0.6	1.3 ± 0.4	ns
Riboflavin (mg/day)	1.3 ± 0.5	1.5 ± 0.4	ns
Niacin (mg/day)	12.8 ± 4.6	14 ± 4.5	ns
Vitamin B₆ (mg/day)	1.5 ± 0.6	1.6 ± 0.5	ns
Folate (ug/day)	438.4 ± 192.7	537.6 ± 299.3	ns
Vitamin B₁₂ (ug/day)	12.6 ± 28.2	9.1 ± 6.8	ns
Calcium (mg/day)	529.7 ± 235.5	553.8 ± 238.8	ns
Phosphorus (mg/day)	995.7 ± 257.8	1,058.8 ± 381.5	ns
Sodium (mg/day)	3,413.9 ± 1,857.3	4,416.9 ± 2,553.2	ns
Potassium (mg/day)	2,549.0 ± 836.4	3,121.4 ± 1,065.1	0.047
Magnesium (mg/day)	96.9 ± 70	106.2 ± 58.2	ns
Iron (mg/day)	12.3 ± 3.6	18.6 ± 5.3	< 0.001
Total fatty acid (g/day)	30.4 ± 18.3	31.6 ± 15.2	ns
Monounsaturated fatty acid (g/day)	11.5 ± 7.8	11.4 ± 5.4	ns
Polyunsaturated fatty acid (g/day)	10.9 ± 6	12.1 ± 8.1	ns

ns, not significant.

¹⁾ Compared between groups: p-value by student t-test or Wilcoxon signed rank test.

Table 6.

Comparison of physical activity changes between intervention and control groups using IPAQ

Types of physical activity (MET-min/week)	Intervention group (n = 21)			Control group (n = 22)			p-value²⁾
Types of physical activity (MET-min/week)	Before	After	p-value¹⁾	Before	After	p-value¹⁾	p-value²⁾
Total physical activity	1,527.3 ± 999.2	2,209.7 ± 3,485.6	ns	1,663.7 ± 1,054.2	1,808.8 ± 1,076.1	ns	ns
Vigorous activity	232.4 ± 439.6	137.1 ± 368.5	ns	550.9 ± 786.2	458.2 ± 773.3	ns	ns
Moderate activity	135.2 ± 315.1	991.4 ± 2,912.8	0.039	247.3 ± 404.9	590.9 ± 584.0	0.008	ns
Walking activity	1,159.7 ± 850.3	1,081.1 ± 950.9	ns	865.5 ± 560.9	759.8 ± 586.5	ns
Total minutes per week sitting activity	361.5 ± 174.5	300.0 ± 140.7	ns	361.4 ± 183.6	264.3 ± 155.8	0.013	ns

Values are mean ± SD.

IPAQ, International Physical Activity Questionnaires; MET, metabolic equivalent task; ns, not significant.

¹⁾ Compared within groups: p-value by paired t-test or Wilcoxon signed rank test.

²⁾ Compared between groups: p-value by student t-test.

Table 7.

Comparison of quality of life changes between two groups using SOFA/GP-K

Quality of life	Intervention group (n = 21)			Control group (n = 22)			p-value²⁾
Quality of life	Before	After	p-value¹⁾	Before	After	p-value¹⁾	p-value²⁾
Normal	15 (71.4)	13 (61.9)	ns	11 (50.0)	16 (72.7)	0.012
Fatigue	6 (28.6)	8 (38.1)		11 (50.0)	6 (27.3)
SOFA/GP-K score	2.2 ± 2.8	2.2 ± 2.4	ns³⁾	2.7 ± 2.5	2.1 ± 2.3	ns³⁾	ns

SOFA/GP-K, Korean Version of Schedule of Fatigue and Anergia: General Physician Questionnaire; ns, not significant.

¹⁾ Categorical variables used Fisher's exact test.

²⁾ Compared between groups: p-value by student t-test.

³⁾ Compared within groups: p-value by paired t-test or Wilcoxon signed rank test.

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