Steinberg Submits NIH R01 Application

Kudos to Dori Steinberg and her team for the submission of their National Institutes of Health (NIH) R01 application entitled “Using digital health to improve diet quality and reduce cancer risk." This proposal requests funding for a five-year period with a start date of July 1, 2019.

Cancer is the second leading cause of death in the U.S., with 694,000 new cases of cancer each year. Of the ten cancer prevention guidelines from American Institute for Cancer Research (AICR), four focus primarily on lifestyle behaviors associated with improving diet quality: 1) Avoid sugary drinks; 2) Eat more of a variety of vegetables, fruits, whole grains and legumes such as beans; 3) Limit consumption of red meats and avoid processed meats; and 4) Limit consumption of salty foods and foods processed with salt. Given that fewer than 20% of Americans meet these dietary recommendations, interventions are needed to improve overall diet quality. Evidence supports the DASH (Dietary Approaches to Stop Hypertension) dietary pattern to reduce cancer risk. Similar to the AICR guidelines, DASH is rich in fruits and vegetables, legumes, lean protein, and low-fat dairy, and reduced in red meats, sweets and processed foods. Numerous trials have demonstrated the health-promoting effects of DASH across a diverse range of populations, yet dissemination of DASH remains a challenge. To address this need, we developed and tested the feasibility of a 3-month digital health intervention called DASH Cloud. Intervention participants tracked their diet daily using a commercial tracking app. 

Our intervention technology platform extracted food and nutrient data from the app using an application programming interface. Each day, we compared individual participant’s nutrient intake to the recommended levels in the DASH diet. We then processed the data against an algorithm and sent automated text messages to each participant with information on DASH diet adherence. Results indicated successful recruitment and retention, high engagement with diet tracking and positive changes in diet quality. In the current proposal, we will improve the personalization of the automated text messages and include a responsive way of delivering coaching, based on daily diet data. The efficacy of this approach will be tested via a fully-powered 12-month randomized controlled trial. The trial will examine the effects of the intervention on changes in dietary quality among adults not meeting the AICR guidelines. The primary outcome is 6-month change in DASH adherence, as measured by 24-hour recalls. Secondary outcomes include 12-month changes in DASH adherence, and changes in clinical (blood pressure weight, lipids, glucose) and behavioral (intervention engagement, physical activity, medication adherence) outcomes. The scientific premise represents establishing the efficacy of a previously-deemed feasible approach for disseminating the DASH diet.

The objective of the current proposal is to improve upon the DASH Cloud intervention, based on findings from the feasibility study. We will enhance the personalization of the automated text messages and include a scalable and responsive way of delivering coaching, based on diet data tracked in the app. We will test the efficacy of this 6-month intervention compared to an attention control arm that includes just diet tracking in a fully-powered randomized controlled trial and examine 6- and 12-month changes in DASH adherence among 160 men and women at risk for cancer based on adherence lifestyle behaviors using the AICR cancer prevention index. We propose the following specific aims: Aim 1: To determine the efficacy of the 6-month DASH Cloud intervention, compared to an attention control arm, on 6- and 12-month changes in DASH adherence. Aim 2: To determine the efficacy of the DASH Cloud intervention, as compared to an attention control arm, on 6- and 12-month changes in relevant clinical (i.e., blood pressure, fasting lipids, weight), behavioral (i.e., engagement with intervention components, physical activity, medication use), and psychosocial variables (i.e., depression, self-efficacy for diet, social support). Aim 3: To explore 6- and 12- month differences across study arms by baseline race/ethnicity, sex, and cancer risk based on AICR guidelines.