Evidence supports recommending the Mediterranean dietary pattern (MDP) in the management of cardiovascular disease (CVD), type 2 diabetes (T2D), non-alcoholic fatty liver disease (NAFLD) and solid organ transplant (SOT). However, the evidence-practice gap is unclear within non-Mediterranean countries. We investigated integration of MDP in Australian dietetic practice, and barriers and enablers to MDP implementation for chronic disease management. Dietitians managing CVD, T2D, NAFLD and/or SOT patients (n = 182, 97% female) completed an online survey in November 2019. Fewer than 50% of participants counsel patients with CVD (48%), T2D (26%), NAFLD (31%) and SOT (0–33%) on MDP in majority of their practice. MDP principles always recommended by >50% of participants were promoting vegetables and fruit and limiting processed foods and sugary drinks. Principles recommended sometimes, rarely or never by >50% of participants included limiting red meat and including tomatoes, onion/garlic and liberal extra virgin olive oil. Barriers to counselling on MDP included consultation time and competing priorities. Access to evidence, professional development and education resources were identified enablers. An evidence-practice gap in Australian dietetic practice exists with <50% of participants routinely counselling relevant patient groups on MDP. Strategies to support dietitians to counsel complex patients on MDP within limited consultations are needed.

Background: Digital health interventions may facilitate management of chronic conditions; however, no reviews have systematically assessed the effectiveness of dietary interventions delivered by digital health platforms for improving dietary intake and clinical outcomes for adults with diet-related chronic conditions. Methods: Databases CINAHL, CENTRAL, Embase and MEDLINE were searched from inception to April 2021 to identify controlled trials for dietary education delivered by digital health (mobile or electronic health) to adults with diet-related chronic conditions. Random effects analysis was performed for diet quality, food groups, nutrients and clinical outcomes. Screening, data extraction and quality checking were completed in duplicate. Results: Thirty-nine studies were included involving 7333 participants. Significant changes were found for Mediterranean diet adherence score (standardised mean difference [SMD] = 0.79; 95% confidence interval [CI] = 0.18 to 1.40), overall fruit and vegetable intake (mean difference [MD]: 0.63 serves/day; 95% CI = 0.27-0.98), fruit intake alone (MD = 0.58 serves/day; 95% CI = 0.39 to 0.77) and sodium intake (SMD = −0.22; 95% CI = −0.44 to −0.01). Improvements were also found for waist circumference [MD = −2.24 centimetres; 95% CI = −4.14 to −0.33], body weight (MD = −1.94 kg; 95% CI = −2.63 to −1.24) and haemoglobin A1c (MD = −0.17%; 95% CI = −0.29 to −0.04). Validity of digital assessment tools to measure dietary intake were not reported. The quality of evidence was considered to have low to moderate certainty. Conclusions: Modest improvements in diet and clinical outcomes may result from intervention via digital health for those with diet-related chronic conditions. However, additional robust trials with better reporting of digital dietary assessment tools are needed to support implementation within clinical practice.

Objectives To determine the effectiveness of dietary education delivered by digital health interventions for improving dietary intake and clinical outcomes in chronic conditions. Methods CINAHL, Cochrane CENTRAL, Embase and MEDLINE databases were systematically searched. Controlled trials involving dietary education delivered via digital health interventions (mobile or electronic health technology) to adults with chronic conditions were included. The dietary intervention component must have been developed or delivered by health professionals, or in line with best practice guidelines. Data was meta-analyzed by a random effects model for diet quality, fruit and vegetable consumption, dietary intake of fat, sodium, protein, fibre and energy, and various clinical outcomes. Screening, data extraction and quality assessment were completed in duplicate. Results Thirty-eight studies compromising 7,303 participants met the inclusion criteria. Digital health interventions included: mobile phone apps and messaging systems (n = 16), internet-based (n = 16), electronic software (n = 1) or a combination of these methods (n = 5). Studies showed digital health was effective at improving Mediterranean diet adherence score [standardized mean difference: 0.79; 95% confidence interval (CI): 0.18, 1.40] and overall fruit and vegetable intake [mean difference (MD): 0.58 serves per day; 95% CI: 0.01, 1.14]. However, no significant effects were found for other measures of diet quality, single food group intake, nutrients and energy intake. Digital health interventions significantly reduced waist circumference [MD: −2.34 cm; 95% CI: −4.29, −0.38cm), body weight [MD: −1.88; 95% CI: −2.60, −1.16 kg) and hemoglobin A1c levels [MD: −0.18%; 95% CI: −0.30, −0.05%). Overall the studies were rated as poor quality. Conclusions Dietary education delivered via digital health interventions significantly improved Mediterranean diet adherence, overall fruit and vegetable intake, waist circumference, weight and hemoglobin A1c levels. However, given the relatively poor quality of the studies, additional robust trials are needed to the guide implementation and scale-up of these interventions in health services. Funding Sources None.