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Dietary patterns and nutritional status during adolescence have a direct effect on future health outcomes.
This study aimed to promote fruit and vegetable intake among adolescents using a smartphone app called MyPlate.
This randomized intervention study was conducted in an urban area of Jeddah, Saudi Arabia. We included 104 adolescents aged 13 to 18 years, who were randomized into intervention (n=55) or control (n=49) arms. We examined the effects of MyPlate on fruit and vegetable intake over 6 weeks in the intervention group. Pre- and postintervention questionnaires were used in the intervention and control groups.
The control group showed a significant increase in fruit consumption scores between baseline (1.15, SD 0.68) and postintervention (1.64, SD 0.98;
These findings suggest that a smartphone app did not significantly improve fruit and vegetable intake among adolescents.
ClinicalTrials.gov NCT05692765; https://clinicaltrials.gov/ct2/show/NCT05692765
Adolescence is a critical period in the growth and development of an individual. Thus, dietary habits during this timeframe are important in shaping future health outcomes [
A diet rich in FVs is associated with numerous health benefits. FVs are a good source of vitamins A and C, minerals, electrolytes, phytochemicals, antioxidants, and dietary fiber [
Recently, smartphone apps have been used to promote health and wellness among individuals in various communities. As a result, several nutritional interventions have been attempted to determine the usefulness of these apps in promoting healthy dietary habits. One of the advantages of these apps is that they can serve as cost-effective and flexible platforms for implementing behavioral changes in nutrition [
In this study, we aimed to examine the effects of the MyPlate smartphone app on FV intake over 6 weeks in adolescents from Jeddah, Saudi Arabia.
This randomized intervention study was conducted between February and March 2021 among adolescents from Jeddah, Saudi Arabia. Since schools were closed because of the COVID-19 pandemic, adolescents were recruited through invitations sent via email and WhatsApp to their parents using snowballing recruitment. The invitation to the study was first sent to members and bachelor of science students at the Food and Nutrition Department of King Abdulaziz University to help the research team with recruitment. Then, the research team contacted the parents and adolescents, who voluntarily agreed to participate in the study. The study procedures were explained to the parents or guardians of all prospective participants. There were no imposed circulation restrictions or curfews in Jeddah during the study period. Participants were included if they were in good health (based on the self-reported absence of diseases, such as diabetes mellitus, that may influence food intake), aged 13 to 18 years, attending school, and had access to a smartphone, either their own or their parents’. The exclusion criteria were poor health or an age not within the age range of this study. In total, 146 adolescents were initially recruited, of whom 26 withdrew from the study because they did not complete the baseline questionnaire or voluntarily decided to withdraw. The remaining 120 adolescents were randomly divided into intervention and control groups. Microsoft Excel (version 22, Microsoft Corp) with the
The sample size was determined based on the ability to detect an expected mean difference of 0.7 servings, a value that was chosen based on a previous parallel intervention study [
CONSORT (Consolidated Standards of Reporting Trials) diagram for the trial.
The study procedures were approved by the Unit of Biomedical Ethics Research Committee at King Abdulaziz University (101-21). All adolescents participated voluntarily and provided verbal consent for participation in the study; their parents or guardians provided written informed consent. This trial was registered on ClinicalTrials.gov (NCT05692765).
This was a randomized intervention study conducted with 104 adolescents: 49 in the control group and 55 in the intervention group. Adolescents in the intervention group were divided into 11 smaller groups, each containing 5 participants, to explain the app. One of the researchers conducted video conference calls with each of these small intervention groups. The researcher provided a brief presentation about the health benefits and appropriate serving sizes of FVs and explained how to use the smartphone app. An instructional brochure was provided in Arabic to all adolescents in the intervention group. The research team was available to assist participants at any time during the study period. The participants were required to choose 3 of 7 goals for fruits and 3 of 7 goals for vegetables. The fruit goals were as follows: (1) have fruit with dinner; (2) add fruit to your salad; (3) snack on fruit; (4) have fruit for a sweet treat; (5) have fruit with lunch; (6) add frozen, canned, or dried fruit to your meal; and (7) start your day with fruit. The vegetable goals were as follows: (1) have vegetables with dinner; (2) have a dark green vegetable; (3) start your day with vegetables; (4) have a red or orange vegetable; (5) have vegetables with lunch; (6) snack on vegetables; and (7) make a salad or side dish using beans, peas, or lentils. After choosing 6 goals (3 for fruit and 3 for vegetables), the participants were required to mark the goal that they chose daily and were requested to adhere to their chosen goals until the end of the study. They were encouraged to turn on notifications for the app to receive reminder messages. The research team also sent weekly WhatsApp text message reminders (in Arabic) to the adolescents. The intervention period was 6 weeks. Adolescents in the control group were not exposed to the smartphone app and did not receive any advice to promote their FV consumption, which may have affected their FV consumption. Instead, they were only asked to complete the pre- and postintervention questionnaires.
This study used the free nutritional MyPlate smartphone app, which is readily available on both iOS and Android platforms, to promote FV intake among adolescents. The app uses a multicomponent communications plan that was developed by the US Department of Agriculture Food and Nutrition Service in 2011. The app aids in translating the American Dietary Guidelines to the public and can be used as a nutritional education resource for children and adults. The app icon is an easy, effective, visual platform that helps promote healthy food choices that include all food groups and create a balanced plate at mealtimes. The app allows one to set daily healthy eating goals for each food group and track individual progress [
All measures were collected via an online questionnaire on Google Forms. The questionnaire consisted of two parts. The first part included sociodemographic data, including information regarding age, sex, school type (private or public), weight and height of the adolescent and their parents, the parents’ education level (high school or lower, bachelor’s degree, or postgraduate degree), the parents’ employment status (employed or unemployed), number of children in the family, and family income. This part of the questionnaire was completed by the participant with the assistance of one of their parents. The research team provided instructions to participants on the appropriate way to measure height and weight using a weight scale and measuring tape. BMI was calculated as the weight in kilograms divided by the height in meters squared (kg/m2). BMI was evaluated using the Saudi growth chart (BMI for age). A BMI between the 15th and 85th percentiles was considered normal; BMI between the 85th and 95th percentiles was considered overweight, and BMI above the 95th percentile indicated obesity [
A validated food-frequency questionnaire (FFQ) was used to compare FV consumption in adolescents at baseline and after the intervention period in both groups. The FFQ was one that has previously been used with some adaptations to make it suitable for Saudi adolescents [
Descriptive and inferential statistics were calculated using SPSS for Windows (version 27.0; IBM Corp). Frequency analysis was conducted to evaluate the baseline sociodemographic characteristics of the sample. The differences in age and BMI for adolescents and parents at baseline between the two study groups were compared using a 2-tailed
In total, 104 adolescents completed the study, of whom 23.1% were boys (24/104). The mean age of the adolescents was 15.1 (SD 1.6) years, and 75% (78/104) attended public school. The mean body weight was 56.9 (SD 15.8) kg. Most of the adolescents were in the normal body weight range, whereas 10.6% (13/104) were overweight, and 4.8% (6/104) were obese (
The main fruit goals chosen by the adolescents were starting the day with fruit or having fruit as a snack (29/55, 52%), having canned fruit or fruit as a sweet (25/55, 45%), and having fruit salad or fruit at dinner (16/55, 29%), whereas the least preferred goal was having fruit at lunch (8/55, 14%). Among the vegetable goals, the most frequently chosen goals were having vegetables at lunch (56%, 31/55), having bean salad (52%, 29/55), having dark green vegetables (47%, 26/55), having vegetables as a snack (36%, 20/55), starting the day with vegetables (34%,19/55), and having red or orange vegetables (32%,18/55), whereas the least chosen goal was having vegetables at dinner (30%,17/55).
Baseline characteristics of the study participants in the control and intervention groups. Differences between the control and intervention groups were analyzed using the chi-square test.
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Control group (n=49) | Intervention group (n=55) | |||||
Age (years), mean (SD) | 15.57 (2) | 14.74 (1) | .11 | ||||
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<.001 | ||||||
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Adolescent boys | 20 (41) | 4 (7) |
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Adolescent girls | 29 (59) | 51 (93) |
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.77 | ||||||
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Government | 36 (73) | 42 (76) |
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Private | 13 (27) | 13 (24) |
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.84 | ||||||
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Normal | 40 (82) | 45 (83) |
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|||
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Overweight | 7 (14) | 6 (11) |
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|||
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Obese | 2 (4) | 4 (6) |
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|||
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.31 | ||||||
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High school or lower | 18 (36) | 17 (32) |
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|||
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Bachelor | 27 (55) | 28 (51) |
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|||
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Postgraduate | 4 (8) | 10 (19) |
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.08 | ||||||
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Unemployed | 1 (2) | 3 (6) |
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Employed | 42 (86) | 37 (67) |
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Retired | 6 (12) | 15 (28) |
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Paternal BMI (kg/m2), mean (SD) | 28.30 (9) | 26.54 (4) | .02 | ||||
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.46 | ||||||
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Unemployed | 28 (57) | 35 (65) |
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Employed | 18 (37) | 19 (34) |
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Retired | 2 (4) | 1 (2) |
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Student | 1 (2) | 0 |
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.37 | ||||||
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High school or lower | 16 (33) | 18 (33) |
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|||
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Bachelor | 22 (45) | 31 (56) |
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Postgraduate | 11 (22) | 6 (11) |
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Maternal BMI (kg/m2), mean (SD) | 26.55 (6) | 26.41 (4) | .90 | ||||
Number of siblings, mean (SD) | 4.93 (2) | 4.61 (2) | .50 | ||||
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.20 | ||||||
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Less than 5000 | 4 (8) | 5 (9) |
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5000 to <10,000 | 4 (8) | 13 (24) |
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10,000 to <20,000 | 21 (43) | 22 (41) |
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>20,000 | 20 (41) | 15 (28) |
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aA conversion rate of 3.75 SR=US $1 applied.
The baseline fruit consumption score in the intervention group (1.48, SD 0.99) was slightly higher than that in the control group (1.15, SD 0.68;
The intake of individual fruit items increased in both groups (
Fruit and vegetable scores in the control (n=49) and intervention (n=55) groups at baseline and after 6 weeks. The adjusted model was assessed using regression analysis. The estimates were adjusted for age, sex, the adolescents’ BMI, the parents’ education and BMI, and family income.
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Preintervention | Postintervention | Adjusted |
||||
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|||||||
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Control | 1.15 (0.68) | 1.64 (0.98) | .01 | |||
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Intervention | 1.48 (0.99) | 1.70 (1.11) | .31 | |||
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Adjusted |
.11 | .52a | N/Ab | |||
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|||||||
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Control | 1.44 (0.97) | 1.55 (0.90) | .54 | |||
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Intervention | 1.50 (0.97) | 1.43 (1.03) | .30 | |||
|
Adjusted |
.35 | .35a | N/A |
aThese estimates were also adjusted for preintervention values; these
bN/A: not applicable.
The use of mobile phone–based approaches to encourage healthier lifestyles is becoming more common. To our knowledge, this is the first study conducted in Saudi Arabia to investigate the effects of using a smartphone app on FV intake among adolescents. Although the fruit consumption score was higher in the intervention group at baseline, this group showed no significant increase in fruit intake after 6 weeks of using the app, whereas the control group showed significantly higher fruit consumption. Both control and intervention groups showed no significant changes in vegetable consumption scores before or after the intervention. The control and intervention groups showed a significant increase in consumption of some fruit items, such as fruit juice, compared with the preintervention period. The intake of some vegetable items (ie, potatoes, lettuce, and Jew’s mallow) decreased in the intervention group after 6 weeks of using the app, whereas no significant changes in vegetable consumption were observed in the control group. Moreover, we found a significant difference in the consumption of some FV items between the control and intervention groups after 6 weeks of the intervention.
Consistent with our findings, several previous studies have demonstrated low FV consumption among school-aged children from different regions in Saudi Arabia. According to a previous cross-sectional study, only 12.8% and 22.8% of adolescents (n=2908, age 14-19 years) reported daily consumption of fruits and vegetables, respectively [
In contrast to our findings, previous studies have confirmed the positive effects of technological interventions, including web-based platforms and smartphone apps, in promoting FV consumption. In one study, an innovative web-based platform (Team Nutriathlon) was used to promote FV intake among adolescents aged 13 to 14 years from the Quebec City region in Canada for 6 weeks. Team Nutriathlon is a 6-week school-based nutrition intervention. The website provided a 6-week calendar on which adolescents were asked to record their consumption of FVs from Monday to Friday. Team Nutriathlon increased FV consumption in the intervention group (n=193) by 3.4 servings, in comparison to an increase of 0.39 servings (n=89) in the control group [
Indeed, it is crucial to note the role of parents in shaping eating behaviors and food preferences from an early stage. Parents are responsible for the availability of healthy food and encouraging children and adolescents to consume and accept different flavors, especially fruits and vegetables, as these foods are not very tasty [
Several prior studies were conducted in schools with the involvement of teachers and peers, which had a positive effect on the adoption of healthy habits and increased FV consumption [
Our study has several limitations, including a limited duration, which should be extended in future research. Second, measuring FV consumption using a self-administered questionnaire may have led to some limitations, although previous studies conducted among individuals in the same age group have employed the same questionnaire, and previous studies showed that a self-administered FFQ is an easy and useful tool for assessing dietary intake among adolescents [
The low FV intake among adolescents in Saudi Arabia highlights the importance of implementing an approach to promote FV intake in this population. However, the use of a smartphone app in the current study did not increase FV consumption among adolescents in the intervention group after 6 weeks. Future nutritional educational studies aiming to enhance the dietary patterns of adolescents should involve parents, as they have an important role in their children’s dietary patterns. Moreover, increased involvement by peers and teachers in schools can promote FV intake among adolescents with beneficial effects.
Supplementary Table 1. Fruit and vegetables listed in the food frequency questionnaire.
Supplementary Table 2. Comparison of fruit and vegetable item scores for the control (n=49) and intervention (n=55) groups at baseline and after 6 weeks.
CONSORT-eHEALTH checklist (V 1.6.2).
food frequency questionnaire
fruit and vegetable
We thank the adolescents for their time and participation in the study.
IMS conceptualized the research topic, designed the study, recruited participants, collected data, and produced the initial manuscript draft. RSA, MFB, DAH, and JKS recruited participants, conducted the interviews, collected data, conducted the analyses, and assisted in writing the initial manuscript draft. NM Aljefree and NM Almoraie conceptualized the research topic, revised the data analysis, and revised the manuscript. All authors critically reviewed and approved the submitted manuscript.
None declared.
This randomized study was only retrospectively registered due to lack of awareness of registration requirements. The editor granted an exception from ICMJE rules mandating prospective registration of randomized trials. However, readers are advised to carefully assess the validity of any potential explicit or implicit claims related to primary outcomes or effectiveness, as retrospective registration does not prevent authors from changing their outcome measures retrospectively.