JMIR Publications

ABSTRACT

Background:

A strong association exists between consuming a healthy diet and lowering cholesterol levels among individuals with high cholesterol. However, implementation and sustaining a healthy diet in the real world is a major challenge. Digital technologies are at the forefront of changing dietary behavior on a massive scale. There is a lack of evidence that has examined the benefit of a digital nutrition intervention, especially one that incorporates nutrition education, meal planning, and food ordering, on cholesterol levels among individuals with dyslipidemia.

Objective:

The aim of this observational, longitudinal study was to characterize users with dyslipidemia and evaluate changes in total cholesterol, high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), non-HDL-c, and triglycerides among individuals with dyslipidemia who used Foodsmart, a digital nutrition platform that integrates education, meal planning, and food ordering.

Methods:

We included 653 adults who used Foodsmart between January 2015 and February 2021 and reported a lipid marker twice. Participants self-reported age, gender, weight, usual dietary intake, and lipid values in a 53-item food frequency questionnaire. Dyslipidemia was defined as total cholesterol ≥ 200 mg/dL, HDL-c ≤ 40 mg/dL, LDL-c ≥ 100 mg/dL, or triglycerides ≥ 150 mg/dL. We retrospectively analyzed distributions of user characteristics and their associations with baseline dyslipidemia. We calculated mean and percent changes in lipid markers and the percent of participants with dyslipidemia at baseline who achieved normal lipid values, by enrollment duration.

Results:

We found that 68% of participants had dyslipidemia at baseline and 60% had dyslipidemia at the end of their program. Participants with dyslipidemia at baseline were more likely to be middle-aged (40-59 years old), be male, have a higher weight and BMI, and have a lower change in healthy diet score compared with participants with normal lipid levels. Participants in the program saw improvements across all six objectives: HDL-c improved by a 38.5% increase, total cholesterol decreased by 6.8%, cholesterol ratio decreased by 20.9%, LDL-c decreased by 5.8%, non-HDL-c decreased by 7.8%, and triglycerides decreased by 10.8%. Overall, 27.0% of participants with dyslipidemia at baseline achieved normal lipid levels at the end of enrollment. The percent of people with dyslipidemia at baseline who achieved normal lipid levels increased with longer enrollment duration. Males, older participants, and participants with obesity class 3 were more likely to have dyslipidemia at baseline.

Conclusions:

This study suggests that usage of the Foodsmart platform is associated with improvements in lipid markers, most likely through improved diet quality, and longer enrollment duration was associated with greater improvements.