{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:33:01Z","timestamp":1787009581522,"version":"build-2736575974"},"reference-count":118,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2024,5,30]],"date-time":"2024-05-30T00:00:00Z","timestamp":1717027200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Institute for Digital Medicine","award":["A-0001319-00-00"],"award-info":[{"award-number":["A-0001319-00-00"]}]},{"name":"Yong Loo Lin School of Medicine"},{"name":"N.1 Institute for Health"},{"name":"College of Design and Engineering at the National University of Singapore"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,5,31]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The digital health field is experiencing substantial growth due to its potential for sustained and longitudinal deployment. In turn, this may drive improved monitoring and intervention as catalysts for behavioral change compared to traditional point-of-care practices. In particular, the increase in incidence of population health challenges such as diabetes, heart disease, fatty liver disease, and other disorders coupled with rising healthcare costs have emphasized the importance of exploring technical, economics, and implementation considerations, among others in the decentralization of health and healthcare innovations. Both healthy individuals and patients stand to benefit from continued technical advances and studies in these domains. To address these points, this study reports a N-of-1 study comprised of sustained regimens of intermittent fasting, fitness (strength and cardiovascular training), and high protein, low carbohydrate diet and parallel monitoring. These regimens were paired with serial blood ketone, blood glucose (wearable and finger stick) and blood pressure readings, as well as body weight measurements using a collection of devices. Collectively this suite of platforms and approaches were used to monitor metabolic switching from glucose to ketones as energy sources\u2014a process associated with potential cardio- and neuroprotective functions. In addition to longitudinal biomarker dynamics, this work discusses user perspectives on the potential role of harnessing digital devices to these dynamics as potential gamification factors, as well as considerations for the role of biomarker monitoring in health regimen development, user stratification, and potentially informing downstream population-scale studies to address metabolic disease, healthy aging and longevity, among other indications.<\/jats:p>","DOI":"10.1093\/pnasnexus\/pgae214","type":"journal-article","created":{"date-parts":[[2024,5,30]],"date-time":"2024-05-30T13:35:00Z","timestamp":1717076100000},"source":"Crossref","is-referenced-by-count":6,"title":["N-of-1 health optimization: Digital monitoring of biomarker dynamics to gamify adherence to metabolic switching"],"prefix":"10.1093","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4925-1738","authenticated-orcid":false,"given":"Peter","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore , Singapore 117583, Singapore"},{"name":"Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore , Singapore 117456, Singapore"},{"name":"The N.1 Institute for Health (N.1), National University of Singapore , Singapore 117456, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0356-826X","authenticated-orcid":false,"given":"Xavier","family":"Tadeo","sequence":"additional","affiliation":[{"name":"Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore , Singapore 117456, Singapore"},{"name":"The N.1 Institute for Health (N.1), National University of Singapore , Singapore 117456, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4209-1647","authenticated-orcid":false,"given":"Han Shi Jocelyn","family":"Chew","sequence":"additional","affiliation":[{"name":"Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore , Singapore 117597 , Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6797-7850","authenticated-orcid":false,"given":"Yoann","family":"Sapanel","sequence":"additional","affiliation":[{"name":"Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore , Singapore 117456, Singapore"},{"name":"Singapore's Health District @ Queenstown, Yong Loo Lin School of Medicine, National University of Singapore , Singapore 117456 , Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoong Hun","family":"Ong","sequence":"additional","affiliation":[{"name":"Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore , Singapore 117456, Singapore"},{"name":"The N.1 Institute for Health (N.1), National University of Singapore , Singapore 117456, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5129-5801","authenticated-orcid":false,"given":"Nicole Yong Ting","family":"Leung","sequence":"additional","affiliation":[{"name":"Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore , Singapore 117456, Singapore"},{"name":"The N.1 Institute for Health (N.1), National University of Singapore , Singapore 117456, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward Kai-Hua","family":"Chow","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore , Singapore 117583, Singapore"},{"name":"Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore , Singapore 117456, Singapore"},{"name":"The N.1 Institute for Health (N.1), National University of Singapore , Singapore 117456, Singapore"},{"name":"Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore , Singapore 117600 , Singapore"},{"name":"Cancer Science Institute of Singapore, National University of Singapore , Singapore 117599 , Singapore"},{"name":"NUS Centre for Cancer Research (N2CR), Yong Loo Lin School of Medicine, National University of Singapore , Singapore 117599 , Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7337-296X","authenticated-orcid":false,"given":"Dean","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore , Singapore 117583, Singapore"},{"name":"Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore , Singapore 117456, Singapore"},{"name":"The N.1 Institute for Health (N.1), National University of Singapore , Singapore 117456, Singapore"},{"name":"Singapore's Health District @ Queenstown, Yong Loo Lin School of Medicine, National University of Singapore , Singapore 117456 , Singapore"},{"name":"Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore , Singapore 117600 , Singapore"},{"name":"The Bia-Echo Asia Centre for Reproductive Longevity and Equality, Yong Loo Lin School of 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