{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T05:15:36Z","timestamp":1788498936637,"version":"build-2803163510"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Digital approaches that capture dietary behavior repeatedly in real-world settings may improve the monitoring of long-term lifestyle interventions while reducing participant burden and supporting self-awareness. This study developed and evaluated a low-burden dietary ecological momentary assessment (EMA) protocol to monitor Mediterranean diet adherence during the 12-month PENSA multimodal lifestyle trial in older adults at increased risk of cognitive decline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 104 participants aged 60\u201380\u202fyears with subjective cognitive decline and APOE-\u03b54 carrier status were included. Daily mobile EMA prompts assessed key Mediterranean diet food groups through a rotating schedule, and participants received personalized feedback every 4\u202fweeks. EMA-derived adherence indicators were evaluated against the Mediterranean Diet Adherence Screener, 3-day food diaries, nutrient profiles, usability data, and cardiometabolic and dementia-risk markers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Mediterranean diet adherence improved over the intervention, with EMA scores increasing from 73.6 to 82.3% and capturing dynamic changes in dietary quality across the year. EMA-derived indicators showed increasing convergence with the Mediterranean Diet Adherence Screener over time (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u202f=\u202f0.36 at 6\u202fmonths and\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u202f=\u202f0.46 at 12\u202fmonths; both\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001) and were associated with expected nutrient patterns, including higher fiber and monounsaturated fat intake and lower free sugar, saturated fat, and sodium intake. Higher EMA-based adherence was also associated with lower body mass index, visceral adiposity, body fat percentage, insulin resistance, glycated hemoglobin, triglyceride-glucose index, and lifestyle-based dementia risk. The protocol showed high feasibility, with sustained completion rates and positive participant evaluations, although engagement declined modestly over time.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      These findings support dietary EMA as a feasible, scalable, and behaviorally meaningful approach for monitoring and promoting Mediterranean diet adherence in real-world lifestyle interventions, with potential value both as an assessment tool and as an active component to reinforce dietary change. The PENSA trial is registered at\n                      <jats:uri>ClinicalTrials.gov<\/jats:uri>\n                      (NCT03978052).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1927498","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T04:25:26Z","timestamp":1788495926000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Dietary ecological momentary assessments: validation against food diaries and associations with health biomarkers"],"prefix":"10.3389","volume":"13","author":[{"given":"Anna","family":"Boronat","sequence":"first","affiliation":[{"name":"Integrative Pharmacology and Clinical Neurosciences, Hospital del Mar Research Institute","place":["Barcelona, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Soldevila-Domenech","sequence":"additional","affiliation":[{"name":"Integrative Pharmacology and Clinical Neurosciences, Hospital del Mar Research Institute","place":["Barcelona, Spain"]},{"name":"Clinical Research and Risk Factors for Neurodegenerative Diseases Group, Barcelona\u03b2eta Brain Research Center, Pasqual Maragall Foundation","place":["Barcelona, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joana","family":"Clivill\u00e9-P\u00e9rez","sequence":"additional","affiliation":[{"name":"Department of General and Digestive Surgery, Hospital del Mar","place":["Barcelona, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aida","family":"Cuenca-Royo","sequence":"additional","affiliation":[{"name":"Integrative Pharmacology and Clinical Neurosciences, Hospital del Mar Research Institute","place":["Barcelona, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Gomis-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Integrative Pharmacology and Clinical Neurosciences, Hospital del Mar Research Institute","place":["Barcelona, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thais","family":"Lorenzo","sequence":"additional","affiliation":[{"name":"Integrative Pharmacology and Clinical Neurosciences, Hospital del Mar Research Institute","place":["Barcelona, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iris","family":"Piera","sequence":"additional","affiliation":[{"name":"Integrative Pharmacology and Clinical Neurosciences, Hospital del Mar Research Institute","place":["Barcelona, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus","family":"Langohr","sequence":"additional","affiliation":[{"name":"Departament d\u2019Estad\u00edstica i Investigaci\u00f3 Operativa, Universitat Polit\u00e8cnica de Catalunya\u2014BarcelonaTech","place":["Barcelona, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Montserrat","family":"Fit\u00f3","sequence":"additional","affiliation":[{"name":"Grup de recerca en Risc Cardiovascular i Nutrici\u00f3, Hospital del Mar Research Institute","place":["Barcelona, Spain"]},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Obesidad y Nutrici\u00f3n (CIBEROBN)","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helmut","family":"Schr\u00f6der","sequence":"additional","affiliation":[{"name":"Grup de recerca en Epidemiologia i Gen\u00e8tica Cardiovascular, Hospital del Mar Research Institute","place":["Barcelona, Spain"]},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Epidemiologia y Salud P\u00fablica (CIBERESP)","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oriol","family":"Grau-Rivera","sequence":"additional","affiliation":[{"name":"Clinical Research and Risk Factors for Neurodegenerative Diseases Group, Barcelona\u03b2eta Brain Research Center, Pasqual Maragall Foundation","place":["Barcelona, Spain"]},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Neurodegenerativas (CIBERNED)","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nieves","family":"Pizarro","sequence":"additional","affiliation":[{"name":"Integrative Pharmacology and Clinical Neurosciences, Hospital del Mar Research Institute","place":["Barcelona, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Forcano","sequence":"additional","affiliation":[{"name":"Integrative Pharmacology and Clinical Neurosciences, Hospital del Mar Research Institute","place":["Barcelona, Spain"]},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Obesidad y Nutrici\u00f3n (CIBEROBN)","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael","family":"de la Torre","sequence":"additional","affiliation":[{"name":"Integrative Pharmacology and Clinical Neurosciences, Hospital del Mar Research Institute","place":["Barcelona, Spain"]},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Obesidad y Nutrici\u00f3n (CIBEROBN)","place":["Madrid, Spain"]},{"name":"Medical and Life Sciences (MELIS) Department, Universitat Pompeu Fabra","place":["Barcelona, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"102509","DOI":"10.1016\/j.cpcardiol.2024.102509","article-title":"Long-term impact of Mediterranean diet on cardiovascular disease prevention: a systematic review and meta-analysis of randomized controlled trials","volume":"49","author":"Sebastian","year":"2024","journal-title":"Curr Probl 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