{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:29:42Z","timestamp":1786116582375,"version":"build-2736575974"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"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. Artif. Intell."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Childhood obesity is a major determinant of lifelong non-communicable disease risk, yet early intervention may modify this trajectory. Digital twins and large language models may provide a scalable means of translating individualized risk prediction into understandable and motivating lifestyle guidance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We developed a precision-preventive intervention integrating a childhood-overweight digital twin with an empathic, supervised-fine-tuned open-source nutrition-guidance large language model. The model was based on Llama 3-70B and fine-tuned using the Standard Tables of Food Composition in Japan 2020 and its 2023 amendment. Response appropriateness was evaluated using 30 nutrition-related questions independently assessed by three registered dietitians. The digital twin adopted a published Tohoku Medical Megabank Birth and Three-Generation cohort model predicting overweight risk at 36\u201347 months, 6 years, 11 years, and 14 years. A total of 121 women with a child under 14 years of age participated in the digital-twin visualization and a single chat-based test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The off-the-shelf Llama 3-70B produced a mean of 18 appropriate responses out of 30, whereas the fine-tuned model produced 27 out of 30. The digital-twin visualization and chat consultation were rated highly for clarity, perceived value, behavioral intention, and willingness to continue, with core-item means above 4.9 on a five-point scale. Thematic analysis showed that 112 of 121 participants perceived the recommended lifestyle changes as feasible and achievable gradually.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The integrated intervention demonstrated preliminary operational feasibility and acceptability. Individualized future-risk visualization combined with supportive conversational guidance was associated with high self-reported behavioral intention. Controlled and longitudinal studies are required to determine whether these preliminary motivational responses translate into sustained behavior change and improved health outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/frai.2026.1927993","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T11:04:21Z","timestamp":1786014261000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Digital twin\u2013supported behavioral intention in mothers of young children to prevent childhood obesity: a large language model\u2013based intervention study"],"prefix":"10.3389","volume":"9","author":[{"given":"Kenji","family":"Nakamura","sequence":"first","affiliation":[{"name":"Center for Mathematics and Data Science, Gunma University","place":["Maebashi, Gunma, Japan"]},{"name":"Innovative Medical Research Center, Gunma University Hospital","place":["Maebashi, Gunma, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Genki","family":"Shinoda","sequence":"additional","affiliation":[{"name":"Tohoku Medical Megabank Organization, Tohoku University","place":["Sendai, Miyagi, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aoi","family":"Noda","sequence":"additional","affiliation":[{"name":"Tohoku Medical Megabank Organization, Tohoku University","place":["Sendai, Miyagi, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mami","family":"Ishikuro","sequence":"additional","affiliation":[{"name":"Tohoku Medical Megabank Organization, Tohoku University","place":["Sendai, Miyagi, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taku","family":"Obara","sequence":"additional","affiliation":[{"name":"Tohoku Medical Megabank Organization, Tohoku University","place":["Sendai, Miyagi, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taeka","family":"Matsubara","sequence":"additional","affiliation":[{"name":"Interfaculty Initiative in Information Studies, The University of Tokyo","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideki","family":"Ishii","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Graduate School of Medicine, Gunma University","place":["Maebashi, Gunma, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiro","family":"Onishi","sequence":"additional","affiliation":[{"name":"System Integration Center, Gunma University Hospital","place":["Maebashi, Gunma, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiaki","family":"Ohyama","sequence":"additional","affiliation":[{"name":"Innovative Medical Research Center, Gunma University Hospital","place":["Maebashi, Gunma, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1001\/jamainternmed.2023.1838","article-title":"Comparing physician and artificial intelligence chatbot responses to patient questions posted to a public social media forum","volume":"183","author":"Ayers","year":"2023","journal-title":"JAMA Intern. Med."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1506","DOI":"10.1038\/s41598-024-85003-w","article-title":"Evaluation of LLMs accuracy and consistency in the registered dietitian exam through prompt engineering and knowledge retrieval","volume":"15","author":"Azimi","year":"2025","journal-title":"Sci. Rep."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"2329","DOI":"10.1056\/NEJMoa072515","article-title":"Childhood body-mass index and the risk of coronary heart disease in adulthood","volume":"357","author":"Baker","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1111","DOI":"10.1136\/bmj.301.6761.1111","article-title":"The fetal and infant origins of adult disease","volume":"301","author":"Barker","year":"1990","journal-title":"BMJ"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1302","DOI":"10.1056\/NEJMoa1713231","article-title":"Change in overweight from childhood to early adulthood and risk of type 2 diabetes","volume":"378","author":"Bjerregaard","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"793","DOI":"10.1056\/NEJMp1500523","article-title":"A new initiative on precision medicine","volume":"372","author":"Collins","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1038\/s41746-022-00640-7","article-title":"The health digital twin to tackle cardiovascular disease - a review of an emerging interdisciplinary field","volume":"5","author":"Coorey","year":"2022","journal-title":"NPJ Digit. Med."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1080770","DOI":"10.3389\/fpsyt.2023.1080770","article-title":"AI-based chatbot micro-intervention for parents: meaningful engagement, learning, and efficacy","volume":"14","author":"Entenberg","year":"2023","journal-title":"Front. Psych."},{"key":"ref9","doi-asserted-by":"crossref","DOI":"10.1016\/B978-155860643-2\/50011-1","volume-title":"Persuasive Technology: using Computers to change what we Think and do","author":"Fogg","year":"2003"},{"key":"ref10","volume-title":"Act on the Comprehensive and Planned Promotion of Measures to Enable the Public to Receive High-Quality and Appropriate Genomic Medicine with Peace of Mind (Genomic Medicine Promotion Act)","year":"2023"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.48550\/arXiv.2407.21783","article-title":"The Llama 3 herd of models","author":"Grattafiori","year":"2024","journal-title":"Meta AI Tech Report"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1875","DOI":"10.1093\/jamia\/ocae120","article-title":"Impact of high-quality, mixed-domain data on the performance of medical language models","volume":"31","author":"Griot","year":"2024","journal-title":"J. Am. Med. Inform. 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Med."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"2177","DOI":"10.1007\/s00234-024-03427-7","article-title":"Automated classification of brain MRI reports using fine-tuned large language models","volume":"66","author":"Kanzawa","year":"2024","journal-title":"Neuroradiology"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1038\/s41746-024-01073-0","article-title":"Digital twins for health: a scoping review","volume":"7","author":"Katsoulakis","year":"2024","journal-title":"NPJ Digit Med."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"104896","DOI":"10.1016\/j.jbi.2025.104896","article-title":"Resource-efficient instruction tuning of large language models for biomedical named entity recognition","volume":"170","author":"Liu","year":"2025","journal-title":"J. Biomed. Inform."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1186\/1748-5908-6-42","article-title":"The behaviour change wheel: a new method for characterising and designing behaviour change interventions","volume":"6","author":"Michie","year":"2011","journal-title":"Implement. Sci."},{"key":"ref20","volume-title":"Standard Tables of Food Composition in Japan - 2020 (Eighth Revised Edition)","year":"2020"},{"key":"ref21","volume-title":"List of Foods Newly Listed in the Standard Tables of Food Composition in Japan (2020, Eighth Revised Edition) - 2023 Amendment","year":"2023"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"e32487","DOI":"10.2196\/32487","article-title":"The effect of a future-self avatar mobile health intervention (FutureMe) on physical activity and food purchases: randomized controlled trial","volume":"24","author":"M\u00f6nninghoff","year":"2022","journal-title":"J. Med. Internet Res."},{"key":"ref23","doi-asserted-by":"publisher","first-page":"CD007145","DOI":"10.1002\/14651858.CD007145.pub3","article-title":"Diet or exercise, or both, for preventing excessive weight gain in pregnancy","volume":"6","author":"Muktabhant","year":"2015","journal-title":"Cochrane Database Syst. 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Digit Health."},{"key":"ref26","doi-asserted-by":"publisher","first-page":"e78625","DOI":"10.2196\/78625","article-title":"Evaluating large language models and retrieval-augmented generation enhancement for delivering guideline-adherent nutrition information for cardiovascular disease prevention: cross-sectional study","volume":"27","author":"Parameswaran","year":"2025","journal-title":"J. Med. Internet Res."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"6122","DOI":"10.3390\/ijerph19106122","article-title":"Preventive counseling in routine prenatal care - a qualitative study of pregnant women's perspectives on a lifestyle intervention, contrasted with the experiences of healthcare providers","volume":"19","author":"Schulz","year":"2022","journal-title":"Int. J. Environ. Res. 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Assoc."},{"key":"ref36","doi-asserted-by":"publisher","first-page":"2169","DOI":"10.1093\/jn\/134.9.2169","article-title":"Maternal nutrition and fetal development","volume":"134","author":"Wu","year":"2004","journal-title":"J. Nutr."},{"key":"ref37","doi-asserted-by":"publisher","first-page":"1833","DOI":"10.1093\/jamia\/ocae045","article-title":"PMC-LLaMA: toward building open-source language models for medicine","volume":"31","author":"Wu","year":"2024","journal-title":"J. Am. Med. Inform. 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