Nurse-led counselling and smartphone-based coaching for dietary behaviors, weight management and cardiometabolic risk in middle-aged Chinese in Hong Kong: a randomized controlled trial

Aims To evaluate the effectiveness of a 6-month multi-component intervention combining nurse-led counseling and smartphone-based coaching in improving dietary behaviors, weight management, and cardiometabolic risk among middle-aged Chinese adults in Hong Kong. Methods and results This randomized controlled trial randomly assigned 221 participants to intervention (n=110) or control (n=111) groups. The intervention group received health assessments (anthropometry, body composition, blood pressure, blood glucose/lipids), immediate nurse-led face-to-face counseling at baseline, 3 and 6 months, and thrice-weekly smartphone coaching. Controls (n=111) received health assessments only. Outcomes included dietary behaviors, weight management and cardiometabolic biomarkers. Linear mixed-effects models were used to assess the intervention effects. The intervention group showed significant improvements in prioritizing food nutrition at 3 months (β = 0.22, 95% CI [0.06, 0.38]) and 6 month (β = 0.23, 95% CI [0.07, 0.39]), and food freshness at 3 month (β = 0.24, 95% CI [0.09, 0.39]) versus controls. The intervention group also exhibited a greater decrease in animal/poultry fat intake at 3 months (β = -0.21, 95% CI [-0.38, -0.03]). Significant reductions in blood glucose (β = -0.46 mmol/L, 95% CI [-0.79, -0.12]), total cholesterol (β = -7.80 mg/dL, 95% CI [-14.78, -0.82]), and triglycerides (β = -22.04 mg/dL, 95% CI [-39.95, -4.12]) were observed in the intervention group at 6 months. Conclusions The nurse-smartphone integrated intervention effectively improved dietary behaviors and cardiometabolic profiles, offering a scalable strategy for cardiometabolic disorders prevention in Hong Kong Chinese populations. Registration ClinicalTrials.gov NCT05400187