Concordance evaluation of a nutrition self-assessment app and clinical experts in estimating energy requirements and deficits among ONS consumers.

BACKGROUND AND OBJECTIVES: The Nutrition Self-Assessment App (APP), a novel smartphone-based tool, was developed to enable users of oral nutritional supplements (ONSs) to self-assess total energy expenditure (TEE) and identify energy deficits, providing personalized ONS recommendations. By integrating step-count track-ing and dietary intake reporting, the app estimates physical activity levels and energy deficits. However, validation against clinician assessments is essential prior to large-scale implementation. METHODS AND STUDY DESIGN: In this multicenter cross-sectional study (October-November 2023), TEE and deficits were evaluated using both the app and clinician assessments. Statistical analyses included paired t-tests, intraclass correlation coefficients (ICC), and Bland-Altman plots. Clinician satisfaction was measured via a 5-point Likert scale. RESULTS: Among 423 ONS users, no significant differences were found between clinician- and app-derived estimates for TEE (1606.2 ± 287.2 vs. 1541.6 ± 300.5 kcal/day, p >0.05) or energy deficits (610.4 ± 376.9 vs. 600.1 ± 384.6 kcal/day, p >0.05). Agreement was moderate for TEE (ICC = 0.66) and excellent for deficits (ICC = 0.94). Bland-Altman analysis showed 93.9% (397/423) of deficit differences within 95% limits of agreement. Clinicians rated the app as "very satisfied" (46.1%) or "fairly satisfied" (37.1%) for most participants. CONCLUSIONS: The app demonstrated moderate agreement with clinician assessments for TEE estimation, while showing high agreement in energy deficit estimation. These findings validate its potential reliabil-ity as a supportive tool for ONS management. Its integration of activity tracking and dietary monitoring supports scalable implementation to improve ONS adherence.