=Paper=
{{Paper
|id=Vol-1953/healthRecSys17_paper_13
|storemode=property
|title=DIETOS: A Recommender System for Health Profiling and Diet Management in Chronic Diseases
|pdfUrl=https://ceur-ws.org/Vol-1953/healthRecSys17_paper_13.pdf
|volume=Vol-1953
|authors=Giuseppe Agapito,Mariadelina Simeoni,Barbara Calabrese,Pietro Hiram Guzzi,Giorgio Fuiano,Mario Cannataro
|dblpUrl=https://dblp.org/rec/conf/recsys/AgapitoSCGFC17
}}
==DIETOS: A Recommender System for Health Profiling and Diet Management in Chronic Diseases==
https://ceur-ws.org/Vol-1953/healthRecSys17_paper_13.pdf
DIETOS: a recommender system for health profiling and diet
management in chronic diseases
Giuseppe Agapito Mariadelina Simeoni Barbara Calabrese
Data Analytics Research Center, Nephrology and Dialysis Unit, Data Analytics Research Center,
Department of Medical and Surgical Department of Medical and Surgical Department of Medical and Surgical
Sciences, University "Magna Græcia" Sciences, University "Magna Græcia" Sciences, University "Magna Græcia"
Catanzaro, Italy 88100 Catanzaro, Italy 88100 Catanzaro, Italy 88100
agapito@unicz.it adelina.simeoni@unicz.it calabreseb@unicz.it
Pietro Hiram, Guzzi Giorgio Fuiano Mario Cannataro
Data Analytics Research Center, Nephrology and Dialysis Unit, Data Analytics Research Center,
Department of Medical and Surgical Department of Medical and Surgical Department of Medical and Surgical
Sciences, University "Magna Græcia" Sciences, University "Magna Græcia" Sciences, University "Magna Græcia"
Catanzaro, Italy 88100 Catanzaro, Italy 88100 Catanzaro, Italy 88100
hguzzi@unicz.it fuiano@unicz.it cannataro@unicz.it
ABSTRACT ACM Reference format:
Currently, there is a lack of food recommender systems able to pro- Giuseppe Agapito, Mariadelina Simeoni, Barbara Calabrese, Pietro Hiram,
Guzzi, Giorgio Fuiano, and Mario Cannataro. 2017. DIETOS: a recommender
vide high quality nutritional advices to both healthy and diet-related
system for health profiling and diet management in chronic diseases.
chronic diseases users, eventually exploiting typical regional foods. In Proceedings of the Second International Workshop on Health
We present DIETOS (DIET Organizer System), a recommender sys- Recommender Systems co-located with ACM RecSys 2017, Como, Italy,
tem for the adaptive delivery of nutrition contents to both healthy August 2017 (RecSys’17), 4 pages.
subjects and patients with diet-related chronic diseases, including
Chronic kidney disease (CKD), hypertension and diabetes. DIETOS
builds health profiles of users and provides individual nutritional
recommendation. Health profiling is based on user answers to dy- 1 INTRODUCTION
namic real-time medical questionnaires, while food recommenda-
Diet-related diseases are the most common cause of death world-
tion is extracted from the DIETOS catalogue. The catalogue con-
wide due to an excessive sature fat acids, animal proteins and/or
tains typical foods from Calabria, a southern Italian region, because
free sugars intake [3]. Chronic kidney disease (CKD) [10] is charac-
of their beneficial properties. For each food, nutrition facts, and
terized by a progressive and irreversible loss of kidney function and
indication or counter-indication for several chronic diseases are
the main determinants of CKD and its progression are hyperten-
reported. DIETOS includes some well known methods for user pro-
sion and diabetes, both clinically silent, i.e. asymptomatic [12]. The
filing (overlay profiling) and content adaptation (content selection)
unawareness of being hypertensive, or diabetic or affected by CKD
coming from general purpose adaptive web systems. A prelimi-
represents the main obstacle to the management of such patients.
nary version (for review purpose only) of DIETOS is available at
Therapeutic diet regimens have been individualized for different
http://www.easyanalysis.it/dietos.
disease stages according to Kidney Disease Outcomes Quality Initia-
tive (KDOQI) guidelines [9]. The clinical profiling is a fundamental
CCS CONCEPTS tool for the correct management of the diet in these patients and the
• Human-centered computing → Collaborative interaction; monitoring of clinical responses and compliance to the prescription
• Applied computing → Health informatics; is the major mission of nephrologists and nephrology-dedicated
nutritionists.
In recent years, different food recommender systems have been
KEYWORDS
proposed in literature [5, 11]. Another example is Yum-me [14], a
Health Recommender Systems, Diet Management, Typical Foods meal recommender that learns fine-grained food preferences with-
out relying on the user’s dietary history. However, currently, there
is a lack of food recommender systems able to provide high qual-
International Workshop on Health Recommender Systems, August 2017, Como, Italy. ity nutritional advices to both healthy and diet-related chronic
© 2017. Copyright for the individual papers remains with the authors. diseases users. Moreover, the impact on clinical outcomes of the
Copying permitted for private and academic purposes. This volume is published and
copyrighted by its editors. available applications for diet and weight management, is not well-
characterized [4]. Some recent works have focused on healthiness
into the food recommendation by analyzing large Internet sourced
datasets of recipes and the most used recommendation process
[8, 13]. To the best of our knowledge, none of currently available
HealthRecSys’17, August 2017, Como, Italy G. Agapito et al.
systems combine together health profiling, specialized dietary ad- DIETOS
vices with focus to typical regional foods, clinical and compliance DIETOSUserProfiler
monitoring in users affected by chronic diseases. UpdateHealthy
We present the architecture and functions of a web-based Rec- Information
DIETOSReminder
ommender System (RS) called DIETOS (DIET Organizer System).
Early version of DIETOS was mainly devoted to profile tourists CKD
Calculator
visiting Calabria and thus to recommend them regional foods com-
patible with their health status [1, 2]. This paper presents a revised
DIETOSSecurity
and extended version of DIETOS that allows a deeper profilation DIETOSHistory
of people affected by chronic diseases and may be used also in a
clinical context for long term diet monitoring. Main innovative
aspects of DIETOS are: Main DIETOS DB Tables
Clinical Pathologies
• The system provides individualized nutritional recommen-
Table
Users’ Profile
dations according to user health profile collected through Table
several medical questionnaires provided by nutrition special-
Typical Food
Nutraceutical
ists and nephrologists and accomplishing to World Health
Table
DIETOS Questionnaires
Organization and KDOQI guidelines. DB Table
• The ability to profile not only healthy users, but also patients Data Management System
affected by CKD, hypertension and/or diabetes. For CKD
users the system also provides glomerular filtration rate DIETOSFoodsFilter
estimation using the Chronic Kidney Disease Epidemiology
Collaboration (CKD-EPI) formula for disease staging.
• To the best of our knowledge, DIETOS is the first RS contain- Figure 1: DIETOS Architecture.
ing a catalogue of typical regional Calabrian foods. DIETOS
provides to the users beneficial properties of typical Cal-
abrian foods as well as benefits and side effects.
• DIETOS is able to achieve high quality health profiling be- are modelled by using a tree, where nodes are the questions while
cause users also provide several clinical measurements (e.g. an edge connects two nodes related to them by a particular value
creatinine, blood glucose, blood pressure). (answer) to the current question. Questionnaires are adaptive, that
is, the next question to submit to the user is obtained by analyz-
ing the child’s node of the current node of the questionnaire tree.
2 DIETOS
This solution allows conveying to the users only relevant questions
DIETOS (DIET Organizer System) is a web-based RS that profiles related to their real health status, making it possible to define the
both healthy users and users with chronic diseases, including CKD, health profile accurately. Thus, the system gives to the user more ac-
diabetes and hypertension. Based on user health profile, DIETOS curate alimentary advice, related to his/her health status, avoiding
provides individualized nutritional recommendations, also consid- to provide unsuitable advice. It is worthy to note that, the system
ering beneficial characteristics of the typical Calabrian foods. In described so far has the potential to provide alimentary advice only
order to define user health profile, DIETOS submits to the user a whether users are willing to answer the questions submitted. The
series of medical questions requiring the entry of different answers, questions to provide to the users are built upon the profiling meth-
including laboratory and vital parameters data. Users health profile ods provided by the medical team, as well as composing the results
is built by analyzing the answers given time to time by the user of querying the database that contains the information related to
and by providing dynamically the next question for the user. The the pathologies.
methodologies implemented in DIETOS make possible to obtain DIETOSHistory saves all changes made by the user so that the
very accurate users’ health profile that matches with the diagnosis data can be used to monitor the user’s health status. DIETOS
made by the doctors using standard clinical procedures. through the DIETOSReminder module can detect possible incongru-
ence related with the newly entered values and the stored data. In
2.1 DIETOS Architecture the case that the entered values are probably incorrect, the system
Figure 1 depicts the DIETOS architecture and its main modules: points out the potential incongruence to the user that can decide
DIETOSUserProfiler, DIETOSReminder, DIETOSHistory, CKDCalcula- to revise or not the entered value. In this way, the system taking
tor, DIETOSFoodsFilter and DIETOSSecurity. The DIETOS Database into account the user’s history can suggest the most suitable foods,
contains several data tables about user profile, foods, pathologies, about his/her up to date state of health, as well as can provide to the
questionnaire, that are used by the software modules described users an automatic assisted procedure to manage his/her personal
below. profile.
DIETOSUserProfiler by giving specific questions about clinical The DIETOSFoodsFilter can advise from the food list submitted
parameters (i.e. blood pressure, blood glucose and so on) to the by the user, the foods compatible with his/her health status, that
users, can infer the user’s health status. A set of questions used to can be eaten without side effect. The food selection is performed
profile a specific pathology is called questionnaire. Questionnaires through a well known adaptation strategy of adaptive web systems
DIETOS: a recommender system for health profiling and diet management in chronic diseases HealthRecSys’17, August 2017, Como, Italy
called "content selection". The DIETOSFoodsFilter selects all the
foods that are labeled as Recommended or Use Moderately (see Table
2) according to the user profile (e.g. the disease). The results are
conveyed to the users in a graphical format, specifying the correct
Start
quantity of each food that can be eaten daily, furthermore, advising Please enter the
Creatinine value (mg/dl)
alternative foods that can help tackle the health problems.
No
2.2 DIETOS Functions eGFR > 80 (ml/min)
No
eGFR > 20 (ml/min) Follow low-protein, low salt,
hypophosphate diet and water
restriction
The adaptive part of the recommender system uses well known Yes Yes
techniques for user profilation and for content adaptation. In adap- If the subject was classified as hypertensive or
diabetic, he/her must follow a low-calorie and
Follow low-protein, low salt
and hypophosphate diet
Hemodialysis or
Peritoneal Dialysis in
No
tive web systems [6, 7], information for building user models can
low-salt diet and physical activity is Progress?
recommended. Otherwise if no pathologies are
found, the subject should not follow specific
be gathered by observing users, thus adopting the Automatic User dietary recommendations
Yes
Modeling (or Implicit Acquisition) or allowing users to directly Stop
Dialysis
Please contact a
intervene in the process of modeling, through content rating, ques-
Nephrologist
tionnaires and explicit data provision. Such Co-operative User Mod- Follow low salt and hypophosphate
diet, with a high content of proteins
eling or Explicit Acquisition has been adopted in DIETOS system and vitamins
for user profilation. Specifically, the information gathered is used
to build a so called "overlay user profile", described through a set Stop
of attribute-value pairs. In DIETOS, food recommendation is per-
formed on the basis of user-specified health characteristics rather
than past history of the users, as usually happens in RSs. A second
aspect of adaptive web systems is the adaptation of contents and Figure 2: Flow chart used to profile a kidney user. This chart
web structure to the user. In DIETOS a "content selection" strategy follows hypertensive and diabetics charts, thus the results of
is used, as illustrated in the following subsections. the left branch of this chart depends on the profile obtained
by using the previous charts.
2.2.1 User’s profiling. DIETOS dynamically builds a health pro-
file for the user, necessary to determine which typical Calabrian
foods are compatible or not with the user’s health condition. The the foods and the categories for which the typical product is rec-
acquisition of the health profile is based on a simple, unidirectional ommended, should be used moderately or not recommended. To
and comprehensive set of questions called questionnaire, provided give users advice, DIETOS uses health status data of the profiled
by the medical specialists that would categorize the screened sub- user, diseases data, and foods data. In particular, the DIETOS Food-
ject as a diabetic, an hypertensive or a CKD patient. User profiling Filter (see Figure 1) uses health-based, diseases-based, foods-based
in DIETOS is done through the implementation of the guidelines information to advise users.
used by doctors during the clinical investigation procedures. Guide-
lines are provided by the doctors in form of flow-charts. Currently Table 1: Some examples of typical Calabrian foods (quantity
DIETOS implements a sequence of three flow-charts for profiling 100 g) stored in database with relative nutritional facts
diabetes, hypertension and CKD. As an example, Figure 2 show the
last flow-chart for CKD profiing. Food Nutrients
Calories (kcal) Protein (g) Fats (g) Carbohydrates (g)
Flow-charts are implemented in DIETOS as questionnaires. It Cipolla di Tropea 26 1 0.1 83
should be noted that the questionnaires employed in DIETOS are Caciocavallo silano 439 37.7 31.1 2.3
original, thus they cannot be found in the literature. In fact, although Capocollo 450 20.8 40.2 1.4
Patata 77 2.02 0.09 17.46
they are based on the international guidelines, flow-charts and
related questionnaires were designed by medical specialists in our
group. Questionnaires are represented in DIETOS as a tree whose
nodes are all the questions used in the guidelines, whereas the edge Table 2: Beneficial effects of the red onion of Tropea and the
connecting two nodes represents the answers. categories for which it is recommended, should be used mod-
erately or not recommended.
2.2.2 Food recommendation. After the user has been profiled,
the system recommends what typical foods can be consumed. DI-
Beneficial effects Recommended Not recommended
ETOS gives to the users information on typical Calabrian foods in Use moderately
three different ways: i) by automatically suggesting foods according Hypoglycemic Diabetes
to the user’s health profile; ii) by displaying on a map the locality Hypolipidemic Hypertension Gastro-Duodenal Ulcer
Antioxidant Cardio-Vascular Diseases
where the Calabrian foods are produced; finally iii) by showing Adjust the intestinal flora Stipsi
the nutritional properties for each food stored in the database, in- Diuretic effect Dyslipidemias
Laxative effect
cluding benefits and side effects on pathologies and specific health Digestive effect
conditions. For example, Table 1 conveys the characteristics of some
of the typical foods while Table 2 shows the beneficial effects of
HealthRecSys’17, August 2017, Como, Italy G. Agapito et al.
2.3 DIETOS Database 3 CONCLUSIONS
The DIETOS database stores data about users’ health status and We presented DIETOS, a RS able to profile health status of both
foods, linking personal health information with nutrition facts and healthy people and individuals affected by chronic diseases (CKD,
effects of Calabrian foods. The food information and user data hypertension, and diabetes), and able to recommend typical regional
contained in DIETOS are archived into a MySQL database that foods, according to the health profile. Using the nutrition facts and
includes the following tables: Clinical Pathologies Table, Users Profile annotations of foods stored in the database, DIETOS recommends
Table, Typical Food Nutraceutical Table, and Questionnaires Table. to the users the foods compatible with their health status and, at
Clinical Pathologies Table stores pathologies identified by using the same time, discourages the eating of foods with negative side
the International Classification of Diseases 1 , 9th Revision, Clinical effects on their health status. The DIETOS prototype is currently
Modification (ICD9-CM) along with a description of the stored under testing by the medical staff at the Department of Nephrology
disease. Using ICD9-CM as identifier makes it possible to uniquely and Dialysis, University Hospital, Catanzaro (Italy), for long term
identify pathologies among all users around the world. monitoring of CKD patients and for evaluating the role of food sug-
Users Profile Table stores all the personal and health information gestion on disease progression. As future work we plan to support
of the user, including the answers to the questions of the question- user preferences using an hybrid approach that combines explicit
naires and some indicators automatically computed (e.g. the eGFR - food preferences and preference learning during DIETOS use.
estimated Glomerular Filtration Rate, for CKD patients).
Typical Food Nutraceutical Table contains extensive information ACKNOWLEDGMENTS
on many typical Calabrian foods. The database stores the Calabrian The authors thank I. Caré, T. Lamprinoudi, and A. Pujia for their
foods classified as Protected Designation of Origin (PDO) and Pro- work on previous version of DIETOS. This work has been partially
tected Geographical Indication (PGI). Tables 1 contain some exam- funded by the BA2Know (PON03PE_00001_1) research project.
ples of stored foods.
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