Validation and evaluation of a tablet-based dietary record app for adults aged 70 and above

Jette Hinrichsen; Vincent Quinten; Rebecca Diekmann

doi:10.1371/journal.pone.0337534

Peer Review History

Original SubmissionAugust 12, 2025
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If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. ?> [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: No ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: No Reviewer #2: Yes Reviewer #3: No ****** Reviewer #1: R1: General comments: � The author need to add inclusion and exclusion criteria and health state in order to divide study participants into groups to to achieve the study objective, so: � This classification must included in statistical analysis in addition to other subclasses. o Better to add background o Good introduction but there is repetition in the idea. author can summarize all introduction in few paragraphs. o Please re write about the app description and app services. Methodology: o Arrange methods as follow: o Please summarise methods by stratified your methods you do step by step.e, .type of study, study sample, study area, study design, principles of the study ....etc, don't repeat information. It is better to re-write materials and methods. o Mention the inclusion and exclusion criteria, health status of study participants o study design is subtitle of methods o Better to write short description about type of statistical analysis used and its importances, using the scale of significance. Results: add descriptive table of study participants to the results o There is mixing of the three sections(methods, results and discussion) o Author need to write every section separated from each other including all subtitles, but links to study aim and objective. Discussion: 1. Give brief introduction about this recent study 2. Discussion of results 3. re-write discussion according to the results. 4. Avoid the numbers that you already mentioned in the result 5. Discuss the finding and compare it with the previous and most resent studies. 6. Defense, confirm and give ethical justification for your results. 7. No subtitles in discussion section 8. Conclusions must be shown and confirmed in the results o Divide your discussion into sub-title include : - conclusion - recommendations - limitation of the study Reviewer #2: The manuscript presents a technically sound, original study that meets high standards for scientific research, ethics, and reporting. Its conclusions are appropriately supported by detailed data analysis, and the article is well-written and organized. Data restrictions are reasonably justified by participant consent issues. Only minor improvements in formatting and a deeper discussion on cognitive screening and sample representativeness are warranted. Accordingly, the manuscript is suitable for publication, pending minor revision for presentation and clarity. Reviewer #3: The subject of this study is interesting. However, there are some points that need consideration and revisions 1. Please make sure to check your in-text citation again. In the third line of the introduction section, your in-text citation is 4??? and after that is 6 and 7??? where is 1-3 and 5 citations??? 2. Is there a data related to percentage of elderly people suffering from malnutrition in Germany or any nearby country with similar setting? it is important to include such data to strengthen your idea 3. I recommend the author (s) to seek English editing service 4. The NuMob-e-App, when was its development and release? 5. In table 1, why was smoking not included? 6. The quality of the figure provided is very low. maybe less than 300 dpi??? very difficult to examine it. The supplementary files figures are very clear. ****** what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy Reviewer #1: Yes: nahla ahmed mohammed Reviewer #2: No Reviewer #3: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org . Please note that Supporting Information files do not need this step. Attachments Attachment Submitted filename: PONE-D-25-42816.pdf Attachment Submitted filename: PLOS ONE - Review app.docx https://doi.org/10.1371/journal.pone.0337534.r001
Revision 1
30 Oct 2025 Author Response “Add inclusion and exclusion criteria and health state” We thank the reviewer for this valuable suggestion. In the revised manuscript, we have added a clear description of the inclusion and exclusion criteria (see Methods section, page 5, lines 77/78). With regard to the health state, we would like to clarify that only health conditions relevant to the safe conduct of the study (e.g., swallowing difficulties) were assessed, in order to avoid any potential risk for participants. To minimize unnecessary data collection and protect participants’ privacy, we did not record a comprehensive health status, but only information directly required for study participation. Furthermore, a complete assessment of the overall health state was not necessary, as no associations with health of the participants were analysed within the study. “Good introduction but there is repetition in the idea. author can summarize all introduction in few paragraphs.” We thank the reviewer for this helpful observation. The Introduction was revised to remove redundancies and is now re-structured. We made some changes in lines 33-35, 45, 51, 60-62 and 69. We believe this improves clarity and readability. “Please re write about the app description and app services.” Lines 117-120 and 131-136 describes the app and lines 124-129 describe the development of the app. “Please summarise methods by stratified your methods you do step by step.e, .type of study, study sample, study area, study design, principles of the study ....etc, don't repeat information. It is better to re-write materials and methods.” In preparing the manuscript, we carefully followed the section structure and subheadings required by the journal. To ensure consistency with the journal’s format, we prefer to keep the structure of Materials and Methods as following: participants and recruitment, study design, the NuMob-e App, the 24hour Recall, statistical analysis, ethical regulations. Within this structure we did some shortages (line 92, 115 and lines 152/153 and refined the MNA-SF, PAL and technical scale in lines 93-100 with the new requirements. “study design is subtitle of methods” In our manuscript, the study design is already presented as a subheading within the Methods section (Level 1 heading = Bold type, 18pt font; Level 2 Heading = Bold type, 16pt font). “Better to write short description about type of statistical analysis used and its importances, using the scale of significance.” The statistical methods used in this study (TOST, ICC, Bland-Altman analysis) are already described in the “Methods” > “Statistical analysis” section (lines167-179). Since these are established procedures, we have refrained from further explaining their general principles in order to maintain overview and have instead concentrated on the study-specific application of these methods. “add descriptive table of study participants to the results” We agree that participant characteristics are important for context. A descriptive table of study participants is already included as „Table 1: Study characteristics of the subjects in the present study (n = 97)“in the Results section, line 207 ff. “There is mixing of the three sections(methods, results and discussion)” After careful review, we did not identify overlaps between the Methods, Results and Discussion sections. Each section is structured according to the journal’s guidelines and presents the required content separately. “Author need to write every section separated from each other including all subtitles, but links to study aim and objective.” The sections are already separated and structured according to the journal’s author requirements. To maintain consistency with the journal’s format, we did not restructure the manuscript further. “Discussion: Give brief introduction about this recent study” In the discussion section you can find a short summary of the study aim and key findings, which serves as an introduction to the discussion of the results, please see lines 282-283. “Divide your discussion into sub-title include: conclusion, recommendations, limitation of the study” In our Discussion, we already present the results structured by statistical methods (Equivalence Testing, Intraclass Correlation Coefficients, Bland–Altman Analysis), followed by Implications and Outlook, and Qualities and Limitations. A separate Conclusion section is also included, in line with the journal’s structure. “Conclusions must be shown and confirmed in the results” Please find the conclusion at line 384 ff. Reviewer#2 “Only minor improvements in formatting and a deeper discussion on cognitive screening and sample representativeness are warranted” We thank the reviewer for this constructive feedback. We have revised the formatting throughout the manuscript. Regarding cognitive screening, we clarify that participants were asked whether a diagnosis of dementia had ever been made, which served as an exclusion criterion. However, no specific cognitive test was performed, as already stated in the Discussion, and we emphasized this point further in the revised version (see lines 370-373). With respect to sample representativeness, we acknowledge that our sample may not fully reflect the general population of older adults, since participants were volunteers in a digital nutrition study and therefore may represent a somewhat more digitally literate subgroup. This limitation was already noted in the Discussion, and we have now elaborated it more explicitly (see Discussion, lines 367-368). Reviewer#3 “Please make sure to check your in-text citation again. In the third line of the introduction section, your in-text citation is 4??? and after that is 6 and 7??? where is 1-3 and 5 citations???” We thank the reviewer for this careful observation! The numbering of the in-text citations was indeed inconsistent due to a formatting error with EndNote. We have carefully revised and corrected the citation order throughout the manuscript to ensure that all references now follow the correct sequence (see Introduction, lines 32-34). “Is there a data related to percentage of elderly people suffering from malnutrition in Germany or any nearby country with similar setting? it is important to include such data to strengthen your idea” We thank the reviewer for this important suggestion. Indeed, data on malnutrition prevalence among older adults in Germany was reported by Kaiser et al. (2010), showing that 22.8% suffered from malnutrition and nearly every second senior (46.2%) was at risk of malnutrition. We have included this information in the Introduction (see lines 33-35). “I recommend the author (s) to seek English editing service” We have carefully revised the manuscript to improve clarity and readability. As the manuscript was already written and reviewed in English at an advanced academic level, we believe that the current version is linguistically sound and does not require additional professional language editing. “The NuMob-e-App, when was its development and release?” Information on the development and release of the NuMob-e-App has been added in the revised manuscript (see Introduction, line 59). The App is still part of research and currently does not meet the criteria to be makted as a medical product according to MDR guidelines. “In table 1, why was smoking not included?” Smoking behaviour was not assessed in our study, as it was not relevant for the primary aim, which was to compare two dietary assessment methods. Since smoking was not part of the data collection, it cannot be added retrospectively. “The quality of the figure provided is very low. maybe less than 300 dpi??? very difficult to examine it. The supplementary files figures are very clear.” The figures have now been revised and re-submitted with improved resolution. Attachments Attachment Submitted filename: Response to Reviewers_0.2.docx https://doi.org/10.1371/journal.pone.0337534.r002
11 Nov 2025 Decision Letter - António Raposo, Editor Validation and Evaluation of a Tablet-Based Dietary Record App for Adults Aged 70 and Above PONE-D-25-42816R1 Dear Dr. Hinrichsen, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. For questions related to billing, please contact billing support . If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, António Raposo Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #3: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> Reviewer #3: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #3: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #3: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #3: Yes ****** Reviewer #3: The authors have addressed all the comments in professional manners, and included the revisions accordingly. Their revisions increases the clarity and readability of the manuscript. I have no additional comments for the authors regarding this manuscript. ****** what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy Reviewer #3: No ******** https://doi.org/10.1371/journal.pone.0337534.r003
Formally Accepted
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