OASIS Nutritional Advisor Service: a technical view Héctor Galan Marti1, Ana María Navarro Cerdá2, Juan Carlos Naranjo Martinez3

ITACA, Health and Welbeing Technologies Universidad Politécnica de Valencia

1hecgamar@itaca.upv.es 2annacer@itaca.upv.es

3jcnaranjo@itaca.upv.es

Abstract— Aging is usually connected to processes related to cognitive and muscular decline and possible loss of autonomy. Inappropriate nutrition habits, having a sedentary lifestyle and decreasing the food intake increases the risk for malnutrition, decline of body functions and developing chronic diseases. Aging and malnutrition have therefore a strong impact on the elderly, lowering their quality of life and independency. For this reason, the Nutritional Advisor Service has been developed in order to control and improve the nutritional habits of the elderly as well as provide a complete tool for the nutritionists. The service has been integrated into the OASIS framework, achieving a more accessible user interface, greater interoperability mechanisms for sharing external services functionalities. The purpose of this paper is to give a technical overview of how the service was developed and integrated into OASIS, as well as the methodology employed to design the service. Finally a discussion about the challenges encountered and the future steps to follow has been also included.

I. INTRODUCTION Recent studies [1, 2] about ageing in Europe show a

growing trend of older population in the next 50-years period. Aging is usually connected to processes related to cognitive

and muscular decline and possible loss of autonomy. The inappropriate food and water ingestion [3] has a direct consequence in the loss of lean body mass such sarcopenia, diabetes, osteoporosis fractures, cardiovascular diseases and some cancers. Approximately 25% of the free-living individuals 65 years of age and older suffers from many of the elements of syndrome of frailty.

Due to all these facts, aging and malnutrition can lead our elderly towards a significant decrease of their quality of life and independency, which, in turn, implies an increase of the health-system costs that can derive in a critical situation of the public health-care system.

In general, Information and Communication Technologies (ICT) demonstrated to be a good help in many processes of our daily lives as citizens and nutrition is one of them [4]. The reason is mainly because it allows implementing:

• Personalization. ICT allows the implementation of personalized nutritional management services: personalized nutritional advices, personalized menus based on preferences and not only in general indicators, personalized motivational strategies.

• Independence from the physical and temporal availability. ICT allows the professional and the user participate in the nutritional process whenever and wherever needed.

• Efficient management. More patients can be treated simultaneously and patients needs less time to do management tasks. Efficiency in the feedback from the patients is one of the objectives that more potential has thanks to the presence of ICT.

• Adaptation to changing conditions of elderly users. • Support in nutritional-related activities of the daily life.

Cooking and shopping assistance depend usually on external support. With ICT systems, support when cooking and automatic generation of shopping can be offered to help the elderly in their daily activities.

It is then needed an approach to face this issue by using

ICT in the promotion of a healthy nutrition. As a result, the Nutritional Advisor Service has been developed, as one the available OASIS [5, 6] services. Its objective is to control and greatly improve the nutritional habits of the elderly as well as provide an integrated tool for nutritionists.

The Nutritional Advisor Service (NA) [7] consists basically of: (i) a nutritional advisor client (application at user’s home) that shows the personalized nutritional content (menus, advises, etc) to the elderly, (ii) a remote server that provides the user with nutritional advisor services: user profiling, personalized weekly menus, nutritional tips and shopping and cooking assistance, and (iii) a desktop application for the nutritionists, that allows them to manage the elderly nutritional information.

All the nutritional content provided by the Nutritional Advisor Service, is customized for each specific user, taking into account the user profile [8], which gathers the likes, needs and requirements of the elderly user.

Moreover, the Nutritional Advisor is integrated into the OASIS platform, which allows the interoperability, the seamless connectivity and sharing of content between services of different application domains.

II. STATE OF THE ART ON NUTRITION SERVICES Other programmes that aim to promote the elderly nutrition

exist. PIPS [9, 10] and PERSONA [11], are two European funded projects on which the presented service is based.

The main purpose of PIPS is to create a health and life knowledge and Services Support Environment for protecting the health of the individual. This will improve current HealthCare (HC) delivery models while creating possibilities for HC professionals to access relevant-updated medical knowledge and for citizens to choose healthier lifestyles.

PERSONA, is developing a scalable open standard technological platform to build a broad range of AAL Services, to demonstrate and test the concept in real life implementations, assessing their social impact and establishing the initial business strategy. Within this project an AAL systems reference architecture allowing seamless integration of the required devices, sub-systems and ontology-based services was developed.

PERSONA and PIPS stress the importance of offering personalized nutritional counseling to each elderly user, so the diet and the recommendations are adapted to the elderly user needs and preferences. Both projects have developed a profiling service, in charge of creating a nutritional profile from user or professional input. However, elderly users are not static individuals, more on the contrary, their conditions and needs change constantly, even daily, so it is necessary to create services that dynamically adapt to these changes.

Besides the changes of the elderly status, environmental changes have also influence on the elderly nutrition. For instance, diet changes with seasons and recommendations depend strongly on the weather conditions. This brings us to consider the importance of taking into account the context when offering nutritional counseling to the elderly.

In addition, when designing an application for the elderly, the user interfaces should be easy to use and accessible. This issue is critical for the success of the service, since the elderly acceptability depends not only on the content offered but also on the design and the simplicity of the system. Future ICT-based nutritional services should take into account these considerations and include accessible GUI in their designs.

III. REFERENCE ARCHITECTURE The Nutritional Advisor service consists of two main actors.

On one hand the elderly, who access the service from home, using a tablet PC; in the other hand the nutritionist who controls and manages the nutritional information. The service is placed in different devices that should interoperate, following a distributed architecture. Furthermore, the different subsystems will communicate through OASIS middleware platform.

The service is compound of four components (see Figure 1): • Nutritional server: a web server that holds all the

information related to the service. • OASIS middleware: a number of frameworks that allow

the interoperability and access to multiple services. • Elderly application: a desktop application which

requests all data to the Nutritional server through the OASIS middleware.

• Nutritionist application: a desktop application which contacts the Nutritional server directly.

In order to assure the flexibility, usability, scalability, and

interoperability among the different subsystems and the OASIS platform, a multitier architecture has been adopted. Multitier architecture [12] is a client–server model in which the user interface, the functional process logic ("business rules"), and the computer data storage and data access are

developed and maintained as independent modules, most often on separate platforms.

Fig. 1 Nutritional Advisor architecture

As architectural designing rule, both the elderly and the

nutritionist’s application are as light and tiny as possible, while the logic and heavy computing workload is placed on the server side.

The Nutritional Advisor offers its services to the elderly user through one device: A tablet PC, intended for the use at home. This client will have the following architecture:

• A presentation layer with the Graphical User Interface (GUI), which presents the nutritional information to the elderly user in an accessible way.

• The local business layer, with light functional process logic. The subsystems’ logic processes and evaluates the data received from the elderly user and requests the server business processes with web services through OASIS middleware, which functions in a transparent way for the application.

• A local data layer, for storing local data (mainly the local profile) that the local business layer will use.

As for the server side, it is compound of the following

layers: • The web service description layer, which offers the

web-services descriptions. On the one hand we have the WSDL Nutritional Advisor services, which offer the communication layer between the Nutritional Advisor client and the server business layer. On the other, the WSDL Nutritionist services, which provide the interface between the Nutritionist GUI and the server business layer:

• The Server Business Layer, which controls the system functionality by performing detailed processing of the different nutritional algorithms.

• Server Data Layer, where the nutritional database is stored in multiple languages.

The nutritionist is able to access the service through a

desktop application which employs a GUI that directly

connects with the WSDL services of the Nutritional Server. This desktop application is called the Nutritionist Service Centre.

Using OASIS: Interoperability The Nutritional Advisor Service is based upon the OASIS

[13] framework and technologies. OASIS framework is a large scale European Integrated Project with aim to develop an open and innovative reference architecture, based upon ontologies and semantic services that allow plug-and-play interconnection of existing and newly developed services in all domains required for the independent and autonomous living of older people and their enhanced quality of life.

In order to provide a service available at OASIS, it must accomplish two requisites:

• Describe the service operations in a publicly accessible WSDL file

• Define the service concepts as ontological concepts in the Ontology Web Language and upload them to OASIS’ Ontology Repository.

The service is then ready to be aligned by using the Content Anchoring and Alignment Tool (CAAT) which aligns the functionality of the nutritional web service through its WSDL file with the ontologies stored at the Ontology Repository]. Once aligned, the service is available to be used by any OASIS application/service by use of the AMbient Intelligence framework [ref 14], a desktop frontend that enables the access to other service’s operations.

The Nutritional Advisor architecture makes use of other OASIS services such as the Health Monitoring [ref 15], Activity Coach [ref 16] or Social Communities. These services create their own profile with detailed information about the user. OASIS provides with a desktop frontend that enables different services to have access to other service’s profile: the User Profile. By accessing a user’s profile from other services it improves and increases the user experience as well as creates new use cases that expand the possibilities of the Nutritional Advisor service by itself. The information read from other service’s profile is described in Table 1.

In the same fashion, other OASIS services are able to use information that the Nutritional Advisor makes available in its User Profile. Table 2 shows a list of the possible usage of the nutrition profile.

Nevertheless, the Nutritional Advisor service is able to work and perform its tasks with no other applications connected. The connection of new applications (coming or not from OASIS) will result in a value-added service for the Nutritional Advisor service.

Ontologies As previously mentioned, the service must define the

knowledge exchanged based on ontologies [17]: a set of concepts within the nutrition domain and the relationship between those concepts. The ontology is defined in the OWL format.

The nutrition ontology contains all the concepts related to the service, including such as menus, dishes, foods,

ingredients, recipes, advises and allergies, among others. Figure 2 shows a diagram of a section of the nutrition ontology. The complete listing of ontologies is available at http://orate.iti.gr/ontologies.

TABLE I

USE OF OTHER SERVICE’S PROFILE

OASIS Application

Useful content for Nutritional Advisor

Activity Coach service

User’s activity, type of exercise, activity level and calories consumed

Health Monitoring

User’s health status and health condition, chronic diseases, current medication, blood test results

Environmental control

Personal habits, room temperature, weather

Social Communities

Friend’s contacts, agenda

TABLE II

USE OF NUTRITIONAL ADVISOR PROFILE BY EXTERNAL SERVICES

OASIS Application

Information provided by Nutritional Advisor

Activity Coach service

Ingested calories, nutritional values of the nutritional plan, menus, recipes

Health Monitoring

Food allergies, food intolerances, food likes/dislikes

Brain trainer Shopping list items, recipes Social Communities

Favourite recipes, Today’s menu

Accessible and self-adaptive User Interaction Developing Graphic User Interfaces that are easy to use,

accessible and usable for elderly people is a known challenge [18]. In this matter, OASIS applications make use of a framework that enables the fast and simple creation of accessible user interfaces that self-adapt to the user’s requirements. This is accomplished by using the Adaptive Widget Library, a framework that encapsulates all the complexity for supporting adaptation (from evaluation request to decision application) and may be integrated into common IDEs to facilitate developers while building self-adaptive interfaces.

Depending on the user’s profile, the user interface will adapt in many ways to satisfy the user’s needs. Some of the adaptation capabilities focus on:

• Bigger font sizes • Lighter / darker backgrounds • Bigger button areas

The result of using the Adaptive Widget Library is shown in Figure 3.

hasDayMenuhasMealMenu

calls

hasDish

-Nutritional PropertiesMenu -NutritionalProperties

NutritionalPlan

ShoppingAssistant::ShoppingItem

FoodRecipe

Dish

1 1..*

1

1

1..*1..*

MealMenuDayMenu

UserslocalNutritionalPlanRepository

-MenuDishRecipeRepository

NutritionalQuestionnaires::PersonalisedQuestionnaire

+createMenuRequest()+changeMenuRequest()+showsNutritionalPlan()+changesAlternativeMeal()

NutritionalPlanner+createsNutritionalPlan()+modifiesNutritionalPlan()+showsNutritionalPlan()

NutritionalPlanBuilderManager

+downloadsNutritionalPlan()

NutritionalPlanAccess

OASIS SocialCommunities

OASIS Agenda

ShoppingAssistant::ShoppingList CookingAssisstant:Recipes

NutritionalProfile::NutritionalProfilingManager

NutritionalPlanBuilder

1

1..*

1

1

1

1

11

1

1

1*

1..*

1

UsersRemoteNutritionalPlanRepository

«uses»«uses»

«uses»

«uses»

«uses»«uses»

1

1

1..*

11

1

Fig. 2 Nutritional Plan Builder ontology

IV. SERVICE DEVELOPED A complete nutritional service has been developed: the

Nutritional Advisor service. It consists of: (i) a nutritional advisor client (application at user’s home) that shows the personalized nutritional content (menus, advises, etc) to the elderly, (ii) a desktop application for the nutritionists, that allows them to manage the elderly nutritional information.

A. Methodology During the development of the Nutritional Advisor Service

the following methodology approach has been followed. User requirements and use cases The elicitation of requirements of elderly users regarding

nutrition and analysis of needs was carried out through questionnaires with 100 users living in sheltered homes and 100 users living alone in homes, as well as 80 carers from four European Centres (Italy, Spain, Germany and Bulgaria). Based on this data, the definition of use cases and application scenarios were developed, showing detailed descriptions of the intended functionality of the nutritional advisor services.

Oasis Participatory Analysis Framework Within OASIS project, several workshops with users

addressing the use cases of the Nutritional Advisor have been performed. These sessions have allowed the extraction of the user requirements and needs, as well as the functionalities and obligations of the NA application for elders. During the

sessions, the design team applied the User Centred Design [19, 20], which seeks to place the user at the forefront of the design effort. A low-fidelity NA prototype intended for the user resulted from these workshops.

Nutrition management requirements In order to extract the nutritionists work methodology and

the nutrition expert’s point of view regarding nutrition of the elderly, several sessions with nutritionists were performed. The main requirements and needs of an application that allows the nutritionist to manage the elderly nutrition were extracted. A low-fidelity nutritionist service centre prototype resulted from these step.

Information exchange between external OASIS services Within OASIS project, several services apart from the

Nutritional Advisor have been developed. For instance, health, activity data and environmental information coming from the Health Monitoring, Activity Coach and the Environmental Control services (amongst others) can be used to refine the user’s nutritional profile and the nutritional content provided to the elderly user. In the same way, NA content and services can be used as input for different OASIS services. In this step, the interconnection and exchange of data with other services was analysed and the interoperability “use cases” detected.

B. Service Subsystems Different subsystems have been developed into the

Nutritional Advisor, providing different sevices that can be used separately.

Profile definition & personalization service This service creates a personalised nutritional habits profile

by collecting the data from the user. It can directly ask the person or retrieve the data from other OASIS applications such as the activity coach or the health monitoring.

Different actors take part in this service. On one hand, the nutritionist creates and manages both the nutritional questionnaires for explicitly gathering the nutritional profile information and the user nutritional profile. On the other hand, the user receives the questionnaires at home and answers them, sending them back to the nutritionist automatically.

Therefore, three components are needed: • Questionnaires Manager server component, for

managing the nutritional questionnaires. • Nutritional Profile Manager server component, for

managing user’s nutritional profile. • Nutritional Questionnaires client component, that

allows end-users at home to receive and send back the nutritional questionnaires.

Nutritional plan builder service This service involves the creation of a nutritionally well-

balanced plan for the elderly that also fits (as much as possible) with his/her preferences and health status. Both elderly user and nutritionist take part in this service: The nutritionist manages the menus tailored for the elderly users: creates the

menus, manages the nutritional content and assures that the nutritional plan provided to each user is tailored to his/her specific needs and the elderly, who receives the Nutritional Plan at home and may switch some of the dishes of the plan.

Fig. 3 Nutritional Advisor showing an advice.

Two components are needed: • Nutritional Plan Builder Manager server component, for

managing the nutritional content: meals, menus and creating the nutritional plan.

• Nutritional Plan client component that shows the menus to the elderly user at home.

Nutritional empowerment & assessment service This service specifies the creation and reinforcement of

correct nutritional habits by showing messages about things to do, things to do not, etc. Figure 3 shows an advice being displayed to the user. These messages will be shown also by taking the information from other OASIS services like the Activity Coach or the Health Monitoring. In order to send the messages, a set of rules (time, schedule) are defined. This allows the creation of smart advices like: “If the user has exercised and is very hot in the room, remember him to drink water” or “If it is the user’s time for lunch and he has to take some medicines at that time, remind him to take his pills”.

The actors that take part in this service are: the nutritionist, who creates and assigns the messages and the triggering rules to the end-user, and the elderly user, who receives the recommendations and warnings at home.

The following components will be developed: • Nutritional Advises Scheduler client component that

should check when the triggering rule is fulfilled and show the message to the user.

• Nutritional Advises Scheduler Manager server component, for managing the messages and rules.

Shopping and cooking assistant This service involves the automatic creation of a shopping

list with the necessary items for preparing the meals of each user, according to their nutritional plan. It assists the user

when getting ready to buy the food: printing the list, sending it to a carer and having direct access to the shopping list when user is outdoors. It also guides the user to cook a recipe, with the needed ingredients and instructions. The elderly user and the carer/family member take part in this service. The elderly user/carer receives the shopping list and is be able to manage it.

In order to achieve these features, the following modules are needed:

• Shopping List Generator server component: automatically calculates the ingredients needed and creates the shopping list.

• Shopping Assistant client component: provides the elderly user with tools to manage the shopping list.

• Cooking Assistant client component: guides the user to cook the meals.

V. DISCUSSION Having a service to manage, motivate and improve an

elderly person’s nutritional habits is a challenge. The developed tools provide a way of handling every day’s cooking habits, as well as recipe instructions and management of the shopping list. The development of a nutrition service involves the management of private user information like life style, meal patterns, cultural background, body measurements, nutritional preferences, intolerances, allergies and use of medicines. Furthermore, the interoperability with other services raises some concerns about privacy issues. Although all information is being treated privately, users feel uneasy when they realize their information and behaviour is being tracked.

The nutrition service has proven to be relatively invasive, since telling an elderly what to eat can be sometimes too restrictive. Consequently, the service could be more flexible and provide with a wider selection of meals to choose from.

VI. FUTURE STEPS The Nutritional Advisor Service is currently being tested at

pilot sites in three different countries: Bulgaria, Romania and Italy. The service has been installed in about 30 people’s houses, with ages that range from 50-70 years old. After the completion of the pilots, a survey will be filled and every pilot user will be asked for feedback. This feedback will be used to further improve the service.

The shopping list assistant could be further improved. A greater control over the kitchen’s movements such as what items are available in the refrigerator or what needs to be bought could be of great interest.

Future developments include the creation of a web based tool for the nutritionist. This would allow an easier access to the service, as well as a simplification of the deployment process.

Tests with nutritionists have demonstrated a big interest of using the application with focus groups of users with specific and more demanding nutritional diets. The tool could be very

handy in order to control and keep track of the user’s progress. Further research in this area will be carried out.

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