DESIGN AND IMPLEMENTATION OF A WEB-BASED NUTRITIONIST

SYSTEM FOR CARDIOVASCULAR DISEASES PREVENTION

BY

ATU KENECHUKWU

(19CG026409)

A PROJECT SUBMITTED TO THE DEPARTMENT OF COMPUTER AND

INFORMATION SCIENCES, COLLEGE OF SCIENCE AND TECHNOLOGY,
COVENANT UNIVERSITY, OTA, OGUN STATE.

IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE AWARD

OF THE BACHELOR OF SCIENCE (HONOURS) DEGREE IN COMPUTER
SCIENCE

APRIL 2023
 CERTIFICATION
I certify that this project is a work by Atu Kenechukwu (19CG026409) under the Department of
Computer and Information Sciences, College of Science and Technology, Covenant University,
Ota.

1. Name: Prof. Olufunke O. Oladipupo

(Head of Department)

Signature ___________________________ Date ____________________

2. Name: Dr. Olamma Iheanetu

(Supervisor)

Signature ____________________________ Date ____________________

 TABLE OF CONTENTS

CERTIFICATION............................................................................................................II

LIST OF TABLES..........................................................................................................III

1.1 BACKGROUND INFORMATION...........................................................................1

1.2 STATEMENT OF THE PROBLEM.........................................................................2

1.3 AIM AND OBJECTIVES...........................................................................................2

1.4 METHODOLOGY......................................................................................................3

1.5 SIGNIFICANCE OF THE STUDY...........................................................................3

1.6 SCOPE OF THE STUDY...........................................................................................4

1.7 OUTLINE OF STUDY................................................................................................4

2.1 INTRODUCTION.......................................................................................................5

2.2 NUTRITION................................................................................................................5
2.2.1 NUTRITIONIST.................................................................................................................5
2.2.2 BALANCED DIET.............................................................................................................7

2.3 CARDIOVASCULAR DISEASE...............................................................................8

2.3.1 PREVALENT TYPES OF CARDIOVASCULAR DISEASES........................................8
2.3.2 RISK FACTORS OF CARDIOVASCULAR DISEASES.................................................9

2.4 RECOMMENDATION SYSTEMS.........................................................................10

2.4.1 RECOMMENDATION FILTERING ALGORITHMS...................................................10
2.4.2 SIMILARITY MODELS..................................................................................................13

2.5 REVIEW OF RELATED WORKS.........................................................................15

2.5.1 U-Babsang.........................................................................................................................15
2.5.2 PREFer..............................................................................................................................16
2.5.3 Buon Appetito...................................................................................................................16
2.5.4 DIETOS............................................................................................................................17

2.6 SYNTHESIS OF LITERATURE.............................................................................17

 LIST OF TABLES

Table 1.1: Objective and Methodology mapping.......................................................................3

 CHAPTER ONE
1.0 INTRODUCTION

1.1 BACKGROUND INFORMATION

Artificial Intelligence (AI) has influenced our everyday lives. From e-commerce to streaming
services to self-driving cars, AI is involved in so many aspects of our daily lives and this is just
the beginning of it. In the coming years, AI is will become much more advanced and many of the
activities seen today will eventually become either semi-automated or fully automated.

In the healthcare sector, massive improvements have been made with AI in patient diagnosis and
has also aided in tackling major issues associated with health. However, despite all the progress,
there still remain some dominant factors affecting the field of health and one of them is
malnutrition.

The term malnutrition does not have a standard definition but a general description of the word
malnutrition is the deficiency or imbalance of a wide range of nutrients and vitamins resulting in
several adverse effects on the body (Saunders & Smith, 2010). Over the years, malnutrition has
remained a constant burden facing many developing countries such as Nigeria, Congo, Pakistan,
and many other countries in the sub-Saharan region of Africa and Southern Asia, with high
poverty rates. (Statista, 2022).

Malnutrition has been identified as a significant factor contributing to various health challenges.
These challenges include but are not limited to cancer, obesity, cardiovascular diseases, and, in
severe cases, mortality when appropriate measures are not taken (Eroğlu, 2019). In addition, it
also has effects on many systems, mainly the immune system.

Cardiovascular diseases are currently recognized as one of the primary causes of death
worldwide in the 21st century. According to Amare, Hamza & Asefa (2015), cardiovascular
diseases accounted for over 17.5 million deaths, about 31 % of all global deaths in 2012 with
over three-quarters of those deaths taking place in low- and middle-income countries in Asia and
Sub-Saharan Africa. Cardiovascular diseases (CVDs) are still common today because they are
caused by a complex interaction of several risk factors, and many of these risk factors are still

1
prevalent in modern societies. One such risk factor is an unhealthy diet. Many people still
consume diets that are high in saturated and trans fats, salt, and sugar. These unhealthy diets can
contribute to high blood pressure, high cholesterol, and obesity, which are all risk factors for
CVDs (Anand et al., 2015).

This study proposes a web-based nutritionist system that generates healthy meal plans for
individuals who either have cardiovascular diseases or are at risk of contracting it and it does this
by collecting information such as age, health condition, allergy, and so on.

1.2 STATEMENT OF THE PROBLEM

Nutritionist systems have become a potent tool in healthcare, notably in the management of
chronic conditions including obesity, Type 2 diabetes, and chronic kidney disease (CKD). To
assess patient data and produce individualized suggestions for the management and treatment of
certain illnesses, these systems employ machine learning algorithms (Yera, Alzahrani, Martínez,
& Rodríguez, 2023).

As stated in the previous section cardiovascular diseases are one of the leading causes of death
worldwide hence there is a need for a solution using AI. Numerous Nutritionist systems have
been developed and have shown substantial progress in the prevention of other chronic diseases
but still there is still a lack of availability of such systems for cardiovascular diseases.

1.3 AIM AND OBJECTIVES

The study seeks to develop a web-based Nutritionist system as a means of reducing risks of
contracting cardiovascular diseases by gathering user information such as their age, weight,
gender, medical condition, and allergy and using the gathered information to provide the user
with healthy meal recommendations.

To achieve the aim, the following objectives will be set in place.

I. Requirement gathering from expert opinion and peer-reviewed publications on nutrition

and cardiovascular diseases and reviewing existing systems
II. Design and model the frontend and backend of the system
III. Implement the web-based public Nutritionist system using HTML CSS and JavaScript
with Python for the backend

2
 IV. Evaluate the system using certain performance metrics.

1.4 METHODOLOGY
OBJECTIVE METHODOLOGY
Requirement gathering from expert opinion Data from related articles, journals, and other
and peer-reviewed publications on nutrition publications covering nutrition and
and cardiovascular diseases and reviewing cardiovascular diseases will be sourced.
existing systems Existing systems and their publications related
to this study will be examined and reviewed as
well
Design and model the frontend of the system The system frontend will be modelled using
UML and use case diagrams and designed
using a design tool called Figma
Implement the web-based Nutritionist system The website will be implemented using the
using HTML CSS and JavaScript with traditional web combination of HTML CSS
python.js for backend and JavaScript with Python for backend.
Evaluate the system using certain performance The system user feedback will be recorded and
metrics. reviewed and processed using a performance
metric on evaluating accuracy of diagnosis and
recommendation.
Table 1.1 Objective and Methodology mapping

1.5 SIGNIFICANCE OF THE STUDY

Personalized food recommendations: This study would provide some information and suggest
a system that would help in assessing a person's health information, including eating habits,
medical history, and current medications, and using that information to offer individualized
nutrition advice. As a result, people may be better able to make decisions about their food and
way of life that may ultimately improve their heart health.

3
Increased awareness: By using the system proposed by this study, individuals can learn more
about the impact of their dietary choices on their heart health. This increased awareness can
motivate individuals to make healthier choices and take steps to prevent cardiovascular disease.

Reduced healthcare costs: The system proposed by this study can potentially reduce healthcare
costs associated with cardiovascular disease by providing personalized nutrition
recommendations and early detection of potential risk factors. This can include lower costs for
medications, fewer hospitalizations, and fewer emergency room visits.

1.6 SCOPE OF THE STUDY

This project was initiated to assist those at risk of cardiovascular diseases in making healthy food
decisions however, individuals who are not at risk but want to reduce their chances of
contracting CVDs are welcome to use the system as well. This study will center its focus on
reducing the risks of contracting cardiovascular diseases by providing healthy food
recommendations tailored to a person’s health profile. Due to the constraint on time, this study
will only center focus on the areas of cardiovascular disease that fit the context of the problem
statement. Because of the limited time and resources, the system Database will contain just
about 10 items each of breakfast, lunch, and dinner for the creation of meal plans for the user.

1.7 OUTLINE OF STUDY

This project report has 5 chapters. The first chapter of this report provides the study's
background, a summary of the problem, aim, and objectives, the research technique employed,
and the study's importance and limitations.

The second chapter gives an introduction to the field of recommendation systems, discusses the
essence of nutrition, and reviews existing systems that have tackled the problem above.

The system analysis is the third chapter, and the design includes the techniques and procedures
needed to complete the project.

Chapter four goes over the outcome analysis and results as well as the design and testing of the
program.

And to conclude chapter five includes the summary, conclusions, and references for additional
research.

4
 CHAPTER TWO
2.0 LITERATURE REVIEW

2.1 INTRODUCTION
In this section, the roles of a nutritionist will be covered. The differences between a dietician and
a nutritionist as well as the types of nutritionists will also be discussed. Also, within this section,
the consequences of malnutrition will be covered and lastly different dietician or nutritionist
systems will be reviewed.

2.2 NUTRITION
Nutrition is an essential part of our daily life. In fact, it could possibly decide how one could live
with the kind of food decisions they make on a daily basis. It is the cornerstone of a healthy life
due to its ability to ensure that individuals consume the right kinds and amounts of nutrients to
maintain good health and prevent diseases such as Chronic Kidney Disease (CKD), obesity, and
cardiovascular diseases (CVD) (Lorente et al., 2023).

An unhealthy dietary habit is widely recognized as one of the risk factors of CVDs. Poor dietary
patterns related to CVDs include a high intake of trans and saturated fatty acids (SFAs), a low
intake of polyunsaturated fatty acids (PUFAs), and excessive cholesterol and sodium intake
(Siniarski et al., 2022). To combat this, nutritional modification is essential in the non-
pharmacological prevention and treatment of CVDs, and since dietary habits are important then
there is a need for proper and well-tailored dietary and nutrition-based advice to ensure that
people eat and live healthily, and such advice can be provided by dieticians or nutritionists.

2.2.1 NUTRITIONIST

A nutritionist is a healthcare provider whose main responsibility is to give patients dietary advice
so they can live a healthy lifestyle or accomplish a particular health goal, such as gaining weight,
decreasing weight, or lowering blood pressure (Santiago, 2022). Nutritionists work mostly at
healthcare facilities including hospitals, nursing homes, assisted living facilities, and even
medical offices, though they can also be found in other settings as well.

5
Confusion may arise in distinguishing between a nutritionist and a dietician and though they may
be quite similar in terms of the kind of work they do they are notably different. A Registered
Dietitian Nutritionist (RDN) is not the same as a nutritionist. As confusing as it sounds, it is the
truth. Although all nutritionists are dietitians, not all dietitians are nutritionists. In order to
practice as a dietitian, one must be certified by the Academy of Nutrition and Dietetics, whereas
anyone can become a nutritionist with no education or training requirements (Wartenberg, 2020).

Nutritionists treat a number of health challenges and conditions and in addition, they also
provide certain individuals with information made specifically for them. For example, a
nutritionist may inform an obese patient on how to consume fewer calories and burn fat.

Below are some basic operations of nutritionists:

 Explaining the importance of observing and keeping track of diet as well as its positive
effects on the customer.
 Examine the nutrition and health needs of the customer.
 Develop meal plans while taking into account the client's preferences and other relevant
information.
 Share tips on how to create a healthy diet and how to stay away from conditions that are
caused by poor nutrition.
 Stay current with nutritional science research.

Indeed, all nutritionists perform similar tasks however the kind of tasks they perform differ
depending on their area of expertise. Here are some examples of nutritionists listed below;

 Clinical nutritionists work individually with patients in hospitals and clinics. They often
collaborate with other doctors, nurses, and other nutritionists on healthcare teams to
develop meal plans that help patients combat certain health issues such as cancer,
hypertension, and obesity. They usually operate in hospitals or private organizations.
 A gerontological nutritionist is someone who studies how nutrition affects the elderly.
They work in hospitals, nursing homes, and community health centers to teach patients
and clients how to care for the elderly. Their main responsibility is to create nutritious
menus for their older clients, who may have age-related diseases including Alzheimer's

6
 disease, Type 2 diabetes, have trouble swallowing food, or are recovering from surgery
(Newlifenutrition, 2016). To guarantee that their customers' nutritional needs are
satisfied, they also teach their clients' caregivers and family members about healthy
eating practices.
 Public health nutritionists, sometimes known as community nutritionists, teach the
general public about nutrition via classes or workshop training sessions. In order to help
persons with low incomes or high-risk jobs maintain healthy lives with the resources at
their disposal, they primarily work with community organizations or local governments.
Their primary objective is to inform the targeted populations and their caregivers about
healthy foods, sensible eating practices, and optimal nutrition.
 Sports nutritionists collaborate with athletes to help them develop meal plans and learn
about nutrition so they can enhance their performance or balance their active lifestyles.
All professional athletes, sports leagues, and universities require sports nutritionists to
ensure that they stay in good health. Sports nutritionists' primary objective is to help
athletes achieve their optimal performance with a healthy diet. Sports dietitians can help
their clients prepare for forthcoming sporting events by creating meal plans, lecturing
about pre- and post-training eating habits, and prescribing supplements to improve the
athletes' immunity and performance. They might also provide tips on how to stay
hydrated and manage your weight.

Among the nutritionist types above this project will focus mainly on a clinical nutritionist system
aimed at treating patients that have cardiovascular diseases or are at risk of contracting it.

2.2.2 BALANCED DIET

A balanced diet supplies the body with the five essential food groups needed for good health.
Foods like yams, maize, and rice are examples of foods high in carbohydrates, which is a major
source of energy. Foods like meat, beans, and nuts provide proteins, which are needed for tissue
growth and repair. Good fats can be found in vegetables, fish, seeds, and nuts. Fats and oils also
help cells develop and have anti-inflammatory effects. Minerals are vital for healthy
development and metabolic processes, with calcium, iron, and zinc being the most well-known.
Vitamins help metabolize food into energy, maintain healthy neurons and immunity, aid in blood
clotting, and regulate growth. A balanced diet ensures the body receives all the nutrients it needs

7
to carry out its internal processes, including breathing, blood circulation, temperature control,
and tissue repair. Pregnant women, growing children, and those who engage in physical activities
require higher amounts of nutrients. A diet rich in fruits, vegetables, whole grains, lean protein,
and healthy fats can promote overall health and reduce the risk of chronic diseases.

2.3 CARDIOVASCULAR DISEASE

As stated in the previous chapter, cardiovascular diseases are the one of leading causes of death
worldwide with about 80 percent of the global burden of all CVD death occurring in low- and
middle-income countries (Gaziano, Reddy, Paccaud, Horton, & Chaturvedi, 2010). By 2020 it
was predicted to be the leading cause of death and disability worldwide because it will increase
in low- and middle-income countries. CVD causes about 28% of fatalities in low- and middle-
income countries and close to 50% of deaths overall in high-income countries (Mathers, Lopez,
& Christopher, 2020).

2.3.1 PREVALENT TYPES OF CARDIOVASCULAR DISEASES

Ischemic Heart Disease (IHD)

Ischemia is defined as a lack of blood flow (circulation) to a specific area caused by a blockage
of the blood arteries that supply the area. When an organ, like the heart, isn't getting enough
blood and oxygen, it's referred to as being ischemic. The term "ischemic heart disease," also
referred to as "coronary heart disease" or "coronary artery disease," refers to cardiovascular
problems brought on by narrowed coronary arteries, which supply blood to the heart muscle
(Institute of Medicine (US) Committee on Social Security Cardiovascular Disability Criteria,
2010).

Angina and sudden myocardial infarction are the two most common symptoms of IHD. In 2001,
IHD was responsible for 7.3 million fatalities and 58 million Disability-Adjusted Life Years
(DALYs) lost worldwide (Guilbert, 2003). 75 percent of worldwide fatalities and 82 percent of
all DALYs caused by IHD occurred in low- and middle-income nations.

Stroke

An obstruction in a blood vessel (ischemic stroke) or a blood vessel rupture disrupts the flow of
blood to a portion of the brain, which results in a stroke (hemorrhagic stroke) (Gaziano et al.,

8
2010). Depending on whatever area of the brain hasn't received blood flow, a stroke may have
distinct effects on you. This may have an impact on how you speak as well as how you move and
think. Types of strokes include ischemic strokes, hemorrhagic strokes, and mini-strokes.

Congestive Heart Failure

Congestive Heart Failure (CHF) is recognized as the terminal stage of many heart diseases. It is
characterized by abnormalities in myocardial and neurohormonal regulation which leads to
tiredness, fluid retention, and decreased lifespan. CHF has a large worldwide impact and is
becoming more prevalent (McMurray & Stewart, 2000). A 0.1 to 0.2 percent annual incidence
rate affects 2 to 3 percent of the developed world. Yet, the incidence and prevalence of CHF
rapidly rise as people age. The prevalence is 27 per 1,000 for those over 65, compared to 0.7 per
1,000 for those under 50 (McKelvie, 2003). Males are more prone to develop CHF, and gender
and socioeconomic status have a substantial impact on incidence and death rates.

2.3.2 RISK FACTORS OF CARDIOVASCULAR DISEASES

The risk factors for CVDs can be divided into two categories: modifiable and non-modifiable.
The non-modifiable risk factors include age, gender, and genetics. Focus will mainly be on the
modifiable risk factors however not all of them will feature in this report due to the scope. Below
includes some modifiable risk factors that could result in one contracting cardiovascular disease.

High blood pressure: Hypertension, another name for high blood pressure, is a condition where
the blood is pushing too hard against the artery walls. This may result in blood vessel damage
and raise the risk of CVDs including heart attack and stroke. A nutritious diet, regular exercise,
stress reduction, and medication, if required, are all effective ways to control high blood
pressure.

High cholesterol: Cholesterol is a waxy material that can accumulate in the artery walls, causing
atherosclerosis (hardening of the arteries). This could make CVDs like heart attacks and stroke
more likely. A nutritious diet, regular exercise, quitting smoking, and other lifestyle
modifications can help lower cholesterol. If necessary, medicines can also be used to treat high
cholesterol.

Unhealthy diet: A diet heavy in salt, sugar, trans fats, and saturated fats can cause high blood
pressure, high cholesterol, obesity, and diabetes, all of which raise the risk of CVDs. A balanced

9
diet rich in fresh produce, whole grains, lean proteins, and heart-healthy fats can help lower the
incidence of CVDs.

Smoking: One of the biggest risk factors for CVDs is cigarette smoking. Cigarette smoke
contains compounds that can harm blood arteries and raise the risk of atherosclerosis. The risk of
CVDs can be significantly reduced by quitting smoking.

Diabetes: Diabetes is a disorder where the body struggles to control blood sugar levels.
Uncontrolled diabetes increases the risk of CVDs such as heart attack and stroke and can harm
blood vessels. Diabetes can be controlled by making lifestyle adjustments such as eating a
nutritious diet, exercising frequently, and using medications when necessary.

Obesity and overweight: High body weight raises the risk of CVDs by a variety of mechanisms,
including insulin resistance, high blood pressure, and inflammation. Regular exercise and a
healthy diet can help people lose weight, which can lower their risk of CVDs.

2.4 RECOMMENDATION SYSTEMS

Recommendation Systems (RS) are a subclass of machine learning systems that use advanced
information filtering techniques to speed up user searches and recommend the most pertinent
content to any particular user (Biswas & Liu, 2022). Choosing what music to listen to, movies to
watch, news articles to read, goods to buy, and what to eat are just a few examples of how RSs
can assist us. The system's user recommendations are referred to as an item in the context of
Recommendation systems.

In the healthcare field, the use of recommendation systems has become more prominent in the
diagnosis, treatment, and prevention of diseases, chronic diseases in particular. With the rise of
chronic diseases in recent years, recommendation systems can help healthcare providers manage
and handle these conditions more effectively. For instance, a recommendation system can
provide personalized treatment plans based on a patient's medical history and health status,
which can lead to better health outcomes and reduce the risk of complications.

2.4.1 RECOMMENDATION FILTERING ALGORITHMS

One of the most important features of a recommendation system and arguably the one that
describes it is the filtering algorithm. Different food recommendation methods employ various

10
filtering algorithms which differ on the basis of the complexity of processing or method of
acquiring information. According to Kaur and G. Bathla (2019) the various recommendation
algorithms used by most RSs include.

Content-based filtering (CBF): Content-based filtering technique is based on the semantic

search which is the retrieval of information. Using the traits or qualities of the things themselves,
this method suggests products that are comparable to ones that a consumer has previously
enjoyed or interacted with. The items that are suggested are the same things that the consumer
has previously enjoyed, and they also fit the user's characteristics. This strategy works best when
the attributes are provided in a concise and sensible manner.

Due to its ease of use and simplicity, this kind of RS is highly popular and is mostly used in
recommending things like websites, music, movies, books, restaurants, and hotels for users who
want to save time, energy, and even resources doing those things themselves.

Collaborative filtering (CF): A major shortcoming of CBF is its unavailability of a feedback

feature for ratings and reviews. Without this feature, users would not be able to verify if their
recommendation is what they wanted or if it is indeed effective. To tackle this issue the
collaborative filtering algorithm was developed. Unlike CBF whose focus is on individual users,
the collaborative filtering approach recommends items based on the preferences of other users
who have similar tastes or preferences as the target user. The main idea of the collaborative
filtering technique is to obtain information relating to other users’ behavior and opinions so as to
correlate with the new user regardless of whether they are similar or not. There are two main
types of collaborative filtering:

 User-based collaborative filtering: This technique suggests products that people with
similar preferences have liked or interacted with.
 Item-based collaborative filtering: With this method, items that the target user has liked
or interacted with are recommended.

Although collaborative filtering may be a definite improvement to CBF, it is much more difficult
to understand and implement. Also, CF recommender systems are often only used when a
sufficient amount of information about both the user and the item is available in order to provide
the user with accurate recommendations.

11
Hybrid filtering: Both the content-based filtering technique and the collaborative filtering
technique are both useful in retrieving useful information but they are not without their pros and
cons. There may be instances that would require both approaches to be used or applied in some
sort and the hybrid approach has made it possible to combine both techniques. This approach
combines multiple recommendation techniques, such as content-based and collaborative filtering
techniques to provide more accurate and diverse recommendations. It bases its recommendations
on both the individual user’s profile and groups of users with similar rating histories. Among the
previous two approaches discussed, the hybrid approach is by far the most applicable and
complex as it has to combine two different approaches and make them function as one.
According to Burke (2002), there are 7 hybrid recommendation techniques.

 Weighted: Mixing several recommendation strategies by giving each technique a certain

amount of weight to create a final recommendation.
 Switching: Alternating between various recommendation methods based on the
circumstances, such as the user's profile, the kind of item being recommended, or the
present context.
 Mixed: Mixing the outcomes of various methods of recommendation without giving
them weight, such as by taking the union or intersection of suggested things.
 Feature Combination: This strategy combines features from other recommendation
algorithms to create new features.
 Feature Augmentation: Including new features in a recommendation method depending
on the output of other methods.
 Cascade: Utilizing one recommendation approach's findings to guide the
recommendations produced by another technique.
 Meta-level: combining the results of many recommendation techniques using a meta-
learner.

The recommendation techniques mentioned above are recognized as the basic or fundamental
recommendation approaches commonly used by most RS apps today however there include
some other recommendation methods not as mainstream as the ones just discussed but just as
effective and they include:

12
Knowledge-based filtering: This method makes recommendations based on explicit knowledge
of the user's preferences or needs, such as age, gender, geography, or other demographic or
psychographic traits. Sometimes, this knowledge involves a distinct functional understanding of
how particular product features meet consumer wants.

Demographic filtering: This method suggests products based on the user's demographic profile,
including things like age, gender, geography, or other pertinent details.

Context-aware filtering: This method suggests products based on the context or circumstance
of the user, such as the time of day, location, weather, or other pertinent circumstances.

2.4.2 SIMILARITY MODELS

For systems making use of CF or CFB techniques to be functional, they would need to be able to
calculate the numerous similarities between users and items. The comparison approach for a CF
system consists of placing the situations (user preferences) in the same area and determining how
much they resemble or differ from one another (Fkih, 2021). For instance, if a person purchases
a product, the system may recommend the same thing to another user who has a fairly similar
taste. Since the goal of this issue is to categorize a collection of individuals or products into
homogeneous groups, it is seen as a clustering process. This clustering depends on determining
the similarity (or semantic distance) between components within a group. As a result, the
similarity value increases with the more traits that the items have in common.

For this reason, selecting a proper similarity measure among a very large set of measures is
regarded as an extremely important task when developing an RS. That is because the efficiency
of a similarity measure has an overall influence on the RS performance.

There are a number of similarity models used by most software systems but according to
Adomavicius and Tuzhilin (2005), the most popular models are the Euclidean distance, Pearson
correlation, and cosine similarity.

Euclidean Distance:

Euclidean distance is a prominent similarity metric used in recommender systems to compute the
distance between two vectors. It is often regarded as the simplest technique of measuring the
similarity between two data points. It calculates the straight-line distance between two locations

13
in a three-dimensional space, which can be used to compare or contrast two objects or users
according to their features or preferences.
The Euclidean distance between two vectors x and y is denoted thus:

√(∑ )
n
2
d ( x , y )= ( xk− yk )
k=1

Where n = the number of attributes

xk = the kth attributes of data objects x
yk = the kth attributes of data objects y
Cosine similarity:

Cosine similarity is a popular similarity metric in RS. In a high-dimensional space, it calculates

the cosine of the angle between two vectors. The vectors in RS might represent item attributes or
user preferences, and so the two items x and y are employed as two vectors in n-dimensional
space. By finding the cosine of the angle between x and y, the similarity between them may be
calculated.

The cosine similarity between two vectors x and y is denoted thus:

x.y
cos ( x , y )=
||x||∨| y|∨¿ ¿
Where (.) = the vector dot product

||x|| = the norm of vector x.

||y|| = the norm of vector y.

Pearson correlation coefficient:

The Pearson correlation coefficient is a measure of the linear correlation between two variables.
It can be used to measure the similarity between two users or two items based on their ratings.
The Pearson correlation coefficient can be denoted as follows:

(∑ ( x , y ) )
r ( x , y )=
σx×σ y

Where ∑ (x , y )= the covariance of x and y

14
σ x ∧σ y = their standard deviation values

2.5 REVIEW OF RELATED WORKS

In recent years many apps catering to chronic and cardiovascular disease treatment and
prevention have been developed and although all of those systems could not be reviewed in this
report, a selected few of them that have tackled problems similar to the one stated in the previous
chapter will be reviewed.

2.5.1 U-Babsang
U-Babsang is a tabletop food recommendation system. This system combines a variety of
information from user profiles, such as body figure, gender, clinical history, and body
constitution, with physiological signals, such as heart rate, skin temperature, and sweat on the
palms, and perceived environmental data, such as illumination intensity, noise level, and
temperature (Oh, Choi, & Woo, 2009). The system uses a time-division layered context
integration system that combines contexts across several layers in order to improve system
performance as a whole. Additionally, it might offer each person personalized food
recommendations in real-time using this context integration technology.

U-Babsang was developed to solve the problem surrounding the lack of individualized context-
aware systems that can reflect personal needs in real-time. In order to achieve this, the system
makes use of the context-aware filtering algorithm and a user-adaptive food recommendation
method which will allow the system to recommend the appropriate food type for each individual
at the dining table in real time.

To evaluate the performance of u-Babsang, the accuracy and the reliability of the context
integration algorithm it used were calculated and the entire system was evaluated using a menu
of breakfast lunch and dinner. The test was done on four intentions closely related to the food
recommendation process. The accuracy of the integrated context in respect to the user’s original
intention and system output was calculated. The correspondence of each component was
analyzed for 100 trials and was expresses on a score of 0-6. At the end of the experiment the
results obtained revealed that the average degree of correctness for the four user’s intentions was
5.28/6 (88%) with 5.19/6 (86.5%) being the lowest score. The system was deemed reliable with

15
failure of just 12% with most of those failures being the wrong order in which the outputs were
displayed.

2.5.2 PREFer
Prescriptions for REcommending Food (PREFer) is a system that recommends food to customers
based on their short- and long-term likes as well as their prescriptions for medication. With the
constraints imposed by the particular user's phenotype, prescriptions are automatically generated
to conform to prescription types that reflect the ideal user's nutrition behavior from a health
standpoint (Bianchini, De Antonellis, De Franceschi, & Melchiori, 2017). In order to find recipes
that fit desired dietary patterns, a prescription type is created for each class of users' profiles.
Prescription types are made up of a set of features that should be used to filter through recipes
and a set of limitations that are used to omit specific recipes from suggestions.

This system was developed to solve the problems concerning healthy nutrition habits and it aims
to do that by making use of a Concept-based filtering algorithm for food recommendations while
also taking into account the educational perspective of the recommendations.

To evaluate the performance of PREFer a population of 4 requests was experimented on using 2

algorithms the first being the brute force algorithm and the other being the algorithm that
PREFer is using. The aim is to test the response time of both algorithms in running those 4
requests and compare their results to see which algorithm is better. The results obtained after
running both algorithms on the requests revealed that PREFer’s algorithm had a better response
time than the brute force algorithm and this is because of its ability to handle larger data sets and
diversify its generated outcomes.

2.5.3 Buon Appetito

Buon Appetite is a recommender system that uses a user-generated content filter to provide menu
suggestions by analyzing the ratings associated with each recipe (Trevisiol, Chiarandini, &
Baeza-Yates, 2014). Sentiment analysis of the written sentences in the reviews is used to create
fuzzy sets based on user sentiment. It may perform scientific analysis and provide food and menu
item recommendations before displaying them to the user.

Buon Appetito makes use of a user-based collaborative filtering algorithm with some sentiment
analysis for improved user recommendation. It is flexible in that it can easily be expanded to

16
recommend goods or services from companies based on customer reviews. Also, it can
recommend meal plans in form of a menu which makes it easy for users to use and understand.

2.5.4 DIETOS
Diet organizer system (DIETOS) is a recommender system that gives personalized nutritional
recommendations based on user health profiles gathered through the administration of medical
questionnaires provided by nutrition specialists and nephrologists (Agapito et al., 2018). The
report's publication marked the debut of a recommendation system (RS) that included a list of
typical regional meals distinguished by their nutraceutical qualities. Also, it contains a food
database that can be quickly updated with new items. It recommends meal plans that catered to
the health profile of the individual using the system and saves all changes made by the user so
that the data can be used to monitor the user’s health status.

The system was developed to solve the problems pertaining to the shortage of research projects
and systems tailored to patients with chronic kidney diseases (CKD) and diabetes and it aims to
do that by making use of the collaborative filtering algorithm for its recommendations.

In order to evaluate the performance of DIETOS, a population of 40 people with 20 of them

having either CKD or diabetes and the other 20 being unaffected, were selected to test the
system. After the test had been concluded the system’s success rate in determining those affected
with CKD or diabetes was 91% and 100% for those who were unaffected. According to the
methodologies used by DIETOS, it is able to appropriately suggest the best meal plan for any
user based on their health profile.

2.6 SYNTHESIS OF LITERATURE

In this Chapter we have reviewed 4 recommendation systems in the nutrition domain and form
reviewing them we have determined that there are many ways that nutrition-based
recommendation systems can be implemented. Though their approaches in development may be
different there are still some similarities between the systems when it comes to processing user
data and generating meal plans for them.

U-Babsang’s primary feature is its ability to infer high-level information, like behavior,
physiological status, and intention. Using the context-aware approach it is able to make use of
this information to recommend food to individuals in a user-centric manner. Though impressive,

17
the system centers mainly on user intentions and preferences and not necessarily on the user’s
health profile of the individual making use of the system. Also, the system requires that the user
has a certain degree of understanding of what they want to eat before they can use the system and
this can pose a challenge for those that are not well-educated on healthy dieting. Buon appetito is
similar to u-Basang in the way it recommends meals to users except that it makes use of a
different recommendation algorithm.

PREFer makes use of a function that possesses the ability to make recommendations based on a
person’s short and long-term preferences and medical prescriptions. This makes sure that all food
recommendations are automatically generated to be compliant with the user's nutritional
behaviour from the health point of view with constraints provided by the user. PREFer can be
seen as an improvement to u-Babsang in the way that it recommends meals to the user and
further educate its’s user based on their prescription generated by the system.

Among all the systems stated above DIETOS is the only one that gives recommendations based
on the user’s current health profile and stores that data in order to use it to monitor user health
status. DIETOS has some similarity with the system that this study will provide except that it is
aimed at chronic kidney disease and this study is aimed at cardiovascular diseases.

This study will focus on developing a system that recommends food to users in a user-centered
manner by taking in certain details such as their age, medical prescription, and allergy. The
system will make use of the health profile of the user to suggest meal plans for them in order to
prevent the contraction of cardiovascular diseases.

18
References

Adomavicius, G., & Tuzhilin, A. (2005). Toward the next generation of recommender systems: a
survey of the state-of-the-art and possible extensions. IEEE Transactions on Knowledge
and Data Engineering, 17(6), 734–749. https://doi.org/10.1109/tkde.2005.99

Agapito, G., Simeoni, M., Calabrese, B., Caré, I., Lamprinoudi, T., Guzzi, P. H., … Cannataro,
M. (2018). DIETOS: a dietary recommender system for chronic diseases monitoring and
management. Computer Methods and Programs in Biomedicine, 153, 93–104.
https://doi.org/10.1016/j.cmpb.2017.10.014

Amare, H., Hamza, L., & Asefa, H. (2015). Malnutrition and associated factors among heart
failure patients on follow up at Jimma university specialized hospital, Ethiopia. BMC
Cardiovascular Disorders, (15), 128. https://doi.org/10.1186/s12872-015-0111-4

Anand, S. S., Hawkes, C., de Souza, R. J., Mente, A., Dehghan, M., Nugent, R., … Popkin, B.
M. (2015). Food consumption and its impact on cardiovascular disease: importance of
solutions focused on the globalized food system. Journal of the American College of
Cardiology, 66(14), 1590–1614. https://doi.org/10.1016/j.jacc.2015.07.050

Bianchini, D., De Antonellis, V., De Franceschi, N., & Melchiori, M. (2017). PREFer: a
prescription-based food recommender system. Computer Standards & Interfaces, 54, 64–
75. https://doi.org/10.1016/j.csi.2016.10.010

Biswas, P. K., & Liu, S. (2022). A hybrid recommender system for recommending smartphones
to prospective customers. Expert Systems with Applications, (208).
https://doi.org/10.1016/j.eswa.2022.118058

Burke, R. (2002). Hybrid recommender systems: survey and experiments. User Modeling and
User-Adapted Interaction, 12(4), 331–370. https://doi.org/10.1023/a:1021240730564

Eroğlu, A. G. (2019). Malnutrition and the heart. Türk Pediatri Arşivi, 54(3),
139-140.https://doi.org/10.14744/turkpediatriars.2019.03764

Fkih, F. (2021). Similarity measures for Collaborative Filtering-based Recommender Systems:

Review and experimental comparison. Journal of King Saud University - Computer and
Information Sciences, 34(9), 7645–7669. https://doi.org/10.1016/j.jksuci.2021.09.014

Gaziano, T., Reddy, S. K., Paccaud, F., Horton, S. & Chaturvedi, V. (2010). Cardiovascular
Disease. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK11767/

Guilbert, J. J. (2003). The world health report 2002 - reducing risks, promoting healthy life.
Education for Health (Abingdon, England), 16(2), 230.
https://doi.org/10.1080/1357628031000116808

19
Institute of Medicine (US) Committee on Social Security Cardiovascular Disability Criteria.
(2010). Ischemic Heart Disease. Retrieved from
https://www.ncbi.nlm.nih.gov/books/NBK209964/

Kaur, H., & G. Bathla. (2019). Techniques of Recommender System. Retrieved April 12, 2023,
from https://www.semanticscholar.org/paper/Techniques-of-Recommender-System-
Kaur-Bathla/23e0ece110708258ef3cbf6e7df4814b434c7218

Lorente, M., Azpiroz, M. J., Guedes, P., Burgos, R., Lluch, A., & Dos, L. (2023). Nutrition,
dietary recommendations, and supplements. International Journal of Cardiology
Congenital Heart Disease, 100449. https://doi.org/10.1016/j.ijcchd.2023.100449

Mathers, C. D., Lopez, A. D., & Christopher. (2020). The Burden of Disease and Mortality by
Condition: Data, Methods, and Results for 2001. Retrieved from
https://www.ncbi.nlm.nih.gov/books/NBK11808/

McKelvie, R. S. (2003). Heart failure. BMJ Clinical Evidence, 2011, 95–118.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3275321/

McMurray, J. J. (2000). Heart Failure: epidemiology, aetiology, and prognosis of heart failure.
Heart, 83(5), 596–602. https://doi.org/10.1136/heart.83.5.596

Oh, Y., Choi, A., & Woo, W. (2009). u-BabSang: a context-aware food recommendation system.
The Journal of Supercomputing, 54(1), 61–81. https://doi.org/10.1007/s11227-009-0314-
5

Santiago, A. C. (2010, February 21). What Is a Nutritionist? Retrieved from

https://www.verywellhealth.com/nutritionist-what-is-a-nutritionist-1736231

Saunders, J., & Smith, T. (2010). Malnutrition: causes and consequences. Clinical Medicine,
10(6), 624–627. https://doi.org/10.7861/clinmedicine.10-6-624

Siniarski, A., Sobieraj, P., Samel-Kowalik, P., Sińska, B., Milewska, M., & Bzikowska-Jura, A.
(2022). Nutrition-related mobile applications - should they be used for dietary prevention
and treatment of cardiovascular diseases? Nutrition, Metabolism and Cardiovascular
Diseases, 32(11), 2505–2514. https://doi.org/10.1016/j.numecd.2022.07.010

Statista. (2022). Countries that are most affected by hunger and malnutrition according to the
Global Hunger Index 2022. https://www.statista.com/statistics/269924/countries-most-
affected-by-hunger-in-the-world-according-to-world-hunger-index/
Tison, G. H., Sanchez, J. M., Ballinger, B., Singh, A., Olgin, J. E., Pletcher, M. J., … Marcus, G.
M. (2018). Passive Detection of Atrial Fibrillation Using a Commercially Available
Smartwatch. JAMA Cardiology, 3(5), 409. https://doi.org/10.1001/jamacardio.2018.0136

Trevisiol, M., Chiarandini, L., & Baeza-Yates, R. (2014). Buon appetito: recommending
personalized menus. Retrieved from https://www.semanticscholar.org/paper/Buon-

20
 appetito%3A-recommending-personalized-menus-Trevisiol-Chiarandini/
64b2845967cbb577b6eb659c646cae3b6934161c

Types of Dietitians. (2020, July 8). Retrieved from https://www.newlifenutrition.com.au/diet-

and-nutrition/types-of-dietitians/

Wartenberg, L. (2020, March 12). Dietitian vs. Nutritionist: What’s the Difference? Retrieved
from https://www.healthline.com/nutrition/dietitian-vs-nutritionist

Yera, R., Alzahrani, A. A., Martínez, L., & Rodríguez, R. M. (2023). A Systematic Review on
Food Recommender Systems for Diabetic Patients. International Journal of
Environmental Research and Public Health, 20(5), 4248.
https://doi.org/10.3390/ijerph20054248

21