Showing papers in "Journal of Human Nutrition and Dietetics in 2015"

Nutrition in early life and the programming of adult disease: a review.

Abstract: Foetal development and infancy are life stages that are characterised by rapid growth, development and maturation of organs and systems. Variation in the quality or quantity of nutrients consumed by mothers during pregnancy, or infants during the first year of life, can exert permanent and powerful effects upon developing tissues. These effects are termed 'programming' and represent an important risk factor for noncommunicable diseases of adulthood, including the metabolic syndrome and coronary heart disease. This narrative review provides an overview of the evidence-base showing that indicators of nutritional deficit in pregnancy are associated with a greater risk of type-2 diabetes and cardiovascular mortality. There is also a limited evidence-base that suggests some relationship between breastfeeding and the timing and type of foods used in weaning, and disease in later life. Many of the associations reported between indicators of early growth and adult disease appear to interact with specific genotypes. This supports the idea that programming is one of several cumulative influences upon health and disease acting across the lifespan. Experimental studies have provided important clues to the mechanisms that link nutritional challenges in early life to disease in adulthood. It is suggested that nutritional programming is a product of the altered expression of genes that regulate the cell cycle, resulting in effective remodelling of tissue structure and functionality. The observation that traits programmed by nutritional exposures in foetal life can be transmitted to further generations adds weight the argument that heritable epigenetic modifications play a critical role in nutritional programming.

A systematic review and meta-analysis of interventions for weight management using text messaging.

Abstract: Background Obesity prevalence continues to increase worldwide, with significant associated chronic disease and health cost implications. Among more recent innovations in health service provision is the use of text messaging for health behaviour change interventions including weight management. This review investigates the efficacy of weight management programmes incorporating text messaging. Methods Medical and scientific databases were searched from January 1993 to October 2013. Eligibility criteria included randomised controlled trials (RCTs), pseudoRCTs and before and after studies of weight management, among healthy children and adults, that used text messaging and included a nutrition component. Data extraction and quality assessment followed guidelines from PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) and the Evidence Analysis Manual of the American Academy of Nutrition and Dietetics. Results From 512 manuscripts retrieved, 14 met the inclusion criteria (five manuscripts in children and nine in adults). Duration of interventions ranged from 1 to 24 months. Frequency of text messaging was from daily to fortnightly. Six studies in adults were included in a meta-analysis with mean body weight change as the primary outcome. The weighted mean change in body weight in intervention participants was −2.56 kg (95% confidence interval = −3.46 to −1.65) and in controls −0.37 kg (95% confidence interval = −1.22 to 0.48). Conclusions The small body of evidence indicates that text messaging interventions can promote weight loss. However, lack of long-term results indicate that further efficacy studies are required. Future investigations should elucidate the determinants, such as intervention duration, text message frequency and level of interactivity that maximise the success and cost effectiveness of the delivery medium.

A systematic review investigating interventions that can help reduce consumption of sugar-sweetened beverages in children leading to changes in body fatness.

Abstract: Background Both the prevalence of childhood obesity and the consumption of sugar-sweetened beverages (SSBs) have increased globally. The present review describes interventions that reduce the consumption of SSBs in children and determines whether this leads to subsequent changes in body fatness. Methods Three databases were searched from 2000 to August 2013. Only intervention control trials, ≥6 months in duration, which aimed to reduce the consumption of SSBs in >100 children aged 2–18 years, and reporting changes in body fatness, were included. The quality of selected papers was assessed. Results Eight studies met inclusion criteria. Six interventions achieved significant (P < 0.05) reductions in SSB intake, although this was not always sustained. In the two interventions providing replacement drinks, significant differences in body mass index (12- or 18-month follow-up) were reported (P = 0.001 and 0.045). The risk of being overweight/obesity was reduced (P < 0.05) in three of the five education programmes but in one programme only for girls who were overweight at baseline and in one programme only for pupils perceived to be at greater risk at baseline. In the one study that included both provision of water and education, the risk of being overweight was reduced by 31% (P = 0.04) in the intervention group. Conclusions The evidence suggests that school-based education programmes focusing on reducing SSB consumption, but including follow-up modules, offer opportunities for implementing effective, sustainable interventions. Peer support and changing the school environment (e.g. providing water or replacement drinks) to support educational programmes could improve their effectiveness. Home delivery of more suitable drinks has a big impact on reducing SSB consumption, with associated reductions in body weight.

Facilitators and barriers to weight loss and weight loss maintenance: A qualitative exploration

Abstract: Background The present study aimed to explore facilitators and barriers to weight loss (WL) and weight loss maintenance (WLM) in women who participated in a primary, 18-week comparative trial that promoted WL with an energy-restricted diet. Methods Twenty-three women participated in seven focus groups conducted by a moderator and co-facilitator using open-ended questions and probes. Focus groups were held in a private room and audio tape-recorded. Tapes were transcribed verbatim and thematic analysis was used to evaluate transcripts for common themes. Results Accountability to others, social support, planning ahead, awareness and mindfulness of food choices, basic nutrition education, portion control, exercise, and self-motivation were perceived as key facilitators for WL and WLM by women. Identified barriers included life transitions, health status changes, internal factors, environmental pressures, lack of accountability and an absence of social support. Conclusions Future interventions should address these salient facilitators and barriers to promote sustainable changes in women across their WL and WLM journeys.

Barriers to food intake in acute care hospitals: a report of the Canadian Malnutrition Task Force

Abstract: Background Poor food intake is common in acute care patients and can exacerbate or develop into malnutrition, influencing both recovery and outcome. Yet, research on barriers and how they can be alleviated is lacking. The present study aimed to (i) describe the prevalence of food intake barriers in diverse hospitals and (ii) determine whether patient, care or hospital characteristics are associated with the experience of these barriers. Methods Patients (n = 890; 87%) completed a validated questionnaire on barriers to food intake, including perceptions of food quality, just before their discharge from a medical or surgical unit in each of 18 hospitals across Canada. Scores were created for barrier domains. Associations between these barriers and selected patient characteristics collected at admission or throughout the hospital stay and site characteristics were determined using bivariate analyses. Results Common barriers were being interrupted at meals (41.8%), not being given food when a meal was missed (69.2%), not wanting ordered food (58%), loss of appetite (63.9%) and feeling too sick (42.7%) or tired (41.1%) to eat. Younger patients were more likely (P < 0.0001) to report being disturbed at meals (44.6%) than older patients (33.9%) and missing a meal for tests (39.0% versus 31.0%, P < 0.05). Patients who were malnourished, women, those with more comorbidity, and those who ate <50% of the meal reported several barriers across domains. Conclusions The present study confirms that barriers to food intake are common in acute care hospitals. This analysis also identifies that specific patient subgroups are more likely to experience food intake barriers. Because self-reported low food intake in hospital was associated with several barriers, it is relevant to consider assessing, intervening and monitoring barriers to food intake during the hospital stay.

Gender differences in dietary intakes: what is the contribution of motivational variables?

Abstract: Background Differences between men and women with respect to dietary intakes and eating behaviours have been reported and could be explained by gender differences in motivational variables associated with the regulation of food intake. The main objectives of the present study were to identify gender differences in dietary intakes, eating behaviours and motivational variables and to determine how motivational variables were associated with dietary intakes and eating behaviours in men and women. Methods Sixty-four men and 59 premenopausal women were included in the present study and presented cardiovascular risk factors. The Regulation of Eating Behaviours scale was completed to assess motivational variables. A validated food frequency questionnaire was administered to evaluate dietary intakes and subjects completed the Three-Factor Eating questionnaire to assess eating behaviours. Results Men had higher energy intake, energy density and percentage of energy from lipids and lower percentage of energy from carbohydrates than women (P ≤ 0.04). Men also had a lower emotional susceptibility to disinhibition than women (P = 0.0001). Women reported a higher score for eating-related self-determined motivation [i.e. eating-related self-determination index (SDI)] than men (P = 0.002). The most notable gender difference in the pattern of associations was that eating-related SDI was negatively associated with energy density (r = −0.30; P = 0.02), only in women. Conclusions Women had a better dietary profile and higher eating-related SDI than men. However, gender differences in dietary variables might be explained by a potential gender-specific pattern of association of eating-related SDI with dietary intakes and eating behaviours.

Factors predictive of drop-out and weight loss success in weight management of obese patients

Abstract: Background The prevention and treatment of overweight and obese individuals on a population-wide basis is challenging because patients have difficulties with adhering to weight loss programmes. The present study aimed to evaluate patients' adherence to the weight reduction programme by identifying factors predictive of both drop-out rate and weight loss success. Methods One-hundred and twenty-four obese patients participated in a 12-month weight reduction programme, involving group therapy during an intensive 5-day educational intervention, followed by five, 2-h follow-up visits. The primary outcome measures included drop-out rate and percentage weight loss. Sociodemographic and clinical characteristics, as well as type of diet, were explored as potential predictive factors. Type of diet was assigned based on randomisation. Regression analyses were conducted to identify predictive variables of drop-out and weight loss success. Results In total, 33.1% of all recruited participants were deemed successful because they reduced the initial weight by more than 5% after the 12-month intervention. The overall attrition rate was 32.3%. In a multiple regression model, initial weight loss and marital status were the strongest predictors of weight loss success after 1-year period (r2 = 0.481, P < 0.001). In a separate analysis, subjects more likely to drop-out were those with a lower educational level [odds ratio (OR) = 3.26, 95% confidence interval (CI) = 1.22–8.70, P = 0.018] and a higher level of obesity (OR = 0.974, 95% CI = 0.95–0.99, P = 0.010). Conclusions The present study demonstrates that initial weight loss at 1 month made the strongest unique contribution to the prediction of percentage weight loss after 12 months, whereas being married was a negative predictor. Those with a lower educational level and a higher level of obesity were more likely to drop-out.

Fluid intake from beverages across age groups: a systematic review

Abstract: Background Fluid intake, especially water, is essential for human life and also necessary for physical and mental function. The present study aimed to assess beverage consumption across age groups. Methods A systematic review was conducted. Original research in English language publications and available studies (or abstracts in English) from 2000 to 2013 was searched for by using the medical subheading (MeSH) terms: (‘beverage’ OR ‘fluid’ [Major]) AND (‘consumption’ [Mesh] OR ‘drinking’ [Mesh] OR ‘intake’ [Mesh]) AND (‘child’ [Mesh] OR ‘adolescent’ [Mesh] OR ‘adult’ [Mesh]). Article selection was restricted to those papers covering healthy populations of all age groups in a nationwide sample, or from a representative sample of the population of a city or cities, which examined the trends or patterns of beverage intake and the determinants of beverage intake. Sixty-five studies were identified with respect to beverage consumption across age groups. The papers were screened by thoroughly reading titles or abstracts. Full-text articles were assessed by three investigators. Results Total beverage intake varied between 0.6 and 3.5 L day−1 among all age groups (males more than females). Plain water contributed up to 58%, 75% and 80% of the total beverage intake in children, adolescents and adults, respectively. Milk consumption was higher among children; consumption of soft drinks was higher among adolescents; and the consumption of tea, coffee and alcoholic beverages was higher among adults. Conclusions Plain water is the main water source for all age groups and the consumption of other beverages varies according to age.

Clinical effectiveness and economic costs of group versus one-to-one education for short-chain fermentable carbohydrate restriction (low FODMAP diet) in the management of irritable bowel syndrome.

Abstract: Background: Restriction of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) is an effective dietary treatment for irritable bowel syndrome (IBS). Patient dietary education is essential but labour intensive. Group FODMAP education may alleviate this somewhat but has not previously been investigated. The present study aimed to investigate the clinical effectiveness of low FODMAP group education in patients with IBS and to explore the cost of a group pathway. Methods: Patients with IBS (n = 364) were assessed for their suitability to attend dietitian-led group education or traditional one-to-one education in a novel group pathway. Clinical effectiveness (global symptom question, symptom prevalence, stool output) were compared at baseline and follow-up using the chi-squared test. The costs of the novel group pathway were assessed using a decision model. Results: The global symptom question indicated more patients were satisfied with their symptoms following dietary advice, in both group education [baseline 48/263 (18%) versus follow-up 142/263 (54%), P < 0.001] and one-to-one education [baseline 5/101 (5%) versus follow-up 61/101 (60%), P < 0.001], with no difference between group and one-to-one education at follow-up (P = 0.271). Overall, there was a significant decrease in symptom severity from baseline to follow-up (P < 0.001 for both groups) but no difference in symptom response between group and one-to-one education. The cost for the group education pathway for all 364 patients was £31 713.36. Conclusions: The present study shows that dietitian-led FODMAP group education is clinically effective and the costs associated with a FODMAP group pathway are worthy of further consideration for routine clinical care.

You are what you choose to eat: Factors influencing young adults' food selection behaviour

Abstract: Background Young or ‘emerging’ adulthood (ages 18–24 years) is a life-stage characterised by rapid weight gain, particularly among those born in recent decades, when environments have become saturated with cheap, highly palatable, processed foods. Although intervening in the immediate food environments of emerging adults is indicated, little is known about the factors influencing their food selection. The present study aimed to: (i) measure the relative importance of different influences on foods selected by emerging adults for consumption from a tertiary education setting and (ii) examine whether these influences differ according to gender, adiposity status, perceived stress and dieting or physical activity behaviours. Methods An online survey was administered with 112 emerging adults aged 19–24 years assessing demographics, perceived stress, dieting, physical activity and influences on food selection. Adiposity indicators (body mass index and waist circumference) were measured. Analyses compared the importance of influences on food selection by gender, adiposity, perceived stress, dieting and physical activity. Results Taste was the most important influence on food selection, followed by convenience (availability), cost, nutrition/health value, smell and stimulatory properties (alertness). Participants with an elevated waist circumference selected foods to help them cope with stress and control their weight. Those reporting a higher level of physical activity placed greater importance on nutritional/health value of foods but less importance on taste. Female dieters also placed less importance on taste and value for money. Conclusions Health promotion strategies addressing tertiary education food environments of emerging adults should ensure the ready availability of tasty and nutritious foods at a low cost.

Comparison of multi‐ and single‐frequency bioelectrical impedance analysis with dual‐energy X‐ray absorptiometry for assessment of body composition in post‐menopausal women: effects of body mass index and accelerometer‐determined physical activity

Abstract: Background Bioelectric impedance analysis (BIA) is commonly used in research to assess body composition. However, studies that validate the accuracy of BIA exclusively in post-menopausal women are lacking. The main purpose of the present study was to evaluate the agreement of multi-frequency (MF)-BIA and single-frequency (SF)-BIA with dual-energy X-ray absorptiometry (DXA) in the estimation of fat mass (FM) and fat-free mass (FFM) among post-menopausal women with variation in body mass index (BMI) and physical activity (PA). Methods FM and FFM were estimated by BIA and DXA in 146 post-menopausal women with a mean (SD) age of 62.8 (5.2) years. PA was determined by an accelerometer. Results The mean (SD) difference between MF-BIA and DXA was −1.8 (1.8) kg (P = 0.08) and 1.3 (1.8) kg (P = 0.01) for FM and FFM, respectively. SF-BIA provided a significantly lower estimate of FM [−2.0 (2.2) kg; P = 0.04] and a higher estimate of FFM [1.8 (2.4) kg; P < 0.01] compared to DXA. MF-BIA provided significantly better estimates of FM and FFM with narrower limits of agreement than SF-BIA in obese and insufficiently active subjects. In other BMI and PA groups, both BIA devices showed a similar deviation from DXA. Conclusions BIA tends to underestimate FM and overestimate FFM relative to DXA. MF-BIA appears to be a more appropriate method for the assessment of body composition than SF-BIA in post-menopausal woman with BMI >30 kg/m2 and in those who are insufficiently active.

Detox diets for toxin elimination and weight management: a critical review of the evidence

Abstract: Detox diets are popular dieting strategies that claim to facilitate toxin elimination and weight loss, thereby promoting health and well-being. The present review examines whether detox diets are necessary, what they involve, whether they are effective and whether they present any dangers. Although the detox industry is booming, there is very little clinical evidence to support the use of these diets. A handful of clinical studies have shown that commercial detox diets enhance liver detoxification and eliminate persistent organic pollutants from the body, although these studies are hampered by flawed methodologies and small sample sizes. There is preliminary evidence to suggest that certain foods such as coriander, nori and olestra have detoxification properties, although the majority of these studies have been performed in animals. To the best of our knowledge, no randomised controlled trials have been conducted to assess the effectiveness of commercial detox diets in humans. This is an area that deserves attention so that consumers can be informed of the potential benefits and risks of detox programmes.

The spatial clustering of obesity: does the built environment matter?

Abstract: Background Obesity rates in the USA show distinct geographical patterns. The present study used spatial cluster detection methods and individual-level data to locate obesity clusters and to analyse them in relation to the neighbourhood built environment. Methods The 2008–2009 Seattle Obesity Study provided data on the self-reported height, weight, and sociodemographic characteristics of 1602 King County adults. Home addresses were geocoded. Clusters of high or low body mass index were identified using Anselin's Local Moran's I and a spatial scan statistic with regression models that searched for unmeasured neighbourhood-level factors from residuals, adjusting for measured individual-level covariates. Spatially continuous values of objectively measured features of the local neighbourhood built environment (SmartMaps) were constructed for seven variables obtained from tax rolls and commercial databases. Results Both the Local Moran's I and a spatial scan statistic identified similar spatial concentrations of obesity. High and low obesity clusters were attenuated after adjusting for age, gender, race, education and income, and they disappeared once neighbourhood residential property values and residential density were included in the model. Conclusions Using individual-level data to detect obesity clusters with two cluster detection methods, the present study showed that the spatial concentration of obesity was wholly explained by neighbourhood composition and socioeconomic characteristics. These characteristics may serve to more precisely locate obesity prevention and intervention programmes.

‘Health and happiness is more important than weight’: a qualitative investigation of the views of parents receiving written feedback on their child's weight as part of the National Child Measurement Programme

Abstract: Background The present study aimed to explore parental perceptions of overweight children and associated health risks after receiving National Child Measurement Programme (NCMP) weight feedback. Methods Fifty-two parents of overweight and obese children aged 4–5 years and 10–11 years enrolled in the NCMP programme in England in 2010–2011 participated in qualitative, semi-structured interviews about their perceptions of their child's weight and health risk after receiving weight feedback. Interviews were audio tape recorded and were conducted either by telephone (n = 9) or in the respondents’ homes (n = 41). Interviews were transcribed verbatim and analysed using interpretative thematic analysis. Results Parents who received NCMP written feedback informing them that their child was overweight disregarded the results because they viewed ‘health and happiness as being more important than weight’. The feedback was viewed as less credible because it did not consider the individual child's lifestyle. ‘Broad definitions of healthy’ were described that did not include weight, such as reference to the child having good emotional and physical health and a healthy diet. Parents attributed weight to ‘inherited/acquired factors’ such as genetics or puppy fat, or did not regard their child's ‘appearance’ as reflecting being overweight. ‘Cultural influence’ also meant that being overweight was not viewed negatively by some non-white parents. Conclusions After receiving written weight feedback, parents use methods other than actual weight when evaluating their child's weight status and health risks. Parents’ conceptions of health and weight should be considered when communicating with parents, with the aim of bridging the gap between parental recognition of being overweight and subsequent behaviour change.

Impact of eating and drinking on body composition measurements by bioelectrical impedance.

Abstract: Background Bioelectrical impedance analysis would be a more practical tool to measure body composition in clinical settings, dietetic practice and epidemiological studies if patients/subjects did not have to fast before measurements. The present study assessed whether the ingestion of food or drink had any biologically significant effect on bioimpedance measurements and body composition by the foot-to-foot method. Methods Fifty-five healthy adults [30 males and 25 females; mean (SD) age 27.7 (7.1) years; mean (SD)body mass index 24 (3.8) kg m−2] were randomly assigned to a 2-day food trial (high-fat meal or high-carbohydrate meal) or a 2-day drink trial (water or high electrolyte drink). Body composition measurements were carried out in the fasting state, immediately after meal consumption and every 30 min for 2 h by the foot-to-foot single frequency bioimpedance technique. Results Bioimpedance increased significantly after the ingestion of food and fluid, although the changes were small. The electrolyte drink, high-fat and high-carbohydrate meals significantly increased the percentage body fat and fat mass. In all cases, the median percentage changes from baseline were approximately 1% in body fat percentage units. Conclusions Although there were statistically significant changes in body composition estimates after food or drink consumption, these were small and within the imprecision of the impedance technique, and so are unlikely to be of clinical significance. The present study suggests that impedance measures of body fatness in clinical settings do not require strict adherence to fasting, and this should increase the opportunities for clinical application.

Relationships between dietary intakes of children and their parents: a cross‐sectional, secondary analysis of families participating in the Family Diet Quality Study

Abstract: Background Being overweight and obese in Australian children is common. Current evidence related to parental influence on child dietary intake is conflicting, and is particularly limited in terms of which parent exerts the stronger relationship. The present study aimed to assess mother–father and parent–child dietary relationships and to identify which parent–child relationship is stronger. Methods A cross-sectional analysis was performed of dietary intake data from 66 families with one parent and one child aged 8–12 years who were participating in the Family Diet Quality Study, in the Hunter and Forster regions of New South Wales, Australia. Dietary intakes were assessed using adult and child specific, validated semi-quantitative 120-item food frequency questionnaires. Diet quality and variety subscores were assessed using the Australian Recommended Food Scores for adults and children/adolescents. Pearson's correlations were used to assess dietary relationships between mother–father, father–child and mother–child dyads. Results Weak-to-moderate correlations were found between mother–child dyads for components of dietary intake (r = 0.27–0.47). Similarly, for father–child dyads, predominantly weak-to-moderate correlations were found (r = 0.01–0.52). Variety of fruit intake was the most strongly correlated in both parent–child dyads, with the weakest relationships found for fibre (g 1000 kJ–1) in father–child and percentage energy from total fats for mother–child dyads. Mother–father dyads demonstrated mostly moderate-to-strong correlations (r = 0.13–0.73), with scores for condiments showing the weakest relationship and vegetables the strongest. For all dyads, strong correlations were observed for overall diet quality (r = 0.50–0.59). Conclusions Parent–child dietary intake is significantly related but differs for mother versus fathers. Further research is required to examine whether differing dietary components should be targeted for mothers versus fathers in interventions aiming to improve family dietary patterns.

The effect of interventions to prevent and treat malnutrition in patients admitted for rehabilitation: a systematic review with meta-analysis.

Abstract: Background Malnutrition occurs frequently among patients in rehabilitation, leading to poorer outcomes. Evidence of the effects of interventions to prevent or treat malnutrition is required to guide clinical practice in this setting. This systematic review aimed to determine the effect of oral nutrition interventions implemented in rehabilitation on nutritional and functional outcomes. Methods Five databases were searched to identify relevant publications; intervention trials of oral nutrition interventions (such as oral nutrition supplements, foodservice interventions, clinical care processes, enhanced eating environments) conducted with patients admitted for rehabilitation, reporting dietary intake, anthropometric, biochemical or functional outcomes. The reviewers determined study eligibility and assessed the included studies for risk of bias. Outcome data were combined narratively and by meta-analyses. Results From 1765 publications, 10 studies trialling oral nutrition supplements, foodservice interventions and clinical care processes (of neutral or positive quality) were identified. Compared to meals alone, oral nutritional supplements significantly improved energy and protein intake, with some evidence for improvements in anthropometry and length of stay. There was little evidence that speciality supplements were beneficial compared to standard versions. Meta-analyses demonstrated significantly greater energy [weighted mean difference (WMD) = 324 kcal, 212–436 kcal 95% confidence interval (CI)] and protein (WMD = 9.1 g, 0.2–17.9 g 95% CI) intake with energy dense meals. Opposing results were reported in studies investigating enhanced clinical care processes. Conclusions The provision of oral nutrition supplements and energy dense meals improved energy and protein intake and therefore may comprise effective strategies for addressing malnutrition in rehabilitation. The effect of these strategies on other nutritional and functional outcomes should be explored further.

Impact of supplementation with amino acids or their metabolites on muscle wasting in patients with critical illness or other muscle wasting illness: a systematic review.

Abstract: Muscle wasting during critical illness impairs recovery. Dietary strategies to minimise wasting include nutritional supplements, particularly essential amino acids. We reviewed the evidence on enteral supplementation with amino acids or their metabolites in the critically ill and in muscle wasting illness with similarities to critical illness, aiming to assess whether this intervention could limit muscle wasting in vulnerable patient groups. Citation databases, including MEDLINE, Web of Knowledge, EMBASE, the meta-register of controlled trials and the Cochrane Collaboration library, were searched for articles from 1950 to 2013. Search terms included ‘critical illness’, ‘muscle wasting’, ‘amino acid supplementation’, ‘chronic obstructive pulmonary disease’, ‘chronic heart failure’, ‘sarcopenia’ and ‘disuse atrophy’. Reviews, observational studies, sport nutrition, intravenous supplementation and studies in children were excluded. One hundred and eighty studies were assessed for eligibility and 158 were excluded. Twenty-two studies were graded according to standardised criteria using the GRADE methodology: four in critical care populations, and 18 from other clinically relevant areas. Methodologies, interventions and outcome measures used were highly heterogeneous and meta-analysis was not appropriate. Methodology and quality of studies were too varied to draw any firm conclusion. Dietary manipulation with leucine enriched essential amino acids (EAA), β-hydroxy-β-methylbutyrate and creatine warrant further investigation in critical care; EAA has demonstrated improvements in body composition and nutritional status in other groups with muscle wasting illness. High-quality research is required in critical care before treatment recommendations can be made.

Effects of a green tea extract, Polyphenon E, on systemic biomarkers of growth factor signalling in women with hormone receptor‐negative breast cancer

Abstract: Background Observational and experimental data support a potential breast cancer chemopreventive effect of green tea. Methods We conducted an ancillary study using archived blood/urine from a phase IB randomised, placebo-controlled dose escalation trial of an oral green tea extract, Polyphenon E (Poly E), in breast cancer patients. Using an adaptive trial design, women with stage I–III breast cancer who completed adjuvant treatment were randomised to Poly E 400 mg (n = 16), 600 mg (n = 11) and 800 mg (n = 3) twice daily or matching placebo (n = 10) for 6 months. Blood and urine collection occurred at baseline, and at 2, 4 and 6 months. Biological endpoints included growth factor [serum hepatocyte growth factor (HGF), vascular endothelial growth factor (VEGF)], lipid (serum cholesterol, triglycerides), oxidative damage and inflammatory biomarkers. Results From July 2007-August 2009, 40 women were enrolled and 34 (26 Poly E, eight placebo) were evaluable for biomarker endpoints. At 2 months, the Poly E group (all dose levels combined) compared to placebo had a significant decrease in mean serum HGF levels (−12.7% versus +6.3%, P = 0.04). This trend persisted at 4 and 6 months but was no longer statistically significant. For the Poly E group, serum VEGF decreased by 11.5% at 2 months (P = 0.02) and 13.9% at 4 months (P = 0.05) but did not differ compared to placebo. At 2 months, there was a trend toward a decrease in serum cholesterol with Poly E (P = 0.08). No significant differences were observed for other biomarkers. Conclusions Our findings suggest potential mechanistic actions of tea polyphenols in growth factor signalling, angiogenesis and lipid metabolism.

Limiting antenatal weight gain improves maternal health outcomes in severely obese pregnant women: findings of a pragmatic evaluation of a midwife-led intervention.

Abstract: Background: Antenatal obesity in pregnancy is associated with complications of pregnancy and poor obstetric outcomes. Although most guidance on pregnancy weight is focused on the pre-pregnancy period, pregnancy is widely viewed as a period where women are open to lifestyle change to optimise their health. Method: The hospital-based Bumps and Beyond intervention invited all pregnant women with a BMI of over 35 kg/m2 to take part in a programme of health education around diet and exercise, accompanied by one-to-one guidance and monitoring of dietary change. This service evaluation compares 89 women who completed at a programme of 7 sessions with healthy lifestyle midwives and advisors (intervention) with a group of 89 women who chose not to attend (non-intervention). Results: Weight gain in the intervention group (4.5±4.6 kg) was less than in the non-intervention group (10.3±4.4 kg) between antenatal booking and 36 weeks gestation (<0.001). This was associated with a 95% reduction in the risk of gestational hypertension during pregnancy and a general reduction in pregnancy complications. There was no effect of the intervention upon gestational diabetes or complications in labour other than post-partum haemorrhage (reduced 55%). The impact of the intervention on gestational weight gain was greater in women with BMI over 40 kg/m2 at booking. There were no adverse effects of the intervention, even though 21% of the intervention group lost weight during their pregnancy. Conclusion: Intensive, personalised weight management intervention may be an effective strategy for prevention of hypertensive disorders during pregnancy.

Trial for Reducing Weight Retention in New Mums: a randomised controlled trial evaluating a low intensity, postpartum weight management programme.

Abstract: Background Failure to return to pregnancy weight by 6 months postpartum is associated with long-term obesity, as well as adverse health outcomes. This research evaluated a postpartum weight management programme for women with a body mass index (BMI) > 25 kg m–2 that combined behaviour change principles and a low-intensity delivery format with postpartum nutrition information. Methods Women were randomised at 24–28 weeks to control (supported care; SC) or intervention (enhanced care; EC) groups, stratified by BMI cohort. At 36 weeks of gestation, SC women received a ‘nutrition for breastfeeding' resource and EC women received a nutrition assessment and goal-setting session about post-natal nutrition, plus a 6-month correspondence intervention requiring return of self-monitoring sheets. Weight change, anthropometry, diet, physical activity, breastfeeding, fasting glucose and insulin measures were assessed at 6 weeks and 6 months postpartum. Results Seventy-seven percent (40 EC and 41 SC) of the 105 women approached were recruited; 36 EC and 35 SC women received a programme and 66.7% and 48.6% completed the study, respectively. No significant differences were observed between any outcomes. Median [interquartile range (IQR)] weight change was EC: −1.1 (9.5) kg versus SC: −1.1 (7.5) kg (6 weeks to 6 months) and EC: +1.0 (8.7) kg versus SC: +2.3 (9) kg (prepregnancy to 6 months). Intervention women breastfed for half a month longer than control women (180 versus 164 days; P = 0.10). An average of 2.3 out of six activity sheets per participant was returned. Conclusions Despite low intervention engagement, the high retention rate suggests this remains an area of interest to women. Future strategies must facilitate women's engagement, be individually tailored, and include features that support behaviour change to decrease women's risk of chronic health issues.

Validation of a web-based questionnaire to assess the dietary intake of Brazilian children aged 7-10 years.

Abstract: Background The Food Intake and Physical Activity of School Children (CAAFE) comprises an online questionnaire to self-report diet and physical activity of Brazilian schoolchildren. Background The present study aimed to assess the validity (matches, omissions and intrusions) and moderating factors of the CAAFE. Methods Direct observation was made of foods consumed (five public schools) and child self-reporting on the CAAFE. Additional data included school grade, gender, body mass index, completion of food diary, socioeconomic status and access to computer. Data were analysed using regression. Results In total, 602 children participated in the study [mean (SD) age 9.5 (1.24) years; 53.6% boys]. On average, there were 43% matches, 29% intrusions and 28% omissions. Matches doubled in third grade compared to the second grade (P = 0.004); matches almost tripled for afternoon snack compared to morning snack (P < 0.001); and matches were 69% higher for children with access to a computer at home (P < 0.01). Intrusions decreased by almost one-half in fifth compared to fourth grades (P = 0.004). Omissions declined significantly in the third and fourth grades but increased in the fifth grade. Omissions were 47% lower for children in the highest income and lower among children who completed the food diary. No differences were found for gender or body mass index. Conclusions Children older than 8 years old, who owned a computer and completed a food diary, performed better in the CAAFE. A high incidence of disagreement was found in relation to the schools and the type of meal. Overall matches (43%), intrusions (29%) and omissions (28%) indicate that further studies are required to improve the validity of the CAAFE.

Vitamin D and muscle strength throughout the life course: a review of epidemiological and intervention studies.

Abstract: The putative role of vitamin D in muscle function and strength throughout the life course is of interest because muscle strength is required for engagement in physical activity at all ages. As vitamin D deficiency is widely reported in the population, especially in countries at high latitude, the potential importance of vitamin D in muscle function throughout life, and the potential impacts on growth and development, participation in physical activity, and effects on skeletal and cardio-metabolic health, comprise an important topic for discussion. This review provides an overview of muscle function and summarises the role of the vitamin D receptor and the proposed molecular mechanisms of action of vitamin D in muscle cells. In addition, the review provides a comprehensive assessment of the clinical evidence surrounding the association between vitamin D and muscle strength. Among adults, particularly older adults, cross-sectional and cohort studies reported a positive association between vitamin D status and muscle strength. These associations have been largely confirmed by intervention studies. Limited research has been carried out in adolescents and children; two cross-sectional studies in adolescents have suggested an association between serum 25-hydroxyvitamin D concentrations and muscle strength. However, the two intervention studies in adolescents have yielded conflicting results. Other than a single observational study, data in young children are very limited and further investigation in under 12-year-olds is warranted.

Cereal, fruit and vegetable fibre intake and the risk of the metabolic syndrome: a prospective study in the Tehran Lipid and Glucose Study

Abstract: Background The present study aimed to determine whether total fibre or specific fibre food sources are associated with the incidence of the metabolic syndrome (MetS) after 3 years of follow-up in the Tehran Lipid and Glucose Study. Methods This population-based prospective study, conducted within the framework of the Tehran Lipid and Glucose Study, included 1582 adults, who were aged 19–84 years and free of MetS at baseline. Usual dietary fibre intake was assessed at baseline using a 168-item food frequency questionnaire. Anthropometrics, blood pressure, and fasting blood glucose and lipid profiles were measured at baseline and 3 years later. The MetS was defined according to the definition of the revised Adult treatment Panel III. Results During the 3-year follow-up, there was 15.2% incidence of MetS. Among sources of dietary fibre, fruit fibre was significantly and inversely associated with the occurrence of MetS, after adjustment for confounding factors, with a 21% lower risk [odds ratio (OR) = 0.79, 95% confidence interval (CI) = 0.60–0.97] in the highest tertile of intake compared to the lowest tertile. Subjects in the highest tertile of cereal fibre intake had lower odds of MetS compared to those in the lowest tertile (OR = 0.73, 95% CI = 0.52– 0.97) and this association disappeared after adjustment for confounders. No significant association was found between intakes of vegetables, legumes and nut fibre with the incidence of MetS. Conclusions Among specific fibre food sources, fruit fibre had a protective effect against the risk of MetS.

Liquid versus solid energy intake in relation to body composition among Australian children.

Abstract: Background The debate about whether energy consumed in liquid form is more obesogenic than energy consumed in solid form remains equivocal We aimed to evaluate the effects of liquid versus solid energy intake and different beverage types on changes in childhood adiposity Methods Our analyses included 8-year-old Australian children (n = 158) participating in the Childhood Asthma Prevention Study Dietary information was collected using three 24-h recalls at age 9 years Multivariate linear regression was used to evaluate the effects of liquid versus solid energy intake and different beverage types on changes in body mass index (BMI) Z-score from ages 8 to 115 years (△BMIz8–115y) and percentage body fat (%BF) at age 115 years (%BF115y) Substitution models were used to evaluate the effects of substituting other beverage types for sugar-sweetened beverages (SSB) Results Liquid energy intake (1 MJ day–1) was more closely associated with both △BMIz8–115y (β = 023, P = 002) and %BF115y (β = 231%, P = 001) than solid energy intake (△BMIz8–115y: β = 012, P = 001 and %BF115y: β = 080%, P = 007) SSB consumption (100 g day–1) was directly associated with △BMIz8–115y (β = 008, P = 002) and %BF115y (β = 092%, P = 0004),whereas diet drinks (100 g day–1) were inversely associated with △BMIz8–115y (β = 018, P = 002) Substitution of 100 g of SSB by 100 g of water or diet drink, but not other beverages, was inversely associated with both △BMIz8–115y and %BF115y (P < 001) Conclusions Our findings indicate that liquid energy is more obesogenic than solid energy In particular, SSB, but not other beverage types, are a significant predictor of childhood adiposity and replacing SSB with water can have long-term beneficial effects on childhood adiposity

Validation of a food frequency questionnaire to assess food group intake by pregnant women.

Abstract: Background Previous studies conducted among pregnant women to test the accuracy of food frequency questionnaires (FFQ) for estimating food group intake were restricted to one specific trimester of pregnancy. The present study aimed to validate a FFQ for assessing the intake of food groups throughout pregnancy. Methods In total, 75 adult pregnant Brazilian women were evaluated. Dietary intake was assessed by the FFQ (completed at the third trimester of pregnancy) and by three 24-h dietary recalls; one in each trimester of pregnancy. Results The food items were classified into 20 groups. Adequate deatenuatted Pearson correlation coefficients (>0.4) were observed for the intake of bread/cake, butter/margarine; milk/dairy products; soft drinks/artificial juices; coffee/tea; and pastries/sandwiches. The FFQ served poorly for estimating fruit and vegetable intake. A high percentage (>70%) of women were classified into the same or adjacent quartiles for estimates of cookies/crackers, butter/margarine, milk/dairy products, fruit juices, soft drinks/artificial juices, coffee/tea, roots, rice, beans, meat/chicken/sausages, fried foods, fish, eggs, sweets/sugars, and pastries/sandwiches. Nevertheless, the agreement of joint classification between the dietary methods was mostly into adjacent quartiles, rather than in the same quartile, and low values of kappa were found. Conclusions The data reported in the present study suggest that the FFQ might not be an appropriate dietary method for evaluating food group intake throughout pregnancy. The joint classification between methods by categories of intake of food groups was mostly into adjacent quartiles, which could lead to attenuated associations when investigating diet–disease relationships during pregnancy.

Traditional food patterns are associated with better diet quality and improved dietary adequacy in Aboriginal peoples in the Northwest Territories, Canada

Abstract: Background Traditionally, the Arctic diet has been derived entirely from locally harvested animal and plant species; however, in recent decades, imported foods purchased from grocery stores have become widely available. The present study aimed to examine Inuvialuit, traditional or nontraditional dietary patterns; nutrient density of the diet; dietary adequacy; and main food sources of energy and selected nutrient intakes. Methods This cross-sectional study used a culturally appropriate quantitative food frequency questionnaire to assess diet. Traditional and nontraditional eaters were classified as those consuming more or less than 300 g of traditional food daily. Nutrient densities per 4184 kJ (1000 kcal) were determined. Dietary adequacy was determined by comparing participants' nutrient intakes with the Dietary Reference Intakes. Results The diet of nontraditional eaters contained, on average, a lower density of protein, niacin, vitamin B12, iron, selenium, zinc, omega-3 fatty acids (P ≤ 0.0001), vitamin B6, potassium, thiamin, pantothenic acid (P ≤ 0.001), riboflavin and magnesium (P ≤ 0.05). Inadequate nutrient intake was more common among nontraditional eaters for calcium, folate, vitamin C, zinc, thiamin, pantothenic acid, vitamin K, magnesium, potassium and sodium. Non-nutrient-dense foods (i.e. high fat and high sugar foods) contributed to energy intake in both groups, more so among nontraditional eaters (45% versus 33%). Traditional foods accounted for 3.3% and 20.7% of total energy intake among nontraditional and traditional eaters, respectively. Conclusions Diet quality and dietary adequacy were better among Inuvialuit who consumed more traditional foods. The promotion of traditional foods should be incorporated in dietary interventions for this population.

Factors associated with dropout in a group weight-loss programme: a longitudinal investigation.

Abstract: Background Attrition is a major limitation of most weight management intervention programmes. The present study aimed to conduct an extensive investigation of personal, sociodemographic and treatment-related factors associated with attrition at different stages of a 10-week group weight-loss programme. Methods The present study is part of a longitudinal, clinical intervention study comparing three conditions in a 10-week group programme: Control, Behavioural Intentions and Implementation Intentions. The study included 587 participants with a mean (SD) age of 46 (11) years (range 18–78 years) and a mean (SD) body mass index (BMI) of 31.9 (5.5) kg m–2, with 90% being female. To characterise dropout in each week separately, as well as overall dropout (dropout until week 9, the median time of dropout), we tested several logistic regression models, including multiple imputations to cope with missing data. Results The results of the different dropout models consistently showed that a smaller reduction in BMI in the first 2 weeks of the programme was the strongest predictor of dropout. Dropout in the tenth and last week differed from the earlier weeks both in the relatively high dropout rate (56% of total dropout) and in that, in contrast to earlier weeks, the week 10 model included the reduction in BMI during the last 2 weeks before dropout but did not include the reduction in BMI at the initiation of the intervention. Conclusions Weight-loss in the beginning of the programme is a crucial independent determinant of dropout in each week except the last one. This finding is important because it suggests a simple assessment for a major dropout risk factor in adult weight-loss intervention programmes.

Health literacy issues surrounding weight management among African American women: a mixed methods study.

Abstract: Background Individuals with limited health literacy (LHL) have poorer health outcomes and have difficulty understanding and complying with recommendations to maintain a healthy lifestyle. The present study examined the association between health literacy (HL) and sources of dieting information, the weight-loss methods used and the information needed to manage weight among African American women. Methods This mixed method study included seven focus groups and a survey of 413 African American women. Binary logistic regression analyses were performed to examine the association between HL category and sources of dieting information, weight-loss methods and information needed to lose weight. Thematic analysis was used to analyse focus group data. Results Women with LHL were significantly more likely to have a higher body mass index (BMI) than those with AHL (P < 0.05). Compared to respondents with LHL, those with adequate health literacy (AHL) are more likely to rely on information obtained from the Internet (P < 0.001), although they are less likely to rely on information obtained from the television (P < 0.05). They also are significantly more likely to participate in physical activity to lose weight (P ≤ 0.002). In addition, women with AHL were significantly less likely to want information on portion control (P = 0.002). Major qualitative themes were the importance of television and the Internet as major sources of health information, the use of healthy and unhealthy weight-loss methods, and being overwhelmed by the plethora of dieting information. Conclusions HL may affect BMI among AA women, where they access dieting information and the types of information needed to manage their weight.

Associations between dietary intake and the presence of the metabolic syndrome in patients with non-alcoholic fatty liver disease.

Abstract: Background Although dietary habits have been associated with the likelihood of the metabolic syndrome (MetS) in the general population, similar associations in non-alcoholic fatty liver disease (NAFLD) patients have not been explored. The aim of this cross-sectional study was to assess the presence of the MetS and to explore its potential association with dietary habits in a sample of NAFLD patients. Methods Seventy-three adult patients with recent NAFLD diagnosis based on elevated liver enzyme levels and evidence of hepatic steatosis on ultrasound were enrolled. Participants' habitual food consumption was retrospectively assessed through a food frequency questionnaire and adherence to the Mediterranean diet (MD) was assessed via the Mediterranean Diet Score (MedDietScore). The presence of the MetS was defined as the concomitant presence of at least three of its individual components, according to the criteria proposed by a recent joint statement of several major organisations. Results The MetS was present in 46.5% of the sample, with increased waist circumference values and decreased high-density lipoprotein cholesterol levels being the most prevalent disorders (63% and 88.7%, respectively). Consumption of refined grains [odds ratio (OR) = 1.02, 95% confidence interval (CI) = 1.00–1.05] and red meat and products (OR = 1.10, 95% CI = 1.01–1.21) were positively associated with the presence of the MetS, whereas the consumption of whole grains (OR = 0.92, 95% CI = 0.84–0.99) and MedDietScore (OR = 0.87, 95% CI = 0.76–0.99) were negatively associated, after adjusting for participants' age, sex, daily energy intake and time spent in sedentary activities. Conclusions Low refined grain and red meat intake, high whole grain intake and high adherence to the MD were associated with lower odds of the MetS in NAFLD patients.