A rapid food screener to assess fat and fruit and vegetable intake

Osteoarthritis prevalence and modifiable factors: a population study

BACKGROUND

This study's objectives were to investigate the prevalence of self-reported knee and hip osteoarthritis (OA) stratified by age and sex and to examine the association of modifiable factors with knee and hip OA prevalence. The study was conducted using randomly sampled data gathered from four communities in the province of Alberta, Canada.

METHODS

A large adult population sample (N = 4733) of individuals ≥18 years were selected. Health-related information was collected through telephone interviews and community measurement clinics for which a sub-sample (N = 1808) attended. Participants self-reported OA during telephone interviews. Clinic interviews further assessed if the diagnosis was made by a health care professional. Statistical analyses compared prevalence of OA between sexes and across age categories. Associations between modifiable factors for OA and the prevalence of knee and hip OA were assessed using binary logistic regression modelling.

RESULTS

Overall prevalence of self-reported OA in the total sample was 14.8 %, where 10.5 % of individuals reported having knee OA and 8.5 % reported having hip OA. Differences in prevalence were found for males and females across age categories for both knee and hip OA. In terms of modifiable factors, being obese (BMI >30 kg/m2) was significantly associated with the prevalence of knee (OR: 4.37; 95 % CI: 2.08,9.20) and hip (OR: 2.52; 95 % CI: 1.17,5.43) OA. Individuals who stand or walk a lot, but do not carry or lift things during their occupational activities were 2.0 times less likely to have hip OA (OR: 0.50; 95 % CI: 0.26,0.96). Individuals who usually lift or carry light loads or have to climb stairs or hills were 2.2 times less likely to have hip OA (OR: 0.45; 95 % CI: 0.21,0.95). The odds of having hip OA were 1.9 times lower in individuals consuming recommended or higher vitamin C intake (OR: 0.52; 95 % CI: 0.29,0.96). Significant differences in prevalence were found for both males and females across age categories.

CONCLUSION

The prevalence of knee and hip OA obtained in this study is comparable to other studies. Females have greater knee OA prevalence and a greater proportion of women have mobility limitations as well as hip and knee pain; it is important to target this sub-group.

Controlling anal incontinence in women by performing anal exercises with biofeedback or loperamide (CAPABLe) trial: Design and methods

The goals of this trial are to determine the efficacy and safety of two treatments for women experiencing fecal incontinence. First, we aim to compare the use of loperamide to placebo and second, to compare the use of anal sphincter exercises with biofeedback to usual care. The primary outcome is the change from baseline in the St. Mark's (Vaizey) Score 24weeks after treatment initiation. As a Pelvic Floor Disorders Network (PFDN) trial, subjects are enrolling from eight PFDN clinical centers across the United States. A centralized data coordinating center supervises data collection and analysis. These two first-line treatments for fecal incontinence are being investigated simultaneously using a two-by-two randomized factorial design: a medication intervention (loperamide versus placebo) and a pelvic floor strength and sensory training intervention (anal sphincter exercises with manometry-assisted biofeedback versus usual care using an educational pamphlet). Interventionists providing the anal sphincter exercise training with biofeedback have received standardized training and assessment. Symptom severity, diary, standardized anorectal manometry and health-related quality of life outcomes are assessed using validated instruments administered by researchers masked to randomized interventions. Cost effectiveness analyses will be performed using prospectively collected data on care costs and resource utilization. This article describes the rationale and design of this randomized trial, focusing on specific research concepts of interest to researchers in the field of female pelvic floor disorders and all other providers who care for patients with fecal incontinence.

Disparities in healthy food zoning, farmers' market availability, and fruit and vegetable consumption among North Carolina residents

Background

Context and purpose of the study. To examine (1) associations between county-level zoning to support farmers’ market placement and county-level farmers’ market availability, rural/urban designation, percent African American residents, and percent of residents living below poverty and (2) individual-level associations between zoning to support farmers’ markets; fruit and vegetable consumption and body mass index (BMI) among a random sample of residents of six North Carolina (NC) counties.

Methods

Zoning ordinances were scored to indicate supportiveness for healthy food outlets. Number of farmers’ markets (per capita) was obtained from the NC-Community Transformation Grant Project Fruit and Vegetable Outlet Inventory (2013). County-level census data on rural/urban status, percent African American, and percent poverty were obtained. For data on farmers’ market shopping, fruit and vegetable consumption, and BMI, trained interviewers conducted a random digit dial telephone survey of residents of six NC counties (3 urban and 3 rural). Pearson correlation coefficients and multilevel linear regression models were used to examine county-level and individual-level associations between zoning supportiveness, farmers’ market availability, and fruit and vegetable consumption and BMI.

Results

At the county-level, healthier food zoning was greater in more urban areas and areas with less poverty. At the individual-level, self-reported fruit and vegetable consumption was associated with healthier food zoning.

Conclusions

Disparities in zoning to promote healthy eating should be further examined, and future studies should assess whether amending zoning ordinances will lead to greater availability of healthy foods and changes in dietary behavior and health outcomes.

Oleogustus: The Unique Taste of Fat

Considerable mechanistic data indicate there may be a sixth basic taste: fat. However, evidence demonstrating that the sensation of nonesterified fatty acids (NEFA, the proposed stimuli for "fat taste") differs qualitatively from other tastes is lacking. Using perceptual mapping, we demonstrate that medium and long-chain NEFA have a taste sensation that is distinct from other basic tastes (sweet, sour, salty, and bitter). Although some overlap was observed between these NEFA and umami taste, this overlap is likely due to unfamiliarity with umami sensations rather than true similarity. Shorter chain fatty acids stimulate a sensation similar to sour, but as chain length increases this sensation changes. Fat taste oral signaling, and the different signals caused by different alkyl chain lengths, may hold implications for food product development, clinical practice, and public health policy.

¡Cocinar Para Su Salud!: Randomized Controlled Trial of a Culturally Based Dietary Intervention among Hispanic Breast Cancer Survivors

BACKGROUND

There is a need for culturally relevant nutrition programs targeted to underserved cancer survivors.

OBJECTIVE

Our aim was to examine the effect of a culturally based approach to dietary change on increasing fruit/vegetable (F/V) intake and decreasing fat intake among Hispanic breast cancer survivors.

DESIGN

Participants were randomized to Intervention and Control groups. Diet recalls, detailed interviews, fasting blood, and anthropometric measures were collected at baseline, 3, 6, and 12 months.

PARTICIPANTS/SETTING

Hispanic women (n=70) with stage 0 to III breast cancer who completed adjuvant treatment and lived in New York City were randomized between April 2011 and March 2012.

INTERVENTION

The Intervention group (n=34) participated in ¡Cocinar Para Su Salud!, a culturally based nine-session (24 hours over 12 weeks) intervention including nutrition education, cooking classes, and food-shopping field trips. The Control group (n=36) received written dietary recommendations for breast cancer survivors.

MAIN OUTCOME MEASURES

Change at 6 months in daily F/V servings and percent calories from total fat were the main outcome measures.

STATISTICAL ANALYSES

Linear regression models adjusted for stratification factors and estimated marginal means were used to compare changes in diet from baseline to 3 and 6 months.

RESULTS

Baseline characteristics were the following: mean age 56.6 years (standard deviation 9.7 years), mean time since diagnosis 3.4 years (standard deviation 2.7 years), mean body mass index (calculated as kg/m(2)) 30.9 (standard deviation 6.0), 62.9% with annual household income ≤$15,000, mean daily servings of all F/V was 5.3 (targeted F/V 3.7 servings excluding legumes/juices/starchy vegetables/fried foods), and 27.7% of daily calories from fat. More than 60% in the Intervention group attended seven or more of nine classes, with overall study retention of 87% retention at 6 months. At month 6, the Intervention group compared with Control group reported an increase in mean servings of F/V from baseline (all F/V: +2.0 vs -0.1; P=0.005; targeted F/V: +2.7 vs +0.5; P=0.002) and a nonsignificant decrease in percent calories from fat (-7.5% vs -4.4%; P=0.23) and weight (-2.5 kg vs +3.8 kg; P=0.22).

CONCLUSIONS

¡Cocinar Para Su Salud! was effective at increasing short-term F/V intake in a diverse population of Hispanic breast cancer survivors.

Food environments are relevant to recruitment and adherence in dietary modification trials

Few studies have examined the built environment's role in recruitment to and adherence in dietary intervention trials. Using data from a randomized dietary modification trial of urban Latina breast cancer survivors, we tested the hypotheses that neighborhood produce access could act as a potential barrier and/or facilitator to recruitment, and that a participant's produce availability would be associated with increased fruit/vegetable intake, one of the intervention's targets. Eligible women who lived within a higher produce environment had a non-significant trend towards being more likely to enroll in the trial. Among enrollees, women who had better neighborhood access to produce had a non-significant trend toward increasing fruit/vegetable consumption. As these were not a priori hypotheses to test, we consider these analyses to be hypothesis generating and not confirmatory. Results suggest that participants' food environment should be considered when recruiting to and assessing the adherence of dietary intervention studies.

Body image and health: eating disorders and obesity

Eating behavior in adolescents can be as high risk as other behaviors that arise during this period and can have serious health consequences. This article presents a framework for screening and treatment of abnormal adolescent eating behavior by the primary care provider. A review of the types of disordered eating is presented along with suggested ways to screen. Indications for subspecialty eating disorder referrals and key aspects of screening and intervention in adolescent obesity and eating disorders are also reviewed. Specific attention is paid to the aspects of care that can be provided in primary care and multidisciplinary care.

A survey of diet self-efficacy and food intake in students with high and low perceived stress

Objective

Given the rise in obesity and obesity-related disorders, understanding the relationship between stress, self-efficacy and food choice in young adulthood may have implications for preventing negative health outcomes later in life that stem from poor eating habits. The current study examined whether stress levels and diet self-efficacy may be associated with unhealthy eating habits in young adults.

Methods

Male and female undergraduate students (N = 136) completed questionnaires that tap into diet self-efficacy (DSE), perceived stress (PS), sodium, and fat intake. Sex differences in choice of food were predicted, and low levels of perceived stress and high diet self-efficacy were expected to be associated with lower fat and sodium intake.

Results

Findings indicate an interaction between perceived stress and diet self-efficacy on fat intake and a main effect for diet self-efficacy on sodium intake in this population. As expected, low levels of perceived stress and high diet self-efficacy were associated with the lowest levels of fat and sodium intake in students. Findings were driven by females.

Conclusions

This study provides preliminary evidence that diet self-efficacy and perceived stress levels relate to nutrient intake in young adult females, and that increasing diet self-efficacy and reducing perceived stress in young adult females may lead to reductions in fat and sodium intake, leading to healthier eating habits.

Farmers' market shopping and dietary behaviours among Supplemental Nutrition Assistance Program participants

OBJECTIVE

Because farmers' markets include a variety of fruits and vegetables, shopping at farmers' markets would likely improve diet quality among low-income consumers, as well as promote sustainable direct farm-to-consumer business models. However, not much is known about how to promote farmers' market shopping among low-income consumers. Therefore, the purpose of the present paper was to examine barriers to and facilitators of shopping at farmers' markets and associations between shopping at farmers' markets and self-reported dietary behaviours (fruit and vegetable, sugar-sweetened beverage and fast-food consumption) and BMI.

DESIGN

Cross-sectional analyses of associations between farmers' market shopping frequency, awareness of markets, access to markets, dietary behaviours and BMI.

SETTING

Department of Social Services, Pitt County, eastern North Carolina, USA.

SUBJECTS

Between April and July 2013, Supplemental Nutrition Assistance Program (SNAP) participants (n 205) completed a quantitative survey.

RESULTS

Barriers to shopping at farmers' markets included does not accept SNAP/electronic benefit transfer, out of the way and lack of transportation. Farmers' market shopping was associated with awareness of farmers' markets (estimate =0·18 (se 0·04), P<0·001). Fruit and vegetable consumption was positively associated with farmers' market shopping (estimate =1·06 (se 0·32), P=0·001).

CONCLUSIONS

Our study is one of the first to examine SNAP participants' farmers' market shopping, distance to farmers' markets and dietary behaviours. Barriers to shopping at farmers' markets and increasing awareness of existing markets should be addressed in future interventions to increase SNAP participants' use of farmers' markets, ultimately improving diet quality in this high-risk group.

Reproducibility and intermethod reliability of a calcium food frequency questionnaire for use in Hispanic, non-Hispanic Black, and non-Hispanic White youth

BACKGROUND

A dietary assessment instrument designed for use in a nationally representative pediatric population was required to examine associations between calcium intake and bone mineral accrual in a large, multicenter study.

OBJECTIVE

To determine the reproducibility and intermethod reliability of a youth calcium food frequency questionnaire (FFQ) in a multiracial/ethnic sample of children and adolescents.

DESIGN

Reproducibility (n=69) and intermethod reliability (n=393) studies were conducted by administering repeat FFQs and three unannounced 24-hour dietary recalls to stratified random samples of individuals participating in the Bone Mineral Density in Childhood Study.

PARTICIPANTS/SETTING

Children and adolescents ages 5 to 21 years.

MAIN OUTCOME MEASURES

Calcium intake estimated from the FFQ and 24-hour dietary recalls.

STATISTICAL ANALYSIS

Reproducibility was assessed by the intraclass correlation coefficient (ICC). Intermethod reliability was assessed by deattenuated Pearson correlations between the FFQ and 24-hour recalls. Attenuation factors and calibration corrected effect estimates for bone density were calculated to determine the potential influence of measurement error on associations with health outcomes.

RESULTS

The ICC (0.61) for repeat administrations and deattenuated Pearson correlation between the FFQ and 24-hour recalls (r=0.60) for all subjects indicated reproducibility and intermethod reliability (Pearson r=0.50 to 0.74 across sex and age groups). Attenuation factors were ≤0.50 for all sex and age groups and lower for non-Hispanic blacks (λ=0.20) and Hispanics (λ=0.26) than for non-Hispanic whites (λ=0.42).

CONCLUSIONS

The Bone Mineral Density in Childhood Study calcium FFQ appears to provide a useful tool for assessing calcium intake in children and adolescents drawn from multiracial/ethnic populations and/or spanning a wide age range. However, similar to other FFQs, attenuation factors were substantially <1, indicating the potential for appreciable measurement error bias. Calibration correction should be performed and racial/ethnic differences in performance considered when analyzing and interpreting findings based on this instrument.

Work-related psychosocial stress and glycemic control among working adults with diabetes mellitus

OBJECTIVE

To examine the association between glycosylated hemoglobin (HbA1c) and four subscales of work-related psychosocial stress at study baseline and over time.

MATERIALS AND METHODS

We used survey data from a major HMO located in the Southeastern part of the US on health and healthy behaviors linked with patients' clinical, pharmacy and laboratory records for the period between 2005 and 2009. Study participants (n=537) consisted of working adults aged 25-59 years, diagnosed with diabetes mellitus (DM) but without advanced micro or macrovascular complications at the time of the survey. We estimated the baseline (2005) association between HbA1c and work-related psychosocial stress and their interactions using linear regression analysis. Using individual growth model approach, we estimated the association between HbA1c over time and work-related psychosocial stress. Each of the models controlled for socio-demographic variables, diet and physical activity factor, laboratory factor, physical examinations variables and medication use in a hierarchical fashion.

RESULTS

After adjusting for all study covariates, we did not find a significant association between work-related psychosocial stress and glycemic control either at baseline or over time.

CONCLUSION

Among fairly healthy middle aged working adults with DM, work-related psychosocial stress was not directly associated with glycemic control.

Effectiveness of a worksite-based weight loss randomized controlled trial: the worksite study

OBJECTIVE

To determine the effectiveness of an individually targeted Internet-based intervention with monetary incentives (INCENT) at reducing weight of overweight and obese employees when compared with a less-intensive intervention (Livin' My Weigh [LMW]) 6 months after program initiation.

METHODS

Twenty-eight worksites were randomly assigned to either INCENT or LMW conditions. Both programs used evidence-based strategies to support weight loss. INCENT was delivered via daily e-mails over 12 months while LMW was delivered quarterly via both newsletters and on-site educational sessions. Generalized linear mixed models were conducted for weight change from baseline to 6 months post-program and using an intention-to-treat analysis to include all participants with baseline weight measurements.

RESULTS

Across 28 worksites, 1,790 employees (M = 47 years of age; 79% Caucasian; 74% women) participated. Participants lost an average of 2.27 lbs (P < 0.001) with a BMI decrease of 0.36 kg/m(2) (P < 0.001) and 1.30 lbs (P < 0.01) with a BMI decrease of 0.20 kg/m(2) (P < 0.01) in INCENT and LMW, respectively. The differences between INCENT and LMW in weight loss and BMI reduction were not statistically significant.

CONCLUSIONS

This study suggests that INCENT and a minimal intervention alternative may be effective approaches to help decrease the overall obesity burden within worksites.

Appraising nutrient availability of household food supplies using Block Dietary Screeners for individuals

BACKGROUND/OBJECTIVE

The growing interest in environmental influences on obesity risk has spawned the development of tools for appraising home food availability. These tools reveal good reliability but tend to be limited in scope and burdensome to use. This cross-sectional study investigated the feasibility of using food categories and scoring algorithms from valid food frequency questionnaires for individuals (that is, Block Dietary Fat and Fruit-Vegetable-Fiber Screeners) to estimate nutrient availability in household food supplies.

SUBJECTS/METHODS

Screeners were compared with household food inventories from 100 two-parent families with ⩾1 children ⩽12 years of age. Inventoried foods were coded to match Screener food groups, and amounts available were converted to total adult daily equivalent servings to express the greatest possible frequency at which each food group could be eaten/day/household. Scoring algorithms were converted to express all scores on a per-day basis. For the most conservative assessment, the highest point was used for day ranges for the Fruit-Vegetable-Fiber Screener and the lowest range point was used for the Fat Screener.

RESULTS

Spearman's rank-order correlations (r⩾0.76) showed that the Fruit-Vegetable-Fiber Screener ranked households well for fruit/vegetable servings, vitamin C and dietary fiber. The Fat Screener and household inventory were positively correlated (r⩾0.58) for total fat, saturated fat and cholesterol. Concordance of household inventories and the Fruit-Vegetable-Fiber Screener, as determined by kappa with quadratic weighting, were strong and significant. Fat Screener concordance was moderate.

CONCLUSIONS

Results indicate that it is feasible to use the efficient, valid Block Dietary Screeners for individuals to appraise household food supplies.

Applying Health Locus of Control and Latent Class Modelling to food and physical activity choices affecting CVD risk

Health Locus of Control (HLC) classifies our beliefs about the connection between our actions and health outcomes (Skinner, 1996) into three categories: "internal control", corresponding to health being the result of an individual's effort and habits; "control by powerful others", whereby health depends on others, such as doctors; and "chance control", according to which health depends on fate and chance. Using Choice Experiments we investigate the relationship between HLC and willingness to change lifestyle, in terms of eating habits, physical activity and associated cardiovascular disease risk, in a 384 person sample representative of the 40-65 aged population of Northern Ireland administered between February and July 2011. Using latent class analysis we identify three discrete classes of people based on their HLC: the first class is sceptical about their capacity to control their health and certain unhealthy habits. Despite being unsatisfied with their situation, they are reluctant to accept behaviour changes. The second is a group of individuals unhappy with their current situation but willing to change through exercise and diet. Finally, a group of healthy optimists is identified, who are satisfied with their current situation but happy to take more physical activity and improve their diet. Our findings show that any policy designed to modify people's health related behaviour should consider the needs of this sceptical class which represents a considerable proportion of the population in the region.

Humans are more sensitive to the taste of linoleic and α-linolenic than oleic acid

Health concerns have led to recommendations to replace saturated fats with unsaturated fats. However, addition of unsaturated fatty acids may lead to changes in the way foods are perceived in the oral cavity. This study tested the taste sensitivity to and emulsion characteristics of oleic, linoleic, and α-linolenic acids. The hypothesis tested was that oral sensitivity to nonesterified fatty acids would increase with degree of unsaturation but that in vitro viscosities and particle sizes of these emulsions would not differ. Oral taste thresholds were obtained using the three-alternative, forced-choice, ascending method. Each participant was tested on each fat 7 times, for a total of 21 study visits, to account for learning effects. Viscosities were obtained for the blank solutions and all three emulsions. Results indicate lower oral thresholds to linoleic and α-linolenic than oleic acid. At higher shear rates, 5% oleic and linoleic acid were more viscous than other samples. More-dilute emulsions showed no significant differences in viscosity. Particle sizes of the emulsions increased very slightly with increasing unsaturation. Together, the emulsion characteristics and oral sensitivity data support a taste mechanism for nonesterified fatty acid detection.

¡Cocinar Para Su Salud!: Randomized Controlled Trial of a Culturally Based Dietary Intervention among Hispanic Breast Cancer Survivors

BACKGROUND

There is a need for culturally relevant nutrition programs targeted to underserved cancer survivors.

OBJECTIVE

Our aim was to examine the effect of a culturally based approach to dietary change on increasing fruit/vegetable (F/V) intake and decreasing fat intake among Hispanic breast cancer survivors.

DESIGN

Participants were randomized to Intervention and Control groups. Diet recalls, detailed interviews, fasting blood, and anthropometric measures were collected at baseline, 3, 6, and 12 months.

PARTICIPANTS/SETTING

Hispanic women (n=70) with stage 0 to III breast cancer who completed adjuvant treatment and lived in New York City were randomized between April 2011 and March 2012.

INTERVENTION

The Intervention group (n=34) participated in ¡Cocinar Para Su Salud!, a culturally based nine-session (24 hours over 12 weeks) intervention including nutrition education, cooking classes, and food-shopping field trips. The Control group (n=36) received written dietary recommendations for breast cancer survivors.

MAIN OUTCOME MEASURES

Change at 6 months in daily F/V servings and percent calories from total fat were the main outcome measures.

STATISTICAL ANALYSES

Linear regression models adjusted for stratification factors and estimated marginal means were used to compare changes in diet from baseline to 3 and 6 months.

RESULTS

Baseline characteristics were the following: mean age 56.6 years (standard deviation 9.7 years), mean time since diagnosis 3.4 years (standard deviation 2.7 years), mean body mass index (calculated as kg/m²) 30.9 (standard deviation 6.0), 62.9% with annual household income ≤$15,000, mean daily servings of all F/V was 5.3 (targeted F/V 3.7 servings excluding legumes/juices/starchy vegetables/fried foods), and 27.7% of daily calories from fat. More than 60% in the Intervention group attended seven or more of nine classes, with overall study retention of 87% retention at 6 months. At month 6, the Intervention group compared with Control group reported an increase in mean servings of F/V from baseline (all F/V: +2.0 vs -0.1; P=0.005; targeted F/V: +2.7 vs +0.5; P=0.002) and a nonsignificant decrease in percent calories from fat (-7.5% vs -4.4%; P=0.23) and weight (-2.5 kg vs +3.8 kg; P=0.22).

CONCLUSIONS

¡Cocinar Para Su Salud! was effective at increasing short-term F/V intake in a diverse population of Hispanic breast cancer survivors.

Diet-Related Colorectal Cancer Prevention Beliefs and Dietary Intakes in an Urban Minority Population

In the United States, colorectal cancer (CRC) is the third leading cause of cancer-related death and third most commonly diagnosed cancer among adults. This study is the first to examine the relationship between diet-related beliefs for colorectal cancer prevention and dietary intake among an urban, predominantly Black population (n = 169). More than two-thirds reported diet-related CRC prevention beliefs. Those with diet-related CRC prevention beliefs had healthier intakes for dietary fiber (p = .005), fruit, vegetable, bean (p = .027), red meat (p = .032), vitamin C (p = .039), and cholesterol (p = .045). Most people may already have diet-related CRC prevention beliefs and having them is associated with a more healthful dietary intake.

A cross-sectional study of the phenotypes of obesity and insulin resistance in adults with down syndrome

BACKGROUND

Despite the confluence of multiple cardiovascular risk factors, subclinical atherosclerotic damage and cardiovascular events remain extremely rare in adults with Down syndrome (DS). We aim to determine the prevalence of obesity and metabolic disorders in an adult cohort with DS and to compare our findings with adults without DS.

METHODS

Cross-sectional study of 51 consecutively selected adults with DS living in the community and 51 healthy controls in an outpatient clinic of a tertiary care hospital in Madrid, Spain. Epidemiological data (age and gender), anthropometric data (body mass index and waist-to-height ratio), coexisting clinical conditions, and laboratory data (fasting glucose, insulin, glycated hemoglobin, creatinine, thyroid hormones, vitamins, and lipid profile) were measured and compared between the groups.

RESULTS

Adults with DS were significantly younger and more often men with a higher prevalence of overweight and obesity than controls. Their waist-to-height ratio was higher, and they more frequently had abdominal obesity. The results of an analysis adjusted for age and gender revealed no differences in fasting insulin levels, homeostatic model assessment indexes, or lipid profile between adults with DS and controls.

CONCLUSION

Adults with DS presented a high prevalence of overweight and obesity. However, we found no differences in lipid profile, prevalence of insulin resistance, or metabolic syndrome between adults with DS and controls.

Evaluation of the impact of abdominal obesity on glucose and lipid metabolism disorders in adults with Down syndrome

We aimed to describe anthropometric differences in weight-related disorders between adults with Down syndrome (DS) and healthy controls, as well as their disparate impact on glucose and lipid metabolism disorders. We underwent a cross-sectional study of 49 consecutively selected, community-residing adults with DS and 49 healthy controls in an outpatient clinic of a tertiary care hospital in Madrid, Spain. Siblings of adults with DS were studied as controls in 42 cases. Epidemiological data (age and gender), anthropometric data (body mass index, waist circumference, and waist-to-height ratio [WHR]), coexisting clinical conditions, and laboratory data (fasting glucose, insulin, glycated hemoglobin, creatinine, thyroid hormones, and lipid profile) were measured and compared between the groups. Adults with DS were significantly younger and more often male, with a higher prevalence of overweight and obesity than controls. Adults with DS also had a higher WHR, and more frequently presented abdominal obesity. Moreover, insulin resistance measured using the homeostatic model assessment was more prevalent among adults with DS and abdominal obesity. However, lipid profiles were similar between groups. The kappa correlation index for the diagnosis of abdominal obesity between waist circumference and WHR was 0.24 (95%CI: 0.13-0.34). We concluded that the prevalence of overweight, obesity, and abdominal obesity was higher in adults with DS than in controls. Adults with DS and abdominal obesity showed higher indexes of insulin resistance than their non-obese peers. WHR was a useful tool for the evaluation of abdominal obesity in this population.

Behavioral impacts of sequentially versus simultaneously delivered dietary plus physical activity interventions: the CALM trial

BACKGROUND

Few studies have evaluated how to combine dietary and physical activity (PA) interventions to enhance adherence.

PURPOSE

We tested how sequential versus simultaneous diet plus PA interventions affected behavior changes.

METHODS

Two hundred participants over age 44 years not meeting national PA and dietary recommendations (daily fruit and vegetable servings and percent of calories from saturated fat) were randomized to one of four 12-month telephone interventions: sequential (exercise first or diet first), simultaneous, or attention control. At 4 months, the other health behavior was added in the sequential arms.

RESULTS

Ninety-three percent of participants were retained through 12 months. At 4 months, only exercise first improved PA, and only the simultaneous and diet-first interventions improved dietary variables. At 12 months, mean levels of all behaviors in the simultaneous arm met recommendations, though not in the exercise- and diet-first arms.

CONCLUSIONS

We observed a possible behavioral suppression effect of early dietary intervention on PA that merits investigation.

The role of perceived barriers in explaining socio-economic status differences in adherence to the fruit, vegetable and fish guidelines in older adults: a mediation study

OBJECTIVE

We aimed to identify barriers for meeting the fruit, vegetable and fish guidelines in older Dutch adults and to investigate socio-economic status (SES) differences in these barriers. Furthermore, we examined the mediating role of these barriers in the association between SES and adherence to these guidelines.

DESIGN

Cross-sectional.

SETTING

Longitudinal Aging Study Amsterdam (LASA), the Netherlands.

SUBJECTS

We used data from 1057 community-dwelling adults, aged 55-85 years. SES was measured by level of education and household income. An FFQ was used to assess dietary intake and barriers were measured with a self-reported lifestyle questionnaire.

RESULTS

Overall, 48.9 % of the respondents perceived a barrier to adhere to the fruit guideline, 40.0 % for the vegetable and 51.1 % for the fish guideline. The most frequently perceived barriers to meet the guidelines were the high price of fruit and fish and a poor appetite for vegetables. Lower-SES groups met the guidelines less often and perceived more barriers. The association between income and adherence to the fruit guideline was mediated by 'perceiving any barrier to meet the fruit guideline' and the barrier 'dislike fruit'. The association between income and adherence to the fish guideline was mediated by 'perceiving any barrier to meet the fish guideline' and the barrier 'fish is expensive'.

CONCLUSIONS

Perceived barriers for meeting the dietary guidelines are common in older adults, especially in lower-SES groups. These barriers and in particular disliking and cost concerns explained the lower adherence to the guidelines for fruit and fish in lower-income groups in older adults.

Different oral sensitivities to and sensations of short-, medium-, and long-chain fatty acids in humans

Fatty acids that vary in chain length and degree of unsaturation have different effects on metabolism and human health. As evidence for a "taste" of nonesterified fatty acids (NEFA) accumulates, it may be hypothesized that fatty acid structures will also influence oral sensations. The present study examined oral sensitivity to caproic (C6), lauric (C12), and oleic (C18:1) acids over repeated visits. Analyses were also conducted on textural properties of NEFA emulsions and blank solutions. Oral thresholds for caproic acid were lower compared with oleic acid. Lauric acid thresholds were intermediate but not significantly different from either, likely due to lingering irritating sensations that prevented accurate discrimination. From particle size analysis, larger droplets were observed in blank solutions when mineral oil was used, leading to instability of the emulsion, which was not observed when emulsions contained NEFA or when mineral oil was removed from the blank. Rheological data showed no differences in viscosity among samples except for a slightly higher viscosity with oleic acid concentrations above 58 mM. Thus, texture was unlikely to be the property used to distinguish between the samples. Differences in oral detection and sensation of caproic, lauric, and oleic acids may be due to different properties of the fatty acid alkyl chains.

Validity evidence for self-report with assistance to measure physical activity behavior in adults with intellectual disabilities

Self-reported physical activity (PA) behavior with assistance from a secondary source has previously been used with adults with an intellectual disability (ID). Limited evidence of reliability and validity have been provided for this approach. This study examined evidence of convergent (CV) and discriminant (DV) validity for self-report with assistance from a secondary source as a measure of PA in adults with ID. PA of 37 participants with ID were assessed using (a) self-report, (b) accelerometers, and (c) pedometers. The multitrait-multimethod (MTMM) analysis was used to evaluate validity. MTMM analysis revealed high reliability among variables, low to strong CV, and moderate DV. The study outcomes provide initial convergent and discriminant validity evidence for this measure of PA in adults with ID.

A comparison of live counseling with a web-based lifestyle and medication intervention to reduce coronary heart disease risk: a randomized clinical trial

IMPORTANCE

Most primary care clinicians lack the skills and resources to offer effective lifestyle and medication (L&M) counseling to reduce coronary heart disease (CHD) risk. Thus, effective and feasible CHD prevention programs are needed for typical practice settings.

OBJECTIVE

To assess the effectiveness, acceptability, and cost-effectiveness of a combined L&M intervention to reduce CHD risk offered in counselor-delivered and web-based formats.

DESIGN, SETTING, AND PARTICIPANTS

A comparative effectiveness trial in 5 diverse family medicine practices in North Carolina. Participants were established patients, aged 35 to 79 years, with no known cardiovascular disease, and at moderate to high risk for CHD (10-year Framingham Risk Score [FRS], ≥10%).

INTERVENTIONS

Participants were randomized to counselor-delivered or web-based format, each including 4 intensive and 3 maintenance sessions. After randomization, both formats used a web-based decision aid showing potential CHD risk reduction associated with L&M risk-reducing strategies. Participants chose the risk-reducing strategies they wished to follow.

MAIN OUTCOMES AND MEASURES

The primary outcome was within-group change in FRS at 4-month follow-up. Other measures included standardized assessments of blood pressure, blood lipid levels, lifestyle behaviors, and medication adherence. Acceptability and cost-effectiveness were also assessed. Outcomes were assessed at 4 and 12 months.

RESULTS

Of 2274 screened patients, 385 were randomized (192 counselor; 193 web): mean age, 62 years; 24% African American; and mean FRS, 16.9%. Follow-up at 4 and 12 months included 91% and 87% of the randomized participants, respectively. There was a sustained reduction in FRS at both 4 months (primary outcome) and 12 months for both counselor-based (-2.3% [95% CI, -3.0% to -1.6%] and -1.9% [95% CI, -2.8% to -1.1%], respectively) and web-based groups (-1.5% [95% CI, -2.2% to -0.9%] and -1.7% [95% CI, -2.6% to -0.8%] respectively). At 4 months, the adjusted difference in FRS between groups was -1.0% (95% CI, -1.8% to -0.1%) (P = .03), and at 12 months, it was -0.6% (95% CI, -1.7% to 0.5%) (P = .30). The 12-month costs from the payer perspective were $207 and $110 per person for the counselor- and web-based interventions, respectively.

CONCLUSIONS AND RELEVANCE

Both intervention formats reduced CHD risk through 12-month follow-up. The web format was less expensive.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT01245686.

Associations between low consumption of fruits and vegetables and nutritional deficiencies in Brazilian schoolchildren

Objective

We examined associations between the frequency of fruit and vegetable (F&V) consumption and nutritional deficiencies among Brazilian schoolchildren.

Design

A cross-sectional, population-based study was performed. A short FFQ was used to assess consumption of fruits and vegetables (F&V) over the past month. The prevalence ratios (PR) and 95 % confidence intervals for stunting, obesity, anaemia, vitamin A and folate deficiencies, vitamin E and vitamin D insufficiencies were estimated for low F&V consumption frequency (vegetables ≤3 times/month and fruits ≤3 times/week) and compared with children with usual F&V consumption frequency (vegetables ≥1 time/week and fruits ≥4 times/week).

Setting

Acrelândia, Western Brazilian Amazon.

Subjects

A total of 702 children aged 4–10 years.

Results

Only 5 % of children consumed F&V ≥5 times/d. Prevalence of deficiency was 31 %, 15 %, 9 % and 2 % for vitamins D, A, E and folate, respectively. Overall, 6·3 % of children were anaemic, 3·3 % were stunted, 2·7 % were obese and 33 % had multiple nutritional deficiencies. Low frequency of F&V consumption was associated with lower plasma concentrations of carotenoids and vitamin E. Nutritional deficiencies were higher among non-consumers of F&V when compared with usual consumers: anaemia (PR=1·9; 95 % CI 1·0, 3·7), vitamin E insufficiency (PR=2·5; 95 % CI 1·5, 4·2), vitamin D insufficiency (PR=1·5; 95 % CI 1·1, 1·9) and stunting (PR=2·6; 95 % CI 1·1, 6·1).

Conclusions

In our study, the occurrence of nutritional deficiencies in children with low F&V consumption was twice as high as in children with usual F&V consumption, reinforcing the importance of effective actions to promote the consumption of F&V.

Design and methods of "diaBEAT-it!": a hybrid preference/randomized control trial design using the RE-AIM framework

BACKGROUND

Diabetes prevention is a public health priority that is dependent upon the reach, effectiveness, and cost of intervention strategies. However, understanding each of these outcomes within the context of randomized controlled trials is problematic.

PURPOSE

To describe the methods and design of a hybrid preference/randomized control trial using the RE-AIM framework.

METHODS

The trial, which was developed using the RE-AIM framework, will contrast the effects of 3 interventions: (1) a standard care, small group, diabetes prevention education class (SG), (2) the small group intervention plus 12 months of interactive voice response telephone follow-up (SG-IVR), and (3) a DVD version of the small group intervention with the same IVR follow-up (DVD-IVR). Each intervention includes personal action planning with a focus on key elements of the lifestyle intervention from the Diabetes Prevention Program (DPP). Adult patients at risk for diabetes will be randomly assigned to either choice or RCT. Those assigned to choice (n=240) will have the opportunity to choose between SG-IVR and DVD-IVR. Those assigned to RCT group (n=360) will be randomly assigned to SG, SG-IVR, or DVD-IRV. Assessment of primary (weight loss, reach, & cost) and secondary (physical activity, & dietary intake) outcomes will occur at baseline, 6, 12, and 18 months.

CONCLUSION

This will be the first diabetes prevention trial that will allow the research team to determine the relationships between reach, effectiveness, and cost of different interventions.

Influence of individual differences in disease perception on consumer response to direct-to-consumer genomic testing

Individuals who undergo multiplex direct-to-consumer (DTC) genomic testing receive genetic risk results for multiple conditions. To date, research has not investigated the influence of individual differences in disease perceptions among consumers on testing outcomes. A total of 2037 participants received DTC genomic testing and completed baseline and follow-up surveys assessing disease perceptions and health behaviors. Participants were asked to indicate their most feared disease of those tested. Perceived seriousness and controllability of the disease via lifestyle or medical intervention were assessed. Participants most frequently reported heart attack (19.1%) and Alzheimer's disease (18.6%) as their most feared disease. Perceived seriousness and control over the feared disease both influenced response to DTC genomic testing. Greater perceived seriousness and diminished perceived control were associated with higher, but not clinically significant levels of anxiety and distress. In some cases these associations were modified by genetic risk. No significant associations were observed for diet, exercise and screening behaviors. Individual differences in disease perceptions influence psychological outcomes following DTC genomic testing. Higher perceived seriousness may make a consumer more psychologically sensitive to test results and greater perceived control may protect against adverse psychological outcomes. Findings may inform development of educational and counseling services.

Fatores associados ao consumo de dietas ricas em gordura em adultos de uma cidade no sul do Brasil

O objetivo deste estudo foi descrever a frequência de consumo de dieta rica em gordura por adultos de 20 a 69 anos de Pelotas, RS, e analisar fatores associados. Foi realizado um estudo transversal de base populacional, incluindo 972 adultos. A frequência do consumo de gordura alimentar no ano anterior à pesquisa foi avaliada pelo questionário de Block, composto por quinze itens alimentares, pontuados de acordo com a frequência de consumo de alimentos com elevados teores de gordura. Cerca de 1/3 da população adulta (32,7%) consumia regularmente dieta rica em gordura. Para ambos os sexos, o consumo regular de gordura mostrou-se associado a idades mais jovens e consumo regular de refrigerantes e, somente para homens, aos níveis econômicos A/B. A frequência do consumo regular de alimentos ricos em gordura na população adulta residente no município de Pelotas encontra-se além das recomendações atuais do Ministério da Saúde. Políticas públicas que estimulem uma alimentação saudável são urgentemente necessárias.

Parent skills training to enhance weight loss in overweight children: evaluation of NOURISH

OBJECTIVE

Although there is general agreement that parents should be involved in pediatric obesity treatment, few studies have investigated the effectiveness of interventions that target parents exclusively. Moreover, the effectiveness of this approach has not been adequately assessed with racially diverse families, particularly African Americans(AA), a group at high risk for elevated Body Mass Index (BMI).

METHODS

NOURISH (Nourishing Our Understanding of Role modeling to Improve Support and Health) is a culturally-sensitive parenting intervention targeting overweight (AA) children (ages 6-11; MBMI = 98.0%ile). Families (N = 84; 61% AA, 37% White) were randomly assigned to NOURISH or a control group.

RESULTS

NOURISH families significantly improved on child BMI from pre- to post-testing after adjustment for random effects, baseline BMI, and child race. NOURISH parents were very satisfied with the intervention and would recommend it to other parents; 91% strongly or moderately agreed that NOURISH helped them eat in a healthier manner.

CONCLUSIONS

These pilot data suggest that NOURISH is acceptable and, with refinement, offers promise for reducing pediatric BMI. Outcomes, lessons learned, and parent feedback will inform a larger randomized controlled trial.

A community based prevention of weight gain intervention (Mothers In Motion) among young low-income overweight and obese mothers: design and rationale

BACKGROUND

Over 45% of American women 20-39 years old are at risk for type 2 diabetes, cardiovascular disease, and other health conditions because they are overweight or obese. The prevalence of overweight and obesity is disproportionately high among low-income women. This paper describes the study design and rationale of a community based intervention (Mothers In Motion, MIM) aimed to prevent weight gain among low-income overweight and obese mothers 18-39 years old by promoting stress management, healthy eating, and physical activity.

METHODS/DESIGN

Peer recruiters approach participants from 5 Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Michigan. The MIM delivers theory-based, culturally-sensitive intervention messages via a combination of DVDs and peer support group teleconferences (PSGTs). The DVD features African American and white overweight and obese WIC mothers who participated in a healthy lifestyle intervention patterned after MIM. The PSGTs are led by paraprofessionals from Michigan State University Extension and WIC providers in Michigan who are trained in motivational interviewing and group facilitation skills. Participants are randomly assigned to an intervention (n=350) or comparison group (n=175). The intervention group receives a 16-week intervention on a weekly or bi-weekly basis. Participants are asked to watch 10 MIM DVD chapters at home and join 10 PSGT sessions by phone. The comparison group receives printed educational materials. The primary outcome is body weight. Secondary outcomes include dietary fat, fruit, and vegetable intake; physical activity; stress, and affect. Mediators are self-efficacy, emotional coping response, social support, and autonomous motivation. Telephone interviews and in-person data collection at WIC offices occur at 3 time points: baseline, immediately, and 3 months after the 16-week intervention.

DISCUSSION

If MIM shows effectiveness, it could have a favorable impact on public health and community programs. The DVDs and PSGTs will be disseminated in WIC, Extension, clinical practice that promote healthy lifestyles for similar target audiences to make a broad contribution to the prevention of weight gain in low-income mothers. Also, our methodology can be adapted by researchers and community stakeholders to help other low-income populations prevent weight gain.

TRIAL REGISTRATION

Clinical Trials Number: NCT01839708.

Dulce Mothers: an intervention to reduce diabetes and cardiovascular risk in Latinas after gestational diabetes

Latina women with prior gestational diabetes mellitus (GDM) are at elevated risk for type 2 diabetes mellitus and cardiovascular disease. Few primary prevention programs are designed for low socioeconomic status, Spanish-speaking populations. We examined the effectiveness of a Diabetes Prevention Program (DPP) translation in low-income Latinas with a history of GDM. Eighty-four Latinas, 18-45 years old with GDM in the past 3 years, underwent an 8-week peer-educator-led group intervention, with tailoring for Latino culture and recent motherhood. Lifestyle changes and diabetes and cardiovascular risk factors were assessed at study baseline, month 3 and month 6. Participants showed significant improvements in lipids, blood pressure, physical activity, dietary fat intake, and fatalistic and cultural diabetes beliefs (p < 0.05). Formative evaluation provides preliminary evidence of program acceptability. A peer-led, culturally appropriate DPP translation was effective in improving lifestyle changes and some indicators of cardiovascular and diabetes risk in Latinas with GDM.

Racial Disparities in Health Behaviors and Conditions Among Lesbian and Bisexual Women: The Role of Internalized Stigma

There are documented disparities in physical health behaviors and conditions, such as physical activity and obesity, with regard to both race/ethnicity and sexual orientation. However, physical health disparities for lesbian and bisexual (LB) women who are also racial minorities are relatively unexplored. Minority stressors, such as internalized stigma, may account for disparities in such multiply marginalized populations. We sought to (1) characterize inequalities among non-Hispanic white and African American LB women and (2) examine the roles of internalized sexism and homophobia in disparities. Data on health behaviors (diet, physical activity); physical health (hypertension, diabetes, overweight/obesity); internalized sexism; and internalized homophobia were collected via a web-based survey. Recruitment ads were sent electronically to over 200 listservs, online groups, and organizations serving the lesbian, gay, and bisexual community in all 50 U.S. states. The analytic sample consisted of 954 white and 75 African American LB women. African American participants were more likely than white participants to report low fruit/vegetable intake and physical activity, a higher body mass index, and a history of diabetes and hypertension. There were no racial differences in internalized homophobia, but African American women reported higher levels of internalized sexism. Internalized sexism partially mediated racial disparities in physical activity and diabetes, but not in the other outcomes. Findings suggest that African American LB women may be at greater risk than their white counterparts for poor health and that internalized sexism may be a mediator of racial differences for certain behaviors and conditions.

Relationship between nutrition knowledge and dietary intake

The present systematic review examined the relationship between nutrition knowledge and dietary intake in adults (mean age ≥ 18 years). Relevant databases were searched from the earliest record until November 2012. Search terms included: nutrition; diet or food knowledge and energy intake; feeding behaviour; diet; eating; nutrient or food intake or consumption. Included studies were original research articles that used instruments providing quantitative assessment of both nutrition knowledge and dietary intake and their statistical association. The initial search netted 1,193,393 potentially relevant articles, of which twenty-nine were eligible for inclusion. Most of them were conducted in community populations (n 22) with fewer (n 7) in athletic populations. Due to the heterogeneity of methods used to assess nutrition knowledge and dietary intake, a meta-analysis was not possible. The majority of the studies (65·5%: community 63·6%; athletic 71·4%) reported significant, positive, but weak (r< 0·5) associations between higher nutrition knowledge and dietary intake, most often a higher intake of fruit and vegetables. However, study quality ranged widely and participant representation from lower socio-economic status was limited, with most participants being tertiary educated and female. Well-designed studies using validated methodologies are needed to clarify the relationship between nutrition knowledge and dietary intake. Diet quality scores or indices that aim to evaluate compliance to dietary guidelines may be particularly valuable for assessing the relationship between nutrition knowledge and dietary intake. Nutrition knowledge is an integral component of health literacy and as low health literacy is associated with poor health outcomes, contemporary, high-quality research is needed to inform community nutrition education and public health policy.

Prevalence of metabolic syndrome and associated factors in women aged 35 to 65 years who were enrolled in a family health program in Brazil

OBJECTIVE

The aims of this study were to estimate the prevalence of metabolic syndrome among women aged 35 to 65 years and to identify associated factors.

METHODS

This was a cross-sectional study. We randomly selected 581 women (aged 35-65 y) from among those enrolled in a family health program in the city of Pindamonhangaba, Brazil. Metabolic syndrome was identified in accordance with the definition of the National Cholesterol Education Program Adult Treatment Panel III. Health conditions and lifestyle habits were evaluated by a survey, and anthropometric measurements were obtained. The prevalence of metabolic syndrome was estimated, and Poisson regression was used to evaluate the associations between metabolic syndrome `and the factors investigated.

RESULTS

The prevalence of metabolic syndrome was 42.2% (95% CI, 38.1-46.2). The most common metabolic syndrome component was abdominal obesity (60.6%), followed by low levels of high-density lipoprotein cholesterol (51.3%), high levels of triglycerides (41.4%), high blood pressure (31.7%), and diabetes (13.9%). The following factors were associated with metabolic syndrome: the 45- to 54-year age group (prevalence ratio, 1.54; 95% CI, 1.08-2.01), the 55- to 65-year age group (prevalence ratio, 3.51; 95% CI, 1.49-3.10), hyperuricemia (prevalence ratio, 2.95; 95% CI, 1.15-1.86), and sleep apnea risk (prevalence ratio, 2.41; 95% CI, 1.16-1.82). We found an inverse association between metabolic syndrome and having had more than 5 years of schooling (prevalence ratio, 0.65; 95% CI, 0.65-1.04).

CONCLUSIONS

The prevalence of metabolic syndrome is high, and the associated clinical factors are hyperuricemia and risk of sleep apnea.

Evaluation of the effectiveness of a problem-solving intervention addressing barriers to cardiovascular disease prevention behaviors in 3 underserved populations: Colorado, North Carolina, West Virginia, 2009

INTRODUCTION

In low-income and underserved populations, financial hardship and multiple competing roles and responsibilities lead to difficulties in lifestyle change for cardiovascular disease (CVD) prevention. To improve CVD prevention behaviors, we adapted, pilot-tested, and evaluated a problem-solving intervention designed to address barriers to lifestyle change.

METHODS

The sample consisted of 81 participants from 3 underserved populations, including 28 Hispanic or non-Hispanic white women in a western community (site 1), 31 African-American women in a semirural southern community (site 2), and 22 adults in an Appalachian community (site 3). Incorporating focus group findings, we assessed a standardized intervention involving 6-to-8 week group sessions devoted to problem-solving in the fall of 2009.

RESULTS

Most sessions were attended by 76.5% of participants, demonstrating participant adoption and engagement. The intervention resulted in significant improvement in problem-solving skills (P < .001) and perceived stress (P < .05). Diet, physical activity, and weight remained stable, although 72% of individuals reported maintenance or increase in daily fruit and vegetable intake, and 67% reported maintenance or increase in daily physical activity.

CONCLUSION

Study results suggest the intervention was acceptable to rural, underserved populations and effective in training them in problem-solving skills and stress management for CVD risk reduction.

Associations between BMI and fat taste sensitivity in humans

The objective of this study was to examine the reliability of associations between fat taste, hunger, dietary fat intake, and body mass index (BMI). Detection thresholds for oleic acid (OA) were obtained during each of 7 consecutive visits using a modified staircase procedure. Participants were 48 (N = 17 male; N = 31 female) healthy adults (mean age: 28.5 ± 10.4 years) with BMI's ranging from 18.9 to 47.2 (≥ 25 kg · m(-2), N = 24). OA detection thresholds and self-reported hunger (100-mm visual analog scale) were assessed at each visit. BMI and dietary fat intake (Block Rapid Fat Screener) were determined at baseline. There was a significant decrease of threshold concentration over repeated trials among lean and overweight (BMI between 25.0 and 29.9 kg · m(-2)) participants but not in the obese. Combining the lean and overweight and contrasting their responses to the obese revealed the lean plus overweight group to be significantly more sensitive at visits 6 and 7. No change of threshold sensitivity or correlation with fat intake was observed in the obese participants unlike findings in the lean and lean plus overweight participants. Correlations between saturated fat intake and threshold sensitivity were positive (greater intake associated with higher thresholds) at baseline for the group, with additional correlations observed among the lean plus overweight but not in the obese, leaving open questions about the nutritional significance of the association. No significant associations were observed between sensitivity to OA and hunger. Repeated testing is required to assess associations between fat taste and other outcome variables.

The effects of a community-based, culturally tailored diabetes prevention intervention for high-risk adults of Mexican descent

PURPOSE

This article reports the results of a community-based, culturally tailored diabetes prevention program for overweight Mexican American adults on weight loss, waist circumference, diet and physical activity self-efficacy, and diet behaviors.

METHODS

The intervention used content from the Diabetes Prevention Program but culturally tailored the delivery methods into a community-based program for Spanish-speaking adults of Mexican descent. The design was a randomized controlled trial (N = 58) comparing the effects of a 5-month educational intervention with an attention control group. The primary study outcome was weight loss. Secondary outcomes included change in waist circumference, body mass index, diet self-efficacy, and physical activity self-efficacy.

RESULTS

There were significant intervention effects for weight, waist circumference, body mass index, and diet self-efficacy, with the intervention group doing better than the control group. These effects did not change over time.

CONCLUSIONS

Findings support the conclusion that a community-based, culturally tailored intervention is effective in reducing diabetes risk factors in a 5-month program.

Influence of chronic exercise on carotid atherosclerosis in marathon runners

OBJECTIVES

The effect of habitual, high-intensity exercise training on the progression of atherosclerosis is unclear. We assessed indices of vascular health (central systolic blood pressure (SBP) and arterial stiffness as well as carotid intima-medial thickness (cIMT)) in addition to cardiovascular risk factors of trained runners versus their untrained spouses or partners to evaluate the impact of exercise on the development of carotid atherosclerosis.

SETTING

field study at Boston Marathon.

PARTICIPANTS

42 qualifiers (mean age±SD: 46±13 years, 21 women) for the 2012 Boston Marathon and their sedentary domestic controls (46±12 years, n=21 women).

OUTCOMES

We measured medical and running history, vital signs, anthropometrics, blood lipids, C reactive protein (CRP), 10 years Framingham risk, central arterial stiffness and SBP and cIMT.

RESULTS

Multiple cardiovascular risk factors, including CRP, non-high-density lipoprotein cholesterol, triglycerides, heart rate, body weight and body mass index (all p<0.05), were reduced in the runners. The left and right cIMT, as well as central SBP, were not different between the two groups (all p>0.31) and were associated with age (all r≥0.41; p<0.01) and Framingham risk score (all r≥0.44; p<0.01) independent of exercise group (all p>0.08 for interactions). The amplification of the central pressure waveform (augmentation pressure at heart rate 75 bpm) was also not different between the two groups (p=0.07) but was related to age (p<0.01) and group (p=0.02) in a multiple linear regression model.

CONCLUSIONS

Habitual endurance exercise improves the cardiovascular risk profile, but does not reduce the magnitude of carotid atherosclerosis associated with age and cardiovascular risk factors.

Use of the Go-for-Green nutrition labeling system in military dining facilities is associated with lower fat intake

Point-of-purchase nutrition labeling is a potential tool to help consumers choose healthier foods. The objectives of our study were to survey soldiers on their use of the Go-for-Green nutrition labeling system in dining facilities and compare characteristics of users and nonusers. The study population consisted of 299 US Army active duty soldiers at two US Army installations. The frequency of use of food labels and characteristics were calculated and differences in characteristics of label users and nonusers were compared using χ(2) and regression analyses. Forty-seven percent of soldiers reported using nutrition labels to make food choices always or sometimes. Users were more likely to be following a special diet (P=0.04) and to take a multivitamin or protein supplement (P<0.001) than nonusers. Users consumed a mean of 32% of energy from fat vs 36% for nonusers (P<0.0001) after adjusting for reported use of special diets. Use of the Go-for-Green nutrition labeling system is encouraging and should be further investigated to determine whether the program is actually influencing dietary choices in broader military settings.

Outcomes of a church-based diabetes prevention program delivered by peers: a feasibility study

PURPOSE

This purpose of this study was to investigate the feasibility and potential health impact of a church-based diabetes prevention program delivered by peers.

METHODS

Thirteen at-risk African American adults were recruited to a peer-led diabetes prevention program adapted from the National Diabetes Education Program's Power to Prevent curriculum. The program consisted of 6 core education sessions followed by 6 biweekly telephone support calls. Components of feasibility examined included recruitment, attendance, and retention. Baseline, 8-week, and 20-week assessments measured clinical outcomes (percentage body weight change, waist circumference, lipid panel, blood pressure) and lifestyle behaviors (eg, physical activity and diet).

RESULTS

Of the 13 participants enrolled at baseline, 11 completed the intervention. Mean attendance across 6 core sessions was 5.2 classes (87%). At 8 weeks, significant improvements were found for physical activity (P = .031), waist circumference (P = .049), serum cholesterol (P = .036), systolic blood pressure (P = .013), and fat intake (P = .006). At 20 weeks, not only did participants sustain the improvements made following the core intervention, but they also demonstrated additional improvements for HDL (P = .002) and diastolic blood pressure (P = .004).

CONCLUSION

Findings suggest that it is feasible to conduct a peer-led diabetes prevention program in a church-based setting that has a potentially positive impact on health-related outcomes.

Changing behavior in senior housing residents: testing of phase I of the PRAISEDD-2 intervention

PURPOSE

Programs focused on health related behaviors implemented in senior centers, senior housing or churches have not been strongly successful in showing significant improvement in cardiovascular disease (CVD) prevention behaviors or important clinical outcomes such as decreasing blood pressure. The purpose of this study was to consider the feasibility and preliminary efficacy of phase I of the PRAISEDD-2 intervention. PRAISEDD-2 was implemented to increase physical activity, adherence to heart healthy diets and antihypertensive and/or lipid lowering medications.

METHOD

This was a single site pre post intervention trial. The 12 week phase I activities included education, motivational interventions and exercise classes two times per week implemented by a lay trainer and nurse.

RESULTS

A total of 29 residents were recruited from a single senior housing facility. The majority was Black or African American, female and had at least a high school education. The average age of participants was 74 years of age. At the end of phase I, participants had stronger outcome expectations for exercise, decreased fat and salt intake and decreased pain. There was a non-significant improvement in time spent in physical activity and distance walked in 6 minutes.

CONCLUSION

Phase I of the PRAISEDD-2 intervention was feasible based on adherence to study design, training of the interventionists, delivery and receipt, and there was some support for efficacy across some study outcomes.

A pragmatic cluster randomized clinical trial of diabetes prevention strategies for women with gestational diabetes: design and rationale of the Gestational Diabetes' Effects on Moms (GEM) study

Background

Women with gestational diabetes (GDM) are at high risk of developing diabetes later in life. After a GDM diagnosis, women receive prenatal care to control their blood glucose levels via diet, physical activity and medications. Continuing such lifestyle skills into early motherhood may reduce the risk of diabetes in this high risk population. In the Gestational Diabetes’ Effects on Moms (GEM) study, we are evaluating the comparative effectiveness of diabetes prevention strategies for weight management designed for pregnant/postpartum women with GDM and delivered at the health system level.

Methods/Design

The GEM study is a pragmatic cluster randomized clinical trial of 44 medical facilities at Kaiser Permanente Northern California randomly assigned to either the intervention or usual care conditions, that includes 2,320 women with a GDM diagnosis between March 27, 2011 and March 30, 2012. A Diabetes Prevention Program-derived print/telephone lifestyle intervention of 13 telephonic sessions tailored to pregnant/postpartum women was developed. The effectiveness of this intervention added to usual care is to be compared to usual care practices alone, which includes two pages of printed lifestyle recommendations sent to postpartum women via mail. Primary outcomes include the proportion of women who reach a postpartum weight goal and total weight change. Secondary outcomes include postpartum glycemia, blood pressure, depression, percent of calories from fat, total caloric intake and physical activity levels. Data were collected through electronic medical records and surveys at baseline (soon after GDM diagnosis), 6 weeks (range 2 to 11 weeks), 6 months (range 12 to 34 weeks) and 12 months postpartum (range 35 to 64 weeks).

Discussion

There is a need for evidence regarding the effectiveness of lifestyle modification for the prevention of diabetes in women with GDM, as well as confirmation that a diabetes prevention program delivered at the health system level is able to successfully reach this population. Given the use of a telephonic case management model, our Diabetes Prevention Program-derived print/telephone intervention has the potential to be adopted in other settings and to inform policies to promote the prevention of diabetes among women with GDM.

Trial registration

Clinical Trials.gov number, NCT01344278.

Evaluation of a worksite wellness program designed to reduce cardiovascular risks

We evaluated a multifactorial worksite wellness program designed to improve lifestyle and reduce cardiovascular risks at a small professional services company. Program participation (N = 60 employees) consisted of an enrollment session, a 6-month period of wellness program activities, and a disenrollment session. Lifestyle and biometric measures were obtained at enrollment and disenrollment. Over 6-months, percentage of dietary fat intake decreased (P < .01); daily fruit and vegetable servings and fiber intake increased (P = .02); systolic and diastolic blood pressure decreased (P = .04 and 0.01, respectively), and high-density lipoprotein increased (P < .01). This worksite wellness program achieved meaningful improvements in dietary intake and reduction in cardiovascular risks.