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Sudak NL, Harry ML. Employee Dietary Initiative Improved Chronic Symptoms. Mayo Clin Proc Innov Qual Outcomes 2024; 8:201-212. [PMID: 38596168 PMCID: PMC11000019 DOI: 10.1016/j.mayocpiqo.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/28/2024] [Accepted: 03/11/2024] [Indexed: 04/11/2024] Open
Abstract
With the awareness that the Standard American Diet is a critical contributor to chronic diseases, this initiative aimed to assess the effects of a 28-day dietary challenge health care improvement project on health system employee energy level, sleep quality, gastrointestinal function, ability to concentrate, and aches/pains, including the impact of adherence level, during a period of restricted intake of gluten, dairy, and sugar offered annually from 2021 to 2023. A total of 754 employees completed the pre-challenge survey; analyses included 354 employees who completed both pre-challenge and post-challenge surveys in at least 1 year of this project. Wilcoxon signed rank tests compared presurvey and postsurvey responses to self-reported energy level, sleep quality, gastrointestinal function, ability to concentrate, and aches/pains. Analysis of variance with Tukey's honestly significant difference tests compared self-reported adherence level with change scores, with η2 representing effect size. In each challenge year, the mean rank levels of energy, sleep quality, gastrointestinal function, concentration, and aches/pains improved significantly between pre-surveys and post-surveys (all P<.001). Although an association between significant positive change and diet adherence level was found for all items in at least 1 challenge year, those who mostly or completely adhered to the challenge diet restrictions reported significantly greater positive change in energy levels and gastrointestinal symptoms than those who did not or minimally adhered in all challenge years, with small to medium effect sizes. In conclusion, Essentia Health's employee challenge appeared to improve self-reported outcomes in 5 symptom domains, with energy levels and gastrointestinal symptoms correlating most favorably to adherence to the challenge. These findings have health and cost implications, which could be confirmed by formal research in employee and other populations.
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Dabas J, Shunmukha Priya S, Alawani A, Budhrani P. What could be the reasons for not losing weight even after following a weight loss program? JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:37. [PMID: 38429842 PMCID: PMC10908186 DOI: 10.1186/s41043-024-00516-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/28/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION Approximately four million people worldwide die annually because of obesity. Weight loss is commonly recommended as a first-line therapy in overweight and obese patients. Although many individuals attempt to lose weight, not everyone achieves optimal success. Few studies point out that weight loss eventually slows down, stagnates or reverses in 85% of the cases. RESEARCH QUESTION What could be the reasons for not losing weight even after following a weight loss program? METHODS A scoping review of the literature was performed using weight loss-related search terms such as 'Obesity,' 'Overweight,' 'Lifestyle,' 'weight loss,' 'Basal Metabolism,' 'physical activity,' 'adherence,' 'energy balance,' 'Sleep' and 'adaptations. The search involved reference tracking and database and web searches (PUBMED, Science Direct, Elsevier, Web of Science and Google Scholar). Original articles and review papers on weight loss involving human participants and adults aged > 18 years were selected. Approximately 231 articles were reviewed, and 185 were included based on the inclusion criteria. DESIGN Scoping review. RESULTS In this review, the factors associated with not losing weight have broadly been divided into five categories. Studies highlighting each subfactor were critically reviewed and discussed. A wide degree of interindividual variability in weight loss is common in studies even after controlling for variables such as adherence, sex, physical activity and baseline weight. In addition to these variables, variations in factors such as previous weight loss attempts, sleep habits, meal timings and medications can play a crucial role in upregulating or downregulating the association between energy deficit and weight loss results. CONCLUSION This review identifies and clarifies the role of several factors that may hinder weight loss after the exploration of existing evidence. Judging the effectiveness of respective lifestyle interventions by simply observing the 'general behavior of the groups' is not always applicable in clinical practice. Each individual must be monitored and advised as per their requirements and challenges.
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Affiliation(s)
- Jyoti Dabas
- Institute of Nutrition and Fitness Sciences, Platinum Square, 4th floor, Office, 403, Opp. WNS, Sakore Nagar, Viman Nagar, Pune, Maharashtra, 411014, India
| | - S Shunmukha Priya
- Institute of Nutrition and Fitness Sciences, Platinum Square, 4th floor, Office, 403, Opp. WNS, Sakore Nagar, Viman Nagar, Pune, Maharashtra, 411014, India.
| | - Akshay Alawani
- Institute of Nutrition and Fitness Sciences, Platinum Square, 4th floor, Office, 403, Opp. WNS, Sakore Nagar, Viman Nagar, Pune, Maharashtra, 411014, India
| | - Praveen Budhrani
- Institute of Nutrition and Fitness Sciences, Platinum Square, 4th floor, Office, 403, Opp. WNS, Sakore Nagar, Viman Nagar, Pune, Maharashtra, 411014, India
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Yin YH, Liu JYW, Välimäki M. Dietary behaviour change intervention for managing sarcopenic obesity among community-dwelling older people: a pilot randomised controlled trial. BMC Geriatr 2023; 23:597. [PMID: 37752447 PMCID: PMC10521482 DOI: 10.1186/s12877-023-04327-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 09/18/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND The effects of dietary intervention in managing sarcopenic obesity are controversial, and behavior change techniques are lacking in previous studies which are important for the success of dietary intervention. This study aimed to evaluate the feasibility and preliminary effects of a dietary behaviour change (DBC) intervention on managing sarcopenic obesity among community-dwelling older people in the community. METHODS A two-armed, RCT was conducted. Sixty community-dwelling older adults (≥ 60 years old) with sarcopenic obesity were randomised into either the experimental group (n = 30), receiving a 15-week dietary intervention combined with behaviour change techniques guided by the Health Action Process Approach model, or the control group (n = 30), receiving regular health talks. Individual semi-structured interviews were conducted with 21 experimental group participants to determine the barriers and facilitators of dietary behaviour changes after the intervention. RESULTS The feasibility of the DBC intervention was confirmed by an acceptable recruitment rate (57.14%) and a good retention rate (83.33%). Compared with the control group, the experimental group significantly reduced their body weight (p = 0.027, d = 1.22) and improved their dietary quality (p < 0.001, d = 1.31). A positive improvement in handgrip strength (from 15.37 ± 1.08 kg to 18.21 ± 1.68 kg), waist circumference (from 99.28 ± 1.32 cm to 98.42 ± 1.39 cm), and gait speed (from 0.91 ± 0.02 m/s to 0.99 ± 0.03 m/s) was observed only in the experimental group. However, the skeletal muscle mass index in the experimental group decreased. The interview indicated that behaviour change techniques enhanced the partcipants' compliance with their dietary regimen, while cultural contextual factors (e.g., family dining style) led to some barriers. CONCLUSION The DBC intervention could reduce body weight, and has positive trends in managing handgrip strength, gait speed, and waist circumference. Interestingly, the subtle difference between the two groups in the change of muscle mass index warrants futures investigation. This study demonstrated the potential for employing dietary behaviour change interventions in community healthcare. TRIAL REGISTRATION Registered retrospectively on ClinicalTrailas.gov (31/12/2020, NCT04690985).
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Affiliation(s)
- Yue-Heng Yin
- School of Nursing, Nanjing Medical University, Nanjing, China.
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China.
| | - Justina Yat Wa Liu
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Maritta Välimäki
- Faculty of Medicine, Department of Nursing Science, University of Turku, Turku, Finland
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"I Always Buy the Purple Ones … If I See Them": Socioecological Factors Influencing Anthocyanin-Rich Food Consumption for Cognitive Health in Older Adults. Nutrients 2023; 15:nu15051194. [PMID: 36904196 PMCID: PMC10005612 DOI: 10.3390/nu15051194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/16/2023] [Accepted: 02/24/2023] [Indexed: 03/08/2023] Open
Abstract
Despite the positive relationship between anthocyanin-rich foods and cognitive health, a dietary deficit exists in older adults. Effective interventions require an understanding of people's dietary behaviors situated in social and cultural contexts. Therefore, the aim of this study was to explore older adults' perceptions about increasing their consumption of anthocyanin-rich foods for cognitive health. Following an educational session and the provision of a recipe and information book, an online survey and focus groups with Australian adults aged 65 years or older (n = 20) explored the barriers and enablers towards eating more anthocyanin-rich foods and potential strategies to achieve dietary change. An iterative, qualitative analysis identified the themes and classified the barriers, enablers and strategies onto the Social-Ecological model levels of influence (individual, interpersonal, community, society). Enabling factors included a desire to eat healthily, taste preference and familiarity of anthocyanin-rich foods (individual), social support (community), and the availability of some anthocyanin-rich foods (society). The barriers included budget, dietary preferences and motivation (individual), household influences (interpersonal), limited availability and access to some anthocyanin-rich foods (community) and the cost and the seasonal variability (society). The strategies included increasing individual-level knowledge, skills, and confidence in utilizing anthocyanin-rich foods, educational initiatives about the potential cognitive benefits, and advocating to increase access to anthocyanin-rich foods in the food supply. This study provides for the first time, insight into the various levels of influence impacting older adults' ability to consume an anthocyanin-rich diet for cognitive health. Future interventions should be tailored to reflect the barriers and enablers and to provide targeted education about anthocyanin-rich foods.
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Patel SK, Gupta A. How did the dietary habits of patients with chronic medical conditions change during COVID-19? J Osteopath Med 2023; 123:7-17. [PMID: 36102320 DOI: 10.1515/jom-2022-0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/19/2022] [Indexed: 12/27/2022]
Abstract
CONTEXT Previous studies have examined the changes in the dietary habits of general populations during the COVID-19 pandemic but have not focused on specific populations such as those with chronic medical conditions (CMCs). Prior to major vaccination efforts, 96.1% of deaths were attributed to patients with preexisting CMCs, thus it is important to examine how this population has endured changes. OBJECTIVES The purpose of this study was to identify differences in dietary habits, lifestyle habits, and food attitudes between those with CMCs compared to the populations without chronic medical conditions (non-CMCs) since the beginning of the COVID-19 pandemic. METHODS An online cross-sectional study was conducted from May 2021 to July 2021. Participants (n=299) responded to a 58-item questionnaire regarding demographics (n=9), health information (n=8), lifestyle habits (n=7), dietary habits (n=28), and food attitudes (n=6). Frequency counts and percentages were tabulated, and t-test sampling and ANOVA testing were conducted to examine the associations utilizing SPSS V28 at a statistical significance level of p<0.05. RESULTS When compared to non-CMC participants, with CMCs had a less frequent change in their diet and had better food attitudes when it came to consumption habits. Non-CMC and CMC participants had no statistically significant differences in overall dietary habits; however, an examination of specific food items reviews significant findings. Compared to non-CMC participants, those with CMCs reported significantly decreased consumption of energy-dense food such as French fries, white pasta, sweets, and salty snacks, with notable exceptions in increased consumption of energy-dense foods, starchy veggies, and vegetable/tomato juice. CONCLUSIONS These findings indicate that participants with CMCs indicated that fewer changes occurred in participants with a CMC; however, when these participants made changes, they were beneficial to their consumption habits. Future studies should aim to develop interventions for the demographics with poor dietary habits so that those that are most vulnerable may have their needs met.
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Affiliation(s)
- Sahil K Patel
- Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Adarsh Gupta
- Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
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Gross M, Beckenbauer UE, Bruder L, Zehrer A. [Diverticular disease: treatment and management by general practitioners in Germany - high importance of probiotics in primary care]. MMW Fortschr Med 2022; 164:16-26. [PMID: 36520376 DOI: 10.1007/s15006-022-2072-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The symptomatic uncomplicated diverticular disease (SUDD) is often difficult to treat and guidelines only provide few evidence-based treatment options. METHOD For the German-wide survey, a questionnaire was sent to 13790 physicians. It contained questions concerning the status of medical care for patients with diverticula and queried their individual option in regards to current treatment options and challenges for the daily medical routine. RESULTS In total, 526 questionnaires were sent back for analysis. The biggest challenge for doctors handling patients with chronic diverticular disease (SUDD) is to make the correct diagnosis (17%) and the distinction to the irritable bowel syndrome (22%). Despite the high abundance of SUDD pathology, only 6% of the medical practitioners feel themselves sufficiently informed about it. The support for general practitioners by medical specialists (gastroenterologists) is limited: In the case of a SUDD or a diverticulitis diagnosis, the physicians sometimes receive an acute therapy plan (27%), but rarely get recommendations for diverticulitis pre- and post-care (11% and 18%), or assisting information for patient education (4%). For primary prophylaxis for persons with asymptomatic diverticula, practitioners give nutrition (41%) and life style (37%) recommendations, as well as probiotics (18%). After an acute diverticulitis, 42% recommend life style and nutrition modifications and 26% the intake of probiotics. For the treatment of SUDD symptoms, they advise mostly life style and nutrition modifications (45%) and probiotics (30%). About 60% of the doctors are satisfied with the efficacy of probiotics. Another 15% stated that they have not yet used them to treat SUDD. The main reasons for it seem to be the lack of reimbursability for probiotics (31%), the poor adherence of patients to therapy (20%) due to the slow onset of positive effects, and the difficulty of finding an evidence-based probiotic (16%). CONCLUSION In the daily medical routine the correct diagnosing of SUDD is a major challenge and supporting information by medical specialist is scarce. Physicians frequently choose life style and nutrition recommendations and the use of probiotics as treatment options. The majority of the general practitioners is thereby satisfied with the efficacy of probiotics for patients with chronic diverticular disease, even though the choice of an evidence-based probiotic is an obstacle.
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Affiliation(s)
- Manfred Gross
- Klinik für Allgemeine Innere Medizin und Gastroenterologie, Internistisches Klinikum München Süd, Am Isarkanal 36, 81379, München, Deutschland.
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Silva VC, Gorgulho B, Marchioni DM, Alvim SM, Giatti L, de Araujo TA, Alonso AC, Santos IDS, Lotufo PA, Benseñor IM. Recommender System Based on Collaborative Filtering for Personalized Dietary Advice: A Cross-Sectional Analysis of the ELSA-Brasil Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14934. [PMID: 36429651 PMCID: PMC9690822 DOI: 10.3390/ijerph192214934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/06/2022] [Accepted: 11/11/2022] [Indexed: 06/16/2023]
Abstract
This study aimed to predict dietary recommendations and compare the performance of algorithms based on collaborative filtering for making predictions of personalized dietary recommendations. We analyzed the baseline cross-sectional data (2008-2010) of 12,667 participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). The participants were public employees of teaching and research institutions, aged 35-74 years, and 59% female. A semiquantitative Food Frequency Questionnaire (FFQ) was used for dietary assessment. The predictions of dietary recommendations were based on two machine learning (ML) algorithms-user-based collaborative filtering (UBCF) and item-based collaborative filtering (IBCF). The ML algorithms had similar precision (88-91%). The error metrics were lower for UBCF than for IBCF: with a root mean square error (RMSE) of 1.49 vs. 1.67 and a mean square error (MSE) of 2.21 vs. 2.78. Although all food groups were used as input in the system, the items eligible as recommendations included whole cereals, tubers and roots, beans and other legumes, oilseeds, fruits, vegetables, white meats and fish, and low-fat dairy products and milk. The algorithms' performances were similar in making predictions for dietary recommendations. The models presented can provide support for health professionals in interventions that promote healthier habits and improve adherence to this personalized dietary advice.
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Affiliation(s)
- Vanderlei Carneiro Silva
- Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil
- Center of Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo 05508-000, Brazil
| | - Bartira Gorgulho
- Department of Food and Nutrition, School of Nutrition, Federal University of Mato Grosso, Cuiaba 78060-900, Brazil
| | - Dirce Maria Marchioni
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil
| | - Sheila Maria Alvim
- Institute of Collective Health, Federal University of Bahia, Salvador 40110-040, Brazil
| | - Luana Giatti
- Department of Social and Preventive Medicine, Faculty of Medicine & Clinical Hospital, Federal University of Minas Gerais, Belo Horizonte 30130-100, Brazil
| | - Tânia Aparecida de Araujo
- Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil
| | - Angelica Castilho Alonso
- Laboratory of the Study of Movement, Faculty of Medicine, University of São Paulo, São Paulo 05403-010, Brazil
| | - Itamar de Souza Santos
- Center of Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo 05508-000, Brazil
| | - Paulo Andrade Lotufo
- Center of Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo 05508-000, Brazil
| | - Isabela Martins Benseñor
- Center of Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo 05508-000, Brazil
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Narayana V, McMeans AR, Levy RL, Shulman RJ, Chumpitazi BP. Children with functional abdominal pain disorders successfully decrease FODMAP food intake on a low FODMAP diet with modest improvements in nutritional intake and diet quality. Neurogastroenterol Motil 2022; 34:e14392. [PMID: 35535019 PMCID: PMC9529764 DOI: 10.1111/nmo.14392] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 03/29/2022] [Accepted: 04/25/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND We sought to determine how a low fermentable oligosaccharide, disaccharide, monosaccharide, and polyol (FODMAP) diet (LFD) affected high FODMAP food intake, nutrient intake, and diet quality in children with functional abdominal pain disorders (FAPD). METHODS Children (ages 7-13 years) with Rome IV FAPD began a dietitian-guided LFD. Three-day food records were captured at baseline and 2-3 weeks into the LFD. Intake of high FODMAP foods, energy, macronutrients, micronutrients, food groups, and ultra-processed foods were determined. KEY RESULTS Median age of participants was 11 years, and 19/31 (61%) were female. Twenty-eight (90%) decreased high FODMAP food intake on the LFD: overall median (25-75%) high FODMAP foods/day decreased from 5.7 (3.6-7.3) to 2 (0.3-3.7) (p < 0.001). A more adherent subset (n = 22/71%) of participants consumed on average ≤3 high FODMAP foods per day during the LFD. Baseline nutritional intake and quality were generally poor with several micronutrient deficiencies identified. Diet quality improved on the LFD with increased servings of vegetables and protein and decreased consumption of ultra-processed foods, trans-fatty acids, and added sugars. On the LFD, there were significant decreases in total carbohydrates and thiamin (remained within recommended intake) and significant increases in vitamin B6 (p = 0.029), vitamin C (p = 0.019), and vitamin E (p = 0.009). Children more adherent to the LFD further increased vitamin D, magnesium, potassium, and fat servings. CONCLUSIONS AND INFERENCES The majority of children with FAPD on a dietitian-led LFD successfully decreased high FODMAP food intake. Children with FAPD on the LFD (vs. baseline) modestly improved micronutrient intake and diet quality.
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Affiliation(s)
- Vishnu Narayana
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Ann R. McMeans
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Children’s Nutrition Research Center, Houston, TX, USA
| | - Rona L. Levy
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Robert J. Shulman
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Children’s Nutrition Research Center, Houston, TX, USA
| | - Bruno P. Chumpitazi
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Children’s Nutrition Research Center, Houston, TX, USA
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Żarnowski A, Jankowski M, Gujski M. Nutrition Knowledge, Dietary Habits, and Food Labels Use-A Representative Cross-Sectional Survey among Adults in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11364. [PMID: 36141633 PMCID: PMC9517017 DOI: 10.3390/ijerph191811364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
An unhealthy diet is an important risk factor for disability and premature death. This study aimed to assess nutrition knowledge, dietary habits, and food label use among adults in Poland as well as to identify factors associated with diet-related behaviors. A cross-sectional survey was carried out in July 2020 on a non-probability quota-based sample of 1070 adult citizens of Poland. The most common sources of nutrition knowledge were news websites (41.8%) or family/friends (32.4%). Over one-quarter of adults in Poland were on a diet (28.7%). Over one-tenth of respondents (11.9%) consumed less than three meals per day. Half of the respondents (50.3%) declared that they use food labels when shopping, and 15.4% checked the nutrition information on restaurant menus. Female gender (OR:1.70; 95%CI:1.26-2.29; p < 0.001), presence of chronic diseases (OR:1.83; 95%CI:1.37-2.44; p < 0.001), regular physical activity (p < 0.001), and being a non-smoker (OR:1.45; 95%CI:1.02-2.06; p = 0.04) were significantly associated with higher odds of being on a diet. Females (OR:1.63; 95%CI:1.24-2.15; p < 0.001), respondents with higher education (OR:1.53; 95%CI:1.17-2.01; p = 0.002), those who had never been married (OR:1.49; 95%CI:1.07-2.07; p = 0.02), respondents with chronic diseases (OR:1.73; 95%CI:1.30-2.31; p < 0.001), those with regular physical activity (p < 0.05), as well as non-smokers (OR:1.42; 95%CI:1.04-1.95; p = 0.03) had higher odds of checking the food labels. This study showed a significant gap in nutrition knowledge among adults in Poland.
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Affiliation(s)
- Adam Żarnowski
- Department of Public Health, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Mateusz Jankowski
- School of Public Health, Centre of Postgraduate Medical Education, 01-826 Warsaw, Poland
| | - Mariusz Gujski
- Department of Public Health, Medical University of Warsaw, 02-097 Warsaw, Poland
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George ES, Forsyth AK, Reddy A, Itsiopoulos C, Roberts SK, Nicoll AJ, Ryan MC, Tierney AC. A Mediterranean and Low-Fat dietary intervention in Non-Alcoholic Fatty Liver Disease patients -Exploring participant experience and perceptions about dietary change. J Hum Nutr Diet 2022; 36:592-602. [PMID: 35962482 DOI: 10.1111/jhn.13069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/15/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND A Mediterranean Diet (MD) appears to be beneficial in NAFLD patients in Mediterranean countries, however the acceptability of a MD in non-Mediterranean populations has not been thoroughly explored. This study aimed to explore the acceptability, through understanding the barriers and enablers of MD and low-fat diet (LFD) interventions as perceived by Australian adults from multicultural backgrounds, with NAFLD, who participated. METHODOLOGY Semi-structured telephone interviews were performed with 23 NAFLD trial participants at the end of a 12-week dietary intervention in a multicentre, parallel, randomised clinical trial. Data was analysed using thematic analysis. RESULTS Participants reported that they enjoyed taking part in the MD and LFD interventions and perceived that they had positive health benefits from their participation. Compared to the LFD, the MD group placed greater emphasis on enjoyment and intention to maintain dietary changes. Novelty, convenience and the ability to swap food/meals were key enablers for the successful implementation for both of the dietary interventions. Flavour and enjoyment of food, expressed more prominently by MD intervention participants, were fundamental components of the diets with regard to reported adherence and intention to maintain dietary change. CONCLUSIONS Participants randomised to the MD reported greater acceptability of the diet than those randomised to the LFD, predominantly related to perceived novelty and palatability of the diet. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Elena S George
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Adrienne K Forsyth
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Anjana Reddy
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | | | - Stuart K Roberts
- Gastroenterology Department, Alfred Health, Prahran, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | | | - Marno C Ryan
- Gastroenterology Department, St Vincent's Hospital, Australia
| | - Audrey C Tierney
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,School of Allied Health, Health Implementation Science and Technology Research Group, Health Research Institute, University of Limerick, Limerick, Ireland
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Determining the effective factors in predicting diet adherence using an intelligent model. Sci Rep 2022; 12:12340. [PMID: 35853992 PMCID: PMC9296581 DOI: 10.1038/s41598-022-16680-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 07/13/2022] [Indexed: 11/08/2022] Open
Abstract
Adhering to a healthy diet plays an essential role in preventing many nutrition-related diseases, such as obesity, diabetes, high blood pressure, and other cardiovascular diseases. This study aimed to predict adherence to the prescribed diets using a hybrid model of artificial neural networks (ANNs) and the genetic algorithm (GA). In this study, 26 factors affecting diet adherence were modeled using ANN and GA(ANGA). A dataset of 1528 patients, including 1116 females and 412 males, referred to a private clinic was applied. SPSS Ver.25 and MATLAB toolbox 2017 were employed to make the model and analyze the data. The results showed that the accuracy of the proposed ANN and ANGA models for predicting diet adherence was 93.22% and 93.51%, respectively. Also, the Pearson coefficient showed a significant relationship among the factors. The developed model showed the proper performance for predicting adherence to the diet. Moreover, the most effective factors were selected using GA. Some important factors that affect diet adherence include the duration of the marriage, the reason for referring to the clinic, weight, body mass index (BMI), weight satisfaction, lunch and dinner times, and sleep time. Therefore, applying the proposed model can help dietitians identify people who need more support to adhere to the diet.
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Hermel M, Tsai S, Dlouhy L, B K A, Rana JS, Dani SS, Virani SS. Highlights of Cardiovascular Disease Prevention Studies Presented at the 2022 American College of Cardiology Scientific Sessions. Curr Atheroscler Rep 2022; 24:671-680. [PMID: 35633463 PMCID: PMC9142342 DOI: 10.1007/s11883-022-01042-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW Focused review highlighting select studies presented at the 2022 American College of Cardiology (ACC) Scientific Sessions. RECENT FINDINGS Included studies assessed the impact of a low-sodium diet on heart failure outcomes (SODIUM-HF); outcomes of pregnant patients with chronic hypertension treated with antihypertensive therapies (CHAP); cardiovascular outcomes in patients with type 2 diabetes and renal impairment treated with sotagliflozin (SCORED); a safety and efficacy study investigating SLN360, a short interfering RNA targeting lipoprotein(a) (APOLLO); a supermarket and web-based intervention targeting nutrition for cardiovascular risk reduction (SuperWIN); a superiority trial comparing myocardial injury following very mild perioperative hypothermia versus aggressive warming after non-cardiac surgery (PROTECT); and 3-year efficacy outcomes of renal denervation on blood pressure reduction from the SPYRAL HTN-ON MED pilot study. Research presented at the 2022 ACC Scientific Sessions underscores the new potential and meaningful impact of cardiovascular disease prevention and management interventions.
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Affiliation(s)
- Melody Hermel
- Department of Cardiology, Scripps Clinic, La Jolla, CA, USA
| | - Stacy Tsai
- Department of Cardiology, Scripps Clinic, La Jolla, CA, USA
| | - Luis Dlouhy
- Department of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Anupama B K
- Department of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jamal S Rana
- Department of Cardiology, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - Sourbha S Dani
- Department of Cardiology, Beth Israel Lahey Health, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Salim S Virani
- Department of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA. .,Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center, 2002 Holcombe Blvd Houston, Houston, TX, 77030, USA. .,Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
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13
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Key process features of personalized diet counselling in metabolic syndrome: secondary analysis of feasibility study in primary care. BMC Nutr 2022; 8:45. [PMID: 35534841 PMCID: PMC9081667 DOI: 10.1186/s40795-022-00540-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 04/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background Personalized diet counselling, as part of lifestyle change programs for cardiometabolic risk conditions (combinations of prediabetes or type 2 diabetes, hypertension, dyslipidemia and high waist circumference) has been shown to reduce progression to type 2 diabetes overall. To identify key process of care measures that could be linked to changes in diet, we undertook a secondary analysis of a Canadian pre-post study of lifestyle treatment of metabolic syndrome (MetS). Diet counselling process measures were documented and association with diet quality changes after 3 months were assessed. Results of the primary study showed 19% reversal of MetS after 1 year. Methods Registered dietitians (RDs) reported on contact time, specific food behaviour goals (FBG), behaviour change techniques (BCT; adapted from the Michie CALO-RE taxonomy) and teaching resources at each contact. Diet quality was measured by 2005 Canadian Healthy Eating Index (HEI-C) and assessed for possible associations with individual BCT and FBG. Results Food behaviour goals associated with improved HEI-C at 3 months were: poultry more than red meat, increased plant protein, increased fish, increased olive oil, increased fruits and vegetables, eating breakfast, increased milk and alternatives, healthier fats, healthier snacks and increased nuts, with an adverse association noted for more use (> 2 times/ 3 months) of the balanced meal concept (F test; p < 0.001). Of 16 BCT, goal setting accounted for 15% of all BCT recorded, yet more goal setting (> 3 times/3 months) was associated with poorer HEI-C at 3 months (F test; p = 0.007). Only self-monitoring, feedback on performance and focus on past success were associated with improved HEI-C. Conclusions These results identify key aspects of process that impact diet quality. Documentation of both FBG and BCT is highly relevant in diet counselling and a summary diet quality score is a promising target for assessing short-term counselling success. Supplementary Information The online version contains supplementary material available at 10.1186/s40795-022-00540-9.
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14
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De Mauri A, Carrera D, Vidali M, Bagnati M, Rolla R, Riso S, Chiarinotti D, Torreggiani M. Does Mediterranean Adequacy Index Correlate with Cardiovascular Events in Patients with Advanced Chronic Kidney Disease? An Exploratory Study. Nutrients 2022; 14:nu14091687. [PMID: 35565655 PMCID: PMC9101145 DOI: 10.3390/nu14091687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/11/2022] [Accepted: 04/17/2022] [Indexed: 11/23/2022] Open
Abstract
The Mediterranean Diet (MD) is a healthy dietary pattern, demonstrated to reduce the risk of cancer, diabetes, cardiovascular and neurodegenerative diseases, and early death. The Mediterranean Adequacy Index (MAI) is used to measure adherence to the MD in perspective studies in the general population and correlates with cardiovascular events. The aim of this study was to calculate the MAI among patients with advanced chronic kidney disease (CKD) and correlate it with traditional uremic, microbiota-derived, and proatherogenic toxins as well as nutritional status, quality of life, and cardiovascular events. A total of 60 adult patients with advanced CKD were enrolled and their MAI was calculated. According to the median value, patients were divided into lower (l-MAI, <1.80) and higher (h-MAI, ≥1.80) MAI groups. Biochemical parameters, microbiota-derived and proatherogenic toxins (p-Cresyl sulphate, Indoxyl-sulphate, and Lipoprotein-associated phospholipase A2), nutritional status, quality of life, and cardiovascular events that occurred in the previous three years were recorded. The mean value of the MAI was 2.78 ± 2.86. The MAI was significantly higher in foreigners (median (IQR) 6.38 (8.98) vs. 1.74 (1.67), p < 0.001) and diabetic patients. The l-MAI and h-MAI groups had similar routinary blood, p-Cresyl-sulphate, Indoxyl-sulphate, and Lp-PLA2 as well as nutritional status and quality of life parameters. The MAI was not associated with previous cardiovascular events and did not correlate with cardiovascular events in CKD patients. New and nephro-tailored indexes are warranted to evaluate nutritional therapy in CKD patients.
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Affiliation(s)
- Andreana De Mauri
- Nephrology and Dialysis Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy;
- Correspondence:
| | - Deborah Carrera
- Nutritional Science and Dietetic, Maggiore della Carità University Hospital, 28100 Novara, Italy; (D.C.); (S.R.)
| | - Matteo Vidali
- Clinical Chemistry Unit, Fondazione IRCCS Ca’ Granda Maggiore Policlinico Hospital, 20122 Milano, Italy;
| | - Marco Bagnati
- Clinical Chemistry Laboratory, Maggiore della Carità University Hospital, 28100 Novara, Italy; (M.B.); (R.R.)
| | - Roberta Rolla
- Clinical Chemistry Laboratory, Maggiore della Carità University Hospital, 28100 Novara, Italy; (M.B.); (R.R.)
- Department of Health Sciences, Amedeo Avogadro University of Eastern Piedmont, 28100 Novara, Italy
| | - Sergio Riso
- Nutritional Science and Dietetic, Maggiore della Carità University Hospital, 28100 Novara, Italy; (D.C.); (S.R.)
| | - Doriana Chiarinotti
- Nephrology and Dialysis Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy;
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Barriers to the Provision of Preventive Care to People Living with Mental Health Conditions: Self-Report by Staff Working in an Australian Community Managed Organisation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084458. [PMID: 35457326 PMCID: PMC9027436 DOI: 10.3390/ijerph19084458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/02/2022] [Accepted: 04/02/2022] [Indexed: 11/30/2022]
Abstract
People living with mental health conditions experience a reduced life expectancy largely due to a higher prevalence of chronic diseases. Addressing health risk behaviours, including tobacco smoking, inadequate nutrition, harmful alcohol consumption, and physical inactivity (SNAP), through the provision of preventive care, is recommended to reduce this burden. Community Managed Organisations (CMOs) may play an important role in providing preventive care to consumers with mental health conditions, however, few studies have examined preventive care provision in CMO settings; and no studies have comprehensively assessed barriers to the provision of this care using a tool such as the Theoretical Domains Framework (TDF). To fill this research gap, we conducted an online survey among staff (N = 190) from one CMO in Australia to (1) identify barriers to preventive care provision (ask, advise, assist, connect) to address SNAP behaviours among consumers; and (2) explore associations between barriers and preventive care provision. Results demonstrate that while staff reported knowing how to provide preventive care and believed it would positively impact consumers; barriers including confidence in providing this care and consumer uptake of referrals, were identified. Further research among multiple CMOs is needed to identify care provision and associated barriers in the sector more widely.
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Healthy and unhealthy eating after a behaviour change intervention in primary care. Prim Health Care Res Dev 2022; 23:e23. [PMID: 35357281 PMCID: PMC8991859 DOI: 10.1017/s1463423622000147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND To prevent and reduce non-communicable diseases, the Norwegian Directorate of Health encourages Healthy Life Centres (HLCs) in all municipalities. AIMS This study investigates whether the behaviour change interventions at HLCs positively affected participants' diet and to evaluate predictors for healthy and unhealthy eating. Our data are part of the Norwegian Healthy Life Centre Study, a 6-month, pragmatic randomised controlled trial (RCT). METHODS Totally, 118 participants ≥18 years old were randomised to an intervention group (n 57), or a waiting list (control group) (n 61). Eighty-six participants met at the 6 months follow-up visit. We merged the participants to one cohort for predictor analyses, using linear regressions. FINDINGS The RCT of the HLCs' interventions had no effect on healthy and unhealthy eating 6 months after baseline compared with controls. A short, additional healthy eating education programme produced a modest, statistically significant improvement in healthy eating compared with controls. This did not, however, reduce unhealthy eating. Higher income predicted unhealthier eating over time. Increasing body mass index and impaired physical functioning also led to an increase in unhealthy eating. Healthy eating at 6 months was predicted by self-rated health (SRH), vitality and life satisfaction, and hampered by musculo-skeletal challenges and impaired self-esteem (SE). SRH impacted improvement in healthy eating during the 6 months. The effect of interventions on healthier eating may be improved by an emphasis on developing positive self-concepts like better SRH, vitality, life satisfaction, and SE.
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Dening J, George ES, Ball K, Mohebbi M, Shariful Islam SM. Randomised controlled trial of a web-based low carbohydrate diet intervention for adults with type 2 diabetes: the T2Diet study protocol. BMJ Open 2022; 12:e054594. [PMID: 35190434 PMCID: PMC8862456 DOI: 10.1136/bmjopen-2021-054594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Type 2 diabetes (T2D) management frequently involves a multidisciplinary care team. However, standard care for patients with T2D is the central role of the general practice physician, and consists of routine appointments to monitor glycaemic status and overall health. Dietary modification is an essential component of T2D management. Evidence suggests that a low carbohydrate diet (LCD) provides better clinical outcomes for people with T2D compared with other diets. However, providing dietary support in face-to-face settings is challenged by issues of availability and accessibility. Provided in conjunction with standard care, digital interventions can help bridge this gap. The objective of this paper is to describe the protocol of a randomised controlled trial (RCT) of a web-based intervention that will evaluate the effectiveness of standard care plus web-based LCD intervention when compared with standard care only. METHODS AND ANALYSIS In a two-arm parallel RCT, 100 adults with non-insulin-dependent T2D aged between 40 and 89 years will be randomised to either a theoretically informed 16-week automated web-based LCD intervention plus standard care or standard care only. LCD recommendations emphasise consuming nutrient-dense whole foods and encourage a daily carbohydrate goal of 50-100 g, with an objective of achieving 10% to <26% carbohydrates from total energy intake. Assessments will take place at baseline and 16 weeks. The primary outcome will be haemoglobin A1c. Additional data collected will include dietary intake, self-efficacy, weight and height, anti-diabetes medication and dosages, and diabetes-related comorbidities. Process evaluation will consist of a mixed-methods assessment of website engagement metrics, user experience and participants' perspectives. ETHICS AND DISSEMINATION All study procedures have been approved by the Deakin University Human Research Ethics Committee (2020-349). Study findings will be disseminated widely through public, professional and academic presentation and publication. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12621000096853).
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Affiliation(s)
- Jedha Dening
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Elena S George
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Kylie Ball
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Mohammadreza Mohebbi
- Biostatistics Unit, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
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18
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Dening J, George ES, Ball K, Islam SMS. User-centered development of a digitally-delivered dietary intervention for adults with type 2 diabetes: The T2Diet study. Internet Interv 2022; 28:100505. [PMID: 35242592 PMCID: PMC8861390 DOI: 10.1016/j.invent.2022.100505] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/01/2022] [Accepted: 02/09/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Web-based interventions can help address challenges of accessibility and availability of dietary support for people with type 2 diabetes (T2D). However, concerns regarding adherence and engagement in web-based interventions have been noted. Implementing a user-centered approach to intervention development has been shown to encourage better participant engagement. The overarching aim of this paper was to describe the user-centered approach used in the T2Diet Study to develop a new web-based dietary intervention for adults with T2D, exploring strategies for enhancing adherence and engagement. METHODS Intervention development was based on a flexible iterative user-centered approach to enable new product development. Twenty-one adults with T2D were engaged in six guided discussion groups across four iterative development phases, alongside reference to evidence and theory throughout the process. The phases of user inquiry progressed from broad discussion on areas to support dietary needs; to design feedback on aspects of site layout; through to further feedback on aesthetics and functionality; then into a two-week field test followed by final user inquiry and participation in user experience polls. A hybrid approach of thematic data analysis was used, incorporating both a data-driven inductive approach and a deductive approach based on a priori identification of themes. RESULTS Group discussion across the four phases highlighted factors the participants considered may motivate them to adhere and engage, which predominantly included relevance of resources, clear and simple positive communication, and flexibility for personal tailoring. Participant feedback provided an actionable list of intervention developments and input to inform intervention structure and theoretical framework. The two-week field test highlighted factors participants valued in terms of the user experience, most notably usability and accessibility. Additionally, the field test indicated a positive user experience, with no significant usability issues identified. CONCLUSION This paper provided the first detailed report of a user-centered approach to iterative development in the context of a web-based T2D dietary intervention. The insights will be useful to inform future digitally-delivered dietary interventions for adults with T2D or to inform a similar user-centered approach for other chronic health conditions.
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Affiliation(s)
- Jedha Dening
- Corresponding author at: Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Locked Bag 20000, Geelong, Victoria 3220, Australia.
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De Mauri A, Carrera D, Vidali M, Bagnati M, Rolla R, Riso S, Torreggiani M, Chiarinotti D. Compliance, Adherence and Concordance Differently Predict the Improvement of Uremic and Microbial Toxins in Chronic Kidney Disease on Low Protein Diet. Nutrients 2022; 14:nu14030487. [PMID: 35276846 PMCID: PMC8839589 DOI: 10.3390/nu14030487] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 02/06/2023] Open
Abstract
Background. In medicine, “compliance” indicates that the patient complies with the prescriber’s recommendations, “adherence” means that “the patient matches the recommendations” and “concordance” means “therapeutic alliance” between patient and clinician. While a low protein diet (LPD) is a cornerstone treatment of chronic kidney disease (CKD), monitoring the actual performance of LPD is a challenge. Patients. Fifty-seven advanced CKD adult patients were enrolled and LPD prescribed. Compliance was evaluated through the normalized protein catabolic rate (nPCR), adherence by the dietitian by means of a 24-h dietary recall and concordance by the nephrologist during consultations. Traditional parameters as well as total p-Cresyl Sulphate (t-PCS), total Indoxyl Sulphate (t-IS) and Lipoprotein-associated phspholipase A2 (Lp-PLA2) were compared between adherent/not adherent and concordant/not concordant subjects at enrolment and after two months. Results. nPCR, blood urea nitrogen, cholesterol and triglycerides significantly decreased in all patients. t-PCS and t-IS decreased among adherent subjects. Lp-PLA2, t-PCS, free-PCS and t-IS decreased among concordant subjects, while these increased in non-concordant ones. Conclusion. This study demonstrates that LPD may improve the control of traditional uremic toxins and atherogenic toxins in “adherent” and “concordant” patients. A comprehensive and multidisciplinary approach is needed to evaluate the compliance/adherence/concordance to LPD for optimizing nutritional interventions.
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Affiliation(s)
- Andreana De Mauri
- Nephrology and Dialysis Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy;
- Correspondence:
| | - Deborah Carrera
- Nutritional Science and Dietetic, Maggiore della Carità University Hospital, 28100 Novara, Italy; (D.C.); (S.R.)
| | - Matteo Vidali
- Clinical Chemistry Unit, Fondazione IRCCS Ca’ Granda Maggiore Policlinico Hospital, 20122 Milano, Italy;
| | - Marco Bagnati
- Clinical Chemistry Laboratory, Maggiore della Carità University Hospital, 28100 Novara, Italy; (M.B.); (R.R.)
| | - Roberta Rolla
- Clinical Chemistry Laboratory, Maggiore della Carità University Hospital, 28100 Novara, Italy; (M.B.); (R.R.)
- Department of Health Sciences, Amedeo Avogadro University of Eastern Piedmont, 28100 Novara, Italy
| | - Sergio Riso
- Nutritional Science and Dietetic, Maggiore della Carità University Hospital, 28100 Novara, Italy; (D.C.); (S.R.)
| | | | - Doriana Chiarinotti
- Nephrology and Dialysis Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy;
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20
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Richardson KM, Saleh AA, Jospe MR, Liao Y, Schembre SM. Using Biological Feedback to Promote Health Behavior Change in Adults: Protocol for a Scoping Review. JMIR Res Protoc 2022; 11:e32579. [PMID: 35040792 PMCID: PMC8808341 DOI: 10.2196/32579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/19/2021] [Accepted: 11/30/2021] [Indexed: 11/26/2022] Open
Abstract
Background Many health conditions can be prevented, managed, or improved through behavioral interventions. As a component of health behavior change interventions, biological feedback is of particular interest given recent advances in wearable biosensing technology, digital health apps, and personalized health and wellness. Nevertheless, there is a paucity of literature to guide the design and implementation of interventions that incorporate biological feedback to motivate health behavior change. Objective The goal of this scoping review is to deeply explore the use of biological feedback as a component of health behavior change interventions that target adults. The objectives of the review include (1) mapping the domains of research that incorporate biological feedback and (2) describing the operational characteristics of using biological feedback in the context of health behavior change. Methods A comprehensive list of search terms was developed to capture studies from a wide range of domains. The studies to be included are randomized controlled trials published as primary research articles, theses, or dissertations targeting adults 18 years and older, who use biological feedback to change a health-related behavior. The following electronic databases were searched: Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, EBSCOhost, PsycINFO, and ProQuest Dissertations & Theses Global. The screening and data extraction process will be guided by the Joanna Briggs Institute Manual for Evidence Synthesis and conducted by trained reviewers. Results Database searches were completed in June 2021. A total of 50,459 unique records were returned after the removal of 48,634 duplicate records. The scoping review is planned for completion in 2022. Conclusions To our knowledge, this will be the first scoping review to map the literature that uses biological feedback as a component of health behavior change interventions targeting adults. The findings will be used to develop a framework to guide the design and implementation of future health behavior change interventions that incorporate biological feedback. Trial Registration OSF Registries OSF.IO/YP5WA; https://osf.io/yp5wa International Registered Report Identifier (IRRID) DERR1-10.2196/32579
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Affiliation(s)
- Kelli M Richardson
- Department of Nutritional Sciences, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ, United States
| | - Ahlam A Saleh
- Arizona Health Sciences Library, Tucson, AZ, United States
| | - Michelle R Jospe
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Yue Liao
- Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, United States
| | - Susan M Schembre
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, United States
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21
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Goncalves MD, Maddocks OD. Engineered diets to improve cancer outcomes. Curr Opin Biotechnol 2021; 70:29-35. [PMID: 33232844 PMCID: PMC8702371 DOI: 10.1016/j.copbio.2020.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/22/2020] [Accepted: 10/20/2020] [Indexed: 12/13/2022]
Abstract
Cancer cells acquire a diverse range of metabolic adaptations that support their enhanced rates of growth and proliferation. While these adaptations help tune metabolism to support higher anabolic output and bolster antioxidant defenses, they can also decrease metabolic flexibility and increase dependence on nutrient uptake versus de novo synthesis. Diet is the major source of nutrients that ultimately support tumor growth, yet the potential impact of diet is currently underutilized during the treatment of cancer. Here, we review several forms of dietary augmentation therapy including those that alter the content of food, such as energy or macronutrient restriction, and those that alter the timing of food consumption, like intermittent fasting regimens. We discuss how these dietary strategies can be combined with pharmacologic therapies to exaggerate the metabolic liabilities of different cancer types.
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Affiliation(s)
- Marcus D Goncalves
- Division of Endocrinology, Weill Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA; Meyer Cancer Center, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA.
| | - Oliver Dk Maddocks
- Institute of Cancer Sciences, Wolfson Wohl Cancer Research Centre, University of Glasgow, Glasgow, UK
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22
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Vidmar AP, Jones RB, Wee CP, Berger PK, Plows JF, Rios RDC, Raymond JK, Goran MI. Timing of food consumption in Hispanic adolescents with obesity. Pediatr Obes 2021; 16:e12764. [PMID: 33370849 PMCID: PMC8178160 DOI: 10.1111/ijpo.12764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/01/2020] [Accepted: 12/04/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Little is known about the normal eating time periods in adolescents with obesity and how these patterns change throughout development. As the obesity epidemic continues to rise in adolescence, it becomes imperative to understand developmentally appropriate eating behaviours and to create weight management strategies that build on those innate patterns and preferences. The purpose of this study was to determine the most common habitual eating windows observed in adolescents with obesity. METHODS Participants were 101 Hispanic adolescents (mean age 14.8 ± 2.1 years; 48 male/53 female) with obesity (BMI ≥95th percentile) who were recruited as part of a larger clinical trial. Dietary intake and meal timing was determined using multiple pass 24-hours recalls. Histograms were utilized to determine the natural distribution of percent consumption of total kilocalories, carbohydrates and added sugar per hour. RESULTS The majority of total kilocalories (65.4%), carbohydrates (65.3%) and added sugar (59.1%) occurred between 11:00 and 19:00. Adolescents were 2.5 to 2.9 times more likely to consume kilocalories, carbohydrates, and added sugar during the 8-hour window between 11:00 am and 19:00 pm than other time windows examined (all P < .001). The consumption of these calories did not differ between weekdays and weekend (P > .05) or by sex. CONCLUSIONS In this cohort, more than 60% of calories, carbohydrates and added sugar were consumed between 11:00 am and 19:00 pm, which is concordant with an afternoon/evening chronotype that is common in adolescents. Our findings support this 8-hour period as a practical window for weight loss interventions that target pre-specified eating periods in this population.
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Affiliation(s)
- Alaina P. Vidmar
- Diabetes & Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California
- Keck School of Medicine of USC, Los Angeles, California
| | - Roshonda B. Jones
- Diabetes & Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California
- Keck School of Medicine of USC, Los Angeles, California
| | - Choo Phei Wee
- CTSI Biostatics Core, The Saban Research Institute, Los Angeles, California
| | - Paige K. Berger
- Diabetes & Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California
- Keck School of Medicine of USC, Los Angeles, California
| | - Jasmine F. Plows
- Diabetes & Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California
- Keck School of Medicine of USC, Los Angeles, California
| | - R. D. Claudia Rios
- Diabetes & Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California
- Keck School of Medicine of USC, Los Angeles, California
| | - Jennifer K. Raymond
- Diabetes & Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California
- Keck School of Medicine of USC, Los Angeles, California
| | - Michael I. Goran
- Diabetes & Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California
- Keck School of Medicine of USC, Los Angeles, California
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Mirmiran P, Bahadoran Z, Gaeini Z. Common Limitations and Challenges of Dietary Clinical Trials for Translation into Clinical Practices. Int J Endocrinol Metab 2021; 19:e108170. [PMID: 34567133 PMCID: PMC8453651 DOI: 10.5812/ijem.108170] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 03/01/2021] [Accepted: 03/29/2021] [Indexed: 01/31/2023] Open
Abstract
The progressive development of clinical and public health nutrition has long relied on dietary clinical trials (DCTs), investigating the causal relationship between diet and multiple risk factors of non-communicable and chronic diseases. DCTs are also hallmarks for establishing dietary requirements and promoting overall nutritional health among the population. Despite their critical importance in translation into public health strategies and practices, DCTs have several limitations and challenges for study design, implementation and finding interpretation. The complex nature of nutrition interventions, collinearity between diet components, multi-target effects of the interventions, diverse dietary behaviors, and food culture are the most challenging issues. Furthermore, baseline exposure and dietary status, appropriate control groups, blinding, randomization, and poor adherence undermine the effectiveness of DCTs in translation into practices. Disruptive factors will be minimized if researchers are committed to following good clinical practice (GCP) standards available for common designs of clinical trials. Planning DCTs, however, needs careful considerations for hypothesis generation, study design development, the definition of primary and secondary outcome measures, and target population.
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Affiliation(s)
- Parvin Mirmiran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Bahadoran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding Author: Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P. O. Box: 1985717413, Tehran, Iran. Tel: +98-2122432500,
| | - Zahra Gaeini
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Bailey R, English J, Knee C, Keller A. Treatment Adherence in Integrative Medicine-Part One: Review of Literature. Integr Med (Encinitas) 2021; 20:48-60. [PMID: 34373679 PMCID: PMC8325505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Treatment adherence is a topic that is well studied but not well understood. Low treatment adherence is a significant issue that limits the effective management and treatment of chronic conditions, creating significant health care burden, costs, and poor patient outcomes. This report provides a review of the factors that facilitate or create barriers to treatment adherence, as well as strategies recommended to overcome adherence barriers. A total of 25 interviews were conducted with practitioners demonstrating both high (n = 16) and low (n = 9) treatment adherence rates. A total of 185 survey responses were received from high-treatment adherence rate practitioners (n = 21), low-treatment adherence rate practitioners (n = 83), and practitioners that were neither in the high- or low-treatment adherence rate range (n = 81). Practitioner prescribing behaviors and adherence statistics were determined and stratified by high-treatment adherence rate and low-treatment adherence rate practitioners. From the interviews, 78% of low-rate practitioners mentioned that establishing trust is a primary best practice for optimizing adherence, and for high-rate practitioners, 69% thought that facilitating trust was important to optimizing adherence. Both low- and high-adherence rate practitioners prioritized using a staged approach as a strategy to overcome barriers to adherence. From the total survey sample it was found that key strategies to improving adherence included the practice of booking follow-up appointments, using lab results to explain treatment plans, and using a staged approach for treatment plans. Our research sought to elicit strategies and skills that can help improve treatment adherence in integrative medicine and our findings have identified several common practices that can help to improve adherence. Research taking advantage of mobile devices and the internet for adherence has started to expand within the last 10 to 15 years. Technology has the potential to lead the development and establishment of a centralized database that acquires adherence information and provides solutions to its practitioners and patients. Further work to advance the field of integrative medicine through additional research and interventions that support treatment adherence would be valuable to the effective treatment and management of integrative medicine patients.
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Del Razo-Olvera FM, Martin-Vences AJ, Brito-Córdova GX, Elías-López D, Landa-Anell MV, Melgarejo-Hernández MA, Cruz-Bautista I, Manjarrez-Martínez I, Gómez-Velasco DV, Aguilar-Salinas CA. Primary Barriers of Adherence to a Structured Nutritional Intervention in Patients with Dyslipidemia. Nutrients 2021; 13:nu13061744. [PMID: 34063795 PMCID: PMC8223790 DOI: 10.3390/nu13061744] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 01/30/2023] Open
Abstract
PURPOSE To describe the primary barriers to adequately adhering to a structured nutritional intervention. PATIENTS AND METHODS A total of 106 participants diagnosed with dyslipidemia and without a medical nutrition therapeutic plan were included in this two-year study conducted at the INCMNSZ dyslipidemia clinic in Mexico City. All patients were treated with the same structured strategies, including three face-to-face visits and two telephone follow-up visits. Diet plan adherence was evaluated at each site visit through a 3-day or 24-h food recall. RESULTS Barriers to adhere to the nutritional intervention were: lack of time to prepare their meals (23%), eating outside the home (19%), unwillingness to change dietary patterns (14%), and lack of information about a correct diet for dyslipidemias (14%). All barriers decreased significantly at the end of the intervention. Female gender, current smoking, and following a plan of more than 1500 kcal (R2 = 0.18 and p-value = 0.004) were associated with good diet adherence. Participants showed good levels of adherence to total caloric intake at visit 2 and 3, reporting 104.7% and 95.4%, respectively. Adherence to macronutrient intake varied from 65.1% to 126%, with difficulties in adhering to recommended carbohydrate and fat consumption being more notable. CONCLUSION The study findings confirm that a structured nutritional intervention is effective in reducing barriers and improving dietary adherence and metabolic control in patients with dyslipidemias. Health providers must identify barriers to adherence early on to design interventions that reduce these barriers and improve adherence.
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Affiliation(s)
- Fabiola Mabel Del Razo-Olvera
- Research Unit of Metabolic Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City 14080, Mexico; (F.M.D.R.-O.); (D.E.-L.); (I.C.-B.); (D.V.G.-V.)
- Deparment of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City 14080, Mexico; (G.X.B.-C.); (M.A.M.-H.); (I.M.-M.)
| | | | - Griselda X. Brito-Córdova
- Deparment of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City 14080, Mexico; (G.X.B.-C.); (M.A.M.-H.); (I.M.-M.)
| | - Daniel Elías-López
- Research Unit of Metabolic Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City 14080, Mexico; (F.M.D.R.-O.); (D.E.-L.); (I.C.-B.); (D.V.G.-V.)
- Deparment of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City 14080, Mexico; (G.X.B.-C.); (M.A.M.-H.); (I.M.-M.)
| | - María Victoria Landa-Anell
- Centro de Atención Integral del Paciente con Diabetes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City 14080, Mexico;
| | - Marco Antonio Melgarejo-Hernández
- Deparment of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City 14080, Mexico; (G.X.B.-C.); (M.A.M.-H.); (I.M.-M.)
- Centro de Atención Integral del Paciente con Diabetes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City 14080, Mexico;
| | - Ivette Cruz-Bautista
- Research Unit of Metabolic Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City 14080, Mexico; (F.M.D.R.-O.); (D.E.-L.); (I.C.-B.); (D.V.G.-V.)
- Deparment of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City 14080, Mexico; (G.X.B.-C.); (M.A.M.-H.); (I.M.-M.)
| | - Iliana Manjarrez-Martínez
- Deparment of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City 14080, Mexico; (G.X.B.-C.); (M.A.M.-H.); (I.M.-M.)
| | - Donají Verónica Gómez-Velasco
- Research Unit of Metabolic Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City 14080, Mexico; (F.M.D.R.-O.); (D.E.-L.); (I.C.-B.); (D.V.G.-V.)
| | - Carlos Alberto Aguilar-Salinas
- Research Unit of Metabolic Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City 14080, Mexico; (F.M.D.R.-O.); (D.E.-L.); (I.C.-B.); (D.V.G.-V.)
- Deparment of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City 14080, Mexico; (G.X.B.-C.); (M.A.M.-H.); (I.M.-M.)
- Division of Nutrition, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán (INCMNSZ), Vasco de Quiroga #15, Tlalpan, Mexico City 14080, Mexico
- Correspondence: ; Tel.: +52-55-54-87-09-00 (ext. 1501); Fax: +52-55-55-13-45-07
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Mendoza-Vasconez AS, Landry MJ, Crimarco A, Bladier C, Gardner CD. Sustainable Diets for Cardiovascular Disease Prevention and Management. Curr Atheroscler Rep 2021; 23:31. [PMID: 33970349 DOI: 10.1007/s11883-021-00929-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW Healthy dietary patterns are recommended for prevention of cardiovascular disease, which remains the leading cause of morbidity and mortality globally. In this review, we discuss dietary patterns that are not only optimal for CVD prevention and management but also sustainable in maximizing health, environmental, and economic benefits. RECENT FINDINGS The growing literature on sustainable diets in the context of environmental sustainability includes subtopics of climate change, land use, biodiversity loss, freshwater use, and reactive nitrogen emissions. Similarly, economic sustainability, beyond the retail cost of food, extends to healthcare costs and the economic costs of environmental destruction related to current agricultural practices and food choices. Dietary patterns that are high in plant foods and low in animal foods could maximize health, environmental, and economic benefits; however, questions remain about how to best promote these patterns to achieve wider adoption in an environmentally and economically sustainable way.
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Affiliation(s)
| | - Matthew J Landry
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Anthony Crimarco
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Claire Bladier
- Risk Assessment Department, French Agency for Food, Environmental and Occupational Health and Safety (ANSES), Maisons-Alfort, France
| | - Christopher D Gardner
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA.
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Beidelschies M, Alejandro-Rodriguez M, Guo N, Postan A, Jones T, Bradley E, Hyman M, Rothberg MB. Patient outcomes and costs associated with functional medicine-based care in a shared versus individual setting for patients with chronic conditions: a retrospective cohort study. BMJ Open 2021; 11:e048294. [PMID: 33849860 PMCID: PMC8051390 DOI: 10.1136/bmjopen-2020-048294] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To compare outcomes and costs associated with functional medicine-based care delivered in a shared medical appointment (SMA) to those delivered through individual appointments. DESIGN A retrospective cohort study was performed to assess outcomes and cost to deliver care to patients in SMAs and compared with Propensity Score (PS)-matched patients in individual appointments. SETTING A single-centre study performed at Cleveland Clinic Center for Functional Medicine. PARTICIPANTS A total of 9778 patients were assessed for eligibility and 7323 excluded. The sample included 2455 patients (226 SMAs and 2229 individual appointments) aged ≥18 years who participated in in-person SMAs or individual appointments between 1 March 2017 and 31 December 2019. Patients had a baseline Patient-Reported Outcome Measurement Information System (PROMIS) Global Physical Health (GPH) score and follow-up score at 3 months. Patients were PS-matched 1:1 with 213 per group based on age, sex, race, marital status, income, weight, body mass index, blood pressure (BP), PROMIS score and functional medicine diagnostic category. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was change in PROMIS GPH at 3 months. Secondary outcomes included change in PROMIS Global Mental Health (GMH), biometrics, and cost. RESULTS Among 213 PS-matched pairs, patients in SMAs exhibited greater improvements at 3 months in PROMIS GPH T-scores (mean difference 1.18 (95% CI 0.14 to 2.22), p=0.03) and PROMIS GMH T-scores (mean difference 1.78 (95% CI 0.66 to 2.89), p=0.002) than patients in individual appointments. SMA patients also experienced greater weight loss (kg) than patients in individual appointments (mean difference -1.4 (95% CI -2.15 to -0.64), p<0.001). Both groups experienced a 5.5 mm Hg improvement in systolic BP. SMAs were also less costly to deliver than individual appointments. CONCLUSION SMAs deliver functional medicine-based care that improves outcomes more than care delivered in individual appointments and is less costly to deliver.
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Affiliation(s)
| | | | - Ning Guo
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anna Postan
- Community Care, Cleveland Clinic, Cleveland, Ohio, USA
| | - Tawny Jones
- Center for Functional Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Elizabeth Bradley
- Center for Functional Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mark Hyman
- Center for Functional Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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Ndahura NB, Munga J, Kimiywe J, Mupere E. Effectiveness of a Structured Nutrition Education Course for Caregivers of Children and Adolescents with Type 1 Diabetes in Improving Glycemic and Dietary Outcomes: A Cluster-Randomized Controlled Trial Protocol. OPEN ACCESS JOURNAL OF CLINICAL TRIALS 2021. [DOI: 10.2147/oajct.s304290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Babateen AM, Shannon OM, O’Brien GM, Okello E, Khan AA, Rubele S, Wightman E, Smith E, McMahon N, Olgacer D, Koehl C, Fostier W, Mendes I, Kennedy D, Mathers JC, Siervo M. Acceptability and Feasibility of a 13-Week Pilot Randomised Controlled Trial Testing the Effects of Incremental Doses of Beetroot Juice in Overweight and Obese Older Adults. Nutrients 2021; 13:769. [PMID: 33653009 PMCID: PMC7996834 DOI: 10.3390/nu13030769] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 11/17/2022] Open
Abstract
Nitrate-rich food can increase nitric oxide production and improve vascular and brain functions. This study examines the feasibility of a randomised controlled trial (RCT) testing the effects of prolonged consumption of different doses of dietary nitrate (NO3-) in the form of beetroot juice (BJ) in overweight and obese older participants. A single-blind, four-arm parallel pilot RCT was conducted in 62 overweight and obese (30.4 ± 4 kg/m2) older participants (mean ± standard deviation (SD), 66 ± 4 years). Participants were randomized to: (1) high-NO3- (HN: 2 × 70 mL BJ/day) (2) medium-NO3- (MN: 70 mL BJ/day), (3) low-NO3- (LN: 70 mL BJ on alternate days) or (4) Placebo (PL: 70 mL of NO3--depleted BJ on alternate days), for 13 weeks. Compliance was checked by a daily log of consumed BJ, NO3- intake, and by measuring NO3- and NO2- concentrations in plasma, saliva, and urine samples. Fifty participants completed the study. Self-reported compliance to the interventions was >90%. There were significant positive linear relationships between NO3- dose and the increase in plasma and urinary NO3- concentration (R2 = 0.71, P < 0.001 and R2 = 0.46 P < 0.001, respectively), but relationships between NO3- dose and changes in salivary NO3- and NO2- were non-linear (R2 = 0.35, P = 0.002 and R2 = 0.23, P = 0.007, respectively). The results confirm the feasibility of prolonged BJ supplementation in older overweight and obese adults.
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Affiliation(s)
- Abrar M. Babateen
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne NE2 4HH, UK; (A.M.B.); (O.M.S.); (E.O.); (D.O.); (C.K.); (W.F.); (J.C.M.)
- Faculty of Applied Medical Sciences, Clinical Nutrition Department, Umm Al-Qura University, Makkah 21421, Saudi Arabia;
| | - Oliver M. Shannon
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne NE2 4HH, UK; (A.M.B.); (O.M.S.); (E.O.); (D.O.); (C.K.); (W.F.); (J.C.M.)
| | - Gerard M. O’Brien
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne NE2 4HH, UK; (A.M.B.); (O.M.S.); (E.O.); (D.O.); (C.K.); (W.F.); (J.C.M.)
| | - Edward Okello
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne NE2 4HH, UK; (A.M.B.); (O.M.S.); (E.O.); (D.O.); (C.K.); (W.F.); (J.C.M.)
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne NE1 7RU, UK
| | - Anmar A. Khan
- Faculty of Applied Medical Sciences, Clinical Nutrition Department, Umm Al-Qura University, Makkah 21421, Saudi Arabia;
| | - Sofia Rubele
- Department of Geriatrics, St Bortolo Hospital, Vicenza, 37030 Verona, Italy;
| | - Emma Wightman
- Brain Performance and Nutrition Research Centre, Northumbria University, Newcastle Upon Tyne NE1 8ST, UK; (E.W.); (E.S.); (D.K.)
- Nutrition Trials at Northumbria (NUTRAN), Northumbria University, Newcastle Upon Tyne NE1 8ST, UK
| | - Ellen Smith
- Brain Performance and Nutrition Research Centre, Northumbria University, Newcastle Upon Tyne NE1 8ST, UK; (E.W.); (E.S.); (D.K.)
- Nutrition Trials at Northumbria (NUTRAN), Northumbria University, Newcastle Upon Tyne NE1 8ST, UK
| | - Nicholas McMahon
- School of Human Movement and Nutrition Sciences, University of Queensland, St. Lucia, QLD 4067, Australia;
| | - Dilara Olgacer
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne NE2 4HH, UK; (A.M.B.); (O.M.S.); (E.O.); (D.O.); (C.K.); (W.F.); (J.C.M.)
| | - Christina Koehl
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne NE2 4HH, UK; (A.M.B.); (O.M.S.); (E.O.); (D.O.); (C.K.); (W.F.); (J.C.M.)
| | - William Fostier
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne NE2 4HH, UK; (A.M.B.); (O.M.S.); (E.O.); (D.O.); (C.K.); (W.F.); (J.C.M.)
| | - Inês Mendes
- Endocrinology and Nutrition Department, Divino Espirito Santo Hospital, D. Manuel I Avenue, 9500-370 Azores, Portugal;
| | - David Kennedy
- Brain Performance and Nutrition Research Centre, Northumbria University, Newcastle Upon Tyne NE1 8ST, UK; (E.W.); (E.S.); (D.K.)
- Nutrition Trials at Northumbria (NUTRAN), Northumbria University, Newcastle Upon Tyne NE1 8ST, UK
| | - John C. Mathers
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne NE2 4HH, UK; (A.M.B.); (O.M.S.); (E.O.); (D.O.); (C.K.); (W.F.); (J.C.M.)
| | - Mario Siervo
- School of Life Sciences, Queen’s Medical Centre, The University of Nottingham Medical School, Nottingham NG7 2UH, UK
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Saglimbene VM, Su G, Wong G, Natale P, Ruospo M, Palmer SC, Craig JC, Carrero JJ, Strippoli GFM. Dietary intake in adults on hemodialysis compared with guideline recommendations. J Nephrol 2021; 34:1999-2007. [PMID: 33591554 PMCID: PMC8610942 DOI: 10.1007/s40620-020-00962-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 12/29/2020] [Indexed: 11/25/2022]
Abstract
Background Clinical practice guidelines of dietary management are designed to promote a balanced diet and maintain health in patients undergoing haemodialysis but they may not reflect patients’ preferences.
We aimed to investigate the consistency between the dietary intake of patients on maintenance haemodialysis and guideline recommendations. Methods Cross-sectional analysis of the DIET-HD study, which included 6,906 adults undergoing haemodialysis in 10 European countries. Dietary intake was determined using the Global Allergy and Asthma European Network (GA2LEN) Food Frequency Questionnaire (FFQ), and compared with the European Best Practice Guidelines. Consistency with guidelines was defined as achieving the minimum daily recommended intake for energy (≥ 30 kcal/kg) and protein (≥ 1.1 g/kg), and not exceeding the maximum recommended daily intake for phosphate (≤ 1000 mg), potassium (≤ 2730 mg), sodium (≤ 2300 mg) and calcium (≤ 800 mg). Results Overall, patients’ dietary intakes of phosphate and potassium were infrequently consistent with guidelines (consistent in 25% and 25% of patients, respectively). Almost half of the patients reported that energy (45%) and calcium intake (53%) was consistent with the guidelines, while the recommended intake of sodium and protein was consistent in 85% and 67% of patients, respectively. Results were similar across all participating countries. Intake was consistent with all six guideline recommendations in only 1% of patients. Conclusion Patients on maintenance haemodialysis usually have a dietary intake which is inconsistent with current recommendations, especially for phosphate and potassium. Supplementary Information The online version contains supplementary material available at 10.1007/s40620-020-00962-3.
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Affiliation(s)
- Valeria M Saglimbene
- Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia
- Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare, 70124, Bari, Italy
| | - Guobin Su
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Department of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province, China
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou City, Guangdong Province, China
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Germaine Wong
- Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia
- Department of Renal Medicine, Westmead Hospital, Westmead, Australia
| | - Patrizia Natale
- Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia
- Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare, 70124, Bari, Italy
| | - Marinella Ruospo
- Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare, 70124, Bari, Italy
| | - Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Juan J Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Giovanni F M Strippoli
- Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia.
- Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare, 70124, Bari, Italy.
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Strategies for Reducing Salt and Sugar Intakes in Individuals at Increased Cardiometabolic Risk. Nutrients 2021; 13:nu13010279. [PMID: 33478028 PMCID: PMC7835960 DOI: 10.3390/nu13010279] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/10/2021] [Accepted: 01/18/2021] [Indexed: 01/09/2023] Open
Abstract
Non-communicable diseases (NCDs) are the first causes of death worldwide. Reduction in the dietary intake of salt and sugars is important lifestyle advice that is useful for NCD prevention. However, the simple recommendations of reducing salt and sugars by healthcare professionals are often ineffective; innovative strategies are therefore necessary. This review aimed at describing the current knowledge about the strategies to reduce dietary salt and sugar intake, including both strategies for the food industry to reduce the salt or sugar of its products and recommendations for health professionals in a clinical context, such as the replacement with substitutes in foods, the gradual reduction to allow a progressive consumer adaptation towards less intense taste, and the different spatial distribution of tastants within the food matrix with taste intensity enhancement. In addition, the cross-modal interaction between two or more different sensory modalities as an innovative strategy for enhancing sweetness and saltiness perception was described. Finally, the dietary tips for salt and sugar reduction were summarized in order to create a comprehensive guide of dietary advices for healthcare professionals for optimizing the management of patients at increased cardiometabolic risk.
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Roy G, Boucher A, Couture P, Drouin-Chartier JP. Impact of Diet on Plasma Lipids in Individuals with Heterozygous Familial Hypercholesterolemia: A Systematic Review of Randomized Controlled Nutritional Studies. Nutrients 2021; 13:nu13010235. [PMID: 33561083 PMCID: PMC7829745 DOI: 10.3390/nu13010235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Conclusive data on the effectiveness of dietary interventions in heterozygous familial hypercholesterolemia (HeFH) management are unavailable. Whether this is due to a true lack of effects or biases in intervention designs remains unsettled. We systematically assessed the impact on LDL-C of published dietary randomized controlled trials (RCTs) conducted among individuals with HeFH in relation to their design and risk of bias. METHODS We systematically searched PubMed, Web of Science, and Embase in November 2020 to identify RCTs that assessed the impact of: (1) food-based interventions; (2) dietary counseling interventions; or (3) dietary supplements on LDL-C in individuals with HeFH. We evaluated the risk of bias of each study using the Cochrane Risk of Bias 2 method. RESULTS A total of 19 RCTs comprising 837 individuals with HeFH were included. Of those, five were food-based interventions, three were dietary counseling interventions and 12 were dietary supplement-based interventions (omega-3, n = 3; phytosterols, n = 7; guar gum, n = 1; policosanol, n = 1). One study qualified both as a food-based intervention and as a dietary supplement intervention due to its factorial design. A significant reduction in LDL-C levels was reported in 10 RCTs, including eight dietary supplement interventions (phytosterols, n = 6, omega-3, n = 1; guar gum, n = 1), one food-based intervention and one dietary counseling intervention. A total of 13 studies were judged to have some methodological biases in a way that substantially lowers confidence in the results. Studies at low risk of biases were more likely to report significant reductions in LDL-C concentrations, compared with studies at risk of bias (chi-square statistic: 5.49; p = 0.02). CONCLUSION This systemic review shows that the apparent lack of effectiveness of diet manipulation in modulating plasma levels of LDL-C among individuals with HeFH is likely due to biases in study designs, rather than a true lack of effects. The likelihood of reporting significant reductions in LDL-C was associated with the concurrent risk of bias.
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Affiliation(s)
- Gabrielle Roy
- Centre Nutrition, Santé et Société (NUTRISS), Institut Sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada; (G.R.); (A.B.); (P.C.)
| | - Anykim Boucher
- Centre Nutrition, Santé et Société (NUTRISS), Institut Sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada; (G.R.); (A.B.); (P.C.)
| | - Patrick Couture
- Centre Nutrition, Santé et Société (NUTRISS), Institut Sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada; (G.R.); (A.B.); (P.C.)
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC G1V 4G2, Canada
| | - Jean-Philippe Drouin-Chartier
- Centre Nutrition, Santé et Société (NUTRISS), Institut Sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada; (G.R.); (A.B.); (P.C.)
- Faculté de Pharmacie, Université Laval, Québec, QC G1V 0A6, Canada
- Correspondence: ; Tel.: +418-656-2131
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Hendrie GA, Lyle G, Mauch CE, Haddad J, Golley RK. Understanding the Variation within a Dietary Guideline Index Score to Identify the Priority Food Group Targets for Improving Diet Quality across Population Subgroups. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E378. [PMID: 33418998 PMCID: PMC7825319 DOI: 10.3390/ijerph18020378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/24/2020] [Accepted: 12/25/2020] [Indexed: 11/18/2022]
Abstract
Globally, population dietary intakes fall below the guideline recommendations and large-scale interventions have had modest success in improving diet quality. To inform the development of more targeted approaches, this study analysed the variations in self-reported data from an online survey of Australian adults collected between 2015 and 2020, to identify common combinations of low scoring components within a dietary guideline index. A low score was defined as meeting less than half the guideline recommendations (a score <50 out of 100). Among 230,575 adults, a single component analysis showed that 79.5% had a low score for discretionary choices, 72.2% for healthy fats and 70.8% for dairy. The combinations approach showed 83.0% of individuals had two to five low scoring components, with men, younger adults aged 18-30 years and individuals with obesity (BMI ≥ 30) more likely to have five or more. The most common dietary pattern combination included low scores for discretionary choices, dairy and healthy fats. There was a considerable but systematic variation in the low scoring components within the dietary patterns, suggesting that interventions with the flexibility to address particular combinations of key food groups across subgroups could be an effective and resource efficient way to improve diet quality in the population.
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Affiliation(s)
- Gilly A. Hendrie
- Nutrition and Health Program, Health & Biosecurity, CSIRO, Adelaide, SA 5000, Australia; (G.A.H.); (J.H.)
| | - Greg Lyle
- School of Public Health, Curtin University, Bentley Campus, Perth, WA 6102, Australia;
| | - Chelsea E. Mauch
- Nutrition and Health Program, Health & Biosecurity, CSIRO, Adelaide, SA 5000, Australia; (G.A.H.); (J.H.)
| | - Joyce Haddad
- Nutrition and Health Program, Health & Biosecurity, CSIRO, Adelaide, SA 5000, Australia; (G.A.H.); (J.H.)
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia;
| | - Rebecca K. Golley
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia;
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The degree of engagement of overweight/obese adult women in the recommended activities of the Chilean "Vida Sana" program is directly correlated with its effectiveness. NUTR HOSP 2021; 38:807-813. [PMID: 33703910 DOI: 10.20960/nh.03461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Introduction: the Chilean Ministry of Health implements the Vida Sana (VS) program with the objective of reducing risk factors for chronic diseases in overweight/obese (OW/OB) individuals, aged 2-64. Objective: to determine the effectiveness of VS in OW/OB women (20-44 yrs) in terms of their engagement in the recommended activities. These consist of participating in a minimum number each of three core activities (psychologist consultations, lifestyle workshops, and physical activity sessions) during 6 months, to obtain a 5 % weight loss and improved physical fitness (PF). Methods: a retrospective study involving secondary analyses of the 2017 VS database (n = 5,179 OW/OB women). We determined effectiveness by: a) comparing changes in weight and PF in participants who achieved one or both outcomes, using t-tests and tests of proportions, and b) assessing the probability of achieving the program´s goal, according to participation in 1, 2, or 3 core activities, individually and jointly, using the OR (95 % CI) and trend analysis. Results: around 32 %, 88 %, and 29 % of women achieved 5 % weight loss, improved PF, and both, respectively. The high percentage of women who improved PF was due to a permissive criterion. Although 20 % of women attained the program´s goal with 0 engagement, among participants, the ORs (95 % CI) for achieving the program´s goal when engaging in 1, 2, or 3 core activities were 1.55 (CI 1.2-2.03), 2.34 (1.76-3.11), and 3.5 (2.21-5.53), respectively. Conclusion: effectiveness parallels degree of engagement in the recommended activities of VS. A characterization of a program´s participation rate is crucial for improving its effectiveness.
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Tang D, Mitchell P, Liew G, Burlutsky G, Flood VM, Gopinath B. Telephone-Delivered Dietary Intervention in Patients with Age-Related Macular Degeneration: 3-Month Post-Intervention Findings of a Randomised Controlled Trial. Nutrients 2020; 12:E3083. [PMID: 33050401 PMCID: PMC7650817 DOI: 10.3390/nu12103083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/02/2020] [Accepted: 10/06/2020] [Indexed: 11/17/2022] Open
Abstract
There is an evidence-practice gap between the dietary recommendations for age-related macular degeneration (AMD) presented in the literature and those practiced by patients. This study reports on the 3-month post-intervention results of a randomised controlled trial (RCT) evaluating telephone-delivered counselling to improve dietary behaviours among AMD patients. A total of 155 AMD patients (57% female, aged 78 ± 8 years; control: 78, intervention: 77), primarily residing in New South Wales, Australia, were recruited. Participants completed a baseline questionnaire and a short dietary questionnaire (SDQ-AMD). The intervention included an evidence-based nutrition resource and four monthly calls with a dietitian. Immediately post-intervention, intervention participants repeated the SDQ-AMD and completed a feedback form. At 3 months post-intervention, both study arms repeated the SDQ-AMD. Statistical analyses included t-tests and McNemar's test. Intervention participants reported satisfaction with the tailored phone calls, nutrition resource and nutrition education provided. At 3 months post-intervention, there was no statistically significant difference between study arms in the proportion of participants meeting the dietary goals nor in intake (mean servings ± SE) of total vegetables (primary outcome) and other key food groups; however, there was a significantly higher intake of nuts (secondary outcome) (3.96 ± 0.51 vs. 2.71 ± 0.32; p = 0.04) among participants in the intervention versus control group. Within the intervention arm, there were also significant improvements in intakes of the following secondary outcomes: dark green leafy vegetables (0.99 ± 0.17 vs. 1.71 ± 0.22; p = 0.003) and legumes (0.69 ± 0.10 vs. 1.12 ± 0.16; p = 0.02) and intake of sweets and processed/prepared foods (8.31 ± 0.76 vs. 6.54 ± 0.58, p = 0.01). In summary, although there were few dietary differences between study arms at 3 months post-intervention, the intervention involving four monthly calls was acceptable and helpful to the participants. This type of intervention therefore has the potential to provide people with AMD the needed support for improving their nutrition knowledge and dietary practices, especially if continued over a longer period.
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Affiliation(s)
- Diana Tang
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Camperdown, NSW 2006, Australia; (P.M.); (G.L.); (G.B.); (B.G.)
| | - Paul Mitchell
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Camperdown, NSW 2006, Australia; (P.M.); (G.L.); (G.B.); (B.G.)
| | - Gerald Liew
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Camperdown, NSW 2006, Australia; (P.M.); (G.L.); (G.B.); (B.G.)
| | - George Burlutsky
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Camperdown, NSW 2006, Australia; (P.M.); (G.L.); (G.B.); (B.G.)
| | - Victoria M. Flood
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia;
- Western Sydney Local Health District, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Bamini Gopinath
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Camperdown, NSW 2006, Australia; (P.M.); (G.L.); (G.B.); (B.G.)
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Aparecida Silveira E, Falco MO, Santos ASEADC, Noll M, de Oliveira C. Nutritional Intervention Reduces Dyslipidemia, Fasting Glucose and Blood Pressure in People Living with HIV/AIDS in Antiretroviral Therapy: A Randomized Clinical Trial Comparing Two Nutritional Interventions. Nutrients 2020; 12:E2970. [PMID: 32998416 PMCID: PMC7601880 DOI: 10.3390/nu12102970] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/25/2020] [Accepted: 09/23/2020] [Indexed: 11/16/2022] Open
Abstract
Antiretroviral therapy (ART) increases the risk of cardiometabolic diseases in people living with HIV/AIDS (PLWHA). However, there is a lack of evidence regarding the effectiveness of a nutritional intervention on several cardiometabolic parameters in this population. Therefore, this study aimed to evaluate the effectiveness of two nutritional interventions on several cardiometabolic parameters in PLWHA treated with ART. A parallel randomized clinical trial was performed with PLWHA treated with ART. The participants (n = 88) were divided into two intervention groups: (1) nutritional counseling (n = 44) and (2) individualized dietary prescription (n = 44). The follow-up period was 30 weeks. A reduction in low-density lipoprotein (LDL) was the primary outcome. Secondary outcome variables were reductions in total cholesterol (TC), triglycerides (TG), fasting plasma glucose (FPG), systolic and diastolic blood pressures (SBP and DBP, respectively), waist circumference (WC), body mass index (BMI), and increases in high-density lipoproteins (HDL). A multiple linear regression was used to analyze the effectiveness of the interventions, adjusted for sociodemographic, lifestyle, and clinical characteristics. Sixty-two PLWHA completed the trial (nutritional counseling, n = 32; individualized dietary prescription, n = 30). At follow-up, we observed in the nutritional counseling group significant reductions in SBP (p = 0.036) and DBP (p = 0.001). Significant reductions in FPG (p = 0.008) and DBP (p = 0.023) were found in the individualized dietary prescription group. In the fully adjusted models, significant reductions in LDL, SBP, DBP, and BMI were found in the individualized dietary prescription group. In conclusion, the two investigated nutritional interventions were effective in reducing some cardiometabolic risk factors in PLWHA. However, after adjustments for covariates, the individualized dietary prescription showed significant reductions in the primary outcome and, also, in more cardiometabolic risk factors than the nutritional counseling.
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Affiliation(s)
- Erika Aparecida Silveira
- Department of Epidemiology & Public Health, Institute of Epidemiology & Health Care, University College London, London WC1E 6BT, UK
- Postgraduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiânia 74605-050, Brazil; (M.O.F.); (A.S.e.A.d.C.S.)
| | - Marianne Oliveira Falco
- Postgraduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiânia 74605-050, Brazil; (M.O.F.); (A.S.e.A.d.C.S.)
| | | | - Matias Noll
- Department of Public Health, Instituto Federal Goiano, Ceres 76300-000, Brazil;
| | - Cesar de Oliveira
- Department of Epidemiology & Public Health, Institute of Epidemiology & Health Care, University College London, London WC1E 6BT, UK
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Gibson CA, Gupta A, Greene JL, Lee J, Mount RR, Sullivan DK. Feasibility and acceptability of a televideo physical activity and nutrition program for recent kidney transplant recipients. Pilot Feasibility Stud 2020; 6:126. [PMID: 32944274 PMCID: PMC7488333 DOI: 10.1186/s40814-020-00672-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 08/21/2020] [Indexed: 02/07/2023] Open
Abstract
Background Post-transplant weight gain affects 50-90% of kidney transplant recipients adversely affecting survival, quality of life, and risk for diabetes and cardiovascular disease. Diet modification and physical activity may help prevent post-transplant weight gain. Methods for effective implementation of these lifestyle modifications are needed. The objective of this study is to assess the feasibility and acceptability of a remotely delivered nutrition and physical activity intervention among kidney transplant recipients. Secondary aims were to estimate the effectiveness of the intervention in producing changes in physical activity, qualify of life, fruit and vegetable intake, and consumption of whole grains and water from baseline to 6 months. Methods A randomized controlled study for stable kidney transplant recipients between 6 and 12 months post-transplantation was conducted. Participants were randomly assigned 1:1 to a technology-based, lifestyle modification program (intervention) or to enhanced usual care (control). Results The first 10 kidney transplant recipients screened were eligible and randomized into the intervention and control groups with no significant between-group differences at baseline. Health coaching attendance (78%) and adherence to reporting healthy behaviors (86%) were high. All participants returned for final assessments. The weight in controls remained stable, while the intervention arm showed weight gain at 3 and 6 months. Improvements were found for physical activity, quality of life, and fruit and vegetable intake in both groups. All participants would recommend the program to other transplant recipients. Conclusions Our data suggest that a remotely delivered televideo nutrition and physical activity intervention is feasible and valued by patients. These findings will aid in the development of a larger, more prescriptive, randomized trial to address weight gain prevention. Trial registration Clinicaltrials.gov Identifier NCT03697317. Retrospectively registered on October 5, 2018.
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Affiliation(s)
- Cheryl A Gibson
- Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd., MS1020, Kansas City, KS 66160 USA
| | - Aditi Gupta
- Department of Internal Medicine, Division of Nephrology and Hypertension, Kidney Institute, University of Kansas Medical Center, Kansas City, KS USA
| | - J Leon Greene
- Department of Health, Sports, and Exercise Sciences, University of Kansas, Lawrence, KS USA
| | - Jaehoon Lee
- Department of Educational Psychology and Leadership, Texas Tech University, Lubbock, TX USA
| | - Rebecca R Mount
- Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd., MS1020, Kansas City, KS 66160 USA
| | - Debra K Sullivan
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS USA
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Byaruhanga J, Atorkey P, McLaughlin M, Brown A, Byrnes E, Paul C, Wiggers J, Tzelepis F. Effectiveness of Individual Real-Time Video Counseling on Smoking, Nutrition, Alcohol, Physical Activity, and Obesity Health Risks: Systematic Review. J Med Internet Res 2020; 22:e18621. [PMID: 32915156 PMCID: PMC7519427 DOI: 10.2196/18621] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/18/2020] [Accepted: 07/26/2020] [Indexed: 12/11/2022] Open
Abstract
Background Real-time video communication technology allows virtual face-to-face interactions between the provider and the user, and can be used to modify risk factors for smoking, nutrition, alcohol consumption, physical activity, and obesity. No systematic reviews have examined the effectiveness of individual real-time video counseling for addressing each of the risk factors for smoking, nutrition, alcohol consumption, physical activity, and obesity. Objective This systematic review aims to examine the effectiveness of individually delivered real-time video counseling on risk factors for smoking, nutrition, alcohol consumption, physical activity, and obesity. Methods The MEDLINE (Medical Literature Analysis and Retrieval System Online), EMBASE (Excerpta Medica Database), PsycINFO, Cochrane Register of Controlled Trials, and Scopus databases were searched for eligible studies published up to November 21, 2019. Eligible studies were randomized or cluster randomized trials that tested the effectiveness of individual real-time video communication interventions on smoking, nutrition, alcohol, physical activity, and obesity in any population or setting; the comparator was a no-intervention control group or any other mode of support (eg, telephone); and an English-language publication. Results A total of 13 studies were eligible. Four studies targeted smoking, 3 alcohol, 3 physical activity, and 3 obesity. In 2 of the physical activity studies, real-time video counseling was found to significantly increase physical activity when compared with usual care at week 9 and after 5 years. Two obesity studies found a significant change in BMI between a video counseling and a documents group, with significantly greater weight loss in the video counseling group than the in-person as well as the control groups. One study found that those in the video counseling group were significantly more likely than those in the telephone counseling group to achieve smoking cessation. The remaining studies found no significant differences between video counseling and telephone counseling or face-to-face counseling for smoking cessation, video counseling and face-to-face treatment on alcohol consumption, video counseling and no counseling for physical activity, and video counseling and face-to-face treatment on BMI. The global methodological quality rating was moderate in 1 physical activity study, whereas 12 studies had a weak global rating. Conclusions Video counseling is potentially more effective than a control group or other modes of support in addressing physical inactivity and obesity and is not less effective in modifying smoking and alcohol consumption. Further research is required to determine the relative benefits of video counseling in terms of other policy and practice decision-making factors such as costs and feasibility.
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Affiliation(s)
- Judith Byaruhanga
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Health Behaviour, Faculty of Health & Medicine, University of Newcastle, Callaghan, Australia
| | - Prince Atorkey
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Health Behaviour, Faculty of Health & Medicine, University of Newcastle, Callaghan, Australia
| | - Matthew McLaughlin
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Health Behaviour, Faculty of Health & Medicine, University of Newcastle, Callaghan, Australia
| | - Alison Brown
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Health Behaviour, Faculty of Health & Medicine, University of Newcastle, Callaghan, Australia
| | - Emma Byrnes
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Christine Paul
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Health Behaviour, Faculty of Health & Medicine, University of Newcastle, Callaghan, Australia
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Health Behaviour, Faculty of Health & Medicine, University of Newcastle, Callaghan, Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Health Behaviour, Faculty of Health & Medicine, University of Newcastle, Callaghan, Australia
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Vidmar AP, Goran MI, Naguib M, Fink C, Wee CP, Hegedus E, Lopez K, Gonzalez J, Raymond JK. Time limited eating in adolescents with obesity (time LEAd): Study protocol. Contemp Clin Trials 2020; 95:106082. [PMID: 32682994 DOI: 10.1016/j.cct.2020.106082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/22/2020] [Accepted: 07/06/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Time limited eating (TLE) has been shown to be effective for weight loss and improvement of glycemic control in adults with obesity and type 2 diabetes (T2D), but has not been well studied in adolescents. TLE may be a more feasible, flexible and effective dietary intervention for adolescents because it removes the need for intensive counting of calories or macronutrients, and emphasizes eating during a specified time period. OBJECTIVES The aim of this study is to assess the feasibility of a TLE approach in adolescents with obesity using a continuous glucose monitor (CGM) to promote adherence to the intervention. METHODS We propose a prospective, randomized controlled trial, in 60 adolescents (ages 14-18) with obesity (BMI% ≥ 95th percentile). Youth will be randomized to one of three treatment groups for a 12-week intervention: Group 1) Low sugar and carbohydrate education (LSC, 5% of total daily calories from sugar (<35 g)/day; <90 g carbohydrate (CHO)/day) + blinded CGM (used to monitor adherence and glycemic outcomes without real time feedback), Group 2) LSC + TLE (16-h fast/8-h feed for 5 days per week) + blinded CGM, and Group 3) LSC + TLE+ real time feedback via CGM (to evaluate effect of providing CGM data on intervention efficacy). Outcomes will include change in total body fat (TBF) percentage measured on DEXA scan, BMI status and fasting blood glucose at 12 weeks compared to baseline. CONCLUSIONS TLE is a potentially powerful lifestyle intervention that could be readily integrated into pediatric weight management programs to optimize their impact and accelerate healthy changes. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03954223.
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Affiliation(s)
- Alaina P Vidmar
- Diabetes & Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine of USC, Los Angeles, CA, United States of America.
| | - Michael I Goran
- Diabetes & Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine of USC, Los Angeles, CA, United States of America
| | - Monica Naguib
- Diabetes & Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine of USC, Los Angeles, CA, United States of America
| | - Cassandra Fink
- Diabetes & Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine of USC, Los Angeles, CA, United States of America
| | - Choo Phei Wee
- CTSI Biostatics Core, Saban Research Institute, Los Angeles, CA, United States of America
| | - Elizabeth Hegedus
- Diabetes & Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine of USC, Los Angeles, CA, United States of America
| | - Kelleen Lopez
- Diabetes & Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine of USC, Los Angeles, CA, United States of America
| | - Janelle Gonzalez
- Diabetes & Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine of USC, Los Angeles, CA, United States of America
| | - Jennifer K Raymond
- Diabetes & Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine of USC, Los Angeles, CA, United States of America
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Kelly JT, Allman-Farinelli M, Chen J, Partridge SR, Collins C, Rollo M, Haslam R, Diversi T, Campbell KL. Dietitians Australia position statement on telehealth. Nutr Diet 2020; 77:406-415. [PMID: 32596950 PMCID: PMC7540717 DOI: 10.1111/1747-0080.12619] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 12/21/2022]
Abstract
It is the position of Dietitians Australia that clients can receive high‐quality and effective dietetic services such as Medical Nutrition Therapy (MNT) delivered via telehealth. Outcomes of telehealth‐delivered dietetic consultations are comparable to those delivered in‐person, without requiring higher levels of additional training nor compromising quality of service provision. Dietitians Australia recommends that policy makers and healthcare funders broaden the recognition for telehealth‐delivered dietetic consultations as a responsive and cost‐effective alternative or complement to traditional in‐person delivery of dietetic services. The successful implementation of telehealth can help to address health and service inequalities, improve access to effective nutrition services, and support people with chronic disease to optimise their diet‐related health and well‐being, regardless of their location, income or literacy level, thereby addressing current inequities.
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Affiliation(s)
- Jaimon T Kelly
- Menzies Health Institute Queensland, Faculty of Medicine, Griffith University, Gold Coast, Australia
| | - Margaret Allman-Farinelli
- Charles Perkins Centre, Discipline of Nutrition and Dietetics, School of Life and Environmental Sciences, The University of Sydney, Sydney, Australia
| | - Juliana Chen
- Charles Perkins Centre, Discipline of Nutrition and Dietetics, School of Life and Environmental Sciences, The University of Sydney, Sydney, Australia
| | - Stephanie R Partridge
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Clare Collins
- Priority Research Centre in Physical Activity & Nutrition and School of Health Sciences, Faculty of Health and Medicine , The University of Newcastle, Callaghan, Australia
| | - Megan Rollo
- Priority Research Centre in Physical Activity & Nutrition and School of Health Sciences, Faculty of Health and Medicine , The University of Newcastle, Callaghan, Australia
| | - Rebecca Haslam
- Priority Research Centre in Physical Activity & Nutrition and School of Health Sciences, Faculty of Health and Medicine , The University of Newcastle, Callaghan, Australia
| | | | - Katrina L Campbell
- Menzies Health Institute Queensland, Faculty of Medicine, Griffith University, Gold Coast, Australia
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Kelly JT, Conley M, Hoffmann T, Craig JC, Tong A, Reidlinger DP, Reeves MM, Howard K, Krishnasamy R, Kurtkoti J, Palmer SC, Johnson DW, Campbell KL. A Coaching Program to Improve Dietary Intake of Patients with CKD: ENTICE-CKD. Clin J Am Soc Nephrol 2020; 15:330-340. [PMID: 32111701 PMCID: PMC7057309 DOI: 10.2215/cjn.12341019] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/22/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND OBJECTIVES The dietary self-management of CKD is challenging. Telehealth interventions may provide an effective delivery method to facilitate sustained dietary change. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This pilot, randomized, controlled trial evaluated secondary and exploratory outcomes after a dietitian-led telehealth coaching intervention to improve diet quality in people with stage 3-4 CKD. The intervention group received phone calls every 2 weeks for 3 months (with concurrent, tailored text messages for 3 months), followed by 3 months of tailored text messages without telephone coaching, to encourage a diet consistent with CKD guidelines. The control group received usual care for 3 months, followed by nontailored, educational text messages for 3 months. RESULTS Eighty participants (64% male), aged 62±12 years, were randomized to the intervention or control group. Telehealth coaching was safe, with no adverse events or changes to serum biochemistry at any time point. At 3 months, the telehealth intervention, compared with the control, had no detectable effect on overall diet quality on the Alternative Health Eating Index (3.2 points, 95% confidence interval, -1.3 to 7.7), nor at 6 months (0.5 points, 95% confidence interval, -4.6 to 5.5). There was no change in clinic BP at any time point in any group. There were significant improvements in several exploratory diet and clinical outcomes, including core food group consumption, vegetable servings, fiber intake, and body weight. CONCLUSIONS Telehealth coaching was safe, but appeared to have no effect on the Alternative Healthy Eating Index or clinic BP. There were clinically significant changes in several exploratory diet and clinical outcomes, which require further investigation. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER Evaluation of Individualized Telehealth Intensive Coaching to Promote Healthy Eating and Lifestyle in CKD (ENTICE-CKD), ACTRN12616001212448.
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Affiliation(s)
- Jaimon T Kelly
- Faculty of Health Science and Medicine and .,Menzies Health Institute, Griffith University, Brisbane, Queensland, Australia
| | | | - Tammy Hoffmann
- Centre for Research in Evidence Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Allison Tong
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | | | | | - Kirsten Howard
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rathika Krishnasamy
- Department of Nephrology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia.,Centre for Kidney Disease Research, University of Queensland, Brisbane, Queensland, Australia
| | - Jagadeesh Kurtkoti
- Department of Renal Medicine, Gold Coast University Hospital, Southport, Queensland, Australia.,School of Medicine and
| | - Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand; and
| | - David W Johnson
- Centre for Kidney Disease Research, University of Queensland, Brisbane, Queensland, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia
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Chiba M, Nakane K, Tsuji T, Tsuda S, Ishii H, Ohno H, Watanabe K, Obara Y, Komatsu M, Sugawara T. Relapse Prevention by Plant-Based Diet Incorporated into Induction Therapy for Ulcerative Colitis: A Single-Group Trial. Perm J 2020; 23:18-220. [PMID: 31050638 DOI: 10.7812/tpp/18-220] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
CONTEXT No known previous study has focused on plant-based diet (PBD) to prevent relapse of ulcerative colitis (UC) except our previous educational hospitalization study. OBJECTIVE To describe the relapse rate in a large case series of UC after incorporation of PBD into induction therapy. DESIGN All patients with UC between 2003 and 2017 were admitted for induction therapy. Patients receiving educational hospitalization or treated with infliximab were excluded. A lacto-ovo-semivegetarian diet (PBD) together with medication prescribed according to UC guidelines was provided during hospitalization. MAIN OUTCOME MEASURES The primary endpoint was relapse during follow-up. The secondary endpoint was change over time in the plant-based diet score (PBDS), which evaluated adherence to the PBD. RESULTS Ninety-two cases were studied, of which 51 were initial episodes and 41 were relapses. Cases varied in severity (31 mild, 48 moderate, 13 severe) and extent (15 proctitis, 22 left-sided colitis, 55 extensive colitis). More severe cases existed among the relapse cases than among the initial episode cases. Cumulative relapse rates at 1- and 5-year follow-up (Kaplan-Meier analysis) were 14% and 27%, respectively, for the initial episode cases, and 36% and 53%, respectively, for relapse cases. At long-term follow-up (6 years 4 months), PBDS was significantly higher than baseline PBDS (p < 0.0001). CONCLUSION Relapse rates in UC after induction therapy with PBD were far lower than those previously reported with conventional therapy. Adherence to PBD was significantly higher than baseline even at 6-year follow-up. We conclude PBD is effective for preventing UC relapse.(Study identification no.: UMIN000019061: Registration: www.umin.ac.jp).
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Affiliation(s)
- Mitsuro Chiba
- Inflammatory Bowel Disease Section, Akita City Hospital, Japan
| | - Kunio Nakane
- Gastroenterology Division, Akita City Hospital, Japan
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Kinnear FJ, Wainwright E, Bourne JE, Lithander FE, Hamilton-Shield J, Searle A. The development of a theory informed behaviour change intervention to improve adherence to dietary and physical activity treatment guidelines in individuals with familial hypercholesterolaemia (FH). BMC Health Serv Res 2020; 20:27. [PMID: 31914998 PMCID: PMC6950899 DOI: 10.1186/s12913-019-4869-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/23/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Familial hypercholesterolaemia (FH) is a genetic condition characterised by elevated levels of low-density lipoprotein cholesterol (LDL-C) and an increased risk of cardiovascular disease (CVD). Following dietary and physical activity guidelines could help minimise this risk but adherence is low. Interventions to target these behaviours are therefore required. A comprehensive understanding of the target behaviours and behaviour change theory should drive the process of intervention development to increase intervention effectiveness and scalability. This paper describes the application of a theoretical framework to the findings of a qualitative evidence synthesis (QES) to inform the content and delivery of an intervention to improve adherence to dietary and physical activity guidelines in individuals with FH. METHODS The Behaviour Change Wheel (BCW) was used to guide intervention development. Factors influencing dietary and physical activity behaviours were identified from an earlier QES and mapped onto factors within the BCW. A comprehensive behavioural diagnosis of these factors was conducted through application of the theoretical domains framework (TDF). Using these data, the most appropriate intervention functions and behaviour change techniques (BCTs) for inclusion in the intervention were identified. Decision making was guided by evaluation criteria recommended by BCW guidance and feedback from individuals with FH. RESULTS Factors influencing dietary and physical activity behaviours mapped onto twelve of the fourteen TDF domains, with seven intervention functions deemed suitable to target the domains' theoretical constructs. Twenty-six BCTs were identified as being appropriate for delivery within these functions and were included in the intervention. For instance, within the enablement intervention function, the BCT problem solving was incorporated by inclusion of a 'barriers and solutions' section. Guided by evaluation criteria and feedback from individuals with FH, the intervention will be delivered as an hour-long family-based appointment, followed up with four telephone calls. CONCLUSIONS The novel application of the BCW and TDF to the results of a QES has enabled the development of a theory and evidence informed behaviour change intervention. This systematic approach facilitates evaluation of the intervention as part of an ongoing feasibility trial. The transparent approach taken can be used to guide intervention development by researchers in other fields.
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Affiliation(s)
- F J Kinnear
- NIHR Bristol Biomedical Research Centre (Nutrition Theme), University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK.
| | - E Wainwright
- Psychology Department, Bath Spa University and Honorary Research Fellow, Department for Health, University of Bath, Bath, UK
| | - J E Bourne
- NIHR Bristol Biomedical Research Centre (Nutrition Theme), University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - F E Lithander
- NIHR Bristol Biomedical Research Centre (Nutrition Theme), University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - J Hamilton-Shield
- NIHR Bristol Biomedical Research Centre (Nutrition Theme), University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - A Searle
- NIHR Bristol Biomedical Research Centre (Nutrition Theme), University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
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44
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Gajewska D, Kucharska A, Kozak M, Wunderlich S, Niegowska J. Effectiveness of Individual Nutrition Education Compared to Group Education, in Improving Anthropometric and Biochemical Indices among Hypertensive Adults with Excessive Body Weight: A Randomized Controlled Trial. Nutrients 2019; 11:nu11122921. [PMID: 31810342 PMCID: PMC6950305 DOI: 10.3390/nu11122921] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 11/28/2019] [Indexed: 12/18/2022] Open
Abstract
Objective: The study aims to compare the effectiveness of individual and group nutrition education methods in improving key anthropometric and biochemical markers in drug-treated, overweight-obese hypertensive adults. Methods: The randomized trial included 170 patients with pharmacologically well-controlled primary hypertension and body mass index (BMI) ≥ 25 kg/m2. For six months, the patients received six sessions, either one-to-one individual nutrition education (IE, n = 89) or group education (GE, n = 81), developed by dietitians. Anthropometric measurements, body composition, and fasting measures of biochemical parameters were obtained at baseline and after six months of intervention. Results: 150 patients completed the nutrition education program. The IE group significantly improved in many parameters compared to the GE group, including weight (p < 0.001), waist circumference (p < 0.001), BMI (p < 0.001), systolic and diastolic blood pressure (BP) (p < 0.001), fasting plasma glucose (p = 0.011), oral glucose tolerance test (OGGT) (p = 0.030), and insulin resistance (homeostatic model assessment of insulin resistance, HOMA-IR) (p < 0.001). The groups did not differ in terms of total cholesterol, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) concentrations. Conclusion: Individual nutrition education is more effective than group education in terms of improving anthropometric and biochemical indices in overweight-obese hypertensive adults.
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Affiliation(s)
- Danuta Gajewska
- Department of Dietetics, Faculty of Human Nutrition, Warsaw University of Life Sciences—SGGW (WULS), 159C Nowoursynowska Str, 02-776 Warsaw, Poland;
- Correspondence: ; Tel.: +48-22-593-7021; Fax: +48-22-593-7018
| | - Alicja Kucharska
- Human Nutrition Department, Warsaw Medical University, 02-776 Warsaw, Poland;
| | - Marcin Kozak
- Department of Botany, Warsaw University of Life Sciences—SGGW (WULS), 159C Nowoursynowska Str, 02-776 Warsaw, Poland;
| | - Shahla Wunderlich
- Department of Nutrition and Food Studies, Montclair State University, 1 Normal Avenue, Montclair, NJ 07043, USA;
| | - Joanna Niegowska
- Department of Dietetics, Faculty of Human Nutrition, Warsaw University of Life Sciences—SGGW (WULS), 159C Nowoursynowska Str, 02-776 Warsaw, Poland;
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45
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Brauer P, Royall D, Li A, Rodrigues A, Green J, Macklin S, Craig A, Pasanen J, Brunelle L, Maitland S, Dhaliwal R, Klein D, Tremblay A, Rheaume C, Mutch DM, Jeejeebhoy K. Nutrient intake and dietary quality changes within a personalized lifestyle intervention program for metabolic syndrome in primary care. Appl Physiol Nutr Metab 2019; 44:1297-1304. [DOI: 10.1139/apnm-2019-0070] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A team-based 12-month lifestyle program for the treatment of metabolic syndrome (MetS) (involving physicians, registered dietitians (RDs), and kinesiologists) was previously shown to reverse MetS in 19% of patients (95% confidence interval, 14% to 24%). This work evaluates changes in nutrient intake and diet quality over 12 months (n = 205). Individualized diet counselling was provided by 14 RDs at 3 centres. Two 24-h recalls, the Canadian Healthy Eating Index (HEI-C), and the Mediterranean Diet Score (MDS) were completed at each time point. Total energy intake decreased by 145 ± 586 kcal (mean ± SD) over 3 months with an additional 76 ± 452 kcal decrease over 3–12 months. HEI-C improved from 58 ± 15 to 69 ± 12 at 3 months and was maintained at 12 months. Similarly, MDS (n = 144) improved from 4.8 ± 1.2 to 6.2 ± 1.9 at 3 months and was maintained at 12 months. Changes were specific to certain food groups, with increased intake of fruits, vegetables, and nuts and decreased intake of “other foods” and “commercial baked goods” being the most prominent changes. There was limited change in intake of olive oil, fish, and legumes. Exploratory analysis suggested that poorer diet quality at baseline was associated with greater dietary changes as assessed by HEI-C. Novelty Multiple dietary assessment tools provided rich information on food intake changes in an intervention for metabolic syndrome. Improvements in diet were achieved by 3 months and maintained to 12 months. The results provide a basis for further dietary change implementation studies in the Canadian context.
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Affiliation(s)
- Paula Brauer
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Dawna Royall
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Airu Li
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Ariellia Rodrigues
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Jennifer Green
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Sharon Macklin
- Edmonton Oliver Primary Care Network, Edmonton, AB T5G 0E5, Canada
| | - Alison Craig
- Edmonton Oliver Primary Care Network, Edmonton, AB T5G 0E5, Canada
| | - Jennifer Pasanen
- Edmonton Oliver Primary Care Network, Edmonton, AB T5G 0E5, Canada
| | - Lucie Brunelle
- Department of Kinesiology, Laval University, Québec, QC G1V 0A6, Canada
| | - Scott Maitland
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada
| | | | - Doug Klein
- Department of Family Medicine, University of Alberta, Edmonton, AB T6G 2R7, Canada
| | - Angelo Tremblay
- Department of Kinesiology, Laval University, Québec, QC G1V 0A6, Canada
| | - Caroline Rheaume
- Department of Family Medicine and Emergency Medicine, Laval University, Québec, QC G1V 0A6, Canada
| | - David M. Mutch
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON N1G 2W1, Canada
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Crowder SL, Douglas KG, Frugé AD, Carroll WR, Spencer SA, Locher JL, Demark-Wahnefried W, Rogers LQ, Arthur AE. Head and neck cancer survivors' preferences for and evaluations of a post-treatment dietary intervention. Nutr J 2019; 18:57. [PMID: 31506077 PMCID: PMC6737706 DOI: 10.1186/s12937-019-0479-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 08/27/2019] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND Dietary preferences vary depending on cancer type. The purpose of this study was to report dietary intervention preferences and a study program evaluation from post-treatment head and neck cancer survivors participating in a dietary intervention. METHODS Between January 2015 and August 2016, 24 head and neck cancer survivors participated in a 12-week randomized clinical dietary intervention trial that promoted weekly consumption of 2.5 cups of cruciferous vegetables and 3.5 cups of green leafy vegetables. At study completion, survivors completed a preferences survey and a study program evaluation to probe interests and improvement aspects for planning future dietary intervention trials. Descriptive statistics (means and frequencies) were generated for multiple choice question responses. Responses to open-ended questions were recorded and grouped based on themes, and verified by quality assurance checks by a second study team member. RESULTS Twenty-three survivors completed the preferences and evaluation surveys (response rate 96%). Overall, most participants reported a preference for one-on-one telephone counseling from a registered dietitian nutritionist before beginning treatment. Ninety-six percent of participants ranked the overall study program as "very good" to "excellent," and all agreed the objectives of the study were clear, the study staff was helpful and easy to contact, and the registered dietitian nutritionist was knowledgeable. CONCLUSIONS Future research and dietary intervention planning for head and neck cancer survivors should focus on strategies to promote one-on-one telephone or other distance-based counseling combined with face-to-face visits, according to survivor preference.
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Affiliation(s)
- Sylvia L Crowder
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, 905 S Goodwin Ave, 386A Bevier Hall, Urbana, IL, 61801, USA
| | - Katherine G Douglas
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, 905 S Goodwin Ave, 386A Bevier Hall, Urbana, IL, 61801, USA
| | - Andrew D Frugé
- Department of Nutrition, Dietetics, & Hospitality Management, Auburn University, Auburn, AL, USA
| | - William R Carroll
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sharon A Spencer
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Julie L Locher
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Laura Q Rogers
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anna E Arthur
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, 905 S Goodwin Ave, 386A Bevier Hall, Urbana, IL, 61801, USA. .,Carle Cancer Center, Carle Foundation Hospital, Urbana, IL, USA.
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47
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Zhu J, Cui L, Wang K, Xie C, Sun N, Xu F, Tang Q, Sun C. Mortality pattern trends and disparities among Chinese from 2004 to 2016. BMC Public Health 2019; 19:780. [PMID: 31474224 PMCID: PMC6717976 DOI: 10.1186/s12889-019-7163-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 06/13/2019] [Indexed: 11/10/2022] Open
Abstract
Background With the changes in environmental, medical technique, population structure and national health projects, human mortality rates have undergone great changes all over the world. According to “World Health Statistics 2016: Monitoring Health for the SDGs (Sustainable Development Goals)”, we can draw a globally vision about life expectancy and cause of death; also, significant inequality still persists within and among countries. This study was designed to research into the trend of mortality pattern in China, evaluate the disparities of age-specific and disease-specific mortality rates between male and female, and provides a scientific basis for further prevention strategies and policies design. Methods Data from the Chinese Disease Surveillance Points system were used to calculate crude and age-adjusted death rates, annual percent changes (APC) for men and women during 2004 to 2016. Age-standardized mortality rates (ASMR) were performed through the direct method with the World Health Organization’s World Standard Population. APC, according to log linear model, was adopted to describe the mortality rate trend. The χ2 test was used to compare differences between age-specific and cause-specific mortality rates of men and women. Data analysis and figures were completed by R software. Results The mortality rates of men and women have decreased significantly (P < 0.05) during 2004–2016, and the APC were1.98 and 2.45%, respectively. In 2016, the crude mortality rate (CMR) and ASMR in all causes of death were 658.50 and 490.28 per 100,000 per year, respectively. The 5 leading causes of death were malignant neoplasm, cerebrovascular disease, heart disease, COPD, and accidental injury. The mortality rates of men were higher than that of women in all age groups. Conclusions There are severe health gaps and disparities between male and female, and the chronic non-communicable diseases continue to be a serious health threat to Chinese residents. Electronic supplementary material The online version of this article (10.1186/s12889-019-7163-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jicun Zhu
- College of Public Health, Zhengzhou University, 100 Science Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Lingling Cui
- College of Public Health, Zhengzhou University, 100 Science Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Kehui Wang
- The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, People's Road, Zhengzhou, 450000, Henan, People's Republic of China
| | - Chen Xie
- College of Public Health, Zhengzhou University, 100 Science Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Nan Sun
- Department of Management Information Systems, University of Georgia Terry College of Business Athens, Georgia, 30602, USA
| | - Fei Xu
- College of Public Health, Zhengzhou University, 100 Science Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Qixin Tang
- College of Public Health, Zhengzhou University, 100 Science Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Changqing Sun
- College of Public Health, Zhengzhou University, 100 Science Avenue, Zhengzhou, 450001, Henan, People's Republic of China.
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Quintana-Navarro GM, Alcala-Diaz JF, Lopez-Moreno J, Perez-Corral I, Leon-Acuña A, Torres-Peña JD, Rangel-Zuñiga OA, Arenas de Larriva AP, Corina A, Camargo A, Yubero-Serrano EM, Rodriguez-Cantalejo F, Garcia-Rios A, Luque RM, Ordovas JM, Perez-Martinez P, Lopez-Miranda J, Delgado-Lista J. Long-term dietary adherence and changes in dietary intake in coronary patients after intervention with a Mediterranean diet or a low-fat diet: the CORDIOPREV randomized trial. Eur J Nutr 2019; 59:2099-2110. [DOI: 10.1007/s00394-019-02059-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 07/15/2019] [Indexed: 01/05/2023]
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Stevenson J, Campbell KL, Brown M, Craig J, Howard K, Howell M, Khalid R, Sud K, Teixeira-Pinto A, Thiagalingam A, Tong A, Chow C, Lee VW. Targeted, structured text messaging to improve dietary and lifestyle behaviours for people on maintenance haemodialysis (KIDNEYTEXT): study protocol for a randomised controlled trial. BMJ Open 2019; 9:e023545. [PMID: 31061013 PMCID: PMC6502028 DOI: 10.1136/bmjopen-2018-023545] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Managing nutrition is critical for reducing morbidity and mortality in patients on haemodialysis but adherence to the complex dietary restrictions remains problematic. Innovative interventions to enhance the delivery of nutritional care are needed. The aim of this phase II trial is to evaluate the feasibility and effectiveness of a targeted mobile phone text messaging system to improve dietary and lifestyle behaviours in patients on long-term haemodialysis. METHODS AND ANALYSIS Single-blinded randomised controlled trial with 6 months of follow-up in 130 patients on haemodialysis who will be randomised to either standard care or KIDNEYTEXT. The KIDNEYTEXT intervention group will receive three text messages per week for 6 months. The text messages provide customised dietary information and advice based on renal dietary guidelines and general healthy eating dietary guidelines, and motivation and support to improve behaviours. The primary outcome is feasibility including recruitment rate, drop-out rate, adherence to renal dietary recommendations, participant satisfaction and a process evaluation using semistructured interviews with a subset of purposively sampled participants. Secondary and exploratory outcomes include a range of clinical and behavioural outcomes and a healthcare utilisation cost analysis will be undertaken. ETHICS AND DISSEMINATION The study has been approved by the Western Sydney Local Health District Human Research Ethics Committee-Westmead. Results will be presented at scientific meetings and published in peer-reviewed publications. TRIAL REGISTRATION NUMBER ACTRN12617001084370; Pre-results.
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Affiliation(s)
- Jessica Stevenson
- The Centre for Kidney Research, The University of Sydney, Sydney, New South Wales, Australia
- Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Katrina L Campbell
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Mark Brown
- Renal Medicine, St George Hospital, Kogarah, New South Wales, Australia
- St George Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Jonathan Craig
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Kirsten Howard
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Martin Howell
- School of Public Health, University of Sydney – Camperdown and Darlington Campus, Sydney, New South Wales, Australia
| | - Rabia Khalid
- Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Kamal Sud
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- Department of Renal Medicine, Nepean Hospital, Sydney, New South Wales, Australia
| | - Armando Teixeira-Pinto
- Screening and Test Evaluation Program (STEP), School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Aravinda Thiagalingam
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Cardiology Department, Westmead Hospital, Westmead, New South Wales, Australia
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Clara Chow
- Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- Cardiology Department, Westmead Hospital, Westmead, New South Wales, Australia
| | - Vincent W Lee
- Renal Medicine, Westmead Hospital, Westmead, New South Wales, Australia
- The Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
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50
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Development and preliminary results on the feasibility of a renal diet specific question prompt sheet for use in nephrology clinics. BMC Nephrol 2019; 20:48. [PMID: 30755163 PMCID: PMC6373020 DOI: 10.1186/s12882-019-1231-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/25/2019] [Indexed: 01/05/2023] Open
Abstract
Background Adherence to the diet prescription for chronic kidney disease is suboptimal. Interventions to improve dietary adherence suggest that improving communication between the patient and the health professional is fundamental to improving outcomes. Providing patients with a question prompt sheet prior to the consultation has been demonstrated to be an effective method for improving communication between patient and health professional. In the absence of a renal diet specific version, the aims of this study were to develop and test the feasibility of a renal diet specific question prompt sheet for use in nephrology clinics. Methods Phase one utilized social listening methodology, online content analysis and clinic observations to obtain an extensive list of frequently asked questions about the renal diet. Following refinement with health professionals, the draft question prompt sheet was then sent in Phase two to patients one week prior to their scheduled consultation with the renal dietitian. Feedback was obtained from patients, carers and dietitians using semi structured interviews post clinic consultation. Quantitative data was analyzed using counts and proportions, while free text responses were analyzed thematically. Results A total of 769 unique renal diet related questions were reduced to an 18-item question prompt sheet. Feedback from thirteen patients (six males), six carers and six dietitians involved in the preliminary feasibility study was overwhelmingly positive. The majority of patients found the question prompt sheet to be easy to understand and agreed it facilitated communication with the dietitian. All participants agreed that they would recommend use of question prompt sheet to other patients. Suggestions for future use included health professional training in use of the sheet, particularly about how to help patients prioritize their most important questions. Conclusions The 18-item renal diet question prompt sheet developed in this preliminary study appears to be a feasible tool for use in nephrology consultations especially by dietitians. Further research quantifying the impact on question asking and patient centeredness should be undertaken. In addition, user testing with patients from culturally diverse and low literacy backgrounds would be useful. Electronic supplementary material The online version of this article (10.1186/s12882-019-1231-3) contains supplementary material, which is available to authorized users.
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