Creation and validation of a NOVA scored picture set to evaluate ultra-processed foods

There has been a rapid shift in the modern food environment towards increased processing in foods consumed in the United States (US) and globally. The NOVA system (not an acronym) for classifying food on degree of processing currently has the most empirical support. Consumption of foods in the NOVA 4 category, ultra-processed foods (UPF), is a risk factor for a host of poor health outcomes including heart disease, stroke, and cancer. Despite these poor health outcomes, UPF make up 58% of calories consumed in the US. Methodologies for assessing the reinforcing and rewarding properties of these foods are necessary tools. The Becker-DeGroot-Marschak auction paradigm (BDM) is a well validated tool for measuring value and is amenable to neuromonitoring environments. To allow for the testing of hypotheses based on level of food processing, we present a picture set of 14 UPF and 14 minimally-processed foods (MPF) matched on visual properties, food characteristics (fat, carbohydrate, cost, etc.), and rated perceptual properties. Further, we report our scoring of these foods using the NOVA classification system and provide additional data from credentialed nutrition professionals and on inter-rater reliability using NOVA, a critique of the system. Finally, we provide all pictures, data, and code used to create this picture set as a tool for researchers.

Validity and reliability of a new whole room indirect calorimeter to assess metabolic response to small-calorie loads

Objective

To provide an overview of our whole room indirect calorimeter (WRIC), demonstrate validity and reliability of our WRIC, and explore a novel application of Bayesian hierarchical modeling to assess responses to small carbohydrate loads.

Methods

Seven gas infusion studies were performed using a gas blender and profiles designed to mimic resting and postprandial metabolic events to assess WRIC validity. In a crossover design, 16 participants underwent fasting and postprandial measurements, during which they consumed a 75-kcal drink containing sucrose, dextrose, or fructose. Linear mixed effects models were used to compare resting and postprandial metabolic rate (MR) and CO (CO). Bayesian Hierarchical Modeling was also used to model postprandial CO trajectories for each participant and condition.

Results

Mean total error in infusions were 1.27 ± 1.16% and 0.42 ± 1.21% for VO2 and VCO2 respectively, indicating a high level of validity. Mean resting MR was similar across conditions (x ¯ = 1.05 ± 0.03   kcal / min , p=0.82, ICC: 0.91). While MR increased similarly among all conditions (~13%, p=0.29), postprandial CO parameters were significantly lower for dextrose compared with sucrose or fructose.

Conclusions

Our WRIC validation and novel application of statistical methods presented here provide important foundations for new research directions using WRIC.

Computer-generated profiles of the anal canal in patients with anal fissure

PURPOSE

The pathophysiology of anal fissure remains poorly understood. This study examines manometric findings in patients with anal fissure with use of a computer-assisted system, which helps to standardize manometric performance as well as generating longitudinal and cross-sectional profiles of the anal canal.

METHODS

Water-perfused, eight-channel, computer-assisted manometry was performed on 12 patients with chronic anal fissure and compared with 12 age-matched and sex-matched controls.

RESULTS

Mean maximum average resting pressure (MARP) was 120.5 mmHg in patients and 82.6 mmHg in controls (P = 0.0005). Pain was felt during manometry in six patients. In these patients, MARP was 123.2 mmHg, and, in the other six patients, MARP was 117.8 mmHg. Sphincter length was 4.72 cm, and the high pressure zone or that part of the sphincter with pressure more than 50 percent of MARP) was 2.78 cm in length. The high pressure zone/sphincter length ratio was 58 percent compared with 48 percent in controls. Longitudinal profile was bell shaped. Elevated pressures were not confined to the site of the fissure. Cross-sectional analysis showed higher anterior pressures in the distal sphincter. Ultraslow waves were seen in as many as 91 percent of patients and 73 percent of controls. However, ultraslow wave amplitude was 31 mmHg in patients and 15 mmHg in controls (P = 0.03). The rectoanal reflex was normal; overshoot was not seen.

CONCLUSIONS

The primary abnormality in fissure is persistent hypertonia affecting the entire internal sphincter, unrelated to pain. Cross-sectional pressure profiles may explain the predilection of fissures to occur in the posterior midline; other factors must prevent chronic fissures from healing.

Biofeedback training is useful in fecal incontinence but disappointing in constipation

BACKGROUND

Successful biofeedback therapy has been reported in the treatment of fecal incontinence and constipation. It is uncertain which groups of incontinent patients benefit from biofeedback, and our impression has been that biofeedback is more successful for incontinence than for constipation.

PURPOSE

This study was designed to review the results of biofeedback therapy at the Lahey Clinic.

METHODS

Biofeedback was performed using an eight-channel, water-perfused manometry system. Patients saw anal canal pressures as a color bar graph on a computer screen. Assessment after biofeedback was by manometry and by telephone interview with an independent researcher.

RESULTS

Fifteen patients (13 women and 2 men) with incontinence underwent a mean of three (range, 1-7) biofeedback sessions. The cause was obstetric (four patients), postsurgical (five patients), and idiopathic (six patients). Complete resolution of symptoms was reported in four patients, considerable improvement in four patients, and some improvement in three patients. Manometry showed a mean increase of 15.3 (range, -3-30) mmHg in resting pressure and 35.7 (range, 13-57) mmHg in squeezing pressure after biofeedback. A successful outcome could not be predicted on the basis of cause, severity of incontinence, or initial manometry. Twelve patients (10 women and 2 men) with constipation underwent a mean of three (range, 1-14) biofeedback sessions. Each had manometric evidence of paradoxic nonrelaxing external sphincter or puborectalis muscle confirmed by defography or electromyography. All patients could be taught to relax their sphincter in response to bearing down. Despite this, only one patient reported resolution of symptoms, three patients had reduced straining, and three patients had some gain in insight.

CONCLUSIONS

Biofeedback helped 73 percent of patients with fecal incontinence, and its use should be considered regardless of the cause or severity of incontinence or of results on initial manometry. In contrast, biofeedback directed at correcting paradoxic external sphincter contraction has been disappointing.