Effectiveness of "Reducing Disability in Alzheimer's Disease" Among Dyads With Moderate Dementia

Replications of evidence-based dementia care receiver-caregiver dyad interventions in the community are scarce. We aimed to assess the effectiveness of the Kansas City implementation of Reducing Disability in Alzheimer's Disease (RDAD) among a convenience sample of dyads with moderate dementia, which addressed needs identified by nine participating community agencies. We hypothesized that dyads' mental health and physical activity outcomes would improve from baseline to end-of-treatment. The final analytic sample included 66 dyads. Outcomes improved (p < .01) from pre- to post-intervention: behavioral symptom severity (range 0-36) decreased from 11.3 to 8.6, physical activity increased from 125.0 to 190.0 min/week, caregiver unmet needs (range 0-34) decreased from 10.6 to 5.6, caregiver behavioral symptom distress (0-60) decreased from 15.5 to 10.4, and caregiver strain (0-26) decreased from 11.1 to 9.7. This adapted implementation of RDAD leads to clinically meaningful improvements and might inform scaling-up.

P1548 Changes in left ventricular deformation with weight loss in obese adolescents with intellectual and developmental delays (IDD)

Funding Acknowledgements

AHA Career Development grant

Background

Adolescents with IDD have twice the prevalence of obesity as their typically developed peers, leading to frequent early obesity-related subclinical cardiac dysfunction, detected by strain echo. The effects of weight loss on cardiac deformation are unknown in this population.

Purpose

To evaluate early cardiac dysfunction in overweight IDD adolescents before and after a 6-month caloric restriction-weight loss program.

Methods

Subjects with IDD co-enrolling in a weight loss program were consented for this strain imaging study, excluding those with congenital heart disease. An echo measuring LVEF (bullet), 2D speckle longitudinal LV global strain (GLS) and strain rate (GLSr) from 3 apical views and global circumferential strain from a parasternal short axis view at the paps (GCS) was performed at baseline and 6 months. Analysis included paired T-test and regression analysis, p ≤ 0.05 significant.

Results

Overweight (5) and obese (15) adolescents (40% female) had baseline LV strain measurements that were mildly diminished with increased baseline body weight predicting diminished GLS (P = 0.034) and GCS (P = 0.046) on regression modeling. After 6 months, weight and BMI decreased significantly with improvements in GLS and GCS and non-significant trends towards improvement in GLSr and early diastolic global strain rate. BMI change at 6 months predicted change in GLS (p = 0.015) and GCS (p = 0.0087) on regression modeling. At baseline, LVEF and LV end-diastolic volume were normal with no change over 6 months (p &gt; 0.55).

Conclusions

Baseline abnormalities in LV deformation with preserved LVEF are present in this young, obese IDD population with improvements in BMI predicting those in GLS and GCS after a 6-month caloric restriction-weight loss program. These data provide compelling justification for larger studies in this population.

n Baseline (mean ± SD) 6-mo. follow up 0-6 mo. change p-value Age (years) 20 17.0 ± 2.0 17.5 ± 2.1 0.5 ± 0.1 Weight (kg) 20 86.9 ± 22.2 83.1 ± 22.7 -3.7 ± 5.9 0.014 BMI (kg/m&sup2;) 20 32.2 ± 5.3 30.4 ± 5.7 -1.8 ± 2.2 0.0031 GLS (%) 20 16.9 ± 1.6 19.2 ± 2.7 2.4 ± 2.0 0.00023 GLSr 20 1.15 ± 0.018 1.22 ± 0.18 0.06 ± 0.16 0.096 EaGLSr 20 1.83 ± 0.038 2.01 ± 0.46 0.18 ± 0.45 0.098 GCS (%) 20 19.1 ± 2.3 22.0 ± 2.6 2.82 ± 2.6 0.00019 LV deformation before and after weight loss. GLS, GLSr, and GCS are reported as positive values (absolute values). Body Mass Index (BMI); Early Diastolic Global Longitudinal Strain Rate (EaGLSr)

Weight management in rural health clinics: The Midwest diet and exercise trial

Obesity prevalence is higher in rural compared to urban residents. Rural health clinics offer a potential venue for delivery of weight management. However, traditional programs require travel to attend on-site meetings which is impractical or inconvenient for rural residents. Clinic staff in most rural settings are unlikely to be trained to provide effective weight management. Remote delivery using group phone conferences (GP) or individual phone calls (IP), by staff associated with rural clinics eliminates the need for travel to attend on-site meetings. The effectiveness of these approaches will be the focus of this trial. Staff at five primary care clinics, serving primarily rural residents, will be trained to deliver GP and IP interventions and an enhanced usual care (EUC), (i.e., individual face-to-face meetings (~45 min) at clinic site, four times across 18 mos.). Two hundred overweight/obese adults (BMI ≥ 25.0-45.0 kg/m², age ≥ 21 yrs.) will be recruited through each clinic and randomized to GP (n = 80), IP (n = 80), or EUC (n = 40) to compare weight loss (0-6 mos.), weight maintenance (7-18 mos.), and weight change during a 6 mo. no contact follow-up (19-24 mos.) between intervention arms. The GP and IP interventions will be identical in lesson plan content, diet, and physical activity. The only difference between groups will be the delivery format (group vs. individual) and session duration (GP ~45 min/session; IP ~15 min/session). Primary (body weight) and secondary outcomes (waist circumference, energy/macronutrient intake, physical activity) will be assessed at baseline, 6, 12, 18 and 24 mos. Cost and contingent valuation analyses will also be completed.

NCT REGISTRATION

NCT02932748.

Longitudinal Weight Loss Patterns and their Behavioral and Demographic Associations

BACKGROUND

Identification of weight change patterns may allow tailored interventions to improve long-term weight loss.

PURPOSE

To identify patterns of weight change over 18 months, and assess participant characteristics and intervention adherence factors associated with weight change patterns in a sample of 359 overweight/obese adults.

METHODS

Weight loss (0-6 months) was achieved with reduced energy intake and increased physical activity (PA). Maintenance (7-18 months) provided adequate energy to maintain weight and continued PA.

RESULTS

Latent profile analysis identified three weight change profiles. During weight loss/maintenance, participants in profiles 2 and 3 (18-month weight loss ∼14 %) attended more behavioral sessions and performed more PA compared with profile 1 (18-month weight loss <1 %). Self-efficacy for both weight management and exercise barriers were higher in profiles 2 and 3 compared with profile 1 following weight loss and during maintenance.

CONCLUSION

Weight change patterns can be identified and are associated with both participant characteristics and intervention adherence.

Dairy intake is associated with brain glutathione concentration in older adults

BACKGROUND

A reduction in key antioxidants such as glutathione has been noted in brain tissue undergoing oxidative stress in aging and neurodegeneration. To date, no dietary factor has been linked to a higher glutathione concentration. However, in an earlier pilot study, we showed evidence of a positive association between cerebral glutathione and dairy intake.

OBJECTIVE

We tested the hypothesis that dairy food consumption is associated with cerebral glutathione concentrations in older adults.

DESIGN

In this observational study, we measured cerebral glutathione concentrations in 60 healthy subjects (mean ± SD age: 68.7 ± 6.2 y) whose routine dairy intakes varied. Glutathione concentrations were measured by using a unique, noninvasive magnetic resonance chemical shift imaging technique at 3 T and compared with dairy intakes reported in 7-d food records.

RESULTS

Glutathione concentrations in the frontal [Spearman's rank-order correlation (rs) = 0.39, P = 0.013], parietal (rs = 0.50, P = 0.001), and frontoparietal regions (rs = 0.47, P = 0.003) were correlated with average daily dairy servings. In particular, glutathione concentrations in all 3 regions were positively correlated with milk servings (P ≤ 0.013), and those in the parietal region were also correlated with cheese servings (P = 0.015) and calcium intake (P = 0.039). Dairy intake was related to sex, fat-free mass, and daily intakes of energy, protein, and carbohydrates. However, when these factors were controlled through a partial correlation, correlations between glutathione concentrations and dairy and milk servings remained significant.

CONCLUSIONS

Higher cerebral glutathione concentrations were associated with greater dairy consumption in older adults. One possible explanation for this association is that dairy foods may serve as a good source of substrates for glutathione synthesis in the human brain.

Diet Quality of Overweight and Obese Adults with Intellectual and Developmental Disabilities as Measured by the Healthy Eating Index-2005

BACKGROUND

Little research has been conducted to examine diet quality of overweight and obese adults with intellectual and developmental disabilities (IDD) in the United States. The purpose of this study was to determine diet quality, as measured by the Healthy Eating Index-2005 (HEI-2005), of overweight and obese adults with IDD.

METHODS

Data were obtained from community-dwelling overweight individuals. 3-day food records were administered and completed with assistance by staff or family members and then reviewed by a dietitian. All records were analyzed and HEI-2005 was calculated using NDSR output.

RESULTS

178 records were analyzed from 70 subjects (28 male, 42 female; mean age 33.9 ±11.5 years). The mean energy intake was 1928 ± 891 kcals and the mean total HEI-2005 score was 46.7± 11.5. Participants scored the lowest in total fruits, whole grains, dark green and orange vegetables, non-hydrogenated vegetable oils, and sodium. Both male and females had diets deficient in fiber, vitamin A, vitamin D, vitamin E, folate, and potassium. Additionally men were deficient in vitamin K, and women were deficient in calcium.

CONCLUSIONS

Overweight and Obese adults with IDD had a lower HEI-2005 score compared to the general population and are at an increased risk of poor diet quality and nutritional deficiencies that could contribute to the development of diabetes, cardiovascular disease, cancer and other health complications.