Chronic Disease Risk Reduction Research Articles

Moving the Needle on Hypertension: What Knowledge Is Needed?

This review highlights the gaps in knowledge and methodological challenges discussed during the Experimental Biology 2019 expert panel session titled "Moving the Needle on Hypertension: What Knowledge Is Needed?" Hypertension is a critical public health burden. Despite a demonstrated benefit of blood pressure reduction on measures of hypertension-related morbidity and mortality, rates for successful blood pressure control remain low. Dietary sodium reduction has been shown to reduce both systolic blood pressure by approximately 3.2 mm Hg and diastolic blood pressure by 2.3 mm Hg, depending on baseline blood pressure and degree of sodium reduction. The updated Dietary Reference Intakes for adults released by the National Academies of Sciences, Engineering, and Medicine include a Chronic Disease Risk Reduction sodium intake level of 2300 mg/d, highlighting the importance of dietary sodium intake in reducing elevated blood pressure and indicating that reducing intakes to this level is expected to reduce blood pressure and risk of cardiovascular disease. The average US daily sodium intake of 3400 mg/d is well above the Chronic Disease Risk Reduction of 2300 mg/d, suggesting that dietary sodium reduction has the potential to significantly improve public health. Although the National Academies of Sciences, Engineering, and Medicine report presents intake recommendations based on a systematic, comprehensive, and thorough evaluation of the evidence, several challenges to moving the needle on hypertension remain. Success will require a more advanced understanding of sodium and potassium physiology, as well as development of the tools needed to effectively address existing research gaps and reduce barriers to sodium intake reduction.

Changing Sodium Knowledge, Attitudes and Intended Behaviours Using Web-Based Dietary Assessment Tools: A Proof-Of-Concept Study.

Despite public health efforts to reduce dietary sodium, sodium intakes in most countries remains high. The purpose of this study was to determine if using novel web-based tools that provide tailored feedback, the Sodium Calculator and Sodium Calculator Plus, improves users’ sodium-related knowledge, attitudes, and intended behaviours (KAB). In this single arm pre- and post-test study, 199 healthy adults aged 18–34 years completed a validated questionnaire to assess changes to sodium-related KAB before and after using the calculators. After using the calculators, the proportion of participants who accurately identified the sodium adequate intake and chronic disease risk reduction level increased (19% to 74% and 23% to 74%, respectively, both p = 0.021). The proportion accurately self-assessing their sodium intake as ‘high’ also increased (41% to 66%, p = 0.021). Several intended behavioural changes were reported, i.e., buying foods with sodium-reduced labels, using the Nutrition Facts table, using spices and herbs instead of salt, and limiting eating out. Evidence-based eHealth tools that assess and provide personalized feedback on sodium intake have the potential to aid in facilitating sodium reduction in individuals. This study is an important first step in evaluating and optimizing the implementation of eHealth tools to help reduce Canadians’ sodium intakes.

Magnesium Requirements in Children

Magnesium (Mg), a cofactor in 300 enzymes, is essential for energy transfer and adequate vitamin D status and plays an important structural role with 60% of bodily reserves residing in bone. The Food and Nutrition Board recommendations for dietary intake of Mg, the Dietary Reference Intakes, have not been updated since 1997. Current recommendations for children were set based on an intake producing positive Mg balance. Population-based studies showed that the average intakes in children are suboptimal relative to the current recommendation. Newer evidence suggests Mg requirement should be related to body size. Other potential modifying factors of Mg requirements include calcium and sodium intake and chronic disease state. Future research is needed to refine public health recommendations for Mg and to establish the new Dietary Reference Intakes category of Chronic Disease Risk Reduction level for Mg, especially for children.

Testing the Effect of Multiple Weight Management Modalities for Chronic Disease Risk Reduction in a Clinical Setting

Testing the Effect of Multiple Weight Management Modalities for Chronic Disease Risk Reduction in a Clinical Setting

Resistance Exercise Training as a Primary Countermeasure to Age-Related Chronic Disease

Age is a primary risk factor for a number of chronic diseases including mobility disability, cardiovascular disease (CVD), type 2 diabetes (T2D), and cancer. Most physical activity guidelines emphasize the performance of 150 min of moderate-to-vigorous or 75 min of vigorous aerobic exercise training (AET) weekly for reduction of chronic disease risk. Nonetheless, there is an emerging body of evidence showing that resistance exercise training (RET) appears to be as effective as AET in reducing risk of several chronic diseases. It may also be that RET is more effective than AET in some regards; the converse is likely also true. We posit that the perceived divergent exercise mode-dependent health benefits of AET and RET are likely small in most cases. In this short review, our aim is to examine evidence of associations between the performance of RET and chronic health disease risk (mobility disability, T2D, CVD, cancer). We also postulate on how RET may be influencing chronic disease risk and how it is a critical component for healthy aging. Accumulating evidence points to RET as a potent and robust preventive strategy against a number of chronic diseases traditionally associated with the performance of AET, but evidence favors RET as a potent countermeasure against declines in mobility. On the basis of this review we propose that the promotion of RET should assume a more prominent position in exercise guidelines particularly for older persons.

Eat Better, Run Longer? Dietary Energy Density Is Associated with Cardiovascular Fitness Level in a Nationally Representative Sample of Adolescents (P16-030-19)

ObjectivesObesity during childhood and adolescence is a risk factor for several types of chronic disease in adulthood. Researchers have identified dietary energy density (ED, kcal/g) and sedentary behavior as risk factors for obesity during adulthood, but little is known about the relationship between diet and measured cardiovascular fitness levels. The 2012 National Health and Nutrition Examination Survey National Youth Fitness Survey (NNYFS) collected data on dietary intake, physical activity and fitness levels in a nationally representative sample of US adolescents. The objective of this study was to determine the association between eating patterns, specifically dietary energy density, and physical fitness in a nationally representative sample of youth. MethodsUsing data from NHANES National Youth Fitness Survey, the association between dietary energy density (ED, kcal/g) and cardiovascular fitness level was evaluated. During the NNYFS, cardiovascular fitness was assessed in adolescents aged 12–15y. Dietary intake information was collected using 24-hour recall, and assessment of diet quality involved calculation of dietary energy density. Cardiovascular fitness level was categorized based on gender-age specific cut-points of estimated VO2max. All data were analyzed using SAS 9.4 survey procedures to account for the unequal sampling probability and complex survey design of the NHANES. ResultsWe observed a significant positive association between dietary energy density and cardiovascular fitness level after controlling for age, sex, race, and household income. Children with cardiovascular fitness levels categorized as “high risk” had significantly higher dietary energy density than children in the “healthy fitness zone” (1.82 vs 1.97, P = 0.04). ConclusionsThese findings expand on previous work from our group indicating that dietary energy density is associated with obesity in children and that diet in early childhood corresponds with development of physical characteristics that are associated with fitness ability. Interventions that aim to lower dietary energy density in adolescence may aid in the reduction of chronic disease risk during adulthood. Funding SourcesNone. Supporting Tables, Images and/or Graphs▪

A report of activities related to the Dietary Reference Intakes from the Joint Canada-US Dietary Reference Intakes Working Group

The governments of the United States and Canada have jointly undertaken the development of the Dietary Reference Intakes (DRIs) since the mid-1990s. The Federal DRI committees from each country work collaboratively to identify DRI needs, prioritize nutrient reviews, advance work to resolve methodological issues that is necessary for new reviews, and sponsor DRI-related committees through the National Academies of Sciences, Engineering and Medicine. In recent years, the Joint Canada-US DRI Working Group, consisting of members from both Federal DRI committees, developed an open and transparent nomination process for prioritizing nutrients for DRI review, by which sodium, the omega-3 (n-3) fatty acids, vitamin E, and magnesium were identified. In addition, discussions during the nutrient nomination process prompted the Federal DRI committees to address previously identified issues related to the use of chronic disease endpoints when setting DRIs. The development of guiding principles for setting DRIs based on chronic disease risk reduction will be applied for the first time during the DRI review of sodium and potassium. In summary, the US and Canadian governments have worked collaboratively to adapt our approach to prioritizing nutrients for DRI review and to broaden the scope of the DRIs to better incorporate the concept of chronic disease risk reduction in order to improve public health.

The Sodium Conundrum

The potential contribution of sodium to chronic disease risk has been an area of exploration for many years. Currently, a National Academies of Sciences, Engineering, and Medicine committee is working to update the 2005 Dietary Reference Intakes for sodium and potassium, evaluating the latest evidence with a look to excesses, inadequacies, and chronic disease risk reduction. Two recent reports will support the National Academies of Sciences, Engineering, and Medicine review: a systematic review of the science related to sodium, potassium, and chronic disease and guidelines for considering chronic disease in setting dietary reference intakes. While sodium intake reduction initiatives have been underway for years, current intake estimates significantly exceed recommendations. Recently, the US Food and Drug Administration issued draft guidance on voluntary sodium reduction targets for 150 food categories. This review is based on a session at the American Society for Nutrition 2018 Annual Meeting, which brought together stakeholders to discuss these developments, progress, conundrums, and opportunities toward reducing sodium intakes.

Clinically Focused Hands on Cooking Classes to Promote Behavioral Changes

Upon completion, participant will be able to recognize the importance of culinary based nutrition interventions in facilitating optimal learning and dietary behavioral changes leading to chronic disease risk reduction.

Controversies in the role of vitamin D in infertility

The study that implicates vitamin D in playing a role in fertility is compelling, and it is backed up by sound hypothesis. Nevertheless, further research needs to be assess for the health benefits and reaching appropriate levels. This could represent a starting point of a new domain which could find simple approaches to improve health. Notwithstanding fertility benefits, patients should have vitamin D supplementation for health benefits, including pregnancy health, bone health and chronic disease risk reduction. This review is based on the results of clinical trials and studies published in medical journals and database from the moment it was first acknowledged until nowadays. We aim to present the evolution of the perspective on the subject and the new findings surrounding it. Vitamin D has its well-known function in calcium and phosphorus hemostasis, and its deficiency is predominant in high-risk populations, but the prevalence among healthy or asymptomatic adults is not well defined. Several theories and hypothesis have been launched over the last years regarding the etiology of vitamin D deficiency, none of them being flawless or able to explain the entire panel of symptoms. Taken into consideration the insufficiency of vitamin D which could have implications also in infertility, especially in young fertile women, the newest research could lead to new supplementation of vitamin D in the treatment of both women and male infertility management.

Cost-effectiveness of a school-based health promotion program in Canada: A life-course modeling approach.

BackgroundThe Alberta Project Promoting active Living and healthy Eating in Schools (APPLE Schools) has been recognized as a “best practice” in preventing childhood obesity. To inform decision making on the economic implications of APPLE Schools and to justify investment, we evaluated the project’s cost-effectiveness following a life-course approach.MethodsWe developed a state transition model for the lifetime progression of body weight status comparing elementary school students attending APPLE Schools and control schools. This model quantified the lifetime impact of APPLE Schools in terms of prevention of excess body weight, chronic disease and improved quality-adjusted life years (QALY), from a school system’s cost perspective. Both costs and health outcomes were discounted to their present value using 3% discount rate.ResultsThe incremental cost-effectiveness ratio(ICER) of APPLE schools was CA$33,421 per QALY gained, and CA$1,555, CA$1,709 and CA$14,218 per prevented person years of excess weight, obesity and chronic disease, respectively. These estimates show that APPLE Schools is cost effective at a threshold of ICER < CA$50,000.In probabilistic sensitivity analysis, APPLE Schools was cost effective more than 64% of the time per QALY gained, when using a threshold of ICER<CA$50,000, and more than 93% of the time when using a threshold of ICER<CA$100,000.ConclusionSchool-based health promotion, such as APPLE Schools is a cost-effective intervention for obesity prevention and reduction of chronic disease risk over the lifetime. Expanding the coverage and allocating resources towards school-based programs like the APPLE Schools program, is likely to reduce the public health burden of obesity and chronic diseases.

US and Canada Joint Effort for Dietary Reference Intake Updates

Representatives from the US and Canadian Government will present updates from the Joint US and Canada Dietary Reference Intake (DRI) Working Group on activities conducted to work toward updating the sodium and potassium DRIs. The Governments of the United States and Canada have jointly undertaken the development of the Dietary Reference Intakes since the mid‐1990s. Federal DRI committees from each country work collaboratively to identify DRI needs, prioritize nutrient reviews and advance work to resolve any methodological issues that could impede new reviews. The commission of a systematic review for nutrients under review is now an integral part of the DRI process. Recently the DRI Working Group sponsored an evidence review by the Agency for Health Care Research and Quality (AHRQ) on sodium and potassium to inform the update of the sodium and potassium DRIs by the National Academy of Medicine (NAM). The AHRQ review will be completed in 2017. Additionally, the DRI steering committees jointly decided that prior to undertaking a nutrient review, the scientific framework for setting DRIs needed to be adapted to include a framework for including data on chronic disease risk reduction. Thus, a scientific expert panel was convened to review and critically evaluate evidentiary, dose response, and process issues related to the use of chronic disease endpoints and develop options for their incorporation into future DRI reviews. The Joint US/Canadian‐sponsored Working Group's report ‘Options for Basing DRIs on Chronic Disease Endpoints’ will inform the NAM committee that will develop guiding principles for inclusion of chronic disease endpoints to be used by committees setting future DRIs. In summary, the US and Canadian Governments are working collaboratively to adapt the methods for updating the DRIs utilizing rigorous systematic evidence reviews and a chronic disease endpoint framework.Support or Funding InformationUnited States Department of Health and Human Services, United States Department of Agriculture, and Health Canada.

The influence of a home-based exercise intervention on human health indices in individuals with chronic spinal cord injury (HOMEX-SCI): study protocol for a randomised controlled trial.

BackgroundSpinal cord injury (SCI) creates a complex pathology that can lead to an increase in sedentary behaviours and deleterious changes in body composition. Consequently, individuals with SCI are at increased risk of developing cardiovascular disease and type-2 diabetes mellitus. While the role of physical activity on the reduction of chronic disease risk is well documented in non-disabled individuals the evidence is less conclusive for persons with SCI. The aim of this methodological paper is to outline the design of a study that will assess the role of a home-based exercise intervention on biomarkers of metabolic and cardiovascular health in persons with SCI: the HOMEX-SCI study.Methods/designEligible participants will be inactive (physical activity level ≤1.60) individuals, with a chronic (more than 1 year) spinal cord lesion between the second thoracic and the fifth lumbar vertebrae, and aged between 18 and 65 years. Following baseline laboratory testing and lifestyle monitoring, participants will be randomly allocated to a control (CON) group or a 6-week home-based exercise intervention (INT) group. The INT consists of 45 minutes of moderate-intensity (60–65 % peak oxygen uptake) arm-crank exercise four times per week. Participants assigned to the CON group will be asked to maintain their normal lifestyle. The main outcomes of this study (biomarkers of metabolic and cardiovascular health) are obtained from venous blood samples, collected in the fasted and postprandial state. Eight other measurement categories will be assessed: (1) body composition, (2) physical activity, (3) energy intake, (4) measures of health and wellbeing, (5) resting metabolic rate, heart rate and blood pressure, (6) aerobic capacity, (7) immune function, and (8) adipose tissue gene expression.DiscussionThis study will explore the feasibility of home-based moderate-intensity exercise and ascertain its impact on metabolic and cardiovascular health in comparison to a lifestyle maintenance CON group. Findings from this study may help to inform new evidence-based physical activity guidelines and also help to elucidate the physiological mechanisms whereby exercise might exert beneficial effects in persons with chronic SCI. The results will also act as a scientific platform for further intervention studies in other diverse and at-risk populations.Trial registrationInternational Standard Randomised Controlled Trial Number: ISRCTN57096451. Registered on 11 July 2014.

Enhancing the Evidence for Behavioral Counseling: A Perspective From the Society of Behavioral Medicine.

U.S. Preventive Services Task Force (USPSTF) clinical guidelines at present rarely assign the highest grade recommendation to behavioral counseling interventions for chronic disease prevention or risk reduction because of concerns about the certainty and quality of the evidence base. As a result, the broad integration of behavioral counseling interventions in primary care remains elusive. Thus, there is an urgent need for novel perspectives on how to generate the highest-quality and -certainty evidence for primary care-focused behavioral counseling interventions. As members of the Society of Behavioral Medicine (SBM)--a multidisciplinary scientific organization committed to improving population health through behavior change--we review the USPSTF mandate and current recommendations for behavioral counseling interventions and provide a perspective for the future that calls for concerted and coordinated efforts among SBM, USPSTF, and other organizations invested in the rapid and wider uptake of beneficial, feasible, and referable primary care-focused behavioral counseling interventions. This perspective highlights five areas for further development, including (1) behavioral counseling-focused practice-based research networks; (2) promotion of USPSTF evidence standards and the increased use of pragmatic RCT design; (3) quality control and improvement procedures for behavioral counseling training; (4) systematic research on effective primary care-based collaborative care models; and (5) methodologic innovations that capitalize on disruptive technologies and healthcare transformation. Collective efforts to improve the health of all Americans in the 21st century and beyond must ensure that effective, feasible, and referable behavioral counseling interventions are embedded in modern primary care practice.

Successive Generations in a Rat Model Respond Differently to a Constant Obesogenic Environment.

Research has shown that if a mother experiences a transitory perturbation to her environment during pregnancy or lactation, there are transgenerational consequences often involving a disordered metabolic phenotype in first generation offspring with recovery across subsequent generations. In contrast, little is known about the nature of the transgenerational response of offspring when a mother experiences a perturbation that is not transitory but instead persists across generations. Our study, using a rat model, subjected the parental generation to a change in environment and concomitant shift from a grain-based to obesogenic diets to generate an adipose phenotype in first generation offspring emulating a common scenario in human urbanisation and migration. We then investigated whether the obese phenotype was stable across generations when maintained in the transitioned environment, and whether dietary macronutrient balance affected the response. We found that second and third generation offspring had a reduced body fat to lean mass ratio and a reduced appetite relative to first generation offspring, irrespective of dietary macronutrient balance. The trajectory of this response is suggestive of a reduction in chronic disease risk across generations. This is one of the first studies, to our knowledge, to investigate the transgenerational response following parental transition to a persistent obesogenic environment, and to demonstrate that successive generations respond differently to this constant environment.

Validation of a Brief Dietary Assessment Tool for Estimating Dietary EPA and DHA Intake in Australian Adults at Risk of Cardiovascular Disease

Background: Short food frequency questionnaires (FFQs) are powerful screening instruments for estimating nutrient intakes and play an important role in risk stratification in vulnerable populations. Omega-3 fatty acids are of increasing importance in the prevention of chronic and degenerative disease, especially in older adults who are at higher risk of these chronic conditions. A short FFQ exists to rapidly assess omega-3 intake from marine sources, however it has not previously been validated for agreement with total omega-3 intake and ability to identify suboptimal omega-3 intakes in older adults or for use in Australia.Objective: The aim of the study was to validate a 9-item marine omega-3 FFQ (MFQ) for assessment of omega-3 intake against a validated 74-item semiquantitative FFQ.Methods: One hundred and eight participants (mean age 67 ± 10 years, 47% male) completed the MFQ designed to estimate omega-3 intake from marine sources and the 74-item FFQ designed to estimate usual omega-3 and total energy intake in addition to other nutrients. To test agreement between the two questionnaires for estimating total omega-3 intake, mean bias and 95% limits of agreement (LOA) were calculated. Sensitivity and specificity were assessed using 2 × 2 contingency tables based on whether participants did or did not meet National Heart Foundation (NHF) recommendations for omega-3 intake per day.Results: Mean intake of omega-3 estimated from the MFQ was 210 ± 235 mg/day compared with 295 ± 260 mg/day as estimated by the FFQ. Mean bias (95% LOA) for omega-3 assessed by the two questionnaires was 89 mg/day (−475 mg to 653 mg). The MFQ achieved 98% sensitivity and 31% specificity for the omega-3 cut-off of 500 mg/day. When nutrient composition of the marine products were replaced with Australian data, mean intake of omega-3 was 230 ± 253 mg and the mean bias improved to 64 mg (−681 mg to 553 mg) and achieved 93% sensitivity and 40% specificity.Conclusions: The MFQ shows promise as a rapid screening tool for identifying older adults with intakes of omega-3 fatty acids likely to be below recommendations for chronic and degenerative disease risk reduction. Given the clinically meaningful mean bias and wide LOA, it cannot be recommended as an appropriate tool for the purpose of reporting average intake of individuals. Use of Australian nutrient data improved the mean bias of the tool in estimating total omega-3 intake. The values should be replaced and the MFQ could then be a useful tool for research purposes at the population level.

Menopausal hormone therapy and breast cancer mortality: clinical implications.

The Women's Health Initiative (WHI) has conducted two randomized, placebo-controlled clinical trials to evaluate the influence of menopausal hormone therapy on chronic disease risk. Estrogen plus progestin was evaluated in 16,608 postmenopausal women without prior hysterectomy during 5.6 years' intervention. In that setting, combined hormone therapy use significantly increased breast cancer incidence and interfered with breast cancer detection. The breast cancers were not limited to estrogen receptor positive, favorable prognosis cancers and were identified at more advanced stage. As a result, deaths from breast cancer were significantly increased by estrogen plus progestin use. While the absolute breast cancer risk for relatively short term (2-4 years) use of combined hormone therapy is small, on a population basis a therapy which nearly doubles deaths from breast cancer requires cautious use. Estrogen alone was evaluated in 10,739 postmenopausal women with prior hysterectomy during 7.1 years' intervention. There was an overall reduction of breast cancer incidence seen with estrogen alone use and a suggestion that the effect on risk was more pronounced in women initiating hormone therapy further from menopause. Nonetheless, women with prior hysterectomy can be assured that short duration estrogen alone use for climacteric symptom management is relatively safe. Neither estrogen plus progestin nor estrogen alone should be used for chronic disease risk reduction. The safety of duration of use on chronic disease risk longer than in the WHI clinical trials is not defined.

Berries: Anti-inflammatory Effects in Humans

A sustained pro-inflammatory state is a major contributing factor in chronic disease development, progression, and complication, including the most commonly known diseases: cardiovascular disease, Alzheimer's, and type 2 diabetes. Fruits, such as berries, contain polyphenol compounds purported to have anti-inflammatory activity in humans. Among the most notable polyphenols in berries are anthocyanins, responsible for their distinctive colors of red, blue, and purple. Berries have been studied widely for their antioxidant properties; however, preclinical data suggest important effects on inflammatory pathways. Correspondingly, the effects of berries, including extracts and purified anthocyanins, have been the subject of a number of human trials. This review aims to evaluate the current state of the human science on berry (products) as a source of dietary polyphenols, particularly anthocyanins, to modulate inflammatory status. Identifying dietary strategies that manage the modern-day inflammatory burden has important implications for chronic disease risk reduction and informing dietary guidelines aimed at achieving and maintaining health.

Impact of weight regain on metabolic disease risk: a review of human trials.

Dietary restriction interventions are effective for weight loss and reduction of chronic disease risk. Unfortunately, most people tend to regain much of this lost weight within one year after intervention. While some studies suggest that minor degrees of weight regain have no effect on metabolic disease risk parameters, other studies demonstrate a complete reversal in metabolic benefits. In light of these conflicting findings, it is of interest to determine how complete weight maintenance versus mild weight regain affects key risk parameters. These findings would have important clinical implications, as they could help identify a weight regain threshold that could preserve the metabolic benefits of weight loss. Accordingly, this review examined the impact of no weight regain versus mild regain on various metabolic disease risk parameters, including plasma lipids, blood pressure, glucose, and insulin concentrations, in adult subjects.

Consumption of fruits and vegetables among college students living in dormitory in Shahid Beheshti University of Medical Sciences

Obesity is rising rapidly in Iran. Nutrition is an important issue of obesity; Fruits and vegetables are among the best food sources of antioxidant vitamins, soluble fibers, phytochemicals, and other nutrient constituents. Further, some of these foods have been shown to be protective related to reduction of chronic disease risk. In this study, consumption of fruits & vegetables and body mass index (BMI) among College Students Living in dormitory at Shahid Beheshti University of medical sciences were evaluated. In this descriptive analytic survey, 658 college students whose have being lived in dormitory at Shahid Beheshti University of medical sciences were selected by clustering sampling method. Data collected using a food frequency questionnaire and analyzed by SPSS 16 software. Mean age of participants was 21.82 for females and 22.76 years for males. Frequency of fruits consumption was 2.6± 0.9 per day in female and 2.3±0.7 in male, while frequency of vegetables consumption was 3.2±1.00 in female and 2.9± 0.9 per day in male students. In general, consumption of fruits (p=0.003) and vegetables (p<0.001) were significantly more in female than males students. BMI in students was normal. Results indicated that students hadn’t optimal practice towards fruits and vegetables consumption. Thus, it is essential that authorities pay more attention to this specific problem in training the students, in order to maintain the optimal nutritional status.