Decrease In Fat Intake Research Articles

Effects of probiotics on selected anthropometrics and biochemical measures in overweight or obese Saudi subjects: a double-blind, placebo-controlled, randomised clinical trial.

This study aimed to assess the effects of multi-strain probiotics on anthropometric and biochemical measures in Saudi adults with overweight or obesity. Single-centre, double-blind, placebo-controlled, randomised clinical trial. Occupational Health Clinics at King Saud University Medical City, Riyadh, Saudi Arabia. Ninety-three Saudi participants with overweight or obesity were randomly assigned to receive twice-daily doses of either placebo (n 49) or 30 × 109 CFU/g of HEXBIO® containing three Lactobacillus and three Bifidobacterium species (n 44) in a double-blind manner over a 12-week period, respectively. Both groups adhered to a hypoenergetic diet. Anthropometric measurements, glycaemic indices and lipid profiles were evaluated at baseline and post-intervention. Following the 12-week intervention, no statistically significant differences were found in all between the probiotic group and placebo group comparisons, except for fat intake, where the group*time interaction showed a significant decrease in favour of the probiotic group (P = 0·02). However, significant within-group reductions were observed in the probiotic group: body weight (-0·9 kg, P = 0·02), HC (-1·5 cm, P = 0·002), energy intake (-387·3 kcal/d, P = 0·002), fasting glucose (-0·7, P = 0·002) and LDL-cholesterol (-0·7, P = 0·02). Consumption of multi-strain probiotic supplementation over 12 weeks significantly decreased fat intake in Saudi adults with overweight or obesity, with the probiotic group highlighting improved anthropometric and biochemical parameters. Further research is needed to evaluate the long-term clinical significance of this dietary practice and whether it has a meaningful impact on overall health beyond the placebo effect.

Assessing the Effectiveness of eHealth Interventions to Manage Multiple Lifestyle Risk Behaviors Among Older Adults: Systematic Review and Meta-Analysis.

Developing adverse lifestyle behaviors increases the risk of a variety of chronic age-related diseases, including cardiovascular disease, obesity, and Alzheimer disease. There is limited evidence regarding the effectiveness of eHealth-based multiple health behavior change (MHBC) interventions to manage lifestyle risk behaviors. The purpose of this systematic evaluation was to assess the effectiveness of eHealth MHBC interventions in changing ≥2 major lifestyle risk behaviors in people aged ≥50 years. The literature search was conducted in 6 electronic databases-PubMed, Embase, Web of Science, Scopus, Cochrane Library, and SPORTDiscus-from inception to May 1, 2024. Eligible studies were randomized controlled trials of eHealth interventions targeting ≥2 of 6 behaviors of interest: alcohol use, smoking, diet, physical activity (PA), sedentary behavior, and sleep. A total of 34 articles with 35 studies were included. eHealth-based MHBC interventions significantly increased smoking cessation rates (odds ratio 2.09, 95% CI 1.62-2.70; P<.001), fruit intake (standardized mean difference [SMD] 0.18, 95% CI 0.04-0.32; P=.01), vegetable intake (SMD 0.17, 95% CI 0.05-0.28; P=.003), self-reported total PA (SMD 0.22, 95% CI 0.02-0.43; P=.03), and objectively measured moderate to vigorous PA (SMD 0.25, 95% CI 0.09-0.41; P=.002); in addition, the interventions decreased fat intake (SMD -0.23, 95% CI -0.33 to -0.13; P<.001). No effects were observed for alcohol use, sedentary behavior, or sleep. A sensitivity analysis was conducted to test the robustness of the pooled results. Moreover, the certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework. eHealth-based MHBC interventions may be a promising strategy to increase PA, improve diet, and reduce smoking among older adults. However, the effect sizes were small. Further high-quality, older adult-oriented research is needed to develop eHealth interventions that can change multiple behaviors. PROSPERO International Prospective Register of Systematic Reviews CRD42023444418; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023444418.

Educational intervention based on the extended parallel process model improves adherence to diabetic diet and glycaemic control indices: a randomised, double-blind, controlled, factorial field trial.

Nutritional education is pivotal in the medical nutritional therapy of type 2 diabetes mellitus (T2DM). The extended parallel process model (EPPM) is a health education method for inducing desirable health behaviours. The present study aimed to investigate the effect of nutritional education based on the EPPM in T2DM patients on knowledge, attitude, practice, anthropometric indices, glycaemic factors, lipid profile and adherence to the diabetic diet. A randomised, double-blind, controlled, factorial field trial was designed for T2DM patients aged 30-59 years (n 88). Participants were randomly allocated into four groups to receive EPPM-based nutritional education through gain framed message (GFM), loss framed message (LFM), their combination (G\LFM) or usual diabetic education in the control group (CG). Participants were assessed before and after the study duration. After 3 months of intervention, eighty participants finished the study. The EPPM-based intervention increased participants' knowledge, behavioural intention, perceived sensitivity, severity, self-efficacy (P < 0·001 for all) and response efficacy (P = 0·029) in comparison with CG. GFM (P = 0·004) and G\FLM (P = 0·034) reduced carbohydrate intake and LFM (P = 0·034) and G\LFM (P = 0·047) decreased fat intake. Between-group analysis indicated interventions reduced weight (P = 0·046), BMI (P = 0·038), fasting blood sugar (P = 0·030), 2-hour postprandial blood glucose (P = 0·027) and TAG (P = 0·002) in comparison with the CG. Results were NS for protein intake, waist and hip circumference, waist:hip ratio, HbA1c, total cholesterol, LDL and HDL. Nutritional education based on EPPM could increase the knowledge and awareness of T2DM patients. Also, it could be beneficial for blood glucose amendment. Further investigations are recommended.

Assessment of Impact of Dietary Patterns on Obstructive Sleep Apnea Patients.

Objective Obstructive sleep apnea syndrome (OSAS) is characterized by episodic cessations of breathing due to upper airway obstruction during sleep, which may cause disturbances in dietary patterns resulting from appetite-related hormonal changes. The aim of the present study was to investigate the relationship between OSAS and nutritional and dietary patterns. Materials and Methods A total of 20 female and 53 male OSAS patients aged > 30 years were enrolled. Demographic data, as well as data on smoking and alcohol habits, were noted, anthropometric measures were made, and a questionnaire regarding chronic diseases including OSAS and four questionnaires on recent food intake frequency and content of nutrition were filled out. The content of nutrition was noted under seven categories: meat, legumes, milk and dairy products, fruits and vegetables, bread and cereals, fat and carbohydrates, and beverages. Results The severity of OSAS (assessed by the apnea-hypopnea index. AHI) was positively correlated with the body mass index (BMI), the circumferences of the waist, chest, and buttocks, and, in males, with the circumference of the neck as well. There was no correlation between the AHI and nutritional habits in terms of the frequency of meals or snacks, the scores on the Snoring, Tiredness, Observed Apnea, and High Blood Pressure-Body Mass Index, Age, Neck Circumference, and Gender (STOP-BANG) Questionnaire and the corresponding macro- and micronutrients. Worsening apnea scores led to increased intake of macronutrients of carbohydrate and protein and micronutrients of niacin and pyridoxine ( p < 0.05), and decreased intake of fat ( p < 0.05). Conclusion The present study demonstrated an association between OSAS severity and recent food intake, manifested in increased intake of carbohydrates, niacin, and pyridoxine, and decreased fat intake.

Compliance to modification of risk factors for recurrent myocardial infarction in the long term of the disease: a randomized study

Purpose: to study the relationship between awareness and commitment to modifying risk factors for recurrent myocardial infarction in a long period of the disease. Material &amp; Methods: to study the awareness of risk factors and adherence to secondary prevention of myocardial infarction (MI), a representative sample was created. Of 912 patients treated for myocardial infarction, 333 patients were randomized, taking into account proportional distribution in the population by age (under 65 and over 65 years) and gender. The average age of patients was 62.5±9.8 years: 70,27% of men and 29,73% of women. Patients' awareness of risk factors, the use of preventive measures and adherence to treatment were assessed on the basis of a questionnaire. Statistical processing of the obtained material was carried out using the statistical program STATISTICA 12.5 (StatSoft.Inc). Results are presented as mean and standard deviation (M±s), number of options (n). To compare the qualitative characteristics (frequency tables), the χ2 test and Fisher's exact test were used. All participants were informed about the aims of the study and gave written consent to participate in the study. Results: low awareness (Aw) and commitment (Cm) to the modification of such risk factors for recurrent infarction in a long period of the disease as: reduced fat intake Aw 16,52%, Cm 19,4%; regular consumption of vegetables and fruits Aw 11,41%, Cm 9,7%; smoking cessation Aw 15,92%, Cm 11,04%; decrease in alcohol consumption Aw 16,52%, Cm 10,70%; increased physical activity Aw 14,41%, Cm 12,37%; weight loss with its excess Aw 3,0%, Cm 2,34%; avoidance of stress Aw 28,53%, Cm 18,06%. Although the vast majority of patients received appropriate recommendations from the doctor. Conclusions: low awareness of the possibility of modifying heart disease risk factors is associated with the failure to implement such non-pharmacological measures in secondary prevention after MI: decrease in fat intake (χ2=65,12; p=0,000) and regular consumption of vegetables and fruits (F p=0,000), unwillingness to quit smoking (F p=0,000) and decrease in alcohol consumption (F p=0,000), unwillingness to increase physical activity (χ2=17,61; p=0,000) and reduce weight in case of its excess (F p=0,015), avoiding stress (χ2=27,42; p=0,000).

Association of Serum 25-Hydroxyvitamin D and Vitamin D Intake with the Prevalence of Metabolic Syndrome in Korean Adults: 2013–2014 Korea National Health and Nutrition Examination Survey

Vitamin D deficiency is prevalent in Korea and an insufficient vitamin D status increases the risk of various chronic diseases including metabolic syndrome (MetS). We examined the relationship between serum 25-hydroxyvitamin D (25(OH)D) levels, dietary vitamin D intake, and MetS. The 2013–2014 Korea National Health and Nutrition Examination Survey’s (KNHANES) included participants (n = 4.541; 1145 men; 1368 women) who were aged ≥19. In men, higher serum 25(OH)D levels were correlated with significantly increased protein intake (p = 0.032) and saturated fatty acid intake (p = 0.006), but significantly decreased fat intake (p = 0.027), monounsaturated fatty acid intake (p = 0.005), and polyunsaturated fatty acid intake (p = 0.003), and significantly decreased serum triglycerides levels (p = 0.002), whereas women had no association with any dietary intake or biochemical markers. Furthermore, our study found a significant negative correlation between abdominal obesity (OR, 0.970; CI, 0.946, 0.994) and hypertriglyceridemia (OR, 0.974; CI, 0.950, 0.998) and serum 25(OH)D levels in men, as well as a significant decrease in hypertriglyceridemia (OR, 0.980; CI, 0.961, 0.999) with vitamin D intake. However, women had a significantly negative correlation between serum LDL cholesterol (β, −1.751; p = 0.018) and vitamin D intake. By increasing the vitamin D intake and serum 25(OH)D levels, Korean adults could reduce their risk of MetS-related factors.

Exiting the Cave

This is a follow-up of a recent case study of the Paleolithic diet that investigates dietary changes, including energy intake, food sources, and macronutrient and micronutrient distribution, associated with a transition from a Paleolithic diet toward a more omnivorous pattern. We observed a more than 40% increase in carbohydrate intake and a 10% decrease in fat intake, including 20% less energy from saturated fat, less intake of nearly all micronutrients, and a substantially greater energy contribution from nonpaleo sources, including ultraprocessed foods. This analysis of 2 full years of nutrition data provides a unique description of changing dietary patterns in a free-living individual.

Community-based Interventions to Reduce Fat Intake in Healthy Populations: A Systematic Review and Meta-Analysis

Background: Reducing fat intake is a major focus of most dietary recommendations aiming to prevent chronic diseases. Thus, this study aimed to summarize community-based interventions for reducing fat consumption among healthy people. Methods: According to PRISMA guidelines, in this systematic review and meta-analysis, databases including PubMed/MEDLINE, Scopus, EMBASE, Cochrane Library, Web of Science, ProQuest, and Google Scholar were searched up to January 2021. Randomized clinical trials (RCTs) or quasi-experimental studies reporting the effect of community-based interventions to reduce fat intake in healthy populations were included. The quality of studies was assessed using the Cochrane Collaboration tool and The Joanna Briggs Institute Critical Appraisal Checklist. Meta-analysis was performed using CMA2 software. Results: Our search strategy resulted in a total of 1,621 articles, 43 of which were included in the study after screening. Of the 43 included studies, 35 studies reported a significant decrease in fat intake using educational and multiple intervention methods. About 82 % of studies using the technology were effective in reducing fat intake. Moreover, studies specifically designed to change fat intake were more effective than multicomponent interventions. The meta-analysis of high-quality studies showed that the differences in total fat (-0.262 g/d) and saturated fat (-0.350 g/d) intake between the intervention and control groups were statistically significant (P &lt;0.05). Conclusion: Based on the high-quality studies, educational and multiple interventions are suggested in the community settings to decrease fat intake. In addition, long-term and high frequency interventions focusing on reducing fat intake are desirable.

Wheat Biscuits Enriched with Plant-Based Protein Contribute to Weight Loss and Beneficial Metabolic Effects in Subjects with Overweight/Obesity.

The present study aimed to assess the impact of daily consumption of a snack fortified with plant proteins with high content in amino acids with appetite regulating properties (BCAAs and L-arginine), as part of a dietary intervention, on weight loss. Seventy adults without diabetes (26 male, 44 female) and with overweight/obesity participated in a 12-week restricted dietary intervention and were randomized to either a control or an intervention group, consuming daily 70 g of conventional wheat biscuits (CB) or an isocaloric amount of wheat biscuits enriched with plant proteins (PB) originating from legumes and seeds, respectively. Anthropometric characteristics were measured and venous blood samples were collected at baseline and at the end of the intervention. Decreases in body weight, body fat mass and waist circumference were observed in both groups. Participants in the intervention group experienced greater weight loss (7.6 ± 2.7 vs. 6.2 ± 2.7%, p = 0.025) and marginally significant larger decrease in body fat mass (4.9 ± 2.2 vs. 3.9 ± 2.4 kg, p = 0.059). A moderate reduction in IL-1β levels (p = 0.081), a significantly higher decrease in TNF-α levels (p < 0.001) and a marginally significant greater leptin decrease (p = 0.066) in subjects of the PB group were noticed. Greater reductions in caloric and carbohydrate intake and a trend towards a higher decrease in fat intake were also observed in participants of this group. Incorporation of plant-based proteins with high content in amino acids with appetite-regulating properties in wheat biscuits may contribute to greater weight loss and improvement of metabolic parameters in subjects who are overweight or obese. Protein enrichment of snacks offers a beneficial qualitative manipulation that could be successfully incorporated in a diet plan.

536-P: Impact of Physical Activity (PA) and Macronutrient Intake on CGM Glucometrics in Youth with T1D

Aim: Maintaining in-range glucose on days with PA is challenging for youth with T1D, often requiring fine-tuning of diet and insulin. We examined how PA and macronutrient intake impact glycemic outcomes in youth with T1D. Methods: Youth and parents completed 3-day PA and diet records and youth wore 3-day masked CGM (iPro) every 3 months for 18 months. Days were classified as active (≥60 min PA) or inactive. Diet data were analyzed using Nutrition Data System for Research (NDSR) . Daytime (6 AM-11:59 PM) CGM glucometrics were: % time (T) in range (TIR) 70-180 mg/dL, %T&amp;lt;70, %T&amp;gt;180, and glucose CV. Analyses included complete days for PA, diet, and CGM data. Separate longitudinal mixed models for daily carb, fat, and protein intake (adjusted for age, T1D duration, sex, pump vs. MDI) , assessed changes in glucometrics on active vs. inactive days. Results: Youth (N=136, 49% male, 73% pump users) were ages 8-17 yrs (12.9±2.6) with T1D duration 6.0±3.1 yrs and daily insulin 0.9±0.3 U/kg. At baseline, A1c was 8.0±0.9%, daytime %TIR 50±22% (12.0 hrs) , %T&amp;lt;70 5±8% (1.2 hrs) , %T&amp;gt;180 44±25% (10.6 hrs) , CV 37±11%; macronutrient intake was 49±9% carb, 35±8% fat, 16±4% protein. In all models of macronutrient intakes, %TIR increased by ∼5.3% (76 min; p=.01) with pump use; by 2.8% (40 min; p=.02) on active days; by 1.4% (20 min; p=.03) with 10% increase in carb intake; and by 1.7% (24 min; p=.02) with 10% decrease in fat intake. PA and carb intake did not impact %T&amp;lt;70; %T&amp;lt;70 decreased by 0.6% (9 min; p=.03) with 10% increase in fat intake. PA did not impact %T&amp;gt;180; %T&amp;gt;180 decreased by ∼5.6% (81 min; p=.02) with pump use; by 1.7% (24 min; p=.02) with 10% increase in CHO intake; and by 2.2% (32 min; p=.01) with 10% decrease in fat intake. CV decreased by 1.3% on inactive days (p=.04) ; by 1.1% with 10% decrease in CHO intake (p&amp;lt;.01) ; and by 1.3% with 10% increase in fat intake (p&amp;lt;.01) . Conclusion: PA and macronutrient intake have varying effects on glycemic outcomes. The findings reinforce the need to tailor insulin dosing algorithms for diet and PA. Disclosure R.O.La banca: None. L.K.Volkening: None. E.Dassau: Employee; Eli Lilly and Company, Research Support; Dexcom, Inc., JDRF, National Institute of Diabetes and Digestive and Kidney Diseases, Stock/Shareholder; Eli Lilly and Company. S.N.Mehta: None. L.M.Laffel: Advisory Panel; Medtronic, Roche Diabetes Care, Consultant; Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompé, Insulet Corporation, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk, Provention Bio, Inc. Funding National Institutes of Health (K12DK094721, P30DK036836) ; Iacocca Foundation

Effects of Maternal Exclusion Diet for Infants Suspected Food Allergy on Fatty Acid Composition in Breast Milk

Background: Levels of fatty acid (FA) in breast milk (BM) may vary depending on the maternal diet. This study aimed to explore FA composition in BM of lactating women following dietary restrictions due to infant allergic conditions. Materials and Methods: Thai lactating mothers of term infants who were on exclusion diets were recruited. Mature BM was collected before and after a period (at least 2 weeks) of dietary restriction. FA in BM was analyzed by gas chromatography-mass spectrometry. Results: Fifty lactating women 33.7 ± 3.6 years of age were enrolled. Thirty-three percent of the lactating mothers restricted more than eight food items. Most common dietary restriction were cow's milk (88%) and eggs (74%). After the period of dietary exclusion, total polyunsaturated FA showed no significant change, while saturated FA (SFA) declined, and monounsaturated FA (MUFA) increased. A decrease in fat intake was associated with an increase in arachidonic acid (ARA) and docosahexaenoic acid (DHA) content in BM (r = -0.37, r = -0.36; p < 0.05). However, a rise in ARA, eicosapentaenoic acid (EPA), and DHA intake was associated with an increase in linoleic acid and EPA in BM, respectively (r = 0.38, r = 0.55 and r = 0.41; p < 0.05). Infant weight-for-age z-score did not significantly change after the period of maternal dietary exclusion. Conclusion: Maternal exclusion diet resulted in lower SFA and higher MUFA composition in BM. Further study should explore the long-term outcomes of maternal dietary restriction on infant and child health.

Changes in Food and Nutrient Intake and Diet Quality on a Low-Fat Vegan Diet Are Associated with Changes in Body Weight, Body Composition, and Insulin Sensitivity in Overweight Adults: A Randomized Clinical Trial

BackgroundConsuming different food groups and nutrients can have differential effects on body weight, body composition, and insulin sensitivity. ObjectiveThe aim was to identify how food group, nutrient intake, and diet quality change relative to usual-diet controls after 16 weeks on a low-fat vegan diet and what associations those changes have with changes in body weight, body composition, and measures of metabolic health. DesignSecondary analysis of a randomized clinical trial conducted between October 2016 and December 2018 in four replications. Participants/settingParticipants included in this analysis were 219 healthy, community-based adults in the Washington, DC, area, with a body mass index (BMI) between 28 and 40, who were randomly assigned to either follow a low-fat vegan diet or make no diet changes. InterventionA low-fat, vegan diet deriving approximately 10% of energy from fat, with weekly classes including dietary instruction, group discussion, and education on the health effects of plant-based nutrition. Control group participants continued their usual diets. Main outcome measuresChanges in food group intake, macronutrient and micronutrient intake, and dietary quality as measured by Alternate Healthy Eating Index-2010 (AHEI-2010), analyzed from 3-day diet records, and associations with changes in body weight, body composition, and insulin sensitivity were assessed. Statistical analyses performedA repeated-measure analysis of variance model that included the factors group, subject, and time was used to test the between-group differences throughout the 16-week study. Interaction between group and time was calculated for each variable. Within each diet group, paired comparison t tests were calculated to identify significant changes from baseline to 16 weeks. Spearman correlations were calculated for the relationship between changes in food group intake, nutrient intake, AHEI-2010 score, and changes in body weight, body composition, and insulin sensitivity. The relative contribution of food groups and nutrients to weight loss was evaluated using linear regression. ResultsFruit, vegetable, legume, meat alternative, and whole grain intake significantly increased in the vegan group. Intake of meat, fish, and poultry; dairy products; eggs; nuts and seeds; and added fats decreased. Decreased weight was most associated with increased intake of legumes (r = −0.38; P < 0.0001) and decreased intake of total meat, fish, and poultry (r = +0.43; P < 0.0001). Those consuming a low-fat vegan diet also increased their intake of carbohydrates, fiber, and several micronutrients and decreased fat intake. Reduced fat intake was associated with reduced body weight (r = +0.15; P = 0.02) and, after adjustment for changes in BMI and energy intake, with reduced fat mass (r = +0.14; P = 0.04). The intervention group’s AHEI-2010 increased by 6.0 points on average, in contrast to no significant change in the control group (treatment effect, +7.2 [95% CI +3.7 to +10.7]; P < 0.001). Increase in AHEI-2010 correlated with reduction in body weight (r = 0.14; P = 0.04), fat mass (r = −0.14; P = 0.03), and insulin resistance as measured by the Homeostasis Model Assessment (HOMA-IR; r = −0.17; P = 0.02), after adjustment for changes in energy intake. ConclusionsWhen compared with participants’ usual diets, intake of plant foods increased, and consumption of animal foods, nuts and seeds, and added fats decreased on a low-fat vegan diet. Increased legume intake was the best single food group predictor of weight loss. Diet quality as measured by AHEI-2010 improved on the low-fat vegan diet, which was associated with improvements in weight and metabolic outcomes. These data suggest that increasing low-fat plant foods and minimizing high-fat and animal foods is associated with decreased body weight and fat loss, and that a low-fat vegan diet can improve measures of diet quality and metabolic health.

Abstract 156: Nutrition therapy: Evaluating relevant interactions for therapeutic success

Background: Clinical nutrition services focus on calories and when a patient looses weight, it may result in both fat and protein loss. There is a lacunae in incorporating anthropometric data as part of nutritional services.Aim: To evaluate nutritional therapy in Diabetes with anthropometric data beyond weight.Materials and Methods: A total number of 847 diabetes patients in age group 35-71 years referred to Division of Nutrition, St. John's Medical College Hospital, Bangalore were recruited from 2015 to 2017. Anthropometric measurements including Body-Mass-Index (BMI), Waist-circumference (WC), Waist–Hip Ratio (WHR), Mid-ArmCircumference (MAC) were carried out on the patients on the first visit and subsequently on every other visit. A 24-hour dietary and physical activity recall was done by a nutritionist and a specific individualised plan was provided based on current intake. Wherever applicable paired ‘t’ test & univariate regression analysis were carried out between anthropometric, biochemical and dietary variables. The mean follow up was 12 months.Results: There was a significant positive association between BMI, percent body fat and WC, but not with WHR. On 24-hour dietary recall done during follow up, individuals in all the BMI groups consumed diets that closely matched international dietary recommendations for diabetes in terms of fibre intake, carbohydrate:protein:fat ratio. Patient's blood glucose profiles improved with a decrease in fat intake, without significant weight-loss. The mid-arm-circumference remained same through the study period.Conclusion: Clinical nutrition programs should utilize anthropometric data like WC & MAC along with dietary recall. Appropriate counselling with balanced diet beyond calories should be provided to achieve a decrease in fat mass without a decrease in mid-arm-circumference to maintain the protein mass. This data compares favourably with the Finnish Diabetes Prevention Study (DPS).

Improvements in Diet and Physical Activity-Related Psychosocial Factors Among African Americans Using a Mobile Health Lifestyle Intervention to Promote Cardiovascular Health: The FAITH! (Fostering African American Improvement in Total Health) App Pilot Study.

BackgroundAfrican Americans continue to have suboptimal cardiovascular health (CVH) related to diet and physical activity (PA) behaviors compared with White people. Mobile health (mHealth) interventions are innovative platforms to improve diet and PA and have the potential to mitigate these disparities. However, these are understudied among African Americans.ObjectiveThis study aims to examine whether an mHealth lifestyle intervention is associated with improved diet and PA-related psychosocial factors in African Americans and whether these changes correlate with diet and PA behavioral change.MethodsThis study is a retrospective analysis evaluating changes in diet and PA-related self-regulation, social support, perceived barriers, and CVH behaviors (daily fruit and vegetable intake and moderate-intensity PA [MPA] per week) in 45 African American adults (mean age 48.7 years, SD 12.9 years; 33/45, 73% women) enrolled in the FAITH! (Fostering African American Improvement in Total Health) app pilot study. The intervention is a 10-week, behavioral theory–informed, community-based mHealth lifestyle intervention delivered through a mobile app platform. Participants engaged with 3 core FAITH! app features: multimedia education modules focused on CVH with self-assessments of CVH knowledge, self-monitoring of daily fruit and vegetable intake and PA, and a sharing board for social networking. Changes in self-reported diet and PA-related self-regulation, social support, perceived barriers, and CVH behaviors were assessed by electronic surveys collected at baseline and 28 weeks postintervention. Changes in diet and PA-related psychosocial factors from pre- to postintervention were assessed using paired 2-tailed t tests. The association of changes in diet and PA-related psychosocial variables with daily fruit and vegetable intake and MPA per week was assessed using Spearman correlation. Associations between baseline and 28-week postintervention changes in diet and PA-related psychosocial measures and CVH behaviors with covariates were assessed by multivariable linear regression.ResultsParticipants reported improvements in 2 subscales of diet self-regulation (decrease fat and calorie intake, P=.01 and nutrition tracking, P<.001), one subscale of social support for healthy diet (friend discouragement, P=.001), perceived barriers to healthy diet (P<.001), and daily fruit and vegetable intake (P<.001). Improvements in diet self-regulation (increase fruit, vegetable, and grain intake, and nutrition tracking) and social support for healthy diet (friend encouragement) had moderate positive correlations with daily fruit and vegetable intake (r=0.46, r=0.34, and r=0.43, respectively). A moderate negative correlation was observed between perceived barriers to healthy diet and daily fruit and vegetable intake (r=−0.25). Participants reported increases in PA self-regulation (P<.001). Increase in social support subscales for PA (family and friend participation) had a moderate positive correlation with MPA per week (r=0.51 and r=0.61, respectively).ConclusionsOur findings highlight key diet and PA-related psychosocial factors to target in future mHealth lifestyle interventions aimed at promoting CVH in African Americans.

Modification of cardiovascular disease risk by health behaviour change following type 2 diabetes diagnosis.

Among adults with type 2 diabetes (T2D), unhealthy behaviours are associated with increased risk of cardiovascular disease (CVD) events. To date, little research has considered whether healthy changes in behaviours following T2D diagnosis reduce CVD risk. A cohort of 867 adults with screen-detected T2D, participating in the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION)-Cambridge trial, were followed for 10years for incidence of CVD events. Diet, alcohol consumption, moderate/vigorous physical activity and smoking were assessed by questionnaire at the time of T2D screening and 1year later. We estimated associations between health behaviours and CVD using Cox regression. We assessed modification of the associations by behaviour change in the year following T2D diagnosis. Smoking [hazard ratio (HR): 1.73 (95% CI: 1.04, 2.87)] and high fat intake [HR: 1.70 (95% CI: 1.02, 2.85)] were associated with a higher hazard of CVD, while high plasma vitamin C [HR: 0.44 (95% CI: 0.22, 0.87)] and high fibre intake [HR: 0.60 (95% CI: 0.36, 0.99)] were associated with a lower hazard of CVD. Reduction in fat intake following T2D diagnosis modified associations with CVD. In particular, among those with the highest fat intake, decreasing intake attenuated the association with CVD [HR: 0.75 (95% CI: 0.36, 1.56)]. Following T2D diagnosis, decreasing fat intake was associated with lower long-term CVD risk. This evidence may raise concerns about low-carbohydrate, high-fat diets to achieve weight loss following T2D diagnosis. Further research considering the sources of fat is needed to inform dietary recommendations. This trial is registered as ISRCTN86769081. Retrospectively registered on 15 December 2006.

Impact of malnutrition on health-related quality of life in persons receiving dialysis: a prospective study.

Health-related quality of life (HRQoL) is severely impaired in persons receiving dialysis. Malnutrition has been associated with some measures of poor HRQoL in cross-sectional analyses in dialysis populations, but no studies have assessed the impact of malnutrition and dietary intake on change in multiple measures of HRQoL over time. We investigated the most important determinants of poor HRQoL and the predictors of change in HRQoL over time using several measures of HRQoL. We enrolled 119 haemodialysis and thirty-one peritoneal dialysis patients in this prospective study. Nutritional assessments (Subjective Global Assessment (SGA), anthropometry and 24-h dietary recalls) and HRQoL questionnaires (Short Form-36 (SF-36) mental (MCS) and physical component scores (PCS) and European QoL-5 Dimensions (EQ5D) health state (HSS) and visual analogue scores (VAS)) were performed at baseline, 6 and 12 months. Mean age was 64 (14) years. Malnutrition was present in 37 % of the population. At baseline, malnutrition assessed by SGA was the only factor independently (and negatively) associated with all four measures of HRQoL. No single factor was independently associated with decrease in all measures of HRQoL over 1 year. However, prevalence/development of malnutrition over 1 year was an independent predictor of 1-year decrease in EQ5D HSS, and 1-year decrease in fat intake independently predicted the 1-year decline in SF-36 MCS and PCS, and EQ5D VAS. These findings strengthen the importance of monitoring for malnutrition and providing nutritional advice to all persons on dialysis. Future studies are needed to evaluate the impact of nutritional interventions on HRQoL and other long-term outcomes.

Cardiometabolic, dietary and physical health in graduate paramedics during the first 12-months of practice – a longitudinal study

Objective: Shift work is an established risk factor for poor health yet is necessary for paramedics to provide continuous care to the public. It is unknown how early into a career shift work may begin to impact health. This study sought to identify changes in cardiometabolic health, diet, aerobic capacity, physical activity and health-related quality of life (HRQoL) in graduate paramedics during the first 12-months of their career. Methods: Fifty-six paramedics with no history of regular shift work (28 female, 28 male; median age 24.5, IQR 23-26 years) were recruited for this study. Dietary patterns (food frequency questionnaires) and HRQoL (36-Item Short Form Questionnaire) were assessed at baseline, 6- and 12-months. Body weight, body mass index (BMI) and blood samples (fasting lipids, glucose, insulin and C-reactive protein) were measured at baseline and 12-months to ascertain cardiometabolic health risk. A subset of participants (n = 19; 10 female, 9 male) wore a physical activity monitor for 12 months and completed baseline and 12-month maximal aerobic capacity assessments (V̇O2max). Results: Body weight and BMI decreased in males and increased in females (-0.7% versus 1.7%, p = 0.02). HRQoL and dietary intake did not change over 12-months, except for a small decrease in fat intake (-1%). Consumption of core/healthy foods was lower than recommended at all timepoints. Biomarkers of cardiometabolic health were within normal range and did not change over 12-months, excepting insulin where a small non-significant increase was seen (+0.5 mIU/L, p = 0.61). Baseline V̇O2max was 41.4 (37.1-49.1) ml.kg−1.min−1, with no change noted at 12-months. Comparison of quarterly physical activity data showed no difference in steps per day (p = 0.47) or moderate to vigorous physical activity (MVPA, p = 0.92) across the 12-months. Paramedics completed less MVPA on day shifts compared to rostered days off (-14.68 minutes, p = 0.04). Conclusions: Dietary patterns, HRQoL, cardiometabolic health, aerobic capacity and physical activity levels did not change meaningfully in the first year of practice. Some dietary behaviors and physical activity levels could be improved and may mitigate health effects of exposure to shift work. Long-term follow-up of this group may aid in developing programs to enhance health for paramedics and other health workers.

Effects of Food Insecurity on Nutritional Outcomes during a Pragmatic Weight Loss Trial in an Underserved Adult Population: PROPEL - A Cluster-Randomized Trial

ObjectivesPersons with food insecurity (FI) have been shown to have lower fruit and vegetable (F/V) intake and higher fat intake compared to individuals with food security (FS). However, currently there are limited data as to whether diet can be improved during weight loss interventions in persons with FI. MethodsPatients with obesity (BMI 30 - 50 kg/m2) were recruited into the Promoting Successful Weight Loss in Primary Care in Louisiana (PROPEL) trial, which randomized 18 clinics to either an intensive lifestyle intervention (ILI) or usual care (UC). At baseline, FI was determined by the 6-Item Food Security Survey. At baseline and Month (M) 6, 12, and 24, F/V intake was determined by a brief screener and fat intake was determined by the % Energy from Fat Screener. The outcomes were analyzed by repeated-measures linear mixed-effects multilevel models, which included random cluster (clinic) effects and were stratified by FI. In addition to group, time, and their interaction, the models included age, sex, race, education, income, health literacy, and marital status as covariates. ResultsA total of 803 patients were recruited, and 30.8% reported FI. About 84% were female, 67.2% black, 26.1% received Medicaid, and 65.5% made less than $40,000. At baseline, patients with FI reported lower F/V intake than patients with FS (2.04 ± 0.11 vs. 2.32 ± 0.07 servings/day [d]; mean ± SEM), but no differences in fat intake were seen (35.30 ± 0.41 vs. 35.34 ± 0.27%). In patients with FI, the ILI only improved F/V intake compared to UC at M 24 (0.70 ± 0.28 servings/d). In patients with FS, F/V intake was improved in the ILI vs. UC groups at M 6 (0.55 ± 0.16), 12 (0.39 ± 0.16), and 24 (0.39 ± 0.17 servings/d). Fat intake was not improved in ILI patients with FI, but patients with FS decreased fat intake at all time points compared to UC (M6 –2.79 ± 0.91, M12 –2.51 ± 0.92, and M24 –2.55 ± 0.92%, respectively). ConclusionsOn average, patients with FI in the ILI improved F/V intake, but the high variability (i.e., heterogeneity) in this nutritional outcome prevented significant differences between the ILI and UC groups. Patients with FI failed to decrease fat intake in response to a weight loss intervention. For persons with FI to achieve greater weight loss, targeting nutritional outcomes may be an important consideration. Funding SourcesPCORI OB-1402–10,977, NIH U54 GM104940 and P30 DK072476.

Interventions to Promote Healthy Meals in Full-Service Restaurants and Canteens: A Systematic Review and Meta-Analysis.

Out-of-home eating is increasing, but evidence about its healthiness is limited. The present systematic review and meta-analysis aimed to elucidate the effectiveness of full-service restaurant and canteen-based interventions in increasing the dietary intake, food availability, and food purchase of healthy meals. Studies from 2000–2020 were searched in Medline, Scopus, and Cochrane Library using the PRISMA checklist. A total of 35 randomized controlled trials (RCTs) and 6 non-RCTs were included in the systematic review and analyzed by outcome, intervention strategies, and settings (school, community, workplace). The meta-analysis included 16 RCTs (excluding non-RCTs for higher quality). For dietary intake, the included RCTs increased healthy foods (+0.20 servings/day; 0.12 to 0.29; p < 0.001) and decreased fat intake (−9.90 g/day; −12.61 to −7.19; p < 0.001), favoring the intervention group. For food availability, intervention schools reduced the risk of offering unhealthy menu items by 47% (RR 0.53; 0.34 to 0.85; p = 0.008). For food purchases, a systematic review showed that interventions could be partially effective in improving healthy foods. Lastly, restaurant- and canteen-based interventions improved the dietary intake of healthy foods, reduced fat intake, and increased the availability of healthy menus, mainly in schools. Higher-quality RCTs are needed to strengthen the results. Moreover, from our results, intervention strategy recommendations are provided.

Changes in dietary fat intake and associations with mental health in a UK public sample during the COVID-19 pandemic.

ABSTRACTBackgroundConsumption of unhealthy foods may have changed during the COVID-19 pandemic. This study explored how dietary fat intake was impacted in a sample of the UK public who were social distancing during the COVID-19 pandemic.MethodsData were collected from a UK COVID-19 online survey. Fat intake was measured using the Dietary Instrument for Nutrition Education questionnaire. Anxiety and depressive symptoms were assessed using Becks’ Anxiety and Depression Inventories, while the short-form Warwick-Edinburgh Mental Well-being Scale assessed mental well-being. Differences between individuals who increased versus decreased fat intake were explored using chi-square or independent sample t-tests. Association between fat intake and mental health was explored using adjusted linear regression models.ResultsEight hundred and eighty-seven adults were included. Approximately, 34% recorded medium-to-high levels of fat consumption during social distancing. Around 48% reported decreased fat intake during social distancing compared to usual levels, while 41.3% documented increased fat intake. Fat intake was not significantly associated (P > 0.05) with any measures of mental health.ConclusionsA higher proportion of a sample of UK adults social distancing during the COVID-19 pandemic recorded decreased fat intake when compared to levels prior to social distancing. There appeared to be no associations between fat intake and mental health.