Dietary Modification Intervention Research Articles

Diet Intake After Diet Modification Intervention in Women With Fecal Incontinence.

Older women with fecal incontinence (FI) who underwent diet modification intervention (DMI) showed significant improvement in FI symptoms. It is unclear whether improvement in symptoms was associated with objective changes in dietary intake quality. The primary aim was to determine if improvement in overall dietary intake quality was associated with improvement in FI symptoms. Our secondary aim was to evaluate whether individual food group consumption changes were associated with changes in FI symptoms. This was an ancillary analysis of a prospective cohort study of women aged 65 years and older with FI who underwent DMI. Seven-day diet-and-bowel diaries at baseline and 6 weeks after DMI were examined for how frequently participants consumed food categories and FI triggers. Adherence to recommended dietary guidelines was assessed between 2 and 4 weeks using a 24-hour diet recall. Baseline and postintervention consumption were compared using the Wilcoxon signed rank test. Spearman correlation was used to compare dietary intake changes with FI symptom changes. Twenty-four women completed the 24-hour diet recalls, and 17 women completed the 7-day diet-and-bowel diaries at baseline and 6 weeks. More participants who were adherent had clinically significant improvement in symptoms compared with those who were not adherent (70% vs 30%, P=0.57). Decreased consumption of saturated fats (P=0.01) and fried foods (P<0.001) was associated with improvement in FI symptoms. In this small population, overall dietary intake quality was not associated with change in FI symptom improvement. Decreased intake of saturated fat and fried food was associated with FI symptom improvement.

Evidence based lifestyle interventions in Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a common endocrine condition which affects up to 13% of reproductive-aged women and is associated with reproductive, metabolic and psychological features. Women with PCOS have a higher prevalence of longitudinal weight gain in population-based cohort studies compared to women without PCOS. On meta-analysis, women with PCOS also have an increased prevalence of overweight, obesity and central obesity, compared with controls. PCOS is therefore associated with an elevated prevalence of overweight and obesity which further worsen metabolic, reproductive and psychological dysfunction. Given the association between overweight and obesity and metabolic, reproductive and psychological dysfunction in women, weight management is a logical treatment strategy. This can be defined as prevention of excess weight gain, achieving a modest weight loss and sustaining a reduced weight long-term. This is best achieved through lifestyle management which traditionally refers to a complex multidisciplinary approach that combines dietary modification, physical activity and behavioural interventions. Lifestyle interventions and modest weight loss (5-10% of initial body weight) are associated with improvements in outcomes including central adiposity, hyperandrogenism, insulin resistance and cardiovascular risk factors. In PCOS specifically for dietary interventions, the majority of evidence indicates no differences between dietary approaches Lifestyle management advice should therefore follow general population guidance which states that lifestyle intervention can be achieved through a variety of dietary approaches providing these are tailored to dietary preferences and ensure the nutritional and health status of the individual patient with referral to a nutrition professional where possible. These recommendations are summarised in the 2023 International Evidence-based Guidelines on the Assessment and Management of PCOS. 1 These guidelines are now being translated and implemented internationally.

Chylothorax: pathophysiology, diagnosis, and management-a comprehensive review.

Chylothorax is a rare condition characterized by the accumulation of chyle in the pleural space. While it accounts for a small percentage of pleural effusions, chylothorax can lead to significant morbidity and mortality. This article provides a comprehensive overview of chylothorax, covering its relevant anatomy, aetiology, pathophysiology, clinical features, diagnosis, and management. Injury or disruption to the thoracic duct (which is responsible for chyle transport) leads to the development of chylothorax. This may result from trauma, such as iatrogenic injury during surgery, or non-traumatic causes, including malignancy, lymphatic disorders, and heart failure. Recognition of the underlying cause is essential to tailor management. Clinical presentation varies, with symptoms linked to rate of chyle accumulation and the causative condition. Diagnosis relies on pleural fluid analysis, with demonstration of elevated triglyceride levels (>110 mg/dL) and reduced cholesterol levels (<200 mg/dL) being the key diagnostic criteria employed in clinical practice. Various imaging modalities, including computed tomography (CT) scans and lymphatic-specific investigations, may be utilised to aid identification of the site of chyle leak, as well as determine the likely underlying cause. Chylothorax management is multifaceted, with conservative approaches such as dietary modification and pharmacological interventions often initiated as first-line treatment. Drainage of chylous effusion may be necessary for symptom relief. When conservative methods fail, interventional procedures like thoracic duct ligation or embolization can be considered. Due to the diverse aetiological factors and patient characteristics associated with chylothorax, individualized management strategies are recommended. Nonetheless, management of chylothorax is an evolving field with a paucity of high-quality evidence or standardized guidelines, highlighting the importance of ongoing research and a multidisciplinary approach to optimize individual patient care.

Impact of a 6-week dietary and lifestyle modification intervention on food cravings and eating behaviors in women.

the multifaceted nature of food craving mirrors the complexity underlying the development of eating disorders. the study aimed to investigate the impact of a 6-week dietary and lifestyle intervention on food cravings, eating behaviors, and changes in physical and biochemical measures among women. this study constitutes a behavior modification investigation involving a cohort of 35 female participants who sought consultation at a private nutrition counseling facility. At first, anthropometric and biochemical data were recorded; Information Form, Food Craving Questionnaire-Trait Scale (FCQ-T), Three-Factor Eating Scale (TFEQ-R21) were applied and 3-Day Food Consumption Records were taken. After 6 weeks of dietitian follow-up, the data collection tools were repeated and the individuals were compared with the baseline. after 6-week follow-up, according to the examination of the food consumption records, differences in daily energy, fat, monounsaturated fatty acid, fibre, vitamin E, potassium, magnesium, iron intake levels were found significant (p < 0.05). Differences in body weight, body mass index (BMI), waist/height ratio, fat mass, fat ratio and fasting glucose, HbA1c, total cholesterol, triglyceride, LDL, AST, TSH, free T3, free T4 levels were found significant (p < 0.05). According to the FCQ-T evaluation; differences in total and nine sub-dimension scores of the scale were found significant (p < 0.001). According to the TFEQ-R21 evaluation; differences in cognitive restraint, emotional eating and uncontrolled eating scores were found significant (p < 0.05). a successful 6-week dietary and lifestyle intervention with improvement in anthropometric measurements and biochemical parameters is effective in reducing food cravings and regulating eating behaviours.

Effect of Low-Fat Dietary Modification on Incident Open-Angle Glaucoma

We tested whether dietary modification (DM) altered the risk for incident primary open-angle glaucoma (POAG). Secondary analysis of a randomized intervention trial. We linked Medicare claims data to 45 203 women in the Women's Health Initiative Dietary Modification Trial, of which 23 776 participants were enrolled in fee-for-service Medicare Part B and had physician claims. Women were randomized to follow either DM (a low-fat diet, with increased vegetable, fruit, and grain intake) or their usual diet without modification. Nine thousand three hundred forty women were randomized to the DM intervention, whereas 13 877 women were randomized to the control group. Our analyses were based on an intention-to-treat design, with a follow-up to the end of continuous Medicare coverage, death, or the last claims date (12/31/2018), whichever occurred first. Primary open-angle glaucoma was defined as the first claim with the International Classification of Diseases, Ninth or Tenth Revision, codes. Dietary data were assessed using a food frequency questionnaire. We used Cox proportional hazards models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for risk of POAG. Subgroup analyses were performed with P values for interaction. After exclusion of women with Medicare-derived glaucoma before randomization, the final analysis included 23 217 women (mean age, 64.4 ± 5.8 years). Baseline characteristics were balanced between the intervention and control groups. Primary open-angle glaucoma incidence was 11.1 per 1000 woman-years (mean follow-up, 11.6 ± 7.4 years; mean DM duration, 5.2 ± 3.2 years). We found no overall benefit of DM in reducing incident POAG (HR, 1.04; 95% CI, 0.96-1.12). Race and participant age did not modify this relation (P = 0.08 and P = 0.24 for interaction, respectively). In further analysis of baseline nutrient and food intake stratified by quartile groups, risk of open-angle glaucoma (OAG) in DM participants in the lowest quartile group for percentage calories (kilocalories) from total fat (33.8 or lower) was increased (HR, 1.22; 95% CI, 1.05-1.41; P = 0.007 for interaction). Analysis suggests that DM in participants in the lowest quartile group for percentage calories from total fat at baseline increased the risk of incident OAG among women regardless of age or race. Proprietary or commercial disclosure may be found after the references.

Lifestyle modification for improving anxiety and depression among patients with irritable bowel syndrome

Summary: Objective: The aim of this study was to evaluate the beneficial effects of lifestyle modification and dietary intervention on the severity of symptoms, quality of life, anxiety and depression status in patients with irritable bowel syndrome. Methods: In this clinical interventional trial study, patients aged 15 to 65 years with IBS (based on the ROME IV criteria) who were referred to the gastrointestinal clinic of Taleghani hospital, Tehran, Iran between March 2020 and August 2020 were included. After initial evaluation, lifestyle modification intervention was performed. Statistical analysis was performed using SPSS software. Results: In the present study, 55 patients consisting in 27 men and 28 women with IBS were included. The patients‘ mean anxiety score (based on BAI) and mean depression score (based on BDI) were significantly reduced after lifestyle and diet modification intervention as compared to the baseline. The mean score of the patients‘ quality of life (based on IBS-QOL) was 68.36 ±24.90 before the intervention, which increased to 82.75 ±29.52 after the intervention, indicating a significant difference (P &lt;0.001). Similarly, the mean score of severity of IBS symptoms (based on IBS-SSS) was 28.29 ±8.27 before the intervention, which was reduced to 20.87 ±8.47 after the intervention with a significant difference (P &lt;0.001). Conclusion: Our findings suggest that lifestyle and dietary modification might be a feasible and effective treatment approach in patients with IBS, which has a positive and significant effect on amelioration of the severity of symptoms, improving the quality of life as well as alleviating symptoms of anxiety and depression. Key words: irritable bowel syndrome – anxiety – depression – quality of life – lifestyle modification

The Changing Landscape of Nutrition in Cystic Fibrosis: The Emergence of Overweight and Obesity.

Cystic fibrosis has historically been characterized by malnutrition, and nutrition strategies have placed emphasis on weight gain due to its association with better pulmonary outcomes. As treatment for this disease has significantly improved, longevity has increased and overweight and obesity have emerged issues in this population. The effect of excess weight and adiposity on CF clinical outcomes is unknown but may produce similar health consequences and obesity-related diseases as those observed in the general population. This review examines the prevalence of overweight and obesity in CF, the medical and psychological impact, as well as the existing evidence for treatment in the general population and how this may be applied to people with CF. Clinicians should partner with individuals with CF and their families to provide a personalized, interdisciplinary approach that includes dietary modification, physical activity, and behavioral intervention. Additional research is needed to identify the optimal strategies for preventing and addressing overweight and obesity in CF.

Low-fat dietary pattern reduces urinary incontinence in postmenopausal women: post hoc analysis of the Women's Health Initiative Diet Modification Trial

BACKGROUNDUrinary incontinence affects >40% of women in the United States, with an annual societal cost of >$12 billion and demonstrated associations with depressive symptoms, social isolation, and loss of work productivity. Weight has been established as an exposure that increases urinary incontinence risk and certain dietary components have been associated with urinary incontinence symptoms. We hypothesized that diet plays a key role in the association between weight and urinary incontinence in US women.OBJECTIVEThis study aimed to examine the effect of a low-fat diet on urinary incontinence in postmenopausal women as a post hoc analysis of a randomized controlled trial of diet modification.STUDY DESIGNThis was a post hoc analysis of the Women's Health Initiative Dietary Modification randomized controlled trial of 48,835 postmenopausal women from 40 US centers assigned to a dietary intervention (20% energy from fat, 5 fruits or vegetable servings, and 6 whole grain servings daily and an intensive behavioral modification program) or to the usual diet comparison group. The outcome was urinary incontinence at 1 year.RESULTSOf the participants, 60% were randomized to the usual diet comparison group and 40% to the dietary modification intervention. After adjusting for weight change, women assigned to the dietary modification intervention were less likely to report urinary incontinence (odds ratio, 0.94; 95% confidence interval, 0.90–0.98; P=.003), more likely to report urinary incontinence resolution (odds ratio, 1.11; 95% confidence interval, 1.03–1.19; P=.01), and less likely to develop urinary incontinence (odds ratio, 0.92; 95% confidence interval, 0.87–0.98; P=.01) in adjusted models.CONCLUSIONDietary modification may be a reasonable treatment for postmenopausal women with incontinence and also a urinary incontinence prevention strategy for continent women. Our results provide evidence to support a randomized clinical trial to determine whether a reduced fat-intake dietary modification is an effective intervention for the prevention and treatment of urinary incontinence. In addition to providing further insights into mechanisms of lower urinary tract symptoms, these findings may have a substantial impact on public health based on the evidence that diet seems to be a modifiable risk factor for urinary incontinence.

Low-Fat Dietary Modification and Risk of Ductal Carcinoma In Situ of the Breast in the Women's Health Initiative Dietary Modification Trial.

Results of observational studies of the association between dietary fat and risk of invasive breast cancer have been inconsistent. In the Women's Health Initiative dietary modification (DM) randomized trial designed to lower fat intake, the intervention was not associated with a statistically significant reduction of overall breast cancer risk. However, the DM association with risk of ductal carcinoma in situ (DCIS) of the breast, a putative breast cancer precursor, has not been reported. A total of 48,835 postmenopausal women, ages 50-79 years at enrollment, with no breast cancer history and ≥32% of total energy intake from fat, were randomly assigned either to a dietary intervention (n = 19,541) designed to reduce total fat intake to 20% of energy and to increase vegetable, fruit, and grain consumption, or to a comparison group (n = 29,294). Cox proportional hazards models were used to estimate HRs and 95% confidence intervals for the association between the intervention and DCIS risk. During 18.7 years (median) cumulative follow-up, including intervention (∼8.7 years) and post-intervention phases (∼13.0 years), 817 DCIS cases were ascertained. No evidence of an association between the DM intervention and DCIS risk was observed overall, or by trial phase (intervention and post-intervention). Similarly, no associations were found in subgroups defined by potential risk factors for DCIS. DM aiming to reduce fat intake was not associated with altered risk of DCIS. These results do not provide evidence of an association between dietary fat reduction and the risk of DCIS among postmenopausal women.

Effects of a dietary modification intervention on menstrual pain and urinary BPA levels: a single group clinical trial

BackgroundExposure to endocrine-disrupting chemicals (EDCs) occurs mainly through dietary intake. Due to current lifestyle trends, young people tend to consume fast food, to use disposable products, and to utilize convenient household items, all of which are major sources of EDCs. This study aimed to investigate the effects of a dietary modification intervention on menstrual pain and urinary bisphenol A (BPA) levels throughout three menstrual cycles in female college students who experienced severe menstrual pain. We also analyzed participants’ adherence to the intervention and examined whether their level of adherence was associated with differences in the effects of the intervention.MethodsA single-group pretest and repeated posttest experimental design was employed. Thirty female college students with a score of 5 or higher on a menstrual pain scale were recruited through convenience sampling. During three menstrual cycles, menstrual pain was scored on a 10-point scale after each cycle, and urinary BPA levels were measured from the first morning urine collected after each cycle. The intervention involved three components: small-group education, follow-up monitoring, and peer support via social network communication. Statistical analyses were conducted using Friedman one-way repeated-measure analysis of variance by ranks, non-parametric two-way analysis of variance, and the Wilcoxon signed-rank test as a post-hoc test.ResultsThe dietary modification intervention had significant effects on menstrual pain at all three time points of menstrual cycles (χ2 = 119.64, p = 0.000) and on urinary BPA levels until the 2nd menstrual cycle (χ2 = 205.42, p = 0.000). Slightly fewer than half (43.3%) of the participants were highly adherent. Menstrual pain differed according to adherence level (F = 4.67, p = 0.032) and decreased over time through the third cycle post-intervention (F = 18.30, p = 0.000). Urinary BPA levels also decreased significantly (F = 7.94, p = 0.000), but did not differ according to adherence level.ConclusionsThe dietary modification intervention was effective and sustainable for reducing menstrual pain and urinary BPA levels. Detailed information about EDCs and dietary experiences seemed to encourage the young women to become more concerned about EDCs and to perform self-protective actions. Further experimental research is suggested to examine the relationships of EDCs with various health indicators in women.Trial registration: KCT0005472 at 2020-9-24 retrospectively registered.

Lifestyle changes for treating psoriasis.

Lifestyle changes for treating psoriasis.

The effect of continuity of care on the incidence of end-stage renal disease in patients with newly detected type 2 diabetic nephropathy: a retrospective cohort study

BackgroundDiabetic nephropathy requires periodic monitoring, dietary modification, and early intervention to prevent the disease severity within limited resource settings. To emphasize the importance of continuous care for chronic diseases, various studies have focused on the association between continuity of care (COC) and common adverse outcomes. However, studies aimed at understanding the effect of COC on the incidence of chronic diseases, such as end-stage renal disease (ESRD), are few. The aim of this study was to determine whether there is an association between COC and the incidence of ESRD among patients with diabetic nephropathy. Moreover, we identified individual- and hospital-level factors associated with the incidence of ESRD among diabetic nephropathy patients.MethodsWe conducted a retrospective cohort study using the administrative National Health Insurance claims data from 2005 to 2012 in the Republic of Korea. The dependent variable, a binary variable, was the incidence of ESRD due to diabetic renal complication. In addition, using the COC index as a binary variable with a cutoff point of 0.75, we divided patients into a ‘Good COC group’ (COC index≥0.75) and a ‘Bad COC group’ (COC index< 0.75). The survival analysis was performed using the Cox proportional hazards models.ResultsAmong 3565 diabetic renal complication patients, ESRD occurred among 83 diabetes mellitus patients (2.3%). Nephropathy patients with lower COC level (< 0.75) had 1.99 times higher risk of ESRD incidence (95% confidence interval [CI]:1.27–3.12). In addition, the lowest income level patients had higher hazard ratio (HR) of ESRD than the highest income level patients (HR: 1.69 95% CI: 0.95–2.98), while patients with disabilities had 2.70 higher HR of ESRD than patients without disabilities (95% CI: 0.64–43).ConclusionsAmong patients with diabetic renal complication, higher continuity of care was associated with lower risk of ESRD. It is therefore recommended that continuous follow-up be encouraged to prevent ESRD among diabetic renal complication patients. Moreover, disparities in health outcomes between socially vulnerable groups including patients with disabilities and those in the lowest income level should be addressed.

Exploring Wellness Interventions in Progressive Multiple Sclerosis: an Evidence-Based Review.

There has been recent interest in the role of lifestyle and wellness-based approaches in the treatment and management of multiple sclerosis (MS). These approaches may be particularly relevant for patients with progressive MS, considering limited therapeutic options currently available. The purpose of this review is to examine the role of wellness-based interventions including exercise training, emotional well-being therapies, and dietary modification in patients with progressive MS. We conducted a literature search on the efficacy of wellness-based interventions in patients with progressive MS published between 1985 and July 2017. The level of evidence for each trial was evaluated using the American Academy of Neurology criteria. Overall, 21 articles reporting on 16 wellness-based interventions were identified: ten trials involved exercise training, three involved emotional wellness therapies, two involved dietary modification, and one was a combined wellness intervention. There is level C evidence (possibly effective; one class II study) for the efficacy of aerobic exercise training on cardiorespiratory fitness in patients with progressive MS. There is level B evidence (probably effective; one class I study) for the efficacy of mindfulness training on psychological distress, depression, anxiety, pain, and quality of life in patients with progressive MS. There is inadequate evidence (level U) for efficacy of dietary modification (one class III study and one class IV study) and combined wellness interventions involving exercise training, meditation, and dietary modification (one class IV study). High-quality research is needed to provide evidence-based recommendations for wellness behaviors and lifestyle change in patients with progressive MS.

A cost-analysis of complex workplace nutrition education and environmental dietary modification interventions

BackgroundThe workplace has been identified as a priority setting to positively influence individuals’ dietary behaviours. However, a dearth of evidence exists regarding the costs of implementing and delivering workplace dietary interventions. This study aimed to conduct a cost-analysis of workplace nutrition education and environmental dietary modification interventions from an employer’s perspective.MethodsCost data were obtained from a workplace dietary intervention trial, the Food Choice at Work Study. Micro-costing methods estimated costs associated with implementing and delivering the interventions for 1 year in four multinational manufacturing workplaces in Cork, Ireland. The workplaces were allocated to one of the following groups: control, nutrition education alone, environmental dietary modification alone and nutrition education and environmental dietary modification combined. A total of 850 employees were recruited across the four workplaces. For comparison purposes, total costs were standardised for 500 employees per workplace.ResultsThe combined intervention reported the highest total costs of €31,108. The nutrition education intervention reported total costs of €28,529. Total costs for the environmental dietary modification intervention were €3689. Total costs for the control workplace were zero. The average annual cost per employee was; combined intervention: €62, nutrition education: €57, environmental modification: €7 and control: €0. Nutritionist’s time was the main cost contributor across all interventions, (ranging from 53 to 75% of total costs).ConclusionsWithin multi-component interventions, the relative cost of implementing and delivering nutrition education elements is high compared to environmental modification strategies. A workplace environmental modification strategy added marginal additional cost, relative to the control. Findings will inform employers and public health policy-makers regarding the economic feasibility of implementing and scaling dietary interventions.Trial registrationCurrent Controlled Trials: ISRCTN35108237. Date of registration: The trial was retrospectively registered on 02/07/2013.

PREVIEW Behavior Modification Intervention Toolbox (PREMIT): A Study Protocol for a Psychological Element of a Multicenter Project.

Background: Losing excess body weight and preventing weight regain by changing lifestyle is a challenging but promising task to prevent the incidence of type-2 diabetes. To be successful, it is necessary to use evidence-based and theory-driven interventions, which also contribute to the science of behavior modification by providing a deeper understanding of successful intervention components.Objective: To develop a physical activity and dietary behavior modification intervention toolbox (PREMIT) that fulfills current requirements of being theory-driven and evidence-based, comprehensively described and feasible to evaluate. PREMIT is part of an intervention trial, which aims to prevent the onset of type-2 diabetes in pre-diabetics in eight clinical centers across the world by guiding them in changing their physical activity and dietary behavior through a group counseling approach.Methods: The program development took five progressive steps, in line with the Public Health Action Cycle: (1) Summing-up the intervention goal(s), target group and the setting, (2) uncovering the generative psychological mechanisms, (3) identifying behavior change techniques and tools, (4) preparing for evaluation and (5) implementing the intervention and assuring quality.Results: PREMIT is based on a trans-theoretical approach referring to valid behavior modification theories, models and approaches. A major “product” of PREMIT is a matrix, constructed for use by onsite-instructors. The matrix includes objectives, tasks and activities ordered by periods. PREMIT is constructed to help instructors guide participants' behavior change. To ensure high fidelity and adherence of program-implementation across the eight intervention centers standardized operational procedures were defined and “train-the-trainer” workshops were held. In summary PREMIT is a theory-driven, evidence-based program carefully developed to change physical activity and dietary behaviors in pre-diabetic people.

A Randomized Trial of a Low-Fat Diet Intervention on Blood Pressure and Hypertension: Tertiary Analysis of the WHI Dietary Modification Trial.

This post hoc analysis determined if the Women's Health Initiative (WHI) Diet Modification intervention (DM-I) resulted in a significantly different rate of incident hypertension (HTN), as well as longitudinal changes in blood pressure. Participants were 48,835 postmenopausal women aged 50-79 years who were randomly assigned to either the intervention or comparison group. HTN was defined as self-report of treated HTN collected semiannually or blood pressure ≥140/90mm Hg at one of the annual follow-up clinic visits. After a mean follow-up of 8.3 years, and among those who did not have HTN at baseline (n = 31,146), there were 16,174 (51.9%) HTN cases and those assigned to the intervention group had a 4% lower overall risk of developing incident HTN (hazard ratio (HR): 0.96, 95% confidence interval (CI): 0.93-0.99). Although the risk of HTN was lower in the DM-I group in the first few years, the HR became greater than 1 after year 5 (P-trend < 0.01). Similarly, randomization to the DM-I arm resulted in a small but significantly lower average systolic blood pressure (SBP) at 1 year of follow-up (-0.66mm Hg, 0.44-0.89) that increased over the following 8 years (0.16mm Hg/year, 0.11-0.21), such that any early benefit was eliminated by year 5 and a minimal deleterious effect emerged by year 7. Randomization to an intensive behavioral dietary modification program aimed at a lower total fat intake is not associated with sustained reductions in blood pressure or risk of HTN in postmenopausal women. url http://www.clinicaltrials.gov, unique identifier nct00000611.

Lifestyle changes for treating psoriasis

Lifestyle changes for treating psoriasis

Effects of a dietary modification intervention model applied by ward nurse on dietary behavior in patients with type 2 diabetes mellitus

Objective The purpose of this study was to investigate the effect of a dietary modification intervention model applied by ward nurse on change of dietary behavior among patients with type 2 diabetes mellitus (T2DM). Methods A total of 80 participants were divided into intervention patients (n= 40) and control subjects (n=40) by random number table. Except lecture-based diabetes educational which was applied for control subjects, a dietary modification intervention model was conducted in intervention patients for a period of two weeks. The intervention program consisted of evaluating an individual's stage of change after being provided dietary information regarding kind of food and portions, discussion with a role model, and keeping a food diary record. Body mass index (BMI), waist-hip ratio (WHR), fasting plasma glucose (FPG), postprandial 2-h plasma glucose (2hPG), glycosylated hemoglobin (HbAlc) and score of healthy eating behavior were measured at initial and six months later. Results Compared with control group, BMI, WHR, FPG, 2hPG, HbA1c in intervention group were significantly decreased, P<0.01 or 0.05. After six months intervention, FPG, 2hPG and HbA1c in both groups were significantly decreased compared with baseline levels, P<0.01. Compared with control group, the scores of healthy eating behavior in intervention group were significantly decreased, P<0.05. After six months intervention, the scores of healthy eating behavior in both groups were significantly elevated, P <0.01, compared with baseline levels. Conclusions This study yielded evidence for the benefits of using the dietary modification intervention model as a framework in healthy eating behavior among patients with T2DM. Key words: Diabetes mellitus, type 2; Food habits; Dietary intervention model

Low-Fat Dietary Pattern Intervention and Health-Related Quality of Life: The Women’s Health Initiative Randomized Controlled Dietary Modification Trial

BackgroundIntensive dietary intervention programs may lead to benefits in vitality and other components of health quality. The Women's Health Initiative Dietary Modification (DM) intervention includes a large randomized controlled trial of an intensive intervention. ObjectiveTo evaluate whether the intervention is associated with improved health-related quality of life (HRQoL) subscales, overall self-reported health, depression symptoms, cognitive functioning, and sleep quality. DesignThis randomized controlled trial was analyzed as intent to treat. ParticipantsBetween 1993 and 1998, 48,835 women aged 50 to 79 years were recruited by 40 clinical centers across the United States. Eligibility included having fat intake at baseline ≥32% of total calories, and excluded women with any prior colorectal or breast cancer, recent other cancers, type 1 diabetes, or medical conditions with predicted survival <3 years. InterventionGoals were to reduce calories from fat to 20%, increase vegetables and fruit to 5+ servings, and increase grain servings to 6+ servings a day. During the first year, 18 group sessions were held, with quarterly sessions thereafter. Main outcome measuresThe RAND 36-Item Health Survey was used to assess HRQoL at baseline, Year 1, and close-out (about 8 years postrandomization), and estimate differential HRQoL subscale change scores. Statistical analyses performedMean change in HRQoL scores (Year 1 minus baseline) were compared by randomization group using linear models. ResultsAt 1 year, there was a differential change between intervention and comparison group of 1.7 units (95% CI 1.5, 2.0) in general health associated with the intervention. DM intervention improved physical functioning by 2.0 units (95% CI 1.7, 2.3), vitality by 1.9 units (95% CI 1.6, 2.2), and global quality of life by 0.09 units (95% CI 0.07, 0.12). With the exception of global quality of life, these effects were significantly modified by body mass index at baseline. ConclusionsDM intervention was associated with small, but significant improvements in three HRQoL subscales: general health, physical functioning, and vitality at 1 year follow-up, with the largest improvements seen in the women with the greatest baseline body mass index.

OP73 The effect of complex workplace dietary interventions on dietary behaviours, nutrition knowledge and health status: a cluster controlled trial

Background Although the workplace is a potentially important setting to influence dietary behaviours, evidence on effective interventions is limited. The study aim was to assess the comparative effectiveness of a workplace environmental dietary modification intervention and an educational intervention both alone and in combination versus a control workplace on employees’ dietary behaviours, nutrition knowledge and health status. Methods In the Food Choice at Work cluster controlled trial, four large, purposively selected manufacturing workplaces were allocated to A, (Control), B, nutrition education alone (Education), C, environmental dietary modification alone (Environment) and D, nutrition education and environmental dietary modification (Combined intervention). Nutrition education included: group presentations, individual consultations and detailed nutrition information (traffic light menu-labelling, posters and emails). Environmental dietary modification included: menu modification (restriction of fat, saturated fat, sugar and salt), increase in fruit and vegetables, price discounts for fruit, strategic positioning of healthier alternatives and portion size control. Data on dietary intakes (24-hour dietary recalls and food frequency questionnaires), nutrition knowledge (validated questionnaire tool), BMI, waist circumference and blood pressure were obtained at baseline and follow-up at 7–9 months. The Dietary Approaches to Stopping Hypertension (DASH) score was used as a composite measure of diet quality. Analysis of covariance was used to compare changes between baseline and follow-up across the four groups with adjustment for age, gender, educational status and other baseline characteristics. Results At baseline, 850 employees aged 18–64 years were recruited with N (response rate%) in each workplace as follows: A-control: 111(72%), B-Education: 226(71%), C-Environment: 113(91%), D-Combined intervention: 400(61%). Complete follow-up data was obtained for 517 employees (61%). There were significant positive changes in intakes of saturated fat (p = 0.013), salt (p = 0.010) and nutrition knowledge (p = 0.009) between baseline and follow-up in the combined intervention versus the control workplace in the fully adjusted multivariate analysis. Small but significant changes in BMI (–1.4kg/m 2 (95% CI –2.447, –0.346, p = 0.047) were observed in the combined intervention. Changes in the DASH score (p = 0.028) were only significant when adjusted for age and gender. No significant changes in waist circumference and blood pressure were observed. Effects in the education alone and environment alone workplaces were smaller and generally non-significant. Conclusion The ‘Food Choice at Work’ combined intervention represents a potentially viable model that is effective and feasible in a large workplace setting. However, it needs to be fully tested using an optimal randomised controlled trial design and full-scale evaluation to provide robust evidence for policy makers. Current Controlled Trials: ISRCTN35108237.