Dietary Nonadherence Research Articles

Food Desert Residence Is Not Associated With Dietary Adherence or Complication Rates in Patients With Isolated Mandibular Fractures

BackgroundMandible fracture management requires postoperative dietary modifications to promote healing. Over 20 million Americans live in food deserts, low-income neighborhoods over one mile from a grocery store. The relationship between food desert residence (FDR) and adherence to postoperative dietary instructions remains unexplored. PurposeThis study’s purpose is to evaluate the relationships between FDR, known risk factors, dietary adherence, and complications among patients with isolated mandible fractures.Study design, setting, sample: This retrospective cohort study was conducted at a level 1 trauma center and analyzed patients with mandible fractures between January 2015 and December 2020. Inclusion criteria included operative treatment of adult patients for mandible fractures; pregnant, incarcerated, and patients with incomplete data were excluded. PredictorFDR was the predictor variable of interest. FDR (coded yes or no) was generated by converting patient addresses to census tract GeoIDs and comparing them to the USDA Food Access Research Atlas. OutcomeThe study examined two outcome variables: dietary adherence and postoperative complications. Dietary adherence was coded as adherent or nonadherent, indicating documented compliance with postoperative dietary modifications. Postoperative complications were coded as present or absent, reflecting infection, hardware failure, and mandible malunion or nonunion. CovariatesThe covariates analyzed included age, sex, ethnicity, mechanism of injury, medical and psychiatric comorbidities (including diagnoses such as diabetes, hypertension, and schizophrenia), and tobacco use. AnalysisRelative risks and multivariate logistic regression models were generated for both outcome variables. Two-tailed p-values < 0.05 were considered statistically significant. ResultsDuring the study period, 143 patients had complete data allowing for FDR and dietary adherence determination; 124 of whom (86.7%) had complication data recorded. Of the cohort, 51/143 (35.7%) resided within a food desert, 30/143 (21.0%) exhibited dietary nonadherence, and 46/124 (37.1%) experienced complications. FDR was not associated with increased risk of dietary nonadherence (RR 0.92, 95% CI 0.52-1.61, p=0.76) or complications (RR 1.19, 95% CI 0.75 – 1.89; p=0.46). On multivariate regression, dietary nonadherence was associated with increased complications (OR 2.85, 95% CI 1.01-8.09, p=0.049). ConclusionThere was no association between FDR and dietary nonadherence or complications in mandible fracture patients. However, dietary nonadherence was associated with complications, highlighting the need for further research and intervention.

Hunger, temptation, and dietary adherence during weight management

Preliminary evidence suggests that hunger and temptation may predict nonadherence to dietary intake goals; however, no studies have investigated the potential interaction between hunger and temptation in relation to dietary nonadherence nor have any investigated whether these associations may be different after the end of active behavioral intervention. Thus, the current study examined the week-to-week associations between hunger, temptation, and dietary adherence in 74 adults with overweight or obesity (mean ± SD age = 50.7 ± 10.4, BMI = 31.2 ± 4.5 kg/m2) enrolled in a 12-week, Internet-based weight loss program followed by a 40-week post-intervention observational maintenance period. Each week during the study, participants completed a questionnaire on which they rated their hunger, temptation, and dietary adherence on 7-point scales. Multilevel models demonstrated that higher levels of hunger and temptation were associated with lower ratings of dietary adherence during the same week, ps < 0.0001, such that 1-point higher ratings of hunger or temptation were associated with 0.2- and 0.5-point lower ratings of dietary adherence, respectively. Further, there was an interaction between hunger and temptation such that the association between temptation and dietary nonadherence was stronger when ratings of hunger were lower, p = .028. There were no differences in associations between the initial weight loss period and the maintenance period. Results suggest that hunger and temptation may serve as potential treatment targets for interventions aimed at improving adherence to dietary intake goals. Future studies should investigate whether interventions targeting hunger and temptation can improve dietary adherence and weight loss outcomes.

FINANCIAL HARDSHIP AND DIETARY ADHERENCE DURING COVID-19 PANDEMIC

&#x0D; &#x0D; &#x0D; The COVID-19 pandemic affected the global economy resulting in financial hardship due to declining wages or job losses. A decreased income influences food expenditure and accessibility affecting dietary adherence to healthy recommendations. Thus, this study aimed to investigate the association between financial hardship and dietary adherence among Malaysian working adults during the pandemic. Individuals aged 18 to 59 years (N=163) who experienced financial hardship during the pandemic participated in this cross-sectional study. The data were collected through an online survey. The reported number of servings consumed by the respondents for nine food groups was compared with the recommendations by the Malaysian Dietary Guidelines 2020 and Malaysian Food Pyramid 2020 using one-sample t-test to measure dietary adherence. The association between the financial hardship categories (≤25%, 26-50%, 51-75%, and 76-100% of monthly household income reduction rate during the pandemic) and dietary adherence status was assessed using the chi-squared test. The respondents consumed significantly lower number of servings of vegetables, fruits, cereals, fish, legumes, milk and milk products, and fat/oils, compared to recommendations (all p&lt;0.001) whereas their sugar intake was significantly higher than recommended (p=0.041). These indicate dietary non-adherence. However, no association between financial hardship and dietary adherence was detected among adults who were financially affected during the COVID-19 pandemic in this study. In conclusion, most Malaysian adults who reportedly experienced financial hardship during the COVID-19 pandemic demonstrated non-adherence to healthy dietary recommendations. However, whether this was influenced by financial difficulties faced during the pandemic is inconclusive and warrants further investigation.&#x0D; &#x0D; &#x0D;

The effectiveness of gluten-free dietary interventions: A systematic review.

Celiac disease is a chronic autoimmune gastroenterological disorder in which the digestion of gluten leads to damage and constant inflammation in the small intestine. Moreover, there are associated physical and mental health problems related to celiac disease, i.e., a lower health-related quality of life and increased depression and anxiety symptoms. The only effective treatment for celiac disease is lifelong adherence to a gluten-free diet. However, researchers suggest that strict adherence to a gluten-free diet ranges from 42 to 80%, depending on the definition and method of assessment that was utilized. This review examines interventions designed for those who need to adhere to life-long dietary measures and their success in terms of increasing gluten-free dietary adherence and improving their health-related quality of life. In April 2022, the Scopus, Web of Science, PubMed and ProQuest databases were searched using the following terms: "coeliac disease" OR "celiac disease" AND "gluten free diet" AND "intervention" AND "health related quality of life" AND "diabetes." Eight studies were suitable for this review. The studies were used to analyze different intervention techniques and their impact on gluten-free dietary adherence, quality of life, and the reasons for dietary nonadherence. The studies revealed statistically significant improvements in the knowledge base regarding celiac disease and the gluten-free diet, dietary adherence and quality-of-life satisfaction immediately after the intervention and at a three-month follow-up. Some studies were also focused on behavioral and cognitive aspects of nonadherence to dietary measures.

Dynamic Changes in Dietary Guideline Adherence and Its Association with All-Cause Mortality among Middle-Aged Chinese: A Longitudinal Study from the China Health and Nutrition Survey.

The traditional approach to evaluating dietary quality is based on the achievement of the recommended intakes for each food group, which may overlook the achievement of correct relative proportions between food groups. We propose a "Dietary Non-Adherence Score (DNAS)" to assess the degree of similarity between subjects' diets and those recommended in the Chinese Dietary Guidelines (CDG). Furthermore, it is important to incorporate the time-dependent nature of dietary quality into mortality prediction. This study investigated the association between long-term changes in adherence to the CDG and all-cause mortality. This study included 4533 participants aged 30-60 from the China Health and Nutrition Survey study with a median follow-up of 6.9 years. Intakes from 10 food groups were collected in 5 survey rounds from 2004 to 2015. We calculated the Euclidean distance between the intake of each food and the CDG-recommended intake, and then summed all the food groups as DNAS. Mortality was assessed in 2015. Latent class trajectory modeling was used to identify three classes of participants with distinct longitudinal trajectories of DNAS during the follow-up period. The Cox proportional hazard model was used to assess the risk of all-cause mortality in the three classes of people. Risk factors for death and confounders for diets were sequentially adjusted in the models. There were 187 deaths overall. Participants in the first class identified had consistently low and decreasing DNAS levels (coefficient = -0.020) over their lifetime, compared with a hazard ratio (HR) of 4.4 (95% confidence interval [CI]: 1.5, 12.7) for participants with consistently high and increasing DNAS levels (coefficient = 0.008). Those with moderate DNAS had an HR of 3.0 (95% CI: 1.1, 8.4). In summary, we find that people with consistently high adherence to CDG-recommended dietary patterns had a significantly lower mortality risk. DNAS is a promising method to assess diet quality.

Understanding disease-specific and non-specific factors predicting disordered eating in adults with coeliac disease

An adverse relationship between coeliac disease and the development of disordered eating patterns is well established. The aim of this study was to replicate and extend Satherley et al.‘s (2016) study exploring coeliac-specific and non-specific factors predicting disordered eating. An online survey was completed by 187 adults with coeliac disease (90.4% female; Mean age = 48.92; Mean years living with coeliac disease = 11.86). Results indicated that greater disordered eating correlated with being female, poorer dietary adherence, greater gastrointestinal and psychological symptoms, and more coeliac-related food concerns. Hierarchical regression analyses found that psychological distress remained the only predictor of disordered eating when both coeliac-specific and non-specific factors were considered. Age, body mass index, psychological distress, years with coeliac disease and dietary nonadherence were found to significantly predict binge eating severity. The findings suggest that psychological distress is a risk factor for disordered eating in coeliac disease and that binge eating behaviours may be a particularly relevant factor for dietary nonadherence in those living with coeliac disease.

Challenges of Monitoring the Gluten-Free Diet Adherence in the Management and Follow-Up of Patients with Celiac Disease.

Celiac disease (CD) is a chronic gluten-responsive immune mediated enteropathy and is treated with a gluten-free diet (GFD). However, a strict diet for life is not easy due to the ubiquitous nature of gluten. This review aims at examining available evidence on the degree of adherence to a GFD, the methods to assess it, and the barriers to its implementation. The methods for monitoring the adherence to a GFD are comprised of a dietary questionnaire, celiac serology, or clinical symptoms; however, none of these methods generate either a direct or an accurate measure of dietary adherence. A promising advancement is the development of tests that measure gluten immunogenic peptides in stools and urine. Causes of adherence/non-adherence to a GFD are numerous and multifactorial. Inadvertent dietary non-adherence is more frequent than intentional non-adherence. Cross-contamination of gluten-free products with gluten is a major cause of inadvertent non-adherence, while the limited availability, high costs, and poor quality of certified gluten-free products are responsible for intentionally breaking a GFD. Therefore, several studies in the last decade have indicated that many patients with CD who follow a GFD still have difficulty controlling their diet and, therefore, regularly consume enough gluten to trigger symptoms and damage the small intestine.

Is Dietary Nonadherence Unique to Obesity and Weight Loss? Results From a Randomized Clinical Trial.

ObjectiveWeight stigma is associated with poor dietary adherence, yet adherence is essential for weight loss and maintenance. This study aimed to determine differences in dietary adherence and perceived hunger between lean individuals and two groups of individuals with obesity.MethodsIn a 6‐week outpatient dietary intervention (23 males; aged 48 [SD 14] years), lean participants (n = 23; BMI 23 [SD 2] kg/m2) received a weight‐maintaining energy needs (WMEN) diet, and participants with obesity (BMI 36 [SD 7]) were randomized to either WMEN (n = 18) or a 35% calorie‐reduced (CR) diet (n = 19). All food was provided, and multiple adherence and hunger ratings were assessed daily and weekly on an outpatient basis and in person at twice‐weekly visits (e.g., 24‐hour recall, diaries).ResultsWeight decreased more in the group of CR individuals with obesity (β = −0.301 kg/wk, P = 0.02) compared with the group of lean individuals and the group of WMEN individuals with obesity. However, total percent adherence did not differ between groups (P = 0.60), and hunger scores did not change across groups over time (P = 0.08).ConclusionsResults indicate that there are no differences in dietary adherence between lean individuals and individuals with obesity and adherence is not associated with adiposity or hunger. Thus, the belief that nonadherence (e.g., lack of willpower) is unique to obesity is untrue and may perpetuate weight bias and stigma.

Understanding How Nutrition Literacy Links to Dietary Adherence in Patients Undergoing Maintenance Hemodialysis: A Theoretical Exploration Using Partial Least Squares Structural Equation Modeling.

Dietary non-adherence is pervasive in the hemodialysis (HD) population. Health literacy is a plausible predictor of dietary adherence in HD patients, but its putative mechanism is scarcely studied. Thus, this study aimed to establish the causal model linking nutrition literacy to dietary adherence in the HD population. This was a multi-centre, cross-sectional study, involving 218 randomly selected multi-ethnic HD patients from nine dialysis centres in Klang Valley, Malaysia. Dietary adherence and self-management skills were assessed using validated End-Stage Renal Disease Adherence Questionnaire and Perceived Kidney/Dialysis Self-Management Scale, respectively. Validated self-developed scales were used to gauge nutrition literacy, dietary knowledge and Health Belief Model constructs. Relationships between variables were examined by multiple linear regressions and partial least squares structural equation modeling. Limited nutrition literacy was evident in 46.3% of the HD patients, associated with older age, lower education level, and shorter dialysis vintage. Dietary adherence rate was at 34.9%. Nutrition literacy (β = 0.390, p < 0.001) was an independent predictor of dietary adherence, mediated by self-efficacy (SIE = 0.186, BC 95% CI 0.110–0.280) and self-management skills (SIE = 0.192, BC 95% CI 0.103–0.304). Thus, nutrition literacy-enhancing strategies targeting self-efficacy and self-management skills should be considered to enhance dietary adherence in the HD population.

Dietary non-adherence and associated factors among individuals with diabetes who are on treatment follow up at Felege-Hiwot Referral Hospital, Northwest Ethiopia

Difficulty in adhering to the recommended diet is a common problem in individuals with diabetes mellitus (DM). Dietary non-adherence among diabetic individuals leads to diabetes related complication and death. As far as our search established, there is a scarcity of scientific evidence of dietary non-adherence of individuals with diabetes to the recommended diet in Ethiopia, specifically in the Northwest part of the country. Hence, this study aims to assess the dietary non-adherence and associated factors among individuals with diabetes at Felege-Hiwot Referral Hospital, Bahir Dar city, Northwest Ethiopia. An institution-based cross-sectional study was conducted on 385 systematically selected individuals with diabetes following their treatment from March to April 2017. Quantitative data were collected using a pre-tested and structured questionnaire. The dependent variable association with explanatory variables was determined using logistic regression. Statistical significance was considered at p-value <0.05 with 95% CI. The overall proportion of dietary non-adherence among participants was 46.8% (95% CI: 41.1–52.0). Living rurally (AOR = 3. 75; 95% CI: 2.12–6.63), duration of diabetes less than 5 years (AOR = 2. 81; 95% CI: 1.22–6.50), did not receive nutritional education (AOR = 5. 88; 95% CI: 3.30–10.48), poor social support (AOR = 3. 84; 95% CI: 1.74–8.46) and did not make choices when eating out (AOR = 3. 49; 95% CI: 2.09–5.81) were significantly associated with dietary non-adherence. Nearly half of the individuals with diabetes involved in this study did not adhere to the recommended diet. This problem could be addressed through the provision of nutritional education and strengthening social support to adhere to diabetes dietary recommendations. Therefore, health professional and nutritional educators should take appropriate action to increase the proportion of dietary adherence of individuals with diabetes.

Spouses' responses to the dietary nonadherence of their partners managing diabetes

AbstractThe association between patients' dietary nonadherence and spouses' involvement in patients' diabetes diet was examined, with spouses' anxiety about nonadherence considered as a mediator of this association. Daily diary data from 128 older adult patients with type 2 diabetes and their spouses were analyzed using multilevel models. Results revealed that on days when patients reported less adherence to their diabetes diet than usual, spouses reported greater anxiety about patients' diabetes management, which, in turn, was related to greater spousal persuasion and pressure the same day. The association between patients' nonadherence and diet‐related support on the same day was not mediated, however, through spouses' anxiety. The findings contribute to an understanding of spouses' responses to patients' nonadherence to their diabetes regimen.

63-LB: Self-Reported Adherence among Cardiac Surgery Patients with Diabetes Mellitus

Successful cardiac surgery and recovery typically requires significant treatment adherence. For adults who undergo cardiac surgery and have diabetes mellitus (DM), the complex nature of behavior adherence is unique and especially demanding. Thus, we hypothesized that cardiac surgery patients with comorbid DM (CSDM) would report poorer treatment adherence than cardiac surgery patients without DM (CS). In this secondary data analysis, we assessed self-reported adherence (diet, medications, appointments) among CSDM (N=51) and CS (N=240) pre- and 3 months post-operatively. Participants were predominately male (64%), middle aged (M=63, SD=14), and presented for valve (N=137), coronary artery bypass graft (CABG; N=42), valve + CABG (N=57), or another cardiac (N=55) surgeries. Chi-square analyses assessed differences in self-reported adherence (adherent/not adherent/not applicable) by DM diagnosis (yes/no). Pre-operatively, CSDM were more likely to endorse that following any specific diet was applicable to them (70% vs. 50%), yet reported higher rates of dietary nonadherence (42%) than CS (29%), x2(2)=7.2, p=.027. Rates of medication (p=.420) or appointment (p=.875) adherence did not differ by DM diagnosis. At follow-up, a greater proportion of participants reported that dietary adherence was applicable to them (CSDM: 94%; CS: 74%), still with greater rates of non-adherence for CSDM (81%) compared to CS (55%), x2(2)=7.7, p=.021. Medication adherence (p=.570) and appointment attendance (p=.054) did not differ between groups. In this sample, CSDM seemed more aware of the importance of healthy diet, but were less likely to adhere to a diet (low sugar, sodium) than CS. This pattern may be due to greater awareness of dietary restrictions among patients with DM, as well as additional burden. Cardiac surgery patients with comorbid DM may benefit from additional support from dieticians and psychologists to address the complex psychosocial nature of dietary adherence in comorbid health conditions. Disclosure A. Vela: None. A.J. Carroll: None. P. McCarthy: None. G. Osterman: None. K. Grady: None. K. Feingold: None.

Serum nonesterified fatty acids have utility as dietary biomarkers of fat intake from fish, fish oil, and dairy in women

Nutritional studies rely on various biological specimens for FA determination, yet it is unclear how levels of serum NEFAs correlate with other circulating lipid pools. Here, we used a high-throughput method (<4 min/sample) based on multisegment injection-nonaqueous capillary electrophoresis-mass spectrometry (MSI-NACE-MS) to investigate whether specific serum NEFAs have utility as biomarkers of dietary fat intake in women. We first identified circulating NEFAs correlated with long-term/habitual food intake among pregnant women with contrasting dietary patterns (n = 50). Acute changes in serum NEFA trajectories were also studied in nonpregnant women (n = 18) following high-dose (5 g/day) fish oil (FO) supplementation or isoenergetic sunflower oil placebo over 56 days. In the cross-sectional study, serum ω-3 FAs correlated with self-reported total ω-3 daily intake, notably EPA as its NEFA (r = 0.46; P = 0.001), whereas pentadecanoic acid was associated with full-fat dairy intake (r = 0.43; P = 0.002), outcomes consistent with results from total FA serum hydrolysates. In the intervention cohort, serum ω-3 NEFAs increased 2.5-fold from baseline within 28 days following FO supplementation, and this increase was most pronounced for EPA (P = 0.0004). Unlike for DHA, circulating EPA as its NEFA also strongly correlated to EPA concentrations measured from erythrocyte phospholipid hydrolysates (r = 0.66; P = 4.6 × 10-10) and was better suited to detect dietary nonadherence. We conclude that MSI-NACE-MS offers a rapid method to quantify serum NEFAs and objectively monitor dietary fat intake in women that is complementary to food-frequency questionnaires.

Depressive symptoms and dietary non-adherence among end stage renal disease patients undergoing hemodialysis therapy: systematic review

BackgroundResearch suggests that patients with end stage renal disease undergoing hemodialysis have a higher rate of depression and dietary non adherence leading to hospitalization and mortality. The purpose of this review was to synthesize the quantitative evidence on the relationship between depressive symptoms and dietary non adherence among end stage renal disease (ESRD) patients receiving hemodialysis.MethodsA systematic review was undertaken. Three electronic databases were searched including PubMed, CINHAL and Web of Science. Only quantitative studies published between 2001 and 2016 were included in the review.ResultA total of 141 publications were reviewed during the search process and 28 articles that fulfilled the inclusion criteria were included in the review. Eleven studies (39.3%) reported on the prevalence of depressive symptoms or depression and its effect on patient outcomes. Ten studies (35.7%) focused on dietary adherence/non adherence in patients with ESRD and the remaining seven (25%) articles were descriptive studies on the relationship between depressive symptoms and dietary non adherence in patients with ESRD receiving hemodialysis. The prevalence of depressive symptoms and dietary non adherence ranged as 6–83.49% and from 41.1–98.3% respectively. Decreased quality of life & increased morbidity and mortality were positively associated with depressive symptoms. Other factors including urea, hemoglobin, creatinine and serum albumin had also association with depressive symptoms. Regarding dietary non adherence, age, social support, educational status, behavioral control and positive attitudes are important factors in ESRD patients receiving hemodialysis. Having depressive symptoms is more likely to increase dietary non adherence.ConclusionDepressive symptoms and dietary non adherence were highly prevalent in patients with end stage renal disease receiving hemodialysis therapy. Nearly all of the articles that examined the relationship between depressive symptoms and dietary non adherence found a significant association. Future research using experimental or longitudinal design and gold standard measures with established cut-points is needed to further explain the relationship.

2579 Calcium Disorders in Celiac Disease

INTRODUCTION: Celiac disease is known to affect calcium homeostasis in various ways leading to osteoporosis and osteopenia. We present a case of active celiac disease complicated by hypocalcemia and osteoporosis. CASE DESCRIPTION/METHODS: The patient is a 74-year-old male with known Celiac disease diagnosed 25 years ago. He had known hypocalcemia with secondary hyperparathyroidism treated with calcium and calcitriol supplements to maintain calcium levels (Corrected Calcium: 8.5 mg/dl with PTH of 89 pg/ml and 25-hydroxy Vitamin D of 80 ng/ml). The patient had a mechanical fall, a few months ago and subsequent DEXA scan showed osteoporosis (Bone mineral density of L1-L4 vertebral bodies was 3.5 standard deviation below normal). The patient was treated with an infusion of zoledronic acid. A week later the patient presented with malabsorptive diarrhea likely due to reported non-compliance with a gluten-free diet. On admission labs, he was noted to have severe hypocalcemia (ionized 0.8, corrected calcium was 6.7). Of note, his PTH had increased to 385. Incidentally, his INR was also noted to be mildly elevated at 1.5. Despite this, he had no apparent symptoms of hypocalcemia. During the admission, the patient had an EGD and biopsies were done showing mucosal changes consistent with celiac disease confirming dietary non-adherence. Hypocalcemia was treated with IV infusion of Calcium and he was discharged on increased doses of Calcitriol and calcium supplements with close follow-up with endocrinology. DISCUSSION: Celiac disease affects the small intestine including duodenum, the primary site of absorption of divalent ions including calcium. The intraluminal dietary fats bind to this calcium decreasing the absorption of fat-soluble vitamins K &amp; Vitamin D. The parathyroids release more PTH in an attempt to maintain serum calcium levels through increasing osteoclastic activity. Other mechanisms active in celiac disease also increases bone resorption (See Figure 2). Bisphosphonates are a standard treatment for preventing osteoporotic fractures, by reducing osteoclastic activity. In this patient with active celiac disease, with low availability of dietary calcium, this resulted in hypocalcemia. This can be mitigated with closer observation and adjustment of doses of vitamin D and calcium supplementation when administering bisphosphonates.

SUN-313 EXPLORING THE RELATIONSHIPS BETWEEN HEALTH LITERACY, DIETARY ADHERENCE AND ITS MEDIATORS IN HEMODIALYSIS PATIENTS IN MALAYSIA

Dietary non-adherence is prevalent in hemodialysis (HD) patients. Limited health literacy is a recognized contributing factor to non-adherence in patients with chronic kidney disease. This study aimed to investigate health literacy in the context of dietary knowledge, health belief, self-management skill and dietary adherence in Malaysian HD patients.

Examining the Effects of Mindful Eating Training on Adherence to a Carbohydrate-Restricted Diet in Patients With Type 2 Diabetes (the DELISH Study): Protocol for a Randomized Controlled Trial.

BackgroundDiet patterns have a profound influence on glycemic control for individuals with type 2 diabetes mellitus (T2DM), and craving-related eating is an important obstacle to dietary adherence. A growing body of research suggests that carbohydrate-restricted (CR) diets can improve glycemic control and reduce medication dependence in T2DM. However, limited data speak to the effects of long-term adherence to CR diets. Mindful eating training has been shown to reduce craving-related eating in overweight populations but has yet to be examined as a behavioral support for dietary adherence in T2DM. This trial examines behavioral mechanisms, particularly craving-related eating, through which mindful eating training might improve adherence to CR dietary recommendations in T2DM. This will clarify the importance of focusing on craving-related eating in the optimization of dietary adherence interventions.ObjectiveThe aim of this trial is to determine whether providing training in mindful eating increases adherence to a CR dietary recommendation in T2DM.MethodsWe are randomizing 60 participants to receive a CR diet with or without mindful eating training (12-week group intervention) and are following participants for 12 weeks after intervention completion. We hypothesize that participants who receive mindful eating training (relative to those who do not) will demonstrate greater adherence to the CR diet.ResultsOur primary outcome is change in craving-related eating, as assessed using an ecological momentary assessment mobile phone–based platform. Secondary behavioral pathway outcomes include changes in stress-related eating, impulsivity, glycemic control, weight change, dietary adherence, and resumption of dietary adherence after dietary nonadherence.ConclusionsThis theory-driven trial will shed light on the impact of mindfulness training on mechanisms that may impact dietary adherence in T2DM.Trial RegistrationClinicalTrials.gov NCT03207711; https://clinicaltrials.gov/ct2/show/NCT03207711 (Archived by WebCite at http://www.webcitation.org/73pXscwaU)

Screening Tool to Determine Risk of Having Muscle Dysmorphia Symptoms in Men Who Engage in Weight Training at a Gym.

Although 2 screening tests exist for having a high risk of muscle dysmorphia (MD) symptoms, they both require a long time to apply. Accordingly, we proposed the construction, validation, and implementation of such a test in a mobile application using easy-to-measure factors associated with MD. Cross-sectional observational study. Gyms in Alicante (Spain) during 2013 to 2014. One hundred forty-one men who engaged in weight training. The variables are as follows: age, educational level, income, buys own food, physical activity per week, daily meals, importance of nutrition, special nutrition, guilt about dietary nonadherence, supplements, and body mass index (BMI). A points system was constructed through a binary logistic regression model to predict a high risk of MD symptoms by testing all possible combinations of secondary variables (5035). The system was validated using bootstrapping and implemented in a mobile application. High risk of having MD symptoms (Muscle Appearance Satisfaction Scale). Of the 141 participants, 45 had a high risk of MD symptoms [31.9%, 95% confidence interval (CI), 24.2%-39.6%]. The logistic regression model combination providing the largest area under the receiver operating characteristic curve (0.76) included the following: age [odds ratio (OR) = 0.90; 95% CI, 0.84-0.97, P = 0.007], guilt about dietary nonadherence (OR = 2.46; 95% CI, 1.06-5.73, P = 0.037), energy supplements (OR = 3.60; 95% CI, 1.54-8.44, P = 0.003), and BMI (OR = 1.33, 95% CI, 1.12-1.57, P < 0.001). The points system was validated through 1000 bootstrap samples. A quick, easy-to-use, 4-factor test that could serve as a screening tool for a high risk of MD symptoms has been constructed, validated, and implemented in a mobile application.

Knowledge, barriers and attitudes toward dietary sodium in patients with decompensated heart failure

Background and objective: Nonadherence to sodium restriction is one of the main precipitating factors of heart failure (HF) decompensation. The three-subscale Dietary Sodium Restriction Questionnaire (DSRQ) enables evaluation of factors that can interfere with adherence. The objective of this study was to assess knowledge, barriers, and attitudes of patients with decompensated HF toward dietary sodium, by comparing those hospitalized for decompensation due to dietary nonadherence (alone or with medication nonadherence) versus those admitted for decompensation due to other causes.Methods: Cross-sectional study carried out at the emergency departments of two public hospitals in Southern Brazil between 2013 and 2014. The sample included patients admitted for decompensated HF. Patients were divided into two groups: decompensation due to nonadherence to diet (alone or with medication nonadherence) and other causes.Results: A total of 225 patients were included (mean age 66 ± 12 years). Patients exhibited a high degree of knowledge about sodium restriction (up to 50\% achieved 40 of 45 points). The opinions of family and health professionals influenced adherence. The main barriers to adherence concerned palatability and dietary preferences. When compared to patients admitted for other causes, those decompensated due to nonadherence had lower ejection fraction (p = .004) and higher Perceived Behavioral Control subscale scores (p = .009).Conclusions: Patients have a high level of knowledge about sodium restriction. The opinion of significant others affects adherence. Nonadherent patients appeared to be more severely ill and endorsed a greater number of barriers that prevent adequate behavior. Some factors-particularly the taste of foods and patients’ dietary preferences – may justify the high prevalence of nonadherence.

Patients Commonly Believe Their Heart Failure Hospitalizations Are Preventable and Identify Worsening Heart Failure, Nonadherence, and a Knowledge Gap as Reasons for Admission

BackgroundThere are few data describing patient-identified precipitants of heart failure (HF) hospitalization. We hypothesized a patient's perception of reason for or preventability of an admission may be related to 30-day readmission rates. Methods and ResultsNinety-four patients admitted with decompensated HF from July 2014 to March 2015 completed a brief questionnaire regarding circumstances leading to admission. Thirty-day outcomes were assessed via telephone call and chart review. Mean age was 58 ± 14 years, with 60% blacks (n = 56) and 41% females (n = 39). Median left ventricular ejection fraction was 30%; 27 had preserved ejection fraction. Seventy-two patients identified their hospitalization to be due to HF (± another condition). Most common patient-identified precipitants of admission were worsening HF (n = 37) and dietary nonadherence (n = 11). Readmitted patients tended to have longer time until first follow-up appointment (21 vs 8 days). Seven of the 42 patients who identified their hospitalization as preventable were readmitted compared with 21/49 who believed their hospitalization was unpreventable (P = .012). On multivariate regression analysis, patients who thought their hospitalization was preventable were less likely to be readmitted (odds ratio 0.31; 95% confidence interval 0.10–0.91; P = .04). ConclusionAlmost 50% of patients believe their HF hospitalization is preventable, and these patients appear to be less likely to be readmitted within 30 days. Notably, patients cite nonadherence and lack of knowledge as reasons hospitalizations are preventable. These results lend insight into possible interventions to reduce HF readmissions.