Intervention Studies In Adults Research Articles

Depressive Symptoms and Gut Microbiota after Bowel Preparation and Colonoscopy: A Pre-Post Intervention Study.

Mechanical bowel preparation (MBP) is essential for visualisation of the colon during colonoscopy. Previous studies have identified changes in gut microbiota composition after MBP and colonoscopy. Considering the gut microbiota is increasingly implicated in psychiatry, we explored the potential impact of this intervention on mood and the microbiota-gut-brain axis. We conducted a pre-post intervention study in adults, with timepoints of one week before and one month after MBP and colonoscopy. Our primary outcome was change in average Hospital Anxiety and Depression Scale depression sub-scores. We examined changes in average anxiety, stress, and quality of life scores and gut microbiota composition using 16S rRNA sequencing. We further explored associations between changes in depressive symptoms and gut microbiota and conducted post hoc analyses to explore potential effect modifiers. Average depressive symptom scores decreased one month post-procedure compared to baseline (n = 59; adjusted β = -0.64; 95%CI: -1.18, -0.11). Irritable bowel syndrome (IBS) appeared to moderate this relationship (β = 1.78; 95%CI: 0.292, 3.26); depressive symptoms increased in those with, and decreased in those without, IBS. Reduced alpha diversity, modest effects on beta-diversity, and increases in health-associated genera were observed one month post-procedure. Increases in the CLR-transformed abundances of Ruminococcaceae UCG-009 were associated with improvements in depressive symptoms. There is preliminary evidence of a potential mental health effect of MBP and colonoscopy, particularly for those with IBS, which may be associated with changes to the gut microbiota. Further research is required to confirm these findings and their clinical relevance.

Evaluation of Conflicts of Financial Interest in Publications on the Consumption of High-Intensity Sweeteners and Body-Weight Changes: A Systematic Review.

Diseases related to excessive sugar consumption have become a public health concern. However, there may be a direct association between the consumption of artificial sweeteners and changes in body weight. The aim was to evaluate potential industry financial conflicts of interest in publications on the relationship between high-intensity sweetener consumption and changes in body weight in observational and intervention studies. The systematic review used the Medline, Embase, Cochrane, Scopus, and the VHL (Virtual Health Library) Regional Portal, including the LILACS databases. The PICOS strategy were used in the search strategy for intervention studies and for observational studies used the exposure factor as the criterion. Inclusion criteria were observational and intervention studies in adults, without population or health status restrictions, without restriction on the year of publication, but restricted to full articles in Portuguese, English, and Spanish. Exclusion criteria were humans younger than 18 years, cross-sectional studies, and animal and in vitro studies. There were extracted effect estimates, odds ratios, and linear associations, quantifying the effects per unit of intake of high-intensity sweeteners. The risk of bias in the intervention studies was assessed using the Cochrane Collaboration Risk of Bias tool (RoB). The Newcastle Ottawa Scale was used for observational studies (case-control and cohort). Most clinical trials favor using artificial sweeteners and receive contributions from the food industry. Observational studies, for the most part, show that the use of artificial sweeteners is unfavorable. In these studies, there was no sponsorship from the food industry, only from regulatory bodies. This result suggests that studies that had the support of the food industry had their influence on their outcomes. PROSPERO registration no: CRD42016036204.

Prior Appendicectomy and Gut Microbiota Re-Establishment in Adults after Bowel Preparation and Colonoscopy.

Emerging evidence suggests that the human vermiform appendix is not a vestigial organ but rather an immunological organ of biological relevance. It is hypothesised that the appendix acts as a bacterial 'safe house' for commensal gut bacteria and facilitates re-inoculation of the colon after disruption through the release of biofilms. To date, no studies have attempted to explore this potential mechanistic function of the appendix. We conducted a pre-post intervention study in adults (n = 59) exploring re-establishment of the gut microbiota in those with and without an appendix after colonic disruption via bowel preparation and colonoscopy. Gut microbiota composition was measured one week before and one month after bowel preparation and colonoscopy using 16S rRNA sequencing. We observed between group differences in gut microbiota composition between those with (n = 45) and without (n = 13) an appendix at baseline. These differences were no longer evident one-month post-procedure, suggesting that this procedure may have 'reset' any potential appendix-related differences between groups. Both groups experienced reductions in gut microbiota richness and shifts in beta diversity post-procedure, with greater changes in those without an appendix, and there were five bacterial genera whose re-establishment post-procedure appeared to be moderated by appendicectomy status. This small experimental study provides preliminary evidence of a potential differential re-establishment of the gut microbiota after disruption in those with and without an appendix, warranting further investigation into the potential role of the appendix as a microbial safe house.

MEDEA randomised intervention study protocol in Cyprus, Greece and Israel for mitigation of desert dust health effects in adults with atrial fibrillation

IntroductionMediterranean countries experience frequent desert dust storm (DDS) events originating from neighbouring Sahara and Arabian deserts, which are associated with significant increase in mortality and hospital admissions, mostly from cardiovascular...

Serum concentrations of amino acids and tryptophan metabolites are affected by consumption of a light breakfast: a clinical intervention study in adults with overweight or obesity

BackgroundEpidemiological studies often investigate amino acids and their metabolites as biomarkers, but do not always consistently use fasting or non-fasting blood samples, or may lack information on the prandial status of the study participants. Since little information is available on the effects of the prandial status on many biomarkers, and since blood is typically sampled early in the day with participants in a fasting state or after having consumed a light meal in many trials, the main purpose of this study was to investigate the short-term effects of a light breakfast on serum concentrations of amino acids and related metabolites.MethodsBlood was collected from sixty-three healthy adults (36 women) in the fasting state and at set times for 120 min after intake of a light breakfast with low protein content (14 g protein, 2218 kJ). Relative changes in serum biomarker concentrations from fasting to postprandial serum concentrations were tested using T test.ResultsThe serum concentrations of 13 of the 20 measured amino acids were significantly changed 60 min following breakfast intake, with the most marked effects seen as increases in alanine (34%) and proline (45%) concentrations. The response did not reflect the amino acid composition of the breakfast. The concentrations of seven kynurenine metabolites were significantly decreased after breakfast.ConclusionConsumption of a light breakfast affected serum concentrations of several amino acids and related metabolites, underlining the importance of having information regarding the participants’ prandial state at the time of blood sampling in studies including these biomarkers.Trial registrationThis trial was registered at clinicaltrials.gov as NCT02350595 (registered January 2015).

Conversion of calcium-l-methylfolate and (6S)-5-methyltetrahydrofolic acid glucosamine salt into dietary folate equivalents.

Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver a scientific opinion on the conversion of calcium‐l‐methylfolate and (6S)‐5‐methyltetrahydrofolic acid glucosamine salt (collectively called 5‐MTHF hereafter) into dietary folate equivalents (DFE). Following a systematic review, the conclusions of the opinion are based on one intervention study in adults for intakes < 400 μg/day and three intervention studies in adults for intakes ≥ 400 μg/day. At intakes below 400 μg/day, folic acid (FA) is assumed to be linearly related to responses of biomarkers of intake and status and is an appropriate comparator for deriving a DFE conversion factor for 5‐MTHF. It is proposed to use the same factor as for folic acid for conversion of 5‐MTHF into DFE for intakes < 400 μg/day. As such intake levels are unlikely to be exceeded through fortified food consumption, the conversion factor of 1.7 relative to natural food folate (NF) could be applied to 5‐MTHF added to foods and to food supplements providing < 400 μg/day. At 400 μg/day, 5‐MTHF was found to be more bioavailable than folic acid and a conversion factor of 2 is proposed for this intake level and for higher intakes. The derived DFE equations are DFE = NF + 1.7 × FA + 1.7 × 5‐MTHF for fortified foods and food supplements providing intakes < 400 μg/day; and DFE = NF + 1.7 × FA + 2.0 × 5‐MTHF for food supplements providing intakes ≥ 400 μg/day. Although this assessment applies to calcium‐L‐methylfolate and 5‐MTHF glucosamine salt, it is considered that the influence of the cation on bioavailability is likely to be within the margin of error of the proposed DFE equations. Therefore, the proposed equations can also be applied to 5‐MTHF associated with other cations.

Sixteen-week multicentre randomised controlled trial to study the effect of the consumption of an oat beta-glucan-enriched bread versus a whole-grain wheat bread on glycaemic control among persons with pre-diabetes: a study protocol of the CarbHealth study

IntroductionIn 2012, the estimated global prevalence of pre-diabetes was 280 million, and the prevalence is expected to rise to 400 million by 2030. Oat-based foods are a good source of...

Intuitive and mindful eating to improve physiological health parameters: a short narrative review of intervention studies.

This brief narrative review aims to give an up-to-date overview of intuitive and mindful eating (I/ME) interventions with specific focus on cardiometabolic risk factors, including glucose, lipid profile, blood pressure and inflammatory markers. I/ME intervention studies in adults which measured at least one physiological parameter other than weight were identified from PubMed. The clinical trial/randomized controlled trial filters and publication dates 2001 through April 2021 with variations of the following keywords were applied: intuitive eating, mindful eating, weight neutral. Ten articles were identified. Of the 10 studies, seven showed I/ME interventions were more effective than control in at least one cardiometabolic outcome, two showed significant I/ME within-group improvements but no between-group differences, and one showed neither within-group nor between-group differences. Specifically, I/ME improved glucose levels among pregnant women with or without gestational diabetes, lipid profile among adults with overweight or obesity, blood pressure among participants with overweight and inflammatory markers among post-menopausal women with obesity. However, the positive impact of I/ME on each of these cardiometabolic parameters was not consistent across studies: of the six studies that examined glucose regulation, two demonstrated positive outcomes for I/ME group, whereas four found no effect compared to control. Three out of five studies had positive lipid effects, one out of five demonstrated systolic blood pressure (SBP) improvements and one of two showed improvements in inflammatory markers. Given these mixed results, more research is needed to understand the possible effectiveness of I/ME to improve cardiometabolic health.

Short-term impact of a vegetarian and the nordic diet on metabolic risk factors: a human intervention study in adults with a risk phenotype for cardio metabolic diseases

Rationale: Recent epidemiological studies indicate that both the so-called Nordic diet (ND, rich in berries, fish, and nuts) as well as a vegetarian diet (VD) may reduce the risk for the development of cardio metabolic diseases compared to a typical ‘Western Diet’. The aim of this comparative human intervention trial was to define the short-term effects of both dietary patterns on decisive biomarkers.

Caffeine exposure from beverages and its association with self-reported sleep duration and quality in a large sample of Icelandic adolescents

Previous risk assessments have concluded that adolescent's caffeine exposure from energy drinks (ED) are of limited concern. Recent surveys have, however, shown substantial increase in consumption. This cross-sectional survey conducted in 2020 estimated caffeine exposure from beverages among ∼80% of all 13-15-year-old adolescents (n = 10358) relative to the European Food Safety Authority's level of no safety concern of (3.0 mg/kg bw) and level for effects on sleep (1.4 mg/kg bw). Associations with self-reported sleep duration and quality were also explored. ED consumers were more likely to exceed the limit of no safety concern (prevelance: 12–14%) compared to non-ED-consumers (1–2%). Exceeding the limit for effects on sleep was also higher among ED consumers (31–38%) than non-ED-consumers (5–8%). Across categories of low (<0.5 mg/kg bw) to high (>3.0 mg/kg bw) caffeine intake, the prevalence of participants sleeping <6 h increased from 3% to 24%, respectively. The corresponding adjusted Prevalence Ratio was 4.5 (95% CI: 3.6, 5.7) and mean decrease in duration of sleep was 0.74 h (95% CI: 0.65, 0.84). In conclusion, caffeine intake from beverages above the limit of no safety concern was largely confined to ED consumers. Consistent with effects from intervention studies in adults, caffeine intake was strongly associated with self-reported sleep duration in this representative population.

Accuracy of early warning scores for predicting serious adverse events in pre-hospital traumatic injury

BackgroundTraumatically injured patients are at higher risk of serious adverse events. Numerous physiological scoring systems are employed as diagnostic and/or prognostic tools. The objective of this study was to evaluate the scales most commonly used by emergency medical services for the early detection of prehospital serious adverse events. MethodsDesign. Preliminary longitudinal prospective observational study without intervention study in adults with prehospital traumatic injury.Setting. The study was carried out in the public health system of Castile and León (Spain), from April 1, 2018 to October 31, 2019, involving seven advanced life support units and five hospitals.Participants. Traumatically injured patients over 18 years of age who were stabilized and transferred in advanced life support units to their referral hospital.Main outcome measures. Appearance of serious adverse events at the prehospital level at the scene or during the transfer to the emergency department. ResultsA total of 346 patients were included in the study. The median age was 50 years (IQR: 38–65). 32 cases (7.8%) presented serious adverse events at the prehospital level. Areas under the curve for the detection of serious adverse events were obtained with the Prehospital Index (0.979; 95% CI: 0.94–1.00) and National Early Warning Score 2 (0.956; 95% CI: 0.90–1.00); p <0.001 for all scores. The Prehospital Index had a positive probability coefficient of 78.4 (95% CI: 62.8–68.6) and the National Early Warning Score 2 obtained 52.9 (95% CI: 39.7–65.6). A comparison of the curves was not significant for any of the scores studied (p> 0.05). ConclusionsAll scoring systems were able to detect prehospital serious adverse events early in traumatic injury; therefore, any of the scoring systems could be useful and represent an ideal tool for routine use by emergency medical services in cases of traumatic injury.

Diet and sleep health: a scoping reviewof intervention studies in adults.

Recent research has demonstrated an association between dietary intake and sleep health that can influence chronic disease risk factors. A scoping review of research studies investigating dietary intake and sleep was undertaken to determine the extent and scope of research in laboratory-based, free-living and mixed settings. Additionally, this review determines how well subpopulations and geographical locations are represented and the methodologies used to assess outcome measures. Five online databases were used to identify papers published between 1970 and 2017. Included studies were those conducted in adults and reported both outcomes of interest: (i) sleep health, including sleep restriction and sleep hygiene and (ii) dietary outcomes, including altered nutrients, dietary patterns and supplements. In total, 129 publications were included with the majoritybeing dietary interventions investigating sleep outcomes (n=109) with fewerbeing sleep interventions investigating and reporting dietary outcomes (n=20). Dietary interventions were most often carried out in free-living environments, in contrast to sleep interventions that were most often carried out in laboratory-based environments. The majority of dietary interventions investigated use of a supplement (n=66 studies), which was predominantly caffeine (n=49). Sleep interventions investigated sleep duration only, with the majority (n=17) investigating the effect of partial sleep restriction under 5.5h per night on dietary intake,while three studies investigating total sleep deprivation. Investigating broader aspects of dietary such as overall diet quality and dietary patterns and other components of sleep health such as quality, timing and sleephygiene are important aspects for future research.

The association of dietary phosphorus with blood pressure: results from a secondary analysis of the PREMIER trial.

Inconsistent findings exist for the association between dietary phosphorus intake and blood pressure (BP). We examined the longitudinal association between urinary excretion and dietary intake of phosphorus (total, plant, animal, and added) with BP.This is a secondary analysis of PREMIER, a randomized behavioral intervention study in adults (25–79y) with BP, measured at six months, as the primary outcome. We classified total phosphorus intake from dietary recalls into plant, animal, and added phosphorus. We modeled six month change of phosphorus intake (from 24h dietary recalls, N = 622) and excretion (from 24h urine collection, N = 564) on BP, using linear regression crude and adjusted for intervention, age, race, sex, income, education, study site, and change in energy intake (kcal/d), sodium intake (mg/d), fitness (heart rate, bpm), and DASH diet index.Baseline phosphorus intake was 1154 mg/d (95%CI 1126, 1182) with 38%, 53%, and 10% from plant, animal, and added phosphorus, respectively. Total phosphorus intake was not associated with significant changes in BP. Increased urinary phosphorus excretion was associated with a significant increase in DBP [0.14 mmHg/100 mg (0.01, 0.28), adjusted]. In several analyses, phosphorus type (plant, animal, or added) significantly modified the association between phosphorus intake and BP. For example, added phosphorus (but not plant or animal) was associated with increases in SBP and DBP, 1.24 mmHg/100 mg (0.36, 2.12) and 0.83 mmHg/100 mg (0.22, 1.44), respectively, crude.These findings suggest that the type of phosphorus may modify the association between phosphorus intake and BP. Trial registration (clinicaltrials.gov).

Identifying and improving adherence to the gluten-free diet in people with coeliac disease.

Coeliac disease (CD) is an autoimmune gastrointestinal disorder whereby the ingestion of gluten, a storage protein found in wheat, barley and rye, causes damage to intestinal mucosa with resultant malabsorption, increased risk of anaemia and osteoporosis. Worldwide estimates suggest 1% of the population have CD. With no cure, the only treatment is a gluten-free diet (GFD). Adhering to a GFD can be very challenging; it requires knowledge, motivation and modified behaviours. Assessing adherence to a GFD is methodologically challenging. This review aims to provide an overview of the literature reporting adherence to a GFD in people with CD and the methodological challenges encountered. From six studies it has been reported that rates of adherence to a GFD range between 45 and 90% in patients of different ethnicities with CD. GF dietary adherence can be influenced by age at diagnosis, coexisting depression, symptoms on ingestion of gluten, nutrition counselling, knowledge of GF foods, understanding of food labels, cost and availability of GF foods, receiving GF foods on prescription and membership of a coeliac society. To date only five intervention studies in adults with CD have been undertaken to improve GF dietary adherence. These have included dietary and psychological counselling, and the use of online training programmes, apps, text messages and telephonic clinics. Future interventions should include people of all ethnicities, consider patient convenience and the cost-effectiveness for the healthcare environment.

Administration of two probiotic strains during early childhood does not affect the endogenous gut microbiota composition despite probiotic proliferation

BackgroundProbiotics are increasingly applied to prevent and treat a range of infectious, immune related and gastrointestinal diseases. Despite this, the mechanisms behind the putative effects of probiotics are poorly understood. One of the suggested modes of probiotic action is modulation of the endogenous gut microbiota, however probiotic intervention studies in adults have failed to show significant effects on gut microbiota composition. The gut microbiota of young children is known to be unstable and more responsive to external factors than that of adults. Therefore, potential effects of probiotic intervention on gut microbiota may be easier detectable in early life. We thus investigated the effects of a 6 month placebo-controlled probiotic intervention with Bifidobacterium animalis subsp. lactis (BB-12®) and Lactobacillus rhamnosus (LGG®) on gut microbiota composition and diversity in more than 200 Danish infants (N = 290 enrolled; N = 201 all samples analyzed), as assessed by 16S rRNA amplicon sequencing. Further, we evaluated probiotic presence and proliferation by use of specific quantitative polymerase chain reaction (qPCR).ResultsProbiotic administration did not significantly alter gut microbiota community structure or diversity as compared to placebo. The probiotic strains were detected in 91.3% of the fecal samples from children receiving probiotics and in 1% of the placebo treated children. Baseline gut microbiota was not found to predict the ability of probiotics to establish in the gut after the 6 month intervention. Within the probiotics group, proliferation of the strains LGG® and BB-12® in the gut was detected in 44.7% and 83.5% of the participants, respectively. A sub-analysis of the gut microbiota including only individuals with detected growth of the probiotics LGG® or BB-12® and comparing these to placebo revealed no differences in community structure or diversity.ConclusionSix months of probiotic administration during early life did not change gut microbiota community structure or diversity, despite active proliferation of the administered probiotic strains. Therefore, alteration of the healthy infant gut microbiota is not likely to be a prominent mechanism by which these specific probiotics works to exert beneficial effects on host health.Trial registrationNCT02180581. Registered 30 June 2014.

Lutein and Cognition Across the Lifespan

Epidemiological studies suggest that consumption of lutein-rich foods may be of benefit in promoting cognitive health. Among the carotenoids, lutein and it isomer, zeaxanthin, are the only 2 that cross the blood-retina barrier to form macular pigment (MP) in the retina. Lutein also preferentially accumulates in the human brain across multiple life stages. Lutein concentrations in the retina of both human and nonhuman primates are significantly correlated with their levels in matched brain tissues, allowing for the use of MP density, which can be measured noninvasively in humans, as a biomarker of lutein in the brain. This has important implications for intervention studies involving lutein given that MP density, such as brain lutein, has been reported to be significantly related to cognitive function in adults. Although less is known about infants, cross-sectional studies have shown that breast milk lutein content enriches lutein in brain tissue and is related to infant recognition memory scores. Intervention studies in adults indicate that lutein may positively affect cognitive performance, and this effect may be influenced by the omega-3 fatty acid, docosahexaenoic acid. Although lutein is not an essential nutrient, efforts may be warranted to establish age-specific recommended intakes for this dietary bioactive for promotion of cognitive health.

Exercise as treatment for alcohol use disorders: systematic review and meta-analysis

ObjectivesTo conduct a systematic review and meta-analysis investigating effects of exercise for people with alcohol use disorders (AUDs) across multiple health outcomes. We also investigated the prevalence and predictors of...

100% citrus juice: Nutritional contribution, dietary benefits, and association with anthropometric measures

ABSTRACTCitrus juices such as 100% orange (OJ) and grapefruit juice (GJ) are commonly consumed throughout the world. This review examines the contributions of OJ and GJ to nutrient intake, diet quality, and fruit intake, and supports citrus juices as nutrient-dense beverages. This review also explores the research examining associations between OJ and GJ intake and anthropometric measures. Citrus juices are excellent sources of vitamin C and contribute other key nutrients such as potassium, folate, magnesium, and vitamin A. OJ intake has been associated with better diet quality in children and adults. OJ intake has not been associated with adverse effects on weight or other body measures in observational studies in children and adults. In adults, some observational studies report more favorable body mass index or body measure parameters in OJ consumers compared to nonconsumers. Intervention studies in adults report no negative impacts of OJ or GJ consumption on anthropometric measures, although these measures were typically not the primary outcomes examined in the studies. Moderate consumption of citrus juices may provide meaningful nutritional and dietary benefits and do not appear to negatively impact body weight, body composition, or other anthropometric measures in children and adults.

Impact of soy isoflavones on the epigenome in cancer prevention.

Isoflavones (IF) such as genistein are cancer preventive phytochemicals found in soy and other legumes. Epidemiological studies point to a reduced risk for hormone‑dependent cancers in populations following a typical Asian diet rich in soy products. IF act as phytoestrogens and prevent tumorigenesis in rodent models by a broad spectrum of bioactivities. During the past 10 years, IF were shown to target all major epigenetic mechanisms regulating gene expression, including DNA methylation, histone modifications controlling chromatin accessibility, and non-coding RNAs. These effects have been suggested to contribute to cancer preventive potential in in vitro and in vivo studies, affecting several key processes such as DNA repair, cell signaling cascades including Wnt-signaling, induction of apoptosis, cell cycle progression, cell proliferation, migration and invasion, epithelial-mesenchymal transition (EMT), metastasis formation and development of drug-resistance. We here summarize the state-of-the-art of IF affecting the epigenome in major hormone-dependent, urogenital, and gastrointestinal tumor types and in in vivo studies on anti-cancer treatment or developmental aspects, and short-term intervention studies in adults. These data, while often requiring replication, suggest that epigenetic gene regulation represents an important novel target of IF and should be taken into consideration when evaluating the cancer preventive potential of IF in humans.

Improving arithmetic performance with number sense training: An investigation of underlying mechanism

A nonverbal primitive number sense allows approximate estimation and mental manipulations on numerical quantities without the use of numerical symbols. In a recent randomized controlled intervention study in adults, we demonstrated that repeated training on a non-symbolic approximate arithmetic task resulted in improved exact symbolic arithmetic performance, suggesting a causal relationship between the primitive number sense and arithmetic competence. Here, we investigate the potential mechanisms underlying this causal relationship. We constructed multiple training conditions designed to isolate distinct cognitive components of the approximate arithmetic task. We then assessed the effectiveness of these training conditions in improving exact symbolic arithmetic in adults. We found that training on approximate arithmetic, but not on numerical comparison, numerical matching, or visuo-spatial short-term memory, improves symbolic arithmetic performance. In addition, a second experiment revealed that our approximate arithmetic task does not require verbal encoding of number, ruling out an alternative explanation that participants use exact symbolic strategies during approximate arithmetic training. Based on these results, we propose that nonverbal numerical quantity manipulation is one key factor that drives the link between the primitive number sense and symbolic arithmetic competence. Future work should investigate whether training young children on approximate arithmetic tasks even before they solidify their symbolic number understanding is fruitful for improving readiness for math education.