Nutrition-based Interventions Research Articles

A midpoint process evaluation of the Los Angeles Basin Racial and Ethnic Approaches to Community Health Across the US (REACH US) Disparities Center, 2007-2009.

Racial/ethnic minority groups have higher risks for disease resulting from obesity. The University of California, Los Angeles, and the Los Angeles County Department of Public Health partnered with community organizations to disseminate culturally targeted physical activity and nutrition-based interventions in worksites. We conducted community dialogues with people from 59 government and nonprofit health and social service agencies to develop wellness strategies for implementation in worksites. Strategies included structured group exercise breaks and serving healthy refreshments at organizational functions. During the first 2 years, we subcontracted with 6 community-based organizations (primary partners) who disseminated these wellness strategies to 29 organizations within their own professional networks (secondary worksites) through peer modeling and social support. We analyzed data from the first 2 years of the project to evaluate our dissemination approach. Primary partners had difficulty recruiting organizations in their professional network as secondary partners to adopt wellness strategies. Within their own organizations, primary partners reported significant increases in implementation in 2 of the 6 core organizational strategies for promoting physical activity and healthy eating. Twelve secondary worksites that completed organizational assessments on 2 occasions reported significant increases in implementation in 4 of the 6 core organizational strategies. Dissemination of organizational wellness strategies by trained community organizations through their existing networks (train-the-trainer) was only marginally successful. Therefore, we discontinued this dissemination approach and focused on recruiting leaders of organizational networks.

Dietary conjugated linoleic acid and n-3 polyunsaturated fatty acids in inflammatory bowel disease

Inflammatory bowel disease (IBD) is a debilitating and widespread immune-mediated illness of unknown etiology. Current treatments are modestly successful and with significant side-effects. The purpose of this review is to summarize the current understanding of mechanisms of action underlying the anti-inflammatory actions of conjugated linoleic acid (CLA) and n-3 polyunsaturated fatty acids (PUFAs) in IBD. Nutrition-based interventions that target peroxisome proliferator-activated receptors (PPARs) such as dietary CLA and n-3 PUFA have demonstrated anti-inflammatory efficacy in animal models of IBD. Clinical data on n-3 PUFA in IBD remains generally unimpressive, although results of a recent human study demonstrate that IBD remission can be maintained by maintaining the n-3: n-6 ratio more than 0.65 via n-3 PUFA intervention. In mice, CLA prevented inflammation-driven colorectal cancer by activating PPAR gamma and modulating regulatory T cells and macrophages. CLA is the subject of an ongoing clinical study in Crohn's disease patients. Compelling evidence demonstrates that n-3 PUFA and CLA prevent or ameliorate IBD in animal models. However, this basic knowledge has not been translated into novel nutrition-based clinical interventions. For both compounds there is an urgent need for placebo-controlled, large-scale, multicenter clinical trials.

Modelling Lipid Metabolism to Improve Healthy Ageing

Lipid metabolism has a key role in human longevity and healthy ageing. This has been demonstrated by a recent genetic study examining the lipoprotein phenotype in individuals with exceptional longevity, in a population of Ashkenazi Jews [1]. It is highly probable such subjects with exceptional longevity, have avoided cardiovascular disease (CVD). CVD is the primary cause of mortality in developed countries. Among the risk factors for CVD, elevated plasma cholesterol has consistently stood out. In response, the pharmaceutical industry has produced a wide range of agents for lowering plasma cholesterol. These work well, but are generally expensive and may pose further health problems. It is therefore important that novel, effective and risk-free ways are developed to control elevated plasma cholesterol. The goal of our work, is to use mathematical modelling to infer nutrition-based interventions, which may help to prevent the dysregulation of lipid metabolism that leads to CVD. Furthermore we are aiming to gain a better understanding of how disease-free ageing can be extended. To do this we are developing a model of cholesterol homeostasis. With the model we can monitor changes in the state of key variables, such as LDL-cholesterol. The model definition is being developed using Systems Biology Markup Language (SBML).

Marital Interactions in the Process of Dietary Change for Type 2 Diabetes

Objective To explore how couples adjust to dietary management of type 2 diabetes. Design Couples were interviewed, first together and then separately, during the first year after diagnosis and 1 year later. Setting Qualitative interviews conducted in hospital classrooms using a semistructured interview guide. Participants Couples (N = 20) with a recently diagnosed spouse who met the study criteria were purposefully selected from volunteers solicited from hospital-based diabetes classes. Phenomenon of Interest Processes used by the couple to address the prescribed diet. Analysis Thematic analysis of interview transcripts using grounded theory to identify patterns of adaptation processes used over time. Results Three couple categories emerged (cohesive, enmeshed, and disengaged), representing adaptation to the diabetic diet. Initially, 5 couples were cohesive (teamwork approach), 7 were enmeshed (nondiabetic spouse responsible for the diet; spouse was dependent), and 8 were disengaged (spouses functionally separate; spouse was solely responsible for the diet management). A year later, the majority of couples were disengaged (n = 14), 1 couple remained cohesive, and 4 couples remained enmeshed. Themes of flexibility, roles, rules, and communication varied across categories. Conclusions and Implications Understanding categories of marital adjustment to the diabetic diet may improve nutrition-based diabetes interventions. Further study is needed to verify these findings in larger and more diverse populations.

Nutrition and low birth weight: from research to practice

Low birth weight (LBW) remains a significant public health problem in many developing countries, and poor nutrition both before and during pregnancy is recognized as an important cause. Emerging evidence on the role of intergenerational effects in determining maternal preconceptual nutritional status indicates the need for continued investment in strategies that improve women's nutrition and health throughout the life cycle, especially during the early years. Controlled trials have shown that improving food intakes during pregnancy effectively reduces LBW, but programs have been less successful because these interventions are expensive and difficult to manage. Multivitamin-mineral supplements have been viewed as a simpler solution, but 2 of 3 controlled trials conducted to date failed to show that multivitamin-mineral supplements are more effective than are iron-folate supplements, which are already the standard of care during pregnancy. Emerging evidence indicating the benefits of iron supplements in improving birth weight illustrate the need for increased efforts to reduce iron deficiency by improving coverage of antenatal programs and promoting fortification. Other causes of LBW include environmental factors, such as smoking; indoor air pollution; and infections, such as malaria. However, little is known about the interactions between nutrition and infection. Underlying social factors, such as poverty and women's status, are also important, especially in South Asia, where more than one-half of the world's LBW infants are born. In summary, strategies that combine nutrition-based interventions, such as improving food intakes and micronutrient status, especially iron status, with approaches that improve women's status and reproductive health are needed to reduce LBW.

Recent implications of weight loss in lung cancer management.

Successful lung cancer management has been hindered by the limited efficacy of dietary and pharmacologic interventions to prevent or reverse cancer-associated weight loss. The addition of total parenteral nutrition to chemotherapy in early trials was associated with survival detriment. Dietary counseling and enteral supplement use are common strategies that, when evaluated in randomized trials, do not improve anthropometrics or clinical outcome in lung cancer. Pharmacologic agents including corticosteroids, cyproheptadine, growth hormone, hydrazine sulfate, dronabinol, and pentoxyphylline also have failed to improve even anthropometric parameters in this condition. Megestrol acetate use is associated with appetite stimulation and non-fluid weight gain but, when evaluated in small cell lung cancer patients receiving defined chemotherapy, failed to improve global quality of life, and survival and was associated with toxicity. New strategies for nutrition-based interventions in lung cancer cachexia must consider their potential influence on tumor growth as well as on nutritional status. Recent lung cancer prognostic analyses have identified gender differences in outcome and weight loss that suggest potential targets for combined hormonal and nutrition interventions. Emerging information regarding the influence of specific fatty acids on tumor growth and cachexia development have identified additional approaches for future evaluation.

Recent implications of weight loss inlung cancer management

Successful lung cancer management has been hindered by the limited efficacy of dietary and pharmacologic interventions to prevent or reverse cancer-associated weight loss. The addition of total parenteral nutrition to chemotherapy in early trials was associated with survival detriment. Dietary counseling and enteral supplement use are common strategies that, when evaluated in randomized trials, do not improve anthropometrics or clinical outcome in lung cancer. Pharmacologic agents including corticosteroids, cyproheptadine, growth hormone, hydrazine sulfate, dronabinol, and pentoxyphylline also have failed to improve even anthropometric parameters in this condition. Megestrol acetate use is associated with appetite stimulation and non-fluid weight gain but, when evaluated in small cell lung cancer patients receiving defined chemotherapy, failed to improve global quality of life, and survival and was associated with toxicity. New strategies for nutrition-based interventions in lung cancer cachexia must consider their potential influence on tumor growth as well as on nutritional status. Recent lung cancer prognostic analyses have identified gender differences in outcome and weight loss that suggest potential targets for combined hormonal and nutrition interventions. Emerging information regarding the influence of specific fatty acids on tumor growth and cachexia development have identified additional approaches for future evaluation.