Standard Nutrition Counseling Research Articles

Muscle Status Response to Oral Nutritional Supplementation in Hemodialysis Patients With Protein Energy Wasting: A Multi-Center Randomized, Open Label-Controlled Trial.

Background: Muscle wasting, observed in patients with end-stage kidney disease and protein energy wasting (PEW), is associated with increased mortality for those on hemodialysis (HD). Oral nutritional supplementation (ONS) and nutrition counseling (NC) are treatment options for PEW but research targeting muscle status, as an outcome metric, is limited.Aim: We compared the effects of combined treatment (ONS + NC) vs. NC alone on muscle status and nutritional parameters in HD patients with PEW.Methods: This multi-center randomized, open label-controlled trial, registered under ClinicalTrials.gov (Identifier no. NCT04789031), recruited 56 HD patients identified with PEW using the International Society of Renal Nutrition and Metabolism criteria. Patients were randomly allocated to intervention (ONS + NC, n = 29) and control (NC, n = 27) groups. The ONS + NC received commercial renal-specific ONS providing 475 kcal and 21.7 g of protein daily for 6 months. Both groups also received standard NC during the study period. Differences in quadriceps muscle status assessed using ultrasound (US) imaging, arm muscle area and circumference, bio-impedance spectroscopy (BIS), and handgrip strength (HGS) methods were analyzed using the generalized linear model for repeated measures.Results: Muscle indices as per US metrics indicated significance (p < 0.001) for group × time interaction only in the ONS + NC group, with increases by 8.3 and 7.7% for quadriceps muscle thickness and 4.5% for cross-sectional area (all p < 0.05). This effect was not observed for arm muscle area and circumference, BIS metrics and HGS in both the groups. ONS + NC compared to NC demonstrated increased dry weight (p = 0.039), mid-thigh girth (p = 0.004), serum prealbumin (p = 0.005), normalized protein catabolic rate (p = 0.025), and dietary intakes (p < 0.001), along with lower malnutrition–inflammation score (MIS) (p = 0.041). At the end of the study, lesser patients in the ONS + NC group were diagnosed with PEW (24.1%, p = 0.008) as they had achieved dietary adequacy with ONS provision.Conclusion: Combination of ONS with NC was effective in treating PEW and contributed to a gain in the muscle status as assessed by the US, suggesting that the treatment for PEW requires nutritional optimization via ONS.

Treating high-risk moderate acute malnutrition using therapeutic food compared with nutrition counseling (Hi-MAM Study): a cluster-randomized controlled trial

ABSTRACTBackgroundThere is a lack of consensus on what is the most appropriate treatment of moderate acute malnutrition (MAM).ObjectivesWe aimed to determine if provision of ready-to-use-therapeutic food (RUTF) and antibiotics to “high-risk” MAM (HR-MAM) children in addition to nutritional counseling would result in higher recovery and less deterioration than nutrition counseling alone.MethodsAt the 11 intervention clinics, HR-MAM children were given RUTF and amoxicillin along with standard nutrition counseling, for 2–12 wk. All others received 6 wk of nutrition counseling alone. HR-MAM was defined as midupper arm circumference (MUAC) <11.9 cm, weight-for-age z score (WAZ) <−3.5, mother not the main caregiver, or a child <2 y old not being breastfed. Outcomes were compared using intention-to-treat analysis.ResultsAnalysis included 573 children at the intervention sites and 714 children at the control sites. Of the intervention group, 317 (55%) were classified as HR-MAM. Short-term recovery was greater at the intervention sites [48% compared with 39% at week 12; risk difference (rd): 0.08; 95% CI: 0.03, 0.13]. The intervention group had lower risk of deteriorating to severe acute malnutrition (SAM) (18% compared with 24%; rd: −0.07; 95% CI: −0.11, −0.04), lower risk of dying (1.8% compared with 3.1%; rd: −0.02; 95% CI: −0.03, −0.00), and greater gains in MUAC and weight than did children at the control sites. However, by 24 wk, the risk of SAM was similar between the 2 arms (31% compared with 34%; rd: −0.03; 95% CI: −0.09, 0.02). Control group data identified recent illness, MUAC <12.0 cm, WAZ <−3, dropping anthropometry, age <12 mo, being a twin, and a history of previous SAM as risk factors for deterioration.ConclusionsProvision of RUTF and antibiotics to HR-MAM children improved short-term recovery and reduced short-term risk of deterioration. However, recovery rates were still suboptimal and differences were not sustained by 6 mo post enrollment.This trial was registered at clinicaltrials.gov as NCT03647150.

A combination of Omega-3 PUFAs and COX inhibitors: A novel strategy to manage obesity-linked dyslipidemia and adipose tissue inflammation

We previously reported that fish oil in combination with cyclooxygenase (COX) inhibitors exerts enhanced hypolipidemic and anti-inflammatory effects in mice. Here, we sought to determine the effects of omega-3 polyunsaturated fatty acids (ω-3 PUFAs) in combination with naproxen (NX), a COX inhibitor, on dyslipidemia and gene expression in adipose tissue (AT) in humans. Obese dyslipidemic patients were randomly assigned to one of these interventions for 12 wk: 1) Standard nutrition counseling (control), 2) ω-3 PUFAs (2 g twice daily), 3) NX (220 mg twice daily), and 4) ω-3 PUFAs (2 g twice daily) + NX (220 mg twice daily). The serum triglycerides showed a trend towards a reduction and a significant reduction (P<0.05) in ω-3 and ω3 + NX-treated subjects, respectively, compared to control. The mRNA expression of vascular cell adhesion molecule-1 (Vcam1), an inflammatory marker, increased significantly in AT of ω-3 PUFA-treated subjects but not in ω-3 PUFAs+NX-treated group. The plasma level of glycine-conjugated hyodeoxycholic acid, a secondary bile acid with hypolipidemic property, increased significantly in ω-3 PUFAs + NX-treated group. Our data suggest that combining NX with ω-3 PUFAs increases their effectiveness in reducing serum TG and favorably altering AT gene expression and plasma bile acid profile.

Behavior Change Interventions Delivered through Interpersonal Communication, Agricultural Activities, Community Mobilization, and Mass Media Increase Complementary Feeding Practices and Reduce Child Stunting in Ethiopia

ABSTRACTBackgroundAppropriate infant and young child feeding practices are critical for optimal child growth and development, but in Ethiopia, complementary feeding (CF) practices are very poor. Alive & Thrive (A&T) provided intensive behavior change interventions through 4 platforms: interpersonal communication (IPC), nutrition-sensitive agricultural activities (AG), community mobilization (CM), and mass media (MM).ObjectivesThe aim of this study was to evaluate the impact of A&T intensive compared with nonintensive interventions (standard nutrition counseling and agricultural extension service and less intensive CM and MM) on CF practices and knowledge and child anthropometric outcomes.MethodsWe used a cluster-randomized evaluation design with cross-sectional surveys among households with children aged 6–23.9 mo [n = 2646 at baseline (2015) and n = 2720 at endline (2017)]. We derived difference-in-difference impact estimates (DDEs) and conducted dose–response and path analyses to document plausibility of impacts.ResultsAt endline, exposure to IPC was 17.8–32.3%, exposure to AG was 22.7–36.0%, exposure to CM was 18.6–54.3%, and exposure to MM was 35.4% in the intensive group. Minimum dietary diversity and minimum acceptable diet increased significantly in the intensive group but remained low at endline (24.9% and 18.2%, respectively). Significant differential declines in stunting prevalence were observed (DDE: −5.6 percentage points; P < 0.05) in children aged 6–23.9 mo, decreasing from 36.3% to 22.8% in the intensive group. Dose–response analyses showed higher odds of minimum dietary diversity (OR: 3.3; 95% CI: 2.2, 4.8) and minimum meal frequency (OR: 1.9; 95% CI: 1.4, 2.6) and higher height-for-age z score (HAZ) (β: 0.24; 95% CI: 0.04, 0.4) among women exposed to 3 or 4 platforms. Path analyses showed a strong relation between AG and egg consumption, which led to increased child dietary diversity and HAZ.ConclusionsDelivery of social and behavior change interventions using multiple platforms was feasible and effective, resulting in improvements in CF practices and child stunting within a 2-y period. There is a need for continued efforts, however, to expand intervention coverage and to improve CF practices in Ethiopia. This trial was registered at clinicaltrials.gov as NCT02775552.

Large-Scale Social and Behavior Change Communication Interventions Have Sustained Impacts on Infant and Young Child Feeding Knowledge and Practices: Results of a 2-Year Follow-Up Study in Bangladesh

BackgroundSustained improvements in infant and young child feeding (IYCF) require continued implementation of effective interventions. From 2010–2014, Alive & Thrive (A&T) provided intensive interpersonal counseling (IPC), community mobilization (CM), and mass media (MM) in Bangladesh, demonstrating impact on IYCF practices. Since 2014, implementation has been continued and scaled up by national partners with support from other donors and with modifications such as added focus on maternal nutrition and reduced program intensity.ObjectiveWe assessed changes in intervention exposure and IYCF knowledge and practices in the intensive (IPC + CM + MM) compared with nonintensive areas (standard nutrition counseling + less intensive CM and MM) 2 y after termination of initial external donor support.MethodsWe used a cluster-randomized design with repeated cross-sectional surveys at baseline (2010, n = 2188), endline (2014, n = 2001), and follow-up (2016, n = 2400) in the same communities, among households with children 0–23.9 mo of age. Within-group differences over time and differences between groups in changes were tested.ResultsIn intensive areas, exposure to IPC decreased slightly between endline and follow-up (88.9% to 77.2%); exposure to CM activities decreased significantly (29.3% to 3.6%); and MM exposure was mostly unchanged (28.1–69.1% across 7 TV spots). Exposure to interventions did not expand in nonintensive areas. Most IYCF indicators in intensive areas declined from endline to follow-up, but remained higher than at baseline. Large differential improvements of 12–17 percentage points in intensive, compared with nonintensive areas, between baseline and follow-up remained for early initiation of and exclusive breastfeeding, timely introduction of foods, and consumption of iron-rich foods. Differential impact in breastfeeding knowledge remained between baseline and follow-up; complementary feeding knowledge increased similarly in both groups.ConclusionsContinued IPC exposure and sustained impacts on IYCF knowledge and practices in intensive areas indicated lasting benefits from A&T's interventions as they underwent major scale-up with reduced intensity. This trial was registered at clinicaltrials.gov as NCT02740842.

Changes in weight, physical activity and its theory-based psychosocial correlates within an adolescent bariatric clinic: contrasts with adults with extreme obesity.

Albeit their practical implications, psychosocial correlates of physical activity and related weight loss in the treatment of extreme obesity have been only sparsely addressed in adults; and even more minimally focused upon in adolescents. This research contrasted results of a 6-month social cognitive theory-based physical activity-support protocol along with standard nutrition counseling in groups of adolescents (n = 19; agemean = 15.4 years) and adults (n = 26, agemean = 44.7 years) with class 3 (extreme) obesity [overall body mass index (BMI)mean = 53.4 kg/m2, standard deviation (SD) = 8.2]. Although baseline total mood disturbance scores were significantly greater in both groups when contrasted with age-corresponding normative values, between-group scores did not significantly differ. BMI and physical activity changes over 3 and 6 months were significantly more favorable in the adult group. There were significant overall improvements in exercise self-efficacy, physical activity self-regulation and total mood disturbance scores, however, the self-efficacy and self-regulation increases were significant in only the adult group. Inverse relationships between changes in physical activity and BMI were stronger in the adult group. Regardless of group, simultaneous entry of changes in exercise self-efficacy, physical activity self-regulation and total mood disturbance scores, over both 3 and 6 months, significantly predicted physical activity changes (R2-values = 0.45-0.75, p-values < 0.001). In each model, self-regulation change was the most salient of those three psychosocial predictors. Although findings suggested that psychosocial correlates of physical activity, leading to weight change, are similar in adolescents and adults with extreme obesity, facilitation of larger effect sizes and/or foci on additional theory-based determinants may be required for clinically meaningful treatment outcomes in adolescents.

Integrating Nutrition Interventions into an Existing Maternal, Neonatal, and Child Health Program Increased Maternal Dietary Diversity, Micronutrient Intake, and Exclusive Breastfeeding Practices in Bangladesh: Results of a Cluster-Randomized Program Evaluation

Background: Maternal undernutrition is a major concern globally, contributing to poor birth outcomes. Limited evidence exists on delivering multiple interventions for maternal nutrition simultaneously. Alive & Thrive addressed this gap by integrating nutrition-focused interpersonal counseling, community mobilization, distribution of free micronutrient supplements, and weight-gain monitoring through an existing Maternal, Neonatal, and Child Health (MNCH) program in Bangladesh.Objectives: We evaluated the effect of providing nutrition-focused MNCH compared with standard MNCH (antenatal care with standard nutrition counseling) on coverage of nutrition interventions, maternal dietary diversity, micronutrient supplement intake, and early breastfeeding practices.Methods: We used a cluster-randomized design with cross-sectional surveys at baseline (2015) and endline (2016) (n ∼ 300 and 1000 pregnant or recently delivered women, respectively, per survey round). We derived difference-in-difference effect estimates, adjusted for geographic clustering and infant age and sex.Results: Coverage of interpersonal counseling was high; >90% of women in the nutrition-focused MNCH group were visited at home by health workers for maternal nutrition and breastfeeding counseling. The coverage of community mobilization activities was ∼50%. Improvements were significantly greater in the nutrition-focused MNCH group than in the standard MNCH group for consumption of iron and folic acid [effect: 9.8 percentage points (pp); 46 tablets] and calcium supplements (effect: 12.8 pp; 50 tablets). Significant impacts were observed for the number of food groups consumed (effect: 1.6 food groups), percentage of women who consumed ≥5 food groups/d (effect: 30.0 pp), and daily intakes of several micronutrients. A significant impact was also observed for exclusive breastfeeding (EBF; effect: 31 pp) but not for early initiation of breastfeeding.Conclusions: Addressing nutrition during pregnancy by delivering interpersonal counseling and community mobilization, providing free supplements, and ensuring weight-gain monitoring through an existing MNCH program improved maternal dietary diversity, micronutrient supplement consumption, and EBF practices. This trial was registered at clinicaltrials.gov as NCT02745249.

Impact on psychosocial outcomes of a nationally available weight management program tailored for individuals with type 2 diabetes: Results of a randomized controlled trial

AimsType 2 diabetes mellitus (T2DM) can substantially decrease quality of life (QOL). This study examined the effects on QOL-relevant psychosocial measures of a widely available commercial weight loss program enhanced for individuals with T2DM. MethodsA year-long multi-site randomized clinical trial compared the Weight Watchers (WW) approach, supplemented with phone and email counseling with a certified diabetes educator (CDE), to brief standard diabetes nutrition counseling and education (Standard Care; SC). Participants were 400 women and 163 men (N=279 WW; 284 SC) with T2DM [mean (±SD) HbA1c 8.32±1%; BMI=37.1±5.7kg/m2; age=55.1 ± 9.1years]. Psychosocial outcomes were assessed at baseline, month 6, and month 12 using a diabetes specific psychosocial measure (Diabetes Distress Scale [DDS]), Impact of Weight on Quality of Life-Lite scale (IWQOL), a generic QOL measure (SF-36), and a depression screen (PHQ-9). ResultsWW participants showed significantly greater improvements than did SC participants on all DDS subscales and total score and on IWQOL total score and physical function, sex life and work domains (all ps<.05). There was no significant treatment effect on SF-36 scores or PHQ-9. ConclusionsWW enhanced for individuals with T2DM was superior to SC in improving psychosocial outcomes most specific to T2DM and obesity. Available commercial WL programs, combined with scalable complementary program-specific diabetes counseling, may have benefits that extend to diabetes-related distress and weight-relevant QOL.

Randomized controlled trial of a nationally available weight control program tailored for adults with type 2 diabetes.

Modest weight loss from clinical interventions improves glycemic control in type 2 diabetes (T2DM). Data are sparse on the effects of weight loss via commercial weight loss programs. This study examined the effects on glycemic control and weight loss of the standard Weight Watchers program, combined with telephone and email consultations with a certified diabetes educator (WW), compared with standard diabetes nutrition counseling and education (standard care, SC). In a 12-month randomized controlled trial at 16 U.S. research centers, 563 adults with T2DM (HbA1c 7-11%; BMI 27-50 kg/m2 ) were assigned to either the commercially available WW program (regular community meetings, online tools), plus telephone and email counseling from a certified diabetes educator, or to SC (initial in-person diabetes nutrition counseling/education, with follow-up informational materials). Follow-up rate was 86%. Twelve-month HbA1c changes for WW and SC were -0.32 and +0.16, respectively; 24% of WW versus 14% of SC achieved HbA1c <7.0% (P = 0.004). Weight losses were -4.0% for WW and -1.9% for SC (Ps < 0.001). 26% of WW versus 12% of SC reduced diabetes medications (P < 0.001). WW participants had greater reductions in waist circumference (P < 0.001) and C-reactive protein (P = 0.02) but did not differ on other cardiovascular risk factors. Widely available commercial weight loss programs with community and online components, combined with scalable complementary diabetes education, may represent accessible and effective components of management plans for adults with overweight/obesity and T2DM.

Impacts on Breastfeeding Practices of At-Scale Strategies That Combine Intensive Interpersonal Counseling, Mass Media, and Community Mobilization: Results of Cluster-Randomized Program Evaluations in Bangladesh and Viet Nam.

BackgroundDespite recommendations supporting optimal breastfeeding, the number of women practicing exclusive breastfeeding (EBF) remains low, and few interventions have demonstrated implementation and impact at scale. Alive & Thrive was implemented over a period of 6 y (2009–2014) and aimed to improve breastfeeding practices through intensified interpersonal counseling (IPC), mass media (MM), and community mobilization (CM) intervention components delivered at scale in the context of policy advocacy (PA) in Bangladesh and Viet Nam. In Bangladesh, IPC was delivered through a large non-governmental health program; in Viet Nam, it was integrated into government health facilities. This study evaluated the population-level impact of intensified IPC, MM, CM, and PA (intensive) compared to standard nutrition counseling and less intensive MM, CM, and PA (non-intensive) on breastfeeding practices in these two countries.Methods and FindingsA cluster-randomized evaluation design was employed in each country. For the evaluation sample, 20 sub-districts in Bangladesh and 40 communes in Viet Nam were randomized to either the intensive or the non-intensive group. Cross-sectional surveys (n ~ 500 children 0–5.9 mo old per group per country) were implemented at baseline (June 7–August 29, 2010, in Viet Nam; April 28–June 26, 2010, in Bangladesh) and endline (June 16–August 30, 2014, in Viet Nam; April 20–June 23, 2014, in Bangladesh). Difference-in-differences estimates (DDEs) of impact were calculated, adjusting for clustering. In Bangladesh, improvements were significantly greater in the intensive compared to the non-intensive group for the proportion of women who reported practicing EBF in the previous 24 h (DDE 36.2 percentage points [pp], 95% CI 21.0–51.5, p < 0.001; prevalence in intensive group rose from 48.5% to 87.6%) and engaging in early initiation of breastfeeding (EIBF) (16.7 pp, 95% CI 2.8–30.6, p = 0.021; 63.7% to 94.2%). In Viet Nam, EBF increases were greater in the intensive group (27.9 pp, 95% CI 17.7–38.1, p < 0.001; 18.9% to 57.8%); EIBF declined (60.0% to 53.2%) in the intensive group, but less than in the non-intensive group (57.4% to 40.6%; DDE 10.0 pp, 95% CI −1.3 to 21.4, p = 0.072). Our impact estimates may underestimate the full potential of such a multipronged intervention because the evaluation lacked a “pure control” area with no MM or national/provincial PA.ConclusionsAt-scale interventions combining intensive IPC with MM, CM, and PA had greater positive impacts on breastfeeding practices in Bangladesh and Viet Nam than standard counseling with less intensive MM, CM, and PA. To our knowledge, this study is the first to document implementation and impacts of breastfeeding promotion at scale using rigorous evaluation designs. Strategies to design and deliver similar programs could improve breastfeeding practices in other contexts.Trial registrationClinicalTrials.gov NCT01678716 (Bangladesh) and NCT01676623 (Viet Nam)

Combining Intensive Counseling by Frontline Workers with a Nationwide Mass Media Campaign Has Large Differential Impacts on Complementary Feeding Practices but Not on Child Growth: Results of a Cluster-Randomized Program Evaluation in Bangladesh

Background: Complementary feeding (CF) contributes to child growth and development, but few CF programs are delivered at scale. Alive & Thrive addressed this in Bangladesh through intensified interpersonal counseling (IPC), mass media (MM), and community mobilization (CM).Objective: The objective was to evaluate the impact of providing IPC + MM + CM (intensive) compared with standard nutrition counseling + less intensive MM + CM (nonintensive) on CF practices and anthropometric measurements.Methods: We used a cluster-randomized, nonblinded evaluation with cross-sectional surveys [n = ∼600 and 1090 children 6–23.9 mo and 24–47.9 mo/group, respectively, at baseline (2010) and n = ∼500 and 1100 children of the same age, respectively, at endline (2014)]. We derived difference-in-difference impact estimates (DDEs), adjusting for geographic clustering, infant age, sex, differences in baseline characteristics, and differential change in characteristics over time.Results: Groups were similar at baseline. CF improvements were significantly greater in the intensive than in the nonintensive group [DDEs: 16.3, 14.7, 22.0, and 24.6 percentage points (pp) for minimum dietary diversity, minimum meal frequency, minimum acceptable diet, and consumption of iron-rich foods, respectively]. In the intensive group, CF practices were high: 50.4% for minimum acceptable diet, 63.8% for minimum diet diversity, 75.1% for minimum meal frequency, and 78.5% for consumption of iron-rich foods. Timely introduction of foods improved. Significant, nondifferential stunting declines occurred in intensive (6.2 pp) and nonintensive (5.2 pp) groups in children 24–47.9 mo.Conclusions: The intensive program substantially improved CF practices compared with the nonintensive program. Large-scale program delivery was feasible and, with the use of multiple platforms, reached 1.7 million households. Nondifferential impacts on stunting were likely due to rapid positive secular trends in Bangladesh. Accelerating linear growth further could require accompanying interventions. This study establishes proof of concept for large-scale behavior change interventions to improve child feeding. This trial was registered at clinicaltrials.gov as NCT01678716.

A Large‐Scale Behavior Change Initiative to Improve Infant and Young Child Feeding Had Positive Impact on Language and Motor Development in Bangladesh

Promotion of adequate nutrition early in life through interventions aimed at improving infant and young child feeding (IYCF) has the potential to contribute to motor, cognitive, and social‐emotional development. This study evaluated this potential in Bangladesh where IYCF interventions were implemented in 300 sub‐districts through the Alive &amp; Thrive (A&amp;T) initiative.A cluster‐randomized, non‐blinded, impact evaluation design was employed comparing two intervention packages i.e., intensive interpersonal counseling on IYCF, mass media, and community mobilization vs. non‐intensive standard nutrition counseling and mass media. Twenty sub‐districts were randomized to either intensive or non‐intensive intervention areas. Cross‐sectional household surveys were conducted at baseline (2010) and four years later (2014) in the same communities. About 4,000 children aged 0–47.9 months in Bangladesh were surveyed at baseline and endline. Language development was measured with 21 items in which the mother was asked if her child had reached each milestone, ordered from least advanced to most advanced, resulting in a score from 0 to 21. Gross motor development was measured through mother report and observation with 29 ordered items, resulting in a score from 0 to 29. We derived difference‐in‐difference impact estimates using fixed‐effects regression models that assessed differences between the two intervention packages over time, adjusting for geographic clustering, infant age, gender, and covariates that differed between packages from baseline to endline.The difference‐in‐difference in language development scores between intensive and non‐intensive areas was 1.07 (p&lt;0.001) among children 6–23.9 months and 0.78 (p&lt;0.10) among children 24–47.9 months. For motor development, the difference‐in‐difference was 0.84 (p&lt;0.10) among 6–23.9 month old children. From baseline to endline, the program had positive impact on language development among children 6–23.9 months (increase of 0.92 for intensive vs. decrease of 0.37 for non‐intensive) and a protective effect among children 24–47.9 months (increase of 0.07 for intensive vs. decrease of 0.87 for non‐intensive).The large‐scale intensive package in Bangladesh had substantial, significant impact on breastfeeding and complementary feeding practices (reported elsewhere). The intensive package, which promoted active, responsive feeding and strategies to manage poor appetite, had significant impact on language development and a marginally significant impact on motor development. Pathways to better development could include greater dietary diversity, more frequent feeding, and/or more effective strategies to manage poor appetite (all three could result in greater nutrient intake) and/or greater caregiver engagement with the child. Thus, both nutritional and behavioral mechanisms could be responsible for the improvements in child development; these mechanisms should be further studied.Support or Funding InformationFunding: Bill &amp; Melinda Gates Foundation, through Alive &amp; Thrive, managed by FHI 360; CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), led by the International Food Policy Research Institute (IFPRI)

Family Intervention for Obese/Overweight Children Using Portion Control Strategy (FOCUS) for Weight Control: A Randomized Controlled Trial.

Nutritional counseling for children with obesity is an important component of management. This randomized controlled trial was conducted to compare change in body mass index (BMI) z score after 6 months. Children 8 to 16 years with a BMI greater than the 85th percentile were randomized to standard of care nutrition counseling versus intervention with standard nutrition counseling including portion control tool training for the family. Measures were completed at baseline, 3 months, and 6 months. Fifty-one children were randomized to control and 48 to intervention. Mean age was 11 years (SD = 2.2). Mean BMI z score was 2.7 (SD = 0.4). Forty-five percent were male (n = 45). Follow-up at 6 months was 73.7% (73/99). Although no differences were seen between the groups, there was a significant decrease in BMI z score between baseline and 6 months within each group.

Abstract 19144: Fish Oil and Cyclooxygenase Inhibitors: a Novel Strategy to Manage Obesity-linked Dyslipidemia

Introduction: Dyslipidemia is a prevalent condition in obesity and type 2 diabetes. Although fish oil rich in omega-3 fatty acids (ω-3) is a widely used hypolipidemic agent, it is often required at high doses. At high doses, these fatty acids can induce oxidative stress or endothelial activation and therefore, strategies to improve their beneficial effects are needed. We previously reported that fish oil in combination with cyclooxygenase (COX) inhibitors exerts enhanced hypolipidemic and anti-inflammatory effects in low density lipoprotein receptor knock-out mice. Here, we sought to determine the effects of ω-3 fatty acids in combination with naproxen (NX), a COX inhibitor, on dyslipidemia and gene expression in subcutaneous adipose tissue (scAT) in humans. Methods: Obese dyslipidemic patients were randomly assigned to receive one of these interventions (n=8/group) for 12 wk: 1) Standard nutrition counseling (control), 2) ω-3 (2 g twice daily), 3) NX (220 mg twice daily), and 4) ω-3 (2 g twice daily) + NX (220 mg twice daily). Results: The body mass index, HOMA-IR, and plasma total, LDL, and HDL cholesterol levels were not altered significantly in any of the groups. The percent change in plasma triglycerides (TG) from baseline was 75% ( P &lt;0.1) and 68% ( P &lt;0.05) in ω-3 and ω3 + NX-treated subjects, respectively. Notably, 25% of subjects who received ω-3s alone did not show a reduction in TG whereas all the patients that received ω-3 + NX showed a reduction in TG. Realtime PCR analysis of scAT showed that the expression of glucose transporter 4 (GLUT-4), a marker of glucose uptake and a key regulator of glucose homeostasis was significantly reduced in ω-3 compared to control group ( P &lt;0.01). However, combining NX with ω-3 abolished this effect. Moreover, the expression of MCP-1 and VCAM-1, markers of inflammatory response or endothelial activation, was significantly increased in ω-3 but not in ω-3 + NX group. The plasma levels of MCP-1 and E-selectin did not vary significantly in any of the groups. Conclusions: Our data reveal previously unrecognized effects of fish oil in scAT. Our data suggest that combining NX with ω-3 fatty acids will increase their effectiveness in reducing plasma TG and improve the benefits of ω-3 supplements by favorably altering gene expression in scAT.

Effect of 8-Week Nutrition Counseling to Increase Phytochemical Rich Fruit and Vegetable Consumption in Korean Breast Cancer Patients: A Randomized Controlled Trial

High fruit and vegetable consumption is associated with a lower risk of breast cancer. The incidence of breast cancer is continuously increasing in Korea, but only a few studies on nutrition intervention in breast cancer patients has been reported. The aim of this study was to investigate whether an 8-week nutrition intervention based on dietary counseling can promote fruit and vegetable consumption, increase serum antioxidant nutrient levels, and improve quality of life in Korean breast cancer patients. Sixty-one breast cancer patients received either standard care (n = 31) or nutrition counseling (n = 30). The standard care group was given brochures recommending phytochemical rich diet. The intervention group was provided with two nutrition counseling sessions and one cooking class session, thereby encouraged subjects to eat at least 10 or more servings of fruits and vegetables per day. After 8-week intervention, waist circumference in the intervention group was significantly decreased (p < 0.001) even though no difference was reported for body mass index. Energy intake (p = 0.007), fiber (p < 0.001), and antioxidant nutrient (vitamin A, C, E, and β-carotene, p < 0.001, respectively) intakes were significantly increased. Serum antioxidant level was also increased significantly, i.e., vitamin A (p = 0.048); vitamin E (p = 0.004). Total vegetable intake (excluding kimchi intake) in the intervention group was increased from 425 g to 761 g (p < 0.001), fruit consumption was also increased from 232 g to 334 g (p < 0.001), while standard care group did not show any significant change. Our study showed that nutrition counseling and providing cooking tips helped to encourage the patient to consume and maintain more fruit and vegetable intakes.

THE GROWTH OF HYPERCHOLESTEROLEMIC CHILDREN DURING DIET INTERVENTION † 511

To evaluate the efficacy and safety of nutrition education for hyperchlesterolemic children, 261 3.9-9.9 year old children with elevated LDL-cholesterol (LDL-C) levels were randomly assigned to an innovative, home-based nutrition education program, standard nutrition counseling, or to an At-Risk Control group. A Not-At-Risk Control group of children with normal cholesterol levels was also recruited (n=81). Height, weight, skinfold measures and dietary intake were evaluated at baseline, 3, 6 and 12 months. At baseline the children were ingesting 29.2-29.9% and 11.1-11.7% calories as fat and saturated fat respectively. The intervention groups demonstrated significant decreases in fat and saturated fat intake after the interventions. At baseline, height z-score (ht-z) and weight z-score (wt-z) were associated with caloric intake, while weight-for-height median (WHM) was associated with fat intake. Wt-z, ht-z, WHM, and the sum of the four skinfolds (total skin) did not vary between the treatment groups over the year. No association between fat intake and wt-z, ht-z, WHM or total skin over time was observed. These results support the safety, with respect to sustaining comparable growth rates, of physician-initiated dietary intervention for hypercholesterolemic children.

ONE YEAR FOLLOW-UP OF NUTRITION EDUCATION FOR HYPERCHOLESTEROLEMIC CHILDREN† 581

The efficacy of an innovative home-based, physician-initiated parent-child autotutorial nutrition education program (PCAT) and of standard nutrition counseling for hypercholesterolemic children were evaluated. Two-hundred-sixty-one 3.9-9.9 year old children with elevated LDL cholesterol(LDL-C) levels were randomly assigned to one of the nutrition interventions, or to an At-Risk Control group. A Not-At-Risk Control group of children with normal cholesterol levels was also recruited (n=81). The change in knowledge of heart healthy foods, dietary intake, and (for the At-Risk groups only) blood lipid levels were evaluated at 3, 6 and 12 months post-baseline. The PCAT group exhibited a significant initial increase in knowledge of heart healthy foods, which was fully retained. The PCAT and Counseling groups lowered their total fat and saturated fat intake throughout the year. The PCAT group's decrease in LDL-C level at 3 months reached borderline significance, when compared to the At-Risk Control group. This trial demonstrated that knowledge and dietary change can be affected and retained via an innovative home-based nutrition intervention for children, though some form of ongoing intervention may be necessary to produce lasting decreases in LDL-C level.