Trend Of Weight Gain Research Articles

Abstract 003: Change in Cardiovascular Risk Factors Associated with Weight Gain in the Dallas Heart Study

Background: Concerning trends in weight gain from 2000-2009 exist in the Dallas Heart Study (DHS), a probability-based sample of Dallas County residents aged 30-65. However, the impact of significant weight gain (≥ 5% increase in body weight) on cardiovascular risk factors (CVRF) in this contemporary, multi-ethnic population is not known. Methods: We measured weight, LDL-c, blood pressure (SBP and DBP), and fasting glucose (FG) in 2,022 DHS participants (58% female) at study entry in 2000 and in 2009. Using logistic regression stratified by sex and race/ethnicity, we determined the age-adjusted odds of worsening CVRF (any increase in LDL-c, SBP, DBP or FG) for people who gained significant weight compared to those who did not. Results: Among women, 43% (N=500) gained significant weight, compared to 42% of men (N=355). Despite similar average weight gain (9.7±5.8 kg for women vs. 10±5.6 kg for men, p=0.4), women who gained significant weight had almost twice as large an increase in LDL-c (14±34 vs. 8±39 mg/dl, p=0.01) and SBP (12±18 vs. 6±19 mmHg, p<0.001) compared with men who gained significant weight. Increases in DBP (5±10 vs. 4±11 mmHg, p=0.05) and FG (4±29 vs. 2±32 mg/dl, p=0.30) were not significantly different between men and women. Among those with significant weight gain who were not on medications, SBP and LDL-c increases were higher in women compared with men (p<0.05). Differences in the amount of weight gained stratified by race and sex were modest (Table). Black women who gained significant weight were likely to have a worsening of all CVRF, while Hispanic women had the highest likelihood of having an increase in SBP associated with weight gain. In contrast, significant weight gain among men was not associated with worsening CVRF. Conclusions: Significant weight gain was associated with a deleterious impact on CVRF among women but not men. Disparate effects of weight gain between men and women highlight the importance of targeting aggressive weight control interventions toward women to help prevent adverse cardiac outcomes.

Preventing Excessive Weight Gain among Publicly Insured Pregnant Women

The purpose of this study is to develop an intervention to help women meet weight gain goals during pregnancy. From 2007 to 2008, pregnant women were recruited at a clinic in Chicago. Intervention participants received an educational pamphlet at their first prenatal visit. At follow up visits, provider counseling was encouraged via a weight gain trend graph and targeted feedback checklist. The primary outcome was the total weight gained over the course of prenatal care. We analyzed 57 intervention group participants and 109 controls. Demographic composition was similar between the groups except for parity. Patients in the intervention group and routine care group gained similar weight (24.5 + 13.5 lb vs. 25.3 + 14.0 lb, P = 0.71). After controlling for baseline weight, the intervention was associated with 4.6 pounds lower follow-up weight (P = 0.029). After controlling for baseline BMI and other covariates, participants who received the intervention were only 34% as likely to gain weight exceeding IOM guidelines (P = 0.009). This pilot prenatal care obesity prevention project was associated with lower weight gain in pregnancy. The feedback checklist, weight gain graph, and educational pamphlet on weight gain proved to be favorable components of this project and merit further examination in a larger intervention trial.

The Unequal Burden of Weight Gain: An Intersectional Approach to Understanding Social Disparities in BMI Trajectories from 1986 to 2001/2002

The implications of recent weight gain trends for widening social disparities in body weight in the United States are unclear. Using an intersectional approach to studying inequality, and the longitudinal and nationally representative American's Changing Lives study (19862001/2002), we examine social disparities in body mass index trajectories during a time of rapid weight gain in the United States. Results reveal complex interactive effects of gender, race, socioeconomic position and age, and provide evidence for increasing social disparities, particularly among younger adults. Most notably, among individuals who aged from 25-39 to 45-54 during the study interval, low-educated and low-income black women experienced the greatest increase in BMI, while high-educated and high-income white men experienced the least BMI growth. These new findings highlight the importance of investigating changing disparities in weight intersectionally, using multiple dimensions of inequality as well as age, and also presage increasing BMI disparities in the U.S. adult population.

Secular Trends in Maternal Prepregnancy BMI and Gestational Weight Gain Over A 15 Year Period in Greece

Secular Trends in Maternal Prepregnancy BMI and Gestational Weight Gain Over A 15 Year Period in Greece

The influence of caffeine on energy content of sugar-sweetened beverages: ‘the caffeine–calorie effect’

Caffeine is a mildly addictive psychoactive chemical and controversial additive to sugar-sweetened beverages (SSBs). The objective of this study is to assess if removal of caffeine from SSBs allows co-removal of sucrose (energy) without affecting flavour of SSBs, and if removal of caffeine could potentially affect population weight gain. The research comprised of three studies; study 1 used three-alternate forced choice and paired comparison tests to establish detection thresholds for caffeine in water and sucrose solution (subjects, n=63), and to determine if caffeine suppressed sweetness. Study 2 (subjects, n=30) examined the proportion of sucrose that could be co-removed with caffeine from SSBs without affecting the flavour of the SSBs. Study 3 applied validated coefficients to estimate the impact on the weight of the United States population if there was no caffeine in SSBs. Detection threshold for caffeine in water was higher (1.09 ± 0.08 mM) than the detection threshold for caffeine in sucrose solution (0.49 ± 0.04 mM), and a paired comparison test revealed caffeine significantly reduced the sweetness of sucrose (P<0.001). Removing caffeine from SSBs allowed co-removal of 10.3% sucrose without affecting flavour of the SSBs, equating to 116 kJ per 500 ml serving. The effect of this on body weight in adults and children would be 0.600 and 0.142 kg, which are equivalent to 2.08 and 1.10 years of observed existing trends in weight gain, respectively. These data suggest the extra energy in SSBs as a result of caffeine's effect on sweetness may be associated with adult and child weight gain.

Alcohol intake does not influence body weight or diet in the first six months of an undergraduate starting university

Background: Weight gain in the first year of university has been consistently reported in the USA. In a recent study, moderate-risk drinkers had a greater increase in BMI during the first semester than low-risk or non-drinkers. Moderate-risk drinkers were also more likely to be overweight compared with low-risk drinkers or non-drinkers (Lloyd-Richardson et al., 2008). However, there has been limited research on British students to date. The aim of this study was to investigate whether alcohol intake affected weight or diet in a sample of first year British university students. Methods: An observational prospective cohort study was conducted using a random sample of undergraduate students; randomisation was achieved by approaching every third person on the main university campus to request participation in the study. Participants completed a validated food frequency questionnaire (EPIC-Norfolk, Date Unknown) to assess alcohol intake and diet prior to university and 6 months later. Nutrients were analysed using McCance and Widdowson's: The Composition of Food (2002) and Food Portion Sizes (Crawley, 1994). An analysis of all major macronutrients was undertaken as well as salt and fruit and vegetable intake. Weight and height were measured to assess change in body weight and body mass index. Data analysis was undertaken using excel and SPSS (version 17.0). Change in body weight, dietary intake and alcohol units per week were analysed using paired t-tests to identify within subject difference. Independent t-tests were used to analyse gender differences in weight gain and alcohol intake. Spearman's rank and/or Pearson's correlation co-efficient were used to test the relationship between alcohol intake and change in body weight, dependent on data distribution. Ethical approval was granted by the University of Plymouth's ethics committee. Results: Twenty participants enrolled at baseline and 15 completed both stages of the study. Of the participants who completed both stages of the study, eight were male and seven were female. Mean age of participants was 19.3 years. Eleven students increased their alcohol intake and 13 gained weight. Alcohol intake increased by 19.6 (25.1) units per week (P = 0.009) and weight increased by 1.99 (3.08) kg (P = 0.03). Increase in alcohol intake was significantly higher in males compared with females [39.8 (29.2) units per week and 5.6 (7.6) units per week respectively (P = 0.04). Weight gain was significantly higher in females than males 3.40 (3.09) kg and 0.73 (2.51) kg respectively]. Alcohol intake was not associated with weight gain in this population sample. There were no significant differences between daily total energy, carbohydrate, fat, protein or salt intake at baseline compared to follow-up; the differences were −37.1 (1071.6) kcal; −23.1 (169.5) g; −5.5 (41.5) g; −11.9 (30.0 g); −1.48 (3.7) g respectively. Fruit and vegetable intake decreased by 2.6 (3.4 portions per day (P = 0.01). Discussion: Findings from the present study support the trend in student weight gain documented elsewhere (Lloyd-Richardson et al., 2008). Unexpectedly, an increase in alcohol intake was not associated with weight gain in the population studied, which is inconsistent with previous findings (Economas, 2008). However, limitations include a small sample size and potential reporting bias. Therefore, results may not be representative of student populations elsewhere. The observed weight gain could be explained by under reporting or differences in physical activity. Further research with a more comprehensive alcohol estimation questionnaire is recommended to support this evidence. Education about healthy eating and alcohol consumption may also benefit the student population. Conclusions: The observed weight gain in the first 6 months of university was not associated with the observed increase in alcohol intake.

P02-167 - “I am gaining weight- get me out of here.” what happens to body mass index (BMI) following admission to a medium secure unit?

IntroductionA diagnosis of mental illness has been associated with weight gain, particularly among patients suffering from schizophrenia1.Aims &amp; objectivesThis study aims to establish trends in weight gain among inpatients and the effects of several public health interventions between 2006 and 2009.MethodsA body mass index (BMI) was calculated on admission and one of the authors has routinely measured the BMI of all inpatients on an annual basis since 2005 as part of a regular audit cycle.ResultsAdmission BMIs are comparable to the male general population2. The vast majority of patients are prescribed antipsychotic medication, approximately 50% receiving clozapine or olanzapine at any given time. There is a wide range of weight change from admission to discharge (−8.5 kg to +60 kg) but the average BMI of each sample exceeds the general population such that a majority of patients in each sample are clinically obese (BMI ≥30).In response to the audit findings the unit promoted public health and individual care plans (2006–09) aimed at addressing the high rates of obesity. Despite these initiatives there was a substantial rise in mean BMI between July 2007 and February 2008.ConclusionsAdmission to a medium secure unit results in substantial weight gain for the majority of patients. The causes of weight gain in a relatively closed institution are probably multi-factorial in origin.

Aripiprazole as Adjunctive Therapy for Patients with Major Depressive Disorder

Aripiprazole was initially approved to treat schizophrenia and later approved for bipolar mania, as a monotherapy and an adjunctive therapy (manic or mixed episodes), and for irritability associated with autism. Aripiprazole is a partial agonist at dopamine D(2) and D(3) and serotonin 5-HT(1A) receptors, and is an antagonist at 5-HT(2A) receptors. This profile, and convincing preliminary data from small-scale studies, provided the rationale for the large-scale exploration of aripiprazole for unipolar depression. Recently, three 6-week, large-scale, randomized, double-blind, placebo-controlled clinical trials demonstrated clinically meaningful efficacy for aripiprazole as an adjunctive therapy to antidepressants for treating major depressive disorder (MDD). In November 2007, aripiprazole was approved by the US FDA as an adjunctive therapy to antidepressants for treating MDD, with support from two of the above-mentioned trials. In the trials, aripiprazole was demonstrated to be safe and well tolerated, and showed a minimal trend for weight gain over the course of a 6-week treatment. The incidence of akathisia was higher than that reported in studies of patients with schizophrenia; however, most cases were mild to moderate and infrequently lead to discontinuation (5/1090 from all three trials). This comprehensive review provides an overview of the data from all three 6-week studies (including a pooled analysis) and from an unpublished 52-week, open-label extension study, to inform physicians and facilitate reasonable treatment decisions. In addition, specific issues associated with the use of aripiprazole as an adjunctive therapy in patients with MDD, including possible early treatment effect, appropriate timing of therapy initiation, appropriate dosing and duration of treatment, possible differential effect on depressive subgroups and long-term tolerability, are also discussed.

Protective Al-rich mullite coatings on Si- based ceramics against hot corrosion at 1200 °C

The hot-corrosion behavior of uncoated SiC, bulk mullite and CVD grown mullite coatings in contact with Na 2SO 4 were investigated at 1200 °C. The range of thermodynamic activity of Na 2O (10 − 4 to 10 − 6 ) simulated in this study makes the oxide very basic leading to high reaction rates with SiO 2. Uncoated SiC corroded severely, forming various Na 2O·SiO 2 compounds with a significant weight gain. Even though the thermodynamic activity of silica is reduced in mullite, several compounds in Na 2O·SiO 2·Al 2O 3 system were formed in case of bulk mullite. CVD based mullite coatings with high alumina content at the top surface of the coating, and therefore reduced SiO 2 activity, offered protection to the underlying SiC in corrosive environments. As predicted correctly by thermodynamic calculations, the trend in weight gain with the coated SiC samples followed the theoretically calculated SiO 2 activity in Al-rich mullite.

Adiposity, adult weight change and breast cancer risk in postmenopausal Japanese women: the Miyagi Cohort Study

Background:The role of adult weight change in breast cancer (BC) risk is unclear in Japanese women.Methods:A total of 10 106 postmenopausal women aged 40–64 years (the Miyagi Cohort) were followed from 1990 to 2003, and 108 BC cases were identified. Hazard ratios (HRs) were estimated according to body mass index (BMI) at the current age and at the of age 20 years, and weight change since age 20 years.Results:Higher current BMI was associated with an increased risk of BC (P for trend=0.02), whereas higher BMI at the age 20 years was inversely associated with this risk (P for trend=0.002). There was a significant association between weight change since age 20 years and BC risk (P for trend=0.0086). Compared with stable weight, HR was 0.35 for weight loss of 5 kg or more (P for weight loss trend=0.04) and 1.55 for weight gain of 12 kg or more (P for weight gain trend=0.05).Conclusion:Adiposity at younger and current age has differential effects on BC risk among postmenopausal women; weight gain in adulthood being associated with an increased, and weight loss with a decreased risk.

Do formulated feeds for juvenile Panulirus ornatus lobsters require dietary cholesterol supplementation?

Mortality rates of wild spiny lobster seed Panulirus ornatus are typically high, with losses of 40–60% occurring within 30 days of capture. Mortality appears symptomatic of a micro-nutrient deficiency or captivity related stressors. Cholesterol is a micro-nutrient essential for healthy ecdysis, growth and survival in crustaceans. This paper reports a 7-week study examining the growth, survival and tissue cholesterol responses of juvenile P. ornatus lobsters fed a low cholesterol basal diet that was serially supplemented with cholesterol at 0.75 g kg − 1 increments from 1.25 to 4.25 g kg − 1 dry matter (DM). The basal diet contained 45 g kg − 1 phospholipid (from natural ingredients and supplemented soybean lecithin) and this was fed to all lobsters for 2 weeks prior to commencement of the experiment to reduce cholesterol reserves in the lobsters. A sixth diet comprising equal amounts of green-lipped mussel ( Perna canaliculus) and whiting fillet ( Silago ciliate) was included in the treatment array as a reference diet. One hundred and fifty lobsters were blocked by initial weight into five groups and then from within these groups they were equally distributed to 30 tanks (n = 5 tanks per treatment). There was no significant difference in survival, daily growth coefficient or tissue dry matter cholesterol content between lobsters fed the lowest and highest cholesterol diets: 55%, 349%, 243 mg 100 g − 1 and 70%, 456%, 253 mg 100 g − 1 respectively. However, there was a trend (P = 0.065) for lobster percentage weight gain to increase linearly with dietary cholesterol. There was a significant relationship between the starting weight of the lobsters and subsequent survival, with only 43% of the smallest lobsters (0.2 to 0.5 g block) surviving compared to 90% for the largest lobsters (2.71 to 3.40 g block). No specific dietary cholesterol requirement for small P. ornatus was determined. Feeds which contain practical marine proteins require no supplementary cholesterol, a significant cost saving in feed formulation. Feeds which contain high levels of plant proteins may require supplementary cholesterol to provide at least 4.0 g kg − 1 DM dietary cholesterol.

Surface Modification of Cellulose Fiber via Supramolecular Assembly of Biodegradable Polyesters by the Aid of Host−Guest Inclusion Complexation

In this article, we report a novel surface modification method for cellulose fiber that is based on supramolecular assembly. Beta-cyclodextrin (beta-CD) was first covalently grafted onto the fiber surface. Then poly(epsilon-caprolactone) (PCL) oligomers having both ends capped with adamantane motifs (i.e., PCL-AD) were immobilized to the cellulose fiber surface through the host-guest inclusion complexation between beta-CD and AD motif. FTIR-ATR and XPS analyses confirmed the successful assembly of PCL-ADs, which was further supported by the increasing trend of weight gain with the concentration of CDs on the fiber surface. Contact angle and TGA measurements reflect the enhanced hydrophobicity and thermal stability of the cellulose fiber as a consequence of this modification. The morphologies of the cellulose fiber before and after the assembly process have also been compared by SEM.

The effect of supplements Bujani Weaner cattle with dried poultry manure based concentrate

Two experiments were conducted at the Livestock Teaching and Research Farm, University of Agriculture; Makurdi to evaluate the effect of dried poultry manure (DPM) based concentrate diets on the performance of Bunaji weaner cattle grazing natural pasture. In experiment 1, ten Bunaji weaner cattle aged between ten and eleven months and weighing approximately 117kg on the average, grazing natural pasture were fed DPM based concentrate diets for 90 days in a complete randomized design. The concentrate diets contained 0, 17.8, 33.7 and 47.96 percent levels of DPM and were designated treatments A, B, C, and D respectively. Animals on treatment E grazed natural pasture only. There was a decreasing trend in body weight gain as the level of DPM in the diets increased. However, no significant difference (P&gt;0.05) were observed in feed intake, body weight gain and feed efficiency among the animals. The daily-weight gain of-the animals that were supplemented with DPM based concentrate diets however was significantly (p&lt;0.05) higher than those on natural pasture alone. The average daily weight gains for treatments A, B, C, D, and E were 0.65kg, 0.60kg, 0.48kg, 0.44kgand 0.10kg respectively. In experiment 2, four male Bunaji weaner cattle with an average ag^ of 13.5 months and weight of 129.5kg cere used ina4x4 latin square digestion trial to evaluate the utilization of the experimental diets. DM, CP, CF, EE and NFE digestibilities were not significantly different (P&gt;0.05) among the treatments. There was however, a decreasing trend in the digestibilities of DM, CP, CF, EE and NFE as the level of DPM in diets increased. DM digestibility were 71.85, 68.53, 65.84 and 60.75 per cent for diets A, B, C and D. CP digestibilities were 80.14, 6.60, 73.91 and 71.68 per cent for diets A, B, C, and D respectively. The CF digestibilities were 56.19,51.48, 9.02 and 45.04 percent; EE digestibilities were 87.81,86.35,85.50, and 85.95percent while the NFE digestibilities were 79.26, 78.46, 77.30 and 74.61 percent for diets A, B, C, and D respectively. The nutritional and practical significance of these results are discussed. Keywords: Supplementation, weaner cattle, poultry manure.

Reexamination of ultra‐thin nipple shield use, infant growth and maternal satisfaction

The primary objective of the multi-site, international study was to examine trends in weight gain for term infants breastfed with and without ultra-thin silicone nipple shields to determine the effect of nipple shield use on infant weight gain over two months. Additionally, the study examined maternal satisfaction with nipple shield use using a structured survey. The nipple shield may facilitate successful breastfeeding outcomes when indicated. There has been question regarding infant weight gain with nipple shield use. A published pilot study using within-subject design indicated no significant difference in infant test weights and maternal prolactin levels when breastfeeding with and without nipple shields. The current study builds and expands upon the pilot study. Prospective, multi-site, non-randomised, between-subject study. Maternal-infant dyads (n = 54) who used a nipple shield for breastfeeding were studied. Results demonstrate no statistically significant difference in infant weight gain at two weeks, one month and two months between infants who breastfed with and infants who breastfed without a nipple shield. A majority (89.8%) of the women reported a positive experience with nipple shield use and 67.3% of the women reported that the nipple shield helped prevent breastfeeding termination. Infant weight gain was similar in maternal-infant dyads using nipple shields for two months compared to those not using the shields. Maternal positive report of nipple shield use lends to the clinical importance of nipple shield use when appropriately indicated. Nipple shield use may facilitate breastfeeding when clinically indicated in maternal-infant dyads without risk of decreased infant weight gain.

The growth of obesity and technological change

This paper presents a dynamic theory of body weight and develops its implications. We argue that technological change has induced weight growth by making home- and market-production more sedentary and by lowering food prices through agricultural innovation. In addition, we illustrate that, while exercise and food intake are complements, reductions in exercise will always raise optimal body weight, as will increases in food intake. We also characterize how body weight varies with income, both within a country, and across countries. Within a country, income may have an inverted U-shaped relationship with body weight, due to the offsetting effects of the demand for food, and the demand for an ideal body weight. This can have important implications for the body weight impacts of public transfer programs. Across countries, however, mean weight is likely to be higher in richer countries. Finally, we present descriptive empirical evidence that illustrates the inverted U-shaped relationship between body weight and income in US males, and suggests the importance of secular trends in weight gain, which are consistent with the impacts of broad-based technological changes.

Temporal trends in pregnancy weight gain and birth weight in Bavaria 2000–2007 – Slightly decreasing birth weight in presence of increasing weight gain in pregnancy

Temporal trends in pregnancy weight gain and birth weight in Bavaria 2000–2007 – Slightly decreasing birth weight in presence of increasing weight gain in pregnancy

Temporal trends in pregnancy weight gain and birth weight in Bavaria 2000–2007: slightly decreasing birth weight with increasing weight gain in pregnancy

To assess temporal trends in birth weight and pregnancy weight gain in Bavaria from 2000 to 2007. Data on 695,707 mother and infant pairs (singleton term births) were available from a compulsory reporting system for quality assurance, including information on birth weight, maternal weight at delivery and at booking, maternal smoking, age, and further anthropometric and lifestyle factors. Pregnancy weight gain was defined as: weight prior to delivery minus weight at first booking minus weight of the newborn. Although mean weight gain during pregnancy increased considerably from 10.10 to 10.73 kg in seven years, the mean birth weight in mature singletons decreased slightly from 3433 to 3414 g. These trends could not be explained by concurrent changes in the rates of primiparity, smoking and gestational diabetes. These German data confirm an increased weight gain during pregnancy with adjustment for potential confounders.

Session 5: Nutrition communication Obesity and social marketing: works in progress

Internationally, socio-economic trends reinforce the complex physiological mechanisms that favour positive energy balance, leading to an accumulation of excess body weight and associated metabolic disorders. This so-called ‘obesogenic environment’ is characterised by increasing accessibility and affordability of energy-dense foods and declining levels of physical activity. In the face of such rapidly-rising obesity rates there is general consensus that strategies to address trends in weight gain must go forwards in the absence of complete evidence of cause or effective prevention strategy. Thus, strategy implementation and evaluation must contribute to, as well as be informed by, the evidence base. Social marketing research and practice has a track record that strongly indicates that it can contribute to both the evolving knowledge base on obesity and overweight control policy and the development of effective intervention strategies. Social marketing draws pragmatically on many disciplines to bring about voluntary behaviour change as well as requisite supporting policy and environmental change. Key objectives include: generating insights into the drivers of current behaviour patterns; important barriers to change; client-oriented approaches to new desirable diet and lifestyle choices. Social marketing recognises that target clients have the power to ensure success or failure of obesity control policies. Social marketing seeks to identify genuine exchange of benefits for target adopters of behaviour change and the advocates of change, and how they may be developed and offered within an appropriate relevant context. Social marketing adopts a cyclical approach of learning, strategic development and evaluation, and therefore is well placed to integrate with the multi-disciplinary demands of obesity prevention strategies.

The efficacy of dietetic intervention in patients with chronic obstructive pulmonary disease

Background: Clinical trials have shown that pulmonary rehabilitation can improve the functional status and quality of life of chronic obstructive pulmonary disease (COPD) patients (Lacasse, 2006) but there is no research examining the efficacy of group dietetic intervention during standard 8 week rehabilitation courses. Current input is usually limited to a 1 h nutrition education session. This pilot study aimed to investigate whether patients receiving additional dietetic intervention during pulmonary rehabilitation significantly increased their general nutritional knowledge, thereby facilitating improvements in dietary intake and nutritional status.Methods: Patients were recruited from two courses of pulmonary rehabilitation and randomly allocated to a control group or an intervention group. Anthropometry (height, weight, body mass index, mid arm circumference and triceps skinfold), 3 day food diaries and nutritional knowledge questionnaires covered guidelines, food groups, choosing healthy options and diet and COPD were completed at baseline and at the end of 8 weeks. In week 2 both groups received the same nutrition education session which covered healthy eating during periods of stability as well as advice on coping with loss of appetite and reduced intake during illness and exacerbations. The intervention group was followed up during weeks 4, 6 and 7 when further anthropometric measurements were taken and additional dietary advice was provided, which addressed issues raised by individual patients. Information from food diaries was converted to nutrients using Windiets dietary analysis software. Statistical analyses were carried out using SPSS (v14) and included Mann–Whitney U non parametric tests, paired t‐tests and Spearman correlations used for comparisons over time and between groups. For analysis purposes patients were classified as normal weight (NW) and overweight (OW). Approval was obtained from the appropriate Ethics Committee.Results: Changes reported were not statistically significant (P &gt; 0.05). Complete data sets were obtained for six control (NW = 2, OW = 4) and five intervention (NW = 1, OW = 4) patients. Nutritional knowledge increased in the control group by 5% compared to 3% in the intervention group. Control NW patients increased their energy intake resulting in a mean weight gain of 0.5 kg (SD 3.3). OW control group patients increased their energy intake by 12.4% (16.9) with a mean weight gain of 0.2 kg (2.5). All control patients increased their intake of in total fat, saturated fatty acids (SFA), sugars and sodium. Conversely there was a decrease in energy intake in the intervention group of 14.4% (17.8) and a mean weight loss of 1.5 kg (1.2) (three out of four overweight patients lost weight). Improvements in diet were shown with reduced intakes of total fat, SFA, sugars and sodium. The NW patient in the intervention group regained weight that had previously been lost. These changes did not correlate with changes in nutritional knowledge.Discussion: An increase in nutritional knowledge was expected to facilitate appropriate changes in dietary intake and nutritional status. Despite the lack of correlation between dietary knowledge and intake, beneficial outcomes were none‐the‐less observed in the intervention group. The trend for weight gain in OW control group patients, and weight loss in OW intervention group patients contrasted with results seen by Slinde et al. (2002) where the control OW patients lost weight, and OW intervention patients gained weight. It is possible that in the current study, patients in the intervention group were motivated to lose weight with repeated exposure to the dietitian, rather than an increase in nutritional knowledge. Significant anthropometrical changes were unlikely to be observed in 8 weeks, and further follow up may be necessary to establish sufficient evidence for the most efficacious level of dietetic intervention. The small sample sizes, especially with regard to weight sub groups, limits the conclusions which can be drawn. Further research is recommended, using a larger sample size, in order to make recommendations for dietetic best practice.Conclusion: The results of this study did not show statistical significance and the association between nutritional knowledge and improved nutritional outcomes remains unclear. However, the findings may have clinical significance since they appear to show that additional dietetic intervention may benefit the nutritional status of patients with COPD attending pulmonary rehabilitation.References Lacasse, Y., Goldstein, R., et al. (2006) Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst. Rev. 4, CD003793.Slinde, F., Gronberg, A.M., et al. (2002) Individual dietary intervention in patients with COPD during multidisciplinary rehabilitation. Respir. Med. 96, 330–336.

The efficacy of dietetic intervention in patients with chronic obstructive pulmonary disease

Background: Clinical trials have shown that pulmonary rehabilitation can improve the functional status and quality of life of chronic obstructive pulmonary disease (COPD) patients (Lacasse, 2006) but there is no research examining the efficacy of group dietetic intervention during standard 8 week rehabilitation courses. Current input is usually limited to a 1 h nutrition education session. This pilot study aimed to investigate whether patients receiving additional dietetic intervention during pulmonary rehabilitation significantly increased their general nutritional knowledge, thereby facilitating improvements in dietary intake and nutritional status. Methods: Patients were recruited from two courses of pulmonary rehabilitation and randomly allocated to a control group or an intervention group. Anthropometry (height, weight, body mass index, mid arm circumference and triceps skinfold), 3 day food diaries and nutritional knowledge questionnaires covered guidelines, food groups, choosing healthy options and diet and COPD were completed at baseline and at the end of 8 weeks. In week 2 both groups received the same nutrition education session which covered healthy eating during periods of stability as well as advice on coping with loss of appetite and reduced intake during illness and exacerbations. The intervention group was followed up during weeks 4, 6 and 7 when further anthropometric measurements were taken and additional dietary advice was provided, which addressed issues raised by individual patients. Information from food diaries was converted to nutrients using Windiets dietary analysis software. Statistical analyses were carried out using SPSS (v14) and included Mann–Whitney U non parametric tests, paired t-tests and Spearman correlations used for comparisons over time and between groups. For analysis purposes patients were classified as normal weight (NW) and overweight (OW). Approval was obtained from the appropriate Ethics Committee. Results: Changes reported were not statistically significant (P > 0.05). Complete data sets were obtained for six control (NW = 2, OW = 4) and five intervention (NW = 1, OW = 4) patients. Nutritional knowledge increased in the control group by 5% compared to 3% in the intervention group. Control NW patients increased their energy intake resulting in a mean weight gain of 0.5 kg (SD 3.3). OW control group patients increased their energy intake by 12.4% (16.9) with a mean weight gain of 0.2 kg (2.5). All control patients increased their intake of in total fat, saturated fatty acids (SFA), sugars and sodium. Conversely there was a decrease in energy intake in the intervention group of 14.4% (17.8) and a mean weight loss of 1.5 kg (1.2) (three out of four overweight patients lost weight). Improvements in diet were shown with reduced intakes of total fat, SFA, sugars and sodium. The NW patient in the intervention group regained weight that had previously been lost. These changes did not correlate with changes in nutritional knowledge. Discussion: An increase in nutritional knowledge was expected to facilitate appropriate changes in dietary intake and nutritional status. Despite the lack of correlation between dietary knowledge and intake, beneficial outcomes were none-the-less observed in the intervention group. The trend for weight gain in OW control group patients, and weight loss in OW intervention group patients contrasted with results seen by Slinde et al. (2002) where the control OW patients lost weight, and OW intervention patients gained weight. It is possible that in the current study, patients in the intervention group were motivated to lose weight with repeated exposure to the dietitian, rather than an increase in nutritional knowledge. Significant anthropometrical changes were unlikely to be observed in 8 weeks, and further follow up may be necessary to establish sufficient evidence for the most efficacious level of dietetic intervention. The small sample sizes, especially with regard to weight sub groups, limits the conclusions which can be drawn. Further research is recommended, using a larger sample size, in order to make recommendations for dietetic best practice. Conclusion: The results of this study did not show statistical significance and the association between nutritional knowledge and improved nutritional outcomes remains unclear. However, the findings may have clinical significance since they appear to show that additional dietetic intervention may benefit the nutritional status of patients with COPD attending pulmonary rehabilitation. References Lacasse, Y., Goldstein, R., et al. (2006) Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst. Rev. 4, CD003793. Slinde, F., Gronberg, A.M., et al. (2002) Individual dietary intervention in patients with COPD during multidisciplinary rehabilitation. Respir. Med. 96, 330–336.