Evaluation of a multidisciplinary Tier 3 weight management service for adults with morbid obesity, or obesity and comorbidities, based in primary care

A multidisciplinary Tier 3 weight management service in primary care recruited patients with a body mass index ≥40 kg·m−2, or 30 kg·m−2 with obesity-related co-morbidity to a 1-year programme. A cohort of 230 participants was recruited and evaluated using the National Obesity Observatory Standard Evaluation Framework. The primary outcome was weight loss of at least 5% of baseline weight at 12 months. Diet was assessed using the two-item food frequency questionnaire, activity using the General Practice Physical Activity questionnaire and quality of life using the EuroQol-5D-5L questionnaire. A focus group explored the participants' experiences. Baseline mean weight was 124.4 kg and mean body mass index was 44.1 kg·m−2. A total of 102 participants achieved 5% weight loss at 12 months. The mean weight loss was 10.2 kg among the 117 participants who completed the 12-month programme. Baseline observation carried forward analysis gave a mean weight loss of 5.9 kg at 12 months. Fruit and vegetable intake, activity level and quality of life all improved. The dropout rate was 14.3% at 6 months and 45.1% at 1 year. Focus group participants described high levels of satisfaction. It was possible to deliver a Tier 3 weight management service for obese patients with complex co-morbidity in a primary care setting with a full multidisciplinary team, which obtained good health outcomes compared with existing services

Free school meals as an approach to reduce health inequalities among 10-12-year-old Norwegian children

BackgroundChildren spend a considerable amount of time at school and consume at least one meal/day. This study aimed to investigate if a free, healthy school meal every day for one school year was associated with children's intake of healthy foods at school, weight status and moderating effects of socio-economic status.MethodsA non-randomized study design with an intervention and a control group was used to measure change in children's dietary habits at lunchtime. In total, 164 children participated; 55 in the intervention group and 109 in the control group (baseline). Intervention-children were served a free, healthy school meal every school day for one year. Participating children completed a food frequency questionnaire at baseline, at five months follow-up and after one year. Children's anthropometrics were measured at all three timepoints. Intervention effects on children's Healthy food score, BMI z-scores, and waist circumference were examined by conducting a Repeated Measures Multivariate ANOVA. Moderating effects of children's gender and parental socio-economic status were investigated for each outcome.ResultsA significant intervention effect on children's outcomes (multivariate) between baseline and after one year (F=2.409, p<0.001), and between follow-up 1 at five months and after one year (F=8.209, p<0.001) compared to the control group was found. The Univariate analyses showed a greater increase in the Healthy food score of the intervention group between baseline and follow-up 1 (F=4.184, p=0.043) and follow-up 2 (F=10.941, p=0.001) compared to the control group. The intervention-children had a significant increase in BMI z-scores between baseline and follow-up 2 (F=10.007, p=0,002) and between follow-up 1 and 2 (F=22.245, p<0.001) compared to a decrease in the control-children. The intervention-children with lower socio-economic status had a significantly higher increase in Healthy food score between baseline and follow-up 2 than the control-children with lower socio-economic status (difference of 2.8 versus 0.94), but not among children with higher socio-economic status.ConclusionsServing a free school meal for one year increased children's intake of healthy foods, especially among children with lower socio-economic status. This study may contribute to promoting healthy eating and suggests a way forward to reduce health inequalities among school children.Trial registrationISRCTN61703361. Date of registration: December 3rd, 2018. Retrospectively registered

Exploring the relationship between dietary patterns, eating behaviour and fat taste detection thresholds : a thesis presented in partial fulfilment of the requirements for the degree of Masters of Science in Nutrition and Dietetics at Massey University, Albany, New Zealand

Background: Dietary pattern analysis provides a unique opportunity to explore combinations of food intake in conjunction with factors known to affect dietary intake. Fat taste sensitivity is an emerging correlate of dietary intake and, when impaired, has a proposed role in the dysregulation of dietary intake and eating behaviours. Aim: To investigate dietary patterns, eating behaviours and fat taste detection thresholds in a group of New Zealand European women aged 19-45 years and identify associations between these factors. Methods: Fifty post-menarche, pre-menopausal New Zealand European (NZE) women, (18-40 years) completed a partially validated, semi-quantiative 220-item food frequency questionnaire and a validated Three-factor eating questionnaire. Height and weight were measured to calculate body mass index (BMI) (kg/m2) and a bioeletrical impedence analysis (BIA) was completed to measure body fat percentage (BF%). During sensory testing protocol participants were exposed to increasing concentrations of ultra-heat treatment (UHT) milk/oleic acid (OA) solutions using the three alternative forced choice method (3-AFC). A naïve OA detection threshold was determined at the point where the participant identified the OA solution correctly three times at the same concentration. Dietary patterns were determined using principal component factor analysis. Associations between dietary pattern scores, taste sensitivity, eating behaviour and baseline characteristics were investigated. Results: Three dietary patterns were identified: ‘unhealthy’, ‘healthy’ and ‘snacking’. Most women had low eating behaviour scores for cognitive restraint (90%) and disinhibition (74%). Hunger scores were comparatively higher, only 40% had low scores. Twenty-three participants (46%) were classified as hypersensitive and 54% were hyposensitive to OA taste. ‘Unhealthy’ pattern scores were inversely associated with cognitive restraint (r=.391, P=.005) and positively associated with age (r=.297, P=.036). ‘Healthy’ pattern scores were positively associated with cognitive restraint (r=.418, P=.003), OA taste detection thresholds (r=0.446, P=.001) and BMI (r=.325, P=.021). Women with low ‘snacking’ pattern scores were significantly older (31.7 years (24.7, 40.4)) than those with moderate scores (24.0 years (22.0, 28.1)) (P=.037). No relationship was found between OA taste detection thresholds and eating behaviour. Conclusion: Participants in this study showed a significant link between habitual dietary intake and measures for eating behaviour and fat taste sensitivity. Both ‘healthy’ and ‘unhealthy’ dietary patterns were associated with one, or both, of these factors. An unexpected positive association between the ‘healthy’ dietary pattern and fat taste sensitivity indicates a need for further investigation to better understand this relationship. Findings from the current study support the use of dietary patterns to better represent habitual intake in future research investigating fat taste sensitivity or eating behaviour. Key words: Habitual intake, dietary intake, fat taste sensitivity, cognitive restraint, disinhibition, hunge

Association between monosodium glutamate intake and sleep-disordered breathing among Chinese adults with normal body weight

ObjectiveTo assess whether monosodium glutamate (MSG) intake is associated with sleep-disordered breathing (SDB).MethodsData from 1227 Chinese subjects who participated in the Jiangsu Nutrition Study were analyzed. All the participants were examined at two time points (baseline in 2002 and follow-up in 2007). The MSG intake was assessed quantitatively in 2002 and a sleep questionnaire was used to assess snoring and to construct an SDB probability score in 2007. Those within the fifth quintile of the score (highest) were defined as having a high probability of SDB.ResultsThe MSG intake was positively associated with snoring and a high probability of SDB in participants who had a normal body weight but in those who were overweight. A comparison of the extreme quartiles of MSG intake in subjects with a body mass index lower than 23 kg/m² showed an odds ratio of 2.02 (95% confidence interval 1.02-4.00) for snoring and an odds ratio of 3.11 (95% confidence interval 1.10-8.84) for a high probability of SDB. There was a joint effect between MSG and overweight in relation to SDB.ConclusionThe intake of MSG may increase the risk of SDB in Chinese adults with a normal body weight.Zumin Shi, Gary A. Wittert, Baojun Yuan, Yue Dai, Tiffany K. Gill, Gang Hu, Robert Adams, Hui Zuo, Anne W. Taylo

Children’s body composition and stress, the ChiBS study : aims, design, methods, population and participation characteristics

BACKGROUND: The last decades, the prevalence of childhood obesity has increased. Apart from other lifestyle factors, the effect of chronic psychosocial stress on the development of obesity has been recognized. However, more research is needed into the influence of chronic stress on appetite regulation, energy balance and body composition, as well as on the interaction with physical activity/sedentary behavior, diet and sleep in children. In this regard, the ChiBS study (Children’s Body composition and Stress) was designed at the Ghent University. Within this paper, we describe the aims, design, methods, participation and population characteristics of the ChiBS study. METHODS: The influence of chronic stress on changes in body composition is investigated over a two-year follow-up period (February-June 2010, 2011 and 2012) in primary-school children between 6 and 12 years old in the city Aalter (Flanders, Belgium). Stress is measured by child- and parent-reported stress-questionnaires, as well as by objective stress biomarkers (serum, salivary and hair cortisol) and heart rate variability. Body composition is evaluated using basic anthropometric measurements and air displacement plethysmography. Additional information on socio-economic status, medical history, physical activity, dietary intake and sleep are obtained by questionnaires, and physical activity by accelerometers. RESULTS: The participation percentage was 68.7% (N = 523/761), with 71.3% of the children willing to participate in the first follow-up survey. Drop-out proportions were highest for serum sampling (12.1%), salivary sampling (8.3%) and heart rate variability measurements (7.4%). DISCUSSION: The ChiBS project is unique in its setting: its standardized and longitudinal approach provides valuable data and new insights into the relationship between stress and changes in body composition in a large cohort of young children. In addition, this study allows an in-depth investigation of the validity of the different methods that were used to assess stress levels in children

Brief guided imagery and body scanning interventions reduce food cravings

mindfulness cognition food intrusive thoughts acceptance eatingElaborated Intrusion (EI) Theory proposes that cravings occur when involuntary thoughts about food are elaborated; a key part of elaboration is affectively-charged imagery. Craving can be weakened by working memory tasks that block imagery. EI Theory predicts that cravings should also be reduced by preventing involuntary thoughts being elaborated in the first place. Research has found that imagery techniques such as body scanning and guided imagery can reduce the occurrence of food thoughts. This study tested the prediction that these techniques also reduce craving. We asked participants to abstain from food overnight, and then to carry out 10 minutes of body scanning, guided imagery, or a control mind wandering task. They rated their craving at ten points during the task on a single item measure, and before and after the task using the Craving Experience Questionnaire. While craving rose during the task for the mind wandering group, neither the guided imagery nor body scanning group showed an increase. These effects were not detected by the CEQ, suggesting that they are only present during the competing task. As they require no devices or materials and are unobtrusive, brief guided imagery strategies might form useful components of weight loss programmes that attempt to address cravings

Efficacy Of Calcium Supplementation And Weightbearing Exercise On Bone Mineral Density In Postmenopausal Chinese Women

The etiology of age-related bone loss is unclear but both habitually low calcium intake and lack of physical activity have been proposed as its determinants. The objective of this two-year randomized controlled trial was to evaluate the efficacy of increasing calcium intake and weight-bearing exercise on bone mineral density (BMD) in postmenopausal Chinese women who were not on hormone replacement therapy. Bone mineral density at the total body, lumbar spine L2-L4, femoral neck, Ward's triangle, trochanter and total hip were measured using dual energy X-ray absorptionmetry (DEXA) at six month intervals. Information on sociodemographic background, lifestyle factors and reproductive history were assessed using a validated questionnaire. Calcium intake was evaluated by both the three-day food record and food frequency questionnaire at baseline, 1 2 and 24 months. Exercise habits were assessed with an exercise diary and Physical Activity Scale for the Elderly (P ASE) questionnaire

Adherence to Nutrition and Physical Activity Cancer Prevention Guidelines and Development of Colorectal Adenoma.

Adherence to the American Cancer Society's (ACS) Nutrition and Physical Activity Cancer Prevention Guidelines is associated with reductions in overall cancer incidence and mortality, including site-specific cancers such as colorectal cancer. We examined the relationship between baseline adherence to the ACS guidelines and (1) baseline adenoma characteristics and (2) odds of recurrent colorectal adenomas over 3 years of follow-up. Cross-sectional and prospective analyses with a pooled sample of participants from the Wheat Bran Fiber (n = 503) and Ursodeoxycholic Acid (n = 854) trials were performed. A cumulative adherence score was constructed using baseline self-reported data regarding body size, diet, physical activity and alcohol consumption. Multivariable logistic regression demonstrated significantly reduced odds of having three or more adenomas at baseline for moderately adherent (odds ratio [OR] = 0.67, 95% confidence intervals [CI]: 0.46⁻0.99) and highly adherent (OR = 0.50, 95% CI: 0.31⁻0.81) participants compared to low adherers (p-trend = 0.005). Conversely, guideline adherence was not associated with development of recurrent colorectal adenoma (moderate adherence OR = 1.16, 95% CI: 0.85⁻1.59, high adherence OR = 1.23, 95% CI: 0.85⁻1.79)

Tests of the elaborated intrusion theory of craving and desire: Features of alcohol craving during treatment for an alcohol disorder

PubMed ID: 1936444