The stability of food intake between adolescence and adulthood: a 21-year follow-up

Studies of the diet of adolescents in the UK demonstrate that dietary habits known to be detrimental to health in adulthood are evident at an early age. For example, Gregory et al (2000) found 4-18 year olds in the UK to have a frequent consumption of fatty and sugary foods and low consumption of fruit and vegetables. Concerns have therefore been expressed regarding the diet of children and adolescents and the continuation of these dietary habits into adulthood (HEA, 1995; Gaziano, 1998). This study aimed to investigate the extent to which these concerns may be justified by determining the stability of food intake of a group of adolescents followed up 21 years later in adulthood. The investigation involved 202 individuals from whom dietary data were collected in 1979-80 (mean age 11.6 years) (Hackett et al. 1984) and again in 2000-1 (mean age 32.5 years). Dietary data were collected at both time-points using two 3 d estimated food diaries followed by an interview to determine portion sizes using the method considered most appropriate at the time, i.e. calibrated food models in 1979-80 and a photographic food atlas (Nelson et al. 1997) in 2000-1. Foods consumed were allocated to one, or a combination of, the five food groups of the ‘Balance of Good Health’ food selection guide (HEA, 1994) according to Gatenby et al. (1995). The weight of food eaten from each of the five food groups was calculated (percentage of total weight of food consumed) and Pearson correlation coefficients generated to provide an estimate of the stability of food intake. The HEA guide advises that a balanced diet should consist of around 33% fruit and vegetables, 33% bread, other cereals and potatoes, 8% foods containing fat and/or sugar, 12% meat, fish and alternatives and 15% milk and dairy products (Gatenby et al. 1995). A shift in the group’s food intake towards the recommendations had occurred with age, most notably with a decrease in foods containing fat and/or sugar and an increase in fruit and vegetables. Nevertheless, at both ages, intakes of foods containing fat and/or sugar, meat, fish and alternatives were higher, and fruit, vegetables, bread, other cereals and potatoes lower than currently recommended. In addition, although there was significant evidence of tracking of relative intake of bread, cereals and potatoes (P<0.01), fruit and vegetables (P<0.01), and meat, fish and alternatives (P=0.02) between 11.6 and 32.5 years, the correlations were not strong. In conclusion, food intake patterns had changed considerably from early adolescence through to adulthood in a direction more in line with the current recommendations. The predictive value of an adolescent’s food intake of their intake in adulthood was found to be significant, but not strong. Further investigations will consider the extent to which this is influenced by factors such as social class, gender and educational level, as well as assessing tracking in terms of relative nutrient intakes

Awareness of lifestyle and colorectal cancer risk:findings from the BeWEL study

It is estimated that 47% of colorectal cancers (CRC) could be prevented by appropriate lifestyles. This study aimed to identify awareness of the causes of CRC in patients who had been diagnosed with a colorectal adenoma through the Scottish Bowel Screening Programme and subsequently enrolled in an intervention trial (using diet and physical activity education and behavioural change techniques) (BeWEL). At baseline and 12-month follow-up, participants answered an open-ended question on factors influencing CRC development. Of the 329 participants at baseline, 40 (12%) reported that they did not know any risk factors and 36 (11%) failed to identify specific factors related to diet and activity. From a potential knowledge score of 1 to 6, the mean score was 1.5 (SD 1.1, range 0 to 5) with no difference between intervention and control groups. At follow-up, the intervention group had a significantly greater knowledge score and better weight loss, diet, and physical activity measures than the control group. Awareness of relevant lifestyle factors for CRC remains low in people at increased risk of the disease. Opportunities within routine NHS screening to aid the capability (including knowledge of risk factors) of individuals to make behavioural changes to reduce CRC risk deserve exploration.Additional co-author: The BeWEL team. The BeWEL Team consists of Shaun Treweek, Fergus Daly, Jill Belch, Jackie Rodger, Alison Kirk, Anne Ludbrook, Petra Rauchhaus, Patricia Norwood, Joyce Thompson, and Jane Wardle

Meeting the challenges of recruitment to multicentre, community-based, lifestyle-change trials : a case study of the BeWEL trial

Peer reviewedPublisher PD

Study Protocol for "MOVEdiabetes":A Trial to Promote Physical Activity for Adults with Type 2 Diabetes in Primary Health Care in Oman

Abstract Background Benefits of physical activity in the management of diabetes are well documented. However, evidence on the effectiveness of interventions integrating physical activity in diabetes care is sparse especially in the countries of the Gulf Cooperation Council. The results from this study will increase our understanding of the use of multi-component interventions aimed at increasing physical activity levels in inactive adults with type 2 diabetes in primary health care in Oman. Methods/design The study is a one year 1:1 cluster randomized controlled trial of the MOVEdiabetes programme (intervention) versus usual care in eight primary health care centres in Oman. The MOVEdiabetes programme utilizes face to face physical activity consultations promoting 150 min of moderate to vigorous physical activity per week (≥600MET-mins/week), pedometers to self-monitor step counts and monthly telephone WhatsApp messages for follow up support. Inactive adults with type 2 diabetes and no contraindication to physical activity will be recruited over a two months period, and followed up for 12 months. To demonstrate a 50% between group difference in physical activity levels (MET-mins/week) over 12 months, (at a power of 80%, and significance level of 5%), 128 participants would be required to complete the study (64 in each arm). Based on a drop-out rate of 20%, 154 participants would require to be recruited (77 in each arm). Assuming a recruitment rate of 70%, 220 potential eligible participants would need to be approached. The primary outcome is change in levels of physical activity measured by the Global Physical Activity Questionnaire. In addition, accelerometers will be used in a sub group to objectively assess physical activity. Secondary outcomes include changes in metabolic and cardiovascular biomarkers, change in self-reported health, social support, self-efficacy for physical activity, and perceived acceptability of the program. All intervention delivery and support costs will be monitored. Discussion This study will contribute to the evidence on the feasibility, cultural acceptability and efficacy of interventional approaches for increasing physical activity in primary care for persons with type 2 diabetes in Oman. Trial registration International Standard Randomised Controlled Trials No: ISRCTN14425284 . Registered 12 April 2016

Perceived barriers to leisure time physical activity in adults with type 2 diabetes attending primary healthcare in Oman:a cross-sectional survey

Objectives: Physical activity is fundamental in diabetes management for good metabolic control. This study aimed to identify barriers to performing leisure time physical activity and explore differences based on gender, age, marital status, employment, education, income and perceived stages of change in physical activity in adults with type 2 diabetes in Oman.Design: Cross-sectional study using an Arabic version of the “Barriers to Being Active” 27 item questionnaire.Setting: Seventeen primary health centres randomly selected in Muscat.Participants: Individuals &gt;18 years with type 2 diabetes, attending diabetes clinic for &gt; 2 years and with no contraindications to performing physical activity.Primary and secondary outcome measures: Participants were asked to rate how far different factors influenced their physical activity, under the following categories: fear of injury, lack of time, social support, energy, willpower, skills, resources, religion and environment. On a scale of 0-9, barriers were considered important if scored ≥5.Results: A total of 305 questionnaires were collected. Most (96%) reported at least one barrier to performing leisure time physical activity. Lack of willpower (44.4%), lack of resources (30.5%) and lack of social support (29.2%) were the most frequently reported barriers. Using chi-square test, lack of willpower was significantly different in individuals with low vs high income (54.2% vs 40%, P=0.002) and in those reporting inactive vs active stages of change for physical activity (50.7% vs 34.7%, P=0.029), lack of resources was significantly different in those with low vs high income (40% vs 24.3%, P=0.004) and married vs unmarried (33.8% vs 18.5%, P=0.018). Lack of social support was significant in females vs males (35.4% vs 20.8%, P=0.005).Conclusions: The findings can inform the design on physical activity intervention studies by testing the impact of strategies which incorporate ways to address reported barriers including approaches that enhance self-efficacy and social support

Changes in Self-Efficacy and Social Support after an Intervention to Increase Physical Activity Among Adults with Type 2 Diabetes in Oman:A 12-month follow-up of the MOVEdiabetes trial

Objectives: This study aimed to describe changes in self-efficacy (SE) and social support (SS) 12 months after the MOVEdiabetes trial, an intervention designed to increase physical activity (PA) among adults with type 2 diabetes mellitus in Oman. Methods: The original MOVEdiabetes trial was conducted between April 2016 and June 2017 in Muscat, Oman. The intervention group (IG) received personalised PA consultations, pedometers and monthly messages using a web-based application, while the comparison group received usual care. Self-reported SE and SS from family and friends were assessed using validated psychosocial scales. Results: Of the 232 original participants in the trial, a total of 174 completed the 12 months follow-up study period (response rate: 75%). However, based on intention-to-treat analysis with several imputation procedures for missing data at 3 and/or 12 months, there was a significant increase in SE scores in the IG (+10.3, 95% confidence interval [CI]: 7.1–13.5; P &lt;0.001); however, the correlation with PA levels was weak (+4.2, 95% CI: 2.7–5.7; P &lt;0.001). Higher SE scores were noted in those without comorbidities (+12.2, 95% CI: 6.8–17.6; P &lt;0.001) and with high income levels (+9.7, 95% CI: 5.2–14.2; P &lt;0.001). Additionally, SS scores increased significantly among those in the IG who received support from friends (+2.3, 95% CI: 1.1–3.7; P &lt;0.001), but not family (+1.2, 95% CI: −0.4–2.8; P = 0.110). The reliability of the scales was acceptable for SE and SS from family, but poor for SS from friends (Cronbach’s alpha coefficients = 0.82, 0.82 and 0.40, respectively). Conclusion: The PA intervention was associated with positive changes in SE and SS from friends. However, further tools for assessing psychosocial influences on PA are needed in Arab countries.   KEYWORDS Physical Activity; Type 2 Diabetes Mellitus; Self-Management; Health Behaviors; Social Support, Self-Efficacy; Primary Healthcare; Oman

Teaching medical students about nutrition: from basic principles to practical strategies

Poor nutrition is widely recognised as one of the key modifiable risks to health and life, with doctors in an ideal position to recognise when suboptimal nutrition is impacting on their patients’ health and provide them with advice and support to create sustainable and achievable diet and lifestyle modifications. However, it has been acknowledged that nutrition training within medical schools is extremely varied, and in many cases inadequate. The Association for Nutrition UK Undergraduate Curriculum in Nutrition for Medical Doctors provides medical schools with guidance on what should be included in the training of all medical students. This paper discusses three key ways in which medical schools can support the implementation of nutrition into their teaching; incorporating nutrition within the core medical curriculum teaching, the use of subject specific experts to support and deliver nutrition training, and the inclusion of nutrition within formal assessment so as to reinforce and cement learnings into practical, applicable actions and advice

Health professionals’ perceptions about physical activity promotion in diabetes care within primary health care settings in Oman

Background: As part of formative work to inform an interventional design to increase physical activity (PA) in patients with type 2 diabetes in Oman, this qualitative study aimed to determine health professionals’ perception of barriers and opportunities, personnel responsibilities and plausible PA promotional approaches. Methods: Four focus group discussions were carried out with groups of health care professionals (family physicians, dieticians and health educators, managers and general practitioners). All discussions were audio recorded and transcribed. Responses were analysed using a thematic analysis. Results: Barriers to PA reported by participants (n = 29) were identified at three levels: health care system (e.g. deficient PA guidelines); individual (e.g. obstructive social norms) and community (e.g. lack of facilities). Participants felt that a multilevel approach is needed to address perceived barriers and to widen current opportunities. In the presence of various diabetes primary care providers, the potential for dieticians to include individualised PA consultations as part of their role was highlighted. Participants felt that consultations should be augmented by approaches within the community (volunteer support and/or appropriate facilities). However, despite lack of experience with technology supported approaches and motivational tools, the telephone application “WhatsApp” and use of pedometers were considered potentially suitable. The need for training in behaviour change techniques and clearly communicated intervention guidelines was emphasised. Conclusions: A multi-component approach including PA consultations, possibly led by trained dieticians, technological routes for providing support along with community mapping for resources appear to offer promising approaches for further PA intervention studies within diabetes primary health care