Whole grain, bran and cereal fibre consumption and CVD: A systematic review

Whole grain intake is associated with lower CVD risk in epidemiological studies. It is unclear to what extent cereal fibre, located primarily within the bran, is responsible. This review aimed to evaluate association between intake of whole grain, cereal fibre and bran and CVD risk. Academic databases were searched for human studies published before March 2018. Observational studies reporting whole grain and cereal fibre or bran intake in association with any CVD-related outcome were included. Studies were separated into those defining whole grain using a recognised definition (containing the bran, germ and endosperm in their natural proportions) (three studies, seven publications) and those using an alternative definition, such as including added bran as a whole grain source (eight additional studies, thirteen publications). Intake of whole grain, cereal fibre and bran were similarly associated with lower risk of CVD-related outcomes. Within the initial analysis, where studies used the recognised whole grain definition, results were less likely to show attenuation after adjustment for cereal fibre content. The fibre component of grain foods appears to play an important role in protective effects of whole grains. Adjusting for fibre content, associations remained, suggesting that additional components within the whole grain, and the bran component, may contribute to cardio-protective association. The limited studies and considerable discrepancy in defining and calculating whole grain intake limit conclusions. Future research should utilise a consistent definition and methodical approach of calculating whole grain intake to contribute to a greater body of consistent evidence surrounding whole grain

Analyzing weight loss intervention studies with missing data: which method should be used?

Objective: Missing data due to study dropout is common in weight loss trials and several statistical methods exist to account for it. The aim of this study was to identify methods in the literature and to compare the effects of methods of analysis using simulated data sets. Methods: Literature was obtained for a 1-y period to identify analytical methods used in reporting weight loss trials. A comparison of methods with large or small between-group weight loss, and missing data that was, or was not, missing randomly was conducted in simulated data sets based on previous research. Results: Twenty-seven studies, some with multiple analyses, were retrieved. Complete case analysis (n ¼ 17), last observation carried forward (n ¼ 6), baseline carried forward (n ¼ 4), maximum likelihood (n ¼ 6), and multiple imputation (n ¼ 2) were the common methods of accounting for missing data. When comparing methods on simulated data, all demonstrated a significant effect when the between-group weight loss was large (P \u3c 0.001, interaction term) regardless of whether the data was missing completely at random. When the weight loss interaction was small, the method used for analysis gave considerably different results with mixed models (P ¼ 0.180) and multiple imputations (P ¼ 0.125) closest to the full data model (P ¼ 0.033). Conclusion: The simulation analysis showed that when data were not missing at random, treatment effects were small, and the amount of missing data was substantial, the analysis method had an effect on the significance of the outcome. Careful attention must be paid when analyzing or appraising studies with missing data and small effects to ensure appropriate conclusions are drawn

Improving blood pressure control in primary care: The ImPress study

Background Hypertension is a preventable risk factor for cardiovascular disease, the leading cause of death globally. When hypertension is present with tobacco smoking, poor nutrition, physical inactivity or excessive alcohol consumption, risk of cardiovascular disease is increased. Given the prolonged engagement and ongoing relationship with patients, general practice nurses are ideally situated to actively engage with patients about optimal blood pressure control and lifestyle risk reduction. Objectives This study will test the effectiveness of a nurse-led intervention to reduce blood pressure in adults with hypertension and high cardiovascular risk. Design A multi-site, cluster randomised control trial where the general practice is the unit of randomisation. Methods General Practices (n = 20) will be block randomised to the intervention or usual care group. Adults with hypertension and high cardiovascular risk will be identified through an audit of electronic medical records and invited to attend an assessment visit. Eligible consenting patients will be recruited to the study. The intervention involves three face-to-face consultations and two telephone consultations with the nurse to assess lifestyle risk and develop an action plan. An appointment with the general practitioner will optimise pharmacotherapy. The primary outcome is blood pressure, with secondary outcomes of lifestyle risk factors; smoking, nutrition, alcohol and physical activity body mass index and medication adherence. Patients will have outcome measures evaluated at 6 and 12 months. Discussion ImPress is innovative in its proactive approach of identifying those at greatest risk of cardiovascular disease in combination with the emerging role of the general practice nurse to target care towards improved blood pressure control. If successful, findings from this trial could enhance the nursing role, improve health outcomes, inform health policy and provide an evidence base from which to transform blood pressure management in general practice

Whole grain intake compared with cereal fibre intake in association to CVD risk factors: a cross-sectional analysis of the National Diet and Nutrition Survey (UK).

OBJECTIVE: To investigate how intakes of whole grains and cereal fibre were associated to risk factors for CVD in UK adults. DESIGN: Cross-sectional analyses examined associations between whole grain and cereal fibre intakes and adiposity measurements, serum lipid concentrations, C-reactive protein, systolic blood pressure, fasting glucose, HbA1c, homocysteine and a combined CVD relative risk score. SETTING: The National Diet and Nutrition Survey (NDNS) Rolling Programme 2008-2014. PARTICIPANTS: A nationally representative sample of 2689 adults. RESULTS: Participants in the highest quartile (Q4) of whole grain intake had lower waist-hip ratio (Q1 0·872; Q4 0·857; P = 0·04), HbA1c (Q1 5·66 %; Q4 5·47 %; P = 0·01) and homocysteine (Q1 9·95 µmol/l; Q4 8·76 µmol/l; P = 0·01) compared with participants in the lowest quartile (Q1), after adjusting for dietary and lifestyle factors, including cereal fibre intake. Whole grain intake was inversely associated with C-reactive protein using multivariate analysis (P = 0·02), but this was not significant after final adjustment for cereal fibre. Cereal fibre intake was also inversely associated with waist-hip ratio (P = 0·03) and homocysteine (P = 0·002) in multivariate analysis. CONCLUSIONS: Similar inverse associations between whole grain and cereal fibre intakes to CVD risk factors suggest the relevance of cereal fibre in the protective effects of whole grains. However, whole grain associations often remained significant after adjusting for cereal fibre intake, suggesting additional constituents may be relevant. Intervention studies are needed to compare cereal fibre intake from non-whole grain sources to whole grain intake

Effect of replacing bread, egg, milk, and yogurt with equivalent ω-3 enriched foods on ω-3 LCPUFA intake of Australian children

Objective In countries with traditionally low fish consumption such as Australia, foods enriched with ω-3 long-chain polyunsaturated fatty acids (ω-3 LCPUFA) may play a role in meeting ω-3 LCPUFA intakes for optimal health. The aim of this study was to assess the effect of replacing bread, egg, milk, and yogurt with ω-3 LCPUFA enrichment of these foods on total ω-3 LCPUFA intake in Australian children\u27s diets. Methods Dietary modeling was undertaken using survey data from a nationally representative sample of 4487 children (2249 boys, 2238 girls) ages 2 to 16 y in whom the Multiple Source Method was used to estimate usual ω-3 LPUFA intakes distributions from two 24-h dietary recalls, corrected for within-person variation; 15 models were constructed. Results The adjusted mean ± SD and median and interquartile range (IQR) of usual dietary intakes of ω-3 LCPUFA gradually increased from 2.5 ± 0.8 to 7.1 ± 4.9 mg/d and 2.3 (1.9–2.9) to 5.4 (3.6–9.2), respectively, after the modeling (P = 0.001 for each model). Median (IQR) intake of total ω-3 LCPUFAs in non-fish eaters and fish eaters was 1.4 (0.8–2.3) and 2.3 (1.0–6.1) mg/d, respectively, which increased threefold to 4.3 (2.6–7.8) and 7.5 (3.9–13) mg/d, respectively, after replacement of all four ω-3 enriched foods. Conclusion Replacement of four core foods with ω-3 enriched alternatives resulted in improved simulated ω-3 LCPUFA intakes in Australian children but not to optimal levels of intake. Increased fish consumption is still the most effective strategy for increasing ω-3 LCPUFA intake

Practical utility and reliability of whole-room calorimetry in young children

The use of whole-room calorimetry (WRC) in young children can increase our understanding of children's energy balance. However, studies using WRC in young children are rare due to concerns about its feasibility. To assess the feasibility of WRC in young children, forty children, aged 4-6 years, were asked to follow a graded activity protocol while in a WRC. In addition, six children participated in two additional resting protocols to examine the effect of diet-induced thermogenesis on resting energy expenditure (REE) measures and the reliability of REE measurement. Refusals to participate and data loss were quantified as measures of practical utility, and REE measured after an overnight fast and after a 90-min fast were compared. In addition, both were compared to predicted BMR values using the Schofield equation. Our results showed that thirty (78·9 %) participants had acceptable data for all intensities of the activity protocol. The REE values measured after a 90-min fast (5·07 (sd 1·04) MJ/d) and an overnight fast (4·73 (sd 0·61) MJ/d) were not significantly different from each other (P = 0·472). However, both REE after an overnight fast and a 90-min fast were significantly higher than predicted BMR (3·96 (sd 0·18) MJ/d) using the Schofield equation (P = 0·024 and 0·042, respectively). We conclude that, with a developmentally sensitive approach, WRC is feasible and can be standardised adequately even in 4- to 6-year-old children. In addition, the effect of a small standardised breakfast, approximately 90 min before REE measurements, is likely to be small

Predictive validity and classification accuracy of actigraph energy expenditure equations and cut-points in young children

Objectives: Evaluate the predictive validity of ActiGraph energy expenditure equations and the classification accuracy of physical activity intensity cut-points in preschoolers. Methods: Forty children aged 4–6 years (5.3±1.0 years) completed a ~150-min room calorimeter protocol involving age-appropriate sedentary, light and moderate-to vigorous-intensity physical activities. Children wore an ActiGraph GT3X on the right mid-axillary line of the hip. Energy expenditure measured by room calorimetry and physical activity intensity classified using direct observation were the criterion methods. Energy expenditure was predicted using Pate and Puyau equations. Physical activity intensity was classified using Evenson, Sirard, Van Cauwenberghe, Pate, Puyau, and Reilly, ActiGraph cut-points. Results: The Pate equation significantly overestimated VO2 during sedentary behaviors, light physical activities and total VO2 (P<0.001). No difference was found between measured and predicted VO2 during moderate-to vigorous-intensity physical activities (P = 0.072). The Puyau equation significantly underestimated activity energy expenditure during moderate-to vigorous-intensity physical activities, light-intensity physical activities and total activity energy expenditure (P<0.0125). However, no overestimation of activity energy expenditure during sedentary behavior was found. The Evenson cut-point demonstrated significantly higher accuracy for classifying sedentary behaviors and light-intensity physical activities than others. Classification accuracy for moderate-to vigorous-intensity physical activities was significantly higher for Pate than others. Conclusion: Available ActiGraph equations do not provide accurate estimates of energy expenditure across physical activity intensities in preschoolers. Cut-points of ≤25counts⋅15 s−1 and ≥420 counts⋅15 s−1 for classifying sedentary behaviors and moderate-to vigorous-intensity physical activities, respectively, are recommended

Promoting motor skills in low-income, ethnic children: The Physical Activity in Linguistically Diverse Communities (PALDC) nonrandomized trial

This study reports the long-term effects of a professional learning program for classroom teachers on fundamental motor skill (FMS) proficiency of primary school students from ethnically diverse backgrounds. Design: A cluster non-randomized trial using a nested cross-sectional design. Methods: The study was conducted in 8 primary schools located in disadvantaged and culturally diverse areas in Sydney, Australia. The intervention used an action learning framework, with each school developing and implementing an action plan for enhancing the teaching of FMS in their school. School teams comprised 4-5 teachers and were supported by a member of the research team. The primary outcome was total proficiency score for 7 FMS (run, jump, catch, throw, kick, leap, side gallop). Outcome data were analyzed using mixed effects models. Results: Eight-hundred and sixty-two students (82% response rate) were assessed at baseline in 2006 and 830 (82%) at follow-up in 2010. Compared with students in the control schools, there was a significantly greater increase in total motor skill proficiency among children in the intervention schools at follow-up (adjusted difference = 5.2 components, 95%CI [1.65, 8.75]; p. = 0.01) and in four of the seven motor skills. Conclusions: Training classroom teachers to develop and implement units of work based around individual FMS is a promising strategy for increasing FMS among ethnically diverse children over an extended period of time

Wrist Accelerometer Cut Points for Classifying Sedentary Behavior in Children.

INTRODUCTION: This study aimed to examine the validity and accuracy of wrist accelerometers for classifying sedentary behavior (SB) in children. METHODS: Fifty-seven children (5-8 and 9-12 yr) completed an ~170-min protocol, including 15 semistructured activities and transitions. Nine ActiGraph (GT3X+) and two GENEActiv wrist cut points were evaluated. Direct observation was the criterion measure. The accuracy of wrist cut points was compared with that achieved by the ActiGraph hip cut point (≤25 counts per 15 s) and the thigh-mounted activPAL3. Analyses included equivalence testing, Bland-Altman procedures, and area under the receiver operating curve (ROC-AUC). RESULTS: The most accurate ActiGraph wrist cut points (Kim; vector magnitude, ≤3958 counts per 60 s; vertical axis, ≤1756 counts per 60 s) demonstrated good classification accuracy (ROC-AUC = 0.85-0.86) and accurately estimated SB time in 5-8 yr (equivalence P = 0.02; mean bias = 4.1%, limits of agreement = -20.1% to 28.4%) and 9-12 yr (equivalence P 0.05) and classification accuracy (ROC-AUC = 0.79-0.80) was lower than for ActiGraph hip and activPAL3. CONCLUSION: The most accurate SB ActiGraph (Kim) and GENEActiv (Schaefer) wrist cut points can be applied in children with similar confidence as the ActiGraph hip cut point (≤25 counts per 15 s), although activPAL3 was generally more accurate.This study was funded by the National Heart Foundation of Australia (G11S5975). DPC is supported by an Australian Research Council Discovery Early Career Researcher Award (DE140101588). ADO is supported by a National Heart Foundation of Australia Career Development Fellowship (CR11S 6099). TH is funded by a National Health and Medical Research Council Early Career Fellowship (APP1070571). The work of UE and SB is funded by the UK Medical Research Council (MC_UU_12015/3). ST is supported by the National Health and Medical Research Council Centre of Research Excellence on Sitting Time and Chronic Disease Prevention (APP1057608)