Targeting persistent fatigue with tailored versus generic self-management strategies in adolescents and young adults with a fatigue syndrome or rheumatic condition: A randomized crossover trial

Objectives: To evaluate the use of two self-management intervention strategies for persistent fatigue in adolescents and young adults with a fatigue syndrome or rheumatic condition. Design: A randomized crossover trial administering tailored lifestyle advice and generic dietary advice, each 12 weeks, with a four-week washout period between. Methods: Sixty participants (aged 12–29) were included. Tailoring was achieved through the PROfeel method. Dietary guidelines were conceptualized by the Netherlands Nutrition Centre. Questionnaires were used pre–post-interventions to measure primary outcome ‘fatigue severity’ (Checklist Individual Strength-8) and secondary outcomes ‘self-efficacy’ (Self-Efficacy Scale-28) and ‘quality of life’ (QoL) (Paediatric Quality of Life Inventory 4.0). Feasibility and adherence were self-rated on a scale of 1 to 10 (low to high). Linear mixed modelling was used to assess change over time, compare strategy effectiveness and study the impact of intervention order. Results: Fatigue severity, self-efficacy and QoL regarding ‘physical’ and ‘emotional’ functioning improved significantly over time (all p <.015). The average improvement of the two QoL subscales was clinically relevant, as was the fatigue improvement in 20 out of 46 participants who completed the trial and 5 dropouts. The interventions were equally effective, and intervention order did not impact the improvement level (prange =.242–.984). The self-management strategies received similar feasibility (M = 6.45, SD = 1.91) and adherence (M = 7.67, SD = 1.67) ratings. Conclusions: As small to clinically relevant improvements were observed, self-management strategies might be particularly useful to bridge waiting time for guided treatments such as Cognitive Behavioural Therapy

Assessment of the Dutch Healthy Diet index 2015 in the Lifelines cohort study at baseline

Background: Dietary indices are useful measures to investigate associations between dietary intake and disease development. The Dutch Healthy Diet index 2015 (DHD2015-index), a measure of diet quality, assesses adherence to the 2015 Dutch dietary guidelines. We assessed the DHD2015-index in the Lifelines cohort study, and compared calculations from basic and detailed dietary intake data. Methods: Dietary intake was assessed with a specially developed Food Frequency Questionnaire (FFQ) called Flower-FFQ, which consists of one main questionnaire (heart-FFQ), which asks for intakes of major food groups, and three complementary questionnaires (petal-FFQs), which ask for detailed information on food types within major food groups of the heart-FFQ. The DHD2015-index was assessed using data from the total Flower-FFQ (for 56,982 participants), and using data from the heart-FFQ only (for 129,030 participants). Agreement between the two indices was assessed with correlation and cross-classification. Results: The median (25th−75th percentile) DHD2015-index score was 70 (60–80) for men and 76 (65–86) for women based on the Flower-FFQ, and 68 (58–78) for men and 73 (63–83) for women based on the heart-FFQ. The Kendall’s tau-b correlation coefficient between the two scores was 0.66. Cross-classification into quartiles of the DHD2015-index showed that 59–60% of participants were classified in the same quartile, 37% in the adjacent, and 4% in the non-adjacent. Conclusion: Dietary data from the Flower-FFQ provide the most optimal information to assess the DHD2015-index. However, the DHD2015-index from the heart-FFQ showed good agreement with the index from the Flower-FFQ of ranking participants according to diet quality, and can be used when the DHD2015 index from the Flower-FFQ is not available

Study protocol of the sweet tooth study, randomized controlled trial with partial food provision on the effect of low, regular and high dietary sweetness exposure on sweetness preferences in Dutch adults

Background: Several health organizations recommend lowering the consumption of sweet-tasting foods. The rationale behind this recommendation is that a lower exposure to sweet foods may reduce preferences for sweet tasting foods, thus lowering sugar and energy intake, and in turn aiding in obesity prevention. However, empirical data supporting this narrative are lacking. In fact, relatively little is known about the contribution of long-term sweet taste exposure on one’s sweetness preferences. Methods: The primary objective of this randomized controlled trial is to assess the effect of low, regular and high dietary sweetness exposure on preference for sweet foods and beverages, and to compare these effects between intervention groups. One hundred and eighty adults aged 18–65 years with a BMI of 18.5–30.0 kg/m2 will be recruited and randomly allocated to either: low dietary sweetness exposure (LSE) (10–15% daily energy from sweet tasting foods), regular dietary sweetness exposure (RSE) (25–30% daily energy from sweet tasting foods), or high dietary sweetness exposure (HSE) (40–45% daily energy from sweet tasting foods), for 6 months, followed by a 4-month follow up. Intervention foods are provided ad libitum, covering approximately 50% of the daily number of food items, to include sugar-sweetened, low-calorie-sweetener-sweetened and non-sweet foods. The primary outcome measure is the difference in change in sweetness preference from baseline to 6 months between intervention groups. Secondary outcomes include: change in sweet taste preferences at different time-points; taste intensity perception; behavioral outcomes: food choice and intake, sweet-liker type, food cravings, dietary taste preferences and dietary taste patterns; anthropometric outcomes: body composition, waist-hip circumference, body weight; and biochemical outcomes: glucose variability and biomarkers related to CVD and diabetes. Discussion: This study will generate important data on the effect of dietary sweetness exposure on sweetness preferences in terms of effect size and change, duration of change and its impact on food intake, body weight status and associated health outcomes. Trial Registration: The study protocol has been registered on ClinicalTrials.gov (ID no. NCT04497974, Registered 4 August 2020, https://clinicaltrials.gov/ct2/show/NCT04497974) and approved by Wageningen’s Medical Ethical Committee (ABR no. NL72134)

Observational study on dietary changes of participants following a multicomponent lifestyle program (Reverse Diabetes2 Now)

Background: Lifestyle intervention studies to treat type 2 diabetes (T2D) are on the rise. However, in-depth research is lacking into the dietary changes that participants make. Methods: The present study aimed to observe the dietary intake of participants following the group program ‘Reverse Diabetes2 Now’ (RD2N) over 12 months. The web-based 24-h dietary recall-tool Compl-eat was used to collect dietary intake data. Results: In total, 147 T2D patients were included in a cross-sectional study (n = 37 at baseline, n = 58 at 6 months, n = 52 at 12 months). A lower intake of total energy, carbohydrates and iodine was found for the groups at 6 and 12 months compared to the baseline group. The absolute consumption of total fat and saturated fat did not differ between the groups; only the percentage as total calorie consumption decreased. Consumption of vegetables and full-fat yoghurt was higher in groups at 6 and 12 months compared to the group at baseline. Consumption of bread, cakes and sweet biscuits, pasta/rice/tortillas, artificially sweetened soft drinks, and crisps were lower in the groups at 6 and 12 months compared to the group at baseline. Similar results were observed in a separate prospective study in 22 participants over 12 months following the same lifestyle-intervention. Conclusions: Overall, participants shifted their dietary intake somewhat towards a healthier dietary pattern with overall lower energy and carbohydrates and more vegetables. Moreover, participants largely maintained this healthier pattern over 12 months. There were some concerns regarding iodine intake. These promising results need to be confirmed in a fully-scaled study, as well in a comparison with controls