Evaluating compliance to a low glycaemic index (GI) diet in women with polycystic ovary syndrome (PCOS)

<p>Abstract</p> <p>Background</p> <p>A low Glycaemic Index (GI) diet may decrease some long-term health risks in Polycystic Ovary Syndrome (PCOS) such as endometrial cancer. This study was performed to assess compliance to a low GI diet in women with PCOS. Food diaries prospectively collected over 6 months from women on a low GI diet or healthy eating diet were analysed retrospectively. The women were recruited for a pilot randomised control trial investigating whether a low GI diet decreased the risk of Endometrial Cancer. Nine women with PCOS completed 33 food diaries (17 from women on a low GI diet and 16 from women on a healthy eating diet) recording 3023 food items (low GI group:n = 1457; healthy eating group:n = 1566). Data was analysed using Foster-Powell international values inserted into an SPSS database as no scientifically valid established nutrition software was found. The main outcome measures were mean item GI and Glyacemic Load (GL), mean meal GL, percentage high GI foods and mean weight loss.</p> <p>Findings</p> <p>Women allocated the low GI diet had a statistically significant lower GI of food items (33.67 vs 36.91, p < 0.05), lower percentage of high GI foods (4.3% vs 12.1%, p < 0.05) and lower GL of food items and meals.</p> <p>Conclusion</p> <p>Women with PCOS on a low GI diet consumed food items with a significantly lower mean GI and GL compared to the healthy eating diet group. Longer term compliance needs evaluation in subsequent studies to ascertain that this translates to reduced long term health risks.</p> <p>Trial Registration</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN86420258">ISRCTN86420258</a></p

Validity of claims made in weight management research: a narrative review of dietetic articles

<p>Abstract</p> <p>Background</p> <p>The best available evidence demonstrates that conventional weight management has a high long-term failure rate. The ethical implications of continued reliance on an energy deficit approach to weight management are under-explored.</p> <p>Methods</p> <p>A narrative literature review of journal articles in <it>The Journal of Human Nutrition and Dietetics </it>from 2004 to 2008.</p> <p>Results</p> <p>Although the energy deficit approach to weight management has a high long-term failure rate it continues to dominate research in the field. In the current research agenda, controversies and complexities in the evidence base are inadequately discussed, and claims about the likely success of weight management misrepresent available evidence.</p> <p>Conclusions</p> <p>Dietetic literature on weight management fails to meet the standards of evidence based medicine. Research in the field is characterised by speculative claims that fail to accurately represent the available data. There is a corresponding lack of debate on the ethical implications of continuing to promote ineffective treatment regimes and little research into alternative non-weight centred approaches. An alternative health at every size approach is recommended.</p

Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan

Polycystic ovary syndrome (PCOS) is of clinical and public health importance as it is very common, affecting up to one in five women of reproductive age. It has significant and diverse clinical implications including reproductive (infertility, hyperandrogenism, hirsutism), metabolic (insulin resistance, impaired glucose tolerance, type 2 diabetes mellitus, adverse cardiovascular risk profiles) and psychological features (increased anxiety, depression and worsened quality of life). Polycystic ovary syndrome is a heterogeneous condition and, as such, clinical and research agendas are broad and involve many disciplines. The phenotype varies widely depending on life stage, genotype, ethnicity and environmental factors including lifestyle and bodyweight. Importantly, PCOS has unique interactions with the ever increasing obesity prevalence worldwide as obesity-induced insulin resistance significantly exacerbates all the features of PCOS. Furthermore, it has clinical implications across the lifespan and is relevant to related family members with an increased risk for metabolic conditions reported in first-degree relatives. Therapy should focus on both the short and long-term reproductive, metabolic and psychological features. Given the aetiological role of insulin resistance and the impact of obesity on both hyperinsulinaemia and hyperandrogenism, multidisciplinary lifestyle improvement aimed at normalising insulin resistance, improving androgen status and aiding weight management is recognised as a crucial initial treatment strategy. Modest weight loss of 5% to 10% of initial body weight has been demonstrated to improve many of the features of PCOS. Management should focus on support, education, addressing psychological factors and strongly emphasising healthy lifestyle with targeted medical therapy as required. Monitoring and management of long-term metabolic complications is also an important part of routine clinical care. Comprehensive evidence-based guidelines are needed to aid early diagnosis, appropriate investigation, regular screening and treatment of this common condition. Whilst reproductive features of PCOS are well recognised and are covered here, this review focuses primarily on the less appreciated cardiometabolic and psychological features of PCOS

'Get healthy, stay healthy': Protocol for evaluation of a lifestyle intervention delivered by text-message following the Get Healthy Information and Coaching Service®

Background: Behavioural lifestyle interventions can be effective at promoting initial weight loss and supporting physical activity and dietary behaviour change, however maintaining improvements in these outcomes is often more difficult to achieve. Extending intervention contact to reinforce learnt behavioural skills has been shown to improve maintenance of behaviour change and weight loss. This trial aims to evaluate the feasibility, acceptability and efficacy of a text message-delivered extended contact intervention to enhance or maintain change in physical activity, dietary behaviour and weight loss among participants who have completed a six month Government-funded, population-based telephone coaching lifestyle program: the Get Healthy Information and Coaching Service (GHS). Methods/Design. GHS completers will be randomised to the 6-month extended contact intervention (Get Healthy, Stay Healthy, GHSH) or a no contact control group (standard practice following GHS completion). GHSH participants determine the timing and frequency of the text messages (3-13 per fortnight) and content is tailored to their behavioural and weight goals and support preferences. Two telephone tailoring calls are made (baseline, 12-weeks) to facilitate message tailoring. Primary outcomes, anthropometric (body weight and waist circumference via self-report) and behavioural (moderate-vigorous physical activity via self-report and accelerometer, fruit and vegetable intake via self-report), will be assessed at baseline (at GHS completion), 6-months (end of extended contact intervention) and 12-months (6-months post intervention contact). Secondary aims include evaluation of: the feasibility of program delivery; the acceptability for participants; theoretically-guided, potential mediators and moderators of behaviour change; dose-responsiveness; and, costs of program delivery. Discussion. Findings from this trial will inform the delivery of the GHS in relation to the maintenance of behaviour change and weight loss, and will contribute to the broader science of text message lifestyle interventions delivered in population health settings. Trial registration. ACTRN12613000949785

The development and evaluation of Student Training, Education and Practice for Dietetics CD-ROM: a computer-assisted instruction programme for dietetic students

The Student Training, Education and Practice for Dietetics (STEP-DIET) CD-ROM was developed at the University of Surrey to prepare dietetic students for the practical dietetic training component of their Nutrition/Dietetics degree. This study aimed to evaluate student response to the programme and its effectiveness as a teaching tool, based on the evaluation framework of D.L. Kirkpatrick (Evaluating a Course, 2nd edn. London, Kogan Page). Quantitative and qualitative methodologies were employed, with 41 dietetic students, separated by year group, completing questionnaires and taking part in six focus groups, at the University of Surrey. Student attitudes towards the instruction method and the STEP-DIET programme itself were investigated, in conjunction with their perceived learning achievements. Students rated the programme highly in terms of design and content, however, there was a reluctance to accept computer-assisted instruction (CAI) as a sole teaching method. A number of learning achievements relevant to dietetic practice were reported including a perceived increase in ability to conduct a dietetic interview and an increased understanding of the management of Type 2 diabetes. In general students reacted positively to the STEP-DIET programme and it was perceived by students to be effective in preparing them for the practical component of their dietetic training

Evaluation of a computer assisted instruction resource in nursing education

The STEP-DIET program, a computer assisted instruction (CAI) tool, was developed to prepare dietetic students for their hospital based practical training in the academic setting. This study aimed to evaluate the potential for using the programme within nursing education. The evaluation framework of Kirkpatrick [I. Forsyth, A. Jolliffe, D. Stevens (Eds.), Evaluating a Course, second ed. Kogan Page, London, p. 5] was employed to assess student response to STEP-DIET and its effectiveness as a teaching tool, with regards to perceived learning achievements. Knowledge and attitudes towards nutrition education were also investigated. Quantitative and qualitative methodologies were employed, with nine second and six final year BSc (Adult) nursing students completing questionnaires and taking part in two focus groups, separated by year group. Students rated STEP-DIET highly in terms of design and content and reported a number of perceived learning achievements including increase in nutritional knowledge, understanding of Type 2 diabetes management and the dietitian's role, however there was a reluctance to accept CAI as a teaching method. Students reported a poor knowledge of nutrition, but recognised its importance. This study demonstrates that multidisciplinary learning by the sharing of resources has benefits to students. However, the integration of CAI into taught programmes needs to be managed to take into account student's reluctance to rely on this method of instruction. (C) 2003 Elsevier Science Ltd. All rights reserved