Exploring the acceptability of, and adherence to, a carbohydrate-restricted, higher fat diet as an instrument for weight loss in women aged 40-55 years

It is well recognised that aging in females is associated with a predilection for weight gain. Women with abdominal obesity are known to be at especially high risk of cardiovascular and metabolic disease, as well as associated poorer overall health outcomes. Many of these metabolic disorders however, can be alleviated through weight loss. The increasing evidence around the impact of hormonal function on weight gain and body composition validates the need for further investigation into the dietary effect on menopause-affected hormones. Current dietary and weight-loss guidelines, considered to be ‘best practice’, equate to promotion of a diet with a macronutrient profile comprising high levels of carbohydrate, moderate amounts of protein, and minimal fat. In contrast to this traditional ‘best practice’ approach, an alternative weight-loss strategy promoting a model of eating that is lower in carbohydrate, moderate in protein, and higher in fat has been posited as an effective weight-loss option. The low carbohydrate, high fat (LCHF) dietary approach recognises that the macronutrient composition of the diet itself may have a positive impact on weight loss due to hormonal interactions. This exploratory study investigated the acceptance of, and adherence to, a LCHF diet in women aged 40 – 55 years. The primary outcome measures of this study were barriers to and motivators for acceptance of and adherence to this way of eating. Secondary outcomes included mood state, adherence, satiety levels, and weight loss. The aim of this study was to determine factors affecting women aged 40 – 55 years in modifying dietary behaviours and maintaining those behaviours while undertaking a LCHF way of eating. The hypothesis underpinning this study was that LCHF - through its macronutrient profile - has the potential to enhance an individual’s adherence to the behavioural lifestyle modifications required to reduce weight and improve metabolic health outcomes. Furthermore, adherence to dietary modifications could be maximised by the combination of appropriate health behaviour theories (HBT), the web-based nature of the study, and the satiating effect of LCHF food options. Overall, mean percentage weight loss from baseline to study completion was 5.6%. Weight loss was greatest in participants with the highest average adherence levels across the study period. The overall average adherence level of 83.5% was a positive outcome and reflected focus group results around factors that impacted adherence. These key findings included support by family members, in particular spouses, who appeared to act as both a barrier and motivator to adherence, satiety, or feeling of fullness, and being prepared, in particular having acceptable LCHF options readily available. Findings from this study suggest that a LCHF way of eating was both acceptable and feasible for study participants. Furthermore this way of eating elicited weight loss and allowed adherence to the dietary intervention, possibly through the mechanism of improved satiety. While findings suggest that LCHF may be a promising weight loss approach for this population, further research is required for this target group

Efficacy of a compulsory homework programme for increasing physical activity and improving nutrition in children: A cluster randomised controlled trial

Background: Most physical activity interventions in children focus on the school setting; however, children typically engage in more sedentary activities and spend more time eating when at home. The primary aim of this cluster randomised controlled trial was to investigate the effects of a compulsory, health-related homework programme on physical activity, dietary patterns, and body size in primary school-aged children. Methods: A total of 675 children aged 7-10 years from 16 New Zealand primary schools participated in the Healthy Homework study. Schools were randomised into intervention and control groups (1:1 allocation). Intervention schools implemented an 8-week applied homework and in-class teaching module designed to increase physical activity and improve dietary patterns. Physical activity was the primary outcome measure, and was assessed using two sealed pedometers that monitored school- and home-based activity separately. Secondary outcome measures included screen-based sedentary time and selected dietary patterns assessed via parental proxy questionnaire. In addition, height, weight, and waist circumference were measured to obtain body mass index (BMI) and waist-to-height ratio (WHtR). All measurements were taken at baseline (T0), immediately post-intervention (T1), and 6-months post-intervention (T2). Changes in outcome measures over time were estimated using generalised linear mixed models (GLMMs) that adjusted for fixed (group, age, sex, group x time) and random (subjects nested within schools) effects. Intervention effects were also quantified using GLMMs adjusted for baseline values. Results: Significant intervention effects were observed for weekday physical activity at home (T1 [P < 0.001] and T2 [P = 0.019]), weekend physical activity (T1 [P < 0.001] and T2 [P < 0.001]), BMI (T2 only [P = 0.020]) and fruit consumption (T1 only [P = 0.036]). Additional analyses revealed that the greatest improvements in physical activity occurred in children from the most socioeconomically deprived schools. No consistent effects on sedentary time, WHtR, or other dietary patterns were observed. Conclusions: A compulsory health-related homework programme resulted in substantial and consistent increases in children's physical activity - particularly outside of school and on weekends - with limited effects on body size and fruit consumption. Overall, our findings support the integration of compulsory home-focused strategies for improving health behaviours into primary education curricula. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12618000590268. Registered 17 April 2018. © 2019 The Author(s)

A 12-week, whole-food carbohydrate-restricted feasibility study in overweight children

Background: Childhood obesity is a global health concern. Conventional nutrition guidelines have come under scrutiny in helping to achieve long-term healthy weight. An alternative carbohydrate-restricted, higher fat approach has shown to be effective in adults, but research is limited in youth.   Aim: To assess the feasibility of a 12-week whole-food, carbohydrate-restricted diet on weight loss and metabolic health.   Setting: Overweight children aged 8–13 years.   Methods: In this single-arm study, 25 overweight children were provided with whole-food, carbohydrate-restricted dietary guidelines. Primary outcomes – dietary acceptability, adherence and affordability – were assessed qualitatively weekly (telephone) and post-intervention (focus groups). Secondary outcomes – Body mass index (BMI), waist circumference, lipids and glycaemic control measures – were assessed at 0 and 12 weeks. Change scores were analysed using the t-statistic and interpreted using the statistical significance threshold, p < 0.05.   Results: Overall, dietary acceptability was mostly positive, and reports of affordability by parents were mixed. Attrition rates were high (48%); adherence was influenced, positively and negatively, by levels of support from friends and family. Completing children reduced BMI by 2.1 ± 1.5 kg.m2 (p < 0.05). Key blood parameter changes included a reduction in triglycerides (−0.17 ± 0.48 mmol/L; p = 0.242) and an increase in high-density lipoprotein (HDL) cholesterol (0.24 ± 0.19 mmol/L; p < 0.05).   Conclusion: Children achieved some weight loss and health outcome success using this dietary approach. For sustainable weight loss maintenance, full family and health professional support, particularly on a more intensive level at the start, may be required

A Two-Stage Theory of Discussant Influence on Vote Choice in Multiparty Systems

This article addresses two aspects of social network influence on voters’ electoral choices that are not well understood: the role of party systems as institutional contexts and the relationship between social pressure and information sharing as mechanisms of influence. It argues that in the cleavage-based multiparty systems of Western Europe, discussant influence at elections occurs in two stages. First, discussants place social pressure on voters to opt for parties from the same ideological camp. Secondly, by providing information, discussants influence which parties voters eventually choose out of these restricted ‘consideration sets’. The study tests these assumptions using a panel survey conducted at the 2009 German federal election. The first proposition is clearly confirmed, and the evidence supports the second proposition, although less unequivocally.</jats:p

European knowledge alliance for innovative measures in prevention of work-related musculoskeletal pain disorders (Prevent4Work Project):Protocol for an international mixed-methods longitudinal study

INTRODUCTION: Work-related musculoskeletal (MSK) pain is a highly prevalent condition and one of the main contributors to disability and loss of work capacity. Current approaches to the management and prevention of work-related MSK pain do not consistently integrate current evidence-based knowledge and seem to be outdated. The Prevent4Work (P4W) Project aims to collect and spread evidence-based information to improve the management and prevention of work-related MSK pain. P4W will longitudinally investigate (1) risk factors associated with the prevalence of work-related MSK pain, (2) predictive factors for new events of work-related MSK pain in the short term and (3) the modification of pain beliefs after participating in evidence-based e-learning courses. METHODS AND ANALYSIS: This project employs a mixed-methods design with international cohorts of workers from Spain, Italy and Denmark. All participants will be assessed using self-reported variables at baseline (ie, cross-sectional design) with follow-up after 3 and 6 months (ie, prospective–predictive design). Throughout the first phase (0–3 months), all participants will be offered to self-enrol in e-learning courses on work-related MSK pain. Changes in pain beliefs (if any) will be assessed. The dataset will include sociodemographic characteristics, physical and psychological job demands, lifestyle-related factors, MSK pain history and pain beliefs. At baseline, all participants will additionally complete the P4W questionnaire developed to detect populations at high risk of suffering work-related MSK pain. Descriptive statistics, binary logistic regression, and analysis of variance will be used to identify the significant factors that influence the history of work-related MSK pain, evaluate the short-term prediction capacity of the P4W questionnaire, and investigate whether workers’ participation in e-learning courses will modify their pain beliefs. ETHICS AND DISSEMINATION: The study received ethical approval from the Ethical Committee of San Jorge University (USJ011-19/20). The results will be made available via peer-reviewed publications, international conferences and P4W official channels

Reengineering a receptor footprint of adeno-associated virus enables selective and systemic gene transfer to muscle

Reengineering the receptor footprints of adeno-associated virus (AAV) isolates may yield variants with improved properties for clinical applications. We generated a panel of synthetic AAV2 vectors by replacing a hexapeptide sequence in a previously identified heparan sulfate receptor footprint with corresponding residues from other AAV strains. This approach yielded several chimeric capsids displaying systemic tropism after intravenous administration in mice. Of particular interest, an AAV2/AAV8 chimera designated AAV2i8 displayed an altered antigenic profile, readily traversed the blood vasculature, and selectively transduced cardiac and whole-body skeletal muscle tissues with high efficiency. Unlike other AAV serotypes, which are preferentially sequestered in the liver, AAV2i8 showed markedly reduced hepatic tropism. These features of AAV2i8 suggest that it is well suited to translational studies in gene therapy of musculoskeletal disorders

Neighbourhoods for Active Kids: study protocol for a cross-sectional examination of neighbourhood features and children's physical activity, active travel, independent mobility and body size.

INTRODUCTION: New Zealand children's physical activity, including independent mobility and active travel, has declined markedly over recent decades. The Neighbourhoods for Active Kids (NfAK) study examines how neighbourhood built environments are associated with the independent mobility, active travel, physical activity and neighbourhood experiences of children aged 9-12 years in primary and intermediate schools across Auckland, New Zealand's largest city. METHODS AND ANALYSIS: Child-specific indices of walkability, destination accessibility and traffic exposure will be constructed to measure the built environment in 8 neighbourhoods in Auckland. Interactive online-mapping software will be used to measure children's independent mobility and transport mode to destinations and to derive measures of neighbourhood use and perceptions. Physical activity will be measured using 7-day accelerometry. Height, weight and waist circumference will be objectively measured. Parent telephone interviews will collect sociodemographic information and parent neighbourhood perceptions. Interviews with school representative will capture supports and barriers for healthy activity and nutrition behaviours at the school level. Multilevel modelling approaches will be used to understand how differing built environment variables are associated with activity, neighbourhood experiences and health outcomes. DISCUSSION: We anticipate that children who reside in neighbourhoods considered highly walkable will be more physically active, accumulate more independent mobility and active travel, and be more likely to have a healthy body size. This research is timely as cities throughout New Zealand develop and implement plans to improve the liveability of intensifying urban neighbourhoods. Results will be disseminated to participants, local government agencies and through conventional academic avenues

Understanding the Relationship between Activity and Neighbourhoods (URBAN) Study: research design and methodology

<p>Abstract</p> <p>Background</p> <p>Built environment attributes are recognized as being important contributors to physical activity (PA) engagement and body size in adults and children. However, much of the existing research in this emergent public health field is hindered by methodological limitations, including: population and site homogeneity, reliance on self-report measures, aggregated measures of PA, and inadequate statistical modeling. As an integral component of multi-country collaborative research, the Understanding the Relationship between Activity and Neighbourhoods (URBAN) Study seeks to overcome these limitations by determining the strengths of association between detailed measures of the neighborhood built environment with PA levels across multiple domains and body size measures in adults and children. This article outlines the research protocol developed for the URBAN Study.</p> <p>Methods and design</p> <p>The URBAN Study is a multi-centered, stratified, cross-sectional research design, collecting data across four New Zealand cities. Within each city, 12 neighborhoods were identified and selected for investigation based on higher or lower walkability and Māori demographic attributes. Neighborhoods were selected to ensure equal representation of these characteristics. Within each selected neighborhood, 42 households are being randomly selected and an adult and child (where possible) recruited into the study. Data collection includes: objective and self-reported PA engagement, neighborhood perceptions, demographics, and body size measures. The study was designed to recruit approximately 2,000 adults and 250 children into the project. Other aspects of the study include photovoice, which is a qualitative assessment of built environment features associated with PA engagement, an audit of the neighborhood streetscape environment, and an individualized neighborhood walkability profile centered on each participant's residential address. Multilevel modeling will be used to examine the individual-level and neighborhood-level relationships with PA engagement and body size.</p> <p>Discussion</p> <p>The URBAN Study is applying a novel scientifically robust research design to provide urgently needed epidemiological information regarding the associations between the built environment and health outcomes. The findings will contribute to a larger, international initiative in which similar neighborhood selection and PA measurement procedures are utilized across eight countries. Accordingly, this study directly addresses the international priority issues of increasing PA engagement and decreasing obesity levels.</p