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

Health and productivity in New Zealand: an exploratory study

Health and productivity management (HPM) is a business strategy employed by organisations to manage employee health risk and improve productivity. The major determinants of health are chronic disease and the associated risk factors and, as adults spend more of their waking time at work, the workplace is gaining ground as a setting for health promotion. However, HPM is in its infancy in New Zealand; thus the aim of this thesis was to examine the individual and environmental determinants of health and their relationship to productivity in this novel contribution to the HPM field. This study explores associations between employee health, environmental and policy attributes of the organisation (workplace), and workplace productivity. Three separate but related studies were conducted using two New Zealand-specific workplace tools, developed to measure the health risk profile of employees and the physical workplace environment. The studies described in this thesis represent the first investigations of these relationships in New Zealand. The initial step was to develop a New Zealand-specific online health risk assessment (HRA) tool to collect employee health risk data, workplace productivity information, and to compare to known population health data. This enabled three sub-studies to be conducted in Study 1 of this thesis. First, three health behaviours of working adults (meeting fruit and vegetable recommendations, being sufficiently active and maintaining a healthy weight) and their relationships with health conditions known to affect employee work factors were examined. Second, the relationship between employee health and organisational health culture was explored using the LifeGain Health Culture Audit (LHCA) tool. Third, associations between health risk factors and productivity in the workplace were characterised. Study 2 tested the first New Zealand-specific environmental audit tool designed to measure physical environmental factors that facilitate or inhibit health behaviour in the workplace. A case study analysis of one organisation with 23 worksites across New Zealand was conducted. Finally, Study 3 consisted of focus groups that were conducted with employees and managers to understand the factors influencing their health and work performance. The novel finding of Study 1 was that few participants adhered to all three selected health behaviours: only 3.8% of participants ate five or more servings of fruit and vegetables, were sufficiently active, and maintained a healthy weight. In addition, employees with two sub-optimal health behaviours reported a significantly greater number of health conditions (odds ratio range: 1.40 - 1.55) when compared to employees meeting the recommendations. The second key finding found support for healthy behaviour in the workplace was negatively (although weakly) associated with psychological distress (range of r = 0.17 to -0.30), and positively associated with the sum of health behaviours (r = 0.13) and being a non-smoker (r = 0.12). The third important finding was that, compared to people reporting high psychological distress scores people with low to moderate psychological distress scores reported a work performances 6.5% and 3.5% higher respectively (p<0.001). Similarly, physically active people reported a work performance 3.5% greater than those not active (p<0.001). In addition, high psychological distress levels and smoking accounted for 16.8 and 11.6 (respectively) additional absentee hours over the previous four weeks. These novel findings suggest that poor employee health may be costly to the employer; the HRA tool is the first to enable associations between work performance and employee health risk factors these associations to be measured and quantified. Study 2 illustrated that the New Zealand-specific workplace audit tool, developed to be freely available to New Zealand businesses, could be used for identifying priority areas of the workplace environment to be targeted for improvement. A number of low cost initiatives around physical activity and nutrition that were not currently utilised by the organisation were recommended based on best-practice guidelines. Though the utility of the tool to examine associations between environmental attributes of the worksite and employee health behaviour revealed trivial associations, the homogeneity of the workplace sample may not have allowed the true effect of the worksite environment to be observed. The environmental audit tool is an important advancement in the field of health and productivity management in New Zealand to provide structure to the development and evaluation of workplace wellness programmes within New Zealand businesses. Physical activity was the most frequently cited behaviour identified for maintaining and improving health in the final qualitative component of this thesis (Study 3). The accessibility of a fitness facility and exercise classes onsite and the inclusion of physical activity into the work day helped some participants manage work-life balance. The opposite was true for others, however, who preferred clearer divisions between work and leisure time. While perceived work stress and high job demands affected their ability to maintain healthy behaviour, employees valued the support they received from their team leader to help them manage work commitments. The team leaders perceived they were not offered the same support from management structures above them. While this organisation had components of a workplace health programme in place, both employees and team leaders felt that inconsistent messages prevailed throughout the organisation regarding the support for health behaviour, which served to undermine the health promotion efforts of the company. These significant findings highlight that wellness programmes need to be supported by health policy and practices that are embedded within all levels of the workplace structures if they are to be effective. Taken together, the novel findings of this research illustrate that poor employee health is associated with business-related outcomes and provides evidence of a business case for HPM in the local context. This novel research significantly contributes to the HPM field with the development and the testing of a HRA and environmental audit tool specifically designed for the New Zealand workplace. Future research could build on these findings by utilising the HRA tool in a variety of worksite settings. Demonstration that employee health and subsequent productivity can be improved through HPM is necessary to advance HPM as a business strategy for New Zealand employers

Defining types and causes of overuse injuries of the foot, ankle, knee and lower leg in distance runners

The purpose of this review is to appraise, characterise and summarise the current evidence and definitions on the types of gradual onset injuries sustained to the foot, ankle, knee and lower leg by distance runners, through a scoping revie

The use of nutritional supplements to induce ketosis and reduce symptoms associated with keto-induction: a narrative review

Background Adaptation to a ketogenic diet (keto-induction) can cause unpleasant symptoms, and this can reduce tolerability of the diet. Several methods have been suggested as useful for encouraging entry into nutritional ketosis (NK) and reducing symptoms of keto-induction. This paper reviews the scientific literature on the effects of these methods on time-to-NK and on symptoms during the keto-induction phase. Methods PubMed, Science Direct, CINAHL, MEDLINE, Alt Health Watch, Food Science Source and EBSCO Psychology and Behavioural Sciences Collection electronic databases were searched online. Various purported ketogenic supplements were searched along with the terms “ketogenic diet”, “ketogenic”, “ketosis” and ketonaemia (/ ketonemia). Additionally, author names and reference lists were used for further search of the selected papers for related references. Results Evidence, from one mouse study, suggests that leucine doesn’t significantly increase beta-hydroxybutyrate (BOHB) but the addition of leucine to a ketogenic diet in humans, while increasing the protein-to-fat ratio of the diet, doesn’t reduce ketosis. Animal studies indicate that the short chain fatty acids acetic acid and butyric acid, increase ketone body concentrations. However, only one study has been performed in humans. This demonstrated that butyric acid is more ketogenic than either leucine or an 8-chain monoglyceride. Medium-chain triglycerides (MCTs) increase BOHB in a linear, dose-dependent manner, and promote both ketonaemia and ketogenesis. Exogenous ketones promote ketonaemia but may inhibit ketogenesis. Conclusions There is a clear ketogenic effect of supplemental MCTs; however, it is unclear whether they independently improve time to NK and reduce symptoms of keto-induction. There is limited research on the potential for other supplements to improve time to NK and reduce symptoms of keto-induction. Few studies have specifically evaluated symptoms and adverse effects of a ketogenic diet during the induction phase. Those that have typically were not designed to evaluate these variables as primary outcomes, and thus, more research is required to elucidate the role that supplementation might play in encouraging ketogenesis, improve time to NK, and reduce symptoms associated with keto-induction

A 12-week low carbohydrate, high fat (LCHF) diet improves metabolic health outcomes over a control diet in a randomised controlled trial with overweight defence force personnel.

Introduction. Overweight, obesity and poor health is becoming a global concern for defence force personnel. Conventional nutrition guidelines are being questioned for their efficacy in achieving optimal body composition and long-term health. This study compared the effects of a 12-week low-carbohydrate, high-fat diet with a conventional, high-carbohydrate, low-fat diet on weight reduction and metabolic health outcomes in at-risk New Zealand Defence Force personnel. Materials and methods. In this randomised controlled trial, 41 overweight personnel were assigned to intervention and control groups. Weight, waist circumference, fasting lipids and glycaemic control were assessed at baseline and at 12 weeks. Within-group change scores were analysed using the t-statistic and interpreted using a pThe accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author

The Effect of Medium Chain Triglycerides on Time to Nutritional Ketosis and Symptoms of Keto-Induction in Healthy Adults: A Randomised Controlled Clinical Trial

Medium chain triglycerides (MCTs) are ketogenic and might reduce adverse effects of keto-induction and improve time to ketosis and the tolerability of very low carbohydrate diets. This study investigates whether MCT supplementation improves time to nutritional ketosis (NK), mood, and symptoms of keto-induction. We compared changes in beta-hydroxybutyrate (BOHB), blood glucose, symptoms of keto-induction, and mood disturbance, in 28 healthy adults prescribed a ketogenic diet, randomised to receive either 30 ml of MCT, or sunflower oil as a control, three times per day, for 20 days. The primary outcome measured was the achievement of NK (≥0.5 mmol·L−1 BOHB). Participants also completed a daily Profile of Mood States and keto-induction symptom questionnaire. MCT resulted in higher BOHB at all time points and faster time to NK, a result that failed to reach significance. Symptoms of keto-induction resulted from both diets, with a greater magnitude in the control group, except for abdominal pain, which occurred with greater frequency and severity in the MCT-supplemented diet. There was a possibly beneficial effect on symptoms by MCT, but the effect on mood was unclear. Based on these results, MCTs increase BOHB compared with LCT and reduce symptoms of keto-induction. It is unclear whether MCTs significantly improve mood or time to NK. The trial was registered by the Australia New Zealand Clinical Trial Registry ACTRN12616001099415