Challenges in sodium intake reduction and meal consumption patterns among participants with metabolic syndrome in a dietary trial

BACKGROUND: Dietary guidelines suggest limiting daily sodium intake to METHODS: Two hundred forty participants with metabolic syndrome enrolled in a dietary intervention trial to lose weight and improve dietary quality. Three 24-hour dietary recalls were collected at each visit which provided meal patterns and nutrient data, including sodium intake. A secondary data analysis was conducted to examine sodium consumption patterns at baseline and at one-year study visits. Sodium consumption patterns over time were examined using linear mixed models. RESULTS: The percentage of meals reported eaten in the home at both baseline and one-year follow-up was approximately 69%. Follow-up for the one-year dietary intervention revealed that the participants who consumed sodium greater than 2,300 mg/d declined from 75% (at baseline) to 59%, and those that consumed higher than 1,500 mg/d declined from 96% (at baseline) to 85%. Average sodium intake decreased from 2,994 mg at baseline to 2,558 mg at one-year (P \u3c 0.001), and the sodium potassium ratio also decreased from 1.211 to 1.047 (P \u3c 0.001). Sodium intake per meal varied significantly by meal type, location, and weekday, with higher intake at dinner, in restaurants, and on weekends. At-home lunch and dinner sodium intake decreased (P \u3c 0.05), while dinner sodium intake at restaurant/fast food chains increased from baseline to one-year (P \u3c 0.05). CONCLUSION: Sodium intake for the majority of participants exceeded the recommended dietary guidelines. Findings support actions that encourage low-sodium food preparation at home and encourage public health policies that decrease sodium in restaurants and prepared foods

Understanding multifactorial influences on the continuum of maternal weight trajectories in pregnancy and early postpartum: study protocol, and participant baseline characteristics

BACKGROUND: Maternal and offspring immediate and long-term health are affected by pregnancy weight gain and maternal weight. This study was designed to determine feasibility of: 1) recruiting a socio-economically and racially/ethnically diverse sample of pregnant women into a longitudinal observational study, including consenting the women for serial biologic specimen evaluations; 2) implementing comprehensive assessments (including biologic, anthropometric, behavioral, cognitive/psychosocial and socio-demographic, and cultural measures) at multiple time points over the study period, including collecting biologic specimens at planned and unplanned pregnancy delivery times; and 3) retaining the sample for one year into the postpartum period. Additionally, the study will provide preliminary data of associations among hypothesized predictors, mediators and moderators of pregnancy and post-partum maternal and infant weight trajectories. The study was conceptualized under a Biopsychosocial Model using a lifespan approach. Study protocol and baseline characteristics are described. METHODS/DESIGN: We sought to recruit a sample of 100 healthy women age 18-45 years, between 28-34 weeks gestation, with singleton pregnancies, enrolled in care prior to 17 weeks gestation. Women provide written consent for face-to-face (medical history, anthropometrics, biologic specimens), and paper-and-pencil assessments, at five time points: baseline (third trimester), delivery-associated, and 6-weeks, 3-months and 6-months postpartum. Additional telephone-based assessments (diet, physical activity and breastfeeding) administered baseline and three-months postpartum. Infant weights are collected until 1-year of life. We seek to retain 80% of participants at six-months postpartum and 80% of offspring at 12-months. 110 women were recruited. Sample characteristics include: mean age 28.3 years, BMI 25.7 kg/m(2), and gestational age at baseline visit of 32.5 weeks. One-third of cohort was non-white, over a quarter were Latina, and almost a quarter were non-US born. The cohort majority was multigravida, had graduated high school and/or had higher levels of education, and worked outside the home. DISCUSSION: Documentation of study feasibility and preliminary data for theory-driven hypothesis of maternal and child factors associated with weight trajectories will support future large scale longitudinal studies of risk and protective factors for maternal and child health. This research will also inform intervention targets facilitating healthy maternal and child weight

Design and methods for testing a simple dietary message to improve weight loss and dietary quality

BACKGROUND: The current food pyramid guidelines have been criticized because of their complexity and the knowledge required for users to understand the recommendations. Simplification of a dietary message to focus on a single key aspect of dietary quality, e.g., fiber intake, may make the message much easier to comprehend and adhere, such that respondents can achieve greater weight loss, better dietary quality and overall metabolic health. METHODS AND DESIGN: This is a randomized controlled clinical trial with two equal sized arms. In total, 240 obese adults who meet diagnostic criteria for the metabolic syndrome will be randomized to one of the two conditions: 1) a high fiber diet and 2) the American Heart Association (AHA) diet. In the high fiber diet condition, patients will be given instruction only on achieving daily dietary fiber intake of 30 g or more. In the AHA diet condition, patients will be instructed to make the several dietary changes recommended by the AHA 2006 guidelines. The trial examines participant weight loss and dietary quality as well as changes in components of the metabolic syndrome, inflammatory biomarkers, low-density lipoprotein cholesterol levels, insulin levels, and glycosolated hemoglobin. Potential mediators, i.e., diet adherence and perceived ease of the diet, and the intervention effect on weight change will also be examined. DISCUSSIONS: The purpose of this paper is to outline the study design and methods for testing the simple message of increasing dietary fiber. If the simple dietary approach is found efficacious for weight loss; and, improves dietary quality, metabolic health, and adherence, it might then be used to develop a simple public health message. TRIAL REGISTRATION: NCT00911885

Simple messages to improve dietary quality: A pilot investigation

Public health recommendations for a healthy diet often involve complex messages, requiring in-depth knowledge for understanding and compliance. The present study compared the feasibility and initial efficacy of two simple messages (a high fiber diet or a low saturated fat diet) to a combination message (high fiber and low saturated fat) on the potential to impact dietary quality and metabolic health. Conclusions: A simple dietary message appears to improve overall dietary quality and aid in weight management. Simple messages are a novel approach which could make a significant impact on the prevention and treatment of chronic disease as well as weight management. Results support the need for a larger randomized controlled trial that is powered to examine the efficacy of a simplified dietary recommendation for dietary quality and metabolic health. It would be worth exploring the impact of simple messages in a larger trial to determine their usefulness as simple public health messages as an alternative the current complex recommendations

Evaluation of Restaurant Menus to Determine the Availability of Healthy Food Options and Guide Community Transformation Grant Activities in Massachusetts

INTRODUCTION. The availability of healthy menu options in restaurants is an important factor in the prevention of obesity. The Mass in Motion Initiative and two Community Transformation Grant (CTG) projects are conducting statewide longitudinal surveys to determine the availability of healthy food in restaurants in the state of Massachusetts. METHODS. The Community Nutrition Environment Evaluation Data System-Restaurant (C-NEEDS-R) was developed for food environment surveillance. C-NEEDS-R takes into account seasonal and geographic variations in food supplies, cultural relevance, and USDA dietary recommendations. Between summer 2012 and winter 2013, 506 restaurants in 36 Massachusetts towns and cities were surveyed and analyzed. Through menu and site evaluation, the availability of healthy entrees was examined for each restaurant, and the total number of healthy entrees as well as the percent of healthy entrees was calculated for each restaurant. For each municipality, the average number and average percentage of healthy entrees for restaurants within the community was also calculated. RESULTS. The surveyed restaurants had average 3.2 healthy entrees on the menu, accounting for 13.4% of the total number of entrees available. The percentage of healthy options varied widely by restaurant and restaurant type, ranging from 0 to 84%, and only 15 of the 506 surveyed restaurants ( DISCUSSION. As noted, menu evaluation demonstrated that the large majority of the surveyed restaurants had few healthy entrees, indicating a need to increase availability of healthy options. Analysis of restaurant- and community-level variations in availability is useful for CTG programs to formulate and prioritize interventions. Future longitudinal surveys of food stores in the intervention and control communities will help evaluate the effectiveness of CTG interventions

Availability of Food Preparation Supplies among Pregnant Women: Preliminary Results from the Decision Making, Eating, and Weight Gain during Pregnancy (DEW) Study

Background: Lack of cooking supplies may be a potential barrier to preparing healthy meals at home. We examined the availability of food preparation supplies among pregnant women in relation to sociodemographic characteristics. Methods: We used preliminary data (N=59) from an ongoing study which enrolled English-speaking women aged 18+ years, pregnant with singleton gestation \u3c36\u3eweeks, pre-pregnancy BMI 18.5-40 kg/m2, and planning to deliver at UMMHC. Women completed the Food Preparation Checklist (FPC) at home. The FPC asks women if 41 specific food preparation items; scores reflect number of items present in the home. Other variables were self-reported. Pearson’s correlation, t-tests, and ANOVAs provided comparisons. We constructed an adjusted linear regression model to explore FPC by sociodemographic characteristics. Results: Women were aged 30.3 (SD=4.1) years, 64.4% were non-Hispanic White, 84.8% were married or living with a partner, and 30.5% reported difficulty paying for basic expenses. Women were enrolled at 22.7 (SD=5.6) weeks gestation; 30.5% were primigravid. Mean pre-pregnancy BMI was 25.0 (SD=4.6) kg/m2; 25.4% were overweight and 17.0% obese. Average FPC score was 32.3 (SD=6.1; range:14-39). FPC scores were higher among Non-Hispanic White women (34.6±3.5 vs. 28.1±7.5, p\u3c0.0001), those with higher education (28.3±7.0 high school/GED or less, 31.0±6.2 some/college degree, vs. 34.7±4.6 some/degree graduate, p\u3c0.01), those married or living with a partner (33.3±5.7 vs. 26.9±5.7, p\u3c0.01), with lower pre-pregnancy BMI (r=-0.38, p\u3c0.01), and who had no difficulty paying for basic expenses (34.0±5.0 vs. 28.4±6.6, p\u3c0.001). In a model that additionally adjusted for pre-pregnancy BMI, non-Hispanic White women had on average 5.7 more food preparation items (95% CI: 3.2, 8.3) and those reporting difficulty paying for basic expenses 3.8 fewer items (95% CI: -6.8, -0.9). Conclusions: Understanding the food preparation supplies available to pregnant women may be useful when designing interventions to improve diet quality and promote healthy weight gain during pregnancy

Evening Snacking in Relation to Self-reported Declines in Sleep Quality during Pregnancy: Preliminary Results from the Decision-Making, Eating, and Weight Gain During Pregnancy (DEW) Study

Background: Poor sleep in non-pregnant adults has been associated with increased evening snacking, which may contribute to weight gain. Sleep disturbances are common during pregnancy. Objective: To examine the association between changes in sleep quality from pre-pregnancy and evening snacking. Methods: In an ongoing prospective cohort study, pregnant women were recruited from UMMHC obstetric practices and the community. Participants are 18+ years, with singleton gestationweeks, pre-pregnancy BMI 18.5-40 kg/m2, English-speaking, and with plans to deliver at UMMHC. Participants were asked “compared to the three months before you became pregnant, how is your sleep quality now?”; we combined responses of “about the same”/“a little better”/“a lot better” versus “a little worse”/“much worse”. Participants completed three 24-hour dietary recalls (2 weekdays, 1 weekend day). Evening snacks were defined as eating occasions after dinner but before bedtime during which food items other than water was consumed. Fisher’s Exact tests and t-tests provided comparisons for evening snacking (yes/no), number of snacks, and energy intake. Results: Women with complete data (n=55) were 58% non-Hispanic White and aged 30.0 (SD:4.3) years; gestational age at study visit was 23.0 (SD:5.9) weeks. Of 866 meals reported, 94 were evening snacks. 71% (n=39) reported that their current sleep quality was worse than before pregnancy. Evening snacks were reported by 90% of women reporting worse sleep and 69% same/better (p=0.1028). While the number of snacks among snackers did not differ by change in sleep quality (M[SD]: 2.2[1.2] versus 1.6[0.8], p=0.2372), energy intake from these snacks was higher among women whose sleep quality had declined (M[SD]: 630[488] versus 309[331] kcal, p=0.0480). Conclusions: Declines in sleep quality during pregnancy may be linked to evening snacking. More research is needed to understand the role of sleep quality, eating behavior, and weight gain during pregnancy

Severity of Depressive Symptoms and Accuracy of Dietary Reporting among Obese Women with Major Depressive Disorder Seeking Weight Loss Treatment

An elevation in symptoms of depression has previously been associated with greater accuracy of reported dietary intake, however this association has not been investigated among individuals with a diagnosis of major depressive disorder. The purpose of this study was to investigate reporting accuracy of dietary intake among a group of women with major depressive disorder in order to determine if reporting accuracy is similarly associated with depressive symptoms among depressed women. Reporting accuracy of dietary intake was calculated based on three 24-hour phone-delivered dietary recalls from the baseline phase of a randomized trial of weight loss treatment for 161 obese women with major depressive disorder. Regression models indicated that higher severity of depressive symptoms was associated with greater reporting accuracy, even when controlling for other factors traditionally associated with reporting accuracy (coefficient  =  0.01 95% CI = 0.01 – 0.02). Seventeen percent of the sample was classified as low energy reporters. Reporting accuracy of dietary intake increases along with depressive symptoms, even among individuals with major depressive disorder. These results suggest that any study investigating associations between diet quality and depression should also include an index of reporting accuracy of dietary intake as accuracy varies with the severity of depressive symptoms

Methodology of a diabetes prevention translational research project utilizing a community-academic partnership for implementation in an underserved Latino community

<p>Abstract</p> <p>Background</p> <p>Latinos comprise the largest racial/ethnic group in the United States and have 2–3 times the prevalence of type 2 diabetes mellitus as Caucasians.</p> <p>Methods and design</p> <p>The Lawrence Latino Diabetes Prevention Project (LLDPP) is a community-based translational research study which aims to reduce the risk of diabetes among Latinos who have a ≥ 30% probability of developing diabetes in the next 7.5 years per a predictive equation. The project was conducted in Lawrence, Massachusetts, a predominantly Caribbean-origin urban Latino community. Individuals were identified primarily from a community health center's patient panel, screened for study eligibility, randomized to either a usual care or a lifestyle intervention condition, and followed for one year. Like the efficacious Diabetes Prevention Program (DPP), the LLDPP intervention targeted weight loss through dietary change and increased physical activity. However, unlike the DPP, the LLDPP intervention was less intensive, tailored to literacy needs and cultural preferences, and delivered in Spanish. The group format of the intervention (13 group sessions over 1 year) was complemented by 3 individual home visits and was implemented by individuals from the community with training and supervision by a clinical research nutritionist and a behavioral psychologist. Study measures included demographics, Stern predictive equation components (age, gender, ethnicity, fasting glucose, systolic blood pressure, HDL-cholesterol, body mass index, and family history of diabetes), glycosylated hemoglobin, dietary intake, physical activity, depressive symptoms, social support, quality of life, and medication use. Body weight was measured at baseline, 6-months, and one-year; all other measures were assessed at baseline and one-year. All surveys were orally administered in Spanish.</p> <p>Results</p> <p>A community-academic partnership enabled the successful recruitment, intervention, and assessment of Latinos at risk of diabetes with a one-year study retention rate of 93%.</p> <p>Trial registration</p> <p>NCT00810290</p