47 research outputs found

    Weight gain prevention in the school worksite setting: Results of a multi-level cluster randomized trial

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    OBJECTIVE: To describe the effectiveness, reach and implementation of a weight gain prevention intervention among public school employees. METHOD: A multi-level intervention was tested in a cluster randomized trial among 782 employees in 12 central Massachusetts public high schools from 2009 to 2012. The intervention targeted the nutrition and physical activity environment and policies, the social environment and individual knowledge, attitudes and skills. The intervention was compared to a materials only condition. The primary outcome measures were change in weight and body mass index (BMI) at 24-month follow-up. Implementation of physical environment, policy and social environment strategies at the school and interpersonal levels, and intervention participation at the individual level were assessed. RESULTS: At 24-month follow-up, there was a net change (difference of the difference) of -3.03 pounds (p=.04) and of -.48 BMI units (p=.05) between intervention and comparison conditions. The majority of intervention strategies were successfully implemented by all intervention schools, although establishing formal policies was challenging. Employee participation in programs targeting the physical and social environment was maintained over time. CONCLUSION: This study supports that a multi-level intervention integrated within the organizational culture can be successfully implemented and prevent weight gain in public high school employees

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

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    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

    Associations of Adipose Tissue Architecture, Adipokines and Inflammatory Markers with Body Mass Index and Gestational Weight Gain in Non-diabetic Pregnancies

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    Background: Some pregnancy weight gain is stored as adipose tissue (AT). Human AT depots vary in their capacity for expansion. Data suggests that subcutaneous (SQ) is adapted for healthy lipid storage. Conversely visceral (V) accumulation is associated with inflammation, obesity-related co-morbidities and Type 2 diabetes (T2DM) risk. We investigated SQ and VAT histologic architecture along with insulin, adipokines and inflammatory markers in relationship to prepregnancy BMI and gestational weight gain (GWG). Methods: Subset of non-diabetic singleton gravidas from the Pregnancy & Postpartum Observational Dietary Study (PPODS), undergoing Cesareans and consenting to SQ & VAT biopsies were included. Average adipocyte size assessed in10 sections/depot/subject. Maternal and cord blood insulin, adiponectin, leptin, PAI-1, CRP, TNFα, IL1b, IL6 and IL8 evaluated using Luminex MAGPIX, laser based fluorescent analytical test instrumentation with MILLIPLEX® multi-analyte panels. GWG determined by difference in pre-pregnancy and last prenatal visit weight. Results: Of 110 subjects enrolled, 19 (17.3%) delivered by Cesarean with 14 consenting to AT sampling, and 7 (50%) having both SQ and VAT available for analysis. These 7 had mean pre-pregnancy BMI 27.8±5.6 kg/m2 and GWG 50.0±25.7 lb (range 19-83) with delivery age 39.2±0.7 wks. Mean SQ and VAT adipocyte sizes were 2892±716 pixels2 (range 1866-3775) and 2427±641 pixels2 (range 1416-3397) respectively (p=0.310); neither were statistically correlated with BMI or GWG. Pre-pregnancy BMI statistically correlated with maternal serum insulin (0.786, p=0.036) at delivery and cord blood leptin (0.886, p=0.019); GWG statistically correlated only with cord blood adiponectin (-0.900, p=0.037). Conclusions: In a small sample of normoglycemic pregnancies undergoing Cesareans and AT sampling, adipocyte size was no different in SQ versus visceral depots, and did not correlate with BMI or GWG. Surprisingly, pre-pregnancy BMI but not GWG correlated with maternal serum insulin at delivery, suggesting that pre-pregnancy weight status may be associated with glycemic control at pregnancy end

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

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    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
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