The Combined Effect of Promoting the Mediterranean Diet and Physical Activity on Metabolic Risk Factors in Adults:A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Adhering to the Mediterranean diet (MD) and physical activity (PA) public health guidelines have independently been linked to health benefits in adults. These behaviours form essential components of the traditional Mediterranean lifestyle. However, their combined effect on metabolic risk has not been systematically assessed. This systematic review with meta-analysis (PROSPERO; CRD42017073958) aimed to examine, for the first time, the combined effect of promoting the MD and PA compared with no treatment, treatment with MD or PA alone, or a different dietary and/or PA treatment, and estimate its magnitude on metabolic risk factors. Medline, Embase, CINAHL and Web of Science were systematically searched until March 2018 for English language controlled interventions reporting the combined effects of the MD and PA on one or multiple metabolic risk factors in adults. Two researchers independently conducted data extraction and risk of bias assessment using a rigorous methodology. Reporting followed PRISMA guidelines. Quality of reporting and risk of bias were assessed using the CONSORT guidelines and the Cochrane Collaboration's tool, respectively. Data from 12 articles reporting 11 randomised controlled trials (n = 1684) were included in the qualitative synthesis; across them, risk of bias was considered low, unclear and high for 42%, 25% and 33% of domains, respectively. Between-study heterogeneity ranged from 44% (triglycerides) to 98% (insulin and high density lipoprotein cholesterol (HDL)-cholesterol). Compared to a control condition, there was strong evidence (p < 0.001) of a beneficial effect of promoting the MD and PA on body weight (-3.68 kg, 95% CI (confidence intervals) -5.48, -1.89), body mass index (-0.64 kg/m², 95% CI -1.10, -0.18), waist circumference (-1.62 cm, 95% CI -2.58, -0.66), systolic (-0.83 mmHg, 95% CI -1.57, -0.09) and diastolic blood pressure (-1.96 mmHg, 95% CI -2.57, -1.35), HOMA-IR index (-0.90, 95% CI -1.22, -0.58), blood glucose (-7.32 mg/dL, 95% CI -9.82, -4.82), triglycerides (-18.47 mg/dL, 95% CI -20.13, -16.80), total cholesterol (-6.30 mg/dL, 95% CI -9.59, -3.02) and HDL-cholesterol (+3.99 mg/dL, 95% CI 1.22, 6.77). There was no evidence of an effect on insulin concentrations. The data presented here provide systematically identified evidence that concurrently promoting the MD and PA is likely to provide an opportunity for metabolic risk reduction. However, due to the high degree of heterogeneity, most likely due to the variation in control group treatment, and the small number of included studies, findings from the pooled analysis should be interpreted with caution. These findings also highlight the need for high quality randomised controlled trials examining the combined effect of the MD and PA on metabolic risk

The association of oral processing and salivary flow rate on food intake and appetite in older adults (aged ≥ 65 years)

Loss of appetite in older adults is common and can lead to reduced food intake, increasing the risk of malnutrition, frailty, and mortality. In addition, older adults often experience age-related deterioration in oral processing ability, saliva flow and chewing efficiency, which can further reduce food intake. This observational study investigated individual variations in these factors and their relative influence on food intake and appetite in healthy adults aged ≥ 65 years. After overnight fast, stimulated and unstimulated saliva samples were collected. A breakfast meal was provided, which was video recorded to enable a subsequent behavioural annotation of bites, chews and swallows using the software “ELAN”. Fasting and postprandial blood glucose were measured. Chewing efficiency was assessed using a two-colour chewing gum mixing ability test and the opto-electronic software ViewGum© (version 4.1.2.1). Saliva uptake was assessed using standard test food, and questionnaire data were collected to assess oral health, lifestyle and sensory preferences. Appetite was assessed subjectively using visual analogue scales for three hours after breakfast and objectively through an ad libitum lunch. Preliminary results from 44 participants (median age 72.5 years, BMI 25.6 kg/m2, 22 males) are presented (target sample size of the study is 86 participants). Males were observed to be faster eaters, with larger average bite size and higher saliva uptake values. Faster eaters had a larger ad libitum meal intake and consumed their meal with a larger average bite size, fewer chews per gram, and shorter total oral exposure time. Individuals with a faster eating rate consumed more food and these differences were associated with differences in subjective satiety ratings, postprandial blood glucose and stimulated saliva flow. No differences in chewing performance were observed. This study is the first to explore the association between oral processing and salivary factors with food intake and appetite in older adults. The preliminary results show that variability between individuals can influence food intake, glucose metabolism and post-meal satiety. This study will provide a foundation for better understanding the food needs of older adults and assist in designing appropriate food products for them

Factors Associated with Significant Weight Loss in Hospitalised Patients with COVID-19: A Retrospective Cohort Study in a Large Teaching Hospital.

SARS-CoV-2 infection (COVID-19) is associated with malnutrition risk in hospitalised individuals. COVID-19 and malnutrition studies in large European cohorts are limited, and post-discharge dietary characteristics are understudied. This study aimed to assess the rates of and risk factors for ≥10% weight loss in inpatients with COVID-19, and the need for post-discharge dietetic support and the General Practitioner (GP) prescription of oral nutritional supplements, during the first COVID-19 wave in a large teaching hospital in the UK. Hospitalised adult patients admitted between March and June 2020 with a confirmed COVID-19 diagnosis were included in this retrospective cohort study. Demographic, anthropometric, clinical, biochemical, and nutritional parameters associated with ≥10% weight loss and post-discharge characteristics were described. Logistic regression models were used to identify risk factors for ≥10% weight loss and post-discharge requirements for ongoing dietetic input and oral nutritional supplement prescription. From the total 288 patients analysed (40% females, 72 years median age), 19% lost ≥ 10% of their admission weight. The length of hospital stay was a significant risk factor for ≥10% weight loss in multivariable analysis (OR 1.22; 95% CI 1.08-1.38; p = 0.001). In addition, ≥10% weight loss was positively associated with higher admission weight and malnutrition screening scores, dysphagia, ICU admission, and artificial nutrition needs. The need for more than one dietetic input after discharge was associated with older age and ≥10% weight loss during admission. A large proportion of patients admitted to the hospital with COVID-19 experienced significant weight loss during admission. Longer hospital stay is a risk factor for ≥10% weight loss, independent of disease severity, reinforcing the importance of repeated malnutrition screening and timely referral to dietetics.This project was funded by the British Dietetic Association General & Education Trust (BDA GET, Registered Charity No. 282553). This research was supported by the NIHR Cambridge Biomedical Research Centre (BRC-1215-20014). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Robert J. B. Goudie was funded by the UKRI Medical Research Council (program code MC_UU_00002/2); Robert J. B. Goudie and Linda M. Oude Griep were supported by the NIHR Cambridge Biomedi-cal Research Centre (BRC-1215-20014)

Children's food choices are highly dependent on patterns of parenting practices and food availability at home in families at high risk for type 2 diabetes in Europe : cross‐sectional results from the Feel4Diabetes study

Background: Food parenting practices, behaviours and food availability at home are associated with children's food choices; however, these associations have been mainly studied for each parenting practice separately and focused mostly on healthy populations. The aim of the study was to identify patterns of parenting practices (including data regarding food availability at home, food and physical activity-related behaviours and rewards) and to investigate their cross-sectional associations with children's food choices in families at high risk for type 2 diabetes (T2D). Methods: Data of parents and children (n = 2278), from the Feel4Diabetes study conducted in six European countries, were collected using validated questionnaires. The data analysed included children's food choices, food availability at home and food and physical activity-related parenting practices. Four patterns of parenting practices were identified using principal component analysis, and associations between those components and children's food choices were assessed using adjusted, individual linear regressions. Results: Parenting patterns focusing on unhealthy habits, such as allowing unhealthy snacks and unlimited screen time, providing higher availability of unhealthy foods at home, rewarding with snacks and screen time, were positively associated with children's unhealthy food choices (consumption of savoury/sweet snacks, fizzy drinks, etc.). The parenting patterns providing fruit/vegetables at home, consuming fruit, and being physically active with the child were positively associated with children's healthier food choices (consumption of fruit, vegetables, whole grain cereals, etc.). Conclusions: Public health initiatives should focus on high-risk families for T2D, assisting them to adopt appropriate parenting practices and behaviours to promote healthier food choices for children