Diet and lifestyle interventions to improve co-morbid conditions of chronic kidney disease

Chronic kidney disease is a progressive inflammatory disorder affecting approximately 15% of US adults, and the prevalence is increasing rapidly. Advanced chronic kidney disease requiring hemodialysis is associated with multiple co-morbid conditions that greatly reduce physical function and quality of life, including muscle wasting, bone disorders, and cardiovascular disease. Protein-energy malnutrition is especially common for reasons including poor nutrient intake, amino acid losses during dialysis, and elevated intradialytic catabolism; these factors promote loss of lean mass and declines in physical function. Low physical function and adverse changes in body composition accelerate development of other co-morbid conditions, highlighting the cycle of disease and disability characteristic of this population. Numerous pharmacological therapies are commonly used in an effort to reduce the incidence or severity of chronic kidney disease co-morbidities, but these treatments are associated with high costs and significant side effects. Furthermore, the complexity of chronic kidney disease suggests multiple therapeutic approaches may be beneficial in this population. Intradialytic protein supplementation and exercise training during dialysis are two lifestyle interventions that have been suggested as potential methods to mitigate the cycle of disease and disability. Studies have shown that both parenteral and oral intradialytic supplementation improve protein homeostasis, increase serum albumin and prealbumin levels, and have anabolic effects on skeletal muscle. However, the effect of intradialytic protein on functional disease outcomes in this population is not known. Similarly, numerous studies have demonstrated that intradialytic exercise training has beneficial effects on physical function and quality of life, but surprisingly few studies have examined its effect on other clinical outcomes, particularly cardiovascular disease. The goal of this research was to examine the relationships between the comorbid conditions associated with advanced chronic kidney disease, and determine the efficacy of intradialytic protein supplementation and exercise training as therapeutic approaches. This goal was accomplished through a series of studies both in animal models and also in clinical populations. In a mouse model of renal insufficiency, a combination of soy protein and exercising improved bone microarchitecture and a main effect of soy protein consumption was observed for improvements plasma urea as an indicator of renal function; results from this study an others prompted consideration of these effects in a clinical population. In a cross-sectional analysis of sixty hemodialysis patients, we found multiple aspects of chronic kidney disease to be interrelated, supporting the idea of the cycle of disease and disability characteristic of these patients. This study was notable for its comprehensive inclusion of functional outcome variables associated with hemodialysis treatment in an effort to characterize relationships among these factors, and possibly provide information on how best to intervene to improve health outcomes in this extremely sick population. For the first clinical intervention study, seventeen hemodialysis patients completed a four month intradialytic cycling program; exercising during dialysis improved physical functioning and improved cardiovascular disease risk as measured by serum alkaline phosphatase and epicardial fat thickness. Protein intake during dialysis, either soy or whey protein, attenuated inflammation associated with a single dialysis session and reduced the acute phase protein response after a six month supplementation program. Long-term protein intake also improved physical functioning and reduced circulating alkaline phosphatase levels, similar to the findings after four months of intradialytic cycling. Taken together, these data suggest modest benefits of intradialytic exercise and protein supplementation on functional outcomes in this critically ill population. Future directions include investigating the combined effects of intradialytic protein and exercise in maintenance dialysis patients, as the complexity of the disease suggests multiple therapeutic strategies may be necessary to improve health outcomes and quality of life for this population

Image-based dietary assessment ability of dietetics students and interns

Image-based dietary assessment (IBDA) may improve the accuracy of dietary assessments, but no formalized training currently exists for skills relating to IBDA. This study investigated nutrition and dietetics students’ and interns’ IBDA abilities, the training and experience factors that may contribute to food identification and quantification accuracy, and the perceived challenges to performing IBDA. An online survey containing images of known foods and serving sizes representing common American foods was used to assess the ability to identify foods and serving sizes. Nutrition and dietetics students and interns from the United States and Australia (n = 114) accurately identified foods 79.5% of the time. Quantification accuracy was lower, with only 38% of estimates within ±10% of the actual weight. Foods of amorphous shape or higher energy density had the highest percent error. Students expressed general difficulty with perceiving serving sizes, making IBDA food quantification more difficult. Experience cooking at home from a recipe, frequent measuring of portions, and having a food preparation or cooking laboratory class were associated with enhanced accuracy in IBDA. Future training of dietetics students should incorporate more food-based serving size training to improve quantification accuracy while performing IBDA, while advances in IBDA technology are also needed. © 2017 by the authors; licensee MDPI, Basel, Switzerland

Parent Involvement in Diet or Physical Activity Interventions to Treat or Prevent Childhood Obesity: An Umbrella Review

Parents substantially influence children’s diet and physical activity behaviors, which consequently impact childhood obesity risk. Given this influence of parents, the objective of this umbrella review was to synthesize evidence on effects of parent involvement in diet and physical activity treatment and prevention interventions on obesity risk among children aged 3–12 years old. Ovid/MEDLINE, Elsevier/Embase, Wiley/Cochrane Library, Clarivate/Web of Science, EBSCO/CINAHL, EBSCO/PsycInfo, and Epistemonikos.org were searched from their inception through January 2020. Abstract screening, full-text review, quality assessment, and data extraction were conducted independently by at least two authors. Systematic reviews and meta-analyses of diet and physical activity interventions that described parent involvement, included a comparator/control, and measured child weight/weight status as a primary outcome among children aged 3–12 years old were included. Data were extracted at the level of the systematic review/meta-analysis, and findings were narratively synthesized. Of 4158 references identified, 14 systematic reviews and/or meta-analyses (eight treatment focused and six prevention focused) were included and ranged in quality from very low to very high. Our findings support the inclusion of a parent component in both treatment and prevention interventions to improve child weight/weight status outcomes. Of note, all prevention-focused reviews included a school-based component. Evidence to define optimal parent involvement type and duration and to define the best methods of involving parents across multiple environments (e.g., home, preschool, school) was inadequate and warrants further research

MarvelD3 couples tight junctions to the MEKK1-JNK pathway to regulate cell behavior and survival

MarvelD3 is a transmembrane component of tight junctions, but there is little evidence for a direct involvement in the junctional permeability barrier. Tight junctions also regulate signaling mechanisms that guide cell proliferation; however, the transmembrane components that link the junction to such signaling pathways are not well understood. In this paper, we show that MarvelD3 is a dynamic junctional regulator of the MEKK1-c-Jun NH2-terminal kinase (JNK) pathway. Loss of MarvelD3 expression in differentiating Caco-2 cells resulted in increased cell migration and proliferation, whereas reexpression in a metastatic tumor cell line inhibited migration, proliferation, and in vivo tumor formation. Expression levels of MarvelD3 inversely correlated with JNK activity, as MarvelD3 recruited MEKK1 to junctions, leading to down-regulation of JNK phosphorylation and inhibition of JNK-regulated transcriptional mechanisms. Interplay between MarvelD3 internalization and JNK activation tuned activation of MEKK1 during osmotic stress, leading to junction dissociation and cell death in MarvelD3-depleted cells. MarvelD3 thus couples tight junctions to the MEKK1-JNK pathway to regulate cell behavior and survival

Food insecurity and physical activity insecurity among rural Oregon families

Among rural families, rates of both child obesity and household food insecurity (FI) are higher compared to non-rural families. These disparities result from a complex interplay of social and environmental conditions that influence behavior. The Transtheoretical Model suggests individual readiness to change underlies success in modifying obesity-preventing behaviors; however, whether an association between readiness to change obesity-related behaviors and FI status among rural families exists is unknown. We examined the association between readiness to change family-level nutrition and physical activity (PA) behaviors that predict child obesity and family FI status within a sample of rural families to better understand these relationships. Families (n=144) were recruited from six rural Oregon communities in 2013. Families completed a FI screener and the Family Stage of Change Survey (FSOC), a measure of readiness to change family-level nutrition and PA behaviors associated with obesity. Demographic differences by FI status were explored, and regression was applied to examine relationships between FI and FSOC scores, adjusting for relevant covariates. Among FI families (40.2%), more were non-white (77.8% vs. 22.2%; p=0.036) and had lower adult education (30.4% vs. 11.8% with >high school degree; p=0.015) compared to non-FI families. After adjusting for education, race, ethnicity, and eligibility for federal meal programs, readiness to provide opportunities for PA was lower among FI families (p=0.002). These data highlight a need to further investigate how food insecurity and low readiness to provide PA opportunities, i.e. “physical activity insecurity” may be contributing to the higher obesity rates observed among rural children and families. Keywords: Food insecurity, Physical activity, Rural, Childhood obesit

Evaluation of a multi-year policy-focused intervention to increase physical activity and related behaviors in lower-resourced early care and education settings: Active Early 2.0

Physical activity is a critical component of obesity prevention, but few interventions targeting early childhood have been described. The Active Early guide was designed to increase physical activity in early care and education (ECE) settings. The purpose of Active Early 2.0 was to evaluate the effectiveness of Active Early along with provider training, microgrant support, and technical assistance over 2years (2012–2014) to increase physical activity and related behaviors (e.g., nutrition) in settings serving a high proportion of children from underserved groups in recognition of significant disparities in obesity and challenges meeting physical activity recommendations in low-resource settings. The physical activity and nutrition environment were assessed before and after the intervention in 15 ECE settings in Wisconsin using the Environment and Policy Observation Assessment tool, and interviews were conducted with providers and technical consultants. There was no significant change in Total Physical Activity Score or any EPAO subscale over the intervention period; however, significant improvements in the Total Nutrition Score and the several Nutrition subscales were observed. Additionally, the percentage of sites with written activity policies significantly increased. Overall minutes of teacher-led physical activity increased to 61.5±29.0min (p<0.05). Interviews identified key benefits to children (i.e., more energy, better rest, improved behavior) and significant barriers, most notably care provider and child turnover and low parent engagement. Moderate policy and environmental improvements in physical activity and nutrition were achieved with this intervention, but more work is needed to understand and address barriers and to support sustained changes in lower-resource ECE settings. Keywords: Physical activity, Nutrition, Obesity, Early care and education, Child care, Health disparities, Polic