Factors determining the integration of nutritional genomics into clinical practice by registered dietitians

YesPersonalized nutrition has the potential to improve health, prevent disease and reduce healthcare expenditure. Whilst research hints at positive consumer attitudes towards personalized nutrition that draws upon lifestyle, phenotypic and genotypic data, little is known about the degree to which registered dietitians (RD) are engaged in the delivery of such services. This review sought to determine possible factors associated with the integration of the emerging science of Nutritional Genomics (NGx) into the clinical practice setting by practicing registered dietitians. Scope Search of online databases (Pubmed; National Library of Medicine; Cochrane Library; Ovid Medline) was conducted on material published from January 2000 to December 2014. Studies that sampled practicing dietitians and investigated integration or application of NGx and genetics knowledge into practice were eligible. Articles were assessed according to the American Dietetic Association Quality Criteria Checklist. Key findings Application of nutritional genomics in practice has been limited. Reluctance to integrate NGx into practice is associated with low awareness of NGx, a lack of confidence in the science surrounding NGx and skepticism toward Direct to consumer (DTC) products. Successful application to practice was associated with knowledge about NGx, having confidence in the science, a positive attitude toward NGx, access to DTC products, a supportive working environment, working in the clinical setting rather than the public health domain and being in private rather than public practice. Conclusions There is a need to provide RGs with a supportive working environment that provides ongoing training in NGx and which is integrated with clinical practice

Psycho-markers of weight loss. The roles of TFEQ Disinhibition and Restraint in exercise-induced weight loss

yesEating behaviour traits, namely Disinhibition and Restraint, have the potential to exert an effect on food intake and energy balance. The effectiveness of exercise as a method of weight management could be influenced by these traits. Fifty eight overweight and obese participants completed 12-weeks of supervised exercise. Each participant was prescribed supervised exercise based on an expenditure of 500 kcal/session, 5 d/week for 12-weeks. Following 12-weeks of exercise there was a significant reduction in mean body weight ( 3.26 ± 3.63 kg), fat mass (FM: 3.26 ± 2.64 kg), BMI ( 1.16 ± 1.17 kg/m2) and waist circumference (WC: 5.0 ± 3.23 cm). Regression analyses revealed a higher baseline Disinhibition score was associated with a greater reduction in BMI and WC, while Internal Disinhibition was associated with a larger decrease in weight, %FM and WC. Neither baseline Restraint or Hunger were associated with any of the anthropometric markers at baseline or after 12-weeks. Furthermore, after 12-weeks of exercise, a decrease in Disinhibition and increase in Restraint were associated with a greater reduction in WC, whereas only Restraint was associated with a decrease in weight. Post-hoc analysis of the sub-factors revealed a decrease in External Disinhibition and increase in Flexible Restraint were associated with weight loss. However, an increase in Rigid Restraint was associated with a reduction in %FM and WC. These findings suggest that exercise-induced weight loss is more marked in individuals with a high level of Disinhibition. These data demonstrate the important roles that Disinhibition and Restraint play in the relationship between exercise and energy balance.BBSR

Dying to Talk? Co-producing resources with young people to get them talking about bereavement, death and dying

YesThe Dying to Talk project in Bradford, UK aimed to build resilience in young people around the topic of death, dying and bereavement. Starting conversations early in life could buttress people’s future wellbeing when faced with bereavement and indeed their own mortality. Research indicates that a key feature in young people’s experience of bereavement is ‘powerlessness’ (Ribbens McCarthy, 2007). Drawing on the principles of co-production, young people led the development of the project aimed at encouraging young people to talk about death, using archaeology as a facilitator to those conversations. The partnership between the University of Bradford, the voluntary sector and the young people proved to be a positive and empowering one. It laid the foundations for future collaboration and developed a framework for engaging young people in talking about death, building their resilience for dealing with death and dying in the future – a step towards building a ‘compassionate city’ for young people (Kellehear, 2012)University of Bradford, Higher Education Innovation Fund; AHR

Relationships among tonic and episodic aspects of motivation to eat, gut peptides, and weight before and after bariatric surgery.

yesBackground The interaction between motivation to eat, eating behaviour traits and gut peptides following gastric bypass (GBP) surgery are not fully understood. Setting Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden. Method Appetite and hormone responses to a fixed liquid pre-load were assessed in 12 obese (BMI 45 ± 1.9 kg/m2) participants immediately before, 3 days, 2 months, and 1 year following gastric by-pass (GBP) surgery. Subjective appetite and plasma levels of ghrelin, leptin, insulin and GLP-1 were measured for a 3-hour postprandial period. Eating behaviour traits were also measured using the TFEQR18. Results There was a decrease in TFEQ Emotional Eating (EE) and Uncontrolled Eating (UE) from pre to 1-year post-surgery, but no significant change in Restraint. In addition, there was a reduction in subjective appetite ratings, and alterations in appetite peptides favouring an anorectic response. Pre-surgery EE was significantly related to fasting and AUC ghrelin; UE was associated with AUC desire to eat while there was a significant association between fasting desire to eat and ghrelin (fasting and AUC). 1 year post-surgery, UE was positively related to fasting insulin and Restraint was negatively associated with GLP-1. UE and subjective hunger were positively correlated, while the relationship between desire to eat and ghrelin remained. Conclusion The relationships amongst subjective appetite ratings, eating behaviour traits and appetite peptides in obese patients both before and at one-year post GBP surgery contribute to the reduction in a propensity to over-eat and weight loss

Mothers’ and fathers’ views on the importance of play for their children’s development: gender differences, academic activities, and the parental role

YesBackground: Play is a main driver of children’s cognitive and social development and is crucial for educational success (Ginsburg, 2007). In recent years however, parents and schools are under pressure to prioritise academic targets over play. Aims: The current research investigated parents’ views about three aspects of their children’s play and academic activities. Sample: Predominantly highly educated UK parents (109 mothers and 49fathers) were recruited via social media. Method: Participants were asked to complete an amended online version of the Preschool Play and Learning Questionnaire (Parmar, Harkness, & Super, 2004). The questionnaire consisted of 25 items covering three themes: the importance of play for children’s development, the importance of academic activities, and the importance of parents’ role in their children’s development. The independent variables were the gender of the parent, the gender of their child, and the age group of their child (4 to 7 years, or 8 to 11 years). Results: Parents rated play higher than academic activities or their own roles, but the difference was not noteworthy. However, fathers rated academic activities and the parents’ role significantly higher than mothers did. In addition, parents of girls rated academic activities and their own role, significantly higher than parents of boys. Conclusions: The findings of the current research highlight gender divisions between parents and towards boys and girls regarding the importance of education. Gender roles appear to influence the way parents think about the academic activities their children partake in

Perceptions and experiences of early-adopting registered dietitians in integrating nutrigenomics into practice

yesPurpose - This research explores the perceptions and experiences of early adopters of the technology. Design/Method/Approach - Registered Dietitians (RD´s) (N=14) were recruited from the UK, Canada, South-Africa, Australia, Mexico and Israel. Six qualitative interviews and two focus groups were conducted online using a conference calling platform. Data were recorded, transcribed and thematically analysed. Findings - Early adopters of Nutrigenomics (NGx) were experienced, self-efficacious RD’s who actively sought knowledge of NGx through communication with one another and the broader scientific community. They considered NGx an extension of current practice and believed RD’s had the skills to deliver it. Perceived barriers to widening the application of NGx were linked to skepticism among the wider dietetics community. Proliferation of unregulated websites offering tests and diets was considered ‘pseudoscience’ and detrimental to dietetics fully embracing NGx. The lack of a sustainable public health model for the delivery of NGx was also perceived to hinder progress. Results are discussed with reference to ‘diffusion of innovation theory’. Originality/Value - The views of RD’s who practice NGx have not been previously studied. These data highlight requirements for future dietetic training provision and more inclusive service delivery models. Regulation of NGx services and formal recognition by professional bodies is needed to address the research/practice translation gap

Exercise Therapy to Reduce Anxiety (ExTRA) in mid-life and later-life adults: study protocol

Background Anxiety in mid-life and later-life is highly prevalent and causes significant distress and disability. There is increasing evidence supporting the potential effectiveness of exercise interventions for reducing clinically significant anxiety. Self-directed online interventions can be scalable and thus reach more people. Aims The Exercise Therapy to Reduce Anxiety (ExTRA) project aims to assess the feasibility and acceptability of an 8-week web-based exercise intervention with the innovation of being self-directed, and facilitated by wearable activity monitors (WAMs) and tailored behaviour change strategies to reduce anxiety in mid-life and later-life adults with clinically significant anxiety. Methods ExTRA will recruit 20-30 community dwelling adults aged 40-79 years with clinically significant anxiety. The self-directed 8-week web-based exercise intervention includes information and strategies to support participants to meet Australian national physical activity guidelines. The intervention is adapted from previous face-to-face trials and includes strategies to support participants living with anxiety. Feasibility will be measured by screening and retention rates. Acceptability will be measured by website usage data, online outcome measure completion, and an evaluation questionnaire. Other outcome measures include anxiety measured by the Depression Anxiety Stress Scales, and physical activity measured by the Global Physical Activity Questionnaire and a WAM. Results Findings will demonstrate whether this intervention is feasible and acceptable, and provide preliminary efficacy data. Conclusions The findings of this pragmatic real-world study will be valuable in guiding development of future trials, including randomised controlled trials of scalable and accessible exercise interventions to reduce the distress, disability and cost of anxiety

Exercise interventions to reduce anxiety in mid-life and late-life anxiety disorders and subthreshold anxiety disorder: a systematic review

Background: Anxiety disorders are highly prevalent and cause significant distress, disability, and cost. Medication adverse effects and interactions increase in mid-life and late-life, highlighting the need for effective non-pharmacological interventions. Objectives: We aimed to evaluate the extent of evidence supporting exercise interventions for anxiety and subthreshold anxiety disorders in mid-life and late-life. Design: Systematic review. Data Sources and Methods: We searched MEDLINE, PsycINFO, Embase, Emcare, Ovid Nursing, CINAHL Plus, Cochrane Library, Health Collection, Humanities & Social Sciences Collection, and https://clinicaltrials.gov databases for trials published January 1994–May 2019. Randomised controlled trials of exercise interventions involving aerobic exercise or resistance training for adults aged 40 years and above with anxiety or subthreshold anxiety disorders in residential or health settings were identified. The primary outcome was change in anxiety. We excluded trials including participants aged below 40 years, participants with diagnosis of separation anxiety, selective mutism, obsessive-compulsive disorder, acute stress disorder and post-traumatic stress disorder, and head-to-head comparisons of interventions. Trial quality was assessed using the Cochrane Risk of Bias Tool and evidence synthesised in narrative form. Results: Four trials totalling 132 participants met inclusion criteria, although some had methodological limitations. Interventions included a home-based resistance training intervention, supervised group-based aerobic intervention, Tai Chi intervention, and supervised group-based aerobic and strength intervention. Three trials included late-life participants and the fourth mid-life. Three trials demonstrated greater reductions in anxiety in the intervention group compared with control. The fourth trial showed pre–post reductions in anxiety in both groups, with between-group difference not reaching statistical significance. Conclusion: There is limited supportive evidence suggesting that exercise interventions have potential to be effective, feasible and safe non-pharmacological interventions for anxiety and subthreshold anxiety disorders in mid-life and late-life. The heterogeneity, limited number and high risk of bias of some trials meant that we were not able to conduct a meta-analysis. Tailoring of interventions may improve uptake and reduce dropout. The paucity of research in this area with only four included trials demonstrates the urgent need for future and larger trials to provide proof of concept, data about effective types and doses of exercise interventions, and guidance to community, clinical, and public health services

Toward a Romanian version of the Three Factor Eating Questionnaire–R21 for children and adolescents (CTFEQr21): Preliminary psychometric analysis and relation with body composition

YesPurpose. The aim of this study was to develop and validate a Romanian version of the three factor eating questionnaire-r21 for children and adolescents (ctfeqr21), and to assess its psychometric properties and factor structure. Associations between this version of the ctfeqr21 and anthropometric measures as well as body composition were also examined. Design and methods. 153 children and adolescents (68 boys and 95 girls; 10.8 ± 3.5 years) took part in this study (bmi of 17.7 ± 3.1 kg/m²). The participants were first interviewed to ascertain their understanding of the ctfeq-r21 and were then asked to self-complete the questionnaire. Height and weight were measured and body composition assessed using bio impedance analyzers (Tanita MC 780). Results. The CTFEQr21 showed satisfactory internal consistency (cronbach’s α=0.78). Cronbach’s alpha coefficients were 0.55 for CR, 0.75 for UE, and 0.76 for EE separately. UE and EE were found to be significantly correlated (r=0.54, p<0.05). The three factors explained 43% of the total variance. Correlation between CR, UE and EE with body weight, BMI and FFM were significant but low to moderate with coefficients ranging from 0.20 to 0.37. The higher the CR, UE and EE tertiles, the higher the weight, fat mass (kg) and fat-free mass values. Conclusions. According to the psychometric analysis of the questionnaire, the proposed version of the CTFEQr21 proposed here is a satisfactory tool to assess eating behaviors in Romanian child population that remains to be further developed

Early Career Aquatic Scientists Forge New Connections at Eco-DAS XV

A sense of kuleana (personal responsibility) in caring for the land and sea. An appreciation for laulima (many hands cooperating). An understanding of aloha ’āina (love of the land). The University of Hawai’i at Manoa hosted the 2023 Ecological Dissertations in Aquatic Sciences (Eco-DAS) program, which fostered each of these intentions by bringing together a team of early career aquatic ecologists for a week of networking and collaborative, interdisciplinary project development (Fig. 1)