Assessing the validity of the past-month, online canadian diet history questionnaire ii pre and post nutrition intervention

Dietary intake tools are used in epidemiological and interventional studies to estimate nutritional intake. The past-month Canadian Diet History Questionnaire II (CDHQII) has not yet been validated. This study aimed to assess the validity of the CDHQII in adults by comparing dietary results from the CDHQII to the same participants’ 24-h recalls consisting of two weekdays and one weekend day. The recalls were collected using the validated multiple-pass method. Participants were asked to complete both tools at baseline, and again at 3-month follow-up. The study further aimed to determine which dietary intake tool was preferred by study participants by comparing completion rates. Data collection occurred at baseline (pre-intervention) and 3-month follow-up (post-intervention). Paired sample t-tests were conducted to compare means for the following nutrients (grams and %kcal): calories, protein, carbohydrates, total fat, saturated fat, unsaturated fat and sodium. Intraclass correlation coefficients of agreement and coefficients of variation were further calculated. Chi-square tests were used to determine the dietary assessment method with the greatest participant completion rate. At baseline (n = 104), there were no significant differences between the results of the CDHQII and three 24-h recalls (averaged), with overall moderate correlation coefficients. At 3-months (n = 53), there were significant differences (p \u3c 0.05) between dietary intake collection methods for all nutrients assessed in this study, except for saturated fat (%kcal), unsaturated fat (%kcal), protein (%kcal) and sodium (mg). Correlation coefficients were moderate. A significantly greater proportion of participants completed the three 24-h recalls compared to the CDHQII after 3 months (completion rates of 67.2% vs. 50.8% of the sample, respectively). The CDHQII provided estimates of mean nutritional intake (calories, macronutrients and sodium) that were comparable to mean intake established from three 24-h recalls, at baseline and was validated in a sample of primarily middle-aged, college-educated, Caucasian female adults with overweight and obesity for mean baseline or cross-sectional measurement only but not for assessing individual/patient dietary intake in clinical practice (r = 0.30–0.68). This tool was not validated at 3-month follow-up. Additionally, participants preferred the three 24-h recalls to the online, past-month CDHQII

Incorporating the ‘Theory of Planned Behavior’ into personalized healthcare behavior change research: a call to action

The ‘Theory of Planned Behavior’ (TPB) has been tested and validated in the scientific literature across multiple disciplines and is arguably the most widely accepted theory among behavior change academics. Despite this widespread acceptability, the TPB has yet to be incorporated into personalized healthcare behavior change research. Several prominent personalized healthcare researchers suggest that personalizing healthcare recommendations have a positive impact on changes in lifestyle habits. However, research in this area has demonstrated conflicting findings. We provide a scientific and theoretical basis to support a proposed expansion of the TPB to include personalization, and call to action-personalized healthcare behavior change researchers to test this expansion. Specific recommendations for study design are included

A Cross Comparative Study to Examine Beliefs and Attitudes regarding Food and Eating between Food and Nutrition and Social Work Students

Background: Little is known regarding attitudes and beliefs toward eating disorders by students interested in working with this population. This study aims to understand similarities and differences between food and nutrition and social work students regarding their attitudes and beliefs toward food and eating, and how these findings may inform curriculum development prior to graduation as well as practice in the field.Methods and Findings: Using a mixed-method approach, 14 social work (SW) and26 food and nutrition (FN) students completed the Eating Disorders Attitudes Questionnaire (EAT-26) and participated in focus groups. After viewing 33 photographs of 11 different foods displayed as small, normal, and large portions according to Canada’s Food Guide, students categorized portions followed by their rationale. Different symptoms of disordered eating emerged; choices by FN students were informed by clinical knowledge and internal tension, whereas choices by SW students were based on external influences including industry, family, and cultural expectations. Language was noticeably different; FN students used clinical language creating distance between themselves and the photos, versus SW students who spoke from a personal and affective standpoint.Conclusions: Understanding attitudes and beliefs concerning food and eating by students planning to work with eating disorder clients raises questions of possible professional competencies and curriculum development prior to entering this practice area

Exploring attitudes, subjective norms and perceived behavioural control in a genetic-based and a population-based weight management intervention: A one-year randomized controlled trial

Background: Several studies demonstrate that the provision of personalized lifestyle advice, based on genetics, can help motivate individuals to engage in greater nutrition and physical activity changes compared to the provision of population-based advice. The theoretical mechanism behind this phenomenon is poorly understood. The objective of this study was to determine the impact of providing genetically tailored and population-based lifestyle advice on key constructs of the Theory of Planned Behaviour (TPB). Materials and Methods: A pragmatic, cluster randomized controlled trial (n = 140) took place at the East Elgin Family Health Team, in Aylmer, Ontario, Canada. Participants were primarily Caucasian females enrolled in a weight management program (BMI ≥ 25.0 kg/m2). Weight management program groups were randomized (1:1) to receive a population-based lifestyle intervention for weight management (Group Lifestyle Balance™ (GLB)) or a lifestyle genomics (LGx)-based lifestyle intervention for weight management (GLB+LGx). Attitudes, subjective norms and perceived behavioural control were measured at baseline, immediately after receiving a report of population-based or genetic-based recommendations and after 3-, 6-and 12-month follow-ups. Linear mixed models were conducted, controlling for measures of actual behavioural control. All analyses were intention-to-treat by originally assigned groups. Results: Significant changes (p \u3c 0.05) in attitudes, subjective norms, and perceived behavioural control tended to be short-term in the GLB group and long-term for the GLB+LGx group. Short-term and long-term between-group differences in measures of subjective norms were discovered, favouring the GLB+LGx group. Conclusions: The TPB can help provide a theoretical explanation for studies demonstrating enhanced behaviour change with genetic-based lifestyle interventions

A Systematic Review of Genetic Testing and Lifestyle Behaviour Change: Are We Using High-Quality Genetic Interventions and Considering Behaviour Change Theory?

Background: Studying the impact of genetic testing interventions on lifestyle behaviour change has been a priority area of research in recent years. Substantial heterogeneity exists in the results and conclusions of this literature, which has yet to be explained using validated behaviour change theory and an assessment of the quality of genetic interventions. The theory of planned behaviour (TPB) helps to explain key contributors to behaviour change. It has been hypothesized that personalization could be added to this theory to help predict changes in health behaviours. Purpose: This systematic review provides a detailed, comprehensive identification, assessment, and summary of primary research articles pertaining to lifestyle behaviour change (nutrition, physical activity, sleep, and smoking) resulting from genetic testing interventions. The present review further aims to provide in-depth analyses of studies conducted to date within the context of the TPB and the quality of genetic interventions provided to participants while aiming to determine whether or not genetic testing facilitates changes in lifestyle habits. This review is timely in light of a recently published “call-to-action” paper, highlighting the need to incorporate the TPB into personalized healthcare behaviour change research. Methods: Three bibliographic databases, one key website, and article reference lists were searched for relevant primary research articles. The PRISMA Flow Diagram and PRISMA Checklist were used to guide the search strategy and manuscript preparation. Out of 32,783 titles retrieved, 26 studies met the inclusion criteria. Three quality assessments were conducted and included: (1) risk of bias, (2) quality of genetic interventions, and (3) consideration of theoretical underpinnings – primarily the TPB. Results: Risk of bias in studies was overall rated to be “fair.” Consideration of the TPB was “poor,” with no study making reference to this validated theory. While some studies (n = 11; 42%) made reference to other behaviour change theories, these theories were generally mentioned briefly, and were not thoroughly incorporated into the study design or analyses. The genetic interventions provided to participants were overall of “poor” quality. However, a separate analysis of studies using controlled intervention research methods demonstrated the use of higher-quality genetic interventions (overall rated to be “fair”). The provision of actionable recommendations informed by genetic testing was more likely to facilitate behaviour change than the provision of genetic information without actionable lifestyle recommendations. Several studies of good quality demonstrated changes in lifestyle habits arising from the provision of genetic interventions. The most promising lifestyle changes were changes in nutrition. Conclusions: It is possible to facilitate behaviour change using genetic testing as the catalyst. Future research should ensure that high-quality genetic interventions are provided to participants, and should consider validated theories such as the TPB in their study design and analyses. Further recommendations for future research are provided

Study protocol of a pragmatic randomized controlled trial incorporated into the Group Lifestyle Balance™ program: the nutrigenomics, overweight/obesity and weight management trial (the NOW trial)

Background The nutrigenomics, overweight/obesity and weight management trial (NOW Trial) is a pragmatic randomized controlled trial of community-dwelling adults recruited from the Group Lifestyle Balance™ (GLB™) Program. The GLB™ Program (formerly referred to as the Diabetes Prevention Program) is an evidence-based, intensive weight management program, which was offered to overweight/obese patients (BMI ≥ 25.0 kg/m2) in a rural Ontario community. Methods Patients enrolled in the GLB™ Program were invited to participate in this study. GLB™ groups were randomized 1:1 to receive either the standard GLB™ program + population-based lifestyle advice for weight management, or a modified GLB™ program + personalized, genetic-based lifestyle advice for weight management. The purpose of this study is to determine if the provision of genetic-based lifestyle guidelines is superior to the provision of population-based guidelines in a pragmatic clinical setting to promote changes in: body composition, weight, body mass index, dietary and physical activity habits, as well as attitudes, subjective norms, and behavioural control. The 12-month intervention protocol consists of 23 group-based sessions and 4 one-on-one sessions. Data collection time points include baseline in addition to 3, 6, and 12-month follow up. The comprehensive study design is described in the present manuscript, using both the extended CONSORT checklist for reporting pragmatic trials and the SPIRIT checklist as guidance during manuscript development. Discussion Overall, this study seeks to pragmatically determine if the provision of DNA-based lifestyle advice leads to improved health and lifestyle outcomes compared to the provision of standard, population-based lifestyle advice. The results of this trial can be used to inform clinical and community nutrition practice guidelines

Can a Lifestyle Genomics Intervention Motivate Patients to Engage in Greater Physical Activity than a Population-Based Intervention? Results from the NOW Randomized Controlled Trial

Background: Lifestyle genomics (LGx) is a science that explores interactions between genetic variation, lifestyle components such as physical activity (PA), and subsequent health- and performance-related outcomes. The objective of this study was to determine whether an LGx intervention could motivate enhanced engagement in PA to a greater extent than a population-based intervention. Methods: In this pragmatic randomized controlled trial, participants received either the standard, population-based Group Lifestyle BalanceTM (GLB) program intervention or the GLB program in addition to the provision of LGx information and advice (GLB + LGx). Participants (n = 140) completed a 7-day PA recall at baseline, 3, 6, and 12 months. Data from the PA recalls were used to calculate metabolic equivalents (METs), a measure of energy expenditure. Statistical analyses included split plot analyses of covariance and binary logistic regression (generalized linear models). Differences in leisure time PA weekly METs, weekly minutes of moderate + high-intensity PA, and adherence to PA guidelines were compared between groups (GLB and GLB + LGx) across the 4 time points. Results: Weekly METs were significantly higher in the GLB + LGx group (1,114.7 ± 141.9; 95% CI 831.5-1,397.8) compared to the standard GLB group (621.6 ± 141.9 MET/week; 95% CI 338.4-904.8) at the 6-month follow-up (p = 0.01). All other results were non-significant. Conclusions: The provision of an LGx intervention resulted in a greater weekly leisure time PA energy expenditure after the 6-month follow-up. Future research should determine how this could be sustained over the long-term. Clinical Trial Registration: NCT03015012

Can a Lifestyle Genomics Intervention Motivate Patients to Engage in Greater Physical Activity than a Population-Based Intervention? Results from the NOW Randomized Controlled Trial

Background: Lifestyle genomics (LGx) is a science that explores interactions between genetic variation, lifestyle components such as physical activity (PA), and subsequent health- and performance-related outcomes. The objective of this study was to determine whether an LGx intervention could motivate enhanced engagement in PA to a greater extent than a population-based intervention. Methods: In this pragmatic randomized controlled trial, participants received either the standard, population-based Group Lifestyle BalanceTM (GLB) program intervention or the GLB program in addition to the provision of LGx information and advice (GLB + LGx). Participants (n = 140) completed a 7-day PA recall at baseline, 3, 6, and 12 months. Data from the PA recalls were used to calculate metabolic equivalents (METs), a measure of energy expenditure. Statistical analyses included split plot analyses of covariance and binary logistic regression (generalized linear models). Differences in leisure time PA weekly METs, weekly minutes of moderate + high-intensity PA, and adherence to PA guidelines were compared between groups (GLB and GLB + LGx) across the 4 time points. Results: Weekly METs were significantly higher in the GLB + LGx group (1,114.7 ± 141.9; 95% CI 831.5-1,397.8) compared to the standard GLB group (621.6 ± 141.9 MET/week; 95% CI 338.4-904.8) at the 6-month follow-up (p = 0.01). All other results were non-significant. Conclusions: The provision of an LGx intervention resulted in a greater weekly leisure time PA energy expenditure after the 6-month follow-up. Future research should determine how this could be sustained over the long-term. Clinical Trial Registration: NCT03015012

Oxidative Stress and Nutrition in Lung and Liver Transplant Recipients

Transplantation is an acceptable treatment for end-stage lung and liver disease patients. In lung transplantation, long-term survival is limited due to Bronchiolitis Obliterans Syndrome (BOS) and in liver transplantation, Hepatitis C Virus (HCV) disease recurrence significantly impacts long-term survival. Treatment options are limited and often not successful. It is therefore important to conduct research on the factors contributing to the pathogenesis and disease severity of BOS and HCV to improve our understanding of the mechanisms and potentially reduce morbidity and mortality. Several factors may play a role. The focus of this thesis is to assess the role of Oxidative Stress (OxS) and nutrition on these patient populations. BOS is a frequent complication of lung transplantation. OxS may contribute to its pathogenesis and induce further tissue injury and inflammation. OxS can be influenced by several factors including nutrition. The cross-sectional study showed that BOS lung recipients have elevated markers of OxS in their Bronchoalveolar Lavage Fluid (BALF) compared to those without BOS. However, there was no difference in nutritional factors potentially affecting OxS. HCV reinfection post transplant is universal, significantly increasing morbidity and mortality. OxS is involved in the pathogenesis of chronic HCV but its role in HCV disease recurrence is unknown. A first study determined whether HCV liver recipients (HCV-LT) were more oxidatively stressed when compared to controls or HCV non-transplant patients. A second study assessed OxS at six-and 12 months post transplant and compared results between those with and without recurrence. The results showed that HCV-LT were more oxidatively stressed, vitamin A intakes were significantly lower and plasma gamma- tocopherol was significantly higher in HCV-LT. Additionally, those with recurrence were more oxidatively stressed at six-months (before recurrence) and 12 months compared to those without recurrence. No differences were seen regarding nutrition parameters. These results suggest that OxS is present in transplant recipients but that nutritional factors do not play a significant role. Other causes of OxS likely play a more significant role such as the presence of inflammation due to immunological reactions associated with BOS and the generation of reactive oxygen species (ROS/RNS) seen in patients with HCV disease.Ph