The influence of sleep health on dietary intake: a systematic review and meta-analysis of intervention studies.

BACKGROUND: Poor dietary intake increases disease risk, and poor sleep influences diet. This systematic review and meta-analysis of intervention studies aimed to evaluate the effect of sleep health on dietary intake in adults. METHODS: Five online databases were used to identify studies published between 1970 and 2019. Included studies were interventions that modified sleep and reported dietary outcomes. RESULTS: Fifty four full texts were assessed and 24 publications were included. Following risk of bias appraisal, data were narratively summarised and a sub-group of studies (n = 15) was meta-analysed to determine the effect of sleep on dietary intake. One intervention modified sleep timing and 23 modified duration. Sleep duration was partially restricted (≤5.5 h night-1 ) (n = 16), totally restricted (n = 4), partially and totally restricted (n = 1), and extended (n = 2). Dietary outcomes were energy intake (n = 24), carbohydrate, fat, protein intake (n = 20), single nutrient intake (n = 5), diet quality (n = 1) and food types (n = 1). Meta-analysis indicated partial sleep restriction results in higher energy intake in intervention compared with control [standardised mean difference (SMD) = 0.37; 95% confidence interval (CI) = 0.21-0.52; P < 0.001], with a mean difference of 204 kcal (95% CI = 112-295; P < 0.001) in daily energy intake, and a higher percentage of energy from fat, protein, carbohydrate (fat: SMD = 0.33; 95% CI = 0.16-0.51; P < 0.001; protein: SMD = 0.30, 95% CI = 0.12-0.47, P = 0.001; carbohydrate: SMD = 0.22, 95% CI = 0.04-0.39, P = 0.014). CONCLUSIONS: Partial sleep restriction with duration of ≤5.5 h day-1 increases daily energy intake, as well as fat, protein and carbohydrate intake. Further research is needed to determine the relationship between other dimensions of sleep health and dietary intake.

DHA-enriched fish oil reduces insulin resistance in overweight and obese adults.

Adipose tissue inflammation is major factor in the development of insulin resistance (IR). Long-chain omega-3 polyunsaturated fatty acids (LCn-3PUFA) docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are anti-inflammatory bioactive lipids, thus may protect against type 2 diabetes (T2D) development. Previous research has demonstrated a sex-dependent association between LCn-3PUFA and T2D, and evidence suggests LCn-3PUFA may improve IR in a sex-dependent manner. This double-blind, randomized, parallel-arm placebo-controlled study aimed to determine whether DHA-enriched fish oil (FO) supplementation improves IR. Sex-dependent effects were assessed by testing for an interaction between sex and treatment in the multiple regression models. Men and women with abdominal obesity (waist circumference: males, ≥102 cm; females, ≥88 cm) and without diabetes were recruited from the community. Participants (age: 50.9 ± 12.7 years, female: 63.7%, BMI: 32.4 ± 6.6 kg/m2) were randomly allocated to either 2 g FO (860 mg DHA + 120 mg EPA) (intervention, n = 38) or 2 g corn oil (CO) /day (control, n = 35) for 12 weeks in a double-blind randomised controlled trial. A fasting blood sample was collected at 0 and 12 weeks for assessment of IR, glucose and blood lipid profile. Sixty-eight participants completed the intervention. Compared with CO (n = 32), FO (n = 36) significantly reduced fasting insulin by -1.62 µIU/L (95%CI: -2.99, -0.26,) (p = 0.021) and HOMA-IR by -0.40 units (95%CI: -0.78, -0.02, p = 0.038). Higher insulin and HOMA-IR at baseline were associated with greater reductions in the FO group (p < 0.001). There was no interaction between sex and treatment for the change in insulin (p-interactionsex*treatment = 0.816) or HOMA-IR (p-interactionsex*treatment = 0.825). DHA-enriched FO reduces IR in adults with abdominal obesity, however, sex-dependent differences were not evident in this study.

Higher diet quality in university students is associated with higher academic achievement: a cross-sectional study.

BACKGROUND: Unhealthy diets are typical of university students and the effects may be wider reaching than health. The present study aimed to describe the association between dietary intake and academic achievement in a sample of Australian university students. METHODS: A cross-sectional analysis of data from an online survey of 278 students from the University of Newcastle (UON), Australia [mean (SD) age 26.9 (10.5) years; 70.9% female] was conducted. Dietary intake, in terms of diet quality score [Australian Recommended Food Score (ARFS)], including individual sub-scales, and percentage energy per day from energy-dense nutrient poor (EDNP) foods, including individual sub-groups, was assessed using the validated Australian Eating Survey Food Frequency Questionnaire, and academic achievement was assessed as self-reported grade point average (GPA). The association between GPA and dietary intake was explored using linear regression, with adjustment for socio-demographic and student characteristics. RESULTS: Higher GPA was associated with higher diet quality (ARFS) (ß = 0.02, P = 0.011), higher sub-scale scores for vegetables (ß = 0.03, P = 0.026) and fruit (ß = 0.05, P = 0.029) and with lower percentage energy per day from EDNP foods overall (ß = -0.01, P = 0.047) and also from sweetened drinks (ß = -0.06, P < 0.001). CONCLUSIONS: The results of the present study demonstrate small associations between a healthier dietary intake and higher academic achievement, as well as vice versa. Given that the associations were small, they may not be particularly meaningful. However, this evidence could be used as a motivator for efforts aiming to improve dietary intake among university students.

A systematic review and meta-analysis of nutrition interventions for chronic noncancer pain.

BACKGROUND: This systematic review aimed to evaluate the impact of nutrition interventions on participant reported pain severity and intensity in populations with chronic pain. METHODS: Eight databases were systematically searched for studies that included adult populations with a chronic pain condition, a nutrition intervention and a measure of pain. Where possible, data were pooled using meta-analysis. Seventy-one studies were included, with 23 being eligible for meta-analysis. RESULTS: Studies were categorised into four groups: (i) altered overall diet with 12 of 16 studies finding a significant reduction in participant reported pain; (ii) altered specific nutrients with two of five studies reporting a significant reduction in participant reported pain; (iii) supplement-based interventions with 11 of 46 studies showing a significant reduction in pain; and (iv) fasting therapy with one of four studies reporting a significant reduction in pain. The meta-analysis found that, overall, nutrition interventions had a significant effect on pain reduction with studies testing an altered overall diet or just one nutrient having the greatest effect. CONCLUSIONS: This review highlights the importance and effectiveness of nutrition interventions for people who experience chronic pain.

Dietary outcomes of overweight fathers and their children in the Healthy Dads, Healthy Kids community randomised controlled trial.

BACKGROUND: Few studies have examined dietary intake changes following a weight loss intervention in fathers and the association between father-child dietary intakes. The present study aimed to: (i) evaluate the change in dietary intake in overweight fathers randomised to a family-based lifestyle intervention [Healthy Dads Healthy Kids (HDHK)] versus controls and (ii) investigate whether an association exists between father-child dietary intakes. METHODS: A secondary analysis was conducted of father-child baseline and 3-month post-intervention data (n = 93) collected in the HDHK community randomised controlled trial. Intention-to-treat linear mixed models were used to assess dietary changes by group, time (baseline and 3-month) and the group-by-time interaction. Cohens d was used to determine effect sizes. RESULTS: Significant group-by-time effects (all P < 0.05) favouring fathers in the intervention group were identified for total daily energy intake (-1956 kJ, d = 0.74), total sugars (-45 g, d = 0.63), sodium (-414 mg, d = 0.58) and % energy from nutrient-dense, core foods (+10.1%, d = 0.86), fruit (+2.4%, d = 0.71), vegetarian protein sources (+1.2%, d = 0.57), pre-packed snacks (+1.7%, d = 0.58) and sugar-sweetened beverages (-4.1%, d = 0.58). At baseline, positive correlations were observed between father-child intakes for a number of dietary variables, and significant correlations were observed between father-child change scores for % energy carbohydrate (r = 0.35, P = 0.023), % energy from fruit (r = 0.47, P = 0.002), vegetarian protein sources (r = 0.46, P = 0.002) and frequency of consuming meals with vegetables (r = 0.38, P = 0.012). CONCLUSIONS: The HDHK intervention successfully improved some aspects of father's dietary intakes compared to controls. The fathers' eating patterns also correlated with those of their children for several dietary variables. These novel data suggest that fathers can be targeted as agents of dietary change within obesity prevention and treatment programmes.

Food and functional dyspepsia: a systematic review.

BACKGROUND: Functional dyspepsia (FD) is a debilitating functional gastrointestinal disorder characterised by early satiety, post-prandial fullness or epigastric pain related to meals, which affects up to 20% of western populations. A high dietary fat intake has been linked to FD and duodenal eosinophilia has been noted in FD. We hypothesised that an allergen such as wheat is a risk factor for FD and that withdrawal will improve symptoms of FD. We aimed to investigate the relationship between food and functional dyspepsia. METHODS: Sixteen out of 6451 studies identified in a database search of six databases met the inclusion criteria of studies examining the effect of nutrients, foods and food components in adults with FD or FD symptoms. RESULTS: Wheat-containing foods were implicated in FD symptom induction in six studies, four of which were not specifically investigating gluten and two that were gluten-specific, with the implementation of a gluten-free diet demonstrating a reduction in symptoms. Dietary fat was associated with FD in all three studies that specifically measured this association. Specific foods reported as inducing symptoms were high in either natural food chemicals, high in fermentable carbohydrates or high in wheat/gluten. Caffeine was associated with FD in four studies, although any association with alcohol was uncertain. CONCLUSIONS: Wheat and dietary fats may play key roles in the generation of FD symptoms and reduction or withdrawal eased symptoms. Randomised trials investigating the roles of gluten, FODMAPs (fermentable oligosaccharide, disaccharide, monosaccharide and polyols) and high fat ingestion and naturally occurring food chemicals in the generation of functional dyspepsia symptoms are warranted and further investigation of the mechanisms is now required.

Comparison of fatty acid intakes assessed by a cardiovascular-specific food frequency questionnaire with red blood cell membrane fatty acids in hyperlipidaemic Australian adults: a validation study.

BACKGROUND/OBJECTIVES: Limited dietary intake tools have been validated specifically for hyperlipidaemic adults. The Australian Eating Survey (AES) Food Frequency Questionnaire (FFQ) was adapted to include foods with cardio-protective properties (CVD-AES). The aims were to estimate dietary fatty acid (FA) intakes derived from the CVD-AES and AES and compare them with red blood cell (RBC) membrane FA content. SUBJECTS/METHODS: Dietary intake was measured using the semi-quantitative 120-item AES and 177-item CVD-AES. Nutrient intakes were calculated using AUSNUT 2011-2013. Fasting RBC membrane FAs were assessed using gas chromatography. Extent of agreement between intakes estimated by AES or CVD-AES and RBC membrane composition (% of total FAs) for linoleic acid (LA), alpha-linolenic acid (ALA), eicosapentanoic acid (EPA), docosapentaenoic acid (DPA) and docosahexaenoic acid (DHA) were assessed using Spearman's correlation coefficients, adjusted linear regressions and Kappa statistics. RESULTS: Data from 39 participants (72% female, 59.3±11.1 years) indicate stronger positive correlations between RBC membrane FAs and CVD-AES dietary estimates compared with the AES. Significant (P<0.05) moderate-strong correlations were found between CVD-AES FAs and FA proportions in RBC membranes for EPA (r=0.62), DHA (r=0.53) and DPA (r=0.42), with a moderate correlation for LA (r=0.39) and no correlation with ALA. Significant moderate correlations were found with the AES for DHA (r=0.39), but not for LA, ALA, EPA or DPA. CONCLUSIONS: The CVD-AES provides a more accurate estimate of long chain FA intakes in hyperlipidaemic adults, compared with AES estimates. This indicates that a CVD-specific FFQ should be used when evaluating FA intakes in this population.

Core food intakes of Australian children aged 9-10 years: nutrients, daily servings and diet quality in a community cross-sectional sample.

BACKGROUND: The present study aimed to evaluate core food intakes in 9-10-year-old Australian children by considering adequacy of nutrient intakes, comparing servings of core food groups with Australian recommendations and scoring overall diet quality. METHODS: Children from an established community-based cohort study completed a semi-quantitative food frequency questionnaire. Daily intakes of energy, macronutrients, micronutrients, servings of core (i.e. nutrient-rich) foods and a diet quality index were calculated and compared with appropriate standards. Sex and socio-economic differences were examined. RESULTS: The 436 children participating were from low to high socio-economic status families. As a group, over half of the children met estimated average requirements for key macro- and micronutrients, with the exception of fibre (inadequate in 41% of boys and 24% of girls). Children obtained 55% of their daily energy from core foods. Most children had fewer than the recommended servings of vegetables (91%) and meat/alternatives (99.8%), whereas boys generally ate fewer servings of grains and cereals than recommended (87%), and girls ate fewer servings of dairy (83%). Diet quality scores indicated room for improvement (median score of 26 for boys and 25 for girls, out of a maximum of 73 points). CONCLUSIONS: As a group, a large proportion of children were able to meet their daily nutrient requirements. However, achieving this through noncore foods meant that diets were high in salt, saturated fat and sugar; more servings of core foods and greater dietary diversity would be preferable. These results suggest that families need more support to optimise dietary patterns of children in this age group.

Relationships between dietary intakes of children and their parents: a cross-sectional, secondary analysis of families participating in the Family Diet Quality Study.

BACKGROUND: Being overweight and obese in Australian children is common. Current evidence related to parental influence on child dietary intake is conflicting, and is particularly limited in terms of which parent exerts the stronger relationship. The present study aimed to assess mother-father and parent-child dietary relationships and to identify which parent-child relationship is stronger. METHODS: A cross-sectional analysis was performed of dietary intake data from 66 families with one parent and one child aged 8-12 years who were participating in the Family Diet Quality Study, in the Hunter and Forster regions of New South Wales, Australia. Dietary intakes were assessed using adult and child specific, validated semi-quantitative 120-item food frequency questionnaires. Diet quality and variety subscores were assessed using the Australian Recommended Food Scores for adults and children/adolescents. Pearson's correlations were used to assess dietary relationships between mother-father, father-child and mother-child dyads. RESULTS: Weak-to-moderate correlations were found between mother-child dyads for components of dietary intake (r = 0.27-0.47). Similarly, for father-child dyads, predominantly weak-to-moderate correlations were found (r = 0.01-0.52). Variety of fruit intake was the most strongly correlated in both parent-child dyads, with the weakest relationships found for fibre (g 1000 kJ(-1) ) in father-child and percentage energy from total fats for mother-child dyads. Mother-father dyads demonstrated mostly moderate-to-strong correlations (r = 0.13-0.73), with scores for condiments showing the weakest relationship and vegetables the strongest. For all dyads, strong correlations were observed for overall diet quality (r = 0.50-0.59). CONCLUSIONS: Parent-child dietary intake is significantly related but differs for mother versus fathers. Further research is required to examine whether differing dietary components should be targeted for mothers versus fathers in interventions aiming to improve family dietary patterns.

A comparison and validation of child versus parent reporting of children's energy intake using food frequency questionnaires versus food records: who's an accurate reporter?

BACKGROUND & AIMS: The aim of this study was to (i) to compare the accuracy of reporting for child's total energy intake from a food frequency questionnaire (FFQ) completed independently by the mother, father and child in comparison to total energy expenditure (TEE) measured using doubly labeled water (DLW) (ii) compare the accuracy of the weighed food record (WFR) and DLW. METHODS: Healthy weight children (mean ± SD age 9.8 ± 1.3 years, n = 6 girls/3 boys) and their parents independently completed an FFQ about children's intake. A 4-day WFR of child intake was recorded simultaneously. The accuracy of energy intakes reports were determined by the absolute and percentage differences between estimated energy intake and TEE measured by DLW. RESULTS: The mean difference (limits of agreement LOA, ± 2SD) when compared to DLW was; child 130 (-1518, 1258) kcal or (113 ± 35% of TEE); father 398 (0,796) kcal or (121 ± 13%); mother 807 (-213, 1824) kcal or (144 ± 26%) and for the WFR -153 (1089, -1395) kcal or 95 ± 32%. CONCLUSIONS: Children were the most accurate reporters when compared to their parents, with fathers more accurate than mothers. The 4-day WFR was approximately equal to the child report FFQ in estimating EI in children 8-11 years.

The 'Healthy Dads, Healthy Kids' randomized controlled trial: efficacy of a healthy lifestyle program for overweight fathers and their children.

OBJECTIVE: To evaluate the feasibility and efficacy of the 'Healthy Dads, Healthy Kids' (HDHK) program, which was designed to help overweight fathers lose weight and be a role model of positive health behaviors for their children. DESIGN: Randomized controlled trial. PARTICIPANTS: A total of 53 overweight/obese men (mean (s.d.) age=40.6 (7.1) years; body mass index (BMI)=33.2 (3.9)) and their primary school-aged children (n=71, 54% boys; mean (s.d.) age=8.2 (2.0) years) were randomly assigned (family unit) to either (i) the HDHK program (n=27 fathers, n=39 children) or (ii) a wait-list control group (n=26 fathers, n=32 children). INTERVENTION: Fathers in the 3-month program attended eight face-to-face education sessions. Children attended three of these sessions. OUTCOMES: The primary outcome was fathers' weight. Fathers and their children were assessed at baseline, and at 3- and 6-month follow-up, for weight, waist circumference, BMI, blood pressure, resting heart rate (RHR), objectively measured physical activity and self-reported dietary intake. RESULTS: Intention-to-treat analysis revealed significant between-group differences at 6 months for weight loss (P<0.001), with HDHK fathers losing more weight (-7.6 kg; 95% confidence interval (CI) -9.2, -6.0; d=0.54) than control group fathers (0.0 kg; 95% CI -1.4, 1.6). Significant treatment effects (P<0.05) were also found for waist circumference (d=0.62), BMI (d=0.53), systolic blood pressure (d=0.92), RHR (d=0.66) and physical activity (d=0.91), but not for dietary intake. In children, significant treatment effects (P<0.05) were found for physical activity (d=0.74), RHR (d=0.51) and dietary intake (d=0.84). CONCLUSION: The HDHK program resulted in significant weight loss and improved health-related outcomes in fathers and improved eating and physical activity among children. Targeting fathers is a novel and efficacious approach to improving health behavior in their children.