Ultra-processed food consumption and non-alcoholic fatty liver disease, metabolic syndrome and insulin resistance: A systematic review.

Background: High ultra-processed food (UPF) consumption is associated with the development of various diet-related non-communicable diseases, especially obesity and type 2 diabetes. The present study aimed to systematically review the association between UPF consumption and non-alcoholic fatty liver disease (NAFLD) and its leading risk factors; metabolic syndrome (MetS) and insulin resistance (IR). Methods: A comprehensive search was conducted in PubMed, Scopus, Embase, Web of Science, CINAHL, and Cochrane (March 2023), and references of the identified articles were checked. The search keywords were defined through an exploratory investigation in addition to MeSH and similarly controlled vocabulary thesauruses. Observational and interventional studies were included. Studies that focused only on specific groups of processed foods or overlapping dietary patterns were excluded. The quality assessment was conducted using the Joanna Briggs Institute's critical appraisal tools for observational studies and Cochrane's risk of bias 2 tool for randomized-control trials. A narrative synthesis was employed to report the results. Results: Fifteen studies were included, with a total of 52,885 participants, one randomized-controlled trial, and fourteen observational studies (nine cross-sectional and five prospective). The review has shown a significant association between UPF consumption and NAFLD in three studies out of six, MetS in five out of eight, and IR in one out of three. All large-scale prospective cohorts that studied NAFLD or MetS outcomes demonstrated a positive association. In contrast, studies that did not demonstrate significant associations were mostly cross-sectional and small. The evidence for an association with IR was insufficient and conflicting. Conclusion: The included studies are few, observational, and based upon self-reported dietary assessment tools. However, current evidence indicates that UPF is not only associated with obesity and type 2 diabetes but may also be a risk factor for NAFLD and MetS. UPF is a worldwide concern deserving further longitudinal research. Impact and implications: Overconsumption of ultra-processed food (UPF) may lead to the development of obesity and type 2 diabetes, but the association with non-alcoholic fatty liver disease (NAFLD) is not well established. The present systematic review shows that UPF may be associated with NAFLD, although more large prospective studies are needed. These findings emphasize the importance of minimizing the consumption of UPF to prevent NAFLD and other metabolic diseases among the general adult population. This systematic review and further prospective studies, epidemiological or interventional, can help physicians provide patients with evidence-based nutritional recommendations and will support policymakers in restricting the marketing of UPF as well as promoting affordable, healthy, and minimally processed foods.

Salt: a narrative review and local policy initiatives in Israel.

High salt intake is a well-known risk factor for cardiovascular disease (CVD). Some recent prospective studies have challenged the salt-CVD link. We conducted a narrative review based on a systematic search and provided a national policy update. We reviewed 14 observational prospective studies in healthy adults, reporting the association between sodium intake and excretion or reduction and CVD incidence. Validated by cohort studies, recommended sodium consumption levels (< 1.5-2 gram per day) are still relevant for the prevention of CVD in adults. We discussed the findings and policy initiatives implemented in Israel. Such initiatives included voluntary and mandatory food labeling, and culturally tailored educational programs. The Ministry of Health in Israel initiated a salt reduction policy in recent years-aimed for the future of the industry as well as the population.

IGF1 Genetic Polymorphism and the Association between Vitamin D Status and BMI Percentiles in Children.

Both the IGF1 axis and hypovitaminosis D play a role in childhood obesity, either as a cause or a causality. While some studies suggest an interrelation between vitamin D status, IGF1, and obesity, this mechanism remains obscure. The aim of this study, therefore, was to explore associations between four genetic polymorphisms in the IGF1 axis in hypovitaminosis D-related obesity. The study included 116 pre-pubertal Israeli Arab children (52 girls), mean age 9.4 ± 2.6. Serum 25(OH)D was measured and anthropometric measures were obtained. Genomic DNA was extracted from peripheral EDTA-treated anti-coagulated blood using a standard protocol. Genotypes were determined using the Taqman allelic discrimination assay. The IGF genetic score was computed according to the additive genetic score model. A moderate-to-high negative correlation (r = 0.580, p < 0.05) was seen between the vitamin D status and body mass index (BMI) percentile of participants with high GS. Yet, no correlations were seen between vitamin D status and BMI percentile for participants with a low-to-moderate genetic score (GS) (GS ≤ 2). These results suggest that IGF1 genetic scores associated with elevated circulating IGF1 may indicate a tendency toward developing hypovitaminosis D-associated obesity.

Advances in Technology Promote Patient-Centered Care in Cardiac Rehabilitation.

Patient-centered health care (PCC) is a framework of clinical care focused on the patient's individual health care needs. In particular, it emphasizes the development of a partnership between the patient, physician, and healthcare workers to actively involve and empower the patient in their health care decisions. Additionally, PCC goals include ensuring access to care, emotional support, engaging patient support systems, physical comfort, and continuity of care. Technology also provides a platform to engage patients and their families in their care and can be a useful tool to gauge their level of interest, knowledge, and motivations to adequately educate them on the many factors that contribute to their disease, including diet, exercise, medication adherence, psychological support, and early symptom detection. In this article, we summarize the importance of technology in promoting PCC in cardiac rehabilitation and the impact technology may have on the different aspects of patient and physician relationships. Modern technological devices including smartphones, tablets, wearables, and other internet-enabled devices have been shown to help patient-staff communication, cater to patients' individual needs, increase access to health care, and implement aspects of PCC domains.

The Influence of Yoga on the Cognitive Function of People Aged 60 Years and Older: A Systematic Review.

Context: With aging, cognition declines, leading to functional limitations and a loss of independence. Yoga is a particular kind of physical activity that can have a positive influence on cognition in older adults, because it aims to improve physical skills and to enhance the ability to focus and to neutralize external mental stimulation. Objective: The literature review intended to evaluate the effects of different types of yoga interventions and to examine which cognitive functions were affected by them for healthy people aged 60 years and older. Design: A search of the terms "yoga and cognition" and "yoga and cognitive function" was conducted using the PubMed and EBSCO databases. For inclusion, an article must have: (1) included healthy participants aged 60 and above, (2) been an intervention lasting between one week and six months, and (3) been an RCT. Three reviewers independently assessed each study. Setting: The Academic College at Wingate, Israel. Participants: Out of 503 articles, only five met the inclusion criteria, and had in total 461 participants, 128 men and 333 women, aged 60 years and older. Interventions: Interventions in the studies lasted between one and six months. Yoga methods included Hatha yoga, Trataka yoga, Iyengar yoga, and Himalayan Siddha yoga. Outcome Measures: Methods and tools applied in the studies were compared. The outcome measures examining cognitive functions included working memory, executive functions, visual memory and processing, focus and attention, and reaction time. Brain physiology outcomes were also screened. Results: An analysis of the type of yoga method was conducted and is presented in terms of the length and frequency of each intervention, the tests applied, and the effects of each intervention. In three articles, with a total of 293 subjects, the yoga intervention groups showed significant improvements in the ability to perform various cognitive functions as compared to the control groups. In two articles, with a total of 168 participants, no significant improvements were found for any of the groups, and none of the articles reported a decline. Conclusions: The studies differed in the type of yoga, length of the intervention, and type of cognitive-function assessments, making results inconclusive. Nevertheless, based on the examined randomized controlled trials (RCTs), overall yoga may offer benefits to cognitive function. However, a greater number of RCTs with a larger number of participants and rigorous research methods are required to support this recommendation.

Religiosity Is Associated with Reduced Risk of All-Cause and Coronary Heart Disease Mortality among Jewish Men.

Previous studies have found an inverse association between religiosity and mortality. However, most of these studies were carried out with Christian participants. This longitudinal study aimed to determine whether a composite variable based on self-reported religious education and religious practices is associated with coronary heart disease (CHD) and all-cause mortality in 9237 Jewish men aged 40-65 years at baseline, over a 32-year follow-up. Jewish men were characterized by their degree of religiosity, from the Ultra-Orthodox ("Haredim")-the strictest observers of the Jewish religious rules, and in descending order: religious, traditional, secular, and agnostic. Demographic and physical assessments were made in 1963 with a 32-year follow-up. The results indicate that Haredim participants, in comparison to the agnostic participants, had lower CHD mortality. Hazard ratio (HR) and 95% confidence interval (95% CI)-adjusted by age, cigarette smoking, systolic blood pressure, diabetes, socioeconomic status, BMI, and cholesterol, was: [HR = 0.68 (95% CI 0.58,0.80)] for Haredim; [HR = 0.82 (95% CI 0.69,0.96)] for religious; [HR = 0.85 (95% CI 0.73-1.00)] for traditional; and [HR = 0.92 (95% CI 0.79-01.06) for secular, respectively (p for trend = 0.001). The same pattern was observed for total mortality. This study shows an association between religious practice among men and a decreased rate of CHD and total mortality.

Potential Role of Insulin-Like Growth Factors in Myofascial Pain Syndrome: A Narrative Review.

ABSTRACT: Insulin-like growth factors have diverse functions in skeletal muscles by acting through multiple signaling pathways, including growth regulation and differentiation, anti-inflammation, and antioxidation. Insulin-like growth factors have anti-inflammatory effects and also play roles in nociceptive pathways, determining pain sensitivity, in addition to their protective role against ischemic injury in both the nervous system and skeletal muscle. In skeletal muscle, insulin-like growth factors maintain homeostasis, playing key roles in maintenance, accelerating muscle regeneration, and repair processes. As part of their maintenance role, increased levels of insulin-like growth factors may be required for the repair mechanisms after exercise. Although the role of insulin-like growth factors in myofascial pain syndrome is not completely understood, there is evidence from a recent study that insulin-like growth factor 2 levels in patients with myofascial pain syndrome are lower than those of healthy individuals and are associated with increased levels of inflammatory biomarkers. Importantly, higher insulin-like growth factor 2 levels are associated with increased pain severity in myofascial pain syndrome patients. This may suggest that too low or high insulin-like growth factor levels may contribute to musculoskeletal disorder process, whereas a midrange levels may optimize healing without contributing to pain hypersensitivity. Future studies are required to address the mechanisms of insulin-like growth factor 2 in myofascial pain syndrome and the optimal level as a therapeutic agent.

A Comparison between Different Types and Frequency of Physiotherapy Treatment for Children and Adolescents with Postural Problems and Low Back Pain.

AIM: To examine the effect of a once-a-week group physiotherapy session in addition to a once-a-month individual physiotherapy treatment, in comparison to a monthly individual physiotherapy treatment. METHODS: Fifty children and adolescents aged 10-18 years with poor back posture, some of whom had LBP, met individually with a physiotherapist once a month. The intervention group received an additional once-a-week group physiotherapy session for 12 weeks. Thorax curve angle, postural behavior, and low back pain (LBP) were measured before and after intervention. RESULTS: The thorax curve angle decreased from 39.2 ± 9.3 to 28.2 ± 6.8 (p < 0.001) in the group + individual therapy group and from 38.9 ± 9.3 to 27.9 ± 7.8 in the individual therapy only group (p < 0.001). LBP decreased from 5.6 ± 2.2 to 1.6 ± 1.9 (p < 0.001) and from 5.5 ± 2.1 to 2.8 ± 2.0 (p < 0.001). A significantly greater improvement in postural behavior was found in the group + individual therapy group (p = 0.04). Moreover, attrition rates were lower in the experimental group. CONCLUSION: A lower-frequency individual physiotherapy treatment for 12 weeks proved as beneficial as the same program with an additional higher-frequency group physiotherapy in improving thorax curve angle and LBP. However, the higher-frequency group physiotherapy in addition to the lower-frequency individual treatment was significantly more effective in improving postural behavior and adherence to treatment.

Differences in the Association between Physical Activity and People's Resilience and Emotions during Two Consecutive Covid-19 Lockdowns in Israel.

Governments worldwide have imposed harsh restrictions for decreasing the Covid-19 pandemic and maintaining public health. Yet such limitations have impacted people's physical activity. This study examined relationships between changes in physical activity and resilience, emotions, and depression during two lockdowns in Israel. An online survey was completed twice by 135 participants during two consecutive lockdowns. The results indicate that resilience and positive emotions were higher, and negative emotions and depression were lower during the second lockdown compared to the first one-even though people spent less time performing physical activity in the later lockdown. Moreover, negative emotions significantly decreased among people who reported increased physical activity during the second lockdown [M = 2.2 (SD = 0.9) compared to M = 1.9 (SD = 0.8) on a scale of 1-5] and increased among those who reported a reduction in activity [M = 1.8 (SD = 0.7) compared to M = 2.2 (SD = 0.7)]. It could therefore be concluded that while the Israeli population's resilience is higher compared to other populations (who do not regularly deal with crisis situations), their increased physical activity was associated with better resilience and emotions and lower depression scores. Since lockdowns are an extreme yet often repeated phenomenon, it is important to understand the psychological implications of engaging in physical activity.

Physical activity, resilience, emotions, moods, and weight control, during the COVID-19 global crisis.

OBJECTIVES: This study aimed at exploring the relationships between physical activity, weight control, and psycho-social aspects of the COVID-19 lockdown, which have characterized the Israeli population's behavior during the COVID-19 global crisis. DESIGN: Cross-sectional survey research. METHODS: Participants included 1855 men and women aged 18 and above, from different regions in the country and representing different sectors. They were recruited through the social media in a "snowball" sampling, and filled out a self-administered six-part survey: Demographic background, the International Physical Activity Questionnaire (IPAQ), the positive and negative affect scales (PANAS), the Conor and Davidson resilience scale, a questionnaire for measuring depressive symptoms, and questions regarding weight change based on the Israeli National Health and Nutrition (MABAT) survey. RESULTS: Routine physical activity (PA) was reported by 76.3% of the participants before the lockdown, 19.3% stopped exercising during this period, and 9.3% began exercising during the lockdown. The participants who were physically active during the lockdown period reported a higher level of resilience and positive feelings, and a lower level of depression, compared with those who were not physically active. People who were physically active during the lockdown maintained their weight compared with those who were inactive. Concerning weight change, 44.8% of the respondents maintained their weight, and a higher percentage of people reported weight gain than those who reported weight loss. CONCLUSIONS: Continuous PA before and during the COVID-19 lockdown were associated with higher resilience and positive emotions, and depressive symptoms, in people aged 18 and above. Although a causal link cannot be established, in light of the results of the present study, encouraging physical activity may contribute to improving mental health and a sense of self-efficacy, as well as to maintaining weight during a crisis.

Dietary recommendations of magnesium for cardiovascular prevention and treatment. A position paper of the Israel Heart Society and the Israel Dietetic Association.

Modern life and the Western industrial diet has enhanced the reduction of magnesium in our food, which may contribute to a marginal or absolute magnesium deficiency. Magnesium deficiency is evident in, among others, the elderly population, those after myocardial infarction and/or chronic heart failure, and diabetics. In Israel, over 60% of the drinking water originates from desalinated seawater lacking magnesium, which may cause hypomagnesemia. Magnesium deficiency can easily be treated by magnesium supplementation if we are aware of the situation. This paper summarizes the magnesium chapter in a position paper published in April 2021 by the Israeli Cardiology Society together with the Israeli Dietetic Association. It summarizes evidence-based nutritional recommendations for prevention and treatment of cardiovascular disease, with emphasis on the level of evidence and practical recommendations according to the European Society of Cardiology definitions. The best recommendation is to increase consumption of magnesium-rich food, such as leafy green vegetables (mainly spinach), nuts, avocado, whole grains, legumes (e.g., beans, peas and soy beans), chocolate and certain seafood. However, for people who do not get sufficient magnesium from their diet completing the daily amount, as needed, with supplements of up to 600 mg/day should be considered. In addition, serum magnesium levels should be checked at least every six months in patients with heart failure, people taking diuretic therapy, and people taking proton-pump inhibitors. In addition, it may be beneficial to add magnesium following myocardial infarction in people with hypertension and in heart failure patients in order to reduce cardiovascular morbidity and mortality (class of recommendation IIa, level of evidence B).

Comparison of Equations Estimating Resting Metabolic Rate in Older Adults with Type 2 Diabetes.

Measuring resting metabolic rate (RMR) is time-consuming and expensive, and thus various equations for estimating RMR have been developed. This study's objective was to compare five equations in elderly people with type 2 diabetes (T2DM). RMR was measured in 90 older adults (≥65 years) with T2DM (mean body mass index (BMI) of 31.5 kg/m2), using indirect calorimetry. Results were compared to four frequently used equations (those of Cunningham, Harris and Benedict, and Gougeon developed for young adults with T2DM, and that of Lührmann, which was developed for the elderly), in addition to a new equation developed recently at the Academic College at Wingate (Nachmani) for overweight individuals. Estimation accuracy was defined as the percentage of subjects with calculated RMR within ±10% of measured RMR. Measured RMR was significantly underestimated by all equations. The equations of Nachmani and Lührmann had the best estimation accuracy: 71.4% in males and 50.9% in females. Skeletal muscle mass, fat mass, hemoglobin A1c (HbA1c), and the use of insulin explained 70.6% of the variability in measured RMR. RMR in elderly participants with T2DM was higher than that calculated using existing equations. The most accurate equations for this specific population were those developed for obesity or the elderly. Unbalanced T2DM may increase caloric demands in the elderly. It is recommended to adjust the RMR equations used for the target population.

Physical activity, resilience, emotions, moods, and weight control of older adults during the COVID-19 global crisis.

BACKGROUND: The main purpose of the research was to examine the differences between adults in the age group 70+ and two other age groups (45-59 and 60-69), concerning their healthy and active lifestyle. The death toll of the current COVID-19 pandemic is strongly biased toward the elderly. However, some studies of crises suggest that older adults tend to perceive events as less stressful than do younger people. Therefore, we examined healthy behavior in populations at risk according to the age cutoff-points used by the Ministry of Health at the time of vaccination, and divided the participants into three age groups (45-59, 60-69, and 70+) following health organizations' recommendations. METHODS: Participants were 1202 people, 381 males and 821 females, aged 45-90. A survey comprised of six parts was used: Demographic background, the International Physical Activity Questionnaire-short version, Positive and Negative Affect Schedule - PANAS, the Connor and Davidson Resilience Scale, a questionnaire for measuring depressive moods, and questions regarding weight change, based on the Israeli National Health and Nutrition (MABAT) survey. Data were collected in Israel during the first complete lockdown. The questionnaire was distributed via e-mail, WhatsApp, Twitter, and Facebook using a snowball sampling method. RESULTS: Resilience and negative feelings and depression symptoms were higher in age group 45-59 compared to 70+ year-old participants, and the depression symptoms score was also higher among participants aged 45-59 compared to ages 60-69. Physical activity was associated with higher resilience, fewer depression symptoms, and fewer negative emotions. Regarding gender and psychological variables, no differences were found. During the time of lockdown, weight change was not prevalent and sleeping hours increased. CONCLUSION: In adults at 70+, the physical activity level, physical activity before and during the lockdown, emotions, sleeping hours, and weight change were similar to the other adult groups that were examined (45-59 and 60-69). However, in the older adults groups (70+ and 60-69), resilience and depression symptoms were lower than in the youngest age group.

Weight change adjusted equations for assessing resting metabolic rate in overweight and obese adults.

BACKGROUND: Although over one hundred equations have been developed to predict the energy expenditure of individuals, none are sensitive to weight change in assessment of resting metabolic rate (RMR) before and after weight loss. OBJECTIVE: To formulate adjusted equations for overweight and obese individuals and to compare their accuracy with existing prediction RMR equations before and after weight loss. SUBJECTS/MATERIALS: This is historical prospective study. Participants included 39 overweight and obese men and women before and after losing 10-20% from baseline weight on a diet and physical activity regimen for at least three months. Pre and post weight loss measured RMR results were compared to estimated RMR using several existing prediction equations: Harris and Benedict, Ravussin and Bogardus, and Mifflin et al. To improve the accuracy of these prediction equations, we suggest new equations adjusted for weight loss, based on measured RMR and evaluated their accuracy. RESULTS: Pre and post weight loss data indicated: significant fat reduction in both genders; reduction in free-fat mass only in men, and a significant decrease in measured RMR only in women. Our suggested equations were the most accurate and closest to measured RMR in both genders, in comparison to the Harris and Benedict, Ravussin and Bogardus, and Mifflin et al equation results. Estimated RMR using the latter equations was significantly lower than measured RMR in both genders at pre and post weight loss (P < 0.01). CONCLUSIONS: This study highlights the need for adjusting RMR equations before and after weight loss in overweight and obese individuals. Further research is needed to validate our suggested equations.

Clinical, Surgical, and Sociopsychological Factors and Depression After Cardiothoracic Surgery.

BACKGROUND: Depression is highly prevalent in cardiac surgical patients and is associated with mortality. The objectives of the study were to evaluate depression scores longitudinally pre- and postoperatively and to examine the association between postoperative depression scores and clinical, surgical, and sociopsychological factors. METHODS: Depression scores were assessed using the Center for Epidemiological Study of Depression (CES-D) in 100 cardiac surgical patients who underwent cardiac surgery preoperatively, during hospitalization, and at 2 and 6 week after discharge. Clinical, surgical, and sociopsychological predictors of depression scores were recorded. RESULTS: The average depression scores significantly increased from preoperative levels (14.9 ± 1.07) to during hospitalization (21.5 ± 1.05) and decreased at both 2 weeks (15.8 ± 1.07) and 6 weeks after discharge (14.0 ± 1.06), as compared with scores during hospitalization (P < .001). The percentage of patients who scored CES-D > 16 increased significantly from preoperative (39%) to hospitalization (71%) and decreased gradually at 2 weeks (45%) and 6 weeks (37%) after discharge (P < .001). Significant predictors of high postoperative CES-D scores were female gender, ejection fraction < 50%, and high preoperative CES-D scores. CONCLUSIONS: High depression scores after cardiac surgery suggest that perioperative screening and management of depression after surgery are necessary and may improve outcomes of these patients who are at high risk for depression. Further understanding of the factors that contribute to high depression scores is required to facilitate clinical intervention.

Sex Differences in Vitamin D Deficiency and Anthropometric Measurements in School-age Children from Rural Areas in Israel.

BACKGROUND: Vitamin D is essential for skeletal health. Because peak bone mass accrual occurs during childhood and adolescence, vitamin D insufficiency during this period of life could cause adverse health outcomes. OBJECTIVES: To explore the potential sex differences in anthropometric indicators and vitamin D status among primary school-age children. METHODS: A modified food-frequency intake questionnaire was completed by 116 pre-pubertal children (52 girls, 64 boys). Body measurements were recorded and blood was drawn to assess vitamin D status. All children were of Arab-Israeli origin and lived in villages or rural areas in the north-east area of Israel. RESULTS: Prevalence of obesity was higher among girls (34%) compared to boys (21.9%, P = 0.018). All the children were vitamin D insufficient, and 80% were deficient. Plasma vitamin D was significantly higher among boys (12.4 ng/ml) compared to girls (9.1 ng/ml, P < 0.01). A significant negative correlation was found between vitamin D status and weight percentile for girls (r = -0.43, P < 0.05) but not for boys. There was a trend toward a statistically significant inverse correlation between vitamin D status and body fat percent in the girls (r = -0.37, P = 0.07). Sex frameworks are important for the understanding of the determinants of health and the development of effective health promotion programs. CONCLUSIONS: Pre-pubertal girls in Arab villages should be provided with tailor-made nutrition and physical activity programs for promoting health.

Can improvement in hormonal and energy balance reverse cardiovascular risk factors in athletes with amenorrhea?

Female athletes display a high prevalence of hypothalamic amenorrhea as a result of energy imbalance. In these athletes with amenorrhea, decreased luteinizing hormone/follicule-stimulating hormone secretion leads to deficiency in endogenous estrogen. The severe estrogen deficiency in these athletes may increase cardiovascular risk similar to that in postmenopausal women. This review discusses the potential cardiovascular risk factors in athletes with amenorrhea as a result of hypoestrogenism, which include endothelial dysfunction and unfavorable lipid profiles. We also consider the potential to reverse the cardiovascular risk by restoring energy or hormonal imbalance along the reproductive axis in athletes with amenorrhea.

Physical activity and telomere length in American Indians: the Strong Heart Study.

Telomere length, a marker of biological aging, has been associated with many chronic diseases, but its relations with physical activity remains unclear. The purpose of this study was to examine the association of objectively measured ambulatory activity with leukocyte telomere length (LTL), a marker of biological aging, among American Indians. This cross-sectional study included 2312 AI participants from the Strong Heart Family Study. Steps per day were measured using Accusplit AE120 pedometers. Quantitative PCR was used to measure LTL. Generalized estimating equations were used to examine the associations of steps per day with LTL. The median steps per day over a 1 week period was 5118 steps (interquartile range = 3163-7576 steps). Compared to participants in the lowest quartile of steps per day, participants in the upper three quartiles of steps per day had longer LTL: beta ± SE = 0.0195 ± 0.0144, 0.0273 ± 0.0139, and 0.0375 ± 0.0143 T/S ratio units longer (p trend = 0.010) after adjustment for potential confounders. These data suggest that ambulatory activity is associated with LTL. Further studies are needed to determine the mechanism by which ambulatory activity influences LTL.

Meal time behavior difficulties but not nutritional deficiencies correlate with sensory processing in children with autism spectrum disorder.

BACKGROUND: Food aversion and nutritional difficulties are common in children with autism spectrum disorder. AIM: To compare meal time behavior of children with autism to their typically developing siblings and to typical controls and to examine if sensory profiles can predict meal time behavior or nutritional deficiencies in the autism group.