Effects of a novel bites, steps and eating rate-focused weight loss randomised controlled trial intervention on body weight and eating behaviours.

BACKGROUND: Eating rate (ER), comprising the amount of food consumed per unit of time, is associated with obesity and energy intake (EI). METHODS: The present study tested whether adding a self-monitoring wearable device to a multifaceted 8-week weight loss intervention increased weight loss. In addition, the device's effect on secondary change outcomes in EI, ER and estimated energy expenditure was explored. Tertiary outcomes included examining eating behaviours measured by the Weight-Related Eating Questionnaire (WREQ). Seventy-two adults who were overweight or obese [mean (SD) age, 37.7 (15.3) years; body mass index, 31.3 (3.2) kg m-2 ] were randomised into two groups: intervention workbook plus device (WD) or intervention workbook only (WO). Three 24-h dietary recalls were obtained before weeks 0 and 8. Participants were weighed, consumed a test meal and completed 7-day Physical Activity Recall and WREQ at weeks 0 and 8. RESULTS: There was no significant difference between WD and WO groups with respect to weight change [-0.46 (1.11) vs. 0.26 (0.82) kg, respectively], ER, EI, energy expenditure or WREQ scores, although there were significant changes over time, and within-group changes on all of these variables. At week 8, participants were dichotomised into weight loss or weight stable/gainers groups. A significant time by group change was seen in susceptibility to external cues scores, with significant time effects for susceptibility and restraint. CONCLUSIONS: An intervention focused on reducing ER, energy density and increasing steps was effective for weight loss, although the wearable device provided no additional benefit. Participants with higher susceptibility to external eating may be more responsive to this intervention.

The Association between Physical Activity and Metabolic Syndrome in Older Adults with Obesity.

BACKGROUND: Physical activity reduces the likelihood of developing metabolic syndrome (MetS). However, the association between different physical activity levels and MetS remains unclear in older adults with obesity. METHODS: This cross-sectional study used four waves of data (2007-2008, 2009-2010, 2011-2012, 2013-2014) from two datasets: The National Health and Nutrition Examination Survey and United Sates Department of Agriculture's Food Patterns Equivalents Database. The sample included adults 60+ years of age (n= 613) with obesity who had physical activity and MetS data. Physical activity was assessed using the Global Physical Activity Questionnaire and categorized into three physical activity levels (low, medium, and high); and medium or high physical activity levels are aligned with or exceed current physical activity recommendations. Participants were classified as having MetS using a commonly agreed upon definition. Multiple logistic regression models examined the association between the three physical activity levels and MetS risk factors and MetS. All analyses adjusted for potential confounding variables and accounted for complex sampling. RESULTS: Of 613 respondents, 72.1% (n=431) were classified as having MetS, and 44.3% (n = 263) had not met physical activity recommendations. Participants with high levels of physical activity had a lower risk of MetS (OR = 0.31, 95%CI: 0.13, 0.72) and more healthful levels of high-density lipoprotein cholesterol (OR = 0.39, 95%CI: 0.18, 0.84), blood pressure (OR = 0.39, 95%CI: 0.20, 0.77), fasting glucose (OR = 0.34, 95%CI: 0.15, 0.78) than participants categorized as having low physical activity. CONCLUSIONS: Physical activity is associated with lower risk of MetS only for participants with the highest level of physical activity, which suggests that physical activity dosage is important to reduce MetS risk in older adults with obesity.

Relationship between Diet Quality, Physical Activity and Health-Related Quality of Life in Older Adults: Findings from 2007-2014 National Health and Nutrition Examination Survey.

BACKGROUND: A growing body of research shows that diet quality and physical activity (PA) are associated with health-related quality of life (HRQOL). However, no study to date has assessed this association using the Healthy Eating Index-2015 as a measure of diet quality. Furthermore, few studies have examined the association between PA dose and HRQOL among a nationally representative sample of older adults. OBJECTIVES: To investigate the relationship between diet quality, physical activity, and HRQOL. DESIGN: A cross-sectional analysis was conducted using data obtained from 5,311 adults aged 60+ years who took part in the National Health and Nutrition Examination Survey between 2007 and 2014. MEASUREMENTS: HRQOL was assessed by general health status, and number of physically unhealthy days, mentally unhealthy days, and inactive days in past 30 days. Diet quality was assessed by the Healthy Eating Index-2015 using data generated by two 24-hour dietary recalls. PA was measured by the Global Physical Activity Questionnaire. Multivariate logistic/or linear regression models were used to examine the association between diet quality, PA and HRQOL controlling for confounders and accounting for complex sampling. RESULTS: Approximately half of the participants (55.2%) were women, 45.1% met current PA recommendations, 65% had less healthful diets according to the Healthy Eating Index-2015. Diet quality was associated with HROQL. For every 1-point diet quality score increase, the likelihood of respondents rating their general health as being excellent/good increased by 3% (OR=1.03, 95%CI: 1.02, 1.04), and number of inactive days (ß =-0.03, 95%CI: -0.05, 0.00) and mental unhealthy days (ß =-0.03, 95%CI: -0.05, -0.01) declined by 0.03 days. PA was associated with all HROQL measures and respondents with high PA levels reported better general health (OR=3.53, 95%CI: 2.69, 4.63), fewer inactive days (ß =-1.53, 95%CI: -2.11, -0.95), fewer physical unhealthy days (ß =-1.88, 95%CI: -2.74, -1.02) than individuals with low PA levels but not fewer mentally unhealthy days. CONCLUSIONS: Among older adults in this study, eating a healthier diet and being physically active were associated with better general health and reporting fewer physical unhealthy days and inactive days. Study results provide valuable information that could inform policies, programs and interventions designed to improve HRQOL in older adults and reduce potentially preventable health disparities.

Validation of decisional balance and situational temptations measures for dietary fat reduction in a large school-based population of adolescents.

Brief, validated, and reliable theory-based measures specifically designed for use in large survey research with adolescent populations are needed to assess attitudes and behaviors about dietary fat consumption. This study validated two transtheoretical model (TTM)-based instruments in 2639 ninth graders from 12 Rhode Island high schools. The Decisional Balance Questionnaire for Adolescent Dietary Fat Reduction (DBQA) measures the importance adolescents assign to the pros and cons of reducing dietary fat consumption, while the Situational Temptations Questionnaire for Adolescents (STQA) measures temptations to eat high-fat foods as both a global construct and across three categories of challenging situations. Four competing models were compared for each instrument. An eight-item, correlated two-factor Pros and Cons model was validated for the decisional balance measure and a nine-item, three-factor hierarchical model was validated for situational temptations. The theoretically predicted relationships between stage of change and the pros and cons, as well as stage and situational temptations were supported. These results demonstrate that both measures have sound psychometric properties and are externally valid.

Defining stage of change for lower-fat eating.

OBJECTIVE: To test the validity of staging methodology for dietary fat reduction by examining cognitive profiles of persons classified in these groups: precontemplation, lowerfat maintenance (< or = 30% of energy as fat), and higher-fat maintenance (> 30% of energy as fat). DESIGN: Cross-sectional survey of a random sample of 491 women residing in Guelph, Ontario, Canada, recruited by telephone. SETTING/SUBJECTS: Mean age of subjects was 43.7 +/- 12.2 years. The majority (58%) lived with a spouse or partner and had completed high school (68%). STATISTICAL ANALYSES: Multivariate analysis of variance was used to compare the pros and cons of lower-fat eating, level of self-efficacy in avoiding high-fat foods, and use of 9 processes of change to support lower-fat eating habits in women assigned to the precontemplation, higher-fat, and lower-fat maintenance stages. RESULTS: When compared with subjects classified in the precontemplation stage, the 2 groups of subjects in the maintenance stage had higher ratings of the pros (49.7 +/- 9.5 vs 43.7 +/- 7.2, P < .05), lower ratings of the cons (47.2 +/- 8.2 vs 51.9 +/- 11.8, P < .05), higher self-efficacy scores, and more frequent use of processes of change than subjects classified in the precontemplation stage. No differences between women in the 2 maintenance groups were observed in self-efficacy; however, those in the lower-fat maintenance group reported lower cons than those in the higher-fat maintenance group (46.2 +/- 7.2 vs 48.2 +/- 9.1, P < .05) and more frequent use of all processes of change. CONCLUSIONS/APPLICATIONS: Stage of change for dietary fat reduction is a cognitive variable that provides insights into attitudes about and motivations to consume lower-fat foods.

Predictive versus measured energy expenditure using limits-of-agreement analysis in hospitalized, obese patients.

BACKGROUND: Accuracy of predictive formulae is crucial for therapeutic planning because indirect calorimetry measurement is not always possible or cost effective. Energy requirements are more difficult to predict in the acutely ill obese patient compared with lean patients because of an increased resting energy expenditure per lean body mass and a variable stress response to illness. METHODS: A retrospective review of 726 patients identified 57 patients (32 spontaneous breathing, S; 25 ventilator dependent, V) with body mass indexes of 30-50 kg/m2. Limits-of-agreement analysis determined bias (the mean difference between measured and predicted values) and precision (the standard deviation of the bias) to evaluate the accuracy of predictive formulae compared with measured resting energy expenditure (MREE) by a Deltatrac Metabolic Monitor. Predictive accuracy was determined within+/-10% MREE. The predictive formulae examined were: variations of the Harris-Benedict equations using ideal, adjusted weights of 25% and 50% and actual weights with stress factors ranging from 1.0 to 1.5; the Ireton-Jones equation for obesity; the Ireton-Jones equations for hospitalized patients (S and V); and the ratio of 21 kcalories per kilogram actual weight. RESULTS: The mean MREE was 21 kcal/kg actual weight. The adjusted Harris-Benedict average weight equation was optimal for predicting MREE for the combined S and V sets (bias = 182+/-123; 67%+/-10% MREE), as well as the S subset (bias = 159+/-112; 69%+/-10% MREE). CONCLUSIONS: The Harris-Benedict equations using the average of actual and ideal weight and a stress factor of 1.3 most accurately predicted MREE in acutely ill, obese patients with BMIs of 30-50 kg/m2. Predictive formulae were least accurate for obese, ventilator-dependent patients.

Stages of change for reducing dietary fat intake over 18 months.

OBJECTIVE: To describe the stages of change that take place over 18 months, using the criterion of fat intake < or = 30% of total energy to define effective action and to investigate the effect of a single dietary feedback report on dietary fat reduction. DESIGN: Subjects were randomly assigned to experimental or control conditions and assessed at 0, 6, 12, and 18 months for fat intake and stage of change. Subjects in the experiment group received 1 feedback report at baseline; all subjects received a report at 12 months. SUBJECTS: Potential subjects (n = 614) were recruited by mail from a random sample of nonsmoking adults (32% response rate). Subjects were excluded if consuming < or = 30% of energy from fat or if pregnant or lactating (n = 145). Although 83% of subjects (n = 389) completed the 18-month study, only 296 provided complete data for all time points. The study was restricted to these 296. INTERVENTION: Dietary feedback reports plus brief educational materials were provided following the experiment design. ANALYSES: Repeated measures analysis of variance with fat intake (percent of energy from fat) as the dependent variable and baseline stage and condition as independent variables. In addition, t tests were used to compare groups at specific time points. RESULTS: There was a main effect for time (F3,286 = 39, P < .0001) and baseline stage (F3,286 = 24, P < .0001), but no effect of feedback. There was a time-by-feedback interaction (F4,286 = 4.7, P < .01). There was a short-term effect of feedback over 6 months (t = 3.8, P < .001), but this effect was not significant at other time points. About 9% to 12% of subjects in the precontemplation or contemplation stages, 24% of subjects in the preparation stage, and 40% of unclassified subjects at baseline progressed to the action stage by 18 months. Between 12 and 18 months, subjects progressing at least 1 stage reduced their fat intake to a greater extent than subjects who failed to progress (t = 5.1, P < .0001). IMPLICATIONS: Interventions targeted to stage of change have the potential for accelerating the rate of change for dietary fat reduction, but reaching the goal of fat intake < or = 30% of total energy may require more intensive interventions than a single dietary feedback report.

Diabetes self-management. Self-reported recommendations and patterns in a large population.

OBJECTIVE: Diabetes self-management is the cornerstone of overall diabetes management. Yet many questions concerning self-management remain unanswered. The current study was designed to examine several questions about diabetes self-management: 1) What do individuals report being told to do? 2) What are their self-reported levels and patterns of self-care? 3) Are there differences on self-reported self-management recommendations and levels across various subgroups? RESEARCH DESIGN AND METHODS: Mailed surveys were returned by 2,056 individuals (73.4% response rate). Of the total, 13.8% had IDDM and the remainder had NIDDM, with 65% of the NIDDM group using insulin. RESULTS: The levels and patterns of self-management were consistent with those found in previous studies, i.e., individuals most regularly followed their prescribed medication regimen and least regularly followed recommendations for lifestyle changes of diet and exercise. There were significant differences on reported self-management recommendations across different subgroups. Comparisons on level of self-management across diabetes type revealed significant differences for diet and glucose testing. Differences were also found on self-management levels for a number of individual characteristics, including age, working status, and type of insurance, along with knowledge of the Diabetes Control and Complications Trial findings. CONCLUSIONS: These findings provide important information on perceived self-management recommendations and the specific self-management levels and patterns in individuals with diabetes. The current findings may help health professionals better understand the levels and correlates of diabetes self-management and direct future research.

Stages of change for reducing dietary fat to 30% of energy or less.

OBJECTIVE: To develop an algorithm that defines a person's stage of change for fat intake < or = 30% of energy. The Stages of Change Model describes when and how people change problem behaviors; change is defined as a dynamic variable with five discrete stages. DESIGN: A stage of change algorithm for determining dietary fat intake < or = 30% of energy was developed using one sample and was validated using a second sample. SUBJECTS: Sample 1 was a random sample of 614 adults who responded to mailed questionnaires. Sample 2 was a convenience sample of 130 faculty, staff, and graduate students. STATISTICS: Subjects in sample 1 were initially classified in a stage of change using an algorithm based on their behavior related to avoiding high-fat foods. Dietary markers were selected for a Behavioral algorithm using logistic regression analyses. Sensitivity, specificity, and predictive value of the Behavioral algorithm were determined, then compared between samples using the Z test. RESULTS: The following dietary markers predicted intake < or = 30% of fat (chi 2 = 131; P < .0001): low-fat cheese, breads without added fat, chicken without skin, low-calorie salad dressing, and vegetables for snacks. The specificity of the Behavioral algorithm was validated; the algorithm classified subjects consuming > 30% of energy from fat with 93% specificity in sample 1 and 87% in sample 2 (Z = 1.36; P > .05). Predictive value was also validated; 64% and 58% of subjects meeting the behavioral criteria had fat intakes < or = 30% of energy (Z = 1.1; P > .05). The algorithm was not sensitive, however; most subjects with fat intakes < or = 30% of energy from fat failed to meet the behavioral criteria. The sensitivity differed between samples 1 and 2 (44% and 27%, respectively; Z = 3.84; P < .0001). APPLICATIONS: The Behavioral algorithm determines stage of change for fat reduction to < or = 30% of energy in populations with high fat intakes. The algorithm could be used in dietary counseling to tailor interventions to a patient's stage of change.

Psychosocial factors influencing low fruit and vegetable consumption.

A major national health campaign has recently been initiated to promote consumption of 5 or more servings of fruits and vegetables each day. This paper investigates psychosocial factors related to fruit and vegetable consumption to understand better who might be receptive and who might resist the national 5-A-Day campaign. We studied 405 adult respondents to a random-digit dial telephone survey. Applying the Transtheoretical Model, respondents were classified by stage of readiness to adopt the practice of eating 5 or more fruits and vegetables each day. Logistic regression models were developed for persons consuming 2 or fewer servings daily and for persons in the Precontemplation stage. Education was directly related to fruit and vegetable intake and indirectly related to being in the Precontemplation stage. Males were twice as likely as females to be in the Precontemplation stage and eat fewer than 2 servings a day. Of special interest, respondents with children at home were at greater risk of eating 2 or fewer servings a day than those without children at home (OR = 1.63; 95% CI, 1.06-2.52). These results imply that stage of readiness to change should be considered as well as other factors in planning interventions for increasing fruit and vegetable consumption.

Participation in a worksite cholesterol education program in a university setting.

Three hundred ninety-six employees of a large northeastern university participated in a blood cholesterol screening and provided follow-up data about their participation in a videotape cholesterol education program. Ten percent of these employees watched the videotape program; these individuals were significantly more likely to be at high risk for cardiovascular disease than were persons who chose not to watch the videotape. Persons participating in the cholesterol education program significantly increased their nutrition knowledge and significantly decreased their fat intake compared with nonparticipants. The most important reason given for watching the videotape was "concern about my cholesterol level." Reasons given for not watching the videotape were that it was "not well advertised" or that it was shown "at an inconvenient time." Although all 98 employees at high risk for cardiovascular disease were referred to their physicians for diagnostic evaluation, one third of these employees reported not seeing their physicians. These findings indicate that worksite cholesterol screening and education programs can improve nutrition knowledge and dietary behavior; however, these programs should develop strategies to increase participation and should follow up physician referrals.

Client perceptions of dietetic students and registered dietitians at a university-based nutrition clinic.

Client perceptions of students enrolled in a nutrition counseling practicum were compared with client perceptions of those students' clinical instructors, who were registered dietitians. One hundred forty-two clients who had either a student (no. = 81) or a dietitian (no. = 61) as primary counselor completed a postcard evaluation or a telephone interview. Students were rated significantly more positively (p less than .01) than their instructors for the item "I would recommend the clinic to others" and (p less than .05) for the items "The counselor helped me with my problem" and "I learned at the clinic what I did not know before." Seventy-two of the 89 clients interviewed by telephone replied to the question "Did students enhance or detract from services provided?" Sixty-one percent replied that students enhanced, but 25% replied that students detracted in some way, primarily because of concerns about having an additional observer during counseling sessions. In general, clients receiving nutrition counseling evaluated student dietitians very positively.

Postpartum weight change: how much of the weight gained in pregnancy will be lost after delivery?

In a large sample (N = 7116) of women who had two pregnancies within six years, the 50th percentile of weight gain between pregnancies was 2 lb (0.9 kg). Weight gain in pregnancy, week of registration, cigarette smoking, race, percent of ideal body weight, complications of pregnancy, and marital status in the first pregnancy, as well as breast-feeding in the hospital and interval between the two pregnancies, correlated significantly with interpregnancy weight change, and explained 24% of the variance (P less than .0001). Weight gain in the first pregnancy alone explained 21% of the variance in weight change between pregnancies. After adjustment for the effects of other variables on weight change, weight gains in pregnancy of 20 lb (9.1 kg) or more were statistically significant (P less than .05); the more weight a woman gained above 20 lb (9.1 kg), the more she retained by the start of her next pregnancy.

Maxillary sinus cancer: a study of 33 cases.

A retrospective analysis of 33 cases of maxillary sinus cancer seen at R.P.M.I. between 1970 and 1979 was performed. The age of the patients ranged from 18-88 years, with a median age of 60.3. The male to female ratio was 2:1.3. Twenty-seven (81.8%) of the cases were squamous cell carcinomas. Of the 33 cases, there were no cases in Stage 1, 2 cases in Stage 2, 8 and 23 in Stages 3 and 4, respectively. The 5-year survival among the patients who were available for a long-term follow-up was 36.4% (8 of 22). The 5-year survival was best for Stage 3 disease (75%) and Stage 4, without local and/or distant metastasis (57.14%). No patient with metastasis lived for more than 3 years. While poorer diagnosis could be related to the degree of local involvement and presence of metastasis, it could not be related to site of involvement, previous treatment, histological findings or delay in diagnosis. Correlation of treatment with prognosis is difficult because selection of treatment is based on a variety of factors, including stage of disease and patient acceptance of treatment. Of the 4 patients treated with surgery alone, all 4 survived for 5 years. Of the 8 patients treated with combined surgery and radiation, 4 survived for 5 years and 2 died without evidence of tumor before 2 years. Other treatments were far less successful.