Psychological Factors of Long-Term Dietary and Physical Activity Adherence among Chinese Adults with Overweight and Obesity in a Community-Based Lifestyle Modification Program: A Mixed-Method Study.

There is a paucity of research on factors influencing long-term adherence to lifestyle modification. We conducted a mixed-method study to explore the psychological factors of dietary and physical activity (PA) adherence among Chinese adults with overweight and obesity at 10 months after enrollment of a community-based lifestyle modification program in Hong Kong. We recruited Chinese adults newly enrolled in a culturally adapted lifestyle modification program and followed them for 10 months. For the quantitative study, primary outcomes were dietary and PA adherence scores while secondary outcomes included knowledge, self-efficacy, motivation and stage of change. For the qualitative study, data were collected using semi-structured interviews and observation. A total of 140 participants completed the 10-month follow-up. They reported moderate level of dietary adherence but low level of PA adherence at 10 months. Multivariable regression analyses revealed that greater improvement in nutrition knowledge and diet stage of change predicted higher dietary adherence while greater improvement in PA self-efficacy and PA stage of change predicted higher PA adherence. Qualitative data on 26 participants suggest that participants' knowledge and self-efficacy but not motivation were enhanced during the program. The findings of this study enhanced our understanding on factors influencing long-term adherence to lifestyle changes.

Identifying psychological predictors of adherence to a community-based lifestyle modification program for weight loss among Chinese overweight and obese adults.

BACKGROUND/OBJECTIVES: Existing evidence on lifestyle modification programs for weight loss is limited by the high attrition rate of such programs. Identifying predictors of adherence to a lifestyle modification program could result in program improvement. However, little is known about behavior-specific adherence and its psychological predictors. This study aimed to examine the psychological predictors of adherence after one-month participation in a community-based lifestyle modification program among Chinese overweight and obese adults in Hong Kong. SUBJECTS/METHODS: A total of 205 Chinese overweight and obese adults aged 38.9 ± 10.5 years completed the study. Data were collected at baseline and after one month using self-reported questionnaires, which assessed knowledge (self-developed scale), motivation (Treatment Self-Regulation Questionnaire), stage of change (Stage of Exercise Scale) and self-efficacy (Self-Rated Abilities for Health Practices Scale). At one month, a 4-day dietary recall and the International Physical Activity Questionnaire-Short Form were used to assess dietary and physical activity (PA) adherence. Food and PA diaries were examined to indicate self-monitoring. Program attendance was tracked between baseline and one-month follow-up. RESULTS: After one month, participants reported high dietary adherence, attendance, and adherence to self-monitoring but low PA adherence. Multiple regression analyses suggested that diet self-efficacy (baseline) and nutrition knowledge (one-month change) were independent predictors of dietary adherence score at one month, whereas autonomous PA motivation (baseline) and PA self-efficacy (both baseline and one-month change) were independent predictors of PA adherence score at one month. No significant psychological predictor was identified for attendance or self-monitoring. CONCLUSIONS: The results suggest that the effect of psychological factors on adherence differs between diet and PA adherence outcomes. To promote adherence, practitioners should assess self-efficacy, knowledge, and motivation at the beginning of a weight-loss program and explore behavior-specific strategies to improve knowledge and self-efficacy. The results of this study have direct implications for program improvements.

Dietary Fiber Intake, Myocardial Injury, and Major Adverse Cardiovascular Events Among End-Stage Kidney Disease Patients: A Prospective Cohort Study.

INTRODUCTION: Dialysis patients are frequently advised to restrict fruit and vegetable intake due to their high potassium content. This study aimed to evaluate the association between dietary fiber intake and major adverse cardiovascular events (MACE) among dialysis patients. METHODS: A total of 219 prevalent dialysis patients were prospectively recruited from a major university teaching hospital and regional dialysis center in Hong Kong. Dietary fiber intake estimated using a 7-day locally validated food frequency questionnaire was examined in relation to a primary composite outcome of MACE over a follow-up period of 4 years. RESULTS: A total of 127 patients were complicated with 1 or more MACE. In the multivariable Cox regression analysis, every 1 g higher fiber intake, and every 1 g/d per 1000 kcal higher fiber intake density were associated with an 11% (95% confidence interval [CI]: 0.81-0.97) and a 13% lower risk of MACE (95% CI: 0.77-0.99), respectively, independent of clinical, demographic, biochemical, hemodynamic, adequacy parameters, dietary protein, energy intake, inflammatory, and cardiac markers. Patients in the lower tertile of fiber intake density showed an increased hazard for MACE (adjusted hazard ratio: 1.78; 95% CI: 1.13-2.80) than those in the upper tertile. CONCLUSION: Higher fiber intake and higher fiber intake density may be associated with less inflammation, less myocardial hypertrophy, injury, and lower risk of MACE in dialysis patients. These data form an important basis for a randomized controlled trial to examine fiber supplementation on cardiovascular outcomes in the dialysis population.

Randomized trial examining effectiveness of lifestyle intervention in reducing gestational diabetes in high risk Chinese pregnant women in Hong Kong.

Gestational diabetes mellitus (GDM) is of public health concern. This trial examined whether a clinically proven lifestyle modification program (LMP) in early pregnancy was superior to routine antenatal care in improving GDM, maternal and infant outcomes. Chinese pregnant women at risk of GDM (n = 220) were recruited at or before 12-week gestation and randomized to either a LMP group or a routine care control group. Eighty subjects completed a dietitian-led LMP including dietary and exercise components from early pregnancy till 24-week gestation. Data were compared with those of 86 control subjects. Twenty three (26.7%) control subjects and 20 (25.0%) LMP subjects developed GDM (p = 0.798). The proportion of infants born large for gestational age and macrosomia was similar between groups. The LMP group showed a lower proportion of excessive gestational weight gain (GWG). Subgroup analysis suggested that those with higher LMP adherence showed more desirable dietary composition and energy intake, and lower proportion of excessive GWG compared with the low LMP adherence group and the control group. The potential effect of LMP on GDM and other maternal and infant outcomes, in particular GWG, as well as barriers for making lifestyle changes warrant further investigations (ClinicalTrials.gov NCT02368600).

An Overview of Factors Associated with Adherence to Lifestyle Modification Programs for Weight Management in Adults.

This review aims to provide an overview of the factors associated with adherence reported in existing literature on lifestyle modification programs for weight management among the adult population. An electronic search was performed using PubMed, Medline, PsycINFO and PsycARTICLE to identify studies that examined the factors of adherence to lifestyle modification programs with explicit definition of adherence indicators. We identified 19 studies published between 2004 and 2016. The most commonly used indicator of adherence was attrition, followed by attendance, self-monitoring and dietary adherence. A broad array of factors has been studied but only few studies exploring each factor. Limited evidence suggested older age, higher education, healthier eating and physical activity behaviours, higher stage of change at baseline and higher initial weight loss may predict better adherence. On the other hand, having depression, stress, strong body shape concern and full-time job may predict poor adherence. Inconsistent findings were obtained for self-efficacy, motivation, male gender and previous weight loss attempt. This review highlights the need for more rigorous studies to enhance our knowledge on factors related to adherence. Identification of the factors of adherence could provide important implication for program improvement, ultimately improving the effectiveness and the cost-effectiveness of lifestyle modification program.

Diet-Quality Scores and Prevalence of Nonalcoholic Fatty Liver Disease: A Population Study Using Proton-Magnetic Resonance Spectroscopy.

Dietary pattern analysis is an alternative approach to examine the association between diet and nonalcoholic fatty liver disease (NAFLD). This study examined the association of two diet-quality scores, namely Diet Quality Index-International (DQI-I) and Mediterranean Diet Score (MDS) with NAFLD prevalence. Apparently healthy Chinese adults (332 male, 465 female) aged 18 years or above were recruited through a population screening between 2008 and 2010 in a cross-sectional population-based study in Hong Kong. DQI-I and MDS, as well as major food group and nutrient intakes were calculated based on dietary data from a food frequency questionnaire. NAFLD was defined as intrahepatic triglyceride content at ≥5% by proton-magnetic resonance spectroscopy. Multivariate logistic regression models were used to examine the association between each diet-quality score or dietary component and prevalent NAFLD with adjustment for potential lifestyle, metabolic and genetic factors. A total of 220 subjects (27.6%) were diagnosed with NAFLD. DQI-I but not MDS was associated with the prevalence of NAFLD. A 10-unit decrease in DQI-I was associated with 24% increase in the likelihood of having NAFLD in the age and sex adjusted model (95% CI: 1.06-1.45, p = 0.009), and the association remained significant when the model was further adjusted for other lifestyle factors, metabolic and genetic factors [OR: 1.26 (95% CI: 1.03-1.54), p = 0.027]. Multivariate regression analyses showed an inverse association of the intake of vegetables and legumes, fruits and dried fruits, as well as vitamin C with the NAFLD prevalence (p<0.05). In conclusion, a better diet quality as characterized by a higher DQI-I and a higher consumption of vegetables, legumes and fruits was associated with a reduced likelihood of having NAFLD in Hong Kong Chinese.

Development and Validation of Chinese Health Literacy Scale for Low Salt Consumption-Hong Kong Population (CHLSalt-HK).

Globally, sodium intake far exceeds the level recommended by the World Health Organization. Assessing health literacy related to salt consumption among older adults could guide the development of interventions that target their knowledge gaps, misconceptions, or poor dietary practices. This study aimed to develop and validate the Chinese Health Literacy Scale for Low Salt Consumption-Hong Kong population (CHLSalt-HK). Based on previous studies on salt intake and nutrition label reading in other countries, we developed similar questions that were appropriate for the Chinese population in Hong Kong. The questions covered the following eight broad areas: functional literacy (term recognition and nutrition label reading), knowledge of the salt content of foods, knowledge of the diseases related to high salt intake, knowledge of international standards, myths about salt intake, attitudes toward salt intake, salty food consumption practices, and nutrition label reading practices. Eight professionals, including doctors, nurses, and dietitians, provided feedback on the scale. The psychometric properties of the scale were assessed based on data collected from a convenience sample of 603 Chinese elderly adults recruited from Elderly Health Centres in Hong Kong. The 49-item CHLSalt-HK had a possible score range of 0 to 98, with a higher score indicating higher health literacy related to salt intake. The CHLSalt-HK had acceptable content validity; the item-level Content Validity Index ranged from 0.857 to 1.000, and the scale-level Content Validity Index was 0.994. Additionally, it had good internal consistency (Cronbach's alpha of 0.799) and good test-retest reliability (intraclass correlation coefficient of 0.846). The mean CHLSalt-HK score among those who were aware of the public education slogan about nutrition labels and sodium intake was higher by 3.928 points (95% confidence interval: 1.742 to 6.115) than that among those who were not aware of the slogan, which supports adequate discriminant validity. The validated CHLSalt-HK had acceptable content validity, acceptable construct validity, good internal consistency, good test-retest reliability, and adequate discriminant validity. The scale could be completed in 10-15 minutes and is easy to administer compared with the collection of biomarkers or food diaries. Further research should investigate its concurrent validity and predictive validity. The development of this scale supports the first step in salt intake reduction among older Chinese adults in Hong Kong by enabling the assessment of their health literacy related to salt consumption in health screenings or health assessments, and it can be used to evaluate salt reduction interventions.

Higher estimated net endogenous Acid production may be associated with increased prevalence of nonalcoholic Fatty liver disease in chinese adults in Hong Kong.

Nonalcoholic fatty liver disease (NAFLD) has been associated with reduced growth hormone levels and signaling. Such hormonal changes also occur in metabolic acidosis. Since mild metabolic acidosis can be diet induced, diet-induced acid load may constitute a nutritional factor with possible influence on NAFLD development. This study explored whether a higher diet-induced acid load is associated with an increased likelihood of NAFLD. Apparently healthy Chinese adults (330 male, 463 female) aged 19-72 years were recruited through population screening between 2008 and 2010 in a cross-sectional population-based study in Hong Kong. Estimated net endogenous acid production (NEAP) was calculated using Frassetto's method and potential renal acid load (PRAL) was calculated using Remer's method based on dietary data from a food frequency questionnaire. NAFLD was defined as intrahepatic triglyceride content at >5% by proton-magnetic resonance spectroscopy. Possible advanced fibrosis was defined as liver stiffness at >7.9 kPa by transient elastography. Multivariate logistic regression models were used to examine the association between each measure of dietary acid load and prevalent NAFLD or possible advanced fibrosis with adjustment for potential anthropometric and lifestyle factors. 220 subjects (27.7%) were diagnosed with NAFLD. Estimated NEAP was positively associated with the likelihood of having NAFLD after adjustment for age, sex, body mass index, current drinker status and the presence of metabolic syndrome [OR (95% CI) = 1.25 (1.02-1.52), p = 0.022]. The association was slightly attenuated but remained significant when the model was further adjusted for other dietary variables. No association between PRAL and NAFLD prevalence was observed. Both estimated NEAP and PRAL were not associated with the presence of possible advance fibrosis. Our findings suggest that there may be a modest association between diet-induced acid load and NAFLD. More studies are needed to ascertain the link between diet-induced acid load and NAFLD and to investigate the underlying mechanisms.

A Randomized Controlled Study to Examine the Effect of a Lifestyle Modification Program in OSA.

BACKGROUND: Obesity is an important risk factor for OSA. This study aimed to assess the effect of weight reduction through a lifestyle modification program (LMP) on patients with moderate to severe OSA. METHODS: This was a parallel group, randomized controlled trial. Altogether, 104 patients with moderate to severe OSA diagnosed on portable home sleep monitoring were randomized to receive a dietician-led LMP or usual care for 12 months. The primary outcome was reduction of apnea-hypopnea index (AHI) at 12 months as assessed by portable home sleep monitoring. RESULTS: In the intention-to-treat analysis (ITT), LMP (n = 61) was more effective in reducing AHI from baseline (16.9% fewer events in the LMP group vs 0.6% more events in the control group, P = .011). LMP was more effective in reducing BMI (-1.8 kg/m2, 6.0% of the initial BMI; -0.6 kg/m2, 2.0% of the initial BMI in control group; P < .001). The reduction in daytime sleepiness as assessed by Epworth Sleepiness Scale was not significant in ITT but was more in the LMP group (-3.5 in the LMP group vs -1.1 in the control group, P = .004) by treatment per protocol analysis. There was modest improvement in mental health in the Short Form Health Survey. Eating behavior was improved with increased intake of protein and fiber. These changes were observed 4 months after the initial intensive diet counseling and persisted at 12 months. CONCLUSIONS: LMP was effective in reducing the severity of OSA and daytime sleepiness. The beneficial effect was sustained in 12 months. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01384760; URL: www.clinicaltrials.gov.

PNPLA3 gene polymorphism and response to lifestyle modification in patients with nonalcoholic fatty liver disease.

BACKGROUND AND AIM: Lifestyle modification is the cornerstone for the management of nonalcoholic fatty liver disease (NAFLD), and patatin-like phospholipase 3 (PNPLA3) is one of the most important genetic determinants of NAFLD. We aimed to investigate the effect of PNPLA3 gene polymorphism on the response to lifestyle modification in NAFLD patients. METHODS: This was a post-hoc analysis of a randomized controlled trial on a lifestyle modification program in community NAFLD patients. The PNPLA3 rs738409 gene polymorphism was correlated with changes in metabolic profile and intrahepatic triglyceride content (IHTG) as measured by proton magnetic resonance spectroscopy. RESULTS: One hundred and fifty-four patients were equally randomized into the intervention and control groups. The presence of G allele was associated with greater reduction in IHTG (CC: 3.7 ± 5.2%, CG: 6.5 ± 3.6%), and GG: 11.3 ± 8.8% (Spearman's correlation, 0.34; P = 0.002), body weight (P = 0.030), waist-to-hip ratio (P = 0.024), total cholesterol (P = 0.031), and low-density lipoprotein cholesterol (P = 0.009) in the intervention group. In contrast, PNPLA3 polymorphism had no impact on IHTG changes in the control group. By multivariable analysis, PNPLA3 genotype and body mass index (BMI) change were independently associated with IHTG reduction in the intervention group. Only BMI change was associated with IHTG reduction in the control group. CONCLUSION: Although the PNPLA3 rs738409 GG genotype confers a higher risk of NAFLD, these patients are more sensitive to the beneficial effects of lifestyle modification and should be encouraged to do so.

A randomized controlled trial to investigate the impact of a low glycemic index (GI) diet on body mass index in obese adolescents.

BACKGROUND: The role of a low glycemic index (GI) diet in the management of adolescent obesity remains controversial. In this study, we aim to evaluate the impact of low GI diet versus a conventional Chinese diet on the body mass index (BMI) and other obesity indices of obese adolescents. METHODS: Obese adolescents aged 15-18 years were identified from population-recruited, territory-wide surveys. Obesity was defined as BMI ≥95th percentile of Hong Kong local age- and sex-specific references. Eligible subjects were randomized to either an intervention with low GI diet (consisting of 45-50% carbohydrate, 30-35% fat and 15-20% protein) or conventional Chinese diet as control (consisting of 55-60% carbohydrate, 25-30% fat and 10-15% protein). We used random intercept mixed effects model to compare the differential changes across the time points from baseline to month 6 between the 2 groups. RESULTS: 104 obese adolescents were recruited (52 in low GI group and 52 in control group; 43.3% boys). Mean age was 16.7 ± 1.0 years and 16.8 ±1.0 years in low GI and control group respectively. 58.7% subjects completed the study at 6 months (65.4% in low GI group and 51.9% in control group). After adjustment for age and sex, subjects in the low GI group had a significantly greater reduction in obesity indices including BMI, body weight and waist circumference (WC) compared to subjects in the control group (all p <0.05). After further adjustment for physical activity levels, WC was found to be significantly lower in the low GI group compared to the conventional group (p = 0.018). CONCLUSION: Low GI diet in the context of a comprehensive lifestyle modification program may be an alternative to conventional diet in the management of obese adolescents. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Ref. No: NCT01278563.

Current evidence on dietary pattern and cognitive function.

With global aging population, age-related cognitive decline becomes epidemic. Lifestyle-related factor is one of the key preventative measures. Dietary pattern analysis which considers dietary complexity has recently used to examine the linkage between nutrition and cognitive function. A priori approach defines dietary pattern based on existing knowledge. Results of several dietary pattern scores were summarized. The heterogeneity of assessment methods and outcome measurements lead to inconsistent results. Posteriori approach derives a dietary pattern independently of the existing nutrition-disease knowledge. It showed a dietary pattern abundant with plant-based food, oily fish, lower consumption of processed food, saturated fat, and simple sugar which appears to be beneficial to cognitive health. Despite inconclusive evidence from both approaches, diet and exercise, beneficial for other diseases, remains to be the two key modifiable factors for cognitive function. Large-scale prospective studies in multiethics population are required to provide stronger evidence in the future.

Community-based lifestyle modification programme for non-alcoholic fatty liver disease: a randomized controlled trial.

BACKGROUND & AIMS: Healthy lifestyle is the most important management of non-alcoholic fatty liver disease (NAFLD). This study aimed at assessing the efficacy of a community-based lifestyle modification programme in the remission of NAFLD. METHODS: This was a parallel group, superiority, randomized controlled trial. 154 adults with NAFLD identified during population screening were randomized to participate in a dietitian-led lifestyle modification programme at 2 community centres or receive usual care for 12 months. The primary outcome was remission of NAFLD at month 12 as evidenced by intrahepatic triglyceride content (IHTG) of less than 5% by proton-magnetic resonance spectroscopy. RESULTS: 74 patients in the intervention group and 71 patients in the control group completed all study assessments. In an intention-to-treat analysis of all 154 patients, 64% of the patients in the intervention group and 20% in the control group achieved remission of NAFLD (difference between groups 44%; 95% CI 30-58%; p<0.001). The mean (SD) changes in IHTG from baseline to month 12 were -6.7% (6.1%) in the intervention group and -2.1% (6.4%) in the control group (p<0.001). Body weight decreased by 5.6 (4.4) kg and 0.6 (2.5) kg in the two groups, respectively (p<0.001). While 97% of patients with weight loss of more than 10% had remission of NAFLD, 41% of those with weight loss of 3.0-4.9% could also achieve the primary outcome. CONCLUSIONS: The community-based lifestyle modification programme is effective in reducing and normalizing liver fat in NAFLD patients.

Nutritionist's variation in counseling style and the effect on weight change of patients attending a community based lifestyle modification program.

Information concerning the nature of nutritionist-patient relationships is very limited. This qualitative and quantitative study examined nutritionist's skills, attributes, and beliefs towards nutrition counseling during a lifestyle modification intervention program, and whether this affected the patient's weight outcome. 24 nutrition consultations were observed during the program and the nutritionists were interviewed for their perception on practice (n = 4). A statistically significant difference was observed between the nutritionists in regard to patient's weight change after adjustment for age and baseline weight (p < 0.001). Key nutritionist skills identified that influenced weight outcome were meticulous investigation of the underlying obesity cause, identification of the subject's stage of change, and psychological support.

Handgrip strength, but not other nutrition parameters, predicts circulatory congestion in peritoneal dialysis patients.

BACKGROUND: Handgrip strength (HGS) is a marker of lean muscle mass. This study aims to test the hypothesis that a low HGS reflects a diseased cardiac status and predicts future risk of circulatory congestion in chronic peritoneal dialysis (PD) patients. METHODS: Two hundred and eighteen chronic PD patients were prospectively recruited from a single regional dialysis unit in Hong Kong. HGS, serum albumin, lean body mass (LBM) by creatinine kinetics (CK) and subjective global assessment (SGA) were assessed at study entry and examined in relation to the risk of developing circulatory congestion over a 4-year follow-up. RESULTS: Adjusting for age, gender and height, HGS showed significant correlations with LBM by CK, SGA, serum albumin, atherosclerotic vascular disease, left ventricular (LV) mass index and early mitral inflow velocity to peak mitral annulus velocity (E/Em ratio). In the multivariable Cox regression analysis, HGS (P = 0.004) and ejection fraction (P = 0.004) were both second to LV mass index (P < 0.001) as the most significant factors in predicting circulatory congestion at 4 years. Serum albumin, LBM by CK and SGA were not independently predictive of circulatory congestion. Patients with systolic dysfunction and HGS < gender-specific median had an adjusted hazard ratio of 2.77 [95% confidence interval (CI), 1.46-5.28; P = 0.002] in developing circulatory congestion than those with normal systolic function and HGS ≥ gender-specific median. CONCLUSIONS: A low HGS reflects a diseased cardiac status and predicts future risk of circulatory congestion independent of other nutritional, echocardiographic and clinical parameters in PD patients. The important link between skeletal myopathy and myocardial disease in uraemic patients warrants further investigation.

Energy intake and expenditure profile in chronic peritoneal dialysis patients complicated with circulatory congestion.

BACKGROUND: Circulatory congestion is an adverse predictor of mortality in peritoneal dialysis (PD) patients. OBJECTIVE: This study evaluated the nutritional status, energy intake, and expenditure profile of PD patients with and without previous circulatory congestion. DESIGN: We conducted a cross-sectional study in 244 PD patients, of whom 92 had previous circulatory congestion. We estimated dietary energy intake by using a locally validated 7-d food-frequency questionnaire and by assessing resting energy expenditure (REE) and total energy expenditure (TEE) with indirect calorimetry and a locally validated physical activity questionnaire, respectively. RESULTS: In comparison with those without circulatory congestion, patients with previous circulatory congestion were more malnourished by subjective global assessment (59% compared with 36%; P < 0.001), had lower handgrip strength, had lower midarm muscle circumference, had lower dietary protein (0.98 +/- 0.45 compared with 1.19 +/- 0.44 g x kg(-1) x d(-1); P < 0.001), and had lower energy intake (92.5 +/- 37.0 compared with 110.9 +/- 35.7 kJ x kg(-1) x d(-1); P < 0.001) but had higher C-reactive protein (P = 0.025) and higher REE (P < 0.001). However, no difference in TEE was noted between the 2 groups, which indicated lower activity energy expenditure among patients with previous circulatory congestion. The resulting energy balance was significantly more negative for patients with previous circulatory congestion than for those without previous circulatory congestion (P = 0.050). Furthermore, the prevalence of malnutrition increased with increasing episodes of circulatory congestion (P = 0.017). CONCLUSIONS: Patients with previous circulatory congestion had significantly more inflammation, more muscle wasting, and higher REE but lower activity energy expenditure and energy and protein intakes in keeping with an anorexia-cachexia syndrome. The mechanisms of increased REE and reduced energy intake among patients with previous circulatory congestion warrant further investigation.

Clients' experiences of a community based lifestyle modification program: a qualitative study.

There is little information about how clients attending lifestyle modification programs view the outcomes. This qualitative study examined the clients' experience of a community based lifestyle modification program in Hong Kong. Semi-structured interviews were conducted with 25 clients attending the program. Clients perceived the program had positive impacts on their health and nutrition knowledge. They experienced frustration, negative emotion, lack of motivation, and pressure from others during the program. Working environment and lack of healthy food choices in restaurants were the major perceived environmental barriers for lifestyle modification. Clients valued nutritionists' capability of providing professional information and psychological support in the program. Our results suggest that nutritionist's capability of providing quality consultations and patient-centered care are important for empowering clients achieve lifestyle modification.

Serum 25-hydroxyvitamin D status and cardiovascular outcomes in chronic peritoneal dialysis patients: a 3-y prospective cohort study.

BACKGROUND: Patients with kidney disease are at high risk of developing 25-hydroxyvitamin D [25(OH)D] deficiency. OBJECTIVE: We studied the association between serum 25(OH)D status and clinical outcomes of chronic peritoneal dialysis patients. DESIGN: We measured serum 25(OH)D concentrations in 230 prevalent peritoneal dialysis patients and then followed these patients prospectively for 3 y or until death. RESULTS: Serum 25(OH)D was deficient or insufficient (ie, <75 nmol/L) in 87% of the patients. Adjusting for clinical and demographic factors, every 1-unit increase in log-transformed serum 25(OH)D was associated with a 44% reduction in the hazard of fatal or nonfatal cardiovascular events (95% CI: 0.35, 0.91; P = 0.018). However, the association was gradually lost when additional adjustment was made in a stepwise fashion for residual glomerular filtration rate (P = 0.078) and echocardiographic measures (P = 0.39). Kaplan-Meier estimates showed a significantly greater fatal or nonfatal cardiovascular event-free survival probability among patients with serum 25(OH)D > 45.7 nmol/L (median) than among patients with concentrations 45.7 nmol/L had a significantly higher cardiovascular event-free survival probability than did patients with 25(OH)D

Effectiveness of a lifestyle modification programme in weight maintenance in obese subjects after cessation of treatment with Orlistat.

OBJECTIVE: To examine the efficacy of a lifestyle modification programme in weight maintenance for obese subjects after cessation of treatment with Orlistat. METHODS: Fifty-five subjects with and without diabetes mellitus were randomized to a lifestyle modification programme or to usual care at the end of 6 months' treatment with Orlistat. The intervention programme was nutritionist led, consisting of components of dietary management, physical activity, peer group support and discussion using techniques of self-monitoring, stimulus control and cognitive restructuring. Anthropometric indices, body composition, basal metabolic rate, blood pressure, fasting glucose, glycosylated haemoglobin, lipid profile, 24-hour urinary albumin excretion, dietary intake, physical activity level, and quality of life were assessed before and after the intervention period. Results Subjects in the intervention group maintained their weight loss and favourable anthropometric, metabolic, dietary intake, physical activity and quality of life profiles, while most parameters deteriorated in the usual care group, being more marked in subjects with diabetes. The magnitude of weight gain was comparable to that lost during Orlistat treatment. CONCLUSION: A specially designed nutritionist-led lifestyle modification programme for obese subjects is effective in weight maintenance after treatment with Orlistat, in the absence of which the benefits of drug treatment were lost. The magnitude of the effect of lifestyle modification is comparable to that observed with Orlistat.

Nutrient intake during peritoneal dialysis at the Prince of Wales Hospital in Hong Kong.

BACKGROUND: Individuals undergoing peritoneal dialysis are at increased risk of developing cardiac disease and malnutrition. STUDY DESIGN: A cross-sectional survey. SETTINGS AND PARTICIPANTS: 249 Chinese continuous ambulatory peritoneal dialysis (CAPD) patients were recruited from the Prince of Wales Hospital in Hong Kong. Another 249 age- and sex-matched controls were recruited from an archive of 1,010 individuals with known food frequency questionnaire (FFQ) data. OBJECTIVE: To compare the dietary intake pattern of CAPD patients with controls and evaluate its association with background cardiac disease. OUTCOMES AND MEASUREMENTS: Intake of different nutrients was estimated by using a 7-day FFQ. RESULTS: Intake of all nutrients was lower in CAPD patients than controls, with resulting lower overall energy intake. Nutrient intake was decreased further in CAPD patients with background cardiac disease, which corresponded to worse nutritional status. Controlling for age, male sex, body weight, diabetes mellitus, dialysis therapy duration, residual renal function, peritoneal dialysis urea clearance, and Charlson Comorbidity Index score, background cardiac disease was associated independently with less intake of energy and most macronutrients and micronutrients. However, the association between background cardiac disease and energy and most nutrient intake was decreased or even lost when additional adjustment was made for C-reactive protein and serum albumin levels. LIMITATIONS: An FFQ is limited in that nutrient quantitation is not exact and may be underestimated as a result of underreporting by patients. CAPD patients were compared with a control group without cardiovascular disease ascertainment that did not include subjects with diabetes. CONCLUSIONS: Chinese CAPD patients had significantly lower nutrient intake than age- and sex-matched controls. The association between cardiac disease and lower dietary macronutrient and micronutrient intake in CAPD patients was mediated in part through systemic inflammation, which also was associated with more malnutrition. More attention should be focused on improving the intake pattern of Chinese CAPD patients.