Etiology of lipid-laden macrophages in the lung.

Uniquely positioned as sentinel cells constantly exposed to the environment, pulmonary macrophages are vital for the maintenance of the lung lining. These cells are responsible for the clearance of xenobiotics, pathogen detection and clearance, and homeostatic functions such as surfactant recycling. Among the spectrum of phenotypes that may be expressed by macrophages in the lung, the pulmonary lipid-laden phenotype is less commonly studied in comparison to its circulatory counterpart, the atherosclerotic lesion-associated foam cell, or the acutely activated inflammatory macrophage. Herein, we propose that lipid-laden macrophage formation in the lung is governed by lipid acquisition, storage, metabolism, and export processes. The cellular balance of these four processes is critical to the maintenance of homeostasis and the prevention of aberrant signaling that may contribute to lung pathologies. This review aims to examine mechanisms and signaling pathways that are involved in lipid-laden macrophage formation and the potential consequences of this phenotype in the lung.

Deep Phenotyping of Parkinson's Disease.

Phenotype is the set of observable traits of an organism or condition. While advances in genetics, imaging, and molecular biology have improved our understanding of the underlying biology of Parkinson's disease (PD), clinical phenotyping of PD still relies primarily on history and physical examination. These subjective, episodic, categorical assessments are valuable for diagnosis and care but have left gaps in our understanding of the PD phenotype. Sensors can provide objective, continuous, real-world data about the PD clinical phenotype, increase our knowledge of its pathology, enhance evaluation of therapies, and ultimately, improve patient care. In this paper, we explore the concept of deep phenotyping-the comprehensive assessment of a condition using multiple clinical, biological, genetic, imaging, and sensor-based tools-for PD. We discuss the rationale for, outline current approaches to, identify benefits and limitations of, and consider future directions for deep clinical phenotyping.

Acute and chronic effects of multivitamin/mineral supplementation on objective and subjective energy measures.

BACKGROUND: Vitamins and minerals play an essential role within many cellular processes including energy production and metabolism. Previously, supplementation with a multivitamin/mineral (MVM) for ≥28 days resulted in improvements to cognition and subjective state. We have also demonstrated shifts in metabolism during cognitively demanding tasks following MVM in females, both acutely and following 8-week supplementation. The current study aimed to assess these effects further in males and females using metabolically challenging exercise and cognitive tasks. METHODS: The current randomised, placebo-controlled, parallel groups study investigated the effects of a MVM complex in 82 healthy young (18-35y) exercisers. Subjective ratings and substrate metabolism were assessed during 30 min each of increasingly effortful incremental exercise and demanding cognitive tasks. Assessments took place on acute study days following a single dose (Day 1) of MVM, containing 3 times recommended daily allowance of water-soluble vitamins plus CoQ10, and following 4-week supplementation (Day 28). RESULTS: Energy expenditure (EE) was increased during cognitive tasks following MVM across Day 1 and Day 28, with greater effects in males. In males, MVM also increased carbohydrate oxidation and energy expenditure during exercise across Day 1 and Day 28. In females, mental tiredness was lower during exercise; increases in physical tiredness following 30 min of exercise were attenuated; and stress ratings following cognitive tasks were reduced following MVM. In males, MVM only lowered mental tiredness following 10 min of exercise. These effects were apparent irrespective of day, but effects on mental tiredness were greater on Day 28. Ferritin levels were also higher on Day 28 in those receiving MVM. CONCLUSION: These findings extend on existing knowledge, demonstrating increased carbohydrate oxidation and increased energy expenditure in males following MVM supplementation for the first time. Importantly, they show modulation of energy expenditure and subjective tiredness following a single dose, providing further evidence for acute effects of MVM. Differential effects in men and women suggest that sex may play an important role in the effects of MVM on energy metabolism and should be considered in future research. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03003442. Registered 22nd November 2016 - retrospectively registered.

Protein for Life: Towards a focussed dietary framework for healthy ageing.

'Ageing well' has been highlighted as an important research area by the World Health Organization. In the UK, healthy ageing has been identified as a priority research area by multiple Research Councils and is a key NHS priority. Sarcopaenia, the decline of muscle mass/strength and a key component of healthy ageing, can have a major impact on quality of life and is associated with premature mortality. Increasing protein intake at all stages of the life course may help to reduce the rate of muscle decline and the onset of associated health conditions. However, there is a lack of understanding of the social, demographic and psychological drivers of food choices surrounding protein intake. This report describes the multidisciplinary approach that has been adopted by the Protein for Life project to create a framework for the development of palatable, cost-effective higher-protein foods suitable for an ageing population.

Telemedicine for Parkinson's Disease: Limited Engagement Between Local Clinicians and Remote Specialists.

INTRODUCTION: The integration of remote specialists into local care teams has not been widely evaluated. METHODS: Therefore, we surveyed clinicians whose patients with Parkinson's disease had participated in a national randomized controlled trial of video visits to determine (1) whether clinicians received recommendations from remote specialists; (2) whether those recommendations were implemented; (3) what barriers to specialty care local clinicians perceived; and (4) whether they would recommend video visits. RESULTS: Of 183 clinicians surveyed, 89 (49%) responded. Less than half received the recommendations of remote specialists, but they implemented most of the recommendations they received and found them to be beneficial. CONCLUSION: The greatest perceived barrier among respondents was distance from patient to specialist, and 40% of local clinicians would recommend video visits. As telemedicine grows, improved communication between remote specialists and local clinicians is likely needed.

Gut microbiota of Type 1 diabetes patients with good glycaemic control and high physical fitness is similar to people without diabetes: an observational study.

AIM: Type 1 diabetes is the product of a complex interplay between genetic susceptibility and exposure to environmental factors. Existing bacterial profiling studies focus on people who are most at risk at the time of diagnosis; there are limited data on the gut microbiota of people with long-standing Type 1 diabetes. This study compared the gut microbiota of patients with Type 1 diabetes and good glycaemic control and high levels of physical-fitness with that of matched controls without diabetes. METHODS: Ten males with Type 1 diabetes and ten matched controls without diabetes were recruited; groups were matched for gender, age, BMI, peak oxygen uptake (VO2max ), and exercise habits. Stool samples were analysed using next-generation sequencing of the 16S rRNA gene to obtain bacterial profiles from each individual. Phylogenetic investigation of communities by reconstruction of unobserved states (PICRUSt) was implemented to predict the functional content of the bacterial operational taxonomic units. RESULTS: Faecalibacterium sp., Roseburia sp. and Bacteroides sp. were typically the most abundant members of the community in both patients with Type 1 diabetes and controls, and were present in every sample in the cohort. Each bacterial profile was relatively individual and no significant difference was reported between the bacterial profiles or the Shannon diversity indices of Type 1 diabetes compared with controls. The functional profiles were more conserved and the Type 1 diabetes group were comparable with the control group. CONCLUSIONS: We show that both gut microbiota and resulting functional bacterial profiles from patients with long-standing Type 1 diabetes in good glycaemic control and high physical fitness levels are comparable with those of matched people without diabetes.

Community Water Improvement, Household Water Insecurity, and Women's Psychological Distress: An Intervention and Control Study in Ethiopia.

BACKGROUND: Over 650 million people worldwide lack access to safe water supplies, and even among those who have gained access to 'improved' sources, water may be seasonally unreliable, far from homes, expensive, and provide insufficient quantity. Measurement of water access at the level of communities and households remains crude, and better measures of household water insecurity are urgently needed to inform needs assessments and monitoring and evaluation. We set out to assess the validity of a quantitative scale of household water insecurity, and to investigate (1) whether improvements to community water supply reduce water insecurity, (2) whether water interventions affect women's psychological distress, and (3) the impacts of water insecurity on psychological distress, independent of socio-economic status, food security, and harvest quality. METHODS AND FINDINGS: Measures were taken before and one to six months after a community water supply improvement in three villages in rural northern Ethiopia. Villages similar in size and access to water sources and other amenities did not receive interventions, and served as controls. Household water insecurity was assessed using a 21-item scale based on prior qualitative work in Ethiopia. Women's psychological distress was assessed using the WHO Self-Reporting Questionnaire (SRQ-20). Respondents were either female heads of household or wives of the heads of household (n = 247 at baseline, n = 223 at endline); 123 households provided data at both rounds. The intervention was associated with a decline of approximately 2 points on the water insecurity scale between baseline and endline compared to the control (beta -1.99; 95% CI's -3.15, -0.84). We did not find evidence of impact of the intervention on women's psychological distress. Water insecurity was, however, predictive of psychological distress (p <0.01), independent of household food security and the quality of the previous year's harvest. CONCLUSION: These results contribute to the construct validity of our water insecurity scale, and establish our approach to measuring water insecurity as a plausible means of evaluating water interventions. Improvements to community water supplies were effective in reducing household water insecurity, but not psychological distress, in this population. Water insecurity was an important predictor of psychological distress. This study contributes to an emerging literature on quantitative assessment of household water insecurity, and draws attention to the potential impact of improved access to water on women's mental well-being.

The effect of milk on the attenuation of exercise-induced muscle damage in males and females.

PURPOSE: The consumption of 500 ml milk following muscle damaging exercise can attenuate decreases in muscle functional capacity and increases in markers of muscle damage and soreness in males. There has been no similar research in female participants. Therefore, the aim of this study was to investigate the effects of milk consumption on exercise-induced muscle damage (EIMD) in males and females. METHODS: Thirty-two team sport players (male n = 16; female n = 16) were randomly, but equally divided into four groups: male milk, male carbohydrate, female milk, and female carbohydrate. Immediately following muscle damaging exercise, participants consumed either 500 ml of milk or 500 ml of an energy-matched carbohydrate solution. Skeletal troponin I (sTnI), creatine kinase (CK), peak torque, counter movement jump height, 20 m sprint performance and passive and active soreness were recorded prior to and 24, 48 and 72 h post-EIMD. RESULTS: For females, milk had a likely/very likely beneficial effect on attenuating losses in peak torque at 60°/s from baseline to 24, 48 and 72 h, and a likely beneficial effect in minimising decrements in sprint performance and soreness over 72 h. Milk was unlikely to have a negative effect on serum markers of damage from baseline to 48 and 72 h. For males, milk had an unclear effect on muscle function variables. Milk had a most likely/likely beneficial effect on limiting muscle soreness from baseline to 72 h, and a possible beneficial effect on attenuating increases in CK. The effect on sTnI was unlikely to be negative from baseline-72 h. Overall gender comparisons provided many unclear outcomes. However, female participants demonstrated smaller increases in sprint time, passive soreness, active soreness (non-dominant leg) and sTnI values. CONCLUSION: Consumption of 500 ml of milk post-EIMD can limit decrements in muscle function in females, and limit increases in soreness and serum markers of muscle damage in females and males.

The influence of calcium supplementation on substrate metabolism during exercise in humans: a randomized controlled trial.

BACKGROUND/OBJECTIVES: High calcium intakes enhance fat loss under restricted energy intake. Mechanisms explaining this may involve reduced dietary fat absorption, enhanced lipid utilization and (or) reductions in appetite. This study aimed to assess the impact of 2 weeks of calcium supplementation on substrate utilization during exercise and appetite sensations at rest. SUBJECTS/METHODS: Thirteen physically active males completed two 14-d supplemental periods, in a double-blind, randomized crossover design separated by a ⩾4-week washout period. During supplementation, a test-drink was consumed daily containing 400 and 1400 mg of calcium during control (CON) and high-calcium (CAL) periods, respectively. Cycling-based exercise tests were conducted before and after each supplemental period to determine substrate utilization rates and circulating metabolic markers (non-esterified fatty acid, glycerol, glucose and lactate concentrations) across a range of exercise intensities. Visual analog scales were completed in the fasting, rested state to determine subjective appetite sensations. RESULTS: No significant differences between supplements were observed in lipid or carbohydrate utilization rates, nor in circulating metabolic markers (both P>0.05). Maximum rates of lipid utilization were 0.47±0.05 and 0.44±0.05 g/min for CON and CAL, respectively, prior to supplementation and 0.44±0.05 and 0.42±0.05 g/min, respectively, post-supplementation (main effects of time, supplement and time x supplement interaction effect all P>0.05). Furthermore, no significant differences were detected in any subjective appetite sensations (all P>0.05). CONCLUSIONS: Two weeks of calcium supplementation does not influence substrate utilization during exercise in physically active males.

The role of cherries in exercise and health.

Recently, cherries and cherry products have received growing attention within the literature with regard to their application in both exercise and clinical paradigms. Reported to be high in anti-inflammatory and anti-oxidative capacity, cherries and their constituents are proposed to provide a similar but natural alternative akin to over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) or analgesics. Within exercise paradigms, concern has been raised with regard to the use of products, which inhibit such inflammatory or oxidative actions, because of the possibility of the blunting of physiological training adaptations. Despite this, numerous scenarios exist both within exercise and clinical populations where a goal of optimal recovery time is more important than physiological adaptation. This review critically evaluates and discusses the use of cherries as a supplementation strategy to enhance recovery of muscle function, inhibit exercise-induced inflammation, oxidative stress, and pain primarily; furthermore, the potential application of cherries to clinical populations is discussed.

Supplementary biotin decreases tibial bone weight, density and strength in riboflavin-deficient starter diets for turkey poults.

1. Growth and skeletal responses to different dietary concentrations of riboflavin and biotin were compared in turkey poults from hatch to 21 d of age. The birds were fed on a turkey starter diet with different concentrations of supplementary riboflavin (0, 20 and 40 mg/kg) and biotin (0, 0.3 and 0.6 mg/kg) in a factorial design. 2. Poults fed on diets with no supplementary riboflavin had poor gait scores, decreased times to sit and higher rates of culling compared to poults fed on the control diet (20 mg riboflavin and 0.3 mg biotin/kg [corrected] diet). Histologically, riboflavin deficiency was associated with a peripheral neuropathy similar to that described previously in chicks and, unexpectedly, in growth plate abnormalities. 3. Tibiae of poults fed on the control diet were larger, more dense, stronger and stiffer than the diets with no supplementary riboflavin. 4. Increasing supplementary biotin in poults fed on diets with no supplementary riboflavin was associated with a decrease in tibia weight, density, strength and stiffness. 5. The results demonstrated that riboflavin deficiency in fast-growing turkey poults was associated with growth retardation, growth plate disturbance and peripheral nerve dysfunction leading to an inability to walk.

Agreement between paper and pen visual analogue scales and a wristwatch-based electronic appetite rating system (PRO-Diary©), for continuous monitoring of free-living subjective appetite sensations in 7-10 year old children.

Electronic capture of free-living subjective appetite data can provide a more reliable alternative to traditional pen and paper visual analogue scales (P&P VAS), whilst reducing researcher workload. Consequently, the aim of this study was to explore the agreement between P&P VAS and a wristwatch-based electronic appetite rating system known as the PRO-Diary© technique, for monitoring free-living appetite sensations in 7-10 year old children. On one occasion, using a within-subject design, the 12 children (n=6 boys; n=6 girls) recorded their subjective appetite (hunger, prospective food consumption, and fullness), at two time points before lunch (11:30 and 12:00) and every 60 min thereafter until 21:00. The agreement between the P&P VAS and PRO-Diary© technique was explored using 95% limits of agreement and 95% confidence intervals (95% CI) calculated using the Bland and Altman (1986) technique. For hunger, prospective food consumption and fullness, the 95% limits of agreement were -1±25 mm (95% CI: lower limit -8mm; upper limit +6mm), 0±21 mm (95% CI: lower limit -6mm; upper limit +6mm) and -6±24 mm (95% CI: lower limit -14 mm; upper limit +1mm), respectively. Given the advantages associated with electronic data capture (inexpensive; integrated alarm; data easily downloaded), we conclude that the PRO-Diary© technique is an equivalent method to employ when continuously monitoring free-living appetite sensations in 7-10 year old children, but should not be used interchangeably with P&P VAS.

Breakfast consumption and exercise interact to affect cognitive performance and mood later in the day. A randomized controlled trial.

The current study assessed the interactive effect of breakfast and exercise on cognition and mood. Twelve active males completed four trials; no breakfast-rest, breakfast-rest, no breakfast-exercise or breakfast-exercise in a randomized, cross-over design. The trials consisted of; breakfast or fast, a 2h rest, exercise (treadmill run) or equivalent rest, a chocolate milk drink, a 90 min rest and an ad libitum lunch. Cognitive performance and mood were recorded frequently throughout each trial. Data was analysed as pre-exercise/rest, during and immediately post exercise/rest and post-drink. No effects were found prior to consumption of the drink. Post-drink, fasting before exercise increased mental fatigue compared to consuming breakfast before exercise and fasting before rest. Tension increased when breakfast was consumed at rest and when exercise was undertaken fasted compared to omitting breakfast before rest. Breakfast before rest decreased rapid visual information processing task speed and impaired Stroop performance. Breakfast omission improved Four Choice Reaction Time performance. To conclude, breakfast before exercise appeared beneficial for post-exercise mood even when a post-exercise snack was consumed. Exercise reversed post-breakfast cognitive impairment in active males.

Effect of calcium intake on fat oxidation in adults: a meta-analysis of randomized, controlled trials.

Calcium intake is likely to increase body fat loss during energy restriction. Part of this effect may be explained by increased fat oxidation in the presence of a similar energy balance, yet studies have not provided a conclusive answer. Therefore a meta-analysis was performed to determine whether chronic or acute high calcium intake increases fat oxidation. Randomized controlled trials of high calcium intake in human adults where measures of fat oxidation were taken were included. A random-effects meta-analysis was performed on outcomes expressed as standardized mean differences. Chronic high calcium intake increased fat oxidation by a standardized mean difference of 0.42 (95% confidence intervals: 0.14, 0.69; P= 0.003; estimated to correspond to an 11% increase), displaying low heterogeneity (I(2) = 18%), which was more prominent when habitual calcium intake was low (<700 mg d(-1) ). Acute high calcium intake increased fat oxidation by a standardized mean difference of 0.41 (0.04, 0.77; P = 0.03), with low heterogeneity (I(2) = 19%), yet sensitivity analysis revealed that this effect was relatively weak. In conclusion, chronic high calcium intake is likely to increase rates of fat oxidation. The effects of acute high calcium intake appear to point in the same direction, but further work is needed to permit a greater degree of certainty.

Effect of breakfast glycemic index on metabolic responses during rest and exercise in overweight and non-overweight adolescent girls.

BACKGROUND/OBJECTIVES: The metabolic responses to mixed breakfast meals with different glycemic indexes (GI) and their effects on substrate metabolism during exercise in adolescent girls have not been examined. The interaction with weight status also warrants investigation. This study investigated the effect of mixed breakfast meals containing high GI (HGI) or low GI (LGI) carbohydrates on metabolic responses and fat oxidation during rest and exercise in overweight (OW) and non-overweight (NO) adolescent girls. SUBJECTS/METHODS: A total of 8 OW and 12 NO adolescent girls consumed an isoenergetic HGI (GI=73) or LGI (GI=44) breakfast 120 min before completing a 30-min treadmill walk at 50% \[Vdot]O(2peak). RESULTS: Peak blood glucose concentration was higher for HGI compared with LGI in OW (P=0.023), but not NO (P>0.05) girls. Blood glucose total area under the curve (TAUC) was 13% higher in HGI compared with LGI in OW (P=0.006), but only 4% higher in NO (P=0.072) girls. Plasma insulin data were log(e) transformed (lninsulin). Plasma lninsulin concentrations were not different between HGI and LGI (P>0.05). Peak plasma lninsulin concentration (P=0.016) and TAUC (P=0.001) were greater in OW than NO girls. Fat oxidation during postprandial rest and exercise was not different between breakfasts (P>0.05). CONCLUSIONS: The elevated glycemic response in HGI compared with LGI was more pronounced in OW girls, suggesting a reduced ability to cope with the metabolic demands of the HGI, but not LGI, breakfast. Manipulation of breakfast GI did not alter fat oxidation during rest or subsequent moderate intensity exercise in OW and NO adolescent girls.

Agreement between two methods of dietary data collection in female adolescent netball players.

The accuracy of a combined dietary data collection method (self-reported, weighed food diary and 24-h recall technique) in 13 female, adolescent netball players (14-16 years) was explored. The girls were observed for a 12 h period (08:00-20:00), during which food and drink items were available ad libitum throughout the day and for the period between 20:00 and 08:00 the following morning. All items were covertly weighed before and after consumption to calculate observed energy intake. To calculate participant reported energy intake, food and drink items were weighed and recorded in a food diary by the participants, which was then supplemented with information from the 24-h recall the following morning. Agreement between observed and participant reported energy intake was calculated using the Bland and Altman technique. The mean difference between observed and participant reported energy intake was 0.46 MJ d(-1) (change in mean of 4.2%) indicating a slight bias towards over-reporting using the combined dietary data collection method. There was good agreement at the group level with the confidence interval for bias ranging from 0.00 to 0.92 MJ d(-1). The combined dietary data collection method is an effective technique to employ in 14-16-year old, female adolescent netball players when quantifying energy intake.

Energy intake and appetite following netball exercise over 5 days in trained 13-15 year old girls.

Free-living energy intake and subjective appetite were monitored in a group of eleven 13-15-year old trained adolescent netball players. During preliminary visits, a FLEX heart rate calibration and resting metabolic test were conducted. Heart rate data were collected during a netball exercise session and sedentary period and during the waking hours of all study days, to enable exercise-induced and 24-h energy expenditure to be quantified. The girls completed two 5-day treatment weeks, interspersed with a 2-week 'wash out' period. A 47-min bout of netball exercise or an equivalent sedentary period was carried out on day 3 of each treatment week. Energy intake was measured over each 5-day period using a combined self-reported, weighed, food diary and 24-h recall interview technique. Subjective appetite (hunger, prospective food consumption, fullness) and mood were rated by subjects immediately before and after meals each day, and before and after the netball exercise and the sedentary period. Forty eight hour energy intake was significantly higher following the netball exercise compared to the sedentary period. The girls felt significantly more hungry immediately following the netball exercise compared to immediately before. In conclusion, a single intermittent exercise bout alters subsequent appetite and energy intake in trained 13-15-year old girls.

Dietary glycemic index influences lipid oxidation but not muscle or liver glycogen oxidation during exercise.

The glycemic index (GI) of dietary carbohydrates influences glycogen storage in skeletal muscle and circulating nonesterified fatty acid (NEFA) concentrations. We hypothesized that diets differing only in GI would alter intramuscular lipid oxidation and glycogen usage in skeletal muscle and liver during subsequent exercise. Endurance-trained individuals (n = 9) cycled for 90 min at 70% Vo(2peak) and then consumed either high- or low-GI meals over the following 12 h. The following day after an overnight fast, the 90-min cycle was repeated. (1)H and (13)C magnetic resonance spectroscopy was used before and after exercise to assess intramuscular lipid and glycogen content of the vastus muscle group and liver. Blood and expired air samples were collected at 15-min intervals throughout exercise. NEFA availability was reduced during exercise in the high- compared with the low-GI trial (area under curve 44.5 +/- 6.0 vs. 38.4 +/- 7.30 mM/h, P < 0.05). Exercise elicited an approximately 55% greater reduction in intramyocellular triglyceride (IMCL) in the high- vs. low-GI trial (1.6 +/- 0.2 vs. 1.0 +/- 0.3 mmol/kg wet wt, P < 0.05). There was no difference in the exercise-induced reduction of the glycogen pool in skeletal muscle (76 +/- 8 vs. 68 +/- 5 mM) or in liver (65 +/- 8 vs. 71 +/- 4 mM) between the low- and high-GI trials, respectively. High-GI recovery diets reduce NEFA availability and increase reliance on IMCL during moderate-intensity exercise. Skeletal muscle and liver glycogen storage or usage are not affected by the GI of an acute recovery diet.

Factors associated with hip protector adherence among older people in residential care.

BACKGROUND: There is evidence to suggest that hip protectors (HPs) prevent fractures among older people living in nursing homes. Studies have found HP wearing rates (adherence) to be low. OBJECTIVES: To investigate factors that are associated with adherence and whether those factors account for the variation in adherence between residential care homes (RCHs). DESIGN: Six-month prospective study. SUBJECTS AND SETTING: 299 people aged 65 years and over (80% female, mean age 86 years) living in 17 RCHs. 128 of these wore HPs at least once. METHODS: All residents in the homes were offered three pairs of SAFEHIP HPs, and adherence was measured using diaries completed daily. A mixed model regression analysis was used to investigate predictive factors for wearing HPs and the effects of these factors on the between-home variability in adherence. RESULTS: Increased HP adherence was associated with hypertension, incontinence, a previous history of falls and fractures, and hip fracture history in the RCH. Decreased adherence was associated with arthritis of the lower limbs and dizziness on first rising. The large variation in adherence between RCHs was almost completely explained by these factors. DISCUSSION: The evidence for the efficacy of HPs is weakening. Low adherence compromises the power of trials to detect a real effect. The literature is inconsistent regarding what factors are associated with adherence. Nevertheless, it suggests that some people who are at increased risk of fracture are more likely to wear HPs. Variations in staff or resident knowledge and attitude towards HPs may explain some variation between homes.

Influence of the glycaemic index of an evening meal on substrate oxidation following breakfast and during exercise the next day in healthy women.

OBJECTIVE: To investigate whether the 'overnight second-meal effect' results in altered substrate oxidation during the postprandial period following breakfast and subsequent sub-maximal exercise in women. SUBJECTS/METHODS: Seven recreationally active women were recruited for the study. In each trial, participants were provided with their evening meal on day 1, which was composed of either high glycaemic index (HGI) or low glycaemic index (LGI) carbohydrates (CHO). On day 2, participants were provided with a standard HGI breakfast and then performed a 60 min run at 65% \[V.]O(2 max) 3 h later. RESULTS: The incremental area under the curve (IAUC) for plasma glucose concentrations during the postprandial period following breakfast was greater in the HGI trial compared to the LGI trial (P<0.01). Similarly, the IAUC for serum insulin concentrations was greater in the HGI trial than the LGI trial (P<0.05). No differences in plasma free-fatty acids (FFA) or plasma glycerol concentrations were found between trials during the postprandial period. During subsequent exercise, there were no significant differences in substrate metabolism. CONCLUSION: The glycaemic index of an evening meal does not alter substrate oxidation at rest following breakfast or during subsequent submaximal exercise in women. This study provides further evidence for the overnight second-meal effect on glycaemic responses following a LGI mixed evening meal.