Examining the Role of Nutrition in Cancer Survivorship and Female Fertility: A Narrative Review.

Female cancer survivors have a higher chance of experiencing infertility than females without a history of cancer diagnosis. This risk remains high despite advances in fertility treatments. There is a need to augment fertility treatments with cost-effective methods such as nutritional guidance to improve fertility chances. The aim of this review article is to connect the current literature on cancer survivorship nutrition and fertility nutrition, focusing on the importance of integrating nutritional guidance into fertility counseling, assessment, and treatment for female cancer survivors. Consuming a healthful diet comprising whole grains, soy, fruits, vegetables, seafood, and unsaturated fats has improved both female fertility and cancer survivorship. Similarly, maintaining a healthy body weight also improves female fertility and cancer survivorship. Therefore, dietary interventions to support female cancer survivors with fertility challenges are of immense importance. The period of follow-up fertility counseling and assessment after cancer treatment may provide a unique opportunity for implementing nutritional guidance for female cancer survivors. Dietary interventions are a promising strategy to improve pregnancy chances and overall quality of life among female cancer survivors; thus, researchers should investigate perceptions regarding fertility, barriers, and challenges to changing nutrition-related behaviors, and preferences for nutritional guidance to support fertility treatments in this population.

Interactions with Nature, Good for the Mind and Body: A Narrative Review.

Interacting with nature may promote mental and physical health. There are multiple ways to interact with nature: indirectly, incidentally, and intentionally. How these types of interactions with nature may be associated with mental and physical health status and health behaviors is unclear. The purpose of this narrative review is to (1) describe the relationship between interactions with nature (indirect, incidental, and intentional) and mental and physical health outcomes and behaviors, (2) identify gaps in the literature, and (3) provide recommendations for future research. Considerable evidence suggests that interacting with nature, indirectly and intentionally, is associated with improvements in mental health and physical exhibitions of mental status. Furthermore, intentionally interacting with nature is associated with engagement in physical activity and gardening is associated with fruit and vegetable consumption. Research suggests that incidentally interacting with nature may be associated with positive mental health status. More research is needed to understand the relationships between incidental interactions with nature and physical health status and behaviors; as well as among all types of interactions with nature and physical health disorders, sleep, and dietary behaviors.

Optimizing Fertility Treatment With Nutrition Guidance: Exploring Barriers and Facilitators to Healthful Nutrition Among Female Cancer Survivors With Fertility Challenges.

INTRODUCTION: Young women diagnosed with cancer are at an increased risk for infertility compared to women without a cancer diagnosis. Consuming a healthful diet comprised of whole grains, fruits, vegetables, and unsaturated fats has been found to improve both fertility and cancer survivorship. Given this reason, dietary interventions tailored to support female cancer survivors with fertility challenges are of immense importance. Therefore, the aim of this study was to explore barriers and facilitators to healthful nutrition among female cancer survivors with fertility challenges, to inform the development of dietary interventions for this population. METHODS: Using a formative research design, interview, survey, and dietary intake data were collected from 20 female cancer survivors of reproductive age. Participant-check focus group discussions were conducted to validate findings. All interviews were recorded and transcribed verbatim. Transcripts were coded and analyzed using a thematic analysis approach. Quantitative data were analyzed using means, standard deviations, ranges, frequencies, and percentages. RESULTS: The average age of respondents was 31.47 ± 3.5 years and the average BMI was 24.78 ± 4.1 kg/m2. All participants were college educated, 45% identified as White, 50% as Black, and 10% as Hispanic or Latinx. Cancer diagnoses included breast, thyroid, ovarian, leukemia, and gastrointestinal cancers. The following themes were identified: (1) Lack of nutrition-related resources and detailed guidance, (2) Work-life balance, (3) Perceived rigidity of dietary guidance, (4) Treatment-related fatigue, (5) Having trust in healthcare providers, (6) Higher motivation to change nutrition behavior, and (7) Recognizing the additional benefits of nutrition. CONCLUSION: These findings indicate a sought-after yet unmet need for post-cancer treatment fertility nutrition recommendations. Interventions should be tailored to women's needs and focus on improving their self-efficacy to make healthful dietary choices.

Altered prefrontal activation during the inhibition of eating responses in women with bulimia nervosa.

BACKGROUND: The sense of 'loss of control' (LOC), or a feeling of being unable to stop eating or control what or how much one is eating, is the most salient aspect of binge eating. However, the neural alterations that may contribute to this experience and eating behavior remain poorly understood. METHODS: We used functional near-infrared spectroscopy (fNIRS) to measure activation in the prefrontal cortices of 23 women with bulimia nervosa (BN) and 23 healthy controls (HC) during two tasks: a novel go/no-go task requiring inhibition of eating responses, and a standard go/no-go task requiring inhibition of button-pressing responses. RESULTS: Women with BN made more commission errors on both tasks. BN subgroups with the most severe LOC eating (n = 12) and those who felt most strongly that they binge ate during the task (n = 12) showed abnormally reduced bilateral ventromedial prefrontal cortex (vmPFC) and right ventrolateral prefrontal cortex (vlPFC) activation associated with eating-response inhibition. In the entire BN sample, lower eating-task activation in right vlPFC was related to more frequent and severe LOC eating, but no group differences in activation were detected on either task when this full sample was compared with HC. BN severity was unrelated to standard-task activation. CONCLUSIONS: Results provide initial evidence that diminished PFC activation may directly contribute to more severe eating-specific control deficits in BN. Our findings support vmPFC and vlPFC dysfunction as promising treatment targets, and indicate that eating-specific tasks and fNIRS may be useful tools for identifying neural mechanisms underlying dysregulated eating.

The Implication of Physiological Ketosis on The Cognitive Brain: A Narrative Review.

Optimal cognitive functions are necessary for activities of daily living and self-independence. Cognitive abilities are acquired during early childhood as part of progressive neurodevelopmental milestones; unfortunately, regressive changes can occur as part of physiological aging, or more ominously, pathological diseases, such as Alzheimer's disease (AD). Cases of AD and its milder subset, mild cognitive impairment (MCI), are rising and would impose a burdensome impact beyond the individual level. Various dietary and nutritional approaches have potential for promising results in managing cognitive deterioration. Glucose is the core source of bioenergy in the body; however, glucose brain metabolism could be affected in aging cells or due to disease development. Ketone bodies are an efficient alternate fuel source that could compensate for the deficient glycolytic metabolism upon their supra-physiologic availability in the blood (ketosis), which, in turn, could promote cognitive benefits and tackle disease progression. In this review, we describe the potential of ketogenic approaches to produce cognitive benefits in healthy individuals, as well as those with MCI and AD. Neurophysiological changes of the cognitive brain in response to ketosis through neuroimaging modalities are also described in this review to provide insight into the ketogenic effect on the brain outside the framework of purely molecular explanations.

Interaction of Protein Preloads and Physical Activity on Intake of an Ultra-Processed, High Sugar/High Fat Food/Low Protein Food.

"Loss of control, LOC" eating is a major contributor to the development of obesity. Dietary protein is known to promote satiety, but little attention has been paid to the ability of protein, consumed in close proximity to snacking (20 min), to reduce the intake of ultra-processed, low-protein snack foods. We hypothesized that a high-protein preload (HP, 8 g of protein) consumed in close proximity to eating an ultra-processed snack food would reduce intake of the snack food as compared to a low-protein preload (LP, 1.2 g of protein). Two laboratory test meals were conducted, and the intake of ice cream (1.99 kcal/gram) after consuming dairy-based liquid preloads was measured. Habitual physical activity, a potential modulator of satiety, was assessed by a self-reporting questionnaire. Thirty (responders) out of 50 participants reduced their intake of ice cream after the HP preload, with a significant difference in intake observed between the responders and non-responders (-30 ± 25 and 18 ± 18 g, F (1, 49) = 54.36, p < 0.001 for responders and non-responders, respectively). Our data demonstrate that protein consumed in close proximity to ultra-processed snack food can reduce caloric intake by ~60 kcal, which could potentially reduce body weight by at least 5 pounds per year.

Increasing Chocolate's Sugar Content Enhances Its Psychoactive Effects and Intake.

Chocolate elicits unique brain activity compared to other foods, activating similar brain regions and neurobiological substrates with potentially similar psychoactive effects as substances of abuse. We sought to determine the relationship between chocolate with varying combinations of its main constituents (sugar, cocoa, and fat) and its psychoactive effects. Participants consumed 5 g of a commercially available chocolate with increasing amounts of sugar (90% cocoa, 85% cocoa, 70% cocoa, and milk chocolates). After each chocolate sample, participants completed the Psychoactive Effects Questionnaire (PEQ). The PEQ consists of questions taken from the Morphine-Benzedrine Group (MBG), Morphine (M,) and Excitement (E) subscales of the Addiction Research Center Inventory. After all testing procedures, participants completed the Binge Eating Scale (BES) while left alone and allowed to eat as much as they wanted of each of the different chocolates. We found a measurable psychoactive dose⁻effect relationship with each incremental increase in the chocolate's sugar content. The total number of positive responses and the number of positive responses on the E subscale began increasing after tasting the 90% cocoa chocolate, whereas the number of positive responses on the MBG and M subscales began increasing after tasting the 85% cocoa chocolate sample. We did not find a correlation between BES scores and the total amount of chocolate consumed or self-reported scores on the PEQ. These results suggest that each incremental increase in chocolate's sugar content enhances its psychoactive effects. These results extend our understanding of chocolate's appeal and unique ability to prompt an addictive-like eating response.

Can bone-regulating hormones and nutrients help characterize the metabolically healthy obese phenotype.

BACKGROUND:: Bone-regulating hormones and nutrients play an important role in influencing metabolic health. AIM:: The aim of this study was to determine whether bone-regulating hormones and nutrients, such as parathyroid hormone (PTH), 25-hydroxyvitamin D (25OHD), and magnesium (Mg) could be used to characterize the metabolically healthy obese (MHO) phenotype. METHODS:: This study included 27 overweight or obese participants (14 men/13 women) classified as MHO ( n = 14) or metabolically unhealthy obese (MUO) ( n = 13) based on the presence or absence of metabolic abnormalities, determined by percentage body fat, percentage trunk fat, and waist circumference. Biochemical (serum concentrations of hormones and cytokines such as PTH, 25OHD, ionized Mg (iMg), cytokines, lipids, glycemic indices), physiological (percentage body fat, percentage trunk fat, blood pressure (BP)), and dietary intake (Mg intake, calcium intake) measurements were obtained. RESULTS:: Serum PTH concentrations were significantly lower ( p = 0.005) in the MHO group (39.68 ± 11.06 pg/mL) compared with the MUO group (63.78 ± 25.82 pg/mL). Serum iMg concentrations were higher ( p = 0.052) in the MHO group (0.565 ± 0.41 mmol/L) than in the MUO group (0.528 ± 0.050 mmol/L). Serum concentrations of osteocalcin were also higher (10.37 ± 3.70 ng/mL) in the MHO compared with the MUO (6.51 ± 4.14 ng/mL) group ( p = 0.017). The MHO group had significantly lower serum insulin concentrations ( p = 0.006) and diastolic BP ( p = 0.035). Concentrations of serum 25OHD, total triglycerides, C-reactive protein and systolic BP did not differ between groups. CONCLUSIONS:: These findings suggest that bone-regulating hormones and nutrients, especially serum PTH, osteocalcin concentrations, and dietary Mg intakes, can help to characterize the MHO phenotype.

Prevalence and potential factors associated with overweight and obesity status in adults with intellectual developmental disorders.

BACKGROUND: The prevalence of being overweight and obese is increasing not just in the general population but also in individuals with intellectual disability (ID). Therefore, a need to identify factors contributing to overweight/obesity arises as this population is escalating. MATERIALS AND METHODS: This narrative review article summarizes pertinent research focusing on prevalence and the potential factors associated with overweight and obesity in adults with intellectual disability during the past decade. RESULTS: Prevalence of being overweight and obese among adults with intellectual disability is reportedly 28%-71% and 17%-43%, respectively. Factors increasing the susceptibility of being overweight or obese have been identified as female gender, increasing age, having a certain diagnosis, mild intellectual disability, as well as living independently/with family, consuming certain prescription medications, and non-participation in physical activities. CONCLUSION: Identification of the potential risk factors associated with being overweight and obese in this population will help tackle the challenges faced by this growing adult population with intellectual disability.

Nutritional status of individuals with autism spectrum disorders: do we know enough?

The incidence of individuals with autism spectrum disorders (ASDs) is on the rise; therefore, well-timed screening is important. Given that this is a nutritionally vulnerable population, it is imperative to conduct a detailed nutritional assessment so that timely and intensive interventions can be recommended. This review article summarizes the research, focusing on the nutritional status of individuals with ASDs based on their anthropometric measurements, biomarkers, and dietary assessments. Research examining anthropometric measurements reveals an abnormally accelerated rate of growth among children with autism but shows inconsistent findings on the prevalence of overweight/obesity in comparison with typically growing children. Although dysregulated amino acid metabolism, increased homocysteine, and decreased folate, vitamins B-6 and B-12, and vitamin D concentrations have been proposed as possible biomarkers for an early diagnosis of ASDs, research investigating their association with age, gender, severity, and other comorbid psychiatric/nonpsychiatric disorders is lacking. There is consensus that children with autism have selective eating patterns, food neophobia, limited food repertoire, and sensory issues. Although inadequate micronutrient but adequate macronutrient intakes are increasingly reported, there are inconsistent results about the extent and type of nutrient deficiencies. Identification and development of nutritional assessment indicators that serve as early warning signs during routine practice beginning at birth and extending throughout the child's growth are necessary. With this population aging, there is also a dire need to study the adult population. A more vigorous role by nutrition professionals is warranted because management of potential comorbidities and contributory factors may be particularly problematic.

Benchmarking a Home-Delivered Meal Program's Annual Satisfaction Survey: A Metropolitan Area Neighborhood Nutrition Alliance (MANNA) Initiative in Philadelphia.

The Metropolitan Area Neighborhood Nutrition Alliance (MANNA) is a community-based organization providing home-delivered meals in Philadelphia, Pennsylvania to individuals at acute nutritional risk and experiencing a life-threatening illness, independent of age or income. The challenge MANNA faces, like other community-based organizations, is to demonstrate effective services by benchmarking with other organizations. This article reports how MANNA benchmarked results of their annual satisfaction survey against the 2013 National Survey of Older Americans Act Program. Overall, MANNA recipients were more often satisfied with the taste and variety of food, and more MANNA recipients rated the program as excellent. However, more MANNA recipients reported not having enough money to buy food, skipping meals because of money, needing to choose between food and medications or food and utilities. MANNA is using these findings as an impetus to better understand the needs of their clients, especially as they transition off the meal program, and to identify additional resources to support transitional programming.

Nutritional rehabilitation in anorexia nervosa: review of the literature and implications for treatment.

Restoration of weight and nutritional status are key elements in the treatment of anorexia nervosa (AN). This review aims to describe issues related to the caloric requirements needed to gain and maintain weight for short and long-term recovery for AN inpatients and outpatients.We reviewed the literature in PubMed pertaining to nutritional restoration in AN between 1960-2012. Based on this search, several themes emerged: 1. AN eating behavior; 2. Weight restoration in AN; 3. Role of exercise and metabolism in resistance to weight gain; 3. Medical consequences of weight restoration; 4. Rate of weight gain; 5. Weight maintenance; and 6. Nutrient intake.A fair amount is known about overall caloric requirements for weight restoration and maintenance for AN. For example, starting at 30-40 kilocalories per kilogram per day (kcal/kg/day) with increases up to 70-100 kcal/kg/day can achieve a weight gain of 1-1.5 kg/week for inpatients. However, little is known about the effects of nutritional deficits on weight gain, or how to meet nutrient requirements for restoration of nutritional status.This review seeks to draw attention to the need for the development of a foundation of basic nutritional knowledge about AN so that future treatment can be evidenced-based.

Psychoactive effects of tasting chocolate and desire for more chocolate.

The purpose of this study was to characterize the psychoactive effects of tasting chocolate and to evaluate the contribution of the main chocolate components to the desire to consume more of it. A total of 280 participants, (F-155; M=125) ranging in age from 18-65, completed the study. Participants were randomly assigned to taste 12.5 g of either white chocolate ("control") or one of four chocolate ("cocoa") samples varying in sugar, fat and percent cocoa content, then answered the question: "Do you want more of this chocolate?" and "If yes, how many more pieces of this chocolate would you like to eat?" They completed pre- and post-consumption surveys, consisting of 30 questions derived from the Addiction Research Center Inventory (ARCI) subscales, Morphine-Benzedrine Group (MBG), Morphine (M) and Excitement (E). Significant decreases in post-pre consumption changes in MBG subscale were observed between the control sample and the 70% cocoa (p=0.046) or the 85% cocoa sample (p=0.0194). Proportionally more men than women wanted more of the tasted chocolate (p=0.035). Participants were more likely to want more of the tasted chocolate if they displayed a greater change in the MBG scale, and if their chocolate sample had high sugar and cocoa content, as assessed by multiple logistic regression. Our results suggest that multiple characteristics of chocolate, including sugar, cocoa and the drug-like effects experienced, play a role in the desire to consume chocolate.

Use of an operant task to estimate food reinforcement in adult humans with and without BED.

OBJECTIVE: The purpose of this study was to demonstrate the utility of food-reinforced operant task performance in modeling binge-eating disorder (BED). We hypothesized that food reinforcement after a caloric preload would be related to BED status, but not hunger. METHODS AND PROCEDURES: We investigated the association between reports of hunger, binge tendency, and food reinforcement in a sample of 18 women (12 non-BED, 7 lean, 5 obese, and 6 obese BED). Participants completed two sessions of operant task performance after consuming 600 ml of flavored water or 600 ml of a 1 kcal/ml liquid meal. RESULTS: Under the water condition, food reinforcement did not differ between the non-BED and BED groups, and was positively correlated with hunger ratings across all participants (r = 0.55, P = 0.023). Under the liquid meal condition, food reinforcement was significantly decreased compared with the water condition in the non-BED group (t = -2.6, P = 0.026). There was also a significant difference between the non-BED and BED groups in the fed condition (41 +/- 40, 117 +/- 60, F = 10.3, P = 0.005, non-BED vs. BED, respectively, mean +/- s.d.). The correlation between food reinforcement and hunger remained significant only in the non-BED group (r = 0.69, P = 0.011). DISCUSSION: Our results support the hypothesis that food reinforcement measured after a caloric preload is related to BED status but not hunger in those subjects with BED. The data also suggest that operant task performance can be useful in modeling BED criteria such as "eating when not physically hungry."

Calcium and magnesium ATPase activities in women with varying BMIs.

OBJECTIVE: Intracellular calcium (Ca) is increased in obese humans, and magnesium (Mg)-ATPase activity is increased in monosodium glutamate-induced obese rats. The aims of this study were to test the hypotheses that Ca-ATPase activity is negatively correlated with BMI, and that Mg-ATPase activity is positively correlated with BMI and Ca-ATPase activity in obese women. RESEARCH METHODS AND PROCEDURES: Thirty healthy adult women, with BMIs of 20 to 40, donated a single sample of whole blood and were interviewed as to medical history and family history of obesity. Erythrocyte membranes were isolated and assayed for Ca-ATPase and Mg-ATPase. Weight and height were self-reported. Regression analysis was used to determine relationship between BMI and enzyme activity. Family history of obesity served as a covariant. RESULTS: Ca-ATPase was negatively correlated with increasing BMI (r = - 0.38, p = 0.02). The relationship between BMI and Ca-ATPase remained valid after controlling for family history of obesity (r = -0.36, p = 0.03). There was a positive correlation between Mg-ATPase activity and Ca-ATPase (r = 0.42, p = 0.024), and this relationship remained valid after controlling for BMI and family history of obesity (r = 0.41, p = 0.03). DISCUSSION: Ca-ATPase activity decreases as BMI increases. Decreased ATPase activity may contribute to increased intracellular calcium, previously reported in obese persons. Further studies are needed to determine whether a drop in Ca-ATPase activity can serve as a marker for the development of obesity.

Impulsivity and test meal intake in obese binge eating women.

Greater impulsivity has been observed in those with chemical (cocaine, marijuana, alcohol) and behavioral addictions (gambling, sex, shopping), as well as in individuals with personality and conduct disorders. Greater impulsivity has also been described in those with Bulimia Nervosa and attributed to aberrations in serotonin, as has eating in response to negative affect. However, less is known about the impact of impulsivity on eating behavior in obese humans in general, and in those who meet sub-clinical and full clinical criteria for Binge Eating Disorder (BED) in particular. Using a laboratory test meal paradigm, we demonstrated: (1) greater Motor Impulsivity (Barratt Impulsivity Scale (BIS) (p = 0.05) in those with BED (n = 11) as compared to those without BED (n = 11) (2) a positive correlation between BED criteria and BIS scores (p < 0.01) (3) a positive correlation between test meal duration and Zung Depression Score, and (4) a positive correlation between Motor Impulsivity and mood rated before consuming the test meal. These associations suggest potential aberrations in serotonin transmission in BED, and a possible target for pharmacotherapy of BED especially in those who are resistant to Cognitive Behavioral Therapy.