Dietary Assessment by Pattern Recognition: a Comparative Analysis.

Background: Diet quality photo navigation (DQPN) is a novel dietary intake assessment tool that was developed to help address limitations of traditional tools and to easily integrate into health care delivery systems. Prevailing practice is to validate new tools against approaches that are in wide use. Objective: This study aimed to assess 1) the validity of Diet ID in measuring diet quality, food group and nutrient intake against 2 traditional dietary assessment methods (i.e., food record [FR], food frequency questionnaire) and 2) the test reproducibility/reliability of Diet ID to obtain similar results with repeat assessments. Methods: Using a participant-sourcing platform for online research, we recruited 90 participants, 58 of whom completed DQPN, a 3-d FR (via the Automated Self-Administered 24-hour Dietary Assessment Tool), and a food frequency questionnaire (FFQ, via the Dietary History Questionnaire III). We estimated mean nutrient and food group intake with all 3 instruments and generated Pearson correlations between them. Results: Mean age (SD) of participants was 38 (11) y, and more than half were male (64%). The strongest correlations for DQPN when compared with the other 2 instruments were for diet quality, as measured by the Healthy Eating Index 2015; between DQPN and the FFQ, the correlation was 0.58 (P < 0.001), and between DQPN and the FR, the correlation was 0.56 (P < 0.001). Selected nutrients and food groups also showed moderate strength correlations. Test-retest reproducibility for measuring diet quality was evaluated for DQPN and showed a correlation of 0.70 (P < 0.0001). Conclusions: The current study offers evidence that DQPN is comparable to traditional dietary assessment tools for estimating overall diet quality. This performance, plus DQPN's ease-of-use and scalability, may recommend it in efforts to make dietary assessment a universal part of clinical care.

A pilot, randomized, placebo-controlled study of mindfulness meditation in treating insomnia in multiple sclerosis.

OBJECTIVE: Mindfulness is an established approach to reduce distress and stress reactivity by improving awareness and tolerability of thoughts and emotions. This study compares mindfulness training to sleep hygiene in persons with multiple sclerosis (PWMS) who report chronic insomnia, examining sleep efficiency (SE), self-reported sleep quality and quality of life. METHODS: Fifty-three PWMS were randomized (1:1) in a single-blinded, parallel group design to ten, two-hour weekly sessions of Mindfulness Based Stress Intervention for Insomnia (MBSI-I) over a span of ten weeks or a single, one hour sleep hygiene (SH) session over one day. The primary outcome measure was SE, measured by the Fitbit™ Charge 2 wrist device, at 10 and 16 weeks from the start of study interventions. Self-report outcomes included the Pittsburg Sleep Quality Rating Scale (PSQI), Insomnia Severity Index (ISI) and the Multiple Sclerosis Quality of Life Inventory (MSQLI). Nineteen participants in the MBSI-I group and 24 in the SH group completed the primary study. Subsequently, ten participants in the original SH group participated in the 10-week MSBI-I course and their data was added to the MBSI-I cohort (eMSBI-I). RESULTS: While neither SE nor the PSQI showed significant differences between MBSI-I, eMBSI-I and SH groups, ISI improved in both the MSBI-I and eMBSI-I vs SH at 10 weeks (p = 0.0014 and p = 0.0275) but not 16 weeks. However, pre and post assessments within the MBSI-I and eMBSI-I cohorts did show significant improvement in the PSQI and ISI at 10 and 16 weeks, while SH was significant in the ISI only at 16 weeks. Several quality of life measurements, including fatigue, mental health and cognitive function favored the mindfulness cohorts. CONCLUSION: This pilot study demonstrates beneficial effects of MBSR on insomnia, sleep quality and quality of life in PWMS. TRIAL REGISTRATION: NCT03949296. 14 May 2019.

Egg Consumption in the Context of Plant-Based Diets and Diet Quality in Adults at Risk for Type 2 Diabetes: A Randomized Single Blind Cross-over Controlled Trial.

Lifestyle changes that emphasis on plant-based diets (PBD) are typically recommended for those at risk for type 2 diabetes mellitus (T2DM) to mitigate their cardo-metabolic risk. We examined the impact of the inclusion of eggs compared with their exclusion from PBD on diet quality among adults at risk for T2DM.This was a randomized, controlled, single-blind, crossover trial of 35 adults (mean age 60.7 years; 25 women, 10 men; 34 Caucasians, 1 African-American) at risk for T2DM (i.e., pre- diabetes or metabolic syndrome) assigned to one of two possible sequence permutations of two treatments (PBD with eggs and exclusively PBD), with a 4-week washout period. Participants received dietary counseling from a dietitian to exclude or to include 2 eggs daily in the context of PBD for a 6-week period. Diet quality was assessed using the Healthy Eating Index 2015 (HEI-2015) at baseline and 6 weeks.Compared with the exclusion of eggs, the inclusion of eggs in the context of PBD improved the diet quality score for intake of total protein foods (1.0 ± 1.1 vs. -0.4 ± 1.0; p <.0001); seafood and plant proteins (0.2 ± 1.2 vs. -0.4 ± 1.1; p = 0.0338); and fatty acids (0.8 ± 2.5 vs. -0.7 ± 2.7; p = 0.0260). Overall diet quality score depreciated with the adoption of exclusively PBD without eggs (-3.1 ± 8.3; p = 0.0411), while it was unaffected with the adoption of a PBD with the inclusion of eggs (-0.6 ± 7.9; p = 0.6892).Eggs could be used as an adjuvant to enhance the diet quality among those at risk for T2DM who adopt plant-based dietary patterns.

Egg Consumption in the Context of Plant-Based Diets and Cardiometabolic Risk Factors in Adults at Risk of Type 2 Diabetes.

BACKGROUND: Plant-based diets (PBDs) are typically recommended to those at risk of type 2 diabetes mellitus (T2DM). OBJECTIVES: We examined how including eggs, compared with excluding them from PBDs, affected cardiometabolic risk factors in adults at risk of T2DM. METHODS: This was a randomized, controlled, single-blind, crossover trial of 35 adults (mean age: 60.7 y; 25 women, 10 men) at risk of T2DM assigned to 1 of 2 sequence permutations of 2 dietary treatments (plant-based plus eggs, and exclusively plant-based), with a 4-wk washout period. A dietitian counseled participants to exclude or include 2 eggs daily in the context of PBDs for a 6-wk interval. Our primary outcome measure was endothelial function (EF) measured as flow-mediated dilatation. Secondary outcome measures included lipid profile, blood pressure, insulin sensitivity, anthropometry, and dietary intake. Data were analyzed using generalized linear models. RESULTS: Compared with egg exclusion, egg inclusion in the context of PBDs did not adversely affect EF (-1.7% ± 6.5% compared with -1.8% ± 7.5%; P = 0.9805). Likewise, egg inclusion, compared with egg exclusion, did not adversely affect (P = 0.1096-0.9781) lipid profile, blood pressure, insulin sensitivity, or anthropometry. Egg inclusion, compared with egg exclusion, improved reported intakes of selenium (23.1 ± 30.3 µg/d compared with 2.3 ± 34.9 µg/d; P = 0.0124) and choline (172.0 ± 96.0 mg/d compared with -3.4 ± 68.1 mg/d; P < 0.0001). CONCLUSIONS: Consuming 2 eggs daily in the context of PBDs does not adversely affect cardiometabolic risk factors among adults at risk of T2DM. Eggs could be used as an adjuvant to enhance PBDs that are typically recommended for those at risk of T2DM.This trial was registered at clinicaltrials.gov as NCT04316429.

Post-prandial effects of high-polyphenolic extra virgin olive oil on endothelial function in adults at risk for type 2 diabetes: A randomized controlled crossover trial.

BACKGROUND: Effects of olive oil on cardiovascular risk have been controversial. We compared the effects of high-polyphenolic extra virgin olive oil (EVOO) and refined olive oil without polyphenols on endothelial function (EF) in adults at risk for Type 2 diabetes mellitus (T2DM). METHODS: Randomized, controlled, double-blind, crossover trial of 20 adults (mean age 56.1 years; 10 women, 10 men) at risk for T2DM (i.e., as defined by either prediabetes or metabolic syndrome) assigned to one of two possible sequence permutations of two different single dose treatments (50 mL of high-polyphenolic EVOO or 50 mL of refined olive oil without polyphenols), with 1-week washout. Participants received their olive oils in a smoothie consisting of ½ cup frozen blueberries and 1 cup (8 oz) low-fat vanilla yogurt blended together. Primary outcome measure was EF measured as flow-mediated dilatation. Participants were evaluated before and 2 h after ingestion of their assigned olive oil treatment. RESULTS: EVOO acutely improved EF as compared to refined olive oil (1.2 ± 6.5% versus -3.6 ± 3.8%; p = 0.0086). No significant effects on systolic or diastolic blood pressure were observed. CONCLUSIONS: High-polyphenolic EVOO acutely enhanced EF in the study cohort, whereas refined olive oil did not. Blood pressure effects were not observed. Reports on the vascular effects of olive oil ingestion should specify the characteristics of the oil. CLINICAL TRIAL REGISTRATION NUMBER: NCT04025281.

Differential response to rituximab in anti-AChR and anti-MuSK positive myasthenia gravis patients: a single-center retrospective study.

BACKGROUND: B-cell targeted therapy with rituximab has shown durable response in treating refractory myasthenia gravis (MG). This study compares the response to rituximab between patients with acetylcholine receptor autoantibody positive (AChR+) and muscle-specific kinase autoantibody positive (MuSK+) MG. METHODS: This retrospective study included 33 patients with either AChR+ or MuSK+ MG who were treated with rituximab from 05/31/2003 to 05/31/2017. Pretreatment and post-treatment immunotherapy regimens, clinical symptoms, and examination findings were evaluated. RESULTS: Median MGFA Class of II at baseline improved to an asymptomatic median classification at 12-months and last follow-up (p-values <.001) post-rituximab. Improvement in MGFA class was not significantly different between the groups. Twenty-one patients achieved clinical remission (12/17 AChR+, 9/16 MuSK+) with time to remission of 441.4 ± 336.6 days for AChR+ versus 230 ± 180.8 days for MuSK+ patients (p-value 0.049). The mean prednisone dosage requirement decreased significantly in both groups post-rituximab. AChR+ patients required more hospitalizations for exacerbation post-rituximab (p-value 0.046). CONCLUSION: Rituximab treatment response is observed in both AChR+ and MuSK+ patients supporting the role of B cell depletion in the management of MG. While there was no significant difference between these groups in terms of clinical improvement, symptom-free state, and prednisone burden, MuSK+ MG patients may experience greater benefits, including earlier time to remission, fewer exacerbations and hospitalizations post-treatment.

Effect of Lifestyle Intervention on Cardiometabolic Risk Factors in Overweight and Obese Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis.

The effects of lifestyle interventions (LSIs) on cardiometabolic risk factors in women with polycystic ovary syndrome (PCOS) are controversial. We conducted a systematic review and meta-analysis to assess the effectiveness of LSI on cardiometabolic risk in women with PCOS. We reviewed five databases for randomized controlled trials (RCTs) published between 2012 and December 2016, evaluating the effect of LSI among adult, reproductive age group, overweight, and obese women with PCOS. Outcome measures included weight change, homeostatic model assessment-insulin resistance index (HOMA-IR), total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL), and high-density lipoprotein (HDL). A total of 564 studies were screened; 35 full text studies assessed for eligibility, 20 excluded with reasons, 15 included in the systematic review, and 9 studies from 8 RCTs included in a meta-analysis. LSI resulted in significant reduction in weight in sensitivity analyses [study 5 dietary arm as intervention: standardized mean difference (SMD) = -0.81 (95% confidence interval {CI} = -1.24 to -0.39); study 5 combination arm as intervention: SMD = -0.85 (95% CI = -1.26 to -0.45)], HOMA-IR overall [study 5 dietary arm: SMD = -1.46 (95% CI = -2.72 to -0.20); study 5 combination arm SMD = -1.50 (95% CI = -2.76 to -0.23)], and LDL overall [SMD = -1.06 (95% CI = -2.00 to -0.12)]. LSI was more beneficial than Metformin in decreasing LDL [SMD = -2.60 (95% CI = -5.15 to -0.05)] but similar to comparator group in terms of TC, TG, and HDL (P > 0.05). Short-term LSI can effectively improve weight, insulin resistance, and lipid profile and could be recommended as first-line therapy in overweight and obese PCOS women to reduce cardiometabolic risk.

The Resulting Variation in Nutrient Intake With the Inclusion of Walnuts in the Diets of Adults at Risk for Type 2 Diabetes: A Randomized, Controlled, Crossover Trial.

PURPOSE: We previously demonstrated that including walnuts in the diets of adults at risk for type 2 diabetes mellitus (T2DM) led to improved overall diet quality. This report examines the specific changes in their nutrient intake. DESIGN: This was a randomized, controlled, modified Latin square parallel design trial with 2 treatment arms. Participants were randomized to walnut intake with, or without, dietary advice to regulate caloric intake. Within each treatment arm, they were further randomized to one of 2 sequence permutations (walnut-included/walnut-excluded or walnut-excluded/walnut-included diet), with a 3-month washout between treatment phases. SETTING: Community hospital in Lower Naugatuck Valley in Connecticut. PARTICIPANTS: Cohort of 112 participants (31 men and 81 women) at risk for T2DM. INTERVENTION: Participants included 56 g (366 kcal) of walnuts in their daily diets for 6 months. MEASURES: Nutrient intake was assessed using web-based Automated Self-Administered 24-Hour Dietary Assessment. ANALYSIS: Data were analyzed using generalized linear models. RESULTS: Walnut inclusion led to increased intake of total fat, calcium, magnesium, thiamin, total saturated fatty acids, and monounsaturated and polyunsaturated fatty acids (379.0 ± 90.3 g vs -136.5 ± 92.7 g, P < .01; 230.7 ± 114.2 mg vs -95.2 ± 117.4 mg, P = .05; 111.0 ± 33.9 mg vs -32.3 ± 34.9 mg, P < .01; 0.28 ± 0.2 mg vs -0.47 ± 0.2 mg, P = .02; 8.6 ± 3.4 g vs -1.1 ± 3.5 g, P =.05; 6.3 ± 3.9 g vs -6.3 ± 4.0 g, P = .03; and 25.4 ± 4.0 vs -6.6 ± 4.2 g, P < .01, respectively). Vitamin C intake decreased (-65.3 ± 55.3 mg vs 98.9 ± 56.8 mg, P = .04). Protein intake increased from baseline with the inclusion of walnuts (20.0 ± 8.8 g, P < .05). Walnut inclusion led to an increase in total calories consumed when caloric intake is not regulated. CONCLUSION: Including walnuts in the diets of these adults led to increased dietary intake of some nutrients associated with lower risk of developing T2DM and other cardiometabolic risk factors.

Efficacy and Safety of Massage for Osteoarthritis of the Knee: a Randomized Clinical Trial.

BACKGROUND: Current treatment options for knee osteoarthritis have limited effectiveness and potentially adverse side effects. Massage may offer a safe and effective complement to the management of knee osteoarthritis. OBJECTIVE: Examine effects of whole-body massage on knee osteoarthritis, compared to active control (light-touch) and usual care. DESIGN: Multisite RCT assessing the efficacy of massage compared to light-touch and usual care in adults with knee osteoarthritis, with assessments at baseline and weeks 8, 16, 24, 36, and 52. Subjects in massage or light-touch groups received eight weekly treatments, then were randomized to biweekly intervention or usual care to week 52. The original usual care group continued to week 24. Analysis was performed on an intention-to-treat basis. PARTICIPANTS: Five hundred fifty-one screened for eligibility, 222 adults with knee osteoarthritis enrolled, 200 completed 8-week assessments, and 175 completed 52-week assessments. INTERVENTION: Sixty minutes of protocolized full-body massage or light-touch. MAIN MEASURES: Primary: Western Ontario and McMaster Universities Arthritis Index. Secondary: visual analog pain scale, PROMIS Pain Interference, knee range of motion, and timed 50-ft walk. KEY RESULTS: At 8 weeks, massage significantly improved WOMAC Global scores compared to light-touch (- 8.16, 95% CI = - 13.50 to - 2.81) and usual care (- 9.55, 95% CI = - 14.66 to - 4.45). Additionally, massage improved pain, stiffness, and physical function WOMAC subscale scores compared to light-touch (p < 0.001; p = 0.04; p = 0.02, respectively) and usual care (p < 0.001; p = 0.002; p = 0.002; respectively). At 52 weeks, the omnibus test of any group difference in the change in WOMAC Global from baseline to 52 weeks was not significant (p = 0.707, df = 3), indicating no significant difference in change across groups. Adverse events were minimal. CONCLUSIONS: Efficacy of symptom relief and safety of weekly massage make it an attractive short-term treatment option for knee osteoarthritis. Longer-term biweekly dose maintained improvement, but did not provide additional benefit beyond usual care post 8-week treatment. TRIAL REGISTRATION: clinicaltrials.gov NCT01537484.

Change in Glycemic Control With Use of a Digital Therapeutic in Adults With Type 2 Diabetes: Cohort Study.

BACKGROUND: Intensive lifestyle change can treat and even reverse type 2 diabetes. Digital therapeutics have the potential to deliver lifestyle as medicine for diabetes at scale. OBJECTIVE: This 12-week study investigates the effects of a novel digital therapeutic, FareWell, on hemoglobin A1c (HbA1c) and diabetes medication use. METHODS: Adults with type 2 diabetes and a mobile phone were recruited throughout the United States using Facebook advertisements. The intervention aim was to effect a sustainable shift to a plant-based dietary pattern and regular exercise by advancing culinary literacy and lifestyle skill acquisition. The intervention was delivered by an app paired with specialized human support, also delivered digitally. Health coaching was provided every 2 weeks by telephone, and a clinical team was available for participants requiring additional support. Participants self-reported current medications and HbA1c at the beginning and end of the 12-week program. Self-efficacy related to managing diabetes and maintaining dietary changes was assessed via survey. Engagement was recorded automatically through the app. RESULTS: We enrolled 118 participants with a baseline HbA1c >6.5%. Participants were 81.4% female (96/118) and resided in 38 US states with a mean age of 50.7 (SD 9.4) years, baseline body mass index of 38.1 (SD 8.8) kg/m2, and baseline HbA1c of 8.1% (SD 1.6). At 12 weeks, 86.2% (94/109) of participants were still using the app. Mean change in HbA1c was -0.8% (97/101, SD 1.3, P<.001) for those reporting end-study data. For participants with a baseline HbA1c >7.0% who did not change medications midstudy, HbA1c change was -1.1% (67/69, SD 1.4, P<.001). The proportion of participants with an end-study HbA1c <6.5% was 28% (22/97). After completion of the intervention, 17% (16/97) of participants reported a decrease in diabetic medication while 8% (8/97) reported an increase. A total of 57% (55/97) of participants achieved a composite outcome of reducing HbA1c, reducing diabetic medication use, or both; 92% (90/98) reported greater confidence in their ability to manage their diabetes compared to before the program, and 91% (89/98) reported greater confidence in their ability to maintain a healthy dietary pattern. Participants engaged with the app an average of 4.3 times per day. We observed a significantly greater decrease in HbA1c among participants in the highest tertile of app engagement compared to those in the lowest tertile of app engagement (P=.03). CONCLUSIONS: Clinically meaningful reductions in HbA1c were observed with use of the FareWell digital therapeutic. Greater glycemic control was observed with increasing app engagement. Engagement and retention were both high in this widely distributed sample.

Factors that contribute to effective nutrition education interventions in children: a systematic review.

Context: Establishing healthy dietary practices at an early age is crucial, as dietary behaviors in childhood track to adulthood. Objective: The purpose of this systematic review was to identify factors associated with successful nutrition education interventions conducted in children and published between 2009 and 2016. Data Sources: Using the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines, relevant studies were identified through the PubMed, Web of Science, ScienceDirect, and ERIC (Educational Resources Information Center) databases. Study Selection: Studies published in English between 2009 and 2016 that included a nutrition education intervention among children aged 2 to 19 years were included. Review articles, abstracts, qualitative or cross-sectional studies, and studies targeting children with special nutritional needs were excluded. Data Extraction: Four authors screened and determined the quality of the studies using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system and extracted the data from the articles. Data Analysis: Forty-one studies were included: 7 targeted preschool children, 26 targeted elementary school children, and 8 targeted secondary school children. A total of 46% met their primary objectives of nutrition education intervention, while the rest either partially achieved or did not achieve their stated objectives. Results: Successful interventions targeting school children engaged parents by means of face-to-face sessions, identified specific behaviors to be modified, and assured fidelity by training teachers or recruiting trained experts to deliver the intervention. In addition, they allowed adequate dosage, with an intervention duration of at least 6 months, and used age-appropriate activities. Conclusions: Interventions with a multicomponent approach that were age appropriate and of adequate duration (≥ 6 months), that engaged parents, and that ensured fidelity and proper alignment between the stated objectives, the intervention, and the desired outcomes were more likely to succeed.

Which foods are displaced in the diets of adults with type 2 diabetes with the inclusion of eggs in their diets? A randomized, controlled, crossover trial.

BACKGROUND: The inclusion or exclusion of specific foods from the overall diet inevitably affects other food choices, and this matter is routinely neglected in dietary guidance and nutritional epidemiology. We examined how the inclusion of eggs in the diets of type 2 diabetics affected dietary pattern. METHODS: Randomized, controlled, single-blind, crossover trial of 34 adults (mean age 64.5 years; 14 women, 20 men) with type 2 diabetes assigned to one of two possible sequence permutations of two different 12-week treatments (two eggs/day or egg exclusion), with 6-week washout periods. For the egg inclusion phase, participants received advice from a dietitian on how to preserve an isocaloric condition relative to the egg exclusion phase. To assess changes in dietary pattern in the diets of our study participants, we analyzed the 12 components of the 2010 Healthy Eating Index. RESULTS: The inclusion of eggs was associated with reduced consumption of refined grains nearing statistical significance (-0.7±3.4 vs 0.7±2.2; p=0.0530). The consumption of total protein foods significantly increased from baseline (0.3±0.7; p=0.0153) with the inclusion of eggs for 12 weeks, while the consumption of dairy products significantly decreased with the exclusion of eggs from their diets (-1.3±2.9; p=0.0188). CONCLUSIONS: Eggs in the diets of type 2 diabetics may lead to increased consumption of some healthful foods and reduced consumption of some less healthful foods. TRIAL REGISTRATION NUMBER: NCT02052037; Post-results.

Snacking, Satiety, and Weight: A Randomized, Controlled Trial.

PURPOSE: To compare the effects of nut-based snack bars (NBSB) vs. prepackaged 200-kcal portions of typical conventional snack foods, when consumed over a 12-week period by a group of overweight adults. DESIGN: Randomized, single-blind parallel design with two treatment groups. SUBJECTS: Thirty-four overweight participants were enrolled. INTERVENTION: Commercially available NBSB or conventional snack foods as part of an ad libitum diet for 12 weeks. PRIMARY OUTCOME MEASURES: body mass index, body weight, body composition, waist circumference. SECONDARY OUTCOME MEASURES: blood pressure, lipid profile, nutrients intake, hunger/satiety, quality of life. ANALYSIS: Generalized linear models with time as repeated measure were used to analyze these data. RESULTS: Daily consumption of NBSB for 12 weeks, as compared to daily consumption of conventional snacks, significantly reduced percentage body fat (-1.7% ± 10.8% vs. 6.2% ± 9.3%; p = .04) and visceral fat (-1.3 ± 5.9 vs. 2.7 ± 4.0; p = .03). There were no between-group differences (p > .05) for blood pressure, lipid panel, satiety, or quality of life measures. CONCLUSION: Our data suggest that daily consumption of NBSB for 12 weeks reduced body fat and had no adverse effects on weight, blood pressure, lipid profile, satiety, or quality of life in this small sample of overweight adults.

Advancing School and Community Engagement Now for Disease Prevention (ASCEND).

PURPOSE: To compare two intensity levels (standard vs. enhanced) of a nutrition and physical activity intervention vs. a control (usual programs) on nutrition knowledge, body mass index, fitness, academic performance, behavior, and medication use among elementary school students. DESIGN: Quasi-experimental with three arms. SETTING: Elementary schools, students' homes, and a supermarket. SUBJECTS: A total of 1487 third-grade students. INTERVENTION: The standard intervention (SI) provided daily physical activity in classrooms and a program on making healthful foods, using food labels. The enhanced intervention (EI) provided these plus additional components for students and their families. MEASURES: Body mass index (zBMI), food label literacy, physical fitness, academic performance, behavior, and medication use for asthma or attention-deficit hyperactivity disorder (ADHD). ANALYSIS: Multivariable generalized linear model and logistic regression to assess change in outcome measures. RESULTS: Both the SI and EI groups gained less weight than the control (p < .001), but zBMI did not differ between groups (p = 1.00). There were no apparent effects on physical fitness or academic performance. Both intervention groups improved significantly but similarly in food label literacy (p = .36). Asthma medication use was reduced significantly in the SI group, and nonsignificantly (p = .10) in the EI group. Use of ADHD medication remained unchanged (p = .34). CONCLUSION: The standard intervention may improve food label literacy and reduce asthma medication use in elementary school children, but an enhanced version provides no further benefit.

Inclusion of walnut in the diets of adults at risk for type 2 diabetes and their dietary pattern changes: a randomized, controlled, cross-over trial.

BACKGROUND: In our recently published study, including walnuts in the diets of adults with prediabetes led to overall improvement in diet quality. This report adds to those study findings by examining the food groups displaced during walnut inclusion in the diets of those adults with prediabetes. METHODS: Randomized, controlled, modified Latin square parallel design with 2 treatment arms. The 112 participants (31 men, 81 women) were randomly assigned to a diet with or without dietary counseling to regulate calorie intake in a 1:1 ratio. Within each treatment arm, participants were further randomized to 1 of 2 sequence permutations to receive a walnut-included diet with 56 g (366 kcal) of walnuts per day and a walnut-excluded diet. Participants in the calorie-regulated arm received advice from a dietitian to preserve an isocaloric condition while including walnuts. We analyzed the 12 components of the 2010 Healthy Eating Index to examine dietary pattern changes of study participants. RESULTS: Seafood and plant protein foods intake significantly increased with walnut inclusion, compared with their exclusion (2.14±2.06 vs -0.49±2.33; p=0.003). The ingestion of healthful fatty acids also significantly increased with walnut inclusion, compared with their exclusion (1.43±4.53 vs -1.76±4.80; p=0.02). Dairy ingestion increased with walnut inclusion in the calorie-regulated phase, compared with walnut inclusion without calorie regulation (1.06±4.42 vs -2.15±3.64; p=0.02). CONCLUSIONS: Our data suggest that walnut inclusion in the diets of adults at risk for diabetes led to an increase in intake of other healthful foods. TRIAL REGISTRATION NUMBER: NCT02330848.

Reducing calories, fat, saturated fat, and sodium in restaurant menu items: Effects on consumer acceptance.

OBJECTIVE: To assess consumer acceptance of reductions of calories, fat, saturated fat, and sodium to current restaurant recipes. METHODS: Twenty-four menu items, from six restaurant chains, were slightly modified and moderately modified by reducing targeted ingredients. Restaurant customers (n = 1,838) were recruited for a taste test and were blinded to the recipe version as well as the purpose of the study. Overall consumer acceptance was measured using a 9-point hedonic (like/dislike) scale, likelihood to purchase scale, Just-About-Right (JAR) 5-point scale, penalty analysis, and alienation analysis. RESULTS: Overall, modified recipes of 19 menu items were scored similar to (or better than) their respective current versions. Eleven menu items were found to be acceptable in the slightly modified recipe version, and eight menu items were found to be acceptable in the moderately modified recipe version. Acceptable ingredient modifications resulted in a reduction of up to 26% in calories and a reduction of up to 31% in sodium per serving. CONCLUSIONS: The majority of restaurant menu items with small reductions of calories, fat, saturated fat, and sodium were acceptable. Given the frequency of eating foods away from home, these reductions could be effective in creating dietary improvements for restaurant diners.

Snack Food, Satiety, and Weight.

In today's society, snacking contributes close to one-third of daily energy intake, with many snacks consisting of energy-dense and nutrient-poor foods. Choices made with regard to snacking are affected by a multitude of factors on individual, social, and environmental levels. Social norms, for example, that emphasize healthful eating are likely to increase the intake of nutrient-rich snacks. In addition, satiety, the feeling of fullness that persists after eating, is an important factor in suppressing overconsumption, which can lead to overweight and obesity. Thus, eating snacks between meals has the potential to promote satiety and suppress overconsumption at the subsequent meal. Numerous studies have explored the relation between snack foods and satiety. These studies concluded that whole foods high in protein, fiber, and whole grains (e.g., nuts, yogurt, prunes, and popcorn) enhance satiety when consumed as snacks. Other foods that are processed to include protein, fiber, or complex carbohydrates might also facilitate satiety when consumed as snacks. However, studies that examined the effects of snack foods on obesity did not always account for satiety and the dietary quality and portion size of the snacks consumed. Thus, the evidence concerning the effects of snack foods on obesity has been mixed, with a number of interventional and observational studies not finding a link between snack foods and increased weight status. Although further prospective studies are warranted to conclusively determine the effects of snack foods on obesity risk, the consumption of healthful snacks likely affects satiety and promotes appetite control, which could reduce obesity.

Egg ingestion in adults with type 2 diabetes: effects on glycemic control, anthropometry, and diet quality-a randomized, controlled, crossover trial.

BACKGROUND: The inclusion of eggs as part of a healthful diet for adults with diabetes is controversial. We examined the effects of including eggs in the diet of adults with type 2 diabetes on cardiometabolic risk factors. METHODS: Randomized, controlled, single-blind, crossover trial of 34 adults (mean age 64.5 years; 14 postmenopausal women, 20 men) with type 2 diabetes assigned to one of two possible sequence permutations of two different 12-week treatments (two eggs/day inclusion or egg exclusion), with 6-week washout periods. For the egg inclusion phase, participants received advice from a dietitian on how to preserve an isocaloric condition relative to the egg exclusion phase. The primary outcome was glycemic control as measured by glycated hemoglobin. Secondary measures included anthropometry, blood pressure, and diet quality. RESULTS: Compared with the exclusion of eggs in the habitual diet, the inclusion of eggs did not measurably affect glycated hemoglobin (0.01±0.5% vs -0.24±0.7%; p=0.115) and systolic blood pressure (-0.8±13.0 vs -3.0±10.0 mm Hg; p=0.438); and significantly reduced body mass index (0.06±0.8 vs -0.4±0.8 kg/m²; p=0.013) and visceral fat rating (0.2±1.1 vs -0.4±1.0; p=0.016). The inclusion of eggs in the habitual diet of diabetics significantly reduced waist circumference (-0.4±1.2 cm; p=0.004) and percent body fat (-0.7±1.8; p=0.033) from baseline. CONCLUSIONS: Short-term daily inclusion of eggs in the habitual diet of adults with type 2 diabetes does not improve glycemic control but can improve anthropometric measures. TRIAL REGISTRATION NUMBER: NCT02052037; results.

Walnut ingestion in adults at risk for diabetes: effects on body composition, diet quality, and cardiac risk measures.

BACKGROUND: Despite their energy density, walnuts can be included in the diet without adverse effects on weight or body composition. The effect of habitual walnut intake on total calorie intake is not well studied. Effects on overall diet quality have not been reported. METHODS: Randomized, controlled, modified Latin square parallel design study with 2 treatment arms. The 112 participants were randomly assigned to a diet with or without dietary counseling to adjust calorie intake. Within each treatment arm, participants were further randomized to 1 of the 2 possible sequence permutations to receive a walnut-included diet with 56 g (providing 366 kcal) of walnuts per day and a walnut-excluded diet. Participants were assessed for diet quality, body composition, and cardiac risk measures. RESULTS: When compared with a walnut-excluded diet, a walnut-included diet for 6 months, with or without dietary counseling to adjust caloric intake, significantly improved diet quality as measured by the Healthy Eating Index 2010 (9.14±17.71 vs 0.40±15.13; p=0.02 and 7.02±15.89 vs -5.92±21.84; p=0.001, respectively). Endothelial function, total and low-density lipoprotein (LDL) cholesterol improved significantly from baseline in the walnut-included diet. Body mass index, percent body fat, visceral fat, fasting glucose, glycated hemoglobin, and blood pressure did not change significantly. CONCLUSIONS: The inclusion of walnuts in an ad libitum diet for 6 months, with or without dietary counseling to adjust calorie intake, significantly improved diet quality, endothelial function, total and LDL cholesterol, but had no effects on anthropometric measures, blood glucose level, and blood pressure. TRIAL REGISTRATION NUMBER: NCT02330848.

Independent and joint effects of sedentary time and cardiorespiratory fitness on all-cause mortality: the Cooper Center Longitudinal Study.

OBJECTIVES: To examine the independent and joint effects of sedentary time and cardiorespiratory fitness (fitness) on all-cause mortality. DESIGN, SETTING, PARTICIPANTS: A prospective study of 3141 Cooper Center Longitudinal Study participants. Participants provided information on television (TV) viewing and car time in 1982 and completed a maximal exercise test during a 1-year time frame; they were then followed until mortality or through 2010. TV viewing, car time, total sedentary time and fitness were the primary exposures and all-cause mortality was the outcome. The relationship between the exposures and outcome was examined utilising Cox proportional hazard models. RESULTS: A total of 581 deaths occurred over a median follow-up period of 28.7 years (SD=4.4). At baseline, participants' mean age was 45.0 years (SD=9.6), 86.5% were men and their mean body mass index was 24.6 (SD=3.0). Multivariable analyses revealed a significant linear relationship between increased fitness and lower mortality risk, even while adjusting for total sedentary time and covariates (p=0.02). The effects of total sedentary time on increased mortality risk did not quite reach statistical significance once fitness and covariates were adjusted for (p=0.05). When examining this relationship categorically, in comparison to the reference category (≤10 h/week), being sedentary for ≥23 h weekly increased mortality risk by 29% without controlling for fitness (HR=1.29, 95% CI 1.03 to 1.63); however, once fitness and covariates were taken into account this relationship did not reach statistical significance (HR=1.20, 95% CI 0.95 to 1.51). Moreover, spending >10 h in the car weekly significantly increased mortality risk by 27% in the fully adjusted model. The association between TV viewing and mortality was not significant. CONCLUSIONS: The relationship between total sedentary time and higher mortality risk is less pronounced when fitness is taken into account. Increased car time, but not TV viewing, is significantly related to higher mortality risk, even when taking fitness into account, in this cohort.