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1
Savoie, Isabelle, Arminée Kazanjian, and Ken Bassett. "Do Clinical Practice Guidelines Reflect Research Evidence?" Journal of Health Services Research & Policy 5, no. 2 (April 2000): 76–82. http://dx.doi.org/10.1177/135581960000500204.
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Objectives: To examine whether existing clinical practice guidelines (CPGs) for cholesterol testing reflect research evidence and hence may control or reduce costs while maintaining or improving the quality of care. Methods: A systematic search for published and unpublished cholesterol testing CPGs and independent critical appraisal of the CPGs by two researchers using a standard checklist. Results: In four of the five CPGs analysed, the link between the research evidence and the recommendations was not maintained. The appraisal, local experience and the literature all suggest that panel composition is an important explanation, in that the greater the involvement of clinical experts in the development process of the CPGs, the less the recommendations reflected the research evidence. Even though their participation is important for CPG uptake, clinical expert panels appear to have difficulty limiting CPGs to research-based recommendations. Conclusions: Existing cholesterol testing CPGs are unlikely to improve the quality of care while controlling or reducing costs. The problem lies not with guideline implementation but with the guidelines themselves. It is unclear how best to ensure that recommendations reflect research evidence but this is likely to require significant and progressive changes to the current guideline development process, including a redefinition of the clinical experts' role.
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Dumuid, Dorothea, Melissa Wake, David Burgner, Mark S. Tremblay, Anthony D. Okely, Ben Edwards, Terence Dwyer, and Timothy Olds. "Balancing time use for children’s fitness and adiposity: Evidence to inform 24-hour guidelines for sleep, sedentary time and physical activity." PLOS ONE 16, no. 1 (January 19, 2021): e0245501. http://dx.doi.org/10.1371/journal.pone.0245501.
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Purpose Daily time spent on one activity cannot change without compensatory changes in others, which themselves may impact on health outcomes. Optimal daily activity combinations may differ across outcomes. We estimated optimal daily activity durations for the highest fitness and lowest adiposity. Methods Cross-sectional Child Health CheckPoint data (1182 11-12-year-olds; 51% boys) from the population-based Longitudinal Study of Australian Children were used. Daily activity composition (sleep, sedentary time, light physical activity [LPA], moderate-to-vigorous physical activity [MVPA]) was from 8-day, 24-hour accelerometry. We created composite outcomes for fitness (VO2max; standing long jump) and adiposity (waist-to-height ratio; body mass index; fat-to-fat-free log-ratio). Adjusted compositional models regressed activity log-ratios against each outcome. Best activity compositions (optimal time-use zones) were plotted in quaternary tetrahedrons; the overall optimal time-use composition was the center of the overlapping area. Results Time-use composition was associated with fitness and adiposity (all measures p<0.001). Optimal time use differed for fitness and adiposity. While both maximized MVPA and minimized sedentary time, optimal fitness days had higher LPA (3.4 h) and shorter sleep (8.25 h), but optimal adiposity days had lower LPA (1.0 h) and longer sleep (10.9 h). Balancing both outcomes, the overall optimal time-use composition was (mean [range]): 10.2 [9.5; 10.5] h sleep, 9.9 [8.8; 11.2] h sedentary time, 2.4 [1.8; 3.2] h LPA and 1.5 [1.5; 1.5] h MVPA. Conclusion Optimal time use for children’s fitness and adiposity involves trade-offs. To best balance both outcomes, estimated activity durations for sleep and LPA align with, but for MVPA exceed, 24-h guidelines.
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Moran, Lisa J., Henry Ko, Marie Misso, Kate Marsh, Manny Noakes, Mac Talbot, Meredith Frearson, Mala Thondan, Nigel Stepto, and Helena J. Teede. "Dietary composition in the treatment of polycystic ovary syndrome: a systematic review to inform evidence-based guidelines†." Human Reproduction Update 19, no. 5 (May 31, 2013): 432. http://dx.doi.org/10.1093/humupd/dmt015.
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Moran, L. J., H. Ko, M. Misso, K. Marsh, M. Noakes, M. Talbot, M. Frearson, M. Thondan, N. Stepto, and H. J. Teede. "Dietary composition in the treatment of polycystic ovary syndrome: a systematic review to inform evidence-based guidelines." Human Reproduction Update 20, no. 1 (October 14, 2013): 152. http://dx.doi.org/10.1093/humupd/dmt051.
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Moran, Lisa J., Henry Ko, Marie Misso, Kate Marsh, Manny Noakes, Mac Talbot, Meredith Frearson, Mala Thondan, Nigel Stepto, and Helena J. Teede. "Dietary Composition in the Treatment of Polycystic Ovary Syndrome: A Systematic Review to Inform Evidence-Based Guidelines." Journal of the Academy of Nutrition and Dietetics 113, no. 4 (April 2013): 520–45. http://dx.doi.org/10.1016/j.jand.2012.11.018.
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Scinto-Madonich, Sara, Sharon M. Donovan, Kathryn Dewey, Rachel Novotny, Jamie Stang, Elsie Taveras, Ronald Kleinman, et al. "Dietary Patterns During Lactation and Human Milk Composition and Quantity: A NESR Systematic Review." Current Developments in Nutrition 5, Supplement_2 (June 2021): 815. http://dx.doi.org/10.1093/cdn/nzab046_112.
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Abstract Objectives To inform the Dietary Guidelines for Americans, 2020–2025, the USDA and HHS identified important public health questions to be examined by the 2020 Dietary Guidelines Advisory Committee. The Committee conducted a systematic review with support from the USDA's Nutrition Evidence Systematic Review (NESR) team to answer the question: What is the relationship between dietary patterns consumed during lactation and human milk composition and quantity? Methods The Committee developed protocols to describe how they would use NESR's SR methodology to examine the evidence related to dietary patterns (DP) during lactation and human milk (HM). NESR librarians conducted a literature search and NESR analysts dual-screened the results using pre-defined inclusion and exclusion criteria to identify articles published between 2000 and 2019. NESR analysts extracted data from and assessed the risk of bias of included studies. The Committee synthesized the evidence, developed conclusion statements, and graded the strength of the evidence. Results This systematic review included 7 articles. Three articles from 2 cross-sectional studies examined DP and HM, while 4 articles from 3 randomized controlled trials examined diets based on macronutrient distributions and HM. The body of evidence was limited by small sample sizes, risk of bias concerns, heterogeneous methods, and study populations with limited racial/ethnic and socioeconomic diversity. Conclusions Limited evidence suggests that maternal consumption of diets higher in fat (>35% fat) and lower in carbohydrate during lactation is related to higher total fat in HM collected in the maternal postprandial period. Limited evidence suggests that certain maternal DP during lactation, including diets based on macronutrient distributions, are related to the relative proportions of saturated fat and monounsaturated fatty acids in HM, and of polyunsaturated fatty acids in HM collected in the maternal postprandial period. Insufficient or no evidence was available to assess the association between DP during lactation and HM quantity, as well as total protein, water- and fat-soluble vitamins, minerals, human milk oligosaccharides, and bioactive proteins in HM. Funding Sources USDA, Food and Nutrition Service, Center for Nutrition Policy and Promotion.
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Allan, John. "Royal Australian and New Zealand College of Psychiatrists mood disorders clinical practice guidelines update." BJPsych Open 7, S1 (June 2021): S170. http://dx.doi.org/10.1192/bjo.2021.469.
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AimsTo provide guidance for the management of mood disorders, both depressive and bipolar disorders, based on scientific evidence supplemented by expert clinical consensus.BackgroundIt is the EIT responsibility to monitor a patient's physical health and the effects of anti-psychotic medication for at least the first 12 months.MethodThe update has been developed in a consistent manner to the 2015 guideline. The composition of the working group has remained largely the same as has the process to evaluate the evidence and synthesise the findings. To approach the update, the working group identified areas within the 2015 guideline where significant changes had occurred, for example the development of new therapies or where thinking and practice have changed and new ideas have emerged. Recommendations were reviewed in light of any new findings and evidence. As only some sections of the 2015 guideline have been updated/revised, the time taken to develop the update has been considerably shorter. Public consultation and peer review informed the final version.ResultThis led us to review the mechanism in the team for arranging and reviewing these investigations.ConclusionThe mood disorders clinical practice guideline update addresses both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework supplemented by expert clinical consensus.
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Martínez-Espinosa, Rosa María, Mariola D. Molina Vila, and Manuel Reig García-Galbis. "Evidences from Clinical Trials in Down Syndrome: Diet, Exercise and Body Composition." International Journal of Environmental Research and Public Health 17, no. 12 (June 16, 2020): 4294. http://dx.doi.org/10.3390/ijerph17124294.
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Down syndrome (DS) is related to diseases like congenital heart disease, obstructive sleep apnea, obesity and overweight. Studies focused on DS associated with obesity and overweight are still scarce. The main objective of this work was to analyze the relationship between dietary intervention, physical exercise and body composition, in DS with overweight and obesity. This review is based on the PRISMA guidelines (Preferred Reporting Items for Systematic reviews and Meta-Analyses). Selection criteria for this analysis were: publications between January 1997 and December 2019; DS individuals with overweight and obesity; clinical trials using dietary intervention and physical exercise paying attention to changes in body composition. Selected clinical trials were focused on an exclusive intervention based on physical exercise. The anthropometric measures analyzed were body fat, BMI, waist circumference, body weight and fat free mass. The main conclusion is that prescribing structured physical exercise intervention may be related to a greater variation in body composition. Despite limited number of clinical trials analyzed, it can be assumed that the reported studies have not achieved optimal results and that the design of future clinical trials should be improved. Some guidelines are proposed to contribute to the improvement of knowledge in this field.
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Hall, Cristin Marie, Rebecca F. Bertuccio, Timothy M. Mazer, and Christieanna O. Tawiah. "Google It." Rural Educator 41, no. 1 (April 8, 2020): 40–60. http://dx.doi.org/10.35608/ruraled.v41i1.680.
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Violence prevention is of the utmost concern in some schools. For various reasons, rural schools face a number of challenges that may prevent them from implementing strong, evidence-based violence prevention initiatives. Given that the Internet houses a plethora of cost-free resources on threat assessment and violence prevention in schools, rural educators may consult the internet for information. However, because little is known about the composition and quality of such resources, it is important that they are properly evaluated. As such, the purpose of the present study was to compare existing, free, online school-based threat assessment resources to an evidence-based threat assessment framework to determine how well online resources communicate evidence-based principles. Using component analysis, a total of 11 online resources were evaluated. Overall, the findings from this investigation revealed that the evaluated online threat assessment resources were not as comprehensive as evidence-based guidelines.
Keywords: online, prevention, schools, threat assessment, violence
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Mithril, Charlotte, Lars Ove Dragsted, Claus Meyer, Inge Tetens, Anja Biltoft-Jensen, and Arne Astrup. "Dietary composition and nutrient content of the New Nordic Diet." Public Health Nutrition 16, no. 5 (October 22, 2012): 777–85. http://dx.doi.org/10.1017/s1368980012004521.
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AbstractObjectiveTo describe the dietary composition of the New Nordic Diet (NND) and to compare it with the Nordic Nutrition Recommendations (NNR)/Danish Food-based Dietary Guidelines (DFDG) and with the average Danish diet.DesignDietary components with clear health-promoting properties included in the DFDG were included in the NND in amounts at least equivalent to those prescribed by the DFDG. The quantities of the other dietary components in the NND were based on scientific arguments for their potential health-promoting properties together with considerations of acceptability, toxicological concerns, availability and the environment. Calculations were conducted for quantifying the dietary and nutrient composition of the NND.SettingDenmark.SubjectsNone.ResultsThe NND is characterized by a high content of fruits and vegetables (especially berries, cabbages, root vegetables and legumes), fresh herbs, potatoes, plants and mushrooms from the wild countryside, whole grains, nuts, fish and shellfish, seaweed, free-range livestock (including pigs and poultry) and game. Overall, the average daily intakes of macro- and micronutrients in the NND meet the NNR with small adjustments based on evidence of their health-promoting properties.ConclusionsThe NND is a prototype regional diet that takes palatability, health, food culture and the environment into consideration. Regionally appropriate healthy diets could be created on similar principles anywhere in the world.
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Griggs, Jennifer J., Kari Bohlke, Edward P. Balaban, James J. Dignam, Evan T. Hall, R. Donald Harvey, Diane P. Hecht, et al. "Appropriate Systemic Therapy Dosing for Obese Adult Patients With Cancer: ASCO Guideline Update." Journal of Clinical Oncology 39, no. 18 (June 20, 2021): 2037–48. http://dx.doi.org/10.1200/jco.21.00471.
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PURPOSE To provide recommendations for appropriate dosing of systemic antineoplastic agents in obese adults with cancer. METHODS A systematic review of the literature collected evidence regarding dosing of chemotherapy, immunotherapy, and targeted therapies in obese adults with cancer. PubMed and the Cochrane Library were searched for randomized controlled trials, meta-analyses, or cohort studies published from November 1, 2010, through March 27, 2020. ASCO convened an Expert Panel to review the evidence and formulate recommendations. RESULTS Sixty studies, primarily retrospective, were included in the review. Overall, the evidence supported previous findings that obese adult patients tolerate full, body-size–based dosing of chemotherapy as well as nonobese patients. Fewer studies have addressed the dosing of targeted therapies and immunotherapies in relation to safety and efficacy in obese patients. RECOMMENDATIONS The Panel continues to recommend that full, weight-based cytotoxic chemotherapy doses be used to treat obese adults with cancer. New to this version of the guideline, the Panel also recommends that full, approved doses of immunotherapy and targeted therapies be offered to obese adults with cancer. In the event of toxicity, the consensus of the Panel is that dose modifications of systemic antineoplastic therapies should be handled similarly for obese and nonobese patients. Important areas for future research include the impact of sarcopenia and other measures of body composition on optimal antineoplastic dosing, and more customized dosing based on pharmacokinetic or pharmacogenetic factors. Additional information is available at www.asco.org/supportive-care-guidelines .
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Lamers, Yvonne, Amanda J. MacFarlane, Deborah L. O'Connor, and Bénédicte Fontaine-Bisson. "Periconceptional intake of folic acid among low-risk women in Canada: summary of a workshop aiming to align prenatal folic acid supplement composition with current expert guidelines." American Journal of Clinical Nutrition 108, no. 6 (December 1, 2018): 1357–68. http://dx.doi.org/10.1093/ajcn/nqy212.
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ABSTRACT The Government of Canada and the Society of Obstetricians and Gynaecologists of Canada both recommend a daily multivitamin supplement containing 400 µg folic acid (FA) for the primary prevention of neural tube defects among low-risk women from before conception and throughout lactation. Prenatal supplements marketed and prescribed in Canada typically exceed the recommended dose, usually providing ≥1000 µg FA/d. This high daily dose, coupled with staple-food FA fortification, has resulted in the observation of very high blood folate concentrations among reproductive-aged women consuming FA-containing supplements. The long-term consequences of high folate status on fetal development are unknown; however, evidence from animal studies and some human epidemiologic data suggest potential adverse consequences. To address this issue, a workshop was convened with the overall goal to identify challenges and solutions to aligning supplemental FA intakes with current evidence-based recommendations. Thirty-eight stakeholders from academia, industry, government, and health professional groups participated. Group discussions facilitated the identification and prioritization of 5 key challenges for which solutions and implementation strategies were proposed. The 5 themes encompassed clarity and harmonization of evidence-based guidelines, reformulation or relabeling of FA-containing supplements, access to FA for all women, knowledge dissemination strategies and education of the public and health care professionals, and attitude change to overcome the perception of “more is better.” A combination of the proposed implementation strategies involving all key stakeholders and directed to health care professionals and the public may enable a sustainable change to align FA intake during the periconceptional period with evidence-based recommendations.
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Costa, Andreu F., Christian B. van der Pol, Pejman Jabehdar Maralani, Matthew D. F. McInnes, Jason R. Shewchuk, Raman Verma, Casey Hurrell, and Nicola Schieda. "Gadolinium Deposition in the Brain: A Systematic Review of Existing Guidelines and Policy Statement Issued by the Canadian Association of Radiologists." Canadian Association of Radiologists Journal 69, no. 4 (November 2018): 373–82. http://dx.doi.org/10.1016/j.carj.2018.04.002.
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Emerging evidence has confirmed that, following administration of a gadolinium-based contrast agent (GBCA), very small amounts of gadolinium will deposit in the brain of humans with intact blood-brain barriers. The literature is evolving rapidly and the degree to which gadolinium will deposit for a particular GBCA or class of GBCAs remains undetermined. Several studies suggest that linear GBCAs deposit more gadolinium in the brain compared with macrocyclic GBCAs; however, our understanding of the molecular composition of deposited gadolinium is preliminary, and the clinical significance of gadolinium deposition remains unknown. To date, there is no conclusive evidence linking gadolinium deposition in the brain with any adverse patient outcome. A panel of radiologists representing the Canadian Association of Radiologists was assembled to assist the Canadian medical imaging community in making informed decisions regarding the issue of gadolinium deposition in the brain. The objectives of the working group were: 1) to review the evidence from animal and human studies; 2) to systematically review existing guidelines and position statements issued by other organizations and health agencies; and 3) to formulate an evidence-based position statement on behalf of the Canadian Association of Radiologists. Based on our appraisal of the evidence and systematic review of 9 guidelines issued by other organizations, the working group established the following consensus statement. GBCA administration should be considered carefully with respect to potential risks and benefits, and only used when required. Standard dosing should be used and repeat administrations should be avoided unless necessary. Gadolinium deposition is one of several issues to consider when prescribing a particular GBCA. Currently there is insufficient evidence to recommend one class of GBCA over another. The panel considered it inappropriate to withhold a linear GBCA if a macrocyclic agent is unavailable, if hepatobiliary phase imaging is required, or if there is a history of severe allergic reaction to a macrocyclic GBCA. Further study in this area is required, and the evidence should be monitored regularly with policy statements updated accordingly.
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Kårlund, Anna, Carlos Gómez-Gallego, Anu M. Turpeinen, Outi-Maaria Palo-oja, Hani El-Nezami, and Marjukka Kolehmainen. "Protein Supplements and Their Relation with Nutrition, Microbiota Composition and Health: Is More Protein Always Better for Sportspeople?" Nutrients 11, no. 4 (April 12, 2019): 829. http://dx.doi.org/10.3390/nu11040829.
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Sports nutrition products are developed and targeted mainly for athletes to improve their nutrient intake, performance, and muscle growth. The fastest growing consumer groups for these products are recreational sportspeople and lifestyle users. Although athletes may have elevated physiological protein requirements and they may benefit from dietary supplements, the evidence regarding the role of dietary protein and supplements in the nutrition of recreational sportspeople and sedentary populations is somewhat complex and contradictory. In high-protein diets, more undigested protein-derived constituents end up in the large intestine compared to moderate or low-protein diets, and hence, more bacterial amino acid metabolism takes place in the colon, having both positive and negative systemic and metabolic effects on the host. The aim of the present review is to summarize the impact of the high-protein products and diets on nutrition and health, in sportspeople and in sedentary consumers. We are opening the debate about the current protein intake recommendations, with an emphasis on evidence-based effects on intestinal microbiota and personalized guidelines regarding protein and amino acid supplementation in sportspeople and lifestyle consumers.
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Poggiano, Maria Rita, Sara Ciarla, Paola Gnerre, Anna Roberts, Laura Magni, Laura Morbidoni, Ada Maffettone, et al. "The management of the patient with malnutrition: from evidence to clinical practice." Italian Journal of Medicine 11, no. 2 (June 14, 2017): 134. http://dx.doi.org/10.4081/itjm.2017.745.
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Malnutrition can be defined as a state of nutrition in which a deficiency or excess (or imbalance) of energy, protein and other nutrients causes measurable adverse effects on tissue/body form (body shape, size, composition) body function and clinical outcome. Malnutrition is a highly prevalent condition in the acute hospital setting with studies reporting rates of approximately 40%. Malnutrition is associated with many adverse outcomes including depression of the immune system, impaired wound healing, muscle wasting, longer lengths of hospital stay and increased mortality. Unidentified malnutrition not only heightens the risk of adverse complications for patients but results in an increase in health care costs. This can be prevented if special attention is given to their nutritional care. For this reason, hospital and healthcare organizations should have a policy and a specific set of protocols for identifying patients at nutritional risk, leading to appropriate care plans. The objective of this monograph is to provide evidence-based recommendations for the proper management of malnutrition by multi-parametric analysis of the guidelines available to date.
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Houston, Kirsty A., Jack G. Gibb, and Kathryn Maitland. "Oral rehydration of malnourished children with diarrhoea and dehydration: A systematic review." Wellcome Open Research 2 (August 18, 2017): 66. http://dx.doi.org/10.12688/wellcomeopenres.12357.1.
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Background: Diarrhoea complicates over half of admissions to hospital with severe acute malnutrition (SAM). World Health Organization (WHO) guidelines for the management of dehydration recommend the use of oral rehydration with ReSoMal (an oral rehydration solution (ORS) for SAM), which has lower sodium (45mmols/l) and higher potassium (20mmols/l) content than standard ORS. The composition of ReSoMal was designed specifically to address theoretical risks of sodium overload and potential under-treatment of severe hypokalaemia with rehydration using standard ORS. In African children, severe hyponatraemia at admission is a major risk factor for poor outcome in children with SAM complicated by diarrhoea. We therefore reviewed the evidence for oral rehydration therapy in children with SAM. Methods: We conducted a systematic review of randomised controlled trials (RCTs) on 18th July 2017 comparing different oral rehydration solutions in severely malnourished children with diarrhoea and dehydration, using standard search terms. The author assessed papers for inclusion. The primary endpoint was frequency of hyponatraemia during rehydration. Results: Six RCTs were identified, all published in English and conducted in low resource settings in Asia. A range of ORS were evaluated in these studies, including standard ORS, hypo-osmolar ORS and ReSoMal. Hyponatraemia was observed in two trials evaluating ReSoMal, three children developed severe hyponatraemia with one experiencing convulsions. Hypo-osmolar ORS was found to have benefits in time to rehydration, reduction of stool output and duration of diarrhoea. No trials reported over-hydration or fatalities. Conclusions: Current WHO guidelines strongly recommend the use of ReSoMal based on low quality of evidence. Studies indicate a significant risk of hyponatraemia on ReSoMal in Asian children, none have been conducted in Africa, where SAM mortality remains high. Further research should be conducted in Africa to evaluate optimal ORS for children with SAM and to generate evidence based, practical guidelines.
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Houston, Kirsty A., Jack G. Gibb, and Kathryn Maitland. "Oral rehydration of malnourished children with diarrhoea and dehydration: A systematic review." Wellcome Open Research 2 (September 28, 2017): 66. http://dx.doi.org/10.12688/wellcomeopenres.12357.2.
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Background: Diarrhoea complicates over half of admissions to hospital with severe acute malnutrition (SAM). World Health Organization (WHO) guidelines for the management of dehydration recommend the use of oral rehydration with ReSoMal (an oral rehydration solution (ORS) for SAM), which has lower sodium (45mmols/l) and higher potassium (40mmols/l) content than old WHO ORS. The composition of ReSoMal was designed specifically to address theoretical risks of sodium overload and potential under-treatment of severe hypokalaemia with rehydration using standard ORS. In African children, severe hyponatraemia at admission is a major risk factor for poor outcome in children with SAM complicated by diarrhoea. We therefore reviewed the evidence for oral rehydration therapy in children with SAM. Methods: We conducted a systematic review of randomised controlled trials (RCTs) on 18th July 2017 comparing different oral rehydration solutions in severely malnourished children with diarrhoea and dehydration, using standard search terms. The author assessed papers for inclusion. The primary endpoint was frequency of hyponatraemia during rehydration. Results: Six RCTs were identified, all published in English and conducted in low resource settings in Asia. A range of ORS were evaluated in these studies, including old WHO ORS, standard hypo-osmolar WHO ORS and ReSoMal. Hyponatraemia was observed in two trials evaluating ReSoMal, three children developed severe hyponatraemia with one experiencing convulsions. Hypo-osmolar ORS was found to have benefits in time to rehydration, reduction of stool output and duration of diarrhoea. No trials reported over-hydration or fatalities. Conclusions: Current WHO guidelines strongly recommend the use of ReSoMal based on low quality of evidence. Studies indicate a significant risk of hyponatraemia on ReSoMal in Asian children, none have been conducted in Africa, where SAM mortality remains high. Further research should be conducted in Africa to evaluate optimal ORS for children with SAM and to generate evidence based, practical guidelines
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Houston, Kirsty A., Jack G. Gibb, and Kathryn Maitland. "Oral rehydration of malnourished children with diarrhoea and dehydration: A systematic review." Wellcome Open Research 2 (October 27, 2017): 66. http://dx.doi.org/10.12688/wellcomeopenres.12357.3.
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Background: Diarrhoea complicates over half of admissions to hospital with severe acute malnutrition (SAM). World Health Organization (WHO) guidelines for the management of dehydration recommend the use of oral rehydration with ReSoMal (an oral rehydration solution (ORS) for SAM), which has lower sodium (45mmols/l) and higher potassium (40mmols/l) content than old WHO ORS. The composition of ReSoMal was designed specifically to address theoretical risks of sodium overload and potential under-treatment of severe hypokalaemia with rehydration using standard ORS. In African children, severe hyponatraemia at admission is a major risk factor for poor outcome in children with SAM complicated by diarrhoea. We therefore reviewed the evidence for oral rehydration therapy in children with SAM. Methods: We conducted a systematic review of randomised controlled trials (RCTs) on 18th July 2017 comparing different oral rehydration solutions in severely malnourished children with diarrhoea and dehydration, using standard search terms. The author assessed papers for inclusion. The primary endpoint was frequency of hyponatraemia during rehydration. Results: Six RCTs were identified, all published in English and conducted in low resource settings in Asia. A range of ORS were evaluated in these studies, including old WHO ORS, standard hypo-osmolar WHO ORS and ReSoMal. Hyponatraemia was observed in two trials evaluating ReSoMal, three children developed severe hyponatraemia with one experiencing convulsions. Hypo-osmolar ORS was found to have benefits in time to rehydration, reduction of stool output and duration of diarrhoea. No trials reported over-hydration or fatalities. Conclusions: Current WHO guidelines strongly recommend the use of ReSoMal based on low quality of evidence. Studies indicate a significant risk of hyponatraemia on ReSoMal in Asian children, none have been conducted in Africa, where SAM mortality remains high. Further research should be conducted in Africa to evaluate optimal ORS for children with SAM and to generate evidence based, practical guidelines
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Krzymien, Janusz, and Piotr Ladyzynski. "Insulin in Type 1 and Type 2 Diabetes—Should the Dose of Insulin Before a Meal be Based on Glycemia or Meal Content?" Nutrients 11, no. 3 (March 13, 2019): 607. http://dx.doi.org/10.3390/nu11030607.
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The aim of this review was to investigate existing guidelines and scientific evidence on determining insulin dosage in people with type 1 and type 2 diabetes, and in particular to check whether the prandial insulin dose should be calculated based on glycemia or the meal composition, including the carbohydrates, protein and fat content in a meal. By exploring the effect of the meal composition on postprandial glycemia we demonstrated that several factors may influence the increase in glycemia after the meal, which creates significant practical difficulties in determining the appropriate prandial insulin dose. Then we reviewed effects of the existing insulin therapy regimens on glycemic control. We demonstrated that in most existing algorithms aimed at calculating prandial insulin doses in type 1 diabetes only carbohydrates are counted, whereas in type 2 diabetes the meal content is often not taken into consideration. We conclude that prandial insulin doses in treatment of people with diabetes should take into account the pre-meal glycemia as well as the size and composition of meals. However, there are still open questions regarding the optimal way to adjust a prandial insulin dose to a meal and the possible benefits for people with type 1 and type 2 diabetes if particular parameters of the meal are taken into account while calculating the prandial insulin dose. The answers to these questions may vary depending on the type of diabetes.
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Gibney, Michael, and Brittmarie Sandström. "A framework for food-based dietary guidelines in the European Union." Public Health Nutrition 4, no. 2a (April 2001): 293–305. http://dx.doi.org/10.1017/s1368980001001550.
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AbstractThe nutrient targets derived from analysis of the relation between nutrient intake and disease prevalence or other scientific evidence, have to be translated into food-based guidelines in order to be understood by die general population. Furthermore, Food-Based Dietary Guidelines (FBGD) have to be realistic, attainable and culturally acceptable and should also give consideration to relevant social, economic, agricultural and environmental factors affecting food availability and eating patterns. This requires a diorough understanding of the relation between foods, food patterns and nutrient intakes in the population. The aims of Working Party 2 were to propose a framework for strategies in the development of FBDG and to examine existing data for nutrient and food intakes in the EU.MethodsThe over-all strategy given by the joint FAO/WHO consultation 1995 was used as the starting point, i.e. target foods or food patterns for public health nutrition programmes should be identified from an analysis of prevailing food and nutrient intakes. Prevailing data for food and nutrient intakes in 14 EU countries were examined and different principles and options for the derivation of FBDG were explored. Methodological issues and their influence on the interpretation of data for the development of FBDG were also examined.ResultsThe process from nutrients to foods can be briefly: 1) identification of major food sources of the nutrient of interest, 2) identification of foods contributing substantially to population intakes, 3) identification of foods or food patterns compatible with desirable nutrient intakes or explaining variations in nutrient intakes, 4) formulation of FBDG into foods, portion sizes, frequency of intake, meal composition taking attainability and acceptability as well as compatibility of co-existing guidelines into account.The level of complexity that can be applied in the analytical approaches depends on the characteristics of available intake data. A detailed analysis requires data on an individual level for nutrients, foods, food patterns, eating and meal habits etc. When individual data are available different analytical approaches (examination of distribution of intakes, correlation analysis between foods and nutrients, examination of food intakes in compliers/non-compliers to nutrient goals, discriminant analysis, cluster/factor analysis) can be used to identify key foods or food patterns fulfilling nutrient goals.The examination of prevailing food and nutrient intake data in the EU revealed:– a number of methodological differences in approaches to dietary surveys exist in the EU countries e.g. regarding mediods used, selection of population, classification of foods, which have to be kept in mind in pan-EU comparisons at present there is a substantial gap between actual intakes and present nutrient goals suggesting that major changes of dietary habits are needed– while some food patterns were consistently related to intake of specific nutrients in most EU countries, other patterns showed large variations between countries– methodological issues, such as survey duration, survey techniques, under- or over-reporting, could have substantial influence on the identification of target foods or food patterns.ConclusionA science-based analysis of nutrient and food intakes allows development of FBDG, which, if implemented, are likely to result in mean population intakes closer to nutrient goals. Acknowledging the social and cultural differences within the EU as well as the need to focus on the most relevant public health problem in die population, FBDG should first be developed widiin member states. Harmonisation of survey methods within the EU would facilitate development of regional and EU FBDG.
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Zaid, Abdul Hafidz, Imam Bahroni, and Ahmad Hifdzil Haq. "STUDENT WORKSHEETS FOR ARABIC COMPOSITION MATERIAL BASED ON ERROR ANALYSIS THEORY." Humanities & Social Sciences Reviews 8, no. 3 (June 15, 2020): 879–89. http://dx.doi.org/10.18510/hssr.2020.8392.
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Purpose of the study: This study aims to produce Composition teaching material to improve Arabic writing skills for students class II Kulliyyatul al-Mu’allimin al-Islamiyyah Al-Iman Putra Islamic Institution in the form of an exciting, fruitful Student Worksheet exercise, drawing assignments and their feasibility as an alternative step in solving the students’ mistakes in structuring Arabic sentences.
Methodology: In collecting data, researchers used the method of Documentary, Observation, Test, and Questionnaire, so that this research instrument was the result of Composition santri, observation guidelines, test questions, and questionnaires. To analyze the data collected, researchers used a descriptive percentage formula and t-test formula.
Main Findings: The results of the Student Worksheets trial arranged can effectively improve the ability of students in composition. This is evidenced by the significant increase in value from the comparison of the difference between the pre-test and post-test scores after the teaching material is applied, which results in a t-test score of 7,740 and is greater than the price of the t table of 2.704. Also, this worksheet is very popular with students because it can facilitate them in developing Arabic language markers.
Applications of the study: Analysis of language errors as an applied linguistic theory can be used in which results are used as remedial material in the form of interesting teaching materials and following the abilities and development of students at that time.
Novelty/Originality of the study: Student Worksheet is teachers can use one of the teaching materials it’s serving students in developing the ability of composition in the learning environment. This research provides a positive contribution for teachers that the development of worksheets as important teaching materials in the learning process.
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Falzon, Dennis, Holger J. Schünemann, Elizabeth Harausz, Licé González-Angulo, Christian Lienhardt, Ernesto Jaramillo, and Karin Weyer. "World Health Organization treatment guidelines for drug-resistant tuberculosis, 2016 update." European Respiratory Journal 49, no. 3 (March 2017): 1602308. http://dx.doi.org/10.1183/13993003.02308-2016.
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Antimicrobial resistance is a major global concern. Tuberculosis (TB) strains resistant to rifampicin and other TB medicines challenge patient survival and public health. The World Health Organization (WHO) has published treatment guidelines for drug-resistant TB since 1997 and last updated them in 2016 based on reviews of aggregated and individual patient data from published and unpublished studies. An international expert panel formulated recommendations following the GRADE approach. The new WHO guidelines recommend a standardised 9–12 months shorter treatment regimen as first choice in patients with multidrug- or rifampicin-resistant TB (MDR/RR-TB) strains not resistant to fluoroquinolones or second-line injectable agents; resistance to these two classes of core second-line medicines is rapidly detectable with molecular diagnostics also approved by WHO in 2016. The composition of longer regimens for patients ineligible for the shorter regimen was modified. A first-ever meta-analysis of individual paediatric patient data allowed treatment recommendations for childhood MDR/RR-TB to be made. Delamanid is now also recommended in patients aged 6–17 years. Partial lung resection is a recommended option in MDR/RR-TB care. The 2016 revision highlighted the continued shortage of high-quality evidence and implementation research, and reiterated the need for clinical trials and best-practice studies to improve MDR/RR-TB patient treatment outcomes and strengthen policy.
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Sui, Zhixian, David Raubenheimer, and Anna Rangan. "Exploratory analysis of meal composition in Australia: meat and accompanying foods." Public Health Nutrition 20, no. 12 (June 5, 2017): 2157–65. http://dx.doi.org/10.1017/s1368980017000982.
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AbstractObjectiveThe study of meal patterns and overall diet in relation to health outcomes may be more important than focusing on single nutrients or food groups. The present study aimed to explore the composition of main meals and snacks in the Australian population and examine associations between meat/poultry/fish and other foods.DesignThe study utilised 24 h recalls. Meal composition was defined based on average intakes of food groups per meal disaggregated from all food sources.Setting2011–12 National Nutrition and Physical Activity Survey.SubjectsAustralian people (n12153) aged 2 years or above.ResultsOverall, breakfast was the smallest meal of the day, typically consisting of grains, dairy products and fruit. Lunch was the second largest meal, consisting mostly of grains, non-starchy vegetables and meat/poultry/fish. The largest meal was dinner, comprising meat/poultry/fish, vegetables (starchy and non-starchy), grains and often including discretionary beverages (children) or alcohol (adults). The main food groups consumed at snacking occasions were dairy, fruit, discretionary foods and beverages (including alcohol for adults). The most frequently consumed meat types were beef and chicken at dinner and ham at lunch. Non-starchy vegetables were accompanying foods for red meat, poultry and fish/seafood consumed in varying portion sizes, but did not accompany processed meat.ConclusionsThe present study considered meat, poultry and fish as the meal centre and their accompaniments of other food groups at different eating occasions. These findings expand the background evidence for health professionals developing meal-based framework/guidelines and public health messages.
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Chaudhary, Abina, František Sudzina, and Bent Egberg Mikkelsen. "Promoting Healthy Eating among Young People—A Review of the Evidence of the Impact of School-Based Interventions." Nutrients 12, no. 9 (September 22, 2020): 2894. http://dx.doi.org/10.3390/nu12092894.
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Intro: Globally, the prevalence of overweight and obesity is increasing among children and younger adults and is associated with unhealthy dietary habits and lack of physical activity. School food is increasingly brought forward as a policy to address the unhealthy eating patterns among young people. Aim: This study investigated the evidence for the effectiveness of school-based food and nutrition interventions on health outcomes by reviewing scientific evidence-based intervention studies amongst children at the international level. Methods: This study was based on a systematic review using the PRISMA guidelines. Three electronic databases were systematically searched, reference lists were screened for studies evaluating school-based food and nutrition interventions that promoted children’s dietary behaviour and health aiming changes in the body composition among children. Articles dating from 2014 to 2019 were selected and reported effects on anthropometry, dietary behaviour, nutritional knowledge, and attitude. Results: The review showed that school-based interventions in general were able to affect attitudes, knowledge, behaviour and anthropometry, but that the design of the intervention affects the size of the effect. In general, food focused interventions taking an environmental approach seemed to be most effective. Conclusions: School-based interventions (including multicomponent interventions) can be an effective and promising means for promoting healthy eating, improving dietary behaviour, attitude and anthropometry among young children. Thus, schools as a system have the potential to make lasting improvements, ensuring healthy school environment around the globe for the betterment of children’s short- and long-term health.
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Chenard, Catherine, Linda Rubenstein, Linda Snetselaar, and Terry Wahls. "Nutrient Composition Comparison between a Modified Paleolithic Diet for Multiple Sclerosis and the Recommended Healthy U.S.-Style Eating Pattern." Nutrients 11, no. 3 (March 1, 2019): 537. http://dx.doi.org/10.3390/nu11030537.
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Multiple sclerosis (MS) is a demyelinating disease that attacks the central nervous system. Evidence-based dietary guidelines do not exist for MS; the default advice is to follow the Dietary Guidelines for Americans (DGA). A modified Paleolithic Wahls Elimination (WahlsElim) diet promoted for MS excludes grains and dairy and encourages 9+ cups fruits and vegetables (F/V) and saturated fat for cooking. This study evaluated the nutritional adequacy of seven-day menus and modeled them with varying amounts of F/V for comparison with the DGA Healthy US-Style Eating Pattern (HEP) for ages 31–50 years. WahlsElim menus had low added sugar and glycemic index. Nutritional adequacy of the menus and modeled versions were similar to HEP for 17 vitamins and minerals (mean adequacy ratio ≥92%). Nutrient shortfalls for the modeled diet with 60% F/V were identical to HEP for vitamin D, iron (females), magnesium (marginally males), choline and potassium; this modeled diet was also low in dietary fiber and calcium but met vitamin E requirements while HEP did not. WahlsElim-prescribed supplements corrected vitamin D and magnesium shortfalls; careful selection of foods are needed to meet requirements of other shortfall nutrients and reduce saturated fat and sodium. Doctors should monitor nutritional status, supplement doses, and possible contraindications to high vitamin K intake in individuals following the WahlsElim diet.
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Yuen, Kevin C. J., Beverly M. K. Biller, Sally Radovick, John D. Carmichael, Sina Jasim, Kevin M. Pantalone, and Andrew R. Hoffman. "AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY GUIDELINES FOR MANAGEMENT OF GROWTH HORMONE DEFICIENCY IN ADULTS AND PATIENTS TRANSITIONING FROM PEDIATRIC TO ADULT CARE." Endocrine Practice 25, no. 11 (November 2019): 1191–232. http://dx.doi.org/10.4158/gl-2019-0405.
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Objective: The development of these guidelines is sponsored by the American Association of Clinical Endocrinologists (AACE) Board of Directors and American College of Endocrinology (ACE) Board of Trustees and adheres with published AACE protocols for the standardized production of clinical practice guidelines (CPG). Methods: Recommendations are based on diligent reviews of clinical evidence with transparent incorporation of subjective factors, according to established AACE/ACE guidelines for guidelines protocols. Results: The Executive Summary of this 2019 updated guideline contains 58 numbered recommendations: 12 are Grade A (21%), 19 are Grade B (33%), 21 are Grade C (36%), and 6 are Grade D (10%). These detailed, evidence-based recommendations allow for nuance-based clinical decision-making that addresses multiple aspects of real-world care of patients. The evidence base presented in the subsequent Appendix provides relevant supporting information for the Executive Summary recommendations. This update contains 357 citations of which 51 (14%) are evidence level (EL) 1 (strong), 168 (47%) are EL 2 (intermediate), 61 (17%) are EL 3 (weak), and 77 (22%) are EL 4 (no clinical evidence). Conclusion: This CPG is a practical tool that practicing endocrinologists and regulatory bodies can refer to regarding the identification, diagnosis, and treatment of adults and patients transitioning from pediatric to adult-care services with growth hormone deficiency (GHD). It provides guidelines on assessment, screening, diagnostic testing, and treatment recommendations for a range of individuals with various causes of adult GHD. The recommendations emphasize the importance of considering testing patients with a reasonable level of clinical suspicion of GHD using appropriate growth hormone (GH) cut-points for various GH–stimulation tests to accurately diagnose adult GHD, and to exercise caution interpreting serum GH and insulin-like growth factor-1 (IGF-1) levels, as various GH and IGF-1 assays are used to support treatment decisions. The intention to treat often requires sound clinical judgment and careful assessment of the benefits and risks specific to each individual patient. Unapproved uses of GH, long-term safety, and the current status of long-acting GH preparations are also discussed in this document. LAY ABSTRACT This updated guideline provides evidence-based recommendations regarding the identification, screening, assessment, diagnosis, and treatment for a range of individuals with various causes of adult growth-hormone deficiency (GHD) and patients with childhood-onset GHD transitioning to adult care. The update summarizes the most current knowledge about the accuracy of available GH–stimulation tests, safety of recombinant human GH (rhGH) replacement, unapproved uses of rhGH related to sports and aging, and new developments such as long-acting GH preparations that use a variety of technologies to prolong GH action. Recommendations offer a framework for physicians to manage patients with GHD effectively during transition to adult care and adulthood. Establishing a correct diagnosis is essential before consideration of replacement therapy with rhGH. Since the diagnosis of GHD in adults can be challenging, GH–stimulation tests are recommended based on individual patient circumstances and use of appropriate GH cut-points. Available GH–stimulation tests are discussed regarding variability, accuracy, reproducibility, safety, and contraindications, among other factors. The regimen for starting and maintaining rhGH treatment now uses individualized dose adjustments, which has improved effectiveness and reduced reported side effects, dependent on age, gender, body mass index, and various other individual characteristics. With careful dosing of rhGH replacement, many features of adult GHD are reversible and side effects of therapy can be minimized. Scientific studies have consistently shown rhGH therapy to be beneficial for adults with GHD, including improvements in body composition and quality of life, and have demonstrated the safety of short- and long-term rhGH replacement. Abbreviations: AACE = American Association of Clinical Endocrinologists; ACE = American College of Endocrinology; AHSG = alpha-2-HS-glycoprotein; AO-GHD = adult-onset growth hormone deficiency; ARG = arginine; BEL = best evidence level; BMD = bone mineral density; BMI = body mass index; CI = confidence interval; CO-GHD = childhood-onset growth hormone deficiency; CPG = clinical practice guideline; CRP = C-reactive protein; DM = diabetes mellitus; DXA = dual-energy X-ray absorptiometry; EL = evidence level; FDA = Food and Drug Administration; FD-GST = fixed-dose glucagon stimulation test; GeNeSIS = Genetics and Neuroendocrinology of Short Stature International Study; GH = growth hormone; GHD = growth hormone deficiency; GHRH = growth hormone–releasing hormone; GST = glucagon stimulation test; HDL = high-density lipoprotein; HypoCCS = Hypopituitary Control and Complications Study; IGF-1 = insulin-like growth factor-1; IGFBP = insulin-like growth factor–binding protein; IGHD = isolated growth hormone deficiency; ITT = insulin tolerance test; KIMS = Kabi International Metabolic Surveillance; LAGH = long-acting growth hormone; LDL = low-density lipoprotein; LIF = leukemia inhibitory factor; MPHD = multiple pituitary hormone deficiencies; MRI = magnetic resonance imaging; P-III-NP = procollagen type-III amino-terminal pro-peptide; PHD = pituitary hormone deficiencies; QoL = quality of life; rhGH = recombinant human growth hormone; ROC = receiver operating characteristic; RR = relative risk; SAH = subarachnoid hemorrhage; SDS = standard deviation score; SIR = standardized incidence ratio; SN = secondary neoplasms; T3 = triiodothyronine; TBI = traumatic brain injury; VDBP = vitamin D-binding protein; WADA = World Anti-Doping Agency; WB-GST = weight-based glucagon stimulation test
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Hirahatake, Kristin M., Arne Astrup, James O. Hill, Joanne L. Slavin, David B. Allison, and Kevin C. Maki. "Potential Cardiometabolic Health Benefits of Full-Fat Dairy: The Evidence Base." Advances in Nutrition 11, no. 3 (January 6, 2020): 533–47. http://dx.doi.org/10.1093/advances/nmz132.
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ABSTRACT Since their inception in 1980, the Dietary Guidelines for Americans have promoted low- or fat-free dairy foods. Removing fat from dairy does not reduce putatively beneficial nutrients per serving, including calcium, vitamin D, and potassium. Additionally, links between saturated fat and dietary cholesterol intakes with cardiovascular disease risk have helped to sustain the view that low-fat dairy foods should be recommended. Emerging evidence shows that the consumption of full-fat dairy foods has a neutral or inverse association with adverse cardiometabolic health outcomes, including atherosclerotic cardiovascular disease, type 2 diabetes, and associated risk factors. Thus, although low-fat dairy is a practical, practice-based recommendation, its superiority compared with full-fat dairy is not obviously supported by results from recent prospective cohort studies or intervention trials. To evaluate the emerging science on full-fat dairy, a group of nutrition experts convened to summarize and discuss the scientific evidence regarding the health effects of consuming full-fat dairy foods. Future studies should focus on full-fat dairy foods (milk, yogurt, and cheese) in the context of recommended dietary patterns and consider meal composition and metabolic phenotype in assessing the relation between full-fat dairy consumption and cardiometabolic health.
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Gubergrits, N. B., and N. V. Byelyayeva. "Pancreatology: debunked myths." Herald of Pancreatic Club 48, no. 3 (July 31, 2020): 44–53. http://dx.doi.org/10.33149/vkp.2020.03.07.
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Enzyme replacement therapy is not always effective enough upon exocrine pancreatic insufficiency. One of the main reasons is myths — doctors’ misconceptions about the indications and rules of replacement therapy.
In particular, there is an outdated opinion about the effectiveness of tablet enzyme preparations used for the relief of pancreatic pain. However, a number of evidence-based studies have proved that enzyme preparations are not effective enough to relieve pain in chronic pancreatitis, and thus should not be used for this purpose. This statement is recorded in the United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis, as well as in the recommendations of the American College of Gastroenterology. In addition, tablet preparations are characterized by asynchronism of the passage of the chyme and the tablet along the digestive tract.
The second myth is that drugs without an acid-resistant coat start hydrolyzing the components of the chyme in the stomach, which ensures higher efficiency as compared to Creon. But in the absence of a coat, enzymes are inactivated in the acidic environment of the stomach and cannot have any effect at all.
The third myth is that enzyme preparations always cause constipation. In fact, constipation occurs in no more than 10% of cases. They are usually associated with an overdose of the drug, concomitant pathology or insufficient compliance.
The fourth myth is that prescribing the doses of enzyme preparations indicated in the European Guidelines causes addiction. It is crucial to know that such doses do not exceed 10% of the pancreas’s own capacities, therefore, they cannot significantly affect these capabilities, which is also demonstrated by evidence-based studies.
The fifth myth is that patients gain weight because of enzyme preparations, and they should not be prescribed upon overweight and obesity. Numerous data firmly show that pancreatic insufficiency often occurs in such cases, and enzyme preparations are required.
The sixth myth is that a drug with a different composition can be produced under the usual established product name. For example, NEO is added to the name to “mask” a drug with a new composition. Doctors should carefully monitor the composition of such drugs.
The seventh myth is that a minimicrospherical preparation (Creon) is as effective as microspherical preparation. However, this statement turned out to be a myth as well. Minimicrospherical preparations are proved to be significantly more effective in clinical practice.
Thus, the above-mentioned myths, like many others, are based on insufficient knowledge in the field of pancreatology.
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van der Schaft, Niels, Katerina Trajanoska, Fernando Rivadeneira, M. Arfan Ikram, Josje D. Schoufour, and Trudy Voortman. "Total Dietary Antioxidant Capacity and Longitudinal Trajectories of Body Composition." Antioxidants 9, no. 8 (August 10, 2020): 728. http://dx.doi.org/10.3390/antiox9080728.
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Although there is some evidence that total dietary antioxidant capacity (TDAC) is inversely associated with the presence of obesity, no longitudinal studies have been performed investigating the effect of TDAC on comprehensive measures of body composition over time. In this study, we included 4595 middle-aged and elderly participants from the Rotterdam Study, a population-based cohort. We estimated TDAC among these individuals by calculating a ferric reducing ability of plasma (FRAP) score based on data from food-frequency questionnaires. Body composition was assessed by means of dual X-ray absorptiometry at baseline and every subsequent 3–5 years. From these data, we calculated fat mass index (FMI), fat-free mass index (FFMI), android-to-gynoid fat ratio (AGR), body fat percentage (BF%) and body mass index (BMI). We also assessed hand grip strength at two time points and prevalence of sarcopenia at one time point in a subset of participants. Data were analyzed using linear mixed models or multinomial logistic regression models with multivariable adjustment. We found that higher FRAP score was associated with higher FFMI (0.091 kg/m2 per standard deviation (SD) higher FRAP score, 95% CI 0.031; 0.150), lower AGR (−0.028, 95% CI −0.053; −0.003), higher BMI (0.115, 95% CI 0.020; 0.209) and lower BF% (−0.223, 95% CI −0.383; −0.064) across follow-up after multivariable adjustment. FRAP score was not associated with hand grip strength or sarcopenia. Additional adjustment for adherence to dietary guidelines and exclusion of individuals with comorbid disease at baseline did not change our results. In conclusion, dietary intake of antioxidants may positively affect the amount of lean mass and overall body composition among the middle-aged and elderly.
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Jansen, Pauline W., Ivonne P. M. Derks, Amber Batenburg, Vincent W. V. Jaddoe, Oscar H. Franco, Frank C. Verhulst, and Henning Tiemeier. "Using Food to Soothe in Infancy is Prospectively Associated with Childhood BMI in a Population-Based Cohort." Journal of Nutrition 149, no. 5 (April 16, 2019): 788–94. http://dx.doi.org/10.1093/jn/nxy277.
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ABSTRACT Background Feeding practices have been implicated in childhood overweight, but the long-term effects of using food to comfort a distressed child remain unknown. Objective This study examined whether the use of food to soothe in infancy was associated with later body composition, and whether children's eating behaviors mediate this relation. Methods Participants were 3960 children of Generation R, a population-based birth cohort in the Netherlands. Parents reported on the use of food to soothe when infants were 6 mo old and on child eating behavior (food responsiveness, emotional eating) at ages 4 and 10 y. Body mass index (BMI), fat mass, and fat-free mass were measured at ages 6 and 10 y. Linear regression and mediation analyses were conducted, accounting for various potential confounding factors. Results The use of food to soothe when infants were 6 mo old predicted a higher BMI from age 6 y onwards, independently of infant weight, maternal BMI, and other confounders. Specifically, frequent use was associated with a BMI z score 0.13 higher at age 10 y (95% CI: 0.03, 0.22) as compared with never use. Children's emotional eating mediated this association (indirect effect B = 0.04; 95% CI: 0.02, 0.06). The feeding–body composition association was most evident for fat mass (P for trend = 0.014) and somewhat less for fat-free mass (P for trend = 0.079). Conclusions The use of food to comfort a distressed infant was consistently associated with obesogenic eating behaviors and an unhealthy body composition throughout middle and late childhood. As our design precludes conclusions on causal associations, we recommend further studies with precise, repeated assessments of infant feeding practices. Such research can help ascertain the direction of effect, which is needed for establishing evidence-based guidelines for parents regarding the use of food to soothe early in life.
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Balestrin, Mariana, Carla Cristina Bauermann Brasil, Ericles Andrei Bellei, Vanessa Ramos Kirsten, and Mario Bernardes Wagner. "Program for Healthier School Cafeterias in Rio Grande do Sul, Brazil: Protocol for a Community-Based Randomized Trial." JMIR Research Protocols 10, no. 1 (January 19, 2021): e22680. http://dx.doi.org/10.2196/22680.
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Background School cafeterias can promote poor eating habits, as these retail outlets have a variety of foods considered to be nonnutritive and unhealthy. However, despite the need for effective preventive strategies, there is still disagreement on the best approach due to the lack of evidence on interventions to prevent and treat obesity in the school settings. Objective We aim to verify the efficacy of an educational intervention program to improve the hygienic conditions and the composition of the menu offered in school cafeterias in the state of Rio Grande do Sul, Brazil. Methods We will conduct a randomized, parallel, two-arm, community-based controlled study. Elementary and high schools, both public and private, in the State of Rio Grande do Sul, Brazil, that have a cafeteria will be eligible. Schools will be recruited and randomly assigned to the intervention (n=27) or control (n=27) group. The intervention group will receive an educational intervention program based on the guidelines issued by the Ministry of Health of Brazil, consisting of a 160-hour distance-learning qualification course, for 10 weeks, and using the Moodle platform and WhatsApp app. The intervention targets the owners and people in charge of the cafeterias, food handlers, principals, vice principals, teachers, pedagogical coordinators, dietitians, representatives of students' parents, and students over 16 years old. Meanwhile, the control group will receive only a printed copy of the book containing the guidelines used. The efficacy of the intervention will be determined by the hygienic conditions of the cafeteria and the composition of the menu offered, also considering the levels of processing of food sold. All outcomes will be analyzed as intention-to-treat and per-protocol. We will use covariance analysis or a generalized linear model for continuous data and ordinal logistic regression for ordinal categorical data. The level of statistical significance considered will be P<.05 for a 95% CI. Results This project was funded in early 2018. We administered the intervention program in 2019. All data have already been collected, and we are analyzing the data. The results are expected in 2021. Conclusions To our knowledge, this may be the first randomized controlled study in school cafeterias held in Brazil. The results will provide evidence for the formulation of public food and nutritional security policies and for the development of effective strategies to provide safe and healthy school meals. Trial Registration Brazilian Clinical Trials Registry RBR-9rrqhk; https://ensaiosclinicos.gov.br/rg/RBR-9rrqhk International Registered Report Identifier (IRRID) DERR1-10.2196/22680
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Mogilnicka, Izabella, Pawel Bogucki, and Marcin Ufnal. "Microbiota and Malodor—Etiology and Management." International Journal of Molecular Sciences 21, no. 8 (April 20, 2020): 2886. http://dx.doi.org/10.3390/ijms21082886.
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Accumulating evidence indicates that microbiota plays a critical role in physiological processes in humans. However, it might also contribute to body malodor by producing numerous odorous molecules such as ammonia, volatile sulfur compounds or trimethylamine. Although malodor is commonly overlooked by physicians, it constitutes a major problem for many otherwise healthy people. Thus, this review aims to investigate most common causes of malodor and describe potential therapeutic options. We searched PUBMED and Google Scholar databases to identify the clinical and pre-clinical studies on bad body smell, malodor, halitosis and microbiota. Unpleasant smell might originate from the mouth, skin, urine or reproductive fluids and is usually caused by odorants that are produced by resident bacterial flora. The accumulation of odorous compounds might result from diet, specific composition of microbiota, as well as compromised function of the liver, intestines and kidneys. Evidence-based guidelines for management of body malodor are lacking and no universal treatment exists. However, the alleviation of the symptoms may be achieved by controlling the diet and physical elimination of bacteria and/or accumulated odorants.
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Trestini, Ilaria, Isabella Sperduti, Alberto Caldart, Clelia Bonaiuto, Elena Fiorio, Veronica Parolin, Daniela Tregnago, et al. "Effect of evidence-based nutrition educational intervention on adherence to dietary guidelines (ADG) and weight management among early-stage breast cancer (EBC) patients (pts): A prospective trial." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): 12056. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.12056.
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12056 Background: Excess adiposity is linked to an increased risk of worse outcome among EBC pts. Pts undergoing EBC treatment are susceptible to change in nutrition status. However, implementation and assessment of the adherence to lifestyle interventions have been limited. This prospective trial aimed to evaluate the impact of an evidence-based nutrition intervention, according to the ADG, in terms of body composition changes in EBC pts. Methods: Entry criteria: EBC pts candidate to neoadjuvant/adjuvant therapy. At study entry, pts received a nutrition evidence-based tailored intervention. Dietary and anthropometric assessments were evaluated at baseline and after 12-months nutritional intervention. Waist circumference (WC) was assessed as a surrogate measure of fat distribution. ADG was estimated by Med-Diet 14-item questionnaire. Health-Related Quality of Life was analysed with EORTC QLQ-C30. Descriptive statistics was adopted. Associations between variables and groups according to nutritional variables were analysed (Chi-square test). Results: From February 2016 to December 2019, 243 pts were enrolled (median age 49 years): 27.6%/48.6% neoadjuvant/adjuvant treatment. At baseline, 38.3% of pts were overweight and 23.9% were obese. Notably, tumor size was significantly correlated with WC in the whole population (p = 0.003). Moreover, pts with central obesity were more likely to present HER2-negative tumors (57.4% vs. 42.5%, p = 0.03). Most pts reported relevant nutrition impact symptoms and symptoms affected QoL. Particularly, dyspepsia and constipation were more prevalent in overweight and obese pts (p < 0.0001 and p = 0.009, respectively), as well as in pts who gained ≥5% of weight (p = 0.04 and p = 0.02, respectively). At baseline, there was low ADG. After the 12-months intervention, ADG significantly increased (median Med-Diet score: 6 vs.12, p < 0.0001). A high ADG (defines as a Med-Diet score ≥10) significantly correlated with: 1) loss of weight ≥5% from the baseline weight (p = 0.003); 2) change in terms of BMI; 3) prevalence of central obesity. Conclusions: A tailored evidence-based nutritional intervention for EBC pts represents a tool to improve their ADG, weight management and, thus, to potentially influence the disease outcome. [Table: see text]
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Kenđel Jovanović, Gordana, Ines Mrakovcic-Sutic, Sandra Pavičić Žeželj, Branislav Šuša, Dario Rahelić, and Sanja Klobučar Majanović. "The Efficacy of an Energy-Restricted Anti-Inflammatory Diet for the Management of Obesity in Younger Adults." Nutrients 12, no. 11 (November 22, 2020): 3583. http://dx.doi.org/10.3390/nu12113583.
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There is growing evidence of the dietary impact on obesity-induced low-grade chronic inflammation and the associated chronic non-communicable diseases modification. We determined changes in body composition and cardiometabolic and inflammatory status of participants with obesity after 24 weeks of a dietary intervention based on an energy-reduced anti-inflammatory diet and examined the relationship of these changes with changes in the inflammatory potential of the diet. The anthropometric and body composition parameters of 81 participants (average age of 43 years, 74 women) were assessed. Metabolic status was determined using the glycemic and lipid statuses, and the cardiometabolic index and inflammatory status were determined using the concentration of high-sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6), and tumor necrosis factor α (TNF-α). The inflammatory potential of the diet was assessed using the Dietary Inflammatory Index (DII®). Intervention with an anti-inflammatory diet resulted in a significant reduction in body weight and visceral adipose tissue and caused improvements in the participants’ cardiometabolic and inflammatory statuses. The anti-inflammatory diet was shown to be effective regarding obesity management. The study data could advance current scientific knowledge in the field of inflammation and diet, provide guidelines for obesity management, and find its application in routine clinical practice.
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Misiura, Maciej M., João A. N. Filipe, Carrie L. Walk, and Ilias Kyriazakis. "How do pigs deal with dietary phosphorus deficiency?" British Journal of Nutrition 124, no. 3 (March 16, 2020): 256–72. http://dx.doi.org/10.1017/s0007114520000975.
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AbstractFeeding strategies for growing monogastric livestock (particularly pigs) must focus on maximising animal performance, while attempting to reduce environmental P load. Achieving these goals requires a comprehensive understanding of how different P feeding strategies affect animal responses and an ability to predict P retention. Although along with Ca, P is the most researched macromineral in pig nutrition, knowledge gaps still exist in relation to: (1) the effects of P feed content on feed intake (FI); (2) the impact of P intake on body composition; (3) the distribution of absorbed P to pools within the body. Here, we address these knowledge gaps by gathering empirical evidence on the effects of P-deficient feeds and by developing a predictive, mechanistic model of P utilisation and retention incorporating this evidence. Based on our statistical analyses of published literature data, we found: (1) no change in FI response in pigs given lower P feed contents; (2) the body ash–protein relationship to be dependent upon feed composition, with the isometric relationship only holding for pigs given balanced feeds and (3) the priority to be given towards P retention in soft tissue over P retention in bones. Subsequent results of the mechanistic model of P retention indicated that a potential reduction in P feeding recommendations could be possible without compromising average daily gain; however, such a reduction would impact P deposition in bones. Our study enhances our current knowledge of P utilisation and by extension excretion and could contribute towards developing more accurate P feeding guidelines.
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Guillamón, Enrique, Pedro Andreo-Martínez, Nuria Mut-Salud, Juristo Fonollá, and Alberto Baños. "Beneficial Effects of Organosulfur Compounds from Allium cepa on Gut Health: A Systematic Review." Foods 10, no. 8 (July 21, 2021): 1680. http://dx.doi.org/10.3390/foods10081680.
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Dietary changes affect the composition and structure of gut microbiota (GM) in animals and humans. One of the beneficial effects of consuming products derived from plants is the positive influence on immunity and gastrointestinal health. Species belonging to the genus Allium contain many organosulfur compounds (OSCs) that have been widely studied showing their biological properties and beneficial effects on intestinal health and GM. This is the first systematic review of OSCs from Allium performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and it is based on the evidence that we found in literature about the benefits on the GM and intestinal health demonstrated by OSCs from Allium, and specifically from onion. OSCs from Allium cepa have shown a significant antibacterial activity against a broad spectrum of antibiotic-resistant Gram-positive and Gram-negative bacteria. In addition, the intake of OSCs from onion was able to modulate the composition of GM, increasing the beneficial bacterial populations in animal models. Moreover, the beneficial effects observed in murine models of colitis suggest that these compounds could be suitable candidates for the treatment of inflammatory bowel disease (IBD) or reverse the dysbiosis caused by a high-fat diet (HFD). Despite the evidence found both in vitro and in vivo, we have not found any article that tested OSCs different from allicin in clinical trials or dietary intervention studies in humans. In this sense, it would be interesting to conduct new research that tests the benefits of these compounds in human GM.
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Milano, Walter, and Anna Capasso. "Psychopharmacological Options in the Multidisciplinary and Multidimensional Treatment of Eating Disorders." Open Neurology Journal 13, no. 1 (February 28, 2019): 22–31. http://dx.doi.org/10.2174/1874205x01913010022.
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Eating Disorders (ED) are a syndrome characterized by persistent alteration of eating behavior and the conditions that cause insufficient ingestion and/or adsorption of foods. There are three different ED diseases: Anorexia Nervosa (AN), Bulimia Nervosa (BN) and Binge Eating Disorders (BED). ED are complex conditions that arise from a combination of long-standing behavioral, emotional, psychological, interpersonal, and social factors. A common trait to all EDs is the incongruous diet, often based on arbitrary parameters, disconnected from physiological needs, with a strong alteration of the sensations of hunger and satiety, to which variations in weight, body composition, health status and quality of life of patients occur. Although EDs are relatively frequent psychiatric disorders in the general population, especially in adolescent and juvenile age groups, evidence based on the scientific evidence of the efficacy of the pharmacological treatment of EDAs remains modest. The currently available international guidelines related to the pharmacological treatment of EDs are currently few and not always adequately informative, as they are affected by the lack of studies on the subject. As a further consequence of this it is not surprising that, with the sole exception of fluoxetine for the treatment of Bulimia Nervosa (BN) symptoms, no psychopharmaceutical has been authorized by national and international regulators for the treatment of ED. This narrative review focuses on the advantages and limitations of drugs used in the treatment of ED.
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Jain, Swati, and Sobhana Ranjan. "Evidence that maintaining optimal nutrition status for well-functioning immune system might promote recovery for mild COVID-19 patients." World Nutrition 11, no. 4 (December 30, 2020): 66–93. http://dx.doi.org/10.26596/wn.202011466-93.
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COVID-19 is a viral infectious disease caused by SARS-COV2. Its clinical signs and symptoms are on a broad spectrum ranging from asymptomatic to severe complications like multi-organ failure, thromboembolism, and severe pneumonia with respiratory failure. Worse outcomes and higher mortality rates have been reported in the elderly, people with co-morbidities, and malnourished individuals. Nutrition is fundamental to good health and immune function. It forms an integral component of treatment modalities for various acute and chronic diseases, especially where a causative treatment is not yet recognized. Taking into consideration the magnitude of demands this pandemic has posed on hospital resources, an orderly assessment of nutritional status and body composition may not be possible for critically ill and/or for patients with mild-moderate symptoms who are managing their illness at home. Adequate intake of various macro and micro-nutrients--energy, protein, fat, vitamins--A, B, C, D, E and minerals--iron, selenium, zinc, and copper, along with supportive health practices like hydration, meal consistency, frequency of meal consumption and physical activity, often ameliorate respiratory infections, in part by modulating the immune response. Though at present there is a lack of well-defined nutrition-based guidelines for COVID-19 patient care, this paper brings forward the existing relevant evidence base for caregivers and patients to use as a reference/guide.
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Pepin, Alexandra, Kimber L. Stanhope, and Pascal Imbeault. "Are Fruit Juices Healthier Than Sugar-Sweetened Beverages? A Review." Nutrients 11, no. 5 (May 2, 2019): 1006. http://dx.doi.org/10.3390/nu11051006.
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Free sugars overconsumption is associated with an increased prevalence of risk factors for metabolic diseases such as the alteration of the blood lipid levels. Natural fruit juices have a free sugar composition quite similar to that of sugar-sweetened beverages. Thus, could fruit juice consumption lead to the same adverse effects on health as sweetened beverages? We attempted to answer this question by reviewing the available evidence on the health effects of both sugar-sweetened beverages and natural fruit juices. We determined that, despite the similarity of fruits juices to sugar-sweetened beverages in terms of free sugars content, it remains unclear whether they lead to the same metabolic consequences if consumed in equal dose. Important discrepancies between studies, such as type of fruit juice, dose, duration, study design, and measured outcomes, make it impossible to provide evidence-based public recommendations as to whether the consumption of fruit juices alters the blood lipid profile. More randomized controlled trials comparing the metabolic effects of fruit juice and sugar-sweetened beverage consumption are needed to shape accurate public health guidelines on the variety and quantity of free sugars in our diet that would help to prevent the development of obesity and related health problems.
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van Neerven, R. J. Joost, and Huub F. J. Savelkoul. "The Two Faces of Cow’s Milk and Allergy: Induction of Cow’s Milk Allergy vs. Prevention of Asthma." Nutrients 11, no. 8 (August 19, 2019): 1945. http://dx.doi.org/10.3390/nu11081945.
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Cow’s milk has been consumed by humans for over 5000 years and contributed to a drastic change in lifestyle form nomadic to settled communities. As the composition of cow’s milk is relatively comparable to breast milk, it has for a very long time been used as an alternative to breastfeeding. Today, cow’s milk is typically introduced into the diet of infants around 6 months, except when breastfeeding is not an option. In that case, most often cow’s milk based infant formulas are given. Some children will develop cow’s milk allergy (CMA) during the first year of life. However, epidemiological evidence also suggests that consumption of unprocessed, “raw” cow’s milk is associated with a lowered prevalence of other allergies. This Special Issue of Nutrients on “Cow’s Milk and Allergy” (https://www.mdpi.com/journal/nutrients/special_issues/milk_allergy) is dedicated to these two different sides of cow’s milk and allergy, ranging from epidemiology of CMA, clinical presentation and sensitization patterns, treatment and prevention, effects of milk processing, and current management guidelines for CMA, but also the epidemiological evidence linking cow’s milk to lower asthma prevalence as well as the tolerance-inducing effect of raw cow’s milk in food allergy models. In this editorial, we discuss these issues by highlighting the contributions in this Special Issue.
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Deledda, Andrea, Giuseppe Annunziata, Gian Carlo Tenore, Vanessa Palmas, Aldo Manzin, and Fernanda Velluzzi. "Diet-Derived Antioxidants and Their Role in Inflammation, Obesity and Gut Microbiota Modulation." Antioxidants 10, no. 5 (April 29, 2021): 708. http://dx.doi.org/10.3390/antiox10050708.
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It is generally accepted that gut microbiota, inflammation and obesity are linked to the development of cardiovascular diseases and other chronic/non-communicable pathological conditions, including cancer, neurodegenerative diseases and ageing-related disorders. In this scenario, oxidative stress plays a pivotal role. Evidence suggests that the global dietary patterns may represent a tool in counteracting oxidative stress, thus preventing the onset of diseases related to oxidative stress. More specifically, dietary patterns based on the regular consumption of fruits and vegetables (i.e., Mediterranean diet) have been licensed by various national nutritional guidelines in many countries for their health-promoting effects. Such patterns, indeed, result in being rich in specific components, such as fiber, minerals, vitamins and antioxidants, whose beneficial effects on human health have been widely reported. This suggests a potential nutraceutical power of specific dietary components. In this manuscript, we summarize the most relevant evidence reporting the impact of dietary antioxidants on gut microbiota composition, inflammation and obesity, and we underline that antioxidants are implicated in a complex interplay between gut microbiota, inflammation and obesity, thus suggesting their possible role in the development and modulation of chronic diseases related to oxidative stress and in the maintenance of wellness. Do all roads lead to Rome?
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Lu, Mengmeng, Konstantin V. Krutovsky, and Carol A. Loopstra. "Predicting Adaptive Genetic Variation of Loblolly Pine (Pinus taeda L.) Populations Under Projected Future Climates Based on Multivariate Models." Journal of Heredity 110, no. 7 (October 2019): 857–65. http://dx.doi.org/10.1093/jhered/esz065.
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Abstract Greenhouse gas emission and global warming are likely to cause rapid climate change within the natural range of loblolly pine over the next few decades, thus bringing uncertainty to their adaptation to the environment. Here, we studied adaptive genetic variation of loblolly pine and correlated genetic variation with bioclimatic variables using multivariate modeling methods—Redundancy Analysis, Generalized Dissimilarity Modeling, and Gradient Forests. Studied trees (N = 299) were originally sampled from their native range across eight states on the east side of the Mississippi River. Genetic variation was calculated using a total of 44,317 single-nucleotide polymorphisms acquired by exome target sequencing. The fitted models were used to predict the adaptive genetic variation on a large spatial and temporal scale. We observed east-to-west spatial genetic variation across the range, which presented evidence of isolation by distance. Different key factors drive adaptation of loblolly pine from different geographical regions. Trees residing near the northeastern edge of the range, spanning across Delaware and Maryland and mountainous areas of Virginia, North Carolina, South Carolina, and northern Georgia, were identified to be most likely impacted by climate change based on the large difference in genetic composition under current and future climate conditions. This study provides new perspectives on adaptive genetic variation of loblolly pine in response to different climate scenarios, and the results can be used to target particular populations while developing adaptive forest management guidelines.
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McDonagh, Michelle. "Nutritional and Metabolic Support in Adults With Amyotrophic Lateral Sclerosis." Perspectives on Swallowing and Swallowing Disorders (Dysphagia) 22, no. 1 (March 2013): 12–16. http://dx.doi.org/10.1044/sasd22.1.12.
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Amyotrophic lateral sclerosis (ALS) is an incurable, degenerative, neuromuscular condition. Nutritional and metabolic support is an integral component of care for patients with ALS because those capable of maintaining a normal nutrition status exhibit a slower rate of disease progression. Although there are multiple barriers to maintaining a normal nutrition status, the multidisciplinary team approach can facilitate early identification of symptoms, early intervention, and better outcomes for these patients. Barriers that patients often encounter include dysphagia, hypermetabolism, hypometabolism, upper extremity weakness, early satiety, constipation, depression, and loss of appetite. The role of the registered dietitian in the multidisciplinary ALS clinic is to intervene by providing a high standard of nutrition support. Further research into other facets of nutrition for ALS could lead to new interventions to slow weight loss and provide evidence-based guidelines for nutrition professionals. Areas for further research include the use of appetite stimulants, dietary supplements, delayed gastric motility, diet composition, metabolic rate, and the development of a standard equation for estimation of caloric needs in ALS.
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Signorini, Cesare, Andrea Nobili, and Cristina Siligardi. "Sustainable mineral coating of alkali-resistant glass fibres in textile-reinforced mortar composites for structural purposes." Journal of Composite Materials 53, no. 28-30 (June 13, 2019): 4203–13. http://dx.doi.org/10.1177/0021998319855765.
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The mechanical performance of a silica-based mineral nano-coating applied to alkali-resistant glass textile-reinforced composite materials aimed at structural strengthening is investigated experimentally. The silica nano-film is directly applied to the alkali-resistant glass fabric by sol–gel deposition. Two lime mortars are adopted as embedding matrix, which differ by the ultimate compressive strength and elongation. Uni-axial tensile tests of prismatic coupons are carried out according to the ICC AC434 guidelines. Remarkable strength and ductility enhancements could be observed in the silica-coated group, as compared to the uncoated group, for both mortar types. Digital image correlation, electron scanning and optical microscopy provide evidence of improved interphase strength. X-ray diffraction of the anhydrous mortars brings out the role of the mineralogical composition of the embedding media on the overall bonding properties of the composites. Consideration of design limits and energy dissipation capabilities reveals the crucial role of matrix ductility in bringing the contribution of interphase enhancement to full effect. We conclude that best performance requires optimizing the pairing between fabric-to-matrix adhesion and matrix ductility.
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Wang, Ye, and Spencer D. Proctor. "Current issues surrounding the definition of trans-fatty acids: implications for health, industry and food labels." British Journal of Nutrition 110, no. 8 (April 18, 2013): 1369–83. http://dx.doi.org/10.1017/s0007114513001086.
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The definition of trans-fatty acids (TFA) was established by the Codex Alimentarius to guide nutritional and legislative regulations to reduce TFA consumption. Currently, conjugated linoleic acid (CLA) is excluded from the TFA definition based on evidence (primarily preclinical studies) implying health benefits on weight management and cancer prevention. While the efficacy of CLA supplements remains inconsistent in randomised clinical trials, evidence has emerged to associate supplemental CLA with negative health outcomes, including increased subclinical inflammation and oxidative stress (particularly at high doses). This has resulted in concerns regarding the correctness of excluding CLA from the TFA definition. Here we review recent clinical and preclinical literature on health implications of CLA and ruminant TFA, and highlight several issues surrounding the current Codex definition of TFA and how it may influence interpretation for public health. We find that CLA derived from ruminant foods differ from commercial CLA supplements in their isomer composition/distribution, consumption level and bioactivity. We conclude that health concerns associated with the use of supplemental CLA do not repudiate the exclusion of all forms of CLA from the Codex TFA definition, particularly when using the definition for food-related purposes. Given the emerging differential bioactivity of TFA from industrial v. ruminant sources, we advocate that regional nutrition guidelines/policies should focus on eliminating industrial forms of trans-fat from processed foods as opposed to all TFA per se.
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Mills, Lane, Smith, Grimaldi, Ross, and Stanton. "Precision Nutrition and the Microbiome Part II: Potential Opportunities and Pathways to Commercialisation." Nutrients 11, no. 7 (June 27, 2019): 1468. http://dx.doi.org/10.3390/nu11071468.
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Modulation of the human gut microbiota through probiotics, prebiotics and dietary fibre are recognised strategies to improve health and prevent disease. Yet we are only beginning to understand the impact of these interventions on the gut microbiota and the physiological consequences for the human host, thus forging the way towards evidence-based scientific validation. However, in many studies a percentage of participants can be defined as ‘non-responders’ and scientists are beginning to unravel what differentiates these from ‘responders;’ and it is now clear that an individual’s baseline microbiota can influence an individual’s response. Thus, microbiome composition can potentially serve as a biomarker to predict responsiveness to interventions, diets and dietary components enabling greater opportunities for its use towards disease prevention and health promotion. In Part I of this two-part review, we reviewed the current state of the science in terms of the gut microbiota and the role of diet and dietary components in shaping it and subsequent consequences for human health. In Part II, we examine the efficacy of gut-microbiota modulating therapies at different life stages and their potential to aid in the management of undernutrition and overnutrition. Given the significance of an individual’s gut microbiota, we investigate the feasibility of microbiome testing and we discuss guidelines for evaluating the scientific validity of evidence for providing personalised microbiome-based dietary advice. Overall, this review highlights the potential value of the microbiome to prevent disease and maintain or promote health and in doing so, paves the pathway towards commercialisation.
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Manzoor, Syed Amir, Geoffrey Griffiths, James Latham, and Martin Lukac. "Scenario-led modelling of broadleaf forest expansion in Wales." Royal Society Open Science 6, no. 5 (May 2019): 190026. http://dx.doi.org/10.1098/rsos.190026.
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Significant changes in the composition and extent of the UK forest cover are likely to take place in the coming decades. Current policy targets an increase in forest area, for example, the Welsh Government aims for forest expansion by 2030, and a purposeful shift from non-native conifers to broadleaved tree species, as identified by the UK Forestry Standard Guidelines on Biodiversity. Using the example of Wales, we aim to generate an evidence-based projection of the impact of contrasting policy scenarios on the state of forests in the near future, with the view of stimulating debate and aiding decisions concerning plausible outcomes of different policies. We quantified changes in different land use and land cover (LULC) classes in Wales between 2007 and 2015 and used a multi-layer perceptron–Markov chain ensemble modelling approach to project the state of Welsh forests in 2030 under the current and an alternative policy scenario. The current level of expansion and restoration of broadleaf forest in Wales is sufficient to deliver on existing policy goals. We also show effects of a more ambitious afforestation policy on the Welsh landscape. In a key finding, the highest intensity of broadleaf expansion is likely to shift from southeastern to more central areas of Wales. The study identifies the key predictors of LULC change in Wales. High-resolution future land cover simulation maps using these predictors offer an evidence-based tool for forest managers and government officials to test the effects of existing and alternative policy scenarios.
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Turocy, Paula Sammarone, Bernard F. DePalma, Craig A. Horswill, Kathleen M. Laquale, Thomas J. Martin, Arlette C. Perry, Marla J. Somova, and Alan C. Utter. "National Athletic Trainers' Association Position Statement: Safe Weight Loss and Maintenance Practices in Sport and Exercise." Journal of Athletic Training 46, no. 3 (May 1, 2011): 322–36. http://dx.doi.org/10.4085/1062-6050-46.3.322.
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Objective: To present athletic trainers with recommendations for safe weight loss and weight maintenance practices for athletes and active clients and to provide athletes, clients, coaches, and parents with safe guidelines that will allow athletes and clients to achieve and maintain weight and body composition goals.Background: Unsafe weight management practices can compromise athletic performance and negatively affect health. Athletes and clients often attempt to lose weight by not eating, limiting caloric or specific nutrients from the diet, engaging in pathogenic weight control behaviors, and restricting fluids. These people often respond to pressures of the sport or activity, coaches, peers, or parents by adopting negative body images and unsafe practices to maintain an ideal body composition for the activity. We provide athletic trainers with recommendations for safe weight loss and weight maintenance in sport and exercise. Although safe weight gain is also a concern for athletic trainers and their athletes and clients, that topic is outside the scope of this position statement.Recommendations: Athletic trainers are often the source of nutrition information for athletes and clients; therefore, they must have knowledge of proper nutrition, weight management practices, and methods to change body composition. Body composition assessments should be done in the most scientifically appropriate manner possible. Reasonable and individualized weight and body composition goals should be identified by appropriately trained health care personnel (eg, athletic trainers, registered dietitians, physicians). In keeping with the American Dietetics Association (ADA) preferred nomenclature, this document uses the terms registered dietitian or dietician when referring to a food and nutrition expert who has met the academic and professional requirements specified by the ADA's Commission on Accreditation for Dietetics Education. In some cases, a registered nutritionist may have equivalent credentials and be the commonly used term. All weight management and exercise protocols used to achieve these goals should be safe and based on the most current evidence. Athletes, clients, parents, and coaches should be educated on how to determine safe weight and body composition so that athletes and clients more safely achieve competitive weights that will meet sport and activity requirements while also allowing them to meet their energy and nutritional needs for optimal health and performance.
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LIM, Wai Feng, Suriati Mohd NASIR, Lay Kek TEH, Richard Johari JAMES, Mohd Hafidz Mohd IZHAR, and Mohd Zaki SALLEH. "The methanolic extract of Garcinia atroviridis (MeGa) reduces body weight and food intake, and improves lipid profiles by altering the lipid metabolism: a rat model." TURKISH JOURNAL OF BIOLOGY 44, no. 6 (December 14, 2020): 437–48. http://dx.doi.org/10.3906/biy-2005-2.
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Garcinia species are widely used for their slimming effects via increased fat burning and suppression of satiety. However, scientific evidence for the biological effects of Garcinia atroviridis (GA) is lacking. We investigated the phytochemical composition, safety profiles, and antioxidant and antiobesity effects of methanolic extracts of Garcinia atroviridis (MeGa) in obese female rats. Repeated dose toxicity studies were conducted according to the OECD guidelines. Upon sacrifice, haematological, biochemical, lipid profile, and serum-based metabolomics analyses were performed to evaluate metabolic expression changes and their related pathways. MeGa contains several phytochemical groups and GA fruit acids. MeGa was found to be nontoxic in both male and female rats with an oral lethal dose (LD50) of 2000 mg/kg. After 9 weeks of treatment, MeGa-treated obese rats had lower weight gain and better lipid profiles (cholesterol and triglyceride), which correlated with the altered metabolic pathways involved in the metabolism of lipid (glycerophospholipid) and biosynthesis of unsaturated fatty acid. In addition, MeGa caused differential metabolism pathways of arachidonic acid and tryptophan that affect the inflammatory response and suppression of appetite. We concluded that MeGa is safe, and its slimming effects are due to the differential metabolism of lipids
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Longde, Wang, Yin Ling, Hua Yang, Zuo Yi, Wang Yongjun, Ji Xunming, Niu Xiaoyuan, et al. "Fixed-Dose Combination Treatment After Stroke for Secondary Prevention in China." Stroke 46, no. 5 (May 2015): 1295–300. http://dx.doi.org/10.1161/strokeaha.114.007384.
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Background and Purpose— There is evidence and international consensus on the advantages and potential of a polypill for established cardiovascular disease patients to improve adherence in the secondary prevention of cardiovascular disease. This study aimed to estimate the numbers of stroke patients who would be eligible for the polypill strategy in China, and the suitable composition of a polypill, based on data of the China National Stroke Prevention Project. Methods— A total of 717 620 residents aged ≥40 years from 6 Chinese representative provinces were screened for prevalent stroke from 2011 to 2012 with an 84.4% response rate. Participants with a history of stroke received further investigation of risk factors and treatments. The potential need for treatment was classified according to the guidelines. Rates were standardized using the population composition of the Sixth National Population Census of China. Results— The standardized prevalence rate of stroke was 1.9%. Up to 93.1% of stroke patients were eligible for a polypill containing at least 2 types of medications, with 75.3% eligible for a statin and antiplatelet agent and 70.6% for antihypertensive and antiplatelet medications. Considering 3 therapies, 54% were eligible for antihypertensive, statin, and antiplatelet medications. The current treatment rate with all required combinations of separate pills was only 6.9%. Conclusions— A huge number of stroke patients in China require preventive therapy and would be eligible for a polypill. This study indicates that it would be reasonable to consider and assess the value of a polypill strategy to improve secondary prevention of stroke in China.