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Background: The Manchester Intermittent versus Daily Diet App Study (MIDDAS) tested the feasibility and potential efficacy of two remotely delivered low‐energy diet (LED) programmes (800 kcal/day) to support weight loss and remission of type 2 diabetes: continuous [CLED] (8 weeks of daily LED) and intermittent [ILED] (2 days of LED/week for 28 weeks). Understanding participant experiences can help us to understand the acceptability of LED programmes to people with type 2 diabetes, informing future programme development and implementation. Methods: Twenty participants (10 CLED; 10 ILED) took part in interviews conducted at the end of the active weight loss phase (CLED week 12, ILED week 28). Interviews were transcribed and analysed thematically using the template analysis approach, with an a priori focus on acceptability. Four themes are presented: prospective acceptability, intervention coherence and perceived effectiveness, opportunity costs and self‐efficacy. Results: Both remotely supported CLED and ILED interventions appeared acceptable to participants. CLED participants found the rapid initial weight loss phase comparatively easy and highly motivating but expressed more concerns around weight maintenance. ILED participants found the more gradual weight loss initially frustrating but expressed greater confidence in their longer‐term adherence. The importance of continued individualised support from healthcare professionals was emphasised, and evidence of weight loss and improvement in other medical markers through monitoring via the mobile phone app was useful. Conclusion: Different approaches to remotely delivered LEDs appear acceptable; therefore asking patients which approach may be more acceptable to them may be a useful way to offer individualised and tailored support. Key points: We interviewed people with type 2 diabetes (T2D) who had taken part in a randomised controlled trial comparing a continuous low‐energy diet (CLED) and an intermittent low‐energy diet (ILED) about how acceptable they found the interventions. We found that both diets appear to be acceptable to people with T2D. Discussing different (CLED/ILED) approaches and their potential benefits and challenges may better prepare patients for a LED, although further research to test the efficacy of ILED for diabetes remission is still required. [ABSTRACT FROM AUTHOR]

Abstract: Background: Childhood nutrition is important in optimising growth, development and future health. The present study compared dietary intakes of Australian children aged 4–8 years with (i) Australian Guide to Healthy Eating (AGHE) food group recommendations and (ii) age‐specific Nutrient Reference Values (NRVs), in addition to (iii) describing food group intakes of children meeting key NRVs. Methods: Data were obtained from a representative sample of children (n = 789) from the National Nutrition and Physical Activity Survey between May 2011 and June 2012. Parent‐reported 24‐h recall dietary data were disaggregated into five core food groups, along with energy‐dense, nutrient‐poor (EDNP) foods, with intakes being compared with AGHE recommendations. Food group intakes were compared for children meeting the NRVs for 10 nutrients used for the development of AGHE food groups. Chi‐squared and t‐tests were performed to determine differences in food group intakes with P < 0.05 considered statistically significant. Results: Only one child met the recommended daily servings for all AGHE core food groups and none met both core and energy‐dense, nutrient‐poor (EDNP) food group recommendations. The lowest level of alignment (percentage meeting recommendations) was for vegetables (4.6%) and the highest was for fruit (47.7%). Mean (SD) daily intake of EDNP foods [4.7 (3.2) serves day−1] accounted for 38.4% of total energy intakes. Children meeting key NRVs (n = 395) consumed greater daily servings of fruit [2.2 (1.7)], dairy [2.2 (1.2)] and EDNP foods [5.0 (3.4)] compared to the total sample (n = 789). Conclusions: Significant discrepancies exist between contemporary dietary patterns of Australian children and national recommendations. Future AGHE revisions should incorporate greater diversity of consumption patterns, including sub‐categories of EDNP foods. [ABSTRACT FROM AUTHOR]

Abstract: Background: Necrotising enterocolitis (NEC) is one of the most common life‐threatening emergencies of the gastrointestinal tract in preterm neonates. The present study aimed to determine the efficacy of oropharyngeal colostrum with respect to reducing NEC in preterm neonates. Methods: A literature search was conducted for various randomised control trials by searching the Cochrane Central Register of Controlled Trials, PubMed, EMBASE and ongoing clinical trials. Randomised or quasi‐randomised trials comparing oropharyngeal colostrum versus placebo in neonates (birthweight ≤ 1500 g or gestational age ≤ 32 weeks) were included in the review. The methodological quality of each trial was independently reviewed by the authors. For categorical and continuous variables, typical estimates for relative risk and typical estimates for weighted mean difference were calculated, respectively. A random effect model was assumed for meta‐analysis. Results: In total, four eligible trials were included in the review. Oropharyngeal colostrum therapy was not associated with a statistically significant reduction in the incidence of NEC stage ≥2 [typical relative risk (RR) = 0.64; 95% confidence interval (CI) = 0.27–1.49], mortality from any cause (typical RR = 0.86; 95% CI = 0.15–4.80) and time to reach full feed [typical weighted mean difference (WMD) = −3.26; 95% CI = −8.87 to 2.35]. Duration of hospital stay was significantly less in the control group (typical WMD = 9.77; 95% CI = 3.96–15.59). Conclusions: The current evidence is insufficient for recommending oropharyngeal colostrum as a routine clinical practice in the prevention of NEC. We emphasise the need for large randomised controlled trials with an adequate sample size and validated clinical outcomes in preterm neonates. [ABSTRACT FROM AUTHOR]

Abstract: Background: The ability to achieve optimal glycaemic control varies widely among individuals with type 1 diabetes. The present study aimed to explore the factors that are associated with optimal glycaemic control compared to suboptimal control. Methods: An observational study design was used to explore the association of various factors with glycaemic control. Surveys were completed by individuals who attended the type 1 diabetes clinic at a tertiary hospital in New South Wales (NSW), Australia. Clinical and demographic information and attendance at dietary review were also collected. Results: One hundred and three individuals completed the survey. Those with optimal control [glycated haemoglobin ≤7.0% (53 mmol mol−1)] had a significantly shorter mean (SD) duration of diabetes [10.1 (12.6) years versus 18.8 (12.8) years, P = 0.005), were less likely to omit basal and bolus insulin (18.2% versus 47.5%, P = 0.016; 36.4% versus 61.8%, P = 0.034, respectively), and were less likely to report low confidence in managing their diabetes (9.1% versus 35.4%, P = 0.017). Participants who were able to identify carbohydrate sources were significantly more likely to have attended dietary review in the past 12 months (60.5% versus 20.0%, P = 0.001). However, they were not more likely to have better glycaemic control. Conclusions: The present study identified that consistency in taking insulin and confidence in self‐management was associated with better glycaemic control. An association was also found between recent dietary review and better carbohydrate knowledge, although this did not translate into better glycaemic control. Future investigation into the application of carbohydrate knowledge is required. [ABSTRACT FROM AUTHOR]

Abstract: Background: Nonresponsive maternal child‐feeding interactions, such as restricting, pressurising and emotional feeding, can affect the ability of a child to self‐regulate intake and increase the risk of becoming overweight. However, despite findings that South Asian and Black children living in the UK are more likely to be overweight, UK research has not considered how maternal child‐feeding style might differ between ethnic groups. The present study aimed to explore variations in maternal child‐feeding style between ethnic groups in the UK, taking into account associated factors such as deprivation and parenting style. Methods: Six hundred and fifty‐nine UK mothers with a child who was aged 5–11 years old completed a questionnaire. Items included ethnicity and demographic data, as well as copies of the Child Feeding Questionnaire, Parental Feeding Styles Questionnaire and Parenting Styles and Dimensions Questionnaire. Results: Significant differences in perceived responsibility (P = 0.002), restriction (P = 0.026), pressure to eat (P = 0.045), instrumental feeding (P = 0.000) and emotional feeding (P = 0.000) were found between the groups. Mothers from South Asian backgrounds reported higher levels of pressure to eat, emotional feeding and indulgent feeding styles, whereas mothers from Chinese backgrounds reported greater perceived responsibility and restriction. Mothers from Black and White British backgrounds were not significantly higher with respect to any behaviour. Maternal child‐feeding style was also associated with deprivation and parenting style, although these did not fully explain the data. Conclusions: Understanding cultural factors behind maternal child‐feeding style, particularly around pressurising and indulgent feeding behaviours, may play an important part in reducing levels of children who are overweight and obese in the UK. [ABSTRACT FROM AUTHOR]

Abstract: Background: A tailored approach to nutrition and physical activity advice can support women following childbirth in managing barriers (i.e. time and childcare) to making healthy lifestyle changes. The aim of the present study was to evaluate the implementation, acceptability and preliminary efficacy of a personally tailored nutrition and exercise programme for postpartum women delivered via video‐consultations by an accredited practising dietitian (APD) and accredited exercise physiologist (AEP). Methods: In this feasibility study (VITAL change for mums), postpartum (3–12 months) women (body mass index ≥25 or >2 kg above pre‐pregnancy weight) who were seeking to achieve a healthy weight participated in a single‐arm intervention. Participants received up to five real‐time personalised video‐consultations (2 × APD, 2 × AEP, 1 × either) over the 8‐week intervention period. Implementation (recruitment, retention, utilisation), acceptability (participant satisfaction) and preliminary efficacy (anthropometry, dietary intake, cardiovascular fitness, physical activity level, psychological wellbeing) were assessed. Results: Thirty women [mean (SD) age 31.6 (3.1) years, body mass index 29.0 (4.0) kg m−2, 100% married/de facto, 80% university level education] were recruited within 10 days and 27 completed the study. Women's mean (SD) ratings (out of a score of 5) indicated satisfaction with the video‐consultations [4.4 (0.9)] and the online setting [4.5 (0.8)]. Women agreed that accessing an APD [4.4 (0.8)] and AEP [4.3 (0.9)] was easier using video‐consultations than attending an in‐person consultation. Statistically significant improvements in waist circumference, body composition, cardiorespiratory fitness, dietary intake and physical activity were observed from baseline to 8 weeks. Conclusions: The findings of the present study suggest that a nutrition and exercise intervention delivered by qualified health professionals via video‐consultations is feasible, acceptable and achieves positive outcomes for women following childbirth. [ABSTRACT FROM AUTHOR]

Abstract: Background: Postpartum weight retention (PPWR) increases the risk for obesity and complications during subsequent pregnancies. Few interventions have been successful in limiting PPWR in mothers. The present study assessed the effectiveness of the mums OnLiNE (Online, Lifestyle, Nutrition & Exercise) intervention with respect to reducing PPWR and improving diet, physical activity and sedentary behaviour. Methods: A subsample of first‐time mothers enrolled in the Extended Melbourne Infant Feeding Activity and Nutrition Trial (InFANT Extend) completed the nonrandomised mums OnLiNE intervention. Women in the intervention (I) group (n = 28) received access to an online calorie tracking program, smartphone app, three telephone counselling calls with a dietitian and written material. Women in two comparison groups (CI and C2) (n = 48; n = 43) were from the control (C1) and intervention (C2) arms of InFANT Extend and received no additional support. Weight and waist circumference were measured objectively. Written surveys assessed diet and physical activity. Sedentary behaviour was self‐reported. Linear and logistic regression assessed changes in outcomes between groups from 9 to 18 months postpartum. Results: Mean PPWR decreased in the (I) group (−1.2 kg) and the C2 group (−1.2 kg), although the changes were not significant. Mean waist circumference for all groups exceeded recommendations at baseline but decreased to below recommendations for women in the (I) group (78.3 cm) and significantly for the (I) group (−6.4 cm) compared to C1 (−1.1 cm; P = 0.002) and C2 (−3.3 cm; P = 0.001). Changes in diet, physical activity or sedentary behaviour were not significant. Conclusions: The online intervention reported in the present study shows promise with respect to reducing waist circumference in postpartum women. Further evidence of strategies that may improve weight and related behaviours in this target group is needed. [ABSTRACT FROM AUTHOR]

Abstract: Background: We assessed the nutritional risks among children hospitalised with acute burn injuries and their associated clinical outcomes using three nutritional risk screening (NRS) tools: Screening Tool for Risk of Impaired Nutritional Status and Growth (STRONGKIDS), Pediatric Yorkhill Malnutrition Score (PYMS) and Screening Tool for the Assessment for Malnutrition in Pediatrics (STAMP). Methods: This prospective cross‐sectional study was conducted from October 2015 to November 2016, in a regional burn centre. Patients were screened by two independent observers, using the three NRS tools. Results: A total of 100 children aged 3 months to 16.5 years were included. STRONGKIDS identified 16% of patients as having high risk, with being identified 45% by PYMS and 44% by STAMP. After adjustment for confounding factors in multivariate regression analysis, patients in the high‐risk group had significantly longer median (SD) lengths of stay [medium versus high risk: STRONGKIDS, 9.5 (6.6) versus 15.0 (24.2) days; PYMS, 8.5 (4.4) versus 13.0 (16.1) days; STAMP, 9.0 (5.7) versus 11.0 (17.4) days] and greater median (SD) weight loss [medium versus high risk: STRONGKIDS, 0.15 (0.8) versus ‐0.35 (0.8) kg; STAMP, 0.5 (0.7) versus 0 (0.1) kg] than patients in the medium‐risk group (P < 0.05). The strengths of agreement in the nutritional risk classification between the two observers were good (κ for STRONGKIDS = 0.61; PYMS = 0.79; STAMP = 0.75) (P < 0.01). Conclusions: The STRONGKIDS, PYMS and STAMP tools could be useful and practical for determining which hospitalised children with acute burn injuries will need additional nutritional intervention. [ABSTRACT FROM AUTHOR]

Abstract: Background: Undernutrition affects over 44% of hospitalised older people, who often dislike oral nutritional supplements (ONS). This review summarises the evidence for an alternative strategy, using energy and protein dense meals (via fortification) or snacks (supplementation) to increase the dietary energy and protein intake of older inpatients. Methods: A search was conducted through PubMed, EMBASE, CINAHL and the Cochrane database of systematic reviews (May 1996 to May 2016) that used fortification or supplementation to increase the energy or protein intake of patients (mean age ≥60 years) in hospitals or rehabilitation centres. Results: Ten articles (546 patients, mean age 60–83 years) were identified. Compared with usual nutritional care, six studies using either energy or protein based fortification and supplementation significantly increased intake of energy (250–450 kcal day−1) or protein (12–16 g day−1). Two studies enriched menus with both energy and protein, and significantly increased both energy (698 kcal day−1 and 21 kJ kg−1) and protein (16 g and 0.2 g kg−1) intake compared to usual care. ONS was similar to supplementation in one study but superior to fortification in another. Four studies reported good acceptability of enriched products and two studies that found they were cost‐effective. Conclusions: Compared with usual nutritional care, energy‐ and protein‐based fortification and supplementation could be employed as an effective, well‐tolerated and cost‐effective intervention to improve dietary intake amongst older inpatients. This strategy may be particularly useful for patients with cognitive impairment who struggle with ONS, and clinical trials are required to compare these approaches and establish their impact on functional outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Background: Low‐carbohydrate diets are becoming increasingly popular, although their dietary quality outside of clinical studies is unknown. A previous study analysed the dietary intake in people consuming a reduced‐carbohydrate diet (<40% calories). However, it is not clear what foods people consume when carbohydrate is reduced to below 26% of total calories. Methods: In the present cross‐sectional study, the dietary and nutrient intake collected via up to five consecutive 24‐h dietary recalls and a food frequency questionnaire of 444 individuals (aged 46‐79 years) consuming <26% of calories from carbohydrate (LCHO) was compared with that of 131 897 individuals consuming ≥45% calories from carbohydrate (NCHO) using the UK Biobank Dataset. Absolute cut‐offs to define the low‐carbohydrate group (<130 g day–1; n = 1953 versus ≥225 g day–1, n = 113 036) were also used. Results: Both NCHO (>45% calories and ≥225 g) groups consumed significantly more high‐sugar, high‐fat snacks [median 6.0, interquartile range (IQR) = 2.0–11.0 and median 6.0, IQR = 3.0–11.8, respectively) compared to the LCHO (<26% calories and <130 g) groups (median 0, IQR = 0–2.8 and median 1, IQR = 0–3.8, respectively) (P < 0.0001). Both LCHO groups reported consuming significantly more red meat, oily fish, nuts and seeds but fewer fruits, vegetables and pulses compared to the NCHO groups. In general, the consumption of oily fish, nuts, seeds and pulses was low across the whole cohort and differences in intake between the LCHO and NCHO groups were small. After adjusting for socio‐economic status, most differences remained. Conclusions: Carbohydrate restriction is associated with both beneficial and potentially deleterious dietary changes compared to a normal carbohydrate intake. [ABSTRACT FROM AUTHOR]

Abstract: Background: Evidence from healthcare professionals suggest that consumer compliance to healthy diet and lifestyle changes is often poor. The present study investigated the effect of advice provided by a physician or dietitian on consumer adherence to these measures combined with consuming foods with added plant sterols (PS) with the aim of lowering low‐density lipoprotein cholesterol (LDL‐C). Methods: One hundred mildly‐to‐moderately hypercholesterolaemic individuals were enrolled into a parallel, randomised, placebo‐controlled study. Dietitians (dietitian group; DG) advised 50 individuals in six weekly face‐to‐face behavioural therapy sessions, whereas the other 50 received standard advice from physicians (physician group, PG). Both groups consumed foods with added PS (three servings a day) for 6 weeks. Subsequently, all individuals were followed‐up for another 6 weeks under real‐life conditions. Blood lipids were measured at baseline and weeks 6 and 12 and 3‐day diet diaries were taken at weeks 1, 6 and 12. Results: Individuals in the DG significantly improved their dietary habits, physical activity and increased PS intake compared to the PG. After 6 weeks, LDL‐C decreased in both groups compared to baseline without any significant differences between groups. At week 12, LDL‐C was further significantly improved only in the DG (P = 0.006) compared to week 6. Total cholesterol, LDL‐C and triglycerides were significantly lower in the DG compared to the PG at week 12 after adjusting for levels at week 6 (P < 0.001, P < 0.001 and P = 0.009, respectively). Conclusions: Although structured counselling by dietitians and common standard advice by physicians were equally effective with respect to improving blood cholesterol after 6 weeks, dietitians were more effective in the longer‐term (i.e. 6 weeks after the end of the intervention period). [ABSTRACT FROM AUTHOR]

Abstract: Background: Although a contributory role of vitamin D levels for the development of chronic hepatitis C has been suggested, the efficacy of vitamin D supplementation in combination with conventional antiviral therapy consisting of pegylated interferon‐α (Peg‐IFN‐α) injection and oral ribavirin (RBV) remains unclear. We investigated its efficacy in the treatment of chronic hepatitis C via a meta‐analysis of randomised controlled trials. Methods: We searched PubMed, EMBASE, the Cochrane Library, ClinicalTrials.gov and the bibliographies of relevant articles to locate additional publications in September 2016. Three evaluators independently reviewed and selected eligible studies based on predetermined selection criteria. Results: Of 522 articles meeting our initial criteria, a total of seven open‐label, randomised controlled trials involving 548 participants, were included in the final analysis. Vitamin D supplementation in combination with Peg‐IFN‐α injection and oral RBV significantly increased the rate of viral response for hepatitis C at 24 weeks after treatment in a random‐effects meta‐analysis (relative risk = 1.30; 95% confidence interval = 1.04–1.62; I2 = 75.9%). Also, its significant efficacy was observed in patients with hepatitis C virus genotype 1, which is known to be refractory to antiviral therapy. Conclusions: In summary, we observed that additional use of vitamin D has a positive effect on sustained viral response rates of patients with chronic hepatitis C infection. However, we cannot establish the efficacy because of substantial heterogeneity, a small sample size and a low methodological quality. [ABSTRACT FROM AUTHOR]

Abstract: Background: There is limited research on the dietary behaviours of Canadian children at school, including where students obtain food from during school hours or whether lunch‐time food source influences diet quality. Methods: Nationally representative cross‐sectional data from 24‐h dietary recalls were analysed from the 2004 Canadian Community Health Survey (n = 4589). Dietary outcomes included school hour and school day dietary intakes and School Healthy Eating Index (S‐HEI) scores. Survey‐weighted covariate‐adjusted linear regression models examined differences in dietary outcomes across lunch‐time food source groups. Results: The majority of children (72.8%) reported bringing lunch from home, whereas fewer students obtained lunch from off‐campus locations (11.6%), schools (9.6%) or skipped lunch (5.9%). Compared to off‐campus lunches, home‐packed lunches were significantly higher in fibre, vitamins A, D and C, thiamin, magnesium, iron, grains, vegetables and fruit, but lower in total calories, fat and calories from minimally nutritious foods. Average school hour diet quality required improvement for all age groups, although S‐HEI scores did not differ significantly by lunch‐time food source among 6–8‐year‐old children. However, for children age 9–17 years, bringing a home‐packed lunch was associated with significantly higher S‐HEI scores compared to students obtaining lunch from off‐campus locations. After adjusting for age and sex, lunch‐time food source was also significantly associated with whole day dietary quality. Conclusions: Although the nutritional quality of off‐campus lunches was lower than home‐packed lunches, the quality of foods was suboptimal, regardless of food source. Strategies are needed to enhance access to nutritious foods on campus and improve the nutritional quality of packed lunches, which supply the majority of lunch‐time foods consumed by Canadian children. [ABSTRACT FROM AUTHOR]

Abstract: Background: Over 200 clinical trials have examined the effect of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) supplements on risk factors associated with cardiovascular disease. However, an updated analysis of the evidence is lacking. The aim of the present meta‐analysis was to quantify the effect of supplements containing EPA and DHA on risk factors for cardiovascular disease. Methods: An analysis was carried on 171 clinical trials with acceptable quality (Jadad score ≥3) that were identified from a comprehensive electronic search strategy of two databases (Pubmed and Cochrane Library). A random effect model was used to obtain an overall estimate on outcomes of interest. Heterogeneity between trial results was tested for using a standard chi‐squared test. Results: Compared with control, EPA and DHA supplements produced significant reductions of triglycerides of 0.368 mmol L−1 [95% confidence interval (CI) = −0.427 to −0.309], systolic blood pressure of 2.195 mmHg (95% CI = −3.172 to −1.217), diastolic blood pressure of 1.08 mmHg (95% CI = −1.716 to −0.444), heart rate of 1.37 bpm (95% CI = −2.41 to −0.325) and C‐reactive protein of 0.343 mg L−1 (95% CI = −0.454 to −0.232). This analysis indicates an increase in both low‐density lipoprotein cholesterol (mean difference = 0.150 mmol L−1; 95% CI = 0.058–0.243) and high‐density lipoprotein cholesterol (mean difference = 0.039 mmol L−1; 95% CI = 0.024–0.054). The triglyceride‐lowering effect was dose‐dependent. Conclusions: The lipid‐lowering, hypotensive, anti‐arrhythmic and anti‐inflammatory actions of EPA and DHA supplements were confirmed in this analysis of randomised placebo‐control blinded clinical trials. [ABSTRACT FROM AUTHOR]

Abstract: Background: The Patient‐Generated Subjective Global Assessment (PG‐SGA) is an instrument used to assess malnutrition and its risk factors. Some items of the PG‐SGA may be perceived as hard to comprehend or as difficult by healthcare professionals. The present study aimed to determine whether and how dietitians’ perceptions of comprehensibility and difficulty of the PG‐SGA change after a single training in PG‐SGA use. Methods: In this prospective evaluation study, Dutch PG‐SGA‐naïve dietitians completed a questionnaire regarding perceived comprehensibility and difficulty of the PG‐SGA before (T0) and after (T1) receiving a single training in the use of the instrument. Perceived comprehensibility and difficulty were operationalised by calculating item and scale indices for comprehensibility (I‐CI, S‐CI) and difficulty (I‐DI, S‐DI) at T0 and T1. An item index of 0.78 was considered acceptable, a scale index of 0.80 was considered acceptable and a scale index of 0.90 was considered excellent. Results: A total of 35 participants completed the questionnaire both at T0 and T1. All item indices related to comprehensibility and difficulty improved, although I‐DI for the items regarding food intake and physical examination remained below 0.78. Scale indices for difficulty and comprehensibility of the PG‐SGA changed significantly (P < 0.001) from not acceptable at T0 (S‐CI = 0.69; S‐DI = 0.57) to excellent for comprehensibility (S‐CI = 0.95) and acceptable for difficulty (S‐DI = 0.86) at T1. Conclusions: The findings of the present study suggest that significant improvement in PG‐SGA‐naïve dietitians’ perception of comprehensibility and difficulty of the PG‐SGA can be achieved quickly by providing a 1 day of training in the use of the PG‐SGA. [ABSTRACT FROM AUTHOR]

Background Price promotions are a promising intervention for encouraging healthier food purchasing. We aimed to assess the impact of a targeted direct marketing price promotion combined with healthy eating advice and recipe suggestions on the purchase of selected healthier foods by low income consumers. Methods We conducted a randomised controlled trial ( n = 53 367) of a direct marketing price promotion (Buywell) combined with healthy eating advice and recipe suggestions for low income consumers identified as 'less healthy' shoppers. Impact was assessed using electronic point of sale data for UK low income shoppers before, during and after the promotion. Results The proportion of customers buying promoted products in the intervention month increased by between 1.4% and 2.8% for four of the five products. There was significantly higher uptake in the promotion month ( P < 0.001) for the intervention group than would have been expected on the basis of average uptake in the other months. When product switching was examined for semi-skimmed/skimmed milk, a modest increase (1%) was found in the intervention month of customers switching from full-fat to low-fat milk. This represented 8% of customers who previously bought only full-fat milk. The effects were generally not sustained after the promotion period. Conclusions Short-term direct marketing price promotions combined with healthy eating advice and recipe suggestions targeted at low income consumers are feasible and can have a modest impact on short-term food-purchasing behaviour, although further approaches are needed to help sustain these changes. [ABSTRACT FROM AUTHOR]

Background Noncommunicable diseases, of which almost half are some form of cardiovascular disease (CVD), have overtaken communicable diseases as the world's major disease burden. There is growing evidence that indices of diet quality could have an association with a decreased risk of CVD in several countries. We aimed to examine the association between diet quality, as measured by the Alternative Healthy Eating Index (AHEI), and 10-year predicted CVD risk based on the Framingham Risk Score (FRS) in a group of Iranian employees. Methods A cross-sectional descriptive study was conducted on 296 (232 male, 64 female) employees aged ≥30 years selected by nonrandom sampling. AHEI was calculated according to a food frequency questionnaire with complementary questions on intake of cooking fats and oils among households. The 10-year risk of CVD was calculated based on FRS. Total and high-density lipoprotein-cholesterol, fasting blood sugar and blood pressure were measured to help in the calculation of FRS. Results AHEI did not have a significant relationship with FRS ( r = −0.02, P = 0.67). However, some of its components, such as the intake of nuts and soy groups ( r = −0.11, P = 0.04) and fruits ( r = −0.14, P = 0.01), had a significant relationship with a reduced risk of CVD. According to stepwise multiple linear regression results, for every single increase in the intake of fruit servings, there would be a 0.14 reduction in the 10-year CVD risk score (β = −0.14, P = 0.01). Conclusions The present study showed no significant relationship between AHEI and the 10-year predicted risk of CVD among Iranian employees. [ABSTRACT FROM AUTHOR]

Background In phenylketonuria ( PKU), there are no data available for children with respect to evaluating casein glycomacropeptide ( CGMP) as an alternative to phenylalanine-free protein substitutes [Phe-free L-amino acid ( AA)]. CGMP contains a residual amount of phenylalanine, which may alter blood phenylalanine control. Methods In a prospective 6-month pilot study, we investigated the effect on blood phenylalanine control of CGMP-amino acid ( CGMP- AA) protein substitute in 22 PKU subjects (13 boys, nine girls), median age (range) 11 years (6-16 years). Twelve received CGMP- AA and nine received Phe-free L- AA, (1 CGMP- AA withdrawal). Subjects partially or wholly replaced Phe-free L- AA with CGMP- AA. If blood phenylalanine exceeded the target range, the CGMP- AA dose was reduced and replaced with Phe-free L-amino acids. The control group remained on Phe-free L- AAs. Phenylalanine, tyrosine and Phe : Tyr ratio concentrations were compared with the results for the previous year. Results In the CGMP- AA group, there was a significant increase in blood phenylalanine concentrations (pre-study, 275 μmol L−1; CGMP- AA, 317 μmol L−1; P = 0.02), a decrease in tyrosine concentrations (pre-study, 50 μmol L−1; CGMP- AA, 40 μmol L−1; P = 0.03) and an increase in Phe : Tyr ratios (pre-study, Phe : Tyr 4.9:1; CGMP- AA, Phe : Tyr 8:1; P = 0.02). In the control group there was a non-significant fall in phenylalanine concentrations (pre-study 325μmol/L: study 280μmol/L [p = 0.9], and no significant changes for tyrosine or phe/tyr ratios [p = 0.9]. Children taking the CGMP-AA found it more acceptable to L-AA. Conclusions Blood phenylalanine control declined with CGMP- AA but, by titrating the dose of CGMP- AA, blood phenylalanine control remained within target range. The additional intake of phenylalanine may have contributed to the change in blood phenylalanine concentration. CGMP- AA use requires careful monitoring in children. [ABSTRACT FROM AUTHOR]

Background The present study aimed to develop a food frequency questionnaire ( FFQ) assessing dietary omega-3 long chain polyunsaturated fatty acid ( n-3 LCPUFA) intake in Australian children and to validate the FFQ against a 7-day food diary. Methods The investigation comprised a cross-sectional and validation study. The study setting was two private primary schools in the in the Illawarra region of New South Wales. Twenty-two Australian children, aged 9-13 years, who were not on a special diet or receiving medical care that limited their food choice in the 3 months prior to recruitment, were recruited into the study. Results A total of 131 items, classified according to seven food group categories, was included in the n-3 LCPUFA FFQ, as identified from published dietary surveys and a supermarket survey. Good correlations between the FFQ and the 7-day food diary were observed for eicosapentaenoic acid ( EPA) [ r = 0.691, 95% confidence interval (CI) = 0.51-0.83, P < 0.001], docosahexaenoic acid ( DHA) ( r = 0.684, 95% CI = 0.45-0.84, P < 0.001) and total n-3 LCPUFA ( r = 0.687, 95% CI = 0.48-0.85, P < 0.001). Bland-Altman plots showed an acceptable limit of agreement between the FFQ and the average 7-day food diary. However, the mean EPA, DHA and total n-3 LCPUFA intakes estimated from the FFQ were significantly higher than those from the average 7-day food diary estimates ( P < 0.001). Conclusions A novel n-3 LCPUFA FFQ that has been developed to estimate dietary n-3 LCPUFA intakes in Australian children has been shown to have relative validity. The FFQ provides a useful contribution to dietary assessment methodology in this age group; however, reproducibility remains to be demonstrated. [ABSTRACT FROM AUTHOR]

Background Mobile applications (apps) could support diabetes management through dietary, weight and blood glucose self-monitoring, as well as by promoting behaviour change. The present study aimed to evaluate diabetes apps for content, functions and behaviour change techniques ( BCTs). Methods Diabetes self-management apps for Android smartphones were searched for on the Google Play Store. Ten apps each from the following search terms were included; 'diabetes', 'diabetes type 1', 'diabetes type 2', 'gestational diabetes'. Apps were evaluated by being scored according to their number of functions and BCTs, price, and user rating. Results The mean ( SD) number of functions was 8.9 (5.9) out of a possible maximum of 27. Furthermore, the mean ( SD) number of BCTs was 4.4 (2.6) out of a possible maximum of 26. Apps with optimum BCT had significantly more functions [13.8; 95% confidence interval ( CI) = 11.9-15.9] than apps that did not (4.7; 95% CI = 3.2-6.2; P < 0.01) and significantly more BCTs (5.8; 95% CI = 4.8-7.0) than apps without (3.1; 95% CI = 2.2-4.1; P < 0.01). Additionally, apps with optimum BCT also cost more than other apps. In the adjusted models, highly rated apps had an average of 4.8 (95% CI = 0.9-8.7; P = 0.02) more functions than lower rated apps. Conclusions 'Diabetes apps' include few functions or BCTs compared to the maximum score possible. Apps with optimum BCTs could indicate higher quality. App developers should consider including both specific functions and BCTs in 'diabetes apps' to make them more helpful. More research is needed to understand the components of an effective app for people with diabetes. [ABSTRACT FROM AUTHOR]

Background It is challenging to identify malnutrition, which is a risk factor for poor outcome in patients with liver cirrhosis. In the present study, we aimed to investigate the prevalence of malnutrition among patients listed for liver transplantation, as assessed by different methods, and also to relate dual-energy X-ray absorptiometry ( DXA) to short-term post-transplant outcomes. Methods In this retrospective cohort study, we reviewed the medical records of 106 patients who underwent liver transplantation in 2009-2012. Body composition was assessed by the fat-free mass index ( FFMI) and fat mass index ( FMI) obtained using DXA. Severe infections within 1 month, length of stay in intensive care unit and length of hospital stay were endpoints of primary interest. Results The prevalence of malnutrition was 2-20% depending on sex and the assessment method. Thirty-nine (37%) patients developed severe infections within 1 month after liver transplantation. In multivariate analysis with logistic regression, body composition was significantly associated with post-operative infection when measured with FFMI ( P = 0.043) but not with FMI ( P = 0.087). Post-operative dialysis ( P = 0.004) and post-operative infections ( P < 0.001) were significantly associated with length of stay in hospital. Post-operative bleeding ( P = 0.015), duration of mechanical ventilation ( P < 0.001) and the need for dialysis ( P < 0.001), but not body composition, were significant predictors of the length of stay in the intensive care unit. Conclusions The prevalence of malnutrition depends on assessment method. FFMI is an independent predictor for early post-transplant infections. Body composition measured by DXA during the pretransplant evaluation provides valuable information about nutritional status in patients with liver cirrhosis. [ABSTRACT FROM AUTHOR]

Background Polycystic ovary syndrome ( PCOS) is the most common endocrine disease in reproductive age women. The present study aimed to determine the effects of Dietary Approaches to Stop Hypertension ( DASH) diet on reproductive hormones, plasma total antioxidant status and anthropometric indices in overweight and obese PCOS women. Methods In this randomised controlled clinical trial, 60 women with PCOS were randomly assigned to one of two diets with energy restriction: the DASH diet and a control diet. The DASH and control diets consisted of 50-55% carbohydrate, 15-20% protein and 25-30% total fat. The DASH diet was designed to be rich in vegetables, fruits, whole grains and low-fat dairy products, as well as low in saturated fats, cholesterol, refined grains and sweets. In the present study, the anthropometric indices, body composition, total testosterone, androstenedione, sex hormone binding globulin ( SHBG), free androgen index and 2,2′-diphenyl-1-picryylhydrazyl (DPPH) scavenging activity were measured before and after 3 months. Results The consumption of DASH diet compared to the control diet was associated with a significant reduction in weight [−5.78 (1.91) kg versus −4.34 (2.87) kg, P = 0.032], body mass index ( BMI) [−2.29 (0.15) kg m-2 versus −1.69 (0.20) kg m-2, P = 0.02], fat mass [−3.23(1.66) kg versus −2.13 (1.26) kg, P = 0.008] and serum androstenedione [−1.75 (1.39) ng mL-1 versus −1.02 (0.72) ng mL-1, P-value = 0.019]. Increased concentrations of SHBG [28.80 (21.71) versus 11.66(18.82) nmol L-1, P = 0.003) and DPPH scavenging activity [30.23% (19.09) versus 12.97% (25.12) were also found in the DASH group. Conclusions The DASH diet could improve weight loss, BMI and fat mass. Furthermore, it could result in a significant reduction in serum androstenedione and a significant increase in antioxidant status and SHBG. [ABSTRACT FROM AUTHOR]

Background In highly invasive diseases, metabolism commonly changes. Hypercatabolism is frequent in acute stroke, and nitrogen balance tends to be negative. However, there has been no study describing nitrogen balance in subacute and chronic stroke patients. The present study aimed to examine nitrogen balance in the subacute and chronic phases and to identify the factors related to it. Methods Nitrogen balance was calculated from the collected urine of 56 patients with subacute stroke [mean (SD) 53.8 (18.4) days post-stroke] who were admitted for rehabilitation for their first-ever ischaemic or nonsurgical haemorrhagic stroke. In the first experiment, their nitrogen balance was measured during the rehabilitation phase, and factors (type, severity of hemiparesis, activities of daily living, dysphagia and malnutrition status) related to it were evaluated. The second experiment was performed to describe the time course of nitrogen balance in 31 consecutive patients, with assessments made at admission and at discharge. Results Nitrogen balance was positive in all patients in the subacute phase. A significant difference was seen in nitrogen balance between high and low fat-free mass in male patients. In the chronic phase, nitrogen balance was positive in 96% of the patients. There was no significant difference in nitrogen balance between discharge and admission. Conclusions In the subacute and chronic phases of stroke, it was confirmed that hypercatabolism had resolved and that intensive rehabilitation is possible in the convalescent period of stroke. [ABSTRACT FROM AUTHOR]

Background This meta-analysis investigated the association of diet quality indices, as assessed by HEI and AHEI, and the risk of all-cause, cardiovascular and cancer mortality. Methods We used PubMed, ISI Web of Science and Google Scholar to search for eligible articles published before July 2015. A total of 12 cohort studies (38 reports) and one cross-sectional study (three reports) met the inclusion criteria and were included in our meta-analysis. Results The highest level of adherence to the Healthy Eating Index (HEI) and Alternative Healthy Eating Index (AHEI) was significantly associated with a reduced risk of all-cause mortality [relative risk (RR) = 0.77, 95% confidence intterval (CI) = 0.76-0.78], cardiovascular mortality (RR = 0.77, 95% CI = 0.74-0.80) and cancer mortality (RR = 0.83, 95% CI = 0.81-0.86). Egger regression tests provided no evidence of publication bias. Conclusions The present study indicates that high adherence to HEI and AHEI dietary patterns, indicating high diet quality, are associated with reduced risk of all-cause mortality (as well as cardiovascular mortality and cancer mortality). [ABSTRACT FROM AUTHOR]

Background The present study aimed to investigate the association between dietary carbohydrate components and polycystic ovary syndrome ( PCOS) in Iran. Methods In this case-control study, the diagnosis of PCOS was made based on the Rotterdam criteria in hospital clinics. Dietary assessments were performed using a validated semi-quantitative food frequency questionnaire. In total, 281 women with incident PCOS and 472 age-matched controls were assessed. Participants were interviewed through the clinics in Tehran, Iran, from February 2012 until March 2014. Average dietary glycaemic index ( GI) and glycaemic load ( GL) were calculated using GI of Iranian Foods Table and international tables of GI and GL values. We also assessed total dietary carbohydrate, refined grains, whole grains and fibre intakes. Results Participation rates were 97.5% among cases and 96.3% among controls. Mean ( SD) dietary GI values among the controls and cases were 51.8 (4.7) and 59.7 (5.9) ( P = 0.02) and GL values were 155.34 (35.2) and 173.6 (39.1) ( P < 0.001), respectively. The multivariate adjusted odds ratio ( OR) comparing the highest tertile of dietary GI and GL with the lowest tertile were 2.18 [95% confidence interval ( CI) = 1.29-3.81; P-test for trend = 0.012] and 2.39 (95% CI = 1.23-3.01; P-test for trend = 0.001), respectively, with a significant trend. Fibre intake was inversely associated with PCOS ( OR = 0.73; 95% CI = 0.49-0.91; P-test for trend = 0.013). Conclusions The findings of the present study suggest that high dietary GI and GL and low fibre intake are significantly associated with PCOS. [ABSTRACT FROM AUTHOR]

Background Suboptimal nutrition accompanied by chronic low-grade increases in circulating cytokine levels is more common in elderly people. We explored the improvement in nutritional status, especially in the level of insulin-like growth factor-1 ( IGF-1) and its relationship with changes in circulating cytokine levels, after providing extra protein and energy content to community-dwelling older adults at risk of undernutrition. Methods Sixty nondiabetic subjects, aged ≥65 years and living independently in a community for elderly people, with a serum pre-albumin level ≤30 mg dL−1 and a body mass index <25 kg m−2, were recruited. The subjects were followed for a 2-week pre-intervention period, during which they maintained routine dietary habits. This was followed by an intervention period, during which they received oral nutritional supplementation for 2 weeks. Results Following 2 weeks of intervention, there were significant increases in total lymphocyte count ( TLC) and insulin-like growth factor ( IGF)-1, pre-albumin and transferrin compared to baseline. Body weight and mid-arm circumference significantly increased without alteration of tricep skinfold thickness at the end of the intervention. There was a significant reduction in interleukin ( IL)-6 levels and a trend toward a decrease in the tumor necrosis factor ( TNF)-α levels. At baseline, age was negatively correlated with IGF-1 levels and positively correlated with IL-6 and TNF-α levels. The change (▵, from baseline) in IGF-1 level was positively correlated with age and negatively correlated with ▵ IL-6 and ▵ TNF-α. Conclusions A 2-week intervention with oral nutritional supplementation improved nutritional status and decreased circulating cytokine levels. Specifically, ▵ IGF-1 was negatively correlated with changes in pro-inflammatory cytokine levels in community-dwelling elderly people at risk of undernutrition. (Clinicaltrials.gov: NCT02656186). [ABSTRACT FROM AUTHOR]

Background Being small for gestational age ( SGA), a foetal growth abnormality, has a long-lasting impact on childhood health. Its aetiology and underlying mechanisms are not well understood. Underlying epigenetic changes of imprinted genes have emerged as a potential pathological pathway because they may be associated with growth, including SGA. As a common methyl donor, folic acid ( FA) is essential for DNA methylation, synthesis and repair, and FA supplementation is widely recommended for women planning pregnancy. The present study aimed to investigate the inter-relationships among methylation levels of two imprinted genes [ H19 differentially methylated regions ( DMRs) and MEST DMRs], maternal FA supplementation and SGA. Methods We conducted a case-control study. Umbilical cord blood was taken from 39 SGA infants and 49 controls whose birth weights are appropriate for gestational age ( AGA). DNA methylation levels of H19 and MEST DMRs were determined by an analysis of mass array quantitative methylation. Results Statistically significantly higher methylation levels were observed at sites 7.8, 9 and 17.18 of H19 ( P = 0.030, 0.016 and 0.050, respectively) in the SGA infants compared to the AGA group. In addition, the association was stronger in male births where the mothers took FA around conception at six H19 sites ( P = 0.004, 0.005, 0.048, 0.002, 0.021 and 0.005, respectively). Conclusions Methylation levels at H19 DMRs were higher in SGA infants compared to AGA controls. It appears that the association may be influenced by maternal peri-conception FA supplementation and also be sex-specific. [ABSTRACT FROM AUTHOR]

Background Previous studies of the health effects of low-fat milk or dairy consumption on the metabolic syndrome have yielded inconsistent results. The present study aimed to investigate the effects of low-fat milk consumption on traits associated with the metabolic syndrome, as well as inflammatory and atherogenic biomarkers, in Korean adults with the metabolic syndrome. Methods Overweight Koreans with the metabolic syndrome ( n = 58) were recruited and randomly assigned to either the low-fat milk or control group. The low-fat milk group was instructed to consume two packs of low-fat milk per day (200 mL twice daily) for 6 weeks, and the control group was instructed to maintain their habitual diet. Clinical investigations were conducted during the screening visit, on study day 0, and after 6 weeks. Results No significant differences in changes in body mass index, blood pressure, lipid profile and adiponectin levels, as well as levels of inflammatory markers, oxidative stress markers and atherogenic markers, were found between the low-fat milk and control groups. However, compared to the controls, significant favourable decreases in serum soluble vascular adhesion molecule-1 and endothelin-1 levels were found in the 12 subjects with high blood pressure and in the 18 subjects with hypertriglyceridaemia in the low-fat milk group. Conclusions The present study did not demonstrate an overall beneficial effect of low-fat milk consumption in subjects with the metabolic syndrome. However, low-fat milk consumption may have a favourable effect on atherogenic markers in subjects with high blood pressure or hypertriglyceridaemia. [ABSTRACT FROM AUTHOR]

Background In order to achieve metabolic stability, dietary treatment of inborn errors of metabolism may require restriction of protein, fat or carbohydrate. Manipulation of dietary intake potentially reduces micronutrient status, and provision of a comprehensive vitamin and mineral supplement becomes an essential adjunct to dietary treatment. Aim To review the efficacy of a new complete vitamin and mineral supplement [Fruitivits, Vitaflo Ltd] in 14 subjects in an open prospective 26-week study. Method All subjects had dietary restrictions: low protein diets (57%, n = 8), regular daytime cornstarch and overnight glucose polymer tube feeds (29%, n = 4), low fat diet (7%, n = 1) and modified Atkins diet (7%, n = 1). Plasma nutritional biochemistry, anthropometry and food frequency questionnaires were collected at week 0, 12 and 26 weeks respectively. Results Five nutritional parameters showed a significant improvement from baseline (week 0) to study end (week 26): folate ( P = 0.01), vitamin E ( P = 0.04), plasma selenium ( P = 0.002), whole blood selenium ( P = 0.04) and total vitamin D ( P = 0.008). All the other nutritional markers did not significantly change. Even with regular monitoring, 37% of the product remained unused. Conclusions Despite improvements in some nutritional markers, overall use of the vitamin and mineral supplement was less than prescribed. New methods are needed to guarantee delivery of micronutrients in children at risk of deficiencies as a result of an essential manipulation of diet in inborn disorders of metabolism. [ABSTRACT FROM AUTHOR]

Background The present study evaluated the association between long-term, exclusive olive oil consumption, in cooking preparation or as a dressing, and the 10-year (2004-2014) incidence of acute coronary syndrome ( ACS) among cardiac patients. Methods From October 2003 to September 2004, a sample of 2172 ACS consecutive patients from six major Greek hospitals were enrolled. During 2013-2014, the 10-year follow-up was performed in 1918 patients (88% participation rate). The development of fatal or nonfatal ACS was recorded through medical records or hospital registries. Among other dietary components, added fats (i.e. olive oil, butter, margarine and seed oils) consumption at baseline examination was assessed using a semi-quantitative food frequency questionnaire. Results Non-exclusive olive oil consumption on a daily basis was associated with an adverse effect on the ACS incidence after taking into account various potential confounders [odds ratio ( OR) = 1.40, 95% confidence interval ( CI) = 1.05-1.86, P = 0.024]. However, significant interactions between olive oil consumption and body mass index ( BMI) ( P = 0.082) and educational level ( P = 0.054) led to further stratified analysis. Using BMI as strata (i.e. ≤29.9 versus >29.9 kg m-2), the above association remained significant only in obese patients ( OR = 1.80, 95% CI = 1.03-3.12, P = 0.038), whereas, on examining the education status (i.e. ≤9 versus >9 years of school), a significant association was observed only among the higher educated patients ( OR = 1.83, 95% CI = 1.01-3.32, P = 0.047). Conclusions Exclusive use of olive oil, either as a salad dressing or in cooking, should be promoted through the dietary management of ACS patients, with the aim of reducing the likelihood of recurrent cardiac episodes. [ABSTRACT FROM AUTHOR]

Background Insulin resistance promotes liver disease progression and may be associated with a lower response rate in treated hepatitis C virus ( HCV) infected patients. n-3 polyunsaturated fatty acid ( PUFA) supplementation may reduce insulin resistance. The present study aimed to evaluate the effect of n-3 PUFA supplementation on insulin resistance in these patients. Methods In a randomised, double-blind clinical trial, 154 patients were screened. After applying inclusion criteria, 52 patients [homeostasis model assessment index of insulin resistance ( HOMA- IR ≥2.5)] were randomly divided into two groups: n-3 PUFA ( n = 25/6000 mg day−1 of fish oil) or control ( n = 27/6000 mg day−1 of soybean oil). Both groups were supplemented for 12 weeks and underwent monthly nutritional consultation. Biochemical tests were performed at baseline and after intervention. Statistical analysis was performed using the Wilcoxon Mann-Whitney test for comparisons and the Wilcoxon test for paired data. Statistical package r, version 3.02 (The R Project for Statistical Computing) was used and P < 0.05 (two-tailed) was considered statistically significant. Results Comparisons between groups showed that n-3 PUFA supplementation was more effective than the control for reducing HOMA- IR ( P = 0.015) and serum insulin ( P = 0.016). The n-3 PUFA group not only showed a significant reduction in HOMA- IR 3.8 (3.2-5.0) versus 2.4 (1.8-3.3) ( P = 0.002); serum insulin 17.1 (13.8-20.6) μ IU mL−1 versus 10.9 (8.6-14.6) μ IU mL−1 ( P = 0.001); and glycated haemoglobin 5.4% (5.0-5.7%) versus 5.1% (4.8-5.6%) ( P = 0.011), but also presented an increase in interleukin-1 97.5 (0.0-199.8) pg mL−1 versus 192.4 (102.2-266.8) pg mL−1 ( P = 0.003) and tumour necrosis factor 121.2 (0.0-171.3) pg mL−1 versus 185.7 (98.0-246.9) pg mL−1 ( P = 0.003). Conclusions n-3 PUFA supplementation reduces insulin resistance in genotype 1 HCV infected patients. [ABSTRACT FROM AUTHOR]

Background There is little information available on the use of social support systems for patients with coeliac disease ( CD). We performed a cross-sectional study aiming to examine the association between participation in different types of social support networks and quality of life ( QOL) in adults with CD. Methods A survey including a validated CD specific QOL instrument was administered online and in-person to adults with CD who were following a gluten-free diet. Participation in social support networks (type, frequency and duration) were assessed. Results Among the 2138 participants, overall QOL scores were high, averaging 68.9 out of 100. Significant differences in QOL scores were found for age, length of time since diagnosis and level of education. Most (58%) reported using no social support networks. Of the 42% reporting use of social support networks (online 17.9%, face-to-face 10.8% or both 12.8%), QOL scores were higher for those individuals who used only face-to-face social support compared to only online support (72.6 versus 66.7; P < 0.0001). A longer duration of face-to-face social support use was associated with higher QOL scores ( P < 0.0005). By contrast, a longer duration and increased frequency of online social support use was associated with lower QOL scores ( P < 0.03). Conclusions Participation in face-to-face social support networks is associated with greater QOL scores compared to online social support networks. These findings have potential implications for the management of individuals with CD. Emphasis on face-to-face support may improve long-term QOL and patient outcomes. [ABSTRACT FROM AUTHOR]

Background In the general population, a higher Alternate Healthy Eating Index ( AHEI)-2010 score is related to decreased cardiovascular disease ( CVD) risk. Few studies have described the dietary patterns that reduce the risk of CVD or coronary heart disease ( CHD) in type 2 diabetes mellitus (T2 DM) patients. In the present study, the association between the American Diabetes Association ( ADA)-recommended dietary pattern, AHEI-2010 , and CVD risk factors and the CVD incidence over 52 months in T2 DM patients was evaluated. Methods The ADA score was developed from the ADA dietary recommendations. In this prospective study, the 24-h dietary recall of 124 adult T2 DM patients without nephropathy or chronic kidney disease was collected. The CVD risk factors were collected at baseline and at 6-month follow-up. Results Compared with lower ADA and AHEI-2010 score participants, the higher score participants exhibited a significantly lower waist circumference, serum low-density lipoprotein cholesterol level and 10-year risk of CHD. Participants with higher ADA dietary scores had a significantly reduced risk of central obesity and systolic blood pressure >140 mmHg. Higher AHEI-2010 scores were significantly related to a reduced risk of serum low-density lipoprotein cholesterol > 100 mg dL-1. Seven participants had their first-ever CVD during the follow-up period, although neither ADA score, nor AHEI-2010 score could predict CVD incidence. Conclusions The ADA-recommended dietary pattern and a higher AHEI-2010 score might both exhibit reduced risk factors of CVD in T2 DM patients. [ABSTRACT FROM AUTHOR]

Background Baby Boomer men (those born in 1946-1964) are becoming obese at an earlier age compared to previous generations. The present study aimed to identify weight-loss strategies used by Baby Boomer men, to determine whether those strategies varied by weight status and to explore their dieting experiences. Methods The study used a cross-sectional survey of 211 men and 20 in-depth interviews. Results Men had a mean (SD) body mass index ( BMI) of 29.35 (5.07) kg m-2, with 82% being overweight or obese. Fifty-six percent were currently trying to lose weight. Healthy weight-loss strategies included reducing portions, increasing physical activity, cutting back on fried foods, cutting back on sweets, cutting back on alcohol, using meal replacement drinks/bars and joining a weight-loss programme. Unhealthy strategies included skipping meals and using over-the-counter 'diet pills'. Men who reduced portions, skipped meals, cut back on sweets, joined a weight-loss programme and used diet pills had significantly higher BMIs than men who said they did not ( P < 0.05 for all). Interviews revealed that older men struggle to lose weight, 'I've been struggling for the last 2-3 years'. 'The last time I really tried to lose weight I stayed on the diet for just a day or two'. Wives were considered essential to their weight management success. Conclusions Men used a do-it-yourself weight-loss approach using both healthy and unhealthy strategies. Obese men were more likely to use unhealthy practices than overweight men. [ABSTRACT FROM AUTHOR]

Background Many older patients are undernourished after hospitalisation. Undernutrition impacts negatively on physical function and the ability of older patients to perform activities of daily living at home after discharge from acute hospital. The present study aimed to evaluate the evidence for an effect of individualised dietary counselling following discharge from acute hospital to home on physical function, and, second, on readmissions, mortality, nutritional status, nutritional intake and quality of life (QoL), in nutritionally at-risk older patients. Methods A systematic review of randomised controlled trials was conducted. The overall quality of the evidence was assessed according to Grading of Recommendations Assessment, Development and Evaluation system (GRADE) criteria. Results Four randomised controlled trials ( n = 729) were included. Overall, the evidence was of moderate quality. Dietitians provided counselling in all studies. Meta-analyses showed a significant increase in energy intake [mean difference (MD) = 1.10 MJ day−1, 95% confidence interval ( CI) = 0.66-1.54, P < 0.001], protein intake ( MD = 10.13 g day−1, 95% CI = 5.14-15.13, P < 0.001) and body weight ( BW) ( MD = 1.01 kg, 95% CI = 0.08-1.95, P = 0.03). Meta-analyses revealed no significant effect on physical function assessed using hand grip strength, and similarly on mortality. Narrative summation of effects on physical function using other instruments revealed inconsistent effects. Meta-analyses were not conducted on QoL and readmissions as a result of a lack of data. Conclusions Individualised dietary counselling by dietitians following discharge from acute hospital to home improved BW, as well as energy and protein intake, in older nutritionally at-risk patients, although without clearly improving physical function. The effect of this strategy on physical function and other relevant clinical outcomes warrants further investigation. [ABSTRACT FROM AUTHOR]

Background Behavioural weight-loss interventions utilising portion-controlled meals ( PCMs) produce significant decreases in weight. However, their impact on diet quality during weight maintenance is unknown. The present study aimed to assess the influence of a weight management intervention employing PCMs and increased physical activity on diet quality during weight loss and weight maintenance. Methods One hundred and ninety-seven overweight and obese adults [67% women; mean (SD) BMI = 34.0 (4.6) kg m−2; age = 46.1 (8.9) years] completed an 18-month trial. The weight-loss phase (0-6 months) consisted of energy restriction, which was achieved using PCMs plus fruits and vegetables and increased physical activity. During weight maintenance (6-18 months), participants consumed a diet designed to maintain weight loss. Body weight and dietary intake were assessed at baseline, and at 6, 12 and 18 months. The Healthy Eating Index-2010 ( HEI) was calculated using data obtained from 3-day food records. Results Mean (SD) body weight was 14.3% (6.6%) and 8.7% (8.0%) below baseline at 6 and 18 months, respectively. The mean (SD) HEI-2010 score after weight loss [66.6 (9.4)] was significantly higher than baseline [46.4 (8.9)] and remained significantly higher than baseline at 18 months [57.7 (10.6)] (both P < 0.001). Conclusions A weight management intervention using PCMs resulted in both clinically significant weight loss and increased diet quality scores, demonstrating that the use of PCMs during weight loss allows for meaningful changes in diet quality during weight maintenance. [ABSTRACT FROM AUTHOR]

Background The UK Eatwell Plate is consumer based advice recommending the proportions of five food groups for a balanced diet: starchy foods, fruit and vegetables, dairy foods, nondairy sources of protein and foods and drinks high in fat or sugar. Many foods comprise ingredients from several food groups and consumers need to consider how these fit with the proportions of the Eatwell Plate. This involves disaggregating composite dishes into proportions of individual food components. The present study aimed to match the diets of adults in Scotland to the Eatwell Plate dietary recommendations and to describe the assumptions and methodological issues associated with estimating Eatwell Plate proportions from dietary records. Methods Foods from weighed intake records of 161 females and 151 males were assigned to a single Eatwell group based on the main ingredient for composite foods, and the overall Eatwell Plate proportions of each subject's diet were calculated. Food group proportions were then recalculated after disaggregating composite foods. Results The fruit and vegetables and starchy food groups consumed were significantly lower than recommended in the Eatwell Plate, whereas the proportions of the protein and foods high in fat or sugar were significantly higher. Failing to disaggregate composite foods gave an inaccurate estimate of the food group composition of the diet. Conclusions Estimating Eatwell Plate proportions from dietary records is not straightforward, and is reliant on methodological assumptions. These need to be standardised and disseminated to ensure consistent analysis. [ABSTRACT FROM AUTHOR]

Background Children with severe congenital heart disease ( CHD) need considerable nutritional support to reach normal growth. The actual intake of macro- and micronutrients in outpatient CHD infants over a 6-month period in infancy is not described in the literature. The present study aimed to prospectively investigate the distribution between macro- and micronutrient intake, meal frequency and growth in children with CHD. Methods At 6, 9 and 12 months of age, a 3-day food diary and anthropometric data were collected in 11 infants with severe CHD and 22 healthy age- and feeding-matched controls. Macro- and micronutrient intake, meal frequency and growth were calculated. Results Compared to the healthy controls, CHD infants had a statistically significantly higher intake of fat at 9 months of age (4.8 versus 3.6 g kg−1day−1), a higher percentage energy (E%) from fat, (40.6% versus 34.5%) and a lower E% from carbohydrates (46.1% versus 39.6%) at 12 months of age, and a lower intake of iron (7.22 versus 9.28 mg day−1) at 6 months of age. Meal frequency was significantly higher at 6 and 9 months of age ( P < 0.01). Mean Z-score weight for height, weight for age and body mass index for age were significant lower ( P < 0.01) at all time points. Conclusions Despite a higher intake of energy from fat and a higher meal frequency, the intake does not meet the needs for growth, and the results may indicate a low intake of micronutrients in CHD infants. [ABSTRACT FROM AUTHOR]

Background Protein-energy wasting ( PEW) is a highly prevalent condition in haemodialysis patients ( HD). The potential usefulness of nutritional-inflammatory markers in the diagnosis of PEW in chronic kidney disease has not been established completely. We hypothesised that a combination of serum albumin, percentage of mid-arm muscle circumference and standard body weight comprises a better discriminator than either single marker of nutritional status in HD patients. Methods A cross-sectional study was performed in 80 HD patients. Patients were categorised in two groups: well-nourished and PEW. Logistic regression analysis was applied to corroborate the reliability of the three markers of PEW with all the nutritional-inflammatory markers analysed. Results PEW was identified in 52.5% of HD patients. Compared with the well-nourished patients, PEW patients had lower body mass index, serum pre-albumin and body cell mass (all P < 0.001) and higher C-reactive protein (s- CRP) ( P < 0.01). Logistic regression analyses showed that the combination of the three criteria were significantly related with s- CRP >1 mg dL−1, phase angle <4°, and serum pre-albumin <30 mg dL−1 (all P < 0.05). Other indicators, such as lymphocytes <20% and Charlson comorbidity index, were significantly involved (both P < 0.01). A receiver operating characteristic curve ( area under the curve) of 0.86 ( P < 0.001) was found. Conclusions The combined utilisation of serum albumin, percentage of mid-arm muscle circumference and standard body weight as PEW markers appears to be useful for nutritional-inflammatory status assessment and adds predictive value to the traditional indicators. Larger studies are needed to achieve the reliability of these predictor combinations and their cut-off values in HD patients and other populations. [ABSTRACT FROM AUTHOR]

Background In traditional medicine, marjoram herb ( Origanum majorana) is locally reputed for its ability to restore hormonal balance and to regulate the menstrual cycle. Therefore, this pilot study aimed to investigate the effects of marjoram tea on the hormonal profile of women with polycystic ovary syndrome ( PCOS) in a randomised, double-blind, placebo-controlled trial. Methods Twenty-five patients were assigned to receive marjoram tea or a placebo tea twice daily for 1 month (intervention group: n = 14; placebo group: n = 11). The hormonal and metabolic parameters measured at baseline, as well as after the intervention, were: follicle-stimulating hormone, luteinising hormone, progesterone, oestradiol, total testosterone, dehydroepiandrosterone-sulphate ( DHEA- S), fasting insulin and glucose, homeostasis model assessment for insulin resistance ( HOMA- IR) and glucose to insulin ratio. Results Marjoram tea significantly reduced DHEA- S and fasting insulin levels ( P < 0.05) by a mean (SD) of 1.4 (0.5) μmol L−1 and 1.9 (0.8) μU mL−1, respectively. In comparison to the placebo group, the change was only significant for DHEA- S ( P = 0.05) but not for insulin ( P = 0.08). HOMA- IR was not reduced significantly in the intervention group ( P = 0.06), although the change was significant compared to the placebo group ( P < 0.05). Conclusions The results obtained in the present study show the beneficial effects of marjoram tea on the hormonal profile of PCOS women because it was found to improve insulin sensitivity and reduce the levels of adrenal androgens. Further research is needed to confirm these results and to investigate the active components and mechanisms contributing to such potential beneficial effects of marjoram herb. [ABSTRACT FROM AUTHOR]

Background The benefits of short-term oral nutritional supplementation ( ONS) in undernourished children are well-established. The benefits of long-term ONS in promoting longitudinal growth and health in children who are at risk of undernutrition have not been reported previously. Methods In this 48-week prospective, single-arm, multicentre trial, 200 Filipino children aged 3-4 years with weight-for-height percentiles from 5th to 25th ( WHO Child Growth Standards) were enrolled. Parents received dietary counselling at baseline, and at weeks 4 and 8. Two servings of ONS (450 mL) were consumed daily, providing 450 kcal, 13.5 g protein and micronutrients. Weight, height, dietary intake using 24-h dietary recalls, and physical activity and appetite using the visual analogue scales were assessed at baseline and weeks 4, 8, 16, 24, 32, 40 and 48. The number of sick days for acute illnesses was collected over the study period. Results At baseline, mean age was 41.2 months with 50% being male. Weight-for-height percentiles showed the greatest increase in the first 4 weeks (12.1 and 12.8 percentiles, respectively, P < 0.0001) and remained significantly higher than baseline ( P < 0.0001) but were relatively stable from week 4 onwards. Height-for-age percentiles increased steadily over time and became significantly higher than baseline from week 24 onwards ( P < 0.0001). Appetite and physical activity scores at all post-baseline visits improved from baseline ( P < 0.0001), and a reduction in the number of sick days from week 16 onwards was also observed ( P < 0.0001). Higher parental education level, being male and higher baseline weight-for-height percentiles were significantly associated with higher ponderal and linear growth over time in repeated measures analysis of covariance. Conclusions Intervention consisting of initial dietary counselling and continued ONS helped sustain normal growth after a catch-up growth in nutritionally at-risk children. [ABSTRACT FROM AUTHOR]

Background Restriction of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) is an effective dietary treatment for irritable bowel syndrome ( IBS). Patient dietary education is essential but labour intensive. Group FODMAP education may alleviate this somewhat but has not previously been investigated. The present study aimed to investigate the clinical effectiveness of low FODMAP group education in patients with IBS and to explore the cost of a group pathway. Methods Patients with IBS ( n = 364) were assessed for their suitability to attend dietitian-led group education or traditional one-to-one education in a novel group pathway. Clinical effectiveness (global symptom question, symptom prevalence, stool output) were compared at baseline and follow-up using the chi-squared test. The costs of the novel group pathway were assessed using a decision model. Results The global symptom question indicated more patients were satisfied with their symptoms following dietary advice, in both group education [baseline 48/263 (18%) versus follow-up 142/263 (54%), P < 0.001] and one-to-one education [baseline 5/101 (5%) versus follow-up 61/101 (60%), P < 0.001], with no difference between group and one-to-one education at follow-up ( P = 0.271). Overall, there was a significant decrease in symptom severity from baseline to follow-up ( P < 0.001 for both groups) but no difference in symptom response between group and one-to-one education. The cost for the group education pathway for all 364 patients was £31 713.36. Conclusions The present study shows that dietitian-led FODMAP group education is clinically effective and the costs associated with a FODMAP group pathway are worthy of further consideration for routine clinical care. [ABSTRACT FROM AUTHOR]

Background Personality traits refer to habitual patterns of behaviour, thought and emotions, and have been shown to influence health professionals' career decisions, career development, job satisfaction and retention. There is an opportunity to better understand and support the career pathways of dietitians by exploring their personality traits. The two primary aspects of personality are: (i) temperament traits, which determine automatic emotional responses to experiences, and are generally stable over lifetime, and (ii) character traits, which reflect personal goals and values, and tend to develop with life experience. The present study explored the levels of temperament and character traits of dietitians, as well as their relationship to demographic variables. Methods The study comprised a cross-sectional online survey of 346 Australian dietitians [95% female; mean ( SD) age 32 (10) years; mean ( SD) time since graduation 7 (9) years]. Temperament and character traits were measured by the Temperament and Character Inventory. Key demographic variables were measured to describe career decisions and pathways of dietitians. Multivariate analyses of variance was used to investigate the relationship between demographic variables and personality traits. Results Levels of several traits were significantly associated with gender, age and highest level of education. In comparison to the general population, the dietitians displayed average levels of Novelty Seeking; high levels of Harm Avoidance, Reward Dependence, Persistence, Self-Directedness and Cooperativeness; and low levels of Self-Transcendence. Conclusions The dietitians in the present study displayed levels of personality traits that were similar to other health professionals, although they differed from the general population. These findings are the precursor to further work that may inform recruitment strategies and career counselling in dietetics. [ABSTRACT FROM AUTHOR]

Background Bioelectric impedance analysis ( BIA) is commonly used in research to assess body composition. However, studies that validate the accuracy of BIA exclusively in post-menopausal women are lacking. The main purpose of the present study was to evaluate the agreement of multi-frequency (MF)-BIA and single-frequency (SF)- BIA with dual-energy X-ray absorptiometry ( DXA) in the estimation of fat mass ( FM) and fat-free mass ( FFM) among post-menopausal women with variation in body mass index ( BMI) and physical activity ( PA). Methods FM and FFM were estimated by BIA and DXA in 146 post-menopausal women with a mean (SD) age of 62.8 (5.2) years. PA was determined by an accelerometer. Results The mean (SD) difference between MF- BIA and DXA was −1.8 (1.8) kg ( P = 0.08) and 1.3 (1.8) kg ( P = 0.01) for FM and FFM, respectively. SF- BIA provided a significantly lower estimate of FM [−2.0 (2.2) kg; P = 0.04] and a higher estimate of FFM [1.8 (2.4) kg; P < 0.01] compared to DXA. MF- BIA provided significantly better estimates of FM and FFM with narrower limits of agreement than SF- BIA in obese and insufficiently active subjects. In other BMI and PA groups, both BIA devices showed a similar deviation from DXA. Conclusions BIA tends to underestimate FM and overestimate FFM relative to DXA. MF- BIA appears to be a more appropriate method for the assessment of body composition than SF- BIA in post-menopausal woman with BMI >30 kg/m2 and in those who are insufficiently active. [ABSTRACT FROM AUTHOR]

Background Adequate hydration is key to good clinical care and essential for preventing problems in elderly patients such as constipation, pressure sores and confusion. The present study aimed to evaluate fluid provision and consumption in elderly patients against current standards for Scottish hospitals. Methods A service evaluation, of fluid provision and consumption over 24 h by elderly orthopaedic rehabilitation patients in a long-stay hospital in Scotland was conducted. Fluids provided and consumed from trolley services, those at meal times and beverages from jugs of water were measured. The average fluid content of a jug, cup and glass on each ward was determined. Each jug of water provided was recorded, as was the acceptance of hot and cold drinks offered. Intake was determined by measuring the leftover water in each jug when these were refreshed and any leftover liquid in patients' cups deducted from that provided. Observations were made with respect to the presentation and encouragement of fluids. Results Fifty-eight patients (12 males, 46 female, aged ≥65 years) were monitored, of whom 56 were provided with more than the recommended minimum fluid per day [mean ( SEM) = 2379 (82) mL]; however, mean intake was lower than recommended [mean ( SEM) = 1302 (60) mL; P = 0.002]. Provision of drinks from a trolley service [mean ( SEM) = 956 (44) mL] was less than fluid from jugs [mean ( SEM) = 1398 (54) mL; P = 0.002]; however, the consumption of drinks from the trolley was greater [77% consumed, mean ( SEM) = 770 (46) mL] than from jugs [41% mean ( SEM) = 514 (36) mL; P < 0.001]. Conclusions Patients consumed significantly more fluid from individual beverages than jugs. Consideration of the method of fluid provision is important with respect to influencing fluid intakes. [ABSTRACT FROM AUTHOR]

Background Asymmetrical dimethyl arginine ( ADMA) is a competitive inhibitor in the production of nitric oxide ( NO) from arginine and NO plays an important role in the preservation of vascular dilation. Elevated ADMA is a strong predictive factor for coronary artery disease ( CAD). Dietary Approaches to Stop Hypertension ( DASH) and Alternative Healthy Eating Index ( AHEI) patterns contain factors that may influence plasma ADMA levels. The present study examined the association between the DASH score and AHEI score with plasma ADMA concentration in people with suspected heart disease selected for coronary angiography. Methods This cross-sectional study was conducted in 148 people aged 40-80 years who were referred for coronary angiography. The DASH diet score and AHEI score were calculated for each individual based on food groups. Plasma ADMA levels were measured by high-performance liquid chromatography. Results ADMA concentrations were higher in the CAD group compared to the non- CAD group [0.98 (0.37) μmol L−1 compared to 0.84 (0.42) μmol L−1; P = 0.02]. There was a significant negative association between the quartile DASH score and ADMA concentration (standardised β = −0.172, P = 0.038). The ADMA concentration was lower in patients who were at the highest quartile of DASH score compared to patients with the lowest quintile score. The ADMA concentration and quartiles of AHEI score were not significantly associated. Conclusions Higher scores of the DASH diet are associated with lower plasma ADMA levels and with reduced coronary artery stenosis. [ABSTRACT FROM AUTHOR]

Background Hospital malnutrition is a significant problem that still remains under-recognised and under-treated in India. The present study assessed the effects of oral nutritional supplementation ( ONS) in conjunction with dietary counselling versus dietary counselling (control) alone in malnourished patients when given in hospital and post-hospital discharge. Methods The present study was conducted in nine private and four public hospitals. Patients from various medical wards were screened for malnutrition using modified Subjective Global Assessment ( mSGA) and randomised to control ( n = 106) or ONS ( n = 106) for 12 weeks. Two servings (460 mL) of ONS were prescribed daily, providing 432 kcal, 16 g of protein and 28 micronutrients. The primary outcome was weight gain over 12 weeks. Other outcomes included change in body mass index (BMI), serum pre-albumin, albumin and C-reactive protein levels, energy and nutrient intakes, and handgrip strength at weeks 4, 8 and 12, as well as mSGA score at week 12. Results The mean age of patients was 39 years. Fifty-five percent were males and 90.3% were moderately malnourished ( mSGA score B) at baseline. At week 12, ONS significantly improved certain parameters compared to control: weight (2.0 versus 0.9 kg; P < 0.001), BMI (0.76 versus 0.37 kg m-2; P < 0.001) and energy intake per day (560 versus 230 kcal; P < 0.05). There were no differences in biochemical parameters and mSGA score between groups. Additionally, patients on ONS who were more functionally impaired at baseline had significantly greater weight gain and improved handgrip strength scores than controls. Conclusions ONS use throughout hospital stay and post-hospital discharge significantly improved energy intake and weight in malnourished Indian patients. Those patients with poorer functional status at baseline demonstrated the most benefit. [ABSTRACT FROM AUTHOR]

Background Observational and experimental data support a potential breast cancer chemopreventive effect of green tea. Methods We conducted an ancillary study using archived blood/urine from a phase IB randomised, placebo-controlled dose escalation trial of an oral green tea extract, Polyphenon E (Poly E), in breast cancer patients. Using an adaptive trial design, women with stage I- III breast cancer who completed adjuvant treatment were randomised to Poly E 400 mg ( n = 16), 600 mg ( n = 11) and 800 mg ( n = 3) twice daily or matching placebo ( n = 10) for 6 months. Blood and urine collection occurred at baseline, and at 2, 4 and 6 months. Biological endpoints included growth factor [serum hepatocyte growth factor ( HGF), vascular endothelial growth factor ( VEGF)], lipid (serum cholesterol, triglycerides), oxidative damage and inflammatory biomarkers. Results From July 2007-August 2009, 40 women were enrolled and 34 (26 Poly E, eight placebo) were evaluable for biomarker endpoints. At 2 months, the Poly E group (all dose levels combined) compared to placebo had a significant decrease in mean serum HGF levels (−12.7% versus +6.3%, P = 0.04). This trend persisted at 4 and 6 months but was no longer statistically significant. For the Poly E group, serum VEGF decreased by 11.5% at 2 months ( P = 0.02) and 13.9% at 4 months ( P = 0.05) but did not differ compared to placebo. At 2 months, there was a trend toward a decrease in serum cholesterol with Poly E ( P = 0.08). No significant differences were observed for other biomarkers. Conclusions Our findings suggest potential mechanistic actions of tea polyphenols in growth factor signalling, angiogenesis and lipid metabolism. [ABSTRACT FROM AUTHOR]

Background The glycaemic responses of staples differ when eaten as mixed meals. We determined the glycaemic responses and glycaemic index (GI) values for common South Asian carbohydrate rich foods and the effect of adding curried chicken to them as mixed meals. Methods The GI and glycaemic response to staples (basmati rice, pilau rice and chapatti) and mixed meals (pilau rice with chicken curry and chapatti with chicken curry) were measured in healthy volunteers. Paired comparisons in each subject were carried out for staples and their equivalent mixed meals ( n = 9). Results GI values for the mixed meals were significantly lower than the staples alone (41 and 60 for pilau rice with chicken curry and pilau rice alone, P = 0.001; 45 and 68 for chapatti with chicken curry and chapatti alone, P = 0.004). Both, pilau rice and chapatti with chicken curry had a significantly lower glycaemic response than their equivalent staples alone: incremental area under the blood glucose response curves (IAUC) 111.9 mmol min−1 L−1 for pilau rice with curry versus 162.4 mmol min−1 L−1 for pilau rice alone ( P = 0.001) and IAUC 110.1 mmol min−1 L−1 for chapatti with chicken curry versus 183.6 mmol min−1 L−1 for chapatti alone ( P = 0.002). Conclusions Adding fat and protein-containing curries as part of a mixed meal to carbohydrate rich staple foods reduced glycaemic responses, and also changed the GI category. [ABSTRACT FROM AUTHOR]

Background The present study aimed to determine whether total fibre or specific fibre food sources are associated with the incidence of the metabolic syndrome (MetS) after 3 years of follow-up in the Tehran Lipid and Glucose Study. Methods This population-based prospective study, conducted within the framework of the Tehran Lipid and Glucose Study, included 1582 adults, who were aged 19-84 years and free of MetS at baseline. Usual dietary fibre intake was assessed at baseline using a 168-item food frequency questionnaire. Anthropometrics, blood pressure, and fasting blood glucose and lipid profiles were measured at baseline and 3 years later. The MetS was defined according to the definition of the revised Adult treatment Panel III. Results During the 3-year follow-up, there was 15.2% incidence of MetS. Among sources of dietary fibre, fruit fibre was significantly and inversely associated with the occurrence of MetS, after adjustment for confounding factors, with a 21% lower risk [odds ratio ( OR) = 0.79, 95% confidence interval ( CI) = 0.60-0.97] in the highest tertile of intake compared to the lowest tertile. Subjects in the highest tertile of cereal fibre intake had lower odds of MetS compared to those in the lowest tertile ( OR = 0.73, 95% CI = 0.52- 0.97) and this association disappeared after adjustment for confounders. No significant association was found between intakes of vegetables, legumes and nut fibre with the incidence of MetS. Conclusions Among specific fibre food sources, fruit fibre had a protective effect against the risk of MetS. [ABSTRACT FROM AUTHOR]