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Introduction Previous research has associated high dietary cholesterol intake with raised low-density lipoprotein cholesterol (LDL-C) and thus increased risk for cardiovascular disease (CVD). Emerging research suggests that it is saturated fat, not dietary cholesterol, associated with increased CVD risk. Despite being high in cholesterol, eggs, low in saturated fat, are not adversely associated with blood lipids or CVD risk. This paper describes a randomised controlled counter-balanced, cross-over trial assessing the effects of a high-cholesterol/low-saturated fat (egg) diet and a low-cholesterol/high-saturated fat diet (egg free) on blood lipids and lipoproteins, while accounting for physical activity levels which can also influence these parameters. The primary aim is to demonstrate that high cholesterol intake (from eggs) within a healthy, low-saturated fat diet does not adversely affect blood lipid levels and lipoprotein profiles. Instead, we propose that adverse effects on these parameters are mediated by saturated fat intake. The secondary aim is to explore relationships between changes in blood lutein and zeaxanthin concentrations and alterations in physical activity, examining whether changes in physical activity mediate effects on blood lipids and lipoproteins.Methods and analysis Fifty-two adults aged 18–60 years with LDL-C less than 3.5 mmol/L will be randomly allocated to three isocaloric diets for 5 weeks each: a high-cholesterol (600 mg)/low-saturated fat (6%) (egg) diet, a low-cholesterol (300 mg)/high-saturated fat (12%) (egg free) diet and a control diet that is high in both cholesterol (600 mg) and saturated fat (12%). Lipid and lipoprotein levels, lipoprotein size and concentrations, blood pressure, blood glucose, physical activity levels, and plasma lutein and zeaxanthin concentrations will be measured. Treatment effects will be analysed using linear mixed effects models.Ethics and dissemination Ethics approval was obtained from the University of South Australia Human Research Ethics Committee no. 204 327. Results will be disseminated through peer-reviewed journals and national and international presentations.Trial registration number NCT05267522

OBJECTIVE: The commute home following a night shift is associated with an increased risk for accidents. This study investigated the relationship between food intake during the night shift and simulated driving performance post-shift. METHODS: Healthy non-shift working males (N=23) and females (N=16), aged 18–39 years (mean 24.5, standard deviation 5.0, years) participated in a seven-day laboratory study and underwent four simulated night shifts. Participants were randomly allocated to one of three conditions: meal at night (N=12; 7 males), snack at night (N=13; 7 males) or no eating at night (N=14; 9 males). During the night shift at 00:30 hours, participants either ate a large meal (meal at night condition), a snack (snack at night condition), or did not eat during the night shift (no eating at night condition). During the second simulated night shift, participants performed a 40-minute York driving simulation at 20:00, 22:30, 01:30, 04:00, and 07:30 hours (similar time to a commute from work). RESULTS: The effects of eating condition, drive time, and time-on-task, on driving performance were examined using mixed model analyses. Significant condition×time interactions were found, where at 07:30 hours, those in the meal at night condition displayed significant increases in time spent outside of the safe zone (percentage of time spent outside 10 km/hour of the speed limit and 0.8 meters of the lane center; P

Introduction Epidemiological studies indicate an inverse association between nut consumption and body mass index (BMI). However, clinical trials evaluating the effects of nut consumption compared with a nut-free diet on adiposity have reported mixed findings with some studies reporting greater weight loss and others reporting no weight change. This paper describes the rationale and detailed protocol for a randomised controlled trial assessing whether the inclusion of almonds or carbohydrate-rich snacks in an otherwise nut-free energy-restricted diet will promote weight loss during 3 months of energy restriction and limit weight regain during 6 months of weight maintenance.Methods and analysis One hundred and thirty-four adults aged 25–65 years with a BMI of 27.5–34.9 kg/m2 will be recruited and randomly allocated to either the almond-enriched diet (AED) (15% energy from almonds) or a nut-free control diet (NFD) (15% energy from carbohydrate-rich snack foods). Study snack foods will be provided. Weight loss will be achieved through a 30% energy restriction over 3 months, and weight maintenance will be encouraged for 6 months by increasing overall energy intake by ~120–180 kcal/day (~500-750kJ/day) as required. Food will be self-selected, based on recommendations from the study dietitian. Body composition, resting energy expenditure, total daily energy expenditure (via doubly labelled water), physical activity, appetite regulation, cardiometabolic health, gut microbiome, liver health, inflammatory factors, eating behaviours, mood and personality, functional mobility and pain, quality of life and sleep patterns will be measured throughout the 9-month trial. The effects of intervention on the outcome measures over time will be analysed using random effects mixed models, with treatment (AED or NFD) and time (baseline, 3 months and 9 months) being the between and within factors, respectively in the analysis.Ethics and dissemination Ethics approval was obtained from the University of South Australia Human Research Ethics Committee (201436). Results from this trial will be disseminated through publication in peer-reviewed journals, national and international presentations.Trial registration number Australian New Zealand Clinical Trials Registry (ACTRN12618001861246).

Background Foods rich in nutrients, such as nitrate, nitrite, L-arginine and polyphenols, can promote the synthesis of nitric oxide (NO), which may induce ergogenic effects on endurance exercise performance. Thus, consuming foods rich in these components, such as almonds, dried grapes and dried cranberries (AGC), may improve athletic performance. Additionally, the antioxidant properties of these foods may reduce oxidative damage induced by intense exercise, thus improving recovery and reducing fatigue from strenuous physical training. Improvements in NO synthesis may also promote cerebral blood flow, which may improve cognitive function.Methods and analysis Ninety-six trained male cyclists or triathletes will be randomised to consume ~2550 kJ of either a mixture of AGC or a comparator snack food (oat bar) for 4 weeks during an overreaching endurance training protocol comprised of a 2-week heavy training phase, followed by a 2-week taper. The primary outcome is endurance exercise performance (5 min time-trial performance) and secondary outcomes include markers of NO synthesis (plasma and urinary nitrites and nitrates), muscle damage (serum creatine kinase and lactate dehydrogenase), oxidative stress (F2-isoprostanes), endurance exercise function (exercise efficiency, submaximal oxygen consumption and substrate utilisation), markers of internal training load (subjective well-being, rating of perceived exertion, maximal rate of heart rate increase and peak heart rate) and psychomotor speed (choice reaction time).Conclusion This study will evaluate whether consuming AGC improves endurance exercise performance, recovery and psychomotor speed across an endurance training programme, and evaluate the mechanisms responsible for any improvement.Trial registration number ACTRN12618000360213.

Collaborative Emergency Centres (CECs) were introduced in Nova Scotia in 2011 to address gaps in rural access to emergency care through enhanced primary care, urgent care, and interprofessional teams supported by remote physicians. In the wake of a historic election win by the New Democratic Party (NDP) in 2009, who promised to keep rural emergency departments open, a series of reports highlighted the troubles with small hospital emergency departments and suggested the development of CECs as a novel model of care. CECs aimed to improve access to emergency care in rural areas by matching the offered services to the needs of the community. The policy window for this reform was created through the convergence of a publicly recognized crisis in rural emergency department closures, a nationwide trend toward community-centred and interprofessional care models, and a historic NDP provincial government victory. Budgetary allocations and enabling legislation supported the development of the first set of four CECs for the province. Ministerial emergency department accountability reports and the Care Right Now report proclaimed the success of the CECs in reducing the number of hours of unplanned emergency department closures and in increasing rural communities' access to primary and emergency care. The CECs allowed Nova Scotia to provide access to around-the-clock emergency care at a greatly reduced cost, improved the work-life balance for rural physicians, and created a case for successful implementation of interprofessional teams in other environments. Les Centres d'urgence collaboratifs (CUC; en anglais les CECs) ont été mis en place en Nouvelle- Écosse en l'an 2011 afín de combler les lacunes en matière d'accès aux soins d'urgence en milieu rural par le biais de soins primaires améliorés, de soins d'urgence, et d'équipes interprofessionnelles soutenues par des médecins à distance. À la suite d'une élection historique remportée par le NPD en 2009, qui avait promis de garder ouverts les services d'urgence ruraux, une série de rapports a souligné les défis de prestation de services d'urgence par des petits hôpitaux, et a recommandé le développement des CUC comme modèle de soins novateur. Les CUC avaient pour objectif d'améliorer l'accès aux soins d'urgence dans les milieux ruraux en favorisant l'alignement entre les services offerts et les besoins de la communauté. L'occasion d'influencer cette politique a été créée par la convergence d'une crise reconnue publiquement en ce qui concerne les fermetures de départements d'urgence en milieux ruraux avec une tendance nationale vers des modèles de soins interprofessionnels centrés sur la communauté au moment d'une victoire historique du gouvernement provincial par le NPD. Les allocations budgétaires et un cadre législatif favorable ont soutenu la création du premier groupe de quatre CUC pour la province. Les rapport ministériel de responsabilisation des départements d'urgence en Nouvelle-Écosse, ainsi que le rapport Care Right Now, ont salué le succès des CUC dans la réduction du nombre d'heures de fermeture imprévues de départements d'urgence et dans l'amélioration de l'accès des communautés rurales aux soins primaires et d'urgence. Les CUC ont permis à la Nouvelle-Écosse de donner accès aux soins d'urgence sans interruption à un coût considérablement réduit, et d'améliorer la conciliation travail-vie personnelle pour les médecins dans les régions rurales, créant un cas de réussite pour les équipes interprofessionnelles dans d'autres environnements.

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AbstractObjective:The aim of this study was to examine the prevalence of metabolic syndrome and identify relationships between clustering and severity of cardio-metabolic risk factors in abdominally obese adults.Methods:Cardio-metabolic risk factors were assessed in a sample of 300 abdominally obese volunteers (233 females, 67 males, mean age 43.7 years) who were not being treated for diabetes, hypertension or dyslipidemia. Waist circumference (WC), blood pressure, fasting lipids, and glucose were measured and prevalence of metabolic syndrome was determined according to International Diabetes Federation (IDF) criteria. Correlation analysis and Poisson regression were used to examine associations between the presence of a particular risk factor and the propensity for clustering and derangement of other risk factors, using continuous data for risk factors and categorical data for number of metabolic syndrome components.Results:In all, 53 had metabolic syndrome and only 16 were free of cardio-metabolic abnormalities. In order of importance, diastolic blood pressure (DBP), high-density lipoprotein cholesterol (HDL), and triglycerides (TGs) were most strongly associated with greater clustering of risk factors, with a one standard deviation difference being associated with a respective difference of 9.65, 1.23, and 0.12 in the number of risk factors present. A greater number of risk factors was associated with an increased derangement for any given risk factor, with this effect being greatest for dyslipidemia, as represented by the TG:HDL ratio.Discussion:In abdominally obese individuals, DBP was strongly associated with metabolic syndome component clustering, which may reflect the pathogenic progression of metabolic syndrome, as DBP is likely to be elevated following establishment of other risk factors. Also, dyslipidemia was strongly related to the magnitude of derangement of cardio-metabolic risk factors which may indicate that increases in dyslipidemia may drive the pathogenic progression of metabolic syndrome once acquired. [ABSTRACT FROM AUTHOR]

BackgroundThe relationship between adiposity and pain is complex. Excess weight increases the risk for chronic musculoskeletal pain (CMP), driven by increased biomechanical load and low-grade systemic inflammation. Pain limits physical function, impacting energy balance contributing to weight gain. The primary aims of this study were to profile pain characteristics in participants with overweight or obesity and determine if weight loss through dietary-induced energy restriction, and presence of CMP, or magnitude of weight loss, was associated with changes in adiposity, pain, functional mobility, and inflammation.MethodsThis was a secondary analysis of data from adults (25–65 years) with overweight or obesity (BMI 27.5–34.9 kg/m2) enrolled in a 3-month, 30% energy-restricted dietary intervention to induce weight loss (January 2019–March 2021). Anthropometric measures (weight, waist circumference and fat mass), pain prevalence, pain severity (McGill Pain Questionnaire, MPQ), pain intensity (Visual Analog Scale, VAS), functional mobility (timed up and go, TUG) and inflammation (high sensitivity C-Reactive Protein, hsCRP) were assessed at baseline and 3-months.ResultsOne hundred and ten participants completed the intervention and had weight and pain assessed at both baseline and 3-months. Participants lost 7.0 ± 0.3 kg, representing 7.9% ± 3.7% of body mass. At 3-months, functional mobility improved (TUG −0.2 ± 0.1 s, 95% CI −0.3, −0.1), but there was no change in hsCRP. Compared to baseline, fewer participants reported CMP at 3-months (n = 56, 51% to n = 27, 25%, p

Abstract Introduction Nutrition-related factors linked to pain chronicity and disability include weight status and dietary behaviours. Dietary patterns associated with concurrent pain episodes, however, remain poorly characterised. This paper outlines the protocol for a feasibility study that aims to characterise pain-related dietary and lifestyle behaviours in people experiencing chronic musculoskeletal pain. Methods The study will recruit participants who experience musculoskeletal pain on 5 or more days of the week for at least 3 months. Participants will attend two in-person clinic visits where physical measurements and a series of pain and lifestyle questionnaires will be completed. Visits will be conducted pre and post a 2-week self-monitoring period where participants will self-report concurrent diet, sleep, mood, and pain on four days and will wear a wrist-worn activity monitor (GENEActiv). Key feasibility metrics will evaluate participant recruitment, enrolment and retention rates, and compliance with the study data collection protocol. Discussion There remains a lack of evidence behind dietary advice as an adjunct pain management tool. Upon completion of the protocol, feasibility outcomes will identify challenges to guide the design and delivery of a dietary intervention for chronic musculoskeletal pain.

Purpose: Cancer survivors often make long-term dietary changes, and nutrition is important for survivorship outcomes. Many survivors experience persisting cognitive difficulties, which can impact health behaviors. This study aimed to identify perceived drivers of eating habit changes, and the barriers to making intentional dietary changes, among breast cancer survivors with persisting self-reported cancer-related cognitive impairment. Materials and Methods: A qualitative framework explored survivors' perceptions of dietary habit changes. Thirteen Australian breast cancer survivors (M.time since diagnosis: 23.6 months, standard deviation [SD] 15.3; M.time since completing primary treatment: 14.7 months, SD 15.3) completed semistructured interviews. Questions related to dietary changes since diagnosis and treatment. Major themes were identified from interview transcripts using thematic analysis. Results: While most individuals perceived their diet to be broadly similar to prediagnosis, several changes to diet and eating habits were identified, which were often meaningful to these survivors. Themes relating to survivors' eating habit changes included the following: (1) meal timing and frequency shifts, (2) more plant-based eating, and (3) less variety and more convenience. Changes in eating habits were attributed to the following: (1) persisting treatment-related changes, (2) help and support from others, (3) old treatment habits, (4) preventative health and self-care, and (5) changes to work schedule. Barriers to making intentional dietary changes included the following: (1) too much time and effort, (2) food cravings and enjoyment, and (3) lacking dietary ideas and resources. Conclusions: Many survivors reported long-term changes in dietary habits, some of which align with current recommendations. Causes of dietary habit changes, and barriers to engaging in healthier dietary habits, involved multiple biopsychosocial elements. Additional resources or strategies that assist navigating survivorship challenges and their effects on dietary habits are needed. Future studies should explore whether post-treatment nutritional review with a qualified dietary health professional is helpful for survivors who experience long-term cancer-related cognitive impairment.

Abstract Background Long-chain omega-3 polyunsaturated fatty acids (LCn-3PUFAs) may act as an effective adjunct therapy for chronic obstructive pulmonary disease (COPD), a condition characterised by persistent airflow limitation and inflammation. However, the nature of this illness presents challenges for evaluating potential benefits. The aim of this study was to determine the feasibility of undertaking a randomised controlled trial of LCn-3PUFA supplementation in adults with COPD. Methods A 16-week parallel, double-blind, randomised, placebo-controlled dietary supplementation trial was conducted. Participants diagnosed with COPD were randomly allocated to take six 1-g capsules of fish oil (3.6 g LCn-3PUFA) or corn oil (placebo) daily for 16 weeks. Key outcomes used to determine the feasibility of the trial included recruitment rate, participant retention rate and supplement adherence (blood biomarker and returned capsule count). An estimate of the effect size for clinical outcomes such as pulmonary function and functional exercise capacity was calculated. Results None of the key feasibility criteria were met. The enrolment target was 40 participants in 52 weeks; however, only 13 were finally enrolled, with just seven in the first 52 weeks. Eight participants completed the study (retention rate 62%). Targets for compliance were not achieved; red blood cell LCn-3PUFA content (expressed as percentage of total fatty acids) did not increase by more than 2% in the fish oil group; capsule counts were unreliable. As the target sample size was not achieved and only a small number of participants completed the study, it was not possible to use the variance in clinical outcomes to estimate a sample size for a future study. Conclusions This study highlights major difficulties, especially with recruitment, in conducting this LCn-3PUFA supplementation trial in people with COPD, rendering the protocol unfeasible by predetermined criteria. A modified approach is needed to investigate potential health benefits of fish oil in people with COPD. A multicentre study with changes to inclusion and exclusion criteria is recommended. Trial registration Australia and New Zealand Clinical Trials Register (ANZCTR), ACTRN12612000158864

Chronic obstructive pulmonary disease (COPD) is a progressive disease of the airways, underpinned by inflammation and worsening lung function. Omega-3 polyunsaturated fatty acids (n-3PUFA) can modulate inflammatory mechanisms and may therefore impact lung function in people with COPD. This observational, cross-sectional study of 577 adults in the Whyalla Intergenerational Study of Health (WISH), conducted during 2008–09 in regional South Australia, explored associations between fish and PUFA intakes (from food frequency questionnaires) and lung function (spirometry). It also included a nested case-control study which compared fish and PUFA intakes and plasma phospholipid PUFA levels between 40 people with COPD and 80 age-sex matched controls. In the whole population, linear regression models adjusted for age, sex, smoking status and education demonstrated a weak negative association between lung function (FEV1% predicted) and consumption of fried fish (OR -0.12, 95% CI -0.22, −0.01, P = 0.026) but not fish prepared by other cooking methods or estimated intakes of PUFA. There was no association between fish or PUFA intakes and COPD risk. Compared to age and sex matched controls, cases had poorer lung function and a higher rate of smoking prevalence but did not differ in their intakes of fish or PUFA or their PUFA levels in plasma phospholipids. In this sub-population, we found a marginally significant association between COPD risk and total long chain n-3PUFA levels in plasma phospholipids (OR 1.22 95% CI 1.00–1.49, P = 0.046). Given the relatively small number of cases in this analysis, this finding should be interpreted with caution, especially given the lack of association with other markers of n-3PUFA intake or status. Taken together, our data suggest that n-3PUFA intake and status are not determinants of improved lung function in this regional Australian population. Keywords: Lung function, Chronic obstructive pulmonary disease, COPD, Polyunsaturated fatty acid, PUFA

Severe demyelinating disorders of the central nervous system (CNS) such as multiple sclerosis (MS), can be devastating for many young lives. To date, the factors resulting in poor remyelination and repair are not well understood, and reparative therapies that benefit MS patients have yet to be developed. We have previously shown that the activity and abundance of Lipoprotein Lipase (LPL)—the rate-limiting enzyme in the hydrolysis of triglyceride-rich lipoproteins—is increased in Schwann cells and macrophages following nerve crush injury in the peripheral nervous system (PNS), suggesting that LPL may help scavenge myelin-derived lipids. We hypothesized that LPL may play a similar role in the CNS. To test this, mice were immunized with MOG35–55 peptide to induce experimental allergic encephalomyelitis (EAE). LPL activity was increased (p < 0.05) in the brain at 30 days post-injection, coinciding with partial remission of clinical symptoms. Furthermore, LPL abundance and activity was up-regulated (p < 0.05) at the transition between de- and re-myelination in lysolecithin-treated ex vivo cerebellar slices. Since microglia are the key immune effector cells of the CNS we determined the role of LPL in microglia. Lipid uptake was decreased (p < 0.001) in LPL-deficient BV-2 microglial cells compared to WT. In addition, LPL-deficient cells showed dramatically reduced expression of anti-inflammatory markers, YM1 (−22 fold, p < 0.001), and arginase 1 (Arg1; −265 fold, p < 0.001) and increased expression of pro-inflammatory markers, such as iNOS compared to WT cells (+53 fold, p < 0.001). This suggests that LPL is a feature of reparative microglia, further supported by the metabolic and inflammatory profile of LPL-deficient microglia. Taken together, our data strongly suggest that LPL expression is a novel feature of a microglial phenotype that supports remyelination and repair through the clearance of lipid debris. This mechanism may be exploited to develop future reparative therapies for MS and primary neurodegenerative disorders (Alzheimer’s disease (AD) and Parkinson’s disease).

Background. Obesity and low cardiorespiratory fitness (CRF) have been shown to independently increase the risk of CVD mortality. The aim of this study was to investigate the relationship between CRF, body fatness and markers of arterial function. Method and Results. Obese (9 male, 18 female; BMI 35.3 ± 0.9 kg·m-2) and lean (8 male, 18 female; BMI 22.5 ± 0.3 kg·m-2) volunteers were assessed for body composition (DXA), cardiorespiratory fitness (predicted ̇VO2max), blood pressure (BP), endothelial vasodilatator function (FMD), and arterial compliance (AC) (via radial artery tonometry). The obese group had more whole body fat and abdominal fat (43.5 ± 1.2% versus 27.2 ± 1.6%; 𝑃