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Vitamin D deficiency is a common health concern during winter. Eggs are one of the few rich dietary sources of vitamin D, containing cholecalciferol (vitamin D-3) and 25-hydroxyvitamin D-3 [25(OH)D3], with the latter reported to be 5 times more potent at increasing serum 25(OH)D concentrations, the major circulating form of vitamin D. However, whether there is an optimal dose of eggs to increase or maintain 25(OH)D concentrations during wintertime is not known.To evaluate the dose-response effect of consuming 2, 7, or 12 commercially available eggs per week on serum 25(OH)D concentrations during the autumn-winter months in young adults. Secondary aims were to investigate changes in serum lipids, and the feasibility (adherence) and acceptability to consuming the eggs.In a 12-wk randomized controlled trial, 51 adults aged 25-40 y were randomly assigned to consume 2 eggs/wk (control, n = 17), 7 eggs/wk (n = 17), or 12 eggs/wk (n = 17). Change in serum 25(OH)D was the primary outcome as assessed by LC/MS/MS. Serum lipids were assessed using standard techniques, and acceptability to consuming the eggs was assessed via a questionnaire.Forty-two (82%) participants completed the study. Mean adherence to the eggs was 83% for controls, 86% for 7 eggs/wk, and 83% for 12 eggs/wk. Mean serum 25(OH)D concentrations did not change significantly in either the 7-eggs/wk (-8.3 nmol/L; 95% CI: -17.0, 0.4 nmol/L) or 12-eggs/wk (-7.2 nmol/L; 95% CI: -18.6, 4.3 nmol/L) groups, but decreased by 28.6 nmol/L (95% CI: -38.1, -18.9 nmol/L) in controls, which led to a significant (P = 0.003) between-group difference for the change after 12 wk. Serum lipids did not differ between the groups, and acceptability profiles to consuming the eggs were positive and similar for all 3 groups.Consuming 7 commercially available eggs per week for 12 wk was effective for attenuating the wintertime decline in circulating vitamin D concentrations in young Australian adults, with 12 eggs/wk not providing any additional benefits.

The health benefits of nuts reported throughout the literature are extensive and well established for reducing the risk of, and managing several chronic conditions such as cardiovascular disease, type 2 diabetes, nonalcoholic fatty liver disease, and cognition. Despite their comparable nutrient profile to nuts, seeds are often not assessed in clinical and epidemiological studies. Interestingly, dietary guidelines and recommendations often refer to "nuts and seeds" collectively, even though they are not consistently examined together in nutrition research when determining associated health benefits. The purpose of this review is to call for future nutrition research to consider combining nuts and seeds. This review provides justification for this proposal by summarizing current definitions for nuts and seeds and highlighting the similarities or dissimilarities in their nutrient compositions. Following this, we summarize current evidence on the health benefits of nuts and seeds, research gaps that should be addressed, and considerations for future research using both epidemiological and interventional study designs.

Background Weight-loss-induced fat loss improves cardiometabolic health in individuals with overweight and obesity; however, weight loss can also result in bone loss and increased fracture risk. Weight-loss-induced bone loss may be attenuated with exercise. Our aim was to compare changes in bone mineral density (BMD) in adults with overweight and obesity who undertook diet-induced weight loss alone or in combination with exercise. Methods We included randomized controlled trials (RCTs) in adults with overweight or obesity (aged ≥18 years; body mass index ≥25 kg/m2) that prescribed diet-induced weight loss alone or in combination with supervised exercise, and measured any bone structural parameters. Risk of bias was assessed using the Cochrane Risk of Bias tool. Random-effects meta-analyses determined mean changes and net mean differences (95% confidence intervals (95%CIs)) in the percentage of areal BMD (aBMD) change between groups. Results We included 9 RCTs. Diet-induced weight loss led to significant losses in femoral neck aBMD (mean change: −1.73% (95%CI: −2.39% to −1.07%), p < 0.001) and total hip aBMD (−2.19% (95%CI: −3.84% to −0.54%), p = 0.009). Femoral neck aBMD losses were significantly greater in the diet-induced weight loss group compared to the exercise plus diet-induced weight loss group (net difference: −0.88% (95%CI: −1.73% to −0.03%)); however, there were no differences in aBMD changes at any other skeletal site: total hip (−1.96% (95%CI: −4.59% to 0.68%)) and lumbar spine (−0.48% (95%CI: −1.81% to 0.86%)). aBMD changes did not differ significantly according to exercise modality (resistance exercise, aerobic exercise, or a combination of the two) during diet-induced weight loss. Conclusion Diet-induced weight loss led to greater femoral neck bone loss compared to diet-induced weight loss plus exercise. Bone loss at the total hip and lumbar spine was not attenuated by exercise during diet-induced weight loss. The lack of consistent skeletal benefits may be due to the insufficient duration and/or training intensities of most exercise interventions. Additional RCTs with appropriate, targeted exercise interventions should be conducted., Highlights • Exercise significantly attenuated weight-loss-induced bone loss at the femoral neck but not at the lumbar spine or radius. • Attenuation of bone loss during diet-induced weight loss was not influenced by exercise mode. • Exercise led to significant attenuation of femoral neck bone loss during diet-induced weight loss in adults aged ≥60 years, but not in those aged, Graphical abstract Image, graphical abstract

Androgen deprivation therapy (ADT) improves survival in men with advanced prostate cancer (PCa), but has been associated with compromised skeletal health and increased fracture risk. However, limited previous research has investigated determinants of bone strength beyond DXA-derived areal bone mineral density (aBMD) in this population group. The aim of this cross-sectional study was to investigate the effects of ADT in men with PCa on BMD, bone structure, estimates of whole bone strength and cortical bone distribution. A total of 70 ADT-treated men, 52 PCa controls and 70 healthy controls had DXA lumbar spine and proximal femur aBMD and pQCT distal (4%) and proximal (66%) tibia and radius cortical and trabecular volumetric BMD (vBMD), bone structure, strength and cortical bone distribution assessed. Analyses included BMI and/or tibia/radius length as covariates. On average, ADT-treated men had a higher BMI than PCa (P 0.05) but not healthy controls. ADT-treated men had 7.2-7.8% lower lumbar spine aBMD than PCa (P = 0.037) and healthy controls (P = 0.010), with a trend for a lower total hip aBMD in the ADT-treated men (P = 0.07). At the distal tibia, total bone area was 6.2-7.3% greater in ADT-treated men than both controls (P 0.01), but total vBMD was 8.4-8.7% lower in ADT-treated men than both controls (P 0.01). Moreover, bone strength index (BSI) was 10.8% lower relative to healthy controls only (P 0.05). At the distal radius, ADT-treated men had lower total and trabecular vBMD (10.7-14.8%, P 0.05) and BSI (23.6-27.5%, P 0.001) compared to both controls. There were no other differences in bone outcomes at the proximal tibia or radius. In conclusion, ADT treatment for PCa was associated with lower BMD and estimated compressive bone strength, particularly at trabecular skeletal sites (lumbar spine, and distal tibia and radius), compared to controls, but there were no consistent differences in cortical bone structure, distribution or bending strength.

Background: Osteoporosis and related fragility fractures are a global public health problem in which pharmaceutical agents targeting bone mineral density (BMD) are the first line of treatment. However, pharmaceuticals have no effect on improving other key fracture risk factors, including low muscle strength, power and functional capacity, all of which are associated with an increased risk for falls and fracture, independent of BMD. Targeted exercise training is the only strategy that can simultaneously improve multiple skeletal and fall-related risk factors, but it must be appropriately prescribed and tailored to the desired outcome(s) and the specified target group. Objectives: In this review, we provide an overview of the general principles of training and specific loading characteristics underlying current exercise guidelines for the prevention of osteoporosis, and an update on the latest scientific evidence with regard to the type and dose of exercise shown to positively influence bone mass, structure and strength and reduce fracture risk in postmenopausal women.

Type 2 Diabetes (T2DM) is emerging as a major global health issue. T2DM can adversely affect cognition and increase dementia risk. This systematic review aimed to examine the functional brain changes that may underlie cognitive dysfunction in adults with T2DM. Studies were restricted to those which used functional magnetic resonance imaging (fMRI). Nineteen independent studies were identified, mostly comprised of middle aged or older adults. Resting-state studies demonstrated that compared to controls, connectivity of the Default Mode Network (DMN) was reduced and the majority of task-based studies identified reduced activation in T2DM patients in regions relevant to task performance. Abnormalities of low frequency spontaneous brain activity were observed, particularly in visual regions. As most studies demonstrated that alterations in fMRI were related to poorer neuropsychological task performance, these results indicate that functional brain abnormalities in T2DM have consequences for cognition.

Objectives Osteoporotic fractures are associated with substantial morbidity and mortality. Although exercise has long been recommended for the prevention and management of osteoporosis, existing guidelines are often non-specific and do not account for individual differences in bone health, fracture risk and functional capacity. The aim of the current position statement is to provide health practitioners with specific, evidence-based guidelines for safe and effective exercise prescription for the prevention or management of osteoporosis, accommodating a range of potential comorbidities. Design Position statement. Methods Interpretation and application of research reports describing the effects of exercise interventions for the prevention and management of low bone mass, osteoporosis and osteoporotic fracture. Results Evidence from animal and human trials indicates that bone responds positively to impact activities and high intensity progressive resistance training. Furthermore, the optimisation of muscle strength, balance and mobility minimises the risk of falls (and thereby fracture), which is particularly relevant for individuals with limited functional capacity and/or a very high risk of osteoporotic fracture. It is important that all exercise programs be accompanied by sufficient calcium and vitamin D, and address issues of comorbidity and safety. For example, loaded spine flexion is not recommended, and impact activities may require modification in the presence of osteoarthritis or frailty. Conclusions Specific guidelines for safe and effective exercise for bone health are presented. Individual exercise prescription must take into account existing bone health status, co-morbidities, and functional or clinical risk factors for falls and fracture.

Background Low serum 25-hydroxyvitamin D (25[OH]D) levels have been associated with chronic kidney disease in cross-sectional studies. However, this association has not been studied prospectively in a large general population–based cohort. Study Design Prospective cohort study. Setting & Participants 6,180 adults 25 years or older participating in the baseline and 5-year follow-up phases of the Australian Diabetes, Obesity and Lifestyle (AusDiab) Study. Predictor Serum 25(OH)D levels Outcomes & Measurements Incident chronic kidney disease was defined as being negative at baseline but positive after 5 years for (1) reduced estimated glomerular filtration rate (eGFR; 2 ) or (2) albuminuria (spot urine albumin-creatinine ratio ≥2.5 mg/mmol [≥22.1 mg/g] for men and ≥3.5 mg/mmol [≥30.9 mg/g] for women). Results 623 (10.9%) participants were vitamin D deficient, 161 developed incident reduced eGFR, and 222 developed incident albuminuria. In participants with and without vitamin D deficiency, annual age-standardized incidences were 0.92% (95% CI, 0.56%-1.30%) and 0.59% (95% CI, 0.51%-0.68%), respectively, for eGFR 2 and 1.50% (95% CI, 1.06%-1.95%) and 0.66% (95% CI, 0.56%-0.76%), respectively, for albuminuria. In multivariate regression models, vitamin D deficiency was associated significantly with the 5-year incidence of albuminuria (OR, 1.71; 95% CI, 1.12-2.61; P = 0.01), but not reduced eGFR (OR, 0.93; 95% CI, 0.53-1.66; P = 0.8). Limitations The observational nature of the study does not account for unmeasured confounders. Only baseline 25(OH)D level was measured and therefore may not accurately reflect lifetime levels. Differences in baseline characteristics of participants who were included compared with those excluded due to missing data or follow-up may limit the applicability of results to the original AusDiab cohort. Conclusions Our prospective cohort study shows that vitamin D deficiency is associated with a higher annual incidence of albuminuria and reduced eGFR and independently predicts the 5-year incidence of albuminuria. These associations warrant further exploration in long-term prospective clinical trials.

As muscles become larger and stronger during growth and in response to increased loading, bones should adapt by adding mass, size, and strength. In this unilateral model, we tested the hypothesis that (1) the relationship between muscle size and bone mass and geometry (nonplaying arm) would not change during different stages of puberty and (2) exercise would not alter the relationship between muscle and bone, that is, additional loading would result in a similar unit increment in both muscle and bone mass, bone size, and bending strength during growth. We studied 47 competitive female tennis players aged 8-17 years. Total, cortical, and medullary cross-sectional areas, muscle area, and the polar second moment of area (I(p)) were calculated in the playing and nonplaying arms using magnetic resonance imaging (MRI); BMC was assessed by DXA. Growth effects: In the nonplaying arm in pre-, peri- and post-pubertal players, muscle area was linearly associated BMC, total and cortical area, and I(p) (r = 0.56-0.81, P0.09 to0.001), independent of age. No detectable differences were found between pubertal groups for the slope of the relationship between muscle and bone traits. Post-pubertal players, however, had a higher BMC and cortical area relative to muscle area (i.e., higher intercept) than pre- and peri-pubertal players (P0.05 to0.01), independent of age; pre- and peri-pubertal players had a greater medullary area relative to muscle area than post-pubertal players (P0.05 to0.01). Exercise effects: Comparison of the side-to-side differences revealed that muscle and bone traits were 6-13% greater in the playing arm in pre-pubertal players, and did not increase with advancing maturation. In all players, the percent (and absolute) side-to-side differences in muscle area were positively correlated with the percent (and absolute) differences in BMC, total and cortical area, and I(p) (r = 0.36-0.40, P0.05 to0.001). However, the side-to-side differences in muscle area only accounted for 11.8-15.9% of the variance of the differences in bone mass, bone size, and bending strength. This suggests that other factors associated with loading distinct from muscle size itself contributed to the bones adaptive response during growth. Therefore, the unifying hypothesis that larger muscles induced by exercise led to a proportional increase in bone mass, bone size, and bending strength appears to be simplistic and denies the influence of other factors in the development of bone mass and bone shape.

Introduction Transcranial direct current stimulation (tDCS) is a non-invasive technique that modulates the excitability of neurons within the primary motor cortex (M1). Neuronal excitability is modified by the application of direct currents in a polarity specific manner, with anodal-tDCS increasing excitability and cathodal decreasing excitability. Recently it has been shown that bilateral tDCS significantly modulates cortical excitability when compared to unilateral anodal stimulation. However, the effects of different tDCS montages on modulating motor performance are unclear. Further, it remains unclear if changes in motor performance following tDCS outlast the period of stimulation. Objective To determine whether unilateral or bilateral tDCS differentially modulates motor performance of the non-dominant hand in healthy participants. A secondary objective was to further elucidate the mechanisms underlying any potential aftereffects on motor performance following unilateral and bilateral tDCS. Methods Using a randomized, counter-balanced, cross-over design, with a one-week wash-out period, 9 participants (5 female and 4 male, age range 22–45 years) were exposed to 13 min of sham, unilateral or bilateral tDCS applied at 1.0 mA. In all tDCS conditions, the anode was placed over the “hot spot” of the non-dominant extensor carpi radialis longus muscle (ECRL) as determined by transcranial magnetic stimulation (TMS). The applied current was induced by a saline-soaked pair of surface sponge electrodes (25 cm2) delivered by a NeuroConn DC stimulator. TMS was used to measure M1 excitability and short-interval intracortical inhibition (SICI) of the non-dominant contralateral ECRL at baseline, immediately post, 30 and at 60 min following cessation of tDCS. We evaluated motor function at each of these time points in all conditions by having participants complete a Purdue peg board test. Results Both unilateral and bilateral tDCS facilitated motor performance immediately following tDCS (7 & 4% respectively), 30 min (13 & 6%) and 60 min post (21 & 9%)(all p Conclusion Our findings show that both unilateral and bilateral tDCS modulated motor performance for up to 60 min following the removal of tDCS, but the different types of tDCS electrode montages did not differentially modulate motor task performance of the non-dominant hand or indices of cortical plasticity. We have also shown that tDCS (unilateral and bilateral) modulates both cortical excitability and inhibition that outlasts the period of stimulation. Together, these results indicate that tDCS induces behavioral changes in the non-dominant hand as a consequence of mechanisms associated with long-term potentiation.

Introduction Neural degeneration accompanies healthy ageing, reducing the ability to perform activities of daily living. Transcranial direct current stimulation (tDCS) is an emerging technique with the potential to alter neuronal excitability. Although mechanisms of tDCS have been described, limited studies have examined whether tDCS can enhance performance benefits of motor skill training. Moreover, the most effective electrode montage to improve motor performance in older adults has not been explored. Objectives The current study compared the effects of unilateral and bilateral tDCS combined with one session of skill practice, on corticospinal excitability, short-interval intracortical inhibition (SICI) and motor performance of the non-dominant limb in older adults. Materials and methods In a double blinded cross-over design, nine participants (age 55–85 yrs.) underwent 15 min of unilateral, bilateral or sham tDCS (1 mA) combined with five minutes of visuomotor tracking of the wrist. In all three conditions, the anode was positioned over the optimal site for the non-dominant extensor carpi radialis longus muscle. The order of conditions were counterbalanced and separated by a one week wash out. Transcranial magnetic stimulation and visuomotor tracking error assessed neurological function and motor performance at baseline, immediately after and 30 min following the cessation of stimulation. Results Unilateral and bilateral tDCS improved visoumotor tracking error relative to sham, immediately post (15% & 21% respectively) and at 30 min following stimulation (both p Conclusions Unilateral and bilateral tDCS modulated elements of cortical plasticity, irrespective of the electrode montage. These changes outlasted the stimulation period with subsequent changes in motor performance, relative to motor practice alone. These findings provide preliminary evidence for tDCS to preserve or improve motor control in the elderly.

towards, weight management. An online survey of Australian GPs (n = 250) from rural (8%), regional (19%) and metro (73%) areas was conducted. The survey included questions relating to patient population characteristics, and attitudes and behaviours in weight management. GPs were found to fall into 1 of 3 categories: (1) confident and self-assured in weight management (47%); (2) less confident in discussing weight management (23%); and (3) casual or apathetic to weight management (30%). Not surprisingly, GPs who appearedmore confident (category 1) reported discussing weight with a higher proportion of their overweight and obese patients (73% overweight and 86% obese, versus 66% overweight and 79% obese for category 2 and 64% overweight and 76% obese for category 3). If a GP’s confidence in weight management influences the likelihood of discussing weight with an overweight or obese patient, then strategies to increase GPs’ confidence in weight management could be an important aspect of managing the obesity epidemic in the primary care setting. This study was funded by iNova.

Introduction : The purpose of the study was to compare the exercise-induced changes in bone mass and geometry between boys and girls. Methods : Eighty competitive tennis players (43 boys, 37 girls) aged 7–19 years participated. Pubertal status was self-assessed using Tanner stages (TS 1–5). The dominant and nondominant humeri were compared for DXA-derived bone mass (BMC) and MRI-derived bone geometry [total bone area (TA), medullary area (MA) and cortical bone area (CA)]. Results/Discussion : Exercise-induced side-to-side differences in BMC, TA and CA were significant from TS1 to 5 in boys and girls ( p p p p p p = 0.1–0.05??) whereas no such reduction was observed in boys. Conclusion : Regular exercise initiated before puberty and maintained throughout puberty leads to greater skeletal benefits in peri-pubertal boys than girls for bone mass and bone size, two of the major determinants of bone strength.