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BACKGROUND: Findings from national surveys suggest that everyone in the United States is exposed to perchlorate. At high doses, perchlorate, thiocyanate, and nitrate inhibit iodide uptake into the thyroid and decrease thyroid hormone production. Small changes in thyroid hormones during pregnancy, including changes within normal reference ranges, have been linked to cognitive function declines in the offspring. [ABSTRACT FROM AUTHOR]

Background: The consumption of advanced glycation end products (AGEs) has increased because of modern food processing and has been linked to the development of type 2 diabetes in rodents. Objective: We determined whether changing dietary AGE intake could modulate insulin sensitivity and secretion in healthy, overweight individuals. Design: We performed a double-blind, randomized, crossover trial of diets in 20 participants [6 women and 14 men; mean ± SD body mass index (in kg/m²): 29.8 ± 3.7]. Isoenergetic- and macronutrient-matched diets that were high or low in AGE content were alternately consumed for 2 wk and separated by a 4-wk washout period. At the beginning and end of each dietary period, a hyperinsulinemiceuglycemic clamp and an intravenous glucose tolerance test were performed. Dietary, plasma and urinary AGEs N∈-(carboxymethyl) lysine (CML), N∈-(carboxyethyl)lysin (CEL), and methylglyoxal-derived hydroimadazolidine (MG-H1) were measured with the use of mass spectrometry. Results: Participants consumed less CML, CEL, and MG-H1 during the low-AGE dietary period than during the high-AGE period (all P < 0.05), which was confirmed by changes in urinary AGE excretion. There was an overall difference in insulin sensitivity of -22.1 mg ⋅ kg-1 ⋅ min-1 between diets (P = 0.001). Insulin sensitivity increased by 1.3 mg ⋅ kg-1 ⋅ min-1 after the low-AGE diet (P = 0.004), whereas it showed a tendency to decrease by 0.8 mg ⋅ kg-1 ⋅ min-1 after the high-AGE diet (P = 0.086). There was no difference in body weight or insulin secretion between diets (P = NS). Conclusions: A diet that is low in AGEs may reduce the risk of type 2 diabetes by increasing insulin sensitivity. Hence, a restriction in dietary AGE content may be an effective strategy to decrease diabetes and cardiovascular disease risks in overweight individuals. This trial was registered at clinicaltrials.gov as NCT00422253. [ABSTRACT FROM AUTHOR]

Background: Poorly absorbed fermentable carbohydrates can provoke irritable bowel syndrome (IBS) symptoms by escaping absorption in the small bowel and being rapidly fermented in the colon in some susceptible subjects. IBS patients often are anxious and stressed, and stress accelerates small bowel transit, which may exacerbate malabsorption. Objective: In this study we investigated the effect of an intravenous injection of corticotropin-releasing factor (CRF) on fructose malabsorption and the resulting volume of water in the small bowel. Design: We performed a randomized, placebo-controlled crossover study of CRF compared with saline injection in 11 male and 10 female healthy subjects, examining the effect on the malabsorption of a 40-g fructose test meal and its transit through the gut, which was assessed by serial MRI and breath hydrogen measurement. Orocecal transit was assessed with the use of the lactose [13C]ureide breath test and the adrenal response to CRF was assessed by serial salivary cortisol measurements. Results: CRF injection caused a significant increase in salivary cortisol, which lasted for 135 min. Small bowel water content (SBWC) rose from baseline, peaking at 45 min after fructose ingestion, whereas breath hydrogen peaked later, at 75 min. The area under the curve for SBWC from –15 min to 135 min was significantly lower after CRF compared with saline [mean difference: 5911 mL · min (95% CI: 18.4, 11,803 mL · min), P = 0.049]. Considering all subjects, the percentage change in ascending colon volume rose significantly after CRF. This increase was significant for male (P = 0.026), but not female, volunteers. Conclusions: CRF constricts the small bowel and increases fructose malabsorption, as shown by increased ascending colon volumes. This mechanism may help to explain the increased sensitivity of some stressed individuals to fructose malabsorption. This trial was registered at clinicaltrials.gov as NCT01763281. [ABSTRACT FROM AUTHOR]

Background: Limited and inconsistent research findings exist about the effect of dietary protein intake on indexes of sleep. Objective: We assessed the effect of protein intake during dietary energy restriction on indexes of sleep in overweight and obese adults in 2 randomized, controlled feeding studies. Design: For study 1, 14 participants [3 men and 11 women; mean ± SE age: 56 ± 3 y; body mass index (BMI; in kg/m²): 30.9 ± 0.6] consumed energy-restricted diets (a 750-kcal/d deficit) with either beef and pork (BP; n = 5) or soy and legume (SL; n = 9) as the main protein sources for 3 consecutive 4-wk periods with 10% (control), 20%, or 30% of total energy from protein (random order). At baseline and the end of each period, the global sleep score (GSS) was assessed with the use of the Pittsburgh Sleep Quality Index (PSQI) questionnaire. For study 2,44 participants (12 men and 32 women; age: 52 ± 1 y; BMI: 31.4 ± 0.5) consumed a 3-wkbaseline energy-balance diet with 0.8 g protein ⋅ kg baseline body mass-1 ⋅ d-1. Then, study 2 subjects consumed either a normal-protein [NP (control); n = 23] or a high-protein (HP; n = 21) (0.8 compared with 1.5 g ⋅ kg-1 ⋅ d-1 1, respectively) energy-restricted diet (a 750-kcal/d deficit) for 16 wk. The PSQI was administered during baseline week 3 and intervention weeks 4, 8,12, and 16. GSSs ranged from 0 to 21 arbitrary units (au), with a higher value representing a worse GSS during the preceding month. Results: In study 1, we showed that a higher protein quantity improved GSSs independent of the protein source. The GSS was higher (P < 0.05) when 10% (6.0 ± 0.4 au) compared with 20% (5.0 ± 0.4 au) protein was consumed, with 30% protein (5.4 ± 0.6 au) intermediate. In study 2, at baseline, the GSS was not different between NP (5.2 ± 0.5 au) and HP (5.4 ± 0.5 au) groups. Over time, the GSS was unchanged for the NP group and improved for the HP group (P-group-by-time interaction < 0.05). After intervention (week 16), GSSs for NP and HP groups were 5.9 ± 0.5 and 4.0 ± 0.6 au, respectively (P < 0.01). Conclusion: The consumption of a greater proportion of energy from protein while dieting may improve sleep in overweight and obese adults. This trial was registered at clinicaltrials.gov as NCT01005563 (study 1) and NCT01692860 (study 2). [ABSTRACT FROM AUTHOR]

Background: In general populations, the effects of dietary cholesterol on blood cholesterol concentrations are modest. However, the relation is stronger in those with an ε4 allele in the apolipoprotein E gene (APOE). There is little information on the association between cholesterol intake and the risk of coronary artery disease (CAD) among those with the ApoE4 phenotype. Objective: We investigated the associations of intakes of cholesterol and eggs, a major source of dietary cholesterol, with carotid intima-media thickness and the risk of incident CAD in middle-aged and older men from eastern Finland. Design: The study included 1032 men aged 42-60 y in 1984-1989 at the baseline examinations of the prospective, population-based Kuopio Ischaemic Heart Disease Risk Factor Study. Data on common carotid artery intima-media thickness (CCA-IMT) were available for 846 men. Dietary intakes were assessed with 4-d food records. Associations with incident CAD and baseline CCA-IMT were analyzed by using Cox regression and ANCOVA, respectively. Results: The ApoE4 phenotype was found in 32.5% of the men. During the average follow-up of 20.8 y, 230 CAD events occurred. Egg or cholesterol intakes were not associated with the risk of CAD. Each 1 additional egg (55 g)/d was associated with a multivariable-adjusted HR of 1.17 (95% CI: 0.85, 1.61) in the ApoE4 noncarriers and an HR of 0.93 (95% CI: 0.50, 1.72) in the ApoE4 carriers (P-interaction = 0.34). Each 100-mg/d higher cholesterol intake was associated with an HR of 1.04 (95% CI: 0.89, 1.22) in the ApoE4 noncarriers and an HR of 0.95 (95% CI: 0.73, 1.25) in the ApoE4 carriers (P-interaction = 0.81). Egg or cholesterol intakes were also not associated with increased CCA-IMT. Conclusion: Egg or cholesterol intakes were not associated with increased CAD risk, even in ApoE4 carriers (i.e., in highly susceptible individuals). [ABSTRACT FROM AUTHOR]

Background: The causal nature of associations between breakfast and health remain unclear in obese individuals. Objective: We sought to conduct a randomized controlled trial to examine causal links between breakfast habits and components of energy balance in free-living obese humans. Design: The Bath Breakfast Project is a randomized controlled trial with repeated measures at baseline and follow-up among a cohort in South West England aged 21-60 y with dual-energy X-ray absorpti-ometry-derived fat mass indexes of ≥13 kg/m² for women (n = 15) and ≥9 kg/m² for men (n = 8). Components of energy balance (resting metabolic rate, physical activity thermogenesis, diet-induced thermo-genesis, and energy intake) were measured under free-living conditions with random allocation to daily breakfast (≥700 kcal before 1100) or extended fasting (0 kcal until 1200) for 6 wk, with baseline and follow-up measures of health markers (e.g., hematology/adipose biopsies). Results: Breakfast resulted in greater physical activity thermogenesis during the morning than when fasting during that period (difference: 188 kcal/d; 95% CI: 40, 335) but without any consistent effect on 24-h physical activity thermogenesis (difference: 272 kcal/d; 95% CI: -254, 798). Energy intake was not significantly greater with breakfast than fasting (difference: 338 kcal/d; 95% CI: 2313, 988). Body mass increased across both groups over time but with no treatment effects on body composition or any change in resting metabolic rate (stable within 8 kcal/d). Metabolic/cardiovascular health also did not respond to treatments, except for a reduced insulinemic response to an oral-glucose-tolerance test over time with daily breakfast relative to an increase with daily fasting (P = 0.05). Conclusions: In obese adults, daily breakfast leads to greater physical activity during the morning, whereas morning fasting results in partial dietary compensation (i.e., greater energy intake) later in the day. There were no differences between groups in weight change and most health outcomes, but insulin sensitivity increased with breakfast relative to fasting. This trial was registered at www.isrctn.org as ISRCTN31521726. [ABSTRACT FROM AUTHOR]

Background: In the context of mandatory and voluntary folic acid fortification, the exposure of children to folic acid has been a focus of concern, particularly regarding the possibility of whether any potentially adverse effects will emerge in the future. Objective: We explored concentrations of fasting unmetabolized folic acid (UFA) in the circulation of children living in Ireland who were exposed to the voluntary folic acid-fortification regimen in place in Ireland. Design: Healthy children who were attending Our Lady's Children's Hospital, Crumlin, for routine minor surgery were recruited to provide a fasting 3-mL blood sample that was taken while a general anesthetic was administered. The samples were analyzed for plasma folate, red blood cell folate, and UFA concentrations. A short dietary questionnaire that captured recent and habitual intakes of folic acid, both as supplements and as fortified foods, was completed face to face with parents. Results: We collected fasting samples (n = 68) and completed questionnaires that captured recent and habitual daily folic acid intakes of children grouped as follows: 0-5 y of age: 6 girls and 21 boys (27 children total); 6-10 y of age: 10 girls and 10 boys (20 children total); and 11-16 y of age: 10 girls and 11 boys (21 children total). UFA was detected in 10.3% of the samples tested (range: 0.5-1.3 nmol/L). Mean plasma folate and red blood cell folate concentrations were 35.1 nmol/L (range: 21-47 nmol/L) and 956 nmol/L (range: 305-2319 nmol/L), respectively. Mean daily intake of folic acid from fortified foods and supplements was 109 µg (range: 0-767 µg). Conclusions: We showed that there was UFA in the plasma of just >10% of the children sampled after an overnight fast. These findings should be considered by policy makers who are responsible for folic acid fortification. This trial was registered at www.isrctn.com as ISRCTN90038765. [ABSTRACT FROM AUTHOR]

The association of dietary exposures with health outcomes may be attenuated or reversed as a result of energy intake (EI) misreporting. This study evaluated several methods for dealing with implausible recalls when analysing the association between dietary factors and obesity. We examined data from 16 187 Canadians aged ≥12 years in the nationally representative Canadian Community Health Survey 2.2. Under- and over-reporting were defined as the ratio of EI:estimated energy requirement <0·7 and >1·42, respectively. Multinomial logistic regression-generalised logit model was conducted to test the utility of different methods for handling misreporting, including (a) adjusting for variables related to misreporting, (b) excluding misreported recalls, (c) adjusting for reporting groups (under-, plausible and over-reporters), (d) adjusting for propensity score and (e) stratifying the analyses by reporting groups. In the basic model, EI showed a negative association with overweight (OR 0·988; 95 % CI 0·979, 0·998) and obesity (OR 0·989; 95 % CI 0·977, 0·999). Similarly, the association between total energy density and overweight (OR 0·670; 95 % CI 0·487, 0·923) and obesity (OR 0·709; 95 % CI 0·495, 1·016) was inverse. Among all methods of handling misreporting, adjusting for the reporting status revealed the most satisfactory results, where a positive association between EI and overweight (OR 1·037; 95 % CI 1·019, 1·055) and obesity (OR 1·109; 95 % CI 1·082, 1·137) was observed (P<0·0001), as well as direct positive associations between energy density and percentage energy from solid fats and added sugars with obesity (P<0·05). The results of this study can help advance knowledge about the relationship between dietary variables and obesity and demonstrate to researchers and nutrition policy makers the importance of adjusting for recall plausibility in obesity research, which is highly relevant in light of global obesity epidemic. [ABSTRACT FROM AUTHOR]

Background: Caring is the core of nursing and should be cultivated in student nurses. However, there are serious concerns about the caring concern in the clinical environment and in nursing education. Clinical instructors are ideally positioned to care for student nurses so that they in turn, can learn to care for their patients. Methods: A descriptive, comparative, cross-sectional and correlational quantitative research design with convenience sampling was conducted to describe the perceptions of junior student nurses (n = 148) and senior student nurses (n = 168) regarding clinical instructor caring. A structured self administered questionnaire using the Nursing Student Perceptions of Instructor Caring (NSPIC) (Wade & Kasper, 2006) was used. Descriptive statistics and hypotheses testing using parametric and non parametric methods were conducted. The reliability of the NSPIC was determined. Results: Respondents had a positive perception of their clinical instructors' caring. No relationship could be found between the course the respondents were registered for, the frequency of contact with a clinical instructor, the ages of the respondents and their perceptions of clinical instructor caring. The NSPIC was found to be reliable if one item each from two of the subscales were omitted. Conclusions: Student nurses perceived most strongly that a caring clinical instructor made them feel confident, specifically when he/she showed genuine interest in the patients and their care, and when he/she made them feel that they could be successful. [ABSTRACT FROM AUTHOR]

Background: The beneficial cardiovascular effects of vegetables may be underpinned by their high inorganic nitrate content. Objective: We sought to examine the effects of a 6-wk once-daily intake of dietary nitrate (nitrate-rich beetroot juice) compared with placebo intake (nitrate-depleted beetroot juice) on vascular and platelet function in untreated hypercholesterolemics. Design: A total of 69 subjects were recruited in this randomized, double-blind, placebo-controlled parallel study. The primary endpoint was the change in vascular function determined with the use of ultrasound flow-mediated dilatation (FMD). Results: Baseline characteristics were similar between the groups, with primary outcome data available for 67 patients. Dietary nitrate resulted in an absolute increase in the FMD response of 1.1% (an ~24% improvement from baseline) with a worsening of 0.3% in the placebo group (P < 0.001). A small improvement in the aortic pulse wave velocity (i.e., a decrease of 0.22 m/s; 95% CI: -0.4, -0.3 m/s) was evident in the nitrate group, showing a trend (P = 0.06) to improvement in comparison with the placebo group. Dietary nitrate also caused a small but significant reduction (7.6%) in platelet-monocyte aggregates compared with an increase of 10.1% in the placebo group (P = 0.004), with statistically significant reductions in stimulated (ex vivo) P-selectin expression compared with the placebo group (P < 0.05) but no significant changes in unstimulated expression. No adverse effects of dietary nitrate were detected. The composition of the salivary microbiome was altered after the nitrate treatment but not after the placebo treatment (P < 0.01). The proportions of 78 bacterial taxa were different after the nitrate treatment; of those taxa present, 2 taxa were responsible for >1% of this change, with the proportions of Rothia mucilaginosa trending to increase and Neisseria flavescens (P < 0.01) increased after nitrate treatment relative to after placebo treatment. Conclusions: Sustained dietary nitrate ingestion improves vascular function in hypercholesterolemic patients. These changes are associated with alterations in the oral microbiome and, in particular, nitrate-reducing genera. Our findings provide additional support for the assessment of the potential of dietary nitrate as a preventative strategy against atherogenesis in larger cohorts. This trial was registered at clinicaltrials.gov as NCT01493752. [ABSTRACT FROM AUTHOR]

Background. Soft tissue massage and exercise are commonly used to treat episodes of shoulder pain. Objective. The study objective was to compare the effects of soft tissue massage and exercise with those of exercise alone on pain, disability, and range of motion in people with nonspecific shoulder pain. Design. This was a randomized controlled trial. Setting. The study was conducted in public hospital physical therapy clinics in Sydney, New South Wales, Australia. Participants. The study participants were 80 people with an average age of 62.6 years (SD=12.2) who were referred to physical therapists for treatment of nonspecific shoulder pain. Intervention. Participants were randomly assigned to either a group that received soft tissue massage around the shoulder and exercises (n=40) or a group that received exercise only (n=40) for 4 weeks. Measurements. The primary outcome was improvement in pain, as measured on a 100-mm visual analog scale, 1 week after the cessation of treatment. Secondary outcomes were disability and active flexion, abduction, and hand-behind-back range of motion. Measurements were obtained at baseline, 1 week after the cessation of treatment, and 12 "weeks after the cessation of treatment. Results. The between-group difference in pain scores from the baseline to 12 weeks after the cessation of treatment demonstrated a small significant difference in favor of the group receiving exercise only (mean difference= 14.7 mm). There were no significant differences between groups in any other variable. Limitations. It was not possible to mask therapists or participants to group allocation. Diagnostic tests were not used on participants to determine specific shoulder pathology. Conclusions. The addition of soft tissue massage to an exercise program for the shoulder conferred no additional benefit for improving pain, disability, or range of motion in people with nonspecific shoulder pain. [ABSTRACT FROM AUTHOR]

Background: Zinc deficiency and contaminated water are major contributors to diarrhea in developing countries. Food fortification with zinc has not shown clear benefits, possibly because of low zinc absorption from inhibitory food matrices. We used a novel point-of-use water ultrafiltration device configured with glass zinc plates to produce zinc-fortified, potable water. Objective: The objective was to determine zinc bioavailability from filtered water and the efficacy of zinc-fortified water in improving zinc status. Design: In a crossover balanced study, we measured fractional zinc absorption (FAZ) from the zinc-fortified water in 18 healthy Swiss adults using zinc stable isotopes and compared it with zinc-fortified maize porridge. We conducted a 20-wk double-blind randomized controlled trial (RCT) in 277 Beninese school children from rural settings who were randomly assigned to receive a daily portion of zinc-fortified filtered water delivering 2.8 mg Zn (Zn+filter), nonfor-tified filtered water (Filter), or nonfortified nonfiltered water (Pump) from the local improved supply, acting as the control group. The main outcome was plasma zinc concentration (PZn), and the 3 groups were compared by using mixed-effects models. Secondary outcomes were prevalence of zinc deficiency, diarrhea prevalence, and growth. Results: Geometric mean ( 2 SD, +SD) FAZ was 7-fold higher from fortified water (65.9%; 42.2, 102.4) than from fortified maize (9.1%; 6.0, 13.7; P < 0.001). In the RCT, a significant time-by-treatment effect on PZn (P = 0.026) and on zinc deficiency (P = 0.032) was found; PZn in the Zn+filter group was significantly higher than in the Filter (P = 0.006) and Pump (P = 0.025) groups. We detected no effect on diarrhea or growth, but our study did not have the duration and power to detect such effects. Conclusions: Consumption of filtered water fortified with a low dose of highly bioavailable zinc is an effective intervention in children from rural African settings. Large community-based trials are needed to assess the effectiveness of zinc-fortified filtered water on diarrhea and growth. These trials were registered at clinicaltrials.gov as NCT01636583 and NCT01790321. [ABSTRACT FROM AUTHOR]

Background: Selenomethionine, which is the principal dietary form of selenium, is metabolized by the liver to selenide, which is the form of the element required for the synthesis of selenoproteins. The liver synthesizes selenium-rich selenoprotein P (SEPP1) and secretes it into the plasma to supply extrahepatic tissues with selenium. Objectives: We conducted a randomized controlled trial to determine whether cirrhosis is associated with functional selenium deficiency (the lack of selenium for the process of selenoprotein synthesis even though selenium intake is not limited) and, if it is, whether the deficiency is associated with impairment of selenomethionine metabolism. Design: Patients with Child-Pugh (C-P) classes A, B, and C (mild, moderate, and severe, respectively) cirrhosis were supplemented with a placebo or supranutritional amounts of selenium as selenate (200 or 400 µg/d) or as selenomethionine (200 µg/d) for 4 wk. Plasma SEPP1 concentration and glutathione peroxidase (GPX) activity, the latter due largely to the selenoprotein GPX3 secreted by the kidneys, were measured before and after supplementation. Results: GPX activity was increased more by both doses of selenate than by the placebo in C-P class B patients. The activity was not increased more by selenomethionine supplementation than by the placebo in C-P class B patients. Plasma selenium was increased more by 400 µg Se as selenate than by the placebo in C-P class C patients. Within the groups who responded to selenate, there was a considerable variation in responses. Conclusion: These results indicate that severe cirrhosis causes mild functional selenium deficiency in some patients that is associated with impaired metabolism of selenomethionine. This trial was registered at clinicaltrials.gov as NCT00271245. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis, including multidrug-resistant tuberculosis (MDR-TB), is a major global health problem. Individuals with tuberculosis disease commonly exhibit vitamin D deficiency, which may adversely affect immunity and the response to therapy. Objective: We determined whether adjunctive high-dose vitamin D3 supplementation improves outcomes in individuals with pulmonary tuberculosis disease. Design: The study was a double-blind, randomized, placebo-controlled, intent-to-treat trial in 199 individuals with pulmonary tuberculosis disease in Tbilisi, Georgia. Subjects were randomly assigned to receive oral vitamin D3 [50,000 IUs (1.25 mg) thrice weekly for 8 wk and 50,000 IU every other week for 8 wk] or a placebo concomitant with standard first-line antituberculosis drugs. The primary outcome was the time for the conversion of a Mycobacterium tuberculosis (Mtb) sputum culture to negative. Results: Baseline characteristics between groups were similar. Most subjects (74%) were vitamin D deficient (plasma 25-hydroxyvitamin D [25(OH)D] concentration,50 nmol/L). With vitamin D3, plasma 25(OH)D concentrations peaked at ~250 nmol/L by 8 wk and decreased to ~125 nmol/L at week 16. Adverse events and plasma calcium concentrations were similar between groups. In 192 subjects with culture-confirmed tuberculosis, an adjusted efficacy analysis showed similar median culture-conversion times between vitamin D3 and placebo groups [29 and 27 d, respectively; HR: 0.86; 95% CI: 0.63, 1.18; P = 0.33). Eight-week culture-conversion rates were also similar (84.0% and 82.1% for vitamin D3 and placebo, respectively; P = 0.99). Conclusion: A high-dose vitamin D3 regimen safely corrected vitamin D deficiency but did not improve the rate of sputum Mtb clearance over 16 wk in this pulmonary tuberculosis cohort. This trial was registered at clinicaltrials.gov at NCT00918086. [ABSTRACT FROM AUTHOR]

Background: Branched-chain amino acids (BCAAs), particularly leucine, act as nutrient signals regulating protein synthesis and degradation as well as glucose metabolism. In addition, leucine has been demonstrated in animal experiments to modulate eating and energy homeostasis. Objective: We aimed to characterize the effects of physiologic and supraphysiologic loads of intraduodenal leucine on eating, gut hormone and motor functions, and blood glucose in humans. Design: Twelve lean men were studied on 3 occasions in a randomized, double-blind order. Antropyloroduodenal motility, plasma ghrelin, cholecystokinin, glucagon-like peptide 1, peptide YY, insulin, glucagon, blood glucose, appetite perceptions, and gastrointestinal symptoms were measured during 90-min intraduodenal infusions of leucine at 0.15 kcal/min (total 3.3 g, 13.5 kcal), 0.45 kcal/min (total 9.9 g, 40.5 kcal), or saline (control). Ad libitum eating from a buffet lunch was quantified immediately after the infusions. Results: Leucine at 0.45 kcal/min inhibited eating (energy intake by w13%, P , 0.05), increased plasma cholecystokinin, slightly reduced blood glucose and increased plasma insulin, and decreased antral pressures (all P , 0.05). Leucine at 0.15 kcal/min had no effect on food intake, blood glucose, or antral pressures but also slightly increased plasma cholecystokinin (P , 0.05). Neither dose affected plasma ghrelin, glucagon, glucagon-like peptide 1 and peptide YY, or pyloric and duodenal pressures. Plasma leucine concentrations were related to the dose of intraduodenal leucine, with substantial increases during both 0.15 and 0.45 kcal/min. Conclusions: The effects of intraduodenal infusions of free leucine on eating are probably not primarily mediated by changes in gut motor and hormone functions, with perhaps the exception of cholecystokinin. Instead, increased plasma leucine concentrations may be a potential signal mediating the eating-inhibitory effect of leucine. The study was registered as a clinical trial with the Australia and New Zealand Clinical Trial Registry (www.anzctr.org.au) as ACTRN12613000899741. [ABSTRACT FROM AUTHOR]

Background: Food-based dietary patterns emphasizing plant protein that were evaluated in the Dietary Approaches to Stop Hypertension (DASH) and OmniHeart trials are recommended for the treatment of metabolic syndrome (MetS). However, the contribution of plant protein to total protein in these diets is proportionally less than that of animal protein. Objective: This study compared 3 diets varying in type (animal compared with plant) and amount of protein on MetS criteria. Design: Sixty-two overweight adults with MetS consumed a healthy American diet for 2 wk before being randomly allocated to either a modified DASH diet rich in plant protein (18% protein, two-thirds plant sources, n = 9 males, 12 females), a modified DASH diet rich in animal protein (Beef in an Optimal Lean Diet: 18.4% protein, two-thirds animal sources, n = 9 males, 11 females), or a moderate-protein diet (Beef in an Optimal Lean Diet Plus Protein: 27% protein, two-thirds animal sources, n = 10 males, 11 females). Diets were compared across 3 phases of energy balance: 5 wk of controlled (all foods provided) weight maintenance (WM), 6 wk of controlled weight loss (minimum 500-kcal/d deficit) including exercise (WL), and 12 wk of prescribed, free-living weight loss (FL). The primary endpoint was change in MetS criteria. Results: All groups achieved w5% weight loss at the end of the WL phase and maintained it through FL, with no between-diet differences (WM compared with WL, FL, P , 0.0001; between diets, P = NS). All MetS criteria decreased independent of diet composition (main effect of phase, P, 0.01; between diets, P=NS). AfterWM, all groups had a MetS prevalence of 80-90% [healthy American diet (HAD) compared with WM, P = NS], which decreased to 50-60% after WL and was maintained through FL (HAD, WM vs WL, FL, P , 0.01). Conclusions: Weight loss was the primary modifier of MetS resolution in our study population regardless of protein source or amount. Our findings demonstrate that heart-healthy weight-loss dietary patterns that emphasize either animal or plant protein improve MetS criteria similarly. This study was registered at clinicaltrials. gov as NCT00937638. [ABSTRACT FROM AUTHOR]

Background: Protein consumed after resistance exercise increases postexercise muscle protein synthesis rates. To date, dairy protein has been studied extensively, with little known about the capacity of other protein-dense foods to augment postexercise muscle protein synthesis rates. Objective: We aimed to compare protein digestion and absorption kinetics, postprandial amino acid availability, anabolic signaling, and the subsequent myofibrillar protein synthetic response after the ingestion of milk compared with beef during recovery from resistance-type exercise. Design: In crossover trials, 12 healthy young men performed a single bout of resistance exercise. Immediately after cessation of exercise, participants ingested 30 g protein by consuming isonitrogenous amounts of intrinsically L-[1-13C]phenylalanine– labeled beef or milk. Blood and muscle biopsy samples were collected at rest and after exercise during primed continuous infusions of L-[ring-2H5]phenylalanine and L-[ring-3,5-2H2]tyrosine to assess protein digestion and absorption kinetics, plasma amino acid availability, anabolic signaling, and subsequent myofibrillar protein synthesis rates in vivo in young men. Results: Beef protein-derived phenylalanine appeared more rapidly in circulation compared with milk ingestion (P , 0.001). The availability of phenylalanine during the 5-h postexercise period tended to be higher after beef (64% 6 3%) ingestion than after milk ingestion (57% 6 3%; P = 0.08). Both beef and milk ingestion were followed by an increase in the phosphorylation of mammalian target of rapamycin complex 1 and 70-kDa S6 protein kinase 1 during postexercise recovery. Milk ingestion increased myofibrillar protein synthesis rates to a greater extent than did beef ingestion during the 0- to 2-h postexercise phase (P = 0.013). However, the increase in myofibrillar protein synthesis rates did not differ between milk and beef ingestion during the entire 0- to 5-h postexercise phase (P = 0.114). Conclusions: Both milk and beef ingestion augment the postexercise myofibrillar protein synthetic response in young men, with a stronger stimulation of myofibrillar protein synthesis during the early postprandial stage after milk ingestion. This trial was registered at www. clinicaltrials.gov as NCT01578590. [ABSTRACT FROM AUTHOR]

Background: The Food Insulin Index (FII) is a novel classification of single foods based on insulin responses in healthy subjects relative to an isoenergetic reference food. Objective: Our aim was to compare day-long responses to 2 nutrientmatched diets predicted to have either high or low insulin demand in healthy controls and individuals with type 2 diabetes (T2DM). Design: Twenty adults (10 healthy adults and 10 adults with T2DM) were recruited. On separate mornings, subjects consumed either a high- or low-FII diet in random order. Diets consisted of 3 consecutive meals (breakfast, morning tea, and lunch), matched for macronutrients, fiber, and glycemic index (GI), but with 2-fold difference in insulin demand as predicted by the FII of the component foods. Postprandial glycemia and insulinemia were measured in capillary plasma at regular intervals over 8 h. Results: As predicted by their GI, there were no differences in glycemic responses between the 2 diets in either group (mean 6 SEM; healthy: 6.2 6 0.2 compared with 6.1 6 0.1 mmol/L $ min, P = 0.429; T2DM: 9.96 1.3 compared with 10.36 1.6 mmol/L $ min, P = 0.485). Compared with the high-FII diet, mean postprandial insulin response over 8 h was 53% lower with the low-FII diet in healthy subjects (mean 6 SEM; incremental AUCinsulin 31,900 6 4100 pmol/L $min compared with 68,100 6 11,400 pmol/L $ min, P = 0.003) and 41% lower in subjects with T2DM (mean 6 SEM; incremental AUCinsulin 11,000 6 1800 pmol/L $ min compared with 18,700 6 3100 pmol/L $ min, P = 0.018). Incremental AUCinsulin was statistically significantly different between diets when groups were combined (P = 0.001). Conclusions: The FII algorithm may be a useful tool for reducing postprandial hyperinsulinemia in T2DM, thereby potentially improving insulin resistance and b-cell function. This trial was registered at the Australian New Zealand Clinical Trials Registry as ACTRN12611000654954. [ABSTRACT FROM AUTHOR]

Objectives: to investigate the association between the scores of the patient safety climate and socio-demographic and professional variables. Methods: an observational, sectional and quantitative study, conducted at a large public teaching hospital. The Safety Attitudes Questionnaire was used, translated and validated for Brazil. Data analysis used the software Statistical Package for Social Sciences. In the bivariate analysis, we used Student's t-test, analysis of variance and Spearman's correlation of (α=0.05). To identify predictors for the safety climate scores, multiple linear regression was used, having the safety climate domain as the main outcome (α=0.01). Results: most participants were women, nursing staff, who worked in direct care to adult patients in critical areas, without a graduate degree and without any other employment. The average and median total score of the instrument corresponded to 61.8 (SD=13.7) and 63.3, respectively. The variable professional performance was found as a factor associated with the safety environment for the domain perception of service management and hospital management (p=0.01). Conclusion: the identification of factors associated with the safety environment permits the construction of strategies for safe practices in the hospitals. [ABSTRACT FROM AUTHOR]

Background: In our increasingly obesogenic environment, in which high-calorie convenience foods are readily available, food choices can drastically affect weight and overall health. Learned food preferences, which are developed through repeated pairings with positively and negatively valenced stimuli, can contribute to obesity susceptibility if positive attitudes toward high-calorie foods are developed. Thus, the modification of automatic associations with food may be a viable strategy to promote healthier eating behaviors. Objective: In this study, we investigated the ability of an implicit priming (IP) intervention to alter responses to visual food cues by using an evaluative conditioning approach. The main objective was to implicitly (i.e., below conscious perception) associate disgust with high-calorie foods with the aim of reducing liking of these foods. Design: Participants were randomly assigned to active or control IP. In active IP (n = 22), high-calorie food images were implicitly primed with negatively valenced images, and low-calorie food images were implicitly primed with positively valenced images. In control IP (n = 20), all food images were primed with neutral images of fixation crosses. Food images were rated on the desire to eat immediately before and after IP. Results: A significant main effect of calorie (high compared with low; P < 0.001) and a significant calorie-by-group (active compared with control) interaction (P = 0.025) were observed. Post hoc tests identified a significantly greater high-calorie rating decline after active IP than after control IP (P = 0.036). Furthermore, there was significantly greater change in high-calorie ratings than in low-calorie ratings in the active group (P = 0.001). Active IP effects extended to high-calorie foods not specifically included in the intervention, which suggested an effect generalization. Moreover, a greater change in high-calorie ratings than in low-calorie ratings persisted 3-5 d after active IP (P < 0.007), which suggested lasting effects. Conclusion: This study provides initial evidence that IP can be used to alter high-calorie food preferences, which could promote healthier eating habits. This trial was registered at clinicaltrials.gov as NCT02347527. [ABSTRACT FROM AUTHOR]

Background: Krill is an increasingly popular source of marine n-3 (ω-3) PUFA that is seen as a premium product. However, to our knowledge, the effect of krill-oil supplementation on insulin sensitivity in humans has not been reported. Objective: We assessed whether supplementation with a blend of krill and salmon (KS) oil [which is rich in eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)] affects insulin sensitivity in overweight men. Design: The design was a randomized, double-blind, controlled crossover trial. A total of 47 men with a mean ± SD age of 46.5 ± 5.1 y, who were overweight [body mass index (in kg/m²) from 25 to 30] but otherwise healthy, received 5 1-g capsules of KS oil or a control (canola oil) for 8 wk and crossed over to another treatment after an 8-wk washout period. The primary outcome was insulin sensitivity assessed by using the Matsuda method from an oral-glucose-tolerance test. Secondary outcomes included lipid profiles, inflammatory markers, 24-h ambulatory blood pressure, and carotid artery intimamedia thickness. Results: Unexpectedly, insulin sensitivity (per the Matsuda index) was 14% lower with the KS oil than with the control oil (P = 0.049). A mediation analysis showed that, after controlling for the likely positive effects of blood EPA and DHA (i.e., the omega-3 index), the reduction in insulin sensitivity after KS-oil supplementation was more marked [27% lower than with the control oil (P = 0.009)]. Conclusions: Supplementation with a blend of KS oil is associated with decreased insulin sensitivity. Thus, krill-oil supplementation in overweight adults could exacerbate risk of diabetes and cardiovascular disease. This trial was prospectively registered at the Australian New Zealand Clinical Trials Registry as ACTRN12611000602921. [ABSTRACT FROM AUTHOR]

Background: Promotion of physical activity (PA) is a key strategy to prevent non-communicable diseases. However, evidence on the effectiveness of community-wide interventions (CWIs) for promoting PA is limited. Purpose: To evaluate the effectiveness of a 3-year CWI for promoting PA in middle-aged and older adults compared with usual public health services. This study is an extension to an original 1-year investigation study. Design: Cluster randomized controlled trial with community as unit of randomization and individual as unit of analysis. Setting/participants: 12 communities in Unnan, Japan were randomly allocated to the intervention (9) or the control (3). Additionally intervention communities were randomly allocated to aerobic activity promotion (Group A), flexibility and muscle-strengthening activities promotion (Group FM), or aerobic, flexibility, and muscle-strengthening activities promotion (Group AFM), each consisting of three communities. Randomly-sampled 4414 residents aged 40 to 79 years responded to the baseline survey (74 %), and were analyzed in 2013-2014. Intervention: A 3-year CWI based on social marketing, to promote PA from 2009 to 2012. Main outcome measures: The primary outcome was a change in regular aerobic, flexibility, and/or muscle-strengthening activities, defined by (1) engaging in 150 mins/week or more of walking, (2) engaging in daily flexibility activity, or (3) engaging 2 or more days/week in muscle-strengthening activities, evaluated at the individual level. Secondary outcomes were changes in specific types of PA and musculoskeletal pain. Outcomes were measured at baseline and at 1 and 3 years (2009, 2010, and 2012). Results: The CWI did not significantly increase the proportion of adults who reached recommended levels of aerobic, flexibility, and/or muscle-strengthening activities (adjusted change difference = 1.6 % [95 % Cl: -3.5, 6.6]). In the subgroup analysis, compared to the controls, adults doing flexibility activity daily significantly increased in Group FM (6.3 % [95 % CI: 1.9, 10.7]). In Group A and AFM for PA outcomes and in all groups for pain outcomes, there was no significant change compared to controls. Conclusions: The CWI did not achieve significant increase in the proportion of adults who reached recommended PA levels. However, it might be effective in promoting flexibility activity in middle-aged and older Japanese. Trial registration: UMIN-CTR UMIN000002683. [ABSTRACT FROM AUTHOR]

Background: There is little empirical evidence of the impact of transition from primary to secondary school on obesity-related risk behaviour. The purpose of this study was to examine the effect of a change of school system on physical activity (PA) and sedentary behaviour in pre-early adolescents. Methods: Fifteen schools in Victoria, Australia were recruited at random from the bottom two strata of a five level socio-economic scale. In nine schools, students in year 6 primary school transitioned to a different school for year 7 secondary school, while in six schools (combined primary-secondary), students remained in the same school environment from year 6 to year 7. Time 1 (T1) measures were collected from students (N=245) in year 6 (age 11-13). Time 2 (T2) data were collected from 243 (99%) of the original student cohort when in year 7. PA and sedentary behaviour data were collected objectively (via ActiGraph accelerometer) and subjectively (via child self-report recall questionnaire). School environment data were collected via school staff survey. Change of behaviour analyses were conducted longitudinally i) for all students and ii) by change/no change of school. Mixed model regression analysis tested for behavioural interaction effects of changing/not changing school. Results: Sixty-three percent (N=152) changed schools from T1 to T2. Across all students we observed declines in average daily moderate to vigorous physical activity (MVPA) (-4 min) and light PA (-23 min), and increases in average daily sedentary behaviour (16 min), weekday leisure screen time (17 min) and weekday homework screen time (25 min), all P<0.05. Compared to students who remained in the same school environment, students who changed school reported a greater reduction in PA intensity at recess and lunch, less likelihood to cycle to/from school, greater increase in weekday (41 mins) and weekend (45 mins) leisure screen time (P<0.05) and greater encouragement to participate in sport. School staff surveys identified that sport participation encouragement was greater in primary and combined primary-secondary than secondary schools (P<0.05). Conclusion: Transitioning from primary to secondary school negatively impacts on children's PA and sedentary behaviour, and has further compounding effects on behaviour type by changing school environments. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate the effects of Wheel of Wellness counseling on wellness lifestyle, depression, and health-related quality of life in community dwelling elderly people. Methods: A parallel, randomized controlled, open label, trial was conducted. Ninety-three elderly people in a senior welfare center were randomly assigned to two groups: 1) A Wheel of Wellness counseling intervention group (n=49) and 2) a no-treatment control group (n=44). Wheel of Wellness counseling consisted of structured, individual counseling based on the Wheel of Wellness model and provided once a week for four weeks. Wellness lifestyle, depression, and health-related quality of life were assessed pre-and post-test in both groups. Results: Data from 89 participants were analyzed. For participants in the experimental group, there was a significant improvement on all of the wellness-lifestyle subtasks except realistic beliefs. Perceived wellness and depression significantly improved after the in the experimental group (n=43) compared to the control group (n=46) from pre- to post-test in the areas of sense of control (p =.033), nutrition (p =.017), exercise (p =.039), self-care (p <.001), stress management (p =.017), work (p =.011), perceived wellness (p =.019), and depression (p =.031). One participant in the intervention group discontinued the intervention due to hospitalization and three in the control group discontinued the sessions. Conclusions: Wheel of Wellness counseling was beneficial in enhancing wellness for the community-dwelling elderly people. Research into long-term effects of the intervention and health outcomes is recommended. [ABSTRACT FROM AUTHOR]

Children with cows' milk protein allergy (CMPA) are at risk of insufficient length and weight gain, and the nutritional efficacy of hypo-allergenic formulas should be carefully assessed. In 2008, a trial assessed the impact of probiotic supplementation of an extensively hydrolysed casein-based formula (eHCF) on acquisition of tolerance in 119 infants with CMPA. First analysis of the study results showed that the studied formula allowed improvement of food-related symptoms. The scoring of atopic dermatitis (SCORAD) index was assessed at randomisation and after 6 months of feeding. A post hoc analysis was performed using WHO growth software's nutritional survey module (WHO Anthro version 3.2.2). All infants who were fed the study formula tolerated it well. The SCORAD index significantly improved from randomisation to 6 months of feeding with the study formula. Anthropometric data indicated a significant improvement in the weight-for-age, length-for-age and weight-for-length z scores, as well as in the restoration of normal BMI. The probiotic supplementation did not show any impact on these parameters. The present data showed that this eHCF was clinically tolerated and significantly improved the SCORAD index and growth indices. [ABSTRACT FROM PUBLISHER]

Research suggests that community reintegration (CR) after injury and rehabilitation is difficult for many servicemembers. However, little is known about the influence of the contextual factors, both personal and environmental, on CR. Framed within the International Classification of Functioning, Disability and Health and social cognitive theory, the quantitative portion of a larger mixed-methods study of 51 injured, community-dwelling servicemembers compared the relative contribution of contextual factors between groups of servicemembers with different levels of CR. Cluster analysis indicated three groups of servicemembers showing low, moderate, and high levels of CR. Statistical analyses identified contextual factors that significantly discriminated between CR clusters. Multivariate analysis of variance and discriminant analysis indicated significant contributions of general selfefficacy, services and assistance barriers, physical and structural barriers, attitudes and support barriers, perceived level of disability and/or handicap, work and school barriers, and policy barriers to CR scores. Overall, analyses indicated that injured servicemembers with lower CR scores had lower general self-efficacy scores, reported more difficulty with environmental barriers, and reported their injuries as more disabling. [ABSTRACT FROM AUTHOR]

Background: Epidemiology associates whole-grain (WG) consumption with several health benefits. Mounting evidence suggests that WG wheat polyphenols play a role in mechanisms underlying health benefits. Objective: The objective was to assess circulating concentration, excretion, and the physiologic role of WG wheat polyphenols in subjects with suboptimal dietary and lifestyle behaviors. Design: A placebo-controlled, parallel-group randomized trial with 80 healthy overweight/obese subjects with low intake of fruits and vegetables and sedentary lifestyle was performed. Participants replaced precise portions of refined wheat (RW) with a fixed amount of selected WG wheat or RW products for 8 wk. At baseline and every 4 wk, blood, urine, feces, and anthropometric and body composition measures were collected. Profiles of phenolic acids in biological samples, plasma markers of metabolic disease and inflammation, and fecal microbiota composition were assessed. Results: WG consumption for 4-8 wk determined a 4-fold increase of serum dihydroferulic acid (DHFA) and a 2-fold increase of fecal ferulic acid (FA) compared with RW consumption (no changes). Similarly, urinary FA at 8 wk doubled the baseline concentration only in WG subjects. Concomitant reduction of plasma tumor necrosis factor-α (TNF-α) after 8 wk and increased interleukin (IL)-10 only after 4 wk with WG compared with RW (P = 0.04) were observed. No significant change in plasma metabolic disease markers over the study period was observed, but a trend toward lower plasma plasminogen activator inhibitor 1 with higher excretion of FA and DHFA in the WG group was found. Fecal FA was associated with baseline low Bifidobacteriales and Bacteroidetes abundances, whereas after WG consumption, it correlated with increased Bacteroidetes and Firmicutes but reduced Clostridium. TNF-α reduction correlated with increased Bacteroides and Lactobacillus. No effect of dietary interventions on anthropometry and body composition was found. Conclusions: WG wheat consumption significantly increased excreted FA and circulating DHFA. Bacterial communities influenced fecal FA and were modified by WG wheat consumption. This trial was registered at clinicaltrials.gov as NCT01293175. [ABSTRACT FROM AUTHOR]

Background: Limited data are available on the accuracy of 24-h dietary recalls used to monitor US sodium and potassium intakes. Objective: We examined the difference in usual sodium and potassium intakes estimated from 24-h dietary recalls and urine collections. Design: We used data from a cross-sectional study in 402 participants aged 18-39 y (w50% African American) in the Washington, DC, metropolitan area in 2011. We estimated means and percentiles of usual intakes of daily dietary sodium (dNa) and potassium (dK) and 24-h urine excretion of sodium (uNa) and potassium (uK). We examined Spearman's correlations and differences between estimates from dietary and urine measures. Multiple linear regressions were used to evaluate the factors associated with the difference between dietary and urine measures. Results: Mean differences between diet and urine estimates were higher in men [dNa - uNa (95% CI) = 936.8 (787.1, 1086.5) mg/d and dK - uK = 571.3 (448.3, 694.3) mg/d] than in women [dNa - uNa (95% CI) = 108.3 (11.1, 205.4) mg/d and dK - uK = 163.4 (85.3, 241.5 mg/d)]. Percentile distributions of diet and urine estimates for sodium and potassium differed for men. Spearman's correlations between measures were 0.16 for men and 0.25 for women for sodium and 0.39 for men and 0.29 for women for potassium. Urinary creatinine, total caloric intake, and percentages of nutrient intake from mixed dishes were independently and consistently associated with the differences between diet and urine estimates of sodium and potassium intake. For men, body mass index was also associated. Race was associated with differences in estimates of potassium intake. Conclusions: Low correlations and differences between dietary and urinary sodium or potassium may be due to measurement error in one or both estimates. Future analyses using these methods to assess sodium and potassium intake in relation to health outcomes may consider stratifying by factors associated with the differences in estimates from these methods. This trial was registered at clinicaltrials.gov as NCT01631240. [ABSTRACT FROM AUTHOR]

Background: Experimental evidence suggests that hepatic de novo lipogenesis (DNL) affects insulin homeostasis via synthesis of saturated fatty acids (SFAs) and monounsaturated fatty acids (MUFAs). Few prospective studies have used fatty acid biomarkers to assess associations with type 2 diabetes. Objectives: We investigated associations of major circulating SFAs [palmitic acid (16:0) and stearic acid (18:0)] and MUFA [oleic acid (18:1n-9)] in the DNL pathway with metabolic risk factors and incident diabetes in community-based older U.S. adults in the Cardiovascular Health Study. We secondarily assessed other DNL fatty acid biomarkers [myristic acid (14:0), palmitoleic acid (16:1n-7), 7-hexadecenoic acid (16:1n-9), and vaccenic acid (18:1n-7)] and estimated dietary SFAs and MUFAs. Design: In 3004 participants free of diabetes, plasma phospholipid fatty acids were measured in 1992, and incident diabetes was identified by medication use and blood glucose. Usual diets were assessed by using repeated food-frequency questionnaires. Multivariable linear and Cox regression were used to assess associations with metabolic risk factors and incident diabetes, respectively. Results: At baseline, circulating palmitic acid and stearic acid were positively associated with adiposity, triglycerides, inflammation biomarkers, and insulin resistance (P-trend < 0.01 each), whereas oleic acid showed generally beneficial associations (P-trend < 0.001 each). During 30,763 person-years, 297 incident diabetes cases occurred. With adjustment for demographics and lifestyle, palmitic acid (ex-treme-quintile HR: 1.89; 95% CI: 1.27, 2.83; P-trend = 0.001) and stearic acid (HR: 1.62; 95% CI: 1.09, 2.41; P-trend = 0.006) were associated with higher diabetes risk, whereas oleic acid was not significantly associated. In secondary analyses, vaccenic acid was inversely associated with diabetes (HR: 0.56; 95% CI: 0.38, 0.83; P-trend = 0.005). Other fatty acid biomarkers and estimated dietary SFAs or MUFAs were not significantly associated with incident diabetes. Conclusions: In this large prospective cohort, circulating palmitic acid and stearic acid were associated with higher diabetes risk, and vaccenic acid was associated with lower diabetes risk. These results indicate a need for additional investigation of biological mechanisms linking specific fatty acids in the DNL pathway to the pathogenesis of diabetes. This trial was registered at clinicaltrials.gov as NCT00005133. [ABSTRACT FROM AUTHOR]

Background: In our published randomized, double-blind, placebo-controlled, 3-period crossover trial, healthy adult men (n = 21) consumed bars containing no supplemental fiber (placebo; NFC), poly-dextrose (21 g/d), and soluble corn fiber (SCF; 21 g/d) for 21 d each. Fecal specimens were collected between days 16 and 21 for fermentative end-product analysis and 16S ribosomal RNA bacterial gene amplification for bacterial taxa identification. Fiber supplementation decreased fecal putrefaction compounds and shifted abundances of several bacterial taxa. Objective: The objective was to perform whole-genome shotgun 454 pyrosequencing on the same fecal specimens collected in that clinical trial to obtain comprehensive fecal bacterial genome sequencing coverage and explore the full range of bacterial genetic information in the fecal microbiome, thereby using a systematic approach to study the impact of dietary fiber supplementation on fecal metabolites, bacterial taxa, and bacterial metagenomes. Design: Fecal samples were subjected to whole-genome shotgun 454 pyrosequencing to identify both fecal bacterial populations present and their functional genetic capacity. Results: Whole-genome shotgun sequencing results revealed that fiber consumption shifted the Bacteroidetes:Firmicutes ratio, increasing the relative abundance of Bacteroidetes 12 ± 2% and 13 ± 2% with polydextrose and SCF, respectively, compared with NFC. Bivariate correlations showed a positive correlation between the Bacteroidetes: Firmicutes ratio and total dietary fiber intake but not body mass index. Principal coordinates analysis of Bray-Curtis distances indicated that bacterial gene composition was more similar in participants consuming fibers (polydextrose and SCF combined) in comparison with NFC. Shifts in bacterial gene abundances after polydextrose and SCF supplementation included genes associated with carbohydrate, amino acid, and lipid metabolism, as well as metabolism of cofactors and vitamins. Conclusion: This study conveys novel information about the impact of dietary fiber supplementation on the phylogenetic structure and functional capacity of the fecal microbiome of healthy adults. This trial was registered at clinicaltrials.gov as NCT02091349. [ABSTRACT FROM AUTHOR]

Background: Effective teamwork has proven to be crucial for providing safe care. The performance of emergencies in general and cardiac arrest situations in particular, has been criticized for primarily focusing on the individual’s technical skills and too little on the teams’ performance of non-technical skills. The aim of the study was to explore intensive care nurses’ team performance in a simulation-based emergency situation by using expert raters’ assessments and nurses’ self-assessments in relation to different intensive care specialties. Methods: The study used an explorative design based on laboratory high-fidelity simulation. Fifty-three registered nurses, who were allocated into 11 teams representing two intensive care specialties, participated in a videotaped simulation-based cardiac arrest setting. The expert raters used the Ottawa Crisis Resource Management Global Rating Scale and the first part of the Mayo High Performance Teamwork Scale to assess the teams’ performance. The registered nurses used the first part of the Mayo High Performance Teamwork Scale for their self-assessments, and the analyses used were Chi-square tests, Mann–Whitney U tests, Spearman’s rho and Intraclass Correlation Coefficient Type III. Results: The expert raters assessed the teams’ performance as either advanced novice or competent, with significant differences being found between the teams from different specialties. Significant differences were found between the expert raters’ assessments and the registered nurses’ self-assessments. Conclusions: Teams of registered nurses representing specialties with coronary patients exhibit a higher competence in non-technical skills compared to team performance regarding a simulated cardiac arrest. The use of expert raters’ assessments and registered nurses’ self-assessments are useful in raising awareness of team performance with regard to patient safety. [ABSTRACT FROM AUTHOR]

Plant stanols have been recommended in combination with individualized dietary interventions to reduce plasma cholesterol concentrations. Even though yogurt is consumed in high quantities in Turkey, it is unclear whether yogurts with plant stanols will reduce high cholesterol levels in a Turkish population. We designed this study to settle this issue. We investigated the effect of plant stanols in yogurt, combined with the traditional Mediterranean diet (TMD), in subjects with high lipid levels. 100 patients were included: 50 in the intervention group and 50 in the control group. Neither the subjects nor the control group were taking any medication for cholesterol. The intervention group received 100 mls of stanol-enriched yogurt, while the control group received the same amount of yogurt without plant stanols. All subjects maintained TMD. Total cholesterol and LDL cholesterol levels decreased significantly in the stanol group (12.9%, 14.9%, respectively). In the control group, a slight decrease in LDL cholesterol (3.3%) was observed. The changes in total and LDL cholesterol between the two groups were significantly different (p=0.01). Intensive dietary intervention with the addition of plant stanols results in a clinically relevant reduction of total and LDL cholesterol in patients with high lipid levels. [ABSTRACT FROM AUTHOR]

aim The study explored nurse educators' perceptions of the frequency (experience) of caring attributes in their current work environments and the attributes' importance (expectation) in an ideal work environment. background Caring has been linked to only a few components of nurse educators' work satisfaction. However, its influence may be much greater. method A multisite convenience sample (N = 241) completed an adapted version of the Nyberg Caring Assessment Scale©. Paired t-tests, correlations, and content analysis were used to explore experience-expectation gaps results Significant and substantive (p < .01, r > .50) experience-expectation gaps and correlations (p < .05) between demographic and work environment characteristics and caring attributes were found. Sources of and opportunities for caring attributes were identified. conclusion The findings suggest that feeling valued contributes to nurse educators' perceptions of a positive work environment and may inform recruitment and retention strategies. A model is proposed. [ABSTRACT FROM AUTHOR]

Background: High intake of cow-milk protein in formula-fed infants is associated with higher weight gain and increased adiposity, which have led to recommendations to limit protein intake in later infancy. The impact of protein from meats for breastfed infants during complementary feeding may be different. Objective: We examined the effect of protein from meat as complementary foods on growth and metabolic profiles of breastfed infants. Design: This was a secondary analysis from a trial in which exclusively breastfed infants (5-6 mo old from the Denver, CO, metro area) were randomly assigned to receive commercially available pureed meats (Meat group; n = 14) or infant cereal (Cereal group; n = 28) as their primary complementary feedings for w 5 mo. Anthropometric measures and diet records were collected monthly from 5 to 9 mo of age; intakes from complementary feeding and breast milk were assessed at 9 mo of age. Results: The Meat group had significantly higher protein intake, whereas energy, carbohydrate, and fat intakes from complementary feeding did not differ by group over time. At 9 mo of age, mean (±SEM) intakes of total (complementary feeding plus breast milk) protein were 2.9 ± 0.6 and 1.4 ± 0.4 g ⋅ kg-1 ⋅ d-1, ~ 17% and ~ 9% of daily energy intake, for Meat and Cereal groups, respectively (P < 0.001). From 5 to 9 mo of age, the weight-for-age z score (WAZ) and length-for-age z score (LAZ) increased in the Meat group (ΔWAZ: 0.24 ± 0.19; ΔLAZ: 0.14 ± 0.12) and decreased in the Cereal group (ΔWAZ: -0.07 6 ±.17; ΔLAZ: -0.27 ± 0.24) (P-group by time < 0.05). The change in weight-for-length z score did not differ between groups. Total protein intake at 9 mo of age and baseline WAZ were important predictors of changes in the WAZ (R² = 0.23, P = 0.01). Conclusion: In breastfed infants, higher protein intake from meats was associated with greater linear growth and weight gain but without excessive gain in adiposity, suggesting that potential risks of high protein intake may differ between breastfed and formula-fed infants and by the source of protein. [ABSTRACT FROM AUTHOR]

To prepare nursing students for evidence-based practice (EBP), it is essential to evaluate the exposure effects of courses and pedagogy on EBP knowledge development. Secondary analysis of cross-sectional, descriptive, correlational study data focused on identifying relationships between completion of undergraduate research and statistics courses and EBP knowledge of baccalaureate nursing students. There were statistically significant differences in EBP knowledge scores when comparing subjects recently exposed versus unexposed to statistical coursework. Research course exposure effects were nonsignificant. Further study of exposure effects is needed to clarify the role of research and statistical coursework in developing EBP knowledge. [ABSTRACT FROM AUTHOR]

Mental health disorders (MHDs), mild traumatic brain injury (mTBI), and alcohol use disorder (AUD) are endemic among recent Veterans, resulting in a population with heterogeneous, co-occurring conditions. While alcohol craving negatively affects rehabilitation and leads to relapse, no studies have examined alcohol craving among Veterans with co-occurring MHDs and mTBI. The purpose of this preliminary cohort study is to describe alcohol craving in a convenience sample of Iraq and Afghanistan Veterans (n = 48), including those exposed to traumatic events and experiencing active symptoms. Veterans completed weekly telephone interviews that included the Alcohol Use Disorder Identification Test, consumption questions (AUDIT-C) (week 1) and the Penn Alcohol Craving Scale (PACS) (weeks 1-6). Sixty percent of the sample screened positive on the AUDIT-C for probable AUD. Using Rasch analysis, the person separation reliability of the PACS was strong (0.87) among AUDIT-C positive Veterans. Higher PACS scores were reported among AUDITC positive versus AUDIT-C negative Veterans (mixed effects analysis, p < 0.001). PACS scores were higher among AUDIT-C positive Veterans with MHDs with and without mTBI versus AUDIT-C positive combat comparison Veterans (pairwise comparison, p < 0.001). Rates of hazardous alcohol use are high among Iraq and Afghanistan conflict Veterans and suggest that alcohol craving is elevated among those with MHDs with and without mTBI. [ABSTRACT FROM AUTHOR]

Background: Exogenous glucagon-like peptide-1 (GLP-1) inhibits eating in healthy, overweight, and diabetic subjects. Objective: The GLP-1 receptor antagonist exendin(9-39)NH2 (ex9-39) was used to further explore the role of GLP-1 as an endogenous satiation signal. Design: Two double-blind, 4-way crossover studies were performed, each of which included 10 healthy men. In study A, subjects received an intravenous infusion of ex9-39 or saline plus an oral glucose preload and an intraduodenal infusion of saline or glucose for 60 min. In study B, intravenous infusions were identical, but an oral mixed-liquid meal preload and a 60-min intraduodenal infusion of saline or oleic acid were administered. Thirty minutes after oral preloads, subjects ate and drank ad libitum, and amounts ingested and the time to meal completion were quantified. In addition, appetite and plasma GLP-1, peptide YY (PYY), insulin, glucagon, and blood glucose concentrations were measured. Results: In both studies, GLP-1, PYY, and glucagon were substantially higher with intravenous ex9-39 than with intravenous saline (P ≤ 0.001). Insulin was lower with intravenous ex9-39 during intraduodenal glucose (P ≤ 0.05). The decrease in prospective food consumption and desire to eat during ad libitum eating after glucose ingestion was slightly attenuated (P ≤ 0.05 and P ≤ 0.01, respectively) with ex9-39. However, with intravenous ex9-39, food and fluid intakes and eating duration were not changed in either study. Conclusions: GLP-1 receptor antagonism slightly modulates appetite during ad libitum eating, but food and fluid intakes and meal duration remain unchanged, suggesting that endogenous GLP-1 is a weak satiation signal. However, concomitant substantial increases in plasma PYY and glucagon may counteract a desatiating effect of ex9-39. The effect of ex9-39 on PYY secretion supports an auto-inhibitory feedback mechanism that controls L cell secretion; the effect on insulin and glucagon confirms the role of GLP-1 in glycemic control through its action on pancreatic α and β cells. This trial was registered at clinicaltrials.gov as NCT01900340. [ABSTRACT FROM AUTHOR]

Background: Previous studies that reported an association of dietary Na+ intake with metabolic syndrome were limited by the use of imprecise measures of obesity, Na+ intake, or exclusion of multiethnic populations. The effect of dietary K+ intake on obesity is less well described. Objective: We hypothesized that high dietary Na+ and low K+, based on the ratio of urinary Na+ to K+ (U[Na+]/[K+]) in a first-void morning urinary sample, is independently associated with total body fat. Design: In a prospective population-based cohort, 2782 participants in the community-dwelling, probability-sampled, multiethnic Dallas Heart Study were analyzed. The primary outcome established a priori was total-body percentage fat (TBPF) measured by dual-energy X-ray absorptiometry. The main predictor was U[Na+]/[K+]. Robust linear regression was used to explore an independent association between U[Na+]/[K+] and TBPF. The analyses were stratified by sex and race after their effect modifications were analyzed. Results: Of the cohort, 55.4% were female, 49.8% African American, 30.8% white, 17.2% Hispanic, and 2.2% other races. The mean (6SD) age was 44 6 10 y, BMI (in kg/m2) was 30 6 7, TBPF was 32 6 10%, and U[Na+]/[K+] was 4.2 6 2.6; 12% had diabetes. In the unadjusted and adjusted models, TBPF increased by 0.75 (95% CI: 0.25, 1.25) and 0.43 (0.15, 0.72), respectively (P = 0.003 for both), for every 3-unit increase in U[Na+]/[K+]. A statistically significant interaction was found between race and U[Na+] /[K+], so that the non-African American races had a higher TBPF than did the African Americans per unit increase in U[Na+]/[K+] (P-interaction, 0.0001 for both). No interaction was found between sex and U[Na+]/[K+]. Conclusions: The ratio of dietary Na+ to K+ intake may be independently associated with TBPF, and this association may be more pronounced in non-African Americans. Future studies should explore whether easily measured spot U[Na+]/[K+] can be used to monitor dietary patterns and guide strategies for obesity management. [ABSTRACT FROM AUTHOR]

Background: The association between the orosensory detection of lipids, preference for fatty foods, and body mass index (BMI; in kg/m²) is controversial in humans. Objective: We explored the oral lipid-sensing system and the oro-sensory-induced autonomic reflex system in lean and obese subjects. Design: Lean (BMI: 19 to,25; n = 30) and obese (BMI .30; n = 29) age-matched men were enrolled. Their oral threshold sensitivity to linoleic acid (LA) was determined by using a 3-alternative forced-choice ascending procedure, and their eating habits were established by the analysis of 4 consecutive 24-h food-consumption diaries. The effect of brief oral lipid stimulations on plasma triglyceride [(TG)pl] concentrations was analyzed in overnight-fasted lean and obese individuals subjected to a whole-mouth stimulation (sip-and-spit procedure) with a control or 1% LA emulsions for 5 min according to a within-subject randomized design. Results: A large distribution of LA detection was shown in both groups. Mean detection thresholds were 0.053% (wt:wt) and 0.071% (wt:wt) in lean and obese subjects, respectively. No relation between the LA detection threshold and BMI was observed. The 5 subjects who detected only the higher concentration of LA (5% wt:wt) or were unable to distinguish properly between control and LA emulsions were obese. An analysis of dietary habits showed that these obese LA nontasters consumed more lipids and energy than did all other subjects. Brief whole-mouth stimulations (sip-and-spit procedure) with a control or 1 % LA emulsion revealed an LA-mediated rise in (TG)pl concentrations in overnight-fasted, lean subjects. The origin of this change seemed to be hepatic. This (TG)pl upregulation was not shown in obese subjects, which suggested that obesity led to disturbances in the oral-brainstem-periphery loop. Conclusion: Altogether, these data strongly suggest that obesity may interfere with the orosensory system responsible for the detection of free long-chain fatty acids in humans. This trial was registered at clinicaltrials.gov as NCT02028975. [ABSTRACT FROM AUTHOR]

Background: The manipulation of the composition of foods consumed as between-meal snacks may aid daily energy restriction. Objectives: We compared the effects of the consumption of 2 energy-matched snack bars on appetite, energy intake (EI), and metabolic and endocrine responses. In addition, we investigated whether the acute effects of the consumption of snacks were maintained under free-living conditions and whether the habitual daily consumption of the snack over 14 d influenced these effects. Design: Ten lean men [mean ± SD age: 30.7 ± 9.7 y; body mass index (in kg/m²): 23.2 ± 2.8] consumed a whey protein and polydextrose (PPX) snack bar or an isoenergetic control snack bar as a midmorning, between-meal snack for 14 consecutive days in a double-blind, randomized, crossover design. The two 14-d intervention phases were separated by a 14-d washout period. On the first (day 1) and last (day 15) days of each intervention phase, appetite, food intake, and blood metabolite and endocrine responses were assessed under laboratory conditions. Free-living EI was recorded on days 4, 8, and 12 of interventions. Results: Total daily EI was significantly lower when the PPX snack was consumed during experimental days (10,149 ± 831 compared with 11,931 ± 896 kJ; P < 0.01), and daily EI remained lower when the PPX snack was consumed during the free-living part of the intervention (7904 ± 610 compared with 9041 ± 928 kJ; P < 0.05). The PPX snack was associated with lower glucose and ghrelin and higher glucagon-like peptide 1 and peptide tyrosine-tyrosine responses. Conclusion: The manipulation of the composition of foods consumed as snacks is an effective way to limit subsequent EI. This trial was registered at clinicaltrials.gov as NCT01927926. [ABSTRACT FROM AUTHOR]

The primary purpose of this investigation was to evaluate postprocedure cognitive function associated with 3 distinct standard sedation regimens used for endoscopic procedures. A secondary aim was to identify complications requiring provider interventions. Subjects scheduled for colonoscopies were approached for enrollment the day of their procedure. A convenience sample of 96 subjects was randomly assigned. Cognitive function was recorded on the day of surgery using the Mini-Mental State Examination (MMSE) and 24 and 48 hours postoperatively using the Telephone Interview of Cognitive Status (TICS). The propofol plus fentanyl group had a mean TICS score of 34.53 at 24 hours compared with 34.96 at 48 hours (P = .017). The midazolam plus fentanyl group had a mean TICS score of 34.76 at 24 hours compared with 36.26 at 48 hours (P = .004). The propofol-alone group had a mean TICS score of 35.09 at 24 hours compared with 35.98 at 48 hours (P = .924). The results of this investigation indicate that the sedation regimen of propofol alone has the least impact on postprocedure cognitive function. Additionally, the number of jaw lift interventions was significantly higher in both groups who received fentanyl. [ABSTRACT FROM AUTHOR]

Context: As evidence-based practice (EBP) becomes a necessity in athletic training, Web-based modules have been developed and made available to the National Athletic Trainers' Association membership as a mechanism to educate athletic trainers (ATs) on concepts of EBP. Objective: To assess the effect of an educational intervention on enhancing knowledge of EBP among ATs. Design: Randomized controlled trial. Setting: Web-based modules and knowledge assessment. Patients or Other Participants: A total of 164 of 473 ATs (34.7% response rate), including professional athletic training students, graduate students, clinical preceptors, educators, and clinicians, were randomized into a control group (40 men, 42 women) or experimental group (33 men, 49 women). Intervention(s): Ten Web-based modules were developed that covered concepts involved in the EBP process. Both groups completed the Evidence-Based Practice Knowledge Assessment before and after the intervention phase. During the intervention phase, the experimental group had access to the Web-based modules for 4 weeks, whereas the control group had no direct responsibilities for the investigation. The knowledge assessment consisted of 60 multiple choice questions pertaining to concepts presented in the 10 modules. Test-retest reliability was determined to be good (intraclass correlation coefficient [2,1] = 0.726, 95% confidence interval = 0.605, 0.814). Main Outcome Measure(s): Independent variables consisted of group (control, experimental) and time (preassessment, postassessment). Knowledge scores were tabulated by awarding 1 point for each correct answer (maximum = 60). Between-group and within-group differences were calculated using a 2 3 2 repeated-measures analysis of variance (P ≤ .05), post hoc t tests, and Hedges g effect size with 95% confidence intervals. Results: We found a group 3 time interaction (F1,162 = 26.29, P < .001). No differences were identified between the control (30.12 ± 5.73) and experimental (30.65 ± 5.93) groups during the preassessment (t162 = 0.58, P = .84). The experimental group (36.35 6 8.58) obtained higher scores on the postassessment than the control group (30.99 ± 6.33; t162 = 4.55, P = .01). No differences were identified among time instances within the control group (t81 =1.77, P=.08); however, the experimental group obtained higher scores on the postassessment than the preassessment (t81 = 7.07, P < .001). Conclusions: An educational intervention consisting of 10 Web-based modules was an effective mechanism to increase knowledge of foundational EBP concepts among ATs. However, it is not known whether ATs are integrating EBP into daily clinical practice. Researchers should determine whether increased knowledge of EBP affects the daily clinical decision making of ATs. [ABSTRACT FROM AUTHOR]

Background: Association studies have suggested that lower circulating 25-hydroxyvitamin D [25(OH)D] in African Americans may partially underlie higher rates of cardiovascular disease and cancer in this population. Nonetheless, the relation between vitamin D supplementation and 25(OH)D concentrations in African Americans remains undefined. Objective: Our primary objective was to determine the doseresponse relation between vitamin D and plasma 25(OH)D. Design: A total of 328 African Americans in Boston, MA, were enrolled over 3 winters from 2007 to 2010 and randomly assigned to receive a placebo or 1000, 2000, or 4000 IU vitamin D3/d for 3 mo. Subjects completed sociodemographic and dietary questionnaires, and plasma samples were drawn at baseline and 3 and 6 mo. Results: Median plasma 25(OH)D concentrations at baseline were 15.1, 16.2, 13.9, and 15.7 ng/mL for subjects randomly assigned to receive the placebo or 1000, 2000, or 4000 IU/d, respectively (P = 0.63). The median plasma 25(OH)D concentration at 3 mo differed significantly between supplementation arms at 13.7, 29.7, 34.8, and 45.9 ng/mL, respectively (P < 0.001). An estimated 1640 IU vitamin D3/d was needed to raise the plasma 25(OH)D concentration to ≥20 ng/mL in ≥97.5% of participants, whereas a dose of 4000 IU/d was needed to achieve concentrations ≥33 ng/mL in ≥80% of subjects. No significant hypercalcemia was seen in a subset of participants. Conclusions: Within African Americans, an estimated 1640 IU vitamin D3/d was required to achieve concentrations of plasma 25(OH)D recommended by the Institute of Medicine, whereas 4000 IU/d was needed to reach concentrations predicted to reduce cancer and cardiovascular disease risk in prospective observational studies. These results may be helpful for informing future trials of disease prevention. This trial was registered at clinicaltrials.gov as NCT00585637. [ABSTRACT FROM AUTHOR]

Background: Chronic peanut consumption is associated with health benefits. To encourage consumption, peanuts are marketed with various flavorings, but questions have been raised as to whether seasonings offset the benefits of peanuts alone. Objective: This study sought to determine whether flavorings on peanuts affect health benefits over 12 wk. Design: In a randomized, parallel-group trial, 151 participants received 42 g peanuts/d as 14-g servings of 3 different flavors (n = 50) or a single flavor (n = 25-26/group). Anthropometric indexes, blood pressure, and heart rate were measured biweekly. Cardiovascular disease risk factors (serum lipids, insulin, glucose, and cortisol) were assessed monthly. Results: No single added flavor differentially altered body weight, body fat, body mass index, heart rate, or blood indexes in the total sample. Participants at greater risk of cardiovascular disease had significantly greater mean (±SE) reductions in diastolic blood pressure (-5.0 ± 1.7 mm Hg compared with -0.7 ± 0.6 mm Hg), cholesterol (-12.1 ± 8.5 mg/dL compared with +5.6 ± 2.0 mg/dL), and triglycerides (-31.7 ± 15.8 mg/dL compared with +2.3 ± 3.0 mg/dL) (n = 27, 24, and 15, respectively; P < 0.01) than did those at lower risk, who did not have significantly different cholesterol or triglyceride concentrations. Consumption of a variety of flavors led to greater weight gain (0.9 ± 0.3 kg) compared with individual flavors alone (0.5 ± 0.2 kg) (P < 0.05), but increases in fat and lean masses were not significant. Conclusions: Regardless of flavoring, peanut consumption offered significant benefits to participants with elevated serum lipids and blood pressure. Sensory variety led to a small, but significant, increase in body weight in comparison with ingestion of a single flavor but no change in fat mass. This trial was registered at clinicaltrials.gov as NCT01886326. [ABSTRACT FROM AUTHOR]

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Background: Circadian rhythm has been shown to be related to glucose metabolism and risk of diabetes, probably through effects on energy balance. Recent genome-wide association studies identified variants in circadian rhythme-related genes (CRY2 and MTNR1B)associated with glucose homeostasis. Objective: We tested whether CRY2 and MTNR1B genotypes affected changes in measures of energy expenditure in response to a weight-loss diet intervention in a 2-y randomized clinical trial, the POUNDS (Preventing Overweight Using Novel Dietary Strategies) LOST Trial. Design: The variants CRY2 rs11605924 (n = 721) and MTNR1B rs10830963 (n = 722) were genotyped in overweight or obese adults who were randomly assigned to 1 of 4 weight-loss diets that differed in their proportions of macronutrients. Respiratory quotient (RQ) and resting metabolic rate (RMR) were measured. Results: By 2 y of diet intervention, the A allele of CRY2 rs11605924 was significantly associated with a greater reduction in RQ (P = 0.03) and a greater increase in RMR and RMR/kg (both P = 0.04). The G allele of MTNR1B rs10830963 was significantly associated with a greater increase in RQ (P = 0.01) but was not related to changes in RMR and RMR/kg. In addition, we found significant gene-diet fat interactions for both CRY2 (P-interaction = 0.02) and MTNR1B (P-interaction, 0.001) in relation to 2-y changes in RQ. Conclusions: Our data indicate that variants in the circadian-related genes CRY2 and MTNR1B may affect long-term changes in energy expenditure, and dietary fat intake may modify the genetic effects. This trial was registered at www.clinicaltrials.gov as NCT00072995. [ABSTRACT FROM AUTHOR]

Background: Leucine is a key amino acid involved in the regulation of skeletal muscle protein synthesis. Objective: We assessed the effect of the supplementation of a lower-protein mixed macronutrient beverage with varying doses of leucine or a mixture of branched chain amino acids (BCAAs) on myofibrillar protein synthesis (MPS) at rest and after exercise. Design: In a parallel group design, 40 men (21 ± 1 y) completed unilateral knee-extensor resistance exercise before the ingestion of 25 g whey protein (W25) (3.0 g leucine), 6.25 g whey protein (W6) (0.75g leucine), 6.25 g whey protein supplemented with leucine to 3.0 g total leucine (W6+Low-Leu), 6.25 g whey protein supplemented with leucine to 5.0 g total leucine (W6+High-Leu), or 6.25 g whey protein supplemented with leucine, isoleucine, and valine to 5.0 g total leucine. A primed continuous infusion of L-[ring-13 C6] phenylalanine with serial muscle biopsies was used to measure MPS under baseline fasted and postprandial conditions in both a rested (response to feeding) and exercised (response to combined feeding and resistance exercise) leg. Results: The area under the blood leucine curve was greatest for the W6+High-Leu group compared with the W6 and W6+Low-Leu groups (P, 0.001). In the postprandial period, rates of MPS were increased above baseline over 0-1.5 h in all treatments. Over 1.5-4.5 h, MPS remained increased above baseline after all treatments but was greatest after W25 (~267%) and W6+High-Leu (~220%) treatments (P=0.002). Conclusions: A low-protein (6.25 g) mixed macronutrient beverage can be as effective as a high-protein dose (25 g) at stimulating increased MPS rates when supplemented with a high (5.0 g total leucine) amount of leucine. These results have important implications for formulations of protein beverages designed to enhance muscle anabolism. This trial was registered at clinicaltrials.gov as NCT 1530646. [ABSTRACT FROM AUTHOR]

Background. Exercise has been suggested to be a viable treatment for depression. This study investigates the effect of supervised aerobic exercise training on depressive symptoms and physical performance among Chinese patients with mild to moderate depression in early in-patient phase. Methods. A randomized repeated measure and assessor-blinded study design was used. Subjects in aerobic exercise group received 30 minutes of aerobic training, five days a week for 3 weeks. Depressive symptoms (MADRS and C-BDI) and domains in physical performance were assessed at baseline and program end. Results. Subjects in aerobic exercise group showed a more significant reduction in depressive scores (MADRS) as compared to control (between-group mean difference = 10.08 ± 9.41; p = 0.026) after 3 weeks training. The exercise group also demonstrated a significant improvement in flexibility (between group mean difference = 4.4 ± 6.13; p = 0.02). Limitations. There was lack of longitudinal followup to examine the long-term effect of aerobic exercise on patients with depression. Conclusions. Aerobic exercise in addition to pharmacological intervention can have a synergistic effect in reducing depressive symptoms and increasing flexibility among Chinese population with mild to moderate depression. Early introduction of exercise training in in-patient phase can help to bridge the gap of therapeutic latency of antidepressants during its nonresponse period. [ABSTRACT FROM AUTHOR]

The study described in this article evaluated sources of contamination of children's food and drinking water in rural households in the highlands of Peru. Samples from children's meals, drinking water, kitchen utensils, and caregivers' and children's hands were analyzed for total coliforms and E. coli counts using Petrifilm EC. Thermotolerant coliforms in water were measured using DelAgua test kits while diarrheagenic E. coli was identified using polymerase chain reaction methods (PCR). Thermotolerant coliforms were found in 48% of all water samples. E. coli was found on 23% of hands, 16% of utensils, and 4% of meals. Kitchen cloths were the item most frequently contaminated with total coliforms (89%) and E. coli (42%). Diarrheagenic E. coli was found in 33% of drinking water, 27% of meals, and on 23% of kitchen utensils. These findings indicate a need to develop hygiene interventions that focus on specific kitchen utensils and hand washing practices, to reduce the contamination of food, water, and the kitchen environment in these rural settings. [ABSTRACT FROM AUTHOR]

The estimation of population allele frequencies using sample data forms a central component of studies in population genetics. These estimates can be used to test hypotheses on the evolutionary processes governing changes in genetic variation among populations. However, existing studies frequently do not account for sampling uncertainty in these estimates, thus compromising their utility. Incorporation of this uncertainty has been hindered by the lack of a method for constructing confidence intervals containing the population allele frequencies, for the general case of sampling from a finite diploid population of any size. In this study, we address this important knowledge gap by presenting a rigorous mathematical method to construct such confidence intervals. For a range of scenarios, the method is used to demonstrate that for a particular allele, in order to obtain accurate estimates within 0.05 of the population allele frequency with high probability (%), a sample size of is often required. This analysis is augmented by an application of the method to empirical sample allele frequency data for two populations of the checkerspot butterfly (Melitaea cinxia L.), occupying meadows in Finland. For each population, the method is used to derive % confidence intervals for the population frequencies of three alleles. These intervals are then used to construct two joint % confidence regions, one for the set of three frequencies for each population. These regions are then used to derive a % confidence interval for Jost's D, a measure of genetic differentiation between the two populations. Overall, the results demonstrate the practical utility of the method with respect to informing sampling design and accounting for sampling uncertainty in studies of population genetics, important for scientific hypothesis-testing and also for risk-based natural resource management. [ABSTRACT FROM AUTHOR]