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BACKGROUND: Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS: We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS: Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, -1.8 percentage points; 95% CI, -4.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS: Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA ClinicalTrials.gov number, NCT01471522.).

Foods and nutrients may influence methyl mercury (MeHg) absorption and / or metabolism in humans. Consequently, epidemiological studies of MeHg exposure should assess dietary habits. The aim of this paper is to describe the development, implementation and preliminary results of the dietary assessment method used in the Seychelles Child Development Nutrition Study (SCDNS). A researcher from the University of Ulster (UU) visited Seychelles to consult with health professionals, and to ascertain the types of foods typically eaten, population characteristics, and potential study resources. Consequently, it was decided that a four- day food diary should be implemented, in conjunction with a ‘food use questionnaire’ (FUQ). Piloting confirmed this approach to be feasible. Diet was assessed in women (n = 282) at 28 weeks gestation. Following FUQ completion, subjects used the food diary to record every item of food / drink that they consumed for four consecutive days (Thursday-Sunday inclusive). Completed diaries were reviewed by project nurses, and quality control was undertaken by the Nutrition Unit (Ministry of Health, Seychelles). Diary processing is ongoing at UU. Of the women who completed the FUQ, only two (0.7%) reported that they had not consumed any fish or fish products in the two weeks prior to questionnaire completion. Fish consumption was high (median, 8.5 fish meals/week; 5th percentile, 3.0 fish meals/week; 95th percentile 15.0 fish meals/week). Karang was the fish most commonly consumed, followed by barracuda, snapper and mackerel. The results of the SCDNS should help to ascertain whether maternal food / nutrient intakes during pregnancy can influence MeHg exposures in mothers and their offspring.

ObjectivesShift work is associated with adverse effects on the health and lifestyle behaviours of employees. This study aimed to examine factors associated with adherence among shift workers to selected indicators of dietary and physical activity guidelines.MethodsA cross-sectional study was conducted on 1300 shift workers. Data were collected using a 15 minute telephone-administered questionnaire. Logistic regression methods were used for data analysis.ResultsMale shift workers (pConclusionsIndividual, work schedule and workplace environment related factors were independently associated with selected indicators of adherence to dietary and physical activity guidelines in this cohort of shift workers.

Background Approximately 17% of the European Union workforce is engaged in shift work. Shift work has been associated with a number of chronic conditions, including obesity and obesity-related metabolic diseases. The aim of this study was to explore the dietary and lifestyle behaviours of shift workers with a healthy vs. overweight/obese body mass index (BMI). Methods A cross-sectional study was conducted on 1080 shift workers using a 15-min, telephone-administered questionnaire developed from qualitative research on Irish shift workers and national dietary intake data. Demographic and work-related factors, as well as dietary and lifestyle behaviours were recorded. BMI was calculated using self-reported height and weight. Univariate and multivariate logistic regression methods were used to analyze data according to BMI category. Results Over 40% of shift workers were classified as overweight or obese. Multivariate analysis indicated that being male [P Conclusions Similar to the general population, overweight and obesity were strongly associated with male sex and middle- or older-age. Male shift workers may benefit from targeted dietary and lifestyle advice specifically focused on limiting fried foods to help protect against overweight and obesity.

BackgroundCOVID-19–related acute illness is associated with an increased risk of venous thromboembolism (VTE).ObjectiveThese evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in decisions about the use of anticoagulation for thromboprophylaxis in patients with COVID-19 who do not have confirmed or suspected VTE.MethodsASH formed a multidisciplinary guideline panel, including 3 patient representatives, and applied strategies to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process, including performing systematic evidence reviews (up to March 2021). The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The panel used the grading of recommendations assessment, development, and evaluation (GRADE) approach to assess evidence and make recommendations, which were subject to public comment.ResultsThe panel agreed on 1 additional recommendation. The panel issued a conditional recommendation against the use of outpatient anticoagulant prophylaxis in patients with COVID-19 who are discharged from the hospital and who do not have suspected or confirmed VTE or another indication for anticoagulation.ConclusionsThis recommendation was based on very low certainty in the evidence, underscoring the need for high-quality randomized controlled trials assessing the role of postdischarge thromboprophylaxis. Other key research priorities include better evidence on assessing risk of thrombosis and bleeding outcomes in patients with COVID-19 after hospital discharge.

Background Dietary habits formed in early childhood can track into later life with important impacts on health. Food-based dietary guidelines (FBDGs) may have a role in improving population health but are lacking for young children. Objectives We aimed to establish a protocol for addressing nutrient shortfalls in 1- to 5-y-old children (12–60 mo) using diet modeling in a population-based sample. Methods Secondary analysis of 2010–2011 Irish National Pre-School Nutrition Survey data (n = 500) was conducted to identify typical food consumption patterns in 1- to 5-y-olds. Nutrient intakes were assessed against dietary reference values [European Food Safety Authority (EFSA) and Institute of Medicine (IOM)]. To address nutrient shortfalls using diet modeling, 4-d food patterns were developed to assess different milk-feeding scenarios (human milk, whole or low-fat cow milk, and fortified milks) within energy requirement ranges aligned with the WHO growth standards. FBDGs to address nutrient shortfalls were established based on 120 food patterns. Results Current mean dietary intakes for the majority of 1- to 5-y-olds failed to meet reference values (EFSA) for vitamin D (≤100%), vitamin E (≤88%), DHA (22:6n–3) + EPA (20:5n–3) (IOM; ≤82%), and fiber (≤63%), whereas free sugars intakes exceeded recommendations of

Summary Gastric bypass surgery is an effective long‐term treatment for individuals with severe obesity. Changes in appetite, dietary intake, and food preferences have all been postulated to contribute to postoperative body weight regulation, however, findings are inconsistent. The aim of this systematic review was to evaluate the current literature on changes in dietary intake and appetite following gastric bypass surgery, in the context of the methodology used and the analysis, interpretation, and presentation of results. Four databases were systematically searched with terms related to “gastric bypass surgery,” “appetite,” and “dietary intake,” and 49 papers (n = 2384 patients after gastric bypass) were eligible for inclusion. The evidence indicated that only a reduction in overall energy intake and an increase in postprandial satiety are maintained beyond 6‐month post‐surgery, whereas relative macronutrient intake and premeal hunger remain unchanged. However, available data were limited by inconsistencies in the methods, analysis, presentation, and interpretation of results. In particular, there was a reliance on data collected by subjective methods with minimal acknowledgment of the limitations, such as misreporting of food intake. There is a need for further work employing objective measurement of appetite and dietary intake following gastric bypass surgery to determine how these mechanisms may contribute to weight regulation in the longer term.

Objective:To characterise different meal types by examining the contribution of specific meals to the total intakes and the nutritional quality of each meal.Design:A cross-sectional analysis was conducted based on dietary data collected using 4-d dietary record. Diet quality was assessed by the Healthy Eating Index-2015 and Nutrient-Rich Food Index 9.3.Setting:Japan.Participants:Adults aged 20–81 years (n 639).Results:Diet quality was, on average, highest for dinner, followed, in order, by lunch, breakfast and snacks. Breakfast, lunch, dinner and snacks, on average, accounted for 21 %, 32 %, 40 % and 11 % of total energy intake, respectively. For many nutrients, the percentage contribution to total intake did not vary within each meal, broadly in line with that for energy: 18–24 % for breakfast, 26–35 % for lunch, 35–49 % for dinner and 4–15 % for snacks. However, intakes of many foods largely depended on one meal type. The foods mainly eaten at dinner were potatoes, pulses, total vegetables, fish, meat and alcoholic beverages (52–70 %), in contrast to noodles (58 %) at lunch and bread (71 %) and dairy products (50 %) at breakfast. The foods mainly eaten at snacks were confectioneries (79 %) and sugar-sweetened beverages (52 %). Conversely, rice and eggs were more evenly distributed across three main meals (19–41 % and 30–38 %, respectively), while fruit and non-energetic beverages were more evenly distributed across all meal types (17–30 % and 19–35 %, respectively).Conclusions:These findings provide the background information on each meal type in Japanese and may help inform the development of meal-based guidelines and public health messages.

The impact of pharmacologic prophylaxis for venous thromboembolism in patients undergoing neurosurgical intervention remains uncertain. We reviewed the efficacy and safety of pharmacologic compared with nonpharmacologic thromboprophylaxis in neurosurgical patients. Three databases were searched through April 2018, including those for randomized controlled trials (RCTs) and for nonrandomized controlled studies (NRSs). Independent reviewers assessed the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Seven RCTs and 3 NRSs proved eligible. No studies reported on symptomatic proximal and distal deep vein thrombosis (DVT). Two RCTs reported on screening-detected proximal and distal DVTs. We used the findings of these 2 RCTs as the closest surrogate outcomes to inform the proximal and distal DVT outcomes. These 2 RCTs suggest that pharmacologic thromboprophylaxis may decrease the risk of developing asymptomatic proximal DVT (relative risk [RR], 0.50; 95% confidence interval [CI], 0.30-0.84; low certainty). Findings were uncertain for mortality (RR, 1.27; 95% CI, 0.57-2.86; low certainty), symptomatic pulmonary embolism (PE) (RR, 0.84; 95% CI, 0.03-27.42; very low certainty), asymptomatic distal DVT (RR, 0.54; 95% CI, 0.27-1.08; very low certainty), and reoperation (RR, 0.43; 95% CI, 0.06-2.84; very low certainty) outcomes. NRSs also reported uncertain findings for whether pharmacologic prophylaxis affects mortality (RR, 0.72; 95% CI, 0.46-1.13; low certainty) and PE (RR, 0.18; 95% CI, 0.01-3.76). For risk of bleeding, findings were uncertain in both RCTs (RR, 1.57; 95% CI, 0.70-3.50; low certainty) and NRSs (RR, 1.45; 95% CI, 0.30-7.12; very low certainty). In patients undergoing neurosurgical procedures, low certainty of evidence suggests that pharmacologic thromboprophylaxis confers benefit for preventing asymptomatic (screening-detected) proximal DVT with very low certainty regarding its impact on patient-important outcomes.

T1ρ relaxation imaging is a quantitative imaging technique that has been used to assess cartilage integrity, liver fibrosis, tumors, cardiac infarction, and Alzheimer's disease. T1 , T2 , and T1ρ relaxation time constants have each demonstrated different degrees of sensitivity to several markers of fibrosis and inflammation, allowing for a potential multi-parametric approach to tissue quantification. Traditional magnetic resonance fingerprinting (MRF) has been shown to provide quick, quantitative mapping of T1 and T2 relaxation time constants. In this study, T1ρ relaxation is added to the MRF framework using spin lock preparations. An MRF sequence involving an RF-spoiled sequence with TR , flip angle, T1ρ , and T2 preparation variation is described. The sequence is then calibrated against conventional T1 , T2 , and T1ρ relaxation mapping techniques in agar phantoms and the abdomens of four healthy volunteers. Strong intraclass correlation coefficients (ICC > 0.9) were found between conventional and MRF sequences in phantoms and also in healthy volunteers (ICC > 0.8). The highest ICC correlation values were seen in T1 , followed by T1ρ and then T2 . In this study, T1ρ relaxation has been incorporated into the MRF framework by using spin lock preparations, while still fitting for T1 and T2 relaxation time constants. The acquisition of these parameters within a single breath hold in the abdomen alleviates the issues of movement between breath holds in conventional techniques.

Objectives While it is widely perceived that the diet consumed by Japanese is healthy, empirical evidence supporting this notion is limited. In this cross-sectional study, we assessed the overall diet quality of Japanese using the Healthy Eating Index-2015 (HEI-2015) and Nutrient-Rich Food Index 9.3 (NRF9.3), and compared diet quality scores between Japanese and Americans. Methods We used 1-d dietary record data from 19,719 adults (aged ≥20 y) in the Japanese National Health and Nutrition Survey 2012 and the first 24-h dietary recall data from 4614 adults in the US NHANES 2011-2012. Results As expected, a higher total score of the HEI-2015 and NRF9.3 was associated with favorable patterns of overall diet in the Japanese population. The range of total score was wide enough for both HEI-2015 (5th percentile 37.2; 95th percentile 67.2) and NRF9.3 (5th percentile 257; 95th percentile 645). Both HEI-2015 and NRF9.3 distinguished known differences in diet quality between sex, age, and smoking status. The mean total scores of HEI-2015 and NRF9.3 were similar between Japanese (51.9 and 448, respectively) and US adults (52.8 and 435, respectively). However, component scores between the 2 populations were considerably different. For HEI-2015, Japanese had higher scores for whole fruits, total vegetables, green and beans, total protein foods, seafood and plant proteins, fatty acids, added sugars, and saturated fats, but lower scores for total fruits, whole grains, dairy, refined grains, and sodium. For NRF9.3, the intakes of vitamin C, vitamin D, potassium, added sugars, and saturated fats were more favorable in Japanese, while those of dietary fiber, vitamin A, calcium, iron, magnesium, and sodium were less favorable. Conclusions This study suggests the usefulness of HEI-2015 and NRF9.3 for assessing the diet quality of Japanese, as well as for highlighting different nutritional concerns between Japan and the US.

This article provides a summary of the topics discussed at the symposium titled “Bariatric Surgery and Its Effects on Taste and Food Selection,” which was held at the Fortieth Annual Meeting of the Association for Chemoreception Sciences. Bariatric surgery such as Roux-en-Y gastric bypass (RYGB) is currently one of the most effective treatments available for weight loss and Type 2 diabetes. For this reason, it is of great interest to clinicians as well as to basic scientists studying the controls of feeding and energy balance. Despite the commonly held view by clinicians that RYGB patients change their food preferences away from fats and sugars in favor of less energy dense alternatives such as vegetables, the empirical support for this claim is equivocal. It is currently thought that the taste and palatability of fats and sugars are affected by the surgery. Some key preclinical and clinical findings addressing these issues were evaluated in this symposium.

Objectives The study aimed to understand lifestyle practices among shift workers, including an exploration of workers' perceptions of their workplace environment (WPE). Methods Fifteen focus groups (FGs) were conducted by two researchers, with a total of 109 participants. A pilot FG was carried out with both researchers present, to ensure consistency in facilitation. To ensure quality control, both researchers analyzed all data collected. Results Two overarching themes were observed: barriers to leading a healthier lifestyle, and facilitators to leading a healthier lifestyle. The influence of WPE was central to both themes. Conclusion Investing in employee health is beneficial, particularly among shift workers, who are at an increased health risk. Adopting organizational policies and environmental changes as a core strategy for workplace health promotion may create an environment that makes healthier choices more accessible to all employees.

Epidemiologic evidence on the associations between dietary acid load and metabolic risk factors are limited and inconsistent. We investigated the hypothesis that dietary acid load is associated with adverse profiles of metabolic risk factors in Japanese adults. This cross-sectional study included 15 618 Japanese adults aged ≥20 years from the 2012 National Health and Nutrition Survey, Japan. Dietary acid load was characterized as potential renal acid load (PRAL) and net endogenous acid production (NEAP) based on information on nutrient intake, which was derived from a 1-day semi-weighed dietary record. After adjustment for potential confounding factors, both PRAL and NEAP were positively associated with body mass index (BMI) and waist circumference in both sexes (P for trend ≤.01). PRAL and NEAP also showed positive associations with systolic and diastolic blood pressure in men, independently of BMI (P for trend ≤.005), while they showed positive associations with systolic (but not diastolic) blood pressure in women (P for trend ≤.03). For other metabolic risk factors, there were positive associations between PRAL and NEAP and total and LDL-cholesterol concentrations only in men (P for trend ≤.04). After excluding participants taking medication for hypertension, dyslipidemia, and diabetes, similar associations were observed for adiposity measures and blood pressure (P for trend ≤.01), with there being positive associations between NEAP and HDL-cholesterol and between PRAL and NEAP and glycated hemoglobin in men (P for trend ≤.04). In conclusion, higher dietary acid load was significantly but weakly associated with higher adiposity measures and blood pressure in Japanese adults.

We examined the reproducibility and relative validity of two measures of overall diet quality, the Healthy Eating Index-2015 (HEI-2015) and Nutrient-Rich Food Index 9.3 (NRF9.3), as estimated by well-established self-administered dietary assessment questionnaires for the Japanese, namely the comprehensive diet history questionnaire (DHQ) and the brief diet history questionnaire (BDHQ). Diet was assessed separately by two DHQs and two BDHQs at a 1-year interval and by 16-day weighed dietary records (DRs) in 121 women and 121 men aged 31&ndash, 81 years. HEI-2015 and NRF9.3 were calculated from each method. The reproducibility correlation for the two questionnaires (intraclass correlation) ranged from 0.53 (HEI-2015 from BDHQ in men) to 0.77 (NRF9.3 from BDHQ in women). The validity correlation between the first questionnaires and DR (Pearson correlation) ranged from 0.37 (NRF9.3 from BDHQ in men) to 0.61 (NRF9.3 from DHQ and BDHQ in women). Bland&ndash, Altman plots showed poor agreement between the DHQ or BDHQ and DR, as well as the presence of weak proportional bias. Overall, these data indicate reasonable reproducibility and ranking ability of the DHQ and BDHQ for assessing the HEI-2015 and NRF9.3 and support their usefulness in future epidemiological research on the overall effects of Japanese diets on various health outcomes.

Background: Individuals living with complex diabetes in medically underserved areas face additional barriers to accessing needed services and support. This study used photo elicitation interviews (PEI) to develop a rich understanding of everyday life among individuals with complex diabetes living in such areas of New Mexico (NM). Methods: Five individuals with T1DM and 3 with complex T2DM receiving care through Endo ECHO in NM received digital cameras and the task of taking photographs about their experience of living with diabetes, and then participated in interviews with our team, during which they selected 10 photos from their collections to discuss. Interviews were recorded and transcribed, and then coded using Grounded Theory in an iterative process. Results: Six family-codes emerged: Self-management, health care, support, complications, food, and coping strategies. Three overarching axial codes were identified: Rural living, body self-knowledge, and diabetes burden. A picture of the relentless and never-ending nature of managing diabetes emerged in the analysis. Over half of the photos were of food, both healthy and forbidden; food is an overriding concern, and participants’ understanding of healthy food varied greatly. Participants noted important sources of support and optimism, and the joy of activities beyond diabetes care such as online gaming, raising chickens, or hiking. Conclusions: Participants shared their unique perspectives; however, regardless of participants’ age, diabetes diagnosis, and gender, they uniformly expressed acute awareness of the permanent burden of their condition, the challenges of self-management, and the need to overcome the barriers of living in medically underserved areas. PEI proved to be a valuable method for ascertaining a deep understanding of individuals’ daily experience of living with complex diabetes. Disclosure M.M. Paul: None. A. Davila Saad: None. M. Tagliaferro: None. J. Billings: None. S. Blecker: Advisory Panel; Self; Medtronic. C. Berry: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust

The purpose of this study was to test a comprehensive model of meal portion size determinants consisting of sociodemographic, psychological and food-related variables, whilst controlling for hunger and thirst. Using cross-sectional nationally representative data collected in 2075 participants from the Island of Ireland (IoI) and Denmark (DK), eight separate hierarchical multiple regression analyses were conducted to examine the association between food-related variables and meal portion size (i.e. pizza, vegetable soup, chicken salad and a pork meal) within each country. Stepwise regressions were run with physiological control measures (hunger and thirst) entered in the first step, sociodemographic variables (sex, age, body mass index (BMI)) in the second step; psychological variables (cognitive restraint, uncontrolled eating, emotional eating, general health interest (GHI)) in the third step and food-related variables (expected fillingness, liking, expected healthfulness, food familiarity) in the fourth step. Sociodemographic variables accounted for 2-19% of the variance in meal portion sizes; psychological variables explained an additional 3-8%; and food-related variables explained an additional 2-12%. When all four variable groups were included in the regression models, liking and sometimes expected healthfulness was positively associated with meal portion size. The strongest association was for liking, which was statistically significant in both countries for all meal types. Whilst expected healthfulness was not associated with pizza portion size in either country, it was positively associated with meals that have a healthier image (vegetable soup; chicken salad and in IoI, the pork meal).In conclusion, after considering sociodemographic and psychological variables, and the food-related variables of liking and expected healthfulness, there may be little merit in manipulating the satiating power, at least of these type of meals, to maintain or promote weight loss.Keywords: Meal portion size; psychological variables; expected fillingness; expected healthfulness; food liking; food familiarity.

The associations between eating frequency and diet quality are inconclusive, which might be a result of different effects of meal frequency and snack frequency.This cross-sectional study examined the associations of eating frequency, meal frequency, and snack frequency with diet quality, based on data from the National Health and Nutrition Examination Survey 2003-2012.Dietary intake was assessed in 19,427 US adults aged 20 years or older, using two 24-hour dietary recalls. All eating occasions providing ≥50 kcal were divided into either meals or snacks on the basis of contribution to daily energy intake (≥15% or15%), self-report, and time (6 am to 10 am, 12 pm to 3 pm, and 6 pm 9 pm or others). Diet quality was assessed using the Healthy Eating Index-2010 (HEI-2010).Linear regression analyses were performed to explore the associations of eating frequency, meal frequency, and snack frequency (independent variables) with dietary intake variables (dependent variables).Higher eating frequency was modestly and positively associated with higher HEI-2010 in both men and women; one additional eating occasion per day increased HEI-2010 by 1.77 points in men and 2.22 points in women (both P0.0001). All measures of meal frequency and snack frequency were also modestly and positively associated with HEI-2010 in both sexes, irrespective of the definition of meals and snacks. However, the associations were stronger for meal frequency than for snack frequency; one additional meal per day increased HEI-2010 by 2.14 to 5.35 points, and one additional snack per day increased HEI-2010 by 1.25 to 1.97 points (all P0.0001).In a representative sample of US adults, both meal frequency and snack frequency were modestly associated with better diet quality.

The association between eating frequency (EF) and adiposity in young populations is inconsistent. This cross-sectional study examined associations of EF, meal frequency (MF) and snack frequency (SF) with adiposity measures in US children aged 6–11 years (n 4346) and adolescents aged 12–19 years (n 6338) participating in the National Health and Nutrition Examination Survey 2003–2012. Using data from two 24-h dietary recalls, all eating occasions providing ≥210 kJ of energy were divided into meals or snacks based on contribution to energy intake (≥15 or

ObjectiveTo examine the associations of meal frequency (MF) and snack frequency (SF) with diet quality.DesignDietary intake was assessed using two 24 h dietary recalls. All eating occasions providing ≥210 kJ of energy were divided into meals or snacks on the basis of contribution to energy intake (≥15 % or SettingNationally representative sample of the US population.SubjectsChildren aged 6–11 years (n 4269) and adolescents aged 12–19 years (n 6193) in the National Health and Nutrition Examination Survey 2003–2012.ResultsIrrespective of the definition of meals, higher MF was associated with higher HEI-2010 in both children and adolescents. One additional meal per day increased HEI-2010 by 1·45–3·59 points (all PP=0·001) and 1·00 (PConclusionsIn a representative sample of US children and adolescents, MF was associated with better diet quality, while the associations for SF varied depending on the definition of snacks. The findings highlight the importance of applying different definitions of meals and snacks when assessing the impact of dietary patterns on health.

Consumption of high-energy foods in the absence of hunger has been identified as a key target to address in the area of obesity. For children, such foods are often provided by adults as treats. There is limited understating of adults' treat giving. The present study aimed to understand adults' provision of treats to children on the Island of Ireland. A total of 1039 participants, including parents, grandparents, child minders and education practitioners completed a face-to-face survey in their home. Participants defined their treats for children primarily as 'something nice', 'deserved/earned' and 'something special'. The top three motivations for treat foods provision were 'to reward for good behaviour' (42.3%), 'because the child(ren) ask' (42.2%) and 'to make the child(ren) feel better' (29.4%). Almost all participants would provide treat foods at celebrations and 52.5% always did so. In addition, 68% participants had structured weekly and/or daily treat for children. Treats provided to children were dominated by energy-dense foods. The top three were sweets, chocolates and ice-creams, being used by 45.2%, 45.1% and 38.8% participants. Variations were observed across different adult groups, in terms of their treat giving behaviour. The main observation was that adults' treat foods provision has become habitual. The findings can help develop targeted strategies to encourage the reduction or replacement of food treats for children.

We assessed breakfast in Japan using data from the 2012 National Health and Nutrition Survey. Dietary data were obtained from 1444 children (aged 6&ndash, 11 years), 1134 adolescents (aged 12&ndash, 17 years), 6531 younger adults (aged 18&ndash, 49 years), and 13,343 older adults (aged &ge, 50 years), using a one-day weighed dietary record. Overall, 97% of participants reported consuming breakfast. Compared with breakfast skippers, breakfast consumers had a higher daily diet quality score assessed by the Nutrient-Rich Food Index 9.3 (NRF9.3). For those who consumed breakfast, breakfast accounted for 20&ndash, 25% of daily energy intake. In comparison with the contribution to energy, breakfast accounted for higher proportions of carbohydrate and riboflavin, and lower proportions of MUFA, n-3 PUFA, thiamin, and niacin, as well as vitamins B-6 and C. The overall diet quality (NRF9.3 score) was positively associated with breakfast intake of protein, n-6 PUFA, n-3 PUFA, carbohydrate, dietary fiber, and almost all micronutrients examined, and inversely with that of added sugar. For foods, the NRF9.3 score was positively associated with breakfast intake of rice, potatoes, pulses, vegetables, fruits, and eggs and inversely with that of bread, sugar, and soft drinks. The findings will be useful in developing dietary recommendations for a balanced breakfast among Japanese.

We assessed the adequacy of nutrient intakes of Japanese children aged 3&ndash, 5 years. Dietary information was collected using a 3-nonconsective-day weighed dietary record among 143 boys and 143 girls. Estimates of usual nutrient intakes from foods and beverages were obtained using the best-power method. The proportions of children with intakes below and above the Japanese Dietary Reference Intakes (DRIs) were estimated. The estimated usual intakes of boys and girls were adequate for most nutrients, given the low proportion (&le, 2%) of children consuming diets that fell below the Estimated Average Requirement (EAR) or the mean usual intakes higher than the Adequate Intake. However, a high percentage of boys and girls had usual intakes below the EAR for calcium (64% and 54%, respectively), vitamin A (20% and 11%, respectively), thiamin (15% and 41%, respectively), and iron (27% and 10%, respectively). Additionally, 62% of boys and 66% of girls had diets that exceeded the recommended range for total fat (20%&ndash, 30% energy). Further, 92% for boys and 85% for girls consumed diets that exceeded the recommended limit for sodium (4.0 and 4.5 g NaCl equivalent/day, respectively). In conclusion, the estimated usual intakes were adequate for most nutrients in this sample of 3&ndash, 5-year-old Japanese children.

We examined 13-year trends in dietary patterns, using data from the National Health and Nutrition Survey, Japan 2003&ndash, 2015. In repeated, independent cross-sectional studies, dietary intake was assessed with a one-day weighed dietary record in 88,527 Japanese adults aged &ge, 20 years. Using principal component analysis based on the daily consumption of 31 food groups, we identified three dietary patterns, the &ldquo, plant food and fish&rdquo, &ldquo, bread and dairy&rdquo, and &ldquo, animal food and oil&rdquo, patterns. In the whole sample, the &ldquo, pattern score decreased while the &ldquo, pattern scores increased. The decreasing trends in the &ldquo, pattern were observed in all subgroups considered. The increasing trends in the &ldquo, pattern were similar across sexes and by current smoking status. However, in terms of age, occupation, and weight status, the increasing trends were only evident in particular subgroups (i.e., age 50&ndash, 64 and &ge, 65 years, security/transportation/labor occupation and nonworker, and normal weight and overweight participants). For the &ldquo, pattern, the increasing trends were observed in all subgroups, except for the youngest age group (20&ndash, 34 years old). This study suggests continuous Westernization of the Japanese diet.

Recent designs of ankle-foot orthoses (AFOs) have been influenced by the increasing demand for higher function from active individuals. The biomechanical function of the individual and device is dependent upon the underlying mechanical characteristics of the AFO. Prior mechanical testing of AFOs has primarily focused on rotational stiffness to provide insight into expected functional outcomes; mechanical characteristics pertaining to energy storage and release have not yet been investigated. A pseudostatic bench testing method is introduced to characterize compressive stiffness, device deflection, and motion of solid-ankle, anterior floor reaction, posterior leaf spring, and the intrepid dynamic exoskeletal orthosis (IDEO) AFOs. Each of these four AFOs, donned over a surrogate limb, were compressively loaded at different joint angles to simulate the foot-shank orientation during various subphases of stance. In addition to force–displacement measurements, deflection of each AFO strut and rotation of proximal and supramalleolar segments were analyzed. Although similar compressive stiffness values were observed for AFOs designed to reduce ankle motion, the corresponding strut deflection profile differed based on the respective fabrication material. For example, strut deflection of carbon-fiber AFOs resembled column buckling. Expanded clinical test protocols to include quantification of AFO deflection and rotation during subject use may provide additional insight into design and material effects on performance and functional outcomes, such as energy storage and release.

Oncoplastic surgery is emerging as a validated, safe, patient-centric approach to breast cancer surgery in the United States. The American Society of Breast Surgeons Oncoplastic Surgery Committee (ASBrS-OSC) conducted a survey to assess the scope of practice and level of interest in oncoplastic surgery among its members. Furthermore, the group sought to identify barriers to incorporating oncoplastic skills in a surgeon’s practice. A 10-question survey was administered in March 2017 to the entire ASBrS membership using an online format. Three solicitations were sent. Unique identifiers allowed a single response. Of the 2655 surveys sent out, 708 members responded. Nearly all (99%) respondents had at least some interest in oncoplastic surgery. The current rates of performing nipple-sparing mastectomy, adjacent tissue transfer, and breast reduction with lumpectomy were 80, 60, and 51%, respectively. A minority of respondents reported independently performing breast reductions/mammaplasties (19%) or contralateral symmetrization (10%). Barriers to learning oncoplastic surgery included surgeon’s time and access to oncoplastic educational material/courses. Most respondents felt that training courses and videos may allow them to better incorporate oncoplastic techniques in their practices. The interest in oncoplastic surgery among U.S. surgeons is significant, yet there are barriers to incorporate these surgical techniques into a breast surgeon’s practice. As professional organizations provide access to effective training and enduring educational resources, breast surgeons will be enabled to develop their oncoplastic skill set and safely offer these techniques to their patients.

Background While the admittedly limited number of epidemiological findings on the association between diet-related greenhouse gas emissions (GHGE) and diet quality are not always consistent, potential influence of bias in the estimation of diet-related GHGE caused by misreporting of energy intake (EI) has not been investigated. This cross-sectional study evaluated diet-related GHGE in the UK and their association with diet quality, taking account of EI under-reporting. Methods Dietary data used were from the National Diet and Nutrition Survey rolling programme 2008/2009–2013/2014, in which 4-day food diaries were collected from 3502 adults aged ≥19 years. Diet-related GHGE were estimated based on 133 food groups, using GHGE values from various secondary sources. Diet quality was assessed by the healthy diet indicator (HDI), Mediterranean diet score (MDS) and Dietary Approaches to Stop Hypertension (DASH) score. EI misreporting was assessed as reported EI divided by estimated energy requirement (EI:EER). Results Mean value of daily GHGE was 5.7 kg carbon dioxide equivalents (CO2eq), which is consistent with those reported from a number of national representative samples in other European countries. Mean EI:EER was 0.74. Assuming that all the dietary variables were misreported in proportion to the misreporting of EI, the mean value of the misreporting-adjusted diet-related GHGE was 8.2 kg CO2eq/d. In the entire population, after adjustment for potential confounders (i.e., age, sex, ethnicity, socioeconomic classification, smoking status and physical activity), diet-related GHGE were inversely associated with HDI and DASH score but not with MDS. However, with further adjustment for EI:EER, diet-related GHGE showed inverse associations with all three measures of diet quality. Similar associations were observed when only under-reporters (EI:EER

Traditionally only a small proportion of the workforce was engaged in shift work. Changing economic pressures have resulted in increased engagement in shift work, with approximately 17 % of the workforce in Europe engaged in this work pattern. The present narrative review aimed to summarise the data on the effects of shift work on the diet, lifestyle and health of employees, while addressing the barriers to, and opportunities for, improving health among shift workers. Shift work can result in low-quality diet and irregular eating patterns. Adverse health behaviours are also reported; particularly increased smoking and poor sleep patterns. These altered lifestyle habits, in conjunction with disruption to circadian rhythms, can create an unfavourable metabolic phenotype which facilitates the development and progression of chronic disease. Although the data are inconclusive due to issues such as poor study design and inadequate control for confounding factors; shift workers appear to be at increased mental and physical health risk, particularly with regard to non-communicable diseases. Information is lacking on the obstacles to leading a healthier lifestyle while working shifts, and where opportunities lie for intervention and health promotion among this group. In order to provide an informed evidence base to assist shift workers in overcoming associated occupational hazards, this gap must be addressed. This review highlights the unique nutritional issues faced by shift workers, and the subsequent effect on health. In societies already burdened with increased incidence of non-communicable chronic diseases, there is a clear need for education and behaviour change interventions among this group.

Evidence of associations between meal frequency (MF) and snack frequency (SF) and diet and obesity in young populations is limited. This cross-sectional study examined MF and SF in relation to dietary intake and adiposity measures in British children aged 4–10 years (n 818) and adolescents aged 11–18 years (n 818). Based on data from a 7-d weighed dietary record, all eating occasions were divided into meals or snacks on the basis of contribution to energy intake (≥15 or

Using data from the National Health and Nutrition Examination Survey (NHANES) 2003–2012, we investigated the prevalence and characteristics of under- and over-reporting of energy intake (EI) among 14 044 US children and adolescents aged 2–19 years. For the assessment of EI, two 24-h dietary recalls were conducted with the use of the US Department of Agriculture Automated Multiple-Pass Method. Under-, plausible and over-reporters of EI were identified using two methods: based on the 95 % confidence limits (1) for agreement between the ratio of EI:BMR and a physical activity level for sedentary lifestyle (1·55) and (2) of the expected ratio of EI:estimated energy requirement (EER) of 1·0. BMR was calculated using Schofield’s equations. EER was calculated using equations from the US Dietary Reference Intakes, assuming ‘low active’ level of physical activity. The risk of being an under- or over-reporter compared with a plausible reporter was analysed using multiple logistic regression. Percentages of under-, plausible and over-reporters were 13·1, 81·5 and 5·4 %, respectively, based on EI:BMR and 18·8, 72·3 and 8·8 %, respectively, based on EI:EER. Under-reporting was associated with older age, non-Hispanic blacks (compared with non-Hispanic whites) and overweight and obesity (compared with normal weight). Over-reporting was associated with younger age, lower family poverty income ratio, normal weight and the first survey cycle. Similar findings were obtained when analysing only the first 24-h recall data from NHANES 1999–2012 (n 22 949). In conclusion, we found that EI misreporting remains prevalent and differential in US children and adolescents.

Using data from the National Health and Nutrition Examination Survey (NHANES) 2003–2012, we investigated the prevalence and characteristics of under-reporting and over-reporting of energy intake (EI) among 19 693 US adults ≥20 years of age. For the assessment of EI, two 24-h dietary recalls were conducted using the US Department of Agriculture Automated Multiple-Pass Method. Under-reporters, acceptable reporters and over-reporters of EI were identified by two methods based on the 95 % confidence limits: (1) for agreement between the ratio of EI to BMR and a physical activity level for sedentary lifestyle (1·55) and (2) of the expected ratio of EI to estimated energy requirement (EER) of 1·0. BMR was calculated using Schofield’s equations. EER was calculated using equations from the US Dietary Reference Intakes, assuming ‘low active’ level of physical activity. The risk of being an under-reporter or over-reporter compared with an acceptable reporter was analysed using multiple logistic regression. Percentages of under-reporters, acceptable reporters and over-reporters were 25·1, 73·5 and 1·4 %, respectively, based on EI:BMR, and 25·7, 71·8 and 2·5 %, respectively, based on EI:EER. Under-reporting was associated with female sex, older age, non-Hispanic blacks (compared with non-Hispanic whites), lower education, lower family poverty income ratio and overweight and obesity. Over-reporting was associated with male sex, younger age, lower family poverty income ratio, current smoking (compared with never smoking) and underweight. Similar findings were obtained when analysing only the first 24-h recall data from NHANES 1999–2012 (n 28 794). In conclusion, we found that misreporting of EI, particularly under-reporting, remains prevalent and differential in US adults.

The present analysis aimed to investigate the changes in the reported portion sizes (PS) of foods and beverages commonly consumed by Irish adults (18–64 years) from the North South Ireland Food Consumption Survey (NSIFCS) (1997–2001) and the National Adult Nutrition Survey (NANS) (2008–10). Food PS, which are defined as the weight of food (g) consumed per eating occasion, were calculated for comparable foods and beverages in two nationally representative cross-sectional Irish food consumption surveys and were published in NSIFCS and NANS. Repeated measure mixed model analysis compared reported food PS at the total population level as well as subdivided by sex, age, BMI and social class. A total of thirteen commonly consumed foods were examined. The analysis demonstrated that PS significantly increased for five foods (‘white sliced bread’, ‘brown/wholemeal breads’, ‘all meat, cooked’, ‘poultry, roasted’ and ‘milk’), significantly decreased for three (‘potatoes’, ‘chips/wedges’ and ‘ham, sliced’) and did not significantly change for five foods (‘processed potato products’, ‘bacon/ham’, ‘cheese’, ‘yogurt’ and ‘butter/spreads’) between the NSIFCS and the NANS. The present study demonstrates that there was considerable variation in the trends in reported food PS over this period.

As under-reporting of dietary intake, particularly by overweight and obese subjects, is common in dietary surveys, biases inherent in the use of self-reported dietary information may distort true diet–obesity relationships or even create spurious ones. However, empirical evidence of this possibility is limited. The present cross-sectional study compared the relationships of 24 h urine-derived and self-reported intakes of Na, K and protein with obesity. A total of 1043 Japanese women aged 18–22 years completed a 24 h urine collection and a self-administered diet history questionnaire. After adjustment for potential confounders, 24 h urine-derived Na intake was associated with a higher risk of general obesity (BMI ≥ 25 kg/m2) and abdominal obesity (waist circumference ≥ 80 cm; both P for trend = 0·04). For 24 h urine-derived protein intake, positive associations with general and abdominal obesity were observed (P for trend = 0·02 and 0·053, respectively). For 24 h urine-derived K intake, there was an inverse association with abdominal obesity (P for trend = 0·01). Conversely, when self-reported dietary information was used, only inverse associations between K intake and general and abdominal obesity were observed (P for trend = 0·04 and 0·02, respectively), with no associations of Na or protein intake. In conclusion, we found positive associations of Na and protein intakes and inverse associations of K intake with obesity when using 24 h urinary excretion for estimating dietary intakes. However, no association was observed based on using self-reported dietary intakes, except for inverse association of K intake, suggesting that the ability of self-reported dietary information using the diet history questionnaire for investigating diet–obesity relationships is limited.

Associations between the overall quality of Japanese diets and metabolic risk factors are largely unknown. This cross-sectional study investigated this issue using data from the 2012 National Health and Nutrition Survey, Japan. Dietary intake was assessed by a 1-day weighed dietary record in 15,618 Japanese adults aged ≥ 20 years. Overall diet quality was assessed by adherence to the Japanese Food Guide Spinning Top (JFG score), its modified version (modified JFG score), the Mediterranean diet score (MDS) and the Dietary Approaches to Stop Hypertension (DASH) score. Metabolic risk factors included BMI, waist circumference, blood pressure, total, HDL- and LDL-cholesterol and glycated haemoglobin. While DASH score was consistently associated with favourable nutrient intake patterns (including higher micronutrient and dietary fibre intakes and lower SFA and sodium intakes), other scores were associated with both favourable and unfavourable aspects (e.g., lower micronutrient intakes for JFG score, higher SFA intakes for modified JFG score and higher sodium intakes for MDS). The associations with metabolic risk factors were also inconsistent and unexpected, including positive associations of JFG and modified JFG scores with LDL-cholesterol, inverse associations of MDS with HDL-cholesterol and null associations of DASH score with blood pressure. This study did not show expected and consistent associations of the four available diet quality scores with nutrient intakes and metabolic risk factors in Japanese adults. This in turn suggests the need for a scientific base on which to develop an appropriate tool for assessing the quality of diets in the Japanese context.

Background Approximately 17% of the European workforce is engaged in shift work. How the experience of shift work impacts on the dietary and lifestyle practices of workers is unclear. Methods Overall, 15 focus groups were conducted by two researchers, with 109 participants. The initial focus group was carried out with both researchers present, to ensure consistency in facilitation. Both researchers thematically analysed all data collected. Results Shift work was described as affecting many areas of workers' lives. Three overarching themes were identified: (i) impact on eating behaviour; (ii) impact on other lifestyle behaviours including physical activity, sleep, alcohol consumption, smoking; and (iii) impact on psychosocial health and wellbeing. There appeared to be overlap between the effect of shift work and the effect of individual internal factors in influencing workers' decision-making with regard to lifestyle practices. Conclusions Shift work affects many areas of workers' lives, negatively impacting on eating and lifestyle behaviours and psychosocial health. This study augments the current literature as it highlights the role internal motivation plays in workers' lifestyle choices. The research should help inform the development of public health strategies to minimize the impact of shift work, such as specialist behavioural change interventions specific to this group.

Objective The objective of this work was to provide easy access to reliable health information based on good quality research that will help health care professionals to learn what works best for seniors to stay as healthy as possible, manage health conditions and build supportive health systems. This will help meet the demands of our aging population that clinicians provide high quality care for older adults, that public health professionals deliver disease prevention and health promotion strategies across the life span, and that policymakers address the economic and social need to create a robust health system and a healthy society for all ages. Results The McMaster Optimal Aging Portal’s (Portal) professional bibliographic database contains high quality scientific evidence about optimal aging specifically targeted to clinicians, public health professionals and policymakers. The database content comes from three information services: McMaster Premium LiteratUre Service (MacPLUS™), Health Evidence™ and Health Systems Evidence. The Portal is continually updated, freely accessible online, easily searchable, and provides email-based alerts when new records are added. The database is being continually assessed for value, usability and use. A number of improvements are planned, including French language translation of content, increased linkages between related records within the Portal database, and inclusion of additional types of content. While this article focuses on the professional database, the Portal also houses resources for patients, caregivers and the general public, which may also be of interest to geriatric practitioners and researchers.

Body fat distribution has been shown to be a predictor of adhesion molecule and inflammatory marker expression albeit the effect of modest weight change on concentrations of adhesion molecules and inflammatory markers in postmenopausal women are not fully understood. The primary aim was to investigate the effects of weight change on adhesion molecules and inflammatory markers over 24 months in postmenopausal women. Body composition was assessed in 254 healthy postmenopausal women using dual-energy X-ray absorptiometry (DXA). Adhesion molecules and inflammatory markers were analysed by multiplex ELISA. Participants weight gain/loss at 24 months was defined as any value that was either above/below the weight value recorded at baseline. Postmenopausal women with an average weight loss of 3% had significantly decreased leptin concentrations by 18% at 24 months (P

The associations of dietary energy density with dietary intake and obesity have been largely unexplored in non-Western populations. The present cross-sectional study examined the associations using data from the 2012 National Health and Nutrition Survey, Japan. Dietary intake was assessed using a 1-d semi-weighed dietary record in 15 618 Japanese adults aged ≥20 years. Mean dietary energy density (calculated on the basis of foods only) was 5·98 (sd 1·20) kJ/g in men and 5·72 (sd 1·16) kJ/g in women. Dietary energy density was positively associated with intakes of bread, noodles (only men), meat, fats and oils, and sugar and confectionery but inversely with intakes of white rice (only men), potatoes, pulses, vegetables, fruits, and fish and shellfish. For nutrient intake, dietary energy density was positively associated with total fat and SFA but inversely associated with all other nutrients examined such as protein, carbohydrate, alcohol (only women), dietary fibre, and several vitamins and minerals, including Na. After adjustment for potential confounding factors, dietary energy density was positively associated with abdominal obesity (waist circumference ≥80 cm) in women (adjusted prevalence ratio between the extreme tertiles 1·07; 95 % CI 1·02, 1·12; Pfor trend=0·003). Dietary energy density was also positively but non-significantly associated with general obesity (BMI≥25 kg/m2) in women (Pfor trend=0·08). There were no such associations in men. In conclusion, lower energy density of the diets of Japanese adults was associated with favourable food and nutrient intake patterns, except for higher Na, and, in only women, a lower prevalence of abdominal obesity.

The biologically active vitamin D metabolite (1[alpha]-dihydroxyvitamin D) has been linked to regulation of human cathelicidin antimicrobial peptide (LL-37) in vitro. Recent studies in athletes indicate that vitamin D inadequacy is associated with lower concentrations of LL-37 and that this may increase risk of upper respiratory tract infection (URTI). PURPOSE: To compare circulating LL-37 concentrations between athletes and healthy controls and to establish if total 25-hydroxyvitamin D (25[OH]D) was a significant determinant of this antimicrobial peptide.METHODS: A total of 221 stored, fasted plasma samples from male and female athletes (elite rugby n=12, elite boxing n=12, Gaelic football n=77) and age and sex-matched healthy controls (n=120) were analysed in duplicate for LL-37 concentrations using an enzyme-linked immunosorbent assay. Total 25(OH)D concentrations were quantified by liquid chromatography-tandem mass spectrometry as part of the previous studies. Comparison of 25(OH)D and LL-37 concentrations between athletes and controls was made using Mann-Whitney U tests. Linear regression was used to test if 25(OH)D concentration was a significant determinant of LL-37 concentration after adjusting for season of sampling.RESULTS: Median [IQR] 25(OH)D concentrations were 49.76[39.37] and 28.90[23.55] nmol/L for athletes and healthy controls respectively, P

WOS: 000397406000012, PubMed ID: 28205285, Background: Development of inhibitors is the most serious complication in haemophilia A treatment. The assessment of risk for inhibitor formation in new or modified factor concentrates is traditionally performed in previously treated patients (PTPs). However, evidence on risk factors for and natural history of inhibitors has been generated mostly in previously untreated patients (PUPs). The purpose of this study was to examine cases of de novo inhibitors in PTPs reported in the scientific literature and to the EUropean HAemophilia Safety Surveillance (EUHASS) programme, and explore determinants and course of inhibitor development. Methods: We used a case series study design and developed a case report form to collect patient level data; including detection, inhibitor course, treatment, factor VIII products used and events that may trigger inhibitor development (surgery, vaccination, immune disorders, malignancy, product switch). Results: We identified 19 publications that reported 38 inhibitor cases and 45 cases from 31 EUHASS centres. Individual patient data were collected for 55/83 (66%) inhibitor cases out of 12 330 patients. The median (range) peak inhibitor titre was 4.4 (0.5-135.0), the proportion of transient inhibitors was 33% and only two cases of 12 undergoing immune tolerance induction failed this treatment. In the two months before inhibitor development, surgery was reported in nine (22%) cases, and high intensity treatment periods reported in seven (17%) cases. Conclusions: By studying the largest cohort of inhibitor development in PTPs assembled to date, we showed that inhibitor development in PTPs, is on average, a milder event than in PUPs., Canadian Hemophilia Society (CHS); PfizerPfizer, This study was supported by two independent unrestricted research grants: a 'Care until Cure' peer reviewed research grant, awarded in 2013 to AMB by the Canadian Hemophilia Society (CHS) supported the collection of inhibitor data reported in the literature; a Pfizer Investigator-Initiated Research grant awarded in 2014 to AI supported the collection of data reported to EUHASS.

Portion size is a key environmental driver of energy intake, and larger-than-appropriate portion sizes could increase the risk of weight gain. Multiple acute, well-controlled laboratory studies, supported by data from free-living settings, demonstrated that portion size has a powerful and proportionate effect on the amount of food consumed. Of particular importance is that bouts of overeating associated with large portions are sustained and not followed by a compensatory reduction in energy intake. The positive effect of portion size on energy intake was demonstrated for different types of foods and beverages, and is particularly pronounced with energy-dense foods. The predisposition to overeat in response to large portions is pervasive and occurs regardless of demographic characteristics, such as socioeconomic status, age, body mass index, and sex. Secular trends toward greater availability of large portions, coupled with value-size pricing, effectively distorted consumption norms and perceptions of what is an appropriate amount to eat. Nevertheless, although a direct causal link between portion size and obesity remains to be established, advice to moderate portion sizes, especially of energy-dense foods, is presently the cornerstone of most weight management advice. Although many strategies have been proposed to counteract the deleterious effects of portion size, there are few data indicating which are likely to be acceptable in the medium- to long term. Further research is urgently needed to establish what types of interventions targeted at portion size are likely to be effective, in what settings, and among which target groups.

Sex differences in the ratio of fat mass (FM):fat-free mass (FFM) during weight change should differentially affect the extent of weight change during energy imbalance in men and women. In the present study, we determined FM and FFM contents by dual-energy X-ray absorptiometry and calculated the P-ratios (protein energy/total energy) of excess weight and weight loss during a randomised controlled trial of four commercial weight loss regimens. Overweight and obese women (n 210) and men (n 77) were studied at baseline and at 2 and 6 months during weight loss on four dietary regimens: Dr Atkins' New Diet Revolution; The Slim-Fast Plan; Weight-Watchers programme; Rosemary Conley's Diet and Fitness Plan. At baseline, the percentage of FFM (%FFM) and P-ratios of excess weight were 40 % and 0·071 for men and 27 % and 0·039 for women. At 2 months, men had lost twice as much weight as women and three times more FFM than women, indicating higher FFM content and P-ratios of weight loss for men, 0·052, than for women, 0·029, with no dietary effects. Between 2 and 6 months, the rate at which weight was lost decreased and the %FFM of weight loss decreased to similar low levels in men (7 %) and women (5 %): i.e. P-ratios of 0·009 and 0·006, respectively, with no dietary effects. Thus, for men compared with women, there were greater FFM content and P-ratios of weight change, which could partly, but not completely, explain their greater weight loss at 2 months. However, protein-conserving adaptations occur with increasing weight loss and over time, more extensively in men, eventually eliminating any sex difference in the composition of weight loss.

Nutrition labelling is an important strategic approach for encouraging consumers to make healthier food choices. The availability of highly palatable foods labelled as 'low fat or reduced calorie' may encourage the over-consumption of these products. This study aimed to determine whether the manipulation of nutrition labelling information can influence food portion size consumption. Normal and overweight men (n=24) and women (n=23) were served an identical lunch meal on three separate days, but the information they received prior to consuming the lunch meal was manipulated as follows: "baseline", "high fat/energy" and "low fat/energy". Food and energy intake was significantly increased in the low fat/energy condition compared with both baseline and the high fat/energy condition. An additional 3% (162 kJ) energy was consumed by subjects under the low fat/energy condition compared to baseline. No differences were observed between the baseline and high fat/energy condition. Subjects who consumed most in the low fat/energy condition were found to be mostly men, to have a higher BMI and to be overweight. Low fat/energy information can positively influence food and energy intake, suggesting that foods labelled as 'low fat' or 'low calorie' may be one factor promoting the consumption of large food portions.

This cross-sectional study examined how energy density (ED) of meals and snacks are associated with overall diet quality and adiposity measures in 1617 British children aged 4–18 years from the 1997 National Diet and Nutrition Survey. On the basis of data from 7-d weighed dietary record, all eating occasions were divided into meals or snacks on the basis of time (meals: 06.00–09.00, 12.00–14.00 and 17.00–20.00 hours; snacks: all others) or contribution to energy intake (EI) (meals: ≥15 %; snacks: v. 9·69–10·52 kJ/g). Both ED of meals and ED of snacks were inversely associated with total intakes of vegetables, fruits, dietary fibre and overall diet quality and positively associated with total intakes of fat. However, the associations were stronger for ED of meals. The change in the Mediterranean diet score with a 1-unit increase of ED (kJ/g) was −0·35 to −0·30 for ED of meals and −0·09 to −0·06 for ED of snacks (all P