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Long term nut consumption is associated with reduced risk of coronary heart disease and better cognitive function. This study examined supplementing habitual diets with almonds or carbohydrate-rich snack foods (providing 15% energy) on biomarkers of cardiovascular and metabolic health, mood and cognitive performance. Participants (overweight/obese, 50&ndash, 80 years) were randomised to an almond-enriched diet (AED) or isocaloric nut-free diet (NFD) for 12 weeks. Body weight, blood lipids, glucose, insulin, blood pressure (BP), arterial stiffness, cell adhesions molecules, C reactive protein (CRP), mood, and cognitive performance (working memory primary outcome), dietary profiles and energy intake/expenditure were measured at baseline and Week 12 in 128 participants (n = 63 AED, n = 65 NFD). Compared with NFD, AED was associated with altered macro and micronutrient profiles, but no differences in energy intake or expenditure. The AED significantly reduced triglycerides and SBP but there were no other changes in cardiometabolic biomarkers, mood, or cognitive performance. The inclusion of almonds in the diet improves aspects of cardiometabolic health without affecting cognitive performance or mood in overweight/obese adults.

Objectives Reductions in maximal rate of heart rate increase (rHRI) correlate with performance reductions when training load is increased. This study evaluated whether rHRI tracked performance changes across a range of training states. Design Prospective intervention. Methods rHRI was assessed during five min of cycling at 100 W (rHRIcyc) and running at 8 km/h (rHRIrun) in 13 male triathletes following two weeks of light-training (LT), two weeks of heavy-training (HT) and a two-day recovery period (RP). A five min cycling time-trial assessed performance and peak oxygen consumption ( V ˙ O 2 peak ) . Results Performance likely decreased following HT (Effect size ± 90% confidence interval = −0.18 ± 0.09), then very likely increased following RP (0.32 ± 0.14). rHRIcyc very likely decreased (−0.48 ± 0.24), and rHRIrun possibly decreased (−0.33 ± 0.48), following HT. Changes in both measures were unclear following RP. Steady-state HR was almost certainly lower (−0.81 ± 0.31) during rHRIcyc than rHRIrun. A large correlation was found between reductions in performance and rHRIrun (r ± 90%; CI = 0.65 ± 0.34) from LT to HT, but was unclear for rHRIcyc. Trivial within-subject correlations were found between rHRI and performance, but the strength of relationship between rHRIrun and performance was largely associated with V ˙ O 2 peak following LT (r = −0.58 ± 0.38). Conclusions Performance reductions were most sensitively tracked by rHRIrun following HT. This may be due to rHRIrun being assessed at a higher intensity than rHRIcyc, inferred from a higher steady-state HR and supported by a stronger within-subject relationship between rHRIrun and performance in individuals with a lower V ˙ O 2 peak , in whom the same exercise intensity would represent a greater physiological stress. rHRI assessed at relatively high exercise intensities may better track performance changes.

Background: This study examined relationships between adiposity, physical functioning, and physical activity. Methods: Obese (N = 107) and healthy-weight (N = 132) children aged 10-13 years underwent assessments of percent body fat (%BF, dual energy X-ray absorptiometry); knee extensor strength (KE, isokinetic dynamometry); cardiorespiratory fitness (CRF, peak oxygen uptake by cycle ergometry); physical health-related quality of life (HRQOL); and worst pain intensity and walking capacity [six-minute walk (6MWT)]. Structural equation modelling was used to assess relationships between variables. Results: Moderate relationships were observed between %BF and (1) 6MWT, (2) KE strength corrected for mass, and (3) CRF relative to mass (r -0.36 to -0.69, p ≤ 0.007). Weak relationships were found between %BF and physical HRQOL (r -0.27, p = 0.008); CRF relative to mass and physical HRQOL (r -0.24, p = 0.003); physical activity and 6MWT (r 0.17, p = 0.004). Squared multiple correlations showed that 29.6% variance in physical HRQOL was explained by %BF, pain, and CRF relative to mass; while 28.0% variance in 6MWT was explained by %BF and physical activity. Conclusions: It appears that children with a higher body fat percentage have poorer KE strength, CRF, and overall physical functioning. Reducing percent fat appears to be the best target to improve functioning. However, a combined approach to intervention, targeting reductions in body fat percentage, reductions in pain, and improvements in physical activity and CRF may assist physical functioning. Refereed/Peer-reviewed

Background Although higher-protein diets (HP) can assist with weight loss and glycemic control, their effect on psychological wellbeing has not been established. The objective of this study was to compare the effects of a HP and a higher-carbohydrate diet (HC), combined with regular exercise, on psychological wellbeing both during weight loss (WL) and weight maintenance phases (WM). Methods In a parallel RCT, 61 adults with T2D (mean ± SD: BMI 34.3 ± 5.1 kg/m2, aged 55 ± 8 years) consumed a HP diet (29% protein, 34% carbohydrate, 31% fat) or an isocaloric HC diet (21%:48%:24%), with moderate intensity exercise, for 12 weeks of WL and 12 weeks of WM. Secondary data evaluating psychological wellbeing was assessed using: Problems Areas in Diabetes (PAID); Diabetes-39 Quality of Life (D-39); Short Form Health Survey (SF-36); Perceived Stress Scale-10 (PSS-10) and the Leeds Sleep Evaluation Questionnaire (LSEQ) at Weeks 0, 12 and 24 and evaluated with mixed models analysis. Results Independent of diet, improvements for PAID; D-39 diabetes control; D-39 severity of diabetes; SF-36 physical functioning and SF-36 general health were found following WL (d = 0.30 to 0.69, P ≤ 0.04 for all) which remained after 12 weeks of WM. SF-36 vitality improved more in the HP group (group x time interaction P = 0.03). Associations were seen between HbA1c and D-39 severity of diabetes rating (r = 0.30, P = 0.01) and SF-36 mental health (r = − 0.32, P = 0.003) and between weight loss and PAID (r = 0.30, P = 0.01). Conclusion Several improvements in diabetes-related and general psychological wellbeing were seen similarly for both diets following weight loss and a reduction in HbA1c with most of these improvements remaining when weight loss was sustained for 12 weeks. A HP diet may provide additional increases in vitality. Trial registration The trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN 12613000008729) on 4 January 2013.

Background: Hypocaloric low-fat diets, high in protein with moderate carbohydrate (HP) can enhance weight loss, improve glycaemic control and improve cardiometabolic health risk factors in type 2 diabetes mellitus (T2DM). However, it is unclear whether the metabolic benefits observed during weight loss are sustained during energy-balance and weight maintenance. Furthermore, there is a lack of evidence regarding the effect of HP diets on food cravings, cognitive function and psychological wellbeing in T2DM, despite carbohydrate food cravings, cognitive impairment and depression being associated with hyperglycaemia. Methods/design: Overweight/obese adults with T2DM were randomised to consume either a HP diet (n. = 32, ~. 32% protein, 33% carbohydrate, 30% fat) or a higher-carbohydrate diet (HC, n. = 29, ~. 22% protein, 51% carbohydrate, 22% fat) for 24 weeks with 30 min of moderate intensity exercise five days/week for the study duration. There were 2 phases: a 12 week weight loss phase followed by a 12 week weight maintenance phase. Primary outcome was glycaemic control (glycosylated haemoglobin; HbA1c). Secondary outcomes were cardiometabolic risk factors (body composition, fasting blood pressure, blood lipids, glucose, insulin and C-reactive protein), food cravings, cognitive function (memory; psychomotor and executive function and psychological well-being. Outcomes were measured at baseline and the end of each 12-week intervention phase. Data will be analysed as intention-to-treat using linear mixed effects models. Conclusion: This study will examine the effects of two dietary interventions on health outcomes in T2DM during weight loss and notably following weight maintenance where there is a paucity of evidence. Refereed/Peer-reviewed

People with dysphagia are at high risk of malnutrition. To maintain safe oral intake, solid food may be texture modified but this is associated with a reduction in the enjoyment of the eating experience. A recent approach to improving the enjoyment of eating texture-modified food has been to mould the food into the shape of the food that has been modified. The aim of this exploratory study was to describe and explain the mealtime experience of older people with dysphagia. Design: Qualitative and exploratory. Participants: In total, thirty five participants (nursing, care workers, lifestyle assistants, catering staff and residents) were involved in non-participant observations and individual interviews for the qualitative assessment of the eating experience. Intervention: Moulded texture-modified food. The intervention occurred at lunchtime for a period of 3 consecutive days. Qualitative assessment: Non-participant observations and individual interviews were conducted before and after the intervention. Analysis: Interpretative, descriptive and explanatory. Findings: Residents with dysphagia are separated from the dining experience and fostering good relationships between residents at mealtimes may lessen the effects of the challenging eating behaviours that often isolate residents with dysphagia from the dining environment. Non-moulded texture-modified food was viewed negatively by all participants and contributed to problems of interaction between care staff and residents by weakening those conversations and interactions that underpin the social dining experience. Residents also experienced difficulties adjusting to texture-modified food. Conclusion: Residents' experience of adjustment to texture-modified food is difficult and non-moulded texture-modified meal that is unrecognisable and indescribable creates a problem of interaction between care staff and residents during mealtimes. The implementation of moulded texture-modified food has resulted in positive qualitative outcomes in the perception of texture-modified food and has improved the verbal interaction between care staff and residents. Refereed/Peer-reviewed

Refereed/Peer-reviewed This paper reviews the current literature around the environmental impacts of dietary recommendations. The focus of the review is on collating evidence relating to environmental impacts of the dietary advice found in the World Health Organisation guidelines, and environmental impact literature: reducing the consumption of fat, reducing the consumption of meat-based protein and animal-based foods, and increasing the consumption of fruit and vegetables. The environmental impact of reducing dietary fat intake is unclear, although reducing consumption of the food category of edible fats and oils appears to have little impact. However most, but not all, studies support environmental benefits of a reduced consumption of animal-based foods and increased consumption of fruit and vegetables. In general, it appears that adhering to dietary guidelines reduces impact on the environment, but further study is required to examine the environmental impacts of animal-based foods, and fruit and vegetable intake in depth.

Background and aims: Very-low carbohydrate diets can improve glycaemic control in patients with type 2 diabetes (T2DM). However, compared to traditional higher carbohydrate, low fat (HighCHO) diets, they have been associated with impaired endothelial function (measured by flow mediated dilatation [FMD]) that is possibly related to saturated fat. This study aimed to examine the effects of a 12-month hypocaloric very-low carbohydrate, low saturated fat (LowCHO) diet compared to an isocaloric HighCHO diet. Methods: One hundred and fifteen obese patients with T2DM (age:58.4 ± 0.7 [SEM] yr, BMI:34.6 ± 0.4 kg/m2, HbA1c:7.33 [56.3 mmol/mol] ± 0.10%) were randomised to consume an energy restricted LowCHO diet (Carb:Pro:Fat:Sat-Fat 14:28:58

† Newly introduced Nutrient Reference Values indicate thatmost Australians need to increase their dietary intake ofthe long chain omega-3 polyunsaturated fatty acids (LComega-3 PUFA), viz. eicosapentaenoic acid (EPA), docosa-pentaenoic acid (DPA) and docosahexaenoic acid (DHA),to reduce the risk of chronic disease.† Analysis of the 1995 National Nutrition Survey revealedthat meat contributed almost as much as seafood to the LComega-3 PUFA intake of adult Australians.† Meat has a relatively high content of DPA, relative to EPAand DHA. Thus DPA accounts for 29% of the average LComega-3 PUFA intake of adult Australians.† Recent evidence suggests that DPA is just as important asEPA or DHA for delivering the health benefits associatedwith LC omega-3 PUFA.† Current regulations, however, do not take account of theDPA content of foods in determining whether they qualifyfor an omega-3 content claim. Moreover, the DPA contentof foods will not be considered in a proposed general levelomega-3 health claim.† Lean red meat is an important natural food source of LComega-3 PUFA, the content of which can be influenced bymodifying the composition of livestock feeds.

CVD is associated with a cellular inflammatory/immune response.n-3 PUFA and moderate aerobic exercise independently alter cytokine production and leucocyte function. There is limited evidence for the combined effect of these treatments on immune function, particularly in patients with risk factors for CVD. We hypothesised that exercise would enhance the anti-inflammatory effects ofn-3 PUFA. In a randomised, placebo-controlled study, fifty volunteers were allocated double-blind to consume either sunflower oil (6 g/d, placebo) or DHA-rich fish oil (6 g/d; about 2 gn-3 PUFA; 1·6 g DHA /d) for 12 weeks. Volunteers were further randomised to undertake regular exercise (walking 3 d/week for 45 min at 75 % of maximum heart rate) or maintain their usual physical activity for 12 weeks. Immune functions were assessed in blood taken initially and after 12 weeks. There was no effect on cytokine production by T cells and monocytes. Superoxide anion production from stimulated blood neutrophils was decreased by fish oil (19·5 (sem8·5) %,P = 0·016) but not by exercise, and this change was negatively correlated with the incorporation of DHA into erythrocytes (r–0·385,P = 0·047). Participation in regular exercise maintained neutrophil bactericidal activity, which decreased in non-exercising subjects (2·9 (sem0·7) %,P = 0·013). Neutrophil chemotaxis and adherence were not significantly affected by exercise, oil, or the combination of the two. Thus the combination of moderate exercise and fish-oil supplementation, which reduces cardiovascular risk, may also help to counteract inflammation.

This paper uses input-output analysis to model the environmental impacts of the weekly food consumption of Australia's households sorted by income quintile in 2003. We found that weekly food consumption of the relatively better off households caused greater environmental burden than that of the less well-off household.Meat and bakery products/flour/cereals were the categories that contributed the largest share of environmental impacts in an average household's food consumption footprint: 58% water, 26% energy, 29% CO2, and 31% wasted materials.Per dollar spent, fruit and vegetables generated 0.0874m3 of water, 0.0055GJ of energy, 0.37kg of CO2, and 0.0114kg of wasted materials. This was lower than the per dollar impacts of bakery products (0.8482, 0.0067, 0.63, 0.0204), meat (0.3471, 0.0070, 0.65, 0.0203), dairy (0.0995, 0.0114, 0.98, 0.0192), and edible fats (0.2373, 0.0080, 0.70, 0.0165). Eating out and fast food consumption also had a low per dollar impact (0.1317, 0.0046, 0.38, 0.0141).We surmise that substituting fruit and vegetables at the expense of animal products, processed foods, and fats would decrease environmental impacts. Change at low income levels should be focused upon meat, bakery and dairy consumption, while higher incomes should be focused upon the consequences of eating food outside the home Refereed/Peer-reviewed

OBJECTIVE To compare bioelectrical impedance analysis (BIA) of body composition using three different methods against DXA in overweight and obese men. RESEARCH METHODS AND PROCEDURES Forty-three healthy overweight or obese men (ages 25 to 60 years; BMI, 28 to 43 kg/m(2)) underwent BIA assessment of body composition using the ImpediMed SFB7 (version 6; ImpediMed, Ltd., Eight Mile Plains, Queensland, Australia) in multifrequency mode (Imp-MF) and DF50 single-frequency mode (Imp-SF) and the Tanita UltimateScale (Tanita Corp., Tokyo, Japan). Validity was assessed by comparison against DXA using linear regression and limits of agreement analysis. RESULTS All three BIA methods showed good relative agreement with DXA [Imp-MF: fat mass (FM), r(2) = 0.81; fat-free mass (FFM), r(2) = 0.81; percentage body fat (BF%), r(2) = 0.69; Imp-SF: FM, r(2) = 0.65; FFM, r(2) = 0.76; BF%, r(2) = 0.40; Tanita: BF%, r(2) = 0.44; all p < 0.001]. Absolute agreement between DXA and Imp-MF was poor, as indicated by a large bias and wide limits of agreement (bias, +/-1.96 standard deviation; FM, -6.6 +/- 7.7 kg; FFM, 8.0 +/- 7.1 kg; BF%, -7.0 +/- 6.6%). Imp-SF and Tanita exhibited a smaller bias but wide limits of agreement (Imp-SF: FM, -1.1 +/- 8.5 kg; FFM, 2.5 +/- 7.9 kg; BF%, -1.7 +/- 7.3%; Tanita: BF%, 1.2 +/- 9.5%). DISCUSSION Compared with DXA, Imp-MF produced large bias and wide limits of agreement, and its accuracy estimating body composition in overweight or obese men was poor. Imp-SF and Tanita demonstrated little bias and may be useful for group comparisons, but their utility for assessment of body composition in individuals is limited.

Bovine colostrum (BC) contains bioactive components that have been shown to enhance gastrointestinal development and increase nutrient absorptive capacity in neonatal animals. Recent studies in adult humans have shown that BC increases lean body mass and improves exercise performance and a number of authors have suggested that BC may elicit these effects by enhancing intestinal nutrient absorption. The purpose of this study was to determine the effects of BC supplementation on plasma nutrient and/or insulin responses to a standard feed as a marker of intestinal absorptive capacity. Twelve healthy adult males consumed 60 g · day −1 of either concentrated BC protein powder ( n = 6) or concentrated whey protein (WP; n = 6) for eight weeks in a randomised, double-blind, placebo controlled, parallel design. Plasma alanine, glucose and insulin concentrations were measured in response to oral L-alanine (OATT) and oral D-glucose (OGTT) tolerance tests prior to and after 8 weeks of supplementation. There were no significant differences in the plasma alanine, glucose or insulin responses to the OATT or OGTT between groups at Week 0 ( P > 0.29), and the 8 weeks of supplementation had no significant effect on the responses in either group ( P > 0.29). Supplementation with BC does not affect the plasma nutrient or insulin response to a standard feed. Therefore, we would conclude that BC does not affect intestinal nutrient absorption in healthy adult humans.

Anecdotal reports suggest that bovine colostrum may prevent upper respiratory tract infection (URTI). There is scant evidence to support such claims, although salivary IgA protects against URTI, and it was recently shown that bovine colostrum increases salivary IgA. The present invesigation examined whether concentrated bovine colostrum protein (CBC) affected the incidence or duration of self-reported symptoms of URTI in adult males. We examined logbooks containing self-reported symptoms of illness from previous studies which examined physiological effects of CBC. In these double-blind, placebo controlled studies, subjects had been randomly allocated to consume 60g · day–1 of CBC (n = 93) or whey protein (WP) (n = 81) for eight weeks. Symptoms were coded using established criteria to identify those related to URTI. Since the incubation period for an URTI is up to five days, symptoms reported during the first week of supplementation (PRE-EXP) were analysed separately to preclude those arising from infection prior to study commencement. During PRE-EXP, there was no difference in the proportion of subjects taking the different supplements who reported symptoms of URTI (CBC, 11%,WP, 5%; 95% Confidence Interval (95% CI) –14% to 2%; P = 0.16). During the subsequent seven weeks (i. e. the experimental period), a significantly lesser proportion of subjects taking CBC reported symptoms of URTI compared with those taking WP (CBC, 32%,WP, 48%, P = 0.03; 95 % CI –30 % to –2 %), but symptom duration did not differ (CBC, 6.8 ± 4.2 days,WP, 6.0 ± 4.4 days; P = 0.27). This study provides preliminary evidence that CBC may enhance resistance to the development of symptoms of URTI.

OBJECTIVE To comprehensively compare the effects of a very low-carbohydrate, high–unsaturated/low–saturated fat diet (LC) with those of a high–unrefined carbohydrate, low-fat diet (HC) on glycemic control and cardiovascular disease (CVD) risk factors in type 2 diabetes (T2DM). RESEARCH DESIGN AND METHODS Obese adults (n = 115, BMI 34.4 ± 4.2 kg/m2, age 58 ± 7 years) with T2DM were randomized to a hypocaloric LC diet (14% carbohydrate [ RESULTS A total of 93 participants completed 24 weeks. Both groups achieved similar completion rates (LC 79%, HC 82%) and weight loss (LC −12.0 ± 6.3 kg, HC −11.5 ± 5.5 kg); P ≥ 0.50. Blood pressure (−9.8/−7.3 ± 11.6/6.8 mmHg), fasting blood glucose (−1.4 ± 2.3 mmol/L), and LDL cholesterol (−0.3 ± 0.6 mmol/L) decreased, with no diet effect (P ≥ 0.10). LC achieved greater reductions in triglycerides (−0.5 ± 0.5 vs. −0.1 ± 0.5 mmol/L), MES (−0.5 ± 0.5 vs. −0.2 ± 0.5), and GV indices; P ≤ 0.03. LC induced greater HbA1c reductions (−2.6 ± 1.0% [−28.4 ± 10.9 mmol/mol] vs. −1.9 ± 1.2% [−20.8 ± 13.1 mmol/mol]; P = 0.002) and HDL cholesterol (HDL-C) increases (0.2 ± 0.3 vs. 0.05 ± 0.2 mmol/L; P = 0.007) in participants with the respective baseline values HbA1c >7.8% (62 mmol/mol) and HDL-C CONCLUSIONS Both diets achieved substantial improvements for several clinical glycemic control and CVD risk markers. These improvements and reductions in GV and antiglycemic medication requirements were greatest with the LC compared with HC. This suggests an LC diet with low saturated fat may be an effective dietary approach for T2DM management if effects are sustained beyond 24 weeks.

This paper reviews the current literature around the environmental impacts of dietary recommendations. The focus of the review is on collating evidence relating to environmental impacts of the dietary advice found in the World Health Organisation guidelines, and environmental impact literature: reducing the consumption of fat, reducing the consumption of meat-based protein and animal-based foods, and increasing the consumption of fruit and vegetables. The environmental impact of reducing dietary fat intake is unclear, although reducing consumption of the food category of edible fats and oils appears to have little impact. However most, but not all, studies support environmental benefits of a reduced consumption of animal-based foods and increased consumption of fruit and vegetables. In general, it appears that adhering to dietary guidelines reduces impact on the environment, but further study is required to examine the environmental impacts of animal-based foods, and fruit and vegetable intake in depth. Refereed/Peer-reviewed

This study examined the effect of mild hypobaria (MH) on the peak oxygen consumption ( O2peak) and performance of ten trained male athletes [ (SEM); O2peak = 72.4 (2.2) ml · kg−1 · min−1] and ten trained female athletes [ O2peak = 60.8 (2.1) ml · kg−1 · min−1]. Subjects performed 5-min maximal work tests on a cycle ergometer within a hypobaric chamber at both normobaria (N, 99.33 kPa) and at MH (92.66 kPa), using a counter-balanced design. MH was equivalent to 580 m altitude. O2peak at MH decreased significantly compared with N in both men [− 5.9 (0.9)%] and women [− 3.7 (1.0)%]. Performance (total kJ) at MH was also reduced significantly in men [− 3.6 (0.8)%] and women [− 3.8 (1.2)%]. Arterial oxyhaemoglobin saturation (SaO2) at O2peak was significantly lower at MH compared with N in both men [90.1 (0.6)% versus 92.0 (0.6)%] and women [89.7 (3.1)% versus 92.1 (3.0)%]. While SaO2 at O2peak was not different between men and women, it was concluded that relative, rather than absolute, O2peak may be a more appropriate predictor of exercise-induced hypoxaemia. For men and women, it was calculated that 67–76% of the decrease in O2peak could be accounted for by a decrease in O2 delivery, which indicates that reduced O2 tension at mild altitude (580 m) leads to impairment of exercise performance in a maximal work bout lasting ≈ 5 min.

Conclusions: The hypothesis that urinary urgency is multidimensional is supported by the range of dimensions assessed with available instruments. To clarify the nature of urinary urgency compared with the normal desire to void, prospective studies are required to determine whether sensory dimensions are distinct, and which may delineate between normal and pathological sensation. Materials and Methods: A systematic search was undertaken of MEDLINE®, Embase®, AMED, CINAHL®, Ageline, Web of Science, InformIT Health and Scopus® databases to identify studies that included assessments of urinary urge or urgency. Articles were included in the analysis if they were primary studies that described the method used to measure urge/urgency in adults and published in English in peer reviewed publications since January 1, 2000. Articles were excluded from study if urgency was measured only in conjunction with other symptoms (eg frequency or incontinence) or if there was no English version of the instrument. Secondary analyses and systematic reviews were retained to hand search references for additional primary studies. Data were extracted for the instruments used to measure urge/urgency. For each instrument the items specific to urinary urgency were reviewed using a prospectively developed categorization process for the sensory dimension and the measurement metric. Items used to assess urinary urgency were collated in a matrix (sensory dimensions vs assessment metric). The most frequently used dimensions, metrics and combinations were descriptively analyzed. Purpose: Urinary urgency is an adverse sensory experience. Confirmation of the multidimensional nature of other adverse sensory experiences such as pain and dyspnea has improved the understanding of neurophysiological and perceptual mechanisms leading to innovations in assessment and treatment. It has been suggested that the sensation of urgency may include multiple dimensions such as intensity, suddenness and unpleasantness. In this systematic review we determine which dimensions of sensation have been assessed by instruments used to measure urinary urgency. Results: After removal of duplicate articles 1,048 full text articles were screened and 411 were excluded, leaving 637 eligible articles from which data were extracted. A total of 216 instruments were identified which were 1 of 6 types, namely 1) wider symptom questionnaires, 2) urgency specific questionnaires, 3) ordinal scales, 4) visual analog scales, 5) event records or 6) body maps. These 216 instruments contained a total of 309 urgency specific items. Of the instruments 51% did not define a dimension of sensation and 26% did not define the metric used. From the remaining instruments 8 dimensions of sensation and 5 types of metrics were identified. From most common to least common, the sensory dimensions assessed were behavioral response, intensity, suddenness, bother, affective response, unpleasantness, quality (descriptors) and problems associated with sensation. Metrics were magnitude, frequency, presence, time frame or location. The most common sensory dimension/metric combinations were frequency of a behavioral response (14% of items) and magnitude of bother caused by the sensation (8% of items). Refereed/Peer-reviewed

All individuals will experience some degree of cognitive impairment in their later years. Diet is one readily modifiable factor that may influence cognitive function and psychological well-being. Very little research has considered the potential role of dairy foods in modulating cognitive and psychological functions. The objective of this study was to determine the effect of a high intake of reduced fat dairy food on cognitive performance. Overweight adults with habitually low dairy intakes (

Objective: To critically appraise the Biodex System 4 isokinetic dynamometer for strength assessment of children. Methods: Appraisal was based on experiences from two independent laboratories involving testing of 213 children. Issues were recorded and the manufacturer was consulted regarding appropriate solutions. Results: The dynamometer had insufficient height adjustment for alignment of the knee for some children, requiring the construction of padding to better fit the child within the dynamometer. Potential for entrapment of the non-testing leg was evident in the passive and eccentric modes and a leg bracket restraint was constructed. Automated gravity correction did not operate when protocols were linked or data was exported to an external device. Conclusions: Limitations were noted, some of which were applicable to knee strength testing in general and others which were specific to use with children. However, most of these obstacles could be overcome, making the Biodex System 4 suitable for assessment of knee strength in children. Refereed/Peer-reviewed

This review addresses the impact of obesity on paediatric physical functioning utilizing the World Health Organization International Classification of Functioning, Disability and Health Framework (ICF). The ICF encompasses functioning (as it relates to all body functions and structures), activities (undertaking a particular task) and participation (in a life situation) with disability referring to impairments in body functions/structures, activity restrictions or participation limitations. Electronic databases were searched for peer-reviewed studies published in English prior to May 2009 that examined aspects of physical functioning in children (≤18 years). Eligible studies (N = 104) were ranked by design and synthesized descriptively. Childhood obesity was found to be associated with deficits in function, including impaired cardiorespiratory fitness and performance of motor tasks; and there was some limited evidence of increased musculoskeletal pain and decrements in muscle strength, gait and balance. Health-related quality of life and the subset of physical functioning was inversely related to weight status. However, studies investigating impacts of obesity on wider activity and participation were lacking. Further research utilizing the ICF is required to identify and better characterize the effects of paediatric obesity on physical function, activity and participation, thereby improving targets for intervention to reduce disability in this population. Refereed/Peer-reviewed

Refereed/Peer-reviewed

Dietary restriction and increased physical activity are recommended for obesity treatment. Very low carbohydrate diets are used to promote weight loss, but their effects on physical function and exercise tolerance in overweight and obese individuals are largely unknown. The aim of this study was to compare the effects of a very low carbohydrate, high fat (LC) diet with a conventional high carbohydrate, low fat (HC) diet on aerobic capacity, fuel utilization during submaximal exercise, perceived exercise effort (RPE) and muscle strength. Sixty subjects (age: 49.2 ± 1.2 years; BMI: 33.6 ± 0.5 kg/m2) were randomly assigned to an energy restricted (∼6-7 MJ, 30% deficit), planned isocaloric LC or HC for 8 weeks. At baseline and week 8, subjects performed incremental treadmill exercise to exhaustion and handgrip and isometric knee extensor strength were assessed. Weight loss was greater in LC compared with HC (8.4 ± 0.4% and 6.7 ± 0.5%, respectively; P = 0.01 time × diet). Peak oxygen uptake and heart rate were unchanged in both groups (P > 0.17). Fat oxidation increased during submaximal exercise in LC but not HC (P < 0.001 time × diet effect). On both diets, perception of effort during submaximal exercise and handgrip strength decreased (P ≤ 0.03 for time), but knee extensor strength remained unchanged (P > 0.25). An LC weight loss diet shifted fuel utilization toward greater fat oxidation during exercise, but had no detrimental effect on maximal or submaximal markers of aerobic exercise performance or muscle strength compared with an HC diet. Further studies are required to determine the interaction of LC diets with regular exercise training and the long-term health effects. Refereed/Peer-reviewed

Background Sustainable lifestyle modification strategies are needed to address obesity and cardiovascular risk factors. Intensive, individualised programs have been successful, but are limited by time and resources. We have formulated a group-based lifestyle education program based upon national diet and physical activity (PA) recommendations to manage obesity and cardio-metabolic risk factors. This article describes the content and delivery of this program, with information on compliance and acceptability. Methods Overweight/obese adults (n = 153) with metabolic syndrome were recruited from the community and randomly allocated to intervention (INT) or control (CON). Written copies of Australian national dietary and PA guidelines were provided to all participants. INT took part in a 16-week lifestyle program which provided a curriculum and practical strategies on 1) dietary and PA information based on national guidelines, 2) behavioural self-management tools, 3) food-label reading, supermarkets tour and cooking, 4) exercise sessions, and 5) peer-group support. Compliance was assessed using attendance records and weekly food/PA logs. Participants' motivations, perceived benefits and goals were assessed through facilitated discussion. Program acceptability feedback was collected through structured focus groups. Results Although completion of weekly food/PA records was poor, attendance at information/education sessions (77% overall) and exercise participation (66% overall) was high, and compared with CON, multiple markers of body composition and cardio-metabolic health improved in INT. Participants reported that the most useful program components included food-label reading, cooking sessions, and learning new and different physical exercises, including home-based options. Participants also reported finding self-management techniques helpful, namely problem solving and short-term goal setting. The use of a group setting and supportive 'peer' leaders were found to be supportive. More frequent clinical assessment was suggested for future programs. Conclusion This group-based lifestyle program achieved improvements in body composition and cardio-metabolic and physical fitness similar to individualised interventions which are more resource intensive to deliver. It confirmed that active training in lifestyle modification is more effective than passive provision of guidelines. Such programs should include social support and self-management techniques. Continued clinical follow up may be required for long-term maintenance in individuals attempting lifestyle behaviour change. Program facilitation by peers may help and should be further investigated in a community-based model.

The long-chain (LC)n-3 PUFA content of pork, particularly DHA, can be increased by including 15 % PorcOmega®(a fortified tuna fishmeal product) in pig finisher diets. The aim of the present study was to see whether this enriched pork could deliver cardiovascular health benefits to consumers. In a double-blind intervention trial, thirty-three healthy adult volunteers (sixteen female and seventeen male) were randomised to consume eithern-3-enriched or regular (control) pork (a selection of five fresh cuts totalling 1000 g/week) for 12 weeks. Fasting blood samples were collected every 4 weeks and analysed for serum lipids, maximally stimulated thromboxane production and erythrocyte fatty acid composition. Then-3-enriched pork provided subjects with 1·3 g LCn-3 PUFA per week. Erythrocyte DHA levels rose 15 % in then-3 group and fell 5 % in the control group over 12 weeks (P = 0·001). Compared with the control group, serum TAG decreased to a greater extent in then-3 group (P = 0·02) and serum thromboxane production increased to a lesser extent (P = 0·004). Changes in the latter were inversely associated with changes in incorporation of DHA into erythrocytes (r − 0·54;P n-3 PUFA intake resulting from regular consumption of enriched pork can improve cardiovascular risk factors.

Objective: Impaired endothelial function in obesity may reduce blood flow to sites of metabolism, contributing to impaired fat oxidation and insulin resistance. This study investigated the effects of cocoa flavanols and regular exercise, interventions known to improve endothelial function, on cardiometabolic function and body composition in obese individuals. Design: Overweight and obese adults were randomly assigned to high-flavanol cocoa (HF, 902 mg flavanols), HF and exercise, low-flavanol cocoa (LF, 36 mg flavanols), or LF and exercise for 12 weeks (exercise duration was 3 � 45 min per week at 75% of age-predicted maximum heart rate). Body composition was assessed by dual-energy X-ray absorptiometry at 0 and 12 weeks. Brachial artery flow-mediated dilatation (FMD), supine blood pressure (BP) and fasting plasma insulin, and glucose levels were assessed at 0, 6 and 12 weeks, respectively. Insulin sensitivity/resistance was determined using the modified homeostasis model assessment of insulin resistance (HOMA2). Results: A total of 49 subjects (M ¼ 18; F ¼ 31) completed the intervention. Baseline averages were as follows: body mass index ¼ 33.5 kg/m 2 ;B P¼ 123/76 mm Hg; HOMA2 ¼ 2.4; FMD ¼ 4.3%; rate of fat oxidation during exercise ¼ 0.34 g min � 1 ; abdominal fat ¼ 45.7% of total abdominal mass. Compared to LF, HF increased FMD acutely (2 h post-dose) by 2.4% (Po0.01) and chronically (over 12 weeks; Po0.01) by 1.6% and reduced insulin resistance by 0.31% (Po0.05), diastolic BP by 1.6 mm Hg and mean arterial BP by 1.2 mm Hg (Po0.05), independent of exercise. Regular exercise increased fat oxidation during exercise by 0.10 g min � 1 (Po0.01) and reduced abdominal fat by 0.92% (Po0.05). Conclusion: Although HF consumption was shown to improve endothelial function, it did not enhance the effects of exercise on body fat and fat metabolism in obese subjects. However, it may be useful for reducing cardiometabolic risk factors in this population.

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Refereed/Peer-reviewed

HILL, ALISON M., JOE LAFORGIA, ALISON M. COATES, JONATHAN D. BUCKLEY, AND PETER R.C. HOWE. Estimating abdominal adipose tissue with DXA and anthropometry. Obesity. 2007;15:504–510. Objective: To identify an anatomically defined region of interest (ROI) from DXA assessment of body composition that when combined with anthropometry can be used to accurately predict intra-abdominal adipose tissue (IAAT) in overweight/obese individuals. Research Methods and Procedures: Forty-one postmenopausal women (age, 49 to 66 years; BMI, 26 to 37 kg/m 2 ) underwent anthropometric and body composition assessments. ROI were defined as quadrilateral boxes extending 5 or 10 cm above the iliac crest and laterally to the edges of the abdominal soft tissue. A single-slice computed tomography (CT) scan was measured at the L3 to L4 intervertebral space, and abdominal skinfolds were taken. Results: Forward step-wise regression revealed the best predictor model of IAAT area measured by CT (r 2 0.68, standard error of estimate 17%) to be: IAAT area (centimeters squared) 51.844 DXA 10-cm ROI (grams) (0.031) abdominal skinfold (millimeters) (1.342). Interobserver reliability for fat mass (r 0.994; coefficient of variation, 2.60%) and lean mass (r 0.986, coefficient of variation, 2.67%) in the DXA 10-cm ROI was excellent. Discussion: This study has identified a DXA ROI that can be reliably measured using prominent anatomical landmarks, in this case, the iliac crest. Using this ROI, combined with an abdominal skinfold measurement, we have derived an equation to predict IAAT in overweight/obese postmenopausal women. This approach offers a simpler, safer, and more cost-effective method than CT for assessing the efficacy of lifestyle interventions aimed at reducing IAAT. However, this warrants further investigation and validation with an independent cohort.

Summary Aims To compare estimations of body composition using two different methods of bioelectrical impedance analysis (BIA) with dual X-ray absorptiometry (DXA) for estimating body composition during weight loss in overweight and obese young females. Methods Twenty-four overweight or obese females (age 29.5±6.1 years, BMI 36.4±4.3 kg/m2) had body composition assessed using single-frequency (Tanita Ultimate Scale™; SF-BIA) and multi-frequency (Impedimed SFB7™; MF-BIA) BIA and DXA before and after a 10-week weight loss intervention. Results MF-BIA estimates of body composition showed good absolute agreement with DXA, as evidenced by the small biases in the estimation of fat free mass (FFM), fat mass (FM) and percentage body fat (BF%); however, the limits of agreement for each variable were wide (bias ±1.96 standard deviation; FFM −1.6±6.5 kg, FM 1.6±6.5 kg, BF% 1.4±6.3%). SF-BIA exhibited a larger bias with wide limits of agreement (FFM 3.8±9.1 kg, FM −3.8±9.1 kg, BF% −4.37±10.3%). During weight loss the values provided by MF-BIA and SF-BIA were not significantly different from DXA (p⩾0.89) due to small bias and the limits of agreement were narrow (MF-BIA: FFM −0.01±3.74 kg, FM 0.01±3.74 kg, BF% 0.22±3.40%; SF-BIA: FFM 0.40±3.92 kg, FM −0.40±3.92 kg, BF% 0.25±3.40%). Conclusion Compared with DXA, both the MF-BIA and SF-BIA accurately assessed changes in body composition with weight loss but, compared with SF-BIA, MF-BIA provided superior cross-sectional estimates of body composition.

Background: This study evaluated the dose-response effects of α-cyclodextrin, a cyclic oligosaccharide, on the glycaemic and insulinaemic responses to the consumption of a standard carbohydrate meal. Methods: In a double-blind, randomised, cross-over design, 10 healthy subjects consumed boiled white rice containing 50 g of digestible carbohydrate to which 0 (control), 2, 5 or 10 g of α-cyclodextrin was added. Plasma glucose and insulin concentrations were determined prior to and for 2 h after consumption of each meal. Results: The area under the plasma glucose curve was negatively related to the dose of α-cyclodextrin (r2 = 0.97, p = 0.02), with the areas being significantly reduced at the 5- and 10-gram doses compared with the control (p < 0.05). α-Cyclodextrin did not affect the area under the plasma insulin curve (p = 0.39). Higher doses of α-cyclodextrin resulted in greater satiety, but were associated with reduced palatability and an increased incidence of minor gastrointestinal complaints (stomach ache, nausea, bloating). Conclusion: α-Cyclodextrin reduces the glycaemic response to a standard carbohydrate meal in a dose-dependent manner and may be useful as an ingredient for reducing the glycaemic impact of such foods.

It has been reported that bovine colostrum (BC) supplementation improves buffer capacity (beta) during exercise, but whether the improvement results from changes in tissue and/or blood buffer systems has not been determined. The purpose of the present study was to examine the effect of supplementation with BC on blood buffer systems. Thirteen elite females rowers were supplemented with 60 g.day(-1) of either BC ( n=6) or whey protein (WP, n=7) during 9 weeks of pre-competition training in a randomised, double-blind, placebo-controlled, parallel design. All subjects undertook the study as a group and completed the same training program. Resting haemoglobin (Hb) concentration and plasma buffer capacity (pbeta) (determined by titration with HCl) were measured pre- and post-supplementation. There were no differences in macronutrient intakes ( P>0.56) or training volumes ( P>0.99) between BC and WP during the study period. There were no differences in Hb [BC 13.28 (0.28) mg.dl(-1), WP 13.70 (0.26) mg.dl(-1); P=0.45] or pbeta [BC 14.8 (1.1) nmol HCl.ml(-1).pH(-1), WP 14.8 (0.5) nmol HCl.ml(-1).pH(-1); P=0.68] between groups at week 0. pbeta increased in both groups during the study period ( P