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Kristen K Hicks,Peter S Murano Texas A&M University, Department of Nutrition and Food Science, College Station, TX, USA Objective: The purpose of this research study was to determine whether a 1-hour online continuing medical education (CME) course focused on nutrition for type 2 diabetes would result in a gain in nutrition knowledge by practicing physicians. Methods: A practicing physician and dietitian collaborated to develop an online CME course (both webinar and self-study versions) on type 2 diabetes. This 1-hour accredited course was launched through the state-level medical association’s education library, available to all physicians. Results: Physicians (n=43) registered for the course, and of those, 31 completed the course in its entirety. A gain in knowledge was found when comparing pre- versus post-test scores related to the online nutrition CME (P

Background We previously reported that consuming a food bar (FB) containing whey protein and the plant fiber isomalto-oligosaccharides [IMO] had a lower glycemic (GI) but similar insulinemic response as a high GI carbohydrate. Therefore, we hypothesized that ingestion of this FB before, during, and following intense exercise would better maintain glucose homeostasis and performance while hastening recovery in comparison to the common practice of ingesting carbohydrate alone. Methods Twelve resistance-trained males participated in an open label, randomized, counterbalanced, crossover trial with a 7-d washout period. Participants consumed a carbohydrate matched dextrose comparitor (CHO) or a FB containing 20 g of whey, 25 g of IMO, and 7 g of fat 30-min before, mid-way, and following intense exercise. Participants performed 11 resistance-exercises (3 sets of 10 repetitions at 70% of 1RM) followed by agility and sprint conditioning drills for time. Participants donated blood to assess catabolic and inflammatory markers, performed isokinetic strength tests, and rated perceptions of muscle soreness, hypoglycemia before, and following exercise and after 48 h of recovery. Data were analyzed using general linear models (GLM) for repeated measures and mean changes from baseline with 95% confidence intervals (CI) with a one-way analysis of variance. Data are reported as mean change from baseline with 95% CI. Results GLM analysis demonstrated that blood glucose was significantly higher 30-min post-ingestion for CHO (3.1 [2.0, 4.3 mmol/L,] and FB (0.8 [0.2, 1.5, mmol/L, p = 0.001) while the post-exercise ratio of insulin to glucose was greater with FB (CHO 0.04 [0.00, 0.08], FB 0.11 [0.07, 0.15], p = 0.013, η2 = 0.25). GLM analysis revealed no significant interaction effects between treatments in lifting volume of each resistance-exercise or total lifting volume. However, analysis of mean changes from baseline with 95% CI’s revealed that leg press lifting volume (CHO -130.79 [− 235.02, − 26.55]; FB -7.94 [− 112.17, 96.30] kg, p = 0.09, η2 = 0.12) and total lifting volume (CHO -198.26 [− 320.1, − 76.4], FB -81.7 [− 203.6, 40.1] kg, p = 0.175, η2 = 0.08) from set 1 to 3 was significantly reduced for CHO, but not for the FB. No significant interaction effects were observed in ratings of muscle soreness. However, mean change analysis revealed that ratings of soreness of the distal vastus medialis significantly increased from baseline with CHO while being unchanged with FB (CHO 1.88 [0.60, 3.17]; FB 0.29 [− 0.99, 1.57] cm, p = 0.083, η2 = 0.13). No significant GLM interaction or mean change analysis effects were seen between treatments in sprint performance, isokinetic strength, markers of catabolism, stress and sex hormones, or inflammatory markers. Conclusion Pilot study results provide some evidence that ingestion of this FB can positively affect glucose homeostasis, help maintain workout performance, and lessen perceptions of muscle soreness. Trial registration clinicaltrials.gov, #NCT03704337. Retrospectively registered 12, July 2018. Electronic supplementary material The online version of this article (10.1186/s12970-019-0301-z) contains supplementary material, which is available to authorized users.

Food irradiation is a processing technology that has been shown to be a wholesome process by many scientific studies conducted worldwide during the past 40 years. The research has been supported by the World Health Organization, the Food and Agricultural Organization, and govemmental agencies in many different countries. Industrial support also has been substantial. Some of the benefits ascribed to this technology include improved shelf life, reduced use of Chemicals as preservatives, and reduced levels of pathogens in foods. Pathogens such as Listeria monocytogenes , Yersinia enterocolitica , and Aeromonas hydrophila are capable of growing at temperatures as low as 0°C and are considered to pose a threat to the safety of refrigerated products. The number of cases of foodborne illness caused by contamination by Salmonella and Campylobacter spp. continues to increase. Researchers have been investigating ways in which food safety can be improved without sacrificing product quality and wholesomeness. The sensitivity of these pathogens to low-dose irradiation has been studied in several food products. Survival curves have been elucidated, and some studies on the effects of storage atmosphere, storage temperature, heating, and various treatments in combination with irradiation have been conducted. This review presents background information on this technology, with an emphasis on the radiation sensitivity of some pathogens of importance. Suggestions for future work in this area are also discussed.

Current trends in obesity and modifiable chronic disease are on the rise globally. Yet in primary care nutrition and lifestyle counseling, potentially the 'first line of defense' to address public health concerns, is limited. Unfortunately, nutrition and lifestyle education in the medical education curriculum is minimal and, in many countries, on the decline. Patients however expect their primary healthcare provider to assist them with diet and lifestyle modification to prevent and delay progression of chronic disease. This is indeed a paradox: the lack of nutrition focused education expertise in the face of the increased demand for nutrition counseling being placed on the physician. Across many countries, programmes of nutrition-centered continuing education, both online and face to face, are scarce. There is a pressing need for these educational opportunities to improve physician knowledge and self-efficacy in integrating nutrition counseling into routine practice, with the ultimate goal of improving overall patient health outcomes.

Vegetables are the major source of the dietary fiber, magnesium, potassium, and vitamins A and C that are crucial in the diets of children. This study assessed the nutrient content of vegetables offered through the National School Lunch Program and examined the relation between the overall nutrient density of vegetable subgroups and the costs of nutrients offered and wasted before and after the changes in school meal standards. Using data collected from 3 elementary schools before and after the changes in school meal standards, we found that vegetable plate waste increased from 52% to 58%. Plate waste for starchy vegetables, exclusive of potatoes, was relatively high compared with other subgroups; however, plate waste for white potatoes was the lowest among any type of vegetable. Energy density; cost per 100 g, per serving, and per 100 kcal; and percentage daily value were calculated and used to estimate nutrient density value and nutrient density per dollar. Cost per 100 kcal was highest for red/orange vegetables followed by dark green vegetables; however, nutrient density for red/orange vegetables was the highest in the group and provided the most nutrients per dollar compared with other subgroups. Given that many vegetables are less energy dense, measuring vegetable costs per 100 g and per serving by accounting for nutrient density perhaps is a better way of calculating the cost of vegetables in school meals.

In a double-blind, crossover, randomized and placebo-controlled trial; 28 men and women ingested a placebo (PLA), 3 g of creatine nitrate (CNL), and 6 g of creatine nitrate (CNH) for 6 days. Participants repeated the experiment with the alternate supplements after a 7-day washout. Hemodynamic responses to a postural challenge, fasting blood samples, and bench press, leg press, and cycling time trial performance and recovery were assessed. Data were analyzed by univariate, multivariate, and repeated measures general linear models (GLM). No significant differences were found among treatments for hemodynamic responses, clinical blood markers or self-reported side effects. After 5 days of supplementation, one repetition maximum (1RM) bench press improved significantly for CNH (mean change, 95% CI; 6.1 [3.5, 8.7] kg) but not PLA (0.7 [−1.6, 3.0] kg or CNL (2.0 [−0.9, 4.9] kg, CNH, p = 0.01). CNH participants also tended to experience an attenuated loss in 1RM strength during the recovery performance tests following supplementation on day 5 (PLA: −9.3 [−13.5, −5.0], CNL: −9.3 [−13.5, −5.1], CNH: −3.9 [−6.6, −1.2] kg, p = 0.07). After 5 days, pre-supplementation 1RM leg press values increased significantly, only with CNH (24.7 [8.8, 40.6] kg, but not PLA (13.9 [−15.7, 43.5] or CNL (14.6 [−0.5, 29.7]). Further, post-supplementation 1RM leg press recovery did not decrease significantly for CNH (−13.3 [−31.9, 5.3], but did for PLA (−30.5 [−53.4, −7.7] and CNL (−29.0 [−49.5, −8.4]). CNL treatment promoted an increase in bench press repetitions at 70% of 1RM during recovery on day 5 (PLA: 0.4 [−0.8, 1.6], CNL: 0.9 [0.35, 1.5], CNH: 0.5 [−0.2, 0.3], p = 0.56), greater leg press endurance prior to supplementation on day 5 (PLA: −0.2 [−1.6, 1.2], CNL: 0.9 [0.2, 1.6], CNH: 0.2 [−0.5, 0.9], p = 0.25) and greater leg press endurance during recovery on day 5 (PLA: −0.03 [−1.2, 1.1], CNL: 1.1 [0.3, 1.9], CNH: 0.4 [−0.4, 1.2], p = 0.23). Cycling time trial performance (4 km) was not affected. Results indicate that creatine nitrate supplementation, up to a 6 g dose, for 6 days, appears to be safe and provide some ergogenic benefit.

Using food labels can be an important component of maintaining healthy weight, but young adolescents are unlikely to have the requisite skills to make use of food labeling information. Our objectives were to determine knowledge about calories and comprehension and use of the Nutrition Facts Panel among a group of inner city African-American and Hispanic middle school students, and to engage the students in refining a Calorie Converter energy expenditure food label. We used quantitative and qualitative methods including questionnaires, focus groups, and hands-on graphic design activities. Correctly defining the word "calorie" was associated with correct answers to three of four questions requiring interpretation of the Nutrition Facts Panel [χ(2)(1, 138, p .05) = 4.56, 4.14, and 5.61.] We incorporated students' design and content modifications for the Calorie Converter label, and the majority indicated that the energy expenditure label would influence their food selection practices.

Plate waste, defined as the quantity of edible food left uneaten after a meal, is a challenge for schools participating in the National School Lunch Program (NSLP). The new nutrition standards in the NSLP of United States Department of Agriculture (USDA) were implemented at the beginning of school year (SY) 2012-2013. School foodservice authorities were concerned that the new standards would result in increased plate waste and reduced participation, especially by students who paid full prices for lunch. There are many reasons for plate waste, including students’ dislike of the foods served, the composition of meals, the environment in which students are eating, the lack of time to eat, or perhaps other factors. The objective of this study was to examine the relationship between entree/vegetable “pairings” and plate waste by elementary school students pre- and post-implementation of the new school meal standards. Plate waste was measured to determine which entree/vegetable pairs produced the least amount of waste. Plate waste of 144 and 305 entree/vegetable pairings was analyzed, pre- and post-implementation, respectively. Our results indicated that more nutritious meals were offered during the post-implementation period. The new school meal standards led to no significant changes in entree plate waste, but vegetable plate waste increased by 5.6%. As such, increases in the combined entree/vegetable plate waste were evident from 40.4% pre-implementation to 43.5% post-implementation. The top five vegetables in terms of popularity were all starchy vegetables, the majority of which were potatoes in various processed forms. The least popular vegetables were dark-green leafy vegetables, such as steamed broccoli, both pre- and post-implementation. Chicken nuggets were the most popular entree and were wasted the least. Understanding the dynamics of food pairings and providing desirable entree and vegetable pairings can help reduce waste from school lunches.

This article was migrated. The article was marked as recommended. Physicians demonstrate an insufficiency in medical nutrition training, yet are expected to deliver nutrition counseling to patients with chronic disease. There is a clear understanding that unhealthy lifestyle behaviors (e.g. smoking, physical inactivity, poor diet) contribute to morbidity and mortality across the nation and worldwide. A preventable contribution to millions of deaths annually, which can be mitigated via brief nutrition and lifestyle counseling. Primary care is the ideal venue to deliver nutrition education and counseling, with a majority of all Americans regularly visiting their physician offices. With preventive medicine on the rise, is it imperative that a physician is proficient to have a sense of medical nutrition, to briefly counsel patients. This missing link, if fixed, will change the healthcare delivery system and overall patient outcomes for the better.

High fructose corn syrup (HFCS) is widely used as sweetener in processed foods and soft drinks in the United States, largely substituting sucrose (SUC). The orexigenic hormone ghrelin promotes obesity and insulin resistance; ghrelin responds differently to HFCS and SUC ingestion. Here we investigated the roles of ghrelin in HFCS- and SUC-induced adiposity and insulin resistance. To mimic soft drinks, 10-week-old male wild-type (WT) and ghrelin knockout (Ghrelin−/−) mice were subjected to ad lib. regular chow diet supplemented with either water (RD), 8% HFCS (HFCS), or 10% sucrose (SUC). We found that SUC-feeding induced more robust increases in body weight and body fat than HFCS-feeding. Comparing to SUC-fed mice, HFCS-fed mice showed lower body weight but higher circulating glucose and insulin levels. Interestingly, we also found that ghrelin deletion exacerbates HFCS-induced adiposity and inflammation in adipose tissues, as well as whole-body insulin resistance. Our findings suggest that HFCS and SUC have differential effects on lipid metabolism: while sucrose promotes obesogenesis, HFCS primarily enhances inflammation and insulin resistance, and ghrelin confers protective effects for these metabolic dysfunctions.

Objective To explore fruit and vegetable (F&V) consumption among urban and rural Black Texas WIC participants. Methods The study included 673 WIC mothers and their 351 children from the TEXFAN study. T-tests, Pearson chi-squared test, and regressions were performed. Results Among children, differences were found for fruit consumption but not vegetable. Urban children were offered and consumed a greater variety of F&V. Mothers' F&V intake was related to age, pregnancy status, and breastfeeding status. Conclusions This study provides insight into a subsection of the WIC population. Further research should be done regarding increasing the amount and variety of F&V consumed by WIC women and children.

The purpose of this study was to examine whether ingesting a pre-workout dietary supplement (PWS) with and without synephrine (S) during training affects training responses in resistance-trained males. Resistance-trained males (N = 80) were randomly assigned to supplement their diet in a double-blind manner with either a flavored placebo (PLA); a PWS containing beta-alanine (3 g), creatine nitrate as a salt (2 g), arginine alpha-ketoglutarate (2 g), N-Acetyl-L-Tyrosine (300 mg), caffeine (284 mg), Mucuna pruiriens extract standardized for 15% L-Dopa (15 mg), Vitamin C as Ascorbic Acid (500 mg), niacin (60 mg), folate as folic acid (50 mg), and Vitamin B12 as Methylcobalamin (70 mg); or, the PWS supplement with Citrus aurantium extract containing 20 mg of synephrine (PWS + S) once per day for 8-weeks during training. Participants donated a fasting blood sample and had body composition (DXA), resting heart rate and blood pressure, cognitive function (Stroop Test), readiness to perform, bench and leg press 1 RM, and Wingate anaerobic capacity assessments determined a 0, 4, and 8-weeks of standardized training. Data were analyzed by MANOVA with repeated measures. Performance and cognitive function data were analyzed using baseline values as covariates as well as mean changes from baseline with 95% confidence intervals (CI). Blood chemistry data were also analyzed using Chi-square analysis. Although significant time effects were seen, no statistically significant overall MANOVA Wilks’ Lambda interactions were observed among groups for body composition, resting heart and blood pressure, readiness to perform questions, 1RM strength, anaerobic sprint capacity, or blood chemistry panels. MANOVA univariate analysis and analysis of changes from baseline with 95% CI revealed some evidence that cognitive function and 1RM strength were increased to a greater degree in the PWS and/or PWS + S groups after 4- and/or 8-weeks compared to PLA responses. However, there was no evidence that PWS + S promoted greater overall training adaptations compared to the PWS group. Dietary supplementation of PWS and PWS + S did not increase the incidence of reported side effects or significantly affect the number of blood values above clinical norms compared to PLA. Results provide some evidence that 4-weeks of PWS and/or PWS + S supplementation can improve some indices of cognitive function and exercise performance during resistance-training without significant side effects in apparently health males. However, these effects were similar to PLA responses after 8-weeks of supplementation and inclusion of synephrine did not promote additive benefits. This trial ( NCT02999581 ) was retrospectively registered on December 16th 2016.

Researchers in nutrition research often use cluster or multistage sampling to gather participants for their studies. These sampling methods often produce violations of the assumption of data independence that most traditional statistics share. Hierarchical linear modeling is a statistical method that can overcome violations of the independence assumption and lead to correct analysis of data, yet it is rarely used in nutrition research. The purpose of this viewpoint is to illustrate the benefits of hierarchical linear modeling within a nutrition research context.

Pediatric hyperlipidemias increasingly require dietary management of overweight and obesity for resolution. Dietary management of inappropriate weight gain may be outside of normal pediatric expertise. This review used scientific statements of expert professional groups, federal program documentation, and selected original articles or opinions to survey dietary techniques and highlight continuing controversies and therapeutic successes. At present, complex societal and environmental factors underlie the current epidemic in pediatric overweight, precluding definitive statements of best practices. Thus, although first-generation professional group recommendations are available, clinicians should expect recommendations to change. However, lack of standardized practices to assess the degree and quality of overweight (central versus peripheral adiposity) limit objective determination of therapeutic need and timely referral to nutrition professionals. Dietary management of insulin-resistant, overweight/obese children with dyslipidemias (metabolic syndrome) requires appropriate laboratory diagnostics to ensure that total fat and energy restrictions do not provoke or exacerbate hypertriglyceridemia or liver fat accumulation. Integrated treatment approaches that combine nutrition education, behavioral modification, and individualized diet instruction are showing success. Diet instructions that include practical translation of nutrition principles to daily eating habits are able to bring about substantial dietary change. The role of the school as a significant component of a child's lifestyle is described, as well as consideration of federally mandated feeding programs as a factor in designing effective dietary management strategies for those likely to be at high risk for overweight and dyslipidemias. The need for coordination among families, and health and school professionals to achieve success is emphasized.

Background A number of nutritional strategies have been developed to optimize nutrient delivery prior to exercise. As a result, a number of pre-workout supplements have been developed to increase energy availability, promote vasodilation, and/ or positively affect exercise capacity. The purpose of this study was to examine the effects of 8 weeks pre-workout dietary supplement ingestion with and without synephrine on blood chemistry panel.

Our aim was to examine the acute (5 h) hemodynamic (HR & BP) and hematologic profiles for a (1) Placebo (PL), (2) Creatine (CR, 5 g), (3) Creatine Nitrate (CrN; 1 g CR; 0.5 N) and (4) CrN2X (2 g CR; 1.0 g N) formula administered in a randomized, double-blind manner with 7d of washout between treatments. Participants (N=13; 22 ± 2 y) presented for testing after abstaining from exercise and fasting for 8 h. Initial unsupplemented measures (Time 0) were assessed, followed by supplement ingestion and serial sampling (0.5, 1, 2, 3, 4, 5h). Variables included heart rate, blood pressure, liver (ALP, AST, ALT), kidney (creatinine, BUN), and muscle (CK, LDH) enzymes, glucose and blood lipids. Analyses included GLM and LSD post-hoc procedures. Significant within group perturbations were noted for LDL-C (CR, PL), HDL-C (CrN, CrN2X), triglycerides (CrN2X, PL), glucose (CrN2X), creatinine (all), CK (CrN2X, PL), BUN (all), ALT (PL) over the 5h study period (all, P < 0.03). Corresponding between group differences (all, ...

Pre-workout supplements can increase energy availability and/or exercise capacity. We examined the effects of ingesting a pre-workout supplement with and without synephrine for 8w in 78 healthy, re...

We examined 28d of randomly assigned of (1) Placebo (PL), (2) Creatine (CR, 3 g), (3) Creatine Nitrate (CrN; 1 g CR; 0.5 N) and (4) CrN2X (2 g CR; 1.0 g N) on exercise performance and body composition. Participants (N=48; 21 ±3 y) presented for fasting (12h) testing after abstaining from exercise and alcohol for 48h. Performance (reps at 70% of bench press 1 RM [BP] and repeated sprints on cycle ergometer) was measured at 0 & 4 wks. Body composition (DXA) was measured at 0, 1, & 4 wks. We used GLM to examine mean change (95% CI) from baseline. While all three treatment groups significantly increased BP repetition at 4 wks, total BP lifting volume was greater at 4 wks for CrN2X (294.6 lbs; 95% CI, 196, 393) vs CrN (164.2 lbs; 95% CI, 25, 304) and PL (187.1 lbs;95% CI, 37, 336, both p=0.02). No treatment effects were observed for cycle ergometry testing (peak or mean power, fatigue slope, and total work). While no difference in fat mass were observed for any treatment group, CrN2X did augment lean mass (1.2...

Ground beef patties were packaged in air with: nylon/polyethylene, Saran/polyester/polyethylene, or Saran film overwrap plus a styrofoam tray. Samples were irradiated at 2 kGy by either gamma rays or electron beam, and evaluated for 7 flavor, 3 mouthfeel, and 7 taste attributes by a trained sensory panel. The only difference observed between irradiated and unirradiated samples was that the latter had a more pronounced beef/brothy flavor than irradiated patties. No differences were detected according to packaging material used. Comparing the two sources of irradiation, patties irradiated by gamma rays had more intense cardboardy and soured flavors, and salty and sour tastes than patties irradiated by electron beam.

Ground pork patties were inoculated separately with 10(9) CFU/g each of three strains of Listeria monocytogenes obtained from the National Animal Disease Center (NADC). Inoculated patties were packaged under vacuum and treated at 414 megapascals (60,000 lb/in2) for up to 60 min by high hydrostatic pressure (HHP). Survivors were determined by surface plating onto modified Oxford agar and trypticase soy agar with yeast extract, as well as by the most probable number method using Listeria enrichment broth. Average D values ranged from 1.89 to 4.17 min, depending on the strain, with the most virulent strain (reported by the NADC) having the highest D value. We tested the usefulness of applying a mild heat treatment at 50 degrees C, simultaneously with HHP, to lower these values. Average D values ranged from 0.37 to 0.63 min, depending on the strain. Thus, a 10-log10 reduction could be achieved even in the most pressure-resistant strain of L. monocytogenes by a 6-min application of heat and HHP. Shelf life studies were also conducted, with spoilage levels reached after 5 days of storage at 4 degrees C for controls versus 28 days for treated samples. Sensory evaluation of uninoculated grilled patties showed that panelists could not distinguish between those treated by heat and HHP and untreated controls (P0.05). Thus, treatment by HHP in combination with mild heating can be used successfully to produce safer, longer-lasting fresh pork without affecting quality.

Ground beef patties (irradiated with 2 kGy and nonirradiated) were packaged using oxygen permeable (polyolefin) or oxygen impermeable material (polyethylene). Samples were irradiated in air and stored in air; irradiated under vacuum and stored under vacuum; or irradiated under vacuum and stored in air. Changes in flavor, texture, juiciness or aftertaste were evaluated after either 1 or 7 days storage at 25°C prior to cooking. Irradiated “Vac/Air” samples were more tender, irradiated “Vac” samples were more moist, and irradiated “Air” samples had the least aftertaste. A 3 log10 reduction in total aerobic counts was detected immediately after irradiation. No difference in lipid oxidation was found within the first week of storage, regardless of packaging atmosphere. Shelf life of ground beef patties was extended 55 days at 4°C.

Obesity is rapidly becoming a global phenomenon. This is more than a cosmetic issue as obesity is associated with several life-threatening diseases, including colon cancer. Insulin resistance and inflammation, underlying factors in obesity-related diseases, promote colonocyte proliferation and suppress programmed cell death, or apoptosis, by activating the insulin-like growth factor (IGF) and prostaglandin pathways. These pathways converge on the Wnt pathway, which is implicated in colon carcinogenesis. Despite tremendous advances in our understanding of the molecular mechanisms involved in colon carcinogenesis, mortality due to colon cancer world-wide is unacceptably high. Even though conventional therapies can prolong a patient's life-span a few years, they cause serious side effects. Thus, there is growing interest in functional foods and dietary bioactive compounds with chemopreventive properties. This search is fueled by the epidemiological studies indicating that plant-based diets are protective against several types of cancers. This review provides a brief summary of the IGF and prostaglandin pathways, which are implicated in obesity-enhanced colon cancer, and some of the functional foods/dietary compounds that target these pathways. It is essential to understand the molecular mechanisms involved in chemoprevention before providing appropriate science-based dietary recommendations to prevent colon cancer in both obese and non-obese individuals.

Background Athletes use ergogenic aids in an attempt to increase training-adaptations, which serves to enhance their performance during competition. Creatine monohydrate is one of the most studied ergogenic aids. Although many studies have reported the efficacy and effectiveness of creatine monohydrate supplement manufacturers continually introduce newer forms of creatine into the marketplace. The newer forms of creatine purport to be more effective than creatine monohydrate alone. However, there is little evidence to support most manufacturers’ claims.