November/December issue

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The year 2016 is moving steadily onwards and here in the UK the temperatures are plummeting. The latest issue of the Journal of Human Nutrition and Dietetics is available online now and we have a great series of articles.

JHND Volume 29Issue 6

Weight and Health

Outcomes of a community-based weight management programme for morbidly obese populations (pages 669–676) L. Nield and S. Kelly

Implementing healthier foodservice guidelines in hospital and federal worksite cafeterias: barriers, facilitators and keys to success (pages 677–686) S. B. Jilcott Pitts, J. Graham, A. Mojica, L. Stewart, M. Walter, C. Schille, J. McGinty, M. Pearsall, O. Whitt, P. Mihas, A. Bradley and C. Simon

Setting targets leads to greater long-term weight losses and ‘unrealistic’ targets increase the effect in a large community-based commercial weight management group (pages 687–696) A. Avery, S. C. Langley-Evans, M. Harrington and J. A. Swift (Open Access)

Nutritional Assessment and Screening

Implementation of nutrition risk screening using the Malnutrition Universal Screening Tool across a large metropolitan health service (pages 697–703) P. L. Cooper, R. Raja, J. Golder, A. J. Stewart, R. F. Shaikh, M. Apostolides, J. Savva, J. L. Sequeira and M. A. Silver

Evaluation of the nutritional status of older hospitalised geriatric patients: a comparative analysis of a Mini Nutritional Assessment (MNA) version and the Nutritional Risk Screening (NRS 2002) (pages 704–713) S. Christner, M. Ritt, D. Volkert, R. Wirth, C. C. Sieber and K.-G. Gaßmann

Body composition and functional assessment of nutritional status in adults: a narrative review of imaging, impedance, strength and functional techniques (pages 714–732) S. Smith and A. M. Madden

Rehabilitation

Nutritional intervention as part of functional rehabilitation in older people with reduced functional ability: a systematic review and meta-analysis of randomised controlled studies (pages 733–745) A. M. Beck, E. Dent and C. Baldwin

Cancer

Meats, milk and fat consumption in colorectal cancer (pages 746–756) R. F. Tayyem, H. A. Bawadi, I. Shehadah, S. S. AbuMweis, L. M. Agraib, T. Al-Jaberi, M. Al-Nusairr, D. D. Heath and K. E. Bani-Hani

Dietary patterns and risk of colorectal adenoma: a systematic review and meta-analysis of observational studies (pages 757–767) J. Godos, F. Bella, A. Torrisi, S. Sciacca, F. Galvano and G. Grosso

A prospective study comparing prophylactic gastrostomy to nutritional counselling with a therapeutic feeding tube if required in head and neck cancer patients undergoing chemoradiotherapy in Thai real-world practice (pages 768–776) P. Pramyothin, S. Manyanont, A. Trakarnsanga, J. Petsuksiri and S. Ithimakin

Infancy

The accuracy of dietary recall of infant feeding and food allergen data (pages 777–785) Z. van Zyl, K. Maslin, T. Dean, R. Blaauw and C. Venter

Taste preference, food neophobia and nutritional intake in children consuming a cows’ milk exclusion diet: a prospective study (pages 786–796) K. Maslin, K. Grimshaw, E. Oliver, G. Roberts, S. H. Arshad, T. Dean, J. Grundy, G. Glasbey and C. Venter – Editor’s Pick for December

Nutrition and Metabolism

The effect of soy or isoflavones on homocysteine levels: a meta-analysis of randomised controlled trials (pages 797–804) X. Song, R. Zeng, L. Ni and C. Liu

Favourable effects of DASH diet on polycystic ovary syndrome

Effects of Dietary Approach to Stop Hypertension diet on androgens, antioxidant status and body composition in overweight and obese women with polycystic ovary syndrome: a randomised controlled trial

Azadi-Yazdi et al., JHND Early View

Background

Polycystic ovary syndrome (PCOS) is the most common endocrine disease in reproductive age women. The present study aimed to determine the effects of Dietary Approaches to Stop Hypertension (DASH) diet on reproductive hormones, plasma total antioxidant status and anthropometric indices in overweight and obese PCOS women.

Methods

In this randomised controlled clinical trial, 60 women with PCOS were randomly assigned to one of two diets with energy restriction: the DASH diet and a control diet. The DASH and control diets consisted of 50–55% carbohydrate, 15–20% protein and 25–30% total fat. The DASH diet was designed to be rich in vegetables, fruits, whole grains and low-fat dairy products, as well as low in saturated fats, cholesterol, refined grains and sweets. In the present study, the anthropometric indices, body composition, total testosterone, androstenedione, sex hormone binding globulin (SHBG), free androgen index and 2,2′-diphenyl-1-picryylhydrazyl (DPPH) scavenging activity were measured before and after 3 months.

Results

The consumption of DASH diet compared to the control diet was associated with a significant reduction in weight [−5.78 (1.91) kg versus −4.34 (2.87) kg, P = 0.032], body mass index (BMI) [−2.29 (0.15) kg m–2 versus −1.69 (0.20) kg m–2, P = 0.02], fat mass [−3.23(1.66) kg versus −2.13 (1.26) kg, P = 0.008] and serum androstenedione [−1.75 (1.39) ng mL–1 versus −1.02 (0.72) ng mL–1, P-value = 0.019]. Increased concentrations of SHBG [28.80 (21.71) versus 11.66(18.82) nmol L–1, P = 0.003) and DPPH scavenging activity [30.23% (19.09) versus 12.97% (25.12) were also found in the DASH group.

Conclusions

The DASH diet could improve weight loss, BMI and fat mass. Furthermore, it could result in a significant reduction in serum androstenedione and a significant increase in antioxidant status and SHBG.

Variable advice from dietitians on carbohydrate

Dietitians’ practice in giving carbohydrate advice in the management of type 2 diabetes: a mixed methods study

McArdle et al., JHND Early View

Background

Carbohydrate is accepted as the principal nutrient affecting blood glucose in diabetes; however, current guidelines are unable to specify the optimal quantity of carbohydrate for glycaemic control. No studies exist that describe current practice amongst healthcare professionals giving carbohydrate advice in type 2 diabetes. The present study aims to improve understanding of the degree of variation in the current practice of UK registered dietitians (RDs) by describing how RDs advise patients.

Methods

UK RDs were contacted through national networks and asked to complete an online survey, which was analysed using stata, version 12 (StataCorp, College Station, TX, USA). Three consultations between dietitians and patients with type 2 diabetes were observed, followed by semi-structured interviews with the dietitians.

Results

In total, 320 complete survey responses were received. Dietitians’ advice varied according to expertise, training and confidence, and the complexity of the patient’s blood glucose treatment. Some 48% (n = 154) of respondents advised patients to restrict carbohydrate intake either occasionally or frequently, with 35.6% (n = 114) considering 30–39% of total energy from carbohydrate to be a realistic expectation. The overall theme from the interviews was ‘Conflicting Priorities’, with three sub-themes: (i) how treatment decisions are made; (ii) the difference between empowerment and advice; and (iii) contradictory advice. A disparity existed between what was observed and interview data on how dietitians rationalise the type of carbohydrate advice provided.

Conclusions

Dietitians’ advice varies for a number of reasons. Consensus exists in some areas (e.g. carbohydrate awareness advice); however, clear definitions of such terms are lacking. Clarification of interventions may improve the consistency of approach and improve patient outcomes.

n-6 and n-3 fatty acids and the metabolic syndrome

Omega-6 polyunsaturated fatty acids, serum zinc, delta-5- and delta-6-desaturase activities and incident metabolic syndrome

Yary et al., JHND Early View

Background

The associations of n-6 polyunsaturated fatty acids (PUFA) with metabolic syndrome have been poorly explored. We investigated the associations of the serum n-6 PUFA and the activities of enzymes involved in the PUFA metabolism, delta-5-desaturase (D5D) and delta-6-desaturase (D6D) with risk of incident metabolic syndrome. We also investigated whether zinc, a cofactor for these enzymes, modifies these associations.

Methods

A prospective follow-up study was conducted on 661 men who were aged 42–60 years old at baseline in 1984–1989 and who were re-examined in 1998–2001.

Results

Men in the highest versus the lowest serum total omega-6 PUFA tertile had a 70% lower multivariate-adjusted risk of incident metabolic syndrome [odds ratio (OR) = 0.30; 95% confidence interval (CI) = 0.18–0.51, Ptrend < 0.001]. Inverse associations were also observed for linoleic acid, arachidonic acid and D5D activity. By contrast, men in the highest tertile of D6D activity had an 84% higher risk (OR = 1.84; 95% CI = 1.15–2.94, Ptrend = 0.008). Similar associations were observed with many of the metabolic syndrome components at the re-examinations. Most associations were attenuated after adjustment for body mass index. Finally, the associations of D6D and LA were stronger among those with a higher serum zinc concentration.

Conclusions

Higher serum total n-6 PUFA, linoleic acid and arachidonic acid concentrations and D5D activity were associated with a lower risk of developing metabolic syndrome and higher D6D activity was associated with a higher risk. The role of zinc also needs to be investigated in other populations.

 

Smartphone apps for behaviour change in diabetes

An evaluation of diabetes targeted apps for Android smartphone in relation to behaviour change techniques

Hoppe et al., JHND Early View

Background

Mobile applications (apps) could support diabetes management through dietary, weight and blood glucose self-monitoring, as well as by promoting behaviour change. The present study aimed to evaluate diabetes apps for content, functions and behaviour change techniques (BCTs).

Methods

Diabetes self-management apps for Android smartphones were searched for on the Google Play Store. Ten apps each from the following search terms were included; ‘diabetes’, ‘diabetes type 1’, ‘diabetes type 2’, ‘gestational diabetes’. Apps were evaluated by being scored according to their number of functions and BCTs, price, and user rating.

Results

The mean (SD) number of functions was 8.9 (5.9) out of a possible maximum of 27. Furthermore, the mean (SD) number of BCTs was 4.4 (2.6) out of a possible maximum of 26. Apps with optimum BCT had significantly more functions [13.8; 95% confidence interval (CI) = 11.9–15.9] than apps that did not (4.7; 95% CI = 3.2–6.2; P < 0.01) and significantly more BCTs (5.8; 95% CI = 4.8–7.0) than apps without (3.1; 95% CI = 2.2–4.1; P < 0.01). Additionally, apps with optimum BCT also cost more than other apps. In the adjusted models, highly rated apps had an average of 4.8 (95% CI = 0.9–8.7; P = 0.02) more functions than lower rated apps.

Conclusions

‘Diabetes apps’ include few functions or BCTs compared to the maximum score possible. Apps with optimum BCTs could indicate higher quality. App developers should consider including both specific functions and BCTs in ‘diabetes apps’ to make them more helpful. More research is needed to understand the components of an effective app for people with diabetes.

Vitamin D status in adolescents

Comparisons of physical activity, adipokines, vitamin D status and dietary vitamin D intake among adolescents

Virecoulon Giudici et al., JHND Early View

Background

Considering that lifestyle and diet are key factors responsible for the increases in adiposity in youth, it is important to understand how vitamin D, adipokines and markers of glucose metabolism are related to physical activity level (PAL) during growth. The present study aimed to investigate associations between physical activity level, adiponectin/leptin ratio, vitamin D status and dietary vitamin D intake among adolescents.

Methods

A cross-sectional study was conducted with adolescents aged 14–18 years old who were living in São Paulo, Brazil. Serum 25 hydroxyvitamin D [25(OH)D], adiponectin (A), leptin (L), glucose and insulin were obtained after 12 h of fasting. Dietary calcium and vitamin D intake were measured by 24-h food record, as repeated in 62.6% of the sample. PAL was measured by the International Physical Activity Questionnaire (IPAQ). Pearson’s chi-square test, Pearson correlation and linear regression analysis were performed.

Results

A total of 198 subjects, mean (SD) age 16.3 (1.4) years, 51% male, were enrolled in the study. Some 9% of participants were sedentary, 22% were insufficiently active (IA), 51% were active and 18% were very active (VA). The A/L ratio was lower among sedentary/IA subjects [2.2 (4.0) versus 5.6 (12.3); P = 0.01] compared to active/VA subjects. PAL was not associated with vitamin D status or markers of glucose metabolism. Serum 25(OH)D positively associated with vitamin D intake, after adjusting for sex, sun exposure and season of the year in regression analysis (partial r2=0.026, P = 0.02).

Conclusions

Low PAL was associated with a lower A/L ratio. Vitamin D status was not associated with sun exposure habits, although it was positively correlated with vitamin D intake.

What limits understanding and use of food labels?

Health literacy, literacy, numeracy and nutrition label understanding and use: a scoping review of the literature

Malloy-Weir and Cooper JHND Early View

Background

Low health literacy, literacy and numeracy have been identified as barriers to consumer understanding and the interpretation of nutrition-related information. To inform policy and dietetic practice, we examined the extent, range and nature of research on empirical relationships between health literacy, literacy or numeracy and the understanding and use of nutrition labels.

Methods

A scoping review of the literature was conducted. A search of eight databases on 15 April 2014 and 26 May 2016 returned 651 and 173 records, respectively. After de-duplication and two levels of relevance screening, 16 studies were deemed eligible for inclusion in the present review.

Results

The majority of studies were conducted in the USA and focused primarily on the use of back-of-pack nutrition labels. Empirical relationships reported between health literacy and nutrition label use were inconsistent and, in some cases, contradictory. The findings from studies examining empirical relationships between literacy, numeracy and nutrition label use suggest that consumers with lower literacy and numeracy: (i) differ from those with higher levels in some of the judgements that they make about food and (ii) may benefit from interventions designed to improve their understanding and use of nutrition label information. Measurement-related issues were identified, such as a reliance on self-reports of nutrition label use, as well as a lack of independence between some measures of health literacy and nutrition label understanding and use.

Conclusions

The empirical relationships between health literacy, literacy, numeracy and nutrition label understanding and use have not been well-studied. Additional attention is needed regarding the measurement-related issues identified in the present review.