Outcomes of a community-based weight management programme for morbidly obese populations

Outcomes of a community-based weight management programme for morbidly obese populations

Nield and Kelly, JHND Early View

Background

Morbid obesity is an ongoing concern worldwide. There is a paucity of research reporting primary care outcomes focussed on complex and morbidly obese populations. The National Institute for Health and Care Excellence (NICE) recommends a specialist, multidisciplinary weight management team for the successful management of such populations. This is the first service evaluation reporting both primary (weight change) and secondary [body mass index (BMI), waist circumference, physical activity levels, fruit and vegetable intake, Rosenberg self-esteem score] outcomes in these patients.

Methods

The present study comprised a prospective observational study of a cohort data set for patients (n = 288) attending their 3-month and 6-month (n = 115) assessment appointments at a specialist community weight management programme.

Results

Patients had a mean (SD) initial BMI of 45.5 (6.6) kg m²; 66% were females. Over 80% of patients attending the service lost some weight by 3 months. Average absolute weight loss was 4.11 (4.95) kg at 3 months and 6.30 (8.41) kg at 6 months, equating to 3.28% (3.82%) and 4.90% (6.26%), respectively, demonstrating a statistically significant weight change at both time points (P < 0.001). This meets NICE best practice guidelines for the commissioning of services leading to a minimum of 3% average weight loss, with at least 30% of patients losing at ≥5% of their initial weight. Waist measurement and BMI were reduced significantly at 3 months. Improvements were also seen in physical activity levels, fruit and vegetable consumption, and self-esteem levels (P < 0.001).

Conclusions

This service was successful in aiding weight loss in morbidly obese populations. The findings of the present study support the view that weight-loss targets of 3% are realistic.

Dietary recall of age at which allergen introduction occurs is unreliable

The accuracy of dietary recall of infant feeding and food allergen data

Van Zyl et al., JHND Early View

Background

Research investigating the association of infant dietary factors with later health outcomes often relies on maternal recall. It is unclear what the effect of recall bias is on the accuracy of the information obtained. The present study aimed to determine the extent of recall bias on the accuracy of infant feeding and food allergen data collected 10 years later.

Methods

Mothers were recruited from a prospective birth cohort from the Isle of Wight. When their child was 10 years of age (2011/2012), mothers were requested to complete a retrospective infant feeding questionnaire asking the same questions as those solicited in 2001/2002.

Results

In total, 125 mothers participated. There was substantial agreement for recollection of any breastfeeding (κ = 0.79) and the duration of breastfeeding from 10 years earlier (r = 0.84). Some 94% of mothers recalled accurately that their child had received formula milk. The exact age at which formula milk was first given was reliably answered (r = 0.63). The brand of formula milk was poorly recalled. Recall of age of introduction of solid food was not reliable (r = 0.16). The age of introduction of peanuts was the only food allergen that was recalled accurately (86%).

Conclusions

The present study highlights the importance of maternal recall bias of infant feeding practices over 10 years. Recall related to breastfeeding and formula feeding were reliable, whereas recalls related to age of introduction of solid or allergenic foods, apart from peanut, were not. Caution should be applied when interpreting studies relying on dietary recall.

5-a-day: We know the message but not the portion size.

How much is ‘5-a-day’? A qualitative investigation into consumer understanding of fruit and vegetable intake guidelines

Rooney et al., JHND Early View

Background

Despite the known health benefits of fruit and vegetables (FV), population intakes remain low. One potential contributing factor may be a lack of understanding surrounding recommended intakes. The present study aimed to explore the understanding of FV intake guidelines among a sample of low FV consumers.

Methods

Six semi-structured focus groups were held with low FV consumers (n = 28, age range 19–55 years). Focus groups were recorded digitally, transcribed verbatim and analysed thematically using nvivo (QSR International, Melbourne, Australia) to manage the coded data. Participants also completed a short questionnaire assessing knowledge on FV intake guidelines. Descriptive statistics were used to analyse responses.

Results

The discussions highlighted that, although participants were aware of FV intake guidelines, they lacked clarity with regard to the meaning of the ‘5-a-day’ message, including what foods are included in the guideline, as well as what constitutes a portion of FV. There was also a sense of confusion surrounding the concept of achieving variety with regard to FV intake. The sample highlighted a lack of previous education on FV portion sizes and put forward suggestions for improving knowledge, including increased information on food packaging and through health campaigns. Questionnaire findings were generally congruent with the qualitative findings, showing high awareness of the ‘5-a-day’ message but a lack of knowledge surrounding FV portion sizes.

Conclusions

Future public health campaigns should consider how best to address the gaps in knowledge identified in the present study, and incorporate evaluations that will allow the impact of future initiatives on knowledge, and ultimately behaviour, to be investigated.

Dietary carbohydrate composition and polycystic ovary syndrome

Dietary carbohydrate composition is associated with polycystic ovary syndrome: a case–control study

Eslamian et al., JHND Early View

Background

The present study aimed to investigate the association between dietary carbohydrate components and polycystic ovary syndrome (PCOS) in Iran.

Methods

In this case–control study, the diagnosis of PCOS was made based on the Rotterdam criteria in hospital clinics. Dietary assessments were performed using a validated semi-quantitative food frequency questionnaire. In total, 281 women with incident PCOS and 472 age-matched controls were assessed. Participants were interviewed through the clinics in Tehran, Iran, from February 2012 until March 2014. Average dietary glycaemic index (GI) and glycaemic load (GL) were calculated using GI of Iranian Foods Table and international tables of GI and GL values. We also assessed total dietary carbohydrate, refined grains, whole grains and fibre intakes.

Results

Participation rates were 97.5% among cases and 96.3% among controls. Mean (SD) dietary GI values among the controls and cases were 51.8 (4.7) and 59.7 (5.9) (P = 0.02) and GL values were 155.34 (35.2) and 173.6 (39.1) (P < 0.001), respectively. The multivariate adjusted odds ratio (OR) comparing the highest tertile of dietary GI and GL with the lowest tertile were 2.18 [95% confidence interval (CI) = 1.29–3.81; P-test for trend = 0.012] and 2.39 (95% CI = 1.23–3.01; P-test for trend = 0.001), respectively, with a significant trend. Fibre intake was inversely associated with PCOS (OR = 0.73; 95% CI = 0.49–0.91; P-test for trend = 0.013).

Conclusions

The findings of the present study suggest that high dietary GI and GL and low fibre intake are significantly associated with PCOS.

 

Dietary fibre, cancer and mortality: results from NHANES III

Association between dietary fibre intake with cancer and all-cause mortality among 15 740 adults: the National Health and Nutrition Examination Survey III

Chan and Lee, JHND Early View

Background

Few prospective studies have examined the longitudinal associations of total dietary fibre intake and water insoluble and soluble fibres with cancer and all-cause mortality. The present study aimed to examine these associations.

Methods

We studied the effects of total dietary fibre intake and water insoluble and soluble fibres on cancer and all-cause mortality, using data from 15 740 adult participants [mean (SD) age: 44.53 (19.22) years, 46.60% male] in the National Health and Nutrition Examination Survey (NHANES) III, 1988–1994, who had completed a 24-h dietary recall. Death certificate data were obtained up to 2006. Participants had been followed for 13.74 years on average. Cox regression was used to estimate the hazard ratios (HRs) of total dietary, insoluble and soluble fibres on cancer and all-cause mortality, with the first quartile as the reference group, adjusted for demographics, lifestyle and dietary factors.

Results

Relative to those in the first quartile of total fibre intake, only the third quartile was associated with all-cause mortality, with an adjusted HR of 0.87 [95% confidence interval (CI) = 0.79, 0.97, P = 0.021], and cancer mortality, with an adjusted HR of 0.77 (95% CI = 0.61, 0.99, P = 0.05). The third quartile of insoluble fibre intake was associated with cancer mortality, with an adjusted HR of 0.76 (95% CI = 0.60, 0.96, P = 0.023), and colorectal–anal cancer mortality (in grouped data as provided for public use), with an adjusted HR of 0.42 (95% CI = 0.19, 0.91, P = 0.03).

Conclusions

Dietary fibre showed protective benefits in terms of mortality risk. Investigating the mechanisms and components of dietary fibres underlying the different protective benefits remains an important consideration for research on fibre-mortality risk.

Consuming a milk-exclusion diet in infancy alters bitter-taste perception

Taste preference, food neophobia and nutritional intake in children consuming a cows’ milk exclusion diet: a prospective study

Maslin et al., JHND Early View

Background

Taste exposure in infancy is known to predict food preferences later in childhood. This is particularly relevant in children with cows’ milk allergy who consume a substitute formula and/or a cows’ milk exclusion (CME) diet early in life. This prospective study aimed to show whether there is a long-term effect of consuming a substitute formula and CME diet on taste preferences and dietary intake.

Methods

Children were predominantly recruited from two large birth cohort studies in the UK. Two groups were recruited: an experimental group of children who had consumed a CME diet during infancy and a control group who had consumed an unrestricted diet during infancy. Parents completed a food neophobia questionnaire and an estimated prospective food diary. Children completed a taste preference test and their growth was assessed.

Results

One hundred and one children with a mean age of 11.5 years were recruited (28 CME and 73 controls). Children in the CME group had a significantly higher preference for bitter taste than those in the control group (P < 0.05). There were significant differences between the groups with respect to the intake of some micronutrients, including riboflavin, iodine, sodium and selenium. Food neophobia did not differ between groups. Some 28% of the CME group were overweight/obese compared to 15% of the control group; however, this difference was not statistically significant.

Conclusions

Consuming a substitute formula and/or a CME diet in infancy has a long-term effect on the preference for bitter taste. Differences exist with respect to the intake of some micronutrients, but not macronutrients. There was a nonsignificant trend towards being overweight and obese in children in the CME group.

 

Nutritional assessment tools for hospitalised elderly patients

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)

Christner et al., JHND Early View

Background

The present study aimed to evaluate a short-form (MNA-SF) version of the Mini Nutritional Assessment (MNA), in which some of the items were operationalised, based on scores from tools used for a comprehensive geriatric assessment, as a method for analysing the nutritional status of hospitalised geriatric patients. We compared this MNA-SF version with the corresponding MNA long-form (MNA-LF) and Nutritional Risk Screening 2002 (NRS 2002) in terms of completion rate, prevalence and agreement regarding malnutrition and/or the risk of this.

Methods

In total, 201 patients aged ≥65 years who were hospitalised in geriatric wards were included in this analysis.

Results

The MNA-SF, MNA-LF and NRS 2002 were completed in 98.0%, 95.5% and 99.5% of patients (= 0.06), respectively. The MNA-SF, MNA-LF and NRS 2002 categorised 93.4%, 91.1% and 66.0% of patients as being malnourished or at risk of being malnourished (< 0.001). Agreement between the MNA-SF and MNA-LF was substantial (κ = 0.70, < 0.001). No agreement between the MNA-SF and NRS 2002 was found (κ = −0.12, < 0.001). Interestingly, NRS 2002 part 1 (prescreening) revealed a false negative rate of 21.0% (only in patients aged ≥70 years who showed moderate disease severity) in relation to the NRS 2002 part 2.

Conclusions

The MNA-SF version emerged as a useful tool for evaluating the nutritional status of hospitalised geriatric patients. The NRS 2002 part 1 showed limited value as a prescreening aid in relation to the NRS 2002 part 2 in the same group of patients.