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Children's, parents' and other stakeholders' perspectives on early dietary self-management to delay disease progression of chronic disease in children: a protocol for a mixed studies systematic review with a narrative synthesis.
Pugh, P, Hemingway, P, Christian, M, Higginbottom, G
Systematic reviews. 2018;(1):20
Abstract
BACKGROUND Chronic disease of childhood may be delayed by early dietary intervention. The purpose of this systematic review is to provide decision-makers with a perspective on the role of early dietary intervention, as a form of self-management, to delay disease progression in children with early chronic disease, as described by children, parents and other stakeholders. METHODS The study will systematically review empirical research (qualitative, quantitative and mixed method designs), including grey literature, using a narrative synthesis. A four-stage search process will be conducted involving a scoping search, the Scottish Intercollegiate Guidelines Network (SIGN) Patient Issues search filter on MEDLINE, the search of seven databases using a chronic disease and chronic kidney disease (CKD) search strategy, and hand searching the reference lists of identified papers for additional studies. All studies retrieved during the search process will undergo a screening and selection process against the inclusion/exclusion criteria. Methodological quality of relevant studies will be assessed using a validated Mixed Studies Review scoring system, before inclusion in the review. Relevant grey literature will be assessed for methodological quality and relative importance using McGrath et al.'s framework and the Academy Health advisory committee categories, respectively. Data extraction will be guided by the Centre for Review and Dissemination guidance and Popay et al.'s work. The narrative synthesis of the findings will use elements of Popay et al.'s methodology of narrative synthesis, applying recognised tools for each of the four elements: (1) developing a theory of how the intervention works, why and for whom; (2) developing a preliminary synthesis of findings of included studies; (3) exploring relationships in the data; and (4) assessing the robustness of the synthesis. DISCUSSION This mixed studies systematic review with a narrative synthesis seeks to elucidate the gaps in current knowledge and generate a fresh explanation of research findings on early dietary self-management in chronic disease, with particular application to CKD, from the stakeholders' perspective. The review will provide an important platform to inform future research, identifying the facilitators and barriers to implementing early dietary interventions. Ultimately, the review will contribute vital information to inform future improvements in chronic disease. The lead author has a particular interest in CKD paediatric service delivery. SYSTEMATIC REVIEW REGISTRATION The review has been registered with PROSPERO (CRD42017078130).
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Interventions to promote healthy eating choices when dining out: A systematic review of reviews.
Wright, B, Bragge, P
British journal of health psychology. 2018;(2):278-295
Abstract
PURPOSE To synthesize review research pertaining to the effectiveness of interventions in dining-out settings to reduce food/calorie consumption. METHODS A rapid review methodology was employed to focus on synthesized research. A comprehensive search for peer-reviewed systematic reviews from 2010 to 2015 yielded 1,847 citations. Following screening, ten systematic reviews were included. RESULTS The 10 included systematic reviews identified 183 primary studies evaluating evidence in three behavioural intervention areas: social models/norms, manipulation of size, and provision of health information. Three systematic reviews evaluating the use of social models/norms found this was an effective intervention for influencing food intake. Five systematic reviews that assessed manipulation of portion/dishware/cutlery size found a small-to-moderate effect on food consumption. Three systematic reviews looked at the provision of health information, which was not effective alone; however, in combination with contextual or interpretive material such as traffic lights or exercise equivalence, this was shown to reduce calorie consumption. One systematic review covered two topic areas. CONCLUSIONS The results indicate that policies or interventions that aim to improve healthy choices or consumption when dining out would benefit from harnessing social norms and positive positioning of social identity. Furthermore, provision of health information should always be accompanied by an interpretative guide, such as traffic lights. Manipulation of plate/portion/cutlery size may be effective; however, the effect size is small and further research is required to investigate whether this effect is retained in overweight or obese populations. Statement of contribution What is already known on this subject? Eating behaviours (food choices, consumption) have played a role in the obesity epidemic. Behavioural 'nudges' have tried to increase healthier eating choices. What does this study add? Social norms and modelling have a strong influence in both directions on how much people consume. Provision of nutritional information needs to be paired with interpretative aids (e.g., traffic lights). Manipulation of portion size is less effective in overweight populations.
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Development of a dietary index based on the Brazilian Cardioprotective Nutritional Program (BALANCE).
Tereza da Silva, J, Bersch-Ferreira, ÂC, Torreglosa, CR, Weber, B, Levy, RB
Nutrition journal. 2018;(1):49
Abstract
BACKGROUND The diet of the Brazilian Cardioprotective Nutritional Program (BALANCE) classifies food into four groups and sets the daily amount to be consumed. The dietary approach of BALANCE is different from other dietary recommendations; therefore, it is not possible to use existing dietary indexes (DI) to assess patient's adequacy to BALANCE diet. For this reason, it is important to develop a specific dietary index based on BALANCE diet. This study aims to describe the development of the BALANCE DI, evaluate its internal consistency, construct and content validity and population characteristics associated with the index. METHODS We analyzed baseline data from the BALANCE randomized clinical trial ( https://www.clinicaltrials.gov/ ; NCT01620398). The four food groups of the diet were adopted as index components. Points ranging from 0 to 10 were given to each index component. Internal consistency was evaluated by correlation coefficients between total score and component scores, as well as Cronbach's Alpha. Content and construct validity were assessed by checking how nutrients are associated with the index and if the index could distinguish between groups with known differences in diet, respectively. Crude and adjusted linear regression analyses were performed to evaluate population characteristics associated with the index. RESULTS The analysis included 2044 subjects (58.6% men). The average of the total index was higher among women (p < 0,05). The components of the index showed low correlations with each other. The correlations between each individual component with the total index were > 0.40. Cronbach's alpha coefficient was 0.66. High scores in the index were inversely associated (p < 0,05) with energy, total fat, monounsaturated fat (MUFA) and cholesterol; they were positively associated (p < 0,05) with carbohydrates and fiber. Hypertensive men and diabetic women had higher scores, while male smokers had lower scores. CONCLUSIONS The BALANCE DI showed reliability and construct validity similar to other DI. It also detected characteristics of individuals that are associated with higher or lower index scores.
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Availability of food and beverage items on school canteen menus and association with items purchased by children of primary-school age.
Clinton-McHarg, T, Janssen, L, Delaney, T, Reilly, K, Regan, T, Nathan, N, Wiggers, J, Yoong, SL, Wyse, R, Grady, A, et al
Public health nutrition. 2018;(15):2907-2914
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Abstract
OBJECTIVE To (i) describe the proportion of foods and beverages available on school canteen menus classified as having high ('green'), moderate ('amber') or low ('red') nutritional value; (ii) describe the proportion of these items purchased by students; and (iii) examine the association between food and beverage availability on school canteen menus and food and beverage purchasing by students. DESIGN A cross-sectional study was conducted as part of a larger randomised controlled trial (RCT). SETTING A nested sample of fifty randomly selected government schools from the Hunter New England region of New South Wales, Australia, who had participated in an RCT of an intervention to improve the availability of healthy foods sold from school canteens, was approached to participate. SUBJECTS School principals, canteen managers and students. RESULTS The average proportion of green, amber and red items available on menus was 47·9, 47·4 and 4·7 %, respectively. The average proportion of green, amber and red items purchased by students was 30·1, 61·8 and 8·1 %, respectively. There was a significant positive relationship between the availability and purchasing of green (R 2=0·66), amber (R 2=0·57) and red menu items (R 2=0·61). In each case, a 1 % increase in the availability of items in these categories was associated with a 1·21, 1·35 and 1·67 % increase in purchasing of items of high, moderate and low nutritional value, respectively. CONCLUSIONS The findings provide support for school-based policies to improve the relative availability of healthy foods for sale in these settings.
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Consumption of fruits, vegetables and fruit juices and differentiated thyroid carcinoma risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study.
Zamora-Ros, R, Béraud, V, Franceschi, S, Cayssials, V, Tsilidis, KK, Boutron-Ruault, MC, Weiderpass, E, Overvad, K, Tjønneland, A, Eriksen, AK, et al
International journal of cancer. 2018;(3):449-459
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Abstract
Fruit and vegetable (F&V) intake is considered as probably protective against overall cancer risk, but results in previous studies are not consistent for thyroid cancer (TC). The purpose of this study is to examine the association between the consumption of fruits, vegetables, fruit juices and differentiated thyroid cancer risk within the European Prospective Investigation into Cancer and Nutrition (EPIC) study. The EPIC study is a cohort including over half a million participants, recruited between 1991 and 2000. During a mean follow-up of 14 years, 748 incident first primary differentiated TC cases were identified. F&V and fruit juice intakes were assessed through validated country-specific dietary questionnaires. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox regression models adjusted for potential confounding factors. Comparing the highest versus lowest quartile of intake, differentiated TC risk was not associated with intakes of total F&V (HR: 0.89; 95% CI: 0.68-1.15; p-trend = 0.44), vegetables (HR: 0.89; 95% CI: 0.69-1.14; p-trend = 0.56), or fruit (HR: 1.00; 95% CI: 0.79-1.26; p-trend = 0.64). No significant association was observed with any individual type of vegetable or fruit. However, there was a positive borderline trend with fruit juice intake (HR: 1.23; 95% CI: 0.98-1.53; p-trend = 0.06). This study did not find any significant association between F&V intakes and differentiated TC risk; however a positive trend with fruit juice intake was observed, possibly related to its high sugar content.
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Re-evaluating the nutritional awareness, knowledge and eating behaviours of women attending a tertiary maternity hospital following iterative service redesign.
Wilkinson, SA, Donaldson, E, McCray, SJ
Nutrition & dietetics: the journal of the Dietitians Association of Australia. 2018;(4):372-380
Abstract
AIM: Since the opening of the new Mater Mothers' Hospital in 2008, innovative initiatives were developed, implemented and evaluated to meet women's nutritional needs. This study evaluated changes in women's nutritional awareness, knowledge and behaviours and compared these data with our baseline survey. METHODS During 2014-2017, 421 postnatal women were surveyed across nine survey periods. Results were compared with those from our 2008 survey (n = 102). Surveys assessed nutrition knowledge, attitudes, behaviour, education preferences, and dietetic service awareness and were distributed on meal trays. RESULTS A greater proportion of women accessed the nutrition services in 2014-2017 compared with 2008 (19.7% vs 9.9%) and rated the resources favourably (≥3.5 out of 5). A similar proportion rated the importance of eating well postnatally (83.1% vs 92.1%) and returning to their pre-pregnancy weight (62.4% vs 68.3%) as important/very important. In both periods, women had poor diet quality, despite identifying healthy eating as a high priority. A reduction in median gestational weight gain (GWG) approached significance, 13.0 kg (2014-2017) versus 14.0 kg (2008), P = 0.055. There was a significant association between GWG and cohort with an increase in the proportion of women gaining within their correct guidelines (by 15.4%), a reduction of excessive gain (by 24.7%, P < 0.001) over time. CONCLUSIONS Evidence-based service changes made since 2008 have effected positive change in women's GWG, service preferences, and access. However, women still require awareness-raising and behaviour change programs to improve diet quality and GWG to ensure optimal pregnancy outcomes.
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Dietitians' perceptions of the healthiness of packaged food.
Thurecht, RL, Pelly, FE, Cooper, SL
Appetite. 2018;:302-309
Abstract
The aim of this cross-sectional study was to determine the factors that influence Australian dietitians' perceptions of the healthiness of a sample of packaged foods. Participant dietitians (n = 120) rated the healthiness (1, less healthy to 10, more healthy), of seven packaged foods (bread, confectionary, breakfast cereal, flavoured yoghurt, curry, spread and crumble) based on information obtained from an ingredient list and nutrient information panel (NIP). Influences on each food's rating were explored via Likert-scale and open-response questions. There was variation in the healthiness rating of all foods, however, least so for confectionary and crumble. Bread (M = 7.39 ± 1.44) and confectionary (M = 1.33 ± 0.69) were rated the most and least healthy foods respectively. Crumble was rated significantly (p = 0.03) healthier by those with more experience (≥6 vs. ≤5 years). No other differences were detected. Highly reported influences on healthiness were sugar, total fat, sodium and saturated fat values and the ingredient list. Content analysis identified 13 categories of information not provided on the NIP that influenced participants' ratings. References to the Australian Guide to Healthy Eating food groups, micronutrients not listed as ingredients, comparisons to other foods, and fibre were most common among the sample. These results have implications for research or public health policy where expert opinion of the healthiness of food is used as a reference measure.
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Different intervention strategies for preventing type 2 diabetes mellitus in China: A systematic review and network meta-analysis of randomized controlled trials.
Pang, B, Zhao, LH, Li, XL, Song, J, Li, QW, Liao, X, Feng, S, Zhao, XY, Zheng, YJ, Gou, XW, et al
Diabetes, obesity & metabolism. 2018;(3):718-722
Abstract
Different strategies are increasingly used for early intervention in prediabetes in China, but the effects of these strategies on incident diabetes have not yet been confirmed. The aim of the present study was to assess systematically the effects of different strategies for preventing diabetes, aimed at Chinese people with prediabetes. Seven electronic databases were searched to identify eligible trials published from inception to September 20, 2016. Randomized controlled trials with a minimum follow-up duration of 6 months were included. Standard pairwise meta-analysis with a random-effects model and network meta-analysis with a frequentist framework were performed. A total of 63 studies, including 11 intervention strategies, were included. Compared with placebo, all strategies, except for lipid-affecting drugs and sitagliptin, reduced the rate of incident diabetes with different levels of effectiveness, ranging from 0.18 (95% confidence interval [CI] 0.12, 0.27) to 0.39 (95% CI 0.20, 0.75). Ranking probability analysis indicated that metformin and β-cell-stimulating drugs reduced the risk of diabetes most, with probabilities of 87.4% and 81%, respectively. Ethnicity and cultural factors should be considered for diabetes prevention. Most of the included trials were of poor methodological quality, however, and the results should be interpreted with caution.
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Weight management in adults with intellectual and developmental disabilities: A randomized controlled trial of two dietary approaches.
Ptomey, LT, Saunders, RR, Saunders, M, Washburn, RA, Mayo, MS, Sullivan, DK, Gibson, CA, Goetz, JR, Honas, JJ, Willis, EA, et al
Journal of applied research in intellectual disabilities : JARID. 2018;:82-96
Abstract
BACKGROUND The prevalence of obesity among individuals with intellectual and developmental disabilities (IDD) is equal to or greater than the general population. METHODS Overweight/obese adults (BMI ≥25 kg/m2 ) with mild-to-moderate intellectual and developmental disabilities were randomized to an enhanced stop light diet (eSLD = SLD + portion-controlled meals, n = 78) or a conventional diet (CD, n = 72) for an 18 months trial (6 months weight loss, 12 months maintenance). Participants were asked to increase physical activity (150 min/week), self-monitor diet and physical activity and attend counselling/educational sessions during monthly home visits. RESULTS Weight loss (6 months) was significantly greater in the eSLD (-7.0% ± 5.0%) compared with the CD group (-3.8% ± 5.1%, p < .001). However, at 18 months, weight loss between groups did not differ significantly (eSLD = -6.7% ± 8.3%; CD = 6.4% ± 8.6%; p = .82). CONCLUSION The eSLD and CD provided clinically meaningful weight loss over 18 months in adults with intellectual and developmental disabilities.
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Learned pleasure from eating: An opportunity to promote healthy eating in children?
Marty, L, Chambaron, S, Nicklaus, S, Monnery-Patris, S
Appetite. 2018;:265-274
Abstract
Across the lifespan, eating is a common everyday act driven by the search for pleasure and reinforced by experienced pleasure. Pleasure is an innate indicator of the satisfaction of physiological needs, in addition to other attributes. Pleasure from eating is also learned and contributes to the development of children's eating habits, which remain mostly stable until adulthood. Based on classical models of determinants of food consumption behaviour, we identified three dimensions of pleasure from eating learned during childhood: 1/the sensory dimension, i.e., pleasure from sensory sensations during food consumption; 2/the interpersonal dimension, i.e., pleasure from the social context of food consumption; and 3/the psychosocial dimension, i.e., pleasure from cognitive representations of food. The objective of this narrative review is to explore whether these three dimensions may play a role in promotion of healthy eating behaviour among children. Up to now, it was assumed that providing nutritional information, pointing out which types of foods are "good" or "bad" for health, would drive healthier food choices in children. Today, we know that such strategies based on a cognitive approach toward eating have a limited impact on healthy choices and can even be counter-productive, leading children to avoid healthy foods. In the context of increasing rates of childhood obesity, new perspectives are needed to build efficient interventions that might help children adopt a healthy diet. This review suggests new directions for further research to test the efficacy of novel interventions that emphasize pleasure from eating.