Food addiction and associations with mental health symptoms: a systematic review with meta‐analysis

Background

The present study systematically reviewed the literature aiming to determine the relationships between food addiction, as measured by the Yale Food Addiction Scale (YFAS ), and mental health symptoms.

Methods

Nine databases were searched using keywords. Studies were included if they reported: (i) YFAS diagnosis or symptom score and (ii) a mental health outcome, as well as the association between (i) and (ii). In total, 51 studies were included.

Results

Through meta‐analysis, the mean prevalence of food addiction diagnosis was 16.2%, with an average of 3.3 (range 2.85–3.92) food addiction symptoms being reported. Subanalyses revealed that the mean number of food addiction symptoms in populations seeking treatment for weight loss was 3.01 (range 2.65–3.37) and this was higher in groups with disordered eating (mean 5.2 3.6–6.7). Significant positive correlations were found between food addiction and binge eating [mean r  = 0.602 (0.557–0.643), P  < 0.05], depression, anxiety and food addiction [mean r  = 0.459 (0.358–0.550), r  = 0.483 (0.228–0.676), P  < 0.05, respectively].

Conclusions

A significant, positive relationship exists between food addiction and mental health symptoms, although the results of the present study highlight the complexity of this relationship.

     

Dietary patterns and risk of ulcerative colitis: a case–control study

Background

Recent evidence indicates a role for dietary factors in the pathogenesis of ulcerative colitis (UC ). The aim of the present study was to investigate the relationship between dietary patterns and UC risk.

Methods

Sixty‐two newly diagnosed cases of UC and 124 healthy age and sex‐matched controls were studied. Data on diet was measured using a validated country‐specific food frequency questionnaire. Factor analysis was used to define major dietary patterns based on 28 food groups and nutrient content.

Results

After adjustment for confounding factors, subjects who were in the highest tertile of the healthy dietary pattern had a 79% lower risk of UC (odds ratio = 0.21, 95% confidence interval = 0.07–0.59, P  =  0.003), whereas the consumption of an unhealthy dietary pattern was associated with a significantly increased risk of UC (odds ratio = 3.39, 95% 95% confidence interval = 1.16–9.90, P  =  0.027).

Conclusions

The findings of the present study suggest that dietary patterns are associated with UC risk.

     

Carbohydrate knowledge,lifestyle and insulin: an observational study of their association with glycaemic control in adults with type 1 diabetes

Background

The ability to achieve optimal glycaemic control varies widely among individuals with type 1 diabetes. The present study aimed to explore the factors that are associated with optimal glycaemic control compared to suboptimal control.

Methods

An observational study design was used to explore the association of various factors with glycaemic control. Surveys were completed by individuals who attended the type 1 diabetes clinic at a tertiary hospital in New South Wales (NSW), Australia. Clinical and demographic information and attendance at dietary review were also collected.

Results

One hundred and three individuals completed the survey. Those with optimal control [glycated haemoglobin ≤7.0% (53 mmol mol^?1)] had a significantly shorter mean (SD) duration of diabetes [10.1 (12.6) years versus 18.8 (12.8) years, P  = 0.005), were less likely to omit basal and bolus insulin (18.2% versus 47.5%, P  = 0.016; 36.4% versus 61.8%, P  = 0.034, respectively), and were less likely to report low confidence in managing their diabetes (9.1% versus 35.4%, P  = 0.017). Participants who were able to identify carbohydrate sources were significantly more likely to have attended dietary review in the past 12 months (60.5% versus 20.0%, P  = 0.001). However, they were not more likely to have better glycaemic control.

Conclusions

The present study identified that consistency in taking insulin and confidence in self‐management was associated with better glycaemic control. An association was also found between recent dietary review and better carbohydrate knowledge, although this did not translate into better glycaemic control. Future investigation into the application of carbohydrate knowledge is required.

     

Determinants of a dietary pattern linked with greater metabolic risk and its tracking during adolescence

Background

Although growing evidence suggests that dietary patterns associated with noncommunicable diseases in adulthood may develop early in life, when these are established, as well as their determinants, remains unclear.

Methods

We examined determinants and tracking of a dietary pattern (DP ) associated with metabolic risk and its key food groups among 860 adolescents in the Western Australian Pregnancy (Raine) Cohort study. Food intake was reported using a food frequency questionnaire (FFQ ) at 14 and 17 years. Z ‐scores for an ‘energy‐dense, high‐fat, low‐fibre’ DP were estimated by applying reduced rank regression at both ages. Tracking was based on the predictive value (PV ) of remaining in the DP Z ‐score or food intake quartile at 14 and 17 years. Early‐life exposures included: maternal age; maternal pre‐pregnancy body mass index ; parent smoking status during pregnancy; and parent socio‐economic position (SEP ) at 14 and 17 years. Associations between the DP Z ‐scores, early‐life factors and SEP were analysed using regression analysis.

Results

Dietary tracking was strongest among boys with high DP Z ‐scores, high intakes of processed meat, low‐fibre bread, crisps and savoury snacks (PV > 1) and the lowest intakes of vegetables, fruit and legumes. Lower maternal education (β = 0.09, P  = 0.002 at 14 years; β = 0.14, P  < 0.001 at 17 years) and lower maternal age at birth (β = 0.09, P  = 0.003 at 14 years; β = 0.11, P  = 0.004 at 17 years) were positively associated with higher DP Z ‐scores.

Conclusions

An energy‐dense, high‐fat, low‐fibre dietary pattern tracks more strongly among adolescent boys who have high scores for this pattern at 14 years of age. These findings highlight target foods and population subgroups for early interventions aiming to improve dietary behaviours.

     

Dietary intake in people consuming a low‐carbohydrate diet in the UK Biobank

Background

Low‐carbohydrate diets are becoming increasingly popular, although their dietary quality outside of clinical studies is unknown. A previous study analysed the dietary intake in people consuming a reduced‐carbohydrate diet (<40% calories). However, it is not clear what foods people consume when carbohydrate is reduced to below 26% of total calories.

Methods

In the present cross‐sectional study, the dietary and nutrient intake collected via up to five consecutive 24‐h dietary recalls and a food frequency questionnaire of 444 individuals (aged 46‐79 years) consuming <26% of calories from carbohydrate (LCHO ) was compared with that of 131 897 individuals consuming ≥45% calories from carbohydrate (NCHO ) using the UK Biobank Dataset. Absolute cut‐offs to define the low‐carbohydrate group (<130 g day^–1; n  = 1953 versus ≥225 g day^–1, n  = 113 036) were also used.

Results

Both NCHO (>45% calories and ≥225 g) groups consumed significantly more high‐sugar, high‐fat snacks [median 6.0, interquartile range (IQR ) = 2.0–11.0 and median 6.0, IQR  = 3.0–11.8, respectively) compared to the LCHO (<26% calories and <130 g) groups (median 0, IQR  = 0–2.8 and median 1, IQR  = 0–3.8, respectively) (P  < 0.0001). Both LCHO groups reported consuming significantly more red meat, oily fish, nuts and seeds but fewer fruits, vegetables and pulses compared to the NCHO groups. In general, the consumption of oily fish, nuts, seeds and pulses was low across the whole cohort and differences in intake between the LCHO and NCHO groups were small. After adjusting for socio‐economic status, most differences remained.

Conclusions

Carbohydrate restriction is associated with both beneficial and potentially deleterious dietary changes compared to a normal carbohydrate intake.

     

Reduced 30‐day gastrostomy placement mortality following the introduction of a multidisciplinary nutrition support team: a cohort study

Background

Percutaneous endoscopic gastrostomy feeding allows patients with dysphagia to receive adequate nutritional support, although gastrostomy insertion is associated with mortality. A nutrition support team (NST ) may improve a gastrostomy service. The present study aimed to evaluate the introduction of a NST for assessment and follow‐up of patients referred for gastrostomy.

Methods

We included adult inpatients referred for gastrostomy insertion consecutively between 1 October 2010 and 31 March 2013. During the first 6 months, a multidisciplinary NST assessment service was implemented. Patient characteristics, clinical condition, referral appropriateness and follow‐up were documented prospectively. We compared the frequencies of appropriate referrals, 30‐day mortality and mental capacity/consent assessment time spent between the 6 months implementation phase and 2 years following establishment of the assessment service (‘established phase’).

Results

In total, 309 patients were referred for gastrostomy insertion and 199 (64%) gastrostomies placed. The percentage of appropriate referrals rose from 72% (61/85) during the implementation phase to 87% (194/224) during the established phase (P  = 0.002). Thirty‐day mortality reduced from 10% (5/52) to 2% (3/147) (P  = 0.01), whereas time allocated to assessment of mental capacity and attainment of informed consent rose from mean 3 days (limits of normal variation 0–7) to mean 6 (0–13) days.

Conclusions

The introduction of a NST to assess and select patients referred for gastrostomy placement was associated with a rise in the frequency of appropriate referrals and a decrease in 30‐day mortality following gastrostomy insertion. Concomitantly, time spent on patient assessment and attainment of informed consent increased.

     

Comparing the effectiveness of a multi‐component weight loss intervention in adults with and without intellectual disabilities

Background

The prevalence of obesity in adults with intellectual disabilities (ID) is rising, although the evidence base for its treatment in this population group is minimal. Weight management interventions that are accessible to adults with ID will reduce the inequalities that they frequently experience in health services. This short report compared the effectiveness of weight management in those with and without ID who completed nine sessions of a multi‐component weight management programme.

Methods

TAKE 5 is a 16‐week multi‐component weight management intervention for adults with ID and obesity [body mass index (BMI) ≥30 kg m^–2]. This intervention is an adaption of the weight management programme provided by the Glasgow & Clyde Weight Management Service (GCWMS) for adults without ID and obesity (National Health Service based). Fifty‐two participants of the TAKE 5 programme were individually matched by baseline characteristics (sex, age and BMI) with two participants without ID of the GCWMS programme. Comparisons in terms of weight and BMI change and rate of weight loss were made for those who attended all nine sessions.

Results

There were no significant differences between the groups in the amount of weight loss (median: ?3.6 versus ?3.8 kg, respectively, P = 0.4), change in BMI (median: ?1.5 versus ?1.4 kg m^–2, P = 0.9), success of achieving 5% weight loss (41.3% versus 36.8%, P = 0.9) and rate of weight loss across the 16‐week intervention.

Conclusions

A multi‐component weight loss intervention can be equally effective for adults with and without ID and obesity.

     

Adherence to Canada's Food Guide recommendations among Alberta's multi‐ethnic youths is a major concern: findings from the WHY ACT NOW project

Background

Dietary habits formed during youth may result in the development of obesity and chronic diseases in adulthood. We aimed to determine the frequency of the consumption of foods and beverages and the degree of adherence to Canada's Food Guide recommendations among multi‐ethnic youths.

Methods

Participants were recruited from 12 schools in the Edmonton, Alberta area by use of posters, school newsletters and advertisements. A 30‐item food frequency questionnaire was administered by a trained interviewer to assess dietary intake in a convenience sample of 557 (328 females and 229 males) youths aged 11–23 years; for the purpose of the present study, only the 14–18 years age group was considered in the analysis. Participants were divided by sex and self‐identified ethnicity into four groups [Indigenous, African & Middle Eastern (AME ), Asian, and European]. Statistical analysis of the data was undertaken using t ‐tests, Welch's analysis of variance and Games‐Howell tests. P  < 0.05 was considered statistically significant.

Results

Vegetables and Fruit recommendations were the least likely to be followed, with 90.7–96.8% of participants in all groups not consuming the recommended number of servings day^–1. The mean frequency of fruit consumption was lower among Indigenous youths compared to Asian youths (0.90 versus 1.37 times day^–1). A greater proportion of males than females (55.9% versus 44.3%) did not meet the minimum recommendations for Meat and Alternatives (P  = 0.016). The percentage of youths not adhering to recommendations for Milk and Alternatives was 81.7% for Indigenous, 73.3% for AME , 78.6% for Asian and 63.5% for European youths. Indigenous youths more frequently consumed potato chips and soft drinks compared to other ethnic youths. The most frequently consumed beverage was milk (1.25 times day^–1).

Conclusions

The majority of youths did not consume minimum daily recommended servings of Vegetables and Fruit, Milk and Alternatives, and/or Meat and Alternatives food groups. Evidence‐based dietary interventions and public health strategies are needed.

     

Effect of oropharyngeal colostrum therapy in the prevention of necrotising enterocolitis among very low birthweight neonates: A meta‐analysis of randomised controlled trials

Background

Necrotising enterocolitis (NEC ) is one of the most common life‐threatening emergencies of the gastrointestinal tract in preterm neonates. The present study aimed to determine the efficacy of oropharyngeal colostrum with respect to reducing NEC in preterm neonates.

Methods

A literature search was conducted for various randomised control trials by searching the Cochrane Central Register of Controlled Trials, PubMed, EMBASE and ongoing clinical trials. Randomised or quasi‐randomised trials comparing oropharyngeal colostrum versus placebo in neonates (birthweight ≤ 1500 g or gestational age ≤ 32 weeks) were included in the review. The methodological quality of each trial was independently reviewed by the authors. For categorical and continuous variables, typical estimates for relative risk and typical estimates for weighted mean difference were calculated, respectively. A random effect model was assumed for meta‐analysis.

Results

In total, four eligible trials were included in the review. Oropharyngeal colostrum therapy was not associated with a statistically significant reduction in the incidence of NEC stage ≥2 [typical relative risk (RR ) = 0.64; 95% confidence interval (CI ) = 0.27–1.49], mortality from any cause (typical RR  = 0.86; 95% CI  = 0.15–4.80) and time to reach full feed [typical weighted mean difference (WMD) = ?3.26; 95% CI  = ?8.87 to 2.35]. Duration of hospital stay was significantly less in the control group (typical WMD  = 9.77; 95% CI  = 3.96–15.59).

Conclusions

The current evidence is insufficient for recommending oropharyngeal colostrum as a routine clinical practice in the prevention of NEC . We emphasise the need for large randomised controlled trials with an adequate sample size and validated clinical outcomes in preterm neonates.

     

A pilot intervention to reduce postpartum weight retention and central adiposity in first‐time mothers: results from the mums OnLiNE (Online,Lifestyle, Nutrition & Exercise) study

Background

Postpartum weight retention (PPWR ) increases the risk for obesity and complications during subsequent pregnancies. Few interventions have been successful in limiting PPWR in mothers. The present study assessed the effectiveness of the mums OnLiNE (Online, Lifestyle, Nutrition & Exercise) intervention with respect to reducing PPWR and improving diet, physical activity and sedentary behaviour.

Methods

A subsample of first‐time mothers enrolled in the Extended Melbourne Infant Feeding Activity and Nutrition Trial (InFANT Extend) completed the nonrandomised mums OnLiNE intervention. Women in the intervention (I) group (n  =  28) received access to an online calorie tracking program, smartphone app, three telephone counselling calls with a dietitian and written material. Women in two comparison groups (CI and C2) (n  =  48; n  =  43) were from the control (C1) and intervention (C2) arms of InFANT Extend and received no additional support. Weight and waist circumference were measured objectively. Written surveys assessed diet and physical activity. Sedentary behaviour was self‐reported. Linear and logistic regression assessed changes in outcomes between groups from 9 to 18 months postpartum.

Results

Mean PPWR decreased in the (I) group (?1.2 kg) and the C2 group (?1.2 kg), although the changes were not significant. Mean waist circumference for all groups exceeded recommendations at baseline but decreased to below recommendations for women in the (I) group (78.3 cm) and significantly for the (I) group (?6.4 cm) compared to C1 (?1.1 cm; P  =  0.002) and C2 (?3.3 cm; P  =  0.001). Changes in diet, physical activity or sedentary behaviour were not significant.

Conclusions

The online intervention reported in the present study shows promise with respect to reducing waist circumference in postpartum women. Further evidence of strategies that may improve weight and related behaviours in this target group is needed.

     

Efficacy of vitamin D supplementation in combination with conventional antiviral therapy in patients with chronic hepatitis C infection: a meta‐analysis of randomised controlled trials

Background

Although a contributory role of vitamin D levels for the development of chronic hepatitis C has been suggested, the efficacy of vitamin D supplementation in combination with conventional antiviral therapy consisting of pegylated interferon‐α (Peg‐IFN ‐α) injection and oral ribavirin (RBV ) remains unclear. We investigated its efficacy in the treatment of chronic hepatitis C via a meta‐analysis of randomised controlled trials.

Methods

We searched PubMed, EMBASE , the Cochrane Library, ClinicalTrials.gov and the bibliographies of relevant articles to locate additional publications in September 2016. Three evaluators independently reviewed and selected eligible studies based on predetermined selection criteria.

Results

Of 522 articles meeting our initial criteria, a total of seven open‐label, randomised controlled trials involving 548 participants, were included in the final analysis. Vitamin D supplementation in combination with Peg‐IFN ‐α injection and oral RBV significantly increased the rate of viral response for hepatitis C at 24 weeks after treatment in a random‐effects meta‐analysis (relative risk = 1.30; 95% confidence interval = 1.04–1.62; I ² = 75.9%). Also, its significant efficacy was observed in patients with hepatitis C virus genotype 1, which is known to be refractory to antiviral therapy.

Conclusions

In summary, we observed that additional use of vitamin D has a positive effect on sustained viral response rates of patients with chronic hepatitis C infection. However, we cannot establish the efficacy because of substantial heterogeneity, a small sample size and a low methodological quality.

     

Beliefs and advice‐seeking behaviours for fertility and pregnancy: a cross‐sectional study of a global sample

Background

Pregnancy can motivate individuals to adopt lifestyle behaviours that protect the health of their offspring. The aims of the present study were to explore men's and women's beliefs about lifestyle, fertility and pregnancy, as well as where they seek advice.

Methods

Participants (2185 women and 221 men, six unspecified) from 104 countries completed a questionnaire that explored their beliefs about what was important for a healthy pregnancy and their advice‐seeking behaviours. Recruitment was via a Massive Open Online Course entitled ‘Food as Medicine’, with food, nutrient and health content. Comparisons of categorical data were performed using a chi‐squared test (P = 0.05).

Results

Eating a variety of fruits and vegetables and not smoking (both 93.7%) were the most frequently and equally ranked in the top‐five factors for a healthy pregnancy. Taking prenatal supplements (26.8%) was considered to be less important. Participants in Westernised countries ranked not smoking or drinking alcohol as being significantly more important than those in other countries. Overall, doctors (47.7%) were the most common source of fertility and pregnancy advice. Larger proportions of those aged <40 years used the Internet (<40 years 44.1%, >40 years 18.2% χ² = 152.7, P < 0.01) and social media (<40 years 16.1%, >40 years 3.6%; χ² = 110.18, P < 0.01) for health information.

Conclusions

There is disconnection between beliefs and actions regarding the lifestyle behaviours considered to be important for a healthy pregnancy, particularly nutrition. Pregnancy advice‐seeking has evolved, with younger men and women utilising the Internet and social media. Health professionals must consider new communication strategies to deliver evidence‐based lifestyle advice, particularly for younger men and women and where access to healthcare is limited.

     

Accuracy of octa‐polar bioelectrical impedance analysis for the assessment of total and appendicular body composition in children and adolescents with HIV: comparison with dual energy X‐ray absorptiometry and air displacement plethysmography

Background

Body composition analysis has been used to investigate fat mass (FM ) and bone mineral content (BMC ) in children and adolescents diagnosed with HIV . Investigating the validity of bioelectrical impedance analysis (BIA ) is interesting with respect to testing useful techniques for monitoring body composition in children and adolescents in clinical practice. The present study aimed to determine the validity of body composition analysis by BIA compared to dual‐energy X‐ray absorptiometry (DXA ) and air displacement plethysmography (ADP ) in children and adolescents an HIV diagnosis.

Methods

Sixty‐four children and adolescents (35 females and 29 males) with a mean (SD ) age of 12.22 (2.13) years and with an HIV diagnosis participated in the study. Fat‐free mass (FFM ), FM and body fat percentage (%BF ) were obtained by BIA for comparison with DXA and ADP . Segmented FM (trunk, legs and arms), lean soft tissue mass (LSTM ) (total and segmented) and BMC were obtained by BIA for comparison with DXA .

Results

BIA presented a clinically acceptable correlation with DXA and ADP for FFM . Values found by BIA were underestimated compared to ADP , and overestimated compared to DXA . BIA presented a clinically acceptable correlation with DXA for LSTM estimates (total and segmented parameters) in both sexes (underestimating FM and overestimating LSTM ). For other components (%BF , FM and BMC ), BIA had a clinically unacceptable correlation with the reference methods in both sexes.

Conclusions

BIA was suitable for evaluating FFM and LSTM in children and adolescents with an HIV diagnosis. For FM , %BF and BMC , BIA was not suitable for performing an evaluation in both sexes.

     

Reducing the maternal dietary intake of indigestible and slowly absorbed short‐chain carbohydrates is associated with improved infantile colic: a proof‐of‐concept study

Background

To investigate if a low fermentable oligo‐, di‐ and mono‐saccharides and polyols (FODMAP) diet consumed by breastfeeding mothers may be associated with reduced symptoms of infantile colic.

Methods

Exclusively breastfeeding mothers and their typically‐developing healthy infants who met the Wessel Criteria for infantile colic were recruited from the community, to this single‐blind, open‐label, interventional study. After a 3‐day qualifying period, mothers were provided a low FODMAP 7‐day diet. On days 5, 6 and 7 mothers completed a Baby Day Diary. At baseline and at the end of the 7‐day dietary intervention, breast milk was analysed for FODMAP content and infant faecal samples for pH .

Results

Eighteen breastfeeding mothers (aged 27–40 years) adhered (100%) to the low FODMAP diet. Infants were of gestational age 37–40.3 weeks and aged 2–17 weeks. At entry, crying durations were a mean [95% CI ] of 142 [106–61] min and fell by 52 [178–120] min (P = 0.005; ancova ). Combined crying‐fussing durations fell by 73 [301–223] min (n = 13; P = 0.007), as did crying episodes (P = 0.01) and fussing durations (P = 0.011). Infant sleeping, feeding, or awake‐and‐content durations did not change. Infant faecal pH did not change. Breast milk lactose content was stable and other known FODMAP s were not detected. At end of study, mothers reported their baby ‘is much more content’ and ‘can be put down without crying’.

Conclusions

Maternal low FODMAP diet may be associated with a reduction in infant colic symptoms. A randomized controlled study is warranted to determine if a maternal low FODMAP diet is effective in reducing symptoms.

     

Clinical significance of nutritional risk screening tool for hospitalised children with acute burn injuries: a cross‐sectional study

Background

We assessed the nutritional risks among children hospitalised with acute burn injuries and their associated clinical outcomes using three nutritional risk screening (NRS ) tools: Screening Tool for Risk of Impaired Nutritional Status and Growth (STRONG_KIDS ), Pediatric Yorkhill Malnutrition Score (PYMS ) and Screening Tool for the Assessment for Malnutrition in Pediatrics (STAMP ).

Methods

This prospective cross‐sectional study was conducted from October 2015 to November 2016, in a regional burn centre. Patients were screened by two independent observers, using the three NRS tools.

Results

A total of 100 children aged 3 months to 16.5 years were included. STRONG_KIDS identified 16% of patients as having high risk, with being identified 45% by PYMS and 44% by STAMP . After adjustment for confounding factors in multivariate regression analysis, patients in the high‐risk group had significantly longer median (SD) lengths of stay [medium versus high risk: STRONG_KIDS , 9.5 (6.6) versus 15.0 (24.2) days; PYMS , 8.5 (4.4) versus 13.0 (16.1) days; STAMP , 9.0 (5.7) versus 11.0 (17.4) days] and greater median (SD) weight loss [medium versus high risk: STRONG_{KIDS ,} 0.15 (0.8) versus ‐0.35 (0.8) kg; STAMP, 0.5 (0.7) versus 0 (0.1) kg] than patients in the medium‐risk group (P < 0.05). The strengths of agreement in the nutritional risk classification between the two observers were good (κ for STRONG_KIDS = 0.61; PYMS = 0.79; STAMP = 0.75) (P < 0.01).

Conclusions

The STRONG_KIDS , PYMS and STAMP tools could be useful and practical for determining which hospitalised children with acute burn injuries will need additional nutritional intervention.

     

Comparison of nutrient intake in adolescents and adults with and without food allergies

Background

Exclusion diets for the management of food allergy pose a risk of nutritional deficiencies and inadequate growth in children, yet less is known about their effect in adolescents and adults. The present study aimed to compare the dietary intake of adolescents and adults with food allergies with that of a control group.

Methods

A food allergic and a control group were recruited from Portsmouth and the Isle of Wight in the UK. Participants were recruited from a food allergy charity, allergy clinics, a local school and university, and previous research studies. Macro and micronutrient intake data were obtained using a 4‐day estimated food diary. Sociodemographic and anthropometric data was collected via a constructed questionnaire.

Results

This cross‐sectional study included 81 adolescents (48 food allergic and 33 controls) aged 11–18 years and 70 adults aged 19–65 years (23 food allergic and 47 controls). Overall, 19 (22.8%) adolescents and 19 (27.1%) adults took dietary supplements, with no difference according to food allergic status. Adolescents with food allergy had higher intakes of niacin and selenium than adolescents without (P < 0.05). This difference persisted when dietary supplements were removed from the analysis. Adults with food allergies had higher intakes of folate and zinc than those without (P < 0.05); however, this difference did not persist when dietary supplements were removed from the analysis. Across all participants, the intake of several micronutrients was suboptimal. There was no difference in protein or energy intake, or body mass index, according to food allergic status.

Conclusions

The dietary intake of food allergic participants was broadly similar and, in some cases, better than that of control participants. However, suboptimal intakes of several micronutrients were observed across all participants, suggesting poor food choices.

     

Structured advice provided by a dietitian increases adherence of consumers to diet and lifestyle changes and lowers blood low‐density lipoprotein (LDL)‐cholesterol: the Increasing Adherence of Consumers to Diet & Lifestyle Changes to Lower (LDL) Cholesterol (ACT) randomised controlled trial

Background

Evidence from healthcare professionals suggest that consumer compliance to healthy diet and lifestyle changes is often poor. The present study investigated the effect of advice provided by a physician or dietitian on consumer adherence to these measures combined with consuming foods with added plant sterols (PS) with the aim of lowering low‐density lipoprotein cholesterol (LDL‐C).

Methods

One hundred mildly‐to‐moderately hypercholesterolaemic individuals were enrolled into a parallel, randomised, placebo‐controlled study. Dietitians (dietitian group; DG) advised 50 individuals in six weekly face‐to‐face behavioural therapy sessions, whereas the other 50 received standard advice from physicians (physician group, PG). Both groups consumed foods with added PS (three servings a day) for 6 weeks. Subsequently, all individuals were followed‐up for another 6 weeks under real‐life conditions. Blood lipids were measured at baseline and weeks 6 and 12 and 3‐day diet diaries were taken at weeks 1, 6 and 12.

Results

Individuals in the DG significantly improved their dietary habits, physical activity and increased PS intake compared to the PG. After 6 weeks, LDL‐C decreased in both groups compared to baseline without any significant differences between groups. At week 12, LDL‐C was further significantly improved only in the DG (P = 0.006) compared to week 6. Total cholesterol, LDL‐C and triglycerides were significantly lower in the DG compared to the PG at week 12 after adjusting for levels at week 6 (P < 0.001, P < 0.001 and P = 0.009, respectively).

Conclusions

Although structured counselling by dietitians and common standard advice by physicians were equally effective with respect to improving blood cholesterol after 6 weeks, dietitians were more effective in the longer‐term (i.e. 6 weeks after the end of the intervention period).

     

The effect of pre‐pregnancy lifestyle counselling on food intakes and association between food intakes and gestational diabetes in high‐risk women: results from a randomised controlled trial

Background

Healthy diets before and during pregnancy have been suggested to reduce the risk of gestational diabetes (GDM ). Several lifestyle intervention studies for pregnant women have reported dietary improvements after counselling. However, evidence concerning the effect of counselling initiated before pregnancy on diets is limited.

Methods

This randomised controlled study explored whether pre‐pregnancy lifestyle counselling influenced food intakes, as well as whether changes in food intakes were associated with GDM . The participants comprised 75 women with prior GDM and/or a body mass index ≥ 30 kg m^–2. Women were randomised into a control or an intervention group, and their food intakes were followed from pre‐pregnancy to early pregnancy using a food frequency questionnaire. The control and intervention groups were combined to assess the association between changes in food intakes and GDM . The diagnosis of GDM was based on a 75‐g oral glucose tolerance test conducted in the first and second trimester of pregnancy.

Results

Pre‐pregnancy lifestyle counselling showed no major overall effect on food intakes. The intake of low‐fat cheese increased significantly in women who did not develop GDM compared to women who did after adjusting for potential confounders (P = 0.028). This association was not observed for regular‐fat cheese.

Conclusions

The findings obtained in the present study suggest that an increased intake of low‐fat but not regular‐fat cheese between pre‐pregnancy and early pregnancy is associated with a lower risk of GDM in high‐risk women.

     

Diet quality and 10‐year healthcare costs by BMI categories in the mid‐age cohort of the Australian Longitudinal Study on Women's Health

Background

Better diets, as evaluated by diet quality indices, are associated with lower rates of morbidity and mortality. Although governments and researchers alike recognise the burden that obesity incurs for increased healthcare spending, there is insufficient evidence for the role of diet quality on healthcare costs.

Methods

Diet quality was assessed by the Australian Recommended Food Score (ARFS ) for 6328 women aged 50–55 years from the Australian Longitudinal Study on Women's Health. The ARFS was ranked by quintile, and 10‐year cumulative data on healthcare costs from Medicare (Australia's Universal healthcare cover) were reported by body mass index category, using generalised linear modelling.

Results

Healthy weight women with the highest diet quality were found to make significantly fewer Medicare claims (P = 0.012) compared to those with the lowest diet quality. In healthy weight and overweight women, the number of healthcare claims and charges was inversely associated with consuming a greater variety of vegetables. For every 1 point increase in the ARFS vegetable component score, healthy weight women made 1.9 fewer healthcare claims and were charged $139 less, whereas overweight women made 2.3 fewer claims and were charged $176 less for healthcare over 10 years.

Conclusions

The results of the present study support the need to prioritise an improved diet quality with the aim of reducing healthcare claims and overall costs in a population‐based sample of Australian females. As the burden of overweight and obesity on the healthcare system increases, strategies to improve diet quality may be of particular importance; however, more research is required to further establish this relationship.

     

Association between dietary carbohydrate quality and the prevalence of obesity and hypertension

Background

Dietary carbohydrate quality may play an important role in disease development. We evaluated the association between carbohydrate quality index (CQI ) and the prevalence of obesity and metabolic disorders among adults in South Korea.

Methods

We analysed 12 027 adults aged 19–64 years from the fifth Korea National Health and Nutrition Examination Survey (KNHANES ). CQI was based on four criteria: crude fibre intake, dietary glycaemic index (DGI ), whole grains/total grains ratio and solid carbohydrates/total carbohydrates ratio.

Results

Participants with a lower CQI were younger, had a lower income and were more likely to be smokers and to drink alcohol. The highest quintile CQI group showed the lowest DGI and the lowest consumption of liquid carbohydrates and refined grains, as well as the highest consumption of solid carbohydrates, crude fibre and whole grains (P < 0.05). A higher CQI was negatively associated with the prevalence of obesity (odds ratio = 0.83; 95% confidence interval = 0.69–0.99) and hypertension (odds ratio = 0.78; 95% confidence interval = 0.61–0.99) but was not associated with other metabolic disorders.

Conclusions

These results suggest that the quality of carbohydrates consumed is associated with the risk of obesity and hypertension. However, the cross‐sectional design does not preclude reverse causality.