A randomized controlled clinical trial investigating the effect of DASH diet on insulin resistance,inflammation, and oxidative stress in gestational diabetes

ObjectiveTo our knowledge, no reports are available indicating the effects of the Dietary Approaches to Stop Hypertension (DASH) eating plan on insulin resistance, inflammation, and oxidative stress among pregnant women with gestational diabetes mellitus (GDM).This study was designed to investigate the effects of the DASH diet on insulin resistance, serum high-sensitivity C-reactive protein (hs-CRP) and biomarkers of oxidative stress among pregnant women with GDM.MethodsThis randomized controlled clinical trial was performed with 32 pregnant women diagnosed with GDM at 24 to 28 wk gestation. Participants were randomly assigned to consume either the control (n = 16) or DASH diet (n = 16) for 4 wk. The DASH diet was rich in fruits, vegetables, whole grains, and low-fat dairy products and was low in saturated fats, total fats, cholesterol, refined grains, and sweets, with a total of 2400 mg/d of sodium. The control diet contained 40% to 55% of its energy as carbohydrates, 10% to 20% as proteins, and 25% to 30% as total fats. Fasting blood samples were taken at baseline and after 4 wk of intervention to measure fasting plasma glucose (FPG), serum insulin, and hs-CRP, Homeostasis Model of Assessment—Insulin Resistance (HOMA-IR), plasma total antioxidant capacity (TAC), and total glutathione levels (GSH).ResultsConsumption of the DASH diet compared with the control diet resulted in decreased FPG (–7.62 versus 3.68 mg/dL; P = 0.02), serum insulin levels (–2.62 versus 4.32 μIU/mL, P = 0.03), and HOMA-IR score (–0.8 versus 1.1; P = 0.03). Increased concentrations of plasma TAC (45.2 versus –159.2 mmol/L; P < 0.0001) and GSH (108.1 versus –150.9 μmol/L; P < 0.0001) also were seen in the DASH group compared with control group. We failed to find a significant difference in mean changes of serum hs-CRP levels between the two diets. Within-group comparisons revealed significant reductions in plasma TAC and GSH levels in the control diet, while a significant increase in these biomarkers in the DASH diet.ConclusionConsumption of the DASH diet in pregnant women with GDM had beneficial effects on FPG, serum insulin levels, HOMA-IR score, plasma TAC, and total GSH levels. The effects of this dietary pattern on pregnancy outcomes need to be investigated in future studies.     

Effect of zinc supplementation on blood sugar control in the overweight and obese population: A systematic review and meta-analysis of randomized controlled trials

BackgroundAlthough overweight and obese people have a higher risk of type 2 diabetes incidence than normal-weight individuals, the efficacy of zinc supplementation in blood sugar control in overweight and obese people remained unknown. This meta-analysis attempted to address this issue.MethodsDatabases including PubMed, Embase, and the Cochrane Library were searched from inception until May 2022 to identify randomized controlled trials (RCTs) investigating the effects of zinc supplementation among participants who were overweight or obese without language restriction. It is a random-effect meta-analysis that analyzed the impact of zinc supplementation on fasting glucose (FG) (i.e., primary outcome) and other variables including fasting insulin (FI), homeostasis model assessment-insulin resistance index (HOMA-IR), glycated hemoglobin (HbA1c), high-sensitivity C-reactive protein (hs-CRP), and 2-hour postprandial glucose (2 h- PG).ResultsAnalysis of 12 eligible RCTs involving 651 overweight/obese participants demonstrated that zinc supplementation significantly improves FG (weighted mean difference [WMD]: −8.57 mg/dL; 95% confidence interval [CI]: −14.04 to −3.09 mg/dL, p = 0.002), HOMA-IR (WMD: −0.54; 95% CI: −0.78 to −0.30, p < 0.001), HbA1c (WMD: −0.25%; 95% CI: −0.43% to −0.07%, p = 0.006), and 2 h-PG (WMD: −18.42 mg/dL; 95% CI: −25.04 to −11.79 mg/dL, p < 0.001) compared to those in the control group. After conducting subgroup analyses, we found that the primary outcome, FG, showed more significant results in the subgroups with Asia, Zinc supplementation alone, higher dose (≥30 mg) and patients with diabetes.ConclusionOur meta-analysis indicated that zinc supplementation benefits blood sugar control in overweight and obese populations, with an especially significant reduction in FG.     

A meal replacement regimen improves blood glucose levels in prediabetic healthy individuals with impaired fasting glucose

ObjectiveThe aim of this study was to investigate the effect of a 6-wk intervention with either lifestyle intervention (increased physical activity and a low-calorie diet) or a meal replacement regimen on glycemic control in patients who are prediabetic and have impaired fasting glucose.MethodsForty-two overweight or obese men and women (age 54 ± 8 y; weight 95.1 ± 11.9 kg; body mass index [BMI] 32.8 ± 2.89 kg/m²) were included in this randomized controlled clinical trial. Patients in the lifestyle group (LS; n = 14) received dietary counseling sessions (fat-restricted low-calorie diet) and instructions on how to increase physical activity. Patients in the meal replacement group (MR; n = 28) were instructed to replace two daily meals with a low-calorie, high soy-protein drink with a low glycemic index.ResultsBoth interventions resulted in a significant decrease in body weight and BMI, although the reduction was more pronounced (P < 0.05) in the MR group. In both groups, glucose concentrations decreased significantly (LS: −12 mg/dL, P < 0.01; MR: −11 mg/dL, P < 0.01), and mean glucose levels returned to the normal range. Insulin (LS: −1 μU/mg [not significant]; MR: −6.3 μU/mg, P < 0.01) and homeostasis model assessment of insulin resistance (HOMA-IR; LS −0.92, P < 0.01; MR: −2.1, P < 0.01) were also significantly lower following both interventions; again improvements were more pronounced in the MR group (insulin: P < 0.05; HOMA P < 0.01)ConclusionIt can be concluded that meal replacement is an effective intervention for rapid improvement of elevated fasting glucose and increased insulin concentrations, these being important biomarkers of the prediabetic state. The 6-wk intervention has shown that the effect of meal replacement on fasting blood glucose was comparable to the effect of lifestyle intervention. The alterations in BMI, insulin, and HOMA-IR were significantly more pronounced following the meal replacement regimen.     

Folic Acid Supplementation Improves Glycemic Control for Diabetes Prevention and Management: A Systematic Review and Dose-Response Meta-Analysis of Randomized Controlled Trials

Background: There is a growing interest in the considerable benefits of dietary supplementations, such as folic acid, on the glycemic profile. We aimed to investigate the effects of folic acid supplementation on glycemic control markers in adults. Methods: Randomized controlled trials examining the effects of folic acid supplementation on glycemic control markers published up to March 2021 were detected by searching online databases, including Scopus, PubMed, Embase, and ISI web of science, using a combination of related keywords. Mean change and standard deviation (SD) of the outcome measures were used to estimate the mean difference between the intervention and control groups at follow-up. Meta-regression and non-linear dose-response analysis were conducted to evaluate the association between pooled effect size and folic acid dosage (mg/day) and duration of the intervention (week). From 1814 detected studies, twenty-four studies reported fasting blood glucose (FBG), fasting insulin, hemoglobin A1C (HbA1C), and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) as an outcome measure. Results: Results revealed significant reductions in FBG (weighted mean difference (WMD): −2.17 mg/dL, 95% CI: −3.69, −0.65, p = 0.005), fasting insulin (WMD: −1.63 pmol/L, 95% CI: −2.53, −0.73, p < 0.001), and HOMA-IR (WMD: −0.40, 95% CI: −0.70, −0.09, p = 0.011) following folic acid supplementation. No significant effect was detected for HbA1C (WMD: −0.27%, 95% CI: −0.73, 0.18, p = 0.246). The dose-response analysis showed that folic acid supplementation significantly changed HOMA-IR (r = −1.30, p-nonlinearity = 0.045) in non-linear fashion. However, meta-regression analysis did not indicate a linear relationship between dose, duration, and absolute changes in FBG, HOMA-IR, and fasting insulin concentrations. Conclusions: Folic acid supplementation significantly reduces some markers of glycemic control in adults. These reductions were small, which may limit clinical applications for adults with type II diabetes. Further research is necessary to confirm our findings.     

Metabolic effects of aloe vera gel complex in obese prediabetes and early non-treated diabetic patients: Randomized controlled trial

ObjectiveThe metabolic effects of an aloe vera gel complex (Aloe QDM complex) on people with prediabetes or early diabetes mellitus (DM) are unknown. The goal of this study was to determine the effects of Aloe QDM complex on body weight, body fat mass (BFM), fasting blood glucose (FBG), fasting serum insulin, and Homeostasis Model of Assessment - Insulin Resistance (HOMA-IR) in obese individuals with prediabetes or early DM who were not on diabetes medications.MethodsParticipants (n = 136) were randomly assigned to an intervention or a control group and evaluated at baseline and at 4 and 8 wk.ResultsThe study lost six participants in the control group and eight in the intervention group. At 8 wk, body weight (P = 0.02) and BFM (P = 0.03) were significantly lower in the intervention group. At 4 wk, serum insulin level (P = 0.04) and HOMA-IR (P = 0.047) were lower in the intervention group; they also were lower at 8 wk but with borderline significance (P = 0.09; P = 0.08, respectively). At 8 wk, FBG tended to decrease in the intervention group (P = 0.02), but the between-group difference was not significant (P = 0.16).ConclusionIn obese individuals with prediabetes or early untreated DM, Aloe QDM complex reduced body weight, BFM, and insulin resistance.     

Effect of Aerobic and Resistant Exercise Intervention on Inflammaging of Type 2 Diabetes Mellitus in Middle-Aged and Older Adults: A Systematic Review and Meta-Analysis

ObjectivesTo examine the effect of aerobic and resistant exercise intervention on inflammaging in middle-aged and older adults with type 2 diabetes mellitus (T2DM) using inflammatory cytokines, such as interleukin (IL)-1 β, IL-6, tumor necrosis factor-α (TNF-α), and C-reactive protein (CRP) as biomarkers.DesignSystematic review and meta-analysis.Setting and ParticipantsMiddle-aged and older adults with T2DM in the community.MethodsArticles were searched from 8 electronic databases. Randomized control trials (RCTs) published in English, from inception to October 31, 2021, were included in this review. Two authors conducted data extraction and quality appraisal independently following guidelines in the Cochrane Handbook for Systematic Reviews of Interventions. Meta-analysis was conducted using Review Manager. Heterogeneity was investigated using subgroup and sensitivity analysis.ResultsThis review included 14 RCTs. The meta-analysis showed significant improvement in IL-6 [Z = 3.05; 95% confidence interval (CI): ?3.60 to ?0.79; P = .002], CRP (Z = 2.44; 95% CI: ?0.55 to ?0.06; P = .01) and TNF-α levels (Z = 2.96; 95% CI: ?2.21 to ?0.45; P = .003) post-exercise programs. Subgroup analysis revealed that combined aerobic and resistance exercises and long-term exercises have more significant improvement to the outcomes than usual care. Based on the Grades of Recommendation, Assessment, Development and Evaluation system, considerable risk of bias and low level of certainty were revealed in all biomarker outcomes.Conclusions and ImplicationsExercise intervention is effective in improving inflammatory, metabolic, and lipid markers in middle-aged and older adults with T2DM. By modifying the levels of these markers with exercise, inflammation and insulin resistance can be improved. Long-term, combined aerobic and resistance exercise interventions have more significant effect on biomarkers. The small sample size of this meta-analysis limited the generalizability of the results. Future studies can consider adopting a more optimized exercise regimen to achieve effective T2DM management in middle-aged and older adults. Similar studies should expand to other populations and larger sample sizes to explore replicability of these effects.     

Effects of Dietary Approaches to Stop Hypertension (DASH)-style diet on fatal or nonfatal cardiovascular diseases—Incidence: A systematic review and meta-analysis on observational prospective studies

BackgroundCardiovascular diseases (CVDs) are a group of disorders affecting heart and blood vessels. However, protective roles are proposed for Dietary Approaches to Stop Hypertension (DASH)-style diets.ObjectiveThe aim of this review was to summarize and if possible quantify the longitudinal effects of a DASH-style diet on the incidence of CVDs.DesignPubmed, ISI web of science, and EMBASE were searched and cohort studies that examined the DASH-style diet in relation to CVDs, coronary heart disease (CHD), stroke, and heart failure (HF) were selected. Cohort studies which included participants with specific CVD risk factors like diabetes mellitus, metabolic syndrome, obesity or hypertension were excluded from review. Relative risks (RRs) that were reported for fully adjusted models and their confidence intervals were extracted for meta-analysis.ResultsRegarding the adherence to the DASH diet and the incidence of CVDs, stroke, CHD, and HF, only 6 studies met our criteria to be included in this systematic review. Meta-analysis showed that imitating a DASH-like diet can significantly reduce CVDs (RR = 0.80; 95% confidence interval [CI], 0.74–0.86; P < 0.001), CHD (RR = 0.79; 95% CI, 0.71–0.88; P < 0.001), stroke (RR = 0.81, 95% CI, 0.72–0.92; P < 0.001), and HF (RR= 0.71, 95% CI, 0.58–0.88; P < 0.001) risk. A linear and negative association was obtained between DASH-style diet concordance and all CVDs, as well.ConclusionIn conclusion, our results showed that a DASH-like diet can significantly protect against CVDs, CHD, stroke, and HF risk by 20%, 21%, 19% and 29%, respectively. Furthermore, there is a significant reverse linear association between DASH diet consumption and CVDs, CHD, stroke, and HF risk.     

Effect of Camel Milk on Glucose Homeostasis in Patients with Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

The effects of camel milk (CM) intake on glycemic control in patients with diabetes are controversial. This systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to summarize the effect of CM intake on glucose homeostasis parameters in patients with both types of diabetes mellitus; T1DM and T2DM. We searched Google Scholar, PubMed/MEDLINE, EBSCO host, CINAHL, ScienceDirect, Cochrane, ProQuest Medical, Web of Science, and Scopus databases from inception until the end of November 2021. Relevant RCTs were identified, and the effect size was reported as mean difference (MD) and standard deviation (SD). Parameters of glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), postprandial blood glucose (PBG), fasting serum insulin (FI), insulin resistance (expressed in terms of HOMA-IR), insulin dose (ID) received, serum insulin antibody (IA), and C-peptide (CP) were tested. Out of 4054 collected articles, 14 RCTs (total 663 subjects) were eligible for inclusion. The pooled results obtained using a random-effects model showed a statistically significant decrease in HbA1c levels (MD, −1.24, 95% confidence interval (CI): −2.00, −0.48, p < 0.001 heterogeneity (I²) = 94%) and ID received (MD, −16.72, 95% CI: −22.09, −11.35 p < 0.00001, I² = 90%), with a clear tendency was shown, but non-significant, to decrease FBG (MD, −23.32, 95% CI: −47.33, 0.70, p = 0.06, I² = 98%) in patients with diabetes who consumed CM in comparison to those on usual care. Conversely, the consumption of CM did not show significant reductions in the rest of the glucose homeostasis parameters. Subgroup analysis revealed that patients with T2DM were more beneficially affected by CM intake than those with T1DM in lowering FBG, while patients with T1DM were more beneficially affected by CM intake than those with T2DM in lowering HbA1c. Both fresh and treated (pasteurized/fermented) CM gave similar beneficial effects in lowering HbA1c. Lastly, a relatively superior effect for longer duration on shorter duration (>6 months, ≤6 months, respectively) of CM intake is found in lowering HbA1c. To conclude, long-term consumption of CM by patients with diabetes could be a useful adjuvant therapy alongside classical medications, especially in lowering the required insulin dose and HbA1c. Due to the high heterogeneity observed in the included studies, more controlled trials with a larger sample size are warranted to confirm our results and to control some confounders and interfering factors existing in the analyzed articles.     

Determinants and Consequences of Adherence to the Dietary Approaches to Stop Hypertension Diet in African-American and White Adults with High Blood Pressure: Results from the ENCORE Trial

BackgroundAlthough the Dietary Approaches to Stop Hypertension (DASH) diet is an accepted nonpharmacologic treatment for hypertension, little is known about what patient characteristics affect dietary adherence and what level of adherence is needed to reduce blood pressure (BP).ObjectiveOur aim was to determine what factors predict dietary adherence and the extent to which dietary adherence is necessary to produce clinically meaningful BP reductions.DesignAncillary study of the ENCORE (Exercise and Nutrition Interventions for Cardiovascular Health) trial—a 16-week randomized clinical trial of diet and exercise.Participants/settingParticipants included 144 sedentary, overweight, or obese adults (body mass index 25 to 39.9) with high BP (systolic 130 to 159 mm Hg and/or diastolic 85 to 99 mm Hg).InterventionPatients were randomized to one of three groups: DASH diet alone, DASH diet plus weight management, and Usual Diet Controls.Main outcomes measuresOur primary outcomes were a composite index of adherence to the DASH diet and clinic BP.Statistical analyses performedGeneral linear models were used to compare treatment groups on post-treatment adherence to the DASH diet. Linear regression was used to examine potential predictors of post-treatment DASH adherence. Analysis of covariance was used to examine the relation of adherence to the DASH diet and BP.ResultsParticipants in the DASH diet plus weight management (16.1 systolic BP [SBP]; 95% CI 13.0 to 19.2 mm Hg and 9.9 diastolic BP [DBP]; 95% CI 8.1 to 11.6 mm Hg) and DASH diet alone (11.2 SBP; 95% CI 8.1 to 14.3 mm Hg and 7.5 DBP; 95% CI 5.8 to 9.3 mm Hg) groups showed significant reductions in BP in comparison with Usual Diet Controls participants (3.4 SBP; 95% CI 0.4 to 6.4 mm Hg and DBP 3.8; 95% CI 2.2 to 5.5 mm Hg). Greater post-treatment consumption of DASH foods was noted in both the DASH diet alone (mean=6.20; 95% CI 5.83 to 6.57) and DASH diet plus weight management groups (mean=6.23; 95% CI 5.88 to 6.59) compared with Usual Diet Controls (mean=3.66; 95% CI 3.30 to 4.01; P<0.0001), and greater adherence to the DASH diet was associated with larger reductions in clinic SBP and DBP (P≤0.01). Only ethnicity predicted dietary adherence, with African Americans less adherent to the DASH diet compared with whites (4.68; 95% CI 4.34 to 5.03 vs 5.83; 95% CI 5.50 to 6.11; P<0.001).ConclusionsGreater adherence to the DASH diet was associated with larger BP reductions independent of weight loss. African Americans were less likely to be adherent to the DASH dietary eating plan compared with whites, suggesting that culturally sensitive dietary strategies might be needed to improve adherence to the DASH diet.     

Association of COVID-19 impact with outcomes of an integrated obesity and depression intervention: Posthoc analysis of an RCT

ObjectiveTo examine the association between COVID-19 impact and clinical outcomes of an integrated collaborative care intervention for adults with obesity and comorbid depression.MethodsLatent class analysis identified clusters of self-reported COVID-19 impact. Cluster characteristics were examined using Fishers’ least significant difference method and canonical discriminant analysis. Intervention vs. usual care effects on primary (body mass index [BMI], depressive symptoms) and secondary (anxiety symptoms and other psychosocial) outcomes stratified by cluster were examined using linear mixed models.ResultsThree clusters were identified: mental health and sleep impact (cluster 1, n = 37), economic impact (cluster 2, n = 18), and less overall impact (cluster 3, n = 20). Clusters differed in age, income, diet, and baseline coping skills. The intervention led to improvements across several health outcomes compared with usual care, with medium to large effects on functional impairments (standardized mean difference, ?0.7 [95% CI: ?1.3, ?0.1]) in cluster 1, depressive symptoms (?1.1 [95% CI: ?2.0, ?0.1]) and obesity-related problems (?1.6 [95% CI: ?2.8, ?0.4]) in cluster 2, and anxiety (?1.1 [95% CI: ?1.9, ?0.3]) in cluster 3.ConclusionsPeople with obesity and comorbid depression may have varied intervention responses based on COVID-19 impact. Interventions tailored to specific COVID-19 impact clusters may restore post-pandemic health.     

Nutrition Practices of Family Child Care Home Providers and Children's Diet Quality

ObjectiveTo examine the relationship between the diet quality of children aged 2–5 years cared for in family child care homes (FCCHs) with provider adherence to nutrition best practices.DesignCross-sectional analysis.ParticipantsFamily child care home providers (n = 120, 100% female, 67.5% Latinx) and children (n = 370, 51% female, 58% Latinx) enrolled in a cluster-randomized trial.Main Outcome MeasuresData were collected over 2 days at each FCCH. The Environment and Policy Assessment and Observation tool was used to document whether providers exhibited nutrition practices on the basis of the Nutrition and Physical Activity Self-Assessment for Child Care. Each practice was scored as either present or absent. Children's food intake was observed using Diet Observation at Child Care and analyzed with the Healthy Eating Index–2015.AnalysisMultilevel linear regression models assessed the association between providers exhibiting best practices regarding nutrition and children's diet quality. The model accounted for clustering by FCCH and controlled for provider ethnicity, income level, and multiple comparisons.ResultsChildren in FCCHs in which more of the best practices were implemented had higher diet quality (B = 1.05; 95% confidence interval [CI], 0.12–1.99; P = 0.03). Specifically, children whose providers promoted autonomous feeding (B = 27.52; 95% CI, 21.02–34.02; P < 0.001) and provided nutrition education (B = 7.76; 95% CI, 3.29–12.23; P = 0.001) had higher total Healthy Eating Index scores.Conclusions and ImplicationsFuture interventions and policies could support FCCH providers in implementing important practices such as autonomy feeding practices, talking informally to children about nutrition, and providing healthful foods and beverages.     

Ethinyl estradiol vs estradiol valerate in combined oral contraceptives – Effect on glucose tolerance: A randomized,controlled clinical trial

ObjectiveTo compare the effects of two formulations of combined oral contraceptives (COCs), estradiol valerate (EV) and ethinyl estradiol (EE) combined with dienogest (DNG), and DNG-only, on glucose tolerance.Study DesignWe performed a randomized, controlled 9-week clinical trial. Inclusion criteria were: age 18–35 years, regular menstrual cycle (28 ± 7 days), no polycystic ovaries, non-smoking, no contraindications for COC use and a 2-month wash-out from hormonal contraceptive use. The women were randomized to EV + DNG (n = 20), EE + DNG (n = 20), and DNG-only (n = 19), and evaluated at baseline, at 4–5 weeks and 8–9 weeks of treatment. Study medications were used continuously for 63 days. Primary outcome measure was change in the whole-body insulin sensitivity index (Matsuda index) derived from the oral glucose tolerance test (OGTT) over the treatment period. Secondary outcome measures were area under curves (AUC) of glucose and insulin, homeostatic model assessment – insulin resistance (HOMA-IR) and Insulin Sensitivity Index (ISI).ResultsFifty-nine women enrolled, and 56 women completed the study. The Matsuda index changed from baseline as follows (mean percentage change, mean change [95%CI]): DNG-only ?12%, ?1.45 [95%CI ?3.22–0.325] P = 0.10; EV + DNG + 2.7%, ?0.10 [?1.34 to 1.14] P = 0.86; EE + DNG ?5.5%, ?1.02 [?2.51 to 0.46] P = 0.16, comparing the groups P = 0.27. There were no clinically significant differences in glucose tolerance between the COC groups, but the DNG-only group showed an improvement in the 2-h glucose levels (5.5 [95%CI 5.0–6.0] to 4.7 mmol/l [4.2–5.2], P = 0.001).ConclusionWe found no clinically significant differences between EV and EE combined with DNG and DNG-only on glucose tolerance in healthy, young, normal-weight women, indicating that these preparations appear close to neutral regarding glucose metabolism when used continuously for nine weeks.ImplicationsCombinations of both ethinyl estradiol and natural estradiol (estradiol valerate) with dienogest (DNG), as well as DNG-only, seem metabolically safe in young and healthy women in short-term continuous use.     

Factors Associated With Remaining in a Skilled Nursing Facility for Over 90 Days from Admission: Residents' Participation in Therapy and Desire to Return to the Community

BackgroundTo identify the factors associated with stay in a skilled nursing facility (SNF) among new enrollees who did not fully participate in therapy sessions.MethodsData (n = 36,133) were obtained from the Minimum Data Set version 2.0 in the state of Michigan in 2009. Study participants were new SNF enrollees (n = 699) who did not fully participate in therapy sessions despite their desire to return to the community. Multivariate logistic regressions were performed to identify factors contributing to remaining in a nursing home for 91 days or longer.ResultsNew SNF enrollees were more likely to remain in nursing home when they were depressed (odds ratio [OR] = 1.41; 95% confidence interval [CI], 1.09–2.08; P = .01), experiencing delirium (OR = 3.20; 95% CI, 1.48–5.92; P < .001), were not in pain (OR = 0.83; 95% CI, 0.60–0.95; P = .03), or in less complex care (OR = 0.57; 95% CI, 0.44–0.81; P < .01).ConclusionsA higher number of new SNF enrollees than previously reported were likely to stay in nursing homes (28.0%). Depression and delirium were associated with stay in an SNF, while pain and higher complexity of care were associated with returning to the community.     

The role of resistance training in influencing insulin resistance among adults living with obesity/overweight without diabetes: A systematic review and meta-analysis

The purpose of this study was to systematically examine the independent effect of resistance training (RT) on markers of insulin resistance (IR) (fasting insulin and HOMA-IR) among individuals with overweight/obesity without diabetes. PubMed, SPORTdiscus, SCOPUS, Prospero, and clinicaltrials.gov were searched through December 19, 2022. Article screening was conducted in three phases: title screen (n = 5020), abstract screen (n = 202), and full text screen (n = 73). A total of 27 studies with 402 individual data points were used for the meta-analysis. Comprehensive Meta-Analysis software version 3.0 was used to interpret pre- and post-IR measurements with a random-effects model. Exploratory sub-analyses were conducted on studies for only females, only males, and age (< 40 and ≥ 40 years). RT had a significant effect on fasting insulin (− 1.03, 95 % CI − 1.03, − 0.75 p < 0.001) and HOMA-IR (− 1.05, 95 % CI − 1.33, − 0.76, p < 0.001). Sub-analyses revealed that males had a more pronounced effect compared to females and those < 40 years of age had a more pronounced effect compared to those ≥ 40 years. The results of this meta-analysis illustrate that RT plays an independent role in improving IR among adults with overweight/obesity. RT should continue to be recommended as part of preventive measures among these populations. Future studies examining the effect of RT on IR should consider dose centered on the current U.S. physical activity guidelines.     

Effect of Dietary Acetic Acid Supplementation on Plasma Glucose,Lipid Profiles,and Body Mass Index in Human Adults: A Systematic Review and Meta-analysis

BackgroundAcetic acid is a short-chain fatty acid that has demonstrated biomedical potential as a dietary therapeutic agent for the management of chronic and metabolic illness comorbidities. In human beings, its consumption may improve glucose regulation and insulin sensitivity in individuals with cardiometabolic conditions and type 2 diabetes mellitus. Published clinical trial evidence evaluating its sustained supplementation effects on metabolic outcomes is inconsistent.ObjectiveThis systematic review and meta-analysis summarized available evidence on potential therapeutic effects of dietary acetic acid supplementation via consumption of acetic acid–rich beverages and food sources on metabolic and anthropometric outcomes.MethodsA systematic search was conducted in Medline, Scopus, EMBASE, CINAHL Plus, and Web of Science from database inception until October 2020. Randomized controlled trials conducted in adults evaluating the effect of dietary acetic acid supplementation for a minimum of 1 week were included. Meta-analyses were performed using a random-effects model on fasting blood glucose (FBG), triacylglycerol (TAG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), glycated hemoglobin (HbA1c), body mass index (BMI), and body fat percentage. Statistical heterogeneity was assessed by calculation of Q and I² statistics, and publication bias was assessed by calculation of Egger’s regression asymmetry and Begg’s test.ResultsSixteen studies were included, involving 910 participants who consumed between 750 and 3600 mg acetic acid daily in interventions lasting an average of 8 weeks. Dietary acetic acid supplementation resulted in significant reductions in TAG concentrations in overweight and obese but otherwise healthy individuals (mean difference [MD] = −20.51 mg/dL [95% confidence intervals = −32.98, −8.04], P = .001) and people with type 2 diabetes (MD = −7.37 mg/dL [−10.15, −4.59], P < .001). Additionally, acetic acid supplementation significantly reduced FBG levels (MD = −35.73 mg/dL [−63.79, −7.67], P = .01) in subjects with type 2 diabetes compared with placebo and low-dose comparators. No other changes were seen for other metabolic or anthropometric outcomes assessed. Five of the 16 studies did not specify the dose of acetic acid delivered, and no studies measured blood acetate concentrations. Only one study controlled for background acetic acid-rich food consumption during intervention periods. Most studies had an unclear or high risk of bias.ConclusionSupplementation with dietary acetic acid is well tolerated, has no adverse side effects, and has clinical potential to reduce plasma TAG and FBG concentrations in individuals with type 2 diabetes, and to reduce TAG levels in people who are overweight or obese. No significant effects of dietary acetic acid consumption were seen on HbA1c, HDL, or anthropometric markers. High-quality, longer-term studies in larger cohorts are required to confirm whether dietary acetic acid can act as an adjuvant therapeutic agent in metabolic comorbidities management.     

Effects of Coffee Consumption on Insulin Resistance and Sensitivity: A Meta-Analysis

Coffee is widely consumed worldwide and impacts glucose metabolism. After a previous meta-analysis that evaluated the effects of coffee consumption on insulin resistance and sensitivity, additional randomized controlled trials (RCTs) were conducted. This meta-analysis aimed to evaluate the effects of coffee consumption on insulin resistance or sensitivity. We selected RCTs that evaluated the effects of coffee consumption for seven days or more on insulin sensitivity or resistance using surrogate indices (homeostasis model assessment for insulin resistance (HOMA-IR) and Matsuda index). The fixed-effects or random-effects model was used according to heterogeneity. Four studies with 268 participants were analyzed in this meta-analysis. Coffee consumption significantly decreased HOMA-IR compared to control (mean difference (MD) = −0.13; 95% CI = −0.24–−0.03; p-value = 0.01). However, the significance was not maintained in the sensitivity analysis (MD = −0.04; 95% CI = −0.18–0.10; p-value = 0.55) after excluding data from the healthy, young, normal-weight group. Matsuda index was not significantly different between coffee and control groups (standardized mean difference (SMD) = −0.33; 95% CI = −0.70–0.03; p-value = 0.08). In conclusion, long-term coffee consumption has a nonsignificant effect on insulin resistance and sensitivity. More studies evaluating the effects of coffee consumption in the healthy, young, and normal-weight individuals are needed.     

Factors affecting antibody responses to immunizations in infants born to women immunized against pertussis in pregnancy and unimmunized women: Individual-Participant Data Meta-analysis

BackgroundExploring factors that affect immune responses to immunizations in infants born to women immunized with tetanus-diphtheria-acellular-pertussis (Tdap) in pregnancy compared with unimmunized women is important in designing immunization programs.MethodsIndividual-participant data meta-analysis of 8 studies reporting post-immunization immunoglobulin G (IgG) levels to vaccine antigens in infants born to either women immunized with Tdap in pregnancy or unimmunized women, using mixed-effects models.ResultsIn infants of Tdap-immunized women, two-fold higher levels of anti-pertussis toxin (PT) and anti-diphtheria-toxoid (DT) IgG pre-primary immunization were associated with 9% and 10% lower post-primary immunization levels, (geometric mean ratio [GMR], PT: 0.91; 95% CI, 0.88–0.95,n = 494, DT: 0.9; 0.87–0.93,n = 519). Timing of immunization in pregnancy did not affect post-primary immunization anti-Bordetella pertussis, anti-tetanus-toxoid (TT) and anti-DT IgG levels. Spacing of infant immunization did not affect post-primary immunization anti-B. pertussis and anti-DT levels. In infants of Tdap-immunized women, two-fold higher levels of anti-PT and anti-filamentous haemagglutinin (FHA) IgG pre-primary immunization were associated with lower post-booster immunization levels, (GMR, PT: 0.91; 0.85–0.97,n = 224, FHA: 0.92; 0.85–0.99,n = 232). Timing of immunization in pregnancy did not affect post-booster immunization anti-Bordetella pertussis, anti-tetanus-toxoid (TT) and anti-DT IgG levels. Spacing of infant immunization did not affect post-booster immunization anti-PT, anti-pertactin (PRN), anti-TT and anti-DT IgG levels.In infants of unimmunized women, two-fold higher IgG levels of some vaccine antigens pre-primary immunization were associated with 8–17% lower post-primary immunization levels (GMR, PT 0.92, 95% CI:0.88–0.97, n = 373; FHA:0.88, 95% CI:0.85–0.92,n = 378; PRN:0.84, 95% CI:0.81–0.88, n = 367; TT:0.88, 95% CI:0.83–0.93, n = 241; DT: 0.83, 95% CI:0.79–0.87,n = 278). Two-fold higher levels of anti-FHA IgG pre-primary immunization were associated with 8% lower post-booster immunization levels (GMR, 0.92; 95% CI: 0.86–0.99,n = 138).DiscussionIncreased IgG levels pre-primary immunization is associated with reduced post-primary and post-booster immunization levels for some antigens in infants of women immunized or unimmunized in pregnancy, but their clinical significance is uncertain.     

Exercise and Nutritional Intervention for Physical Function of the Prefrail: A Systematic Review and Meta-Analysis

ObjectivesThe aim is to inspect the effects of exercise and nutritional intervention on prefrail older adults' physical function.DesignSystematic review and meta-analysis registered with PROSPERO (registration number: CRD42021261197).Setting and ParticipantsRandomized controlled trials involving prefrail older adults who received exercise and/or nutritional interventions.MethodsOvid MEDLINE, EMBASE, Cochrane Central Registry of Controlled Trials (CENTRAL), Web of Science, Clinical Trials, and PubMed were searched from inception to September 1, 2021. Primary outcomes were physical function, including physical performance, mobility, and grip strength. The short physical performance battery score and chair sit-to-stand test were used to assess the physical performance. Timed up and go and gait speed were applied to assess the mobility. Secondary outcomes were frailty status, weight, body mass index, Barthel index, and quality of life (Euro quality of life 5 dimension index values).ResultsWe included 16 randomized controlled trials comprising 1199 prefrail older adults (intervention group, n = 593; control group, n = 606). Exercise and nutritional interventions significantly improved the short physical performance battery score [n = 5, mean difference 0.81, 95% confidence interval (CI) 0.21?1.42, I² = 62%], handgrip strength (n = 7, mean difference 1.52, 95% CI 0.70?2.34, I² = 6%), and gait speed (n = 4, standard weighted mean difference ?1.06, 95% CI -1.87 to ?0.25, I² = 89%). There were no significant differences among the chair sit-to-stand test, timed up and go, weight, body mass index, and Barthel index.Conclusions and ImplicationsOur systematic review and meta-analysis shows that the receipt of exercise and nutritional intervention significantly improved physical function in prefrail older adults.     

The Effect of Replacing Refined Grains with Whole Grains on Cardiovascular Risk Factors: A Systematic Review and Meta-Analysis of Randomized Controlled Trials with GRADE Clinical Recommendation

BackgroundObservational data have established a link between the consumption of whole grains and reduced risk of cardiovascular disease (CVD); however, there is a need to review interventional research.ObjectiveOur aim was to determine whether interventions providing whole grain or whole pseudo-grain for dietary consumption improved CVD-related outcomes compared with refined grain or placebo in adults with or without chronic disease and/or associated risk factors.MethodsA systematic review and meta-analysis of randomized controlled trials that compared whole-grain vs refined-grain or placebo consumption by human adults was conducted. PubMed, CINAHL, Embase, Web of Science, and Cochrane CENTRAL were searched for studies of 12 weeks (or 2 weeks for inflammatory outcomes) duration until 21 February 2020. Data were extracted for 14 types of CVD risk factors (40 outcomes in total). Risk of bias was assessed using the Cochrane Risk-of-Bias tool. Meta-analysis was performed using Comprehensive Meta-Analysis software. The Grading of Recommendations Assessment, Development and Evaluation method was used to determine confidence in the pooled effects and to inform a clinical recommendation.ResultsTwenty-five randomized controlled trials were included and 22 were meta-analyzed. Interventions ranged from 2 to 16 weeks; most samples were healthy (n = 13 studies) and used mixed whole grains (n = 11 studies). Meta-analysis found that whole-grain oats improved total cholesterol (standardized mean difference [SMD] = –0.54, 95% CI –0.95 to –0.12) and low-density lipoprotein cholesterol (SMD = –0.57, 95% CI –0.84 to –0.31), whole-grain rice improved triglycerides (SMD = 0.22, 95% CI –0.44 to –0.01), and whole grains (all types) improved hemoglobin A1c (SMD = –0.33, 95% CI –0.61 to –0.04) and C-reactive protein (SMD = –0.22, 95% CI –0.44 to –0.00).ConclusionsFor adults with or without CVD risk factors, consuming whole grains as opposed to refined grains can improve total cholesterol, low-density lipoprotein cholesterol, hemoglobin A1c, and C-reactive protein. There is insufficient evidence to recommend the whole grains as opposed to refined grains for the prevention and treatment of CVD. Further interventional research is needed to better understand the preventive and treatment potential of whole-grain and whole pseudo-grain dietary intake for cardiovascular disease, particularly among those with existing CVD risk factors.