Effectiveness and Safety of Dietary Interventions for Rheumatoid Arthritis: A Systematic Review of Randomized Controlled Trials

This systematic review assesses the effectiveness and safety of dietary interventions for rheumatoid arthritis. Randomized controlled trials comparing any dietary manipulation with an ordinary diet were included. Eight randomized controlled trials with a total of 366 patients were included. One trial found that fasting, followed by 13 months on a vegetarian eating plan, might reduce pain (mean difference on a zero to 10 scale −1.89, 95% confidence interval [CI] −3.62 to −0.16). Another single trial found that a 12-week Cretan Mediterranean eating plan might reduce pain (mean difference on a 0 to 100 scale −14.00, 95% CI −23.6 to −4.37). Due to inadequate data reporting, the effects of vegan eating plans and elimination diets are uncertain. When comparing any dietary manipulation with an ordinary diet we found a higher total drop-out of 8% (risk difference 0.08, 95% CI −0.01 to 0.17), higher treatment-related drop-out of 5% (risk difference 0.05, 95% CI −0.03 to 0.14) and a significantly higher weight loss (weighted mean difference −3.24, 95% CI −4.81 to −1.67 kg) in the diet groups compared to the control groups. The effects of dietary manipulation, including vegetarian, Mediterranean, and elemental eating plans, and elimination diets on rheumatoid arthritis are still uncertain due to the included studies being small, single trials with moderate to high risk of bias. We conclude that higher dropout rates and weight loss in the groups with dietary manipulation indicate that potential adverse effects should not be ignored.     

PERIOD2 Variants Are Associated with Abdominal Obesity, Psycho-Behavioral Factors, and Attrition in the Dietary Treatment of Obesity

The purpose of this research was to test for association between polymorphisms in the circadian clock-related gene PERIOD2 (PER2) and attrition in patients prone to withdrawal from a behavioral weight-reduction program based on the Mediterranean diet. A total of 454 overweight/obese participants (women=380, men=74), aged 20 to 65 years, who attended outpatient clinics specializing in obesity between January and December 2008, were studied. Anthropometric, biochemical, and dietary-intake variables were analyzed. Effectiveness of the program was assessed, and a questionnaire of barriers to weight loss was considered. Multivariate analysis and logistic regression models were performed. Results indicate that PER2 polymorphisms rs2304672C>G and rs4663302C>T were associated with abdominal obesity (P<0.05). Participants who withdrew from treatment were significantly more obese and had more barriers to lose weight (P<0.05). They also displayed a lower likelihood of planning eating in advance and experiencing stress with dieting than those who completed treatment. Frequency of rs4663307 minor allele was significantly greater in withdrawers than in those who successfully completed treatment (P<0.05). Logistic regression analysis showed that rs2304672 C>G minor allele carriers had a greater probability of dropping out, displaying extreme snacking, experiencing stress with dieting, eating when bored, and skipping breakfast than noncarriers. PER2 is implicated in attrition in weight-loss treatment and may modulate eating-behavior-related phenotypes. These findings could represent a step toward personalized health care and nutrition based on a combination of genotyping and psycho-behavioral characterization.     

Psychosocial Factors Influencing Calcium Intake and Bone Quality in Middle School Girls

Calcium intake has been associated with promoting bone health in children and adolescents, thus preventing osteoporosis later in life. Behavior change such as increased calcium intake, as well as physiological factors such as bone quality, may be facilitated by psychosocial and environmental factors. The purpose of this study was to identify pathways by which psychosocial factors influence calcium intake and bone quality in middle school girls. The study design was cross-sectional. Baseline data from the Incorporating More Physical Activity and Calcium in Teens (IMPACT) study, collected in 2001-2003, were used. IMPACT was a 1.5-year nutrition and physical activity intervention study, designed to improve bone density in 717 middle school girls in Texas. Main outcome measures were calcium intake determined using mean milligrams of calcium consumed per day and number of glasses of milk consumed per day, and bone quality determined using a calcaneal stiffness index. Confirmatory factor analysis and path analysis were performed to identify the direct and indirect pathways used by various psychosocial factors such as knowledge, self-efficacy, outcome expectations, and milk availability at home, to influence calcium intake and bone quality. Results showed that knowledge of osteoporosis and calcium-rich foods had an indirect effect on calcium intake, with outcome expectations as the mediating variable (β=.035 and β=.03, respectively; P<0.05). Calcium self-efficacy had a significant indirect effect on calcium intake, with outcome expectations as the mediator (β=.085, P<0.05). None of the variables significantly influenced bone quality. Thus, several direct and indirect pathways used to influence calcium intake among adolescent girls were identified. These findings are critical for the development of effective interventions to promote calcium intake in this population.     

Factors that Influence Breastfeeding Decisions among Special Supplemental Nutrition Program for Women, Infants, and Children Participants from Central Louisiana

Although human milk provides optimal nutrition for infants, fewer than one third of US infants are breastfed exclusively for 6 months or more. The objectives of this study were to determine the factors that have the greatest impact on the decisions to breastfeed, and to determine the effect of formula provided by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on the initiation and duration of breastfeeding among WIC participants in a rural parish in central Louisiana. A cross-sectional study was done between September 2007 and March 2008 among 130 WIC participants. Approximately half (51%) of the participants reported breastfeeding their youngest child for a mean of 15.7±14.9 weeks, with more white mothers breastfeeding than did African-American mothers or other races (P<0.01). Significantly more people reported that incentives provided to encourage breastfeeding did not affect their decision to breastfeed than those who said incentives affected their decision to breastfeed (P<0.029). Finally, study participants who were breastfed as a child were significantly more likely to breastfeed their children than those who were not breastfed as a child (P<0.022). The majority (96%) of the participants in this study indicated that WIC is providing effective and clear education about the benefits of breastfeeding, and that this advice influenced their decision to breastfeed their children. These findings underscore the importance of emphasizing the health benefits of breastfeeding to increase initiation and duration rates among WIC participants.     

Nutrigenomics Approaches to Functional Foods

By definition, functional foods benefit human health beyond the effect of nutrients alone. However, few are accompanied by convincing health claims, partly because human responses are variable. Nutritional biochemistry explains why polymorphisms in genes for the absorption, circulation, or metabolism of essential nutrients, such as n-3 polyunsaturated fatty acids, would affect the efficacy of that nutrient. However, functional foods often incorporate bioactive compounds, such as epigallocatechin-3-gallate, without considering the interaction with genetic polymorphisms. For either example there will be individuals whose genotype precludes their deriving significant benefit from an increased intake of such foods, and a small segment of the population that may be disadvantaged. Large-scale, whole-genome association studies are providing unprecedented understanding of the genetic basis of health and chronic disease. This rapidly evolving genomic science often fails to consider the interaction with environmental exposure like diet. It is important that the dietetics profession ensures rigorous nutrition science alongside genetic evaluation as part of future study design to derive informed information on gene-diet interactions that may enable clients to rationally select foods leading to optimal health or reduced risk of chronic disease.     

Dietary Quality and Associated Factors among Factory Workers in the Metropolitan Region of São Paulo, Brazil

The workplace is a manageable community-based setting for ensuring proper nutrition. This study aimed to evaluate dietary quality and associated factors among adult workers at a cosmetics factory in the metropolitan area of São Paulo, Brazil. This factory was actively participating in the Brazilian Workers' Meal Program, which was created to ensure workers' nutritional health. In this cross-sectional study, data on 202 adult workers were assessed using questionnaires (sociodemographic, anthropometric, and lifestyle characteristics) administered during August and September 2006. Dietary intake, measured by 24-hour dietary recall, was used to calculate the modified Healthy Eating Index (HEI). A repeated administration of the 24-hour dietary recall was applied in a random subsample to calculate the modified HEI adjusted for the within-person variation in intake. Mean adjusted modified HEI scores were analyzed using multiple linear regression adjusted for energy. The mean adjusted modified HEI score was 72.3±8.0. The lowest adjusted modified HEI components scores were “milk and dairy products” (4.4±3.2) and “sodium” (3.7±3.1). Two percent of workers had “poor diet” (adjusted modified HEI score <51 points) and the majority (87%) had “diet that needs modification” (adjusted modified HEI score between 51 and 80), despite their participation in the meal program. Adjusted modified HEI scores were considerably higher for men (74.7±7.0) than for women (66.9±8.2) and for normal body mass index (calculated as kg/m²) (73.3±7.8) than for overweight/obese (70.9±8.1). Based on these results, the vast majority of workers were found to have diets that needed improvement. Individuals with higher-quality diets were more likely to have lower body mass index and to be male.     

Integration of stakeholder engagement from development to dissemination in genomic medicine research: Approaches and outcomes from the CSER Consortium

PurposeThere is a critical need for genomic medicine research that reflects and benefits socioeconomically and ancestrally diverse populations. However, disparities in research populations persist, highlighting that traditional study designs and materials may be insufficient or inaccessible to all groups. New approaches can be gained through collaborations with patient/community stakeholders. Although some benefits of stakeholder engagement are recognized, routine incorporation into the design and implementation of genomics research has yet to be realized.MethodsThe National Institutes of Health–funded Clinical Sequencing Evidence-Generating Research (CSER) consortium required stakeholder engagement as a dedicated project component. Each CSER project planned and carried out stakeholder engagement activities with differing goals and expected outcomes. Examples were curated from each project to highlight engagement strategies and outcomes throughout the research lifecycle from development through dissemination.ResultsProjects tailored strategies to individual study needs, logistical constraints, and other challenges. Lessons learned include starting early with engagement efforts across project stakeholder groups and planned flexibility to enable adaptations throughout the project lifecycle.ConclusionEach CSER project used more than 1 approach to engage with relevant stakeholders, resulting in numerous adaptations and tremendous value added throughout the full research lifecycle. Incorporation of community stakeholder insight improves the outcomes and relevance of genomic medicine research.     

The Contributions of Dickoff and James to Theory Development in Nursing

This paper is an analysis of a number of articles on nursing by lames Dickoff and Patricia James. The analysis includes their speech given at the Nurse Educators Conference in 1978. Three major content areas are identified: (a) theory as a practice discipline, (b)the role of research, and (c) beliefs and values. There is discussion of how these ideas have changed and developed over time. Other characteristic themes are addressed as well. It is concluded that the greatest contribution of Dickoff and lames to theory development in nursing has been to generate controversy and equilibrium