An expanded role for dietitians in maximising retention in nutrition and lifestyle intervention trials: implications for clinical practice

The demand for clinical trials targeting lifestyle intervention has increased as a result of the escalation in obesity, diabetes mellitus and cardiovascular disease. Little is published about the strategies that dietitians have used to successfully screen potential study volunteers, implement interventions and maximise adherence and retention in large multicentre National Institutes of Health funded nutrition and lifestyle intervention clinical trials. This paper discusses an expanded role for the contributions of dietitians as members of an interdisciplinary team based on research experiences in the Diabetes Control and Complications Trial, Diabetes Prevention Program and Look AHEAD (Action for Health in Diabetes). Many of the strategies and insights discussed are also relevant to effective clinical practice. Dietitians need to broaden their scope of practice so that they are integrated proactively into the screening and intervention phases of large clinical trials to maximise retention and adherence to assigned nutrition, lifestyle and behavioural interventions. The skills of dietitians are a unique fit for this work and it is important that investigators and project managers consider including them in both the screening and intervention phases of such clinical trials to maximise retention results.     

Hypertension Improvement Project (HIP) Latino: results of a pilot study of lifestyle intervention for lowering blood pressure in Latino adults

Objectives. To assess the feasibility of a culturally tailored behavioral intervention for improving hypertension-related health behaviors in Hispanic/Latino adults.

Design. Feasibility pilot study in a community health center and a Latino organization in Durham, North Carolina.

Intervention. The culturally adapted behavioral intervention consisted of six weekly group sessions incorporating motivational interviewing techniques. Goals included weight loss if overweight, adoption of the Dietary Approaches to Stop Hypertension dietary pattern, and increased physical activity. Participants were also encouraged to monitor their daily intake of fruits, vegetables, dairy and fat, and to record physical activity. Cultural adaptations included conducting the study in familiar places, using Spanish-speaking interventionist, culturally appropriate food choices, and physical activity.

Main outcomes. Systolic blood pressure (BP), weight, body mass index (BMI), exercise, and dietary pattern were measured at baseline and at 6 weeks follow-up. Qualitative evaluations of the recruitment process and the intervention were also conducted.

Results. There were 64 potential participants identified via healthcare provider referrals (33%), printed media (23%), and direct contact (44%). Seventeen participants completed the intervention and had main outcome data available. Participants ‘strongly agreed/agreed’ that the group sessions provided them with the tools they needed to achieve weight loss, BP control, and the possibility of sustaining the lifestyle changes after completing the intervention. At the end of the intervention, all physiological, diet, and exercise outcomes were more favorable, with the exception of fat. After 6 weeks, systolic BP decreased an average of ?10.4±10.6 mmHg, weight decreased 1.5±3.2 lbs, BMI decreased 0.3±0.5, and physical activity increased 40 minutes per week.

Conclusion. Our findings suggest that lifestyle interventions for preventing and treating hypertension are feasible and potentially effective in the Hispanic/Latino population.     

上海市闵行区居民控盐知信行现状及干预效果评价

目的了解上海市闵行区居民控盐知、信、行的整体水平,观察派发盐勺对限盐和养成健康生活方式的效果。方法对闵行区160个家庭监测点中15～69岁的居民进行基线调查,并在控盐勺发放后的一个月、半年及一年后对居民盐勺的接受程度、使用情况和行为改变进行跟踪评估。结果控盐勺(包装上印相关宣传资料)派发一年后居民5项控盐知识知晓率从70.8%提高到85.3%,5项控盐措施的平均知晓率从88.1%升到95.4%,有84.6%的家庭养成了使用控盐勺的习惯。但也发现干预后居民"烧菜时优先考虑健康因素"、"购买包装食品时会经常注意看配料中是否有食盐成分"等方面的健康技能形成率仍较低,为55.7%、31.3%。结论项目实施后居民控盐整体知信行水平有提高,控盐勺作为本次项目的重要干预措施,是一种能给居民控盐健康生活方式指导的宣传用品,能有效提高居民健康意识和纠正不良行为习惯。     

中国居民“全民健康生活方式”行动知晓情况的Meta分析

目的 通过Meta分析对中国CHLA行动开展10年来的人群知晓情况进行评估。方法 在中文数据库CNKI、万方、维普,和英文数据库PubMed检索2007 - 2018年的相关文献,在分析时遵照PRISMA声明进行分析及报告。结果 中国人群CHLA知晓率为62.44%,健康“121”知晓率为68.58%,CHLA行动日知晓率为37.07%。“食盐推荐摄入量”和“食用油推荐按摄入量” 知晓率分别为69.01%和50.65%,“平衡膳食”和“推荐活动水平”知晓率分别为93.56%和57.60%。亚组分析显示,2017年的研究(76.53%)CHLA行动的知晓率高于2013 - 2016年(55.90%),东北地区CHLA行动的知晓率最低(28.30%)。2017年的研究(59.23%)CHLA行动日的知晓率高于2013 - 2016年(28.08%),广东省CHLA行动日的知晓率最高(72.64%)。结论 CHLA的开展可有效提高中国居民健康生活方式的知识水平和健康素养,应继续开展支持性环境建设。     

Promising therapies for the treatment of frontotemporal dementia clinical phenotypes: from symptomatic to disease-modifying drugs

Introduction: Frontotemporal dementia (FTD) is a heterogeneous clinical entity that includes several disorders characterized by different cellular mechanisms. Distinctive clinical features in FTD include behavioral, affective, and cognitive symptoms. Unfortunately, little progress has been made over the past 20 years in terms of the development of effective disease-modifying drugs with the currently available symptomatic treatments having limited clinical utility.

Areas covered: This article reviews the principal pharmacological intervention studies for FTD. These are predominantly randomized clinical trials and include symptomatic treatments and potential disease-modifying drugs.

Expert opinion: There is insufficient evidence on effective treatments for FTD and studies with better methodological backgrounds are needed. Most studies reporting therapeutic benefits were conducted with selective serotonin reuptake inhibitors, while anti-dementia drugs have been ineffective in FTD. Since the underlying pathology of FTD mostly consists of abnormal tau protein or TDP-43 aggregates, treatments are being developed to interfere with their aggregation process or with the clearance of these proteins. Furthermore, disease-modifying treatments remain years away as demonstrated by the recent negative Phase III findings of a tau aggregation inhibitor (LMTM) for treating the behavioral variant of FTD. The results from current ongoing Phase I/II trials will hopefully give light to future treatment options.     

Social determinants of health: an economic perspective

The World Health Organization has recently received the findings of its Commission on the Social Determinants of Health. The Commission's report offers a remarkable summary of the evidence, and makes a passionate case for government action to address the social determinants of health, especially as they relate to health inequity. This paper summarizes the ways in which economic analysis could strengthen policy under three headings: examining the causal impact of the determinants of health and of associated policies; prioritising actions; and determining the role of government in influencing behaviour. Copyright © 2009 John Wiley & Sons, Ltd.     

Lifestyle Patterns Are Associated with Elevated Blood Pressure among Qatari Women of Reproductive Age: A Cross-Sectional National Study

Women of childbearing age are particularly vulnerable to the adverse effects of elevated blood pressure (BP), with dietary and lifestyle habits being increasingly recognized as important modifiable environmental risk factors for this condition. Using data from the National STEPwise survey conducted in Qatar in year 2012, we aimed to examine lifestyle patterns and their association with elevated BP among Qatari women of childbearing age (18–45 years). Socio-demographic, lifestyle, dietary, anthropometric and BP data were used (n = 747). Principal component factor analysis was applied to identify the patterns using the frequency of consumption of 13 foods/food groups, physical activity level, and smoking status. Multivariate logistic regression analyses were used to evaluate the association of the identified lifestyle patterns with elevated BP and to examine the socio-demographic correlates of these patterns. Three lifestyle patterns were identified: a “healthy” pattern characterized by intake of fruits, natural juices, and vegetables; a “fast food & smoking” pattern characterized by fast foods, sweetened beverages, and sweets, in addition to smoking; and a “traditional sedentary” pattern which consisted of refined grains, dairy products, and meat in addition to low physical activity. The fast food & smoking and the traditional & sedentary patterns were associated with an approximately 2-fold increase in the risk of elevated BP in the study population. The findings of this study highlight the synergistic effect that diet, smoking and physical inactivity may have on the risk of elevated BP among Qatari women.     

Prevention of Type 2 Diabetes by Diet and Lifestyle Modification

Diabetes mellitus is an epidemic of our time. This disease affects nearly 150 million adults worldwide and nearly 11 million in the United States in 2000. Because of the prevalence of obesity and diabetes and associated vascular complications, preventing even a small proportion of cases would save thousands of lives and billions of dollars in healthcare costs and lost productivity. Researchers have made great strides in identifying many lifestyle and dietary factors associated with diabetes, but solidifying the scientific basis for prevention and control of this disease as well as implementation at a national level remains a difficult challenge. The literature on the influence of diet and lifestyle in the development of diabetes is reviewed here, with emphasis on epidemiologic data. We outline a systematic approach to primary and secondary prevention of this disease by evaluating and prioritizing risk factors for which intervention is effective and developing a framework for application of intervention strategies. Effective interventions must target not only the affected individuals but also families, workplaces, schools and communities. Prevention of this devastating disease calls for the identification of culture-sensitive measures that can be applied to the population in general and some high-risk minority groups in particular.     

Pistachio Nuts Reduce Triglycerides and Body Weight by Comparison to Refined Carbohydrate Snack in Obese Subjects on a 12-Week Weight Loss Program

Objective: There is a widely held view that, due to high fat content, snacking on nuts will lead to weight gain, ultimately causing unhealthy changes in lipid profiles. This study is designed to study the effects of pistachio snack consumption on body weight and lipid levels in obese participants under real-world conditions.

Methods: Participants were randomly assigned to consume 1 of 2 isocaloric weight reduction diets for 12 weeks, with each providing 500 cal per day less than resting metabolic rate. Each diet included an afternoon snack of either 53 g (240 cal) of salted pistachios (n = 31) or 56 g of salted pretzels (220 cal; n = 28).

Results: Both groups lost weight during the 12-week study (time trend, p < 0.001), but there were significant differences in the changes in body mass index between the pretzel and pistachio groups (pistachio, 30.1 ± 0.4 to 28.8 ± 0.4 vs. pretzel, 30.9 ± 0.4 to 30.3 ± 0.5). At 6 and 12 weeks, triglycerides were significantly lower in the pistachio group compared with the pretzel group (88.04 ± 9.80 mg/dL vs. 144.56 ± 18.86 mg/dL, p = 0.01 at 6 weeks and 88.10 ± 6.78 mg/dL vs. 132.15 ± 16.76 mg/dL, p = 0.02 at 12 weeks), and there was a time trend difference between the 2 groups over the 12 weeks (p < 0.01). There were no significant differences in total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, insulin, or glucose between the 2 groups.

Conclusion: Pistachios can be consumed as a portion-controlled snack for individuals restricting calories to lose weight without concern that pistachios will cause weight gain. By comparison to refined carbohydrate snacks such as pretzels, pistachios may have beneficial effects on triglycerides as well.