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Tailored, iterative, printed dietary feedback is as effective as group education in improving dietary behaviours: results from a randomised control trial in middle-aged adults with cardiovascular risk factors
Janine L Wright, Jillian L Sherriff, Satvinder S Dhaliwal, John CL Mamo
International Journal of Behavioral Nutrition and Physical Activity , 2011, DOI: 10.1186/1479-5868-8-43
Abstract: STEPs was a 3-month randomised controlled trial with a pre and post-test design. There were three experimental conditions: 1) tailored, iterative, printed dietary feedback (TF) with three instalments mail-delivered over a 3-month period that were re-tailored to most recent assessment of dietary intake, intention to change and assessment of self-adequacy of dietary intake. Tailoring for dietary intake was performed on data from a validated 63-item combination FFQ designed for the purpose 2) small group nutrition education sessions (GE): consisting of two 90-minute dietitian-led small group nutrition education sessions and 3) and a wait-listed control (C) group who completed the dietary measures and socio-demographic questionnaires at baseline and 3-months later. Dietary outcome measures in the areas of saturated fat intake (g), and the intake of fruit (serves), vegetables (serves), grain and cereals as total and wholegrain (serves) were collected using 7-day estimated dietary records. Descriptive statistics, paired t-tests and general linear models adjusted for baseline dietary intake, age and gender were used to examine the effectiveness of different nutrition interventions.The TF group reported a significantly greater increase in fruit intake (0.3 serves/d P = 0.031) in comparison to GE and the C group. All three intervention groups showed a reduction in total saturated fat intake. GE also had a within-group increase in mean vegetable intake after 3 months, but this increase was not different from changes in the other groups.In this study, printed, tailored, iterative dietary feedback was more effective than small group nutrition education in improving the short-term fruit intake behaviour, and as effective in improving saturated fat intake of middle-aged adults with cardiovascular risk factors. This showed that a low-level dietary intervention could achieve modest dietary behaviour changes that are of public health significance.Cardiovascular disease (CVD) is the
The effect of gold kiwifruit consumed with an iron fortified breakfast cereal meal on iron status in women with low iron stores: A 16 week randomised controlled intervention study
Kathryn Beck, Cathryn Conlon, Rozanne Kruger, Jane Coad, Welma Stonehouse
BMC Public Health , 2010, DOI: 10.1186/1471-2458-10-36
Abstract: Eighty nine healthy women aged 18-44 years with low iron stores (serum ferritin (SF) ≤ 25 μg/L, haemoglobin (Hb) ≥ 115 g/L) living in Auckland, New Zealand were randomised to receive an iron fortified breakfast cereal (16 mg iron per serve) and either two ZESPRI? GOLD kiwifruit or a banana (low ascorbic acid and carotenoid content) to eat at breakfast time every day for 16 weeks. Iron status (SF, Hb, C-reactive protein (CRP) and soluble transferrin receptor (sTfR)), ascorbic acid and carotenoid status were measured at baseline and after 16 weeks. Anthropometric measures, dietary intake, physical activity and blood loss were measured before and after the 16 week intervention.This randomised controlled intervention study will be the first study to investigate the effect of a dietary based intervention of an iron fortified breakfast cereal meal combined with an ascorbic acid and carotenoid rich fruit on improving iron status in women with low iron stores.ACTRN12608000360314Iron deficiency is the most common nutritional deficiency worldwide and is common in premenopausal women [1]. In the 1997 New Zealand National Nutrition Survey low iron stores, iron deficiency and iron deficiency anaemia mainly affected women aged 15 to 44 years of age [2]. Iron deficiency is a concern due to its association with impaired work performance, cognitive function and immunity [3-5].Mild iron deficiency can be effectively treated through dietary intervention [6]. This can include the addition of iron containing foods to the diet, such as foods fortified with iron [7], or improving the bioavailability of iron within meals [8]. Zimmerman et al [9] found that adding 12 mg of iron per day to snack foods increased iron status in Thai women with low iron stores. Snack foods fortified with ferrous sulphate improved iron status to a greater extent than snack foods containing electrolytic and hydrogen-reduced iron [9]. It is well established that ascorbic acid enhances iron absorption when added to
Nutrition Education by a Registered Dietitian Improves Dietary Intake and Nutrition Knowledge of a NCAA Female Volleyball Team  [PDF]
Melinda W. Valliant,Heather Pittman Emplaincourt,Rachel Kieckhaefer Wenzel,Bethany Hilson Garner
Nutrients , 2012, DOI: 10.3390/nu4060506
Abstract: Eleven female participants from a NCAA Division I volleyball team were evaluated for adequate energy and macronutrient intake during two off-seasons. Total energy and macronutrient intake were assessed by food records and results were compared against estimated needs using the Nelson equation. Dietary intervention was employed regarding the individual dietary needs of each athlete as well as a pre- and post-sports nutrition knowledge survey. Post dietary intervention, total energy, and macronutrient intake improved, as well as a significant improvement in sports nutrition knowledge ( p < 0.001). Nutrition education is useful in improving dietary intake and nutrition knowledge of female athletes.
A Theory-Based Dietary Intervention for Overweight, Postpartum Mothers and Their Children Improves Maternal Vegetable Intake  [PDF]
Grace Falciglia, Julia Piazza, Nicholas J. Ollberding, Libbey Spiess, Ardythe Morrow
Open Journal of Obstetrics and Gynecology (OJOG) , 2017, DOI: 10.4236/ojog.2017.77068
Abstract: Objective: To evaluate the effectiveness of a dietary intervention to increase target vegetable intake in overweight, postpartum mothers; and their children. Methods: Overweight mothers attending their six-week postpartum follow-up visit and their infants (n = 104 pairs) were randomized to intervention or usual care groups during the time period 2008-2011. Mothers received four 60 minute education sessions with a nutrition professional and eight monthly follow-up phone calls. Counseling began at the obstetrician office and continued at the regularly scheduled pediatric visits. The primary study outcome was the change in maternal target vegetable intake. Secondary outcomes included child target vegetable intake and whether child vegetable intake was modified by exposure to breastfeeding. Mother/child energy intake and weight indices were also assessed. Outcomes were measured at baseline (6-weeks postpartum), 6, 12 (post-intervention), and 18 (follow-up) months. Mixed-effects models were used to estimate the impact of the dietary intervention on study outcomes relative to usual care. Results: Mothers randomized to the intervention had greater consumption of target vegetables at 6, 12 and 18 months (P < 0.01, P < 0.01 and P = 0.03, respectively). There were no differences between groups in maternal energy intake, body mass index, or child target vegetable or energy intake. The child’s target vegetable intake at 12 months was related to the mother’s intake at 6 months (P = 0.03), however, this relationship was not modified by exposure to breastfeeding. Conclusion: A dietary intervention targeting the diet of the mother/child dyad resulted in improved maternal vegetable intake.
Randomised-controlled trial of a web-based dietary intervention for patients with type 2 diabetes mellitus: Study protocol of myDIDeA
Amutha Ramadas, Kia Quek, Carina KY Chan, Brian Oldenburg, Zanariah Hussein
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-359
Abstract: A minimum total sample of 82 Type 2 diabetics will be randomised, either to the control group, who will receive the standard diabetes care or the e-intervention group, who will participate in a 6-month web-based dietary intervention in addition to the standard care. The dietary recommendations are based on existing guidelines, but personalised according to the patients' Stages of Change (SOC). The participants will be followed up for 6 months post-intervention with data collection scheduled at baseline, 6-month and 12-month.We are aiming for a net improvement in the KAB score in participants of the e-intervention group, besides investigating the impact of the e-intervention on the dietary practices, physical measurements and blood biomarkers of those patients. The successful outcome of this study can be a precursor for policy makers to initiate more rigorous promotion of such web-based programmes in the country.Clinicaltrials.gov NCT01246687Diabetes is a growing concern in Malaysia and in the world. The prevalence of diabetes in adults worldwide was estimated to rise 366 million in the year 2030 from 171 million in 2000 [1]. The prevalence of Type 2 Diabetes Mellitus (T2DM) in Malaysians above 30 years old was reported to be between 11% and 14% in 2006, and it is estimated to rise further [2]. T2DM accounts for a huge burden of morbidity and mortality through micro and macrovascular complications [3,4]. This has lead to an increasing demand on dietary and lifestyle modifications to delay the disease progression.Web-based interventions have been successfully implemented in improving self-management of diabetes [5-8], physical activity [9,10] and weight management [11,12] in adults with T2DM. A web-based nutrition education for diabetes prevention study among young adults has shown significant reduction in dietary fat intake [13]. To date there is no published study focused solely on dietary behaviour change in adults with T2DM via a website-based system. Nevertheless
Sustained Self-Regulation of Energy Intake: Initial Hunger Improves Insulin Sensitivity  [PDF]
Mario Ciampolini,David Lovell-Smith,Riccardo Bianchi,Boudewijn de Pont,Massimiliano Sifone,Martine van Weeren,Willem de Hahn,Lorenzo Borselli,Angelo Pietrobelli
Journal of Nutrition and Metabolism , 2010, DOI: 10.1155/2010/286952
Abstract: Background. Excessive energy intake has been implicated in diabetes, hypertension, coronary artery disease, and obesity. Dietary restraint has been unsuccessful as a method for the self-regulation of eating. Recognition of initial hunger (IH) is easily learned, can be validated by associated blood glucose (BG) concentration, and may improve insulin sensitivity. Objective. To investigate whether the initial hunger meal pattern (IHMP) is associated with improved insulin sensitivity over a 5-month period. Methods. Subjects were trained to recognize and validate sensations of IH, then adjust food intake so that initial hunger was present pre-meal at each meal time (IHMP). The purpose was to provide meal-by-meal subjective feedback for self-regulation of food intake. In a randomised trial, we measured blood glucose and calculated insulin sensitivity in 89 trained adults and 31 not-trained controls, before training in the IHMP and 5 months after training. Results. In trained subjects, significant decreases were found in insulin sensitivity index, insulin and BG peaks, glycated haemoglobin, mean pre-meal BG, standard deviation of diary BG (BG as recorded by subjects' 7-day diary), energy intake, BMI, and body weight when compared to control subjects. Conclusion. The IHMP improved insulin sensitivity and other cardiovascular risk factors over a 5-month period. 1. Introduction In industrialised countries, most people regulate their energy expenditure poorly. Individual energy expenditure may differ up to 20-fold between resting conditions and high physical activity, but such differences have until now been weakly correlated to energy intake at subsequent meals [1]. Frequent episodes of positive energy balance can lead to insulin resistance, overweight, obesity, diabetes, and heart disease [1, 2]. Dietary regimes that attempt to restrain eating have been only marginally successful [3, 4] and the feasibility of self-regulation of energy intake regimes has been questioned [5]. A key reason for this lack of success may be that most dietary methods rely on weekly or monthly measurements of weight. These measurements provide no immediate feedback to dieters, who usually ingest food at least three times daily. The body’s own physiological signaling system is hunger. Blood glucose concentration (BG) is a reliable index of energy availability to body cells [6–8]. It seems reasonable to assume that BG slowly declines in the absence of food intake during the day until hunger emerges to trigger eating behaviour [9, 10]. Previous studies suggested that waiting for hunger
Effects of a free school breakfast programme on school attendance, achievement, psychosocial function, and nutrition: a stepped wedge cluster randomised trial
Cliona Ni Mhurchu, Maria Turley, Delvina Gorton, Yannan Jiang, Jo Michie, Ralph Maddison, John Hattie
BMC Public Health , 2010, DOI: 10.1186/1471-2458-10-738
Abstract: Sixteen primary schools in the North Island of New Zealand will be randomised in a sequential stepped wedge design to a free before-school breakfast programme consisting of non-sugar coated breakfast cereal, milk products, and/or toast and spreads. Four hundred children aged 5-13 years (approximately 25 per school) will be recruited. Data collection will be undertaken once each school term over the 2010 school year (February to December). The primary trial outcome is school attendance, defined as the proportion of students achieving an attendance rate of 95% or higher. Secondary outcomes are academic achievement (literacy, numeracy, self-reported grades), sense of belonging at school, psychosocial function, dietary habits, and food security. A concurrent process evaluation seeks information on parents', schools' and providers' perspectives of the breakfast programme.This randomised controlled trial will provide robust evidence of the effects of a school breakfast programme on students' attendance, achievement and nutrition. Furthermore the study provides an excellent example of the feasibility and value of the stepped wedge trial design in evaluating pragmatic public health intervention programmes.Australian New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12609000854235Up to one-fifth of New Zealand children leave for school without eating breakfast [1-3]. Missing breakfast is more common amongst older children, girls, Māori and Pacific children, and those living in lower socioeconomically resourced areas [2,3]. Missing breakfast has been associated with adverse effects on cognitive function (including memory), academic performance, school attendance, psychosocial function and mood in children and young people [4,5]. Conversely, breakfast consumption is associated with a range of positive outcomes, including better school attendance, academic performance, nutrient intake, fitness, and healthier body weight [6-8].Breakfast contributes substantially to daily ener
A randomised controlled trial investigating the effect of n-3 long-chain polyunsaturated fatty acid supplementation on cognitive and retinal function in cognitively healthy older people: the Older People And n-3 Long-chain polyunsaturated fatty acids (OPAL) study protocol [ISRCTN72331636]
Alan D Dangour, Felicity Clemens, Diana Elbourne, Nicky Fasey, Astrid E Fletcher, Pollyanna Hardy, Graham E Holder, Felicia A Huppert, Rosemary Knight, Louise Letley, Marcus Richards, Ann Truesdale, Madge Vickers, Ricardo Uauy
Nutrition Journal , 2006, DOI: 10.1186/1475-2891-5-20
Abstract: To test this hypothesis, a double-blind randomised placebo-controlled trial will be carried out among adults aged 70–79 years in which the intervention arm will receive daily capsules containing n-3 LCP (0.5 g/day docosahexaenoic acid and 0.2 g/day eicosapentaenoic acid) while the placebo arm will receive daily capsules containing olive oil. The main outcome variable assessed at 24 months will be cognitive performance and a second major outcome variable will be retinal function. Retinal function tests are included as the retina is a specifically differentiated neural tissue and therefore represents an accessible window into the functioning of the brain.The overall purpose of this public-health research is to help define a simple and effective dietary intervention aimed at maintaining cognitive and retinal function in later life. This will be the first trial of its kind aiming to slow the decline of cognitive and retinal function in older people by increasing daily dietary intake of n-3 LCPs. The link between cognitive ability, visual function and quality of life among older people suggests that this novel line of research may have considerable public health importance.The number of individuals with age-related cognitive impairment is rising dramatically in the UK [1] and globally [2]. Global burden of disease estimates now place dementia above stroke, musculoskeletal disorders, cardiovascular disease and all forms of cancer in terms of the percentage of years lived with disability in people aged 60 years and older [2]. Defining simple and effective strategies to prevent or delay cognitive impairment among older people is therefore a priority for healthcare and social services.There has been specific interest in the hypothesis that enhancing the diet of older people may act to slow the progression of cognitive decline. The importance of good nutrition among older people for the maintenance of health has long been advocated, and evidence-based dietary recommendations
A cluster randomised trial of a telephone-based intervention for parents to increase fruit and vegetable consumption in their 3- to 5-year-old children: study protocol
Rebecca J Wyse, Luke Wolfenden, Elizabeth Campbell, Leah Brennan, Karen J Campbell, Amanda Fletcher, Jenny Bowman, Todd R Heard, John Wiggers
BMC Public Health , 2010, DOI: 10.1186/1471-2458-10-216
Abstract: The study, conducted in the Hunter region of New South Wales, Australia, employs a cluster randomised controlled trial design. Two hundred parents from 15 randomly selected preschools will be randomised to receive the intervention, which consists of print resources and four weekly 30-minute telephone support calls delivered by trained telephone interviewers. The calls will assist parents to increase the availability and accessibility of fruit and vegetables in the home, create supportive family eating routines and role-model fruit and vegetable consumption. A further two hundred parents will be randomly allocated to the control group and will receive printed nutrition information only. The primary outcome of the trial will be the change in the child's consumption of fruit and vegetables as measured by the fruit and vegetable subscale of the Children's Dietary Questionnaire. Pre-intervention and post-intervention parent surveys will be administered over the telephone. Baseline surveys will occur one to two weeks prior to intervention delivery, with follow-up data collection calls occurring two, six, 12 and 18 months following baseline data collection.If effective, this telephone-based intervention may represent a promising public health strategy to increase fruit and vegetable consumption in childhood and reduce the risk of subsequent chronic disease.Australian Clinical Trials Registry ACTRN12609000820202Inadequate fruit and vegetable consumption contributes to a variety of chronic diseases and is estimated to be responsible for 2.6 million deaths per year worldwide [1]. A substantial proportion of adults [2,3] and children [4] from developed countries, including Australia [5,6], consume insufficient quantities of fruit and vegetables. The 2002 World Health Report estimated that 4% of the disease burden in developed countries was attributable to low fruit and vegetable intake [7]. Increasing consumption in early childhood may be an effective strategy to reduce the ri
Sustained Self-Regulation of Energy Intake: Initial Hunger Improves Insulin Sensitivity  [PDF]
Mario Ciampolini,David Lovell-Smith,Riccardo Bianchi,Boudewijn de Pont,Massimiliano Sifone,Martine van Weeren,Willem de Hahn,Lorenzo Borselli,Angelo Pietrobelli
Journal of Nutrition and Metabolism , 2010, DOI: 10.1155/2010/286952
Abstract: Background. Excessive energy intake has been implicated in diabetes, hypertension, coronary artery disease, and obesity. Dietary restraint has been unsuccessful as a method for the self-regulation of eating. Recognition of initial hunger (IH) is easily learned, can be validated by associated blood glucose (BG) concentration, and may improve insulin sensitivity. Objective. To investigate whether the initial hunger meal pattern (IHMP) is associated with improved insulin sensitivity over a 5-month period. Methods. Subjects were trained to recognize and validate sensations of IH, then adjust food intake so that initial hunger was present pre-meal at each meal time (IHMP). The purpose was to provide meal-by-meal subjective feedback for self-regulation of food intake. In a randomised trial, we measured blood glucose and calculated insulin sensitivity in 89 trained adults and 31 not-trained controls, before training in the IHMP and 5 months after training. Results. In trained subjects, significant decreases were found in insulin sensitivity index, insulin and BG peaks, glycated haemoglobin, mean pre-meal BG, standard deviation of diary BG (BG as recorded by subjects' 7-day diary), energy intake, BMI, and body weight when compared to control subjects. Conclusion. The IHMP improved insulin sensitivity and other cardiovascular risk factors over a 5-month period.
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