A qualitative exploration on the needs of health care providers working with adolescents who are undergoing bariatric surgery.

Background: With increasing prevalence of severe obesity in youth, more adolescents are becoming candidates for bariatric surgery. In Canada, bariatric surgery in adolescents is in its infancy, and long-term health outcomes are not well known. It is unknown what health care providers (HCPs) are using to prepare and guide their adolescent patients for bariatric surgery. The needs of HCPs should be explored with the aim to improve patient outcomes. Therefore, the purpose of this study was to investigate the resource needs of HCPs working with adolescents living with severe obesity who are undergoing bariatric surgery. Methods: This qualitative study consisted of a focus group with seven HCPs from an adolescent bariatric program using a semi-structured interview guide. The focus group discussion was audio-recorded, and the recording was transcribed verbatim. A thematic analysis was conducted. Results: Four data-generated themes emerged highlighting the perceived needs and challenges faced by HCPs. These included (1) gaps in patient education materials on the subject of the bariatric surgery process, obesity as a chronic disease and mental health, (2) the need for designing resources that are teen-friendly, adaptable, and accessible, (3) the need for resources to facilitate decision-making and patient evaluation delivering more streamlined care and; (4) challenges to addressing resource needs due to limited clinical time and budgets. Conclusion: This needs assessment study highlights the need for appropriate resources for patient education, as well as pre and post-operative preparation. The hope is that HCPs can improve quality of care delivered and positively impact surgical outcomes in their patients.

Perceptions of self-monitoring dietary intake according to a plate-based approach: A qualitative study.

Dietary self-monitoring is a behaviour change technique used to help elicit and sustain dietary changes over time. Current dietary self-monitoring tools focus primarily on itemizing foods and counting calories, which can be complex, time-intensive, and dependent on health literacy. Further, there are no dietary self-monitoring tools that conform to the plate-based approach of the 2019 Canada Food Guide (CFG), wherein the recommended proportions of three food groups are visually represented on a plate without specifying daily servings or portion sizes. This paper explored the perceptions of end-users (i.e., general public) and Registered Dietitians of iCANPlateTM-a dietary self-monitoring mobile application resembling the CFG. Qualitative data were collected through virtual focus groups. Focus group questions were based on the Capability, Opportunity, Motivation-Behaviour (COM-B) theoretical framework to explore perceptions of using the CFG and currently available dietary self-monitoring tools. The prototype iCANPlateTM (version 0.1) was presented to gain feedback on perceived barriers and facilitators of its use. Focus group discussions were audio recorded and verbatim transcribed. Trained researchers used thematic analysis to code and analyze the transcripts independently. Seven focus groups were conducted with Registered Dietitians (n = 44) and nine focus groups with members from the general public (n = 52). During the focus groups, participants mainly discussed the capabilities and opportunities required to use the current iteration of iCANPlateTM. Participants liked the simplicity of the application and its capacity to foster self-awareness of dietary behaviours rather than weight control or calorie counting. However, concerns were raised regarding iCANPlateTM's potential to improve adherence to dietary self-monitoring due to specific characteristics (i.e., insufficient classifications, difficulty in conceptualizing proportions, and lack of inclusivity). Overall, participants liked the simplicity of iCANPlateTM and its ability to promote self-awareness of dietary intakes, primarily through visual representation of foods on a plate as opposed to reliance on numerical values or serving sizes, were benefits of using the app. Findings from this study will be used to further develop the app with the goal of increasing adherence to plate-based dietary approaches.

Boys and girls differ in their rationale behind eating: a systematic review of intrinsic and extrinsic motivations in dietary habits across countries.

Background: Boys' and girls' food habits diverge in adolescence (13-18 years). This contributes to unequal risks of adverse health outcomes based on sex and gender in adulthood (e.g., heart diseases in men vs. disorder eating in women). Though multi-factorial, why these dietary differences occur is unclear. Purpose: To identify the reasons why adolescents' motivation behind dietary habits differs among genders. Methods: Four databases were searched following PRISMA guidelines. Eligible studies had to use qualitative methodology and report at least one gender unique theme. Reported themes were thematically analyzed, with a sub-analysis by country where the studies were conducted. Quality appraisals were assessed using the Critical Appraisal Skills Programme checklist. Results: In the 34 eligible articles (n = 1,694 returned) two overarching themes emerged that dictated dietary habits in adolescents: Self-motivators and Uncontrollable factors. Gender differences arose whereby girls highlighted more external motivators (e.g., eat healthier, change dietary habits around boys and be thin to fit traditional norms) over their dietary habits. In contrast, boys focused on more internal motivators (e.g., gain autonomy, eat for enjoyment and pursue gains in physical performance). This suggests that motivation underlying how boys and girls eat differs. These trends were largely consistent across countries. Conclusion: Boys' and girls' food habits are not motivated by the same factors. To create more effective dietary interventions targeting health promotion, unique motivations behind food habits need to be understood and incorporated. Systematic review registration: Identifier: CRD42022298077.

Confronting Colonialism in Canadian Dietetics Curricula.

Many Canadian universities have committed to becoming more accountable to Indigenous Peoples by confronting the systemic, historical, and ongoing colonialism and anti-Indigenous racism that shape their campuses. In this Perspective in Practice piece, we invite the field of dietetics to consider how colonialism has shaped dietetics research, teaching, and practice. We also consider how we might transform the field of dietetics in ways that accept settler responsibility for interrupting racism and colonial harm; support the resurgence of Indigenous food and health practices; and recognise the connections between struggles to ensure that Indigenous Peoples can access culturally appropriate food and health care, and struggles for Indigenous sovereignty and self-determination. We do this by reviewing the history of the dietetics field, examining critical responses to existing Indigenisation and decolonisation efforts, and reflecting on recent changes to required dietetics competencies. We argue that curricula in dietetics programmes must teach the history of the colonial food system and equip students to identify and interrupt the individual and institutional colonial dynamics that contribute to the ongoing dispossession of Indigenous Peoples' lands and food sources and negatively impact Indigenous patients.

A Qualitative Evaluation of a Plate-Method Dietary Self-Monitoring Tool in a Sample of Adults Over 50.

Background: Self-monitoring is an important behavioral change technique to help users initiate and maintain dietary changes. Diet self-monitoring tools often involve the itemization of foods and recording of serving sizes. However, this traditional method of tracking does not conform to food guides using plate-based approach to nutrition education, such as the 2019 Canada's Food Guide (CFG). Objective: To explore the acceptability, facilitators and barriers of using a plate-based dietary self-monitoring tool based on the 2019 CFG (Plate Tool) compared with a traditional Food Journal (Food Journal). Methods: The 2 dietary self-monitoring tools were compared using a crossover study design over 2 wk. Adults over 50 (n = 47) from Montreal, Canada, were randomly assigned to use one tool over 3 d during 1 wk, then used the other tool the next week. Semistructured interviews (n = 45) were conducted after completing the second tool. A qualitative description of the interviews was conducted through an inductive determination of themes. Results: Facilitators to using the Plate Tool were its simplicity, quick completion time compared with the Food Journal and easiness to use, increased awareness of dietary habits and accountability, with participants expressing that it could help users make informed dietary changes aligning with the CFG. However, barriers to using the Plate Tool were its lack of precision, the participants' difficulty categorizing foods into the CFG categories and recording intake of foods not present on the CFG. Conclusions: The Plate Tool is an acceptable dietary self-monitoring tool for healthy adults over 50. Self-monitoring tools based on the plate method should take the barriers described in this study into account. Future studies should compare dietary self-monitoring methods to assess adherence and effectiveness at eliciting dietary behavior change.

Assessment of electronic patient education materials for adolescent bariatric surgery candidates: An environment scan.

Objective: Adolescents who opt for metabolic and bariatric surgery (MBS) will use the internet to learn about the procedure. The objective of this study is to assess the suitability of electronic patient education materials (ePEM) of North American centers that perform adolescent bariatric surgery. Methods: Canadian and American bariatric centers that perform adolescent MBS were identified from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program and Google web-based searches. Suitability of ePEM for the adolescent readership was evaluated using the Suitability Assessment of Materials (SAM). Results: Sixty-five centers were evaluated from June to July 2020 with 41% citing adolescent specific material. Six percent of the ePEM were evaluated as 'not suitable', 69% were evaluated as 'adequate', and 25% were evaluated as 'superior'. Conclusion: Adequate ePEM scoring was obtained, but centers had little resources tailored to adolescent patients. Further research is needed to evaluate all the resources provided to adolescents (i.e., resources provided by the health team) to ensure the tools are appropriate for the adolescent readership. Innovation: This environmental scan provided insights to ePEM available for adolescents considering MBS.

Understanding the impact of radical changes in diet and the gut microbiota on brain function and structure: rationale and design of the EMBRACE study.

BACKGROUND: Bariatric surgery leads to profound changes in gut microbiota and dietary patterns, both of which may interact to impact gut-brain communication. Though cognitive function improves postsurgery, there is a large variability in outcomes. How bariatric surgery-induced modifications in the gut microbiota and dietary patterns influence the variability in cognitive function is still unclear. OBJECTIVES: To elucidate the associations between bariatric surgery-induced changes in dietary and gut microbiota patterns with cognition and brain structure. SETTING: University hospital. METHODS: A total of 120 adult patients (≥30 years) scheduled to undergo a primary bariatric surgery along with 60 age-, sex-, and body mass index-matched patients on the surgery waitlist will undergo assessments 3-months presurgery and 6- and 12-month postsurgery (or an equivalent time for the waitlist group). Additionally, 60 age-and sex-matched nonbariatric surgery eligible individuals will complete the presurgical assessments only. Evaluations will include sociodemographic and health behavior questionnaires, physiological assessments (anthropometrics, blood-, urine-, and fecal-based measures), neuropsychological cognitive tests, and structural magnetic resonance imaging. Cluster analyses of the dietary and gut microbiota changes will define the various dietary patterns and microbiota profiles, then using repeated measures mixed models, their associations with global cognitive and structural brain alterations will be explored. RESULTS: The coordinating study site (Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, QC, Canada), provided the primary ethical approval (Research Ethics Board#: MP-32-2022-2412). CONCLUSIONS: The insights generated from this study can be used to develop individually-targeted neurodegenerative disease prevention strategies, as well as providing critical mechanistic information.

Barriers and facilitators to diet, physical activity and lifestyle behavior intervention adherence: a qualitative systematic review of the literature.

BACKGROUND: Consuming a balanced diet and regular activity have health benefits. However, many adults have a difficult time adhering to diet and activity recommendations, especially in lifestyle interventions. Adherence to recommendations could be improved if common facilitators and barriers are accounted for in intervention design. The aim of this systematic review was to understand perceived barriers and facilitators to lifestyle (diet and/or activity) intervention guidelines. METHODS: This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Studies included relied on qualitative methods to explore the barriers and facilitators healthy adults ([Formula: see text] 18 years) experienced in lifestyle interventions. Google Scholar, Cochrane Reviews, Medline, PubMed, and Web of Science were searched from January 2005 to October 2021. Main themes from each paper were thematically analyzed and reported as a barrier or facilitator to adherence at the individual, environment or intervention level using inductively derived themes. Study quality was assessed using the Critical Appraisal Skills Programme. RESULTS: Thirty-five papers were included. Of these, 46% were conducted in North America and the majority had more female participants (86% in mixed-sex studies, 26% females only). Similar themes emerged across all three levels as facilitators and barriers. At the individual level, attitudes, concern for health and physical changes. At the environmental level, social support, social accountability, changeable and unchangeable aspects of the community. Finally, delivery and design and content at the intervention level. An additional facilitator at the intervention level included fostering self-regulation through Behavior Change Taxonomies (BCT). CONCLUSIONS: Lifestyle interventions that foster self-regulatory skills, opportunities for social engagement and personalization of goals may improve behaviour adherence. This can be achieved through inclusion of BCT, tapering off of intervention supports, identification of meaningful goals and anticipated barriers with participants.

Body Composition Asymmetry in University Rugby Players: Influence of Sex, Position, and Injury.

CONTEXT: Measures of side-to-side asymmetry in body composition may help identify players who are predisposed to lower limb injuries (LLI) or lower back pain (LBP). This study aimed to examine (1) side-to-side asymmetry in college rugby players according to sex and position and (2) whether side-to-side asymmetry is associated with LBP or LLI. DESIGN: Cross-sectional study. METHODS: Thirty-six rugby players (61% female) underwent a dual-energy X-ray absorptiometry assessment for total and regional (appendicular, truncal) outcomes of fat mass, lean mass, and bone mass. A subsample (n = 23) of players had a second dual-energy X-ray absorptiometry assessment 2 months postbaseline. Two-way analysis of variance was used to assess the effect of position (forward and backs) and sex on body composition asymmetry. Student paired t tests were used to assess side-to-side difference in body composition and compare baseline and follow-up measures. Logistic regression was used to assess possible associations between LLI, LBP, and the degree of side-to-side asymmetry in body composition. RESULTS: Male players had greater asymmetry in arm bone mass compared with female players (P = .026), and trunk fat mass asymmetry was greater in forwards as compared with backs (P = .017). Forwards had significantly greater fat mass (P = .004) and percentage of fat (P = .048) on the right leg compared with the left. Backs had significantly greater bone mass in the right arm compared with the left (P = .015). From baseline to postseason, forwards had a significant increase in side-to-side asymmetry in arm lean mass (P = .006) and a significant decrease in side-to-side asymmetry in leg fat mass (P = .032). In backs, side-to-side asymmetry at baseline compared with postseason was significantly different (P = .011) for trunk fat mass. There were no significant associations between body composition asymmetry, LLI, or LBP by sex or position. CONCLUSION: Our results revealed the presence of side-to-side asymmetries in body composition in university rugby players between sex and position. The amount of asymmetry, however, was not associated with LBP and LLI.

Changes in Adiposity without Impacting Bone Health in Nine- to Twelve-Year-Old Children with Overweight and Obesity after a One-Year Family-Centered Lifestyle Behavior Intervention.

Background: Few family-centered lifestyle interventions (FCLIs) for children with overweight or obesity (OW/OB) have assessed regional adiposity and bone health. This study assessed changes in adiposity in 9- to 12-year olds with OW/OB in a 1-year FCLI. Methods: Children were randomized to FCLI (six registered dietitian-led sessions) or no intervention (Control, CTRL). The FCLI focused on physical activity, nutrition education, and behavioral counseling children with families present. Assessments occurred at baseline and every 3 months for 1 year to assess changes in waist circumference (WC), body mass index for age-and-sex Z-scores (BAZ), body composition (dual-energy x-ray absorptiometry), and cardiometabolic biomarkers. Mixed models were used to determine the effects of group and time or group-by-time interactions for all outcomes. Results: Sixty children (age: 11.1 ± 1.1 years, BAZ: 2.7 ± 0.6) were enrolled; 55 participants (n = 28 CTRL, n = 27 FCLI) completed the study. There were no between group differences from baseline to follow-up for any measure. The FCLI group had significant decreases in BAZ over 12 months (-0.18 ± 0.27, p = 0.03) but not CTRL (-0.05 ± 0.32, p = 0.92). WC and android fat mass did not change in FCLI (p > 0.20) but increased in CTRL (p < 0.02). Whole body bone area, content, and areal bone mineral density (aBMD) increased in both groups (p < 0.010); whole body aBMD Z-score decreased by 5.8% and 1.6% in CTRL and FCLI, respectively (p < 0.001). There were no significant within group changes in biomarkers. Conclusion: The FCLI resulted in small reductions in BAZ and a plateau in android fat mass, which suggest that FCLIs are suitable as an intervention for 9- to 12-year-old children with OW/OB. Clinical Trial Registration number: NCT01290016.

SMART goals of children of 6-12 years enrolled in a family-centred lifestyle intervention for childhood obesity: Secondary analysis of a randomized controlled trial.

This study demonstrates how SMART (Specific, Measurable, Attainable, Realistic and Timely) goals set by children in a lifestyle intervention contributed favorably to weight outcomes. Children (6-12 years) set goals with a registered dietitian over six months. Goals were classified according to their type (diet or activity), direction, (increase healthy or decrease unhealthy), and theoretical constructs. Theoretical constructs included the Theory of Planned Behavior's attitudes (i.e., changing beliefs about behaviour outcomes), subjective norm (i.e., incorporation of health recommendations) and perceived behavioural control (i.e., over goal barriers and facilitators). Constructs from a Socio-Ecological Model (family or individual) were also applied. Participants who maintained or decreased their body mass index for-age-and-sex z-scores (BAZ) after six months created significantly more goals related to the subjective norm compared to those whose BAZ increased (p = 0.003). Future interventions using SMART goals should incorporate health recommendations (i.e., the subjective norm) through actionable items among children to promote success.

Body-composition phenotypes and their associations with cardiometabolic risks and health behaviours in a representative general US sample.

Body mass index is poor at distinguishing between adiposity and muscle. Based on dual energy X-ray absorptiometry data, a diagnostic framework to analyze body composition by categorizing fat- and muscle-mass body composition into four phenotypes has been proposed. The objective of this study was to assess the association between body-composition phenotypes with adiposity measures, health behaviours and cardiometabolic risks in a representative U.S. adult population. Data were from NHANES (1999-2006: n = 9867; 2011-2018: n = 10,454). Four phenotypes based on being above/below the 50th percentile of age- and sex- adjusted reference curves of fat-mass and muscle-mass were identified. Multiple linear and logistic regressions were used to assess phenotypes (high [H] or low [L] adiposity [A] or muscle mass [M]) against adiposity measures, health behaviours, cardiometabolic risk, and dietary intake. Low-adiposity/high-muscle (LA-HM) was the referent. Analyses incorporated the complex sampling design and survey weights, and were adjusted for age, sex, race, and education. Compared to the LA-HM reference group, the HA-LM phenotype was less physically active, had higher total and lower high-density lipoprotein cholesterol, and had lower intake of all examined nutrients (all p < 0.01). For the HA-HM phenotype, unfavourable values were detected for all adiposity and cardiometabolic measures compared to the LA-HM phenotype (all p < 0.01). The two high adiposity phenotypes were associated with poorer health behaviours and cardiovascular risk factors, regardless of muscle-mass, but associations differed across the phenotypes. Results further underscores the importance of accounting for both adiposity and muscle mass in measurement and analysis. Further longitudinal investigation is needed.

Associations between Body Composition and Vitamin D Status in Children with Overweight and Obesity Participating in a 1-Year Lifestyle Intervention.

Background: To examine associations between body composition and vitamin D status in children participating in a lifestyle intervention. Methods: Children (6−12 y, n = 101) with a body mass index (BMI)-for-age >85th percentile were randomized to six dietitian-led behavior counselling sessions or no intervention. Plasma 25-hydroxyvitamin D (25(OH)D), anthropometry, and body composition using dual-energy X-ray absorptiometry were assessed every 3 months for 1 year. For each anthropometry variable (z-scores), tertiles were created to test for differences in 25(OH)D over time (tertile-by-time), and for changes in the z-score (loss, maintain, gain)-by-time, and according to fat patterning (android vs. gynoid) using mixed effects models. Results: The baseline plasma 25(OH)D was 62.2 nmol/L (95%CI: 58.7−65.7), and none < 30 nmol/L. At 6 mo, children with gynoid fat patterning had higher 25(OH)D concentrations than in those with android fat patterning (64.5 ± 1.1 nmol/L vs. 50.4 ± 1.0 nmol/L, p < 0.003, Cohen's f = 0.20). Children with the lowest lean mass index z-score at 9 mo had higher plasma 25(OH)D concentrations than children with the highest z-score at baseline, 3 mo, and 6 mo (p < 0.05, Cohen's f = 0.20). No other significant differences were observed. Conclusion: In this longitudinal study, vitamin D deficiency was not present in children 6−12 y of age with obesity. Reductions in adiposity did not alter the vitamin D status.

Does the 2019 Canada's Food Guide meet the needs of young athletes?

Background: The Canada's Food Guide (CFG) encourages Canadians to consume a balanced plate. However, this recommendation may not meet the nutritional needs of young athletes who have increased nutritional requirements. Aim: To evaluate how the 2019 CGF can be used to meet the nutritional needs of young athletes. Method: Five menu scenarios were created using the CFG's balanced plate and recipes from Health Canada. Each menu was analyzed to compare nutrient and energy needs of an index athlete (15-year-old male, 71 kg). Estimated energy requirements were based on nutrition guidelines set by National and International sports-nutrition position statements. Results: The adjusted CFG balanced plate plus an energy dense beverage at every meal was the closest to meeting the index athlete's nutrient requirements. Conclusion: The 2019 CFG's balanced plate needs to be adjusted to meet the nutritional requirements of individuals with active lifestyles.

Intuitive eating and its association with psychosocial health in adults: A cross-sectional study in a representative Canadian sample.

Intuitive eating has been proposed as a weight-inclusive, effective, and sustainable approach to eating that benefits psychosocial health compared to traditional restrictive dieting. This cross-sectional study examined the associations of intuitive eating with psychosocial health indicators and demographic characteristics in a representative Canadian sample of adults (n = 1,466). Participants completed an online survey consisting of validated measures on intuitive eating and psychosocial health. Average participant engagement in intuitive eating was moderate with males eating more intuitively than females. Intuitive eating was higher in participants ≥65 years compared to those <65 years, and no differences were found among ethnicities. Correlation tests revealed that intuitive eating was positively correlated with self-esteem and negatively correlated with perceived sociocultural pressure, weight concern, disordered eating behaviour, and cognitive restraint in eating. Compared to males, intuitive eating in females was more strongly correlated with sociocultural pressure and weight concern. Regression analyses showed that intuitive eating interacted with sex in predicting sociocultural pressure and weight concern after controlling for age and ethnicity. Sex-stratified regressions resulted in intuitive eating scores being significantly associated with all psychosocial health indicators investigated. This study provides evidence that intuitive eating is associated with better psychosocial health in a sex-balanced, ethnically diverse Canadian adult sample. Study findings suggest that intuitive eating can be an accessible approach to support a healthy lifestyle and demographic differences should be considered when designing interventions. Future studies need to determine whether intuitive eating improves eating behaviour and reduces disordered eating as well as interacts with other health-related behaviours at a population level.

Evaluation of the Diet Tracking Smartphone Application Keenoa™: A Qualitative Analysis.

Keenoa™ is a novel Canadian diet application (app) currently used by Canadian dietitians to collect diet-related data from clients. The goal of this study was to evaluate Keenoa™ based on user feedback and compare it to a conventional pen and paper method. One hundred and two participants were recruited and randomly assigned to record their diets using this application for 3 nonconsecutive days. Following this, participants were invited to complete an online "exit" survey. Seventy-two subjects responded, with 50 completing an open-ended question asking for general feedback about the app. Data were reviewed and 3 main themes emerged: strengths, challenges, and future recommendations. Strengths associated with the app consisted of picture recognition software, the additional commentary feature, and the overall pleasant data collection process. Challenges that were identified included inconsistencies with the barcode scanning features, the limited food database, time to enter food details, and software issues. Future recommendations included using a larger food database, pairing dietary intake with physical activity monitoring, and having accessible nutritional data. Despite these limitations, participants preferred using mobile apps to record diet compared with traditional written food diaries.

Concurrent Validity of the Adult Eating Behavior Questionnaire in a Canadian Sample.

The current study aimed to test the factor structure of the Adult Eating Behavior Questionnaire (AEBQ), its construct validity against the Three-Factor Eating Questionnaire (TFEQ-R18) and its associations with body mass index (BMI) in Canadian adults (n = 534, 76% female). Confirmatory factor analysis (CFA) revealed that a seven-factor AEBQ model, with the Hunger subscale removed, had better fit statistics than the original eight-factor structure. Cronbach's alpha was used to assess the internal reliability of each subscale and resulted with α > 0.70 for all subscales except for Hunger (α = 0.68). Pearson's correlations were used to inform the convergent and discriminant validation of AEBQ against the TFEQ-R18 and to examine the relationship between AEBQ and BMI. All AEBQ Food Approach subscales positively correlated with that of the TFEQ-R18 Emotional Eating and Uncontrolled Eating subscales. Similarly, BMI correlated positively with Food Approach subscales (except Hunger) and negatively with Food Avoidance subscales (except Food Fussiness). These results support the use of a seven-factor AEBQ for adults self-reporting eating behaviors, construct validity of the AEBQ against TFEB-R18, and provide further evidence for the association of these traits with BMI.

Acceptability of a structured diet and exercise weight loss intervention in breast cancer survivors living with an overweight condition or obesity: A qualitative analysis.

BACKGROUND: Weight loss increases survivorship following breast cancer diagnosis. However, most breast cancer survivors (BCS) do not meet diet and exercise recommendations. AIM: The purpose of this study was to explore the barriers and facilitators of BCS who had lymphedema and who participated in a 22-week weight loss lifestyle intervention. METHODS AND RESULTS: Participants completed semi-structured interviews about barriers and facilitators to intervention adherence. Interviews were transcribed verbatim and a thematic analysis was conducted. Participants (n = 17) were 62 ± 8.0 years of age with a mean body mass index of 34.0 ± 7.1 kg/m2 . Four themes emerged: (1) facilitators of intervention adherence, (2) barriers of intervention adherence, (3) continuation of healthy habits post intervention, and (4) recommendations for intervention improvements. Facilitators of intervention adherence were education, social support, routine, motivation, goal-setting, meal-provisioning, self-awareness, and supervised exercise. Barriers to intervention adherence were personal life, health, meal dissatisfaction, seasonality, unchallenging exercises, and exercising alone. All women planned to continue the acquired healthy habits post intervention. Recommendations to improve the study included addressing the exercise regime, meal-provisioning, and dietary intake monitoring methods. CONCLUSION: Future strategies to engage BCS in weight loss interventions should promote group exercise, offer individualized meal-provisioning and exercise regimes, provide transition tools, and allow participants to choose their self-monitoring method.

Validity and Usability of a Smartphone Image-Based Dietary Assessment App Compared to 3-Day Food Diaries in Assessing Dietary Intake Among Canadian Adults: Randomized Controlled Trial.

BACKGROUND: Accurate dietary assessment is needed in studies that include analysis of nutritional intake. Image-based dietary assessment apps have gained in popularity for assessing diet, which may ease researcher and participant burden compared to traditional pen-to-paper methods. However, few studies report the validity of these apps for use in research. Keenoa is a smartphone image-based dietary assessment app that recognizes and identifies food items using artificial intelligence and permits real-time editing of food journals. OBJECTIVE: This study aimed to assess the relative validity of an image-based dietary assessment app - Keenoa - against a 3-day food diary (3DFD) and to test its usability in a sample of healthy Canadian adults. METHODS: We recruited 102 participants to complete two 3-day food records. For 2 weeks, on 2 non-consecutive days and 1 weekend day, in random order, participants completed a traditional pen-to-paper 3DFD and the Keenoa app. At the end of the study, participants completed the System Usability Scale. The nutrient analyses of the 3DFD and Keenoa data before (Keenoa-participant) and after they were reviewed by dietitians (Keenoa-dietitian) were analyzed using analysis of variance. Multiple tests, including the Pearson coefficient, cross-classification, kappa score, % difference, paired t test, and Bland-Altman test, were performed to analyze the validity of Keenoa (Keenoa-dietitian). RESULTS: The study was completed by 72 subjects. Most variables were significantly different between Keenoa-participant and Keenoa-dietitian (P<.05) except for energy, protein, carbohydrates, fiber, vitamin B1, vitamin B12, vitamin C, vitamin D, and potassium. Significant differences in total energy, protein, carbohydrates, % fat, saturated fatty acids, iron, and potassium were found between the 3DFD and Keenoa-dietitian data (P<.05). The Pearson correlation coefficients between the Keenoa-dietitian and 3DFD ranged from .04 to .51. Differences between the mean intakes assessed by the 3DFD and Keenoa-dietitian were within 10% except for vitamin D (misclassification rate=33.8%). The majority of nutrients were within an acceptable range of agreement in the Bland-Altman analysis; no agreements were seen for total energy, protein, carbohydrates, fat (%), saturated fatty acids, iron, potassium, and sodium (P<.05). According to the System Usability Scale, 34.2% of the participants preferred using Keenoa, while 9.6% preferred the 3DFD. CONCLUSIONS: The Keenoa app provides acceptable relative validity for some nutrients compared to the 3DFD. However, the average intake of some nutrients, including energy, protein, carbohydrates, % fat, saturated fatty acids, and iron, differed from the average obtained using the 3DFD. These findings highlight the importance of verifying data entries of participants before proceeding with nutrient analysis. Overall, Keenoa showed better validity at the group level than the individual level, suggesting it can be used when focusing on the dietary intake of the general population. Further research is recommended with larger sample sizes and objective dietary assessment approaches.

Increased adiposity in children with obesity is associated with low red blood cell omega-3 fatty acid status and inadequate polyunsaturated fatty acid dietary intake.

The association between total dietary fat intake and measures of body fatness in children with obesity remains inconsistent. This study aimed to determine whether dietary long-chain polyunsaturated fatty acids (LCPUFA) and LCPUFA status relate to body composition in children with obesity. Children (n = 63, 9.0 ± 0.2 year, BMI Z-score 3.1 ± 0.2) were divided into tertiles of percentage body fat assessed by dual-energy X-ray absorptiometry. Diet was assessed 3-days food diaries. Fatty acid proportions in red blood cells (RBC) were measured by gas chromatography. Data stratified by sex and Tanner stages were compared with a MIXED model ANOVA. Associations between RBC fatty acid status and dietary intakes were examined with Spearman correlation. Moderate correlations were observed between RBC eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) proportions, dietary EPA and DHA (r = 0.39, P < .05) as well as fish servings (r = 0.33, P < .05). Dietary LCPUFA did not differ among tertiles. Children in tertile 3 had lower RBC α-linolenic acid (-40%) and EPA + DHA (-15%) proportions adjusted for age, Tanner stages and race compared with tertile 1. The lower omega-3 LCPUFA status in children with greater adiposity is consistent with suboptimal intakes of omega-3 LCPUFA and fish in the diet.