A comparison of dietary quality and nutritional adequacy of popular energy-restricted diets against the Australian Guide to Healthy Eating and the Mediterranean Diet.

There is limited information regarding the nutrition profile and diet quality of meal plans from currently popular weight loss (WL) diets in Australia. This includes the energy content (kilojoules), the macronutrient distribution and the micronutrient composition. Further, these diets have not been compared with current government guidelines and healthy eating principles (HEP) for nutritional adequacy. Popular diets were identified through grey literature, trending searches and relative popularity in Australia. Meal plans for each diet were analysed using Foodworks Dietary Software to determine food group intake, micronutrient and macronutrient distribution. The results indicated that all popular diets assessed deviated from government recommended HEP such as the Australian Guide to Healthy Eating and the Mediterranean diet. In most cases, both popular diets and the HEP had low intakes of multiple food groups, low intakes of essential micronutrients and a distorted macronutrient distribution. Popular diets may not provide adequate nutrition to meet needs, particularly in the long term and potentially resulting in micronutrient deficiency. When energy restricting for WL, meal plans should be highly individualised in conjunction with a qualified nutrition professional to ensure adequate dietary intake.

Developing and implementing a new methodology to test the affordability of currently popular weight loss diet meal plans and healthy eating principles.

BACKGROUND: Weight loss diets continue to rise in popularity; however, the associated costs are seldom reported. Certain weight loss diets may be unaffordable and differ from their traditional nutrition composition to include non-conventional premium products. In contrast, healthy eating principles such as the Australian Guide to Healthy Eating (AGHE) and the Mediterranean Diet (MedDiet) place an emphasis on fresh produce and staple foods but are sometimes thought to be unaffordable. A new methodology was piloted to assess the cost of weight loss diets using seven meal plans. METHODS: Seven meal plans were analysed to quantify the absolute grams required of all ingredients across seven days and multiplied by the cost of the ingredient per gram to determine the total cost of each ingredient based on unit size and price. The weekly grocery shopping cost was determined through summation of all ingredients and their entire unit size to compare weekly costs. RESULTS: Weekly meal plans (absolute grams) cost between $93-193AUD. The AGHE meal plan was the least expensive and 8 Weeks to Wow was the most expensive. Weekly grocery shopping of entire units cost between $345-$625AUD, over $100AUD greater than the spending of an average Australian ($237AUD/week). CONCLUSIONS: The financial feasibility for long-term sustainment of weight loss diets may be questionable for groups including low-income earners and low socioeconomic status. Further, when dietary patterns are adapted for weight loss, or followed by consumers, deviations from foundational principles tend to occur which may influence overall cost.

Effect of a moderate dose of fructose in solid foods on TAG, glucose and uric acid before and after a 1-month moderate sugar-feeding period.

There are few data on the effects on TAG, glucose and uric acid of chronic consumption of a moderate dose of fructose in solid foods. Twenty-eight participants with prediabetes and/or obesity and overweight commenced the study (BMI 32·3 kg/m2, age 44·7 years, fasting glucose 5·3 (sd 0·89) mmol/l and 2-h glucose 6·6 (sd 1·8) mmol/l). Twenty-four men and women who completed the study consumed, in random order, two acute test meals of muffins sweetened with either fructose or sucrose. This was followed by 4-week chronic consumption of 42 g/d of either fructose or sucrose in low-fat muffins after which the two meal tests were repeated. The sugar type in the chronic feeding period was also randomised. Fasting TAG increased after chronic consumption of fructose by 0·31 (sd 0·37) mmol/l compared with sucrose in those participants with impaired fasting glucose (IFG)/impaired glucose tolerance (IGT) (P = 0·004). Total cholesterol (0·33 mmol/l), LDL-cholesterol (0·24 mmol/l) and HDL-cholesterol (0·08 mmol/l) increased significantly over the 1- month feeding period with no differences between muffin types. Fasting glucose was not different after 1 month of muffin consumption. Uric acid response was not different between the two sugar types either baseline or 1 month, and there were no differences between baseline and 1 month. The increase in fasting TAG in participants with IFG/IGT suggests the need for caution in people at increased risk of type 2 diabetes.

Non-nutritive Sweeteners and Glycaemic Control.

PURPOSE OF REVIEW: The consumption of foods and beverages containing non-nutritive sweeteners (NNS) has increased worldwide over the last three decades. Consumers' choice of NNS rather than sugar or other nutritive sweeteners may be attributable to their potential to reduce weight gain. RECENT FINDINGS: It is not clear what the effects of NNS consumption are on glycaemic control and the incidence of type 2 diabetes. This review aims to examine this question in epidemiological, human intervention and animal studies. It is not clear that NNS consumption has an effect on the incidence of type 2 diabetes or on glycaemic control even though there is some evidence for the modification of the microbiome and for interaction with sweet taste receptors in the oral cavity and the intestines' modification of secretion of glucagon-like peptide-1 (GLP-1), peptide YY (PYY), ghrelin and glucose-dependent insulinotropic polypeptide (GIP), which may affect glycaemia following consumption of NNS. In conclusion, long-term studies of NNS consumption are required to draw a firm conclusion about the role of NNS consumption on glycaemic control.

Effects of Different Weight Loss Approaches on CVD Risk.

PURPOSE OF REVIEW: In this review, we aimed to answer the question as to whether deliberate weight loss can reduce cardiovascular events or improve cardiovascular risk factors and whether different methods of weight loss can have a differential effect on risk factor improvement. RECENT FINDINGS: It would appear that deliberate weight loss reduces total mortality by 16% in obese people with risk factors including type 2 diabetes. People with type 2 diabetes who lose at least 10% of their initial body weight reduce CVD end points by 21% with dietary weight loss while the effect is greater with the greater weight loss induced by bariatric surgery with a 32% reduction in events. Mortality reduction may vary from 29 to up to 79%. Replacing some carbohydrate with protein appears to enhance weight maintenance over 12 months and in addition lowers serum triglyceride and blood pressure. A very-low-carbohydrate diet elevates LDL cholesterol when a high saturated fat "Atkins" style approach is used, but a high unsaturated fat version is safe and effective over a 12-month period and reduces medication requirements in people with type 2 diabetes. A very-low-calorie liquid diet produces excellent weight loss in the short-term, but long-term weight loss is no different to less restrictive dieting. Weight loss lowers CVD events and total mortality and a higher protein (18-25% of energy), lower carbohydrate (< 45% of energy) diet may be superior for weight maintenance and risk factor improvement, but there are no data on event reduction.

Effect of weight loss on pulse wave velocity: systematic review and meta-analysis.

OBJECTIVE: To conduct a systematic review and meta-analysis of clinical trials involving adults, to determine the effect of weight loss induced by energy restriction with or without exercise, antiobesity drugs or bariatric surgery on pulse wave velocity (PWV) measured at all arterial segments. APPROACH AND RESULTS: A systematic search of Pubmed (1966 to 2014), EMBASE (1947 to 2014), MEDLINE (1946 to 2014), and the Cochrane Library (1951 to 2014) was conducted and the reference lists of identified articles were searched to find intervention trials (randomized/nonrandomized) that aimed to achieve weight loss and included PWV as an outcome. The search was restricted to human studies. Two independent researchers extracted the data. Data were analyzed using Comprehensive Meta Analysis version 2 using random effects analysis. A total of 22 studies were included in the qualitative synthesis and 20 studies (3 randomized controlled trials), involving 1259 participants, were included in the meta-analysis. The standardized mean difference for the overall effect of weight loss on PWV measured at all sites was -0.32 (95% confidence interval, -0.41, -0.24; P=0.0001). Carotid femoral pulse wave velocity (standardized mean difference, -0.35; 95% confidence interval, -0.44, -0.26; P=0.0001; 16 studies) and brachial ankle PWV (standardized mean difference, -0.48; 95% confidence interval, -0.78, -0.18; P=0.002; 5 studies) were improved with weight loss. Meta-regression showed that change in blood pressure was a predictor of change in PWV (P<0.01). CONCLUSION: Modest weight loss (mean 8% of initial body weight) achieved with diet and lifestyle measures improved PWV. The results of this meta-analysis suggest that weight loss may reduce PWV, although future research is required.

Salt Restriction in Diabetes.

There are no long-term interventions examining the effects of salt reduction in people with diabetes, and these are urgently required. Sodium reduction is controversial as it appears that an intake below 2.5 g and above 6 g/day of salt is associated with increased cardiovascular disease risk. However, pre-existing illness leading to a lower salt intake may confound the findings. Only a few studies have prospectively collected data on the sodium intake and excretion of people with diabetes and examined hard end points. In addition, future studies need to collect more data on food intake as well as coexistent illnesses to address potential confounding. The World Health Organization recommends a reduction to less than 5 g/day salt in adults. Given that the available evidence suggests that the salt intake of people with type 2 diabetes is generally well above 6 g/day it seems reasonable to ensure individuals with diabetes have an intake below 6 g/day. However, such recommendations need to be individualized.

Dietary intake in adults with type 1 and type 2 diabetes: validation of the Dietary Questionnaire for Epidemiological Studies version 2 FFQ against a 3-d weighed food record and 24-h urinalysis.

The Dietary Questionnaire for Epidemiological Studies version 2 (DQES v2) FFQ has not been validated in adults with diabetes. The aim was to determine the agreement between the DQES v2 FFQ and a 3-d weighed food record (WFR) and 24-h urinalysis in adults with type 1 and type 2 diabetes. The DQES v2 FFQ and a 3-d WFR were completed on one occasion for measurement of food and nutrient intake. A 24-h urine sample was provided for measurement of Na and K excretion. Participants were sixty-seven adults with type 1 and type 2 diabetes recruited from the community. Nutrient intake reported in the FFQ was within 20 % of the corresponding intake level reported in the WFR for the majority of nutrients. However, the 95 % limits of agreement showed large variation at an individual level between the two methods. There was a weak to moderate correlation between nutrient intake measured using the two methods and a moderate to high correlation for food intake. Quintile analysis showed that for the majority of foods and nutrients >60 % of participants were ranked within 1 quintile of the WFR ranking. The weighted κ values showed slight to moderate agreement between the two methods. Na intake was under-estimated in the FFQ by 25 % and K intake was over-estimated by 5 % compared with the 24-h urinalysis. In adults with type 1 and type 2 diabetes, it is appropriate to use the DQES v2 FFQ to measure food and nutrient intake at a group level.

Comparative analysis of the Cancer Council of Victoria and the online Commonwealth Scientific and Industrial Research Organisation FFQ.

FFQ are commonly used to examine the association between diet and disease. They are the most practical method for usual dietary data collection as they are relatively inexpensive and easy to administer. In Australia, the Cancer Council of Victoria FFQ (CCVFFQ) version 2 and the online Commonwealth Scientific and Industrial Research Organisation FFQ (CSIROFFQ) are used. The aim of our study was to establish the level of agreement between nutrient intakes captured using the online CSIROFFQ and the paper-based CCVFFQ. The CCVFFQ and the online CSIROFFQ were completed by 136 healthy participants. FFQ responses were analysed to give g per d intake of a range of nutrients. Agreement between twenty-six nutrient intakes common to both FFQ was measured by a variety of methods. Nutrient intake levels that were significantly correlated between the two FFQ were carbohydrates, total fat, Na and MUFA. When assessing ranking of nutrients into quintiles, on average, 56 % of the participants (for all nutrients) were classified into the same or adjacent quintiles in both FFQ, with the highest percentage agreement for sugar. On average, 21 % of participants were grossly misclassified by three or four quintiles, with the highest percentage misclassification for fibre and Fe. Quintile agreement was similar to that reported by other studies, and we concluded that both FFQ are suitable tools for dividing participants' nutrient intake levels into high- and low-consumption groups. Use of either FFQ was not appropriate for obtaining accurate estimates of absolute nutrient intakes.

Attitudes and beliefs of health risks associated with sodium intake in diabetes.

BACKGROUND: Despite good evidence that reducing sodium intake can reduce blood pressure (BP), salt intake in people with type 1 diabetes (T1DM) or type 2 diabetes (T2DM) remains high. The purpose of this study was to describe the knowledge and beliefs of health risks associated with a high salt diet in adults with diabetes. METHODS: Men and women with T1DM (n = 27; age 38 ± 16 years) or T2DM (n = 124; age 60 ± 11 years) were recruited. RESULTS: Nine (6.0%) respondents knew the correct maximum daily recommended upper limit for salt intake. Thirty-six (23.9%) participants were not concerned with the amount of salt in their diet. Most participants knew that a diet high in salt was related to high BP (88.1%) and stroke (78.1%) and that foods such as pizza (80.8%) and bacon (84.8%) were high in salt. Fewer than 30% of people knew that foods such as white bread, cheese and breakfast cereals are high in salt (white bread 28.5%, cheese 29.1%, breakfast cereals 19.9%) and 51.0% correctly ranked three different nutrition information panels based on the sodium content. Label reading and purchase of low salt products was used by 60-80% of the group. Estimated average 24 hour urinary sodium excretion was 169 ± 32 mmol/24 h in men and 115 ± 27 mmol/24 h in women. CONCLUSION: Label reading and purchase of low salt products was used by the majority of the group but their salt excretion was still high. Men who used label reading had a lower salt intake. Other strategies to promote a lower sodium intake such as reducing sodium in staple foods such as bread need investigation.

Foods contributing to sodium intake and urinary sodium excretion in a group of Australian women.

OBJECTIVES: To identify food sources of Na in a group of community-dwelling women in Adelaide, South Australia. A secondary aim was to measure Na excretion in this group. DESIGN: Survey. SETTING: Community setting, Adelaide, South Australia. SUBJECTS: Seventy healthy women (mean age 48.6 (SD 8.1) years, mean BMI 28.6 (SD 6.3) kg/m2) living in metropolitan Adelaide, South Australia and participating in a validation study of an FFQ. Dietary intake was derived from two 4 d weighed food records. Foods from the 4 d weighed food records were grouped according to foods or food groups to establish contributors to Na intake. Na excretion was measured in two 24 h urine samples. Completeness of urine collections was verified using creatinine excretion. RESULTS: Bread alone contributed 19.0% of Na intake, with an overall contribution from the breads and cereals group of 32.5%. Meat products contributed 14.4% of intake, the dairy and eggs group (excluding cheese) 9.6% and combination dishes (e.g. pizza, quiche, sandwiches and stir fry dishes) 8.4%. Na excretion was 126 (SD 42) mmol/d, i.e. approximately 7.6 (SD 2.5) g salt/d. Seventy per cent of participants (n 48) had Na excretion ≥100 mmol/d (146 (SD 34) mmol/d). CONCLUSIONS: Effective Na reduction could be achieved by reducing the amount in staple foods such as bread and meat products.

Food label education does not reduce sodium intake in people with type 2 diabetes mellitus. A randomised controlled trial.

BACKGROUND: Sodium intake is high in people with type 2 diabetes (T2DM). The aim of this study was to investigate whether urinary sodium excretion can be reduced by educating people with T2DM to read food labels and choose low sodium products. METHOD: In a 3 month randomised controlled trial, 78 men (n=49) and women (n=29) with T2DM were recruited from a Diabetes Centre at a University teaching hospital. The intervention group was educated in a single session to use the nutrition information panel on food labels to choose products which complied with the Food Standards Australia New Zealand (FSANZ) guideline of <120 mg sodium/100 g food. The control group continued on their usual diet. The primary outcome measure was 24h urinary sodium excretion which was performed at baseline and 3 months. Data was analysed using repeated measures analysis of variance, independent samples t-test and Pearson's correlations. RESULTS: At 3 months mean urinary sodium excretion was unchanged in the intervention (174±13 mmol/24 h and 175±13 mmol/24 h) and control group (167±15mmol/24h and 161±13 mmol/24 h), and there was no between group difference (p>0.05). CONCLUSION: Sodium excretion was not reduced following the label reading education provided to this group of people with T2DM.

Evaluation of the Swedish adjustable gastric band VC (SAGB-VC) in an Australian population: early results.

BACKGROUND: The Swedish adjustable gastric band VC (SAGB-VC) has been in use in Australia since 2007. We evaluated its efficacy and safety. METHODS: We retrospectively analyzed the prospective clinical data of patients who received the implant between November 2007 and June 2009 at 3 Australian bariatric centres. RESULTS: In all, 1176 patients (mean age 45.9 [standard deviation (SD) 12.3] yr, mean body mass index 43.4 [SD 7.6]) received the SAGB-VC. At a mean follow-up of 11 (SD 3) months, weight reduced by a mean of 18.4 (SD 11.1) kg with an excess weight loss of 37.8% (SD 19.9%). Body mass index decreased (from mean 43.4 [SD 7.7] to mean 36.7 [SD 6.5], p < 0.001). Type 2 diabetes (T2DM) was reported in 167 patients and hypertension in 373. Improvement occurred in 73.5% of patients with T2DM and 31% with hypertension, with patient-reported reduction or cessation of medication. Metabolic syndrome indices improved during follow-up: high-density lipoprotein cholesterol (mean 1.3 [SD 0.3] v. mean 1.4 [SD 0.3] mmol/L, p < 0.001), triglycerides (mean 1.6 [SD 0.8] v. mean 1.3 [SD 0.7] mmol/L, p < 0.001), waist circumference (men 141 [SD 103] to 121 [SD 15] cm, women 117 [SD 14] to 105 [SD 14] cm, both p < 0.001), C-reactive protein (90.5 [SD 75.2] v. 53.3 [SD 61.9] nmol/L, p < 0.001). The complication rate was 4.2%. CONCLUSION: The SAGB-VC is safe and effective for treating obesity and its comorbidities. The results are reproducible in separate Australian centres and consistent with published literature.

Developing and Piloting a Novel Ranking System to Assess Popular Dietary Patterns and Healthy Eating Principles.

A multitude of weight loss diets exist. However, no one diet has been proven to be superior, despite their claims. Resultingly, this creates confusion amongst consumers and conflicting nutrition messages. The aim of the ranking system was to evaluate a range of dietary pattern's nutrition profile and financial costs, as well as their potential long-term sustainability and associated adverse effects. Nutrition profile is typically the focal point of weight loss diets with less attention focused towards other factors that may affect their suitability. Five popular diets (Keto, Paleo, Intermittent Fasting, Optifast, and 8 Weeks to Wow) and two energy restricted healthy eating principles (Australian Guide to Healthy Eating and the Mediterranean Diet) were compared for diet quality, cost, adverse effects, and support for behaviour change. In general, healthy eating principles scored more favourably compared to popular weight loss diets in all categories. Lower carbohydrate diets tended to score lower for diet quality due to restricting multiple food groups, had more associated adverse effects and did not encourage behaviour change compared to the other weight loss diets. Optifast was the only weight loss diet to receive a negative score for cost. There should be considerations when undertaking a change to dietary patterns beyond nutrition profile. Diets indeed vary in terms of diet quality, and in addition can be costly, incur adverse effects, and disregard behaviour change which is important for sustainable weight loss and maintenance. This ranking system could create a reference point for future comparisons of diets.

The Effect of a Peanut-Enriched Weight Loss Diet Compared to a Low-Fat Weight Loss Diet on Body Weight, Blood Pressure, and Glycemic Control: A Randomized Controlled Trial.

The objective of this study was to examine the effect of consuming 35 g of peanuts prior to two main meals per day as part of a weight loss diet, compared to a traditional low-fat weight loss diet, on body weight, markers of glycemic control, and blood pressure in adults at risk of type 2 diabetes over 6 months. A two-arm randomized controlled trial was conducted. Adults (age > 18 years) with a BMI of >26 kg/m2 at risk of type 2 diabetes were randomized to the peanut group or the traditional low-fat-diet group (control). The peanut group was advised to consume 35 g of lightly salted dry-roasted peanuts prior to two main meals per day. Participants in the control group were given education to follow a low-fat diet. Both groups had dietetic counseling to restrict energy intake (women: <5500 kJ/1300 kcal/d; men: <7000 kJ/1700 kcal/d). Outcome assessment occurred at baseline, 3 months, and 6 months. In total, 107 participants were randomized (65% female; mean age 58 ± 14 years, BMI 33 ± 5.4 kg/m2, waist circumference 109 ± 13 cm, AUSDRISK score 15 ± 5 points), and 76 participants completed the study. No between-group difference in body weight (primary outcome) was observed at 6 months (mean difference, −0.12 kg; 95% CI, −2.42, 2.18; p = 0.92). The mean weight loss at 6 months was 6.7 ± 5.1 kg in the cohort (visit p < 0.001). HbA1c, fasting glucose, fasting insulin, 2-h glucose, and HOMA-IR were not different between the groups. Systolic blood pressure was reduced to a greater extent in the peanut group vs. the control group at 6 months (−5.33 mmHg; 95% CI, −9.23, −1.43; p = 0.008). Intake of 35 g of peanuts prior to two main meals per day, in the context of an energy-restricted diet, resulted in weight loss comparable to a traditional low-fat weight loss diet without preloads. Greater systolic blood pressure reductions were observed with peanut intake, which may lower cardiovascular disease risk.

Slowly and rapidly digested fat emulsions are equally satiating but their triglycerides are differentially absorbed and metabolized in humans.

Little is known about the effect of dietary fat emulsion microstructure on plasma TG concentrations, satiety hormones, and food intake. The aim of this study was to structure dietary fat to slow digestion and flatten postprandial plasma TG concentrations but not increase food intake. Emulsions were stabilized by egg lecithin (control), sodium sterol lactylate, or sodium caseinate/monoglyceride (CasMag) with either liquid oil or a liquid oil/solid fat mixture. In a randomized, double-blind, crossover design, 4 emulsions containing 30 g of fat in a 350-mL preload were consumed by 10 men and 10 women (BMI = 25.1 ± 2.8 kg/m(2); age = 58.8 ± 4.8 y). Pre- and postprandial plasma TG, cholecystokinin (CCK), glucagon-like peptide-1 (GLP-1), and peptide YY (PYY) concentrations and food intake were measured. In a second experiment in a subset of the participants (n = 8, 4 men and 4 women), (13)C-labeled mixed TG was incorporated into 2 different emulsions and breath (13)C was measured over 6 h. In the first experiment, the postprandial rise in plasma TG concentrations following the CasMag-stabilized emulsion containing 30% solid fat was lower than all other emulsions at 90 and 120 min (P < 0.05). Plasma CCK (P < 0.0001), GLP-1 (P < 0.01), and PYY (P < 0.001) concentrations were also reduced following this emulsion compared with control. Food intake at a test meal, eaten 3 h after the preload, did not differ among the emulsions. In the second experiment, when measured by the (13)C breath test, 25% of the TG in the CasMag emulsion was absorbed and metabolized compared with control. In conclusion, fat can be structured to decrease its effect on plasma TG concentrations without increasing food intake.

Fecal butyrate levels vary widely among individuals but are usually increased by a diet high in resistant starch.

Butyrate and other SCFA produced by bacterial fermentation of resistant starch (RS) or nonstarch polysaccharides (NSP) promote human colonic health. To examine variation in fecal variables, especially butyrate, among individuals and the response to these fibers, a randomized cross-over study was conducted that compared the effects of foods supplying 25 g of NSP or 25 g of NSP plus 22 g of RS/d over 4 wk in 46 healthy adults (16 males, 30 females; age 31-66 y). Fecal SCFA levels varied widely among participants at entry (butyrate concentrations: 3.5-32.6 mmol/kg; butyrate excretions: 0.3-18.2 mmol/48 h). BMI explained 27% of inter-individual butyrate variation, whereas protein, starch, carbohydrate, fiber, and fat intake explained up to 16, 6, 2, 4, and 2% of butyrate variation, respectively. Overall, acetate, butyrate, and total SCFA concentrations were higher when participants consumed RS compared with entry and NSP diets, but individual responses varied. Individual and total fecal SCFA excretion, weight, and moisture were higher than those for habitual diets when either fiber diet was consumed. SCFA concentrations (except butyrate) and excretions were higher for males than for females. Butyrate levels increased in response to RS in most individuals but often decreased when entry levels were high. Fecal butyrate and ammonia excretions were positively associated ((2) = 0.76; P < 0.001). In conclusion, fecal butyrate levels vary widely among individuals but consuming a diet high in RS usually increases levels and may help maintain colorectal health.

Weight Loss Barriers and Dietary Quality of Intermittent and Continuous Dieters in Women with a History of Gestational Diabetes.

Weight-loss after gestational diabetes (GDM) lowers the risk of type-2 diabetes (T2DM). Intermittent energy restriction (IER) produces comparable weight-loss to continuous energy restriction (CER), but long-term adherence remains difficult in this population. This exploratory secondary analysis of a 12-month trial comparing IER to CER following GDM examined weight-loss and dietary quality associated with barriers to weight-loss or T2DM risk perception as assessed in a Likert scale questionnaire at baseline. The participants had a median (IQR) BMI of 32.6 (9.4) kg/m2 and 3 (4) years postpartum (n = 121). Forty-five percent (n = 54) of the participants thought they were at a high risk of developing T2DM. Greater affordability of healthy food was related with greater weight-loss at 3 months (p = 0.044, n = 85). At 12 months, there was no significant relationship between weight-loss and the barriers to weight-loss (p > 0.05). CER had superior improvement in dietary quality at 12 months (CER 11 ± 10, IER 6 ± 5.6, n = 42, p = 0.05). Under the Theoretical Domains Framework, the barriers were predominantly related to behavioral regulation (n = 83, 69%; n = 76, 63%) and environmental context and resources (n = 67, 56%). Interventions for diabetes prevention in this population should include behavioral regulation strategies, consider the family home environment, and ensure that the risk of T2DM is conveyed. Women choosing IER may benefit from education to improve their dietary quality.

The Effect of Magnesium Supplementation on Endothelial Function: A Randomised Cross-Over Pilot Study.

Evidence supports an association between low magnesium (Mg) intake and coronary heart disease and between Mg intake and endothelial function. The aim of this study was to assess the effect of one week of Mg supplementation on endothelial function, assessed by flow mediated dilatation (FMD). Nineteen healthy men and women completed this cross-over pilot study in which participants were randomised to take an over-the-counter magnesium supplement for one week or to follow their usual diet. Weight, FMD and blood pressure (BP) were taken on completion of each intervention and 24 h urine collections and blood samples were taken to assess compliance. Baseline serum Mg was within normal range for all participants. Urinary Mg and urinary magnesium-creatinine ratio (Mg/Cr) significantly increased between interventions, (p = 0.03, p = 0.005, respectively). No significant differences in FMD or BP were found between the interventions. A significant negative correlation was seen between age and FMD (r = -0.496, p = 0.031). When adjusted for age, saturated fat was negatively associated with FMD (p = 0.045). One week of Mg supplementation did not improve FMD in a healthy population.

The effect of intermittent energy restriction on weight loss and diabetes risk markers in women with a history of gestational diabetes: a 12-month randomized control trial.

BACKGROUND: Weight loss after gestational diabetes (GDM) can prevent or delay the onset of type 2 diabetes. Intermittent energy restriction (IER) may offer an alternative to continuous energy restriction (CER) for weight loss. OBJECTIVES: We compared the effects of IER (2 days per week) to daily CER over 12 mo on weight loss and diabetes risk markers in overweight women with previous GDM. METHODS: Overweight females (n = 121) ≥18 y were randomized 1:1 to either IER [2-d 500 kcal (2100 kJ); n = 61] or CER [1500 kcal (6000 kJ); n = 60] in this 12-mo noninferiority trial. RESULTS: The trial was completed by 62 participants with a median age of 39.6 y [Quartile (Q) 1 to Quartile 3, 34.9 to 43.9 y] with a median BMI of 32.6 kg/m2 (Q1 to Q3, 28.5 to 37.9 kg/m2) at a median of 2.9 y after GDM (Q1 to Q3, 2.1 to 6.4 y; 49% attrition; IER n = 29; CER n = 30; P = 0.8). The mean ± SD weight loss was significant over time (P < 0.001) but not by diet group (IER -4.8 ± 5.0 kg; CER -3.2 ± 5.0; P = 0.2). The mean between-group difference was -1.6 kg (95% CI: -4.2 to 1.0 kg; P = 0.2). There were no significant between-group differences in change in HbA1c, fasting plasma glucose, fasting serum insulin, HOMA-IR or 2-h oral glucose tolerance at 12 mo (p>0.05). The trial was registered at https://www.anzctr.org.au/ (ACTRN12617001476325). CONCLUSIONS: IER produces comparable weight loss to CER over 12 mo in overweight women with previous GDM. The high dropout rate in this study is a limitation in the interpretation of these results. Larger studies are needed to confirm noninferiority of IER compared to CER.