An Evaluation of Alternative Technology-Supported Counseling Approaches to Promote Multiple Lifestyle Behavior Changes in Patients With Type 2 Diabetes and Chronic Kidney Disease.

OBJECTIVES: Although technology-supported interventions are effective for reducing chronic disease risk, little is known about the relative and combined efficacy of mobile health strategies aimed at multiple lifestyle factors. The purpose of this clinical trial is to evaluate the efficacy of technology-supported behavioral intervention strategies for managing multiple lifestyle-related health outcomes in overweight adults with type 2 diabetes (T2D) and chronic kidney disease (CKD). DESIGN AND METHODS: Using a 2 × 2 factorial design, adults with excess body weight (body mass index ≥27 kg/m2, age ≥40 years), T2D, and CKD stages 2-4 were randomized to an advice control group, or remotely delivered programs consisting of synchronous group-based education (all groups), plus (1) Social Cognitive Theory-based behavioral counseling and/or (2) mobile self-monitoring of diet and physical activity. All programs targeted weight loss, greater physical activity, and lower intakes of sodium and phosphorus-containing food additives. RESULTS: Of 256 randomized participants, 186 (73%) completed 6-month assessments. Compared to the ADVICE group, mHealth interventions did not result in significant changes in weight loss, or urinary sodium and phosphorus excretion. In aggregate analyses, groups receiving mobile self-monitoring had greater weight loss at 3 months (P = .02), but between 3 and 6 months, weight losses plateaued, and by 6 months, the differences were no longer statistically significant. CONCLUSIONS: When engaging patients with T2D and CKD in multiple behavior changes, self-monitoring diet and physical activity demonstrated significantly larger short-term weight losses. Theory-based behavioral counseling alone was no better than baseline advice and demonstrated no interaction effect with self-monitoring.

Feasibility and Acceptability of mHealth Interventions for Managing Hyperphosphatemia in Patients Undergoing Hemodialysis.

OBJECTIVE: The objective of the study was to evaluate the feasibility and acceptability of mobile health (mHealth) phosphorus management programs in hemodialysis (HD) patients. METHODS: Patients receiving thrice-weekly HD who had 3-month average serum phosphorus of >5.5 mg/dL were randomized to one of the three self-directed phosphorus management programs delivered using tablet PCs: (1) educational videos and handouts (Education), (2) education intervention plus mobile self-monitoring with email feedback (Monitoring), or (3) education and monitoring interventions plus social cognitive theory-based behavioral videos (Combined). Feasibility and acceptability were assessed based on enrollment and retention and training needs (feasibility) and adherence to self-monitoring and reported satisfaction (acceptability). RESULTS: Of 312 patients, 56 expressed interest, and 40 were enrolled. The majority of participants (80%) completed the 6-month study; none withdrew for intervention-related reasons. The Monitoring and Combined groups received 44 ± 15 minutes of technology training, which was considered adequate by most (75%). Self-monitoring rates were initially high, with 78% and 71% of the participants recording at least one meal and phosphate binder in week 1, respectively, but decreased over time to 15% and 9% in the final week. Most participants reported that self-monitoring helped them stay motivated (64%), track nutrients (80%), and understand how to change diet (76%), and nearly two-thirds of participants (64%) stated that they would like to continue using the tablet PC to manage their health. However, few participants (16%) indicated that self-monitoring was worth the effort. The Monitoring and Combined groups did not differ from the Education group in study outcomes. CONCLUSION: Although the mHealth programs were generally well received, self-monitoring rates decreased substantially over time and were unaffected by social cognitive theory-based videos. Self-directed mHealth programs may be a useful adjunct to standard care but should be compared to more resource intensive programs (e.g., involving more "live" contact with a dietitian) to determine overall cost-effectiveness and role in HD care.

Competition Level Not Associated With Diet Quality in Marching Artists.

Marching artists are a unique group of athletes whose performance can be influenced by nutrition. Because physical demands are thought to be moderate to high, adequate energy and a variety of nutrient-dense foods are needed. The purpose of this study was to examine diet quality, physical activity, and eating behavior of marching artists across elite and nonelite competition levels. This cross-sectional analysis used the validated National Cancer Institute Diet History Questionnaire II, International Physical Activity Questionnaire, and Eating Behavior Patterns Questionnaire. Diet quality was assessed using the Healthy Eating Index (HEI) 2010. Marching artists who participated in marching band in 2015 were eligible. Those in Drum Corps International (DCI) were considered part of the elite level; all others were considered nonelite. Chi-square analyses assessed associations between categorical variables and competition level, and independent sample t-tests assessed differences between continuous variables among competition level. Participants (n = 323) included 228 (71%) DCI members and 95 (29%) non-DCI members who reported a mean age of 19.8 ± 1.9 years. DCI members reported higher physical activity levels (p < 0.001) and fewer meal-skipping behaviors compared to non-DCI members (p < 0.001). The overall mean HEI score was 58.8 ± 10.3, with no difference between competition levels. Only one participant overall (<1%) met the recommended intake level of whole grains. Additionally, 2% of participants met the sodium restriction recommendation and 7% met the empty calorie upper limit. Suboptimal diet quality combined with high levels of physical activity is a problem for marching artists that should be addressed through carefully planned interventions.

Assessment of Nutrient Status in Athletes and the Need for Supplementation.

Nutrition assessment is a necessary first step in advising athletes on dietary strategies that include dietary supplementation, and in evaluating the effectiveness of supplementation regimens. Although dietary assessment is the cornerstone component of the nutrition assessment process, it should be performed within the context of a complete assessment that includes collection/evaluation of anthropometric, biochemical, clinical, and environmental data. Collection of dietary intake data can be challenging, with the potential for significant error of validity and reliability, which include inherent errors of the collection methodology, coding of data by dietitians, estimation of nutrient composition using nutrient food tables and/or dietary software programs, and expression of data relative to reference standards including eating guidance systems, macronutrient guidelines for athletes, and recommended dietary allowances. Limitations in methodologies used to complete anthropometric assessment and biochemical analysis also exist, as reference norms for the athlete are not well established and practical and reliable biomarkers are not available for all nutrients. A clinical assessment collected from history information and the nutrition-focused physical exam may help identify overt nutrient deficiencies but may be unremarkable in the well-trained athlete. Assessment of potential food-drug interactions and environmental components further helps make appropriate dietary and supplement recommendations. Overall, the assessment process can help the athlete understand that supplement intake cannot make up for poor food choices and an inadequate diet, while a healthy diet helps ensure maximal benefit from supplementation. Establishment of reference norms specifically for well-trained athletes for the nutrition assessment process is a future research priority.

Diet quality of individuals with rheumatoid arthritis using the Healthy Eating Index (HEI)-2010.

BACKGROUND: Rheumatoid arthritis (RA) afflicts approximately 1.5 million American adults and is a major cause of disability. As disease severity worsens, individuals with RA may experience functional decline that can impact dietary intake. OBJECTIVE: The objective of this study is to assess the diet quality of individuals with RA using the Healthy Eating Index (HEI)-2010 and examine associations between diet quality and disease activity and functional status. METHODS: This cross-sectional study assessed diet quality and disease activity and functional status in adults with RA. Participants completed seven-day weighed food records, which were scored using the HEI-2010. Participants had a fasting blood draw and completed the Multidimensional Health Assessment Questionnaire to determine disease activity and functional status. RESULTS: The mean age of individuals with RA ( N = 84) was 53 ± 14 years, and 86.9% were female. The mean HEI-2010 total score was 58.7 ± 15.9, with 7.1% of participants scoring "good", 58.3% "fair", and 34.5% "poor". Most participants did not adhere to recommended intakes of total fruit, total vegetables, whole grains, fatty acids, refined grains, sodium, and empty calories. An unadjusted multiple linear regression model found duration of morning stiffness and C-reactive protein concentration to be significant variables to inversely predict HEI-2010 total score. CONCLUSIONS: The diet quality of many individuals with RA needs improvement and may be related to functional disability associated with RA. Healthcare providers should encourage individuals with RA to meet dietary guidelines and maintain a healthy diet. Moreover, healthcare providers should be aware of the potential impacts of functional disability on diet quality in individuals with RA.

Exploring Problems in Following the Hemodialysis Diet and Their Relation to Energy and Nutrient Intakes: The BalanceWise Study.

OBJECTIVE: To identify the problems experienced by hemodialysis (HD) patients in attempting to follow the HD diet and their relation to energy and nutrient intakes. DESIGN: Cross-sectional analysis of baseline data from the BalanceWise Study. SUBJECTS: Participants included community-dwelling adults recruited from outpatient HD centers. After excluding participants with incomplete dietary analyses (n = 50), 140 African American and white (40/60%) men and women (52/48%) on chronic intermittent HD for at least 3 months (median 3 years) were included. INTERVENTION: Participant responses, on a 5-point Likert scale ranging from "not at all a problem" to "a very important problem for me," to 34 questions pertaining to potential barriers to following the HD diet in the previous 2 months were classified as either a problem (1) or not a problem (2-5). MAIN OUTCOME MEASURE: Energy and nutrient intakes determined using the Nutrition Data System for Research® based on 3, non-consecutive, unscheduled, 2-pass 24-hour dietary recalls collected on 1 dialysis and 1 non-dialysis weekday, and 1 non-dialysis weekend day. RESULTS: More than half of participants reported having problems related to specific behavioral factors (e.g., feeling deprived), technical difficulties (e.g., tracking nutrients), and physical condition (e.g., appetite), but issues of time and food preparation and behavioral factors tended to be most deterministic of reported dietary intakes. Longer duration of HD was associated with lower intakes of protein, potassium, and phosphorus (P < .05). CONCLUSION: Registered dietitian nutritionists should consider issues of time and food preparation, and behavioral factors in their nutrition assessment of HD patients and should continually monitor HD patients for changes in protein intake that may occur over time.

Reexamining the Phosphorus-Protein Dilemma: Does Phosphorus Restriction Compromise Protein Status?

Dietary phosphorus restriction is recommended to help control hyperphosphatemia in hemodialysis patients, but many high-phosphorus foods are important sources of protein. In this review, we examine whether restricting dietary phosphorus compromises protein status in hemodialysis patients. Although dietary phosphorus and protein are highly correlated, phosphorus intakes can range up to 600 mg/day for a given energy and protein intake level. Furthermore, the collinearity of phosphorus and protein may be biased because the phosphorus burden of food depends on: (1) the presence of phosphate additives, (2) food preparation method, and (3) bioavailability of phosphorus, which are often unaccounted for in nutrition assessments. Ultimately, we argue that clinically relevant reductions in phosphorus intake can be made without limiting protein intake by avoiding phosphate additives in processed foods, using wet cooking methods such as boiling, and if needed, substituting high-phosphorus foods for nutritionally equivalent foods that are lower in bioavailable phosphorus.

Prenatal Dietary Patterns and Associations With Weight-Related Pregnancy Outcomes in Hispanic Women With Low Incomes.

Background: Dietary patterns during pregnancy may contribute to gestational weight gain (GWG) and birthweight, but there is limited research studying these associations in racial and ethnic minority groups. The objective of this study was to evaluate associations between prenatal dietary patterns and measures of GWG and birthweight in a cohort of culturally diverse Hispanic women with low incomes. Methods: Data were analyzed from 500 mother-infant dyads enrolled in the Starting Early Program, a childhood obesity prevention trial. Diet over the previous year was assessed in the third trimester of pregnancy using an interviewer-administered food frequency questionnaire. Dietary patterns were constructed using the Healthy Eating Index-2015 (HEI-2015) and principal components analysis (PCA) and analyzed as tertiles. GWG and birthweight outcomes were abstracted from medical records. Associations between dietary pattern tertiles and outcomes were assessed by multivariable linear and multinomial logistic regression analyses. Results: Dietary patterns were not associated with measures of GWG or adequacy for gestational age. Greater adherence to the HEI-2015 and a PCA-derived dietary pattern characterized by nutrient-dense foods were associated with higher birthweight z-scores [ß: 0.2; 95% confidence interval (CI): 0.04 to 0.4 and ß: 0.3; 95% CI: 0.1 to 0.5, respectively], but in sex-specific analyses, these associations were only evident in male infants (ß: 0.4; 95% CI: 0.03 to 0.7 and ß: 0.3; 95% CI: 0.03 to 0.6, respectively). Conclusions: Among a cohort of culturally diverse Hispanic women, adherence to healthy dietary patterns during pregnancy was modestly positively associated with increased birthweight, with sex-specific associations evident only in male infants.

Moving beyond Weight: A Narrative Review of the Dietary and Lifestyle Management for Reducing Cardiometabolic Risk in Polycystic Ovary Syndrome (PCOS).

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder experienced by women. PCOS is a lifelong condition associated with reproductive, metabolic, and psychological presentations. PCOS is also linked with increased prevalence of cardiometabolic risk factors. While an association between body weight and PCOS has been noted, cardiometabolic risk factors are prevalent in individuals with PCOS across body weights. Currently, no consensus exists as to the most appropriate lifestyle strategy for mitigating cardiometabolic risk in PCOS. A large proportion of the literature is focused on weight loss for individuals with PCOS who are overweight or experience obesity, despite PCOS being prevalent across body sizes. The aim of this narrative review is to assess dietary and lifestyle interventions aimed at reducing cardiometabolic risk in individuals with PCOS across body sizes. A total of 51 articles are included in this review. Overall, randomized controlled trials are limited and most studies focus on weight loss, excluding individuals classified within a healthy body weight range. Studies that modified the dietary pattern without an energy deficit saw improvements in cardiometabolic risk. Thus, less restrictive dietary approaches may be effective at reducing cardiometabolic risk in this population. This review also highlights the need for more sustainable lifestyle interventions that meet the needs of individuals with PCOS of varying body weights.

Nurse practitioner and physician assistant physical activity counseling knowledge, confidence and practices.

OBJECTIVE: This exploratory cross-sectional study examined nurse practitioners' (NPs) and physician assistants' (PAs) perceptions about their physical activity counseling practices. METHOD: Participants were currently practicing NPs (n=240) and PAs (n=78) primarily in Arizona, USA during 2010. Participants completed a modified version of the Promotion of Physical Activity by Nurse Practitioners Questionnaire either online or in person during a practitioner specific conference. Mann-Whitney U tests and Chi-Square analyses examined differences between NPs and PAs. RESULTS: NP respondents were older (48 vs. 40 yrs, p<0.001) and more likely to be female (94% vs. 76%; p<0.001) compared to PAs. The majority of respondents (NPs:75%; PAs:64%; p<0.07) reported routinely counseling patients about physical activity. There were no differences in perceived knowledge (p=0.10) or confidence (p=0.75) to provide physical activity counseling between NPs and PAs. Approximately half of all respondents reported receiving training to provide physical activity counseling as part of their educational preparation to become a health practitioner (p=0.18). CONCLUSION: Study results indicate that NPs and PAs are knowledgeable, confident and currently providing some level of physical activity counseling to patients. However, the majority of respondents are interested in receiving additional training to aid in providing physical activity counseling.

The Relationship Between Dietary Intake and Dietary-Focused Lifestyle Interventions on Risk Factors Associated with Cardiovascular Disease in Firefighters.

PURPOSE OF REVIEW: Cardiovascular disease (CVD) is the leading cause of death to on-duty firefighters and is a substantial health concern. Preventative measures, including dietary interventions, may improve CVD in firefighters. The purpose of this review is to examine the literature on the relationship between dietary intake, dietary lifestyle interventions, and risk of CVD in firefighters. RECENT FINDINGS: Existing evidence, albeit limited, suggests that firefighters do not meet dietary guidelines. Lifestyle modifications featuring dietary interventions are effective in improving risk factors associated with CVD in firefighters. Unfortunately, no consistent nutrition-related trend was identified across the retrieved studies and only a limited number of randomized controlled trials have examined the efficacy of lifestyle intervention studies on CVD in firefighters. Although this review suggests dietary lifestyle interventions may facilitate decreases in risk factors associated with CVD in firefighters, current evidence is limited, and additional research is needed.

The Relationship between School Infrastructure and School Nutrition Program Participation and Policies in New York City.

School nutrition programs (SNP) provide much needed access to fruits, vegetables, and other healthy foods at low or no cost. Yet, the infrastructure of school kitchens and cafeteria vary across schools, potentially contributing to systematic barriers for SNP operation and equity. The purpose of this paper is to examine the association between school infrastructure and outcomes including meal participation, untraditional lunch periods, and having an open campus. Regression analyses were conducted using administrative data for 1804 schools and school nutrition manager survey data (n = 821) in New York City (NYC). Co-location was significantly associated with open campus status (OR = 2.84, CI: 1.11, 7.26) and high school breakfast participation (ß = -0.056, p = 0.003). Overcrowding was associated with breakfast (elementary: ß = -0.046, p = 0.03; middle: ß = 0.051, p = 0.04; high: ß = 0.042, p = 0.04) and lunch participation (elementary: ß = -0.031, p = 0.01) and untraditional lunchtimes (elementary: OR = 2.47, CI: 1.05, 5.83). Higher enrollment to cafeteria capacity ratios was associated with breakfast (elementary: ß = -0.025, p = 0.02) and lunch (elementary: ß = -0.015, p = 0.001; high: ß = 0.014, p = 0.02) participation and untraditional lunchtimes (middle: OR = 1.66, CI: 1.03, 2.68). Infrastructure characteristics are an important source of variation across NYC schools that may hinder the equity of school nutrition programs across the city.

Lower Healthy Eating Index-2005 dietary quality scores in older women with rheumatoid arthritis v. healthy controls.

OBJECTIVE: To assess the dietary quality of older women with and without rheumatoid arthritis (RA) using the Healthy Eating Index-2005 (HEI-2005) to identify potential strategies to improve the nutritional status. DESIGN: Cross-sectional. Diet was assessed using 7 d food records and analysed for nutrient composition (Food Processor v. 7.11). Diet quality was determined using the HEI-2005, a measure of compliance with 2005 US Dietary Guidelines. Individuals with RA completed a self-reported evaluation of arthritis (pain scale and disability index). Independent two-tailed t tests or Mann-Whitney tests compared the differences between groups and correlations were computed between HEI-2005 and measures of disease reactivity. SETTING: Arizona, USA. SUBJECTS: Older (> or = 55 years) women (n 108) with RA (n 52) and healthy controls (HC; n 56). RESULTS: There were no differences between groups in age, weight, or BMI (kg/m2). HC participants had higher mean HEI-2005 scores for whole fruit (cups; P = 0.02), total fruit (cups; P = 0.05), whole grains (oz; P = 0.004), oil (g; P = 0.05) and total HEI score (P = 0.04) than the RA group. In the RA group, these same HEI components were inversely correlated with disability index (r = -0.20, P = 0.04). Participants with RA reported lower mean intakes of carbohydrate (g; P = 0.02), fibre (g; P = 0.01) and vitamin C (mg; P = 0.04). CONCLUSIONS: This is the first study examining the dietary quality in older women with and without RA using the HEI-2005. Living with RA was associated with significantly lower dietary quality. Since even small changes in dietary quality can translate into better nutritional status, future interventions should focus on increasing dietary quality in this high-risk group.

Effect of caffeine as an ergogenic aid during anaerobic exercise performance in caffeine naïve collegiate football players.

Research suggests that caffeine may improve performance in aerobic exercise; the evidence for anaerobic performance is mixed. This study examined the effect of caffeine (5 mg/kg body weight [BW]) vs. placebo on performance-based anaerobic exercise tests used during the National Football League (NFL) Combine. Collegiate football athletes (n = 17; 20 +/- 2 yr; body mass index 29.4 +/- 3.6 kg/m) completed 2 study visits, 1 week apart. Participants were low caffeine users with a reported average intake of 16 +/- 20 mg/day. On the day of testing, participants ingested a caffeinated (5 mg/kg BW caffeine + 0.125 g/kg BW carbohydrate) or placebo (0.125 g/kg BW carbohydrate) beverage, ate a light meal, and completed 3 exercise tests (40-yard dash, 20-yard shuttle, and a bench press) 60 minutes later. Borg's rating of perceived exertion (RPE) was recorded after each exercise test. Heart rate (HR) and blood pressure (BP) were monitored (pre-exercise and postexercise). Data were analyzed using paired t-tests, Wilcoxon signed rank test, and repeated measures analysis of variance. No significant differences were found between treatments for the exercise tests (40-yard dash: 5.01 +/- 0.25 vs. 5.03 +/- 0.26 s, p = 0.43; 20-yard shuttle: 4.64 +/- 0.19 vs. 4.66 +/- 0.24 s, p = 0.51; bench press: 17 +/- 8 vs. 17 +/- 8 reps, p = 0.51; caffeine vs. placebo, respectively). However, 59% of the participants improved in performance with the caffeine during the bench press and the 40-yard dash. No differences were found between treatments for RPE, HR, and BP. Caffeine did not improve performance for anaerobic exercise tests used at the NFL Combine in caffeine naïve male football athletes.

Correlates of Prenatal Diet Quality in Low-Income Hispanic Women.

BACKGROUND: Low-income Hispanic women are at-risk of poor prenatal diet quality. Correlates associated with prenatal diet quality in this group of women are understudied. OBJECTIVE: The objective of this study was to examine the associations between financial, cultural, psychosocial, and lifestyle correlates and prenatal diet quality in low-income Hispanic women. DESIGN: This cross-sectional analysis used data from pregnant women enrolled in the Starting Early Trial, a randomized-controlled trial of a primary-care based child obesity prevention program beginning in pregnancy. The trial enrolled women from clinics affiliated with a large urban medical center in New York City from 2012 to 2014. Financial, cultural, psychosocial, and lifestyle variables were collected using a comprehensive baseline questionnaire. Usual dietary intakes over the past year were assessed using the Block Food Frequency Questionnaire 2005 bilingual version. PARTICIPANTS: The study enrolled low-income Hispanic women between 28 and 32 gestational weeks (N=519). MAIN OUTCOME MEASURES: Prenatal diet quality was measured by the Healthy Eating Index 2015. STATISTICAL ANALYSES PERFORMED: Unadjusted and adjusted multivariable linear regression analyses were performed to determine independent associations between financial, cultural, psychosocial, and lifestyle correlates and Healthy Eating Index 2015 total score. RESULTS: Overall prenatal diet quality was poor (mean Healthy Eating Index 2015 total score=69.0±9.4). Most women did not meet the maximum score for total vegetables (65.3%), whole grains (97.1%), dairy (74.8%), fatty acids (84.4%), refined grains (79.8%), sodium (97.5%), saturated fats (92.9%), and added sugars (66.5%). Women who reported screen time ≤2 hours/day, physical activity before and/or during pregnancy, and being born outside the United States had higher mean Healthy Eating Index 2015 total score than women with screen time >2 hours/day, no physical activity, and those born in the United States. CONCLUSIONS: Prenatal diet quality of low-income pregnant Hispanic women was suboptimal. This cross-sectional study revealed associations between cultural and lifestyle factors and prenatal diet quality in low-income Hispanic women. Longitudinal studies are needed to determine long-term influences and specific behaviors to target for effective intervention studies.

Comparison of Dietary Patterns, Perceptions of Health, and Perceived Barriers to a Heart Healthy Diet Before and After Coronary Artery Angiography.

Poor dietary patterns are associated with coronary artery disease (CAD) and cardiovascular events. The aim of this study was to determine whether reported dietary patterns change after undergoing invasive coronary angiography. Participants without a history of coronary revascularization were prospectively enrolled before undergoing coronary angiography at a tertiary center between February 2015 and February 2017. Enrolled participants completed the Rate Your Plate (RYP) survey at baseline (before angiography), 1-month, and 6-month follow-ups. RYP scores range from 24 to 72 (higher scores indicate healthier dietary patterns) are presented as median (interquartile range), and are compared from baseline to follow-up using a nonparametric related-sample test. No dietary guidance was given outside of usual care. Of the 400 participants, 326 (82%) completed at least 1 follow-up survey with no differences in baseline characteristics of participants who had at least 1 versus no follow-up survey. The median RYP score significantly improved from baseline (53 [47 to 57]) to 1-month (58 [52 to 62]) and 6-month (59 [54 to 63]) follow-ups (p <0.001). Angiography demonstrated severe CAD in 125 (38%) and normal or nonobstructive CAD in 201 (62%) participants. RYP scores significantly improved over time in both groups (p <0.001), but the percent change in RYP score over time was greater in participants with versus without severe CAD (13.9% [5.8 to 22.5] vs 9.6% [4.8 to 19.1], p = 0.03). In conclusion, self-reported dietary patterns improved after invasive coronary angiography, particularly in the subset with CAD. Future studies to determine how best to utilize the periprocedural period to further improve dietary patterns in this population are warranted.

Elevated plasma homocysteine and low vitamin B-6 status in nonsupplementing older women with rheumatoid arthritis.

OBJECTIVE: The purpose of this study was to determine if nonsupplementing older women (aged >or=55 years) with rheumatoid arthritis had higher plasma homocysteine and lower B-vitamin status compared to healthy controls. Elevated plasma homocysteine, a risk factor for cardiovascular disease, may help explain why individuals with rheumatoid arthritis have an increased risk of cardiovascular disease. METHODS: Older, free-living women were classified as rheumatoid arthritis (n=18) or healthy control (n=33). Participants were not using B-vitamin supplements. Fasting blood samples were measured for pyridoxal 5'phosphate (PLP) (the metabolically active coenzyme form of vitamin B-6), folate, red blood cell folate, vitamin B-12, transcobalamin II, homocysteine, C-reactive protein, and lipid concentrations. Participants completed 7-day weighed food records, the Stanford Health Assessment Questionnaire (HAQ), and a visual analog pain scale. RESULTS: PLP concentrations were lower in the rheumatoid arthritis vs healthy control participants (4.93+/-3.85 vs 11.35+/-7.11 ng/mL [20+/-16 vs 46+/-29 nmol/L]; P<0.01) whereas plasma homocysteine was higher in the rheumatoid arthritis group (1.63+/-0.74 vs 1.15+/-0.38 mg/L [12.1+/-5.5 vs 8.5+/-2.8 micromol/L]; P=0.02). Red blood cell folate concentrations were lower in the rheumatoid arthritis vs healthy control participants [414+/-141 vs 525+/-172 ng/mL [938+/-320 vs 1,190+/-390 nmol/L]; P=0.02). No significant differences were found for plasma folate, vitamin B-12, and transcobalamin II. An inverse correlation was found between PLP concentrations and the HAQ disability index (r=-0.37; P<0.01). A positive correlation was found between homocysteine concentrations and the HAQ disability index (r=0.36; P=0.01). Total cholesterol and low-density lipoprotein cholesterol levels were lower in the rheumatoid arthritis group (cholesterol 191+/-43 vs 218+/-33 mg/dL [4.95+/-1.11 vs 5.65+/-0.85 mmol/L]; P=0.02; low-density lipoprotein cholesterol 110+/-36 vs 137+/-29 mg/dL [2.85+/-0.93 vs 3.55+/-0.75 mmol/L]; P<0.01). No significant differences were seen between groups for protein (g/day), fat (g/day), cholesterol (mg/day), folate (microg/day), vitamin B-12 (microg/day), and vitamin B-6 (mg/day) dietary intakes. CONCLUSIONS: Poor vitamin B-6 status and elevated plasma homocysteine concentrations were seen in older women with rheumatoid arthritis compared to healthy controls and may contribute to their increased risk of cardiovascular disease.

Physical activity is associated with risk factors for chronic disease across adult women's life cycle.

OBJECTIVE: The purpose of this study was to examine the association of age (young, midlife, and older) and activity level (active and sedentary), determined by a pedometer, with risk factors of chronic disease, including body composition, dietary intake, serum lipids, insulin, leptin, C-reactive protein (CRP), plasma glucose, and resting metabolic rate (RMR) in women across the adult life cycle. METHODS: Young (aged 20 to 30 years) (n=49), midlife (aged 40 to 50 years) (n=62), and older (aged 60 years and older) (n=47) women were recruited for this cross-sectional study. For 7 days, participants completed weighed food records and wore a pedometer. Based on the average number of steps per day, the women were further classified as active (>/=7,500 steps per day) or sedentary (<7,500 steps per day). Height, weight, and waist circumference were determined for each participant. Fasting blood samples were taken to assess serum lipid, CRP, insulin, leptin, thyroid stimulating hormone, and plasma glucose levels. RMR and body composition (via dual-energy x-ray absorptiometry) were assessed. RESULTS: Young and midlife women had lower concentrations compared to older women for serum cholesterol (P<0.01), low-density lipoprotein cholesterol (P<0.01), triglycerides (P<0.01), leptin (P<0.01), and plasma glucose (P<0.01); midlife women had lower serum insulin concentrations vs young and older groups (P=0.01); young women had smaller waist circumference compared to midlife and older groups (P<0.01); percent body fat (P<0.01) and percent fat-free mass (P<0.01) differed between all ages. Lower values were found in active vs sedentary women for serum insulin (P=0.02), serum leptin (P<0.01), waist circumference (P<0.01) and percent body fat (P<0.01). A higher percent fat-free mass (P<0.01) was also found in active compared to sedentary women. No differences were found between activity groups for serum cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, CRP, plasma glucose levels, or RMR. RMR was higher in young and midlife vs the older women (P<0.01). Significant inverse correlations were found between activity (steps per day) and body mass index, insulin level, CRP concentration, leptin level, waist circumference, and body fat. Significant positive correlations were found between age and body mass index, total serum cholesterol level, low-density lipoprotein cholesterol level, serum triglyceride level, leptin level, plasma glucose level, CRP concentration, waist circumference, and body fat. Young and midlife women reported consuming more relative energy (kilocalories per kilogram body weight) and protein (grams per kilogram body weight) than older women (P<0.01). The midlife women reported consuming more dietary cholesterol compared to the young and older women (P<0.01). Active women reported a higher relative energy (kilocalories per kilogram body weight) and protein (grams per kilogram body weight) intake vs the sedentary women (P<0.01). Active women also reported a higher intake of dietary carbohydrates (grams per day, P<0.01; percent of energy, P=0.04). CONCLUSIONS: Overall, these results indicate that younger age and greater physical activity, despite age, are associated with fewer risk factors for chronic disease, such as cardiovascular disease, type 2 diabetes, and obesity.

A Low Glycemic Index and Glycemic Load Diet Decreases Insulin-like Growth Factor-1 among Adults with Moderate and Severe Acne: A Short-Duration, 2-Week Randomized Controlled Trial.

BACKGROUND: A high glycemic index (GI) and glycemic load (GL) diet may stimulate acne proliferative pathways by influencing biochemical factors associated with acne. However, few randomized controlled trials have examined this relationship, and this process is not completely understood. OBJECTIVE: This study examined changes in biochemical factors associated with acne among adults with moderate to severe acne after following a low GI and GL diet or usual eating plan for 2 weeks. DESIGN: This study utilized a parallel randomized controlled design to compare the effect of a low GI and GL diet to usual diet on biochemical factors associated with acne (glucose, insulin, insulin-like growth factor [IGF]-1, and insulin-like growth factor binding protein [IGFBP]-3) and insulin resistance after 2 weeks. PARTICIPANTS: Sixty-six participants were randomly allocated to the low GI and GL diet (n=34) or usual eating plan (n=32) and included in the analyses. MAIN OUTCOME MEASURES: The primary outcomes were biochemical factors of acne and insulin resistance with dietary intake as a secondary outcome. STATISTICAL ANALYSES: Independent sample t tests assessed changes in biochemical factors associated with acne, dietary intake, and body composition pre- and postintervention, comparing the two dietary interventions. RESULTS: IGF-1 concentrations decreased significantly among participants randomized to a low GI and GL diet between pre- and postintervention time points (preintervention=267.3±85.6 mg/mL, postintervention=244.5±78.7 ng/mL) (P=0.049). There were no differences in changes in glucose, insulin, or IGFBP-3 concentrations or insulin resistance between treatment groups after 2 weeks. Carbohydrate (P=0.019), available carbohydrate (P<0.001), percent energy from carbohydrate (P<0.001), GI (P<0.001), and GL (P<0.001) decreased significantly among participants following a low GI/GL diet between the pre- and postintervention time points. There were no differences in changes in body composition comparing groups. CONCLUSIONS: In this study, a low GI and GL diet decreased IGF-1 concentrations, a well-established factor in acne pathogenesis. Further research of a longer duration should examine whether a low GI and GL diet would result in a clinically meaningful difference in IGF-1 concentrations leading to a reduction in acne. This trial was registered at clinicaltrials.gov as NCT02913001.