Implementation of a Family Support Grant to Subsidize Caregiving Needs and Support Attendance at American Society for Nutrition's Annual Professional Scientific Conference.

Attendance at professional society meetings facilitates networking, collaboration, and success in academic/scientific fields. Insufficient funds, support, or resources for caregiving can inhibit attendance for parents/caretakers, who may become professionally disadvantaged by not attending professional society conferences. The American Society for Nutrition (ASN) offered a family support grant for caregiving needs during the annual conference (maximum: $750); however, the perceived impact of caregiving funds on attendance outcomes is unknown. The objective of this study was to assess the need of family support for attendance to the ASN annual conference among applicants and to assess recipients' experience and usage of funds. Applicants completed a pre-conference survey assessing requested funds, out-of-pocket caregiving expenses to attend the meeting, the influence of receiving the grant on attendance, and additional factors. Recipients completed a post-conference survey assessing use of the funds and impact of the grant on attending/participating. Grant applications (n = 110) were majority women, aged 26-45 y, married, at the trainee or assistant professor level, from diverse racial/ethnic backgrounds, and with parenting noted as the primary responsibility. Thirty-seven percent of applicants were currently lactating or expressing milk. The average amount requested was $650 US dollars, and >60% of respondents indicated plans to use funds to bring a family member/friend to the conference. Seventy-seven percent of respondents indicated that receiving the grant would influence their attendance. The post-conference survey (n = 25) indicated that recipients felt that receiving the grant was helpful in attending the conference (92%), specifically attending scientific sessions (96%) and poster sessions (80%). Recipients indicated the grant helped them network with attendees (88%), visit the exhibitor hall (72%), and participate in career development activities (64%). The ASN family support grant aided attendance and supported recipients' participation in conference activities, particularly early-career women who are parents, with the goal of supporting diversity and inclusivity in scientific/academic fields. This trial was registered at www.clinicaltrials.gov as NCT03432585.

Traffic Light Diets for Childhood Obesity: Disambiguation of Terms and Critical Review of Application, Food Categorization, and Strength of Evidence.

Traffic light labeling (TLL) of foods is a strategy often included in multicomponent behavioral interventions (MBIs) for childhood obesity. Traffic light labels categorize foods as "green" (no restrictions), "yellow" (moderation), and "red" (consume minimally). The body of research investigating the effects of TLL conflates the labeling itself with MBIs that include TLL as one component. For instance, the Academy of Nutrition and Dietetics' Evidence Analysis Library gave traffic light diets Grade I evidence for pediatric weight management. Yet, whether the term traffic light diet referenced TLL in isolation or as part of an MBI was ambiguous. Herein, we evaluate the evidence supporting TLL for childhood obesity as a stand-alone treatment and identify areas requiring further research. No articles from a PubMed search for TLL and weight-related outcomes tested TLL in isolation. One article was identified through reference lists that tested TLL mostly in isolation, which observed no significant differences between groups. TLL definitions and categorizations vary across studies and contexts, using average calories in categories of foods, energy density, or specific ingredients to determine labeling. Systematic reviews generally conclude TLL-based approaches affect food selection and consumption, but none studied obesity-related outcomes. We believe the evidence supports that: 1) there is a lack of standardization regarding TLL food classifications; 2) the term "traffic light diet" is inconsistently used to mean intensive lifestyle programs or TLL itself; and 3) there is insufficient evidence to understand the effects of TLL as an isolatable factor for childhood obesity. Importantly, limited evidence about TLL does not mean it is ineffective; TLL has been incorporated into successful childhood obesity intervention programs, but the unique causal contribution of TLL remains uncertain. Standardized definitions of traffic light labels for categorizing foods and trials with TLL alone are needed to test direct impacts of TLL on obesity-related outcomes.

Overstated Claims of Efficacy and Safety. Comment On: "Optimal Nutritional Status for a Well-Functioning Immune System Is an Important Factor to Protect Against Viral Infections". Nutrients 2020, 12, 1181.

Calder et al [...].

Eating versus skipping breakfast has no discernible effect on obesity-related anthropometric outcomes: a systematic review and meta-analysis.

Background: Eating or skipping breakfast for weight interests scientific and lay communities. Our objective was to systematically review and meta-analyze causal effects of eating versus skipping breakfast on obesity-related anthropometric outcomes in humans. Methods: Six databases were searched for obesity- and breakfast-related terms (final search: 02 JAN 2020). Studies needed to isolate eating versus skipping breakfast in randomized controlled trials. Mean differences were synthesized using inverse variance random effects meta-analysis for each outcome. Positive estimates indicate higher outcomes in breakfast conditions (e.g., weight gain). Leave-one-out sensitivity analysis, secondary baseline habit-by-breakfast assignment analysis, and study duration cumulative analysis were performed. Risk of bias was assessed using Cochrane risk of bias tool. Results: Ten articles (12 comparisons; 6d-12wk) were included. Conditions included recommendations to eat versus skip breakfast, or provision of some or all meals. 95% confidence intervals of all main analyses included the null value of no difference for each outcome: body weight (0.17 kg [-0.40,0.73], k=12, n=487, I 2=74.5), BMI (0.07 kg/m 2 [-0.10,0.23, k=8, n=396, I 2=54.1), body fat percentage (-0.27% [-1.01,0.47], k=6, n=179, I 2=52.4), fat mass (0.24 kg [-0.21,0.69], k=6, n=205, I 2=0.0), lean mass (0.18 kg [-0.08,0.44], k=6, n=205, I 2=6.7), waist circumference (0.18 cm [-1.77,2.13], k=4, n=102, I 2=78.7), waist:hip ratio (0.00 [-0.01,0.01], k=4, n=102, I 2=8.0), sagittal abdominal diameter (0.19 cm [-2.35,2.73], k=2, n=56, I 2=0.0), and fat mass index (0.00 kg/m 2 [-0.22,0.23], k=2, n=56, I 2=0.0). Subgroup analysis showed only one statistically significant result. The interaction effect for BMI (-0.36[-0.65,-0.07]) indicates assignment to conditions consistent with baseline habits had lower BMI. Leave-one-out analysis did not indicate substantial influence of any one study. Conclusions: There was no discernible effect of eating or skipping breakfast on obesity-related anthropometric measures when pooling studies with substantial design heterogeneity and sometimes statistical heterogeneity. Registration: PROSPERO CRD42016033290.

The Effectiveness of MyPlate and Paleolithic-based Diet Recommendations, both with and without Exercise, on Aerobic Fitness, Muscular Strength and Anaerobic Power in Young Women: A Randomized Clinical Trial.

The purpose of this study was to evaluate the effectiveness of recommending a MyPlate or a Paleolithic-based diet, both with and without exercise, on aerobic fitness, strength, and anaerobic power over eight weeks. Participants (n=20) were randomized to one of four groups, (1) a MyPlate diet (MP), (2) Paleolithic-based diet (PD), (3) MyPlate and exercise (MP + Ex), and (4) Paleolithic-based diet and exercise (PD + Ex). The exercise included two days of unsupervised aerobic and resistance exercise. At baseline and final, absolute and relative peak oxygen consumption (absVO2peak and relVO2peak), anaerobic power, and upper and lower body strength were determined. Data were analyzed using repeated measures two-way analysis of variance (ANOVA). The ANOVA indicated that there was no significant interaction between time point (TP)*diet (D)*exercise (Ex) for all variables except relVO2peak (p = 0.016). The MP + Ex group (Δ+4.4 ml·kg-1·min-1) had a greater change from baseline compared to the MP group (Δ-2.7 ml·kg-1·min-1, p = 0.002), and PD + Ex group (Δ-0.3 ml·kg-1·min-1, p = 0.03). The results suggest recommending a MyPlate diet with both aerobic and resistance training are effective at improving aerobic fitness when compared to PD recommendations with exercise, although these conclusions may be confounded by low compliance to exercise recommendations.

High Intensity Interval- vs Moderate Intensity- Training for Improving Cardiometabolic Health in Overweight or Obese Males: A Randomized Controlled Trial.

PURPOSE: To compare the effects of six weeks of high intensity interval training (HIIT) vs continuous moderate intensity training (MIT) for improving body composition, insulin sensitivity (SI), blood pressure, blood lipids, and cardiovascular fitness in a cohort of sedentary overweight or obese young men. We hypothesized that HIIT would result in similar improvements in body composition, cardiovascular fitness, blood lipids, and SI as compared to the MIT group, despite requiring only one hour of activity per week compared to five hours per week for the MIT group. METHODS: 28 sedentary overweight or obese men (age, 20 ± 1.5 years, body mass index 29.5 ± 3.3 kg/m2) participated in a six week exercise treatment. Participants were randomly assigned to HIIT or MIT and evaluated at baseline and post-training. DXA was used to assess body composition, graded treadmill exercise test to measure cardiovascular fitness, oral glucose tolerance to measure SI, nuclear magnetic resonance spectroscopy to assess lipoprotein particles, and automatic auscultation to measure blood pressure. RESULTS: A greater improvement in VO2peak was observed in MIT compared to HIIT (11.1% vs 2.83%, P = 0.0185) in the complete-case analysis. No differences were seen in the intention to treat analysis, and no other group differences were observed. Both exercise conditions were associated with temporal improvements in % body fat, total cholesterol, medium VLDL, medium HDL, triglycerides, SI, and VO2peak (P < 0.05). CONCLUSION: Participation in HIIT or MIT exercise training displayed: 1) improved SI, 2) reduced blood lipids, 3) decreased % body fat, and 4) improved cardiovascular fitness. While both exercise groups led to similar improvements for most cardiometabolic risk factors assessed, MIT led to a greater improvement in overall cardiovascular fitness. Overall, these observations suggest that a relatively short duration of either HIIT or MIT training may improve cardiometabolic risk factors in previously sedentary overweight or obese young men, with no clear advantage between these two specific regimes (Clinical Trial Registry number NCT01935323). TRIAL REGISTRATION: ClinicalTrials.gov NCT01935323.

Best (but oft-forgotten) practices: designing, analyzing, and reporting cluster randomized controlled trials.

Cluster randomized controlled trials (cRCTs; also known as group randomized trials and community-randomized trials) are multilevel experiments in which units that are randomly assigned to experimental conditions are sets of grouped individuals, whereas outcomes are recorded at the individual level. In human cRCTs, clusters that are randomly assigned are typically families, classrooms, schools, worksites, or counties. With growing interest in community-based, public health, and policy interventions to reduce obesity or improve nutrition, the use of cRCTs has increased. Errors in the design, analysis, and interpretation of cRCTs are unfortunately all too common. This situation seems to stem in part from investigator confusion about how the unit of randomization affects causal inferences and the statistical procedures required for the valid estimation and testing of effects. In this article, we provide a brief introduction and overview of the importance of cRCTs and highlight and explain important considerations for the design, analysis, and reporting of cRCTs by using published examples.

Increased fruit and vegetable intake has no discernible effect on weight loss: a systematic review and meta-analysis.

BACKGROUND: A common dietary recommendation for weight loss, especially in lay public outlets, is to eat more fruit and vegetables (F/Vs). Without a compensatory reduction in total energy intake, significant weight loss would be unlikely. OBJECTIVE: We aimed to synthesize the best available evidence on the effectiveness of the general recommendation to eat more F/Vs for weight loss or the prevention of weight gain. DESIGN: We searched multiple databases for human randomized controlled trials that evaluated the effect of increased F/V intake on body weight. Inclusion criteria were as follows: ≥15 subjects/ treatment arm, ≥8-wk intervention, a stated primary or secondary outcome of body weight, the stated goal of the intervention was weight or fat loss or the prevention of weight or fat gain, and food intake provided or prescribed was of a variety of F/Vs that remained minimally processed. RESULTS: Two studies met all criteria; 5 other studies met all criteria but one. The primary analysis indicated an effect size of weight change (outcome of interest) from baseline [standardized mean difference (SMD) for studies that met all criteria] of -0.16 (95% CI: -0.78, 0.46) (P = 0.60). The SMD for 7 studies that met all or most criteria was 0.04 (95% CI: -0.10, 0.17) (P = 0.62). CONCLUSIONS: Studies to date do not support the proposition that recommendations to increase F/V intake or the home delivery or provision of F/Vs will cause weight loss. On the basis of the current evidence, recommending increased F/V consumption to treat or prevent obesity without explicitly combining this approach with efforts to reduce intake of other energy sources is unwarranted. This systematic review and meta-analysis was registered at http://www.crd.york.ac.uk/PROSPERO/ as CRD42013004688.

Added sugars in the diet are positively associated with diastolic blood pressure and triglycerides in children.

BACKGROUND: Hypertension and dyslipidemia have traditionally been associated with dietary sodium and fat intakes, respectively; however, they have recently been associated with the consumption of added sugars in adults and older adolescents, but there is no clear indication of how early in the life span this association manifests. OBJECTIVE: This study explored the cross-sectional association between added sugar (sugars not naturally occurring in foods) consumption in children, blood pressure (BP), and fasting blood lipids [triglycerides and total, low-density lipoprotein, and high-density lipoprotein (HDL) cholesterol]. DESIGN: BP, blood lipids, and dietary intakes were obtained in a multiethnic pediatric sample aged 7-12 y of 122 European American (EA), 106 African American (AA), 84 Hispanic American (HA), and 8 mixed-race children participating in the Admixture Mapping of Ethnic and Racial Insulin Complex Outcomes (AMERICO) study-a cross-sectional study conducted in the Birmingham, AL, metro area investigating the effects of racial-ethnic differences on metabolic and health outcomes. Multiple regression analyses were performed to evaluate the relations of added sugars and sodium intakes with BP and of added sugars and dietary fat intakes with blood lipids. Models were controlled for sex, race-ethnicity, socioeconomic status, Tanner pubertal status, percentage body fat, physical activity, and total energy intake. RESULTS: Added sugars were positively associated with diastolic BP (P = 0.0462, ß = 0.0206) and serum triglycerides (P = 0.0206, ß = 0.1090). Sodium was not significantly associated with either measure of BP nor was dietary fat with blood lipids. HA children had higher triglycerides but lower added sugar consumption than did either the AA or EA children. The AA participants had higher BP and HDL but lower triglycerides than did either the EA or HA children. CONCLUSIONS: These data suggest that increased consumption of added sugars may be associated with adverse cardiovascular health factors in children, specifically elevated diastolic BP and triglycerides. Identification of dietary factors influencing cardiovascular health during childhood could serve as a tool to reduce cardiovascular disease risk. This trial was registered at clinicaltrials.gov as NCT00726778.

Genetic admixture and obesity: recent perspectives and future applications.

The process of the colonization of the New World that occurred centuries ago served as a natural experiment, creating unique combinations of genetic material in newly formed admixed populations. Through a genetic admixture approach, the identification and genotyping of ancestry informative markers have allowed for the estimation of proportions of ancestral parental populations among individuals in a sample. These admixture estimates have been used in different ways to understand the genetic contributions to individual variation in obesity and body composition parameters, particularly among diverse admixed groups known to differ in obesity prevalence within the United States. Although progress has been made through the use of genetic admixture approaches, further investigations are needed in order to explore the interaction of environmental factors with the degree of genetic ancestry in individuals. A challenge to confront at this time would be to further stratify and define environments in progressively more granular terms, including nutrients, muscle biology, stress responses at the cellular level, and the social and built environments.

Belief beyond the evidence: using the proposed effect of breakfast on obesity to show 2 practices that distort scientific evidence.

BACKGROUND: Various intentional and unintentional factors influence beliefs beyond what scientific evidence justifies. Two such factors are research lacking probative value (RLPV) and biased research reporting (BRR). OBJECTIVE: We investigated the prevalence of RLPV and BRR in research about the proposition that skipping breakfast causes weight gain, which is called the proposed effect of breakfast on obesity (PEBO) in this article. DESIGN: Studies related to the PEBO were synthesized by using a cumulative meta-analysis. Abstracts from these studies were also rated for the improper use of causal language and biased interpretations. In separate analyses, articles that cited an observational study about the PEBO were rated for the inappropriate use of causal language, and articles that cited a randomized controlled trial (RCT) about the PEBO were rated for misleadingly citing the RCT. RESULTS: The current body of scientific knowledge indicates that the PEBO is only presumed true. The observational literature on the PEBO has gratuitously established the association, but not the causal relation, between skipping breakfast and obesity (final cumulative meta-analysis P value <10(-42)), which is evidence of RLPV. Four examples of BRR are evident in the PEBO literature as follows: 1) biased interpretation of one's own results, 2) improper use of causal language in describing one's own results, 3) misleadingly citing others' results, and 4) improper use of causal language in citing others' work. CONCLUSIONS: The belief in the PEBO exceeds the strength of scientific evidence. The scientific record is distorted by RLPV and BRR. RLPV is a suboptimal use of collective scientific resources.

Myths, presumptions, and facts about obesity.

BACKGROUND: Many beliefs about obesity persist in the absence of supporting scientific evidence (presumptions); some persist despite contradicting evidence (myths). The promulgation of unsupported beliefs may yield poorly informed policy decisions, inaccurate clinical and public health recommendations, and an unproductive allocation of research resources and may divert attention away from useful, evidence-based information. METHODS: Using Internet searches of popular media and scientific literature, we identified, reviewed, and classified obesity-related myths and presumptions. We also examined facts that are well supported by evidence, with an emphasis on those that have practical implications for public health, policy, or clinical recommendations. RESULTS: We identified seven obesity-related myths concerning the effects of small sustained increases in energy intake or expenditure, establishment of realistic goals for weight loss, rapid weight loss, weight-loss readiness, physical-education classes, breast-feeding, and energy expended during sexual activity. We also identified six presumptions about the purported effects of regularly eating breakfast, early childhood experiences, eating fruits and vegetables, weight cycling, snacking, and the built (i.e., human-made) environment. Finally, we identified nine evidence-supported facts that are relevant for the formulation of sound public health, policy, or clinical recommendations. CONCLUSIONS: False and scientifically unsupported beliefs about obesity are pervasive in both scientific literature and the popular press. (Funded by the National Institutes of Health.).

Short-term consumption of sucralose, a nonnutritive sweetener, is similar to water with regard to select markers of hunger signaling and short-term glucose homeostasis in women.

Nonnutritive sweeteners have been used to lower the energy density of foods with the intention of affecting weight loss or weight maintenance. However, some epidemiological and animal evidence indicates an association between weight gain or insulin resistance and artificial sweetener consumption. In the present study, we hypothesized that the nonnutritive sweetener sucralose, a trichlorinated sucrose molecule, would elicit responses similar to water but different from sucrose and sucrose combined with sucralose on subjective and hormonal indications of hunger and short-term glucose homeostasis. Eight female volunteers (body mass index, 22.16 ± 1.71 kg/m(2); age, 21.75 ± 2.25 years) consumed sucrose and/or sucralose in water in a factorial design. Blood samples were taken at fasting and 30 and 60 minutes after treatment followed by a standardized breakfast across treatments, and blood samples were taken 30, 60, 90, and 120 minutes after breakfast. Plasma was analyzed for glucose, insulin, glucagon, triacylglycerols (TAG), and acylated ghrelin. Perceptions of hunger and other subjective measurements were assessed before each blood sample. No differences were detected in subjective responses, circulating triacylglycerol, or glucagon concentrations among treatments over time. Significant differences were observed in insulin, glucose, and acylated ghrelin concentrations over time only between sucrose-containing treatments and non-sucrose-containing treatments regardless of sucralose consumption. Therefore, sucralose may be a relatively inert nonnutritive sweetener with regard to hunger signaling and short-term glucose homeostasis.