Diet is associated with ankle-brachial index, inflammation, and ambulation in patients with intermittent claudication.

OBJECTIVE: The aims of this investigation were to determine whether the daily dietary intake of nutrients by patients with peripheral artery disease (PAD) and intermittent claudication (IC) met recommended levels for adults older than 50 years and to determine whether meeting recommended levels of nutrients was associated with ankle-brachial index (ABI), inflammation, and ambulation of patients with PAD and IC. METHODS: A total of 48 patients were assessed on their dietary intake of 20 nutrients during a 3-day period. Patients were further characterized on demographic variables, comorbid conditions, cardiovascular risk factors, ABI, 6-minute walk distance (6MWD), and high-sensitivity C-reactive protein (hsCRP) concentration. RESULTS: Few patients met the daily recommended intakes for calcium (4%), fiber (6%), vitamin E (6%), trans fatty acids (13%), vitamin A (15%), total sugars (19%), potassium (23%), sodium (29%), saturated fat (29%), and vitamin C (31%), and none of the patients met the daily recommended intake of vitamin D (0%). Overall, patients met few of the 20 dietary recommendations as the median score was seven recommendations. Only 17 of 48 patients met more than seven of the recommendations. For the ABI regression model adjusted for age, sex, race, smoking, hypertension, dyslipidemia, body mass index, and percentage body fat, the only significant predictor was total sugars (P < .001); patients who did not meet the recommendation had lower ABI values. For the hsCRP-adjusted regression model, the strongest significant predictor was omega-3 polyunsaturated fatty acids (P = .001), indicating that those who did not meet the recommendation had higher hsCRP values. Finally, for the 6MWD-adjusted regression model, folate (P = .011) and dietary score index (P = .014) were significant predictors; those who did not meet the recommendation for folate and those who met 5 or fewer of the 20 recommendations had shorter 6MWD. CONCLUSIONS: Patients with PAD and IC consume a low-nutrient-dense diet that is deficient in many vitamins, calcium, fruits, and vegetables and contains too much added sugar, saturated and trans fats, and processed foods. In addition, more severe PAD, greater inflammation, and ambulatory dysfunction are independently associated with aspects of a low-nutrient-dense diet, such as too much intake of added sugars, low intake of omega-3 polyunsaturated fatty acids and folate, and meeting the recommended intakes of only five or fewer nutrients.

Feasibility of Ideal Cardiovascular Health Evaluation in a Pediatric Clinic Setting.

The feasibility of "point-of-care" screening for ideal cardiovascular health was explored in a pediatric specialty clinic setting. Children and adolescents aged 9-18 years (n=91) with treated and stabilized diseases were recruited at a pediatric endocrinology clinic. A table-top device was used to assay fingerstick samples for non-HDL cholesterol (non-HDL-C), which was used to divide participants into two groups based on the non-HDL-C threshold for comparison of the remaining metrics between groups. A significant number of children had low scores, and score frequency distribution was similar to larger retrospective studies, with few participants achieving none or all of the health metrics. Healthy diet was the metric least often achieved. Those with a non-HDL-C above the ideal threshold of 3.1 mmol/L (120 mg/dl) had a higher BMI percentile (p<0.01) and diastolic blood pressure percentile (p<0.05). We conclude that pediatric risk factor screening and scoring can be performed in a specialty clinic with meaningful cardiovascular health scores for patients and providers. Association of abnormal "point-of care" non-HDL-C levels with elevated BMI and blood pressure supports evidence for risk factor clustering and use of the ideal health construct in pediatric clinic settings.

Effects of Blood-Flow Restriction Combined With Postactivation Potentiation Stimuli on Jump Performance in Recreationally Active Men.

Miller, RM, Keeter, VM, Freitas, EDS, Heishman, AD, Knehans, AW, Bemben, DA, and Bemben, MG. Effects of blood-flow restriction combined with postactivation potentiation stimuli on jump performance in recreationally active men. J Strength Cond Res 32(7): 1869-1874, 2018-Whole-body vibration (WBV) and maximum voluntary contractions (MVCs) combined with blood-flow restriction (BFR) to augment postactivation potentiation have yet to be examined. Therefore, the purpose of this investigation was to examine the augmented effects of postactivation potentiation when WBV and MVC are combined with BFR. Twenty men (21.8 ± 2.6 years, 180.5 ± 6.2 cm and 84.5 ± 12.1 kg) completed the study. Participants completed 3 testing sessions in a randomized design that included one of the following: (a) control (CON), (b) WBV and WBV combined with BFR (WBV + BFR), or (c) MVC and MVC combined with BFR (MVC + BFR). Jump height and power were recorded for 3 trials, PRE and POST jump height (cm) mean ± SD for each were as follows: CON 58.9 ± 8.6 and 57.9 ± 8.6, WBV 58.2 ± 8.1 and 59.9 ± 8.1, WBV + BFR 58.7 ± 7.6 and 60.2 ± 8.1, MVC 59.7 ± 7.4 and 60.2 ± 8.6, and MVC + BFR 57.7 ± 7.9 and 59.4 ± 8.1. PRE and POST jump power (W) mean ± SD for each were as follows: CON 1,224.3 ± 221.5 and 1,234.3 ± 189.2, WBV 1,251.1 ± 230.4 and 1,266.1 ± 215.7, WBV + BFR 1,265.8 ± 207.9 and 1,259 ± 223.3, MVC 1,264.7 ± 211.9 and 1,263.5 ± 236.5, and MVC + BFR 1,252.3 ± 222.0 and 1,294.6 ± 256.6. Significant differences were revealed in jump height between the 5 interventions (p < 0.01), WBV (p < 0.01), WBV + BFR (p < 0.01), and MVC + BFR (p < 0.01) revealed significant differences in time but no differences in jump power. In conclusion, the results of this study indicate that WBV, WBV + BFR, and MVC + BFR significantly improve jump height and time in air but not jump power.

Effects of an 8-Month Ashtanga-Based Yoga Intervention on Bone Metabolism in Middle-Aged Premenopausal Women: A Randomized Controlled Study.

Although Yoga has the potential to be an alternative physical activity to enhance bone health, there is a lack of high quality evidence for this type of intervention. The purpose of this randomized controlled trial was to examine the effects of a progressive 8-month Ashtanga-based Yoga program on bone turnover markers (BTM), areal bone mineral density (aBMD) and volumetric bone characteristics in premenopausal women. Thirty-four premenopausal women (35-50 years) were randomly assigned either to a Yoga group (YE, n = 16) or a control group (CON, n = 18). Participants in YE group performed 60 minutes of an Ashtanga-based Yoga series 2 times/week with one day between sessions for 8 months, and the session intensity was progressively increased by adding the number of sun salutations (SS). Participants in CON were encouraged to maintain their normal daily lifestyles monitored by the bone specific physical activity questionnaire (BPAQ) at 2 month intervals for 8 months. Body composition was measured by dual energy x-ray absorptiometry (DXA). Bone formation (bone alkaline phosphatase, Bone ALP) and bone resorption (Tartrate-Resistant Acid Phosphatase-5b, TRAP5b) markers were assessed at baseline and after 8 months. aBMD of total body, lumbar spine and dual proximal femur and tibia bone characteristics were measured using DXA and peripheral Quantitative Computed Tomography (pQCT), respectively. We found that the serum Bone ALP concentrations were maintained in YE, but significantly (p = 0.005) decreased in CON after the 8 month intervention, and there were significant (p = 0.002) group differences in Bone ALP percent changes (YE 9.1 ± 4.0% vs. CON -7.1 ± 2.3%). No changes in TRAP5b were found in either group. The 8-month Yoga program did not increase aBMD or tibia bone strength variables. Body composition results showed no changes in weight, fat mass, or % fat, but small significant increases in bone free lean body mass occurred in both groups. The findings of this study suggest that regular long-term Ashtanga Yoga had a small positive effect on bone formation but did not alter aBMD or tibia bone characteristics in premenopausal women. Key pointsRegular long-term Ashtanga-based Yoga program had a small positive effect on bone formation, but no effects were found on bone resorption.None of the bone density or geometry variables were changed by the 8-month Ashtanga-based Yoga intervention.Future Yoga interventions should focus on longer duration and greater frequency to elicit improvements in bone mineral density.

Dietary Intake among American Indians with Metabolic Syndrome - Comparison to Dietary Recommendations: the Balance Study.

BACKGROUND: American Indians have a very high prevalence of metabolic syndrome that increases their risk of developing cardiovascular disease and type 2 diabetes. Dietary habits are of central importance in the prevention and treatment of metabolic syndrome. OBJECTIVE: The main objective of this article was to describe dietary intake among American Indians with metabolic syndrome and compare it to several dietary recommendations. A secondary objective was to identify certain barriers to dietary adherence experienced by this population. METHODS: A total of 213 participants with metabolic syndrome were enrolled in the Balance Study, a randomized controlled trial with two intervention groups: Guided Group and Self-Managed Group. Dietary intake was assessed using the Block Food Frequency questionnaire. Dietary intakes were evaluated against the Dietary Guidelines for Americans. RESULTS: Intakes of saturated fats, cholesterol, and sodium were higher and intakes of dietary fiber, calcium, magnesium, potassium, vitamin A, vitamin D, and vitamin E were lower than recommended. Additionally, intake of many food groups was noticeably low. Economic factors seem to be related to low adherence to dietary recommendations. CONCLUSION: Results showed low adherence by the participants to dietary recommendations for key nutrients and food groups related to risk factors for metabolic syndrome, type 2 diabetes, and cardiovascular disease. Economic factors are related to this low adherence. These findings illustrate a need to develop innovative, focused, and perhaps individualized health promotion strategies that can improve dietary habits of American Indians with metabolic syndrome.

A cardiovascular risk reduction program for American Indians with metabolic syndrome: the Balance Study.

The Balance Study is a randomized controlled trial designed to reduce cardiovascular disease (CVD) risk in 200 American Indian (AI) participants with metabolic syndrome who reside in southwestern Oklahoma. Major risk factors targeted include weight, diet, and physical activity. Participants are assigned randomly to one of two groups, a guided or a self-managed group. The guided group attends intervention meetings that comprise education and experience with the following components: diet, exercise, AI culture, and attention to emotional wellbeing. The self-managed group receives printed CVD prevention materials that are generally available. The duration of the intervention is 24 months. Several outcome variables will be compared between the two groups to assess the effectiveness of the intervention program.

Leptin, fat mass, and bone mineral density in healthy pre- and postmenopausal women.

The purpose was to examine relationships between age, fat mass, and bone mineral density (BMD) with resting leptin levels in premenopausal and postmenopausal women. Young (aged 18-30 yr, n=30) and estrogen-deficient postmenopausal (aged 55-75 yr, n=43) women were recruited. Total body and segmental fat mass and bone-free lean body mass (BFLBM) and total body, lumbar spine, and proximal femur BMD were assessed using dual-energy X-ray absorptiometry. Serum-resting, fasted leptin levels were measured by Immunoradiometric Assay (IRMA), and leptin-to-fat mass ratios were calculated. Young and older women had similar amounts of BFLBM, but older women had greater (p<0.05) amounts of fat mass and 35% higher leptin levels. Age differences in leptin concentrations were no longer significant after controlling for fat mass. Older women had significantly (p<0.05) lower hip BMD values. Age was negatively related (r=-0.29, p<0.05) to leptin:trunk fat ratio. Increases in fat mass, not menopause per se, contributes to higher leptin levels in older women. Relationships between leptin and BMD may be age dependent.

Dietetic preceptor educational needs from the preceptor, student, and faculty perspectives.

Quality dietetic education relies on strong preceptors to encourage, motivate, and teach dietetic students so that they can excel as practitioners. The purpose of this study was to examine the needs of dietetic preceptors, determine how those needs should be met, and suggest who can best address those needs. Grounded theory methodology was used to design this study of preceptor needs. Focus groups and one-on-one interviews were conducted with 22 preceptors, 5 former students, and 4 faculty members of a clinical dietetic training program. Data were analyzed using open, axial, and selective coding. The central category/ factor that influenced preceptor participation and effectiveness was determined to be lack of time. Preceptors felt they did not have sufficient time to devote to precepting students. Other categories found to be important for successful precepting included student-preceptor orientation, the teaching-learning environment, views of dietetic professionalism, and the responsibilities and rewards of precepting. Based on the themes that emerged with this grounded theory methodology, this study suggests that preceptors should be trained in the following five areas: 1) basic teaching skills, 2) time management strategies, 3) methods for coaching students, 4) adult learning styles, and 5) methods for providing constructive feedback. This training should increase the likelihood that the experience will be both time-efficient and successful for the preceptor, student, and faculty involved. This should improve the effectiveness of preceptors as educators, which should consequently facilitate recruitment and retention of dietetic preceptors.

Effects of combined whole-body vibration and resistance training on muscular strength and bone metabolism in postmenopausal women.

Whole-body vibration (WBV) has been shown to be osteogenic in animal models; however, its application in humans is not clear. The purpose of this study was to examine the effects of an 8-month program involving WBV plus resistance training on bone mineral density (BMD) and bone metabolism in older postmenopausal women. Fifty-five estrogen-deficient postmenopausal women were assigned to a resistance training group (R, n=22), a WBV plus resistance training group (WBVR, n=21), or a control group (CON, n=12). R and WBVR performed upper and lower body resistance exercises 3 days/week at 80% 1 Repetition Maximum (1RM). WBVR received vibration (30-40 Hz, 2-2.8 g) in three different positions preceding the resistance exercises. Daily calcium intake, bone markers (Bone alkaline phosphatase (Bone ALP); C-terminal telopeptide of Type I collagen (CTX), and BMD of the spine, dual femur, forearm, and total body (DXA) were measured at baseline and after the intervention. At baseline, there were no significant group differences in strength, BMD, or bone marker variables. After 8 months of R or WBVR, there were no significant group or time effects in Bone ALP, CTX, or total body, spine, left hip or right trochanter BMD. However, right total hip and right femoral neck BMD significantly (p<0.05) decreased in all groups. A group x time interaction (p<0.05) was detected at radius 33% BMD site, with CON slightly increasing, and WBVR slightly decreasing. R and WBVR significantly (p<0.05) increased 1RM strength for all exercises, while CON generally maintained strength. WBVR had significantly (p<0.05) greater percent increases in muscular strength than R at 4 months for lat pull down, seated row, hip abduction and hip adduction and at 8 months for lat pull down, hip abduction and hip adduction. Bone metabolism in postmenopausal women was not affected by resistance training either with or without WBV. In contrast, the addition of WBV augmented the positive effects of resistance training on muscular strength in these older women.

Impact of maternal body mass index on neonate birthweight and body composition.

OBJECTIVE: The purpose of this study was to compare bodyweight and composition (percent fat, fat mass, and fat-free mass) in neonates born to mothers with a normal pregravid body mass index (BMI; < 25 kg/m(2)) vs neonates born to mothers with an overweight/obese pregravid BMI (> or = 25 kg/m(2)). STUDY DESIGN: Seventy-two neonates (33 from normal mothers and 39 from overweight/obese mothers) of singleton pregnancies with normal glucose tolerance had their bodyweight and body composition assessed by air-displacement plethysmography. RESULTS: After controlling for neonate age at time of testing, significant differences were found between groups for percent fat (12.5 +/- 4.2% vs 13.6 +/- 4.3%; P < or = .0001), fat mass (414.1 +/- 264.2 vs 448.3 +/- 262.2 g; P < or = .05), and fat-free mass (3310.5 +/- 344.6 vs 3162.2 +/- 343.4 g; P < or = .05), with no significant differences between birth length (50.7 +/- 2.6 vs 49.6 +/- 2.6 cm; P = .08) or birthweight (3433.0 +/- 396.3 vs 3368.0 +/- 399.6 g; P = .44). CONCLUSION: Neonates born to mothers who have a normal BMI have significantly less total and relative fat and more fat-free mass than neonates born to overweight/obese mothers. Although preliminary, these data suggest that the antecedents of future disease risk (eg, cardiovascular disease, diabetes, and obesity) occur early in life.

Use of personal digital assistants among dietitians and dietetic students in Oklahoma: should programs incorporate PDA training into their curricula?

The objective of this study was to assess the use of personal digital assistants (PDAs) among dietitians and dietetic students in Oklahoma and the desire for training in the use of PDAs. A survey was mailed to 648 dietitians and dietetic students to assess their PDA use and interest in PDA training. Frequency and percentage of responses were determined. A total of 320 usable surveys were returned, for a response rate of 49%. Sixteen percent of responders were dietetic students. The responses of students did not differ from those of dietitians, so all responses were combined. Subjects were primarily female, between 21 and 50 yrs of age, and had practiced for 5 yrs or more, similar to the demographics of dietitians nationally. Twenty-four percent of responders currently use a PDA, primarily as an organizational tool. Twenty-eight percent of the users indicated that they had received training in PDA use. Thirty-seven percent of the users were using a PDA for nutrition assessments, and 28% were using it for nutrition support. Of nonusers, 80% indicated that they would use a PDA if training were available. PDAs were used most often as an organizational tool, seldom for nutrition-specific applications. Dietitians and students expressed an interest in receiving training in PDA use, preferably from state and local dietetic associations. PDA training might also be incorporated into academic dietetic programs, and employers could provide training in the workplace.

Does nutritional supplementation influence adaptability of muscle to resistance training in men aged 48 to 72 years.

BACKGROUND AND PURPOSE: Isotonic strength training can result in neuromuscular improvements evidenced in other forms of muscular effort, ie, isokinetic or isometric, especially in young subjects; however, it is unclear if older muscle maintains this same adaptive ability. Additionally, it is not known if the benefits of resistance training can be augmented by creatine and protein supplementation in older men. Therefore, the purpose of this study was to assess changes in isokinetic parameters at varying speeds in men aged 48 to 72 years (mean=57+/-2.1) following 16 weeks of isotonic resistance training and creatine and/or protein supplementation. METHODS: Forty-two male subjects were randomly assigned to 1 of 4 training groups: (1) resistance training placebo (n=10), (2) resistance trained creatine supplemented (n=10), (3) resistance trained protein supplemented (n=11), and (4) resistance trained creatine and protein supplemented (n=11). The program consisted of progressive overload resistance training (3 d/wk) and supplement consumption following the workout. RESULTS: There were significant time effects (P>.05) for peak torque (PT), time to PT, and average power for both the knee extensors and flexors at all velocities. However, no significant group or group by time interactions were noted, indicating that the supplementation protocols had no added benefits. CONCLUSIONS: Men aged 48 to 72 years maintained their ability to improve isokinetic muscle function following isotonic training, however, supplementation did not enhance muscle adaptability.

Effect of continuous passive motion (machine-assisted) exercise as an alternative form of training on physiological profiles of women aged 40-65 years.

The purpose of this study was to determine the effectiveness of 16 weeks of continuous passive motion (CPM) or machine-assisted exercise as an alternative form of training on body composition, muscle strength, and flexibility in women aged 40-65 years. Thirty-one exercisers and 8 controls completed 16 weeks of training, with the exercisers averaging 3 sessions per week. Six toning tables targeted different muscle groups by moving the body and/or limbs while subjects attempted to resist the movements. Body composition was assessed by individual measures (dual energy x-ray absorptiometry, hydrodensitometry, and bioelectric impedance) and a 4-compartment model, flexibility was assessed by a Leighton flexometer and the sit and reach procedure, and strength was measured by standard 1 repetition maximum procedures before training began, after 5 weeks of training, and after 16 weeks of training. When the 2 groups were compared after week 5 and week 16 of training, few significant (p < 0.05) group by trial differences were noted; however, these differences were minimal and represented little or no practical significance (very low effect sizes). In conclusion, CPM training did not appear to provide a sufficient stimulus to significantly alter measures of strength, flexibility, or body composition in women aged 40-65 years.

Influence of type of mechanical loading, menstrual status, and training season on bone density in young women athletes.

Bone mineral density (BMD) variables were compared in 2 groups of women Division I collegiate athletes-gymnasts (GYM) and cross-country runners (CC)-during the preseason and during the competitive season. An osteogenic advantage may exist in women athletes involved in impact loading (gymnastics) over those women in active loading sports like long-distance running. The effects of menstrual status and the time of the training season on BMD also were examined. Dietary intake, menstrual status, BMD, and serum estradiol levels were measured during the preseason and during the competitive season in 26 women athletes (18-22 years of age). GYM had significantly higher BMD (p < 0.05) at all sites for both the pre- and posttests compared to CC. Neither group experienced a significant change (p > 0.05) in BMD between trials for any site; however, CC showed slight decreases at all BMD sites from baseline to the posttest. GYM had a higher prevalence of self-reported menstrual cycle disturbances than CC. No significant difference (p > 0.05) in BMD was found between the eumenorrheic and menstrual dysfunction groups (oligo/amenorrheic). In conclusion, the gymnasts had significantly higher (p < 0.05) BMD than the runners, suggesting BMD is influenced by the type of mechanical loading. Menstrual status did not significantly affect BMD in these women athletes. Cross-country runners were determined to be at greater risk than the gymnasts for low bone mass; thus, it is recommended that these athletes include more high-impact activities in their training regimen to optimize their bone health.

Childhood obesity: why is this happening to our children?

Obesity among children is epidemic in the U.S. Although a serious problem because of the rising incidence of Type II diabetes as well as heart disease, it is preventable. Unfortunately, it is difficult to prevent because of the problem of getting people to change dietary habits and increase their physical activity. However, it is a serious enough health issue to require the attention and actions of physicians.