Household chaos and childhood obesity-related health outcomes.

OBJECTIVE: Household chaos, defined as a lack of organization, structure, and predictability, has been linked to deleterious childhood health outcomes and may hinder attempts to initiate and maintain healthy lifestyle changes. This study examined the associations of household chaos and obesity-related health conditions in a sample of youth being treated for obesity. METHODS: Participants were 715 patients (61.8% girls; Mage = 12.3 years; 68.7% non-Hispanic Black; M% of 95th BMI %-ile = 146.9%) enrolled in a pediatric weight management clinic. Caregiver report of household chaos was measured using the Confusion, Hubbub and Order Scale (CHAOS). Physiological obesity-related comorbidities (e.g., insulin resistance, hypertension, dyslipidemia) were assessed by a medical clinician and abstracted from electronic medical records; health conditions were dichotomized as present or not present. Psychological functioning was measured with the Pediatric Symptom Checklist, a caregiver-completed mental health screen that assesses internalizing, externalizing, and attention concerns. RESULTS: The Wilcoxon rank-sum test was used to test differences in household chaos scores for each obesity-related health condition. Caregivers of youth diagnosed with hypertension and obstructive sleep apnea reported significantly lower levels of household chaos, while caregivers who reported clinical levels of psychological dysfunction reported higher levels of chaos. CONCLUSIONS: Traditional management of childhood obesity requires changes across multiple health domains (e.g., dietary, exercise, sleep), and such change may be facilitated by structure and consistency. Present findings suggest that psychological resources within pediatric weight management settings should address individual patient-level factors associated with physiological and mental health as well as household functioning.

Prevalence of Upper Gastrointestinal Inflammation in Teens With Obesity Prior to Sleeve Gastrectomy.

INTRODUCTION: Upper gastrointestinal (UGI) pathologies are common in adolescents with obesity. This study aims to determine the prevalence of UGI inflammation on preoperative esophagogastroduodenoscopy (EGD) in adolescents undergoing sleeve gastrectomy (SG) and to assess weight loss outcomes. METHODS: This is a retrospective analysis of pathology reports from EGD biopsies performed prior to SG from September 2017 to August 2020. Percentage weight loss was measured at 3, 6, and 12 mo after surgery. Percent total body weight loss (TBWL) was compared between patients with and without UGI inflammation. RESULTS: Thirty adolescents underwent laparoscopic SG. Mean TBWL was 22% of total body weight 12 mo after surgery. Preoperative EGD identified 9 (30%) patients with esophagitis, 10 (33%) with gastritis, and 9 (30%) with duodenitis. Twenty-one patients (70%) had inflammation of at least one area, 5 (17%) were Helicobacter pylori positive, and 1 (3%) had a gastric ulcer that delayed surgery. Five (17%) patients were taking antacids prior to EGD. Patients with preoperative gastric or duodenal inflammation had significantly less TBWL 12 mo after SG compared to patients without gastric (24.6% versus 16.7%, P = 0.04) or duodenal inflammation (25.7% versus 14.1%, P = 0.02). CONCLUSIONS: There is a high prevalence of UGI inflammation in adolescents undergoing SG. Gastric and duodenal inflammation is associated with less TBWL after SG.

Waitlist management in a pediatric weight management clinic: implementing an orientation session.

BACKGROUND: This study evaluates implementation of an orientation session to address a waitlist of more than 2000 referrals to a pediatric weight management clinic in the Mid-South United States. METHODS: An hour-long group-based orientation to the pediatric weight management clinic was implemented to provide information about the structure and expectations of the clinic as well as education on healthy lifestyle recommendations. Families were contacted from the waitlist by telephone and invited to attend an orientation session prior to scheduling a clinic appointment. RESULTS: Of 2251 patients contacted from the waitlist, 768 scheduled an orientation session, of which 264 (34 %) attended. Of the 264 orientation participants, 246 (93 %) scheduled a clinic appointment. Of those, 193 (79 %) completed a clinic visit. Waitlist times decreased from 297.8 ± 219.4 days prior to implementation of orientation sessions to 104.1 ± 219.4 days after. CONCLUSIONS: Orientation has been an effective and efficient way to triage patient referrals while maximizing attendance in limited clinic slots for patients and families demonstrating interest and motivation. Elements of this approach are likely generalizable to other pediatric clinical settings that must strategically manage a large volume of patient referrals.

Psychosocial Functioning After One Year of Interdisciplinary Pediatric Weight Management.

Youth with obesity are more likely than normal-weight peers to experience psychosocial problems. Empirically-based recommendations for addressing pediatric obesity include intensive interdisciplinary weight management comprising medical, behavioral health, nutrition, and exercise components. The present study examined changes in psychosocial functioning associated with frequency of participation in an interdisciplinary pediatric weight management program. Participants were 86 patients (55.8% females; median age = 11.5 years; 67.4% Non-Hispanic Black; median BMI percentile = 99.5) enrolled in an interdisciplinary pediatric weight management program for at least one year. Psychosocial functioning was measured with the Pediatric Symptom Checklist (PSC-17), a caregiver-completed mental health screen that assesses internalizing, externalizing, and attention difficulties as well as global functioning. The PSC-17 was completed at the initial clinic visit (baseline) and repeated one-year later (annual). The Wilcoxon Signed Rank test indicated that annual PSC-17 scores were significantly lower than baseline scores across all domains. Spearman correlation coefficients revealed no significant association between total number of clinic visits and PSC-17 global or subscale scores. However, the number of visits for exercise-only sessions was significantly correlated with caregiver-reported improvement in internalizing behaviors. Findings suggest that participation in interdisciplinary pediatric weight management may improve psychosocial functioning in youth with obesity and that attending supervised exercise sessions may be especially beneficial for improving internalizing behavior symptoms.

Potential Utility of a Loaded Treadmill Protocol for Tactical Athletes.

Swearingen, JT, Weiss, LW, Smith, WA, Stephenson, MD, and Schilling, BK. Potential utility of a loaded treadmill protocol for tactical athletes. J Strength Cond Res 32(3): 610-616, 2018-Aerobic capacity is an important variable for tactical athletes, with V[Combining Dot Above]O2max being the most direct way of estimating it in a laboratory setting. A mode-specific protocol involving fixed-weight, torso-borne loads was assessed in the current study. On 4 separate days, 15 men (age 22.1 ± 2.7 years, mass 85.1 ± 10.6 kg, height 179.0 ± 7.7 cm) performed a weighted treadmill walking protocol (2 trials) and a nonweighted treadmill running protocol (2 trials). Both the weighted and nonweighted protocols were reliable, with intraclass correlation coefficient values of 0.79 and 0.87, respectively. V[Combining Dot Above]O2peak values from both protocols were highly correlated (r = 0.90, p < 0.01). However, V[Combining Dot Above]O2peak was higher during the nonweighted protocol (t = 7.547, d = 2.47, p < 0.01). Work rate was calculated for both the last completed stage and stage during which participants reached fatigue. Work rates for both protocols on the last completed stage were similar (t = 1.44, d = 0.83, p = 0.17), although the work rate for the final attempted stage was greater for the weighted-walking protocol (t = 5.85, d = 3.60, p < 0.01). These data suggest a weighted-walking V[Combining Dot Above]O2peak that is highly associated with a running V[Combining Dot Above]O2peak. This test may be applied to those who routinely perform torso-borne load carriage, such as tactical athletes. Future weighted-walking protocols should seek achieve higher resolution, especially near the end stage of the test where subjects reach volitional fatigue. Large increases in work rate may not be feasible at the end stages of the test.

Lifestyle and metabolic syndrome in adult survivors of childhood cancer: a report from the St. Jude Lifetime Cohort Study.

BACKGROUND: Childhood cancer survivors (CCS) are at an increased risk of developing metabolic syndrome (MetSyn), which may be reduced with lifestyle modifications. The purpose of this investigation was to characterize lifestyle habits and associations with MetSyn among CCS. METHODS: CCS who were ≥ 10 years from diagnosis, aged > 18 years, and participating in the St. Jude Lifetime Cohort Study completed medical and laboratory tests and a food frequency questionnaire. The Third Report of the National Cholesterol Education Program Adult Treatment Panel criteria were used to classify participants with MetSyn. Anthropometric, food frequency questionnaire, and self-reported physical activity data were used to characterize lifestyle habits according to World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations. Those who met ≥ 4 of 7 recommendations were classified as having followed guidelines. Sex-stratified log-binomial regression models were used to evaluate associations between dietary/lifestyle habits and MetSyn, adjusted for age, age at cancer diagnosis, receipt of cranial radiotherapy, education, and household income. RESULTS: Among 1598 CCS (49.2% of whom were male, with a median age of 32.7 years [range, 18.9 years-60.0 years]), 31.8% met criteria for MetSyn and 27.0% followed WCRF/AICR guidelines. Females who did not follow WCRF/AICR guidelines were 2.4 times (95% confidence interval, 1.7-3.3) and males were 2.2 times (95% confidence interval, 1.6-3.0) more likely to have MetSyn than those who followed WCRF/AICR guidelines. CONCLUSIONS: Adherence to a heart-healthy lifestyle is associated with a lower risk of MetSyn among CCS. There is a need to determine whether lifestyle interventions prevent or remediate MetSyn in CCS.

Feasibility and initial effectiveness of home exercise during maintenance therapy for childhood acute lymphoblastic leukemia.

PURPOSE: Children with acute lymphoblastic leukemia (ALL) are at increased risk of obesity and deconditioning from cancer therapy. This pilot study assessed feasibility/initial efficacy of an exercise intervention for patients with ALL undergoing maintenance therapy. METHODS: Participants were aged 5 to 10 years, receiving maintenance therapy, in first remission. A 6-month home-based intervention, with written and video instruction, was supervised with weekly calls from an exercise coach. Pre- and poststudy testing addressed strength, flexibility, fitness, and motor function. RESULTS: Seventeen patients enrolled (participation 63%). Twelve (71%) finished the intervention, completing 81.7 ± 7.2% of prescribed sessions. Improvements of 5% or more occurred in 67% for knee and 75% for grip strength, 58% for hamstring/low-back and 83% for ankle flexibility, 75% for the 6-Minute Walk Test, and 33% for performance on the Bruininks-Oseretsky Test of Motor Proficiency Version 2. CONCLUSIONS: This pilot study demonstrated that exercise intervention during ALL therapy is feasible and has promise for efficacy.

Insurance Approval for Laparoscopic Sleeve Gastrectomy in Adolescents in the Midsouth.

Background: Metabolic and bariatric surgery (MBS) has been shown to be safe and effective for the treatment of adolescent obesity, yet many providers express hesitance to refer adolescents for surgery due to concerns for insufficient insurance coverage. Methods: The Healthy Lifestyle Clinic, a pediatric weight management clinic, was established in 2014, and an adolescent MBS program was added in 2017. Patients 15 years or older who meet the selection criteria are eligible for the surgery track. A retrospective chart review was conducted to describe our experience obtaining insurance approval for laparoscopic sleeve gastrectomy (LSG) for our adolescent patients. Results: Almost all patients who were interested in and eligible for LSG ultimately received insurance approval. Most patients had public insurance (70%). Sixty-four percent of patients were approved after the initial application, 23% were approved after a peer-to-peer review, and 11% required an appeal for approval. There was no difference in the time from insurance application to insurance approval based on age, race/ethnicity, or type of insurance. Conclusions: Age <18 years and having public health insurance have not been demonstrated as barriers to insurance approval for LSG in our cohort. Providers should not delay referral for MBS for eligible adolescents based on concern for insufficient insurance coverage. Adolescent MBS programs would benefit from a patient advocate to help families navigate the insurance approval process and reduce barriers to surgery.

Exercise training in childhood cancer survivors with subclinical cardiomyopathy who were treated with anthracyclines.

Childhood cancer survivors (CCS) treated with anthracyclines are at risk for cardiomyopathy. This case series evaluated the response of anthracycline exposed CCS with subclinical cardiomyopathy to aerobic and strength training. Body composition, strength and cardiopulmonary fitness were evaluated before and after the 12-week intervention. All equipment and materials were provided to five 10+ year CCS (3 males, mean age 38.0 ± 3.3 years) for a guideline-based home exercise program. All five completed the study with no adverse events. Compliance with exercise was 86%. These results suggest that exercise training may improve exercise capacity of CCS with subclinical cardiomyopathy. Pediatr Blood Cancer. © 2013 Wiley Periodicals, Inc.

Chemotherapy-related neuropathic symptoms and functional impairment in adult survivors of extracranial solid tumors of childhood: results from the St. Jude Lifetime Cohort Study.

OBJECTIVES: To ascertain prevalence of peripheral sensory and motor neuropathy, and to evaluate impairments in relation to function. DESIGN: St. Jude Lifetime Cohort Study, a clinical follow-up study designed to evaluate adverse late effects in adult survivors of childhood cancer. SETTING: A children's research hospital. PARTICIPANTS: Eligibility required treatment for an extracranial solid malignancy between 1962 and 2002, age ≥ 18 years, ≥ 10 years postdiagnosis, and no history of cranial radiation. Survivors (N=531) were included in the evaluation with a median age of 32 years and a median time from diagnosis of 25 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Primary exposure measures were cumulative doses of vinca-alkaloid and platinum-based chemotherapies. Survivors with scores ≥ 1 on the sensory subscale of the Modified Total Neuropathy Score were classified with prevalent sensory impairment. Those with sex-specific z scores of ≤-1.3 for dorsiflexion strength were classified with prevalent motor impairment. Participants completed the 6-minute walk test (endurance), the Timed Up & Go test (mobility), and the Sensory Organization Test (balance). RESULTS: The prevalence of sensory and motor impairment was 20% and 17.5%, respectively. Vinca-alkaloid exposure was associated with an increased risk of motor impairment (adjusted odds ratio [OR]=1.66; 95% confidence interval [CI], 1.04-2.64) without evidence for a dose response. Platinum exposure was associated with increased risk of sensory impairment (adjusted OR=1.62; 95% CI, .97-2.72) without evidence of a dose response. Sensory impairment was associated with poor endurance (OR=1.99; 95% CI, .99-4.0) and mobility (OR=1.65; 95% CI, .96-2.83). CONCLUSIONS: Vincristine and cisplatin exposure may increase risk for long-term motor and sensory impairment, respectively. Survivors with sensory impairment are at increased risk for functional performance limitations.

Prenatal exposure to acetaminophen and adolescent assessment of behavior: Discrepancies by age and reporter.

Acetaminophen, which is one of the most commonly used medications during pregnancy, has been linked to adverse neurodevelopmental outcomes among offspring during childhood. Less is known about associations with outcomes occurring later in adolescence. Methods: We conducted a follow-up study of children born between 1996 and 2002. Data on illnesses and medications, including acetaminophen, during pregnancy were collected through a standardized interview after delivery. Behavioral assessments were conducted at two subsequent time points, childhood (ages 5-10) and adolescence (ages 11-17). Outcomes examined included internalizing, externalizing, and total behavior problems based on the parent-completed Child Behavior Checklist (CBCL), the teacher-completed Teacher Report Form (TRF), and the youth-completed Youth Self Report (YSR, adolescent follow-up only). Adjusted linear regression models were used to calculate mean differences (MD) and 95% confidence intervals (95% CI) in T-scores comparing those with prenatal acetaminophen exposure to those without. Stabilized inverse probability weights were used to account for attrition. Results: Among the 216 mother-child dyads with completed parent and teacher behavioral assessments at both childhood and adolescence, prenatal acetaminophen exposure was not associated with behavioral problems according to either parent or teacher assessments. Modest increases in externalizing and total behavior problems were observed according to youth report (MD: 1.9). Compared to associations observed during the childhood follow-up, associations at adolescence were attenuated according to parent-report. Conclusion: Reported associations between prenatal acetaminophen exposure and behavioral outcomes were not consistent over time nor between reporters.

Periconceptional intakes of methyl donors and other micronutrients involved in one-carbon metabolism may further reduce the risk of neural tube defects in offspring: a United States population-based case-control study of women meeting the folic acid recommendations.

BACKGROUND: Neural tube defects (NTDs) still occur among some women who consume 400 µg of folic acid for prevention. It has been hypothesized that intakes of methyl donors and other micronutrients involved in one-carbon metabolism may further protect against NTDs. OBJECTIVES: To investigate whether intakes of vitamin B6, vitamin B12, choline, betaine, methionine, thiamine, riboflavin, and zinc, individually or in combination, were associated with NTD risk reduction in offspring of women meeting the folic acid recommendations. METHODS: Data were from the National Birth Defects Prevention Study (United States population-based, case-control). We restricted deliveries between 1999 and 2011 with daily periconceptional folic acid supplementation or estimated dietary folate equivalents ≥400 µg. NTD cases were live births, stillbirths, or terminations affected by spina bifida, anencephaly, or encephalocele (n = 1227). Controls were live births without a major birth defect (n = 7095). We categorized intake of each micronutrient as higher or lower based on a combination of diet (estimated from a food frequency questionnaire) and periconceptional vitamin supplementation. We estimated NTD associations for higher compared with lower intake of each micronutrient, individually and in combination, expressed as odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for age, race/ethnicity, education, and study center. RESULTS: NTD associations with each micronutrient were weak to modest. Greater NTD reductions were observed with concurrent higher-amount intakes of multiple micronutrients. For instance, NTD odds were ∼50% lower among participants with ≥4 micronutrients with higher-amount intakes than among participants with ≤1 micronutrient with higher-amount intake (adjusted OR: 0.53; 95% CI: 0.33, 0.86). The strongest reduction occurred with concurrent higher-amount intakes of vitamin B6, vitamin B12, choline, betaine, and methionine (adjusted OR: 0.26; 95% CI: 0.09, 0.77) compared with ≤1 micronutrient with higher-amount intake. CONCLUSIONS: Our findings support that NTD prevention, in the context of folic acid fortification, could be augmented with intakes of methyl donors and other micronutrients involved in folate metabolism.

Patterns of Prescription Medication Use during the First Trimester of Pregnancy in the United States, 1997-2018.

The objective of this analysis was to describe patterns of prescription medication use during pregnancy, including secular trends, with consideration of indication, and distributions of use within demographic subgroups. We conducted a descriptive secondary analysis using data from 9,755 women whose infants served as controls in two large United States case-control studies from 1997-2011 and 2014-2018. After excluding vitamin, herbal, mineral, vaccine, i.v. fluid, and topical products and over-the-counter medications, the proportion of women that reported taking at least one prescription medication in the first trimester increased over the study years, from 37% to 50% of women. The corresponding proportions increased with increasing maternal age and years of education, were highest for non-Hispanic White women (47%) and lowest for Hispanic women (24%). The most common indication for first trimester use of a medication was infection (12-15%). Increases were observed across the years for medications used for indications related to nausea/vomiting, depression/anxiety, infertility, thyroid disease, diabetes, and epilepsy. The largest relative increase in use among women was observed for medications to treat nausea/vomiting, which increased from 3.8% in the earliest years of the study (1997-2001) to 14.8% in 2014-2018, driven in large part by ondansetron use. Prescription medication use in the first trimester of pregnancy is common and increasing. Many medical conditions require treatments among pregnant women, often involving pharmacotherapy, which necessitates consideration of the risk and safety profiles for both mother and fetus.

Physiological Responses to Active Video Games Compared to Treadmill Walking and TV Watching in Obese Children and Adolescents.

The purpose of this study was to examine the physiological responses to playing different active video games (AVG), as well as document the activity level exerted during AVG in relation to treadmill walking (TM) and watching television (TV). 20 youth (age 11-17 yr) with obesity were recruited from the Healthy Lifestyle Clinic and underwent testing under six randomized conditions: 1) TM, 2) TV, 3) Fitnexx, 4) river rush (RRH), 5) reflex ridge (RFR), and 6) space pop (SP). RRH, RFR, and SP are active video games for the Xbox 360. Fitnexx is a prototype AVG. Each test lasted approximately ten minutes each with ten minutes between conditions and participants wore a wireless physiological monitor (Zephyr BioHarness™3) for all tests. Physical activity was assessed via accelerometer, along with heart rate (HR). Rating of Perceived Exertion (RPE) was also gathered for each condition. Repeated-measures ANOVA examined condition differences. Subjects were age 13.3 ± 2.1 years old with BMI 38.7 ± 7.9 (kg·m·s-2). Fitnexx had the highest activity level (0.63 ± 0.19g ~ jog), while activity levels for TM (0.20 ± 0.04g), RRH (0.29 ± 0.05g), RFR (0.31 ± 0.07g), and SP (0.21 ± 0.05g) were moderate (~walk), Ps < 0.05. Fitnexx had the highest HR (157 ± 13 bpm; Ps < 0.001), compared to TM (117 ± 18 bpm), RRH (128 ± 19 bpm), RFR (127 ± 18 bpm), and SP (122 ± 17 bpm), which were statistically similar. Rating of Perceived Exertion (RPE) was highest for Fitnexx (5 ± 4 RPE) compared to TM (2 ± 1 RPE) on 0-10 scale. TV had lowest activity, HR, and RPE (p < 0.04). Given these results, AVG can increase activity levels in youth with obesity and has potential as a therapeutic tool for obese children.

Misalignment between perceptual boundaries and weight categories reflects a new normal for body size perception.

Combatting the current global epidemic of obesity requires that people have a realistic understanding of what a healthy body size looks like. This is a particular issue in different population sub-groups, where there may be increased susceptibility to obesity-related diseases. Prior research has been unable to systematically assess body size judgement due to a lack of attention to gender and race; our study aimed to identify the contribution of these factors. Using a data-driven multi-variate decision tree approach, we varied the gender and race of image stimuli used, and included the same diversity among participants. We adopted a condition-rich categorization visual task and presented participants with 120 unique body images. We show that gender and weight categories of the stimuli affect accuracy of body size perception. The decision pattern reveals biases for male bodies, in which participants showed an increasing number of errors from leaner to bigger bodies, particularly under-estimation errors. Participants consistently mis-categorized overweight male bodies as normal weight, while accurately categorizing normal weight. Overweight male bodies are now perceived as part of an expanded normal: the perceptual boundary of normal weight has become wider than the recognized BMI category. For female bodies, another intriguing pattern emerged, in which participants consistently mis-categorized underweight bodies as normal, whilst still accurately categorizing normal female bodies. Underweight female bodies are now in an expanded normal, in opposite direction to that of males. Furthermore, an impact of race type and gender of participants was also observed. Our results demonstrate that perceptual weight categorization is multi-dimensional, such that categorization decisions can be driven by ultiple factors.

Oxidative stress in response to forearm ischemia-reperfusion with and without carnitine administration.

UNLABELLED: We have recently noted a decrease in lipid peroxidation with oral intake of glycine propionyl-L-carnitine (GPLC). However, these findings were observed at rest, and in previously sedentary subjects. METHODS: We determined the effect of GPLC on oxidative stress biomarkers at rest and in response to reactive hyperemia in exercise-trained men. Using a double-blind, crossover design, 15 healthy men were assigned to a placebo and GPLC (4.5 g/day) in random order, for four weeks, with a two-week washout between assignments. Blood samples were collected at rest and at 0, 3, and 10 minutes following a protocol of ischemia-reperfusion, and analyzed for lactate, malondialdehyde (MDA), F(2)-isoprostanes (F(2)-iso), hydrogen peroxide (H(2)O(2)), xanthine oxidase activity (XO), hypoxanthine (HYPO), total (TGSH) and oxidized (GSSG) glutathione, and Trolox-equivalent antioxidant capacity (TEAC). RESULTS: No condition or condition by time interaction effects were noted (p>0.05). Time effects were noted for lactate (p<0.0001), MDA (p=0.02), H(2)O(2) (p=0.0003), XO (p=0.03), HYPO (p<0.0001), TGSH (p=0.02), and GSSG (p<0.0001), with peak values noted at 0 minutes post for lactate, MDA, TGSH, and GSSG, at 3 minutes post for H(2)O(2) and XO, and at 10 minutes post for HYPO. F(2)-iso and TEAC were unaffected by treatment or protocol (p>0.05). CONCLUSION: Short-term ischemia-reperfusion in trained men results in a modest and transient increase in selected blood oxidative stress biomarkers. Oral GPLC supplementation does not attenuate the increase in these biomarkers.

Mindful Eating and Active Living: Development and Implementation of a Multidisciplinary Pediatric Weight Management Intervention.

Pediatric overweight and obesity are significant individual and public health issues that require an innovative approach. While evidence suggests that intensive family-based behavioral lifestyle modification can improve weight status, practical and logistical realities limit the ability of primary healthcare providers to intervene effectively. MEALs (Multidisciplinary Engagement and Learning/Mindful Eating and Active Living) is a family-based mindfulness intervention developed to address pediatric overweight and obesity, while improving healthy lifestyle behaviors through cooking classes. The incorporation of mindfulness, a psychological strategy associated with increased awareness of internal experiences, allows for a focus on the importance of healthy eating along with safe and efficacious kitchen practices. The Template for Intervention Description and Replication (TIDieR) checklist and guide is used to describe the intervention with the intention of providing necessary details to implement the intervention in clinical practice or replicate the intervention for further study. Lessons learned from pilot iterations of the intervention are provided.

Glycine propionyl-L-carnitine modulates lipid peroxidation and nitric oxide in human subjects.

OBJECTIVE: To determine the efficacy of glycine propionyl-L-carnitine (GPLC) to decrease lipid peroxidation, elevate nitric oxide, and improve blood lipid profiles in human subjects. METHODS: Thirty untrained, normolipidemic subjects performed eight weeks of supervised aerobic exercise while supplementing GPLC at one of two doses (1 or 3 grams daily of PLC + glycine) or placebo, following random assignment in a double-blind manner. Fasting blood samples were analyzed at rest for malondialdehyde, nitric oxide, and lipids before and after the intervention. RESULTS: Malondialdehyde was decreased (p<0.05) from pre- to post-intervention with 1 g GPLC (1.08+/-0.24 vs. 0.69+/-0.25 micromol.L (-1)) and 3 g GPLC (0.94+/-0.18 vs. 0.66+/-0.17 micromol.L (-1)), but did not change statistically (p>0.05) with placebo (1.12+/-0.21 vs. 1.03+/-0.23 micromol.L (-1)). Nitric oxide was increased (p<0.05) from pre- to post-intervention with 3 g GPLC (21.34+/-2.27 vs. 29.46+/-3.61 micromol.L (-1)), but did not change statistically (p>0.05) with 1 g GPLC (23.22+/-4.13 vs. 26.24+/-4.32 micromol.L (-1)) or placebo (24.31+/-3.90 vs. 26.14+/-4.11 micromol.L (-1)). No main effects or interaction effects were noted for blood lipids (p>0.05). CONCLUSION: GPLC supplementation combined with eight weeks of aerobic exercise decreases lipid peroxidation and elevates nitric oxide, but does not further improve blood lipid profiles in normolipidemic subjects.

Oxidative stress in response to aerobic and anaerobic power testing: influence of exercise training and carnitine supplementation.

The purpose of this study is to compare the oxidative stress response to aerobic and anaerobic power testing, and to determine the impact of exercise training with or without glycine propionyl-L-carnitine (GPLC) in attenuating the oxidative stress response. Thirty-two subjects were assigned (double blind) to placebo, GPLC-1 (1g PLC/d), GPLC-3 (3g PLC/d) for 8 weeks, plus aerobic exercise. Aerobic (graded exercise test: GXT) and anaerobic (Wingate cycle) power tests were performed before and following the intervention. Blood was taken before and immediately following exercise tests and analyzed for malondialdehyde (MDA), hydrogen peroxide (H2O2), and xanthine oxidase activity (XO). No interaction effects were noted. MDA was minimally effected by exercise but lower at rest for both GPLC groups following the intervention (p = 0.044). A time main effect was noted for H2O2 (p = 0.05) and XO (p = 0.003), with values increasing from pre- to postexercise. Both aerobic and anaerobic power testing increase oxidative stress to a similar extent. Exercise training plus GPLC can decrease resting MDA, but it has little impact on exercise-induced oxidative stress biomarkers.

A Randomized Study of Exercise and Fitness Trackers in Obese Patients After Total Knee Arthroplasty.

Functional limitations persist in obese patients after total knee arthroplasty (TKA). This study assessed the effect of an exercise program (EP) and fitness trackers (FT) in obese patients with TKA. Sixty patients 1 year after orthopedic surgery were recruited and received a 16-week tailored EP; half were randomized to receive an FT. FT had no measurable effect compared with EP alone. EP improved knee range of motion, strength, and quality-of-life scores. This study provides preliminary evidence that a 16-week EP in obese individuals 1 year post TKA is feasible and effective in improving function and quality of life.