Using the Hierarchies of Evidence Applied to Lifestyle Medicine (HEALM) Approach to Assess the Strength of Evidence on Associations between Dietary Patterns and All-Cause Mortality.

Dietary guidelines should be underpinned by high-quality evidence. Quality assessment methods that reflect traditional evidence hierarchies prioritise evidence from randomised controlled trials (RCTs). The Hierarchies of Evidence Applied to Lifestyle Medicine (HEALM) approach is an alternative quality assessment method for research questions that for practical and/or ethical reasons, cannot be answered using RCTs. The aim of this study was to investigate how the HEALM approach could be used to assess the strength of evidence on associations between dietary patterns and all-cause mortality (a research question that is difficult to answer using RCTs). Two data sources were used: an existing systematic review of dietary patterns and all-cause mortality that synthesised evidence from observational studies; and an overview of reviews that was conducted to summarise relevant evidence from mechanistic and intervention studies. A set of four criteria were developed and used in the application of HEALM. Using different datasets in combination, the strength of evidence was rated as 'Grade B: moderate/suggestive' or 'Grade C: insufficient/inconclusive'. HEALM is a novel approach for integrating and assessing the strength of evidence from mechanistic, intervention, and observational studies. Further research is needed to address the practical challenges that were identified in the application of HEALM.

A Systematic Review of the Methods Used to Assess and Report Dietary Patterns.

The use of dietary pattern assessment methods has increased over time. However, data from individual studies can be difficult to compare and synthesize when the dietary pattern assessment methods, and the dietary patterns that are identified are not described sufficiently. The aims of this systematic review were to analyze the application and reporting of dietary pattern assessment methods, and the reporting of the dietary patterns that were analyzed with health outcomes. Three electronic databases were searched (Medline, Embase, and Global Health). Cohort and nested case control studies published in English between January 1980 and March 2019 that examined associations between dietary patterns and health outcomes (including cardiovascular disease, cancer, diabetes and metabolic syndrome, and body weight) in apparently healthy, community dwelling adults (aged over 18 years) or children (aged 2-18 years) were eligible for inclusion. A narrative synthesis was conducted and descriptive statistics were used to summarize the application and reporting of each dietary pattern assessment method, and the reporting of the identified dietary patterns. Analysis of associations between dietary patterns and health outcomes was beyond the scope of this review. Of the included studies (n = 410), 62.7% used index-based methods, 30.5% used factor analysis or principal component analysis, 6.3% used reduced rank regression, and 5.6% used cluster analysis. Some studies (4.6%) used more than one method. There was considerable variation in the application and reporting of dietary pattern assessment methods. For example, the application of Mediterranean diet indices varied in terms of the nature of dietary components (foods only or foods and nutrients) and the rationale behind the cut-off points (absolute and/or data driven). In some cases, important methodological details were omitted. The level of detail used to describe the dietary patterns also varied, and food and nutrient profiles were often not reported. To ensure dietary patterns evidence can be synthesized and translated into dietary guidelines, standardized approaches for the application and reporting of dietary pattern assessment methods and the reporting of the identified dietary patterns would be beneficial.

Examination of selected national policies towards mandatory folic acid fortification.

The purpose of this paper is to present an examination of the contrasting policies towards mandatory folic acid fortification in six countries from different regions of the world. Three questions are addressed: 1) What is the policy of the country? 2) Why was the policy adopted? 3) What lessons have been learned? Policy contrasts among countries were assessed as reflecting different interpretations of the potential risks and benefits associated with folic acid fortification. Although commonalities were identified, it was considered unlikely that there could be a standard policy response for all countries. Instead, a country-by-country policy response based on national circumstances is indicated.

Functional neurons and melanocytes induced from immortal lines of postnatal neural crest-like stem cells.

Stem cells, that is, cells that can both reproduce themselves and differentiate into functional cell types, attract much interest as potential aids to healing and disease therapy. Embryonic neural crest is pluripotent and generates the peripheral nervous system, melanocytes, and some connective tissues. Neural-crest-related stem cells have been reported previously in postnatal skin: committed melanocytic stem cells in the hair follicle, and pluripotent cell types from the hair follicle and papilla that can produce various sets of lineages. Here we describe novel pluripotent neural crest-like stem cells from neonatal mouse epidermis, with different potencies, isolated as 3 independent immortal lines. Using alternative regulatory factors, they could be converted to large numbers of either Schwann precursor cells, pigmented melanocytes, chondrocytes, or functional sensory neurons showing voltage-gated sodium channels. Some of the neurons displayed abundant active TRPV1 and TRPA1 receptors. Such functional neurons have previously been obtained in culture only with difficulty, by explantation. The system was also used to generate comparative gene expression data for the stem cells, melanocytes, and melanoblasts that sufficiently explain the lack of pigment in melanoblasts and provide a rationale for some genes expressed apparently ectopically in melanomas, such as ephrin receptors.

A systematic policy approach to changing the food system and physical activity environments to prevent obesity.

As obesity prevention becomes an increasing health priority in many countries, including Australia and New Zealand, the challenge that governments are now facing is how to adopt a systematic policy approach to increase healthy eating and regular physical activity. This article sets out a structure for systematically identifying areas for obesity prevention policy action across the food system and full range of physical activity environments. Areas amenable to policy intervention can be systematically identified by considering policy opportunities for each level of governance (local, state, national, international and organisational) in each sector of the food system (primary production, food processing, distribution, marketing, retail, catering and food service) and each sector that influences physical activity environments (infrastructure and planning, education, employment, transport, sport and recreation). Analysis grids are used to illustrate, in a structured fashion, the broad array of areas amenable to legal and regulatory intervention across all levels of governance and all relevant sectors. In the Australian context, potential regulatory policy intervention areas are widespread throughout the food system, e.g., land-use zoning (primary production within local government), food safety (food processing within state government), food labelling (retail within national government). Policy areas for influencing physical activity are predominantly local and state government responsibilities including, for example, walking and cycling environments (infrastructure and planning sector) and physical activity education in schools (education sector). The analysis structure presented in this article provides a tool to systematically identify policy gaps, barriers and opportunities for obesity prevention, as part of the process of developing and implementing a comprehensive obesity prevention strategy. It also serves to highlight the need for a coordinated approach to policy development and implementation across all levels of government in order to ensure complementary policy action.