Systematic Review of Behaviour Change Theories Implementation in Dietary Interventions for People Who Have Survived Cancer.

BACKGROUND: An increasing number of dietary interventions for cancer survivors have been based on the behaviour change theory framework. The purpose of this study is to review the use and implementation of behaviour change theories in dietary interventions for people after cancer and assess their effects on the reported outcomes. METHODS: The search strategy from a Cochrane review on dietary interventions for cancer survivors was expanded to incorporate an additional criterion on the use of behaviour change theory and updated to September 2020. Randomised controlled trials (RCT) testing a dietary intervention compared to the control were included. Standard Cochrane methodological procedures were used. RESULTS: Nineteen RCTs, with 6261 participants (age range 44.6 to 73.1 years), were included in the review. The Social Cognitive Theory was the most frequently used theory (15 studies, 79%). Studies included between 4 to 17 behaviour change techniques. Due to limited information on the mediators of intervention and large heterogeneity between studies, no meta-analyses was conducted to assess which theoretical components of the interventions are effective. CONCLUSIONS: Whilst researchers have incorporated behaviour change theories into dietary interventions for cancer survivors, due to inconsistencies in design, evaluation and reporting, the effect of theories on survivors' outcomes remains unclear.

Risk Reduction and Prevention of Alzheimer's Disease: Biological Mechanisms of Diet.

Alzheimer's Disease (AD) incidence is increasing and with no disease modifying agents available, preventative measures through lifestyle factors are being investigated. Combined with the prevention of AD risk factors such as heart disease, diabetes, and with more recent evidence, microbiome dysfunction, there is a substantial foundation for diet as a modifiable risk factor and preventative measure for AD. Recent evidence suggests AD associated pathologies, such as oxidative stress and inflammation, can be modulated by the lipids, vitamins, and polyphenols obtained through nutritional intake. Furthermore, epidemiological and preclinical evidence has uncovered certain compounds within foods that may have beneficial effects in the prevention of AD, including omega-3 fatty acids, vitamin E, and resveratrol among others. However, clinical data examining specific compounds are often inconsistent and fail to replicate the preclinical data. On the other hand, dietary patterns such as the Mediterranean or MIND diet have shown promise in terms of clinical outcomes for patients, indicating a reductionist approach to diet is not as effective as a holistic dietary pattern. In this review, we summarize some of the biological mechanisms of key compounds in their relation to AD and how they fit into a dietary pattern that supports the role of diet as a risk reducing factor for AD.

"It's Healthy Because It's Natural." Perceptions of "Clean" Eating among U.S. Adolescents and Emerging Adults.

Definitions for the culturally trendy "clean" eating phenomenon vary: whereas some characterize it as natural and healthy, others adopt more restrictive, moralizing, and affectively-laden definitions that may reflect disordered eating. We examined levels of familiarity with "clean" eating, sources of information, and perceptions of this dietary trend among a large, diverse sample of U.S. adolescents and emerging adults recruited from the National MyVoice Text Message Cohort (n = 1266; ages 14-24 years). Participants answered five questions assessing knowledge of "clean" eating, definitions, perceived healthiness vs. harm, and willingness to adopt "clean" eating, and responses were coded by three trained researchers. Results indicate that 55% of respondents had previously heard of "clean" eating, most commonly through social media, other online sources, and peers. Definitions were heterogeneous, with 40% offering "non-processed" or "whole foods" and 13% noting "non-GMO" or "organic" components. Few respondents (0.6%) expressed outright skepticism about "clean" eating, but many (30%) identified dietary avoidance and restriction as part of the definition. Overall, 71% characterized "clean" eating as a healthy approach, whereas 6% flagged it as "unhealthy", and 18% noted elements of both healthfulness and harm. Notably, 41% reported they "probably would" try "clean" eating themselves, with greater willingness to try "clean" eating among cisgender women. Present findings highlight high levels of awareness and positive attitudes toward "clean" eating among young people in the U.S., with little recognition of the potential risks of dietary restriction. Further research should examine actual dietary behaviors to clarify potential risks of "clean" eating and related trends and thus inform strategies for eating disorder prevention.

Meal planning values impacted by the cancer experience in families with school-aged survivors-a qualitative exploration and recommendations for intervention development.

PURPOSE: Increased cardiovascular disease and second cancer risks among childhood cancer survivors (CCS) makes them and their families important audiences for nutrition intervention. Family meals and home cooking practices have been associated with improved diet and health, but there is a gap in the literature on understanding these behaviors and their motivating values among CCS families. This study qualitatively explores family meal values and behaviors in a sample of CCS parent-child dyads. METHODS: This observational and qualitative study recruited a convenience sample of 11 parent-CCS dyads. Data collection included audio and video recording of food preparation events in participant homes, which were analyzed with an inductive coding technique to examine meal-related values in CCS families. RESULTS: Analyses revealed four major categories of meal values. Effort, including time and difficulty, as well as budget, healthfulness, and family preferences emerged as recurrent values impacting meal preparation. These values were impacted by the cancer experience upon diagnosis, during treatment, and into survivorship. CONCLUSIONS: A better understanding of CCS family meal planning values, the impact of the cancer experience on these values, and the inclusion of CCS in food preparation reveals potential intervention targets, facilitators, and barriers for future interventions to improve dietary behaviors among CCS.

Dietary Intake, Adherence to Mediterranean Diet and Lifestyle-Related Factors in People with Schizophrenia.

The purpose of this study was to examine the dietary intake of both inpatients and outpatients with schizophrenia in the Portuguese population as a potential key contributing factor to the poor physical health profiles, and understand the relationship of diet quality to other lifestyle factors. Participants of this cross-sectional study completed a semi quantitative food frequency questionnaire. Diet quality was determined by adherence to the Mediterranean Diet. In addition participants completed the International Physical Activity Questionnaire-Short-Form and Pittsburgh Sleep Quality Index. Tobacco smoking was assessed through a series of general questions. A total of 100 patients (50% inpatients and 28% female) with schizophrenia were included in the final analysis. Patients reported a high consumption of caffeine, while deficits were evident for fibre and folate intakes, when compared to the European Food Safety Authority recommendations. Both inpatients and outpatients reported poor to moderate diet quality. Smokers reported poorer diet quality when compared to non-smokers (p < 0.001). Dietary intake, and its relationship to other lifestyle components, should be considered for intervention, in order to improve physical health of people living with schizophrenia.

Effect of quantitative and qualitative diet prescription on children behavior after diagnosis of heterozygous familial hypercholesterolemia.

BACKGROUND: Diet and healthy modifications in lifestyle represent the first therapeutic approach for early intervention in hypercholesterolemia. We aimed to evaluate the impact of a qualitative dietetic program rather than a quantitative one on metabolic parameters and anxiety level of children affected by heterozygous familial hypercholesterolemia [heFH] and their mothers. METHODS: In a sample of 42 heFH normal weight children (11.4 ±â€¯2.9 years old), we investigated the factors which were associated with children perceived quality of life and with their mothers' anxiety levels after qualitative dietary changes rather than after quantitative ones. RESULTS: The administered diets had similar metabolic effects. However, higher Child Behavior Checklist (Behavior Problems subscale) [CBCL] scores were significantly associated with the permanence in quantitative diet, as well as children's higher age, higher Children's Depression Inventory 2 [CDI2] and State-Trait Anxiety Inventory for Children [STAI-CH] score, and with mothers' anxiety at the baseline. CONCLUSION: In heFH children, an intervention in the diet to improve food choice seems to be associated with a more healthy children behavior rather than a quantitative diet.

Increased self-care activities and glycemic control rate in relation to health education via Wechat among diabetes patients: A randomized clinical trial.

BACKGROUND: Health education has been considered as the effectiveness method to increase the self-care skills of diabetes patients. However, limited studies to investigate the association of health education via Wechat platform on increased the basic self-care skills and glycemic control rate in patients with type 2 diabetes. METHODS: A total number of 120 type 2 diabetes patients were randomized into intervention (health education by Wechat platform plus usual care) and the control group (usual care). Biochemical parameters including fasting plasma glucose (FPG), 2-hour plasma glucose (2hPG), glycosylated hemoglobin A1c (HbA1c) were measured among the 2 groups at baseline 6-month and 12-month. Diabetes Management Self-Efficacy (SE) Scale was completed at baseline 6-month and 12-month. RESULTS: Significant difference of HbA1c concentration and SE were found between intervention and control groups at 6-month and 12-month (P <.05). The effect of groups and health education duration times was found on reduced HbA1c concentration and increased the total score of SE (P <.05). No significant difference of FPG and 2hPG concentrations were found between intervention and control groups at 6 months and 12 months (P >.05). CONCLUSION: Health education of diabetic individuals via Wechat platform in conjunction with conventional diabetes treatment could improve glycemic control and positively influence other aspects of diabetes self-care skills.

Fish oil supplement use in New Zealand: A cross-sectional survey.

OBJECTIVE: The aims of the survey were to determine: (i) the percentage of fish oil supplement users in a sample population; (ii) why people take fish oil supplements; (iii) where fish oil supplements are stored as well as the average daily dosage; (iv) what dietary and lifestyle behaviours are associated with fish oil supplement use. DESIGN: An online cross-sectional survey. SETTING: New Zealand. RESPONDENTS: A total of 334 New Zealand residents over the age of 18. RESULTS: Fish oil supplements were taken by 21.9% of respondents. Reasons for taking fish oil supplements were - 72.6% for 'general well-being', 54.8% to 'improve brain function', 31.5% for 'pain/inflammation', 12.3% to 'lower cholesterol levels' and 11% for 'a dietary insufficiency'. Approximately 26% of fish oil users reported taking a dose of fish oil supplements that would meet the recommended daily intake of 400-600 mg combined docosahexaenoic acid and eicosapentaenoic acid, and only 6.8% of fish oil users reported storing their fish oil supplements in the refrigerator. After controlling for other characteristics including age, gender, ethnicity and body mass index, fish oil supplementation use was most likely among respondents who already eat oily fish and least likely in respondents who regularly eat nuts and seeds. CONCLUSIONS: Fish oil supplements are a commonly used supplement in New Zealand, yet questions remain about the role of these supplements in improving health outcomes. Safety issues related to manufacturing and storage conditions indicate that there is an urgency in answering these questions.

Heart-rate variability: a biomarker to study the influence of nutrition on physiological and psychological health?

As the influence of diet on health may take place over a period of decades, there is a need for biomarkers that help to identify those aspects of nutrition that have either a positive or a negative influence. The evidence is considered that heart-rate variability (HRV) (the time differences between one beat and the next) can be used to indicate the potential health benefits of food items. Reduced HRV is associated with the development of numerous conditions for example, diabetes, cardiovascular disease, inflammation, obesity and psychiatric disorders. Although more systematic research is required, various aspects of diet have been shown to benefit HRV acutely and in the longer term. Examples include a Mediterranean diet, omega-3 fatty acids, B-vitamins, probiotics, polyphenols and weight loss. Aspects of diet that are viewed as undesirable, for example high intakes of saturated or trans-fat and high glycaemic carbohydrates, have been found to reduce HRV. It is argued that the consistent relationship between HRV, health and morbidity supports the view that HRV has the potential to become a widely used biomarker when considering the influence of diet on mental and physical health.

Rationale and design for the community activation for prevention study (CAPs): A randomized controlled trial of community gardening.

BACKGROUND: Engaging in health-promoting behaviors (e.g., healthy fruit- and vegetable-rich diet, physical activity) and living in supportive social and built environments are consistently and significantly associated with reductions in cancer, heart disease, diabetes, and other chronic diseases. Interventions to change diet and physical activity behaviors should aim to educate individuals, change the environments in which people live, work and recreate, improve access, availability, and affordability of healthy foods, and create safe places the facilitate active lifestyles. This trial will assess whether community gardening increases fruit and vegetable consumption and physical activity, improves social support and mental health, and reduces age-associated weight gain and sedentary time among a multi-ethnic, mixed-income population. METHODS/DESIGN: A randomized controlled trial of community gardening began in Denver, Colorado in January 2017. Over 3 years, we will recruit 312 consenting participants on Denver Urban Gardens' waitlists and randomize them to garden or remain on the waitlist. At baseline (pre-gardening), harvest time, and post-intervention, study participants will complete three 24-hour dietary recalls, a 7-day activity monitoring period using accelerometry, a health interview and physical anthropometry. DISCUSSION: This project addresses health-promoting behaviors among a multi-ethnic, mixed-income adult population in a large metropolitan area. If successful, this trial will provide evidence that community gardening supports and sustains healthy and active lifestyles, which can reduce risk of cancer and other chronic diseases. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03089177: Registered on 03/17/17.

The Role of Primary Care Providers in Encouraging Older Patients to Change Their Lifestyle Behaviors.

OBJECTIVES: This study sought to identify older patients' perceptions of primary care providers' influence on their likelihood of improving diet and physical activity. METHODS: 104 adults ages 65 and older were interviewed immediately following a routine primary care visit about their plans and motivations for behavior change and how their clinic visit would influence their likelihood of making lifestyle changes. All interviews were recorded, transcribed and analyzed using a constant comparison approach. RESULTS: Participants reported that their providers influence their health behaviors by developing strong relationships, addressing concerns and encouraging change, and providing concrete instruction. When providers did not discuss diet or physical activity, or mentioned these topics only briefly, participants often perceived the message that they should continue their current behaviors. CONCLUSIONS: Whether and how diet and physical activity are discussed in primary care influences the likelihood that older adults will make changes in these behaviors. CLINICAL IMPLICATIONS: These findings highlight the need for a patient-centered counseling approach and caution providers to think twice before omitting discussion of the need for lifestyle change.

Acceptability of dietary and physical activity lifestyle modification for men following radiotherapy or radical prostatectomy for localised prostate cancer: a qualitative investigation.

BACKGROUND: The experience and acceptability of lifestyle interventions for men with localised prostate cancer are not well understood, yet lifestyle interventions are increasingly promoted for cancer survivors. We explored the opinions, experiences and perceived acceptability of taking part in nutritional and physical activity interventions amongst men with prostate cancer and their partners; with the ultimate plan to use such information to inform the development of nutritional and physical activity interventions for men with prostate cancer. METHODS: Semi-structured interviews with 16 men, and seven partners, undergoing curative surgery or radiotherapy for prostate cancer. Interviews explored experiences of lifestyle interventions, acceptable changes participants would make and perceived barriers and facilitators to change. Interviews were thematically analysed using the framework approach. RESULTS: Men were frequently open to lifestyle modification and family support was considered vital to facilitate change. Health beneficial, clinician endorsed, understandable, enjoyable interventions were perceived as attractive. Barriers included 'modern' digital technology, poor weather, competing commitments or physical limitations, most notably incontinence following radical prostatectomy. Men were keen to participate in research, with few negative aspects identified. CONCLUSIONS: Men are willing to change behaviour but this needs to be supported by clinicians and health professionals facilitating lifestyle change. An 'intention-behaviour gap', when an intended behaviour does not materialise, may exist. Digital technology for data collection and lifestyle measurement may not be suitable for all, and post-surgery urinary incontinence is a barrier to physical activity. These novel findings should be incorporated into lifestyle intervention development, and implemented clinically.

Brief self-efficacy scales for use in weight-loss trials: Preliminary evidence of validity.

Self-efficacy is a commonly included cognitive variable in weight-loss trials, but there is little uniformity in its measurement. Weight-loss trials frequently focus on physical activity (PA) and eating behavior, as well as weight loss, but no survey is available that offers reliable measurement of self-efficacy as it relates to each of these targeted outcomes. The purpose of this study was to test the psychometric properties of brief, pragmatic self-efficacy scales specific to PA, healthful eating and weight-loss (4 items each). An adult sample (n = 1,790) from 28 worksites enrolled in a worksite weight-loss program completed the self-efficacy scales, as well as measures of PA, dietary fat intake, and weight, at baseline, 6-, and 12-months. Confirmatory factor analysis supported the hypothesized factor structure indicating, 3 latent self-efficacy factors, specific to PA, healthful eating, and weight-loss. Measurement equivalence/invariance between relevant demographic groups, and over time was also supported. Parallel growth processes in self-efficacy factors and outcomes (PA, fat intake, and weight) support the predictive validity of score interpretations. Overall, this initial series of psychometric analyses supports the interpretation that scores on these scales reflect self-efficacy for PA, healthful eating, and weight-loss. The use of this instrument in large-scale weight-loss trials is encouraged. (PsycINFO Database Record

Perceived influences on post-diagnostic dietary change among a group of men with prostate cancer.

A cancer diagnosis is often associated with loss of agency and control that can adversely affect well-being. Patients may try to regain control through dietary change aimed at preventing progression and/or recurrence. Evidence for the effectiveness of post-diagnostic dietary change in prostate cancer is not conclusive, which can cause uncertainty among patients and health professionals. This qualitative study explored how eight men in the U.K., who had been diagnosed with prostate cancer in the previous 5 years, accounted for any post-diagnostic changes they made to their diet. Data were generated through semi-structured telephone interviews and were subjected to thematic analysis. This yielded two themes concerning the perceived nature and importance of dietary change and the perceived determinants of dietary change. The latter focused on internal dimensions such as agency and external dimensions such as the perceived role of relationships with health professionals, the availability of credible dietary information and family influences. The study points to the importance of the family context in enabling the men to implement dietary change. It is suggested that, even if health professionals can only offer qualified, general advice about diet, this may provide men with a focus for action and a means of regaining control.

Changing the endpoints for determining effective obesity management.

Health authorities worldwide recommend weight loss as a primary endpoint for effective obesity management. Despite a growing public awareness of the importance of weight loss and the spending of billions of dollars by Americans in attempts to lose weight, obesity prevalence continues to rise. In this report we argue that effective obesity management in today's environment will require a shift in focus from weight loss as the primary endpoint, to improvements in the causal behaviors; diet and exercise/physical activity (PA). We reason that increases in PA combined with a balanced diet are associated with improvement in many of the intermediate risk factors including cardiorespiratory fitness (CRF) associated with obesity despite minimal or no weight loss. Consistent with this notion, we suggest that a focus on healthy behaviors for the prevention of additional weight gain may be an effective way of managing obesity in the short term.

Positive and cost-effectiveness effect of spa therapy on the resumption of occupational and non-occupational activities in women in breast cancer remission: a French multicentre randomised controlled trial.

PURPOSE OF THE RESEARCH: The main aim was to assess the effects of a spa treatment on the resumption of occupational and non-occupational activities and the abilities of women in breast cancer remission. A cost-effectiveness analysis (CEA) was also performed. METHODS AND SAMPLE: A multicentre randomised controlled trial was carried out between 2008 and 2010 in the University Hospital of Auvergne and two private hospitals in Clermont-Ferrand, France. Eligible patients were women in complete breast cancer remission without contraindication for physical activities or cognitive disorders and a body mass index between 18.5 and 40 kg/m(2). The intervention group underwent spa treatment combined with consultation with dietician whereas the control underwent consultations with the dietician only. Of the 181 patients randomised, 92 and 89 were included in the intervention and the control groups, respectively. The CEA involved 90 patients, 42 from the intervention group and 48 from the control group. KEY RESULTS: The main results showed a higher rate of resumption of occupational activities in the intervention group (p = 0.0025) and a positive effect of the intervention on the women's ability to perform occupational activities 12 months after the beginning of the study (p = 0.0014), and on their ability to perform family activities (p = 0.033). The stay in a thermal centre was cost-effective at 12 months. CONCLUSIONS: Spa treatment is a cost-effective strategy to improve resumption of occupational and non-occupational activities and the abilities of women in breast cancer remission.

Problemas de adherencia a dietoterapia en pacientes hipertensos pehuenches / Problems of adherence to diet therapy in hypertensive pehuenche patients

Background: Hypertension is a disease with a high national prevalence which increases in sectors where there are indigenous populations. The complexity of the disease lies in the behavior that must be maintained to effectively adhere to medication and diet therapy. Objective: To understand the cultural factors that are associated with problems of adherence to diet therapy in hypertensive pehuenches. Methods: Qualitative study in hypertensive patients who do not adhere to diet therapy. We interviewed 42 individuals in the municipality of Alto Bio Bio for 6 months, analyzing them using semantic structural analysis completed with the saturation point of speech. Results: Discourse analysis showed the following results: a) ethnic foods have a symbolic value, b) ethnic foods are described as "natural" in opposition to any food that does not occur in their environment, although they are based in a high consumption of fats, proteins and carbohydrates, c) nonexistent biochemical properties ascribed to ethnic foods justify their use. Conclusion: there are cultural differences between the prescription of the nutritionist and the eating behavior of pehuenches, which affect non-compliance with diet and disease complications.

Introducción: La hipertensión arterial es una patología con una alta prevalencia nacional que aumenta en sectores con poblaciones indígenas. La complejidad de la enfermedad radica en la conducta que se debe mantener para adherir eficazmente al tratamiento farmacológico y dietoterápico. Objetivo: Comprender los factores culturales que se asocian a los problemas de adherencia a la dietoterapia en pacientes hipertensos pehuenches. Metodología: Estudio cualitativo, en pacientes hiper-tensos pehuenches que no adhieren a Dietoterapias. Se entrevistó a 42 pehuenches de la Comuna de Alto Bio Bío durante 6 meses. El análisis de los datos se realizó mediante análisis semántico estructural. La muestra se logró mediante el punto de saturación. Resultados: El análisis de discurso arroja los siguientes resultados: a) los alimentos étnicos tienen un valor simbólico b) los alimentos étnicos son calificados como "naturales" en contraposición a cualquier alimento que no se produzca en su medio, aunque se basan en un alto consumo de grasas, proteínas y carbohidratos, c) a los alimentos étnicos se les atribuye propiedades bioquímicas inexistentes con los cuales se justifica su consumo. Conclusión: Existen diferencias culturales entre la prescripción del nutricionista y lo realizado por pehuenches que inciden en el no cumplimiento de la dietoterapia y complicación de la enfermedad.

High trait self-control predicts positive health behaviors and success in weight loss.

Surprisingly few studies have explored the intuitive connection between self-control and weight loss. We tracked participants' diet, exercise and weight loss during a 12-week weight loss program. Participants higher in self-control weighed less and reported exercising more than their lower self-control counterparts at baseline. Independent of baseline differences, individuals high in dispositional self-control ate fewer calories overall and fewer calories from fat, burned marginally more calories through exercise, and lost more weight during the program than did those lower in self-control. These data suggest that trait self-control is, indeed, an important predictor of health behaviors.