Fueling for and recovering from resistance training: The periworkout nutrition practices of competitive powerlifters.

PURPOSE: Nutrient timing is a concept that emphasizes the intentional ingestion of whole or fortified foods, and dietary supplements, to adequately fuel for, and recover from, acute and chronic exercise. The nutrition strategies used by powerlifters around training sessions have not, to our knowledge, been previously investigated. This study explored the self-reported periworkout (before, during, and after) nutrition practices of competitive powerlifters, including what, why, and information source that informed practice, with comparison to current sport nutrition guidelines. METHODS: Actively competing male (n = 240) and female (n = 65) powerlifters completed a cross-sectional online survey of self-reported periworkout nutrition practices in the pre-, intra-, and postexercise periods, fasted training, and supplementation. Data are presented as the number (n) and percentage (%) of all powerlifters practicing a given strategy followed by a % of responses reporting various practices or beliefs within this strategy. Categorical subgroups (sex, age, and weight class; and competitive caliber) were analyzed with a chi-square test or Fisher's exact test and denoted where significant (P ≤ 0.05). RESULTS: Most powerlifters reported paying specific attention to nutrition practices in the pre-exercise period (n = 261; 85.6%) by ingesting more carbohydrate (CHO) rich foods (n = 234; 89.6%) for the purpose of assisting in training performance (n = 222; 85.1%). Most powerlifters reported intraexercise nutrition strategies (n = 211; 69.2%), of which most included ingesting more CHO rich foods (n = 159; 74.5%) for the purpose of feeling less hungry and/or boosting energy levels during training (n = 129; 61.1%). Most powerlifters reported paying attention to postexercise nutrition (n = 244; 80%), by ingesting more protein rich foods (n = 182; 74.6%) for the purpose of recovering better for the whole day (n = 152; 62.3%) and enhancing the benefits of training (n = 149; 61.1%). Most powerlifters did not complete training sessions in the fasted state (n = 262; 85.9%). Most powerlifters reported paying attention to supplementation before training (n = 237; 77.7%), of which preworkout formulas (n = 137; 57.8%), energy drinks (n = 101; 42.6%), creatine (n = 88; 37.1%), and caffeine pills (n = 70; 29.5%) were most reported. Supplementation was used to assist in training performance (n = 197; 83.1%) and increase wakefulness/alertness (n = 183; 77.2%). Males reported more often than females that they informed multiple elements of their nutrition practices with the information they read or watched somewhere (P = 0.002-0.012). CONCLUSION: The periworkout nutrition practices used by competitive powerlifters followed current sport nutrition guidelines, by using CHO sources to fuel for training and ensuring the provision of protein postexercise. Competitive powerlifters may wish to exert caution with supplementation, as there is a risk of harm or inadvertent doping.

The Human Interference Scoring System (HISS): A New Tool for Quantifying Food Quality Based on Its Level of Processing.

The Human Interference Scoring System (HISS) is a novel food-based diet-quality-classification system based on the existing NOVA method. HISS involves food and fluid allocation into categories from digital imagery based on food processing levels, followed by meal plan analysis using food-servings quantification. The primary purpose of this work was to evaluate the reliability of HISS. Trained nutrition professionals analyzed digital photographs from five hypothetical 24 h food recalls and categorized foods into one of four HISS categories. A secondary purpose was to assess the nutrient composition of the food recalls and other selected foods from the HISS categories. Participants effectively categorized foods into HISS categories, with only minor discrepancies noted. High inter-rater reliability was observed in the outer HISS categories: unprocessed and ultra-processed foods. Ultra-processed items consistently displayed elevated energy, carbohydrates, and sugar compared to unprocessed foods, while unprocessed foods exhibited notably higher dietary fiber. This study introduces the HISS as a potentially useful tool for quantifying a food-quality-based system using digital-photography-based assessments. Its high inter-rater reliability and ability to capture relationships between food processing levels and nutrient composition make it a promising method for assessing dietary habits and food quality.

A low-carbohydrate diet in place of SGLT2i therapy in a patient with diabetic cardiomyopathy.

Summary: In patients with diabetes mellitus, the toxic milieu caused by abnormal glucose and free fatty acid handling can lead to heart failure (HF). Referred to as diabetic cardiomyopathy (DMCM), this syndrome often exists in the absence of conventional risk factors for HF such as history of myocardial infarction or hypertension. Low-carbohydrate diets (LCDs) have recently been endorsed as an efficacious therapeutic dietary approach to prevent and reverse cardiometabolic disease including type 2 diabetes mellitus (T2DM). LCDs improve systemic insulin resistance (IR), reverses cardiac remodelling in a rodent model and downregulates the expression of sodium-glucose co-transporter 2 (SGLT2) receptors in the kidney. It is therefore conceivable that a lifestyle approach such as adopting an LCD can be offered to patients with DMCM. The reported case is that of a 45-year-old man with a 15-year history of non-ischaemic cardiomyopathy, T2DM and obesity. The patient volunteered to engage in a 16-week low-carbohydrate dietary intervention trial and then self-selected to remain on this diet for 1 year. The whole-food LCD was based on simple 'traffic light' style food lists and not designed to restrict calories, protein, fat or salt. After 1 year, the patient had lost 39 kg and his cardiometabolic markers had significantly improved. LCDs present a potentially beneficial approach for patients with DMCM and could be considered as a lifestyle intervention before SGLT2i therapy is commenced. Learning points: Diabetic cardiomyopathy (DMCM) is a syndrome precipitated mainly by the detrimental effects of glucose metabolism disorders such as insulin resistance and diabetes. Low-carbohydrate diets (LCD) mimic many effects of sodium-glucose co-transporter 2 inhibitors (SGLT2i). LCDs are a dietary pattern which can have significant and beneficial effects on metabolic and anthropometric markers in patients with DMCM. LCDs and SGLT2i therapy could be combined and may achieve better clinical outcomes for patients with DMCM. Combination therapy may be carried out under close supervision as the real risk for diabetic ketoacidosis remains.

The nutrient profile and cost of specialty dietary patterns: a hypothetical case study.

OBJECTIVE: Ketogenic and vegan diets have become increasingly popular. The rising popularity of these dietary trends has been met in kind by the food industry producing a variety of specialty ultra-processed foods (UPF). Despite increasing popularity, the cost and nutrient profile of vegan and ketogenic diets (KD) that rely on UPF specialty products is poorly understood. We aimed to assess the cost and nutrient profile of vegan and KD that relied primarily on UPF and compare this to those that relied primarily on whole foods. DESIGN: We designed and calculated the cost of four 1-d meal plans for a hypothetical weight-stable adult female. Two meal plans were created for the vegan-style and ketogenic-style diets, respectively, with one of each being predominantly whole food based and the other constituting primarily of UPF. Carbohydrates were limited to ≤50 g, protein was set at 15-20 % and fat ≥75 % for the ketogenic meal plans. Carbohydrates were set between 45 and 65 %, protein 15 and 25 % and fat 20 and 35 % for the vegan meal plans. FoodWorks dietary analysis software was used to assess data against the national Australian/New Zealand nutrient reference value for adult females and cost was calculated using Countdown online shopping (a local New Zealand supermarket). SETTING: New Zealand. PARTICIPANTS: None. RESULTS: The whole food-based meal plans met a greater proportion of the macro and micronutrient thresholds and were less costly when compared with the specialty-based meal plans. CONCLUSIONS: This study demonstrates that well-planned, predominantly whole food diets (regardless of dietary trend) are nutritionally superior and more cost-effective than those that rely on UPF.

Effects of a low carbohydrate diet on heart failure symptoms and quality of life in patients with diabetic cardiomyopathy: A randomised controlled trial pilot study.

BACKGROUND AND AIMS: Heart failure, insulin resistance and/or type 2 diabetes mellitus coexist in the syndrome that is diabetic cardiomyopathy. Patients with diabetic cardiomyopathy experience high symptom burden and poor quality of life. We tested the hypothesis that a low carbohydrate diet improves heart failure symptoms and quality of life in patients with diabetic cardiomyopathy. METHODS AND RESULTS: We conducted a 16-week randomised controlled pilot trial comparing the effects of a low carbohydrate diet (LC) to usual care (UC) in 17 adult patients with diabetic cardiomyopathy. New York Heart Association classification, weight, thirst distress and quality of life scores as well as blood pressure and biochemical data were assessed at baseline and at 16 weeks. Thirteen (n = 8 LC; n = 5 UC) patients completed the trial. The low carbohydrate diet induced significant weight loss in completers (p = 0.004). There was a large between-group difference in systolic blood pressure at the end of the study (Hedges's g 0.99[-014,2.08]). There were no significant differences in thirst or quality of life between groups. CONCLUSION: This is the first clinical trial utilising the low carbohydrate dietary approach in patients with diabetic cardiomyopathy in an outpatient setting. A low carbohydrate diet can lead to significant weight loss in patients with diabetic cardiomyopathy. Future clinical trials with larger samples and that focus on fluid and sodium requirements of patients with diabetic cardiomyopathy who engage in a low carbohydrate diet are warranted. CLINICAL TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trial Registry (ANZCTR): ACTRN12620001278921. DATE OF REGISTRATION: 26th November 2020.

The general nutrition practices of competitive powerlifters vary by competitive calibre and sex, weight, and age class.

PURPOSE: To characterise self-reported nutrition practices and beliefs of powerlifters. METHODS: Actively competing male (n = 240) and female (n = 65) powerlifters completed a cross-sectional online survey of self-reported nutrition practices across the competitive cycle, within specific competitive phases, and hard and easy training days. Data are presented as number (n) and percentage (%) of all powerlifters practicing a given strategy followed by a % of responses reporting various practices or beliefs within this strategy. Differences in categorical sub-groups (sex, age, and weight class; and competitive calibre) were analysed with a chi-square test and denoted where significant (p ≤ 0.05). RESULTS: Most powerlifters reported following a specific diet long-term (n = 203, 66.6%) of which If It Fits Your Macros (IIFYM)/flexible dieting was most common (n = 159, 78.3%). Over half reported introducing a special diet for a competitive phase (n = 162, 53.1%), of which IIFYM/flexible dieting was most followed for competition preparation (n = 80, 63%) and off-season (n = 48, 71.6%). Compared to normal dietary intake, most reported eating more on harder training days (n = 219, 71.8%) and refraining from eating less on easier training days (n = 186, 61%). CONCLUSIONS: IIFYM/flexible dieting is commonly followed by powerlifters to support performance and body composition goals. Females seemed to report more often restricting energy and dieting for body composition reasons than males. Powerlifters tailor their energy intake on harder training days to the higher training demands but refrain from reducing energy intake on rest/easier training days.

Exploring the Barriers and Enablers to Implementing a 16-Week Low-Carbohydrate Diet for Patients With Diabetic Cardiomyopathy.

AIMS: Cardiac dysfunction in patients with diabetes, referred to as diabetic cardiomyopathy, is primarily precipitated by dysregulations in glucose and lipid metabolism. Diet and lifestyle changes are considered crucial for successful heart failure and diabetes management and are often difficult to achieve. Low-carbohydrate diets (LCDs) have gained popularity for the management of metabolic diseases. Although quantitative research in this field is evolving, little is known about the personal experience of patients with diabetic cardiomyopathy on specific diets. The aim of this qualitative study was to identify enablers and barriers of patients with diabetic cardiomyopathy who engage in an LCD. It further explored patients' perception of dietary education and dietary support received while in hospital. METHODS AND RESULTS: Participants who previously consented to a 16-week LCD trial were invited to share their experiences. Nine patients agreed to be interviewed. Semistructured interviews and a focus group interview were conducted, which were transcribed verbatim. Data were analyzed by using the 6-step approach for thematic analysis. Four themes were identified: (1) nutrition literacy (2) disease-related health benefits, (3) balancing commitments, and (4) availability of resources and support. CONCLUSION: Improvements in disease-related symptoms acted as strong enablers to engage in an LCD. Barriers such as access to resources and time constraints were identified. These challenges may be overcome with efficient communication and ongoing dietary support. More research exploring the experience of patients with diabetic cardiomyopathy on an LCD are warranted.

An Alternate Approach to Military Rations for Optimal Health and Performance.

INTRODUCTION: Operational ration packs are the sole source of nutrition when military personnel cannot access fresh food and field kitchens due to deployment and training in remote and hostile locations. They should be light, durable, nutrient rich, and contain sufficient energy to ensure that the personnel can carry out the expected duties. The macronutrient composition of rations has remained relatively unchanged despite escalating concerns related to the health and operational readiness of personnel globally. Currently, the New Zealand Defence Force (NZDF) provides the personnel with a 24-hour ration pack. The aims of this study were to (1) analyse the nutrient content, cost, and weight of the NZDF-supplied ration pack and (2) develop and analyse an alternate ration pack. The alternate ration pack was designed with the intention of improving overall quality and macronutrient distribution ratio, to align with optimal health and performance outcomes. MATERIALS AND METHODS: Nutrient and weight analyses of the NZDF and alternate ration packs were conducted using nutrition analysis software Foodworks V. 10 (Xyris software). The ration packs were costed using information from the NZDF and from commercial online shopping websites (particularly Countdown supermarket and an online shop, iHerb). Data from nutrition panels were entered into Foodworks V. 10 (Xyris software). The data underlying this article will be shared on reasonable request to the corresponding author. RESULTS: The NZDF-supplied ration pack cost 37.00 NZD and contained an excessive amount of sugar (636 g or 46% total energy) and marginally insufficient protein (118.7 g or 9% total energy) to sustain physically active military personnel. Comparatively, the alternate ration pack was more costly (63.55 NZD) and contained significantly less sugar (74.6 g or 7.2% total energy) and exceeded protein (263.1 g or 26% total energy) requirements for physically active military personnel. Furthermore, the alternate ration pack was significantly lighter (0.71 kg) than the NZDF ration pack (1.4 kg). In summary, the alternate ration was nutritionally superior and lighter when compared to the currently supplied NZDF ration, but more expensive when purchased as a one-off. CONCLUSIONS: This work highlights the shortcomings of currently supplied military rations packs (i.e., excessive sugar and marginally inadequate protein) and proposes a novel alternate approach to ration pack formulation. This approach would significantly reduce sugar and increase protein and fat content in military rations. Although this work indicates that the alternate approach (which would produce lighter and nutritionally superior rations) is more costly, this cost could be reduced significantly through bulk purchasing and purpose-built rations and food items. Considering these findings, field user-testing of the alternate ration pack is recommended and subsequent reformulation of guidelines for ration pack development, as appropriate.

Healthy Food, Healthy Teeth: A Formative Study to Assess Knowledge of Foods for Oral Health in Children and Adults.

Eating patterns characterised by low intakes of processed carbohydrates and higher intakes of fat- and Vitamin D-rich foods are associated with protection against dental caries. The aim of this formative study was to evaluate the extent to which the knowledge of children and adults of foods for oral health reflects dietary guideline advice, and the evidence base for foods associated with increased and decreased caries burdens. Using a novel card-sorting task, the participants categorised foods according to their knowledge of each food for oral health. There were no differences between children and adults in the categorisation of fresh, minimally processed foods. Fish, chicken, and red meat were categorised as healthy by significantly fewer children than adults. High-sugar foods were correctly characterised as unhealthy by nearly all participants. More children categorised breakfast cereals as healthy than adults. There were no statistically significant differences between children and adults for the categorisation of brown or wholegrain breads categorised as healthy. The alignment of the participants' beliefs with dietary guideline recommendations suggests education through health promotion initiatives is successful in achieving knowledge acquisition in children and adults. However, recommendations to increase the intake of refined carbohydrates inadvertently advocate foods associated with increased caries burdens.

The Ergogenic Effects of Acute Carbohydrate Feeding on Resistance Exercise Performance: A Systematic Review and Meta-analysis.

BACKGROUND: Carbohydrate (CHO) ingestion has an ergogenic effect on endurance training performance. Less is known about the effect of acute CHO ingestion on resistance training (RT) performance and equivocal results are reported in the literature. OBJECTIVE: The current systematic review and meta-analysis sought to determine if and to what degree CHO ingestion influences RT performance. METHODS: PubMed, MEDLINE, SportDiscus, Scopus, and CINAHL databases were searched for peer-reviewed articles written in English that used a cross-over design to assess the acute effect of CHO ingestion on RT performance outcomes (e.g., muscle strength, power, and endurance) in healthy human participants compared to a placebo or water-only conditions. The Cochrane Collaboration's risk of bias tool and GRADE approaches were used to assess risk of bias and certainty of evidence, respectively. Random effects meta-analyses were performed for total training session volume and post-exercise blood lactate and glucose. Sub-group meta-analysis and meta-regression were performed for categorical (session and fast durations) and continuous (total number of maximal effort sets, load used, and CHO dose) covariates, respectively. RESULTS: Twenty-one studies met the inclusion criteria (n = 226 participants). Pooled results revealed a significant benefit of CHO ingestion in comparison to a placebo or control for total session training volume (standardised mean difference [SMD] = 0.61). Sub-group analysis revealed a significant benefit of CHO ingestion during sessions longer than 45 min (SMD = 1.02) and after a fast duration of 8 h or longer (SMD = 0.39). Pooled results revealed elevated post-exercise blood lactate (SMD = 0.58) and blood glucose (SMD = 2.36) with CHO ingestion. Meta-regression indicated that the number of maximal effort sets, but not CHO dose or load used, moderates the effect of CHO ingestion on RT performance (beta co-efficient [b] = 0.11). Carbohydrate dose does not moderate post-exercise lactate accumulation nor do maximal effort sets completed, load used, and CHO dose moderate the effect of CHO ingestion on post-exercise blood glucose. CONCLUSIONS: Carbohydrate ingestion has an ergogenic effect on RT performance by enhancing volume performance, which is more likely to occur when sessions exceed 45 min and where the fast duration is ≥ 8 h. Further, the effect is moderated by the number of maximal effort sets completed, but not the load used or CHO dose. Post-exercise blood lactate is elevated following CHO ingestion but may come at the expense of an extended time-course of recovery due to the additional training volume performed. Post-exercise blood glucose is elevated when CHO is ingested during RT, but it is presently unclear if it has an impact on RT performance. PROTOCOL REGISTRATION: The original protocol was prospectively registered on the Open Science Framework (Project identifier: https://doi.org/10.17605/OSF.IO/HJFBW ).

Low Carbohydrate Diets for Diabetic Cardiomyopathy: A Hypothesis.

Elevated blood glucose levels, insulin resistance (IR), hyperinsulinemia and dyslipidemia the key aspects of type 2 diabetes mellitus (T2DM), contribute to the development of a certain form of cardiomyopathy. This cardiomyopathy, also known as diabetic cardiomyopathy (DMCM), typically occurs in the absence of overt coronary artery disease (CAD), hypertension or valvular disease. DMCM encompasses a variety of pathophysiological processes impacting the myocardium, hence increasing the risk for heart failure (HF) and significantly worsening outcomes in this population. Low fat (LF), calorie-restricted diets have been suggested as the preferred eating pattern for patients with HF. However, LF diets are naturally higher in carbohydrates (CHO). We argue that in an insulin resistant state, such as in DMCM, LF diets may worsen glycaemic control and promote further insulin resistance (IR), contributing to a physiological and functional decline in DMCM. We postulate that CHO restriction targeting hyperinsulinemia may be able to improve tissue and systemic IR. In recent years low carbohydrate diets (LC) including ketogenic diets (KD), have emerged as a safe and effective tool for the management of various clinical conditions such as T2DM and other metabolic disorders. CHO restriction achieves sustained glycaemic control, lower insulin levels and successfully reverses IR. In addition to this, its pleiotropic effects may present a metabolic stress defense and facilitate improvement to cardiac function in patients with HF. We therefore hypothesize that patients who adopt a LC diet may require less medications and experience improvements in HF-related symptom burden.

Assessing the Nutrient Status of Low Carbohydrate, High-Fat (LCHF) Meal Plans in Children: A Hypothetical Case Study Design.

There is well-established evidence for low-carbohydrate, high-fat (LCHF) diets in the management of chronic health conditions in adults. The natural next step is to understand the potential risks and benefits of LCHF diets for children, where they may have useful applications for general health and a variety of chronic health conditions. It is vital that any diet delivers sufficient micronutrients and energy to ensure health, wellbeing, and growth. This descriptive study assesses the nutrient and energy status of LCHF sample meal plans for children. We designed four meal plans for hypothetical weight-stable male and female children (11 years) and adolescents (16 years). Carbohydrates were limited to ≤80 g, protein was set at 15-25% of the total energy, and fat supplied the remaining calories. Using FoodWorks dietary analysis software, data were assessed against the national Australian/New Zealand nutrient reference value (NRV) thresholds for children and adolescents. All meal plans exceeded the minimum NRV thresholds for all micronutrients; protein slightly exceeded the AMDR recommendations by up to three percentage points. This study demonstrates that LCHF meal plans can be energy-, protein-, and micronutrient-replete for children and adolescents. As with any dietary approach, well-formulated meals and careful planning are key to achieving the optimal nutrient status.

Health professionals' views and experiences around the dietary and lifestyle management of gestational diabetes in New Zealand.

AIM: This study aimed to investigate New Zealand health professionals' views and experiences around the dietary and lifestyle management of gestational diabetes. METHODS: Semi-structured interviews were conducted remotely with health professionals; sessions were recorded and transcribed. Core themes were extracted using inductive thematic analysis using a framework method. RESULTS: Twenty-seven health professionals were interviewed (13 diabetes dietitians, 8 specialist diabetes midwives, 2 community midwives, 1 antenatal clinic midwife, 1 obstetrician and 2 endocrinologists). Themes were organised into three central domains: (a) Social and cultural barriers, (b) Service provision and (c) Nutrition advice. Enabling themes included professional collaboration, innovation and creating trusting and supportive environments. Key barriers identified included accessibility, cultural barriers, overwhelmed service, fragmentation and conflicting information and nutrition resource gaps. CONCLUSIONS: Findings highlight foremost a deficit in primary antenatal nutrition advice that may play a significant role in the fragmentation identified. Investment in community-inclusive services providing antenatal nutrition and diabetes education appears critical to overcome barriers associated with misinformation and poor outcomes. Pathways to include nutrition education from various primary care health providers should be investigated to ease the burden from specialist gestational diabetes clinicians and allow effective delegation of dietetic resources. Revision of current nutrition guidelines for the management of gestational diabetes in New Zealand is needed to facilitate consistent messaging and standards of care.

The role of maternal diet on offspring hyperinsulinaemia and adiposity after birth: a systematic review of randomised controlled trials.

In utero diet may be directly related to the risk of fetal hyperinsulinaemia and offspring metabolic health. This review examines the relationship between maternal dietary exposures and sub-clinical fetal hyperinsulinaemia and neonatal adiposity. Articles were identified in MEDLINE, Web of Science, Cochrane Controlled Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, SCOPUS, and SPORTDiscus (September 2019-March 2021) using the preferred reporting items for systematic reviews and meta-analyses guidelines. PROSPERO registration ID CRD42020146453. Studies were selected by two independent reviewers. Randomised controlled trials (RCT) involving a dietary intervention with pregnant women (healthy pregnancy, gestational diabetes mellitus and obesity) and reporting fetal cord-blood insulin, c-peptide, glucose or adiposity estimates were included. One author extracted all information on main study characteristics and outcomes. Risk of bias was assessed using the Cochrane Collaboration's bias risk assessment tool. A total of 733 articles were identified. Fourteen articles from 11 RCTs (3614 participants) were included. Studies reviewed showed no specific effect of maternal diet on neonatal cord blood insulin, c-peptide or glucose levels. Infants born to mothers who followed a low glycaemic load (GL) had lower skin fold thickness compared to controls. Interventions that provided individualised nutrition counselling to women with obesity or previous infant born > 4 kg were also associated with lower adiposity. The studies reviewed suggest that lifestyle-based dietary interventions to improve glycaemia (low GL) have a protective effect against excess adiposity. Future studies should incorporate multi-modal interventions with dietary counselling to support lifestyle changes throughout gestation and include assessments of maternal insulin resistance at recruitment.

Hyperinsulinemia during pregnancy across varying degrees of glucose tolerance: An examination of the Kraft database.

AIM: Hyperinsulinemia is a known underlying driver of metabolic disease; however, its role in pregnancy complications is less understood due to insulin measurement not being a part of standard clinical assessments. This study aimed to characterize hyperinsulinemia in pregnancy by gestational diabetes (GD) status using Kraft methodology. METHODS: We analyzed historical data from 926 pregnant women who underwent a 100-g oral glucose tolerance test (OGTT), which included insulin measurement. Subjects were grouped by GD diagnosis status ("Normal", "Borderline", "GD") and insulin responses over 3 h were compared between groups. RESULTS: "GD" was diagnosed in 20.3% of the subjects and 13.8% were grouped as "Borderline." The prevalence of hyperinsulinemia using the Kraft algorithm was 33.1% for Kraft IIB and 42.0% for Kraft III. Compared to normal glucose-tolerant mothers, individuals from the "Borderline" group had an exacerbated insulin response, although not to the same magnitude as those with "GD." CONCLUSIONS: Dynamic OGTT insulin measurement during pregnancy may provide a meaningful assessment of metabolic risk among women who would otherwise not be diagnosed with GD.

The consumption of processed sugar- and starch-containing foods, and dental caries: a systematic review.

The relationship between high dietary intakes of sugar (sucrose) and dental caries is well established. Processed sugars and starches have been associated with greater dental caries experience in retrospective studies. The aim of this systematic review was to determine the relationship between the consumption of processed sugar- and starch-containing foods, the frequency of consumption of these foods, and dental caries. Prospective studies were identified in databases searched from 1970 to July 2020, and relevant retrieved papers that examined associations between the consumption of sugar- and starch-containing foods by human participants and dental caries were eligible for inclusion. Five cohort studies were identified for inclusion, all of which evaluated caries risk in young children or pre-adolescents. The between-meal consumption of processed sugar- and starch-containing foods was consistently found to be associated with greater caries experience. There were mixed findings on total consumption of processed sugar- and starch-containing foods, owing to a range of confounding factors, including the simultaneous consumption of caries-protective foods at mealtimes. Although there is a paucity of research of the dietary effects of frequent consumption of processed sugar- and starch-containing foods on dental caries, there is some evidence of plausible associations between this dietary behaviour and dental caries. Future research should investigate the effectiveness of interventions to change the dietary behaviour of high-frequency consumption of processed sugar- and starch-containing foods to decrease the risk of dental caries.

Deprivation matters: understanding associations between neighbourhood deprivation, unhealthy food outlets, unhealthy dietary behaviours and child body size using structural equation modelling.

BACKGROUND: Children residing in neighbourhoods of high deprivation are more likely to have poorer health, including excess body size. While the availability of unhealthy food outlets are increasingly considered important for excess child body size, less is known about how neighbourhood deprivation, unhealthy food outlets and unhealthy dietary behaviours are interlinked. METHODS: This study involves children aged 8-13 years (n=1029) and resided in Auckland, New Zealand. Unhealthy dietary behaviours (frequency of consumption of unhealthy snacks and drinks) and food purchasing behaviour on the route to and from school were self-reported. Height and waist circumference were measured to calculate waist-to-height ratio (WtHR). Geographic Information Systems mapped neighbourhood deprivation and unhealthy food outlets within individual, child-specific neighbourhood buffer boundaries (800 m around the home and school). Associations between neighbourhood deprivation (calculated using the New Zealand Index of Deprivation 2013), unhealthy food outlets, unhealthy dietary behaviours and WtHR were investigated using structural equation modelling in Mplus V.8.0. Age, sex and ethnicity were included as covariates, and clustering was accounted for at the school level. RESULTS: Structural equation models showed that unhealthy food outlets were unrelated to unhealthy dietary behaviours (estimate 0.029, p=0.416) and excess body size (estimate -0.038, p=0.400). However, greater neighbourhood deprivation and poorer dietary behaviours (estimate -0.134, p=0.001) were associated with greater WtHR (estimate 0.169, p<0.001). CONCLUSION: Excess child body size is associated with neighbourhood deprivation and unhealthy dietary behaviours but not unhealthy outlet density or location of these outlets near home and school.

Nutrition guidelines for dental care vs the evidence: is there a disconnect?

Dental caries is the most common chronic childhood disease in New Zealand. Concurrently, obesity and related chronic metabolic diseases are the most challenging public health problems of modern times. There is considerable evidence that a common dietary behaviour-high frequency consumption of sugar- and starch-containing foods-is the principal aetiological factor for both dental caries, and presentation of children and young people with increased adiposity or obesity. Conversely, consumption of full-fat dairy products by children and young people is associated with reduced risks of dental caries and obesity. Government-endorsed dietary guidelines for young people correctly provide recommendations to decrease intake of high-sugar foods. However, recommendations are provided to increase the frequency of consumption of sugar- and starch-containing foods as children age, and to choose low-fat dairy produce. We contend that this advice directly contradicts evidence of the dietary causes of both dental caries and obesity. This advice also does not reflect evidence regarding observed associations between the consumption of full-fat dairy produce and reduced dental caries and obesity. We present evidence to support our contention that important elements of New Zealand's dietary guidelines have been established without due consideration of the entirety of the evidence, including that which is updated, recent or evolutionarily. Given the epidemics of dental caries and metabolic disease are ongoing public health challenges in New Zealand and share common dietary causes, guidelines for healthy eating should limit refined sugar- and starch-containing foods and encourage intake of full-fat dairy items.

Low-carbohydrate, healthy-fat eating: A cost comparison with national dietary guidelines.

AIM: A low-carbohydrate, healthy-fat (LCHF) dietary approach has been demonstrated as an effective strategy for improving metabolic health; however, it is often criticised for being more expensive than following a dietary approach guided by the national, Ministry of Health nutrition guidelines. This study compared the cost of these two nutritionally replete dietary approaches for one day for a family of four. METHODS: In this descriptive case study, one-day meal plans were designed for a hypothetical family of four representing the average New Zealand (NZ) male and female weight-stable adult and two adolescent children. National documented heights, a healthy body mass index range (18.5-25.0 kg/m2 ), and a 1.7-activity factor was used to estimate total energy requirements using the Schofield equation. Total daily costs were compared based on food prices from a popular Auckland supermarket. Meal plans were analysed for their nutritional adequacy using FoodWorks 8 dietary analysis software against national Australian and NZ nutrient reference value thresholds. RESULTS: The total daily costs were $43.42 (national guidelines) and $51.67 (LCHF) representing an $8.25 difference, or $2.06 per person, with the LCHF meal plan being the costlier option. CONCLUSIONS: We consider this increased cost for an LCHF approach to be negligible. In practice, less costly food items with similar nutrition qualities can be substituted to reduce costs further should this be a goal. The LCHF approach should therefore not be disregarded as a viable dietary approach for improving health outcomes, based on its perceived expense.