Efficacy of Clinic-Based Telehealth vs. Face-to-Face Interventions for Obesity Treatment in Children and Adolescents in the United States and Canada: A Systematic Review.

Background: Childhood obesity is an ever-growing public health concern in the United States and globally. By 2030, it is estimated that 70% of the world's population of children and adolescents will be obese. Therefore, efforts to reduce childhood obesity are of utmost importance, particularly with the current coronavirus disease 2019 pandemic, as rates are expected to soar due to social distancing measures and restrictions. This systematic review aims to examine the literature regarding the effectiveness of clinic-based telehealth vs. face-to-face modalities to reduce obesity among school-aged children. Methods: An electronic database search of articles published in English over the last 10 years was undertaken in PubMed, Medline, and CINAHL. Key terms used to identify studies included school-aged children and adolescents with overweight and obesity in clinic-based weight management interventions conducted face-to-face or via telehealth, and having efficacy determined through changes in measured child BMI as primary outcomes and dietary and physical activity changes, as well as assessing feasibility and satisfaction with telehealth, as secondary outcomes. Results: Out of 1093 articles identified, 10 met the inclusion criteria. While both telehealth and face-to-face weight management interventions are effective in reducing obesity in children and adolescents, the evidence is lacking in which is more effective. Of the 10 studies, 5 showed outcome improvements when both telehealth and face-to-face interventions were combined as adjunct therapies. Conclusions: Findings support using telehealth in conjunction with face-to-face visits for obesity treatment among children and adolescents. However, more research involving telehealth weight management interventions for young children is recommended.

Effectiveness of Arginine Supplementation on Wound Healing in Older Adults in Acute and Chronic Settings: A Systematic Review.

OBJECTIVE: To examine the effect of arginine supplementation on wound healing, as measured by wound size and healing rate, in older adults in acute and long-term care (LTC) settings. DATA SOURCES: PubMed, CINAHL Plus, Google Scholar, and OpenGrey databases. STUDY SELECTION: Randomized clinical trials and clinical studies were considered for this review. Selection criteria included English-language articles published after 2008 that provide data on older adults with pressure injury receiving arginine supplementation in acute care and LTC settings. DATA EXTRACTION: Data were extracted from the articles using a predefined checklist including study size and design, participant characteristics (age, pressure injury stage, relevant comorbidities), nutrition intervention and dosage, duration of study, outcomes, and publication year. Studies were appraised using the National Institutes of Health's Quality Assessment of Controlled Intervention Studies tool. DATA SYNTHESIS: A preliminary search yielded 39 articles after removing duplicates. Abstracts and titles of articles were screened, and 23 full-text articles were examined further. Ultimately, six articles met the inclusion criteria. CONCLUSIONS: Current evidence suggests that arginine supplementation in conjunction with oral nutrition supplementation may promote wound healing in older adult patients in acute care and LTC settings as evidenced by significant reductions in wound size and improvements in wound healing when compared with oral nutrition supplementation alone. A definitive conclusion about the use of arginine supplementation alone to promote wound healing cannot be drawn because of limitations in the available literature. Additional high-quality studies are needed to examine arginine supplementation alone as a potential therapy for PI.

Types, Frequency, Duration, and Dosage of Probiotics to Prevent Necrotizing Enterocolitis in Preterm Infants Among Countries.

BACKGROUND: Probiotic use in the neonatal intensive care unit (NICU) has been linked to reduced rates of necrotizing enterocolitis in preterm infants. Currently, in the United States, probiotic use within the NICU is limited despite being commonly used in other countries. PURPOSE: To provide an overview of the current practices of using probiotics in preterm infants for the prevention of NEC in the NICU in preselected countries. METHODS: A comprehensive literature search was conducted on PubMed and clinicaltrials.gov. Also, studies from 2 recent meta-analyses on the topic were reviewed for inclusion. Selection criteria were as follows: studies involving preterm infants using probiotics in the NICU, reporting on the impact of probiotic use on the incidence of necrotizing enterocolitis, published within the last 10 years and in the English language, and originating from the United States, Canada, or any European country. RESULTS: Twenty-three studies were selected. The most common types of probiotics used were Bifidobacterium infantis and Lactobacillus rhamnosus. The most common frequency of administration was daily or twice day. Duration ranged from 10 days to the entire NICU stay. The dosage was commonly 1 billion colony-forming units daily but ranged from 12 million daily to 12 billion per kilogram daily. IMPLICATIONS FOR PRACTICE: Examining the current practices of probiotic use in the NICU provides useful information as this adjunctive therapy rises in popularity. IMPLICATIONS FOR RESEARCH: Refining methods of probiotic research for necrotizing enterocolitis prevention will improve safety and effectiveness and provide a framework for future clinical trials.

Implementing Evidence-Based Nutrition Practice Guidelines for Type 2 Diabetes Mellitus in Lebanon.

Lebanon is a Middle Eastern country experiencing a surge in the prevalence of type 2 diabetes mellitus among adults. This pilot study evaluated the feasibility and outcomes of implementing the Academy of Nutrition and Dietetics Evidence-Based Nutrition Practice Guidelines (EBNPGs) as part of medical care for patients newly diagnosed with type 2 diabetes mellitus. Seventy-five patients were recruited from 3 Lebanese hospitals, received nutrition care according to EBNPGs, and were followed up for 12 months. Patients achieved significant improvement in clinical outcomes between baseline and 3, 6, and 12 months. Further research is recommended to confirm the benefits of using EBNPGs.

Night eating syndrome and its association with weight status, physical activity, eating habits, smoking status, and sleep patterns among college students.

BACKGROUND: Night eating syndrome (NES) is characterized by evening hyperphagia and/or nocturnal ingestion. OBJECTIVE: The main objective of this study was to assess the percentage of students complying with symptoms and behaviors consistent with the diagnostic criteria for NES, and explore its association with body mass index (BMI), dietary habits, physical activity, smoking status, and sleep patterns, among a sample of college students. METHODS: A cross-sectional survey was conducted among a sample of 413 undergraduate students, mean age of 20.6 ± 1.68 SD, at Central Michigan University. Students completed an online survey including demographic information and the Night Eating Diagnostic Questionnaire (NEDQ) and Pittsburgh Sleep Quality Index Questionnaire (PSQI). Participants were grouped based on self-reporting of the presence and frequency of night eating-related symptoms and behaviors related to the diagnostic criteria for NES as follows: normal, mild night eater, moderate night eater, and full-syndrome night eater. Pearson's Chi-squared, Student's t test, and Wilcoxon rank-sum test were used to test the association between students with and without any night eating behavior in relation to BMI, lifestyle variables, and sleep duration/quality. RESULTS: Results showed that the proportion of students complying with symptoms and behaviors consistent with full-syndrome of NES was 1.2%. There were no significant differences between students complying with symptoms and behaviors consistent with any level of NES and those without any night eating behavior regarding BMI, eating habits, physical activity, and smoking status. NES was significantly related to sleep duration (P = 0.023). Students complying with symptoms consistent with any level of NES reported shorter sleep time and had higher total PSQI score (6.73 ± 4.06) than students without the syndrome (5.61 ± 2.61) (P = 0.007). CONCLUSION: Although the percentage of students complying with full-syndrome NES was relatively low in our student sample, those students had shorter sleep time and poorer sleep quality than the other groups. However, it is unclear whether evening hyperphagia is a response to a lack of sleep or vice versa, and further research is needed. LEVEL OF EVIDENCE: Level III, case-control analytic study.

Prevalence of Metabolic Syndrome and Its Individual Components Among Midwestern University Students.

Michigan has the 17th highest adult obesity rate in the United States. Among college-aged adults between 18 and 25 years old, the rate of obesity was 11.6%. Obesity is a key precedent for the development of metabolic syndrome. Accordingly, the purpose of this study was to examine the prevalence of metabolic syndrome and its individual components among a sample of students at Central Michigan University. A cross-sectional survey was conducted among 462 students, aged 18-25 years, in Spring 2015 and Fall/Spring 2016 semesters. Students were recruited throughout the campus via flyers, in-class, and Blackboard announcements. Biochemical, anthropometric, and blood pressure measurements were taken for all students. Prevalence of metabolic syndrome was estimated based on the National Cholesterol Education Program's Adult Treatment Panel III guidelines. Multivariable analysis was used to assess the prevalence of metabolic risk components. To explore the association between metabolic risk factors and lifestyle behaviors, students filled out a validated online questionnaire related to their eating habits, physical activity, and sleep patterns. Metabolic syndrome was not prevalent in our sample. However, about one-third of the students had at least one metabolic abnormality, and 6.0% had two metabolic abnormalities. The most common metabolic abnormalities were low HDL-cholesterol levels (22.0%) and high waist circumference (12.6%), and elevated serum triglyceride (5.8%). Adjusting for other factors, excess adiposity and high visceral fat scores were associated with increased risk of metabolic risk factors, whereas healthy lifestyle practices such as daily breakfast consumption, eating three meals a day, being active, and not smoking were associated with lower risks for MetS. Given the adverse consequences of undiagnosed metabolic abnormalities, efforts to identify and manage MetS among asymptomatic college students, particularly women, is essential and warrants further research.

Level of nutrition knowledge and its association with fat consumption among college students.

BACKGROUND: Intake of saturated fat, trans fat, and cholesterol has been associated with increased risk of coronary heart disease. The aim of this study was to explore whether increased nutrition knowledge is associated with a reduction in the consumption of unhealthy fats in a sample of university students. METHODS: A sample of 231 students, with a mean age of 20 years, was recruited from university campus during spring 2012. Students completed a validated questionnaire related to students' demographic, nutrition knowledge, and daily fat consumption. Weight, height, and waist circumference were measured. Data were analyzed using one-way ANOVA, chi-square, and student's t-test. RESULTS: Results indicate that female students have greater nutrition knowledge than male students (the mean nutrition score for women was 5 points higher than that of men (P = 0.01)). Nutrition knowledge was negatively correlated with fat and cholesterol intake. Students who consumed more than 35 % calories from fat or >300 mg of cholesterol daily had lower mean nutrition scores than those students with lower fat or cholesterol intake (8 points lower and 7.9 points lower, respectively). Using linear regression for nutrition scores on estimated saturated fat intake and cholesterol intake (controlling for gender, height, weight, age, and dieting), nutrition scores were negatively associated with saturated fat intake (-0.15, P <0.0001) and cholesterol intake (-1.38, P <0.0001). CONCLUSION: Students with greater nutritional knowledge consumed less unhealthy fats and cholesterol. This finding magnifies the role of nutrition education as a potential tool in health campaigns to promote healthy eating patterns among college students. Results of this pilot study can inform the design of future nutrition education intervention studies to assess the efficacy of nutrition knowledge on pattern of fat consumption among college students.

Assessment of weight status, dietary habits and beliefs, physical activity, and nutritional knowledge among university students.

AIMS: The purpose of this study was to assess weight status, dietary habits, physical activity, dietary beliefs, and nutrition knowledge among a sample of students from Central Michigan University. METHODS: A cross-sectional survey was conducted among a sample of undergraduate students in Fall 2011 and Spring 2012 at Central Michigan University. Participating students completed an online questionnaire that included questions related to their eating habits, physical activity and lifestyle, dietary beliefs, and nutritional knowledge. Weight, height, and waist circumference were measured. Percentage body fat and visceral fat score were determined using a Tanita body composition analyser (SC-331S). RESULTS: Outcomes of this study indicated that 78% of female students were within the healthy weight range compared to 52% of male students. Visceral body fat and waist circumference scores were higher in males than in females. Most students showed 'satisfactory' dietary habits. Almost half of the students reported drinking two glasses of milk and consuming two cups of fruits and vegetables daily. Physical activity and lifestyle score indicated that most of the students were not physically active. Only 7% of students reported having a very active lifestyle, and 4% had quite good nutritional knowledge. CONCLUSION: The majority of students, particularly females, were within the healthy body weight range. Students' dietary habits were satisfactory. However, physical activity, students' knowledge of healthy and unhealthy diet habits, and nutritional knowledge needed improvement. Developing gender-specific programmes for promoting healthy lifestyle behaviours among students is recommended.

Assessment of college students' awareness and knowledge about conditions relevant to metabolic syndrome.

BACKGROUND: Despite the increasing prevalence of metabolic syndrome among young adults, little is known about the awareness level of college students about this condition. The purpose of this study was to assess students' level of awareness and knowledge about conditions relevant to metabolic syndrome (MetS). METHODS: A self-reported online questionnaire was administered to 243 students attending Central Michigan University. Questions were divided into seven conditions: diabetes, adiposity, hypertension, high serum cholesterol, arteriosclerosis, stroke, and myocardial infarction. Students' responses were scored and interpreted as follows: poor knowledge if ≤50% of students answered the question correctly; fair knowledge if between 51-80% of students answered the question correctly; and good knowledge if between 81-100% of students answered the question correctly. Anthropometric measurements including height, weight, waist circumference, percentage body fat, and visceral fat score were measured. Fisher's exact test was used to test the differences in students' responses. A p value <0.05 was considered a statistically significant difference. RESULTS: More than 80% of students correctly identified symptoms and complications of diabetes, hypertension, arteriosclerosis, myocardial infarction and stroke, and 92% identified adiposity as a risk factor for heart disease. There were few false beliefs held by students on questionnaire items. For example, 58% of male students falsely believed that individuals with diabetes may only eat special kinds of sweets compared to 39% of females (p < 0.01) and more than half of the students falsely identified liposuction as the best possible treatment in adiposity therapy. Gender, Health Science major, and year in school were found to be positively associated with more knowledge. CONCLUSION: The findings in this study suggest that students' knowledge about conditions relevant to metabolic syndrome can be improved. In this essence, raising awareness about MetS based on students' pre-existing knowledge is essential to enhance students' wellness.

Dieting practices and body image perception among Lebanese university students.

Dieting is becoming a popular phenomenon among university students to achieve or maintain a healthy weight. The purpose of this study is to obtain a preliminary understanding of what dieting practices university students use in order to achieve their desirable body weight and to determine the magnitude of body dissatisfaction in relation to weight status among a sample of students (n=252) from the Lebanese American University in Beirut, Lebanon. Students filled out a self-reported questionnaire that included questions on their dieting and physical activity practices in addition to the body shape questionnaire (BSQ). Weight and height were measured to calculate body mass index. Percentage body fat was measured using Tanita scale body fat analyzer 300A. The outcome of this study showed that smoking and unhealthy dieting practices were not common among students (only 26% reported smoking, 8% reported taking laxatives and 4% taking diet pills). Half of the students reported practicing regular physical activity. Multivitamin intake was also not popular among students. BSQ scores indicate that the majority of students were not worried about their body image perception (64% reported not being worried, 19% were slightly worried, 12% were moderately worried and 5% were extremely worried). A gender difference was observed in the BSQ scores, as 89% of the "extremely worried" students were females. Collectively, results indicate that unhealthy dieting practices are uncommon among students. However, developing health promotion awareness' programs to promote good self image within the concept of a realistic healthy weight will be beneficial, especially among females.

Eating habits and obesity among Lebanese university students.

BACKGROUND: In the past year Lebanon has been experiencing a nutritional transition in food choices from the typical Mediterranean diet to the fast food pattern. As a consequence, the dietary habits of young adults have been affected; thus, overweight and obesity are increasingly being observed among the young. The purpose of this study is to assess the prevalence of overweight and obesity on a sample of students from the Lebanese American University (in Beirut) and to examine their eating habits. METHODS: A cross-sectional survey of 220 students (43.6% male and 56.4% female), aged 20 +/- 1.9 years, were chosen randomly from the Lebanese American University (LAU) campus during the fall 2006 semester. Students were asked to fill out a self-reported questionnaire that included questions on their eating, drinking and smoking habits. Also, their weight, height, percentage body fat and body mass index were measured. Body mass index (BMI) was used to assess students' weight status. Statistical analyses were performed using the Statistical Package for Social Sciences software (version 13.0) to determine overweight and obesity among students and to categorize eating habits. RESULTS: This study showed that the majority of the students (64.7%) were of normal weight (49% male students compared to 76.8% female students). The prevalence of overweight and obesity was more common among male students compared to females (37.5% and 12.5% vs. 13.6% and 3.2%, respectively). In contrast, 6.4% female students were underweight as compared to 1% males. Eating habits of the students showed that the majority (61.4%) reported taking meals regularly. Female students showed healthier eating habits compared to male students in terms of daily breakfast intake and meal frequency. 53.3% of female students reported eating breakfast daily or three to four times per week compared to 52.1% of male students. There was a significant gender difference in the frequency of meal intake (P = 0.001). Intake of colored vegetables and fruits was common among students. A total of 30.5% reported daily intake of colored vegetables with no gender differences (31.5% females vs. 29.2% males). Alcohol intake and smoking were not common among students. CONCLUSION: In spite of the overall low prevalence of overweight and obesity in the studied sample, results indicate that university students would possibly benefit from a nutrition and health promotion program to reduce the tendency of overweight and obesity, especially among male students, and to improve students' eating habits.

Polyunsaturated fatty acids acutely suppress antibodies to malondialdehyde-modified lipoproteins in patients with vascular disease.

Antibodies to malondialdehyde (MDA)-modified low-density lipoprotein (LDL) are transiently reduced during the postprandial period in patients with atherosclerotic heart disease. Previous experiments using mixed meals high in fat have found reductions of approximately 20% within 2 hours. This study was designed to reveal if this phenomenon was due uniquely to saturated fats. Using a standardized immunoassay for the detection of circulating levels of autoantibodies (AAbs) against MDA-modified LDL, we examined the acute changes in AAb levels during 6 hours of postprandial lipemia in 10 men with known atherosclerotic heart disease. Each subject was given 4 meals 1 week apart. Three of the meals differed in content of saturated fat, monounsaturated fat, and polyunsaturated fat. A fat-free meal with equivalent carbohydrate and equivalent protein was also administered. The study was double blinded and the meals were administered in random order. Only the meal enriched with polyunsaturated fatty acids caused the reduction in antibodies to MDA-LDL. This decrease was statistically significant from baseline at 1 hour (p <0.05), 2 hours (p <0.004), and 3 hours (p <0.02), with the nadir occurring at 2 hours. Polyunsaturated fatty acids are the major stimulus for causing a reduction in the AAbs to MDA-LDL during postprandial lipemia. These results strongly suggest that fat in chylomicrons may be a major source of oxidized lipids in the blood of patients with arteriosclerosis.