Association between being at-risk of malnutrition and discontinued home medical care among older patients: a 1-year follow-up study.

BACKGROUND: Both malnutrition and at-risk of malnutrition are prevalent among older patients receiving home medical care. Discontinuation of home medical care usually occurs when an older patient is admitted to a hospital or nursing home or dies. This study aimed to assess prospective associations between nutritional status and discontinuation of home medical care in older patients. METHODS: Three hundred and thirty-three Japanese older patients receiving home-visit nursing care services were included in this study. Their nutritional status was assessed using the Mini Nutritional Assessment®-Short Form, and patients were classified into three groups (well-nourished, at-risk of malnutrition and malnourished). Outcomes were confirmed at the 1-year follow-up survey. Hazard ratios (HRs) and 95% confidence intervals (CIs) for discontinuation of home medical care based on nutritional status were calculated using a Cox proportional hazard model. Covariates included age, sex, living status, economic status, activities of daily living, comorbidities and dysphagia status. RESULTS: In total, 297 patients (median age: 84 years) were analysed. At baseline, 48.5% of the patients were at-risk of malnutrition and 18.9% were malnourished. During the observation period of 1 year, 27.6% patients discontinued their home medical care. In the adjusted model, the HR for discontinuation of home medical care among those at-risk of malnutrition was 2.44 (95% CI: 1.34-4.45) times than that of the well-nourished group, although the malnourished group was not significantly associated with discontinuation of home medical care (HR: 1.69, 95% CI: 0.77-3.72; referent: well-nourished). CONCLUSIONS: At-risk of malnutrition was associated with discontinuation of home medical care among older patients.

Strength and Conditioning Programs to Increase Bat Swing Velocity for Collegiate Baseball Players.

Bat swing velocity (BSV) is an imperative element of a successful baseball hitting performance. This study aimed to investigate the anthropometric and physiological variables associated with BSV and explore strength and conditioning programs to increase BSV in collegiate baseball players. Seventy-eight collegiate baseball players (mean age ± SD, 19.4 ± 1.0 years) participated in this study. Maximum BSV (km/h) was measured using Blast Baseball (Blast Motion Inc., Carlsbad, CA, USA). The anthropometric and physiological variables measured were height, body mass, lean body mass, grip strength, back muscle strength, the 30 m sprint, standing long jump, and backward overhead medicine ball throwing. Analysis using Pearson's product-moment correlation coefficient showed a weak but significant positive correlation between all anthropometric measurements to BSV. Significant relationships existed between physiological variables of hand grip, back muscle strength, and backward overhead medicine ball throwing, but not the standing long jump and 30 m sprint. These data show that BSV is related to anthropometric and physiological variables, particularly upper and lower body strength and full-body explosive power. Based on the results of this study, we designed examples of sound training programs to increase BSV. Strength and conditioning coaches may want to consider using this information when designing a training program for collegiate baseball players.

Prevalence of Obesity and the Factors Associated with Low Obesity Awareness among Urban Adolescents in Harare, Zimbabwe.

Obesity is a global health problem. In developing countries such as Zimbabwe, obesity is both an emerging health problem and a grey area, particularly among adolescents. This study assessed the prevalence of obesity and factors associated with low obesity awareness among adolescents. METHOD: A cross-sectional survey was performed using an interviewer-administered questionnaire. The participants were 423 adolescents aged 14-19 years recruited from 10 schools in Harare using a stratified random sampling technique. Data were analyzed using SPSS software (version 23) and binary logistics regression was used to examine the factors associated with low obesity awareness. The level of significance was set at p < 0.05. RESULTS: The median± IQR age was 16 (14-18) years, and overweight and obesity affected 15.8% of the participants with higher proportions among girls (73.1%, p = 0.002). Low obesity awareness was observed in 27.1% of the adolescents with a higher proportion among girls (67.0%, p = 0.001), 14-16-year-olds (51.3%, p = 0.317), and obese adolescents (56.7%, p = 0.001). Significant factors associated with low obesity awareness were household heads lacking formal education [OR = 9.41 (2.20-40.36), p = 0.003] and inadequate (poor) food habits [OR = 2.58 (1.33-5.01), p = 0.005]. CONCLUSIONS: Our study showed that adolescents had different obesity awareness levels and diverse perceptions in terms of obesity causes, and a range of potential solutions. Obesity awareness and nutrition education should address adolescents' poor eating habits while taking cognizance of the different education levels of household heads.

The Role of Diets and Dietitians for Para-Athletes: A Pilot Study Based on Interviews.

Efforts to provide nutrition support to para-athletes have not been established to date, and are far behind those established for athletes without disabilities. In the present study, we attempted to clarify the actual situation regarding dietary challenges of para-athletes. The aim of this study was to obtain clues to effective intervention methods that encourage the practice of sports nutrition. Six active elite para-athletes (30-70 years, four males) and a female physical therapist without physical disability participated in semi-structured interviews. All para-athletes had lower-limb disabilities and participated in the international wheelchair sports competitions (tennis, softball, and table tennis, with 2-26 years of player history). The interview items were on the ideal diet for improving competitive performance, evaluation of their typical diets, and the role of the dietitian as support. Responses obtained from participants were analyzed using quantitative content analysis by language analysis software. There are differences in the ideal diet based on the characteristics of the sport, but most participants believed that a nutritionally well-balanced diet with abundant vegetables was ideal for improving competitive performance. Para-athletes who use a wheelchair daily pay attention to their total calorie intake, because gaining weight is a critical issue for operating their wheelchairs and transferring themselves to and from their wheelchairs. Despite their world-class competition levels, none of them received routine dietary advice from dietitians. Some para-athletes did not even feel the need to engage with dietitians. Even for these para-athletes at a high level of competition, the "ideal diet" they considered was not always the optimal diet for improving their competitive performance. In addition, there are various barriers to practicing their optimal diet due to disability characteristics. Dietitians need to understand these barriers, their concerns and conflicts, and how to help them plan the optimal diet to improve their performance and maintain overall health.

Effects of Trehalose Solutions at Different Concentrations on High-Intensity Intermittent Exercise Performance.

Trehalose solution ingested during exercise induces gradual increases in blood glucose levels and the insulin response compared with glucose solution. Trehalose solution aids in the maintenance of performance in the later stages of prolonged exercise. The purpose of this study was to identify the lowest concentration at which the properties of trehalose could be exploited. Groups of 12 healthy men (21.3 ± 1.3 years) and 10 healthy men (21.1 ± 0.7 years) with recreational training were included in experiments 1 and 2, respectively. Both experiments followed the same protocol. After fasting for 12 h, the participants performed a 60 min constant-load exercise at 40% V˙O2 peak using a bicycle ergometer and ingested 500 mL of a trial drink (experiment 1: water, 8% glucose, and 6 or 8% trehalose; experiment 2: 4 or 6% trehalose). They performed four sets of the Wingate test combined with a 30 min constant-load exercise at 40% V˙O2 peak. The experiment was conducted using a randomized cross-over design; trial drink experiments were conducted over intervals of 7 to 12 days. The exercise performance was evaluated based on mean power in the Wingate test. Blood was collected from the fingertip at 12 points during each experiment to measure blood glucose levels. During the high-intensity 5 h intermittent exercise, no differences were found between the groups in exercise performance in the later stages with concentrations of 8, 6, and 4% trehalose solution. The results suggest that trehalose could be useful for making a new type of mixed carbohydrate solution. Further studies to determine the trehalose response of individual athletes during endurance exercise are needed.

Carbohydrate Mouth Rinse and Spray Improve Prolonged Exercise Performance in Recreationally Trained Male College Students.

Mouth rinsing with a carbohydrate (CHO) solution has emerged as a sports nutrition strategy to increase endurance performance. This study aimed to clarify the effects of two forms of CHO sensing in the mouth (i.e., CHO mouth rinse (CMR) and CHO mouth spray (CMS)) on exercise performance during prolonged exercise, including ultra-high intensity intermittent exercise over time. We conducted the following experimental trials: (1) 6% glucose solution (G), (2) 6% CMR, (3) 6% CMS, and (4) water (WAT). These trials were conducted at least 1 week apart in a randomized crossover design. Eight male college students performed constant-load exercise for 60 min (intensity 40% VO2peak), four sets of the Wingate test (three 30 s Wingate tests with a 4 min recovery between each test), and a constant-load exercise for 30 min (intensity 40% VO2peak). The mean exercise power output (Watt), ratings of perceived exertion, and blood glucose levels were measured. We found that the mean power values of the CMR and CMS in the third and fourth sets was significantly higher than that of WAT (p < 0.05), and that the G trial did not show a significant difference from any other trial. Thus, when compared to G or WAT, CMR and CMS can help improve endurance exercise performance.

Eating Perception, Nutrition Knowledge and Body Image among Para-Athletes: Practical Challenges in Nutritional Support.

Limited information exists on dietary practices in para-athletes. The aim of this study was to clarify the actual situation of para-athletes' dietary practice and to sort out the factors (i.e., eating perception, nutrition knowledge, and body image), that may hinder their dietary practices, and explored the practical challenges in nutritional support and improving nutrition knowledge for para-athletes. Thirty-two Japanese para-athletes (22 men) and 45 collegiate student athletes without disabilities (27 men) participated in the online survey. The questionnaire included demographic characteristics, eating perception, dietary practices, and nutrition knowledge. The Japanese version of the body appreciation scale was used to determine their body image. Para-athletes who answered that they knew their ideal amount and way of eating showed significantly higher body image scores (r = 0.604, p < 0.001). However, mean score for nutrition knowledge of para-athletes were significantly lower than collegiate student athletes (19.4 ± 6.8 vs. 24.2 ± 6.1 points, p = 0.001). Both groups did not identify a dietitian as the source of nutrition information or receiving their nutrition advice. The results indicate para-athletes have unique eating perceptions and inadequate nutrition knowledge. Future interventions are needed to examine nutritional supports and education in relation to the role of dietitians.

Single Ingestion of Trehalose Enhances Prolonged Exercise Performance by Effective Use of Glucose and Lipid in Healthy Men.

Trehalose increases blood glucose levels slowly and induces a slight insulin response. The present study aimed to study the effect of trehalose on prolonged exercise performance. The participants were 12 healthy men (age: 21.3 ± 0.9 y). After an overnight fast (12 h), they first exercised with a constant load (intensity: 40% V˙O2peak) for 60 min using a bicycle ergometer. They continued to exercise with a constant load (40% V˙O2peak) for 30 min between four sets of the 30-s Wingate test. After the 1st set, each participant ingested 500 mL water (control), 8% glucose, or 8% trehalose in three trials. These three trials were at least one week apart and were conducted in a double-blind and randomized crossover manner. Blood was collected for seven biochemical parameters at 12 time points during the experiment. The area under the curve of adrenaline after ingestion of trehalose was significantly lower than that for water and tended to be lower than that for glucose in the later stage of the exercise. Lower secretion of adrenaline after a single dose of 8% trehalose during prolonged exercise reflected the preservation of carbohydrates in the body in the later stage of the exercise. In conclusion, a single ingestion of trehalose helped to maintain prolonged exercise performance.

Energy Intake Deficiency Promotes Bone Resorption and Energy Metabolism Suppression in Japanese Male Endurance Runners: A Pilot Study.

It has been reported that male athletes face increased risk for low energy availability and resulting health consequences similar to female athletes. The present study aimed to reveal the energy status of Japanese male runners and to examine the association between energy deficiency and physiological characteristics such as energy metabolism, bone health, and hormonal status. Six male collegiate long-distance runners during a training season participated in this study. Energy intake (EI) was assessed using 3-day dietary records with food pictures. Exercise energy expenditure (EEE) was determined by the HR-VO2 method. Body composition and bone status were measured by dual-energy X-ray absorptiometry. Energy availability (EA) was calculated by subtraction of EEE from EI and normalized by fat-free mass (FFM). Energy balance (EB) was calculated EI minus estimated total energy expenditure (TEE). Resting energy expenditure (REE) was measured by indirect calorimetry using the Douglas bag technique, and blood sampling was conducted to assess hormonal status. The mean EA of the subjects was 18.9 ± 6.8 kcal/kg FFM/day, and severe negative EB (range: -1444 ~ -722 kcal/d) was observed. REE of four runners was suppressed, and moreover, bone resorption was promoted in all subjects. The data in our study suggested that energy deficiency could promote bone resorption and energy metabolism suppression in Japanese male endurance runners. Additional short- and long-term studies are needed to clarify the health risks caused by energy deficiency in male athletes and explore strategies to prevent health problems related to energy deficiency in long-distance runners.

Describing Independent Eating Occasions among Low-Income Adolescents.

The purpose of this formative, cross-sectional study was to describe independent eating occasions (iEOs) among a convenience sample of low-income early adolescents (10-13 years, n = 46) in 10 U.S. states, including environmental context, foods selected and reasons for selection, and parental rules about foods consumed. Participants took pictures of all foods consumed over 24 h and participated in semi-structured interviews to describe the context of each eating occasion using the pictures as a guide. Responses based on a total of 304 eating occasions were coded to classify foods based on United States Department of Agriculture (USDA) MyPlate food groups and to characterize parental rules and reasons for food selection. Average age was 10.9 ± 1.1 years and 60% were female. Approximately 58% of eating occasions were classified as iEOs with approximately 65% as snacks. Most iEOs took place at home. Foods frequently consumed during iEOs were from the sweets, total fruit, dairy, and whole fruit food categories. Primary parental rules for iEOs focused on avoiding certain foods and not eating too much. Early adolescents selected foods for convenience, taste preferences, and availability. Foods selected during iEOs were based on parent, household and early adolescent factors, which could be addressed to influence overall diet quality.

Development of Parent and Adolescent Questionnaires to Assess Food Parenting Practices That Address Adolescent Consumption During Independent Eating Occasions.

OBJECTIVE: To develop and test parent and early adolescent questionnaires to assess food parenting practices that influence early adolescent food consumption during independent eating occasions (iEOs). METHODS: Cross-sectional online questionnaires were completed by 206 and 62 low-income parent/early adolescent (11-14 years) dyads at Time 1 and 2, respectively, recruited via a Qualtrics (Provo, UT) US national panel database. Principal component analyses, internal consistency, and test-retest reliability checks were performed. RESULTS: Six parallel components were identified for parents and early adolescents with acceptable internal consistency and test-retest reliability. Scales included autonomy support, monitoring, availability, indulgence, expectations, and modeling. All except indulgence were positively correlated with importance of helping early adolescents make healthy choices during iEOs. CONCLUSIONS AND IMPLICATIONS: Additional research is needed to test the questionnaires' validity regarding relationships between parenting practices and early adolescent consumption during iEOs. Findings could inform development of interventions to improve consumption during these occasions.

Relationship between muscle-strengthening activities recommended by physical activity guidelines and knee extensor strength in the elderly.

[Purpose] This study aimed to cross-sectionally examine the relationship between the practice of muscle-strengthening activities assessed according to Japanese and foreign physical activity guidelines and knee extensor strength in the elderly. [Participants and Methods] Overall, 223 (66 males and 157 females) participants aged ≥60 years were included. The questionnaire included four items on muscle-strengthening activities: undergoing strength training, performing vigorous farming and gardening, carrying heavy loads, and climbing stairs and hills. Thereafter, participant performance was classified as "sufficient" or "insufficient" based on whether they practiced each muscle-strengthening activity for ≥2 or <2 days a week, respectively. [Results] After the adjustment for age, gender, body mass index, physical activity level, and the practice of other muscle-strengthening activities, knee extensor strength was significantly higher in the elderly participants who sufficiently practiced strength training than in those who did not. Furthermore, those who sufficiently practiced farming and gardening had significantly higher knee extensor strength than those who did not. [Conclusion] Our findings suggest that the non-exercise muscle-strengthening activity of sufficient farming and gardening practiced according to physical activity guidelines is positively associated with knee extensor strength independent of other muscle-strengthening activities or the amount of physical activity in healthy elderly individuals.

Food Parenting Practices That Influence Early Adolescents' Food Choices During Independent Eating Occasions.

OBJECTIVE: To identify practices that parents use to influence early adolescents' food choices during independent eating occasions (iEOs) from parent and child perspectives. DESIGN: In-depth interviews. PARTICIPANTS: Low-income parents (n = 49) and early adolescent children (aged 10-13 years; n = 44) from 10 US states and the District of Columbia. PHENOMENON OF INTEREST: Parent and child perspectives on parenting practices that influence food choices during iEOs. ANALYSIS: Audio-recorded interviews transcribed verbatim, NVivo coding, and directed content analysis. RESULTS: Parents reported setting rules and expectations and managing availability or accessibility as the most common practices used to influence iEOs. Other practices included teaching, pressuring to eat, monitoring, and modeling. Children reported that their parents had rules about what they could or could not eat during iEOs and that they used specific strategies (eg, call or text) to monitor their iEOs. CONCLUSIONS AND IMPLICATIONS: Additional studies are needed to confirm findings from this exploratory study. Future cross-sectional and longitudinal studies could determine whether and to what extent food parenting practices identified in the current study are associated with healthy dietary intake during iEOs, as well as potential racial and ethnic differences.

Effects of a Single Ingestion of Trehalose during Prolonged Exercise.

Trehalose (TRE), a disaccharide, is absorbed slowly and gradually increases the blood glucose (GLU) level along with reducing insulin secretion. The aim of this study was twofold. First, we examined exercise performance following ingestions of either GLU, TRE, or water (WAT). The second purpose was to investigate the effects of TRE energy metabolism during prolonged exercise. We examined exercise performance using the Wingate test, with 30-min constant load exercise at 40% VO2peak after exercising for 60 min at 40% VO2peak, by using an electromagnetic brake-type bicycle ergometer (Part 1). The power values, blood glucose and lactate, and respiratory exchange ratio (RER) were measured. In addition, we investigated the energy metabolism after a single ingestion of TRE, by measuring the RER and estimating the lipid oxidation for 60 min at 40% VO2peak (Part 2). Healthy college male students performed three trials-(1) placebo (WAT), (2) GLU, and (3) TRE. Repeated two-way analysis of variance (ANOVA) was used for a comparison of the data among the three trial groups. A multiple comparison test was performed using post hoc Bonferroni correction. The TRE ingestion significantly increased the average and maximum power values (p < 0.01). The TRE ingestion showed significantly higher lipid utilization than the GLU lipid oxidation values the in TRE, 12.5 ± 6.1 g/h; GLU, 9.3 ± 4.7 g/h; and WAT, 15.0 ± 4.4 g/h; (p < 0.01). In conclusion, we provide novel data that a single TRE ingestion was effective in improving prolonged exercise performance by effective use of glucose and lipids.

Salt Restriction Affects the Excretions of Minerals (Na, K, Ca, Mg, P and Zn) in the Second Voided Fasting Early Morning Urine.

The plasma concentrations of mineral (sodium (Na), potassium (K), calcium (Ca), magnesium (Mg), phosphorus (P), and zinc (Zn)) are kept within narrow ranges to maintain homeostasis; hence, it is difficult to use them as indicators of nutritional status. We selected the excretion of these minerals in the second voided fasting early morning urine (EMU) as potential indicators of nutritional status. We previously reported that Na restriction caused a negative balance of Ca and Mg. Therefore, Na restriction can cause changes in EMU-minerals. This study aimed to examine the relationship between dietary Na restriction and urinary mineral excretion. The study lasted for 21 d, including 16 d of balance period and 3 d of recovery period. The participants (11 healthy young women) were divided into the Na restriction group (n=5) (NaCl: 6 g/d) and control group (n=6) (NaCl: 12 g/d). The Na restriction group changed to the control diet (NaCl: 12 g/d) during only the recovery period. The EMU-Na, Ca, Mg, P and Zn in the Na restriction group significantly decreased compared with that of the control group. The EMU-Na, K, Ca, Mg, and Zn in the group with NaCl intake of 6 g/d significantly decreased compared with that of the group with NaCl intake of 12 g/d (in the Na restriction group). We conclude that the decrease in excretion of Na, Ca, Mg and Zn in the EMU can lead to Na restriction. This result can serve as basis when considering EMU as an indicator of mineral status.

Promoting Stair Climbing as an Exercise Routine among Healthy Older Adults Attending a Community-Based Physical Activity Program.

Stair climbing provides a feasible opportunity for increasing physical activity (PA) in daily living. The purpose of this study was to examine the daily walking and stair-climbing steps among healthy older adults (age: 74.0 ± 4.9 years; Body Mass Index (BMI): 22.3 ± 2.5 kg/m²). Participants (34 females and 15 males) attended a weekly 6-month community-based PA program. During the entire program period, daily walking and stair-climbing steps were recorded using a pedometer (Omron, HJA-403C, Kyoto, Japan). Before and after the 6-month program, height, body weight and leg muscle strength were assessed. After the 6-month program, the mean walking and stair-climbing steps in both women and men increased significantly (p ≤ 0.01). Daily stair-climbing steps increased about 36 steps in women and 47 steps in men. At the end of 6 months, only male participants had significant correlation between the number of stair steps and leg muscle strength (r = 0.428, p = 0.037). This study reported that healthy older adults attending the community-based PA program had regular stair-climbing steps during daily living. Promoting stair climbing as an exercise routine was feasible to increase their walking and stair-climbing steps.

Is There Any Relationship Between Body Image Perception, Eating Disorders, and Muscle Dysmorphic Disorders in Male Bodybuilders?

Bodybuilding has increasingly become popular between males since male body shape has become a subject of interest in the last decades. Bodybuilders have desired to gain more muscle and paid attention to their body shape. Based on this purpose, they have string rules that include restrictive eating and excessive exercise program. Recent research has demonstrated that desiring more muscular body shape exhibits eating behavior problems and body dissatisfaction issues in bodybuilders. Limited research exists on the relationship between body dissatisfaction and eating disorders in male bodybuilders. The aim of this study was to determine the relationship between body image disturbance and eating disorders in 120 male bodybuilders. The Eating Attitude Test (EAT-40) was used to determine eating disorders, the Muscle Dysmorphia Disorder Inventory was used to determine bigorexia symptoms, and Bodybuilder Image Grid-Original (BIG O) and Scaled (BIG S) forms were used to detect the factors associated with body dissatisfaction. There was a positive relationship between Eating Attitude Test and Muscle Dysmorphia Disorder Inventory total scores. Eating Attitude Test was positively correlated with both fat and muscle dissatisfaction. Our results indicated that eating disorder psychopathology is positively related to body dissatisfaction and body dysmorphic disorders in male bodybuilders.

Long-term follow-up effects of the HomeStyles randomized controlled trial in families with preschool children on social cognitive theory constructs associated with physical activity cognitions and behaviors.

This study examined long-term follow-up effects of participation in the HomeStyles RCT, using Social Cognitive Theory constructs, on physical activity cognitions, home environment, and lifestyle behavioral practices of families with preschool children (ages 2 to 5 years). Parents were systematically randomized to experimental or attention control group at baseline. Those completing all surveys that comprised of valid, reliable measures were the analytic sample (n = 61 experimental, n = 63 control; mean age 32.8 ±â€¯5.9SD years). Repeated measures ANCOVA, controlling for prognostic variables (e.g., parent sex) revealed that variables assessing modeling of physical activity for children increased significantly (P ≤ .01) in both groups with no significant time by group effects. Paired t-tests indicated the experimental group's self-efficacy for keeping children's weight healthy and performing health promoting behaviors increased significantly over time whereas the control group did not but with no significant time by group effects. Self-regulation paired t-test findings indicated that total screentime the experimental group allowed children decreased significantly over time with no significant time by group effect. The value parents placed on physical activity for children increased over time in both groups with a significant time effect. The experimental group over time had significantly greater increases in the availability of physical activity space and supports inside the home than the control group. Improvements noted have the potential to help protect children and parents from excess weight gain, yet findings indicate considerable opportunity for continued improvement as well as elucidation of factors affecting concomitant changes in both study groups.

Promoting healthy home environments and lifestyles in families with preschool children: HomeStyles, a randomized controlled trial.

The purpose of the HomeStyles randomized controlled trial was to determine the effect of participation in the HomeStyles intervention vs an attention control condition on the weight-related aspects of the home environment and lifestyle behavioral practices of families with preschool children. Parents of preschool children (n=489) were systematically randomized to experimental or attention control group after completing the baseline survey. Baseline and post surveys comprehensively assessed study outcomes using a socio-ecological approach incorporating valid, reliable intrapersonal (e.g., diet, activity), interpersonal (e.g., family meal frequency), and environmental measures (e.g., home media environment), and self-reported parent and child measured heights and weights. For all outcome measures, paired t-tests compared within group differences over time and ANCOVA, controlling for baseline scores and prognostic variables (e.g., parent sex), determined differences in post survey scores between groups. The final analytical sample (N=172; age 32.34±5.71SD; 58% White; 93% female) completed baseline and post surveys. The experimental group families had improved family meal and diet-related behaviors, and self-efficacy for food-related childhood obesity-protective practices. Household food supplies changed little, except for less availability of salty/fatty snacks. Within group effects indicated the control group also experienced some improvements, however these were few in number. ANCOVA revealed the experimental group parents had greater physical activity, reduced screentime, improved family mealtime behaviors, and increased self-efficacy for childhood obesity-protective behaviors and cognitions compared to the control group at post survey, though effect sizes were small. The HomeStyles program for families with preschool children promoted improvements in an array of obesity-preventive behaviors.

Dynamic Energy Balance: An Integrated Framework for Discussing Diet and Physical Activity in Obesity Prevention-Is it More than Eating Less and Exercising More?

Understanding the dynamic nature of energy balance, and the interrelated and synergistic roles of diet and physical activity (PA) on body weight, will enable nutrition educators to be more effective in implementing obesity prevention education. Although most educators recognize that diet and PA are important for weight management, they may not fully understand their impact on energy flux and how diet alters energy expenditure and energy expenditure alters diet. Many nutrition educators have little training in exercise science; thus, they may not have the knowledge essential to understanding the benefits of PA for health or weight management beyond burning calories. This paper highlights the importance of advancing nutrition educators' understanding about PA, and its synergistic role with diet, and the value of incorporating a dynamic energy balance approach into obesity-prevention programs. Five key points are highlighted: (1) the concept of dynamic vs. static energy balance; (2) the role of PA in weight management; (3) the role of PA in appetite regulation; (4) the concept of energy flux; and (5) the integration of dynamic energy balance into obesity prevention programs. The rationale for the importance of understanding the physiological relationship between PA and diet for effective obesity prevention programming is also reviewed.