The Association between the Atherogenic Index of Plasma and Cardiometabolic Risk Factors: A Review.

BACKGROUND: Metabolic syndrome (MetS) is a condition caused by a combination of cardiometabolic risk factors (CMR). MetS leads to type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD), both of which place a burden on not only the patients but also the healthcare system. Diagnostic criteria for MetS vary, and there is no universal tool to detect it. Recently, many studies have found positive associations between the atherogenic index of plasma (AIP) and some CMR factors. Therefore, a comprehensive review was needed to recapitulate these studies and qualitatively estimate the likelihood of AIP being associated with CMR. We aimed to review and summarise observational data on AIP and CMR factors and verify their association. MATERIALS AND METHODS: A review of observational studies was conducted by searching "atherogenic index of plasma" in PubMed, One Search, and the Cochrane library. A total of 2068 articles were screened, and 32 were included after excluding paediatric, non-human and interventional studies, and those carried out on cohorts with conditions unrelated to MetS or on lipid-lowering medication. The Newcastle-Ottawa scale was used to assess their quality. RESULTS: Most studies that reported high waist circumference (WC), triglycerides (TG), insulin resistance (IR) and low high-density lipoprotein cholesterol (HDL-C) concentration, also reported high AIP. Few studies investigated blood pressure (BP) and some discrepancies existed between their results. CONCLUSION: AIP may be associated with WC, TG, IR, and HDL-C. It is unclear if AIP is associated with BP. The current study's results should be used to inform futureward a meta-analysis to be seen quantitatively. It is also recommended that more cohort studies stratified by gender and ethnicity be performed to ascertain if AIP can predict MetS before it manifests.

The Effect of Dietary Carbohydrate and Fat Manipulation on the Metabolome and Markers of Glucose and Insulin Metabolism: A Randomised Parallel Trial.

High carbohydrate, lower fat (HCLF) diets are recommended to reduce cardiometabolic disease (CMD) but low carbohydrate high fat (LCHF) diets can be just as effective. The effect of LCHF on novel insulin resistance biomarkers and the metabolome has not been fully explored. The aim of this study was to investigate the impact of an ad libitum 8-week LCHF diet compared with a HCLF diet on CMD markers, the metabolome, and insulin resistance markers. n = 16 adults were randomly assigned to either LCHF (n = 8, <50 g CHO p/day) or HCLF diet (n = 8) for 8 weeks. At weeks 0, 4 and 8, participants provided fasted blood samples, measures of body composition, blood pressure and dietary intake. Samples were analysed for markers of cardiometabolic disease and underwent non-targeted metabolomic profiling. Both a LCHF and HCLF diet significantly (p < 0.01) improved fasting insulin, HOMA IR, rQUICKI and leptin/adiponectin ratio (p < 0.05) levels. Metabolomic profiling detected 3489 metabolites with 78 metabolites being differentially regulated, for example, an upregulation in lipid metabolites following the LCHF diet may indicate an increase in lipid transport and oxidation, improving insulin sensitivity. In conclusion, both diets may reduce type 2 diabetes risk albeit, a LCHF diet may enhance insulin sensitivity by increasing lipid oxidation.

Leucine-enriched whey protein supplementation, resistance-based exercise, and cardiometabolic health in older adults: a randomized controlled trial.

BACKGROUND: Increasing protein intake (above the Recommended Dietary Amount) alone or with resistance-based exercise is suggested to improve cardiometabolic health; however, randomized controlled trials (RCTs) are needed to confirm this. METHODS: The Liverpool Hope University-Sarcopenia Aging Trial (LHU-SAT) was a 16 week RCT (ClinicalTrials.gov Identifier: NCT02912130) of 100 community-dwelling older adults [mean age: 68.73 ± 5.80 years, body mass index: 27.06 ± 5.18 kg/m2 (52% women)] who were randomized to four independent groups [Control (C), Exercise (E), Exercise + Protein (EP), Protein (P)]. E and EP completed supervised and progressive resistance-based exercise (resistance exercise: two times per week, functional circuit exercise: once per week), while EP and P were supplemented with a leucine-enriched whey protein drink (three times per day) based on individual body weight (0.50 g/kg/meal, 1.50 g/kg/day). Outcome measures including arterial stiffness (pulse wave velocity), fasting plasma/serum biomarkers [glucose/glycated haemoglobin, total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein, insulin, resistin, leptin, adiponectin, C-reactive protein, tumour necrosis factor-alpha, interleukin-6, cystatin-C, & ferritin], insulin resistance (HOMA-IR), and kidney function (eGFR) were measured before and after intervention. RESULTS: Total protein intake (habitual diet plus supplementation) increased to 1.55 ± 0.69 g/kg/day in EP and to 1.93 ± 0.72 g/kg/day in P, and remained significantly lower (P < 0.001) in unsupplemented groups (E: 1.08 ± 0.33 g/kg/day, C: 1.00 ± 0.26 g/kg/day). At 16 weeks, there was a group-by-time interaction whereby absolute changes in LDL-cholesterol were lower in EP [mean difference: -0.79 mmol/L, 95% confidence interval (CI): -1.29, -0.28, P = 0.002] and P (mean difference: -0.76 mmol/L, 95% CI: -1.26, -0.26, P = 0.003) vs. C. Serum insulin also showed group-by-time interactions at 16 weeks whereby fold changes were lower in EP (mean difference: -0.40, 95% CI: -0.65, -0.16, P = 0.001) and P (mean difference: -0.32, 95% CI: -0.56, -0.08, P = 0.009) vs. C, and fold changes in HOMA-IR improved in EP (mean difference: -0.37, 95% CI: -0.64, -0.10, P = 0.007) and P (mean difference: -0.27, 95% CI: -0.53, -0.00, P = 0.048) vs. C. Serum resistin declined in P only (group-by-time interaction at 16 weeks: P = 0.009). No other interactions were observed in outcome measures (P > 0.05), and kidney function (eGFR) remained unaltered. CONCLUSIONS: Sixteen weeks of leucine-enriched whey protein supplementation alone and combined with resistance-based exercise improved cardiometabolic health markers in older adults.

Diagnostic Power of Circulatory Metabolic Biomarkers as Metabolic Syndrome Risk Predictors in Community-Dwelling Older Adults in Northwest of England (A Feasibility Study).

BACKGROUND: Metabolic Syndrome (MetS) is a cluster of risk factors for diabetes and cardiovascular diseases with pathophysiology strongly linked to aging. A range of circulatory metabolic biomarkers such as inflammatory adipokines have been associated with MetS; however, the diagnostic power of these markers as MetS risk correlates in elderly has yet to be elucidated. This cross-sectional study investigated the diagnostic power of circulatory metabolic biomarkers as MetS risk correlates in older adults. METHODS: Hundred community dwelling older adults (mean age: 68.7 years) were recruited in a study, where their blood pressure, body composition and Pulse Wave Velocity (PWV) were measured; and their fasting capillary and venous blood were collected. The components of the MetS; and the serum concentrations of Interleukin-6 (IL-6), Tumor Necrosis Factor-α (TNF-α), Plasminogen Activator Inhibitor-I (PAI-I), Leptin, Adiponectin, Resistin, Cystatin-C, C-Reactive Protein (CRP), insulin and ferritin were measured within the laboratory, and the HOMA1-IR and Atherogenic Index of Plasma (AIP) were calculated. RESULTS: Apart from other markers which were related with some cardiometabolic (CM) risk, after Bonferroni correction insulin had significant association with all components of Mets and AIP. These associations also remained significant in multivariate regression. The multivariate odds ratio (OR with 95% confidence interval (CI)) showed a statistically significant association between IL-6 (OR: 1.32 (1.06-1.64)), TNF-α (OR: 1.37 (1.02-1.84)), Resistin (OR: 1.27 (1.04-1.54)) and CRP (OR: 1.29 (1.09-1.54)) with MetS risk; however, these associations were not found when the model was adjusted for age, dietary intake and adiposity. In unadjusted models, insulin was consistently statistically associated with at least two CM risk factors (OR: 1.33 (1.16-1.53)) and MetS risk (OR: 1.24 (1.12-1.37)) and in adjusted models it was found to be associated with at least two CM risk factors and MetS risk (OR: 1.87 (1.24-2.83) and OR: 1.25 (1.09-1.43)) respectively. Area under curve (AUC) for receiver operating characteristics (ROC) demonstrated a good discriminatory diagnostics power of insulin with AUC: 0.775 (0.683-0.866) and 0.785 by cross validation and bootstrapping samples for at least two CM risk factors and AUC: 0.773 (0.653-0.893) and 0.783 by cross validation and bootstrapping samples for MetS risk. This was superior to all other AUC reported from the ROC analysis of other biomarkers. Area under precision-recall curve for insulin was also superior to all other markers (0.839 and 0.586 for at least two CM risk factors and MetS, respectively). CONCLUSION: Fasting serum insulin concentration was statistically linked with MetS and its risk, and this link is stronger than all other biomarkers. Our ROC analysis confirmed the discriminatory diagnostic power of insulin as CM and MetS risk correlate in older adults.

Dietetic Students' Drivers and Barriers to Healthy Eating While Studying to Be a Healthcare Professional (a Pilot Study).

BACKGROUND: For Dietetics students, starting university means developing the knowledge and skills required to be a healthcare practitioner. This pilot study aimed to explore the perceptions and views of the students on their drivers and barriers of healthy eating while studying Dietetics at university. METHODS: A qualitative study was undertaken with a purposive sample of six final year Dietetic students at a UK university. Semi-structured in-depth interviews were used to elicit students' experiences and perceptions of barriers to healthy eating. Interview data were analysed thematically. RESULTS: Five themes emerged from the interview data including studying Dietetics, placement, influence of significant others, food security, and social and cultural aspects of the university life, with several sub-themes, and perspectives about the future beyond the university life. CONCLUSIONS: The findings suggest a potential need for Dietetics course providers to consider the range of barriers to healthy eating that students may encounter whilst studying and how these may undermine their ability to develop healthy eating practices and effective professional skills. Further research is required that explores the extent of barriers to healthy eating and examine whether these impinge upon effective practice.

Reliability, Validity, and Gender Invariance of the Exercise Benefits/Barriers Scale: An Emerging Evidence for a More Concise Research Tool.

The Exercise Benefits/Barriers Scale (EBBS) research instrument has been extensively used to investigate the perceived benefits and barriers of exercise in a range of settings. In order to examine theoretical contentions and translate the findings, it is imperative to implement measurement tools that operationalize the constructs in an accurate and reliable way. The original validation of the EBBS proposed a nine-factor structure for the research tool, examined the EBBS factor structure, and suggested that various factors are important for the testing of the perception of exercise benefits and barriers, whereas a few items and factors may not be vital. The current study conducted a confirmatory factor analysis (CFA) using hierarchical testing in 565 participants from the northwest region of the United Kingdom, the results of which provided evidence for a four-factor structure of the benefits measure, with the Comparative Fit Index (CFI) = 0.943, Tucker-Lewis Index (TLI) = 0.933, and root means square error of approximation (RMSEA) = 0.051, namely life enhancement, physical performance, psychological outlook, and social interaction, as well as a two-factor structure of the barrier measures, with the CFI = 0.953, TLI = 0.931, and RMSEA = 0.063, including exercise milieu and time expenditure. Our findings showed that for a six-factor correlated model, the CFI = 0.930, TLI = 0.919, and RMSEA = 0.046. The multi-group CFA provided support for gender invariance. The results indicated that after three decades of the original validation of the EBBS, many of the core factors and items are still relevant for the assessment of higher-order factors; however, the 26-item concise tool proposed in the current study displays a better parsimony in comparison with the original 43-item questionnaire. Overall, the current study provides support for a reliable, cross-culturally valid EBBS within the UK adult population, however, it proposes a shorter and more concise version compared with the original tool, and gives direction for future research to focus on the content validity for assessing the perception of the barriers to physical activity.

The Effects of Pre-Game Carbohydrate Intake on Running Performance and Substrate Utilisation during Simulated Gaelic Football Match Play.

BACKGROUND: Previous research has reported that elite Gaelic football players' carbohydrate (CHO) intakes are sub-optimal, especially, in the lead up to competitive matches. Despite clear decrements in running performance across elite Gaelic football matches, there are no studies that have investigated nutrition interventions on match-related Gaelic football performance. The aim of this study was to determine whether a higher-CHO diet in line with sports nutrition guidelines can improve Gaelic football-related performance compared to lower CHO intakes previously observed in Gaelic footballers. METHODS: Twelve Gaelic football players completed a Gaelic football simulation protocol (GFSP) on two occasions after consuming a high-CHO diet (7 g·kg-1) (HCHO) or an energy-matched lower-CHO diet (3.5 g·kg-1) (L-CHO) for 48 h. Movement demands and heart rate were measured using portable global positioning systems devices. Countermovement jump height (CMJ) and repeated-sprint ability (RSA) were measured throughout each trial. Expired respiratory gases were collected throughout the trial using a portable gas analyser. Blood samples were taken at rest, half-time, and post-simulation. RESULTS: There was no significant difference in total distance (p = 0.811; η2 = 0.005) or high-speed running distance (HSRD) covered between both trials. However, in the second half of the HCHO trial, HSRD was significantly greater compared to the second half of the LCHO trial (p = 0.015). Sprint distance covered during GFSP was significantly greater in HCHO (8.1 ± 3.5 m·min-1) compared with LCHO (6.4 ± 3.2 m·min-1) (p = 0.011; η2 = 0.445). RSA performance (p < 0.0001; η2 = 0.735) and lower body power (CMJ) (p < 0.0001; η2 = 0.683) were significantly greater during the HCHO trial compared to LCHO. Overall CHO oxidation rates were significantly greater under HCHO conditions compared to LCHO (3.3 ± 0.5 vs. 2.7 ± 0.6 g·min-1) (p < 0.001; η2 = 0.798). Blood lactate concentrations were significantly higher during HCHO trial versus LCHO (p = 0.026; η2 = 0.375). There were no significant differences in plasma glucose, non-esterified fatty acids (NEFAs), and glycerol concentration between trials. In both trials, all blood metabolites were significantly elevated at half-time and post-trial compared to pre-trial. CONCLUSION: These findings indicate that a higher-CHO diet can reduce declines in physical performance during simulated Gaelic football match play.

Clustered cardiometabolic risk and arterial stiffness of recreational adult tennis players.

BACKGROUND: Recent evidence highlights racquet sports as being associated with a substantially reduced risk of CVD mortality. The purpose of this investigation was to evaluate clustered cardiometabolic risk (CMR) and arterial stiffness in recreational adult tennis players. METHODS: Forty-three recreational tennis players (T) and a matched group of 45 healthy, active non-tennis (NT) players, mean age (±SEM) 41.6±1.8 years participated in this cross-sectional comparative study. Measurements included emerging and traditional CMR factors with pulse wave analysis/velocity utilised to assess indexes of arterial stiffness. Clustered cardiometabolic risk was calculated using two composites: CMR1 (central aortic systolic blood pressure, carotid-femoral pulse wave velocity, percentage body fat, HDL-C and maximal oxygen uptake) and CMR2 (brachial systolic blood pressure, triglycerides, TC:HDL-C, percentage body fat, HbA1c and maximal oxygen uptake). RESULTS: Analysis of covariance, controlling for age, revealed T had significantly lower (healthier) CMR1 scores than NT (EMM±SEM, T: -0.48±0.3 vs. NT: 0.50±0.3, P=0.03). Similarly, T also demonstrated lower clustered CMR2 scores (EMM, T: -0.66±0.4 vs. NT: 0.59±0.4, P=0.04). Augmentation index of the pulse pressure wave, normalised to heart rate 75 bpm (AIx75), was lower in T vs NT (EMM, T: 10.7±1.7% vs. NT: 12.7±1.6%; P=0.03), when controlling for age and gender. CONCLUSIONS: Tennis appears to be a suitable and effective physical activity modality for targeting cardiometabolic and vascular health and should be more frequently advocated in physical activity promotion strategies.

Effects of exercise and whey protein on muscle mass, fat mass, myoelectrical muscle fatigue and health-related quality of life in older adults: a secondary analysis of the Liverpool Hope University-Sarcopenia Ageing Trial (LHU-SAT).

PURPOSE: To investigate the effects of exercise in combination with, or without, a leucine-enriched whey protein supplement on muscle mass, fat mass, myoelectrical muscle fatigue and health-related quality of life (HR-QOL) in older adults. METHODS: 100 community-dwelling older adults [52% women, age: 69 ± 6 years (mean ± SD)] were randomised to four [Control (C); Exercise (E); Exercise + Protein (EP); Protein (P)] independent groups. E and EP groups completed 16 weeks of exercise [resistance (2 times/week) and functional (1 time/week]. EP and P groups were also administered a leucine-enriched whey protein supplement (3 times/day) based on body weight (1.5 g/kg/day). Muscle and fat mass (bioelectrical impedance analysis), myoelectrical muscle fatigue (surface electromyography) and HR-QOL (WHOQOL-BREF) were measured pre- and post-intervention. RESULTS: At post-intervention, the rectus femoris (E: - 4.8%/min, p = 0.007, ES = 0.86; EP: - 3.3%/min, p = 0.045, ES = 0.58) and bicep femoris (E: - 3.9%/min, p < 0.001, ES = 1.46; EP: - 4.3%/min, p < 0.001, ES = 1.58) muscles became more resistant to fatigue in the E and EP groups, respectively (p < 0.05 versus C). HR-QOL improved in the E group only. Muscle and fat mass did not change (p > 0.05). CONCLUSION: Physical exercise is a potent method to improve myoelectrical muscle fatigue and HR-QOL in older adults. However, leucine-enriched whey protein did not augment this response in those already consuming sufficient quantities of protein at trial enrolment.

Improved prediction equations for estimating height in adults from ethnically diverse backgrounds.

BACKGROUND & AIMS: When body height cannot be measured, it can be predicted from ulna length (UL). However, commonly used published prediction equations may not provide useful estimates in adults from all ethnicities. This study aimed to evaluate the relationship between UL and height in adults from diverse ethnic groups and to consider whether this can be used to provide useful prediction equations for height in practice. METHODS: Standing height and UL were measured in 542 adults at seven UK locations. Ethnicity was self-defined using UK Census 2011 categories. Data were modelled to give two groups of height prediction equations based on UL, sex and ethnicity and these were tested against an independent dataset (n = 180). RESULTS: UL and height were significantly associated overall and in all groups except one with few participants (P = 0.059). The new equations yielded predicted height (Hp) that was closer to measured height in the Asian and Black subgroups of the independent population than the Malnutrition Universal Screening Tool (MUST) equations. For Asian men, (Hp (cm) = 3.26 UL (cm) + 83.58), mean difference from measured (95% confidence intervals) was -0.6 (-2.4, +1.2); Asian women, (Hp = 3.26 UL + 77.62), mean difference +0.5 (-1.4, 2.4) cm. For Black men, Hp = 3.14 UL + 85.80, -0.4 (-2.4, 1.7); Black women, Hp = 3.14 UL + 79.55, -0.8 (-2.8, 1.2). These differences were not statistically significant while predictions from MUST equations were significantly different from measured height. CONCLUSIONS: The new prediction equations provide an alternative for estimating height in adults from Asian and Black groups and give mean predicted values that are closer to measured height than MUST equations.

The Musculoskeletal Health Benefits of Tennis.

BACKGROUND: The prevalence of musculoskeletal (MSK) conditions is increasing, and although current guidelines for physical activity attempt to combat this, many fail to achieve the recommended targets. The present study sought to investigate whether regular tennis participation is more effective at enhancing MSK function than meeting the current international physical activity guidelines. HYPOTHESIS: Tennis players will display significantly enhanced MSK function when compared with age-matched healthy active nonplayers. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 3. METHODS: Ninety participants (age range, 18-65 years) took part in this study; there were 43 tennis players (18 men, 25 women) and 47 nonplayers (26 men, 21 women). MSK function was assessed by cluster analysis of 3 factors: (1) electromyographic fatigability of prime movers during handgrip, knee extension, and knee flexion; (2) isometric strength in the aforementioned movements; and (3) body composition measured by bioelectrical impedance analysis. Maximal oxygen uptake was also assessed to characterize cardiorespiratory fitness. RESULTS: Tennis players displayed significantly greater upper body MSK function than nonplayers when cluster scores of body fat percentage, handgrip strength, and flexor carpi radialis fatigue were compared by analysis of covariance, using age as a covariate (tennis players, 0.33 ± 1.93 vs nonplayers, -0.26 ± 1.66; P < 0.05). Similarly, tennis players also demonstrated greater lower extremity function in a cluster of body fat percentage, knee extension strength, and rectus femoris fatigue (tennis players, 0.17 ± 1.76 vs nonplayers, -0.16 ± 1.70; P < 0.05). CONCLUSION: The present study offers support for improved MSK functionality in tennis players when compared with age-matched healthy active nonplayers. This may be due to the hybrid high-intensity interval training nature of tennis. CLINICAL RELEVANCE: The findings suggest tennis is an excellent activity mode to promote MSK health and should therefore be more frequently recommended as a viable alternative to existing physical activity guidelines.

Exercise and Dietary-Protein as a Countermeasure to Skeletal Muscle Weakness: Liverpool Hope University - Sarcopenia Aging Trial (LHU-SAT).

OBJECTIVE: To investigate the effects of a 16-week concurrent exercise regimen [resistance exercise (RE) + functional exercise (FE)] in combination with, or without, a leucine-enriched whey protein isolate supplement on muscle strength, physical functioning, aerobic capacity, and cardiometabolic health in older adults (≥60 years). Physical activity levels were also evaluated 6 months post-cessation of the intervention. METHODS: Forty-six, community-dwelling, previously untrained males, and females [age: 68 ± 5 years (mean ± SD); BMI: 27.8 ± 6.2 kg/m2] who completed the trial were initially randomized to one of two independent arms [Exercise n = 24 (E); Exercise+Protein n = 22 (EP)]. Both arms completed 16 weeks of RE (performed to fatigue) (2 times/week) with FE (1 time/week) on non-consecutive days. Additionally, EP were administered a leucine-enriched whey protein supplement (3 times/day) for 16 weeks based on individual body-weight (1.5 g/kg/day). RESULTS: As a result of dietary supplementation, protein intake increased in EP (∼1.2 ± 0.4 to 1.5 ± 0.7 g/kg/day) during the intervention. Maximal strength (1RM) values for leg press (E: +39 ± 7 kg, p = 0.006; EP: +63 ± 7 kg, p < 0.001), chest press (E: +22 ± 4 kg, p < 0.001; EP: +21 ± 6 kg, p < 0.001), and bicep curl (E: +7 ± 0 kg, p = 0.002; EP: +6 ± 1 kg, p = 0.008) significantly increased in E and EP respectively, with no differences between arms (p > 0.05). Physical functioning in the obstacle course (E: -5.1 ± 6.8 s, p < 0.001; EP: -2.8 ± 0.8 s, p < 0.001) and short-physical performance battery scores (E: +0.5 ± 0.5, p = <0.001; EP: +0.4 ± 0.5, p = 0.038), and aerobic capacity in the 6-min walk test (E: +37 ± 24 m, p = 0.014; EP: +36 ± 3 m, p = 0.005) improved in E and EP respectively, with no differences between arms (p > 0.05). No significant change was observed for markers of cardiometabolic health (glycaemic control or blood pressure) (p > 0.05). At follow-up, 86% of older adults reported to performing physical activity ≥1 per week. Of those, 61% were still participating in strength- and cardiovascular- based exercise. CONCLUSION: Concurrent exercise (RE + FE) offers a potent method to combat age-related muscle weakness, and our results suggest a high proportion of older adults may continue to exercise unsupervised. However, leucine-enriched whey protein isolate supplementation did not confer any additional benefit in those already consuming ample amounts of dietary protein at trial enrolment. Future trials should utilize a whole-foods approach and investigate the effects in frail and non-frail older adults habitually consuming the RDA of protein, to assess if a higher intake of protein is needed to delay the onset of muscle weakness. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT02912130.

Dietary patterns and frailty: a systematic review and meta-analysis.

CONTEXT: Assessing the relationship between single nutrients and frailty fails to take into consideration the interactions between nutrients. An increasing number of investigations in recent years have evaluated the association between dietary patterns and frailty. OBJECTIVE: This systematic review and meta-analysis was conducted to summarize the association between dietary patterns and frailty. DATA SOURCES: PubMed, Scopus, and Google Scholar were searched for epidemiological studies published up to April 2018 that assessed the association between dietary patterns and frailty. STUDY SELECTION: Cohort or cross-sectional studies that examined dietary patterns via an a priori or an a posteriori method in relation to risk of frailty without considering any specific age range were included. Studies were excluded if they examined single nutrients, single foods, or single food groups. DATA EXTRACTION: Pooled effect sizes of eligible studies and their corresponding 95%CIs were estimated using random-effects models. When publication bias was present, trim and fill analysis was conducted to adjust the pooled effect. RESULTS: A total of 13 studies with 15 effect sizes were identified. Results from 9 cohort and cross-sectional studies were included in the meta-analysis. Higher adherence to a healthy dietary pattern was associated with lower odds of frailty (odds ratio = 0.69; 95%CI, 0.57-0.84; P < 0.0001; I2 =92.1%; P for heterogeneity < 0.0001). CONCLUSIONS: The findings suggest that a diet high in fruit, vegetables, and whole grains may be associated with reduced risk of frailty. Nevertheless, additional longitudinal studies are needed to confirm the association of dietary patterns with frailty.

Dietary Intake and Energy Expenditure Assessed during a Pre-Season Period in Elite Gaelic Football Players.

There is currently a lack of research into the energy demands and associated nutritional intakes of elite Gaelic football players during the pre-season period, which is a crucial time of year for physical development. The aim of the current study was to investigate the dietary intake and energy expenditure (EE) of elite Gaelic football players during a typical pre-season week. Over a seven-day period, which included four training days and three rest days, dietary intake (validated self-reported estimated food diary) and EE (Sensewear Pro armband) were recorded in 18 male players from a single elite inter-county Gaelic football team. Average energy intake (EI) (3283 ± 483 kcal) was significantly (p = 0.002) less than average EE (3743 ± 335 kcal), with a mean daily energy deficit of -460 ± 503 kcal. Training days elicited the greatest deficits between intake and expenditure. The mean carbohydrate (CHO) intake was 3.6 ± 0.7 g/kg/day, protein intake was 2.1 ± 0.5 g/kg/day, and fat intake was 1.6 ± 0.2 g/kg/day. These findings indicate that the dietary practices of the sampled players were inadequate to meet EE and CHO recommendations. Training days are of particular concern, with the players not altering energy and CHO intake to encounter increased energy demands. Education on nutritional strategies for elite Gaelic footballers should be considered in relation to training demands to avoid detriments to performance and health.

Anthropometric Indicators of Adiposity Related to Body Weight and Body Shape as Cardiometabolic Risk Predictors in British Young Adults: Superiority of Waist-to-Height Ratio.

Frequently reported poor dietary habits of young adults increase their risk of metabolic syndrome (MetS). Excess adiposity is the most established predictor of MetS, and numerous anthropometric measures have been proposed as proxy indicators of adiposity. We aimed to assess prevalence of MetS in young adult population and to make comparison between weight- and shape-oriented measures of adiposity to identify the best index in association with measured body fat and as a risk predictor for MetS. Healthy males and females aged 18-25 years from the Northwest of England were recruited using convenience sampling (n=550). As part of the assessment of the overall health of young adults, the biochemical variables and adiposity measures BMI, waist circumference (WC), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), new BMI, Body Adiposity Index (BAI), Clinica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE), and A Body Shape Index (ABSI) were assessed. Linear regression analysis was used to investigate the association between the proxy indices of adiposity and measured percentage body fat. The odds ratio with 95% confidence interval was used to investigate the relationship between cardiometabolic (CM) risk factors and proxy measures of adiposity. The discriminatory power of these measures for diagnosis of MetS was investigated using area under the receiver operating characteristic curve. Body weight-related indicators of adiposity, particularly CUN-BAE, had stronger association with measured body fat compared with body shape-related indices. In relation with MetS, body shape-related indices, particularly elevated WC and WHtR, had stronger associations with CM risk compared with body weight-related measures. Amongst all indices, the best predictor for CM risk was WHtR, while ABSI had the weakest correlation with body fat, MetS, and CM risk. Indices directly associated with WC and specifically WHtR had greater diagnostic power in detection of CM risk in young adults.

Fruit and vegetable intake and cognitive impairment: a systematic review and meta-analysis of observational studies.

BACKGROUND/OBJECTIVES: Epidemiological studies investigating the association between fruit and vegetable consumption and cognitive function have produced inconclusive findings. The aim of this review was to systematically investigate if increased fruit and vegetable consumption is linked with decreased risk of cognitive impairment (CI). METHODS: We conducted a systematic literature search using four databases (PubMed, Embase, Cochrane Library, and Scopus) in October 2016 and identified cohort and cross-sectional studies, which estimated the risk of CI for fruit and vegetable consumption. The pooled odds ratio (OR) and 95% confidence interval (CI) were estimated by using a random effects model. RESULTS: The six studies meeting inclusion criteria offered 10 effect sizes and the total of 17,537 participants in the analysis. Increased fruit and vegetable intake was associated with reduced risk of CI (OR: 0.79; 95% CI: 0.67-0.93; P = 0.006). The subgroup analysis demonstrated that in studies conducted in China (but not in Western countries), the corresponding reduction in risk of CI risk was significant (OR: 0.74; 95% CI: 0.61, 0.89; P = 0.002) and the relationship between fruits, vegetables, and CI did not differ by study design, type of exposure, and gender. CONCLUSION: Increased fruit and vegetable consumption is associated with the reduced risk of CI; however, such association might be dependent on the geographical region. Further prospective studies specifically designed to compare vegetables and fruit varieties, and also to determine the recommended amounts to prevent CI are warranted.

A2 Milk Enhances Dynamic Muscle Function Following Repeated Sprint Exercise, a Possible Ergogenic Aid for A1-Protein Intolerant Athletes?

Hyperaminoacidemia following ingestion of cows-milk may stimulate muscle anabolism and attenuate exercise-induced muscle damage (EIMD). However, as dairy-intolerant athletes do not obtain the reported benefits from milk-based products, A2 milk may offer a suitable alternative as it lacks the A1-protein. This study aimed to determine the effect of A2 milk on recovery from a sports-specific muscle damage model. Twenty-one male team sport players were allocated to three independent groups: A2 milk (n = 7), regular milk (n = 7), and placebo (PLA) (n = 7). Immediately following muscle-damaging exercise, participants consumed either A2 milk, regular milk or PLA (500 mL each). Visual analogue scale (muscle soreness), maximal voluntary isometric contraction (MVIC), countermovement jump (CMJ) and 20-m sprint were measured prior to and 24, 48, and 72 h post EIMD. At 48 h post-EIMD, CMJ and 20-m sprint recovered quicker in A2 (33.4 ± 6.6 and 3.3 ± 0.1, respectively) and regular milk (33.1 ± 7.1 and 3.3 ± 0.3, respectively) vs. PLA (29.2 ± 3.6 and 3.6 ± 0.3, respectively) (p < 0.05). Relative to baseline, decrements in 48 h CMJ and 20-m sprint were minimised in A2 (by 7.2 and 5.1%, respectively) and regular milk (by 6.3 and 5.2%, respectively) vs. PLA. There was a trend for milk treatments to attenuate decrements in MVIC, however statistical significance was not reached (p = 0.069). Milk treatments had no apparent effect on muscle soreness (p = 0.152). Following muscle-damaging exercise, ingestion of 500 mL of A2 or regular milk can limit decrements in dynamic muscle function in male athletes, thus hastening recovery and improving subsequent performance. The findings propose A2 milk as an ergogenic aid following EIMD, and may offer an alternative to athletes intolerant to the A1 protein.