Fruit and Vegetable Intake Patterns, Kidney Failure, and Mortality in Adults with and without Chronic Kidney Disease in the United States.

BACKGROUND: Fruits and vegetables (F&Vs) are vital components of healthy diets but may be restricted in chronic kidney disease (CKD) to avoid high-potassium intake. We previously generated F&V patterns for patients in the National Health and Nutrition Examination Survey (NHANES) and demonstrated an increased prevalence of the overall low-intake pattern in patients with CKD. OBJECTIVE: To evaluate the association of F&V patterns (overall low intake, high unprocessed, moderate processed, and high ultraprocessed) with the risk of kidney failure and its composite with death. METHODS: Adults in NHANES III with valid dietary data and longitudinal follow-up for kidney failure and death were included. F&V patterns were identified using 24-h dietary recalls and latent class analysis, yielding 4 patterns. Cox models were used to evaluate the prospective association between each pattern and hazard of kidney failure or a composite of kidney failure or death over ≤20 y. Models were adjusted for demographics and select comorbidities and weighted for the complex survey design. Secondary analyses evaluated serum carotenoids as objective biomarkers of F&V intake. RESULTS: Among 16,726 eligible participants in NHANES III, F&V consumption consistent with the high-ultraprocessed pattern associated with the highest risk of kidney failure after demographic and comorbidity adjustment, but attenuated with adjustment for kidney function. The high unprocessed pattern associated with the lowest adjusted risk of death or kidney failure combined [hazard ratio (HR): 0.73; 95% confidence interval (CI): 0.65, 0.81 relative to overall low intake]. Higher-serum carotenoids were associated with a lower adjusted risk of death or kidney failure combined (HR: 0.57; 95% CI: 0.49, 0.65 for quartile 4 compared with quartile 1). Results were similar in patients with CKD at baseline. CONCLUSIONS: Higher intake of unprocessed F&Vs was associated with better outcomes in the general population and patients with CKD. Results emphasize the need to safely improve F&V intake in CKD.

Endogenous Ghrelin Levels and Perception of Hunger: A Systematic Review and Meta-Analysis.

BACKGROUND: Ghrelin is an orexigenic hormone primarily released by the stomach and has 2 isoforms: acylated ghrelin (AG) and de-acylated ghrelin (DAG), that appear to have different functions in humans. OBJECTIVES: To perform a systematic review and meta-analysis of the association between plasma concentrations of total ghrelin (TG), AG, and DAG and perceptions of hunger in healthy adults. METHODS: The following criteria were used for inclusion: 1) sample contained adults ≥18 y of age, 2) body mass index [BMI kg/m2] was ≥18.5, 3) ghrelin was sampled through blood, 4) subjective hunger was measured on a validated scale, 5) study reported a Pearson product correlation of ghrelin or had relevant figure(s) for data extraction, 6) participants were healthy with no overt disease, 7) protocols contained no physical activity or weight loss medication that suppressed appetite, 8) interventions were conducted without environmental manipulations. Moderators assessed were age, BMI, percentage of body fat (%BF), macronutrient content of test meals, energy intake (kcals), sex, and ghrelin isoform (AG, DAG, or TG). RESULTS: The analysis included 47 studies (110 trials, n = 1799, age: 31.4 ± 12.0 y, BMI: 26.0 ± 4.75 kg/m2) and measured AG (n = 47 trials), DAG (n = 12 trials), and TG (n = 51 trials). The overall model indicated that ghrelin concentrations and perceptions of hunger were moderately correlated (r = 0.43, P < 0.001), and ghrelin isoform significantly moderated this relationship (AG: r = 0.60, P < 0.001; TG: r = 0.215, P = 0.01; DAG: r = 0.53, P = 0.695). Other significant moderators included age (b = -0.02, P = 0.01), BMI (b = -0.03, P = 0.05), %BF (b = -0.03, P = 0.05), energy intake (b = 0.0003, P = 0.04), and percentage of carbohydrates of test meals (b = 0.008, P = 0.05). CONCLUSIONS: Ghrelin is associated with perceptions of hunger in humans, and this relationship is strengthened when AG is isolated; thus, AG may have a large impact on hunger signals in various populations. Future research should attempt to understand the role of DAG in hunger sensations.

Preschool- and childcare center-based interventions to increase fruit and vegetable intake in preschool children in the United States: a systematic review of effectiveness and behavior change techniques.

BACKGROUND: Fruit and vegetable (FV) consumption in children in the United States (US) is very low. Adequate FV consumption is required for proper development during childhood, and dietary habits are established during preschool-age and tend to persist into adulthood. As most U.S. preschool-aged children attend childcare or preschool, this may be an opportune time and setting to conduct interventions to improve FV intake. These interventions should be based in theory and use behavior change techniques (BCTs) to explain mechanisms for expected change. To date, no published reviews have examined the effectiveness of childcare- or preschool-based FV interventions in preschoolers and their use of theoretical frameworks and BCTs. METHODS: This systematic review was completed adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria were randomized controlled trials (RCTs) published between 2012 and 2022 of interventions to improve diet or FV intake in preschoolers (aged 2-5 years) in childcare or preschool-settings. A search of four databases was conducted between in September 2022 using search terms pertaining to the study's primary aim (FV consumption), age group (preschool-aged), settings (US childcare or preschool settings), and study design (RCT). Additional criteria were objective measures of FV consumption or skin carotenoids, as a proxy for FV intake. Included studies were narratively synthesized based on intervention type, measured effect, and use of theory and BCTs. RESULTS: The search resulted in six studies that reported on nine interventions. Overall, six interventions increased FV intake, of which five used nutrition education and one manipulated the feeding environment. Among the three interventions with no measured effect, two manipulated the feeding environment and one used peer modeling. Effective studies used at least three BCTs, though no pattern was observed between use of theory or BCTs and intervention effect. CONCLUSIONS: While several studies have shown promising results, the limited number of studies identified in this review highlights key gaps in this field: there is a need for studies to test FV interventions in US childcare settings that use objective measures of FV intake, directly compare intervention components and BCTs, are theory-based, and assess long-term behavior change.

Patterns of Fruit and Vegetable Intake in Adults With and Without Chronic Kidney Disease in the United States.

OBJECTIVE: To characterize patterns of fruit and vegetable (F&V) intake in US adults with and without chronic kidney disease (CKD). METHODS: We used 24-hour dietary recall data from multiple cycles of the National Health and Nutrition Examination Survey spanning 3 groups from 1988 to 2018 (1988-1994; 2003-2010; 2011-2018). We categorized F&Vs based on food processing and phytochemical content. We assessed patterns of F&Vs using latent class analysis and compared intake patterns across the 3 temporal cohorts and CKD status using weighted multinomial logistic regression. RESULTS: Four similar patterns of F&Vs emerged in each cycle: Overall Low Intake, High Unprocessed, High Ultra-Processed, and Moderate Processed F&Vs. The Overall Low Intake pattern was most prevalent in all cohorts and CKD groups. After adjustment for demographic variables and selected health conditions, participants with compared to without CKD were more likely to be classified as Overall Low Intake in each cohort, although this was not significant in the National Health and Nutrition Examination Survey 2011-2018. CONCLUSIONS: Low consumption of F&Vs was more common in patients with CKD. Longitudinal studies are needed to determine if low intake is a risk factor for, or response to, CKD.

Determinants of physical activity of transitioning adult children with Autism Spectrum Disorder.

Many young adults on the autism spectrum do not attain the recommended minimum weekly amount of moderate to vigorous physical activity (MVPA) to prevent significant health risks. Autism symptoms as well as environmental factors may play a key role in the physical activity (PA) behaviors of young adults on the autism spectrum. The socioecological model (SEM) has been previously used to identify determinants of PA among people within many disability categories. Aims: Explore the overall relationship between determinants of PA of MVPA among parents and their young adult child with ASD as well as MVPA determinants segmented by caregiver level of support. Methods: 336 parents of adult children with ASD completed the Determinants of Physical Activity and Eating Behaviors for Young Adults with ASD Scale. Results: Children's weekly time spent in MVPA was predicted by parent self-reported MVPA, exercise competency, video game use, social skills, and neighborhood qualities. Parent weekly time spent in MVPA was predicted by their child's weekly MVPA, parent exercise competency, parent discretionary time, available home exercise equipment, and parent attitude towards physical activity. Conclusion: These results support the administration of quality community-based motor development, motor skills, and exercise skills programs focused on increasing physical activity and parent's influential role in their children's weekly MVPA.

Diet Quality and Dietary Inflammatory Index Score among Women's Cancer Survivors.

The purpose of this study was to investigate Healthy Eating Index 2015 (HEI-2015) and Energy-Adjusted Dietary Inflammatory Index (E-DIITM) scores in women's cancer survivors and to examine socio-economic (SES) characteristics associated with these two diet indices. In this cross-sectional study, survivors of women's cancers completed a demographic questionnaire and up to three 24-h dietary recalls. HEI-2015 and E-DII scores were calculated from average intakes. One-way ANOVA was used to examine the association of various demographic factors on HEI-2015 and E-DII scores. Pearson Correlation was used to calculate the correlation between the two scores. The average HEI-2015 score was 55.0 ± 13.5, lower than the national average, and average E-DII was -1.14 ± 2.24, with 29% of women having a more pro-inflammatory and 71% a more anti-inflammatory diet. Diets with higher HEI-2015 scores were associated with more anti-inflammatory diets (r = -0.67, p < 0.001). Those having a graduate degree (F(2,49) = 3.6, p = 0.03) and completing cancer treatment > 4 years ago (F(2,49) = 4.8, p = 0.01) had higher HEI-2015 scores. There were no associations between SES and E-DII scores. The diet quality of women's cancer survivors is comparatively low, but many achieved an anti-inflammatory diet; a promising avenue for preventing recurrence. There is an urgent need to involve health care professionals in the guidance of women's cancer survivors to improve diet quality and prevent cancer recurrence.

Intergeneration transfer of diet patterns? Parental self-report of diet and their report of their young adult children with ASD.

Autism Spectrum Disorder (ASD) affects two percent of American children and often results in neophobia, hypersensitivity to foods, and firmly set food preferences, leading to higher proportions of individuals suffering from diet-related chronic diseases. Our objective was to conduct an explorative pilot study to examine parents' perception of food intake for themselves and their young adult children with ASD. We employed comparative analysis to discover potential pathways to improve diet quality and lower the risk for chronic disease in individuals with ASD. Data from an online survey in n = 493 parent-child dyads on parentally reported intake patterns, food group, and food consumption was analyzed using kappa statistics to determine the level of agreement between reported parental and child intake patterns, body weight status and activity level. Average age was 48 years for parents and 22 years for their children, respectively. Parent-child agreement for obesity was high. We found very strong agreement between the reported diet variety (kappa = 0.82) and changing daily intake (kappa = 0.63) and strong agreement for some vegetable intake patterns (kappa = 0.61 for orange, white, and starchy vegetables) but not in meat intake (no agreement). Results of this study indicate evidence for perceived intergenerational transfer of dietary intake patterns, which may offer effective approaches to change parental diet, to subsequently improve diet quality in young adults with ASD and prevent diet-related chronic diseases in individuals with ASD.

Effect of presurgical aerobic exercise on cardiometabolic health 30 days after bariatric surgery.

We evaluated the effect of preoperative standard medical care (SC) vs. unsupervised aerobic exercise combined with SC (EX + SC) on cardiometabolic health and quality of life (QoL) 30 days after bariatric surgery. Bariatric patients (n = 14, age: 42.3 ± 2.5 years, body mass index: 45.1 ± 2.5 kg/m2 ) were match-paired to presurgical SC (n = 7) or EX + SC (n = 7; walking 30 min/day, 5 day/week, 65-85% HRpeak ) for 30 days. Body composition, peak cardiorespiratory fitness (VO2 peak), QoL, inflammation (adiponectin, leptin, cytokeratin-18), and a 120 min mixed meal tolerance test was performed to assess aortic waveforms (augmentation index, AIx@75), insulin sensitivity, and glucose total area under the curve (tAUC) at the time of surgery (post-intervention) and 30 days post-surgery. EX + SC had significantly higher high molecular weight (HMW) adiponectin (p = 0.01) and ratio of HMW to total adiponectin (p = 0.04) than SC at 30 days post-surgery, although they significantly (p = 0.006; ES = 1.86) decreased total time spent in moderate to vigorous physical activity (MVPA). SC had a significantly greater increase in VO2 peak (p = 0.02; ES = 1.54) and decrease in 120 min AIx@75 (p = 0.02; ES = 1.78) than EX + SC during the post-surgical period. The increase in MVPA was associated with a reduction in cytokeratin-18 (r = -0.67, p = 0.02). Increased VO2 peak was associated with increased activity/mobility QoL domain (r = 0.52, p = 0.05) and decreased 120 min AIx@75 (r = -0.61, p = 0.03) from surgery to post-surgery. Preoperative EX + SC did not maintain more favorable cardiometabolic health 30 days post-operation in this pilot study. However, changes in MVPA appear important for QoL and should be considered in future work.

A single bout of exercise improves vascular insulin sensitivity in adults with obesity.

OBJECTIVE: This crossover study explored the impact of a single bout of exercise on insulin-stimulated responses in conduit arteries and capillaries. METHODS: Twelve sedentary adults (49.5 [7.8] years; maximal oxygen consumption [VO2 max]: 23.7 [5.4] mL/kg/min) with obesity (BMI 34.5 [4.3] kg/m2 ) completed a control and exercise bout (70% VO2 max to expend 400 kcal). Sixteen hours later, participants underwent a 2-hour euglycemic-hyperinsulinemic clamp (90 mg/dL; 40 mU/m2 /min) to determine vascular and metabolic insulin sensitivity. Endothelial and capillary functions were assessed by brachial artery flow-mediated dilation and contrast-enhanced ultrasound, respectively. Metabolized glucose infusion rate, substrate oxidation (indirect calorimetry), nonoxidative glucose disposal (NOGD), and inflammation were also determined. RESULTS: Exercise increased insulin-stimulated preocclusion diameter (p = 0.01) and microvascular blood flow (condition effect: p = 0.04) compared with control. Furthermore, exercise improved metabolic insulin sensitivity by 21%, which paralleled rises in NOGD (p = 0.05) and decreases in soluble receptors for advanced glycation end products (condition effect: p = 0.01). Interestingly, changes in NOGD were related to increased insulin-stimulated microvascular blood flow (r = 0.57, p = 0.05). CONCLUSIONS: A single bout of exercise increases vascular insulin sensitivity in adults with obesity. Additional work is needed to determine vascular responses following different doses of exercise in order to design lifestyle prescriptions for reducing chronic disease risk.

Changes in Learning Outcomes after Dietary Intervention in Preschoolers: A Pilot Study.

The executive functioning skill set, which includes working memory, cognitive flexibility, and inhibitory control, begins developing in early life and continues into adulthood. Preschoolers' abilities to perform those skills may be influenced by diet. The purpose of this study was to explore the acute effects of consuming a low-GI diet compared to the usual childcare diet on preschoolers' self-reported feelings of hunger and fullness and their performance on learning-associated tasks. This study was a prospective feeding trial in n = 20 children 3-4 years of age, completed in a laboratory setting where children attended "day camps" and consumed two days of usual diet (CON) and two days of low-GI (INT) diet. Learning outcomes were evaluated using select learning assessments including the Kansas Reflection-Impulsivity Scale for Preschoolers (KRISP), Track-it, Peg Tapping, and Happy/Sad. Repeated measures, full-factorial analysis of covariance revealed that diet was significantly related to impulsivity (p > 0.05), and univariate analysis of variance indicated that feelings of hunger and fullness differentially affected cognitive constructs in that feeling full improved impulsivity and attention, while feeling hungry improved inhibitory control. These findings highlight that the connection between diet and learning-related skills of children are independently mediated by both diet composition and feelings of hunger and fullness.

Mood, Psychological, and Behavioral Factors of Health-Related Quality of Life Throughout Recovery From Sport Concussion.

OBJECTIVE: To measure alterations in mood, psychological, and behavioral factors in collegiate athletes throughout recovery from sport concussion (SC) compared with matched controls. SETTING: University research laboratory. PARTICIPANTS: Twenty (55% female) division I collegiate athletes with SC (19.3 ± 1.08 years old, 1.77 ± 0.11 m, 79.6 ± 23.37 kg) and 20 (55% female) uninjured matched controls (20.8 ± 2.17 years old, 1.77 ± 0.10 m, 81.9 ± 23.45 kg). DESIGN: Longitudinal case control. MAIN MEASURES: Self-reported concussion-related symptoms, anxiety, resilience, stigma, sleep disturbance, fatigue, and appetite were assessed at 3 time points in the SC group: T1 (≤72 hours of SC), T2 (7 days after T1), and TF (after symptom resolution). Control participants were evaluated at similar intervals. Group and group-by-sex differences were assessed using repeated-measures analyses of variance. Post hoc analyses were performed with Tukey's honestly significant difference (HSD) and paired-sample t tests. RESULTS: The SC group had greater sleep disturbance than controls at T1 (P = .001; d = 1.21) and endorsed greater stigma at all time points (P ≤ .03; d ≥ 0.80). Stigma (F(2) = 3.68; P = 0.03; η2p = 0.12), sleep disturbance (F(2) = 5.27; P = .008; η2p = 0.15), and fatigue (F(2) = 3.46; P = .04; η2p = 0.11) improved throughout recovery in those with SC only. No differences were observed between males and females (P > .05). CONCLUSION: Sleep disturbance and stigma were negatively affected by SC, highlighting potential areas for clinical interventions to maximize recovery in males and females.

Factors Associated With Energy Expenditure and Energy Balance in Acute Sport-Related Concussion.

CONTEXT: Sport-related concussion (SRC) is characterized by a pathologic neurometabolic cascade that results in an increased intracranial energy demand and a decreased energy supply. Little is known about the whole-body energy-related effects of SRC. OBJECTIVE: To examine factors associated with whole-body resting metabolic rate (RMR), total energy expenditure (TEE), energy consumption (EC), and energy balance (EBal) in student-athletes acutely after SRC and healthy matched control individuals. DESIGN: Case-control study. SETTING: University research laboratory. PATIENTS OR OTHER PARTICIPANTS: Student-athletes diagnosed with SRC (n = 28, 50% female, age = 18.4 ± 1.8 years, body mass index [BMI] = 24.1 ± 4.1 kg/m2) assessed ≤72 hours postinjury and a matched control group (n = 28, 50% female, age = 19.4 ± 2.9 years, BMI = 24.7 ± 4.78 kg/m2). MAIN OUTCOME MEASURE(S): Resting metabolic rate was measured via indirect calorimetry. Participants reported their physical activity and dietary intake for 3 days, which we used to estimate TEE and EC, respectively, and to calculate EBal (EC:TEE ratio). Resting metabolic rate, TEE, and EC were normalized to body mass. Group and group-by-sex comparisons were conducted for RMR·kg-1, TEE·kg-1, EC·kg-1, and EBal using independent t tests with the a priori α = .05. Associations of age, sex, concussion history, BMI, and symptom burden with RMR·kg-1 and EBal were explored with linear regression models. RESULTS: Total energy expenditure·kg-1 was lower (P < .01; mean difference ± SD = -5.31 ± 1.41 kcal·kg-1) and EBal was higher (P < .01; 0.28 ± 0.10) in SRC participants than in control participants. Both sexes with SRC had lower TEE·kg-1 than did the control participants (P values ≤ .04); females with SRC had higher EBal than controls (P = .01), but male groups did not differ. Higher RMR·kg-1 was associated with history of concussion (adjusted R2 = .10, ß = 0.65). Younger age (ß = -0.35), fewer concussions (ß = -0.35), lower BMI (ß = -0.32), greater symptom duration (ß = 1.50), and lower symptom severity (ß = -1.59) were associated with higher EBal (adjusted R2 = .54). CONCLUSIONS: Total energy expenditure·kg-1 and EBal appeared to be affected by acute SRC, despite no differences in RMR·kg-1. Sex, concussion history, BMI, and symptom burden were associated with acute energy-related outcomes.

Pre-operative aerobic exercise on metabolic health and surgical outcomes in patients receiving bariatric surgery: A pilot trial.

OBJECTIVE: Examine if adding aerobic exercise to standard medical care (EX+SC) prior to bariatric surgery improves metabolic health in relation to surgical outcomes. METHODS: Fourteen bariatric patients (age: 42.3±2.5y, BMI: 45.1±2.5 kg/m2) met inclusion criteria and were match-paired to pre-operative SC (n = 7) or EX+SC (n = 7; walking 30min/d, 5d/wk, 65-85% HRpeak) for 30d. A 120min mixed meal tolerance test was performed pre- and post-intervention (~2d prior to surgery) to assess insulin sensitivity (Matsuda Index) and metabolic flexibility (indirect calorimetry). Aerobic fitness (VO2peak), body composition (BodPod), and adipokines (adiponectin, leptin) were also measured. Omental adipose tissue was collected during surgery to quantify gene expression of adiponectin and leptin, and operating time and length of hospital stay were recorded. ANOVA and Cohen's d effect size (ES) was used to test group differences. RESULTS: SC tended to increase percent body fat (P = 0.06) after the intervention compared to EX+SC. Although SC and EX+SC tended to raise insulin sensitivity (P = 0.11), EX+SC enhanced metabolic flexibility (P = 0.01, ES = 1.55), reduced total adiponectin (P = 0.01, ES = 1.54) with no change in HMW adiponectin and decreased the length of hospital stay (P = 0.05) compared to SC. Albeit not statistically significant, EX+SC increased VO2peak 2.9% compared to a 5.9% decrease with SC (P = 0.24, ES = 0.91). This increased fitness correlated to shorter operating time (r = -0.57, P = 0.03) and length of stay (r = -0.58, P = 0.03). Less omental total adiponectin (r = 0.52, P = 0.09) and leptin (r = 0.58, P = 0.05) expression correlated with shorter operating time, and low leptin expression was linked to shorter length of stay (r = 0.70, P = 0.01), and low leptin expression was linked to shorter length of stay (r = 0.70, P = 0.01). CONCLUSION: Adding pre-operative aerobic exercise to standard care may improve surgical outcomes through a fitness and adipose tissue derived mechanism.

Impact of Pre-operative Aerobic Exercise on Cardiometabolic Health and Quality of Life in Patients Undergoing Bariatric Surgery.

OBJECTIVE: Examine the effect of aerobic exercise (EX) combined with standard medical care (SC) (EX + SC) compared to SC alone on cardiometabolic health and quality of life in relation to surgical outcomes. METHODS: Patients receiving bariatric surgery were match-paired to 30 days of pre-operative SC (n = 7, 1 male, 39.0 ± 5.3 years, body mass index 46.4 ± 3.0 kg/m2; low calorie diet) or EX + SC (n = 7, 0 males, 45.6 ± 4.8 years, body mass index 43.9 ± 4.2 kg/m2; walking 30 min/day, 5 days/week, 65-85% HR peak ). Body mass, waist circumference, cardiorespiratory fitness (VO2peak), high sensitivity C-reactive protein (hs-CRP), cytokeratin 18 (CK18), weight related quality of life (QoL), and a 120 min mixed meal tolerance test (MMTT) was performed to assess arterial stiffness via augmentation index normalized to a heart rate of 75 beats per minute (AIx@75), whole-body insulin sensitivity, and glucose total area under the curve (tAUC) pre- and post-intervention (∼2 days prior to surgery). Length of hospital stay (admission to discharge) was recorded. RESULTS: EX + SC had a greater effect for decreased intake of total calories (P = 0.14; ES = 0.86) compared to SC, but no change in body weight or waist circumference was observed in either group. EX + SC had a greater effect for increased VO2peak (P = 0.24; ES = 0.91) and decreased hs-CRP (P = 0.31; ES = 0.69) compared to SC. EX + SC reduced circulating CK18 (P = 0.05; ES = 3.05) and improved QoL (P = 0.02) compared to SC. Although EX + SC had no statistical effect on arterial stiffness compared to SC, we observed a modest effect size for AIx@75 tAUC (P = 0.36; ES = 0.52). EX + SC had a significantly shorter length of hospital stay (P = 0.05; ES = 1.38) than SC, and a shorter length of hospital stay was associated with decreased sugar intake (r = 0.55, P = 0.04). Decreased AIx@75 tAUC significantly correlated with improved whole-body insulin sensitivity (r = -0.59, P = 0.03) and glucose tAUC (r = 0.57, P = 0.04). CONCLUSION: EX with SC for 30 days prior to bariatric surgery may be important for cardiometabolic health, quality of life, and surgical outcomes in the bariatric patient.

Whole-Body Metabolism, Carbohydrate Utilization, and Caloric Energy Balance After Sport Concussion: A Pilot Study.

BACKGROUND: Sport concussion (SC) causes an energy crisis in the brain by increasing energy demand, decreasing energy supply, and altering metabolic resources. Whole-body resting metabolic rate (RMR) is elevated after more severe brain injuries, but RMR changes are unknown after SC. The purpose of this study was to longitudinally examine energy-related changes in collegiate athletes after SC. HYPOTHESIS: RMR and energy consumption will increase acutely after SC and will return to control levels with recovery. STUDY DESIGN: Case-control study. LEVEL OF EVIDENCE: Level 4. METHODS: A total of 20 collegiate athletes with SC (mean age, 19.3 ± 1.08 years; mean height, 1.77 ± 0.11 m; mean weight, 79.6 ± 23.37 kg; 55% female) were compared with 20 matched controls (mean age, 20.8 ± 2.17 years; mean height, 1.77 ± 0.10 m; mean weight, 81.9 ± 23.45 kg; 55% female). RMR, percentage carbohydrate use (%CHO), and energy balance (EBal; ratio between caloric consumption and expenditure) were assessed 3 times: T1, ≤72 hours after SC; T2, 7 days after T1; and TF, after symptom resolution. A 2 × 2 × 3 (group × sex × time) multivariate analysis of variance assessed RMR, %CHO, and EBal. Changes in RMR, %CHO, and EBal (T1 to TF) were correlated with days to symptom-free and days to return to play in the concussed group. RESULTS: Women reported being symptom-free (median, 6 days; range, 3-10 days) sooner than men (median, 11 days; range, 7-16 days). RMR and %CHO did not differ across time between groups or for group × sex interaction. SC participants had higher EBal than controls at T1 (P = 0.016) and T2 (P = 0.010). In men with SC, increasing %CHO over time correlated with days to symptom-free (r = 0.735 and P = 0.038, respectively) and days to return to play (r = 0.829 and P = 0.021, respectively). CONCLUSION: Participants with SC were in energy surplus acutely after injury. Although women recovered more quickly than men, men had carbohydrate metabolism changes that correlated with recovery time. CLINICAL RELEVANCE: This pilot study shows that male and female student-athletes may have differing physiologic responses to SC and that there may be a role for dietary intervention to improve clinical outcomes after SC.

How Lifestyle Factors Affect Cognitive and Executive Function and the Ability to Learn in Children.

In today's research environment, children's diet, physical activity, and other lifestyle factors are commonly studied in the context of health, independent of their effect on cognition and learning. Moreover, there is little overlap between the two literatures, although it is reasonable to expect that the lifestyle factors explored in the health-focused research are intertwined with cognition and learning processes. This thematic review provides an overview of knowledge connecting the selected lifestyle factors of diet, physical activity, and sleep hygiene to children's cognition and learning. Research from studies of diet and nutrition, physical activity and fitness, sleep, and broader influences of cultural and socioeconomic factors related to health and learning, were summarized to offer examples of research that integrate lifestyle factors and cognition with learning. The literature review demonstrates that the associations and causal relationships between these factors are vastly understudied. As a result, current knowledge on predictors of optimal cognition and learning is incomplete, and likely lacks understanding of many critical facts and relationships, their interactions, and the nature of their relationships, such as there being mediating or confounding factors that could provide important knowledge to increase the efficacy of learning-focused interventions. This review provides information focused on studies in children. Although basic research in cells or animal studies are available and indicate a number of possible physiological pathways, inclusion of those data would distract from the fact that there is a significant gap in knowledge on lifestyle factors and optimal learning in children. In a climate where childcare and school feeding policies are continuously discussed, this thematic review aims to provide an impulse for discussion and a call for more holistic approaches to support child development.

Two weeks of exercise training intensity on appetite regulation in obese adults with prediabetes.

No short-term exercise data exist testing whether training intensity modifies hormonal and perceived appetite in obese adults with prediabetes. Therefore, we compared the effects of short-term moderate-continuous (CONT) vs. high-intensity interval (INT) training on appetite regulation. Twenty-eight obese adults [age: 61.3 ± 1.5 yr; body mass index (BMI): 33.2 ± 1.1 kg/m2] with prediabetes were randomized to work-matched CONT ( n = 14) or INT ( n = 14) training for 2 wk. Plasma acylated ghrelin (AG), des-acylated ghrelin (dAG), active glucagon-like peptide-1 (GLP-1), and insulin were measured at 0, 30, and 60 min of a 75-g oral glucose tolerance test (OGTT) before and after training. Visual analog scales were administered at 0 and 120 min during the OGTT to examine perceived appetite. Three-day food logs were collected before and after testing to assess ad libitum diet. CONT and INT increased peak oxygen consumption ( P < 0.01) and decreased BMI ( P < 0.01). Although neither intervention altered fasting levels of AG ( P = 0.94), dAG ( P = 0.36), or insulin ( P = 0.67), CONT raised GLP-1 compared with INT ( P = 0.05). Exercise training did not affect postprandial suppression of AG ( P = 0.81) and dAG ( P = 0.67) or stimulation of GLP-1 ( P = 0.67) and insulin ( P = 0.32). Both interventions tended to decrease total energy and protein intake ( P = 0.09 and P = 0.05, respectively), despite no change in fasting hunger ( P = 0.88) and reduced perceived fullness at 120 min during the OGTT ( P = 0.05). We conclude that 2 wk of exercise training intensity does not modulate appetite-regulatory hormones in obese adults with prediabetes. Although perceived fullness to the OGTT was reduced after exercise, CONT and INT decreased energy intake, suggesting that exercise does not elicit compensatory appetite behavior to gain weight. NEW & NOTEWORTHY Adults with prediabetes are at risk for appetite dysregulation. Although exercise promotes weight management, it is unclear whether moderate-continuous or high-intensity interval training is more beneficial for appetite regulation. We show that 2 wk of exercise, independent of intensity, does not alter postprandial appetite hormones or hunger, despite slight reductions in food intake and weight. These data support exercise as an effective method to induce negative energy balance without compensatory weight gain.

Recognition of Federal Dietary Guidance Icons Is Associated with Greater Diet Quality.

BACKGROUND: Although the purpose of federal dietary guidance is to improve eating habits, few studies have described awareness of guidance and concurrent diet quality. OBJECTIVE: The objective of the current study was to examine the prevalence of individuals who reported hearing of dietary guidance icons and to describe the association between having heard of the icons and diet quality. DESIGN: This study was a cross-sectional survey. PARTICIPANTS/SETTING: Participants (n=23,343) were from the National Health and Nutrition Examination-What We Eat in America survey 2005-2014 cycles. MAIN OUTCOME MEASURES: Awareness of the Food Guide Pyramid, MyPyramid, or MyPlate icons by sociodemographic characteristics and diet quality were measured using Healthy Eating Index (HEI) scores derived from 24-hour recall data. STATISTICAL ANALYSES PERFORMED: Global Wald tests were used to test for differences in awareness of the icons within sociodemographic groups. Total HEI scores were calculated using the population-ratio method. Z-scores were used to test differences in HEI total scores between those with knowledge of the icons and those who responded negatively. RESULTS: In all cycles, those with less than a high school diploma were the least likely to report having heard of the icons (P<0.001). In every wave except 2011 to 2012, participants with low or marginal food security status were less likely to report affirmatively (P<0.001), and Supplemental Nutrition Assistance Program (SNAP) participants and SNAP-eligible nonparticipants were least likely to report having heard of the icons (P<0.001) except for 2005 to 2006. HEI scores were higher among those who had heard of MyPyramid in 2007-2012 (P<0.05) and MyPlate in 2013-2014 (P<0.001) compared with those who had not heard of the icon. CONCLUSIONS: Recognition of federal dietary guidance icons was associated with higher diet quality recently, but the cross-sectional nature of the data precludes conclusions of causality. Further research is needed to identify barriers and promoters for translating awareness of the federal dietary guidance icons into healthful food purchasing and food consumption decisions.

Bariatric Surgery Resistance: Using Preoperative Lifestyle Medicine and/or Pharmacology for Metabolic Responsiveness.

Bariatric surgery is an effective and durable treatment for individuals with obesity and its associated comorbidities. However, not all patients meet weight loss and/or cardiometabolic goals following bariatric surgery, suggesting that some people are bariatric surgery resistant. The reason for this resistance is unclear, but potential factors, such as adiposity-derived inflammation, insulin resistance, hyperglycemia, and aerobic fitness prior to surgery, have been related to blunted surgery responsiveness. Exercise, diet, and/or pharmacology are effective at reducing inflammation and improving insulin action as well as physical function. Herein, we present data that supports the novel hypothesis that intervening prior to surgery can enhance disease resolution in people who are resistant to bariatric surgery.

Intake Levels of Fish in the UK Paediatric Population.

The United Kingdom (UK) is an island and its culture, including diet, is heavily influenced by the maritime resources. Dietary guidance in the UK recommends intake of fish, which provides important nutrients, such as long-chain omega-3 polyunsaturated fatty acids (n-3 PUFA). This study was designed to describe the fish intake habits of UK children using a nationally representative sample. Dietary and socio-demographic data of children 2-18 (N = 2096) in the National Diet and Nutrition Survey Rolling Program (NDNS) Years 1-4 (2008-2012) were extracted. Average nutrient and food intakes were estimated. Logistic regression models were used to predict the meeting of fish intake recommendations, controlling for age, sex, income, total energy intake, and survey year. All analyses were conducted using survey routines and dietary survey weights. In this nationally representative study, 4.7% of children met the fish and 4.5% the oily fish intake recommendations; only 1.3% of the population met both recommendations. Fish intake levels did not significantly change with children's increasing age. Higher vegetable but lower meat consumption predicted meeting the fish intake recommendations, indicating that children eating fish have better diet quality than non-consumers. Further research is needed to explore how intake behaviours can be changed to improve children's diet quality.