Interventions for health-related physical fitness and overweight and obesity in children with intellectual disability: Systematic review and meta-analysis.

BACKGROUND: Poor health-related physical fitness (HRPF) and overweight and obesity are common health problems for children with intellectual disability. This study aimed to review existing lifestyle intervention studies, and identify effective strategies for this population. METHODS: A systematic search was undertaken in three databases. The random-effects model was used to pool the weighted results by inverse variance methods, and the I2 statistic was applied to assess heterogeneity among the included studies. RESULTS: Most of the identified interventions (27/29) adopted physical activity (PA). For obesity-related outcomes, the results showed no significant effect of PA studies on reducing obesity. For HRPF outcomes, significant effects were found on 6-min walk distance (51.86 m, 95% CI [16.49, 87.22], p < .05). CONCLUSIONS: PA is the predominant intervention component adopted and may contribute to improving cardiopulmonary fitness; but the lack of research limits our ability to draw any confirmed conclusion on obesity-related outcomes and other HRPF outcomes.

Foot posture index and body composition measures in children with and without developmental coordination disorder.

BACKGROUND: Foot posture which forms the distal supporting structure influences on postural stability. Children with developmental coordination disorder (DCD) who are more likely to be overweight or obese may present with flat foot with symptoms that affect daily activities. The aim of this study was to compare the foot posture and body composition measures between children with and without DCD. In addition, this study aimed to investigate the relationship between foot posture and fat percentage. METHODS: Fifty-nine children with DCD (mean age = 8.07±1.10) and sixty-two typically developing children (mean age = 7.97±1.05) were recruited to the DCD and control group respectively. All children received a foot posture assessment and a whole-body dual-energy X-ray absorptiometry (DXA) scan. Foot Posture Index 6 (FPI-6) total scores, sub-scores and lower limb body composition measures including fat mass, lean mass, total mass, fat percentage and fat mass index were measured. RESULTS: Children with DCD revealed a significantly higher FPI-6 left (1.12; 95% CI: 0.172, 2.061) and right (1.15; 95% CI: 0.218, 2.079) total score. FPI-6 sub-scores (talar head palpation and abduction/adduction forefoot on rearfoot) illustrated significant differences between children with and without DCD. Children with DCD had a significantly higher total fat mass (1247.48g; 95% CI: 121.654, 2373.304), total fat percentage (1.82%; 95% CI: 0.115, 3.525) and fat mass index (0.56kg/m2; 95% CI: 0.036, 1.069). There was a significant relationship between FPI-6 right total score and total fat percentage. CONCLUSION: The findings of this study showed that children with DCD exhibited significantly more pronated foot posture and higher body composition measures compared to typically developing children. Moreover, with FPI-6 right total score significantly related to the total fat percentage, it may require more than just detecting abnormal foot structures in children with DCD but also promoting a healthy lifestyle to prevent obesity.

Effectiveness of an adapted physical activity intervention for weight management in adolescents with intellectual disability: A randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness of a 9-month school-based adapted physical activity (APA) program for reducing weight among adolescents with intellectual disability (ID). METHODS: In this randomized controlled trial, adolescents with ID, aged 12-18 years, who were overweight/or with obesity were randomly assigned into intervention and control groups. The APA intervention consisted of aerobic and resistance exercises with an overall moderate intensity and was delivered at a frequency of two sessions per week for 9 months. Changes in body mass index (BMI, primary outcome) and changes in BMIz, weight, percent body fat, waist circumference and waist-to-height ratio (secondary outcomes) were examined using general linear models. RESULTS: In total 61 subjects (39 in the intervention and 22 in the control) completed the study and were included in the analyses. At 9 months, the intervention group exhibited a reduced BMI of -0.66 kg/m2 (95% CI -1.06 to -0.25 kg/m2 , p = 0.002), while a significant increase in BMI was observed in the control group. A significant post-intervention between-group difference in change in BMI (-1.31 kg/m2 [95% CI -1.99 to -0.63], p < 0.01) was found in favour of the intervention group. Similar results were also observed for all secondary outcomes. CONCLUSIONS: This study provides evidence that a 9-month APA intervention induced clinically meaningful effects on weight loss in adolescents with ID.

Younger Adults Are More Likely to Increase Fruit and Vegetable Consumption and Decrease Sugar Intake with the Application of Dietary Monitoring.

Establishing healthy eating habits is considered to be a sustainable strategy for health maintenance, and mobile applications (apps) are expected to be highly effective among the young-aged population for healthy eating promotion. The purpose of this study was to investigate the effectiveness of a dietary monitoring app on younger adults' nutrition knowledge and their dietary habits. A controlled-experimental study was performed with one experimental group having a three-hour nutrition seminar and 12 weeks of dietary monitoring with the app, and one control group receiving a three-hour nutrition seminar. Behavioral feedback delivered by the app was evaluated in facilitating the transfer of nutritional knowledge to nutrition behavior. A total of 305 younger adults aged from 19 to 31 were recruited. Baseline and post-intervention nutrition knowledge and dietary behavior were collected. All mean scores of post-GNKQ-R increased from baseline for both the control and the experimental groups. The mean differences of sugar intake, dietary fiber intake, and vitamin C intake for the experimental group were significantly more than those for the control group (all p < 0.001). In addition, the experimental group increased fruit and vegetable consumption significantly more than the control group (all p < 0.001). For those younger adults with a relatively large body size, they were more likely to increase fruit consumption with the application of dietary monitoring.

Using Physical Food Transformation to Enhance the Sensory Approval of Children with Autism Spectrum Disorders for Consuming Fruits and Vegetables.

Introduction: Children with autistic spectrum disorders (ASD) commonly exhibit aberrant tactile, taste, and smell sensitivity to foods. Food transformation that alters the appearance, texture, and temperature of foods is promising for solving this sensitivity problem. Objectives: This study evaluated the effect of physical transformation of fruits and vegetables (FV) to snacks to enhance ASD children's sensory approval for eating them. Design: This was a quasiexperimental design study. It lasted for 4 weeks with three episodes of FV exposure to the ASD children per week. The original condition was conducted in the first and fourth week, while intervention was performed in the second and third week. Settings: Food exposure took place in schools in a quiet room. Subjects: This study recruited 56 ASD children. Intervention: Food transformation constituted changing bananas into ice-cream, zucchinis and sweet potatoes into chips, apples and kiwis into popsicles, and carrots into juice. Outcome Measures: FV acceptance and habitual consumption were measured at baseline and postintervention. Results: ASD children increased their consumption of all FV, but only banana consumption was statistically significant from 55.3 to 78.0 g (p < 0.05). For habitual consumption, parents reported increases in all FV consumption for all three measured fruits and 2 of 3 measures of vegetables (pre vs. post mean for bananas: 2.4 vs. 2.9, apples 2.6 vs. 3.2, kiwis 2.4 vs. 2.9, zucchinis 1.9 vs. 2.5, and sweet potatoes 1.8 vs. 2.4; p < 0.05). Conclusion: Physical changes of foods may improve impaired sensory processing of ASD children to promote their FV acceptance. Project Code: RG 55/2019-2020R.

A blended intervention to promote physical activity, health and work productivity among office employees using intervention mapping: a study protocol for a cluster-randomized controlled trial.

BACKGROUND: Regular participation in moderate-to-vigorous physical activity (MVPA) is related to decreased risk of morbidity and mortality. Among working populations, lack of MVPA may also be a risk factor for absenteeism and presenteeism. Both traditional workplace-based and web-based interventions have been suggested as being effective in promoting participation MVPA, health-related outcomes, and work-related productivity. However, several challenges limit their application in real world contexts. A 'blended' intervention approach combining the two intervention strategies is proposed to overcome these limitations. The proposed intervention aims to utilize the blended approach to increase participation in MVPA, health-related outcomes, and work productivity among inactive workers. METHODS: The study will comprise of a three-group cluster randomized controlled trial (cluster-RCT), comprising a three-month actual intervention and a nine-month behavioral follow-up period. The three groups will be: a web-based intervention group, a blended intervention group combining the web-based components with face-to-face workshops and posters, and a control group. Physically inactive office employees (N = 495) from 33 companies (i.e., clusters) will be recruited and randomly assigned to the three groups by cluster randomization. The intervention mapping (IM) framework will be used for selecting and applying effective health behavioral theories and behavioral change techniques (BCTs) to the development, implementation and assessment of the intervention, which will be personally tailored. The primary outcome variable will be objectively-measured MVPA using an accelerometer. Secondary outcomes will consist of indices of health including adiposity, blood pressure, blood sugar, blood lipids, self-reported depression, anxiety, stress, health-related quality of life and work-related variables including absenteeism and presenteeism. DISCUSSION: The proposed study adopts a robust blended intervention approach that is expected to overcome challenges in applying workplace-based and web-based interventions separately and yield larger effects in promoting MVPA participation, health-related outcomes and work productivity. Improvements in work productivity outcomes will be of particular interest to employers. If more effective, the new blended intervention has the potential to be implemented on a larger scale to benefit workplace populations. TRIAL REGISTRATION: The trial is prospectively registered at the ClinicalTrials.gov PRS (Trial ID: NCT04391270; Date of First Posted: May 18, 2020).

Effects of tryptophan, serotonin, and kynurenine on ischemic heart diseases and its risk factors: a Mendelian Randomization study.

BACKGROUND/OBJECTIVES: Tryptophan is an essential amino acid that must be obtained from dietary items, such as dairy products, eggs, nuts, legumes, and grains, which are rich in tryptophan. It has also been suggested as a dietary supplement to improve mental health. Observationally plasma tryptophan is inversely associated with ischemic heart disease (IHD), however, its main metabolites, serotonin, and kynurenine are positively associated with IHD, which makes the effects of tryptophan difficult to infer. This study aimed to obtain less-confounded estimates of the associations of tryptophan and physiologically related factors (serotonin and kynurenine) with IHD, its risk factors and depression. SUBJECTS/METHODS: We used a two-sample Mendelian Randomization study design. We used genetic instruments independently associated with tryptophan, serotonin, and kynurenine metabolites applied to a meta-analysis of the UK Biobank SOFT CAD study with the CARDIoGRAMplusC4D consortium (cases n ≤ 76,014 and controls n ≤ 264,785), and other consortia for risk factors including diabetes, lipids, and blood pressure, as well as for depression. We combined genetic variant-specific estimates using inverse variance weighting, with MR-Egger, the weighted median and MR-PRESSO as sensitivity analyses. RESULTS: Tryptophan and serotonin were not associated with IHD. Kynurenine was nominally and positively associated with IHD (odds ratio 1.57 per standard deviation, 95% confidence interval 1.05-2.33) but not after correction for multiple comparisons. Associations with IHD risk factors and depression were null. CONCLUSIONS: We cannot exclude the possibility that one of the main metabolites of tryptophan, kynurenine, might be positively associated with IHD. Further studies are needed to confirm any association and underlying mechanism.

Indoleamine 2,3-dioxygenase and ischemic heart disease: a Mendelian Randomization study.

Tryptophan is an essential amino acid. Indoleamine 2,3-dioxygenase (IDO), the rate-limiting enzyme in the tryptophan-kynurenine pathway, is positively associated with cardiac events, and may be relevant to cancer. We used Mendelian Randomization to obtain unconfounded estimates of the association of IDO1 with ischemic heart disease (IHD), ischemic stroke and their risk factors, all-cancer, cancer of the prostate, lung and bronchus, and breast. We obtained genetic instruments independently and strongly (p-value < 5 × 10-8) predicting plasma IDO1 from a proteome genome-wide association study (GWAS), and applied them to consortia GWAS of the outcomes, including the UK Biobank SOFT CAD GWAS (cases < = 76 014, non-cases < = 264 785) for IHD. Estimates were obtained using inverse variance weighting; with MR-Egger, weighted median and MR-PRESSO as sensitivity analyses. IDO1 was inversely associated with IHD (odds ratio (OR) 0.96 per standard deviation, 95% confidence interval (CI) 0.93 to 1.00, p-value = 0.04), diabetes (OR 0.91, 95% CI 0.85 to 0.97) and prostate cancer (OR 0.96, 95% CI 0.93 to 0.99) with a directionally consistent estimate for stroke (OR 0.98, 95% CI 0.95 to 1.02) but not with blood pressure, or the other cancers considered. IDO1 might be a potential therapeutic target for IHD, diabetes and prostate cancer.

Lean mass, grip strength and risk of type 2 diabetes: a bi-directional Mendelian randomisation study.

AIMS/HYPOTHESIS: Muscle mass and strength may protect against type 2 diabetes as a sink for glucose disposal. In randomised controlled trials, resistance training improves glucose metabolism in people with the metabolic syndrome. Whether increasing muscle mass and strength protects against diabetes in the general population is unknown. We assessed the effect of markers of muscle mass and strength on diabetes and glycaemic traits using bi-directional Mendelian randomisation. METHODS: Inverse variance weighting estimates were obtained by applying genetic variants that predict male lean mass, female lean mass and grip strength, obtained from the UK Biobank GWAS, to the largest available case-control study of diabetes (DIAbetes Genetics Replication And Meta-analysis [DIAGRAM]; n = 74,124 cases and 824,006 controls) and to a study of glycaemic traits (Meta-Analyses of Glucose and Insulin-related traits Consortium [MAGIC]). Conversely, we also applied genetic variants that predict diabetes, HbA1c, fasting glucose, fasting insulin and HOMA-B to UK Biobank summary statistics for genetic association with lean mass and grip strength. As sensitivity analyses we used weighted median, Mendelian randomisation (MR)-Egger and Mendelian Randomization Pleiotropy RESidual Sum and Outlier (MR-PRESSO) and removed pleiotropic SNPs. RESULTS: Grip strength was not significantly associated with diabetes using inverse variance weighting (OR 0.72 per SD increase in grip strength, 95% CI 0.51, 1.01, p = 0.06) and including pleiotropic SNPs but was significantly associated with diabetes using MR-PRESSO (OR 0.77, 95% CI 0.62, 0.95, p = 0.02) after removing pleiotropic SNPs. Female lean mass was significantly associated with diabetes (OR 0.91, 95% CI 0.84, 0.99, p = 0.02) while male lean mass was not significant but directionally similar (OR 0.94, 95% CI 0.88, 1.01, p = 0.09). Conversely, diabetes was inversely and significantly associated with male lean mass (ß -0.02 SD change in lean mass, 95% CI -0.04, -0.00, p = 0.04) and grip strength (ß -0.01, 95% CI -0.02, -0.00, p = 0.01). CONCLUSIONS/INTERPRETATION: Increased muscle mass and strength may be related to lower diabetes risk. Diabetes may also be associated with grip strength and lean mass. Muscle strength could warrant further investigation as a possible target of intervention for diabetes prevention.

Effect of Kinesio taping on electromyographic activity of leg muscles during gait in children with developmental coordination disorder: A randomized controlled trial.

OBJECTIVE: This study aimed to evaluate the effectiveness of Kinesio tape (KT) on lower limb muscle activation pattern in children with developmental coordination disorder (DCD) during walking. DESIGN: A parallel-group randomized controlled trial. SETTING: University laboratory setting. PARTICIPANTS: Twenty-five children with DCD were randomly allocated to the KT group (mean age = 7.97 years) and 24 to the control group (mean age = 8.04 years). INTERVENTION: KT group received KT application to the quadriceps and gastrocnemius muscles whereas the control group received no intervention. MEASUREMENTS: Peak muscle activation (in percentage of maximal voluntary isometric contraction [%MVIC]) in the lower limbs during gait was measured by means of surface electromyography, electrogoniometry, and foot contact switches. RESULTS: Gastrocnemius medialis activation during mid stance (23.46%MVIC, 95% CI = -32.53, -14.39) and late stance phases (3.25%MVIC, 95% CI = -5.67, -0.81) of gait increased after the application of KT in the KT group compared to baseline values. The KT group demonstrated 26.87%MVIC (95% CI = 26.87, 7.11) higher gastrocnemius medialis muscle peak activation during mid stance phase at post-test when compared with the control group. Moreover, gastrocnemius medialis and biceps femoris muscle peak activation during loading response decreased by 8.36%MVIC (95% CI = 2.71, 14.02) and 3.54%MVIC (95% CI = 1.08, 6.01), respectively, in the control group overtime. CONCLUSIONS: The application of KT on children with DCD had an increased gastrocnemius medialis muscle activation during stance phase. KT could be incorporated into gait re-education programmes to facilitate muscle contraction in these children.

Y-Balance Test Performance and Leg Muscle Activations of Children with Developmental Coordination Disorder.

This study compared Lower Quarter Y-Balance Test (YBT-LQ) performance and leg muscle kinetics between children with and without developmental coordination disorder (DCD), and investigated the association between YBT-LQ performance and muscle kinetics in children with DCD. Forty-eight children with DCD and 51 children without DCD participated in the study. Leg muscle kinetics were measured using surface electromyography when performing YBT-LQ. Children with DCD exhibited an overall lower YBT-LQ scores than controls. They had a lower peak gastrocnemius medialis activation for YBT-LQ posteromedial direction and shorter duration for the muscle to reach peak torque for YBT-LQ anterior direction. No relationship was found between YBT-LQ performance and leg muscle activations in children with DCD. Children with DCD exhibited a less competent YBT-LQ performance with atypical neuromuscular control.

Appearance alteration of fruits and vegetables to increase their appeal to and consumption by school-age children: A pilot study.

Picky eating with regard to fruit and vegetables is common among children. This study investigated the effectiveness of enhancing the visual appeal of fruit and vegetables to increase children's liking and consumption of fruit and vegetables. A pre-post experimental design was used, and the control and experimental groups were repeatedly exposed to the original food and transformed food, respectively, over 6 weeks. Significant differences in the consumption of pumpkin, sweet potato, spinach, carrot and aubergine were observed between the groups, demonstrating that the appearance appeal of fruit and vegetables improves the willingness of children to try disliked fruit and vegetables and increases their vegetable consumption.

Role of behavioural feedback in nutrition education for enhancing nutrition knowledge and improving nutritional behaviour among adolescents.

BACKGROUND AND OBJECTIVES: The integration of nutrition knowledge into nutritional behaviour can help children to develop a healthy lifestyle that may be carried forward into adulthood. E-learning enables students to take ownership of recording their dietary intake and modify their diets by making their own decisions regarding food choices and portion sizes through reflective feedback. This study investigated the role of behavioural feedback in nutrition education in modifying students' nutrition knowledge and behaviour. METHODS AND STUDY DESIGN: Ninety-five secondary students studying from Secondary 1 to Secondary 3 were recruited from five schools. Moreover, 50 and 45 students were randomly assigned to experimental and control groups, respectively. Nutrition education delivered through e-learning (NeL) was adopted to record students' diets. Online reports with behavioural feedback were provided for the experimental group but not for the control group. NeL sessions lasted for 12 weeks. The energy and nutrient profiles of the students were recorded as pre-post measurements. Pre-post nutrition knowledge was assessed using a self-administered questionnaire at the baseline and after intervention. RESULTS: The experimental group had significantly higher scores in the 'dietary recommendation' and 'food choices' domains of the questionnaire and demonstrated significant dietary improvement in the intake of all studied macronutrients and micronutrients. CONCLUSIONS: Nutrition education conducted with behavioural feedback can effectively improve adolescents' nutrition knowledge and nutritional behaviour.

Chinese women health ambassadors programme: A process evaluation.

AIMS AND OBJECTIVES: The aim of this study was to assess a community-women health ambassadors programme and report the areas that were successful and those that required improvement. The objectives were to assess the feasibility, effectiveness, implementation and sustainability of the programme. BACKGROUND: Health promotion for the prevention of chronic diseases has always been the top priority in the health sector. To ensure that the relevant health messages are well received in local communities, a health promotion programme must be accessible, acceptable and culturally relevant. DESIGN: We conducted and evaluated a women health ambassador programme based on the lay health advisor model for health promotion in Hong Kong during November 2014 to February 2015. Health needs and the subsequent focus of the programme were determined by underprivileged Chinese women. METHODS: University health educators from different disciplines trained the women (N = 80) to be health ambassadors through mini-lectures and training workshops. The trained women raised awareness about the importance of health within their families and social networks. The programme was evaluated through attendance rates, questionnaires and quizzes, changes in knowledge and behaviour, as well as qualitative discussion. RESULTS: While the majority of participants found the programme valuable and useful, retention rates were unideal. A statistically significant improvement was found in eating habits, but no significant change was identified for other knowledge and behaviour assessments. CONCLUSIONS: The programme empowered underprivileged women to reflect on the importance of health, take responsibility for their own health and actively promote health to their families and personal communities. RELEVANCE TO CLINICAL PRACTICE: Our study supports that health promotion programmes based on the lay health advisor model are effective and encourage large-scale programmes of this nature. Our results also support that future health promotion efforts should deliver brief, clear and simple content as opposed to intricate information.

Predicting actual weight loss: A review of the determinants according to the theory of planned behaviour.

Weight reduction that corresponds with lifestyle modification is difficult to foster. The theory of planned behaviour has been actively cited in explaining health-related behaviour. This review evaluated the application of the theory of planned behaviour to weight-loss behaviour. Among the three reviewed papers, cross-sectional survey designs and subjective outcome measurements were commonly applied. All of the studies recruited obese female adults as participants, limiting the generalisability of the studies' findings. The theory of planned behaviour can be effectively applied in weight-reduction programmes targeting female obese patients. This review confirmed critiques citing the limitations of experimental studies, the subjective measurement of behaviour and short follow-up periods.

Electronic dietary recording system improves nutrition knowledge, eating attitudes and habitual physical activity: a randomised controlled trial.

OBJECTIVE: This study's objective was to investigate whether use of an electronic dietary recording system improves nutrition knowledge, eating attitudes and habitual physical activity levels compared to use of a food diary and no self-monitoring. METHODS: Sixty adults aged 20-60 with a body mass index ≥25 were recruited and randomly assigned to one of three groups: a group using an electronic system (EG), a group using a food diary (FD) and a control group using nothing (CG) to record food intake. All participants took part in three 60-90 nutrition seminars and completed three questionnaires on general nutrition knowledge, habitual physical activity levels and eating attitudes at the beginning and end of the 12-week study. The pre- and post-test scores for each questionnaire were analysed using a paired sample t-test. RESULTS: Significant improvements in the domain of 'dietary recommendations' were found in the EG (p=0.009) and FD groups (p=0.046). Great improvements were found in 'sources of nutrients', 'choosing everyday foods' and 'diet-disease relationships' in EG and FD groups. EG group showed greater improvement in the work index and sport index. CONCLUSION: An electronic dietary recording system may improve eating and exercise behaviour in a self-monitoring process.

Teledietetics improves weight reduction by modifying eating behavior: a randomized controlled trial.

BACKGROUND: Weight reduction without behavioral modification is not sustainable. However, with a technology application such as teledietetics, the recording process could be a cognitive cue for individuals to change their eating behavior. This study tested obese participants to determine whether teledietetics shows better results in weight reduction. STUDY DESIGN AND METHODS: We conducted a double-blinded randomized controlled trial. The participants in the food diary (FD) and electronic diary (ED) groups recorded their dietary intakes in logbooks and on an electronic diary system, respectively. The participants in the control group (CG) did nothing. Subjects were adults 20-60 years of age with a body mass index (BMI) of ≥25 kg/m(2). The ED and FD groups were the intervention groups and were compared with the CG group. The participants' body weights, BMIs, fat percentages, waist-to-hip ratios (WHRs), and mean arterial pressures (MAPs) were measured before the study, at Week 6, and at Week 12. Demographic data were collected using self-administered questionnaires. A chi-squared test and descriptive statistics were used to describe the demographic and biomeasurement data. Repeated-measures analysis of variance was used to evaluate the effectiveness of the three groups over time. RESULTS: Significant decreases in body weight (F1.705,86.950=20.508, p<0.001) and BMI (F1.657, 84.486=21.256, p<0.001) and insignificant decreases in fat percentage (F2,94=0.547, p=0.581), WHR (F1.785,91.052=2.888, p=0.067), and MAP (F2,94=7.542, p=0.0001) were observed among the three measurement times. CONCLUSIONS: Electronic dietary records were better than food diaries in terms of fat percentage reduction in our trials, indicating that teledietetics increases healthy-eating awareness.