Enhancing health outcomes for Maori elders through an intergenerational cultural exchange and physical activity programme: a cross-sectional baseline study.

Background: The study offers baseline data for a strengths-based approach emphasizing intergenerational cultural knowledge exchange and physical activity developed through a partnership with kaumatua (Maori elders) and kaumatua service providers. The study aims to identify the baseline characteristics, along with correlates of five key outcomes. Methods: The study design is a cross-sectional survey. A total of 75 kaumatua from six providers completed two physical functioning tests and a survey that included dependent variables based in a holistic model of health: health-related quality of life (HRQOL), self-rated health, spirituality, life satisfaction, and loneliness. Results: The findings indicate that there was good reliability and moderate scores on most variables. Specific correlates included the following: (a) HRQOL: emotional support (ß = 0.31), and frequent interaction with a co-participant (ß = 0.25); (b) self-rated health: frequency of moderate exercise (ß = 0.32) and sense of purpose (ß = 0.27); (c) spirituality: sense of purpose (ß = 0.46), not needing additional help with daily tasks (ß = 0.28), and level of confidence with cultural practices (ß = 0.20); (d) life satisfaction: sense of purpose (ß = 0.57), frequency of interaction with a co-participant (ß = -0.30), emotional support (ß = 0.25), and quality of relationship with a co-participant (ß = 0.16); and (e) lower loneliness: emotional support (ß = 0.27), enjoyment interacting with a co-participant (ß = 0.25), sense of purpose (ß = 0.24), not needing additional help with daily tasks (ß = 0.28), and frequency of moderate exercise (ß = 0.18). Conclusion: This study provides the baseline scores and correlates of important social and health outcomes for the He Huarahi Tautoko (Avenue of Support) programme, a strengths-based approach for enhancing cultural connection and physical activity.

Taste but not smell sensitivities are linked to dietary macronutrient composition.

Macronutrient intake and composition of diets (i.e., carbohydrate, protein, and fat) can vary substantially across individuals. Chemosensory functions are hypothesised to play a key role in modulating nutrient choices and intake. The present study tests links between individual gustatory or olfactory supra-threshold sensitivities and dietary macronutrient intake. A total of 98 European males (N = 81 for final analyses; age: 20-40 yo; BMI: 18.9-48.1 kg∙m-2) were tested for supra-threshold sensitivities (d') to 3-gustatory (i.e., Sucrose, MSG, Dairy fat) and 3-olfactory stimuli (i.e., Vanillin, Methional, Maltol/Furaneol), followed by a 4-day weighed Food Record to give measures of macronutrient intake (kJ) and composition (%). With multivariate analyses (i.e., K-mean clustering, PCA, and Hierarchical Regression), gustatory and olfactory d' were compared across groups of individuals with distinct macronutrient composition or intake. Significant differences in gustatory d' were found across the clusters based on macronutrient composition (p < 0.05), but not for clusters based on intake. Hierarchical regressions suggested that gustatory d' played a significant role in predicting dietary carbohydrate composition and intake, with one-unit d' increase predicting reduction of 3%-4.66% (R2 = 0.21, F(5,75) = 5.38, p = 0.001). Moreover, every one-unit increase in d' to MSG increased protein composition by 3.45% (R2 = 0.10, F(5,75) = 2.83, p = 0.022) and intake by 392 kJ (R2 = 0.08, F(5,75) = 2.41, p = 0.044). By contrast, olfactory d' showed little association to macronutrient composition or intake (p > 0.05). Overall, we present intriguing new evidence that gustatory, but not olfactory, sensitivities are linked to dietary macronutrient composition, with relatively little effect on actual intake. These findings highlight possible action of a sensory-mediated mechanism guiding food choices.

The role of an individual's olfactory discriminability in influencing snacking and habitual energy intake.

Recent studies have revealed close links between human olfaction, appetite, and food choice. However, it remains unclear whether olfactory sensitivity plays a direct role in determining food and energy intake. The present study addresses this question by assessing relationships between individual olfactory discriminability (at a suprathreshold level), snacking, and habitual energy intake. A total of 92 healthy Caucasian males (mean age = 26.1, SD = 5.8) were tested for their olfactory discriminability (measured by d') to three food-related odorants (O1 - Vanillin, O2 - Methional, and O3 - Maltol/Furaneol mixture) with a 2-AFC method of constant stimuli. These sensory data were then analysed with two separate measures of food consumption - (1) snack energy intake within an ad libitum buffet setting; (2) habitual energy intake using four-day weighed food records. Univariate analyses of variance revealed significant results with regards to O1. Specifically, individuals with higher discriminability consumed significantly less energy from snacking as opposed to their less sensitive counterparts (p = 0.05). However, no significant relationship was found between individual olfactory discriminability and habitual energy intake. While recent years have seen increasing research focus on how external olfactory cues affect food consumption, our study offers particularly novel insights regarding the role of individual olfactory sensitivity in shaping eating behaviour.

Effect of Wholegrain Flour Particle Size in Bread on Glycaemic and Insulinaemic Response among People with Risk Factors for Type 2 Diabetes: A Randomised Crossover Trial.

Wholegrain flour produced by roller-milling is predominantly comprised of fine particles, while stoneground flour tends to have a comparatively smaller proportion of fine particles. Differences in flour particle size distribution can affect postprandial glycaemia in people with type 2 diabetes and postprandial insulinaemia in people with and without type 2 diabetes. No prior studies have investigated the effect of wholegrain flour particle size distribution on glycaemic or insulinaemic response among people with impaired glucose tolerance or risk factors for type 2 diabetes. In a randomised crossover study, we tested the 180-min acute glycaemic and insulinaemic responses to three wholegrain breads differing in flour particle size and milling method: (1) fine roller-milled flour, (2) fine stoneground flour, and (3) coarse stoneground flour. Participants (n = 23) were males and females with risk factors for type 2 diabetes (age 55-75 y, BMI >28 kg/m2, completing less than 150 min moderate to vigorous intensity activity per week). Each test meal provided 50 g available carbohydrate, and test foods were matched for energy and macronutrients. There was no significant difference in blood glucose iAUC (incremental area under the curve) between the coarse stoneground flour bread and the fine stoneground flour bread (mean difference -20.8 (95% CI: -51.5, 10.0) mmol·min/L) and between the coarse stoneground flour bread and the fine roller-milled flour bread (mean difference -23.3 (95% CI: -57.6, 11.0) mmol·min/L). The mean difference in insulin iAUC for fine stoneground flour bread compared with the fine roller-milled flour bread was -6.9% (95% CI: -20.5%, 9.2%) and compared with the coarse stoneground flour bread was 9.9% (95% CI: -2.6%, 23.9%). There was no evidence of an effect of flour particle size on postprandial glycaemia and insulinaemia among older people with risk factors for type 2 diabetes, most of whom were normoglycaemic.

The surface topography of silicone breast implants mediates the foreign body response in mice, rabbits and humans.

Silicone is widely used in chronic implants and is generally perceived to be safe. However, textured breast implants have been associated with immune-related complications, including malignancies. Here, by examining for up to one year the foreign body response and capsular fibrosis triggered by miniaturized or full-scale clinically approved breast implants with different surface topography (average roughness, 0-90 µm) placed in the mammary fat pads of mice or rabbits, respectively, we show that surface topography mediates immune responses to the implants. We also show that the surface surrounding human breast implants collected during revision surgeries also differentially alters the individual's immune responses to the implant. Moreover, miniaturized implants with an average roughness of 4 µm can largely suppress the foreign body response and fibrosis (but not in T-cell-deficient mice), and that tissue surrounding these implants displayed higher levels of immunosuppressive FOXP3+ regulatory T cells. Our findings suggest that, amongst the topographies investigated, implants with an average roughness of 4 µm provoke the least amount of inflammation and foreign body response.

Gelatinisation and milling whole-wheat increases postprandial blood glucose: randomised crossover study of adults with type 2 diabetes.

AIMS/HYPOTHESES: We examined the effects of milling and cooking whole grains in water to achieve starch gelatinisation on postprandial blood glucose using a randomised crossover open-label design. Participants were adults with type 2 diabetes whose body weight or medications had not changed in at least 3 months. METHODS: Postprandial blood glucose (measured as incremental AUC [iAUC]) was measured following consumption of four nutrient-matched whole-wheat porridge test-meals. Test-meals included gelatinised or native starch and were made with either finely milled or intact whole-wheat. RESULTS: Eighteen adults (63.1 ± 9.8 years, HbA1c 57.0 ± 11.5 mmol/mol [7.4 ± 3.2%]) completed the study. iAUC was higher following cooked meals (gelatinised starch) than following uncooked meals (native starch) (mean difference [MD] 268, 95% CI 188, 348 mmol/l × min). Consuming finely milled whole-wheat produced a higher iAUC compared with intact whole-wheat (MD 173, 95% CI 80, 266 mmol/l × min). There was no evidence of an interaction effect (p = 0.841). CONCLUSIONS: Both the nature of starch and the grain structure of whole-wheat influence the glycaemic response of adults with type 2 diabetes mellitus. FUNDING: Baking Industry Research Trust of New Zealand and the Riddet Centre of Research Excellence. TRIAL REGISTRATION: www.anzctr.org.au ACTRN12617000328370.

Factors Influencing Energy Drink Consumption in Participants and Viewers of Extreme Sports.

OBJECTIVE: To quantify energy drink consumption and influences affecting consumption in those who participate in or watch extreme sports. METHODS: An online survey, informed by focus groups, was administered via Quadrics®. Advertisement was via social media, emailing extreme sport clubs, flyers at extreme sport locations, and word of mouth. Participation was limited to those >18 y who watched and/or participated in extreme sports. The study was conducted in New Zealand, with international online availability. Variables measured comprised age, sex, energy drink consumption, reasons for their use, extreme sport viewing, advertising, and sponsorship. Logistic regression models were utilised. RESULTS: Amongst participants who completed the questionnaire (n = 247), the mean (SD) age was 26.2 (8.2) y, 40.5% were female, 57.9% consumed energy drinks, and 25.5% consumed >one per week. For every year older, odds of consuming energy drinks were 3.1% lower (p=0.04). A 31% increase in energy drink consumption for every single increase of viewing extreme sport per week was observed (p=0.009); however, reported viewing of advertising was not associated with increased consumption. CONCLUSIONS: A large proportion of extreme sport enthusiasts regularly consume energy drinks, especially younger adults. Extreme sport viewing, where energy drink sponsorship is common, appears to increase their consumption, even if not considered advertising by the viewers themselves.

Energy utilisation and postprandial responses during sitting interrupted by regular activity breaks.

Interrupting sedentary behaviour with regular activity breaks benefits glycaemic control; however, the influence of the energy utilised during these activity breaks on postprandial metabolic response is relatively unknown. Therefore, the aim of this study was to investigate whether the energy utilisation of regular (every 30 min) short (1 min 40 s or 2 min) activity breaks was associated with the lowering of postprandial glycaemia, insulinemia and lipidemia.Using separate data from two previously performed studies (ALPhA Study n = 65, age 25.7 (5.2) y, 40% male, BMI 23.6 (4.1) kg · m-2. ABPA study n = 35, age 25.1 (3.7) y, 31% male, BMI 23.4 (3.2) kg · m-2) we investigated the association between energy utilisation (measured by indirect calorimetry) and postprandial glucose, insulin and triglycerides during prolonged sitting, and regular activity breaks.Results.Mixed effects regression models indicated that energy utilisation was not consistently associated with postprandial glucose, insulin or triglyceride responses (p > 0.05 for all). Additionally, there was some indication that energy utilisation was obscuring (mildly suppressing) the effects of regular activity breaks on glucose, insulin and triglyceride iAUC.Conclusions.If energy utilisation does not mediate the association between regular activity breaks and postprandial glycaemic response, it is possible that it is the frequency of the activity breaks that is beneficial.

Interrupting Sedentary Time in the Workplace Using Regular Short Activity Breaks: Practicality From an Employee Perspective.

OBJECTIVE: To understand the practicalities of undertaking 2 to 3 minutes of light to moderate intensity physical activity after every 30 minutes of prolonged sitting by examining barriers and facilitators. METHODS: Around 27 (n = 22 women) employees working in higher education who sat for greater than 5 hours during a work day participated in a focus group discussion. RESULTS: Through inductive thematic analysis, themes characterising workplace culture and having the knowledge (or not) of benefits were found to be a facilitator and a barrier. Additional barriers were a perceived reduction in work productivity and specific work tasks that precluded taking activity breaks. Extrinsic motivators and prompts were suggested to facilitate participation. CONCLUSIONS: Environmental and individual strategies are required to build capability, opportunity, and motivation for undertaking regular activity breaks and should inform the development of an ecologically valid workplace intervention.

Wholegrain Particle Size Influences Postprandial Glycemia in Type 2 Diabetes: A Randomized Crossover Study Comparing Four Wholegrain Breads.

OBJECTIVE: Wholegrain foods vary in the extent of processing. We investigated whether wholegrain particle size in bread influences postprandial glycemia in type 2 diabetes. RESEARCH DESIGN AND METHODS: Postprandial glycemia (incremental area under the blood glucose curve [iAUC]) was measured after consumption of three breads made with roller-milled wholegrain flour and added grains and a fourth made with stone-ground flour. All flours and grains were 100% wholegrain wheat. Breads were nutrient matched. RESULTS: Fifteen adults (64 ± 10 years, HbA1c 58 ± 13 mmol/mol) completed the study. iAUC for the three breads made with roller-milled flour ranged from 376 to 641 mmol-1min-1, inverse linear trend for grain particle size P = 0.039. The iAUC for stone-ground wholegrain bread (503) was smaller than predicted from mean particle size. CONCLUSIONS: Wholegrain structural integrity in bread is a determinant of glycemic response. These findings have implications for dietary advice and the definition of the term "'wholegrain."

Device-Measured Sedentary Behavior Patterns in Office-Based University Employees.

OBJECTIVE: The aim of this study was to describe device-measured patterns of sedentary behavior in self-identified sedentary university employees. METHODS: Participants (n = 78) wore the ActiGraph GT3X+ and the activPAL3 for 7 days. Data from the ActiGraph were used to identify time in sedentary behavior, light-intensity, and moderate-to-vigorous physical activity. Data from the activPAL identified time sitting/lying, standing, and stepping. Breaks in sedentary time and prolonged sedentary bouts were described. RESULTS: During workdays, participants spent 65% to 79% of time sedentary, 16% in light-intensity physical activity, and 4% in moderate-to-vigorous physical activity, 76% of time was spent sitting/lying, 16% standing, and 8% stepping. Between 10 and 12 breaks in sedentary time were accumulated. CONCLUSION: Office-based university employees spend a high proportion of their time sedentary, but accumulate a high number of breaks. Whether these breaks are appropriate in timing, duration, and intensity to elicit health benefits seen in laboratory studies requires further investigation.

Interrupting Prolonged Sitting with Regular Activity Breaks does not Acutely Influence Appetite: A Randomised Controlled Trial.

Regular activity breaks increase energy expenditure; however, this may promote compensatory eating behaviour. The present study compared the effects of regular activity breaks and prolonged sitting on appetite. In a randomised, cross-over trial, 36 healthy adults (BMI (Body Mass Index) 23.9 kg/m² (S.D. = 3.9)) completed four, two-day interventions: two with prolonged sitting (SIT), and two with sitting and 2 min of walking every 30 min (RAB). Standardized meals were provided throughout the intervention, with an ad libitum meal at the end of Day 2. Appetite and satiety were assessed throughout both days of each intervention using five visual analogue scales. The five responses were combined into a single appetite response at each time point. The area under the appetite response curve (AUC) was calculated for each day. Intervention effects for appetite response AUC and ad libitum meal intake were tested using linear mixed models. Appetite AUC did not differ between interventions (standardised effect of RAB compared to SIT: Day 1: 0.11; 95% CI: -0.28, 0.06; p = 0.212; Day 2: 0.04; 95% CI: -0.15, 0.24; p = 0.648). There was no significant difference in energy consumed at the ad libitum lunch meal on Day 2 between RAB and SIT. Interrupting prolonged sitting with regular activity breaks does not acutely influence appetite or volume of food consumed, despite inferred increases in energy expenditure. Longer-term investigation into the effects of regular activity breaks on energy balance is warranted.

Vitamin D3 Supplementation Does Not Improve Sprint Performance in Professional Rugby Players: A Randomized, Placebo-Controlled, Double-Blind Intervention Study.

Vitamin D insufficiency is common in athletes and may lower physical performance. Many cross-sectional studies associate vitamin D status with physical performance in athletes; however, there have been few prospective randomized controlled trials with adequate statistical power to test this relationship, and none in the southern hemisphere. Thus, a prospective double-blind, randomized, placebo-controlled intervention trial was conducted involving 57 professional rugby union players in New Zealand. Participants were randomized to receive 50,000 IU of cholecalciferol (equivalent to 3,570 IU/day) or placebo once every two weeks over 11-12 weeks. Serum 25(OH)D concentrations and physical performance were measured at baseline, weeks 5-6, and weeks 11-12. Mean (SD) serum 25(OH)D concentrations for all participants at baseline was 94 (18) nmol/L, with all players above 50 nmol/L. Vitamin D supplementation significantly increased serum 25(OH)D concentrations compared to placebo, with a 32 nmol/L difference between groups at 11-12 weeks (95% CI, 26-38; p < 0.001). Performance in five of the six tests at study completion, including the primary outcome variable of 30-m sprint time, did not differ between the vitamin D supplemented and placebo groups (p > 0.05). Performance on the weighted reverse-grip chin up was significantly higher in players receiving vitamin D compared with placebo, by 5.5 kg (95% CI, 2.0-8.9; p = 0.002). Despite significantly improving vitamin D status in these professional rugby union players, vitamin D supplementation had little impact on physical performance outcomes. Thus, it is unlikely that vitamin D supplementation is an ergogenic aid in this group of athletes.

Sedentary Behavior and Body Weight and Composition in Adults: A Systematic Review and Meta-analysis of Prospective Studies.

BACKGROUND: The cumulative effect of too much sedentary behavior may contribute to weight gain and obesity. OBJECTIVE: The aim of this study was to conduct a systematic review and meta-analysis of prospective cohorts and randomized controlled studies to determine the association between sedentary behavior and body weight and obesity in adults. DATA SOURCES AND STUDY SELECTION: Relevant studies were identified from searches of the MEDLINE, Embase, AMED and PubMed databases up to May 2017, and by manual searches of in-text citations. Studies that evaluated the association in adults between sedentary behavior and body weight or obesity, while controlling for physical activity, were included. Overall, 31 publications met the eligibility criteria, including 23 prospective cohort studies with data that could be extracted for a quantitative meta-analysis, and a single randomized controlled trial. RESULTS: There were no significant associations between sedentary behavior and any measure of body weight or obesity, with the exception of waist circumference. For the latter outcome, over a 5-year follow-up period, each 1 h per day increase-from baseline to follow-up-in sedentary behavior was associated with a 0.02 mm [95% confidence interval (CI) 0.01-0.04; p = 0.001) increase in waist circumference. The odds ratio of becoming overweight or obese was 1.33 (95% CI 1.11-1.60; p = 0.001) in the highest compared with lowest categories of sedentary behavior. CONCLUSIONS: Meta-analysis of data from prospective cohort studies showed small, inconsistent and non-significant associations between sedentary behavior and body weight.

Regular activity breaks combined with physical activity improve postprandial plasma triglyceride, nonesterified fatty acid, and insulin responses in healthy, normal weight adults: A randomized crossover trial.

BACKGROUND: Compared with prolonged sitting, regular activity breaks immediately lower postprandial glucose and insulin, but not triglyceride responses. Postprandial triglycerides can be lowered by physical activity but the effect is often delayed by ∼12 to 24 hours. OBJECTIVE: The objective of the study was to determine whether regular activity breaks affect postprandial triglyceride response in a delayed manner similar to physical activity. METHODS: In a randomized crossover trial, 36 adults (body mass index 23.9 kg/m2 [standard deviation 3.9]) completed four 2-day interventions: (1) prolonged sitting (SIT); (2) prolonged sitting with 30 minutes of continuous walking (60% VO2max), at the end of Day 1 (SIT + PAD1); (3) Sitting with 2 minutes of walking (60% VO2max) every 30 minutes (RAB); (4) A combination of the continuous walking and regular activity breaks in 2 and 3 above (RAB + PAD1). Postprandial plasma triglyceride, nonesterified fatty acids, glucose, and insulin responses were measured in venous blood over 5 hours on Day 2. RESULTS: Compared with SIT, both RAB (difference: -43.61 mg/dL·5 hours; 95% confidence interval [CI] -83.66 to -2.67; P = .035) and RAB + PAD1 (-65.86 mg/dL·5 hours; 95% CI -112.14 to -19.58; P = .005) attenuated triglyceride total area under the curve (tAUC). RAB + PAD1 produced the greatest reductions in insulin tAUC (-23%; 95% CI -12% to -31%; P < .001), whereas RAB resulted in the largest increase in nonesterified fatty acids (tAUC, 10.08 mg/dL·5 hours; 95% CI 5.60-14.84; P < .001). There was no effect on glucose tAUC (P = .290). CONCLUSIONS: Postprandial triglyceride response is attenuated by regular activity breaks, when measured ∼24 hours after breaks begin. Combining regular activity breaks with 30 minutes of continuous walking further improves insulinemic and lipidemic responses.

Medication discrepancy rates among Medicaid recipients at hospital discharge.

OBJECTIVES: To compare the rate of discrepancies per patient for medications changed during hospitalization in patients with and without prescription provider comments at hospital discharge. Secondary objectives included comparing 35-day readmission rates, describing the overall medication discrepancy rate stratified by age group and type of discrepancy, collecting average number of medication changes, and reporting percentage change in admission medications at discharge. METHODS: This single-center prospective cohort included NC Medicaid recipients discharged from East Carolina University Family Medicine service from November 1, 2015, to January 31, 2016. Patients were assigned to a group based on presence or absence of provider comments on discharge prescriptions. Outpatient pharmacy claims were compared with the discharge summary to identify medication discrepancies. Medication discrepancy rates between groups were to be compared by means of independent-samples t test. Medication discrepancy rates were compared according to 35-day readmission status, age group, and type of discrepancy by means of independent-samples t tests and analysis of variance. Descriptive statistics were used for other secondary outcomes. RESULTS: Of 118 patients included, only 1 had provider comments. Therefore, a medication discrepancy rate comparison was not performed. Patients had a mean of 4 medication changes made to their regimen and 21.3% change in admission medications. Sixty-one percent of patients had at least 1 medication discrepancy, with an overall rate of 1.19. Patients readmitted within 35 days had a significantly greater medication discrepancy rate than those not readmitted (1.63 vs. 1.05, respectively; P = 0.044). Patients 18-49 years of age had the highest discrepancy rate and those older than 80 years of age the lowest (1.58 and 0.50, respectively). New or changed discharge medication not filled accounted for 69% of discrepancies. CONCLUSION: Although medication discrepancies were common, use of provider comments was rare. Future studies should address more effective ways to communicate pertinent information to community pharmacists and methods to improve adherence in obtaining new medications.

Diet app use by sports dietitians: a survey in five countries.

BACKGROUND: Despite the hundreds of diet apps available for use on smartphones (mobile phones), no studies have examined their use as tools for dietary assessment and tracking in sports nutrition. OBJECTIVE: The aim is to examine the prevalence and perceptions of using smartphone diet apps for dietary assessment and tracking among sports dietitians. METHODS: A cross-sectional online survey to examine the use and perception of diet apps was developed and distributed to sports dietitians in Australia, Canada, New Zealand, the United Kingdom, and the United States (US). RESULTS: The overall response rate from the 1709 sports dietitians invited to participate was 10.3% (n=180). diet apps were used by 32.4% (57/176) of sports dietitians to assess and track the dietary intake of athletes. Sports dietitians from the US were more likely to use smartphone diet apps than sports dietitians from other countries (OR=5.61, 95% CI 1.84-17.08, P=.002). Sports dietitians used 28 different diet apps, with 56% (32/57) choosing MyFitnessPal. Overall, sports dietitians held a positive perception of smartphone diet apps, with the majority of respondents viewing diet apps as "better" (25/53, 47%) or "equivalent" (22/53, 41%) when compared with traditional dietary assessment methods. CONCLUSIONS: Nearly one-third of sports dietitians used mobile phone diet apps in sports nutrition practice, and viewed them as useful in helping to assess and track the dietary intake of athletes.