Identification of lipids that accumulate during the routine storage of prestorage leukoreduced red blood cells and cause acute lung injury.

BACKGROUND: Lipids accumulate during the storage of red blood cells (RBCs), prime neutrophils (PMNs), and have been implicated in transfusion-related acute lung injury (TRALI). These lipids are composed of two classes: nonpolar lipids and lysophosphatidylcholines based on their retention time on separation by high-pressure liquid chromatography. Prestorage leukoreduction significantly decreases white blood cell and platelet contamination of RBCs; therefore, it is hypothesized that prestorage leukoreduction changes the classes of lipids that accumulate during storage, and these lipids prime PMNs and induce acute lung injury (ALI) as the second event in a two-event in vivo model. STUDY DESIGN AND METHODS: RBC units were divided: 50% was leukoreduced (LR-RBCs), stored, and sampled on Day 1 and at the end of storage, Day 42. Priming activity was evaluated on isolated PMNs, and the purified lipids from Day 1 or Day 42 were used as the second event in the in vivo model. RESULTS: The plasma and lipids from RBCs and LR-RBCs primed PMNs, and the LR-RBC activity decreased with longer storage. Unlike RBCs, nonpolar lipids comprised the PMN-priming activity from stored LR-RBCs. Mass spectroscopy identified these lipids as arachidonic acid and 5-, 12-, and 15-hydroxyeicsotetranoic acid. At concentrations from Day 42, but not Day 1, three of four of these lipids individually, and the mixture, primed PMNs. The mixture also caused ALI as the second event in a two-event model of TRALI. CONCLUSION: We conclude that the nonpolar lipids that accumulate during LR-RBC storage may represent the agents responsible for antibody-negative TRALI.

Elementary student and teacher perceptions of a mindfulness and yoga-based program in school: A qualitative evaluation.

RESEARCH QUESTION: What are the qualitative insights and perspectives about the implementation of a mindfulness and yoga-based program from elementary youth and teachers? CONTEXT: A mindfulness and yoga-based curriculum was implemented in 15 schools. The curriculum was taught to students during a physical education or dance class by instructors who were within each school and received training on the curriculum. SAMPLE SELECTION: Volunteer focus group elementary students who participated for one year and teachers who did not implement the program were qualitatively interviewed, by three trained University researchers. DATA COLLECTION: Nine focus groups were completed within three different elementary schools. Six focus groups were completed with 3rd and 5th grade students. Three focus groups were conducted with teachers within each school which received the program, excluding instructors. ANALYSIS: Focus group data were coded and a thematic analysis was completed among the 40 students and 23 teachers. INTERPRETATION AND MAIN RESULTS: Teachers had varying degrees of involvement with the program and communication emerged as a critical theme for buy-in as communication represents the underpinnings of creating and retaining stakeholders. Most students talked about perceived improvements in focus, emotional regulation, flexibility, breathing, and school work. A common theme to describe benefits of the program emerged with the idea of "increased focus". Conceptually, it may be that increasing mindfulness increases "focus" thus increasing positive outcomes. More research is needed to understand if "focus" may serve as a mediating variable on emotional regulation, cognitive improvements, and other health outcomes.

High and low glycemic index mixed meals and blood glucose in youth with type 2 diabetes or impaired glucose tolerance.

This cross-over pilot study tested blood glucose response to low and high glycemic index meals in 12 obese youth with type 2 diabetes or impaired glucose tolerance. Participants demonstrated significantly lower mean daytime blood glucose and a trend toward lower variability, suggesting a clinically relevant impact of reducing glycemic index.

The effect of a low-glycemic diet vs a standard diet on blood glucose levels and macronutrient intake in children with type 1 diabetes.

A low-glycemic index (GI) diet may lower postprandial hyperglycemia and decrease the risk for postabsorptive hypoglycemia in people with type 1 diabetes. However, insufficient evidence exists on the efficacy of a low-GI diet to support practice recommendations. The goal of this study was to examine the blood glucose response to and the macronutrient composition of low-GI meals vs usual meals consumed ad libitum at home in children with type 1 diabetes. A within-subject, crossover design was employed. Twenty-three participants were recruited between June and August 2006. Participants wore a continuous blood glucose monitoring system and completed diet diaries on 2 days. On 1 day, participants consumed their usual meal; on another day, participants consumed low-GI meals ad libidum. Order of the 2 days was counterbalanced. The mean GI was 34+/-6 for the low-GI day and 57+/-6 for the usual meal day (P<0.0001). During the low-GI day, mean daytime blood glucose values (125+/-28 mg/dL [6.9+/-1.5 nmol/L] vs 185+/-58 mg/dL [10.3+/-3.2 nmol/L], P<0.001), blood glucose area above 180 mg/dL (4,486+/-6,138 vs 26,707+/-25,038, P<0.006), and high blood glucose index (5.1+/-5.1 vs 13.6+/-7.6, P<0.001) were lower compared to the usual mean day. During the low-GI day, subjects consumed more fiber (24.5+/-12.3 g vs 14.5+/-6.1 g, P<0.007) and less fat (45.7+/-12.2 g vs 76.8+/-32.4 g, P<0.005); however, there were no differences in energy, carbohydrate, or protein intake. In this pilot study, a low-GI diet was associated with improved diet quality and a reduction in hyperglycemia.

Whole grain and legume acceptability among youths with type 1 diabetes.

PURPOSE: This pilot study investigated the acceptability of whole grain and legume foods in youths with type 1 diabetes and determined demographic and behavioral factors associated with their acceptability. METHODS: Youths with type 1 diabetes (7.0 to 16.9 years) were recruited during a diabetes camp and completed self-report measures of food acceptability, eating behaviors, and demographics. An overall acceptability score for whole grains and for legumes was calculated as the sum of foods in each category rated as either "tried and liked" or "not tried and willing to try." Correlations of whole grain and legume acceptability with demographic characteristics were examined. RESULTS: One hundred twenty-eight youths participated (70% females, mean age 11.6 +/- 2.3 years). Whole grain foods with the highest acceptability were corn bread (85% tried/liked and 11% willing to try) and whole wheat bread (72% tried/liked and 3% willing to try). Total whole grain acceptability was negatively associated with days per week of fast food consumption (r = -0.21; P < .02) and living in an urban environment (r = -0.24; P < .01). Chili with beans (66% tried/liked and 8% willing to try) and baked beans (57% tried/liked and 19% willing to try) were the legume-containing foods with the highest acceptability. There were no significant associations between demographic factors and total legume acceptability. CONCLUSIONS: These findings demonstrate the variability in acceptability among whole grains and legumes in youths with type 1 diabetes and the importance of addressing acceptability when counseling youths or designing nutrition interventions to improve consumption of these foods.

Healthy eating practices: perceptions, facilitators, and barriers among youth with diabetes.

PURPOSE: The purpose of this study was to explore the perceptions of healthy eating by youth with diabetes as well as facilitators of and barriers to healthy eating behavior. METHODS: One hundred forty youth aged 7 to 16 years with diabetes participated in 18 focus groups. Sample race/ethnicity was 71% white, 18% African American, 6% Hispanic, and 5% other; 69% of the participants were female. RESULTS: Healthy eating was defined primarily in terms of eating fruits and vegetables, low fat, low sugar, and eating to keep blood sugar in range. However, there were notable differences in perceptions of healthy eating versus perceptions of eating practices good for diabetes management. Specifically, "free" foods (foods high in fat but low in carbohydrate) were commonly reported as being good for diabetes management. Major barriers to healthy eating included widespread availability of unhealthy foods, preparation time, and social situations. Parental behaviors, including monitoring food choices and positive modeling, were the most commonly reported facilitators of healthy eating. CONCLUSION: Findings suggest that youth with diabetes have a general understanding of healthy eating and face similar barriers and facilitators to healthy eating as nondiabetic children do. However, the diabetes regimen may influence their understanding of healthy eating, sometimes negatively. Diabetes nutrition education sessions should emphasize the connection between healthy eating and both short- and long-term diabetes outcomes, and they should highlight strategies to reduce saturated fat consumption while avoiding excessive carbohydrate consumption. The diabetes educator can play an integral role in promoting healthy dietary practices by facilitating parental involvement, designing action plans for managing social situations, and increasing awareness of healthier alternatives to widely available unhealthy foods.

Acceptability of lower glycemic index foods in the diabetes camp setting.

OBJECTIVE: To determine the acceptability of lower glycemic index (GI) foods served at diabetes camp. DESIGN: Crossover design of standard and lower GI menus. SETTING: Three consecutive 5-day diabetes camp sessions. PARTICIPANTS: 140 youth, age 7-16, with type 1 or 2 diabetes. INTERVENTION: A standard camp cycle menu was reformulated to include 2 1/2 days of standard foods and 2 1/2 days of lower GI foods. MAIN OUTCOME MEASURES: Youth provided satisfaction ratings after meals and snacks using measures designed for this study. Observations of food consumption were conducted on a random sample of youth for each meal. ANALYSIS: Descriptive analyses and t-tests were conducted to assess differences in satisfaction with and consumption of standard and lower GI foods. RESULTS: Lower GI foods served at dinner and for snacks received satisfaction ratings equal to standard foods (dinner: 3.68 lower GI versus 3.79 standard, P = .30; snacks: 3.74 lower GI versus 3.79 standard, P = .60). Lower GI foods served at breakfast and lunch received lower, though very acceptable, ratings (breakfast: 3.76 lower GI versus 4.04 standard, P < .01; lunch: 3.64 lower GI versus 3.88 standard, P = .01). Consumption of all meals was acceptable. No differences occurred in the frequency of high or low blood sugars between standard and lower GI days. CONCLUSIONS AND IMPLICATIONS: Higher quality carbohydrates may be provided to youth in institutional settings while maintaining sufficient levels of acceptability; specific findings are instructive for designing efforts to increase their consumption.

Decrease in Glycemic Index Associated with Improved Glycemic Control among Latinos with Type 2 Diabetes.

BACKGROUND: Glycemic index and glycemic load are used to facilitate glucose control among adults with type 2 diabetes, with a low glycemic index diet associated with improved glycemic control. OBJECTIVE: To examine long-term longitudinal associations between changes in glycemic index and glycemic load with glycemic and metabolic control among Latino adults with diabetes. DESIGN: Secondary data from intervention and comparison participants in the Latinos en Control trial (2006 to 2008) were analyzed. PARTICIPANTS/SETTING: Data on dietary intake and metabolic characteristics were from low-income, Latino adults (N=238; 87.7% Puerto Rican) with type 2 diabetes. INTERVENTION: The Latinos en Control trial was a randomized clinical trial targeting diabetes self-management among Latinos with type 2 diabetes. Participants were randomized to a group-based behavioral intervention or usual care and followed through 12 months. MAIN OUTCOME MEASURES: Outcomes included hemoglobin A1c (HbA1c) levels, fasting blood glucose, lipid profiles, anthropometrics, and blood pressure. STATISTICAL ANALYSIS: Glycemic index and load were analyzed using data from three 24-hour dietary recalls conducted at baseline, 4 months, and 12 months. Repeated measures regression models were used to examine change in glycemic index and load associated with metabolic characteristics at 12 months. Covariates included sex, age, body mass index, blood pressure, total energy intake, medication use and intensity, physical activity, intervention status (intervention vs usual care), and time. RESULTS: Increases in glycemic index from baseline to 12 months were associated with increased logarithm of HbA1c levels (ß=0.003; P=0.034) and waist circumference (ß=0.12; P=0.026) over time, but not with fasting glucose, blood lipids, or body mass index. There was modest evidence to support small, positive associations between glycemic load and HbA1c levels and waist circumference. CONCLUSIONS: Lowering glycemic index is associated with improvements in certain metabolic risk factors among Latinos with diabetes. Targeting glycemic index may be an important component of dietary strategies for diabetes self-management.

The Role of Social Support vs. Modeling on Adolescents' Diet and Physical Activity: Findings from a School-based Weight Management Trial.

OBJECTIVE: Social influences play an important role in shaping adolescents' dietary and physical activity behaviors. We examined the role of perceived modeling and perceived social support from family and friends on diet and physical activity behaviors among overweight and obese adolescents participating in a weight management trial. METHODS: Six high schools were randomized to a school-nurse delivered behavioral weight management intervention or an information attention-control. Data on perceived support and modeling of healthy eating and physical activity from family and friends and dietary and physical activity behaviors were obtained from participants (N=82) at baseline and 2- and 6-months follow-up. RESULTS: Linear mixed models were used to examine associations between social factors at baseline and diet and physical behaviors at 6 months. Friend support was correlated with increased fruit and vegetable consumption (0.4 servings/day) and decreased added sugar intake (-14.2 grams/day) (p's<0.05). Family support for physical activity, friend support for physical activity, and family modeling of physical activity were associated with increased number of days/week active for ≥ 60 minutes/day (0.7 days/week; 0.6 days/week; and 0.4 days/week, respectively, p's<0.05). CONCLUSIONS: Among overweight and obese high school adolescents, support from family and friends was associated with a greater number of improvements in diet and physical activity at follow-up than modeling. Strategies to solicit support may maximize efficacy of adolescent obesity intervention efforts.

A school nurse-delivered intervention for overweight and obese adolescents.

BACKGROUND: Models are needed for implementing weight management interventions for adolescents through readily accessible venues. This study evaluated the feasibility and efficacy of a school nurse-delivered intervention in improving diet and activity and reducing body mass index (BMI) among overweight and obese adolescents. METHODS: Six high schools were randomized to either a 6-session school nurse-delivered counseling intervention utilizing cognitive-behavioral techniques or nurse contact with provision of information. Eighty-four overweight or obese adolescents in grades 9 through 11 completed behavioral and physiological assessments at baseline and 2- and 6-month follow-ups. RESULTS: At 2 months, intervention participants ate breakfast on more days/week (difference = 1.01 days; 95% CI: 0.11, 1.92), and had a lower intake of total sugar (difference = -45.79 g; 95% CI: -88.34, -3.24) and added sugar (difference = -51.35 g; 95% CI: -92.45, -10.26) compared to control participants. At 6 months, they were more likely to drink soda ≤ one time/day (OR 4.10; 95% CI: 1.19, 16.93) and eat at fast food restaurants ≤ one time/week (OR 4.62; 95% CI: 1.10, 23.76) compared to control participants. There were no significant differences in BMI, activity, or caloric intake. CONCLUSION: A brief school nurse-delivered intervention was feasible, acceptable, and improved selected obesogenic behaviors, but not BMI.

Exploratory research to design a school nurse-delivered intervention to treat adolescent overweight and obesity.

OBJECTIVE: In preparation for a pilot study to evaluate the efficacy of a school nurse-delivered intervention, focus groups were conducted to gain insight into the perceptions of stakeholders regarding the design and implementation of the intervention. SETTING AND PARTICIPANTS: Fifteen focus groups at participating schools. One hundred subjects, including overweight and obese high school students, parents, high school nurses, and staff. MAIN OUTCOME MEASURE: Stakeholders' perceptions. ANALYSIS: Focus groups were audiotaped and transcribed verbatim. Theme instances related to the research aim were identified, coded, and sorted into theme categories. RESULTS: Major topics discussed included teen issues, family support, intervention implementation-related concerns, and curriculum content. Teen issues included dealing with peer pressure, avoiding emotional eating, and support from friends. Many participants thought it should be the teen's choice to involve parents. Confidentiality was the most commonly identified potential barrier to implementation. Recommendations for nutrition and physical activity curriculum content focused on concrete, practical strategies. CONCLUSIONS AND IMPLICATIONS: Results of this research provided insight into stakeholder's needs and perceptions regarding the content and structure of a school nurse-delivered intervention to treat adolescent overweight and obesity. Findings were used in the design and implementation of intervention protocols and materials.

Effect of varying glycemic index meals on blood glucose control assessed with continuous glucose monitoring in youth with type 1 diabetes on basal-bolus insulin regimens.

OBJECTIVE: The purpose of this study was to test the effect of high glycemic index (HGI) and low glycemic index (LGI) meals on blood glucose levels using continuous blood glucose monitoring in youths with type 1 diabetes. RESEARCH DESIGN AND METHODS: A total of 20 youths on basal-bolus regimens consumed macronutrient-matched HGI and LGI meals 1 day each in a controlled setting in varying order following consumption of a standardized evening meal. Medtronic MiniMed Continuous Glucose Monitoring Systems were used to assess blood glucose (BG) profiles. RESULTS: Participants demonstrated significantly lower daytime mean BG, BG area >180 mg/dl, and high BG index when consuming LGI meals but no differences for daytime BG area <70 mg/dl, daytime low BG index, or any nighttime values. Significantly more BG values <80 mg/dl were treated on LGI days. CONCLUSIONS: Findings indicate that consumption of an LGI diet may reduce glucose excursions, improving glycemic control.