Whole grain intake, compared to refined grain, improves postprandial glycemia and insulinemia: a systematic review and meta-analysis of randomized controlled trials.

Whole grain (WG) intake has been associated with reduced risk of type 2 diabetes (T2D) and may protect against T2D by lowering postprandial glycemia and insulinemia and improving insulin sensitivity. The objective of this systematic review and meta-analysis was to evaluate the effect of WG intake, compared to refined grain (RG) intake, on postprandial glycemia and insulinemia and markers of glycemic control and insulin resistance in randomized controlled trials (RCTs) in adults. A search of PubMed and Scopus yielded 80 relevant RCTs. Compared to RG, WG intake significantly reduced postprandial glycemia (SMD: -0.30; 95% CI: -0.43, -0.18; P < 0.001), insulinemia (SMD: -0.23; 95% CI: -0.35, -0.10; P < 0.001) and glycated hemoglobin (HbA1c) (SMD: -0.21; 95% CI: -0.37, -0.06; P = 0.007). There was no effect of WG on fasting glucose, fasting insulin, or homeostatic model assessment of insulin resistance (HOMA-IR). These results suggest WG foods improve short-term glycemia and insulinemia, which may improve HbA1c, a marker of long-term glycemic control. This may partially explain the inverse association between WG intake and risk of T2D, but further investigations are needed to understand if short-term reductions in glycemia translate to longer term benefits in reducing the risk of T2D.Systematic Review Registration: PROSPERO Registration CRD42020180069.Supplemental data for this article is available online at https://doi.org/10.1080/10408398.2021.2017838.

Changes in the time of COVID-19: a quality improvement initiative to maintain services at a youth sexual health clinic.

OBJECTIVES: Adolescents and young adults (AYAs) face difficulties accessing sexual and reproductive health services. These difficulties were exacerbated for a variety of reasons by the COVID-19 pandemic. We document strategies and outcomes implemented at an urban youth sexual health clinic in Florida that allowed uninterrupted provision of services while protecting against spread of COVID-19. METHODS: The plan-do-study-act (PDSA) model was used to implement COVID-19 interventions designed to allow continued service delivery while protecting the health and safety of staff and patients. This method was applied to clinic operations, community referral systems and community outreach to assess and refine interventions within a quick-paced feedback loop. RESULTS: During the COVID-19 pandemic, changes made via PDSA cycles to clinical/navigation services, health communications and youth outreach/engagement effectively responded to AYA needs. Although overall numbers of youth served decreased, all youth contacting the clinic for services were able to be accommodated. Case finding rates for chlamydia, gonorrhoea, syphilis and HIV were similar to pre-pandemic levels. CONCLUSIONS: Quality improvement PDSA initiatives at AYA sexual health clinics, particularly those for underserved youth, can be used to adapt service delivery when normal operating models are disrupted. The ability for youth sexual health clinics to adapt to a changing healthcare landscape will be crucial in ensuring that under-resourced youth are able to receive needed services and ambitious Ending the HIV Epidemic goals are achieved.

Spatial release from informational masking declines with age: Evidence from a detection task in a virtual separation paradigm.

Declines in spatial release from informational masking may contribute to the speech-processing difficulties that older adults often experience within complex listening environments. The present study sought to answer two fundamental questions: (1) Does spatial release from informational masking decline with age and, if so, (2) does age predict this decline independently of age-typical hearing loss? Younger (18-34 years) and older (60-80 years) adults with age-typical hearing completed a yes/no target-detection task with low-pass filtered noise-vocoded speech designed to reduce non-spatial segregation cues and control for hearing loss. Participants detected a target voice among two-talker masking babble while a virtual spatial separation paradigm [Freyman, Helfer, McCall, and Clifton, J. Acoust. Soc. Am. 106(6), 3578-3588 (1999)] was used to isolate informational masking release. The younger and older adults both exhibited spatial release from informational masking, but masking release was reduced among the older adults. Furthermore, age predicted this decline controlling for hearing loss, while there was no indication that hearing loss played a role. These findings provide evidence that declines specific to aging limit spatial release from informational masking under challenging listening conditions.

The Helicobacter pylori CZB Cytoplasmic Chemoreceptor TlpD Forms an Autonomous Polar Chemotaxis Signaling Complex That Mediates a Tactic Response to Oxidative Stress.

UNLABELLED: Cytoplasmic chemoreceptors are widespread among prokaryotes but are far less understood than transmembrane chemoreceptors, despite being implicated in many processes. One such cytoplasmic chemoreceptor is Helicobacter pylori TlpD, which is required for stomach colonization and drives a chemotaxis response to cellular energy levels. Neither the signals sensed by TlpD nor its molecular mechanisms of action are known. We report here that TlpD functions independently of the other chemoreceptors. When TlpD is the sole chemoreceptor, it is able to localize to the pole and recruits CheW, CheA, and at least two CheV proteins to this location. It loses the normal membrane association that appears to be driven by interactions with other chemoreceptors and with CheW, CheV1, and CheA. These results suggest that TlpD can form an autonomous signaling unit. We further determined that TlpD mediates a repellent chemotaxis response to conditions that promote oxidative stress, including being in the presence of iron, hydrogen peroxide, paraquat, and metronidazole. Last, we found that all tested H. pylori strains express TlpD, whereas other chemoreceptors were present to various degrees. Our data suggest a model in which TlpD coordinates a signaling complex that responds to oxidative stress and may allow H. pylori to avoid areas of the stomach with high concentrations of reactive oxygen species. IMPORTANCE: Helicobacter pylori senses its environment with proteins called chemoreceptors. Chemoreceptors integrate this sensory information to affect flagellum-based motility in a process called chemotaxis. Chemotaxis is employed during infection and presumably aids H. pylori in encountering and colonizing preferred niches. A cytoplasmic chemoreceptor named TlpD is particularly important in this process, and we report here that this chemoreceptor is able to operate independently of other chemoreceptors to organize a chemotaxis signaling complex and mediate a repellent response to oxidative stress conditions. H. pylori encounters and must cope with oxidative stress during infection due to oxygen and reactive oxygen species produced by host cells. TlpD's repellent response may allow the bacteria to escape niches experiencing inflammation and elevated reactive oxygen species (ROS) production.

Musical Meter Modulates the Allocation of Attention across Time.

Dynamic attending theory predicts that attention is allocated hierarchically across time during processing of hierarchical rhythmic structures such as musical meter. ERP research demonstrates that attention to a moment in time modulates early auditory processing as evidenced by the amplitude of the first negative peak (N1) approximately 100 msec after sound onset. ERPs elicited by tones presented at times of high and low metric strength in short melodies were compared to test the hypothesis that hierarchically structured rhythms direct attention in a manner that modulates early perceptual processing. A more negative N1 was observed for metrically strong beats compared with metrically weak beats; this result provides electrophysiological evidence that hierarchical rhythms direct attention to metrically strong times during engaged listening. The N1 effect was observed only on fast tempo trials, suggesting that listeners more consistently invoke selective processing based on hierarchical rhythms when sounds are presented rapidly. The N1 effect was not modulated by musical expertise, indicating that the allocation of attention to metrically strong times is not dependent on extensive training. Additionally, changes in P2 amplitude and a late negativity were associated with metric strength under some conditions, indicating that multiple cognitive processes are associated with metric perception.

Cost savings of reduced constipation rates attributed to increased dietary fiber intakes: a decision-analytic model.

BACKGROUND: Nearly five percent of Americans suffer from functional constipation, many of whom may benefit from increasing dietary fiber consumption. The annual constipation-related healthcare cost savings associated with increasing intakes may be considerable but have not been examined previously. The objective of the present study was to estimate the economic impact of increased dietary fiber consumption on direct medical costs associated with constipation. METHODS: Literature searches were conducted to identify nationally representative input parameters for the U.S. population, which included prevalence of functional constipation; current dietary fiber intakes; proportion of the population meeting recommended intakes; and the percentage that would be expected to respond, in terms of alleviation of constipation, to a change in dietary fiber consumption. A dose-response analysis of published data was conducted to estimate the percent reduction in constipation prevalence per 1 g/day increase in dietary fiber intake. Annual direct medical costs for constipation were derived from the literature and updated to U.S. $ 2012. Sensitivity analyses explored the impact on adult vs. pediatric populations and the robustness of the model to each input parameter. RESULTS: The base case direct medical cost-savings was $12.7 billion annually among adults. The base case assumed that 3% of men and 6% of women currently met recommended dietary fiber intakes; each 1 g/day increase in dietary fiber intake would lead to a reduction of 1.9% in constipation prevalence; and all adults would increase their dietary fiber intake to recommended levels (mean increase of 9 g/day). Sensitivity analyses, which explored numerous alternatives, found that even if only 50% of the adult population increased dietary fiber intake by 3 g/day, annual medical costs savings exceeded $2 billion. All plausible scenarios resulted in cost savings of at least $1 billion. CONCLUSIONS: Increasing dietary fiber consumption is associated with considerable cost savings, potentially exceeding $12 billion, which is a conservative estimate given the exclusion of lost productivity costs in the model. The finding that $12.7 billion in direct medical costs of constipation could be averted through simple, realistic changes in dietary practices is promising and highlights the need for strategies to increase dietary fiber intakes.

Preventing Behavioral Human Immunodeficiency Virus Infections in Adolescents and Young Adults.

HIV prevention in adolescents and young adults (AYA) requires a multi-pronged strategy encompassing behavioral, biologic, and structural approaches. This article reviews the epidemiology of HIV infection in the United States and its pathogenesis and transmission. Prevention approaches are discussed in more detail, with an emphasis on how each approach is relevant to AYA populations. Information is summarized in a resource table with links to references and in-depth discussions of the topics reviewed in this article.

Violations of Lab-Learned Phonological Patterns Elicit a Late Positive Component.

The experimental study of artificial language learning has become a widely used means of investigating the predictions of theories of language learning and representation. Although much is now known about the generalizations that learners make from various kinds of data, relatively little is known about how those representations affect speech processing. This paper presents an event-related potential (ERP) study of brain responses to violations of lab-learned phonotactics. Novel words that violated a learned phonotactic constraint elicited a larger Late Positive Component (LPC) than novel words that satisfied it. Similar LPCs have been found for violations of natively acquired linguistic structure, as well as for violations of other types of abstract generalizations, such as musical structure. We argue that lab-learned phonotactic generalizations are represented abstractly and affect the evaluation of speech in a manner that is similar to natively acquired syntactic and phonological rules.

A supplemented soft agar chemotaxis assay demonstrates the Helicobacter pylori chemotactic response to zinc and nickel.

Directed motility, or chemotaxis, is required for Helicobacter pylori to establish infection in the stomach, although the full repertoire of this bacterium's chemotactic responses is not yet known. Here we report that H. pylori responds to zinc as an attractant and nickel as a repellent. To reach this conclusion, we employed both a temporal chemotaxis assay based on bacterial reversals and a supplemented soft agar spatial assay. We refined the temporal assay using a previously described chemorepellent, acid, and found that H. pylori requires rich media with serum to maintain optimal swimming motility. Surprisingly, we found that some strains respond to acid as an attractant, and that the TlpC chemoreceptor correlated with whether acid was sensed as an attractant or repellent. Using this same assay, we detected weak repellent responses to nickel and copper, and a varied response to zinc. We thus developed an alternative spatial chemotactic assay called the supplemented soft agar assay, which utilizes soft agar medium supplemented with the test compound. With Escherichia coli, the attractant serine slowed overall bacterial migration, while the repellent nickel increased the speed of overall migration. In H. pylori we detected slowed migration with doubled tryptone media, as well as zinc, consistent with an attractant response. In contrast, nickel increased migration, consistent with repulsion.

Impact of Pasta Intake on Body Weight and Body Composition: A Technical Review.

Pasta is a staple carbohydrate across many cultures but has been implicated in overweight and obesity due to its position as a refined carbohydrate. Yet, the unique structure of pasta and its low glycemic response suggest it may contribute to a healthy body weight. The purpose of this review is to summarize the literature on the effects of pasta and dietary patterns high in pasta on body weight and body composition outcomes, and evaluate potential mechanisms by which pasta may influence body weight. A search of PubMed and CENTRAL identified 38 relevant studies examining pasta intake and body weight outcomes or potential mechanisms. Observational studies generally report no association or an inverse association of pasta intake with body weight/body composition outcomes. One clinical trial reported no difference in weight loss between a hypocaloric diet with high intake vs. low intake of pasta. Pasta may influence body weight via its low glycemic response, but evidence of effects on appetite, appetite-related hormones, and gastric emptying is limited and inconclusive. In conclusion, observational and limited clinical data suggest pasta is either inversely or not associated with overweight or obesity in healthy children and adults, and does not contribute to weight gain within the context of a healthy diet.

Red meat consumption and risk factors for type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND AND OBJECTIVES: Results from observational studies suggest an association of red meat intake with risk of type 2 diabetes mellitus (T2D). However, results from randomized controlled trials (RCTs) have not clearly supported a mechanistic link between red meat intake and T2D risk factors. Therefore, a systematic review and meta-analysis were conducted on RCTs evaluating the effects of diets containing red meat (beef, pork, lamb, etc.), compared to diets with lower or no red meat, on markers of glucose homeostasis in adults. METHODS: A search of PubMed and CENTRAL yielded 21 relevant RCTs. Pooled estimates were expressed as standardized mean differences (SMDs) between the red meat intervention and the comparator intervention with less or no red meat. RESULTS: Compared to diets with reduced or no red meat intake, there was no significant impact of red meat intake on insulin sensitivity (SMD: -0.11; 95% CI: -0.39, 0.16), insulin resistance (SMD: 0.11; 95% CI: -0.24, 0.45), fasting glucose (SMD: 0.13; 95% CI: -0.04, 0.29), fasting insulin (SMD: 0.08; 95% CI: -0.16, 0.32), glycated hemoglobin (HbA1c; SMD: 0.10; 95% CI: -0.37, 0.58), pancreatic beta-cell function (SMD: -0.13; 95% CI: -0.37, 0.10), or glucagon-like peptide-1 (GLP-1; SMD: 0.10; 95% CI: -0.37, 0.58). Red meat intake modestly reduced postprandial glucose (SMD: -0.44; 95% CI: -0.67, -0.22; P < 0.001) compared to meals with reduced or no red meat intake. The quality of evidence was low to moderate for all outcomes. CONCLUSIONS: The results of this meta-analysis suggest red meat intake does not impact most glycemic and insulinemic risk factors for T2D. Further investigations are needed on other markers of glucose homeostasis to better understand whether a causal relationship exists between red meat intake and risk of T2D. PROSPERO REGISTRATION: CRD42020176059.

Auditory pseudoword rhyming effects in bilingual children reflect second language proficiency: An ERP study.

This study investigated second language (L2-English) phonological processing in 31 Spanish-English bilingual, 6- to 8-year-old schoolchildren in an event-related potential (ERP) auditory pseudoword rhyming paradigm. In addition, associations between ERP effects and L2 proficiency as measured by standardized tests of receptive language and receptive vocabulary were explored. We found a classic posterior ERP rhyming effect that was more widely distributed in children with higher L2 proficiency in group analyses and was larger for children with better L2 proficiency in correlation analyses. In contrast, the amplitude of an early (75-125 ms) auditory positivity was larger in children with lower L2 proficiency. This pattern suggests differential use of early and late auditory/phonological processing resources in the pseudoword rhyme task associated with L2 proficiency, which is consistent with the predictions of the lexical restructuring model in a bilingual context.

The Impact of Ready-to-Eat Cereal Intake on Body Weight and Body Composition in Children and Adolescents: A Systematic Review of Observational Studies and Controlled Trials.

Results from observational studies suggest that children and adolescents consuming ready-to-eat cereals (RTECs) have a healthier BMI and lower odds of overweight and obesity than consumers of other breakfasts or breakfast skippers. However, randomized controlled trials in children and adolescents are few and have been inconsistent in demonstrating a causal relationship between RTEC intake and body weight or body composition. The objective of this study was to evaluate the effect of RTEC intake on body weight and body composition outcomes in children and adolescents. Prospective cohort, cross-sectional and controlled trials in children or adolescents were included. Retrospective studies and studies in subjects with disease, other than obesity, type-2 diabetes (T2D), metabolic syndrome, or prediabetes, were excluded. A search in PubMed and CENTRAL databases yielded 25 relevant studies, which were qualitatively analyzed. Fourteen of the 20 observational studies demonstrated that children and adolescents consuming RTEC have a lower BMI, lower prevalence and odds of overweight/obesity and more favorable indicators of abdominal obesity than nonconsumers or less frequent consumers. Controlled trials were few and only one reported a loss of 0.9 kg in overweight/obese children with RTEC consumption when accompanied by nutrition education. The risk of bias was low for most studies, but six had some concerns or high risk. The results were similar with presweetened and nonpresweetened RTEC. No studies reported a positive association of RTEC intake with body weight or body composition. Although controlled trials do not show a direct effect of RTEC consumption on body weight or body composition, the preponderance of observational data supports the inclusion of RTEC as part of a healthy dietary pattern for children and adolescents. Evidence also suggests similar benefits on body weight and body composition regardless of the sugar content. Additional trials are needed to determine the causality between RTEC intake and body weight and body composition outcomes. PROSPERO REGISTRATION: CRD42022311805.

The Relationship of Ready-to-Eat Cereal Intake and Body Weight in Adults: A Systematic Review of Observational Studies and Controlled Trials.

Results from observational studies indicate that consumption of ready-to-eat cereal (RTEC) is associated with higher diet quality and lower incidence of overweight and obesity in adults compared with other breakfasts or skipping breakfast. However, randomized controlled trials (RCTs) have had inconsistent results regarding effects of RTEC consumption on body weight and composition. This systematic review aimed to evaluate the effect of RTEC intake on body weight outcomes in observational studies and RCTs in adults. A search of PubMed and Cochrane Central Register of Controlled Trials (CENTRAL) databases yielded 28 relevant studies, including 14 observational studies and 14 RCTs. Results from observational studies demonstrate that frequent RTEC consumers (usually ≥4 servings/wk) have lower BMI, lower prevalence of overweight/obesity, less weight gain over time, and less anthropometric evidence of abdominal adiposity compared with nonconsumers, or less frequent consumers. RCT results suggest that RTEC may be used as a meal or snack replacement as part of a hypocaloric diet, but this approach is not superior to other options for those attempting to achieve an energy deficit. In addition, RTEC consumption was not associated with significantly less loss of body weight, or with weight gain, in any of the RCTs. RTEC intake is associated with favorable body weight outcomes in adults in observational studies. RTEC does not hinder weight loss when used as a meal or snack replacement within a hypocaloric diet. Additional long-term RCTs (≥6 mo) in both hypocaloric and ad libitum conditions are recommended to evaluate further the potential effects of RTEC consumption on body weight outcomes. PROSPERO (CRD42022311805).