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1.
Public Health Nutr ; 26(11): 2276-2287, 2023 11.
Artigo em Inglês | MEDLINE | ID: mdl-37548181

RESUMO

OBJECTIVE: Night shift workers are at a 20 to 40 % increased risk of metabolic diseases, which may be associated with their disrupted eating patterns. This qualitative study explores factors that influence night shift workers' eating habits, within and outside of the workplace, to identify target areas for health promotion strategies. PARTICIPANTS AND SETTING: Eligible participants resided in Australia, working at least three overnight shifts per month. DESIGN: The photovoice method was used, whereby participants were asked to take photos that represent their typical eating habits. These photos were incorporated as prompts in a semi-structured interview, which explored factors influencing eating habits on night shifts and days-off and perceptions and enablers to healthy eating. RESULTS: Ten participants completed the study. Thematic analysis generated four main themes, which were mapped onto the Social Ecological Model (SE Model). Aligned with the SE Model, our results show night shift workers' eating habits are influenced by intrapersonal, interpersonal and (work) organisational levels. Participants reported that at work, appropriate food preparation facilities are required to enable healthy food choices. Poor shift work rostering leads to prolonged fatigue on days-off, limiting their ability and motivation to engage in healthy eating. Consequently, night shift workers seem to require additional supports from their social networks and enhanced food literacy skills, in order to adopt/ maintain healthy eating behaviours. CONCLUSIONS: Night shift work creates individual and environmental barriers to healthy eating, which are present during and outside of work. Health promotion strategies for this population should include multiple approaches to address these barriers.


Assuntos
Comportamento Alimentar , Jornada de Trabalho em Turnos , Humanos , Austrália , Preferências Alimentares , Pesquisa Qualitativa
2.
Curr Diab Rep ; 22(4): 147-155, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35403984

RESUMO

PURPOSE OF REVIEW: The aim of this short review is to provide an updated commentary on the current literature examining the impact of meal timing on obesity and weight gain in adults. The potential mechanisms, including novel and emerging factors, behind timing of food intake across the 24-h period in the development of obesity, and dietary strategies manipulating meal timing to ameliorate weight gain are also explored. RECENT FINDINGS: Dietary patterns that feature meal timing outside of the regular daytime hours can contribute to circadian disruption as food is metabolised in opposition to internal daily rhythms and can feedback on the timekeeping mechanisms setting these rhythms. Epidemiological evidence examining the impact of late meal timing patterns is beginning to suggest that eating at night increases the risk of weight gain over time. Mechanisms contributing to this include changes to the efficiency of metabolism across the day, and dysregulation of appetite hormone and gut microbiota by mis-timed meals. When meals are eaten, in relation to the time of day, is increasingly considered of importance when implementing dietary change in order to address the growing burden of obesity, although further research is required in order to determine optimal patterns.


Assuntos
Refeições , Aumento de Peso , Adulto , Apetite , Ritmo Circadiano , Ingestão de Energia/fisiologia , Comportamento Alimentar , Humanos , Obesidade/epidemiologia
3.
Nutr Metab Cardiovasc Dis ; 31(6): 1890-1902, 2021 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-33994064

RESUMO

BACKGROUND AND AIMS: Shift workers face an increased risk of cardiovascular disease (CVD), type-2 diabetes and obesity. Eating during the night is a likely contributing factor, as it coincides with the time at which postprandial metabolism is least efficient. In this pilot randomised crossover trial, we examine the effects of a short overnight fast on CVD risk markers (primarily postprandial triglyceride and glucose response) of night shift workers. METHODS AND RESULTS: Night shift workers with abdominal obesity underwent 4-week intervention and control periods, separated by ≥ 2 weeks washout. In the intervention period, an overnight fast (0100 h-0600 h) was implemented, by redistributing 24-h energy intake. Usual dietary habits were followed in the control period. Outcomes between intervention and control were compared using mixed effects linear regression models. Nineteen adults completed the trial [13 females, mean (±SD) age 41 ± 10 years, BMI 30.7 ± 5.7 kg/m2]. Postprandial triglyceride and glucose response post intervention were not different to post control. The overnight fast was well-tolerated by participants with an adherence rate of 95%, assessed by weekly 24-h dietary recalls. Exploratory analysis indicates lower mean body weight post intervention compared to post control (mean difference: -0.9 kg, 95% CI: -1.3 to -0.4). CONCLUSIONS: Night shift workers who habitually ate during their night shifts were able to rearrange their meal times to maintain a small overnight fast, which may have promoted small weight changes. This warrants further investigation into the role of meal timing in mitigating the metabolic consequences of night shift work. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (http://anzctr.org.au/) registered on the 30th May 2017 (ACTRN12617000791336).


Assuntos
Doenças Cardiovasculares/prevenção & controle , Jejum , Comportamento Alimentar , Refeições , Obesidade Abdominal/dietoterapia , Jornada de Trabalho em Turnos , Tolerância ao Trabalho Programado , Adulto , Biomarcadores/sangue , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/etiologia , Estudos Cross-Over , Metabolismo Energético , Feminino , Fatores de Risco de Doenças Cardíacas , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Abdominal/complicações , Obesidade Abdominal/diagnóstico , Projetos Piloto , Medição de Risco , Fatores de Tempo , Resultado do Tratamento , Vitória , Redução de Peso
4.
BMC Med Educ ; 20(1): 148, 2020 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-32393249

RESUMO

BACKGROUND: Older persons consume disproportionately more healthcare resources than younger persons. Tri-Generational HomeCare (TriGen), a service-learning program, aims to reduce hospital admission rates amongst older patients with frequent admissions. The authors evaluated the educational and patient outcomes of TriGen. METHODS: Teams consisting of healthcare undergraduates and secondary school (SS) students - performed fortnightly home visits to patients over 6 months. Self-administered scales were used to evaluate the educational outcomes in knowledge and attitudes towards the older people and nine domains of soft skills pre- and post-intervention. Patients' reported satisfaction and clinical outcomes were also assessed. RESULTS: Two hundred twenty-six healthcare undergraduates and 359 SS students participated in the program from 2015 to 2018. Response rates were 80.1 and 62.4% respectively. One hundred six patients participated in TriGen. There was a significant increase in Kogan's Attitudes towards Old People Scale (KOP) scores for healthcare undergraduates and SS students with a mean increase of 12.8 (95%CI: 9.5-16.2, p <  0.001) and 8.3 (95%CI: 6.2-10.3, p <  0.001) respectively. There was a significant increase in Palmore Facts on Aging Quiz (PFAQ) score for SS students but not for healthcare undergraduates. Most volunteers reported that TriGen was beneficial across all nine domains assessed. There was also a significant decrease in hospital admission rates (p = 0.006) and emergency department visits (p = 0.004) during the 6-month period before and after the program. Fifty-one patients answered the patient feedback survey. Of this, more than 80% reported feeling less lonely and happier. CONCLUSION: TriGen, a student-initiated, longitudinal, inter-generational service-learning program consisting of SS students and healthcare undergraduates can reduce ageism, develop soft skills, inculcate values amongst SS students and healthcare undergraduates. In addition, TriGen potentially reduces hospital admissions and emergency department visits, and loneliness amongst frequently admitted older patients.


Assuntos
Etarismo , Atitude do Pessoal de Saúde , Visita Domiciliar , Relação entre Gerações , Relações Interprofissionais , Estudantes de Ciências da Saúde , Estudantes de Medicina , Adolescente , Adulto , Feminino , Humanos , Estudos Longitudinais , Masculino , Adulto Jovem
5.
Obes Rev ; 25(2): e13659, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37985937

RESUMO

Shift workers have an increased risk of obesity and metabolic conditions. This mixed-methods systematic literature review on night shift workers aimed to: (1) identify barriers/enablers of weight management; (2) examine effectiveness of weight management interventions; and (3) determine whether interventions addressed enablers/barriers. Six databases were searched, articles screened by title/abstract, followed by full-text review, and quality assessment. Eligible qualitative studies documented experiences of behaviors related to weight change. Eligible quantitative studies were behavior change interventions with weight/body mass index outcomes. A thematic synthesis was undertaken for qualitative studies using the social-ecological model (SEM). Interventions were synthesized narratively including: weight/body composition change; components mapped by behavior change taxonomy; and SEM. A synthesis was undertaken to identify if interventions addressed perceived enablers/barriers. Eight qualitative (n = 169 participants) and 12 quantitative studies (n = 1142 participants) were included. Barriers predominated discussions: intrapersonal (time, fatigue, stress); interpersonal (work routines/cultural norms); organizational (fatigue, lack of: routine, healthy food options, breaks/predictable work); community (lack of healthy food options). The primary outcome for interventions was not weight loss and most did not address many identified enablers/barriers. One intervention reported a clinically significant weight loss result. Weight loss interventions that address barriers/enablers at multiple SEM levels are needed.


Assuntos
Obesidade , Redução de Peso , Humanos , Fadiga/etiologia , Obesidade/prevenção & controle , Obesidade/complicações , Pesquisa Qualitativa , Jornada de Trabalho em Turnos
6.
PLoS One ; 19(5): e0302047, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38696541

RESUMO

BACKGROUND: Over a quarter of children aged 2-17 years living in Australia are overweight or obese, with a higher prevalence reported in regional and remote communities. Systems thinking approaches that seek to support communities to generate and implement locally appropriate solutions targeting intertwined environmental, political, sociocultural, and individual determinants of obesity have the potential to ameliorate this. There have however been reported challenges with implementation of such initiatives, which may be strengthened by incorporating implementation science methods. METHODS: This pilot randomised controlled trial protocol outlines the development and proposed evaluation of a multicomponent implementation strategy (Action-RESPOND). to increase the implementation of community-based systems thinking child obesity prevention initiatives The target of this intervention is ten rural and regional communities (or local government areas as the unit of allocation) within Northeast Victoria who were participants in a whole-of-systems intervention (RESPOND). Action-RESPOND builds on this intervention by assessing the impact of offering additional implementation strategies to five communities relative to usual care. The development of the multicomponent implementation strategy was informed by the Promoting Action on Research Implementation in Health Services (PARIHS) framework and consists of seven implementation strategies primarily delivered via 'facilitation' methods. Implementation strategies aimed to ensure initiatives implemented are i) evidence-based, ii) address community's specific needs and iii) are suitable for local context. Strategies also aimed to increase the community's capacity to implement, through iv) improving the health promotion team's implementation knowledge and skills, fostering v) leadership, vi) physical resources and vii) community culture to drive implementation. The feasibility, acceptability, potential impact, and cost of the strategy will be assessed at baseline and follow up using surveys administered to key representatives within the community and internal records maintained by the research team. DISCUSSION: By leveraging an existing community-based whole-of-systems intervention, Action-RESPOND offers a unique opportunity to collect pilot feasibility and early empirical data on how to apply implementation and systems science approaches to support obesity prevention in rural and regional communities in Victoria.


Assuntos
Obesidade Infantil , População Rural , Humanos , Projetos Piloto , Criança , Adolescente , Obesidade Infantil/prevenção & controle , Pré-Escolar , Feminino , Masculino , Vitória/epidemiologia , Promoção da Saúde/métodos
7.
Commun Med (Lond) ; 4(1): 75, 2024 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-38643248

RESUMO

BACKGROUND: Lifestyle choices, metformin, and dietary supplements may prevent GDM, but the effect of intervention characteristics has not been identified. This review evaluated intervention characteristics to inform the implementation of GDM prevention interventions. METHODS: Ovid, MEDLINE/PubMed, and EMBASE databases were searched. The Template for Intervention Description and Replication (TIDieR) framework was used to examine intervention characteristics (who, what, when, where, and how). Subgroup analysis was performed by intervention characteristics. RESULTS: 116 studies involving 40,940 participants are included. Group-based physical activity interventions (RR 0.66; 95% CI 0.46, 0.95) reduce the incidence of GDM compared with individual or mixed (individual and group) delivery format (subgroup p-value = 0.04). Physical activity interventions delivered at healthcare facilities reduce the risk of GDM (RR 0.59; 95% CI 0.49, 0.72) compared with home-based interventions (subgroup p-value = 0.03). No other intervention characteristics impact the effectiveness of all other interventions. CONCLUSIONS: Dietary, physical activity, diet plus physical activity, metformin, and myoinositol interventions reduce the incidence of GDM compared with control interventions. Group and healthcare facility-based physical activity interventions show better effectiveness in preventing GDM than individual and community-based interventions. Other intervention characteristics (e.g. utilization of e-health) don't impact the effectiveness of lifestyle interventions, and thus, interventions may require consideration of the local context.


The effect of any given intervention to prevent gestational diabetes (high blood sugar levels that arise during pregnancy) may depend on the way it is delivered (how, when, what, etc). This study reviewed published literature to investigate if the effects of interventions (diet, exercise, metformin, probiotics, myoinositol) to prevent gestational diabetes differ according to the way it is being delivered (e.g., online vs in-person, by health professionals or others, etc.). Exercise delivered to group settings, or those delivered at a healthcare facility worked better to prevent gestational diabetes. Although we did not observe any differences with other delivery characteristics (e.g., online vs in-person), it does not mean they are always equally effective, it is important to consider individual situations when prescribing or developing interventions.

8.
Nutrients ; 15(4)2023 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-36839319

RESUMO

The negative impact of an unhealthy diet on the shiftworker population has been well-documented. However, little evidence exists on the underlying reasons for unhealthy eating behaviours and the existing barriers to healthy eating withinshiftwork environments. This qualitative study investigated the dietary behaviours reported by shiftworkers through Facebook comments. Comments were collected if they were on public shiftworker-relevant posts pertaining to dietary news or dietary information on Facebook and were posted by self-identified shiftworkers, relatives of shiftworkers, or partners of shiftworkers. A thematic analysis of the 144 comments collected generated four categories that can be used to understand the motivations for eating behaviour on-shift: what shiftworkers eat, where food is sourced from, when food is eaten, and why certain foods are chosen. Results reveal motivations, attitudes, and both internal and external barriers to healthy eating behaviours, as well as similarities and differences across shiftwork industries. Recommendations for future research include further explorations on the link between scheduled eating (e.g., time-restricted eating) and shiftwork, the impact of a rotating shift arrangements on dietary health behaviours, and the impact of interpersonal relationships on shiftworker dietary choices. Understanding these motivations will inform strategies to promote healthy eating and help understand barriers for shiftworkers.


Assuntos
Mídias Sociais , Humanos , Dieta Saudável , Comportamento Alimentar , Tolerância ao Trabalho Programado
9.
Diabetes Metab J ; 47(6): 719-742, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37709502

RESUMO

Type 2 diabetes mellitus (T2DM) and sarcopenia (low skeletal muscle mass and function) share a bidirectional relationship. The prevalence of these diseases increases with age and they share common risk factors. Skeletal muscle fat infiltration, commonly referred to as myosteatosis, may be a major contributor to both T2DM and sarcopenia in older adults via independent effects on insulin resistance and muscle health. Many strategies to manage T2DM result in energy restriction and subsequent weight loss, and this can lead to significant declines in muscle mass in the absence of resistance exercise, which is also a first-line treatment for sarcopenia. In this review, we highlight recent evidence on established treatments and emerging therapies targeting weight loss and muscle mass and function improvements in older adults with, or at risk of, T2DM and/or sarcopenia. This includes dietary, physical activity and exercise interventions, new generation incretin-based agonists and myostatin-based antagonists, and endoscopic bariatric therapies. We also highlight how digital health technologies and health literacy interventions can increase uptake of, and adherence to, established and emerging treatments and therapies in older adults with T2DM and/or sarcopenia.


Assuntos
Diabetes Mellitus Tipo 2 , Sarcopenia , Humanos , Idoso , Sarcopenia/complicações , Sarcopenia/epidemiologia , Sarcopenia/terapia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Músculo Esquelético , Redução de Peso , Doença Crônica
10.
Commun Med (Lond) ; 3(1): 137, 2023 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-37794119

RESUMO

BACKGROUND: Precision prevention involves using the unique characteristics of a particular group to determine their responses to preventive interventions. This study aimed to systematically evaluate the participant characteristics associated with responses to interventions in gestational diabetes mellitus (GDM) prevention. METHODS: We searched MEDLINE, EMBASE, and Pubmed to identify lifestyle (diet, physical activity, or both), metformin, myoinositol/inositol and probiotics interventions of GDM prevention published up to May 24, 2022. RESULTS: From 10347 studies, 116 studies (n = 40940 women) are included. Physical activity results in greater GDM reduction in participants with a normal body mass index (BMI) at baseline compared to obese BMI (risk ratio, 95% confidence interval: 0.06 [0.03, 0.14] vs 0.68 [0.26, 1.60]). Combined diet and physical activity interventions result in greater GDM reduction in participants without polycystic ovary syndrome (PCOS) than those with PCOS (0.62 [0.47, 0.82] vs 1.12 [0.78-1.61]) and in those without a history of GDM than those with unspecified GDM history (0.62 [0.47, 0.81] vs 0.85 [0.76, 0.95]). Metformin interventions are more effective in participants with PCOS than those with unspecified status (0.38 [0.19, 0.74] vs 0.59 [0.25, 1.43]), or when commenced preconception than during pregnancy (0.21 [0.11, 0.40] vs 1.15 [0.86-1.55]). Parity, history of having a large-for-gestational-age infant or family history of diabetes have no effect on intervention responses. CONCLUSIONS: GDM prevention through metformin or lifestyle differs according to some individual characteristics. Future research should include trials commencing preconception and provide results disaggregated by a priori defined participant characteristics including social and environmental factors, clinical traits, and other novel risk factors to predict GDM prevention through interventions.


An individual's characteristics, such as medical, biochemical, social, and behavioural may affect their response to interventions aimed at preventing gestational diabetes, which occurs during pregnancy. Here, we evaluated the published literature on interventions such as diet, lifestyle, drug treatment and nutritional supplement and looked at which individual participant characteristics were associated with response to these interventions. Certain participant characteristics were associated with greater prevention of gestational diabetes through particular treatments. Some interventions were more effective when started prior to conception. Future studies should consider individual characteristics when assessing the effects of preventative measures.

11.
Clin Transl Med ; 13(11): e1481, 2023 11.
Artigo em Inglês | MEDLINE | ID: mdl-37983931

RESUMO

BACKGROUND: Gastric cancer (GC) is one of the most common tumours in East Asia countries and is associated with Helicobacter pylori infection. H. pylori utilizes virulence factors, CagA and VacA, to up-regulate pro-inflammatory cytokines and activate NF-κB signaling. Meanwhile, the PIEZO1 upregulation and cancer-associated fibroblast (CAF) enrichment were found in GC progression. However, the mechanisms of PIEZO1 upregulation and its involvement in GC progression have not been fully elucidated. METHODS: The CAF enrichment and clinical significance were investigated in animal models and primary samples. The expression of NF-κB and PIEZO1 in GC was confirmed by immunohistochemistry staining, and expression correlation was analysed in multiple GC datasets. GSEA and Western blot analysis revealed the YAP1-CTGF axis regulation by PIEZO1. The stimulatory effects of CTGF on CAFs were validated by the co-culture system and animal studies. Patient-derived organoid and peritoneal dissemination models were employed to confirm the role of the PIEZO1-YAP1-CTGF cascade in GC. RESULTS: Both CAF signature and PIEZO1 were positively correlated with H. pylori infection. PIEZO1, a mechanosensor, was confirmed as a direct downstream of NF-κB to promote the transformation from intestinal metaplasia to GC. Mechanistic studies revealed that PIEZO1 transduced the oncogenic signal from NF-κB into YAP1 signaling, a well-documented oncogenic pathway in GC progression. PIEZO1 expression was positively correlated with the YAP1 signature (CTGF, CYR61, and c-Myc, etc.) in primary samples. The secreted CTGF by cancer cells stimulated the CAF infiltration to form a stiffened collagen-enrichment microenvironment, thus activating PIEZO1 to form a positive feedback loop. Both PIEZO1 depletion by shRNA and CTGF inhibition by Procyanidin C1 enhanced the efficacy of 5-FU in suppressing the GC cell peritoneal metastasis. CONCLUSION: This study elucidates a novel driving PIEZO1-YAP1-CTGF force, which opens a novel therapeutic avenue to block the transformation from precancerous lesions to GC. H. pylori-NF-κB activates the PIEZO1-YAP1-CTGF axis to remodel the GC microenvironment by promoting CAF infiltration. Targeting PIEZO1-YAP1-CTGF plus chemotherapy might serve as a potential therapeutic option to block GC progression and peritoneal metastasis.


Assuntos
Fibroblastos Associados a Câncer , Infecções por Helicobacter , Helicobacter pylori , Neoplasias Peritoneais , Neoplasias Gástricas , Animais , Humanos , NF-kappa B/genética , NF-kappa B/metabolismo , Neoplasias Gástricas/patologia , Helicobacter pylori/metabolismo , Fibroblastos Associados a Câncer/metabolismo , Infecções por Helicobacter/complicações , Infecções por Helicobacter/genética , Infecções por Helicobacter/metabolismo , Microambiente Tumoral/genética , Canais Iônicos
12.
Sci Rep ; 12(1): 15487, 2022 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-36109573

RESUMO

This study explored the feasibility of implementing a meal timing intervention during night shift work. Data were collected via semi-structured interviews. Interviews were coded inductively by two researchers independently, then three major themes were collaboratively developed. Subthemes from each major theme were mapped to the theoretical domains framework and the Capability Opportunity Motivation model of behaviour change. Seventeen night shift workers (rotating or permanent) aged between 25 and 65 years were interviewed. Participants predominately worked as health professionals. The feasibility of a simple meal timing intervention to avoid eating between 1 and 6 am on night shift is largely affected by three major influences (1) physical and emotional burden of shift work which drives food temptations; (2) the workplace context including the meal break environment, social and cultural context at work, and break scheduling; and (3) motivation of the individual. Facilitators to avoiding eating at night were, keeping busy, having co-worker support, management support, education of health benefits and/or belief that the intervention was health promoting. The barriers to avoiding eating at night were the emotional and physical toll of working at night leading to comfort eating and not having rest areas away from food environments. To support night shift workers with changing timing of meals, interventions at work should target both individual and organisational level behaviour change.


Assuntos
Jornada de Trabalho em Turnos , Adulto , Idoso , Humanos , Refeições , Pessoa de Meia-Idade , Motivação , Pesquisa Qualitativa , Local de Trabalho/psicologia
13.
BMJ Open ; 12(4): e060520, 2022 04 26.
Artigo em Inglês | MEDLINE | ID: mdl-35473743

RESUMO

INTRODUCTION: Shift workers are at an increased risk of developing obesity and type 2 diabetes. Eating and sleeping out of synchronisation with endogenous circadian rhythms causes weight gain, hyperglycaemia and insulin resistance. Interventions that promote weight loss and reduce the metabolic consequences of eating at night are needed for night shift workers. The aim of this study is to examine the effects of three weight loss strategies on weight loss and insulin resistance (HOMA-IR) in night shift workers. METHODS AND ANALYSIS: A multisite 18-month, three-arm randomised controlled trial comparing three weight loss strategies; continuous energy restriction; and two intermittent fasting strategies whereby participants will fast for 2 days per week (5:2); either during the day (5:2D) or during the night shift (5:2N). Participants will be randomised to a weight loss strategy for 24 weeks (weight loss phase) and followed up 12 months later (maintenance phase). The primary outcomes are weight loss and a change in HOMA-IR. Secondary outcomes include changes in glucose, insulin, blood lipids, body composition, waist circumference, physical activity and quality of life. Assessments will be conducted at baseline, 24 weeks (primary endpoint) and 18 months (12-month follow-up). The intervention will be delivered by research dietitians via a combination of face-to-face and telehealth consultations. Mixed-effect models will be used to identify changes in dependent outcomes (weight and HOMA-IR) with predictor variables of outcomes of group, time and group-time interaction, following an intention-to-treat approach. ETHICS AND DISSEMINATION: The study protocol was approved by Monash Health Human Research Ethics Committee (RES 19-0000-462A) and registered with Monash University Human Research Ethics Committee. Ethical approval has also been obtained from the University of South Australia (HREC ID: 202379) and Ambulance Victoria Research Committee (R19-037). Results from this trial will be disseminated via conference presentations, peer-reviewed journals and student theses. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ACTRN-12619001035112).


Assuntos
Diabetes Mellitus Tipo 2 , Resistência à Insulina , Diabetes Mellitus Tipo 2/prevenção & controle , Jejum , Humanos , Obesidade/terapia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Vitória , Redução de Peso
14.
Chronobiol Int ; 37(3): 311-326, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31782659

RESUMO

Current dietary trends show that humans consume up to 40% of their energy intake during the night. Those who habitually eat during the night are observed to have an increased risk of metabolic conditions such as type-2 diabetes and cardiovascular disease. Increasing evidence suggest that a biological consequence of eating during the night is a larger postprandial glucose response, compared to meals eaten earlier in the day. However, findings from individual acute postprandial studies have been inconsistent, due to variations in protocols. Therefore, this review aimed to systematically summarize findings from acute postprandial studies and investigate whether postprandial glucose and insulin response at night differs to during the day in healthy adults. This would indicate a possible physiological mechanism linking habitual nighttime eating and increased risk of metabolic conditions. Seven electronic databases were searched in February 2018. Included studies met the following criteria: had a day-time test between 0700 - 1600h, a nighttime test between 2000 and 0400h, the test meals were identical and consumed by the same participant at both day and night time points, preceded by a 3-h fast (minimum). Primary outcome measures were postprandial glucose and insulin incremental area under the curve (iAUC) or area under the curve (AUC). Studies that reported numerical data were included in the meta-analyses, conducted using Stata statistical software (version 13.0, StataCorp, College Station, TX, USA). For eligible studies that did not report numerical data, their authors' conclusions on the effect of time of day on the primary outcome measures were summarized qualitatively. Full text of 172 articles were assessed for eligibility. Fifteen studies met the eligibility criteria, ten of which were included in the meta-analyses. Meta-analysis for glucose showed a lower postprandial glucose response in the day compared to during the night, after an identical meal (SMD = -1.66; 95% CI, -1.97 to -1.36; p < .001). This was supported by the findings from included studies ineligible for meta-analysis. Meta-analysis also showed a lower postprandial insulin response in the day compared to during the night (SMD = -0.35; 95% CI, -0.63 to -0.06; p = .016). However, findings from included studies ineligible for meta-analysis were inconsistent. Our results suggest poor glucose tolerance at night compared to the day. This may be a contributing factor to the increased risk of metabolic diseases observed in those who habitually eat during the night, such as shift workers.


Assuntos
Glucose , Insulina , Adulto , Glicemia , Ritmo Circadiano , Estudos Cross-Over , Humanos , Período Pós-Prandial , Tolerância ao Trabalho Programado
15.
Clin Nutr ; 39(2): 369-377, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-30853262

RESUMO

BACKGROUND & AIMS: Meals consumed out of synchronisation with normal circadian rhythms are associated with metabolic dysregulation. Changes in macronutrient composition of meals can improve metabolic responses during the day. Therefore, we aimed to investigate whether macronutrient manipulation of meals alters postprandial glucose and lipid responses and the expression of circadian genes during the night. METHODS: In a randomised crossover trial, 16 overweight males with high fasting lipids were fed isocaloric meals (2.7 MJ) at 0000 h. The meals differed primarily in total fat and total sugars content (control (8% total sugar, 5% saturated fat) vs test (16% total sugar, 26% saturated fat)). Postprandial blood samples were collected for glucose, insulin (3 h) and triglycerides (6 h) and analysed as incremental area under the curve (iAUC). RNA was extracted at 0 h, 2 h and 4 h and changes in expressions of the circadian genes clock and Per 1-3 analysed. RESULTS: Postprandial glucose (p = 0.04) and insulin iAUC (p = 0.02) were significantly higher after consumption of the test meal compared to the control meal. Postprandial triglyceride iAUC was not statistically different between the two meal types (p = 0.72). No change in circadian gene expression was observed after the two meals. CONCLUSIONS: Our results showed that macronutrient composition affects postprandial metabolic response at night. It emphasizes the need to consider the role and effects of night time eating, when developing metabolic disease prevention strategies for shift workers. STUDY ID NUMBER: ACTRN12618001115224. WEBSITE OF TRIAL REGISTRY: http://www.anzctr.org.au/. Retrospectively registered after data collection.


Assuntos
Glicemia/metabolismo , Insulina/sangue , Nutrientes/administração & dosagem , Sobrepeso/sangue , Jornada de Trabalho em Turnos , Triglicerídeos/sangue , Adolescente , Adulto , Estudos Cross-Over , Jejum , Humanos , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Período Pós-Prandial , Adulto Jovem
16.
Acta Neurochir (Wien) ; 151(12): 1601-7, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19551338

RESUMO

PURPOSE: We aimed to explore the cognitive profiles of subarachnoid haemorrhage patients who returned to the community, along with the associated risk factors. METHODS: We recruited 40 Chinese patients with spontaneous subarachnoid haemorrhage 7-27 months after the initial presentation. They had all been discharged to their homes or to care homes for the elderly. For cognitive assessment, we employed the Cognitive Subscale of the Alzheimer Disease Assessment Scale (ADAS-cog) for global cognitive function, the Frontal Assessment Battery (FAB) for frontal lobe function, and the Rivermead Behavioural Memory Test (RBMT) for everyday memory function. RESULTS: An ADAS-cog of more than 21/85 (poor global cognitive function) was noted in 14 (35%) patients. A FAB of less than 12/18 (poor frontal lobe function) was noted in 13 (27.5%) patients. An RBMT score of less than 15/26 (poor everyday memory function) was noted in 17 (43.6%) patients. Poor cognitive function was found to be associated with chronic hydrocephalus (in terms of FAB), with clinical vasospasm (in terms of RBMT), and with cerebral infarction (in terms of RBMT). CONCLUSIONS: Poor cognitive function was common and occurred in up to 43.6% of the patients, with the verbal and behavioural memory aspects predominantly affected. We did not find a significant association between cholinergic dysfunction and cognitive dysfunction. Organization of future drug trials and cognitive rehabilitation should take into account the association between frontal lobe dysfunction and chronic hydrocephalus.


Assuntos
Acetilcolina/deficiência , Transtornos Cognitivos/etiologia , Hemorragia Subaracnóidea/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos Cognitivos/diagnóstico , Avaliação da Deficiência , Feminino , Hong Kong/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Fatores de Risco , Adulto Jovem
17.
Clin Nutr ; 38(1): 465-471, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29248250

RESUMO

BACKGROUND & AIMS: Glucose metabolism is, in part, regulated by the circadian rhythm. Postprandial glucose response is exaggerated and insulin sensitivity is reduced at night compared with the morning. Sustained poor glucose tolerance may be related to the increased risk of type-2 diabetes mellitus and cardiovascular disease experienced by shift workers. Manipulation of meal type may be able to dampen such postprandial excursions. Therefore, the study's aim was to investigate postprandial glucose and insulin responses to a low glycemic index (GI) meal in the morning compared to night in healthy volunteers. METHODS: An oral glucose tolerance test (OGTT), was undertaken to confirm diurnal glucose response. Participants consumed a glucose solution at 0800h (morning) and 2000h (evening). In a separate trial, participants consumed a low GI meal (3.3 MJ, 48% energy (E) from carbohydrate, 40%E from fat and 11%E from protein, 22 g fiber) at 0800h, 2000h and 0000h (midnight). Postprandial glucose and insulin were collected over 3 h. Incremental area under the curve (iAUC) was calculated and significance tested using Wilcoxon-signed rank. A p-value <0.05 was taken as significant. RESULTS: In the OGTT (n = 10), postprandial glucose iAUC was higher in the evening compared to morning (p = 0.007). In the low GI meal trial (n = 9), postprandial glucose iAUC at evening and midnight were higher than the morning (p = 0.008, p = 0.021) but not significantly different between evening and midnight (p = 0.594). Postprandial insulin iAUC was also higher in the evening and at midnight compared to the morning (p = 0.008 for both). CONCLUSIONS: The current study confirms that meal intake at night, even when comprised of low glycemic ingredients, contributes to higher glucose excursions and concomitantly greater insulin levels, compared with an equivalent meal in the morning. This demonstrates that meal timing has an effect on glucose metabolism, which can be observed from as early as 8pm and persists throughout the night. This identifies meal timing as an important modifiable risk factor for metabolic-related disease, which may have implications for high risk populations such as shift workers but also the general population. TRIAL REGISTRATION: Study ID number: ACTRN12616000164493; Website of trial registry: http://www.anzctr.org.au/.


Assuntos
Comportamento Alimentar/fisiologia , Glucose/metabolismo , Índice Glicêmico/fisiologia , Refeições/fisiologia , Período Pós-Prandial/fisiologia , Adulto , Estudos Cross-Over , Feminino , Voluntários Saudáveis , Humanos , Masculino , Valores de Referência , Adulto Jovem
18.
Nutrients ; 11(10)2019 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-31590425

RESUMO

There is evidence to indicate that the central biological clock (i.e., our endogenous circadian system) plays a role in physiological processes in the body that impact energy regulation and metabolism. Cross-sectional data suggest that energy consumption later in the day and during the night is associated with weight gain. These findings have led to speculation that when, as well as what, we eat may be important for maintaining energy balance. Emerging literature suggests that prioritising energy intake to earlier during the day may help with body weight maintenance. Evidence from tightly controlled acute experimental studies indicates a disparity in the body's ability to utilise (expend) energy equally across the day and night. Energy expenditure both at rest (resting metabolic rate) and after eating (thermic effect of food) is typically more efficient earlier during the day. In this review, we discuss the key evidence for a circadian pattern in energy utilisation and balance, which depends on meal timing. Whilst there is limited evidence that simply prioritising energy intake to earlier in the day is an effective strategy for weight loss, we highlight the potential benefits of considering the role of meal timing for improving metabolic health and energy balance. This review demonstrates that to advance our understanding of the contribution of the endogenous circadian system toward energy balance, targeted studies that utilise appropriate methodologies are required that focus on meal timing and frequency.


Assuntos
Relógios Biológicos , Ritmo Circadiano , Ingestão de Energia , Metabolismo Energético , Refeições , Animais , Peso Corporal , Peptídeos e Proteínas de Sinalização do Ritmo Circadiano/genética , Peptídeos e Proteínas de Sinalização do Ritmo Circadiano/metabolismo , Humanos , Oxirredução , Período Pós-Prandial , Termogênese , Fatores de Tempo
19.
Chronobiol Int ; 36(12): 1613-1625, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31495232

RESUMO

Understanding shift workers dietary intake patterns may inform interventions targeted at lowering chronic disease risk. This study examined the temporal distribution of food intake as shift workers rotate between night shifts, day shift and/or days off to identify differences in energy intake, eating frequency, and adherence to dietary guidelines by shift type (night shift vs. day). Night shift (NS) workers completed a four-day food diary that included a minimum of two night shifts and one-day shift (DS)/day off (DO), recording all food, beverages and time of consumption. Comparisons were between shift types, using ANOVA for continuous data and generalized estimating equations for count data, data reported as mean (SE). When comparing NS and DSDO, there were no differences in energy intake (24 h) (8853 (702) vs. 9041 (605) kJ, n = 22) or adherence to dietary guidelines. There was no difference between the number of eating occasions on NS and DSDO (5.6(0.3) vs 5.1(0.6) occasions) but less energy per eating occasion at night (1661(125) vs 1933(159) kJ). When working NS compared with DSDO there was higher total sugar (%E, 19.1(2.0) vs 15.0(2.4)) and lower saturated fat (%E, 13.8(1.2) vs 15.7(1.3)). Further, DSDO were characterized by a pattern of three main meals and a prolonged fasting period. It is important to determine if reducing eating occasions and providing opportunities for fasting improves metabolic health.


Assuntos
Ritmo Circadiano , Ingestão de Alimentos/fisiologia , Comportamento Alimentar/fisiologia , Jornada de Trabalho em Turnos , Adolescente , Adulto , Estudos Cross-Over , Feminino , Humanos , Masculino , Refeições , Pessoa de Meia-Idade , Fatores de Tempo , Adulto Jovem
20.
J Biol Rhythms ; 34(2): 119-130, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30681036

RESUMO

Eating at night time, as is frequent in shift workers, may contribute to increased cardiovascular disease (CVD) risk through a disruption in usual lipid metabolism, resulting in repeated and sustained hyperlipidemia at night. This systematic review aimed to investigate the impact of eating a meal at night compared with the same meal eaten during the day on postprandial lipemia. Six databases were searched: CINAHL Plus, Cochrane Library, EMBASE, Ovid MEDLINE, Informit, and SCOPUS. Eligible studies were original research cross-over design with a minimum fasting period of 5 h before testing preceded by a standardized control meal; measured postprandial triacylglycerol (TAG) for 5 h or greater; had meal time between 0700 h and 1600 h for day time and between 2000 h and 0400 h for night time; and had within-study test meals (food or drink) that were identical in macronutrient composition and energy. Two authors independently completed eligibility and quality assessment using the American Dietetic Association Quality Criteria Checklist for Primary Research. After removing duplicates, 4,423 articles were screened, yielding 5 studies for qualitative synthesis. All studies identified at least one parameter of the postprandial TAG response that was different as a result of meal time (e.g., the total concentration or the time course kinetics). Two studies reported a greater total TAG concentration (area under curve) at night compared with day, and 3 studies found no difference. Four studies reported that the kinetics of the postprandial time course of TAGs was different at night compared with during the day. Inconsistent reporting in the primary studies was a limitation of the review. Night eating may negatively affect postprandial lipemia and this review shows there is a need to rigorously test this using standardized methods and analysis with larger sample sizes. This is critical for informing strategies to lower CVD risk for shift workers.


Assuntos
Ritmo Circadiano , Comportamento Alimentar , Período Pós-Prandial , Triglicerídeos/metabolismo , Adulto , Estudos Cross-Over , Humanos , Hiperlipidemias/etiologia , Fatores de Tempo , Triglicerídeos/sangue
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