Preparing for colorectal surgery: a feasibility study of a novel web-based multimodal prehabilitation programme in Western Canada.

AIM: Prehabilitation for colorectal cancer has focused on exercise-based interventions that are typically designed by clinicians; however, no research has yet been patient-oriented. The aim of this feasibility study was to test a web-based multimodal prehabilitation intervention (known as PREP prehab) consisting of four components (physical activity, diet, smoking cessation, psychological support) co-designed with five patient partners. METHOD: A longitudinal, two-armed (website without or with coaching support) feasibility study of 33 patients scheduled for colorectal surgery 2 weeks or more from consent (January-September 2021) in the province of British Columbia, Canada. Descriptive statistics analysed a health-related quality of life questionnaire (EQ5D-5L) at baseline (n = 25) and 3 months postsurgery (n = 21), and a follow-up patient satisfaction survey to determine the acceptability, practicality, demand for and potential efficacy in improving overall health. RESULTS: Patients had a mean age of 52 years (SD 14 years), 52% were female and they had a mean body mass index of 25 kg m-2 (SD 3.8 kg m-2). Only six patients received a Subjective Global Assessment for being at risk for malnutrition, with three classified as 'severely/moderately' malnourished. The majority (86%) of patients intended to use the prehabilitation website, and nearly three-quarters (71%) visited the website while waiting for surgery. The majority (76%) reported that information, tools and resources provided appropriate support, and 76% indicated they would recommend the PREP prehab programme. About three-quarters (76%) reported setting goals for lifestyle modification: 86% set healthy eating goals, 81% aimed to stay active and 57% sought to reduce stress once a week or more. No patients contacted the team to obtain health coaching, despite broad interest (71%) in receiving active support and 14% reporting they received 'active support'. CONCLUSION: This web-based multimodal prehabilitation programme was acceptable, practical and well-received by all colorectal surgery patients who viewed the patient-oriented multimodal website. The feasibility of providing active health coaching support requires further investigation.

Changes in UK price disparities between healthy and less healthy foods over 10 years: An updated analysis with insights in the context of inflationary increases in the cost-of-living from 2021.

Food prices and affordability play an important role in influencing dietary choices, which in turn have implications for public health. With inflationary increases in the cost-of-living in the UK since 2021, understanding the dynamics of food prices becomes increasingly important. In this longitudinal study, we aimed to examine changes in food prices from 2013 to 2023 by food group and by food healthiness. We established a dataset spanning the years 2013-2023 by combining price data from the UK Consumer Price Index for food and beverage items with nutrient and food data from the UK nutrient databank and UK Department of Health & Social Care's National Diet and Nutrition Survey data. We calculated the price (£/100 kcal) for each food item by year as well as before and during the period of inflationary pressure, and classified items into food groups according to the UK Eatwell Guide and as either "more healthy" or "less healthy" using the UK nutrient profiling score model. In 2023, bread, rice, potatoes and pasta was cheapest (£0.12/100 kcal) and fruit and vegetables most expensive (£1.01/100 kcal). Less healthy food was cheaper than more healthy food (£0.33/100 kcal versus £0.81/100 kcal). Before the inflationary pressure period (from 2013 to late 2021), the price of foods decreased by 3%. After this period, the price of food increased by 22%: relative increases were highest in the food group milk and dairy food (31%) and less healthy category (26%). While healthier foods saw smaller relative price increases since 2021, they remain more expensive, potentially exacerbating dietary inequalities. Policy responses should ensure food affordability and mitigate price disparities via, for example, healthy food subsidies.

Association between social jetlag and sugar-sweetened beverages (SSBs) in adolescents in Western Canada.

BACKGROUND: Sleep debt is linked to poor health behaviours, and adolescents may be especially vulnerable to deficit from the mismatch of their late chronotype with socially determined sleep timing. We aimed to investigate the potential association between social jetlag and sugar-sweetened beverages (SSBs) consumption among adolescents. METHODS: Cross-sectional data from 1031 adolescents (13-18 years) who participated in the population-based British Columbia Adolescent Substance Use Survey in 2012. Regression analysis using interaction terms estimated the associations between social jetlag (using self-reported weekday/weekends sleep times) and odds of SSB intake in girls and boys. RESULTS: On average, adolescents reported 1.59 (SD 0.73) hours of social jetlag, but girls had significantly more social jetlag (1.64) than boys (1.52). Most adolescents (84%) reported consuming SSBs, and significantly more boys (87%) than girls (81%); median SSB intake in boys was 1-2 times per week and in girls less than once per week. Significant differences in girls consuming any SSB were seen across levels of social jetlag. The odds of any SSB intake were significantly higher in adolescents with social jetlag between 1 and 2 h [odds ratio (OR): 1.6 (1.14-2.38)] and over 2 h [OR 1.87 (1.11-3.14)], compared with 1 h or less; associations were stronger and only significant in girls. CONCLUSIONS: This study is the first to show social jetlag is a common sleep deficit that is associated with SSB intake in adolescents, particularly among teen girls.

Is eating a mixed diet better for health and survival?: A systematic review and meta-analysis of longitudinal observational studies.

The role of dietary diversity in chronic disease or survival is controversial. This meta-analysis quantified the health impact of dietary diversity. Random-effects models pooled risk ratios (RRs) and 95% confidence intervals (CIs) of 20 longitudinal studies. Total dietary diversity was associated with a 22% lower risk of all-cause mortality (RR 0.78 [95%CI: 0.64, 0.96]), and was inversely associated with incident cancer- or CVD-specific mortality only in subgroup analyses (RR range: 0.53 to 0.90, p < 0.05). Similarly, diversity across healthy foods was inversely associated with all-cause mortality (RR 0.84 [95%CI: 0.73, 0.96]). An inverse association between total diet diversity and incident CVD was significant in non-European populations consuming diets with diverse food groups (RR: 0.93 [95% CI: 0.86-0.99]). Effects on cancer risk are unstudied. Diversity within fruits and/or vegetables showed null associations for all outcomes, except potentially for squamous cell-type carcinomas. More robust research is warranted. Findings indicated greater dietary diversity may benefit overall survival.

Preparing for colorectal surgery: a qualitative study of experiences and preferences of patients in Western Canada.

OBJECTIVES: The burden and costs of abdominal surgery for chronic conditions are on the rise, but could be reduced through self-management support. However, structured support to prepare for colorectal surgery is not routinely offered to patients in Canada. This study aimed to describe experiences and explore preferences for multimodal prehabilitation among colorectal surgery patients. METHODS: A qualitative descriptive study using three focus groups (FG) was held with 19 patients who had a surgical date for abdominal surgery (April 2017-April 2018) and lived close (≤ 50 km radius) to a tertiary hospital in Western Canada (including a Surgical Lead for the British Columbia Enhanced Recovery After Surgery (ERAS) Collaborative). FGs were audio-taped and verbatim transcribed with coding and pile-and-sort methods performed by two independent reviewers, confirmed by a third reviewer, in NVivo v9 software; followed by thematic analysis and narrative synthesis. RESULTS: Four themes emerged: support, informed decision-making, personalization of care, and mental/emotional health, which patients felt was particularly important but rarely addressed. Patient preferences for prehabilitation programming emphasised regular support from a single professional source, simple health messages, convenient access, and flexibility. CONCLUSIONS: There is an unmet need for structured preoperative support to better prepare patients for colorectal surgery. Future multimodal prehabilitation should be flexible and presented with non-medical information so patients can make informed decisions about their preoperative care and surgical outcomes. Healthcare providers have an important role in encouraging healthy lifestyle changes before colorectal surgery, though clearer communication and accurate advice on self-care, particularly mental health, are needed for improving patient outcomes.

Letter to Editor: a cautionary note about "Dietary diversity score and cardio-metabolic risk factors: an updated systematic review and meta-analysis".

In the Journal's recent issue, Qorbani and colleagues conducted a systematic review and meta-analysis to determine if a dietary diversity score is associated with cardio-metabolic outcomes. Given the importance of evidence synthesis for nutrition policy and practice, robust review methodology is necessary to avoid spurious conclusions about the health impacts of a mixed diet. There are important conceptual and methodological issues unique to this nutrition topic that warrant consideration and attention and that raise concerns for internal validity of the review. We write to emphasise the need for readers' caution when interpreting this research evidence.

Adiposity and the role of diverse social supports: an observational, gender-sensitive study using the baseline Canadian Longitudinal Study on Aging.

OBJECTIVE: To quantify associations between four types of social support and measured adiposity among women and men. DESIGN: The cross-sectional sample from the Canadian Longitudinal Study on Aging (CLSA, 2012-2015). Height, weight and waist circumference (WC) were clinically measured, and perceived availability of informational, tangible, emotional and belonging social supports was self-reported. SETTING: Canada. PARTICIPANTS: 28 779 adults aged 45-85 years from the CLSA. RESULTS: All social support types were associated with WC and BMI among women but not among men. Women reporting the lowest informational support had significantly higher mean BMI (28·84 kg/m2 (95 % CI 28·63, 29·05)) and WC (90·81 cm (95 % CI 90·31, 91·30)) compared with women reporting maximum support (respectively, 28·09 kg/m2 (95 % CI 27·88, 28·30) and 88·92 cm (95 % CI 88·43, 89·4)). Women's abdominal obesity was associated with low levels of informational, emotional and belonging support, and women's general obesity with informational and emotional support. Notably, informational and emotional support were associated with both obesity outcomes independent of other supports among women. Only a low level of informational support was significantly independently associated with higher odds of obesity among men. CONCLUSIONS: Our study provides novel insights into gender-specific associations between different types of social support and adiposity. Prospective studies are needed to further investigate potential causality of these associations between the specific social supports and future weight status, especially among women.

The impact of rising food prices on obesity in women: a longitudinal analysis of 31 low-income and middle-income countries from 2000 to 2014.

OBJECTIVES: To examine whether changes in food prices are associated with changes in obesity prevalence among women in developing countries, and assess effect modification by individual socioeconomic status (SES). METHODS: Longitudinal study of country-level food price inflation temporally and geographically linked to anthropometric data on non-pregnant adult women (n = 295,984) in 31 low-income and middle-income countries over the 2000-2014 time period, using separate multivariable multilevel growth models of five SES indicators. Post-estimation analysis computed the relationship between food price inflation and predicted mean probabilities of being obese, by SES. RESULTS: Rising food price inflation was strongly associated with women's obesity prevalence, and SES consistently modified the relationship. Regardless of indicator used, higher food price inflation was positively associated with obesity among women in top SES categories, but was flat or negative among women in low SES categories, averaging over time. The SES differences were widest across educational strata and were most pronounced when food price inflation was highest. Overall, for every 1-unit increase in food price inflation, predicted mean obesity prevalence was between 0.02 and 0.06 percentage points greater in women of high SES compared to low SES women. CONCLUSION: There is a strong link between food price inflation and obesity in adult women in developing countries which is clearly modified by individuals' SES. Greater food price inflation was associated with greater obesity prevalence only among women in higher SES groups, who may be net food buyers most at risk of obesity in low-income and middle-income countries.

Chronic sleep disturbance, not chronic sleep deprivation, is associated with self-rated health in adolescents.

Improving our understanding of the cumulative effects of persistent sleep problems on adolescent health has been identified as an important area of research. This prospective study aimed to ascertain prospectively gender-specific associations between quantity and quality of sleep and self-reported health. Data from a cohort of 3104 adolescents (13-18 y) with repeated measures of sleep deprivation and sleep disturbance (2011 fall, 2012 spring, 2012 fall), and self-reported health (SRH) (2011 fall, 2012 fall) were analysed with multivariable logistic regression models adjusted for confounders. The results of the regression models indicated that cumulative exposure to sleep disturbance was monotonically associated with SRH in both genders, however cumulative sleep deprivation was not associated with self-reported health among young people. Young women reporting chronic exposure to sleep disturbance had over twice the odds of reporting sub-optimal health at follow-up (OR 2.18 [CI95: 1.13, 4.22]), compared to those with no history. Similar results were found in chronically sleep disturbed young men (OR 2.41 [1.05, 5.51]). These findings suggest that chronic exposure to impaired quality of sleep, such as difficulty falling or staying asleep, is related to adolescent self-reported health and thus may be an important determinant of young people's wellbeing.

Economic policy and the double burden of malnutrition: cross-national longitudinal analysis of minimum wage and women's underweight and obesity.

OBJECTIVE: To examine changes in minimum wage associated with changes in women's weight status. DESIGN: Longitudinal study of legislated minimum wage levels (per month, purchasing power parity-adjusted, 2011 constant US dollar values) linked to anthropometric and sociodemographic data from multiple Demographic and Health Surveys (2000-2014). Separate multilevel models estimated associations of a $10 increase in monthly minimum wage with the rate of change in underweight and obesity, conditioning on individual and country confounders. Post-estimation analysis computed predicted mean probabilities of being underweight or obese associated with higher levels of minimum wage at study start and end. SETTING: Twenty-four low-income countries. SUBJECTS: Adult non-pregnant women (n 150 796). RESULTS: Higher minimum wages were associated (OR; 95 % CI) with reduced underweight in women (0·986; 0·977, 0·995); a decrease that accelerated over time (P-interaction=0·025). Increasing minimum wage was associated with higher obesity (1·019; 1·008, 1·030), but did not alter the rate of increase in obesity prevalence (P-interaction=0·8). A $10 rise in monthly minimum wage was associated (prevalence difference; 95 % CI) with an average decrease of about 0·14 percentage points (-0·14; -0·23, -0·05) for underweight and an increase of about 0·1 percentage points (0·12; 0·04, 0·20) for obesity. CONCLUSIONS: The present longitudinal multi-country study showed that a $10 rise in monthly minimum wage significantly accelerated the decline in women's underweight prevalence, but had no association with the pace of growth in obesity prevalence. Thus, modest rises in minimum wage may be beneficial for addressing the protracted underweight problem in poor countries, especially South Asia and parts of Africa.

Chronic sleep deprivation and gender-specific risk of depression in adolescents: a prospective population-based study.

BACKGROUND: Chronic exposure to sleep deprivation may increase the risk of depression in young people who are particularly vulnerable to changes in sleep and mental health. Sleep deprivation and incident depression may also differ by gender. We investigated the prospective association between cumulative sleep deprivation and subsequent levels of depressive symptomatology among adolescents from a gender perspective. METHODS: A longitudinal study of 3071 young people in the British Columbia Adolescent Substance Use Survey (BASUS) cohort with three sleep time and two depression measures over 12 months (2011-12). Multivariable linear regression models with interaction terms estimated gender-specific associations between self-reported chronic sleep deprivation and changes in depressive symptomatology; post-estimation analysis calculated adjusted mean depression scores for each level of cumulative sleep deprivation. RESULTS: Cumulative sleep deprivation was associated with a monotonic increase in depression scores at follow-up in young women, but no consistent pattern was seen in young men. During follow-up, 15% of young women were chronically sleep deprived and 29% were depressed (CESD ≥24). Young women reporting chronic exposure to sleep deprivation had higher CESD scores at follow-up (21.50 points, [CI95 19.55-23.45]), than those reporting no history (16.59 [15.72-17.45]); that remained after multivariable adjustment (19.48 [17.59-21.38]). CONCLUSION: Results suggested that chronic sleep deprivation increases the risk of major depression among young women. Mental health promotion for young people should include relevant strategies to ensure young women can achieve recommended amounts of sleep.

Dietary Diversity, Diet Cost, and Incidence of Type 2 Diabetes in the United Kingdom: A Prospective Cohort Study.

BACKGROUND: Diet is a key modifiable risk factor for multiple chronic conditions, including type 2 diabetes (T2D). Consuming a range of foods from the five major food groups is advocated as critical to healthy eating, but the association of diversity across major food groups with T2D is not clear and the relationship of within-food-group diversity is unknown. In addition, there is a growing price gap between more and less healthy foods, which may limit the uptake of varied diets. The current study had two aims: first, to examine the association of reported diversity of intake of food groups as well as their subtypes with risk of developing T2D, and second, to estimate the monetary cost associated with dietary diversity. METHODS AND FINDINGS: A prospective study of 23,238 participants in the population-based EPIC-Norfolk cohort completed a baseline Food Frequency Questionnaire in 1993-1997 and were followed up for a median of 10 y. We derived a total diet diversity score and additional scores for diversity within each food group (dairy products, fruits, vegetables, meat and alternatives, and grains). We used multivariable Cox regression analyses for incident diabetes (892 new cases), and multivariable linear regression for diet cost. Greater total diet diversity was associated with 30% lower risk of developing T2D (Hazard ratio [HR] 0.70 [95% CI 0.51 to 0.95]) comparing diets comprising all five food groups to those with three or fewer, adjusting for confounders including obesity and socioeconomic status. In analyses of diversity within each food group, greater diversity in dairy products (HR 0.61 [0.45 to 0.81]), fruits (HR 0.69 [0.52 to 0.90]), and vegetables (HR 0.67 [0.52 to 0.87]) were each associated with lower incident diabetes. The cost of consuming a diet covering all 5 food groups was 18% higher (£4.15/day [4.14 to 4.16]) than one comprising three or fewer groups. Key limitations are the self-reported dietary data and the binary scoring approach whereby some food groups contained both healthy and less healthy food items. CONCLUSIONS: A diet characterized by regular consumption of all five food groups and by greater variety of dairy, fruit, and vegetable subtypes, appears important for a reduced risk of diabetes. However, such a diet is more expensive. Public health efforts to prevent diabetes should include food price policies to promote healthier, more varied diets.

Gender and the double burden of economic and social disadvantages on healthy eating: cross-sectional study of older adults in the EPIC-Norfolk cohort.

BACKGROUND: Multiple economic factors and social relationships determine dietary behaviours, but the inter-relations between determinants is unknown. Whether women and men differ in the vulnerability to, and impact of, combined disadvantages is also unclear. We examined associations between diverse combinations of economic resources and social relationships, and healthy eating in British older women and men. METHODS: Our sample comprised 9,580 over-50s (47 % of over-50 respondents) in the EPIC-Norfolk cohort study. We examined six economic factors (education, social class, home-ownership, money for needs, frequency of insufficient money for food/clothing, paying bills) and three social relationships (marital status, living arrangement and friend contact), independently and in combination, in relation to fruit variety and vegetable variety. We analysed gender-specific associations using multivariable linear regression with interaction terms. RESULTS: Lower social class, lower education, and difficulty paying bills were associated with lower fruit and vegetable variety in both genders, independent of social relationships. All social relationships were independently associated with fruit variety in men and with vegetable variety in both genders. Substantially lower variety was found for all combinations of low economic resources and lack of social relationship than for either measure alone, with men faring worse in the majority of combined disadvantages. For example, the difference in vegetable variety for men reporting low social class and non-married was much greater (ß -4.1, [-4.8, -3.4]), than the independent association of low social class (ß -1.5, [-1.8,-1.2]), or non-married (ß -1.8, [-2.3,-1.3]). Variety was also lower among men with high economic resources but non-married or lone-living. CONCLUSION: A double burden of low economic resources and lack of social relationships suggested they are unique joint determinants, particularly in older men, and that public health efforts to improve healthy eating would offer most benefit to older adults with intersecting economic and social disadvantages.

Variety more than quantity of fruit and vegetable intake varies by socioeconomic status and financial hardship. Findings from older adults in the EPIC cohort.

BACKGROUND: Beyond quantity, variety of fruit and vegetable (FV) intake prevents chronic conditions and is widely recommended as critical to healthful eating. FV consumption is socially patterned, especially for women, but little is known about multiple economic determinants of variety or whether they differ from those of quantity. OBJECTIVE: To examine socioeconomic status and financial hardships in relation to variety and quantity of FV intakes among older British women and men. METHODS: Cross-sectional study of 9580 adults (50-79 years) in the nationally representative EPIC cohort who responded to a postal Health and Life Experiences Questionnaire (1996-2000) and Food Frequency Questionnaire (1998-2002). Variety counted unique items consumed (items/month) and quantity measured total intake (g/day). RESULTS: No consistent differences by any economic factor were observed for quantity of fruits or vegetables, except education in men. Lower education, lower social class and renting were independently associated with lower fruit variety and vegetable variety (p-trend < 0.001), with differences stronger in men. Mean vegetable variety differed between top and bottom social classes by 2.9 items/month for men and 2.5 for women. Greater financial hardships were also independently associated with lower variety, with differences stronger in women for fruits and in men for vegetables. CONCLUSIONS: British older adults reporting greater economic disadvantage consistently consumed fewer different fruits or vegetables, but not lower amounts. Further nutrition studies of the protective effects, and underlying mechanisms, of FV variety are warranted for addressing social inequalities in older adults' diet quality. Dietary guidance should separately emphasise variety, and interventions should aim to address financial barriers to older adults' consumption of diverse FV.

Does Retirement and Work Stoppage Impact Body Weight and Waist Circumference Changes in Middle- and Older-Aged Women and Men? Results From the Canadian Longitudinal Study on Aging.

This study aimed to examine the impact of employment transitions (ETs) on anthropometric changes among middle-aged and older workers (ages 45y+). Using two waves of data from the Canadian Longitudinal Study on Aging, we analyzed the impact of ETs (stayed working, entered retirement, and stopped working) on change in body weight and waist circumference (WC) on continuous scales as well as categories (≥5% cut-off). Analyses were sex/gender-stratified. Women did not show significant weight or WC change that differed across ETs, but estimated directions suggested those who stopped working were more likely to have ≥5% change in weight. Estimated directions of continuous outcomes for women who stopped working relative to continued workers showed less weight gain and more WC gain. Men who retired gained less weight and had smaller WC gain compared to reference. The findings imply that the short-run impact of exiting the labor force may not exacerbate weight gain.

Promoting Slhánay̓ Skwálwen (Indigenous Women's Heart Health): Findings From Sharing Circles With Squamish Nation.

OBJECTIVE: To gather knowledge and experiences from Squamish Nation citizens to codevelop a model of foraging walks for Indigenous women's heart health. DESIGN: Qualitative study (sharing circles). SETTING: Vancouver, Canada (virtual). PARTICIPANTS: Squamish Nation community members (n = 9), Elders or Knowledge Keepers (n = 5), and researchers (n = 2). INTERVENTION: Community-led foraging walks as a culturally safe nutrition education strategy. MAIN OUTCOME MEASURE(S): Perspectives and experiences. ANALYSIS: Content analysis and narrative synthesis. RESULTS: Personal experiences of foraging walks or knowledge of traditional plants were limited for most participants, and all desired to learn more about traditional foods using land-based activities. Participants identified a lack of nutrition education surrounding heart health and common mistreatment and judgment from health professionals. Participants identified important elements of a future Squamish program, including who should be involved, how to implement it, and the most effective temporal and physical setting. All agreed foraging walks help promote 5 dimensions of heart health (physical, emotional, spiritual, mental, and social) through physical activity, purposeful nutrition, and connection to community and culture. Findings from the sharing circles were used in the creation of a template for future foraging sessions and contributed to plant identification cards for the whole community. CONCLUSIONS AND IMPLICATIONS: Community-based pilot studies to test foraging walks as a culturally safe and environmental approach to nutrition education and cardiovascular health awareness for Indigenous communities are warranted. Research to examine the similarities and differences across Indigenous groups related to understanding heart health and land-based practices for nutrition education and heart health awareness is needed.

Socioeconomic status, financial hardship and measured obesity in older adults: a cross-sectional study of the EPIC-Norfolk cohort.

BACKGROUND: Socioeconomic status is strongly associated with obesity. Current economic circumstances are also independently associated with self-reported weight status in Finnish civil servants. We aimed to examine three types of financial hardship in relation to measured general and central obesity in a general population of older adults, while considering conventional socioeconomic indicators. METHODS: Data from 10,137 participants (≥50 years) in the EPIC-Norfolk cohort who responded to a postal Health and Life Experiences Questionnaire (1996-2000) and attended a clinical assessment (1998-2002). Multivariable logistic regression models assessed likelihood of general obesity (BMI ≥30 kg/m²) and central obesity (women: ≥88 cm; men: ≥102 cm) calculated from measured anthropometrics. RESULTS: Obesity prevalence was consistently patterned by standard socioeconomic indicators, with over-50s in the lowest social class being twice as likely to be obese than those in the highest class (women OR 2.10 [CI95: 1.41-3.13]; men OR 2.36 [1.44-3.87]). After adjustment for socioeconomic status, reporting having less than enough money for one's needs (compared to more than enough) was associated with obesity in women (OR 2.04 [1.54-2.69]) and men (OR 1.83 [1.34-2.49]). Similar associations were demonstrated between obesity and always or often not having enough money for food/clothing (women OR 1.40 [1.03-1.90]; men OR 1.81 [1.28-2.56]), compared to reporting this never occurred. The strongest independent associations were seen for obesity and reported greatest level of difficulty paying bills (women OR 2.20 [1.37-3.55]; men 2.40 [1.38-4.17]), compared to having no difficulties. Findings for central obesity were slightly higher in women and lower in men. CONCLUSIONS: Obesity in British over-50s was more likely in study participants who reported greater financial hardship, even after education, social class and home ownership were taken into account. Public health policies need to consider the hitherto neglected role of financial hardship in older people, especially difficulty paying bills, as part of strategies to prevent or reduce obesity.

Prescribing diabetes nutrition therapy: a qualitative study of dietitians' experiences of carbohydrate restriction in Canada.

Background: Diabetes care has traditionally not included nutrition therapy using carbohydrate restriction, nor has carbohydrate restriction been taught to registered dietitians (RDs) to support patients living with diabetes choosing this dietary approach. We aimed to describe the experiences and views of RDs caring for patients using therapeutic carbohydrate-restricted diets (TCR), particularly metabolic conditions such as type 2 diabetes or prediabetes. Subjects/Methods: A qualitative study design using free-text responses from an online needs assessment survey was employed. RDs who practised in Canada were invited (n=6640) and 274 completed the survey, with 45 respondents who regularly prescribed TCR to their patients providing open-text responses (2987 words), which were analysed using inductive thematic analysis. Results: We identified four themes characterising Canadian RDs' experiences around prescribing TCR: interpersonal context, personal experience/knowledge, regulatory environment and patient-centredness. While these themes often interacted, each impacted TCR prescription uniquely, with patient-centred care at the core of reported experiences of prescribing. Conclusions: There exists a variety of experiences and perspectives related to prescribing of TCR among Canadian RDs caring for patients with diabetes, and all focus on the patient's needs, benefits and preferences. Prescribing TCR was often informed by the scientific literature yet also by RDs' experiential knowledge. Responses highlighted a desire for evidence-based educational materials and greater discussion within the diabetes nutrition community on this topic.

Therapeutic carbohydrate restriction pre-COVID pandemic: assessing registered dietitians' knowledge, use and perceived barriers in Canada.

BACKGROUND/OBJECTIVES: Evidence supports therapeutic carbohydrate restriction (TCR) for managing appropriate patients with chronic illness, but little is known about TCR prescribing among dietitians. This study evaluated dietitians' knowledge, information use and needs for TCR in Canada. METHODS: Registered dietitians (RDs) were recruited (n = 274) from January to December 2020 to collect semi-structured data using an online needs assessment survey (French and English). Descriptive and inferential statistics were used to describe and assess which nine RD practice characteristics predicted TCR prescription in clinical practice. RESULTS: Respondents were located in all provinces and territories in Canada, with few international responses in the sample (3.5%). We found statistically significant differences between RDs who have prescribed TCR or not in four practice characteristics studied: level of knowledge (p < 0.001), reviewing literature (p = 0.02), clinician referrals (p < 0.001) or personal experience (p < 0.001). Multivariable models showed that the odds of prescribing TCR was associated with intermediate/expert knowledge (OR 5.92 [95% CI: 2.26-17.77]), clinician's referral (OR 3.22 [1.73-6.14]) and personal experience, whether a former user (OR 2.24 [1.09-4.72]) or a current user of TCR (OR 9.09 [2.70-42.09]), compared to no knowledge, no referral or no experience. CONCLUSION: There is a strong link between the use, or lack, of TCR in clinical practice among RDs and their knowledge level, personal experience and clinician referrals/support. Scope exists to develop novel educational tools and resources on scientific evidence for TCR, and increase multidisciplinary teams, so as to better support RDs in Canada to safely implement TCR in appropriate patients with chronic illness.

Setting Goals to Reduce Cardiovascular Risk: A Retrospective Chart Review of a Pharmacist-Led Initiative in the Workplace.

Background: Cardiovascular diseases (CVD) are the second leading cause of death in Canada with many modifiable risk factors. Pharmacists at a Canadian university delivered a novel CVD risk management program, which included goal-setting and medication management. Aim: This study aimed to describe what CVD prevention goals are composed of in a workplace CVD risk reduction program, and how might these goals change over time. Methods: A longitudinal, descriptive qualitative study using a retrospective chart review of clinical care plans for 15 patients enrolled in a CVD prevention program. Data across 6 visits were extracted from charts (n = 5413 words) recorded from May 2019-November 2020 and analyzed using quantitative content analysis and descriptive statistics. Results: Behavioural goals were most popular among patients and were more likely to change over the 12-month follow-up period, compared to health measure goals. Behavioural goals included goals around diet, physical activity (PA), smoking, medication, sleep and alcohol; health measure goals centered on weight measures, blood pressure (BP) and blood lipid levels. The most common behavioural goals set by patients were for diet (n = 11) and PA (n = 9). Over time, goals around PA, medication, alcohol and weight were adapted while others were added (e.g. diet) and some only continued. Patients experienced a number of barriers to their goal(s) which informed how they adapted their goal(s). These included environmental limitations (including COVID-19) and work-related time constraints. Conclusions: This study found CVD goal-setting in the pharmacist-led workplace wellness program was complex and evolved over time, with goals added and/or adapted. More detailed qualitative research could provide further insights into the patient-provider goal-setting experience in workplace CVD prevention.