Efficacy of a school-based obesity prevention intervention at reducing added sugar and sodium in children's school lunches: the LA Health randomized controlled trial.

BACKGROUND: Decreasing selection and consumption of sodium and added sugars in the school cafeteria setting is important to provide optimal nutrition to children. OBJECTIVE: The ofjective of this study is to determine whether Louisiana (LA) Health, a school-based obesity prevention intervention, could successfully reduce children's selection and consumption of sodium and added sugars during school lunches vs. the control group. DESIGN: Food selection, consumption, and plate waste from student lunches (3 consecutive days) in 33 public schools in rural Louisiana were collected and analyzed using the digital photography of foods method at baseline and after a 28-month obesity prevention intervention (LA Health) beginning in 4th-6th grade (87% of children received free or reduced cost lunch). Selection and consumption of energy, added sugar, and sodium was objectively measured using digital photography of foods. Mixed models, including Race and BMI, were used to determine whether change in selection and consumption differed by group. RESULTS: Sodium decreased for selection (- 233.1 ± 89.4 mg/lunch, p = 0.04) and consumption (- 206.3 ± 65.9, mg/lunch) in the intervention (vs. control) by month 18, and in consumption by month 28 (- 153.5 ± 66.9 mg/lunch, p = 0.03). Change in added sugar consumption decreased in the intervention (vs. control) at month 18 (- 3.7 ± 1.6, p = 0.05) and at month 28 (- 3.5 ± 1.6 tsp/lunch, p = 0.05). CONCLUSIONS: LA Health decreased the amount of added sugar and sodium selected and consumed, but not plate waste, by month 28. Results highlight the importance of long-term interventions and policies targeting provision and selection to improve dietary patterns in children, with less focus on plate waste.

Digital Tools to Support Family-Based Weight Management for Children: Mixed Methods Pilot and Feasibility Study.

BACKGROUND: Family-based behavioral therapy is an efficacious approach to deliver weight management counseling to children and their parents. However, most families do not have access to in-person, evidence-based treatment. We previously developed and tested DRIVE (Developing Relationships that Include Values of Eating and Exercise), a home-based parent training program to maintain body weight among children at risk for obesity, with the intent to eventually disseminate it nationally alongside SafeCare, a parent support program that focuses on parent-child interactions. Currently the DRIVE program has only been tested independently of SafeCare. This study created the "mHealth DRIVE" program by further adapting DRIVE to incorporate digital and mobile health tools, including remotely delivered sessions, a wireless scale that enabled a child-tailored weight graph, and a pedometer. Telehealth delivery via mHealth platforms and other digital tools can improve program cost-effectiveness, deliver long-term care, and directly support both families and care providers. OBJECTIVE: The objective of this study was to examine preliminary acceptability and effectiveness of the mHealth DRIVE program among children and parents who received it and among SafeCare providers who potentially could deliver it. METHODS: Study 1 was a 13-week pilot study of a remotely delivered mHealth family-based weight management program. Satisfaction surveys were administered, and height and weight were measured pre- and post-study. Study 2 was a feasibility/acceptability survey administered to SafeCare providers. RESULTS: Parental and child satisfaction (mean of 4.9/6.0 and 3.8/5.0, respectively) were high, and children's (N=10) BMI z-scores significantly decreased (mean -0.14, SD 0.17; P=.025). Over 90% of SafeCare providers (N=74) indicated that SafeCare families would benefit from learning how to eat healthily and be more active, and 80% of providers reported that they and the families would benefit from digital tools to support child weight management. CONCLUSIONS: Pediatric mHealth weight management interventions show promise for effectiveness and acceptability by families and providers. TRIAL REGISTRATION: Clinicaltrials.gov NCT03297541, https://clinicaltrials.gov/ct2/show/NCT03297541.

Efficacy of a Home-Based Parent Training-Focused Weight Management Intervention for Preschool Children: The DRIVE Randomized Controlled Pilot Trial.

OBJECTIVES: To pilot-test a home-based parent training intervention aimed at maintaining body weight among children at risk for obesity (> the 75th body mass index percentile). METHODS: Sixteen parent-child dyads were randomized to a health education or Developing Relationships that Include Values of Eating and Exercise (DRIVE) intervention arm. The DRIVE curriculum was a structured parenting program to promote healthy weight in children by relying on behavioral principles to promote skill acquisition in the family's natural setting. Body weight and waist circumference were measured at baseline and weeks 9 and 19. RESULTS: Body mass index z-score, body weight, and percent body weight increased in children in the health education arm vs DRIVE at weeks 9 and 19. Body weight, percent body weight, and waist circumference decreased in parents in DRIVE vs the health education arm at week 19, whereas no differences were shown at week 9. CONCLUSIONS AND IMPLICATIONS: The DRIVE program mitigated weight gain in a small sample of at-risk children and showed promising results in reducing weight in parents. Home-based interventions emphasizing parent-child interactions are indicated as a practical model to deliver weight management in children.

The role of fMRI in drug development.

Functional magnetic resonance imaging (fMRI) has been known for over a decade to have the potential to greatly enhance the process of developing novel therapeutic drugs for prevalent health conditions. However, the use of fMRI in drug development continues to be relatively limited because of a variety of technical, biological, and strategic barriers that continue to limit progress. Here, we briefly review the roles that fMRI can have in the drug development process and the requirements it must meet to be useful in this setting. We then provide an update on our current understanding of the strengths and limitations of fMRI as a tool for drug developers and recommend activities to enhance its utility.

Running Performance With Nutritive and Nonnutritive Sweetened Mouth Rinses.

Using mouth rinse (MR) with carbohydrate during exercise has been shown to act as an ergogenic aid. PURPOSE: To investigate if nutritive or nonnutritive sweetened MR affects exercise performance and to assess the influence of sweetness intensity on endurance performance during a time trial (TT). METHODS: This randomized, single-blinded study had 4 treatment conditions. Sixteen subjects (9 men, 7 women) completed a 12.8-km TT 4 different times. During each TT, subjects mouth-rinsed and expectorated a different solution at time 0 and every 12.5% of the TT. The 4 MR solutions were sucrose (S) (sweet taste and provides energy of 4 kcal/g), a lower-intensity sucralose (S1:1) (artificial sweetener that provides no energy but tastes sweet), a higher-intensity sucralose (S100:1), and water as control (C). Completion times for each TT, heart rate (HR), and ratings of perceived exertion (RPE) were also recorded. RESULTS: Completion time for S was faster than for C (1:03:47 ± 00:02:17 vs 1:06:56 ± 00:02:18, respectively; P < .001) and showed a trend to be faster vs S100:1 (1:03:47 ± 00:02:17 vs 1:05:38 ± 00:02:12, respectively; P = .07). No other TT differences were found. Average HR showed a trend to be higher for S vs C (P = .08). The only difference in average or maximum RPE was for higher maximum RPE in C vs S1:1 (P = .02). CONCLUSION: A sweet-tasting MR did improve endurance performance compared with water in a significant manner (mean 4.5% improvement; 3+ min.); however, the presence of energy in the sweet MR appeared necessary since the artificial sweeteners did not improve performance more than water alone.

Predictive variables for half-Ironman triathlon performance.

OBJECTIVES: To examine the relationship between training, anthropometric characteristics, tapering, and time performance for a half-Ironman distance race. DESIGN: Cross sectional study in triathletes. METHODS: Data were obtained for 209 participants (155 males; 54 females) competing in a half-Ironman triathlon. Participants provided information regarding triathlon experience, training, race preparation, and tapering. Participants were divided into three groups based on finish time for analysis. RESULTS: Males in the fastest group weighed less and had lower body fat percentage compared to males in the slower groups (p ≤ 0.01). Athletes in the fastest group had completed more half-Ironman races and took fewer rest days during training compared to athletes in the slower groups (p<0.01). The average time spent training was 13.9 ± 5.4 h per week, and this did not differ between groups. The faster group of athletes set lower race time goals (p<0.01) and placed greater importance on achieving goal time (p=0.04). Eighty-one percent reported performing a taper with a decrease in training volume of 58.5 ± 34.7% and a decrease in training intensity of 44.9 ± 40.8%. However, there were no differences in taper variables between the three groups. Age, previous best half-Ironman time, goal time, and goal importance predicted 58% of variance in finish time. CONCLUSIONS: The fastest group of triathletes exhibited differences in anthropometrics, race experience, and goal-setting compared to slower athletes. There were no differences in total training hours or tapering between groups. The best predictors of race performance were age, previous best half-Ironman time, goal time, and importance of reaching this goal.