Impact of interprofessional geriatric teamwork on students' perceptions of older persons and collaborative practice.

Health professions programs lack sufficient exposure to geriatric education in curricula. The Seniors Assisting in Geriatric Education (SAGE) Program exposes interprofessional (IP) teams of health professions students to older adults. To determine the impact of an interprofessional geriatric educational experience on student perceptions of team collaboration and older adults. IP teams of three or four students (n = 662) representing eight disciplines from two institutions were paired with an older adult to promote person-centered care over three semesters. Students completed two online questionnaires (pre- and post-SAGE Program, ~10 min). 136 students completed both questionnaires. Three IP collaborative practice sub-competencies under the Roles & Responsibilities and Interprofessional Communication Core Competencies increased significantly from pre- to post-SAGE Program (p ≤ 0.002). Comparison of the means for attitudes toward geriatric patients revealed statistically significant improvement in one item, Compassion (p < .002). The SAGE Program had a positive impact on IP collaborative practice and attitudes toward older people in some, but not all, areas.

Effect of a late afternoon/early evening bout of aerobic exercise on postprandial lipid and lipoprotein particle responses to a high-sugar meal breakfast the following day in postmenopausal women: a randomized cross-over study.

High-sugar consumption is related to dyslipidemia. How acute exercise affects postprandial lipid and lipoprotein particle responses to a high-sugar meal (HSM) in postmenopausal women is unclear. We examined the effects of a late afternoon/early evening bout of aerobic exercise on postprandial lipid and lipoprotein particle responses to a HSM breakfast the following day in 22 postmenopausal women. Subjects underwent exercise (EX) and no exercise (NE) conditions in the evening 13-16 h before the HSM breakfast consumption, in a random order. During the EX condition, subjects performed supervised aerobic exercise for 60 min at 75% of age-predicted maximum heart rate. The HSM (75.6% carbohydrate and 33% energy needs) was consumed after a 12-h fast. Serum lipids and lipoproteins were assessed at baseline and postprandially (60, 120, 180 min). Repeated measures analysis showed significantly lower area under the curve (geometric means [95% CI]) for triglycerides (TG) (2.96[2.43, 3.61] vs. 3.24[2.70, 3.88] mmol/L*hr; p = 0.049) and very low density lipoprotein particles (VLDLP) (114.6[88.2, 148.9] vs. 134.3[108.1, 166.9] nmol/L*hr; p = 0.02) during the EX versus NE condition. There were no condition effects for other variables. In conclusion, the EX versus NE condition lowered postprandial AUC for TG and VLDLP following HSM consumption in postmenopausal women.Trial Registration: ClinicalTrials.gov Identifier: NCT02919488.

Improved Physiological Markers of Omega-3 Status and Compliance With Omega-3 Supplementation in Division I Track and Field and Cross-Country Athletes: A Randomized Controlled Crossover Trial.

A sufficient omega-3 index may enhance cardiovascular function, enhance performance, and decrease inflammation. However, most collegiate athletes are deficient in omega-3s, requiring supplementation. A new type of omega-3 (N3) supplement, Enhanced Recovery™ (ER), claims to improve N3 index while addressing the current issues with traditional supplementation. The purpose of this study was to determine if ER improves N3 status and enhances compliance compared with the current standard in collegiate Division I Track and Field and cross-country athletes during a competitive season. Twenty-five (male = 15 and female = 10) athletes completed this longitudinal, randomized controlled crossover trial. Measurements of N3 status were collected at baseline prior to supplementation, and every 2 weeks for 6 weeks with a 33- to 36-day washout period before crossing over. Supplement compliance and dietary intake of N3 rich foods were collected throughout. Visual analog scales and an exit survey asked questions regarding each treatment. Results showed that N3 index increases within 6 weeks (p < .001) for ER (+37.5%) and control (CON; +55.1%), with small differences between treatments at Weeks 4 (ER = 7.3 ± 1.0; CON = 7.7 ± 1.1; p = .043) and 6 (ER = 7.4 ± 1.2; CON = 7.9 ± 1.2; p = .043). Dietary intake of N3-rich foods and supplement compliance were significant drivers of improvements in N3 status (p < .050). Compliance was not different between treatments but was affected by sex (males = 90.0 ± 17.0% and females = 76.5 ± 21.0%; p = .040), likability (p = .001; r = .77, p < .001), ease (p = .023; r = .53, p = .006), and supplement preference (p = .004), which appeared to favor ER. We conclude that consumption of N3-rich foods and consistent supplementation should be implemented for improvements in N3 status in collegiate athletes, but taste tests/trial periods with ER or CON may help determine preference and improve compliance.

Body composition, not dietary fatty acid composition, explains metabolic responses following a high-fat meal in premenopausal normal-weight women: a single-blind, randomised, crossover study.

The aim of this study was to examine the effect of three different fatty acid (FA)-rich meals enriched in either SFA, MUFA or PUFA on postprandial metabolic responses in premenopausal, normal-weight women. For this randomised, single-blind, crossover study, three high-fat (HF) meals rich in either SFA, MUFA or PUFA (65 % energy from fat; 35 % of participants' total daily energy needs) were tested. For each visit, anthropometrics and RMR were measured following a 12-15 h fast. Then, participants consumed one of the HF meals, and respiratory gases were collected using indirect calorimetry for 3 h postprandially. Energy expenditure (EE) following a SFA-rich meal was significantly higher than a MUFA-rich meal (P = 0·04; η2 = 0·19), but SFA was not significantly different from PUFA. There was a trend towards significance in EE between PUFA and MUFA (P = 0·06). After adjusting for fat-free mass (FFM), there were no longer condition or time effects for EE, although FFM remained a significant predictor (P = 0·005; η2 = 0·45). There were no significant differences between conditions for dietary-induced thermogenesis or substrate oxidation. The relationship between fat mass (FM) and both total fat oxidation (r 0·62; P = 0·025) and total change in RER following a MUFA-rich meal was observed (r -0·55; P = 0·05). In conclusion, weight loss through increases in EE may be best achieved by increasing FFM rather than selection of FA type. Further, a relationship exists between FM and fat oxidation following a MUFA-rich meal, most likely due to an unidentified mechanism.

Manipulation of fatty acid composition in a high-fat meal does not result in differential alterations in appetite or food intake in normal weight females: A single-blind randomized crossover study.

A behavioral concept that generates a path to obesity is eating in the absence of hunger (EAH). One strategy that may be effective in preventing EAH is the manipulation of dietary fatty acid (FA) composition. However, it remains unclear which FA has the greatest impact on both appetite and EAH. Therefore, the purpose of this study was to examine the effect of different dietary FA compositions (monounsaturated, MUFA; polyunsaturated, PUFA; saturated, SFA) on subjective ratings of appetite and subsequent ad libitum eating after a 3 h postprandial period. Sixteen apparently healthy normal weight females between ages 18-40 completed this randomized, single-blind, crossover study. Participants consumed a HF meal (65% energy from fat) rich in SFA, MUFA, and PUFA with an energy content corresponding to 35% of their measured resting metabolic rate on three separate occasions. Visual analog scales were collected while fasted and every 30 min for 3 h during a postprandial period to measure feelings of hunger, fullness, and desire to eat (DTE). Participants were provided an ad libitum buffet meal 3 h after the HF meal. There were no statistically significant differences for ratings of hunger, fullness, or DTE across conditions. Further, there was no significant difference in energy intake during the ad libitum lunch. We conclude that the manipulation of FA composition in a HF meal does not differentially affect appetite sensations or subsequent energy intake.

Age Drives the Differences in Dietary Supplement Use in Endurance Athletes: A Cross-Sectional Analysis of Cyclists, Runners, and Triathletes.

Most athletes use dietary supplements (DS) to improve health and performance beyond what can be achieved through diet. Improvements in health and exercise performance through the use of DS are especially attractive to older athletes (OA) challenged with age-related declines. However, there are few DS shown to improve endurance performance, and the prevalence of DS in OA are unknown. Two-hundred cyclists, runners, and triathletes (females = 108; age = 39.4 ± 13.5) completed a questionnaire regarding the prevalence and type of DS currently used, in addition to variables associated with using DS such as motivation and sources of information. Overall, 78.0% of athletes reported current DS use. OA used more DS (Total DS = 4.3 ± 3.0) than younger athletes (2.7 ± 1.8, p < 0.001), with ages 40-49 and 50-59 using more DS than ages 18-29 and 30-39 (p < 0.05). The majority of athletes (53.8%) used ≥ 3 DS. Age was the only significant predictor of total DS use (p = 0.002); OA used ≥ 3 DS more than younger (p < 0.001). Specifically, more athletes 40-49 (67.5%) and 50-59 (76.2%) used ≥ 3 DS compared to 18-29 (33.3%, p = 0.003). More OA used electrolytes (p = 0.005), probiotics (p = 0.045), melatonin (p = 0.004), and vitamin D (p = 0.016) than younger athletes. Motivations to use DS were related to age and were supplement specific. Sources of DS information varied by sex more than age. Age is a significant determining factor for DS use in a sample of cyclists, runners, and triathletes. The prevalence and trends of DS warrant further investigation into the benefits and risks of DS to develop safe, targeted, and age-specific DS strategies on a recreative competitive level.Supplemental data for this article is available online at https://doi.org/10.1080/19390211.2022.2056670 .

Chronic and Postprandial Metabolic Responses to a Ketogenic Diet Compared to High-Carbohydrate and Habitual Diets in Trained Competitive Cyclists and Triathletes: A Randomized Crossover Trial.

Extreme carbohydrate deficits during a ketogenic diet (KD) may result in metabolic adaptations reflective of low energy availability; however, the manifestation of these adaptations outside of exercise have yet to be elucidated in cyclists and triathletes. The purpose of this study is to investigate the chronic and postprandial metabolic responses to a KD compared to a high-carbohydrate diet (HCD) and habitual diet (HD) in trained competitive cyclists and triathletes. For this randomized crossover trial, six trained competitive cyclist and triathletes (F: 4, M: 2) followed an ad libitum KD and HCD for 14 d each after their HD. Fasting energy expenditure (EE), respiratory exchange ratio (RER), and fat and carbohydrate oxidation (FatOx and CarbOx, respectively) were collected during their HD and after 14 d on each randomly assigned KD and HCD. Postprandial measurements were collected on day 14 of each diet following the ingestion of a corresponding test meal. There were no significant differences in fasting EE, RER, FatOx, or CarbOx among diet conditions (all p > 0.050). Although postprandial RER and CarbOx were consistently lower following the KD meal, there were no differences in peak postprandial RER (p = 0.452), RER incremental area under the curve (iAUC; p = 0.416) postprandial FatOx (p = 0.122), peak FatOx (p = 0.381), or FatOx iAUC (p = 0.164) between the KD and HD meals. An ad libitum KD does not significantly alter chronic EE or substrate utilization compared to a HCD or HD; postprandial FatOx appears similar between a KD and HD; this is potentially due to the high metabolic flexibility of cyclists and triathletes and the metabolic adaptations made to habitual high-fat Western diets in practice. Cyclists and triathletes should consider these metabolic similarities prior to a KD given the potential health and performance impairments from severe carbohydrate restriction.

Virtual teaching kitchen classes and cardiovascular disease prevention counselling among medical trainees.

Background: Hands-on culinary medicine education for medical trainees has emerged as a promising tool for cardiovascular health promotion. Purpose: To determine whether virtual culinary medicine programming associates with Mediterranean diet (MedDiet) adherence and lifestyle medicine competencies among medical trainees across the USA. Method: A total of 1433 medical trainees across 19 sites over a 12-month period were included. The Cooking for Health Optimisation with Patients-Medical Trainees survey composed of 61 questions regarding demographics, nutritional attitudes, dietary habits including MedDiet score and lifestyle medicine counselling competencies. Multivariable logistic regression assessed the association of virtual culinary medicine education with MedDiet intake and nutritional attitudes. Results: There were 519 medical trainees who participated in virtual culinary medicine education and 914 medical trainees who participated in their standard nutrition curricula. More than one-half of participants were women (n=759) and the mean age was 27 years old. Compared with students enrolled in traditional nutrition curricula, participants in virtual culinary medicine education were 37% more likely to adhere to MedDiet guidelines for fruit intake (OR 1.37, 95% CI 1.03 to 1.83, p=0.03). Virtual culinary medicine education was associated with higher proficiency in lifestyle medicine counselling categories, notably recommendations involving fibre (OR 4.03; 95% CI 3.05 to 5.34), type 2 diabetes prevention (OR 4.69; 95% CI 3.51 to 6.27) and omega fatty acids (OR 5.21; 95% CI 3.87 to 7.02). Virtual culinary medicine education had a similar, although higher magnitude association with MedDiet counselling competency (OR 5.73, 95% CI 4.26 to 7.70) when compared with historical data previously reported using hands-on, in-person culinary medicine courseware (OR 4.97, 95% CI 3.89 to 6.36). Conclusions: Compared with traditional nutritional educational curricula, virtual culinary medicine education is associated with higher MedDiet adherence and lifestyle medicine counselling competencies among medical trainees. Both virtual and hands-on culinary medicine education may be useful for cardiovascular health promotion.

The impact of dieting culture is different between sexes in endurance athletes: a cross-sectional analysis.

BACKGROUND: Frequent dieting is common in athletes attempting to achieve a body composition perceived to improve performance. Excessive dieting may indicate disordered eating (DE) behaviors and can result in clinical eating disorders. However, the current nutrition patterns that underly dieting culture are underexplored in endurance athletes. Therefore, the purpose of this study was to identify the sex differences in nutrition patterns among a group of endurance athletes. METHODS: Two-hundred and thirty-one endurance athletes (females = 124) completed a questionnaire regarding their dieting patterns and associated variables. RESULTS: The majority of athletes did not follow a planned diet (70.1%). For endurance athletes on planned diets (n = 69), males were more likely follow a balanced diet (p = 0.048) and females were more likely to follow a plant-based diet (p = 0.021). Female endurance athletes not on a planned diet (n = 162) were more likely to have attempted at least one diet (p < 0.001). Male athletes attempted 2.0 ± 1.3 different diets on average compared to 3.0 ± 2.0 for females (p = 0.002). Female athletes were more likely to attempt ≥ three diets (p = 0.022). The most common diet attempts included carbohydrate/energy restrictive, plant-based, and elimination diets. Females were more likely to attempt ketogenic (p = 0.047), low-carbohydrate (p = 0.002), and energy restricted diets (p = 0.010). Females made up the entirety of those who attempted gluten-/dairy-free diets (F = 22.0%, M = 0.0%). CONCLUSIONS: Being a female athlete is a major determinant of higher dieting frequency and continual implementation of popular restrictive dietary interventions. Sports dietitians and coaches should prospectively assess eating behavior and provide appropriate programming, education, and monitoring of female endurance athletes.

Collective Perceptions of Aging and Older Persons Held by Students From Eight Healthcare Professions.

In order to increase the number of students entering the geriatric workforce, an understanding of factors influencing career preference and what may prevent students from pursuing geriatric careers is necessary. Using a convergent parallel mixed methods approach, the aim of this study was to provide insight for geriatric educators regarding the collective perceptions of aging and older persons held by 864 students from eight healthcare professions. Quantitative questions assessed students' attitudes (Geriatric Attitudes Scale). Student responses to four open-ended questions were assessed using conventional content analysis. Results included rich narrative examples of healthcare professions students' perceptions and understanding of the aging process, as well as myths and misconceptions of aging and older persons that can be used to inform geriatric curricula across multiple health professions training and education programs. Geriatric education is a critical avenue to correct misperceptions, quell ageism and address the current shortage in the geriatrician workforce.

Emerging evidence of the relationship between fat-free mass and ghrelin, glucagon-like peptide-1, and peptide-YY.

Historically, fat mass has been considered to have significant influence on human body energy homeostasis through its indirect relationship with appetite control. However, over the past decade, there has been a surge of evidence supporting the potential role of fat-free mass (FFM) in appetite control, and thus the regulatory involvement of FFM in appetite-related measures. Yet, the underlying biological mechanisms that explain the role of FFM in tonic/episodic appetite regulation remain unclear. Available evidence points to a biological link between FFM and peripheral appetite hormones; however, these relationships may be appetite hormone specific. Therefore, the purpose of this review was to present the potential relationship between FFM and appetite hormones, while also emphasizing that further research is needed to elucidate potential cause-effect. Overall, available evidence suggests the appetite stimulating hormone, ghrelin, has an inverse relationship with FFM. The relationship between FFM and the appetite suppression hormones, peptide tyrosine-tyrosine and glucagon-like peptide-1, has been relatively unexplored. The evidence presented in this review should encourage researchers, clinicians, and health professionals to consider investigating FFM maintenance as a suitable strategy during weight loss for improvements in appetite control.

Perceptions of appetite do not match hormonal measures of appetite in trained competitive cyclists and triathletes following a ketogenic diet compared to a high-carbohydrate or habitual diet: A randomized crossover trial.

Endurance athletes may implement rigid dietary strategies, such as the ketogenic diet (KD), to improve performance. The effect of the KD on appetite remains unclear in endurance athletes. This study analyzed the effects of a KD, a high-carbohydrate diet (HCD), and habitual diet (HD) on objective and subjective measures of appetite in trained cyclists and triathletes, and hypothesized that the KD would result in greater objective and subjective appetite suppression. Six participants consumed the KD and HCD for 2-weeks each, in a random order, following their HD. Fasting appetite measures were collected after 2-weeks on each diet. Postprandial appetite measures were collected following consumption of a ketogenic meal after the KD, high-carbohydrate meal after the HCD, and standard American/Western meal after the HD. Fasting total ghrelin (GHR) was lower and glucagon-like peptide-1 (GLP-1) and hunger were higher following the KD versus HD and HCD. Fasting insulin was not different. Mixed-effects model repeated measures analysis and effect sizes and 95% confidence intervals showed that postprandial GHR and insulin were lower and GLP-1 was higher following the ketogenic versus the standard and high-carbohydrate meals. Postprandial appetite ratings were not different across test meals. In conclusion, both fasting and postprandial concentrations of GHR were lower and GLP-1 were higher following the KD than the HC and HD, and postprandial insulin was lower on the KD. Subjective ratings of appetite did not correspond with the objective measures of appetite in trained competitive endurance athlete. More research is needed to confirm our findings.