The Effect of a Multidisciplinary Lifestyle Intervention on Obesity Status, Body Composition, Physical Fitness, and Cardiometabolic Risk Markers in Children and Adolescents with Obesity.
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Children and adolescents with obesity are at a high risk of being obese in adulthood. The aim of this study was to develop a multidisciplinary lifestyle intervention program targeted at children and adolescents with moderate to severe obesity. The study is based on the Intervention for Childhood and Adolescents Obesity via Activity and Nutrition (ICAAN) – quasi-experimental intervention trial - which recruited 103 participants aged between 6 and sixteen years (63 were boys and 40 girls). The study was based on 2 active treatment groups (usual care group vs exercise group) receiving a 16-week intervention program. Results indicate that children and adolescents with obesity can achieve positive effects on body composition, physical fitness, and cardiometabolic markers, particularly with the exercise intervention. Authors conclude that the moderate-intensity multidisciplinary lifestyle intervention program they developed, can be sustained in the real-world setting and it is applicable to both moderate and severe obesity.
undefined: This study aimed to develop a multidisciplinary lifestyle intervention program targeted at children and adolescents with moderate to severe obesity, and assess the additional effects of exercise intervention when compared to usual care. Overall, the 103 enrolled participants were ≥85th percentile of age and sex-specific body mass index (BMI). Participants were divided into groups that received 16 weeks of either usual care or exercise intervention. The BMI -score of the overall completers decreased by about 0.05 after the 16-week intervention ( = 0.02). After the intervention, only the exercise group had a significantly lower BMI -score than the baseline score by about 0.1 ( = 0.03), but no significant group by time interaction effects were observed. At the 16-week follow-up, significant group by time interaction effects were observed in percentage body fat (%BF) (β = -1.52, 95%CI = -2.58⁻-0.45), lean body mass (LM) (β = 1.20, 95%CI = 0.12⁻2.29), diastolic blood pressure (β = -5.24, 95%CI = -9.66⁻-0.83), high-sensitivity C-reactive protein (β = -1.67, 95%CI = -2.77⁻-1.01), and wall sit test score (β = 50.74, 95%CI = 32.30⁻69.18). We developed a moderate-intensity intervention program that can be sustained in the real-world setting and is practically applicable to both moderate and severe obesity. After interventions, the exercise group had lower %BF and cardiometabolic risk markers, and higher LM and leg muscle strength compared to the usual care group.
Systematic review of palm oil consumption and the risk of cardiovascular disease.
PloS one. 2018;13(2):e0193533
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Palm oil, the most widely consumed vegetable oil in the world, derives from the palm tree fruit with a balanced ratio of unsaturated and saturated fatty acids. Studies have shown an association between high contents of saturated fats in palm oil with the detrimental atherogenic profile. The review aims at synthesising the available evidence reporting the association of palm oil consumption with cardiovascular disease risk and cardiovascular disease-specific mortality, including specifically Coronary Heart Disease (CHD) and stroke. The authors systematically searched three databases up to June 2017 without restriction on setting or language. Published interventional and observational studies that evaluated palm oil consumption with coronary heart disease or stroke in adults were searched. Separate searches were performed depending on the outcome. The study did not find a clear association between palm oil consumption and risk or mortality of cardiovascular disease, namely coronary heart disease and stroke. The health effects found between association of palm oil consumption and risk of coronary heart disease were not unique to just palm oil consumption as other food items were also included in the analysis. The review could not establish strong evidence for or against palm oil consumption relating to cardiovascular disease risk and cardiovascular disease-specific mortality. A healthy overall diet is suggested for good cardiometabolic health.
BACKGROUND The high amount of saturated fatty acids (SFA) coupled with the rising availability and consumption of palm oil have lead to the assumption that palm oil contributes to the increased prevalence of cardiovascular diseases worldwide. We aimed at systematically synthesising the association of palm oil consumption with cardiovascular disease risk and cardiovascular disease-specific mortality. METHODS We systematically searched Central, Medline and Embase databases up to June 2017 without restriction on setting or language. We performed separate searches based on the outcomes: coronary heart disease and stroke, using keywords related to these outcomes and palm oil. We searched for published interventional and observational studies in adults (Age: >18 years old). Two investigators extracted data and a consensus was reached with involvement of a third. Only narrative synthesis was performed for all of the studies, as the data could not be pooled. RESULTS Our search retrieved 2,738 citations for stroke with one included study and 1,777 citations for coronary heart disease (CHD) with four included studies. Palmitic acid was reported to be associated with risk of myocardial infarction (MI) (OR 2.76; 95%CI = 1.39-5.47). Total SFA intake was reported to be not significant for risk of MI. Varying intake of fried foods, highest contributor to total SFA with 36% of households using palm oil for frying, showed no significant associations to risk of MI. Odds of developing first non-fatal acute MI was higher in palm oil compared to soybean oil with 5% trans-fat (OR = 1.33; 95%CI = 1.09-1.62) than palm oil compared to soybean oil with 22% trans-fat (OR = 1.16; 95%CI = 0.86-1.56). Nevertheless, these risk estimates were non-significant and imprecise. The trend amongst those taking staple pattern diet (characterised by higher palm oil, red meat and added sugar consumption) was inconsistent across the factor score quintiles. During the years of 1980 and 1997, for every additional kilogram of palm oil consumed per-capita annually, CHD mortality risk was 68 deaths per 100,000 (95% CI = 21-115) in developing countries and 17 deaths per 100,000 (95%CI = 5.3-29) in high-income countries, whereas stroke was associated with 19 deaths per 100,000 (95%CI = -12-49) and 5.1 deaths per 100,000 (95% CI: -1.2-11) respectively. The evidence for the outcomes of this review were all graded as very low. The findings of this review should be interpreted with some caution, owing to the lack of a pooled effect estimate of the association, significant bias in selection criteria and confounding factors, inclusion of other food items together with palm oil, and the possible out-dated trend in the ecological study. CONCLUSION In view of the abundance of palm oil in the market, quantifying its true association with CVD outcomes is challenging. The present review could not establish strong evidence for or against palm oil consumption relating to cardiovascular disease risk and cardiovascular disease-specific mortality. Further studies are needed to establish the association of palm oil with CVD. A healthy overall diet should still be prioritised for good cardiometabolic health.
Dietary intake of antioxidants and fats in the context of coronary heart disease prevention among elderly people.
Annals of agricultural and environmental medicine : AAEM. 2018;25(1):131-136
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Coronary heart disease (CHD) remains the leading cause of mortality in developed countries and is rapidly becoming a dominant cause of all deaths worldwide. The most important modifiable risk factor for cardiovascular disease is diet. A diet which includes non-hydrogenated unsaturated fats as the predominant form of dietary fat, whole grains as the main form of carbohydrates, an abundance of fruits and vegetables and adequate omega-3 fatty acids, can offer significant protection against CHD. The primary aim of the study was to estimate a diet's antioxidant capacity and assess the hierarchy of contribution of particular food products to a Dietary Antioxidant Index (DAI). The study included 143 men and women aged 65-80 who were independent and without any physical or mental disability. On average, the DAI of study participants was low, with fruit having the largest contribution. In comparison to results obtained in a previous report by the same authors, the study showed that the participants consumed too little antioxidant food, as well as grains and cereal-based products, fresh herbs and beverages. This study recommends that the elderly population should be advised to consume a well-balanced diet rich in antioxidants originating from fresh fruit, vegetables and wholegrains to reduce the risk of CHD.
INTRODUCTION Some literature data indicate that the proper intake of exogenic antioxidants from food and the proper intake of fats can offer significant protection against coronary heart disease. OBJECTIVES The estimation of total antioxidant capacity of food intake on the basis of Dietary Antioxidant Index (DAI), together with an assessment of the contribution of particular food products in DAI, and the evaluation of consumption of all dietary fats and frequency of consumption of products that are a source of fats among elderly people in Krakow, Poland. MATERIAL AND METHODS 143 persons (73 women and 70 men) aged 65-80 were studied. None of them was under specialist medical control, including cardiological control. DAI was investigated on the basis of the Food Frequency Questionnaire (FFQ) which included 145 food items. DAI was measured using the method by Benzi and expressed as FRAP (the ability to reduce Fe3+ to Fe2+, measured in mMol/l). The daily intake of fats was estimated using the 24-h nutritional recall. The frequency of fats consumption was estimated with the usage of FFQ. For statistical analysis, χ2 test was used. RESULTS The mean value of DAI of all studied persons was 34.27 + 11.72 mMol/l. The largest percentage of those studied had FRAP values in the range 25-35 mMol/l. The highest contribution in the total DAI value was found in fruit (36.2%), grains and cereal-based products (23.6%), and beverages (24.0%). The consumption of vegetables was on the fourth position (7.1%). The contribution of the remaining food products was low. The consumption of total fats (about 70g/24h) and saturated fatty acids (14% of energetic value) exceeded the recommendations. The participation of mono-and polyunsaturated fatty acids in the diets was not in accordance with recommendations. The most frequently consumed fats were animal fats (sausages, butter) and cakes, but the consumption of vegetable oils, fish, nuts and seeds of oil plants was too low. CONCLUSIONS The majority of elderly people made mistakes in their nutrition. The enrichment in natural antioxidants of the diets of elderly people and the normalization of their fats consumption should become an important element of primary and secondary prophylaxis of cardiovascular diseases.
The Association between Mediterranean Diet and the Risk of Falls and Physical Function Indices in Older Type 2 Diabetic People Varies by Age.
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Diabetes is associated with high risk for disability, and accelerated rate of decline in physical capacity. The aim of the study is to examine whether a higher adherence to a Mediterranean Diet in a Mediterranean country is associated with walking speed, better physical function and decreased risk for falls. This cross-sectional study includes data of 117 individuals, of which 40% were females, with Type 2 diabetes aged over 60 years. Results indicate that those individuals with a higher adherence to the Mediterranean Diet were at lower risk for falls and had greater muscle strength. The relationship between physical performance measured by walking speed, walking distance and Mediterranean Diet differed by age. Authors conclude that there is an association between the balances indices, risk for falls, muscle strength, aerobic capacity, and Mediterranean Diet among 60+ individuals with diabetes.
BACKGROUND AND AIMS Diabetes and dysglycemia increase the risk of frailty and decreased physical abilities. Adherence to the Mediterranean Diet (MD) may reduce this risk. We hypothesized that adherence to the MD is associated with physical function in older type-2 diabetic patients and that the association is stratified by age. METHODS AND RESULTS We recruited type-2 diabetes patients aged >60 years at the Center for Successful Aging with Diabetes at Sheba Medical Center. Health status and demographic data were obtained from medical records. Food Frequency Questionnaire was used for nutritional assessment and calculation of MD score. Physical function indices were determined by a physiotherapist and included: Berg Balance test, Timed Get-Up-and-Go, 6-min walk (6 MW), 10-m walk (10 MW), Four Square Step Test, 30-s chair stand and Grip strength, and activities and instrumental activities of daily living. Among 117 participants (age 70.6 ± 6.5), high adherence to MD was associated with better score on functional tests (low vs. high MD adherence: 9.7% vs. 25%, ANOVA = 0.02). A significant age by MD interaction was found: a higher adherence to MD was associated with a better 6 MW (low vs. high: 387 ± 35 m vs. 483 ± 26 m; = 0.001) and higher 10 MW (low vs. high: 1.8 ± 0.16 m/s vs. 2.0 ± 0.13 m/s; = 0.02) in participants aged >75 years. These associations remained significant after controlling for gender, age, BMI, and physical activity. CONCLUSION In the current study, we showed relationships between strength, physical performance, and MD among older diabetic patients. Future studies are needed to confirm this association and establish temporal relationships.
Spices and Atherosclerosis.
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Cardiovascular disease (CVD) is one of the leading causes of death and disability in the world. Atherosclerosis, characterised by the accumulation of fat and inflammation in blood vessels, is the main feature of CVD. Common spices such as pepper, ginger, garlic, onion, cinnamon and chilli may have effects on the initiation and development of atherosclerosis. In this review, the authors focused on the potential protective effects of spices, in atherosclerosis and CVD. Most studies to date have been carried out either in cell culture or in animals. These have revealed various potential mechanisms by which spices exert their beneficial effects, including anti-oxidant, anti-atherogenic, anti-coagulant, anti-inflammatory and cholesterol-lowering properties. There are some human studies evaluating the effects of spices on high blood pressure. Although saffron, turmeric, and chilli pepper had no effect on blood pressure, cinnamon demonstrated significant blood pressure lowering effects in patients with diabetes. Garlic has been shown to have the potential to reduce blood pressure in patients with high blood pressure. These studies provide information on the beneficial roles of spices in reducing cardiovascular risk factors. The types of spices consumed vary across cultures, and currently there are no available population studies showing that consumption of spices is associated with reduction of CVD nor any recommendations for the amounts of spices to be consumed. The authors conclude that the consumption of spices should be encouraged across countries to promote good health.
Cardiovascular disease is one of the leading causes of death and disability in the world. Atherosclerosis, characterized by lipid accumulation and chronic inflammation in the vessel wall, is the main feature of cardiovascular disease. Although the amounts of fruits and vegetables present in the diets vary by country, diets, worldwide, contain large amounts of spices; this may have positive or negative effects on the initiation and development of atherosclerosis. In this review, we focused on the potential protective effects of specific nutrients from spices, such as pepper, ginger, garlic, onion, cinnamon and chili, in atherosclerosis and atherosclerotic cardiovascular disease. The mechanisms, epidemiological analysis, and clinical studies focusing on a variety of spices are covered in this review. Based on the integrated information, we aimed to raise specific recommendations for people with different dietary styles for the prevention of atherosclerotic cardiovascular disease through dietary habit adjustments.
Associations between Yogurt Consumption and Weight Gain and Risk of Obesity and Metabolic Syndrome: A Systematic Review.
Advances in nutrition (Bethesda, Md.). 2017;8(1):146S-154S
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According to the WHO, overweight and obesity is defined as an excessive or abnormal fat accumulation that may affect human health. The prevalence of metabolic syndrome is growing which is mainly due to sedentary lifestyles, as well as the increasing prevalence of obesity. The aim of the study was to analyse the relation between yoghurt consumption and changes in weight or waist circumference and the risk of becoming overweight, obese or develop metabolic syndrome. This study is a systemic review based on 10 cohort studies, 1 of which included the results of 3 cohort studies. Results demonstrate that there was no detrimental affect of yoghurt consumption on weight status or on the risk of developing metabolic syndrome. The study also showed that high consumption of yoghurt in tandem with high consumption of fruit may be inversely associated with the development of metabolic syndrome. Authors conclude that further prospective studies and high-quality randomised control trials are required in order to confirm that yoghurt consumption may contribute to a reduction in adiposity indexes and the risk of metabolic syndrome.
The role of yogurt consumption in the risk of developing overweight, obesity, or metabolic syndrome has been the subject of epidemiologic studies over the last 10 y. A comprehensive literature search on MEDLINE and ISI Web of Knowledge from 1966 through June 2016 was conducted to examine the relation between yogurt consumption and weight gain, as well as the risk of overweight, obesity, or metabolic syndrome, in prospective cohort studies. Ten articles met all the inclusion criteria and were included in our systematic review. Of the 10 cohort studies, 3 analyzed the relation between yogurt consumption and the risk of overweight or obesity, 8 analyzed changes in waist circumference or weight changes, 3 studied the association with the risk of developing metabolic syndrome, and 1 studied the probability of abdominal obesity reversion. Although an inverse association between yogurt consumption and the risk of developing overweight or obesity was not fully consistent or always statistically significant, all studies but one showed in their point estimates inverse associations between yogurt consumption and changes in waist circumference, changes in weight, risk of overweight or obesity, and risk of metabolic syndrome during follow-up, although not all estimates were statistically significant (2 studies). Prospective cohort studies consistently suggested that yogurt consumption may contribute to a reduction in adiposity indexes and the risk of metabolic syndrome. Therefore, there is a need for more prospective studies and high-quality randomized clinical trials to confirm this apparent inverse association.