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Moderate-Intensity Aerobic vs Resistance Exercise and Dietary Modification in Patients With Nonalcoholic Fatty Liver Disease: A Randomized Clinical Trial.
Charatcharoenwitthaya, P, Kuljiratitikal, K, Aksornchanya, O, Chaiyasoot, K, Bandidniyamanon, W, Charatcharoenwitthaya, N
Clinical and translational gastroenterology. 2021;(3):e00316
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Abstract
INTRODUCTION This randomized trial aimed to compare the effects of moderate-intensity aerobic vs resistance exercise with dietary modification in patients with nonalcoholic fatty liver disease (NAFLD). METHODS Patients with NAFLD were randomly assigned (1:1) to a 12-week supervised training program of moderate-intensity aerobic or resistance exercise with dietary intervention consisting of monthly individual nutritional counseling by a dietician. Transient elastography, anthropometry, body composition, cardiorespiratory fitness, biochemistries, and glucose tolerance were measured at baseline and 12 weeks. RESULTS Eighteen subjects exercised for an average of 3.35 ± 0.30 sessions a week in the aerobic group, and 17 subjects exercised an average of 3.39 ± 0.28 sessions a week in the resistance group. After completion of the training program, hepatic fat content was similarly reduced in both groups (P < 0.001). The mean relative reduction from baseline in the aerobic group was -10.3% (95% confidence interval -18.2 to -2.40) and the resistance group was -12.6% (-20.5 to -4.69). Liver steatosis (defined as controlled attenuation parameter >248 dB/m) disappeared in 9 (50%) of the aerobic group and in 9 (53%) of the resistance group. Whole-body and muscle insulin sensitivity indexes were improved, and waist circumference was reduced comparably in both exercise groups. The number of exercise sessions per week was correlated with the absolute reduction in hepatic fat content (r = 0.52; P = 0.001). Weekly exercise training ≥3 sessions substantially attenuates liver fat accumulation independent of weight loss. DISCUSSION Moderate-intensity aerobic training and resistance training with dietary modification are equally effective for reducing intrahepatic fat and improving underlying insulin resistance among patients with NAFLD.
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Impact of ENHANCED (diEtitiaNs Helping pAtieNts CarE for Diabetes) Telemedicine Randomized Controlled Trial on Diabetes Optimal Care Outcomes in Patients with Type 2 Diabetes.
Benson, GA, Sidebottom, A, Hayes, J, Miedema, MD, Boucher, J, Vacquier, M, Sillah, A, Gamam, S, VanWormer, JJ
Journal of the Academy of Nutrition and Dietetics. 2019;(4):585-598
Abstract
BACKGROUND Clinical care for type 2 diabetes has improved but remains suboptimal. Collaborative, team-based models that maximize skills of different disciplines may improve care for individuals with diabetes, but few have been tested using rigorous research designs. OBJECTIVE To investigate the efficacy of a registered dietitian nutritionist-led telemedicine program compared with that of a control group in terms of diabetes optimal care goals. DESIGN A randomized controlled trial in which participants were assigned to a control or intervention group. PARTICIPANTS/SETTING One hundred eighteen adults with type 2 diabetes (mean age, 60 years; 45% female) participated in the study between April 2016 and December 2017. Participants were recruited from separate primary care clinics in two rural Minnesota communities. INTERVENTION For those assigned to the intervention, registered dietitian nutritionists used a treatment protocol to initiate and titrate therapies for blood glucose, hypertension, and lipid levels in addition to providing medical nutrition therapy; telemedicine visits supplemented usual care. MAIN OUTCOME MEASURES Primary outcomes included composite and individual diabetes optimal care goals: hemoglobin A1c, blood pressure, not using tobacco, and taking a statin and aspirin (as appropriate). Secondary measures included physical activity, breakfast, fruits and vegetables, whole grains, body mass index, low-density lipoprotein, and medication adherence. STATISTICAL ANALYSIS Mixed-model regression was used to examine outcomes between baseline and 1-year follow-up. RESULTS A modest but significantly greater improvement in the number of diabetes optimal care measures met at follow-up was found in the intervention group (3.7 vs 3.2 in the control group [P=0.017]). Among individual measures, the intervention group had significantly greater medication use, with 2.5 and 2.2 higher odds (compared with the control group) of taking a statin [95% CI, 1.0 to 6.24]) and aspirin [95% CI, 0.90 to 5.19] as appropriate, respectively. CONCLUSIONS ENHANCED (diEtitiaNs Helping pAtieNts CarE for Diabetes) findings suggest that registered dietitian nutritionists following medication treatment protocols can effectively improve care for adults with type 2 diabetes and can serve an instrumental role as part of the health care team in providing evidence-based, patient-centered care.
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Structured advice provided by a dietitian increases adherence of consumers to diet and lifestyle changes and lowers blood low-density lipoprotein (LDL)-cholesterol: the Increasing Adherence of Consumers to Diet & Lifestyle Changes to Lower (LDL) Cholesterol (ACT) randomised controlled trial.
Sialvera, TE, Papadopoulou, A, Efstathiou, SP, Trautwein, EA, Ras, RT, Kollia, N, Farajian, P, Goumas, G, Dimakopoulos, I, Papavasiliou, K, et al
Journal of human nutrition and dietetics : the official journal of the British Dietetic Association. 2018;(2):197-208
Abstract
BACKGROUND Evidence from healthcare professionals suggest that consumer compliance to healthy diet and lifestyle changes is often poor. The present study investigated the effect of advice provided by a physician or dietitian on consumer adherence to these measures combined with consuming foods with added plant sterols (PS) with the aim of lowering low-density lipoprotein cholesterol (LDL-C). METHODS One hundred mildly-to-moderately hypercholesterolaemic individuals were enrolled into a parallel, randomised, placebo-controlled study. Dietitians (dietitian group; DG) advised 50 individuals in six weekly face-to-face behavioural therapy sessions, whereas the other 50 received standard advice from physicians (physician group, PG). Both groups consumed foods with added PS (three servings a day) for 6 weeks. Subsequently, all individuals were followed-up for another 6 weeks under real-life conditions. Blood lipids were measured at baseline and weeks 6 and 12 and 3-day diet diaries were taken at weeks 1, 6 and 12. RESULTS Individuals in the DG significantly improved their dietary habits, physical activity and increased PS intake compared to the PG. After 6 weeks, LDL-C decreased in both groups compared to baseline without any significant differences between groups. At week 12, LDL-C was further significantly improved only in the DG (P = 0.006) compared to week 6. Total cholesterol, LDL-C and triglycerides were significantly lower in the DG compared to the PG at week 12 after adjusting for levels at week 6 (P < 0.001, P < 0.001 and P = 0.009, respectively). CONCLUSIONS Although structured counselling by dietitians and common standard advice by physicians were equally effective with respect to improving blood cholesterol after 6 weeks, dietitians were more effective in the longer-term (i.e. 6 weeks after the end of the intervention period).
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The efficacy of a nutrition education intervention to prevent risk of malnutrition for dependent elderly patients receiving Home Care: A randomized controlled trial.
Fernández-Barrés, S, García-Barco, M, Basora, J, Martínez, T, Pedret, R, Arija, V, ,
International journal of nursing studies. 2017;:131-141
Abstract
OBJECTIVE To assess the effect of a nutrition education intervention included in the Home Care Program for caregivers to prevent the increasing risk of malnutrition of dependent patients at risk of malnutrition. DESIGN Randomized controlled multicenter trial of 6 months of duration and 12 months follow-up. SETTINGS 10 Primary Care Centers, Spain. PARTICIPANTS Patients enrolled in the Home Care Program between January 2010 and March 2012, who were dependent and at risk of malnutrition, older than 65, and had caregivers (n=190). INTERVENTION The nurses conducted initial educational intervention sessions for caregivers and then monitored at home every month for 6 months. MEASUREMENTS The nutritional status was assessed using the Mini Nutritional Assessment test (primary outcome), diet, anthropometry, and biochemical parameters (albumin, prealbumin, hemoglobin and cholesterol). Other descriptive and outcome measures were recorded: current medical history, Activities of daily living (Barthel test), cognitive state (Pfeiffer test), and mood status (Yesavage test). All the measures were recorded in a schedule of 0-6-12 months. RESULTS 173 individuals participated after exclusions (intervention n=101; control n=72). Mean age was 87.8±8.9years, 68.2% were women. Difference were found between the groups for Mini Nutritional Assessment test score change (repeated measures ANOVA, F=10.1; P<0.001), the intervention improved the Mini Nutritional Assessment test score of the participants in the intervention group. The egg consumption (F=4.1; P=0.018), protein intake (F=3.0; P=0.050), polyunsaturated fatty acid intake (F=5.3; P=0.006), folate (F=3.3; P=0.041) and vitamin E (F=6.4; P=0.002) showed significant group×time interactions. CONCLUSION A nutrition education intervention for caregivers halted the tendency of nutritional decline, and reduced the risk of malnutrition of older dependent patients. TRIAL REGISTRATION Clinical Trial Registration-URL: www.clinicaltrials.gov. Identifier: NCT01360775.
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A randomized pilot trial of dietary modification for the chemoprevention of noninvasive bladder cancer: the dietary intervention in bladder cancer study.
Parsons, JK, Pierce, JP, Natarajan, L, Newman, VA, Barbier, L, Mohler, J, Rock, CL, Heath, DD, Guru, K, Jameson, MB, et al
Cancer prevention research (Philadelphia, Pa.). 2013;(9):971-8
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Abstract
Epidemiological data suggest robust associations of high vegetable intake with decreased risks of bladder cancer incidence and mortality, but translational prevention studies have yet to be conducted. We designed and tested a novel intervention to increase vegetable intake in patients with noninvasive bladder cancer. We randomized 48 patients aged 50 to 80 years with biopsy-proven noninvasive (Ta, T1, or carcinoma in situ) urothelial cell carcinoma to telephone- and Skype-based dietary counseling or a control condition that provided print materials only. The intervention behavioral goals promoted seven daily vegetable servings, with at least two of these as cruciferous vegetables. Outcome variables were self-reported diet and plasma carotenoid and 24-hour urinary isothiocyanate (ITC) concentrations. We used two-sample t tests to assess between-group differences at 6-month follow-up. After 6 months, intervention patients had higher daily intakes of vegetable juice (P = 0.02), total vegetables (P = 0.02), and cruciferous vegetables (P = 0.07); lower daily intakes of energy (P = 0.007), fat (P = 0.002) and energy from fat (P = 0.06); and higher plasma α-carotene concentrations (P = 0.03). Self-reported cruciferous vegetable intake correlated with urinary ITC concentrations at baseline (P < 0.001) and at 6 months (P = 0.03). Although urinary ITC concentrations increased in the intervention group and decreased in the control group, these changes did not attain between-group significance (P = 0.32). In patients with noninvasive bladder cancer, our novel intervention induced diet changes associated with protective effects against bladder cancer. These data show the feasibility of implementing therapeutic dietary modifications to prevent recurrent and progressive bladder cancer.
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Are anti-stigma films a useful strategy for reducing weight bias among trainee healthcare professionals? Results of a pilot randomized control trial.
Swift, JA, Tischler, V, Markham, S, Gunning, I, Glazebrook, C, Beer, C, Puhl, R
Obesity facts. 2013;(1):91-102
Abstract
BACKGROUND Weight bias is an important clinical issue that the educators of tomorrow's healthcare professionals cannot afford to ignore. This study, therefore, aimed to pilot a randomized controlled trial of the effects of educational films designed to reduce weight stigmatization toward obese patients on trainee dietitians' and doctors' attitudes. METHODS A pre-post experimental design with a 6-week follow-up, which consisted of an intervention group (n = 22) and a control group (n = 21), was conducted to assess the efficacy of brief anti-stigma films in reducing weight bias, and to test whether future, larger-scale studies among trainee healthcare professionals are feasible. RESULTS Participants at baseline demonstrated weight bias, on both implicit and explicit attitude measures, as well as strong beliefs that obesity is under a person's control. The intervention films significantly improved explicit attitudes and beliefs toward obese people, and participant evaluation was very positive. The intervention did not significantly improve implicit anti-fat bias. CONCLUSION The current study suggests both that it is possible to conduct a substantive trial of the effects of educational films designed to reduce weight stigma on a larger cohort of trainee healthcare professionals, and that brief educational interventions may be effective in reducing stigmatizing attitudes in this population.
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Use of MyPyramid Menu Planner for Moms in a weight-loss intervention during lactation.
Colleran, HL, Lovelady, CA
Journal of the Academy of Nutrition and Dietetics. 2012;(4):553-8
Abstract
The Internet offers a valuable resource for promotion of healthy eating and Web-based communication between the dietetics practitioner and client. In a 16-week intervention examining the effects of energy restriction (500 kcal/day) and exercise on body composition in overweight/obese lactating women, MyPyramid Menu Planner for Moms was used to support dietary counseling. Random assignment occurred at 4 weeks postpartum to either an Intervention group (n=14) or Minimal Care group (n=13) from 2008 through 2010. Three 24-hour dietary recalls were obtained using the Nutrition Data System at 4 and 20 weeks postpartum. Individual MyPyramid Menu Planner accounts were created for the Intervention group and used in face-to-face dietary counseling. Repeated measures analysis of variance was used to test for differences between groups for change in dietary intake and weight. Changes in energy, saturated fat, and percent of energy from added sugars were significantly different between Intervention group and Minimal Care group (-613 [521] kcal vs -171 [435] kcal; P=0.03; -14.9 [14.0] g vs +0.9 [13.4] g; P<0.01; and -3.5% [5.3%] vs +2.2% [4.8%]; P<0.01, respectively). The Intervention group significantly increased their whole fruit servings and decreased their total grain and milk servings compared with the Minimal Care group (P<0.05). The Intervention group lost significantly more weight (-5.8 [3.5] kg) than the Minimal Care group (-1.6 [5.4] kg) (P=0.03). Although participants must have access to an Internet-based computer and possess basic food knowledge, these results suggest MyPyramid Menu Planner might prove to be an effective dietary counseling support tool for improving dietary intake and promoting weight loss during lactation.
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E-mail contact as an effective strategy in the maintenance of weight loss in adults.
Thomas, D, Vydelingum, V, Lawrence, J
Journal of human nutrition and dietetics : the official journal of the British Dietetic Association. 2011;(1):32-8
Abstract
BACKGROUND Professional face-to-face contact is known to be beneficial in effective weight management, but costly, in supporting weight maintenance. Within the UK, studies have examined using the Internet to achieve weight loss; however, there is a need to evaluate the use of dietetic intervention via e-mail to support the maintenance of weight loss in a National Health Service (NHS) setting. The present study aimed to assess the effects of dietetic support through e-mail on weight loss maintenance on individuals who were successful in weight loss. METHODS Fifty-five patients, who had lost ≥5% body weight, were assigned to either an intervention group (weekly e-mail messages and monthly personal e-mail message with reporting of weight, n = 28) or a control group (n = 27). The level of weight maintenance, plus dietary changes and the ability to maintain a level of activity, were recorded after 6 months. RESULTS At 6 months, the e-mail group maintained an average weight loss of 10%, which was significantly (P = 0.05) greater than the mean percentage weight loss maintained by the control group (7.3%). The control group regained weight at a statistically significant greater velocity (P = 0.02) than the intervention group. There were correlations between the amount of fruits and vegetables (P = 0.07) eaten and exercise episodes (P = 0.01) against weight change in maintenance. CONCLUSIONS The present study showed that dietetic support using e-mail can be used effectively in reducing weight gain velocity and assisting in the maintenance of weight loss. It is a system that can be used in the UK NHS to reach many people.
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Brief telephone intervention increases soy intake in peri- and postmenopausal US women: the Herbal Alternatives Trial (HALT).
Beasley, JM, Schenk, JM, Ludman, E, Lampe, JW, Reed, SD, Grothaus, L, Newton, KM
Journal of the American Dietetic Association. 2010;(8):1189-97
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OBJECTIVE Effective dietary intervention strategies that can be widely disseminated and have the potential for sustainable dietary modifications are needed. The purpose of this study was to describe and evaluate the effectiveness of a telephone-based soy intervention. DESIGN A randomized controlled trial comparing self-reported intake and serum measures of soy during a 1-year dietary soy (Soy) to fruit and vegetable (Placebo) intervention conducted in two of five arms from the Herbal Alternatives Trial between May 2001 and September 2004. SUBJECTS/SETTING One hundred sixty-three peri- and postmenopausal women (mean age=52 years) consuming self-selected diets in the Pacific Northwest, United States. INTERVENTION Five telephone contacts with a registered dietitian during a 12-month intervention with the goal to increase soy food consumption to two servings daily. MAIN OUTCOME MEASURES Change from baseline in self-reported soy servings and serum isoflavone (daidzein and genistein) concentrations were estimated using analysis of variance and generalized estimating equations. Proportions of participants achieving the intervention goal were compared using chi(2) tests. RESULTS Ninety-four percent (n=74) of participants in the Soy arm and 89% (n=75) in the Placebo arm completed the trial, and slightly more than one third (n=27) received five phone contacts. Mean (+/-standard deviation) intakes of soy were similar for the Soy and Placebo arms at baseline (0.6+/-1.0 vs 0.4+/-0.8 servings/day; P>0.05). At 12-month follow-up visit, mean+/-standard deviation servings of soy per day were 1.6+/-1.4 for the Soy intervention compared to 0.5+/-0.9 within the Placebo arm (P<0.001). There were concomitant increases in serum isoflavones at 3 and 6 months from baseline in the Soy arm only, with approximately twofold increases in both daidzein (mean=66.4 nmol/L, 95% confidence interval [CI]: 39.0 to 93.9 [mean 16.9 ng/mL, 95% CI: 9.9 to 23.8]) and genistein (mean=100.4 nmol/L, 95% CI: 60.9 to 139.9 [mean 27.1 ng/mL, 95% CI: 16.5 to 37.8]) concentrations. Mean weight changed by <1 kg during the 12-month period in each group and physical activity remained stable, suggesting that participants incorporated soy foods into their diet by substituting for non soy foods rather than adding them to their diet. CONCLUSIONS A brief telephone-based intervention with a focused message delivered by a registered dietitian is a feasible approach for encouraging targeted dietary changes, such as an increase in soy intake among peri- and postmenopausal women.
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Weight bias among dietetics students: implications for treatment practices.
Puhl, R, Wharton, C, Heuer, C
Journal of the American Dietetic Association. 2009;(3):438-44
Abstract
BACKGROUND Several studies have examined attitudes about obesity among food and nutrition professionals, yielding mixed results, and no experimental research has tested the impact of dietitians' attitudes on their treatment practices or health evaluations with obese patients. OBJECTIVE This study investigated attitudes of dietetics students toward obese persons and tested whether a patient's body weight influences students' treatment decisions and health evaluations within a randomized experiment. DESIGN Between the months of September and December 2007, a convenience sample of 182 dietetics undergraduate students (92% women; mean age 23.1+/-5.4 years) from colleges throughout the United States completed online self-report surveys to assess weight bias (using the Fat Phobia Scale). Participants were also randomly assigned to read one of four mock health profiles of patients who varied only by weight-related characteristics (eg, obese or average weight) and sex (male or female), and asked to make judgments about the patient's health status and participation in treatment. STATISTICAL ANALYSES PERFORMED To compare group data, multiple analysis of variance was used to test for an effect of the patient's body mass index on participants' health evaluations and their perceptions of patients in each of the four experimental conditions. Correlations were calculated between mean fat phobia scores and perceptions of patients. RESULTS Participants in all conditions expressed a moderate amount of fat phobia (mean=3.7), and students rated obese patients as being less likely to comply with treatment recommendations compared with nonobese patients (P<0.05). Results from multivariate analysis of variance tests showed students also evaluated obese patients' diet quality and health status to be poorer than nonobese patients, despite equivalent nutritional and health information across weight categories for each sex in patient profiles. In contrast, obese and nonobese patients were rated to be similarly motivated, receptive, and successful in treatment. CONCLUSION Implications of these findings for education and intervention in dietetics training are discussed, with emphasis on increasing awareness of weight bias in existing dietetics curricula.