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Interventions to Promote Healthy Meals in Full-Service Restaurants and Canteens: A Systematic Review and Meta-Analysis.
Mandracchia, F, Tarro, L, Llauradó, E, Valls, RM, Solà, R
Nutrients. 2021;(4)
Abstract
Out-of-home eating is increasing, but evidence about its healthiness is limited. The present systematic review and meta-analysis aimed to elucidate the effectiveness of full-service restaurant and canteen-based interventions in increasing the dietary intake, food availability, and food purchase of healthy meals. Studies from 2000-2020 were searched in Medline, Scopus, and Cochrane Library using the PRISMA checklist. A total of 35 randomized controlled trials (RCTs) and 6 non-RCTs were included in the systematic review and analyzed by outcome, intervention strategies, and settings (school, community, workplace). The meta-analysis included 16 RCTs (excluding non-RCTs for higher quality). For dietary intake, the included RCTs increased healthy foods (+0.20 servings/day; 0.12 to 0.29; p < 0.001) and decreased fat intake (-9.90 g/day; -12.61 to -7.19; p < 0.001), favoring the intervention group. For food availability, intervention schools reduced the risk of offering unhealthy menu items by 47% (RR 0.53; 0.34 to 0.85; p = 0.008). For food purchases, a systematic review showed that interventions could be partially effective in improving healthy foods. Lastly, restaurant- and canteen-based interventions improved the dietary intake of healthy foods, reduced fat intake, and increased the availability of healthy menus, mainly in schools. Higher-quality RCTs are needed to strengthen the results. Moreover, from our results, intervention strategy recommendations are provided.
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Gamification for the Improvement of Diet, Nutritional Habits, and Body Composition in Children and Adolescents: A Systematic Review and Meta-Analysis.
Suleiman-Martos, N, García-Lara, RA, Martos-Cabrera, MB, Albendín-García, L, Romero-Béjar, JL, Cañadas-De la Fuente, GA, Gómez-Urquiza, JL
Nutrients. 2021;(7)
Abstract
Currently, one of the main public health problems among children and adolescents is poor adherence to healthy habits, leading to increasingly high rates of obesity and the comorbidities that accompany obesity. Early interventions are necessary, and among them, the use of gamification can be an effective method. The objective was to analyse the effect of game-based interventions (gamification) for improving nutritional habits, knowledge, and changes in body composition. A systematic review and meta-analysis were performed in CINAHL, EMBASE, LILACS, MEDLINE, SciELO, and Scopus databases, following the PRISMA recommendations. There was no restriction by year of publication or language. Only randomized controlled trials were included. Twenty-three articles were found. After the intervention, the consumption of fruit and vegetables increased, as well as the knowledge on healthy food groups. The means difference showed a higher nutritional knowledge score in the intervention group 95% CI 0.88 (0.05-1.75). No significant effect of gamification was found for body mass index z-score. Gamification could be an effective method to improve nutritional knowledge about healthier nutritional habits. Promoting the development of effective educational tools to support learning related to nutrition is necessary in order to avoid and prevent chronic diseases.
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The effect of meal frequency on biochemical cardiometabolic factors: A systematic review and meta-analysis of randomized controlled trials.
Abdollahi, S, Kazemi, A, de Souza, RJ, Clark, CCT, Soltani, S
Clinical nutrition (Edinburgh, Scotland). 2021;(5):3170-3181
Abstract
BACKGROUND Although several randomized controlled trials (RCTs) have supported the beneficial effects of higher meal frequency (MF) on cardiometabolic risk factors, the putative effects of higher MF on health remain inconclusive. This study systematically reviewed the evidence from RCTs of the effect of higher compared with lower MF on the blood lipid profile, glucose homeostasis, and adipokines. METHODS PubMed, Scopus, ISI Web of Science, and the Cochrane database were searched up to October 2020 to retrieve relevant RCTs. A DerSimonian and Laird random effects model was used to pool mean differences and 95% CI for each outcome. The quality of studies and evidence was assessed through standard methods. RESULTS Twenty-one RCTs (686 participants) were included in this meta-analysis. Overall results showed a significant improvement in total cholesterol [weighted mean difference (WMD) = -6.08 mg/dl; 95% CI: -10.68, -1.48; P = 0.01; I2 = 88%], and low-density cholesterol (LDL-C) (WMD = -6.82 mg/dl; 95% CI: -10.97, -1.60; P = 0.009; I2 = 85.7%), while LDL-C to high-density cholesterol ratio (LDL-C: HDL-C) increased (WMD = 0.22; 95% CI: 0.07, 0.36; P = 0.003; I2 = 0.0%) in higher MF vs. lower MF. No significant effects were found on measures of glycemic control, apolipoproteins-A1 and B, or leptin. In subgroup analyses, higher MF significantly reduced serum triglyceride (TG), and increased HDL-C, compared with lower MF in interventions > 12 weeks, and decreased serum TC and LDL-C in healthy participants. A significant reduction in LDL-C also was observed in studies where the same foods given both arms, simply divided into different feeding occasions, and in feeding studies, following higher MF compared to lower MF. CONCLUSION Our meta-analysis found that higher, compared with lower MF may improve total cholesterol, and LDL-C. The intervention does not affect measures of glycemic control, apolipoproteins-A1 and B, or leptin. However, the GRADE ratings of low credibility of the currently available evidence highlights the need for more high-quality studies in order to reach a firm conclusion.
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Relation of Different Fruit and Vegetable Sources With Incident Cardiovascular Outcomes: A Systematic Review and Meta-Analysis of Prospective Cohort Studies.
Zurbau, A, Au-Yeung, F, Blanco Mejia, S, Khan, TA, Vuksan, V, Jovanovski, E, Leiter, LA, Kendall, CWC, Jenkins, DJA, Sievenpiper, JL
Journal of the American Heart Association. 2020;(19):e017728
Abstract
Background Public health policies reflect concerns that certain fruit sources may not have the intended benefits and that vegetables should be preferred to fruit. We assessed the relation of fruit and vegetable sources with cardiovascular outcomes using a systematic review and meta-analysis of prospective cohort studies. Methods and Results MEDLINE, EMBASE, and Cochrane were searched through June 3, 2019. Two independent reviewers extracted data and assessed study quality (Newcastle-Ottawa Scale). Data were pooled (fixed effects), and heterogeneity (Cochrane-Q and I2) and certainty of the evidence (Grading of Recommendations Assessment, Development, and Evaluation) were assessed. Eighty-one cohorts involving 4 031 896 individuals and 125 112 cardiovascular events were included. Total fruit and vegetables, fruit, and vegetables were associated with decreased cardiovascular disease (risk ratio, 0.93 [95% CI, 0.89-0.96]; 0.91 [0.88-0.95]; and 0.94 [0.90-0.97], respectively), coronary heart disease (0.88 [0.83-0.92]; 0.88 [0.84-0.92]; and 0.92 [0.87-0.96], respectively), and stroke (0.82 [0.77-0.88], 0.82 [0.79-0.85]; and 0.88 [0.83-0.93], respectively) incidence. Total fruit and vegetables, fruit, and vegetables were associated with decreased cardiovascular disease (0.89 [0.85-0.93]; 0.88 [0.86-0.91]; and 0.87 [0.85-0.90], respectively), coronary heart disease (0.81 [0.72-0.92]; 0.86 [0.82-0.90]; and 0.86 [0.83-0.89], respectively), and stroke (0.73 [0.65-0.81]; 0.87 [0.84-0.91]; and 0.94 [0.90-0.99], respectively) mortality. There were greater benefits for citrus, 100% fruit juice, and pommes among fruit sources and allium, carrots, cruciferous, and green leafy among vegetable sources. No sources showed an adverse association. The certainty of the evidence was "very low" to "moderate," with the highest for total fruit and/or vegetables, pommes fruit, and green leafy vegetables. Conclusions Fruits and vegetables are associated with cardiovascular benefit, with some sources associated with greater benefit and none showing an adverse association. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03394339.
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Behavioral factors influencing childhood obesity: a systematic review and meta-analysis.
Poorolajal, J, Sahraei, F, Mohamdadi, Y, Doosti-Irani, A, Moradi, L
Obesity research & clinical practice. 2020;(2):109-118
Abstract
BACKGROUND This report provides information on 14 behavioral and nutritional factors that can be addressed in childhood overweight/obesity prevention programs. METHODS Web of Science, PubMed, and Scopus were searched through November 2018. Reference lists were also screened for additional references. Observational studies addressing the associations between overweight/obesity in children/adolescents aged between 5 to 19 years and associated risk factors were analyzed. Between-studies heterogeneity was assessed by χ2, τ2, and I2 statistics. The likelihood of publication bias was evaluated using the Begg and Egger tests and trim & fill analysis. Effect sizes were expressed as odds ratios (ORs) with 95% confidence intervals (CIs) using a random-effects model. RESULTS Of 34,537 retrieved studies, 199 including 1,636,049 participants were eligible. The ORs (95% CI) of factors associated with childhood overweight/obesity were as follows: sufficient physical activity 0.70 (0.66, 0.75); eating breakfast every day 0.66 (0.59, 0.74); sufficient consumption of fruits/vegetables 0.92 (0.84, 1.01); breastfeeding <4 months 1.24 (1.16, 1.33); inadequate sleep 1.26 (1.13, 1.40); watching TV >1-2 h/day 1.42 (1.35, 1.49); playing computer games >2 h/day 1.08 (0.95, 1.23); eating sweets ≥3 times/week 0.78 (0.71, 0.85); eating snack ≥4 times/week 0.84 (0.71, 1.00); drinking sugar-sweetened beverages ≥4 times/week 1.24 (1.07, 1.43); eating fast-food ≥3 times/week 1.03 (0.89, 1.18); eating fried-food ≥3 times/week 1.09 (0.90, 1.33); smoking 1.17 (1.07, 1.29); and drinking alcohol 1.05 (0.95, 1.16). CONCLUSIONS This meta-analysis provided a clear picture of the behavioral and nutritional factors associated with weight gain in children.
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Skipping breakfast is associated with overweight and obesity: A systematic review and meta-analysis.
Ma, X, Chen, Q, Pu, Y, Guo, M, Jiang, Z, Huang, W, Long, Y, Xu, Y
Obesity research & clinical practice. 2020;(1):1-8
Abstract
OBJECTIVE In recent years, many original studies have shown that skipping breakfast has been associated with overweight and obesity; however, the results of different studies are inconsistent. Therefore, we conducted a systematic review and meta-analysis of observational studies to synthesize the associations between skipping breakfast and the risk of overweight/ obesity. METHODS We did a systematic search using Pubmed, and Ovid searched up to August 2019. Observational studies (cohort studies and cross-sectional studies) reporting adjusted Odds Ratio or Risk Ratio estimates for the association between breakfast skipping and overweight/obesity (including abdominal obesity). Summary odds ratio (or Risk Ratio) and 95% confidence intervals calculated with a random-effects model. RESULTS 45 observational studies (36 cross-sectional studies and 9 cohort studies) were included in this meta-analysis. In cross-sectional studies, The ORs of low frequency breakfast intake per week versus high frequency were 1.48 (95% CI 1.40-1.57; I2=54.0%; P=0.002) for overweight/obesity, 1.31 (95% CI 1.17-1.47; I2=43.0%; P=0.15) for abdominal obesity. In cohort studies, The RR of low-frequency breakfast intake per week versus high frequency was 1.44 (95% CI 1.25-1.66; I2=61%; P=0.009) for overweight/obesity. CONCLUSIONS This meta-analysis confirmed that skipping breakfast is associated with overweight/obesity, and skipping breakfast increases the risk of overweight/obesity. The results of cohort studies and cross-sectional studies are consistent. There is no significant difference in these results among different ages, gender, regions, and economic conditions.
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Obesity has limited behavioural overlap with addiction and psychiatric phenotypes.
Vainik, U, Misic, B, Zeighami, Y, Michaud, A, Mõttus, R, Dagher, A
Nature human behaviour. 2020;(1):27-35
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Abstract
Obesity is a widespread health condition1, likely to be driven by the increased availability of inexpensive high-calorie food2. People vary greatly in their behavioural response to food. Such variation is likely to be driven by behavioural styles3,4, as behaviour accounts for overall food intake5. A prominent hypothesis is that people with obesity respond to rewards similarly to people with addictions such as alcohol abuse or smoking6,7. For instance, perceived overeating or 'uncontrolled eating' (UE) is the most common obesity-associated personality trait8 and resembles the perceived loss of control seen in drug addiction. Likewise, both obesity and addictive behaviours have similar correlations with broad personality domains3. Here we seek to empirically test whether obesity and UE overlap behaviourally with addiction and psychiatric disorders, collectively referred to as phenotypes. We test for behavioural similarity by linking the personality profiles of each phenotype. NEO Personality Inventory profiles of 28 phenotypes were extracted from 22 studies, encompassing summary statistics from 18,611 unique participants. Obesity had moderate and UE high behavioural similarity with addictions. UE also overlapped behaviourally with most psychiatric phenotypes, whereas obesity was behaviourally similar with mood disorders and certain personality disorders. Facet-based phenotype profiles provided more information than domain-based profiles.
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The effect of screen advertising on children's dietary intake: A systematic review and meta-analysis.
Russell, SJ, Croker, H, Viner, RM
Obesity reviews : an official journal of the International Association for the Study of Obesity. 2019;(4):554-568
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Evidence indicates that screen advertising for unhealthy food results in significant increases in dietary intake among children. This review was undertaken with the main aim of estimating the quantitative effect of screen advertising in experimental and nonexperimental conditions on children's dietary intake. Systematic searches were undertaken of interdisciplinary databases. Studies from 1980 to April 2018, all geography and languages, were included; participants were children and adolescents aged between 2 and 18 years; the intervention was screen advertising; and the outcome was dietary intake. Meta-analyses were conducted for measured and nonmeasured outcomes. Food advertising was found to increase dietary intake among children (age range 2-14, mean 8.8 years) in experimental conditions for television (TV) advertising and advergames. Meta-analysis revealed that children exposed to food advertising on TV (11 studies) and advergames (five studies) respectively consumed an average 60.0 kcal (95% confidence interval [CI], 3.1-116.9) and 53.2 kcal (95% CI, 31.5-74.9) more than children exposed to nonfood advertising. There was also an effect by body mass index (BMI). Findings from nonexperimental studies revealed that exposure to TV food advertising was positively associated with and predictive of dietary intake in children. Short-term exposure to unhealthy food advertising on TV and advergames increases immediate calorie consumption in children.
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A Meta-Analysis of Food Labeling Effects on Consumer Diet Behaviors and Industry Practices.
Shangguan, S, Afshin, A, Shulkin, M, Ma, W, Marsden, D, Smith, J, Saheb-Kashaf, M, Shi, P, Micha, R, Imamura, F, et al
American journal of preventive medicine. 2019;(2):300-314
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CONTEXT The influence of food and beverage labeling (food labeling) on consumer behaviors, industry responses, and health outcomes is not well established. EVIDENCE ACQUISITION PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Ten databases were searched in 2014 for studies published after 1990 evaluating food labeling and consumer purchases/orders, intakes, metabolic risk factors, and industry responses. Data extractions were performed independently and in duplicate. Studies were pooled using inverse-variance random effects meta-analysis. Heterogeneity was explored with I2, stratified analyses, and meta-regression; and publication bias was assessed with funnel plots, Begg's tests, and Egger's tests. Analyses were completed in 2017. EVIDENCE SYNTHESIS From 6,232 articles, a total of 60 studies were identified, including 2 million observations across 111 intervention arms in 11 countries. Food labeling decreased consumer intakes of energy by 6.6% (95% CI= -8.8%, -4.4%, n=31), total fat by 10.6% (95% CI= -17.7%, -3.5%, n=13), and other unhealthy dietary options by 13.0% (95% CI= -25.7%, -0.2%, n=16), while increasing vegetable consumption by 13.5% (95% CI=2.4%, 24.6%, n=5). Evaluating industry responses, labeling decreased product contents of sodium by 8.9% (95% CI= -17.3%, -0.6%, n=4) and artificial trans fat by 64.3% (95% CI= -91.1%, -37.5%, n=3). No significant heterogeneity was identified by label placement or type, duration, labeled product, region, population, voluntary or legislative approaches, combined intervention components, study design, or quality. Evidence for publication bias was not identified. CONCLUSIONS From reviewing 60 intervention studies, food labeling reduces consumer dietary intake of selected nutrients and influences industry practices to reduce product contents of sodium and artificial trans fat.
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Cognitive training on eating behaviour and weight loss: A meta-analysis and systematic review.
Yang, Y, Shields, GS, Wu, Q, Liu, Y, Chen, H, Guo, C
Obesity reviews : an official journal of the International Association for the Study of Obesity. 2019;(11):1628-1641
Abstract
Cognitive deficits play a role in the development and maintenance of overeating and obesity, and cognitive training in obesity refers to a family of interventions aimed at reducing overeating and obesity by improving these cognitive deficits. In this review, we synthesize the current literature on these issues by conducting a meta-analysis of studies investigating the effects of cognitive trainings on eating behaviour and presenting a systematic review of studies investigating the effects of cognitive trainings on weight loss. We examined 66 independent experiments that examined the effects of cognitive training aimed at reducing cognitive bias or improving executive control on eating behaviour and weight loss. Overall, inhibition training, attention bias modification training, and episodic future thinking training significantly influenced eating behaviour; however, approach/avoidance training did not significantly influence eating behaviour. Moderator analyses indicated that the effect of inhibition training on eating behaviour was moderated by training task and food novelty, the effect of approach/avoidance training was moderated by food type, and the effect of episodic future thinking training was moderated by type of episodic future thinking. Literature reviewed on cognitive training and weight loss provided preliminary support for the effects of food-specific inhibition training on weight loss from pre-intervention to post intervention. However, because most of the included studies focused on short-term outcomes in normal-weight samples, longer duration studies in clinical populations (eg, individuals with obesity) are needed to examine the generalizability of these results.