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Gluten-Free Diet: Nutritional Strategies to Improve Eating Habits in Children with Celiac Disease: A Prospective, Single-arm Intervention Study.
Suárez-González, M, Bousoño-García, C, Jiménez-Treviño, S, Díaz-Martín, JJ
Nutrients. 2021;(4)
Abstract
BACKGROUND Elimination of gluten-containing cereals and consumption of ultra-processed gluten-free foods might cause an unbalanced diet, deficient in fiber and rich in sugar and fat, circumstances that may predispose celiac children to chronic constipation. AIM: to evaluate if counseling with a registered dietitian (RD) was capable of improving eating and bowel habits in a celiac pediatric population. METHODS Dietetic, lipid profile and stool modifications were analyzed, comparing baseline assessments with those twelve months after receiving heathy eating and nutrition education sessions. At both time points, 3-day food records, a bowel habit record and a lipid panel were conducted. Calculated relative intake of macro- and micro-nutrients were compared with current recommendations by the European Food Safety Authority (EFSA). Student's paired t-test, McNemar test, Mandasky test and Pearson correlation tests were used. RESULTS Seventy-two subjects (58.3% girls) with a mean (standard deviation (SD)) age of 10.2 (3.4) years were included. Baseline diets were imbalanced in macronutrient composition. Significant improvements were observed in their compliance with dietary reference values (DRVs), where 50% of the subjects met fat requirements after the education and 67% and 49% with those of carbohydrates and fiber, respectively (p < 0.001). Celiac children decreased red meat and ultra-processed foods consumption (p < 0.001) and increased fruits and vegetables intake (p < 0.001), leading to a reduction in saturated fat (p < 0.001) and sugar intake (p < 0.001). Furthermore, 92% of the patients achieved a normal bowel habit, including absence of hard stools in 80% of children constipated at baseline (p < 0.001). CONCLUSIONS RD-led nutrition education is able to improve eating patterns in children with celiac disease (CD).
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The Effect of a Family-Based Lifestyle Education Program on Dietary Habits, Hepatic Fat and Adiposity Markers in 8-12-Year-Old Children with Overweight/Obesity.
Arenaza, L, Medrano, M, Oses, M, Amasene, M, Díez, I, Rodríguez-Vigil, B, Labayen, I
Nutrients. 2020;(5)
Abstract
Healthy lifestyle education programs are recommended for obesity prevention and treatment. However, there is no previous information on the effects of these programs on the reduction of hepatic fat percentage. The aims were (i) to examine the effectiveness of a 22-week family-based lifestyle education program on dietary habits, and (ii) to explore the associations of changes in dietary intake with percent hepatic fat reduction and adiposity in children with overweight/obesity. A total of 81 children with overweight/obesity (aged 10.6 ± 1.1 years, 53.1% girls) and their parents attended a 22-week family based healthy lifestyle and psychoeducational program accompanied with (intensive group) or without (control) an exercise program. Hepatic fat (magnetic resonance imaging), adiposity (dual energy X-ray absorptiometry) and dietary habits (two non-consecutive 24 h-recalls) were assessed before and after the intervention. Energy (p < 0.01) fat (p < 0.01) and added sugar (p < 0.03) intake were significantly reduced in both groups at the end of the program, while, in addition, carbohydrates intake (p < 0.04) was reduced exclusively in the control group, and simple sugar (p < 0.05) and cholesterol (p < 0.03) intake was reduced in the exercise group. Fruit (p < 0.03) and low-fat/skimmed dairy consumption (p < 0.02), the adherence to the Mediterranean Diet Quality Index for children and teenagers (KIDMED, p < 0.01) and breakfast quality index (p < 0.03) were significantly higher in both control and intervention groups after the intervention. Moreover, participants in the exercise group increased the adherence to the Dietary Approaches to Stop Hypertension (DASH) diet (p < 0.001), whereas the ratio of evening-morning energy intake was significantly lower exclusively in the control group after the program (p < 0.02). Changes in energy intake were significantly associated with changes in fat mass index (FMI) in the exercise group, whereas changes in sugar-sweetened beverages (SSB) consumption was associated with percent hepatic fat reduction (p < 0.05) in the control group. A 22-week family-based healthy lifestyle program seems to be effective on improving diet quality and health in children with overweight/obesity and these should focus on SSB avoidance and physical activity.
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Mobile Phone Text Message Intervention on Diabetes Self-Care Activities, Cardiovascular Disease Risk Awareness, and Food Choices among Type 2 Diabetes Patients.
Nepper, MJ, McAtee, JR, Wheeler, L, Chai, W
Nutrients. 2019;(6)
Abstract
This study examines the effects of educational text messages on diabetes self-care activities, cardiovascular disease (CVD) risk awareness, and home food availabilities related to food choices among patients with type 2 diabetes. Quasi-experimental design was used with 40 patients (58.0 ± 10.6 years) in the intervention group and 39 (55.7 ± 12.2 years) in the control group. In addition to the usual care provided for all participants, the intervention group received three educational text messages weekly for 12 weeks. Pre- and post-intervention measures were collected for both groups. Ninety-four percent of the participants receiving text messages indicated the usefulness of this program. The intervention group either maintained the same level or demonstrated small improvements in diabetes self-care activities after the intervention. Significant increases in scores of CVD risk awareness (57% increase; p = 0.04) and availabilities of fresh fruits (320% increase; p = 0.01) and fresh vegetables (250% increase; p = 0.02) in the home and weekly total (16% increase; p = 0.02) and moderate/vigorous (80% increase; p = 0.006) physical activity levels were observed for the intervention group relative to the control group. The pilot results suggest the feasibility and usefulness of the text message program for diabetes education. The study is registered with Clinical Trials.gov (NCT03039569).
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Glycemic Index, Extended Bolusing, and Diabetes Education in Insulin Pump Therapy (GLIDE: A Pilot Study).
Rilstone, S, Reddy, M, Oliver, N
Diabetes technology & therapeutics. 2019;(8):452-455
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Background: There is no published evidence on whether advanced bolus education affects outcomes in insulin pump-treated type 1 diabetes. We assess the feasibility of delivering a clinical education program on rates of digestion and bolusing, and to assess its preliminary impact. Methods: An interactive education session on glycemic index (GI), extended bolusing, and superbolusing was developed and assessed in a nonrandomized single-arm study for 12 weeks. Insulin pump-treated participants with type 1 diabetes were recruited. Glucose outcomes were assessed by blinded continuous glucose monitoring after the consumption of high-fat and high-GI test meal. The primary outcome measure was 8-h glucose area under the curve (AUC) after high-fat meals, before and after intervention. Secondary outcomes included time spent in hypoglycemia, quality of life, treatment satisfaction, HbA1c, frequency of use of extended boluses, and postprandial AUC. Results: Eleven participants completed the study [mean (SD) age 42.3 (12.8) years, baseline HbA1c 57.3 (10.0) mmol/mol, duration of diabetes 19.5 (9.9) years]. AUC for glucose after test meals did not differ significantly after education except for in the first 2 h after the high-GI meal [precourse 83.1 (0.23-88.9), postcourse 5.38 (-16.2 to 50.8)]. Percentage time spent in hypoglycemia (<3.9 and <3.3 mmol/L) fell at week 12 compared with baseline [5.8 (IQR 2.1-8.3) % to 4.3 (IQR 2.1-5.4) %, P = 0.013, and 2.9 (IQR 1.2-3.9) % to 1.6 (IQR 0.7-2.4) %, P = 0.029, respectively]. Conclusion: Delivering an education program to support advanced boluses is feasible and may reduce exposure to hypoglycemia. A further trial is required to confirm the findings.
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Interventional study to improve adherence to phosphate binder treatment in dialysis patients.
Hjemås, BJ, Bøvre, K, Mathiesen, L, Lindstrøm, JC, Bjerknes, K
BMC nephrology. 2019;(1):178
Abstract
BACKGROUND Adherence to phosphate binder treatment is important to prevent high serum phosphate level in chronic dialysis patients. We therefore wanted to investigate patient knowledge, beliefs about and adherence to phosphate binders among these patients and assess whether one-to-one pharmacist-led education and counselling enhance adherence and lead to changes in serum phosphate levels. METHODS A descriptive, interventional, single arm, pre-post study was performed at a hospital in Norway, including chronic dialysis patients aged 18 years or more using phosphate binders. The primary end-point was change in the proportion of patients with serum phosphate below 1.80 mmol/L and the secondary end-points included change in the patient's knowledge, beliefs and adherence after the intervention measured by completion of questionnaires 'Patient Knowledge', Medication Adherence Report Scale (MARS- 5) and Beliefs about Medicines Questionnaire (BMQ). Data was collected both prior to and after one-to-one pharmacist-led education and counselling about their phosphate binders. Other medicines used by the patient was also registered. RESULTS A total of 69 patients were enrolled in the study. After intervention, the probability of serum phosphate being below the target threshold 1.80 mmol/L (5.58 mg/dL) increased, although no significant change in mean serum phosphate levels was seen. On the other hand, the knowledge regarding phosphate binder treatment and the patients' beliefs about the necessity of the treatment increased, while the concerns decreased (BMQ). This effect did not lead to increase in self-reported adherence measured by MARS-5. However the scores were high before the intervention. CONCLUSIONS Short term one-to-one individualized pharmacist-led education and counselling about phosphate binders increased the probability of serum phosphate concentrations being below the target threshold level 1.80 mmol/L (5.58 mg/dL), although not statistically significant. However, it did not decrease the mean serum phosphate level or increase the patients' self-reported adherence. The patients increased their knowledge about the phosphate binder and their understanding of adherence, and were less concerned about the side effects of the medication. TRIAL REGISTRATION ISRCTN52852596 , registered 11 April 2019. The trial was registered retrospectively.
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Decreased Body Mass Index in Schoolchildren After Yearlong Information Sessions With Parents Reinforced With Web and Mobile Phone Resources: Community Trial.
Vilchis-Gil, J, Klünder-Klünder, M, Duque, X, Flores-Huerta, S
Journal of medical Internet research. 2016;(6):e174
Abstract
BACKGROUND The obesity pandemic has now reached children, and households should change their lifestyles to prevent it. OBJECTIVE The objective was to assess the effect of a comprehensive intervention on body mass index z-score (BMIZ) in schoolchildren. METHODS A yearlong study was conducted at 4 elementary schools in Mexico City. Intervention group (IG) and control group (CG) were split equally between governmental and private schools. Three educational in-person parents and children sessions were held at 2-month intervals to promote healthy eating habits and exercise. To reinforce the information, a website provided extensive discussion on a new topic every 2 weeks, including school snack menus and tools to calculate body mass index in children and adults. Text messages were sent to parents' mobile phones reinforcing the information provided. The IG contained 226 children and CG 181 children. We measured their weight and height and calculated BMIZ at 0, 6, and 12 months. RESULTS The CG children showed a change of +0.06 (95% CI 0.01, 0.11) and +0.05 (95% CI 0.01, 0.10) in their BMIZ at 6 and 12 months, respectively. The BMIZ of IG children decreased by -0.13 (95% CI -0.19 to -0.06) and -0.10 (95% CI -0.16 to -0.03), respectively, and the effect was greater in children with obesity. CONCLUSIONS The comprehensive intervention tested had beneficial effects, preserved the BMIZ of normal weight children, and reduced the BMIZ of children with obesity.
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Gender differences in diabetes self-management: a mixed-methods analysis of a mobile health intervention for inner-city Latino patients.
Burner, E, Menchine, M, Taylor, E, Arora, S
Journal of diabetes science and technology. 2013;(1):111-8
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BACKGROUND The benefit of mobile health (mHealth) on diabetes management among low-income, inner-city patients is largely unknown, particularly for Latino patients. TExT-MED (Trial to Examine Text Message for Emergency Department Patients with Diabetes) is a text message-based program designed to improve disease knowledge, self-efficacy, and glycemic control among low-income, inner-city Latinos. In phase I, 23 patients participated in an acceptability and feasibility study. Contrary to our model, there was no increase in knowledge despite increases in self-efficacy and healthy behaviors. In phase II, we performed a mixed-methods analysis to understand how TExT-MED achieved these seemingly contradictory findings. METHOD We performed a qualitative analysis of focus groups with patients from phase I. We explored patients' receipt of health information from TExT-MED and other information sources. We used these qualitative findings to perform a mixed-methods analysis of the outcomes from phase I, reanalyzing the quantitative measures of self-efficacy, diabetes knowledge, and healthy behaviors. RESULTS We conducted two focus groups, one in English and one in Spanish. Through qualitative analysis, we found gender differences in information sources, dietary self-efficacy, and desired educational content. Applying this knowledge, we re-stratified phase I outcomes by gender and found differential changes in diabetes knowledge, self-efficacy, and behaviors. Men had increased self-efficacy while women showed increased knowledge. CONCLUSIONS The efficacy of mHealth on diabetes management was affected by gender. Specifically, men and women differ in their dietary self-efficacy, information sources, and desired topics in future mHealth interventions. To achieve maximal impact, future mHealth interventions should be mindful of this gender difference.
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An in-home intervention to improve nutrition, physical activity, and knowledge among low-income teen mothers and their children: results from a pilot study.
Davis, AM, Gallagher, K, Taylor, M, Canter, K, Gillette, MD, Wambach, K, Nelson, EL
Journal of developmental and behavioral pediatrics : JDBP. 2013;(8):609-15
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OBJECTIVE Teenage pregnancy is a major public health concern in the United States. In addition to other life stressors, adolescent mothers and their children are at risk for obesity and other negative health outcomes. The current study examines the impact of a brief in-home educational intervention designed to improve health knowledge and behavior in a sample of low-income adolescent mothers. METHOD Forty-six teen mothers received 6 in-home educational sessions focused on nutrition and physical activity, with baseline and follow-up knowledge and behavior assessments. RESULTS Results indicate significant improvements in mothers' health knowledge and physical activity pertaining to themselves and to their children, and also an unexpected increase in sedentary behaviors. CONCLUSION Results from this study indicate that knowledge-focused interventions may be an effective method to facilitate positive health behavioral change for teenage mothers.
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Feasibility and effectiveness of the implementation of a primary prevention programme for type 2 diabetes in routine primary care practice: a phase IV cluster randomised clinical trial.
Sanchez, A, Silvestre, C, Sauto, R, Martínez, C, Grandes, G, ,
BMC family practice. 2012;:109
Abstract
BACKGROUND The objective of this study is to perform an independent evaluation of the feasibility and effectiveness of an educational programme for the primary prevention of type 2 diabetes (DM2) in high risk populations in primary care settings, implanted within the Basque Health Service - Osakidetza. METHODS/DESIGN This is a prospective phase IV cluster clinical trial conducted under routine conditions in 14 primary health care centres of Osakidetza, randomly assigned to an intervention or control group. We will recruit a total sample of 1089 individuals, aged between 45 and 70 years old, without diabetes but at high risk of developing the condition (Finnish Diabetes Risk Score, FINDRISC ≥ 14) and follow them up for 2 years. Primary health care nursing teams of the intervention centres will implement DE-PLAN, a structured educational intervention program focused on changing healthy lifestyles (diet and physical activity); while the patients in the control centres will receive the usual care for the prevention and treatment of DM2 currently provided in Osakidetza. The effectiveness attributable to the programme will be assessed by comparing the changes observed in patients exposed to the intervention and those in the control group, with respect to the risk of developing DM2 and lifestyle habits. In terms of feasibility, we will assess indicators of population coverage and programme implementation. DISCUSSION The aim of this study is to provide the scientific basis for disseminate the programme to the remaining primary health centres in Osakidetza, as a novel way of addressing prevention of DM2. The study design will enable us to gather information on the effectiveness of the intervention as well as the feasibility of implementing it in routine practice.
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Preventing recurrence of thromboembolic events through coordinated treatment in the District of Columbia.
Dromerick, AW, Gibbons, MC, Edwards, DF, Farr, DE, Giannetti, ML, Sánchez, B, Shara, NM, Fokar, A, Jayam-Trouth, A, Ovbiagele, B, et al
International journal of stroke : official journal of the International Stroke Society. 2011;(5):454-60
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RATIONALE PROTECT DC examines whether stroke navigators can improve cardiovascular risk factors in urban underserved individuals newly hospitalized for stroke or ischemic attack. Within one-year of hospital discharge, up to one-third of patients no longer adhere to secondary prevention behaviors. Adherence rates are lower in minority-underserved groups, contributing to health disparities. In-hospital programs increase use of stroke prevention therapies but may not be as successful in underserved individuals. In these groups, low literacy, limited healthcare access, and sparse community resources may reduce adherence. Lay community health workers (navigators) improve adherence in other illnesses through education and assisting in overcoming barriers to achieving desired health behaviors and obtaining needed healthcare services. AIMS AND DESIGN PROTECT DC is a Phase II, single-blind, randomized, controlled trial comparing in-hospital education plus stroke navigators to usual care. Atherogenic ischemic stroke and transient ischemic attack survivors are recruited from Washington, DC hospitals. Navigators meet with participants during the index hospitalization, perform home visits, and meet by phone. They focus on stroke education, medication compliance, and overcoming practical barriers to adherence. The interventions are driven by the theories of reasoned action and planned behavior. STUDY OUTCOMES The primary dependent measure is a summary score of four objective measures of stroke risk factor control: systolic blood pressure, low-density lipoprotein, hemoglobin Hb A1C, and antiplatelet agent pill counts. Secondary outcomes include stroke knowledge, exercise, dietary modification, and smoking cessation. CONCLUSION PROTECT DC will determine whether a Phase III trial of stroke navigation for urban underserved individuals to improve adherence to secondary stroke prevention behaviors is warranted.