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One- and Two-Year Effects of the Healthy Primary School of the Future on Children's Dietary and Physical Activity Behaviours: A Quasi-Experimental Study.
Bartelink, NHM, van Assema, P, Kremers, SPJ, Savelberg, HHCM, Oosterhoff, M, Willeboordse, M, van Schayck, OCP, Winkens, B, Jansen, MWJ
Nutrients. 2019;11(3)
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Diet and Physical Activity (PA) habits are formed at a young age, and unhealthy habits can lead to childhood obesity and lifelong health problems. Schools are globally recognised as having access to children across all socio-economic backgrounds and to play an important role in influencing healthy habits. This Dutch experimental longitudinal study looks at the impact Primary schools can have on the health of their students by implementing a dedicated Nutrition and PA Program called ‘Healthy Primary Schools for the Future (HPSF), modelled on an American initiative, piloted in 4 schools and 2 control schools. The study tests whether a fully implemented program (focused on Nutrition and PA - including free lunches & daily PA sessions) or a partial program (focused only on PA sessions) influences healthy change in children’s behaviours versus control schools (no program). The data from 1676 children aged 4-12 yrs was used and the study took place over 3 yrs (2015-2017) with a commitment to continue till 2019 where follow-up data could be obtained. The data was collected once a year using parental and child questionnaires. Additional movement data was obtained from accelerometers the children wore for 7 days during each annual measurement week. The results at year 3 show that a combined nutrition and PA program had greatest benefits on improving diet (variety of foods eaten), and reducing unhealthy snacking, and increasing PA. Neither the partial program or control schools displayed positive changes. The researchers reflect that the full program allowed greater involvement from all parties involved (schools, parents, children’s, educational and health partners) which led to changes becoming an integral part of the school routine. Focusing on nutrition and PA together seemed to encourage complementary behavioural changes compared to focusing only on PA.
Abstract
Schools can help to improve children's health. The 'Healthy Primary School of the Future' (HPSF) aims to sustainably integrate health and well-being into the school system. This study examined the effects of HPSF on children's dietary and physical activity (PA) behaviours after 1 and 2 years' follow-up. The study (n = 1676 children) has a quasi-experimental design with four intervention schools, i.e., two full HPSF (focus: nutrition and PA) and two partial HPSF (focus: PA), and four control schools. Accelerometers and child- and parent-reported questionnaires were used at baseline, after 1 (T1) and 2 (T2) years. Mixed-model analyses showed significant favourable effects for the full HPSF versus control schools for, among others, school water consumption (effect size (ES) = 1.03 (T1), 1.14 (T2)), lunch intake of vegetables (odds ratio (OR) = 3.17 (T1), 4.39 (T2)) and dairy products (OR = 4.43 (T1), 4.52 (T2)), sedentary time (ES = -0.23 (T2)) and light PA (ES = 0.22 (T2)). Almost no significant favourable effects were found for partial HPSF compared to control schools. We conclude that the full HPSF is effective in promoting children's health behaviours at T1 and T2 compared with control schools. Focusing on both nutrition and PA components seems to be more effective in promoting healthy behaviours than focusing exclusively on PA.
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Calorie restriction regime enhances physical performance of trained athletes.
Pons, V, Riera, J, Capó, X, Martorell, M, Sureda, A, Tur, JA, Drobnic, F, Pons, A
Journal of the International Society of Sports Nutrition. 2018;15:12
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Athletes commonly aim to reduce body weight to improve their strength-to-mass ratio. In this study caloric restriction (CR) of 33% was achieved through alternate day fasting in trained athletes, which the authors hypothesised to be more easy to adhere to than daily reduced energy intake. The macronutrient composition remained the same as prior to calorie reduction. Study participants lost an average of 4.4% in body weight over 6 weeks, most of which came from fat, 15.1%. Despite also losing some lean mass (2.9%), exercise performance of the athletes improved, as did energy efficiency, possibly due to increased mitochondrial efficiency. Nutritional record analysis revealed that athletes ingested less than the RDA for several nutrients prior to the CR intervention, and intake was even lower with CR. The authors conclude that CR may be a good way for athletes to achieve weight loss as, unlike other body weight reduction techniques, the alternate day fasting CR improved physical performance. They suggest though that to ensure adequate micronutrient intake, supplementation may be required.
Abstract
BACKGROUND Caloric restriction induces mitochondrial biogenesis and improves physical fitness in rodents. We aimed to provide evidence of how caloric restriction affects the body composition and physical performance of trained athletes and to evaluate the possible impact of an every-other-day feeding diet on nutritional deficiencies of micronutrients and essential fatty acids. METHODS The study was performed with 12 healthy male athletes by carrying out a 33% caloric restriction with respect to their usual diet. Athletes performed a maximal exercise stress test both before and after the caloric restriction period. Blood samples were taken before and after the caloric restriction at basal conditions and 30 min post-exercise. Although energy intake was reduced by about 33%, the contribution of carbohydrates, proteins, and lipids to total energy intake during the caloric restriction was similar to the original diet. RESULTS The caloric restriction reduced the daily specific micronutrient intake to values lower than 90% of recommended dietary allowances. No effects were observed in blood parameters related to iron metabolism and tissue damage, glucose levels, lipid profiles, or erythrocyte fatty acid composition. In addition, oxidative damage markers decreased after the nutritional intervention. The caloric restriction intervention significantly reduced body weight and trunk, arm, and leg weights; it also caused a decrease in fat and lean body mass, the energy expenditure rate when performing a maximal exercise stress test, and the energy cost to run one meter at various exercise intensities. Furthermore, the intervention ameliorated the onset of the anaerobic phase of exercise. CONCLUSION A caloric restriction improves athletes' performance and energy efficiency, but reduces the daily intake of micronutrients; so, when caloric restriction programs are implemented micronutrient supplementation should be considered. TRIAL REGISTRATION The project was registered at ClinicalTrials.gov (NCT02533479).
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Effective nationwide school-based participatory extramural program on adolescent body mass index, health knowledge and behaviors.
Heo, M, Jimenez, CC, Lim, J, Isasi, CR, Blank, AE, Lounsbury, DW, Fredericks, L, Bouchard, M, Faith, MS, Wylie-Rosett, J
BMC pediatrics. 2018;18(1):7
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Adolescent obesity is a major public health concern that affects health status not only during adolescence but also during adulthood. The aim of this study was to test whether the HealthCorps program would improve weight status represented by body mass index (BMI; kg/m2) z-score and obesity class. A secondary aim was to identify knowledge and health behaviour domains that would be increased with the program. The study design was a two parallel arm quasi-experimental pre-post comparison design. A total of 2279 students from 62 schools participated in the HealthCorps program. Results indicate that HealthCorps program participation resulted in BMI z-score improvement among overweight/obese female students. Participation also resulted in increased knowledge in most domains regardless of sex and improved a few behaviour domains. However, it did not improve weight status among male students. Authors conclude that the HealthCorps was effective for BMI z-score improvements among female students in addition to significant positive effects on knowledge and a few behaviors in both sexes.
Abstract
BACKGROUND Adolescent obesity is a major public health concern. Open to all high school students regardless of weight status, HealthCorps is a nationwide program offering a comprehensive high school-based participatory educational program to indirectly address obesity. We tested a hypothesis that the HealthCorps program would decrease BMI z-scores among overweight or obese students, and reduce obesity rates, and evaluated its effects on health knowledge and behaviors. METHODS HealthCorps aimed to improve student knowledge and behaviors regarding nutrition quality, physical activity, sleep, breakfast intake, and mental resilience. Participating students received through HealthCorps coordinators weekly or bi-weekly classroom lessons either for a semester or a year in addition to various during- and after-school health-promoting activities and mentorship. Self-reported height and weight were collected along with questionnaires assessing knowledge and behaviors during 2013-2014 academic year among 14 HealthCorps-participating New York City high schools. This quasi experimental two-arm pre-post trial included 611 HealthCorps and 221 comparison arm students for the analytic sample. Sex-specific analyses stratified by weight status were adjusted for age and Hispanic ethnicity with clustering effects of schools and students taken into account. RESULTS HealthCorps female overweight/obese and obese student had a significant decrease in BMI z-scores (post-pre delta BMI z-score = -0.16 (95%CI = (-0.26, -0.05), p = 0.004 for the former; and = -0.23 (-0.44, -0.03), p = 0.028, for the latter) whereas comparison female counterparts did not. The HealthCorps students, but not the comparison students, had a significant increase for all knowledge domains except for the breakfast realm, and reported a greater number of significant behavior changes including fruit and vegetable intake and physical activities. CONCLUSIONS The HealthCorps program was associated with reduced BMI z-score in overweight/obese and obese female adolescents, with enhanced health knowledge and behavior for both sexes. With its wide reach, this may be a promising program to help combat adolescent obesity in schools. TRIAL REGISTRATION This study is registered as a clinical trial at the ClinicalTrials.gov registry with trial number NCT02277496 on September 10, 2014 (Retrospectively registered).
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Effects of Products Containing Bacillus subtilis var. natto on Healthy Subjects with Neck and Shoulder Stiffness, a Double-Blind, Placebo-Controlled, Randomized Crossover Study.
Sunagawa, Y, Okamura, N, Miyazaki, Y, Shimizu, K, Genpei, M, Funamoto, M, Shimizu, S, Katanasaka, Y, Morimoto, E, Yamakage, H, et al
Biological & pharmaceutical bulletin. 2018;41(4):504-509
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Neck and shoulder stiffness and pain are common complaints, and causative factors include muscle tension and reduced blood flow around the neck and shoulders. NKCP® is as a food supplement that contains bacillopeptidase F, a protease (enzyme) that is isolated and purified from the culture of the probiotic bacterium B. subtilis var. natto, which is used to ferment soy beans to natto, a traditional Japanese food. Various health benefits have been attributed to natto, and NKCP® has been shown to have blood thinning properties. This double-blind, placebo controlled crossover study aimed to evaluate the effects of NKCP® on healthy individuals with neck and shoulder stiffness and pain. Subjects received either NKCP® or placebo for 4 weeks, then had a 4 week washout period where they received neither test supplement, and then received the other test supplement for another 4 weeks. Shoulder and neck symptoms were assessed prior to starting the trial, and at 4, 8 and 12 weeks, through subjective reporting and a muscle hardness meter to measure muscle stiffness. Neck and shoulder stiffness and pain were improved after taking NKCP® but not significantly more than in the placebo group. Headaches improved significantly more in the NKCP® group compared to the placebo group. No significant changes were observed for lower back pain, cold hands and feet, eyestrain, and dry eye.
Abstract
Neck and shoulder stiffness is a typical subjective symptom in developed countries. This stiffness is caused by factors such as muscle tension and poor blood flow, leading to reduce work efficiency and diminish QOL. NKCP®, a natto-derived dietary food supplement whose main component is bacillopeptidase F, has antithrombotic, fibrinolytic, and blood viscosity-lowering effects. Here, we investigated the effect of NKCP® on neck and shoulder stiffness in a double-blind placebo-controlled randomized crossover study. Thirty subjects with neck and shoulder stiffness were randomly divided into 2 groups and ingested 250 mg of NKCP® or placebo daily for 4 weeks. Headache score significantly improved in the NKCP® group compared to the placebo group. Moreover, NKCP® significantly improved the score of visual analogue scale for neck and shoulder stiffness and pain, reduced muscle stiffness of the neck, and increased the skin surface temperature of neck and shoulders, compared to before ingestion. No adverse effects were observed during this study. These results suggest that NKCP® may alleviate headaches and chronic neck and shoulder stiffness and pain.
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Exercise before breakfast increases 24-h fat oxidation in female subjects.
Iwayama, K, Kawabuchi, R, Nabekura, Y, Kurihara, R, Park, I, Kobayashi, M, Ogata, H, Kayaba, M, Omi, N, Satoh, M, et al
PloS one. 2017;12(7):e0180472
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The timing of exercise in relation to food intake can affect the impact on fat reduction. The aim of this small randomised trial of 9 female subjects was to study the effect of exercise done following food intake compared to a fasting state on 24 hour fat breakdown. Measurements were taken over 24 hours using a metabolic chamber. The results showed that exercise performed in a fasted state increased 24 hour fat release in female subjects. Whilst this is a very small study, Nutrition Practitioners may want to discuss exercise timing with their clients who are engaging in a weight loss programme.
Abstract
BACKGROUND Exercise performed in a postprandial state does not increase 24-h fat oxidation of male and female subjects. Conversely, it has been shown in male subjects that exercise performed in a postabsorptive state increases 24-h fat oxidation compared with that in sedentary control and that with exercise trials performed after breakfast, lunch, or dinner. There is a paucity of study evaluating the effect of exercise performed in a postabsorptive state in female subjects. METHOD Nine young female subjects participated in indirect calorimetry measurement over 24-h using a room-size metabolic chamber in which subjects remained sedentary or performed 60 min exercise before breakfast at 50% of [Formula: see text]. Exercise was accompanied by an increase in energy intake to ensure that subjects were in a similar state of energy balance over 24 h for the two trials. FINDINGS Compared with the sedentary condition, exercise performed before breakfast increased 24-h fat oxidation (519 ± 37 vs. 400 ± 41 kcal/day). Time courses of relative energy balance differed between trials with transient negative energy balance observed before breakfast. The lowest values of relative energy balance observed during the 24-h calorimetry, i.e., transient energy deficit, were greater in exercise trials than in sedentary trials. The transient deficit in carbohydrate balance was also observed before breakfast, and magnitude of the deficit was greater in exercise trial compared to that of sedentary trial. INTERPRETATION Under energy-balanced conditions, exercise performed in a post-absorptive state increases 24-h fat oxidation in female subjects. The effect of exercise performed before breakfast can be attributed to nutritional state: a transient deficit in energy and carbohydrate at the end of exercise.
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The Effect of a 12-Week Health Training Program on Selected Anthropometric and Biochemical Variables in Middle-Aged Women.
Pilch, W, Tota, Ł, Sadowska-Krępa, E, Piotrowska, A, Kępińska, M, Pałka, T, Maszczyk, A
BioMed research international. 2017;2017:9569513
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Regular physical activity is an important factor for health. This study evaluated physiological and biochemical changes induced by a 12 week regular exercise programme in healthy middle-aged women. 15 healthy women aged 42-47 participated in this programme which consisted of three 45 minutes high and low impact aerobics classes for 12 weeks. Body composition and biochemical markers were determined at baseline and after 12 weeks. The investigators observed a significant increase in lean body mass, and a decrease in total weight and fat mass. Biochemical markers showed decreased inflammation, increased antioxidant status and an improvement in lipid profiles (these had been within normal range at baseline). The authors also determined vitamin D status of the participants. Vitamin D levels were within normal range at baseline and did not change during the duration of the study. Higher vitamin D levels were correlated with better antioxidant status. The authors conclude that regular aerobic exercise had beneficial effects on body composition, antioxidant status, inflammatory markers and lipid profiles. The main limitation of this study was a lack of control group.
Abstract
Regular moderate physical activity positively affects health, fitness, and body composition; it regulates the pro- and anti-inflammatory cytokines levels. Vitamin D plays an important regulatory role; its adequate levels correlate with low values of inflammation markers and an increase in muscle strength and fitness in exercising people. The study's aim was to evaluate changes in somatic variables, oxidative stress, and inflammation markers, as well as blood calcidiol concentration in middle-aged healthy women after 12 weeks of aerobics classes-endurance exercises, including choreographic sequences, aiming to improve fitness and motor coordination. The training led to a significant reduction of body mass and fat tissue; it induced an increase in lean body mass. After the 12-week training program, plasma antioxidant status increased (0.65 ± 0.21, p < 0.01) and the concentration of lipid peroxidation products decreased (0.07 ± 0.02, p < 0.001). A significant increase in plasma antioxidant status associated with training could have reduced the level of proinflammatory interleukin as indicated by a positive correlation between these variables (rs = 0.64, p < 0.05). The study proved that a 12-week health training program in physically inactive middle-aged women might provide improvements in their anthropometric parameters and selected biochemical indicators.
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Effects of eight weeks of time-restricted feeding (16/8) on basal metabolism, maximal strength, body composition, inflammation, and cardiovascular risk factors in resistance-trained males.
Moro, T, Tinsley, G, Bianco, A, Marcolin, G, Pacelli, QF, Battaglia, G, Palma, A, Gentil, P, Neri, M, Paoli, A
Journal of translational medicine. 2016;14(1):290
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Time-restricted feeding (TRF) allows subjects to consume ad libitum energy intake within a defined window of time, which means a fasting window of 12–21 h per day is employed. The aim of the present study was to investigate the effects of an isoenergetic TRF protocol on body composition, athletic performance, and metabolic factors during resistance training in healthy resistance trained males. The study enrolled thirty-four resistance-trained males. The participants were randomly assigned to a TRF group (n = 17) or standard diet group (n = 17). Training was standardized for both groups. Results indicate that after 8 weeks, a significant decrease in fat mass was observed in the TRF group, while fat-free mass was maintained in both groups. The same trend was observed for arm and thigh muscle cross-sectional area. Leg press maximal strength increased significantly, but no difference was present between treatments. Authors conclude that TRF can maintain muscle mass, reducing body fat, and reducing inflammation markers and anabolic hormones. This kind of regimen could be adopted by athletes during maintenance phases of training in which the goal is to maintain muscle mass while reducing fat mass.
Abstract
BACKGROUND Intermittent fasting (IF) is an increasingly popular dietary approach used for weight loss and overall health. While there is an increasing body of evidence demonstrating beneficial effects of IF on blood lipids and other health outcomes in the overweight and obese, limited data are available about the effect of IF in athletes. Thus, the present study sought to investigate the effects of a modified IF protocol (i.e. time-restricted feeding) during resistance training in healthy resistance-trained males. METHODS Thirty-four resistance-trained males were randomly assigned to time-restricted feeding (TRF) or normal diet group (ND). TRF subjects consumed 100 % of their energy needs in an 8-h period of time each day, with their caloric intake divided into three meals consumed at 1 p.m., 4 p.m., and 8 p.m. The remaining 16 h per 24-h period made up the fasting period. Subjects in the ND group consumed 100 % of their energy needs divided into three meals consumed at 8 a.m., 1 p.m., and 8 p.m. Groups were matched for kilocalories consumed and macronutrient distribution (TRF 2826 ± 412.3 kcal/day, carbohydrates 53.2 ± 1.4 %, fat 24.7 ± 3.1 %, protein 22.1 ± 2.6 %, ND 3007 ± 444.7 kcal/day, carbohydrates 54.7 ± 2.2 %, fat 23.9 ± 3.5 %, protein 21.4 ± 1.8). Subjects were tested before and after 8 weeks of the assigned diet and standardized resistance training program. Fat mass and fat-free mass were assessed by dual-energy x-ray absorptiometry and muscle area of the thigh and arm were measured using an anthropometric system. Total and free testosterone, insulin-like growth factor 1, blood glucose, insulin, adiponectin, leptin, triiodothyronine, thyroid stimulating hormone, interleukin-6, interleukin-1β, tumor necrosis factor α, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides were measured. Bench press and leg press maximal strength, resting energy expenditure, and respiratory ratio were also tested. RESULTS After 8 weeks, the 2 Way ANOVA (Time * Diet interaction) showed a decrease in fat mass in TRF compared to ND (p = 0.0448), while fat-free mass, muscle area of the arm and thigh, and maximal strength were maintained in both groups. Testosterone and insulin-like growth factor 1 decreased significantly in TRF, with no changes in ND (p = 0.0476; p = 0.0397). Adiponectin increased (p = 0.0000) in TRF while total leptin decreased (p = 0.0001), although not when adjusted for fat mass. Triiodothyronine decreased in TRF, but no significant changes were detected in thyroid-stimulating hormone, total cholesterol, high-density lipoprotein, low-density lipoprotein, or triglycerides. Resting energy expenditure was unchanged, but a significant decrease in respiratory ratio was observed in the TRF group. CONCLUSIONS Our results suggest that an intermittent fasting program in which all calories are consumed in an 8-h window each day, in conjunction with resistance training, could improve some health-related biomarkers, decrease fat mass, and maintain muscle mass in resistance-trained males.
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Consumption of calcium-fortified cereal bars to improve dietary calcium intake of healthy women: randomized controlled feasibility study.
Lee, JT, Moore, CE, Radcliffe, JD
PloS one. 2015;10(5):e0125207
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Calcium intake is essential to maintain bone heath and reduce the risk of osteoporosis, however most adult women are not meeting the current daily recommendations. The aim of this trial was to examine the benefits of including a non-dairy source of calcium in the diet of women during a 9-week crossover study. 35 women aged 21-58 were assigned to consume two calcium-fortified cereal bars daily for three weeks, after which diets were switched for another three weeks. Diet diaries were used to monitor intake. This study found that dietary calcium was significantly higher during the intervention period when two calcium-fortified cereal bars were consumed than during the baseline period. This addition did not increase total energy intake or result in weight gain. Further research is warranted to determine the whether consumption of calcium-fortified bars improves calcium bioavailability, and should monitor changes of bone health markers and bone density.
Abstract
UNLABELLED Calcium is an important structural component of the skeletal system. Although an adequate intake of calcium helps to maintain bone health and reduce the risk of osteoporosis, many women do not meet recommended daily intakes of calcium. Previous interventions studies designed to increase dietary intake of women have utilized primarily dairy sources of calcium or supplements. However, lactose intolerance, milk protein allergies, or food preferences may lead many women to exclude important dairy sources of dietary calcium. Therefore, we undertook a 9 week randomized crossover design trial to examine the potential benefit of including a non-dairy source of calcium in the diet of women. Following a 3 week run-in baseline period, 35 healthy women > 18 years were randomized by crossover design into either Group I or Group II. Group I added 2 calcium-fortified cereal bars daily (total of 400 mg calcium/day) (intervention) to their usual diet and Group II continued their usual diet (control). At the end of 3 weeks, diets were switched for another 3 weeks. Intakes of calcium and energy were estimated from 3-day diet and supplemental diaries. Wilcoxon signed-rank tests were used for within group comparisons and Mann Whitney U tests were used for between group comparisons of calcium and energy intake. Dietary calcium was significantly higher during intervention (1071 mg/d) when participants consumed 2 calcium-fortified cereal bars daily than during the baseline (720 mg/d, P <0.0001) or control diets (775 mg/d, P = 0.0001) periods. Furthermore, the addition of 2 calcium-fortified cereal bars daily for the 3 week intervention did not significantly increase total energy intake or result in weight gain. In conclusion, consumption of calcium-fortified cereal bars significantly increased calcium intake of women. Further research examining the potential ability of fortified cereal bars to help maintain and improve bone health of women is warranted. TRIAL REGISTRATION ClinicalTrials.gov NCT01508689.