Nutritional Update for Physicians: Plant-Based Diets.

Nutritional Update for Physicians: Plant-Based Diets.

Perm J. 2013; 17(2): 61-66
Tuso PJ, Ismail MH, Ha BP, Bartolotto C

The objective of this article is to present to physicians an update on plant-based diets. Concerns about the rising cost of health care are being voiced nationwide, even as unhealthy lifestyles are contributing to the spread of obesity, diabetes, and cardiovascular disease. For these reasons, physicians looking for cost-effective interventions to improve health outcomes are becoming more involved in helping their patients adopt healthier lifestyles. Healthy eating may be best achieved with a plant-based diet, which we define as a regimen that encourages whole, plant-based foods and discourages meats, dairy products, and eggs as well as all refined and processed foods. We present a case study as an example of the potential health benefits of such a diet. Research shows that plant-based diets are cost-effective, low-risk interventions that may lower body mass index, blood pressure, HbA1C, and cholesterol levels. They may also reduce the number of medications needed to treat chronic diseases and lower ischemic heart disease mortality rates. Physicians should consider recommending a plant-based diet to all their patients, especially those with high blood pressure, diabetes, cardiovascular disease, or obesity. HubMed – eating

Weight-Loss Study in African-American Women: Lessons Learned from Project Take HEED and Future, Technologically Enhanced Directions.

Perm J. 2013; 17(2): 55-59
Murphy PJ, Williams RL

African-American women are more overweight and have greater difficulty maintaining weight loss than do Caucasian women. Evidence suggests that African-American women are more successful with culturally tailored weight-loss programs.Begun in 2005, an 18-month randomized clinical trial, Project Take HEED (Healthy Eating and Exercise Decisions), culturally adapted an evidence-based dietary approach and exercise program to fit the female African-American population in an attempt to improve program attrition rates. The study was conducted with 223 African-American women (120 women in the experimental group; 103 controls), age 35 to 65 years, with a body mass index of 30 kg/m(2) or higher. The experimental group received education and instruction at 24 group sessions and were asked to record their daily food intake and physical activity. Cultural adaptation included social and spiritual components. Controls received usual care (referral to a dietitian).After 18 months, Project Take HEED demonstrated the following outcomes: ATTRITION: the treatment group consisted of 12 African-American women at the end of month 18-(an attrition rate of 87%). (It had been 70% at the end of month 15.)FACTORS CONTRIBUTING TO ATTRITION INCLUDED: caregiver responsibilities, transportation difficulties, work schedules, and others. Those clients that did remain, however, provided the impetus for our next study. The remaining participants had, by and large, begun the study as being low in self-efficacy regarding weight loss and weight loss maintenance.Initial Findings: The high self-efficacy that some women had at the beginning of the intervention did not translate into the desired behavior change. The inverse relationship seen in this study suggests that treatments that improve participants’ self-efficacy may result in greater weight loss. New Directions: A new study, commencing in 2013, will use at-home Web-based and virtual reality technology (avatars) in an attempt to enhance client motivation to persist in long-term weight management programs. Bandura’s pioneering work on self-efficacy will be the theoretical foundation of the pilot study, also enrolling African-American women. HubMed – eating

Consumers’ estimation of calorie content at fast food restaurants: cross sectional observational study.

BMJ. 2013; 346: f2907
Block JP, Condon SK, Kleinman K, Mullen J, Linakis S, Rifas-Shiman S, Gillman MW

OBJECTIVE: To investigate estimation of calorie (energy) content of meals from fast food restaurants in adults, adolescents, and school age children. DESIGN: Cross sectional study of repeated visits to fast food restaurant chains. SETTING: 89 fast food restaurants in four cities in New England, United States: McDonald’s, Burger King, Subway, Wendy’s, KFC, Dunkin’ Donuts. PARTICIPANTS: 1877 adults and 330 school age children visiting restaurants at dinnertime (evening meal) in 2010 and 2011; 1178 adolescents visiting restaurants after school or at lunchtime in 2010 and 2011. MAIN OUTCOME MEASURE: Estimated calorie content of purchased meals. RESULTS: Among adults, adolescents, and school age children, the mean actual calorie content of meals was 836 calories (SD 465), 756 calories (SD 455), and 733 calories (SD 359), respectively. A calorie is equivalent to 4.18 kJ. Compared with the actual figures, participants underestimated calorie content by means of 175 calories (95% confidence interval 145 to 205), 259 calories (227 to 291), and 175 calories (108 to 242), respectively. In multivariable linear regression models, underestimation of calorie content increased substantially as the actual meal calorie content increased. Adults and adolescents eating at Subway estimated 20% and 25% lower calorie content than McDonald’s diners (relative change 0.80, 95% confidence interval 0.66 to 0.96; 0.75, 0.57 to 0.99). CONCLUSIONS: People eating at fast food restaurants underestimate the calorie content of meals, especially large meals. Education of consumers through calorie menu labeling and other outreach efforts might reduce the large degree of underestimation. HubMed – eating

Healthy eating index for pregnancy: adaptation for use in pregnant women in Brazil.

Rev Saude Publica. 2013 Feb; 47(1): 20-28
Melere C, Hoffmann JF, Nunes MA, Drehmer M, Buss C, Ozcariz SG, Soares RM, Manzolli PP, Duncan BB, Camey SA

OBJECTIVE: To evaluate dietary quality in a sample of pregnant women based on one simple and objective parameter. METHODS: Pregnant women (n = 712), between 16 and 36 weeks, attending primary care clinics in Porto Alegre and Bento Gonçalves, Southern Brazil, in 2010 were recruited to take part. The Healthy Eating Index for Brazilian Pregnancy (HEIP-B) was created, derived from the American instrument called Alternate Healthy Eating Index for Pregnancy (AHEI-P). Questionnaires on frequency of consumption and on socio-demographic factors were completed. Focused principal component analysis (ACPF) was used to assess the relationship between the index and nutrients relevant to pregnancy. RESULTS: The median (interquartile range) of AHEI-P and HEIP-B were 66.6 (57.8-72.4) and 67.4 (60.0-73.4), respectively. The HEIP-B showed a good positive correlation with nutrients which are specifically recommended for pregnancy: folate (r = 0.8; p < 0.001), calcium (r = 0.6; p < 0.001) and iron (r = 0.7; p < 0.001). CONCLUSIONS: The quality of the diet of the pregnant women in this study was classified as within the "improvements needed" cut off point, which demonstrates the need for more specific education on nutrition for this stage of life. The index showed good correlations and, thus, may be considered an effective tool for assessing the quality of nutrition during pregnancy. HubMed – eating

Eating disorders in childhood and adolescence.

Rev Paul Pediatr. 2013 Mar; 31(1): 96-103
Gonçalves JD, Moreira EA, Trindade EB, Fiates GM

OBJECTIVE: To discuss eating disorders in children and adolescents regarding their characteristics and risk factors. DATA SOURCES: Articles were searched in the PubMed and ScieLO databases, combining the terms ‘children’, ‘adolescents’, ‘eating behavior’, ‘eating disorder’, ‘bulimia’, and ‘anorexia’, both in Portuguese and in English. Studies published between 2007 and 2011 were retrieved and 49 articles that assessed eating behavior and disorders, nervous anorexia and bulimia, and non-specific eating disorders were selected. DATA SYNTHESIS: Eating disorders, especially non-specific ones, were common during childhood and adolescence. The presence of such disorders was attributed mainly to family environment and exposure to the media. Eating disorders were frequently followed by psychological comorbidities. CONCLUSIONS: Among the risk factors for eating disorders, social and family environment and the media were the most important ones. The influence of the media and social environment has been related to the worship of thinness. As to family environment, mealtimes appeared to be fundamental in shaping eating behavior and the development of disorders. Eating disorders were associated with nutritional problems (growing impairment and weight gain), oral health (cheilitis, dental erosion, periodontitis, and hypertrophy of salivary glands), and social prejudice. HubMed – eating

Copy of Model Emma Buckley talks nutrition and eating disorders. – Model Emma Buckley talks to Health News Ireland editor, Rory Hafford about nutrition and eating disorders.