Search

OBJECTIVES: Emerging evidence suggests that anti-inflammatory dietary patterns may improve depression, stress, and quality of life. Similar benefits are observed during weight loss interventions; however, the effect of combining these dietary patterns with weight loss is not clear. We evaluated the association between dietary inflammation and measures of psychological health in female military dependents with overweight and obesity during a behavioral weight loss intervention. METHODS: Participants (n = 120) received a 6-month intervention recommending dietary patterns with an anti-inflammatory profile. An energy-adjusted dietary inflammatory index (DII) score was calculated from 28 food components collected using 3 interviewer-administered multiple-pass 24-hour recalls at each study time point. A negative score indicates a lower-inflammatory dietary pattern, and a positive score indicates a pro-inflammatory pattern. Self-reported symptoms of depression, stress, general health, vitality, and psychological quality of life were measured by validated questionnaires. Multivariable linear mixed models were used to assess the association between 6-month changes in DII and each outcome and were adjusted for age, ethnicity, military rank of spouse, body weight, and physical activity. RESULTS: On average, females were 42.2 ± 11.8 years old with a body mass index of 34.9 ± 6.4 kg/m(2). The average DII score was 0.07 (range: −4.3, 3.0) at baseline. Six-month improvements in DII scores (i.e., for a 1-unit reduction) were associated with fewer self-reported symptoms of depression (β: −0.87; 95% confidence interval: −1.43, −0.31; P = 0.003) and stress (−0.85; −1.44, −0.26; P = 0.005), as well as higher general health (0.57; 0.23, 0.91; P = 0.001), vitality (0.45; 0.12, 0.77; P = 0.008), and psychological quality of life (0.33; 0.11, 0.55; P = 0.004). No significant associations between weight loss or physical activity and any outcome were observed in these models that included the DII. CONCLUSIONS: Anti-inflammatory dietary patterns are associated with beneficial effects on a range of psychological health and wellbeing measures independent of weight loss. FUNDING SOURCES: Jean Mayer USDA Human Nutrition Research Center on Aging Doctoral Scholarship; Department of Defense (DoD) grant W81XWH-14–2-0005 (SBR). Author views do not reflect official DoD or Army policy.

OBJECTIVES: There is persistent controversy over the extent to which different components of energy expenditure disproportionately decrease after weight loss and contribute to weight regain through decreased energy requirements. We conducted a secondary analysis of the CALERIE I study to test the hypothesis that decreased resting metabolic rate (RMR) and energy expenditure for physical activity (EEPA) after a 6-month calorie restriction intervention would predict weight regain at 12 months, with a greater decrease in RMR than EEPA. METHODS: Participants (n = 46) received all food and energy-containing beverages for 6 months. Outcome measures included total energy expenditure by doubly labeled water, RMR by indirect calorimetry, and body composition by BOD POD. Predictions for RMR and EEPA were derived from baseline linear regression models including age, sex, fat mass, and fat free mass. Baseline regression coefficients were used to calculate the predicted RMR and EEPA at 6 months. Residuals were calculated as the difference between measured and predicted values and were adjusted for body weight. The presence of metabolic adaptation was evaluated by a paired t-test comparing measured and predicted RMR at 6 months. Differences between 6-month RMR and EEPA residuals were evaluated by the same method. Linear regression was used to assess the association between 6-month residuals and weight loss maintenance (% weight change, 6 to 12 months). RESULTS: Mean weight loss was 6.9% at 6 months with 2.1% regain from 6 to 12 months. No adaptation in RMR was observed at 6 months (mean residual: 19 kcal; 95% confidence interval: −9, 48; P = 0.18). However, significant adaptation was observed in EEPA (mean residual: −199 kcal; −126, −272; P

The amount of time spent in poor health at the end of life is increasing. This narrative review summarizes consistent evidence indicating that healthy dietary patterns and maintenance of a healthy weight in the years leading to old age are associated with broad prevention of all the archetypal diseases and impairments associated with aging including: noncommunicable diseases, sarcopenia, cognitive decline and dementia, osteoporosis, age-related macular degeneration, diabetic retinopathy, hearing loss, obstructive sleep apnea, urinary incontinence, and constipation. In addition, randomized clinical trials show that disease-specific nutrition interventions can attenuate progression-and in some cases effectively treat-many established aging-associated conditions. However, middle-aged and older adults are vulnerable to unhealthy dietary patterns, and typically consume diets with inadequate servings of healthy food groups and essential nutrients, along with an abundance of energy-dense but nutrient-weak foods that contribute to obesity. However, based on menu examples, diets that are nutrient-dense, plant-based, and with a moderately low glycemic load are better equipped to meet the nutritional needs of many older adults than current recommendations in US Dietary Guidelines. These summary findings indicate that healthy nutrition is more important for healthy aging than generally recognized. Improved public health messaging about nutrition and aging, combined with routine screening and medical referrals for age-related conditions that can be treated with a nutrition prescription, should form core components of a national nutrition roadmap to reduce the epidemic of unhealthy aging.

BACKGROUND Lifestyle interventions are the first-line treatment for obesity, but participant weight loss is typically low. OBJECTIVES We evaluated the efficacy of an alternative lifestyle intervention [Healthy Weight for Living (HWL)] compared with a modified Diabetes Prevention Program (m-DPP). HWL was based on a revised health behavior change model emphasizing hunger management and the development of healthy food preferences. m-DPP was a standard Diabetes Prevention Program implemented with counselor time matched to HWL. Participants were adult dependents of military personnel and had overweight or obesity. METHODS Participants were randomly assigned to HWL (n = 121) or m-DPP (n = 117), delivered primarily by group videoconference with additional midweek emails. The primary outcome was 12-mo weight change. Secondary outcomes included 6-mo changes in cardiometabolic risk factors and diet. Intention-to-treat (ITT) and complete case (CC) analyses were performed using linear mixed models. RESULTS Retention did not differ between groups (72% and 66% for HWL and m-DPP at 12 mo, respectively; P = 0.30). Mean ± SE adjusted 12-mo weight loss in the ITT cohort was 7.46 ± 0.85 kg for HWL and 7.32 ± 0.87 kg for m-DPP (P = 0.91); in the CC cohort, it was 7.83 ± 0.82 kg for HWL and 6.86 ± 0.88 kg for m-DPP (P = 0.43). Thirty-eight percent of HWL and 30% of m-DPP completers achieved ≥10% weight loss (P = 0.32). Improvements in systolic blood pressure, LDL cholesterol, triglycerides, fasting glucose, general health, sleep, and mood were similar across groups; improvements in diastolic blood pressure were greater in m-DPP. Adjusted group mean reductions in energy intake were not significantly different between groups, but HWL participants were more adherent to their dietary prescription for lower glycemic index and high fiber and protein (P = 0.05 to

OBJECTIVES: Self-monitoring daily dietary intake is recommended for weight loss and weight loss maintenance. However, current online platforms and applications are often burdensome, which may limit use. We conducted a pilot study to evaluate the accuracy of a new application designed to self-monitor dietary intake using natural spoken language (COCO; The Conversational Calorie Counter). METHODS: A total of 35 participants were enrolled in this pilot study. Participants were asked to record daily dietary intake using the COCO application for a period of at least five days. Two 24-hour dietary recalls were conducted during this time, between day three and day five, and served as the reference method for evaluating total energy intake (TEI; measured in kcal). Mean two-day energy intake was calculated for each assessment method for the days when the 24-hr recall and COCO data were collected. Self-reported TEI from COCO were compared to estimates obtained from the 24-hour dietary recalls by a paired samples t-test and a Pearson's correlation coefficient. RESULTS: On average, participants consumed three meals a day and recorded six days of food intake days with COCO (range: 4 to 10 days). The mean TEI was not significantly different between the two methods (1902 ± 621 kcal by 24-hour dietary recall and 1988 ± 1033 kcal by COCO, P = 0.59). There was a significant correlation between mean TEI measured with the two methods (r = 0.45; P = 0.006). In addition, a strong correlation was observed between the number of food items logged in COCO and those recalled in the 24-hour diet recalls (r = 0.82; P >0.0001). Completion of the exit survey by 28 participants indicated that 43% would definitely or probably use the application again. CONCLUSIONS: These results suggest that natural spoken language technology may have utility in applications to self-monitor food intake. Additional research is required to fully elucidate the validity of COCO in estimating dietary intake. FUNDING SOURCES: This research was supported by the NIH Grant # 1R21HL118347–01 (SBR and JG), Quanta Computing, Inc., and the National Defense Science and Engineering Graduate fellowship.

OBJECTIVES: Self-monitoring daily dietary intake is recommended for weight loss, weight maintenance, and healthy eating. However, current tracking methods are often burdensome and result in short-term use. We conducted a pilot study to evaluate the accuracy of a new application designed to self-monitor dietary intake using natural spoken language (COCO; The Conversational Calorie Counter). METHODS: A total of 14 participants were recruited for the pilot study. They were instructed to record daily dietary intake using the COCO application for at least five consecutive days. Two unscheduled 24-hour dietary recalls were conducted between day 3 and day 5 as the reference method for evaluating total energy intake (TEI). The two-day energy estimates were averaged for each assessment method. Pearson's correlation coefficient was used to assess the validity of the COCO application. Estimates of TEI from COCO were compared to the 24-hour dietary recall by a paired samples t-test. RESULTS: Participants were primarily female (86%), with an average body mass index of 22.2 ± 1.8 kg/m(2) (mean ± standard deviation). On average, participants consumed three daily meals and recorded dietary intake for six days using the COCO application. The average TEI was 1782 ± 773 kcal for all recorded days (range: 4 to 10). The mean TEI measured by 24-hour dietary recall was 1791 ± 862 kcal, and mean TEI measured by COCO for the corresponding days was 1818 ± 916 kcal. We observed a significant correlation between the assessment methods (r = 0.58; P = 0.03), and there was no significant difference in TEI estimates from COCO compared to the 24-hour recall (P = 0.90). CONCLUSIONS: These results suggest that natural spoken language technology can be used in applications that facilitate self-monitoring of food intake to support weight management and the prevention of noncommunicable diseases. The significant correlation between estimates of TEI from COCO and the 24-hour dietary recall indicates the potential validity of this novel approach for capturing dietary data and assessing energy intake. FUNDING SOURCES: Sponsored by the National Institutes of Health (R21HL118347), the U.S. Department of Agriculture with Tufts University (58–1950-4–003), Quanta Computing, Inc., and the Department of Defense (National Defense Science Engineering Graduate Fellowship Program).

OBJECTIVES: Anti-inflammatory diets have been suggested to improve psychological health. This research evaluated the combined effects of consuming an anti-inflammatory diet and caloric restriction (CR) on changes in perceived stress and health-related quality of life in a healthy, non-obese population. METHODS: We conducted a secondary analysis of the publicly available CALERIE data. Participants were randomized to a 2 year CR intervention (n = 143) or an ad libitum Control group (n = 75) and self-selected their dietary intake. An energy-adjusted dietary inflammatory index (DII) was calculated based on 28 components from self-reported food records. Self-reported stress and general health outcomes were measured using validated questionnaires. Linear mixed models were used to assess changes in each outcome from baseline to 12 and 24 months. Models were adjusted for age, sex, baseline outcome measure, change in body fat, and a treatment by DII interaction term. RESULTS: On average, participants were 38.1 ± 7.2 years old with a BMI of 25.1 ± 1.7 kg/m(2). Baseline characteristics, including the DII, stress, and general health, did not differ with randomization. There was no significant association between temporal changes in DII and changes in stress or general health in the CR or Control groups. On average, both groups tended to report higher stress at 12 months; however, there was no difference in perceived stress between groups (adjusted mean difference [MD]: 0.5; 95% confidence interval [CI]: −0.4, 1.5; P = 0.25). There was an improvement in reported general health in the CR group at 12 months (MD: 4.1; 95% CI: 2.2, 6.0; P

OBJECTIVES: Undernutrition is prevalent among young children worldwide and is associated with impaired cognition and reduced educational attainment. We conducted a randomized controlled trial to test the effect of a novel supplementary food (regenerative nutrition for enhanced wellness-cognition; RENEW-C) compared to traditional feeding practices on cognitive function, cerebral blood flow and oxygen metabolism in rural Guinea-Bissau. METHODS: Children aged 15 months to 7 years (n = 1059) were randomized to receive isocaloric quantities of RENEW-C (a highly-fortified cocoa-based bar), a USAID fortified blended food (FBF) or a Control food (rice cooked with oil, replicating a traditional breakfast). The primary outcome was executive function. Secondary outcomes included a cerebral blood flow index (CBF(i)) and cerebral metabolic rate of oxygen (CMRO(2)) measured by Frequency-Domain Near-Infrared Spectroscopy and Diffusion Correlation Spectroscopy (FDNIRS-DCS, MetaOx, ISS Inc.). Six-month changes for RENEW-C and FBF versus Controls were assessed by multivariable linear mixed models adjusted for age, sex, baseline measurement, and study cohort. RESULTS: Improvements in executive function (0.38; 95% CI: 0.10, 0.71; P = 0.02) were observed for RENEW-C compared to Controls in the predefined study focus (children 75% their supplement). There was no significant effect of RENEW-C in children ≥ 4 years. No benefit of the FBF was observed in either age group. In addition, changes in CBF(i) and CMRO(2) in RENEW-C children were greater than in Controls in both ventrolateral prefrontal cortical regions (P = 0.03 and P = 0.04 for left and right, respectively) and greater than FBF in the left ventrolateral (P = 0.05) and left dorsolateral (P = 0.03) prefrontal cortices. CONCLUSIONS: Compared with traditional feeding practices, the RENEW-C supplement consumption was correlated with a marked improvement in executive function among children

Background There is growing evidence of the importance of nutrition in age-related macular degeneration (AMD), but few studies have explored associations with folate and B vitamins. No effective therapeutic strategy for geographic atrophy (GA) is available, and prevention could be of great value. Objective We investigated associations between dietary folate, B vitamins, and progression to GA and whether these associations might be modified by genetic susceptibility. Design Among 2525 subjects (4663 eyes) in the Age-Related Eye Disease Study, 405 subjects (528 eyes) progressed to GA over 13 y. Folate and B vitamins were log transformed and calorie adjusted separately for men and women. Ten loci in 7 AMD genes [complement factor H, age-related maculopathy susceptibility 2/high-temperature requirement A serine peptidase 1, complement component 2, complement component 3, complement factor B, collagen type VIII α 1, and RAD51 paralog B] were examined. Survival analysis was used to assess associations between incident GA and dietary intake of folate and B vitamins. Interaction effects between these nutrients and genetic variation on AMD risk were also evaluated. Subjects with at least one eye free of advanced AMD at baseline were included in these analyses. Results There was a reduced risk of progression to GA with increasing intake of thiamin, riboflavin, and folate after adjusting for age, sex, and total energy intake (P-trend = 0.01, 0.03, and 0.001, respectively). After adjustment for demographic, behavioral, ocular, and genetic covariates, trends remained statistically significant for folate (P-trend = 0.007) and were borderline for thiamin (P-trend = 0.05). Riboflavin did not retain statistical significance (P-trend = 0.20). Folate was significantly associated with lower risk of incident GA among subjects homozygous for the complement component 3 (C3) R102G rs2230199 nonrisk genotype (CC) (HR = 0.43; 95% CI: 0.27, 0.70; P = 0.0005) but not subjects carrying the risk allele (G) (P = 0.76). Neither folate nor any B vitamin was significantly associated with neovascular AMD. Conclusions High folate intake was associated with a reduced risk of progression to GA. This relation could be modified by genetic susceptibility, particularly related to the C3 genotype. This trial was registered at clinicaltrials.gov as NCT00594672.