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The coronavirus disease 2019 pandemic necessitated the use of distance education, which sparked a technological transformation that was long overdue in higher education. The purpose of this narrative review is two-fold: to summarize the state of knowledge regarding distance education in nutrition and dietetics education over the past 30 years to inform recommendations for future education/research and implications for practice and to determine the influence that distance education has had on the knowledge, skills, and attitudes of both nutrition and dietetics educators and their students. A narrative review of 822 publications yielded 25 that met the search criteria. In the scope of 30 years, the literature shows that attitudes and perceptions of distance education have changed as barriers to online access have diminished and the availability of online nutrition and dietetics courses and Accreditation Council for Education in Nutrition and Dietetics-accredited distance education programs has expanded. However, whereas the limited results are promising, the paucity of large-sample research about the use of distance education in nutrition and dietetics education restricts educators' knowledge of and ability to evaluate the learning outcomes of distance programs and courses. Moreover, differences in how accreditors, government agencies, and institutions define distance education could have significant influence on funding and financial aid benefits for students and research. Recommendations for future research and implications for practice are provided given the relevance and importance of distance education to nutrition and dietetics education.

OBJECTIVES: The study investigated the effects of blueberry consumption for 8 weeks on subjective mood states in men with type 2 diabetes. METHODS: In a double-blind, parallel randomized controlled trial, 37 men who are U.S. veterans (mean baseline characteristics: 67 years, range: 51–74 years; body mass index (BMI), 34 kg/m(2), range: 26–44 kg/m(2)) were randomly assigned to 1 of 2 intervention groups. The interventions were either 22 g of freeze-dried blueberries (equivalent to 1 cup fresh blueberries) or 22 g of a placebo (matched in energy and carbohydrate content to the blueberries). The Profile of Mood States (POMS) was assessed twice using POMS 2 65-item questionnaire at the beginning (week 0) and at the end of the study (week 8). Increases in Vigor-Activity and Friendliness scores indicate a positive mood state. Increases in Total Mood Disturbance, Anger-Hostility, Confusion-Bewilderment, Depression-Dejection, Fatigue-Inertia, and Tension-Anxiety scores indicate a negative mood state. RESULTS: Vigor-Activity, Friendliness, Total Mood Disturbance, Anger-Hostility, Confusion-Bewilderment, Depression-Dejection, Fatigue-Inertia and Tension-Anxiety scores were not significantly different after 8 weeks of consumption of blueberries compared with the placebo. Total Mood Disturbance (38.7 ± 1.8 vs. 41.1 ± 2.5, respectively; P = 0.034) and Confusion-Bewilderment (37.3 ± 2.1 vs. 41.6 ± 3.0, respectively; P = 0.044) scores were significantly lower for those consuming blueberries for 8 weeks compared with the placebo in subgroup analysis of men with lower baseline Total Mood Disturbance scores (

Dual energy X-ray absorptiometry (DXA) is recommended for osteoporosis screening in men aged 70 years and older but supportive data is limited. The aim of this study was to determine the efficacy of DXA for the diagnosis of increased fragility in this group of subjects. We retrospectively identified men aged 70 years and older without prior history of fracture and/or conditions predisposing to low bone mineral density (BMD) who attended the VA endocrinology clinic and performed DXA for osteoporosis screening. We analyzed the relationship between BMD and demographic, anthropometric data and biochemical parameters using linear regression models. Out of 55 subjects identified, 13 (24%) men had normal BMD, 30 (54%) had osteopenia and 12 (22%) had a diagnosis of osteoporosis based on the femoral neck (FN) T-score. Lumbar spine T-scores were normal in all three groups. Weight and body mass index (BMI) were significantly higher in the normal BMD group compared with the osteopenia and osteoporosis groups (p

OBJECTIVES: The study investigated the effects of blueberry consumption on biomarkers of glycemic control in US veterans with type 2 diabetes. METHODS: In a double-blind, placebo-controlled parallel study, fifty-five men (mean baseline characteristics: 67 years; weight, 103 kg; body mass index, 34 kg/m(2)) with type 2 diabetes were randomly assigned to 1 of 2 treatment groups for 8 weeks. The treatment groups were either 22 g of a freeze-dried whole blueberry powder (equivalent to 1 cup of fresh blueberries; containing 845 mg phenolics and 470 mg anthocyanins) or 22 g of a blueberry placebo treatment (matched in energy and carbohydrate content to the blueberry treatment). The study participants were asked to consume 11 g of freeze-dried (equivalent to ½ cup of fresh blueberries) blueberry powder or placebo, reconstituted with 240 ml water, with their morning and evening meals along with their typical diet. Fasting blood samples were collected at the beginning and at the end of the study. RESULTS: Fructosamine (275.5 ± 4.1 µmol/L vs. 292.4 ± 7.9 µmol/L, respectively; P = 0.04) and hemoglobin A1C (7.1 ± 0.1% vs. 7.5 ± 0.2%, respectively; P = 0.03) were significantly lower for study participants consuming blueberries for 8 weeks compared with the placebo. In addition, triglycerides (160.6 ± 13.1 mg/dl vs. 183.9 ± 10.7 mg/dl, respectively; P = 0.03), aspartate transaminase (AST) (23.2 ± 1.4 units/L vs. 30.5 ± 2.7 units/L, respectively; P = 0.02) and alanine transaminase (ALT) (35.6 ± 1.5 units/L vs. 48.3 ± 2.9 units/L, respectively; P = 0.0003), were significantly lower for those consuming blueberries compared with the placebo. Glucose, insulin, total cholesterol, LDL cholesterol, HDL cholesterol and body weight were not significantly different after 8 weeks of consumption of blueberries compared with the placebo. CONCLUSIONS: Consumption of 22 g of freeze-dried blueberries daily for 8 weeks results in better glycemic control, such as lowering of fructosamine and hemoglobin A1C. These results along with lower triglyceride concentrations show improvement in the liver enzymes, AST and ALT, which may beneficially affect the cardiometabolic health status of men with type 2 diabetes. FUNDING SOURCES: The U.S. Highbush Blueberry Council; the study is the result of work supported with resources and the use of facilities at the Stratton VA Medical Center, Albany, NY, USA.

Systematic seasonal bias may confound efforts to estimate usual dietary intake and diet quality. Little is known about dietary quality over the winter holiday season.The aims of this study were to test for differences in intakes of energy, percentage of energy from macronutrients, fruits and vegetables, and diet quality measured using the Healthy Eating Index 2010 (HEI-2010) by calendar and winter holiday seasons.Longitudinal cohort design.Data were derived from the Life in All Seasons study. Two cohorts of women aged 40 to 60 years (N=52) from the greater Grand Forks, ND, area were followed for 1 year each between July 2012 and July 2014. Each woman completed an online diet recall using the Automated Self-Administered 24-Hour Recall every 10 days during the year, with a 92% response rate.Effects of calendar and winter holiday seasons on intakes of energy, percent energy from macronutrients, HEI-2010 total and component scores, and grams per day of individual fruits and vegetables were tested using mixed linear models.The mean total HEI-2010 score was 60.1±1.4. There were seasonal differences in some HEI-2010 component scores, but not in total scores. More lettuce or mixed lettuce salad was consumed during summer than during winter (P=0.034), and more fresh tomatoes were consumed during summer and fall compared with winter (P=0.001). More corn, berries, peaches and nectarines, and melons (P0.001) were consumed during summer. There was no seasonal difference in reported intakes of energy (P=0.793). The total HEI-2010 score for dietary intake observed over the winter holiday season was lower than the rest of the year (P0.001). Reported energy intake was not different (P=0.228).In this population, diet quality is significantly lower during the winter holiday period, but mostly consistent by season. Multiple recalls in any season can give a reasonable representation of usual overall diet quality throughout the year.

The consumption of blueberries, as well as the phenolic compounds they contain, may alter metabolic processes related to type 2 diabetes. The study investigated the effects of adding 140 g of blueberries to a higher-carbohydrate breakfast meal on postprandial glucose metabolism, gastrointestinal hormone response, and perceived appetite. As part of a randomized crossover design study, 17 healthy adults consumed a standardized higher-carbohydrate breakfast along with 2 treatments: (1) 140 g (1 cup) of whole blueberries and (2) a placebo gel (matched for calories, sugars, and fiber of the whole blueberries). Each subject participated in two 2-h meal tests on separate visits &ge, 8 days apart. Venous blood samples and perceived appetite ratings using visual analog scales were obtained prior to and at 30, 60, 90, and 120 min after consuming the breakfast meals. Results show that glucose metabolism, several gastrointestinal hormones, glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic peptide (GIP), peptide YY (PYY) concentrations and perceived appetite did not change significantly with blueberry consumption. However, pancreatic polypeptide (PP) concentrations were statistically significantly higher (p = 0.0367), and the concentrations were higher during 30, 60, 90, and 120 min after consumption of the blueberry breakfast meal than the placebo breakfast meal. Additional research is needed to determine whether blueberries and other flavonoid-rich foods reduce type 2 diabetes risk by modifying gastrointestinal hormones and perceived appetite.

Background Blueberries are dietary sources of polyphenols, specifically anthocyanins. Anthocyanins have been identified as having a strong association with type 2 diabetes risk reduction; however, to date few human clinical trials have evaluated the potential beneficial health effects of blueberries in populations with type 2 diabetes. Objectives We investigated the effects of blueberry consumption for 8 wk on cardiometabolic parameters in men with type 2 diabetes. Methods In a double-blind, parallel-arm, randomized controlled trial, 52 men who are US veterans [mean baseline characteristics: age, 67 y (range: 51–75 y); weight, 102 kg (range: 80–130 kg); BMI (in kg/m2), 34 (range: 26–45)] were randomly assigned to 1 of 2 intervention groups. The interventions were either 22 g freeze-dried blueberries or 22 g placebo. The study participants were asked to consume 11 g freeze-dried blueberries or placebo with each of their morning and evening meals along with their typical diet. Results Mean ± SE hemoglobin A1c (7.1% ± 0.1% compared with 7.5% ± 0.2%; P = 0.03), fructosamine (275.5 ± 4.1 compared with 292.4 ± 7.9 µmol/L; P = 0.04), triglycerides (179.6 ± 10.1 compared with 199.6 ± 19.9 mg/dL; P = 0.03), aspartate transaminase (23.2 ± 1.4 compared with 30.5 ± 2.7 units/L; P = 0.02), and alanine transaminase (35.6 ± 1.5 compared with 48.3 ± 2.9 units/L; P = 0.0003) were significantly lower for those consuming blueberries for 8 wk than for those consuming the placebo. Fasting plasma glucose concentrations; serum insulin, total cholesterol, LDL-cholesterol, HDL-cholesterol, and C-reactive protein concentrations; blood pressure; and body weight were not significantly different after 8 wk consumption of blueberries compared with the placebo. Conclusions Consumption of 22 g freeze-dried blueberries for 8 wk may beneficially affect cardiometabolic health parameters in men with type 2 diabetes. This trial was registered at clinicaltrials.gov as NCT02972996.

Introduction The purpose of this pilot study was to assess the effectiveness of the revised My Body Knows When (MBKW) program to promote intuitive eating behaviors within a sample of a military population through an online or in-person delivery mode. Materials and Methods Fifty-six overweight or obese adults (70% female); military service members (20%), retirees (38%) and family (42%) participated in the 10-week MBKW program at two military installations from 2012 to 2014. Body Mass Index, Intuitive Eating Scale-2 (IES-2; 23-item) and Motivation for Eating scale (MFES; 43-item) were collected at baseline and 10-weeks. Data were stratified by sex. Descriptive data were reported as mean ± standard deviation (SD), frequency, or percentage. A paired t-test was conducted with data at baseline and 10 weeks (α = 0.05, 80% power). Results Participants were predominantly female (70%); mean age of 51 ± 13 years; and BMI of 34.1 ± 5.5 kg/m2. There were no demographic, MFES, or IES-2 baseline differences between groups (in-person vs. online) or location. All subjects were collapsed into one group for a pre-post MBKW implementation assessment due to small sample size despite the original intent to stratify by online and in-person grouping. At 10 weeks, the remaining 26 participants exhibited a significant improvement (mean ± SD) in BMI (−0.4 ± 0.6 kg/m2; p = 0.012), environmental/social eating score (2.7 ± 0.4 points [pts]; −0.5 pt change; p < 0.001), emotional eating score (2.2 ± 0.5 pts; −0.6 pt change; p = 0.001), unconditional permission to eat score (3.4 ± 0.4 pts; +0.3 pt change; p = 0.017), eating for physical rather than emotional eating score (3.7 ± 0.8 pts; +1.0 pt change; p < 0.001), and reliance on hunger and satiety cues score (3.6 ± 0.5 pts; +0.8 pt change; p = 0.001). High attrition rates at the 10-week follow-up assessment precluded accurate assessment of long-term intervention effects. Conclusions The MBKW program was associated with improved intuitive eating behaviors and with less external eating influence on behavior; however, a larger sample is required to assess the effectiveness of MBKW delivery mode. Modest weight loss was attained but testing the efficacy of the MBKW program in a large diverse sample with alternate scenarios may be worthwhile (e.g., primary prevention against weight gain, or during weight maintenance to prevent weight regain).

Inflammation and hemostasis contribute to the etiology of cardiovascular disease. We previously demonstrated that moderate alcohol consumption (1-2 drinks/day) may decrease risk for cardiovascular disease because of an improved lipid profile. In addition to these beneficial changes, the alcohol-mediated reduction in risk may be through its effect on inflammation and hemostasis. The objective of the study was to evaluate the effect of moderate alcohol consumption on biomarkers of inflammation and hemostasis in postmenopausal women.As part of a controlled diet study, 53 postmenopausal women each consumed a weight-maintaining diet plus 0, 15 and 30 g/day of alcohol for 8 weeks, in a randomized crossover design. The controlled diet contained 15%, 53% and 32% of energy from protein, carbohydrate and fat, respectively.Soluble intercellular adhesion molecule-1 decreased by 5% (P0.05) with consumption of both 15 and 30 g of alcohol. Fibrinogen concentrations decreased by 4% and 6% (P0.05) after consumption of 15 and 30 g alcohol, respectively. Fibrin D-dimer decreased by 24% (P0.05) after consumption of 30 g of alcohol. Plasminogen activator inhibitor-1 (PAI-1) concentrations were increased 27 and 54% (P0.05) after consumption of 15 and 30 g of alcohol. Plasma high-sensitivity C-reactive protein, interleukin-6 and factor VII coagulant activity did not change with alcohol consumption.These data suggest that moderate alcohol consumption may have beneficial effects on inflammation and hemostasis in postmenopausal women, and this may be somewhat mitigated by an increase in PAI-1.

Wild blueberries have a high content of polyphenols, but there is limited data evaluating their health benefits in adults at risk for type 2 diabetes. The objective of the study was to investigate whether consumption of 100% wild blueberry juice improves cardiometabolic biomarkers associated with type 2 diabetes risk. A single-blind, randomized, placebo-controlled, crossover design trial was conducted in which adults (women, n = 19, ages 39–64 y) at risk for type 2 diabetes consumed 240 mL of wild blueberry juice or a placebo beverage as part of their free-living diet for 7 days. Blood was collected to determine various biomarkers such as fasting plasma glucose, fasting serum insulin, surrogate markers of insulin sensitivity, triglycerides, inflammation (interleukin-6, interleukin-10, high-sensitivity C-reactive protein, tumor necrosis factor-alpha, serum amyloid A), adhesion molecules (soluble intercellular adhesion molecule-1, soluble vascular adhesion molecule-1), oxidative stress (LDL-oxidation, total 8-isoprostanes), and nitric oxide. Endothelial function and blood pressure were also assessed. Wild blueberry juice consumption for 7 days produced no significant changes in glucose, insulin, insulin sensitivity, triglycerides, inflammatory markers, adhesion molecules, oxidative stress, endothelial function or blood pressure. However, wild blueberry juice consumption showed a trend for lowering systolic blood pressure: 120.8 ± 2.2 mmHg in the placebo group vs 116.0 ± 2.2 mmHg in the blueberry juice group (P = 0.088). Serum concentrations of nitrates and nitrites, an index of nitric oxide production, increased from 2.9 ± 0.4 μM after placebo drink to 4.1 ± 0.4 μM after drinking wild blueberry juice (P = 0.039). Short-term consumption of wild blueberry juice may promote cardioprotective effects, by improving systolic blood pressure, possibly through nitric oxide production, in adults at risk for type 2 diabetes. This outcome warrants longer-term human studies of blueberries, including defined amounts of either the whole fruit or juice, to clarify whether polyphenol-rich foods can be efficacious for improving cardiometabolic biomarkers in adults at risk for type 2 diabetes. NCT02139878 , clinicaltrials.gov; date of registration: May 4, 2014.

One hundred percent fruit juice (FJ) contains bioactive compounds with antioxidant activity. As such, this fruit form has the potential to improve antioxidant status and mediate outcomes influenced by redox status. A systematic review of the literature published between 1995 and 2013 was conducted using PubMed database to evaluate associations between intake of 100% FJ and markers of antioxidant/oxidant status and blood lipid levels in healthy, free-living adults ≥18 years. Data extraction and analysis was conducted according to the Academy of Nutrition and Dietetics Evidence Analysis Process. Limited evidence from ten clinical trials meeting inclusion/exclusion criteria suggests potential improvements in a variety of antioxidant or oxidants biomarkers postconsumption of 100% FJ. Weak evidence from five studies suggests that one or more blood lipid measures may be positively influenced by consumption of 100% FJ. Heterogeneity in study methodology including biomarkers, 100% FJ type, dosage, and intervention duration precludes the ability to make evidence-based recommendations regarding a specific dose-duration-juice effect. Key characteristics in study designs were identified which must either be controlled or statistically adjusted for in future investigations in order to obtain a more accurate understanding of the complex relationship between metabolic outcomes and consumption of 100% FJ in context of a healthy dietary pattern.

Differences in energy and macronutrient intakes by weekday and weekend have been reported, but there are few data on differences in food group consumption and indices of diet quality.The aim of this study was to describe dietary intake by day and on weekends compared with weekdays.This study utilized a longitudinal cohort design with self-reported dietary intake collected using the Automated Self-Administered 24-Hour Dietary Assessment Tool.Participants were ambulatory women with access to high-speed internet, body mass index between 18 and 35, and aged 40 to 60 years from the Life in All Seasons study (n=52) conducted in Grand Forks, ND, between July 2012 and July 2014. Each woman completed an Automated Self-Administered 24-Hour Dietary Assessment Tool diet recall every 10 days for 1 year.Primary outcome measures were total and energy intake from macronutrients, food groups (per 1,000 kcal), and Healthy Eating Index-2010 (HEI-2010) scores from 1,866 24-hour recalls.Effects of weekend on energy and macronutrient intake, energy-adjusted food groups, and HEI-2010 scores and component scores were tested using mixed linear models.Participants (n=52) completed 1,080 recalls on weekdays and 786 on weekends. Seventy-five percent of women reported consuming more energy on weekends than on weekdays, with a higher mean intake of 158 kcal on weekends (P0.01). The percentage of energy from carbohydrate (P0.01) and protein (P0.01) were both lower on weekends, and percentage of energy from alcohol higher (P0.01). There was no difference in the percentage of energy from fat (P=0.07). Reported energy intake was greatest on Saturdays and lowest on Tuesdays. On weekends, women had reduced diet quality with more alcoholic beverages, solid fat, and potatoes, and less yogurt, whole fruits, dark green and orange vegetables, poultry, nuts and seeds, and whole grains per 1,000 kcal than on weekdays. HEI-2010 scores were lower on weekends than weekdays (P0.01). Component scores were lower for whole fruits (P0.01), greens and beans (P=0.02), whole grains (P0.01), and dairy (P0.01).Midlife women should be encouraged to maintain diet quality during weekends to improve overall diet quality scores.

AIMS Increased concentrations of parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF23) often coincide with normal serum phosphorus ([P]s) in chronic kidney disease (CKD). We hypothesized that the phosphate concentration ([P]f) in the cortical distal nephron (CDN) determines [PTH] and [FGF23] in this circumstance. METHODS We studied 29 patients with CKD at 4 visits and 28 controls at 1 visit. Assuming GFR = creatinine clearance (Ccr), we examined the following regressions: [P]s on its determinants, EP/Ccr and TRP/Ccr (P excretion and reabsorption per volume of filtrate); [PTH] and [FGF23] on [P]s and EP/Ccr; and TRP/Ccr on [PTH] and [FGF23]. We assumed that EP/Ccr is proportional to [P]f in the CDN. RESULTS In controls, [P]s correlated with TRP/Ccr but not EP/Ccr. [PTH] and [FGF23] were unrelated to [P]s, EP/Ccr, and TRP/Ccr. In CKD, [P]s correlated with EP/Ccr and TRP/Ccr. [PTH] correlated with [P]s at 2 visits and with EP/Ccr at 4; [FGF23] correlated with [P]s and EP/Ccr at all visits. TRP/Ccr correlated with [FGF23] and [PTH] at one visit each. CONCLUSIONS [P]f in the CDN, not [P]s, determined [PTH] in CKD. Because [FGF23] was consistently associated with only one determinant of [P]s, EP/Ccr, we infer that [P]f also determined [FGF23]. In patients with CKD, we speculate that [P]f in the CDN regulates FGF23 synthesis at that site.

ObjectiveTo test differences in dietary intake by individual day and on weekends (Friday, Saturday, Sunday) compared to weekdays using energy and macronutrient intake, food groupings and Healthy Ea...

A double-blind, randomized clinical trial was conducted to determine the effect of consumption of supplemental whey protein (WP), soy protein (SP), and an isoenergetic amount of carbohydrate (CHO) on body weight and composition in free-living overweight and obese but otherwise healthy participants. Ninety overweight and obese participants were randomly assigned to 1 of 3 treatment groups for 23 wk: 1) WP; 2) SP (each providing ~56 g/d of protein and 1670 kJ/d); or 3) an isoenergetic amount of CHO. Supplements were consumed as a beverage twice daily. Participants were provided no dietary advice and continued to consume their free-choice diets. Participants’ body weight and composition data were obtained monthly. Dietary intake was determined by 24-h dietary recalls collected every 10 d. After 23 wk, body weight and composition did not differ between the groups consuming the SP and WP or between SP and CHO; however, body weight and fat mass of the group consuming the WP were lower by 1.8 kg (P < 0.006) and 2.3 kg (P < 0.005), respectively, than the group consuming CHO. Lean body mass did not differ among any of the groups. Waist circumference was smaller in the participants consuming WP than in the other groups (P < 0.05). Fasting ghrelin was lower in participants consuming WP compared with SP or CHO. Through yet-unknown mechanisms, different sources of dietary protein may differentially facilitate weight loss and affect body composition. Dietary recommendations, especially those that emphasize the role of dietary protein in facilitating weight change, should also address the demonstrated clinical potential of supplemental WP.

Laboratory experiments are often considered the defining characteristic of science courses. Such activities provide students with real‐world contexts for applying scientific concepts, while also allowing them to develop scientific ways of thinking and promoting an interest in science. In recent years, an increasing number of campuses have moved their instruction to the online learning environment. Consequently, in the sciences there is a growing need to develop best practices related to the integration of laboratory‐based activities with online science coursework. This research study explored how online students engaged in scientific processes as they conducted relevant and real‐world experiments from their own locations. An analysis of three online science courses revealed that laboratory experiments can be performed successfully by distance learning students.

ObjectiveTo determine the number of 24 h dietary recalls required to adequately estimate nutrient intake in overweight and obese adults using the US Department of Agriculture's (USDA) automated multiple-pass method (AMPM). In addition, the study quantified sources of variation in dietary intake, such as day of the week, season, sequence of diet interviews (training effect), diet interviewer, body weight and within- and between-subject variances in the intake of selected nutrients.DesignAdults having a BMI of ≥ 28 but 2 were included in the study. The USDA's AMPM was used to obtain 24 h dietary recalls every 10 d for 6 months. Dietary intake data were analysed to adequately estimate the number of 24 h recalls necessary to assess nutrient intake. Variance component estimates were made by using a mixed-model procedure.SettingThe greater Washington, DC, metropolitan area.SubjectsAdults (34 men and 39 women) aged 35–65 years.ResultsOverweight and obese adults completed fourteen 24 h dietary recalls. Utilizing within- and between-subject variances requires 5–10 and 12–15 d of 24 h dietary recalls in men and women, respectively, to estimate energy and macronutrient intakes in a 6-month period. Within- and between-subject variances were the major contributors to variance in nutrient intakes. Day of the week, season, sequence, diet interviewer and body weight had little impact on variance.ConclusionsThis information is valuable for researchers planning to conduct studies on free-living individuals that include the collection of dietary intake data.

Studies of the influence of tea on glucose metabolism have produced inconsistent results, possibly because of the lack of dietary control and/or unclear characterization of tea products. Therefore, a double-blind crossover study was conducted in which healthy males (n=19) consumed each of three oolong tea products or a control beverage as part of a controlled diet. Treatment beverages (1.4 l/day) were consumed for 5 days, followed by assessment of fasting plasma glucose, fasting serum insulin and an oral glucose tolerance test. Tea products included oolong tea, oolong tea with added catechins and oolong tea with added oolong tea polyphenols, and control beverages included caffeinated water and unsupplemented water. On the fifth day of each treatment period, treatment beverages were consumed with a standardized meal, and glucose and insulin responses were assessed for 240 min. No significant differences were detected for fasting plasma glucose, fasting serum insulin, incremental plasma glucose area under the concentration time curve (AUC), total plasma glucose AUC or total serum insulin AUC. Neither oolong tea nor oolong tea supplemented with catechins or other polyphenols produced improved glucose metabolism in healthy adult volunteers on the basis of this highly controlled dietary intervention trial.

Although consumption of 3 meals/d is the most common pattern of eating in industrialized countries, a scientific rationale for this meal frequency with respect to optimal health is lacking. A diet with less meal frequency can improve the health and extend the lifespan of laboratory animals, but its effect on humans has never been tested.A pilot study was conducted to establish the effects of a reduced-meal-frequency diet on health indicators in healthy, normal-weight adults.The study was a randomized crossover design with two 8-wk treatment periods. During the treatment periods, subjects consumed all of the calories needed for weight maintenance in either 3 meals/d or 1 meal/d.Subjects who completed the study maintained their body weight within 2 kg of their initial weight throughout the 6-mo period. There were no significant effects of meal frequency on heart rate, body temperature, or most of the blood variables measured. However, when consuming 1 meal/d, subjects had a significant increase in hunger; a significant modification of body composition, including reductions in fat mass; significant increases in blood pressure and in total, LDL-, and HDL-cholesterol concentrations; and a significant decrease in concentrations of cortisol.Normal-weight subjects are able to comply with a 1 meal/d diet. When meal frequency is decreased without a reduction in overall calorie intake, modest changes occur in body composition, some cardiovascular disease risk factors, and hematologic variables. Diurnal variations may affect outcomes.

Consumption of 100% fruit juice remains controversial for its potential adverse impact on weight and displacement of essential foods in the diets of children. A systematic review of the literature published from 1995-2013 was conducted using the PubMed database to evaluate associations between intake of 100% fruit juice and weight/adiposity and nutrient intake/adequacy among children of 1 to 18 years of age. Weight status outcome measures included body mass index (BMI), BMI z-score, ponderal index, obesity, weight gain, adiposity measures, and body composition. Nutrient outcome measures included intake and adequacy of shortfall nutrients. Data extraction and analysis was conducted according to the Academy of Nutrition and Dietetics Evidence Analysis Process. Twenty-two studies on weight status provided evidence that did not support an association between 100% fruit juice consumption and weight/adiposity in children after controlling for energy intake. Limited evidence from eight studies suggests that children consuming 100% fruit juice have higher intake and adequacy of dietary fiber, vitamin C, magnesium, and potassium. Differences in methodology and study designs preclude causal determination of 100% fruit juice as sole influencer of weight status or nutrient intake/adequacy of shortfall nutrients. In context of a healthy dietary pattern, evidence suggests that consumption of 100% fruit juice may provide beneficial nutrients without contributing to pediatric obesity.

AIMS Influx (IP) determines urinary excretion of phosphorus (EP). Contributions of IP and reabsorption (TRP) to serum phosphorus ([P]s) can be depicted by normalization to creatinine clearance (EP/Ccr and TRP/Ccr) or by calculation of fractional excretion and reabsorption (FEP and FTRP). We analyzed these parameters at normal and reduced GFR. METHODS We studied 29 patients with chronic kidney disease (CKD) and 28 controls. From [cr] and [P] in serumand urine we calculated [P]u/[cr]u, EP/Ccr, TRP/Ccr, (TRP/Ccr)/(EP/Ccr), FEP, and FTRP. We compared means between groups and examined pertinent linear regressions. RESULTS [P]s was not different in CKD and controls. [Cr]s, EP/Ccr, and FEP were higher and TRP/Ccr, (TRP/Ccr)/(EP/Ccr), and FTRP were lower in CKD. [P]u/[cr]u, a surrogate for IP, was similar in both groups. In CKD, [P]s correlated with EP/Ccr and TRP/Ccr; EP/Ccr with [P]u/[cr]u and [cr]s; and FEP with EP/Ccr, TRP/Ccr, [P]u/[cr]u, and [cr]s. In controls, [P]s correlated with TRP/Ccr; EP/Ccr with [P]u/[cr]u; and FEP with EP/Ccr and [P]u/[cr]u. In both groups, FEP was a precise inverse function of (TRP/Ccr)/(EP/Ccr). Despite wide variation in TRP/Ccr, FEP was 20% in 27/29 patients with CKD. CONCLUSIONS GFR affected determinants of [P]s, EP/Ccr, and FEP. FTRP was often dissociated from TRP/Ccr at normal or reduced GFR.

The primary objective of this study was to identify potentially synergistic or additive effects of combining consumption of dark chocolate with almonds as part of a low-fat diet on circulating levels of serum lipids and inflammatory markers: intercellular adhesion molecule (ICAM), vascular adhesion molecule, and high-sensitivity C-reactive protein. A 6-week, 4-armed parallel design was used; 49 healthy normocholesterolemic women participated. Subjects were randomized to 1 of 3 treatments: chocolate (41 g/d), almonds (60 g/d), chocolate and almonds, or control (no chocolate or almonds). All subjects followed the National Cholesterol Education Program Therapeutic Lifestyle Changes diet. All subjects improved dietary intakes in accordance with guidelines, and no subjects gained or lost weight. Serum cholesterol concentrations showed no changes after 6 weeks; however, triacylglycerol levels were reduced by approximately 21%, 13%, 19%, and 11% ( P P = .027). No significant changes were observed for vascular adhesion molecule and high-sensitivity C-reactive protein levels in any treatment group. No synergistic or additive effects were observed when both products were consumed. In conclusion, consumption of chocolate and almonds as part of the Therapeutic Lifestyle Changes diet for 6 weeks showed no harmful effects in healthy women; all dietary modifications improved serum triacylglycerol levels, and consumption of chocolate reduced levels of circulating ICAM.

AIMS Parathyroid hormone (PTH) promotes calcium reabsorption in the cortical distal nephron (CDN). The phosphate concentration ([P]f) rises in that segment in chronic kidney disease (CKD); in theory, high [P]f could reduce availability of calcium for reabsorption and necessitate a compensatory rise in [PTH]. With assumptions, [P]f is proportional to phosphate excreted/volume of filtrate (EP/GFR). We therefore hypothesized that [PTH] would correlate with EP/GFR in CKD, and ΔPTH] would correlate with ΔEP/GFR after sevelamer therapy. METHODS We conducted a 4-week, placebo-controlled trial of sevelamer carbonate in patients with CKD. [PTH]1-84 and parameters of phosphate homeostasis were measured before and after treatment. GFR was assumed to equal creatinine clearance (Ccr). Pertinent linear regressions were performed. RESULTS Phosphate excretion fell in the sevelamer group only. Decrements in [PTH] with sevelamer differed from increments with placebo. With either treatment, [PTH] correlated with EP/Ccr and ΔPTH] correlated with ΔEP/Ccr. Changes in [PTH] were minimal in some sevelamer recipients despite reductions in EP/Ccr; calcium excreted/volume of filtrate was low in these subjects. CONCLUSIONS Phosphate influx affected [PTH] in CKD by determining [P]f in the CDN. In some patients, low calcium influx may have blunted the effect of sevelamer on [PTH].

AIMS Primary hyperparathyroidism (PHPT) causes hypercalcemia by increasing tubular calcium reabsorption. Because chronic kidney disease (CKD) is associated with normocalcemia, we inferred that calcium reabsorption is also normal, and hypothesized that normal reabsorption requires excessive parathyroid hormone (PTH) in CKD. METHODS The following were obtained in controls and patients with CKD or PHPT: estimated GFR (eGFR); concentrations of PTH 1-84, 1,25-dihydroxyvitamin D, and ultrafilterable and ionized calcium ([PTH], [1,25(OH)2D], [Ca]uf, [Ca]i); and ratios of calcium excreted or reabsorbed per volume of filtrate (ECa/Ccr, TRCa/Ccr). Pertinent linear regressions were examined. RESULTS In CKD, [PTH] was increased, but ECa/Ccr, TRCa/Ccr, [Ca]uf, and [Ca]i equaled control values. [PTH] was inversely related to eGFR but unrelated to [1,25(OH)2D]. TRCa/Ccr was constant at all [PTH]. In PHPT, [PTH] was no higher than in CKD, but TRCa/Ccr, [Ca]uf, and [Ca]i were increased. [1,25(OH)2D] correlated with [PTH]. In controls, TRCa/Ccr varied directly with [1,25(OH)2D] and inversely with [PTH]. CONCLUSIONS In controls, calcium reabsorption rose with [1,25(OH)2D], and [PTH] fell in response. In PHPT, [PTH] determined [1,25(OH)2D]; together, the hormones increased calcium reabsorption and caused hypercalcemia. In CKD, normal calcium reabsorption required high [PTH].

Background:The number of days of data and number of subjects necessary to estimate total physical activity (TPA) and moderate-to-vigorous physical activity (MVPA) requires an understanding of within- and between-subject variances, and the influence of sex, body composition, and age.Methods:Seventy-one adults wore accelerometers for 7-day intervals over 6 consecutive months.Results:Body fat and sex influenced TPA and MVPA. The sources of subject-related variation for TPA and MVPA were within-subject (48.4% and 54.3%), between-subject (34.3% and 31.8%), and calendar effects (17.3% and 13.9%). Based on within-subject variances, the error associated with estimating TPA and MVPA by collecting 1 to 7 days of data ranged from 28.2% to 13.3% for TPA and 62.0% to 28.6% for MVPA. Based on between-subject variances, detecting a 10% difference between 2 groups at a power of 90% requires approximately 200 and 725 subjects per group for TPA and MVPA, respectively.Conclusions:Estimates of MVPA are more variable than TPA in overweight adults, therefore more days of data are required to estimate MVPA and larger sample sizes to detect treatment differences for MVPA. Log-transforming data reduces the need for additional days of data collection, thereby improving chances of detecting treatment effects.

Resistant maltodextrin (RM) is a novel soluble, nonviscous dietary fiber. Its metabolizable energy (ME) and net energy (NE) values derived from nutrient balance studies are unknown, as is the effect of RM on fecal microbiota. A randomized, placebo-controlled, double-blind crossover study was conducted (n = 14 men) to determine the ME and NE of RM and its influence on fecal excretion of macronutrients and microbiota. Participants were assigned to a sequence consisting of 3 treatment periods [24 d each: 0 g/d RM + 50 g/d maltodextrin and 2 amounts of dietary RM (25 g/d RM + 25 g of maltodextrin/d and 50 g/d RM + 0 g/d maltodextrin)] and were provided all the foods they were to consume to maintain their body weight. After an adaptation period, excreta were collected during a 7-d period. After the collection period, 24-h energy expenditure was measured. Fluorescence in situ hybridization, quantitative polymerase chain reaction, and 454 titanium technology-based 16S rRNA sequencing were used to analyze fecal microbiota composition. Fecal amounts of energy (544, 662, 737 kJ/d), nitrogen (1.5, 1.8, 2.1 g/d), RM (0.3, 0.6, 1.2 g/d), and total carbohydrate (11.1, 14.2, 16.2 g/d) increased with increasing dose (0, 25, 50 g) of RM (P < 0.0001). Fat excretion did not differ among treatments. The ME value of RM was 8.2 and 10.4 kJ/g, and the NE value of RM was -8.2 and 2.0 kJ/g for the 25 and 50 g/d RM doses, respectively. Both doses of RM increased fecal wet weight (118, 148, 161 g/d; P < 0.0001) and fecal dry weight (26.5, 32.0, 35.8 g/d; P < 0.0001) compared with the maltodextrin placebo. Total counts of fecal bacteria increased by 12% for the 25 g/d RM dose (P = 0.17) and 18% for the 50 g/d RM dose (P = 0.019). RM intake was associated with statistically significant increases (P < 0.001) in various operational taxonomic units matching closest to ruminococcus, eubacterium, lachnospiraceae, bacteroides, holdemania, and faecalibacterium, implicating RM in their growth in the gut. Our findings provide empirical data important for food labeling regulations related to the energy value of RM and suggest that RM increases fecal bulk by enhancing the excretion of nitrogen and carbohydrate and the growth of specific microbial populations.

Flavanols may provide protection against insulin resistance, but little is known about the amounts and types of flavanols that may be efficacious.This study was designed to determine whether cocoa flavanols, over a range of intakes, improve biomarkers of glucose regulation, inflammation and hemostasis in obese adults at risk for insulin resistance. As an adjunct, green tea and cocoa flavanols were compared for their ability to modulate these biomarkers. In a randomized crossover design, 20 adults consumed a controlled diet for 5 days along with four cocoa beverages containing 30-900 mg flavanol per day, or tea matched to a cocoa beverage for monomeric flavanol content.Cocoa beverages produced no significant changes in glucose, insulin, total area under the concentration-time curve (AUC) for glucose or total insulin AUC. As the dose of cocoa flavanols increased, total 8-isoprostane concentrations were lowered (linear contrast, P=0.02), as were C-reactive protein (CRP) concentrations (linear contrast, P=0.01). The relationship between cocoa flavanol levels and interleukin-6 (IL-6) concentrations was quadratic, suggesting that a maximum effective dose was achieved (quadratic contrast, P=0.01). There were no significant effects on measured indices of glucose regulation, nor on those of total 8-isoprostane, CRP and IL-6 concentrations, when cocoa and green tea were compared. However, relative to cocoa, green tea lowered fibrinogen concentrations (P=0.0003).Short-term intake of cocoa and green tea flavanols does not appear to improve glucose metabolism; they do affect selected markers of one or more measures of oxidative stress, inflammation or hemostasis in obese adults at risk for insulin resistance.

Background Intermittent fasting (IF) improves healthy lifespan in animals by a mechanism involving reduced oxidative damage and increased resistance to stress. However, no studies have evaluated the impact of controlled meal frequency on immune responses in human subjects. Objective A study was conducted to establish the effects of controlled diets with different meal frequencies, but similar daily energy intakes, on cytokine production in healthy male and female subjects. Design In a crossover study design with an intervening washout period, healthy normal weight middle-age male and female subjects (n = 15) were maintained for 2 months on controlled on-site one meal per day (OMD) or three meals per day (TMD) isocaloric diets. Serum samples and peripheral blood mononuclear cells (PBMCs) culture supernatants from subjects were analyzed for the presence of inflammatory markers using a multiplex assay. Results There were no significant differences in the inflammatory markers in the serum of subjects on the OMD or TMD diets. There was an increase in the capacity of PBMCs to produce cytokines in subjects during the first month on the OMD or TMD diets. Lower levels of TNF-α, IL-17, MCP-1 and MIP-1β were produced by PBMCs from subjects on the OMD versus TMD diet. Conclusions PBMCs of subjects on controlled diets exhibit hypersensitivities to cellular stimulation suggesting that stress associated with altered eating behavior might affect cytokine production by immune cells upon stimulation. Moreover, stimulated PBMCs derived from healthy individuals on a reduced meal frequency diet respond with a reduced capability to produce cytokines.

A high intake of whole grains containing soluble fiber has been shown to lower glucose and insulin responses in overweight humans and humans with type 2 diabetes.We investigated the linearity of this response after consumption of 5 breakfast cereal test meals containing wheat and/or barley to provide varying amounts of soluble fiber, beta-glucan (0, 2.5, 5, 7.5 and 10 g).Seventeen normoglycemic, obese women at increased risk for insulin resistance consumed 5 test meals within a randomized cross-over design after consuming controlled diets for 2 days. Blood samples for glucose and insulin response were obtained prior to and 30, 60, 120 and 180 min after consuming the test meals.Consumption of 10 g of beta-glucan significantly reduced peak glucose response at 30 min and delayed the rate of glucose response. Area under the curve for 2 h-postprandial glycemic response was not affected by beta-glucan content. However, peak and area under the curve of insulin responses were significantly affected by the beta-glucan amount in an inverse linear relationship.These data suggest that acute consumption of 10 g of beta-glucan is able to induce physiologically beneficial effects on postprandial insulin responses in obese women at risk for insulin resistance.

Diabetes mellitus and its sequelae are a major and growing public health problem. The prevalence of diabetes worldwide is 194 million persons, or 5.1% of the population, and is projected to increase to 333 million, or 6.3% of the population, by 2025. Type 2 diabetes accounts for approximately 90-95% of those with diabetes in the United States and other developed countries. Tea is the most widely consumed beverage in the world, second only to water. Tea contains polyphenols and other components that may reduce the risk of developing chronic diseases such as cardiovascular disease and cancer. Some evidence also shows that tea may affect glucose metabolism and insulin signaling, which, as a result, has spurred interest in the health effects of tea consumption on diabetes. Epidemiologic studies suggest some relation between tea consumption and a reduced risk of type 2 diabetes, although the mechanisms for these observations are uncertain. Findings from in vitro and animal models suggest that tea and its components may influence glucose metabolism and diabetes through several mechanisms, such as enhancing insulin sensitivity. Some human clinical studies evaluating tea and its components show improvement in glucoregulatory control and endothelial function. However, further controlled clinical trials are required to gain a better understanding of the long-term effects of tea consumption in persons with diabetes.

Background Activity monitors (AM) are small, electronic devices used to quantify the amount and intensity of physical activity (PA). Unfortunately, it has been demonstrated that data loss that occurs when AMs are not worn by subjects (removals during sleeping and waking hours) tend to result in biased estimates of PA and total energy expenditure (TEE). No study has reported the degree of data loss in a large study of adults, and/or the degree to which the estimates of PA and TEE are affected. Also, no study in adults has proposed a methodology to minimize the effects of AM removals. Methods Adherence estimates were generated from a pool of 524 women and men that wore AMs for 13 – 15 consecutive days. To simulate the effect of data loss due to AM removal, a reference dataset was first compiled from a subset consisting of 35 highly adherent subjects (24 HR; minimum of 20 hrs/day for seven consecutive days). AM removals were then simulated during sleep and between one and ten waking hours using this 24 HR dataset. Differences in the mean values for PA and TEE between the 24 HR reference dataset and the different simulations were compared using paired t-tests and/or coefficients of variation. Results The estimated average adherence of the pool of 524 subjects was 15.8 ± 3.4 hrs/day for approximately 11.7 ± 2.0 days. Simulated data loss due to AM removals during sleeping hours in the 24 HR database (n = 35), resulted in biased estimates of PA (p < 0.05), but not TEE. Losing as little as one hour of data from the 24 HR dataset during waking hours results in significant biases (p < 0.0001) and variability (coefficients of variation between 7 and 21%) in the estimates of PA. Inserting a constant value for sleep and imputing estimates for missing data during waking hours significantly improved the estimates of PA. Conclusion Although estimated adherence was good, measurements of PA can be improved by relatively simple imputation of missing AM data.

An unresolved issue in the field of diet and health is if and how changes in meal frequency affect energy metabolism in humans. We therefore evaluated the influence of reduced meal frequency without a reduction in energy intake on glucose metabolism in normal-weight, healthy male and female subjects. The study was a randomized crossover design, with two 8-week treatment periods (with an intervening 11-week off-diet period) in which subjects consumed all of their calories for weight maintenance distributed in either 3 meals or 1 meal per day (consumed between 4:00 pm and 8:00 pm). Energy metabolism was evaluated at designated time points throughout the study by performing morning oral glucose tolerance tests and measuring levels of glucose, insulin, glucagon, leptin, ghrelin, adiponectin, resistin, and brain-derived neurotrophic factor (BDNF). Subjects consuming 1 meal per day exhibited higher morning fasting plasma glucose levels, greater and more sustained elevations of plasma glucose concentrations, and a delayed insulin response in the oral glucose tolerance test compared with subjects consuming 3 meals per day. Levels of ghrelin were elevated in response to the 1-meal-per-day regimen. Fasting levels of insulin, leptin, ghrelin, adiponectin, resistin, and BDNF were not significantly affected by meal frequency. Subjects consuming a single large daily meal exhibit elevated fasting glucose levels and impaired morning glucose tolerance associated with a delayed insulin response during a 2-month diet period compared with those consuming 3 meals per day. The impaired glucose tolerance was reversible and was not associated with alterations in the levels of adipokines or BDNF.

Dual-absorbance x-ray absorptiometry (DEXA) is a rapid method for body fat estimation that correlates well with more time-consuming, technically challenging “gold standard” methods, and is relative...

A double-blind, randomized clinical trial was conducted to determine the effects of supplemental whey protein, compared to soy protein and an isocaloric amount of carbohydrate, on body weight and c...

Methods: A convenience sample of adults was surveyed utilizing an online learning management system. The Motivation for Eating Scale (MFES), a validated 42-item survey, was used to evaluate the primary motivation influencing eating behavior with three subscales classified as emotional, environmental and physical. Additionally, anthropometrics and six 24-hour dietary recalls were collected utilizing a web-based automated self-administered 24-hour dietary recall (National Cancer Institute's ASA24) method over 15 weeks.

MULTIPLE PASS METHOD AND THEIR IMPACT ON DETERMINING USUAL ENERGY AND NUTRIENT INTAKE IN OBESE INDIVIDUALS Author(s): K. S. Stote, A. J. Moshfegh, L. A. Ingwersen, S. V. Radecki, D. J. Baer; Diet and Human Performance Laboratory, Beltsville Human Nutrition Research Center, USDA, ARS, Beltsville, MD, Food Surveys Research Group, Beltsville Human Nutrition Research Center, USDA, ARS, Beltsville, MD, Statistical Consulting, Fort Collins, CO