Dietary flavanols and procyanidin oligomers from cocoa (Theobroma cacao) inhibit platelet function

BACKGROUND: Flavonoids may be partly responsible for some health benefits, including antiinflammatory action and a decreased tendency for the blood to clot. An acute dose of flavanols and oligomeric procyanidins from cocoa powder inhibits platelet activation and function over 6 h in humans. OBJECTIVE: This study sought to evaluate whether 28 d of supplementation with cocoa flavanols and related procyanidin oligomers would modulate human platelet reactivity and primary hemostasis and reduce oxidative markers in vivo. DESIGN: Thirty-two healthy subjects were assigned to consume active (234 mg cocoa flavanols and procyanidins/d) or placebo (< or = 6 mg cocoa flavanols and procyanidins/d) tablets in a blinded parallel-designed study. Platelet function was determined by measuring platelet aggregation, ATP release, and expression of activation-dependent platelet antigens by using flow cytometry. Plasma was analyzed for oxidation markers and antioxidant status. RESULTS: Plasma concentrations of epicatechin and catechin in the active group increased by 81% and 28%, respectively, during the intervention period. The active group had significantly lower P selectin expression and significantly lower ADP-induced aggregation and collagen-induced aggregation than did the placebo group. Plasma ascorbic acid concentrations were significantly higher in the active than in the placebo group (P < 0.05), whereas plasma oxidation markers and antioxidant status did not change in either group. CONCLUSIONS: Cocoa flavanol and procyanidin supplementation for 28 d significantly increased plasma epicatechin and catechin concentrations and significantly decreased platelet function. These data support the results of acute studies that used higher doses of cocoa flavanols and procyanidins.

Applying GIS in physical activity research: community walkability and walking behaviours.

Physical activity provides many health benefits, including reduced risk of cardiovascular disease, Type II diabetes and some cancers. Environmental exposure factors (e.g., the built environment) are now receiving ever-increasing attention. Large-scale interdisciplinary studies on the association between attributes of local community environments and residents’ physical activity are being conducted. We will focus on findings from Australia - the Physical Activity in Localities and Community Environments (PLACE) study. PLACE is examining factors that may influence the prevalence and the social and spatial distribution of walking for transport and walking for recreation. A stratified two-stage cluster sampling strategy was used to select 32 urban communities (154 census collection districts), classified as high and low ‘walkable’ using a GISbased walkability index (dwelling density, intersection density, net retail area and land use mix) and matched for socio-economic status. We report data on a sub-sample of 1,216 residents who provided information on the perceived attributes of their community environments (e.g., dwelling density, access to services, street connectivity) and weekly minutes of walking for transport and for recreation. Moderate to strong associations were found between GIS indicators of walkability and the corresponding self-report measures. The walkability index explained the same amount of neighborhood-level variance in walking for transport as did the complete set of self-report measures. No significant associations were found with walking for recreation. Relevant GIS-based indices of walkability, for purposes other than transport need to be   developed.

The cognitive contexts of beliefs about the healthiness of meat

Objective: The overall aim of this study was to examine a variety of belief and demographic factors that are associated with the perception that meat is intrinsically unhealthy.

Design: State-wide survey (written questionnaire) that included questions on meat and nutrition beliefs, perceived barriers and benefits of vegetarian diets, personal values, number of vegetarian friends and family members, and use and trust of health/nutrition/food information sources.

Setting: South Australia.

Subjects: Six hundred and one randomly selected South Australians and 106 non-randomly selected vegetarians and semi-vegetarians.

Results: For all respondents considered as a group, the most important predictors of the belief that meat is intrinsically unhealthy were the perceived benefits of vegetarian diets (all positive predictors). These included: (1) the perceived links between vegetarianism, peace and increased contentment; (2) animal welfare and environmental benefits; and (3) health benefits. There were differences between different dietary groups however. For non-vegetarians, social concerns about vegetarianism (positive) were most important, followed by health and non-health benefits (positive) of vegetarianism. Red meat appreciation was the strongest (positive) predictor for vegetarians, with health benefits of vegetarianism (positive) and education (negative predictor) also important.

Conclusions: The implications of the findings for health and other issues are discussed. Judgements about the healthiness of meat are likely to be related to moral and environmental beliefs and, for non-vegetarians, to social concerns about vegetarianism, in addition to health beliefs. These need to be considered if any attempts are made to influence meat consumption.

Dietary conjugated linoleic acid differentially alters fatty acid composition and increases conjugated linoleic acid content in porcine adipose tissue

Conjugated linoleic acids (CLA) have been shown to decrease body fat content in pigs. It is possible that feeding pigs diets rich in CLA may increase carcass lipid CLA to levels that could provide health benefits when included as a part of a healthy diet. Therefore, the aim of the present study was to determine whether dietary CLA supplementation has any effect on the fatty acid composition of subcutaneous and intramuscular adipose tissue in pigs. Thirty-five female cross bred (Large White X Landrace) pigs (initial weight 57·2 kg and initial P2 back fat 11·5 mm) were used in the present study. Pigs were housed individually and randomly allocated to one of six dietary treatments (0·00, 1·25, 2·50, 5·00, 7·50 and 10·00 g CLA55 (55 g CLA isomers/100 g total fatty acids; Natural Lipids Ltd, Hovdebygda, Norway)/kg)
and fed their respective diets for 8 weeks. Twelve CLA isomers in the diet and in pig tissue lipids were separated by Agþ-HPLC. CLA was incorporated at fivefold higher levels in subcutaneous fat as compared with intramuscular fat and in a dose-dependant manner. Overall, the transfer efficiency of CLA was maximized at 5·00 g CLA55/kg. However, there was clear selectivity in the uptake or incorporation of cis,trans-9,11 isomer over the trans,cis-10,12 isomer. In general, CLA supplementation produced significant changes in skeletal muscle and adipose tissue fatty acid composition, indicating that dietary CLA had a potent affect on lipid transport and metabolism in vivo. Significant increases in myristic, palmitic and palmitoleic acids and a reduction in arachidonic acid were observed, suggesting an alteration in
activity of Δ5-, Δ6- and Δ9-desaturases in pig adipose tissue. In conclusion, feeding pigs diets supplemented with CLA increases carcass lipid CLA, but also results in changes in the fatty acid profile in pig fat that could potentially outweigh the benefits of CLA.

Does elite competition inhibit growth and delay maturation in some gymnasts? quite possibly

Today, elite young gymnasts undertake training programs of progressive volume and intensity from an early age. For example, talented young female gymnasts often commence training at age 5 or 6 and train more than 20 to 30 hours per week year-round throughout childhood and adolescence. Despite the "normal" short stature of top-level gymnasts and the obvious health benefits of physical activity during growth, there is concern that elite level or those gymnasts involved in heavy training regimens may be at risk for adverse effects on growth and maturation. This concern has been the source of much debate in the literature and is complicated by the difficulties in distinguishing between the genetic predisposition to short stature and late or delayed maturation, and the effect of environmental factors such as nutrition and exercise that may influence growth and maturation. The effect of gymnastics training on growth and maturation is often reported as averaged data: an approach that does not identify individual growth patterns. Finding no difference between groups is not proof that there is "in fact" no difference. Accepting the null hypothesis without the appropriate critical review of both the methodological and statistical power to detect differences is a flawed endeavor. We believe there is compelling "circumstantial" evidence to build a case that preparation for advanced gymnastics competition may place some children and youth at risk of reduced growth and delayed maturation.

Destinations that matter: associations with walking for transport

Associations between access to destinations and walking for transport were examined. Households (N=2650) were selected from 32 urban communities varying in walkability and socio-economic status. Respondents reported perceived proximity of destinations, transport-related walking, reasons for neighbourhood selection, and socio-demographic characteristics. Geographic Information Systems data defined objective measures of access to destinations. Measures of access to destinations were associated with transport-related walking. Associations depended on socio-demographic factors and type of destinations. Workplace proximity was the most significant contributor to transport-related walking, especially among women. Regular walking to work resulted in the accrual of sufficient physical activity for health benefits.

The a-linolenic acid content of green vegetables commonly available in Australia

Green vegetable consumption has long been considered to have health benefits mainly due to the vitamins, minerals and phytonutrients (such as vitamin C, folate, antioxidants etc) contained in a vegetable-rich diet. Additionally, green vegetables are known to contain a relatively high proportion of omega-3 polyunsaturated fatty acids (PUFAs), primarily in the form of alpha-linolenic acid (18:3n-3). However, there are no data available on the fatty acid composition and concentration of green vegetables commonly consumed in Australia. The present study determined the fatty acid content of 11 green vegetables that are commonly available in Australia. The total fatty acid concentrations of the vegetables under study ranged from 44 mg/100 g wet weight in Chinese cabbage to 372 mg/100 g in watercress. There were three PUFAs in all vegetables analyzed; these were 16:3n-3, 18:2n-6, and 18:3n-3 fatty acids. Sample vegetables contained significant quantities of 16:3n-3 and 18:3n-3, ranging from 23 to 225 mg/100 g. Watercress and mint contained the highest amounts of 16:3n-3 and 18:3n-3, and parsley had the highest amount of 18:2n-6 in both percentage composition and concentration. Mint had the highest concentration of 18:3n-3 with a value of 195 mg/100 g, while watercress contained the highest concentration of 16:3n-3 at 45 mg/100 g. All 11 green vegetables contained a high proportion of PUFAs, ranging from 59 to 72% of total fatty acids. The omega-3 PUFA composition ranged from 40 to 62% of total fatty acids. Monounsaturated fatty acid composition was less than 6% of total fatty acids. The proportion of saturated fatty acids ranged from 21% in watercress and mint to 32% of total fatty acids in Brussels sprouts. No eicosapentaenoic and docosahexaenoic acids were detected in any of the samples. Consumption of green vegetables could contribute to 18:3n-3 PUFA intake, especially for vegetarian populations.

Healthy parks healthy people : annotated bibliography

This annotated bibliography is part of a joint initiative between Parks Victoria, the International Park Strategic Partners Group, and Deakin University. All organisations recognise the significance of the health and wellbeing benefits from interacting with nature in park settings, the implications for public health, and the lack of collated information on this topic. This document brings together significant research on the health benefits of interacting with nature, not previously compiled, to provide park managers with key references to guide decision-making, and future park planning. Criteria for inclusion included significance of the work, and relevance to either the health benefits of contact with nature or implications for park management and planning. Funding was provided by the International Park Strategic Partners Group.

Altered experience mediates the relationship between schizotypy and mood disturbance during shamanic-like journeying

Studies have found that shamanic practices are associated with statistically significant reductions in mood disturbance relative to baseline. However, contrary results were obtained for non-shamanic practitioners exposed to shamanic-like techniques. These inconsistent results may be partially due to a personality trait referred to as schizotypy, which has been demonstrated to influence susceptibility to shamanic-like techniques. Furthermore, given that an integral feature of shamanism is the production of altered states of awareness and altered experiences, and that shamanism is associated with health benefits, perhaps the production of such alterations affects health benefits. Consequently, the present study aimed to investigate whether altered state of awareness and altered experience mediated the association between schizotypy and mood disturbance during exposure to a shamanic-like condition. Sixty-nine non-shamans were randomly assigned to one of two conditions: shamanic-like journeying with drumming or sitting quietly with eyes open. Total mood disturbance-change was significantly negatively correlated with schizotypy and altered experience -- but not altered state of awareness -- and these correlations were significantly stronger for the shamanic-like journeying condition relative to the control condition. Furthermore, altered experience significantly mediated the association between schizotypy and total mood disturbance-change during exposure to shamanic-like journeying.

Cost-effectiveness of a family-based GP-mediated intervention targeting overweight and moderately obese children

Objective
 To assess from a societal perspective the incremental cost-effectiveness of a family-based GP-mediated intervention targeting overweight and moderately obese children. The intervention was modelled on the LEAP (live, eat and play) trial, a randomised controlled trial conducted by the Centre for Community Child Health, Melbourne, Australia in 2002–2003. This study was undertaken as part of the assessing cost-effectiveness (ACE) in obesity project which evaluated, using consistent methods, 13 interventions targeting unhealthy weight gain in children and adolescents.
Method
A logic pathway was used to model the effects of the intervention compared to no intervention on body mass index (BMI) and health outcomes (disability-adjusted life years—DALYs). Disease costs and health benefits were tracked until the cohort of eligible children reached the age of 100 years or death. Simulation-modelling techniques were used to present a 95% uncertainty interval around the cost-effectiveness ratio. The intervention was also assessed against a series of filters (‘equity’, ‘strength of evidence’, ‘acceptability’, ‘feasibility’, sustainability’ and ‘side-effects’) to incorporate additional factors that impact on resource allocation decisions.
Results
The intervention, as modelled, reached 9685 children aged 5–9 years with a BMI z-score of ≥3.0, and cost $AUD6.3M (or $AUD4.8M excluding time costs). It resulted in an incremental saving of 2300 BMI units which translated to 511 DALYs. The cost-offsets stemming from the intervention totalled $AUD3.6M, resulting in a net cost per DALY saved of $AUD4670 (dominated; $0.1M) (dominated means intervention costs more for less effect).
Conclusion
Compared to a ‘no intervention’ control group, the intervention was cost-effective under current assumptions, although the uncertainty intervals were wide. A key question related to the long-term sustainability of the small incremental weight loss reported, based on the 9-month follow-up results for LEAP.

Weight status and perception barriers to healthy physical activity and diet behavior

Background : Physical inactivity and insufficient fruit and vegetable consumption are key risk factors for obesity and noncommunicable diseases. Weight perceptions may affect physical activity and diet behaviors. We report current prevalence estimates of Australian adults meeting recommended levels of leisure-time physical activity (LTPA) (150 min/week or more of at least moderate-intensity physical activity (including walking) on 5 days/week) and fruit (2 servings/day) and vegetable (5 servings/day) consumption for health benefits, by weight status and perceptions.
Methods : We conducted a cross-sectional survey analysis of data for 16 314 adults from the Australian National Health Survey 2004–2005. All variables were collected by self-report. Weighted estimates were age- and gender-specific, and data were analyzed using logistic regression with acceptable weight referent categories, adjusting for covariates.
Results : Among acceptable, overweight and obese adults, the prevalence of LTPA was 26.8, 26.1 and 19.3% for men, and 27.7, 23.7 and 19.7% for women, respectively. Approximately 55 and 15% of adults consumed sufficient fruit servings/day and vegetable servings/day, respectively, and less than 5% of adults met combined LTPA and diet guidelines. Overweight decreased the odds ratio for LTPA among women but not men, and obesity decreased the odds ratio for LTPA among both men and women. Overweight perception conferred odds ratios of 0.83 (95% CI 0.70–0.97, P=0.021) for overweight men, and of 0.74 (95% CI 0.62–0.88, P=0.001) and 0.69 (95% CI 0.59–0.80, P<0.001) for obese men and women, respectively; for LTPA, whereas no significant associations were found for acceptable weight perception. No consistent associations between weight status or perceptions and diet behaviors were found.
Conclusions : Overweight perception may be another barrier to physical activity participation among men and women with excess body weight. Public health strategies might need to focus on overcoming weight perception as well as weight status barriers to adopting healthy physical activity behaviors.

Physical activity behaviours of adults in the Greater Green Triangle region of rural Australia

Objective: To assess physical activity (PA) behaviours of adults in rural Australia.

Design and setting: Three cross-sectional surveys in the Greater Green Triangle area covering the south-east of South Australia (Limestone Coast), and south-west (Corangamite Shire) and north-west (Wimmera) of Victoria during 2004–2006.

Participants: A total of 1546 persons, aged 25– 74 years, randomly selected from the electoral roll.

Main outcome measures: Overall PA, leisure-time PA, occupational PA, active commuting and moderate-to-vigorous PA.

Results: Approximately 80% of participants, more women than men, engaged in 30 minutes or more of daily PA. Only 30% (95% CI 26.3, 33.0) of men and 21% (95% CI 18.3, 23.9) of women did moderate-to-vigorous PA for at least 20–30 minutes four or more times a week. In leisure time, most participants were moderately active; almost one-fifth were inactive and another fifth highly active. Two-thirds of men engaged in high-level occupational PA, compared with one-sixth of women. Only 30% of participants actively commuted to work. There was a tendency for a positive association between income level and leisure-time PA.

Conclusions: One-fifth of adults in rural Australia were inactive. While there was a high prevalence of participants who engaged in daily PA, few did so at moderate-to-vigorous intensity to achieve health benefits. As occupational PA is difficult to change, improvements in levels of PA are more likely during leisure-time and for some people by engaging in commuting PA.

The influence of heat on biological activity and concentration of oleocanthal - a natural anti-inflammatory agent

Background – The olive oil phenolic, oleocanthal is a natural non-steroidal anti-inflammatory compound that irritates the oropharynx in a dose-dependent manner. It has been proposed that the biological activity of oleocanthal is partially responsible for the beneficial health effects of the Mediterranean diet. Virgin olive oil containing oleocanthal is often added as an ingredient in a number of cooked dishes and therefore it is of great importance to understand how best to preserve the putative health promoting benefits of this compound, as olive oil phenolics are
subject to heat degradation.

Objective – To investigate if oleocanthal is thermally degraded or its biological activity reduced during cooking.

Design – One extra virgin olive oil containing 54mg/kg oleocanthal was heated at varying temperatures (100°C, 170°C and 240°C) for set time periods (0, 1, 5, 20, 60, 90 min). Oleocanthal concentrations were quantified using HPLC and its biological activity determined with a taste bioassay measuring the intensity of throat irritation.

Outcomes – Results demonstrated that oleocanthal was heat stable compared with other olive oil phenolics, with a maximum loss of 16% as determined by HPLC analysis. In contrast, there was a significant decrease of up to 38% (p<0.05) in the biological activity of oleocanthal as determined by the taste bioassay.

Conclusions – Minimal degradation of oleocanthal concentration was observed upon heating however a significant decrease in the biological activity of this compound was noted with extended heating time. This has important implications for health in that, consumers may be unable to reap all of the putative health benefits associated with oleocanthal when adding virgin olive oil as an ingredient to dishes requiring prolonged heat treatment.

The 'caffeine-sweetness' effect; potential reduction of energy in caffeinated sugar-sweetened soft drinks

Background – Excessive consumption of sugar sweetened beverages (SSB) is a contributing factor in the occurrence of overweight and obesity. The high energy intake, low satiation, high glycemic index, and intense marketing are all thought to contribute to their over consumption. In addition, the role of the mildly-addictive chemical caffeine in SSB has been questioned (Griffiths and Vernotica, 2000, Keast and Riddell, 2007). We have previously shown that low concentrations of caffeine may decrease sweetness of sugars and thereby result in excess energy in SSB formulations (Ebbeling et al., 2006).
Objective – Without noticeably affecting flavour, to determine potential energy reduction when decreasing sucrose concentration from caffeinated and de-caffeinated SSB.
Design – Human psychophysical taste evaluations in water, sucrose and model SSB. Triangle forced-choice ascending method of limits was used to determine caffeine taste threshold in water and sucrose (n= 62). Directional paired comparison tests to determine 1/ the influence of caffeine on sweetness of sucrose (n= 23), and 2/ the nonperceivable difference when decreasing the sucrose and caffeine concentrations in a model SSB (n= 30).
Outcomes – Caffeine, at sub-threshold concentrations in common SSB (0.67mM) can be perceived in sucrose solutions because it significantly inhibits sweetness (p<0.001), the ‘caffeine sweetness effect’. Presumably coremoval of caffeine and sucrose could be achieved without affecting the sweetness of the SSB. Removing caffeine from the model SSB allowed an energy reduction of 137.4 KJ per 500 ml serving (12.6% sucrose reduction) without noticeably affecting flavour for 80% of the population. The energy reduction possible without co-removal of caffeine was a more modest 32 KJ per 500 ml serving (3.5% sucrose reduction).
Conclusion – Sub-threshold concentrations of caffeine suppress sweetness resulting in higher concentrations of sugars in SSB. Excessive consumption of SSB is linked to the obesity epidemic, and we suggest the removal of caffeine and subsequent removal of 137.4 KJ energy will have long term public health benefits.

Cost-effectiveness of surgically induced weight loss for the management of type 2 diabetes : modeled lifetime analysis

OBJECTIVE--To estimate the cost-effectiveness of surgically induced weight loss relative to conventional therapy for the management of recently diagnosed type 2 diabetes in class VII obese patients.

RESEARCH DESIGN AND METHODS--This study builds on a within-trial cost-efficacy analysis. The analysis compares the lifetime costs and quality-adjusted life-years (QALYs) between the two intervention groups. Intervention costs were extrapolated based on observed resource utilization during the trial. The proportion of patients in each intervention group with remission of diabetes at 2 years was the same as that observed in the trial. Health care costs for patients with type 2 diabetes and outcome variables required to derive estimates of QALYs were sourced from published literature. A health care system perspective was adopted. Costs and outcomes were discounted annually at 3%. Costs are presented in 2006 Australian dollars (AUD) (currency exchange: 1 AUD = 0.74 USD).

RESULTS--The mean number of years in diabetes remission over a lifetime was 11.4 for surgical therapy patients and 2.1 for conventional therapy patients. Over the remainder of their lifetime, surgical and conventional therapy patients lived 15.7 and 14.5 discounted QALYs, respectively. The mean discounted lifetime costs were 98,900 AUD per surgical therapy patient and 101,400 AUD per conventional therapy patient. Relative to conventional therapy, surgically induced weight loss was associated with a mean health care saving of 2,400 AUD and 1.2 additional QALYs per patient.

CONCLUSIONS--Surgically induced weight loss is a dominant intervention (it both saves health care costs and generates health benefits) for managing recently diagnosed type 2 diabetes in class IBI obese patients in Australia.