'Better health choices' by telephone: a feasibility trial of improving diet and physical activity in people diagnosed with psychotic disorders

The study objective was to evaluate the feasibility of a telephone delivered intervention consisting of motivational interviewing and cognitive behavioural strategies aimed at improving diet and physical activity in people diagnosed with psychotic disorders. Twenty participants diagnosed with a non-acute psychotic disorder were recruited. The intervention consisted of eight telephone delivered sessions targeting fruit and vegetable (F&V) consumption and leisure screen time, as well as smoking and alcohol use (as appropriate). F&V frequency and variety, and overall diet quality (measured by the Australian Recommended Food Score, ARFS), leisure screen time, overall sitting and walking time, smoking, alcohol consumption, mood, quality of life, and global functioning were examined before and 4-weeks post-treatment. Nineteen participants (95%) completed all intervention sessions, and 17 (85%) completed follow-up assessments. Significant increases from baseline to post-treatment were seen in ARFS fruit, vegetable and overall diet quality scores, quality of life and global functioning. Significant reductions in leisure screen time and overall sitting time were also seen. Results indicated that a telephone delivered intervention targeting key cardiovascular disease risk behaviours appears to be feasible and relatively effective in the short-term for people diagnosed with psychosis. A randomized controlled trial is warranted to replicate and extend these findings.

Parents' food choice motives and their associations with children's food preferences

Objective The objective was to investigate parents' motives for selecting foods for their children and the associations between these motives and children's food preferences. Design Cross-sectional survey. A modified version of the Food Choice Questionnaire was used to assess parents' food choice motives. Parents also reported children's liking/disliking of 176 food and beverage items on 5-point Likert scales. Patterns of food choice motives were examined with exploratory principal component analysis. Associations between motives and children's food preferences were assessed with linear regression while one-way and two-way ANOVA were used to test for sociodemographic differences. Setting Two Australian cities. Subjects Parents (n 371) of 2-5-year-old children. Results Health, nutrition and taste were key motivators for parents, whereas price, political concerns and advertising were among the motives considered least important. The more parents' food choice for their children was driven by what their children wanted, the less children liked vegetables (β =-0·27, P<0·01), fruit (β=-0·19, P<0·01) and cereals (β=-0·28, P<0·01) and the higher the number of untried foods (r=0·17, P<0·01). The reverse was found for parents' focus on natural/ethical motives (vegetables β=0·17, P<0·01; fruit β=0·17, P<0·01; cereals β=0·14, P=0·01). Health and nutrition motives bordered on statistical significance as predictors of children's fruit and vegetable preferences. Conclusions Although parents appear well intentioned in their motives for selecting children's foods, there are gaps to be addressed in the nature of such motives (e.g. selecting foods in line with the child's desires) or the translation of health motives into healthy food choices.

Healthy weight regulation and eating disorder prevention in high school students: a universal and targeted web-based intervention

Background: Given the rising rates of obesity in children and adolescents, developing evidence-based weight loss or weight maintenance interventions that can be widely disseminated, well implemented, and are highly scalable is a public health necessity. Such interventions should ensure that adolescents establish healthy weight regulation practices while also reducing eating disorder risk.

Objective: This study describes an online program, StayingFit, which has two tracks for universal and targeted delivery and was designed to enhance healthy living skills, encourage healthy weight regulation, and improve weight/shape concerns among high school adolescents.

Methods: Ninth grade students in two high schools in the San Francisco Bay area and in St Louis were invited to participate. Students who were overweight (body mass index [BMI] >85th percentile) were offered the weight management track of StayingFit; students who were normal weight were offered the healthy habits track. The 12-session program included a monitored discussion group and interactive self-monitoring logs. Measures completed pre- and post-intervention included self-report height and weight, used to calculate BMI percentile for age and sex and standardized BMI (zBMI), Youth Risk Behavior Survey (YRBS) nutrition data, the Weight Concerns Scale, and the Center for Epidemiological Studies Depression Scale.

Results: A total of 336 students provided informed consent and were included in the analyses. The racial breakdown of the sample was as follows: 46.7% (157/336) multiracial/other, 31.0% (104/336) Caucasian, 16.7% (56/336) African American, and 5.7% (19/336) did not specify; 43.5% (146/336) of students identified as Hispanic/Latino. BMI percentile and zBMI significantly decreased among students in the weight management track. BMI percentile and zBMI did not significantly change among students in the healthy habits track, demonstrating that these students maintained their weight. Weight/shape concerns significantly decreased among participants in both tracks who had elevated weight/shape concerns at baseline. Fruit and vegetable consumption increased for both tracks. Physical activity increased among participants in the weight management track, while soda consumption and television time decreased.

Conclusions: Results suggest that an Internet-based, universally delivered, targeted intervention may support healthy weight regulation, improve weight/shape concerns among participants with eating disorders risk, and increase physical activity in high school students. Tailored content and interactive features to encourage behavior change may lead to sustainable improvements in adolescent health.

Influence of price discounts and skill-building strategies on purchase and consumption of healthy food and beverages: outcomes of the Supermarket Healthy Eating for Life randomized controlled trial

BACKGROUND: Fiscal strategies are increasingly considered upstream nutrition promotion measures. However, few trials have investigated the effectiveness or cost effectiveness of pricing manipulations on diet in real-world settings. OBJECTIVE: We assessed the effects on fruit, vegetable, and beverage purchasing and consumption of a 20% price-reduction intervention, a tailored skills-based behavior-change intervention, and a combined intervention compared with a control condition. DESIGN: The Supermarket Healthy Eating for Life trial was a randomized controlled trial conducted over 3 mo [baseline (time 1) to postintervention (time 2) with a 6-mo follow-up (time 3)]. Female primary household shoppers in Melbourne, Australia, were randomly assigned to a 1) skill-building (n = 160), 2) price-reduction (n = 161), 3) combined skill-building and price-reduction (n = 160), or 4) control (n = 161) group. Supermarket transaction data and surveys were used to measure the following study outcomes: fruit, vegetable, and beverage purchases and self-reported fruit and vegetable consumption at each time point. RESULTS: At 3 mo (time 2), price reduction-alone participants purchased more total vegetables and frozen vegetables than did controls. Price reduction-alone and price reduction-plus-skill-building participants purchased more fruit than did controls. Relative to controls, in the price-reduction group, total vegetable consumption increased by 233 g/wk (3.1 servings or 15% more than at baseline), and fruit purchases increased by 364 g/wk (2.4 servings; 35% more than at baseline). Increases were not maintained 6 mo postintervention (time 3). Price reduction-alone participants showed a tendency for a slight increase in fruit consumption at time 2 (P = 0.09) that was maintained at time 3 (P = 0.014). No intervention improved purchases of bottled water or low-calorie beverages. CONCLUSIONS: A 20% price reduction in fruit and vegetables resulted in increased purchasing per household of 35% for fruit and 15% for vegetables over the price-reduction period. These findings show that price modifications can directly increase produce purchases. The Supermarket Healthy Eating for Life trial was registered at Current Controlled Trials Registration as ISRCTN39432901.

Responsiveness to psychological stress and food intake : the influence of adiposity in men and physical activity in women

Hyperactivity of the stress pathways can cause diseases. This research concludes that levels of adiposity and physical activity status does not influence physiological responsiveness to psychological stress. Nevertheless, stress pathway activity in response to food intake can be influenced by increased adiposity but not by increased levels of physical activity.

Parenting behaviors and nutrition in children with leukemia

The aim of this study was to examine whether parenting behaviors are associated with child nutrition amongst pre-school children receiving treatment for acute lymphoblastic leukemia (ALL), and to determine whether this association differs from that observed amongst a healthy population. Participants were 73 parents of children aged 2–6 years. The children were either a) receiving treatment for ALL (n = 43), or b) had no major medical history (n = 30). Participants completed psychometrically validated questionnaires that assessed parenting behaviors and child diet. Increased parental overprotection was associated with higher fruit and vegetable consumption for the control group but lower fruit and vegetable consumption for the ALL group. Parental overprotection, inconsistent discipline and emotional feeding were positively associated with non-core (“junk”) food consumption for the ALL group, particularly those who had recently received steroid treatment. To the best of our knowledge, this is the first study to show that certain parenting behaviors may be associated with poor nutrition during treatment for ALL. In light of these results, parenting interventions, specifically targeting parenting behaviors such as assertive discipline, may be a mechanism for nutrition promotion amongst this vulnerable group.

Dietary sources and sodium intake in a sample of Australian preschool children

OBJECTIVES: To assess dietary sodium intake and the food sources of sodium in a sample of Australian preschool children. DESIGN: Cross-sectional. SETTING: Mothers were followed up when children were approximately 3.5 years of age after participating in a cluster randomised controlled trial: the Melbourne Infant Feeding Activity and Nutrition Trial Program. PARTICIPANTS: 251 Australian children aged 3.5±0.19 (SD) years. PRIMARY AND SECONDARY OUTCOME MEASURES: The average daily sodium intake was determined using three unscheduled 24 h dietary recalls. The contributions of food groups, core, discretionary and processed foods to daily sodium intake were assessed. RESULTS: The average sodium intake was 1508±495 (SD) mg/day, (salt equivalent 3.9±1.3 (SD) g/day) and 87% of children exceeded the Australian Upper Level of Intake (UL) for sodium of 1000 mg/day (salt equivalent 2.6 g/day). Main food sources of sodium were cereal/cereal products (25%), milk products (19%), meat, poultry/game (17%) and cereal-based products (15%). Core foods contributed 65%, and discretionary foods 35% of total daily sodium intake, and within the total diet, minimally processed, processed, processed culinary ingredient and ultraprocessed foods contributed 16%, 35%, 1% and 48% of sodium, respectively. CONCLUSIONS: Within this sample, most children exceeded the recommended UL for sodium. Core and ultraprocessed foods were key sources of sodium which suggests that reductions in the sodium content of these foods are required to reduce sodium intake in young children. These data also provide further support for public health campaigns that seek to reduce consumption of energy-dense, nutrient-poor foods.

Randomized controlled study of the urinary excretion of biophenols following acute and chronic intake of olive leaf supplements

Olive leaf supplement was characterised by HPLC and administered to healthy young adults over 28 d (three tablets or equivalent liquid dose per day), or in a single bolus dose of three tablets (or liquid equivalent). Oleuropein was the major biophenol in the extracts. There are no data on the excretion of urinary end-products of the metabolism of the olive leaf biophenols. Following both chronic and acute ingestion neither oleuropein, nor its hydrolysis product, hydroxytyrosol, were detected in urine samples. However, glucuronic acid conjugates, derived from oleuropein aglycone were detected in all urine samples up to 6 h following acute ingestion. The data suggest that oleuropein is bioavailable, which is a necessary pre-condition for bioactivity.

The mediating role of dietary factors and leisure time physical activity on socioeconomic inequalities in body mass index among Australian adults

BACKGROUND: The relationship between socioeconomic position and obesity has been clearly established, however, the extent to which specific behavioural factors mediate this relationship is less clear. This study aimed to ascertain the contribution of specific dietary elements and leisure-time physical activity (LTPA) to variations in obesity with education in the baseline (1990-1994) Melbourne Collaborative Cohort Study (MCCS).

METHODS: 18, 489 women and 12, 141 men were included in this cross-sectional analysis. A series of linear regression models were used in accordance with the products of coefficients method to examine the mediating role of alcohol, soft drink (regular and diet), snacks (healthy and sweet), savoury items (healthy and unhealthy), meeting fruit and vegetable guidelines and LTPA on the relationship between education and body mass index (BMI).

RESULTS: Compared to those with lowest educational attainment, those with the highest educational attainment had a 1 kg/m2 lower BMI. Among men and women, 27% and 48%, respectively, of this disparity was attributable to differences in LTPA and diet. Unhealthy savoury item consumption and LTPA contributed most to the mediated effects for men and women. Alcohol and diet soft drink were additionally important mediators for women.

CONCLUSIONS: Diet and LTPA are potentially modifiable behavioural risk factors for the development of obesity that contribute substantially to inequalities in BMI. Our findings highlight the importance of specific behaviours which may be useful to the implementation of effective, targeted public policy to reduce socioeconomic inequalities in obesity.

Socio-economic differences in eating-related attitudes, behaviours and environments of adolescents

OBJECTIVE: The aim of the present study was to investigate the relationship between area-level socio-economic status and healthy and less healthy eating behaviours among adolescents and to determine whether the relationship between area-level socio-economic status and dietary behaviours was related to the relevant attitudes and environments. DESIGN: Data were collected as part of Youth'07, a nationally representative survey of the health and well-being of New Zealand youth. SETTING: New Zealand secondary schools, 2007. SUBJECTS: A total of 9107 secondary-school students in New Zealand. RESULTS: Students from more deprived areas perceived more supportive school environments and cared as much about healthy eating as students in more affluent areas. However, these students were significantly more likely to report consuming fast food, soft drinks and chocolates. CONCLUSIONS: Addressing area-level socio-economic disparities in healthy eating requires addressing the availability, affordability and marketing of unhealthy snack foods, particularly in economically deprived areas.

Associations between FTO genotype and total energy and macronutrient intake in adults: a systematic review and meta-analysis

Risk variants of fat mass and obesity-associated (FTO) gene have been associated with increased obesity. However, the evidence for associations between FTO genotype and macronutrient intake has not been reviewed systematically. Our aim was to evaluate the potential associations between FTO genotype and intakes of total energy, fat, carbohydrate and protein. We undertook a systematic literature search in OVID MEDLINE, Scopus, EMBASE and Cochrane of associations between macronutrient intake and FTO genotype in adults. Beta coefficients and confidence intervals (CIs) were used for per allele comparisons. Random-effect models assessed the pooled effect sizes. We identified 56 eligible studies reporting on 213,173 adults. For each copy of the FTO risk allele, individuals reported 6.46 kcal day(-1) (95% CI: 10.76, 2.16) lower total energy intake (P = 0.003). Total fat (P = 0.028) and protein (P = 0.006), but not carbohydrate intakes, were higher in those carrying the FTO risk allele. After adjustment for body weight, total energy intakes remained significantly lower in individuals with the FTO risk genotype (P = 0.028). The FTO risk allele is associated with a lower reported total energy intake and with altered patterns of macronutrient intake. Although significant, these differences are small and further research is needed to determine whether the associations are independent of dietary misreporting.

Assessment of eating rate and food intake in spoon versus fork users in a laboratory setting

Accumulating evidence show positive relationships between eating rate and body weight. Acute food intake is affected by eating rate, bite size, and palatability. The objective was to assess differences between participants who chose to use a spoon vs. fork in eating rate and food intake of four meals that differ in palatability (low vs. high salt) and in energy density (low vs. high fat). Forty-eight healthy adults (16 males, 18-54 y, BMI: 17.8-34.4 kg/m2) were recruited. Participants attended four lunch time sessions after a standardised breakfast. Meals were either (1) low-fat/low-salt, (2) low-fat/high-salt, (3) high-fat/low-salt, or (4) high-fat/high-salt. Nineteen participants (6 males) consistently used a fork and 21 (8 males) used a spoon, 8 participants were inconsistent in cutlery use and excluded from analyses. Spoon users had on average a higher BMI than fork users (p=0.006). Effects of cutlery use, BMI status (BMI<25 vs. BMI>25), salt, and fat, and their interactions were assessed in a General Linear Model. Spoon users consumed faster (fork: 53±2.8g/min; spoon: 62±2.1g/min, p=0.022) and tended to consume more (p=0.09), whereas the duration of the meals were similar (fork: 6.9±0.3min; spoon: 6:7±0.2min, p=0.55). BMI status affected both eating rate and food intake (p=0.005). There were no significant two-way or three-way interactions between salt, fat, and cutlery use on eating rate or food intake. In conclusion, participants who chose to consume with forks ate slower compared to spoon users.

Economic evaluation of price discounts and skill-building strategies on purchase and consumption of healthy food and beverages: The SHELf randomized controlled trial

OBJECTIVE: Pricing strategies are a promising approach for promoting healthier dietary choices. However, robust evidence of the cost-effectiveness of pricing manipulations on dietary behaviour is limited. We aimed to assess the cost-effectiveness of a 20% price reduction on fruits and vegetables and a combined skills-based behaviour change and price reduction intervention. DESIGN AND METHODS: Cost-effectiveness analysis from a societal perspective was undertaken for the randomized controlled trial Supermarket Healthy Eating for Life (SHELf). Female shoppers in Melbourne, Australia were randomized to: (1) skill-building (n = 160); (2) price reductions (n = 161); (3) combined skill-building and price reduction (n = 161); or (4) control group (n = 161). The intervention was implemented for three months followed by a six month follow-up. Costs were measured in 2012 Australian dollars. Fruit and vegetable purchasing and consumption were measured in grams/week. RESULTS: At three months, compared to control participants, price reduction participants increased vegetable purchases by 233 g/week (95% CI 4 to 462, p = 0.046) and fruit purchases by 364 g/week (95% CI 95 to 633, p = 0.008). Participants in the combined group purchased 280 g/week more fruits (95% CI 27 to 533, p = 0.03) than participants in the control group. Increases were not maintained six-month post intervention. No effect was noticed in the skill-building group. Compared to the control group, the price reduction intervention cost an additional A$2.3 per increased serving of vegetables purchased per week or an additional A$3 per increased serving of fruit purchased per week. The combined intervention cost an additional A$12 per increased serving of fruit purchased per week compared to the control group. CONCLUSIONS: A 20% discount on fruits and vegetables was effective in promoting overall fruit and vegetable purchases during the period the discount was active and may be cost-effective. The price discount program gave better value for money than the combined price reduction and skill-building intervention. The SHELf trial is registered with Current Controlled Trials Registration ISRCTN39432901.

The association between sweet taste function, anthropometry, and dietary intake in adults

Variation in ability to detect, recognize, and perceive sweetness may influence food consumption, and eventually chronic nutrition-related conditions such as overweight and obesity. The aim of this study was to investigate the associations between sweet taste function, anthropometry, and dietary intake in adults. Participants' (n = 60; mean age in years = 26, SD = ±7.8) sweet taste function for a range of sweeteners (glucose, fructose, sucrose, sucralose, erythritol, and Rebaudioside A) was assessed by measuring detection and recognition thresholds and sweetness intensity. Height, weight, and waist circumference were also measured, and participants also completed a Food Frequency Questionnaire. There was large inter-individual variation in detection, recognition and sweetness intensity measures. Pearson's correlation coefficient revealed no robust correlations between measures of sweet taste function, anthropometry, and dietary intake, with the exception of suprathreshold intensity, which was moderately correlated with total energy intake (r = 0.23-0.40). One-way analysis of variance revealed no significant differences between the most and least sensitive participants in terms of BMI, waist circumference, and dietary intake for all measures of sweet taste function and sweeteners (all p > 0.01). When stratified into BMI categories, there were no significant differences in any measure of sweet taste function between the normal weight and overweight/obese participants (all p > 0.01). Results show that that sweet taste function is not associated with anthropometry and sweetness intensity measures are the most appropriate measure when assessing links between sweet taste and food consumption.

Socioeconomic variations in women's diets : what is the role of perceptions of the local food environment

Objectives : To test the contribution of perceived environmental factors (food availability, accessibility and affordability) to mediating socioeconomic variations in women’s fruit, vegetable and fast food consumption.

Methods : A community sample of 1580 women from 45 neighbourhoods provided survey data on their socioeconomic position (SEP) (education and income); diet (fruit, vegetable and fast food consumption); and the perceived availability of, access to and cost of healthy food in their local area.

Results : Once perceived environmental variables were considered, the associations between SEP and diet were weak and non-significant, suggesting that socioeconomic differences in diet were almost wholly explained by perceptions of food availability, accessibility and affordability.

Conclusions : Strategies to decrease socioeconomic inequalities in diet could involve promoting inexpensive ways to increase fruit and vegetable consumption, and ensuring that people of low SEP are aware that many healthy foods are available at relatively low cost. Future research should also confirm if perceptions match objective measures of food availability, accessibility and affordability, in order to address the real and/or perceived lack of healthy options in low SEP neighbourhoods.