Judith M Ashley

Nutrient adequacy during weight loss interventions: a randomized study in women comparing the dietary intake in a meal replacement group with a traditional food group

BackgroundSafe and effective weight control strategies are needed to stem the current obesity epidemic. The objective of this one-year study was to document and compare the macronutrient and micronutrient levels in the foods chosen by women following two different weight reduction interventions.MethodsNinety-six generally healthy overweight or obese women (ages 25–50 years; BMI 25–35 kg/m2) were randomized into a Traditional Food group (TFG) or a Meal Replacement Group (MRG) incorporating 1–2 meal replacement drinks or bars per day. Both groups had an energy-restricted goal of 5400 kJ/day. Dietary intake data was obtained using 3-Day Food records kept by the subjects at baseline, 6 months and one-year. For more uniform comparisons between groups, each diet intervention consisted of 18 small group sessions led by the same Registered Dietitian.ResultsWeight loss for the 73% (n = 70) completing this one-year study was not significantly different between the groups, but was significantly different (p ≤ .05) within each group with a mean (± standard deviation) weight loss of -6.1 ± 6.7 kg (TFG, n = 35) vs -5.0 ± 4.9 kg (MRG, n = 35). Both groups had macronutrient (Carbohydrate:Protein:Fat) ratios that were within the ranges recommended (50:19:31, TFG vs 55:16:29, MRG). Their reported reduced energy intake was similar (5729 ± 1424 kJ, TFG vs 5993 ± 2016 kJ, MRG). There was an improved dietary intake pattern in both groups as indicated by decreased intake of saturated fat (≤ 10%), cholesterol (<200 mg/day), and sodium (< 2400 mg/day), with increased total servings/day of fruits and vegetables (4.0 ± 2.2, TFG vs 4.6 ± 3.2, MRG). However, the TFG had a significantly lower dietary intake of several vitamins and minerals compared to the MRG and was at greater risk for inadequate intake.ConclusionIn this one-year university-based intervention, both dietitian-led groups successfully lost weight while improving overall dietary adequacy. The group incorporating fortified meal replacements tended to have a more adequate essential nutrient intake compared to the group following a more traditional food group diet. This study supports the need to incorporate fortified foods and/or dietary supplements while following an energy-restricted diet for weight loss.

Feasibility of a low-fat/high-fiber diet intervention with soy supplementation in prostate cancer patients after prostatectomy.

Objectives:To evaluate the feasibility and long-term compliance with a low-fat diet supplemented with soy protein in men at increased risk for recurrence after radical prostatectomy.Design:Randomized, control study.Setting:Academic center in USA.Subject:Forty men who had undergone radical prostatectomy and were at increased risk for recurrence.Intervention:Low-fat (15% fat), high-fiber (18 g/1000 kcal) diet supplemented with 40 g soy protein isolate (n=26) was compared to USDA recommended diet (n=14).Results:Over 4 years, subjects in the intervention group but not in the control group made and sustained significant changes in their diet as measured by the dietary assessment instruments and urinary isoflavone excretion. In the intervention group, dietary fat intake was reduced from 33.46±1.27% energy/day to 21.04±1.74% (P<0.05), fiber intake increased from 14.6±1.06 to 21.05±2.29 g/day. The insulin growth factor-1 (IGF-1) level was decreased from 260.4±8.6 ng/ml at baseline to 220.5±7.9 ng/ml at 6 months (P<0.05) in the intervention group with no significant change in the control group. An ex vivo assay demonstrated inhibition of LNCaP cell growth (−20.0±7.7%, P<0.05) by sera from patients in the intervention group after 6 months of dietary change compared to baseline.Conclusion:These data suggest that long-term low-fat dietary interventions as part of prospective randomized trials in prostate cancer survivors are feasible, and lead to reductions in circulating hormones or other growth factors stimulating prostate cancer growth ex vivo.

Live well: a practical and effective low-intensity dietary counseling intervention for use in primary care patients with dyslipidemia--a randomized controlled pilot trial.

BackgroundDiet is the first line of treatment for elevated cholesterol. High-intensity dietary counseling (≥360 minutes/year of contact with providers) improves blood lipids, but is expensive and unsustainable in the current healthcare settings. Low-intensity counseling trials (≤ 30 minutes/year) have demonstrated modest diet changes, but no improvement in lipids. This pilot study evaluated the feasibility and the effects on lipids and diet of a low-intensity dietary counseling intervention provided by the primary care physician (PCP), in patients at risk for cardiovascular diseases.MethodsSix month study with a three month randomized-controlled phase (group A received the intervention, group B served as controls) followed by three months of intervention in both groups.Sixty-one adults age 21 to 75 years, with LDL-cholesterol ≥ 3.37 mmol/L, possessing Internet access and active email accounts were enrolled. Diet was evaluated using the Rate-Your-Plate questionnaire. Dietary counseling was provided by the PCP during routine office visits, three months apart, using printed educational materials and a minimally interactive counseling website. Weekly emails were sent reminding participants to use the dietary counseling resources. The outcomes were changes in LDL-cholesterol, other lipid subclasses, and diet quality.ResultsAt month 3, group A (counseling started at month 1) decreased their LDL-cholesterol by −0.23 mmol/L, (−0.04 to −0.42 mmol/L, P = 0.007) and total cholesterol by −0.26 mmol/L, (−0.05 to −0.47 mmol/L, P = 0.001). At month 6, total and LDL-cholesterol in group A remained better than in group B (counseling started at month 3). Diet score in group A improved by 50.3 points (38.4 to 62.2, P < 0.001) at month 3; and increased further by 11.8 (3.5 to 20.0, P = 0.007) at month 6. Group B made the largest improvement in diet at month 6, 55 points (40.0 to 70.1, P < 0.001), after having a small but significant improvement at month 3, 22.3 points (12.9 to 31.7, P < 0.001). No significant changes occurred in HDL-cholesterol in either group.ConclusionsA low-intensity dietary counseling provided by the PCP in patients at risk for cardiovascular diseases produced clinically meaningful improvements in both diet and lipids of magnitude similar to changes reported with high intensity interventions.Trial registrationClinicalTrials.gov: NCT01695837

Relationships of Record Keeping, Levels of Reported Physical Activity and Body Composition with Weight Loss

Abstract Physical activity has been indicated for the reduction of body fat mass but its association with preservation of lean body mass has not been thoroughly examined. Thus, this study examined the relationships of different levels of physical activity measured by an activity monitor which counted steps (digiwalker) with record keeping on a monthly log and lean body mass (fat free mass and body cell mass) obtained by bioelectrical impedance. To study whether recording physical activity on the monthly record was associated with increased weight loss, data on 61 women (BMI 25 to 35; ages 30 to 50) currently participating in a one-year weight loss study were analyzed. A total of 42/61 (69%) of these women were classified as compliant (digiwalker recordings of ≥ 25%) and 19/61 (31%) were classified as non-compliant. Overall, the compliant women had lost an average of 2.5 Ibs. of fat (p=.037) determined by bioimpedance and 4.5 pounds (p=.033) in total weight more than the non-compliant women. Further, data from the 36/42 (86%) compliant women on whom complete data for a 21-week period were available were analyzed for relationships with body composition. Reported physical activity (digiwalker readings) on the monthly records were categorized into low, medium, or high levels based on the population studied ( 10,000 steps/day, respectively). The average weight loss at the end of the 21-week period was 8.5 ± 7.2 Ibs. Women who had reported low activity tended to significantly (p=.090) lose more fat free mass (−2.0 ± 1.5 Ibs.) than those reporting both medium and high activity levels (−3.0 ±1.5 Ibs.) and although body cell mass also tended to decrease more in those with low activity, these findings were not significant at the one-tail level. This study indicates that moderate to high levels of physical activity was related to preservation of lean body mass and is an important factor to consider when trying to lose weight. Additionally, record keeping was assumably related to level of physical activity and increased not only total weight loss, but also loss of fat mass and was shown to be a valuable tool in successful weight loss efforts.