Jyoti Savla

Water Consumption Increases Weight Loss During a Hypocaloric Diet Intervention in Middle‐aged and Older Adults

Water consumption acutely reduces meal energy intake (EI) among middle‐aged and older adults. Our objectives were to determine if premeal water consumption facilitates weight loss among overweight/obese middle‐aged and older adults, and to determine if the ability of premeal water consumption to reduce meal EI is sustained after a 12‐week period of increased water consumption. Adults (n = 48; 55–75 years, BMI 25–40 kg/m2) were assigned to one of two groups: (i) hypocaloric diet + 500 ml water prior to each daily meal (water group), or (ii) hypocaloric diet alone (nonwater group). At baseline and week 12, each participant underwent two ad libitum test meals: (i) no preload (NP), and (ii) 500 ml water preload (WP). Meal EI was assessed at each test meal and body weight was assessed weekly for 12 weeks. Weight loss was ∼2 kg greater in the water group than in the nonwater group, and the water group (β = −0.87, P < 0.001) showed a 44% greater decline in weight over the 12 weeks than the nonwater group (β = −0.60, P < 0.001). Test meal EI was lower in the WP than NP condition at baseline, but not at week 12 (baseline: WP 498 ± 25 kcal, NP 541 ± 27 kcal, P = 0.009; 12‐week: WP 480 ± 25 kcal, NP 506 ± 25 kcal, P = 0.069). Thus, when combined with a hypocaloric diet, consuming 500 ml water prior to each main meal leads to greater weight loss than a hypocaloric diet alone in middle‐aged and older adults. This may be due in part to an acute reduction in meal EI following water ingestion.

Psychosocial and Biological Markers of Daily Lives of Midlife Parents of Children with Disabilities

Using daily telephone interviews, 82 midlife parents (mean age = 57.4) of children with disabilities (mean age = 29.9) were compared with a closely matched sample of unaffected parents (N = 82) to elucidate the daily experience of nonnormative parenting. In addition, salivary cortisol samples were obtained to examine whether parents of children with disabilities had dysregulated diurnal rhythms and the extent to which the amount of time spent with children was associated with divergent patterns of cortisol expression. We found that parents of children with disabilities had similar patterns of daily time use and similar likelihood of positive daily events as the comparison group, but they had elevated levels of stress, negative affect, and physical symptoms, all reported on a daily basis. In addition, their diurnal rhythm of cortisol expression differed significantly from the comparison group, a pattern that was strongest for parents of children with disabilities on days when they spent more time with their children.

The beverage intake questionnaire: determining initial validity and reliability.

Consuming energy-containing beverages may lead to weight gain, yet research investigating this issue is limited. An easily administered beverage intake assessment tool could facilitate research on this topic. The purpose of this cross-sectional investigation was to determine the validity and reliability of a self-administered beverage intake questionnaire (BEVQ) that estimates mean daily intake of beverages consumed across 19 beverage categories. Participants (N=105; aged 39+/-2 years) underwent assessments of height, weight, body mass index, and dietary intake using 4-day food intake records from June 2008 to June 2009. The BEVQ was completed at two additional visits (BEVQ1, BEVQ2). Urine samples were collected to objectively determine total fluid intake and encourage accurate self-reporting. Validity was assessed by comparing BEVQ1 with food intake record results; reliability was assessed by comparing BEVQ1 and BEVQ2. Analyses included descriptive statistics, bivariate correlations, paired samples t tests, and independent samples t tests. Self-reported water and total beverage intake (in grams) were not different between the BEVQ1 and food intake records (mean difference 129+/-77 g [P=0.096] and 61+/-106 g [P=0.567], respectively). Total beverage and sugar-sweetened beverage energy intake were significantly different, although mean differences were small (63 and 44 kcal, respectively). Daily consumption (in grams) of water (r=0.53), total beverages (r=0.46), and sugar-sweetened beverages (r=0.49) determined by the BEVQ1 were correlated with reported intake determined by the food intake record, as was energy from total beverages (r=0.61) and sugar-sweetened beverages (r=0.59) (all P values <0.001). Reliability was demonstrated, with correlations (P<0.001) detected between BEVQ1 and BEVQ2 results. The BEVQ is a valid, reliable, and rapid self-administered dietary assessment tool.

A systematic literature review and meta-analysis: The Theory of Planned Behavior's application to understand and predict nutrition-related behaviors in youth

BACKGROUND Efforts to reduce unhealthy dietary intake behaviors in youth are urgently needed. Theory-based interventions can be effective in promoting behavior change; one promising model is the Theory of Planned Behavior (TPB). PURPOSE The aim of this study was to determine, using a systematic literature review, how the TPB has been applied to investigate dietary behaviors, and to evaluate which constructs are associated with dietary behavioral intentions and behaviors in youth. METHODS Publications were identified by searching electronic databases, contacting experts in the field, and examining an evolving Internet-based TPB-specific bibliography. Studies including participants aged 2-18years, all TPB constructs discernible and measured with a description of how the variables were assessed and analyzed, were published in English and peer-reviewed journals, and focused on nutrition-related behaviors in youth were identified. Accompanying a descriptive statistical analysis was the calculation of effect sizes where possible, a two-stage meta-analysis, and a quality assessment using tenants from the Consolidated Standards of Reporting Trials (CONSORT) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statements. RESULTS Thirty-four articles, including three intervention studies, were reviewed. The TPB was most often used to evaluate healthy eating and sugary snack and beverage consumption. Attitude had the strongest relationship with dietary behavioral intention (mean r=0.52), while intention was the most common predictor of behavior performance (mean r=0.38; both p<0.001). All three interventions revealed beneficial outcomes when using the TPB (e.g. η(2)=0.51 and ds=0.91, 0.89, and 0.79); extending the Theory with implementation intentions may enhance its effectiveness (e.g. η(2)=0.76). CONCLUSIONS Overall, the TPB may be an effective framework to identify and understand child and adolescent nutrition-related behaviors, allowing for the development of tailored initiatives targeting poor dietary practices in youth. However, support from the literature is primarily from observational studies and a greater effort towards examining these relationships within intervention studies is needed.

Home help services in Sweden: responsiveness to changing demographics and needs

Decreases in Swedish home help services have not resulted in increased rates of unmet need. To understand these changes, we identified predictors of home help services and rates of institutional care and how these effects changed over time using longitudinal data (1994–2000) from 286 Swedish municipalities. Outcomes were home help coverage rates, intensity of home help per recipient, and rates of institutional living. Predictors reflected availability and need for services. Services decreased over time, but not uniformly. Coverage rates were higher in municipalities with a greater proportion of population 65 and older and greater proportion of unmarried elders. Decreases in coverage rates were greater in municipalities with a higher proportion of unmarried elders, greater ratio of older women to men, with more home help staff workers, and more expensive services. Home help was provided more intensively in municipalities with higher median incomes, higher unemployment rates and municipalities spending more per inhabitant on child care. Decreases in intensity were greater in municipalities with lower proportions of unmarried elders and fewer home help staff workers. Rates of institutional living were higher in municipalities that spent more on old age services and with a greater proportion of unmarried elders. Decreases in institutionalization were greater in municipalities with a greater proportion of unmarried elders and lower ratio of older women to men. Variability in how municipalities responded to these changes may explain continued low rates of unmet need. Results are consistent with both increased efficiency and more effective targeting, but cannot capture service quality.

Cortisol, alpha amylase, and daily stressors in spouses of persons with mild cognitive impairment.

This study examines the effects of daily primary objective stressors (behavioral problems exhibited by persons with mild cognitive impairment) and subjective stressors (unpleasant marital interactions) on the diurnal cortisol pattern and the diurnal pattern of salivary alpha-amylase (sAA) of spousal care partners. Thirty spouse care partners (age 59-85 years) participated in a 7-day diary study and submitted saliva samples on 4 consecutive study days, totaling 406 valid samples. Results from multilevel models revealed that daily objective stressors were associated with elevated cortisol levels and a flatter slope but were not associated with sAA activity. Conversely, unpleasant marital interactions were associated with flatter sAA slopes but not associated with cortisol activity. Furthermore, daily levels of sAA moderated variations in cortisol in the presence of a primary objective stressor. The utility of our research has implications for advancing scientific understanding of biosocial processes and the development of stress prevention and intervention strategies.

Grandparent-Grandchild Relationships: From Families in Contexts to Families as Contexts

Relationships between grandparents and grandchildren provide an excellent framework for integrating family theory and family methodology. Systematic differences as a function of age, gender, life expectancy, and health as played out through generations suggest some topics are best studied by disentangling variability between and within families. Using data from 1,345 grandchildren (52% girls, mean age 13.69 years, range 9 to 20) reporting on 3,664 grandparents, we compare results obtained from studying grandparent-grandchild relationships individually and at the family level. Results suggest important predictors of relationship quality at the within-subject and between-subject levels. Future research should more carefully integrate each level into theory and design.

A rapid beverage intake questionnaire can detect changes in beverage intake

UNLABELLED Attention on beverage intake, specifically sugar-sweetened beverages (SSB), has increased in recent years. A brief valid, reliable and sensitive assessment tool for quantifying beverage consumption and determining its influence on weight status could help to advance research on this topic. The valid and reliable 15-item beverage questionnaire (BEVQ-15) estimates mean daily intake of water, SSB and total beverages (g, kcal) across multiple beverage categories. OBJECTIVE to determine the ability of the BEVQ-15 to detect changes in beverage intake over time. Participants (n=70; age=37±2 yr; BMI=24.5±0.4 kg/m(2)) underwent two randomly assigned 30-day periods (intervention, increased water and fruit juice consumption; control, increased solid fruit consumption), with a 30-day washout phase between feeding periods. The BEVQ-15 was administered at the beginning and end of each period. Reliability was assessed by Pearsons correlations, paired sample t tests and Cronbachs alpha. Paired sample t tests and repeated measures ANOVA were used to evaluate sensitivity to change. Sixty-nine participants completed all study sessions. Reliability was acceptable for most beverages (range: R(2)=0.52-0.95, P<0.001), but not for energy drinks. Increases in water (g), juice (kcal, g) and total beverage (g) were detected during the intervention period (P<0.001); no changes in these variables were detected in the control period. The BEVQ-15 demonstrates the ability to detect changes in beverage intake over time. This brief (~2 min), self-administered, valid, reliable and sensitive beverage intake assessment tool may be used by researchers and practitioners who evaluate and intervene upon beverage intake patterns in adults.

Estimating Statistical Power With Incomplete Data

Software developments increasingly facilitate inclusion of incomplete data, but relatively little research has examined the effects of incomplete data on statistical power. Seven steps needed to conduct power analyses with incomplete data for a variety of commonly tested hypotheses are illustrated, focusing on significance tests of individual parameters. The example extends a growth curve model simulation presented by Curran and Muthén (1999) to the incomplete data situation. How to estimate statistical power for a range of sample sizes from a single model, as well as how to calculate the sample size required to obtain a desired value of statistical power, is demonstrated. Effects of data being missing completely at random (MCAR) or missing at random (MAR) across a range from 0% (complete data) to 95% missing data are considered. SAS and LISREL syntax are provided in this paper with syntax for other software available from the authors.

Kin relationship of caregivers and people with dementia: stress and response to intervention

This study examined the effects of kin relationship on response to use of adult day services (ADS) on feelings of overload, depressive symptoms, and positive affect for family caregivers of people with dementia.