Melinda J. Hutchesson

eHealth interventions for the prevention and treatment of overweight and obesity in adults: a systematic review with meta-analysis

A systematic review of randomized controlled trials was conducted to evaluate the effectiveness of eHealth interventions for the prevention and treatment of overweight and obesity in adults. Eight databases were searched for studies published in English from 1995 to 17 September 2014. Eighty‐four studies were included, with 183 intervention arms, of which 76% (n = 139) included an eHealth component. Sixty‐one studies had the primary aim of weight loss, 10 weight loss maintenance, eight weight gain prevention, and five weight loss and maintenance. eHealth interventions were predominantly delivered using the Internet, but also email, text messages, monitoring devices, mobile applications, computer programs, podcasts and personal digital assistants. Forty percent (n = 55) of interventions used more than one type of technology, and 43.2% (n = 60) were delivered solely using eHealth technologies. Meta‐analyses demonstrated significantly greater weight loss (kg) in eHealth weight loss interventions compared with control (MD −2.70 [−3.33,−2.08], P < 0.001) or minimal interventions (MD −1.40 [−1.98,−0.82], P < 0.001), and in eHealth weight loss interventions with extra components or technologies (MD 1.46 [0.80, 2.13], P < 0.001) compared with standard eHealth programmes. The findings support the use of eHealth interventions as a treatment option for obesity, but there is insufficient evidence for the effectiveness of eHealth interventions for weight loss maintenance or weight gain prevention.

Reproducibility and comparative validity of a food frequency questionnaire for Australian adults

BACKGROUND Food frequency questionnaires (FFQ) are used in epidemiological studies to investigate the relationship between diet and disease. There is a need for a valid and reliable adult FFQ with a contemporary food list in Australia. AIMS To evaluate the reproducibility and comparative validity of the Australian Eating Survey (AES) FFQ in adults compared to weighed food records (WFRs). METHODS Two rounds of AES and three-day WFRs were conducted in 97 adults (31 males, median age and BMI for males of 44.9 years, 26.2 kg/m(2), females 41.3 years, 24.0 kg/m(2). Reproducibility was assessed over six months using Wilcoxon signed-rank tests and comparative validity was assessed by intraclass correlation coefficients (ICC) estimated by fitting a mixed effects model for each nutrient to account for age, sex and BMI to allow estimation of between and within person variance. RESULTS Reproducibility was found to be good for both WFR and FFQ since there were no significant differences between round 1 and 2 administrations. For comparative validity, FFQ ICCs were at least as large as those for WFR. The ICC of the WFR-FFQ difference for total energy intake was 0.6 (95% CI 0.43, 0.77) and the median ICC for all nutrients was 0.47, with all ICCs between 0.15 (%E from saturated fat) and 0.7 (g/day sugars). CONCLUSIONS Compared to WFR the AES FFQ is suitable for reliably estimating the dietary intakes of Australian adults across a wide range of nutrients.

Effectiveness of interventions targeting physical activity, nutrition and healthy weight for university and college students: A systematic review and meta-analysis

To examine the effectiveness of interventions aimed at improving physical activity, diet, and/or weight-related behaviors amongst university/college students. Five online databases were searched (January 1970 to April 2014). Experimental study designs were eligible for inclusion. Data extraction was performed by one reviewer using a standardized form developed by the researchers and checked by a second reviewer. Data were described in a narrative synthesis and meta-analyses were conducted when appropriate. Study quality was also established. Forty-one studies were included; of these, 34 reported significant improvements in one of the key outcomes. Of the studies examining physical activity 18/29 yielded significant results, with meta-analysis demonstrating significant increases in moderate physical activity in intervention groups compared to control. Of the studies examining nutrition, 12/24 reported significantly improved outcomes; only 4/12 assessing weight loss outcomes found significant weight reduction. This appears to be the first systematic review of physical activity, diet and weight loss interventions targeting university and college students. Tertiary institutions are appropriate settings for implementing and evaluating lifestyle interventions, however more research is needed to improve such strategies.

Self-monitoring of dietary intake by young women: online food records completed on computer or smartphone are as accurate as paper-based food records but more acceptable.

Adherence and accuracy of self-monitoring of dietary intake influences success in weight management interventions. Information technologies such as computers and smartphones have the potential to improve adherence and accuracy by reducing the burden associated with monitoring dietary intake using traditional paper-based food records. We evaluated the acceptability and accuracy of three different 7-day food record methods (online accessed via computer, online accessed via smartphone, and paper-based). Young women (N=18; aged 23.4±2.9 years; body mass index 24.0±2.2) completed the three 7-day food records in random order with 7-day washout periods between each method. Total energy expenditure (TEE) was derived from resting energy expenditure (REE) measured by indirect calorimetry and physical activity level (PAL) derived from accelerometers (TEE=REE×PAL). Accuracy of the three methods was assessed by calculating absolute (energy intake [EI]-TEE) and percentage difference (EI/TEE×100) between self-reported EI and TEE. Acceptability was assessed via questionnaire. Mean±standard deviation TEE was 2,185±302 kcal/day and EI was 1,729±249 kcal/day, 1,675±287kcal/day, and 1,682±352 kcal/day for computer, smartphone, and paper records, respectively. There were no significant differences between absolute and percentage differences between EI and TEE for the three methods: computer, -510±389 kcal/day (78%); smartphone, -456±372 kcal/day (80%); and paper, -503±513 kcal/day (79%). Half of participants (n=9) preferred computer recording, 44.4% preferred smartphone, and 5.6% preferred paper-based records. Most participants (89%) least preferred the paper-based record. Because online food records completed on either computer or smartphone were as accurate as paper-based records but more acceptable to young women, they should be considered when self-monitoring of intake is recommended to young women.

Recruitment and retention of young women into nutrition research studies: practical considerations

BackgroundSuccessful recruitment and retention of participants into research studies is critical for optimising internal and external validity. Research into diet and lifestyle of young women is important due to the physiological transitions experienced at this life stage. This paper aims to evaluate data related to recruitment and retention across three research studies with young women, and present practical advice related to recruiting and retaining young women in order to optimise study quality within nutrition research.MethodsRecruitment and retention strategies used in three nutrition studies that targeted young women (18 to 35 years) were critiqued. A randomised controlled trial (RCT), a crossover validation study and a cross-sectional survey were conducted at the University of Newcastle, Australia between 2010 and 2013Successful recruitment was defined as maximum recruitment relative to time. Retention was assessed as maximum participants remaining enrolled at study completion.ResultsRecruitment approaches included notice boards, web and social network sites (Facebook and Twitter), with social media most successful in recruitment. The online survey had the highest recruitment in the shortest time-frame (751 participants in one month). Email, phone and text message were used in study one (RCT) and study two (crossover validation) and assisted in low attrition rates, with 93% and 75.7% completing the RCT and crossover validation study respectively. Of those who did not complete the RCT, reported reasons were: being too busy; and having an unrelated illness.ConclusionRecruiting young women into nutrition research is challenging. Use of social media enhances recruitment, while Email, phone and text message contact improves retention within interventions. Further research comparing strategies to optimise recruitment and retention in young women, including flexible testing times, reminders and incentives is warranted.

Diet Quality, Measured by Fruit and Vegetable Intake, Predicts Weight Change in Young Women

This study investigates the relationship between diet quality and weight gain in young women. Young women (n = 4,287, with 1,356 women identified as plausible subsample aged 27.6 ± 1.5 years at baseline) sampled from the Australian Longitudinal Study on Womens Health study completed food frequency questionnaires in 2003, which were used to evaluate diet quality using three indices: Australian Recommended Food Score (ARFS), Australian Diet Quality Index (Aus-DQI), and Fruit and Vegetable Index (FAVI). Weight was self-reported in 2003 and 2009. Multivariate linear regression was used to examine the association between tertiles of each diet quality index and weight change from 2003 to 2009. The ARFS and FAVI were significant predictors of 6-year weight change in this group of young women, while Aus-DQI did not predict weight change (P > 0.05). In the fully adjusted model, those who were in the top tertile of the ARFS significantly gained lower weight gain compared with the lower tertile for the plausible TEI sub-sample (β = −1.6 kg (95% CI: −2.67 to −0.56), P = 0.003). In the fully adjustment model, young women were classified in the highest FAVI tertile and gained significantly less weight than those in the lowest tertile for the plausible TEI (β = −1.6 kg (95% CI: −2.4 to −0.3) P = 0.01). In conclusion, overall diet quality measured by the ARFS and the frequency and variety of fruit and vegetable consumption may predict long-term weight gain in young women. Therefore, health promotion programs encouraging frequent consumption of a wide variety of fruits and vegetables are warranted.

The Comparative Validity and Reproducibility of a Diet Quality Index for Adults: The Australian Recommended Food Score

Adult diet quality indices are shown to predict nutritional adequacy of dietary intake as well as all-cause morbidity and mortality. This study describes the reproducibility and validity of a food-based diet quality index, the Australian Recommended Food Score (ARFS). ARFS was developed to reflect alignment with the Australian Dietary Guidelines and is modelled on the US Recommended Food Score. Dietary intakes of 96 adult participants (31 male, 65 female) age 30 to 75 years were assessed in two rounds, five months apart. Diet was assessed using a 120-question semi-quantitative food frequency questionnaire (FFQ). The ARFS diet quality index was derived using a subset of 70 items from the full FFQ. Reproducibility of the ARFS between round one and round two was confirmed by the overall intraclass correlation coefficient of 0.87 (95% CI 0.83, 0.90), which compared favourably to that for the FFQ at 0.85 (95% CI 0.80, 0.89). ARFS was correlated with FFQ nutrient intakes, particularly fiber, vitamin A, beta-carotene and vitamin C (0.53, 95% CI 0.37–0.67), and with mineral intakes, particularly calcium, magnesium and potassium (0.32, 95% CI 0.23–0.40). ARFS is a suitable brief tool to evaluate diet quality in adults and reliably estimates a range of nutrient intakes.

Impact of dietary macronutrient distribution on BMI and cardiometabolic outcomes in overweight and obese children and adolescents: a systematic review

The present systematic review examined the effectiveness of weight management interventions comparing diets with varying macronutrient distributions on BMI and cardiometabolic risk factors in overweight or obese children and adolescents. A systematic search of seven databases for the period 1975-2013 identified 14 eligible randomized or quasi-randomized controlled trials conducted with 6-18-year-old subjects. Seven trials compared a low-fat (≤ 33% energy or < 40 g/day) to an isocaloric (n = 2) or ad libitum (n = 5) low-carbohydrate diet (< 20% energy or < 60 g/day). Meta-analysis indicated a greater reduction in BMI in the low-carbohydrate group immediately after dietary intervention; however, the quality of the studies was limited and cardiometabolic benefits were inconsistent. Six trials compared increased-protein diets (19-30% energy) to isocaloric standard-protein diets (15-20% energy) and one compared an increased-fat diet (40% energy) to an isocaloric standard-fat diet (27% energy); there were no differences in outcomes in these studies. Current evidence suggests that improved weight status can be achieved in overweight or obese children and adolescents irrespective of the macronutrient distribution of a reduced-energy diet. Tailoring the macronutrient content to target specific cardiometabolic risk factors, such as a low-carbohydrate diet to treat insulin resistance, may be possible, but further research is needed before specific recommendations can be made.

Fruit and vegetable intake assessed by food frequency questionnaire and plasma carotenoids: A validation study in adults

Dietary validation studies of self-reported fruit and vegetable intake should ideally include measurement of plasma biomarkers of intake. The aim was to conduct a validation study of self-reported fruit and vegetable intakes in adults, using the Australian Eating Survey (AES) food frequency questionnaire (FFQ), against a range of plasma carotenoids. Dietary intakes were assessed using the semi-quantitative 120 item AES FFQ. Fasting plasma carotenoids (α- and β-carotene, lutein/zeaxanthin, lycopene and cryptoxanthin) were assessed using high performance liquid chromatography in a sample of 38 adult volunteers (66% female). Significant positive correlations were found between FFQ and plasma carotenoids for α-carotene, β-carotene and lutein/zeaxanthin (52%, 47%, 26%, p < 0.001, 0.003, 0.041; respectively) and relationships between plasma carotenoids (except lycopene) and weight status metrics (BMI, waist circumference, fat mass) were negative and highly significant. The results of the current study demonstrate that carotenoid intakes as assessed by the AES FFQ are significantly related to plasma concentrations of α-carotene, β-carotene and lutein/zeaxanthin, the carotenoids commonly found in fruit and vegetables. Lower levels of all plasma carotenoids, except lycopene, were found in individuals with higher BMI. We conclude that the AES can be used to measure fruit and vegetable intakes with confidence.

Changes to dietary intake during a 12-week commercial web-based weight loss program: a randomized controlled trial

Background/objectives:The primary aim of this secondary analysis was to compare changes in dietary intake among participants randomized to two versions of a 12-week commercial web-based weight loss program (basic or enhanced) with a waiting-list control. An additional investigation compared changes in dietary intake of successful participants (weight loss ⩾5%) with those not successful.Subjects/methods:Dietary intake was assessed at baseline and 12 weeks using a validated 120-item semiquantitative food frequency questionnaire. Adults (n=268, 60% female participants, body mass index 32.1±3.9) classified as plausible reporters of energy intake were included in the analyses. Analysis of covariance with baseline observations carried forward for drop-outs (n=38) was used.Results:The basic and enhanced groups significantly increased their percentage of energy contribution from fruits and reduced energy-dense, nutrient-poor foods compared with controls (P<0.001). Successful participants (n=49) reported superior improvements in dietary intake including greater reductions in the mean daily energy intake (P<0.001), the percentage of energy from energy-dense, nutrient-poor foods (−12.0% E vs −4.3% E, P<0.001) and greater increases in the energy contribution from fruits (P<0.001), vegetables (P=0.003) and breads/cereals (P=0.02).Conclusions:Use of a commercial web-based weight loss program facilitated some improvements in the dietary intake. The enhanced web-based tools appeared not to have generated greater improvements in reported dietary intake, compared with the basic or control groups. Those who achieved a weight loss of ⩾5% improved their dietary intake in line with the program recommendations and dietary guidelines. Further research to determine web-based components that may improve success and the reasons why programs are successful for some participants is required.