Michelle Wien

Childhood obesity and adult morbidities

The prevalence and severity of obesity have increased in recent years, likely the result of complex interactions between genes, dietary intake, physical activity, and the environment. The expression of genes favoring the storage of excess calories as fat, which have been selected for over many millennia and are relatively static, has become maladaptive in a rapidly changing environment that minimizes opportunities for energy expenditure and maximizes opportunities for energy intake. The consequences of childhood and adolescent obesity include earlier puberty and menarche in girls, type 2 diabetes and increased incidence of the metabolic syndrome in youth and adults, and obesity in adulthood. These changes are associated with cardiovascular disease as well as with several cancers in adults, likely through insulin resistance and production of inflammatory cytokines. Although concerns have arisen regarding environmental exposures, there have been no formal expert recommendations. Currently, the most important factors underlying the obesity epidemic are the current opportunities for energy intake coupled with limited energy expenditure.

Vegetarian diets and childhood obesity prevention

The increased prevalence of childhood overweight and obesity is not unique to industrialized societies; dramatic increases are occurring in urbanized areas of developing countries. In light of the consensus that obesity is a significant public health concern and that many weight-loss interventions have been unsuccessful in the long term, an exploration of food patterns that are beneficial in the primary prevention of obesity is warranted. The focus of this article is to review the relation between vegetarian diets and obesity, particularly as they relate to childhood obesity. Epidemiologic studies indicate that vegetarian diets are associated with a lower body mass index (BMI) and a lower prevalence of obesity in adults and children. A meta-analysis of adult vegetarian diet studies estimated a reduced weight difference of 7.6 kg for men and 3.3 kg for women, which resulted in a 2-point lower BMI (in kg/m(2)). Similarly, compared with nonvegetarians, vegetarian children are leaner, and their BMI difference becomes greater during adolescence. Studies exploring the risk of overweight and food groups and dietary patterns indicate that a plant-based diet seems to be a sensible approach for the prevention of obesity in children. Plant-based diets are low in energy density and high in complex carbohydrate, fiber, and water, which may increase satiety and resting energy expenditure. Plant-based dietary patterns should be encouraged for optimal health and environmental benefits. Food policies are warranted to support social marketing messages and to reduce the cultural and economic forces that make it difficult to promote plant-based dietary patterns.

The risk of child and adolescent overweight is related to types of food consumed

Background/AimsTo investigate the association between the risk of overweight and the consumption of food groups in children and adolescents.MethodsWe studied 1764 healthy children and adolescents (age 6-19y) attending 16 Seventh-Day Adventist schools and 13 public schools using a 106-item non-quantitative food frequency questionnaire from the late 1980 Child-Adolescent Blood Pressure Study. Logistic regression models were used to compute the risk of overweight according to consumption of grains, nuts, vegetables, fruits, meats/fish/eggs, dairy, and, low nutrient-dense foods (LNDF).ResultsThe frequency of consumption of grains, nuts, vegetables and LNDF were inversely related to the risk of being overweight and dairy increased the risk. Specifically, the odds ratio (95% CI) for children in the highest quartile or tertile of consumption compared with the lowest quartile or tertile were as follows: grains 0.59(0.41-0.83); nuts 0.60(0.43-0.85); vegetables 0.67(0.48-0.94); LNDF 0.43(0.29-0.63); and, dairy 1.36(0.97, 1.92).ConclusionThe regular intake of specific plant foods may prevent overweight among children and adolescents.

A perspective on vegetarian dietary patterns and risk of metabolic syndrome

The vegetarian dietary pattern is traditionally a plant-based diet that includes fruits, vegetables, cereals, legumes, nuts, vegetable oils, soya, and possibly dairy products and/or eggs. Vegetarians and other populations who follow a plant-based dietary pattern enjoy longevity. Specifically, vegetarian dietary patterns have been associated with a lower risk for developing IHD, type 2 diabetes, hypertension, specific cancers, lower all-cause mortality and reduction in cause-specific mortality. The prevalence of the metabolic syndrome (MetS) in the USA is approximately 20 % and is currently increasing in developing countries in line with the obesity epidemic. The health care costs associated with the MetS are on a magnitude of 1.6 overall compared with healthy individuals, which makes it an important public health problem. Current evidence from several cross-sectional and case-control studies shows an association between consumption of a vegetarian dietary pattern and a reduced prevalence or risk of developing the MetS. There is a need for further research to be conducted, particularly prospective cohort studies to evaluate the effect of vegetarian dietary patterns on reducing the incidence of the MetS and, clinical trials should be designed to explore vegetarian dietary patterns for the reversal of the MetS in high-risk populations. This research could contribute to reduce the societal and economic burdens associated with the disorder.

The environmental cost of protein food choices

OBJECTIVE To investigate the resource efficiency and environmental impacts of producing one kilogram of edible protein from two plant- and three animal-protein sources. DESIGN Primary source data were collected and applied to commodity production statistics to calculate the indices required to compare the environmental impact of producing 1 kg of edible protein from kidney beans, almonds, eggs, chicken and beef. Inputs included land and water for raising animals and growing animal feed, total fuel, and total fertilizer and pesticide for growing the plant commodities and animal feed. Animal waste generated was computed for the animal commodities. SETTING Desk-based study at the Department of Nutrition and Department of Occupational and Environmental Health, Loma Linda University. SUBJECTS None. RESULTS To produce 1 kg of protein from kidney beans required approximately eighteen times less land, ten times less water, nine times less fuel, twelve times less fertilizer and ten times less pesticide in comparison to producing 1 kg of protein from beef. Compared with producing 1 kg of protein from chicken and eggs, beef generated five to six times more waste (manure) to produce 1 kg of protein. CONCLUSIONS The substitution of beef with beans in meal patterns will significantly reduce the environmental footprint worldwide and should also be encouraged to reduce the prevalence of non-communicable chronic diseases. Societies must work together to change the perception that red meat (e.g. beef) is the mainstay of an affluent and healthy diet.

A randomized 3x3 crossover study to evaluate the effect of Hass avocado intake on post-ingestive satiety, glucose and insulin levels, and subsequent energy intake in overweight adults

BackgroundThe behavioral outcome of food ingestion is a complex process that involves psychological and biological factors. Avocados are nutrient dense with properties that may favorably impact energy balance. This study sought to evaluate if incorporating approximately one half of a Hass avocado by addition or inclusion into a lunch meal will influence post-ingestive satiety, glucose and insulin response, and subsequent energy intake among overweight adults.MethodsThis was a randomized 3x3 single-blind crossover design study with 26 healthy overweight adults (mean ±SD age 40.8±11.0 years and BMI 28.1±2.4 kg/m2). Participants consumed a standardized breakfast followed by 1 of 3 lunch test meals [Control (C), avocado-free; Avocado Inclusive (AI); and, Avocado Added (AA)]. Participants rated five appetite sensations using a visual analog scale (VAS) before lunch and at specific intervals over 5 hours following the start of the test meal. Blood glucose and insulin were measured before lunch and at specific intervals over 3 hours following the start of the test meal. Mixed models were used to compare differences among the 3 test meals, and the area under the curve (AUC0-xh) was computed for the VAS and biological measures.ResultsThere were significant differences in the AUC(0-5h) for the self-reported feelings of satisfaction (P=0.04) and desire to eat (P=0.05) in the mixed model analysis. Compared to the C test meal, the AA test meal increased satisfaction by 23% (P=0.05) and decreased the desire to eat by 28% (P=0.04) for the AUC(0-5h). For the AUC(0-3h), the AA test meal increased satisfaction by 26% (P=0.02) and decreased the desire to eat by 40% (P=0.01) as compared to the C test meal. Compared to the AI meal, the AUC(0-3h) for blood insulin was higher in the C and AA meals (P=0.04 and P=0.05, respectively).ConclusionsThe addition of approximately one half of a Hass avocado at a lunch meal can influence post-ingestive satiety over a subsequent 3 and 5 hour period in overweight adults. A caveat to these findings is that the avocado contained an additional 112 kcal, which may have accounted for the observed increase in satisfaction and decreased desire to eat. Future trials are warranted to evaluate the effects of avocado intake on weight management in adults of varying BMIs and among insulin resistant individuals.

Management of Hyperglycemia and Enteral Nutrition in the Hospitalized Patient

There has been increased attention on the importance of identifying and distinguishing the differences between stress-induced hyperglycemia (SH), newly diagnosed hyperglycemia (NDH), and hyperglycemia in persons with established diabetes mellitus (DM). Inpatient blood glucose control is now being recognized as not only a cost issue for hospitals but also a concern for patient safety and care. The reasons for the increased incidence of hyperglycemia in hospitalized patients include preexisting DM, undiagnosed DM or prediabetes, SH, and medication-induced hyperglycemia with resulting transient blood glucose variability. It is clear that identifying and documenting hyperglycemia in hospitalized patients with and without a previous diagnosis of DM and initiating prompt insulin treatment are important. Agreement on the optimum treatment goals for hyperglycemia remains quite controversial, and the benefits of intensive glucose management may be lost at the cost of hypoglycemia in intensive care unit patients. Nutrition support in the form of enteral nutrition (EN) increases the risk of hyperglycemia in both critical and non-critically ill hospitalized patients. Reasons for beginning a tube feeding are the same whether a person has NDH or DM. What differs is how to incorporate EN into the established insulin management protocols. The risk for hyperglycemia with the addition of EN is even higher in those without a previous diagnosis of DM. This review discusses the incidence of hyperglycemia, the pathogenesis of hyperglycemia, factors contributing to hyperglycemia in the hospitalized patient, glycemic management goals, current glycemic management recommendations, and considerations for EN formula selection, administration, and treatment.

Food selection criteria for disaster response planning in urban societies

BackgroundNutrition professionals that have menu planning and disaster management responsibilities should consider factors that have transcended from ancient to current times, in addition to recognizing societal trends that have led to our current increased vulnerability in the event of a disaster. Hence, we proceeded to develop a set of “Disaster Response Diets” (DRDs) for use in urban societies inclusive of the aforementioned considerations.MethodsA three-phase multidimensional approach was used to identify food groups suitable for creating a set of DRDs. Phase One consisted of calculating the percent daily nutrient intake and Drewnowski’s naturally nutrient rich (NNR) score for an individual or mean composite for one serving of food from 11 specific food groups. In Phase Two, in addition to nutrient density, the 11 food groups were evaluated and scored based on the following DRD planning criteria: storage and handling properties, preparation ease and, cultural acceptance/individual tolerance. During Phase Three, three DRDs were developed based upon the data retrieved from Phases one and two.ResultsIn Phase One, the NNR scores ranged from 2.1 for fresh fruits to 28.1 for dry cereals, a higher score indicating a higher nutrient density. During Phase Two, a maximum score of 12 was possible based on appropriateness for a disaster situation. Five plant-based food groups (dry cereals, nuts, dried fruits, grains and legumes) achieved a score ranging between 7 and 12, whereas the five fresh food groups were deemed ineligible due to sanitation and perishability concerns. During Phase Three, three DRDs (milk-inclusive, milk-free and Grab-and-Go) were developed as benchmarks for disaster response planning.ConclusionsPlant-based DRDs are universally acceptable and tolerated across cultures and religions. Therefore, we suggest nutrition professionals consider using a plant-based approach for creating DRDs for public health institutions and organizations.

Nut Intake and Health

Nuts have been consumed by animals and humans as an energy dense food since Paleolithic times. They are rich sources of plant protein, polyunsaturated and monounsaturated fatty acids, dietary fiber, vitamins, minerals, phenolic antioxidants, and phytosterols. The focus of this chapter will include the scientific evidence surrounding the role of tree nuts and peanuts as a whole food for reducing disease risk (e.g., cardiovascular, diabetes, obesity, metabolic syndrome, and cognitive decline) and thus promoting optimal health. Building the scientific evidence base through continued nut-based research will provide additional information for future dietary guidelines committees to consider for positioning and promoting nuts in the context of improving the health of the worlds population.

Weight Loss and Maintenance in Adult Populations: What Works?

Selecting the optimal composition of macronutrients for a low-calorie meal plan is an important consideration for the initiation and maintenance of weight loss of overweight and obese patients. Physical activity is an effective adjunct plan after some initial weight loss has been achieved. However, the management of medications in patients with comorbidities is imperative for the prevention of complications. Suitable administration of medications that are associated with weight gain or satiety should be considered. The inverse association between the frequency of nut intake and body mass index found in epidemiologic studies may be due to several factors, including dietary compensation and reduced bioavailability of energy from nuts. Some studies have observed that nut consumption is advantageous for the initiation and maintenance of weight loss and yields an improvement in cardiometabolic risk factors. However, additional studies on the effectiveness of using nuts for maintenance of initial weight loss are warranted.