Sinead Watson

Effect of a Web-Based Behavior Change Program on Weight Loss and Cardiovascular Risk Factors in Overweight and Obese Adults at High Risk of Developing Cardiovascular Disease: Randomized Controlled Trial.

Background Web-based programs are a potential medium for supporting weight loss because of their accessibility and wide reach. Research is warranted to determine the shorter- and longer-term effects of these programs in relation to weight loss and other health outcomes. Objective The aim was to evaluate the effects of a Web-based component of a weight loss service (Imperative Health) in an overweight/obese population at risk of cardiovascular disease (CVD) using a randomized controlled design and a true control group. Methods A total of 65 overweight/obese adults at high risk of CVD were randomly allocated to 1 of 2 groups. Group 1 (n=32) was provided with the Web-based program, which supported positive dietary and physical activity changes and assisted in managing weight. Group 2 continued with their usual self-care (n=33). Assessments were conducted face-to-face. The primary outcome was between-group change in weight at 3 months. Secondary outcomes included between-group change in anthropometric measurements, blood pressure, lipid measurements, physical activity, and energy intake at 3, 6, and 12 months. Interviews were conducted to explore participants’ views of the Web-based program. Results Retention rates for the intervention and control groups at 3 months were 78% (25/32) vs 97% (32/33), at 6 months were 66% (21/32) vs 94% (31/33), and at 12 months were 53% (17/32) vs 88% (29/33). Intention-to-treat analysis, using baseline observation carried forward imputation method, revealed that the intervention group lost more weight relative to the control group at 3 months (mean –3.41, 95% CI –4.70 to –2.13 kg vs mean –0.52, 95% CI –1.55 to 0.52 kg, P<.001), at 6 months (mean –3.47, 95% CI –4.95 to –1.98 kg vs mean –0.81, 95% CI –2.23 to 0.61 kg, P=.02), but not at 12 months (mean –2.38, 95% CI –3.48 to –0.97 kg vs mean –1.80, 95% CI –3.15 to –0.44 kg, P=.77). More intervention group participants lost ≥5% of their baseline body weight at 3 months (34%, 11/32 vs 3%, 1/33, P<.001) and 6 months (41%, 13/32 vs 18%, 6/33, P=.047), but not at 12 months (22%, 7/32 vs 21%, 7/33, P=.95) versus control group. The intervention group showed improvements in total cholesterol, triglycerides, and adopted more positive dietary and physical activity behaviors for up to 3 months verus control; however, these improvements were not sustained. Conclusions Although the intervention group had high attrition levels, this study provides evidence that this Web-based program can be used to initiate clinically relevant weight loss and lower CVD risk up to 3-6 months based on the proportion of intervention group participants losing ≥5% of their body weight versus control group. It also highlights a need for augmenting Web-based programs with further interventions, such as in-person support to enhance engagement and maintain these changes. Trial Registration ClinicalTrials.gov NCT01472276; http://clinicaltrials.gov/ct2/show/study/NCT01472276 (Archived by Webcite at http://www.webcitation.org/6Z9lfj8nD).

Dietary exposure to aflatoxin and micronutrient status among young children from Guinea

SCOPE Aflatoxin exposure coincides with micronutrient deficiencies in developing countries. Animal feeding studies have postulated that aflatoxin exposure may be exacerbating micronutrient deficiencies. Evidence available in human subjects is limited and inconsistent. The aim of the study was to investigate the relationship between aflatoxin exposure and micronutrient status among young Guinean children. METHODS AND RESULTS A total of 305 children (28.8 ± 8.4 months) were recruited at groundnut harvest (rainy season), of which 288 were followed up 6 months later postharvest (dry season). Blood samples were collected at each visit. Aflatoxin-albumin adduct levels were measured by ELISA. Vitamin A, vitamin E and β-carotene concentrations were measured using HPLC methods. Zinc was measured by atomic absorption spectroscopy. Aflatoxin exposure and micronutrient deficiencies were prevalent in this population and were influenced by season, with levels increasing between harvest and postharvest. At harvest, children in the highest aflatoxin exposure group, compared to the lowest, were 1.98 (95%CI: 1.00, 3.92) and 3.56 (95%CI: 1.13, 11.15) times more likely to be zinc and vitamin A deficient. CONCLUSION Although children with high aflatoxin exposure levels were more likely to be zinc and vitamin A deficient, further research is necessary to determine a cause and effect relationship.

Interventions targeting child undernutrition in developing countries may be undermined by dietary exposure to aflatoxin

ABSTRACT Child undernutrition, a form of malnutrition, is a major public health burden in developing countries. Supplementation interventions targeting the major micronutrient deficiencies have only reduced the burden of child undernutrition to a certain extent, indicating that there are other underlying determinants that need to be addressed. Aflatoxin exposure, which is also highly prevalent in developing countries, may be considered an aggravating factor for child undernutrition. Increasing evidence suggests that aflatoxin exposure can occur in any stage of life, including in utero through a trans-placental pathway and in early childhood (through contaminated weaning food and family food). Early life exposure to aflatoxin is associated with adverse effects on low birth weight, stunting, immune suppression, and the liver function damage. The mechanisms underlying impaired growth and aflatoxin exposure are still unclear but intestinal function damage, reduced immune function, and alteration in the insulin-like growth factor axis caused by the liver damage are the suggested hypotheses. Given the fact that both aflatoxin and child undernutrition are common in sub-Saharan Africa, effective interventions aimed at reducing undernutrition cannot be satisfactorily achieved until the interactive relationship between aflatoxin and child undernutrition is clearly understood, and an aflatoxin mitigation strategy takes effect in those vulnerable mothers and children.

Seasonal and geographical differences in aflatoxin exposures in Senegal

The aim of the study was to determine the geographical and seasonal variations in aflatoxin dietary exposure levels in adults from Senegal. A total of 168 adults (50% male) were recruited from three districts: Nioro du Rip (n=90), located in the Sudan Savannah agro-ecological zone where rainfall is sufficient for groundnut growth; Saint-Louis (n=40) and Mboro (n=38), located in the Sahel zone where groundnuts are produced under irrigated conditions. Diet information and samples were collected at groundnut harvest and post-harvest seasons. Plasma aflatoxin-albumin adducts (AF-alb) and total aflatoxin in household groundnut samples were measured by ELISA and a quantitative thin layer chromatography method, respectively. The blood AF-alb geometric mean was 45.7 pg/mg albumin (range 5.5-588.2 pg/mg). Nioro du Rip had a higher AF-alb level at harvest than Saint-Louis and Mboro (80.0 vs 15.6 and 33.3 pg/mg, P<0.001). Similar trends were observed at post-harvest (P<0.05). Seasonal trends were not consistent acro...

Meat consumption trends and relationship with body composition measurements in adolescents and young adults: the Northern Ireland Young Hearts Project

S. Watson, S. Brennan, J.V. Woodside, M. Cantwell, C.A. Boreham, C.E. Neville, Y.Y. Gong and G.J. Cuskelly Institute for Global Food Security, School of Biological Sciences, Queen’s University Belfast, Belfast BT9 5BN, UK, Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast BT12 6BA, UK and Institute for Sport and Health, University College Dublin, Dublin, Republic of Ireland

Association between sleep, eating behaviours, cardiovascular risk factors and emotional states in an overweight sample

A relationship between obesity and poor sleep quality has been well documented in the literature. Both conditions can, independently, have detrimental effects on physical and mental well being. Few studies have examined both conditions simultaneously in relation to other parameters of health and behaviour. The objective of this study was to examine the association between sleep quality, eating behaviours, cardiovascular disease (CVD) risk factors and emotional states in an overweight/obese sample of adults (median age 52.0 years). The analyses are based on data collected from 62 (29 males and 33 females) overweight and obese participants recruited for a webbased weight loss study. Sleep quality was measured by the Pittsburgh Sleep Quality Index (PSQI); eating behaviours were measured by the Dutch Eating Behaviour Questionnaire (DEBQ); emotional state was measured by the Depression, Stress and Anxiety scale (DASS-21); self esteem was measured by the Rosenberg Self Esteem scale and quality of life was assessed by the Impact of Weight on Quality of Life scale (IWQOL). Measured CVD risk factors included body mass index (BMI), waist hip ratio (WHR), body fat %, blood pressure and pulse wave velocity (PWV). PSQI score was significantly correlated with emotional eating (r = 0.41, P = 0.001), QOL (r = 0.43, P = 0.001), self esteem (r = 0.56, P = <0.001), depression (r = 0.62, P = <0.001), stress (r = 0.43, P = <0.001) and anxiety (r = 0.36, P = 0.004). As shown in the table below, participants with poor sleep quality, compared to those with good sleep quality, were more likely to report higher levels of stress, anxiety and depression, have a lower self esteem and QOL score and were more likely to eat in response to their emotions and external influences. There was no significant association between CVD risk factors and sleep quality, with the exception of PWV which was significantly higher in good sleepers. A trend towards increased body fat % in poor sleepers compared to good sleepers was observed (P = 0.06). Chi-square tests were used to examine the occurrence of the risk factors listed below with the occurrence of poor sleep quality. Participants with poor sleep quality were significantly more likely to be classified as being depressed (c = 19.8, df = 1, P = <0.001), stressed (c = 7.7, df = 1, P = 0.006) and having low self esteem (c = 5.0, df = 1, P = 0.04).