Sophie Desroches

Assessments of the extent to which health-care providers involve patients in decision making: a systematic review of studies using the OPTION instrument.

We have no clear overview of the extent to which health‐care providers involve patients in the decision‐making process during consultations. The Observing Patient Involvement in Decision Making instrument (OPTION) was designed to assess this.

Lack of effect of dietary conjugated linoleic acids naturally incorporated into butter on the lipid profile and body composition of overweight and obese men

BACKGROUND Dietary conjugated linoleic acid (CLA) is known to reduce atherosclerosis, plasma total and LDL-cholesterol concentrations, and body fat accumulation in several animal species. Of the few studies that investigated the effects of CLA supplementation in humans, all used commercially formulated oral supplements made from a mixture of CLA isomers. OBJECTIVE We compared the effects on plasma lipoproteins and body composition of the consumption of a modified butter naturally enriched with CLA (CLA-B: 4.22 g CLA/100 g butter fat) by the addition of sunflower oil to the diet of dairy cows with the consumption of a control butter (CON-B) that was low in CLA (0.38 g CLA/100 g butter fat). DESIGN In a crossover design study including an 8-wk washout period, 16 men [x +/- SD age: 36.6 +/- 12.4 y; body mass index (in kg/m2): 31.2 +/- 4.4] were fed each of the 2 experimental isoenergetic diets, providing 15% of energy as protein, 45% as carbohydrates, and 40% as lipids, of which >60% was derived from experimental fats, for 4 wk. RESULTS Consumption of the CLA-B diet induced a significantly (P < 0.05) smaller reduction in plasma total cholesterol and in the ratio of total to HDL cholesterol (-0.02 mmol/L and -0.00, respectively) than did consumption of the CON-B diet (-0.26 mmol/L and-0.34, respectively). Abdominal adipose tissue area measured by computed tomography showed no difference in accumulation of either visceral or subcutaneous adipose tissue after the 2 experimental diets. CONCLUSION These results suggest that a 10-fold CLA enrichment of butter fat does not induce beneficial metabolic effects in overweight or obese men.

Effect of the mediterranean diet with and without weight loss on markers of inflammation in men with metabolic syndrome

Intervention studies on the Mediterranean Diet (MedDiet) have often led to weight loss, which may have contributed to the purported anti‐inflammatory effects of the MedDiet. To investigate the impact of the MedDiet consumed under controlled feeding conditions before (−WL) and after weight loss (+WL) on markers of inflammation in men with metabolic syndrome (MetS).

Advancing theories, models and measurement for an interprofessional approach to shared decision making in primary care: a study protocol.

BackgroundShared decision-making (SDM) is defined as a process by which a healthcare choice is made by practitioners together with the patient. Although many diagnostic and therapeutic processes in primary care integrate more than one type of health professional, most SDM conceptual models and theories appear to be limited to the patient-physician dyad. The objectives of this study are to develop a conceptual model and propose a set of measurement tools for enhancing an interprofessional approach to SDM in primary healthcare.Methods/DesignAn inventory of SDM conceptual models, theories and measurement tools will be created. Models will be critically assessed and compared according to their strengths, limitations, acknowledgement of interprofessional roles in the process of SDM and relevance to primary care. Based on the theory analysis, a conceptual model and a set of measurements tools that could be used to enhance an interprofessional approach to SDM in primary healthcare will be proposed and pilot-tested with key stakeholders and primary healthcare teams.DiscussionThis study protocol is informative for researchers and clinicians interested in designing and/or conducting future studies and educating health professionals to improve how primary healthcare teams foster active participation of patients in making health decisions using a more coordinated approach.

Impact of dairy products on biomarkers of inflammation: a systematic review of randomized controlled nutritional intervention studies in overweight and obese adults

BACKGROUND Recent data from cross-sectional studies suggest that consumption of dairy products is inversely associated with low-grade systemic inflammation, but a cause-and-effect relation can be confirmed only with results from randomized controlled trials. OBJECTIVE We reviewed the results of randomized controlled nutritional intervention studies that have assessed the impact of dairy product consumption (ie, milk, yogurt, and/or cheese) on biomarkers of inflammation in adults (aged ≥18 y). DESIGN We performed a systematic literature search in PubMed in April 2012, which was limited to randomized controlled trials in humans published in English. Studies that included pregnant or lactating women or that did not include a low-dairy control intervention were excluded. RESULTS Eight trials that were conducted in overweight or obese adults were included in the review. The only study that had identified change in the inflammatory profile as its primary outcome measure showed that dairy food consumption improved pro- and antiinflammatory biomarker concentrations compared with the low-dairy control diet. Three of the 7 studies in which inflammation was a secondary or undefined outcome showed improvement in key inflammatory biomarkers, ie, C-reactive protein, IL-6, or TNF-α after dairy product consumption, whereas the other 4 studies showed no effect. CONCLUSIONS Dairy product consumption does not exert adverse effects on biomarkers of inflammation in overweight or obese adults. Several methodologic factors and limitations among existing studies do not allow differentiation between a beneficial or neutral impact of dairy products on inflammation. Further studies specifically designed to assess inflammation-related outcomes are warranted.

Combined effects of a dietary portfolio of plant sterols, vegetable protein, viscous fibre and almonds on LDL particle size.

Studies conducted in the last 20 years have led to the identification of small dense LDL as an important risk factor for CVD. Consumption of plant sterols, soyabean proteins, viscous fibre and nuts are known to modulate the risk of CVD favourably through their cholesterol (Chol)-lowering properties, both independently and more recently in combination. Nevertheless, their combined impact on the LDL particle size phenotype has never been tested. In the present study, we assessed the effect of incorporating concurrently plant sterols (1 g/4.2 MJ), soyabean protein (23 g/4.2 MJ), viscous fibre (9 g/4.2 MJ) and almonds (15 g/4.2 MJ) into a diet very low in saturated fat in twelve patients with mildly elevated plasma LDL-Chol levels. Fasting blood lipids were obtained at the start of the study and at 2-week intervals during the 4-week study. The diet-induced reduction in plasma LDL-Chol of 30.0 (se 3.0) % (P<0.0001) was attributed to concurrent reductions in the serum Chol concentrations of large (>26.0 nm-30 (se 8) %, P<0.001), medium (25.5-26.0 nm-29 (se 3) %, P<0.001) and small (<25.5 nm-21 (sd 6) %, P<0.01) LDL particles, with near maximal reductions seen by week 2. These results indicate that foods and dietary components advocated for their potential to reduce the risk of CVD are effective in reducing serum concentrations of all LDL fractions including small dense LDL, thus potentially further contributing to an overall lower risk of CVD.

Effect of the Mediterranean diet with and without weight loss on cardiovascular risk factors in men with the metabolic syndrome

BACKGROUND AND AIMS No study has yet examined how weight loss modifies the impact of the Mediterranean diet (MedDiet) on cardiovascular risk factors in men with the metabolic syndrome (MetS). The objective of the study was to assess the efficacy of MedDiet, with and without weight loss, to modify the cardiometabolic risk profile of male patients with MetS. METHODS AND RESULTS Twenty-six men aged between 24 and 62 years with the MetS consumed a North American control diet for 5 weeks followed by a 5-week MedDiet, both under weight-maintaining conditions. Participants then underwent a 20-week weight loss period, after which they consumed the MedDiet for five weeks under weight stable conditions. Body weight was reduced by 10.2% ± 2.9% after the weight loss period (p < 0.001). All foods were provided to participants during the weight stable phases of the study. The MedDiet in the absence of weight loss decreased total plasma cholesterol (C) (-7.1%), LDL-C (-9.3%) and the total/HDL-C ratio (-6.5%) compared to the control diet (all p < 0.04). The MedDiet combined with weight loss led to reductions in systolic blood pressure (-4.7%), diastolic blood pressure (-7.7%), triglycerides (-18.2%), ApoB (-10.7%), fasting glucose (-4.2%) and insulin (-29.9%) compared to the control diet (all p < 0.001). CONCLUSION The MedDiet in the absence of weight loss leads to significant changes in plasma cholesterol concentrations but has little effects on other cardiometabolic risk factors associated with the MetS in men.

Systematic Review of the Association between Dairy Product Consumption and Risk of Cardiovascular-Related Clinical Outcomes

The objective of this systematic review was to determine if dairy product consumption is detrimental, neutral, or beneficial to cardiovascular health and if the recommendation to consume reduced-fat as opposed to regular-fat dairy is evidence-based. A systematic review of meta-analyses of prospective population studies associating dairy consumption with cardiovascular disease (CVD), coronary artery disease (CAD), stroke, hypertension, metabolic syndrome (MetS), and type 2 diabetes (T2D) was conducted on the basis of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Quality of evidence was rated by using the Grading of Recommendations Assessment, Development, and Evaluation scale. High-quality evidence supports favorable associations between total dairy intake and hypertension risk and between low-fat dairy and yogurt intake and the risk of T2D. Moderate-quality evidence suggests favorable associations between intakes of total dairy, low-fat dairy, cheese, and fermented dairy and the risk of stroke; intakes of low-fat dairy and milk and the risk of hypertension; total dairy and milk consumption and the risk of MetS; and total dairy and cheese and the risk of T2D. High- to moderate-quality evidence supports neutral associations between the consumption of total dairy, cheese, and yogurt and CVD risk; the consumption of any form of dairy, except for fermented, and CAD risk; the consumption of regular- and high-fat dairy, milk, and yogurt and stroke risk; the consumption of regular- and high-fat dairy, cheese, yogurt, and fermented dairy and hypertension risk; and the consumption of regular- and high-fat dairy, milk, and fermented dairy and T2D risk. Data from this systematic review indicate that the consumption of various forms of dairy products shows either favorable or neutral associations with cardiovascular-related clinical outcomes. The review also emphasizes that further research is urgently needed to compare the impact of low-fat with regular- and high-fat dairy on cardiovascular-related clinical outcomes in light of current recommendations to consume low-fat dairy.

A conceptual framework for interprofessional shared decision making in home care: Protocol for a feasibility study

BackgroundShared decision making (SDM) is fundamental to informed consent and client-centered care. So far, SDM frameworks have been limited to the client-physician dyad, even though care is increasingly delivered by interprofessional (IP) teams. IP collaboration is especially essential in home care, one of health cares most rapidly growing areas. This study will assess whether it is possible to practice SDM in IP home care.Methods/DesignWe will use a qualitative case study and a quantitative survey to capture the macro, meso and micro levels of stakeholders in home care. The case study will follow the knowledge-to-action process framework to evaluate the work of an IP home care team at a Quebec City health center. Sources of data will include one-on-one interviews with patients, family caregivers or surrogates and significant others, and administrators; a focus group of home care health professionals; organizational documents; and government policies and standards. The interview guide for the interviews and the focus group will explore current practices and clinical problems addressed in home care; factors that could influence the implementation of the proposed IP approach to SDM; the face and content validity of the approach; and interventions to facilitate the implementation and evaluation of the approach. The survey will ask 300 health professionals working in home care at the health center to complete a questionnaire based on the Theory of Planned Behaviour that measures their intentions to engage in an IP approach to SDM. We will use our analysis of the individual interviews, the focus group and the survey to elaborate a toolkit for implementing an IP approach to SDM in home care. Finally, we will conduct a pilot study in Alberta to assess the transferability of our findings.DiscussionWe believe that developing tools to implement IP SDM in home care is essential to strengthening Canadas healthcare system and furthering patient-centered care. This study will contribute to the evaluation of IP SDM delivery models in home care. It will also generate practical, policy-oriented knowledge regarding the barriers and facilitators likely to influence the practice of IP SDM in home care.

Apolipoprotein A-I, A-II, and VLDL-B-100 metabolism in men: comparison of a low-fat diet and a high-monounsaturated fatty acid diet

The impact of a low-fat diet and a high-MUFA diet on apolipoprotein A-I (apoA-I), apoA-II, and VLDL-apoB-100 metabolism in conditions of unrestricted (ad libitum) energy intake was compared in 65 men randomly assigned to one of two predefined experimental diets. A subsample of 18 men participated in the kinetic study. Before and after the 6–7 week dietary intervention, kinetic subjects received a primed-constant infusion of [5,5,5-2H3]l-leucine for 12 h under feeding conditions. ApoA-I production rate (PR; −31.5%; P < 0.001) and fractional catabolic rate (FCR; −24.3%; P < 0.05) were significantly decreased after the low-fat diet. These changes in apoA-I PR and FCR with the low-fat diet were also significantly different from those observed with the high-MUFA diet (P < 0.01 and P < 0.05, respectively). ApoA-II FCR was significantly increased in the high-MUFA group only. No significant within- or between-diet difference was found in VLDL-apoB-100 PR or FCR. These results emphasize the differential impact of the low-fat diet and high-MUFA diet on HDL metabolism.