Zubaida Faridi

Effects of sugar-sweetened and sugar-free cocoa on endothelial function in overweight adults.

BACKGROUND Studies of cocoa suggest an array of cardiovascular benefits; however, the effects of daily intake of sugar-free and sugar-sweetened cocoa beverages on endothelial function (EF) have yet to be established. METHODS 44 adults (BMI 25-35 kg/m2) participated in a randomized, controlled, crossover trial. Participants were randomly assigned to a treatment sequence: sugar-free cocoa beverage, sugar-sweetened cocoa beverage, and sugar-sweetened cocoa-free placebo. Treatments were administered daily for 6 weeks, with a 4-week washout period. RESULTS Cocoa ingestion improved EF measured as flow-mediated dilation (FMD) compared to placebo (sugar-free cocoa: change, 2.4% [95% CI, 1.5 to 3.2] vs. -0.8% [95% CI, -1.9 to 0.3]; difference, 3.2% [95% CI, 1.8 to 4.6]; p<0.001 and sugar-sweetened cocoa: change, 1.5% [95% CI, 0.6 to 2.4] vs. -0.8% [95% CI, -1.9 to 0.3]; difference, 2.3% [95% CI, 0.9 to 3.7]; p=0.002). The magnitude of improvement in FMD after consumption of sugar-free versus sugar-sweetened cocoa was greater, but not significantly. Other biomarkers of cardiac risk did not change appreciably from baseline. BMI remained stable throughout the study. CONCLUSIONS Daily cocoa ingestion improves EF independently of other biomarkers of cardiac risk, and does not cause weight gain. Sugar-free preparations may further augment endothelial function.

Partners reducing effects of diabetes (PREDICT): a diabetes prevention physical activity and dietary intervention through African-American churches

Type 2 diabetes is epidemic in the United States with greater incidence rates in African-American communities. Lifestyle interventions during the phase of insulin resistance mitigate cardiovascular risk and prevent diabetes. The primary aim of this study is to test the impact of a Community Health Advisor (CHA)-based diabetes prevention controlled intervention in urban African-American communities. In this controlled trial, church congregants in New Haven, CT, receiving a 1-year CHA-led diabetes prevention intervention were compared with church congregants in Bridgeport, CT, who did not receive an intervention. Outcome measures included physical activity, dietary pattern, anthropometric measure, social support, diabetes knowledge, nutrition and exercise self-efficacy. The results indicate that at the end of the 1-year intervention period, there were no significant differences observed between intervention and control groups. Possible explanations for the lack of change include difficulty in engaging the CHAs, variability in the CHA-led interventions, baseline discrepancies between the two sites which could not be fully controlled and loss to follow-up. The results indicate important obstacles which impeded the successful implementation of this intervention and lessons learned for future interventions.

The Stratification of Foods on the Basis of Overall Nutritional Quality: The Overall Nutritional Quality Index

Purpose. Consumer understanding of nutrition information is key to making dietary choices consistent with guidelines. The development of an objective, science-based, and universally applicable system of nutrition guidance would be of considerable potential value to the public health. Design. A multidisciplinary expert panel was convened to develop the Overall Nutritional Quality Index (ONQI). Dietary guidelines, existing nutritional scoring systems, and other pertinent scientific literature were reviewed. An algorithm based on the overall nutritional quality of food was developed and subjected to consumer research and validation testing. Results. The ONQI algorithm incorporates over 30 entries representing both micronutrient and macronutrient properties of foods, as well as weighting coefficients representing epidemiologic associations between nutrients and health outcomes. The basic entry in the algorithm is a weighted trajectory score, which compares nutrient concentration in a food to the recommended concentration of a given nutrient in a healthful diet. In content validity testing, ONQI rankings and expert panel rankings correlated highly (R = .92; p < .001). In regression analysis, aggregated ONQI scores for total diet corresponded well with the Healthy Eating Index (p < .001) in the National Health and Nutrient Examination Survey 2003–2006 cohort (n = 15,900). Consumer research indicated strong appeal to consumers of the ONQI system in general, and the scores on a 1 to 100 scale specifically. A system for acquiring nutrient data, meeting U.S. Food and Drug Administration and U.S. Department of Agriculture standards, has been established so that virtually any food, beverage, meal, or recipe can be scored. Conclusions. The ONQI is a sophisticated nutrition guidance system developed by a multidisciplinary group independently of all food industry interests with excellent initial performance in both consumer research and validation testing. Combined with a consumer education program, the ONQI has considerable potential to improve dietary patterns, and consequently the public health. Prospective study of effects on dietary patterns and health outcomes is warranted.

Daily egg consumption in hyperlipidemic adults - Effects on endothelial function and cardiovascular risk

BackgroundLimiting consumption of eggs, which are high in cholesterol, is generally recommended to reduce risk of cardiovascular disease. However, recent evidence suggests that dietary cholesterol has limited influence on serum cholesterol or cardiac risk.ObjectiveTo assess the effects of egg consumption on endothelial function and serum lipids in hyperlipidemic adults.MethodsRandomized, placebo-controlled crossover trial of 40 hyperlipidemic adults (24 women, 16 men; average age = 59.9 ± 9.6 years; weight = 76.3 ± 21.8 kilograms; total cholesterol = 244 ± 24 mg/dL). In the acute phase, participants were randomly assigned to one of the two sequences of a single dose of three medium hardboiled eggs and a sausage/cheese breakfast sandwich. In the sustained phase, participants were then randomly assigned to one of the two sequences of two medium hardboiled eggs and 1/2 cup of egg substitute daily for six weeks. Each treatment assignment was separated by a four-week washout period. Outcome measures of interest were endothelial function measured as flow mediated dilatation (FMD) and lipid panel.ResultsSingle dose egg consumption had no effects on endothelial function as compared to sausage/cheese (0.4 ± 1.9 vs. 0.4 ± 2.4%; p = 0.99). Daily consumption of egg substitute for 6 weeks significantly improved endothelial function as compared to egg (1.0 ± 1.2% vs. -0.1 ± 1.5%; p < 0.01) and lowered serum total cholesterol (-18 ± 18 vs. -5 ± 21 mg/dL; p < 0.01) and LDL (-14 ± 20 vs. -2 ± 19 mg/dL; p = 0.01). Study results (positive or negative) are expressed in terms of change relative to baseline.ConclusionsEgg consumption was found to be non-detrimental to endothelial function and serum lipids in hyperlipidemic adults, while egg substitute consumption was beneficial.

A Pilot Study of Chromium Picolinate for Weight Loss

BACKGROUND Chromium is an essential trace element and nutritional supplement that has garnered interest for use as a weight loss aid. OBJECTIVE This trial assesses the effects of chromium picolinate supplementation, alone and combined with nutritional education, on weight loss in apparently healthy overweight adults. DESIGN This was a randomized, double-blind, placebo-controlled trial of 80 otherwise healthy, overweight adults assessed at baseline for central adiposity measured by computerized tomography. Subjects were randomly assigned to daily ingestion of 1000 microg of chromium picolinate or placebo for 24 weeks. All subjects received passive nutritional education at the 12-week point in both the intervention and control groups. Outcomes include weight, height, blood pressure, percent body fat, serum, and urinary biomarkers. RESULTS At baseline, both the chromium and placebo groups had similar mean body mass index (BMI) (chromium = 36 +/- 6.7 kg/m(2) versus placebo = 36.1 +/- 7.6 kg/m(2); p = 0.98). After 12 weeks, no change was seen in BMI in the intervention as compared to placebo (chromium = 0.3 +/- 0.8 kg/m(2) versus placebo = 0.0 +/- 0.4 kg/m(2); p = 0.07). No change was seen in BMI after 24 weeks in the intervention as compared to placebo (chromium = 0.1 +/- 0.2 kg/m(2) versus placebo = 0.0 +/- 0.5 kg/m(2); p = 0.81). Variation in central adiposity did not affect any outcome measures. CONCLUSIONS Supplementation of 1000 microg of chromium picolinate alone, and in combination with nutritional education, did not affect weight loss in this population of overweight adults. Response to chromium did not vary with central adiposity.

Impediment Profiling for Smoking Cessation: Application in the Worksite

Purpose. To replicate results of a pilot smoking cessation study and demonstrate applicability to a worksite setting. Methods. Smokers employed by a community hospital participated in an onsite smoking cessation program. Participants used an “impediment profiling” instrument to rate personal barriers to cessation and were assigned to between one and seven interventions. Cessation was defined as carbon monoxide concentration in expired air of ≤ 10 ppm. Results. Fifty-one employees participated. Subjects lost to follow-up were assumed to be smoking, resulting in a 39.2% 1-year quit rate; 47.5% of program completers (n = 40) were smoke-free at 1 year. Self-reported quit rate at 2.5 years was 25.5% (17 lost to attrition assumed to be smoking) with 38.2% of program completers smoke-free. Discussion. This study suggests that impediment profiling holds promise for smoking cessation and demonstrates feasibility in a worksite setting. Further evaluation of this intervention in the context of randomized controlled trials is warranted.

Health Care System Approaches to Obesity Prevention and Control

A health care system may be one of those things that we know when we see, but have a hard time defining. Challenges in defining the scope of the health care system have long been noted (Rodwin, 1990). It has been suggested by some that such systems encompass all societal activities designed to protect or restore health; others have suggested a more limited definition, related expressly to medical care but interacting with heredity, lifestyle and environmental influences. Defined narrowly or broadly, the health care system represents an array of resources and activities with considerable potential to influence healthrelated behavioral patterns and outcomes over time. This is of course germane to the challenge of obesity prevention and control, which is ultimately a matter of dietary and activity patterns over the course of a lifetime. The role of the health care system in weight management has obvious implications for other conditions, including the most prevalent chronic diseases in our society – cardiovascular diseases, diabetes mellitus, cancer, arthritis – which represents an incomplete list of the potential metabolic sequelae of obesity. Obesity and overweight are among the most common conditions seen in adult primary care, and are increasingly prevalent in pediatric and adolescent patients (Hedley et al., 2004; M. Noel et al., 1998a; O’Brien et al., 2004; Ogden et al., 2006). The number of children in the United States who are overweight has tripled over the last two decades. Also, despite a conservative definition of overweight, at least 15% (over 9 million) of children aged 6–19 years are considered overweight (Grundy, 2000; Hassink, 2003; Richard, 2003). Independent of any other considerations, the epidemiology of obesity makes weight management efforts by the health care system a priority. Health care efforts directed toward weight management (implying both obesity prevention and control) should be universal and anticipatory, meaning prevention-oriented. While there is certainly a place in obesity management for various specialists (e.g., endocrinologists, cardiologists, etc.), obesity prevention is largely a task for primary care providers, including the disciplines of pediatrics, family practice, obstetrics and gynecology, and internal medicine Chapter 14