Developing and implementing a new methodology to test the affordability of currently popular weight loss diet meal plans and healthy eating principles

Background Weight loss diets continue to rise in popularity; however, the associated costs are seldom reported. Certain weight loss diets may be unaffordable and differ from their traditional nutrition composition to include non-conventional premium products. In contrast, healthy eating principles such as the Australian Guide to Healthy Eating (AGHE) and the Mediterranean Diet (MedDiet) place an emphasis on fresh produce and staple foods but are sometimes thought to be unaffordable. A new methodology was piloted to assess the cost of weight loss diets using seven meal plans. Methods Seven meal plans were analysed to quantify the absolute grams required of all ingredients across seven days and multiplied by the cost of the ingredient per gram to determine the total cost of each ingredient based on unit size and price. The weekly grocery shopping cost was determined through summation of all ingredients and their entire unit size to compare weekly costs. Results Weekly meal plans (absolute grams) cost between $93-193AUD. The AGHE meal plan was the least expensive and 8 Weeks to Wow was the most expensive. Weekly grocery shopping of entire units cost between $345-$625AUD, over $100AUD greater than the spending of an average Australian ($237AUD/week). Conclusions The financial feasibility for long-term sustainment of weight loss diets may be questionable for groups including low-income earners and low socioeconomic status. Further, when dietary patterns are adapted for weight loss, or followed by consumers, deviations from foundational principles tend to occur which may influence overall cost.

Changes in the nutritional profile of medicine students during the COVID-19 pandemic period and its correlation with anxiety: a prospective cross-sectional observational study

Introduction: Pandemics cause strong social, economic, and political impacts. Social isolation to reduce the virus’ impact and to retard the health system breakdown caused by SARS-Cov-2 have affected the population’s lifestyle, including medical students. Objective: Identity which impacts the daily meal plan has the COVID-19’s Pandemic caused in medical students; Correlate data obtained in different grades of the medical course and present the nutritional profile of the students, who attended the study. Methods: Survey realized in students of a private medical course in the São Paulo northwestern region, with a questionary containing open questions and tests, sent online in conjunction with the Term of Consent. This study was analyzed and approved by the Research Ethics Committee according to a substantiated opinion number 4.373.785, and obtaining the patient's consent through the Informed Consent Form. Results: 117 students, between the 1st and 4th grade of the course, have attended the following study, 75 female, 42 male, allocated in similar proportions in the 4 initial grades of the course, ages between 17 and 31 years old; Most of the students feel more anxiety (78,6%), associated with changes in the nutritional profile, with the increase of high-energy food, highlighted by the bigger propension of this group to the consumption of sweets and white-wheat pasta in the daily meal plan. It is important to notice that many other food groups have suffered an enhancement in consumption as well, such as legumes, dried meat, vegetal oil, olive oil, and greenery. Conclusion: The COVID-19 Pandemic brought impacts to the daily meal plan of the medical students, especially in the ones who feel more anxious. The enhancement of the daily consumption of food by the medical students is notable, in the most diverse food classifications. However, it is concluded in this study that it cannot be said that anxiety and/or self-declared stress is a risk factor for the increase in food consumption observed, as well as a pattern of its impacts on the students' food, cannot be defined.

Tackling constipation in patients on high dose antipsychotics

AimsThe aim of this audit was to look into patients on high dose antipsychotics who had developed complications of constipation in the PICU setting .BackgroundAntipsychotics are usually used in the treatment of Schizophrenia and other psychotic illnesses. Drug such as Clozapine mainly has a higher risk profile due to gastrointestinal hypo motility. It could present as constipation, fecal impaction or a bowel obstruction and could even lead to death.MethodDuring ward rounds enquired on bowel habits and diet.Physical examination of patients complaining of abdominal pain.Screened notes in past to see how many patients complained of constipation and interventions suggested and used.I65.Result3 of the 10 patients on PICU were on high dose antipsychotics and 2 of them had reported constipation. Of which one required daily review and vigorous treatment with laxatives and dietary changes.RecommendationBristol stool chart introduced as part of care plan for all patients.Teaching presentation of constipation and its treatment management was given to the PICU team.Involving medical team early on for assessment and prophylactic laxatives prescription.Liaison with the pantry team to include more options of fruits and vegetables into daily meal plan for patients.Data and material handed over to next trainee to Re-audit and complete audit cycle.ConclusionAppropriate prevention and early management of side effects can enhance the benefits of antipsychotics. Bowel function monitoring and the use of prophylactic laxatives for patient on high dose antipsychotics such as clozapine is advisable to prevent complications related to it.

A Mediterranean Meal Plan Modulates Human Milk Composition in Women With Obesity

Objectives Human milk (HM) is impacted by both maternal obesity and diet. HM from women with obesity has higher fat, leptin and insulin concentrations. Additionally, maternal dietary fat intake is associated with increased HM fat content. The objective of this study was to determine the impact of a Mediterranean meal plan on the composition of HM from women with obesity. Methods In this pilot study, thirteen women with obesity (body mass index (BMI) ≥ 30 kg/m2) enrolled at five months post-partum and followed a provided Mediterranean meal plan focused on reducing fat intake and increasing unsaturated fat and fiber intake for four weeks. Participants’ diet was assessed using Nutrition Data System for Research. HM was collected at baseline and after the 4-week intervention and the concentrations of metabolites, hormones and cytokines were assayed. Wilcoxon signed-rank tests and analysis of variance were used to assess changes in participant diet and HM composition. Summary statistics are presented as mean ± standard deviation. Results The participants’ Healthy Eating Index Score, a measure of diet quality, significantly improved (38.3 ± 5.13 vs. 78.2 ± 6.75, p < 0.001) and total fat intake was significantly lower (99.6 ± 23.3 g vs. 66.9 ± 12.0 g/day, p < 0.001) after the intervention. Human milk leptin (694 ± 464 pg/ml vs. 437 ± 324 pg/ml, p = 0.007) and tumor necrosis factor α (0.515 ± 0.267 pg/ml vs. 0.310 ± 0.127 pg/ml, p = 0.010) concentrations were lower post intervention, whereas HM macronutrient composition was unchanged. The concentrations of several individual human milk oligosaccharides (HMO) and total HMOs (7720 ± 797 nmol/ml vs. 6986 ± 940 nmol/ml, p = 0.049), as well as HM tyrosine concentration (18.2 ± 6.16 nmol/ml vs. 14.5 ± 4.69 nmol/ml, p = 0.005) were significantly lower post intervention. Conclusions The composition of HM from women with obesity can be modulated by short-term adherence to a Mediterranean meal pattern. These findings merit further studies that use longer interventions and examine the impact of any changes in HM composition on infant growth and development. Modifying HM composition via a dietary intervention may provide a novel strategy to promote child development and health. Funding Sources USDA ARS #6026-51,000-010-05S and #6026-51,000-012-06S, NIH/NIDDK R01DK107516, Arkansas Children's Research Institute/Arkansas Biosciences Institute GR037121.

Adaptation of a Community-based Type-2 Diabetes Mellitus Remission Intervention During COVID-19: Empowering Persons Living With Diabetes to Take Control

Background: The Barbados Diabetes Remission Study-2 reported that a community-based low-calorie diet (LCD) for weight loss and diabetes remission was both an acceptable implementation strategy and a clinically effective intervention. This study aimed to examine the adaptability of the face-to-face BDRS-2 protocol into an online modality.Methods: The Iterative Decision‐making for Evaluation of Adaptations framework questions the necessity of the adaptation and the preservation of core elements of the intervention during the adaptation process – these elements were identified as the 12-week intervention duration, weekly monitoring of participants for change in weight and fasting blood glucose and daily 840kcal allowance. The adaptation outcomes were documented using the framework for reporting adaptations and modifications to evidence-based interventions. Implementation effectiveness was determined by fidelity to core intervention elements. Intervention effectiveness was determined from the analysis of clinical data.Results: We decided that an adaptation was needed as the COVID-19 measures to control transmission prohibited in-person interactions, and that key elements of the intervention could be preserved during the adaptation process. Adaptations were made to the following: (1) The context in which the data was collected: participants self-measured at home instead of being measured by community health advocates (CHA) at a community site. (2) The context in which the data was entered: participants first posted their measurements to a mobile application site which was accessible by the CHAs. As with the original protocol, CHAs then entered the measurements into an online database. (3) The formulation of the LCD: participants substituted the liquid formulation for a solid meal plan of equivalent caloric content. There was increased fidelity to the attendance schedule with the online format (1 incomplete entry out of 45 entries), as compared to the face-to-face modality (1 absence out of 20 visits). Regarding the solid meal plan, 1 participant logged difficultly averaging non-exact potion sizes. Weight change ranged from -14.3kgs to 0.4kgs over the 12-week period and all group members achieved induction of diabetes remission. Conclusion: Larger studies are needed to confirm that this adapted online protocol is both acceptable and clinically effective while maintaining fidelity to key elements of the original protocol.Trial Registration: NCT03536377 registered 24th May 2018 at https://clinicaltrials.gov/ct2/show/NCT03536377

Refeeding Patients with Moderate and Severe Eating Disorders: A Retrospective Cohort Study

Background: Anorexia Nervosa (AN) is a life-threatening mental illness that can cause significant medical complications, including the potentially fatal refeeding syndrome. Registered dietitians (RDs) are a critical part of an eating disorder multidisciplinary team that focuses treatment on safe weight restoration and nutrition rehabilitation. Method: This study is a description of how the nutrition rehabilitation protocol of 395 adult patients diagnosed with AN and admitted to residential eating disorder treatment is implemented, how the protocol is sustained throughout a patient’s treatment stay to achieve desired weight gain, and how the patients’ biochemical and clinical progress proceeded between admission and discharge, including laboratory results and body mass index (BMI). Results: One hundred twenty-six patients required phosphorus supplementation for refeeding hypophosphatemia (RH); admission BMI was not significantly different between those with and without RH. The 15% of patients who required enteral nutrition at any point during their admission gained significantly less weight than patients who only received an oral meal plan. 34.4% of patients admitted with starvation induced hepatitis, 28.6% experienced refeeding hepatitis at some point, 21.0% of patients had elevated liver function tests 2 weeks into refeeding and 28.6% at discharge. Conclusions: This study demonstrated overall effectiveness in achieving weight restoration goals with aggressive kcal increases without a single incidence of refeeding syndrome and infrequent RH. No significant biochemical changes were observed during refeeding. With close medical supervision and concurrent RD oversight, a refeeding approach with consistent calorie increases that is more aggressive than previously recommended appears to be safe.

Acquired Brain Injury-Induced Hyperphagia and Obesity, Successfully Treated With a GLP-1 Agonist

Background: Several Glucagon-like peptides 1 (GLP-1s) were approved since 2005 for the treatment of DM & obesity. Their usefulness in other conditions is not well studied. We present two cases of hyperphagia after TBI successfully treated with GLP-1 agonists. Clinical cases: Case 1: A 54-year-old female with a history of multiple traumatic brain injuries (multiple falls and a ski accident) complained of years of insatiable hunger leading to hyperphagia and over 20 pounds weight gain. With tremendous will-power, she avoided additional weight gain by adopting a strict meal-plan and increasing her water intake (10–12 liters a day) to relieve her hunger. She sipped so much water, that her sodium remained 123 - 133 mmol/L (ref: 135–146) with dilute urine. Initial tests revealed: IGF-1 315 ng/ml (52–328), FSH 77.5 mIU/ml (23–116.3), LH 24.3 mIU/ml (14.2–52.3), prolactin 17.1 ng.ml (10–54.7), estradiol 17 (<31), TSH 1.09mIU/ml (0.45–4.5), FT4 1.0 ng/dl(0.8–1.8), all within the normal limit for her age. Semaglutide 0.25mg/week was started and increased to 0.5mg/week. Within the first six months of treatment, she experienced 22 pounds of weight loss, hunger relief, less water sipping behavior, and more enjoyment of food. Her sodium rose to 137 mmol/L. Case 2: A 40-year-old female, s/p craniectomy and aneurysm clipping due to intracranial hemorrhage complicated by an ischemic stroke developed sudden, documented, 45-pound weight gain over thirteen months despite aggressive lifestyle modification attempts. Initial labs revealed: TSH 1.33 mIU/ml (0.45–4.5), FT4 1.22 ng/dl (0.8–1.8), midnight salivary cortisol 0.03 mcg/dl (<0.09), ruling out hypothyroidism and Cushing syndrome. Liraglutide 1.8mg/day was started and has resulted to date in 26 pounds (11.8% of maximum weight) by 9 months with an associated decrease in subjective hunger. Conclusion: Hyperphagia can be seen in brain injury, in response to some medications, and some genetic conditions, like Prader-Willi. The exact mechanisms are not clear am may be multifactorial. In the case of brain injury, proposed mechanisms include insatiable hunger due to ventromedial hypothalamic or brain stem dysfunction, or disinhibition and poor impulse control due to frontal lobe injury. GLP-1’s may act on the causal mechanism for increased hunger, or it may result in clinical improvement through a parallel pathway. More studies are warranted to investigate the application of GLP-1’s to hyperphagia.

The Effects of a Low Sodium Meal Plan on Blood Pressure in Older Adults: The SOTRUE Randomized Feasibility Trial

Reduced sodium meal plans are recommended by the Centers of Disease Control to lower blood pressure in older adults; however, this strategy has not been tested in a clinical trial. The Satter House Trial of Reduced Sodium Meals (SOTRUE) was an individual-level, double-blind, randomized controlled pilot study of adults living in a congregate living facility subsidized by the Federal Department of Housing and Urban Development (HUD). Adults over age 60 years ate 3 isocaloric meals with two snacks daily for 14 days. The meal plans differed in sodium density (<0.95 vs. >2 mg/kcal), but were equivalent in potassium and macronutrients. Seated systolic BP (SBP) was the primary outcome, while urine sodium-creatinine ratio was used to measure compliance. Twenty participants were randomized (95% women; 95% white; mean age 78 ± 8 years), beginning in 7 October 2019. Retention was 100% with the last participant ending 4 November 2019. Mean baseline SBP changed from 121 to 116 mmHg with the typical sodium diet (−5 mmHg; 95% CI: −18, 8) and from 123 to 112 mmHg with the low sodium diet (−11 mmHg; 95% CI: −15.2, −7.7). Compared to the typical sodium meal plan, the low sodium meal plan lowered SBP by 4.8 mmHg (95% CI: −14.4, 4.9; p = 0.31) and urine sodium-creatinine ratio by 36% (−36.0; 95% CI: −60.3, 3.4; p = 0.07), both non-significant. SOTRUE demonstrates the feasibility of sodium reduction in federally mandated meal plans. A longer and larger study is needed to establish the efficacy and safety of low sodium meals in older adults.