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Nutrients
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Dietary Interventions: From Development to Assessment of Efficacy and Effectiveness
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Dietary Interventions: From Development to Assessment of Efficacy and Effectiveness

A special issue of Nutrients (ISSN 2072-6643).

Deadline for manuscript submissions: closed (31 July 2019) | Viewed by 101831

Special Issue Editor

Dr. Angeliki Papadaki

E-Mail Website
Guest Editor
Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol BS8 1TZ, UK
Interests: dietary patterns; Mediterranean diet; public health nutrition; traditional diets
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue of Nutrients, entitled “Dietary Interventions: From Development to Assessment of Efficacy and Effectiveness”, welcomes the submission of manuscripts describing either original, quantitative or qualitative, research or systematic reviews and meta-analyses of dietary interventions. Manuscripts can focus on primary, secondary or tertiary prevention. Studies in a variety of population groups (defined by age, socioeconomic status, etc) and dietary components (dietary patterns, foods and nutrients), and those conducted in both research settings (evaluating efficacy) and under ‘real-world’ conditions (evaluating effectiveness) will be considered.

Potential topics may include, but are not limited to:

  • Interventions, including randomised, non-randomised and pilot/feasibility controlled trials and pre and post studies, that evaluate dietary programmes to improve dietary behaviours and/or health outcomes (from risk factors to chronic disease endpoints)
  • Studies investigating components of effective dietary interventions (e.g., with regards to methods of intervention delivery, intensity of treatment, etc)
  • Methodologies for the assessment of dietary compliance in interventions
  • Methodologies for the assessment of adherence and retention in dietary interventions
  • Process evaluation of dietary interventions
  • Formative research (qualitative or quantitative), with a clear focus on its use to inform dietary intervention development
  • Qualitative research, with a clear focus on its use to inform dietary intervention development or dietary intervention evaluation
  • Use of behaviour change taxonomies to inform or evaluate dietary interventions
  • Systematic reviews and meta-analyses of dietary interventions and health outcomes

Dr. Angeliki Papadaki
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Dietary intervention
  • Chronic disease
  • Prevention
  • Intervention development
  • Intervention evaluation
  • Dietary behaviour change

Published Papers (15 papers)

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Research

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14 pages, 1118 KiB  
Article
Effectiveness of the Diabetes Prevention Program for Obesity Treatment in Real World Clinical Practice in a Middle-Income Country in Latin America
by Brianda Armenta-Guirado, Teresita Martínez-Contreras, Maria C. Candia-Plata, Julián Esparza-Romero, Raúl Martínez-Mir, Michelle M. Haby, Mauro E. Valencia and Rolando G. Díaz-Zavala
Nutrients 2019, 11(10), 2324; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11102324 - 01 Oct 2019
Cited by 8 | Viewed by 6495
Abstract
The Diabetes Prevention Program (DPP) is effective for the prevention of type 2 diabetes by weight loss with diet and physical activity. However, there is little evidence as to whether this program could be translated into real-world clinical practice in Latin American countries. [...] Read more.
The Diabetes Prevention Program (DPP) is effective for the prevention of type 2 diabetes by weight loss with diet and physical activity. However, there is little evidence as to whether this program could be translated into real-world clinical practice in Latin American countries. The objective of this work was to evaluate the effectiveness of the DPP for the management of overweightness and obesity at 6 and 12 months in clinical practice in Mexico. This was a non-controlled intervention study implemented in five public clinics in northern Mexico. Two hundred and thirty-seven adults aged 45.7 ± 9.9 years with a Body Mass Index (BMI) of 34.4 ± 5.4 kg/m2 received group sessions with an adaptation of the DPP, in addition to nutrition counseling. One hundred and thirty-three (56%) participants concluded the 6 month phase. They showed a significant weight loss, ranging from 2.76 ± 4.76 to 7.92 ± 6.85 kg (p ≤ 0.01) in the clinics. The intention-to-treat analysis showed a more conservative weight loss. Participant retention at the end of 12 months was low (40%). The implementation of the DPP in different public clinics in Mexico was effective in the management of obesity in the short term, but better strategies are required to improve participant retention in the long term. Full article
(This article belongs to the Special Issue Dietary Interventions: From Development to Assessment of Efficacy and Effectiveness)
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19 pages, 907 KiB  
Article
Food Safety Knowledge, Attitudes, and Practices of Brazilian Food Truck Food Handlers
by Lígia Isoni Auad, Verônica Cortez Ginani, Elke Stedefeldt, Eduardo Yoshio Nakano, Aline Costa Santos Nunes and Renata Puppin Zandonadi
Nutrients 2019, 11(8), 1784; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11081784 - 02 Aug 2019
Cited by 29 | Viewed by 7954
Abstract
This study aimed to (i) compare the food safety knowledge, attitudes, and self-reported practices (KAP) and observed food safety practices of food truck (FT) food handlers, (ii) evaluate the microbiological quality of food and water samples collected from these vehicles, and (iii) establish [...] Read more.
This study aimed to (i) compare the food safety knowledge, attitudes, and self-reported practices (KAP) and observed food safety practices of food truck (FT) food handlers, (ii) evaluate the microbiological quality of food and water samples collected from these vehicles, and (iii) establish a score classification for the KAP instrument according to the food contamination probability assessment. This study was conducted in three stages with 40 food truck food handlers conveniently sampled in the Federal District, Brazil, through structured interviews, application of an observational checklist for the assessment of handlers’ practices and the collection of food and water samples for determination of microbiological quality. FTs that are likely to exhibit food contamination and are at a high risk of foodborne diseases if at least one of the following situations occur: (1) if a food handler scores ≤6 in the knowledge section; (2) if a food handler scores ≤5 in the attitudes section; or (3) if a food handler scores ≤6 in the self-reported practices section. On the other hand, FTs in which handlers score higher than the cutoff points in all the sections are unlikely to exhibit food contamination and are at a low risk of foodborne diseases. The findings of this study are the first step to understand food handlers’ point of view and the initial diagnosis to guide educational strategies in the FT sector. Full article
(This article belongs to the Special Issue Dietary Interventions: From Development to Assessment of Efficacy and Effectiveness)
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11 pages, 1279 KiB  
Article
Assessing the Lifetime Cost-Effectiveness of Low-Protein Infant Formula as Early Obesity Prevention Strategy: The CHOP Randomized Trial
by Diana Sonntag, Freia De Bock, Martina Totzauer and Berthold Koletzko
Nutrients 2019, 11(7), 1653; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11071653 - 19 Jul 2019
Cited by 4 | Viewed by 4247
Abstract
Background: Although there is a growing number of early childhood obesity prevention programs, only a few of them are effective in the long run. Even fewer reports exist on lifetime cost-effectiveness of early prevention strategies. This paper aimed to assess the lifetime cost-effectiveness [...] Read more.
Background: Although there is a growing number of early childhood obesity prevention programs, only a few of them are effective in the long run. Even fewer reports exist on lifetime cost-effectiveness of early prevention strategies. This paper aimed to assess the lifetime cost-effectiveness of infant feeding modification aiming at reducing risk of later obesity. Methods: The simulation model consists of two parts: (a) Model I used data from the European Childhood Obesity Project (CHOP) trial (up to 6 years) and the German Interview and Examination Survey for Children (KiGGS) (6–17 years) to evaluate BMI trajectories of infants receiving either lower protein (LP) or higher protein (HP) content formula; and (b) Model II estimated lifetime cost-effectiveness based on Model I BMI trajectories. Compared to HP formula, LP formula feeding would incur lower costs that are attributable to childhood obesity across all decades of life. Results: Our analysis showed that LP formula would be cost-effective in terms of a positive net monetary benefit (discounted 3%) as an obesity prevention strategy. For the 19% of infants fed with formula in Germany, the LP strategy would result in cost savings of € 2.5 billion. Conclusions: Our study is one of the first efforts to provide much-needed cost-effectiveness evidence of infant feeding modification, thereby potentially motivating interventionists to reassess their resource allocation. Full article
(This article belongs to the Special Issue Dietary Interventions: From Development to Assessment of Efficacy and Effectiveness)
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9 pages, 242 KiB  
Article
Improving Nutrition Care, Delivery, and Intakes Among Hospitalised Patients: A Mixed Methods, Integrated Knowledge Translation Study
by Shelley Roberts, Lauren T. Williams, Ishtar Sladdin, Heidi Neil, Zane Hopper, Julie Jenkins, Alan Spencer and Andrea P. Marshall
Nutrients 2019, 11(6), 1417; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11061417 - 24 Jun 2019
Cited by 14 | Viewed by 4672
Abstract
Malnutrition is a common and complex problem in hospitals. This study used an integrated knowledge translation approach to develop, implement, and evaluate a multifaceted, tailored intervention to improve nutrition care, delivery, and intake among acute medical inpatients. This observational, pre-post study was conducted [...] Read more.
Malnutrition is a common and complex problem in hospitals. This study used an integrated knowledge translation approach to develop, implement, and evaluate a multifaceted, tailored intervention to improve nutrition care, delivery, and intake among acute medical inpatients. This observational, pre-post study was conducted in a medical ward at a public hospital in Australia. The intervention was co-developed with key stakeholders and targeted three levels: individuals (nutrition intake magnets at patient bedsides), the ward (multidisciplinary hospital staff training), and the organisation (foodservice system changes). Observational data were collected pre- and post-intervention on patient demographics, food intakes, and the mealtime environment. Data were entered into SPSS and analysed using descriptive and inferential statistics. Ethical approval was gained through the hospital and university ethics committees. A total of 207 patients were observed; 116 pre- and 91 post-intervention. After intervention implementation, patients’ mean energy and protein intakes (in proportion to their estimated requirements) were significantly higher and the number of patients eating adequately doubled (p < 0.05). In summary, a multifaceted, pragmatic intervention, tailored to the study context and developed and implemented alongside hospital staff and patients, seemed to be effective in improving nutrition practices and patient nutrition intakes on an acute medical ward. Full article
(This article belongs to the Special Issue Dietary Interventions: From Development to Assessment of Efficacy and Effectiveness)
20 pages, 897 KiB  
Article
Effects of Intermittent Energy Restriction Combined with a Mediterranean Diet on Reducing Visceral Adiposity: A Randomized Active Comparator Pilot Study
by Chloe E. Panizza, Unhee Lim, Kim M. Yonemori, Kevin D. Cassel, Lynne R. Wilkens, Michelle N. Harvie, Gertraud Maskarinec, Edward J. Delp, Johanna W. Lampe, John A. Shepherd, Loïc Le Marchand and Carol J. Boushey
Nutrients 2019, 11(6), 1386; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11061386 - 20 Jun 2019
Cited by 33 | Viewed by 7938
Abstract
Intermittent energy restriction combined with a Mediterranean diet (IER+MED) has shown promise to reduce body fat and insulin resistance. In the Multiethnic Cohort Adiposity Phenotype Study, Japanese Americans had the highest visceral adipose tissue (VAT) when adjusting for total adiposity. We conducted this [...] Read more.
Intermittent energy restriction combined with a Mediterranean diet (IER+MED) has shown promise to reduce body fat and insulin resistance. In the Multiethnic Cohort Adiposity Phenotype Study, Japanese Americans had the highest visceral adipose tissue (VAT) when adjusting for total adiposity. We conducted this pilot study to demonstrate feasibility and explore efficacy of following IER+MED for 12 weeks to reduce VAT among East Asians in Hawaii. Sixty volunteers (aged 35–55, BMI 25–40 kg/m2, VAT ≥ 90 cm2 for men and ≥ 80 cm2 for women) were randomized to IER+MED (two consecutive days with 70% energy restriction and 5 days euenergetic MED) or an active comparator (euenergetic Dietary Approaches to Stop Hypertension (DASH) diet). Participants and clinic staff (except dietitians) were blinded to group assignments. IER+MED had significantly larger reductions in DXA-measured VAT and total fat mass (−22.6 ± 3.6 cm2 and −3.3 ± 0.4 kg, respectively) vs. DASH (−10.7 ± 3.5 cm2 and −1.6 ± 0.4 kg) (p = 0.02 and p = 0.005). However, after adjusting for total fat mass, change in VAT was not statistically different between groups; whereas, improvement in alanine transaminase remained significantly greater for IER+MED vs. DASH (−16.2 ± 3.8 U/L vs. −4.0 ± 3.6 U/L, respectively, p = 0.02). Attrition rate was 10%, and participants adhered well to study prescriptions with no reported major adverse effect. Results demonstrate IER+MED is acceptable, lowers visceral and total adiposity among East Asian Americans, and may improve liver function more effectively than a healthful diet pattern. ClinicalTrials.gov Identifier: NCT03639350. Full article
(This article belongs to the Special Issue Dietary Interventions: From Development to Assessment of Efficacy and Effectiveness)
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12 pages, 675 KiB  
Article
Food Trucks: Assessment of an Evaluation Instrument Designed for the Prevention of Foodborne Diseases
by Lígia Isoni Auad, Verônica Cortez Ginani, Eliana dos Santos Leandro, Elke Stedefeldt, Sascha Habu, Eduardo Yoshio Nakano, Aline Costa Santos Nunes and Renata Puppin Zandonadi
Nutrients 2019, 11(2), 430; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11020430 - 19 Feb 2019
Cited by 12 | Viewed by 4173
Abstract
This study aimed to validate an evaluation instrument for food trucks (FTs) regarding its internal consistency and to establish a score classification according to the food contamination probability assessment. The instrument was applied in 44 food trucks (convenience sample), along with microbial analysis, [...] Read more.
This study aimed to validate an evaluation instrument for food trucks (FTs) regarding its internal consistency and to establish a score classification according to the food contamination probability assessment. The instrument was applied in 44 food trucks (convenience sample), along with microbial analysis, in the Federal District, Brazil. After its application, sample collection and statistical analysis, the evaluation instrument was reduced to a 22-item final version. FTs were divided into three groups according to their ready-to-eat foods. Food trucks from Group A (hot and cold sandwiches) presented the highest percentage of contamination. The lowest percentage of contamination was observed in food trucks from Group C (regional and international cuisine). The application of the validated evaluation instrument to the 44 food trucks revealed that none achieved 100% adequacy. The reproducibility analysis exhibited an Intraclass Correlation Coefficient (ICC) value of 0.780 (CI 95%: 0.597; 0.880), indicating good reproducibility of the instrument. The reliability assessment presented a Kuder–Richardson Formula 20 (KR-20) value of 0.627 and a Cronbach’s alpha coefficient of 0.634, indicating good internal consistency. The proposed classification score was obtained by assigning 1 point for each item with an inadequate response, and the final score may vary between 0 and 20 points. Food trucks with up to 11 points exhibit low probability of contamination and low risk of foodborne diseases, while food trucks scoring 12 or more points exhibit a high probability of contamination and high risk of foodborne diseases. The evaluation instrument will allow effective assessment of the hygienic–sanitary practices and conditions of food trucks and potentially ensure consumers’ access to safe food. Full article
(This article belongs to the Special Issue Dietary Interventions: From Development to Assessment of Efficacy and Effectiveness)
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18 pages, 1099 KiB  
Article
Changes in Dietary Intake and Adherence to the NU-AGE Diet Following a One-Year Dietary Intervention among European Older Adults—Results of the NU-AGE Randomized Trial
by Agnes A. M. Berendsen, Ondine Van de Rest, Edith J. M. Feskens, Aurelia Santoro, Rita Ostan, Barbara Pietruszka, Anna Brzozowska, Agnieszka Stelmaszczyk-Kusz, Amy Jennings, Rachel Gillings, Aedin Cassidy, Aurélie Caille, Elodie Caumon, Corinne Malpuech-Brugere, Claudio Franceschi and Lisette C. P. G. M. De Groot
Nutrients 2018, 10(12), 1905; https://0-doi-org.brum.beds.ac.uk/10.3390/nu10121905 - 04 Dec 2018
Cited by 34 | Viewed by 7007
Abstract
Background: The Mediterranean Diet has been proposed as an effective strategy to reduce inflammaging, a chronic low grade inflammatory status, and thus, to slow down the aging process. We evaluated whether a Mediterranean-like dietary pattern specifically targeting dietary recommendations of people aged over [...] Read more.
Background: The Mediterranean Diet has been proposed as an effective strategy to reduce inflammaging, a chronic low grade inflammatory status, and thus, to slow down the aging process. We evaluated whether a Mediterranean-like dietary pattern specifically targeting dietary recommendations of people aged over 65 years (NU-AGE diet) could be effective to shift dietary intake of older adults towards a healthful diet. Methods: Adults aged 65–80 years across five EU-centers were randomly assigned to a NU-AGE diet group or control group. The diet group followed one year of NU-AGE dietary intervention specifying consumption of 15 food groups plus the use of a vitamin D supplement. Participants in the diet group received counselling and individually tailored dietary advice, food products and a vitamin D supplement. Dietary intake was assessed by means of seven-day food records at baseline and one-year follow-up. A continuous NU-AGE index (0–160 points) was developed to assess NU-AGE diet adherence. Results: In total 1296 participants were randomized and 1141 participants completed the intervention (571 intervention, 570 control). After one year, the diet group improved mean intake of 13 out of 16 NU-AGE dietary components (p < 0.05), with a significant increase in total NU-AGE index (difference in mean change = 21.3 ± 15.9 points, p < 0.01). Conclusions: The NU-AGE dietary intervention, based on dietary recommendations for older adults, consisting of individual dietary counselling, free healthy foods and a vitamin D supplement, may be a feasible strategy to improve dietary intake in an aging European population. Full article
(This article belongs to the Special Issue Dietary Interventions: From Development to Assessment of Efficacy and Effectiveness)
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14 pages, 437 KiB  
Article
Substantial Increase in Compliance with Saturated Fatty Acid Intake Recommendations after One Year Following the American Heart Association Diet
by Miaomiao Zhao, David Chiriboga, Barbara Olendzki, Bin Xie, Yawen Li, Lisa Jo McGonigal, Ana Maldonado-Contreras and Yunsheng Ma
Nutrients 2018, 10(10), 1486; https://doi.org/10.3390/nu10101486 - 12 Oct 2018
Cited by 13 | Viewed by 3811
Abstract
The American Heart Association (AHA) dietary guidelines recommend 30–35% of energy intake (%E) be from total fat, <7%E from saturated fatty acids (SFA), and <1%E from trans fatty acid (TFA). This study evaluates the effect of AHA dietary counselling on fat intake. Between [...] Read more.
The American Heart Association (AHA) dietary guidelines recommend 30–35% of energy intake (%E) be from total fat, <7%E from saturated fatty acids (SFA), and <1%E from trans fatty acid (TFA). This study evaluates the effect of AHA dietary counselling on fat intake. Between 2009 and 2014, 119 obese adults with metabolic syndrome (MetS), (71% women, average 52.5 years of age, and 34.9 kg/m2 of body mass index), received individual and group counselling on the AHA diet, over a one-year study period. Each participant attended 2 individual sessions (months 1 and 12) and 12 group sessions, at one-month intervals. At baseline and one-year, we collected three random 24-h diet recalls (two weekdays and one weekend day). Fat intake patterns over time were analyzed using paired-t test and linear mixed-effect models. There was significant variation on SFA and TFA intake per meal, being highest at dinner, in restaurants, and on weekends. Over the one-year study period, daily intake of total fat, SFA, and TFA decreased by 27%, 37% and 41%, respectively (p-value < 0.01, each). Correspondingly, the percentage of participants complying with AHA’s recommendations, increased from 25.2% to 40.2% for total fat (p-value = 0.02); from 2.5% to 20.7% for SFA (p-value < 0.01); and from 45.4% to 62% for TFA (p-value = 0.02). Additionally, SFA intake for all meal types at home decreased significantly (p-value < 0.05, each). AHA dietary counselling significantly increased the compliance with AHA dietary guidelines, with an eightfold increase in compliance in SFA intake. Nonetheless, ~80% of our participants still exceeded the recommended SFA intake. Substantial efforts are needed to encourage low-SFA and low-TFA food preparation at home, with strong public health policies to decrease SFA and TFA in restaurants and prepared foods. Full article
(This article belongs to the Special Issue Dietary Interventions: From Development to Assessment of Efficacy and Effectiveness)
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14 pages, 859 KiB  
Article
A Combined Dietary and Cognitive Intervention in 3–5-Year-Old Children in Indonesia: A Randomized Controlled Trial
by Nora Schneider, Eveline Geiser, Laura M. Gosoniu, Yulianti Wibowo, Gertrude Gentile-Rapinett, Mayke S. Tedjasaputra and Sudigdo Sastroasmoro
Nutrients 2018, 10(10), 1394; https://0-doi-org.brum.beds.ac.uk/10.3390/nu10101394 - 01 Oct 2018
Cited by 8 | Viewed by 7236
Abstract
Early childhood nutritional interventions typically combine nutritional and psychosocial stimulation. Such combined interventions result in long-lasting improvements of cognitive abilities in children who are malnourished. Here, we investigated potential cognitive abilities in normally developing children in Indonesia who were, however, at risk for [...] Read more.
Early childhood nutritional interventions typically combine nutritional and psychosocial stimulation. Such combined interventions result in long-lasting improvements of cognitive abilities in children who are malnourished. Here, we investigated potential cognitive abilities in normally developing children in Indonesia who were, however, at risk for suboptimal cognitive development due to little psychosocial stimulation in their home environment. In a randomized controlled intervention, children of the experimental group received nutritional supplementation combined with cognitive stimulation. Pre- and post-intervention measurements included cognitive development and functioning, behavior, and mother–child interaction. The experimental and control group received nutritional supplementation in the form of a fortified or unfortified milk powder, respectively. Additionally, the children and parents of the experimental group jointly engaged in daily learning activities at home and performed iPad-based tasks designed to foster cognitive abilities. The experimental group compared to the control group displayed a significantly higher increase in intelligence quotient as well as a significantly larger reduction in attentional problems after the intervention. These results indicate that low-level cognitive stimulation in combination with nutritional supplementation during early childhood can be an effective intervention that improves global cognitive functioning in healthy developing children. ClinicalTrials.gov Identifier: NCT02359669. Full article
(This article belongs to the Special Issue Dietary Interventions: From Development to Assessment of Efficacy and Effectiveness)
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17 pages, 1424 KiB  
Article
Keep Calm and Carry on: Parental Opinions on Improving Clinical Dietary Trials for Young Children
by Analise Nicholl and Therese A. O’Sullivan
Nutrients 2018, 10(9), 1166; https://0-doi-org.brum.beds.ac.uk/10.3390/nu10091166 - 25 Aug 2018
Cited by 4 | Viewed by 3415
Abstract
Recruitment can be an issue for paediatric research. We aimed to investigate parental opinions of paediatric clinical assessments, and to combine findings with recent literature to inform the design of a clinical dietary trial. We used convenience sampling to recruit 17 parents of [...] Read more.
Recruitment can be an issue for paediatric research. We aimed to investigate parental opinions of paediatric clinical assessments, and to combine findings with recent literature to inform the design of a clinical dietary trial. We used convenience sampling to recruit 17 parents of children aged 2–6 years from two community playgroups in Perth, Western Australia. Three focus groups considered proposed child assessments, study design, and potential study enrolment. Qualitative thematic analysis of focus group transcripts used NVivo 11 (QSR, Melbourne, VIC, Australia). Four main parental concerns emerged, presented here with solutions combining parent responses and relevant literature. (1) Parent and child needle fear: a good experience and a good phlebotomist help keep participants calm, and offering additional analysis (e.g., iron status) makes blood tests more worthwhile. (2) Concerns about children’s age, stage, understanding and ability to cope: create a themed adventure to help explain concepts and make procedures fun. (3) Persistent misunderstandings involving study purpose, design, randomization and equipoise: provide clear information via multiple platforms, and check understanding before enrolment. (4) Parental decisions to enrol children focused on time commitment, respectful treatment of their child, confronting tests and altruism: child-centred methodologies can help address concerns and keep participants engaged throughout procedures. Addressing the concerns identified could improve participation in a range of paediatric health interventions. Full article
(This article belongs to the Special Issue Dietary Interventions: From Development to Assessment of Efficacy and Effectiveness)
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Review

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19 pages, 445 KiB  
Review
Systematic Review: Effect of Health Education Intervention on Improving Knowledge, Attitudes and Practices of Adolescents on Malnutrition
by Ruth Charles Shapu, Suriani Ismail, Norliza Ahmad, Poh Ying Lim and Ibrahim Abubakar Njodi
Nutrients 2020, 12(8), 2426; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12082426 - 13 Aug 2020
Cited by 16 | Viewed by 6868
Abstract
Adolescence is a phase in the life cycle of human beings. Adequate knowledge, attitudes and practices towards malnutrition are necessary for proper growth and development and for their future children. This systematic review aimed to determine the effect of health education intervention to [...] Read more.
Adolescence is a phase in the life cycle of human beings. Adequate knowledge, attitudes and practices towards malnutrition are necessary for proper growth and development and for their future children. This systematic review aimed to determine the effect of health education intervention to improve the knowledge, attitudes and practices of adolescents on malnutrition. PubMed, Scopus, clinical trials, CINAHL, SAGE, Science Direct and Medline were searched according to Preferred Reporting Item for Systematic Reviews and Meat-analysis (PRISMA) guidelines to identified published studies from January 2013 to December 2019 based on the inclusion and exclusion criteria. A total of eight studies were included in this review. Data extraction was done based on randomized controlled trial only. Three out of the eight studies had low risk of bias, the overall evidence of the study was moderate. Findings from this study suggest that health education intervention among adolescents have significantly improved their knowledge, attitudes and practices. More specific interventions should be conducted in low and middle income countries since they bear more of the burden of malnutrition globally. Full article
(This article belongs to the Special Issue Dietary Interventions: From Development to Assessment of Efficacy and Effectiveness)
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19 pages, 1631 KiB  
Review
The Combined Effect of Promoting the Mediterranean Diet and Physical Activity on Metabolic Risk Factors in Adults: A Systematic Review and Meta-Analysis of Randomised Controlled Trials
by Evangelia Malakou, Manolis Linardakis, Miranda Elaine Glynis Armstrong, Dimitra Zannidi, Charlie Foster, Laura Johnson and Angeliki Papadaki
Nutrients 2018, 10(11), 1577; https://0-doi-org.brum.beds.ac.uk/10.3390/nu10111577 - 25 Oct 2018
Cited by 43 | Viewed by 9003
Abstract
Adhering to the Mediterranean diet (MD) and physical activity (PA) public health guidelines have independently been linked to health benefits in adults. These behaviours form essential components of the traditional Mediterranean lifestyle. However, their combined effect on metabolic risk has not been systematically [...] Read more.
Adhering to the Mediterranean diet (MD) and physical activity (PA) public health guidelines have independently been linked to health benefits in adults. These behaviours form essential components of the traditional Mediterranean lifestyle. However, their combined effect on metabolic risk has not been systematically assessed. This systematic review with meta-analysis (PROSPERO; CRD42017073958) aimed to examine, for the first time, the combined effect of promoting the MD and PA compared with no treatment, treatment with MD or PA alone, or a different dietary and/or PA treatment, and estimate its magnitude on metabolic risk factors. Medline, Embase, CINAHL and Web of Science were systematically searched until March 2018 for English language controlled interventions reporting the combined effects of the MD and PA on one or multiple metabolic risk factors in adults. Two researchers independently conducted data extraction and risk of bias assessment using a rigorous methodology. Reporting followed PRISMA guidelines. Quality of reporting and risk of bias were assessed using the CONSORT guidelines and the Cochrane Collaboration’s tool, respectively. Data from 12 articles reporting 11 randomised controlled trials (n = 1684) were included in the qualitative synthesis; across them, risk of bias was considered low, unclear and high for 42%, 25% and 33% of domains, respectively. Between-study heterogeneity ranged from 44% (triglycerides) to 98% (insulin and high density lipoprotein cholesterol (HDL)-cholesterol). Compared to a control condition, there was strong evidence (p < 0.001) of a beneficial effect of promoting the MD and PA on body weight (−3.68 kg, 95% CI (confidence intervals) −5.48, −1.89), body mass index (−0.64 kg/m2, 95% CI −1.10, −0.18), waist circumference (−1.62 cm, 95% CI −2.58, −0.66), systolic (−0.83 mmHg, 95% CI −1.57, −0.09) and diastolic blood pressure (−1.96 mmHg, 95% CI −2.57, −1.35), HOMA-IR index (−0.90, 95% CI −1.22, −0.58), blood glucose (−7.32 mg/dL, 95% CI −9.82, −4.82), triglycerides (−18.47 mg/dL, 95% CI −20.13, −16.80), total cholesterol (−6.30 mg/dL, 95% CI −9.59, −3.02) and HDL-cholesterol (+3.99 mg/dL, 95% CI 1.22, 6.77). There was no evidence of an effect on insulin concentrations. The data presented here provide systematically identified evidence that concurrently promoting the MD and PA is likely to provide an opportunity for metabolic risk reduction. However, due to the high degree of heterogeneity, most likely due to the variation in control group treatment, and the small number of included studies, findings from the pooled analysis should be interpreted with caution. These findings also highlight the need for high quality randomised controlled trials examining the combined effect of the MD and PA on metabolic risk. Full article
(This article belongs to the Special Issue Dietary Interventions: From Development to Assessment of Efficacy and Effectiveness)
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13 pages, 621 KiB  
Review
Dietary Interventions for the Prevention of Type 2 Diabetes in High-Risk Groups: Current State of Evidence and Future Research Needs
by Nicola D. Guess
Nutrients 2018, 10(9), 1245; https://0-doi-org.brum.beds.ac.uk/10.3390/nu10091245 - 06 Sep 2018
Cited by 38 | Viewed by 18123
Abstract
A series of large-scale randomised controlled trials have demonstrated the effectiveness of lifestyle change in preventing type 2 diabetes in people with impaired glucose tolerance. Participants in these trials consumed a low-fat diet, lost a moderate amount of weight and/or increased their physical [...] Read more.
A series of large-scale randomised controlled trials have demonstrated the effectiveness of lifestyle change in preventing type 2 diabetes in people with impaired glucose tolerance. Participants in these trials consumed a low-fat diet, lost a moderate amount of weight and/or increased their physical activity. Weight loss appears to be the primary driver of type 2 diabetes risk reduction, with individual dietary components playing a minor role. The effect of weight loss via other dietary approaches, such as low-carbohydrate diets, a Mediterranean dietary pattern, intermittent fasting or very-low-energy diets, on the incidence of type 2 diabetes has not been tested. These diets—as described here—could be equally, if not more effective in preventing type 2 diabetes than the tested low-fat diet, and if so, would increase choice for patients. There is also a need to understand the effect of foods and diets on beta-cell function, as the available evidence suggests moderate weight loss, as achieved in the diabetes prevention trials, improves insulin sensitivity but not beta-cell function. Finally, prediabetes is an umbrella term for different prediabetic states, each with distinct underlying pathophysiology. The limited data available question whether moderate weight loss is effective at preventing type 2 diabetes in each of the prediabetes subtypes. Full article
(This article belongs to the Special Issue Dietary Interventions: From Development to Assessment of Efficacy and Effectiveness)
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20 pages, 521 KiB  
Review
Gaps in the Evidence on Population Interventions to Reduce Consumption of Sugars: A Review of Reviews
by Sharon I. Kirkpatrick, Amanda Raffoul, Merryn Maynard, Kirsten M. Lee and Jackie Stapleton
Nutrients 2018, 10(8), 1036; https://0-doi-org.brum.beds.ac.uk/10.3390/nu10081036 - 08 Aug 2018
Cited by 19 | Viewed by 5087
Abstract
There is currently considerable attention directed to identifying promising interventions to reduce consumption of sugars among populations around the world. A review of systematic reviews was conducted to identify gaps in the evidence on such interventions. Medline, EMBASE CINAHL, and the Cochrane Database [...] Read more.
There is currently considerable attention directed to identifying promising interventions to reduce consumption of sugars among populations around the world. A review of systematic reviews was conducted to identify gaps in the evidence on such interventions. Medline, EMBASE CINAHL, and the Cochrane Database of Systematic Reviews were searched to identify systematic reviews published in English from January 2005 to May 2017 and considering research on interventions to reduce sugar intake. Twelve systematic reviews that considered price changes, interventions to alter the food available within specific environments, and health promotion and education programs were examined. Each of the identified reviews focused on sugar-sweetened beverages (SSBs). The existing literature provides some promising indications in terms of the potential of interventions to reduce SSB consumption among populations. However, a common thread is the limited scope of available evidence, combined with the heterogeneity of methods and measures used in existing studies, which limits conclusions that can be reached regarding the effectiveness of interventions. Reviewed studies typically had limited follow-up periods, making it difficult to assess the sustainability of effects. Further, there is a lack of studies that address the complex context within which interventions are implemented and evaluated, and little is known about the cost-effectiveness of interventions. Identified gaps speak to the need for a more holistic approach to sources of sugars beyond SSBs, consensus on measures and methods, attention to the implementation of interventions in relation to context, and careful monitoring to identify intended and unintended consequences. Full article
(This article belongs to the Special Issue Dietary Interventions: From Development to Assessment of Efficacy and Effectiveness)
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4 pages, 198 KiB  
Commentary
Assessing Dietary Outcomes in Intervention Studies: Pitfalls, Strategies, and Research Needs
by Sharon I. Kirkpatrick, Clare E. Collins, Ruth H. Keogh, Susan M. Krebs-Smith, Marian L. Neuhouser and Angela Wallace
Nutrients 2018, 10(8), 1001; https://0-doi-org.brum.beds.ac.uk/10.3390/nu10081001 - 31 Jul 2018
Cited by 32 | Viewed by 4657
Abstract
To inform strategies to improve the dietary intakes of populations, robust evaluations of interventions are required. This paper is drawn from a workshop held at the International Society of Behavioral Nutrition and Physical Activity 2017 Annual Meeting, and highlights considerations and research priorities [...] Read more.
To inform strategies to improve the dietary intakes of populations, robust evaluations of interventions are required. This paper is drawn from a workshop held at the International Society of Behavioral Nutrition and Physical Activity 2017 Annual Meeting, and highlights considerations and research priorities relevant to measuring dietary outcomes within intervention studies. Self-reported dietary data are typically relied upon in such studies, and it is recognized that these data are affected by random and systematic error. Additionally, differential error between intervention and comparison groups or pre- and post-intervention can be elicited by the intervention itself, for example, by creating greater awareness of eating or drinking occasions or the desire to appear compliant. Differential reporting can render the results of trials incorrect or inconclusive by leading to biased estimates and reduced statistical power. The development of strategies to address intervention-related biases requires developing a better understanding of the situations and population groups in which interventions are likely to elicit differential reporting and the extent of the bias. Also needed are efforts to expand the feasibility and applications of biomarkers to address intervention-related biases. In the meantime, researchers are encouraged to consider the potential for differential biases in dietary reporting in a given study, to choose tools carefully and take steps to minimize and/or measure factors such as social desirability biases that might contribute to differential reporting, and to consider the implications of differential reporting for study results. Full article
(This article belongs to the Special Issue Dietary Interventions: From Development to Assessment of Efficacy and Effectiveness)
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