Poor diet quality is the leading cause of death both in the United States and worldwide, and the prevalence of obesity is at an all-time high and is projected to significantly worsen. Results from an ...eight-week group program utilizing an ad-libitum whole-food plant-based dietary pattern, were reviewed. There were 79 participants, all self-referred from the community, including 24 (30.4%) who were already vegetarian or vegan at baseline. Seventy-eight participants (98.7%) completed the eight-week program. Among completers, those with higher BMI at baseline lost a larger percentage of their body weight (total body weight loss of 3.0 ± SD 2.1%, 5.8 ± 2.8%, and 6.4 ± 2.5% for participants who had baseline BMI in normal, overweight, and obese range, respectively). The average weight loss for all the completers was 5.5 ± 3.0 kg (
0.0001). Final blood pressure and plasma lipids were reduced compared to baseline (SBP decreased 7.1 ± 15.5 mmHg (
= 0.0002), DBP decreased 7.3 ± 10.9 mmHg (
0.0001), total cholesterol decreased 25.2 ± 24.7 mg/dL (
0.0001), LDL decreased 15.3 ± 21.1 mg/dL (
0.0001)). Twenty-one (26.9%) participants were able to decrease or stop at least one chronic medication compared to two (2.6%) participants who required an increased dose of a chronic medication. Participants who were already vegetarian or vegan at baseline experienced statistically significant weight loss and reductions in total and LDL cholesterol. There was a non-significant trend toward less weight loss in these participants compared to participants who were non-vegetarian at baseline. Reductions in total and LDL cholesterol were not significantly different when comparing vegetarian or vegan and non-vegetarian participants. A whole-food plant-based dietary intervention may provide significant short-term benefits for both non-vegetarian, vegetarian, and vegan individuals.
Anhedonia and amotivation are symptoms of many different mental health disorders that are frequently associated with functional disability, but it is not clear whether the same processes contribute ...to motivational impairments across disorders. This study focused on one possible factor, the willingness to exert cognitive effort, referred to as cognitive effort–cost decision making.
We examined performance on the deck choice task as a measure of cognitive effort–cost decision making, in which people choose to complete an easy task for a small monetary reward or a harder task for larger rewards, in 5 groups: healthy control (n = 80), schizophrenia/schizoaffective disorder (n = 50), bipolar disorder with psychosis (n = 58), current major depression (n = 60), and past major depression (n = 51). We examined cognitive effort–cost decision making in relation to clinician and self-reported motivation symptoms, working memory and cognitive control performance, and life function measured by ecological momentary assessment and passive sensing.
We found a significant diagnostic group × reward interaction (F8,588 = 4.37, p < .001, ηp2 = 0.056). Compared with the healthy control group, the schizophrenia/schizoaffective and bipolar disorder groups, but not the current or past major depressive disorder groups, showed a reduced willingness to exert effort at the higher reward values. In the schizophrenia/schizoaffective and bipolar disorder groups, but not the major depressive disorder groups, reduced willingness to exert cognitive effort for higher rewards was associated with greater clinician-rated motivation impairments, worse working memory and cognitive control performance, and less engagement in goal-directed activities measured by ecological momentary assessment.
These findings suggest that the mechanisms contributing to motivational impairments differ among individuals with psychosis spectrum disorders versus depression.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Americans consume diets that fall short of dietary recommendations, and the cost of healthier diets is often cited as a barrier to dietary change. We conducted a nonrandomized crossover trial with ...meals provided utilizing 2 diets: Dietary Approaches to Stop Hypertension (DASH) and whole food, plant-based (WFPB), and thus had intake data from baseline and both intervention diets.
Using actual diet records, describe food costs of baseline diets of individuals with type 2 diabetes (T2DM) as well as therapeutic DASH and WFPB diets.
Three-day food records were collected and analyzed for each 7-d diet phase: baseline, DASH, and WFPB. Nutrient content was analyzed using the Nutrient Data System for Research and cost was determined using Fillet, an application to manage menu pricing. Food costs were calculated for each diet as consumed and adjusted to a standardized 1800 kcal/d. Ingredient-only costs of food away from home (FAFH) were approximated and analyzed. Costs were analyzed using linear mixed-effect models as a function of diet.
Fifteen subjects enrolled; 12 completed all dietary phases. The baseline, DASH, and WFPB diets, as consumed, cost $15.72/d (95% CI; $13.91, $17.53), $12.74/d ($11.23, $14.25), and $9.78/d ($7.97, $11.59), respectively. When adjusted to an 1800 kcal/d intake, the baseline, DASH, and WFPB diets cost $15.69/d ($13.87, $17.52), $14.92/d ($13.59, $16.26), and $11.96/d ($10.14, $13.78), respectively. When approximated ingredient-only costs of FAFH were analyzed, as consumed baseline $11.01 ($9.53, $12.49) and DASH diets $11.81 ($10.44, $13.18) had similar costs; WFPB diet $8.83 ($7.35, $10.31) cost the least.
In this short-term study with meals provided, the food costs of plant-predominant diets offering substantial metabolic health benefits were less than or similar to baseline food costs of adults with insulin-treated T2DM. Longer-term data without meal provision are needed for more generalizable results.
This trial was registered at clinicaltrials.gov as NCT04048642.
Loneliness, the subjective experience of feeling alone, is associated with physical and psychological impairments. While there is an extensive literature linking loneliness to psychopathology, ...limited work has examined loneliness in daily life in those with serious mental illness. We hypothesized that trait and momentary loneliness would be transdiagnostic and relate to symptoms and measures of daily functioning.
The current study utilized ecological momentary assessment and passive sensing to examine loneliness in those with schizophrenia (N = 59), bipolar disorder (N = 61), unipolar depression (N = 60), remitted unipolar depression (N = 51), and nonclinical comparisons (N = 82) to examine relationships of both trait and momentary loneliness to symptoms and social functioning in daily life.
Findings suggest that both trait and momentary loneliness are higher in those with psychopathology (F(4,284) = 28.00, P < .001, ηp2 = 0.27), and that loneliness significantly relates to social functioning beyond negative symptoms and depression (β = -0.44, t = 6.40, P < .001). Furthermore, passive sensing measures showed that greater movement (β = -0.56, t = -3.29, P = .02) and phone calls (β = -0.22, t = 12.79, P = .04), but not text messaging, were specifically related to decreased loneliness in daily life. Individuals higher in trait loneliness show stronger relationships between momentary loneliness and social context and emotions in everyday life.
These findings provide further evidence pointing to the importance of loneliness transdiagnostically and its strong relation to social functioning. Furthermore, we show that passive sensing technology can be used to measure behaviors related to loneliness in daily life that may point to potential treatment implications or early detection markers of loneliness.
Purpose
Breast cancer treatment is associated with weight gain, and obesity and its related cardiometabolic and hormonal risk factors have been associated with poorer outcomes. Dietary intervention ...may address these risk factors, but limited research has been done in the setting of metastatic breast cancer requiring systemic therapy.
Methods
Women with metastatic breast cancer on stable treatment were randomized 2:1 to an 8-week intervention (
n
= 21) or control (
n
= 11). The intervention included weekly assessment visits and an ad libitum whole-food, plant-based (WFPB) diet with provided meals. Cardiometabolic, hormonal, and cancer markers were assessed at baseline, 4 weeks, and 8 weeks.
Results
Within the intervention group, mean weight decreased by 6.6% (
p
< 0.01) after 8 weeks. Fasting insulin decreased from 16.8 uIU/L to 11.2 uIU/L (
p
< 0.01), concurrent with significantly reduced insulin resistance. Total cholesterol decreased from 193.6 mg/dL to 159 mg/dL (
p
< 0.01), and low-density lipoprotein (LDL) cholesterol decreased from 104.6 mg/dL to 82.2 mg/dL (
p
< 0.01). Total testosterone was unchanged, but free testosterone trended lower within the intervention group (
p
= 0.08) as sex hormone binding globulin increased from 74.3 nmol/L to 98.2 nmol/L (
p
< 0.01). There were no significant differences in cancer progression markers at week 8, although mean CA 15-3, CA 27.29, and CEA were lower in the intervention group (
p
= 0.53,
p
= 0.23, and
p
= 0.54, respectively) compared to control, when adjusted for baseline.
Conclusion
WFPB dietary changes during treatment for metastatic breast cancer are well tolerated and significantly improve weight, cardiometabolic and hormonal parameters. Longer studies are warranted to assess the durability of changes.
Trial registration
First registered at Clinicaltrials.gov (NCT03045289) on February 7, 2017.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Purpose
Quality of life (QOL) is among the most important outcomes for women with metastatic breast cancer (MBC), and it predicts survival. QOL is negatively impacted by cognitive impairment, ...fatigue, and weight gain. We assessed whether a whole food, plant-based (WFPB) diet-promoting weight loss is feasible and might improve QOL.
Methods
Women with MBC on stable systemic treatments were randomized 2:1 to 1) WFPB dietary intervention (
n
= 21) or 2) usual care (
n
= 11) for 8 weeks. Participants attended weekly education visits and consumed an ad libitum WFPB diet (3 prepared meals/day provided). Patient-reported outcomes and 3-day food records were assessed at baseline and 8 weeks. The effects of WFPB diet on changes in outcomes were assessed by analysis of covariance model controlling for baseline.
Results
20 intervention and 10 control participants completed the trial. Intervention participants were highly adherent to the WFPB diet (94.3 % total calories on-plan). Intervention group nutrient intakes changed significantly including dietary fat (35.8 % to 20.4 % percent calories from fat,
p
< 0.001) and fiber content (12.7 to 30.8 g fiber/1000 kcal,
p
< 0.001). Perceived cognitive function (FACT-Cog total + 16.1; 95 % confidence interval CI = 0.8–31.7;
p
= 0.040) and emotional well-being (FACT-B emotional well-being subscale + 2.3; CI = 0.5–4.1;
p
= 0.016) improved in the WFPB versus the control group. Fatigue, measured by the BFI, improved within the WFPB group for fatigue severity (M = 4.7 ± 2.5SD to 3.7 ± 2.3,
p
= 0.047) and fatigue at its worst (5.8 ± 2.8 to 4.4 ± 2.4,
p
= 0.011).
Conclusions
Significant dietary changes in this population are feasible and may improve QOL by improving treatment-related symptoms. Additional study is warranted.
Trial Registration: ClinicalTrials.gov identifier: NCT03045289. Registered 7 February 2017.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Patients with serious respiratory illness and their caregivers suffer considerable burdens, and palliative care is a fundamental right for anyone who needs it. However, the overwhelming majority of ...patients do not receive timely palliative care before the end of life, despite robust evidence for improved outcomes.
This policy statement by the American Thoracic Society (ATS) and partnering societies advocates for improved integration of high-quality palliative care early in the care continuum for patients with serious respiratory illness and their caregivers and provides clinicians and policymakers with a framework to accomplish this.
An international and interprofessional expert committee, including patients and caregivers, achieved consensus across a diverse working group representing pulmonary-critical care, palliative care, bioethics, health law and policy, geriatrics, nursing, physiotherapy, social work, pharmacy, patient advocacy, psychology, and sociology.
The committee developed fundamental values, principles, and policy recommendations for integrating palliative care in serious respiratory illness care across seven domains:
) delivery models,
) comprehensive symptom assessment and management,
) advance care planning and goals of care discussions,
) caregiver support,
) health disparities,
) mass casualty events and emergency preparedness, and
) research priorities. The recommendations encourage timely integration of palliative care, promote innovative primary and secondary or specialist palliative care delivery models, and advocate for research and policy initiatives to improve the availability and quality of palliative care for patients and their caregivers.
This multisociety policy statement establishes a framework for early palliative care in serious respiratory illness and provides guidance for pulmonary-critical care clinicians and policymakers for its proactive integration.
Head-turning morphologies Linden, Abby Vander; Campbell, Kristin M.; Bryar, Erin K. ...
Evolution,
10/2019, Volume:
73, Issue:
10
Journal Article
Peer reviewed
Open access
Mammals flex, extend, and rotate their spines as they perform behaviors critical for survival, such as foraging, consuming prey, locomoting, and interacting with conspecifics or predators. The ...atlas–axis complex is a mammalian innovation that allows precise head movements during these behaviors. Although morphological variation in other vertebral regions has been linked to ecological differences in mammals, less is known about morphological specialization in the cervical vertebrae, which are developmentally constrained in number but highly variable in size and shape. Here, we present the first phylogenetic comparative study of the atlas–axis complex across mammals. We used spherical harmonics to quantify 3D shape variation of the atlas and axis across a diverse sample of species, and performed phylogenetic analyses to investigate if vertebral shape is associated with body size, locomotion, and diet. We found that differences in atlas and axis shape are partly explained by phylogeny, and that mammalian subclades differ in morphological disparity. Atlas and axis shape diversity is associated with differences in body size and locomotion; large terrestrial mammals have craniocaudally elongated vertebrae, whereas smaller mammals and aquatic mammals have more compressed vertebrae. These results provide a foundation for investigating functional hypotheses underlying the evolution of neck morphologies across mammals.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NMLJ, NUK, OILJ, PNG, SAZU, SBCE, SBMB, UL, UM, UPUK
There is limited research regarding insulin dosing changes following adoption of plant-based diets. We conducted a nonrandomized crossover trial utilizing two plant-based diets (Dietary Approaches to ...Stop Hypertension, or DASH, and Whole Food, Plant-Based, or WFPB) to assess acute changes in insulin requirements and associated markers among individuals with insulin-treated type 2 diabetes.
Participants (n = 15) enrolled in a 4-week trial with sequential, one-week phases: Baseline, DASH 1, WFPB, and DASH 2. Each diet was ad libitum and meals were provided.
Compared to baseline, daily insulin usage was 24%, 39%, and 30% lower after DASH 1, WFPB, and DASH 2 weeks respectively (all p < 0.01). Insulin resistance (HOMA-IR) was 49% lower (p < 0.01) and the insulin sensitivity index was 38% higher (p < 0.01) at the end of the WFPB week before regressing toward baseline during DASH 2. Total, LDL, and HDL cholesterol, leptin, urinary glucose, and hsCRP decreased to a nadir at the end of the WFPB week before increasing during DASH 2.
Adopting a DASH or WFPB diet can result in significant, rapid changes in insulin requirements, insulin sensitivity, and related markers among individuals with insulin-treated type 2 diabetes, with larger dietary changes producing larger benefits.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Much research has identified how people react to receiving threatening information about the self. The purpose of this article is to discuss such experiences in the context of a model of state ...self-esteem regulation. The authors propose that people engage in one of three regulatory responses to threat: compensation, resistance, and breaking. They conduct a meta-analysis aimed to examine when people engage in each of these three responses to threat and how trait self-esteem affects the selection and success of selecting each regulatory response. Furthermore, the authors test six theoretical models that might explain why responses to ego threat vary across level of trait self-esteem. The models for differences between people with low and high trait self-esteem that fit the data best suggest that (a) self-esteem serves as a resource and (b) there is a self-verification motivation.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
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