The characteristic trait of individuals developing a pathological obsession and preoccupation with healthy foods and a restrictive and avoidant eating behavior is described as orthorexia nervosa ...(ON). For ON, neither universal diagnosis criteria nor valid tools for large-scale epidemiologic assessment are available in the literature. The aim of the current study is to analyze the psychometric properties of a translated German version of the ORTO-15 questionnaire. The German version of the ORTO-15, a eating behavior and dieting habits questionnaire were completed by 1029 German-speaking participants (74.6% female) aged between 19 and 70 years (M = 31.21 ± 10.43 years). Our results showed that after confirmatory factor analysis, the best fitting model of the original version is a single-factor structure (9-item shortened version: ORTO-9-GE). The final model showed only moderate internal consistency (Cronbach's alpha = .67), even after omitting 40% of the original question. A total of 69.1% participants showed orthorectic tendencies. Orthorectic tendencies are associated with special eating behavior features (dieting frequency, vegetarian and vegan diet). Education level did not influence ON tendency and nutritional students did not show higher ON tendency compared to students from other disciplines. This study is the first attempt to translate and to evaluate the psychometric properties of a German version of the ORTO-15 questionnaire. The ORTO-9-GE questionnaire, however, is only a mediocre tool for assessing orthorectic tendencies in individuals and shows moderate reliability and internal consistency. Our research suggests, that future studies are needed to provide more reliable and valid assessment tools to investigate orthorexia nervosa.
To gain further insight into the strength of evidence and extent of possible biases in the scope of studies investigating the impact of garlic and garlic supplement intake on biomarkers of ...cardiovascular disease, we performed an umbrella review of all published meta-analyses synthesizing data from both observational studies and randomized controlled trials.
Electronic database PubMed (between 1966 and June 2015) was searched for systematic reviews and meta-analyses using following search terms: (“garlic” OR “allium sativum” OR “allicin” OR “organosulfur”) AND (“cardiovascular” OR “coronary” OR “cholesterol” OR “triglyceride” OR “atherosclerosis” OR “blood pressure” OR “hypertension” OR “blood glucose”) AND (“systematic review” OR “meta-analysis”), with no restriction to calendar data and language. Hand-search of reference lists and relevant clinical guidelines was performed as well.
Nine systematic reviews investigated the effects of garlic on lipid parameters and eight systematic reviews analyzed the effects on blood pressure parameters were identified. Eight of nine meta-analyses synthesizing the effect of garlic on blood lipids reported significantly decreased total cholesterol levels. Inconsistent results could be detected for HDL-cholestrol, LDL-cholesterol, and triacylglycerols. The effect of garlic on systolic blood pressure showed consistent results across publications with 7 out of 8 meta-analyses demonstrating a substantial decrease in systolic blood pressure. Similar results could be reported regarding the effect of garlic on diastolic blood pressure, i.e. 6 out of 8 meta-analyses detected significant reductions in diastolic blood pressure levels following interventions with garlic.
According to the data summarized in the present umbrella review, garlic preparations as well as garlic exerted some positive effects on indicators and biomarkers of cardiovascular disease, typically without causing any serious side effects. However, with regard to the substantial heterogeneities between the different trials enrolled in the various meta-analyses of this review, a conservative interpretation of the outcome seems to be appropriate.
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The objective of this study was to develop a scoring system (NutriGrade) to evaluate the quality of evidence of randomized controlled trial (RCT) and cohort study meta-analyses in nutrition research, ...building upon previous tools and expert recommendations. NutriGrade aims to assess the meta-evidence of an association or effect between different nutrition factors and outcomes, taking into account nutrition research–specific requirements not considered by other tools. In a pretest study, 6 randomly selected meta-analyses investigating diet–disease relations were evaluated with NutriGrade by 5 independent raters. After revision, NutriGrade was applied by the same raters to 30 randomly selected meta-analyses in the same thematic area. The reliability of ratings of NutriGrade items was calculated with the use of a multirater κ, and reliability of the total (summed scores) was calculated with the use of intraclass correlation coefficients (ICCs). The following categories for meta-evidence evaluation were established: high (8–10), moderate (6–7.99), low (4–5.99), and very low (0–3.99). The NutriGrade scoring system (maximum of 10 points) comprises the following items: 1) risk of bias, study quality, and study limitations, 2) precision, 3) heterogeneity, 4) directness, 5) publication bias, 6) funding bias, 7) study design, 8) effect size, and 9) dose-response. The NutriGrade score varied between 2.9 (very low meta-evidence) and 8.8 (high meta-evidence) for meta-analyses of RCTs, and it ranged between 3.1 and 8.8 for meta-analyses of cohort studies. The κ value of the ratings for each scoring item varied from 0.32 (95% CI: 0.22, 0.42) for risk of bias for cohort studies and 0.95 (95% CI: 0.91, 0.99) for study design, with a mean κ of 0.66 (95% CI: 0.53, 0.79). The ICC of the total score was 0.81 (95% CI: 0.69, 0.90). The NutriGrade scoring system showed good agreement and reliability. The initial findings regarding the performance of this newly established scoring system need further evaluation in independent analyses.
Nuts have been an indispensable component of the human diet for hundreds because of their unique nutrient composition and are thought to play a beneficial part in the prevention of cardiovascular ...diseases.
To evaluate the extent, validity and presence of evidence for studies investigating the impact of nuts intake on biomarkers of cardiovascular disease and cardiovascular events, we performed an umbrella review of all published meta-analyses synthesizing data from both observational studies and randomized controlled trials.
PubMed (between 1966 and April 2016) was searched for systematic reviews and meta-analyses. Methodological quality was assessed by applying the AMSTAR score (0-11 points), and the meta-evidence by applying NutriGrade, our recently developed scoring system (0-10 points).
In total, 14 meta-analyses were included in the umbrella review. Only 4 out of 14 reported an AMSTAR score ≥8 (high methodological quality), whereas NutriGrade meta-evidence score varied between 2 (very low meta-evidence) and 7.9 (moderate meta-evidence). There is consistent evidence from intervention trials, reporting significant reductions for total cholesterol, and from observational studies that higher intakes of nuts were associated with reduced risk of cardiovascular disease and hypertension. On the other side no effect could be observed for stroke, HDL-cholesterol, and blood pressure in the normal range.
In summary, the present umbrella review showed that nuts intake was associated with reduced risk of cardiovascular disease and hypertension, and lower levels of total cholesterol. The observed evidence is limited by the moderate methodological quality and very low to moderate quality of evidence.
Notwithstanding a growth in popularity and consumption of gluten-free (GF) food products, there is a lack of substantiated analysis of the nutritional quality compared with their gluten-containing ...counterparts. To put GF foods into proper perspective both for those who need it (patients with celiac disease) and for those who do not, we provide contemporary data about cost and nutritional quality of GF food products. The objective of this study is to develop a food composition database for seven discretionary food categories of packaged GF products. Nutrient composition, nutritional information and cost of foods from 63 GF and 126 gluten-containing counterparts were systematically obtained from 12 different Austrian supermarkets. The nutrition composition (macro and micronutrients) was analyzed by using two nutrient composition databases in a stepwise approximation process. A total of 63 packaged GF foods were included in the analysis representing a broad spectrum of different GF categories (flour/bake mix, bread and bakery products, pasta and cereal-based food, cereals, cookies and cakes, snacks and convenience food). Our results show that the protein content of GF products is >2 fold lower across 57% of all food categories. In 65% of all GF foods, low sodium content was observed (defined as <120 mg/100 g). Across all GF products, 19% can be classified as source high in fiber (defined as >6g/100 g). On average, GF foods were substantially higher in cost, ranging from +205% (cereals) to +267% (bread and bakery products) compared to similar gluten-containing products. In conclusion, our results indicate that for GF foods no predominant health benefits are indicated; in fact, some critical nutrients must be considered when being on a GF diet. For individuals with celiac disease, the GF database provides a helpful tool to identify the food composition of their medical diet. For healthy consumers, replacing gluten-containing products with GF foods is aligned with substantial cost differences but GF foods do not provide additional health benefits from a nutritional perspective.
Research should benefit society at large. Involving citizens those who are affected by research may not only increase the quality, but can also push research towards generating greater societal ...benefits and relevant outcomes for citizens. Including citizens in research also has ethical implications, which necessitate structured guidance on 'how to' meaningfully involve them. In our project, we invited a multi-stakeholder group consisting of researchers from multiple disciplines, citizen scientists, youth and patient advocates to co-create a guide on 'how to' meaningfully involve citizens in research. In five consecutive workshops, we discussed how the characteristics of interactions between researchers and citizens (e.g., building trustful relationships and communication) and what a possible project steering structure enabling meaningful public involvement in research could look like. As a result of these workshops, the PPIE 'How to' Guide for Researchers was developed to support the implementation of 'Patient and Public Involvement and Engagement' (PPIE) activities and informed a PPIE Implementation Programme funding public involvement activities in Austria.
Involving citizens in research is not widely utilised across research disciplines and countries. It requires the readiness of researchers and their organisations as well as guides on 'how to' successfully involve citizens in a meaningful way. Including the patient and citizen voice in research activities has been most frequently demonstrated in health research, however, is implemented along various degrees of involvement - from passively receiving information about science to actively involving the citizens in steering projects and research activities. In this commentary, we aim to report a multi-stakeholder co-creation process developing 'Patient and Public Involvement and Engagement' (PPIE) activities across disciplines to provide guidance for researchers and the public. We use Ludwig Boltzmann Society's (LBG) organisational framework as a case study, hence it consists of research institutes ranging from the life sciences to humanities and therefore represents a well-suited research environment for this endeavour. In a co-creation approach - to accomplish a shared understanding of public involvement in research among different stakeholders - a multi-stakeholder group comprising 11 researchers from natural sciences, life sciences, social sciences and humanities, and 13 citizens (such as patient advocates, young people and citizen scientists) were involved. In five consecutive workshops, we co-developed the nature of interactions between citizens and researchers, as well as governance structures enabling meaningful involvement in research. The workshops' content was informed by an initial literature review. As a result of this process, the PPIE 'How to' Guide for Researchers was developed to support the implementation of involvement activities in their research projects according to the public involvement principles. These principles informed assessment criteria for the newly established PPIE Implementation Programme at LBG. It provides funding and support for public involvement activities in research to embed a sustainable and meaningful implementation of public involvement activities in Austria.
Imagined food consumption is a method of elaborately imagining oneself eating a specific food that, when repeated 30 times, has been shown to decrease subsequent intake of the same food. The ...technique relies on a memory-based habituation process when behavioral and motivational responses to a stimulus decrease after its repeated presentation. Thus, repeatedly imagining food consumption leads to food-specific habituation effects. Large numbers of imagined consumption repetitions are effortful and time consuming and can be problematic when applied in interventions with the goal of reducing food intake. In the present study, we assessed the efficacy of the technique at smaller numbers of repetitions while testing motor simulation as a potential facilitator of the habituation-based consumption-reduction effect. 147 participants imagined eating chocolate pudding 15 or 3 consecutive times and simultaneously performed either facilitating or not-facilitating eating movements. Results showed that participants who imagined eating the chocolate pudding 15 times (
= 178.20,
= 68.08) ate more of the pudding than those who imagined consuming it 3 times (
= 150.73,
= 73.31). The nature of the motor movements that were performed did not impact this effect. The data suggest that the imagined food consumption technique can result in an unexpected increase in food consumption, when smaller numbers of imagination repetitions are performed.
Abstract Food marketing for children is a major concern for public health nutrition and many schools make efforts to increase healthy eating. Food environments surrounding schools in urban areas may ...undermine these efforts for healthy nutrition within school programs. Our study aim is to describe the nutrition environment within walking distance of schools in terms of food quality and food marketing and to explore the degree to which elements of the nutrition environment varies by proximity to schools. In a cross-sectional study, we analyzed the surrounding food environments of a convenience sample of 46 target schools within 950m walking distance in 7 different urban districts across Vienna, Austria. In total, we analyzed data from 67 fast food outlets and 54 supermarkets analyzing a total of 43.129 packaged snack food and beverage products, from which 85% were for adults and 15% of the products were child-oriented. Proximity to the schools did not affect the availability of child-oriented products and dedicated food advertisements for children. After applying nutrient profiling using the Nutrient Profiling Model (NPM) on child-oriented products, results showed that 15.8% of the packaged snack food were categorized as “healthy” foods and 84.2% as “less healthy”; for beverages 65.7% were categorized as “healthy” and 34.3% as “less healthy”. In conclusion, our results show that child-oriented snacks are not more frequently advertised around schools but substantially lack in nutritional quality with the potential to undermine efforts for promoting healthy eating practices within schools.
Adherence to a Mediterranean diet is associated with significant improvements in health status. However, to date no systematic review and meta-analysis has summarized the effects of Mediterranean ...diet adherence on the risk of type 2 diabetes mellitus.
Electronic searches for randomized controlled trials and cohort studies were performed in MEDLINE, SCOPUS, EMBASE and the Cochrane Trial Register until 2 April 2014. Pooled effects were calculated by an inverse-variance random-effect meta-analysis using the statistical software Review Manager 5.2 by the Cochrane Collaboration.
Meta-analysis of randomized controlled trials and cohort studies.
19+years of age.
One randomized controlled trial and eight prospective cohort studies (122 810 subjects) published between 2007 and 2014 were included for meta-analysis. For highest v. lowest adherence to the Mediterranean diet score, the pooled risk ratio was 0.81 (95 % CI 0.73, 0.90, P<0.0001, I 2=55 %). Sensitivity analysis including only long-term studies confirmed the results of the primary analysis (pooled risk ratio=0.75; 95 % CI 0.68, 0.83, P<0.00001, I 2=0 %). The Egger regression test provided no evidence of substantial publication bias (P=0.254).
Greater adherence to a Mediterranean diet is associated with a significant reduction in the risk of diabetes (19 %; moderate quality evidence). These results seem to be clinically relevant for public health, in particular for encouraging a Mediterranean-like dietary pattern for primary prevention of type 2 diabetes mellitus.
Aims/hypothesis
This study aimed to systematically review randomised controlled trials comparing the effects of aerobic exercise training (AET), resistance training (RT) and combined training (CT) on ...glycaemic control and blood lipids in patients with type 2 diabetes mellitus.
Methods
Searches were performed in MEDLINE, EMBASE and the Cochrane Library. Inclusion criteria were: type 2 diabetes mellitus, adult, supervised training and a minimum intervention period of 8 weeks. Pooled effects were calculated by fixed/random effect pairwise and Bayesian fixed/random effects network meta-analyses.
Results
A total of 14 trials enrolling 915 participants were included. AET was more effective than RT in improving HbA
1c
levels (mean difference MD −0.20% −2.2 mmol/mol; 95% CI −0.32, −0.08;
p
= 0.0007, 10 trials/515 participants) and fasting glucose (MD −0.9 mmol/l; 95% CI −1.71, −0.09;
p
= 0.03, 8 trials/245 participants). Compared with AET, CT resulted in a significantly more pronounced reduction in HbA
1c
(MD −0.17% −1.87 mmol/mol; 95% CI −0.31, −0.03;
p
= 0.02, 9 trials/493 participants). Compared with RT, the MD of the change in HbA
1c
(MD −0.62%, −6.82 mmol/mol; 95% CI −0.95, −0.30;
p
= 0.0002, 5 trials/362 participants, fasting glucose (MD −1.99 mmol/l; 95% CI −3.07, −0.90;
p
= 0.0003, 3 trials/99 participants) and triacylglycerols (MD −0.28 mmol/l; 95% CI −0.46, −0.10;
p
= 0.003, 4 trials/213 participants) were all in favour of CT. The exclusion of trials with a high risk of bias yielded only non-significant results.
Conclusions/interpretation
The present data suggest that CT might be the most efficacious exercise modality to improve glycaemic control and blood lipids. Interpretation with respect to clinical relevance is limited by the low quality of the studies included and the limited information on the clinically important outcomes or adverse effects of exercise.
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