Objective
Intermittent fasting (IF) is a term used to describe a variety of eating patterns in which no or few calories are consumed for time periods that can range from 12 hours to several days, on ...a recurring basis. This review is focused on the physiological responses of major organ systems, including the musculoskeletal system, to the onset of the metabolic switch: the point of negative energy balance at which liver glycogen stores are depleted and fatty acids are mobilized (typically beyond 12 hours after cessation of food intake).
Results and Conclusions
Emerging findings suggest that the metabolic switch from glucose to fatty acid‐derived ketones represents an evolutionarily conserved trigger point that shifts metabolism from lipid/cholesterol synthesis and fat storage to mobilization of fat through fatty acid oxidation and fatty acid‐derived ketones, which serve to preserve muscle mass and function. Thus, IF regimens that induce the metabolic switch have the potential to improve body composition in overweight individuals. Moreover, IF regimens also induce the coordinated activation of signaling pathways that optimize physiological function, enhance performance, and slow aging and disease processes. Future randomized controlled IF trials should use biomarkers of the metabolic switch (e.g., plasma ketone levels) as a measure of compliance and of the magnitude of negative energy balance during the fasting period.
Introduction Muscle strength may play a role in cardiometabolic disease. We examined the relationship between hand grip strength and diabetes and hypertension in a sample of healthy weight adults. ...Methods In 2015, we analyzed the National Health and Nutrition Examination Survey 2011–2012 for adults aged ≥20 years with healthy BMIs (between 18.5 and <25) and no history of cardiovascular disease (unweighted n =1,467; weighted n =61,587,139). Hand grip strength was assessed with a dynamometer. Diabetes was based on hemoglobin A1c level and reported diabetes diagnosis. Hypertension was based on measured blood pressure and reported hypertension diagnosis. Results Individuals with undiagnosed diabetes compared with individuals without diabetes had lower grip strength (51.9 vs 69.8, p =0.0001), as did individuals with diagnosed diabetes compared with individuals without diabetes (61.7 vs 69.8, p =0.008). Mean grip strength was lower among individuals with undiagnosed hypertension compared with individuals without hypertension (63.5 vs 71.5, p =0.008) as well as among individuals with diagnosed hypertension compared with those without hypertension (60.8 vs 71.5, p <0.0001). In adjusted analyses controlling for age, sex, race, smoking status, and first-degree relative with disease, mean grip strength was lower for undiagnosed diabetes (β=–10.02, p <0.0001) and diagnosed diabetes (β=–8.21, p =0.03) compared with individuals without diabetes. In adjusted analyses, grip strength was lower among individuals with undiagnosed hypertension (β=–6.6, p =0.004) and diagnosed hypertension (β=–4.27, p =0.04) compared with individuals without hypertension. Conclusions Among healthy weight adults, combined grip strength is lower in individuals with diagnosed and undiagnosed diabetes and hypertension.
The Circle of Trust is a new conceptual model that can help investigators and the American Indian/Alaska Natives (AI/AN) community work together to promote inclusion of AI/AN populations in clinical ...trials to improve health outcomes. Racial/ethnic minority groups remain underrepresented in clinical trials and this creates the need and opportunity for novel approaches. Indigenous populations are particularly underrepresented in clinical trials. Studies show that AI/AN have the lowest representation of race/ethnic groups in the United States. American Indian/Alaska Natives suffer from significant health disparities with higher rates of morbidity and mortality and lower rates for preventative measures and access to health services. A variety of barriers to recruitment of minority patients exist at several levels including the system/institutional, interpersonal, and the individual. The authors, experts in AI/AN health and recruitment of minorities into research, collaborated to modify the currently existing and published "trust triangle" model that focuses on minority recruitment to include participants, researcher, and trusted entity. We advocate for expanding the trust triangle into a circle of trust inclusive of community. The "circle of trust" is a new conceptual model that can help investigators and the AI/AN community work together to promote inclusion of AI/AN populations in clinical trials to improve health outcomes.
Wearable devices have become a standard health care intervention with emerging health care technologies. These devices are designed to promote healthy behaviors and decrease risk for chronic disease ...like cardiovascular disease and diabetes. The purpose of this study was to provide evidence of the benefit of wearable devices in chronic disease outcomes among adults. Systematic search of PubMed, Web of Science, World Health Organization international clinical trials registry platform, BMC ISRCTN registry, and the Institute of Electrical and Electronics Engineers was performed based upon the PRISMA guideline. Included articles were randomized controlled trials or quasi-experimental studies with health outcomes published in English up to October 2018. Studies focusing on adults were selected. Three investigators reviewed the selected publications and made agreement on final selection. Of a total of 550 publications extracted, 6 studies met the final criteria. There was little indication that wearable devices provide a benefit for health outcomes. Of the 6 studies examined, only one study showed a significant reduction for weight loss among participants who used wearable devices. No significant reduction was discovered in cholesterol or blood pressure. Among the 6 studies, only one study examined hemoglobin A1c, and it showed a significant reduction in older patients with type 2 diabetes. The current literature evaluating wearable devices indicates little benefit of the devices on chronic disease health outcomes. Wearable devices play a role as a facilitator in motivating and accelerating physical activity, but current data do not suggest other consistent health benefits.
Abstract Background Intake of dietary fiber has been recommended for many years as part of the guidelines from the American Heart Association, the Institute of Medicine, and other groups. The ...recommended Adequate Intake for dietary fiber for adults is 25 to 38 g/day (14 g/1,000 kcal/day). Objective To determine the average daily intake of dietary fiber among adults during the past decade and, specifically, to document progress toward national goals. Design Cross-sectional weighted data from the National Health and Nutrition Examination Survey among adults aged 18 years and older. Participants/setting Data were collected from noninstitutionalized adults aged 18 years and older using a nationally representative, complex, multistage, probability-based survey of people living in the United States that was conducted by the National Center for Health Statistics. Main outcome measures Daily dietary fiber intake by members of the US population based on 2-year groupings of the continuous survey from 1999 to 2008. Results Mean daily dietary fiber intake for 1999-2000 was 15.6 g/day, for 2001-2002 intake was 16.1g/day, for 2003-2004 intake was 15.5 g/day, for 2005-2006 intake was 15.8 g/day, and for 2007-2008 intake was 15.9 g/day. Participants with obesity (body mass index ≥30) consistently reported lower fiber intake than did individuals with normal weight or overweight (14.6 to 15.4 g/day and 15.6 to 16.8 g/day, respectively; P <0.0001). Mexican Americans had significantly higher intake in 1999-2000 than non-Hispanic whites (18.0 vs 16.1g/day; P <0.05), but Mexican Americans' intake did not increase over time (17.7 g/day in 2007-2008). Non-Hispanic blacks had fiber intake of 12.5 g/day at baseline that increased modestly to 13.1 g/day by 2007-2008. Conclusions Daily fiber intake generally has not progressed toward national goals during the past decade, but there are some differences according to health and social factors. Additional clinical practice and public health strategies are needed.
Abstract Background Lifestyle choices are associated with cardiovascular disease and mortality. The purpose of this study was to compare adherence to healthy lifestyle habits in adults between 1988 ...and 2006. Methods Analysis of adherence to 5 healthy lifestyle trends (≥5 fruits and vegetables/day, regular exercise >12 times/month, maintaining healthy weight body mass index 18.5-29.9 kg/m2 , moderate alcohol consumption up to 1 drink/day for women, 2/day for men and not smoking) in the National Health and Nutrition Examination Survey 1988-1994 were compared with results from the National Health and Nutrition Examination Survey 2001-2006 among adults aged 40-74 years. Results Over the last 18 years, the percent of adults aged 40-74 years with a body mass index ≥30 kg/m2 has increased from 28% to 36% ( P <.05); physical activity 12 times a month or more has decreased from 53% to 43% ( P <.05); smoking rates have not changed (26.9% to 26.1%); eating 5 or more fruits and vegetables a day has decreased from 42% to 26% ( P <.05), and moderate alcohol use has increased from 40% to 51% ( P <.05). Adherence to all 5 healthy habits has gone from 15% to 8% ( P <.05). Although adherence to a healthy lifestyle was lower among minorities, adherence decreased more among non-Hispanic Whites over the period. Individuals with a history of hypertension/diabetes/cardiovascular disease were no more likely to be adherent to a healthy lifestyle than people without these conditions. Conclusions Generally, adherence to a healthy lifestyle pattern has decreased during the last 18 years, with decreases documented in 3 of 5 healthy lifestyle habits. These findings have broad implications for the future risk of cardiovascular disease in adults.
Abstract Purpose Building research capacity and increasing scholarly productivity are identified needs of the specialty of family medicine. The Accreditation Council for Graduate Medical Education ...(ACGME) has increased the scholarly requirements for residency programs, placing even more pressure on faculty to be productive in the scholarly realm. The Council of Academic Family Medicine Educational Research Alliance (CERA) was created by volunteer members of the specialty with shared interests in overcoming barriers and increasing scholarly production. Methods CERA has developed the infrastructure and expertise to regularly conduct omnibus surveys of key family medicine educational leaders. Proposals are centrally collected and competitively chosen. The omnibus survey process includes collaboration with experienced mentors, centralized institutional review board clearance, pilot testing, and centralized data collection. The survey results are disseminated back to research teams for presentation and publication of the findings. Results To date, over 115 research teams have had their projects included in CERA omnibus surveys. Projects have been led by research teams from across the country and with a wide variety of research experience. This collaborative work has resulted in more than 75 scientific presentations and over 55 peer-reviewed papers in the medical literature. The raw data are now available online and serve as a repository for future secondary analysis and as an educational resource. Conclusions The CERA infrastructure has allowed a large number of research teams to conduct meaningful scholarship at a fraction of the typical cost in terms of time and energy. CERA has expanded family medicine research by removing barriers for teams with limited experience or resources.
PDF
