Effectiveness of dietary advice given by community dietitians to men with elevated blood cholesterol in a clinical setting: a pilot study

Sugar-fat seesaw: a systematic review of the evidence

Further to reports of a reciprocal relationship between sugar and fat intakes, this review aimed to provide an in-depth analysis and to determine the likely influence of this relationship on the achievement of population dietary guidelines. Using systematic methods, relevant literature was selected according to preset criteria. A strong and consistent inverse association was found between total sugars and total fat intakes expressed as percentage energy. Fewer studies considered absolute intakes and these reported a positive relationship, which may be influenced by confounding with energy intakes. Evidence for an inverse relationship between percentage energy from fat and extrinsic sugars was weaker and less consistent than for fat and total sugars. Reciprocal relationships were also observed for sugar-saturated fat, sugar-protein, sugar-alcohol, and sugar-starch expressed as percentage energy. Under-reporting of dietary intakes had no major influence on the findings. This review confirms the existence of the sugar-fat seesaw on a percentage energy basis and concludes that it is most likely explained by a combination of mathematical and food compositional effects. This finding is relevant because dietary guidelines are expressed as percentage energy and implies that at the population level multiple guidelines may be difficult to achieve in practice.

Effects on nutrient intake of a family-based intervention to promote increased consumption of low-fat starchy foods through education, cooking skills and personalised goal setting: the Family Food and Health Project

Reducing the prevalence of fat-rich, energy-dense diets is a public health priority. The present parallel-designed randomised study compared three interventions aimed to increase intakes of low-fat starchy foods and to reduce fat intakes among 589 individuals from 169 families in the Family Food and Health Project (FFHP). Intervention A was education only, intervention B provided 'cook and eat' sessions only, whereas intervention C included personalised goal setting, 'cook and eat' and education. Diet was assessed at baseline (T0) and at 3 months (T1), 6 months (T2) and 18 months (T3) post-intervention. Retention rates were 75 % at T1, 63 % at T2 and 40 % at T3. ANCOVA (baseline intake as covariate) was assessed between intervention differences at T1, T2 and T3. At T1, individuals in intervention C consumed less fat (P = 0·02) and more total carbohydrate (P = 0·001), starch (P = 0·04) vitamin C (P = 0·002) and NSP (P = 0·01) than those in intervention A. Whereas similar dietary intakes were reported across interventions at T2, participants in intervention C had less energy-dense diets that contained more NSP and vitamin C at T3 than intervention A (P < 0·0001, P = 0·002 and P = 0·01, respectively). Across all intervention groups, the more socially deprived participants in the FFHP (n 119) consumed less fat (P = 0·01) and more total carbohydrate (P = 0·02) at T2 than the least socially deprived (n 240). These data demonstrate the importance of personalised goal setting to translate knowledge and practical cooking skills into healthier food choices, suggesting that low-fat starchy food-focused interventions may be effective in reducing fat intake.

The value of a general therapeutic approach in subjects with irritable bowel syndrome

BACKGROUND

The general therapeutic approach is the cornerstone in the management of irritable bowel syndrome, but the effect is poorly documented.

AIM

To evaluate the effect of the general therapeutic approach for irritable bowel syndrome.

METHODS

Subjects with irritable bowel syndrome identified in a public screening were included. Scores for abdominal symptom (range 0-12), musculoskeletal pain and mood disorders were calculated. After exclusion of other disorders, a doctor presented irritable bowel syndrome as a positive diagnosis, gave information, reassurance and lifestyle advice, but no pharmacotherapy. A dietician gave dietary advice. There was a follow-up after 6 months.

RESULTS

Sixty-five persons (females/males: 44/21) with mean age 49 years (range 31-76) were included, 31 (48%) were recommended dietary changes. Twenty subjects (31%) had satisfactory relief of symptoms after 6 months. The scores for abdominal symptom was reduced from 3.1 to 2.2 (P = 0.007), the reduction was 2.2 in the diarrhoea-predominant group given advice compared with 0.4 in the other subjects (P = 0.035). Previous consultations for the complaints, visits for psychiatric disorders, and presence of mood disorders were predictors of persistent complaints.

CONCLUSIONS

There was a significant relief of symptoms after 6 months, those with psychological co-morbidity responded less well. The effect of dietary advice was only seen in those with diarrhoea-predominant irritable bowel syndrome.