What Are “Regular Meals”? A Dietary Quality-Driven Definition Supports a Meal-Specific Day-to-Day Consistency Approximating 0–120 Minutes

Objectives

Develop a definition of “regular meals” that aligns with optimum dietary quality.

Methods

Parents of 4th grade youth in an impact assessment of a school-based culinary & physical activity intervention completed three, 24-hour ASA24 dietary assessments. Intervals among the breakfasts, the lunches, and the dinners were arithmetically calculated and values of 3, 2, and 1 were assigned to definitions of “always,” “often/sometimes,” and “rarely/never” respectively for each meal to achieve a mealtime regularity score (MRS) ranging from 3 to 9. Values were assigned using 3 interval-based MRS versions iteratively based on descriptor proportionality. For each version, MRS was divided into groups based on 4 separate categorization strategies, i.e., 3 groups based on extremes and middle scores, 3 groups with more moderate delimiters, breakfast vs non-breakfast eaters, and 2 groups derived from median splits. Linear regression was used to predict HEI scores from MRS. Energy adjusted nutrient values and HEI scores were compared among MRS version categories using one-way ANOVA, independent t-tests, Mann-Whitney U, and Kruskal-Wallis as appropriate.

Results

Parents (n = 68) were non-Hispanic white (94%), female (88%), college educated (95%), had normal BMI (57%), with little history of SNAP participation (21%). HEI and Kcals were typical (55.8 ± 12.1; 1815 ± 553). No scoring scheme was unequivocally aligned with dietary quality indicators, but the median-driven categorization of 1 MRS version was more consistently correlated. This version assigned “always” to a day-to-day consistency of 60 minutes for breakfast, up to 120 min for lunch/dinner; “often/sometimes” for intervals as high as 90 minutes for breakfast and 120 minutes for lunch/dinner and “rarely/never” for greater intervals. 47%, 55%, and 71% identified with “always” for breakfast, lunch, and dinner respectively. Only the MRS based on these moderate delimiters (mean 7.24 ± 1.42) predicted HEI (ß 2.1, P 0.043), total fruit and whole fruit HEI. With this scoring strategy, regular eaters, i.e., those with scores ≥ median, consumed more dietary fiber and had greater HEI, total fruit and whole fruit HEI scores.

Conclusions

“Regular meals,” as aligned with dietary quality, were defined as MRS ≥ median that were derived using less stringent interval and meal-skipping parameters.

Funding Sources

USDA, NIFA

Aurora Kinase A is critical for the Nkx6.1 mediated β-cell proliferation pathway

Type 1 and type 2 diabetes are ultimately characterized by depleted β-cell mass. Characterization of the molecular pathways that control β-cell proliferation could be harnessed to restore these cells. The homeobox β-cell transcription factor Nkx6.1 induces β-cell proliferation by activating the orphan nuclear receptors Nr4a1 and Nr4a3. Here, we demonstrate that Nkx6.1 localizes to the promoter of the mitotic kinase AURKA (Aurora Kinase A) and induces its expression. Adenovirus mediated overexpression of AURKA is sufficient to induce proliferation in primary rat islets while maintaining glucose stimulated insulin secretion. Furthermore, AURKA is necessary for Nkx6.1 mediated β-cell proliferation as demonstrated by shRNA mediated knock down and pharmacological inhibition of AURKA kinase activity. AURKA preferentially induces DNA replication in β-cells as measured by BrdU incorporation, and enhances the rate of histone H3 phosphorylation in primary β-cells, demonstrating that AURKA induces the replicative and mitotic cell cycle phases in rat β-cells. Finally, overexpression of AURKA results in phosphorylation of the cell cycle regulator p53, which targets p53 for degradation and permits cell cycle progression. These studies define a pathway by which AURKA upregulation by Nkx6.1 results in phosphorylation and degradation of p53, thus removing a key inhibitory factor and permitting engagement of the β-cell proliferation pathway.

Administration of Recombinant Factor VIIa Decreases Blood Loss After Blunt Trauma in Noncoagulopathic Pigs

BACKGROUND

Activated factor VII catalyzes the activation of clotting factors IX and X within the clotting cascade, and has been used clinically to decrease bleeding in patients with hemophilia and other bleeding disorders. Studies suggest the use of recombinant VIIa (rVIIa) may decrease bleeding after injury in the presence of a coagulopathy, but there is conflicting evidence regarding its use in the absence of coagulopathy. This study was performed to determine whether a single dose of rVIIa would reduce blood loss in noncoagulopathic pigs after blunt trauma.

METHODS

Anesthetized pigs were subject to multiple blunt injuries consisting of a femur fracture, liver laceration, and soft-tissue crush injury. Fifteen minutes after the trauma, pigs were randomized to receive a single 120 microg/kg dose of rVIIa or placebo. Mean arterial pressure, heart rate, temperature, and hematocrit (Hct) were measured during a 2-hour period of standardized fluid resuscitation. The primary endpoint was blood loss.

RESULTS

The degree of trauma in the two groups was similar. Animals in the treated group had a mean blood loss of 19.6 mL/kg (13.5-25.7) versus 30.0 mL/kg (24.8-35.3) in the control group (p = 0.037).

CONCLUSIONS

A single dose of 120 microg/kg of rVIIa can significantly decrease blood loss in traumatized pigs with no preexisting coagulopathy. Further studies are required to determine the lowest effective dose of this medication.