Lived experiences of healthcare. Putting the person in person centred care in the medical radiation sciences

INTRODUCTION

Contemporary healthcare models recognise person-centred care (PCC) as a fundamental principle of quality, safe care. While substantial literature exists on PCC in healthcare generally, there is less evidence on how this relates to medical imaging and radiation therapy. Embedding patient-lived experiences of healthcare into healthcare education has promise in enhancing students' confidence in delivering PCC. Digital storytelling (DST) of patient-lived experiences can help improve reflection, understanding, critical thinking and empathy.

METHODS

Authentic patient-lived experiences were extracted from students' clinical workbooks, transformed into first person vignettes and integrated into the curriculum. Students were invited to attend focus groups to explore the impact the activity had on the student.

RESULTS

Thematic analysis identified three themes. (1) Enhancing PCC; (2) Mode of Delivery (Scaffolded Learning); and (3) Collaborative Learning. PCC was the strongest theme with students stating this is the first time they engaged in an activity focused on the psychosocial aspect of patient care. The majority of students indicated the mode of delivery was engaging and unique, whereby the vignettes were presented incrementally. Collaborative learning was identified by over half of the students where learning took place in a safe and supportive environment.

CONCLUSION

This project explored students' perspectives of integrating patient-lived experiences into the curriculum via DST. Students who engaged with the activities felt better prepared to deliver quality safe PCC.

IMPLICATIONS FOR PRACTICE

Providing healthcare students with opportunities to develop skills to deliver PCC before they enter the workforce can enhance their confidence in delivering effective PCC.

Severe vitamin C deficiency associated with continuous renal replacement therapy: A case report

Hypovitaminosis C is prevalent in critically ill patients. Continuous renal replacement therapy (CRRT) clears vitamin C, increasing the risk for vitamin C deficiency. However, recommendations for vitamin C supplementation in critically ill patients receiving CRRT vary widely, from 250 mg/day to 12 g/day. This case report describes a patient who developed a severe vitamin C deficiency after prolonged CRRT despite receiving ascorbic acid (450 mg/day) supplementation in her parenteral nutrition. This report summarizes recent research investigating vitamin C status in critically ill patients receiving CRRT, discusses the patient case, and provides recommendations for clinical practice. In critically ill patients receiving CRRT, the authors of this manuscript suggest providing at least 1000 mg/day of ascorbic acid to prevent vitamin C deficiency. Baseline vitamin C levels should be checked in patients who are malnourished and/or have other risk factors for vitamin C deficiency, and vitamin C levels should be monitored thereafter every 1-2 weeks.

Small-bore feeding tubes placed with an electromagnetic imaging device leads to cost avoidance and decreased time to initiation of enteral nutrition

BACKGROUND

The Cortrak Enteral Access System (CEAS) was previously approved by the United States Food and Drug Administration (FDA) to be used in lieu of radiographic confirmation imaging for feeding tubes placed by trained clinicians. Following an institutional protocol change in 2016, our registered dietitians had the option to forgo radiographic confirmation imaging for tubes placed using the CEAS. Our research aimed to determine the difference in the number of radiographic confirmation images for feeding tubes placed using the CEAS between preprotocol and postprotocol environments and the associated cost avoidance after the institutional policy change.

METHODS

We retrospectively reviewed data from 506 tube placements (n = 253 per protocol environment) in adult patients with diverse diagnoses admitted to various in-patient care units.

RESULTS

There was a significant reduction in the mean number of radiographic images per tube placement (preprotocol = 1.10 [95% CI, 1.05-1.15]; postprotocol = 0.36 [95% CI, 0.30-0.41]; P < 0.001), leading to a cost avoidance of $67,282.80 for the 253 tube placements and a potential cost avoidance of $279,236 over the 5-year postprotocol environment. Additionally, the mean time to initiation of enteral nutrition was significantly reduced by 2.65 h in the postprotocol environment (P < 0.001).

CONCLUSION

Our findings suggest that using the CEAS can reduce the number of radiographic images, provide cost avoidance, and improve nutrition outcomes. However, updated 2022 FDA regulatory changes to the use of the CEAS for tube confirmation lead to an uncertain future for this practice because of safety concerns.

Early and intensive Motor Training for people with spinal cord injuries (the SCI-MT Trial): description of the intervention

STUDY DESIGN

Descriptive.

OBJECTIVES

The primary objective is to describe the intervention that will be provided in a large multi-centre randomised controlled trial titled: Early and Intensive Motor Training for people with Spinal Cord Injuries (the SCI-MT Trial). The secondary objective is to describe the strategies that will be used to operationalise and standardise the Motor Training provided to participants while keeping the intervention person-centred.

METHODS

The paper focuses on the rationale and principles of Motor Training for people with spinal cord injuries (SCI). The description of the intervention is based on the Template for Intervention Description and Replication (TIDieR) checklist. Specifically, it addresses the following 6 criteria of the TIDieR checklist: why the effectiveness of Motor Training is being examined; what, how, where and when the Motor Training will be administered; and how much Motor Training will be provided.

RESULTS

A detailed intervention manual has been developed to help standardise the delivery of the intervention.

CONCLUSIONS

This paper describes the details of a complex intervention administered as part of a large randomised controlled trial. It will facilitate the subsequent interpretation of the trial results and enable the intervention to be reproduced in clinical practice and future trials.

Greater male variability in daily energy expenditure develops through puberty

There is considerably greater variation in metabolic rates between men than between women, in terms of basal, activity and total (daily) energy expenditure (EE). One possible explanation is that EE is associated with male sexual characteristics (which are known to vary more than other traits) such as musculature and athletic capacity. Such traits might be predicted to be most prominent during periods of adolescence and young adulthood, when sexual behaviour develops and peaks. We tested this hypothesis on a large dataset by comparing the amount of male variation and female variation in total EE, activity EE and basal EE, at different life stages, along with several morphological traits: height, fat free mass and fat mass. Total EE, and to some degree also activity EE, exhibit considerable greater male variation (GMV) in young adults, and then a decreasing GMV in progressively older individuals. Arguably, basal EE, and also morphometrics, do not exhibit this pattern. These findings suggest that single male sexual characteristics may not exhibit peak GMV in young adulthood, however total and perhaps also activity EE, associated with many morphological and physiological traits combined, do exhibit GMV most prominently during the reproductive life stages.

A215 EVALUATING THE COMPARABILITY OF CARE FOR PERSONS ADMITTED TO TORONTO AREA HOSPITALS WITH ACUTE SEVERE ULCERATIVE COLITIS

Background

Approximately 20% of patients with ulcerative colitis will experience an acute severe exacerbation requiring hospitalization. Acute severe ulcerative colitis (ASUC) is a medical emergency associated with significant morbidity and a mortality rate of 1%. Timely initiation of treatment and assessment of clinical response is critical in the management of ASUC. With an aim to reduce treatment variability and improve outcomes, multiple gastrointestinal societies have published guidelines highlighting recommendations for optimal care in ASUC. It remains unclear how closely these guidelines are implemented in clinical practice. Measuring adherence to these recommended processes of care may act as a surrogate measure for quality of care and a way to indirectly evaluate outcomes in the management of patients with ASUC. Studies have shown that even amongst experienced providers practice pattern variability exists. Identifying significant variations in the management of patients with ASUC will highlight where improvement in guideline dissemination and greater adherence is required.

Purpose

We sought to evaluate how quality of care indicators varied across 7 hospital sites for patients admitted ASUC in the Greater Toronto Area.

Method

Using GEMINI, a research collaborative that collects and analyses data from inpatient admissions at 7 Toronto area hospitals, we identified patients admitted to hospital with ASUC from June 2016-December 2019. Hospital sites were further categorized into 3 hospital types; 1 IBD specialty centre (ISC), 3 other academic centres (AC) and 3 community centres (CC). Process measures assessed included proportion tested for C-reactive protein at baseline and following treatment initiation, duration of corticosteroid use, timing and initiation of biologic agents, rates of venous thromboembolism prophylaxis and opioid use. Outcome measures included hospital length of stay, rates of colectomy and mortality.

Result(s)

765 hospitalizations were included in the study; 320 occurring at ISC, 308 at AC and 137 at CC. Corticosteroid use on admission were highest at the ISC at 78% compared to 64% at AC and 63% at CC (p <0.001). Among those who received steroids on admission, 47% of patients remained on intravenous corticosteroids for at least 5 days in the ISC compared to 39% in AC and 75% in CC (p< 0.001). Initiation of biologic rescue therapy was highest at the ISC occurring in 37% of hospitalizations compared to 22% in AC and 23% in CC (p<0.001). In addition, VTE prophylaxis rates were highest at the ISC at 83% followed by 60% in AC and 45% in CC (p<0.001). Rates of colectomy were highest at ISC (12% of hospitalizations vs. 7% in AC).

Conclusion(s)

Greater adherence to indicators of quality of care were seen at the ISC compared to ACs and CCs, although patient outcomes assessed were not clearly different between sites. Further strategies are required to improve adherence to markers of quality care for patients admitted with ASUC.

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None

Disclosure of Interest

None Declared

Suicide crises among women and mothers during and around the time of pregnancy: Prevalence and timing of initial contact with first responders and health services

OBJECTIVES

Suicide is a leading cause of maternal mortality. Suicidality during and around the time of pregnancy can have detrimental impacts on a child's development and outcomes. This paper examines prevalence, demographic characteristics, and timing of initial contact with first responders and health services for a cohort of women who experienced suicidality during and around the time of pregnancy.

METHODS

Findings are drawn from the Partners in Prevention (PiP) study, a population-wide linked data set of suicide-related attendances by police or paramedics in Queensland, Australia. A sub-cohort of women was identified, who were between 6 months preconception and 2 years postpartum at the time of a suicide-related contact with police or paramedics (PiP-Maternal). Findings are compared to other girls and women who had a suicide-related contact with police or paramedics (PiP-Female). Prevalence, demographic characteristics, timing of contact with first responders and health services, re-presentations, and mortality are reported.

RESULTS

The PiP-Maternal cohort comprised 3020 individuals and 3400 births. Women in the PiP-Maternal cohort were younger, more likely to be of Aboriginal and/or Torres Strait Islander descent and live outside of a major city than the PiP-Female cohort. There were high rates of out-of-hours calls to police and ambulance, and similar perceived seriousness of the call between women in the PiP-Maternal and PiP-Female cohorts. Women in the PiP-Maternal cohort were less likely to be admitted to an emergency department within 24 hours, even after matching on covariates. Prevalence of suicidality for women who were pregnant and up to 2 years postpartum was 1.32% (95% CI = [1.27, 1.37]).

CONCLUSION

Vulnerabilities and high rates of contact with police or paramedics, coupled with lower levels of follow-up, highlight the critical need to improve service responses for women with mental health needs during these phases of life.

A review of the efficacy of appetite stimulating medications in hospitalized adults

BACKGROUND

The majority of evidence on efficacy of appetite-stimulating medications is limited to specific populations and the outpatient treatment setting. However, hospitalized adults remain at risk for poor appetite and inadequate intake.

METHOD

The purpose of this review was to assess recent evidence on the efficacy of dronabinol, megestrol acetate, and mirtazapine (used to stimulate appetite) on promoting change in intake; somatic symptoms, such as appetite and nausea; and weight change during hospital stay. The population was limited to hospitalized adults or adults who demonstrated a need for appetite stimulation during hospitalization.

RESULTS

Of the 382 articles screened, four met inclusion criteria (one randomized control trial, two retrospective cohort studies, and one retrospective case series). Based on the studies included, these appetite stimulants have limited efficacy on improving appetite and meal intake. There was no significant change in weight.

CONCLUSION

Current data lack standardization, generalizability, and comparability, and higher quality evidence is needed before conclusions can be identified on the efficacy of dronabinol, megestrol acetate, and mirtazapine in the inpatient setting.

Are UK pharmacists ready for consultant-level practice? A cross-sectional survey of self-assessed development needs

OBJECTIVES

The four nations of the United Kingdom (UK) have endorsed a new curriculum and credentialing process for consultant pharmacists. This study aimed to measure the self-reported consultant-level practice development needs of pharmacists across the UK.

METHODS

The study was a cross-sectional electronic survey. Inclusion criteria were: pharmacists registered to practice with the General Pharmaceutical Council; working in any professional sector across the UK; and self-identifying as already working at an advanced level of practice or in an advanced pharmacist role. Participants were asked to rate their confidence that their current practice aligns to the level described in the Royal Pharmaceutical Society Consultant Pharmacist curriculum on a 5-point Likert scale. Predictors of overall confidence with the whole curriculum were analysed using binomial regression.

KEY FINDINGS

Nine hundred and forty-four pharmacists participated. Median age was 42 years; 72.6% were female. Research skills and strategic leadership skills had low self-reported confidence. Patient-Centred Care and Collaboration was the domain with the highest reported confidence. 10.2% (96/944) of participants self-reported confidence across the whole curriculum. The strongest predictors of overall confidence across the curriculum were advanced clinical practitioner qualification, research qualifications and self-identifying as a specialist. Increasing age and male gender also predicted confidence. White ethnicity and having an independent prescribing qualification negatively predicted confidence.

CONCLUSION

A small minority of pharmacists self-reported confidence across the whole curriculum. A planned approach to develop research skills across the career spectrum, coupled with better identification of workplace-based experiential strategic leadership opportunities, may help deliver a larger cohort of 'consultant-ready' pharmacists.

Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry

AIMS

The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation.

METHODS AND RESULTS

Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin.

CONCLUSION

The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.

Uncovering the Model and Philosophy of Care of a Psychiatric Inpatient Mother-Baby Unit in a Qualitative Study with Staff

The postnatal period is high-risk time for the first onset and recurrence of maternal mental health disorders. Untreated maternal mental illness can have significant adverse impacts on a woman, her baby, and the wider family unit. For women with mental illnesses that cannot be managed in the community, psychiatric inpatient mother-baby units are the gold standard treatment whereby mothers are co-admitted with their infant for specialist perinatal and infant mental health assessment and treatment. The study explores the model of care and examines the philosophies of care that are used within a psychiatric mother-baby unit. Purposive sampling was used to conduct semi-structured focus group and individual interviews with multidisciplinary staff members at a single mother-baby unit. Themes derived from these interviews were coded into two primary themes and a range of sub-themes. The first primary theme focused on the Model of Care consisting of the following sub-themes: mental health care, physical health care, babies' care, building mother-baby relationship, fostering relationships with supports, and facilitating community support. The second primary theme centered around the Philosophy of Care comprising of: person-centered care, trauma-informed care, compassion-centered care, recovery-oriented care, attachment-informed care, non-judgmental care, strengths-based care and interdisciplinary care. The model can be used to provide consistency across mother-baby units and to support core capabilities of staff in providing an optimal level of care.

Hunger Associations With Meal Timing and Adherence to Potential Meal Timing Recommendations for Weight Loss

Objectives

Poor meal timing (MT) habits, such as irregular day-to-day eating and eating late at night, increase the risk for weight gain and developing chronic diseases such as type 2 diabetes and cardiovascular disease. We examined two potential barriers to improving MT habits, overall hunger level and time of day of greatest hunger, in relation to MT habits. We hypothesized that a greater overall hunger level and later onset of greatest hunger would associate with unhealthier MT habits and lower adherence to MT recommendations.

Methods

This was a secondary analysis of data from a cross-sectional study on diet and energy regulation in 116 healthy, nonsmoking adults (63% F; aged 29.4 ± 11.9 y; BMI 24.3 ± 3.8 kg/m²; race/ethnicity distribution: 76% white, 15% Asian American, 9% Black/African American/other). Three poor MT habits were examined: eating later in the day (later midpoint of ingestive period), eating late at night (2000–2259) and overnight (2300–0459); and having a shorter overnight fast. Hunger, assessed by the Eating Inventory, and self-reported time of day of greatest hunger, were examined in relation to MT patterns and categorical MT outcomes which, based on the literature, could represent desirable target cutoffs for improvements of MT habits (i.e., potential MT recommendations). MT was determined using the Meal Pattern Grid modified to assess MT on both weekdays and weekend days.

Results

After inclusion of all covariates (age, sex, race, physical activity, bed time, dietary restraint and disinhibition scores, sleep duration, and sleep quality), a higher hunger score was associated with a ≥ 13 h overnight fast (p < 0.05), suggesting that participants were able to achieve a longer overnight fast despite being hungrier. Additionally, higher hunger was marginally associated with eating less often late at night (8:00–10:59 pm) (p = 0.08). Time of day of greatest hunger was not associated with any MT variables examined.

Conclusions

Our findings did not support the hypothesis that greater hunger prevents healthier MT patterns that have a longer interval of overnight fasting. Future studies are needed to determine if dietary approaches to reducing hunger promote adherence to healthy MT patterns.

Funding Sources

NIDDK.

Weight Loss Trajectory Patterns and Short-Term Prediction in a Weight Management Program

Objectives

There is controversy over the extent to which initial weight loss in behavioral weight control interventions predicts long-term success. In this study, we aimed to identify typical weight trajectories, develop an algorithm to automatically classify participants’ performance, and examine the capacity for long-term prediction of weight loss from weight records in the first 14 days.

Methods

A commercial weight loss program offering clinically impactful behavioral support provided weight data for unrestricted use to Tufts University (Instinct Health Science, www.theidiet.com). We analyzed 302,762 weight records for 2508 participants who enrolled in the program between 2012 and 2019 and were asked to self-report weight daily. For this analysis, we focused on 73,545 records from 747 participants who met the following criteria: weight records for a duration of 70–365 days with the interval between consecutive records <30 days and with a minimum of 5 records over the recorded duration. We applied sequential polynomial regressions with linear, quadratic, and cubic terms to model the individual weight trajectory. Based on models’ fit, coefficients, and estimated critical values, we classified individual weight trajectories into 7 distinct weight loss patterns. We applied a multinomial logistic regression to test the weight records in the first 14 days can predict the late outcomes of the individuals’ trajectory.

Results

Among the selected participants, the average weight loss was 6.9 ± 5.1 kg over 163.1 ± 85.4 days. We identified 7 weight trajectory patterns: 1-Steady decrease over time (31%); 2-Decrease to a plateau with subsequent decline (11%); 3-Decrease to a plateau with subsequent increase (48%); 4-Prominent short-term increase at the start followed by decrease (2%); 5-Decrease with a prominent increase at the end (3%); 6-No detectable increase or decrease (4%); 7-Steady increase over time (1%). Participants with the shallower weight loss and less frequent recording in the first 14 days along with the longer duration are more likely to adhere to Pattern 3 as compared to Pattern 1 (52%: 0.48 [0.26,0.89]; 7%: 0.93 [0.87,0.99]; 0.9%: 1.009 [1.005,1.012], respectively).

Conclusions

Sequential predictive modeling of weight change patterns could help to inform personalized weight management programs.

Funding Sources

None.

Protocol for Determining Appropriate Adaptations for the International Weight Control Registry to Be Inclusive of People With Physical Disabilities

Objectives

People with physical disabilities (PWD) are at increased risk for developing obesity and weight-related comorbidities compared to the general population. While some barriers to weight loss (WL) are known, many behavioral, environmental, and psychological contributors to WL and weight loss maintenance (WLM) have yet to be identified for PWD. The International Weight Control Registry (IWCR) is a newly established longitudinal study that seeks to facilitate a deeper understanding of factors contributing to successes and challenges of weight management in diverse populations. However, the IWCR has not been systematically evaluated for its inclusiveness of PWD. The objective of this study is to identify suitable adaptations to the IWCR for it to be inclusive of PWD and identify unique contributors to WL and WLM for PWD.

Methods

Adaptations will be identified using two expert panels: 1) a panel of inclusion specialists from the National Center on Health, Physical Activity & Disability and 2) a panel of PWD recruited from the Lakeshore Foundation in Birmingham, AL, (a fitness and advocacy organization for PWD) and previous participants in research including PWD. A Delphi method will be used to review questionnaires for inclusive language and to ensure the survey accurately represents issues relevant to PWD. PWD will then be recruited into the IWCR using the adapted questionnaire. Participants with and without disabilities will then be compared to determine components integral for WL and WLM between groups.

Results

Study results will lead to an adapted version of the IWCR which will 1) identify psychological, environmental, and behavioral components leading to WL and WLM success for PWD and 2) evaluate differences between people with and without disabilities regarding barriers and facilitators to WL and WLM.

Conclusions

The resulting registry is the first of its kind for PWD and will provide invaluable insight related to WL and WLM for PWD. These findings will help to inform obesity treatment for this population and will be incorporated into weight loss interventions for PWD in an effort to improve outcomes.

Funding Sources

PhD training of Julianne Clina has been supported by the National Center on Health, Physical Activity & Disability.

Feasibility of whole genome and transcriptome profiling in pediatric and young adult cancers

The utility of cancer whole genome and transcriptome sequencing (cWGTS) in oncology is increasingly recognized. However, implementation of cWGTS is challenged by the need to deliver results within clinically relevant timeframes, concerns about assay sensitivity, reporting and prioritization of findings. In a prospective research study we develop a workflow that reports comprehensive cWGTS results in 9 days. Comparison of cWGTS to diagnostic panel assays demonstrates the potential of cWGTS to capture all clinically reported mutations with comparable sensitivity in a single workflow. Benchmarking identifies a minimum of 80× as optimal depth for clinical WGS sequencing. Integration of germline, somatic DNA and RNA-seq data enable data-driven variant prioritization and reporting, with oncogenic findings reported in 54% more patients than standard of care. These results establish key technical considerations for the implementation of cWGTS as an integrated test in clinical oncology.

Cancer whole-genome and transcriptome sequencing (cWGTS) has been challenging to implement in clinical settings. Here, the authors develop a workflow to deliver robust cWGTS analyses and reports within clinically-relevant timeframes for paediatric, adolescent and young adult solid tumour patients.

Evaluation of an Inpatient Psychiatric Mother-Baby Unit Using a Patient Reported Experience and Outcome Measure

Understanding the patient experience of admission to a psychiatric mother-baby unit (MBU) informs service improvement and strengthens patient-centered care. This study aims to examine patients’ experience, satisfaction, and change in mental health status related to MBU admission. At discharge, 70 women admitted to a public MBU completed the Patient Outcome and Experience Measure (POEM), rated the usefulness of therapeutic groups, and provided written qualitative feedback. Paired sample t-tests, correlations, and thematic content analysis were completed. Women were highly satisfied with the level of care and support received, particularly for those who were voluntarily admitted. Women reported an improvement in mental health from admission to discharge. Women appreciated the staff’s interpersonal skills, provision of practical skills, education, advice, support from other women, and therapeutic groups offered. Women suggested improvements such as having greater food choices, more MBU beds, more group sessions, family visitations, which had been restricted due to COVID-19, environmental modifications, and clarity of communication surrounding discharge. This study highlights the benefits of MBUs and the specific aspects of care that are favorable in treating women with mental illnesses who are co-admitted with their baby in an MBU.

Appetite Loss and Anorexia of Aging in Clinical Care: An ICFSR Task Force Report

Appetite loss/anorexia of aging is a highly prevalent and burdensome geriatric syndrome that strongly impairs the quality of life of older adults. Loss of appetite is associated with several clinical conditions, including comorbidities and other geriatric syndromes, such as frailty. Despite its importance, appetite loss has been under-evaluated and, consequently, under-diagnosed and under-treated in routine clinical care. The International Conference on Frailty and Sarcopenia Research (ICFSR) Task Force met virtually on September 27th 2021 to debate issues related to appetite loss/anorexia of aging. In particular, topics related to the implementation and management of appetite loss in at-risk older adult populations, energy balance during aging, and the design of future clinical trials on this topic were discussed. Future actions in this field should focus on the systematic assessment of appetite in the care pathway of older people, such as the Integrated Care for Older People (ICOPE) program recommended by the World Health Organization. Moreover, clinical care should move from the assessment to the treatment of appetite loss/anorexia. Researchers continue to pursue their efforts to find out effective pharmacologic and non-pharmacologic interventions with a favorable risk/benefit ratio.

Exploring Discharge Outcomes and Readmission Rates of Mothers Admitted to a Psychiatric Mother and Baby Unit

To evaluate change in Health of the Nation Outcome Scale (HoNOS) scores from admission to discharge, readmission rates after 28-day and six months post-discharge, and factors associated with readmission in a Mother and Baby Unit (MBU). An exploratory cohort study was completed of mother-infant dyads admitted to a public psychiatric MBU in Australia between March 2017 and August 2018 (18 months). Admission and discharge scores on the clinician-rated Health of the Nation Outcome Scale (HoNOS) were compared using dependent samples t-tests. The frequency of readmission to any psychiatric inpatient unit within six months of discharge was determined from medical records. Characteristics of mothers who were and were not readmitted were evaluated. Of the 82 mother-infant dyads admissions, 12 (14.63%) women were readmitted within six months, and six (7.31%) were readmitted within 28-days. Total HoNOS scores significantly improved between admission and discharge (t₍₈₁₎=9.45, p<.000). Descriptive statistics for demographics, diagnoses, Mental Health Act status and discharge supports were computed for women readmitted and not readmitted. While these readmission rates and HONOS scores reflect a successful MBU admission, further research is required with larger sample sizes and more specific maternal and infant mental health outcome measures.

Use of Natural Spoken Language With Automated Mapping of Self-reported Food Intake to Food Composition Data for Low-Burden Real-time Dietary Assessment: Method Comparison Study

Background

Self-monitoring food intake is a cornerstone of national recommendations for health, but existing apps for this purpose are burdensome for users and researchers, which limits use.

Objective

We developed and pilot tested a new app (COCO Nutritionist) that combines speech understanding technology with technologies for mapping foods to appropriate food composition codes in national databases, for lower-burden and automated nutritional analysis of self-reported dietary intake.

Methods

COCO was compared with the multiple-pass, interviewer-administered 24-hour recall method for assessment of energy intake. COCO was used for 5 consecutive days, and 24-hour dietary recalls were obtained for two of the days. Participants were 35 women and men with a mean age of 28 (range 20-58) years and mean BMI of 24 (range 17-48) kg/m².

Results

There was no significant difference in energy intake between values obtained by COCO and 24-hour recall for days when both methods were used (mean 2092, SD 1044 kcal versus mean 2030, SD 687 kcal, P=.70). There were also no significant differences between the methods for percent of energy from protein, carbohydrate, and fat (P=.27-.89), and no trend in energy intake obtained with COCO over the entire 5-day study period (P=.19).

Conclusions

This first demonstration of a dietary assessment method using natural spoken language to map reported foods to food composition codes demonstrates a promising new approach to automate assessments of dietary intake.

917 Metaplastic Thymic Sarcoma of The Thyroid: A Case Report and A Review of The Literature

In this paper, the authors present a case diagnosed as ‘metaplastic thymic sarcoma’. Tumours of the thymus are extremely rare: there is a disparity in terminology and histology observed, although there have been efforts to make classification clearer. The reported case concerns a seventy-eight-year-old woman, who presented with a rapidly enlarging neck mass. Histological diagnosis was made challenging by the unusual characteristics of the tumour; the diagnosis of ‘metaplastic thymic sarcoma’ was eventually established, following consultation with an internationally renowned soft tissue pathologist. Review of the relevant literature demonstrated no comparable cases; the presentation of a thymic tumour within the thyroid is also considered unusual. The tumour observed did not conform to any previously sub type of thymic tumour and is therefore believed to be a distinct entity. The patient suffered aggressive recurrence of the disease shortly after her surgery. Genetic testing indicated the tumour was BRAF positive, and there was a dramatic clinical response to Dabrafenib/ Trametinib treatment. The successful use of immunotherapy is encouraging finding, however the diagnosis of another distinct sub type of thymic tumour, further demonstrates the diagnostic and therapeutic challenges presented by this rare and heterogenous group.

Metabolic Adaptations to Weight Loss: Relative Changes in Resting Metabolic Rate and Energy Expenditure for Physical Activity and Association With Weight Loss Maintenance

Objectives

There is persistent controversy over the extent to which different components of energy expenditure disproportionately decrease after weight loss and contribute to weight regain through decreased energy requirements. We conducted a secondary analysis of the CALERIE I study to test the hypothesis that decreased resting metabolic rate (RMR) and energy expenditure for physical activity (EEPA) after a 6-month calorie restriction intervention would predict weight regain at 12 months, with a greater decrease in RMR than EEPA.

Methods

Participants (n = 46) received all food and energy-containing beverages for 6 months. Outcome measures included total energy expenditure by doubly labeled water, RMR by indirect calorimetry, and body composition by BOD POD. Predictions for RMR and EEPA were derived from baseline linear regression models including age, sex, fat mass, and fat free mass. Baseline regression coefficients were used to calculate the predicted RMR and EEPA at 6 months. Residuals were calculated as the difference

between measured and predicted values and were adjusted for body weight. The presence of metabolic adaptation was evaluated by a paired t-test comparing measured and predicted RMR at 6 months. Differences between 6-month RMR and EEPA residuals were evaluated by the same method. Linear regression was used to assess the association between 6-month residuals and weight loss maintenance (% weight change, 6 to 12 months).

Results

Mean weight loss was 6.9% at 6 months with 2.1% regain from 6 to 12 months. No adaptation in RMR was observed at 6 months (mean residual: 19 kcal; 95% confidence interval: −9, 48; P = 0.18). However, significant adaptation was observed in EEPA (mean residual: −199 kcal; −126, −272; P &lt; 0.0001). In addition, the mean 6-month RMR residual was significantly greater than the mean 6-month EEPA residual (218 kcal; 133, 304; P &lt; 0.0001). There was no significant association between 6-month RMR or EEPA residuals and weight regain at 12 months (P = 0.56, 0.34).

Conclusions

There was no measurable decrease in RMR with weight loss after adjusting for changes in fat free mass and fat mass, but there was a decrease in EEPA. Changes in RMR and EEPA with weight loss over 6 months did not predict weight regain at 12 months.

Funding Sources

Jean Mayer USDA Human Nutrition Research Center on Aging Doctoral Scholarship; USDA agreement #8050–51000-105–01S

Associations of Low-Inflammatory Dietary Patterns With Psychological Health and Wellbeing During Weight Loss in Military Family Dependents

Objectives

Emerging evidence suggests that anti-inflammatory dietary patterns may improve depression, stress, and quality of life. Similar benefits are observed during weight loss interventions; however, the effect of combining these dietary patterns with weight loss is not clear. We evaluated the association between dietary inflammation and measures of psychological health in female military dependents with overweight and obesity during a behavioral weight loss intervention.

Methods

Participants (n = 120) received a 6-month intervention recommending dietary patterns with an anti-inflammatory profile. An energy-adjusted dietary inflammatory index (DII) score was calculated from 28 food components collected using 3 interviewer-administered multiple-pass 24-hour recalls at each study time point. A negative score indicates a lower-inflammatory dietary pattern, and a positive score indicates a pro-inflammatory pattern. Self-reported symptoms of depression, stress, general health, vitality, and psychological quality of life were measured by validated questionnaires. Multivariable linear mixed models were used to assess the association between 6-month changes in DII and each outcome and were adjusted for age, ethnicity, military rank of spouse, body weight, and physical activity.

Results

On average, females were 42.2 ± 11.8 years old with a body mass index of 34.9 ± 6.4 kg/m2. The average DII score was 0.07 (range: −4.3, 3.0) at baseline. Six-month improvements in DII scores (i.e., for a 1-unit reduction) were associated with fewer self-reported symptoms of depression (β: −0.87; 95% confidence interval: −1.43, −0.31; P = 0.003) and stress (−0.85; −1.44, −0.26; P = 0.005), as well as higher general health (0.57; 0.23, 0.91; P = 0.001), vitality (0.45; 0.12, 0.77; P = 0.008), and psychological quality of life (0.33; 0.11, 0.55; P = 0.004). No significant associations between weight loss or physical activity and any outcome were observed in these models that included the DII.

Conclusions

Anti-inflammatory dietary patterns are associated with beneficial effects on a range of psychological health and wellbeing measures independent of weight loss.

Funding Sources

Jean Mayer USDA Human Nutrition Research Center on Aging Doctoral Scholarship; Department of Defense (DoD) grant W81XWH-14–2-0005 (SBR). Author views do not reflect official DoD or Army policy.

Verification and Validation of Digital Pathology (Whole Slide Imaging) for Primary Histopathological Diagnosis: All Wales Experience

Aims:

The study is aimed to verify Aperio AT2 scanner for reporting on the digital pathology platform (DP) and to validate the cohort of pathologists in the interpretation of DP for routine diagnostic histopathological services in Wales, United Kingdom.

Materials, Methods and Results:

This was a large multicenter study involving seven hospitals across Wales and unique with 22 (largest number) pathologists participating. 7491 slides from 3001 cases were scanned on Leica Aperio AT2 scanner and reported on digital workstations with Leica software of e-slide manager. A senior pathology fellow compared DP reports with authorized reports on glass slide (GS). A panel of expert pathologists reviewed the discrepant cases under multiheader microscope to establish ground truth. 2745 out of 3001 (91%) cases showed complete concordance between DP and GS reports. Two hundred and fifty-six cases showed discrepancies in diagnosis, of which 170 (5.6%) were deemed of no clinical significance by the review panel. There were 86 (2.9%) clinically significant discrepancies in the diagnosis between DP and GS. The concordance was raised to 97.1% after discounting clinically insignificant discrepancies. Ground truth lay with DP in 28 out of 86 clinically significant discrepancies and with GS in 58 cases. Sensitivity of DP was 98.07% (confidence interval [CI] 97.57–98.56%); for GS was 99.07% (CI 98.72–99.41%).

Conclusions:

We concluded that Leica Aperio AT2 scanner produces adequate quality of images for routine histopathologic diagnosis. Pathologists were able to diagnose in DP with good concordance as with GS.

Strengths and Limitations of this Study:

Strengths of this study – This was a prospective blind study. Different pathologists reported digital and glass arms at different times giving an ambience of real-time reporting. There was standardized use of software and hardware across Wales. A strong managerial support from efficiency through the technology group was a key factor for the implementation of the study.

Limitations:

This study did not include Cytopathology and in situ hybridization slides. Difficulty in achieving surgical pathology practise standardization across the whole country contributed to intra-observer variations.

Maternal deaths by suicide in Queensland, Australia, 2004-2017: an analysis of maternal demographic, psychosocial and clinical characteristics

To characterise the demographic and clinical characteristics of women who died by suicide in the perinatal period to inform and improve suicide prevention strategies. Retrospective analysis of maternal suicides during and within 1 year after the end of pregnancy in Queensland between January 2004 and December 2017. Outcomes measured included timing of death in relation to pregnancy, sociodemographic and clinical characteristics and health service use prior to death. There were 65 deaths by suicide in the study period; six occurred during pregnancy, 30 occurred after a live birth, 22 occurred after a termination of pregnancy and seven followed a miscarriage or stillbirth. Most suicides were late maternal deaths. Women were younger, and more likely to identify as Aboriginal or Torres Strait Islander, when compared to all women giving birth for the same time period. Most women had a prior mental health diagnosis, most commonly depression. Over half of women had recent relationship separation or conflict prior to death. Perinatal women had higher rates of death by violent means than all women in Queensland who died by suicide during the same time period. The demographic, psychosocial and clinical characteristics of a group of women who died by suicide have been described, and this shows a high proportion of women with a prior mental health diagnosis. To reduce maternal mortality, psychosocial screening must be implemented broadly and continued until the end of the first year postpartum. Similar screening attention is needed for women who had a termination of pregnancy, miscarriage or stillbirth.

Effective therapeutic interventions for Australian adolescents using alcohol and/or other drugs: a scoping review

Background

There are a variety of residential and community service models of therapeutic interventions for people using substances. The focus of much of the currently available research is on adult populations with relatively little known about effective therapeutic interventions for adolescents. The aim of this paper is to identify the most effective therapeutic interventions for Australian adolescents using substances by conducting a systematic scoping literature review.

Methods

We followed the PRISMA guidelines to conduct a systematic scoping review that included searches of nine electronic databases (EMBASE, MEDLINE, EBSCO Host, APA PsycNet, SocIndex, Social Science Abstracts, Proquest Central Informit) and grey literature searches of government department and alcohol and other drugs peak body and service provider websites, Google Scholar and the Cochrane library.

Results

A total of 21 studies were identified. These studies included biological, psychological, social and technological therapeutic interventions targeted at different population groups and different substances. The review findings are limited and should considered with caution due to the inability to disaggregate the combinations of interventions provided and the low quality of most of the studies included.

Conclusions

This scoping review highlights the paucity of quality research on effective therapeutic interventions for Australian adolescents using substances. This is primarily due to the available studies not controlling for all of the therapeutic interventions provided. While there is an evidence-base for some of these interventions, others such as encounter groups and journaling require further and more substantive research for use with adolescents. This is necessary to enable informed service design and delivery decision-making and fiscal accountability.

NICE update NICE public health guidance update

This article covers recently published National Institute for Health and Care Excellence (NICE) guidance relevant to public health and a review of evidence published since we released the NICE guidance on unintentional injury prevention in under 15 year olds. The article features some of this evidence that was found to reinforce published recommendations on safety in the home and on the roads, indicating the guidance remains up to date and relevant. In addition, it importantly highlights that there is great opportunity to prevent future unintentional injury through integrated and coordinated, evidence and intelligence-informed approaches.

Untold Stories: Male Child Sexual Abusers' Accounts of Telling and Not Telling about Sexual Abuse Experienced in Childhood

With evidence suggesting that females are more likely to be victims of child sexual abuse (CSA), much of the literature - including that on disclosure - focuses on females. Thus, male victims remain "under-studied". Given this, the aim here is to contribute to the scant knowledge base on the sexual abuse of males and disclosure by focusing on males whose voices are even more rarely heard than those in the general male population: those who have perpetrated CSA. The men whose stories are told here had been convicted of, and imprisoned for, CSA in the United Kingdom (UK). They were part of a sample of 101 incarcerated males, 40 of whom reported at interview that they had been sexually abused in childhood. Eighteen of those 40 men are focused on here as they provided some detail as to whether they had disclosed that abuse in childhood or adulthood, the responses they had received, and also why they had not disclosed. Their narratives shed some much-needed light on the nature of sexual abuse experienced by males, its onset and duration, sexual re-victimization, relationships with perpetrators, the diverse nature of disclosure, the extent to which victims disclose and when, the responses received, and why they do not tell. Little is known of these aspects of male CSA. The implications of the findings are considered together with future research directions.

Injected human umbilical cord-derived mesenchymal stromal cells do not appear to elicit an inflammatory response in a murine model of osteoarthritis

Objective

This study investigated the effect of hUC-MSCs on osteoarthritis (OA) progression in a xenogeneic model.

Design

Male, 10 week-old C57BL/6 mice underwent sham surgery (n = 15) or partial medial meniscectomy (PMM; n = 76). 5x10⁵ hUC-MSCs (from 3 donors: D1, D2 and D3) were phenotyped via RT-qPCR and immunoprofiling their response to inflammatory stimuli.

They were injected into the mouse joints 3 and 6 weeks post-surgery, harvesting joints at 8 and 12 weeks post-surgery, respectively. A no cell ‘control’ group was also used (n = 29). All knee joints were assessed via micro-computed tomography (μCT) and histology and 10 plasma markers were analysed at 12 weeks.

Results

PMM resulted in cartilage loss and osteophyte formation resembling human OA at both time-points. Injection of one donor's hUC-MSCs into the joint significantly reduced the loss of joint space at 12 weeks post-operatively compared with the PMM control.

This ‘effective’ population of MSCs up-regulated the genes, IDO and TSG6, when stimulated with inflammatory cytokines, more than those from the other two donors.

No evidence of an inflammatory response to the injected cells in any animals, either histologically or with plasma biomarkers, arose.

Conclusion

Beneficial change in a PMM joint was seen with only one hUC-MSC population, perhaps indicating that cell therapy is not appropriate for severely osteoarthritic joints. However, none of the implanted cells appeared to elicit an inflammatory response at the time-points studied. The variability of UC donors suggests some populations may be more therapeutic than others and donor characterisation is essential in developing allogeneic cell therapies.

Validity of Two Questionnaires and Two Prediction Equations for Estimating Total Energy Expenditure in Healthy Adults: A Doubly Labeled Water Study

Objectives

The doubly labeled water (DLW) method is the gold standard for assessing total energy expenditure (TEE), but is costly. Questionnaires and prediction equations for TEE are nearly cost-free but research on their validity is scarce. We evaluated the validity of TEE assessed by two questionnaires and two prediction equations in comparison with TEE assessed by DLW. Based on previous work, we hypothesized that the questionnaires would be valid at a group level, and that the prediction equations would be valid at an individual level.

Methods

Data from a 10-d observational study in 124 healthy, nonsmoking adults were used (63% F, aged 29.8 ± 12.2 y, BMI 24.5 ± 3.9 kg/m2 (Mean ± SD)). TEE was measured by DLW using a mixed oral 2H218O dose containing 0.15 g 2H218O and 0.07 g of 2H2O per kg body weight. Analysis of urine samples and calculations of TEE were carried out using standard methodology. TEE was estimated from the 7-day Physical Activity Recall (7dPAR; Sallis et al. 1985), the Block Work and Home Survey (BWHS; Block et al. 2009), Dietary Reference Intakes (DRI) equations for estimated energy requirements of adults with normal weight or overweight/obesity (IOM 2005), and the BOD POD air displacement plethysmograph. 7dPAR TEE was estimated by multiplying MET-min/day with resting metabolic rate estimated from DRI basal energy expenditure equations. The BOD POD measured body composition by densitometry and TEE was estimated from fat-free mass and fat mass (Nelson et al. 1992) and an activity factor (WHO 1985).

Results

TEE values were 2430 ± 535 (DLW), 2375 ± 445 (7dPAR), 2407 ± 750 (BWHS), 2335 ± 388 (DRI), 2134 ± 439 (BOD POD) kcal/d (Mean ± SD), with DRI and BOD POD significantly lower than DLW (P &lt;0.01). Mean ± 2SD limits of agreement (kcal/d) between DLW and 7dPAR (−766, 877) and BWHS (−1420, 1468) were wider than those between DLW and DRI (−630, 822) and BOD POD (−463, 1057). The R2 and SEE of the method associations with DLW ranged from 0.17 to 0.54 and 264 to 688 kcal/d, respectively (all P = 0.000).

Conclusions

The 7dPAR and BWHS were valid for estimating TEE at a group level. While the DRI and BOD POD equations were more accurate at estimating TEE of individuals, none of the tools are recommended for individual assessment of TEE due to their low R2 and wide Bland-Altman limits of agreement with DLW.

Funding Sources

NIH R01 DK075862 and Purdue University.

Attitudes and Experiences Related to Feeding in Early Infancy in Guinea-Bissau

Objectives

Globally, more than 200 million children under 5 experience wasting and stunting. Wasting and stunting often begin during early infancy and have detrimental impacts on childhood health. Understanding local perspectives on feeding during early infancy might allow the design of interventions to improve early infant growth. The purpose of this study was to identify attitudes and experiences related to feeding during the first month after birth in Guinea-Bissau.

Methods

We employed a mixed-methods approach to data collection, using focus groups and individual interviews. We completed five focus groups with mothers, fathers, community health workers and nurses, and six individual interviews with hospital administrators and policy makers. Portuguese and Mandinka, common languages in Guinea-Bissau, were used for data collection. All focus groups and interviews were recorded, translated and transcribed in English for analyses. Thematic analyses were used to examine variations in the participants’ perspectives on a priori themes and to discern emerging themes.

Results

A priori themes were (1) perspectives on breastfeeding, (2) issues related to infant health, (3) local practices of early supplementation, and (4) opinions about a nutritional intervention for infants. Emerging themes included (a) maternal health and (b) maternal supplementation. Participants reported a wide variety of feeding practices in early infancy, including exclusive breastfeeding, supplementation with baby formula and supplementation with other foods including fruit, grain, nuts, milk and herbs. Poverty, inadequate knowledge on breastfeeding and childhood health, and poor access to health care were identified as potential challenges for successfully implementing an intervention to improve growth during early infancy. Also, participants described that maternal health is fundamental to infant health and advocated for interventions supplementing mothers’ nutrition.

Conclusions

A wide range of feeding practices are common during the newborn period in Guinea-Bissau. While early interventions to improve infant growth may be acceptable and feasible, developing effective strategies must include components addressing the stakeholders’ concerns related to poverty, inadequate knowledge and poor access to health care.

Funding Sources

Melinda and Bill Gates Foundation.

Development of a Questionnaire to Assess the Relationship Between Weight Status and Sociocultural Factors

Objectives

Cultural factors influence obesity risk, but this relationship has not been systematically studied due to the lack of a validated survey instrument. The objective of this project was to develop a prototype questionnaire to assess the relationship between body mass index (BMI) and sociocultural factors.

Methods

Interviews and focus groups were conducted in the US (N = 24) and France (N = 25). Recordings were transcribed and analyzed (NVivo), and results informed the new questionnaire. The questionnaire was administered in two pilots using Amazon Mechanical Turk (pilot 1: N = 25 adults in France and 25 in US; pilot 2: N = 120 US adults). Demographic information was also collected. Questions were grouped by theme and scores were created from response averages within each theme. The scores were analyzed in relation to BMI, age and country (ANOVA, Spearman correlation). The scores included cultural insularity (high score = greater role of cultural identity in food choices), external eating pressures (high score = stronger perceived and overt pressures), food insecurity (high score = greater food insecurity), childhood intake control (high score = stricter parental control of eating during childhood), and nutrition knowledge (high score = better discernment of healthy vs. unhealthy foods).

Results

In France, the cultural insularity score was higher than in the US (P = 0.01) and was correlated with BMI (r = 0.5, P = 0.03). The childhood intake control score was also inversely associated with BMI in France (r = −0.5, P = 0.03). In the US, BMI was positively associated with the external eating pressures (pilot 2: r = 0.2, P = 0.03) and nutrition knowledge (pilot 2: r = 0.2, P = 0.04) scores, and was inversely associated with the food insecurity score (pilot 2: r = −0.24, P = 0.008). In both countries, age was associated with the childhood intake control score (France: r = 0.5, P = 0.03, and US pilot 1: r = 0.4, P = 0.03, pilot 2: r = 0.4, P &lt; .0001).

Conclusions

This approach and prototype questionnaire identified novel cultural factors associated with high BMI in France and the US. Additional research is needed to validate the prototype and identify core cultural factors associated with risk of obesity in different cultures.

Funding Sources

USDA agreement #8050–51,000-105–01S; Danone Research; Institute of Cardiometabolism and Nutrition.

Comparison of Energy Intake Determined by a Natural Spoken Language Application with 24-h Recall

Objectives

Self-monitoring daily dietary intake is recommended for weight loss and weight loss maintenance. However, current online platforms and applications are often burdensome, which may limit use. We conducted a pilot study to evaluate the accuracy of a new application designed to self-monitor dietary intake using natural spoken language (COCO; The Conversational Calorie Counter).

Methods

A total of 35 participants were enrolled in this pilot study. Participants were asked to record daily dietary intake using the COCO application for a period of at least five days. Two 24-hour dietary recalls were conducted during this time, between day three and day five, and served as the reference method for evaluating total energy intake (TEI; measured in kcal). Mean two-day energy intake was calculated for each assessment method for the days when the 24-hr recall and COCO data were collected. Self-reported TEI from COCO were compared to estimates obtained from the 24-hour dietary recalls by a paired samples t-test and a Pearson's correlation coefficient.

Results

On average, participants consumed three meals a day and recorded six days of food intake days with COCO (range: 4 to 10 days). The mean TEI was not significantly different between the two methods (1902 ± 621 kcal by 24-hour dietary recall and 1988 ± 1033 kcal by COCO, P = 0.59). There was a significant correlation between mean TEI measured with the two methods (r = 0.45; P = 0.006). In addition, a strong correlation was observed between the number of food items logged in COCO and those recalled in the 24-hour diet recalls (r = 0.82; P &gt;0.0001). Completion of the exit survey by 28 participants indicated that 43% would definitely or probably use the application again.

Conclusions

These results suggest that natural spoken language technology may have utility in applications to self-monitor food intake. Additional research is required to fully elucidate the validity of COCO in estimating dietary intake.

Funding Sources

This research was supported by the NIH Grant # 1R21HL118347–01 (SBR and JG), Quanta Computing, Inc., and the National Defense Science and Engineering Graduate fellowship.

No Effect of the Dietary Inflammatory Index on Psychological Health During Caloric Restriction: A Secondary Analysis of the CALERIE Trial Data

Objectives

Anti-inflammatory diets have been suggested to improve psychological health. This research evaluated the combined effects of consuming an anti-inflammatory diet and caloric restriction (CR) on changes in perceived stress and health-related quality of life in a healthy, non-obese population.

Methods

We conducted a secondary analysis of the publicly available CALERIE data. Participants were randomized to a 2 year CR intervention (n = 143) or an ad libitum Control group (n = 75) and self-selected their dietary intake. An energy-adjusted dietary inflammatory index (DII) was calculated based on 28 components from self-reported food records. Self-reported stress and general health outcomes were measured using validated questionnaires. Linear mixed models were used to assess changes in each outcome from baseline to 12 and 24 months. Models were adjusted for age, sex, baseline outcome measure, change in body fat, and a treatment by DII interaction term.

Results

On average, participants were 38.1 ± 7.2 years old with a BMI of 25.1 ± 1.7 kg/m2. Baseline characteristics, including the DII, stress, and general health, did not differ with randomization. There was no significant association between temporal changes in DII and changes in stress or general health in the CR or Control groups. On average, both groups tended to report higher stress at 12 months; however, there was no difference in perceived stress between groups (adjusted mean difference [MD]: 0.5; 95% confidence interval [CI]: −0.4, 1.5; P = 0.25). There was an improvement in reported general health in the CR group at 12 months (MD: 4.1; 95% CI: 2.2, 6.0; P &lt; 0.001), but not in Controls (MD: 1.6; 95% CI: −1.2, 4.3; P = 0.26). Yet self-reported general health was similar both groups (MD: 2.5; 95% CI: −1.3, 6.3; P = 0.16). The effect of a CR intervention on both outcomes did not differ with change in DII. Similar results were observed at 24 months.

Conclusions

There was no indication of any contribution of a low DII score on perceived stress and general health in the presence of CR. Additional research is required to enhance our understanding of the implications of dietary inflammation on a broad range of psychological health outcomes.

Funding Sources

Jean Mayer USDA Human Nutrition Research Center on Aging Doctoral Scholarship; USDA agreement #8050–51,000-105–01S.