Browsing by Author "Davy, Brenda M."

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    Adult Cancer Survivorship: An Evaluation of Survivorship Care Planning and Follow-Up
    Kelleher, Sarah A. (Virginia Tech, 2014-05-05)
    Over 1 million Americans are diagnosed with cancer in a given year and currently there are approximately 12 million cancer survivors in the United States. With improved detection strategies and medical advances, the number of cancer survivors continues to rise, making survivorship care an increasingly important phase along the continuum of cancer care. The purpose of the current study was to investigate the emerging field of survivorship care, including care planning and follow-up, in survivors of different types of cancer. We quantitatively evaluated the post-treatment care received by 123 cancer survivors, including the use of survivorship care plans and the impact of these care plans and subsequent follow-up on a variety of behavioral health outcomes. We qualitatively assessed survivorship care providers' (n = 8) perspectives on comprehensive survivorship care and experiences delivering post-treatment services. The majority of participants (54%) are receiving a moderate level of survivorship care, including minimal receipt of a written care plan (31%) and some amount of referrals for mental health, diet, and physical activity (28%). Results suggest significantly lower general psychological distress (F [1, 104] = 8.316, p = .005) and higher coping self-efficacy (F [1, 104] = 6.627, p = .011) for those who received some form of written care plan versus those who did not. These results imply that written care plan documents have the potential to lead to higher psychosocial functioning for survivors of cancer. The qualitative data provide initial evidence supporting the value of SCPs for patients and providers. Critical barriers to implementation of comprehensive survivorship care and SCPs, from the providers' perspective, include the fragmented healthcare system and resources. The current study is an important step toward increasing knowledge of and potential intervention targets to improve cancer survivorship experiences – from both the patients' and providers' perspectives. Future directions include developing a standardized system for delivering survivorship care and SCPs, and increasing the evidence base to examine the impact of SCPs on short- and long-term patient-reported and clinical outcomes, increase the focus on patient-centered care, and explore the impact of SCPs delivered to vulnerable groups of survivors.
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    Advances in Nutrition Science and Integrative Physiology: Insights From Controlled Feeding Studies
    Davy, Kevin P.; Davy, Brenda M. (Frontiers, 2019-10-29)
    Nutrition science is a highly impactful but contentious area of biomedical science. Establishing cause and effect relationships between the nutrients and/or diets we consume and the avoidance of or risk of disease is extremely challenging. As such, evidence-based nutrition is best served by considering the totality of evidence across multiple study types including nutritional epidemiological studies, randomized controlled trials of behavioral interventions, and controlled feeding studies. The purpose of the present review is to provide an overview for those conducting research outside of clinical nutrition on how controlled feeding studies can be used to gain insight into integrative physiology/metabolism as well as to inform dietary guidelines. We discuss the rationale, basic elements, and complexities of conducting controlled feeding studies and provide examples of contributions of controlled feeding studies to advances in nutrition science and integrative physiology. Our goal is to provide a resource for those wishing to leverage the experimental advantage provided by controlled feeding studies in their own research programs.
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    Aging, Physical Activity, and Energy Intake Regulation
    Van Walleghen, Emily Lynn (Virginia Tech, 2006-07-31)
    More than seventy percent of Americans over the age of sixty are classified as overweight or obese, and the future incidence of these conditions is expected to rise. Although it is unclear why older adults are predisposed to weight gain, decreased total energy expenditure may contribute to positive energy balance. It is also possible that age-related impairments in energy intake regulation result in the inability to appropriately adjust food intake to meet energy requirements with advancing age. The purpose of these investigations was to determine the influence of age and habitual physical activity on acute regulation of energy intake. Secondary objectives were to determine if there are sex differences in energy intake regulation, and to determine if pre-meal water consumption decreases meal energy intake in young and older adults. To achieve these objectives, the ability to spontaneously adjust energy intake at a meal under "preloading" conditions in which a yogurt shake or water was consumed prior to the meal was determined. We hypothesized that older adults would demonstrate less accurate energy intake regulation than younger adults, but that energy intake dysregulation would be attenuated in physically active older adults. We also expected that young men would have higher accuracy of energy intake regulation compared to young women matched for dietary cognitive restraint and cardiorespiratory fitness, and that pre-meal water consumption would decrease meal energy intake in young and older adults. Our main finding was that energy intake regulation is significantly impaired in older compared to younger adults, and that habitual physical activity improves short-term, but not acute, energy intake regulation. We also found that young men demonstrate significantly higher accuracy of energy intake regulation compared to young women. Lastly, we determined that pre-meal water consumption significantly decreases meal energy intake in older, but not young, adults. Overall, these results indicate that acute energy intake regulation is less accurate with advancing age, but that regular physical activity improves short-term energy intake regulation. Additionally, sex appears to influence energy intake regulation, and water consumption is a potential strategy to reduce energy intake in older adults.
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    Aging, resistance training, and diabetes prevention
    Flack, Kyle D.; Davy, Kevin P.; Hulver, Matthew W.; Winett, Richard A.; Frisard, Madlyn I.; Davy, Brenda M. (2010-12-15)
    With the aging of the baby-boom generation and increases in life expectancy, the American population is growing older. Aging is associated with adverse changes in glucose tolerance and increased risk of diabetes; the increasing prevalence of diabetes among older adults suggests a clear need for effective diabetes prevention approaches for this population. The purpose of paper is to review what is known about changes in glucose tolerance with advancing age and the potential utility of resistance training (RT) as an intervention to prevent diabetes among middle-aged and older adults. Age-related factors contributing to glucose intolerance, which may be improved with RT, include improvements in insulin signaling defects, reductions in tumor necrosis factor-α, increases in adiponectin and insulin-like growth factor-1 concentrations, and reductions in total and abdominal visceral fat. Current RT recommendations and future areas for investigation are presented.
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    Are Cooking Interventions Effective at Improving Dietary Intake and Health Outcomes? A Systematic Review
    Wunderlich, Kayla Marie (Virginia Tech, 2022-09-14)
    Existing systematic reviews have suggested that cooking interventions can be beneficial for improving dietary intake and health outcomes, with research indicating that the ability to prepare meals at home may prove to be more complex, and involve influencing factors (i.e., cooking self-efficacy, food agency [i.e., one's ability to procure and prepare food with the considerations of their physical, social and economic environment], and nutritional literacy/knowledge) for improving health outcomes. With the average American's diet consisting of about 60% of total energy coming from the consumption of ultra-processed foods, interventions that target increasing cooking skills and the frequency of consuming home-cooked meals may help to reduce reliance on processed foods, improve dietary intake quality, and reduce risk of weight gain, obesity, and related conditions. To date, there are no systematic reviews that have addressed the impact of cooking interventions on processed or ultra-processed food consumption. Therefore, this research systematically reviewed the body of literature focused on cooking interventions and dietary intake including processed food consumption and evaluated intervention's effectiveness at improving dietary intake and physical and mental health outcomes. English and full-text research articles published through January 2021 were obtained through PubMed, CINAHL using EBSCO, Web of Science from Clarivate, Scopus and PsycInfo. Overall, 55 articles were obtained after meeting the inclusion criteria and going through the data extraction process. Outcomes of interests to measure included fruit and vegetable consumption, body mass index (BMI), body weight, waist circumference, blood pressure, physical activity, and if the study measured psychosocial outcomes or processed food consumption. Results indicate that when analyzing the effect sizes for studies that reported mean data for each group (eg, intervention and control/comparison groups), 86% of studies measuring fruit intake found a positive effect size (Average: Cohen's d: 0.65, 95% CI: 0.30, 0.99); 90% of studies measuring vegetable intake found a positive effect size (Average: Cohen's d: 0.80, 95% CI: 0.37, 1.09); 82% of studies measuring BMI found a negative effect size (Average: Cohen's d: -0.20, 95% CI: -0.58, 0.17); 100% of studies measuring body weight had a negative effect size (Average: Cohen's d: -0.27, 95% CI: -0.77, 0.23); and 100% of studies measuring waist circumference had a negative effect size (Cohen's d: -0.16, 95% CI: -0.60,0.24). This systematic review will provide information on recently published studies that were not incorporated in prior reviews that can be utilized in future interventions that aim to improve health outcomes and reduce processed food consumption.
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    Are the Initiation and Maintenance of a Resistance Training Program Associated with Changes to Dietary Intake and Non-Resistance Training Physical Activity in Adults with Prediabetes?
    Halliday, Tanya M. (Virginia Tech, 2016-05-02)
    Prediabetes is associated with an elevated risk for developing type 2 diabetes (T2DM) and associated cardiovascular complications. Lifestyle factors such as physical activity (PA) and dietary intake are strongly implicated in the development of metabolic disease, yet few Americans meet PA and dietary recommendations. Middle-aged and older adults are at increased risk for developing prediabetes and T2DM due to age-related muscle loss, increased fat mass, and alterations in glucose handling. In addition, this segment of the population is least likely to meet PA guidelines, particularly the resistance training (RT) recommendation of completing a whole body routine 2x/week. Ideally, individuals would alter their lifestyle in order to meet PA guidelines and habitually consume a healthy diet, to decrease disease risk. However, behavior change is difficult and optimal strategies to promote and maintain changes have yet to be determined. Furthermore, behavior change interventions tend to be time-, cost-, and resource-intensive, limiting the ability for efficacious programs to be translated into community settings and broadly disseminated. Evidence suggests that health-related behaviors, particularly diet and exercise habits, tend to cluster together. Thus, intervening on one behavior (e.g. PA) may elicit a spillover effect, promoting alterations in other behaviors (e.g. diet), though findings to date are conflicting. The purpose of this dissertation was to determine if participation in a social cognitive theory-based RT program targeting the initiation and maintenance of RT exerts a spillover effect and is associated with alterations in dietary intake and/or non-RT PA in a population at risk for T2DM. Data from the 15-month Resist Diabetes study was analyzed to evaluate this possibility. Sedentary, overweight/obese (BMI 25-39.9 kg/m2 ), middle-aged and older (50 -69 years) adults with prediabetes (impaired fasting glucose and/or impaired glucose tolerance) completed a 3 month initiation phase where they RT 2x/week in a lab-gym with an ACSM-certified personal trainer. Participants then completed a 6-month faded contact maintenance phase, and a 6-month no-contact phase during which they were to continue RT on their own in a public facility. No advice or encouragement was given to participants to alter dietary intake or non-RT PA habits. At baseline, and months 3, 9, and 15, three non-consecutive 24-hour diet recalls were collected to evaluate dietary intake and quality, the Aerobics Institute Longitudinal Study Questionnaire was completed to evaluate non-RT PA, and body mass, body composition, and strength (3 repetition maximum on leg and chest press) were measured. At months 3, 9, and 15 social cognitive theory (SCT) constructs were assessed with a RT Health Beliefs Questionnaire. In the first study, dietary intake was assessed at baseline and after 3 months of RT. Using paired sample t-tests, reductions in intake of energy (1914 ± 40 kcal vs. 1834 ± 427 kcal, p = 0.010), carbohydrate (211.6 ± 4.9 g vs. 201.7 ± 5.2 g, p = 0.015), total sugar (87.4 ± 2.7 g vs. 81.5 ± 3.1 g, p = 0.030), glycemic load (113.4 ± 3.0 vs. 108.1 ±3.2, p= 0.031), fruits and vegetables (4.6±0.2 servings vs. 4.1±0.2 servings, p= 0.018), and sweets and desserts (1.1 ± 0.07 servings vs. 0.89 ± 0.07 servings, p = 0.023) were detected from baseline to month 3. No changes in other dietary intake variables were observed. These findings supported additional investigation in this area. The second study assessed changes in overall diet quality (Healthy Eating Index [HEI]-2010 scores) and non-RT PA over the initiation, maintenance, and no-contact phases using mixed effects models. Demographic, physiological, and psychosocial factors that may predict alterations to diet quality and non-RT PA were also explored. Energy and carbohydrate intake decreased with RT (β= -87.9, p=.015 and β= -16.3, p<.001, respectively). No change in overall dietary quality (HEI-2010 score: β= -0.13, p=.722) occurred, but alterations in HEI-2010 sub-scores were detected. Maintenance of RT was accompanied by an increase in MET-min/week of total non-RT PA (β=153.5, p=0.01), which was predicted by increased self-regulation for RT (β=78.1, p=0.03). RT may be a gateway behavior leading to improvements in other health-related behaviors among adults with prediabetes. These results support the use of singlecomponent vs. multi-component interventions. This may have broad translational potential for the development of time-, resource-, and cost-efficient lifestyle interventions which can improve multiple health-related behaviors and decrease disease risk.
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    Are There Sex Differences in Behavioral Predictors of Successful Weight Loss Maintenance?
    Baugh, Mary Elizabeth (Virginia Tech, 2013-10-16)
    Current literature emphasizes poor long-term weight loss maintenance (WTLM) outcomes, and the need for inexpensive, practical solutions for effective WTLM is evident. Individuals successful at WTLM utilize similar behaviors but in varying amounts and combinations, seemingly choosing behaviors that best fit their preferences. Researchers have attempted to identify characteristics of individuals that may predict successful WTLM in order to develop flexible WTLM treatments based on individuals' lifestyle and preferences. The purpose of this analysis was to examine sex differences in WTLM outcomes and to identify potential behaviors related to WTLM success. In a 12-month study targeting WTLM, weight-reduced middle-aged and older men and women (n=39) were assigned behavioral goals for body weight, fruit and vegetable intake, water consumption, and physical activity and were asked to daily self-monitor body weight and these behaviors. Sex difference in clinically significant WL ≥5% WL) at 12 months was determined. A growth curve model assessed interactions of sex and WTLM predictors, and a crisp set qualitative comparative analysis (QCA) characterized individuals' weight changes and behaviors. No sex difference was found in clinically significant WL or in the interaction of sex and behaviors on weight change; however, QCA evidence suggests men and women may approach WTLM with different behaviors. Additionally, QCA findings suggest weight change in the first 3 months of WTLM may determine success at 12-months. WTLM treatments should provide more intensive support during the transition period from WL to WTLM. Future research in predictors of WTLM, particularly within the context of sex, is essential.
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    Arterial Destiffening with Weight Loss in Overweight and Obese Middle-Aged and Older Adults
    Dengo Flores, Ana Laura (Virginia Tech, 2010-06-15)
    Cardiovascular diseases (CVD) are the leading cause of mortality in the United States. Aging is the major risk factor for CVD development, which is independently predicted by arterial stiffness (AS). Arterial stiffening is closely related to age-related arterial structural/functional changes and obesity. Therefore, obese middle-aged and older adults are considered a high CVD risk population. In light of the current obesity epidemic and the projected growth of the older population, there is an overwhelming need to determine if weight loss (WL) may reduce AS (CVD risk) in this population. Thus, we hypothesized that WL via a hypocaloric diet-alone would reduce AS in overweight and obese middle-aged and older adults. To test our hypothesis, baseline assessment of anthropometrics, blood pressure and AS was conducted, and subjects were randomized to a 12-week WL intervention or a control group. Arterial stiffness was measured using applanation tonometry to estimate carotid-femoral artery pulse wave velocity (C-F PWV), and with high-resolution ultrasonography of the carotid artery (β-SI). There were no baseline differences between groups in our variables of interest. Consistent with our hypothesis, both measures of AS were significantly reduced (C-F PWV= -16% and β-SI= -12%, P<0.05) with WL (-8%, P<0.05). Weight loss also resulted in significantly decreased blood pressure, total body and abdominal fat. No such changes were observed in the control group. Pooled correlation analysis suggests that the magnitude of change in C-F PWV was not associated with changes in systolic, diastolic or mean blood pressure. We further hypothesized that reductions in AS, if observed, would be associated with the magnitude of reduction in total body or abdominal adiposity. Concordant with our hypothesis, the reductions in C-F PWV were significantly associated with total and abdominal fat. However, linear regression analysis indicate that neither total body nor abdominal body fat were capable of independently predicting reductions in C-F PWV. Our findings suggest that moderate WL in overweight and obese middle-aged and older adults is an efficacious treatment strategy for reducing AS. Further studies are needed to determine if the improvements in arterial compliance would be sustained with long-term WL maintenance.
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    Assessment of the Validity, Reliability, and Sensitivity of Fingerstick δ¹³C as an Added Sugar Biomarker in Adolescents: A Controlled Feeding Study Approach
    Liu, Sarah Victoria (Virginia Tech, 2017-05-22)
    An estimated 20.5% of adolescents ages 12 – 19 years were obese (≥95th percentile of BMI-for-age) in 2011 – 2014. Consumption of added sugars (AS) has been linked with adverse effects on weight and cardiovascular disease risk factors. Approximately 16% of adolescents’ calories come from AS, of which sugar-sweetened beverages (SSB) are a major contributor. However, the relationship between AS/SSB intake and obesity is controversial, partly due to limitations in self-reported dietary data. Objective dietary intake biomarkers may circumvent this problem. The δ13C biomarker for AS intake is based upon the fact that C4 plants– major source for sugar production in the United States – have elevated δ¹³C values compared to C3 plants, which includes most fruits and vegetables. The δ¹³C value of blood, which is influenced by diet, has been established as a valid, reliable, and sensitive biomarker, but when compared to selfreported AS intake. This investigation evaluated the sensitivity and reliability of the δ13C biomarker, assessed with fingerstick blood samples, in adolescents using a controlled feeding, crossover design. Fingerstick δ¹³C values significantly changed by -0.05‰ and +0.03‰ after subjects completed the 5% and 25% AS diets, respectively (F(1, 30) = 18.828, p < 0.001). High reliability was found between two consecutive fingerstick δ¹³C values on the low (ICC = 0.996) and high (ICC = 0.997) AS diets. Thus, fingerstick δ¹³C may be a sensitive and reliable indicator of AS intake in adolescents. Future investigations should develop an equation to estimate AS intake based on fingerstick δ¹³C
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    Beginning A Patient-Centered Approach in the Design of A Diabetes Prevention Program
    Seidel, Richard W.; Pardo, Kimberlee A.; Estabrooks, Paul A.; You, Wen; Wall, Sarah S.; Davy, Brenda M.; Almeida, Fabio A. (MDPI, 2014-02-01)
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    Changes in Non-Nutritive Sweetener Consumption Patterns in Response to a Sugar-Sweetened Beverage Reduction Intervention
    Acero, Darlene; Zoellner, Jamie M.; Davy, Brenda M.; Hedrick, Valisa E. (MDPI, 2020-11-08)
    Data are lacking on whether non-nutritive sweeteners (NNS) can be used as a strategy to support decreases in sugar-sweetened beverage (SSB) consumption. The purpose of this secondary analysis of a 6-month SSB-reduction intervention was to explore changes in NNS consumption patterns in Talking Health participants within the SIPsmartER (n = 101) intervention. Additionally, participant characteristics were compared for three SSB-NNS change groups (decrease SSB/increase NNS; decrease SSB/no increase in NNS; increase/no change in SSB/regardless of NNS). There was a significant increase in aspartame and total NNS intake for participants (mean daily mg increases of 37.2 ± 13.9 and 63.7 ± 18.5, respectively). With the exception of sex, no differences in participant characteristics were found between the three SSB-NNS change groups. Furthermore, no significant changes in weight or body mass index (BMI) were demonstrated between SSB-NNS change groups over time. Diet soda was the most commonly consumed source of NNS; however, other dietary sources of NNS also contributed to intake. At 6 months, intake of sucralose and saccharin were primarily from dietary sources other than diet sodas (94% and 100%, respectively). These findings suggest that NNS may be a feasible strategy to help reduce SSB consumption. This study supports the need to consistently quantify and identify NNS intake, beyond using diet soda intake as a proxy for NNS intake and grouping all NNS types into one variable, to more accurately address the potential health effects of NNS.
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    Changes in the Healthy Beverage Index in Response to an Intervention Targeting a Reduction in Sugar-Sweetened Beverage Consumption as Compared to an Intervention Targeting Improvements in Physical Activity: Results from the Talking Health Trial
    Hedrick, Valisa E.; Davy, Brenda M.; Myers, Emily A.; You, Wen; Zoellner, Jamie M. (MDPI, 2015-12-04)
    The recently developed Healthy Beverage Index (HBI) was designed to evaluate overall beverage intake quality (including total fluid consumption and beverage calories), yet no known intervention studies have assessed longitudinal changes to the HBI. The objective of this investigation was to assess changes in HBI scores in response to a sugar-sweetened beverage (SSB) reduction trial as compared to a physical activity comparison group. Participants were enrolled into a six-month, community-based, controlled behavioral trial and randomized into either a SSB reduction group (SIPsmartER) or a physical activity group (MoveMore). Correlations and multilevel mixed-effects linear regression with intention-to-treat analyses are presented. Total HBI score significantly increased for SIPsmartER (n = 149) (mean increase = 7.5 points (5.4, 9.7), p ≤ 0.001) and MoveMore (n = 143) (mean increase = 3.4 points (1.6, 5.2), p ≤ 0.001) participants, with a significant between group effect (p ≤ 0.05), over the six-month intervention. Other significant changes in HBI components for SIPsmartER included increased SSB and total beverage calorie scores, and decreased low-fat milk and diet soda scores. Changes in total HBI scores were significantly correlated with changes in total Healthy Eating Index-2010 scores (r = 0.15, p ≤ 0.01). Our findings suggest that individual HBI component scores, beyond the SSB component, are influenced by intervention strategies that primarily focus on SSB reduction.
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    Characterization of Metallic Flavor in Drinking Water: An Interdisciplinary Exploration through Sensory Science, Medicine, Health, and the Environment
    Mirlohi, Susan (Virginia Tech, 2012-02-22)
    Scientific explorations can lead to life changing discoveries or light the path for new discoveries as scientists continue to carry or pass on the torch of knowledge to current and future generations. This torch of knowledge radiates in many directions, as the path of discovery often demands a multidimensional perspective. This research explored the many aspects of metallic flavor in drinking water through applications of sensory science, medicine, health, and the environment. Humans interact with their environment through the five senses and are often exposed to contaminants through multiple routes; oral intake of trace metal contaminants through drinking water is a likely source. The biochemical mechanism by which humans are able to detect the flavor of strongly metallic agents such as iron has been previously elucidated, but little is known about population variability in the ability to sense metallic flavors. This research evaluated sensory thresholds and biochemical indicators of metallic flavor perception in healthy adults for ferrous iron in drinking water; 61 subjects aged 19 – 84 years, participated. The findings demonstrated an age-dependent sensitivity to iron indicating as people age they are less sensitive to metallic perception; impairment of olfactory functions is a contributing factor. Unlike in healthy adults, where human senses are often protective of overexposure to contaminants, and supportive of sensations of everyday life's pleasures, cancer patients often suffer from chemosensory dysfunctions. Metallic phantom taste is a commonly experienced sensation, yet very little studied aspect of this debilitating disorder. Impact of cancer therapy on chemosensory functions of patients with malignant brain tumors undergoing combined modality treatment (CMT) was explored. The results indicated that chemosensory dysfunctions of the patients can range from minimal to moderate impairment with maximum impairment developing during the 6-week CMT. Study of salivary constituents may provide clues on to the causes of chemosensory dysfunctions. On health aspects, implication of individual sensitivity to metallic flavor on beverage choices and overall water consumption was assessed in 33 healthy adults through self-reported beverage questionnaire. The results indicated that among the elderly reduced intake of drinking water coincided with reduced sensitivity to metallic flavor. The findings have important health implications in terms of hydration status and beverage choices. Finally, with environmental exposure relevance, preliminary findings on sensory properties of zerovalent iron nanoparticles (nZVI) indicated that oral exposure to nZVI may induce sensory properties different from that of ferrous iron, likely predictive of a diminished detection of metallic flavor by humans. Further research is warranted in this area.
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    Characterization of Non-Nutritive Sweetener Intake in Rural Southwest Virginian Adults Living in a Health-Disparate Region
    Hedrick, Valisa E.; Passaro, Erin M.; Davy, Brenda M.; You, Wen; Zoellner, Jamie M. (MDPI, 2017-07-01)
    Few data assessing non-nutritive sweetener (NNS) intake are available, especially within rural, health-disparate populations, where obesity and related co-morbidities are prevalent. The objective of this study is to characterize NNS intake for this population and examine the variance in demographics, cardio-metabolic outcomes, and dietary intake between NNS consumers and non-consumers. A cross-sectional sample (n = 301) of Virginian adults from a randomized controlled trial (data collected from 2012 to 2014) targeting sugar-sweetened beverage (SSB) intake completed three 24-h dietary recalls, and demographics and cardio-metabolic measures were assessed. The frequency, types, and sources of NNS consumption were identified. Thirty-three percent of participants reported consuming NNS (n = 100). Sucralose was the largest contributor of mean daily NNS intake by weight (mg), followed by aspartame, acesulfame potassium, and saccharin. NNS in tabletop sweeteners, diet tea, and diet soda were the top contributors to absolute NNS intake. The most frequently consumed NNS sources were diet sodas, juice drinks, and tabletop sweeteners. Although mean body mass index (BMI) was greater for NNS consumers, they demonstrated significantly lower food, beverage, and SSB caloric intake and energy density, and higher overall dietary quality. It remains unclear whether NNS use plays a role in exacerbating weight gain. NNS consumers in this sample may have switched from drinking predominantly SSB to drinking some NNS beverages in an effort to cope with weight gain. Future studies should explore motivations for NNS use across a variety of weight and health categories.
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    Characterization of Non-nutritive Sweetener Intake Patterns in a Sample of Rural Southwest Virginian Adults
    Passaro, Erin Marie (Virginia Tech, 2016-06-03)
    Controversy surrounds the use of artificial sweeteners (non-nutritive sweeteners [NNS]) as an effective weight-loss and/or maintenance strategy. This controversy is especially important as obesity is an epidemic in the United States. Excessive added sugar intake, primarily from sugar-sweetened beverages, has been linked to increased risk of overweight and obesity, as well as type 2 diabetes and cardiovascular disease. NNS provide minimal to no calories and thus, they have been suggested as a method to reduce added sugar intake, and consequently decrease energy intake, weight, and cardiometabolic risk. However, NNS intake has been associated with various health outcomes in observational studies and randomized controlled trials, including cancer, weight gain and loss, physiological and intestinal changes, cardiovascular disease, and diabetes. The uncertainties around the effect of NNS on health outcomes stem from a variety of limitations, one of which is inadequate dietary assessment methodology. Accuracy of dietary intake assessment methods is limited by the inability to distinguish between different types of NNS and lack of information about consumer use of NNS in a variety of beverages and foods. The purpose of this investigation is to explore NNS consumer characteristics and to characterize NNS intake in a sample of rural Southwest Virginian adults. This characterization is especially important for rural populations, as they are known to be high sugar-sweetened beverage consumers and are at an increased risk of obesity and chronic disease; thus, NNS could serve as a replacement method to facilitate cardiometabolic health. Cross-sectional data from a large randomized controlled trial, Talking Health (n=301), was utilized in this investigation to compare demographic characteristics, anthropometrics, biochemical markers, dietary quality, and dietary factors between NNS consumers and NNS non-consumers. This data was also used to characterize NNS intake (frequency, type, and source of sweetener). Of this rural sample, 33% consumed NNS, with sucralose being the most prevalent type of NNS and diet soda being the most frequently consumed source of NNS. NNS consumers had a higher BMI status than NNS non-consumers. However, NNS consumers had better overall dietary quality than NNS non-consumers. The characteristics of these NNS consumers and their intake patterns can be used to develop well-designed dietary intake assessment tools that accurately measure NNS intake, which can facilitate a better understanding of the associations of NNS with health outcomes.
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    The Civil War Diet
    Brennan, Matthew Philip (Virginia Tech, 2005-05-20)
    The soldier's diet in the Civil War has been known as poor, and a number of illnesses and disorders have been associated with it. However, a nutritional analysis placed within the context of mid-nineteenth century American nutrition has been lacking. Such an approach makes clear the connection between illness and diet during the war for the average soldier and defines the importance of nutrition's role in the war. It also provides a bridge from the American diet to the soldier diet, outlining correlations between the two and examining the influence of physicians, chemists, and health reformers on the Civil War diet.
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    The Comparative Validity of Interactive Multimedia Questionnaires to Paper-Administered Questionnaires for Beverage Intake and Physical Activity: Pilot Study
    Riebl, Shaun K.; Paone, Allyson C.; Hedrick, Valisa E.; Zoellner, Jamie M.; Estabrooks, Paul A.; Davy, Brenda M. (JMIR Publications, 2013-10-22)
    Background: Brief, valid, and reliable dietary and physical activity assessment tools are needed, and interactive computerized assessments (ie, those with visual cues, pictures, sounds, and voiceovers) can reduce administration and scoring burdens commonly encountered with paper-based assessments. Objective: The purpose of this pilot investigation was to evaluate the comparative validity and reliability of interactive multimedia (IMM) versions (ie, IMM-1 and IMM-2) compared to validated paper-administered (PP) versions of the beverage intake questionnaire (BEVQ-15) and Stanford Leisure-Time Activity Categorical Item (L-Cat); a secondary purpose was to evaluate results across two education attainment levels. Methods: Adults 21 years or older (n=60) were recruited to complete three laboratory sessions, separated by three to seven days in a randomly assigned sequence, with the following assessments–demographic information, two IMM and one paper-based (PP) version of the BEVQ-15 and L-Cat, health literacy, and an IMM usability survey. Results: Responses across beverage categories from the IMM-1 and PP versions (validity; r=.34-.98) and the IMM-1 and IMM-2 administrations (reliability; r=.61-.94) (all P<.001) were significantly correlated. Paired t tests revealed significant differences in sugar-sweetened beverage (SSB) grams and kcal (P=.02 and P=.01, respectively) and total beverage kcal (P=.03), on IMM-1 and IMM-2; however, comparative validity was demonstrated between IMM-2 and the PP version suggesting familiarization with the IMM tool may influence participant responses (mean differences: SSB 63 grams, SEM 87; P=.52; SSB 21 kcal, SEM 33; P=.48; total beverage 65 kcal, SEM 49; P=.19). Overall mean scores between the PP and both IMM versions of the L-Cat were different (both P<.001); however, responses on all versions were correlated (P<.001). Differences between education categories were noted at each L-Cat administration (IMM-1: P=.008; IMM-2: P=.001; PP: P=.002). Major and minor themes from user feedback suggest that the IMM questionnaires were easy to complete, and relevant to participants' typical beverage choices and physical activity habits. Conclusions: In general, less educated participants consumed more total beverage and SSB energy, and reported less engagement in physical activity. The IMM BEVQ-15 appears to be a valid and reliable measure to assess habitual beverage intake, although software familiarization may increase response accuracy. The IMM-L-Cat can be considered reliable and may have permitted respondents to more freely disclose actual physical activity levels versus the paper-administered tool. Future larger-scale investigations are warranted to confirm these possibilities.
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    Comparison of assessment techniques: plasma lipid and lipoproteins related to the metabolic syndrome
    Davy, Brenda M.; Davy, Kevin P. (Biomed Central, 2006-01-31)
    Background The purpose of this investigation was to determine the influence of analytical method on reported concentrations of plasma lipids and lipoproteins, and to determine if there are clinical implications of any potential differences on identification of the metabolic syndrome dyslipidemia, CVD risk stratification and classification of LDL subclass phenotype. Results Plasma triglyceride (TG) concentrations were 1.09 ± 0.06 and 1.17 ± 0.06 mmol/L and plasma high density lipoprotein cholesterol (HDL-C) concentrations were 1.09 ± 0.03 vs 1.19 ± 0.03 mmol/L (both p < 0.05) from 113 duplicate samples sent to two laboratories utilizing different lipid and lipoprotein analytical methods (LABS 1 and 2, respectively). Plasma total cholesterol and low-density lipoprotein cholesterol (LDL-C) concentrations were also significantly different between laboratories. Spearman rho correlations indicate excellent agreement of TG and HDL-C determined by the two laboratories (r = 0.96, TG; r = 0.91, HDL-C, both p < 0.001). Eleven vs. 14 individuals met the TG criteria and 70 vs. 48 met HDL-C metabolic syndrome criteria with LAB 1 and 2, respectively. Apoprotein B concentration (LAB 1) and LDL particle number (LAB 2) were highly correlated. (r = 0.92, P < 0.01). LAB 2 characterized more individuals as LDL pattern B phenotype, as compared to LAB 1 (30 vs. 14%, P < 0.05). Conclusion Different plasma lipid and lipoprotein analytical techniques yield results which are highly correlated, yet significantly different, which suggests a consistent measurement difference. This difference has clinical implications, in that the proportion of individuals identified as meeting the metabolic syndrome dyslipidemia criteria, "at risk" based upon apo B or LDL particle number, and the LDL pattern B phenotype will differ based upon choice of analytical method.
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    Daily Self-Monitoring During the Winter Holiday Period: A Strategy for Holiday Weight Maintenance in Reduced-Obese Older Adults?
    Cornett, Rachel Ann (Virginia Tech, 2011-02-23)
    Weight management is problematic among Americans, as the number of overweight adults has risen to two-thirds of the population (1). Without the identification of successful approaches to promote weight stability, it is predicted that 86% of American adults will be overweight or obese by 2030 (2). Body-weight influenced diseases, such as diabetes and cardiovascular disease, are now leading causes of death (3). Annually, adult Americans are thought to increase their body weight by 0.5-0.9 kg (4). Of this gain, 52% is believed to occur during the winter holiday period of mid-late November to early January (5). Unfortunately, obesity research specific to this high-risk period is limited. Older adults and weight-reduced individuals are thought to be highly susceptible to significant holiday body weight gains (1, 6). To date, little research has investigated effective interventions that may be used to assist in successful body weight maintenance during the winter holiday period. Therefore, our purpose was to determine if daily self-monitoring of body weight, physical activity, and step counts is a feasible and effective tool to prevent weight gain in older, weight-reduced adults during the winter holiday period. This intervention represents a holiday weight maintenance approach that may be translatable to larger, more diverse populations.
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    Dash 2 Wellness: Effects of a Multi-Component Lifestyle Modification Program on Nutrition, Physical Activity, and Blood Pressure in Prehypertensive Middle-Aged Adults, a Randomized Controlled Trial
    Dorough, Ashley E. (Virginia Tech, 2009-04-17)
    The primary goal of this project was to develop, implement, and evaluate a lifestyle modification intervention that did not require extensive, ongoing personal contact to improve lifestyle behaviors shown to lower blood pressure (BP) in adults with prehypertension (N=23, mean age=54, mean BP=126.7/75.1). Incorporating clinical practices and psychological approaches to behavior change, this intervention used primarily the DASH Eating Plan, coupled with a low-sodium diet and a walking program; it applied social cognitive theory to health behavior change, specifically self-regulation for self-monitoring and management of BP, diet, exericse, and weight. The study compared two conditions, the DASH 2 Wellness Only standard of care condition to the DASH 2 Wellness Plus treatment condition on the primary outcome measures of fruit and vegetable (servings/day), sodium consumption (milligrams/day), physical activity (steps/day), weight (kgs), and blood pressure (primarily systolic BP). Consistent with hypotheses, MANOVAs detected significant differences between the conditions with D2W Plus evidencing a larger increase in change of total daily steps (M= 2900.14, SD= 1903.83) than D2W Only, (M= 636.39, SD= 1653.26), a larger decrease in systolic BP change (MMHG) (M= 15.14, SD= 4.33) than D2W Only, (M= 4.61, SD= 8.28), and a larger decrease in weight change (kg) (M= 4.78, SD= 3.81) than D2W Only, (M= 1.47, SD= 2.57). While conditions did not significantly differ on daily sodium reduction or fruit and vegetable increase, D2W Plus evidenced a larger decrease in sodium (mg) (M= 932.22, SD= 1019.22) than D2W Only, (M= 423.64, SD= 749.15) and larger increase in fruit and vegetable increase, (M= 2.10, SD= 1.73) than D2W Only, (M= 1.02, SD= 2.24). It was also hypothesized that the D2W Plus condition would show greater improvements in nutrition-specific and PA-specific health beliefs of self-regulation, social support, self-efficacy, social support, and outcome-expectancy compared to those in the D2W Only condition. A MANOVA revealed significant group differences in PA-specific health beliefs primarily attributable to increased PA self-regulation in D2W Plus compared to D2W Only, (M= 1.78, SD= 0.75) and (M= 0.55, SD= 0.57), respectively. While no overall significant group differences were found for nutrition-specific health beliefs, analyses showed meaningful differences in nutrition-specific health beliefs attributable to increased nutrition self-regulation strategies in D2W Plus compared to D2W Only. Results provide preliminary support for the efficacy of an electronic delivery of an intervention aimed at improving lifestyle behaviors and lowering BP in middle-aged individuals with prehypertension.