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Item A Systematic Review and Qualitative Analysis of Existing Dietary Mobile Applications for People With Chronic Kidney Disease(Elsevier, 2022) Russell, Carl R., III; Zigan, Clarisse; Wozniak, Kirsten; Soni, Kshaunish; Hill Gallant, Kathleen M.; Friedman, Allon N.; Medicine, School of MedicineObjective: The goal of this study was to systematically evaluate the quality of electronic applications (apps) available for chronic kidney disease (CKD) dietary management. Methods: The review consisted of (1) a systematic search for all mobile CKD diet apps available on the App Store and Google Play Store, (2) an evaluation to determine how well existing apps met criteria for an ideal app, and (3) a systematic literature review of publications found through Google Scholar, Mendeley, and PubMed that reviewed specific CKD diet apps and the broader field. Results: After applying systematic search criteria, 10 unique apps were identified. Ten of 14 criteria considered necessary in an ideal CKD diet app were applied to the 13 apps. Important criteria such as tailoring recommendations to CKD stage or individual dietary needs, tracking nutrient intake, allowing data to be accessible to clinicians, availability on different app platforms, and including CKD-friendly recipes were not consistently available in the apps. None of the apps used the most contemporary nutrition guidelines on which to base their recommendations. While the literature suggests there is demand for CKD diet apps, common shortcomings of available apps including barriers to usability, inclusion of erroneous information, the requirement of a high e-literacy level, user costs, lack of privacy, security, and interactive features, and the inability of caregivers or family members to use apps to assist in patient care. Conclusions: The few CKD dietary apps currently on the market for people with CKD have notable limitations in terms of content and software design. Opportunities therefore exist for improving on available CKD diet apps and thereby fulfilling an important unmet need for patients with CKD.Item Adverse effects of autoclaved diets on the progression of chronic kidney disease (CKD) and CKD-Mineral Bone Disorder in rats(Karger, 2020) Biruete, Annabel; Srinivasan, Shruthi; O’Neill, Kalisha D.; Vorland, Colby J.; Hill Gallant, Kathleen M.; Cai, Weijing; Uribarri, Jaime; Johnston, Nancy; Allen, Matthew R.; Chen, Neal X.; Moe, Sharon M.; Medicine, School of MedicineBackground: Autoclaving rodent diets is common in laboratory animals, but autoclaving increases the formation of dietary advanced glycation end-products (AGE). We studied the effect of autoclaved (AC) diet alone or in combination with a diet high in bioavailable phosphorus on biochemistries of chronic kidney disease-mineral and bone disorder (CKD-MBD), intestinal gene expression, and oxidative stress. Methods: Male CKD rats (Cy/+) and normal littermates were fed 1 of 3 diets: AC 0.7% phosphorus grain-based diet for 28 weeks (AC); AC diet for 17 weeks followed by non-autoclaved (Non-AC) 0.7% phosphorus casein diet until 28 weeks (AC + Casein); or Non-AC diet for 16 weeks followed by a Non-AC purified diet until 30 weeks (Non-AC + Casein). Results: AC diets contained ~3× higher AGEs and levels varied depending on the location within the autoclave. Rats fed the AC and AC + Casein diets had higher total AGEs and oxidative stress, irrespective of kidney function. Kidney function was more severely compromised in CKD rats fed AC or AC + Casein compared to Non-AC + Casein. There was a disease-by-diet interaction for plasma phosphorus, parathyroid hormone, and c-terminal fibroblast growth factor-23, driven by high values in the CKD rats fed the AC + Casein diet. Compared to Non-AC + Casein, AC and AC + Casein-fed groups had increased expression of receptor of AGEs and intestinal NADPH oxidase dual oxidase-2, independent of kidney function. Conclusions: Autoclaving rodent diets impacts the progression of CKD and CKD-MBD, highlighting the critical importance of standardizing diets in experiments.Item Advertisement with illustration of garden vegetables and text emphasizing the importance of eating more vegetables and fruit, and less meat.(Indiana State Board of Health, 1915-06)[Text in capital letters within image] Health First. For health eat little meat and eat more freely of fruit and vegetables.Item Barriers and Facilitators to Adherence to a Mediterranean Diet Intervention during Chemotherapy Treatment: A Qualitative Analysis(Taylor & Francis, 2023) Harvey, Brianna I.; Youngblood, Shari M.; Kleckner, Amber S.; Surgery, School of MedicinePatients undergoing chemotherapy are at risk for malnutrition and a high symptom burden, and nutritional interventions can address clinical and supportive care outcomes. Herein, we identified barriers and facilitators to adhering to a Mediterranean Diet (MedDiet) intervention during chemotherapy. Patients with cancer (any type) who were undergoing chemotherapy were enrolled into a clinical trial testing the effects of an 8-week MedDiet intervention on cancer-related fatigue. Participants were randomized 2:1, MedDiet:control. The intervention entailed food provision, education, a cookbook, a session with a nutritionist, and weekly check-ins. Post-intervention, all participants completed semi-structured exit interviews. The interviews were transcribed and open coding was conducted to describe the facilitators and barriers to MedDiet adherence. Participants (n=29, n=21 in the intervention group) were 51.0±15.1 years old and 93.1% had breast cancer. Educational materials and convenient food delivery were the highest reported facilitators. Many patients offered that changing their diet gave a sense of control and empowerment. Barriers to adherence were that the frozen food was unappetizing, participants’ (or their spouse/children’s) food preferences did not align with the MedDiet, and chemotherapy-induced side effects that prevented food consumption (e.g., mouth sores, lack of appetite). This project helps understand the patient experience within nutritional interventions to optimize dietary programs during chemotherapy treatment.Item Caffeine Intake, Coffee Consumption, and Risk of Cutaneous Malignant Melanoma(Ovid Technologies (Wolters Kluwer) - Lippincott Williams & Wilkins, 2015-11) Wu, Shaowei; Han, Jiali; Song, Fengju; Cho, Eunyoung; Gao, Xiang; Hunter, David J.; Qureshi, Abrar A.; Department of Epidemiology, Richard M. Fairbanks School of Public HealthBACKGROUND: Caffeine has been shown to prevent ultraviolet radiation-induced carcinogenesis and to inhibit growth of melanoma cells in experimental studies. We evaluated the association among caffeine intake, coffee consumption, and melanoma risk among three large cohort studies. METHODS: The analysis used data from 89,220 women in the Nurses' Health Study II (1991-2009), 74,666 women in the Nurses' Health Study (1980-2008), and 39,424 men in the Health Professionals Follow-up Study (1986-2008). We used Cox proportional hazards models to estimate the hazard ratios (HR) with 95% confidence intervals (CIs) of melanoma associated with dietary intakes. RESULTS: We documented 2,254 melanoma cases over 4 million person-years of follow-up. After adjustment for other risk factors, higher total caffeine intake was associated with a lower risk of melanoma (≥393 mg/day vs. <60 mg/day: HR = 0.78, 95% CI = 0.64, 0.96; Ptrend = 0.048). The association was more apparent in women (≥393 mg/day vs. <60 mg/day: HR = 0.70, 95% CI = 0.58, 0.85; Ptrend = 0.001) than in men (HR = 0.94, 95% CI = 0.75, 1.2; Ptrend = 0.81), and more apparent for melanomas occurring on body sites with higher continuous sun exposure (head, neck, and extremities; ≥393 mg/day vs. <60 mg/day: HR = 0.71, 95% CI = 0.59, 0.86; Ptrend = 0.001) than for melanomas occurring on body sites with lower continuous sun exposure (trunk including shoulder, back, hip, abdomen, and chest; HR = 0.90, 95% CI = 0.70, 1.2; Ptrend = 0.60). This pattern of association was similar to that for caffeinated coffee consumption, whereas no association was found for decaffeinated coffee consumption and melanoma risk. CONCLUSIONS: Increasing caffeine intake and caffeinated coffee consumption is associated with decreased risk of cutaneous malignant melanomas.Item Cancer survivors' uptake and adherence in diet and exercise intervention trials: an integrative data analysis(Wiley, 2015-01-01) Adams, Rebecca N.; Mosher, Catherine E.; Blair, Cindy K.; Snyder, Denise C.; Sloane, Richard; Demark-Wahnefried, Wendy; Department of Psychology, School of ScienceBACKGROUND: The health benefits of diet and exercise interventions for cancer survivors are well documented. However, little is known regarding demographic and medical predictors of survivors' willingness to participate in diet and exercise intervention trials, study enrollment, intervention adherence, and study completion. To assist in interpreting the generalizability of trial findings and to improve the design of future trials, this study examined predictors of these process measures. METHODS: An integrative data analysis was performed on data from 3 of the largest home-based diet and exercise intervention trials for cancer survivors (n = 23,841). Demographic and medical factors (ie, sex, race, age, time since diagnosis, and cancer type) were examined as predictors of willingness to participate, study enrollment, intervention adherence, and study completion in the pooled sample. A 99% confidence interval was used to determine statistical significance. RESULTS: Across trials, 11.1% of contacted survivors were willing to participate, and 5.7% were eligible and enrolled. Among enrollees, 53.4% demonstrated ≥75% adherence to the intervention, and 91.1% completed the study. Race (Caucasian vs others), age, time since diagnosis, and cancer type predicted survivors' willingness to participate (P < .01). All examined predictors were associated with the likelihood of study enrollment (P < .01). No significant predictors of intervention adherence or study completion were found among study enrollees (P ≥ .01). CONCLUSIONS: Cancer survivors' demographic and medical characteristics predicted their interest and participation in diet and exercise intervention trials. These findings have implications for the generalizability of results and can help to guide procedures used in future trials to enhance patient representation.Item Cell Kinetic Analysis of Osteoblast Histogenesis in the Rat Periodontal Ligament Following Exposure to Hard and Soft Diet(1991) Colter, Robert D.; Roberts, W. Eugene; Garetto, Lawrence P.; Hohlt, William F.; Newell, Donald; Shanks, James C.This is the first in a series of experiments designed to investigate the effect of local and systemic factors on osteoblast histogenesis in rats. A soft diet is an experimental means thought to decrease the overall mechanical loading (a local factor) on the masticatory apparatus. Eighteen Sprague-Dawley rats were divided into three equally sized groups: 1) an experimental group, which was maintained on a soft paste diet; 2) a control group, pair fed with the experimental group; and 3) a control group fed ad libitum. Both control groups continued to eat standard Purina rat chow pellets. Twenty-three days later all animals were injected subcutaneously with 1.0 μCi/ g tritiated thymidine and sacrificed one hour later. The maxillae of the animals were dissected and sectioned. The periodontal ligament (PDL) of the mesial surface of the mesial root of the first molar was analyzed microscopically 110 μm above and below the mid root area. Nuclear size was used to determine the stage of osteoblast differentiation. The labeling index was used to determine the proliferative activity of the cells. The distance of cells from the nearest major blood vessel (NMBV) was measured and the cells were grouped into one to four extravascular zones. For each zone, cell density was determined. PDL widths were measured to evaluate tooth function. If osteogenesis is due primarily to stress and strain on bones, then rats maintained on the soft diet should show a decreased labeling index, increased number of A and A' cells, decreased number of C and D cells, and an unaltered vascularly-oriented cell density gradient. The number of osteoblastic precursor cells (A and A' cells) close to blood vessels should increase relative to the number of preosteoblastic cells (C and D) further from the vessels. Also, the width of the PDL space in the soft diet rats should be narrower since their function was decreased. The results of this study did not support the hypothesis that a decrease in masticatory stress and strain within the rat periodontal ligament due to softened dietary consistency reduces osteoblast histogenesis. No differences were seen in the PDL widths or the vascularly-oriented cell density gradient between groups. High levels of A+A' cells were seen paravascularly for all groups, and their relative numbers decreased as one moved away from the blood vessel into a lower cell density area, supporting previous studies. No differences were seen in the fractional distribution of A+A' cells or C+D cells between groups, as was hypothesized, except for a higher level of A+A' cells in the pair fed group across all zones. This latter finding was probably due to physiologic variation and the small sample sizes used in this study. Decreased masticatory stress and strain due to a softened diet did not reduce osteoblast histogenesis. Further research needs to investigate systemic factors which may influence bone formation.Item Clinically Actionable Hypercholesterolemia and Hypertriglyceridemia in Children with Nonalcoholic Fatty Liver Disease(Elsevier, 2018-07) Harlow, Kathryn E.; Africa, Jonathan A.; Wells, Alan; Belt, Patricia H.; Behling, Cynthia A.; Jain, Ajay K.; Molleston, Jean P.; Newton, Kimberly P.; Rosenthal, Philip; Vos, Miriam B.; Xanthakos, Stavra A.; Lavine, Joel E.; Schwimmer, Jeffrey B.; Pediatrics, School of MedicineOBJECTIVE: To determine the percentage of children with nonalcoholic fatty liver disease (NAFLD) in whom intervention for low-density lipoprotein cholesterol or triglycerides was indicated based on National Heart, Lung, and Blood Institute guidelines. STUDY DESIGN: This multicenter, longitudinal cohort study included children with NAFLD enrolled in the National Institute of Diabetes and Digestive and Kidney Diseases Nonalcoholic Steatohepatitis Clinical Research Network. Fasting lipid profiles were obtained at diagnosis. Standardized dietary recommendations were provided. After 1 year, lipid profiles were repeated and interpreted according to National Heart, Lung, and Blood Institute Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction. Main outcomes were meeting criteria for clinically actionable dyslipidemia at baseline, and either achieving lipid goal at follow-up or meeting criteria for ongoing intervention. RESULTS: There were 585 participants, with a mean age of 12.8 years. The prevalence of children warranting intervention for low-density lipoprotein cholesterol at baseline was 14%. After 1 year of recommended dietary changes, 51% achieved goal low-density lipoprotein cholesterol, 27% qualified for enhanced dietary and lifestyle modifications, and 22% met criteria for pharmacologic intervention. Elevated triglycerides were more prevalent, with 51% meeting criteria for intervention. At 1 year, 25% achieved goal triglycerides with diet and lifestyle changes, 38% met criteria for advanced dietary modifications, and 37% qualified for antihyperlipidemic medications. CONCLUSIONS: More than one-half of children with NAFLD met intervention thresholds for dyslipidemia. Based on the burden of clinically relevant dyslipidemia, lipid screening in children with NAFLD is warranted. Clinicians caring for children with NAFLD should be familiar with lipid management.Item Diet and exercise intervention adherence and health-related outcomes among older long-term breast, prostate, and colorectal cancer survivors(Springer, 2014-10) Winger, Joseph G.; Mosher, Catherine E.; Rand, Kevin L.; Morey, Miriam C.; Snyder, Denise C.; Demark-Wahnefried, Wendy; Department of Psychology, School of ScienceBACKGROUND: Diet and exercise interventions for cancer survivors result in health benefits; however, few studies have examined health outcomes in relation to adherence. PURPOSE: We examined associations between adherence to components of a diet-exercise intervention and survivors' physical and mental health. METHODS: A randomized controlled trial tested a telephone and mailed print intervention among 641 older, overweight, long-term survivors of breast, prostate, and colorectal cancer. Dietary and exercise behaviors were assessed at 14 time points throughout the year-long intervention; health outcomes were examined postintervention. RESULTS: Telephone session attendance had significant indirect relationships with health outcomes through intervention-period exercise and dietary behavior. Attendance showed positive indirect relationships with physical function (β = 0.11, p < 0.05), basic and advanced lower extremity function (β = 0.10, p < 0.05/β = 0.09, p < 0.05), and mental health (β = 0.05, p < 0.05), and a negative indirect relationship with body mass index (β = -0.06, p < 0.05). CONCLUSIONS: Session attendance is vital in facilitating improvement in health behaviors and attendant outcomes (Clinicaltrials.gov number NCT00303875).