Background: Effective glucose management using exercise modalities in older patients with type 2 diabetes and activities of daily living (ADL) disabilities are unknown.

Purpose: The study investigated the acute effects of motor-assisted cycling and functional electrical stimulation (FES) cycling on the 2-h postprandial glucose responses compared with sitting control in older adults with type 2 diabetes and ADL disabilities.

Methods: The study used a 3×3 crossover study design. Nine participants were randomly assigned to one of the three treatment sequences: ABC, BCA, and CAB. (A, motor-assisted cycling; B, FES cycling; C, sitting control). Linear mixed models (LMM) with Bonferroni post-hoc tests were used to test the mean differences for the 2-h postprandial glucose, estimated by the area under the curve (AUC) and incremental AUC (iAUC), between intervention and control treatments after adjustment for covariates (e.g., age, sex, and race).

Results: There were significant mean differences for iAUC (p = 0.005) and AUC (p = 0.038) across motor-assisted cycling, control, and FES cycling treatments. The FES cycling had a lower mean of 2-hour postprandial iAUC as compared with sitting control (iAUC 3.98 mmol∙h/L vs 6.92 mmol∙h/L, p = 0.006, effect size [ES] = 1.72) and the motor-assisted cycling (iAUC, 3.98 mmol∙h/L vs 6.19 mmol∙h/L , p = 0.0368, ES = 1.29), respectively. The FES cycling also had a lower mean of the 2-hour postprandial AUC as compared with sitting control (AUC, 18.29 mmol∙h/L vs 20.95 mmol∙h/L, p = 0.043, ES = 0.89), but had an AUC similar to the motor-assisted cycling (18.29 mmol∙h/L vs 20.23 mmol∙h/L , p = 0.183, ES = 0.19). There were no statistical differences in iAUC (6.19 mmol∙h/L vs 6.92 mmol∙h/L) and AUC (20.23 mmol∙h/L vs 20.95 mmol∙h/L) between the motor-assisted cycling and sitting control (all p>0.05).

Conclusion: Performing 30 minutes of FES cycling on a motor-assisted bike (40 Hz, 39 rpm, 25-29 mA) significantly decreased the 2-h postprandial glucose levels in older adults with type 2 diabetes and ADL disabilities. These findings suggested that FES cycling can be a promising exercise modality for glucose management in diabetic patients with ADL disabilities.

Background. Despite extensive research in the literature aimed at understanding the role of hypertension as a major risk factor for numerous leading causes of death in the United

States, rates of this disease continue to rise. Recent findings suggest that antiseptic mouthwash use may increase blood pressure through elimination of oral bacteria that facilitate the enterosalivary nitrate-nitrite-nitric oxide pathway.

Objective. The purpose of this randomized, controlled, crossover trial was to examine the effects of antiseptic mouthwash use and sodium intake on blood pressure and salivary nitrate levels in prehypertensive adults.

Methods. Healthy adults (n=10; 47.3±12.5) with mildly elevated blood pressure (average baseline blood pressure of 114.9/75.2 mmHg) were recruited and were randomly assigned to a control condition, antiseptic mouthwash use, or antiseptic mouthwash use + consumption of three pickles per day (~6000 mg/day of sodium) for a total of 7 days. Given the crossover design of this study, participants adhered to a 1-week washout period between each condition and all participants received all three treatments. Findings were considered significant at a p-value of <0.05 and a repeated measures ANOVA test was used to compare change data of each condition.

Results. Changes in systolic and diastolic blood pressure were not statistically significant (p=0.469 and p=0.859, respectively). Changes in salivary nitrite levels were not statistically significant (p=0.493). Although there appeared to be fluctuations in sodium intake between interventions, differences in sodium intake were not statistically significant when pickles were not accounted for (p=0.057).

Conclusion. Antiseptic mouthwash use did not appear to induce significant changes in systolic or diastolic blood pressure in this population.

Healthy lifestyle behaviors including quality nutrition have been shown to successfully prevent chronic disease or minimize symptoms. However, many physicians lack the knowledge and skills to provide adequate nutrition counseling and education for their patients. A major component of this problem is that medical schools are not required to teach nutrition education. The purpose of this feasibility study was to compare the changes in the perceived importance of nutrition in the medical field in medical students before and after participating in a week-long interactive nutrition course in order to determine if a week-long course can positively influence students’ perceptions of nutrition. Ultimately by changing these perceptions, medical students may be able to better help patients prevent chronic disease. The participants were first year medical students at the Mayo Clinic School of Medicine (Scottsdale, AZ) who chose to participate in this medical school “Selective”. The study included a five-day curriculum of case-studies, lectures from specialized health professionals, and a cooking class led by a chef who trained in France. An anonymous pre- and post-study questionnaire with five-point Likert scale questions was used to measure changes in attitudes. The data suggest that students’ perceptions regarding the importance and relevance of nutrition in the medical shifted slightly more positive after attending this Selective, although these shifts in attitude were not statistically significant. Limitations of this study include a small sample size and selection bias, which may have decreased the potential of having significant results. Both of these factors also make the results of this study less generalizable to all medical students. This study supports the need for a larger experimental study of a similar design to verify that an interactive, evidence-based nutrition class and culinary experience increases medical students’ positive perceptions of nutrition in the medical field.

Exposure to sun radiation (SUR) with ambient temperature may be an influencer on athletes’ sweat loss in different environments, but the results are not currently known. The purpose of this study was to determine the effects of SUR on fluid balance (FB) and hydration status (HS) in athletes exercising indoors and outdoors.

Initial FB and HS were assessed in NCAA-DI female soccer athletes (n=10) of a single team in temperate, dry conditions (55-68°F, 18-48% humidity) who were monitored during 3 practices of equal estimated energy expenditure (EE): two outdoors in direct SUR (cold/moderate temperatures) and one indoors without SUR (moderate temperatures). Humidity, temperature, and wet bulb globe temperature (WBGT – a measurement partly based on SUR, including ambient temperature/relative humidity) were recorded using Heat Stress Meters placed in the direct sun or in the shade. Each athlete’s semi-nude dry body weight was recorded before and after exercise. Urine samples were taken before, after, and the morning after. Urine specific gravity (USG) was tested to assess HS. Athletes wore combined heart rate and activity monitors to estimate EE and were provided ad libitum water and/or a zero-calorie sports drink. Their total intake included weights of consumed food and drink. Sweat rate was calculated using body weight change and intakes of liquids minus urine losses/hour.

Two-way repeated measures ANOVA analyzed group-level differences. No significance was found in total FB (1.01±0.32 L/hr) or EE/hr (444±97.1 kcal/hr) across all days (p>0.05). In analyzing individual athlete results, 40% had consistent USG >1.025 (p=0.001) suggesting potential dehydration. These 4 athletes selected water as their beverage, of which is known that consuming only water does not stimulate drinking behavior as does electrolyte drinks. The remaining 60% were overall not dehydrated (USG <1.025) but must be aware of incidental dehydration in hotter temperatures.

The conclusion is that in low-moderate temperatures, athletes self-regulate drinking habits and achieve fluid balance during exercise with or without sun radiation. However, athletes with average USG >1.025 are likely to remain dehydrated in moderate temperatures. The findings suggest that more education would benefit these athletes by ensuring hydration in any environment.

Chronic diseases, such as diabetes, heart disease, and cancer are leading causes of death in the United States. Although they result from a host of personal and environmental factors, diet remains a critical way to reduce the risk. Plant-based diets in particular are associated with reduction in risk for chronic disease due to an intake that closely mirrors the Dietary Guidelines for fruit and vegetable consumption, fiber, and fat intake. Additionally, plant-based diets offer a sustainable alternative in relation to food production as they often require fewer natural resources overall.

While there are many benefits to following a plant-based diet, potential concerns arise as well. Certain micronutrients can be lacking and protein intake can be inadequate without careful consideration of dietary intake. Protein is especially important for its role in maintaining lean body mass, which allows individuals to function in activities of daily living. Plant-based sources of protein are often less digestible; therefore, those consuming vegetarian and vegan diets may benefit from increased protein intake for preservation and perhaps improved lean body mass as well as strength changes.

Recent research has shown that vegetarians had significantly less muscle mass compared to omnivores despite similar amounts of protein intake in grams per day. Other research has shown that vegetarians do not necessarily see an increase in muscle mass when exposed to resistance exercise, whereas those following an omnivorous diet or lacto-ovo-vegetarian diet do. However, other studies have found that vegetarians can achieve increases in lean body mass comparable to omnivores if 30g/meal of plant-based protein is ingested consistently.

It remains unclear what effect protein supplementation might have on strength and muscle mass among sedentary plant-based eaters. As such, the present study assessed sedentary vegetarian and vegan individuals as to whether increases in dietary plant-based protein could elicit changes in body composition, hand grip and lower body strength independent of exercise. After an 8-week intervention, no significant differences for lean body mass or strength were noted. Results are discussed in the context of trial integrity and supplement consumption issues.

The true number of food borne illness occurrences that stem from the home is largely unknown, but researchers believe the number is much greater than represented in national data. The focus on food safety has generally been directed at food service establishments, which have made great strides at improving the methods of how their food is prepared. However, that same drive for proper food safety education is lacking in home kitchens, where the majority of food is prepared. Young adults are among some of the riskiest food preparers, and limited research and education methods have been tested on this vulnerable population. This study examined the effect of a basic food safety intervention on consumer food safety knowledge in young adults in the United States (U.S.) over a week period. The study had a pre/post survey design, where participants answered a survey, watched a short 10-minute video, and then recompleted the same survey a week later. Ninety-one participants age 18-29 years completed the initial food safety knowledge questionnaire. Twenty-six of those participants completed both the pre- and post-intervention food safety knowledge questionnaires. A paired t-test was used to analyze changes in questionnaire scores pre/post intervention. The majority of participants were female (78.9%), Arizona State University (ASU) students (78.0%), did not have any formal food safety education (58.2%), prepared a minimum of one meal per week from home (96.7%), and had completed 0-1 college nutrition courses (64.8%). The average overall score for all participants who completed the initial questionnaire was 62.6%. For those that took both the initial questionnaire and the follow up questionnaire (n=26), their scores shifted from 66.8% to 65.5% after the intervention. Scores increased significantly only for one question post-intervention: 38.5% (n=10) to 53.8% (n=14) for the safest method for cooling a large pot of hot soup (p = 0.050). This was the first study of its kind to test a video intervention in attempts to increase food safety knowledge in young adults, and additional studies must be done to solidify the results of this study. Other means of education should be explored as well to determine the best way of reaching this population and others.

Background: The Academy of Nutrition and Dietetics states that it is possible for a vegetarian to obtain the recommended amount of nutrients with a properly planned diet but nutrient deficiencies, such as vitamin B12 deficiency, may occur if diet planning is not optimal. An early indicator of B12 deficiency is raised homocysteine concentrations in blood which can cause health issues.

Objective: The amino acid methionine is consumed via dietary protein. Methionine is used in the biosynthesis of other proteins. After a removal of a methyl group, it makes homocysteine. Slightly raised homocysteine may promote greater synthesis of glutathione, an important endogenous antioxidant protectant. It can then be recycled back into methionine or converted into cysteine with the addition of various B-vitamins such as vitamin B12, folic acid, and vitamin B6. Cysteine then uses outside sources of glutamate and glycine to create glutathione (GSH). With the catalyst glutathione peroxidase it donates an electron and becomes the oxidized form, glutathione disulfide (GSSG). It can then convert back to GSH with the aid of glutathione reductase by using the reduced form of nicotinamide adenine dinucleotide phosphate (NADPH) as an electron donor. This study will examine glutathione levels in omnivores and vegetarians and see if it is related to vitamin B12 and homocysteine levels.

Design: This cross-sectional study encompassed 16 omnivores and 17 vegetarians from Phoenix, Arizona. A vegetarian diet was defined as one that excludes red meat, poultry, pork and seafood but allows dairy products and/or eggs; the diet had to be followed for at least one year. An omnivore diet is defined as eats meat daily. Participants completed a diet questionnaire and a vitamin B12, B6 and folate food questionnaire and provided a fasting blood sample.

Results: The mean plasma B12 and homocysteine did not differ between diet groups. Glutathione was significantly lower among vegetarians in comparison to omnivores, 1.9±0.5 and 2.3±0.7 mmol respectively (p=0.046).

Conclusions: The hypothesis was shown to be incorrect that vegetarians would have a higher glutathione level than omnivores as a result of their modest consumption of vitamin B12. The implications of a reduced glutathione status are discussed.

Objectives: To investigate the potential of vinegar supplementation as a means for reducing visceral fat in healthy overweight and obese adults, and to evaluate its effects on fasting blood glucose and fasting insulin.

Subjects and Methods: Forty-five sedentary overweight and obese adult participants with a waist circumference greater than 32 inches for women and 37 inches for men were randomly assigned to one of two groups, the vinegar group (VIN, n=21) or the control group (CON, n=24), and instructed to consume either two tablespoons of liquid red wine vinegar (3.6g acetic acid) or a control pill (0.0225g acetic acid) twice daily at the beginning of a meal for 8 weeks. Participants were also instructed to maintain normal diet and physical activity levels. Anthropometric measures, dual-energy x-ray absorptiometry (DXA) scans, blood samples, and 24-hour dietary recalls were collected at baseline and at end of trial. A compliance calendar was provided for daily tracking of vinegar supplementation.

Results: Compliance to vinegar supplementation averaged 92.7 ±13.3% among the VIN group and 89.1 ±18.9% among the CON group. There were no statistically significant differences in anthropometric measurements between baseline and week 8: weight (P=0.694), BMI (P=0.879), and waist circumference (P=0.871). Similarly, DXA scan data did not show significant changes in visceral fat (P=0.339) or total fat (P=0.294) between baseline and week 8. The VIN group had significant reductions in fasting glucose (P=0.003), fasting insulin (P <0.001), and homeostatic model assessment of insulin resistance scores (P <0.001) after treatment.

Conclusions: These data do not support the findings from previous studies that indicated a link between vinegar supplementation and increased fat metabolism, specifically visceral fat reduction.

Most American children consume less than the recommend amount of fruits and vegetables (F&V), 74% and 84%, respectively. Eating too few F&V in childhood is associated with increased risk of cardiovascular disease, hypertension, respiratory symptoms, and some cancers later in life. Adequate F&V consumption favorably impacts antioxidant status, gut flora, mood, and cognitive functioning. Nutrients such as vitamin C and fiber are only naturally occurring in plant foods. For many children, school lunches are an important source of F&V. This pilot study assessed the feasibility of providing condiments to increase children’s consumption of salad bar F&V in an elementary school cafeteria at lunchtime. The trial site was a single Title 1 elementary school in a large, urban district in the greater Phoenix metropolitan area. Taste tests were conducted on three convenience samples of children in grades 3 – 7, aged 8 – 12 years (n=57) to identify the most popular condiment flavors. The five highest rated flavors were made available daily at a “flavor station” in the school’s lunchroom for three consecutive weeks during the Fall 2018 semester. Descriptive and inferential statistics were used to analyze data. A cost analysis was conducted for capital outlays related to the flavor station. School employee perceptions of F&V and the flavor station were assessed via posttest online surveys. Peanut butter was rated the best tasting condiment by children and was the only condiment that increased in popularity throughout the intervention. Overall, daily F&V consumption increased 17 g per child. There was a linear increase in F&V consumption during the study (r=0.986; P=0.014). As a proportion of the total F&V selected, F&V waste decreased by nearly 3%. The average daily cost of providing the flavor station was $0.09 per student. Sixty-five percent of school staff felt that the flavor station should continue at their school. Peanut butter is an affordable, nutrient-dense food that accommodates the USDA Food and Nutrition Service meal patterns and nutrition standards, and thus, is a viable strategy for increasing F&V consumption and decreasing F&V waste. The results herein inform the development of future interventions to improve the palatability of F&V for children.

Urinary sucrose and fructose has been suggested as a predictive biomarker of total sugars intake based on research involving UK adults. The purpose of this study was to determine the association between total sugars consumption and 24-hour urinary sucrose and fructose (24uSF) in US adult population and to investigate the effect of physical activity on this association. Fifty seven free-living healthy subjects 20 to 68 years old, participated in a 15-day highly controlled feeding study, consuming their habitual diet, provided by the research metabolic kitchen. Dietary sugars were estimated using Nutrition Data System for Research (NDSR). Subjects collected eight 24-hour urine samples measured for urinary sucrose and fructose. Physical activity was assessed daily using a validated 15-day log that inquired about 38 physical activities across six domains; home activities, transportation, occupation, conditioning, sports and leisure. The mean total sugars intake and added sugars intake of the sample was 112.2 (33.1) g/day and 65.8 (29.0) g/day (9.7%EI), respectively. Significant moderate positive correlation was found between 15-d mean total sugars intake and 8-day mean 24uSF (r = 0.56, p < 0.001). Similarly, added sugars were moderately correlated with 24uSF (r = 0.56, p < 0.001), while no correlation was found between naturally-occurring sugars and 24uSF (r = 0.070, p < 0.001). In a linear multiple regression, total and added sugars each explained 30% of variability in 24uSF (Adjusted R2, p value; total sugars: 0.297, 0.001; added sugars: 0.301, p < 0.001). Physical activity had no effect on the association between dietary and urinary sugars in neither the correlation nor the linear regression analysis. 24uSF can be used as a biomarker for total and added sugars consumption in US adults, although its predictability was weaker compared to findings involving UK adults. No evidence was found showing that physical activity levels affect the association between 24uSF and total sugars intake in US adults. More detailed investigation through future feeding studies including subjects with wide range of sugars intake and of different ethnic/racial backgrounds are needed to better understand the characteristics of the biomarker and its uses.