Amy Reyes

A comprehensive systematic review and meta-analysis of 36 randomized clinical trials shows that using activity trackers produces some health benefit, but primarily when combined with coaching.

According to U.K. researchers writing online Oct. 9 in 

the devices produce statistically significant small and medium-sized improvements in health-such as lowering blood glucose levels, blood pressure, cholesterol levels, body weight and body mass index-but primarily in the short-term.

Studies in recent years have produced conflicting results on the benefits of activity trackers, so researchers, led by Alexander Hodkinson, Ph.D., of the University of Manchester, sought clarity from the published literature. The final analysis included of 4,856 patients with cardiometabolic conditions-diabetes, prediabetes, obesity and cardiovascular disease.

The final analysis included 20 studies on the use of accelerometers and 16 on pedometers. Of these, 32 trials showed "medium" improvements in physical activty in studies that followed patients over short and medium time spans of up to 32 weeks.

They found that the frequency of physical activity improved when patients met one-on-one with coaching consultants. These interactions led to "significant" small to medium improvements in physical activity frequency, but it's not enough, the authors stated.

"People with cardiometabolic conditions have demonstrated encouraging results, but levels of physical activity remain below the targets set by clinical recommendations," the authors wrote.

More studies are needed to determine if improvements in health continue long-term and if so, whether the improvements are signiciant.

But one thing is certain:  coaching helps. "This study found no evidence that simple self-monitored interventions using either pedometers or accelerometers are associated with improvements in physical activity," the authors wrote.

Sales for fitness activity trackers have skyrocketed in recent years. MobileHealthNews.com reports that the global revenue for smartphone-connected fitness tracking devices and equipment will close in 2019 at $5.4 billion, which is up from $2 billion in 2014.

Alexander Hodkinson, PhD; Evangelos Kontopantelis, PhD; Charles Adeniji, MD; et al.

 "Accelerometer- and Pedometer-Based Physical Activity Interventions Among Adults With Cardiometabolic Conditions A Systematic Review and Meta-analysis."

 Oct. 9, 2019. DOI:10.1001/jamanetworkopen.2019.12895

Articles

Activity Trackers Work Best with Coaching

A systematic review and meta-analysis of observational studies assessing the association between plant-based dietary patterns and the risk of type 2 diabetes among adults, provides the strongest evidence to date that eating a plant-based diet does indeed lower the risk of type 2 diabetes.

The benefits were even stronger when the plant-based foods included fruits, vegetables, whole grains, legumes and nuts, wrote researchers writing online July 22 in 

Led by Qi Sun, M.D., ScD, of the Harvard T. H. Chan School of Public Health in Boston, researchers based their findings on nine studies from seven publications that included 307,099 patients, 23,544 cases of type 2 diabetes. The studies varied in follow-up periods from two to 28 years. The association may even be greater than reported here, the researchers wrote, because the studies all adjusted for BMI.

“By analyzing dietary patterns, we can quantify the synergistic effects of dietary compositions on overall disease risk, including the substitution and replacement of major macronutrient types (ie, plant sources of fat and protein for the respective animal sources),” researchers wrote.

In addition to the inverse relationship between consuming a plant-based diet and lowering the risk of type 2 diabetes, researchers outlined several other ways in which plant-based foods can lower the risk of diabetes.

Plant-based diets are rich in fiber, vitamins and minerals, antioxidants, phenolic compounds, and unsaturated fatty acidsâall of which improve insulin sensitivity and blood pressure, reduce long-term weight gain and can control systemic inflammation pathways that lead to type 2 diabetes.

Avoiding red and processed meats in itself lowers the risk of type 2 diabetes. This may be due to their high cholesterol or heme iron content. Animal-derived compounds, such as choline and l-carnitine, can interact negatively with the gut microbiome.

Eating a plant-based diet can control the excessive weight gain associated with type 2 diabetes, which is probably the most important key factor in reducing type 2 diabetes risk.

But then the health benefits may extend beyond weight control, the researchers said because some evidence suggests that a plant-based diet can improve glycemic control regardless of body weight and diabetes status.

Preliminary evidence suggests that consuming a plant-based diets may lower the risk of adiposity-related risk markers, including leptin, adiponectin, high-sensitivity C-reactive protein, and interleukin-6.

Three of the studies in the analysis found that a plant-based diet largely defined by refined grains, starches and sugars was consistently associated with a higher risk of type 2 diabetes.

“The totality of current evidence supports health benefits for increasing plant-based food consumption in lowering the risk of type 2 diabetes and, potentially, other cardiometabolic diseases,”  researchers wrote.

JAMA Intern Med. Published online July 22, 2019.

Definitive Evidence Supports Plant-Based Diet to Control Diabetes

Findings from two studies recently published in the British Medical Journal  highlight the clear impact of consuming ultra-high processed foods to the risk of cardiovascular events and overall mortality.

In a study led by Bernard Srour, M.D., of the University of Paris, researchers found that a 10 percent increase in the consumption of ultra-processed foods corresponded to increases in coronary heart and cerebrovascular disease of 13 and 11 percent, respectively, and a 12 percent overall increase in total cardiovascular disease.

The authors highlight the need for improvements in nutritional quality and a reduction in the use of unnecessary additives.

“Various factors in processing, such as nutritional composition of the final product, additives, contact materials, and neoformed contaminants might play a role in these associations,” they wrote. “Further studies are needed to understand the relative contributions.”

While other studies have linked the consumption of ultra-processed food to increased risks of cancer and cardiometabolic disorders, including obesity, hypertension and high cholesterol, this is the first epidemiological study to show an association between a diet high in processed foods and the risk of cardiovascular disease.

The study included 105,159 adults (79.2 percent women, average age 42.7 years). Dietary habits were recorded for 24-hour periods over an average of 5.2 years in which 1,409 participants experienced their first cardiovascular event:  106 myocardial infarctions, 485 angioplasties, 74 acute coronary syndromes, 155 strokes, and 674 transient ischaemic events.

The amount of ultra-processed foods consumed was found to be directly correlated with the incidence of cardiovascular disease:  277 of 100,000 person years for high consumers as compared 242 among low consumers and 253 for the entire population.

The group who consumed the most amount of ultra-processed foods tended to be younger, current smokers, less educated and be less physically active. They also consumed more foods high in carbohydrates and sodium. They consumed less alcohol, but also less fruit, vegetables, and foods rich in fiber. Even though this group had a higher BMI, they had a lower prevalence of metabolic diseases and less of a family history of cardiovascular disease suggesting the onset of cardiovascular disease in this group could very well be acquired.

“It is important to inform consumers about these associations and to implement actions targeting product reformulation taxation, and communication to limit the proportion of ultra-processed foods in the diet and promote the consumption of unprocessed or minimally processed foods instead,” the authors wrote.

An observational study published in the same issue of British Medical Journal by Maira Bes-Rastrollo, M.D., of the University of Navarra in Spain, evaluated all-cause mortality for 19,899 adult men (7,786) and women (12,113) who were followed every two years between December 1999 and February 2014.

Researchers found that the consumption of four or more servings of ultra-processed foods per day was independently associated with a 62 percent “relatively increased hazard” for all-cause mortality as compared to those who consumed less than two servings. For each additional serving of ultra-processed food, all-cause mortality increased by 18 percent.

Participants who consumed high amounts of ultra-processed foods had a higher hazard  for all-cause mortality compared to those who consumed the least amount of ultra-processed foods. The main cause of death was cancer (n=164, mean age 58 years).

“Our results suggest that an increased consumption of ultra-processed food is associated with a higher hazard of all-cause mortality. Improving diet based on adherence to minimally processed food-a key aspect of the 

-has been shown to protect against chronic disease and all-cause mortality,” researchers wrote. “Discouraging the consumption of ultra-processed foods; targeting products, taxation, and marketing restrictions on ultra-processed products; and promotion of 

, should be considered part of important health policy to improve global public health.”

Consuming ultra-processed food products has become a way of life for most people in the U.S., European countries, Canada, New Zealand and Latin American countries where these products represent up to 60 percent of an individual’s daily diet intake.

Ultra-processed foods include prepared foods with ingredients that are high in total fat, sugar and salt. These foods are usually low in fiber and nutrients, but are associated with a high glycemic load which leave consumers craving more. This combination can take a toll on cardiovascular health, but in ways the average consumer may not realize. Heat-treated food products contain contaminants such as acrylamide and acrolein which may be associated with cardiovascular disease risk, according to a previous study. They also contain additives, such as glutamates, emulsifiers, sulfites and carrageenan, which have been linked to adverse cardiometabolic effects in animal models.

Foods in the Srour et al. study were categorized into one of four groups ranging from low to high intake:

:  Mass produced packaged breads, sweet or savory snacks, confections and desserts, sodas and sweetened beverages; processed meatballs, poultry and fish nuggets, and other reconstituted meat products transformed with the addition of preservatives other than salt (such as sodium nitrite); instant noodles and soups, frozen or shelf stable ready meals, and food products made mostly or entirely from sugar, oils, and fats and other substances such as hydrogenated oils, modified starches and protein isolates.

Canned vegetables with added salt, sugar-coated dried fruit, meat products only preserved by salting, cheeses and freshly made unpackaged breads, and other products manufactured with the addition of basic food ingredients such as salt and sugar.

Unprocessed or minimally processed foods: 

Fresh, dried, grounded, chilled, frozen, pasteurized or fermented staple foods such as fruit, vegetables, pulses, rice, pasta, eggs, meat, fish, or milk; salt, vegetable oils, butter, sugar, and other substances extracted from foods and used in kitchens to transform unprocessed or minimally processed foods.

See "New Research on Food Additives" next page...

Ultra-processed foods are most commonly known to be associated with weight gain, obesity, metabolic syndrome and functional gastrointestinal disorders, and now a French study documented as association to cancer and breast cancer.

Not only are the ingredients harmful, but so too is the packaging which can include bisphenol A, which could increase the risk of cardiometabolic disorders, research shows.

At least 350 additives are allowed in processed foods, the culmulative impact of which are largely unknown. Heat processes used to manufacture these foods often produce known neoform contaminants, and packaging materials and containers used in distribution may also leach contaminants into the food.

Results from these two studies form the basis of a wave of new research into specific features of ultra-processed food consumption that are likely to impact clinical and public health policy directives regarding diet.

Dr. Srour and his research team are currently conducting research that examines the health effects of chronic exposure to food additives, and eventually they will be exploring the effects of microwavable food containers for ready-made meals on health.

“Further studies are needed to investigate the relative impact of nutritional composition, food additives, contact materials, and neoformed contaminants in this association,” he and colleagues wrote.

MORE FROM ENDOCRINOGY NETWORK ON NUTRITION

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Neighborhood Access To Exercise Facilities And Healthy Food Resources Tied To Decreased T2DM

 BMJ. May 29, 2019. DOI:10.1136/bmj.l1451.

Rico-CampÃ  A, MartÃ­nez-GonzÃ¡lez MA, Alvarez-Alvarez I, et al. 

“Association between consumption of ultra-processed foods and all-cause mortality: SUN prospective cohort study.” 

BMJ. May 29, 2019 DOI: 10.1136/bmj.l1949.

A high consumption of ultra-processed foods (i.e. almost any consumable food item, except fresh fruits and vegetables) is associated with an increased risk of cardiovascular disease and mortality, show two studies in BMJ.

Processed Foods Linked to Heart Disease and Heightened Mortality Risk

Infants who are not breastfed, or infrequently breastfed, have an increased risk of becoming obese, shows a WHO study presented last week at the European Conference on Obesity (ECO) held in Glasgow.

“The longer a child is breastfed, the greater their protection from obesity," said Bente Mikkelsen, M.D., in a press release. He is director of the Division of Noncommunicable Diseases for WHO Europe.

"This knowledge can strengthen our efforts in preventing obesity. Acting on childhood obesityâincluding severe obesity–can have major benefits, not only for child health and well-being, but also for national health care systems, so we must do all we can to promote and protect breastfeeding across the Region,” he said.

The study found that despite global guidelines on the importance of breastfeeding, the adoption of these guidelines in the European region falls below the recommended levels. WHO presented a second study at the meeting finding that 400,000 of 13.7 million children between 6-9 years old, suffer from severe obesity. The study included data from 21 countries.

"The adoption of exclusive breastfeeding is below global recommendations and far from the target endorsed by WHO member states…of increasing the prevalence of exclusive breastfeeding in the first six months up to at least 50 percent by 2025," authors stated in the study.

The study is based on data from 22 countries in the WHO European COSI study. It included an analysis of 100,583 children between the ages of 6-9 years old.

The highest prevalence of obesity was in Spain (17.7%), Malta (17.2%) and Italy (16.8%), which corresponded with the highest rates of obese children who were never breastfed:  21 percent in Spain and 21.2 percent in Malta and Italy.

In France, Ireland and Malta, only one in four children were breastfed for at least six months.

Tajikistan had the highest rates of children who were breastfed for at least six months and exclusively breastfed for at least six months.

Researchers also found that in 11 of 22 countries, babies of higher birth weight had a higher risk of being overweight. In Bulgaria, Croatia, France, Italy, Poland and Romania, the data showed that preterm infants were more likely to be obese as they aged as compared to full-term infants.

Rito AI, Buoncristiano M, Spinelli A., et al. "Association between Characteristics at Birth, Breastfeeding and Obesity in 22 Countries: The WHO European Childhood Obesity Surveillance Initiative - COSI 2015/2017," 

. April 29, 2019. DOI: 10.1159/000500425.

"New WHO studies: Europe battles childhood obesity and experts confirm breastfeeding protects against child obesity," 

Amy Reyes

Articles

Activity Trackers Work Best with Coaching

Definitive Evidence Supports Plant-Based Diet to Control Diabetes

Processed Foods Linked to Heart Disease and Heightened Mortality Risk

Breastfeeding may Prevent Obesity in Childhood