Publications by authors named "Abby G Ershow"

29 Publications

  • Page 1 of 1

The Type and Amount of Dietary Fat Affect Plasma Factor VIIc, Fibrinogen, and PAI-1 in Healthy Individuals and Individuals at High Cardiovascular Disease Risk: 2 Randomized Controlled Trials.

J Nutr 2020 08;150(8):2089-2100

Department of Medicine, Irving Center for Clinical Research, Columbia University College of Physicians and Surgeons, New York, NY, USA.

Background: Factor VIIc, fibrinogen, and plasminogen activator inhibitor 1 (PAI-1) are cardiovascular disease (CVD) risk factors and are modulated, in part, by fat type and amount.

Objective: We evaluated fat type and amount on the primary outcomes: factor VIIc, fibrinogen, and PAI-1.

Methods: In the Dietary Effects on Lipoproteins and Thrombogenic Activity (DELTA) Trial, 2 controlled crossover feeding studies evaluated substituting carbohydrate or MUFAs for SFAs. Study 1: healthy participants (n = 103) were provided with (8 wk) an average American diet [AAD; designed to provide 37% of energy (%E) as fat, 16% SFA], a Step 1 diet (30%E fat, 9% SFA), and a diet low in SFA (Low-Sat; 26%E fat, 5% SFA). Study 2: participants (n = 85) at risk for CVD and metabolic syndrome (MetSyn) were provided with (7 wk) an AAD, a step 1 diet, and a high-MUFA diet (designed to provide 37%E fat, 8% SFA, 22% MUFA).

Results: Study 1: compared with AAD, the Step 1 and Low-Sat diets decreased mean factor VIIc by 1.8% and 2.6% (overall P = 0.0001), increased mean fibrinogen by 1.2% and 2.8% (P = 0.0141), and increased mean square root PAI-1 by 0.0% and 6.0% (P = 0.0037), respectively. Study 2: compared with AAD, the Step 1 and high-MUFA diets decreased mean factor VIIc by 4.1% and 3.2% (overall P < 0.0001), increased mean fibrinogen by 3.9% and 1.5% (P = 0.0083), and increased mean square-root PAI-1 by 2.0% and 5.8% (P = 0.1319), respectively.

Conclusions: Replacing SFA with carbohydrate decreased factor VIIc and increased fibrinogen in healthy and metabolically unhealthy individuals and also increased PAI-1 in healthy subjects. Replacing SFA with MUFA decreased factor VIIc and increased fibrinogen but less than carbohydrate. Our results indicate an uncertain effect of replacing SFA with carbohydrate or MUFA on cardiometabolic risk because of small changes in hemostatic factors and directionally different responses to decreasing SFA. This trial was registered at https://clinicaltrials.gov/ct2/show/NCT00000538?term=NCT00000538&rank=1 as NCT00000538.
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http://dx.doi.org/10.1093/jn/nxaa137DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7398773PMC
August 2020

Large Variability of Iodine Content in Retail Cow's Milk in the U.S.

Nutrients 2020 Apr 28;12(5). Epub 2020 Apr 28.

University of Maryland, College Park MD 20742, USA.

Iodine intake is of contemporary public health interest. The recommended daily iodine intake is 150 µg for most adults, and milk is an important source of iodine in the U.S. diet. Iodine concentration in cow's milk is affected by diet and iodine supplementation levels, milking sanitation practices, and other factors. Current analytical iodine data in U.S. retail milk are crucial for evaluating population-wide health outcomes related to diet. Samples of whole (3.25% fat), 2%, 1%, and skim (0-0.5% fat) milk were procured from 24 supermarkets across the U.S. using a census-based statistical plan. Iodine was analyzed by inductively coupled plasma mass spectrometry, including certified reference materials and control samples to validate results. No difference in iodine content was found between milkfat levels (F 1.033, = 0.4). Overall mean (SEM) was 85(5.5) µg/serving (240 mL). However, the 95% prediction interval of 39-185 µg/serving for individual samples indicated high variability among individual samples. Given the recommended 150 µg iodine per day for most adults along with the study mean, one milk serving can provide approximately 57% of daily intake. Researchers, health care professionals, and consumers should be aware of iodine variability in milk, while additional research is needed to investigate the impact of iodine variability factors.
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http://dx.doi.org/10.3390/nu12051246DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7281966PMC
April 2020

Characteristics and Challenges of Dietary Supplement Databases Derived from Label Information.

J Nutr 2018 08;148(suppl_2):1422S-1427S

Office of Dietary Supplements, National Institutes of Health, Bethesda, MD.

Launched in 2008, the Dietary Supplement Label Database (DSLD) permits the search of any term that appears anywhere on product labels. Since then, the database's search and download features have been periodically improved to enhance use for researchers and consumers. In this review, we describe how to customize searches and identify products and ingredients of interest to users in the DSLD, and provide the limitations of working with information derived from dietary supplement product labels. This article describes how data derived from information printed on product labels are entered and organized in the DSLD. Among the challenges are determining the chemical forms, types of extract, and amounts of dietary ingredients, especially when these are components of proprietary blends. The FDA announced new dietary supplement labeling regulations in May 2016. The 2017 DSLD has been updated to reflect them. These new regulations and examples cited in this article refer to this redesigned version of the DSLD. Search selection characteristics such as for product type and intended user group are as described in FDA guidance and regulations for dietary supplements. For this reason, some age groups (such as teens and seniors) and marketing recommendations for use (e.g., weight loss, performance, and other disease- or condition-specific claims) are not included in the search selections. The DSLD user interface features will be revised periodically to reflect regulatory and technologic developments to enhance user experience. A comprehensive database derived from analytically verified data on composition would be preferable to label data, but is not feasible for technical, logistic, and financial reasons. Therefore, a database derived from information printed on product labels is the only practical option at present for researchers, clinicians, and consumers interested in the composition of these products.
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http://dx.doi.org/10.1093/jn/nxy103DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6857608PMC
August 2018

The Dietary Supplement Label Database: Recent Developments and Applications.

J Nutr 2018 08 3;148(Suppl 2):1428S-1435S. Epub 2018 Aug 3.

Division of Health and Nutrition Examination Surveys/Analysis Branch, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD.

Objective: To describe the history, key features, recent enhancements, and common applications of the Dietary Supplement Label Database (DSLD).

Background And History: Although many Americans use dietary supplements, databases of dietary supplements sold in the United States have not been widely available. The DSLD, an easily accessible public-use database was created in 2008 to provide information on dietary supplement composition for use by researchers and consumers.

Rationale: Accessing current information easily and quickly is crucial for documenting exposures to dietary supplements because they contain nutrients and other bioactive ingredients that may have beneficial or adverse effects on human health. This manuscript details recent developments with the DSLD to achieve this goal and provides examples of how the DSLD has been used.

Recent Developments: With periodic updates to track changes in product composition and capture new products entering the market, the DSLD currently contains more than 71,000 dietary supplement labels. Following usability testing with consumer and researcher user groups completed in 2016, improvements to the DSLD interface were made. As of 2017, both a desktop and mobile device version are now available. Since its inception in 2008, the use of the DSLD has included research, exposure monitoring, and other purposes by users in the public and private sectors.

Future Directions: Further refinement of the user interface and search features to facilitate ease of use for stakeholders is planned.

Conclusions: The DSLD can be used to track changes in product composition and capture new products entering the market. With over 71,000 DS labels it is a unique resource that policymakers, researchers, clinicians, and consumers may find valuable for multiple applications.
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http://dx.doi.org/10.1093/jn/nxy082DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6597011PMC
August 2018

Federal Monitoring of Dietary Supplement Use in the Resident, Civilian, Noninstitutionalized US Population, National Health and Nutrition Examination Survey

J Nutr 2018 08 3;148(Suppl 2):1436S-1444S. Epub 2018 Aug 3.

National Institutes of Health, Office of Dietary Supplements, Bethesda MD.

Objective: This review summarizes the current and previous data on dietary supplement (DS) use collected from participants in the National Health and Nutrition Examination Survey (NHANES), describes the NHANES dietary supplement database used to compute nutrient intakes from DSs, discussed recent developments and future direction, and describes many examples to demonstrate the utility of these data in informing nutrition research and policy.

Background And History: Since 1971, NHANES, has been collecting information on the use of DSs from participants. These data are critical to national nutrition surveillance and have been used to characterize usage patterns, examine trends over time, assess the percentage of the population meeting or exceeding nutrient recommendations, and to help elucidate the sources contributing nutrients to the diet of the US population.

Rationale: Over half of adults and about one-third of children in the United States use at least one dietary supplement in the past 30 days. Dietary supplements contribute to the dietary intake of nutrients and bioactive compounds in the US and therefore need to be assessed when monitoring nutritional status of the population and when studying diet-health associations.

Recent Developments: With the recent development and availability of the Dietary Supplement Label Database (DSLD), a comprehensive DS database that will eventually contain labels for all products marketed in the US, NHANES DS data will be more easily linked to product information to estimate nutrient intake from DS.

Future Directions: Over time, NHANES has both expanded and improved collection methods. The continued understanding of sources of error in collection methods will continue to be explored and is critical to improved accuracy.

Conclusions: NHANES provides a rich source of nationally representative data on the usage of dietary supplements in the US.
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http://dx.doi.org/10.1093/jn/nxy093DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6516064PMC
August 2018

Use of Iodine-Containing Dietary Supplements Remains Low among Women of Reproductive Age in the United States: NHANES 2011-2014.

Nutrients 2018 Mar 29;10(4). Epub 2018 Mar 29.

Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.

In the United States, the American Thyroid Association recommends that women take a dietary supplement containing 150 µg of iodine 3 months prior to conception and while pregnant and lactating to support fetal growth and neurological development. We used data from the National Health and Nutrition Examination Survey 2011–2014 to describe the use of dietary supplements with and without iodine in the past 30 days among 2155 non-pregnant, non-lactating (NPNL) women; 122 pregnant women; and 61 lactating women. Among NPNL women, 45.3% (95% Confidence Interval [CI]: 42.0, 48.6) used any dietary supplement and 14.8% (95% CI: 12.7, 16.8) used a dietary supplement with iodine in the past 30 days. Non-Hispanic black and Hispanic women were less likely to use any dietary supplement as well as one with iodine, than non-Hispanic white or non-Hispanic Asian women ( < 0.05). Among pregnant women, 72.2% (95% CI: 65.8, 78.6) used any dietary supplement; however, only 17.8% (95% CI: 11.4, 24.3) used a dietary supplement with iodine. Among lactating women, 75.0% (95% CI: 63.0, 87.0) used a dietary supplement; however, only 19.0% (95% CI: 8.8, 29.2) used a dietary supplement with iodine. Among NPNL women using a supplement with iodine, median daily iodine intake was 75.0 µg. Self-reported data suggests that the use of iodine containing dietary supplements among pregnant and lactating women remains low in contrast with current recommendations.
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http://dx.doi.org/10.3390/nu10040422DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5946207PMC
March 2018

Development of Databases on Iodine in Foods and Dietary Supplements.

Nutrients 2018 Jan 17;10(1). Epub 2018 Jan 17.

Nutrient Data Laboratory, US Department of Agriculture, Beltsville, MD 20705, USA.

Iodine is an essential micronutrient required for normal growth and neurodevelopment; thus, an adequate intake of iodine is particularly important for pregnant and lactating women, and throughout childhood. Low levels of iodine in the soil and groundwater are common in many parts of the world, often leading to diets that are low in iodine. Widespread salt iodization has eradicated severe iodine deficiency, but mild-to-moderate deficiency is still prevalent even in many developed countries. To understand patterns of iodine intake and to develop strategies for improving intake, it is important to characterize all sources of dietary iodine, and national databases on the iodine content of major dietary contributors (including foods, beverages, water, salts, and supplements) provide a key information resource. This paper discusses the importance of well-constructed databases on the iodine content of foods, beverages, and dietary supplements; the availability of iodine databases worldwide; and factors related to variability in iodine content that should be considered when developing such databases. We also describe current efforts in iodine database development in the United States, the use of iodine composition data to develop food fortification policies in New Zealand, and how iodine content databases might be used when considering the iodine intake and status of individuals and populations.
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http://dx.doi.org/10.3390/nu10010100DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5793328PMC
January 2018

Is Nutrient Content and Other Label Information for Prescription Prenatal Supplements Different from Nonprescription Products?

J Acad Nutr Diet 2017 Sep 29;117(9):1429-1436. Epub 2017 May 29.

Background: Prenatal supplements are often recommended to pregnant women to help meet their nutrient needs. Many products are available, making it difficult to choose a suitable supplement because little is known about their labeling and contents to evaluate their appropriateness.

Objective: To determine differences between prescription and nonprescription prenatal supplements available in the United States regarding declared nutrient and nonnutrient ingredients and the presence of dosing and safety-related information.

Design: Using two publicly available databases with information about prenatal supplement products, information from prescription and nonprescription product labels were extracted and evaluated. For the 82 prescription and 132 nonprescription products, declared label amounts of seven vitamins and minerals, docosahexaenoic acid (DHA), the presence of other nonnutrient components, and the presence of key safety and informational elements as identified in two Department of Health and Human Services Office of Inspector General (OIG)'s 2003 reports were compiled and compared.

Results: Compared with nonprescription products, prescription products contained significantly fewer vitamins (9±0.2 vs 11±0.3; P≤0.05) and minerals (4±0.1 vs 8±0.3; P≤0.05). Declared amounts of folic acid were higher in prescription products, whereas vitamin A, vitamin D, iodine, and calcium were higher in the nonprescription products. Amounts of iron, zinc, and DHA were similar. Virtually all products contained levels of one or more nutrients that exceeded the Recommended Dietary Allowances for pregnant and/or lactating women. Product type also influenced ingredients added. Fewer prescription products contained botanical ingredients (6% prescription vs 33% nonprescription) and probiotics (2% prescription vs 8% nonprescription). Only prescription products contained the stool softener docusate sodium.

Conclusions: Our analysis of prenatal supplements indicates that prescription and nonprescription supplements differ in terms of declared composition and nutrient strength, but have labels that are similarly sparse regarding aspects of use such as dosing information.
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http://dx.doi.org/10.1016/j.jand.2017.04.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573647PMC
September 2017

National Institutes of Health Research Plan on Rehabilitation: NIH Medical Rehabilitation Coordinating Committee.

Phys Ther 2017 04;97(4):104-407

Center for Scientific Review (CSR).

One in five Americans experiences disability that affects their daily function because of impairments in mobility, cognitive function, sensory impairment, or communication impairment. The need for rehabilitation strategies to optimize function and reduce disability is a clear priority for research to address this public health challenge. The National Institutes of Health (NIH) recently published a Research Plan on Rehabilitation that provides a set of priorities to guide the field over the next 5 years. The plan was developed with input from multiple Institutes and Centers within the NIH, the National Advisory Board for Medical Rehabilitation Research, and the public. This article provides an overview of the need for this research plan, an outline of its development, and a listing of six priority areas for research. The NIH is committed to working with all stakeholder communities engaged in rehabilitation research to track progress made on these priorities and to work to advance the science of medical rehabilitation.This article is being published almost simultaneously in the following six journals: American Journal of Occupational Therapy, American Journal of Physical Medicine and Rehabilitation, Archives of Physical Medicine and Rehabilitation, Neurorehabilitation and Neural Repair, Physical Therapy, and Rehabilitation Psychology. Citation information is as follows: NIH Medical Rehabilitation Coordinating Committee. Am J Phys Med Rehabil. 2017;97(4):404-407.
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http://dx.doi.org/10.1093/ptj/pzx026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5436691PMC
April 2017

Assessing iodine intake, iodine status, and the effects of maternal iodine supplementation: introduction to articles arising from 3 workshops held by the NIH Office of Dietary Supplements.

Am J Clin Nutr 2016 Sep 17;104 Suppl 3:859S-63S. Epub 2016 Aug 17.

Office of Dietary Supplements, NIH, Bethesda, MD; and.

The NIH Office of Dietary Supplements (ODS) convened 3 workshops on iodine nutrition in 2014, each held in Rockville, Maryland. These workshops were part of the ongoing ODS Iodine Initiative, begun in 2011 in response to concerns that US pregnant women may be at risk of iodine deficiency and that a high fraction of prenatal dietary supplements do not contain the recommended amounts of iodine. The primary purpose of the workshops was to consider the data and resources necessary to evaluate the clinical and public health benefits and risks of maternal iodine supplementation in the United States. The first workshop focused on the assessment of iodine intake, the second focused on the assessment of iodine status, and the third focused on the design and interpretation of clinical trials of maternal iodine supplementation. Here we provide the background of the ODS Iodine Initiative, summarize the 3 workshops held in 2014, and introduce the articles that arose from the workshops and are published in this supplement issue.
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http://dx.doi.org/10.3945/ajcn.115.111161DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5004504PMC
September 2016

Research needs for assessing iodine intake, iodine status, and the effects of maternal iodine supplementation.

Am J Clin Nutr 2016 09 17;104 Suppl 3:941S-9S. Epub 2016 Aug 17.

Office of Dietary Supplements, NIH, Bethesda, MD; and.

The Office of Dietary Supplements of the NIH convened 3 workshops on iodine nutrition in Rockville, Maryland, in 2014. The purpose of the current article is to summarize and briefly discuss a list of research and resource needs developed with the input of workshop participants. This list is composed of the basic, clinical, translational, and population studies required for characterizing the benefits and risks of iodine supplementation, along with related data, analyses, evaluations, methods development, and supporting activities. Ancillary studies designed to use the participant, biological sample, and data resources of ongoing and completed studies (including those not originally concerned with iodine) may provide an efficient, cost-effective means to address some of these research and resource needs. In the United States, the foremost question is whether neurobehavioral development in the offspring of mildly to moderately iodine-deficient women is improved by maternal iodine supplementation during pregnancy. It is important to identify the benefits and risks of iodine supplementation in all population subgroups so that supplementation can be targeted, if necessary, to avoid increasing the risk of thyroid dysfunction and related adverse health effects in those with high iodine intakes. Ultimately, there will be a need for well-designed trials and other studies to assess the impact of maternal supplementation on neurodevelopmental outcomes in the offspring. However, 2 basic information gaps loom ahead of such a study: the development of robust, valid, and convenient biomarkers of individual iodine status and the identification of infant and toddler neurobehavioral development endpoints that are sensitive to mild maternal iodine deficiency during pregnancy and its reversal by supplementation.
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http://dx.doi.org/10.3945/ajcn.116.134858DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5004498PMC
September 2016

The effect of gender on outcomes of aortoiliac artery interventions for claudication.

Clin Imaging 2016 Jan-Feb;40(1):96-100. Epub 2015 Sep 4.

Clinical Investigations, Harvard Clinical Research Institute, 930 Commonwealth Avenue, Boston, MA, USA. Electronic address:

Objective: To explore the relationship between gender, native artery diameters, and outcomes of stent revascularization (ST) in the "Claudication: Exercise versus Endoluminal Revascularization" trial.

Methods: A comparative analysis was performed of the impact of gender, age, weight, height, body mass index, and body surface area on revascularization outcomes at baseline and 6months in 55 arterial segments of aorta, common iliac artery, and external iliac artery (EIA).

Results: Women demonstrated smaller diameter of the EIA. However, the clinical outcomes of revascularization were not negatively affected by the gender-based differences.

Conclusion: Gender-based differences are unlikely to significantly impact outcome of ST.
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http://dx.doi.org/10.1016/j.clinimag.2015.09.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4688129PMC
August 2016

Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence: A Scientific Statement From the American Heart Association and the American Diabetes Association.

Diabetes Care 2015 Sep 5;38(9):1777-803. Epub 2015 Aug 5.

Cardiovascular disease risk factor control as primary prevention in patients with type 2 diabetes mellitus has changed substantially in the past few years. The purpose of this scientific statement is to review the current literature and key clinical trials pertaining to blood pressure and blood glucose control, cholesterol management, aspirin therapy, and lifestyle modification. We present a synthesis of the recent literature, new guidelines, and clinical targets, including screening for kidney and subclinical cardiovascular disease for the contemporary management of patients with type 2 diabetes mellitus.
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http://dx.doi.org/10.2337/dci15-0012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4876675PMC
September 2015

Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence: A Scientific Statement From the American Heart Association and the American Diabetes Association.

Circulation 2015 Aug 5;132(8):691-718. Epub 2015 Aug 5.

Cardiovascular disease risk factor control as primary prevention in patients with type 2 diabetes mellitus has changed substantially in the past few years. The purpose of this scientific statement is to review the current literature and key clinical trials pertaining to blood pressure and blood glucose control, cholesterol management, aspirin therapy, and lifestyle modification. We present a synthesis of the recent literature, new guidelines, and clinical targets, including screening for kidney and subclinical cardiovascular disease for the contemporary management of patients with type 2 diabetes mellitus.
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http://dx.doi.org/10.1161/CIR.0000000000000230DOI Listing
August 2015

Monthly haemostatic factor variability in women and men.

Eur J Clin Invest 2014 ;44(3):309-18

Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA; Nutritional Physiology Research Centre, The University of South Australia, Adelaide, Australia.

Background: Hormonal status influences haemostatic factors including fibrinogen, factor VII and plasminogen activator inhibitor (PAI-1), and concentrations differ among men, premenopausal and postmenopausal women. This study examines how phases of the menstrual cycle influence variability of fibrinogen, factor VII and PAI-1.

Design: We studied 103 subjects (39 premenopausal women, 18 postmenopausal women and 46 men) during three, randomized, 8-week energy- and nutrient-controlled experimental diets in the Dietary Effects on Lipids and Thrombogenic Activity (DELTA) Study. Fasting blood samples were collected weekly during the last 4 weeks of each diet period, and haemostatic factors were quantified. Two linear mixed-effects models were used for fibrinogen, factor VII and PAI-1: one to estimate and compare group-specific components of variance, and the other to estimate additional fixed effects representing cyclical functions of day of menstrual cycle in premenopausal women.

Results: Systematic cyclical variation with day of menstrual cycle was observed for fibrinogen (P < 0.0001), factor VII (P = 0.0012) and PAI-1 (P = 0.0024) in premenopausal women. However, the amplitude of cycling was small relative to the total magnitude of intra-individual variability. In addition, the intra-individual variance and corresponding coefficient of variation observed in premenopausal women did not differ from postmenopausal women and men.

Conclusions: The variability in haemostatic factors in premenopausal women is no greater than for postmenopausal women or men. Consequently, premenopausal women can be included in studies investigating haemostatic factor responses without controlling for stage of menstrual cycle.
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http://dx.doi.org/10.1111/eci.12235DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153833PMC
October 2014

Expanding research to provide an evidence base for nutritional interventions for the management of inborn errors of metabolism.

Mol Genet Metab 2013 Aug 23;109(4):319-28. Epub 2013 May 23.

Office of Dietary Supplements, National Institutes of Health, Bethesda, MD 20892, USA.

A trans-National Institutes of Health initiative, Nutrition and Dietary Supplement Interventions for Inborn Errors of Metabolism (NDSI-IEM), was launched in 2010 to identify gaps in knowledge regarding the safety and utility of nutritional interventions for the management of inborn errors of metabolism (IEM) that need to be filled with evidence-based research. IEM include inherited biochemical disorders in which specific enzyme defects interfere with the normal metabolism of exogenous (dietary) or endogenous protein, carbohydrate, or fat. For some of these IEM, effective management depends primarily on nutritional interventions. Further research is needed to demonstrate the impact of nutritional interventions on individual health outcomes and on the psychosocial issues identified by patients and their families. A series of meetings and discussions were convened to explore the current United States' funding and regulatory infrastructure and the challenges to the conduct of research for nutritional interventions for the management of IEM. Although the research and regulatory infrastructure are well-established, a collaborative pathway that includes the professional and advocacy rare disease community and federal regulatory and research agencies will be needed to overcome current barriers.
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http://dx.doi.org/10.1016/j.ymgme.2013.05.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4131198PMC
August 2013

Fruit, vegetables, fibre and micronutrients and risk of US renal cell carcinoma.

Br J Nutr 2012 Sep 20;108(6):1077-85. Epub 2011 Dec 20.

Department of Behavioural and Social Sciences, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia.

The association between renal cell cancer (RCC) and intake of fruit, vegetables and nutrients was examined in a population-based case-control study of 323 cases and 1827 controls; dietary intake was obtained using a mailed questionnaire. Cancer risks were estimated by OR and 95 % CI, adjusting for age, sex, smoking, obesity, hypertension, proxy status, alcohol consumption and dietary fat intake and energy. Intake of vegetables was associated with a decreased risk of RCC (OR 0·5; 95 % CI 0·3, 0·7; P trend = 0·002), (top compared to the bottom quartile of intake). When intake of individual nutrients was investigated, vegetable fibre intake was associated with decreased risks (OR 0·4; 95 % CI 0·2, 0·6; P < 0·001), but this was not the case with fruit fibre (OR 0·7; 95 % CI 0·4, 1·1) or grain fibre (OR 1·0; 95 % CI 0·6, 1·5). β-Cryptoxanthin and lycopene were also associated with decreased risks, but when both were included in a mutually adjusted backwards stepwise regression model, only β-cryptoxanthin remained significant (OR 0·5; 95 % CI 0·3, 0·8). When other micronutrients and types of fibre were investigated together, only vegetable fibre and β-cryptoxanthin had significant trends (P < 0·01) (OR 0·6; 95 % CI 0·3, 0·9) (OR 0·5; 95 % CI 0·3, 0·9), respectively. These findings were stronger in those aged over 65 years (P interaction = 0·001). Among non-smokers, low intake of cruciferous vegetables and fruit fibre was also associated with increased risk of RCC (P interaction = 0·03); similar inverse associations were found for β-cryptoxanthin, lycopene and vitamin C. When nutrients were mutually adjusted by backwards regression in these subgroups, only β-cryptoxanthin remained associated with lower RCC risk. These findings deserve further investigation in ongoing prospective studies when sample size becomes sufficient.
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http://dx.doi.org/10.1017/S0007114511006489DOI Listing
September 2012

Virtual reality technologies for research and education in obesity and diabetes: research needs and opportunities.

J Diabetes Sci Technol 2011 Mar 1;5(2):212-24. Epub 2011 Mar 1.

Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892, USA.

The rising rates, high prevalence, and adverse consequences of obesity and diabetes call for new approaches to the complex behaviors needed to prevent and manage these conditions. Virtual reality (VR) technologies, which provide controllable, multisensory, interactive three-dimensional (3D) stimulus environments, are a potentially valuable means of engaging patients in interventions that foster more healthful eating and physical activity patterns. Furthermore, the capacity of VR technologies to motivate, record, and measure human performance represents a novel and useful modality for conducting research. This article summarizes background information and discussions for a joint July 2010 National Institutes of Health - Department of Defense workshop entitled Virtual Reality Technologies for Research and Education in Obesity and Diabetes. The workshop explored the research potential of VR technologies as tools for behavioral and neuroscience studies in diabetes and obesity, and the practical potential of VR in fostering more effective utilization of diabetes- and obesity-related nutrition and lifestyle information. Virtual reality technologies were considered especially relevant for fostering desirable health-related behaviors through motivational reinforcement, personalized teaching approaches, and social networking. Virtual reality might also be a means of extending the availability and capacity of health care providers. Progress in the field will be enhanced by further developing available platforms and taking advantage of VR's capabilities as a research tool for well-designed hypothesis-testing behavioral science. Multidisciplinary collaborations are needed between the technology industry and academia, and among researchers in biomedical, behavioral, pedagogical, and computer science disciplines. Research priorities and funding opportunities for use of VR to improve prevention and management of obesity and diabetes can be found at agency websites (National Institutes of Health: http://grants.nih.gov/grants/guide/index.html; Department of Defense: www.tatrc.org).
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3125907PMC
http://dx.doi.org/10.1177/193229681100500202DOI Listing
March 2011

Obesity research and programs at the National Heart, Lung, and Blood Institute.

J Am Coll Cardiol 2010 Mar;55(9):917-20

Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, 6701 Rockledge Drive, Suite 10018, MSC 7936, Bethesda, Maryland 20892-7936, USA.

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http://dx.doi.org/10.1016/j.jacc.2009.09.058DOI Listing
March 2010

Environmental influences on development of type 2 diabetes and obesity: challenges in personalizing prevention and management.

Authors:
Abby G Ershow

J Diabetes Sci Technol 2009 Jul 1;3(4):727-34. Epub 2009 Jul 1.

Division of Cardiovascular Diseases, National Heart, Lung, and Blood Institute, Bethesda, Maryland 20892, USA.

Recent epidemic increases in the U.S. prevalence of obesity and diabetes are a consequence of widespread environmental changes affecting energy balance and its regulation. These environmental changes range from exposure to endocrine disrupting pollutants to shortened sleep duration to physical inactivity to excess caloric intake. Overall, we need a better understanding of the factors affecting individual susceptibility and resistance to adverse exposures and behaviors and of determinants of individual response to treatment. Obesity and diabetes prevention will require responding to two primary behavioral risk factors: excess energy intake and insufficient energy expenditure. Adverse food environments (external, nonphysiological influences on eating behaviors) contribute to excess caloric intake but can be countered through behavioral and economic approaches. Adverse built environments, which can be modified to foster more physical activity, are promising venues for community-level intervention. Techniques to help people to modulate energy intake and increase energy expenditure must address their personal situations: health literacy, psychological factors, and social relationships. Behaviorally oriented translational research can help in developing useful interventions and environmental modifications that are tailored to individual needs.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769972PMC
http://dx.doi.org/10.1177/193229680900300418DOI Listing
July 2009

Design of the multicenter standardized supervised exercise training intervention for the claudication: exercise vs endoluminal revascularization (CLEVER) study.

Vasc Med 2009 Nov;14(4):313-21

School of Nursing, University of Minnesota, Minneapolis, MN 55455, USA.

The CLaudication: Exercise Vs Endoluminal Revascularization (CLEVER) study is the first randomized, controlled, clinical, multicenter trial that is evaluating a supervised exercise program compared with revascularization procedures to treat claudication. In this report, the methods and dissemination techniques of the supervised exercise training intervention are described. A total of 217 participants are being recruited and randomized to one of three arms: (1) optimal medical care; (2) aortoiliac revascularization with stent; or (3) supervised exercise training. Of the enrolled patients, 84 will receive supervised exercise therapy. Supervised exercise will be administered according to a protocol designed by a central CLEVER exercise training committee based on validated methods previously used in single center randomized control trials. The protocol will be implemented at each site by an exercise committee member using training methods developed and standardized by the exercise training committee. The exercise training committee reviews progress and compliance with the protocol of each participant weekly. In conclusion, a multicenter approach to disseminate the supervised exercise training technique and to evaluate its efficacy, safety and cost-effectiveness for patients with claudication due to peripheral arterial disease (PAD) is being evaluated for the first time in CLEVER. The CLEVER study will further establish the role of supervised exercise training in the treatment of claudication resulting from PAD and provide standardized methods for use of supervised exercise training in future PAD clinical trials as well as in clinical practice.
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http://dx.doi.org/10.1177/1358863X09102295DOI Listing
November 2009

Dietary fat and risk of renal cell carcinoma in the USA: a case-control study.

Br J Nutr 2009 Apr 12;101(8):1228-38. Epub 2008 Sep 12.

Department of Behavioural and Community Health Sciences, Faculty of Heath Sciences, University of Sydney, Sydney, NSW, Australia.

An increased risk of renal cell carcinoma (RCC) has been linked with obesity. However, there is limited information about the contribution of dietary fat and fat-related food groups to RCC risk. A population-based case-control study of 406 cases and 2434 controls aged 40-85 years was conducted in Iowa (1986-89). For 323 cases and 1820 controls from the present study, information on dietary intake from foods high in fat nutrients and other lifestyle factors was obtained using a mailed questionnaire. Cancer risks were estimated by OR and 95 % CI, adjusting for age, sex, smoking, obesity, hypertension, physical activity, alcohol and vegetable intake and tea and coffee consumption. In all nutrient analyses, energy density estimates were used. Dietary nutrient intake of animal fat, saturated fat, oleic acid and cholesterol was associated with an elevated risk of RCC (OR = 1.9, 95 % CI 1.3, 2.9, P trend < 0.001; OR = 2.6, 95 % CI 1.6, 4.0, P trend < 0.001; OR = 1.9, 95 % CI 1.2, 2.9, P trend = 0.01; OR = 1.9, 95 % CI 1.3, 2.8, P trend = 0.006, respectively, for the top quartile compared with the bottom quartile of intake). Increased risks were also associated with high-fat spreads, red and cured meats and dairy products (OR = 2.0, 95 % CI 1.4, 3.0, P trend = 0.001; OR = 1.7, 95 % CI 1.0, 2.2, P trend = 0.01; OR = 1.8, 95 % CI 1.2, 2.7, P trend = 0.02; OR = 1.6, 95 % CI 1.1, 2.3, P trend = 0.02, respectively). In both the food groups and nutrients, there was a significant dose-response with increased intake. Our data also indicated that the association of RCC with high-fat spreads may be stronger among individuals with hypertension. These findings deserve further investigation in prospective studies.
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http://dx.doi.org/10.1017/S0007114508056043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3075010PMC
April 2009

Obesity and hypertension interact to increase risk of renal cell carcinoma in Iowa, USA.

Obes Res Clin Pract 2007 May;1(2):I-II

Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Department of Health and Human Services, Bethesda, MD, USA.

Summary: Renal cell carcinoma (RCC) rates in the US have risen, along with those of obesity and hypertension. We investigated the interactive relationship with obesity and hypertension (HT) through a population-based case-control study of RCC in Iowa consisting of 406 cases and 2434 controls. Data on height and weight at various ages and history of HT were collected and interaction tested by log-likelihood ratio tests. After adjustment, both obesity and HT were independently and interactively associated with increased RCC risk. Hypertensive subjects, obese (BMI ≥ 30) at age 40 were 4.2 (CI: 2.38-6.53) times more likely to develop RCC as normotensive individuals of normal weight (BMI < 25). A similar interactive pattern was observed for obesity at age 60 (p = 0.02). Interaction with obesity was more evident in women (pinteraction = 0.04 age 40, pinteraction = 0.01 age 60). Our findings suggest that maintaining body weight and/or controlling HT are strategies for preventing RCC.:
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http://dx.doi.org/10.1016/j.orcp.2007.02.004DOI Listing
May 2007

Engineering approaches to energy balance and obesity: opportunities for novel collaborations and research: report of a joint national science foundation and national institutes of health workshop.

J Diabetes Sci Technol 2007 Jan;1(1):95-105

Division of Cardiovascular Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland 20892, USA.

Energy balance disorders account for a large public health burden. The obesity epidemic in particular is one of the most rapidly evolving public health problems of our day. At present, two-thirds of American adults and one-sixth of American children and adolescents are considered either overweight or obese. Public health concern about obesity is high because of the increased risk and increased mortality of cardiovascular disease, Type 2 diabetes, many forms of cancer, gallbladder disease, and osteoarthritis. These risks increase with the severity of the obesity. Excess adipose tissue, representing fat storage, ultimately derives from an imbalance between energy intake and energy expenditure. Conversely, undesirable and inadvertent loss of body weight and muscle mass, as seen in aging and cachectic states of chronic diseases such as heart failure and cancer, have serious clinical and functional consequences without satisfactory clinical or behavioral solutions. Innovative engineering technologies could help to address unresolved problems in energy balance, intake, and expenditure. Novel sensors, devices, imaging technologies, nanotechnologies, biomaterials, technologies to detect biochemical markers of energy balance, mathematical modeling, systems biology, and other approaches could be developed, evaluated, and leveraged through multidisciplinary collaborations. Engineers, physical scientists, and mathematicians can work with scientists from other relevant disciplines who possess expertise in obesity and nutrition. Furthermore, the possibility of re-engineering the "built environment" to encourage higher levels of physical activity has been suggested as another promising and important approach to which engineers can contribute (see http://www.obesityresearch.nih.gov). Ultimately, systematic application of the "Engineering Approach" can help in developing the needed technologies and tools to facilitate research and eventually support therapeutic advances and behavioral change. This article summarizes important public health concerns related to disordered energy balance and describes research priorities identified at a recent National Science Foundation-National Institutes of Health workshop. Research funding opportunities are described as posted on the NIH Guide to Grants and Contracts (see http://www.nih.gov/grants/guide).
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769607PMC
http://dx.doi.org/10.1177/193229680700100115DOI Listing
January 2007

Dietary guidance in heart failure: a perspective on needs for prevention and management.

Heart Fail Rev 2006 Mar;11(1):7-12

National Heart, Lung, and Blood Institute, National Institutes of Health, 6701 Rockledge Drive, Room 10-194, MSC 7956, Bethesda, MD 20892-7956, USA.

The role that dietary factors play in preventing heart failure (HF) and in improving prognosis is increasingly recognized, indicating a need for well-grounded guidelines that can provide recommendations for daily nutrient intakes. At present, however, the state of dietary guidance is more satisfactory for persons at risk of HF (Stages A and B) than for those with a diagnosis of HF (Stages C and D). For individuals at risk of HF, a good starting point is provided by governmental and professional society guidance directed at dietary management of cardiovascular risk factors such as hypertension, hyperlipidemia, and obesity. These dietary recommendations are consonant with epidemiologic research suggesting that improving risk factor profiles likely will lower the risk of developing HF. For patients with diagnosed HF, however, little information is available to define optimal nutrient intakes and optimal food patterns. Dietary services have been shown useful in improving clinical outcomes, but nutritional management must be individualized to the patient's needs and must accommodate pharmacologic therapy, multiple co-morbidities, the possible need for nutritional supplements, repeated hospitalizations, salt and fluid retention, voluntary vs. involuntary weight loss, and other nutritional issues relevant to the aged population who comprise the majority of HF patients. Progress in the field will require well-designed clinical investigations addressing nutrient intake, nutrient metabolism, and nutritional status while mindful of the complex pathophysiology of HF.
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http://dx.doi.org/10.1007/s10741-006-9187-3DOI Listing
March 2006

An overview of methodologies, proficiencies, and training resources for controlled feeding studies.

J Am Diet Assoc 2003 Jun;103(6):729-35

Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808-4124, USA.

Dietary intervention studies of human beings produce valuable information regarding dietary effects on biological processes and risk factors for chronic diseases. Using the well-controlled feeding approach, participants consume only foods that have been precisely prepared in a research kitchen, whereas in behavioral counseling studies, participants self-select their foods within guidelines. Because controlled feeding studies meticulously control experimental diets, they are intellectually and logistically challenging to conduct. They afford exciting opportunities for dietetic professionals in designing protocols, developing budgets, and collaborating in multidisciplinary research teams. Research dietitians use food composition data and chemical analysis of menus to prepare research diets with precision. They determine the energy requirements of subjects and adjust diets as required, most often for weight maintenance, throughout the study. All people involved in research must be attentive to the ethical treatment of the study participants while motivating them to adhere to the protocol requirements. Dietitians possess many of these skills, but may require training specific to well-controlled feeding studies. Information related to the conduct of controlled feeding studies has recently become more accessible. We provide an overview of well-controlled feeding study methodologies, proficiencies for planning and implementing these studies, and training resources.
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http://dx.doi.org/10.1053/jada.2003.50132DOI Listing
June 2003

Gender, alcohol consumption, and renal cell carcinoma.

Am J Epidemiol 2002 Mar;155(5):455-62

Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.

The nature of the association between alcohol consumption and renal cell carcinoma (RCC) is not well understood, but there are indications of effect modification by gender. The authors report data from a population-based case-control study conducted in Iowa from 1986 to 1989. RCC cases (261 men and 145 women) were identified through the Iowa Cancer Registry, while controls (1,598 men and 831 women) were randomly selected from the general population, frequency matched on age and gender. Subjects provided detailed information on a mailed questionnaire regarding demographic, anthropometric, lifestyle, dietary, and medical history risk factors. In age-adjusted analysis, there was a decrease in risk for women who reported consuming more than three servings (median among drinkers) of alcohol per week (odds ratio = 0.5, 95% confidence interval: 0.2, 0.9) compared with never drinkers. No evidence of an association among men was noted (odds ratio = 1.1, 95% confidence interval: 0.8, 1.5). Multivariate adjustment for anthropometric, lifestyle, smoking, and dietary factors did not alter the findings. Analysis by type of alcohol suggested that the inverse association was strongest for beer consumption, but estimates were imprecise. These findings suggest an inverse association of alcohol consumption and RCC development among women but not among men.
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http://dx.doi.org/10.1093/aje/155.5.455DOI Listing
March 2002