This systematic review and meta-analysis examined the effectiveness of combined diet and physical activity interventions on changes in dietary and physical activity behaviors, and adiposity related outcomes in adolescents globally. PubMed, Embase, and Cochrane were searched for controlled interventions targeting dietary behaviors and physical activity in adolescents aged 10-19 years at baseline and reporting on the outcomes of changes in dietary and physical activity behaviors. Behavioral outcomes were synthesized narratively, and meta-analyses were conducted for changes in adiposity related outcomes (e.g., BMI z-scores, body fat percentage). Thirty-six studies were included, most (79%) were conducted in high-income countries and delivered in school settings (n = 28, 78%). Ten interventions (28%) showed no effect on any behaviors, and 5 (14%) reported changing all behaviors targeted and assessed. Most (72%) interventions changed at least one of the behaviors assessed, and 39% changed one or more indicator of adiposity. In a subsample (k = 16), there was a nonsignificant reduction in BMI (SMD -0.11 [95% CI -0.26 to 0.04]; I2 = 90%), a significant moderate reduction in BMI z-score (k = 14) (SMD -0.62 [-1.09 to -0.16]; I2 = 99%), and in body fat percentage in favor of the intervention groups (k = 11) (SMD -1.32 [-2.22 to -0.42]; I2 = 99%). The evidence for interventions targeting both dietary and physical activity behaviors and their effect on behavior and adiposity in adolescents is largely inconsistent. The positive findings from few studies suggests that there is potential to improve some lifestyle behaviors and associated adiposity outcomes in adolescents. However, the current evidence is focussed on high income countries with little consideration given to potential inequities in the effects of interventions.

Introduction In Fiji, multiple burdens of malnutrition including undernutrition, overweight/obesity, and micronutrient deficiencies coexist at the individual, household, and population levels. The diets of children, adolescents, and adults are generally unhealthy. The objective of this review was to understand how the dietary behaviors of children, adolescents, and women in Fiji are influenced by individual, social, and food environment factors. Methods This rapid review was conducted to synthesize existing evidence, identify research gaps in the evidence base, and make recommendations for future research. The Cochrane Rapid Reviews Methods and the updated guideline for reporting systematic reviews were used. The search strategy for this rapid review was based on the Population Context Outcome [P(E)CO] framework, including search terms for population (children, adolescents, and adults), context (Fiji), and outcome (dietary behaviors). Searches were conducted in PubMed, Scopus, PsycINFO, and Google Scholar. Results The 22 studies included in this review identified different factors influencing dietary behaviors in Fiji. Individual preferences for processed and imported foods, especially of younger generations, and social dynamics, especially gender norms and social pressure, to serve meat and overeat appeared to be prominent in driving dietary habits. The ongoing nutrition transition has led to increasing availability and affordability of ultra-processed and fast foods, especially in urban areas. Concerns about food safety and contamination and climate change and its effect on local food production also appear to influence dietary choices. Discussion This review identified different dynamics influencing dietary behaviors, but also research gaps especially with regard to the food environment, calling for an integrated approach to address these factors more systemically.

Background: Global consumption of unhealthy foods, including ultra-processed foods (UPFs) and sugar-sweetened beverages (SSBs), has increased substantially among pediatric populations. Suboptimal diet during early life can track into adulthood, alongside risk factors for cardiometabolic disease.Objective: To inform the development of updated WHO guiding principles for complementary feeding of infants and young children, this systematic review sought to examine the association between unhealthy food consumption during childhood and cardiometabolic risk biomarkers.Methods: PubMed (Medline), EMBASE, and Cochrane CENTRAL were systematically searched, with no language restriction, up to 10 March 2022. Inclusion criteria were randomized controlled trials (RCTs), non-RCTs, and longitudinal cohort studies; children aged <10.9 y at exposure; studies reporting greater consumption of unhealthy foods and beverages (defined using nutrient-and food-based approaches) than no or low consumption; studies assessing critical nonanthropometric cardiometabolic disease risk outcomes (blood lipid profile, glycemic control, or blood pressure).Results: Of 30,021 identified citations, 11 articles from 8 longitudinal cohort studies were included. Six studies focused on exposure to unhealthy foods or UPF, and 4 focused on SSB only. Methodological heterogeneity was too high across studies to meta-analyze effect es-timates. A narrative synthesis of quantitative data revealed that exposure to unhealthy foods and beverages, specifically NOVA-defined UPF, in children of preschool age may be associated with a worse blood lipid and blood pressure profile in later childhood (Grading of Rec-ommendations Assessment, Development, and Evaluation [GRADE]: low and very low certainty, respectively). No associations were evident between SSB consumption and blood lipids, glycemic control, or blood pressure (GRADE: all low certainty). Conclusions: No definitive conclusion can be made because of quality of the data. More high-quality studies that purposefully assess the effects of unhealthy food and beverage exposure during childhood on cardiometabolic risk outcomes are needed. This protocol was registered at https://www.crd.york.ac.uk/PROSPERO/ as CRD42020218109.

Context: The impact of unhealthy foods and beverages, namely those high in sugar, salt, and saturated or trans fats, has been studied extensively in relation to weight, body composition, and noncommunicable diseases, but less so in relation to the risk of dental caries. Few previous reviews have examined the evidence from all countries globally. Objective: A systematic review was conducted to assess the impact of unhealthy food and beverage consumption on the risk of dental caries in children aged <= 10 years, commissioned by the World Health Organization to inform updated complementary feeding recommendations. Data sources: Systematic searches were conducted in the PubMed, Cochrane, and Embase databases for articles meeting the inclusion criteria dating from January 1971 to March 2022; supplementary searches were undertaken for articles from that period to June 2022. Data extraction: Unhealthy foods and beverages were identified using nutrient- and food-based approaches. Risk of bias was assessed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I).Data analysis: A total of 30 023 unique citations were screened, yielding 37 studies for inclusion. Studies were conducted in high-income (n = 23 [62.2%]) or middle-income countries (n = 14 [37.8%]). Evidence synthesis was performed narratively, stratified by age (0 years to <2 years, 2 years to <5 years, and 5 years to <= 10 years) and exposure (unhealthy foods and unhealthy beverages). The heterogeneity of the exposures and comparators across studies was high. Almost all studies (n = 34) reported positive associations between the consumption of sugar-sweetened beverages or foods high in free sugars and dental caries. However, 67.6% of studies were assessed as having serious risk of bias. Conclusion: The evidence indicates that the consumption of unhealthy food and beverages in children <= 10 years appears to increase the risk of dental caries. Further longitudinal studies with high-quality dietary assessments, including studies in low-income countries and children aged >5 years at baseline, are recommended in order to build a more robust evidence base for use in the development of policy recommendations.

This WHO-commissioned review contributed to the update of complementary feeding recommendations, synthesizing evidence on effects of unhealthy food and beverage consumption in children on overweight and obesity. We searched PubMed (Medline), Cochrane CENTRAL, and Embase for articles, irrespective of language or geography. Inclusion criteria were: 1) randomized controlled trials (RCTs), non-RCTs, cohort studies, and pre/post studies with control; 2) participants aged ≤10.9 y at exposure; 3) studies reporting greater consumption of unhealthy foods/beverages compared with no or low consumption; 4) studies assessing anthropometric and/or body composition; and 5) publication date ≥1971. Unhealthy foods and beverages were defined using nutrient- and food-based approaches. Risk of bias was assessed using the ROBINS-I (risk of bias in nonrandomized studies of interventions version I) and RoB2 [Cochrane RoB (version 2)] tools for nonrandomized and randomized studies, respectively. Narrative synthesis was complemented by meta-analyses where appropriate. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation. Of 26,542 identified citations, 60 studies from 71 articles were included. Most studies were observational (59/60), and no included studies were from low-income countries. The evidence base was low quality, as assessed by ROBINS-I and RoB2 tools. Evidence synthesis was limited by the different interventions and comparators across studies. Evidence indicated that consumption of sugar-sweetened beverages (SSBs) and unhealthy foods in childhood may increase BMI/BMI z-score, percentage body fat, or odds of overweight/obesity (low certainty of evidence). Artificially sweetened beverages and 100% fruit juice consumption make little/no difference to BMI, percentage body fat, or overweight/obesity outcomes (low certainty of evidence). Meta-analyses of a subset of studies indicated a positive association between SSB intake and percentage body fat, but no association with change in BMI and BMI z-score. High-quality epidemiological studies that are designed to assess the effects of unhealthy food consumption during childhood on risk of overweight/obesity are needed to contribute to a more robust evidence base upon which to design policy recommendations. This protocol was registered at https://www.crd.york.ac.uk/PROSPERO as CRD42020218109.

Purpose: Exercise reduces pain and improves physical function in osteoarthritis (OA) patients with no negative effects on wet or imaging biomarkers. Exercises with high strain magnitudes and rates are beneficial for bone health. High impact exercise generates high strain magnitudes and rates required for an osteogenic response however, the effects on joint health and OA risk are less certain. High impact, multidirectional exercise stimulated localised changes in bone properties that may affect bone shape and OA risk. Statistical shape modelling (SSM) could be used to detect such changes. SSM is an image analysis method employing principal component analysis that has previously been employed for the early identification of OA and hip fracture prediction. The aims of this study are 1) to investigate changes in hip shape after high impact exercise interventions and 2) to apply a previously developed model to determine whether there are any changes in modes previously associated with OA risk.

ABSTRACT Purpose This study aimed to determine whether the pattern of carbohydrate sports drink ingestion during prolonged submaximal running affects exogenous carbohydrate oxidation rates and gastrointestinal (GI) comfort. Methods Twelve well-trained male runners (27 ± 7 yr; 67.9 ± 6.7 kg; V˙O2peak, 68 ± 7 mL·kg−1·min−1) completed two exercise trials of 100 min steady-state running at 70%V˙O2peak. In each of the trials, 1 L of a 10% dextrose solution, enriched with [U-13C] glucose, was consumed as either 200 mL every 20 min (CHO-20) or 50 mL every 5 min (CHO-5). Expired breath and venous blood samples were collected at rest and every 20 min during exercise. Subjective scales of GI comfort were recorded at regular intervals. Results Average exogenous carbohydrate oxidation rates were 23% higher during exercise in CHO-20 (0.38 ± 0.11 vs 0.31 ± 0.11 g·min−1; P = 0.017). Peak exogenous carbohydrate oxidation was also higher in CHO-20 (0.68 ± 0.14 g·min−1 vs 0.61 ± 0.14 g·min−1; P = 0.004). During exercise, total carbohydrate oxidation (CHO-20, 2.15 ± 0.47; CHO-5, 2.23 ± 0.45 g·min−1, P = 0.412) and endogenous carbohydrate oxidation (CHO-20, 1.78 ± 0.45; CHO-5, 1.92 ± 0.40 g·min−1; P = 0.148) were not different between trials. Average serum glucose (P = 0.952) and insulin (P = 0.373) concentrations were not different between trials. There were no differences in reported symptoms of GI comfort and stomach bloatedness (P > 0.05), with only 3% of reported scores classed as severe (≥5 out of 10). Conclusion Ingestion of a larger volume of carbohydrate solution at less frequent intervals during prolonged submaximal running increased exogenous carbohydrate oxidation rates. Neither drinking pattern resulted in increased markers of GI discomfort to a severe level.

D.S. Akerib, 2 S. Alsum, H.M. Araújo, X. Bai, J. Balajthy, A. Baxter, E.P. Bernard, A. Bernstein, T.P. Biesiadzinski, 2 E.M. Boulton, 10, 11 B. Boxer, P. Brás, S. Burdin, D. Byram, 14 M.C. Carmona-Benitez, C. Chan, J.E. Cutter, L. de Viveiros, E. Druszkiewicz, A. Fan, 2 S. Fiorucci, 16 R.J. Gaitskell, C. Ghag, M.G.D. Gilchriese, C. Gwilliam, C.R. Hall, S.J. Haselschwardt, S.A. Hertel, 10 D.P. Hogan, M. Horn, 8 D.Q. Huang, C.M. Ignarra, 2 R.G. Jacobsen, O. Jahangir, W. Ji, 2 K. Kamdin, 10 K. Kazkaz, D. Khaitan, E.V. Korolkova, S. Kravitz, V.A. Kudryavtsev, E. Leason, B.G. Lenardo, 9 K.T. Lesko, J. Liao, J. Lin, A. Lindote, M.I. Lopes, A. Manalaysay, 6 R.L. Mannino, 3 N. Marangou, D.N. McKinsey, 10 D.-M. Mei, M. Moongweluwan, J.A. Morad, A.St.J. Murphy, A. Naylor, C. Nehrkorn, H.N. Nelson, F. Neves, A. Nilima, K.C. Oliver-Mallory, 10 K.J. Palladino, E.K. Pease, 10 Q. Riffard, 10 G.R.C. Rischbieter, C. Rhyne, P. Rossiter, S. Shaw, 18 T.A. Shutt, 2 C. Silva, M. Solmaz, V.N. Solovov, P. Sorensen, T.J. Sumner, M. Szydagis, D.J. Taylor, R. Taylor, W.C. Taylor, B.P. Tennyson, P.A. Terman, D.R. Tiedt, W.H. To, L. Tvrznikova, 10, 11 U. Utku, S. Uvarov, A. Vacheret, V. Velan, ∗ R.C. Webb, J.T. White, T.J. Whitis, 2 M.S. Witherell, F.L.H. Wolfs, D. Woodward, J. Xu, and C. Zhang

and WALK8 (25%) than for SIT (all P < 0.05) on day 1, whereas 2-h dinner postprandial glucose iAUC was significantly higher for WALK8 (25%) than for SIT (P = 0.038). No significant treatment effects on both lunch (day 1) and breakfast (day 2) postprandial glucose iAUC were found. CONCLUSIONS:Three kinds of regular walking break conditions attenuated 26-h glucose responses. WALK8 most likely influenced the 2-h postprandial glucose metabolism of the healthy young adults in this study.

OBJECTIVES:Ingested ketogenic agents offer the potential to enhance endurance performance via the provision of an alternative exogenous, metabolically efficient, glycogen-sparing fuel (i.e. ketone bodies). This study aimed to assess the impact of combined carbohydrate and 1,3-butanediol (CHO-BD) supplementation on endurance performance, blood beta-hydroxybutyrate (βHB) concentration and glycolytic activity, in comparison to carbohydrate supplementation alone (CHO). DESIGN:Eleven male runners (age 38±12years, mass 67.3±6.5kg, height 174.5±5.0cm, [Formula: see text] 64.2±5.0ml⋅kg-1⋅min-1) performed two experimental trials in a randomised crossover design. METHODS:Each trial consisted of 60min of submaximal running, followed by a 5km running time-trial (TT), and was performed following the ingestion of an energy matched ∼650ml drink (CHO-BD or CHO). RESULTS:There was no difference in TT completion time between the trials (CHO: 1265±93, CHO-BD: 1261±96s; p=0.723). However, blood βHB concentration in the CHO-BD trial was at least double that of the CHO trial at all time points following supplementation (p<0.05). While blood lactate concentration was lower in the CHO-BD versus CHO trial after 30min submaximal exercise (CHO-BD: 1.46±0.67mmol⋅L-1, CHO: 1.77±0.46mmol⋅L-1, p=0.040), it was similar at other time points. Blood glucose concentrations were higher post-TT in the CHO-BD trial (CHO-BD: 5.83±1.02mmol⋅L-1, CHO: 5.26±0.95mmol⋅L-1, p=0.015). CONCLUSIONS:An energy matched CHO-BD supplementation drink raised βHB concentration and acutely lowered blood lactate concentration, without enhancing 5km TT running performance.