Introduction: Epidemiological studies have linked prenatal maternal diet to fetal growth, but whether diet affects placental outcomes is poorly understood.Methods: We collected past month dietary intake from 148 women in mid-pregnancy enrolled at University of California Los Angeles (UCLA) antenatal clinics from 2016 to 2019. We employed the food frequency Diet History Questionnaire II and generated the Healthy Eating Index-2015 (HEI-2015), the Alternate Healthy Eating Index for Pregnancy (AHEI-P), and the Alternate Mediterranean Diet (aMED). We conducted T-2-weighted magnetic resonance imaging (MRI) in mid-pregnancy (1st during 14-17 and 2nd during 19-24 gestational weeks) to evaluate placental volume (cm(3)) and we measured placenta weight (g) at delivery. We estimated change and 95 % confidence interval (CI) in placental volume and associations of placenta weight with all dietary index scores and diet items using linear regression models.Results: Placental volume in mid-pregnancy was associated with an 18.9 cm(3) (95 % CI 5.1, 32.8) increase per 100 gestational days in women with a higher HEI-2015 (>= median), with stronger results for placentas of male fetuses. We estimated positive associations between placental volume at the 1st and 2nd MRI and higher intake of vegetables, high-fat fish, dairy, and dietary intake of B vitamins. A higher aMED (>= median) score was associated with a 40.5 g (95 % CI 8.5, 72.5) increase in placenta weight at delivery, which was mainly related to protein intake.Discussion: Placental growth represented by volume in mid-pregnancy and weight at birth is influenced by the quality and content of the maternal diet.

Popular modern diets are often seen as a panacea for improving health and promoting weight reduction. While there is a large body of literature reporting the health benefits of popular diets, few studies have described their planetary benefits. Our investigation aims to evaluate the simultaneous impacts of six popular diets within the United States on both human and planetary health. Using carbon footprint databases and representative meal plans, the environmental and health-related impacts of the Standard American, Mediterranean, vegan, paleo, keto, and climatarian diets are compared using the currently available literature. Results indicate that diets that exhibit lower carbon footprints also have positive effects on human health. The diets found to have the lowest environmental impacts were the vegan, climatarian, and Mediterranean diets. These low-carbon-footprint diets can likely be attributed to a reduced reliance on ruminant meat (cattle and sheep) and processed food consumption, while diets with high carbon footprints are more dependent on ruminant meat and saturated fat. Moderate consumption of meats such as chicken, pork, and fish in conjunction with an emphasis on locally grown fruits and vegetables can be maintained without adversely affecting the planetary carbon footprint and with the added benefit of promoting good health. Thus, making simple substitutions within each individual's diet can be advertised as an effective approach to collectively lower the environmental impact in tandem with improving health and longevity.

Nutrition knowledge, confidence, and skills are thought to be important elements in the role of healthcare professionals in obesity prevention and management. The Upstream Obesity Solutions curriculum goes upstream with a multidisciplinary approach to supplement nutrition education among health professional trainees. Educational strategies of didactics, teaching kitchens, and service-based learning were employed for medical, dental, and nursing students and resident physicians. Pre/post participation surveys assessed knowledge, attitude, and practices; lifestyle habits; and culinary skills among 75 trainees in this cross-sectional descriptive study. There was variability in statistically significant improvement in knowledge, attitudes, and practices about obesity management and nutrition education, lifestyle habits, and culinary skills among learner groups.

Objective. To examine whether a weight loss intervention programme improves RA disease activity and/or musculoskeletal ultrasound synovitis measures in obese RA patients. Methods. We conducted a proof-of-concept, 12-week, single-blind, randomized controlled trial of obese RA patients (BMI >= 30) with 28-joint DAS (DAS28) >= 3.2 and with evidence of power Doppler synovitis. Forty patients were randomized to the diet intervention (n = 20) or control group (n = 20) . Diet intervention consisted of a hypocaloric diet of 1000-1500 kcal/day and high protein meal replacements. Co-primary outcomes included change in DAS28 and power Doppler ultrasound (PDUS)-34. Clinical disease activity, imaging, biomarkers, adipokines and patient-reported outcomes were monitored throughout the trial. Recruitment terminated early. All analyses were based on intent-to-treat for a significance level of 0.05. Results. The diet intervention group lost an average 9.5 kg/patient, while the control group lost 0.5 kg (P < 0.001). Routine Assessment of Patient Index Data 3 (RAPID3) improved, serum leptin decreased and serum adiponectin increased significantly within the diet group and between the groups (all P < 0.03). DAS28 decreased, 5.2 to 4.2, within the diet group (P < 0.001; -0.51 [95% CI -1.01, 0.00], P = 0 .056 , between groups). HAQ-Disability Index (HAQ-DI) improved significantly within the diet group (P < 0.04; P = 0 .065 between group). Ultrasound measures and the multi-biomarker disease activity score did not differ between groups (PDUS-34 -2.0 [95% CI -7.00, 3.1], P = 0.46 between groups). Conclusion. Obese RA patients on the diet intervention achieved weight loss. There were significant between group improvements for RAPID3, adiponectin and leptin levels, and positive trends for DAS28 and HAQ-DI. Longer-term, larger weight loss studies are needed to validate these findings, and will allow for further investigative work to improve the clinical management of obese RA patients.

Background: In spite of aromatase inhibitors reducing risk of recurrence and mortality, painful side effects often cause women to discontinue use of the drug. Side effects of aromatase inhibitors include joint and muscle pain, loss of bone mineral density, and impairment of heart functioning. Discontinuation of aromatase inhibitors due to these side effects occur in up to 40% of breast cancer survivors, and consequently risks of recurrence and mortality increase. Objective: We developed two interventions designed to reduce inflammation, alleviate pain and stabilize bone mineral density. Methods: We are currently conducting a pilot parallel intervention trial that is targeted toward alleviating side effects from aromatase inhibitors through dietary and exercise controlled interventions lasting for three months. The dietary intervention is an anti-inflammatory Mediterranean diet designed to decrease inflammation and lessen joint and muscle pain. Participants randomized to the Mediterranean dietary intervention are exclusively consuming food provided by Territory Foods®, an outside food preparation and delivery service, local to Los Angeles. Our exercise intervention is designed to mobilize the joints, and strengthen and reduce bone loss. Participants are visiting the UCLA Kinross gym for three days per week and are undergoing tailored exercise sessions delivered from personal trainers following our bone strengthening intervention protocol. Anthropometric measures, muscle strength, DXA scanning of bone mineral density, peripheral arterial tonometry, pulse wave velocity and biomarkers of inflammation, bone turnover and heart functioning are conducted at baseline, mid- and end of intervention. Results: Our trial is targeted to accrue 20 participants. Thus far we enrolled six participants, with three participants completing the trial. Analysis is ongoing and preliminary results will be presented at the San Antonio Breast Cancer Symposium in December, 2022. Post intervention reports from participants have noted a reduction in pain symptoms, moderate weight loss and increase in muscle strength. Citation Format: Catherine L. Carpenter, Aashini K. Master, Olivia Julian, Dina Ben-Nissan, Michele Rakoff, Gail Thames, Zhaoping Li. Improving the health of women on Aromatase Inhibitors: A pilot controlled dietary and exercise intervention trial [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-06-01.

Creating a decision-making environment that promotes sustainable food choices is a priority for both the individual and society. This study aimed at encouraging plant-based menu choices by re-ordering the menu according to the carbon footprint values. The project was conducted in a grab-and-go eatery at a large United States public university, where students could order their meals choosing among different menu options that were customizable with various ingredients. The order of menu ingredients was changed twice: for five weeks, from the most to the least impactful in terms of carbon footprint; subsequently, for another five weeks the order was reversed. At both times, all sales data were recorded. A total of 279,219 and 288,527 items were selected, respectively, during the first and the second intervention. A significant association was found between menu re-ordering and customers’ choices for almost all food categories considered. Overall, despite beef choices not changing, results showed that students were more likely to choose low-carbon options when these were placed at the beginning, emphasizing that food selections were impacted by ingredient placement on the menu list. These findings highlight the need for a multi-level strategy focused on raising students’ awareness of the environmental impact of animal-based foods, particularly beef.

Objective To examine medical students’ perceptions of the nutrition education received and their ability to apply that knowledge in clinical settings. Methods This is a qualitative study using a structured survey with free responses to solicit the perspective of US medical students regarding their nutrition education. A national online survey was distributed by the American Academy of Pediatrics, Section on Pediatric Trainees. An expert committee in nutrition education evaluated and conducted a thematic analysis of the survey responses. Results Twenty-four surveys were completed (10 medical students and 14 pediatric interns). The survey revealed students were not satisfied with the nutrition education they received in several areas including nutritional recommendations for obesity and prediabetes/diabetes; nutritional needs during pregnancy, childhood, and adolescent age-related dietary recommendations; cultural influences on diet and eating habits; and food insecurity. Students also reported a lack of confidence in providing healthful nutrition counseling to adolescent patients and delivering culturally appropriate nutrition advice. Conclusions Survey responses revealed the need for improvements in several areas of nutrition curricula related to health and chronic disease management and suggest broader social determinants of health such as cultural influences on nutrition practices and food insecurity. The results of this survey provide unique insight into the medical student perspective on nutrition education and can inform the development of future medical school nutrition curriculums.

Objective Workplace wellness programs can reduce cardiovascular risk and improve worker productivity; however, recruitment and adherence remain a challenge. Tailoring programs based on employee exercise preferences may address these concerns. Methods A total of 458 UCLA adult employees who responded to UCLA Bruin marketing e-mail completed a battery of questions regarding their exercise preferences (eg, preferred duration, intensity, type). Recruitment took place in June 2021. Results Participants prefer workplace wellness programs that (1) focus on improving multiple different aspects of physical health; (2) take place in a variety of locations; (3) were administered by a coach who is physically present; (4) occur 2-3 times per week for roughly 60 minutes each time; (5) include a range of intensities; and (6) consist of aerobic and weight training. Conclusions Future studies should use these results to design future workplace wellness programs.

Loss of lean muscle mass impairs immunity and increases mortality risk among individuals with HIV/AIDS. We evaluated the relative contributions of protein supplementation and nutrition education on body composition among 600 women living with HIV/AIDS in rural Andhra Pradesh, India. We conducted a cluster randomized controlled 2 × 2 factorial trial lasting six months with follow up at twelve and eighteen months. Interventions occurred in the Nellore and Prakasam regions of Andhra Pradesh by trained village women, ASHA (Accredited Social Health Activists), and included: (1) the usual supportive care from ASHA (UC); (2) UC plus nutrition education (NE); (3) UC plus nutritional protein supplementation (NS); (4) combined UC plus NE plus NS. A Bioimpedance Analyzer Model 310e measured body composition. SAS 9.4 analyzed all data. Mixed models using repeated measures evaluated lean mass change from baseline as primary and fat weight and total weight as secondary outcomes. Lean mass change was significantly associated with NS (p = 0.0001), NE (p = 0.0001), and combined NS plus NE (p = 0.0001), with similar associations for secondary outcomes. Stronger associations for total weight were observed with greater ART adherence. Nutritional interventions may improve physiologic response to HIV. Significant increases in lean mass resulted from independent and combined protein supplementation and nutrition education.

Background: Head trauma has been associated with increased brain tumor risk in adults. Instrument assisted delivery can be a cause of head trauma in newborns. The goal of this study was to determine if instrumentassisted deliveries influenced the odds of childhood brain tumors in Denmark. Methods: We conducted a matched case-control study of childhood (<20 years) brain tumors in Denmark born between 1978 and 2013 and diagnosed 1978-2016. A total of 1678 brain tumor cases were identified and 25 controls were matched to each case based on the child's sex and birth date (N = 40,934). Conditional logistic regression was used to estimate effects (odds ratios (OR) and 95% confidence intervals (95%CI)) for variables of interest. Results: Compared to children birthed by spontaneous vaginal delivery, children who later developed ependymomas (N = 118) had a greater likelihood of having experienced vacuum assisted deliveries (OR=1.74, 95% CI 1.02-2.96). Forceps use was low, and declined across the study period. We did not observe an overall increase in all CNS tumors (combined) with either vacuum delivery (OR=0.99, 95% CI 0.84-1.18) or forceps delivery (OR=1.26, 95% CI 0.78-2.03). Conclusion: Our findings suggest an association between vacuum assisted deliveries and ependymomas.

BACKGROUND:The elderly population of Jordan is growing, due to the low mortality rate, high total fertility rate, and the high rate of forced migration from neighboring countries to Jordan in recent years. However, the prevalence of chronic illnesses associated with other comorbidities among the elderly population in Jordan is high. Maintaining a good nutritional status is essential for maintaining general health and well-being among older people.AIM:The aim of this study is to identify the nutritional status of community-dwelling older adults in Jordan and determine its possible associated factors.METHODOLOGY:A cross-sectional, descriptive design was utilized. Proportional multistage nonprobability sampling was employed to obtain a convenient sample of 225 Jordanian community-dwelling older adults. The participants were asked to complete a set of questionnaires related to nutritional status, which included a demographic information sheet, and the Mini Nutritional Assessment (MNA).RESULTS:Among the sample, only 60 participants (26.7%) showed normal nutritional status. Most of the participants (n = 156; 68.3%) were found to be at risk of malnutrition, and nine participants (4%) were found to suffer from malnutrition. Advanced age (r = -0.631; p = 0.001), body mass index (BMI) (r = 0.546; p = 0.001), being single (mean (M) = 20.43, SD = 3.55), being male (M = 21.10, SD = 3.73), being unemployed (M = 21.71, SD = 3.51), being dependent in activities of daily living (ADLs) (M = 21.35; SD = 3.62), eating only two meals per day (M = 19.60; SD = 3.39), having suffered from illness or anxiety in the preceding 3 months (M = 21.11; SD = 2.39), having a mid-arm circumference of less than 31 cm (M = 19.51; SD = 3.47), low consumption of fruit and vegetables (M = 20.79; SD = 2.53), and polypharmacy (M = 20.62, SD = 4.09) were found to predict susceptibility to malnutrition among the participating older adults. Amongst the variables, age was identified as the most significant predictor of nutritional status and explained approximately 40% of the variance in nutritional status.CONCLUSION:Malnutrition in older adults is a multifaceted phenomenon that needs to be integrated into the comprehensive assessment of older adults. It is essential that health-care professionals, particularly nurses, are fully aware of the associated risks of malnutrition among the elderly population. The high prevalence of the risk factors for malnutrition warrants conducting a controlled national-based assessment, using probability sampling, of the nutritional status among older adults in Jordan. Specifically, there is a real need to assess nutritional status among older adults who are at high risk of malnutrition, including senior, unmarried, male, unemployed, ADL dependent, and/or poly-medicated older adults.

An increasing proportion of people ever diagnosed with invasive cancer will live 5 years or more after their cancer diagnosis. For them, the clinical focus has been shifting from a focus on extending recurrence-free survival to a focus on improving the survivor's quality of life. Fortunately, increasingly sophisticated behavior change research is equipping healthcare providers with patient behavior change strategies and providing cancer survivors with practical steps that can optimize cancer survivors' physical well-being and quality of life. Although different cancer diagnoses require somewhat different lifestyle prescriptions to optimize the survivor's quality of life, a variety of cancer diagnoses respond well to lifestyle interventions that promote greater adherence to federal nutrition and physical activity guidelines for all Americans. More specifically, cancer survivors experience higher quality of life by eating a more Mediterranean-style diet and by engaging in a 30-minute brisk walk at least 5 days a week for reasons that probably involve salubrious impacts on their gut microbiota composition. Behavior change approaches to promoting healthier lifestyle behaviors in cancer survivors can be cancer-specific or originally designed for the general population. Either way, research in which behavior theory-specific components are exhaustively embedded yield greater impact than research that is merely theory-informed. Selected theories are discussed with illustrations taken from recent scientific literature. Which behavioral approaches are most appropriate depends on the progress with which the cancer survivor has embedded the desired behaviors into their everyday routines as well as on supports for the recommended behaviors by family and community members. The most appropriate behavioral approaches are also, of course, conditioned on the survivor's demographic, physical, and emotional health status characteristics. Finally, we present several recommendations for accelerating progress in the use of behavior change interventions to optimize cancer survivors' recurrence-free survival and quality of life.

Exercise promotes well-being of people at all ages. Exercise influences multiple physiologic systems, including circulation, metabolism, adipose tissue, skeletal muscle, endocrine system, and immunity. The effect of exercise activity on these systems can modify cancer risk. Exercise causes lipolysis or metabolism of fat. Based on body composition and fitness level, fat loss occurs at lower intensity exercise, with the exception of visceral fat. Visceral fat loss depends on higher intensity exercise occurring over longer durations. Exercise prevents weight gain and promotes weight loss among individuals with excess fat. Acute exercise does not influence energy balance in the short term. However, consistent and frequent moderate exercise over time results in negative energy balance, particularly when dietary intake is constant. Maintenance of stable weight through exercise necessitates regular intervals of moderate exercise that exceeds 30 minutes per day for five or more days per week. Physical activity reduces postmenopausal breast, endometrial, colon, pancreatic, and kidney cancers through reduction in body fat and decreases in obesity-related hormonal, inflammatory, and metabolic factors. Increased skeletal muscle metabolism, while receiving little study, may play an indirect role in cancer risk reduction by facilitating basal metabolic rate increases, improving insulin sensitivity, and boosting rate of lipolysis.

People living with HIV/AIDS are at increased risk of nutritional deficiencies. Loss of lean muscle mass has been associated with a more rapid decline of immune function and increased risk of mortality among individuals suffering from HIV. Our objectives were to evaluate the relative contributions of nutrition supplementation and nutrition education on body composition outcomes using a cluster randomized factorial trial among 600 women living with HIV/AIDS in rural Andhra Pradesh, India. We conducted a prospective cluster randomized controlled 2 × 2 factorial design to assess impacts of nutritional education and nutritional supplementation over a six-month period, with follow up at six, twelve and eighteen months post enrollment. Study protocols were approved by Human Subjects Committees at the Universities of California at Los Angeles, Irvine, and San Francisco and the Ministry of Health in India. Interventions were delivered in the Nellore and Prakasam regions of Andhra Pradesh by trained lay village women, Ashas (Accredited Social Health Activists). Interventions included: usual supportive care provided by Ashas; 2) Asha Support plus Nutrition education; 3) Asha support plus Nutrition supplementation; and, 4) Asha support plus Nutrition education plus Nutrition supplementation. We measured body composition using a Bioimpedance Analyzer Model 310e. All data was analyzed using SAS 9.4. Mixed models evaluated change in lean muscle mass from baseline as the primary outcome, and fat weight, overall weight and BMI changes as secondary outcomes. Change in muscle mass from baseline was significantly associated with nutrition supplementation (P = 0.001), nutrition education (P = 0.01), with a significant interaction (P = 0.03) for the combined nutrition supplementation and education term. Using the same factorial structure, nutrition supplementation and education were independently associated with changes in BMI and fat mass. Interventions that target nutrition may be an important approach to improving the physiologic response to HIV. We observed significant increases in muscle mass resulting from independent contributions of nutrition education and nutrition supplementation, as well as their combined contribution. NIMH R01MH098728.

Background Malnutrition is a common clinical concern among children in low-income communities affected by human immunodeficiency virus (HIV). We examined the effect of a community-based nutritional intervention on anthropometric and clinical outcomes of children of women living with HIV in rural India. Methods We assigned women living with HIV and their child (oldest 3-8 years) to 1 of 4 programs: (1) community-based HIV care program, (2) program 1 + nutrition education, (3) program 1 + food supplement, and (4) all elements of programs 1-3. Study data were collected at baseline and months 6, 12, and 18. We applied mixed-effects modeling with restricted maximum likelihood estimation to examine changes in weight (all children) and CD4(+) T-cell counts (children with HIV only). Results Overall, 600 mother-child pairs were enrolled (150/group) with 100% retention at follow-up visits. Approximately 20% of children were living with HIV. Children in program 4 had higher weight gain than those in programs 1, 2, and 3 at all time points (adjusted P < .001). We found a higher increase in CD4(+) T cells across all time points among participants in programs 3 and 4 compared with program 1 (adjusted P < .001). Factorial analysis suggested a synergistic effect of combining nutrition education and food supplements for weight gain but not for increase in CD4(+) T cells. Conclusions A combination of nutrition education and food supplements provided to women living with HIV significantly increased weight and CD4(+) T cells, and such interventions can be integrated into HIV-care programs in low-income settings. A combination of nutrition education and food supplements delivered by community healthcare workers to women living with HIV significantly increased body weight of their dependent child regardless of human immunodeficiency virus (HIV)-infection status, and CD4(+) T-cell counts among their children living with HIV.

Leptin is derived in adipose tissue and circulates in the body to play a key role in metabolism and energy regulation. In non-psychiatric populations, there is evidence that leptin levels are associated with neurocognitive performance. The production of its circulating soluble binding receptor increases during exercise, which has been associated with neuroplasticity and memory enhancement. The soluble leptin receptor (SLR) is the main leptin binding protein in blood in humans, which serves as an antagonist of the transport of leptin to the brain. Cognitive deficits are well established in schizophrenia, even early in the course of the disorder. However, the question as to whether leptin plays a role in the well-observed cognitive deficits in schizophrenia is unanswered. We examined the relationship between soluble leptin receptor levels and cognitive deficits assessed with the MATRICS Consensus Cognitive Battery (MCCB) prior to participation in a longitudinal study of a combined cognitive training and aerobic exercise program intended to improve cognition and functional outcomes in these young-adult schizophrenia patients. The participants were 48 first-episode adult-onset schizophrenia patients treated at the UCLA Aftercare Research Program. Plasma soluble leptin R levels were measured by solid phase sandwich ELISA (D0BR00, R&D Systems) using a Molecular Devices SpectraMax M2 plate reader, and concentrations calculated using a 5-Parameter Logistic Nonlinear Regression Model (SoftMax Pro software). The MATRICS Consensus Cognitive Battery (MCCB) was administered contemporaneously with the plasma blood draw during study baseline, prior to the randomized treatment conditions. Higher plasma soluble leptin receptor levels were significantly correlated in cross-sectional analyses with lower MCCB overall composite cognitive index scores (r= -.33, P=.03). Post-hoc analyses of the individual MCCB domains found 4 of the 7 to be significantly correlated with leptin levels (Speed of Processing (r = -34, P=.02), Attention/Vigilance (r = -34, P=.02), Verbal Learning and Memory (r = -30, P=.04), and Social Cognition (r = -30, P=.04). Soluble leptin receptor levels were not, however, significantly associated Working Memory (r = -19, P=.20), Visual Learning and Memory (r = -.21, P=.15), or Reasoning and Problem Solving (r = -07, P=.63). These results indicate certain cognitive deficits after onset of schizophrenia are moderately associated with soluble leptin receptor levels, even early in the course of the disorder. The higher incidence of the leptin receptor levels is thought to have an impact on lower rates of bioavailability of leptin to cross the blood-brain barrier and thus lend to improved neuroplasticity. Weight very commonly increases over time on antipsychotic medication. These findings are consistent with the known association between weight, and in particular, adipose tissue, and leptin. The negative impact of weight increase on cognitive functioning is rarely considered in the treatment of schizophrenia. However, these findings suggest that they should be an area of concern. Future reports will examine the effects of an exercise intervention on both leptin and cognition.

Background: Women living with HIV (WLH) in rural communities face challenges to obtaining treatment and accurate disease-related information. Nutritional deficits exacerbate disease progression. Setting: WLH were recruited from primary health centers in rural India. Method: A quasi-experimental trial of a comprehensive Accredited Social Health Activist (Asha)-supported intervention compared 4 distinct Asha-based programs [(1) standard education (SE) alone; (2) nutrition education (+NE); (3) nutrition supplements (+NS); or (4) nutrition education and nutrition supplements (+NENS)] on key disease and nutrition-related outcomes [CD4 count, body mass index (BMI), serum albumin, and hemoglobin]. Assessments occurred at baseline, and months 6 (immediately after intervention), 12, and 18. Multilevel modeling examined effects of program (group) over time. Findings: Among 600 WLH enrolled (n = 150 per arm), mean age, CD4 count, and BMI (kg/m(2)) were 34.31, 447.42, and 20.09, respectively, at baseline. At 18-month follow-up, program 4 (+NENS) experienced greatest improvements in CD4 counts compared with program 1 (+SE) [adjusted difference = 223.81, 95% confidence interval (CI): 170.29 to 277.32]. For BMI, programs 3 (+NS; adjusted difference = 2.33, 95% CI: 1.39 to 3.26) and 4 (+NENS; adjusted difference = 2.14, 95% CI: 1.17 to 3.12) exhibited greater gains compared with program 1 (+SE). Programs 3 and 4 were not significantly different from each other (adjusted difference = -0.18, 95% CI: -1.12 to 0.76). Hemoglobin and serum albumin also improved over time; program 4 (+NENS) exhibited the greatest gains. Conclusions: A low-cost Asha-supported behavioral and nutritional intervention improved outcomes for WLH. Gains were sustained at 18-month follow-up. Similar approaches may help improve HIV and other infectious disease-related outcomes in vulnerable populations.

Spices were used as food preservatives prior to the advent of refrigeration, suggesting the possibility of effects on microbiota. Previous studies have shown prebiotic activities in animals and in vitro, but there has not been a demonstration of prebiotic or postbiotic effects at culinary doses in humans. In this randomized placebo-controlled study, we determined in twenty-nine healthy adults the effects on the gut microbiota of the consumption daily of capsules containing 5 g of mixed spices at culinary doses by comparison to a matched control group consuming a maltodextrin placebo capsule. The 16S ribosomal RNA sequencing data were used for microbial characterization. Spice consumption resulted in a significant reduction in Firmicutes abundance (p < 0.033) and a trend of enrichment in Bacteroidetes (p < 0.097) compared to placebo group. Twenty-six operational taxonomic units (OTUs) were different between the spice and placebo groups after intervention. Furthermore, there was a significant negative correlation between fecal short-chain fatty acid propionate concentration and Firmicutes abundance in spice intervention group (p < 0.04). The production of individual fecal short-chain fatty acid was not significantly changed by spice consumption in this study. Mixed spices consumption significantly modified gut microbiota, suggesting a prebiotic effect of spice consumption at culinary doses.

Cervical cancer is a leading cause of death among women in low- and middle-income countries, and women living with HIV are at high risk for cervical cancer. The objective of this study was to estimate the prevalence and correlates of cervical cancer and pre-cancer lesions and to examine cervical cancer knowledge among women living with HIV receiving antiretroviral therapy in rural Andhra Pradesh, India. We conducted cytology-based screening and administered a standardized questionnaire among 598 HIV-infected women. We found 5 (0.8%), 39 (6.5%), 29 (4.9%), and 4 (0.7%) had atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), and squamous cervical carcinoma (SCC), respectively. In multivariable logistic regression analysis, ASCUS/LSIL was independently associated with age >16 years old at first sexual encounter and smokeless tobacco use. We found no factors associated with HSIL/SCC. In total, 101 women (16.9%) had heard of cervical cancer and 28 (27.7%) of them correctly identified HIV infection as a risk factor. In light of the high prevalence of pre-cancer lesions and low level of cervical cancer knowledge in our study population, focused interventions are needed to improve cervical cancer literacy and prevention among rural women living with HIV.