Background:Individuals with chronic kidney disease (CKD) can develop metabolic acidosis which, in turn, is associated with faster progression of CKD and an increased need for dialysis. Oral sodium bicarbonate (the current standard of care therapy for metabolic acidosis) is poorly tolerated leading to low adherence. Base-producing or alkalizing Fruit and vegetables have potential as an alternative treatment for metabolic acidosis as they have been shown to reduce acid load arising from the diet.Objective:This trial will evaluate the feasibility of providing base-producing fruit and vegetables as a dietary treatment for metabolic acidosis, compared with oral sodium bicarbonate.Design:A 2-arm, open-label, dual-center, randomized controlled feasibility trial.Setting:Two Canadian sites: a nephrology clinic in Winnipeg, Manitoba, and a nephrology clinic in Halifax, Nova Scotia.Participants:Adult participants with G3-G5 CKD and metabolic acidosis.Measurements:Participants will undergo baseline measurements and attend 5 study visits over 12 months at which they will have a measurement of feasibility criteria as well as blood pressure, blood and urine biochemistry, 5-repetition chair stand test (STS5), and questionnaires to assess quality of life and symptoms. Furthermore, participants fill out Automated Self-Administered 24-hour recalls (ASA-24) in the beginning, middle, and end of trial.Methods:A total of 40 eligible participants will be randomized 1:1 to either base-producing fruit and vegetables (experimental) group or sodium bicarbonate (control) group, beginning from a daily dose of 1500 mg.Limitations:Using self-administered dietary assessments, lack of supervision over the consumption of study treatments and the possible disappointment of the control group for not receiving fruit and vegetables would be considered as limitations for this study. However, we are planning to undertake proper practices to overcome the possible limitations. These practices are discussed throughout the article in detail.Conclusions:This study will generate data on base-producing fruit and vegetables consumption as a dietary treatment for metabolic acidosis in CKD. The data will be used to design a future multi-center trial looking at slowing CKD progression in people with metabolic acidosis.Trial Registration:This study is registered on clinicaltrials.gov with the identifier NCT05113641.

IntroductionWith the prevalence of obesity increasing, many weight-loss programs were created to aid in combating the trend. The Weight Loss Clinic (WLC) was created to provide personalized support for lifestyle changes using a multidisciplinary team with medical oversight. This study evaluated the clinically-managed weight loss program at the Wellness Institute.MethodsThis was a prospective evaluation of a newly established program between January 2019–August 2020. Participants who entered the weight loss program were approached to learn about the evaluation. A total of 41 participants were included. The primary outcomes included changes in body weight and achievement of more than 5% initial body weight loss. Outcome measures were collected pre-and post-program and the data was analyzed through paired t-tests on R studio.ResultsGreater body weight-loss was seen in completers pre-COVID-19 compared to those who completed during the pandemic (Mean, ±SD; 7.51 ± 6.24 kg n = 13 p < 0.001 vs. 1.75 ± 4.43 kg n = 9, p = 0.02). Completers pre-COVID-19 demonstrated improvements in waist circumference, Framingham risk score, blood pressure, hemoglobin A1C, and body fat percentage.Conclusions and implicationsThough the sample size was small to show definitve evidence, the results may suggest the program worked well prior to the pandemic but the pandemic created barriers to weight-loss for participants.

An unhealthy diet is a critical modifiable risk factor for chronic diseases.The Diabetes Canada Clinical Practice (DCCP) Guidelines encourage healthy eating by recommending consumption of certain foods or nutrients (e.g., fruits and vegetables, fibre), while limiting the intake of others (e.g., high salt/sugar foods).However, many consumers find it challenging to interpret these recommendations.Nutrient profiling (NP) models are interpretative tools that set nutrient thresholds aligned with dietary guidelines, which can be used to guide consumers towards healthier food choices.To develop a NP model based on the healthy eating recommendations in the DCCP guidelines.A systematic methodology to assess foods in alignment with DCCP guidelines was developed, using the University of Toronto Food Label Information Program database 2017 (n=17,360 packaged foods and beverages).The DCCP-NP model categorizes individual food and beverage items into two categories (i.e., 'in alignment' and 'not in alignment') with the guidelines, based on specific nutrient thresholds (i.e., high-sodium, high-fat, highsugar) or recommended food groups (e.g., whole grains).Products were categorized according to Health Canada's Table of Reference Amounts.The DCCP-NP model requires a 'pass' on all four steps to be considered 'in alignment' with this model: 1) exclude processed product (i.e., choosing whole and less refined foods); 2) lean animal protein (≤10% of total fat) and more vegetable protein; 3) low glycemic-index foods; and 4) foods without excessive saturated fats (≤9% daily value).Overall, 10% of packaged foods were 'in alignment' the DCCP-NP.Specifically, 77% of nuts/seeds, 46% of legumes, 31% of cereals, 23% of vegetables 17% of fruits, 13% of eggs, 12% of beverages, 11% of marine, 3% of dairy, 3% of potatoes, 2% of salads and 1% of processed meat were 'in alignment' with the DCCP-NP.This study developed the first NP model specific for an at-risk population.This indicates that very few packaged foods and beverages meet the standards in the DCCP guidelines, suggesting an overall low nutritional quality of the packaged food supply.People with diabetes can choose very few packaged foods and still follow the DCCP guidelines.

Background Obesity has become a major driver in the burden of chronic diseases. The Canadian Clinical Practice Guidelines recommend a lifestyle intervention for the management and prevention of obesity. This includes behavior modification, dietary counseling, and physical activity. With the market overwhelmed with weight loss programs, the majority are focused on low-calorie diets and general recommendations for exercise. Most are not personalized and are not administered by healthcare professionals. An interdisciplinary team of highly trained healthcare professionals has the ability to provide medically sound and safe advice in all aspects of an individuals’ life, such as lifestyle, sleep, mental health, and behaviors. A clinically managed weight loss program is defined as a team including a dietitian, exercise professional, psychologist, and/or physician or nurse practitioner oversight. With limiting results in the literature regarding clinically managed weight loss programs, it is difficult to conclude whether it may be effective. Therefore, the objective of this systematic review is to assess clinically managed weight loss programs, with a physician or nurse practitioner oversight in comparison with non-clinically managed weight loss programs with no physician oversight or nurse practitioner oversight in adults who are living with overweight or obesity. Methods A literature search will be executed by a knowledge synthesis librarian on MEDLINE, Cochrane Central, Embase, PsycINFO, and CINAHL. The data collected will be extracted, stored, and managed in MS Excel 2016. The extraction of the data will include study details, study population details, health team details, intervention details, and outcome details. Discussion The prevalence of obesity has been increasing throughout the decades. The results from this systematic review may aid in recommending a more clinically safe weight loss program for those who struggle with overweight or obesity. Systematic review registration PROSPERO CRD42020170014

Background: Obesity is a worldwide problem. With the prevalence of obesity increasing, many weight loss programs have been created to aid in the epidemic. Based on the Canadian Clinical Practice Guidelines for obesity management, a weight loss program should involve nutrition, exercise, and psychological components. The Wellness Institute (WI) is a non-profit organization that operates as a medical fitness facility and created the Weight Loss Clinic (WLC) to provide personalized support for individuals based on diet, exercise, and lifestyle, targeting all the core components required for a weight loss program. Since the weight loss industry is dominated by non-evidence-based programs with majority focused on calorie-reduced diets, there is a gap in research on weight loss programs with an exercise and psychological component. Thus, the aim of this pilot study is to collect data on the effectiveness of the comprehensive evidence-based clinically managed weight loss program offered at the WI for future research applications. Materials and Methods : The WLC is a 17-week program during which each participant will progress depending on their personal goals. Population: Inclusion criteria are individuals over the age of 18 years old, are overweight or obese (BMI > 25 kg/m 2 ), have been told by a physician or primary care provider to lose weight, who are concerned with weight and may have other health problems, and have tried to lose weight in the past but have been unsuccessful at maintaining weight loss. Outcome Measures: Outcome measures include: anthropometric measurements, body composition, cardiovascular assessment, clinical chemistry, physical activity assessment, nutrition assessment, behaviour change assessment, and health screenings. Ethics Approval: This evaluation received approval from the University of Manitoba Health Research Ethics Board (Ethics # HS22267 (H2018:401)). Clinicaltrials.gov ID: NCT04290910