Diabetes affects approximately 11% of Canadians and is linked to poor diet and an increasingly sedentary lifestyle. With growing demand for convenient, ready-to-eat foods and improved glycemic properties, this study evaluates postprandial blood glucose (BG) responses to alternative grain-based products, such as wild rice. Wild rice (WR), a traditional Indigenous food, contains more antioxidants, fibre, and protein, and less fat and calories than white or brown rice, suggesting potential benefits for appetite and BG control. This randomized crossover study examined postprandial BG, appetite, and palatability in 18 healthy adults after consumption of white bread (32 g, 66 g), brown rice (BR) cakes, and WR blend cakes (25% WR, 75% BR). BG responses varied by time and treatment (p < 0.05), but not between rice cakes. The 32 g white bread resulted in lower BG iAUC and appetite ratings, while the 66 g serving lowered BG only at 30 min.

Risk factors contributing to cardiovascular diseases (CVD) can be addressed through behavior modification, including changes in diet and physical activity. In 2021, The Wellness Institute (WI), located at Seven Oaks General Hospital, created a virtual cardiometabolic risk reduction program in response to COVID-19 pandemic public health restrictions, encompassing virtual health coaching and lifestyle education. The objective was to evaluate the acceptability, adherence, efficacy, and engagement of the WI online cardiometabolic and weight loss program. The study followed a mixed methods quasi-experimental design. A total of 93 participants enrolled. Quantitative measures including anthropometrics, blood chemistry, and lifestyle were assessed for changes via paired t tests at baseline and 16 weeks. Qualitatively, short answer questionnaires and three focus groups were completed to understand participants' experiences and program acceptability. We combined qualitative and quantitative data for analysis. Seventy-three participants (64 females, 87.7%) completed the final study visit (age 58 ± 11 years, weight 98 ± 20.9 kg). Of those, 98% attended all coaching sessions, would recommend the program, and reported the coaching sessions helped them stay motivated. A reduction in weight (5 ± 9 kg, p < 0.001), systolic blood pressure (6 ± 10 mmHg, p < 0.001), and diastolic blood pressure (4 ± 8 mmHg, p < 0.001) were observed. Lifestyle factors also improved, including increases in physical activity (p < 0.05). Most participants adhered to the program and found it acceptable. Completion was associated with an improvement in weight and blood pressure. These findings highlight the potential of virtual programming to contribute to improving lifestyle and health. Clinicaltrials.gov (ID# NCT04784624CT).

BACKGROUND:Metabolic acidosis is a common complication of kidney disease and can result in further disease progression. Alkali therapy has been used to treat metabolic acidosis for decades. However, some concerns have been raised regarding its safety and long-term tolerability. Existing data suggest that dietary interventions can be beneficial in the management of chronic kidney disease (CKD). This systematic review and meta-analysis aims to summarize findings from studies comparing dietary interventions with placebo/usual care/no treatment in the management of metabolic acidosis in outpatient adults with CKD. METHODS:Medline, Embase, Cochrane Central, CINAHL and Web of Science Core Collection were searched from inception to June 2022. Our primary outcome measure was change in serum bicarbonate. Any dietary intervention looking to manipulate dietary acid load was considered as an intervention. Data screening and extraction were performed by two independent reviewers. Random effects meta-analysis was performed to pool data. RESULTS:Dietary interventions resulted in clinically significant improvement in serum bicarbonate [mean difference 2.98 (95% confidence interval 0.77, 5.19); I2: 91%] and higher estimated glomerular filtration rate (eGFR) levels [mean difference 3.16 (95% confidence interval 0.24, 6.08); I2: 67%] compared with controls. Serum potassium, albumin and body mass index remained unchanged. Dietary interventions were reported to be safe. Subgroup analyses indicated a superiority of plant-based over non-plant-based interventions in the improvement of acid-base balance and eGFR; however, these findings are from low-quality and heterogenous studies. CONCLUSION:Our findings support the beneficial effects of dietary interventions aimed at reducing acid or adding base in the management of metabolic acidosis and kidney function in adults with CKD, with no adverse effects on serum potassium and nutritional status. Well-designed clinical trials looking at the treatment of metabolic acidosis with dietary interventions with a focus on adding base through fruit and vegetables are required.

Background To date, very little is known about the lived experiences of families impacted by chronic kidney disease (CKD), especially regarding the adaptive coping strategies these families use to successfully cope with the chronic stress they must face due to CKD. Methods An exploratory qualitative descriptive study was conducted by recruiting a sub-sample of adults with advanced CKD participating in the Canadian Frailty Observation and Interventions Trial (CanFIT) study and some of their caregivers. As part of this ongoing larger study, 12 adults with advanced CKD and seven of their caregivers ( N = 19) completed one focus group discussion that explored topics related to their unique lived experiences of individuals impacted by CKD. Narrative data was analyzed using a 3-step inductive thematic analysis process. Results Three themes that portray participants’ lived experiences were identified, including 1) experiencing chronic stress due to CKD; 2) coping successfully with the stress caused by CKD; and 3) recommendations to improve family well-being. Conclusions Social and health services for families impacted by CKD may be more effective in promoting the health, well-being, and quality of life of both adults with CKD and their caregivers if they acknowledge the chronic stressors these families face daily and provide support strategies that help them successfully cope with such stressors.

Abstract Background Public health nutrition recommendations and clinical dietary interventions emphasize eating healthy food at home, implicitly requiring household foodwork. Household foodwork is defined as the physical and mental tasks a household does for eating meals and snacks. Because no tools exist to measure it, how much time people spend doing household foodwork and the foodwork barriers they experience remain unknown. The objective of the present research was to develop the first stand-alone household foodwork assessment tool. Methods Through informal interviews with partners with lived experience, clinicians, and researchers, a literature review, a stakeholder meeting of advisors, and a two-round electronic Delphi process including face/content validation by expert panelists (n = 21), we developed the 10-question household foodwork interactional assessment questionnaire (FIA-Q10). An optional accompanying module was developed to collect self-identified demographic data to provide context for understanding how social-structural positionality factors may interact to influence foodwork. Results The FIA-Q10 assesses the domains of household composition, frequency of eating at home, special diets within a household, foodwork stress intensity, foodwork barriers, desired supports related to foodwork, and time use for foodwork. The FIA-Q10 measures time use for four subdomains of foodwork among individuals and their households: (1) planning, (2) getting, (3) preparing/cooking, and (4) cleaning up food. In the second Delphi round, the FIA-Q10 scored 95% for language appropriateness, 67% for visual appropriateness, 95% for relevance, 95% for representativeness, and 95% for distribution. Suggested improvements were implemented. All Delphi panelists (100%) reported they would consider using the FIA-Q10. Conclusions The FIA-Q10’s development is the first step towards a standardized assessment of foodwork, enabling examination of challenges in foodwork that may impact nutrition and nutrition equity. Future research will focus on FIA-Q10 validation in multiple populations.

Background: The effects of consuming hemp seed protein (HSP) as well as its hydrolysate-derived bioactive peptide (HSP+) on blood pressure (BP) has not, to our knowledge, been investigated in humans. Objectives: We aimed to investigate how consumption of HSP and its hydrolysate modulates 24-h systolic (SBP) and diastolic BP (DBP) and plasma biomarkers of BP compared with casein. Methods: In a double-blind, randomized, crossover design trial, 35 adults who had mild hypertension with SBP between 130 and 160 mmHg and DBP <110 mmHg were recruited. Participants were randomly assigned to varying sequences of 3 6-wk treatments, 50 g casein/d, 50 g HSP/d, or 45 g HSP plus 5 g HSP-derived bioactive peptides/d (HSP+), separated by a 2-wk washout period. Treatment effects were assessed with a linear mixed model with repeated measures. Results: Compared with casein, after HSP+ consumption, 24-h SBP and 24-h DBP decreased from 135.1 and 80.0 mmHg to 128.1 +/- 1.6 (P < 0.0001) and 76.0 +/- 1.4 mmHg (P < 0.0001), respectively, whereas these values were 133.5 +/- 1.6 and 78.9 +/- 1.4 mmHg after HSP consumption (P < 0.0001). There were no differences between the HSP and HSP+ consumption in plasma angiotensin-converting enzyme (ACE) activity, renin, or nitric oxide (NO) concentrations. However, these 2 treatments were able to lower both ACE and renin activities and raise NO concentration in plasma compared with casein. Conclusions: These results suggest that hemp protein consumption, as well as in combination with bioactive peptides, may have a role in the dietary management of hypertension.

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.

Abstract Background. Recent research has shown that the COVID-19 pandemic has caused a significant increase in physical and mental health problems reported by adults worldwide, which may be addressed by peer-led interventions that focus on promoting health and reducing isolation or loneliness. To date, evaluation studies that have assessed the effectiveness of these programs have shown mixed results. The Hans Kai trial described here aims to evaluate the efficacy of the peer-led health promotion Hans Kai program in supporting the health and wellbeing of its participants and investigate the experiences of the Hans Kai participants and facilitators.Methods. This research will involve a mixed methods trial combining an experimental component with a qualitative component. The experimental component will involve a randomized controlled trial (RCT) with an appropriate control group, randomization of participants to conditions, and a focus on the impact of the program on several health indicators. The qualitative component will investigate the experiences of program participants and facilitators to identify the main strengths and limitations of Hans Kai, uncover potential implementation issues, and elucidate the mechanisms through which the program works. The population of interest will include adults aged 18 + with or without chronic health conditions who are interested in taking control of their own health and improving their lifestyle. In the RCT, all outcomes of interest will be measured using a multi-method approach, involving self-report questionnaires and objective (direct) indicators. The qualitative component of the RCT will also involve a multi-method approach in which multiple qualitative data collection methods will be used to reach a deeper and more nuanced understanding of the program strengths, how the program works, and for which people it is more effective in promoting health and wellbeing. Adaptable components of the program will also be investigated and modified according to the feedback provided by the RCT participants.Discussion. The RCT findings will help support the further development and use of Hans Kai as well as other peer-led health promotion interventions.Trial Registration. United Stated Clinical Trial Registry Clinicaltrials.gov (registration# NCT03949725; Protocol version 2, June 22nd, 2022).

Background Metabolic acidosis is a common complication of chronic kidney disease (CKD) which can impair the function of multiple organs and accelerate CKD progression to kidney failure. The condition is usually treated with sodium bicarbonate (NaHCO3), which is an alkali salt. Although effective, alkali therapy has numerous side effects including gastric discomfort and bloating, with many people having difficulty tolerating higher doses. Research has shown that base producing fruit and vegetables may have the ability to increase serum bicarbonate concentrations similar to what is achieved with alkali therapy, but also provides added benefits. This systematic review aims to identify, critically-appraise and meta-analyze findings from randomized clinical trials (RCTs) comparing the effects of dietary interventions, including base producing fruit and vegetables, on serum bicarbonate concentrations as well as other factors related to kidney function in adult patients with CKD. Methods RCTs (in adult participants (18 years of age or older), with CKD will be included in the study. Studies will be excluded if participants are undergoing dialysis or have chronic obstructive pulmonary disease (COPD) requiring oxygen therapy. The interventions of interest are any dietary intervention aimed at manipulating dietary acid load, compared with usual care, no treatment or placebo. Our primary outcome measure will be changes in serum bicarbonate concentration, while other parameters related to kidney function will be considered as secondary outcomes. A knowledge synthesis librarian developed a literature search strategy for MEDLINE (Ovid). The search strategy was then adjusted for use in Cochrane Central (Ovid), Embase (Ovid), Web of Science Core Collection (Clarivate) and CINAHL (EBSCO). Two independent reviewers will select studies for eligibility in Covidence and data extraction will be conducted using a custom MS Excel worksheet. We are planning to perform meta-analysis wherever possible using random effects model. Standardized mean difference (95% confidence interval) and risk ratio will be used to present continuous and dichotomous data, respectively. The assessment of publication bias will be performed using funnel plots and Egger’s regression test while I2 statistics will be used to assess heterogeneity. We are planning to perform subgroup analysis to deal with potential heterogeneity. Discussion The results of this systematic review and meta-analysis will be useful in designing effective dietary strategies for the management of CKD-related metabolic acidosis. Systematic review registration The present systematic review is registered in International Prospective Register of Systematic Reviews (PROSPERO) (, registration ID: CRD42022342612). ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors * BUN : Blood Urea Nitrogen CKD : Chronic Kidney Disease COPD : Chronic Obstructive Pulmonary Disease CVD : Cardiovascular Disease GFR : Glomerular Filtration Rate KDIGO : Kidney Disease Improving Global Outcomes PRISMA-P : Preferred Reporting Items for Systematic review and Meta-Analysis Protocols PROSPERO : Prospective Register of Systematic Reviews RCT : Randomized Clinical Trial

Background A significant proportion of Canadian adults is impacted by chronic noncommunicable diseases. These conditions may be improved by peer-led health promotion interventions that target modifiable risk factors; however, to date, there is mixed evidence on the effectiveness of these interventions. Unlike other health promotion programs, Hans Kai is grounded in a holistic model of health that simultaneously addresses multiple determinants of health at different levels of human ecology. In Hans Kai, a set of informational sessions that are delivered in a group setting by healthcare professionals are followed by regular peer-led group meetings in a self-governed support group setting that is designed to promote implementation of newly learned health competences. The Hans Kai trial described here aims to evaluate the efficacy of the Hans Kai program in promoting the health and wellbeing of its participants and investigate the experiences of the Hans Kai participants and facilitators. Methods This research will involve a mixed methods trial combining an experimental component with a qualitative component. The experimental component will involve a 6-month 2-group parallel superiority randomized controlled trial (RCT) in which 105 participants will be randomly assigned to two conditions, an intervention group ( n = 70) that will participate in the Hans Kai program and a control group ( n = 35) that will have access to standard care using a computer-generated random sequence; blinding will not occur. The RCT will test the impact of the program on several health outcomes and will be followed by a 12–18-month observational follow-up study that will provide data on the long-term durability of the 6-month RCT health outcomes. The qualitative component will investigate the experiences of program participants ( n = 30) and facilitators ( n = 15) to identify the main strengths and limitations of Hans Kai, uncover potential implementation issues, and elucidate the mechanisms through which the program works. The population of interest will include adults aged 18 + with or without chronic health conditions who self-report an interest in taking control of their own health and improving their lifestyle. In the RCT, all outcomes of interest will be measured using a multi-method approach, involving self-report questionnaires and objective indicators, and within-subject mean changes in outcomes over time between the two groups will be compared to address the RCT aims. Similarly, in the qualitative component, a multi-method approach, involving in-depth individual interviews, photovoice, and online surveys, will be used to reach a deeper and more nuanced understanding of the program strengths, how the program works, and for which people it is more effective. Adaptable components of the program will also be investigated and modified according to the feedback provided by the RCT participants. In the mixed methods integration of evidence, the qualitative findings will be used to explain the quantitative RCT results. Discussion The RCT findings will help support the further development and use of Hans Kai as well as other peer-led health promotion interventions. Trial registration United Stated Clinical Trial Registry ClinicalTrials.gov (registration# NCT03949725; Protocol version 2, June 22nd, 2022).

Abstract Background Potassium regulation in the body is primarily done in the kidney. In addition to this, hyperkalemia, occurs in approximately 10% of individuals with chronic kidney disease (CKD) and is associated with elevated all-cause mortality. Individuals with CKD are often told to restrict dietary potassium (K), however, this recommendation is based on low quality evidence. Reduced quality of life, limited dietary choices and nutritional deficiencies are all potential negative outcomes that may occur when restricting dietary K in CKD patients. There is a need for randomized controlled trials investigating the impact of dietary K modification on serum K concentrations in people with CKD. Methods A randomized 2-period crossover design comparing a liberalized K fruit and vegetable diet where participants will be required to consume ~ 3500 mg of dietary K daily, to a standard K restricted diet where participants will be required to consume < 2000 mg of dietary K daily. All participants will begin on a liberalized K run-in period for 2 weeks where they will receive fruit and vegetables home deliveries and for safety will have clinical chemistry, including serum potassium measurements taken after 1 week. Participants will then be randomized into either liberalized K or standard K diet for six weeks and then crossover to the other intervention for another 6 weeks after a 2-week washout period. Discussion 30 male and female CKD outpatients, ≥ 18 years of age, who have an estimated glomerular filtration rate (eGFR) between 15 and 45 ml/min/1.73m2 and serum K between 4.5 and 5.5 mEq/L. This design would have greater than 80% power to detect a difference of 0.35 mEq/L serum K between groups. Anthropometric measurements, clinical chemistry, dietary recalls, physical function assessments, as well as a quality of life assessments will also be measured in this trial. These findings will provide high quality evidence for, or against, recommendations for dietary K restriction in individuals living with CKD. The removal of K restriction could provide individuals living with CKD more dietary choice leading to improved dietary status and quality of life. Trial Registration This trial has received approval from the University of Manitoba Research Ethics board (HS25191 (B2021:104)).

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.

Background: People living with chronic kidney disease (CKD) have identified diet as an important aspect of their life and care. Understanding current consumption patterns in this population, and how they relate to patient perspectives of dietary recommendations, may help identify and design potential dietary intervention strategies in CKD. Objective: To investigate the dietary intake patterns of people with advanced-stage CKD, as well as subjective perspectives regarding dietary recommendations from participants and their caregivers. Design: Mixed-methods study with a sequential explanatory design. Setting: Manitoba, Canada. Participants: Individuals with late-stage CKD (CKD stages G4-G5, including dialysis) participating in the Canadian Frailty Observation and Interventions Trial (CanFIT). Methods: First, quantitative data were collected via a cross-sectional dietary assessment, using three 24-hour dietary recalls, a 36-question short diet questionnaire (SDQ), and a Nutrition Quality of Life (NQoL) tool (n = 59). Second, qualitative data were collected during 2 focus groups ( n 1 = 12 and n 2 = 7) held with a subsample of individuals who had completed the dietary surveys, along with their caregivers. Focus groups explored topics related to diet and CKD; transcribed data were analyzed thematically. In the interpretation stage, the qualitative findings were combined with the quantitative results to help explain the latter and reach a deeper understanding of the subjective experiences of adults with CKD. Results: Quantitatively, nearly all (48/51; 94%) participants (mean age 70.8 ± 10.8 years) reported energy intakes below recommendations and most (86%) did not achieve recommended fiber intake. In addition, 15/21 (71%) of patients on dialysis had low protein intake. Qualitatively, 2 themes were identified: (1) Lacking/Needing dietary guidance—incomplete “information overload,” and (2) Experiencing difficulty in adapting to restrictions. Within the former theme, participants spoke of getting too much information at once, often at the wrong time. Within the latter theme, participants spoke of a loss of appetite, and cheating on their dietary recommendations. Limitations: Potential recall bias recalling dietary patterns, small sample size limiting generalizability, self-selection bias. Conclusion: Despite the reported lifestyle changes made by individuals with CKD, which negatively impacted their lives, many had suboptimal nutrition, especially in terms of energy and fiber. In addition, those on dialysis were not eating enough protein, which could be due to changing dietary recommendations as CKD progresses. Qualitative findings provided additional insight into how requisite CKD-dietary changes were perceived and how participants coped with these changes. The timing and delivery of the dietary education within CKD care in Manitoba may not be working for people with CKD as they progress through the disease.

Background: Resistant starches (RSs) are not digested by human digestive enzymes and pass through the upper digestive tract to become substrates for colonic bacteria. Resistant starch supplementation has shown promising results in altering the microbiota of animal models of chronic kidney disease (CKD). Resistant starch consumption may influence the production of uremic toxins in CKD. Objective: To conduct a systematic review to determine whether the consumption of RS reduces the progression of kidney disease in adult patients with CKD. Design: We included randomized controlled trials comparing RS supplementation to placebo, no treatment, or standard care. Cochrane Central, Embase, MEDLINE, Web of Science, and CINAHL databases were searched. There was no limitation on publication date, but only English manuscripts were included. The search was conducted in July 2020. Patients: Adult outpatient populations with CKD, using any recognized diagnostic criteria. Measurements: The primary outcome was change in glomerular filtration rate (GFR) from baseline through the end of the trial in patients not on dialysis; secondary outcomes included change in uremic toxin concentrations (p-cresol/p-cresyl sulfate [p-CS], indoxyl sulfate [IS]) and inflammatory markers (tumor necrosis factor alpha [TNF-α], C-reactive protein [CRP], interleukin 6 [IL-6]) from baseline through the end of the trial, and changes in self-reported symptom scores. Methods: The Cochrane Collaboration Risk of Bias tool was used to assess risk of bias in included studies. The systematic review results are reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Results: We identified 4 unique studies, reported in 9 publications that met our inclusion criteria, including a total of 215 enrolled participants. Results were calculated using data from the longest reported follow-up time. The primary outcome of changes in kidney function markers was only studied in 1 trial; this trial reported an increase in creatinine and a decrease in blood urea nitrogen; no changes in GFR were reported. A review of the secondary outcomes showed an overall decline in IS, TNF-α, and IL-6, in RS groups, but with mixed results in p-CS and CRP/high-sensitivity CRP. Safety data showed that RS was well tolerated with no reports of excessive side effects. Limitations: We determined a meta-analysis was not feasible due to clinical heterogeneity between study populations and differences in reported outcomes in the included studies. Conclusion: There is limited and inconsistent evidence on the impact of RS in adult patients with CKD. Further research is needed to determine the safety and efficacy of RS supplementation in this population.

Research indicates that the post-prandial glycemic benefits of consuming whole pulses are retained when consumed in a mixed meal, pureed, and ground into flours. The glycemic benefits of pulse flours when incorporated into extruded products are unknown. In a randomized, repeated-measures crossover study, adults (n = 26) consumed extruded corn snacks made with the addition of 40% pulse flour from either: whole yellow pea, split yellow pea, green lentil, chickpea, or pinto bean. The control snack was 100% corn. Food intake was measured with an ad libitum meal consumed at 120 min. Blood glucose (BG), insulin and appetite were measured regularly before (pre-meal, 0-120 min) and after (post-meal, 140-200 min) the meal. Pinto bean and chickpea snacks led to lower (p<0.05) pre-meal BG incremental area under the curve (iAUC), compared with control, whole yellow pea and green lentil snacks. Pinto bean snack also led to lower (pre-meal BG (p<0.05) and insulin (p<0.05) iAUC compared with control, whole yellow pea, and split yellow pea snacks. There were no differences in food intake or appetite. These findings indicate that effects of replacing corn with pulse flours in extruded snacks on BG, and insulin are dependent on pulse type. ClinicalTrials.gov Identifier: NCT02402504. Registered on 30 March 2015. Novelty bullets: The incorporation of pinto bean and chickpea flour into extruded corn snacks improves postprandial glycemic response. Pulse containing snacks were equally as palatable as the corn snacks. The incorporation of pulses into corn snacks increased the protein and fibre content.

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.

Oat has procured its acclaim as a health promoting food partially due to its positive effect on glucose control. It has been demonstrated that oat β-glucan can interfere with postprandial glucose response. A large majority of this action is attributed to the increase in viscosity due to the β-glucan content in oat foods. While it is known that an increase in viscosity due to higher molecular weight of β-glucan can improve its glycemic effects, it is not known if an increase in viscosity attained by processing variables can further enhance the positive effect of oat on glucose control. In the current study we have examined the effect of kilning, tempering, microwaving, cooking, soaking and flaking on oat β-glucan viscosity. An acute randomized crossover clinical trial was also conducted to test oatmeal products containing low, medium and high β-glucan viscosity for their effect on postprandial glycemic response. Results from the processing experiments demonstrate that kilned samples, when tempered to 25% moisture and microwaved for 2 minutes, can produce much higher final viscosity compared to other samples with similar β-glucan content, molecular weight and solubility. However, results from the clinical trial show that the increase in the viscosity of the oat β-glucan attained through processing in this study did not have any effect on postprandial glucose control.

Dairy snacks are available in various physical forms and their consumption is linked to improved metabolic health. The objective of this study was to determine the effect of dairy snacks of different physical forms on short-term food intake (FI), subjective appetite, and the stress hormone, cortisol, in children. Following a repeated-measures crossover design, 40 children aged 9-14 years randomly consumed 1 of 5 isoenergetic (180 kcal) snacks per study session. These snacks included solid (potato chips, cookies, and cheese), semi-solid (Greek yogurt), and fluid (2% fat milk) snacks. FI was measured 120 min after snack consumption. Subjective appetite was measured at 0 (immediately before the snack), 15, 30, 45, 60, 90, and 120 min. Salivary cortisol (n = 18) was measured after the Greek yogurt and cookie snacks at 0, 30, 60, 90, and 120 min. FI did not differ between snacks (P = 0.15). The Greek yogurt (P < 0.0001) and cheese (P = 0.0009) snacks reduced average appetite compared with the 2% fat milk snack. Salivary cortisol levels were not affected by snack (P = 0.84). This study demonstrates that dairy snacks are as effective as other popular snacks at influencing subsequent FI. However, solid and semi-solid dairy snacks are more effective at repressing subjective appetite than a fluid dairy snack. Registered at ClinicalTrials.gov (NCT02484625). Novelty: Milk, Greek yogurt and cheese have a similar effect on short-term food intake in children as popular potato chips and cookie snacks. Solid, semi-solid and liquid snacks have a similar effect on short-term food intake in children.