News and Articles on Health. Medical research topics.

Study Medication and Dosage
After a 1-week run-in phase, subjects ate 20 grams of one of two forms of high-polyphenol dark chocolate daily for 2 weeks, after which they crossed over to the next intervention separated by a 1-week washout period. One of the chocolates contained 500 mg of polyphenols per serving, the other 1,000 mg.

Outcome Measures
Changes in fasting blood sugar, blood chemistry, cortisol/cortisone ratio, and blood pressure were tracked.

Key Findings
Both doses, the 500 mg and the 1,000 mg/day of polyphenols, were equally effective at reduced fasting blood glucose levels and systolic and diastolic blood pressure. This suggests a possible saturation effect with increasing doses of polyphenols. A trend towards a reduction in urinary free cortisone levels was seen, but it did not reach statistical significance. Cholesterol levels did not change.

The fact that the decrease in free cortisol did not reach statistical significance may be related to a number of factors: Sample size was small, measuring techniques could have been more complete, and all but one of the subjects had peripheral rather than abdominal obesity.

Practice Implications
The present study tells us that eating dark chocolate with 500 mg polyphenol is as effective at reducing fasting blood sugar levels in overweight or obese individuals as a dose twice as large. Obesity is associated with insulin resistance and elevated blood pressure. The authors of this study had hoped to establish a causal link to improved cortisol levels to explain some of these changes.

This study, although suggestive of a connection between chocolate and cortisol, was unable to prove a connection; though these authors did not prove it, chocolate might someday become a treatment for metabolic syndrome.

This study, although suggestive of a connection between chocolate and cortisol, was unable to prove a connection. Though these authors did not prove it, chocolate might someday become a treatment for metabolic syndrome. This is just one in a fast growing series of papers telling us that the poyphenols in chocolate are beneficial to health. Earlier papers by Grassi et al and Taubert et al have already demonstrated decreases in fasting blood sugar and blood pressure using 500 mg/day polyphenol doses over periods of several weeks.

The caveat in interpreting these data is that these researchers have not used “over the counter” chocolate but instead selected chocolates especially manufactured to contain much higher than usual polyphenol levels. In this particular study the chocolate was made by Barry Callebaut, a Belgium company, and manufactured using the Acticoa process, which preserves the cocoa bean flavanols that are typically lost during processing. Analysis and comparison of 20 grams of 70% cocoa solid chocolate made through the Acticoa process with a 70% cocoa solid chocolate made by conventional manufacturing processes found that the Acticoa chocolate had more than 600 mg flavanols, while the standard process had less than 30 mg.4 The chocolate used in this research is about 20 times as strong as what we might buy as ‘good’ chocolate (the brand used in this and several other recent studies is not yet sold in the United States).

One of the pleasures of winter in New England is its revelation of the wonder of my dog’s nose. During our walks at any other time of year, with her nose pressed to the ground, it appears as if my dog is enthusiastically, albeit randomly, on the hunt for something—anything—that she hasn’t found yet. However, in the winter, those apparently random sniffs are transformed before my eyes into a precise tracing of an animal’s trail. With the help of tracks left in the snow, I can now see the trail that my dog’s nose is leading her along. It amazes me how accurate she is in staying on the trail, and I know that, with enough time, she could easily follow the trail all the way to its source.

Dietary supplement products leave their own trails; however, I think my dog would meet her match in trying to follow these paths. For one thing, the trails leading to dietary supplements start in all parts of the globe. For another, the trails branch and intersect their way to the final product. There are very few linear, entirely transparent paths from starting material to finished product. As ingredients work their way from their original source to the final product, they can be mixed with the same ingredient from other parts of the world. The ingredients, while the same by name, may have different histories of cultivation, processing, extraction, and testing. The globalization of the dietary supplement industry along with the increasing demand on ingredients has turned the traceability into a veritable maze.

The globalization of the dietary supplement industry along with the increasing demand on ingredients has turned the traceability into a veritable maze.

In the midst of this layered and complex supply chain, manufacturers are left with the formidable challenge of identifying safe and pure ingredients that they can reliably utilize in their products. Thus, manufacturers source every ingredient with a myriad of considerations in mind. These considerations include things like ingredient price, availability, quality, processing, and traceability. A good manufacturer will set specifications for each of these areas and will use these specifications to determine from whom to purchase their ingredients. While this may seem challenging enough, to make matters even more complicated, for many ingredients there are multiple layers of supply. An ingredient may actually be sourced from multiple suppliers around the globe, and then mixed and sold to the manufacturer by a broker of that ingredient. This layering of suppliers can make it very challenging to identify the traceability of raw materials. Ultimately, manufacturers have three choices. They can decide to test every receipt of raw material for all known quality attributes (ie, identity, potency, known possible contaminants); they can vertically integrate, taking responsibility for all of their products’ ingredients from seed to bottle; or they can qualify their raw material suppliers to be reliable purveyors of acceptable-quality materials and do skip-lot testing verification. The majority of dietary supplement manufacturers fall into this last category.

It is clear that Gaby has taught many clinicians through the years and understands how to distill information, whether from trials or molecular biology, into useful patient care-oriented take home points.

The three of us also agreed that this would be the go-to textbook for that moment when you realize you are about to see a patient with a condition you haven’t thought about in many years. Each condition begins with a short summary, then goes into clinical considerations divided into three sections: Dietary Factors, Nutritional Supplements, and Other Treatments. There are references throughout the text, whether from clinical trials or case reports of therapeutic agents.

Let’s look at chapter 306 on Beta Thalassemia as a sample chapter. First, under Dietary Factors, we find that patients with this condition who drank black tea with their meals reduced their iron absorption by 41-95%, a desirable effect given the propensity for iron overload with blood transfusions that often accompany the disease. Moving on to Nutritional Supplements, considerations include folic acid, L-carnitine, magnesium, vitamin E, B6, riboflavin, vitamin C, and zinc. Each of these supplements has multiple lines of evidence regarding possible therapeutic usage. In the case of B6, Gaby cites evidence suggesting the conversion of pyridoxine to pyridoxal-5-phosphate (P5P) is impaired. Both genetics and a deficiency in riboflavin, the cofactor for the rate-limiting enzyme pyridoxine phosphate oxidase, are implicated in the impaired metabolism. Regardless of the cause, he suggests one consider supplementing B6 specifically in the form of P5P in this population, along with riboflavin. In the same chapter, under the heading Other Treatments, he cites a small trial of wheat grass juice. Consumption of 100 ml of wheat grass juice daily decreased transfusion requirements by 25% in more than 50% of study subjects. This chapter is an example of how the evidence is woven together with a thoughtful consideration of what has possible therapeutic benefit without risk to the patient. It is this perspective, from a long-time practicing clinician, that is infused throughout the book, bringing with it a clinical utility that busy practitioners can appreciate.

The shortfalls of the book were few and none of any substantial note. Absent for each condition was a thorough review of the progression and clinical presentation. Of course, this information can be gotten from reliable references such as Cecil’s Textbook of Medicine or the Merck Manual. As Gaby admits, this textbook was never intended to be exhaustive, but to be a review of therapeutic agents and a compilation of the must-know natural medicine interventions for given conditions. Certainly, at the size and weight of the current volume, any additions to the chapters would warrant at least a two-volume set. From clinicians who are just graduating to those that have been out long enough to forget a few things, this book is an invaluable resource for any practitioner who uses natural medicine in his or her practice, regardless of degree or years in practice.

When Alan Gaby’s Nutritional Medicine textbook arrived in the mail, my first thought was, “This book weighs a lot.” I walked over and placed it on the office scale. It weighs in at just over 8 pounds, 6 ounces. “Dr. Gaby birthed a textbook,” I thought to myself. As I read the textbook, I realized that the analogy of birth was not far from the truth. The information contained in its pages is a culmination of evidence, anecdotal cases, and Gaby’s own clinical experience. This seemed to be a rare deviation for a textbook, most of which use only staid information cited from medical literature.

The reason for this departure from the norm is best explained by Gaby himself in the Introduction to Therapeutic Agents: “Because of the low risk of adverse effects and the relatively low cost of most of the therapeutic agents discussed in this book, I believe the reader should be aware of all the potentially useful clinical applications, not just those that are supported by the highest levels of evidence.” (p51) In addition to his experience, the textbook has Dr. Gaby’s immutable writing style throughout: no words are superfluous, there are no irrelevant tangents to distract, and it is at all times obvious that the intended audience is practicing clinicians.

The textbook is divided into 3 parts. The first is a short section (49 pages) titled “Fundamentals of Nutritional Medicine,” covering topics such as food additives and food storage and cooking. Part 2, titled “Therapeutic Agents” is 185 pages divided into 4 sections: Vitamins, Minerals, Amino Acids, and Other Therapeutic Agents. Then comes the vast majority of the book: “Medical Conditions.” Beginning with chapter 72 on page 239, each chapter explores a different condition. 263 conditions later, this section ends at chapter 335, page 1272. The next section, called “Modalities,” reviews many novel pieces of clinically useful information to address symptoms that may arise from conventional interventions such as anesthesia and radiation. Finally, the last chapter is a concise overview of drug-nutrient interactions, with an emphasis on drug-nutrient depletions. Without the index or the appendix on Food Elimination, the text of this book spans a total of 1322 pages. I cannot recall ever having read a textbook of such breadth that was authored by one person. Certainly, there have been texts with a single author’s name attributed, but in truth that person is generally the editor with many authors contributing. Having written a fair amount myself, I am left in awe of the gargantuan task Gaby has completed.

What is the clinical utility of Nutritional Medicine? I asked two other practicing naturopathic physicians to use the textbook and give me feedback regarding its strengths and weaknesses. Teresa Silliman, ND, has been practicing for more than 10 years and has an emphasis in women’s health. Catherine Clinton, ND, is a more recent graduate whose interests are autoimmune disease and gastrointestinal complaints. My specialty is naturopathic oncology, and I have seen oncology patients exclusively for many years now. Interestingly, despite our differing knowledge bases, many of our observations about the book were in lock step. Namely, we were impressed by Gaby’s approachable and easy-to-understand writing style, the well organized chapters and index, and the impressive number of references, including some too obscure to find through mere internet searching. Of course, our commonality is that we are all clinicians. It is clear that Gaby has taught many clinicians through the years and understands how to distill information, whether from trials or molecular biology, into useful patient care-oriented take home points.

The potential health implications caused by the nuclear disaster in Japan may extend beyond Japanese citizens. The wind and water currents have carried radioactive materials to many parts of the world. Furthermore, concerns are arising regarding consumable goods exported from Japan. Included in this category are dietary supplement ingredients and their finished products. In this issue, you will find several commentaries from manufacturers about some of the proactive steps that they are taking to ensure the continued safety of their products. These manufacturers, along with other dietary supplement manufacturers, are to be lauded for their timely and quick accountability to this situation. On March 25, 2011, the US Food and Drug Administration (FDA) began detaining all shipments of FDA-regulated products imported from the Japanese prefectures (sub-national jurisdictions) that are in the closest proximity to the Fukushima Daiichi nuclear plant, specifically Fukushima, Gunma Ibaraki, and Tochigi. This is a result of the fact that in mid-March, the Japanese Ministry of Health, Labour and Welfare confirmed the presence of radioactive iodine contamination in dairy and fresh produce from these regions. The FDA’s Import Alert further explains that radioactive iodine has a short half-life of about 8 days and naturally decays, but does pose risk to human health if contaminated food is absorbed into the body prior to its decay. In addition to produce, other at-risk Japanese exports, such as seafood, are being tested by the FDA prior to release into the US market. It is not clear at this time what degree of risk is represented by dietary supplements with ingredients sourced from Japan. One would presume that there is risk associated with products containing raw materials sourced from, or processed in, the prefectures with proximity to the nuclear power plant. Michael McGuffin, president of the American Herbal Products Association (AHPA), recently released this statement: “AHPA will keep its membership apprised of any additional information of interest that may impact raw materials and ingredients, supply chains, distribution, and members’ ability to market products.” This statement summarizes the current state of watchfulness and caution. Online pharmacy viagra Emerson Ecologics* is in the process of soliciting information from each of its suppliers any raw materials that present risk of radioactive contamination and how they are mitigating this risk. Thus far, several companies whose operations are based in Japan have noted that their manufacturing facilities are located in the southern region of Japan, hundreds of miles away from the nuclear reactors, and areas which have not evidenced significant radioactive contamination. These companies continue to monitor the situation. Other companies with raw materials at risk for contamination are subjecting their raw materials to testing. Testing for radioactive iodine and cesium can be done by FDA-certified methodology. This test analyzes Cesium-134/137 and Iodine-131 by means of gamma-spectrometry using a Germanium-detector. Sample quantities of about 1 kg are typically required which effectively restricts the use of this test to raw materials as opposed to finished products. One qualified independent analytical laboratory charges $160 for this test. Apcalis sx 20mg At this point in time, the radiation risk to dietary supplements appears to be minimal. That being said, continued vigilance is required on the part of dietary supplement manufacturers to ensure that is parameter of supplement safety remains a non-issue for consumers.

Third-Party Certifications
Adherence to GMPs is often substantiated via a third-party audits by organizations like the Natural Products Association (NPA) and NSF International, and include an FDA audit of facilities. Other third-party verifications include ConsumerLab certification, botanical testing by the Institute for Nutraceutical Advancement, the National Nutritional Food Association’s (NNFA) TruLabel program, Paracelsian’s BioFIT certification, USP standards, and the Council for Responsible Nutrition standards.

These audits are meant to assure customers regarding GMP verification and are intended as a “short cut” for practitioners who might not have the time to conduct their own rigorous research. Practitioners will want to learn more about each program online, and look for designating marks on product labeling or brand.

The Emerson Quality Partner (SM) program, recently launched by distributor Emerson Ecologics™ is another such program. “The supplement manufacturing process is very complex,” says Lise Alschuler, ND, FABNO, Emerson’s vice president of quality and education. “Each product often includes multiple layers of production and supply, with many sources within each layer. The EQP is an investment in researching and verifying the quality practices on the customers’ behalf so they can successfully incorporate product quality into their practices.

The EQP Seal will mark manufacturers who successfully complete an audit and checkpoint verification process meeting quality targets established by Emerson Ecologics. The team uses a combination of self-disclosed GMP and third-party audit information from organizations like NSF and NPA, along with Emerson’s own onsite audit and document audit.

“Companies can’t buy their way in or out of the program,” Alschuler emphasizes, “Our customers will be able to trust the EQP Seal as a sign of product purity, potency, identity, and stability.”

Research and Testing
Rigorous testing is another cornerstone of quality assurance. As vice president of regulatory affairs and quality assurance/quality control for Integrative Therapeutics, Travis Borchardt is intimately involved with every aspect of supplement manufacture.

“There are a few key categories a practitioner wants to assess regarding product quality, safety, and effectiveness,” says Borchardt. “Identity of materials, product stability over time, contaminant testing, and potency assays are all important signifiers of a quality manufacturing facility.”

Liva echoes, “It’s ‘Show me the quality,’ yes, but it also needs to be ‘Show me the testing!’” In the service of this kind of discovery, Liva has created Manufacturer Certification and Quality Assurance Self-Audit, a guide for practitioners seeking more information from supplement manufacturers. Liva’s manual contains questions soliciting information about companies, personnel, quality procedures and GMPs, raw materials, and finished products. Within the audit, Liva identifies several “critical” questions (see sidebar) he believes most important for quality, which gives practitioners a good place to start during the research process.

Practitioners should also ask manufacturers about the research driving their product development. “An important indicator of product quality is the incorporation of clinically studied, branded, or patented ingredients,” says Barry Ritz, PhD, vice president of scientific affairs for Atrium Innovations. Underwriting either in-house or third-party research, both generally and product- or ingredient-specific, can be a significant manufacturer investment and good indicator of commitment to product quality. Supplement companies sponsoring basic and/or clinical research benefit the industry and clinical care, and are often industry leaders.

The 2010 projected total global market for nutraceuticals is in the neighborhood of $187 billion. US contribution to this number represents 32 percent, or about $21 billion, of which the majority of use focuses on the categories of weight loss, heart problems, and digestion.

Further, research-based evidence has proven sufficient to compel FDA approval for full and qualified dietary supplement health claims, such as those for calcium and vitamin D in osteoporosis, folic acid for neural tube birth defects, and plant sterols and stanols in coronary heart disease risk reduction. Additionally, research shows pharmaceutical drug treatments can interact with and/or deplete healthy levels of certain vitamins and minerals.

It is no wonder supplement use has moved out of the natural grocery aisle and into the examining room. In fact, “more than three-quarters of US physicians (79%) and nurses (82%) recommend dietary supplements to their patients,” according to the Healthcare Professionals Impact Study from the Council for Responsible Nutrition (CRN), released in early 2009. Many healthcare practitioners now offer supplements to their patients directly in the office.

Things You Should Have Learned in School?
Some clinical curricula, however, exclude significant instruction dedicated to nutrition and health, let alone objective information about assessing supplement quality and efficacy as linked to research-based recommendations.

“Most healthcare practitioners end up choosing a supplement brand ‘by accident’ rather than as a result of personal research,” says Rick Liva, RPh, ND, and CEO of Vital Nutrients. “It’s unfortunate, because this is one of the most important aspects of a typical practice. Practitioners need to take time to educate themselves about the keys to supplement quality.”

Certain signs of poor quality are obvious—disease claims on marketing materials or labels or improper labeling altogether, such as the absence of a proper supplement facts box and missing “best by” or expiration date. Egregious mistakes signify ignorance or a general disregard for regulatory responsibility—both potential signs of poor quality control. But even when these unmistakably deficient brands are set aside, practitioners are still left with a dizzying array of product choices.

Indeed, most of the many dietary supplement manufacturers servicing clinicians maintain quality standards and meet basic requirements set out by the Dietary Supplement Health and Education Act (DSHEA). The question then becomes distinguishing superior quality among the options.

Good Manufacturing Practices (GMPs)
In the US, the FDA regulates dietary supplements via DSHEA. As required by DSHEA, FDA recently established dietary supplement good manufacturing practices (GMPs) to provide the baseline for quality standards among supplement manufacturers. GMPs, implemented in 2007 for rollout to all manufacturers by 2010, have the force of law. They are designed to ensure manufacturers follow procedures to keep products safe, effective, and free of harm. GMPs include requirements around the process of product supply, preparation, testing, and storage. GMPs also regulate the packaging and labeling of products.

Study Design
The newest of the Francesco Sofi papers, this study added data from 7 prospective studies, published in the last 2 years, to an earlier meta-analysis published in 2008. The statistical analysis of the compiled data correlated adherence to a Mediterranean diet with relative risk of several diseases and overall mortality risk. These new additions included 1 study for overall mortality, 3 studies for cardiovascular incidence or mortality, 1 study for cancer incidence or mortality, and 2 studies for neurodegenerative diseases.

Participants
The number of subjects whose data was compiled varied by condition. For cardiovascular disease incidence and mortality, there were a total of 534,064 subjects with 8,739 events compiled for analysis. For cancer incidence and mortality, there were 1,006,410 subjects and 11,378 events. For neurodegenerative diseases, there were 136,235 subjects and 1,074 cases from which to draw conclusions. The earlier 2008 meta-analysis utilized data from 12 qualifying studies published between 1966 and 2008 with a total of 1,574,299 subjects.

Study Intervention
Adherence to a Mediterranean diet was defined via scores that estimated the conformity of the subject’s dietary pattern with the traditional Mediterranean dietary pattern. Values of zero or 1 were assigned to each of 7 to 9 different dietary characteristics by using medians of consumption among the study participants as the divider. People whose consumption was characteristic of a Mediterranean diet (vegetables, fruits, beans, cereals, fish, olive oil, and a moderate intake of red wine during meals) above the median consumption were given 1 point for each characteristic in which they were above average. A zero score was given to those with consumptions below the median. People whose consumption patterns of components not considered to be part of a Mediterranean diet (red and processed meats, poultry, eggs, or dairy products) was above the median consumption also had a zero assigned, while those at or below the median received 1 point for that category. Different studies varied in the total number of food categories scored. Thus while lowest score was always zero, the highest possible scores varied among the studies from 7 to 9 points for greatest adherence.

Primary Outcome Measures
The study calculated changes in relative risk of either incidence of or mortality from cardiovascular disease, cancer, or neurodegenerative diseases associated with greater adherence to a Mediterranean diet. Relative risk of total mortality was also calculated.

Key Findings
This paper is an update of Sofi et al 2008, adding data from newly published studies. The increased quantity of data did not have a substantial effect on Sofi’s original findings. This new meta-analysis showed that a 2-point increase in adherence to the Mediterranean diet was associated with a significant reduction of overall mortality [relative risk (RR)=0.92; 95% CI: 0.90, 0.94], cardiovascular incidence or mortality (RR=0.90; 95% CI: 0.87, 0.93), cancer incidence or mortality (RR=0.94; 95% CI: 0.92, 0.96), and neurodegenerative diseases (RR=0.87; 95% CI: 0.81, 0.94).

These new data are consistent with a number of earlier publications that suggest both a strong protective effect and possibly a useful therapeutic effect from coffee or caffeine against glioma. Members of the public frequently view coffee in a negative light and will often “give it up” after a cancer diagnosis. At least in the case of glioma, coffee may have benefit, and these patients should be discouraged from discontinuing their coffee consumption.

Holick et al already reported that coffee lowered risk of glioma in January 2010. In this earlier paper, data from 3 prospective cohort studies were combined to yield 335 incident cases of glioma. Consumption of 5 or more cups of coffee and tea per day compared with no consumption decreased risk significantly (RR, 0.60; 95% CI, 0.41–0.87; P(trend)=0.04). The inverse association was stronger in men (RR, 0.46; 95% CI, 0.26–0.81; P(trend) = 0.03).

Other recent studies suggest coffee, in particular caffeine, may be more than protective against glioma and that both may have therapeutic value during treatment of glioma.

In February 2010, Kang et al reported that caffeine might be a useful adjunctive therapy against invasive glioma. After showing that caffeine inhibited migration of glioblastoma cells in various in vitro assays, the researchers showed in vivo that caffeine greatly increased mean survival using a mouse xenograft model of glioblastoma.
Caffeine sensitizes glioma cells to both ionizing radiation and chemotherapy.

Caffeine sensitizes glioma cells to both ionizing radiation and chemotherapy. In February 2010, Sinn et al reported that “caffeine or its derivative pentoxifylline are promising candidate drugs for the radiosensitization of glioma cells.”3 Caffeine also enhances the effect of the chemotherapy drug temozolomide (Temador), which is often used in conjunction with radiation to treat malignant glioma.

One possible explanation for these benefits is that coffee is a peroxisome proliferator-activated receptor (PPAR) gamma agonist. PPAR gamma agonists not only inhibit brain tumor growth,6 but they may also inhibit brain cancer stem cells.

Interestingly, a number of synthetic PPAR gamma agonists are already under investigation for treating brain tumors. Ciglitazone and troglitazone, both synthetic PPAR gamma agonists, are being investigated and showing promise.8,9 Pioglitazone (Actos), a drug already used to treat diabetes, may be of possible use. A 2006 study using a rat glioma model reported that “oral administration of pioglitazone reduced tumor volumes by 76.9%. Subsequent brain tissue analysis revealed induction of apoptotic cell death.”

Leaving all of these interesting details aside for the moment, our bottom line should be that glioma patients should be drinking coffee with the caffeine still in it. The next time a patient with a malignant glioma tells you they have stopped drinking coffee to be healthy, explain to them that it’s better to drink more coffee rather than less.

The qualitative surveys implied that the nutrition information presented resulted in gained knowledge and skills that were utilized by the participants. As the participants began to use the skills and tools provided in the program curriculum their awareness of undesired behaviors and healthy alternatives increased. Participants reported that they were eating better and exercising more.

Limitations
This study was non-controlled and relied only on outcomes from those who participated and completed the program. Reliance on self-reports for eating and activity behavior assessed by the Likert survey could be biased due to test-retest bias and increased knowledge rather than actual behavior changes. Collection of eating and activity record data from the participants may have helped to assess and verify behavior changes. There are limitations to the use of leg-to-leg BIA for assessing small changes in percentage body fat, especially for growing children. The data for ethnicity, age, income, and education level of the parent was not collected, nor was food availability/security issues or availability of safe recreation environments. This type of information can be helpful for identifying barriers to change for the participants.

Conclusion
The family-based lifestyle change intervention, LEAP program, was effective for decreasing BMI and increasing fitness level for both the child and adult participants. Survey responses for both the parents and the children indicated positive changes in eating and activity behaviors and attitudes after completing the program. Parental involvement may be associated with the achievement of desired changes for children. Social and family support is an important factor in the modification of family-based lifestyle behaviors. Interventions need to target multiple areas at both the personal and family environmental levels, as there is a reciprocal interaction between behavior and multiple levels of influence. Short-term outcomes were favorable for both the child and parent participants. Further research is needed to evaluate the long-term effects.

The greater decrease in BMI as compared with the current study might be attributed to the intervention design, which utilized a structured exercise-training component, and the older age of the participants. The L.E.S.T.E.R. (Let’s Eat Smart Then Exercise Right) program, which uses a modified stoplight diet, behavior modification, physical activity and targets family lifestyle had positive weight loss for 26 children ages six to 11 after an eight-week intervention (Kibbe & Offner, 2003). Consistent with the current study, L.E.S.T.E.R. participants had improvements in eating & exercise patterns, knowledge and attitude and significant decreases in anthropometric measures. Heard (2004) reported that 87% (n=425) of the L.E.S.T.E.R. children achieved a significant decrease of about 1.0 BMI unit (p = .03). 77% (n = 107) of the LEAP children achieved a significant decrease of 1.0 BMI unit (p <.01) versus the 0.74 BMI unit mean decrease for all children in the study, which included children that had an increase in BMI. The results of the current study indicate a significant mean decrease in percent body fat for the child participants from week one to week eight. Bio-impedance analysis to measure percent body fat is less commonly used as an outcome measure for body composition changes in children undergoing small changes in weight. The use of the Tanita body composition analyzer has been reported to be an accurate method for measuring body fat in adult women during weight loss (Powell, Nieman, Melby, Cureton, Schmidt, & Howley, et al, 2001). A validation study reported no significant differences in % body fat measures with leg-to-leg BIA and UWW between obese and non-obese women and was accurate in measuring small body composition changes during weight loss in the obese (Utter, Nieman, Ward, & Butterworth, 1999). However, leg-to-leg BIA as an assessment of body fat change for children is not as well defined and results can vary by age, gender, especially for girls, and among different ethnicities (Daniels, Khoury, & Morrison, 1997; Taylor, Jones, Williams, & Goulding, 2002).

Results from the Likert scale eating and activity survey and the exit survey demonstrated that both the child and parent participants achieved desired changes toward healthy behaviors. The child participants reported an increase in daily physical activity levels in response to the pre and post survey statement — “I exercise 60 minutes or more each day”. In support, the parent survey scores indicated stronger agreement to the statements — “I structure an active family lifestyle” and “I exercise 30 minutes a day with my child”. Both the children and parents indicated stronger agreement with the statement “I eat 5 or more fruits and vegetables each day” at the end of the program. These results are consistent with results from a six-week program, FIT KIDS, for overweight children aged six to 12 and their parents, which is similar to the LEAP program in design and goals. According to information currently distributed by FIT KIDS, pre-post questionnaires showed that “86% of the children report eating more fruits and vegetables, 71% drink more water and 64% report exercising more as a family” (Passehl, 2005).