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* Individualized Eating Plans for Diabetes


* Sitting Too Much


* Eating Disorders Worldwide



The Food and Drug Administration (FDA) unveiled a new effort last month to protect consumers from potentially unsafe dietary supplements that may contain unlawful ingredients. The Dietary Supplement Ingredient Advisory List, an online tool, alerts the public to chemical compounds that may not meet legal requirements for use in supplements. Dietary supplements are regulated by FDA as a category of food. Supplement manufacturers-unlike drug companies-do not need to prove that a product is safe and effective before marketing it, but there are rules about which ingredients can be included in supplements.


Only substances that meet FDA's definition of dietary ingredients can lawfully be included in supplements. But the process for making final determinations can take time, and consumers may unknowingly consume unlawful ingredients during that process. With the new list, FDA can flag suspect ingredients before a final decision.


Qualified ingredients that make the list can be vitamins, herbs, botanicals, or amino acids, among other substances. To be considered lawful, older ingredients must have been in the food supply when the law that governs FDA authority over supplements was enacted in October 1994, and they cannot be chemically altered. Manufacturers of any product that contains a new dietary ingredient that was not in the food supply at that time must demonstrate a history of use or other evidence that the ingredient "will be reasonably expected to be safe," according to FDA standards.


Housed on the FDA website, the new list can be used by consumers who do not want to buy dietary supplements containing questionable substances as well as manufacturers eager to avoid including these ingredients in their products. FDA says it will communicate separately and clearly any time it identifies safety concerns about specific dietary ingredients or supplements and deploy other enforcement tools, such as safety warnings, when appropriate. The new list is part of FDA's ongoing effort to strengthen oversight of supplements and better protect consumers from unsafe products. Because the list will be updated regularly, FDA encourages stakeholders to submit information that may support or refute preliminary assessments about various ingredients. You can access the website at:



Personalized nutrition plans, nutrition for optimal weight management, and the prevention and management of diabetes complications, including cardiovascular and kidney disease and gastroparesis, are detailed in the new guidance document, Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (Consensus Report), produced by a panel of experts assembled by the American Diabetes Association. This new Consensus Report focuses on evidence-based guidelines that are achievable and aim to meet people where they are. It recommends an individualized nutrition plan for every person with diabetes or prediabetes.


New guidelines and highlights in the report include the following:


* The Consensus Report panel emphasizes that there is not one, single recommended nutrition plan for all people with diabetes, especially given the broad spectrum of people affected by diabetes and prediabetes, as well as other factors, such as cultural preferences, food availability, and socioeconomic factors.


* Weight management is recommended as an essential component of care for people with type 1 diabetes who have overweight or obesity.


* A comprehensive table on eating patterns reviewed graphically summarizes the various types of eating patterns and the benefits reported. Healthcare providers should focus on the key factors that are common among the pattern including an emphasis on nonstarchy vegetables, minimizing added sugars and refined grains, and choosing whole, unprocessed foods over processed foods to the extent possible.


* Replace sugar-sweetened beverages with water as often as possible.


* In general, replace saturated fat with unsaturated fats to reduce both total cholesterol and low-density lipoprotein C and also decrease cardiovascular disease risk.


* People with prediabetes should be referred to an intensive behavioral lifestyle intervention program modeled on the Diabetes Prevention Program and/or an individualized nutrition plan with the goals of improving eating habits, increasing moderate-intensity physical activity to at least 150 minutes per week, and achieving and maintaining 7% to 10% loss of initial body weight, if needed.


* When healthcare providers, including registered dietitian nutritionists and diabetes educators, are counseling individuals with diabetes and prediabetes about weight management, they should give special attention to prevent, diagnose, and treat individuals with disordered eating.



Also notable is the addition of critical information on the interval role that nutrition therapy plays in the prevention and management of diabetes complications, including cardiovascular disease, diabetic kidney disease, and gastroparesis. Additional emphasis is placed on coordinating and aligning the medical nutrition therapy plan with the overall management strategy, including use of medications and physical activity, on an ongoing basis.


"Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report" was produced by cochairs Alison B. Evert, MS, RD, CDE, University of Washington-UW Neighborhood Clinics, Seattle, Washington; and William S. Yancy, Jr., MD, MHS, Duke University, Durham, North Carolina, et al.



Most Americans continue to sit for prolonged periods despite public health messages that such inactivity increases the risk of obesity, diabetes, heart disease, and certain cancers, according to a new study.


The research team analyzed surveys of 51 000 people from 2001 to 2016 to track sitting trends in front of TVs and computers and the total amount of time spent sitting on a daily basis. Unlike other studies that have looked at sedentary behaviors, this research is the first to document sitting in a nationally representative sample of the US population across multiple age groups-from children to the elderly-and different racial and ethnic groups.


The researchers found that most Americans spend at least 2 hours per day sitting and watching television or videos. Among children aged 5 to 11 years, 62% spent at least that long in front of screens daily. For adolescents aged 12 to 19 years, that number was 59%. Approximately 65% of adults aged 20 to 64 years spent at least 2 hours watching television per day. And most recently, from 2015 to 2016, 84% of adults older than 65 years spent at least that much time sitting watching television. And this remained steady over the course of the study.


Across all age groups, 28% to 38% of those surveyed spent at least 3 hours per day watching television or videos, and 13% to 23% spent 4 hours or more engaged in watching television or videos.


Importantly, males of all age groups, non-Hispanic black individuals of all age groups, and participants who reported being obese or physically inactive were more likely to spend more time sitting to watch televisions or videos compared with their counterparts.


In addition, computer screen time outside work and school increased over this period. At least half of individuals across all age groups used a computer during leisure time for more than 1 hour per day in the 2 most recent years of the study. And up to a quarter of the US population used computers outside work and school for 3 hours or more. The new study fills a gap in knowledge on sedentary behavior, according to the researchers, putting specific numbers on the amount of time Americans actually spend sitting. For example, the most recent edition of the Physical Activity Guidelines for Americans, published in 2018 by the Department of Health and Human Services, recommends less sitting time but offers no guidance on how much.


Source: Yang L, Cao C, Kantor ED, Nguyen LH, et al. Trends in sedentary behavior among the US population, 2001-2016. JAMA 2019;321(16):1587.