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Data suggest that nutrient order during a meal significantly impacts postprandial glucose and insulin excursions in type 2 diabetes, while its effects in prediabetes have not been reported. Fifteen participants with prediabetes consumed the same meal on 3 days in random order: carbohydrate first, followed 10 minutes later by protein and vegetables (CF); protein and vegetables first, followed 10 minutes later by carbohydrate (PVF); or vegetables first followed by protein and carbohydrate (VF). Blood was sampled for glucose and insulin measurements at 0, 30, 60, 90, 120, 150 and 180 minutes. Incremental glucose peaks were similarly attenuated by >40% in the PVF and VF meal conditions compared with CF. The incremental area under the curve for glucose was 38.8% lower following the PVF meal order, compared with CF, and postprandial insulin excursions were significantly lower in the VF meal condition compared with CF. The CF meal pattern showed marked glycaemic variability whereas glucose levels were stable in the PVF and VF meal conditions. Food order presents a novel, simple behavioural strategy to reduce glycaemic excursions in prediabetes.

IntroductionComplete reporting assists readers in confirming the methodological rigor and validity of findings and allows replication. The reporting quality of observational functional magnetic resonance imaging (fMRI) studies involving clinical participants is unclear.ObjectivesWe sought to determine the quality of reporting in observational fMRI studies involving clinical participants.MethodsWe searched OVID MEDLINE for fMRI studies in six leading journals between January 2010 and December 2011.Three independent reviewers abstracted data from articles using an 83-item checklist adapted from the guidelines proposed by Poldrack et al. (Neuroimage 2008; 40: 409–14). We calculated the percentage of articles reporting each item of the checklist and the percentage of reported items per article.ResultsA random sample of 100 eligible articles was included in the study. Thirty-one items were reported by fewer than 50% of the articles and 13 items were reported by fewer than 20% of the articles. The median percentage of reported items per article was 51% (ranging from 30% to 78%). Although most articles reported statistical methods for within-subject modeling (92%) and for between-subject group modeling (97%), none of the articles reported observed effect sizes for any negative finding (0%). Few articles reported justifications for fixed-effect inferences used for group modeling (3%) and temporal autocorrelations used to account for within-subject variances and correlations (18%). Other under-reported areas included whether and how the task design was optimized for efficiency (22%) and distributions of inter-trial intervals (23%).ConclusionsThis study indicates that substantial improvement in the reporting of observational clinical fMRI studies is required. Poldrack et al.'s guidelines provide a means of improving overall reporting quality. Nonetheless, these guidelines are lengthy and may be at odds with strict word limits for publication; creation of a shortened-version of Poldrack's checklist that contains the most relevant items may be useful in this regard.

Schizophrenia is associated with abnormalities in cortical thickness, including both thicker and thinner cortices than controls. Although less reliably than in patients, non-psychotic relatives of schizophrenia patients have also demonstrated both thicker and thinner cortices than controls, suggesting an effect of familial or genetic liability. We investigated cortical thickness in 25 schizophrenia patients, 26 adult non-psychotic first-degree biological relatives, and 23 community controls using the automated program FreeSurfer. Contrary to hypotheses, we found relatives of schizophrenia patients had greater cortical thickness in all lobes compared to patients and controls; however, this finding was not as widespread when compared to controls. In contrast, schizophrenia patients only demonstrated a thinner right fusiform region than controls and relatives. Our finding of greater thickness in adult biological relatives could represent a maladaptive abnormality or alternatively, a compensatory mechanism. Previous literature suggests that the nature of abnormalities in relatives can vary by the age of relatives and change across the developmental period. Abnormalities in patients may depend on lifestyle factors and on current and previous anti-psychotic medication use. Our results speak to the need to study various populations of patients and relatives across the lifespan to better understand different developmental periods and the impact of environmental factors. © 2015 Wiley Periodicals, Inc.

IntroductionDepression is the leading cause of disability worldwide, affecting approximately 350 million people. Evidence indicates that only 60–70% of persons with major depressive disorder who tolerate antidepressants respond to first-line drug treatment; the remainder become treatment resistant. Electroconvulsive therapy (ECT) is considered an effective therapy in persons with treatment-resistant depression. The use of ECT is controversial due to concerns about temporary cognitive impairment in the acute post-treatment period. We will conduct a meta-analysis to examine the effects of ECT on cognition in persons with depression.MethodsThis systematic review and meta-analysis has been registered with PROSPERO (registration number: CRD42014009100). We developed our methods following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. We are searching MEDLINE, PsychINFO, EMBASE, CINAHL and Cochrane from the date of database inception to the end of October 2014. We are also searching the reference lists of published reviews and evidence reports for additional citations. Comparative studies (randomised controlled trials, cohort and case–control) published in English will be included in the meta-analysis. Three clinical neuropsychologists will group the cognitive tests in each included article into a set of mutually exclusive cognitive subdomains. The risk of bias of randomised controlled trials will be assessed using the Jadad scale. We will supplement the Jadad scale with additional questions based on the Cochrane risk of bias tool. The risk of bias of cohort and case–control studies will be assessed using the Newcastle-Ottawa Scale. We will employ the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to assess the strength of evidence.Statistical analysisSeparate meta-analyses will be conducted for each ECT treatment modality and cognitive subdomain using Comprehensive Meta-Analysis V.2.0.

Data suggest that the temporal sequence of carbohydrate ingestion during a meal has a significant impact on postprandial glucose (1-3), insulin, and glucagon-like peptide 1 (GLP-1) excursions (4) in type 2 diabetes, while the effects on ghrelin suppression and satiety have not been reported.The study design and methods have previously been described in detail (4). Briefly, using a crossover design, 16 subjects with overweight/obesity and metformin-treated type 2 diabetes were assigned to consume the same meal on 3 days in random order:c Carbohydrate-first meal: carbohydrate (bread and orange juice), followed 10 min later by protein (chicken) and vegetables c Carbohydrate-last meal: protein and vegetables, followed 10 min later by carbohydrate c Sandwich: all meal components together, each half consumed over 10 min with a 10-min interval in between Blood was sampled for glucose, insulin, active GLP-1, and total ghrelin measurements at baseline (just before meal ingestion) and at 30-min intervals up to 180 min. Participants rated their hunger and fullness levels using a visual analog scale (VAS) at the same time points.Baseline glucose, insulin, GLP-1, and ghrelin concentrations, as well as hunger and satiety scores, were similar in the three meal conditions. At 180 min, ghrelin levels remained suppressed following the carbohydrate-last meal order, while the carbohydrate-first meal led to a rebound in ghrelin to preprandial levels (percent ghrelin change from baseline to 180 min 211.45 6 3.86% vs. 4.13 6 4.38%; P 5 0.003) (Fig. 1). Decremental areas under the curve for 0-180 min were similar in the three meal conditions. There was an inverse correlation between percent change in ghrelin and percent change in glucose from baseline when assessing all participants in the three meal conditions at the evaluated time points (r 5 20.204; P , 0.001). We did not observe a significant effect of food order on subjective VAS appetite measures.

ObjectivesTo systematically summarize the randomized trial evidence regarding the relative effectiveness of cognitive behavioural therapy (CBT) in patients with depression in receipt of disability benefits in comparison to those not receiving disability benefits.Data SourcesAll relevant RCTs from a database of randomized controlled and comparative studies examining the effects of psychotherapy for adult depression (http://www.evidencebasedpsychotherapies.org), electronic databases (MEDLINE, EMBASE, PSYCINFO, AMED, CINAHL and CENTRAL) to June 2011, and bibliographies of all relevant articles.Study Eligibility Criteria, Participants and InterventionAdult patients with major depression, randomly assigned to CBT versus minimal/no treatment or care-as-usual.Study Appraisal and Synthesis MethodsThree teams of reviewers, independently and in duplicate, completed title and abstract screening, full text review and data extraction. We performed an individual patient data meta-analysis to summarize data.ResultsOf 92 eligible trials, 70 provided author contact information; of these 56 (80%) were successfully contacted to establish if they captured receipt of benefits as a baseline characteristic; 8 recorded benefit status, and 3 enrolled some patients in receipt of benefits, of which 2 provided individual patient data. Including both patients receiving and not receiving disability benefits, 2 trials (227 patients) suggested a possible reduction in depression with CBT, as measured by the Beck Depression Inventory, mean difference [MD] (95% confidence interval [CI]) = −2.61 (−5.28, 0.07), p = 0.06; minimally important difference of 5. The effect appeared larger, though not significantly, in those in receipt of benefits (34 patients) versus not receiving benefits (193 patients); MD (95% CI) = −4.46 (−12.21, 3.30), p = 0.26.ConclusionsOur data does not support the hypothesis that CBT has smaller effects in depressed patients receiving disability benefits versus other patients. Given that the confidence interval is wide, a decreased effect is still possible, though if the difference exists, it is likely to be small.

The length of telomeres, the protective caps of linear chromosomes, is predictive of the proliferation capacities of cells. Shorter average telomere length in leukocytes has been linked to a broad range of aging-related diseases, including being predictive of incidence and poor prognosis of a variety of cancers. Our previous work showed that perceived psychological stress is associated with shorter telomere length in lymphocytes in caregivers of chronically sick children; thus impaired telomere maintenance potentially mediates the previously-documented detrimental effects of stress on human health. In the current study, we examined leukocyte telomere length in 63 healthy post-menopausal women, who were the primary caregivers of family member dementia patients. We previously found in this study that short telomere length is associated with high levels of IL-6 and with pessimism. In addition, among the non-exercisers, increase in the Perceived Stress Scale was related to an increase in the odds of having short telomeres, whereas in exercisers, perceived stress appeared to be unrelated to telomere length. Here we report that, longitudinally, increase in perceived stress over one year was associated with a one-year decrease in telomere length, while decrease or no change in stress was associated with a one-year increase in telomere length (p<0.03). In a recent study of young to middle-aged adults, we found that those exposed to multiple types of trauma in childhood have shorter leukocyte telomere length than those without such exposure, F(1,38)=2.86, p=0.04. In a separate study of 60 healthy, non-smoking women (ages 50 to 65), as part of a larger prospective study on telomere change and lifestyle factors, we found that leisure-time physical activity buffered the negative effects of childhood abuse (βinteraction=0.08, SE=0.03, p=0.01) and accumulated life stress (βinteraction=0.01, SE 0.00, p=0.03) on leukocyte telomere length, after covarying for BMI and age. Specifically, in those reporting a sedentary leisure lifestyle (one standard deviation below the mean), shorter leukocyte telomeres were related to childhood abuse (β=−0.11, SE=0.04, p=0.01) and accumulated life stress (β=−0.01, SE=0.00, p=0.05). However, in those who reported at least a physical activity regimen that included activity minimally 3 times a week, neither childhood abuse nor accumulated life stress was significantly related to leukocyte telomere length (p>0.05). Our results demonstrate that while traumatic and chronic stressful life events are associated with leukocyte telomere shortness, which in turn is associated with high risks of aging-related diseases including cancer, physical activity as a preventive change may moderate the impact of stress on leukocyte telomere shortening, a manifestation of cell aging. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1834. doi:10.1158/1538-7445.AM2011-1834