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 ( n1 = 12 and n2 = 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 Generation Health (GH) is a 10-week family-based lifestyle program designed to promote a healthy lifestyle for families with children who are off the healthy weight trajectory in British Columbia, Canada. GH uses a blended delivery format that involves 10 weekly in-person sessions, and self-guided lessons and activities on a web portal. The blended program was adapted to be delivered virtually due to the COVID-19 pandemic. Currently, the effectiveness of the virtual GH program compared with that of the blended GH program remains unclear. Objective We aimed to (1) compare the effectiveness of the virtual GH program delivered during the COVID-19 pandemic with that of the blended GH program delivered prior to the pandemic for changing child physical activity, sedentary and dietary behaviors, screen time, and parental support–related behaviors for child physical activity and healthy eating, and (2) explore virtual GH program engagement and satisfaction. Methods This study used a single-arm pre-post design. The blended GH program (n=102) was delivered from January 2019 to February 2020, and the virtual GH program (n=90) was delivered during the COVID-19 pandemic from April 2020 to March 2021. Families with children aged 8-12 years and considered overweight or obese (BMI ≥85th percentile according to age and sex) were recruited. Participants completed preintervention and postintervention questionnaires to assess the children’s physical activity, dietary and sedentary behaviors, and screen time, and the parent’s support behaviors. Intervention feedback was obtained by interviews. Repeated measures ANOVA was used to evaluate the difference between the virtual and blended GH programs over time. Qualitative interviews were analyzed using thematic analyses. Results Both the virtual and blended GH programs improved children’s moderate-to-vigorous physical activity (F1,380=18.37; P<.001; ηp2=0.07) and reduced screen time (F1,380=9.17; P=.003; ηp2=0.06). However, vegetable intake was significantly greater in the virtual GH group than in the blended GH group at the 10-week follow-up (F1,380=15.19; P<.001; ηp2=0.004). Parents in both groups showed significant improvements in support behaviors for children’s physical activity (F1,380=5.55; P=.02; ηp2=0.002) and healthy eating (F1,380=3.91; P<.001; ηp2=0.01), as well as self-regulation of parental support for children’s physical activity (F1,380=49.20; P<.001; ηp2=0.16) and healthy eating (F1,380=91.13; P<.001; ηp2=0.28). Families in both groups were satisfied with program delivery. There were no significant differences in attendance for the weekly in-person or group video chat sessions; however, portal usage was significantly greater in the virtual GH group (mean 50, SD 55.82 minutes) than in the blended GH group (mean 17, SD 15.3 minutes; P<.001). Conclusions The study findings suggested that the virtual GH program was as effective as the blended program for improving child lifestyle behaviors and parental support–related behaviors. The virtual program has the potential to improve the flexibility and scalability of family-based childhood obesity management interventions.

No abstract

BACKGROUND Generation Health (GH) was a 10-week family-based lifestyle program designed to promote a healthy lifestyle for families with children who are off the healthy weight trajectory in British Columbia, Canada. GH used a blended delivery format which consisted of 10 weekly in-person sessions and self-guided lessons and activities on a web portal. The blended GH was adapted to be delivered virtually due to the COVID-19 pandemic. Currently, the effectiveness of the virtual GH compared with the blended GH remains unclear. OBJECTIVE 1) to compare the effectiveness of virtual GH delivered during the COVID-19 pandemic with the blended GH delivered prior to the COVID-19 pandemic in changing child physical activity, sedentary, dietary behaviours, screen time behaviours and parental support related behaviours for child physical activity and healthy eating; 2) to explore virtual GH program engagement and satisfaction. METHODS This study used a single-arm design. The blended GH (n=102) was delivered from October 2018 to February 2020, and the virtual GH (n=90) was delivered during the COVID-19 pandemic from April 2020 to March 2021. Families with children between the ages of 8-12 years old and a BMI ≥85th percentile for age and sex were recruited. Participants completed pre-and post-intervention questionnaires to assess the child’s physical activity, dietary, sedentary, screen time and parent support behaviours. Repeated measure ANOVA was used to evaluate the difference between the virtual and blended GH over time. RESULTS Both the virtual and blended GH improved child MVPA (F(1,380)=18.37, p<.00001, ηp2=.07) and reduced screen time (F(1,380)= 9.17, p=.003, ηp2=.06 ). However, participants in the virtual GH reported significantly greater vegetable intake than in blended GH at 10-week follow-up (F(1,380)=15.19, p<.001, ηp2 =.004).. Parents in both virtual and blended GH showed significant improvements in support behaviours for child physical activity (F(1,380)=5.55, p<.02, ηp2 =.002) and healthy eating (F(1,380)=3.91, p<.001, ηp2=.01), as well as self-regulation of parent support for child physical activity (F(1,380)=49.20, p<.0001, ηp2=.16) and healthy eating (F(1,380)=91.13, p<.0001, ηp2) =.28). Families in both the virtual and blended GH were satisfied with the program delivery. There were no significant differences in attendance for the weekly in-person (77%) or group video chat sessions (76%) for the blended and virtual GH, respectively (p>.05). However, webportal usage was significantly greater in the virtual GH (50 [55.82] minutes) compared with blended GH (17 [15.3] minutes) (p<.001). CONCLUSIONS Findings from this study suggested that virtual GH was as effective in improving child lifestyle behaviours and parental support-related behaviours as the blended program. Virtual GH has the potential to improve the flexibility and scalability of family-based childhood obesity management interventions.