• Dietary management of heart failure: room for improvement?

      Butler, Thomas; Department of Clinical Sciences and Butrition, University of Chester (Cambridge University Press, 2016-02-06)
      There is growing awareness of the role of diet in both health and disease management. Much data are available on the cardioprotective diet in the primary and secondary prevention of CVD. However, there is limited information on the role of diet in the management of heart failure (HF). Animal models of HF have provided interesting insight and potential mechanisms by which dietary manipulation may improve cardiac performance and delay the progression of the disease, and small-scale human studies have highlighted beneficial diet patterns. The aim of this review is to summarise the current data available on the role of diet in the management of human HF and to demonstrate that dietary manipulation needs to progress further than the simple recommendation of salt and fluid restriction.
    • Saturated Fatty Acid Intake as a Risk Factor for Cardiovascular Disease in Healthy Caucasian Adults from Western Populations

      Thomas, Patricia; Mushtaq, Sohail; University of Chester (Cambridge University Press, 2014-02-02)
      ABSTRACT Background: Cardiovascular disease (CVD) is the leading cause of premature death globally (WHO, 2010).For over 50 years saturated fatty acids (SFA) have been implicated as a main dietary risk factor for CVD. Therefore national guidelines recommend limiting SFA to <10% of total daily energy intake COMA, [1]. However, recent literature has begun to question this advice due to contra evidence showing SFA not to be a risk factor for CVD, Hoenselaar [2]. This study’s aim was to investigate the relationship between SFA and CVD to assess whether or not recommendations should be made to review national guidelines. Method: A systematic review and meta-analysis were conducted. Electronic research databases were searched using variations of the keywords “saturated fatty acids” and “cardiovascular disease”. Articles were only included if they had a randomised control trial (RCT) or prospective cohort (PC) study design. Additionally participants had to meet the following criteria: Caucasian, non-smokers, normal BMI, classed as healthy, no preexisting CVD related conditions, not taking cholesterol altering drugs and no inborn errors of lipid metabolism. Articles were also only included if they were conducted in western populations in an attempt to standardise environmental factors. In the PCs, only data which was adjusted for these factors was included. Articles were assessed for quality using the Jadad et al. [3] scoring/CASP tool and for confounding variables, risk of bias and homogeneity. Results: A total of 411 articles were identified. Eight articles were included after exclusion for duplication, study design, not meeting full inclusion criteria, low quality, confounding variables, high risk of bias and heterogeneity. Of these, 4 were RCTs and 4 were PCs including 193,409 participants (192,686 female, 723 male). RCT and PC data were analysed separately. For the RCTs, LDL-cholesterol concentration post high/low SFA intervention was used as a functional biomarker for CVD risk. For the PCs the number of CVD related events in the low/high SFA diet groups was used as the marker for CVD risk. In the RCT meta-analysis there was a standard mean difference (95%CI) of -0.94 (-1.17, - 0.71) (p<0.00001) favouring the low SFA diet to decrease the risk of CVD. In the PC metaanalysis a risk ratio (95%CI) of 1.00 (0.64, 1.58) (p=1.00) showed there to be no statistically significant relationship between SFA and CVD. Sensitivity analyses conducted predominantly showed no change in outcome. Discussion: RCT outcomes favoured a low SFA diet for lowering CVD risk whereas the PC outcome showed no relationship. Although these differed they indicate that SFA does not increase CVD risk in western Caucasian adults. However further research is needed before requesting recommendations for the review of national guidelines. These findings correlate with other systematic reviews/meta-analyses e.g. Skeaff and Miller, [4]. Conclusion: From the studies included SFA does not increase CVD risk in affluent Caucasian adults.
    • Staff perspectives

      Astbury-Ward, Edna; University of Chester (Cambridge University Press, 2014-08-24)
      This chapter will focus on the medical, nursing and psychological care of the woman during the abortion process, in particular, from the perspective of staff caring for women undergoing induced abortions.
    • Vitamin D3 supplementation for 8 weeks leads to improved haematological status following the consumption of an iron-fortified breakfast cereal: a double-blind randomised controlled trial in iron-deficient women.

      Mushtaq, Sohail; Ahmed Fuzi, Salma F; University of Chester (Cambridge University Press, 2019-03-01)
      The effect of 38 µg (1500 IU) daily vitamin D3 supplementation, consumed with an iron-fortified breakfast cereal for 8 weeks, on haematological indicators in iron-deficient female subjects was investigated. Fifty iron-deficient subjects (plasma ferritin concentration < 20 µg/L; mean age ± SD: 27.4 ± 9.4 years) were randomised to consume an iron-fortified breakfast cereal containing 9 mg of iron daily, with either a vitamin D3 supplement or placebo. Blood samples were collected at baseline, interim (4 weeks) and post-intervention (8 weeks) for measurement of iron and vitamin D status biomarkers. The effect of intervention was analysed using mixed-model repeated measures ANOVA. Significant increases were observed in two main haematological indices: haemoglobin concentration and haematocrit level from baseline to post-intervention in the vitamin D group, but not in the placebo group. The increase from baseline to post-intervention in haemoglobin concentration in the vitamin D group (135 ± 11 to 138 ± 10 g/L) was significantly higher compared to the placebo group (131 ± 15 to 128 ± 13 g/L) (P=0.037). The increase in haematocrit level from baseline to post-intervention was also significantly higher in the vitamin D group (42.0 ± 3.0 to 43.8 ± 3.4%) compared to the placebo group (41.2 ± 4.3 to 40.7 ± 3.6%) (P=0.032). Despite the non-significant changes in plasma ferritin concentration, this study demonstrates that 38 µg supplemental vitamin D, consumed daily, with iron-fortified breakfast cereal led to improvement in haemoglobin concentration and haematocrit levels in women with low iron stores. These findings may have therapeutic implications in the recovery of iron status in iron-deficient populations at a healthcare level.