This systematic review of scientific literature was undertaken to investigate the possibility of a role for diet in the alleviation of rheumatoid arthritis (RA) symptoms, with an objective of highlighting specific nutrients and/or certain food groups and diets that may impact upon the symptoms of RA. Studies displaying conflicting evidence (i.e. show diets that have no effect on RA symptom alleviation) were also reviewed. A comprehensive literature search to identify relevant papers was carried out with the use of criteria, in an attempt to identify as many studies as possible, but also to minimise selection bias for those that were found. Electronic databases, library catalogues and internet search engines played key parts in paper identification. A total of 31 papers were identified after meeting selection criteria and summaries and critical appraisals were compiled for comparison. Some studies show that fish oil supplementation displayed the greatest benefits through a reduction in the number of tender joints and morning stiffness. One paper offers a dosage figure for improvement in clinical symptoms as 40mg/kg body weight/day of oil containing n-3 fatty acids (FAs) combined with <10g/day of dietary (n-6) FAs. Periods of fasting with a vegetarian diet promotes a reduction in RA symptoms. Several studies identify Gammalinolenic Acid as capable of decreasing pro-inflammatory products of Arachidonic Acid. Similarly, elemental diets and foods devoid of allergens may benefit RA activity parameters, however improvements in RA symptoms seen in response to elemental diets are not sustained on individualised diets. Many researchers recognised the influence of a Mediterranean diet, rich in anti-oxidant containing vegetables, n-3 FAs and a lower ratio of n-6 to n-3 FAs as sources of inflammation reduction. Vitamin E treatment was shown to provide a small analgesic property compared to placebo, the mechanism of which and identification of additional vitamins and food sources with such potential require further study. Further work is required on establishing most beneficial supplement dosage, duration and length of treatment interval. Knowledge of correlations of food allergies in RA sufferers to immune responses compared to food antigens in the fluid of blood and joints would be useful.
Critical illness polyneuropathy (CIP) is a term for neuromuscular weakness acquired by patients treated in a hospital intensive care unit (ICU). It is thought to affect almost half of all patients admitted and causes delayed weaning from mechanical ventilation, increased requirement for renal replacement therapy and increased length of stay in ICU. Although evidence is inconsistent, increased mortality has been shown in patients who experience CIP. The pathophysiology of CIP remains largely unexplained but it is known to be associated with sepsis and systemic inflammatory response syndrome (SIRS), which can lead to multi-organ failure. Recently the potential of antioxidants and minerals to modulate the immunological processes contributing to SIRS has been an area of increasing interest. Large scale trials are currently underway to establish if intravenous supplementation of selenium is of benefit in the ICU population. In certain clinical conditions it has been shown that enteral feeds enriched with specific trace elements, vitamins and lipids can improve outcomes for ICU patients. However, very little work has been done to specifically investigate any potential contribution of nutritional status to the development of CIP. The present study investigated if plasma levels of trace elements are different in CIP patients compared to matched controls. This retrospective case-control study investigated eighteen patients diagnosed with CIP at the Royal Liverpool University Hospital ICU over a thirteen-month period. Information collected included length of stay, mortality data, use of inotropic drugs and steroids, nutritional intake and biochemical markers including plasma levels of zinc, selenium and copper. Mean length of stay in ICU was more than doubled in CIP patients compared to controls (p=0.002). Patients with CIP were also less likely to survive their ICU admission compared with controls (p=0.034). No significant differences were found between any of the plasma trace element levels or biochemical markers apart from alkaline phosphatase levels, a marker of liver function. The retrospective nature of this study caused several limitations with the methodology, which made it difficult to draw firm conclusions from the results. Further research is required to investigate the role of trace elements and antioxidants in the pathophysiology and treatment of CIP.
Dietary antioxidants (AO) are believed to contribute to the overall health benefits seen from fruit and vegetables. Despite increased public awareness of the health benefits of fruit and vegetables through campaigns such as 5 A DAY, consumption remains low. Freezing is usually regarded as destructive to AO and ascorbic acid (AA) and this has fostered a belief that fresh vegetables are nutritionally superior to frozen. In this study, AO and AA activity in commercially bought fresh and frozen vegetables were investigated and compared after a typical home cooking practice (boiling). Five different vegetables were examined: carrots, broccoli, green beans, peas and spinach. Each vegetable was bought four times from a selection of local supermarkets and green grocers in the Wirral, United Kingdom to account for variation. The oxygen radical absorbance capacity (ORAC) assay and 2, 6-dichlorophenolindophenol (DCPIP) assay were utilised to measure total antioxidant capacity (TAC) and AA content respectively. The results showed both fresh and frozen vegetables to contain AO and AA after cooking. Cooked fresh spinach and peas contained significantly (p<.05) higher levels of total AO than cooked frozen spinach and peas. However the remaining fresh and frozen vegetables (broccoli, carrots and green beans) did not appear to differ in AO content after cooking. Furthermore there was no difference between AA content in fresh and frozen cooked vegetables. The current study provides evidence against the misconception that fresh is always nutritionally superior to frozen at the point of consumption. Frozen vegetable promotion may be the way forward to increase fruit and vegetable consumption as they are generally nutritionally comparable to fresh but, cheaper, result in less waste, are more convenient and, if packaged correctly, taste the same as fresh. Further work, on a larger scale, is needed, to measure AO and AA content of fresh and frozen vegetables bought and cooked by the consumer.
Kendall, Rebecca (University of Chester, 2011-09-08)
Weaning practices including the age of the infant at time of weaning, nutritional composition of the weaning diet and rapid weight gain have been suggested to be risk factors for overweight and obesity in childhood. The purpose of this review was to investigate the relationship between weaning practices and overweight and obesity in childhood (from birth to 18yrs) and to identify the risk factors associated with weaning for overweight and obesity in childhood (birth to 18yrs). This was achieved through a systematic review of relevant literature, identified using a number of databases such as CINAHL, EMBASE, and MEDLINE and through searching individual journals. Inclusion criteria consisted of children’s age 0-18yrs, details on stage of and weaning diet, studies published in English from 2000-2010 and human studies. The quality of the methodology of studies was assessed using the Downs & Black (1998) quality assessment tool. Thirteen studies out of an original 67 were included in the review. Study sizes varied from 90 to 10,553 subjects and quality assessment scores ranged from 14 to 23. All of the studies which considered the relationship between age at introduction of complementary foods and weight gain found those infants weaned before 16 weeks (wks) gained more weight than those weaned later; these findings were more significant in those infants who were not breastfed or breastfed for less than 4wks. One study (from 5) found a significant relationship between the age at introduction of complementary foods and overweight and obesity. Four studies (from 5) reported a significant relationship between nutritional composition of the weaning diet during the first year of life and overweight; the most significant effect being that of protein as a percentage of energy intake. The evidence for the impact of early weaning on adiposity levels, overweight and/ or obesity remains is inconsistent. Findings suggest that there is no relationship between adiposity and BMI in childhood with early weaning practices. However, the introduction of complementary foods before 16wks was shown to lead to greater weight gain in early childhood (independent of other confounding factors), especially in those infants who are fed formula food or is only breastfed for less than 4wks, which in turn could lead to overweight and obesity in later childhood. High protein intake (as percentage of energy) is strongly suggested to influence weight gain during infancy and BMI in early childhood.
The increase in diet related diseases is considered to be primarily caused by a changing environment that encourages poor dietary habits and a sedentary lifestyle (Swinburn, Caterson, Seidell & James, 2004) . Research by Ng et al . (2014) has found that the number of obese and overweight people worldwide has increased from 857 million in 1980 to 2.1 billion in 2013. Bowman and Vinyard (2004) make the point that frequent consumption of fast food, in particular , is associated with poorer diet quality and risk of obesity for both children and adults. This literature review examines studies both in favour of calories being posted on menus in restaurants that argue that the implementation of this will have a positive effect on the obesity crisis and those that argue that its implementation will have a limited effect. This review looks at various studies that argue that the policy is likely only to affect certain population segments or socio economic groups.
Despite the reported health benefits of consuming fruit and vegetables on a daily basis, many residents of areas of deprivation, such as Blacon, still do not appear to be meeting the ‘5 a day’ recommendations. This study assessed the correlation between declarative nutrition knowledge (the awareness of processes, events and constituents of food substances) and fruit and vegetable intake in a LLSOA (low-level super output area) in the North West of England. The aim was to understand the relevance of providing factual advice and recommendations to increase fruit and vegetable consumption. Method: 42 participants (16 males and 26 females) took part in this cross sectional, correlational study. All participants completed a nutrition knowledge questionnaire (adapted from Parmenter and Wardle, 1999) and a dietary instrument for nutrition education (DINE) (Roe et al, 1994). During analysis, the participants were categorised in to age and gender groups. Average scores for fruit and vegetable consumption and declarative nutrition knowledge were compared. Nutrition knowledge was used as the independent variable against fruit and vegetable consumption in order to observe a correlation between the two. Spearmans Rank Correlation Coefficient showed that a statistically significant positive correlation was apparent between combined daily fruit and vegetable intake and total declarative nutrition knowledge (rs = 0.33, p = 0.033). Although numerous correlations were observed, none appeared stronger than combined daily fruit and vegetable intake and expert advice (rs = 0.368, p = 0.016). Females scored significantly better than males in expert advice (U = 124, p = 0.020) and daily fruit intake (U = 129.5, p = 0.035). The eldest age group (35-44 years) performed significantly better than the middle age group (25-34 years) for answers on health and disease (F(2,39) = 5.588, p = 0.007). The significant findings from this study indicate that, while food intake is a complex issue involving a wide range of factors, declarative nutrition knowledge could be used to predict a small percentage of variance of fruit and vegetable intake in Blacon. This is significant for health authorities, governments and local communities, as efforts should continue to convey health messages and provide advice to the people who consume the least amount of fruit and vegetables in the least affluent areas.
Robinson, Michael (University of Chester, 2018-09-28)
Nutrition in Golf is a relatively new area of research with only a small amount of published studies. Golf nutrition is distinct from other sports primarily due to the variable conditions faced by players over an extended period of time. Despite that only a low to moderate exercise intensity is maintained, players are required to make multiple maximal velocity swings requiring high level motor skill whilst cognitive functioning is challenged through decision making on every shot, often under intense pressure. Caffeine supplementation has been the most investigated topic with findings of improved performance in certain areas of the game such as driving and putting whilst fatigue appeared to be attenuated towards the end of a round. Dehydration has been shown to be prevalent even in the elite amateur game with a significant decline in a range of performance variables found with only mild-dehydration. Carbohydrate consumption has been shown to prevent the decline in blood glucose experienced over a round, however an optimal consumption protocol has not been established. Future research should further investigate nutritional techniques to offset the physical and mental challenges arising over a round of golf.
Background Evidence supporting the link between diet and health has prompted policy makers to develop nutrition related food labelling as an established communication medium of health messages. However, several studies have demonstrated the difficulty consumers face in understanding and using food labelling information. The recent introduction of Front Of Pack (FOP) labelling schemes, aim to aid consumers in making informed food choices. Whilst there has been substantial research on the perceived need of these systems, there is limited research on the impact they may be having to the consumer and how they may be affecting food choice. Purpose To develop an appreciation of consumers’ current attitudes to and understanding of food labelling, with particular reference to nutritional information. The study aims to assess if the Front of Pack voluntary nutritional labelling schemes are having an impact on consumer understanding of nutrition information and healthy food choice and if these labelling schemes are influencing food purchase decisions. Methods Participants were recruited from the general public. Four focus groups were conducted involving 22 people in total. Thematic analysis was used to analyse the data and build an understanding of consumer interest, perception knowledge and use of food labelling. Results Knowledge and understanding of food label varied across participant groups and within individuals. Use of FOP nutrition labels were used for one off meal purchases but rarely in the context of a whole diet. Consumers were generally confused and distrusting of the variety of different FOP nutrition labelling systems currently in use. Conclusions Individuals who have more of an interest in food labels and a belief in the ability of the information to aid food choice are more likely to use FOP labelling. FOP labelling improved general awareness of food and food choice, limited understanding shown of the relationship between food and health and the ability of FOP labelling to aid food choices that can be part of a healthy, balanced diet.
Expert opinion and information in the public domain suggest that an individual's dietary and nutritional intake may be importance factors in both physical and mental health. However, at this tome in the counselling and psychotherapy field, it is not common for therapists to address issues of dietary intake and nutrition with clients. Further to quantiative studies exploring therapists' inclusion of such factors in their work, this qualitative heuristic study explores the perceptions and beliefs of six qualified counsellors and psychotherapists and how they understand dietary and nutritional information to be relevant as part of the therapeutic process with clients. Data was gathered with semi-structed telephone interviews and analysed using interpretative phenomenologcal analysis. Findings suggests that the personal history and lifestyle of the therapist may be significant in such an approach, as well as the professional maturity of the therapist. Maintaining the therapetic relationship, therapist self-awareness and professional competence were also discussed. Implications for practice include the consideration of multidisciplinary working and developing appropriate training for practitioners in this area.
Objective: To establish whether there is a relationship between nutrition knowledge and dietary behaviour in members of commercial slimming clubs. Design: A self-completed questionnaire on nutrition knowledge, dietary behaviour and factors associated with weight-loss management. Setting: Members of slimming clubs in their home environment. Subjects: The targeted sample comprised of 56 members of slimming clubs in the Greater Manchester area recruited through social media and the local Rosemary Conley slimming club leader. Results: The level of nutrition knowledge in the study population was high, however this was not significantly correlated with dietary behaviour which was poor (r=0.054; p=.694). Similarly, nutrition knowledge and dietary behaviour were not significantly correlated with education levels, age or alcohol consumption (p>.05). However, a significant inverse relationship was found between educational attainment and BMI (r=-0.392, p=.005). Barriers to weight loss were not reported to be major factors by this study group; the greatest benefits of membership were support and encouragement from other members and the club leader. The proportion of returning members was >70%. Conclusions: Dietary behaviour in members of commercial slimming clubs is not significantly influenced by nutrition knowledge. Although healthy eating recommendations can be valuable, other factors are more important for achieving weight loss, particularly support and fellowship from other members. Slimming club members regain the weight lost after leaving the clubs and inevitably re-join.
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