RSS 1.0Clinical Sciences and Nutrition
The Department of Clinical Sciences and Nutrition has an experienced team of researchers, with an international reputation. Their main research themes are Public Health Nutrition and Physical Activity, Cardiometabolic Health, and Clinical Practice.
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Effect of vitamin D3 supplementation on cardiometabolic disease risk among overweight/obese adult males in United Kingdom- A pilot randomised controlled trialBackground Observational studies suggest links between reduced serum 25(OH)D concentration and increased cardiometabolic disease risk. However, these studies provide limited evidence of causation, with few conclusive randomised controlled trials (RCT) having been carried out to date. This RCT investigated the effect of vitamin D3 supplementation on vascular function and cardiometabolic disease risk markers, in fifty-five healthy males aged 18-65 years with plasma 25(OH)D concentration <75nmol/L and BMI ≥24.9kg/m2. Method Participants were assigned to consume 125µg/day (5,000 IU/day) vitamin D3 or placebo for 8-weeks. Blood samples and vascular function measures were obtained at baseline, week 4 and week 8. The primary outcome was arterial stiffness, an indicator of cardiovascular diseases risk (CVD), assessed by pulse wave velocity. Biomarkers of CVD risk, insulin resistance and endothelial function were measured using enzyme linked immunosorbent assay. Results Daily oral intake of 125µg supplemental vitamin D3 led to a significant improvement in plasma 25(OH)D concentrations over the 8-week intervention in the vitamin D group compared to the change in the placebo group (P ˂ 0.001). In the vitamin D group the baseline mean (±SD) 25(OH)D concentration was 38.4 ± 15.9 and this increased to 72.8 ± 16.1 nmol/L after 8 weeks of supplementation. The intervention had no effect on arterial stiffness, as measured by pulse wave velocity (PWV) but vitamin D3 supplementation did lead to a decrease in mean (±SD) brachial pulse pressure from baseline to 8 weeks, by − 2.9 ± 3.4 mmHg, (P = 0.027) in the vitamin D group compared to the same period in the placebo group. The intervention had no effect on the remaining cardiometabolic parameters. Conclusion Overall, treatment significantly improved brachial pulse pressure but no other cardiometabolic disease risk markers. To follow on from this pilot RCT, future large-scale clinical trials over longer durations may offer further insights. Clinical trial registration http://www.clinicaltrials.gov NCT02359214.
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Assessment of serum total 25-hydroxyvitamin D assays for Vitamin D External Quality Assessment Scheme (DEQAS) materials distributed at ambient and frozen conditionsThe Vitamin D External Quality Assessment Scheme (DEQAS) distributes human serum samples four times per year to over 1000 participants worldwide for the determination of total serum 25-hydroxyvitamin D [25(OH)D)]. These samples are stored at −40 °C prior to distribution and the participants are instructed to store the samples frozen at −20 °C or lower after receipt; however, the samples are shipped to participants at ambient conditions (i.e., no temperature control). To address the question of whether shipment at ambient conditions is sufficient for reliable performance of various 25(OH)D assays, the equivalence of DEQAS human serum samples shipped under frozen and ambient conditions was assessed. As part of a Vitamin D Standardization Program (VDSP) commutability study, two sets of the same nine DEQAS samples were shipped to participants at ambient temperature and frozen on dry ice. Twenty-eight laboratories participated in this study and provided 34 sets of results for the measurement of 25(OH)D using 20 ligand binding assays and 14 liquid chromatography–tandem mass spectrometry (LC–MS/MS) methods. Equivalence of the assay response for the frozen versus ambient DEQAS samples for each assay was evaluated using multi-level modeling, paired t-tests including a false discovery rate (FDR) approach, and ordinary least squares linear regression analysis of frozen versus ambient results. Using the paired t-test and confirmed by FDR testing, differences in the results for the ambient and frozen samples were found to be statistically significant at p < 0.05 for four assays (DiaSorin, DIAsource, Siemens, and SNIBE prototype). For all 14 LC–MS/MS assays, the differences in the results for the ambient- and frozen-shipped samples were not found to be significant at p < 0.05 indicating that these analytes were stable during shipment at ambient conditions. Even though assay results have been shown to vary considerably among different 25(OH)D assays in other studies, the results of this study also indicate that sample handling/transport conditions may influence 25(OH)D assay response for several assays.
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Interlaboratory Comparison of 25-Hydroxyvitamin D Assays: Vitamin D Standardization Program (VDSP) Intercomparison Study 2 – Part 2 Ligand Binding Assays – Impact of 25 Hydroxyvitamin D2 and 24R,25- Dihydroxyvitamin D3 on Assay PerformanceAn interlaboratory comparison study was conducted by the Vitamin D Standardization Program (VDSP) to assess the performance of ligand binding assays (Part 2) for the determination of serum total 25-hydroxyvitamin D [25(OH)D]. Fifty single-donor samples were assigned target values for concentrations of 25-hydroxyvitamin D2 [25(OH)D2], 25-hydroxyvitamin D3 [25(OH)D3], 3-epi-25-hydroxyvitamin D3 [3-epi-25(OH)D3], and 24R,25-dihydroxyvitamin D3 [24R,25(OH)2D3] using isotope dilution liquid chromatography-tandem mass spectrometry (ID LC-MS/MS). VDSP Intercomparison Study 2 Part 2 includes results from 17 laboratories using 32 ligand binding assays. Assay performance was evaluated using mean % bias compared to the assigned target values and using linear regression analysis of the test assay mean results and the target values. Only 50% of the ligand binding assays achieved the VDSP criterion of mean % bias ≤ |± 5%|. For the 13 unique ligand binding assays evaluated in this study, only 4 assays were consistently within ± 5% mean bias and 4 assays were consistently outside ± 5% mean bias regardless of the laboratory performing the assay. Based on multivariable regression analysis using the concentrations of individual vitamin D metabolites in the 50 single-donor samples, most assays underestimate 25(OH)D2 and several assays (Abbott, bioMérieux, DiaSorin, IDS-EIA, and IDS-iSYS) may have cross-reactivity from 24R,25(OH)2D3. The results of this interlaboratory study represent the most comprehensive comparison of 25(OH)D ligand binding assays published to date and is the only study to assess the impact of 24R,25(OH)2D3 content using results from a reference measurement procedure.
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Perspectives on Adolescents’ Obesity Amidst the Nutrition Transition in LebanonAdolescent obesity is a major public health concern, increasingly affecting low and middle-income countries (LMICs) undergoing the nutrition transition. In developed countries, governments had the time to adjust to this rise in the consequent non-communicable diseases (NCDs), whereas the developing world is facing a triple burden of nutrition-related disease simultaneously. However, amidst the nutrition transition, drivers to obesity may differ within the same country especially between the urban and rural areas, depending on the context and environmental factors. In order to unravel how the nutrition transition process unfolds in both urban and rural areas, an exploration of the factors affecting adolescents’ lifestyle and eating behaviours, in the current context was deemed appropriate. Additionally, exploring stakeholders’ views on adolescents’ obesity including facilitators and barriers to obesity prevention is key in intervention and policy drawing. This study thus aimed to explore in-depth, whether, how, and to what extent is the nutrition transition currently affecting adolescents’ environments in Lebanon, focusing on both adolescents’ and stakeholders’ perspectives, awareness, and barriers to the prevention of adolescents’ obesity. The study used a sequential multi-method approach along a bricolage methodology. The first phase of the study adopted a qualitative approach, involving focus groups with adolescents (n = 78) to explore their perceptions regarding their eating behaviours as well as the role of the environment surrounding them in both urban and rural areas. A number of direct (availability of Western foods, peer pressure, parental control, eating location, body image) and indirect (adolescence autonomy, role modeling, cultural beliefs, peer surveillance) factors seemed to influence adolescents’ eating behaviours. Almost similar behaviours were perceived between the urban and rural area, showcasing the impact of the nutrition transition in both areas although different underlying factors were stated. The factors identified in this study were grouped and discussed based on the socioecological model (SEM) highlighting the importance of the social and environmental influences on adolescents’ eating behaviours. The second phase of the study adopted a qualitative approach; using one-to-one interviews to investigate stakeholders’ opinions on adolescents’ obesity. The study highlighted the barriers and facilitators in preventing adolescents’ obesity in relation to adolescents’ eating behaviours and the surrounding environment. Key stakeholders interviewed in this phase included different sectors such as the Ministry of Education, Municipalities, Transportation NGOs, with a special emphasis on the school setting including school directors, manager of school cafeteria, sports teacher, school nurse and head teacher. Interviews revealed the lack of awareness concerning the obesity problem and the importance of the environmental influences, a lack of intersectoral cooperation between stakeholders in Lebanon and a greater emphasis on the individual responsibility in the prevention of adolescents’ obesity. This study has revealed and engaged with the varied conceptualisations of obesity causation amongst adolescents, in both urban and rural areas, amid the nutrition transition in Lebanon. Acknowledging that the causes of obesity are complex this study collects insights of both adolescents and key stakeholders’ perceptions; to date, no study has engaged with both in Lebanon, justifying the need for the present study. Clearly, in keeping with the literature on the different rate of nutrition transition between rural and urban environments further justifies the consideration of both context. Given the findings of this study in regards to the dramatic changes affecting both urban and rural areas regarding the number of meals consumed away from home, the increase in fast-food consumption and the increase in sedentary lifestyles, new challenges in relation to adolescent obesity prevention in LMICs are created. The creation of supportive local environments, in both urban and rural areas, represents an important avenue where eating behaviours concerns, and thus adolescents’ obesity can be addressed.
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Assessment of serum total 25-hydroxyvitamin D assay commutability of Standard Reference Materials and College of American Pathologists Accuracy-Based Vitamin D (ABVD) Scheme and Vitamin D External Quality Assessment Scheme (DEQAS) materials: Vitamin D Standardization Program (VDSP) Commutability Study 2An interlaboratory study was conducted through the Vitamin D Standardization Program (VDSP) to assess commutability of Standard Reference Materials® (SRMs) and proficiency testing/external quality assessment (PT/EQA) samples for determination of serum total 25-hydroxyvitamin D [25(OH)D] using ligand binding assays and liquid chromatography-tandem mass spectrometry (LC-MS/MS). A set of 50 single-donor serum samples were assigned target values for 25-hydroxyvitamin D2 [25(OH)D2] and 25-hydroxyvitamin D3 [25(OH)D3] using reference measurement procedures (RMPs). SRM and PT/EQA samples evaluated included SRM 972a (four levels), SRM 2973, six College of American Pathologists (CAP) Accuracy-Based Vitamin D (ABVD) samples, and nine Vitamin D External Quality Assessment Scheme (DEQAS) samples. Results were received from 28 different laboratories using 20 ligand binding assays and 14 LC-MS/MS methods. Using the test assay results for total serum 25(OH)D (i.e., the sum of 25(OH)D2 and 25(OH)D3) determined for the single-donor samples and the RMP target values, the linear regression and 95% prediction intervals (PIs) were calculated. Using a subset of 42 samples that had concentrations of 25(OH)D2 below 30 nmol/L, one or more of the SRM and PT/EQA samples with high concentrations of 25(OH)D2 were deemed non-commutable using 5 of 11 unique ligand binding assays. SRM 972a (level 4), which has high exogenous concentration of 3-epi-25(OH)D3, was deemed non-commutable for 50% of the LC-MS/MS assays.
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Public Policy for Obesity Prevention in LebanonBackground: In Lebanon, the population is experiencing nutrition transition and a high prevalence of obesity. Studies have shown that the Lebanese people are shifting their dietary behaviours from the traditional Lebanese diet, a variation of the Mediterranean diet, towards a westernised diet and are being physically inactive. To achieve a population behaviour change and address the obesity epidemic, the root causes of these behaviours and food choices should be explored and addressed. This approach requires joint efforts from different sectors such as the government, healthcare, and civil society to develop action plans and enact policies. In Lebanon, the factors that influence eating behaviours and physical activity are still not explored, national level policies are still lacking, and researchers have called for an urgent need to implement policies to halt the rise of obesity prevalence. Aims and objectives: The general aim of this thesis is to explore the perceived factors that influence adults’ eating behaviours and physical activity using the socio-ecological model as the conceptual framework. In addition, this PhD research explores the relevant contribution and the position of different stakeholders towards obesity prevention in Lebanon. Finally, this thesis draws on lessons learned from countries worldwide that help in developing guidelines for obesity prevention in Lebanon. Methods: Two studies were conducted for this PhD research. In the first study, the Photovoice method was used to engage Lebanese adults from the North Governorate to explore different factors that influence their eating behaviours and physical activity and to identify their perceptions towards the actions needed to address obesity. The second study involved a series of one-to-one face-to-face semi-structured interviews which were conducted with key stakeholders from different public and private sectors (government, civil society, education, and healthcare). These interviews aimed to explore the key stakeholders’ perceptions towards obesity and its causes, their relevant contribution towards obesity prevention, their priority of action to address obesity, and finally the barriers to effective action to reduce obesity in Lebanon. Results: The findings of the two qualitative studies show that obesity is commonly perceived as a body image issue rather than a health issue. Some of the main factors that were perceived to influence Lebanese adults’ eating behaviours and physical activity were: females’ (wives’ and mothers’) employment, social gatherings, and social norms (e.g. food and meal sharing), safety concerns, the availability of countless unhealthy food options that are relatively cheaper than healthy food, the lack of a physical environment that encourages physical activity, and food marketing and advertisements. The results of the stakeholder’s interviews show that the key stakeholders are aware of the nutrition transition and some of the underlying environmental factors that caused these behaviour changes. Yet, most of the key stakeholders framed obesity in an “individualistic approach” by focusing on unhealthy dietary behaviours, the physical inactivity and placed the responsibility on individuals for their lifestyle. Due to their approach, most of them focused their actions on raising awareness such as the role of education. Some of the barriers to effective policy action to address obesity in Lebanon are the political instability, lack of public demand for action, and lack of coordinated multi-sectoral actions. Implications: The recognition of obesity as a disease as well as strengthening the public, stakeholders’, and policymakers’ support towards obesity prevention strategies are essential to overcome the “policy inertia” in Lebanon. The key areas that need to be addressed for obesity prevention are raising awareness on obesity health consequences, increasing access to healthy food in public and private settings, limiting unhealthy food advertisements, and fiscal measures such as taxing unhealthy food and subsidising healthy food. To facilitate the implementation of policies that aim to prevent obesity, a systematic plan of action should be developed. To engage stakeholders from different sectors and establish a national multi-sectoral collaboration, national strategies and policies that follow a Health in all Policies Approach (HiPA) are recommended. This requires strong leadership from the government. Conclusions: There is an urgent need to shift the actions beyond targeting the individual by implementing public policies to address the obesogenic environment in Lebanon. Recommendations for research, policy actions, and practice are provided to guide the action towards establishing an appropriate public policy that recognises the need to adopt a socioecological model of implementation.
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An Exploration into the Impact of Social Networking Site (SNS) Use on Body Image and Eating Behavior of Physically Active MenThe rapid proliferation of social networking sites (SNSs) has transformed the way people now socialize and communicate. SNSs have been recognized to contribute to body image (BI) dissatisfaction and disordered eating behavior (EB). Few qualitative studies have explored this issue in men. The aim of the current study was to investigate male SNS use and possible impacts on BI and EB. One-to-one semi-structured interviews were conducted with eight men in the United Kingdom. Interviews aimed to examine men’s views on the potential impact of SNSs on BI and EB. Data were thematically analyzed. Findings suggested that SNSs may be a useful nutrition idea tool and motivational platform for men to improve their diet and exercise uptake. However, results also indicated that SNS use may contribute to BI dissatisfaction and increased risk of disorder. Future research may identify risk factors of SNS use, male BI concerns, and eating pathology across the lifespan.
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Leading brand products and their supermarket economy line equivalents, is there a difference in nutritional content?Since the introduction of supermarket economy lines (SELs) in the early 1990s, their popularity has been established nationwide(1).However, these economical alternatives are commonly perceived to be of lower nutritional quality than their leading brand (LB)equivalents(2,3,4). The present study aimed to determine if there is a significant difference in nutritional content between the UKtop-selling LBs and their SEL equivalents. Additionally, the study aimed to investigate if on average, LBs or SELs provide better‘value for money’.The LBs of 38 most popular food categories were identified from UK market research, and equivalent SEL products were identifiedfrom each of the retailers with the top-five majority UK market share: Tesco, Sainsbury’s, Asda, Morrisons and Aldi. In each foodcategory, differences between LBs and SELs in: energy, fat, saturated fatty acid, carbohydrate, sugar,fibre, protein and salt content,per 100 g of food product were determined using a one-sample T-test. The nutritional quality of each product was also determined bya nutrient profiling system. Cost was analysed in relation to shopping baskets containing 33 equivalent products. Six shopping basketswere analysed, one containing LB products and one from each SEL retailer. The cost of each shopping basket was calculated usingpack price and price per 100 g or 100mL of food product.Data was collected for 219 products; 38 LBs and 181 SELs. 86 significant differences were identified in specific nutrients across thefood categories, but the direction of the differences was inconsistent. Based on pack price, the total LB shopping basket cost was£61·91 whereas average SEL basket cost £28·62, a difference of £33·29 or 54 % (P = 0·001). However, there was no difference betweenthe nutrient profile of LBs and SELs.Although significant differences were identified between nutrients in some food categories, overall, there appeared to be no differ-ence in nutritional content between LBs and SEL equivalents. This association is consistent with previous studies and is contrary tothe common perception that SELs are of lower nutritional quality than LBs(2,3,4,5,6). Pertinent to public health, the present studyfound that SEL breakfast cereals contained a significantly higher amount of salt than the LB (P = 0·035)(4,6). Additionally, althoughthe majority of food categories did not show a significant difference in energy content per 100 g of food product (29 of 38) LB pastahad significantly higher energy content per 100 g of food product than SEL equivalents (P = 0·017)(6).In conclusion, there appears to be no difference in nutritional content between the LB and SEL equivalents in 38 popular foodcategories, however, there appears to be twofold difference in price The cost analysis demonstrates that consumers can purchasethe same quantity of foodstuff for significantly less when opting for SEL products. Low income households may therefore be encour-aged to purchase SEL products to reduce weekly household expenditure and enable a greater proportion of the budget to be availablefor the purchase fresh produce such as fruit, vegetables and meat
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Estimates of fibre intake and percentage of the population with intake below the dietary reference values (DRVs) in England (1991–2015)In 1991, the Committee on Medical Aspects of Foods (COMA) defined dietary fibre as non-starch polysaccharides (NSP) and set the DRV as the population average intake of 18 g/day 1 , determined using the Englyst method of analysis 2 . The latest publication of the Scientific Advisory Committee on Nutrition (SACN) 3 broadened the definition of dietary fibre beyond NSP to broader definition of Association of Analytical Communities (AOAC) fibre, recommending the DRV to be 30 g/day based on AOAC method. The COMA 1991, DRV of 18 g/day of NSP corresponds to around 24 g/day of AOAC fibre 3 and therefore the new DRV of fibre would represent a higher recommendation (around 22·5 g fibre as per the Englyst method) for the average population. The purpose of this study was to investigate variation in fibre intake of English population by age and gender, in comparison with the COMA and SACN DRVs. Data on the core sample of the National Diet and Nutrition Survey rolling programme from 2008–2012 was reanalysed. Children aged below 16 years were excluded in consideration of their different DRVs. The data on dietary fibre was extracted from fully productive individuals (i.e. participants who completed three/four diary days), as an average daily intake based on the NSP/Englyst fibre. Inferential statistics included the analysis of variance to discover if there were any significant variations in fibre intake of males and females in relation to their age groups. The statistical significance was set at 0·05. For all age groups, the average fibre intake is below the DRVs. The average daily fibre intake slightly increased with age for both genders until 64 years. When differences in energy intake were taken into account, the average daily fibre density (g/1000 kcal) still increased with the age of participants. Overall, less than a third of populations had an intake above the COMA DRV 1 . More than 90 % of the population had intake below the SACN DRV 3 , demonstrating a challenge for future policies to meet the nutritional guidelines, particularly amongst females and younger adults. The findings should be treated with caution considering the definition of AOAC fibre used as the basis for the SACN DRV includes non-digestible oligosaccharides, resistant starch and polydextrose, going beyond NSP/Englyst variables analysed.
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Full fat cheese intake and cardiovascular health: a randomised control trialMilk and milk products contribute approximately 22 % of the nation's saturated fat (SFA) intake. Recently, the role of dairy and its SFA composition and link to cardiovascular disease (CVD) has been analysed( 1 ), suggesting a beneficial action of this food group on reducing cardiovascular risk in high-risk groups( 2 , 3 ). The aim of this study was to examine the effects of 4 weeks full-fat cheese on circulating lipoprotein fractions, blood pressure and arterial stiffness in healthy adults. Participants were recruited in the city of Chester, UK. Those meeting entry criteria of: 18–65 years of age, not taking antihypercholesterolaemic or antihypertensive medication took part in the study. Participants were randomised to receive either 50 g of a full-fat Red Leicester (FFC) or placebo (virtually zero fat Cheddar cheese, ZFC) per day for 4 weeks. Anthropometry, blood pressure, brachial and aortic augmentation index (BAIX and AAIX, respectively), pulse-wave velocity (PWV) and a full lipid profile were determined at baseline and post-intervention. Participants were asked to keep a 3-day food diary prior to and for the last 3 days of the protocol. All procedures were approved by the Faculty of Medicine, Dentistry and Life Sciences Research Ethics Committee at the University of Chester. Eighty-six (86) individuals completed the study (43 per group). No significant changes were observed in any measured parameter (Table 1). Both ZFC and FFC groups showed a significant increase in calcium intake during the course of the study (1002·1 ± 639·1 mg to 1815·0 ± 1340·1 mg and 1219·6 ± 1169·1 mg 1845·8 ± 1463·2 mg, P < 0·001, respectively) showing good adherence to the protocol. In conclusion, these results suggest that inclusion of 50 g full fat cheese into the diet of a healthy population does not impact negatively on traditional CVD risk markers. Future strategies to reduce SFA intake should focus on – and acknowledge the importance of the source – of SFA in the diet.
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Effect of a single serving of pecan nuts on blood lipids and weight: a single blind randomised control trialNuts are a common component of many traditional cardioprotective diets primarily due to their ability to lower blood lipids and reduce cardiovascular risk(1, 2). Studies consistently show nut intake is associated with favourable changes in energy balance(3). However there is a paucity of data examining the acute changes following nut consumption. We sought to examine the effect of a single serving of pecan nuts on plasma lipids and bodyweight. Participants were sampled from the University of Chester, UK. Individuals (n = 54) were screened for eligibility to participate. Those meeting entry criteria (n = 25) of being either male or female aged 30 years or more and with no previous history of CVD were randomised to either a control (CON) or pecan nut group (PECAN). Participants in the PECAN group received a single 50 g serving of pecan nuts. Capillary blood was taken for analysis of triacylglycerol, total-cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein-cholesterol and non-high density lipoprotein cholesterol (TAG, TC, LDL-C, HDL-C and non-HDL-C, respectively), and anthropometric measurements were performed. All measurements were repeated after 3 days. Participants were instructed to record all food and drink consumed, and not to change their habitual eating habits. Procedures were approved by the Faculty of Medicine, Dentistry and Clinical Sciences Research Ethics Committee, University of Chester. No significant effect on TC, HDL-C or TAG was observed during the study (Fig. 1A–C). LDL-C decreased by 0.09 ± 0.37 mmol/L and increased by 0.16 ± 0.40 mmol/L in CON and PECAN groups, respectively. Non-HDL-C showed a similar pattern with the CON group showing a decrease and PECAN group displaying an increase (−0.18 ± 0.36 mmol/L vs. 0.16 ± 0.40 mmol/L, respectively). Bodyweight significantly (P = 0.025) decreased in the PECAN group when compared to the CON group (−0.58 ± 0.56 kg vs. −0.05 ± 0.55 kg, respectively). In conclusion, a single serving of pecan nuts had no significant impact on lipid markers of cardiovascular risk. Bodyweight was significantly reduced consistent with recent literature showing a favourable relationship with nut intake and energy balance(3).
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Acute and chronic effects of beetroot supplementation on blood pressure and arterial stiffness in humansDietary supplementation of beetroot juice, containing nitrate- a potent vasodilation agent, has been shown to be vasoprotective( 1 ), and dose dependent decreases in blood pressure (BP) have been previously demonstrated(2,3). To our knowledge there has been only one study investigating the effect of beetroot supplementation in humans on arterial stiffness, measured using pulsewave velocity (PWV) and, although there was no effect of supplementation on PWV, there was a significant reduction due to beetroot supplementation in acute diastolic BP (3hrs, P = 0·023)( 4 ). A double-blind, randomised, cross-over intervention trial was carried out in a cohort of 12 healthy male participants (mean age (SEM) = 43 (2·1) yrs, BMI = 27·8 (1·1) kg.m2) who underwent both beetroot juice and placebo supplementation for 14 days. The aim of the study was to assess the effect of 6·45 mmol of nitrate in a concentrated 70 ml beetroot drink (James White Ltd, Ipswich, UK) on systolic and diastolic BP, mean arterial pressure (MAP) and arterial stiffness (PWV, aortic augmentation index (Aix), brachial Aix) in humans. BP and arterial stiffness measurements weretaken using PWV (Arteriograph, TensioMed,Hungary). Measurements were taken intriplicate at baseline, 3 hours post-supplementation (either beetroot juice orplacebo) and post-intervention (day 15). This was followed by a 7-day washoutperiod before participants were transferred to the alternate supplement. Table 1 shows that there was no significant acute or short term effect of beetroot juice supplementation on the parameters measured when compared to placebo. However, there was a significant decrease in systolic BP (P = 0·009), diastolic BP (P = 0·035), MAP (P = 0·017), aortic and brachial AIX (P = 0·042 and 0·041 respectively), 3hours post beetroot supplementation. These results confirm previous findings( 4 ) that beetroot supplementation does not have an acute or short term effect on arterial stiffness measures. However, acute effects on arterial stiffness and BP within the beetroot juice supplementation group were observed. Further large scale studies on dietary nitrate supplementation and cardiovascular health are required to further assess efficacy.
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Dietary supplementation with n-3 fatty acids (n-3 FA) for 4 weeks reduces post-exercise fatigue and delayed onset muscle soreness (DOMS) in trained male athletesHigh intensity exercise in the form of eccentric contractions can lead to the formation of free radicals, stimulating an inflammatory response( 1 , 2 ). Consumption of n-3 FA may help modify inflammation and immune reactions beneficial to health by decreasing interleukin-6, tumour necrosis factor-alpha and C-reactive protein( 3 ). For trained athletes to improve athletic performance, recovery from training is important and DOMS is frequently experienced following eccentric exercise, impacting negatively on strength( 4 ). The Western diet is however, characterised by a high n-6 FA consumption relative to n-3 FA, formulating ratios often in excess of 16:1( 5 ). The use of non-steroidal anti-inflammatory drugs in the form of n-3 FA has been investigated by a number of clinical trials in untrained athletes, but whether this can be translated into attenuating exercise induced inflammation in trained athletes is still under investigation. A double-blind, randomised controlled trial was conducted in 22 trained male athletes who supplemented their diet with either 3000 mg/d of fish oil (gel capsules) consisting of 990 mg eicosapentaenoic acid (EPA) and 660 mg docosahexaenoic acid (DHA) (n = 11), or 3000 mg/d olive oil placebo (n = 11), for 28d. Participants underwent 3 sets of eccentric bicep curls in their dominant arm until failure and arm circumference, number of repetitions completed and DOMS/fatigue scores via visual analogue scale (VAS) were recorded at 0, 24 and 48 h after exercise, pre and post supplementation. No group performed better during the eccentric bicep test, pre and post supplementation, and at baseline, no differences were observed between groups for DOMS and fatigue. However, post supplementation, DOMS was significantly lower at 24 h (P = 0·005) and 48 h (P = 0·002) and fatigue was significantly lower at 24 h (P = 0·043) and 48 h post exercise (P < 0·001) in the n-3 FA group compared to the placebo group (Fig. 1). These findings indicate that n-3 FA supplementation has the potential to promote recovery and subsequently increase athletic performance in trained male athletes and may be a useful ergogenic aid. Possible anti-inflammatory mechanisms of n-3 FA should be further investigated using specific biomarkers of inflammation.
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Estimation of fruit and vegetable consumption in a cohort of Ghanaian women and evaluation of knowledge, attitudes and practiceNon-communicable diseases (NCDs), previously confined to industrialised nations, are spreading through the developing world at unprecedented rates( 1 ). With communicable diseases still prevalent, this imposes a double-burden of disease in countries with limited resources and ill-equipped health systems( 2 ). An unhealthy diet, including insufficient consumption of fruit and vegetables is one of four main behavioural risk factors in the development of NCDs. However, consumption across the world, including Ghana, is below recommended levels( 3 ). Despite a wealth of research in developed countries, few studies have investigated barriers to fruit and vegetable consumption in Ghana. The aim of the present study was to assess fruit and vegetable consumption and evaluate knowledge, attitudes and practice in a cohort of Ghanaian women. A mixed-methods approach, incorporating a survey delivered in a guided interview format was utilised to investigate patterns and determinants of fruit and vegetable consumption in a cohort of Ghanaian women. Data were collected from female environmental health and nursing students aged 18–33 years (n=74, response rate 98.7%), residing in the Korle-Bu district of Accra, Ghana. A 24-hour recall questionnaire, local handy measures and a specially designed portion size assessment sheet allowed estimation of fruit and vegetable consumption, whilst a questionnaire comprising both qualitative and quantitative questions enabled investigation of barriers to consumption in Ghanaian society. A significantly greater level of low fruit and vegetable consumption was found in the present study (69%), than detailed in the World Health Survey 2002–03 (p⩽0.001). There was a significant positive association between meal frequency and consumption levels (p=0.025), however, no association was found between consumption and knowledge levels, income, home-production or perceived adequate consumption. Themes emerging from the research related to barriers affecting consumption included cost, availability, quality, and health and safety issues. Unhealthy snacking was found to be common, as were unhealthy substitutions during periods of scarcity. Numerous barriers causing the observed decrease in fruit and vegetable consumption were identified in the present study. The interrelating nature of the barriers identified suggests a multidirectional approach to address these issues would offer the greatest benefits for consumption levels. Increasing agricultural infrastructure is key, whilst educational initiatives should also play a major role in future strategies to increase fruit and vegetable consumption. Future investment and policy in Ghana should focus on prevention rather than cure, if the growing NCD burden is to be halted.
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Dietary vitamin D supplementation improves haematological status following consumption of an iron-fortified cereal: an 8-week randomised controlled trialVitamin D, a secosteroid, has recently been implicated in the stimulation of erythroid precursors and ultimately the rate of erythropoiesis. However, there are a paucity of randomised controlled trials (RCT), investigating the effect of vitamin D supplementation iron status, especially in populations at risk of iron deficiency. An eight-week, double-blind RCT was carried out in 50 female (mean age (± SD): 27 ± 9 years), iron-deficient (plasma ferritin concentration < 20 μg/L) participants, randomised to consume an iron-fortified cereal containing 9 mg of iron, with either a vitamin D supplement (1,500 international units (IU)/day, 38 μg/day) or placebo. The effect of dietary vitamin D supplementation on haematological indicators was investigated. Blood samples were collected at baseline, 4-weeks and 8-week timepoints for measurement of iron and vitamin D status biomarkers. The effect of intervention was analysed with a mixed-model repeated measures ANOVA using IBM SPSS statistical software (Version 21, IBM Corporation, New York, USA). Significant increases were observed in two haematological parameters: 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 than in the placebo group (131 ± 15 to 128 ± 13 g/L) (P ≤ 0.05). 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 49 ± 3.4%) compared to the placebo group (41.2 ± 4.3 to 40.7 ± 3.6%) (P ≤ 0.05). Despite non-significant changes in plasma ferritin concentration, this study demonstrates that dietary supplementation with 1,500IU vitamin D, consumed daily with an iron-fortified cereal led to improvement in haemoglobin concentration and haematocrit levels in women with low iron stores. Further long-term studies are required, however, these findings suggest a potential role for improvement of vitamin D status as an adjunct therapy for recovery of iron status in iron-deficient populations.
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Dietary vitamin D consumption, sunlight exposure, sunscreen use and parental knowledge of vitamin D sources in a cohort of children aged 1–6 years in North West EnglandHospital admission for children with rickets in England has dramatically increased, from <1 child per 100,000 in the early 1990's to 4·78 (4·58–4·99) per 100 000 between 2007 and 2011( 1 ). The re-emergence of rickets thus suggests poor vitamin D status( 2 ). Additionally, there has been a plethora of publications associating low vitamin D status with many adverse health outcomes other than the classical role of vitamin D in the development, maintenance and function of a healthy skeleton( 3 ). Vitamin D is a fat lipophilic steroid pro hormone obtained from few foods in the diet. However, the majority (90–95%) of vitamin D is synthesised from exposure of bare skin to sunlight( 4 ), and casual sunlight exposure has been considered adequate for the majority of the population. Consequently, there is no reference nutrient intake (RNI) for ages 4–65 yrs( 5 ). With modern indoor lifestyles, cautious sun screen usage and changes in food habits, sunlight exposure may no longer be sufficient to maintain adequate vitamin D status. To avoid vitamin D deficiency, supplementation and fortification may need to play a more prominent role in everyday lives( 6 ). The aim of the present study was to investigate vitamin D dietary intake in children, parents’ knowledge of vitamin D sources, children's outdoor habits and sun screen application practices. A retrospective, cross sectional study approach was utilised. Parents of children (n = 42) aged between 1 and 6 yrs completed a semi-validated food frequency questionnaire, a sources of vitamin D knowledge questionnaire, and a sunlight exposure and sunscreen use questionnaire, in Adlington, N.W. England (latitude 55oN) during May 2013. Children's mean (±SD) dietary vitamin D intake was 4·4 ± 2·5 μg/d, significantly lower than 7μg/d (P = < 0·001, for comparison 7μg/d, the RNI for ages 3 months-4 yrs was used). As expected, children taking supplements had a significantly higher mean (±SD) vitamin D intake (8·49 ± 1·78 μg/d) compared to those that did not supplement (3·34 ± 1·23 μg/d, P < 0·001). The greatest contribution to dietary vitamin D intake from food was from butter and spreads (0·028μg/d), followed by cakes, biscuits & scones (0·023μg/d). Parents' knowledge of food sources was poor, with a mean (±SD) incorrect response of 76% ±11·2. Contrastingly, 93% correctly identified sunlight exposure as a potential source of vitamin D. Eighty nine percent of participants played outdoors daily for 1 hour or more, 81% used sunscreen with an SPF ≥30 and only 2% rarely applied sunscreen. This study revealed that children's diet in the NW England is lacking sufficient vitamin D content, in line with larger surveys( 7 , 8 ). Parents' knowledge regarding vitamin D dietary sources was poor but 93% of parents knew that sunlight was the non-dietary source of vitamin D. Outdoor play indicated sufficient exposure time to produce endogenous vitamin D but sunscreen usage may have potentially diminished epidermal UVB exposures. Further research is needed using biomarkers to confirm vitamin D insufficiency, and public health strategies should be implemented to promote existing recommendations regarding supplementation and consumption of vitamin D rich foods. Additionally, guidelines for safe sun exposure and sunscreen use are required.
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Nutrition knowledge and dietary intake of hurlersThe current study investigated the association between sports nutrition knowledge and dietary quality in a sample of adult Irish male hurling players. Nutrition knowledge was measured by the validated Sports Nutrition Knowledge Questionnaire (SNKQ). Diet quality was measured by the Australian Recommended Food Score (ARFS) calculated from food frequency questionnaire data. Analysis of variance and linear modelling were used to assess associations between variables. A total of 265 (129 elite, 136 sub-elite) players were recruited. No significant difference in nutrition knowledge (SNKQ) was found between groups. Results showed a significant difference (p = 0.02; d = 0.39 ± 0.25; small) in food score (ARFS) between groups. A weak, positive association (r = 0.3, p = 0.007) was found between nutrition knowledge and food score. Elite level players, aged 28–32, with college degrees, that have previously received nutritional guidance displayed the highest levels of both nutrition knowledge and food score. Higher levels of nutrition knowledge and food score were expected in elite players, however were only found in food score. Nutrition knowledge does contribute to dietary quality although future interventions should focus on specific gaps in knowledge such as how to meet total energy/carbohydrate requirements.
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A call for action on the development and implementation of new methodologies for safety assessment of chemical-based products in the EU – A short communicationSafety assessment of chemicals and products in the European Union (EU) is based on decades of practice using primarily animal toxicity studies to model hazardous effects in humans. Nevertheless, there has been a long-standing ethical concern about using experimental animals. In addition, animal models may fail to predict adverse effects in humans. This has provided a strong motivation to develop and use new approach methodologies and other alternative sources of evidence. A key challenge for this is integration of evidence from different sources. This paper is a call for action with regard to development, validation, and implementation of modern safety assessment approaches for human health assessment by means of focused applied research and development with three strands: (a) to improve screening and priority setting, (b) to enhance and partially replace animal studies under the current regulatory schemes and eventually (c) to fully replace animal studies, while achieving at least the same level of protection. For this gradual but systematic replacement of animal studies, a long-term concerted and coordinated effort with clear goals is needed at EU level, as a societal and political choice, to plan and motivate research and innovation in regulatory safety assessment.
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A validated food frequency questionnaire to determine dietary intake of vitamin DObjective The aim of the present study was to develop and validate a vitamin D food frequency questionnaire (FFQ) for assessment of dietary vitamin D intake in healthy adults in England, UK. Design: The current study assessed the agreement between a four-day food diary (4d-FD) and a new vitamin D FFQ to measure dietary intake of vitamin D. Dietary intake was estimated using Nutritics dietary analysis software and Spearman’s and Bland-Altman tests were utilised to assess correlation and agreement, respectively. Participants also provided a blood sample for plasma analysis of vitamin D concentrations. Setting: Home setting. Participants: Fifty participants were recruited to the study from the University of Chester and vicinity. Results: Results showed a strong correlation between vitamin D intake recorded by the FFQ and the 4d-FD (r = 0.609; P < 0.0001) within 95% limits of agreement. Furthermore, a significant correlation between plasma 25(OH)D concentrations and vitamin D intake measured by the FFQ (r = 0.290, P = 0.041) and the 4d-FD (r = 0.360, P = 0.01) was observed. Conclusion: Our analysis suggests this FFQ is a useful and rapid tool for researchers and health professionals to assess vitamin D dietary intakes in healthy adults in the UK.
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Bioavailability of Orally Administered Active Lipid Compounds from four Different Greenshell™ Mussel FormatsAbstract: Greenshell™ mussel (GSM, Perna canaliculus) is New Zealand’s most important aquaculture species. They are a good source of long chain-polyunsaturated fatty acids (n-3 LC PUFA). Beyond a traditional food product, GSMs are also sold as mussel powders and oil extract formats in the nutraceutical markets. In this study, a four-sequence, single dose, randomized crossover human trial with eight evaluable healthy male participants was undertaken to determine the bioavailability of the n-3 LC PUFA in four different GSM formats (oil, powder, food ingredient and half-shell unprocessed whole mussel) by measuring area under the curve (AUC) and maximal concentration (CMax). Blood samples were collected at baseline and up to 48 h after initiation of product consumption in each administration period. There were minor differences between the bioavailability of FA (fatty acid) between the different GSM formats. Eicosapentaenoic acid (EPA) peak concentrations and plasma exposures were significantly lower with GSM oil compared to GSM half-shell and GSM powder formats, which resulted in AUC0–48 for the intake of GSM half-shell mussel and GSM powder being significantly higher than that for GSM oil (p = 0.013, f= 4.84). This equated to a 20.6% and 24.3% increase in the amount of EPA present in the plasma after consumption of half-shell mussels and mussel powder respectively compared to GSM oil. GSM oil produced the shortest median time to maximal plasma n-3 LC PUFA concentration of all evaluated products demonstrated by a shorter maximum measured plasma concentration (TMax = 5 h). Docosahexaenoic acid (DHA) and n-3 LC PUFA plasma exposure parameters were statistically comparable across the four GSM products evaluated.
