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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SCCS Opinion on Biphenyl-2-ol and Sodium 2-biphenylolate used in cosmetic products (CAS/EC No. 90-43-7/201-993-5 and 132-27-4/205-055-6)– SCCS/1669/24‘Biphenyl-2-ol’ and ‘Sodium 2-biphenylolate’ (CAS/EC No. 90-43-7/201-993-5 and 132-27-4/205-055-6) are known with the INCI names ‘o-Phenylphenol’ and Sodium ‘o-Phenylphenate’, respectively, as cosmetic ingredients. The use of o-Phenylphenol as a preservative is currently authorised in entry 7 of Annex V to the Cosmetics Regulation (EC) No.1223/2009, with a maximum concentration of 0.15 % (as phenol) in leave-on and 0.2 % (as phenol) in rinse-off cosmetic products. The Scientific Committee on Consumer Safety (SCCS) adopted an opinion on o-Phenylphenol (OPP), Sodium o-Phenylphenate (SOPP), and Potassium o-Phenylphenate (POPP) (SCCS/1555/15) in June 2015, later revised on 15 December 2015, with the following conclusion: ‘Based on the information provided, no conclusions of safe use can be drawn for Sodium o-Phenylphenate and Potassium o-Phenylphenate’. In 2018, the SCCS released an addendum to the above scientific opinion, specifically addressing Sodium o-Phenylphenate, Potassium o-Phenylphenate, and MEA o-Phenylphenate. The SCCS concluded that ‘Due to the lack of relevant information, the SCCS is unable to answer the question regarding the safe use level of sodium-OPP, potassium-OPP, and MEA-OPP. In the SCCS's view, a direct comparison between the safety of o-Phenylphenate (OPP) and its three compounds cannot be made’. The conclusions of this opinion resulted in amending entry 7 of Annex V to the Cosmetics Regulation, removing from the list the previously authorised OPP salts. It should be noted that o-Phenylphenol, Sodium and Potassium o-Phenylphenate are active ingredients in broad-spectrum fungicides surface biocides. Under EU biocidal Regulation (EU) 528/2012, o-Phenylphenol has been evaluated for the different product types (PTs) such as PT 1, PT 2, PT4, PT 6 as a preservative ranging from 0.1 to 0.5 % w/w. The European Risk Assessment Committee (RAC) of ECHA issued in December 2022 an opinion recommending among others a classification for o-Phenylphenol as ‘Carcinogen of Category 2’. Following the RAC opinion, the European Commission may propose a classification for o-Phenylphenol as a ‘Carc.2’ (CLP Regulation Annex VI entry). According to Article 15(1) of the Cosmetics Regulation ‘the use in cosmetic products of substances classified as CMR substances, of category 2, under Part 3 of Annex VI to Regulation (EC) No 1272/2008 shall be prohibited. However, a substance classified in category 2 may be used in cosmetic products where the substance has been evaluated by the SCCS and found safe for use in cosmetic products’. In view of these provisions, regulatory measures must be adopted by the Commission services within 15 months of the classification as CMR 1A or 1B of the substance(s) concerned in Part 3 of Annex VI to Regulation (EC) No 1272/2008. In December 2023, the Commission services received a dossier to defend the safe use of o-Phenylphenol, as well as its sodium salt (CAS/EC No. 90-43-7/201-993-5 and 132-27-4/205-055-6) as preservatives in cosmetic products according to Article 15(1) of the Cosmetics Regulation 1223/2009. The Commission, therefore, requests the SCCS to carry out a safety assessment on these ingredients in view of the information provided.
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An Investigation of Hydrocolloids Film Forming Ability on a Vertically Rotating DiscHydrocolloids are widely used in the food industry to perform variety of functions such as coatings, thickening, emulsifying, stabilizing and edible films. Their functionality for a given application are underpinned by the molecular weight, shape, and conformation in aqueous solution. The film forming ability of selected hydrocolloids, different in shape (rod, random coil and spherical) and/or conformation in aqueous solution were investigated experimentally and numerically on a vertically rotating disc. These include: xanthan, pectin, carboxymethyl cellulose (CMC) and gum arabic. The Laser scan method was used for the measurement of film thickness of the respective the hydrocolloids. The Volume of Fluid (VOF) Computational Fluid Dynamics (CFD) modelling approach was used in the numerical model. The variation in film formation at different concentrations has been observed to ascertain a trend. Both the experimental and simulation results revealed that the film formation depends on the molecular structure of the hydrocolloid while viscosity and rotating speed significantly influenced the film thickness. Xanthan showed higher film formation ability compared to the other hydrocolloids due to its higher viscosity. It was interesting to note that the film formation ability by CMC was significantly higher than pectin though pectin was five times more viscous than CMC. Gum arabic exhibited the lowest viscosity but formed almost the same film thickness on the disc as pectin despite being twenty times less viscous. Increasing CMC concentration from 0.5% to 1% resulted in increasing its viscosity and the film thickness. The film thickness increased at the disc rotating speed of 6 rpm as compared to 3 rpm. The simulation results were in good agreement with the experimental data.
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Potential for behaviour change among Kenyan type 2 diabetes service users and to understand behaviour change from healthcare professionals’ perspectivesIntroduction: The rising type two diabetes mellitus (T2DM) prevalence is largely due to unhealthy dietary practices, lack of physical activity, economic development, urbanisation, and an ageing population. Management of T2DM involves pharmacological treatment and or lifestyle behaviour changes focusing on diet and physical activity behaviour modifications. Diet and physical activity behaviour modifications are crucial in T2DM management. However, behaviour change is complex and challenging and more so in diet and physical activity behaviours as these are influenced by a myriad of behavioural, social, emotional and environmental, neuroendocrine and genetic factors. Behaviour change thus remains one of the most significant public health concerns. Underpinning this research study is the continued challenge with behaviour change among T2DM service users that leads to development of T2DM related complications and even death. The purpose of this study was therefore to examine the likelihood to change behaviour so as to avoid T2DM related complications and to explore whether being in receipt of the recommended care services had any influence on likelihood to change behaviour. This is particularly important because numerous interventions have been carried out but while change may be initially noted, the positive behaviour is in many cases not sustained over time. The main impact of this study to provide an understanding on the influences of behaviour change as influenced by the health belief model and to explore hinderances to access to the diabetes recommended care services. Methods: The study utilised a mixed-method approach to gain an in-depth comprehension of the topic. The target population for the study comprised of T2DM service users at the Thika Level 5 Hospital diabetes comprehensive clinic and healthcare professionals directly involved in T2DM management. Through power calculations, a sample size of 346 service users was determined. Forty three healthcare professionals were also included in the study as key informants. The inclusion criterion for the diabetes clinic service users was persons diagnosed with type two diabetes and aged 20-70. The inclusion criterion for the healthcare professionals was those who directly worked with service users with regards to behaviour change. Purposive sampling was used in selecting the participants for the study. The exclusion criterion for the service users was those who had type one diabetes or were aged below 20 or above 70 years. For the healthcare professionals, those not directly involved with type two diabetes service users behaviour change (diet and physical activity) were not included in the study. Questionnaires were used to collect quantitative data from the service users. Semi-structured individual interviews were used to collect data from the healthcare professionals. Quantitative data was coded and entered into the Statistical Package for Social Sciences, Version 28.0, for analysis. Qualitative data was entered into Nvivo 13 for thematic analysis. Findings: Behaviour change among healthcare professionals and T2DM service users is based on four constructs of the health belief model: susceptibility to complications, intention to exercise, perceived benefits of exercise and health eating and healthy eating intentions (likened to cues to action). Different factors that affect T2DM management are categorised into predisposing factors, reinforcing factors and enabling factors. Management processes of T2DM should include primary targets to prevent T2DM, primary targets towards promoting behaviour change, actions engaged in the management of T2DM, multi-sectorial approaches and actions by other sectors. Conclusion: According to the study, behaviour change is perceived differently among healthcare professionals and service users. The study therefore recommends that tailored messages should be delivered to different categories of patients so as to enhance behaviour change. The health belief model should be adopted in crafting the messages so as to so as to effectively address complications (perceived susceptibility and severity) associated with T2DM, perceived barriers, perceived benefits, and self-efficacy for behaviour change to be effective. A “one size fits all” approach is not recommended when coming up with interventions towards behaviour change. Further, the study also concludes that policy makers in the Kenyan health system should consider predisposing factors, reinforcing factors and enabling factors towards T2DM management policy making. Since T2DM management involves different targets, the Kenyan health system should engage different stakeholders. A “one size fits all” approach is therefore not appropriate towards T2DM management.
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UPLC-Q-TOF-MS/MS identification, antioxidant, and alpha-glucosidase inhibition activities of three forms of phenolic compounds from Yemeni jujube fruit: In vitro and in silico investigationsJujube fruits have rich medicinal value due to their biological properties which are affected mainly by geographical locations. This study investigates the antioxidant properties of free fraction (FF), esterified fraction (EF), bound fraction (BF), and other metabolites prepared from dried Yemeni jujube fruit and compare to those previously reported in the literature. Results from UPLC-Q-TOF-MS/MS analysis showed that this fruit consists of a total of 33, 26, and 27 free, esterified, and bound compounds identified, respectively. In terms of ABTS, DPPH, FRAP, and H<sub>2</sub>O<sub>2</sub> assays, the BF exhibited values 1.2, 1.3,1.3, and 1.4 times higher than those of the FF, and similarly, 1.8, 1.9,2.0, and 2.5 times higher than the EF. A similar trend was observed in the inhibition of α-glucosidase (α-Glu), where the BF was 1.6, and 2.4 times more effective compared to the FF and EF, respectively. In silico analysis showed that flavonoids, the key active compounds, had substantial α-glucosidase binding capacity. In the meat model, all fractions inhibited protein and lipid oxidation during storage, and the BF exhibited the highest antioxidant capacity. This study provides the first investigation of the structure of active compounds and their biological properties in Yemeni jujube fruit. Yemeni fruits can be utilized as natural antioxidants, and nutraceuticals in food preservation, and medicine respectively.
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Analytical study on secondary metabolites extraction and characterization from Acacia Gums (AGs)Acacia gums (AGs), derived from Acacia senegal, Acacia seyal, and Acacia polyacantha trees, are widely used in various industries, including food, pharmaceuticals, and cosmetics. They serve as emulsifiers, stabilizers, thickeners, and soluble dietary fibers. This study aimed to optimize the extraction process of secondary metabolites extracted (SME) from AGS to enhance their efficiency and quality for industrial applications. Gum arabic, primarily composed of D-galactose, L-arabinose, L-rhamnose, D-glucuronic acid, and 4-O-methyl-D-glucuronic acid with a small fraction of proteins, is a multifunctional ingredient known for its emulsifying activity, attributed to its amphiphilic nature. Its effectiveness as an emulsifier stems from its high water solubility, low-viscosity, good surface activity, and ability to form a protective film around emulsion droplets. AGS in Sudan play crucial ecological roles by providing fodder, firewood, gums, and soil erosion control, which are essential for gum arabic production. Sudan’s diverse biodiversity hosts many plant species traditionally used for medicinal purposes, with extensive knowledge of medicinal plant species stemming from their widespread use among different ethnic groups. This study highlights the importance of optimizing the extraction of secondary metabolites from AGS for industrial applications, and the significance of AGS in Sudan’s ecological balance and economic stability.
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Isolation and characterisation of acid soluble collagens and pepsin soluble collagens from Eel (Anguilla japonica Temminck et Schlegel) skin and boneEel (Anguilla japonica) is an important and valuable food fish in East Asia and its by-products have been reported to include bioactive and profitable components. This study aimed to extract, characterise, and compare the structure and properties of acid-soluble collagens (ASCs) and pepsin-soluble collagens (PSCs) from the skin and bone of eel (Anguilla japonica), providing insights into their composition, structure, and properties for various applications. The yields of ASC-S (from skin), PSC-S (from skin), ASC-B (from bone), and PSC-B (from bone) were 12.16%, 15.54%, 0.79%, and 1.34% on a dry weight basis, respectively. Glycine, the dominant amino acid, accounted for 16.66% to 22.67% of total amino acids in all samples. SDS-PAGE and FTIR analyses showed the typical triple-helical structure of type I collagen with slight variations in molecular order in extract and intermolecular cross-linking between skin and bone collagens. The denaturation temperature (Tmax1) measured by differential scanning calorimetry (DSC) is 81.39 °C and 74.34 °C, respectively, for ASC-B and ASC-S. Bone collagen has higher thermal resistance than skin collagen. Surface morphology imaged using a scanning electron microscope (SEM) showed that the bone collagen had a denser network structure, whilst the skin collagen was more fibrous and porous. The findings suggest that eel-derived collagens from skin and bone can serve as potential alternatives in the food, cosmetic, and healthcare industries.
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“Some people sit, some people stand, that’s just what we do ”: A qualitative exploration of sit-stand desk use in naturalistic settingsProlonged sedentary behaviour is associated with poor health. Office-based workers spend much of the working day sitting. Sit-stand desks have become a popular intervention, but real-life experiences of the value of sit-stand desks remain relatively unexplored outside of research-led interventions. A qualitative study was therefore undertaken to explore real-life experiences, including perceived barriers, and facilitators of using sit-stand desks. Six focus-group interviews were undertaken with a total of 34 desk-based employees in North-West England. Interviews were transcribed and analysed using thematic analysis. Three main themes emerged: The Sedentary Office, Motivators, and The Active Office. The Sedentary Office highlighted participants’ frustration with an increasingly sedentary office environment. Motivators to reducing sitting time were knowledge of the health consequences of prolonged sitting, previous (ill) health, and the potential benefits expected. The Active Office highlighted the importance of control, choice, enhanced interaction with colleagues, and the benefits associated with moving more and enhancing an overall sense of workplace wellbeing. Perceived benefits, facilitators, and barriers - experienced and observed – from sit-stand desk use in the real world were examined, thus contributing to important discussions of transferability. Overall, the study shed light on the perceived facilitators, benefits, and drawbacks of sit-stand desk work whilst also giving evidence of the real-world acceptability and research translation of sit-stand desk use. Future research should examine this in multiple contexts and should explore implications of an increasing prevalence in home working.
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Exploring puffed rice as a novel Ink for 3D food printing: Rheological characterization and printability analysisThis study introduces a novel approach by using puffed rice (PR) as a sustainable and innovative ink for 3D food printing. Due to gelatinization and dextrinization, PR saw notable water absorption and solubility gains, with a modest viscosity uptick from 39.2 to 49.9 RVU, sharply contrasting Native rice (NR)'s jump from 128.9 to 167.8 RVU, emphasizing PR's minimal retrogradation. Gelatinized rice (GR) demonstrates similar stability in viscosity changes as PR, yet it requires more water and extended processing times for gelatinization. Conversely, PR's puffing process, which eliminates the need for water, offers quicker preparation and notable environmental benefits. Rheological analysis at 25% PR concentration reveals an optimal balance of viscosity (η, 897.4 Pa s), yield stress (τy, 2471.3 Pa), and flow stress (τf, 1509.2 Pa), demonstrating superior viscoelastic properties that facilitate enhanced printability and shape fidelity. Texture Profile Analysis outcomes reveals that PR significantly enhances key textural properties including hardness, adhesiveness, and springiness at this specific concentration. These findings highlight PR's potential as an eco-friendly and efficient ink choice for 3D-printed food products, providing enhanced performance and sustainability compared to GR and NR.
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A multi-dimensional Sustainable Diet Index (SDI) for Ghanaian adults under transition: The RODAM studyThe sustainability of diets consumed by African populations under socio-economic transition remains to be determined. This study developed and characterized a multi-dimensional Sustainable Diet Index (SDI) reflecting healthfulness, climate-friendliness, sociocultural benefits, and financial affordability using individual-level data of adults in rural and urban Ghana and Ghanaian migrants in Europe to identify the role of living environment in dietary sustainability. Methods: We used cross-sectional data from the multi-centre Research on Obesity and Diabetes among African Migrants Study (N = 3169; age range: 25–70 years). For the SDI construct (0–16 score points), we used the Diet Quality Index-International, food-related greenhouse gas emission, the ratio of natural to processed foods, and the proportion of food expenditure from income. In linear regression analyses, we estimated the adjusted ß-coefficients and 95% confidence intervals (CIs) for the differences in mean SDI across study sites (using rural Ghana as a reference), accounting for sociodemographic and lifestyle factors. Results: The overall mean SDI was 8.0 (95% CI: 7.9, 8.1). Participants in the highest SDI-quintile compared to lower quintiles were older, more often women, non-smokers, and alcohol abstainers. The highest mean SDI was seen in London (9.1; 95% CI: 8.9, 9.3), followed by rural Ghana (8.2; 95% CI: 8.0, 8.3), Amsterdam (7.9; 95% CI: 7.7, 8.1), Berlin (7.8; 95% CI: 7.6, 8.0), and urban Ghana (7.7; 95% CI: 7.5, 7.8). Compared to rural Ghana, the differences between study sites were attenuated after accounting for age, gender and energy intake. No further changes were observed after adjustment for lifestyle factors. Conclusion: The multi-dimensional SDI describes four dimensions of dietary sustainability in this Ghanaian population. Our findings suggest that living in Europe improved dietary sustainability, but the opposite seems true for urbanization in Ghana.
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The effect of vitamin D supplementation on markers of insulin resistance in women with polycystic ovarian syndrome: a systematic reviewInsulin resistance (IR) is a common pathology in women with polycystic ovarian syndrome (PCOS) involved in increased rates of cardiometabolic disease such as diabetes and cardiovascular disease. Low serum vitamin D is often associated with insulin resistance but there is no consensus on whether vitamin D supplementation can ameliorate markers of IR in PCOS. We assessed evidence on the effects of vitamin D supplementation (≥ 1000 IU/day), without the use of additional supplements or other pharmacological treatments known to affect IR, on markers of IR and glycemic control in women with PCOS. A systematic search was conducted using PubMed, Medline and Web of Science databases from January 2000 up to November 2023. Randomized controlled trials that assessed the effects of vitamin D supplementation in women with PCOS, on fasting glucose, fasting insulin, glycated haemoglobin (HbA1c) or homeostatic model assessment for insulin resistance (HOMA-IR) were included. 9 studies were identified. Study populations ranged from 28 to 180 participants, with mean ages ranging from 22 to 30 years. Daily vitamin D doses ranged from 1714-12,000 IU. Of the included studies, 3 reported statistically significant reductions in fasting glucose, 2 reported reductions in fasting insulin, 2 reported reductions in HOMA-IR, none reported reductions in HbA1c and 5 reported no differences in any of the relevant outcomes. In conclusion, in RCTs of vitamin D supplementation in women with PCOS, the majority of studies do not report statistically significant improvements in fasting glucose, fasting insulin, HbA1c or HOMA-IR. However, as a minority of studies report some statistically significant results, further investigation may be warranted. PROSPERO ID: CRD42023486144. [Abstract copyright: © 2024. The Author(s).]
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The efficacy of Ketamine for acute and chronic pain in patients with cancer: A systematic review of randomized controlled trialsManaging cancer-related pain poses significant challenges, prompting research into alternative approaches such as ketamine. This systematic review aims to analyze and summarize the impact of ketamine as an adjuvant to opioid therapy for cancer-related pain. We conducted a literature review in MEDLINE, EMBASE, and Scopus from 1 January 1982 to 20 October 2023. Abstracts were screened against inclusion criteria, and eligible studies underwent a full-text review. Data was extracted from the included studies, and a framework analysis approach summarized the evidence regarding ketamine’s use in patients with cancer. A total of 21 randomized clinical trials were included, and the quality of all the included studies was good or fair. Significant improvements in pain scores and reduced morphine consumption were consistently observed with intravenous ketamine administration for postoperative pain control, particularly when combined with other analgesics such as morphine. Ketamine was less effective when used as an analgesic for chronic pain management, with several studies on neuropathic pain or chemotherapy-induced neuropathy finding minimal significant effect on reduction of pain scores or morphine requirements. The efficacy of ketamine in pain management appears to depend on factors such as dosage, route of administration, and patient population.
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Assessment of performance of the profilers provided in the OECD QSAR toolbox for category formation of chemicalsGrowing restrictions and bans on animal testing for chemical safety assessment under different regulations have led to an increasing use of alternative methods. Read-across is one of the major approaches used for this purpose, which relies on the identification of toxicological hazards of a data-poor or untested (target) chemical from data on other already-tested (source) similar chemicals. This requires the target substance to be first assigned to a group or category of ‘similar’ chemicals. The ‘similarity’ may be in terms of structural features alone, or in combination with certain rules that are based on mechanistic and/or toxicological aspects. In this regard, the OECD QSAR toolbox—a major free-access in silico platform—is widely used to derive toxicity predictions for a range of (eco) toxicological endpoints. The Toolbox allows the user to identify a set of similar chemicals (analogues) by computational ‘profilers’ that incorporate different structural alerts, or a combination of structural alerts and physicochemical and/or toxicokinetic rules relevant to a specific toxicological endpoint. The overall aim of this study was to assess the performance of the in silico profilers provided in the OECD QSAR Toolbox for reliability for identifying chemical analogues for category formation in a number of high-quality databases on mutagenicity, carcinogenicity, and skin sensitisation. The study also aimed to identify the reasons for any limitations in the performance of the profilers, and propose ways to improve their overall accuracy. The results showed that whilst some structural alerts are fit-for-purpose as such within the acceptable limits, others need refinement or a consideration for their possible exclusion from the profiler. Such refinements are imperative for a reliable use of the profilers in read-across and grouping/categorisation for classification, labelling and risk assessment of chemicals.
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Evaluating the Stability and Digestibility of Long-Chain Omega-3 Algal Oil Nanoemulsions Prepared with Lecithin and Tween 40 Emulsifiers Using an In Vitro Digestion ModelThe health benefits of long-chain omega-3 polyunsaturated fatty acid (LCn-3PUFA) intake have been well documented. However, currently, the consumption of oily fish (the richest dietary source of LCn-3PUFA) in the UK is far below the recommended level, and the low digestibility of LCn-3PUFA bulk oil-based supplements from triglyceride-based sources significantly impacts their bioavailability. LCn-3PUFA-rich microalgal oil offers a potential alternative for populations who do not consume oily fish, and nanoemulsions have the potential to increase LCn-3PUFA digestibility and bioavailability. The aims of this study were to produce stable algal oil-in-water nanoemulsions with ultrasonic technology to increase DHA digestibility, measured using an in vitro digestion model. A nanoemulsion of LCn-3PUFA algal oil was developed with 6% w/w emulsifiers: lecithin (LE) or an equal ratio of Tween 40 (3%) and lecithin (LTN) (3%), 50% w/w, algal oil and 44% w/w water using rotor–stator and ultrasound homogenization. The in vitro digestion experiments were conducted with a gastric and duodenal digestion model. The results showed the creation of nanoemulsions of LCn-3PUFA algal oils offers potentially significant increases in the bioavailability of DHA in the human body. The increase in digestibility can be attributed to the smaller particle size of the nanoemulsions, which allows for higher absorption in the digestive system. This showed that the creation of nanoemulsions of LCn-3PUFA algal oils offers a potentially significant increase in the bioavailability of DHA in the human body. The LE and LTN nanoemulsions had average droplet sizes of 0.340 ± 0.00 µm and 0.267 ± 0.00 µm, respectively, but the algal oil mix (sample created with same the components as the LTN nanoemulsion, hand mixed, not processed by rotor–stator and ultrasound homogenization) had an average droplet size of 73.6 ± 6.98 µm. The LTN algal oil nanoemulsion was stable in the gastric and duodenal phases without detectable destabilization; however, the LE nanoemulsion showed signs of oil phase separation in the gastric phase. Under the same conditions, the amount of DHA digested from the LTN nanoemulsion was 47.34 ± 3.14 mg/g, compared to 16.53 ± 0.45 mg/g from the algal oil mix, showing DHA digestibility from the LTN nanoemulsion was 2.86 times higher. The findings of this study contribute to the insight of in vitro DHA digestion under different conditions. The stability of the LTN nanoemulsion throughout digestion suggests it could be a promising delivery system for LCn-3PUFAs, such as DHA, in various food and pharmaceutical applications.
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The experiences of a therapeutic relationship between dietitians and patients in UK eating disorder treatment: A qualitative studyObjective: Dietitians have a central role in eating disorder (ED) treatment, however few studies exist investigating therapeutic aspects of dietetic care and factors influencing the dietitian‐patient relationship. To address the gap, this study aimed to use a qualitative description approach to explore the experiences of delivering and receiving dietetic care in ED treatment in the UK. Method: Semi‐structured interviews were conducted with 6 specialist ED dietitians and focus groups with 11 recovered ED patients. Interviews were transcribed and inductive thematic analysis was performed to identify key themes describing the data. Results: Six key themes were generated: (1) Building trust, (2) Appropriate timing, (3) Adapting, (4) Dietitians as experts, (5) Boundaries, and (6) Difficult relationships. Participants highlighted the importance of building trust and considering nutritional risk and readiness in treatment approach. Patients expressed a desire for dietitians to have experience in EDs, facilitating understanding of their illness. However, dietitians identified the nature of EDs making their role challenging at times. Discussion: This study described various factors affecting dietetic care in EDs and provided a valuable insight into patients' perceptions of treatment. The findings support advancements in ED dietitians' knowledge and understanding, helping to enhance quality of care.
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A 12-week double-blind randomised controlled trial investigating the effect of dietary supplementation with 125 µg/day vitamin D in adults with asthmaVitamin D deficiency has previously been linked to higher rates of exacerbation and reduced lung function in asthmatics. Previous randomised controlled trials (RCT) investigating the effect of vitamin D supplementation have mainly focussed on children with asthma. Trials involving adults have typically used bolus dosing regimes and the main outcomes have been patient focussed without investigating underlying inflammation. The present study aimed to conduct a 12-week placebo-controlled RCT administering a daily 5000 IU (125 µg) vitamin D3 supplement to adults with mild to moderate asthma. A total of 32 participants were randomised to receive either the 5000 IU vitamin D3 supplement or an identical matching placebo. The primary outcome of the study was lung function measured by ratio of FEV1:FVC (effect size 2.5) with secondary outcomes including asthma symptoms and inflammatory biomarkers. There was a small but statistically significant higher increase in the mean (± SD) ratio of FEV1: FVC from baseline to post-intervention in the vitamin D group (+ 0.05 ± 0.06) compared to the placebo group (+ 0.006 ± 0.04, p = 0.04). There was no effect of the intervention on asthma control test scores, or the inflammatory biomarkers measured. There was a moderate, significant association between baseline plasma 25(OH)D concentration and baseline plasma IL-10 (r = 0.527, p = 0.005) and TNF-α (r = -0.498. p = 0.008) concentrations. A daily vitamin D3 supplement led to slightly improved lung function in adult asthmatics and may be a useful adjunct to existing asthma control strategies, particularly for individuals with suboptimal vitamin D status.
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Yellow Stickers: A mixed methods study exploring household food poverty experiences, in the UKBackground: As more and more British people struggle to make ends meet and turn to food banks to feed themselves, food poverty has become a serious and growing public health concern in the United Kingdom (UK). There is a clear need for effective policies and interventions to prevent and alleviate food poverty. Aim: This thesis aimed to explore household food poverty experiences in order to develop an understanding of the current nature and vulnerability of food poverty in the UK. The research findings inform policy and practice in improving food and nutrition security for those most vulnerable. Methods: A sequential exploratory mixed methods design was adopted for this thesis, where the qualitative phase of data collection and analysis informed the quantitative phase. The first qualitative phase of the study was conducted in Greater Manchester and comprised of two exploratory investigations, in which in-depth interviews were carried out. The first study explored food poverty experiences, and coping practices from forty-two food insecure householders visiting food banks, food pantries, and community centres. The second study explored the perspectives of twenty-six frontline service providers on the local nature and vulnerability of food poverty along with programme responses to alleviate food hardships. The interviews were examined using thematic analysis. The findings generated from these two studies informed the development of the quantitative follow-up study. This study examined the prevalence and risk factors of food insecurity among single mother households using secondary data from the Family Resources Survey (2019/20). Descriptive statistics and multi-logistic analyses were used to analyse the quantitative data. Key findings: The findings from study 1, revealed that food insecure householders often employ multiple coping practices such as resourceful shopping and budgeting practices, cutting back on food quality and intake, and seeking support from food banks, family or friends. Regardless, regular and extended disruptions in food access and eating were commonly reported because of limited money. In study 2, frontline service providers described cost-of-living gaps in working wages and welfare benefits, exacerbated by rising living costs were driving local food poverty issues. Single mother families and single men, were found to be disproportionately accessing food banks compared to other households. Although, food banks have grown substantially in response to rising need and they provide immediate relief from hunger for a few days, there was a deep sense of shame associated with accessing them. Moreover, food banks like other community food aid programmes have limited ability to reduce and prevent food poverty since they do not address the driving factors behind income poverty. In the third study, high levels of food insecurity were found among single mother households. Thirty percent of single mother households were classified as being food insecure, however, in households with three or more children this rose to 41 percent. Conclusions: The findings in this thesis highlight serious food security concerns for welfare recipients and low waged workers. It is a particular salient problem among single mothers and their children who experience high levels of food insecurity. Given the adverse health and social consequences of food poverty the government should prioritise and lead on this issue through policy initiatives and legislation that tackle income poverty alongside efforts that support and strengthen third sector responses in alleviating food poverty in the UK.
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The experiences of dietary acculturation of international students in an ethnically un-diverse city and its impact on dietary healthBackground: Dietary acculturation occurs when people, including students, move to a new host country and their habitual diet changes. Several factors impact international students’ dietary acculturation, including the diversity of the area. Students’ eating habits are reported to be poorer in less ethnically diverse areas where access to their cultural foods may be limited. However, these settings provide a unique opportunity to study the processes (influencers, challenges, and enablers) for eating a culturally acceptable healthy diet in the host country. This study explores the immediate and longitudinal experiences of dietary acculturation for international students in a university and city with low ethnic diversity. Methods: Using an interpretivist design, data were collected longitudinally, at baseline (0-2 months), at six months and one year of sojournment from a purposive sample of international students studying at a university location in the northwest of England, United Kingdom. Focus groups, one-to-one interviews and diet diaries were utilised respectively across the year, progressively focussing the discussion on the lived experience of accessing a healthy and culturally acceptable diet and dietary acculturation. The data were transcribed verbatim and analysed using an inductive thematic approach with the guide of hermeneutic phenomenology. Analysis at baseline, six months, and one year was undertaken, followed by a trajectory analysis to understand the impact of studying and living in a city with little ethnic diversity on international students’ food and health experiences. Results: The analysis shows that international students at the University struggled with adjusting to British cuisine and culture, leading to irregular eating habits that impacted mental health and well-being. The study found that inadequate assistance from the University with regard to diet played a significant role. Over the course of the three phases of the study, participants had limited opportunities to access a broad assortment of foods due to the constrained availability, accessibility, and affordability of familiar options in both the University cafeteria and the city of Chester. Trajectory analysis findings highlight four central issues in accessing culturally acceptable healthy diets at a university located in a less ethnically diverse area: i) the capability and capacity to cook for one’s self; ii) orientation, catering menus, and lack of support from the institution; iii) accessing community support networks; iv) the need to improve cultural awareness, acceptance, and inclusion. The lack of social support, inclusion, and the feeling of no sense of belonging were critical determinants of the student’s experiences. Perceived discriminatory experiences contributed to poorer mental health among participants and performance in their studies. This study suggests that it is imperative to fully grasp the importance of on-campus catering to the dietary requirements of international students for food offerings and menus in this setting. Such inclusion can go a long way towards creating a sense of belonging and promoting integration within universities that have low levels of ethnic diversity. Furthermore, the study sheds light on the development of segregation apparent in classroom settings and academic progress, which begins to perpetuate in higher education and may continue into everyday life. Conclusion: The availability of familiar food is crucial for maintaining a healthy diet, directly affecting one’s well-being. Through promoting inclusivity and a sense of belonging, we can address the negative impact on mental health that comes with feeling disconnected. The lack of availability of culturally acceptable ethnic foods was key, and students reported feelings of exclusion linked to being unable to obtain what they would like to eat easily. Wider community support from friends, family, and local organisations was crucial in developing healthier dietary habits and, crucially, a sense of community and settling. By supporting students in this way, we help them have a positive journey of acculturation, leading to overall success. Therefore, the University in this study needs to create activities and programmes that could bring balance to the entire student population’s dietary experiences. This would promote belongingness within the student group, according to the findings of this study. In addition, this thesis emphasises the importance of university leaders acknowledging the presence of perceived discrimination and implementing an actionable plan with measurable objectives that fosters inclusivity. This research has shown the importance of inclusivity, belonging, and integration for the dietary acculturation experiences of international students who live in a less diverse city. Whilst the research is undertaken in one such city, their findings are applicable to similar settings.
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Optimal omegas – barriers and novel methods to narrow omega-3 gaps. A narrative reviewDietary intakes of omega-3 long chain polyunsaturated fatty acids (O3LC-PUFAs) such as eicosapentaenoic and docosahexaenoic acid are central to development and health across the life course. O3LC-PUFAs have been linked to neurological development, maternal and child health and the etiology of certain non-communicable diseases including age-related cognitive decline, cardiovascular disease, and diabetes. However, dietary inadequacies exist in the United Kingdom and on a wider global scale. One predominant dietary source of O3LC-PUFAs is fish and fish oils. However, growing concerns about overfishing, oceanic contaminants such as dioxins and microplastics and the trend towards plant-based diets appear to be acting as cumulative barriers to O3LC-PUFAs from these food sources. Microalgae are an alternative provider of O3LC-PUFA-rich oils. The delivery of these into food systems is gaining interest. The present narrative review aims to discuss the present barriers to obtaining suitable levels of O3LC-PUFAs for health and wellbeing. It then discusses potential ways forward focusing on innovative delivery methods to utilize O3LC-PUFA-rich oils including the use of fortification strategies, bioengineered plants, microencapsulation, and microalgae.
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The efficacy and safety of ketamine for depression in patients with cancer: A systematic reviewManagement of depression in the oncology population includes supportive psychotherapeutic interventions with or without psychotropic medication, which take time to demonstrate effectiveness. Fast-acting interventions, like ketamine, can provide a rapid antidepressant effect; however, there has been limited research on effects of ketamine among cancer patients. The objective of this review is to provide an overview of research on the efficacy and safety of ketamine on depression in patients with cancer. We reviewed the published literature in MEDLINE® (via PubMed®), EMBASE, and Scopus from 1 January 1982 to 20 October 2022. We screened the retrieved abstracts against inclusion criteria and conducted a full-text review of eligible studies. Following extraction of data from included studies, we used a framework analysis approach to summarize the evidence on using ketamine in patients with cancer. All 5 included studies were randomized clinical trials conducted in inpatient settings in China. In all included studies ketamine was administered intravenously. Three studies used only racemic ketamine, and two studies used both S-ketamine and racemic ketamine. All included studies reported ketamine a tolerable and effective drug to control depression symptoms. Included studies showed administration of sub-anesthesia ketamine significantly improves postoperative depression among patients with cancer. [Abstract copyright: © 2023 The Author(s).]
