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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Bowel cancer knowledge gaps evident among Irish residents: results of a national questionnaire survey.The extent of knowledge of bowel cancer, its symptoms and risk factors are unknown in Irish residents. An understanding of bowel cancer awareness may be useful in aiding healthcare professionals, and policy makers develop improved bowel cancer awareness programmes and public health initiatives in Ireland. A 22-question online questionnaire survey was designed to gather data to assess residents' awareness of bowel cancer, its symptoms, and risk factors and to determine reasons for not participating in BowelScreen Ireland. There were 449 participants (329 women, 119 men and 1 'prefer not to say'). The majority of participants were aged 35-49 years (42.8%), and 82.6% had completed a third level qualification. Irish residents (non-healthcare professionals/scientists (NHCP/S)) recalled on average less than three warning signs/symptoms. Among NHCP/S the most well-recalled protective diet and lifestyle choices were active lifestyle/exercise (62.1%), a fibre rich diet (45.4%) and no/low alcohol consumption (32.1%). Many were unable to recall red and processed meat as risk factors with only 10.7% and 4.9%, respectively, citing these foods. However, prompted awareness was superior with 71.1% agreeing or strongly agreeing that consumption of red and processed meat is a risk factor. 43.4% said they would be 'fairly confident' in recognising a sign/symptom, but more than a third (38.7%) reported they were 'not very confident'. This survey emphasises the need to improve the awareness of bowel cancer as gaps in this specific cancer knowledge were evident among Irish residents. [Abstract copyright: © 2023. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.]
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Exploring the interplay between fat talk, social media use and body image among young women: New opportunities for health education?Background: ‘Fat Talk’, or the act of negatively discussing one’s own or another person’s body, is linked to body image constructs, body dissatisfaction, low self-esteem and disordered eating. The spaces in which young women talk about the body are changing, as social media use escalates. Understanding the interplay between social media use, body image and fat talk, in different contexts, is needed. Method: Focus group interviews were used to explore how young women (aged 15–19) experience fat talk while using social media and the possible effect on body image constructs. Using purposive convenience sampling, young women who regularly used social media and were living in an inner city of England were recruited. Thematic analysis was used for analysis and six themes were identified, both a priori and inductively, to explore the interplay between them. Findings: Over 35 women were successfully recruited into the study, with 18 of these finally participating in focus group interviews. Among participants, social media use was linked to increased self-evaluation of the body, engagement in social comparative behaviour and negative self-talk about the body. Although fat talk was reportedly common and widespread, it was unacceptable in the online space. However, body talk, other than size or shape, was permissible. Conclusion: Fat talk can be divisive; however, if it becomes unacceptable in the online space, negative self-talk may increase. If fat talk is replaced by an all-encompassing ‘body talk’, then this too may exacerbate existing pressures on young people and their mental health and well-being. Understanding the relationship between social media, body dissatisfaction and body talk may provide new opportunities for health education to promote a more constructive prevention discourse of the body, including body talk, in or around the online space.
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SCCS scientific opinion on Butylated hydroxytoluene (BHT) - SCCS/1636/21Opinion to be cited as SCCS (Scientific Committee on Consumer Safety), scientific opinion on Butylated hydroxytoluene (BHT), preliminary version of September 27, 2021, final version of December 2, 2021, SCCS/1636/21.
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The Effect of Dietary Carbohydrate and Fat Manipulation on the Metabolome and Markers of Glucose and Insulin Metabolism: A Randomised Parallel TrialHigh carbohydrate, lower fat (HCLF) diets are recommended to reduce cardiometabolic disease (CMD) but low carbohydrate high fat (LCHF) diets can be just as effective. The effect of LCHF on novel insulin resistance biomarkers and the metabolome has not been fully explored. The aim of this study was to investigate the impact of an ad libitum 8-week LCHF diet compared with a HCLF diet on CMD markers, the metabolome, and insulin resistance markers. n = 16 adults were randomly assigned to either LCHF (n = 8, < 50 g CHO p/day) or HCLF diet (n = 8) for 8 weeks. At weeks 0, 4 and 8, participants provided fasted blood samples, measures of body composition, blood pressure and dietary intake. Samples were analysed for markers of cardiometabolic disease and underwent non-targeted metabolomic profiling. Both a LCHF and HCLF diet significantly (p < 0.01) improved fasting insulin, HOMA IR, rQUICKI and leptin/adiponectin ratio (p < 0.05) levels. Metabolomic profiling detected 3489 metabolites with 78 metabolites being differentially regulated, for example, an upregulation in lipid metabolites following the LCHF diet may indicate an increase in lipid transport and oxidation, improving insulin sensitivity. In conclusion, both diets may reduce type 2 diabetes risk albeit, a LCHF diet may enhance insulin sensitivity by increasing lipid oxidation.
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“It’s Like Being Pushed into Sea on a Boat with No Oars”: Breast cancer survivorship and rehabilitation support in Ireland and the United KingdomBackground: Cancer survivorship is associated with co-morbidities including anxiety, depression, and cardiovascular disease. Rehabilitative care post treatment is vital for survivors’ psychological and physical well-being. The aims of this study were to investigate breast cancer survivors’ attitudes towards their health post-treatment; their awareness of co-morbidities associated with treatment; and their awareness of support systems available. Methodology: A qualitative research approach was employed, using semi-structured interviews with breast cancer survivors from the UK and Ireland. Data were analysed using thematic analysis. Eight breast cancer survivors were recruited through purposive sampling. Results: Two themes emerged from the data 1) Health & Rehabilitation Post Treatment, which included mental and physical health and a desire to control one’s own health in survivorship as well as a discussion around co-morbidities, and 2) Access to support services in survivorship which highlighted both positive and negative experiences of accessing support, as well as reasons for not accessing support in survivorship. Principal Conclusions: Access to rehabilitation support including diet, exercise and stress management are key components in survivorship. Rehabilitation and support services need to be more readily available for survivors to aid them in this journey and to educate them on the increased risk of conditions such as CVD with cancer treatment. Utilising current cardiac rehabilitation models could be a solution to provide a holistic cancer rehabilitation thus providing the lifelong support cancer survivors both want and need.
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N-3 fatty acid supplementation mediates lipid profile, including small dense LDL, when combined with statins: a randomized double blind placebo controlled trialBackground: Epidemiological and clinical evidence suggests that high-dose intake of omega 3 fatty acids (n-3 FA) have a favorable role in altering serum triglycerides (TG) and non-high density lipoprotein cholesterol (non-HDL-C) when combined with statins in hyperlipidemic patients. Their efficacy in altering low-density lipoprotein cholesterol (LDL-C) particle size is yet to be established. Aim: This study evaluated the effects of supplementing 4 g/day Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA) on serum blood lipids, including small, dense LDL-C particle concentration, in hyperlipidemic patients receiving stable statin therapy. Methods: In this randomized, placebo-controlled, double-blind parallel group study, 44 patients on statin therapy for > 8 weeks with non-HDL-C concentrations above 130 mg/dL were randomized into two groups. For 8 weeks, together with their prescribed statin, the intervention group received 4 g/day EPA + DHA (3000 mg EPA + 1000 mg DHA in ethyl ester form) and the placebo group received 4 g/day olive oil (OO). Measurements of serum non-HDL-C, TG, total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), LDL-C (including large - LDL I; intermediate - LDL II; and small - LDL III subclasses), very-low-density lipoprotein cholesterol (VLDL-C) concentration, were taken at baseline and post-intervention. Dietary intake was assessed with a weighed intake, 3-day food diary at week 4. Primary outcome measures were percent change in LDL III, non-HDL-C and LDL particle number. Results: At the end of treatment, the median percent change in serum LDL III concentration was significantly greater in the n-3 FA group plus atorvastatin compared to placebo (− 67.5% vs − 0%, respectively; P < 0.001). Supplemen- tation with n-3 FA plus atorvastatin led to significant reductions in serum non-HDL-C (− 9.5% vs 4.7%, P < 0.01), TG (− 21.5% vs 6.2%, P < 0.001) and VLDL-C (− 36.9% vs 4.0%, P < 0.001) and TC (− 6.6% vs 2.1%, P < 0.001). Between the groups, no significant difference in percent change in the serum concentration of LDL-C, HDL-C, as well as in the LDL I and LDL II subclasses was observed. Conclusion: In this group of hyperlipidemic patients on a stable statin prescription, OM3 plus atorvastatin improved small dense LDL concentrations, non-HDL-C, VLDL-C and TG to a greater extent than atorvastatin alone. Further stud- ies are warranted in this area.
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Cucumeropsis mannii seed oil (CMSO) attenuates alterations in testicular biochemistry and histology against Bisphenol a-induced toxicity in male Wister albino ratsMale reproductive health has deteriorated in recent years as a result of industrialization, which has led to the use of desirable chemicals, like Bisphenol A (BPA), of underlying toxicity. seed is a common soup thickener that produces vegetable oil as well as essential nutrients making it a source of nutraceuticals enlisted with a wide range of therapeutic effects. A total of 48 adult male Wistar rats (120 ± 200g) were used in this study. They were completely randomized and divided into six groups: A (1ml olive oil) irrespective of the weight, B [BPA 100 mg/kg body weight (bw)], C (CMSO 7.5 ml/kg bw), D (CMSO 7.5 ml/kg bw + BPA 100 mg/kg bw), E (CMSO 5.0 ml/kg bw + BPA 100 mg/kg bw), and E (CMSO 2.5 ml/kg bw + BPA 100 mg/kg bw). At the end of the administration via oral routes, rats were sacrificed and testes were collected for biochemistry and histological analysis. BPA significantly (P < 0.05) decreased total testicular protein, epididymal sperm parameters (count, volume, and motility), Mitochondrial Membrane Potential (MMP), body weight, testicular volume; and significantly (P < 0.05) increased testicular enzymes (alkaline phosphatase and lactate dehydrogenase), testicular index; plus histological damages. Interestingly, co-administration of BPA and CMSO significantly (P < 0.05) reversed the biochemical and histological changes. CMSO prevented the biochemistry and histological alterations hence reducing the testicular toxicity. Therefore, CMSO has the potential to be a promising novel nutraceutical for the treatment and management of BPA-induced testicular toxicity. [Abstract copyright: © 2022 The Authors. Published by Elsevier Ltd.]
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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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Effects of Ramadan and Non-ramadan Intermittent Fasting on Gut MicrobiomeBackground: In recent years, intermittent fasting (IF) has gained popularity in the health and wellness in the world. There are numerous types of IF, all of which involve fasting periods that last longer than an overnight fast and involve limited meal time-windows, with or without calorie restriction. The objective of this review is to summarize the current evidence for the effects of Ramadan and non-Ramadan IF on gut microbiome. Methods: We explored PubMed, Scopus, Web of Science, and Google Scholar according to the PRISMA criteria (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). Animal and human studies were screened and reviewed separately by two researchers. Results: Twenty-eight studies were selected after screening. Some of the studies were performed on animal models and some on humans. The results of these studies indicate a significant shift in the gut microbiota, especially an increase in the abundance of Lactobacillus and Bifidobacteria following fasting diets. The results of some studies also showed an increase in the bacterial diversity, decrease inflammation and increased production of some metabolites such as short-chain fatty acids (SCFAs) in individuals or samples under fasting diets. Moreover, Ramadan fasting, as a kind of IF, improves health parameters through positive effects on some bacterial strains such as Akkermansia muciniphila and Bacteroide. However, some studies have reported adverse effects of fasting diets on the structure of the microbiome. Conclusion: In general, most studies have seen favorable results following adherence from the fasting diets on the intestinal microbiome. However, because more studies have been done on animal models, more human studies are needed to prove the results.
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Using Human Biomonitoring Data to Support Risk Assessment of Cosmetic Ingredients—A Case Study of Benzophenone-3Safety assessment of UV filters for human health by the Scientific Committee on Consumer Safety (SCCS) is based on the estimation of internal dose following external (skin) application of cosmetic products, and comparison with a toxicological reference value after conversion to internal dose. Data from human biomonitoring (HBM) could be very useful in this regard, because it is based on the measurement of real-life internal exposure of the human population to a chemical. UV filters were included in the priority list of compounds to be addressed under the European Human Biomonitoring Initiative (HBM4EU), and risk assessment of benzophenone-3 (BP-3) was carried out based on HBM data. Using BP-3 as an example, this study investigated the benefits and limitations of the use of external versus internal exposure data to explore the usefulness of HBM to support the risk assessment of cosmetic ingredients. The results show that both approaches did indicate a risk to human health under certain levels of exposure. They also highlight the need for more robust exposure data on BP-3 and other cosmetic ingredients, and a standardized framework for incorporating HBM data in the risk assessment of cosmetic products.
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Effects of Radiation sterilization Dose on the Molecular Weight and Gelling Properties of Commercial Alginate SamplesTo estimate the molecular weight (Mw) and gelling properties, a total of 26 alginate samples consisting of control (n = 13) and 15 kGy γ-irradiated (n = 13) samples were characterized through viscometric and gel permeation chromatography (GPC-MALLS) methods. Based on the observations, a remarkable decrease in the intrinsic viscosity of all samples of alginates was evident due to the effects of radiation, with a linear relationship between viscosity and concentration in 0.01 M NaCl solution. The correlation among the Mw, percentage mass recovery, radii of gyration (Rz/Rg), and percentage reduction of Mw assessed by GPC was significant. The Mw decreased dramatically (from 3.1 × 105 to 0.49 × 105 mole/g in sample no. 12) by the effect of radiation with momentous relation to the % reduction of the molecular weight. The highest molecular weight reduction (84%), which is the most sensitive to γ-radiation, and the average reduction rate was ≥50%. The mass recovery was 100% obtained from samples no. 1,3,4,5,7,12, and 13, while the rest of the samples’ recovery rate was significantly higher. The reduction rate of mass molecular weight (Mw) is higher than the average molecular weight (Mv), but they showed a sensitivity towards radiation, consequently their performance are different from each other. The stability test was performed as a critical behaviour in the control, recurrently same as in the irradiated samples. Thus, the sterilization dose of 15 kGy for the Mw distribution, and subsequently for the characterization, was significantly effective.
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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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Can Weight Watchers (WW) Help Address Maternal Obesity? An Audit of Weight Change in Women of Childbearing Age and Mothers-To-Be, Referred into a Commercial Slimming Programme.The scale of overweight and obesity amongst women of childbearing age or mothers to be, living in Wales, places a considerable burden on the NHS and public health. High BMI (over 30) during pregnancy increases the health risks for mother and baby. Policy advice recommends weight management services are available to help women lose weight before and whilst planning pregnancy. In parts of Wales, NHS partnerships with commercial companies provide weight management services for women considering or planning pregnancy. This study evaluates whether an established referral Weight Watchers (WW) programme, known to be effective in adults in England, can help mothers-to-be living in North Wales lose weight. Analysis used routine data from 82 referrals to WW between June 2013 and January 2015. Participants received a referral letter inviting them to attend face-to-face group workshops combined with a digital experience. The programme encompassed healthy eating, physical activity and positive mind-set. Trained WW staff measured bodyweight before, during and at 12 weeks. On entry to the course, participants had a median age of 31.4 years (interquartile range (IQR) 28-34) with a median BMI of 36.8 kg/m (IQR 33.3-43.7). Women completing the course (n = 34) had a median weight loss of 5.65 kg (IQR 0.45-10.85), equating to 5.7% (SD 3.46) of initial body weight. Intention-to-treat analysis (last observation carried forward), which included lapsed courses n = 66, showed a median weight loss of 3.6 kg (IQR - 2.53 to 9.73), equating to 3.7% (SD 3.62) of initial body weight. Overall, there was significant weight loss during the WW programme (Wilcoxon signed rank test Z = - 6.16; p < 0.001). Weight loss was significantly correlated with the number of workshops attended (Spearman correlation coefficient 0.61 p < 0.001). The proportion of all 82 participants (intention to treat, baseline observation carried forward) that achieved a weight loss of ≥ 5% initial weight was 30.5%. Referral of obese mothers-to-be into WW can successfully achieve short-term weight loss, at or above 5%, in approximately one third of participants. The dose-response effect supports a causal inference. Successful weight loss at this critical life stage may provide women with the necessary motivation to initiate weight loss for healthy pregnancy, however further research is required. [Abstract copyright: © 2021. The Author(s).]
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Suicide in probation: Towards the ideation-to-action modelSuicide in probation services is far higher than the general population. This paper presents secondary analysis of data previously used to evaluate the outcome of delivering psychological treatment to probationers in London. A sample of probation service users who screened positive for clinically significant symptoms of distress and were subsequently assessed and offered treatment ( n = 274) were allocated retrospectively to one of three groups: those with a history of suicidal ideations but no suicide attempts (ideation group), those with a history of a suicidal act (attempt group) or a control group where suicide was not evident (no history group). Results indicate no significant difference between the ideation and the attempt groups, but significant differences between these and the no history group. The findings are discussed within the context of the suicide ideation-to-action models that have been debated in other offender settings. We conclude that a more nuanced understanding of suicidal acts and suicide attempts is required in probation services including a prospective study that tests the ideation-to-action model.
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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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The SCCS scientific advice on the safety of nanomaterials in cosmeticsThe Cosmetic Regulation (EC) No 1223/2009 specifically covers the risk of nanomaterials used in cosmetic products. If there are concerns regarding the safety of a nanomaterial, the European Commission refers it to the SCCS for a scientific opinion. The Commission mandated the SCCS to identify the scientific basis for safety concerns that could be used as a basis for identifying and prioritising nanomaterials for safety assessment, and to revisit previous inconclusive SCCS opinions on nanomaterials to identify any concerns for potential risks to the consumer health. The SCCS Scientific Advice identified the key general aspects of nanomaterials that should raise a safety concern for a safety assessor/manager, so that the nanomaterial(s) in question could be subjected to safety assessment to establish safety to the consumer. The Advice also developed a list of the nanomaterials notified to the Commission for use in cosmetics in an order of priority for safety assessment, and revisited three previous inconclusive opinions on nanomaterials to highlight concerns over consumer safety that merited further safety assessment.
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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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Nutritional parameters and outcomes in patients admitted to intensive care with COVID-19: a retrospective single-centre service evaluationBackground: COVID-19 is an inflammatory syndrome caused by novel coronavirus SARS-CoV-2. Symptoms range from mild infection to severe acute respiratory distress syndrome (ARDS) requiring ventilation and intensive care. At the time of data collection, UK cases were around 300 000 with a fatality rate of 13% necessitating over 10 000 critical care admissions; now there have been over 4 million cases. Nutrition is important to immune function and influences metabolic risk factors such as obesity and glycaemic control, as well as recovery from acute illnesses. Poor nutritional status is associated with worse outcomes in ARDS and viral infections, yet limited research has assessed pre-morbid nutritional status and outcomes in patients critically unwell with COVID-19. Objectives: Investigate the effect of body mass index (BMI), glycaemic control and vitamin D status on outcomes in adult patients with COVID-19 admitted to an intensive care unit (ICU). Methods: Retrospective review of all patients admitted to a central London ICU between March and May 2020 with confirmed COVID-19. Electronic patient records data were analysed for patient demographics; comorbidities; admission BMI; and serum vitamin D, zinc, selenium and haemoglobin A1c (HbA1c) concentrations. Serum vitamin D and HbA1c were measured on admission, or within 1 month of admission to ICU. Primary outcome of interest was mortality. Secondary outcomes included time intubated, ICU stay duration and ICU-related morbidity. Results: Seventy-two patients; 54 (75%) men, mean age 57.1 (±9.8) years, were included. Overall, mortality was 24 (33%). No significant association with mortality was observed across BMI categories. In the survival arm admission, HbA1c (mmol/mol) was lower, 50.2 vs 60.8, but this was not statistically significant. Vitamin D status did not significantly associate with mortality (p=0.131). However, 32% of patients with low vitamin D (<25 IU/L) died, compared with 13% of patients with vitamin D levels >26 IU/L. Serum zinc and selenium, and vitamin B12 and folate levels were measured in 46% and 26% of patients, respectively. Discussion/conclusion: Increased adiposity and deranged glucose homeostasis may potentially increase risk of COVID-19 infection and severity, possibly relating to impaired lung and metabolic function, increased proinflammatory and prothrombotic mechanisms. Vitamin D deficiency may also associate with poorer outcomes and mortality, supporting a possible role of vitamin D in immune function specific to pulmonary inflammation and COVID-19 pathophysiology. There are plausible associations between raised BMI, glycaemic control, vitamin D status and poor prognosis, as seen in wider studies; however, in this service evaluation audit during the first wave of the pandemic in the UK, with a limited data set available for this analysis, the associations did not reach statistical significance. Further research is needed into specific nutritional markers influencing critical care admissions with COVID-19.
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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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Keto-on-the-Clock: A Survey of Dietetic Care Contact Time Taken to Provide Ketogenic Diets for Drug-Resistant Epilepsy in the UKMedical ketogenic diets (KDs) are effective yet resource-intensive treatment options for drug-resistant epilepsy (DRE). We investigated dietetic care contact time, as no recent data exist. An online survey was circulated to ketogenic dietitians in the UK and Ireland. Data were collected considering feeding route, KD variant and type of ketogenic enteral feed (KEF), and the estimated number of hours spent on patient-related activities during the patient journey. Fifteen dietitians representing nine KD centres responded. Of 335 patients, 267 (80%) were 18 years old or under. Dietitians spent a median of 162 h (IQR 54) of care contact time per patient of which a median of 48% (IQR 6) was direct contact. Most time was required for the classical KD taken orally (median 193 h; IQR 213) as a combined tube and oral intake (median 211 h; IQR 172) or a blended food KEF (median 189 h; IQR 148). Care contact time per month was higher for all KDs during the three-month initial trial compared to the two-year follow-up stage. Patients and caregivers with characteristics such as learning or language difficulties were identified as taking longer. Twelve out of fifteen (80%) respondents managed patients following the KD for more than two years, requiring an estimated median contact care time of 2 h (IQR 2) per patient per month. Ten out of fifteen (67%) reported insufficient official hours for dietetic activities. Our small survey gives insight into estimated dietetic care contact time, with potential application for KD provision and service delivery
