• Acculturation and Food Intake Among Ghanaian Migrants in Europe: Findings From the RODAM Study

      Osei-Kwasi, Hibbah Araba; email: h.a.osei-kwasi@sheffield.ac.uk; Boateng, Daniel; Danquah, Ina; Holdsworth, Michelle; Mejean, Caroline; Terragni, Laura; Powell, Katie; Schulze, Matthias B.; Owusu-Dabo, Ellis; Meeks, Karlijn; orcid: 0000-0003-3032-405X; et al.
      Abstract Objective This study examined the role of migration and acculturation in the diet of Ghanaian migrants in Europe by (1) comparing food intake of Ghanaian migrants in Europe with that of Ghanaians living in Ghana and (2) assessing the association between acculturation and food intake. Design Data from the cross-sectional multicenter study Research on Obesity and Diabetes among African Migrants were used. Food intake was assessed using a Ghana-specific food propensity questionnaire (134 items and 14 food groups); foods were grouped based on a model of dietary change proposed by Koctürk-Runefors. Setting Ghana, London, Amsterdam, and Berlin. Participants A total of 4,534 Ghanaian adults living in Ghana and Europe, with complete dietary data. Of these, 1,773 Ghanaian migrants had complete acculturation data. Main Outcome Measure Food intake (the weighted intake frequency per week of food categories). Analysis Linear regression. Results Food intake differed between Ghanaians living in Ghana and Europe. Among Ghanaian migrants in Europe, there were inconsistent and small associations between acculturation and food intake, except for ethnic identity, which was consistently associated with intake only of traditional staples. Conclusions and Implications Findings indicate that migration is associated with dietary changes that cannot be fully explained by ethnic, cultural, and social acculturation. The study provides limited support to the differential changes in diet suggested by the Koctürk-Runefors’ model of dietary change.
    • Numerical simulation of non-Newtonian polymer film flow on a rotating spoked annulus

      Miah, Md Salim; orcid: 0000-0002-9722-8073; Hossain, Mohammad Sayeed; Ashraf, Muhammad Arif; Al-Assaf, Saphwan; McMillan, Alison (Wiley, 2017-03-03)
    • Arabinoxylans from rice bran and wheat immunomodulatory potentials: a review article

      Fadel, Abdulmannan; Plunkett, Andrew; Li, Weili; Ranneh, Yazan; Tessu Gyamfi, Vivian Elewosi; Salmon, Yasser; Nyaranga, Rosemarie Roma; Ashworth, Jason (Emerald, 2018-02-12)
    • Nice to know: impact of NICE guidelines on ketogenic diet services nationwide

      Whiteley, Victoria; Martin-McGill, Kirsty; Carroll, Jennifer; Taylor, Hannah; Schoeler, Natasha; Royal Manchester Childrens Hospital; University of Salford; University of Chester; University of Liverpool; University of Plymouth; Sheffield Childrens Hospital; UCL Great Ormond Street Institute of Child Health (Wiley, 2019-08-20)
      Background In 2012, the National Institute for Health and Care Excellence (NICE) Clinical Guidelines for Epilepsies: Diagnosis and Management (CG137) included, for the first time, ketogenic diets (KDs) as a treatment option for drug‐resistant paediatric epilepsy. The recommendation was made to refer children and young people with epilepsy whose seizures have not responded to appropriate anti‐epileptic drugs to a tertiary paediatric epilepsy specialist for consideration of the use of KDs. We aimed to assess the impact of this change in guidance on the numbers of ketogenic centres and patients following KDs for epilepsy in the UK and Ireland. Methods An online survey was circulated to ketogenic dietitians from the UK and Ireland. The results were compared with similar surveys published in 2000 and 2010. Results The number of centres offering KDs for treatment of epilepsy has risen from 22 in 2000, to 28 in 2010, and to 39 in 2017 (77% overall increase). Seven of these centres accept adult referrals, in comparison to only two centres in 2010. Patient numbers have increased from 101 in 2000 to 754 in 2017. In total, 267 patients are waiting to commence KD at 31 centres. Conclusions Over the last 7 years, the number of patients treated with a KD for epilepsy in the UK and Ireland has increased by 647%, with a 77% increase in the number of centres offering KDs. Despite this rapid growth, there is ongoing demand for patients to be considered for dietary therapy, highlighting the need for continued expansion of KD services nationally.
    • Sulthiame add-on therapy for epilepsy

      Bresnahan, Rebecca; Martin-McGill, Kirsty; Milburn-McNulty, Philip; Powell, Graham; Sills, Graeme; Marson, Anthony; University of Chester; University of Liverpool; The Walton Centre NHS Foundation Trust; University of Glasgow; Liverpool Health Partners (Wiley, 2019-08-27)
      Background This is an updated version of the Cochrane Review previously published in the Cochrane Database of Systematic Reviews 2015, Issue 10. Epilepsy is a common neurological condition, characterised by recurrent seizures. Most people respond to conventional antiepileptic drugs, however, around 30% will continue to experience seizures, despite treatment with multiple antiepileptic drugs. Sulthiame, also known as sultiame, is a widely used antiepileptic drug in Europe and Israel. We present a summary of the evidence for the use of sulthiame as add-on therapy in epilepsy. Objectives To assess the efficacy and tolerability of sulthiame as add-on therapy for people with epilepsy of any aetiology compared with placebo or another antiepileptic drug. Search methods For the latest update, we searched the Cochrane Register of Studies (CRS Web), which includes the Cochrane Epilepsy Group’s Specialized Register and CENTRAL (17 January 2019), MEDLINE Ovid (1946 to January 16, 2019), ClinicalTrials.gov and the WHO ICTRP Search Portal (17 January 2019). We imposed no language restrictions. We contacted the manufacturers of sulthiame, and researchers in the field to seek any ongoing or unpublished studies. Selection criteria Randomised controlled trials of add-on sulthiame, with any level of blinding (single, double or unblinded) in people of any age, with epilepsy of any aetiology. Data collection and analysis Two review authors independently selected trials for inclusion, and extracted relevant data. We assessed these outcomes: (1) 50% or greater reduction in seizure frequency between baseline and end of follow-up; (2) complete cessation of seizures during follow-up; (3) mean seizure frequency; (4) time-to-treatment withdrawal; (5) adverse effects; and (6) quality of life. We used intention-to-treat for primary analyses. We presented results as risk ratios (RR) with 95% confidence intervals (CIs). However, due to the paucity of trials, we mainly conducted a narrative analysis. Sulthiame add-on therapy for epilepsy (Review) 1 Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. For Preview Only Main results We included one placebo-controlled trial that recruited 37 infants with newly diagnosed West syndrome. This trial was funded by DESITIN Pharma, Germany. During the study, sulthiame was given as an add-on therapy to pyridoxine. No data were reported for the outcomes: 50% or greater reduction in seizure frequency between baseline and end of follow-up; mean seizure frequency; or quality of life. For complete cessation of seizures during a nine-day follow-up period for add-on sulthiame versus placebo, the RR was 11.14 (95% CI 0.67 to 184.47; very low-certainty evidence), however, this difference was not shown to be statistically significant (P = 0.09). The number of infants experiencing one or more adverse events was not significantly different between the two treatment groups (RR 0.85, 95% CI 0.44 to 1.64; very low-certainty evidence; P = 0.63). Somnolence was more prevalent amongst infants randomised to add-on sulthiame compared to placebo, but again, the difference was not statistically significant (RR 3.40, 95% CI 0.42 to 27.59; very low-certainty evidence; P = 0.25). We were unable to conduct meaningful analysis of time-to-treatment withdrawal and adverse effects due to incomplete data. Authors’ conclusions Sulthiame may lead to a cessation of seizures when used as an add-on therapy to pyridoxine in infants with West syndrome, however, we are very uncertain about the reliability of this finding. The included study was small and had a significant risk of bias, largely due to the lack of details regarding blinding and the incomplete reporting of outcomes. Both issues negatively impacted the certainty of the evidence. No conclusions can be drawn about the occurrence of adverse effects, change in quality of life, or mean reduction in seizure frequency. No evidence exists for the use of sulthiame as an add-on therapy in people with epilepsy outside West syndrome. Large, multi-centre randomised controlled trials are needed to inform clinical practice, if sulthiame is to be used as an add-on therapy for epilepsy
    • Felbamate add‐on therapy for drug‐resistant focal epilepsy

      Shi, Li LI; Bresnahan, Rebecca; Martin-McGill, Kirsty; Dong, JianCheng; Ni, HengJian; Geng, JinSong; Medical School of Nantong University, China; University of Liverpool; University of Chester (John Wiley & Sons, Ltd, 2019-08-01)
      Background This is an updated version of the Cochrane Review previously published in 2017. Epilepsy is a chronic and disabling neurological disorder, affecting approximately 1% of the population. Up to 30% of people with epilepsy have seizures that are resistant to currently available antiepileptic drugs and require treatment with multiple antiepileptic drugs in combination. Felbamate is a second-generation antiepileptic drug that can be used as add-on therapy to standard antiepileptic drugs. Objectives To evaluate the efficacy and tolerability of felbamate versus placebo when used as an add-on treatment for people with drug-resistant focal-onset epilepsy. Search methods For the latest update we searched the Cochrane Register of Studies (CRS Web), MEDLINE, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP), on 18 December 2018. There were no language or time restrictions. We reviewed the reference lists of retrieved studies to search for additional reports of relevant studies. We also contacted the manufacturers of felbamate and experts in the field for information about any unpublished or ongoing studies. Selection criteria We searched for randomised placebo-controlled add-on studies of people of any age with drug-resistant focal seizures. The studies could be double-blind, single-blind or unblinded and could be of parallel-group or crossover design. Data collection and analysis Two review authors independently selected studies for inclusion and extracted information. In the case of disagreements, the third review author arbitrated. Review authors assessed the following outcomes: 50% or greater reduction in seizure frequency; absolute or percentage reduction in seizure frequency; treatment withdrawal; adverse effects; quality of life. Main results We included four randomised controlled trials, representing a total of 236 participants, in the review. Two trials had parallel-group design, the third had a two-period cross-over design, and the fourth had a three-period cross-over design. We judged all four studies to be at an unclear risk of bias overall. Bias arose from the incomplete reporting of methodological details, the incomplete and selective reporting of outcome data, and from participants having unstable drug regimens during experimental treatment in one trial. Due to significant methodological heterogeneity, clinical heterogeneity and differences in outcome measures, it was not possible to perform a meta-analysis of the extracted data. Only one study reported the outcome, 50% or greater reduction in seizure frequency, whilst three studies reported percentage reduction in seizure frequency compared to placebo. One study claimed an average seizure reduction of 35.8% with add-on felbamate while another study claimed a more modest reduction of 4.2%. Both studies reported that seizure frequency increased with add-on placebo and that there was a significant difference in seizure reduction between felbamate and placebo (P = 0.0005 and P = 0.018, respectively). The third study reported a 14% reduction in seizure frequency with add-on felbamate but stated that the difference between treatments was not significant. There were conflicting results regarding treatment withdrawal. One study reported a higher treatment withdrawal for placebo-randomised participants, whereas the other three studies reported higher treatment withdrawal rates for felbamate-randomised participants. Notably, the treatment withdrawal rates for felbamate treatment groups across all four studies remained reasonably low (less than 10%), suggesting that felbamate may be well tolerated. Felbamate-randomised participants most commonly withdrew from treatment due to adverse effects. The adverse effects consistently reported by all four studies were: headache, dizziness and nausea. All three adverse effects were reported by 23% to 40% of felbamate-treated participants versus 3% to 15% of placebo-treated participants. We assessed the evidence for all outcomes using GRADE and found it as being very-low certainty, meaning that we have little confidence in the findings reported. We mainly downgraded evidence for imprecision due to the narrative synthesis conducted and the low number of events. We stress that the true effect of felbamate could likely be significantly different from that reported in this current review update. Authors' conclusions In view of the methodological deficiencies, the limited number of included studies and the differences in outcome measures, we have found no reliable evidence to support the use of felbamate as an add-on therapy in people with drug-resistant focal-onset epilepsy. A large-scale, randomised controlled trial conducted over a longer period of time is required to inform clinical practice.
    • Are urological patients at increased risks of developing haemostatic complications following shock wave lithotripsy (SWL) for solitary unilateral kidney stones?

      Hughes, Stephen; Thomas-Wright, S. J.; Banwell, J.; Mushtaq, Sohail; Williams, R.; Abdulmajed, I.; Shergill, Iqbal; University of Chester; Wrexham Maelor Hospital (Elsevier, 2014-04-01)
      INTRODUCTION & OBJECTIVES: During the past two years there has been an increase in the number of patients undergoing shock wave lithotripsy (SWL) in Welsh hospitals (United Kingdom) for solitary unilateral kidney stones. Serious complications of SWL include haematuria, acute kidney injury and sepsis. Currently, there are no simple blood tests available, which can predict complications following SWL. Here we have tested the hypothesis that SWL will result in changes to haemostatic function, increase endothelial and haemostatic involvement postoperatively. MATERIAL & METHODS: In this pilot study, ten patients undergoing SWL for solitary unilateral kidney stones, were recruited (n=10). From patients (6 male and 4 female) aged between 31-70 years (mean=50 years), venous blood samples were collected pre-operatively (baseline), at 30 minutes, 120 minutes and 240 minutes postoperatively. Specific haemostatic biomarkers [D-dimer, von Willebrand Factor (vWF), Prothrombin time and sE-selectin] were measured. RESULTS: D-dimer and vWF concentrations were significantly increased from baseline at 240 minutes postoperatively (p=0.05 and <0.01 respectively). Prothrombin time and sE-selectin parameters were not significantly changed following SWL. CONCLUSIONS: The observed increase in D-dimer and vWF concentrations suggests that these markers would provide a more clinically relevant assessment of the extent of haemostatic involvement due to surgery. Analysis of such markers, have the potential to improve the detection of complications occurring postoperatively, such as haematuria and acute kidney injury.
    • Saturated Fatty Acid Intake as a Risk Factor for Cardiovascular Disease in Healthy Caucasian Adults from Western Populations

      Thomas, Patricia; Mushtaq, Sohail; University of Chester (Cambridge University Press, 2014-02-02)
      ABSTRACT Background: Cardiovascular disease (CVD) is the leading cause of premature death globally (WHO, 2010).For over 50 years saturated fatty acids (SFA) have been implicated as a main dietary risk factor for CVD. Therefore national guidelines recommend limiting SFA to <10% of total daily energy intake COMA, [1]. However, recent literature has begun to question this advice due to contra evidence showing SFA not to be a risk factor for CVD, Hoenselaar [2]. This study’s aim was to investigate the relationship between SFA and CVD to assess whether or not recommendations should be made to review national guidelines. Method: A systematic review and meta-analysis were conducted. Electronic research databases were searched using variations of the keywords “saturated fatty acids” and “cardiovascular disease”. Articles were only included if they had a randomised control trial (RCT) or prospective cohort (PC) study design. Additionally participants had to meet the following criteria: Caucasian, non-smokers, normal BMI, classed as healthy, no preexisting CVD related conditions, not taking cholesterol altering drugs and no inborn errors of lipid metabolism. Articles were also only included if they were conducted in western populations in an attempt to standardise environmental factors. In the PCs, only data which was adjusted for these factors was included. Articles were assessed for quality using the Jadad et al. [3] scoring/CASP tool and for confounding variables, risk of bias and homogeneity. Results: A total of 411 articles were identified. Eight articles were included after exclusion for duplication, study design, not meeting full inclusion criteria, low quality, confounding variables, high risk of bias and heterogeneity. Of these, 4 were RCTs and 4 were PCs including 193,409 participants (192,686 female, 723 male). RCT and PC data were analysed separately. For the RCTs, LDL-cholesterol concentration post high/low SFA intervention was used as a functional biomarker for CVD risk. For the PCs the number of CVD related events in the low/high SFA diet groups was used as the marker for CVD risk. In the RCT meta-analysis there was a standard mean difference (95%CI) of -0.94 (-1.17, - 0.71) (p<0.00001) favouring the low SFA diet to decrease the risk of CVD. In the PC metaanalysis a risk ratio (95%CI) of 1.00 (0.64, 1.58) (p=1.00) showed there to be no statistically significant relationship between SFA and CVD. Sensitivity analyses conducted predominantly showed no change in outcome. Discussion: RCT outcomes favoured a low SFA diet for lowering CVD risk whereas the PC outcome showed no relationship. Although these differed they indicate that SFA does not increase CVD risk in western Caucasian adults. However further research is needed before requesting recommendations for the review of national guidelines. These findings correlate with other systematic reviews/meta-analyses e.g. Skeaff and Miller, [4]. Conclusion: From the studies included SFA does not increase CVD risk in affluent Caucasian adults.
    • Qualitative Study of the Determinants of Food Choice of International Students and Its Associated Health Risk (P10-080-19).

      Nwaugochi, Ifeanyi; Kennedy, Lynne (2019-06-13)
      Migration to study in an industrialized country is an important time when unhealthy food choice behaviour among students reach its peak. This dietary pattern is linked to increased risk level of developing food-related chronic diseases (F-RCD). During this period, students tends to consume more ultra-processed diet (high in fat, sugar, & energy) and very low in fruits and vegetable. The main objective of this study was to explore the factors influencing food choice and dietary acculturation of international students using qualitative study design to explore their knowledge/perception on nutrition and the link between food, health and F-RCDs. Recent studies have shown dearth on determinants of food choice, dietary acculturation and its associated health challenges of international students. International students were recruited by purposive and snowball sampling through poster advert and international office of the University of Chester.Using an open-ended, semi-structured question guide, focus group interviews was carried out. Focus group data were transcribed verbatim and analysed using manual content analysis and inductive thematic approach.23 participants were recruited into the study comprising 13 undergraduate and 10 postgraduate students (12 males and 11 females) aged 18-25 years from Africa, Asian, and the Caribbean. Factors identified by most international students as being the main determining factor on their food choice includes residency status (as a full or semi-catered student), price, availability, accessibility (location of shop), preservation/storage temperature, UK weather conditions, structure of foods in the UK among others. The results presented here may facilitate the improvements of wellbeing of international students' by promoting healthy food choice, thereby encouraging positive acculturation of these students. This research was funded by the researcher.
    • "I cannot sit here and eat alone when I know a fellow Ghanaian is suffering": Perceptions of food insecurity among Ghanaian migrants.

      Osei-Kwasi, Hibbah Araba; Nicolaou, Mary; Powell, Katie; Holdsworth, Michelle (17/05/2019)
      In the UK, ethnic minority groups tend to have higher levels of poverty than the white British population and therefore may be at high risk of food insecurity. Ghanaians, living in Ghana or as migrants are thought to have a high level of social support in their communities, but the role of this resource in relation to food security is unknown. We explored participants' perceptions of social and economic factors influencing food security among Ghanaian migrants in Greater Manchester. Participants aged ≥25 years (n = 31) of Ghanaian ancestry living in Greater Manchester were interviewed using a semi-structured interview guide developed by the researchers. Participants varied in socioeconomic status (SES), gender and migration status. Interviews were transcribed verbatim and analysed thematically using a framework approach. Participants offered similar accounts of the social and economic factors influencing food security. Accounts were based on participants' perceptions and/or personal experiences of food insecurity within the community. Participants indicated that they and their fellow Ghanaians can 'manage' even when they described quite challenging food access environments. This has negative implications on their food choices in the UK. Participants reported food insecure households may be reluctant to make use of food banks for fear of 'gossip' and 'pride'. Paradoxically, this reluctance does not extend to close network. Many participants described the church and other social groups as a trusted base in which people operate; support given through these channels is more acceptable than through the 'official context'. Government assisted food banks could partner with the social groups within this community given that these are more trusted. Keywords: food insecurity; food choice; social networks; Ghanaians; healthy eating; migrants. [Abstract copyright: Copyright © 2019 Elsevier Ltd. All rights reserved.]
    • Dietary Patterns Are Associated with Predicted 10-Year Risk of Cardiovascular Disease Among Ghanaian Populations: the Research on Obesity and Diabetes in African Migrants (RODAM) Study.

      Boateng, Daniel; Galbete, Cecilia; Nicolaou, Mary; Meeks, Karlijn; Beune, Erik; Smeeth, Liam; Osei-Kwasi, Hibbah Araba; Bahendeka, Silver; Agyei-Baffour, Peter; Mockenhaupt, Frank P; et al. (01/05/2019)
      Sub-Saharan African populations are disproportionately affected by cardiovascular disease (CVD). Although diet is an important lifestyle factor associated with CVD, evidence on the relation between dietary patterns (DPs) and CVD risk among sub-Saharan African populations is limited. We assessed the associations of DPs with estimated 10-y atherosclerotic cardiovascular disease (ASCVD) risk in Ghanaian adults in Ghana and Europe. Three DPs ('mixed'; 'rice, pasta, meat, and fish'; and 'roots, tubers, and plantain') were derived by principal component analysis (PCA) based on intake frequencies obtained by a self-administered Food Propensity Questionnaire in the multi-center, cross-sectional RODAM (Research on Obesity and Diabetes among African Migrants) study. The 10-y ASCVD risk was estimated using the Pooled Cohort Equations (PCE) for 2976 subjects, aged 40-70 y; a risk score ≥7.5% was defined as 'elevated' ASCVD risk. The associations of DPs with 10-y ASCVD risk were determined using Poisson regression with robust variance. Stronger adherence to a 'mixed' DP was associated with a lower predicted 10-y ASCVD in urban and rural Ghana and a higher 10-y ASCVD in Europe. The observed associations were attenuated after adjustment for possible confounders with the exception of urban Ghana (prevalence ratio [PR] for Quintile 5 compared with 1: 0.70; 95% CI: 0.53, 0.93, P-trend = 0.013). The 'rice, pasta, meat, and fish' DP was inversely associated with 10-y ASCVD across all study sites, with the adjusted effect being significant only in urban Ghana. A 'roots, tubers, and plantain' DP was directly associated with increased 10-y ASCVD risk. Adherence to 'mixed' and 'rice, pasta, meat, and fish' DPs appears to reduce predicted 10-y ASCVD risk in adults in urban Ghana. Further investigations are needed to understand the underlying contextual-level mechanisms that influence dietary habits and to support context-specific dietary recommendations for CVD prevention among sub-Saharan African populations. [Abstract copyright: Copyright © American Society for Nutrition 2019.]
    • The low-risk perception of developing type 2 diabetes among women with a previous history of gestational diabetes

      Sharma, Manisha; Purewal, Tejpal Singh; Fallows, Stephen; Kennedy, Lynne; Edge Hill University; Royal Liverpool Hospital; University of Chester (Wiley, 12/02/2019)
      We conducted a qualitative study to explore the risk perceptions, health beliefs and behaviours of women with a previous history of gestational diabetes mellitus (GDM). Women aged between 18 to 40 years (at the time of pregnancy) with a previous history of GDM, registered at The Royal Liverpool University Hospital, United Kingdom, participated in individual, semi-structured, face-to-face interviews. Qualitative data from seven participants were collected until data saturation and were analysed by thematic analysis. Participants had a low-risk perception of the future risk of developing diabetes. Some believed that their risk was the same as that of any other woman without a history of GDM, and some other participants were not aware of the risk at all and perceived GDM as a temporary health condition with no long-term risks. Participants showed some understanding of a healthy lifestyle in general. However, most of the information was self-acquired by participants and not linked to the future risk of developing diabetes. The findings of this research also indicated a contrast between the high perception of the immediate risks of complications during the pregnancy and low long-term risk of developing diabetes after pregnancy associated with GDM. Participants received healthy lifestyle advice during their pregnancy, but none of them reported involvement in any postnatal health education, intervention or counselling as recommended by 2008 and 2014 NICE guidelines. The low-risk perception impedes positive health behaviour required to overcome the barriers against a healthy lifestyle. This was a small research project but the findings warrant scope for more research in this field. A larger study might promote the development of a well-structured, long-term follow-up health intervention programme, incorporating a reminder system for annual diabetes screenings to improve the risk perception and reduce the risk for the development of type 2 diabetes in this population.
    • Vitamin D3 supplementation for 8 weeks leads to improved haematological status following the consumption of an iron-fortified breakfast cereal: a double-blind randomised controlled trial in iron-deficient women.

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

      Vaandrager, Lenneke; Kennedy, Lynne; Wageningen University and University of Chester (Springer, 07/09/2016)
      Summary There is growing consensus that the places where people live and the various social processes, relationships and psycho-social concepts associated with strong healthy communities and neighbourhoods make an important contribution to health. Where you live makes a considerable difference; people living in more affluent communities for example are more likely to experience better self-reported health and wellbeing. This is particularly evident in current theoretical and policy debates concerning the salutogenic and so-called strength or assets based approach to health; healthy communities have various social and physical resources available, which if they can recognise, share and utilise, can result in stronger SOC, increasing their ability to cope and thrive. Within health promotion we actively encourage communities to organise themselves for better health and well-being. The concept of ‘community’ is both complex and subjective and difficult to define. So we start by conceptualising the definitions, dimensions and meanings of community – beyond a physical location - underpinning this chapter. There are several ideas linking the community or neighbourhood as a setting, including community as a place to live, connectedness (social capital) and social action (the development of a strong SOC). The evidence is variable in quality and furthermore, few studies explicitly apply the theory of salutogenesis when they study health and wellbeing in the community context. The body of this chapter is devoted therefore to summarising the available research about salutogenic and asset-based community interventions, drawing upon examples from empirical work. In doing so, we will highlight debates emerging around the concepts of a salutogenic framework and health assets in relation to community and neighbourhood. As such, we are specifically interested in examining the resources (and/or assets) of communities and neighbourhoods and the associated processes enabling these resources to be accessed for the benefit of the community’s health and wellbeing.
    • A FRAP Assay at pH 7 unveils Extra Antioxidant Activity from Green, Black, White and Rooibos Tea but not Apple Tea

      Owusu-Apenten, Richard K.; Wong, C. W.; Cheung, W. S. M.; Lau, Y. Y.; Bolanos de la Torre, Angelica A. S.; University of Chester, University of Ulster (Verizona publisher, 26/06/2015)
      Abstract Aim: Realization of a ferric reducing antioxidant power (FRAP) assay at neutral pH and re-evaluation of tea antioxidant activity for comparisons with the standard FRAP assay. Method: A FRAP assay at neutral pH utilized ferrozine (7.3-(2-Pyridyl)-5, 6-diphenyl-1, 2, 4-triazine-4’, 4’’-disulfonic acid;ferrozine) dye in conjunction with Tris-HCl buffer (0.1M. pH 7.0) with 280 µl of regent addition to 20 µl of tea infusions and absorbance measurements at 562 nm with a microplate reader. Results: The microplate ferrozine FRAP assay (mFzFRAP) gave linear calibrations for ascorbic acid, gallic acid, ammonium ferrous sulphate, (AFS), trolox, cysteine and glutathione (R2 = 0.998 -1.000) with molar absorptivity (measures of sensitivity) similar to literature values. The analytical precision was 5-7% and the minimum detectable concentrations (MDC) were 1.4- 2.8 µM (0.4-0.8 nanomoles). Discussion: Values for FRAP were higher at pH 7.0 compared to pH 4.0 for gallic acid, ascorbic acid, glutathione, and cysteine possibly due to their ionization at high pH. The assay sensitivity for AFS and trolox were unchanged at pH 4.0 and pH 7.0. When assayed at pH 7 the water infusions from green tea, black tea, white tea, and rooibos tea had 200-360% antioxidant activity normally observable at low pH. Conclusion: A FRAP assay at pH 7 unveils extra antioxidant activity for green, black, white and Rooibos teas compared to values from the standard TptzFRAP (pH 3.6) method. As a recommendation, the antioxidant activity of teas and other herbal preparations should be re-evaluated over a wide pH range.
    • Socio-economic causes of undernutrition

      Kennedy, Lynne; Woodall, Alison; University of Chester (John Wiley and Sons, 26/01/2018)
      In this chapter we explore the role of socio-economic factors in the development of under-nutrition in high-income countries, such as the UK, with particular reference to food access and nutrition inequality. For the purpose of this chapter we use the term under-nutrition to refer to the physiological effects of inadequate food supply resulting from the inability to access sufficient quantity and quality of food to meet recommended nutritional requirements; a situation otherwise termed food poverty or food insecurity (See Box 1 for definitions). In affluent societies, hunger and malnutrition coexist alongside obesity and diet-related diseases such as coronary heart disease and diabetes. Before the food system was industrialised in the mid-20th Century, people ate a basic, traditional diet of limited variety. Hunger and under nutrition was common. Today, food is both varied and widely available. Access to cheap, energy-dense and nutrient-poor food is linked with the so-called obesity epidemic and diseases of affluence. Despite this a growing number of people in societies such as the UK experience hunger or malnutrition because of limited access or availability to a nutritionally adequate diet (3, 4, and 5).
    • Effects of ascorbic acid, dehydroascorbic acid and methotrexate on breast cancer cell viability.

      Dosunmu, Yewande; Owusu-Apenten, Richard K.; University of Chester, University of Ulster (Sciencedomain international, 28/10/2017)
      Aims: To examine the effects of ascorbic acid (AA), dehydroascorbic acid (DHA) and methotrexate (MTX) combined treatments on (MDA-MB-231) breast cancer cell viability and intracellular reactive oxygen species (ROS). Study Design: In-vitro method. Place and Duration of Study: Biomedical Sciences Research Institute, University of Ulster, Coleraine, BT52 1SA, United Kingdom. September 2016-2017 Methodology: Cytotoxicity tests were performed with MTX (0.01- 1000 µmol/l) alone or in combination with AA or DHA, for 72 h. Cell viability was measured by 3-4,5 dimethylthiazol-2,5 diphenyl tetrazolium bromide (MTT) or Sulforhodamine B (SRB) assays. Intracellular ROS was measured by 2’,7’-dichlorofluroscein diacetate assay. Results: Treatments of MDA-MB231 cells with single agents, showed dose dependent response with 50% inhibition of cell viability (IC50) of 110.5-201.4 µmol/l (MTX), 2237-5703 µmol/l (AA) or 2474 µmol/l (DHA). Combination studies showed clear synergisms for MTX (~10 µmol/l) and DHA or AA (1100 µmol/l) but weak or no interactions at other concentrations. Three days combination treatment of DHA showed decrease of ROS, which was reversed by MTX (>10 µmol/l). Conclusions: Co-treatment of methotrexate with AA or DHA showed synergism (C1<1.0) and enhanced cytotoxicity of the anti-folate towards MDA-MB-231 breast cancer cells. Intracellular ROS decreased with AA and DHA treatment, which might be useful for reducing MTX-related oxidative stress.
    • Effect of pH on the Radical Quenching Capacity of Tea Infusions Using the ABTS•+ Assay

      Chan, Yuk Man; Cheng, Nga Kwan; Nigam, Poonam S.; Owusu-Apenten, Richard K.; University of Chester, University of Ulster (Sciencedomain International, 22/06/2016)
      Aims: The aims of this study were to assess the impact of pH on the free radical quenching activity of tea infusions using a modified 2,2'-azino-bis (3-ethylbenzothiazoline-6-sulphonic acid (ABTS) assay and three antioxidant compounds as reference. Study Design: In-vitro method. Place and Duration of Study: Faculty of Life and Health Science, School of Biomedical Sciences, Ulster University, UK. From Sept 2014 and May 2016. Methodology: Free radical quenching capacity of tea (Earl grey, black tea, Ceylon tea, & green tea) infusions were investigated using persulfate activated ABTS with acetate buffer (pH 4.5) or phosphate buffer saline (pH 7.0) as solvent. Tests were performed using 96-well microplates, 20 µl of sample and 280 µl of ABTS reagent, and calibrated using ascorbic acid, trolox or gallic acid as reference antioxidants. Results: Gallic acid free radical quenching was pH dependent and unsuitable as reference. The free radical quenching capacity of trolox and ascorbic acid was not significantly different at pH 4.5 and pH 7.0. The radical quenching capacity of tea infusions expressed as Trolox Equivalent Antioxidant Capacity (TEAC) or Ascorbic Acid Equivalent Antioxidant Capacity (AAEAC) was greater by 50-300% at pH 7 compared to pH 4.5. Conclusion: The modified ABTS assay is suitable for examining the influence of pH on free radical quenching ability of tea samples. Gallic acid was not a suitable reference compound. The radical quenching capacity of tea infusions increases with rising pH.
    • Enhanced growth-inhibitory effect of microemulsified curcumin formulation in human prostate cancer LNCaP Cells

      Dubey, Vaibhav; Owusu-Apenten, Richard K.; University of Chester, University of Ulster (Sciencedomain international, 01/01/2015)
      Aim: To assess the effect of curcumin microemulsified with non-ionic surfactant surfynol 465 W or dispersed using edible oils on prostate LNCaP cancer cell viability and glutathione status. Methodology: LNCaP cells were treated for 72-144 hr with curcumin dissolved with fish or corn oil and microemulsified using non-ionic surfactant surfynol 465 W; alternatively LNCaP cells were treated with curcumin directly dispersed in fish or corn oil (0-50 μM) for 24 -72-144 hr. Cell viability was determined using resazurin (Vision blueTM) fluorescence assay. Glutathione status was determined by monochlorobimane (MCB) assay. Results: Treatment with 0-34 μM of microemulsified curcumin produced moderate cytotoxic effect on LNCaP cells, no 50% reduction of cell viability was observed graphically. However, when LNCaP cells were treated with curcumin dispersed with corn oil the concentration or 50% reduction of cell viability (IC50) was 12-45 μM. Similarly for cells treated with curcumin dispersed with fish oil, the IC50 was between 20-40 μM. Cytotoxic doses of curcumin dispersed with corn or fish oil increased GST status in cells by 272-656% (p =<0.01). Conclusion: Microemulsified curcumin formulation prepared using fish or corn oil and surfynol 465 W surfactant had an inhibitory effect on viability of LNCaP cells as did direct dispersion of curcumin in fish or corn oil coupled with the ability for inducing intracellular GST status in LNCaP cells.
    • Antioxidant, Anticancer and Antibacterial Activity of Withania somnifera Aqueous Root Extract

      Barnes, D. A.; Barlow, R.; Nigam, Poonam S.; Owusu-Apenten, Richard K.; University of Chester, University of Ulster (Sciencedomain international, 10/11/2015)
      Aims: To evaluate total antioxidant capacity, anticancer activity and antibacterial effects Withania somnifera aqueous-root extracts. Study Design: In vitro study. Place of Study: School of Biomedical Sciences, Ulster University, UK. Methodology: Total antioxidant capacity (TAC) of whole powder and freeze dried W. somnifera aqueous-root extracts was determined using FRAP, DPPH, Folin and ABTS assays. Anticancer activity was accessed using MDA-MB-231 breast cells and Sulforhodamine B staining for cell viability. Antibacterial activity was by disk diffusion assay with penicillin, amoxicillin and streptomycin as positive controls. Results: The TAC for W. somnifera extract was 86, 47, 195,or 443 gallic acid equivalents per 100g dry basis (mgGAE/ 100 g) using FRAP, DPPH, Folin or ABTS assays, respectively. Corresponding TAC values for freeze dried W. somnifera aqueous-root extract were, 418, 553, 1898 or, 1770 (mgGAE/100 g). W. somnifera aqueous-root extract inhibited MDA-MB-231 cell proliferation in a dose-dependent manner with IC50 = 0.19 mg/ml (21 µM GAE). Nil antibacterial effects were detected for freeze dried W. somnifera extract (0-1 mg/ml) across six species of bacteria tested. Conclusion: Withania somnifera root water extract showed significant antioxidant and anticancer activity for MDA-MB-231 breast cancer cells but no antibacterial activity under the conditions of this study.