• Impacts of Reducing UK Beef Consumption Using a Revised Sustainable Diets Framework

      Chalmers, Neil; email: neil.chalmers@abdn.ac.uk; Stetkiewicz, Stacia; email: s.stetkiewicz@lancaster.ac.uk; Sudhakar, Padhmanand; orcid: 0000-0003-1907-4491; email: Padhmanand.Sudhakar@earlham.ac.uk; Osei-Kwasi, Hibbah; orcid: 0000-0001-5084-6213; email: h.oseikwasi@chester.ac.uk; Reynolds, Christian J; orcid: 0000-0002-1073-7394; email: c.reynolds@sheffield.ac.uk (MDPI, 2019-12-02)
      The impact of beef consumption on sustainability is a complex and evolving area, as sustainability covers many areas from human nutrient adequacy to ecosystem stability. Three sustainability assessment frameworks have been created to help policy makers unpack the complexities of sustainable food systems and healthy sustainable dietary change. However, none of these frameworks have yet to be applied to a case study or individual policy issue. This paper uses a hybrid version of the sustainability assessment frameworks to investigate the impact of reducing beef consumption (with a concurrent increase in consumption of plant-based foods, with a focus on legumes) on sustainability at a UK level. The aim of this paper is to understand the applicability of these overarching frameworks at the scale of an individual policy. Such an assessment is important, as this application of previously high-level frameworks to individual policies makes it possible to summarise, at a glance, the various co-benefits and trade-offs associated with a given policy, which may be of particular value in terms of stakeholder decision-making. We find that many of the proposed metrics found within the sustainability assessment frameworks are difficult to implement at an individual issue level; however, overall they show that a reduction in beef consumption and an increase in consumption of general plant-based foods, with a focus around legumes production, would be expected to be strongly beneficial in five of the eight overarching measures which were assessed.
    • Clobazam add-on therapy for drug-resistant epilepsy

      Bresnahan, Rebecca; Williamson, John; Martin-McGill, Kirsty J.; Michael, Benedict D.; Marson, Anthony G. (Wiley, 2019-10-22)
    • Tiagabine add-on therapy for drug-resistant focal epilepsy

      Bresnahan, Rebecca; Martin-McGill, Kirsty J.; Hutton, Jane L.; Marson, Anthony G. (Wiley, 2019-10-14)
    • A UK consensus on optimising CVD secondary prevention care: perspectives from multidisciplinary team members

      The ICON (Integrating Care Opportunities across the NHS) CVD Secondary Prevention Working Group (2019-10-03)
      Although overall cardiovascular (CV) mortality has declined in recent years, patients with clinically manifest cardiovascular disease (CVD) remain at increased risk of recurrent CV events. To minimise the likelihood of future CV events following an acute myocardial infarction (MI), changes in diet and lifestyle, alongside pharmaceutical interventions, such as dual antiplatelet therapy, a β-blocker, an ACE inhibitor, and a statin, are recommended within current clinical guidelines. The use of cardiac rehabilitation (CR) programmes has been shown to be highly effective in reducing mortality and morbidity following MI, and a cost-benefit analysis suggests that increasing the uptake of CR to 65% among eligible patient would result in potential cost savings of over £30 million annually for the NHS. The involvement of a multidisciplinary team (MDT) of healthcare professionals is central to delivering post-MI care, with initial and/or ongoing input from cardiologists, hospital-based specialist pharmacists, specialist nurses, GPs, dietitians, smoking cessation specialists and practice-based and community pharmacists, among others. This consensus statement was developed based on a meeting of HCPs actively involved in delivering CV secondary prevention care at primary and secondary care centres across the UK. Recognising that HCP team configuration and availability of resources/services vary by location, the authors have focused on three common themes which have broad relevance in CVD secondary prevention, specifically: integration of care, medicines optimisation, and encouraging patient activation. Opportunities for MDT members to improve outcomes in post-MI patients are suggested and examples of best practice models which have been implemented successfully are described.
    • Sulthiame add-on therapy for epilepsy

      Bresnahan, Rebecca; Milburn-McNulty, Philip; Powell, Graham; Sills, Graeme; Marson, Anthony G.; Martin-McGill, Kirsty J.; 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
    • Nice to know: impact of NICE guidelines on ketogenic diet services nationwide

      Whiteley, Victoria; Carroll, Jennifer; Taylor, Hannah; Schoeler, Natasha; Martin-McGill, Kirsty J.; 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.
    • Felbamate add‐on therapy for drug‐resistant focal epilepsy

      Shi, Li LI; Bresnahan, Rebecca; Martin-McGill, Kirsty J.; 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.
    • 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 (2019-05-17)
      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. (2019-05-01)
      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.]
    • Chester treadmill police tests as alternatives to 15-m shuttle running

      Morris, Mike; Deery, Elizabeth; Sykes, Kevin; Department of Clinical Sciences & Nutrition, University of Chester, Parkgate Road, Chester CH1 4BJ, UK (Oxford University Press, 2019-04-13)
      Background Police officers require a specific level of aerobic fitness to allow them to complete personal safety training and specialist roles. Officers’ aerobic fitness is assessed using the 15-m multi-stage fitness test (MSFT); however, due to the agility required and risk of injury, two alternative treadmill tests have been designed to predict four of the key minimum VO2 criteria of 35, 41, 46 and 51 ml·kg−1·min−1. Aims To investigate the validity and reliability of Chester Treadmill Police Walk Test (CTPWT) and Chester Treadmill Police Run Test (CTPRT). Methods Seventy-eight UK police officers (18 females) completed the CTPWT (n = 53) or CTPRT (n = 35), or both, generating a total of 88 data sets. To assess reliability, 43 participants returned for a second visit (T2), to repeat the treadmill test. Results Mean differences between predicted and actual VO2 at 35, 41, 46 and 51 ml·kg−1·min−1 were as follows −1.1, −2.1, −0.1 and −1.2 ml·kg−1·min−1. Despite a significant under prediction (p = 0.001), a minimum of 92% of participants were within 10% of target VO2 at all levels. There was no significant difference between actual and predicted VO2 in the CTPRT, at 46 ml·kg−1·min−1 (T1 46.0 ± 1.4 or T2 45.1 ± 1.3 ml·kg−1·min−1). Similarly, there was no significant difference at 51 ml·kg−1·min−1 (T2 50.5 ± 1.4 ml·kg−1·min−1). We observed no differences for gender or trial. Ninety-five per cent limits of agreement were at worst T1–T2 −0.25 ± 4.0 ml·kg−1·min−1. Conclusions The CTPWT and the CTPRT provide a valid and reliable alternative to the 15-m MSFT. Key words Exercise testing; fitness; fitness standards; occupational; police; predictive; treadmill test.
    • 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.
    • 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, 2019-02-12)
      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.
    • Antibacterial activity of Manuka honey and its components: An overview

      Johnston, Matthew; McBride, Michael; Dahiya, Divakar; Owusu-Apenten, Richard K.; Nigam, Poonam S.; University of Chester, University of Ulster (AIMS Press, 2018-11-27)
      The importance of honey for medicinal purposes is well documented in some of the world’s oldest literature. Honey is well known and studied for its antimicrobial properties. The medicinal properties in honey originate from the floral source used by bees. Manuka honey is a dark monofloral honey rich in phenolic content, and currently it is gaining much attention for its antimicrobial activity. Researchers have found that honey is effective against a wide range of pathogens. The antibacterial potency of Manuka honey was found to be related to the Unique Manuka Factor (UMF) rating, which is correlated with the methylglyoxal and total phenols content. It is reported that different types of Manuka honey have differing effects and Gram-negative bacteria are more resistant than Gram-positive bacteria. Bacterial resistance to honey as antimicrobial agent has yet to be identified, possibly due to the presence of a complex mixture of methylglyoxal and other components. Honey is also reported to alter a bacterium’s shape and size through septal ring alteration, which affects cell morphology and growth. Research has shown that Manuka honey of different UMF values has medicinal properties of interest and it can be beneficial when used as a combination treatment with other antimicrobial agents
    • Improving the extractability of arabinoxylans and the molecular weight of wheat endosperm using extrusion processing

      Abdulmannan, Fadel; Jason, Ashworth; Andrew, Plunkett; Mahmoud, Ayman M.; Yazan, Ranneh; University of Leeds; Manchester Metropolitan University; Beni-Suef University; Universiti Putra Malaysia; University of Chester (Elsevier, 2018-09-14)
      Cereal derived arabinoxylans (AXs) are non-starch polysaccharides that have immunomodulatory activities. These activities are thought to be related to the low molecular weight fractions of AXs. Wheat and wheat by-products are rich in AXs, however, the water extractable fraction of AXs in wheat products is low. Water extraction of AXs can be improved by extrusion processing, which increases the extractability of the water soluble fraction. The aim of this study was to determine the extractability and molecular weight of the water soluble fraction of AXs from wheat endosperm after extrusion at screw speeds of 80 and 160 rpm. Extrusion processing significantly (P<0.05) increased the water extractability of AXs in a screw-speed dependent manner (13.07±0.12% at 80 rpm and 15.45±0.16% at 160 rpm compared to8.95±0.10% in the non-extruded control) due to a significant increase (P<0.05) in low molecular weight fractions of AXs in extruded samples.
    • Dietary approaches for patients with heart failure and diabetes

      Butler, Thomas; Georgousopoulou, Ekavi N; Mellor, Duane (Wiley, 2018-08-20)
    • The Efficacy of Energy-Restricted Diets in Achieving Preoperative Weight Loss for bariatric Pateints: A Systematic Review

      Naseer, Fathimath; Shabbir, Asim; Livingstone, Barbara; Price, Ruth; Syn, Nicholas, L; Flannery, Orla; Ulster University; National University Hospital, Singapore; University of Chester (Springer Verlag, 2018-08-18)
      In bariatric practice, a preoperative weight loss of at least 5% is recommended. However, the hypocaloric diets prescribed vary and no consensus exists. This study examined the efficacy of preoperative diets in achieving 5% weight loss. From a systematic literature search, eight randomised controlled trials (n = 862) were identified. Half of the trials used a Bvery-low-calorie diet^ whilst the rest employed a Blow-calorie diet^. Only five diets achieved ≥ 5% weight loss over varying durations and energy intakes. By inference, compliance with a 700–1050 kcal (2929–4393 kJ) diet, consisting of moderate carbohydrate, high protein and low/moderate fat, for 3 weeks is likely to achieve 5% weight loss. A low-carbohydrate diet (< 20 g/day) may achieve this target within a shorter duration. Additional research is required to validate these conclusions.
    • Comparison of Iron (III) Reducing Antioxidant Capacity (iRAC) and ABTS Radical Quenching Assays for Estimating Antioxidant Activity of Pomegranate

      Wan, Hau Ching; Sultana, Bushra; Nigam, Poonam S.; Owusu-Apenten, Richard K.; University of Ulster; University of Agriculture Parkistan; University of Chester (MDPI, 2018-08-07)
      Pomegranate juice (PJ) has total antioxidant capacity which is reportedly higher compared to other common beverages. This short study aimed to assess the total antioxidant capacity of commercial PJ and pomegranate fruit using a newly described method for iron (III) reducing antioxidant capacity (iRAC) and to compare with the ABTS (2,2′-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid)) and Folin–Ciocalteu assays. Commercial PJ, freeze-dried pomegranate, and oven-dried pomegranate were analyzed. The calibration results for iRAC were comparable to ABTS and Folin–Ciocalteu methods in terms of linearity (R2 > 0.99), sensitivity and precision. The total antioxidant capacity for PJ expressed as trolox equivalent antioxidant capacity (TEAC) was 33.4 ± 0.5 mM with the iRAC method and 36.3 ± 2.1 mM using the ABTS method. For dried pomegranates, total antioxidant capacity on a dry weight basis (DB) was 89–110 mmol/100 g DB or 76.0 ± 4.3 mmol/100 g DB using iRAC and ABTS methods, respectively. Freeze-dried pomegranate had 15% higher total antioxidant capacity compared with oven-dried pomegranate. In conclusion, pomegranate has high total antioxidant capacity as evaluated by the iRAC and ABTS methods, though variations occur due to the type of cultivar, geographic origin, processing and other factors. The study is relevant for attempts to refine food composition data for pomegranate and other functional foods
    • Determination of Iron (III) Reducing Antioxidant Capacity for Manuka Honey and Comparison with ABTS and Other Methods

      Yusof, Hasif I. M.; Owusu-Apenten, Richard K.; Nigam, Poonam S.; Universiti Kebangsaan Malaysia Medical Centre; Ulster University; University of Chester (SCIENCEDOMAIN International, 2018-06-11)
      Aims: Applying multiple assays with trolox as the sole reference compound is a recent AOAC proposal to improve the reliability of total antioxidant capacity determinations. The aim of this study was to evaluate, iron (III) reducing antioxidant capacity (iRAC) for Manuka honey samples and comparisons with ABTS and other well-known assays. Study Design: In-vitro, laboratory-based study. Place and Duration of Study: School of Biomedical Sciences, Faculty of Life and Health Sciences, Ulster University, Cromore Road, Coleraine, BT52 1SA, UK; September 2015-May 2016. Methodology: Manuka honey rated Unique Manuka Factor (UMF) 5+, 10+, 15+, 18+ and a nonrated (NR) sample were analysed using five assays for total antioxidant capacity namely, iRAC, ABTS, DPPH, FRAP, and Folin assays. Values for total antioxidant capacity were normalized as Trolox Equivalent Antioxidant capacity (TEAC) for comparison within and between assays. Results: The TAC were correlated for all methods (R2 = 0.83-0.99) and also correlated with the total phenols content. Actual TEAC value for a given honey ranged by 21-70-fold depending on the assay method with the following general order of increase; DPPH < FRAP (pH 3.6) < iRAC (pH 7.0) <ABTS (pH7) < Folin (pH ~11). The trends in TAC values are discussed alongside of TEAC values for 50 food items and some challenges for comparing different antioxidant methods are highlighted. Conclusion: Total antioxidant capacity of Manuka honey changes in a regular manner probably affected by assay pH. The findings are important for attempts to standardize antioxidant methods as currently applied to foods, beverages and dietary supplements. Further research is recommended to examine the effect of normalizing antioxidant methods for solvent composition and pH.
    • Effects of temperature and solvent condition on phase separation induced molecular fractionation of gum arabic/hyaluronan aqueous mixtures

      Hu, Bing; Han, Lingyu; Gao, Zhiming; Zhang, Ke; Al-Assaf, Saphwan; Nishinari, Katsuyoshi; Phillips, Glyn O.; Yang, Jixin; Fang, Yapeng; Hubei University of Technology; Wrexham Glyndwr University (Elsevier, 2018-05-14)
      Effects of temperature and solvent condition on phase separation-induced molecular fractionation of gum arabic/hyaluronan (GA/HA) mixed solutions were investigated. Two gum arabic samples (EM10 and STD) with different molecular weights and polydispersity indices were used. Phase diagrams, including cloud and binodal curves, were established by visual observation and GPC-RI methods. The molecular parameters of control and fractionated GA, from upper and bottom phases, were measured by GPC-MALLS. Fractionation of GA increased the content of arabinogalactan-protein complex (AGP) from ca. 11% to 18% in STD/HA system and 28% to 55% in EM10/HA system. The phase separation-induced molecular fractionation was further studied as a function of temperature and solvent condition (varying ionic strength and ethanol content). Increasing salt concentration (from 0.5 to 5 mol/L) greatly reduced the extent of phase separation-induced fractionation. This effect may be ascribed to changes in the degree of ionization and shielding of the acid groups. Increasing temperature (from 4oC to 80oC) also exerted a significant influence on phase separation-induced fractionation. The best temperature for GA/HA mixture system was 40oC while higher temperature negatively affected the fractionation due to denaturation and possibly degradation in mixed solutions. Increasing the ethanol content up to 30% showed almost no effect on the phase separation induced fractionation.