• Acute and chronic effects of beetroot supplementation on blood pressure and arterial stiffness in humans

      Mushtaq, Sohail; Turner, Emma; University of Chester
      Dietary supplementation of beetroot juice, containing nitrate- a potent vasodilation agent, has been shown to be vasoprotective( 1 ), and dose dependent decreases in blood pressure (BP) have been previously demonstrated(2,3). To our knowledge there has been only one study investigating the effect of beetroot supplementation in humans on arterial stiffness, measured using pulsewave velocity (PWV) and, although there was no effect of supplementation on PWV, there was a significant reduction due to beetroot supplementation in acute diastolic BP (3hrs, P = 0·023)( 4 ). A double-blind, randomised, cross-over intervention trial was carried out in a cohort of 12 healthy male participants (mean age (SEM) = 43 (2·1) yrs, BMI = 27·8 (1·1) kg.m2) who underwent both beetroot juice and placebo supplementation for 14 days. The aim of the study was to assess the effect of 6·45 mmol of nitrate in a concentrated 70 ml beetroot drink (James White Ltd, Ipswich, UK) on systolic and diastolic BP, mean arterial pressure (MAP) and arterial stiffness (PWV, aortic augmentation index (Aix), brachial Aix) in humans. BP and arterial stiffness measurements weretaken using PWV (Arteriograph, TensioMed,Hungary). Measurements were taken intriplicate at baseline, 3 hours post-supplementation (either beetroot juice orplacebo) and post-intervention (day 15). This was followed by a 7-day washoutperiod before participants were transferred to the alternate supplement. Table 1 shows that there was no significant acute or short term effect of beetroot juice supplementation on the parameters measured when compared to placebo. However, there was a significant decrease in systolic BP (P = 0·009), diastolic BP (P = 0·035), MAP (P = 0·017), aortic and brachial AIX (P = 0·042 and 0·041 respectively), 3hours post beetroot supplementation. These results confirm previous findings( 4 ) that beetroot supplementation does not have an acute or short term effect on arterial stiffness measures. However, acute effects on arterial stiffness and BP within the beetroot juice supplementation group were observed. Further large scale studies on dietary nitrate supplementation and cardiovascular health are required to further assess efficacy.
    • Dietary management of heart failure: room for improvement?

      Butler, Thomas; Department of Clinical Sciences and Butrition, University of Chester (Cambridge University Press, 2016-02-06)
      There is growing awareness of the role of diet in both health and disease management. Much data are available on the cardioprotective diet in the primary and secondary prevention of CVD. However, there is limited information on the role of diet in the management of heart failure (HF). Animal models of HF have provided interesting insight and potential mechanisms by which dietary manipulation may improve cardiac performance and delay the progression of the disease, and small-scale human studies have highlighted beneficial diet patterns. The aim of this review is to summarise the current data available on the role of diet in the management of human HF and to demonstrate that dietary manipulation needs to progress further than the simple recommendation of salt and fluid restriction.
    • Dietary supplementation with n-3 fatty acids (n-3 FA) for 4 weeks reduces post-exercise fatigue and delayed onset muscle soreness (DOMS) in trained male athletes

      Mushtaq, Sohail; Benson, Lindsay; University of Chester
      High intensity exercise in the form of eccentric contractions can lead to the formation of free radicals, stimulating an inflammatory response( 1 , 2 ). Consumption of n-3 FA may help modify inflammation and immune reactions beneficial to health by decreasing interleukin-6, tumour necrosis factor-alpha and C-reactive protein( 3 ). For trained athletes to improve athletic performance, recovery from training is important and DOMS is frequently experienced following eccentric exercise, impacting negatively on strength( 4 ). The Western diet is however, characterised by a high n-6 FA consumption relative to n-3 FA, formulating ratios often in excess of 16:1( 5 ). The use of non-steroidal anti-inflammatory drugs in the form of n-3 FA has been investigated by a number of clinical trials in untrained athletes, but whether this can be translated into attenuating exercise induced inflammation in trained athletes is still under investigation. A double-blind, randomised controlled trial was conducted in 22 trained male athletes who supplemented their diet with either 3000 mg/d of fish oil (gel capsules) consisting of 990 mg eicosapentaenoic acid (EPA) and 660 mg docosahexaenoic acid (DHA) (n = 11), or 3000 mg/d olive oil placebo (n = 11), for 28d. Participants underwent 3 sets of eccentric bicep curls in their dominant arm until failure and arm circumference, number of repetitions completed and DOMS/fatigue scores via visual analogue scale (VAS) were recorded at 0, 24 and 48 h after exercise, pre and post supplementation. No group performed better during the eccentric bicep test, pre and post supplementation, and at baseline, no differences were observed between groups for DOMS and fatigue. However, post supplementation, DOMS was significantly lower at 24 h (P = 0·005) and 48 h (P = 0·002) and fatigue was significantly lower at 24 h (P = 0·043) and 48 h post exercise (P < 0·001) in the n-3 FA group compared to the placebo group (Fig. 1). These findings indicate that n-3 FA supplementation has the potential to promote recovery and subsequently increase athletic performance in trained male athletes and may be a useful ergogenic aid. Possible anti-inflammatory mechanisms of n-3 FA should be further investigated using specific biomarkers of inflammation.
    • Dietary vitamin D consumption, sunlight exposure, sunscreen use and parental knowledge of vitamin D sources in a cohort of children aged 1–6 years in North West England

      Mushtaq, Sohail; Aitken, Amanda; University of Chester
      Hospital admission for children with rickets in England has dramatically increased, from <1 child per 100,000 in the early 1990's to 4·78 (4·58–4·99) per 100 000 between 2007 and 2011( 1 ). The re-emergence of rickets thus suggests poor vitamin D status( 2 ). Additionally, there has been a plethora of publications associating low vitamin D status with many adverse health outcomes other than the classical role of vitamin D in the development, maintenance and function of a healthy skeleton( 3 ). Vitamin D is a fat lipophilic steroid pro hormone obtained from few foods in the diet. However, the majority (90–95%) of vitamin D is synthesised from exposure of bare skin to sunlight( 4 ), and casual sunlight exposure has been considered adequate for the majority of the population. Consequently, there is no reference nutrient intake (RNI) for ages 4–65 yrs( 5 ). With modern indoor lifestyles, cautious sun screen usage and changes in food habits, sunlight exposure may no longer be sufficient to maintain adequate vitamin D status. To avoid vitamin D deficiency, supplementation and fortification may need to play a more prominent role in everyday lives( 6 ). The aim of the present study was to investigate vitamin D dietary intake in children, parents’ knowledge of vitamin D sources, children's outdoor habits and sun screen application practices. A retrospective, cross sectional study approach was utilised. Parents of children (n = 42) aged between 1 and 6 yrs completed a semi-validated food frequency questionnaire, a sources of vitamin D knowledge questionnaire, and a sunlight exposure and sunscreen use questionnaire, in Adlington, N.W. England (latitude 55oN) during May 2013. Children's mean (±SD) dietary vitamin D intake was 4·4 ± 2·5 μg/d, significantly lower than 7μg/d (P = < 0·001, for comparison 7μg/d, the RNI for ages 3 months-4 yrs was used). As expected, children taking supplements had a significantly higher mean (±SD) vitamin D intake (8·49 ± 1·78 μg/d) compared to those that did not supplement (3·34 ± 1·23 μg/d, P < 0·001). The greatest contribution to dietary vitamin D intake from food was from butter and spreads (0·028μg/d), followed by cakes, biscuits & scones (0·023μg/d). Parents' knowledge of food sources was poor, with a mean (±SD) incorrect response of 76% ±11·2. Contrastingly, 93% correctly identified sunlight exposure as a potential source of vitamin D. Eighty nine percent of participants played outdoors daily for 1 hour or more, 81% used sunscreen with an SPF ≥30 and only 2% rarely applied sunscreen. This study revealed that children's diet in the NW England is lacking sufficient vitamin D content, in line with larger surveys( 7 , 8 ). Parents' knowledge regarding vitamin D dietary sources was poor but 93% of parents knew that sunlight was the non-dietary source of vitamin D. Outdoor play indicated sufficient exposure time to produce endogenous vitamin D but sunscreen usage may have potentially diminished epidermal UVB exposures. Further research is needed using biomarkers to confirm vitamin D insufficiency, and public health strategies should be implemented to promote existing recommendations regarding supplementation and consumption of vitamin D rich foods. Additionally, guidelines for safe sun exposure and sunscreen use are required.
    • Dietary vitamin D supplementation improves haematological status following consumption of an iron-fortified cereal: an 8-week randomised controlled trial

      Mushtaq, Sohail; Ahmad Fuzi, Salma F.; University of Chester
      Vitamin D, a secosteroid, has recently been implicated in the stimulation of erythroid precursors and ultimately the rate of erythropoiesis. However, there are a paucity of randomised controlled trials (RCT), investigating the effect of vitamin D supplementation iron status, especially in populations at risk of iron deficiency. An eight-week, double-blind RCT was carried out in 50 female (mean age (± SD): 27 ± 9 years), iron-deficient (plasma ferritin concentration < 20 μg/L) participants, randomised to consume an iron-fortified cereal containing 9 mg of iron, with either a vitamin D supplement (1,500 international units (IU)/day, 38 μg/day) or placebo. The effect of dietary vitamin D supplementation on haematological indicators was investigated. Blood samples were collected at baseline, 4-weeks and 8-week timepoints for measurement of iron and vitamin D status biomarkers. The effect of intervention was analysed with a mixed-model repeated measures ANOVA using IBM SPSS statistical software (Version 21, IBM Corporation, New York, USA). Significant increases were observed in two haematological parameters: haemoglobin concentration and haematocrit level from baseline to post-intervention in the vitamin D group, but not in the placebo group. The increase from baseline to post-intervention in haemoglobin concentration in the vitamin D group (135 ± 11 to 138 ± 10 g/L) was significantly higher than in the placebo group (131 ± 15 to 128 ± 13 g/L) (P ≤ 0.05). The increase in haematocrit level from baseline to post-intervention was also significantly higher in the vitamin D group (42.0 ± 3.0 to 43.8 49 ± 3.4%) compared to the placebo group (41.2 ± 4.3 to 40.7 ± 3.6%) (P ≤ 0.05). Despite non-significant changes in plasma ferritin concentration, this study demonstrates that dietary supplementation with 1,500IU vitamin D, consumed daily with an iron-fortified cereal led to improvement in haemoglobin concentration and haematocrit levels in women with low iron stores. Further long-term studies are required, however, these findings suggest a potential role for improvement of vitamin D status as an adjunct therapy for recovery of iron status in iron-deficient populations.
    • Effect of a single serving of pecan nuts on blood lipids and weight: a single blind randomised control trial

      Mushtaq, Sohail; Butler, Thomas; Confue, Charlotte; Guild, Joanne; University of Chester
      Nuts are a common component of many traditional cardioprotective diets primarily due to their ability to lower blood lipids and reduce cardiovascular risk(1, 2). Studies consistently show nut intake is associated with favourable changes in energy balance(3). However there is a paucity of data examining the acute changes following nut consumption. We sought to examine the effect of a single serving of pecan nuts on plasma lipids and bodyweight. Participants were sampled from the University of Chester, UK. Individuals (n = 54) were screened for eligibility to participate. Those meeting entry criteria (n = 25) of being either male or female aged 30 years or more and with no previous history of CVD were randomised to either a control (CON) or pecan nut group (PECAN). Participants in the PECAN group received a single 50 g serving of pecan nuts. Capillary blood was taken for analysis of triacylglycerol, total-cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein-cholesterol and non-high density lipoprotein cholesterol (TAG, TC, LDL-C, HDL-C and non-HDL-C, respectively), and anthropometric measurements were performed. All measurements were repeated after 3 days. Participants were instructed to record all food and drink consumed, and not to change their habitual eating habits. Procedures were approved by the Faculty of Medicine, Dentistry and Clinical Sciences Research Ethics Committee, University of Chester. No significant effect on TC, HDL-C or TAG was observed during the study (Fig. 1A–C). LDL-C decreased by 0.09 ± 0.37 mmol/L and increased by 0.16 ± 0.40 mmol/L in CON and PECAN groups, respectively. Non-HDL-C showed a similar pattern with the CON group showing a decrease and PECAN group displaying an increase (−0.18 ± 0.36 mmol/L vs. 0.16 ± 0.40 mmol/L, respectively). Bodyweight significantly (P = 0.025) decreased in the PECAN group when compared to the CON group (−0.58 ± 0.56 kg vs. −0.05 ± 0.55 kg, respectively). In conclusion, a single serving of pecan nuts had no significant impact on lipid markers of cardiovascular risk. Bodyweight was significantly reduced consistent with recent literature showing a favourable relationship with nut intake and energy balance(3).
    • Estimates of fibre intake and percentage of the population with intake below the dietary reference values (DRVs) in England (1991–2015)

      Mushtaq, Sohail; Farzad, Amirabdollahian; Buczkowski, Bartek; Davies, Ian; University of Chester
      In 1991, the Committee on Medical Aspects of Foods (COMA) defined dietary fibre as non-starch polysaccharides (NSP) and set the DRV as the population average intake of 18 g/day 1 , determined using the Englyst method of analysis 2 . The latest publication of the Scientific Advisory Committee on Nutrition (SACN) 3 broadened the definition of dietary fibre beyond NSP to broader definition of Association of Analytical Communities (AOAC) fibre, recommending the DRV to be 30 g/day based on AOAC method. The COMA 1991, DRV of 18 g/day of NSP corresponds to around 24 g/day of AOAC fibre 3 and therefore the new DRV of fibre would represent a higher recommendation (around 22·5 g fibre as per the Englyst method) for the average population. The purpose of this study was to investigate variation in fibre intake of English population by age and gender, in comparison with the COMA and SACN DRVs. Data on the core sample of the National Diet and Nutrition Survey rolling programme from 2008–2012 was reanalysed. Children aged below 16 years were excluded in consideration of their different DRVs. The data on dietary fibre was extracted from fully productive individuals (i.e. participants who completed three/four diary days), as an average daily intake based on the NSP/Englyst fibre. Inferential statistics included the analysis of variance to discover if there were any significant variations in fibre intake of males and females in relation to their age groups. The statistical significance was set at 0·05. For all age groups, the average fibre intake is below the DRVs. The average daily fibre intake slightly increased with age for both genders until 64 years. When differences in energy intake were taken into account, the average daily fibre density (g/1000 kcal) still increased with the age of participants. Overall, less than a third of populations had an intake above the COMA DRV 1 . More than 90 % of the population had intake below the SACN DRV 3 , demonstrating a challenge for future policies to meet the nutritional guidelines, particularly amongst females and younger adults. The findings should be treated with caution considering the definition of AOAC fibre used as the basis for the SACN DRV includes non-digestible oligosaccharides, resistant starch and polydextrose, going beyond NSP/Englyst variables analysed.
    • Estimation of fruit and vegetable consumption in a cohort of Ghanaian women and evaluation of knowledge, attitudes and practice

      Mushtaq, Sohail; Moss, Jennifer; University of Chester
      Non-communicable diseases (NCDs), previously confined to industrialised nations, are spreading through the developing world at unprecedented rates( 1 ). With communicable diseases still prevalent, this imposes a double-burden of disease in countries with limited resources and ill-equipped health systems( 2 ). An unhealthy diet, including insufficient consumption of fruit and vegetables is one of four main behavioural risk factors in the development of NCDs. However, consumption across the world, including Ghana, is below recommended levels( 3 ). Despite a wealth of research in developed countries, few studies have investigated barriers to fruit and vegetable consumption in Ghana. The aim of the present study was to assess fruit and vegetable consumption and evaluate knowledge, attitudes and practice in a cohort of Ghanaian women. A mixed-methods approach, incorporating a survey delivered in a guided interview format was utilised to investigate patterns and determinants of fruit and vegetable consumption in a cohort of Ghanaian women. Data were collected from female environmental health and nursing students aged 18–33 years (n=74, response rate 98.7%), residing in the Korle-Bu district of Accra, Ghana. A 24-hour recall questionnaire, local handy measures and a specially designed portion size assessment sheet allowed estimation of fruit and vegetable consumption, whilst a questionnaire comprising both qualitative and quantitative questions enabled investigation of barriers to consumption in Ghanaian society. A significantly greater level of low fruit and vegetable consumption was found in the present study (69%), than detailed in the World Health Survey 2002–03 (p⩽0.001). There was a significant positive association between meal frequency and consumption levels (p=0.025), however, no association was found between consumption and knowledge levels, income, home-production or perceived adequate consumption. Themes emerging from the research related to barriers affecting consumption included cost, availability, quality, and health and safety issues. Unhealthy snacking was found to be common, as were unhealthy substitutions during periods of scarcity. Numerous barriers causing the observed decrease in fruit and vegetable consumption were identified in the present study. The interrelating nature of the barriers identified suggests a multidirectional approach to address these issues would offer the greatest benefits for consumption levels. Increasing agricultural infrastructure is key, whilst educational initiatives should also play a major role in future strategies to increase fruit and vegetable consumption. Future investment and policy in Ghana should focus on prevention rather than cure, if the growing NCD burden is to be halted.
    • Full fat cheese intake and cardiovascular health: a randomised control trial

      Mushtaq, Sohail; Butler, Thomas; Davies, Ian; University of Chester
      Milk and milk products contribute approximately 22 % of the nation's saturated fat (SFA) intake. Recently, the role of dairy and its SFA composition and link to cardiovascular disease (CVD) has been analysed( 1 ), suggesting a beneficial action of this food group on reducing cardiovascular risk in high-risk groups( 2 , 3 ). The aim of this study was to examine the effects of 4 weeks full-fat cheese on circulating lipoprotein fractions, blood pressure and arterial stiffness in healthy adults. Participants were recruited in the city of Chester, UK. Those meeting entry criteria of: 18–65 years of age, not taking antihypercholesterolaemic or antihypertensive medication took part in the study. Participants were randomised to receive either 50 g of a full-fat Red Leicester (FFC) or placebo (virtually zero fat Cheddar cheese, ZFC) per day for 4 weeks. Anthropometry, blood pressure, brachial and aortic augmentation index (BAIX and AAIX, respectively), pulse-wave velocity (PWV) and a full lipid profile were determined at baseline and post-intervention. Participants were asked to keep a 3-day food diary prior to and for the last 3 days of the protocol. All procedures were approved by the Faculty of Medicine, Dentistry and Life Sciences Research Ethics Committee at the University of Chester. Eighty-six (86) individuals completed the study (43 per group). No significant changes were observed in any measured parameter (Table 1). Both ZFC and FFC groups showed a significant increase in calcium intake during the course of the study (1002·1 ± 639·1 mg to 1815·0 ± 1340·1 mg and 1219·6 ± 1169·1 mg 1845·8 ± 1463·2 mg, P < 0·001, respectively) showing good adherence to the protocol. In conclusion, these results suggest that inclusion of 50 g full fat cheese into the diet of a healthy population does not impact negatively on traditional CVD risk markers. Future strategies to reduce SFA intake should focus on – and acknowledge the importance of the source – of SFA in the diet.
    • Leading brand products and their supermarket economy line equivalents, is there a difference in nutritional content?

      Mushtaq, Sohail; Jackson, Emma; University of Chester
      Since the introduction of supermarket economy lines (SELs) in the early 1990s, their popularity has been established nationwide(1).However, these economical alternatives are commonly perceived to be of lower nutritional quality than their leading brand (LB)equivalents(2,3,4). The present study aimed to determine if there is a significant difference in nutritional content between the UKtop-selling LBs and their SEL equivalents. Additionally, the study aimed to investigate if on average, LBs or SELs provide better‘value for money’.The LBs of 38 most popular food categories were identified from UK market research, and equivalent SEL products were identifiedfrom each of the retailers with the top-five majority UK market share: Tesco, Sainsbury’s, Asda, Morrisons and Aldi. In each foodcategory, differences between LBs and SELs in: energy, fat, saturated fatty acid, carbohydrate, sugar,fibre, protein and salt content,per 100 g of food product were determined using a one-sample T-test. The nutritional quality of each product was also determined bya nutrient profiling system. Cost was analysed in relation to shopping baskets containing 33 equivalent products. Six shopping basketswere analysed, one containing LB products and one from each SEL retailer. The cost of each shopping basket was calculated usingpack price and price per 100 g or 100mL of food product.Data was collected for 219 products; 38 LBs and 181 SELs. 86 significant differences were identified in specific nutrients across thefood categories, but the direction of the differences was inconsistent. Based on pack price, the total LB shopping basket cost was£61·91 whereas average SEL basket cost £28·62, a difference of £33·29 or 54 % (P = 0·001). However, there was no difference betweenthe nutrient profile of LBs and SELs.Although significant differences were identified between nutrients in some food categories, overall, there appeared to be no differ-ence in nutritional content between LBs and SEL equivalents. This association is consistent with previous studies and is contrary tothe common perception that SELs are of lower nutritional quality than LBs(2,3,4,5,6). Pertinent to public health, the present studyfound that SEL breakfast cereals contained a significantly higher amount of salt than the LB (P = 0·035)(4,6). Additionally, althoughthe majority of food categories did not show a significant difference in energy content per 100 g of food product (29 of 38) LB pastahad significantly higher energy content per 100 g of food product than SEL equivalents (P = 0·017)(6).In conclusion, there appears to be no difference in nutritional content between the LB and SEL equivalents in 38 popular foodcategories, however, there appears to be twofold difference in price The cost analysis demonstrates that consumers can purchasethe same quantity of foodstuff for significantly less when opting for SEL products. Low income households may therefore be encour-aged to purchase SEL products to reduce weekly household expenditure and enable a greater proportion of the budget to be availablefor the purchase fresh produce such as fruit, vegetables and meat
    • 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.
    • Staff perspectives

      Astbury-Ward, Edna; University of Chester (Cambridge University Press, 2014-08-24)
      This chapter will focus on the medical, nursing and psychological care of the woman during the abortion process, in particular, from the perspective of staff caring for women undergoing induced abortions.
    • A validated food frequency questionnaire to determine dietary intake of vitamin D

      Watkins, Stephanie; Mushtaq, Sohail; Freeborn, Ellen; University of Chester
      Objective The aim of the present study was to develop and validate a vitamin D food frequency questionnaire (FFQ) for assessment of dietary vitamin D intake in healthy adults in England, UK. Design: The current study assessed the agreement between a four-day food diary (4d-FD) and a new vitamin D FFQ to measure dietary intake of vitamin D. Dietary intake was estimated using Nutritics dietary analysis software and Spearman’s and Bland-Altman tests were utilised to assess correlation and agreement, respectively. Participants also provided a blood sample for plasma analysis of vitamin D concentrations. Setting: Home setting. Participants: Fifty participants were recruited to the study from the University of Chester and vicinity. Results: Results showed a strong correlation between vitamin D intake recorded by the FFQ and the 4d-FD (r = 0.609; P < 0.0001) within 95% limits of agreement. Furthermore, a significant correlation between plasma 25(OH)D concentrations and vitamin D intake measured by the FFQ (r = 0.290, P = 0.041) and the 4d-FD (r = 0.360, P = 0.01) was observed. Conclusion: Our analysis suggests this FFQ is a useful and rapid tool for researchers and health professionals to assess vitamin D dietary intakes in healthy adults in the UK.
    • 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.