652 research outputs found
British Nutrition Foundation Annual Lecture 2017 - Diet, obesity and cardiovascular risk
No full textThis paper provides a summary of the British Nutrition Foundation Annual Lecture by Professor Susan Jebb held at the Royal College of Physicians, London, on 14 November 2017. Professor Jebb, recipient of the 2016 British Nutrition Foundation Prize for outstanding achievement in the area of nutrition, spoke of her research on diet, obesity and cardiovascular disease (CVD) risk and her work to translate science into action to help improve the nation's diet. This paper briefly summarises her research, including analyses of the links between dietary patterns and cardiometabolic risk in prospective cohorts, mechanistic studies such as the effect of portion size on energy intake, a series of randomised controlled trials to test the impact of diet composition on markers of CVD risk, and clinical trials of interventions to treat obesity in primary healthcare settings. Professor Jebb emphasised the need to translate the considerable scientific knowledge about the prevention of CVD through modification of risk factors such as obesity, into systems embedded in routine practice and population‐level interventions, in order to improve public health and tackle health inequalities
TV and Inactivity Are Separate Contributors to Metabolic Risk Factors in Children
No full textInterventions against childhood obesity will need to target both excess TV viewing and physical inactivity "separately, yet together," say Prentice and Jebb
Eglantine Jebb and her contribution to the development of children's rights
No full textThe article refers to Eglantine Jebb (1876 - 1928), little known in Poland, prominent English social activist, founder of Save the Children, the author of the Declaration of the Rights of the Child. The content of this article is an attempt to show the impact of E. Jebb on the development and promotion of children's rights
Capturing the healthfulness of the in-store environments of United Kingdom supermarket stores over 5 months (January–May 2019)
No full textIntroduction: Numerous environmental factors within supermarkets can influence the healthfulness of food purchases. This research aims to identify the changes in store healthfulness scores and assess the variations by store type and neighborhood deprivation using an adapted Consumer Nutrition Environment tool. Methods: Between January and May 2019, a total of 104 supermarkets in London were surveyed on 1–3 occasions. The adapted Consumer Nutrition Environment tool included data on 9 variables (variety, price, quality, promotions, shelf placement, store placement, nutrition information, healthier alternatives, and single fruit sale) for 11 healthy and 5 less healthy food items. An algorithm was used to create a composite score of in-store healthfulness and to assess inter-rater reliability. Longitudinal changes in overall store healthfulness and individual variables were investigated using multivariable hierarchical mixed models. Descriptive statistics were used to describe the differences by store type and neighborhood deprivation in each month. All analyses were conducted between January and July 2020. Results: The adapted Consumer Nutrition Environment tool showed acceptable inter-rater reliability. Large stores exhibited healthier environments than small stores (p<0.001), with a similar pattern for each of the 9 individual variables. Within large stores, the overall healthfulness score did not change over the study period. Promotions on more healthful items increased in February (p=0.04), and the availability of healthier alternatives for less healthy foods decreased in March (p=0.01). Within small stores, there was a trend toward increasing healthfulness (p<0.001), primarily owing to more promotions on healthy items (p<0.001). There was no difference in overall healthfulness by neighborhood deprivation. Conclusions: The adapted Consumer Nutrition Environment tool is sensitive to longitudinal changes in environmental variables that contribute to store healthfulness. A wider application of this tool could be used to map in-store environments to identify targets for interventions to encourage healthier food purchasing.</p
Participants’ perspectives of being recruited into a randomised trial of a weight loss intervention before colorectal cancer surgery: a qualitative interview study
No full textBackground: the period between cancer diagnosis and surgery presents an opportunity for trials to assess the feasibility of behaviour change interventions. However, this can be a worrying time for patients and may hinder recruitment. We describe the perspectives of patients with excess weight awaiting colorectal cancer surgery about their recruitment into a randomised trial of a prehabilitation weight loss intervention.Methods: we interviewed the first 26 participants from the 8 recruitment sites across England in the ‘CARE’ feasibility trial. Participants were randomised into either usual care (n=13) or a low-energy nutritionally-replete total diet replacement programme with weekly remote behavioural support by a dietitian (n=13). The semi-structured interviews occurred shortly after recruitment and the questions focused on participants’ recollections of being recruited into the trial. We analysed data rapidly and then used a mind-mapping technique to develop descriptive themes. Themes were agreed by all co-authors, including a person with lived-experience of colorectal surgery.Results: participants had a mean body mass index (± SD) of 38 kg/m2 (± 6), age of 50 years (± 12), and 42% were female. People who participated in the trial were motivated by the offer of structured weight loss support that could potentially help them improve their surgical outcomes. However, participants also had concerns around the potential unpalatability of the intervention diet and side effects. Positive attitudes of clinicians towards the trial facilitated recruitment but participants were disappointed when they were randomised to usual care due to clinical teams’ overemphasis on the benefits of losing weight.Conclusions: patients were motivated to take part by the prospect of improved surgical outcomes. However, the strong preference to be allocated to the intervention suggests that balanced communication of equipoise is crucial to minimise disappointment from randomisation to usual care and differential dropout from the trial.<br/
Plasma oxylipins respond in a linear dose-response manner with increased intake of eicosapentaenoic and docosahexaenoic acids: results from a randomized controlled trial in healthy humans
No full textBackgroundThe health effects of long-chain omega-3 polyunsaturated fatty acids (n–3 PUFAs) are partly mediated by their oxidized metabolites, i.e., eicosanoids and other oxylipins. Some intervention studies have demonstrated that eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) increase systemic concentrations of n–3 PUFA–derived oxylipins and moderately decrease arachidonic acid–derived oxylipins. There is no information on the dose-response of oxylipin concentrations after n–3 PUFA intake.ObjectiveThe aim of this study was to quantify oxylipins in human plasma samples from an intervention study in which participants were randomly assigned to different daily intakes of EPA and DHA for 12 mo.MethodsHealthy adult men and women with low habitual fish consumption (n = 121) were randomly assigned to receive capsules providing doses of n–3 PUFAs reflecting 3 patterns of consumption of oily fish [1, 2, or 4 portions/wk with 3.27 g EPA + DHA (1:1.2, wt:wt) per portion] or placebo. Oxylipins were quantified in plasma after 3 and 12 mo. Relative and absolute changes of individual oxylipins were calculated and concentrations were correlated with the dose and the content of EPA and DHA in blood lipid pools.ResultsSeventy-three oxylipins, mostly hydroxy-, dihydroxy-, and epoxy-PUFAs, were quantified in the plasma samples. After 3 and 12 mo a linear increase with dose was observed for all EPA- and DHA-derived oxylipins. Cytochrome-P450-derived anti-inflammatory and cardioprotective epoxy-PUFAs increased linearly with n–3 PUFA dose and showed low interindividual variance (r2 > 0.95). Similarly, 5, 12-, and 15-lipoxygenase–derived hydroxy-PUFAs as well as those formed autoxidatively increased linearly. These include the precursors of so-called specialized pro-resolving lipid mediators (SPMs), e.g., 17-hydroxy-DHA and 18-hydroxy-EPA.ConclusionsPlasma concentrations of biologically active oxylipins derived from n–3 PUFAs, including epoxy-PUFAs and SPM-precursors, increase linearly with elevated intake of EPA and DHA. Interindividual differences in resulting plasma concentrations are low. This trial was registered at controlled-trials.com as ISRCTN48398526
Measurement of total energy expenditure in grossly obese women: comparison of the bicarbonate-urea method with whole-body calorimetry and free-living doubly labelled water
No full textOBJECTIVE: To establish validity of the bicarbonate-urea (BU) method against direct measurements of gaseous exchange (GE) in a whole-body indirect calorimeter and to compare BU and doubly labelled water (DLW) measurements in free-living conditions in the same group of grossly obese women.DESIGN: Energy expenditure (EE) was estimated by the BU method over 24 h concurrently with whole-body indirect calorimetry and subsequently over 5 consecutive days at home concurrently with 14 day DLW. Six women, body mass index (BMI) 52.4±10.4 kg/m2 (s.d.), were studied.RESULTS: Total energy expenditure (TEE) measurements by BU and GE within the metabolic chamber were not significantly different (BU=11.79±1.89 MJ/day and GE=11.64±1.86 MJ/day; mean difference, 0.25±0.49 MJ/day, P>0.05). Free-living TEE derived from BU and DLW was also similar (13.28±1.86 and 13.86±2.25 MJ/day, respectively; mean difference 0.17±1.33 MJ/day, P<0.05). The measured physical activity level (PAL) in these very obese subjects was within the range reported in other free-living studies in less obese individuals (1.62±0.14 using DLW and 1.56±0.20 using BU). The BU method was well tolerated by the subjects.CONCLUSIONS: This study in grossly obese subjects, heavier than those participating in previous studies involving tracer methods, demonstrates validity of the BU against GE under controlled metabolic conditions, and the equivalence between BU and DLW under free-living conditions. The results suggest that both tracer methods are valid in this population group. This study also demonstrates the practicalities of using the BU method over 5 days, the longest application of the method so far
CARE: protocol of a randomised trial evaluating the feasibility of pre-operative intentional weight loss to support post-operative recovery in patients with excess weight and colorectal cancer
No full textAim: excess weight increases the risk of morbidity following colorectal cancer surgery. Weight loss may improve morbidity, but it is uncertain whether patients can follow an intensive weight loss intervention while waiting for surgery and there are concerns about muscle mass loss. The aim of this trial is to assess the feasibility of intentional weight loss in this setting and determine progression to a definitive trial.Methods: CARE is a prospectively registered, multicentre, feasibility, parallel, randomised controlled trial with embedded evaluation and optimisation of the recruitment process. Participants with excess weight awaiting curative colorectal resection for cancer are randomised 1:1 to care as usual or a low-energy nutritionally-replete total diet replacement programme with weekly remote behavioural support by a dietitian. Progression criteria will be based on the recruitment, engagement, adherence, and retention rates. Data will be collected on the 30-day postoperative morbidity, the typical primary outcome of prehabilitation trials. Secondary outcomes will include, among others, length of hospital stay, health-related quality of life, and body composition. Qualitative interviews will be used to understand patients' experiences of and attitudes towards trial participation and intervention engagement and adherence.Conclusion: CARE will evaluate the feasibility of intensive intentional weight loss as prehabilitation before colorectal cancer surgery. The results will determine the planning of a definitive trial
Interventions to accelerate change towards a healthier diet
No full textPoor diets are a significant contributor to non-communicable diseases and obesity. Despite years of health promotion, change in dietary habits is slow and there is growing recognition of the need to provide greater support to individuals and to complement individual efforts with changes in the food environment to shift the default towards healthier diets. The present paper summarises opportunities for intervention at the individual and population level. It discusses the role of voluntary or mandatory approaches to drive change in the food industry and the need for improved methods to monitor and evaluate progress. It concludes with a call to action from all stakeholders to accelerate change towards a healthier diet
Developing and evaluating interventions of diet and weight control to reduce the risk for gestational diabetes
No full textGestational diabetes mellitus (GDM) is a type of diabetes which develops, or is first recognised during pregnancy. GDM increases the risk of medical complications during pregnancy, and its consequences extend to later in life, as both women and their children are at high risk of developing cardio-metabolic disease. Obesity and excessive gestational weight gain (GWG) are modifiable risk factors for GDM development. Therefore, the research in this thesis aimed to develop and evaluate dietary interventions to help prevent GDM. I initially explored the full burden of the disease using data from a big UK cohort. I found that women with GDM are at high risk of premature death. GDM increases the risk of subsequently developing cardiovascular disease (CVD) risk factors (diabetes, hypertension, dyslipidaemia), and increases the risk of incident CVD by 50% compared to no GDM. There was no evidence that the CVD risk factors explained the association of GDM with CVD, suggesting that all women with GDM are at increased risk of cardio-metabolic disease post-partum, and should be monitored. I then developed a dietary intervention of moderate total carbohydrate reduction, suitable for use in pregnancy, to help prevent GDM (RECORD). It combined a 30-minute dietary behavioural consultation, with structured written materials, brief telephone support throught pregnancy, and weekly self-weighing. In designing the behavioural component, I sought ways to increase motivation and adherence. I thought about using Motivational Interviewing (MI), a popular counselling style in behavioural weight management programmes (BWMPs). Due to increased training and time required for its delivery, I conducted a systematic review and meta-analysis to explore MI’s independent effectiveness over other behavioural approaches in BWMPs for weight loss or maintenance, but found that it only leads to a small short-term weight benefit (-1 kg), and only when compared to no/minimal interventions, which makes it not a worthwile addition to weight management programmes with standard behavioural support. In a feasibility trial, I tested if it is possible to deliver the RECORD intervention alongside routine antenatal appointments, and how successful women with obesity would be in following it from early or mid-pregnancy until delivery. The trial’s retention rate was excellent (96%), but recruitment was difficult. Adherence was highly variable, and on average, the
reduction in total carbohydrate intake in women receiving the intervention was small (-19.5 g/day and -24.6 g/day absolute and adjusted changes from baseline), which limits the likelihood of achieving the desired goal to prevent GDM. I observed potentially favourable effects of the intervention on blood glucose, GWG, and blood pressure, but the trial was not powered to detect differences in these outcomes. In qualitative interviews, participants praised the intervention for its structure and simplicity, and generally found it acceptable, but a sub-sample reported barriers to adherence, such as competing priorities, and emotional relationship with food. Combining qualitative and quantitative data from this research, I identified opportunities for refinement of the intervention, recruitment strategy, and for routine practice, which could be explored in the future
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