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    ABSTRACT: Objective: Obesity is the biggest challenge facing preventive medicine. Calorie-labelling has been suggested as a way of changing the architecture of an 'obesogenic' environment without limiting consumer choice. This study examined the effect of calorie-labelling on sales of food items at catering outlets on a city-centre university campus. Methods: Sales data were collected for two consecutive months in 2013 on three UK university sites (two with calorie-labelling during second month, one control) and analysed with chi-square 'Goodness-of-Fit' tests. A questionnaire seeking consumers' views and use of the calorie-labelling was administered and analysed at group-level with chi-square tests. Results: In intervention vs control sites, total sales of all labelled items fell significantly (-17% vs -2%, p<0.001) for the month with calorie-labelling. Calorie-labelling was associated with substantially reduced sales of high-calorie labelled items, without any compensatory changes in unlabelled alternative items. Among 1166 student- and 646 staff-respondents, 56% reported using the calorie-labels, 97% of them to make lower-calorie choices. More females (63%) than males (40%) reported being influenced by calorie-labels when choosing foods (p=0.01). Conclusions: This study provides evidence, beyond that from single-meal exposures, for the acceptability of meal calorie-labelling and its potential as an effective low-cost anti-obesity measure.
    Preventive Medicine 07/2014; 67. DOI:10.1016/j.ypmed.2014.07.027
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    ABSTRACT: To test the appeal of the eatwell week, a nutritionally balanced 7 d menu which satisfies nutritional guidelines of the Food Standards Agency in Scotland; determine the clarity and understanding of the main messages; and gather views on the usability and acceptability of the eatwell week resource format. Focus group discussions with consumers and health professionals. Four locations across the UK. The eatwell week was considered realistic by consumers as it contained foods they recognised and already ate. A preconceived idea had been that there would be more fruit and vegetables and fewer 'treats'. Consumers found the recipes simple and lack of cooking skills was not an apparent barrier. However, the message of 'balance' was poorly understood. Consumers often lacked the knowledge to make informed substitutions in the week. Both the general public and some health professionals felt the menu contained too much carbohydrate. Health professionals felt it was unclear who the eatwell week was intended for and what purpose it served. Use of familiar foods and the provision of simple, easy-to-follow recipes have the potential to overcome some barriers to healthy eating encountered by the general public and encourage improvements in dietary intakes. The eatwell week shows promise as a resource to facilitate implementation of the principles of the eatwell plate and supports government priorities and policies for health.
    Public Health Nutrition 06/2013; 17(07):1-7. DOI:10.1017/S1368980013001663
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    ABSTRACT: Background: Being underweight or overweight and obesity at diagnosis may all worsen prognosis in childhood acute lymphoblastic leukaemia (ALL), although no studies have estimated the prevalence of an unhealthy weight status at diagnosis in large representative samples using contemporary definitions of weight status based on body mass index (BMI) for age. Methods: The present study comprised a retrospective study that aimed to estimate prevalence of being underweight and overweight and obesity at diagnosis for patients with childhood ALL on three successive UK treatment trials: UKALL X (1985-1990; n = 1033), UKALL XI (1990-1997; n = 2031), UKALL 97/99 (1997-2002; n = 898).The BMI for age was used to define weight status with both UK 1990 BMI for age reference data and the Cole-International Obesity Task Force (IOTF) definitions. Results: The prevalence of being underweight was 6% in the most recent trial for which data were available. The prevalence of being overweight and obesity was 35% in the most recent trial when expressed using Cole-IOTF definitions and 41% when expressed relative to UK 1990 reference data. Conclusions: Even with highly conservative estimates, >40% of all UK patients with ALL were underweight, overweight or obese at diagnosis in the most recent trial for which UK data are available (UKALL 97/99, 1997-2002).
    Journal of Human Nutrition and Dietetics 06/2013; 27(1). DOI:10.1111/jhn.12112
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    ABSTRACT: OBJECTIVE: To document iodine status in Indian pregnancies, associations with maternal diet and demographics, and offspring developmental measures. DESIGN: Longitudinal study following mothers through pregnancy and offspring up to 24 months. SETTING: Rural health-care centre (Vadu) and urban antenatal clinic (Pune) in the Maharashtra region of India. SUBJECTS: Pregnant mothers at 17 (n 132) and 34 weeks' (n 151) gestation and their infants from birth to the age of 24 months. RESULTS: Median urinary iodine concentration (UIC) was 203 and 211 μg/l at 17 and 34 weeks of pregnancy, respectively (range 26-800 μg/l). Using the UIC distribution adjusted for within-person variation, extreme UIC quartiles were compared for predictors and outcomes. There was no correlation between UIC at 17 and 34 weeks, but 24 % of those with UIC in the lowest quartile at 17 weeks had UIC in the same lowest quartile at 34 weeks. Maternal educational, socio-economic status and milk products consumption (frequency) were different between the lowest and highest quartile of UIC at 34 weeks. Selected offspring developmental outcomes differed between the lowest and highest UIC quartiles (abdominal circumference at 24 months, subscapular and triceps skinfolds at 12 and 24 months). However, UIC was only a weak predictor of subscapular skinfold at 12 months and of triceps skinfold at 24 months. CONCLUSIONS: Median UIC in this pregnant population suggested adequate dietary provision at both gestational stages studied. Occasional high results found in spot samples may indicate intermittent consumption of iodine-rich foods. Maternal UIC had limited influence on offspring developmental outcomes.
    Public Health Nutrition 05/2013; 17(06):1-10. DOI:10.1017/S1368980013001201
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    ABSTRACT: Context:Immunoassay-based techniques, routinely used to measure serum estradiol (E2), are known to have reduced specificity, especially at lower concentrations, when compared with the gold standard technique of mass spectrometry (MS). Different measurement techniques may be responsible for the conflicting results of associations between serum E2 and clinical phenotypes in men.Objective:Our objective was to compare immunoassay and MS measurements of E2 levels in men and evaluate associations with clinical phenotypes.Design and Setting:Middle-aged and older male subjects participating in the population-based Osteoporotic Fractures in Men (MrOS) Sweden study (n = 2599), MrOS US (n = 688), and the European Male Aging Study (n = 2908) were included.Main Outcome Measures:Immunoassay and MS measurements of serum E2 were compared and related to bone mineral density (BMD; measured by dual energy x-ray absorptiometry) and ankle-brachial index.Results:Within each cohort, serum E2 levels obtained by immunoassay and MS correlated moderately (Spearman rank correlation coefficient rS 0.53-0.76). Serum C-reactive protein (CRP) levels associated significantly (albeit to a low extent, rS = 0.29) with immunoassay E2 but not with MS E2 levels. Similar associations of immunoassay E2 and MS E2 were seen with lumbar spine and total hip BMD, independent of serum CRP. However, immunoassay E2, but not MS E2, associated inversely with ankle-brachial index, and this correlation was lost after adjustment for CRP.Conclusions:Our findings suggest interference in the immunoassay E2 analyses, possibly by CRP or a CRP-associated factor. Although associations with BMD remain unaffected, this might imply for a reevaluation of previous association studies between immunoassay E2 levels and inflammation-related outcomes.
    The Journal of Clinical Endocrinology and Metabolism 04/2013; 98(6). DOI:10.1210/jc.2012-3861
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    ABSTRACT: Context:There is little information on the potential impact of serum 1,25-dihydroxyvitamin D [1,25(OH)(2)D] on bone health including turnover.Objective:The objective of the study was to determine the influence of 1,25(OH)(2)D and 25-hydroxyvitamin D [25(OH)D] on bone health in middle-aged and older European men.Design, Setting, and Participants:Men aged 40-79 years were recruited from population registers in 8 European centers. Subjects completed questionnaires that included questions concerning lifestyle and were invited to attend for quantitative ultrasound (QUS) of the heel, assessment of height and weight, and a fasting blood sample from which 1,25(OH)(2)D, 25(OH)D, and PTH were measured. 1,25(OH)(2)D was measured using liquid chromatography tandem mass spectrometry. Bone markers serum N-terminal propeptide of type 1 procollagen (P1NP) and crosslinks (β-cTX) were also measured. Dual-energy x-ray absorptiometry (DXA) of the hip and lumbar spine was performed in 2 centers.Main Outcome Measure(s):QUS of the heel, bone markers P1NP and β-cTX, and DXA of the hip and lumbar spine were measured.Results:A total of 2783 men, mean age 60.0 years (SD 11.0) were included in the analysis. After adjustment for age and center, 1,25(OH)(2)D was positively associated with 25(OH)D but not with PTH. 25(OH)D was negatively associated with PTH. After adjustment for age, center, height, weight, lifestyle factors, and season, 1,25(OH)(2)D was associated negatively with QUS and DXA parameters and associated positively with β-cTX. 1,25(OH)(2)D was not correlated with P1NP. 25(OH)D was positively associated with the QUS and DXA parameters but not related to either bone turnover marker. Subjects with both high 1,25(OH)(2)D (upper tertile) and low 25(OH)D (lower tertile) had the lowest QUS and DXA parameters and the highest β-cTX levels.Conclusions:Serum 1,25(OH)(2)D is associated with higher bone turnover and poorer bone health despite being positively related to 25(OH)D. A combination of high 1,25(OH)(2)D and low 25(OH)D is associated with the poorest bone health.
    The Journal of Clinical Endocrinology and Metabolism 02/2013; 98(3). DOI:10.1210/jc.2012-2772
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    ABSTRACT: There is limited evidence on objectively measured physical activity from Africa. This study quantified physical activity by accelerometry in rural South African children at ages 7, 11, and 15 years. Total physical activity was generally high (mean accelerometer counts per minute ranged 485-1017 across the 3 groups), but moderate- to vigorous-intensity physical activity was low: <1% of the sample met international recommendations. A low intensity, high volume of physical activity is present in rural South African children and adolescents.
    Applied Physiology Nutrition and Metabolism 02/2013; 38(1):81-84. DOI:10.1139/apnm-2012-0115
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    ABSTRACT: Background: To examine whether the nutritional status of aged undernourished residents in care could be improved through dietary modification to increase energy intake but not portion size. Methods: A 12-week cluster randomised controlled trial was carried out in 21 residential care homes. Participants comprised undernourished residents with a body mass index (BMI) <18.5 kg m(-2) . All menus were analysed to evaluate nutrient provision. Energy and macronutrient intakes of undernourished residents were estimated using 3-day weighed food intake diaries. Those resident in homes randomised to intervention had their usual meals enriched with energy-dense foods to a maximum of +1673 kJ day(-1) . Results: Of 445 residents screened, 41 (9%) had a BMI <18.5 kg m(-2) and entered the study. Despite adequate food provision, energy and macronutrient intakes were below UK dietary reference values. Mean (SEM) energy intake increased [+556 (372) kJ, P = 0.154] in residents allocated to intervention but fell in those residents in 'control homes' receiving usual care [-151 (351) kJ, P = 0.676]. Weight change [+1.3 (0.53) kg, P = 0.03] was seen in intervention residents but not in controls [-0.2 (1.5) kg, P = 0.536]. Between-group differences for changes in weight and energy intake were not significant (P = 0.08 and 0.20, respectively). Six residents allocated to the intervention increased their BMI >18.5 kg m(-2) (P = 0.018). Conclusions: Achieving weight gain in frail older people is difficult. These results suggest that enriching food could help address undernutrition and slow chronic weight loss. Interventions of a longer duration are needed to confirm or exclude the value of food enrichment.
    Journal of Human Nutrition and Dietetics 12/2012; 26(4). DOI:10.1111/jhn.12020
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    ABSTRACT: OBJECTIVE: A variety of methods are available for defining undernutrition (thinness/underweight/under-fat) and overnutrition (overweight/obesity/over-fat). The extent to which these definitions agree is unclear. The present cross-sectional study aimed to assess agreement between widely used methods of assessing nutritional status in children and adolescents, and to examine the benefit of body composition estimates. DESIGN: The main objective of the cross-sectional study was to assess underweight, overweight and obesity using four methods: (i) BMI-for-age using WHO (2007) reference data; (ii) BMI-for-age using Cole et al. and International Obesity Taskforce cut-offs; (iii) weight-for-age using the National Centre for Health Statistics/WHO growth reference 1977; and (iv) body fat percentage estimated by bio-impedance (body fat reference curves for children of McCarthy et al., 2006). Comparisons were made between methods using weighted kappa analyses. SETTING: Rural South Africa. SUBJECTS: Individuals (n 1519) in three age groups (school grade 1, mean age 7 years; grade 5, mean age 11 years; grade 9, mean age 15 years). RESULTS: In boys, prevalence of unhealthy weight status (both under- and overnutrition) was much higher at all ages with body fatness measures than with simple anthropometric proxies for body fatness; agreement between fatness and weight-based measures was fair or slight using Landis and Koch categories. In girls, prevalence of unhealthy weight status was also higher with body fatness than with proxies, although agreement between measures ranged from fair to substantial. CONCLUSIONS: Methods for defining under- and overnutrition should not be considered equivalent. Weight-based measures provide highly conservative estimates of unhealthy weight status, possibly more conservative in boys. Simple body composition measures may be more informative than anthropometry for nutritional surveillance of children and adolescents.
    Public Health Nutrition 10/2012; 16(11):1-9. DOI:10.1017/S1368980012004338
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    ABSTRACT: Objective To develop a menu and resource to illustrate to consumers and health professionals what a healthy balanced diet looks like over the course of a week. Design Development and analysis of an illustrative 7 d ‘eatwell week’ menu to meet current UK recommendations for nutrients with a Dietary Reference Value, with a daily energy base of 8368 kJ (2000 kcal). Foods were selected using market research data on meals and snacks commonly consumed by UK adults. Analysis used the food composition data set from year 1 (2008) of the UK National Diet and Nutrition Survey rolling programme. The eatwell week menu was developed using an iterative process of nutritional analysis with adjustments made to portion sizes and the inclusion/exclusion of foods in order to achieve the target macronutrient composition. Results Three main meals and two snacks were presented as interchangeable within the weekdays and two weekend days to achieve adult food and nutrient recommendations. Main meals were based on potatoes, rice or pasta with fish (two meals; one oily), red meat (two meals), poultry or vegetarian accompaniments. The 5-a-day target for fruit and vegetables (range 5–6·7 portions) was achieved daily. Mean salt content was below recommended maximum levels (<6 g/d). All key macro- and micronutrient values were achieved. Conclusions Affordable foods, and those widely consumed by British adults, can be incorporated within a 7 d healthy balanced menu. Future research should investigate the effect of using the eatwell week on adults’ dietary habits and health-related outcomes.
    Public Health Nutrition 09/2012; 16(5):1-8. DOI:10.1017/S1368980012004193
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