Shelly Coe’s research while affiliated with Oxford Brookes University and other places

Firefighters face significantly elevated cancer risks due to chronic exposure to carcinogenic fire effluents and occupational stressors. In 2022, the World Health Organization classified firefighting as a 'carcinogenic occupation,' linking it to increased incidences of cancers, including mesothelioma, bladder, prostate, colon, and melanoma. Drawing on UK-specific data where possible, this narrative review explores how dietary strategies, particularly the Mediterranean Diet, may complement existing protective measures in mitigating these risks. It investigates specific food-based nutrients that show promise in addressing risks associated with fire effluent contaminants, examining nutrient-mediated mechanisms and their relevance to firefighter health. The review also highlights the distinct combination of challenges firefighters face in adopting healthier dietary patterns, including disrupted routines, group eating cultures, and gaps in nutritional education. While the evidence for firefighter-specific dietary interventions is still emerging, this review highlights the potential of sustainable dietary strategies to significantly reduce cancer risks and improve long-term health outcomes. Finally, it calls for targeted research and interventions to refine these strategies and deliver tangible health benefits for firefighters worldwide.

Fatigue is a prevalent symptom in people with multiple sclerosis (MS), significantly impacting quality of life and daily functioning ⁽¹⁾ . The Mediterranean diet, with its anti-inflammatory and neuroprotective properties, may help to alleviate fatigue ⁽²⁾ . However, existing evidence linking the Mediterranean diet to fatigue in people with MS is primarily cross-sectional, providing limited insights into long-term effects ⁽³⁾ . This study aimed to prospectively test associations between the alternate Mediterranean diet score (aMED) and fatigue using data from the United Kingdom (UK) Multiple Sclerosis Register. Dietary intake was measured in 2016 (n = 2,455) and 2022 (n = 3,740) using the EPIC-Norfolk 130-item Food Frequency Questionnaire. A total of 879 participants provided dietary intake data at both timepoints. aMED is a score ranging from 0 to 9, with higher scores indicating greater adherence to a Mediterranean diet (higher consumption of vegetables, fruit, nuts, legumes, whole-grains, fish; greater monounsaturated-to-saturated fat ratio; lower consumption of red meat; moderate consumption of alcohol). Fatigue was measured using the Fatigue Severity Scale (FSS), a 9-item questionnaire that evaluates the extent to which fatigue interferes with daily activities, with scores ranging from 1 to 7. Additionally, fatigue levels were categorised as either ‘high’ (FSS score: ≥ 5) or ‘low’ (FSS score: < 5). The association between aMED and fatigue over six years (from 2016 to 2022) was assessed using generalized mixed-effects models for the continuous FSS score, while mixed-effects logistic regression models were employed to examine the association between aMED and binary FSS categories (high/low). The models were adjusted for age, sex, MS type (benign, relapse-remitting, secondary progressive, primary progressive, unknown), and total energy intake (kcal/day). Analysis was restricted to those participating at both timepoints and who had complete data on diet, covariates, and FSS (n = 379). The study population consisted of 71.5% females, with a mean age of 55.0 years (standard deviation, 9.9). Higher aMED scores (one-unit increase) were significantly associated with lower FSS scores (adjusted β = -0.08; 95% CI: -0.14, -0.03; p = 0.004) and with 17% lower odds of having high fatigue (FSS > 5), with an adjusted odds ratio of 0.83 (95% CI: 0.71, 0.98; p = 0.029). These findings suggest that adherence to a Mediterranean diet may play a protective role in reducing fatigue severity in people with MS over a 6-year period. Further research could explore associations between a Mediterranean diet and other MS related outcomes in this study population.

Purpose: Using systematic review methodology, we set out to describe the evidence for physical activity and nutrition interventions for children and adolescents with cerebral palsy (CP) as compared with no intervention or exposure that reports physical health and cognitive outcomes. Method: Quantitative, primary studies that explored the effectiveness of these interventions, replicable in school and home contexts, in comparison to any other or no intervention or exposure in children and adolescents between the ages of 6-18 years old with a diagnosis of cerebral palsy were included (PROSPERO CRD42022322143). Risk of bias was assessed by Joanna Briggs Institute and QualSyst. Results: A total of 16 international heterogeneous studies (13 physical activity and 3 nutrition) with interventions ranging from a single exposure to 8 months, with quality 58% to 89% and effectiveness, D = 0.03 to 0.97, were included. Outcome measures were varied. Conclusion: The review brings together a number of high-quality studies on physical activity and nutrition interventions and promising findings of impact on cardiovascular, musculoskeletal, and cognitive outcomes. Evidence supports implementation of these interventions in community contexts. Future research would benefit from agreement on the use of core outcome measures for meta-synthesis.

Background/Objectives: The interest in creating new products to decrease the risk of developing non-communicable chronic diseases such as type 2 diabetes (T2D) is increasing. These products include traditional food sources used as part of diverse cultures around the world, such as dragon fruit. The aim of this study was to investigate the effects of a frozen red dragon fruit (FRDF) beverage on blood pressure, glycaemic response (GR) and insulinaemic response (IR), lipid profile (LP), total antioxidant status (TAS), and C-reactive protein (CRP) levels in healthy subjects and individuals at risk of T2D. Methods: A parallel design trial (UREC registration number 211527; ClinicalTrials.gov registration number NCT05199636/19 January 2022) lasting four weeks and involving three testing sessions was conducted; participants were randomly assigned to one of two treatments (following general health guidance or consuming FRDF beverage). Systolic and diastolic blood pressures were taken; venous blood samples were collected to determine the LP and CRP levels; and capillary blood samples were taken before and after consuming a standard glucose drink to evaluate GR and IR at 15 min intervals (first hour) and 30 min intervals (second hour). Results: Eighteen participants completed this study, nine healthy (28.44 ± 5.20 years) and nine at risk (31.78 ± 12.11 years). The daily consumption of an FRDF-based beverage for four weeks by individuals at risk of T2D resulted in a reduction in blood pressure and IR–incremental area under the curve. The LP showed a downward trend, and a significant difference between treatments (p = 0.009) was found for CRP levels. Conclusions: Beverages based on FRDF may have the potential to decrease the risk of T2D.

Background Malnutrition is a significant risk for patients during cancer treatment. Neglecting to monitor or provide timely dietetic support can result in lower tolerance to treatments and reduced quality of life. This audit aimed to assess the completeness and accuracy of the documentation of anthropometric measurements in medical records and dietetic referral practices across four day-treatment units (DTUs) in England. Methodology Data were collected from electronic patient records of 100 patients in each DTU attending for systemic anti-cancer treatment (SACT) over a 2-week period. Data collected included patients’ demographics, anthropometric data, referrals to dietitians, and whether the patients referred had a MUST score ≥ 2, which was calculated by the authors. Results Findings revealed that weights and heights were documented for 58–85% and 94–98% of patients attending DTUs, respectively. On average, 55% (range of 7–85%) of patients had their body mass index (BMI) documented on the day of SACT. The Malnutrition Universal Screening Tool (MUST) was rarely completed (≤ 3% in each centre). Dietetic referral practices varied across centres. Conclusions Findings highlight the need to improve anthropometric documentation practices in cancer centres, in order to allow better monitoring of malnutrition risk and early nutritional support interventions when needed.

Objective: This study aimed to assess and comparatively analyse two menus from a Young Offenders Institution (YOI). One menu from 2019, and one from 2022, with the objective of identifying any improvements in meeting dietary guidelines. Design: Cross-sectional and comparative analysis. Setting: United Kingdom, a YOI in Northern England. Participants: YOI Menus. Results: Analysis of 30 dietary components identified that 25 exceeded the dietary guidelines (P < 0.05) for the 2022 menu, with five failing to meet the guidelines (P < 0.05). When compared to the 2019 menu, the 2022 menu showed improvements in saturated fat, sodium, and vitamin D. Despite the improvement, vitamin D levels remained below dietary guidelines (P < 0.01). Salt and energy content were reduced in the 2022 menu (P < 0.05); however, they were still above the dietary guidelines (P < 0.01). Free sugars were significantly above dietary guidelines for both menus, with no significant change between the 2019 and 2022 menu (P = 0.12). Conclusion: The 2022 menu has demonstrated progress in alignment with meeting dietary guidelines, particularly in reducing calories, fat, saturated fat, salt, sodium, and chloride, as well as increasing vitamin D. Despite improvements, calories, free sugars, salt, saturated fat, sodium, and chloride are still exceeding dietary guidelines, posing as potential health risks.

Parkinson’s Disease (PD) is a neurodegenerative disorder in which dopaminergic neurons of the substantia nigra, a region of the brain that controls movement, are lost over time ⁽¹⁾ . This results in motor symptoms, such as bradykinesia, and non-motor symptoms such as depression ⁽²⁾ . Evidence- based resources and programmes utilising exercise for symptom management are widely available ⁽³⁾ . However, despite emerging evidence showing that diet changes can improve quality of life and reduce disease severity ⁽⁴⁾ , there are few dietary guidelines and programmes. This study aims to address a current literature gap in qualitative studies assessing the opinions of healthcare professionals (HCPs) towards diet and exercise in PD care, and to identify barriers and facilitators of this in care. A qualitative design was used to assess the views and beliefs of HCPs. Semi-structured interviews were conducted via telephone, using a topic guide developed by the research team, consisting of 20 questions. The data were analysed using the six-phase process of Reflexive Thematic analysis to determine key themes in the data ⁽⁵⁾ . Five HCPs participated in this study. One main theme and two subthemes were identified. The main theme was that provisions of care and dietary advice are limited by a lack of knowledge of evidence- based, PD-specific, dietary guidelines. Subtheme 1 was that evidence-based exercise guidelines have been important facilitators in supporting care provision. Subtheme 2 was that lack of dietary guidance has been a barrier to optimum care provision and self-efficacy of HCPs. HCPs were less likely to discuss diet, due to barriers including lack of available resources or knowledge thereof, self-efficacy to recommend dietary changes, time constraints in the clinic, and less well-established referral pathways for dietitians. HCPs were unaware of the influence of diet in PD treatment, despite diet’s impact on symptoms being discussed in clinic. However, HCPs agreed that evidence-based resources would benefit HCPs’ practice, to improve symptom severity and nutritional status of patients. Exercise was more likely to be discussed, as evidence-based guidelines and empirical understanding meant HCPs were more aware of the beneficial effects on symptoms. While limited by small numbers, these findings suggest that a lack of knowledge, low self-efficacy, and time pressures mean that patients may not receive dietary guidelines which may be beneficial to their care. Self-efficacy of HCPs should be improved through PD-specific nutritional education, development and dissemination of PD-specific nutrition guidelines and resources. Future research should aim to determine the effectiveness of relevant dietary strategies’ in managing and caring for PD.

Adequate nutrition is necessary for overall health and development ⁽¹⁾ . Prisoners in general lack autonomy over their diet, in addition to being a population with a high risk of poor health outcomes (2, 3) . It is important therefore that prisons are offered menus which meet dietary reference values (DRVs), as set by the UK government, aiming for equity with the general population, and that prisoners choose food options that are beneficial for their health. The aim of this study was to conduct a nutritional analysis of prisoners’ food diaries to determine whether dietary recommendations were being met. Seven-day food diaries were collected from prisoners eating the normal food supplied by three young offender institutions in 2009. Food eaten was analysed using DietPlan6 version 6.0 (Forestfield Software Ltd). Individual nutrient data were tested for normality and compared against the UK DRVs and NDNS data from 2008/9 using either the one-sample T-test, or one-sample Wilcoxon Signed Rank Test. Data in the results is presented as (Mean ± SD). There were n=466 diaries analysed, from male participants aged between 16 to 24 years. Twenty- eight nutrients were compared with their respective DRVs by age categories: 16-18y (n=156), 19-24y (n=310), and 16-24y (n=466). For ages 16-24y, chloride (5556 ± 1692mg), folate (302 ± 112ug), iodine (195 ± 81ug), monounsaturated fat (35 ± 10g), potassium (3667 ± 1161mg), sodium (3899 ± 1392mg), sugar (136 ± 73g), riboflavin (2 ± 1mg), vitamin B 12 (6 ± 4ug), vitamin C (92 ± 63mg), and zinc (11 ± 3mg) exceeded DRV requirements (P<0.01). Carbohydrates (53 ± 5%E), saturated fat (12 ± 5%E), and sugar (19 ± 9%E) all exceeded their DRVs (P<0.05). Vitamin A (553 ± 531ug) and fibre (15 ± 6g) were found 24% and 18% lower than the DRVs, respectively (P<0.01). Fat (34 ± 5%E), polyunsaturated fat (6 ± 1%E), and protein (14 ± 2%E), as a percent of energy, were below the DRV by 3%, 8%, and 7% respectively (P<0.01). Magnesium (301 ± 107mg) was equal to the DRV (P=0.81). For 16-18, and 19-24 respectively, calcium (1286 ± 928mg; 1337 ± 489mg), copper (1 ± 0.6mg; 2 ± 0.6mg), iron (14 ± 5mg; 15 ± 6mg), niacin (19 ± 7mg; 21 ± 7mg), phosphorus (1545 ± 381mg; 1620 ± 493mg), protein (96 ± 24g; 100 ± 29g), thiamine (2 ± 0.6mg; 2 ± 0.7mg), and vitamin B 6 (2.3 ± 0.7ug; 3 ± 0.9ug) exceeded their DRV (P<0.01). For 16-18y, energy (kcals) was equal to the DRV (2748 ± 787kcal, P=0.91). For years 19-24y, energy (kcal) exceeded the DRV (2931 ± 939kcal, P<0.01). This study represents the largest assessment of dietary intake of prisoners and demonstrates that the prison catering, for the most part, met the DRVs. However, sugar, fat, and energy intake exceeded their DRV target, posing clear risks to health by possibly contributing to later obesity, hypertension, Type 2 diabetes and heart disease.