Sally Ayyad's Posts (19)

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Vitamin D plays an important role in regulating the calcium and phosphate levels in the human body, in addition to its role in preventing diseases, with insufficient concentrations reported as mortality risk factors.  Ethnicities with darker skin colour are reported as being at higher risk of deficiency due to a multi-gene regulatory function of the Vitamin D receptors.  This recent systematic review investigates the effect of different types of vitamin D supplementation in Black and Asian ethnicities on changes in 25(OH)D levels.

 Quick takes:

  • Oral supplementation of vitamin D increased 25(OH)D, regardless of the supplement source (vitamin D2or D3), the administered dosage, mode of delivery or duration
  • In comparison to food fortification, which reflected smaller increases, oral supplementation increased 25(OH)D to considerably adequate levels
  • Supplementation with vitamin D3 showed significantly higher increases in 25(OH)D than increases yielded from supplementation of vitamin D2. A possible explanation could be the increased ability of vitamin D3 to bind to the vitamin D receptors after the formation of 1,24,25 (OH)3 in the kidneys
  • This systematic review reflected findings from recent literature suggesting daily intake of 7000 – 10000 IU supplementation of vitamin D3 to have potential protective capacity against adverse COVID-19 outcomes
  • Supplementation of vitamin D3 in Black and Asian ethnicities could be a beneficial intervention to reduce infection mortalities

 To read the article:

https://onlinelibrary.wiley.com/doi/full/10.1111/jhn.12949?campaign=wolearlyview

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In some studies, physiological distresses have been proposed as risk factors for diabetes, due to their effect on increasing the level of cortisol secretion, that which in turn leads to insulin resistance, dyslipidaemia, obesity and type 2 diabetes.  Other studies found an association between psychological distress and quality of sleep with pre-diabetes and diabetes.

This study investigates the effect of vitamin D and omega-3 supplementation on psychological distresses in women of reproductive age with pre-diabetes and hypovitaminosis, using the Depression Anxiety Stress Scale-21 and the Pittsburgh Sleep Quality Index.

Quick takes:

  • Supplementation of vitamin D alone showed significant improvement in Vitamin D levels, sleep quality, anxiety and depression symptoms
  • Supplementation of Omega-3 alone showed no significant difference on the quality of sleep, stress or depression, despite a significant difference in terms of the anxiety score
  • The co-supplementation of vitamin D and Omega-3 showed great positive effects on the quality of sleep, and the reduction of depression and anxiety levels
  • A combination of vitamin D and Omega-3 supplementation could be used as a preventative method for improving the mental health women of reproductive age with pre-diabetes and hypovitaminosis

 To read the article:

https://onlinelibrary.wiley.com/doi/10.1002/brb3.2342

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Diet and dietary patterns have been shown, in various studies, to influence cardiometabolic health.  This study investigates the association between the consumption of a Mediterranean diet in childhood and cardiometabolic disease risk in young adults

Quick takes:

  • Various studies show diet as a modifiable risk factor that can influence cardiometabolic diseases
  • This study used the children’s relative Mediterranean-style diet score (C-rMED) to calculate diet and dietary patterns for UK children at ages 7, 10, and 13 years; and anthropometric and biochemical data to calculate the Cardiometabolic risk (CMR) scores at the age of 17 and 24 years old in children from the Avon Longitudinal Study of Parents and Children (ALSPAC)
  • A high C-rMED score at the age of 13 years old was associated with a 32% decrease in CMR at the age of 24 years old, with no associations evident at other ages. Two high scores of C-rMED during the age bracket of 7 – 13 years old showed the highest decreased odds of having a high CMR score at the age of 24 years old
  • The impact of the Mediterranean diet in reducing adiposity and improving glucose metabolism appear to be the main factors driving the association, as reflected by homeostatic model assessment of insulin resistance (HOMA-IR) and fat mass index (FMI)
  • Findings highlight the importance of establishing healthy eating habits during childhood and early adolescents to support cardiometabolic health in later life stages
  • The potential application of a Mediterranean diet and dietary patterns in early life could be considered as a preventative strategy for cardiometabolic diseases in later life stages

 To read the article:

https://link.springer.com/article/10.1007%2Fs00394-021-02652-7

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The quality and quantity of food consumed contribute to the high rates of overweight and obesity.  This study investigates the effect of reducing the proportion of higher energy (kcal) foods, in worksite cafeterias in England, Scotland and Wales, to explore the effectiveness of targeting the food environment as a potential intervention to reduce energy intake 

Quick takes:

  • A decrease in the proportion of higher energy food availability in cafeterias lead to a reduction in total energy consumed from purchased foods
  • A decrease in portion sizes on offer lead to a further reduction in total energy consumed from worksite cafeterias, in addition to that decrease from availability control
  • Creating healthier environments both in and out of home setting maybe effective as part of a broader strategy to reduce energy from food consumed out of the home. This can contribute to national and international efforts to tackle overweight and obesity
  • Making healthier changes to the food environment supports sustained behaviour change, a major obstacle to BMI reduction

To read the article:

https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003743

 

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This systematic review was conducted by the 2020 Dietary Guidelines Advisory Committee to evaluate the strengths of evidence on diet and health, and inform the dietary guidelines for Americans on possible associations with all-cause mortality

Quick takes:

  • Current focus shifted from interest in single nutrient consumption to dietary patterns for overall health
  • Dietary patterns reflect quantities, proportions, variety and combinations of foods as well as the frequency of habitual consumption
  • Nutrient dense dietary patterns, high in vegetables, fruits, legumes, nuts, whole grains, unsaturated vegetable oils, lean meat, poultry and fish was associated with low cause mortality in adults and older adults
  • Dietary patterns low in high-fat dairy, red and processed meat, refined carbs and sweets and moderate in alcohol consumption were considered healthy
  • Following a healthy dietary pattern at any life stage supports health in subsequent stages

 To read the article:

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2783625

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Child obesity is a global public health priority.  This study suggests a low-intensive multicomponent child centred intervention for the prevention of obesity in children aged 2 -4 years to be cost effective

Quick takes:

  • Child obesity has both mental and physical consequences and affects children’s wellbeing both in the short and long term
  • Child obesity most frequently extends to adulthood and is associated with various comorbidities; therefore, prevention is deemed vital
  • There’s a need from caregivers to receive structures and easy to understand information from health care professionals to be able to support children
  • The efficacy of prevention efforts offered by Child Health Services against child obesity is of concern
  • Continuous training to healthcare professionals in the application of structured person-centred and family counselling management plan to prevent and support overweight children and their families is still lacking
  • A low-intensive multicomponent prevention program implemented in Sweden is suggested to be cost effective with the potential to decrease zBMI in overweight children, however with no statistical significance
  • Methods to communicate and engage with children and their families in weight related topics is an area requiring future research

 To read the article:

https://onlinelibrary.wiley.com/doi/10.1002/osp4.547

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Dietary phytochemicals have been shown to have a protective effect against chronic diseases, however the association with the metabolic syndrome (MetS) has not yet been investigated.

This recent study investigates the Dietary Phytochemical Index (DPI), based on daily dietary energy (kcal) derived from phytochemical rich foods, in association with the odds ratio of MetS and its components.

 Quick takes:

  • The prevalence of MetS is affected by various factors including race, age, gender, lifestyle, diet, genetics, and history of diabetes, hypertension and CVD
  • Previous studies focused on nutrients, foods, and food groups; however, new approaches in nutritional studies take dietary patterns into consideration
  • Phytochemicals are natural bioactive compounds that have been shown to have health boosting effects due to their antioxidant and anti-inflammatory properties, and their protective effects against the development of insulin resistance, abnormal glucose and lipid levels, and abdominal obesity
  • Results from this study show a lower risk of MetS associated with higher DPI scores in a large sample of Iranian women
  • High DPI scores were also associated with lower odds ratio of individual components of MetS
  • Consumption of foods high in DPI could reduce the odds of MetS and its components, especially in women

To read the full article:

https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-11590-2

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Nutritional intake and bone health

Food intake, nutrient sufficiency and dietary patterns play a major role in maintaining bone health.  While the avoidance of a specific food group is likely to have harmful effects, the diversity of food intake is emphasized for bone health and mineral homeostasis

Quick takes:

  • Bone fractures are quite common amongst those older than 50 years of age, affecting 1 in 2 women and 1 in 5 men
  • Fractures lead to increased risk of morbidity and mortality, in addition to an impaired quality of life
  • 60-80% of variations in peak bone mass are due to genetic factors while the rest is related to environmental factors and dietary patterns
  • Recommendations for a decreased risk of fragility fracture include an optimal intake of protein and calcium and sufficient vitamin D, coupled with weight bearing physical exercise
  • Observational studies show that a high consumption of dairy, and fermented products in specific, is associated with lower fracture risk
  • Diversity in nutrient intake and following a dietary pattern like that of the Mediterranean diet is associated with lower fracture risk, which could be attributed to a diversified gut microbiota composition and enhanced function

 To read the article:

https://www.thelancet.com/journals/landia/article/PIIS2213-8587(21)00119-4/fulltext

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A randomised controlled trial was conducted for 3 months on Indian adolescents and young adults to test the effect of almond consumption on metabolic risk factors

Quick takes:

  • India is currently ranked in 4th place world-wide in terms of impaired glucose tolerance in adults
  • The Indian population has higher total body and visceral fat at similar BMIs, in comparison to the Caucasian populations, that which could lead to the early onset of metabolic syndrome and diabetes
  • The prevalence of impaired glucose is found to be higher in adolescents with abdominal adiposity
  • Daily consumption of 56g of almonds lead to a significant decrease in GbA1C, total cholesterol and LDL-cholesterol, and the potential to reduce insulin resistance at the pre-diabetes stage
  • The consumption of almonds could be considered as a preventative strategy against diabetes
  • The introduction of healthy snacks could favourably affect glycaemic and lipid markers and decrease the risk of NCDs in the young Indian population

 To read the article: https://www.frontiersin.org/articles/10.3389/fnut.2021.668622/full

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Adolescence overweight and obesity (AOO) remains to be a global health concern associated with a higher risk of non-communicable diseases.  The challenging double burden of nutrition reflects the coexistence of obesity and malnutrition in many countries, including those in east and south Asia.  This study investigates the determinants and prevalence of adolescent obesity in Indonesia, aiming to offer solutions with global implications.

 Quick takes:

  • According to the Indonesian National Health Survey (INHS), the prevalence of AOO has been on the rise for the past 5 years
  • Potential risk factors included being male, sedentary, lower education, married, having depression symptoms, and the consumption of high fat diet. Further contributing factors included higher socioeconomic status and living in urban locations
  • An association between depression in adolescents and obesity was observed, especially in females
  • Higher consumption of fruit and vegetables or fewer consumption of sweets did not appear to have a protective effect against AOO
  • Preventative and health support programs for young children and adolescents remain to be lacking, reflecting a need for closer attention
  • Population-based interventions, including environmental and lifestyle changes, are urgently needed to combat obesity on a national level
  • Personalised interventions and lifestyle changes are of critical importance to mitigate for potential contributors to AOO

To read the article: https://journals.sagepub.com/doi/10.1177/0379572121992750

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Severe acute malnutrition (SAM) remains to be a main cause for child mortality in Africa.  A recent 3-arm pilot study performed on 58 children from Uganda investigated the effect of SAM on the gut microbiota, the gut barrier integrity, mucosal immunity, and risk of gram-negative bacteraemia.  Gastrointestinal functions in terms of gut permeability, inflammation, and satiety were compared amongst those consuming legumes (cowpeas in particular) versus those consuming conventional feeds.

Quick takes:

  • SAM is associated with significant relative gut microbiota immaturity
  • Legumes, specifically cowpeas have a high content of resistant starch, in addition to their ability to improve the protein digestibility corrected amino acid score (PDCAAS) of traditional sorghum foods consumed in Africa
  • Feeding with standard feeds or legume-based feeds resulted in similar weight gain in children suffering from SAM
  • The consumption of fermentable carbohydrate source (cowpeas) has a protective effect on the microbiota functionality, as reflected in the maintenance of butyrate levels even with the administration of antibiotics
  • The consumption of cowpeas allows for the preservation of gut microbial fermentation, which is positively related to gut health and integrity

 

To read the article:

https://www.cell.com/cell-reports-medicine/fulltext/S2666-3791(21)00108-7?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS2666379121001087%3Fshowall%3Dtrue

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Inflammation is chronically and acutely affected by diet.  Chronic effects include those linked to the generation of reactive oxygen species (ROS), haemostatic function, lipoprotein remodelling, and endotoxemia.  These are mainly thought to be associated with postprandial spikes in insulin and triglycerides (TG) that are linked with the consumption of dietary CHO and fat.  Acute inflammatory responses are a physiological defence mechanism however a continuous activated response may result in a persistent low-grade inflammation and an increased risk of CVD.

Quick takes:

  • Current dietary approaches aimed to lower CVD risk are not aimed at reducing inflammation
  • The postprandial effect of diet can last up to 18 hours therefore the reduction of an individual’s postprandial inflammatory response could provide a dietary preventative mechanism against CVD
  • IL-6 is the only inflammatory marker consistently changing postprandially
  • Glycoprotein acetylation (GlycA) is an emerging inflammatory biomarker, with low intra-individual variability. High levels are linked with fatty liver disease, type 2 diabetes, some cancers, CVD and mortality
  • GlycA concentrations show a composite measure of systematic inflammation, unlike traditional markers like CRP and IL-6
  • This study shows an independent and cumulative association between postprandial glycemia and lipemia with GlycA
  • Lipemia and adiposity play a key role in food-induced inflammation
  • Potential dietary strategies to control fasting and postprandial TG include consumption of low GI foods, fibre, high intake of Omega 3 fatty acids, low alcohol consumption, and consumption of polyphenols / antioxidant rich foods.  Exercise and consuming larger meals earlier in the day are also recommended as lifestyle modification strategies
  • The large interindividual variability in postprandial inflammation highlights the potential for personalised strategies to target obesity and post prandial metabolic responses associated with low-grade inflammation

To read the article:

https://academic.oup.com/ajcn/advance-article/doi/10.1093/ajcn/nqab132/6293856

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This randomized controlled trial was conducted in 2019 to investigate the effects of longer seated lunch time (20 minutes) on food consumption, waste, and dietary intake for elementary and middle school age children.  Each meal component was analysed separately and the behaviour of children during meals was observed.

Quick takes:

  • Less fruit and vegetables were consumed during a shorter mealtime (10 min) in comparison to 20 minutes of seated mealtime
  • There was no difference in the consumption or waste of entrees and beverage consumption between the 10 min mealtime and the 20min mealtime
  • In general, children consumed more and wasted less during the longer (20 min) mealtime
  • Findings from this study support policies that require longer seated lunch time for the National School Lunch Program (NSLP). These policies are regarded as favourable in terms of reducing food waste and supporting the provision of an adequate dietary intake for children
  • Significantly fewer social interactions were observed during the shorter mealtime in comparison to a 20-minute mealtime which allowed for more time for peer interaction and socialisation amongst children
  • Further research is needed to ascertain the relationship between longer mealtimes and the consumption of fruit and vegetables; and to examine the effects of a seated lunchtime constraints on different age groups and children of different ethnicities

To read the article: 

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2781214

 

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As series of studies have shown over the past few years the mechanism that causes type 2 diabetes.  Recent evidence shows that this mechanism can be reversed back to normal functioning through the restriction of food intake and a weight loss of around 15kg on average.  This article summarises new understandings of type 2 diabetes and explores changes to food intake that can help achieve the necessary weight loss for remission and maintenance of normal haemoglobin A1C concentrations.

Quick takes:

  • The interpretation of remission requires special attention as sometimes the word ‘remission’ is used to describe the state of meeting glycaemic targets even when the hypoglycaemic drugs are being administered
  • Different people have different threshold, which explains why only 50% of those with type 2 diabetes are obese
  • Avoiding weight regain can be achieved through different dietary interventions, based on an individual’s preferences.The inclusion of physical activity also supports weight loss and maintenance
  • RCT show caloric restriction, low carbohydrates diets, and intermittent fasting effective for weight loss, given adherence.
  • Factors that affect food intake include age, sex, genetics, percentage of body fat, family and sociocultural factors, in addition to food availability and accessibility, cost, and food advertising and promotion
  • Policy interventions are needed to support healthy dietary intakes in populations. These include but are not limited to education, clear dietary guidelines and food labelling, taxation on high caloric foods, and guidance on food portions

To read the article:

https://www.bmj.com/content/374/bmj.n1449

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Undernutrition in children remains to be a global public concern.  This article explores how using the radio to communicate nutrition education to mothers affects their children’s nutrition, feeding practices and growth.

 Quick takes:

  • Interventions to tackle undernutrition, and related stunting and childhood mortality continue to be vital, especially in middle-income countries
  • Malnutrition and stunting in children occur due to a combination of several factors including gender, socio-demographic, home environment, maternal, dietary practices, and hygiene
  • Nutrition knowledge is essential for adequate food intake and diet quality
  • Mothers who received health/nutrition education through the radio possessed better nutrition and health knowledge and a more positive attitude towards preventative health and diet diversity and quality, however, this had little effects on the nutritional status of children
  • The use of mass media for nutrition education at the population level could be an effective tool, especially when combined with other interventions that support the implementation of knowledge into practice

To read the article:

https://www.cambridge.org/core/journals/journal-of-nutritional-science/article/effect-of-nutrition-behaviour-change-communication-delivered-through-radio-on-mothers-nutritional-knowledge-child-feeding-practices-and-growth/AC14414F381003DF1CB87CF46CD4033E

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This study explores the extent of which the players in the ultra-processed food industry have attempted to influence the global policy on non-communicable disease (NCD) at WHO 

Quick takes:

  • The interference of the food industry to influence policies aimed at reducing NCDs is widely documented on the national level, but not on the global level
  • Evidence show that the ultra-processed food industry has consistently engaged in political activities at the national level, through direct lobbying, independent third parties, and the production or strategic use of evidence; that which is similar to approaches followed by the tobacco industry
  • This study shows that attempts to influence WHO and its policies were mainly through action-based strategies like coalition management, involvement in policy formulation, and information management
  • A need for increased awareness of and safeguarding against commercial interference to influence NCD policy was identified as having the potential to strengthen the work of WHO on a global level

 To read the article: https://gh.bmj.com/content/6/6/e005216?utm_source=alert&utm_medium=email&utm_campaign=bmjgh&utm_content=latest&utm_term=15062021

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This article advocates a shift from excessive reliance on hierarchal models of causal evaluation based on RCTs towards context-specific evidence evaluation

Quick takes:

  • Robust and consistent evidence from individual and pooled studies support folic acid fortification as an effective public health intervention for reducing the incidence of Spina Bifida and Anencephaly
  • Skepticism to implement fortification by some policymakers in countries with no folic acid fortification programs arises from a concern that evidence of causation and efficacy is not supported by RCTs
  • Several studies highlighted limitations of RCTs in providing information to guide public health interventions, highlighting that the pyramid of evidence may vary, giving more weight to specific study designs, depending on the kind of decision to be made
  • A paradigm shift towards context-specific evidence evaluation, and away from excessive reliance on experimental study designs, is advocated in modern epidemiology to support public health policy decisions
  • Current evidence should be sufficient to generate the political will to implement fortification programs 

To read the article: https://www.nutritionintl.org/wp-content/uploads/2021/03/Food-fortification-with-folic-acid-prevents-spina-bifida-and-anencephaly_A-need-for-paradigm-shift-in-evidence-evaluation-for-policy-making.pdf

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A population-based case-control study in six countries was recently conducted to investigate the association between dietary patterns and COVID-19

Quick takes:

  • Prior studies suggest a connection between comorbidities and the severity of COVID-19
  • The aetiology of non-communicable diseases like obesity, type 2 diabetes, CVD, and hypertension, each of which considered a risk factor associated with COVID-19 severity, is largely driven by poor nutrition and unfavourable lifestyle choices
  • In six countries, following plant-based or pescatarian diets were associated with lower odds of moderate to severe COVID-19 severity
  • Those consuming low-carbs high protein diets were more susceptible to COVID-19 severity
  • Plant-based or pescatarian dietary patterns may be considered for protection against severe COVID-19 and duration of symptoms

To read the article: https://nutrition.bmj.com/content/early/2021/05/18/bmjnph-2021-000272

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Research continues to investigate the causality of the association of serum vitamin D with the risk and severity of COVID-19 infection. A Mendelian Randomised study was recently conducted to address causality using genetic variants that are associated with serum vitamin D as instrumental variables to represent long-term usual exposure.  Findings suggest that genetically predicted long-term vitamin D nutritional status does not causally affect susceptibility to and severity of COVID-19 infections, including severe respiratory infection and hospitalisation.  However, results do not exclude the possibility that therapeutic doses of vitamin D may be effective in preventing or treating COVID-19 infection, warranting the need for future larger randomised controlled studies to investigate potential therapeutic effects of vitamin D supplementation in the prevention and treatment of COVID-19.

 

For access to the full article, click the link below

https://nutrition.bmj.com/content/early/2021/05/04/bmjnph-2021-000255?utm_source=alert&utm_medium=email&utm_campaign=nph&utm_content=latest&utm_term=19052021

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