1
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Ni Lochlainn M, Bowyer RCE, Moll JM, García MP, Wadge S, Baleanu AF, Nessa A, Sheedy A, Akdag G, Hart D, Raffaele G, Seed PT, Murphy C, Harridge SDR, Welch AA, Greig C, Whelan K, Steves CJ. Effect of gut microbiome modulation on muscle function and cognition: the PROMOTe randomised controlled trial. Nat Commun 2024; 15:1859. [PMID: 38424099 PMCID: PMC10904794 DOI: 10.1038/s41467-024-46116-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 02/12/2024] [Indexed: 03/02/2024] Open
Abstract
Studies suggest that inducing gut microbiota changes may alter both muscle physiology and cognitive behaviour. Gut microbiota may play a role in both anabolic resistance of older muscle, and cognition. In this placebo controlled double blinded randomised controlled trial of 36 twin pairs (72 individuals), aged ≥60, each twin pair are block randomised to receive either placebo or prebiotic daily for 12 weeks. Resistance exercise and branched chain amino acid (BCAA) supplementation is prescribed to all participants. Outcomes are physical function and cognition. The trial is carried out remotely using video visits, online questionnaires and cognitive testing, and posting of equipment and biological samples. The prebiotic supplement is well tolerated and results in a changed gut microbiome [e.g., increased relative Bifidobacterium abundance]. There is no significant difference between prebiotic and placebo for the primary outcome of chair rise time (β = 0.579; 95% CI -1.080-2.239 p = 0.494). The prebiotic improves cognition (factor score versus placebo (β = -0.482; 95% CI,-0.813, -0.141; p = 0.014)). Our results demonstrate that cheap and readily available gut microbiome interventions may improve cognition in our ageing population. We illustrate the feasibility of remotely delivered trials for older people, which could reduce under-representation of older people in clinical trials. ClinicalTrials.gov registration: NCT04309292.
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Affiliation(s)
- Mary Ni Lochlainn
- King's College London, Department of Twin Research and Genetic Epidemiology, London, SE1 7EH, UK.
| | - Ruth C E Bowyer
- King's College London, Department of Twin Research and Genetic Epidemiology, London, SE1 7EH, UK
- The Alan Turing Institute, London, NW1 2DB, UK
| | | | - María Paz García
- King's College London, Department of Twin Research and Genetic Epidemiology, London, SE1 7EH, UK
| | - Samuel Wadge
- King's College London, Department of Twin Research and Genetic Epidemiology, London, SE1 7EH, UK
| | - Andrei-Florin Baleanu
- King's College London, Department of Twin Research and Genetic Epidemiology, London, SE1 7EH, UK
| | - Ayrun Nessa
- King's College London, Department of Twin Research and Genetic Epidemiology, London, SE1 7EH, UK
| | - Alyce Sheedy
- King's College London, Department of Twin Research and Genetic Epidemiology, London, SE1 7EH, UK
| | - Gulsah Akdag
- King's College London, Department of Twin Research and Genetic Epidemiology, London, SE1 7EH, UK
| | - Deborah Hart
- King's College London, Department of Twin Research and Genetic Epidemiology, London, SE1 7EH, UK
| | - Giulia Raffaele
- GKT School of Medical Education, King's College London, London, UK
| | - Paul T Seed
- Unit for Medical Statistics/Department for Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Caroline Murphy
- King's Clinical Trials Unit, Research Management and Innovation Directorate, King's College London, London, UK
| | - Stephen D R Harridge
- Centre for Human & Applied Physiological Sciences, King's College London, London, UK
| | - Ailsa A Welch
- Department of Epidemiology and Public Health, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Carolyn Greig
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Kevin Whelan
- King's College London, Department of Nutritional Sciences, Franklin Wilkins Building, SE1 9NH, London, UK
| | - Claire J Steves
- King's College London, Department of Twin Research and Genetic Epidemiology, London, SE1 7EH, UK.
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2
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Li MCM, Cheng YK, Cui C, Chow SKH, Wong RMY, Kwok TC, Siu PM, Yang M, Tian M, Rubin C, Welch AA, Qin L, Law SW, Cheung WH. Biophysical and nutritional combination treatment for myosteatosis in patients with sarcopenia: a study protocol for single-blinded randomised controlled trial. BMJ Open 2024; 14:e074858. [PMID: 38176874 PMCID: PMC10773315 DOI: 10.1136/bmjopen-2023-074858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION Sarcopenia is characterised by age-related loss of skeletal muscle and function and is associated with risks of adverse outcomes. The prevalence of sarcopenia increases due to ageing population and effective interventions is in need. Previous studies showed that β-hydroxy β-methylbutyrate (HMB) supplement and vibration treatment (VT) enhanced muscle quality, while the coapplication of the two interventions had further improved muscle mass and function in sarcopenic mice model. This study aims to investigate the efficacy of this combination treatment in combating sarcopenia in older people. The findings of this study will demonstrate the effect of combination treatment as an alternative for managing sarcopenia. METHODS AND ANALYSIS In this single-blinded randomised controlled trial, subjects will be screened based on the Asian Working Group for Sarcopenia (AWGS) 2019 definition. 200 subjects who are aged 65 or above and identified sarcopenic according to the AWGS algorithm will be recruited. They will be randomised to one of the following four groups: (1) Control+ONS; (2) HMB+ONS; (3) VT+ONS and (4) HMB+VT + ONS, where ONS stands for oral nutritional supplement. ONS will be taken in the form of protein formular once/day; HMB supplements will be 3 g/day; VT (35 Hz, 0.3 g, where g=gravitational acceleration) will be received for 20 mins/day and at least 3 days/week. The primary outcome assessments are muscle strength and function. Subjects will be assessed at baseline, 3-month and 6-month post treatment. ETHICS AND DISSEMINATION This study was approved by Joint CUHK-NTEC (The Chinese University of Hong Kong and New Territories East Cluster) Clinical Research Management Office (Ref: CRE-2022.223-T) and conformed to the Declaration of Helsinki. Trial results will be published in peer-reviewed journals and disseminated at academic conferences. TRIAL REGISTRATION NUMBER NCT05525039.
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Affiliation(s)
- Meng Chen Michelle Li
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Yu Kin Cheng
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Can Cui
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Simon Kwoon Ho Chow
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - Ronald Man Yeung Wong
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Timothy Cy Kwok
- Medicine and Therapeutics, The Chinese University of Hong Kong Faculty of Medicine, Hong Kong, Hong Kong
| | - Parco M Siu
- University of Hong Kong, Hong Kong, Hong Kong
| | - Minghui Yang
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Beijing, China
| | - Maoyi Tian
- Harbin Medical University, Harbin, China
- University of New South Wales, Sydney, New South Wales, Australia
| | - Clinton Rubin
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA
| | - A A Welch
- University of East Anglia, Norwich, UK
| | - Ling Qin
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Sheung Wai Law
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Wing Hoi Cheung
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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3
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Skinner J, Shepstone L, Hickson M, Welch AA. Alcohol Consumption and Measures of Sarcopenic Muscle Risk: Cross-Sectional and Prospective Associations Within the UK Biobank Study. Calcif Tissue Int 2023; 113:143-156. [PMID: 37227465 PMCID: PMC10372115 DOI: 10.1007/s00223-023-01081-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/31/2023] [Indexed: 05/26/2023]
Abstract
Alcohol intake is a major modifiable risk factor for many diseases. Alcohol can also damage skeletal muscle health during ageing which in turn increases risk of sarcopenia, frailty and falls but this relationship is understudied. The aim of this study was to model the relationship between a full range of alcohol consumption and components of sarcopenic risk, skeletal muscle mass and function, in middle-aged and younger older-aged men and women. A cross-sectional analyses was undertaken of 196,561 white participants from the UK Biobank with longitudinal analysis also in 12,298 of these participants, with outcome measures for the latter repeated after around four years. For the cross-sectional analysis fractional polynomial curves were fitted in models of measures of skeletal muscle mass, appendicular lean mass/body mass index (ALM/BMI), fat-free mass as a percentage of body weight (FFM%) and grip strength, all predicted from alcohol consumption with models fitted for men and women separately. Alcohol consumption at baseline was based on the mean of up to five dietary recalls, typically over 16 months. Linear regression was used for longitudinal analyses to model the effects of alcohol consumption groups on these measures. All models were adjusted for covariates. In the cross-sectional analysis, modelled values of the muscle mass measures all showed a peak at medium levels of alcohol consumption and a steep decline with increasing alcohol consumption. Modelled differences in muscle mass from zero consumption of alcohol to 160 g/d ranged from 3.6 to 4.9% for ALM/BMI for men and women, respectively, and 3.6 to 6.1% for FFM%. Grip strength consistently increased with alcohol consumption. No association between alcohol consumption and muscle measures were seen in the longitudinal results. Our results suggest that higher levels of alcohol consumption could have detrimental effects on muscle mass in middle- and older-aged men and women.
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Affiliation(s)
- Jane Skinner
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK.
| | - Lee Shepstone
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Mary Hickson
- School of Health Professions, University of Plymouth, Plymouth, PL4 8AA, UK
| | - Ailsa A Welch
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
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4
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Ni Lochlainn M, Bowyer RCE, Welch AA, Whelan K, Steves CJ. Higher dietary protein intake is associated with sarcopenia in older British twins. Age Ageing 2023; 52:7036280. [PMID: 36800504 DOI: 10.1093/ageing/afad018] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Sarcopenia, characterised by an accelerated loss of skeletal muscle mass and function, is associated with negative outcomes. This study aimed to evaluate factors associated with skeletal muscle strength, mass and sarcopenia, particularly protein intake, and to assess whether shared twin characteristics are important. METHODS This study utilised cross-sectional data from a study of community-dwelling twins aged ≥60 years. Multivariable logistic regression and between- and within-twin pair regression modelling were used. RESULTS Participants (n = 3,302) were 89% female (n = 2,923), aged a mean of 72.1 (±7.3) years and composed of 858 (55%) monozygotic, 709 (45%) dizygotic twin pairs and 168 individual lone twins. Using optimal protein intake as the reference group (1.0-1.3 g/kg/day), there was no significant association between protein intake (neither high nor low) and low muscle strength, or between low protein intake and sarcopenia (odds ratio (OR) 0.7; 95% confidence interval (CI) 0.39-1.25; P = 0.229) in unadjusted models. High protein intake (>1.3 g/kg/day) was associated with low muscle mass (OR 1.76; 95% CI 1.39-2.24; P < 0.0001), while low protein intake was protective (OR 0.52; 95% CI 0.40-0.67; P < 0.0001). High protein intake was associated with sarcopenia (OR 2.04; 95% CI 1.21-3.44; P = 0.008), and this was robust to adjustment for demographic, anthropometric and dietary factors. The association between muscle strength and weight, body mass index, healthy eating index, protein intake and alpha diversity was not significantly influenced by shared twin factors, indicating greater amenability to interventions. CONCLUSIONS High protein intake is associated with sarcopenia in a cohort of healthy older twins.
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Affiliation(s)
- Mary Ni Lochlainn
- Department of Twin Research and Genetic Epidemiology, King's College London, London SE1 7EH, UK
| | - Ruth C E Bowyer
- Department of Twin Research and Genetic Epidemiology, King's College London, London SE1 7EH, UK.,AI for Science and Government, The Alan Turing Institute, London NW1 2DB, UK
| | - Ailsa A Welch
- Department of Public Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - Kevin Whelan
- Department of Nutritional Sciences, King's College London, London SE1 9NH, UK
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, King's College London, London SE1 7EH, UK
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5
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Elsner F, Matthiessen LE, Średnicka-Tober D, Marx W, O’Neil A, Welch AA, Hayhoe RP, Higgs S, van Vliet M, Morphew-Lu E, Kazimierczak R, Góralska-Walczak R, Kopczyńska K, Steenbuch Krabbe Bruun T, Rosane BP, Gjedsted Bügel S, Strassner C. Identifying Future Study Designs for Mental Health and Social Wellbeing Associated with Diets of a Cohort Living in Eco-Regions: Findings from the INSUM Expert Workshop. Int J Environ Res Public Health 2022; 20:669. [PMID: 36612999 PMCID: PMC9819394 DOI: 10.3390/ijerph20010669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/13/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
Diets influence our mental health and social wellbeing (MHSW) in multiple ways. A rising community concept, Eco-Regions, has gained interest. The research project "Indicators for assessment of health effects of consumption of sustainable, organic school meals in Ecoregions" (INSUM) aims to develop future-oriented research approaches to measure the potential health effects of more sustainable and healthy diets. This first part of the project focuses on MHSW with the goal to identify suitable study designs and indicators. The methodology is based on a 2-day workshop with an interdisciplinary group of experts. This paper describes commonly applied research methods on the nexus between diet and MHSW as presented by the experts and summarises key points from the discussions. The results show that the dominating tool to investigate MSHW is questionnaires. Questionnaires vary largely depending on the research design, such as participants or distribution channels. Cohort studies addressing families and including in-depth interventional and/or experimental studies may be suitable for an Eco-Region investigation. Those MHSW studies can be conducted and combined with measurements of somatic health effects. We conclude that indicators should be seen as complementary rather than independent. Explorative research designs are required to investigate complex Eco-Regions.
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Affiliation(s)
- Friederike Elsner
- Department of Food, Nutrition, Facilities, FH Münster University of Applied Sciences, 48149 Muenster, Germany
| | - Lea Ellen Matthiessen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg, Denmark
| | - Dominika Średnicka-Tober
- Department of Functional and Organic Food, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences, 02-776 Warsaw, Poland
| | - Wolfgang Marx
- Food & Mood Centre, IMPACT—The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, VIC 3220, Australia
| | - Adrienne O’Neil
- Food & Mood Centre, IMPACT—The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, VIC 3220, Australia
| | - Ailsa A. Welch
- Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK
| | - Richard Peter Hayhoe
- School of Allied Health, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford CM1 1SQ, UK
| | - Suzanne Higgs
- School of Psychology, University of Birmingham, Birmingham B15 2TT, UK
| | - Marja van Vliet
- Institute for Positive Health, 3521 AL Utrecht, The Netherlands
| | | | - Renata Kazimierczak
- Department of Functional and Organic Food, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences, 02-776 Warsaw, Poland
| | - Rita Góralska-Walczak
- Department of Functional and Organic Food, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences, 02-776 Warsaw, Poland
| | - Klaudia Kopczyńska
- Department of Functional and Organic Food, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences, 02-776 Warsaw, Poland
| | | | - Beatriz Philippi Rosane
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg, Denmark
| | - Susanne Gjedsted Bügel
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg, Denmark
| | - Carola Strassner
- Department of Food, Nutrition, Facilities, FH Münster University of Applied Sciences, 48149 Muenster, Germany
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6
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Hooper L, Esio-Bassey C, Brainard J, Fynn J, Jennings A, Jones N, Tailor BV, Abdelhamid A, Coe C, Esgunoglu L, Fallon C, Gyamfi E, Hill C, Howard Wilsher S, Narayanan N, Oladosu T, Parkinson E, Prentice E, Qurashi M, Read L, Getley H, Song F, Welch AA, Aggett P, Lietz G. Evidence to Underpin Vitamin A Requirements and Upper Limits in Children Aged 0 to 48 Months: A Scoping Review. Nutrients 2022; 14:nu14030407. [PMID: 35276767 PMCID: PMC8840537 DOI: 10.3390/nu14030407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/31/2021] [Accepted: 01/10/2022] [Indexed: 02/04/2023] Open
Abstract
Vitamin A deficiency is a major health risk for infants and children in low- and middle-income countries. This scoping review identified, quantified, and mapped research for use in updating nutrient requirements and upper limits for vitamin A in children aged 0 to 48 months, using health-based or modelling-based approaches. Structured searches were run on Medline, EMBASE, and Cochrane Central, from inception to 19 March 2021. Titles and abstracts were assessed independently in duplicate, as were 20% of full texts. Included studies were tabulated by question, methodology and date, with the most relevant data extracted and assessed for risk of bias. We found that the most recent health-based systematic reviews and trials assessed the effects of supplementation, though some addressed the effects of staple food fortification, complementary foods, biofortified maize or cassava, and fortified drinks, on health outcomes. Recent isotopic tracer studies and modelling approaches may help quantify the effects of bio-fortification, fortification, and food-based approaches for increasing vitamin A depots. A systematic review and several trials identified adverse events associated with higher vitamin A intakes, which should be useful for setting upper limits. We have generated and provide a database of relevant research. Full systematic reviews, based on this scoping review, are needed to answer specific questions to set vitamin A requirements and upper limits.
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Affiliation(s)
- Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
- Correspondence: ; Tel.: +44-1603-591268
| | - Chizoba Esio-Bassey
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Julii Brainard
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Judith Fynn
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Amy Jennings
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Natalia Jones
- School of Environmental Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK;
| | - Bhavesh V. Tailor
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Asmaa Abdelhamid
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Calvin Coe
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Latife Esgunoglu
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Ciara Fallon
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Ernestina Gyamfi
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Claire Hill
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Stephanie Howard Wilsher
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Nithin Narayanan
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Titilopemi Oladosu
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Ellice Parkinson
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK;
| | - Emma Prentice
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Meysoon Qurashi
- Department of Medicine, Luton and Dunstable Hospital NHS Foundation Trust, Lewsey Road, Luton LU4 0DZ, UK;
| | - Luke Read
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Harriet Getley
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Fujian Song
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Ailsa A. Welch
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK; (C.E.-B.); (J.B.); (J.F.); (A.J.); (B.V.T.); (A.A.); (C.C.); (L.E.); (C.F.); (E.G.); (C.H.); (S.H.W.); (N.N.); (T.O.); or (E.P.); (L.R.); (H.G.); (F.S.); (A.A.W.)
| | - Peter Aggett
- Lancashire School of Postgraduate Medicine and Health, University of Central Lancashire, Preston PR1 2HE, UK;
| | - Georg Lietz
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne NE2 4HH, UK;
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7
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Hayhoe R, Rechel B, Clark AB, Gummerson C, Smith SJL, Welch AA. Cross-sectional associations of schoolchildren's fruit and vegetable consumption, and meal choices, with their mental well-being: a cross-sectional study. BMJ Nutr Prev Health 2022; 4:447-462. [PMID: 35028515 PMCID: PMC8718853 DOI: 10.1136/bmjnph-2020-000205] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 07/21/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Poor mental well-being is a major issue for young people and is likely to have long-term negative consequences. The contribution of nutrition is underexplored. We, therefore, investigated the association between dietary choices and mental well-being among schoolchildren. METHODS Data from 7570 secondary school and 1253 primary school children in the Norfolk Children and Young People Health and Well-being Survey, open to all Norfolk schools during October 2017, were analysed. Multivariable linear regression was used to measure the association between nutritional factors and mental well-being assessed by the Warwick-Edinburgh Mental Well-being Scale for secondary school pupils, or the Stirling Children's Well-being Scale for primary school pupils. We adjusted all analyses for important covariates including demographic, health variables, living/home situation and adverse experience variables. RESULTS In secondary school analyses, a strong association between nutritional variables and well-being scores was apparent. Higher combined fruit and vegetable consumption was significantly associated with higher well-being: well-being scores were 3.73 (95% CI 2.94 to 4.53) units higher in those consuming five or more fruits and vegetables (p<0.001; n=1905) compared with none (n=739). The type of breakfast or lunch consumed was also associated with significant differences in well-being score. Compared with children consuming a conventional type of breakfast (n=5288), those not eating any breakfast had mean well-being scores 2.73 (95% CI 2.11 to 3.35) units lower (p<0.001; n=1129) and those consuming only an energy drink had well-being scores 3.14 (95% CI 1.20 to 5.09) units lower (p=0.002; n=91). Likewise, children not eating any lunch had well-being scores 2.95 (95% CI 2.22 to 3.68) units lower (p<0.001; 860) than those consuming a packed lunch (n=3744). In primary school analyses, the type of breakfast or lunch was associated with significant differences in well-being scores in a similar way to those seen in secondary school data, although no significant association with fruit and vegetable intake was evident. CONCLUSION These findings suggest that public health strategies to optimise the mental well-being of children should include promotion of good nutrition.
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Affiliation(s)
- Richard Hayhoe
- Norwich Medical School, University of East Anglia, Norwich, UK.,School of Allied Health, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, UK
| | - Boika Rechel
- Public Health, Norfolk County Council, Norwich, UK
| | - Allan B Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | | | - Ailsa A Welch
- Norwich Medical School, University of East Anglia, Norwich, UK
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8
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Hayhoe RPG, Chan R, Skinner J, Leung J, Jennings A, Khaw KT, Woo J, Welch AA. Fracture Incidence and the Relevance of Dietary and Lifestyle Factors Differ in the United Kingdom and Hong Kong: An International Comparison of Longitudinal Cohort Study Data. Calcif Tissue Int 2021; 109:563-576. [PMID: 34085088 PMCID: PMC8484188 DOI: 10.1007/s00223-021-00870-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/19/2021] [Indexed: 11/04/2022]
Abstract
Geographic variation in fracture risk may be due to divergent profiles of dietary, lifestyle, and other risk factors between populations. We investigated differences in fracture rates between two older-population cohorts: the European Prospective Investigation into Cancer and Nutrition (EPIC) Norfolk cohort (n = 7732) in the United Kingdom (UK), and the Mr and Ms Os cohort (n = 3956) in Hong Kong (HK). Data were collected by questionnaires, laboratory assessments, and hospital records. Incidence of hip, spine, and wrist fractures in the two cohorts was calculated and multivariable regression was used to explore variables important to fracture risk. Total hip, spine, and wrist fracture incidence was higher in the UK vs HK for women (13.70 vs 8.76 per 1000 person-years; p < 0.001), but not men (5.95 vs 5.37 per 1000 person-years; p = 0.337), and the proportions of different fractures also varied between cohorts (p < 0.001). Hip fracture was the most common UK fracture (accounting for 56.8% fractures in men and 52.6% in women), while wrist fracture was most common in HK (42.9% in men and 57.9% in women). The major contributor to total fracture risk in multivariable regression models of both cohorts and sexes, was age; with BMI also an important contributor to fracture risk HK men and UK women. The distribution of factors relevant to fracture risk, and the rates of different fractures, varied significantly between UK and HK cohorts. However, the importance of each factor in contributing to fracture risk was similar between the cohorts. The differences in fracture rates suggest targeted approaches may be required when developing interventions and public health recommendations to reduce the burden of osteoporosis in these two countries.
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Affiliation(s)
- Richard P G Hayhoe
- Department of Epidemiology and Public Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
- School of Allied Health, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Bishops Hall Lane, Chelmsford, CM1 1SQ, UK
| | - Ruth Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Jane Skinner
- Department of Epidemiology and Public Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Jason Leung
- Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Amy Jennings
- Department of Epidemiology and Public Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, Institute of Public Health, Strangeways Research Laboratory, University of Cambridge, Worts Causeway, Cambridge, CB1 8RN, UK
| | - Jean Woo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
- Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Ailsa A Welch
- Department of Epidemiology and Public Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK.
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9
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Truijen SPM, Hayhoe RPG, Hooper L, Schoenmakers I, Forbes A, Welch AA. Predicting Malnutrition Risk with Data from Routinely Measured Clinical Biochemical Diagnostic Tests in Free-Living Older Populations. Nutrients 2021; 13:1883. [PMID: 34072686 PMCID: PMC8226876 DOI: 10.3390/nu13061883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/25/2021] [Accepted: 05/25/2021] [Indexed: 12/20/2022] Open
Abstract
Malnutrition (undernutrition) in older adults is often not diagnosed before its adverse consequences have occurred, despite the existence of established screening tools. As a potential method of early detection, we examined whether readily available and routinely measured clinical biochemical diagnostic test data could predict poor nutritional status. We combined 2008-2017 data of 1518 free-living individuals ≥50 years from the United Kingdom National Diet and Nutrition Survey (NDNS) and used logistic regression to determine associations between routine biochemical diagnostic test data, micronutrient deficiency biomarkers, and established malnutrition indicators (components of screening tools) in a three-step validation process. A prediction model was created to determine how effectively routine biochemical diagnostic tests and established malnutrition indicators predicted poor nutritional status (defined by ≥1 micronutrient deficiency in blood of vitamins B6, B12 and C; selenium; or zinc). Significant predictors of poor nutritional status were low concentrations of total cholesterol, haemoglobin, HbA1c, ferritin and vitamin D status, and high concentrations of C-reactive protein; except for HbA1c, these were also associated with established malnutrition indicators. Additional validation was provided by the significant association of established malnutrition indicators (low protein, fruit/vegetable and fluid intake) with biochemically defined poor nutritional status. The prediction model (including biochemical tests, established malnutrition indicators and covariates) showed an AUC of 0.79 (95% CI: 0.76-0.81), sensitivity of 66.0% and specificity of 78.1%. Clinical routine biochemical diagnostic test data have the potential to facilitate early detection of malnutrition risk in free-living older populations. However, further validation in different settings and against established malnutrition screening tools is warranted.
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Affiliation(s)
- Saskia P. M. Truijen
- Department of Epidemiology and Public Health, Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (S.P.M.T.); (R.P.G.H.); (L.H.); (I.S.); (A.F.)
| | - Richard P. G. Hayhoe
- Department of Epidemiology and Public Health, Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (S.P.M.T.); (R.P.G.H.); (L.H.); (I.S.); (A.F.)
- School of Allied Health, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford CM1 1SQ, UK
| | - Lee Hooper
- Department of Epidemiology and Public Health, Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (S.P.M.T.); (R.P.G.H.); (L.H.); (I.S.); (A.F.)
| | - Inez Schoenmakers
- Department of Epidemiology and Public Health, Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (S.P.M.T.); (R.P.G.H.); (L.H.); (I.S.); (A.F.)
| | - Alastair Forbes
- Department of Epidemiology and Public Health, Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (S.P.M.T.); (R.P.G.H.); (L.H.); (I.S.); (A.F.)
| | - Ailsa A. Welch
- Department of Epidemiology and Public Health, Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (S.P.M.T.); (R.P.G.H.); (L.H.); (I.S.); (A.F.)
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10
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Cunha DL, Richardson R, Tracey-White D, Abbouda A, Mitsios A, Horneffer-van der Sluis V, Takis P, Owen N, Skinner J, Welch AA, Moosajee M. REP1 deficiency causes systemic dysfunction of lipid metabolism and oxidative stress in choroideremia. JCI Insight 2021; 6:146934. [PMID: 33755601 PMCID: PMC8262314 DOI: 10.1172/jci.insight.146934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/17/2021] [Indexed: 12/17/2022] Open
Abstract
Choroideremia (CHM) is an X-linked recessive chorioretinal dystrophy caused by mutations in CHM, encoding for Rab escort protein 1 (REP1). Loss of functional REP1 leads to the accumulation of unprenylated Rab proteins and defective intracellular protein trafficking, the putative cause for photoreceptor, retinal pigment epithelium (RPE), and choroidal degeneration. CHM is ubiquitously expressed, but adequate prenylation is considered to be achieved, outside the retina, through the isoform REP2. Recently, the possibility of systemic features in CHM has been debated; therefore, in this study, whole metabolomic analysis of plasma samples from 25 CHM patients versus age- and sex-matched controls was performed. Results showed plasma alterations in oxidative stress-related metabolites, coupled with alterations in tryptophan metabolism, leading to significantly raised serotonin levels. Lipid metabolism was disrupted with decreased branched fatty acids and acylcarnitines, suggestive of dysfunctional lipid oxidation, as well as imbalances of several sphingolipids and glycerophospholipids. Targeted lipidomics of the chmru848 zebrafish provided further evidence for dysfunction, with the use of fenofibrate over simvastatin circumventing the prenylation pathway to improve the lipid profile and increase survival. This study provides strong evidence for systemic manifestations of CHM and proposes potentially novel pathomechanisms and targets for therapeutic consideration.
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Affiliation(s)
- Dulce Lima Cunha
- Department of Development, Ageing and Disease, UCL Institute of Ophthalmology, London, United Kingdom
| | - Rose Richardson
- Department of Development, Ageing and Disease, UCL Institute of Ophthalmology, London, United Kingdom
| | - Dhani Tracey-White
- Department of Development, Ageing and Disease, UCL Institute of Ophthalmology, London, United Kingdom
| | - Alessandro Abbouda
- Department of Development, Ageing and Disease, UCL Institute of Ophthalmology, London, United Kingdom
- Department of Genetics, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Andreas Mitsios
- Department of Development, Ageing and Disease, UCL Institute of Ophthalmology, London, United Kingdom
- Department of Genetics, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Panteleimon Takis
- MRC-NIHR National Phenome Centre, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Nicholas Owen
- Department of Development, Ageing and Disease, UCL Institute of Ophthalmology, London, United Kingdom
| | - Jane Skinner
- Department of Public Health & Primary Care, Norwich Medical School, Norfolk, United Kingdom
| | - Ailsa A. Welch
- Department of Public Health & Primary Care, Norwich Medical School, Norfolk, United Kingdom
| | - Mariya Moosajee
- Department of Development, Ageing and Disease, UCL Institute of Ophthalmology, London, United Kingdom
- Department of Genetics, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
- The Francis Crick Institute, London, United Kingdom
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11
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Mulligan AA, Hayhoe RPG, Luben RN, Welch AA. Positive Associations of Dietary Intake and Plasma Concentrations of Vitamin E with Skeletal Muscle Mass, Heel Bone Ultrasound Attenuation and Fracture Risk in the EPIC-Norfolk Cohort. Antioxidants (Basel) 2021; 10:antiox10020159. [PMID: 33499166 PMCID: PMC7911901 DOI: 10.3390/antiox10020159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/13/2021] [Accepted: 01/17/2021] [Indexed: 02/02/2023] Open
Abstract
The prevalence of sarcopenia, frailty and fractures is increasing. Prevention options are limited, but dietary factors including vitamin E have the potential to confer some protection. This study investigated cross-sectional associations between dietary and plasma concentrations of vitamin E with indices of skeletal muscle mass (SMM) (n = 14,179 and 4283, respectively) and bone density (n = 14,694 and 4457, respectively) and longitudinal fracture risk (n = 25,223 and 7291, respectively) in European Prospective Investigation Into Cancer and Nutrition (EPIC)-Norfolk participants, aged 39-79 years at baseline. Participants completed a health and lifestyle questionnaire, a 7-day diet diary (7dDD) and had anthropometric measurements taken. Fat-free mass (as a SMM proxy) was measured using bioimpedance and bone density was measured using calcaneal broadband ultrasound attenuation (BUA) and incident fractures over 18.5 years of follow-up. Associations between indices of SMM, BUA and fracture risk were investigated by quintiles of dietary vitamin E intake or plasma concentrations. Positive trends in SMM indices and BUA were apparent across dietary quintiles for both sexes, with interquintile differences of 0.88%-1.91% (p < 0.001), and protective trends for total and hip fracture risk. Circulating plasma α- and γ-tocopherol results matched the overall dietary findings. Dietary vitamin E may be important for musculoskeletal health but further investigation is required to fully understand the relationships of plasma tocopherols.
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Affiliation(s)
- Angela A. Mulligan
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridgeshire CB1 8RN, UK;
- NIHR BRC Diet, Anthropometry and Physical Activity Group, MRC Epidemiology Unit, University of Cambridge, Cambridgeshire CB2 0AH, UK
- Correspondence: or
| | - Richard P. G. Hayhoe
- Department of Epidemiology and Public Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK; (R.P.G.H.); (A.A.W.)
| | - Robert N. Luben
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridgeshire CB1 8RN, UK;
| | - Ailsa A. Welch
- Department of Epidemiology and Public Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK; (R.P.G.H.); (A.A.W.)
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12
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Lewis LN, Hayhoe RPG, Mulligan AA, Luben RN, Khaw KT, Welch AA. Lower Dietary and Circulating Vitamin C in Middle- and Older-Aged Men and Women Are Associated with Lower Estimated Skeletal Muscle Mass. J Nutr 2020; 150:2789-2798. [PMID: 32851397 PMCID: PMC7549302 DOI: 10.1093/jn/nxaa221] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/06/2020] [Accepted: 07/07/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Age-related loss of skeletal muscle mass contributes to poor outcomes including sarcopenia, physical disability, frailty, type 2 diabetes, and mortality. Vitamin C has physiological relevance to skeletal muscle and may protect it during aging, but few studies have investigated its importance in older populations. OBJECTIVES We aimed to investigate cross-sectional associations of dietary and plasma vitamin C with proxy measures of skeletal muscle mass in a large cohort of middle- and older-aged individuals. METHODS We analyzed data from >13,000 men and women in the European Prospective Investigation into Cancer and Nutrition-Norfolk cohort, aged 42-82 y. Fat-free mass (FFM), as a proxy for skeletal muscle mass, was estimated using bioelectrical impedance analysis and expressed as a percentage of total mass (FFM%) or standardized by BMI (FFMBMI). Dietary vitamin C intakes were calculated from 7-d food diary data, and plasma vitamin C was measured in peripheral blood. Multivariable regression models, including relevant lifestyle, dietary, and biological covariates, were used to determine associations between FFM measures and quintiles of dietary vitamin C or insufficient compared with sufficient plasma vitamin C (<50 μmol/L and ≥50 μmol/L). RESULTS Positive trends were found across quintiles of dietary vitamin C and FFM measures for both sexes, with interquintile differences in FFM% and FFMBMI of 1.0% and 2.3% for men and 1.9% and 2.9% for women, respectively (all P < 0.001). Similarly, FFM% and FFMBMI measures were higher in participants with sufficient than with insufficient plasma vitamin C: by 1.6% and 2.0% in men, and 3.4% and 3.9% in women, respectively (all P < 0.001). Associations were also evident in analyses stratified into <65-y and ≥65-y age groups. CONCLUSIONS Our findings of positive associations, of both dietary and circulating vitamin C with measures of skeletal muscle mass in middle- and older-aged men and women, suggest that dietary vitamin C intake may be useful for reducing age-related muscle loss.
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Affiliation(s)
- Lucy N Lewis
- Department of Epidemiology and Public Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Richard P G Hayhoe
- Department of Epidemiology and Public Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Angela A Mulligan
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Robert N Luben
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Ailsa A Welch
- Department of Epidemiology and Public Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
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13
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Abdelhamid A, Jennings A, Hayhoe RPG, Awuzudike VE, Welch AA. High variability of food and nutrient intake exists across the Mediterranean Dietary Pattern-A systematic review. Food Sci Nutr 2020; 8:4907-4918. [PMID: 32994952 PMCID: PMC7500794 DOI: 10.1002/fsn3.1784] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 12/14/2022] Open
Abstract
A Mediterranean style dietary pattern (MDP) is considered beneficial for health. The MD Score (MDS) definition has evolved, resulting in considerable variability in the foods and nutrients associated with MDS adherence. We systematically investigated food and nutrient composition of the MD between studies, countries, and methods of classifying the MDS. We searched Embase for MD systematic reviews and selected observational studies reporting intakes of foods, macronutrients, or micronutrients by categories of MDS adherence. The percentage differences in food and nutrient intakes between categories of high and low adherence to the MDS were calculated for each study. A total of 369 full-text primary papers were reviewed from the included systematic reviews and 74 papers selected (66 adults, 8 children). We found considerable differences in MDS definitions and scoring criteria. Between-study variation in food intake between high- and low-adherence MDS adherence categories ranged from a mean of -23% for meat, to 119% for fruit, and 278% for fish. Greater variability was evident in non-Mediterranean than Mediterranean regions. We conclude that few studies report food and nutrient intakes across the range of the MDP in adults and even fewer in children. The considerable variability in the foods and nutrients reported makes comparison of results from studies and translation into dietary guidelines difficult. We recommend that future publications of MD studies include full details of the range of food and nutrient intakes across the distribution of MD adherence in order to facilitate translation into health policy and practice.
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Affiliation(s)
| | - Amy Jennings
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
| | | | | | - Ailsa A. Welch
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
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14
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Lanham-New SA, Webb AR, Cashman KD, Buttriss JL, Fallowfield JL, Masud T, Hewison M, Mathers JC, Kiely M, Welch AA, Ward KA, Magee P, Darling AL, Hill TR, Greig C, Smith CP, Murphy R, Leyland S, Bouillon R, Ray S, Kohlmeier M. Vitamin D and SARS-CoV-2 virus/COVID-19 disease. BMJ Nutr Prev Health 2020; 3:106-110. [PMID: 33230499 PMCID: PMC7246103 DOI: 10.1136/bmjnph-2020-000089] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 12/12/2022] Open
Affiliation(s)
- Susan A Lanham-New
- Department of Nutritional Sciences, School of Biosciences and Medicine, Faculty of Health & Medical Sciences, University of Surrey, Guildford, Surrey, UK
| | - Ann R Webb
- Earth and Environmental Sciences, University of Manchester, Manchester, UK
| | - Kevin D Cashman
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | | | | | - Tash Masud
- Department of Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Martin Hewison
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - John C Mathers
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Mairead Kiely
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Ailsa A Welch
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Kate A Ward
- MRC Lifecourse Epidemiology, NIHR Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Pamela Magee
- School of Biomedical Sciences, Ulster University at Coleraine, Coleraine, UK
| | - Andrea L Darling
- Department of Nutritional Sciences, School of Biosciences and Medicine, Faculty of Health & Medical Sciences, University of Surrey, Guildford, Surrey, UK
| | - Tom R Hill
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Carolyn Greig
- School of Sport, Exercise and Rehabilitation Sciences and MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK
| | - Colin P Smith
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
| | - Richard Murphy
- Centre for Environment & Sustainability, Faculty of Engineering & Physical Sciences, University of Surrey, Guildford, UK
| | | | - Roger Bouillon
- Laboratory of Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, 3000 Leuven, Belgium
| | - Sumantra Ray
- School of Biomedical Sciences, Ulster University at Coleraine, Coleraine, UK
- School of Humanities and Social Sciences, University of Cambridge, Cambridge, UK
- NNEdPro Global Centre for Nutrition and Health, St John’s Innovation Centre, Cambridge, UK
| | - Martin Kohlmeier
- NNEdPro Global Centre for Nutrition and Health, St John’s Innovation Centre, Cambridge, UK
- School of Medicine & Gillings School of Global Public Health, University of North Carolina at Chapel Hill & UNC Nutrition Research Institute, Chapel Hill, North Carolina, USA
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Welch AA, Jennings A, Kelaiditi E, Skinner J, Steves CJ. Cross-Sectional Associations Between Dietary Antioxidant Vitamins C, E and Carotenoid Intakes and Sarcopenic Indices in Women Aged 18-79 Years. Calcif Tissue Int 2020; 106:331-342. [PMID: 31813016 PMCID: PMC7072069 DOI: 10.1007/s00223-019-00641-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/22/2019] [Indexed: 12/18/2022]
Abstract
The prevalence of sarcopenia is increasing in aging populations, so prevention is critical. Vitamins (A, C, E and carotenoids) modify skeletal muscle via protein and collagen synthesis and anti-inflammatory activities. Previous studies have not investigated intake of these vitamins in relation to sarcopenic indices in both younger and older-aged women. Indices of skeletal muscle mass (as fat-free mass (FFM) relative to body size) were measured using DXA and leg explosive power (LEP) using the Nottingham Power Rig in 2570 women aged 18-79 years. Adjusted measures of skeletal muscle were calculated according to quintiles of vitamin C, E, retinol and carotenoid intake, derived from Food Frequency Questionnaires, after stratification by age. Higher vitamin C intake was associated with significantly higher indices of FFM and LEP, (Q5-Q1 = 2.0-12.8%, P < 0.01-0.02). Intakes of total and individual carotenoids were significantly associated with indices of FFM and LEP (Q5-Q1 = 1.0-7.5%). Vitamin E was significantly associated with FFM% and FFMBMI only. In mutually adjusted analysis with vitamin C, total carotene, vitamin E and protein in the model, the strongest associations were with vitamin C. These associations were stronger in younger women (< 65 years). For the first time, our research shows higher dietary intakes of antioxidant vitamins, particularly vitamin C, is associated with higher skeletal muscle mass and power in free-living women. These findings have relevance for the treatment and prevention of frailty and sarcopenia throughout adulthood.
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Affiliation(s)
- A A Welch
- Department of Epidemiology & Public Health, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, Norfolk, NR4 7TJ, UK.
| | - A Jennings
- Department of Epidemiology & Public Health, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, Norfolk, NR4 7TJ, UK
| | - E Kelaiditi
- Department of Epidemiology & Public Health, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, Norfolk, NR4 7TJ, UK
- Faculty of Sport, Health and Applied Science, St Mary's University, Waldegrave Road, Twickenham, London, TW1 4SX, UK
| | - J Skinner
- Department of Epidemiology & Public Health, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, Norfolk, NR4 7TJ, UK
| | - C J Steves
- Department of Twin Research and Genetic Epidemiology, King's College, London, UK
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16
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Cameron D, Welch AA, Adelnia F, Bergeron CM, Reiter DA, Dominguez LJ, Brennan NA, Fishbein KW, Spencer RG, Ferrucci L. Age and Muscle Function Are More Closely Associated With Intracellular Magnesium, as Assessed by 31P Magnetic Resonance Spectroscopy, Than With Serum Magnesium. Front Physiol 2019; 10:1454. [PMID: 31827445 PMCID: PMC6892402 DOI: 10.3389/fphys.2019.01454] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 11/11/2019] [Indexed: 11/13/2022] Open
Abstract
Total serum magnesium is a common clinical measurement for assessing magnesium status; however, magnesium in blood represents less than 1% of the body's total magnesium content. We measured intramuscular ionized magnesium by phosphorus magnetic resonance spectroscopy (31P-MRS) and tested the hypothesis that this measure better correlates with skeletal muscle function and captures more closely the effect of aging than the traditional measure of total serum magnesium. Data were collected from 441 participants (age 24-98 years) in the Baltimore Longitudinal Study of Aging (BLSA), a study of normative aging that encompasses a broad age range. Results showed that intramuscular ionized magnesium was negatively associated with age (β = -0.29, p < 0.001, R 2 = 0.08) and positively associated with knee-extension strength (β = 0.31, p < 0.001, and R 2 = 0.1 in women; and β = 0.2, p = 0.003, and R 2 = 0.04 in men), while total serum magnesium showed no association with age or strength (p = 0.27 and 0.1, respectively). Intramuscular ionized magnesium was significantly lower in women that in men (p < 0.001), perhaps due to chronic latent Mg deficiency in women that is not otherwise detected by serum magnesium levels. Based on these findings, we suggest that intramuscular ionized magnesium from 31P-MRS is a better clinical measure of magnesium status than total serum magnesium, and could be measured when muscle weakness of unidentified etiology is detected. It may also be used to monitor the effectiveness of oral magnesium interventions, including supplementation.
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Affiliation(s)
- Donnie Cameron
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States.,Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Ailsa A Welch
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Fatemeh Adelnia
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States
| | - Christopher M Bergeron
- Laboratory of Clinical Investigation, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States
| | - David A Reiter
- Emory University School of Medicine, Atlanta, GA, United States
| | - Ligia J Dominguez
- Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Nicholas A Brennan
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States
| | - Kenneth W Fishbein
- Laboratory of Clinical Investigation, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States
| | - Richard G Spencer
- Laboratory of Clinical Investigation, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States
| | - Luigi Ferrucci
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States
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Sarkar H, Mitsios A, Smart M, Skinner J, Welch AA, Kalatzis V, Coffey PJ, Dubis AM, Webster AR, Moosajee M. Nonsense-mediated mRNA decay efficiency varies in choroideremia providing a target to boost small molecule therapeutics. Hum Mol Genet 2019; 28:1865-1871. [PMID: 30689859 PMCID: PMC6522067 DOI: 10.1093/hmg/ddz028] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/18/2019] [Accepted: 01/21/2019] [Indexed: 12/15/2022] Open
Abstract
Choroideremia (CHM) is an x-linked recessive chorioretinal dystrophy, with 30% caused by nonsense mutations in the CHM gene resulting in an in-frame premature termination codon (PTC). Nonsense-mediated mRNA decay (NMD) is the cell's natural surveillance mechanism that detects and destroys PTC-containing transcripts, with UPF1 being the central NMD modulator. NMD efficiency can be variable amongst individuals with some transcripts escaping destruction, leading to the production of a truncated non-functional or partially functional protein. Nonsense suppression drugs, such as ataluren, target these transcripts and read-through the PTC, leading to the production of a full length functional protein. Patients with higher transcript levels are considered to respond better to these drugs, as more substrate is available for read-through. Using Quantitative reverse transcription PCR (RT-qPCR), we show that CHM mRNA expression in blood from nonsense mutation CHM patients is 2.8-fold lower than controls, and varies widely amongst patients, with 40% variation between those carrying the same UGA mutation [c.715 C>T; p.(R239*)]. These results indicate that although NMD machinery is at work, efficiency is highly variable and not wholly dependent on mutation position. No significant difference in CHM mRNA levels was seen between two patients' fibroblasts and their induced pluripotent stem cell-derived retinal pigment epithelium. There was no correlation between CHM mRNA expression and genotype, phenotype or UPF1 transcript levels. NMD inhibition with caffeine was shown to restore CHM mRNA transcripts to near wild-type levels. Baseline mRNA levels may provide a prognostic indicator for response to nonsense suppression therapy, and caffeine may be a useful adjunct to enhance treatment efficacy where indicated.
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Affiliation(s)
- Hajrah Sarkar
- Development, Ageing and Disease, UCL Institute of Ophthalmology, London, UK
| | - Andreas Mitsios
- Development, Ageing and Disease, UCL Institute of Ophthalmology, London, UK
- Department of Genetics, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Matthew Smart
- Development, Ageing and Disease, UCL Institute of Ophthalmology, London, UK
| | - Jane Skinner
- Department of Public Health & Primary Care, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Ailsa A Welch
- Department of Public Health & Primary Care, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Vasiliki Kalatzis
- Inserm U1051, Institute for Neurosciences of Montpellier, Montpellier, Montpellier Cedex, France
| | - Peter J Coffey
- Development, Ageing and Disease, UCL Institute of Ophthalmology, London, UK
| | - Adam M Dubis
- Development, Ageing and Disease, UCL Institute of Ophthalmology, London, UK
- Department of Genetics, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Andrew R Webster
- Development, Ageing and Disease, UCL Institute of Ophthalmology, London, UK
- Department of Genetics, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Mariya Moosajee
- Development, Ageing and Disease, UCL Institute of Ophthalmology, London, UK
- Department of Genetics, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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18
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Bailey RL, Sahni S, Chocano-Bedoya P, Daly RM, Welch AA, Bischoff-Ferrari H, Weaver CM. Best Practices for Conducting Observational Research to Assess the Relation between Nutrition and Bone: An International Working Group Summary. Adv Nutr 2019; 10:391-409. [PMID: 30926984 PMCID: PMC6520043 DOI: 10.1093/advances/nmy111] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/30/2018] [Accepted: 11/12/2018] [Indexed: 12/14/2022] Open
Abstract
Diet is a modifiable factor that can affect bone strength and integrity, and the risk of fractures. Currently, a hierarchy of scientific evidence contributes to our understanding of the role of diet on bone health and fracture risk. The strength of evidence is generally based on the type of study conducted, the quality of the methodology employed, the rigor and integrity of the data collected and analysis plan, and the transparency and completeness of the results. Randomized controlled trials (RCTs) are considered to be the gold standard from a clinical research paradigm, but there is a dearth of high-quality diet-related intervention trials with bone as the primary outcome, forcing the use of observational research to inform research and clinical practices. However, for observational research to be of the most utility, standardization and optimization of the study design, accurate and reliable measurement of key variables, and appropriate data analysis and data reporting are paramount. Although there have been recommendations made in relation to RCTs in the field of nutrition, no clear rubric exists for best practices in conducting observational research with regard to nutrition and bone health. Therefore, the purpose of this paper is to describe the best practices and considerations for designing, conducting, analyzing, interpreting, and reporting observational research specifically for understanding the role of nutrition in bone health, amassed by a global panel of scientific experts with strengths in bone, nutrition epidemiology, physical activity, public health, clinical and translational trials, and observational study methods. The global panel of scientific experts represents the leadership and selected participants from the 10th annual International Symposium for the Nutritional Aspects of Osteoporosis. The topics selected and best practices presented reflect expert opinion and areas of scientific expertise of the authors rather than a systematic or comprehensive literature review or professional reporting guidelines.
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Affiliation(s)
- Regan L Bailey
- Department of Nutrition Science, Purdue University, West Lafayette, IN,Address correspondence to RLB (e-mail: )
| | - Shivani Sahni
- Institute for Aging Research, Hebrew SeniorLife and Harvard Medical School
| | | | - Robin M Daly
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Melbourne, Australia
| | - Ailsa A Welch
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | | | - Connie M Weaver
- Department of Nutrition Science, Purdue University, West Lafayette, IN
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19
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Hayhoe RPG, Lentjes MAH, Mulligan AA, Luben RN, Khaw KT, Welch AA. Cross-sectional associations of dietary and circulating magnesium with skeletal muscle mass in the EPIC-Norfolk cohort. Clin Nutr 2019; 38:317-323. [PMID: 29395373 DOI: 10.1016/j.clnu.2018.01.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 01/02/2018] [Accepted: 01/07/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Maintenance of skeletal muscle in older age is critical to reducing frailty and the risk of falls and fractures. Nutrition has established importance for muscle health in general, but less research has looked at associations of dietary intake of specific micronutrients on skeletal muscle mass in older adults. AIMS This study aimed to investigate the influence of dietary and circulating magnesium on skeletal muscle mass in a UK population of 14,340 middle to older-aged men and women participating in the EPIC-Norfolk cohort study. METHODS Dietary nutrient intakes were estimated from 7-day food diaries and fat-free mass (FFM) by bioelectrical impedance analysis. Multivariable regression was used to investigate associations of FFM-based indices of muscle mass with quintiles of dietary magnesium intake or serum magnesium concentration groups. All analyses were stratified by sex, and regression models were adjusted for relevant covariates. RESULTS Significant positive trends in FFM measures were evident across magnesium dietary intake quintiles for both sexes (all p < 0.001; n = 6350 men; n = 7990 women) and both <60 and ≥ 60 year olds, with all-age quintile 5 versus quintile 1 maximal differences of 4.6% in men and 6.3% in women; highly relevant compared to the estimated 1% decline per year after 40 years of age. These observations were not reflected in serum magnesium analyses, where no consistent trends were found across the skeletal muscle mass indices tested. CONCLUSION Further investigation will be required to improve our understanding of the relationship between serum magnesium concentration and skeletal muscle mass. However, this study has demonstrated strong associations between dietary magnesium intake and indices of skeletal muscle mass in a UK population of middle to older-aged adults, highlighting the likely importance of dietary magnesium for optimal muscle health in this population.
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Affiliation(s)
- Richard P G Hayhoe
- Department of Population Health and Primary Care, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Marleen A H Lentjes
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, CB1 8RN, UK
| | - Angela A Mulligan
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, CB1 8RN, UK
| | - Robert N Luben
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, CB1 8RN, UK
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, CB1 8RN, UK
| | - Ailsa A Welch
- Department of Population Health and Primary Care, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK.
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20
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Paterson KE, Myint PK, Jennings A, Bain LK, Lentjes MA, Khaw KT, Welch AA. Mediterranean Diet Reduces Risk of Incident Stroke in a Population With Varying Cardiovascular Disease Risk Profiles. Stroke 2018; 49:2415-2420. [PMID: 30580733 PMCID: PMC6159687 DOI: 10.1161/strokeaha.117.020258] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 07/09/2018] [Accepted: 08/07/2018] [Indexed: 01/20/2023]
Abstract
Background and Purpose— Although some evidence has found that the Mediterranean diet (MD) is protective for stroke risk, few studies have investigated whether this relationship differs by sex or cardiovascular disease risk. Methods— We investigated the relationship between adherence to the MD score, estimated using 7-day dietary diaries and risk of incident stroke in an observational prospective population-based cohort study of 23 232 men and women (54.5% women) aged 40 to 77 years who participated in the European Prospective Investigation into Cancer study in Norfolk, United Kingdom. Risk of incident stroke was calculated using multivariable Cox regression, in the whole population, and also stratified by sex and cardiovascular disease risk profile, using the Framingham risk score. Results— During 17.0 years of follow-up (395 048 total person-years), 2009 incident strokes occurred. Risk of stroke was significantly reduced with greater adherence to the MD score (quartile 4 versus quartile 1 hazard ratio [HR], 0.83; 95% CI, 0.74-0.94; P-trend <0.01) in the whole population and in women (quartile 4 versus quartile 1 HR, 0.78; 95% CI, 0.65, 0.93; P-trend <0.01) but not in men (quartile 4 versus quartile 1 HR, 0.94; 95% CI, 0.79-1.12; P-trend =0.55). There was reduced risk of stroke in those at high risk of cardiovascular disease and across categories of the MD score (quartile 4 versus quartile 1 HR, 0.87; 95% CI, 0.76-0.99; P-trend =0.04). However, this was driven by the associations in women (quartile 4 versus quartile 1 HR, 0.80; 95% CI, 0.65-0.97; P-trend =0.02). Conclusions— Greater adherence to the MD was associated with lower risk of stroke in a UK white population. For the first time in the literature, we also investigated the associations between the MD score in those at both low and high risk of cardiovascular disease. Although the findings in our study were driven by the associations in women, they have implications for the general public and clinicians for prevention of stroke.
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Affiliation(s)
- Katherine E. Paterson
- From the Department of Population Health and Primary Care (K.E.P., L.K.M.B., A.A.W.), Norwich Medical School, University of East Anglia, United Kingdom
- Department of Nutrition and Dietetics, Norfolk & Norwich University NHS Foundation Trust, United Kingdom (K.E.P.)
| | - Phyo K. Myint
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, United Kingdom (P.K.M.)
| | - Amy Jennings
- Department of Nutrition and Preventive Medicine (A.J.), Norwich Medical School, University of East Anglia, United Kingdom
| | - Lucy K.M. Bain
- From the Department of Population Health and Primary Care (K.E.P., L.K.M.B., A.A.W.), Norwich Medical School, University of East Anglia, United Kingdom
| | - Marleen A.H. Lentjes
- Clinical Gerontology Unit, Department of Public Health and Primary Care, University of Cambridge, United Kingdom (M.A.H.L., K.-T.K.)
| | - Kay-Tee Khaw
- Clinical Gerontology Unit, Department of Public Health and Primary Care, University of Cambridge, United Kingdom (M.A.H.L., K.-T.K.)
| | - Ailsa A. Welch
- From the Department of Population Health and Primary Care (K.E.P., L.K.M.B., A.A.W.), Norwich Medical School, University of East Anglia, United Kingdom
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21
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Bowyer RCE, Jackson MA, Pallister T, Skinner J, Spector TD, Welch AA, Steves CJ. Use of dietary indices to control for diet in human gut microbiota studies. Microbiome 2018; 6:77. [PMID: 29695307 PMCID: PMC5918560 DOI: 10.1186/s40168-018-0455-y] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 03/28/2018] [Indexed: 05/22/2023]
Abstract
BACKGROUND Environmental factors have a large influence on the composition of the human gut microbiota. One of the most influential and well-studied is host diet. To assess and interpret the impact of non-dietary factors on the gut microbiota, we endeavoured to determine the most appropriate method to summarise community variation attributable to dietary effects. Dietary habits are multidimensional with internal correlations. This complexity can be simplified by using dietary indices that quantify dietary variance in a single measure and offer a means of controlling for diet in microbiota studies. However, to date, the applicability of different dietary indices to gut microbiota studies has not been assessed. Here, we use food frequency questionnaire (FFQ) data from members of the TwinsUK cohort to create three different dietary measures applicable in western-diet populations: The Healthy Eating Index (HEI), the Mediterranean Diet Score (MDS) and the Healthy Food Diversity index (HFD-Index). We validate and compare these three indices to determine which best summarises dietary influences on gut microbiota composition. RESULTS All three indices were independently validated using established measures of health, and all were significantly associated with microbiota measures; the HEI had the highest t values in models of alpha diversity measures, and had the highest number of associations with microbial taxa. Beta diversity analyses showed the HEI explained the greatest variance of microbiota composition. In paired tests between twins discordant for dietary index score, the HEI was associated with the greatest variation of taxa and twin dissimilarity. CONCLUSIONS We find that the HEI explains the most variance in, and has the strongest association with, gut microbiota composition in a western (UK) population, suggesting that it may be the best summary measure to capture gut microbiota variance attributable to habitual diet in comparable populations.
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Affiliation(s)
- Ruth C. E. Bowyer
- The Department of Twin Research, Kings College London, 3-4th Floor South Wing Block D, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
| | - Matthew A. Jackson
- The Department of Twin Research, Kings College London, 3-4th Floor South Wing Block D, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
| | - Tess Pallister
- The Department of Twin Research, Kings College London, 3-4th Floor South Wing Block D, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), 150 Cours Albert Thomas, 69008 Lyon, France
| | - Jane Skinner
- Norwich Medical School 2.02, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ UK
| | - Tim D. Spector
- The Department of Twin Research, Kings College London, 3-4th Floor South Wing Block D, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
| | - Ailsa A. Welch
- Norwich Medical School 2.02, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ UK
| | - Claire J. Steves
- The Department of Twin Research, Kings College London, 3-4th Floor South Wing Block D, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
- Clinical Age Research Unit, Kings College Hospital Foundation Trust, London, UK
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22
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Craig JV, Bunn DK, Hayhoe RP, Appleyard WO, Lenaghan EA, Welch AA. Relationship between the Mediterranean dietary pattern and musculoskeletal health in children, adolescents, and adults: systematic review and evidence map. Nutr Rev 2018; 75:830-857. [PMID: 29028268 PMCID: PMC5939869 DOI: 10.1093/nutrit/nux042] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Context: An understanding of the modifiable effects of diet on bone and skeletal muscle mass and strength over the life course will help inform strategies to reduce age-related fracture risk. The Mediterranean diet is rich in nutrients that may be important for optimal musculoskeletal health. Objective: The aim of this systematic review was to investigate the relationship between a Mediterranean diet and musculoskeletal outcomes (fracture, bone density, osteoporosis, sarcopenia) in any age group. Data Sources: Ten electronic databases were searched. Study Selection: Randomized controlled trials and prospective cohort studies that investigated a traditional Mediterranean diet, published in any language, were eligible. Studies using other designs or other definitions of the Mediterranean diet were collated separately in an evidence map. Data Extraction: Details on study design, methods, population, dietary intervention or exposure, length of follow-up, and effect on or association with musculoskeletal outcomes were extracted. Results: The search yielded 1738 references. Data from eligible randomized controlled trials (n = 0) and prospective cohort studies (n = 3) were synthesized narratively by outcome for the systematic review. Two of these studies reported on hip fracture incidence, but results were contradictory. A third study found no association between the Mediterranean diet and sarcopenia incidence. Conclusions: Overall, the systematic review and evidence map demonstrate a lack of research to understand the relationship between the Mediterranean diet and musculoskeletal health in all ages. Systematic Review Registration: PROSPERO registration number IDCRD42016037038.
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Affiliation(s)
- Jean V Craig
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Diane K Bunn
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Richard P Hayhoe
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Will O Appleyard
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Elizabeth A Lenaghan
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Ailsa A Welch
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
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23
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Welch AA, Skinner J, Hickson M. Dietary Magnesium May Be Protective for Aging of Bone and Skeletal Muscle in Middle and Younger Older Age Men and Women: Cross-Sectional Findings from the UK Biobank Cohort. Nutrients 2017; 9:nu9111189. [PMID: 29084183 PMCID: PMC5707661 DOI: 10.3390/nu9111189] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 10/20/2017] [Accepted: 10/24/2017] [Indexed: 01/06/2023] Open
Abstract
Although fragility fractures, osteoporosis, sarcopenia, and frailty are becoming more prevalent in our aging society the treatment options are limited and preventative strategies are needed. Despite magnesium being integral to bone and muscle physiology, the relationship between dietary magnesium and skeletal muscle and bone health has not been investigated concurrently to date. We analysed cross-sectional associations between dietary magnesium and skeletal muscle mass (as fat free mass—FFM), grip strength, and bone density (BMD) in 156,575 men and women aged 39–72 years from the UK Biobank cohort. FFM was measured with bioelectrical impedance and was expressed as the percentage of body weight (FFM%) or as divided by body mass index (FFMBMI). Adjusted mean grip strength, FFM%, FFMBMI, and BMD were calculated according to quintiles of dietary magnesium, while correcting for covariates. Significant inter-quintile differences across intakes of magnesium existed in men and women, respectively, of 1.1% and 2.4% for grip strength, 3.0% and 3.6% for FFM%, 5.1% and 5.5% for FFMBMI, and 2.9% and 0.9% for BMD. These associations are as great or greater than annual measured losses of these musculoskeletal outcomes, indicating potential clinical significance. Our study suggests that dietary magnesium may play a role in musculoskeletal health and has relevance for population prevention strategies for sarcopenia, osteoporosis, and fractures.
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Affiliation(s)
- Ailsa A Welch
- Department of Population Health and Primary Care, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK.
| | - Jane Skinner
- Department of Population Health and Primary Care, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK.
| | - Mary Hickson
- Institute of Health and Community, Plymouth University, Peninsula Allied Health Centre, Derriford Road, Plymouth PL6 8BH, UK.
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Lentjes MAH, Keogh RH, Welch AA, Mulligan AA, Luben RN, Wareham NJ, Khaw KT. Longitudinal associations between marine omega-3 supplement users and coronary heart disease in a UK population-based cohort. BMJ Open 2017; 7:e017471. [PMID: 29030414 PMCID: PMC5652534 DOI: 10.1136/bmjopen-2017-017471] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Assess the association between marine omega-3 polyunsaturated fatty acid (n-3 PUFA) intake from supplements, mainly cod liver oil, and coronary heart disease (CHD) mortality. DESIGN Prospective cohort study, with three exposure measurements over 22 years. SETTING Norfolk-based European Prospective Investigation into Cancer (EPIC-Norfolk, UK). PARTICIPANTS 22 035 men and women from the general population, 39-79 years at recruitment. EXPOSURE Supplement use was assessed in three questionnaires (1993-1998; 2002-2004; 2004-2011). Participants were grouped into non-supplement users (NSU), n-3 PUFA supplement users (SU+n3) and non-n-3 PUFA supplement users (SU-n3). Cox regression adjusted for time-point specific variables: age, smoking, prevalent illnesses, body mass index, alcohol consumption, physical activity and season and baseline assessments of sex, social class, education and dietary intake (7-day diet diary). PRIMARY AND SECONDARY OUTCOME MEASURES During a median of 19-year follow-up, 1562 CHD deaths were registered for 22 035 included participants. RESULTS Baseline supplement use was not associated with CHD mortality, but baseline food and supplement intake of n-3 PUFA was inversely associated with CHD mortality after adjustment for fish consumption. Using time-varying covariate analysis, significant associations were observed for SU+n3 (HR: 0.74, 95% CI 0.66 to 0.84), but not for SU-n3 versus NSU. In further analyses, the association for SU+n3 persisted in those who did not take other supplements (HR: 0.83, 95% CI 0.71 to 0.97). Those who became SU+n3 over time or were consistent SU+n3 versus consistent NSU had a lower hazard of CHD mortality; no association with CHD was observed in those who stopped using n-3 PUFA-containing supplements. CONCLUSIONS Recent use of n-3 PUFA supplements was associated with a lower hazard of CHD mortality in this general population with low fish consumption. Residual confounding cannot be excluded, but the findings observed may be explained by postulated biological mechanisms and the results were specific to SU+n3.
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Affiliation(s)
| | - Ruth H Keogh
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Ailsa A Welch
- Department of Population Health and Primary Care, University of East Anglia, Norwich, UK
| | - Angela A Mulligan
- Department of Public Health and Primary Care, University of Cambridge, UK
| | - Robert N Luben
- Department of Public Health and Primary Care, University of Cambridge, UK
| | - Nicholas J Wareham
- MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Cambridge, UK
| | - Kay-Tee Khaw
- School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
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Hayhoe RPG, Lentjes MAH, Mulligan AA, Luben RN, Khaw KT, Welch AA. Carotenoid dietary intakes and plasma concentrations are associated with heel bone ultrasound attenuation and osteoporotic fracture risk in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Norfolk cohort. Br J Nutr 2017; 117:1439-1453. [PMID: 28587685 DOI: 10.1017/s0007114517001180] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Carotenoids are found in abundance in fruit and vegetables, and may be involved in the positive association of these foods with bone health. This study aimed to explore the associations of dietary carotenoid intakes and plasma concentrations with bone density status and osteoporotic fracture risk in a European population. Cross-sectional analyses (n 14 803) of bone density status, using calcaneal broadband ultrasound attenuation (BUA) and longitudinal analyses (n 25 439) of fracture cases were conducted on data from the prospective European Prospective Investigation into Cancer and Nutrition-Norfolk cohort of middle-aged and older men and women. Health and lifestyle questionnaires were completed, and dietary nutrient intakes were derived from 7-d food diaries. Multiple regression demonstrated significant positive trends in BUA for women across quintiles of dietary α-carotene intake (P=0·029), β-carotene intake (P=0·003), β-cryptoxanthin intake (P=0·031), combined lutein and zeaxanthin intake (P=0·010) and lycopene intake (P=0·005). No significant trends across plasma carotenoid concentration quintiles were apparent (n 4570). The Prentice-weighted Cox regression showed no trends in fracture risk across dietary carotenoid intake quintiles (mean follow-up time 12·5 years), except for a lower risk for wrist fracture in women with higher lutein and zeaxanthin intake (P=0·022); nevertheless, inter-quintile differences in fracture risk were found for both sexes. Analysis of plasma carotenoid data (mean follow-up time 11·9 years) showed lower hip fracture risk in men across higher plasma α-carotene (P=0·026) and β-carotene (P=0·027) quintiles. This study provides novel evidence that dietary carotenoid intake is relevant to bone health in men and women, demonstrating that associations with bone density status and fracture risk exist for dietary intake of specific carotenoids and their plasma concentrations.
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Affiliation(s)
- Richard P G Hayhoe
- 1Department of Population Health and Primary Care,Norwich Medical School, Faculty of Medicine and Health Sciences,University of East Anglia,Norwich NR4 7TJ,UK
| | - Marleen A H Lentjes
- 2Strangeways Research Laboratory,Department of Public Health and Primary Care,Institute of Public Health,University of Cambridge,Worts Causeway,Cambridge CB1 8RN,UK
| | - Angela A Mulligan
- 2Strangeways Research Laboratory,Department of Public Health and Primary Care,Institute of Public Health,University of Cambridge,Worts Causeway,Cambridge CB1 8RN,UK
| | - Robert N Luben
- 2Strangeways Research Laboratory,Department of Public Health and Primary Care,Institute of Public Health,University of Cambridge,Worts Causeway,Cambridge CB1 8RN,UK
| | - Kay-Tee Khaw
- 2Strangeways Research Laboratory,Department of Public Health and Primary Care,Institute of Public Health,University of Cambridge,Worts Causeway,Cambridge CB1 8RN,UK
| | - Ailsa A Welch
- 1Department of Population Health and Primary Care,Norwich Medical School, Faculty of Medicine and Health Sciences,University of East Anglia,Norwich NR4 7TJ,UK
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Kelaiditi E, Jennings A, Steves CJ, Skinner J, Cassidy A, MacGregor AJ, Welch AA. Measurements of skeletal muscle mass and power are positively related to a Mediterranean dietary pattern in women. Osteoporos Int 2016; 27:3251-3260. [PMID: 27417218 PMCID: PMC5409925 DOI: 10.1007/s00198-016-3665-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 06/08/2016] [Indexed: 01/18/2023]
Abstract
The age-related loss of skeletal muscle and function are risk factors for osteoporosis and fractures. We found that higher adherence to the Mediterranean diet score was significantly associated with greater fat-free mass and leg explosive power suggesting a role for the Mediterranean Diet in prevention of loss of muscle outcomes. INTRODUCTION The loss of skeletal muscle mass, strength, and function with age are contributing risk factors for the onset of sarcopenia, frailty, osteoporosis, fractures, and mortality. Nutrition may affect the progression and trajectory of these changes in skeletal muscle but the role of the micronutrient-rich Mediterranean diet (MD) has hardly been investigated in relation to these muscle outcomes. METHODS We examined associations between the MD score (MDS) and FFM% (fat-free mass / weight × 100), FFMI (fat-free mass/height2), hand grip strength, and leg explosive power (LEP, watts/kg) in a cross-sectional study in 2570 women aged 18-79 years from the TwinsUK study. Measurements of body composition were made using dual-energy X-ray absorptiometry and dietary intake assessed by a food frequency questionnaire. FFM%, FFMI, grip strength, and LEP were compared across quartiles of the MDS after adjustment for covariates, with CRP measured in a subgroup (n = 1658). RESULTS Higher adherence to the MDS was positively associated with measurements of muscle outcomes, with significant differences of 1.7 % for FFM% and 9.6 % for LEP (P trend <0.001), comparing extreme quartiles of intake, but not with grip strength or CRP concentrations. CONCLUSIONS For the first time in a northern European population, we have observed significant positive associations between the MDS and FFM% and LEP in healthy women that are potentially clinically relevant, independent of the factors known to influence muscle outcomes. Our findings emphasize the potential role for overall diet quality based on the MD in the prevention of age-related loss of skeletal muscle outcomes.
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Affiliation(s)
- E Kelaiditi
- Department of Nutrition, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - A Jennings
- Department of Nutrition, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - C J Steves
- Department of Twin Research and Genetic Epidemiology, King's College London, London, SE1 7EH, UK
| | - J Skinner
- Department of Public Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - A Cassidy
- Department of Nutrition, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - A J MacGregor
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - A A Welch
- Department of Public Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK.
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Kwok CS, Loke YK, Welch AA, Luben RN, Lentjes MAH, Boekholdt SM, Pfister R, Mamas MA, Wareham NJ, Khaw KT, Myint PK. Habitual chocolate consumption and the risk of incident heart failure among healthy men and women. Nutr Metab Cardiovasc Dis 2016; 26:722-734. [PMID: 27052923 PMCID: PMC4987462 DOI: 10.1016/j.numecd.2016.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 01/07/2016] [Accepted: 01/11/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND We aimed to examine the association between chocolate intake and the risk of incident heart failure in a UK general population. We conducted a systematic review and meta-analysis to quantify this association. METHODS AND RESULTS We used data from a prospective population-based study, the European Prospective Investigation into Cancer (EPIC)-Norfolk cohort. Chocolate intake was quantified based on a food frequency questionnaire obtained at baseline (1993-1997) and incident heart failure was ascertained up to March 2009. We supplemented the primary data with a systematic review and meta-analysis of studies which evaluated risk of incident heart failure with chocolate consumption. A total of 20,922 participants (53% women; mean age 58 ± 9 years) were included of whom 1101 developed heart failure during the follow up (mean 12.5 ± 2.7 years, total person years 262,291 years). After adjusting for lifestyle and dietary factors, we found 19% relative reduction in heart failure incidence in the top (up to 100 g/d) compared to the bottom quintile of chocolate consumption (HR 0.81 95%CI 0.66-0.98) but the results were no longer significant after controlling for comorbidities (HR 0.87 95%CI 0.71-1.06). Additional adjustment for potential mediators did not attenuate the results further. We identified five relevant studies including the current study (N = 75,408). The pooled results showed non-significant 19% relative risk reduction of heart failure incidence with higher chocolate consumption (HR 0.81 95%CI 0.66-1.01). CONCLUSIONS Our results suggest that higher chocolate intake is not associated with subsequent incident heart failure.
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Affiliation(s)
- C S Kwok
- School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, Scotland, United Kingdom; Keele Cardiovascular Research Group, Institute for Science & Technology in Medicine, Keele University, Stoke-on-Trent, United Kingdom
| | - Y K Loke
- Department of Population Health & Primary Care, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - A A Welch
- Department of Population Health & Primary Care, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - R N Luben
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - M A H Lentjes
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - S M Boekholdt
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - R Pfister
- Department III of Internal Medicine, Heart Centre of the University of Cologne, Cologne, Germany
| | - M A Mamas
- Keele Cardiovascular Research Group, Institute for Science & Technology in Medicine, Keele University, Stoke-on-Trent, United Kingdom
| | - N J Wareham
- Medical Research Council Epidemiology Unit, Cambridge, United Kingdom
| | - K-T Khaw
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - P K Myint
- School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, Scotland, United Kingdom.
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Welch AA, Kelaiditi E, Jennings A, Steves CJ, Spector TD, MacGregor A. Dietary Magnesium Is Positively Associated With Skeletal Muscle Power and Indices of Muscle Mass and May Attenuate the Association Between Circulating C-Reactive Protein and Muscle Mass in Women. J Bone Miner Res 2016; 31:317-25. [PMID: 26288012 DOI: 10.1002/jbmr.2692] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 07/29/2015] [Accepted: 08/13/2015] [Indexed: 01/06/2023]
Abstract
Age-related loss of skeletal muscle mass and strength are risk factors for sarcopenia, osteoporosis, falls, fractures, frailty, and mortality. Dietary magnesium (Mg) could play a role in prevention of age-related loss of skeletal muscle mass, power, and strength directly through physiological mechanisms or indirectly through an impact on chronic low-grade inflammation, itself a risk factor for loss of skeletal muscle mass and strength. In a cross-sectional study of 2570 women aged 18 to 79 years, we examined associations between intakes of Mg, estimated using a food-frequency questionnaire (FFQ), dual-energy X-ray absorptiometry (DXA)-derived measures of muscle mass (fat-free mass as a percentage of body weight [FFM%], fat-free mass index [FFMI, kg/m(2)]), leg explosive power (LEP), and grip strength (n = 949 only). We also examined associations between circulating hs-CRP (C-reactive protein) and muscle mass and LEP, and explored the potential attenuation of these relationships by Mg. We compared our findings with those of age and protein intake. Endpoints were calculated by quintile of Mg and adjusted for relevant confounders. Significant positive associations were found between a higher Mg and indices of skeletal muscle mass and LEP, and also with hs-CRP, after adjustment for covariates. Contrasting extreme quintiles of Mg intake showed differences of 2.6% for FFM% (p trend < 0.001), 0.4 kg/m(2) for FFMI (p trend = 0.005), and 19.6 watts/kg for LEP (p trend < 0.001). Compared with protein, these positive associations were 7 times greater for FFM% and 2.5 times greater for LEP. We also found that higher hs-CRP was negatively associated with skeletal muscle mass and, in statistical modeling, that a higher dietary Mg attenuated this negative relationship by 6.5%, with greater attenuation in women older than 50 years. No association was found between Mg and grip strength. Our results suggest that dietary magnesium may aid conservation of age-related loss of skeletal muscle mass and power in women of all ages.
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Affiliation(s)
- Ailsa A Welch
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Amy Jennings
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, King's College London, UK
| | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, UK
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Hayhoe RPG, Lentjes MAH, Luben RN, Khaw KT, Welch AA. Reply to W Lin and R Wang. Am J Clin Nutr 2016; 103:290-1. [PMID: 26728694 DOI: 10.3945/ajcn.115.122291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Richard P G Hayhoe
- From the Department of Population Health and Primary Care, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom (RPGH; AAW, e-mail: ); and the Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Strangeways Research Laboratory, Cambridge, United Kingdom (MAHL, RNL, K-TK)
| | - Marleen A H Lentjes
- From the Department of Population Health and Primary Care, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom (RPGH; AAW, e-mail: ); and the Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Strangeways Research Laboratory, Cambridge, United Kingdom (MAHL, RNL, K-TK)
| | - Robert N Luben
- From the Department of Population Health and Primary Care, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom (RPGH; AAW, e-mail: ); and the Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Strangeways Research Laboratory, Cambridge, United Kingdom (MAHL, RNL, K-TK)
| | - Kay-Tee Khaw
- From the Department of Population Health and Primary Care, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom (RPGH; AAW, e-mail: ); and the Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Strangeways Research Laboratory, Cambridge, United Kingdom (MAHL, RNL, K-TK)
| | - Ailsa A Welch
- From the Department of Population Health and Primary Care, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom (RPGH; AAW, e-mail: ); and the Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Strangeways Research Laboratory, Cambridge, United Kingdom (MAHL, RNL, K-TK)
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Finck H, Hart AR, Lentjes MAH, Jennings A, Luben RN, Khaw KT, Welch AA. Cross-sectional and prospective associations between dietary and plasma vitamin C, heel bone ultrasound, and fracture risk in men and women in the European Prospective Investigation into Cancer in Norfolk cohort. Am J Clin Nutr 2015; 102:1416-24. [PMID: 26537939 DOI: 10.3945/ajcn.115.111971] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 09/23/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Vitamin C sufficiency may help prevent osteoporosis and fractures by mediating osteoclastogenesis, osteoblastogenesis, and bone collagen synthesis. OBJECTIVE We determined whether dietary intakes and plasma concentrations of vitamin C were associated with a heel ultrasound and hip and spine fracture risks in older men and women. DESIGN Participants were recruited from the European Prospective Investigation into Cancer in Norfolk study with 7-d diet diary estimates of vitamin C intake and plasma concentrations. A random subset (4000 of 25,639 subjects) was available for the cross-sectional (ultrasound) study of broadband ultrasound attenuation (BUA) and velocity of sound (VOS), which were determined during the second health examination. The prospective (fracture) study was a case-cohort sample of all participants with a fracture up to March 2009 and the random subset (n = 5319). ANCOVA-determined associations between quintiles of vitamin C intake and plasma status with adjusted BUA and VOS and adjusted Prentice-weighted Cox proportional HRs were calculated for fracture risk. RESULTS Women were 58% of the population (39-79 y old), and the median follow-up was 12.6 y (range: 0-16 y). Positive associations across all quintiles of vitamin C intake but not plasma status were significant for VOS in men (β = 2.47 m/s, P = 0.008) and BUA in women (β = 0.82 dB/MHz, P = 0.004). Vitamin C intake was not associated with fracture risk, but there was an inverse association with plasma concentrations in men, with quintile 4 having significantly lower risks of hip fractures (HR: 0.35; 95% CI: 0.16, 0.80) and spine fractures (HR: 0.26; 95% CI: 0.10, 0.69) than quintile 1. CONCLUSIONS Higher vitamin C intake was significantly associated with higher heel ultrasound measures in men and women, and higher plasma vitamin C concentrations were significantly associated with reduced fracture risk in men only. Our findings that vitamin C intake and status were inconsistently associated with bone health variables suggest that additional research is warranted.
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Affiliation(s)
| | | | - Marleen A H Lentjes
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratories, Cambridge, United Kingdom
| | - Amy Jennings
- Nutrition, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom; and
| | - Robert N Luben
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratories, Cambridge, United Kingdom
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratories, Cambridge, United Kingdom
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Hayhoe RPG, Lentjes MAH, Luben RN, Khaw KT, Welch AA. Dietary magnesium and potassium intakes and circulating magnesium are associated with heel bone ultrasound attenuation and osteoporotic fracture risk in the EPIC-Norfolk cohort study. Am J Clin Nutr 2015; 102:376-84. [PMID: 26135346 DOI: 10.3945/ajcn.114.102723] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 05/27/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In our aging population, maintenance of bone health is critical to reduce the risk of osteoporosis and potentially debilitating consequences of fractures in older individuals. Among modifiable lifestyle and dietary factors, dietary magnesium and potassium intakes are postulated to influence bone quality and osteoporosis, principally via calcium-dependent alteration of bone structure and turnover. OBJECTIVE We investigated the influence of dietary magnesium and potassium intakes, as well as circulating magnesium, on bone density status and fracture risk in an adult population in the United Kingdom. DESIGN A random subset of 4000 individuals from the European Prospective Investigation into Cancer and Nutrition-Norfolk cohort of 25,639 men and women with baseline data was used for bone density cross-sectional analyses and combined with fracture cases (n = 1502) for fracture case-cohort longitudinal analyses (mean follow-up 13.4 y). Relevant biological, lifestyle, and dietary covariates were used in multivariate regression analyses to determine associations between dietary magnesium and potassium intakes and calcaneal broadband ultrasound attenuation (BUA), as well as in Prentice-weighted Cox regression to determine associated risk of fracture. Separate analyses, excluding dietary covariates, investigated associations of BUA and fractures with serum magnesium concentration. RESULTS Statistically significant positive trends in calcaneal BUA for women (n = 1360) but not men (n = 968) were apparent across increasing quintiles of magnesium plus potassium (Mg+K) z score intake (P = 0.03) or potassium intake alone (P = 0.04). Reduced hip fracture risk in both men (n = 1958) and women (n = 2755) was evident for individuals in specific Mg+K z score intake quintiles compared with the lowest. Statistically significant trends in fracture risk in men across serum magnesium concentration groups were apparent for spine fractures (P = 0.02) and total hip, spine, and wrist fractures (P = 0.02). None of these individual statistically significant associations remained after adjustment for multiple testing. CONCLUSIONS These findings enhance the limited literature studying the association of magnesium and potassium with bone density and demonstrate that further investigation is warranted into the mechanisms involved and the potential protective role against osteoporosis.
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Affiliation(s)
- Richard P G Hayhoe
- Department of Population Health and Primary Care, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom; and
| | - Marleen A H Lentjes
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Strangeways Research Laboratory, Cambridge, United Kingdom
| | - Robert N Luben
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Strangeways Research Laboratory, Cambridge, United Kingdom
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Strangeways Research Laboratory, Cambridge, United Kingdom
| | - Ailsa A Welch
- Department of Population Health and Primary Care, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom; and
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Bain LKM, Myint PK, Jennings A, Lentjes MAH, Luben RN, Khaw KT, Wareham NJ, Welch AA. The relationship between dietary magnesium intake, stroke and its major risk factors, blood pressure and cholesterol, in the EPIC-Norfolk cohort. Int J Cardiol 2015; 196:108-14. [PMID: 26082204 DOI: 10.1016/j.ijcard.2015.05.166] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 05/28/2015] [Accepted: 05/29/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Dietary magnesium could modify the major stroke risk factors, high blood pressure (BP) and cholesterol, but has been understudied in both sexes in a single population. This study aimed to investigate if dietary magnesium intake was associated with BP, total cholesterol (TC) and incident stroke risk in an adult population. METHODS We conducted cross-sectional analyses in a case-cohort study of 4443, men and women aged 40-75, representative of 25,639 participants years of the EPIC (European Prospective Investigation into Cancer)-Norfolk cohort. The cohort included 928 stroke cases (42,556.5 person years). Dietary data from 7 day food diaries were analysed using multivariate regression to assess associations between quintiles or data-derived categories of dietary magnesium intake and BP, TC and stroke risk, adjusted for relevant confounders. RESULTS We observed differences of -7 mmHg systolic BP (P trend ≤ 0.01) and -3.8 mmHg diastolic BP (P trend=0.01) between extreme intakes of magnesium in men, a significant inverse association with TC was observed (P trend=0.02 men and 0.04 women). Compared to the bottom 10%, the top 30% of magnesium intake was associated with a 41% relative reduction in stroke risk (HR 0.59; 95% CI 0.38-0.93) in men. CONCLUSIONS Lower dietary magnesium intake was associated with higher BP and stroke risk, which may have implications for primary prevention.
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Affiliation(s)
- Lucy K M Bain
- Department of Population Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Phyo K Myint
- Aberdeen Gerontological and Epidemiological INterdisciplinary Research Group (AGEING), Epidemiology Group, Institute of Applied Health Sciences, School of Medicine & Dentistry, Aberdeen, UK
| | - Amy Jennings
- Department of Nutrition, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Marleen A H Lentjes
- Department of Public Health and Primary Care, Institute of Public Health, Cambridge University, Cambridge, UK
| | - Robert N Luben
- Department of Public Health and Primary Care, Institute of Public Health, Cambridge University, Cambridge, UK
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, Institute of Public Health, Cambridge University, Cambridge, UK
| | - Nick J Wareham
- Department of Public Health and Primary Care, Institute of Public Health, Cambridge University, Cambridge, UK
| | - Ailsa A Welch
- Department of Population Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich, UK.
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Lentjes MAH, Mulligan AA, Welch AA, Bhaniani A, Luben RN, Khaw KT. Contribution of cod liver oil-related nutrients (vitamins A, D, E and eicosapentaenoic acid and docosahexaenoic acid) to daily nutrient intake and their associations with plasma concentrations in the EPIC-Norfolk cohort. J Hum Nutr Diet 2014; 28:568-82. [PMID: 25228113 PMCID: PMC4657496 DOI: 10.1111/jhn.12271] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Total nutrient intake (TNI) is intake from food and supplements. This provides an assessment of nutrient adequacy and the prevalence of excessive intake, as well as the response with respect to biomarkers. Cod liver oil (CLO) is the most frequently consumed supplement in the UK, containing nutrients that might have varying influences on health. We calculated TNI for vitamins A, D and E, as well as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and assessed associations with the respective blood concentrations. Methods Seven-day diet diaries and blood samples were taken from two subsets of the European Prospective Investigation into Cancer (EPIC-Norfolk) cohort (age range 39–79 years; n = 1400 for vitamin D; n = 6656 for remaining nutrients). TNI was calculated for the subgroups: nonsupplement users, those consuming the nutrient in supplement form and those consuming a supplement without this nutrient. Results CLO-related nutrients were supplemented by 15%–33%, which approximately doubled median intakes. Almost everyone in the supplement + vitamin A group reached the estimated average requirement; however, guideline levels were likely to be exceeded. Partial correlations between intake of vitamins A and D and biomarkers were low and modestly strengthened by the inclusion of supplement sources (correlation = 0.01–0.13). Correlations between biomarker and TNI of vitamin E and EPA+DHA were in the range 0.40–0.46; however, vitamin E exceeding food intake resulted in attenuated coefficients. Linear associations between food or TNI EPA+DHA and plasma were weak but consistent across subgroups. Conclusions CLO-related nutrients contribute substantially to nutrient intake, with a risk of over-consumption. Apart from EPA+DHA, biomarker data suggest that CLO-related nutrients in supplements are not linearly associated with vitamin status.
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Affiliation(s)
- M A H Lentjes
- Department of Public Health & Primary Care, EPIC-Norfolk Study, University of Cambridge, Cambridge, UK
| | - A A Mulligan
- Department of Public Health & Primary Care, EPIC-Norfolk Study, University of Cambridge, Cambridge, UK
| | - A A Welch
- Norwich Medical School, Department of Population Health and Primary Care, University of East Anglia, Norwich, UK
| | - A Bhaniani
- Department of Public Health & Primary Care, EPIC-Norfolk Study, University of Cambridge, Cambridge, UK
| | - R N Luben
- Department of Public Health & Primary Care, EPIC-Norfolk Study, University of Cambridge, Cambridge, UK
| | - K-T Khaw
- University of Cambridge, School of Clinical Medicine, Clinical Gerontology Unit, Cambridge, UK
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Abstract
Osteoporosis and fragility fractures are a growing problem for our aging population with around 1 in 2 women and 1 in 5 men suffering from an osteoporotic fracture during their lifetime. Although there are established factors that can reduce the risk of fracture such as maintaining physical activity, ceasing smoking, and adequate vitamin D status, and intakes of calcium; dietary mechanisms are less well established. The relevance of the flavonoid group of bioactive compounds found in fruits and vegetables has been less investigated. Two human epidemiologic studies in women found positive associations between total dietary flavonoid intake and bone mineral density. Flavonoids may protect against bone loss by upregulating signaling pathways that promote osteoblast function, by reducing the effects of oxidative stress or chronic low-grade inflammation. The limitations of the existing research are explored in the manuscript and it is concluded that further research is needed, in this promising area.
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Affiliation(s)
- Ailsa A Welch
- Department of Population Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK,
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Welch AA, MacGregor AJ, Minihane AM, Skinner J, Valdes AA, Spector TD, Cassidy A. Dietary fat and fatty acid profile are associated with indices of skeletal muscle mass in women aged 18-79 years. J Nutr 2014; 144:327-34. [PMID: 24401817 DOI: 10.3945/jn.113.185256] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Age-related loss of skeletal muscle mass results in a reduction in metabolically active tissue and has been related to the onset of obesity and sarcopenia. Although the causes of muscle loss are poorly understood, dietary fat has been postulated to have a role in determining protein turnover through an influence on both inflammation and insulin resistance. This study was designed to investigate the cross-sectional relation between dietary fat intake, as dietary percentage of fat energy (PFE) and fatty acid profile, with indices of skeletal muscle mass in the population setting. Body composition [fat-free mass (FFM; in kg)] and the fat-free mass index (FFMI; kg FFM/m(2)) was measured by using dual-energy X-ray absorptiometry in 2689 women aged 18-79 y from the TwinsUK Study and calculated according to quintile of dietary fat (by food-frequency questionnaire) after multivariate adjustment. Positive associations were found between the polyunsaturated-to-saturated fatty acid (SFA) ratio and indices of FFM, and inverse associations were found with PFE, SFAs, monounsaturated fatty acids (MUFAs), and trans fatty acids (TFAs) (all as % of energy). Extreme quintile dietary differences for PFE were -0.6 kg for FFM and -0.28 kg/m(2) for FFMI; for SFAs, MUFAs, and TFAs, these were -0.5 to -0.8 kg for FFM and -0.26 to -0.38 kg/m(2) for FFMI. These associations were of a similar magnitude to the expected decline in muscle mass that occurs over 10 y. To our knowledge, this is the first population-based study to demonstrate an association between a comprehensive range of dietary fat intake and FFM. These findings indicate that a dietary fat profile already associated with cardiovascular disease protection may also be beneficial for conservation of skeletal muscle mass.
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Affiliation(s)
- Ailsa A Welch
- Norwich Medical School, University of East Anglia, Norwich, UK
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Jennings A, Welch AA, Spector T, Macgregor A, Cassidy A. Intakes of anthocyanins and flavones are associated with biomarkers of insulin resistance and inflammation in women. J Nutr 2014; 144:202-8. [PMID: 24336456 DOI: 10.3945/jn.113.184358] [Citation(s) in RCA: 158] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Although laboratory data suggest that several flavonoid subclasses are involved in glucose metabolism, limited clinical and epidemiologic data are available. The current study examined associations between habitual intake of flavonoid subclasses, insulin resistance, and related inflammatory biomarkers. In a cross-sectional study of 1997 females aged 18-76 y, intakes of total flavonoids and their subclasses (flavanones, anthocyanins, flavan-3-ols, polymeric flavonoids, flavonols, flavones) were calculated from food frequency questionnaires using an extended USDA database. Fasting serum glucose, insulin, high-sensitivity C-reactive protein (hs-CRP; n = 1432), plasminogen activator inhibitor-1 (n = 843), and adiponectin (n = 1452) concentrations were measured. In multivariable analyses, higher anthocyanin and flavone intake were associated with significantly lower peripheral insulin resistance [homeostasis model assessment of insulin resistance; quintile 5 (Q5) to Q1 = -0.1, P-trend = 0.04 for anthocyanins and flavones] as a result of a decrease in insulin concentrations (Q5-Q1 = -0.7 μU/mL, P-trend = 0.02 anthocyanins; Q5-Q1 = -0.5 μU/mL, P-trend = 0.02 flavones). Higher anthocyanin intake was also associated with lower hs-CRP concentrations (Q5-Q1 = -0.3 mg/L, P-trend = 0.04), whereas those in the highest quintile of flavone intake had improved adiponectin concentrations (Q5-Q1 = 0.7 μg/L, P-trend = 0.01). Anthocyanin-rich foods were also associated with lower insulin and inflammation levels. No significant associations were observed for total or other flavonoid subclasses. Higher intakes of both anthocyanins and flavones were associated with improvements in insulin resistance and hs-CRP. These associations were found with intakes readily achieved in the diet. The observed reduction in insulin concentrations was similar to that reported previously for other lifestyle factors. Dose-response trials are needed to ascertain optimal intakes for the potential reduction of type 2 diabetes risk.
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Affiliation(s)
- Amy Jennings
- Department of Nutrition, Norwich Medical School, University of East Anglia, Norwich, UK
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Lentjes MAH, Welch AA, Luben RN, Khaw KT. Differences in dietary supplement use and secular and seasonal trends assessed using three different instruments in the EPIC-Norfolk population study. J Diet Suppl 2014; 10:142-51. [PMID: 23725527 DOI: 10.3109/19390211.2013.790336] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Supplement use has increased over time and measurements of supplement use are dependent on instruments chosen. Therefore, we investigated three different questionnaires to measure supplement use and whether these results were associated with age, year of recruitment (secular trend, 1993-1998), and seasonal trends. DESIGN The questionnaires were self-administered within a median time interval of 54 days and included a Health and Lifestyle Questionnaire (1-year recall), a Food Frequency Questionnaire (1-year recall), and a 7-day diet diary. SETTING Men and women, aged 40-79 years from the general population living in Norfolk (East Anglia, UK), recruited between 1993 and 1998 in the European Prospective Investigation into Cancer Study (EPIC-Norfolk). RESULTS The prevalence of supplement use estimated with different instruments ranged from 31.7% to 39.0% for men and 45.0% to 54.3% for women. Agreement was substantial with kappa-statistics between 0.72 and 0.81. Participants' age (men only) and recruitment year were independently associated with supplement use; season showed inconsistent results. CONCLUSIONS The diary provides a good agreement as measured by the kappa-statistic, compared to more long-term measures of supplement use classification. The secular and seasonal trends in supplement use and type of assessment instrument need to be taken into account in studies on health and supplement use.
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Affiliation(s)
- Marleen A H Lentjes
- Department of Public Health & Primary Care, EPIC-Norfolk Study, Strangeways Research Laboratories, University of Cambridge, Worts Causeway, Cambridge, United Kingdom.
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Welch AA, MacGregor AJ, Minihane AM, Skinner J, Valdes AA, Spector TD, Cassidy A. Dietary fat and fatty acid profile are associated with indices of skeletal muscle mass in women aged 18-79 years. J Nutr 2014. [PMID: 24401817 DOI: 10.3945/jn.113.185256"] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Age-related loss of skeletal muscle mass results in a reduction in metabolically active tissue and has been related to the onset of obesity and sarcopenia. Although the causes of muscle loss are poorly understood, dietary fat has been postulated to have a role in determining protein turnover through an influence on both inflammation and insulin resistance. This study was designed to investigate the cross-sectional relation between dietary fat intake, as dietary percentage of fat energy (PFE) and fatty acid profile, with indices of skeletal muscle mass in the population setting. Body composition [fat-free mass (FFM; in kg)] and the fat-free mass index (FFMI; kg FFM/m(2)) was measured by using dual-energy X-ray absorptiometry in 2689 women aged 18-79 y from the TwinsUK Study and calculated according to quintile of dietary fat (by food-frequency questionnaire) after multivariate adjustment. Positive associations were found between the polyunsaturated-to-saturated fatty acid (SFA) ratio and indices of FFM, and inverse associations were found with PFE, SFAs, monounsaturated fatty acids (MUFAs), and trans fatty acids (TFAs) (all as % of energy). Extreme quintile dietary differences for PFE were -0.6 kg for FFM and -0.28 kg/m(2) for FFMI; for SFAs, MUFAs, and TFAs, these were -0.5 to -0.8 kg for FFM and -0.26 to -0.38 kg/m(2) for FFMI. These associations were of a similar magnitude to the expected decline in muscle mass that occurs over 10 y. To our knowledge, this is the first population-based study to demonstrate an association between a comprehensive range of dietary fat intake and FFM. These findings indicate that a dietary fat profile already associated with cardiovascular disease protection may also be beneficial for conservation of skeletal muscle mass.
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Affiliation(s)
- Ailsa A Welch
- Norwich Medical School, University of East Anglia, Norwich, UK
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Welch AA, MacGregor AJ, Minihane AM, Skinner J, Valdes AA, Spector TD, Cassidy A. Dietary fat and fatty acid profile are associated with indices of skeletal muscle mass in women aged 18-79 years. J Nutr 2014. [PMID: 24401817 DOI: 10.3945/jn.113.185256;] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Age-related loss of skeletal muscle mass results in a reduction in metabolically active tissue and has been related to the onset of obesity and sarcopenia. Although the causes of muscle loss are poorly understood, dietary fat has been postulated to have a role in determining protein turnover through an influence on both inflammation and insulin resistance. This study was designed to investigate the cross-sectional relation between dietary fat intake, as dietary percentage of fat energy (PFE) and fatty acid profile, with indices of skeletal muscle mass in the population setting. Body composition [fat-free mass (FFM; in kg)] and the fat-free mass index (FFMI; kg FFM/m(2)) was measured by using dual-energy X-ray absorptiometry in 2689 women aged 18-79 y from the TwinsUK Study and calculated according to quintile of dietary fat (by food-frequency questionnaire) after multivariate adjustment. Positive associations were found between the polyunsaturated-to-saturated fatty acid (SFA) ratio and indices of FFM, and inverse associations were found with PFE, SFAs, monounsaturated fatty acids (MUFAs), and trans fatty acids (TFAs) (all as % of energy). Extreme quintile dietary differences for PFE were -0.6 kg for FFM and -0.28 kg/m(2) for FFMI; for SFAs, MUFAs, and TFAs, these were -0.5 to -0.8 kg for FFM and -0.26 to -0.38 kg/m(2) for FFMI. These associations were of a similar magnitude to the expected decline in muscle mass that occurs over 10 y. To our knowledge, this is the first population-based study to demonstrate an association between a comprehensive range of dietary fat intake and FFM. These findings indicate that a dietary fat profile already associated with cardiovascular disease protection may also be beneficial for conservation of skeletal muscle mass.
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Affiliation(s)
- Ailsa A Welch
- Norwich Medical School, University of East Anglia, Norwich, UK
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Welch AA, MacGregor AJ, Minihane AM, Skinner J, Valdes AA, Spector TD, Cassidy A. Dietary fat and fatty acid profile are associated with indices of skeletal muscle mass in women aged 18-79 years. J Nutr 2014. [PMID: 24401817 DOI: 10.3945/jn.113.185256-- or] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Age-related loss of skeletal muscle mass results in a reduction in metabolically active tissue and has been related to the onset of obesity and sarcopenia. Although the causes of muscle loss are poorly understood, dietary fat has been postulated to have a role in determining protein turnover through an influence on both inflammation and insulin resistance. This study was designed to investigate the cross-sectional relation between dietary fat intake, as dietary percentage of fat energy (PFE) and fatty acid profile, with indices of skeletal muscle mass in the population setting. Body composition [fat-free mass (FFM; in kg)] and the fat-free mass index (FFMI; kg FFM/m(2)) was measured by using dual-energy X-ray absorptiometry in 2689 women aged 18-79 y from the TwinsUK Study and calculated according to quintile of dietary fat (by food-frequency questionnaire) after multivariate adjustment. Positive associations were found between the polyunsaturated-to-saturated fatty acid (SFA) ratio and indices of FFM, and inverse associations were found with PFE, SFAs, monounsaturated fatty acids (MUFAs), and trans fatty acids (TFAs) (all as % of energy). Extreme quintile dietary differences for PFE were -0.6 kg for FFM and -0.28 kg/m(2) for FFMI; for SFAs, MUFAs, and TFAs, these were -0.5 to -0.8 kg for FFM and -0.26 to -0.38 kg/m(2) for FFMI. These associations were of a similar magnitude to the expected decline in muscle mass that occurs over 10 y. To our knowledge, this is the first population-based study to demonstrate an association between a comprehensive range of dietary fat intake and FFM. These findings indicate that a dietary fat profile already associated with cardiovascular disease protection may also be beneficial for conservation of skeletal muscle mass.
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Affiliation(s)
- Ailsa A Welch
- Norwich Medical School, University of East Anglia, Norwich, UK
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Welch AA, MacGregor AJ, Minihane AM, Skinner J, Valdes AA, Spector TD, Cassidy A. Dietary fat and fatty acid profile are associated with indices of skeletal muscle mass in women aged 18-79 years. J Nutr 2014. [PMID: 24401817 DOI: 10.3945/jn.113.185256\] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Age-related loss of skeletal muscle mass results in a reduction in metabolically active tissue and has been related to the onset of obesity and sarcopenia. Although the causes of muscle loss are poorly understood, dietary fat has been postulated to have a role in determining protein turnover through an influence on both inflammation and insulin resistance. This study was designed to investigate the cross-sectional relation between dietary fat intake, as dietary percentage of fat energy (PFE) and fatty acid profile, with indices of skeletal muscle mass in the population setting. Body composition [fat-free mass (FFM; in kg)] and the fat-free mass index (FFMI; kg FFM/m(2)) was measured by using dual-energy X-ray absorptiometry in 2689 women aged 18-79 y from the TwinsUK Study and calculated according to quintile of dietary fat (by food-frequency questionnaire) after multivariate adjustment. Positive associations were found between the polyunsaturated-to-saturated fatty acid (SFA) ratio and indices of FFM, and inverse associations were found with PFE, SFAs, monounsaturated fatty acids (MUFAs), and trans fatty acids (TFAs) (all as % of energy). Extreme quintile dietary differences for PFE were -0.6 kg for FFM and -0.28 kg/m(2) for FFMI; for SFAs, MUFAs, and TFAs, these were -0.5 to -0.8 kg for FFM and -0.26 to -0.38 kg/m(2) for FFMI. These associations were of a similar magnitude to the expected decline in muscle mass that occurs over 10 y. To our knowledge, this is the first population-based study to demonstrate an association between a comprehensive range of dietary fat intake and FFM. These findings indicate that a dietary fat profile already associated with cardiovascular disease protection may also be beneficial for conservation of skeletal muscle mass.
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Affiliation(s)
- Ailsa A Welch
- Norwich Medical School, University of East Anglia, Norwich, UK
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Welch AA, MacGregor AJ, Minihane AM, Skinner J, Valdes AA, Spector TD, Cassidy A. Dietary fat and fatty acid profile are associated with indices of skeletal muscle mass in women aged 18-79 years. J Nutr 2014. [PMID: 24401817 DOI: 10.3945/jn.113.185256,] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Age-related loss of skeletal muscle mass results in a reduction in metabolically active tissue and has been related to the onset of obesity and sarcopenia. Although the causes of muscle loss are poorly understood, dietary fat has been postulated to have a role in determining protein turnover through an influence on both inflammation and insulin resistance. This study was designed to investigate the cross-sectional relation between dietary fat intake, as dietary percentage of fat energy (PFE) and fatty acid profile, with indices of skeletal muscle mass in the population setting. Body composition [fat-free mass (FFM; in kg)] and the fat-free mass index (FFMI; kg FFM/m(2)) was measured by using dual-energy X-ray absorptiometry in 2689 women aged 18-79 y from the TwinsUK Study and calculated according to quintile of dietary fat (by food-frequency questionnaire) after multivariate adjustment. Positive associations were found between the polyunsaturated-to-saturated fatty acid (SFA) ratio and indices of FFM, and inverse associations were found with PFE, SFAs, monounsaturated fatty acids (MUFAs), and trans fatty acids (TFAs) (all as % of energy). Extreme quintile dietary differences for PFE were -0.6 kg for FFM and -0.28 kg/m(2) for FFMI; for SFAs, MUFAs, and TFAs, these were -0.5 to -0.8 kg for FFM and -0.26 to -0.38 kg/m(2) for FFMI. These associations were of a similar magnitude to the expected decline in muscle mass that occurs over 10 y. To our knowledge, this is the first population-based study to demonstrate an association between a comprehensive range of dietary fat intake and FFM. These findings indicate that a dietary fat profile already associated with cardiovascular disease protection may also be beneficial for conservation of skeletal muscle mass.
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Affiliation(s)
- Ailsa A Welch
- Norwich Medical School, University of East Anglia, Norwich, UK
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Welch AA, MacGregor AJ, Minihane AM, Skinner J, Valdes AA, Spector TD, Cassidy A. Dietary Fat and Fatty Acid Profile Are Associated with Indices of Skeletal Muscle Mass in Women Aged 18–79 Years. J Nutr 2014. [DOI: 10.3945/jn.113.185256 or 1=1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ailsa A. Welch
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | | | - Jane Skinner
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Anna A. Valdes
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Tim D. Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Aedin Cassidy
- Norwich Medical School, University of East Anglia, Norwich, UK
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Welch AA, MacGregor AJ, Skinner J, Spector TD, Moayyeri A, Cassidy A. A higher alkaline dietary load is associated with greater indexes of skeletal muscle mass in women. Osteoporos Int 2013; 24:1899-908. [PMID: 23152092 DOI: 10.1007/s00198-012-2203-7] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 09/12/2012] [Indexed: 12/15/2022]
Abstract
UNLABELLED Conservation of muscle mass is important for fall and fracture prevention but further understanding of the causes of age-related muscle loss is required. This study found a more alkaline diet was positively associated with muscle mass in women suggesting a role for dietary acid-base load in muscle loss. INTRODUCTION Conservation of skeletal muscle is important for preventing falls and fractures but age-related loss of muscle mass occurs even in healthy individuals. However, the mild metabolic acidosis associated with an acidogenic dietary acid-base load could influence loss of muscle mass. METHODS We investigated the association between fat-free mass (FFM), percentage FFM (FFM%) and fat-free mass index (FFMI, weight/height²), measured using dual-energy X-ray absorptiometry in 2,689 women aged 18-79 years from the TwinsUK Study, and dietary acid-base load. Body composition was calculated according to quartile of potential renal acid load and adjusted for age, physical activity, misreporting and smoking habit (FFM, FFMI also for fat mass) and additionally with percentage protein. RESULTS Fat-free mass was positively associated with a more alkalinogenic dietary load (comparing quartile 1 vs 4: FFM 0.79 kg P < 0.001, FFM% 1.06 % <0.001, FFMI 0.24 kg/m² P = 0.002), and with the ratio of fruits and vegetables to potential acidogenic foods. CONCLUSIONS We observed a small but significant positive association between a more alkaline diet and muscle mass indexes in healthy women that was independent of age, physical activity and protein intake equating to a scale of effect between a fifth and one half of the observed relationship with 10 years of age. Although protein is important for maintenance of muscle mass, eating fruits and vegetables that supply adequate amounts of potassium and magnesium are also relevant. The results suggest a potential role for diet in the prevention of muscle loss.
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Affiliation(s)
- A A Welch
- Department of Nutrition, Norwich Medical School, University of East Anglia, NR4 7TJ Norwich, UK.
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Jennings A, Welch AA, Fairweather-Tait SJ, Kay C, Minihane AM, Chowienczyk P, Jiang B, Cecelja M, Spector T, Macgregor A, Cassidy A. Higher anthocyanin intake is associated with lower arterial stiffness and central blood pressure in women. Am J Clin Nutr 2012; 96:781-8. [PMID: 22914551 DOI: 10.3945/ajcn.112.042036] [Citation(s) in RCA: 192] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Although a high intake of some flavonoid subclasses may reduce cardiovascular disease mortality, data regarding the in vivo mechanisms of action are limited. OBJECTIVE We examined associations between habitual flavonoid intakes and direct measures of arterial stiffness, central blood pressure, and atherosclerosis. DESIGN In a cross-sectional study of 1898 women aged 18-75 y from the TwinsUK registry, intakes of total flavonoids and their subclasses (flavanones, anthocyanins, flavan-3-ols, polymers, flavonols, and flavones) were calculated from validated food-frequency questionnaires by using an updated and extended USDA database. Direct measures of arterial stiffness and atherosclerosis included central systolic blood pressure (cSBP), central diastolic blood pressure, mean arterial pressure (MAP), augmentation index, pulse wave velocity (PWV), and intima-media thickness. RESULTS In multivariate analyses, a higher anthocyanin intake was associated with significantly lower cSBP (mean ± SE: -3.0 ± 1.4 mm Hg for quintile 5 compared with quintile 1; P-trend = 0.02), MAP (-2.3 ± 1.2 mm Hg for quintile 5 compared with quintile 1; P-trend = 0.04), and PWV (-0.4 ± 0.2 m/s for quintile 5 compared with quintile 1; P-trend = 0.04), whereas a higher flavone intake was associated with a lower PWV (-0.4 ± 0.2 m/s for quintile 5 compared with quintile 1; P-trend = 0.04). Although a higher wine and berry intake was associated with a lower PWV, no associations were observed for total and other flavonoid subclasses. CONCLUSIONS These data, which include direct measures of arterial stiffness and thickness, suggest that higher intake of anthocyanins and flavones are inversely associated with lower arterial stiffness. The intakes of anthocyanins associated with these findings could be incorporated into the diet by the consumption of 1-2 portions of berries daily and are, therefore, relevant for public health strategies to reduce cardiovascular disease risk.
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Affiliation(s)
- Amy Jennings
- Department of Nutrition, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
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Jennings A, Cassidy A, van Sluijs EMF, Griffin SJ, Welch AA. Associations between eating frequency, adiposity, diet, and activity in 9-10 year old healthy-weight and centrally obese children. Obesity (Silver Spring) 2012; 20:1462-8. [PMID: 22436840 PMCID: PMC3736103 DOI: 10.1038/oby.2012.72] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The rising prevalence of childhood obesity is a key public health issue worldwide. Increased eating frequency (EF) is one aspect of diet that has been beneficially associated with obesity, although the mechanisms are unclear. The aims of the current study were to determine whether increased EF was associated with improved adiposity in children, and if this was due to differences in dietary and activity behaviors. Cross-sectional data from 1,700 children aged 9-10 year were analyzed to examine the associations between EF, as estimated from diet diaries, measures of adiposity, and activity measured by accelerometer. Analyses were stratified by obesity status using waist-to-height ratio to define obesity as it has been shown to be a good predictor of adverse health outcomes. Mean EF was 4.3 occasions/day and after adjustment for underreporting, energy intake (EI), and activity significant relative mean differences of -2.4% for body weight (P = 0.001), -1.0% for BMI (P = 0.020), -33% for BMI z-score (P = 0.014), and -0.6% for waist circumference (P = 0.031) per increase in eating occasion were found in healthy-weight but not centrally obese children. Differences between the extreme quartiles of EF were observed for total fat intake at breakfast (-18%, P < 0.001), fruit and vegetables from snacks (201% healthy-weight and 209% centrally obese children, P < 0.01), and for healthy-weight children, vigorous activity (4%, P = 0.003). Increased EF was favorably associated with adiposity, diet quality, and activity behaviors in healthy-weight but not centrally obese children. Future obesity interventions should consider the mediating role of diet quality and activity in the relationship between EF and adiposity in children.
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Affiliation(s)
- Amy Jennings
- Department of Nutrition, Norwich Medical School, University of East Anglia, Norwich, UK
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Affiliation(s)
- Phyo Kyaw Myint
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK.
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Welch AA, Wareham NJ, Khaw KT. Reply to N Salem Jr and CN Kuratko. Am J Clin Nutr 2011. [DOI: 10.3945/ajcn.111.012906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Welch AA, Shakya-Shrestha S, Lentjes MAH, Wareham NJ, Khaw KT. Dietary intake and status of n-3 polyunsaturated fatty acids in a population of fish-eating and non-fish-eating meat-eaters, vegetarians, and vegans and the product-precursor ratio [corrected] of α-linolenic acid to long-chain n-3 polyunsaturated fatty acids: results from the EPIC-Norfolk cohort. Am J Clin Nutr 2010; 92:1040-51. [PMID: 20861171 DOI: 10.3945/ajcn.2010.29457] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Intakes of n-3 (omega-3) polyunsaturated fatty acids (PUFAs) are important for health. Because fish is the major source of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), non-fish-eaters may have suboptimal n-3 PUFA status, although the importance of the conversion of plant-derived α-linolenic acid (ALA) to EPA and DHA is debated. OBJECTIVE The objective was to determine intakes, food sources, and status of n-3 PUFAs according to dietary habit (fish-eaters and non-fish-eating meat-eaters, vegetarians, or vegans) and estimated conversion between dietary ALA and circulating long-chain n-3 PUFAs. DESIGN This study included 14,422 men and women aged 39-78 y from the EPIC (European Prospective Investigation into Cancer and Nutrition)-Norfolk cohort with 7-d diary data and a substudy in 4902 individuals with plasma phospholipid fatty acid measures. Intakes and status of n-3 PUFAs were measured, and the product-precursor ratio [corrected] of ALA to circulating n-3 PUFAs was calculated. RESULTS Most of the dietary intake of EPA and DHA was supplied by fish; however, meat was the major source in meat-eaters, and spreading fats, soups, and sauces were the major sources in vegetarians. Total n-3 PUFA intakes in non-fish-eaters were 57-80% of those in fish-eaters, but status differences were considerably smaller [corrected]. The estimated product-precursor ratio [corrected] was greater in women than in men and greater in non-fish-eaters than in fish-eaters. CONCLUSIONS Substantial differences in intakes and in sources of n-3 PUFAs existed between the dietary-habit groups, but the differences in status were smaller than expected, possibly because the product-precursor ratio [corrected] was greater in non-fish-eaters than in fish-eaters, potentially indicating increased estimated conversion of ALA. If intervention studies were to confirm these findings, it could have implications for fish requirements.
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Affiliation(s)
- Ailsa A Welch
- School of Medicine Health Policy and Practice, University of East Anglia, Norwich, United Kingdom.
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Freisling H, Fahey MT, Moskal A, Ocké MC, Ferrari P, Jenab M, Norat T, Naska A, Welch AA, Navarro C, Schulz M, Wirfält E, Casagrande C, Amiano P, Ardanaz E, Parr C, Engeset D, Grioni S, Sera F, Bueno-de-Mesquita B, van der Schouw YT, Touvier M, Boutron-Ruault MC, Halkjaer J, Dahm CC, Khaw KT, Crowe F, Linseisen J, Kröger J, Huybrechts I, Deharveng G, Manjer J, Agren A, Trichopoulou A, Tsiotas K, Riboli E, Bingham S, Slimani N. Region-specific nutrient intake patterns exhibit a geographical gradient within and between European countries. J Nutr 2010; 140:1280-6. [PMID: 20484545 DOI: 10.3945/jn.110.121152] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Until recently, the study of nutrient patterns was hampered at an international level by a lack of standardization of both dietary methods and nutrient databases. We aimed to describe the diversity of nutrient patterns in the European Prospective Investigation into Cancer and Nutrition (EPIC) study at population level as a starting point for future nutrient pattern analyses and their associations with chronic diseases in multi-center studies. In this cross-sectional study, 36,034 persons aged 35-74 y were administered a single, standardized 24-h dietary recall. Intake of 25 nutrients (excluding intake from dietary supplements) was estimated using a standardized nutrient database. We used a graphic presentation of mean nutrient intakes by region and sex relative to the overall EPIC means to contrast patterns within and between 10 European countries. In Mediterranean regions, including Greece, Italy, and the southern centers of Spain, the nutrient pattern was dominated by relatively high intakes of vitamin E and monounsaturated fatty acids (MUFA), whereas intakes of retinol and vitamin D were relatively low. In contrast, in Nordic countries, including Norway, Sweden, and Denmark, reported intake of these same nutrients resulted in almost the opposite pattern. Population groups in Germany, The Netherlands, and the UK shared a fatty acid pattern of relatively high intakes of PUFA and SFA and relatively low intakes of MUFA, in combination with a relatively high intake of sugar. We confirmed large variability in nutrient intakes across the EPIC study populations and identified 3 main region-specific patterns with a geographical gradient within and between European countries.
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Affiliation(s)
- Heinz Freisling
- Dietary Exposure Assessment Group, International Agency for Research on Cancer, Lyon 69372, France
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