Dietetics, Nutrition and Biological Sciences

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Consumer use of the nutritional label on food packages: a cognitive task analysis
(Queen Margaret University, Edinburgh, 2000) Higginson, Catherine Susan
The acute and long-term effects of 3,4- methylenedioxymethamphetamine (MDMA; 'ecstasy') upon cerebral and cerebrovascular serotonergic processes.
(Queen Margaret University, 2004) Ferrington, Linda
The amphetamine derivative 3,4,-methylenedioxymethamphetamine (MDMA; Ecstasy) is a recreational drug of abuse, particularly popular among young people with whom it has formed a well-established sub-culture. MDMA is popular for its euphoria-inducing and mild stimulant properties and its popularity continues to rise despite a number of well-publicised cases of MDMA-associated fatalities and evidence of MDMA-induced acute toxicity. MDMA is known to produce an acute efflux of serotonin (5-HT) release in the brains of experimental animals, in which a marked behavioural response is also demonstrated. In the long-term MDMA causes specific neurotoxic damage to serotonergic nerve terminals, a phenomenon which is not demonstrated in other neurotransmitters. MDMA use has been associated with long-term adverse effects on both psychological and physiological health and this may represent a major public health problem given the 2 million people who use the drug in the UK alone. However, there is a perceived imbalance between the relative number of those who use MDMA and the serious adverse effects of the drug and it is possible that these may occur in a more susceptible sub-population of users. This thesis involves in vivo work using the Dark Agouti (DA) rat strain which is known to be more susceptible to MDMA and which may therefore provide an insight in this more susceptible sub-population of human MDMA users. The data presented in this thesis demonstrate that a single exposure to MDMA (15mg.kg-1) has a significal effect upon local cerebral glucose utilisation (LCMRglu) and local cerebral blood flow (LCBF) in DA rats both acutely and in the longer-term. This work demonstrates that this single dose of MDMA is neurotoxic to serotonergic neurons, inducing up to 80% depletion of serotonergic nerve terminals 6 weeks later. Furthermore, data generated from pharmacological challenges upon animals treated with MDMA 6 weeks earlier demonstrates the existence of compensatory mechanisms which act to normalise LCMRglu and LCBF, despite the persistence of serotonergic depletion. Thus this thesis extends the currently available information regarding acute and long-term effects of MDMA in a vulnerable sub-population of users and also proposes potential theories for the mechanisms of action by which pharmacological compensation for these long-term effects of MDMA-induced neurotoxicity may occur. In addition this thesis examines the effects of previous exposure to MDMA upon physiological challenges that might realistically be encountered by human users of the drug. The nature of MDMA-induced neurotoxicity suggests that human users of MDMA may suffer from untreatable chronic psychosis, and this thesis lends support to the view that currently available first line anti-depressant therapies may not be useful in the treatment of this sub-section of the population.
An evaluation of the impact of introducing a breakfast club on nutritional status and cognitive function in lower social class primary school children
(Queen Margaret University, 2005) Mehrotra, S.
Breakfast has been shown to increase the supply of glucose to the brain which improves short-term memory. On waking hepatic glycogenolysis is the major buffer against short-term (12-18 hrs) fasting. The higher ratio of brain weight to liver weight in the child (1.4 - 1.6 versus 0.73 for the adult) and the 50% greater metabolic rate per unit brain weight in the child, places a greater demand on the child's glycogenic stores during a short fast as compared to the adult. Few school breakfast studies have examined the effect of different breakfasts on cognitive performance. This study investigated the nutritional differences of a habitual breakfast consumed at hom (NBC) and breakfast served at a breakfast club in (BC) school and the effect of these breakfasts on cognitive performance. Subjects were primary school children aged 7-11 years old in Scotland. When baseline cognitive performance scores were compared to scored at data collections 2,3 and 4 there were more significantly pronounced improvements for the NBC group than the BC group (p < 0.001). There were significantly greater numbers of children eating a cooked breakfast in the BC group and significantly higher numbers of children eating a cereal breakfast in the NBC group. As a result breakfasts of the BC group were higher in fat (MUFA and PUFA) (p < 0.01) and lower in percentage energy from carbohydrate than the NBC group. Positive correlations existed between percentage energy from carbohydrate and percentage energy from starch and cognitive test performance (p < 0.01). This suggests that a breakfast higher in % energy from carbohydrate such as a cereal breakfast benefits short-term memory, by supplying the brain with readily available supply of glucose it's primary and preferred fuel. This results of this research provide evidence for the requirement of guidelines to ensure that breakfasts served at school will both assist learning in morning lessons and be in-line with healthy eating recommendations.
Role of eating frequency and macronutrient content of in-between-meal snacks incompliance with a low fatdietary advice in overweight men aged 25-50 years
(Queen Margaret University, 2007) Zaveri, Swati
The prevalence of obesity is increasing rapidly. Eating frequency has been shown to be inversely related to body weight status and appetite control. In addition, macronutrients have a role to play in appetite control, as protein has shown to be more satiating than either carbohydrate or fat. This dietary intervention study aimed to assess the impact of increasing daily eating frequency (EF), by providing either high carbohydrate (HC), high protein (HP), high fat (HF) snacks, or no snacks (control, C) on energy intake (EI), hunger ratings (HR), body weight status and metabolic parameters over 12 weeks in 59 healthy overweight to moderately obese Scottish men. Subjects were also followed up at 24 weeks (12 weeks post intervention). The HC (n = 14) and HF (n = 14) groups did not show a significant change in EF, HR, EI, body weight and % body fat at 6, 12 and 24 weeks compared to baseline. In contrast, the HP group (n = 18) showed a significant increase in the EF compared to HC group at 12 weeks, however, this did not result in a corresponding increase in EI, body weight or % body fat. Additionally, at 12 weeks, HP group tended to feel less hungry compared to baseline and HC group. However, the difference in the EF in HP group was not sustained after removing the under-reporters (URs). The C group (n = 13) showed a significant increase in HR at 12 weeks and an increase in % body fat at 24 weeks. There was no change in metabolic parameters in any study groups in the total sample. However, after removing the URs, there was a significant increase in total cholesterol level in HC group and a significant decrease in triglycerides level in control group. The study demonstrates that addition of extra energy, in the form of snacks, to the habitual diet may be compensated at the subsequent meals and does not result in an increase in EI and body weight. Including snacks that are healthy and of a reasonable portion size may help in maintaining a healthy diet and lifestyle.
Integrating components of energy intake in impaired glucose tolerant and type 2 diabetic populations
(Queen Margaret University, 2008) Sommerville, Jill
Objective - During feeding there is an integrated 'whole body' response which endeavours to maintain energy homeostasis. The integrated response consists of sensory, postingestive, postabsorptive and cognitive feedback which exerts control over ingestive behaviour. It is accepted that when an imbalance in this integrated response occurs and may promote an increased fat mass and ultimately can lead to obesity which is known to play an important role in the development of IGT and type 2 diabetes. This study investigated the integrated responses of a test meal to determine any differences between IGT, type 2 diabetics and controls in their integrated response mechanisms. This knowledge may be important in both predicting the onset of these diseases and in the treatment of them. Research Design and Methods - IGT and type 2 diabetics with a BMI greater than 30 and were recruited together with a group of healthy controls. The study assessed habitual energy intakes and energy expenditure in all groups. All participants' height, weight, BMI and WHR were measured. A taste test assessed the sensory component of food intake. The metabolic response and parallel changes in appetite to the meal were recorded at baseline and at 15, 30, 60, 90 and 120 minutes. Results - Control participants had significantly lower weight (p<0.01), BMI (p<0.01), waist (p<0.01) and hip (p<0.01) measurements compared to IGT and the type 2 diabetic groups. Habitual diet diaries indicated a lower sugar intake in the type 2 diabetic group compared with IGT and control groups. Percentage protein intake was significantly lower in control participants (14.4%, p<0.05) compared to IGT (17.2%) and type 2 diabetics (18.5%). Activity diaries highlighted an indication of increased strenuous/physical activity in the control participants compared to IGT participants however, this was not statistically significant. The control group showed greater sensitivity to PROP followed by type 2 diabetics and then IGT participants (p<0.05). Throughout the study the control participants rated themselves the most hungry compared to IGT (p<0.05) and type 2 diabetics (p<0.01) respectively and controls were also the least satiated (p<0.05). There was no difference in fullness ratings. Control participants rated prospective consumption the highest compared to IGT and then type 2 diabetics (p<0.05) respectively. The differences in EE measured by calorimetry when normalised for body weight indicated that IGT (p<0.01) and type 2 diabetic participants (p<0.01) had significantly lower EE than control participants. CHO oxidation rates were significantly lower in IGT and type 2 diabetics (p<0.05). Investigating the blood parameters showed no differences in plasma ghrelin responses, that IGT participants had the highest overall plasma glucose (p<0.01) and insulin (p<0.05) responses. Conclusions - It is clear that there are subtle differences in the pathways of energy balance in IGT and type 2 diabetics compared to controls; including sensitivity to taste, subjective feelings of appetite, EE, oxidation rates and differing blood parameters. Taste appears to be an important contributor to the sensory control of food intake and is associated with an increased sugar intake. Furthermore, differences between IGT and type 2 diabetics demonstrate that the degree of management of the disease can influence the effectiveness of the metabolic pathways controlling food intake. It is not clear which component is the most influential in the control of food intake and it is likely that the synergistic effects are what potentiate the diseases and make them difficult to combat.
The inhibitory properties and mode of action of plant essential oils and fruit extracts on protozoan parasites
(Queen Margaret University, 2008) Anthony, Jean-Paul
The main aims and objectives of this study was to determine if plant essential oils (PEOs) and polyphenol-rich fruit extracts (PRFEs) could reduce the viability of Giardia duodenalis trophozoites, Trypanosoma cruzi epimastigotes and Cryptospordium parvum oocysts in vitro. All PEOs tested reduced epimastigote and trophozoite viability at a concentration of 0.02% v/v, with titrations of the PEOs showing a concentration dependant decrease in viability. The minimum inhibitory concentrations (MICs) of PEOs demonstrated that myrtle and elemi oil were the most active PEOs (trophozoites = 0.005% v/v; epimastigotes = 0.00125% v/v) with the terpenes, α-pinene and limonene, constituents of these oils, being responsible for their action. Incubation of palmarosa oil and its terpene, geraniol, with C. parvum oocysts caused the almost complete excystation of oocysts (in the presence of increased temperature and time), with geranium oil and its terpene, citronellol, being nearly as effective. PRFEs reduce trophozoite viability, with 4 members of the Rosaceae Family causing complete reduction at 167 μg ml-1, possibly through their ellagitannin content. Cloudberry extract was found to have an MIC comparable to the drug metronidazole (67 μg ml-1). The historical use of blueberries for the treatment of diarrhoeal diseases was demonstrated by the ability of blueberry PRFE, pressed juice and drink to kill trophozoites. Protein expression was both inhibited and upregulated in several proteins in whole cell lysates of PEO treated trophozoites, indicating a supplemental intracellular mode of action. Both PEOs and PRFEs cause morphological changes to epimastigotes and trophozoites through flagellar truncation and internalisation, swelling and rounding of the cell body, cytoplasmic condensation and the formation of large membrane protrusions. These indicate an action on the membrane itself with possible changes in osmoregulation. Both PEOs and PRFEs can be considered to be candidates for novel drug discovery for the treatments of cryptosporidiosis, giardiasis and American trypanosomiasis.
Talk about homeopathy: discursive strategies as ways to continually marginalise homeopathy from mainstream acceptance
(Queen Margaret University, 2009) Campbell, Craig
Traditionally, quantifiable research into homeopathy has largely focused on its effectiveness compared to forms of mainstream medicine. The effect of such comparisons is that homeopathy is commonly constructed as not being demonstrably effective. It becomes discredited, demarcated and downgraded as an alternative 'type' of practice, subsequently marginalised in terms of mainstream acceptance. Qualitative studies concerned with homeopathy and focusing on notions of personal credibility, demarcation and the marginal are primarily concerned with practitioners' perspectives, where views are taken for granted and regarded as representative of accurate events. Thus, no study has focused on and investigated social constructions of homeopathic practice derived from practitioners, and their patients, in the semi-structured interview and in the context of the homeopathic consultation. Here, I identify and fill a gap in the literature which is currently under-represented. The corpus of twenty practitioners, seventeen patients and five homeopathic consultations drawn from interview and consultation contexts were recorded and subsequently transcribed verbatim. The innovative analytical framework is informed by discursive psychology perspectives that focus on accounts as action. Discourse analysis (DA) led to new, original and significant findings about how interpersonal experiences in relation to homeopathic practice are contingently formulated and constituted in interaction and configured over broader discourses. The analytical chapters show how talk about homeopathy is presented via four discursive strategies: by using the communicative competencies and descriptions they do, the participants' factual accounts function to enhance their own individual credibility and that of their practices, defend their practices and attend to the notion of personal accountability as a discursive practice. For those advocates for homeopathy, managing their personal credibility is accomplished only through sensitive ways of accounting. This reflects the way in which homeopathic practice is located in a culture of scepticism, as an alternative, contested and controversial 'type' of practice positioned on the fringe of the modern medical market. Demonstrating an understanding of homeopathy and their expectations of it as a form of treatment, participants draw upon dichotomised categories attributed to notions of mainstream medicine and homeopathy, combined with various discursive devices to add persuasiveness to their descriptions. Overall, the originality of the research lies in the application of the innovative interactional DA framework, its broad range of participants and unique findings from within the field of homeopathy. With several implications, it forms a unique interdisciplinary, theoretical, and methodological contribution to the DA literature. It has practical implications for future policy makers, in the education and training of practitioners, and offers ways to approach future research in homeopathic encounters and in parallel health-related encounters such as other CAM therapies, Myalgic Encephalomyelitis or Chronic Fatigue Syndrome and Attention-Deficit Hyperactivity Disorder. Notably, the transferability of the findings has wider implications for the understanding of other contested, controversial and new medical practices in the ways that mainstream medicine is the taken-for-granted, accepted yardstick for practice. In making this distinction, the paradoxical boundaries of what is and what is not acceptable is seen as a central issue to members' mutually intelligible sense-making practices in everyday medical encounters.
The effects of Hypoxia on neuronal cell signalling
(Queen Margaret University, 2009) Ibegbu, Augustine
Hypoxia adversely affects cells and tissues, and neuronal cells in particular have been shown to be more susceptible to the injurious effects of hypoxia i.e. they may begin to die when oxygen supply is reduced or completely eliminated. Cannabinoid (CB1) receptor and opioid (μ, δ and κ) receptor agonists have been shown to elicit several central nervous system (CNS) effects, mediated via G protein-coupled receptors. The aim of the research presented in this thesis was to study the effect of hypoxia on neuronal cell signalling and the consequent neuroprotectant effects of cannabinoid and opioid receptor agonists against hypoxia in the rat cortical neuronal cell line (B50) in culture. The B50 cells cultured in hypoxic conditions were treated and concurrently cultured with cannabinoid and opioid receptor agonists to determine the effects of these drugs on hypoxia-induced changes using downstream signalling activities such as cellular morphogenesis, growth, proliferation, differentiation, lactate dehydrogenase (LDH) leakage, second messenger (cAMP) and extracellular signalregulated kinases (ERK1/2) quantification, to assess the level of cellular damage and injury, repair and protection. Cortical B50 cells were cultured in either a normal incubator (21%O2; 5% CO2) as the normoxic control group, or a hypoxic incubator (5%O2; 5% CO2) as the experimental group. Three cannabinoid agonists [Win55,212- 2 mesylate (Win), anandamide or arachidonoylethanolamide (AEA), and 2- arachidonylglycerol (2-AG)] and three opioid agonists [DAMGO (μ), DSLET (δ) and ICI-199,441 hydrochloride (κ)], were selected and administered to the cells as treatment group for 48 hours after 48 hours of initial culture for a total of 96 hours of culture and pre-treatment group treated at 0 hour for a total of 96 hours in hypoxic conditions at concentrations of 10nM, 50nM and 100nM for cannabinoid agonists, and 10μM, 50μM and 100μM for opioid agonists. Neuronal viability, proliferation, differentiation and second messenger activity were assessed using morphological same-field assessment, LDH leakage, cellular proliferation assay, second messenger (cAMP) assay, and phospho-ERK1 & 2 assay and dibutyryl cyclic adenosine monophosphate (DbcAMP) induced differentiation method. Levels of G-protein coupled receptor (cannabinoid, CB1 and mu opioid, MOR) mRNAs were assessed using the RT-PCR method. The results showed that hypoxia induced a 4-fold increase in LDH leakage from B50 cells cultured in hypoxia when compared to the cells xxviii cultured in normoxic conditions (440% versus 100%, respectively; p<0.05). Cannabinoid receptor agonist treatment was able to reduce the LDH release in hypoxic cells to between 2-to 4-folds: 100nM AEA (69%), 100nM 2-AG (103%) and 10nM Win (217%), when compared to untreated hypoxic B50 cells (440% versus cannabinoid treated; p<0.05). The results of opioid administration showed a 3-fold decrease in the level of LDH leakage in B50 cells cultured in hypoxia when compared to untreated hypoxic cells (587%). The results of hypoxic treated B50 cells with opioid agonists are 100μM ICI-199,441 (318%); 50μM DSLET (339%) and 50μM DAMGO (352%) (p<0.05; untreated hypoxia versus opioid treated). The result of cAMP quantification in B50 cells in culture showed a reduction in cAMP concentration in untreated hypoxic B50 cells when compared to normoxic cells (0.7 pmol/ml versus 3.0 pmol/ml; p<0.05). Cannabinoid treated hypoxic cells showed increases in cAMP concentration: 2-AG 10nM (3.5 pmol/ml), 50nM (3.1 pmol/ml) and 100nM (0.9 pmol/ml), (p<0.05; Cannabinoid treated versus hypoxia untreated). The cAMP concentration in B50 cells treated in hypoxia with opioid agonist, ICI 199,441 hydrochloride, was significantly increased when compared to untreated hypoxic B50 cells (0.7 pmol/ml). The treatment with ICI 199,441 hydrochloride are 10μM (10.0 pmol/ml), 50μM (3.15 pmol/ml) and 100μM (1.15 pmol/ml), (p<0.05; opioid treated versus hypoxia untreated). The result of phospho-ERK1&2 assay in B50 cells showed decrease in phospho-ERK1&2 in untreated hypoxic cells when compared to normoxic untreated cells (6.0 units/ml versus 87.0 units/ml; p<0.05). The result of cannabinoid treated hypoxic cells showed increases in phospho-ERK1&2 when compared with the hypoxic untreated B50 cells: Win 10nM (98 units/ml), Win 100nM (27 units/ml), AEA 10nM (62 units/ml), AEA 100nM (60.5 units/ml), 2-AG 10nM (45 units/ml) and 2-AG 100nM (68 units/ml) (cannabinoid treated versus untreated hypoxia; p<0.05). The phospho-ERK1&2 in hypoxic B50 cells treated with opioid showed increase with DAMGO 10μM (22 units/ml), DSLET 10μM (16 units/ml) and ICI 199,441 hydrochloride 10μM (23.5 units/ml) (P<0.05; opioid treated versus hypoxia untreated). The result showed a decrease in cellular proliferation in untreated hypoxic cells when compared to the normoxic cells (7x106 cells/ml versus 20x106 cells/ml; p<0.05), while cannabinoid and opioid treatments was able to increase cell proliferation in hypoxic treated cells with: Win 10nM (11x106 cells/ml), AEA 100nM (12x106 cells/ml) and 2-AG 100nM (13.8x106 cells/ml), DAMGO 10μM (16x106 cells/ml), DSLET 10μM (20x106 cells/ml) and ICI xxix 199,441 100μM (21.5x106 cells/ml) when compared to hypoxic untreated cells (7x106 cells/ml) (hypoxia untreated versus hypoxia treated; p<0.05). Some of these changes were shown to be concentration-dependent between the normal and hypoxic B50 neurons, and between treated and untreated hypoxic B50 cells in culture, while the CB1 and MOR mRNA levels showed no appreciable change. The results show that B50 neuronal cells are susceptible to damage and injurious effects of hypoxia, as are most brain cells, while the results of the administration of cannabinoid and opioid agonists suggest that these agents have some potential therapeutic and protective benefits in the treatment and prevention of hypoxia-induced toxicity in neuronal B50 cells in culture. This could be of potential benefit in the treatment and protection against hypoxia-related neurodegenerative diseases and disorders such as stroke, dementias, ageing, Alzheimer’s and Parkinson’s diseases.
An Investigation Into The Effectiveness Of Homeopathy In Improving Perceived Well Being And Quality Of Life In The 55+ Age Group
(Queen Margaret University, 2010) Schyma, Jan
The purpose of this study is to investigate the effectiveness of homeopathy in improving perceived health and well being in the 55+ age group. Homeopathy is defined as a complex intervention including the homeopathic remedy, the therapeutic relationship and participant choices about self care. The literature on health care for the 55+ age group suggests growing concern about the need to find ways of improving the health and quality of life of older people. Smallwood (2005) suggests that homeopathy and Complementary and Alternative Medicine (CAM) may contribute to improvement in the health and well being of older people in our society. Research has been carried out into the use of homeopathy to improve health and well being, but has not focused on homeopathy as a complex intervention or its use for the 55+ age group. A mixed methodology was chosen for this research study based on a pragmatic approach. An embedded design was used, with qualitative measures as the primary source of data and quantitative measures as the secondary source. Twenty participants were recruited and received homeopathic treatment. Their response to treatment was recorded in interview transcripts, case notes, the practitioner‟s reflective journal, and results from Measure Your Own Medical Outcomes Profile (MYMOP) and SF-36 questionnaires. The practitioner was also the researcher. The participants in this study clearly identified the outcomes and the nature of the experience. 18 out of 20 participants noted a definite or limited improvement in their health which they associated with homeopathic treatment. Additionally, participants valued the opportunity to review life experiences, to make connections between life events and health issues and the resulting increase in self awareness. They reported benefits that were consistent with classical homeopathic philosophy and practice, and other research studies into homeopathic treatment. Their evidence confirmed that homeopathy provided a healing experience both physically and emotionally which met the complex needs of participants in the study, and potentially future health care needs of this age group.
Nutrient content of different types of lunchtime meal, and their contribution towards the overall daily nutrient intakes of 11-14-year-old schoolchildren from two schools in Scotland
(Queen Margaret University, 2010) Norris, Carina
Introduction Due to concern regarding the quality and health implications of schoolchildren's diets, large amounts of funding have been invested into improving school canteen lunches. However, children may also have packed lunches, or 'street' lunches (those purchased outside school). This study was undertaken to ascertain whether canteen lunches are nutritionally superior to packed and street lunches, the contribution of the lunch types towards total nutritional intake, and whether children who eat nutritionally poor lunches compensate with food consumed at other times. Method During 2007 and 2008, dietary intake data was collected from 332 children aged 11 - 14, from two secondary schools in Fife, Scotland. Using 5-day estimated intake food diaries, data from 1,532 days was collected. Nutrient intake and density for 9 nutrients (plus fruit/vegetables) included in the Scottish Nutrient Standards for School Meals (2003) were compared with the Scottish Nutrient Standards for School Lunches (for lunchtimes) and Dietary Reference Values (for the whole day). Comparisons were undertaken between canteen, packed and street lunches, and between days including them. Results Many children 'flitted' between canteen, packed and street lunches on different days. Some children also consumed food from more than one lunch type on a single day. Dietary quality was poor; intakes of non starch polysaccharide, iron, and fruit and vegetables (at lunchtime and over the whole day) were of particular concern. When canteen lunches were consumed, the diet was closest to guidelines. However, many dietary targets remained unmet. When street lunches were consumed, the diet was furthest from the guidelines. This was the case both at lunchtime and over the whole day. There was some compensation for poor lunchtime nutrient intake by foods eaten at other times during the day. However, this was not as great as noted by previous studies, and many significant differences between the lunch types existed at the end of the day. Conclusion Due to the superior nutritional quality of canteen lunches compared with the other options available, and the contribution of canteen lunches towards overall nutrient intake, children should be encouraged to have canteen lunches.
The effect of a 12 month intradialytic exercise intervention on function, quality of life, nutritional status and clinical status
(Queen Margaret University, 2010) Smith, Sara
Haemodialysis (HD) patients are reported to have low levels of physical function, poor quality of life, protein energy wasting and inflammation, which negatively impact on morbidity and mortality. Exercise has previously been used as an intervention in HD patients; however the majority of previous studies have been of short duration and utilised moderate or high intensities requiring individual supervision of each exercise session. These studies recruited young patients with low levels of comorbidity and primarily focused on changes in VO2max/peak. This limits the ability to generalise findings to the wider prevalent HD population. The aims of the present study were therefore to determine whether a low to moderate intensity intradialytic exercise intervention with broad applicability, could over a 12 month period improve functional status and in turn quality of life, nutritional status and clinical status in a prevalent HD population in Scotland. Patients were recruited from NHS Fife, to a non-randomised controlled study and followed a progressive intradialytic aerobic exercise programme. One exercise session was conducted with individual supervision and two sessions with general supervision from dialysis staff. Outcome measures included measures of function (sit to stand, timed up and go, and handgrip), quality of life (SF36v2), nutritional status (anthropometric measurements, dual frequency bioelectrical impedance analysis, dietary intake and appetite) and clinical status (dialysis adequacy, biochemistry, high sensitivity C-reactive protein, blood pressure, medications). Measurements were taken at 6 time points: -1, 0, 3, 6, 9 and 12 months. 25 patients (mean age 56 + 11.4 years) volunteered for the intervention and 13 patients (mean age 60.8 + 14.6 years) volunteered as controls. At baseline groups demonstrated functional impairment, poor quality of life, and low fat free mass and had evidence of low grade inflammation. 25 patients completed 3 months of the exercise intervention, 20 completed 6 months, 16 completed 9 months and 13 patients completed 12 months. Of the 13 control patients 6 remained at 3 months and 5 at 6 months. In the exercise group, significant improvements were observed in all measures of function and 6 out of 8 physical and psychosocial quality of life domains. Anthropometric measures of fat free mass increased. Clinical status improved significantly seen as reductions in systolic blood pressure and prescribed erythropoietin stimulating agent doses. These improvements were observed in the intervention group at 3 and 6 months. No improvements were observed in the control group. Improvements in the majority of outcome measures were also seen in the intervention group at 6 and 12 months. These results suggest that the introduction of a low to moderate intensity intradialytic exercise programme requiring minimal individual supervision is feasible and provides clinically significant improvements in function from 3 months onwards. Such improvements are accompanied by higher quality of life scores and improved aspects of nutritional and clinical status.
The Effect Of Alcohol Toxicology In The Form Of Different Alcohol Drinking Patterns On A Biomarker Of Cardiovascular Disease Risk
(Queen Margaret University, 2011) Murdoch, Julie M.
Introduction The amino acid homocysteine has been identified as a risk factor for cardiovascular disease (CVD), as elevated levels induce atherosclerosis, through a direct effect on arterial tissue. In alcohol dependent individuals an association between plasma homocysteine levels and alcohol consumption has been found (Bleich et al. 2000d). However this link has not been explored in individuals who have a range of nondependent alcohol drinking patterns. This fact has informed the design of the present work. Material and Methods A convenience sample of abstainers (N=7), non-dependent drinkers (N=28) and alcohol dependent individuals (N=18) was recruited. Alcohol consumption was recorded using questionnaires and diaries. All study participants’ biological samples were analysed for the following biomarkers: plasma homocysteine (HPLC); serum folate and vitamin B12 (competitive immunoassay); serum Carbohydrate Deficient Transferrin (N-Latex immunoassay); urinary creatinine (colorimetric assay) and the methylenetetrahydrofolate (MTHFRC677T) polymorphism (Real-Time Polymerase Chain Reaction (PCR)). Results There was no association between alcohol consumption during drinking days and plasma homocysteine levels in non-dependent drinkers. However when this group was categorised according to pattern of consumption, plasma homocysteine levels were found to be lower in abstainers (median 5.60 μmol/l), but higher in sessional drinkers (median 7.15 μmol/l) and alcohol-dependent individuals (median 7.89 μmol/). The mutant MTHFR(C677T) polymorphism when present was associated with an increase in plasma homocysteine levels, which correlated with alcohol consumption (R=0.975). CDT levels were found to be elevated in both sessional and alcohol-dependent individuals at baseline (median 2.68% and 5.95% respectively) compared with abstainers (2.16%). Additionally there was a linear relationship between the number of drinking days in a week and a positive CDT result, in a sample of sessional drinkers (R=0.98). Discussion The work undertaken has shown that sessional drinking and alcohol dependence does increase homocysteine levels in comparison to abstainers. This may have important implications in relation to CVD risk. Additionally new evidence of the utility of CDT as a biomarker of alcohol consumption within a sample of sessional drinkers, has been identified.
Investigating the effects of common dietary isoflavones on breast cancer cell proliferation, apoptosis, and potassium channel activity
(Queen Margaret University, 2013) Wallace, Joanne
Epidemiological evidence suggests that due to its high isoflavone (genistein and daidzein) content a diet rich in soy could protect against breast cancer, particularly tumours expressing oestrogen receptor alpha (ERα+). Isoflavones are weakly oestrogenic, and have other wide ranging cellular activities. Contradictory in vitro evidence means that isoflavones’ mechanism(s) of action remain to be elucidated. ERα+ MCF7 and ERα-/ERβ+ MDA-MB-231 cell proliferation and apoptosis were quantified at a range of achievable serum concentrations of genistein or daidzein (0.01nM to 31.6μM) with or without pre-/post-menopausal 17β-oestradiol (E2) levels (1nM and 1pM). Additionally, cell volume regulation and macroscopic K+ current modulation by isoflavones and E2 in MCF7 cells were investigated. In MCF7 cells isoflavones (≥1μM) induce apoptosis, even in the presence of E2, but this did not reverse the synergistic effect of postmenopausal E2 and isoflavones on proliferation. Isoflavones slightly reduced MDA-MB-231 proliferation at all concentrations, dropping dramatically at 31.6μM. This response was partially maintained in the presence of postmenopausal E2. Isoflavones also induced markers of apoptosis. Treating MCF7 with 1nM E2 or 1μM genistein resulted in cell swelling, and a significant increase in whole cell current (E2 only), indicating a proliferative response. Conversely, treatment with 31.6μM genistein resulted in shrinkage, and inhibition of outward K+ current (not statistically significant). Daidzein treatment inhibited current to a lesser extent. Co-treatment with K+ channel blockers indicated the hEAG channel as a potential molecular target of genistein in MCF7. These results suggest that in ERα+ breast cancers, isoflavones may act by inducing apoptosis, shrinkage, and inhibition of hEAG current. There was no evidence suggesting that isoflavones reduce E2-promoted ERα+ cancer cell proliferation. Importantly, the inhibition of K+ channel activity by isoflavones represents a novel target for anti-cancer therapies. However, even low levels of isoflavones may be beneficial chemotherapeutic agents against ERα-/ERβ+ breast cancer, indicating an urgent requirement for further characterization of the effects of isoflavones in these breast cancers.
Paediatric coeliac disease in Scotland: epidemiological trends, management and adolescent adherence to gluten-free diet
(Queen Margaret University, Edinburgh, 2013) White, Lois
The incidence of paediatric coeliac disease (CD) is rising globally. It is uncertain whether this is attributed to improved case ascertainment or signifies a true rise in numbers. Geographical variation in incidence has also been reported in some European countries, although it is not known whether regional differences present in Scotland. Furthermore, data on the management of children diagnosed with CD in Scotland is lacking. The cornerstone of CD treatment is a strict gluten-free diet (GFD). Adherence may reduce risk of future complications including osteoporosis, malignancy and fertility difficulties. Nonetheless, the GFD is known to be particularly challenging during adolescence and may be nutritionally inadequate. Limited adolescent research addresses factors associated with adherence to the GFD, the diet’s nutritional quality or effect on health-related quality of life (HRQoL). Retrospective longitudinal and prospective regional trends in age-sex standardised incidence of childhood CD (≤16 years) in Scotland were determined. Data on case presentation, reasons for diagnosis and the management of newly diagnosed children were collected. A cross-sectional study was undertaken to identify adherence to the GFD in Scottish adolescents with CD (11-18 years) using a short validated questionnaire. A further questionnaire was developed to identify factors associated with adherence to the GFD. Teenagers’ energy and nutrient intakes were compared to Dietary Reference Values (DRVs) and a healthy, age-matched control group. Generic and disease-specific HRQoL indices were compared between adherent teenagers, non-adherent teenagers and age-matched controls. The incidence of paediatric CD in Scotland between 01.09.09 and 31.08.10 was 10.0/100,000/yr. Incidence in the East was 16.3, West 8.1 and North 7.7. More than twice the incidence of cases were diagnosed due to active screening in the East (4.6) compared to the West (2.0) and North (1.3), as was the incidence of classical cases. Significantly more CD diagnostic antibody tests were performed per head of population in the East compared to the West (OR 1.65, 95% CI 1.57-1.73) and North (OR 1.81 95% CI 1.70-1.92). The incidence of childhood CD rose from 1.8 (95% CI 1.1-2.7) to 11.7 (95% CI 9.8-13.9) per 100,000 from 1990-1994 to 2005-2009, respectively (p<0.0001). The incidence of non-classical and actively screened cases increased 1467% (p<0.05) and 1100% (p<0.001) from 1990-1999 to 2000-2009, respectively. A significant rise in the incidence of Oslo classical cases from 1.51 (95% CI 0.91-2.38) in 1990-1994 to 5.22 (95% CI 3.98-6.75) in 2005-2009 (p<0.01) remained. A number of differences in the dietetic management of newly diagnosed children were observed between a regional (multidisciplinary team) and a district general (dietetic-led) clinic. Differences in the management of dietary concerns as well as the type of education and resources provided were reported. Sixteen participants were categorised as non-adherent to the GFD in the adolescent study (41%; 0/7 boys, 16/32 girls). Male gender, being a member of a CD support group, ability to follow a GFD on holiday, when traveling and at social and special events were associated with better adherence to the GFD (p<0.05). Never checking food labels was associated with poorer adherence. Compared to controls, boys and girls with CD had higher median energy intakes (p<0.05). Mean percentage energy intake from protein, saturated fat and non-milk extrinsic sugar was significantly higher in the CD group compared to controls and DRVs (p<0.05). Ten (34%) girls with CD II had estimated iron intakes below the Lower Reference Nutrient Intake (LRNI). This was not significantly different compared to NDNS data (44% 0.05). Adherent adolescents had significantly better generic HRQoL scores for the domains ‘physical health’ and ‘self perception’ compared to non-adherent teenagers and controls (p<0.05). Evidence of more actively screened cases and more antibody tests performed in the East suggests the higher incidence observed may be due to a lower threshold to test. An environmental influence cannot be dismissed since more classic cases were also captured. The incidence of pediatric CD increased 6.4-fold over the 20 years studied. This rise is significant for classic CD, indicating a true rise in incidence. Further research is needed to highlight the role of exogenous factors in CD development and whether differences in management affect disease outcomes. A number of factors appear to be associated with adherence to the GFD in Scottish adolescents and dietary intakes were of concern regarding the distribution from different macronutrients. The results imply that HRQoL should be monitored alongside adherence in this population. Further studies are required to identify independent predictors of adherence, the nutritional status of teenagers following a GFD and to ascertain whether poor HRQoL is a cause or effect of non-adherence.
The nutritional risks of children with cancer
(Queen Margaret University, 2013) Paciarotti, Ilenia
Nutrition is a major concern in paediatric cancer, increasing the risk of co-morbidities, affecting tolerance of therapies and influencing survival. Despite this, very few studies have aimed to identify the nutritional risks of children treated for cancer in the western world. A unique retrospective study was therefore proposed to assess the degree of nutritional risk in paediatric cancer using the need for nutrition support (NS) as a proxy for high nutritional risk. Of 168 patients, seventy four (44%) required NS of whom 50 (67%) and 24 (33%) had solid and haematological malignancies. These findings underline the common need for NS in this childhood cancer cohort. A prospective study was consequently designed to assess the effect of cancer and its treatment on nutritional status, using commonly used assessment techniques. Measurements were taken regularly at six time points over a period of up to 18 months. 26 patients, 18 (69%) male and 8 (31%) female (median age 5.1; IQR 2.3, 7.9) volunteered for the study. At recruitment and during the first three months of treatment, those with solid tumour demonstrated nutritional deprivation, low BMI (median 25.5, IQR 5.5-60.5; median 18.0, IQR 7.5-54.2 respectively), low fat mass %(median 76.3, IQR 48.5-99.1; median 70.8, IQR 62.6-124.8 respectively), low energy intake (median kcal/d 1200, IQR 866-1970; median 1305 kcal/d, IQR 901-1488) and a high need for NS. In contrast, those with haematological cancer demonstrated an excess BMI (median 66.0, IQR 41.5-82.2; median 79.5; IQR 70- 94.2 respectively), high fat mass % (median 102.0, IQR 78.6- 153.0; median 129.4, IQR 96.5-202.6,respectively) and excessive energy intake (median kcal/d 2076; IQR 1453-2525, median kcal/d 1078, IQR 919-1206 respectively) These results suggest that children undergoing cancer therapy are at high risk of both undernutrition and obesity and they indicate apparent differences in nutritional risk according to diagnosis and treatment.
Effect of polyphenol-rich dark chocolate on anthropometric, nutritional, biochemical and physiological markers in normal weight and overweight adults
(Queen Margaret University, Edinburgh, 2014) Farhat, Grace
Polyphenols are phytochemicals widely available in plants. Dark chocolate (DC) is a high source of polyphenols, particularly flavanols. Studies previously reported a beneficial effect of polyphenol-rich dark chocolate (PRDC) on insulin sensitivity and oxidative stress, while its effects on blood pressure, serum lipid levels and inflammation remain unclear. In addition, a research area regarding the effect of PRDC on body weight control emerged recently. Two investigations were carried out. Study I (61 participants) looked at the effect of PRDC on insulin sensitivity in normal weight and overweight adults, while Study II (14 participants) investigated the effect of PRDC on body weight in overweight individuals. Volunteers received 20g of either PRDC (500mg of polyphenols) or placebo DC (low in polyphenols) daily for 4 weeks (Study I) or 12 weeks (Study II). Anthropometric measures and blood, saliva and urine samples were taken. Results showed that 4 weeks of PRDC supplementation decreased insulin levels (p<0.001) and HOMA-IR (p=0.003), and increased QUICKI (p<0.001), but had no significant impact on glucose levels (p=0.16). However, participants administered placebo DC showed an increase in insulin (p=0.014), HOMA-IR (p=0.003), TG (p= 0.008), glucose (p=0.041) and BMI (p=0.007) levels and a decrease in QUICKI (p=0.013). No significant changes in blood pressure, other serum lipid levels or glucocorticoid hormones were noted in both groups. In study II, there was an increase in BMI in the whole study population (p=0.046) with no significant difference between groups. Results indicate a potential implication of PRDC in the prevention of risk factors for cardiovascular diseases. Findings also highlight the detrimental effects of placebo DC, and propose the analysis of polyphenol content of different DC brands in the market. The increase in BMI and other markers only in the placebo group after four weeks, suggests that PRDC may counteract the adverse effects of fat and energy in the diet. However, the increase in BMI in both groups after 12 weeks implies further investigations to test the counteracting effect of PRDC over the long term.
A randomised controlled trial investigating the influences of food form and energy density on appetite, satiation and satiety in healthy adults
(Queen Margaret University, Edinburgh, 2014) Carroll, Sarah
Background: Texture and energy density are two physical properties of foods known to impact on eating behaviour. For those with mastication and/or deglutition disorders; diets which have their texture altered are prescribed. Further these texture modified diets may be energy enriched in an effort to optimise the opportunity for individuals prescribed them to meet their required energy intakes. However there is insufficient evidence supporting this strategy. No well controlled studies have been conducted evaluating these alterations (made in line with clinical guidelines), which specifically investigates their impact on eating behaviour. As such despite their intention to facilitate food and energy intakes it is unknown if these diets are in fact fit for purpose. Objective: To investigate the effect of texture modification, and/or energy enrichment of a standard meal developed to meet current recommendations for meal provision in hospitals on appetite parameters and food and energy intakes at a single eating occasion, in healthy adults. Design: A single blind, randomised crossover within-subjects design, where on four occasions 33 healthy adults consumed a test meal at lunch until satiation (i.e. meal termination) was reached whilst rating their appetite parameters. The meal had its texture and/or energy density altered to compare the effects of food form and energy density on appetite and satiation. The quantity of meal consumed was calculated using a plate wastage method. Subsequent intakes were recorded in a food diary to determine the effect of the treatments on satiety and identify any evidence of energy compensation. Food (g) and energy intakes (kcal) consumed during the feeding session were analysed using repeated measures ANOVA. Results: Test meal energy intakes (kcal) were significantly higher with energy enrichment of both meals (standard texture (ST); 315 kcal and texture modified (TM); 303 kcal (p=0.001)). Area under the curve (AUC) did not differ between meals for hunger, fullness, or desire to eat however palatability was significantly reduced with texture modification. Regardless of the composition and quantity consumed at the test meal, post-meal energy and macronutrient intakes remained the same across all days. Evidence of partial energy compensation was revealed (15 % (ST) and 22% (TM)) thus energy intakes remained higher over the day for both (260 kcal and 225 kcal respectively) (p<0.05). Conclusions: Enriching a meal, suitable for provision in a hospital setting results in significantly greater energy content without impacting on rated palatability. In a well-controlled, healthy sample, this enriched meal was sufficient to increase energy intakes (kcal) at an individual eating occasion for both ST and TM meals without affecting absolute food intake (g) or appetite responses (between meals) at the testing session. Incomplete subsequent energy compensation resulted in daily energy intakes remaining significantly higher with consumption of the enriched meals. Thus energy enrichment at a single meal, appropriate for provision for patients requiring a “Texture C” diet appears to be a suitable method to optimise short term energy intakes, in a healthy sample not confounded by disease state. Further investigation into enrichment of these meals in a clinical setting is justified.
The Determinants of Nutritional Risk in Paediatric Cancer
(Queen Margaret University, Edinburgh, 2015) Revuelta-Iniesta, Raquel
The five-year survival rates of paediatric cancer patients have improved considerably in the last 40 years with the implementation of more intensive and progressive treatments. Consequently attention is shifting to the reduction of treatment-related sequelae during and after the completion of therapy. Malnutrition and vitamin D inadequacy are a major concern as they are thought to increase the risk of short- and long-term complications in this population. Furthermore, emerging evidence has found a protective role of antioxidants and docosahexanoic acid (DHA) and eicosapentaenoic acid (EPA) against chronic conditions, including cardiovascular disease and cancer, which are common long-term complications in survivors of paediatric cancer. Therefore, this thesis aimed to investigate the nutritional status (NS), vitamin D, antioxidants and oxidative stress levels, as well as DHA and EPA levels of paediatric cancer patients. Potential factors that may contribute to the development of malnutrition in this population were also investigated. A prospective cohort-study of SE Scottish children aged <18 years, diagnosed with and treated for cancer between Aug 2010-Jan 2014 was performed. Clinical and nutritional data were collected at defined periods up to 36 months. NS was assessed using anthropometry, bioelectrical impedance analyisis (BIA), plasma micronutrients and dietary intake. DHA, EPA, antioxidant capacity and oxidative stress were measured at baseline and 6 months between April 2013-Jan 2014. Paediatric cancer was stratified by treatment risk (high, medium and low) and by diagnostic criteria. The primary outcome was malnutrition defined as body mass index (BMI) according to UK growth chart centiles; underweight (<2.3rd), overweight (85-95th) and obese (>95th). Vitamin D status was defined by the Endocrine Society Clinical Practice Guidelines (2011); inadequacy (<50nmol/L). Eighty-two patients [median(IQR) age 3.9(1.9-8.8) years; 56% males)] were recruited. At diagnosis, the prevalence of undernutrition was 13%, overweight 7% and obesity 15%. TSF identified the highest prevalence of undernutrition (15%) and the lowest of obesity (1%). BMI [p<0.001; 95% CI (1.31-3.47)] and FM (BIA) [p<0.05; 95% CI (0.006-0.08)] significantly increased after 3 months of treatment, whilst FFM (BIA) [p<0.05; 95% CI (-0.78-(-0.01)] significantly decreased during the first three months and these patterns remained until the end of the study. High-treatment risk significantly contributed to undernutrition during the first three months of treatment [p=0.04; 95% CI (-16.8-(-0.4)] and solid tumours had the highest prevalence of undernutrition [BMI (17%)]. Vitamin D inadequacy was highly prevalent (64%; 42/65) at both baseline and during treatment (33-50%) and those children who were not supplemented had the lowest vitamin D levels at every stage with median(IQR) levels ranging from 32.0(21.0-46.5)nmol/L to 45.0(28.0-64.5)nmol/L. Paediatric cancer patients had high levels of oxidative stress and low levels of DHA and EPA, especially at baseline. Antioxidant status remained steady at 6 months, however antioxidant capacity increased slightly. Finally, antioxidant levels, antioxidant capacity, oxidative stress and EPA and DHA did not statistically differ between children receiving nutritional support and those who were not. Arm anthropometry (or BIA) alongside appropriate nutritional supplementation should be implemented in clinical practice due to the high risk of malnutrition (undernutrition and obesity), the changes in body composition (increase in fat mass and reduction in lean mass) and vitamin D inadequacy, as well as the low levels of EPA and DHA seen in this paediatric cancer cohort.
An exploratory study to determine the relationship between levels of habitual activity and nutritional status, functional status, dietary intake and fatigue in older adults.
(Queen Margaret University, Edinburgh, 2015) Jones, Jacklyn
Introduction: Scotland has an ageing population which has significant implications for health and social care services. Encouraging older people to engage in healthy lifestyle behaviours has the potential to maintain a person’s functional ability, increase healthy life years and thus has the potential to enable older people to live at home independently for longer. Recommendations for levels of activity have been produced for older adults but whether these are being achieved is currently unknown. Levels of activity are influenced by many factors including nutritional and functional status, dietary intake and fatigue but as yet the relationship between these parameters and habitual activity has not been established. Therefore the aims of this study were 1) to determine the relationship between levels of habitual activity and nutritional status, functional ability, dietary intake, and levels of fatigue in older adults and 2) to inform physical activity targets for the aging population. Methods: Older adults were recruited from a range of social and leisure facilities across central Scotland. Habitual activity was measured continuously for seven consecutive days using an activPALTM accelerometer. Nutritional status (BMI, waist circumference (WC), tricep skinfold and mid arm muscle circumference) was measured using ISAK methodology. Functional status (handgrip dynamometry, sit to stand (STS), six minute walk (6MW) and gait speed (m/s)) was measured along with dietary intake using a seven day unweighed diet diary. In addition levels of fatigue were measured using the Multi-dimensional Fatigue Inventory. Pearson’s correlation coefficient analysis was utilised to establish relationships between levels of habitual activity and markers of nutritional status, functional status and dietary intake. Spearman’s rho correlation analysis was utilised to establish the relationship between levels of habitual activity and levels of fatigue. Partial correlation analysis was used to establish the influence of age and gender on these relationships. Results: Forty four (21m, 23f) healthy older adults were recruited and completed the study. Participants were found to spend a mean±sd 551 ± 88 min in sedentary behaviour daily which equates to 61±10% awake time being sedentary. They took 8721 ± 3585 steps daily and spent 108±38 min stepping, 253±78 min standing and 1080±103 min sitting or lying each day. Percent time in sedentary behaviour was positively associated with BMI (r=.302, p=.049), WC (cm) (r=.302, p=.049), percent energy intake from fat (r=.535, p<.001) and saturated fat (r=.381, p=.011) and was negatively associated with 6MW (m) (r=-.445, p=.002) and % energy from non-milk extrinsic sugar (r=-.314, p=.038). Total weekly time in moderate intensity activity accumulated in blocks of at least 10 minutes was positively associated with 6MW (r=0.321, p=.041), daily protein intake (g) (r=.350, p=.025) and mean daily vitamin D intake (μg) (r=.404, p=.009) and was negatively associated with STS (r=-.321, p=.041). Age but not gender influenced the relationships. Conclusion: This is the first study to report objectively measured levels of sedentary behaviour where habitual activity was measured continuously over seven days and sedentary behaviour was considered during waking hours only in a Scottish older adult population. Recommendations for physical activity were not consistently met and there is therefore some indication that current recommendations for sedentary behaviour and physical activity should be reviewed. However activity cannot be considered in isolation as many factors influence this including nutritional status, functional status, dietary intake and levels of fatigue.
The impact of a healthy eating intervention: A comparative, longitudinal observation of dietary intake, knowledge and behaviour in council sector nursery school children and their parents in Edinburgh.
(Queen Margaret University, Edinburgh, 2016) Lawton, Kirstie
Good nutrition is essential for optimal growth and functional development in children. Research indicates that the preschool years are essential for encouraging children to develop a taste for healthy food. Scotland's obesity rates are amongst the highest in the world, and in areas of low socio-economic status, obesity and related conditions are considered to be most prevalent. It is also widely reported that areas of deprivation are related to poor dietary intake. In 2004, Edinburgh Community Food Initiative (ECFI) was responsible for initiatives that were based on ECFI's 'provide and promote' philosophy, combining health promotion activities with the provision of fresh fruit and vegetables to schools, child and family centres and community centres in the most disadvantaged communities of Edinburgh. Funding was acquired from the Big Lottery Fund to initiate a citywide health initiative in the nursery school setting called 'the Pip Project'. The aim of this research was to identify dietary intake at baseline in pre-school children and their parents from council sector nurseries, and to observe changes in dietary intake and behaviour over a period of 20 months, comparing dietary intake of children and their parents from areas of lower socio-economic status who received the Pip project interventions to those from areas of higher socio-economic status, who did not. Dietary intake was recorded using a 5 day diet diary at three time points; prior to nursery school attendance (August 2005), at completion of year one (June 2006), and two months prior to leaving nursery (April 2007). A questionnaire was also completed to determine knowledge and dietary behaviour at baseline (August 2005) and at the end of the research period (April 2007). Baseline intake was compared to the National Diet and Nutrition Surveys for adults and for children aged 1.5 to 4.5 years, the Payne and Belton Edinburgh preschool dietary survey, the Food Standards Agency Low Income Diet and Nutrition Survey, and the standards devised by UK Scientific Advisory Committee for Nutrition (SACN). Results at baseline were comparable to results from other national surveys. Research indicated that all adults were aware of the 5 a day message and 80 % thought that 400 g was 'just right' or 'not enough'. Adults, and particularly those from the lower SES group, had clear knowledge of what constituted one portion of fruit or vegetables and did not report any barriers to healthy eating, however at baseline fruit and vegetable intake was 260 g/d, which was significantly lower (p = < 0.05) than the recommended 400 g/d and intakes were significantly less (p = < 0.05) in the lower SES group (219.5 g/d compared with 297.5 g/d in the higher SES group). Minimal increase was seen in fruit and vegetable intake of adults from the lower SES group, who consumed significantly less (p = < 0.05) than adults from the higher SES group by the end of the 20 month research period; children from the lower SES increased their intake by 1 portion (82 g) per day but still consumed less than the children from the higher SES group by stage 3 (203 g/d compared to 253 g/d). At baseline, the diet was balanced for adults and children in terms of % energy from CHO and fat, but mean intakes of both NME sugar and saturated fat were greater than the recommended maximum intake of 11 % total food energy. Mean intake NME sugar in children was 17.9 %; intakes were greater in the higher SES group (19.5 % compared to 16.6 %). Mean intakes were also significantly greater (p = < 0.05) in the parents from the higher SES group (15.2 % compared to 11 %). Mean intakes of NME sugar in parents decreased in both groups over the 18-month duration of the study but mean intakes in children remained high throughout the research period. Saturated fat intakes increased in adults from both SES groups, but were higher in the lower SES group at all stages. There was no change in mean saturated fat intake over time in children from the higher SES group, but mean intake decreased in children from the lower SES group (from 16.2 % to 14.1 %). Mean intake of NSP increased in both parents and children, but remained below the recommended 18 g/d throughout the study. With the exception of iron, mean intakes of all micronutrients for parents were greater than the RNI in both groups. Iron intake was lower than the RNI (14.8 mg/d) at all stages. At baseline intakes were lowest in the lower SES group (9.3 mg/d compared to 11.4 mg/d); 11 participants consumed less than the LRNI (8 mg/d), eight of whom from the lower SES group (73 % of participants). Mean intakes increased in the lower SES group by 3.7 mg/d over the duration of the study but neither group reached the RNI at any stage. At baseline, children met the RNI for all micronutrients, and there were no significant differences between groups. Overall the diet of children, particularly from the lower SES group, improved over the duration of the study, although salt and NME sugar intake did not decrease over time. Further research is required to investigate the best methods to improve diet in families with young children, with particular emphasis on reducing % energy from NME sugar and saturated fat, reducing salt intake and increasing fruit, vegetable and NSP intake.