Dietetics, Nutrition and Biological Sciences

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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.
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.
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.
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.
ASSESSING THE LIFESTYLE (PHYSICAL ACTIVITY LEVELS, SEDENTARY BEHAVIOUR AND EATING HABITS) OF OMANI ADOLESCENT GIRLS: A MIXED METHODS STUDY
(Queen Margaret University, Edinburgh, 2019) Al-Mahrouqi, Zuwaina Humaid
Background: Rising body mass index (BMI) in the world population is a serious global health issue of 21st century. Epidemiology and management of high BMI have been the themes of many studies. In the Arab world, including in Oman where this study is based, the prevalence of obesity and inactivity emerged late but is accelerating rapidly, particularly among the youth. The aim of this study is to bridge the research gap that exists regarding Omani adolescent girls’ lifestyle and their association with body weight status by studying the diet and activity habits of this population using a mixed method approach. To date, this is the first study of its kind from Oman. Methods: An explanatory sequential mixed methods study was conducted to assess the lifestyle characteristics (physical activity level, sedentary behaviour, and eating habits) among Omani girls aged 15–18 years, and to understand their perceptions related to this lifestyle. A total of 421 female students were randomly selected from two schools in Ibri, Oman, to participate in this study. A validated online ATLS questionnaire (N = 421), diet diary and pedometer (n = 59) and focus groups (n = 16) were used as data collection instruments. Ethical approvals were granted by the Queen Margaret University (QMU) ethics committee and Oman Ministry of Education (MOE). Informed consent was obtained from the participants and their parents and the confidentiality of the collected data maintained. Results: The prevalence of overweight was 21% and obesity 14% among this sample of Omani female adolescents. The average footstep tally of the participants (n=59) was 5,755 footsteps per day against the recommended 10,000–11,700 with significant differences between BMI groups. The pedometer data indicated that normal weight participants scored mean footstep counts of 6,625 per day, while it was 6,094 in the overweight girls, falling further to 5,755 for their obese peers. The majority of the participants (56%) who maintained diet diaries were normal reporters, while misreporters were 44%. After excluding the misreporters, the energy intake (EI) of the diet diary cohort was lower than the recommended value of 2400 Kcal/day. The overweight participants were significantly more likely to consume French fries/ chips (82%) and cake/ doughnuts (74%) than the other BMI groups, while the obese participants consumed more sweets (61%) and fast food (42%). The participants perceived environmental and sociocultural factors, rapid modernisation and acculturation of Omani society, lack of encouragement from family, friends, and teachers, as well as lack of self-motivation and role models as barriers to physical activity. Even though they perceived fast food as unhealthy, they were attracted to these due to the taste and advertisements. The study also found that increased digital screen-time, sleeping less, and missing breakfast were other factors that positively correlated with inactivity and increased the BMI among Omani female adolescents. Conclusion: The current study establishes a positive correlation between the overweight and obesity in Omani teenage girls and their physical inactivity and nutritional habits. While the current results are similar to those from other parts of the world, there are also factors that are specific to the region such as the climate and culture that makes the problem complex. The trend for BMI to rise with age among teenagers raises apprehension that it may continue in their adulthood. Urgent action needs to be taken by adolescent girls in Oman, their parents, and higher authorities at Oman ministries of education and health to improve the nutritional habits and physical activity of this age group. Specific culture-sensitive suggestions are provided in this thesis to meet these challenges. Key words: adolescent girls, obesity, overweight, BMI, Arab, Oman, school children, lifestyle, physical activity, dietary habits, sedentary behaviour, fast food, sleep, Ibri
Consumer use of the nutritional label on food packages: a cognitive task analysis
(Queen Margaret University, Edinburgh, 2000) Higginson, Catherine Susan
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.
THE EFFECT OF POMEGRANATE ON ANTHROPOMETRIC, BIOCHEMICAL, COGNITIVE AND SATIETY INDICATORS OF RISK FACTORS FOR NON-COMMUNICABLE DISEASES
(Queen Margaret University, Edinburgh, 2019) Stockton, Angela
Non-communicable diseases (NCDs) such as cardiovascular, endocrine, metabolic and cerebrovascular diseases are increasing contributors to, and major causes of worldwide morbidity and mortality. Hypertension and obesity are the most preventable cardiovascular risk factors which can be modified by diet and lifestyle changes. The pomegranate, valued as a medicinal fruit since antiquity, and its extract (PE), are both rich in polyphenol antioxidants which have the potential to improve both the management and outcomes of chronic disease, to decrease blood pressure and increase satiety, thus assisting in the reduction of cardiovascular disease (CVD), overweight and obesity. Chronic pomegranate supplementation has recently been shown to improve memory retention, and verbal memory with increased functional brain activity during visual and verbal memory tasks. PE consumption may perform a role in enhancing cognitive performance or towards preventing cognitive decline. The primary aims of this research were to investigate the effects of PE on BP and stress hormones, and to explore the relationship between PE intake and satiety, anthropometry, quality of life (QoL) and cognitive function indicators. Four studies were conducted in healthy volunteers to fulfil these aims using double-blind, placebo-controlled, RCT designs. The first three parallel studies were conducted over 4 and 8 weeks. The exploratory (Pom-01; n=29), satiety (Pom-01s; n=29) and blood pressure and anthropometry (Pom-02; n=55) studies investigated the effect of PE consumption on anthropometric, physiological, biochemical, satiety and QoL parameters. The fourth crossover RCT (Pom-03; n=20) explored the acute effect of PE on cognitive function. In Pom-01, paired t-tests showed that systolic BP was significantly reduced following PE intake (4.75 mmHg; p = 0.012), with reductions in diastolic BP (1.73 mmHg; p˃0.05). Levels of HOMA-IR (p = 0.045), glucose, insulin and uric acid all decreased. No significant changes were recorded in volunteers taking the placebo (PL). ANOVA indicated no significant differences between the groups. PE consumption caused a highly significant drop in salivary cortisol levels (p = 0.016 to p<0.001), and the cortisol/cortisone ratio was also significantly reduced (p = 0.011 to p< 0.001). The RAND 36 QoL questionnaire showed significant improvements in physical (p = 0.018) and social functioning (p = 0.021), pain (p = 0.003), general health (p = 0.008) and overall QoL score (p = 0.007) over the 4-week study within the PE group compared to no significant changes in these parameters within the PL. In Pom-01s, volunteers taking PE reported feeling less hungry, with less desire to eat, felt fuller and more satisfied, and ate less (p = 0.05) than those who consumed the PL. There was a significant difference between the PE and PL groups in Pom-02 for diastolic BP (F2, 102 =4·4; p = 0·02), where PE decreased (2.79mmHg) compared to placebo. There was a similar non-significant decrease in magnitude of SBP (2.6mmHg) compared to PL. The QoL questionnaire, showed that significant improvements were also found in four parameters for the PE group between baseline and 8 weeks: energy (p = 0.017), emotional well-being (p = 0.003), social functioning (p = 0.046) and the overall QoL score (p = 0.022). There were no significant differences in the PL group. Acute PE ingestion in Pom-03 improved aspects of cognitive performance in healthy adults (Picture Recognition, p = 0.026; overall logical reasoning reaction time (RT), p<0.001; serial subtraction, p<0.001) compared to the non-biophenol PL. These results suggest that PE intake could be useful for public health. It may ameliorate non-communicable disease risk factors, reducing stress and blood pressure levels, improving cardiovascular health, perceived health related quality of life and aspects of cognitive function. The concurrent ability to decrease insulin resistance and modulate indicators of satiety could be of benefit to those who suffer from diabetes (type 2), metabolic syndrome or obesity. Future dietary intervention RCTs should focus on PE treatment effects over time and explore the most effective dosages in different population groups, age and body composition ranges. Key words: Pomegranate, Pomegranate Extract (PE), Polyphenols, Antioxidants, Anthropometry, Blood Pressure, Cholesterol, Cortisol, Diabetes, Stress, Insulin resistance, Satiety, Quality of Life, Health, Cognitive function, Memory, Ageing, Obesity, Cardiovascular Disease, Non-communicable diseases.
THE EFFECTS OF OAT β-GLUCAN CONSUMPTION ON THE ENERGY INTAKES OF HEALTHY INDIVIDUALS
(Queen Margaret University, Edinburgh, 2018) Zaremba, Suzanne
Overweight and obesity are disease states of a huge public health concern, therefore strategies to impede or reverse the current detrimental overweight and obesity epidemic are of fundamental importance. It is important to understand dietary factors that affect appetite and food intake both in short- and long-term, as energy intake can lead to positive energy balance. Following the discovery of the bioactivity of cereal soluble fibre, (1→3,1→4)-β-ᴅ-glucan, there has been extensive attention among researchers, the food industry and consumers since the 1980s. Several authorities, including the U.S Food and Drug Administration (FDA) and European Food and Safety Administration (EFSA) have acknowledged the cardiovascular (CV) health benefits of β-glucan consumption by broadcasting ratified health claims based on robust scientific evidence. Yet despite evidence to suggest that cereal β-glucan can beneficially impact on appetite, the underpinning mechanisms whereby β-glucan influences energy intakes remain elusive. Given that there is no ratified health claim for β-glucan consumption and satiety, the aim of this work was to investigate the impact of oat β-glucan consumption on energy intakes of healthy individuals over both short- and medium-term. β-glucan enrichment of a semi-solid, viscous breakfast (4 g oat β-glucan) had no effect on subsequent eating (p=0.388) in 33 normal-weight subjects (22 female/11 male, mean age (y): 27.0 ± 1.0, BMI (kg/m2): 23.5 ± 0.4), however there was a significant increase in subjective feelings of satiety (p=0.034) and fullness (p=0.048). Additionally, attenuation of glucose (p<0.001) and insulin (p=0.001) were reported alongside a decreased response in GLP-1 after 90 minutes (p=0.021) in study A. A novel β-glucan-enriched oatcake snack (4.46 g β-glucan) had no effect on daily energy intakes of healthy overweight and obese subjects (11 female/2 male, mean age (y): 34 ± 9, BMI (kg/m2): 29.8 ± 4.4) when consumed daily for six weeks when compared to a control snack group during week 3 (p=0.39) or week 6 (p=0.58) of the study. Moreover, there were no significant improvements in markers of abdominal obesity, waist circumference (WC, p=0.67), sagittal abdominal diameter (SAD, p=0.38), BMI (p=0.99) or body fat percentage (BF%, p=0.54) between groups in study B following 6 weeks of β-glucan-enriched snack consumption. To conclude, evidence reported in this thesis supports evidence that oat β-glucan consumption does not influence short- or medium-term energy intakes in healthy individuals, however, in the short term β-glucan does increase subjective ratings of appetite and attenuates postprandial glucose, insulin and GLP-1 responses. Keywords: oat β-glucan, energy intake, appetite, GLP-1, body composition
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.
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.
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.
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.
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.
SARCOPENIC OBESITY IN SCOTISH OLDER COMMUNITY-DWELLERS: A WEIGHT LOSS INTERVENTION USING HIGH PROTEIN INTAKE AND MIXED EXERCISE TRAINING TO AUGMENT BODY COMPOSITION AND FUNCTION IN OLDER AGE
(Queen Margaret University, Edinburgh, 2018) Theodorakopoulos, Christos
Background: Sarcopenic obesity is the condition where obesity and sarcopenia (age-related low muscle mass and strength) occur together, which may predispose older individuals to more adverse health effects than either of the two conditions alone. Thus, improvements in body composition and function are of vital importance. Aim: The aims of this study were to A) systematically search the databases for nutritional and/or exercise interventions in sarcopenic obesity and assess their effectiveness in augmenting body composition and function. B) Screen Scottish older community-dwellers for sarcopenia and obesity. C) Implement a nutritional and exercise programme for individuals with sarcopenic obesity. Methods: A) Four databases were systematically searched for trials with sarcopenic obese older adults. B) Scottish community dwellers (≥ 65 years) were screened for body fat (using bioelectrical impedance analysis; BIA), body mass index (BMI), muscle mass, and grip strength. C) Those with a high % body fat (≥ 28 % in men; ≥ 40 % in women) and low skeletal muscle mass index (≤ 10.75 kg·m-2 in men; ≤ 6.75 kg·m-2 in women) were randomly allocated to a 16-week intervention with exercise (EX) or exercise plus dietary modifications (EXD). The EX group followed a mixed-exercise training programme, whereas the EXD followed the same exercise protocol alongside an energy-deficit (500 kcal daily deficit) and high protein diet (1.2 – 1.5 g kg bodyweight-1). Results: A) Two studies were identified from the literature with sarcopenic obese participants (one diet and one resistance-exercise trial) but neither noted a significant change in body composition. However, resistance exercise training significantly improved physical function. B) In total, 108 (men, n=29; women, n=79) adults (median (IQR) age, 70 (67, 75) yr) took part in the screening test. Prevalence of sarcopenia was 14.8%, of obesity 27.8 % (using BMI) vs 63.0 % (using BIA), and sarcopenic obesity 4.6 % (using BMI) vs 12.0 % (using BIA). C) After 16 weeks of the intervention, the median (IQR) changes in EXD vs EX in bodyweight, fat mass and muscle mass were: -5.0 (-5.0, -6.8) kg vs. +0.5 (0.0, 1.0) kg, -4.7 (-4.8, -4.2) kg vs 0.0 (-0.4, 0.7) kg, and +0.1 (-0.4, 0.7) kg vs +0.5 (0.3, 0.7) kg, respectively. Improvements that may be of clinical significance were noted in both groups for strength and physical function. Conclusion: More intervention trials are needed with sarcopenic obese older adults. Prevalence of high adiposity in Scottish older adults may be higher than what has been previously documented. High adiposity and the use of BMI may mask sarcopenia and sarcopenic obesity. A high-protein energy-restriction diet with exercise training can potentially improve body compostion, and augment physical function in older adults with low muscle and high fat mass. Keywords: sarcopenia, obesity, sarcopenic obesity, body composition, older age, weight loss, high protein diet, exercise training, physical function
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 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.
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.
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.