Dietetics, Nutrition and Biological Sciences
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Item Vitamin D status and health outcomes in school children in Northern Ireland: Year one results from the D-VinCHI study(MDPI, 2022-02-14) Glatt, Dominique; McSorley, Emeir; Pourshahidi, L. Kirsty; Revuelta-Iniesta, Raquel; McCluskey, Jane T.; Beggan, Laura; Slevin, Mary; Gleeson, Nigel; Cobice, Diego F.; Dobbin, Sara; Magee, Pamela J.(1) Background: Vitamin D status has never been investigated in children in Northern Ireland (UK). (2) Methods: Children (4−11 years) (n = 47) were recruited from November 2019 to March 2020 onto the cross-sectional study. Anthropometry was assessed. Plasma 25-hydroxyvitamin D (25(OH)D) was analysed. Vitamin D intake, parental knowledge and perceptions, participant habits, physical activity and sedentary behaviour were established via questionnaire. Muscle strength was assessed via isometric grip strength dynamometry and balance via dominant single-leg and tandem stance. Parathyroid hormone, bone turnover markers (OC, CTX and P1NP), glycated haemoglobin and inflammatory markers (CRP, IFN-γ, IL-10, IL-12p70, IL-13, IL-1β, IL-2, IL-4, IL-6, IL-8 and TNF-α) were analysed. (3) Results: Mean (SD) 25(OH)D was 49.17 (17.04) nmol/L (n = 47); 44.7% of the children were vitamin D sufficient (25(OH)D >50 nmol/L), 48.9% were insufficient (25−50 nmol/L) and 6.4% were deficient (25 nmol/L). 25(OH)D was positively correlated with vitamin D intake (µg/day) (p = 0.012, r = 0.374), spring/summer outdoor hours (p = 0.006, r = 0.402) and dominant grip strength (kg) (p = 0.044, r = 0.317). Vitamin D sufficient participants had higher dietary vitamin D intake (µg/day) (p = 0.021), supplement intake (µg/day) (p = 0.028) and spring/summer outdoor hours (p = 0.015). (4) Conclusion: Over half of the children were vitamin D deficient or insufficient. Wintertime supplementation, the consumption of vitamin D rich foods and spring/summer outdoor activities should be encouraged to minimise the risk of vitamin D inadequacy.Item A systematic review of N-3 and N-6 polyunsaturated fatty acid concentration in childhood cancer patients and associated clinical outcomes(E-Cronicon Open Access, 2019-08-22) Revuelta-Iniesta, Raquel; Wyness, Laura; Wilson, David C.Background: This systematic review evaluated primary research to establish blood omega-3 polyunsaturated fatty acids (n-3 PUFA); eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and omega-6 polyunsaturated fatty acids (n-6 PUFA); arachidonic acid (AA) concentration. The effectiveness of their supplementation on clinical and nutritional outcomes and associations between their concentration and clinical and nutritional outcomes were also evaluated.Item Nutritional status of children and adolescents with cancer in Scotland: A prospective cohort study(Elsevier, 2019-05-17) Revuelta-Iniesta, Raquel; Paciarotti, Ilenia; Davidson, Isobel; McKenzie, Jane M.; Brougham, Mark F. H.; Wilson, David C.Background and aims Malnutrition (under and overnutrition) in paediatric cancer patients during and after treatment increases short and long-term side-effects; however, factors contributing to malnutrition and patterns of change in nutritional status are still unclear. The aims were to investigate the prevalence of malnutrition, patterns of change in nutritional status and factors contributing to malnutrition in Scottish paediatric cancer patients.Item Knowledge, attitudes and perceptions towards Vitamin D in a UK adult population: A cross-sectional study(MDPI, 2018-10-27) O’Connor, Clodagh; Glatt, Dominique; White, Lois; Revuelta-Iniesta, RaquelThe prevalence of vitamin D deficiency in the United Kingdom is high, despite updated Scientific Advisory Committee on Nutrition (SACN) guidelines. Therefore, our aims were to identify population knowledge, attitudes and perceptions of vitamin D supplementation and factors contributing to supplement use in a UK adult population. A cross-sectional study was performed between April–June 2018 using a newly designed piloted questionnaire. Scores for knowledge were calculated as a percentage (Boland et al. 2015). Logistic regression analysis was used to predict supplement use. 209 participants (82% female), mean (±SD) age 34.9 (±12.3) completed the questionnaire. The mean (±SD) vitamin D knowledge score was 56.6% (±19.9%); only 48% were concerned about their vitamin D concentration and 57% did not take vitamin D. Most participants (86%) wished to learn more about vitamin D. Knowledge score (OR 2.5; p = 0.01; 95% CI 1.2–5.3), concern (OR 2.1; p = 0.03; 95% CI 1.0–4.2) and location (OR 0.3; p = 0.006; 95% CI 0.1–0.7) predicted supplemented use. Individuals living in England had 2.9 (95% CI 1.4–6.3) lower odds of taking vitamin D than those living in Scotland. As a result of these findings, this study suggests that vitamin D supplementation and fortification, alongside education strategies, may be an effective method for improving UK vitamin D health; however, more research is warranted.Item Systematic review and meta-analysis: Prevalence and possible causes of vitamin D deficiency and insufficiency in pediatric cancer patients(Elsevier, 2015-01-16) Revuelta-Iniesta, Raquel; Rush, Robert; Paciarotti, Ilenia; Rhatigan, E. B.; Brougham, F. H. M.; McKenzie, Jane; Wilson, D. C.Background and aims: Vitamin D inadequacy is now an internationally recognized health problem and pediatric cancer patients may be at even higher risk than healthy children. We aimed to evaluate primary research to establish the prevalence of vitamin D inadequacy and to explore its possible causes in pediatric cancer patients. Methods: Electronic databases were searched (no restriction-Aug 2013) with no language restrictions and keywords related to cancer and vitamin D. We included studies of patients aged <18 years, diagnosed with and treated for cancer and reporting plasma vitamin D status. Evidence was critically appraised employing the CASP tool. Meta-analysis was performed when appropriate. Results: We included 19 studies, which were mainly of moderate-quality and heterogeneous in the definitions of vitamin D deficiency and insufficiency. The median (range) prevalence of vitamin D deficiency was 14% (0-61.5%) and insufficiency 23% (0-83%). Finally, a significant effect of younger age with vitamin D inadequacy was shown (effect size:-0.132; 95%CI-0.203,-0.060). Conclusion: There is a possibility of a high prevalence of vitamin D inadequacy in pediatric cancer patients, especially older children, urging the need for high-quality population-based longitudinal studies using standard definitions.Item Effect of Vitamin D supplementation on aerobic exercise performance in healthy adults; a randomised single blinded placebo controlled pilot study(ECronicon, 2016-09-27) Ferrington, Linda; Bell, Steph; Robertson, Amy; Revuelta-Iniesta, RaquelBackground: 1,25-dihydroxyvitamin D (1,25(OH)D), the biologically active form of vitamin D, is thought to be directly related to exercise induced inflammation and skeletal muscle performance and deficiency has catabolic effects on muscle tissue, causes muscle weakness and impairs cross-bridge formation. 1,25(OH)D may also affect cardiovascular risk factors such as blood pressure (BP), which in turn may have an effect on aerobic exercise; however, at present evidence investigating this association are lacking. Therefore,the aim of this study was to investigate the effect of vitamin D supplementation on aerobic exercise following two weeks of intervention. Methods: A randomised placebo controlled single-blinded pilot study aimed to investigate the short term effects of vitamin D supplementation on aerobic exercise performance in a group of healthy adults. Eleven healthy adults were allocated to receive either 2000IU (50_g/day) of vitamin D or a placebo (sucrose) for 14 days. Physical activity and diet diaries were completed throughout the study. Aerobic exercise performance was assessed at baseline and day 14 following a 15-minute run on a treadmill set at a gradient of 1.5%. Height, weight, systolic/diastolic BP and heart rate (HR) were recorded at baseline and day 14 before running. Parameters of aerobic exercise exertion (BP, %HR and difference in blood lactate) were recorded before and after each run. The rate of perceived exertion (RPE) was recorded after each run. Results: HR reduced significantly by 2.5% (p = 0.002) from 91.5 4.5% to 89.0 3.7% in the intervention group, but not in the placebo group (1.2%; 87.8 4.5% to 86.6 5.1%. p = 0.4). The difference in blood lactate between pre and post run was smaller in the intervention group [(3.9 3.7 mmol/L; p = 0.2 SEM (1.5)] than in the placebo group [(5.5 3.8 mmol/L; p = 0.1; SEM (5.9)]; however,this did not statistically differ between [p = 0.5; SEM (2.2)] and within the groups. Finally, a statistically significant reduction [(p = 0.001; SEM (0.7)] in RPE was found in the intervention group only (15.8 1.9 to 14.7 2.2). Conclusion: The significant reduction in both percentage heart rate and rate of perceived exertion found in this study over a two week period suggest that short term vitamin D supplementation may improve aerobic exercise performance. However, larger scale studies are now warranted to verify these findings.Item 25-hydroxyvitamin D concentration in paediatric cancer patients from Scotland: A prospective cohort study(Cambridge University Press, 2016-12-15) Revuelta-Iniesta, Raquel; Paciarotti, Ilenia; Davidson, Isobel; McKenzie, Jane; Brand, Celia; Chin, Richard; Brougham, Mark FH; Wilson, D. C.Children with cancer are potentially at high risk of plasma 25-hydroxyvitamin D [25(OH)D] inadequacy and despite UK vitamin D supplementation guidelines their implementation remains inconsistent. Thus, we aimed to investigate 25(OH)D concentration and factors contributing to 25(OH)D inadequacy in paediatric cancer patients. A prospective cohort study of Scottish children aged <18 years, diagnosed with and treated for cancer (patients) between Aug 2010-Jan 2014 was performed, with control data from Scottish healthy children (controls). Clinical and nutritional data were collected at defined periods up to 24 months. 25(OH)D status was defined by the Royal College of Paediatrics and Child Health (2013); inadequacy [<50 nmol/L: deficiency (<25 nmol/L), insufficiency (25-50 nmol/L)], sufficiency (51-75 nmol/L), optimal (>75 nmol/L). Eighty-two patients [median(IQR) age 3.9(1.9-8.8); 56% males)] and 35 controls [median(IQR) age (6.2(4.8-9.1); 49% males] were recruited. 25(OH)D inadequacy was highly prevalent in the controls (63%; 22/35), and in the patients (64%; 42/65) at both baseline and during treatment (33-50%). Non-supplemented children had the highest prevalence of 25(OH)D inadequacy at every stage with 25(OH)D median(IQR) ranging from 32.0 (21.0-46.5) nmol/L to 45.0(28.0-64.5) nmol/L. Older age at baseline [R=-0.46; p<0.001], overnutrition (BMI ≥85th centile) at 3 months [p=0.005; RR=3.1] and not being supplemented at 6 months (p=0.04; RR=4.3) may have contributed to lower plasma 25(OH)D. Paediatric cancer patients are not at higher risk of 25(OH)D inadequacy than healthy children at diagnosis; however prevalence of 25(OH)D inadequacy is still high and non-supplemented children have a higher risk. Appropriate monitoring and therapeutic supplementation should be implemented.Item Assessment of Plasma Antioxidants, Oxidative Stress and Polyunsaturated Fatty Acids in Paediatric Cancer Patients: A Prospective Cohort Pilot Study(ECronicon Open Access, 2015-10-07) Revuelta-Iniesta, Raquel; Wilson, David C.; Brougham, Mark FH; Smail, Nacer Foudil; Davidson, Isobel; McKenzie, Jane; Fergus Maclay Leukaemia Trust; Queen Margaret University; Cancer and Leukaemia TrustBackground: Paediatric cancer patients may have a limited dietary intake, particularly nutrients high in antioxidants, docosahexanoic acid (DHA) and eicosapentanoic acid (EPA). Objective: To investigate the antioxidant status (TAS), antioxidant capacity (TAC), oxidative stress, DHA and EPA of paediatric cancer patients during treatment. Methods: A prospective cohort study of Scottish children aged <18 years, diagnosed with and treated for cancer between April-2013 to Jan-2014 was performed. Clinical data and blood samples were collected at baseline and 6 months. Data were stratified by treatment risk (low, medium and high) and nutritional support. We used Oxygen Radical Absorbance Capacity (ORAC) Antioxidant Assay to measure TAC, thiobarbituric acid reactive substances (TBARS) for lipid peroxidation and high performance liquid chromatography and Inductively Coupled Plasma Mass Spectrometry for TAS. The analyses of DHA and EPA were performed by analysing fatty acidmethyl esters (FAME) using gas-liquid chromatography. The reference ranges used were: Yagi 1998 (1.86-3.94) _mol for lipid peroxidation and Damsgaard.,et al. 2014 for EPA (0.45-0.77) % and DHA (2.22-3.76) %. Results: 20 patients (median (IQR) age 4.2 (1.5-8.5) years; 50% males) were recruited. There were no significant changes in plasma TAS, TAC and EPA, but lipid peroxidation significantly decreased from 7.4 (6.2-9.0) at baseline to 5.3 (4.5-6.4) _mol/MDA at 6 months(p = 0.003). The median (IQR) blood percentage of DHA significantly increased from 1.3 (0.9-1.9) to 1.8 (1.3-2.1) (p = 0.001). Lipid peroxidation was high in 95% (19/20) of patients at baseline and 94% (15/16) at 6 months; whilst DHA and EPA were low in 95%(19/20) and 70% (14/20) at baseline and 87.5% (14/16) and 60% (12/16) at 6 months. Children on high-treatment risk exhibited the highest oxidative stress levels. No statitically significant differences were found between non-supplemented and supplemented children in any of the following parameters (TAS, TAC, oxidative stress, EPA and DHA). Conclusion: There was a high prevalence of oxidative stress, especially in children treated with high-risk protocols and during the initial phases of treatment. Nutritional support does not appear to provide enough TAS, EPA and DHA in this cohort; however, larger high-quality population based studies are warranted to confirm these findings. Keywords: Paediatric cancer; Antioxidants; Oxidative stress; Docosahexanoic acid; Eicosapentanoic acidItem Effects of pediatric cancer and its treatment on nutritional status: A systematic review(2015-03-28) Revuelta-Iniesta, Raquel; Paciarotti, Ilenia; Brougham, F. H. M.; McKenzie, Jane; Wilson, D. C.Context: Malnutrition in pediatric cancer is common worldwide, yet its prevalence and effects on clinical outcomes remain unclear. Objective: The aim of this review was to evaluate primary research reporting the prevalence of malnutrition in pediatric cancer patients and to assess the effects of pediatric cancer and its treatment on nutritional status. Data Sources: Electronic databases of MEDLINE, CINHAL, and PubMed were searched (January 1990-February 2013). Study Selection: Studies of patients aged <18 years who were diagnosed with and treated for cancer and for whom measurements of anthropometry were reported were included. The primary outcome was the prevalence of malnutrition (undernutrition and overnutrition), expressed as body mass index (BMI), in children diagnosed with and treated for cancer. Data Extraction: Evidence was appraised critically by employing the Critical Appraisal Skills Program tool, and data was extracted from original articles. Data Synthesis: A total of 46 studies were included, most of which were considered to be of low quality on the basis of heterogeneity in both the criteria and the measurements used to define malnutrition. Undernutrition was identified by measuring BMI, weight loss, mid-upper arm circumference, and triceps skinfold thickness, while overnutrition was assessed using BMI. Overall, the prevalence of undernutrition ranged from 0% to 65% and overnutrition from 8% to 78%. Finally, undernutrition in pediatric cancer at diagnosis was associated with poor clinical outcomes in 6 of 9 studies. Conclusion: The possibility of a high prevalence of malnutrition in childhood cancer, indicated by the studies reviewed, highlights the need for high-quality, populationbased, longitudinal studies using standard criteria to identify malnutrition.Item Effect of vitamin D supplementation on cardiovascular disease risk factors and exercise performance in healthy participants: a randomized placebo-controlled preliminary study(Sage, 2016-06-30) Al-Dujaili, Emad A. S.; Munir, Nimrah; Revuelta-Iniesta, RaquelBackground and objectives: Evidence suggests associations between vitamin D deficiency and cardiovascular disease (CVD) risk factors, including hypertension and excessive cortisol levels. Also, vitamin D levels may impact exercise performance. Thus, we aimed to investigate the effects of vitamin D intake on cardiovascular risk factors, free urinary cortisol and exercise performance. Methods: A randomized placebo-controlled single-blinded parallel trial was conducted in healthy participants (n = 15). They received 2000 IU (50 _g) vitamin D3 per day (n = 9) or placebo (lactose) (n = 6) for 14 days. Body composition, systolic blood pressure (SBP), diastolic blood pressure (DBP) and arterial elasticity (as measured by pulse wave velocity, (PWV) were recorded at baseline, day 7 and day 14 of intervention. A total of two 24-hour urine samples were collected to estimate free cortisol and cortisone levels. Exercise performance was assessed at the baseline and day 14 of the intervention using a bike ergometer in which BP and PWV were measured before and after exercise. The distance cycled in 20 minutes and the Borg Scale rate of perceived exertion (RPE) were recorded. Results: In the intervention arm, at day 14, vitamin D supplementation significantly reduced SBP and DBP from 115.8 17.1 and 75.4 10.3 at baseline to 106.3 10.9 (p = 0.022) and 68.5 10.1 mmHg (p = 0.012) respectively. Also arterial stiffness was markedly reduced in the vitamin D group (from 7.45 1.55 to 6.11 1.89, p = 0.049). Urinary free cortisol levels and cortisol/cortisone ratio were significantly reduced from 162.65 58.9 nmol/day and 2.22 0.7 to 96.4 37.2 (p = 0.029) and 1.04 0.4 (p = 0.017) respectively. Exercise induced SBP and DBP were significantly reduced post vitamin D intake from 130.7 12.2 to 116.1 8.1 (p = 0.012) and from 76.2 8.4 to 70.5 7.7 mmHg (p = 0.042) respectively. The distance cycled in 20 minutes significantly increased from 4.98 2.65 to 6.51 2.28km (p= 0.020), while the Borg Scale RPE reduced from 5.13 1.36 to 4.25 0.71 RPE (p = 0.021). In the placebo arm, no significant effects on CVD risk factors and exercise performance were observed. Conclusion: These results suggest that daily vitamin D supplementation may ameliorate CVD risk factors including a decrease in 11_-HSD1 activity, as evidenced by the decrease in the cortisol/cortisone ratio, and improve exercise performance in healthy individuals. However, large scale studies are required to verify our findings.