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 Dietary sources of vitamin D in school children in Northern Ireland(The Nutrition Society, 2021-08-17) Benson, H.; Glatt, Dominique; Beggan, L.; McSorley, E. M.; Pourshahidi, L. K.; McCluskey, Jane T.; Revuelta-Iniesta, Raquel; Gleeson, Nigel; Magee, P. J.Item Micronutrient status influences clinical outcomes of paediatric cancer patients during treatment: A prospective cohort study(2021-03-20) Revuelta-Iniesta, Raquel; Gerasimidis, Konstantinos; Paciarotti, Ilenia; McKenzie, Jane; Brougham, Mark F. H.; Wilson, David C.Research reporting plasma micronutrient status and its impact on clinical outcomes in paediatric cancer is scarce. Therefore, we investigated the prevalence of plasma micronutrient abnormalities and their impact on clinical outcomes and treatment complications. A multicentre prospective-cohort study of children aged <18 years diagnosed with cancer was performed between Aug 2010-Jan 2014. Clinical and nutritional data were collected at diagnosis, 3, 6, 9, 12 and 18 months. Micronutrient status was established using in-house laboratory references (vitamin B12, vitamin A and Vitamin E/Ch) and aged adjusted Z-scores (Mg, Se, Zn and Cu) generated from a cohort of healthy Scottish children. Clinical outcomes were classified as "event free survival (EFS)" or "event" (relapse, death, new metastasis or becoming palliative) and treatment complications. Descriptive statistics, logistic regression multilevel analysis were performed. Eighty-two patients [median (IQR) 3.9 (1.9-8.8) years, 56% males] were recruited. Of these, 72 (88%) samples were available, 74% (53/72) patients had micronutrient abnormalities at baseline; deficiencies (25%, 18/72), excesses (19%, 14/72) and a combination of both (29%, 21/72), which continued for 18 months. Vitamin A deficiency (15%, 3/20) and excess (50%, 10/20) were most prevalent at 18 months, whilst vitamin E/Cholesterol and vitamin B12 were mostly within the normal range. Prevalence of Zn deficiency at diagnosis was 36% (16/44 adjusted for CRP), which remained at these levels throughout the study. Reduction in each selenium concentration unit increased the odds of an event by 2% (OR 0.02) and lower Se predicted higher complications at diagnosis [β (-1.2); t (-2.1); 95% CI (-2.9 - (-0.04)); p = 0.04], 3 months [β (-3.9); t (-4.2); 95% CI (-5.57 - (-2.02)); p < 0.001] and 12 months [β (-2.3); t (-2.4); 95% CI (-4.10 - (-0.34)); p = 0.02]. Given the prevalence of micronutrient abnormalities and the negative impact of low selenium on clinical outcome, micronutrient status should be assessed and monitored in paediatric cancer patients. Larger multicentre population based studies and clinical trials are now warranted.Item Nutritional screening and assessment of paediatric cancer patients: A quality improvement project (baseline results)(European Society for Clinical Nutrition and Metabolism, 2020-04-14) Glatt, Dominique; Hughes, Caoimhe; McCarthy, Orlaith; O'Shea, Fiona; Brougham, Mark F. H.; Wilson, David C.; Revuelta-Iniesta, RaquelThe department of Haematology and Oncology at the Royal Hospital for Sick Children (RHSC) in Edinburgh have developed their own nutritional standards specific to paediatric cancer. We aimed to audit the current nutritional practice in anthropometry, nutritional biochemistry and malnutrition screening for paediatric cancer patients against nutritional standards to identify areas for nutritional-practice improvement and progress nutrition-related clinical outcomes. A Clinical audit was conducted >20 weeks between 2015 and 2017 in three data collection locations (inpatient (IP), day-care (DC), or outpatient (OP)) at RHSC. We included patients aged 0-18 years and undergoing treatment for diagnosed malignant childhood cancer (ICCC-3 or Langerhans Cell Histiocytosis). Data were collected by analysing documentation and observing clinical practice for frequency and mode of administration of anthropometry, malnutrition screening, nutritional biochemistry and resulting documentation completion. Results were presented as descriptive statistics and stratified by percentage of standard met (100%, 99-70%, <70%). 185 audited patient records (22 IP, 54 DC and 109 OP) were analysed. The areas which were <70% of the standard were: height and weight documentation for DC; head-circumference for IP; arm anthropometry assessment for all locations; initial PYMS screening and re-screening in IP; malnutrition screening in DC and OP; and initial assessment and re-assessment for serum vitamins D, A, E, B and parathyroid hormone levels. Baseline nutritional practice was successfully established, identifying areas for practice improvement in the RHSC Paediatric Oncology and Haematology Department; this will be implemented in the next step of the audit to optimise patient care. [Abstract copyright: Copyright © 2020 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.]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.