Dietary fibre in Europe: current state of knowledge on definitions, sources, recommendations, intakes and relationships to health

Research into the analysis, physical properties and health effects of dietary fibre has continued steadily over the last 40-50 years. From the knowledge gained, countries have developed guidelines for their populations on the optimal amount of fibre to be consumed each day. Food composition tables from many countries now contain values for the dietary fibre content of foods, and, from these, combined with dietary surveys, population intakes have been determined. The present review assessed the uniformity of the analytical methods used, health claims permitted, recommendations and intakes, particularly from national surveys across Europe and around the world. It also assessed current knowledge on health effects of dietary fibre and related the impact of different fibre types on health. The overall intent was to be able to provide more detailed guidance on the types of fibre which should be consumed for good health, rather than simply a total intake figure, the current situation. Analysis of data indicated a fair degree of uniformity in the definition of dietary fibre, the method used for analysis, the recommended amount to be consumed and a growing literature on effects on digestive health and disease risk. However, national dietary survey data showed that intakes do not reach recommendations and very few countries provide guidance on the types of fibre that are preferable to achieve recommended intakes. Research gaps were identified and ideas suggested to provide information for more detailed advice to the public about specific food sources that should be consumed to achieve health benefits

Sitting time, fidgeting and all-cause mortality in the UK Women's Cohort Study

Introduction: Sedentary behaviours (including sitting) may increase risk of mortality independently of physical activity level. Little is known about how fidgeting behaviours might modify the association. Methods: Data were drawn from the UK Women’s Cohort Study. In 1999/2002, 12,778 women (age 37 to 78) provided data on average daily sitting time, overall fidgeting (irrespective of posture), and a range of relevant covariates including physical activity, diet, smoking status and alcohol consumption. Participants were followed for mortality over a mean of 12 years. Proportional hazards Cox regression models were used to estimate the relative risk of mortality in the high (vs. low) and medium (vs. low) sitting time groups. Results: Fidgeting modified the risk associated with sitting time (p value for interaction = 0.04), leading us to separate groups for analysis. Adjusting for a range of covariates, sitting for 7+ hours/day (vs. <5 hours/day) was associated with 30% increased risk of all-cause mortality (HR = 1.30, 95% CI 1.02, 1.66) only among women in the low fidgeting group. Among women in the high fidgeting group, sitting for 5/6 (vs. <5 hrs/day) was associated with decreased risk of mortality (HR = 0.63, 95% CI 0.43, 0.91), adjusting for a range of covariates. There was no increased risk of mortality from longer sitting time in the middle and high fidgeting groups. Conclusions: Fidgeting may reduce the risk of all-cause mortality associated with excessive sitting time. More detailed and better validated measures of fidgeting should be identified in other studies in order to replicate these findings and identity mechanisms, particularly measures that distinguish fidgeting in a seated from standing posture

Analysis of dietary fibre of boiled and canned legumes commonly consumed in the United Kingdom

The use of different analytical methods to measure the dietary fibre content of foods complicates the interpretation of epidemiological studies. The aim of this study was to determine the total (TDF) and insoluble (IDF) fibre content of 14 boiled and canned legumes commonly consumed in the UK using the Association of Official Analytical Chemists (AOAC) enzymatic gravimetric method. The fibre values obtained were compared to non-starch polysaccharide (NSP) values. The results showed that mean values for TDF (2.7–11.2 g/100 g) were higher than NSP (2.6–6.7 g/100 g), with a mean NSP:TDF ratio of 1:1.43. TDF was correlated with NSP (r = 0.6; p = 0.02). Canning significantly reduced TDF and IDF by an average of 30% and 26% compared to boiling respectively. However, IDF represented at least 60% of the TDF in both boiled and canned samples. In conclusion, fibre values are affected by the processing and analytical method used

Early Menarche, Nulliparity, and the Risk for Premature and Early Natural Menopause

Study question: How the timing of menarche and parity link with premature and early natural 42 menopause? Summary answer: Early menarche (≤11 years) is a risk factor for both premature menopause (final 44 menstrual period, FMP <40 years) and early menopause (FMP 40-44 years), a risk that is amplified for nulliparous women. What is known already: Women with either premature or early menopause face increased risk of chronic conditions in later life and of early death. Findings from some studies suggest that early menarche and nulliparity are associated with early menopause, however overall the evidence is mixed. Much of the evidence for a direct relationship is hampered by a lack of comparability across studies, adjustment for confounding factors, and statistical power. Study design, size, duration: This pooled study comprises 51,450 postmenopausal women from nine observational studies in the UK, Scandinavia, Australia, and Japan that contribute to the International collaboration for a Life course Approach to reproductive health and Chronic disease Events (InterLACE). Participants/materials, setting, methods: Age at menarche (categorised as ≤11, 12, 13, 14, and 15 56 or more years) and parity (categorised as no children, one child, and two or more children) were exposure of interest. Age at FMP was confirmed by at least 12 months of cessation of menses where this was not the result of an intervention (such as surgical menopause due to bilateral oophorectomy or hysterectomy) and categorised as premature menopause (FMP before age 40), early menopause (FMP 40-44 years), 45-49 years, 50-51 years, 52-53 years, and 54 or more years. We used multivariate multinomial logistic regression models to estimate relative risk ratio (RRR) and 95% confidence intervals (95%CI) for associations between menarche, parity and age at FMP adjusting for within-study correlation. Main results and the role of chance: The median age at FMP was 50 years (interquartile range 48 to 53 years), with 2% of the women experiencing premature menopause and 7.6% early menopause. Women with early menarche (≤11 years, compared with 12-13 years) were at higher risk of premature menopause (RRR 1.80, 95% CI 1.53 to 2.12) and early menopause (1.31, 1.19 to 1.44). Nulliparity was associated with increased risk of premature menopause (2.26, 1.84 to 2.77) and early menopause (1.32, 1.09 to 1.59). Women having early menarche and nulliparity were at over five folds increased risk of premature menopause (5.64, 4.04 to 7.87) and two folds increased risk of early menopause (2.16, 1.48 to 3.15) compared with women who had menarche at ≥12 years and two or more children. Limitations, reasons for caution: Most of the studies (except the birth cohorts) relied on retrospectively reported age at menarche which may have led to some degree of recall bias. Wider implications of the findings: Our findings support early monitoring of women with early menarche, especially those who have no children, for preventive health interventions aimed at mitigating the risk of adverse health outcomes associated with early menopause

Continuity and change?: Exploring reactions to a guided self-management intervention in a randomised controlled trial for IBS with reference to prior experience of managing a long term condition

Self-care interventions are promoted as effective strategies for improving the quality of life and health outcomes for individuals with long-term health conditions. Outcome measures used in evaluations using Randomised Controlled Trials (RCTs) are not designed to consider patients' prior management strategies and experience of illness. Yet the experience of illness literature suggests that adjusting to living with chronic illness, together with broader contextual influences, are likely to be relevant to understanding responses to self-management initiatives. Using group and individual interview data we attempt to illuminate the transposition of IBS from a condition unsatisfactorily managed by medicine to one successfully managed within the life worlds of individuals. If routine embedding of complex interventions depends on the accomplishment of integration and workability in patients' everyday lives then the design and evaluation of such interventions should view participation as part of a process of continuity as well as change. Responses to formal self-management can be extended beyond psychological and other quantitatively measured outcomes. A useful addendum to trial outcomes for self-management education is an understanding of change as being inextricably linked to people's previous attempts to, and experience of, managing long-term conditions. We suggest that the benefits of understanding the prior experience of managing illness and contact with health services include the acceptability and workability of complex interventions in patients' everyday lives

The InterLACE study: design, data harmonization and characteristics across 20 studies on women's health

The International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease Events (InterLACE) project is a global research collaboration that aims to advance understanding of women's reproductive health in relation to chronic disease risk by pooling individual participant data from several cohort and cross-sectional studies. The aim of this paper is to describe the characteristics of contributing studies and to present the distribution of demographic and reproductive factors and chronic disease outcomes in InterLACE

Nutrient intakes and nutritional biomarkers in pregnant adolescents: a systematic review of studies in developed countries

Background: Babies born to adolescent mothers have been shown to have poorer outcomes compared to those born to adults. Nutritional status may have an important role to play in improving the health of pregnant adolescents; however there is a lack of evidence regarding the adequacy of adolescent diets during pregnancy. This systematic review aims to examine what is known about the nutritional status of adolescent pregnant women. Methods: A systematic search of the literature identified 21 studies which met the inclusion criteria for the review. Primary research papers using any methods were included where they were published in English between January 1995 and May 2015 and included measurements of nutrient intakes or biological markers of nutritional status in pregnant women aged 11-19 years. Individual study data was first summarised narratively before study means were pooled to give an estimate of nutritional status in the population. Results: The results show that individual studies reported intakes of energy, fibre and a number of key micronutrients which were below recommended levels. Biological markers of iron and selenium status also showed cause for concern. Pooled analysis of individual means as a percentage of UK Dietary Reference Intakes showed intakes of vitamin D (34.8 % CI 0-83.1) to be significantly below recommendations (p=0.05). Serum selenium levels were also found to be low (61.8 μg/L, CI 39-84). Conclusions: This review has identified a number of areas where the nutritional status of pregnant adolescents is sub-optimal, which may have implications for the health of adolescent mothers and their babies. It was not however possible to examine the impact of supplement use or socio-demographic characteristics which limits the interpretation these results. Further work is needed to establish the characteristics of those most at risk within this population, how this differs from adult pregnant women and the role of supplementation in achieving adequate nutrition

Height and pancreatic cancer risk: A systematic review and meta-analysis of cohort studies

Background Greater height has been associated with increased risk of several cancers, but epidemiological data on height and pancreatic cancer are inconclusive. We conducted a systematic review and meta-analysis of prospective studies to clarify these results. Methods PubMed and several other databases were searched up to September 2011. Prospective studies of height and pancreatic cancer were included. Summary relative risks were estimated by the use of a random effects model. Results We identified twelve cohort studies that were included in the meta-analysis. The summary RR per 5-cm increase in height was 1.07 (95 % CI: 1.03-1.12, I2 = 57 %). The results were similar among men and women. The summary estimate was attenuated when we included results from two pooled analyses together with these studies, summary RR = 1.03 (95 % CI: 1.00-1.07, I2 = 44 %). Conclusions This meta-analysis of cohort studies provides further evidence that greater adult attained height is associated with increased pancreatic cancer risk. However, given the unexplained heterogeneity, further studies are needed before a conclusion can be drawn