A qualitative investigation into the follow-up support offered to patients after an NHS obesity weight management programme in Liverpool

The prevalence of obesity has been increasing in Liverpool over the last 20 years(1). In response a weight management programme was devised by Liverpool Community Health using existing related services. The service involves dietitians working towards facilitating dietary and lifestyle changes in local obese NHS patients via a 12 week education programme. Follow up support is highlighted in the literature as a required element for success in weight management, however there is a lack of existing qualitative research focussing on this area(2). This study investigated patients’ lived experiences of the programme; specifically regarding follow up support. Participants (n 16) were recruited from the programme to engage in a semi-structured focus group after their final education session with an emphasis on post-programme support. Data was audio-recorded, transcribed verbatim and analysed using constant comparison analysis. A coding frame was developed until saturation was reached. The table outlines themes which emerged from the data and future recommendations. Regardless of many positive comments, participants frequently complained about a lack of follow up support from the programme and from family and friends. Some explained how they were often insulted and belittled by those closest to them and were vehemently against involving these people in their weight management. Follow up weigh-in groups based around peer support were suggested, however these were also met with criticism as participants mentioned they would be unhappy to engage unless sessions were run by a dietitian or qualified health professional. Despite favourable remarks concerning the social elements of the programme and the acquisition of new skills and knowledge, many participants still felt unable to continue without suitable follow up support and excessive practitioner dependence, therefore deflecting accountability for their health away from themselves. The results show that for changes made during programme to be sustainable, patients need a robust, post-programme support network where they become responsible for their own actions and are encouraged to set and work towards their own goals. Proposed solutions to this are the introduction of online support programmes, follow up dietitian phone calls and weight management support inventories to assess the level of social support needed(3). Furthermore, NHS Community Food Workers have also been effective in offering individualised support for behaviour changes and may too be useful for assisting with follow up sessions(4)

Macronutrient intake and prevalence of markers of metabolic syndrome in white UK adult males in the National Diet and Nutrition Survey Rolling Programme 2008–2014

The amount of carbohydrates recommended for consumption by current dietary guidelines has been challenged in relation to their suitability to prevent or manage cardiometabolic (CM) diseases with suggestions that they should be decreased and replaced by protein or fat( 1 , 2 ). Others have argued that a more personalised approach is required( 3 ). Aim of this investigation was to assess the potential impact of lower versus higher consumption of dietary macronutrients and prevalence of CM risk markers in a representative sample of the UK male white population. Unweighted data from 642 white adult males aged 19 and over in the National Diet and Nutrition Survey Rolling Programme( 4 ) (NDNS RP) 2008–2014 with or without metabolic syndrome (MetS)( 5 ) were analysed for associations of dietary macronutrient intake as percentage food energy (%FE) with CM risk markers. Logistic regression analysis (adjusted for age group and smoking status) was used to compare the odds ratios [OR] of prevalence of individual markers of MetS between the lowest and highest quartiles of dietary macronutrient intake as %FE (⩽44 vs. ≥52 for carbohydrates; ⩽31 vs. ≥39 for fats; ⩽15. vs. ≥19 for protein). There was a significant (p < 0·05) reduction in likelihood of MetS (OR, .55; 95 % confidence interval [CI], .34 to .84), and elevated waist circumference (OR, .50; 95 % CI, .30 to .83) and glucose levels (OR, .51; 95 % CI, .30 to .87) for those in the highest quartile of carbohydrate %FE intake compared to the lowest quartile, whereas those in the highest quartile of protein %FE intake had a significantly (p < 0·05) increased risk of presenting with the same markers of MetS (OR, 1·75; 95 % CI, 1·05 to 2·93; OR, 2·12; 95 % CI, 1·24 to 3·63; and OR, 2·15; 95 % CI, 1·25 to 3·70 respectively). Those with the highest compared to the lowest total dietary fat intake also presented with elevated CM risk markers, albeit these findings were not significant. *Metabolic Syndrome (MetS) definition: 3 out of 5 of the following: triglycerides (TRIG) ≥1·7 mmol/L; High-density lipoprotein cholesterol (HDL-C) ⩽1·03 mmol/L for males; Waist circumference (WC) ≥94 cm for white males; Glucose (GLUC) ≥5·6 mmol/L; Blood pressure (BP) ≥130 mmHg systolic or ≥85 mmHg diastolic respectively; CHO%FE – total carbohydrates percentage food energy; FAT%FE – total fats food energy; PROT%FE– total protein food energy; OR – odds ratio (adjusted for age group and smoking status), 1st vs. 4th quartile of intake; CI – confidence interval; a p < 0·05 Further investigations need to confirm whether the quality of the macronutrients consumed and overall diet quality( 6 ) has had an impact on these results. In the context of a personalised approach to nutrition future cohort studies should also provide data that allow for examining inter-individual variations in responses to dietary macronutrients, especially carbohydrates, to achieve optimum CM health for a larger proportion of the population

Speeds and arrival times of solar transients approximated by self-similar expanding circular fronts

The NASA STEREO mission opened up the possibility to forecast the arrival times, speeds and directions of solar transients from outside the Sun-Earth line. In particular, we are interested in predicting potentially geo-effective Interplanetary Coronal Mass Ejections (ICMEs) from observations of density structures at large observation angles from the Sun (with the STEREO Heliospheric Imager instrument). We contribute to this endeavor by deriving analytical formulas concerning a geometric correction for the ICME speed and arrival time for the technique introduced by Davies et al. (2012, ApJ, in press) called Self-Similar Expansion Fitting (SSEF). This model assumes that a circle propagates outward, along a plane specified by a position angle (e.g. the ecliptic), with constant angular half width (lambda). This is an extension to earlier, more simple models: Fixed-Phi-Fitting (lambda = 0 degree) and Harmonic Mean Fitting (lambda = 90 degree). This approach has the advantage that it is possible to assess clearly, in contrast to previous models, if a particular location in the heliosphere, such as a planet or spacecraft, might be expected to be hit by the ICME front. Our correction formulas are especially significant for glancing hits, where small differences in the direction greatly influence the expected speeds (up to 100-200 km/s) and arrival times (up to two days later than the apex). For very wide ICMEs (2 lambda > 120 degree), the geometric correction becomes very similar to the one derived by M\"ostl et al. (2011, ApJ, 741, id. 34) for the Harmonic Mean model. These analytic expressions can also be used for empirical or analytical models to predict the 1 AU arrival time of an ICME by correcting for effects of hits by the flank rather than the apex, if the width and direction of the ICME in a plane are known and a circular geometry of the ICME front is assumed.Comment: 15 pages, 5 figures, accepted for publication in "Solar Physics

Dietary carbohydrate intake, visceral adipose tissue and associated markers of cardiometabolic risk

Risk of cardiometabolic (CM) disease is characterised by elevated visceral adipose tissue (VAT) and a number of associated biomar- kers(1). Some dietary carbohydrates (CHO) have been found to contribute to VAT accumulation(2). Little is known about the impact of following a low-carbohydrate diet versus a high-carbohydrate diet on VAT, adiponectin (ADPN), leptin (LEPT) and leptin:adipo- nectin ratio (LAR). The aim of this investigation was to assess the impact of dietary carbohydrates (CHO) on VAT and emerging CM risk markers in a sample of 10 healthy normal-weight and overweight Caucasian adults aged 32–60 (80 % male) at increased CM risk(3). This pilot study received ethical approval from Liverpool John Moores University Research Ethics Committee (16/ELS/ 029) and was registered with ClinicalTrials.gov (Ref. NCT03257085). Participants were randomly allocated to one of two groups and asked to either consume 50 % energy from CHO (high-carb (HC)) for a duration of 8 weeks. VAT was ana- lysed via bioelectrical impedance (SECA mBCA 515). Blood plasma samples were collected at baseline (BL), interim point (IP) and endpoint (EP) after a 12-hour overnight fast, immediately processed and frozen at -80°C. Thawed plasma samples were analysed via immunoassay technology (Randox Evidence InvestigatorTM Metabolic Syndrome Arrays I and II) for ADPN and LEPT levels. Statistical analysis was undertaken using IBM SPSS 24®. Parametric data was analysed via two-way mixed ANOVA; non-parametric data was analysed via Mann-Whitney U test and Friedman test. Average daily carbohydrate intake in the LC group was 44·2 g at IP and 48·9 g at EP. There were no significant differences between groups at any time point for ADPN, LEPT, LAR or VAT and no significant inter- actions for time or group*time for ADPN, LEPT or LAR. However, in the LC group VAT decreased significantly between baseline and endpoint by 15 % (p = ·015) Over the course of the intervention ADPN and LEPT decreased non- significantly (by 4 % and 70 % respectively) in the LC group, whilst increasing non-significantly in the HC group (9 % and 65 % respectively). LAR increased in the HC group throughout the study, whilst LAR in the LC group decreased albeit not significantly. VAT (litre) ADPN (ng/mL) LEPT (ng/mL) LAR BL IP EP Median Median Median M SD M SD M SD BL IP EP BL IP EP BL IP EP LC 4·1a 1·2 3·8 1·3 3·5a 1·2 8·9 8·6 8·5 3·96 1·64 1·20 0·45 0·19 0·14 HC 2·7 0·1 1·6 0·3 2·5 0·1 11·3 13·4 12·3 0·97 1·1 1·60 0·07 0·07 0·46 ADPN = adiponectin, BL = baseline, EP = endpoint, HC = high-carbohydrate, moderate fat diet, IP = interim point, LAR = leptin:adiponectin ratio, LEPT = leptin, LC = low-carbohydrate, high-fat diet, VAT = visceral adipose tissue, ap = ·015. NB: interquartile ranges not provided for median values due to missing data. Higher LAR has been found to be a marker of increased CM risk(4). In conclusion, while the significant reduction in VAT in the LC group corresponds with the reduction of LAR further evidence is required to corroborate these findings. Previous evidence for LC is supportive for improved CM health from various biomarkers(5); LAR should be considered as a useful endocrine addition for future LC studies. 1. Krasimira A, Mozaffarian D & Pischon T (2018) Clin Chem 64, 142–153. 2. Rüttgers D, Fischer K, Koch M et al. (2015) Br J Nutr 114, 1929–1940. 3. Jebb S, Lovegrove J, Griffin B et al. (2010) Am J Clin Nutr 92, 748–58. 4. López-Jaramillo P, Gómez-Arbeláez D, López-López J et al. (2014) Horm Mol Biol Clin Investig 18, 37–45. 5. Bazzano L, Hi T, Reynolds K et al. (2014) Ann Intern Med 161, 309–318

The impact of deep-sea fisheries and implementation of the UNGA Resolutions 61/105 and 64/72. Report of an international scientific workshop

The scientific workshop to review fisheries management, held in Lisbon in May 2011, brought together 22 scientists and fisheries experts from around the world to consider the United Nations General Assembly (UNGA) resolutions on high seas bottom fisheries: what progress has been made and what the outstanding issues are. This report summarises the workshop conclusions, identifying examples of good practice and making recommendations in areas where it was agreed that the current management measures fall short of their target

Low density lipoprotein quality and discordance with apolipoprotein B in intensively controlled Type 1 diabetes: Any relationship with nutrition?

Type 1 diabetes (T1D) is partly characterised by a higher prevalence of cardiovascular disease (CVD). Despite low density lipoprotein cholesterol (LDL-C) being a commonly treated target, apolipoprotein B (Apo B) has been shown to be a superior predictor of CVD and discordance between these two markers may predispose patients to altered risk(1). The distribution of LDL-C also contributes to these risks, with LDL III & IV fractions possessing greater atherogenic potential(2). Few studies have investigated LDL-C quality and its discordance with Apo B in relation to the nutritional intake of patients with intensively controlled Type 1 diabetes. The aim of this study was to address this dearth of research. Following ethical approval and informed consent 28 patients (32 % male; 68 % female) (mean age 48 ± 15) were asked to complete a food frequency questionnaire (FFQ), donate a sample of blood and allow the authors access to their medical records to determine HbA1c. The initial FFQ responses were processed using FETA software. The blood sample was analysed for LDL-C, constituent subfractions and Apo B. All data were interrogated using descriptive statistics. Dichotomous dependent variables pertaining to LDL-C and Apo B were compared using McNemar’s test and correlations between dietary variables were determined with Spearman’s rho test. Significant differences were shown between LDL-C categories when compared to Apo B (p = 0·039) and the majority of patients (46·4 %) presented LDL-C >2·0 mmol/L and Apo B >80 mg/dL (Fig. 1). Although not discordant, these findings still suggest an increased risk according to recommendations(3). Closer inspection of results revealed that individuals with raised LDL-C typically had an abundance of LDL I & II fractions which may somewhat reduce this risk (Fig. 2). Spearman’s correlation applied to the whole population produced no relationship between diet and LDL-C or Apo B; however, when focussing on the predominant ‘at risk’ cluster significant and strong relationships between LDL-C and total carbohydrate (R2 = 0·835; p = <0·001) and sucrose (R2 = 0·758; p = 0·003) were found. No hypoglycaemia data were collected and the authors tentatively speculate that these relationships may be a consequence of its treatment. In the light of the small sample size a further more comprehensive investigation with an appropriately powered sample would be beneficial

The influence of continuous subcutaneous insulin infusion therapy vs. multiple daily injections upon the diet of those with Type 1 diabetes: A food diary investigation

There exist a number of therapeutic options for the management of Type 1 diabetes (T1D). Multiple daily injections (MDI) are one such treatment and involve 4-5 daily subcutaneous injections of insulin. This frequently used approach is widely regarded as an effective method of controlling glycaemia; however, if a patient continues to suffer disabling episodes of hypoglycaemia, or if HbA1c remains above 8.5% continuous subcutaneous insulin infusion (CSII) may instead be recommended1. This therapy employs a small programmable pump device to facilitate the administration of insulin to the patient via a cannula. Various advantages of CSII have been documented compared to MDI, including improvements in glycaemic control and reduced incidence of both hypoglycaemia and the dawn phenomenon. An additional attribute, characterised by the flexible nature of the therapy, is that a liberalised diet may be enjoyed by patients, which in turn may infer potential nutrition and quality of life aberrations. This phenomenon is surprisingly under researched and further investigations to inform both treatment and risk would therefore be beneficial. Following ethical approval and informed consent patients with T1D using either CSII or MDI from the Royal Liverpool Hospital were asked to complete a 5 day weighed food diary. Dietplan 6 software was used to process the responses and demographic data from participants’ medical records were added to the dataset. All data were then interrogated using descriptive statistics and any non-normal data were transformed logarithmically before further enquiry with t-tests or analysed non-parametrically with Mann-Whitney-U-tests. The sample comprised of 20 patients (35% male, 65% female) with 11 using CSII and 9 using MDI. The patients’ mean age was 49±16 years and the majority were overweight or obese (72.7% CSII, 55.6% MDI). Nutrient Amount per day (CSII group) Amount per day (MDI group) % energy intake per day (CSII group) % energy intake per day (MDI group) Energy 1866.6 Kcal 2110.5 Kcal N/A N/A Protein 69.0 g/day 89.9 g/day 14.8 17.0 Total CHO 232.3 g/day 251.8 g/day 46.7 44.7 Total sugars 99.8 g/day 88.6 g/day 20.0 15.7 Total fat 73.5 g/day 80.1 g/day 35.4 34.2 Saturated fat 31.6 g/day 29.8 g/day 15.2 12.7 Table. Selected food diary results from patients using CSII and MDI compared to reference nutrient intakes. Results showed mean energy intake was below the reference nutrient intake (RNI) for the CSII group; potentially suggestive of underreporting (Table)3. Patients using both CSII and MDI consumed protein above the RNI; however, this macronutrient contributed towards 14.8% of the daily energy intake of patients using CSII and 17.0% of those using MDI3. Total carbohydrate (CHO) consumption was below the RNI of 50%; however, it should be noted that consumption of total sugars was above the RNI for males and females in both groups4. Previous research by the authors suggesting habitual fruit consumption, particularly in those using CSII, may explain this5. Total fat and saturated fat consumption was mostly synonymic with RNI’s. Although no statistically significant associations were seen between any of the variables and the diets of the two populations appeared largely homogenous it is reassuring that no detrimental changes occurred. Despite this further analysis of total energy, protein and CHO quality is warranted

Heat kernel and number theory on NC-torus

The heat trace asymptotics on the noncommutative torus, where generalized Laplacians are made out of left and right regular representations, is fully determined. It turns out that this question is very sensitive to the number-theoretical aspect of the deformation parameters. The central condition we use is of a Diophantine type. More generally, the importance of number theory is made explicit on a few examples. We apply the results to the spectral action computation and revisit the UV/IR mixing phenomenon for a scalar theory. Although we find non-local counterterms in the NC $\phi^4$ theory on \T^4, we show that this theory can be made renormalizable at least at one loop, and may be even beyond