Response of appetite and potential appetite regulators following intake of high energy nutritional supplements

Background: The net clinical benefit of high-energy nutritional supplements (HENSDs) consumption is lower than expected. Objectives: To investigate the extent to which consumption of oral HENSD in the fasted state reduces energy intake in slim females during consecutive breakfast and lunch, and whether this relates to changes in appetite and metabolic appetite regulators. Design: Twenty three females of 24.4 ± 2.8 years with BMI of 18.2 ± 0.8 kg/m2 consumed HENSD (2.5 MJ) or PLACEBO (0.4 MJ) in fasted state in a single blind randomized cross-over study. Appetite and metabolic rate measurements and blood collection were conducted prior to and during 240 min after the intake of the supplements. Energy intake was recorded during ad libitum buffet breakfast and lunch served 60 min and 240 min post supplementation respectively. Results: Energy intake during breakfast was significantly (P < 0.01) lower in the HENSD trial but the net cumulative effect on energy intake was 1.07 ± 0.34 MJ higher in the HENSD compared to PLACEBO. Plasma concentration of CCK and PYY and insulin and were significantly (P < 0.05) higher in the HENSD trial while appetite measures were not significantly different between HENSD and PLACEBO trials. Correlations for the within participant relations between the responses of plasma hormones and appetite scores were significant (P < 0.05) for PYY and insulin but not CCK. The energy expended aboveresting metabolic rate was significantly (P < 0.05) higher in the HENDS trial but relative increase in energy expenditure was not significantly different between the two trials. Conclusion: Oral high-energy nutritional supplements have a partial and relatively short lived suppressive action on energy intake and can be expected to increase net energy intake by approximately half the energy value of the supplement consumed

A multicentre development and evaluation of a dietetic referral score for nutritional risk in sick infants

Background & aims: Unrecognized nutritional issues may delay recovery in hospitalized infants. It has been proposed that nutritional risk screening should be performed at hospital admission, but few tools include infants. The aim of this study was to develop and test a tool to identify sick infants in need of dietetic input. Methods: Hospitalised infants were recruited from hospitals in the United Kingdom (UK), Greece and Iran. Weight, skinfold thickness and mid upper arm circumference (MUAC) were measured, with detailed dietetic assessment in the UK and Greece. Simple screening questions were used in the UK cohort to formulate a score (infant early nutrition warning score-iNEWS) which was then validated in the Greek and Iranian groups. Results: After dietetic assessment, 20 (9.6%) UK and 22 (22%) Greek infants were rated as needing dietetic input. Underweight, poor weight gain/loss and reduced intake were all independent predictors of perceived need for dietetic input in stepwise multivariate regression analysis. The score based on these items (iNEWS), had 84% sensitivity, 91% specificity and 49% positive predictive value to predict need for dietetic input in the UK cohort. In the Greek cohort this was 86%, 78% and 53% respectively. In all three countries, infants with high iNEWS had significantly lower average skinfold thickness (between −1 and −1.8 SD, p < 0.0001) and MUAC (between −1.8 and −2 SD, p < 0.0001) than those at low risk. Conclusions: iNEWS, a simple nutritional risk tool, identifies most hospitalised infants who need dietetic input. Clinical trial registration: https://clinicaltrials.gov/ct2/show/NCT03323957

Effects of long-term consumption of two plant-based dietary supplements on cardiovascular health and low-grade inflammation in middle-aged and elderly people: study protocol for a randomised, controlled trial

Abstract Background Ageing is a process characterised by chronic low-grade inflammation and oxidative stress which could lead to increased prevalence of both physical and mental age-related chronic conditions. A healthy balanced diet, rich in fruit and vegetables as well as omega-3 polyunsaturated fatty acids (n3 PUFA), could reduce oxidative stress and improve markers of low-grade inflammation. Nonetheless, considering that a large part of the population struggles to meet current guidelines on fruit and vegetable and n3 PUFA recommendations, fruit and vegetable concentrate supplements and mixed omega fatty acid supplements could be an effective strategy to bridge the gap between actual and recommended intakes. Methods In this randomised, controlled, open-labelled, parallel-grouped clinical trial, 112 participants will be allocated to one of four arms (n = 28 on each arm): an encapsulated juice powder concentrate, a plant-based omega fatty acid supplement, both or a control group. We aim to investigate whether long-term separate or combined ingestion of the two can affect biomarkers of cardiovascular health, low-grade inflammation and indicators of ageing, including cognitive function, in middle-aged and elderly people. We will additionally explore the effect of the different supplementations on plasma levels of vitamins, carotenoids and fatty acids. Intervention will last 2 years and participants will be assessed at baseline and at follow-up visits at 6, 12, 18 and 24 months. Discussion This study will provide evidence whether long-term, plant-based dietary supplementation can support cardiovascular health, anti-inflammatory processes, immunity and nutritional status in ageing. Trial registration This trial was registered at ClinicalTrials.gov (NCT04763291) on February 21, 2021

Brief support and personalised feedback on food shopping to encourage saturated fat reduction: the PC-SHOP randomised controlled trial

Reducing saturated fat (SFA) intake can lower low-density lipoprotein (LDL)-cholesterol and thereby cardiovascular disease (CVD) but there are no brief interventions sufficiently scalable to achieve this. The Primary Care Shopping Intervention for Cardiovascular Disease Prevention (PC-SHOP) study developed and tested a behavioural intervention to provide health professional (HP) advice alone or in combination with personalised feedback on food shopping, which was delivered using a bespoke tool that created a nutritional profile of the grocery shopping based on loyalty card data from the UK largest supermarket.Participants with raised LDL-cholesterol were randomly allocated to one of three groups: ‘No Intervention’ (n = 17), ‘Brief Support’ (BS, n = 48), ‘Brief Support plus Shopping Feedback’ (BSSF, n = 48). BS consisted of a 10-minute consultation with a nurse to inform and motivate participants to reduce their SFA intake. The BSSF group received brief support as well as personalised feedback on the SFA content of their grocery shopping including lower SFA swaps. The primary outcome was the between-group difference in the change between baseline and 3 months in SFA intake (% total energy intake) adjusted for baseline SFA intake and GP practice. The trial was powered to detect a reduction in SFA of 3% (SD3).There was no evidence of a difference between the groups. Changes in SFA intake from baseline to follow-up were: -0.7% (SD3.5) in BS, -0.9% (SD3.6) in BSSF and -0.1% (SD3.3) with no intervention. Compared to no intervention, the adjusted difference in SFA intake was -0.33%; 95%CI -2.11, 1.44 with BS and -0.11%; 95%CI -1.92, 1.69 with BSSF. There was no significant difference in total energy intake (BS: -152kcal; 95%CI -513, 209; BSSF: -152kcal; 95%CI -516, 211); body weight (BS: -1.0 kg; 95%CI -2.5, 0.5; BSSF: -0.6 kg 95%CI -2.1, 1.0); or LDL-cholesterol (BS: -0.15mmol/L; 95%CI -0.47, 0.16; BSSF: -0.04mmol/L; 95%CI -0.28, 0.36) compared to no intervention.This trial shows that it is feasible to deliver brief advice in primary care to encourage reductions in SFA intake and we have developed a system to provide personalised advice to encourage healthier choices using supermarket loyalty data. This small trial showed no evidence of large benefits but we are unable to exclude more modest benefits. Even a reduction of 1% in SFA intake when replaced by polyunsaturated fat may reduce CVD incidence by 8%, suggesting that a larger trial to assess whether benefits of this size may occur is now warranted

Brief support and personalised feedback on food shopping to encourage saturated fat reduction: the PC-SHOP randomised controlled trial

Reducing saturated fat (SFA) intake can lower low-density lipoprotein (LDL)-cholesterol and thereby cardiovascular disease (CVD) but there are no brief interventions sufficiently scalable to achieve this. The Primary Care Shopping Intervention for Cardiovascular Disease Prevention (PC-SHOP) study developed and tested a behavioural intervention to provide health professional (HP) advice alone or in combination with personalised feedback on food shopping, which was delivered using a bespoke tool that created a nutritional profile of the grocery shopping based on loyalty card data from the UK largest supermarket.Participants with raised LDL-cholesterol were randomly allocated to one of three groups: ‘No Intervention’ (n = 17), ‘Brief Support’ (BS, n = 48), ‘Brief Support plus Shopping Feedback’ (BSSF, n = 48). BS consisted of a 10-minute consultation with a nurse to inform and motivate participants to reduce their SFA intake. The BSSF group received brief support as well as personalised feedback on the SFA content of their grocery shopping including lower SFA swaps. The primary outcome was the between-group difference in the change between baseline and 3 months in SFA intake (% total energy intake) adjusted for baseline SFA intake and GP practice. The trial was powered to detect a reduction in SFA of 3% (SD3).There was no evidence of a difference between the groups. Changes in SFA intake from baseline to follow-up were: -0.7% (SD3.5) in BS, -0.9% (SD3.6) in BSSF and -0.1% (SD3.3) with no intervention. Compared to no intervention, the adjusted difference in SFA intake was -0.33%; 95%CI -2.11, 1.44 with BS and -0.11%; 95%CI -1.92, 1.69 with BSSF. There was no significant difference in total energy intake (BS: -152kcal; 95%CI -513, 209; BSSF: -152kcal; 95%CI -516, 211); body weight (BS: -1.0 kg; 95%CI -2.5, 0.5; BSSF: -0.6 kg 95%CI -2.1, 1.0); or LDL-cholesterol (BS: -0.15mmol/L; 95%CI -0.47, 0.16; BSSF: -0.04mmol/L; 95%CI -0.28, 0.36) compared to no intervention.This trial shows that it is feasible to deliver brief advice in primary care to encourage reductions in SFA intake and we have developed a system to provide personalised advice to encourage healthier choices using supermarket loyalty data. This small trial showed no evidence of large benefits but we are unable to exclude more modest benefits. Even a reduction of 1% in SFA intake when replaced by polyunsaturated fat may reduce CVD incidence by 8%, suggesting that a larger trial to assess whether benefits of this size may occur is now warranted

Evaluation of an intervention to provide brief support and personalized feedback on food shopping to reduce saturated fat intake (PC-SHOP): A randomized controlled trial.

BackgroundGuidelines recommend reducing saturated fat (SFA) intake to decrease cardiovascular disease (CVD) risk, but there is limited evidence on scalable and effective approaches to change dietary intake, given the large proportion of the population exceeding SFA recommendations. We aimed to develop a system to provide monthly personalized feedback and healthier swaps based on nutritional analysis of loyalty card data from the largest United Kingdom grocery store together with brief advice and support from a healthcare professional (HCP) in the primary care practice. Following a hybrid effectiveness-feasibility design, we tested the effects of the intervention on SFA intake and low-density lipoprotein (LDL) cholesterol as well as the feasibility and acceptability of providing nutritional advice using loyalty card data.Methods and findingsThe Primary Care Shopping Intervention for Cardiovascular Disease Prevention (PC-SHOP) study is a parallel randomized controlled trial with a 3 month follow-up conducted between 21 March 2018 to 16 January2019. Adults ≥18 years with LDL cholesterol >3 mmol/L (n = 113) were recruited from general practitioner (GP) practices in Oxfordshire and randomly allocated to "Brief Support" (BS, n = 48), "Brief Support + Shopping Feedback" (SF, n = 48) or "Control" (n = 17). BS consisted of a 10-minute consultation with an HCP to motivate participants to reduce their SFA intake. Shopping feedback comprised a personalized report on the SFA content of grocery purchases and suggestions for lower SFA swaps. The primary outcome was the between-group difference in change in SFA intake (% total energy intake) at 3 months adjusted for baseline SFA and GP practice using intention-to-treat analysis. Secondary outcomes included %SFA in purchases, LDL cholesterol, and feasibility outcomes. The trial was powered to detect an absolute reduction in SFA of 3% (SD3). Neither participants nor the study team were blinded to group allocation. A total of 106 (94%) participants completed the study: 68% women, 95% white ethnicity, average age 62.4 years (SD 10.8), body mass index (BMI) 27.1 kg/m2 (SD 4.7). There were small decreases in SFA intake at 3 months: control = -0.1% (95% CI -1.8 to 1.7), BS = -0.7% (95% CI -1.8 to 0.3), SF = -0.9% (95% CI -2.0 to 0.2); but no evidence of a significant effect of either intervention compared with control (difference adjusted for GP practice and baseline: BS versus control = -0.33% [95% CI -2.11 to 1.44], p = 0.709; SF versus control = -0.11% [95% CI -1.92 to 1.69], p = 0.901). There were similar trends in %SFA based on supermarket purchases: control = -0.5% (95% CI -2.3 to 1.2), BS = -1.3% (95% CI -2.3 to -0.3), SF = -1.5% (95% CI -2.5 to -0.5) from baseline to follow-up, but these were not significantly different: BS versus control p = 0.379; SF versus control p = 0.411. There were small reductions in LDL from baseline to follow-up (control = -0.14 mmol/L [95% CI -0.48, 0.19), BS: -0.39 mmol/L [95% CI -0.59, -0.19], SF: -0.14 mmol/L [95% CI -0.34, 0.07]), but these were not significantly different: BS versus control p = 0.338; SF versus control p = 0.790. Limitations of this study include the small sample of participants recruited, which limits the power to detect smaller differences, and the low response rate (3%), which may limit the generalisability of these findings.ConclusionsIn this study, we have shown it is feasible to deliver brief advice in primary care to encourage reductions in SFA intake and to provide personalized advice to encourage healthier choices using supermarket loyalty card data. There was no evidence of large reductions in SFA, but we are unable to exclude more modest benefits. The feasibility, acceptability, and scalability of these interventions suggest they have potential to encourage small changes in diet, which could be beneficial at the population level.Trial registrationISRCTN14279335

The Antiplatelet Action of S-Nitroso Human Serum Albumin in Whole Blood

Nitric oxide donors (NO-donors) have been shown to have therapeutic potential (e.g., ischemia/reperfusion injury). However, due to their release rate/antiplatelet properties, they may cause bleeding in patients. We therefore studied the antiplatelet effects of the two different NO-donors, i.e., S-NO-Human Serum Albumin (S-NO-HSA) and Diethylammonium (Z)-1-(N,N-diethylamino)diazen-1-ium-1,2-diolate (DEA-NONOate) in whole blood (WB) samples. WB samples were spiked with S-NO-HSA or DEA-NONOate (100 µmol/L or 200 µmol/L), and the NO release rate (nitrite/nitrate levels via HPLC) and antiplatelet efficacy (impedance aggregometry, platelet function analyzer, Cone-and-platelet analyzer, thrombelastometry) were assessed. S-NO-HSA had a significantly lower NO release compared to equimolar concentrations of DEA-NONOate. Virtually no antiplatelet action of S-NO-HSA was observed in WB samples, whereas DEA-NONOate significantly attenuated platelet function in WB. Impedance aggregometry measurements revealed that Amplitudes (slope: −0.04022 ± 0.01045 ohm/µmol/L, p = 0.008) and Lag times (slope: 0.6389 ± 0.2075 s/µmol/L, p = 0.0051) were dose-dependently decreased and prolonged by DEA-NONOate. Closure times (Cone-and-platelet analyzer) were dose-dependently prolonged (slope: 0.3738 ± 0.1403 s/µmol/L, p = 0.0174 with collagen/ADP coating; slope: −0.5340 ± 0.1473 s/µmol/L, p = 0.0019 with collagen/epinephrine coating) by DEA-NONOate. These results in WB further support the pharmacological potential of S-NO-HSA as an NO-donor due to its ability to presumably prevent bleeding events even at high concentrations up to 200 µmol/L

Orthostatic Challenge-Induced Coagulation Activation in Young and Older Persons

The incidence of thrombosis increases with aging. We investigated the coagulatory/haemostatic system across the ages and tested the hypothesis that older persons have a hypercoagulable state compared to younger persons at rest, and that standing up (orthostasis) leads to greater changes in coagulation in older persons. In total, 22 older and 20 young participants performed a 6 min sit-to-stand test (orthostatic challenge). Blood was collected prior to and at the end of standing and haemostatic profiling was performed via thrombelastometry (TEM), calibrated automated thrombogram (CAT) and standard coagulation assays. At baseline, three CAT-derived values indicated enhanced capability to generate thrombin in older participants. However, other measured parameters did not suggest a hypercoagulable state in older participants: prolonged TEM-derived coagulation times (295 vs. 209 s, medians, p = 0.0025) and prothrombin times (103 vs. 114%, medians, p = 0.0087), as well as lower TF levels (440 vs. 672 pg/mL, medians, p = 0.0245) and higher t-PA levels (7.3 vs. 3.8 ng/mL, medians, p = 0.0002), indicative of enhanced fibrinolytic capability, were seen. Younger participants were more sensitive to the orthostatic challenge: CAT-derived endogenous thrombin potentials (ETPs) were only increased in the young (1337 to 1350 nM.min, medians, p = 0.0264) and shortening of PTs was significantly higher in the young vs. older participants (p = 0.0242). Our data suggest that the increased thrombosis propensity in older persons is not primarily attributable to a hyperactive coagulation cascade but may be due to other pathologies associated with aging