Time to address the double inequality of differences in dietary intake between Scotland and England

Geographical disparities in health outcomes have been evident across the UK for decades. There is limited recent analysis on the dietary differences between Scotland and England that might go some way to explain these health differences. This study aimed to assess whether, and to what degree, aspects of diet and nutrition differ between Scottish and English populations, specifically between those with similar household incomes. Twelve years of UK food purchase data (2001-2012) were pooled and used to estimate household level consumption data for Scotland and England. Population mean food consumption and nutrient intakes were estimated, adjusting for known confounders (year, age of household reference person, age they left full-time education and income). Comparison was also made within equivalised income quintiles. Analysis showed that the foods and nutrients that should be increased in the diet (highlighted in the Scottish Dietary Goals) were lower in Scotland than England (e.g. fruit and vegetables 267g/day (99%CI 259-274g/day) vs. 298g/day (99%CI 296-301g/day), P<0.001). Likewise, foods and drinks linked with poor health outcomes were higher in Scotland. These regional inequalities in diet were even more pronounced in the lower income groups (e.g. red and processed meat consumption in the lowest income quintile was 65g/day (99% CI 61-69g/day) in Scotland vs. 58g/day (99% CI 57-60g/day) in England, P<0.001, but similar in the highest income quintile (58g/day (99%CI 54-61 g/day) vs. 59g/day (99% CI 58-60 g/day) respectively). A poorer diet in Scotland compared to England, particularly among disadvantaged groups, may contribute to differences in excess mortality between countries

Translating evidence-based guidelines to improve feedback practices:the interACT case study

Background: There has been a substantial body of research examining feedback practices, yet the assessment and feedback landscape in higher education is described as ‘stubbornly resistant to change’. The aim of this paper is to present a case study demonstrating how an entire programme’s assessment and feedback practices were re-engineered and evaluated in line with evidence from the literature in the interACT (Interaction and Collaboration via Technology) project.Methods: Informed by action research the project conducted two cycles of planning, action, evaluation and reflection. Four key pedagogical principles informed the re-design of the assessment and feedback practices. Evaluation activities included document analysis, interviews with staff (n = 10) and students (n = 7), and student questionnaires (n = 54). Descriptive statistics were used to analyse the questionnaire data. Framework thematic analysis was used to develop themes across the interview data.Results: InterACT was reported by students and staff to promote self-evaluation, engagement with feedback and feedback dialogue. Streamlining the process after the first cycle of action research was crucial for improving engagement of students and staff. The interACT process of promoting self-evaluation, reflection on feedback, feedback dialogue and longitudinal perspectives of feedback has clear benefits and should be transferable to other contexts.Conclusions: InterACT has involved comprehensive re-engineering of the assessment and feedback processes using educational principles to guide the design taking into account stakeholder perspectives. These principles and the strategies to enact them should be transferable to other contexts

Identifying dietary differences between Scotland and England:a rapid review of the literature

Rates of premature mortality have been higher in Scotland than in England since the 1970s. Given the known association of diet with chronic disease, the study objective was to identify and synthesise evidence on current and historical differences in food and nutrient intakes in Scotland and England.A rapid review of the peer-reviewed and grey literature was carried out. After an initial scoping search, Medline, CINAHL, Embase and Web of Science were searched. Relevant grey literature was also included. Inclusion criteria were: any date; measures of dietary intake; representative populations; cross-sectional or observational cohort studies; and English-language publications. Study quality was assessed using the Quality Assessment Tool for Observational Cohort and Cross-sectional Studies. A narrative synthesis of extracted information was conducted.Fifty publications and reports were included in the review. Results indicated that children and adults in Scotland had lower intakes of vegetables and vitamins compared with those living in England. Higher intakes of salt in Scotland were also identified. Data were limited by small Scottish samples, difficulty in finding England-level data, lack of statistical testing and adjustment for key confounders.Further investigation of adequately powered and analysed surveys is required to examine more fully dietary differences between Scotland and England. This would provide greater insight into potential causes of excess mortality in Scotland compared with England and suitable policy recommendations to address these inequalities

Developing a national dental education research strategy:priorities, barriers and enablers

Objectives: This study aimed to identify national dental education research (DER) priorities for the next 3-5 years and to identify barriers and enablers to DER. Setting: Scotland Participants: In this two-stage online questionnaire study we collected data with multiple dental professions (e.g. dentistry, dental nursing, dental hygiene) and stakeholder groups (e.g. learners, clinicians, educators, managers, researchers, academics). Eighty-five participants completed the Stage 1 qualitative questionnaire and 649 participants the Stage 2 quantitative questionnaire. Results: Eight themes were identified at Stage 1. Of the 24 DER priorities identified, the top three were: role of assessments in identifying competence; undergraduate curriculum prepares for practice; and promoting teamwork. Following exploratory factor analysis, the 24 items loaded onto four factors: teamwork and professionalism, measuring and enhancing performance, dental workforce issues, and curriculum integration and innovation. Barriers and enablers existed at multiple levels: individual, interpersonal, institutional structures and cultures, and technology. Conclusion: This priority setting exercise provides a necessary first step to developing a national DER strategy capturing multiple perspectives. Promoting DER requires improved resourcing alongside efforts to overcome peer stigma and lack of valuing and motivation

Inter-individual differences in the nutrition response:from research to recommendations

The 2019 Nutrition Society Spring Conference, which convened in Dundee, focused on the challenges presented by inter-individual differences in the responses to nutrition and in conducting nutritional research. The programme brought together national and international experts to discuss the collective evidence on inter-individual nutritional responses and impacts on health. Speakers and delegates from across the UK, Europe and the USA debated new methods of conducting research in nutrition and discussed the development of appropriate dietary interventions to maintain health and prevent disease in diverse populations. Symposium 1 focused on the effects of ethnicity on nutrient availability and type 2 diabetes and cardio-metabolic disease. Symposium 2 explored sex differences in nutrient availability and health and metabolism. The final symposium examined genetic and phenotypic variation, nutrition and health. The meeting ended with a panel discussion about how we take research to recommendations and concluded with a need to consider inter-individual differences in planning, conducting and analysing nutritional research.</p

Development of food photographs for use with children aged 18 months to 16 years:comparison against weighed food diaries – The Young Person’s Food Atlas (UK)

Traditional dietary assessment methods, used in the UK, such as weighed food diaries impose a large participant burden, often resulting in difficulty recruiting representative samples and underreporting of energy intakes. One approach to reducing the burden placed on the participant is to use portion size assessment tools to obtain an estimate of the amount of food consumed, removing the need to weigh all foods. An age range specific food atlas was developed for use in assessing children’s dietary intakes. The foods selected and portion sizes depicted were derived from intakes recorded during the UK National Diet and Nutrition Surveys of children aged 1.5 to 16 years. Estimates of food portion sizes using the food atlas were compared against 4-day weighed intakes along with in-school / nursery observations, by the research team. Interviews were conducted with parents the day after completion of the diary, and for children aged 4 to 16 years, also with the child. Mean estimates of portion size consumed were within 7% of the weight of food recorded in the weighed food diary. The limits of agreement were wide indicating high variability of estimates at the individual level but the precision increased with increasing age. For children 11 years and over, agreement with weighed food diaries, was as good as that of their parents in terms of total weight of food consumed and of intake of energy and key nutrients. The age appropriate food photographs offer an alternative to weighed intakes for dietary assessment with children

The acute effects of diet-induced energy restriction on physical activity energy expenditure and basal metabolic rate in men and women with overweight and obesity

Introduction: Reductions in physical activity energy expenditure (PAEE) and basal metabolic rate (BMR) have been proposed as factors that may hinder diet-induced body mass loss. Although diet-mediated changes in PAEE and BMR are subject to large inter-individual variability, research investigating the impact of sex on diet-induced modulation of PAEE and BMR is lacking. Therefore, this study examined the effect of a diet-induced energy restriction on PAEE and BMR in non-exercising overweight and obese men and women. Methods: Eleven women (Age: 25 ± 7 yr; BMI: 29.7 ± 4.2 kg/m 2) and eight men (Age 29.6 ± 4.0 yr; BMI: 29.7 ± 4.0 kg/m 2) completed a 29-day investigation. Assessment of physical activity (PA) (PAEE and step count), BMR, body composition, systolic (SBP) and diastolic (DBP) blood pressure and fasting blood glucose (FBG) occurred on days 1, 8, 15, 22 and 29. Between days 15–22, participants consumed a liquid diet formula equivalent to 50% of their total daily energy expenditure (TDEE). The effects of time, sex and their interaction on all variables were assessed through a two-way mixed model ANOVA. Results: Both men and women achieved a modest 3% body mass loss at the end of the intervention week. An effect of time was detected for body mass (p &lt; 0.001), BMI (p &lt; 0.001), body fat % (p = 0.001), SBP (p = 0.007), DBP (p = 0.033) and BG (p &lt; 0.001). There was a time and sex interaction for body mass (p = 0.002), BMI (p = 0.002) and body fat % (p = 0.043). Sex differences were only present for body fat % (p = 0.001) and BMR (p &lt; 0.001). No main or interaction effects were present for PAEE and step count. Conclusion: In the present study, a 7-day diet-induced energy restriction of 50% did not elicit compensatory changes in PAEE and BMR in overweight and obese men and women. Findings suggest that it may be a viable short-term strategy to produce initial reductions in body mass and body fat %, with improvements in fasting blood glucose and resting blood pressure.</p

What can secondary data tell us about household food insecurity in a high-income country context?

In the absence of routinely collected household food insecurity data, this study investigated what could be determined about the nature and prevalence of household food insecurity in Scotland from secondary data. Secondary analysis of the Living Costs and Food Survey (2007–2012) was conducted to calculate weekly food expenditure and its ratio to equivalised income for households below average income (HBAI) and above average income (non-HBAI). Diet Quality Index (DQI) scores were calculated for this survey and the Scottish Health Survey (SHeS, 2008 and 2012). Secondary data provided a partial picture of food insecurity prevalence in Scotland, and a limited picture of differences in diet quality. In 2012, HBAI spent significantly less in absolute terms per week on food and non-alcoholic drinks (£53.85) compared to non-HBAI (£86.73), but proportionately more of their income (29% and 15% respectively). Poorer households were less likely to achieve recommended fruit and vegetable intakes than were more affluent households. The mean DQI score (SHeS data) of HBAI fell between 2008 and 2012, and was significantly lower than the mean score for non-HBAI in 2012. Secondary data are insufficient to generate the robust and comprehensive picture needed to monitor the incidence and prevalence of food insecurity in Scotland.</p