Contemporary challenges to iodine status and nutrition: the role of foods, dietary recommendations, fortification and supplementation

Iodine deficiency (ID) in women of childbearing age remains a global public health concern, mainly through its impact on fetal and infant neurodevelopment. While iodine status is improving globally, ID is still prevalent in pregnancy, when requirements increase. More than 120 countries have implemented salt iodisation and food fortification, strategies that have been partially successful. Supplementation during pregnancy is recommended in some countries and supported by the WHO when mandatory salt iodisation is not present. The UK is listed as one of the ten countries with the lowest iodine status globally, with approximately 60 % of pregnant women not meeting the WHO recommended intake. Without mandatory iodine fortification or recommendation for supplementation in pregnancy, the UK population depends on dietary sources of iodine. Both women and healthcare professionals have low knowledge and awareness of iodine, its sources or its role for health. Dairy and seafood products are the richest sources of iodine and their consumption is essential to support adequate iodine status. Increasing iodine through the diet might be possible if iodine-rich foods get repositioned in the diet, as they now contribute towards only about 13 % of the average energy intake of adult women. This review examines the use of iodine-rich foods in parallel with other public health strategies, to increase iodine intake and highlights the rare opportunity in the UK for randomised trials, due to the lack of mandatory fortification programmes

Protein–phenolic interactions and inhibition of glycation – combining a systematic review and experimental models for enhanced physiological relevance

Background: While antiglycative capacity has been attributed to (poly)phenols, the exact mechanism of action remains unclear. Studies so far are often relying on supra-physiological concentrations and use of non-bioavailable compounds.<p></p> Methods: To inform the design of a physiologically relevant in-vitro study, we carried out a systematic literature review of dietary interventions reporting plasma concentrations polyphenol metabolites. Bovine Serum Albumin (BSA) was pre-treated prior to in vitro glycation: either no treatment (native), pre-oxidised (incubated with 10nM H2O2, for 8 hours) or incubated with a mixture of phenolic acids at physiologically relevant concentrations, for 8 hours). In-vitro glycation was carried out in presence of i) glucose only (0, 5 or 10mM), ii) glucose (0, 5 or 10mM) plus H2O2 (10nM), or iii) glucose (0, 5 or 10mM) plus phenolic acids (10-160nM). Fructosamine was measured using the nitroblue tetrazolium method.<p></p> Results: Following (high) dietary polyphenol intake, 3-hydroxyphenylacetic acid is the most abundant phenolic acid in peripheral blood (up to 338μM) with concentrations for other phenolic acids ranging from 13nM-200μM. Presence of six phenolic acids with BSA during in-vitro glycation did not lower fructosamine formation. However, when BSA was pre-incubated with phenolic acids, significantly lower concentration of fructosamine was detected under glycoxidative conditions (glucose 5 or 10mM plus H2O2 10nM) (p<0.001 vs. native BSA).<p></p> Conclusion: Protein pre-treatment, either with oxidants or phenolic acids, is an important regulator of subsequent glycation in a physiologically relevant system. High quality in-vitro studies under conditions closer to physiology are feasible and should be employed more frequently.<p></p&gt

Changes in BMI and waist circumference in Scottish adults: use of repeated cross-sectional surveys to explore multiple age groups and birth-cohorts

Objective: To document changes in body mass index (BMI) and waist circumference (WC) over a 10-year period 1998-2008, in representative surveys of adults.<p></p> Subjects: Adults aged 18-72 in the Scottish Health Surveys conducted in 1998, 2003 and 2008 were divided, separately for men and women, into eleven 5-year age bands. ‘Synthetic birth-cohorts’ were created by dividing participants into thirteen 5-years-of-birth bands (n=20,423). Weight, height and waist circumference were objectively measured by trained observers.<p></p> Results: Subjects with data available on BMI/waist circumference were 7743/6894 in 1998, 5838/4437 in 2003 and 4688/925 in 2008 with approximately equal gender distributions. Mean BMI and waist were both greater in successive surveys in both men and women. At most specific ages, people were consistently heavier in 2008 than in 1998 by about 1-1.5 BMI units, and waist circumferences were greater, by about 2-6 cm in men and 5-7 cm in women. Greater increases were seen at younger ages between 1998 and 2003 than between 2003 and 2008, however increases continued at older ages, particularly in waist. All birth-cohorts observed over the 10 years 1998-2008 showed increases in both BMI and waist, most marked in the younger groups. The 10-year increases in waist within birth-cohorts (mean 7.4 cm (8.1%) in men and 8.6 cm (10.9%) in women) were more striking than BMI (mean 1.8 kg/m2 (6.6%) in men and 1.5 kg/m2 (6.4%) in women) were particularly steep in older women.<p></p> Conclusion: People were heavier and fatter in 2003 than those of the same age in 1998, with less marked increases in WC between 2003 and 2008 than 1998 and 2003. There were proportionally greater increases in waist circumference than BMI, especially in older women. This suggests a disproportionate increase in body fat, compared to muscle, particularly among older women.<p></p&gt

Altered gut and adipose tissue hormones in overweight and obese individuals: cause or consequence?

The aim of this article is to review the research into the main peripheral appetite signals altered in human obesity, together with their modifications after body weight loss with diet and exercise and after bariatric surgery, which may be relevant to strategies for obesity treatment. Body weight homeostasis involves the gut–brain axis, a complex and highly coordinated system of peripheral appetite hormones and centrally mediated neuronal regulation. The list of peripheral anorexigenic and orexigenic physiological factors in both animals and humans is intimidating and expanding, but anorexigenic glucagon-like peptide 1 (GLP-1), cholecystokinin (CCK), peptide YY (PYY) and orexigenic ghrelin from the gastrointestinal tract, pancreatic polypeptide (PP) from the pancreas and anorexigenic leptin from adiposites remain the most widely studied hormones. Homeostatic control of food intake occurs in humans, although its relative importance for eating behaviour is uncertain, compared with social and environmental influences. There are perturbations in the gut–brain axis in obese compared with lean individuals, as well as in weight-reduced obese individuals. Fasting and postprandial levels of gut hormones change when obese individuals lose weight, either with surgical or with dietary and/or exercise interventions. Diet-induced weight loss results in long-term changes in appetite gut hormones, postulated to favour increased appetite and weight regain while exercise programmes modify responses in a direction expected to enhance satiety and permit weight loss and/or maintenance. Sustained weight loss achieved by bariatric surgery may in part be mediated via favourable changes to gut hormones. Future work will be necessary to fully elucidate the role of each element of the axis, and whether modifying these signals can reduce the risk of obesity

Weight losses with low energy formula diets in obese patients with and without type 2 diabetes: Systematic review and meta-analysis

Aim: To provide a systematic review, of published data, to compare weight losses following very low calorie (<800 kcal per day VLCD) or low-energy liquid-formula (>800 kcal per day LELD) diets, in people with and without type 2 diabetes mellitus (T2DM). Methods: Systematic electronic searches of Medline (1946–2015) and Embase (1947–2015) to identify published studies using formula total diet replacement diets (VLCD/LELD). Random effects meta-analysis using weighted mean difference (WMD) in body weight between groups (with and without diabetes) as the summary estimate. Results: Final weight loss, in the five included studies, weighted for study sizes, (n=569, mean BMI=35.5–42.6 kg/m2), was not significantly different between participants with and without T2DM: −1.2 kg; 95% CI: −4.1 to 1.6 kg). Rates of weight loss were also similar in the two groups −0.6 kg per week (T2DM) and 0.5 kg per week (no diabetes), and for VLCD (lt;800 kcal per day) and LELD (>800 kcal per day). Conclusions: Weight losses with liquid-formula diets are very similar for VLCD and LELD and for obese subjects with or without T2DM. They can potentially achieve new weight loss/ maintenance targets of >15–20% for people with severe and medically complicated obesity

Effects of moderate weight loss on anginal symptoms and indices of coagulation and fibrinolysis in overweight patients with angina pectoris

Objective: To evaluate the effects of moderate weight loss, in overweight patients with angina, on plasma coagulation, fibrinolytic indicies and pain frequency. Design: Single- stranded 12-week dietary intervention, an individualised eating plan with quantitative advice delivered by a dietitian. Target weight loss of 0.5 kg per week. Setting: Outpatient research clinic. Subjects: Fifty-four volunteers with angina pectoris were recruited. Five subjects withdrew, so 27 males, 22 females, mean body mass index (BMI) 29.3 (s.d. 4.3) kg/m(2) and age 60.3 (s.d. 6.5) y completed the intervention. Measurements: Body weight and frequency of anginal pain. Plasma fibrinogen, red cell aggregation (RCA), viscosity, factor VII activity, plasminogen activator inhibitor (PAI) activity, tissue plasminogen activator antigen (t-PA), plasma cholesterol, triglyceride and insulin. Results: After the 12-week dietary intervention period, mean body weight fell by 3.5 (s.d. 2.6) kg or 4.3% (P = 0.0001), range -11.7 to +1.7 kg. Mean angina frequency fell by 1.8 (s.d. 3.6) from 3.2 to 1.4 episodes/week (P = 0.009) and plasma cholesterol by 0.4 (s.d. 0.7) from 6.3 to 5.9 mmol/1 (P = 0.0001). HDL cholesterol and triglyceride were unchanged. Of the coagulation and fibrinolytic factors, factor VII activity and RCA were significantly reduced by 5 (s.d. 20), IU/dl (P = 0.04) and 1.3 (s.d. 1.3) arbitrary units (P = 0.014), respectively. Conclusions: A conventional dietetic intervention, resulting in 4% weight loss, offers the potential to reduce atherosclerotic and thrombotic risk, and to reduce pain frequency, in angina patients. Given the importance of this result in a public health context, these results indicate that this may be a fruitful area for future nutrition research

Iodine and pregnancy – a UK cross-sectional survey of dietary intake, knowledge and awareness

Iodine is a key component of the thyroid hormones, which are critical for healthy growth, development and metabolism. The UK population is now classified as mildly iodine-insufficient. Adequate levels of iodine during pregnancy are essential for fetal neurodevelopment, and mild iodine deficiency is linked to developmental impairments. In the absence of prophylaxis in the UK, awareness of nutritional recommendations during pregnancy would empower mothers to make the right dietary choices leading to adequate iodine intake. The present study aimed to: estimate mothers' dietary iodine intake in pregnancy (using a FFQ); assess awareness of the importance of iodine in pregnancy with an understanding of existing pregnancy dietary and lifestyle recommendations with relevance for iodine; examine the level of confidence in meeting adequate iodine intake. A cross-sectional survey was conducted and questionnaires were distributed between August 2011 and February 2012 on local (Glasgow) and national levels (online electronic questionnaire); 1026 women, UK-resident and pregnant or mother to a child aged up to 36 months participated in the study. While self-reported awareness about general nutritional recommendations during pregnancy was high (96 %), awareness of iodine-specific recommendations was very low (12 %), as well as the level of confidence of how to achieve adequate iodine intake (28 %). Median pregnancy iodine intake, without supplements, calculated from the FFQ, was 190 μg/d (interquartile range 144–256μg/d), which was lower than that of the WHO's recommended intake for pregnant women (250 μg/d). Current dietary recommendations in pregnancy, and their dissemination, are found not to equip women to meet the requirements for iodine intake

Role of oxidative stress in physiological albumin glycation: a neglected interaction

Protein glycation is a key mechanism involved in chronic disease development in both diabetic and nondiabetic individuals. About 12–18% of circulating proteins are glycated in vivo in normoglycemic blood, but in vitro studies have hitherto failed to demonstrate glucose-driven glycation below a concentration of 30 mM. Bovine serum albumin (BSA), reduced BSA (mercaptalbumin) (both 40 g/L), and human plasma were incubated with glucose concentrations of 0–30 mM for 4 weeks at 37 °C. All were tested preoxidized for 8 h before glycation with 10 nM H2O2 or continuously exposed to 10 nM H2O2 throughout the incubation period. Fructosamine was measured (nitroblue tetrazolium method) at 2 and 4 weeks. Oxidized BSA (both preoxidized and continuously exposed to H2O2) was more readily glycated than native BSA at all glucose concentrations (p = 0.03). Moreover, only oxidized BSA was glycated at physiological glucose concentration (5 mM) compared to glucose-free control (glycation increased by 35% compared to native albumin, p < 0.05). Both 5 and 10 mM glucose led to higher glycation when mercaptalbumin was oxidized than when unoxidized (p < 0.05). Fructosamine concentration in human plasma was also significantly higher when oxidized and exposed to 5 mM glucose, compared to unoxidized plasma (p = 0.03). The interaction between glucose concentration and oxidation was significant in all protein models (p < 0.05). This study has for the first time demonstrated albumin glycation in vitro, using physiological concentrations of albumin, glucose, and hydrogen peroxide, identifying low-grade oxidative stress as a key element early in the glycation process

A patient-centred approach to estimate total annual healthcare cost by body mass index in the UK Counterweight programme

<p>Background: Previous studies, based on relative risks for certain secondary diseases, have shown greater healthcare costs in higher body mass index (BMI) categories. The present study quantifies the relationship between BMI and total healthcare expenditure, with the patient as the unit of analysis.</p> <p>Methods: Analyses of cross-sectional data, collected over 18-months in 2002–2003, from 3324 randomly selected patients, in 65 general practices across UK. Healthcare costs estimated from primary care, outpatient, accident/emergency and hospitalisation attendances, weighted by unit costs taken from standard sources.</p> <p>Results: In univariate analyses, significant associations (P<0.05) were found between total healthcare expenditure and all dependent variables (women>men, drinker<non-drinkers, smokers>non-smokers, and increasing with greater physical activity, age and BMI. In multivariate analysis, age, sex, BMI, smoking and alcohol consumption remained significantly associated with healthcare cost, and together explained just 9% of the variance in healthcare expenditure. Adjusted total annual healthcare cost was £16 (95% CI £11–£21) higher per unit BMI. All cost categories were significantly (P<0.003) higher for those with BMI >40 compared with BMI <20 kg m−2: prescription drugs (men: £390 versus £16; women: £211 versus £73), hospitalisation (men: £72 versus £0; women: £243 versus £107), primary care (men: £191 versus £69; women: £268 versus £153) and outpatient care (£234 versus £107 women only).</p> <p>Conclusions: Annual healthcare expenditure rose a mean of £16 per unit greater BMI, doubling between BMI 20–40 kg m−2. This gradient may be an underestimate if the lower-BMI patients with heights and weights recorded had other costly diseases.</p&gt

Different associations between body composition and alcohol when assessed by exposure frequency or by quantitative estimates of consumption

Background: Alcohol intake is widely assumed to contribute to excess body fatness, especially among young men; however, the evidence is inconsistent. We have addressed this research question by investigating associations between reported alcohol consumption and body composition from large representative national surveys in a high alcohol‐consuming country with a high obesity prevalence. Methods: The present study comprised a secondary analysis of combined cross‐sectional nationally representative Scottish Health Surveys (1995–2010). Reported alcohol‐drinking frequency was divided into five groups: from ‘nonfrequent drinking’ (reference) to daily/‘almost every day’ among 35 837 representative adults [mean (SD) age: 42.7 (12.7) years (range 18–64 years)]. Quantitative alcohol consumption was categorised into seven groups: from ‘1–7 to ≥50 10 g units per week’. Regression models against measured body mass index (BMI) and waist circumference (WC) were adjusted for age, physical activity, income, smoking, deprivation category and economic status. Results: Among alcohol‐consuming men, heavier drinking (21–28 units per week) was associated with a higher BMI by +1.4 kg m–2 [95% confidence interval (CI) = 1.38–1.43] and higher WC by +3.4 cm (95% CI = 3.2–3.6) than drinking 1–7 units per week. However, those who reported daily drinking frequency were associated with a lower BMI by −2.45 kg m–2 (95% CI = −2.4 to −2.5) and lower WC by −3.7 cm (95% CI = −3.3 to −4.0) than those who reported less‐frequent drinking. Similar associations were found for women. Most of these associations were restricted to subjects aged >30 years. Unexplained variances in BMI and WC are large. Conclusions: Quantitative alcohol consumption and frequency of consumption were positively and inversely associated, respectively, with both BMI and WC among alcohol‐consuming adults. Surveys are needed that evaluate both the quantity and frequency of consumption. The lowest BMI and WC were associated with a ‘Mediterranean’ drinking style (i.e. relatively little, but more frequently)