Effect of tart cherry juice on risk of gout attacks: protocol for a randomised controlled trial

Introduction: Gout is a painful form of inflammatory arthritis associated with several comorbidities, particularly cardiovascular disease. Cherries, which are rich in anti-inflammatory and antioxidative bioactive compounds, are proposed to be efficacious in preventing and treating gout, but recommendations to patients are conflicting. Cherry consumption has been demonstrated to lower serum urate levels and inflammation in several small studies. One observational case cross-over study reported that cherry consumption was associated with reduced risk of recurrent gout attacks. This preliminary evidence requires substantiation. The proposed randomised clinical trial aims to test the effect of consumption of tart cherry juice on risk of gout attacks. Methods and analysis: This 12-month, parallel, double-blind, randomised, placebo-controlled trial will recruit 120 individuals (aged 18–80 years) with a clinical diagnosis of gout who have self-reported a gout flare in the previous year. Participants will be randomly assigned to an intervention group, which will receive Montmorency tart cherry juice daily for a 12-month period, or a corresponding placebo group, which will receive a cherry-flavoured placebo drink. The primary study outcome is change in frequency of self-reported gout attacks. Secondary outcome measures include attack intensity, serum urate concentration, fractional excretion of uric acid, biomarkers of inflammation, blood lipids and other markers of cardiovascular risk. Other secondary outcome measures will be changes in physical activity and functional status. Statistical analysis will be conducted on an intention-to-treat basis. Ethics and dissemination: This study has been granted ethical approval by the National Research Ethics Service, Yorkshire and The Humber—Leeds West Research Ethics Committee (ref: 18/SW/0262). Results of the trial will be submitted for publication in a peer-reviewed journal. Trial registration number: NCT03621215

Why rational argument fails the genetic modification (GM) debate

AbstractGenetic modification (GM) of crops provides a methodology for the agricultural improvements needed to deliver global food security. However, public opposition to GM-food is great. The debate has tended to risk communication, but here we show through study of a large nationally representative sample of British adults that public acceptance of GM-food has social, cultural and affective contexts. Regression models showed that metaphysical beliefs about the sanctity of food and an emotional dislike of GM-food were primary negative determinants, while belief in the value of science and favourable evaluation of the benefits-to-risks of GM-food were secondary positive determinants. Although institutional trust, general knowledge of the GM-food debate and belief in the eco-friendliness of GM-food were all associated with acceptance, their influence was minor. While a belief in the sanctity of food had a direct inverse effect on GM acceptance, belief in the value of science was largely mediated through favourable perception of benefits-to-risks. Furthermore, segmentation analysis demonstrated that anxiety about GM-food had social and cultural antecedents, with white men being least anxious and older vegetarian women being most anxious. Rational argument alone about the risks and benefits of GM-food is unlikely to change public perceptions of GM-technology

A content analysis of online videos containing dietary recommendations for gout and their alignment with evidence-based dietary guidelines

Abstract Objective: To assess the alignment of YouTube® videos providing dietary recommendations for gout with evidence-based guidelines targeted at the United Kingdom (UK) population and to establish their quality. Design: A content analysis of YouTube® videos providing dietary recommendations for gout was undertaken. Videos were categorised by video source. Each video’s dietary recommendations for gout were compared with three evidence-based guidelines for gout, producing a compliance score. Presence of non-guideline advice was assessed. Understandability and actionability were evaluated using the Patient Education Material Assessment Tool for Audio-Visual Materials. Reliability was assessed using an adapted-DISCERN tool and educational quality using the Global Quality Score Five-Point Scale. Differences between video source and continuous variables were assessed using one-way Kruskal–Wallis H tests. For categorical variables, associations were investigated using Fisher–Freeman–Halton tests. Setting: Online, May–June 2020. Participants: One-hundred thirty-one videos. Results: Alignment of videos with evidence-based guidelines was poor (median compliance score 27 % (interquartile range 17–37 %)). Additionally, 57 % of videos contained non-guideline advice. The health professional source group had the fewest videos containing non-guideline advice, but this was only significantly lower than the naturopath group (31 % v. 81 %, P = 0·009). Almost 70 % of videos were considered poorly actionable and 50 % poorly understandable. Most videos were rated poor for reliability (79 %) and poor to generally poor for educational quality (49 %). Conclusions: YouTube® videos providing dietary recommendations for gout frequently fail to conform to evidence-based guidelines, and their educational quality, reliability, understandability and actionability are often poor. More high-quality, comprehensive, evidence-based YouTube® videos are required for UK gout patients

Meeting school food standards – students’ food choice and free school meals

Objective To examine students’ school food choice in relation to school food standards and entitlement to free school meals (FSM). Design Cross-sectional analysis of students’ school food choices. Setting Two large secondary schools in Yorkshire, England. Subjects Students (n 2660) aged 11–18 years. Results Sandwiches and pizza were the most popular main food items: 40·4 % and 31·2 %, respectively, in School A; 48·3 % and 27·3 %, respectively, in School B. More nutritionally valuable ‘dishes of the day’ accounted for 8·7 % and 8·3 % of main foods for School A and School B, respectively. FSM students were more likely (P < 0·0 0 1) to choose main foods (School A: FSM 87·04 %, non-FSM 70·28 %; School B: FSM 75·43 %, non-FSM 56·13 %). Dishes of the day were chosen on a significantly greater (P < 0·0 0 1) percentage of days by FSM v. non-FSM students (School A: FSM 15·67 %, non-FSM 7·11 %; School B: FSM 19·42 %, non-FSM 5·17 %). Conclusions Despite the availability of nutritionally valuable dishes of the day, the most popular food items were sandwiches, pizza and desserts. FSM students were more likely to choose the more nutritionally valuable dish of the day. School food standards should be reassessed in light of students’ preferences

A content analysis of online videos containing dietary recommendations for gout and their alignment with evidence-based dietary guidelines

Objective: To assess the alignment of YouTube® videos providing dietary recommendations for gout with evidence-based guidelines targeted at the United Kingdom (UK) population and to establish their quality. Design: A content analysis of YouTube® videos providing dietary recommendations for gout was undertaken. Videos were categorised by video source. Each video’s dietary recommendations for gout were compared with three evidence-based guidelines for gout, producing a compliance score. Presence of non-guideline advice was assessed. Understandability and actionability were evaluated using the Patient Education Material Assessment Tool for Audio-Visual Materials. Reliability was assessed using an adapted-DISCERN tool and educational quality using the Global Quality Score Five-Point Scale. Differences between video source and continuous variables were assessed using one-way Kruskal-Wallis H tests. For categorical variables, associations were investigated using Fisher-Freeman-Halton tests. Setting: Online, May-June 2020. Participants: 131 videos. Results: Alignment of videos with evidence-based guidelines was poor (median compliance score 27% (IQR 17-37%)). Additionally, 57% of videos contained non-guideline advice. The health professional source group had the fewest videos containing non-guideline advice, but this was only significantly lower than the naturopath group (31% vs 81%, p = 0.009). Almost 70% of videos were considered poorly actionable and 50% poorly understandable. Most videos were rated poor for reliability (79%) and poor to generally poor for educational quality (49%). Conclusions: YouTube® videos providing dietary recommendations for gout frequently fail to conform to evidence-based guidelines and their educational quality, reliability, understandability, and actionability is often poor. More high-quality, comprehensive, evidence-based YouTube® videos are required for UK gout patients

Effect of a tart cherry juice supplement on arterial stiffness and inflammation in healthy adults: a randomised controlled trial.

Tart cherries are a particularly rich source of anthocyanins. Evidence indicates that dietary intake of anthocyanins is inversely associated with arterial stiffness. We conducted an open-label randomised placebo controlled study to determine whether a tart cherry juice concentrate (Cherry Active®) reduced arterial stiffness, inflammation and risk markers for cardiovascular disease in 47 healthy adults (30 – 50 y). Participants consumed 30 ml of cherry concentrate diluted to a volume of 250 ml with water or the same volume of an energy matched control drink daily for 6 weeks. Measurements were taken at baseline and at the end of the intervention. There was no effect of the intervention on arterial stiffness (P=0.218), c-reactive protein (P=0.220), systolic blood pressure (P=0.163), diastolic blood pressure (P=0.121), total cholesterol (P=0.342) and high density lipoprotein cholesterol (P=0.127). At the end of the intervention, plasma antioxidant capacity (measured as the ferric reducing ability of plasma (FRAP) was significantly higher in the intervention group than the control group (P=0.012). We conclude that a tart cherry juice concentrate rich in anthocyanins has no effect on arterial stiffness, c-reactive protein and risk markers for cardiovascular disease, but evokes a minor increase in antioxidant status in healthy adults

Food purchasing decisions and environmental ideology: an exploratory survey of UK shoppers

Environmentally and ethically conscious food purchasing has traction with British consumers. We examined how broad environmental worldviews related to shoppers’ ratings of the importance of various shopping criteria, including recognition of eco-labels, by surveying 502 shoppers from the city of Sheffield, England. Environmental worldviews were measured using the New Ecological Paradigm (NEP) scale. Responses to the scale split into two dimensions reflecting the scale’s origins: the Dominant Social Paradigm (DSP) and NEP subscales. Subscription to the NEP (ecocentric values) was associated with greater importance ratings of nutrition &amp; health, animal welfare, the environment, Fairtrade, seasonal, local and organic criteria. Subscription to the DSP (anthropocentric values) was associated with greater importance ratings of quality, taste, safety, price and convenience criteria. Notably, subscription to DSP values was the only predictor of eco-label recognition score in a multivariate model. These results indicate that the NEP scale should be considered as two subscales. The results suggest that campaigns to increase consumers’ environmental awareness in order to encourage environmentally driven food shopping are likely to motivate only consumers disenchanted with technological and anthropocentric development

Attitudes and behaviour towards convenience food and food waste in the United Kingdom

Households in the UK discard much food. A reduction in such waste to mitigate environmental impact is part of UK government policy. This study investigated whether household food waste is linked to a lifestyle reliant on convenience food in younger consumers. A survey of 928 UK residents aged 18-40 years and responsible for the household food shopping (male n = 278; female n = 650) completed an online questionnaire designed to measure attitudes to convenience food and to quantify household food waste. Cluster analysis of 24 food-related lifestyle factors identified 5 consumer groups. General linear modelling techniques were used to test relationships between the purchase frequency of convenience food and household food waste. From the cluster analysis, five distinct convenience profiles emerged comprising: ‘epicures’ (n = 135), ‘traditional consumers’ (n = 255), ‘casual consumers’ (n = 246), ‘food detached consumers’ (n = 151) and ‘kitchen evaders’ (n = 141). Casual consumers and kitchen evaders were the most reliant on convenience food and notably were the most wasteful. The demographic profile of kitchen evaders matched the population groups currently targeted by UK food waste policy. Casual consumers represent a new and distinct group characterised by “buy a lot and waste a lot” behaviour. Household size, packaging format, price-awareness and marketing all appear to influence levels of food waste. However, it seems that subtle behavioural and sociocultural factors also have impact. Further research is needed to elucidate the factors that mediate the positive association between the purchase of convenience food and reported food waste in order to inform food waste policy and initiatives

Dietary advice for muscularity, leanness and weight control in Men's Health magazine: a content analysis

Background: The dietary content of advice in men’s lifestyle magazines has not been closely scrutinised. Methods: We carried out an analysis of such content in all 2009 issues (n = 11) of Men’s Health (MH) focusing on muscularity, leanness and weight control. Results: Promotion of a mesomorphic body image underpinned advice to affect muscle building and control weight. Diet advice was underpinned by a strong pseudo-scientific discourse, with citation of expert sources widely used to legitimise the information. Frequently multiple dietary components were advocated within one article e.g. fat, omega-3 fatty acids, thiamine, zinc and high-glycaemic index foods. Furthermore advice would cover numerous nutritional effects, e.g. strengthening bones, reducing stress and boosting testosterone, with little contextualisation. The emphasis on attainment of a mesomorphic body image permitted promotion of slimming diets. Advice to increase calorie and protein intake to augment muscle mass was frequent (183 and 262 references, respectively). Such an anabolic diet was advised in various ways, including consumption of traditional protein foods (217 references) and sports foods (107 references), thereby replicating muscle magazines’ support for nutritional supplements. Although advice to increase consumption of red meat was common (52 references), fish and non-flesh sources of protein (eggs, nuts & pulses, and soy products) together exceeded red meat in number of recommendations (206 references). Advice widely asserted micronutrients and phytochemicals from plant food (161 references) as being important in muscle building. This emphasis diverges from stereotypical gender-based food consumption patterns. Dietary advice for control of body weight largely replicated that of muscularity, with strong endorsement to consume fruits and vegetables (59 references), diets rich in nuts and pulses and fish (66 references), as well as specific micronutrients and phytochemicals (62 references). Notably there was emphasis on fat-burning, good fats and consumption of single foods, with relatively little mention of dietary restriction. Conclusions: Despite the widespread use of scientific information to endorse dietary advice, the content, format and scientific basis of dietary content of MH leaves much to be desired. The dietary advice as provided may not be conducive to public health

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy