Associations of BMI with COVID-19 vaccine uptake, vaccine effectiveness, and risk of severe COVID-19 outcomes after vaccination in England: a population-based cohort study

Background A high BMI has been associated with a reduced immune response to vaccination against influenza. We aimed to investigate the association between BMI and COVID-19 vaccine uptake, vaccine effectiveness, and risk of severe COVID-19 outcomes after vaccination by using a large, representative population-based cohort from England. Methods In this population-based cohort study, we used the QResearch database of general practice records and included patients aged 18 years or older who were registered at a practice that was part of the database in England between Dec 8, 2020 (date of the first vaccination in the UK), to Nov 17, 2021, with available data on BMI. Uptake was calculated as the proportion of people with zero, one, two, or three doses of the vaccine across BMI categories. Effectiveness was assessed through a nested matched case-control design to estimate odds ratios (OR) for severe COVID-19 outcomes (ie, admission to hospital or death) in people who had been vaccinated versus those who had not, considering vaccine dose and time periods since vaccination. Vaccine effectiveness against infection with SARS-CoV-2 was also investigated. Multivariable Cox proportional hazard models estimated the risk of severe COVID-19 outcomes associated with BMI (reference BMI 23 kg/m²) after vaccination. Findings Among 9 171 524 participants (mean age 52 [SD 19] years; BMI 26·7 [5·6] kg/m²), 566 461 tested positive for SARS-CoV-2 during follow-up, of whom 32 808 were admitted to hospital and 14 389 died. Of the total study sample, 19·2% (1 758 689) were unvaccinated, 3·1% (287 246) had one vaccine dose, 52·6% (4 828 327) had two doses, and 25·0% (2 297 262) had three doses. In people aged 40 years and older, uptake of two or three vaccine doses was more than 80% among people with overweight or obesity, which was slightly lower in people with underweight (70–83%). Although significant heterogeneity was found across BMI groups, protection against severe COVID-19 disease (comparing people who were vaccinated vs those who were not) was high after 14 days or more from the second dose for hospital admission (underweight: OR 0·51 [95% CI 0·41–0·63]; healthy weight: 0·34 [0·32–0·36]; overweight: 0·32 [0·30–0·34]; and obesity: 0·32 [0·30–0·34]) and death (underweight: 0·60 [0·36–0·98]; healthy weight: 0·39 [0·33–0·47]; overweight: 0·30 [0·25–0·35]; and obesity: 0·26 [0·22–0·30]). In the vaccinated cohort, there were significant linear associations between BMI and COVID-19 hospitalisation and death after the first dose, and J-shaped associations after the second dose. Interpretation Using BMI categories, there is evidence of protection against severe COVID-19 in people with overweight or obesity who have been vaccinated, which was of a similar magnitude to that of people of healthy weight. Vaccine effectiveness was slightly lower in people with underweight, in whom vaccine uptake was also the lowest for all ages. In the vaccinated cohort, there were increased risks of severe COVID-19 outcomes for people with underweight or obesity compared with the vaccinated population with a healthy weight. These results suggest the need for targeted efforts to increase uptake in people with low BMI (<18·5 kg/m²), in whom uptake is lower and vaccine effectiveness seems to be reduced. Strategies to achieve and maintain a healthy weight should be prioritised at the population level, which could help reduce the burden of COVID-19 disease.UK Research & Innovation (UKRI)National Institute for Health Research (NIHR

Associations between food group intakes and circulating insulin‑like growth factor‑I in the UK Biobank: a cross‑sectional analysis

Purpose Circulating insulin-like growth factor-I (IGF-I) concentrations have been positively associated with risk of several common cancers and inversely associated with risk of bone fractures. Intakes of some foods have been associated with increased circulating IGF-I concentrations; however, evidence remains inconclusive. Our aim was to assess cross-sectional associations of food group intakes with circulating IGF-I concentrations in the UK Biobank. Methods At recruitment, the UK Biobank participants reported their intake of commonly consumed foods. From these questions, intakes of total vegetables, fresh fruit, red meat, processed meat, poultry, oily fish, non-oily fish, and cheese were estimated. Serum IGF-I concentrations were measured in blood samples collected at recruitment. After exclusions, a total of 438,453 participants were included in this study. Multivariable linear regression was used to assess the associations of food group intakes with circulating IGF-I concentrations. Results Compared to never consumers, participants who reported consuming oily fish or non-oily fish ≥ 2 times/week had 1.25 nmol/L (95% confidence interval:1.19–1.31) and 1.16 nmol/L (1.08–1.24) higher IGF-I concentrations, respectively. Participants who reported consuming poultry ≥ 2 times/week had 0.87 nmol/L (0.80–0.94) higher IGF-I concentrations than those who reported never consuming poultry. There were no strong associations between other food groups and IGF-I concentrations. Conclusions We found positive associations between oily and non-oily fish intake and circulating IGF-I concentrations. A weaker positive association of IGF-I with poultry intake was also observed. Further research is needed to understand the mechanisms which might explain these associations.Nuffield Department of Population Health Doctor of Philosophy student scholarshipCancer Research UK C8221/A29017Clarendon Scholarship from the University of OxfordNuffield Department of Population Health Intermediate FellowshipUK Research & Innovation (UKRI)Medical Research Council UK (MRC) MR/M012190/1Thames Valley NIHR Applied Research CentreSpanish Government Spanish State Plan for Scientific and Technical Research and Innovation RYC2020-028818-IGirdlers' New Zealand Health Research Council Fellowship 19/031Wellcome TrustOur Planet Our Health (Livestock, Environment and People -LEAP) 205212/Z/16/ZCancer Research UK Population Research Fellowship C60192/A28516World Cancer Research Fund (WCRF UK), as part of the Word Cancer Research Fund International grant programme 2019/195

The impact of price promotions on confectionery and snacks on the energy content of shopping baskets: A randomised controlled trial in an experimental online supermarket

Overconsumption of foods high in fat, sugars, and salt (HFSS) poses a significant risk to health. The government in England has passed legislation that would limit some price promotions of HFSS foods within supermarkets, but evidence regarding likely impacts of these policies, especially in online settings, is limited. This study aimed to determine whether there were any differences in the energy and nutrient content of shopping baskets after removing promotions on HFSS foods in an online experimental supermarket. UK adults (n = 511) were asked to select food from four categories with a £10 budget in an online experimental supermarket: confectionery; biscuits and crackers; crisps, nuts and snacking fruit; cakes and tarts. They were randomly allocated to one of two trial arms: (1) promotions present (matched to promotion frequency seen in a major UK retailer) (n = 257), or (2) all promotions removed from all products within the target food categories (n = 254). The primary outcome analysis used linear regression to compare total energy (kcal) of items placed in shopping baskets when promotions were present vs. absent, while secondary analyses investigated differences in nutrients and energy purchased from individual food categories. Mean energy in food selected without promotions was 5156 kcal per basket (SD 1620), compared to 5536 kcal (SD 1819) with promotions, a difference of −552kcal (95%CIs: −866, −238), equivalent to 10%. There were no significant differences in energy purchased for any individual category between groups. No evidence was found of other changes in nutritional composition of baskets or of significant interactions between the impact of promotions and participant characteristics (gender, age, ethnicity) on energy purchased. Removing promotions on HFSS foods resulted in significantly less total energy selected in an online experimental supermarket study

Interwoven challenges of covid-19, poor diet, and cardiometabolic health

This article is part of a collection proposed by Swiss Re, which also provided funding for the collection, including open access fees.Carmen Piernas and Jordi Merino argue that suboptimal diet and poor metabolic health aggravated the covid-19 pandemic and require greater attention to increase population resilience and reduce health inequalities.Swiss R

Dietary pattern adherence in association with changes in body composition and adiposity measurements in the UK Biobank study

Background Unhealthy dietary patterns (DP) have been frequently linked to avoidable ill-health, mediated in part through higher body mass index. However it is unclear how these patterns relate to specific components of body composition or fat distribution, and whether this may explain reported gender differences in the relationship between diet and health. Methods Data from 101,046 UK Biobank participants with baseline bioimpedance analysis and anthropometric measures and dietary information on two or more occasions were used, of which 21,387 participants had repeated measures at follow up. Multivariable linear regressions estimated the associations between DP adherence (categorised in quintiles Q1–Q5) and body composition measures adjusted for a range of demographic and lifestyle confounders. Results After 8.1 years of follow-up, individuals with high adherence (Q5) to the DP showed significantly positive changes in fat mass (mean, 95 % CI): 1.26 (1.12–1.39) kg in men, 1.11 (0.88–1.35) kg in women vs low adherence (Q1) − 0.09 (− 0.28 to 0.10) kg in men and − 0.26 (− 0.42 to − 0.11) kg in women; as well as in waist circumference (Q5): 0.93 (0.63–1.22) cm in men and 1.94 (1.63, 2.25) cm in women vs Q1 − 1.06 (− 1.34 to − 0.78) cm in men and 0.27 (− 0.02 to 0.57) cm in women. Conclusion Adherence to an unhealthy DP is positively associated with increased adiposity, especially in the abdominal region, which may help explain the observed associations with adverse health outcomes.Ramon y Cajal Fellowship RYC2020-028818-I (Ministry of Science and Innovation, Spain)Oxford NIHR Biomedical Research CentreNIHR Oxford and Thames Valley Applied Research Collaboration and NIHR Biomedical Research CentreCancer Research UK Population Research Fellowship (C60192/A28516)World Cancer Research Fund (WCRF UK),Word Cancer Research Fund International Grant Programme (2019/1953)CTSU (Clinical Trial Service Unit)Council and the British Heart Foundation (CH/ 1996001/9454)UK Biobank was established by the Wellcome Trust, Medical Research CouncilDepartment of Health, Scottish government,Northwest Regional Development AgencyWelsh assembly government and the British Heart FoundationDepartment of Health and Social Car

Removing seasonal confectionery from prominent store locations and purchasing behaviour within a major UK supermarket: Evaluation of a nonrandomised controlled intervention study

Background: The proportion of energy from free sugars and saturated fat currently exceeds the UK-recommended intake across all age groups. Recognising the limits of reformulation programmes, the government in England has announced their intention to introduce legislation to restrict the promotion of foods high in free sugars, salt, and saturated fats in prominent store locations. Here, we evaluated a grocery store intervention to remove seasonal confectionery from prominent locations within a major UK supermarket. Methods and findings: A nonrandomised controlled intervention study with interrupted time series (ITS) analysis was used. Data were analysed from 34 intervention stores located in 2 London boroughs and 151 matched control stores located elsewhere in the UK owned by the same retailer. Stores were matched based on store size and overall sales during the previous year. Between 15 February 2019 and 3 April 2019 (before Easter), stores removed free-standing promotional display units of seasonal confectionery from prominent areas, although these products were available for purchase elsewhere in the store. Store-level weekly sales (units, weight (g), and value (£)) of seasonal chocolate confectionery products were used in primary analyses, with data from 1 January 2018 to 24 November 2019. Secondary outcomes included total energy, fat, saturated fat, and sugars from all in-store purchases. Multivariable hierarchical models were used to investigate pre/post differences in weekly sales of confectionery in intervention versus control stores. ITS analyses were used to evaluate differences in level and trends after intervention implementation. Over a preintervention baseline period (15 February 2018 to 3 April 2018), there were no significant differences in sales (units, weight, and value) of all chocolate confectionery between intervention versus control stores. After intervention implementation, there was an attenuation in the seasonal increase of confectionery sales (units) in intervention stores compared to control (+5% versus +18%; P < 0.001), with similar effects on weight (g) (+12% versus +31%; P < 0.001) and value (£) (−3% versus +10%; P < 0.001). ITS analyses generally showed statistically significant differences in the level at the point of intervention (P ranges 0.010 to 0.067) but also in the trend afterwards (P ranges 0.024 to 0.053), indicating that the initial difference between intervention and control stores reduced over time. There was a significant difference in level change in total energy sold, adjusted for the total weight of food and drink (kcal/g, P = 0.002), and total fat (fat/g) (P = 0.023), but no significant changes in saturated fat or sugars from total sales in ITS models. There was no evidence that the main results varied across store deprivation index. The limitations of this study include the lack of randomisation, residual confounding from unmeasured variables, absolute differences in trends and sales between intervention versus control stores, and no independent measures of intervention fidelity. Conclusions: Removal of chocolate confectionery from prominent locations was associated with reduced purchases of these products, of sufficient magnitude to observe a reduction in the energy content of total food purchases. These results from a “real-world” intervention provide promising evidence that the proposed legislation in England to restrict promotions of less healthy items in prominent locations may help reduce overconsumption. Trial registration: https://osf.io/br96f/

Low Calorie-­‐and Caloric-­‐Sweeteners: Diet Quality, Food Intake and Purchase Patterns of U.S. Household Consumers

Although most food and beverage products consumed in the U.S. contain caloric-sweeteners (CS), consumption of low calorie sweeteners (LCS) such as aspartame, saccharin or stevia in foods and beverages has increased rapidly over the past 30 years. However, there is limited knowledge about the long-term determinants and consequences of LCS and CS consumption. This dissertation aimed to specifically examine consumption of products containing LCS and CS over the last decade and investigate the dietary quality and food patterns of consumers in the U.S. This research used measures of foods as purchased from the Homescan dataset 2000-2010, and dietary intake data from the National Health and Nutrition Examination Surveys (NHANES) 2003-2010. Aim 1 implemented an innovative approach based on ingredient and nutrition facts panel information to identify sweeteners in food products. Coincident with declining purchases and consumption of CS products over the last decade, we documented an important increasing trend in products containing LCS and a previously unexplored trend in products with both LCS and CS, especially important among households with children. In aim 2, we examined the dietary quality and food patterns of consumers of beverages with LCS and CS from 2000-10. Compared to non/low consumers of LCS- and CS-beverages, consumers had a significantly lower probability of adherence to a Prudent dietary pattern and higher average energy from purchases or intake of high calorie food groups such as salty snacks, fast food meals or desserts. LCS-beverage consumers also followed another different pattern of purchases consisting in fruits, vegetables, nuts and also snacks and desserts. Aim 3 used a dynamic panel model and instrumental variables to investigate the long-term effect of CS- and LCS-beverages on dietary quality and food purchasing patterns from 2000-2010. Despite overall declines in calories from all sources, we found that increasing one daily serving of either CS- or LCS-beverages is associated with significantly increased total daily energy, energy from food, and also increased daily energy from carbohydrates, total sugar, and total fat. We also found that increasing one serving of either beverage per day was mainly associated with increased purchases of caloric desserts and sweeteners. In conclusion, as consumers appear to be turning to LCS for their sweet options, our study opens up new pathways that relate consumption of both LCS- and CS-beverages to poorer dietary patterns and increased purchases of overall energy, carbohydrates, sugar, and caloric desserts and sweeteners. It is essential to understand if sweetener consumption translates into a better or worse dietary quality before continuing with more complex studies that relate sweetener intake to health outcomes. Our findings suggest that any type of sweetened beverage consumption could have a negative effect on diet, which can potentially inform future intervention strategies and nutrition policy recommendations aimed at improving diet and nutrition in the U.S.Doctor of Philosoph

Increased portion sizes from energy-dense foods affect total energy intake at eating occasions in US children and adolescents: patterns and trends by age group and sociodemographic characteristics, 1977–2006

Background: Larger portion sizes of foods and beverages could affect overall energy intake at meals and promote overeating

Effectiveness of an Online Programme to Tackle Individual’s Meat Intake through SElf-regulation (OPTIMISE):A randomised controlled trial

Purpose A reduction in meat intake is recommended to meet health and environmental sustainability goals. This study aimed to evaluate the effectiveness of an online self-regulation intervention to reduce meat consumption. Methods One hundred and fifty one adult meat eaters were randomised 1:1 to a multi-component self-regulation intervention or an information-only control. The study lasted 9 weeks (1-week self-monitoring; 4-week active intervention; and 4-week maintenance phase). The intervention included goal-setting, self-monitoring, action-planning, and health and environmental feedback. Meat intake was estimated through daily questionnaires in weeks 1, 5 and 9. The primary outcome was change in meat consumption from baseline to five weeks. Secondary outcomes included change from baseline to nine weeks and change in red and processed meat intake. We used linear regression models to assess the effectiveness of all the above outcomes. Results Across the whole sample, meat intake was 226 g/day at baseline, 118 g/day at five weeks, and 114 g/day at nine weeks. At five weeks, the intervention led to a 40 g/day (95%CI − 11.6,− 67.5, P = 0.006) reduction in meat intake, including a 35 g/day (95%CI − 7.7, − 61.7, P = 0.012) reduction in red and processed meat, relative to control. There were no significant differences in meat reduction after the four-week maintenance phase (− 12 g/day intervention vs control, 95% CI 19.1, − 43.4, P = 0.443). Participants said the intervention was informative and eye-opening. Conclusion The intervention was popular among participants and helped achieve initial reductions in meat intake, but the longer-term reductions did not exceed control. Trial registration ClinicalTrials.gov NCT04961216, 14th July 2021, retrospectively registered