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Nisreen A Alwan,1 Debbie A Lawlor,2 Harry J McArdle,3 Darren C Greenwood,4 Janet E Cade11Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK; 2MRC Centre for Causal Analyses in Translational Research, University of Bristol, Bristol; 3Rowett Institute of Nutrition and Health, University of Aberdeen, Aberdeen; 4Biostatistics Unit, Leeds Institute for Health, Genetics and Therapeutics, University of Leeds, Leeds, UKBackground: Iron deficiency is the most common micronutrient deficiency worldwide. Experimental animal studies suggest that mothers deficient in iron during pregnancy are more likely to have offspring who become obese with high blood pressure. C282Y mutation carriers are more likely to have higher iron stores.Methods: We undertook an instrumental variable (IV) analysis, using maternal C282Y as an indicator for the mother’s iron status, to examine its association with offspring blood pressure (BP), waist circumference (WC), and body mass index (BMI), and compared the results to that of ordinary least squares (OLS) regression. Offspring of a sub-cohort of mothers from the UK Women’s Cohort Study (UKWCS) were recruited in 2009–2010 (n = 348, mean age = 41 years). Their blood pressure, height, and weight were measured at their local general medical practice, and they were asked to self-measure their waist circumference. About half were offspring of C282Y carriers. Maternal ferritin was used as a biomarker of maternal iron status.Results: Maternal C282Y was strongly associated with maternal ferritin (mean difference per allele = 84 g/L, 95% confidence interval: 31–137, P = 0.002). Using IV analyses, maternal ferritin was not linked to offspring’s BP, BMI, or WC. The first stage F-statistic for the strength of the instrument was 10 (Kleibergen–Paap rk LM P = 0.009). Maternal ferritin was linked to offspring diastolic BP, WC, and BMI in univariable, but not in multivariable OLS analysis. There was no difference between the OLS and the IV models coefficients for any of the outcomes considered.Conclusion: We found no association between maternal iron status and adult offspring’s BP and adiposity using both multivariable OLS and IV modeling. To our knowledge, this is the first study examining this relationship. Further exploration in larger studies that have genetic variation assessed in both mother and offspring should be considered.Keywords: iron, pregnancy, developmental origins, Mendelian randomization

Objective: The present analysis evaluates the overall appreciation and implementation of an intervention, Project Tomato, designed to maintain fruit and vegetable intake in children aged 8-9 years.Design: A random sample of fifty-four English primary schools (658 children) were randomised to either the intervention group or the control. The intervention group received a multi-component programme delivered in school by teachers and items sent home for parents/children. Dietary measurements were collected at baseline and follow-up. The intervention participants completed questionnaires on the intervention materials, to identify implementation and appreciation of the intervention, and other environmental mechanisms.Setting: Fifty-four primary schools were randomly selected, with twenty-seven schools allocated to the intervention group.Subjects: A total of 311 children received the intervention.Results: Implementation of the intervention was low, 21·3 % of school items and 56·0 % of home items were implemented. The intervention materials were well received by teachers, parents and children. Other mechanisms that may affect fruit and vegetable intake were explored. Children who ate their main meal with their parents 3-7 nights/week on average consumed 37·6 (95 % CI 9·8, 65·4) g more fruit and vegetables than children who ate with their parents 0-2 times/week.Conclusions: Implementation of the trial components was poor. However, the results identified the importance of parental environment and mealtime structure on children's fruit and vegetable intake. [ABSTRACT FROM AUTHOR]

Objective: To determine whether frequent vitamin C supplement use is associated with healthier behaviours, and a history of cancer and other illnesses in UK women.Design: The present cross-sectional analysis examines the odds of taking supplements containing vitamin C as recorded in 4 d food diaries, based on lifestyle characteristics and morbidity history self-reported by questionnaire.Setting: A large national UK cohort study.Subjects: A total of 12,453 women aged between 37 and 79 years.Results: Women frequently taking supplements containing vitamin C, compared to those who did not, had healthier behaviours, including higher consumption of fruit and vegetables. Frequent high-dose vitamin C users (≥1000 mg) had a higher socio-economic status, visited alternative practitioners more often than family or private doctors, and were more likely to be ex-smokers and to drink little or no alcohol. Women who self-reported having had cancer (OR = 1·33, 95% CI 1·00, 1·76) or specifically breast cancer (OR = 1·70, 95% CI 1·14, 2·55), or reported a family history of cancer (OR = 1·16, 95% CI 0·95, 1·41) or breast cancer (OR = 1·26, 95% CI 1·01, 1·58) had increased odds of being frequent high-dose users after adjusting for sociodemographic and health behaviours. Women with personal or family histories of some cardiovascular or intestinal disorders were more likely to take supplements containing vitamin C, though not necessarily at high doses.Conclusions: High-dose vitamin C intake by UK women was associated with healthier behaviours and a history of breast cancer, total cancer and other illnesses. Consequences of high-dose vitamin C supplement intake are not clear at the population level. [ABSTRACT FROM AUTHOR]

Background: Results of epidemiological studies of dietary fiber and colorectal cancer risk have not been consistent, possibly because of attenuation of associations due to measurement error in dietary exposure ascertainment.Methods: To examine the association between dietary fiber intake and colorectal cancer risk, we conducted a prospective case-control study nested within seven UK cohort studies, which included 579 case patients who developed incident colorectal cancer and 1996 matched control subjects. We used standardized dietary data obtained from 4- to 7-day food diaries that were completed by all participants to calculate the odds ratios for colorectal, colon, and rectal cancers with the use of conditional logistic regression models that adjusted for relevant covariates. We also calculated odds ratios for colorectal cancer by using dietary data obtained from food-frequency questionnaires that were completed by most participants. All statistical tests were two-sided.Results: Intakes of absolute fiber and of fiber intake density, ascertained by food diaries, were statistically significantly inversely associated with the risks of colorectal and colon cancers in both age-adjusted models and multivariable models that adjusted for age; anthropomorphic and socioeconomic factors; and dietary intakes of folate, alcohol, and energy. For example, the multivariable-adjusted odds ratio of colorectal cancer for highest vs the lowest quintile of fiber intake density was 0.66 (95% confidence interval = 0.45 to 0.96). However, no statistically significant association was observed when the same analysis was conducted using dietary data obtained by food-frequency questionnaire (multivariable odds ratio = 0.88, 95% confidence interval = 0.57 to 1.36).Conclusions: Intake of dietary fiber is inversely associated with colorectal cancer risk. Methodological differences (ie, study design, dietary assessment instruments, definition of fiber) may account for the lack of convincing evidence for the inverse association between fiber intake and colorectal cancer risk in some previous studies. [ABSTRACT FROM AUTHOR]

Objectives: To develop a concise, simple tool for use by non-specialists to assess diet in children aged 3-7 years attending primary schools.Design: A 24-hour food tick list covering all aspects of the diet and with a focus on fruit and vegetable consumption was developed. This was compared against a 24-hour semi-weighed food diary obtained for the same day as the tick list.Setting: Six primary schools with a range of socio-economic and ethnic backgrounds from a large city in the north of England (Leeds).Participants: One hundred and eighty children returned completed packs of information; a response rate of 77% of those who were willing to take part, 48% of those approached.Results: On average, 2.4 items of fruit including juice (2.1 items as 5-a-day count) were eaten and 1.6 items of vegetables (excluding potato). Twenty-seven per cent and 36% of boys and 23% and 24% of girls reported not eating any fruit or vegetables, respectively, on the recording day. Correlations comparing the diary and tick list were high for both foods (range r=0.44 to 0.89) and nutrients (range r=0.41 to 0.68). The level of misclassification was much less than would be expected by chance. Parent and teacher evaluation of the tick list was very positive. Parents felt the tick list was easy and quick to complete.Conclusion: The Child and Diet Evaluation Tool (CADET) tick list has been used successfully for rapid collection of food and nutrient information from children aged 3-7 years from diverse social and ethnic backgrounds. The tool has performed better than many food-frequency questionnaires in comparison to a food diary. [ABSTRACT FROM AUTHOR]

Background/aims: Fortified breakfast cereals (FBCs) are an important source of iron in the UK diet. In order to quantify their contribution to iron nutrition, food composition data for these products must be accurate. The very large amount of products available, together with inter-brand differences in iron content mean that discrepancies between the iron content of many FBCs and values in standard food composition databases (FCD) exist. The variation in reported iron contents of FBCs was examined and the impact of this variation on measurement of iron intake using standard food composition tables was investigated.Method: Data on the reported iron content of 128 FBCs were collected. Completed food diaries from 291 participants of the UK Women's Cohort study were used in the analysis. Mean iron intake from a 4-day food diary was calculated using UK food tables' values for FBCs. This was repeated using values reported by the manufacturer for each brand of cereal. The two sets of results were then compared.Results: There is wide variation in iron content of breakfast cereals available in the United Kingdom. Use of FCD values instead of brand-specific values under- or overestimates an individual's iron intake by as much as 28 or 22% respectively. These results suggest that use of FCD values for breakfast cereals is potentially a source of substantial error in measurement of individuals' iron intake.Conclusion: Dietitians need to be aware of inter-brand differences in iron content and formulate advice accordingly. Failure to collect brand-specific data for the iron content of FBCs could lead to measurement error in measuring iron intake in dietary studies. [ABSTRACT FROM AUTHOR]

Background: This paper describes the development of the UK Women's Cohort Study and presents cohort baseline characteristics.Methods: In total, 35,372 women, aged 35-69 years at recruitment, were selected to ensure a wide range of dietary intakes. Diet was assessed by a 217-item food-frequency questionnaire (FFQ). Detailed lifestyle information was collected by postal questionnaire. Vegetarians, fish-eaters and meat-eaters were compared.Results: The cohort women are mainly white, well-educated, middle-class and married with children. They are health-conscious with only 11% current smokers and 58% taking dietary supplements. Twenty-eight per cent of subjects self-report as being vegetarian and 1% as vegan. However, only 18% are defined as 'vegetarian' from the FFQ. Fat provides 32% of energy; vitamin and mineral intakes are high, with a broad range of intakes. Meat-eaters are older, with a higher body mass index (BMI) and the lowest intakes of carbohydrate, fibre, vitamin C, folate, iron and calcium. Other fish-eaters are similar to vegetarians. Vegetarians have the lowest intakes of protein, fat and saturated fat. Oily fish-eaters have the lowest BMI; are the least likely to smoke or use full-fat milk; and are the most likely to use dietary supplements and consume the most fruit and vegetables. Oily fish-eaters have the highest total energy intake and vegetarians the lowest. Semi-skimmed milk, bread, potatoes, wine, bananas and muesli are important contributors to energy for all groups.Conclusion: A large cohort of middle-aged women has been created encompassing a wide range of different eating patterns, including diets currently of interest to research into protection against cancer and coronary heart disease. Participants will be followed up to study the effects of different food and nutrient intakes on long-term health outcomes. [ABSTRACT FROM AUTHOR]

Objective: Many public health campaigns encourage increased fibre consumption, but short-term studies suggest that various components of dietary fibre inhibit the absorption of certain micronutrients including carotenoids. These do not take into account long-term adaptation to nutrient intake levels. We aimed to investigate the effect of non-starch polysaccharide (NSP) fibre on plasma micronutrient concentrations in a large free-living population consuming their usual diet.Design: Prospective cohort study. Semi-weighed 4-day food diaries were analysed for micronutrient and NSP fibre intakes. Blood samples were taken and analysed for carotenoids, vitamin A, vitamin E, thiamine, riboflavin, vitamin B6, vitamin B12, folic acid, vitamin C and trace metals.Setting: Participants in a large national cohort study who lived within 30 miles of Leeds.Subjects: Two hundred and eighty-three middle-aged women.Results: The association between NSP intake and plasma nutrient concentrations was assessed taking into account nutrient intakes and other dietary and lifestyle factors. Higher levels of NSP were not associated with lower plasma concentrations of the micronutrients measured, even allowing for the higher nutrient levels generally found in high-fibre foods.Conclusions: Amongst middle-aged women we have shown that current guidelines for increasing the population's NSP consumption can be safely applied. Such guidelines are unlikely to reduce serum micronutrient concentrations, although other, more vulnerable population groups may benefit from further investigation. [ABSTRACT FROM AUTHOR]

As concepts in nutrition move towards emphasising the use of foods to promote better health and to help reduce the risk of disease, a new generation of functional food products has emerged. Nutritionists play a key role in educating the public on matters regarding diet and health. Therefore, they need to understand consumers' attitudes to ensure their work is effective. This study aims to explore consumers' and nutritionists' perceptions of this relatively new area of nutrition using a psychometric questionnaire, adapted from Fife-Schaw and Rowe (1996), to quantify attitudes towards five types of functional foods. The questionnaire was administered to 331 members of the British public (40% response rate) and a random sample of 199 members of the Nutrition Society (58% response rate). Perceptions held by the two groups were compared. Principal Components Analysis (PCA) was carried out to highlight underlying components revealed by the questionnaire. The most extreme differences in responses were evident on three issues: the ability to tell if functional foods were about to be consumed; who should take responsibility for informing consumers about the health effects; and understanding of functional foods. Nutritionists believed they had a greater understanding of functional foods and found it easier to tell if the foods they ate contained a functional component. Consumers had a stronger belief that it is the food manufacturers' responsibility to provide information about functional foods. Using PCA to identify components of importance to each group confirmed differences in perceptions. For the consumer group worry and benefit were the most prominent components. For nutritionists, components relating to control and responsibility were most apparent. As consumers are more willing to look to food manufacturers than the government for information regarding these new foods, the importance of appropriate food labelling and legislation on health claims is of increasing importance. The differences in perceptions will be of interest to the different stakeholders involved in the provision of information to consumers, and should be used to ensure that appropriate messages and channels of communication are used in the development of this new branch of nutritional science. [ABSTRACT FROM AUTHOR]

Objectives: To examine clinical outcomes associated with optional beta blockade in a population of patients with evidence of heart failure after myocardial infarction.Design and Patients: Data from the acute infarction ramipril efficacy (AIRE) study were analysed retrospectively. At baseline 22.3% of the patients were receiving a beta blocker. To minimise confounding, beta blocker and diuretic treatments, presence of clinical signs of heart failure, left ventricular ejection fraction, and 16 other baseline clinical variables were simultaneously entered in a multivariate Cox regression model. In addition, the same analysis was repeated separately within a high and a low risk group of patients, as defined according to the need for diuretic treatment.Results: beta Blocker treatment was an independent predictor of reduced risk of total mortality (hazard ratio 0.66, 95% confidence interval (CI) 0. 48 to 0.90) and progression to severe heart failure (0.58, 95% CI 0.40 to 0.83) for the entire study population. There were similar findings in high risk patients requiring diuretics (0.59, 95% CI 0.40 to 0.86; and 0.58, 95% CI 0.38 to 0.89).Conclusions: beta Blocker treatment is associated with improved outcomes in patients with clinical evidence of mild to moderate heart failure after myocardial infarction. Most importantly, high risk patients with persistent heart failure appear to benefit at least as much as lower risk patients with transient heart failure. [ABSTRACT FROM AUTHOR]

This study investigated the beliefs held by survivors of a heart attack about the causes of heart attacks. A survey of survivors was carried out in six coronary care units involved in the Anglo-Scandinavian Study of Early Thrombolysis (ASSET). The results were based on 1283 returned questionnaires. Stress or worry were nominated by most people (66 per cent). Only 22 per cent of all patients named smoking as a cause of heart attacks (28 per cent among smokers). Smokers who named smoking as a cause were not significantly more likely to stop smoking within a month than smokers who did not nominate it (78 per cent versus 73 per cent, respectively). The findings were compared to those from a survey of the general population; knowledge of established risk factors was poor in both populations. Smokers were more aware of smoking as a cause than non-smokers in both populations but this knowledge did not appear to affect smoking behaviour soon after the heart attack in the survivors. There were substantial differences in the level of knowledge of some risks in those from lower social classes in the survivor group. Health promotion activity in survivors need not be substantially different from that delivered to the general population but needs to impart more than just knowledge of risk factors to be effective. Survivors who are in lower social classes may have a poorer knowledge base and present a particular challenge. [ABSTRACT FROM AUTHOR]

Background: The School Fruit and Vegetable Scheme (SFVS) is an important public health intervention. The aim of this scheme is to provide a free piece of fruit and/or vegetable every day for children in Reception to Year 2. When children are no longer eligible for the scheme (from Year 3) their overall fruit and vegetable consumption decreases back to baseline levels. This proposed study aims to design a flexible multi-component intervention for schools to support the maintenance of fruit and vegetable consumption for Year 3 children who are no longer eligible for the scheme.Method: This study is a cluster randomised controlled trial of Year 2 classes from 54 primary schools across England. The schools will be randomly allocated into two groups to receive either an active intervention called Project Tomato, to support maintenance of fruit intake in Year 3 children, or a less active intervention (control group), consisting of a 5 A DAY booklet. Children's diets will be analysed using the Child And Diet Evaluation Tool (CADET), and height and weight measurements collected, at baseline (Year 2) and 18 month follow-up (Year 4). The primary outcome will be the ability of the intervention (Project Tomato) to maintain consumption of fruit and vegetable portions compared to the control group.Discussion: A positive result will identify how fruit and vegetable consumption can be maintained in young children, and will be useful for policies supporting the SFVS. A negative result would be used to inform the research agenda and contribute to redefining future strategies for increasing children's fruit and vegetable consumption.Trial Registration: Medical Research Council Registry code G0501297. [ABSTRACT FROM AUTHOR]