ABSTRACT
OBJECTIVE: To assess and develop a consensus among a European panel of public health nutrition workforce stakeholders (academics and employers) regarding core functions required for effective public health nutrition practice. DESIGN: A modified Delphi study involving data from two rounds of questionnaires administered among a panel of public health nutrition workforce stakeholders. SETTING: Europe. SUBJECTS: A panel of fifty-three public health nutrition development stakeholders, including thirty-three academics and twenty employers, sampled from eighteen European countries. RESULTS: Panellists rated 50 % (19/38) of the initially listed functions as core (i.e. without which public health capacity is limited), using a majority cut-off (>50 %). Out of the nineteen core functions seven were categorised under the heading Intervention management, emphasising high agreement on the importance of managing interventions in public health nutrition work. Only one of the identified core public health nutrition functions was rated differently between academics and employers, suggesting consistent identification of core functions between stakeholder groups. CONCLUSIONS: This consensus on core functions of the public health nutrition workforce in Europe can be used to promote a consistent understanding of the role and value of public health nutritionists as a discrete disciplinary sub-specialty of the public health workforce. The convergence of opinions of academics and employers, as well as comparison with previous international studies, indicates that there is a set of core public health nutrition functions transferable between countries that can be used as a benchmark to guide further development of the public health nutrition workforce in Europe.
Subject(s)
Consensus , Dietetics , Nutritional Sciences , Professional Role , Public Health Practice , Public Health , Delphi Technique , Employment , Europe , Humans , Internationality , Surveys and Questionnaires , UniversitiesABSTRACT
BACKGROUND: Recent whole genome analysis and follow-up studies have identified many new risk variants for coeliac disease (CD, gluten intolerance). The majority of newly associated regions encode candidate genes with a clear functional role in T-cell regulation. Furthermore, the newly discovered risk loci, together with the well established HLA locus, account for less than 50% of the heritability of CD, suggesting that numerous additional loci remain undiscovered. Linkage studies have identified some well-replicated risk regions, most notably chromosome 5q31 and 11q23. METHODS: We have evaluated six candidate genes in one of these regions (11q23), namely CD3E, CD3D, CD3G, IL10RA, THY1 and IL18, as risk factors for CD using a 2-phase candidate gene approach directed at chromosome 11q. 377 CD cases and 349 ethnically matched controls were used in the initial screening, followed by an extended sample of 171 additional coeliac cases and 536 additional controls. RESULTS: Promotor SNPs (-607, -137) in the IL18 gene, which has shown association with several autoimmune diseases, initially suggested association with CD (P < 0.05). Follow-up analyses of an extended sample supported the same, moderate effect (P < 0.05) for one of these. Haplotype analysis of IL18-137/-607 also supported this effect, primarily due to one relatively rare haplotype IL18-607C/-137C (P < 0.0001), which was independently associated in two case-control comparisons. This same haplotype has been noted in rheumatoid arthritis. CONCLUSION: Haplotypes of the IL18 promotor region may contribute to CD risk, consistent with this cytokine's role in maintaining inflammation in active CD.
Subject(s)
Celiac Disease/genetics , Chromosomes, Human, Pair 11/genetics , Chromosomes, Human, Pair 5/genetics , Genetic Association Studies/methods , Case-Control Studies , Chromosome Mapping , Genetic Linkage , Genetic Predisposition to Disease , Genetic Variation , Humans , Interleukin-10/genetics , Interleukin-10 Receptor alpha Subunit/genetics , Interleukin-18/genetics , Polymorphism, Single Nucleotide/genetics , Risk , Risk FactorsABSTRACT
Our genome-wide association study of celiac disease previously identified risk variants in the IL2-IL21 region. To identify additional risk variants, we genotyped 1,020 of the most strongly associated non-HLA markers in an additional 1,643 cases and 3,406 controls. Through joint analysis including the genome-wide association study data (767 cases, 1,422 controls), we identified seven previously unknown risk regions (P < 5 x 10(-7)). Six regions harbor genes controlling immune responses, including CCR3, IL12A, IL18RAP, RGS1, SH2B3 (nsSNP rs3184504) and TAGAP. Whole-blood IL18RAP mRNA expression correlated with IL18RAP genotype. Type 1 diabetes and celiac disease share HLA-DQ, IL2-IL21, CCR3 and SH2B3 risk regions. Thus, this extensive genome-wide association follow-up study has identified additional celiac disease risk variants in relevant biological pathways.
Subject(s)
Biomarkers , Celiac Disease/genetics , Genetic Markers/genetics , Genetic Predisposition to Disease , Genome, Human , Polymorphism, Single Nucleotide , Animals , Case-Control Studies , Celiac Disease/immunology , Chromosome Mapping , Cohort Studies , Diabetes Mellitus, Type 1/genetics , Female , HLA-DQ Antigens/metabolism , Humans , Interleukin-12 Subunit p35/genetics , Interleukin-18 Receptor beta Subunit/blood , Interleukin-18 Receptor beta Subunit/genetics , Linkage Disequilibrium , Male , Mice , Polymerase Chain Reaction , RGS Proteins/genetics , RNA, Messenger/genetics , RNA, Messenger/metabolism , Receptors, CCR3/genetics , Risk Factors , Tissue DistributionABSTRACT
Anthropometric screening has been recommended for the detection of undernutrition as it is simple, inexpensive and non-invasive. However, a recent study estimating the prevalence of undernutrition on admission to hospital in Dublin, Republic of Ireland, highlighted that the anthropometric reference data currently available in the UK and Republic of Ireland are inadequate to accurately determine nutritional status. In order to provide current anthropometric data, we carried out a cross-sectional study of 874 free-living, apparently healthy Irish-born elderly individuals aged over 65 years. Height, weight, triceps skinfold thickness, mid-arm and calf circumference were measured, values for BMI, mid-arm muscle circumference and arm muscle area were calculated and smoothed centile data derived for each variable. One-third of these elderly individuals had a BMI between 20-25 kg/m2, approximately two-thirds (68.5 % of males and 61 % of females) were classified as overweight or obese, almost one-fifth having a BMI over 30 kg/m2 (17 % of men and 20 % of women). Very few were underweight, only 3 % having a BMI below 20 kg/m2. Height, weight, BMI and muscle reserves decreased with increasing age. The reduction in muscle size was associated with lower handgrip strength. Fat reserves declined with age in females only. Just over half of elderly Irish women reported participating in active leisure of 20 min duration four or more times/week, although 13 % reported having no involvement in active leisure. These data for the Irish elderly extend the data generated from a recent countrywide survey of Irish adults aged 18-64 years, thus providing suitable reference standards for nutritional assessment of elderly Irish individuals.
