Impact of weight loss and weight gain trajectories on body composition in a population at high risk of type 2 diabetes: A prospective cohort analysis.

AIM: In a primary care population at high risk of type 2 diabetes, 24-month weight change trajectories were used to investigate the impact of weight cycling on fat mass (FM) and fat-free mass (FFM). MATERIALS AND METHODS: Cohort data from the Walking Away from Type 2 Diabetes trial was used, which recruited adults at-risk of type 2 diabetes from primary care in 2009/10. Annual weight change trajectories based on weight loss/gain of ≥5% were assessed over two 24-month periods. Body composition was measured by bioelectrical impedance analysis. Repeated measures were analysed using generalized estimating equations with participants contributing up to two 24-month observation periods. RESULTS: In total, 622 participants were included (average age = 63.6 years, body mass index = 32.0 kg/m2 , 35.4% women), contributing 1163 observations. Most observations (69.2%) were from those that maintained their body weight, with no change to FM or FFM. A minority (4.6% of observations) lost over 5% of body weight between baseline and 12 months, which was then regained between 12 and 24 months. These individuals regained FM to baseline levels, but lost 1.50 (0.66, 2.35) kg FFM, adjusted for confounders. In contrast, those that gained weight between baseline and 12 months but lost weight between 12 and 24 months (5.5% of observations) had a net gain in FM of 1.70 (0.27, 3.12) kg with no change to FFM. CONCLUSION: Weight cycling may be associated with a progressive loss in FFM and/or gain in FM in those with overweight and obesity at-risk of type 2 diabetes.

Ethnic differences in complement system biomarkers and their association with metabolic health in men of Black African and White European ethnicity.

Inflammation plays a fundamental role in the development of several metabolic diseases, including obesity and type 2 diabetes (T2D); the complement system has been implicated in their development. People of Black African (BA) ethnicity are disproportionately affected by T2D and other metabolic diseases but the impact of ethnicity on the complement system has not been explored. We investigated ethnic differences in complement biomarkers and activation status between men of BA and White European (WE) ethnicity and explored their association with parameters of metabolic health. We measured a panel of 15 complement components, regulators, and activation products in fasting plasma from 89 BA and 96 WE men. Ethnic differences were statistically validated. Association of complement biomarkers with metabolic health indices (BMI, waist circumference, insulin resistance, and HbA1c) were assessed in the groups. Plasma levels of the key complement components C3 and C4, the regulators clusterin and properdin and the activation marker iC3b were significantly higher in BA compared to WE men after age adjustment, while FD levels were significantly lower. C3 and C4 levels positively correlated with some or all markers of metabolic dysfunction in both ethnic groups while FD was inversely associated with HbA1c in both groups, and clusterin and properdin were inversely associated with some markers of metabolic dysfunction only in the WE group. Our findings of increased levels of complement components and activation products in BA compared to WE men suggest differences in complement regulation that may impact susceptibility to poor metabolic health.

Reducing risk of Type 2 diabetes in HIV: a mixed-methods investigation of the STOP-Diabetes diet and physical activity intervention.

AIM: To conduct a mixed-methods feasibility study of the effectiveness and acceptability of an individualized diet and physical activity intervention designed to reduce the risk of Type 2 diabetes experienced by people living with HIV. METHODS: Participants with impaired fasting glucose and HIV were invited to take part in a 6-month diet and physical activity intervention. Individualized advice to achieve 10 lifestyle goals was delivered monthly. Diabetes risk was assessed pre- and post-intervention by measurement of the glucose and insulin response to a 3-h meal tolerance test. Six-month change was analysed using paired t-tests. Research interviews exploring the acceptability of the intervention and factors influencing behaviour change were conducted with those who participated in the intervention, and those who declined participation. RESULTS: The intervention (n=28) significantly reduced the following: glucose and insulin, both fasting and postprandial incremental area under the curve (glucose 7.9% and 17.6%; insulin 22.7% and 31.4%, respectively); weight (4.6%); waist circumference (6.2%); systolic blood pressure (7.4%); and triglycerides (36.7%). Interview data demonstrated the acceptability of the intervention. However, participants expressed concern that deliberate weight loss might lead to disclosure of HIV status or association with AIDS-related illness. The belief that antiretroviral medications drove diabetes risk was associated with declining study participation or achieving fewer goals. CONCLUSIONS: We have demonstrated the beneficial effects of a lifestyle intervention in mitigating the increased risk of Type 2 diabetes associated with HIV. Future interventions should be designed to further reduce the unique barriers that prevent successful outcomes in this cohort.

A Systematic Review of Beta Cell Function in Adults of Black African Ethnicity.

BACKGROUND: Understanding ethnic differences in beta cell function has important implications for preventative and therapeutic strategies in populations at high risk of type 2 diabetes (T2D). The existing literature, largely drawn from work in children and adolescents, suggests that beta cell function in black African (BA) populations is upregulated when compared to white Europeans (WE). METHODS: A systematic literature search was undertaken in June 2018 to identify comparative studies of beta cell function between adults (>age 18 years) of indigenous/diasporic BA and WE ethnicity. All categories of glucose tolerance and all methodologies of assessing beta cell function in vivo were included. RESULTS: 41 studies were identified for inclusion into a qualitative synthesis. The majority were studies in African American populations (n = 30) with normal glucose tolerance (NGT)/nondiabetes (n = 25), using intravenous glucose stimulation techniques (n = 27). There were fewer studies in populations defined as only impaired fasting glucose/impaired glucose tolerance (IFG/IGT) (n = 3) or only T2D (n = 3). Although BA broadly exhibited greater peripheral insulin responses than WE, the relatively small number of studies which measured C-peptide to differentiate between beta cell insulin secretion and hepatic insulin extraction (n = 14) had highly variable findings. In exclusively IGT or T2D cohorts, beta cell insulin secretion was found to be lower in BA compared to WE. CONCLUSIONS: There is inconsistent evidence for upregulated beta cell function in BA adults, and they may in fact exhibit greater deficits in insulin secretory function as glucose intolerance develops.

Ethnicity and Type 2 diabetes in the UK.

Type 2 diabetes is a major UK public health priority. Among minority ethnic communities, the prevalence is alarmingly high, approximately three to five times higher than in the white British population. Particularly striking is the earlier onset of Type 2 diabetes, which occurs some 10-12 years younger, with a significant proportion of cases being diagnosed before the age of 40 years. This review focuses on the UK context and Type 2 diabetes in adult populations, exploring the available evidence regarding the complex interplay of biological, lifestyle, social, clinical and healthcare system factors that are known to drive these disparities.

Dietary intakes of HIV-infected adults in urban UK.

Maintaining a good nutritional status is important for immune health and for managing metabolic comorbidities in adults with HIV infection. Little is known about the dietary habits of adults living with HIV infection in the United Kingdom. The aims of this study were to characterise their dietary intakes, and to identify subgroups of patients who may require nutritional counselling and/or food support services. An observational study of adults attending a London HIV out-patient clinic who completed a demographics questionnaire and a structured 24 h diet recall interview was conducted. In all, 196 (162 men, 34 women) adults participated. Forty-three percent (n=66) of men and thirty-six percent (n=11) of women did not consume enough energy to meet their basal metabolic requirements and activity factor. The majority of both men (64%) and women (56%) consumed more than the recommended amount of saturated fat. Self-report of lipodystrophy (B coefficient -2.27 (95% CI -3.92 to -0.61), P=0.008) was associated with lower dietary fibre intake/1000 kcal per day, and a more recent diagnosis of HIV (B coefficient -0.11 (95% CI -0.20 to -0.02), P=0.013) was associated with a higher dietary fibre/1000 kcal intake per day. Recreational drug use was associated with a higher overall calorie (P=0.003) and protein (P=0.001) intake than non-usage after adjusting for basal metabolic requirements and weight, respectively. Our data describe the dietary intakes of a diverse group of adults with HIV infection in the United Kingdom. These dietary habits may have an impact on their overall health and development of other metabolic comorbidities common in people with HIV.

Low glycaemic index diets and blood lipids: a systematic review and meta-analysis of randomised controlled trials.

AIMS: Low glycaemic index (GI) diets are beneficial in the management of hyperglycemia. Cardiovascular diseases are the major cause of mortality in diabetes therefore it is important to understand the effects of GI on blood lipids. The aim was to systematically review randomised controlled trials (RCTs) of low GI diets on blood lipids. DATA SYNTHESIS: We searched OVID Medline, Embase and Cochrane library to March 2012. Random effects meta-analyses were performed on twenty-eight RCTs comparing low- with high GI diets over at least 4 weeks (1272 participants; studies ranged from 6 to 155 participants); one was powered on blood lipids, 3 had adequate allocation concealment. Low GI diets significantly reduced total (-0.13 mmol/l, 95%CI -0.22 to -0.04, P = 0.004, 27 trials, 1441 participants, I(2) = 0%) and LDL-cholesterol (-0.16 mmol/l, 95%CI -0.24 to -0.08, P < 0.0001, 23 trials, 1281 participants, I(2) = 0%) compared with high GI diets and independently of weight loss. Subgroup analyses suggest that reductions in LDL-C are greatest in studies of shortest duration and greatest magnitude of GI reduction. Furthermore, lipid improvements appear greatest and most reliable when the low GI intervention is accompanied by an increase in dietary fibre. Sensitivity analyses, removing studies without adequate allocation concealment, lost statistical significance but retained suggested mean falls of ~0.10 mmol/l in both. There were no effects on HDL-cholesterol (MD -0.03 mmol/l, 95%CI -0.06 to 0.00, I(2) = 0%), or triglycerides (MD 0.01 mmol/l, 95%CI -0.06 to 0.08, I(2) = 0%). CONCLUSIONS: This meta-analysis provides consistent evidence that low GI diets reduce total and LDL-cholesterol and have no effect on HDL-cholesterol or triglycerides.

Estimating energy requirements in hospitalised underweight and obese patients requiring nutritional support: a survey of dietetic practice in the United Kingdom.

BACKGROUND: Many methods are available to determine energy requirements, however, all have limitations, particularly when used for the obese. OBJECTIVES: The aim of this survey was to investigate current practice in the estimation of energy requirements in an underweight and obese hospitalised patient in a large cohort of UK dietitians. SUBJECT/METHODS: A cross-sectional anonymous online survey of UK registered dietitians was performed. RESULTS: A total of 672 responses were received. Underweight patient: prediction equations with adjustment for metabolic stress and physical activity were most commonly used (90%). The median estimated energy requirement was 2079 kcals/day. The estimated energy requirement using calorie per kilogram method was significantly lower compared with equations (P<0.001). The median target volume of feed prescribed was 2000 mls/day. A significant reduction in feed prescribed compared with estimated energy requirements was found (P<0.001). Obese patient: prediction equations to estimate the basal metabolic rate alone were most commonly used (51%). Nutrition support dietitians used a lower stress factor compared with non-nutrition support dietitians (P=0.016). Method used to estimate the energy requirements was associated with years in clinical practice and place of work (P<0.001, 0.001). Calorie per kilogram used in the obese case study (median: 25 kcal/kg) was significantly lower than calorie per kilogram used in the underweight case study (median: 30 kcal/kg; P=0.014). CONCLUSIONS: A significant variation in the methods used by dietitians to estimate the energy requirements was found, particularly in the obese patient group. In an age of rapidly increasing rates of obesity a professional consensus of treatment of this patient group is needed.

Clinical guidelines and enteral nutrition support: a survey of dietetic practice in the United Kingdom.

BACKGROUND: Artificial nutrition support is used in treating hospital patients and has been shown to reduce hospital stays. The NICE (National Collaborating Centre for Acute Care) guidelines are the first national consensus guidelines for dietetic practice in artificial nutrition. The aim of the current survey was to explore the influence of local and national guidelines, and clinical experience on enteral tube feeding practices in a large cohort of UK dietitians. METHODS: A cross-sectional anonymous online survey of UK registered dietitians was performed. RESULTS: A total of 681 responses were received. In all, 85% deemed 'clinical experience' to be of greatest influence when initiating a tube feeding regimen; the influence of 'clinical experience' was significantly associated with the number of years in practice (P=<0.001). A total of 70% of respondents were aware of a department feeding protocol with 67% of protocols using a start rate of 24-49 ml/h; furthermore, 65% of respondents reported most commonly using a feeding start rate of 24-49 ml/h and 75% of them reported that their department had a protocol for preventing refeeding syndrome; 23% had mandatory implementation of NICE guidelines. CONCLUSIONS: Enteral feeding practice varies among practitioners. Clinical experience and published clinical guidelines have a pivotal role when treating adult patients that require enteral tube feeding.

Different experiences and perspectives between head and neck cancer patients and their care-givers on their daily impact of a gastrostomy tube.

BACKGROUND: Gastrostomy feeding in head and neck cancer patients is recognised standard practice in some cancer centres with beneficial effects on outcomes for appropriately selected patients. However, the impact on patients and care-givers needs consideration. The present study aimed to understand the daily impact of gastrostomy feeding on head and neck cancer patients and their care-givers to identify improvements to services. METHODS: Twenty-one adult patients were randomly selected from the Head and Neck centre at University College London Hospital. Six head and neck cancer patients and three care-givers participated in focus groups. The sessions were recorded, fully transcribed and qualitatively thematically analysed, and the resulting data were tabulated. RESULTS: Patients and care-givers expressed opposite experiences within knowledge and understanding of why the tube was necessary; their personal perceptions and objectives of nutritional support. Themes expressing similar experiences included: developing positive coping strategies; preventing nutritional decline; tube dependency; dentures; finance; active care; and psychological support. Furthermore, both groups expressed the benefits of retaining a support network for rehabilitation with the hospital-based specialist team. Also patients and carers recognised that the gastrostomy tube helped patient survival and, with timely dietetic management, helped them wean off the tube reliance with more confidence. CONCLUSIONS: It is essential that patients and care-givers attend pretreatment clinics to discuss nutritional support via the artificial route; their quality of life can be enhanced if guided through a specialist support pathway based at the clinical site where they initiated their care, with links to key agencies.

Structural and biomechanical aspects of equine sacroiliac joint function and their relationship to clinical disease.

Pain originating from the sacroiliac joint (SIJ) in horses has long been associated with poor performance, yet specific diagnosis of sacroiliac dysfunction (SID) has been difficult to achieve. Clinical presentation of SID appears to fall into two categories. The first, presenting as pain and poor performance, is responsive to local analgesia of periarticular structures with poorly defined pathology. The second presents primarily as poor performance with bony pathological changes as a result of chronic instability. Diagnostic tests based on biomechanics as well as manual provocation for SIJ pain have formed the basis of tests currently used to diagnose SIJ dysfunction in humans. This review summarises the anatomy and biomechanics of the equine SIJ and current biomechanical, innervation and motor control concepts in human SID. The relationship between abnormal SIJ motion and altered neuromotor control with clinical disease of the equine SIJ are discussed. Future utilisation of these principles to develop new diagnostic and management tools for the equine SID is promising.

Movement between the equine ilium and sacrum: in vivo and in vitro studies.

REASONS FOR PERFORMING STUDY: Sacroiliac disease (SID) is an important cause of loss of performance in horses, yet little is known about the biomechanics of movement of the sacroiliac joint (SIJ). OBJECTIVES: (a) To document the presence of equine SIJ motion by measuring the change in cross-sectional area (CSA) of the dorsal portion of the dorsal sacroiliac ligament (DSIL) during application of manual forces to the pelvis, and to ascertain if this varied between horses with SID and normal horses; (b) To determine the amount and direction of motion available at the equine SIJ using 3-D orientation sensors, and how motion is limited by the DSIL and sacrotuberous ligament. METHODS: Study 1: CSA obtained ultrasonographically was compared before and during manual force application to the ilium, on a group of 10 horses, 5 with SID and 5 clinically normal. Study 2: direction and degrees of motion between sacrum and ilium were measured in 8 cadaveric SIJs. 3D orientation sensors were mounted to the fixated sacrum and the moveable ilium, and relative motion recorded between the 2 bones when manual forces were applied to the ilium. RESULTS: Study 1 showed a significant decrease in the CSA of the equine DSIL during application of manual forces to both tuber coxae (TC) (P<0.001) and tuber sacrale (TS) (P<0.001) when compared to at rest. Study 2 described range of motion to be greatest in the transverse or coronal plane, when lateral and oblique forces were applied to the pelvis, and recorded significant increases (P<0.05) in range of motion in the sagittal plane following resection of both the DSIL and sacrotuberous ligament. CONCLUSION AND POTENTIAL RELEVANCE: The change in DSIL CSA with application of manual force may be due to a lengthening of the ligament, reflecting equine SIJ motion in vivo. The motion recorded between ilium and sacrum in vitro suggests that greatest sacroiliac motion may occur in the transverse plane. Increases in range of motion following resection of ligaments give some indication of the role of each ligament.

Veganism and its relationship with insulin resistance and intramyocellular lipid.

OBJECTIVE: To test the hypothesis that dietary factors in the vegan diet lead to improved insulin sensitivity and lower intramyocellular lipid (IMCL) storage. DESIGN: Case-control study. SETTING: Imperial College School of Medicine, Hammersmith Hospital Campus, London, UK. SUBJECTS: A total of 24 vegans and 25 omnivores participated in this study; three vegan subjects could not be matched therefore the matched results are shown for 21 vegans and 25 omnivores. The subjects were matched for gender, age and body mass index (BMI). INTERVENTIONS: Full anthropometry, 7-day dietary assessment and physical activity levels were obtained. Insulin sensitivity (%S) and beta-cell function (%B) were determined using the homeostatic model assessment (HOMA). IMCL levels were determined using in vivo proton magnetic resonance spectroscopy; total body fat content was assessed by bioelectrical impedance. RESULTS: There was no difference between the groups in sex, age, BMI, waist measurement, percentage body fat, activity levels and energy intake. Vegans had a significantly lower systolic blood pressure (-11.0 mmHg, CI -20.6 to -1.3, P=0.027) and higher dietary intake of carbohydrate (10.7%, CI 6.8-14.5, P<0.001), nonstarch polysaccharides (20.7 g, CI 15.8-25.6, P<0.001) and polyunsaturated fat (2.8%, CI 1.0-4.6, P=0.003), with a significantly lower glycaemic index (-3.7, CI -6.7 to -0.7, P=0.01). Also, vegans had lower fasting plasma triacylglycerol (-0.7 mmol/l, CI -0.9 to -0.4, P<0.001) and glucose (-0.4 mmol/l, CI -0.7 to -0.09, P=0.05) concentrations. There was no significant difference in HOMA %S but there was with HOMA %B (32.1%, CI 10.3-53.9, P=0.005), while IMCL levels were significantly lower in the soleus muscle (-9.7, CI -16.2 to -3.3, P=0.01). CONCLUSION: Vegans have a food intake and a biochemical profile that will be expected to be cardioprotective, with lower IMCL accumulation and beta-cell protective.

Imagination inflation for action events: repeated imaginings lead to illusory recollections.

In two experiments, subjects heard simple action statements (e.g., "Break the toothpick"), and, in some conditions, they also performed the action or imagined performing the action. In a second session that occurred at a later point (10 min, 24 h, 1 week, or 2 weeks later), subjects imagined performing actions one, three, or five times. Some imagined actions represented statements heard, imagined, or performed in the first session, whereas other statements were new in the second session. During a third (test) phase, subjects were instructed to recognize statements only if they had occurred during the first session and, if recognized, to tell whether the action statement had been carried out, imagined, or merely heard. The primary finding was that increasing the number of imaginings during the second session caused subjects to remember later that they had performed an action during the first session when in fact they had not (imagination inflation). This outcome occurred both for statements that subjects had heard but not performed during the first session and for statements that had never been heard during the first session. The results are generally consistent with Johnson, Hashtroudi, and Lindsay's (1993) source monitoring framework and reveal a powerful memory illusion: Imagining performance of an action can cause its recollection as actually having been carried out.