Pragmatic patchwork ethnography, a call to action for health, nutrition and dietetic researchers.

Qualitative research methods are increasingly used in nutrition and dietetics research. Ethnography is an underexploited approach which seeks to explore the diversity of people and cultures in a given setting, providing a better understanding of the influences that determine their choices and behaviours. It is argued that traditional ethnography, that is, the methodology of living within participant communities, is a dated practice, with roots in colonialism, accessible to only researchers with the means, connections and status to conduct such research, typically white, privileged males. This paper proposes a formal interpretation of 'patchwork ethnography', whereby research is carried out in situ around existing modern-day commitments of the researcher, thus enabling more researchers within health, nutrition and dietetic practice to benefit from the rich data that can be discovered from communities. This review proposes the concept that pragmatic patchwork ethnography is required, proposing a framework for implementation, providing researchers, particularly within the fields of human nutrition, dietetics and health, the accessibility and means to deploy a meaningful client-centric methodology. We present pragmatic patchwork ethnography as a modern method for use within multiple healthcare settings, thus adding a progressive brick in the wall of qualitative research.

Method development to characterise elephant tail hairs by LA-ICP-MS to reflect changes in elemental chemistry.

This paper evaluated analytical methods used to generate time-series data from elephant tail hairs, which can be used to reflect changing exposure to environmental geochemistry. Elephant tail hairs were analysed by three methods sequentially, each providing data to inform subsequent analysis. Scanning Electron Microscopy (SEM) and X-ray Microanalysis visually showed the structure of the hair, specific structures such as tubules, and the mineral crusting around the edge of the hair, informing targeting of subsequent analysis by Laser Ablation-Inductively Coupled Plasma Mass Spectrometry (LA-ICP-MS). LA-ICP-MS generated time-series data which informed sectioning of the tail hairs for subsequent quantitative analysis for potentially toxic elements and micronutrients using Inductively Coupled Plasma Mass Spectrometry (ICP-MS) of dissolved tail hairs. This novel approach to characterise the tail hair enabled time-series analysis to reflect changes in environmental exposure which may result from seasonal or geochemical spatial variation and could inform elephant movement patterns. The seasonal change between wet and dry seasons was reflected down the length of the hair. Correlations were seen between LA-ICP-MS data and ICP-MS data in several elements including Mg, P, Ca, Fe, Na, Mn and U. This study provided time-series data for the analysis of elephant tail hairs by evaluating analytical challenges to obtaining quantitative data, such as improving protocols to ensure removal of extraneous material, determining where to section the tail hairs to best reflect environmental changes/exposure and ensuring representative analyses. A protocol was established to determine mineral status across a 12-18 month time period utilizing single elephant tail hairs.

The Response of the Human Umbilical Vein Endothelial Cell Transcriptome to Variation in Magnesium Concentration.

Vascular endothelial cells have a critical role in the maintenance of cardiovascular function. Evidence suggests that endothelial function may be compromised under conditions of magnesium deficiency, which increases vulnerability to inflammation. Whole genome transcription analysis was used to explore the acute (24 h) effects of magnesium on human umbilical vascular endothelial cells (HUVEC) cultured in low (0.1 mM) or high (5 mM) concentrations. With low magnesium 2728 transcripts were differentially expressed compared to the 1 mM control cultures and 3030 were differentially expressed with high magnesium. 615 transcripts were differentially expressed under both conditions, of which only 34 showed a concentration-dependent response. Analysis indicated that cellular organisation and biogenesis and key cellular processes such as apoptosis were impacted by both low and high conditions. High magnesium also influenced protein binding functions, intracellular signal transduction, metabolic and catalytic processes. Both conditions impacted on stress-related processes, in particular the inflammatory response. Key mediators of calcium-dependent regulation of gene expression were responsive to both high and low magnesium conditions. The HUVEC transcriptome is highly sensitive to acute changes in the concentration of magnesium in culture medium. The findings of this study support the view that whilst inflammation is an important process that is responsive to magnesium, the function of the endothelium may be impacted by other magnesium-induced changes including maintenance of cellular integrity, receptor expression and metabolic functions. The high proportion of transcripts that did not show a concentration-dependent response suggests variation in magnesium may elicit indirect changes, possibly mediated by other ions.

Early life programming of health and disease: The long-term consequences of obesity in pregnancy.

The prevalence of overweight and obesity is rising in all parts of the world and, among young women, it presents a very clear danger during pregnancy. Women who are overweight or who gain excessive weight during pregnancy are at greater risk of complications in pregnancy and labour, and are more likely to lose their child to stillbirth or die themselves during pregnancy. This narrative review considers the evidence that, in addition to increasing risk of poor pregnancy outcomes, obesity has the capacity to programme foetuses to be at greater risk of cardiometabolic disorders later in life. An extensive body of evidence from prospective and retrospective cohorts, as well as record linkage studies, demonstrates associations of maternal obesity and/or gestational diabetes with cardiovascular disease, as well as type 1 and type 2 diabetes. Studies in animals suggest that these associations are underpinned by adaptations that occur in foetal life, which remodel the structures of major organs, including the brain, kidney and pancreas.

Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: A narrative review.

The global prevalence of overweight and obesity in pregnancy is rising and this represents a significant challenge for the management of pregnancy and delivery. Women who have a pre-pregnancy body mass index greater than 25 kg m-2 are more likely than those with a body mass index in the ideal range (20-24.99 kg m-2 ) to have problems conceiving a child and are at greater risk of miscarriage and stillbirth. All pregnancy complications are more likely with overweight, obesity and excessive gestational weight gain, including those that pose a significant threat to the lives of mothers and babies. Labour complications arise more often when pregnancies are complicated by overweight and obesity. Pregnancy is a stage of life when women have greater openness to messages about their lifestyle and health. It is also a time when they come into greater contact with health professionals. Currently management of pregnancy weight gain and the impact of overweight tends to be poor, although a number of research studies have demonstrated that appropriate interventions based around dietary change can be effective in controlling weight gain and reducing the risk of pregnancy complications. The development of individualised and flexible plans for avoiding adverse outcomes of obesity in pregnancy will require investment in training of health professionals and better integration into normal antenatal care.

Comparison of food and nutrient intake in infants aged 6-12 months, following baby-led or traditional weaning: A cross-sectional study.

BACKGROUND: A baby-led approach to weaning (BLW) encompasses self-feeding and self-selecting graspable foods, offering an alternative to traditional weaning (TW). This cross-sectional study explored adherence to characteristics of BLW and differences in food group exposure and nutrient intake between babies following either TW or BLW. METHODS: Nutritional data were collected via multiple-pass 24-h recall, following parental completion of an online survey. RESULTS: Infants were grouped according to age (6-8 months; TW [n = 36] and BLW [n = 24]) and (9-12 months; TW [n = 24] and BLW [n = 12]). BLW babies were more likely to be breast fed (p = 0.002), consumed a higher percentage of foods also consumed by their mother (p = 0.008) and were fed less purees (p < 0.001) at 6-8 months. TW babies were spoon fed more (p ≤ 0.001) at all ages. Amongst babies aged 6-8 months, total intake (from complementary food plus milk) of iron (p = 0.021), zinc (p = 0.048), iodine (p = 0.031), vitamin B12 (p = 0.002) and vitamin D (p = 0.042) and both vitamin B12 (p = 0.027) and vitamin D (p = 0.035) from complementary food alone was higher in babies following TW. Compared to TW, BLW babies aged 6-8 months had a higher percentage energy intake from fat (p = 0.043) and saturated fat (p = 0.026) from their milk. No differences in nutrient intake were observed amongst infants aged 9-12 months. Few differences were observed between groups in their number of exposures to specific food groups. CONCLUSIONS: TW infants had higher intakes of key micronutrients at 6-8 months, although there were few differences in nutritional intake at 9-12 months or food group exposure between babies following TW or BLW. BLW appears to be socially desirable. Guidance for parents is required, along with larger, longer-term studies, which explore the potential impact of BLW in later childhood.

Acute changes to breast milk composition following consumption of high-fat and high-sugar meals.

Breast milk composition is influenced by habitual diet, yet little is known about the short-term effects of changes in maternal diet on breast milk macronutrient concentrations. Our aim was to determine the acute effect of increased consumption of sugar/fat on breast milk protein, lactose and lipids. Exclusively breastfeeding women (n = 9) were provided with a control, higher fat (+28 g fat) and higher sugar (+66 g sugar) diet over three separate days at least 1 week apart. Hourly breast milk samples were collected concurrently for the analysis of triglycerides, cholesterol, protein, and lactose concentrations. Breast milk triglycerides increased significantly following both the higher fat and sugar diet with a greater response to the higher sugar compared to control diet (mean differences of 3.05 g/dL ± 0.39 and 13.8 g/dL ± 0.39 in higher fat and sugar diets, respectively [P < 0.001]). Breast milk cholesterol concentrations increased most in response to the higher sugar diet (0.07 g/dL ± 0.005) compared to the control (0.04 g/dL) and the higher fat diet (0.05 g/dL) P < 0.005. Breast milk triglyceride and lactose concentrations increased (P < 0.001, P = 0.006), whereas protein decreased (p = 0.05) in response to the higher fat diet compared to the control. Independent of diet, there were significant variations in breast milk composition over the day; triglycerides and cholesterol concentrations were higher at end of day (P < 0.001), whereas protein and lactose concentrations peaked at Hour 10 (of 12) (P < 0.001). In conclusion, controlled short-term feeding to increase daily sugar/fat consumption altered breast milk triglycerides, cholesterol, protein and lactose. The variations observed in breast milk protein and lactose across the 12 h period is suggestive of a circadian rhythm.

Biofortified Maize Improves Selenium Status of Women and Children in a Rural Community in Malawi: Results of the Addressing Hidden Hunger With Agronomy Randomized Controlled Trial.

Background: Selenium deficiency is widespread in the Malawi population. The selenium concentration in maize, the staple food crop of Malawi, can be increased by applying selenium-enriched fertilizers. It is unknown whether this strategy, called agronomic biofortification, is effective at alleviating selenium deficiency. Objectives: The aim of the Addressing Hidden Hunger with Agronomy (AHHA) trial was to determine whether consumption of maize flour, agronomically-biofortified with selenium, affected the serum selenium concentrations of women, and children in a rural community setting. Design: An individually-randomized, double-blind placebo-controlled trial was conducted in rural Malawi. Participants were randomly allocated in a 1:1 ratio to receive either intervention maize flour biofortified with selenium through application of selenium fertilizer, or control maize flour not biofortified with selenium. Participant households received enough flour to meet the typical consumption of all household members (330 g capita -1 day-1) for a period of 8 weeks. Baseline and endline serum selenium concentration (the primary outcome) was measured by inductively coupled plasma mass spectrometry (ICP-MS). Results: One woman of reproductive age (WRA) and one school-aged child (SAC) from each of 180 households were recruited and households were randomized to each group. The baseline demographic and socioeconomic status of participants were well-balanced between arms. No serious adverse events were reported. In the intervention arm, mean (standard deviation) serum selenium concentration increased over the intervention period from 57.6 (17.0) µg L-1 (n = 88) to 107.9 (16.4) µg L-1 (n = 88) among WRA and from 46.4 (14.8) µg L-1 (n = 86) to 97.1 (16.0) µg L-1 (n = 88) among SAC. There was no evidence of change in serum selenium concentration in the control groups. Conclusion: Consumption of maize flour biofortified through application of selenium-enriched fertilizer increased selenium status in this community providing strong proof of principle that agronomic biofortification could be an effective approach to address selenium deficiency in Malawi and similar settings. Clinical Trial Registration: http://www.isrctn.com/ISRCTN85899451, identifier: ISRCTN85899451.

Early postnatal exposure to a cafeteria diet interferes with recency and spatial memory, but not open field habituation in adolescent rats.

The cafeteria diet (CD), an experimental diet that mimics the obesogenic Western diet, can impair memory in adult rats. However, the suckling period is also particularly susceptible to diet-induced behavioural modification. Here, following exposure to CD feeding during lactation, 24- to 26-day-old offspring were tested to determine maternal dietary effects on either open field habituation, object location (OL) learning or on recency learning. Whereas no impact on habituation learning could be demonstrated, both OL and recency memory were impaired. In controls (C), OL memory was shown both after a 5 min (p < .05) or 60 min (p < .001) inter-trial interval (ITI). After the 60 min ITI, the difference between C and CD was significant (p < .05). Learning did not occur in the CD group at any time point and was not observed after the 24hr ITI in in either group. Whereas control rats demonstrated intact recency memory (p < .00001), no learning occurred in the CD group. Both groups differed significantly in their exploration ratios (p < .01). This study suggests a detrimental effect of exposure to an unhealthy Western diet during lactation, on cognitive functions in adolescent rats. These results could have implications for human cognition in the context of obesity epidemic.