The UK Diabetes and Diet Questionnaire (UKDDQ) is a brief dietary questionnaire developed for people with, or at high risk of, type 2 diabetes(1). It consists of 20 items scored from 0–5 (0 healthiest, 5 least healthy). It has been demonstrated to be reliable and compares well with food diaries. A study evaluating sensitivity to change of the UKDDQ was undertaken at the specialist weight management service (WMS) at Musgrove Park Hospital, Taunton. WMS patients receive an initial appointment with an endocrinologist and dietitian, followed by referral to group sessions or dietary advice. Follow up appointments with a WMS specialist occur over the next 26 weeks. Adults attending the service were recruited for the study between September 2016-March 2017. Participants completed the UKDDQ in the waiting room at the initial appointment and the first follow-up. Diabetes status, binge eating assessment and weight at both timepoints were obtained from WMS records. UKDDQ scores from 0–5 were calculated for each participant by summing the score for each item and dividing by 20. Change in UKDDQ scores and absolute and percentage change in weight between appointments were calculated. Paired sample t-tests were used to test differences in means for UKDDQ scores and weight from baseline to follow up. Multivariable regression analysis was used to examine associations between changes in the UKDDQ scores and percentage change in weight. The model was adjusted for age, gender, follow up time, diabetes status and binge eating. Forty-eight White British participants completed the study (67% women, 37% type 2 diabetes, 29% binge eating). Baseline mean weight was 132.4 (29.4)kg, mean BMI 46.5(7.7)kg/m2 and mean UKDDQ score was 1.39 (0.49). Participants lost weight (-2.4 (6.9)kg, p = 0.006) and the UKDDQ score improved between baseline and follow up (-0.27(0.53), p = 0.001). The mean percentage weight change was -1.6 (5.0)%. There was some evidence that a one point deterioration in healthy eating was associated with a 2.4 (-0.2 to 5.1)% increase in weight (p = 0.072). The UKDDQ can measure dietary change in people attending a specialist WMS and there is some evidence that a change in score is associated with a change in weight. The UKDDQ could be used as an outcome measure in these services.

Plant proteins constitute a rich and complex source of nutrients with health benefits for most populations. However, an ever-growing number of people have been affected by protein allergies and sensitivities. Furthermore, there is evidence suggesting that plant proteins can activate the innate immune system by stimulating the toll like receptor 4 (TLR4)-MD2-CD14 complex in cells of the mononuclear phagocyte system. Therefore, we have explored the effects of genetic variability, agricultural practices and area of cultivation (Andes vs Mediterranean) on the innate stimulatory capacity of quinoa proteins.

Plant proteins were exhaustively extracted from milled and defatted samples using salt solutions or enzymatic digestion (pepsin/trypsin) and dialyzed against neutral buffers, sterile filtrated and lyophilized. Ethanol soluble proteins were extracted from the resulting pellet and additionally, milled samples were digested with pepsin and trypsin, dialyzed and sterile filtrated. Extracts were cultured with monocytic cell lines and the concentration of IL-8 and other innate cytokines released was measured in cell culture supernatants after overnight incubation. Additionally, samples were tested with cells transfected with TLR4-MD2-CD14 and the Renilla luciferase reporter gene under the transcriptional control of the IL-8 promoter.

We observed that proteins from 4 quinoa cultivars from the Andes (cultivated at 3800 meters above sea level) had very low innate immune stimulatory activity (< 5% of modern wheat). However the same quinoa variants cultivated at sea level had significantly higher bioactivity (> 10 % higher than modern wheat) which was absent in the ethanol extracts and reduced by ~60% in the enzymatically digested extracts. Other samples such as millet and buckwheat also showed reduced bioactivity compared to modern wheat after enzymatic digestion in murine and human cells. To conclude: 1) We have identified that the innate stimulatory activity of quinoa proteins is significantly affected by agricultural practices and area of cultivation; 2) This immune-stimulatory activity can be reduced by enzymatic digestion; 3) Depending on the varieties, cultivation and further processing, plant proteins may impact on the development of allergies and sensitivities.

Recent findings point at novel benefits of specific fibres, like inulin, as their fermentation metabolites can improve mucosal immunity and protect against infections (1,2). This outcome is desirable for athletes, who are at increased exposure to oxidative damage and thus risk of upper respiratory tract infections (URTI). However, whether inulin can improve immune function in athletes is unknown. We investigated the effect of supplementation with inulin-enriched foods on salivary immunoglobulin A (sIgA), a marker of immunity associated with URTI, in rugby players. We hypothesised that inulin supplementation would increase sIgA, and such change would be greater than that observed in a group following a diet without inulin supplementation. Ten rugby players volunteered for this pilot study (24.2 ± 5.4 years, 93.2 ± 18.7 kg). Participants were randomly assigned to either control (CON) or intervention diet (IN) for 3-weeks; and provided with 2% inulin-enriched pasta and bread (IN) or the same products without inulin (CON), to be consumed as part of a prescribed diet plan. sIgA was measured before and after each condition by collecting saliva with validated swabs, and was quantified with enzyme-linked immunoassay. Differences within and between groups were assessed with paired-samples t-test and ANOVA, respectively. Relationships between inulin intake and sIgA were explored with Spearman's correlation and regression analysis. There was a significant increase in sIgA following inulin supplementation (p = 0.002), which was significantly different to CON (+ 53.6 ± 44.7 and 5.8 ± 37.2 mg/dL, p = 0.054). Average inulin intake was 10.9 ± 1.6 g/day, and it was positively associated with sIgA (rs = 0.661, p = 0.038) and correlated with sIgA changes (r2 = 0.438, p = 0.037). There were no significant differences in energy intake between and within groups (p > 0.10). There were no reports of upper-respiratory tract or other infections during the study period (winter). Some IN participants reported improved bowel function. Inulin-enriched products could represent a simple approach to promote mucosal immunity and gut health in athletes. Larger controlled trials are warranted to confirm the dose-response and long-term effects of inulin supplementation including metabolic and performance outcomes.

Does dietary intervention affect the change of the intestinal microflora, causes the unsealing of the intestinal mucosa. After four weeks of dietary intervention with FODMAP diets and a diet based on NICE recommendations in children with functional abdominal pain, the intestinal microflora will change and the level of zonulin will decrease.

Bacterial intestine, intestinal bacteria is a set of microorganisms, the main bacteria that form a complex ecosystem in the digestive tract. Scientific research indicates that some bacteria may contribute to the formation of certain disease entities.

Children with functional abdominal pain participated in the research.

The study was a randomized intervention and a double-blind test. 32 children were examined, patients of gastroenterological counseling center of the Provincial Specialist Children's Hospital in Olsztyn. Children were 4–12 years old, functional abdominal pain was diagnosed on the basis of Roman criteria, a positive decision of the gastroenterologist regarding the inclusion of the patient, conscious and voluntary consent of the child's guardian to participate in the study. Exclusion criteria include irritable bowel syndrome, abdominal migraine, diagnosed food allergies or food intolerance, the coexistence of chronic diseases or antibiotic therapy in the last 8 weeks.

The dietary intervention lasted 4 weeks, meals were prepared on the basis of a menu developed by a dietician.

Diagnostic tests were carried out before and after dietary intervention. One group of children with functional abdominal pain received the Fodmap diet, the second group, a diet based on NICE recommendations.

The intestinal microflora, the level of zonulin in the stool were tested and the organic acids in the urine were determined by capillary gas chromatography/mass spectrometers (GC/MS).

A preliminary analysis of test conditions prior to dietary intervention was found.

Dysbiosis occurred in all 26 children (4 children did not perform the test). An increased number of Bacteroides spp. Was observed in the majority of children in stool tests, studies have reported that the growth of this bacterium in the intestinal microflora occurs in IBD intestinal inflammatory syndrome. Preliminary researches show that this bacterium was dominant in the examined children. In the test, an intermediate urine dysbiosis test of 24 out of 26 children was tested had at least one parameter elevated. After the dietary intervention, the diet had an effect on changing the intestinal microflora, changing the parameters of dysbiosis and the parameter of zonulin, although more research is needed on a larger population.

Tea is often described as having “refreshing” properties. Indeed, components of both green and black tea have been shown to acutely improve aspects of cognition and mood and to affect cardiovascular function. There is, however, surprising little research directly comparing these effects between different types of tea. This study therefore examined acute cognitive, mood, and cardiovascular effects of green tea and black tea.

A double blind, randomised, placebo-controlled,balanced, three-way cross-over study was conducted. Fourteen healthy young adults (M = 23.8, SD = 3 years) consumed placebo (water), green tea and black tea in balanced order at least 24 h apart.The drinks were prepared according to standardised procedures and consumed under double-blind conditions (in opaque containers with lemon cordial added for taste-masking). Mood and cognition were measured at baseline then 90 min post-treatment, cardiovascular function was assessed post-dose only. Mood was evaluated using a series of visual analogue scales, cognitive performance was assessed using a suite of standardised tests from the Computerised Mental Performance Assessment System (COMPASS), gauging performance on aspects of attention, memory and executive function.Peripheral and central systolic and diastolic pressure,augmentation pressure, augmentation index,and blood flow velocity were measured via Sphygmocor pulse wave analysis and Doppler ultrasound, respectively. There were a number of significant effects associated with the active treatments. Compared with placebo, black tea and green tea was associated with significantly improved digit vigilance accuracy (p < .01), while green tea was associated with higher alertness (p < .05).Regarding cardiovascular outcomes, black tea and green tea significantly increased central diastolic pressure, and peripheral diastolic pressure in comparison to placebo (P < .01). Black tea also significantly increased central systolic pressure compared to green tea and placebo (p < .05). Analysis of treatment guessing suggested that the masking procedure was highly effective. In conclusion, the present study shows that green tea improves alertness. Since black tea contains higher levels of caffeine, this effect is likely underpinned by non-caffeine mechanisms or caffeine/non-caffeine compound interactions.Improved vigilance is consistent with caffeine effects which may be modulated by cardiovascular effects. Interestingly the cardiovascular effects are opposite to those reported for chronic tea interventions. These results suggest that acute cognitive and cardiovascular components of tea merit further investigation both in the presence and absence of caffeine.

Apolipoproteins (apo) regulate lipoprotein characteristics and lipid metabolism. ApoC-III is a regulator of triglyceride-rich lipoprotein (TRL) metabolism and apolipoproteins are important biomarkers for cardiovascular disease (CVD) risk prediction. A low carbohydrate high fat (LCHF) diet improves cardiometabolic risk, especially via reduction of TRL. However, few studies have compared a LCHF vs. a high carbohydrate (HC), lower fat diet under ad libitum conditions on apoC-III levels. The objectives of this investigation were to measure the effect of a LCHF vs. a HC diet on apoC-III, apoA1, apoB and apoB/apoA1 in 16 healthy Caucasian adults aged 19–64. Ethical approval: Liverpool John Moores University Research Ethics Committee (16/ELS/029); registered with ClinicalTrials.gov (Ref. NCT03257085). Participants randomly assigned to a HC diet (UK Eatwell guidelines; ≥ 50% of energy from carbohydrates) (n = 8), or a LCHF diet (consume < 50 g/day of carbohydrates) (n = 8) provided plasma samples at 0, 4 and 8 weeks. ApoA1 and apoB were analysed by an automated chemistry analyser (Daytona, Randox Laboratories Ltd, UK). ApoC-III was analysed via ELISA (Thermo Fisher Ltd, USA). Factorial 2×3 ANOVA and ANCOVA (IBM SPSS 25®) were undertaken to investigate significant differences and to control for variables influenced by baseline measures and visceral adipose tissue (VAT). Results show 0, 4, and 8 weeks respectively: ApoC-III (LCHF: 19.12 ± 9.14, 16.05 ± 7.95, 15.11 ± 3.17 mg/dl; HC: 22.13 ± 8.38, 28.22 ± 13.85, 22.22 ± 7.7 mg/dl) showed no significant (P = 0.319) change. No significant (P = 0.23) change was also observed in ApoB (LCHF: 107.25 ± 20.35, 111.38 ± 24.81, 111.43 ± 19.93 mg/dl; HC: 94.38 ± 20.79, 105.00 ± 20.13, 99.00 ± 29.09 mg/dl). Similarly apoA1 (LCHF: 158.71 ± 14.27, 166.50 ± 23.09, 173.00 ± 29.42 mg/dl; HC: 164.71 ± 30.25, 172.50 ± 29.44, 174.00 ± 32.83 mg/dl) showed no significant change (P = 0.76). This resulted in a relatively unchanged apoB/A1 throughout the study in both diets (P = 0.30). No significant (P > 0.05) differences were found after 4 weeks or between groups also. ANCOVA revealed a trend (P = 0.06) in apoC-III for a difference between groups (LCHF: Δ-6.6 mg/dl vs. HC: Δ1.2 mg/dl) after 8 weeks but no significant (P > 0.05) changes in other apolipoproteins were detected. These preliminary data reveal that a LCHF diet does not improve the apolipoprotein profile; however, when accounting for other metabolic risk factors (i.e. VAT) there was a trend towards lowering apoC-III levels (P = 0.06). Modulation of apoC-III may lead to improved lipid metabolism, but higher-powered studies are warranted before any improvement on CVD risk can be inferred.

Targeted nutrition is defined as personalised nutrition tailored to groups of individuals. Such groups can be identified based on metabolic profiles and are named metabotypes. Metabotypes have been identified in a range of populations and offer the potential to deliver personalised nutrition advice. The objective of the current study was to optimise a targeted approach to deliver dietary advice through comparison with an individualised approach. Study participants (n = 160) were classified into metabotypes previously defined by four markers (triacylglycerols (TAG), total cholesterol (TC), HDL-c, and glucose) in a cross-sectional study with Irish adults. Targeted advice was designed using a decision tree approach. A personalised approach was achieved through the use of the Food4Me decision trees(1). Agreement between methods was compared and the metabotype approach was optimised to incorporate the most prevalent advice exclusively given by the Food4Me decision trees. The optimised metabotype approach was subsequently tested by comparison with individualised advice manually compiled by a dietitian. Individuals in metabotype-1 had high TC (median 5.0 mmol/L, interquartile range 4.2–5.4 mmol/L); individuals in metabotype-2 had normal concentrations of the four biomarkers; and individuals in metabotype-3 had high TAG (1.8, mmol/L 1.4–2.6 mmol/L) and TC (5.4 mmol/L, 4.8–5.9 mmol/L), with the highest BMI and diastolic blood pressure, and the most unfavourable profile for glycaemia (highest fasting insulin and HOMA-IR). Using the metabotype approach, advice for lowering TC, weight, waist circumference, TAG, and blood pressure was given to 79.4%, 46.9%, 28.1%, 20.6%, and 11.9% of the individuals, respectively. Considering the personalised approach, the most frequent advice was given to improve the intake of saturated fatty acids (56.5%), fibre (56.0%), and folate (55.0%). The total agreement between the methods was 64.0%. The optimised metabotype approach revealed a good total agreement of 80.3% with the individualised manual approach, especially in metabotype-1 (93.8%) and metabotype-3 (94.3%). Agreement was higher in females (84.8% vs. 76.4%, p = 0.02) and in older (≥ 45 years old) people (92.5% vs. 78.1%, p = 0.02). These results confirm metabotypes as a promising approach to deliver targeted dietary advice. Future work should ascertain if targeted nutrition is effective in changing behaviours that will affect health outcomes.

The increasing worldwide prevalence of obesity is a major public health concern, which has led to the development of surgical treatment strategies that achieve long-term sustainable weight loss and improvement of comorbidities and quality of life. However, nonsurgical complications can occur which sometimes necessitate hospital readmission depending on the severity. Current literature about hospital admission for nonsurgical complications after bariatric surgery is especially sparse. We performed a 5-year retrospective analysis of patients admitted for nonsurgical complications after bariatric surgery at the Department of Endocrinology, University Hospitals Leuven (Belgium). Patient and readmission characteristics were described by type of first bariatric surgery performed, time after first surgery, amount of bariatric surgeries in total, reason for hospitalization (nutritional, functional, psychological, metabolic and medical), need for parenteral and enteral feeding during hospitalization and duration of hospitalization. In a period of five years, there were 152 hospitalizations of 107 patients (86% females). The majority of patients (53%) underwent Roux-en-Y gastric bypass (RYGB) and had in total 1 (1–2) bariatric procedures. The median BMI before the first bariatric procedure was 40.7 (37.9–46.7) kg/m2. Patients were admitted 7.6 (3.4–13.1) years after surgery at an average age of 49 ± 12 years. Nutritional (66.4%), functional (37.5%) and co-presenting nutritional-functional (25.0%) problems were the most important reasons for hospitalization. In regard to the nutritional complications, the most important reasons for hospital admission were dumping syndrome (19.7%), macro- and micronutrient deficiencies (16.4%), bad compliance to prescribed nutritional guidelines (14.5%), anorexia (11.2%), extensive weight loss (10.5%) and failure to thrive (9.2%). During hospitalization, parenteral and enteral feeding was started in 19.1% and 9.9% of hospitalizations, respectively. The median duration of all hospitalizations was 8 (4–13) days. To conclude, the majority of hospitalized patients underwent RYGB and was female. Most patients were admitted late after surgery and nutritional problems were the most common complication. Nonsurgical complications after bariatric surgery are a clear illustration of the double-edged sword of surgical obesity management. The exact gastrointestinal anatomical and physiological changes provide the intended effect of weight loss, but may also elicit unintended imbalances of excessive losses of nutrients that compromise the outcome. Our findings demonstrate the need for lifelong multidisciplinary follow-up of lifestyle behavior and education on diet both before and after bariatric surgery.

Chrono-nutrition is an emerging field of research that focuses on the interplay between nutrition, circadian rhythms and metabolism. Most nutritional guidelines recommend regular and frequent meals for children and adolescents throughout the day. However, preliminary research, mostly in animals suggests that eating at the “wrong” time of the day and longer eating windows (and concomitant shorter fasting periods) may relate to metabolic health. This study aimed to identify meal-timing patterns of European children and adolescents in eight European countries.

We examined 1225 children and adolescents (mean age: 11.8 years, 50% boys, and 26% overweight/obese) from Belgium, Cyprus, Estonia, Germany, Hungary, Italy, Spain and Sweden enrolled in the European I.Family study (2013/2014). Information on energy intake and meal-timing patterns was derived from multiple web-based 24-hour dietary recalls (proxy-assisted for children < 12 years). We used the National Cancer Institute (NCI) method to estimate individual usual intakes. Subsequently, we applied the k-means algorithm to identify clusters for meal-timing patterns. Five variables were selected for the cluster analysis: 1) Duration between first and last meal of the day (eating window in hours), 2) Proportion of daily energy intake before 11am, 3) Proportion of daily energy intake after 5pm, 4) Number of meals per day, and 5) Pre-sleep fasting time.

Three clusters, labelled “late and time-restricted”, “late and long” and “early and frequent” meal-timing patterns were identified. Similar clusters were derived when excluding energy misreporters according to Goldberg cut-offs. Children in the “early and frequent” pattern were younger, had a lower body mass index (BMI) z-score, and a longer sleep duration than children in the other two meal-timing patterns. A higher proportion of plausible energy reporters were classified into the “early and frequent” pattern than into the other two patterns. The proportion of children from Italy, Cyprus and Spain was highest in the “late and long” pattern, while the proportion of children from Belgium, Sweden, Germany and Hungary was highest in the “early and frequent” patterns, and the proportion of children from Estonia was highest in the “late and time-restricted” pattern.

In conclusion, this study identified three different meal-timing patterns in children that varied by age, BMI z-score, country, misreporting status, and sleep duration. Investigations on the associations between meal timing patterns and metabolic health in this study sample are currently ongoing.

Coffee is one of the most widely consumed beverages around the world. Several studies have observed an inverse association between coffee consumption and all-cause mortality in population-based studies. Nevertheless, little is known about these associations in patient populations with a prior Acute Coronary Syndrome (ACS). To examine the association between coffee consumption and the risk of mortality in patients with a prior acute myocardial infarction (MI) or unstable angina. Data were from the longitudinal prospective study “Strategy of Registry of Acute Coronary Syndrome Cohort - ERICO”. The cohort involved 1,085 patients diagnosed with ACS, between 2009 to 2013. For this analysis we used data after 180 days until 4 years’ follow-up, totalizing 928 participants. The coffee consumption was obtained using a questionnaire multiplying the reported frequency by the reported portion size. Subsequently was calculated the average of coffee intake (mL/day) and categorized (cups/day) into ≤ 1, 1–3, and > 3. Information on mortality was ascertained by medical registries and death certificates. Cox regression models to estimate hazard ratios (HRs) for mortality according to coffee consumption adjusted for potential confounders were performed. Kaplan-Meier survival curves with the log-rank test were analyzed. Most patients (99.0%) drank coffee, and the median total coffee intake was 125 mL/day. During a median follow-up of 4 years, a total of 111 deaths occurred, including 59 CVD-related and 24 MI-related deaths. Moderate coffee consumption was inversely associated with all-cause mortality. Participants who consumed 1–3 cups of coffee/day, showed an 81% lower risk of all-cause mortality than those who consumed ≤ 1 cup/day (adjusted HR 0.19; 95%CI: 0.11, 0.34). For patients with higher coffee consumption (> 3 cups/day), there was a positive association with mortality, with HR of 2.10 (95%CI: 1.05, 4.22). Corresponding HRs were 0.22 (95%CI: 0.11, 0.48) for 1–3 cups/day and 2.66 (95%CI: 1.04, 6.83) for > 3 cups/day for CVD mortality; and 0.23 (95%CI: 0.07, 0.71) and 1.59 (95%CI: 0.25, 10.0) for MI mortality, respectively. After stratification by smoking status the analysis revealed lower risk of all-cause mortality in never and former smokers drinking 1–3 cups/day (HRs 0.10; 95%CI: 0.04, 0.24 and 0.18; 0.08, 0.42, respectively). Among current smokers there was a positive association between > 3 cups/day and mortality (HR 8.50; 95%CI: 1.18, 16.35). The moderate consumption of coffee, impacted in a lower risk of all-cause, CVD and MI mortality in patients with a prior Acute Coronary Syndrome, particularly in nonsmokers.