Vitamin D status has been found to be inversely associated with risk of respiratory tract infections (RTIs)(1). It varies by ethnicity, with several ethnic minority groups in the United Kingdom (UK) reported to be at a higher risk of vitamin D deficiency (serum 25-hydroxyvitamin D (25(OH)D) concentrations <25 nmol/L) compared to their white counterparts(2, 3). However, the relationship between serum 25(OH)D concentrations and incidence of RTIs by ethnicity in the UK remains unclear. This study aimed to investigate the association between serum 25(OH)D concentrations and likelihood of hospitalisation for RTI in UK ethnic groups.

A nested, case-control study was conducted using data from UK Biobank, which has data for 500k adults for serum 25(OH)D and hospital episodes from linked records. Binary logistic regression models were used to explore the association between serum 25(OH)D concentrations and likelihood of RTIs overall, and by ethnicity.

Of the 36,772 participants included in the analysis, 12,638 (34%) were white Caucasian, 10,311 (28%) Asian, 7,138 (19%) black, 4,034 (11%) other, and 2,651 (7%) of mixed ethnicity. In fully adjusted models, compared to participants with a serum 25(OH)D concentration <15 nmol/L (severe deficiency), those with 25-49 nmol/L, 50-74 nmol/L, and ≥75 nmol/L were found to have statistically significantly lower odds of RTI hospitalisation, with odds ratios (ORs) of 0.53 (95% CI: 0.37, 0.75), 0.61 (95% CI: 0.40, 0.92) and 0.54 (95% CI: 0.30, 0.97), respectively. In the subgroup analysis, ethnic minorities and white individuals with vitamin D deficiency (<25 nmol/L) were more likely to be hospitalised with RTI compared to those that were not deficient, with ORs of 1.36 (95% CI: 1.02, 1.81) and 2.03 (95% CI: 1.30, 3.17), respectively. This association was not statistically significant within ethnic minority subgroups when analysed separately.

Serum 25(OH)D concentrations above 25 nmol/L are associated with lower likelihood of RTI hospitalisation among UK adults. This finding was noted across white and ethnic minority groups, although ethnic minorities with vitamin D deficiency had a lower likelihood of RTIs compared to white individuals. Further studies are warranted to validate these findings and explore the mechanisms underlying the association between vitamin D status and RTIs in different ethnic groups.

Acknowledgements

This project was conducted using the UK Biobank resource under project 15168.

Obesity prevalence has tripled in over the past 35 years and has detrimental effects on physical and psychological health(1). Weight loss via dietary intervention is a mainstay for the treatment of obesity and reduces body fat(2), but also results in loss of lean tissue(3). A potential solution to mitigate the loss of lean tissue, and thus enhance the benefits of weight loss, is resistance exercise. The aim of the current systematic review was to examine the impact of resistance exercise on body weight/composition and markers of cardiometabolic health, as well as physical function, in people living with overweight or obesity undergoing dietary weight loss interventions.

A search was performed in PubMed, Embase, CINAHL, SCOPUS, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) based on the set inclusion and exclusion criteria. Systematic searches yielded N=5147 studies of which n=27 were relevant for inclusion after screening for eligibility. We included randomised controlled clinical trials of adult participants (18-65 years of age) with body mass index (BMI) ≥ 25kg/m2) that compared dietary weight loss interventions including resistance exercise with 1) dietary weight loss interventions including other non-resistance exercise and/or 2) dietary weight loss interventions without any exercise. Resistance exercise was classed as any form of resistance or muscle strengthening exercise (e.g. gym or home- based, supervised or non-supervised, used equipment or body weight only). Key data were extracted, risk of bias was assessed using the Cochrane risk of bias tool, and the quality of evidence assessed using Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Meta-analysis was performed including only studies that compared dietary weight loss plus resistance exercise interventions to diet-only (i.e. not including any other exercise) weight loss interventions to explore differences in body weight/composition and cardiometabolic health changes between diet plus resistance exercise and diet only interventions.

Overall, resistance exercise in addition to diet-induced weight loss had no effect on weight loss (mean difference between groups: -0.32kg, 95% confidence interval [CI] -1.00 to 0.35; p=0.35) but did preserve fat free mass (between-group standardised mean difference (SMD): 0.40, 95%, [CI] 0.18 to 0.61; p=0.0003) and increase loss of fat mass (SMD: -0.36, 95% [CI] -0.49 to -0.23; p< 0.00001). Muscular strength was also improved (SMD: 2.36, 95% [CI] 1.38 to 3.34; p=0.00001) by the inclusion of resistance exercise. No effects of resistance exercise were seen in any of the other cardiometabolic markers studied, although data were limited.

In people who are obese or overweight, the addition of resistance exercise to dietary restriction may enhance its beneficial effects. Current evidence, therefore, supports the inclusion of resistance exercise during weight loss to attenuate the loss of lean mass, increase fat mass loss and improve muscle strength.

A diet high in fruit and vegetables is beneficial to reduce the risk of many diseases such as cardiovascular diseases, certain cancers and hypertension(1,2). However, reports show that vegetable consumption among children is still low. Intervention must be made to encourage children to eat more vegetables as a dietary pattern in childhood will determine a dietary pattern in adulthood(3). This current study investigated the effects of an e-storybook on children’s vegetable acceptance.

Sixty-five parents and their children aged 4 to 7 years participated in this study and they were divided into 2 groups. Parents in an experimental group read an e-storybook about a target vegetable (asparagus) with their child for 10 days, while the control group did not receive an e-book. Parents in both groups were asked to offer the target vegetable and a match control vegetable (peas) before and after the intervention and record their child’s vegetable intake (measured using a 6-point scale) and liking (measured using a 6-point scale).

In the experimental group, liking of target vegetable increased from 2.5 ± 1.5 to 3.0 ± 1.4 (p = 0.01), but not for control vegetable. There was a tendency that intake of target vegetable increased following exposure to the e-storybook, from 1.6 ± 1.6 to 1.9 ± 1.7 (p=0.052), but there was no significant increase in intake for control vegetable. While in the control group, there were no significant increases in intake and liking for both vegetables post-intervention. When comparing means between groups, there were no significant differences in intake and liking at pre-intervention, however at post-intervention, there was a significant difference in intake (p=0.02), where the intervention group had a higher intake than the control group by 0.9 ± 1.9. There was also a significant difference in liking between these groups at post-intervention (p=0.001), where the intervention group had a higher liking than the control group by 1.1 ± 1.8.

Results suggest that e-storybooks are an effective strategy for parents to use to increase vegetable acceptance in children.

Adequate nutrition is necessary for overall health and development(1). Prisoners in general lack autonomy over their diet, in addition to being a population with a high risk of poor health outcomes(2, 3). It is important therefore that prisons are offered menus which meet dietary reference values (DRVs), as set by the UK government, aiming for equity with the general population, and that prisoners choose food options that are beneficial for their health. The aim of this study was to conduct a nutritional analysis of prisoners’ food diaries to determine whether dietary recommendations were being met.

Seven-day food diaries were collected from prisoners eating the normal food supplied by three young offender institutions in 2009. Food eaten was analysed using DietPlan6 version 6.0 (Forestfield Software Ltd). Individual nutrient data were tested for normality and compared against the UK DRVs and NDNS data from 2008/9 using either the one-sample T-test, or one-sample Wilcoxon Signed Rank Test. Data in the results is presented as (Mean ± SD).

There were n=466 diaries analysed, from male participants aged between 16 to 24 years. Twenty- eight nutrients were compared with their respective DRVs by age categories: 16-18y (n=156), 19-24y (n=310), and 16-24y (n=466).

For ages 16-24y, chloride (5556 ± 1692mg), folate (302 ± 112ug), iodine (195 ± 81ug), monounsaturated fat (35 ± 10g), potassium (3667 ± 1161mg), sodium (3899 ± 1392mg), sugar (136 ± 73g), riboflavin (2 ± 1mg), vitamin B12 (6 ± 4ug), vitamin C (92 ± 63mg), and zinc (11 ± 3mg) exceeded DRV requirements (P<0.01). Carbohydrates (53 ± 5%E), saturated fat (12 ± 5%E), and sugar (19 ± 9%E) all exceeded their DRVs (P<0.05). Vitamin A (553 ± 531ug) and fibre (15 ± 6g) were found 24% and 18% lower than the DRVs, respectively (P<0.01). Fat (34 ± 5%E), polyunsaturated fat (6 ± 1%E), and protein (14 ± 2%E), as a percent of energy, were below the DRV by 3%, 8%, and 7% respectively (P<0.01). Magnesium (301 ± 107mg) was equal to the DRV (P=0.81).

For 16-18, and 19-24 respectively, calcium (1286 ± 928mg; 1337 ± 489mg), copper (1 ± 0.6mg; 2 ± 0.6mg), iron (14 ± 5mg; 15 ± 6mg), niacin (19 ± 7mg; 21 ± 7mg), phosphorus (1545 ± 381mg; 1620 ± 493mg), protein (96 ± 24g; 100 ± 29g), thiamine (2 ± 0.6mg; 2 ± 0.7mg), and vitamin B6 (2.3 ± 0.7ug; 3 ± 0.9ug) exceeded their DRV (P<0.01). For 16-18y, energy (kcals) was equal to the DRV (2748 ± 787kcal, P=0.91). For years 19-24y, energy (kcal) exceeded the DRV (2931 ± 939kcal, P<0.01).

This study represents the largest assessment of dietary intake of prisoners and demonstrates that the prison catering, for the most part, met the DRVs. However, sugar, fat, and energy intake exceeded their DRV target, posing clear risks to health by possibly contributing to later obesity, hypertension, Type 2 diabetes and heart disease.