Showing papers by "Andy R Ness published in 2016"

Does low-energy sweetener consumption affect energy intake and body weight? A systematic review, including meta-analyses, of the evidence from human and animal studies

Abstract: By reducing energy density, low-energy sweeteners (LES) might be expected to reduce energy intake (EI) and body weight (BW). To assess the totality of the evidence testing the null hypothesis that ...

Genome-wide association analyses identify new susceptibility loci for oral cavity and pharyngeal cancer

Abstract: We conducted a genome-wide association study of oral cavity and pharyngeal cancer in 6,034 cases and 6,585 controls from Europe, North America and South America. We detected eight significantly associated loci (P < 5 × 10-8), seven of which are new for these cancer sites. Oral and pharyngeal cancers combined were associated with loci at 6p21.32 (rs3828805, HLA-DQB1), 10q26.13 (rs201982221, LHPP) and 11p15.4 (rs1453414, OR52N2-TRIM5). Oral cancer was associated with two new regions, 2p23.3 (rs6547741, GPN1) and 9q34.12 (rs928674, LAMC3), and with known cancer-related loci-9p21.3 (rs8181047, CDKN2B-AS1) and 5p15.33 (rs10462706, CLPTM1L). Oropharyngeal cancer associations were limited to the human leukocyte antigen (HLA) region, and classical HLA allele imputation showed a protective association with the class II haplotype HLA-DRB1*1301-HLA-DQA1*0103-HLA-DQB1*0603 (odds ratio (OR) = 0.59, P = 2.7 × 10-9). Stratified analyses on a subgroup of oropharyngeal cases with information available on human papillomavirus (HPV) status indicated that this association was considerably stronger in HPV-positive (OR = 0.23, P = 1.6 × 10-6) than in HPV-negative (OR = 0.75, P = 0.16) cancers.

HPV-related oropharynx cancer in the United Kingdom: An evolution in the understanding of disease etiology

Abstract: A rising incidence of oropharyngeal squamous cell carcinoma (OPSCC) incidence has occurred throughout the developed world, where it has been attributed to an increasing impact of human papillomavirus (HPV) on disease etiology. This report presents the findings of a multicenter cross-sectional retrospective study aimed at determining the proportion of HPV-positive and HPV-negative OPSCC within the United Kingdom (UK). Archival tumor tissue blocks from 1602 patients previously diagnosed with OPSCC (2002-2011) were collated from 11 centers. HPV status was determined with 3 validated commercial tests to provide valid data for 1474 cases in total. Corresponding national incidence data from the same decade were obtained from UK Cancer registries.The overall proportion of HPV+ OPSCC between 2002-2011 was 51.8% (95% CI:49.3, 54.4) and this remained unchanged throughout the decade (unadjusted risk ratio:1.00 (95% CI:0.99, 1.02). However, over the same period, the incidence of OPSCC in the broader UK population underwent a 2-fold increase (age standardised rate (ASR) 2002:2.1 (95% CI:1.9, 2.2); 2011:4.1(95% CI:4.0, 4.3)). Although the number of OPSCC diagnosed within the UK from 2002-2011 nearly doubled, the proportion of HPV+ cases remained static at ~50%. Our results argue that the rapidly increasing incidence of OPSCC in the UK cannot be solely attributable to the influence of HPV. The parallel increase in HPV+ and HPV- cases we documented warrants further investigation, so that appropriate future prevention strategies for both types of disease can be implemented.

ω-3 fatty acids for major depressive disorder in adults: an abridged Cochrane review

Abstract: Objective To assess the effects of n-3 polyunsaturated fatty acids (n-3PUFAs; also known as ω-3 fatty acids) compared with comparator for major depressive disorder (MDD) in adults. Design Systematic review and meta-analyses. Data sources The Cochrane Depression, Anxiety and Neurosis Review Group9s Specialised Registers (CCDANCTR) and International Trial Registries searched to May 2015. CINAHL searched to September 2013. Trial selection Inclusion criteria: a randomised controlled trial (RCT); that provided n-3PUFAs as an intervention; used a comparator; measured depressive symptomology as an outcome; and was conducted in adults with MDD. Outcomes Primary outcomes were depressive symptomology and adverse events. Results 20 trials encompassing 26 relevant studies were found. For n-3PUFAs versus placebo, n-3PUFA supplementation resulted in a small-to-modest benefit for depressive symptomology: SMD=−0.32 (95% CI −0.52 to −0.12; 25 studies, 1373 participants, very low-quality evidence), but this effect is unlikely to be clinically meaningful, is very imprecise and, based on funnel plot inspection, sensitivity analyses and comparison with large well-conducted trials, is likely to be biased. Considerable evidence of heterogeneity between studies was also found, and was not explained by subgroup or sensitivity analyses. Numbers of individuals experiencing adverse events were similar in intervention and placebo groups (OR=1.24, 95% CI 0.95 to 1.62; 19 studies, 1207 participants; very low-quality evidence). For n-3PUFAs versus antidepressants, no differences were found between treatments in depressive symptomology (MD=−0.70 (95% CI −5.88 to 4.48); 1 study, 40 participants, very low-quality evidence). Conclusions At present, we do not have sufficient evidence to determine the effects of n-3PUFAs as a treatment for MDD. Further research in the form of adequately powered RCTs is needed.

Randomized clinical trial of postoperative chewing gum versus standard care after colorectal resection

Abstract: Background Chewing gum may stimulate gastrointestinal motility, with beneficial effects on postoperative ileus suggested in small studies. The primary aim of this trial was to determine whether chewing gum reduces length of hospital stay (LOS) after colorectal resection. Secondary aims included examining bowel habit symptoms, complications and healthcare costs. Methods This clinical trial allocated patients randomly to standard postoperative care with or without chewing gum (sugar-free gum for at least 10 min, four times per day on days 1–5) in five UK hospitals. The primary outcome was LOS. Cox regression was used to calculate hazard ratios for LOS. Results Data from 402 of 412 patients, of whom 199 (49·5 per cent) were allocated to chewing gum, were available for analysis. Some 40 per cent of patients in both groups had laparoscopic surgery, and all study sites used enhanced recovery programmes. Median (i.q.r.) LOS was 7 (5–11) days in both groups (P = 0·962); the hazard ratio for use of gum was 0·94 (95 per cent c.i. 0·77 to 1·15; P = 0·557). Participants allocated to gum had worse quality of life, measured using the EuroQoL 5D-3L, than controls at 6 and 12 weeks after operation (but not on day 4). They also had more complications graded III or above according to the Dindo–Demartines–Clavien classification (16 versus 6 in the group that received standard care) and deaths (11 versus 0), but none was classed as related to gum. No other differences were observed. Conclusion Chewing gum did not alter the return of bowel function or LOS after colorectal resection. Registration number: ISRCTN55784442 (http://www.controlled-trials.com).

Objectively measured physical activity and sedentary time: cross-sectional and prospective associations with adiposity in the Millennium Cohort Study

Abstract: Objective To examine whether physical activity (PA) and sedentary time (ST) in primary school-aged children are associated with adiposity at the start of secondary school, and whether these associations differ by sex or ethnic group. Design Nationally representative prospective cohort study. Setting Children born across the UK, between 2000 and 2002. Participants 6497 singleton children. Outcome measures Measures of adiposity (body mass index (BMI), fat mass index (FMI) and fat free mass index (FFMI))—obtained at 7 and 11 years. Explanatory measures Total daily PA (mean counts per minute (cpm)); minutes of moderate-to-vigorous PA (MVPA); and ST. All assessed at 7 years using accelerometers. Results In cross-sectional analyses, total PA was inversely associated with FMI (3.7% (95% CI 2.7% to 4.7%) reduction per 150 cpm increase), as was MVPA (4.2% (CI 3.2% to 5.2%) reduction per 20 min/day increase). Associations were stronger in black and South Asian ethnic groups. Total PA and MVPA were not associated with FFMI. ST was positively associated with FMI (1.3% (CI 0.2% to 2.3%) increase per 50 min/day increase) and inversely associated with FFMI (0.5% (CI 0.2% to 0.7%) reduction per 50 min/day increase). Longitudinally, MVPA at age 7 years remained inversely associated with FMI at age 11 years (1.5% (CI 0.4% to 2.6%) reduction per 20 min/day increase). No association was found between total PA and ST and any of the later adiposity measures. Conclusions 7-year-old children who are more physically active are less likely to be obese at that age and at age 11 years. These associations were particularly evident in children from black or South Asian ethnicity at age 7 years and in boys at age 11 years. Measurements of fat mass provide valuable insights into ethnic differences in associations between adiposity and activity.

Recruitment, response rates and characteristics of 5511 people enrolled in a prospective clinical cohort study: head and neck 5000

Abstract: *School of Oral and Dental Sciences, National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle, UniversityHospitals Bristol NHSFoundation Trust, School ofOral andDental Sciences, University of Bristol, Surgical Research Team, University Hospitals Bristol NHS Foundation Trust, School of Social and Community Medicine, University of Bristol, Bristol, UK National Cancer Research Institute Consumer Liaison Group (NCRI CLG), Independent Cancer Patients Voice (ICPV), London, UK **MRC Integrative Epidemiology Unit and Avon Longitudinal Study of Parents and Children, School of Social and CommunityMedicine, School of Clinical Sciences, University of Bristol, Bristol, Cochrane Oral Health Group, School of Dentistry, University of Manchester, Manchester, Royal Marsden Hospital and the Institute for Cancer Research, London, Leeds Institute for Cancer and Pathology, University of Leeds, Leeds, ***Evidence-Based Practice Research Centre (EPRC), Faculty of Health and Social Care, Edge Hill University, Ormskirk, Lancashire, UK

Patient experiences of perioperative nutrition within an Enhanced Recovery After Surgery programme for colorectal surgery: a qualitative study.

Abstract: Aim Nutrition is an important element of the Enhanced Recovery After Surgery (ERAS) programme. Patients have previously indicated that nutrition is a key component of ERAS that requires improvement. Our aim was to explore the perioperative nutrition experiences of colorectal surgical patients to identify barriers and facilitators to the integration of nutrition within ERAS.

Patient experiences of perioperative nutrition within an Enhanced Recovery After Surgery programme for colorectal surgery: a qualitative study Colorectal Disease (In press)

Abstract: Nutrition is an important element of the Enhanced Recovery After Surgery (ERAS) programme. Patients have previously indicated that nutrition is a key component of ERAS that requires improvement. Our aim was to explore the perioperative nutrition experiences of colorectal surgical patients to identify barriers and facilitators to the integration of nutrition within ERAS.

Pre-admission interventions to improve outcome after elective surgery-protocol for a systematic review

Abstract: Poor physical health and fitness increases the risk of death and complications after major elective surgery. Pre-admission interventions to improve patients’ health and fitness (referred to as prehabilitation) may reduce postoperative complications, decrease the length of hospital stay and facilitate the patient’s recovery. We will conduct a systematic review of RCTs to examine the effectiveness of different types of prehabilitation interventions in improving the surgical outcomes of patients undergoing elective surgery. This review will be conducted and reported according to the Cochrane and PRISMA reporting guidelines. MEDLINE, EMBASE, CENTRAL, CINAHL, PsycINFO, ISI Web of Science and clinical trial registers will be searched for any intervention administered before any elective surgery (including physical activity, nutritional, educational, psychological, clinical or multicomponent), which aims to improve postoperative outcomes. Reference lists of included studies will be searched, and grey literature including conference proceedings, theses, dissertations and preoperative assessment protocols will be examined. Study quality will be assessed using Cochrane’s risk of bias tool, and meta-analyses for trials that use similar interventions and report similar outcomes will be undertaken where possible. This systematic review will determine whether different types of interventions administered before elective surgery are effective in improving postoperative outcomes. It will also determine which components or combinations of components would form the most effective prehabilitation intervention. PROSPERO CRD42015019191

Associations between children’s behavioural and emotional development and objectively measured physical activity and sedentary time: Findings from the UK Millennium Cohort Study

Abstract: Physical activity (PA) can have a positive influence on mental health. Less is known about the influence of mental health on recent and later PA and sedentariness in childhood. This study investigated cross-sectional and distal associations between behavioural and emotional development, and objectively-measured moderate-to-vigorous PA (MVPA) and sedentary time, in seven-year-old children participating in the Millennium Cohort Study ( n = 6497). Markers of behavioural/emotional development (scores for total difficulties, internalising and externalising problems) were obtained using the Strengths and Difficulties Questionnaire at ages three, five and seven years. Associations between sedentary time or MVPA (outcomes) and behavioural/emotional development (exposures) were analysed using median regressions, stratified by sex. In cross-sectional analyses, boys’ sedentary time decreased with higher total difficulties scores (-1.1 minutes/day per score unit), boys’ and girls’ sedentary time decreased with higher externalising scores (-2.3 minutes/day per unit), and girls with higher internalising scores were more sedentary (1.4 minutes/day per unit). In analyses of MVPA, boys and girls were marginally more active with higher externalising scores (0.4 and 0.5 minutes/day per unit), and boys were less active for higher internalising scores (-0.7 minutes/day per unit). Distal associations showed similar patterns: children with increasing total difficulty and externalising scores at all ages were less sedentary at age seven; girls with increasing internalising scores more so. Boys and girls with increasing externalising scores were more active at age seven, whilst increasing internalising problems reduced MVPA for boys. In conclusion, behavioural behavioural/emotional development is associated with mid-childhood sedentary time and, more weakly, MVPA.

Are photographs a suitable alternative to dental study casts when assessing primary surgical outcome in children born with unilateral cleft lip and palate

Abstract: Objective: To compare the use of the 5-year-olds’ index on both dental study casts and intraoral photographs when measuring primary surgical outcome for children born with unilateral cleft lip and palate (UCLP). Design: A cross-sectional study. Setting: Models and photographs collected from cleft units across the UK as part of the CCUK (Cleft Care UK) study were scored by two clinicians at the School of Oral and Dental Sciences, Bristol, UK. Participants: Five-year-old children born with UCLP as part of the CCUK study. One hundred and ninety-eight had dental study casts available and 49 had intraoral photographs available. Methods: The records of both groups, that is study casts ( n = 198) and photographs ( n = 49) were scored using the 5-year-olds’ index on two occasions by two examiners. Results: Reliability of scoring is reduced for intraoral photographs compared with dental study casts. Using weighted Kappa the inter-rater reliability for dental study casts was 0.72 to 0.77 and the inter-rater reliability for intraoral photographs was 0.52 to 0.59. Limitations: The photographs and study casts were not matched for each individual and were collected by a number of different clinicians in each unit, both of which will have had an effect on the quality and consistency of the final records. Conclusions: Dental study casts provide more reliable results and thus still represent the gold standard when assessing primary surgical outcome in cleft care using the 5-year-olds’ index.

A Mixed-Method Study to Determine the Benefits of Periconceptional Folic Acid Supplementation and Effects of Folic Acid Deficiency in Mothers on Birth Outcomes

Abstract: Background: Evidence from high income countries shows mothers who are supplemented with folic acid in their periconceptional period and early pregnancy have significantly reduced adverse outcomes like birth defects. However, in India there is a paucity of data on association of birth defects and folic acid supplementation. We identified a few important questions to be answered using separate scientific methods and then planned to triangulate the information. Objective: In this paper, we describe the protocol of our study that aims to determine the association of folic acid and pregnancy outcomes like neural tube defects (NTDs) and orofacial clefts (OFCs). We decided to fill the gaps in knowledge from India to determine public health consequences of folic acid deficiency and factors influencing dietary and periconceptional consumption of folic acid. Methods: The proposed study will be carried out in five stages and will examine the questions related to folic acid deficiency across selected locations in South and North India. The study will be carried out over a period of 4 years through the hierarchical evidence-based approach. At first a systematic review was conducted to pool the current birth prevalence of NTDs and orofacial clefts OFCs in India. To investigate the population prevalence, we plan to use the key informant method to determine prevalence of NTDs and OFCs. To determine the normal serum estimates of folic acid, iron, and vitamin B12 among Indian women (15-35 years), we will conduct a population-based, cross-sectional study. We will further strengthen the evidence of association between OFCs and folic acid by conducting a hospital-based, case-control study across three locations of India. Lastly, using qualitative methods we will understand community and health workers perspective on factors that decide the intake of folic acid supplements. Results: This study will provide evidence on the community prevalence of birth defects and prevalence folic acid and vitamin B12 deficiency in the community. The case-control study will help understand the association of folic acid deficiency with OFCs. Conclusions: The results from this study are intended to strengthen the evidence base in childhood disability for planning and policy initiatives. [JMIR Res Protoc 2016;5(2):e129]

P29 Best practice guidance for dietary assessment in research: DIET@NET Guidelines

Abstract: Background Accurate assessment of dietary intake is important for planning, implementing of health promotion and when evaluating the effectiveness of public health interventions. However, measuring dietary intake is one of the most challenging aspects of public health research as no dietary method can measure dietary intake without error. Therefore, strategies that support researchers to choose the most appropriate dietary assessment method will help to strengthen research in this field. This study, undertaken for the Diet@net consortium aims to establish expert consensus on best practice guidelines (BPG) for carrying out dietary assessment in order to help non-experts in collecting dietary information. Methods The guidelines were developed through a Delphi consultation technique (Moher recommendations). Two Delphi rounds were conducted using self-administered questionnaires, asking for prioritisation of suggested guidelines. Twelve expert members of the BPG-working group reviewed findings from participants and finalised the guidelines. Results One hundred and thirty-experts were invited to take part, of whom 65 agreed to participate. Forty-eight completed Delphi-I and 51 Delphi-II. Overall, a total of 57 experts from different countries contributed feedback; these included nutritional epidemiologists, statisticians, and public health specialists. Initially, 47 statements were included in the guidelines. Following both Delphi rounds this was reduced to 43. The final consensus BPG includes four main stages with eight sub-sections. These stages are summarised as follows: Stage I. researchers need to define what is to be measured in terms of dietary intake to guide the choice of the most suitable Dietary Assessment Tool (DAT). Considering the ‘who?’, ‘what?’, and ‘when?’ of the study participants. Stage II. Investigate different types of DAT and appraise their appropriateness for the research question. Stage III. Evaluate existing tools to fine-tune choice of the most appropriate DAT by evaluating published validation studies, and considering the need for any modification or updating of the existing tools. Stage IV. Think about the implementation of the chosen DATs in the population of interest. Also, by addressing the source and range of the potential biases when using chosen DAT, aiming to minimise these where possible. Conclusion Delphi techniques allowed us to synthesise experts’ consensus on best practice in assessing dietary intake. The BPG will help non-expert researchers to consider key factors when selecting a DAT. These guidelines will be included on the Nutritools website (http://www.food.leeds.ac.uk/nutritools). Nutritools will host interactive dietary assessment tools and guidance for nutrition researchers, healthcare practitioners and other scientists.