BMJ Nutrition, Prevention and Health最新文献

Background: Type 2 diabetes (T2D) is often regarded as a progressive, lifelong disease requiring an increasing number of drugs. Sustained remission of T2D is now well established, but is not yet routinely practised. Norwood surgery has used a low-carbohydrate programme aiming to achieve remission since 2013.

Methods: Advice on a lower carbohydrate diet and weight loss was offered routinely to people with T2D between 2013 and 2021, in a suburban practice with 9800 patients. Conventional 'one-to-one' GP consultations were used, supplemented by group consultations and personal phone calls as necessary. Those interested in participating were computer coded for ongoing audit to compare 'baseline' with 'latest follow-up' for relevant parameters.

Results: The cohort who chose the low-carbohydrate approach (n=186) equalled 39% of the practice T2D register. After an average of 33 months median (IQR) weight fell from 97 (84-109) to 86 (76-99) kg, giving a mean (SD) weight loss of -10 (8.9)kg. Median (IQR) HbA1c fell from 63 (54-80) to 46 (42-53) mmol/mol. Remission of diabetes was achieved in 77% with T2D duration less than 1 year, falling to 20% for duration greater than 15 years. Overall, remission was achieved in 51% of the cohort. Mean LDL cholesterol decreased by 0.5 mmol/L, mean triglyceride by 0.9 mmol/L and mean systolic blood pressure by 12 mm Hg. There were major prescribing savings; average Norwood surgery spend was £4.94 per patient per year on drugs for diabetes compared with £11.30 for local practices. In the year ending January 2022, Norwood surgery spent £68 353 per year less than the area average.

Conclusions: A practical primary care-based method to achieve remission of T2D is described. A low-carbohydrate diet-based approach was able to achieve major weight loss with substantial health and financial benefit. It resulted in 20% of the entire practice T2D population achieving remission. It appears that T2D duration <1 year represents an important window of opportunity for achieving drug-free remission of diabetes. The approach can also give hope to those with poorly controlled T2D who may not achieve remission, this group had the greatest improvements in diabetic control as represented by HbA1c.

Objective: Household food insecurity is positively associated with depression; however, the association among adolescents is not well known. We examined the association between household food insecurity and depression among adolescent girls in Northern Ghana.

Methods: We analysed data from the Ten2Twenty-Ghana randomised controlled trial end-line for adolescent girls aged 10-17 years (n=582). The girls were chosen at random from 19 primary schools in the Mion District of Ghana's northern region. The children's depression inventory and the Food Insecurity Experience Scale were used in face-to-face interviews to assess depression and household food insecurity. Hierarchical survey binary logistic regression and linear mixed models were used to examine the association between household food insecurity and depressive symptoms. We took into account a number of potential confounders in the analysis, such as life satisfaction, self-efficacy, self-esteem, health complaints, child's age, menarche status, pubertal development, anaemia, stunting, frequency of consuming fruits and vegetables, frequency of consuming animal-sourced foods, maternal age, household wealth index and size, and the intervention group the girl was assigned to in the trial.

Results: About 20.1% of adolescent girls were classified as likely depressed, and 70.3% of their households were food insecure, with 22.9% and 18.0% being moderately and severely food insecure, respectively. Compared with girls from food-secure households, those from moderately (adjusted OR (AOR) 2.63, 95% CI (1.35 to 5.12)) and severely (AOR 3.28, 95% CI (1.66 to 6.49)) food insecure households had about three times the odds of being classified as depressed, after controlling for potential confounders. The odds of being likely depressed were about twice for adolescent girls from food-insecure households compared with their peers from food-secure households in both the crude and final adjusted model.

Conclusion: The study discovered high levels of household food insecurity and depression in adolescent girls in Northern Ghana, with a dose-response association between the two.

Background: Public health interventions are essential to prevent a long tail of costly, avoidable and worsening ill health in coastal communities following the COVID-19 pandemic, yet no research exists to guide policy and practice as to which groups within coastal communities are vulnerable and most in need of such interventions. Within this aim, we explore engrained and emerging vulnerabilities of food insecurity, health and well-being for different demographic groups within the deprived coastal community of Fleetwood, Lancashire, UK, before and after the pandemic.

Methods: Routinely collected data of free school meal eligibility, community mental health referrals and hospital admissions between 28 March 2016 and 31 December 2021 were aggregated by locality and deprivation within Fleetwood. Temporal autoregressive models, generalised linear mixed models and survival analyses were employed to compare trends and associations in food insecurity, health and well-being indicators against deprivation indices, demographics, comorbidities (including COVID-19), the COVID-19 pandemic period and locality.

Results: Areas with better housing and income, but higher health and disability deprivation, showed increased levels of free school meal eligibility following the pandemic. Mental health was insensitive to the first 14 months of pandemic yet is worsened by unemployment deprivation and cardiovascular and respiratory comorbidities, with a greater predisposition to poor mental health in adolescents and young adults. After accounting for the effect of COVID-19, hospital mortality risk increased with demographic influences in fitting with the typology of coastal communities having an older population, struggling healthcare and a greater prevalence of comorbidities.

Conclusions: Public health managers and policy makers seeking to prevent worsening health and well-being within coastal communities following the pandemic should focus on broader-scale patterns reflecting entrenched poor health typical of coastal communities, and emerging food insecurity within specific demographic and deprivation groups at finer scales.

Objectives: Even though disinfectants are commonly used in clinical practice and daily life, there are few studies on their antibacterial ability and cytotoxicity, which are closely related to the safety and effectiveness of their use. To provide a basis for the use of disinfectants, the cytotoxicity and antibacterial activity of three most commonly used disinfectants, povidone-iodine, chlorhexidine acetate and polyhexamethylene biguanide (PHMB), were investigated.

Design: A CCK-8 assay was used to measure the activities of human fibroblasts (HF) and keratinocytes (HaCat), the two most important cells in wound healing, following their exposure to disinfectants. The effects of different times and concentrations were included. The antibacterial activity of disinfectants against Staphylococcus aureus, Acinetobacter baumannii, Klebsiella pneumoniae was reflected by their minimum inhibitory concentration and minimum bactericidal concentration.

Results: All three disinfectants showed strong cytotoxicity in direct contact with HF and HaCat cells. Cytotoxicity increased with increasing exposure time and concentration. S. aureus, A. baumannii and K. pneumoniae comprised 70%, 55% and 85% of the strains sensitive to povidone iodine; 50%, 45% and 80% of the strains sensitive to chlorhexidine acetate; and 60%, 45% and 80% of the strains sensitive to PHMB, respectively.

Conclusions: All three disinfectants were cytotoxic; therefore, it is necessary to pay attention to the use time and concentration in the clinical setting. All three disinfectants were cytotoxic, with povidone-iodine being the most cytotoxic even at low concentrations. PHMB had better antibacterial efficacy against S. aureus and is suitable for the treatment of shallow wounds primarily. All three tested bacteria were significantly more sensitive to PHMB than to the other disinfectants.

This study explored the prevalence of low serum vitamin D in patients admitted with acute respiratory tract infections (ARTIs) such as COVID-19. This study investigated whether patients with COVID-19 had lower serum vitamin D compared with patients with ARTIs of other aetiology. A case-control study was performed with cases of COVID-19 and controls of non-COVID-19 ARTIs. Patients were enrolled from a single general medical ward in a secondary care hospital between 15 April 2020 and 15 May 2020. Exclusion criteria were an oxygen requirement of >8 L/min. Data collected included serum 25-hydroxyvitamin D concentration, venous plasma glucose concentration and heamoglobin A1c. Outcomes measured were length of hospital stay, deaths, the need for high dependency and intensive care unit involvement. A total of 60 patients of five ethnic groups were enrolled, 85% (n=46) were of White-British ethnicity. The data analysis is based on these 46 patients of which 24 were non-COVID-19 patients with ARTI and 22 were patients with COVID-19. Overall, 80% of the study population had a serum vitamin D concentration below 50 nmol/L with median concentrations of 30 nmol/L and 35 nmol/L for patients with COVID-19 and non-COVID-19 ARTIs respectively. A Mann-Whitney sign-ranked test with respect to serum vitamin D concentration found no statistically significant difference between cases and controls, p=0.09. There was no significant difference in the length of stay, body mass index and rates of various comorbidities such as diabetes mellitus (DM), hypertension and lung disease in both study groups. However, DM was found to be associated with lower serum vitamin D concentrations. The results of this study support published literature showing an association between low serum vitamin D and ARTIs including COVID-19. However, this study did not identify patients with COVID-19 to have a statistically significant lower serum vitamin D concentration than non-COVID-19 patients with ARTI.

Introduction: Good nutrition is the foundation of sustainable growth and development among children. The United Nations aims to achieve food security and improve nutrition through its Sustainable Development Goal 2 - Zero Hunger. In close collaboration with local communities and authorities, the Tanga International Competence Centre, Tanzania, supports projects aimed at achieving the United Nations Sustainable Development Goals. One of their initiatives, The Banana Project, which is a free school fruit scheme, started in 2011 based on a recognised need for nutritional support among preschool children at a rural school in Tanga District. In the interest of improving nutrition, the free school fruit scheme provides one banana 5 school days a week to each child in the class. This study aimed to explore caregivers' (parents and/or guardians) and teachers' experiences with preschool children's participation in the project, with a specific focus on nutrition and health.

Methods: This qualitative study was performed in 2017. A total of 16 semistructured indepth interviews with 14 caregivers and 2 teachers of the preschool children participating in the project were conducted. Data were analysed using a hermeneutic perspective.

Results: Caregivers and teachers of the preschool children participating in the intervention experienced that bananas (1) reduced children's hunger and nutritional deficiency, (2) increased fruit intake and improved their appetite for other foods, (3) improved their physical health and provided energy, and (4) supported cognitive and socioemotional development.

Conclusion: These findings indicate that the banana intervention has several benefits to preschool children and has an impact on their families. To improve health and reduce the risk of malnutrition of children in rural Tanzania, The Banana Project can be an recommended as a simple, cost-effective and sustainable health and nutrition promotion initiatives.

Objective: Type 2 diabetes is one of the main causes of kidney damage. Recent intervention studies suggest that the progression of type 2 diabetes can be halted, or even brought into remission by lifestyle interventions. In a pragmatic trial, the Reverse Diabetes2 Now programme (RD2N, NL: Keer Diabetes2 Om), a multicomponent lifestyle intervention, reduced the need for bloodglucose lowering medications up to 24 months.

Research design and methods: Here, we retrospectively investigate the effect of RD2N on markers of kidney function in patients selected for impaired kidney function at baseline (eGFR <70 mL/min/1.73 m² (n=45). Baseline data were retrieved from the intervention database and follow-up data on renal markers were collected from routine medical records. Wilcoxon non-parametric tests were used to assess changes over 6 and 12 months.

Results: After 6 months median eGFR increased significantly from 62.0 (IQR 55.5-65.0) to 69.0 (IQR 55.0-76.5) mL/min/1.73 m² (p=0.002). Median albumin/creatinine ratio (n=26) remained within the normal range (<3 mg/mmol). The effect on eGFR was similar after exclusion of patients in whom medication was changed (median eGFR 62.0 ((IQR 59.5-66.0) to 69.0 (IQR 60.0-77.0) mL/min/1.73 m², p=0.006, n=29), suggesting that the effect on eGFR is not related to medication changes. At 12 months, eGFR was not significantly changed (n=22, median eGFR 63.5 mL/min/1.73 m² (IQR 58.5-71.0), p=0.067).

Conclusions: The retrospective nature of this study and the despite guidelines limited availability of renal markers in routine type 2 diabetes care are limiting. Nevertheless, these data support a favourable effect of RD2N on renal function. Further research, with proper documentation of renal function, urinary protein excretion and dietary intake, is needed to substantiate these results, ideally in a large-scale prospective cohort study.

Background: 'Lockdowns' to control the spread of COVID-19 in the UK affected many aspects of life and may have adversely affected diets. We aimed to examine (1) the effect of lockdowns on fruit and vegetable consumption, as a proxy for healthy diets more generally, and on weight and well-being, (2) whether any subgroup was particularly affected and (3) the barriers and facilitators to a healthy diet in lockdown.

Methods: We conducted a mixed-method longitudinal study, involving an online survey of 1003 adults in the West Midlands, UK, 494 of whom were surveyed at two different points in time. Our first time point was during stringent COVID-19 lockdown and the second during a period of more relaxed restrictions. We asked quantitative questions about fruit and vegetable consumption; physical activity, sociodemographic characteristics, body mass index and well-being and qualitative questions about the reasons behind reported changes.

Results: We find no evidence for decreased fruit and vegetable consumption during lockdown compared with afterwards. If anything, consumption increased by half a portion daily among women, particularly among those who normally have a long commute. This finding, combined with a significant increase in physical activity, suggests that behaviours were healthier during lockdown, consistent with higher self-reported health. However, well-being deteriorated markedly, and participants reported being heavier during the lockdown as well. Our qualitative data suggest that an abundance of resources (more time) supported higher fruit and vegetable consumption during lockdown, despite increased access issues.

Conclusions: Our results may assuage concerns that lockdowns adversely affected diets. They may point to the impact of commuting on diet, particularly for women. We add longitudinal evidence to a growing body of literature on the adverse effect of lockdown on mental health.