Publications by authors named "Alastair Ross"

108 Publications

A Distinct Faecal Microbiota and Metabolite Profile Linked to Bowel Habits in Patients with Irritable Bowel Syndrome.

Cells 2021 Jun 10;10(6). Epub 2021 Jun 10.

Department of Microbiology and Immunology, Institute of Biomedicine, University of Gothenburg, 405 30 Gothenburg, Sweden.

Patients with irritable bowel syndrome (IBS) are suggested to have an altered intestinal microenvironment. We therefore aimed to determine the intestinal microenvironment profile, based on faecal microbiota and metabolites, and the potential link to symptoms in IBS patients. The faecal microbiota was evaluated by the GA-map dysbiosis test, and tandem mass spectrometry (GC-MS/MS) was used for faecal metabolomic profiling in patients with IBS and healthy subjects. Symptom severity was assessed using the IBS Severity Scoring System and anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. A principal component analysis based on faecal microbiota ( = 54) and metabolites ( = 155) showed a clear separation between IBS patients ( = 40) and healthy subjects ( = 18). Metabolites were the main driver of this separation. Additionally, the intestinal microenvironment profile differed between IBS patients with constipation ( = 15) and diarrhoea ( = 11), while no clustering was detected in subgroups of patients according to symptom severity or anxiety. Furthermore, ingenuity pathway analysis predicted amino acid metabolism and several cellular and molecular functions to be altered in IBS patients. Patients with IBS have a distinct faecal microbiota and metabolite profile linked to bowel habits. Intestinal microenvironment profiling, based on faecal microbiota and metabolites, may be considered as a future non-invasive diagnostic tool, alongside providing valuable insights into the pathophysiology of IBS.
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http://dx.doi.org/10.3390/cells10061459DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8230381PMC
June 2021

Occupational socioeconomic risk associations for head and neck cancer in Europe and South America: individual participant data analysis of pooled case-control studies within the INHANCE Consortium.

J Epidemiol Community Health 2021 Aug 23;75(8):779-787. Epub 2021 Feb 23.

Division of Public Health, Department of Family and Preventive Medicine and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah, USA.

Background: The association between socioeconomic disadvantage (low education and/or income) and head and neck cancer is well established, with smoking and alcohol consumption explaining up to three-quarters of the risk. We aimed to investigate the nature of and explanations for head and neck cancer risk associated with occupational socioeconomic prestige (a perceptual measure of psychosocial status), occupational socioeconomic position and manual-work experience, and to assess the potential explanatory role of occupational exposures.

Methods: Pooled analysis included 5818 patients with head and neck cancer (and 7326 control participants) from five studies in Europe and South America. Lifetime job histories were coded to: (1) occupational social prestige-Treiman's Standard International Occupational Prestige Scale (SIOPS); (2) occupational socioeconomic position-International Socio-Economic Index (ISEI); and (3) manual/non-manual jobs.

Results: For the longest held job, adjusting for smoking, alcohol and nature of occupation, increased head and neck cancer risk estimates were observed for low SIOPS OR=1.88 (95% CI: 1.64 to 2.17), low ISEI OR=1.74 (95% CI: 1.51 to 1.99) and manual occupations OR=1.49 (95% CI: 1.35 to 1.64). Following mutual adjustment by socioeconomic exposures, risk associated with low SIOPS remained OR=1.59 (95% CI: 1.30 to 1.94).

Conclusions: These findings indicate that low occupational socioeconomic prestige, position and manual work are associated with head and neck cancer, and such risks are only partly explained by smoking, alcohol and occupational exposures. Perceptual occupational psychosocial status (SIOPS) appears to be the strongest socioeconomic factor, relative to socioeconomic position and manual/non-manual work.
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http://dx.doi.org/10.1136/jech-2020-214913DOI Listing
August 2021

Communication strategies to encourage child participation in an oral health promotion session: An exemplar video observational study.

Health Expect 2021 Apr 19;24(2):700-708. Epub 2021 Feb 19.

School of Dentistry, University of Dundee, Dundee, UK.

Background: The oral health promotion sessions for young children and parents in a clinical setting pose challenges to the dental team.

Aim: To apply PaeD-TrICS (Paediatric dental triadic interaction coding scheme) to investigate the interaction of child, parent and dental nurse and determine the effect of nurse and parental behaviours on child participation within an oral health promotion session.

Method: A video observational study was applied. The sample consisted of a dental nurse and 22 children aged 2-5 years in a general dental practice in Scotland. Behaviours were catalogued with time stamps using PaeD-TrICS. Analysis of behavioural sequences with child participation as the dependent variable was conducted using multilevel modelling.

Results: Children varied significantly in their participation rate. The statistical model explained 28% of the variance. The older the child and longer consultations significantly increased child participation. Both nurse and parental behaviour had immediate influence on child participation. Parental facilitation had a strong moderating effect on the influence of the nurse on child participation.

Conclusions: Child participation was dependent on nurse and parent encouragement signalling an important triadic communication process. The coding scheme and analysis illustrates an important tool to investigate these advisory sessions designed for delivering tailored messages to young children and parents.

Patient Or Public Contribution: The dental staff, child patients and their parents were involved closely in the conduct and procedures of the present study.
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http://dx.doi.org/10.1111/hex.13219DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077076PMC
April 2021

Use of Rapid Evaporative Ionisation Mass Spectrometry fingerprinting to determine the metabolic changes to dry-aged lean beef due to different ageing regimes.

Meat Sci 2021 Nov 16;181:108438. Epub 2021 Jan 16.

Meat Quality Team, Food & Bio-based Products, AgResearch Ltd, Ruakura Research Centre, Hamilton, New Zealand.

Rapid Evaporative Ionisation Mass Spectrometry (REIMS) was used to determine the impact of in-bag ageing regimes (stepwise-ageing at different air velocities and straight-dry-ageing) and trimming on the metabolic profile of dry-aged lean beef. Orthogonal projection to latent structures-discriminant analysis (OPLS-DA) models based on 1705 tentatively identified m/z features were found for ageing methods (Q = 0.85), ageing time (0 vs. 21 days, Q = 0.95) and sampling locations (surface meat vs. trimmings, Q = 0.94). No significant (P > 0.05) difference in metabolites due to air velocities. Small metabolites such as dipeptides and amino acids were more abundant, especially on the surface of untrimmed lean beef, following 21 days of straight-dry-ageing. Stepwise-ageing produced different metabolic profiles from straight-dry-ageing, suggesting that the two methods may differ in dry-aged meat quality and flavour. This work demonstrates REIMS's potential for real time differentiation of meat on processing parameters.
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http://dx.doi.org/10.1016/j.meatsci.2021.108438DOI Listing
November 2021

Child health interventions delivered by lay health workers to parents: A realist review.

J Child Health Care 2021 Jan 26:1367493520983124. Epub 2021 Jan 26.

Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary & Life Sciences, 3526University of Glasgow, Glasgow, UK.

There is a growing body of evidence that lay health worker (LHW) interventions are a cost-effective model of care which can improve health outcomes and reduce the burden on existing health and community services. Nonetheless, there is a dearth of information to specify which intervention characteristics contribute to their success. This realist review aimed to identify how, why and in what context UK-based LHW interventions aimed at improving child health parenting behaviours can lead to health promoting behaviour and improve child health outcomes. Results show that the 'peerness' of the LHW role gives parents a sense of equality with, and trust in, LHWs which facilitates continued engagement with interventions and sustained positive behaviour. Training and support is crucial to retention of LHWs, enhancing confidence and perceived value of the role in the context of the intervention. LHW interventions which are embedded within communities as a result of stakeholder buy-in demonstrate stable models of delivery and ease the burden on existing health and community services. In conclusion, this review found that LHW interventions can positively influence child health parenting behaviours in certain contexts and provide programme theory to inform future development of LHW interventions.
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http://dx.doi.org/10.1177/1367493520983124DOI Listing
January 2021

Umbilical cord blood metabolome differs in relation to delivery mode, birth order and sex, maternal diet and possibly future allergy development in rural children.

PLoS One 2021 25;16(1):e0242978. Epub 2021 Jan 25.

Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden.

Allergy is one of the most common diseases among young children yet all factors that affect development of allergy remain unclear. In a small cohort of 65 children living in the same rural area of south-west Sweden, we have previously found that maternal factors, including prenatal diet, affect childhood allergy risk, suggesting that in utero conditions may be important for allergy development. Here, we studied if metabolites in the umbilical cord blood of newborns may be related to development of childhood allergy, accounting for key perinatal factors such as mode of delivery, birth order and sex. Available umbilical cord blood plasma samples from 44 of the participants were analysed using gas chromatography-mass spectrometry metabolomics; allergy was diagnosed by specialised paediatricians at ages 18 months, 3 years and 8 years and included eczema, asthma, food allergy and allergic rhinoconjunctivitis. Nineteen cord blood metabolites were related to future allergy diagnosis though there was no clear pattern of up- or downregulation of metabolic pathways. In contrast, perinatal factors birth order, sex and mode of delivery affected several energy and biosynthetic pathways, including glutamate and aspartic acid-histidine metabolism (p = 0.004) and the tricarboxylic acid cycle (p = 0.006) for birth order; branched chain amino acid metabolism (p = 0.0009) and vitamin B6 metabolism (p = 0.01) for sex; and glyoxylate and dicarboxylic acid metabolism (p = 0.005) for mode of delivery. Maternal diet was also related to some of the metabolites associated with allergy. In conclusion, the cord blood metabolome includes individual metabolites that reflect lifestyle, microbial and other factors that may be associated with future allergy diagnosis, and also reflects temporally close events/factors. Larger studies are required to confirm these associations, and perinatal factors such as birth order or siblings must be considered in future cord-blood metabolome studies.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0242978PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7833224PMC
April 2021

Metabolic fingerprinting of in-bag dry- and wet-aged lamb with rapid evaporative ionisation mass spectroscopy.

Food Chem 2021 Jun 7;347:128999. Epub 2021 Jan 7.

Meat Quality Team, Food & Bio-based Products, AgResearch Ltd, Ruakura Research Centre, Hamilton, New Zealand.

The effect of in-bag dry- and wet-ageing on metabolite profiles of lamb legs was determined using Rapid Evaporative Ionisation Mass Spectrometry (REIMS). Using orthogonal projection to latent structures-discriminant analysis (OPLS-DA) with REIMS, 1705 metabolite ions were identified (Q = 0.86) in four muscles: m. semimembranosus, m. biceps femoris, m. vastus lateralis and m. rectus femoris. A total of 663 metabolites differed between ageing methods (P < 0.05) which mainly resulted from proteolysis and lipid metabolism. Dry-aged lamb had higher pH (P = 0.016) and lower moisture content (P = 0.034) than the wet-aged. Dry-ageing produced more (P < 0.05) smaller sized metabolites including dipeptides and free amino acids and lipid oxidation metabolites compared to wet-aged equivalents. Different muscles had distinct REIMS metabolic profiles. Outcomes of this study demonstrated that REIMS can be used for authentication between in-bag dry- and wet-aged lamb based on their metabolic fingerprints.
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http://dx.doi.org/10.1016/j.foodchem.2020.128999DOI Listing
June 2021

Is the 'never event' concept a useful safety management strategy in complex primary healthcare systems?

Int J Qual Health Care 2021 Jan;33(Supplement_1):25-30

Dental School, University of Glasgow, 378 Sauchiehall Street, Scotland, UK Glasgow G2 3JZ.

Why Is The Area Important?: A sub-group of rare but serious patient safety incidents, known as 'never events,' is judged to be 'avoidable.' There is growing interest in this concept in international care settings, including UK primary care. However, issues have been raised regarding the well-intentioned coupling of 'preventable harm' with zero tolerance 'never events,' especially around the lack of evidence for such harm ever being totally preventable.

What Is Already Known And Gaps In Knowledge?: We consider whether the ideal of reducing preventable harm to 'never' is better for patient safety than, for example, the goal of managing risk materializing into harm to 'as low as reasonably practicable,' which is well-established in other complex socio-technical systems and is demonstrably achievable.We reflect on the 'never event' concept in the primary care context specifically, although the issues and the polarized opinion highlighted are widely applicable. Recent developments to validate primary care 'never event' lists are summarized and alternative safety management strategies considered, e.g. Safety-I and Safety-II.

Future Areas For Advancing Research And Practice: Despite their rarity, if there is to be a policy focus on 'never events,' then specialist training for key workforce members is necessary to enable examination of the complex system interactions and design issues, which contribute to such events. The 'never event' term is well intentioned but largely aspirational-however, it is important to question prevailing assumptions about how patient safety can be understood and improved by offering alternative ways of thinking about related complexities.
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http://dx.doi.org/10.1093/intqhc/mzaa101DOI Listing
January 2021

Making complex measurements of meat composition fast: Application of rapid evaporative ionisation mass spectrometry to measuring meat quality and fraud.

Meat Sci 2021 Nov 6;181:108333. Epub 2020 Oct 6.

Ghent University, Laboratory of Chemical Analysis, Belgium. Electronic address:

Increasing demands are being placed on meat producers to verify more about their product with regards to safety, quality and authenticity. There are many methods that can detect aspects of these parameters in meat, yet most are too slow to keep up with the demands of modern meat processing plants and supply chains. A new technology, Rapid Evaporative Ionisation Mass Spectrometry (REIMS), has the potential to bridge the gap between advanced laboratory measurements and technology that can screen for quality, safety and authenticity parameters in a single measurement. Analysis with REIMS generates a detailed mass spectral fingerprint representative of a meat sample without the need for sample processing. REIMS has successfully been used to detect species fraud, detect use of hormones in meat animals, monitor meat processing and to detect off flavours such as boar taint. The aim of this review is to summarize these and other applications to highlight the potential of REIMS for meat analysis. Sampling methods and important considerations for data analysis are discussed as well as limitations of the technology and remaining challenges for practical adoption.
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http://dx.doi.org/10.1016/j.meatsci.2020.108333DOI Listing
November 2021

Brain foods - the role of diet in brain performance and health.

Nutr Rev 2021 May;79(6):693-708

Department of Biology and Biological Engineering, Food and Nutrition Science, Chalmers University of Technology, Gothenburg, Sweden.

The performance of the human brain is based on an interplay between the inherited genotype and external environmental factors, including diet. Food and nutrition, essential in maintenance of brain performance, also aid in prevention and treatment of mental disorders. Both the overall composition of the human diet and specific dietary components have been shown to have an impact on brain function in various experimental models and epidemiological studies. This narrative review provides an overview of the role of diet in 5 key areas of brain function related to mental health and performance, including: (1) brain development, (2) signaling networks and neurotransmitters in the brain, (3) cognition and memory, (4) the balance between protein formation and degradation, and (5) deteriorative effects due to chronic inflammatory processes. Finally, the role of diet in epigenetic regulation of brain physiology is discussed.
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http://dx.doi.org/10.1093/nutrit/nuaa091DOI Listing
May 2021

Whole-Grain Processing and Glycemic Control in Type 2 Diabetes: A Randomized Crossover Trial.

Diabetes Care 2020 08 18;43(8):1717-1723. Epub 2020 May 18.

Department of Medicine, University of Otago, Dunedin, New Zealand

Objective: To consider the effects of whole-grain processing, specifically milling, on glycemic control in free-living adults with type 2 diabetes.

Research Design And Methods: Participants of this crossover trial were randomized to two interventions of 2 weeks, separated by washout. They were advised to replace the grain foods they normally consumed with intervention foods. Intervention foods were nutrient-matched whole-grain products of wheat, oats, and brown rice that differed in their degree of processing. No other lifestyle advice was given. Continuous glucose monitoring systems were worn. Other cardiometabolic risk factors and alkylresorcinols (a biomarker of whole-grain intake) were measured pre- and postintervention.

Results: Thirty-one adults with type 2 diabetes (63 ± 13 years old, BMI 32.4 ± 7 kg/m, HbA 7.5 ± 3.4% [59 ± 14 mmol/mol]) commenced the trial; 28 (90%) completed both interventions. The increase in alkylresorcinols did not differ between interventions, and there was no difference in reported energy intake. Postprandial responses were 9% (95% CI 3-15) lower following breakfast and 6% (1-10) lower following all meals of less-processed whole grains when compared with finely milled grains. Day-long glycemic variability also was reduced when measured by 24-h SD (-0.16 mmol/L [95% CI -0.25 to -0.06]) and mean amplitude of glycemic excursion (-0.36 [95% CI -0.65 to -0.08]). Mean change in body weight differed by 0.81 kg (95% CI 0.62-1.05) between interventions, increasing during the finely milled intervention and decreasing during the less-processed whole-grain intervention. This was not a mediating factor for the glycemic variables considered.

Conclusions: Consuming less-processed whole-grain foods over 2 weeks improved measures of glycemia in free-living adults with type 2 diabetes compared with an equivalent amount of whole-grain foods that were finely milled. Dietary advice should promote the consumption of minimally processed whole grains.
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http://dx.doi.org/10.2337/dc20-0263DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7372063PMC
August 2020

Randomized clinical trial: Effects of Aloe barbadensis Mill. extract on symptoms, fecal microbiota and fecal metabolite profiles in patients with irritable bowel syndrome.

Neurogastroenterol Motil 2020 08 20;32(8):e13860. Epub 2020 Apr 20.

Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.

Background: Aloe barbadensis Mill. (Aloe) with potential prebiotic effects has been suggested to reduce symptoms in patients with irritable bowel syndrome (IBS). We therefore aimed to determine the effects of an Aloe extract on symptoms of IBS, and evaluate whether effects may be mediated by fecal microbiota and metabolites in a randomized, double-blind, controlled trial.

Methods: Patient with IBS diagnosed according to the ROME III criteria (all subtypes), received Aloe or control treatment (inulin) for 4 weeks. IBS Symptom Severity Score (IBS-SSS) was assessed, and fecal samples collected before and at end of treatment. Fecal microbiota composition and metabolomic profile were determined.

Key Results: In total, 160 IBS patients completed the study. The overall severity of IBS symptoms was reduced in both Aloe and control treatment groups (P < .001, both groups, comparing baseline vs end of treatment), without difference between groups (P = .62). The frequency of responders (IBS-SSS reduction ≥ 50) did not differ between Aloe treatment (n = 33, 39%) and control (n = 34, 45%) (P = .49). However, fecal microbiota and metabolite profiles differed between Aloe, but not control treatment responders and non-responders both before and after treatment.

Conclusion: In a mixed group of IBS patients, Aloe was not superior to control treatment, although it showed potential to reduce IBS symptom severity in subsets of IBS patients which could be predicted by fecal microbiota and metabolite profiles. ClinicalTrials.gov no: NCT01400048.
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http://dx.doi.org/10.1111/nmo.13860DOI Listing
August 2020

A systematic review and meta-analysis of antibiotic prophylaxis in skin graft surgery: A protocol.

Int J Surg Protoc 2019 28;14:14-18. Epub 2019 Feb 28.

St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK.

Introduction: There is little evidence-based guidance on the use of prophylactic antibiotics in skin surgery; whilst antibiotics may protect against surgical site infections (SSI), they have associated side effects, increase the risk of adverse events, and can propagate antibiotic resistance. We present a protocol for a systematic review to establish whether the benefit of prophylactic antibiotics overrides the risk, for patients undergoing autograft surgery.

Methods: The systematic review will be registered a priori on researchregistry.com and will be conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). A search strategy will be devised to investigate 'skin graft surgery and use of antibiotics'. The following electronic databases will be searched, 1979-2018: PubMed, MEDLINE®, EMBASE, SCOPUS, CINAHL, PsychINFO, SciELO, The Cochrane Library, including the Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effect (DARE), the Cochrane Methodology Register, Health Technology Assessment Database, the NHS Economic Evaluation Databases and Cochrane Groups, ClinicalTrials.gov, Current Controlled Trials Database, the World Health Organisation (WHO) International Clinical Trials Registry Platform, UpToDate.com, NHS Evidence and the York Centre for Reviews and Dissemination. Grey literature will be searched. All comparative study designs reporting on the use of antibiotics in skin graft surgery will be considered for inclusion, namely randomized controlled trials (RCTs). Two trained independent teams will screen all titles and abstracts, followed by relevant full texts, for eligibility. Data will be extracted under standardized extraction fields into a preformatted database. Note will be made of the indication for skin graft surgery (traumatic, congenital, malignant, benign), the graft site (head & neck, trunk, upper extremities, lower extremities), type of skin graft (split thickness, full-thickness). The primary outcome will be occurrence of SSI at the donor and/or recipient sites. Secondary outcomes, if reported, will include: length of hospital stay, revision surgery required, cost of medical care, time to wound healing and cosmetic outcome.

Ethics And Dissemination: The systematic review will be published in a peer-reviewed journal and presented at national and international meetings within fields of plastic, reconstructive, and aesthetic surgery. The work will be disseminated electronically and in print. Brief reports of the review and findings will be disseminated to interested parties through email and direct communication. The review aims to guide healthcare practice and policy.
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http://dx.doi.org/10.1016/j.isjp.2019.02.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6913549PMC
February 2019

The Omega-3 Fatty Acids EPA and DHA, as a Part of a Murine High-Fat Diet, Reduced Lipid Accumulation in Brown and White Adipose Tissues.

Int J Mol Sci 2019 Nov 24;20(23). Epub 2019 Nov 24.

Division of Food and Nutrition Science, Department of Biology and Biological Engineering, Chalmers University of Technology, SE-41296 Gothenburg, Sweden.

Excess energy intake can trigger an uncontrolled inflammatory response, leading to systemic low-grade inflammation and metabolic disturbances that are hypothesised to contribute to cardiovascular disease and type 2 diabetes. The long chain n-3 polyunsaturated fatty acids (LC n-3 PUFAs) eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are suggested to mitigate this inflammatory response, but the mechanisms are unclear, especially at the tissue level. Adipose tissues, the first tissues to give an inflammatory response, may be an important target site of action for EPA and DHA. To evaluate the effects of EPA and DHA in white and brown adipose tissues, we fed male C57Bl/6J mice either a high fat diet (HFD) with 5% corn oil, an HFD with 40% of the corn oil substituted for purified EPA and DHA triglycerides (HFD-ED), or normal chow, for 8 weeks. Fatty acid profiling and transcriptomics were used to study how EPA and DHA affect retroperitoneal white and brown adipose tissues. HFD-ED fed mice showed reduced lipid accumulation and levels of the pro-inflammatory fatty acid arachidonic acid in both white and brown adipose tissues, compared with HFD-corn oil fed animals. The transcriptomic analysis showed changes in β-oxidation pathways, supporting the decreased lipid accumulation in the HFD-ED fed mice. Therefore, our data suggests that EPA and DHA supplementation of a high fat diet may be anti-inflammatory, as well as reduce lipid accumulation in adipose tissues.
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http://dx.doi.org/10.3390/ijms20235895DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6928976PMC
November 2019

Recording communication in primary dental practice: an exploratory study of interactions between dental health professionals, children and parents.

Br Dent J 2019 Nov;227(10):887-892

Dental Health Services Research Unit, University of Dundee, DD1 4HN and Dental Public Health, NHS Tayside, UK.

Aim To explore the time taken and the types of communication strategies used by dental health professionals (DHPs) when interacting with and providing fluoride varnish and oral health advice to children with their parents.Methods A video observational study was conducted to explore the types of communication strategies used by DHPs when interacting with child patients and their parents during preventive oral healthcare appointments. Three dentists and two extended duty dental nurses (EDDNs) from four general dental practices were recruited in East of Scotland. Forty-four child-parent dyads participated in the study. Verbal and non-verbal behaviours were coded with Observer XT 10.5 using the PaeD-TrICS coding scheme. Frequencies of communication behaviours were compared using Mann-Whitney U-tests.Results The communication during the preventive care appointment ranged in time from 130 seconds to 1,756 seconds with an average of 736 seconds. The total number of communication strategies (verbal and non-verbal behaviours) based on 44 video observations was 7,299. DHPs used different communication strategies when providing fluoride varnish application (FVA) and oral health advice. Dentists used more direct communication strategies to elicit child patients' cooperation in FVA. EDDNs used communication behaviours to maintain a balanced relationship with children. Consequently, children exhibited different responses to the two different dental professional groups.Conclusions Differences in the style of communication strategies existed between the participating DHPs when interacting with children during preventive dental appointments. Further work is required to confirm these initial findings.
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http://dx.doi.org/10.1038/s41415-019-0890-6DOI Listing
November 2019

Cartilage-like composition of keloid scar extracellular matrix suggests fibroblast mis-differentiation in disease.

Matrix Biol Plus 2019 Nov 30;4:100016. Epub 2019 Oct 30.

King's College London, School of Immunology & Microbial Sciences, Department of Inflammation Biology, Centre for Inflammation Biology & Cancer Immunology, New Hunt's House, Guy's Campus, London SE1 1UL, UK.

Following wound damage to the skin, the scarring spectrum is wide-ranging, from a manageable normal scar through to pathological keloids. The question remains whether these fibrotic lesions represent simply a quantitative extreme, or alternatively, whether they are qualitatively distinct. A three-way comparison of the extracellular matrix (ECM) composition of normal skin, normal scar and keloids was performed using quantitative discovery-based proteomics. This approach identified 40 proteins that were significantly altered in keloids compared to normal scars, and strikingly, 23 keloid-unique proteins. The major alterations in keloids, when functionally grouped, showed many changes in proteins involved in ECM assembly and fibrillogenesis, but also a keloid-associated loss of proteases, and a unique cartilage-like composition, which was also evident histologically. The presence of Aggrecan and Collagen II in keloids suggest greater plasticity and mis-differentiation of the constituent cells. This study characterises the ECM of both scar types to a depth previously underappreciated. This thorough molecular description of keloid lesions relative to normal scars is an essential step towards our understanding of this debilitating clinical problem, and how best to treat it.
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http://dx.doi.org/10.1016/j.mbplus.2019.100016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7852214PMC
November 2019

Community-Based Study of Celiac Disease Autoimmunity Progression in Adults.

Gastroenterology 2020 01 24;158(1):151-159.e3. Epub 2019 Sep 24.

Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. Electronic address:

Background & Aims: Celiac disease can develop at any age, but outcomes of adults with positive results from serologic tests for tissue transglutaminase antibodies (tTGA) without endoscopic determination of celiac disease (called celiac autoimmunity) have not been thoroughly evaluated. We investigated the proportion of adults with celiac autoimmunity at a community medical center and their progression to celiac disease.

Methods: We analyzed waste blood samples from a community clinic from 15,551 adults for tTGA and, if titer results were above 2 U/mL, for endomysial antibody. The blood samples had been collected at 2 time points (median interval, 8.8 years) from 2006 through 2017. We collected data from the clinic on diagnoses of celiac disease based on duodenal biopsy analysis.

Results: Of the serum samples collected at the first time point, 15,398 had negative results for tTGA, and 153 had positive results for tTGA (>4 U/mL). Based on medical records, 6 individuals received a diagnosis of celiac disease, for a cumulative incidence of celiac disease diagnosis of 0.06% (95% confidence interval, 0.01-0.11). Forty-nine (0.32%) individuals with a negative result from the first serologic test for tTGA had a positive result from the second test. Among the 153 adults who were tTGA positive at the first time point, 31 (20%) had a subsequent diagnosis of celiac disease, 81 (53%) remained positive for tTGA without a clinical diagnosis of celiac disease, and 41 (27%) had negative test results for tTGA at the second time point. Higher initial tTGA titers, female sex, and a history of hypothyroidism and autoimmune disease were associated with increased risks of subsequent diagnosis of celiac disease. Interestingly, adults whose first blood sample had a positive test result but second blood sample had a negative result for tTGA were older, had lower-than-average initial tTGA titer results, and had a higher mean body mass index than adults whose blood samples were positive for tTGA at both time points and adults later diagnosed with celiac disease.

Conclusions: In an analysis of serum samples collected from a community clinic an average of 8.8 years apart, we found that fewer than 1% of adults with negative results from an initial test for tTGA have a positive result on a second test. Of adults with positive results from the test for tTGA, only 20% are later diagnosed with celiac disease; the remaining individuals maintain persistent increases in tTGA without diagnoses of celiac disease or have negative results from second tests.
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http://dx.doi.org/10.1053/j.gastro.2019.09.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7065356PMC
January 2020

Moderate-to-high intensity exercise with person-centered guidance influences fatigue in older adults with rheumatoid arthritis.

Rheumatol Int 2019 Sep 20;39(9):1585-1594. Epub 2019 Jul 20.

Rheumatology and Inflammation Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

Fatigue is described as a dominant and disturbing symptom of rheumatoid arthritis (RA) regardless of the advances in pharmacological treatment. Fatigue is also found to correlate with depression. The objective was to evaluate the impact of moderate-to-high intensity, aerobic and resistance exercise with person-centered guidance on fatigue, anxiety and depression, in older adults with RA. Comparisons were made between older adults (> 65 years) with RA taking part in a 20-week moderate-to-high intensity exercise at a gym (n = 36) or in home-based exercise of light intensity (n = 38). Assessments were performed at baseline, at 20 weeks, and at 52 weeks. Outcomes were differences in Multidimensional Fatigue Inventory (MFI-20), Visual Analog Scale Fatigue (VAS fatigue), and Hospital Anxiety and Depression Scale (HADS). Analysis of metabolomics was also performed. The subscales "physical fatigue" and "mental fatigue" in MFI-20 and symptoms of depression using HADS depression scale improved significantly at week 20 in the exercise group compared with the control group. Exercise did not influence global fatigue rated by VAS or subscales "reduced motivation", "reduced activity" and "general fatigue" in MFI-20. No significant change was found on the anxiety index of HADS. The improvements in physical fatigue were associated with changes in the metabolism of lipids, bile acids, the urea cycle and several sugars. Moderate-to-high intensity exercise with person-centered guidance decreased fatigue and improved symptoms of depression and were accompanied by metabolic changes in older adults with RA.
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http://dx.doi.org/10.1007/s00296-019-04384-8DOI Listing
September 2019

Reply to RB Yarandi.

Am J Clin Nutr 2019 04;109(4):1233-1234

From the Department of Nutrition, Exercise, and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark LL; MK; JNE) and the Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden (ABR).

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http://dx.doi.org/10.1093/ajcn/nqz022DOI Listing
April 2019

A Whole-Grain Diet Increases Glucose-Stimulated Insulin Secretion Independent of Gut Hormones in Adults at Risk for Type 2 Diabetes.

Mol Nutr Food Res 2019 04 20;63(7):e1800967. Epub 2019 Mar 20.

Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.

Introduction: The effect of whole-grain (WG) versus refined-grain (RG) diets on glucose-stimulated insulin secretion (GSIS) and β-cell function is unclear.

Methods: In a double-blind crossover randomized controlled trial, 13 prediabetic adults (37.2 ± 1.8 y, BMI: 33.6 ± 1.4 kg m , 2 h glucose: 146.9 ± 11.6 mg dL ) are provided isocaloric-matched WG and RG diets for 8-weeks each, with an 8-10 week washout between diets. Glucose, insulin, and C-peptide are studied over 240 min following a 75 g OGTT. Incretins (GLP-1 and GIP), PYY, and total ghrelin are assessed at 0, 30, and 60 min. Mixed-meal diets for carbohydrate (54%), fat (28%), and protein (18%) contain either WG (50 g/1000 kcal) or equivalent RG.

Results: Both diets induce fat loss (≈2 kg). While neither diet impacts early phase GSIS, the WG diet increases total GSIS (iAUC of C-peptide /Glc , p = 0.02) and β-cell function (disposition index; GSIS × insulin sensitivity, p = 0.02). GIP and PYY are unaltered by either diet, but GLP-1 is higher at 30 min following RG versus WG (p = 0.04). Ghrelin levels are higher at 60 min of the OGTT following both interventions (p = 0.01).

Conclusion: A WG-rich diet increases β-cell function independent of gut hormones in adults with prediabetes.
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http://dx.doi.org/10.1002/mnfr.201800967DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6559794PMC
April 2019

Effect of folate supplementation on insulin sensitivity and type 2 diabetes: a meta-analysis of randomized controlled trials.

Am J Clin Nutr 2019 01;109(1):29-42

Department of Nutrition, Exercise, and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark.

Background: Various mechanisms link higher total homocysteine to higher insulin resistance (IR) and risk of type 2 diabetes (T2D). Folate supplementation is recognized as a way to lower homocysteine. However, randomized controlled trials (RCTs) show inconsistent results on IR and T2D outcomes.

Objective: The aim of this study was to examine the effect of folate supplementation on IR and T2D outcomes.

Design: We conducted a systematic literature search in PubMed, Web of Science, and EMBASE and prior systematic reviews and meta-analyses and identified 29 RCTs (22,250 participants) that assessed the effect of placebo-controlled folate supplementation alone or in combination with other B vitamins on fasting glucose, insulin, homeostasis model assessment for insulin resistance (HOMA-IR), glycated hemoglobin (HbA1c), or risk of T2D. The meta-analysis was conducted using both random- and fixed-effects models to calculate weighted mean differences (WMDs) or risk ratios with 95% CIs. Subgroup analyses were conducted based on intervention type (folate alone or in combination with other B vitamins), as well as analysis based on population characteristics, duration, dose, and change in homocysteine.

Results: When compared with placebo, folate supplementation lowered fasting insulin (WMD: -13.47 pmol/L; 95% CI: -21.41, -5.53 pmol/L; P < 0.001) and HOMA-IR (WMD: -0.57 units; 95% CI: -0.76, -0.37 units; P < 0.0001), but no overall effects were observed for fasting glucose or HbA1c. Heterogeneity was low in all meta-analyses, and subgroup analysis showed no signs of effect modification except for change in homocysteine, with the most pronounced effects in trials with a change of >2.5 µmol/L. Changes in homocysteine after folate supplementation correlated with changes in fasting glucose (β = 0.07; 95% CI: 0.01, 0.14; P = 0.025) and HbA1c (β = 0.46; 95% CI: 0.06, 0.85; P = 0.02). Only 2 studies examined folate supplementation on risk of T2D, and they found no change in RR (pooled RR: 0.91; 95% CI: 0.80, 1.04; P = 0.16).

Conclusion: Folate supplementation might be beneficial for glucose homeostasis and lowering IR, but at present there are insufficient data to conclusively determine the effect on development of T2D. This trial was registered on the Prospero database as CRD42016048254.
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http://dx.doi.org/10.1093/ajcn/nqy234DOI Listing
January 2019

The effectiveness of Dental Health Support Workers at linking families with primary care dental practices: a population-wide data linkage cohort study.

BMC Oral Health 2018 11 21;18(1):191. Epub 2018 Nov 21.

Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of MVLS, University of Glasgow, 378 Sauchiehall Street, Glasgow, UK.

Background: Link workers (lay health workers, health support workers) based in the community provide additional support to individuals and families to facilitate engagement with primary care and other services and resources. This additional support aims to tackle the wider socio-economic determinants of health that lead to inequalities. To date, there is no clear evidence of the effectiveness of these programmes. This study evaluates the effectiveness of Dental Health Support Workers (DHSW) at linking targeted families with young children to primary care dental practices. The DHSW role is one component of Childsmile, the national oral health improvement programme in Scotland.

Methods: A quasi-experimental approach captured the natural variation in the rollout of the DHSW intervention across Scotland in a cohort of children born between 2010 and 2013. Survival analysis explored "time to attendance" at primary care dental practice. Cox's regression models compared attendance rates and time until first attendance between those families who received support from the DHSW and those who did not.

Results: The cohort consisted of 35236 children. Thirty-three percent of the cohort (n = 11495) were considered to require additional support from a DHSW. Of these, 44% (5087) received that support. These families were more likely to attend a dental practice (Hazard Ratio [95% Confidence Interval] =1.87 [1.8 to 1.9]) and, on average, did so 9 months earlier (median time until first attendance: 8.8 months versus 17.8 months), compared to families not receiving additional support.

Conclusions: Link workers (DHSW) within the Childsmile programme are effective at linking targeted children to primary care dental services and, most notably, at a younger age for prevention. This is the first study of its kind to evaluate the effectiveness of link-worker programmes using a robust quasi-experimental design on three, population-wide, linked datasets. These results will inform future health programmes which aim to improve health and reduce inequalities by reaching and supporting families from more disadvantaged backgrounds.
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http://dx.doi.org/10.1186/s12903-018-0650-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6249895PMC
November 2018

A low-gluten diet induces changes in the intestinal microbiome of healthy Danish adults.

Nat Commun 2018 11 13;9(1):4630. Epub 2018 Nov 13.

Department of Biotechnology and Biomedicine, Technical University of Denmark, DK-2800, Kgs. Lyngby, Denmark.

Adherence to a low-gluten diet has become increasingly common in parts of the general population. However, the effects of reducing gluten-rich food items including wheat, barley and rye cereals in healthy adults are unclear. Here, we undertook a randomised, controlled, cross-over trial involving 60 middle-aged Danish adults without known disorders with two 8-week interventions comparing a low-gluten diet (2 g gluten per day) and a high-gluten diet (18 g gluten per day), separated by a washout period of at least six weeks with habitual diet (12 g gluten per day). We find that, in comparison with a high-gluten diet, a low-gluten diet induces moderate changes in the intestinal microbiome, reduces fasting and postprandial hydrogen exhalation, and leads to improvements in self-reported bloating. These observations suggest that most of the effects of a low-gluten diet in non-coeliac adults may be driven by qualitative changes in dietary fibres.
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http://dx.doi.org/10.1038/s41467-018-07019-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6234216PMC
November 2018

Nutritional impact on Immunological maturation during Childhood in relation to the Environment (NICE): a prospective birth cohort in northern Sweden.

BMJ Open 2018 10 21;8(10):e022013. Epub 2018 Oct 21.

Sunderby Research Unit, Region Norrbotten, Luleå, Sweden.

Introduction: Prenatal and neonatal environmental factors, such as nutrition, microbes and toxicants, may affect health throughout life. Many diseases, such as allergy and impaired child development, may be programmed already in utero or during early infancy. Birth cohorts are important tools to study associations between early life exposure and disease risk. Here, we describe the study protocol of the prospective birth cohort, 'Nutritional impact on Immunological maturation during Childhood in relation to the Environment' (NICE). The primary aim of the NICE cohort is to clarify the effect of key environmental exposures-diet, microbes and environmental toxicants-during pregnancy and early childhood, on the maturation of the infant's immune system, including initiation of sensitisation and allergy as well as some secondary outcomes: infant growth, obesity, neurological development and oral health.

Methods And Analysis: The NICE cohort will recruit about 650 families during mid-pregnancy. The principal inclusion criterion will be planned birth at the Sunderby Hospital in the north of Sweden, during 2015-2018. Questionnaires data and biological samples will be collected at 10 time-points, from pregnancy until the children reach 4 years of age. Samples will be collected primarily from mothers and children, and from fathers. Biological samples include blood, urine, placenta, breast milk, meconium, faeces, saliva and hair. Information regarding allergic heredity, diet, socioeconomic status, lifestyle including smoking, siblings, pet ownership, etc will be collected using questionnaires. Sensitisation to common allergens will be assessed by skin prick testing and allergic disease will be diagnosed by a paediatrician at 1 and 4 years of age. At 4 years of age, the children will also be examined regarding growth, neurobehavioural and neurophysiological status and oral health.

Ethics And Dissemination: The NICE cohort has been approved by the Regional Ethical Review Board in Umeå, Sweden (2013/18-31M). Results will be disseminated through peer-reviewed journals and communicated on scientific conferences.
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http://dx.doi.org/10.1136/bmjopen-2018-022013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6196815PMC
October 2018

Metabotypes Related to Meat and Vegetable Intake Reflect Microbial, Lipid and Amino Acid Metabolism in Healthy People.

Mol Nutr Food Res 2018 11 28;62(21):e1800583. Epub 2018 Aug 28.

Nutrition and Metabolic health Department, Nestle Institute of Health Sciences (NIHS), Lausanne, Switzerland.

Scope: The objective of this study is to develop a new methodology to identify the relationship between dietary patterns and metabolites indicative of food intake and metabolism.

Methods And Results: Plasma and urine samples from healthy Swiss subjects (n = 89) collected over two time points are analyzed for a panel of host-microbial metabolites using GC- and LC-MS. Dietary intake is evaluated using a validated food frequency questionnaire. Dietary pattern clusters and relationships with metabolites are determined using Non-Negative Matrix Factorization (NNMF) and Sparse Generalized Canonical Correlation Analysis (SGCCA). Use of NNMF allows detection of latent diet clusters in this population, which describes a high intake of meat or vegetables. SGCCA associates these clusters to i) diet-host microbial and lipid associated bile acid metabolism, and ii) essential amino acid metabolism.

Conclusion: This novel application of NNMF and SGCCA allows detection of distinct metabotypes for meat and vegetable dietary patterns in a heterogeneous population. As many of the metabolites associated with meat or vegetable intake are the result of host-microbiota interactions, the findings support a role for microbiota mediating the metabolic imprinting of different dietary choices.
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http://dx.doi.org/10.1002/mnfr.201800583DOI Listing
November 2018

Evaluating Whole Grain Intervention Study Designs and Reporting Practices Using Evidence Mapping Methodology.

Nutrients 2018 Aug 9;10(8). Epub 2018 Aug 9.

Nutritional Epidemiology, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA 02111, USA.

Consumption of whole grains have been associated with reduced risk of chronic diseases in many observational studies; yet, results of intervention studies are mixed. We aimed to use evidence mapping to capture the methodological and reporting variability in whole grain intervention studies that may contribute to this inconsistency. We conducted a reproducible search in OVID Medline for whole grain human intervention studies (published 1946 to February 2018). After screening based on a priori criteria, we identified 202 publications describing a total of 213 unique trials. Over half (55%) were acute trials, lasting ≤1 day, 30% were moderate duration studies (up to 6 weeks) and 15% were of longer duration (more than 6 weeks). The majority of acute trials (75%) examined measures of glycaemia and/or insulinemia, while most of the longer trials included measures of cardiometabolic health (71%), appetite/satiety (57%) and weight/adiposity (56%). Among the moderate and long duration trials, there was a wide range of how whole grains were described but only 10 publications referenced an established definition. Only 55% of trials reported the actual amount of whole grains (in grams or servings), while 36% reported the amount of food/product and 9% did not report a dose at all. Of the interventions that provided a mixture of whole grains, less than half (46%) reported the distribution of the different grain types. Reporting of subject compliance also varied and only 22% used independent biomarkers of whole grain intake. This evidence map highlights the need to standardize both study protocols and reporting practices to support effective synthesis of study results and provide a stronger foundation to better inform nutrition scientists and public health policy.
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http://dx.doi.org/10.3390/nu10081052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6115963PMC
August 2018

Low-phytate wholegrain bread instead of high-phytate wholegrain bread in a total diet context did not improve iron status of healthy Swedish females: a 12-week, randomized, parallel-design intervention study.

Eur J Nutr 2019 03 23;58(2):853-864. Epub 2018 May 23.

Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.

Purpose: To investigate the effects of eating wholegrain rye bread with high or low amounts of phytate on iron status in women under free-living conditions.

Methods: In this 12-week, randomized, parallel-design intervention study, 102 females were allocated into two groups, a high-phytate-bread group or a low-phytate-bread group. These two groups were administered: 200 g of blanched wholegrain rye bread/day, or 200 g dephytinized wholegrain rye bread/day. The bread was administered in addition to their habitual daily diet. Iron status biomarkers and plasma alkylresorcinols were analyzed at baseline and post-intervention.

Results: Fifty-five females completed the study. There was a significant difference in change over time in total body iron stores between the two groups (p < 0.035). In the low-phytate bread group (n = 24) there were significant within-group decreases in both ferritin (mean 12%; from 32 ± 7 to 27 ± 6 μg/L, geometric mean ± SEM, p < 0.018) and total body iron (mean 12%; from 6.9 ± 1.4 to 5.4 ± 1.1 mg/kg, p < 0.035). Plasma alkylresorcinols indicated that most subjects complied with the intervention

Conclusions: In Swedish females of reproductive age, no statistically significant difference in iron status was detected after 12 weeks of high-phytate wholegrain bread consumption. However, consumption of low-phytate wholegrain bread for 12 weeks resulted in a reduction of markers of iron status. Although single-meal studies clearly show an increase in iron bioavailability from dephytinization of cereals, medium-term consumption of reduced phytate bread under free-living conditions suggests that this strategy does not work to improve iron status in healthy women of reproductive age.
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http://dx.doi.org/10.1007/s00394-018-1722-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6437124PMC
March 2019

Analysis of avenanthramides in oat products and estimation of avenanthramide intake in humans.

Food Chem 2018 Jul;253:93-100

Division of Food and Nutrition Science, Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden. Electronic address:

Avenanthramides are phenolic compounds found only in oats, and are of interest due to suggested bioactivities, including anti-inflammatory effects and induction of apoptosis. The objective of this work was to optimise a high performance liquid chromatography (HPLC) method for analysis of avenanthramides in food, and analyse the avenanthramide content in 45 oat fractions and products. The optimised HPLC method was based on triplicate extraction of 100 mg sample with 1 ml 80% ethanol in phosphate buffer (pH 2.8) and used gallacetophenone as an internal standard. Avenalumic acid-derived avenanthramide homologues 2f and 2p were also present, making up to 20% of the total avenanthramides detected in oats. The amounts of avenanthramides detected in oat products was 2-82 µg/g. It was estimated that mean avenanthramide intake among oat consumers ranges from 0.3 to 2.1 mg/day, considerably lower than the amount used in studies that have investigated biological effects of avenanthramides in humans.
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http://dx.doi.org/10.1016/j.foodchem.2018.01.138DOI Listing
July 2018
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