Publications by authors named "Martin Veysey"

58 Publications

Bitter and sweet taste perception: relationships to self-reported oral hygiene habits and oral health status in a survey of Australian adults.

BMC Oral Health 2021 10 29;21(1):553. Epub 2021 Oct 29.

School of Environmental and Life Sciences, The University of Newcastle, Ourimbah, NSW, Australia.

Background: Oral health, an essential part of general health and well-being, is influenced by multiple factors, including oral hygiene habits and dietary factors. Dietary preferences are influenced by variation in taste perceptions and threshold tasting. Polymorphisms in specific genes for sweet and bitter taste receptors and bitter taste perception have been associated with dental caries. However, taste is complex with multiple receptors, each with multiple potential polymorphisms contributing to taste perception as well as social, cultural, and environmental influences. Additionally, these association studies have been conducted in restricted cohorts (e.g., children only). Furthermore, outcomes have been limited to dental caries and studies between taste perception and oral hygiene habits have not been completed.

Methods: A cross-sectional online survey was conducted to investigate the relationships between bitter and sweet taste perception (liking and intensity of index food items), self-reported oral hygiene habits and oral health (n = 518).

Results: Higher mean intensity scores for bitter (16-21%) and sweet (< 5%-60%) were seen with higher frequencies of oral hygiene habits (brushing, use of mouthwash, chewing gum and tongue cleaning). Lower mean bitter liking scores (18-21%) were seen with higher frequencies of oral hygiene habits (brushing, mouthwash use, floss use and chewing gum). Sweet liking scores varied by reported frequency of mouthwash use and flossing only, with mixed patterns of variance. Mean bitter and sweet intensity perception scores varied with the number of dental caries ((13-20% higher in those with 3 or more caries, compared to none).

Conclusions: While there were numerous relationships identified between liking and perception of sweet and bitter and oral health outcomes, the magnitude and direction of associations varied by outcome. The direction of the associations cannot be inferred due to the cross-sectional nature of the study. The demonstrated relationships justify further future investigations, which could help better understand if taste liking and perception is impacted by oral hygiene and health, or vice versa. This could be important in understanding the causation and progression of oral health diseases or the development of novel therapeutics for oral health.
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http://dx.doi.org/10.1186/s12903-021-01910-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8555166PMC
October 2021

Sour Taste SNP -rs236514 and Differences in Nutrient Intakes and Metabolic Health Markers in the Elderly.

Front Nutr 2021 17;8:701588. Epub 2021 Aug 17.

School of Environmental and Life Sciences, The University of Newcastle, Ourimbah, NSW, Australia.

Single nucleotide polymorphisms (SNPs) in taste receptors influence dietary choices that contribute to health and quality of life. Individual differences in sour taste perception and preference have been linked to heritable genetics, yet the impact of sour taste receptor SNPs on sour taste is under-researched, and studies on sour taste SNP associations to diet and health are lacking. Therefore, this study explored the relationships between the sour taste SNP -rs236514 and estimated macronutrient, vitamin and mineral intakes, and markers of metabolic health. Associations were explored in 523 participants aged 65 years and older with data analysed using standard least squares and nominal logistic regression modelling with student's -tests and Tukey's HSD. Associations were found between the presence of the -rs236514 variant allele (A) and lower intakes of energy, total fat, monounsaturated fat and saturated fat. The lower fat intakes were significant in female carriers of the variant allele (A), along with lower water intake. Lower retinol, riboflavin, folate, calcium and sodium intakes were found in the -A allele carriers. In females, the variant allele was associated with lower sodium intake before and after Bonferroni adjustment. Higher body mass index, waist and waist-to-hip ratio measures were found in males carrying the variant allele. Lower levels of liver function biomarkers were associated with the presence of the -A allele. Overall and in males, the variant's association to lower gamma-glutamyl transferase (GGT) levels remained significant after Bonferroni adjustments. These novel findings suggest the sour taste SNP, -rs236514, may be modifying macronutrient, vitamin and mineral intakes, and markers of metabolic health. Research on the extra-oral functions of this SNP may improve health outcomes for those with overweight, obesity and liver disease.
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http://dx.doi.org/10.3389/fnut.2021.701588DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8415820PMC
August 2021

A Rapid Review of Prescribing Education Interventions.

Med Sci Educ 2021 Feb 16;31(1):273-289. Epub 2020 Nov 16.

Health Professions Education Unit, Hull York Medical School, University of York, York, YO10 5DD UK.

Introduction: Many studies conducted on the causes and nature of prescribing errors have highlighted the inadequacy of teaching and training of prescribers. Subsequently, a rapid review was undertaken to update on the nature and effectiveness of educational interventions aimed at improving the prescribing skills and competencies.

Methods: Twenty-two studies taking place between 2009 and 2019 were identified across nine databases.

Results And Discussion: This review reinforced the importance of the WHO Guide to Good Prescribing to prescribing curriculum design as well as the effectiveness of small group teaching. However, it also highlighted the lack of innovation in prescribing education and lack of longitudinal follow-up regarding the effectiveness of prescribing education interventions.
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http://dx.doi.org/10.1007/s40670-020-01131-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8368780PMC
February 2021

Biophysical evidence to support and extend the vitamin D-folate hypothesis as a paradigm for the evolution of human skin pigmentation.

Am J Hum Biol 2021 Aug 21:e23667. Epub 2021 Aug 21.

School of Environmental and Life Sciences, University of Newcastle, Ourimbah, New South Wales, Australia.

Objective: To test the "vitamin D-folate hypothesis for the evolution of human skin pigmentation."

Methods: Total ozone mapping spectrometer (TOMS) satellite data were used to examine surface UV-irradiance in a large (n = 649) Australian cross-sectional study population. Genetic analysis was used to score vitamin D- and folate-related gene polymorphisms (n = 22), along with two pigmentation gene variants (IRF4-rs12203592/HERC2-rs12913832). Red cell folate and vitamin D were measured by immunoassay and HPLC, respectively.

Results: Ultraviolet radiation (UVR) and pigmentation genes interact to modify blood vitamin levels; Light skin IRF4-TT genotype has greatest folate loss while light skin HERC2-GG genotype has greatest vitamin D synthesis (reflected in both TOMS and seasonal data). UV-wavelength exhibits a dose-response relationship in folate loss within light skin IRF4-TT genotype (305 > 310 > 324 > 380 nm). Significant vitamin D photosynthesis only occurs within light skin HERC2-GG genotype, and is maximal at 305 nm. Three dietary antioxidants (vitamins C, E, and β-carotene) interact with UVR and pigmentation genes preventing oxidative loss of labile reduced folate vitamers, with greatest benefit in light skin IRF4-TT subjects. The putative photosensitiser, riboflavin, did not sensitize red cell folate to UVR and actually afforded protection. Four genes (5xSNPs) influenced blood vitamin levels when stratified by pigmentation genotype; MTHFR-rs1801133/rs1801131, TS-rs34489327, CYP24A-rs17216707, and VDR-ApaI-rs7975232. Lightest IRF4-TT/darkest HERC2-AA genotype combination (greatest folate loss/lowest vitamin D synthesis) has 0% occurrence. The opposing, commonest (39%) compound genotype (darkest IRF4-CC/lightest HERC2-GG) permits least folate loss and greatest synthesis of vitamin D .

Conclusion: New biophysical evidence supports the vitamin D-folate hypothesis for evolution of skin pigmentation.
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http://dx.doi.org/10.1002/ajhb.23667DOI Listing
August 2021

Association between Sour Taste SNP -rs236514, Diet Quality and Mild Cognitive Impairment in an Elderly Cohort.

Nutrients 2021 Feb 24;13(3). Epub 2021 Feb 24.

School of Environmental and Life Sciences, The University of Newcastle, Ourimbah, NSW 2258, Australia.

Differences in sour-taste thresholds have been identified in cognition-related diseases. Diet is a modulator of cognitive health, and taste perception influences dietary preferences and habits. Heritable genetics and polymorphisms in the gene involved in the transduction of sour taste have been linked to variations in sour taste and non-gustatory functions. However, relationships between sour taste genetics, mild cognitive impairment, and diet quality are yet to be elucidated. This study investigated the associations between the presence of the -rs236514 variant (A) allele, diet quality indices, and mild cognitive impairment evaluated by the Mini-Mental State Examination (MMSE), in a secondary cross-sectional analysis of data from the Retirement Health & Lifestyle Study. Data from 524 elderly Australians (≥65y) were analyzed, using standard least squares regression and nominal logistic regression modeling, with demographic adjustments applied. Results showed that the presence of the -A allele is associated with increased proportions of participants scoring in the range indicative of mild or more severe cognitive impairment (MMSE score of ≤26) in the total cohort, and males. These associations remained statistically significant after adjusting for age, sex, and diet quality indices. The absence of association between the -A allele and cognitive impairment in women may be related to their higher diet quality scores in all indices. The potential link between sour taste genotype and cognitive impairment scores may be due to both oral and extra-oral functions of sour taste receptors. Further studies are required on the role and relationship of neurotransmitters, sour taste genotypes and sour taste receptors in the brain, and dietary implications, to identify potential risk groups or avenues for therapeutic or prophylactic interventions.
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http://dx.doi.org/10.3390/nu13030719DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7996326PMC
February 2021

Genetic Variation in the Bitter Receptors Responsible for Epicatechin Detection Are Associated with BMI in an Elderly Cohort.

Nutrients 2021 Feb 9;13(2). Epub 2021 Feb 9.

School of Environmental and Life Sciences, University of Newcastle, Ourimbah 2258, Australia.

Globally, more than one-third of adults are overweight. Overweight and obesity are complex and multifaceted conditions, associated with an increased risk of chronic illness and early mortality. While there are known risk factors, these alone do not fully explain the varying outcomes between individuals. Recently, taste receptors have been proposed to have a role in the risk for obesity. These receptors are expressed throughout the gastrointestinal tract. In this system, they may be involved in modulating dietary intake and metabolic processes. The taste 2 family of receptors (T2Rs) detects bitter compounds. Receptors T2R4 and T2R5 detect (-)-epicatechin (epicatechin), an antioxidant polyphenol, which may have protective effects against obesity. However, the potential role for taste receptors in this association has not been explored. This study assessed whether polymorphisms in (rs2233998 and rs2234001) and (rs2227264) were associated with body mass index (BMI). Genotyping (Taqman qPCR assays) was performed on DNA extracted from blood samples ( = 563) from an elderly cohort. Homozygosity for the minor allele of all polymorphisms was significantly associated with a lower BMI in males. The -rs2233998 CC genotype, the -rs2234001 CC genotype and the -rs2227264 TT genotype were associated with lower BMI (2.1, 2.1 and 2.2 units; = 0.002, 0.003 and 0.001, respectively). Epicatechin intake was not associated with BMI and genotype was not associated with epicatechin intake. This suggests that the association between genotype and elevated BMI risk occurs through altered extra-oral responses and not directly via altered epicatechin intake.
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http://dx.doi.org/10.3390/nu13020571DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7914776PMC
February 2021

What makes a model prescriber? A documentary analysis.

Med Teach 2021 02 8;43(2):198-207. Epub 2020 Nov 8.

Health Professions Education Unit, Hull York Medical School, University of York, York, UK.

Introduction: In recent years, the authority to prescribe medications in healthcare has expanded to include pharmacists, nurses and Allied Healthcare Professionals. Subsequently, the quantity of guidelines describing appropriate prescribing practice has increased. Despite this, the literature notes a lack of consensus regarding the overall qualities of a good prescriber. The aim of this study was to attempt to define what makes a model prescriber in practice, regardless of professional background.

Methods: A documentary analysis of UK-based and international prescribing practice guidelines was performed. Data analysis was conducted through a constructivist grounded theory approach to enable concepts to be identified from the data itself without the use of pre-defined categories.

Results: A total of 13 guideline documents were analysed. Overall, four core categories of a model prescriber in practice were identified: Knowledgeable: including that of disease and drug properties; Safe: relating to appropriate drug quantities and treatment-monitoring; Good Communicators: with both patients and colleagues; Contemporary: through enhancing knowledge and skills.

Conclusions: These four categories can serve as a definition of a high-level prescriber and as an additional tool for prescribing educators to evaluate the extent their curriculum develops and assesses the core qualities needed by their students to be high-level prescribers in practice.
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http://dx.doi.org/10.1080/0142159X.2020.1839031DOI Listing
February 2021

Factors associated with the development of acute general surgical pathology in medical in-patients.

Intern Med J 2020 Nov 2. Epub 2020 Nov 2.

York Teaching Hospitals NHS Foundation Trust, Wigginton Road, York, YO31 8HE, UK.

Background: Medical inpatients can develop acute general surgical conditions. However, this is rare. The presence of multiple acute pathologies delays diagnosis and these patients have poorer prognoses.

Aim: To determine the incidence, risk factors and prognosis of medical inpatients developing acute general surgical conditions.

Methods: A single-centre retrospective case-control study was conducted over one year in the United Kingdom. Medical patients developing acute surgical pathology were identified using the local referral system. For each case, two controls were selected from a pool of medical in-patients receiving no general surgical input during their admission. Patient records were used to collect hospital admission details, demographic and laboratory data. Univariate analysis and multi-variable analysis were performed.

Results: The study included 42 cases and 84 controls. The incidence of general surgical pathology in medical in-patients was 2.3/1000 admissions/year. In multivariate analysis, risk factors associated with developing general surgical pathology were previous abdominal surgery (Odds Ratio [OR] =3.68, 95% Confidence interval [CI]: 1.43 to 9.48, p=0.007) and doubling from baseline creatinine (OR=18.9, 95%CI: 2.57 to 139, p=0.004). Patients with surgical pathology had longer in-patient stays (22.8 vs 9.4 days, p<0.001) and a higher inpatient mortality (23.8% vs 7.1%, p=0.011). Development of surgical pathology was strongly associated with mortality (OR=4.06, 95%CI: 1.36 to 12.1).

Conclusion: The development of acute surgical pathology in medical in-patients is rare but associated with longer in-patient stays and higher mortality. We have identified risk-factors associated with the development of surgical pathology which can be used to identify patients at risk of surgical pathology. This article is protected by copyright. All rights reserved.
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http://dx.doi.org/10.1111/imj.15126DOI Listing
November 2020

The impact of inflammatory bowel disease on sexual health in men: A scoping review.

J Clin Nurs 2020 Oct 11;29(19-20):3638-3651. Epub 2020 Aug 11.

Department of Health Sciences, University of York, York, UK.

Aims And Objectives: To review the literature on the impact of inflammatory bowel disease on the sexual health of men and make recommendations for nursing practice and research.

Background: Inflammatory bowel disease is a chronic condition of the gastrointestinal tract, causing symptoms that may impact upon sexual health. Specialist nurses are well positioned to assess and manage sexual health, but there is a lack of clinical guidance, especially in relation to men.

Design: A systematic scoping review following the Arksey and O'Malley (International Journal of Social Research Methodology, 8, 2005, 19) framework reported in line with the PRISMA-ScR checklist (Tricco et al., Annals of Internal Medicine, 169, 2018, 467).

Methods: OVID MEDLINE ALL [R], OVID EMBASE [R], OVID PsychINFO, EBSCO CINAHL Complete, The Cochrane Library and ProQuest were searched. Inclusion and exclusion criteria were applied independently by two reviewers. Data were extracted, charted and summarised from eligible studies.

Results: Thirty-one studies met the inclusion criteria. These were synthesised under three categories: mediators, moderators and descriptors of sexual health. Depression, disease activity and surgery were the most commonly cited disease-related factors to affect sexual health in men. The most commonly used assessment tool was The International Index of Erectile Function. Descriptors of function included frequency of intercourse, libido and the ability to maintain a desired sexual role.

Conclusions: The effect of inflammatory bowel disease on sexual health in men involves a complex interaction of physical and psychosocial factors. Researchers must explore areas outside of erectile function to understand how the disease impacts sexuality, sexual well-being and masculinity. This can be achieved through qualitative exploration of patient, partner and health professional experiences.

Relevance To Clinical Practice: A holistic nursing assessment of men with inflammatory bowel disease should include sexual health. Developing understanding of how the disease influences sexual interaction and expression will facilitate support that is relevant, accessible and of value to men living with the disease.
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http://dx.doi.org/10.1111/jocn.15418DOI Listing
October 2020

Intense Sweeteners, Taste Receptors and the Gut Microbiome: A Metabolic Health Perspective.

Int J Environ Res Public Health 2020 06 8;17(11). Epub 2020 Jun 8.

School of Environmental and Life Sciences, University of Newcastle, Ourimbah 2258, Australia.

Intense sweeteners (IS) are often marketed as a healthier alternative to sugars, with the potential to aid in combating the worldwide rise of diabetes and obesity. However, their use has been counterintuitively associated with impaired glucose homeostasis, weight gain and altered gut microbiota. The nature of these associations, and the mechanisms responsible, are yet to be fully elucidated. Differences in their interaction with taste receptors may be a potential explanatory factor. Like sugars, IS stimulate sweet taste receptors, but due to their diverse structures, some are also able to stimulate bitter taste receptors. These receptors are expressed in the oral cavity and extra-orally, including throughout the gastrointestinal tract. They are involved in the modulation of appetite, glucose homeostasis and gut motility. Therefore, taste genotypes resulting in functional receptor changes and altered receptor expression levels may be associated with metabolic conditions. IS and taste receptors may both interact with the gastrointestinal microbiome, and their interactions may potentially explain the relationship between IS use, obesity and metabolic outcomes. While these elements are often studied in isolation, the potential interactions remain unexplored. Here, the current evidence of the relationship between IS use, obesity and metabolic outcomes is presented, and the potential roles for interactions with taste receptors and the gastrointestinal microbiota in modulating these relationships are explored.
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http://dx.doi.org/10.3390/ijerph17114094DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7312722PMC
June 2020

Independent and Interactive Influences of Environmental UVR, Vitamin D Levels, and Folate Variant -rs2236225 on Homocysteine Levels.

Nutrients 2020 May 18;12(5). Epub 2020 May 18.

School of Environmental & Life Sciences, University of Newcastle, Ourimbah, NSW 2258, Australia.

Elevated homocysteine (Hcy) levels are a risk factor for vascular diseases. Recently, increases in ultraviolet radiation (UVR) have been linked to decreased Hcy levels. This relationship may be mediated by the status of UVR-responsive vitamins, vitamin D and folate, and/or genetic variants influencing their levels; however, this has yet to be examined. Therefore, the independent and interactive influences of environmental UVR, vitamin D and folate levels and related genetic variants on Hcy levels were examined in an elderly Australian cohort ( = 619). Red blood cell folate, 25-hydroxyvitamin D (25(OH)D), and plasma Hcy levels were determined, and genotyping for 21 folate and vitamin D-related variants was performed. Erythemal dose rate accumulated over six-weeks (6W-EDR) and four-months (4M-EDR) prior to clinics were calculated as a measure of environmental UVR. Multivariate analyses found interactions between 6W-EDR and 25(OH)D levels (p = 0.002), and 4M-EDR and -rs2236225 (p = 0.006) in predicting Hcy levels. The association between 6W-EDR and Hcy levels was found only in subjects within lower 25(OH)D quartiles (<33.26 ng/mL), with the association between 4M-EDR and Hcy occurring only in subjects carrying the -rs2236225 variant. 4M-EDR, 6W-EDR, and -rs2236225 were also independent predictors of Hcy. Findings highlight nutrient-environment and gene-environment interactions that could influence the risk of Hcy-related outcomes.
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http://dx.doi.org/10.3390/nu12051455DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7284830PMC
May 2020

Salt Taste Genotype, Dietary Habits and Biomarkers of Health: No Associations in an Elderly Cohort.

Nutrients 2020 Apr 10;12(4). Epub 2020 Apr 10.

School of Environmental and Life Sciences, The University of Newcastle, Ourimbah, NSW, 2258, Australia.

A small amount of emerging research has observed variations between individual sensitivity, preference and intake of salt in the presence of single nucleotide polymorphisms (SNP) on the genes encoding salt taste receptors. Sodium intake is a significant risk factor for common diseases in elderly populations such as hypertension and cardiovascular disease; however, this does not fully explain the risk. Research into the influence of salt taste genetics on diet quality is yet to be undertaken and current research on indicators of health is limited and mixed in the direction of associations. Therefore, a secondary analysis of data from a well-characterised elderly cohort (the cross-sectional Retirement Health and Lifestyle Study, = 536) was conducted to explore relationships between the salt taste-related SNP -rs8065080 (assessed by Taqman genotyping assay), dietary habits and biomarkers of health. Data were analysed with standard least squares regression modelling and Tukey's HSD post hoc tests. No association was found between the -rs8065080 genotype, sodium intake or multiple diet quality indices (assessed by food frequency questionnaire). Sodium-related markers of health including blood pressure and markers of kidney function (urinary creatinine and albumin/creatinine ratio) and general health markers, such as Body Mass Index (BMI), were also not related to -rs8065080 genotype. To date, this study is the most comprehensive investigation conducted to determine if the -rs8065080 genotype relates to sodium intake and health markers influenced by sodium intake. Although no significant relationships were found, these findings are an important contribution to the limited body of knowledge surround this SNP. In addition to further research across other ages and cultures, the -rs8065080 genotype may interact with other ion channels, and so further studies are required to determine if polymorphic variations influence sodium intake, diet and health.
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http://dx.doi.org/10.3390/nu12041056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7231396PMC
April 2020

Distribution of variants in multiple vitamin D-related loci (DHCR7/NADSYN1, GC, CYP2R1, CYP11A1, CYP24A1, VDR, RXRα and RXRγ) vary between European, East-Asian and Sub-Saharan African-ancestry populations.

Genes Nutr 2020 Mar 13;15(1). Epub 2020 Mar 13.

School of Environmental & Life Sciences, University of Newcastle, 10 Chittaway Rd, Ourimbah, NSW, 2258, Australia.

Background: The frequency of vitamin D-associated gene variants appear to reflect changes in long-term ultraviolet B radiation (UVB) environment, indicating interactions exist between the primary determinant of vitamin D status, UVB exposure and genetic disposition. Such interactions could have health implications, where UVB could modulate the impact of vitamin D genetic variants identified as disease risk factors. However, the current understanding of how vitamin D variants differ between populations from disparate UVB environments is limited, with previous work examining a small pool of variants and restricted populations only.

Methods: Genotypic data for 46 variants within multiple vitamin D-related loci (DHCR7/NADSYN1, GC, CYP2R1, CYP11A1, CYP27A1, CYP24A1, VDR, RXRα and RXRγ) was collated from 60 sample sets (2633 subjects) with European, East Asian and Sub-Saharan African origin via the NCBI 1000 Genomes Browser and ALFRED (Allele Frequency Database), with the aim to examine for patterns in the distribution of vitamin D-associated variants across these geographic areas.

Results: The frequency of all examined genetic variants differed between populations of European, East Asian and Sub-Saharan African ancestry. Changes in the distribution of variants in CYP2R1, CYP11A1, CYP24A1, RXRα and RXRγ genes between these populations are novel findings which have not been previously reported. The distribution of several variants reflected changes in the UVB environment of the population's ancestry. However, multiple variants displayed population-specific patterns in frequency that appears not to relate to UVB changes.

Conclusions: The reported population differences in vitamin D-related variants provides insight into the extent by which activity of the vitamin D system can differ between cohorts due to genetic variance, with potential consequences for future dietary recommendations and disease outcomes.
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http://dx.doi.org/10.1186/s12263-020-00663-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7071568PMC
March 2020

Environmental UVR Levels and Skin Pigmentation Gene Variants Associated with Folate and Homocysteine Levels in an Elderly Cohort.

Int J Environ Res Public Health 2020 02 28;17(5). Epub 2020 Feb 28.

School of Environmental & Life Sciences, University of Newcastle, Ourimbah, NSW 2258, Australia.

Ultraviolet radiation (UVR) is a ubiquitous exposure which may contribute to decreased folate levels. Skin pigmentation mediates the biological effect of UVR exposure, but its relationship to folate levels is unexamined. Interactions may exist between UVR and pigmentation genes in determining folate status, which may, in turn, impact homocysteine levels, a potential risk factor for multiple chronic diseases. Therefore, independent and interactive influences of environmental UVR and genetic variants related to skin pigmentation (MC1R-rs1805007, IRF4-rs12203592 and HERC2-rs12913832) on folate (red blood cell (RBC) and serum) and homocysteine levels were examined in an elderly Australian cohort (n = 599). Genotypes were assessed by RT/RFLP-PCR, and UVR exposures were assessed as the accumulated erythemal dose rate accumulated over 4 months (4M-EDR). Multivariate analysis found significant negative associations between 4M-EDR and RBC folate (p < 0.001, β = -0.19), serum folate (p = 0.045, β = -0.08) and homocysteine levels (p < 0.001, β = -0.28). Significant associations between -rs1805007 and serum folate levels ( = 0.020), and -rs12203592 and homocysteine levels ( = 0.026) occurred but did not remain significant following corrections with confounders. No interactions between 4M-EDR and pigmentation variants in predicting folate/homocysteine levels were found. UVR levels and skin pigmentation-related variants are potential determinants of folate and homocysteine status, although, associations are mixed and complex, with further studies warranted.
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http://dx.doi.org/10.3390/ijerph17051545DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7084217PMC
February 2020

Budesonide treatment for microscopic colitis: systematic review and meta-analysis.

Eur J Gastroenterol Hepatol 2019 Aug;31(8):919-927

Hull York Medical School, Hull.

Microscopic colitis (MC), encompassing lymphocytic and collagenous colitis, is a common cause for chronic nonbloody diarrhoea, which impacts significantly on the quality of life for patients. Despite increasing awareness of the condition and its treatment, there is considerable variation in therapeutic approaches. To conduct a systematic review and meta-analysis on the efficacy and safety of budesonide in the treatment of MC. We searched Medline, Embase and Central databases using predefined search methodology for randomised trials using budesonide in the treatment of MC. We extracted data, on the efficacy and safety of budesonide, from studies identified that met the feasibility for analysis criteria. These data were pooled with a fixed effects model. Nine studies met the inclusion criteria for analysis. The pooled odds ratios (ORs) for a response to budesonide therapy at induction and maintenance were 7.34 [95% confidence interval (CI): 4.08-13.19] and 8.35 (95% CI: 4.14-16.85) respectively. Histological response rates were superior in budesonide-treated patients compared to placebo following induction (OR: 11.52; 95% CI: 5.67-23.40) and maintenance treatment (OR: 5.88; 95% CI: 1.90-18.17). There was no difference in adverse events. Significant relapse rates (>50%) were observed following treatment cessation with no difference noted between the budesonide or the placebo-treated patients. Budesonide is an effective treatment option for MC for achieving induction and maintenance of both clinical and histological response. High relapse rates on treatment cessation were observed.
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http://dx.doi.org/10.1097/MEG.0000000000001456DOI Listing
August 2019

Early lifecycle UV-exposure calibrates adult vitamin D metabolism: Evidence for a developmentally originated vitamin D homeostat that may alter related adult phenotypes.

Am J Hum Biol 2019 07 11;31(4):e23272. Epub 2019 Jun 11.

School of Environmental & Life Sciences, University of Newcastle, Ourimbah, New South Wales, Australia.

Objectives: Within the Developmental Origins of Adult Disease (DOHaD) model, early life environmental exposures can confer a long-term legacy on human health. This mechanism may be adaptive or maladaptive depending on lifestyle circumstances. This article examines the role of first trimester UV-exposure on late-life vitamin D levels, and potentially related adaptive and maladaptive phenotypes (height and osteoporosis respectively).

Methods: Six hundred and forty nine subjects were examined for vitamin D and D (HPLC) and height (stadiometer). Osteoporosis was assessed with an extensive medical history questionnaire.

Results: Solar irradiance over the first 90 days postconception correlated positively with late-life vitamin D (R = .0140; P = .0082; β = .1075), but not vitamin D levels. It also correlated positively with female adult height (R = .170; P = .0103; β = .1291) and negatively with the occurrence of female osteoporosis (P = .0495). All data were adjusted for age and gender as appropriate (unadjusted data also provided). From a contemporary perspective, vitamin D levels varied significantly according to season of blood sampling as might be predicted (P = .0009).

Conclusions: Increased solar irradiance/UV exposure during the first trimester of pregnancy calibrates adult vitamin D metabolism, which is an important hormone in maintaining calcium balance. This may explain how very early lifecycle UV exposure can influence skeletal development (adult height) and modify risk for the skeletal degenerative disorder osteoporosis. The data demonstrate humans are tuned to the world (exposome) in ways we have not yet fully considered, and which are entrained at the earliest phase of the lifecycle.
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http://dx.doi.org/10.1002/ajhb.23272DOI Listing
July 2019

Relationship Between B-Vitamin Biomarkers and Dietary Intake with Apolipoprotein E є4 in Alzheimer's Disease.

J Nutr Gerontol Geriatr 2019 Apr-Jun;38(2):173-195. Epub 2019 Mar 29.

a Faculty Health , University of Canberra , Canberra, ACT , Australia.

The potential for B-vitamins to reduce plasma homocysteine (Hcy) and reduce the risk of Alzheimer's disease (AD) has been described previously. However, the role of Apolipoprotein E є4 (APOE4) in this relationship has not been adequately addressed. This case-control study explored APOE4 genotype in an Australian sample of 63 healthy individuals (female = 38; age = 76.9 ± 4.7 y) and 63 individuals with AD (female = 35, age = 77.1 ± 5.3 y). Findings revealed 55 of 126 participants expressed the APOE4 genotype with 37 of 126 having both AD and the APOE4 genotype. Analysis revealed an increased likelihood of AD when Hcy levels are >11.0 µmol/L (p = 0.012), cysteine levels were <255 µmol/L (p = 0.033) and serum folate was <22.0 nmol/L (p = 0.003; in males only). In females, dietary intake of total folate <336 µg/day (p=0.001), natural folate <270 µg/day (p = 0.011), and vitamin B2 < 1.12 mg/day (p = 0.028) was associated with an increased AD risk. These results support Hcy, Cys, and SF as useful biomarkers for AD, irrespective of APOE4 genotype and as such should be considered as part of screening and managing risk of AD.
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http://dx.doi.org/10.1080/21551197.2019.1590287DOI Listing
April 2020

Population based study: atopy and autoimmune diseases are associated with functional dyspepsia and irritable bowel syndrome, independent of psychological distress.

Aliment Pharmacol Ther 2019 03 27;49(5):546-555. Epub 2019 Jan 27.

Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.

Background: The pathogenesis of functional GI disorders (FGIDs) is uncertain. However, underlying immune activation and psychological distress has been documented in irritable bowel syndrome (IBS) and functional dyspepsia (FD). Epidemiological data from the UK suggest that FGIDs are linked to atopy and certain autoimmune diseases but this has not been confirmed.

Aim: To test if allergic or autoimmune diseases are independently associated with FGIDs, irrespective of psychological distress in a large population based study.

Methods: A total of 3542 people (mean age 57.9 years and 52.7% females) randomly selected from the Australian population, returned a mail survey (response rate = 43%). The survey asked about a physician diagnosis of autoimmune disease (scleroderma, psoriasis, rheumatoid arthritis and diabetes mellitus) or allergic conditions (asthma, food, pollen and/or animal allergy). The questionnaire assessed psychological distress and Rome III criteria for FD and IBS.

Results: Asthma, food, pollen and animal allergies, psoriasis and rheumatoid arthritis were univariately significantly associated with IBS and FD. Food allergy (OR = 1.66; 95% CI = 1.15-2.40, P = 0.007), psoriasis (OR = 1.81; 95% CI = 1.19-2.74, P = 0.006) and rheumatoid arthritis (OR = 1.68; 95% CI = 1.15-2.4, P = 0.007) were independent risk factors for IBS, controlling for age, gender and psychological distress. In FD, asthma (OR = 1.32; 95% CI = 1.04-1.68, P = 0.025) and food allergy (OR = 1.78; 95% CI = 1.28-2.49, P = 0.001) were independent predictors, controlling for age, sex and psychological distress.

Conclusions: There is evidence that both atopic and autoimmune diseases are risk factors for FGIDs, independent of psychological distress, differing in IBS and FD. This provides evidence that different peripheral pathways may be involved in the pathogenesis of certain FGIDs.
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http://dx.doi.org/10.1111/apt.15120DOI Listing
March 2019

Reply: "Comment on: The Vitamin D⁻Folate Hypothesis as an Evolutionary Model for Skin Pigmentation: An Update and Integration of Current Ideas, , , 554".

Nutrients 2018 Nov 14;10(11). Epub 2018 Nov 14.

School of Environmental & Life Sciences, University of Newcastle, Ourimbah, NSW 2258, Australia.

We thank Elias and Williams for their interest in our review [...].
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http://dx.doi.org/10.3390/nu10111759DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6265952PMC
November 2018

Interactions between Bitter Taste, Diet and Dysbiosis: Consequences for Appetite and Obesity.

Nutrients 2018 Sep 20;10(10). Epub 2018 Sep 20.

School of Medicine and Public Health, University of Newcastle, Ourimbah 2258, Australia.

The type 2 family of taste receptors (T2Rs) detect and respond to bitter tastants. These receptors are expressed throughout the gastrointestinal (GI) tract, with location dependant roles. In the oral cavity, T2Rs are involved in the conscious perception of bitter tastants, while in the lower GI tract they have roles in chemoreception and regulation of GI function. Through these diverse roles, these receptors may be involved in modulating appetite and diet, with consequences for weight regulation and obesity. Interestingly, the concentration of T2Rs in the GI tract is greatest in the large intestine, the organ with the densest colonisation of bacteria. The gut microbiome has been the subject of intense research, as a plethora of roles linking microbiota to human health continue to be uncovered. Of particular interest is the microbial signature associated with obesity. Obesity is a leading health concern, and advances in our understanding of this disease are needed. Diet is a known modifiable factor in the development of obesity. However, diet only partially explains disease risk. Changes in microbial energy harvesting by the microbiota plays a role in obesity, and the composition of these energy harvesting populations may be controlled by taste receptors. This review explores T2Rs as a potential link between obesity and the human GI microbiome.
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http://dx.doi.org/10.3390/nu10101336DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6213475PMC
September 2018

Vitamin D and folate: A reciprocal environmental association based on seasonality and genetic disposition.

Am J Hum Biol 2018 09 9;30(5):e23166. Epub 2018 Sep 9.

School of Environmental & Life Sciences, University of Newcastle, Ourimbah, New South Wales, Australia.

Objectives: The purpose of this study was (1) to elucidate any reciprocal seasonal relationship that might exist between red cell folate (RCF) and serum vitamin D Levels; (2) to explore whether folate-related gene variants that influence/alter DNA-thymidylate and methyl group biosynthesis modify any associations detected in objective 1; and (3) to consider whether these processes might influence reproductive success consistent with the "folate-vitamin D-UV hypothesis of skin pigmentation" evolutionary model.

Methods: A large (n = 649) Australian cross-sectional study population was examined. Polymerase chain reaction (PCR)/Restriction fragment length polymorphism (RFLP) analysis was used to genotype C677T-MTHFR, C1420T-SHMT, T401C-MTHFD and 2R > 3R-TS. RCF was measured by chemiluminescent immunoassay and vitamin D and D by HPLC.

Results: RCF and photosynthesized vitamin D , but not RCF and dietary vitamin D , exhibit a significant reciprocal association in spring and summer. Three folate genes (C677T-MTHFR, C1420T-SHMT, and 2R > 3R-TS) strengthen this effect in spring, and another (T401C-MTHFD) in summer. Effects are seasonal, and do not occur over the whole year.

Conclusions: Findings are consistent with what might be required for the "folate-vitamin D-UV hypothesis of skin pigmentation" model. It suggests genetic influence in provision of one-carbon units by 5,10-methylene-H folate, may be an important factor in what appears to be a clear seasonal relationship between vitamin D and folate status.
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http://dx.doi.org/10.1002/ajhb.23166DOI Listing
September 2018

Photobiology of vitamins.

Nutr Rev 2018 07;76(7):512-525

School of Environmental & Life Sciences, University of Newcastle, New South Wales, Australia.

This review explores contemporary ideas about the relationship between light exposure and vitamin biology. Nutritional biochemistry has long recognized the relationship between vitamins A and D and light exposure, but in recent years other vitamins have also been implicated in photoresponsive biological mechanisms that influence health, well-being, and even evolutionary processes. Interactions between light and vitamins can modify genotype-phenotype relationships across the life cycle, providing a basis for interesting new explanations relevant to wide aspects of human biology. This review examines both well-established and emerging ideas about vitamin photobiology in the context of the following: (1) light responsiveness of vitamin D (photosynthesized in skin), vitamin A (linked to vision), and vitamin B3 (needed to repair genomic damage); (2) vulnerability of folate and vitamins B1, B2, B12, and D to ultraviolet (UV) light (all potentially degraded); (3) protective/filtering actions of carotenoids and vitamins C and E, which act as antioxidants and/or natural sunscreens, against UV light; (4) role of folate, carotenoids, and vitamins A, B3, C, D, and E in UV-related genomic regulation, maintenance, and repair; (5) role of folate and vitamins A, B2, B12, and D in a range of light-signaling and light-transduction pathways; and (6) links between folate and vitamin D and the evolution of UV light-adaptive phenotypes.
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http://dx.doi.org/10.1093/nutrit/nuy013DOI Listing
July 2018

The Vitamin D⁻Folate Hypothesis as an Evolutionary Model for Skin Pigmentation: An Update and Integration of Current Ideas.

Nutrients 2018 Apr 30;10(5). Epub 2018 Apr 30.

School of Environmental & Life Sciences, University of Newcastle, Ourimbah, NSW 2258, Australia.

Vitamin D is unique in being generated in our skin following ultraviolet radiation (UVR) exposure. Ongoing research into vitamin D must therefore always consider the influence of UVR on vitamin D processes. The close relationship between vitamin D and UVR forms the basis of the “vitamin D⁻folate hypothesis”, a popular theory for why human skin colour has evolved as an apparent adaption to UVR environments. Vitamin D and folate have disparate sensitivities to UVR; whilst vitamin D may be synthesised following UVR exposure, folate may be degraded. The vitamin D⁻folate hypothesis proposes that skin pigmentation has evolved as a balancing mechanism, maintaining levels of these vitamins. There are several alternative theories that counter the vitamin D⁻folate hypothesis. However, there is significant overlap between these theories and the now known actions of vitamin D and folate in the skin. The focus of this review is to present an update on the vitamin D⁻folate hypothesis by integrating these current theories and discussing new evidence that supports associations between vitamin D and folate genetics, UVR, and skin pigmentation. In light of recent human migrations and seasonality in disease, the need for ongoing research into potential UVR-responsive processes within the body is also discussed.
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http://dx.doi.org/10.3390/nu10050554DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5986434PMC
April 2018

Standard setting in Australian medical schools.

BMC Med Educ 2018 Apr 23;18(1):80. Epub 2018 Apr 23.

Education Office, Sydney Medical School, The University of Sydney, Sydney, NSW, 2006, Australia.

Background: Standard setting of assessment is critical in quality assurance of medical programs. The aims of this study were to identify and compare the impact of methods used to establish the passing standard by the 13 medical schools who participated in the 2014 Australian Medical Schools Assessment Collaboration (AMSAC).

Methods: A survey was conducted to identify the standard setting procedures used by participating schools. Schools standard setting data was collated for the 49 multiple choice items used for benchmarking by AMSAC in 2014. Analyses were conducted for nine schools by their method of standard setting and key characteristics of 28 panel members from four schools.

Results: Substantial differences were identified between AMSAC schools that participated in the study, in both the standard setting methods and how particular techniques were implemented. The correlation between the item standard settings data by school ranged from - 0.116 to 0.632. A trend was identified for panel members to underestimate the difficulty level of hard items and overestimate the difficulty level of easy items for all methods. The median derived cut-score standard across schools was 55% for the 49 benchmarking questions. Although, no significant differences were found according to panel member standard setting experience or clinicians versus scientists, panel members with a high curriculum engagement generally had significantly lower expectations of borderline candidates (p = 0.044).

Conclusion: This study used a robust assessment framework to demonstrate that several standard setting techniques are used by Australian medical schools, which in some cases use different techniques for different stages of their program. The implementation of the most common method, the Modified Angoff standard setting approach was found to vary markedly. The method of standard setting used had an impact on the distribution of expected minimally competent student performance by item and overall, with the passing standard varying by up to 10%. This difference can be attributed to the method of standard setting because the ASMSAC items have been shown over time to have consistent performance levels reflecting similar cohort ability. There is a need for more consistency in the method of standard setting used by medical schools in Australia.
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http://dx.doi.org/10.1186/s12909-018-1190-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5913814PMC
April 2018

Frequency of folate-related polymorphisms varies by skin pigmentation.

Am J Hum Biol 2018 03 21;30(2). Epub 2017 Nov 21.

School of Environmental & Life Sciences, University of Newcastle, Ourimbah, NSW, Australia.

Objectives: Folate-mediated 1-carbon transfer processes are vital in human health but are susceptible to independent and interactive influences of genetic variance and environmental exposures. Evidence suggests folate levels may be impacted by genetic variance and environmental UVR, with the effect of UVR levels influenced in part by degree of skin pigmentation. Folate-related genes are also influenced by UVR levels; however, the potential relationship between key folate-related genes and skin pigmentation has not yet been explored. The purpose of this study was to examine potential associations between frequencies of key folate variants and degree of skin pigmentation.

Methods: Association between population prevalence of 17 variants in 9 folate-related genes (MTRR, MTR, MTHFR, CBS, SHMT1, MTHFD1, RFC1, BHMT, TYMS) and the Fitzpatrick skin phototype of populations was assessed via collation of genotypic data from ALFRED (Allele Frequency Database) and 1000 Genomes databases.

Results: A significant association between variant frequency and Fitzpatrick phototype was observed for 16 of 17 examined variants (P < .0029 Bonferroni corrected significance threshold in all cases).

Conclusions: These findings demonstrate novel relationships between skin color and folate-related genes, with trends suggesting folate genotypes are selected to maintain homeostasis in the folate system under differing UVR conditions.
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http://dx.doi.org/10.1002/ajhb.23079DOI Listing
March 2018

InsuTAG: A novel physiologically relevant predictor for insulin resistance and metabolic syndrome.

Sci Rep 2017 11 9;7(1):15204. Epub 2017 Nov 9.

Nutraceuticals Research Program, School of Biomedical Sciences & Pharmacy, University of Newcastle, Newcastle, NSW 2308, Australia.

The aim of this study was to investigate whether a novel physiologically relevant marker, InsuTAG (fasting insulin × fasting triglycerides) can predict insulin resistance (IR) and metabolic syndrome (MetS). Data of 618 participants from the Retirement Health and Lifestyle Study (RHLS) were evaluated for the current study. IR was defined by homeostatic model assessment (HOMA-IR) scores. Pearson correlations were used to examine the associations of InsuTAG with HOMA-IR and other markers. Predictions of IR from InsuTAG were evaluated using multiple regression models. Receiver operating characteristic curves (ROC) were constructed to measure the sensitivity and specificity of InsuTAG values and to determine the optimum cut-off point for prediction of IR. InsuTAG was positively correlated with HOMA-IR (r = 0.86; p < 0.0001). InsuTAG is a strong predictor of IR accounting for 65.0% of the variation in HOMA-IR values after adjusting for potential confounders. Areas under the ROC curve showed that InsuTAG (0.93) has higher value than other known lipid markers for predicting IR, with a sensitivity and specificity of 84.15% and 86.88%. Prevalence of MetS was significantly (p < 0.0001) higher in subjects with InsuTAG values greater than optimal cut-off value of 11.2. Thus, InsuTAG appears to be a potential feasible marker of IR and metabolic syndrome.
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http://dx.doi.org/10.1038/s41598-017-15460-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5680177PMC
November 2017

Folate and microRNA: Bidirectional interactions.

Clin Chim Acta 2017 Nov 4;474:60-66. Epub 2017 Sep 4.

School of Environmental and Life Sciences, The University of Newcastle, Australia.

Low folate status is linked to increased risk of a number of conditions, including developmental disorders, some cancers, neurodegenerative and cardiovascular diseases. Some of the mechanisms of these associations are known, but much remains to be elucidated. Aberrant microRNA (miRNA) profiles are also signatures of these conditions, and as such, the association between folate status and miRNA are now being investigated. Potential associations are bidirectional, with miRNA linked to regulation of folate-mediated pathways, and folate linked to modulation of miRNA expression. miRNA are short non-coding RNA, involved in post-transcriptional regulation of gene expression via complementary binding to mRNA. Evidence is emerging that links folate levels to the regulation of miRNA levels, and miRNA to the regulation of the expression of enzymes involved in folate mediated one carbon metabolism. One carbon metabolism is the source of methyl groups for methylation reactions, including DNA methylation and is important in DNA synthesis and repair. miRNA may be modulated by DNA methylation and other epigenetic mechanisms directly, or indirectly via modulation of upstream signalling pathways. As such, there may be bi-directional associations between folate status and miRNA profiles. miRNA may also act as biomarkers for diagnosis or prognosis of conditions associated with folate status.
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http://dx.doi.org/10.1016/j.cca.2017.09.001DOI Listing
November 2017

B vitamins and pollution, an interesting, emerging, yet incomplete picture of folate and the exposome.

Proc Natl Acad Sci U S A 2017 05 8;114(20):E3878-E3879. Epub 2017 May 8.

Molecular Nutrition Laboratory, School of Environmental & Life Sciences, University of Newcastle, Ourimbah, NSW 2258, Australia.

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http://dx.doi.org/10.1073/pnas.1704662114DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5441768PMC
May 2017

VDR gene methylation as a molecular adaption to light exposure: Historic, recent and genetic influences.

Am J Hum Biol 2017 Sep 22;29(5). Epub 2017 Apr 22.

School of Environmental & Life Sciences, University of Newcastle, PO Box 127, Brush Rd, Ourimbah, NSW, 2258, Australia.

Objectives: The vitamin D receptor (VDR) is a member of the nuclear receptor family of transcription factors. We examined whether degree of VDR gene methylation acts as a molecular adaptation to light exposure. We explored this in the context of photoperiod at conception, recent UV irradiance at 305 nm, and gene-latitude effects.

Methods: Eighty subjects were examined for VDR gene-CpG island methylation density. VDR gene variants were also examined by PCR-RFLP.

Results: Photoperiod at conception was significantly positively related to VDR methylation density, explaining 17% of the variance in methylation (r  = 0.17; P = .001). Within this model, photoperiod at conception and plasma 25(OH)D independently predicted methylation density at the VDR-CpG island. Recent UV exposure at 305 nm led to a fivefold increase in mean methylation density (P = .02). Again, UV exposure and plasma 25(OH)D independently predicted methylation density at the VDR-CpG island. In the presence of the BsmI mutant allele, methylation density was increased (P = .01), and in the presence of the TaqI or FokI mutant allele, methylation density was decreased (P = .007 and .04 respectively). Multivariate modelling suggests plasma 25(OH)D, photoperiod at conception, recent solar irradiance, and VDR genotype combine as independent predictors of methylation at the VDR-CpG island, explaining 34% of the variance in methylation (R  = 0.34, P < .0001).

Conclusions: Duration of early-life light exposure and strength of recent irradiance, along with latitudinal genetic factors, influence degree of VDR gene methylation consistent with this epigenetic phenomenon being a molecular adaptation to variation in ambient light exposure. Findings contribute to our understanding of human biology.
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http://dx.doi.org/10.1002/ajhb.23010DOI Listing
September 2017

Undiagnosed pancreatic exocrine insufficiency and chronic pancreatitis in functional GI disorder patients with diarrhea or abdominal pain.

J Gastroenterol Hepatol 2017 Nov;32(11):1813-1817

Department of Psychology, Macquarie University, Ryde, New South Wales, Australia.

Background And Aim: A previous UK study showed that 6.1% of patients with diarrhea-predominant irritable bowel syndrome (IBS-D) had evidence of severe pancreatic exocrine insufficiency (PEI), but these findings need replication. We aimed to identify the prevalence of PEI based on fecal elastase stool testing in consecutive outpatients presenting with chronic unexplained abdominal pain and/or diarrhea and/or IBS-D.

Methods: Patients aged over 40 years presenting to hospital outpatient clinics from six sites within Australia with unexplained abdominal pain and/or diarrhea for at least 3 months and/or IBS-D were studied. Patients completed validated questionnaires and donated a stool sample in which elastase concentration was measured by ELISA. A concentration of < 100 mcg/g stool represented severe and < 200 mcg/g mild to moderate PEI. Patients whose fecal elastase was < 200 mcg/g underwent testing for pancreatic pathology with an endoscopic ultrasound or abdominal CT.

Results: Two hundred eighteen patients (mean age of 60 years, 29.4% male) were studied. PEI was found in 4.6% (95% CI 2.2-8.3%) (n = 10), with five patients (2.3% (95% CI 0.8-5.3%) having severe PEI. Only male sex and heavy alcohol use were significantly associated with abnormal versus normal pancreatic functioning. Of seven patients who underwent endoscopic ultrasound or CT, two had features indicative of chronic pancreatitis.

Conclusion: One in 50 patients with IBS-D or otherwise unexplained abdominal pain or diarrhea have an abnormal fecal elastase, but unexpected pancreatic insufficiency was detected in only a minority of these. This study failed to confirm the high prevalence of PEI among patients with unexplained GI symptoms previously reported.
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http://dx.doi.org/10.1111/jgh.13791DOI Listing
November 2017
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