into research
by Dr Amelia A Lake, Senior Lecturer in Food & Nutrition, Applied Biosciences, School of Applied Sciences
Dr Amelia A Lake trained as a dietitian and worked in the NHS before taking up a research post with Newcastle University where she completed a PhD and held a National Institute for Health Research Postdoctoral Fellowship on the theme of Obesogenic Environments.
It’s not simply what you eat, but when...
Attending the Nutrition Society summer meeting is an opportunity for learning, but importantly catching up with friends, colleagues and forming new networks. It’s as much about what happens outside the sessions, in the breakfast queue, ceilidh and conference dinner as what is going on in the plenary sessions!
It was after said ceilidh that I managed to make it to the
breakfast session. Aside from feeling an overwhelming sense of achievement at managing to make it up so early, I found the presentation by Prof John M de Castro from Sam Houston State University in Texas early morning food for thought, so much so that I had to have a second breakfast and mull the topic over with colleagues. Prof de Castro’s presentation focused on the influences of time of day on food intake. Exploring the satiating influence of the time of day and types of macro nutrients consumed by free living individuals, his presentation was both insightful and engaging. His finding suggested that there is much truth in the saying: ‘breakfast like a king, lunch like a prince and dine like a pauper’. His research concluded that morning food intake is particularly satiating and is associated with a reduced total intake throughout the day, however the opposite is true for the night intake. I will be reading Prof de Castro’s findings in his original articles with interest. My second breakfast, there- fore, was justified, although my food choice, which was fried potato bread and fried egg, was not at all in line with de Castro’s recommendations. When I was an undergraduate dietetic student, I won the British Dietetic Association’s Elizabeth Washington Award to explore nutritional transitions in W Sumatera, Indonesia for my honours project. Back then, in my first ever piece of research, the main academic whose work I referenced on the topic of nutritional transitions, was Prof Barry Popkin. The Rank Prize lecture was given by Prof Popkin on ‘Contemporary nutri- tional transition: determinants of diet and its impact on body composition.’ Once again a thought-provoking lecture which inspired me to note down further research questions about eating occasions, the type of beverages consumed and food pricing. An oral presentation which caught my interest was that
from a group at Oxford Brookes University exploring higher chewing rates and reduced food intake (2). Perhaps, un- surprisingly, there is a lack of literature around chewing rate and overall food intake. While Victorian doctrines suggested chewing 50-100 times per mouthful, more recent research suggests that slower eating results in reduced energy intake (1). So, bearing that in mind, how many times did you chew your last mouthful? If you are just about to go and have something to eat, like the audience at the Nutrition Society summer meeting did when this was presented, I hope you remember to count the number of times you chew.
References 1 Andrade AM, Greene GW & Melanson KJ (2008) Eating slowly led to decreases in en- ergy intake within meals in healthy women. J Am Diet Assoc 108, 1186-1191 2 Smit HJ, Kemsley EK, Tapp HS & Henry CJK (2010) Higher chewing rates reduce food intake – a pilot study building towards a clear public health message. Nutrition Society Summer meeting OC110.
NHDmag.com Aug/Sept '10 - issue 57
coeliac watch
60 percent of people with coeliac disease have been previously misdiagnosed with IBS
Coeliac UK, the national charity for people with coeliac disease, surveyed over 1,600 members and found that nearly 60 percent of them had previously been incorrectly diagnosed with irritable bowel syn- drome (IBS), instead of being tested and diagnosed with coeliac disease.
One in 100 people in the UK have coeliac disease, an autoimmune disease caused by intolerance to gluten. There is no cure and no medication for the condition and the only treatment is a strict lifelong gluten-free diet. Left untreated, it can lead to osteoporosis, infertility and bowel cancer. The survey also highlighted that nearly 60 percent of people had also been diagnosed with anaemia without testing for the cause. Other conditions that had been diag- nosed by doctors included: anxiety and depression; ‘holiday tummy’; gastroenteritis, gallstones; duodenal ulcer; ME or chronic fatigue syndrome; appendicitis and even hypo- chondria.
Coeliac UK launched the survey in 2009 at the same time that the National Institute of Health and Clinical Excellence (NICE) issued a guideline on coeliac disease in order to pro- vide a benchmark on the then current situation surrounding diagnosis.
The NICE guideline on the recognition and diagnosis of coeliac disease identified specific symptoms and associ- ated conditions such as Type 1 diabetes, which are linked to coeliac disease. As a result, more people should be tested for the condition, driving up diagnosis rates. See
www.nice.
org.uk/CG86 for full details of the guidelines. Sarah Sleet, Chief Executive of Coeliac UK said, “It is too early to tell if the NICE guidelines are improving diagnosis rates, but as a charity we are receiving around 1,000 new member requests a month from people who have just been diagnosed. But with around 500,000 people currently undi- agnosed in the UK, there is still a long way to go. “The NICE guideline is an important first step, but we need a sea change in practice among GPs. In order to prevent years of misery for patients and needless waste of hard pressed NHS resources, we need a target for diagnosis of the disease in the Quality and Outcomes Framework (QOF) of the GP contract which has been recognised as an impor- tant lever in changing GP practice."
The survey also asked how long they had visited the GP with symptoms related to coeliac disease before they were diagnosed. 23 percent had visited for 11 years or more and a further 11 percent of patients having symptoms and visit- ing their doctor for over 20 years before finally being diag- nosed. Nearly a third (32 percent) of respondents said that they thought GP knowledge about coeliac disease was poor or very poor.
Although the condition is genetic and the prevalence
increases from one in 100 in the general population, to one in 10 for close family members, worryingly the survey found that 79 percent of respondents’ family members had not been offered a test for coeliac disease despite a recom- mendation to do so within the NICE guideline. For further information please call the Helpline on 0845 305 2060 or visit the website:
www.coeliac.org.uk.
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