SACM - United Kingdom
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Item Unknown Bariatric Surgery and Its Impact on Taste Perception and Preference: A Systematic Review(University of Nottingham, 2024-09-02) Alsaud, Alhanoof; Eldeghaidy, SallyBackground: Changes in taste perception and food preferences could play a significant role in driving dietary modifications and facilitating weight loss following bariatric surgery. These sensory alterations may influence the types of food patients are inclined to consume post-surgery, potentially leading to healthier eating patterns that support sustained weight reduction. Objective: to assess variations in taste thresholds, in the intensity and quality of taste sensations and in changes to food preferences following bariatric surgery. Methodology: A systematic review was conducted using databases such as PubMed, Scopus, and Web of Science to identify studies examining changes in taste perception and preferences following bariatric surgery. Inclusion criteria were set to include studies with pre- and post-surgery taste perception and preference measurements. Data were extracted and synthesised to highlight changes assess variations in taste perception and food preferences. Result: The review included 12 studies, found that bariatric surgery lead to significant taste changes in taste thresholds, intensity and quality. Alterations in taste thresholds, including increased or decreased sensitivity for sweetness, bitterness, and saltiness, and the hedonic value of food that reduce enjoyment of high-calorie and high-fat food were commonly reported. Changes in food preference often shifted toward healthier choices, with reduced cravings for sweet and fat and increased intake of fruits and vegetables. However, these changes were not always sustained over time. Potential mechanisms also mentioned which involve hormonal changes, neurobiological adaptations in brain reward system, and inflammatory responses. Conclusion: Current evidence indicates that bariatric procedures lead to significant changes in taste perception and food preference, which may play a critical role in supporting the long-term maintenance of weight loss after bariatric surgery. Future research should include extended follow-up and investigate the mechanism behind this change to better understand the long-term effect of taste alteration and dietary changes.14 0Item Unknown The Impact of Zinc Levels on Taste Change and Hair Loss Following Bariatric Surgery and Reporting of Dietary Compliance to Weight Loss Interventions(The University of Nottingham, 2024-06-17) Mozaffar, Boshra; Idris, IskandarCurrently, there is significant interest in the effective treatment of obesity, particularly the implementation of a very low-calorie diet (VLCD) and the use of bariatric surgery (BS) which is a well-established long-term treatment. However, much of the contemporary research has noted that patients who have undergone bariatric surgery have reported unexplained side effects, such as a change in their sense of taste which may impact dietary compliance post- surgery. Additionally, there is limited research concerning long-term compliance with a very low-calorie diet which is a crucial aspect of pre-and post-bariatric surgery eating requirement. This thesis is divided into two sections: the first section investigates the links between taste change and zinc following BS, and the second section examines patients’ compliance with a VLCD. The over-arching theme of the thesis focuses on the speculative association of taste and hair loss following bariatric surgery with decreased circulating zinc levels, which might affect compliance to post-surgery eating requirements and the reporting of compliance to significant calorie restriction. In the initial part of the first section, a systematic review was conducted to collect evidence regarding the role of zinc in the development of taste disorders among patients who had undergone bariatric surgery and those who had not. This study used PRISMA guidelines to conduct systematic reviews of several electronic bibliographical databases, including EMBASE, PubMed, AMED, and MEDLINE, for studies concerning the effects of BS on taste, the effects of BS on zinc levels, and the effect of zinc replacement on taste. The results from this systematic review demonstrated that, according to the findings of qualitative research (conducted via questionnaires), taste change was observed in the majority of patients within a year following bariatric surgery. However, experimental investigations did not yield statistically significant evidence of taste alteration. A total of twelve investigations were conducted to examine the occurrence of zinc deficiency following bariatric surgery (BS), VI which revealed a notable reduction in zinc levels that persisted for six months post-surgery. The administration of zinc sulphate was found to be efficacious in enhancing taste perception in patients, apart from those with a cancer diagnosis who did not exhibit any improvement in taste following the dispensation of zinc supplements. Given that zinc deficiency and taste disorders occur in repeated cases at approximately the same time, this study hypothesises the existence of a potential relationship between these two factors. Therefore, the subsequent section of this work examines the connection between zinc and taste change following sleeve gastrectomy (SG) and gastric bypass (GB) via a single- centre, prospective cohort study conducted at King Abdullah Medical City (KAMC) in Saudi Arabia (Makkah). Forty-three patients were selected, consisting of eighteen gastric bypass patients and twenty-five patients who had undergone sleeve gastrectomy (SG). The duration of the follow-up period spanned a length of six months. The assessment of taste alteration was conducted via the utilisation of a validated questionnaire and implementation of the taste strips technique. Additionally, the study involved the measurement of serum zinc levels and salivary flow rate for all of the participants. Following the administration of the questionnaire, the results of this study demonstrate that patients who had undergone gastric bypass (GB) surgery exhibited a higher prevalence of hypogeusia (at the three-month mark) when compared with those who underwent sleeve gastrectomy (SG), with percentages of 72.0% and 36.0% respectively (p=0.03). However, no significant difference in hypogeusia prevalence was discovered between the two groups at the six-month mark, with percentages of 56.0% for GB and 45.0% for SG patients (p=0.74). However, when taste strips were utilised, there was no notable disparity in the occurrence of hypogeusia between patients with GB and SG at the three-month point (44.4% versus 36.0%,p=0.75). Nevertheless, at six months, a higher proportion of patients with GB reported experiencing hypogeusia compared to SG patients (44.0% vs. 11.0%, p=0.052). The study observed a significant decrease in zinc levels among GB patients, from the initial measurement of 85.6±16.9μgm /dl to the six-month measurement of 67.5±9.2μgm/dl. Conversely, SG patients reported an increase in zinc levels from the baseline measurement of 76.9±11.4 to the six-month measurement of 84.9±21.7μgm/dl. A decrease in the salivary flow rate was noted in 66.0% and 72.0% of individuals with GB and SG, respectively, after 3 months, and in 47.0% and 70.0%, respectively, after 6 months. Hair loss was noted as an additional side-effect following BS; however, the underlying causes and factors of this condition remain unidentified. Therefore, a subsequent section investigates the potential association between hair loss and decreased circulating zinc levels following BS and the differences between SG and GB patients. The findings of the study revealed that the prevalence of hair loss among patients who underwent GB was double that of SG. Specifically, at three months post-surgery, the percentage of hair loss was 66.6% in the GB group and 32% in the SG group, indicating a significant difference between the two groups (P = 0.025). Furthermore, at six months post-surgery, the percentage of hair loss increased to 75% among GB patients, while it decreased to 20% among SG patients. The findings also indicated a statistically significant difference between the groups, with a p-value of 0.001. This research established that individuals who had undergone bariatric surgery and experienced subsequent hair loss displayed reduced zinc levels compared to the established reference value and that, in this patient population, females were more susceptible to hair loss than males. These findings suggest that hair loss is a frequently observed adverse outcome that can occur following both types of surgeries; however, it has been shown that GB patients are inclined to VIII experience a higher degree of hair loss, which has been linked to lower levels of zinc in their blood. In the final part of this section, a study assessed the effective zinc doses for taste disorder treatment to inform future clinical guidelines and studies regarding the use of zinc as a remedy for taste disorders following BS. A systematic review and meta-analysis were conducted regarding the effectiveness of zinc supplementation in taste disorder treatment following the guidelines outlined in the PRISMA Statement. A comprehensive search of four electronic bibliographic databases (Ovid MEDLINE, Ovid Embase, Ovid AMAD, and PubMed) was conducted. This review has been duly recorded with PROSPERO and assigned the unique identification number CRD42021228461. The results demonstrate that zinc supplementation, when administered at high dosages ranging from 68 to 86.7 mg/d for a duration of up to six months, is an efficacious intervention for taste abnormalities in individuals with zinc deficiency, idiopathic taste disorders, and those with taste disorders resulting from chronic renal failure. The second section of this thesis concerns a clinical study involving thirty-five, healthy, middle-aged male volunteers and is designed to investigate and document the consumption of an extra calorie allowance derived from conventional foods or only from vegetables and nuts (up to 200kcal/day). Additionally, this study employed two distinct evaluation methodologies to analyse the macronutrient composition of these dietary additions to evaluate VLCD compliance for up to six weeks. The results revealed that patients following a very low-calorie diet (VLCD) who are provided with an additional food allowance from traditional sources or have their food intake confined to vegetables and nuts, frequently consume more calories than the prescribed daily limit. How compliance is reported exhibits substantial variation depending on the method of monitoring employed. The data presented in the conclusion of this thesis suggest that: firstly, decreased circulating zinc level following bariatric surgery is directly correlated to taste change, low salivary flow and hair loss, and that high doses of zinc supplementation are an effective remedy for taste change; and, secondly, patients fail to strictly adhere to VLCD. Additionally, the data presented by this thesis suggests that future research concerning the effectiveness of zinc supplementation in taste disorder treatment (following bariatric surgery), and additional studies concerning long-term compliance with a very low-calorie diet, are required.39 0Item Unknown Childhood Obesity and Weight Stigma: A Public Health Nutrition Approach(University of Glasgow, 2024-04-20) Abuznada, Salma; Combet, Emilie; Garcia, AdaPoor understanding of obesity, its causes and consequences contribute to weight-related stigma in the UK. Children’s understanding of obesity shapes their views and perceptions towards obesity as a disease, body image, and weight stigma behaviours. Exploring children’s and adolescents’ knowledge, perceptions and views of obesity, weight stigma, and nutrition is essential to establishing effective health promotion programmes that cater to young people’s needs, understanding and perspectives. Successful programmes also need continuous monitoring and evaluation, which are currently lacking in the UK. Perceptions and views around obesity among the public vary in different cultures and among healthcare professionals. These different perspectives lead to debates on defining, managing and treating obesity. Weight stigma research in adults tends to focus on weight stigma due to the poor understanding of obesity both among the public (especially women of white ethnicity) and healthcare professionals rather than children and adolescents. This thesis uses systematic reviews and a mixed-methods approach to explore weight stigma across the age spectrum, including children, adolescents and adults. Furthermore, the research investigates children’s and adolescents’ views on obesity and nutrition knowledge. Study 1 systematically reviewed existing observational, quantitative and qualitative studies focusing on the sources, frequency and implications of weight stigma on children’s and adolescents’ mental health, well-being and eating behaviours. The Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) were followed for study selection, screening and data extraction. Synthesis Without Meta-Analysis (SWiM) guidelines were applied to report the synthesis and results. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies from the National Heart, Lung, and Blood Institute (NHLBI) was used to assess the quality of the included studies. Twenty observational studies were included in the final text analysis. Synthesised evidence highlighted that bullying and victimisation play a fundamental role in developing and perpetuating weight-related stigma. Weight-related bullying was correlated with participants’ low self-esteem. Most of the included studies (N=15/20) were of fair quality (average score 5 to 8), although two were of poor quality (average score 0 to 4), and most of the quality criteria were not met. One of the main gaps identified during the literature search in Study 1 was children and adolescents were poorly represented in the studies, with an overemphasis on white adult women. After identifying existing gaps in the literature (e.g., the overemphasis on recruiting white women), Studies 2, 3 and 4 were developed to explore underrepresented groups and gain a deeper understanding of their views and opinions of obesity and weight stigma. Children’s and adolescents’ views and opinions of obesity and nutrition knowledge were explored in Study 2, using a cross-sectional questionnaire and phone interviews. The questionnaire was structured in six sections, exploring sociodemographic characteristics, anthropometric measurements, views and perceptions of obesity, nutrition knowledge, general health, and eating habits and lifestyle. Online interviews followed a narrative focusing on obesity knowledge and experience, obesity perception and the relationship between nutrition and obesity. Study 2 recruited a total of n=317 participants, 54% boys, 72% White/British, with a median age of 16 years (interquartile range (IQR) 15- 18). There was an overall lack of understanding of obesity and its causes and consequences. There was also a lack of consensus and agreement about whether obesity is a sign of disease, a disease, or merely a body shape. There was agreement that obesity can be a personal responsibility (median=4: likely, IQR 3: neutral – 4: likely). Food knowledge was low, with 83% correctly answering three questions or fewer out of six. Although participants reported and believed that they knew what obesity was, most participants linked obesity to body image and placed the responsibility of having obesity on the individuals or their parents. This can lead to increased stigmatising behaviours and isolation of children and adolescents with obesity. Proper education about obesity is imperative to help support children in understanding the general concepts behind obesity’s complexity as a disease. Study 3 used a cross-sectional questionnaire and phone interviews to explore weight stigma and its implications on weight stigma attitudes and body image perceptions in children. In Study 3 (n=667, 62% boys, 70% White/British, median age 16 years (IQR 15-18)), 50% of participants who experienced weight stigma had a BMI ≥30 kg/m². Almost two-thirds of participants who experienced weight stigma (n=259) said it happened at local community places (e.g., clubs, during extracurricular activities) (n=149, 58%). Over a quarter (n=67,26%) reported that it was extremely harsh. Participants who self-reported having obesity (n=214) experienced more weight stigma (n=114, 53%) than those who believed they have overweight (n=87, 41%) or underweight (n=13, 6%). More than half of the sample (n=408, 61%) were dissatisfied with their body image. Most participants who self-reported having obesity were dissatisfied with their body image, demonstrating a significant relationship between self-reported weight problems ‘underweight, overweight, obesity’ and body image satisfaction levels ‘dissatisfied, neutral and satisfied’". In summary, unsurprisingly, most participants who reported weight stigma had a BMI ≥30 kg/m2. Interestingly, more boys than girls who reported experiencing weight stigma believed there was weight stigma in society. To better understand the contribution and impact of childhood lived experiences of weight stigma on adult perceptions and beliefs around overweight and obesity, Study 4 employed similar methods to Study 3. In Study 4 (n=738, 52% men, 76% White/British, 39% BMI ≥30 kg/m2, median age=26 years (IQR=24-31)), less than a quarter of participants had experienced weight stigma as children (n=154, 21%). More women (n=108/154, 70%) experienced weight stigma during childhood than men (n=46/154, 30%, p≤0.001). Participants were mostly undecided about whether obesity is a disease (median=3: undecided, IQR=1: strongly disagree – 3: undecided). Experiencing weight stigma in childhood was positively associated with parents reporting their children’s weight stigma experiences. Parents dissatisfied with their body image (n=62) were more likely to be dissatisfied with their children’s body image (n=23/62, 37%) than satisfied (n=17/62, 24%). Understanding and awareness of obesity are essential in developing public health strategies and health education programmes that are child-oriented and specific to children and adolescents regarding location and intervention tools. The findings in this thesis highlight the negative impact of weight stigma on children and adolescents' physical and mental health. Moreover, a poor understanding of obesity was evident in this research. The work of this research is beneficial in informing programs explicitly targeting the gaps explored and found. This thesis attempts to improve the knowledge of public and academic domains in elements surrounding perceptions, views, and attitudes regarding obesity and weight stigma, the reasonings behind perceptions, and strategies to address obesity stigmatising behaviour.18 0Item Unknown The role of matrix metalloproteinase 28 and gut microbiome in the regulation of obesity and metabolic disorders(Saudi Digital Library, 2023-11) Alzahrani, Ahmad Mohammad; Pender, SylviaMatrix metalloproteinase 28 is a member of the matrix metalloproteinases family. In preliminary studies, the absence of it was found to relate to obesity. Obesity increases the risk of many health issues, including type 2 diabetes, both considered challenges to the global economy. In this study, we hypothesise that Mmp28 knock-out (KO) mice have altered metabolism influenced by the gut microbiome, and changing the living conditions will mitigate these effects. We aim to investigate whether the deletion of the Mmp28 gene is a crucial factor through which environmental management can affect the composition of gut microbiota, resulting in improved metabolism. Mmp28-KO and wild-type C57BL/6J mice were on a standard chow diet in specific pathogen-free (SPF) conditions and transferred to the conventional mouse room (CMR) for five weeks. Mice were fasted overnight and sacrificed at 30 weeks old. The livers were used for histology, and metabolic indicators were analysed using RT-qPCR and biochemical assays, while the faecal samples were used for microbiome analysis using 16s rRNA sequencing. When housed in SPF, Mmp28-KO mice had dyslipidaemia and fatty livers in addition to increased body weights and insulin resistance. They also had lower levels of the carbohydrate-digesting bacterium Bifidobacterium and higher levels of the Firmicutes phylum and its genus, Lachnospiraceae. The five weeks transfer to CMR caused weight loss, improved insulin resistance and reduced fatty liver in the mice. There was a rise in the abundance of Oscilibacter and a decline in the quantity of Firmicutes following decreased circulating butyrate. These results suggest Mmp28 is vital in regulating body weight and metabolism via alterations to the gut microbiome. They also show a change of sanitation conditions for five weeks can rebalance the gut microbiome and reshape body metabolism and obesity in genetically susceptible individuals. There are lessons to learn and study in humans.11 0Item Unknown Ectopic Lipids and hepatokines: interaction between movement behaviours and cardiometabolic health(Saudi Digital Library, 2023-11-17) Malaikah, Sundus; King, James; Stensel, DavidEctopic fat and insulin resistance are pathophysiological determinants of obesity-related metabolic disease. High liver fat is particularly detrimental for cardiometabolic risk, with hepatic lipid composition (saturated, unsaturated, polyunsaturated) potentially mediating risk severity. The studies in this thesis examined associations between movement behaviours and cardiorespiratory fitness (CRF) with ectopic fat and adipose tissue insulin resistance. In men with non-alcoholic fatty liver disease (NAFLD), associations between glycaemic control and hepatic lipid composition were also examined, as well as the effect of exercise training on hepatic lipid composition. Study 1 (Chapter 3) shows that, in community volunteers, device-based measured sedentary time is independently (positively) associated with adipose tissue insulin resistance (Adipo-IR) and visceral fat (V A T). Additionally, CRF was independently (inversely) associated with V A T and subcutaneous abdominal adipose tissue (ScAT). In the same population, Study 2 (Chapter 4) demonstrated that CRF was independently (inversely) associated with circulating concentrations of the hepatokines leukocyte cell- derived chemotaxin 2 (LECT2) and fibroblast growth factor 21 (FGF21). Study 3 (Chapter 5) showed that in men with NAFLD, hepatic lipid saturation is higher in those with impaired versus healthy glycaemic regulation. Circulating cytokeratin-18 (M65) concentration, a marker of liver injury, were also higher in men with IGR and correlated positively with hepatic lipid saturation. Finally, the randomised controlled trial in Study 4 (Chapter 6) demonstrated that 6-weeks of aerobic exercise training does not influence hepatic lipid composition (saturation, unsaturation, polyunsaturation) in men with NAFLD and impaired glycaemic regulation. Collectively, the studies in this thesis demonstrate that higher levels of sedentary time are associated with ectopic lipid accumulation and adipose tissue dysfunction. Conversely, higher levels of CRF are linked to favourable adiposity and circulating hepatokine profiles. Finally, poorer glycaemic control is associated with greater hepatic lipid saturation in men with NAFLD, but 6-weeks of exercise training does not alter hepatic lipid composition.16 0Item Unknown Socioeconomic inequalities in cardiovascular diseases risk factors: Analysis of the Health Survey of England(Saudi Digital Library, 2023-11-01) Abideen, Raseel; Douiri, AbdelIntroduction: Cardiovascular diseases present a significant global health challenge, contributing substantially to morbidity and mortality. This complex issue arises from a confluence of genetic, lifestyle, and environmental factors. Despite medical advancements, socioeconomic determinants persist as formidable barriers to achieving equitable health outcomes. Addressing these inequalities is pivotal in mitigating the impact of cardiovascular diseases on public health. Aim: The primary aim of this research is to investigate the association between socioeconomic factors and the prevalence of three cardiovascular risk factors: hypertension, obesity, and smoking. By delving into the Health Survey of England dataset for 2019, this study seeks to unravel the complex web of associations that link demographic and socioeconomic strata with the prevalence of these risk factors. Methodology: This research adopts a cross-sectional design, leveraging the comprehensive Health Survey of England dataset. Analyzing a range of demographic and socioeconomic variables, the study employs rigorous statistical methods, including chi-square tests, logistic regression, and descriptive analysis. This approach offers a comprehensive examination of the relationships between socioeconomic factors and cardiovascular risk profiles. Results: The study offers nuanced insights into the interplay of age and hypertension, revealing a significant surge in prevalence and odds beyond the age of 45. Distinct ethnic disparities in hypertension prevalence highlights higher rates among Black individuals, signifying their increased susceptibility. Socioeconomic status emerges as an important factor, with lower income groups displaying elevated odds of hypertension. Exploring obesity patterns uncovers the influence of gender and culture, with males at higher risk and Asian ethnic groups displaying lower odds. Socioeconomic status is again noteworthy, as higher standing correlates with decreased obesity risk. Smoking behaviors exhibit age-related variation, with young adults aged 25-34 displaying the highest prevalence and likelihood of being current smokers. Ethnic disparities in smoking behaviors underscore cultural influences, while income and deprivation complexities link with smoking behaviors. Conclusion: This dissertation underscores the interconnected nature of age, gender, ethnicity and socioeconomic status in shaping cardiovascular risk profiles. Recommendations include targeted interventions for hypertension among older adults and ethnic minority populations, culturally sensitive obesity interventions, and comprehensive antismoking initiatives. Findings emphasize the significance of addressing health disparities and fostering equitable health outcomes in the pursuit of a healthier future for all.18 0Item Restricted IRREGULARITY OF MEAL PATTERN AND METABOLIC HEALTH(Saudi Digital Library, 2023-05-23) Ali, Midad; Taylor, MoiraThe potential for an irregular, or chaotic, eating pattern which exhibits day to day variation has increased recently. Irregular eating may increase the risk of obesity and associated health consequences by possibly causing chrono-disruption because of the fluctuations in the timing of food intake disrupting entrainment of circadian patterns. This thesis 1. undertook a systematic review to identify the literature relating to meal pattern irregularity and obesity and associated negative health consequences, 2. developed a new methodology for characterising meal pattern irregularity and explored association with obesity and health outcomes (Study 1), 3. determined the potential impact of meal pattern irregularity on nitrogen balance (Study 2) and 4. investigated the feasibility of providing a hypo-energetic diet to participants with normal/overweight to explore day-to-day variation of energy expenditure, TEF, fasting blood glucose, fasting lipid profiles, fasting gut hormones, interstitial glucose concentrations and subjective appetite (Study 3). Methods 1. A systematic search was undertaken using relevant databases for studies with adults and children in which between day variability in meal pattern was measured, and related to body weight, metabolic syndrome components and cognitive function. 2. Two methods for characterising meal pattern variability were proposed using NDNS data in study. The first method used a variety of different meal pattern properties to describe the degree of irregularity in meal patterns. The second method involved the derivation of two indices relating to the energy consumption and time of eating, each with two threshold systems. 3. Using cross-over design, a randomized controlled trial with two 7-day intervention periods, separated by a wash- out period of three weeks was conducted on 14 healthy female participants to investigate the effect of irregular meal pattern on nitrogen balance 4. Study 3 had a randomised, parallel design with 7 days (pre-standardisation period) during which participants consumed their estimated energy requirement. Participants then adopted one of two meal patterns for the 14-day intervention period when they consumed a hypoenergetic diet, followed by a further 3 days (post-standarisation period) consuming their estimated energy requirement. 1 Results 1. The systematic review showed that many different methods in the literature for characterizing between day variability in meal pattern tended not to utilise all the potential properties of the meal pattern. Moreover, between day variability in meal pattern was associated with obesity and health outcomes including higher weight, reduced thermogenic response to meals and poorer academic achievement. 2. The two novel methods for characterising meal pattern irregularity in Study 1 suggested that day-to-day variation appears to be associated with obesity, dyslipidemia and hyperglycemia. However, the nature of the association in Method 2 was not consistent between the two indices as the Irregular time index showed the opposite relation to BMI, HDL cholesterol and HbA1c. Although the effect size in each model of the linear regression were small between 0.6% and 15%, the associations were statically significant. 3. The findings from Study 2 have indicated that the effect of meal pattern irregularity on nitrogen balance over 7-day period is not significant (P=0.091). 4. Study 3 has demonstrated that the protocol to test the hypo-energetic diet based on regular or irregular meal pattern on energy expenditure, metabolism and circadian rhythm is feasible and required some amendments. Conclusion Following a regular meal pattern might be a potential additional goal for body weight management as it seems to improve energy expenditure and insulin sensitivity which may indicate a favourable effect on insulin resistance and the risk of cardiovascular diseases. However further randomised controlled studies are required to confirm these results and elucidate the magnitude of the effect, hence potential clinical significance.25 0