Saudi Cultural Missions Theses & Dissertations
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Item Restricted Assessment of low-intake dehydration in hospitalised older people and the role of Bioelectrical Impedance Spectroscopy(University of Southampton, 2024-06-27) Alsanie, Saleh; Wootton, Stephen; Lim, Stephen; Ibrahim, KindaBackground: Older people are susceptible to low-intake dehydration, which is often not recognised and can result in significant morbidity through falls, constipation, delirium, respiratory and urinary tract disorders, and even death. Identifying low-intake dehydration at hospital admissions is challenging, leading to treatment delays and poor outcomes. Aims: To examine the factors underlying the identification of low-intake dehydration in older people admitted to Medicine for Older People (MOP) wards at University Hospital Southampton NHS Trust and to explore the feasibility of performing a study whereby bioelectrical impedance analysis (BIA) might be used alongside existing hydration risk screening tools in identifying low-intake dehydration in older people admitted to hospital. Methodology: A narrative review of the role of water in the body and the consequences of dehydration was carried out. This was followed by a sequential explanatory mixed-methods study involving quantitative service evaluation of recognition of dehydration in MOP wards and qualitative staff interviews to determine barriers and facilitators of hydration care and examine the factors influencing the routine assessment and diagnosis of dehydration in MOP wards. This led to a systematic review of the literature on the role of BIA in detecting low-intake dehydration. Finally, a study was conducted to examine the feasibility of conducting measurements of hydration status in hospitalised older patients using the existing hospital screening tool for dehydration and BIA measurements. Results: Most older patients admitted were at moderate to severe risk of developing dehydration. The service evaluation of hydration care provision showed good compliance with completing the initial hydration assessment. However, follow-up of patients at severe risk via 24-hour fluid balance charts needed improvement. Nursing and medical staff were aware of the importance of assessing hydration status but faced challenges in the diagnosis and management of dehydration. The proposed design for a study exploring the concurrent validity of the current screening tools and bedside measurements of BIA, its implementation and conduct was shown to be both feasible and acceptable to patients and staff and generated high-quality impedance measurements at the bedside alongside routine clinical care. Clinical demographics and directly measured impedance values of resistance, reactance, phase angle and impedance ratio were obtained in 25 patients reflected both age and hydration state but did not significantly correlate with risk categorisation of dehydration based on the established screening tools. Conclusion: Identifying older people admitted to hospitals who are at risk of or have low-intake dehydration requires continued vigilance, adherence to screening and assessment, and continued oversight within ordered systems and processes. Continued service improvement and staff training are needed, together with objective measures of hydration status, such as bioelectrical impedance, which may be used to improve clinical decision-making and care. Further studies are required to determine the reliability and validity of BIA in detecting low-intake dehydration compared with pre-existing objective measures such as serum osmolality, as well as its cost-effectiveness and evaluability in clinical practice.34 0Item Restricted Enhancing iron bioavailability from cereals as a strategy to reduce iron deficiency: in vitro digestion studies and a randomised control trial in UK females(Saudi Digital Library, 2023-12-24) Arafsha, Sarah Mohammed; Sharp, PaulBackground and hypothesis: Iron deficiency (ID) is the most common nutritional deficiency worldwide, and progress towards prevention of this disorder is slow. Plant foods are important sources of minerals in the United Kingdom. For example, 50% of iron is provided by cereals and a further 15% by vegetables. However, physical encapsulation within plant cells and the presence of absorption inhibitors such as phytic acid limit the availability of iron from plants for absorption in the human small intestine. The overall hypothesis for this project is physical disruption of wheat flour cell walls will increase the release of iron (i.e. the bioaccessibility) from foods during digestion and thereby enhance the bioavailability of iron from wheat-based foods. If successful, this change in milling of flour may provide a strategy to reduce the incidence of ID. Materials and methods: Studies were carried out using wheat flour produced by either standard milling or by micro-milling to reduce flour particle size. Mineral content of foods were determined by ICP-OES. The effects of cooking (boiling and baking), digestive enzymes, and pH on iron bioaccessibility from wheat-based foods following in vitro digestion was measured by ICP-OES. Food digests were applied to intestinal Caco-2 cells and iron bioavailability was assessed using ICP-MS. A human study was also carried out to assess the bioavailability of iron wheat breads made from standard and micronized flour. Results and conclusion: Micro-milling reduced flour particle size by 3-times. Foods made from micronized flour had higher iron bioavailability. This was particularly evident following gastric digestion when pH was low. In summary, the results suggest that micro-milling may increase iron bioaccessibility and bioavailability of iron from wheat flour. If endogenous iron in wheat-based foods was more bioavailable this might decrease the incidence of ID seen in some population groups in the UK.14 0Item Restricted Assessing metabolic profiling for personalised nutrition(Saudi Digital Library, 2023-09-27) Alqarni, Lina; Frost, GaryBackground: Non-communicable diseases (NCDs) are the main causes of mortality and morbidity, globally and in the UK. Dietary changes, such as increasing intake of fibre, fruits and vegetables and reducing intake of saturated fat, free sugar and salt, have shown positive impacts on the risk factors associated with NCDs. However, there are concerns about the effectiveness of general dietary advice, due to the ineffectiveness in motivating people to change their eating habits or differences in individual biological responses to dietary intakes. Personalised dietary advice is proposed as an effective approach when considering the differences in individual response to diet and can be a more proactive intervention when it comes to encouraging people to change their eating habits. Recent advances have been made in the development of a new methodology that uses metabolic profiling and multivariate mathematical modelling to provide objective, accurate information about an individual's dietary patterns based on urine composition, which can be used to design personalised nutritional interventions. The aim of the thesis is to assess the feasibility of translating the metabolic profiling strategy into clinic to improve the nutritional management in the prevention of NCDs, including cardiovascular disease (CVD), by objectively assessing dietary habits and monitoring the compliance to dietary recommendations in order to provide personalised nutritional advice. Methods: Data from a previous pilot study was used to investigate concordance between metabolic profiling and traditional methods on long term dietary assessment in order to assess accurate dietary intakes. In a highly controlled environment, a randomised inpatient crossover clinical trial was conducted to assess the impact of dietary interventions on urinary metabolic profiles and clinical parameters in order to build a new mathematical model, particularly for people at risk of CVD. A dietary protocol was developed to facilitate personalised dietary counselling in alignment with public and patient involvement. A randomised pilot clinical trial was conducted to assess the feasibility of providing metabolically personalised dietary advice in clinic to help people at risk of CVD to change their dietary habits within their own environment using the new mathematical model and dietary protocol. Results: Findings from the pilot study showed poor agreement between the DASH score and the urinary dietary patterns score in overall data and subgroups. There were discrepancies in the concordance between the classifications of the dietary adherence of the urinary biomarkers and their related dietary intakes. In the randomised inpatient trial, two distinct isoenergetic dietary interventions with different compliance levels to NICE dietary guidelines were designed. Significant differences in the dietary intakes between the interventions (Diet1 vs Diet2) were reflected in the urinary metabolic profiles of participants; the RM-MCCV-PLS-DA model shows clear separation in the global urinary metabolic profiles of the two dietary patterns. A robust model has been developed using the global urinary metabolic profile associated with distinct dietary patterns. A dietary protocol has been developed to facilitate personalised dietary counselling and this was in alignment with public and patient involvement (PPI). PPI has positively impacted our dietary intervention design, researchers, dietitians, and participants at risk of CVD who involved in PPI activities. Finally, the randomised pilot clinical trial shows the feasibility of using metabolic profiling in clinic to personalise dietary advice for people at risk of CVD. Conclusion: A metabolic profiling strategy is promising and feasible and can objectively provide information about dietary adherence. In addition, it can be applied in conjunction with traditional dietary assessment methods to obtain further details about individual diets. However, some considerations need to be taken when applying urinary metabolic profiles in personalise nutrition and further research is needed to enhance the application of urinary metabolic profile.8 0Item Restricted Association Between Diet Quality, Tooth Loss, and Dental Caries: Data from NHANES 2015-2018(Saudi Digital Library, 2023-04) Alghamdi, Sondos; AlDosari, Muath; Hayes, Catherine; Chamut, Steffany; Leung, CindyBackground: Optimum oral health and nutrition are essential to achieve and maintain overall and systemic health. The relationship between nutritional status and oral health has been examined in several studies. Cariogenic dietary patterns have been associated with tooth loss and dental caries. Dietary factors affect a variety of health factors, such as oral health, aside from social and psychological areas essential to maintaining the quality of life (QoL). This study aims to investigate the association between AHEI-2010, tooth loss and dental caries. Methods: Using the data from NHANES 2015-2018, we included adults 18 years and older. We measured the status of tooth loss, dental caries, and the diet quality of the individuals using AHEI-2010 and investigated the association between them while adjusting for covariates using Poisson and Logistic regression. Results: The mean AHEI-2010 score was 38.7±10.8 (out of 100). Our results showed an inverse association between the diet quality index (AHEI-2010) score and the presence of untreated coronal and root carious lesions and the loss of functional dentition. The mean ratio of teeth with untreated caries among the third quartile was 0.61 times the average number of teeth (95% CI=0.47, 0.78) and 0.49 times among individuals in the fourth quartile (95% CI=0.36, 0.66) compared to the lowest quartile group. Conclusion: This study indicates that lower diet quality measured using the AHEI- 2010 is associated with coronal and root dental caries and loss of functional dentition. Establishing a strong evidence-based foundation of the association between diet patterns and oral-systemic health can facilitate the development and promotion of sustainable, effective policies, strategies, and cost-effective interventions with the end goal of improving diet intake, oral-overall health, and food security while reducing the risk of developing malnutrition, diet-related NCDs, disability, and premature deaths.26 0