By Dr. Adrian Holliday

The “obesity epidemic” is a term with which we are all very familiar. However, the prevalence and health consequences of low weight and undernutrition are less well documented and communicated. This is of particular relevance for older adults.

Somewhat paradoxically, we are at an increased risk of both excess weight and low weight as we enter later life. Perhaps surprising to many of us, is that the latter carries the greater risk to health for older adults. In fact, what many would consider as excess weight is protective as we age. A study in the USA followed a cohort of over 4000 over 65s for an average period of 10 years¹. Using World Health Organisation definitions of healthy weight (18.5 – 24.9 km/m²), overweight (25 – 29.9 km/m², and obesity (30 km/m² and above), those in the “overweight” category had a 20% lower risk of all-cause mortality than those in the “healthy weight” category. In fact, those classified as living with obesity were 22% more likely to pass away than those deemed healthy weight. At the other end of the BMI spectrum, those with a BMI of less than 18.5 km/m² were over three-times more likely to pass away than those not classified as underweight. Given that unintentional weight-loss is experienced by 15-20% of older adults, awareness of the health detriments of low weight should be raised.

One reason for older adults having an increased risk of losing weight is a decline in appetite. We may have observed this in loved ones: parents or grandparents who have a small appetite and struggle to eat what we would consider to be a “normal” portion. This age-related reduction in appetite and food intake – termed “anorexia of ageing” – effects approximately 30% of free-living older adults and over half of those in residential care.

Low appetite can be the result of numerous changes experienced in later life. These include the loss of a loved one and loneliness, reductions in physical activity, reductions in smell and taste, and the onset of disease. Recently, our research group has shown that another possible contributing factor is a change in the way our gut senses and responds to the nutrients that we eat. We recruited younger adults and older adults, who we identified as exhibiting either a healthy appetite or low appetite². All participants ate the same porridge breakfast. Before, and for 4 hours after breakfast, we took blood samples to measure the concentration of some appetite-related hormones that are released from the gut in response to feeding. We measured the hunger hormone, ghrelin, and two satiety hormones that signal fullness: PYY and GLP-1. Compared with younger adults, older adults with low appetite had a greater suppression of the hunger hormone ghrelin, while PYY and GLP-1 concentrations increased to a greater extent and stayed elevated for longer. This was not seen in the older adults with healthy appetite, who showed a very similar hormone response to food that was seen in younger people. Consequently, the older adults with low appetite ate less at lunch.

These data suggest that some, but not all, older adults exhibit a degree of hypersensitivity to nutrients, causing an amplified hormone response to cause greater feelings of fullness and suppression of hunger.

Why this occurs in some older adults but not others is not currently known. But, continuing our research in this field, we hope to find out. We suspect that it could be a result of changes in the way the gut digests and absorbs nutrients; changes in the gut environments, such as altered gut microbiome; or changes in the behaviour of the cells which secrete hormones³.

Identifying the cause of this heightened hormone response to feeding may help us design nutritional and pharmaceutical interventions to help appetite-suppressed older adults eat well for health, wellbeing, and longevity in later life.

1. Cheng et al., 2016. Body mass index and all-cause mortality among older adults. Obesity, 24(10), 2232-2239. doi.org/10.1002/oby.21612
2. Dagbasi et al., 2024. Augmented gut hormone response to feeding in older adults exhibiting low appetite. Appetite, 201(3), 107415. doi.org/10.1016/j.appet.2024.107415
3. Dagbasi et al., 2024. The role of nutrient sensing dysregulation in anorexia of ageing: The little we know and the much we don’t. Appetite, 203(6), 107718. doi.org/10.1016/j.appet.2024.107718

Dr. Rachel Stocker

I’m Dr Rachel Stocker and I joined Newcastle University in early 2016, moving to my current lectureship in 2022. As a lecturer in exercise and health psychology, I’m particularly interested in how our thoughts, emotions, and behaviours influence our physical health. My research focuses on helping people engage in various aspects of healthy lifestyles, especially those living with chronic conditions like diabetes.

Breaking down the barriers

For people with chronic illnesses, there are often extra psychological barriers that make it hard to stay active. An example is those living with insulin-treated diabetes. Whilst we know that exercising is good for us, many people with diabetes worry about managing their blood glucose levels during exercise. Resistance training, however, carries less risk of low blood sugar (hypoglycaemia) than aerobic forms of exercise. Resistance training involves working against a force to build strength—think weightlifting, or resistance band exercises. Research shows that resistance exercise is not only safe but also beneficial for managing insulin-treated diabetes.

In fact, resistance training can help stave off sarcopenia—the age-related loss of muscle mass and strength—and frailty, a syndrome that involves decreased physical reserve and increased vulnerability to stressors, which can lead to poor health outcomes. Both conditions are common in older adults, especially in those with insulin-treated diabetes, and contribute significantly to loss of independence. The evidence suggests that regular resistance exercise can slow down the progression of sarcopenia, improving muscle strength and overall physical function. This, in turn, reduces the risk of frailty and helps maintain quality of life.

In my current research, I’m investigating the experiences of older adults with insulin-treated diabetes who are mildly frail, and exploring the psychological and practical challenges they face when engaging in resistance exercise. Using qualitative methods, I’m identifying their fears and barriers to exercising, and also, the strategies they’ve developed to stay active. This work will be important in designing tailored interventions that encourage more people to take up resistance training, ultimately improving health and reducing frailty in this population.

Other research projects

As a chartered psychologist specialising in health psychology, I really enjoy applying health psychology and behaviour science principles in different settings and disease/illnesses. Alongside my work in diabetes, I’m involved in some exciting projects that look at other health issues. One of these explores the experiences of patients using the NHS specialist Chimeric Antigen Receptor (CAR) T-cell therapy service, focusing on their psychosocial and supportive care needs and how to address them. Another project is about increasing physical activity to reduce dementia risk in ethnically minoritised communities in the North East of England, by working together to create interventions that really fit their needs.

Supporting future health researchers

Another part of my work that I’m passionate about is supervising PhD students. For example, Ayat Bashir is working on improving the diagnosis and management of diabetes secondary to chronic pancreatitis. Keaton Irvine is researching how to improve health for individuals with type 2 diabetes from historically underrepresented groups. Blossom Bell is exploring the long-term care experiences of haematopoietic stem cell recipients, and Evridiki Iliaki is studying how museum experiences can promote mindfulness and social unity in the Middle East.

Looking ahead

Ultimately, my aim is to make healthy lifestyles more accessible for everyone, particularly for those living with chronic health conditions. By understanding the psychological factors that affect exercise and dietary behaviour, we can design strategies that don’t just improve physical health but also have a positive impact on mental wellbeing and quality of life.

By Dr. Changhyun Lim

As many of you know, lifting heavier weights is the most effective method for muscle hypertrophy. I completely agree with this. However, if you’re asking whether lifting heavy weights is the only way to induce muscle growth, my answer is clearly NO.

The practice of lifting heavier weights (70-80% of your 1 rep max or maximal effort) for muscle growth originally came from the bodybuilding community. Interestingly, this approach wasn’t based on scientific research at first, but rather on the undeniable visual proof — the massive muscle mass of bodybuilders. This was so persuasive that most exercise prescription textbooks have long recommended heavy weight lifting for hypertrophy. However, this can sometimes become a barrier to initiating exercise for the first or increase the risk of injury, especially for individuals who may be physically frail, ill, ageing, or simply uncomfortable lifting heavy weights.

Thankfully, research, including my own study, has shown that lifting lighter weights (30% 1RM) can result in similar muscle growth to higher weights, as long as the sets are performed to near failure [1-3]. In other words, whether you’re lifting heavy or light weights, muscle hypertrophy can be achieved as long as you push your muscles close to fatigue (you don’t need to reach complete failure but close to it).  

So, how does this work? When you lift weights, your body recruits motor units — bundles of muscle fibres controlled by a nerve — to contract the muscle. As you continue lifting closer to fatigue, some motor units get tired, and your body has to recruit additional motor units to maintain the effort. Eventually, all available motor units (i.e., muscle fibres) are recruited [4], triggering the cellular and molecular mechanisms responsible for protein synthesis [5].

In line with this, my previous study demonstrated that lighter-weight resistance training effectively recruits type II fibres (those typically activated during higher-force contractions, such as with heavier weight lifting) [1]. This was evidenced by the increase in the cross-sectional area of both type I and II muscle fibres. Additionally, and surprisingly, lighter-weight training with higher repetitions (to reach near fatigue) showed significantly improved mitochondrial function ¾ an effect usually associated with aerobic exercise, not heavy-weight training.

This doesn’t mean there’s anything wrong with lifting heavy for muscle growth. However, it’s important to know that there are more choices available for muscle hypertrophy, such as lighter-weight training. The lighter-weight training can be safer, reduce barriers to participation, and offer similar results. Lastly, while more research is needed, lighter weight training may even provide the added bonus of improving aerobic adaptations while building muscle mass— essentially, “kill two birds with one stone.”

References

1. Lim C, Kim HJ, Morton RW, Harris R, Phillips SM, Jeong TS, et al. Resistance Exercise-induced Changes in Muscle Phenotype Are Load Dependent. Med Sci Sports Exerc. 2019;51:2578-85. doi:10.1249/MSS.0000000000002088

2. Carvalho L, Junior RM, Barreira J, Schoenfeld BJ, Orazem J, Barroso R. Muscle hypertrophy and strength gains after resistance training with different volume-matched loads: a systematic review and meta-analysis. Appl Physiol Nutr Metab. 2022;47:357-68. doi:10.1139/apnm-2021-0515

3. Schoenfeld BJ, Grgic J, Ogborn D, Krieger JW. Strength and Hypertrophy Adaptations Between Low- vs. High-Load Resistance Training: A Systematic Review and Meta-analysis. J Strength Cond Res. 2017;31:3508-23. doi:10.1519/JSC.0000000000002200

4. Morton RW, Sonne MW, Farias Zuniga A, Mohammad IYZ, Jones A, McGlory C, et al. Muscle fibre activation is unaffected by load and repetition duration when resistance exercise is performed to task failure. J Physiol. 2019;597:4601-13. doi:10.1113/JP278056

5. Lim C, Nunes EA, Currier BS, McLeod JC, Thomas ACQ, Phillips SM. An Evidence-Based Narrative Review of Mechanisms of Resistance Exercise-Induced Human Skeletal Muscle Hypertrophy. Med Sci Sports Exerc. 2022;54:1546-59. doi:10.1249/MSS.0000000000002929

By Dr. Wouter Peeters

Whether you are a weekend-warrior going out for a ride with your friends or are an elite cyclist, there is usually an element of competition in road cycling. For the weekend-warrior, this could be winning the sprint for the coffee stop or the town sign, for an elite cyclist it means putting in a final effort after having already cycled for several hours. To understand what makes you be able to beat the competition, you first need to understand the physiology behind it. Historically, determinants of endurance performance have been based on three pillars: your maximal oxygen uptake capacity (VO2max), the ability to sustain high exercise intensities without rapidly fatiguing (lactate thresholds) and how much oxygen you use for at a particular exercise intensity (exercise economy)(1). However, in the last few years sports scientists have revealed the possibility of a fourth pillar. This pillar is defined as “physiological resilience” (2). There are plenty of people that can produce extraordinarily exercise values in a fresh, non-fatigued state. However, ask the same group of people to do the same test after several hours of exercise and there will be great variability in the ability to produce the same exercise values. Those who are more physiologically resilient will see a smaller decline in their exercise values. As road cycling races are usually decided after several hours of racing, having greater resilience will help you outperform the competition (3). So, understanding this fourth pillar and how to improve on it will become an active area of research over the next few years.

In science, testing methods have to be robust, reliable and ideally ecologically valid. In exercise physiology, this means: the test in the laboratory should reflect the real-world scenario (ecological validity), where, without any experimental intervention, the outcome of the test should produce very similar results on two different occasions (test-retest reliability). In that way, when an intervention in a subsequent experiment shows a significant difference in the outcome, you can be more confident that this is due to the actual intervention and not because of variability originating from the test itself.

Most cycling experiments in the laboratory use exercise protocols where participants cycle for a fixed time at a fixed exercise intensity before completing the final effort. Although the test-retest reliability of such protocols are found to be good (4), it has limited ecological validity, since in the real world, road races constantly vary in intensity in response to tactics and changes in gradients of the road whilst the race is distance-based rather than time-based. Moreover, performance is differentially affected following a protocol of variable intensity compared to a fixed intensity (5, 6).

Combining the points raised above, we are currently testing the reliability of an exercise protocol that is accessible in a commercially-available application. In this exercise protocol, participants have to cover a distance of 128 km on three separate occasions to assess the reliability of the protocol. The virtual course contains several climbs where participants have to dig deep just as in the real world and the final 12 km is all uphill, which in the real world is often where competition of the Tour de France and the likes are decided. The overall outcomes on reliability can inform researchers whether this protocol can be used or not in subsequent investigations. If the results shows that this protocol is a reliable test, it can have an impact in the way future research in this area is conducted. For example, since the application is available from a device with Bluetooth anywhere with an internet connection, people could complete the protocol at home instead of having to come to the laboratory. Travelling to laboratories can sometimes be a barrier for people to participate in scientific experiments whilst often laboratories can only host one participant at a time. By simplifying the logistics for both the researcher and participant, these experiments could be completed at a much higher rate and thereby advancing knowledge in the area of cycling performance under fatigued conditions more rapidly.

References:

1.           Joyner MJ, Coyle EF. Endurance exercise performance: the physiology of champions. J Physiol. 2008;586(1):35-44.

2.           Jones AM. The fourth dimension: physiological resilience as an independent determinant of endurance exercise performance. J Physiol. 2023.

3.           T VANE, Sanders D, Lamberts RP. Maintaining Power Output with Accumulating Levels of Work Done Is a Key Determinant for Success in Professional Cycling. Med Sci Sports Exerc. 2021;53(9):1903-10.

4.           Sewell DA, McGregor RA. Evaluation of a cycling pre-load time trial protocol in recreationally active humans. Eur J Appl Physiol. 2008;102(5):615-21.

5.           Mateo-March M, Leo P, Muriel X, Javaloyes A, Mujika I, Barranco-Gil D, Pallarés JG, Lucia A, Valenzuela PL. Is all work the same? Performance after accumulated work of differing intensities in male professional cyclists. J Sci Med Sport. 2024.

6.           Palmer GS, Noakes TD, Hawley JA. Effects of steady-state versus stochastic exercise on subsequent cycling performance. Med Sci Sports Exerc. 1997;29(5):684-7.

Dr. Jen Bradley

The state of a nation’s dietary habits often makes the news headlines. But how do we know what people are eating and drinking? Dietary assessment is the collection of information on food and drink consumption from an individual or a group of people and the evaluation of this information to assess nutrient intake and dietary patterns. In nutritional epidemiology, dietary assessment methods are needed to obtain food intake data from a large population of individuals to investigate dietary exposure – these findings sometimes make the news.

My research is based on self-reported dietary assessment, which means the data we collect is based on people recalling or recording what they consume. Dietary assessment has changed a lot in recent years and I have observed this change. When I started working as a research assistant at HNRC (before it gained the ‘E’) in 2008, dietary assessment was an arduous task and quite cumbersome at times! Conducting dietary interviews with secondary school pupils required a car boot full of equipment; paper food diaries, food portion photos and food models. In addition, finding a suitable space for us to work in, in a busy school environment was not always easy. After weeks working in schools we would have a pile of completed paper food diaries and would spend months of project time linking the foods and drinks in the diaries to a nutrient food code (to allow us to look at nutrient intakes) and then more time entering these onto a database. Eventually we would have some dietary intake data to analyse!

Fast forward 16 years, and dietary assessment is a much more streamlined process. Intake24 is an online dietary recall system. I worked on the initial development and testing of the tool, which was led by Dr Emma Foster and Prof Patrick Olivier at Newcastle University. Research participants can log on to the website and enter all the foods and drinks they consumed the previous day. There are 1000s of foods in the system which users can select from and choose the portion size eaten by clicking on the relevant photo. The system has been created to be as close to an in-person interviewer-led recall as possible, for example the system prompts for any additions to foods which are commonly forgotten, such as ketchup on chips, milk on cereal, sugar in tea. If there are long gaps between meals, the user will be prompted to think if they had anything to eat within that time.   

One of the many advantages of Intake24 compared to the traditional paper-based methods, is the ability to collect dietary data from 1000s of study participants remotely. Arranging suitable times to meet with participants to conduct dietary interviews is no longer a requirement and saves hours of researcher time. Intake24 automatically codes the food and drink intakes, therefore dietary data can be downloaded from the system immediately, removing the laborious task of food diary coding and data entry onto a database. This also improves consistency of nutrient coding and removes human error. The development of Intake24 has changed the way dietary intakes are collected globally. The system is being used in the UK National Diet and Nutrition Survey and national surveys in Australia and New Zealand. Versions have been created for Portugal, Denmark, Malaysia, Indonesia and Japan.

However, I have a small confession. I miss meeting study participants. I always had a great deal of fun talking about what they had eaten and the little conversations they led to. In a pilot study for the Diet and Nutrition Survey of Infants and Young Children I met many parents of young babies and infants and it was an absolute joy to talk about foods their infants were eating and funny anecdotes about food flying onto ceilings and how on earth they were meant to measure the amount eaten when half of it was soaked into the bib! Dietary interviews with school children were always enlightening and again often led to interesting conversations about favourite foods and drinks. There is an argument, however, that removing the researcher from the dietary collection process, reduces the risk of social desirability; participants who may not have recorded that extra biscuit, might feel they can be more honest without a researcher present.

I remember the first time I downloaded dietary data from Intake24 during the testing of the tool in 180 participants in Scotland. At the end of a very busy few weeks collecting data from participants, I clicked the download button, and everyone’s food and nutrient intakes were there on the screen right in front of me. I didn’t need to cart a pile of food diaries and food models around with me, spend hours coding them and entering them into a database. I realised that Intake24 was going to vastly improve the process of dietary assessment, and importantly help make dietary assessment possible in large population-based studies where the cost of traditional methods would have previously been prohibitive. It was a moment I won’t forget, and I am so proud to have played a small part in its very successful journey so far.

The Power of Connection: Exploring Support in Performance and Health

Supporting others, or getting support, can be beneficial in lots of ways. It helps build and maintain relationships and allows us to feel connected to the people around us. This support can help every one of us, including people trying to become physically active, or to improve self-confidence and performance.

But are we comfortable opening up and asking for help? Do we really know the intricacies of support and how it should be provided or perceived? What are the effects of support for different populations?

Beyond SMART Goals: Tailoring Motivation Interventions

Goal setting has been shown to be beneficial for helping develop and maintain motivation in a variety of settings. Although recent research suggests a one-size fits all approach to goal setting might not lead to sustained change, particularly for an inactive population.

What innovative alternatives might be available to us? How might we design goals for clinical populations looking to improve physical activity?

Behind the Scenes: Unveiling the Science of Support in Health and Performance

Dr Adam Coussens, of Newcastle University, has been addressing these types of questions from his PhD focussing on social support of athletes, through to his recent research applying support and goal setting principles in different populations, including emergency services. Adam also co-hosts the internationally attended conference, Psychological Insights into Coaching Practice. This blog will focus on one current project Adam is working on, an intervention to improve physical activity levels in heart failure patients.

Adam has collaborated with fellow researchers from Teesside University, Newcastle University, and healthcare professionals from NHS Trusts across the north-east, as part of the BeActive Heart Failure group. Adam is working on this Heart Failure UK funded feasibility project to provide resources and support to people to understand the barriers within cardiac rehabilitation, and subsequently promote physical activity and cardiac rehabilitation uptake.

Adam has been working with healthcare professionals leading tailored workshops, equipping them with the tools to guide their patients towards utilising social support and setting effective goals. These workshops emphasise the crucial role of perceived and received support, identify potential gaps, and offer strategies for effectively utilising existing networks. Furthermore, practical guidance is provided on how to set more ‘open’ and ‘do your best’ goals, to help maintain motivation and physical activity.

What is Next for the Project?

Physical activity levels of heart failure patients involved in the project are being monitored using Actigraph measures. Interviews will also take place with healthcare professionals who delivered the intervention, and heart failure patients, to evaluate the effectiveness and practicality of this project.

As this is currently a feasibility study, the aim is to develop the multidisciplinary intervention further to include more NHS Trusts and identify whether a BeActive-HF intervention could be used as part of routine clinical care for patients with heart failure.

Reposted with permission from the Newcastle University Extreme Environments Group blog (https://blogs.ncl.ac.uk/extremeenvironments/blog-why-is-the-kona-ironman-world-champs-so-hard-for-the-pros/)

Hawaii is the birth place of the IronMan triathlon where in 1978 Judy and John Collins challenged individuals to swim bike and run 140.6 miles and joked they would call the winner an “Iron man”. The event now sees 1000s of athletes test themselves in IronMan races all over the globe, including myself. But Kona, home to the Ironman World Championships which begins today (6^th October 2022), holds something special for all triathletes. The history of the race is full of epic tails of survival (see the story of Julie Moss or Sian Welsh & Wendy Ingraham) and infamous battles such as the Iron War (between Dave Scott and Mark Allen). The weather is generally consistent and therefore predictable in Kona in October: sunny, windy and humid. However, while the air temperatures are generally around 30 ^oC which are not necessarily remarkable, it is the humidity “swamp-like” conditions that really challenge athlete’s thermoregulatory capacity when competing in the Ironman World Championships.

So why is Kona so hard?

It is well established that heat will reduce exercise performance incrementally, mediated by increasing heat gain and a rise in core body temperature. When athletes are faced with hot environments, preparation strategies such as heat acclimation facilitate heat tolerance which drive a range of physiological adaptations to help them tolerate heat. However, it is an adaptive increase in sweat rate that facilitates the greatest heat loss. Heat transfer is mediated by evaporation of sweat from the skin which transfers heat away from the body. In fact, when all sweat is able to evaporate from the skin (we will call this ideal conditions – typically dry-hot) heat is removed at a rate of 2.34 kJ/g. The human body can produce sweat at rates approximating ~ 30 g/min (losses in body mass equivalent to ~ 1.5-2 L/hr). Although, if you have been keeping up to date with Lionel Sanders vlog he mentions much higher changes in body mass after training that indicate sweat losses of ~2.5 L/hr. However, if using our sweat rate value of ~ 30 g/min this equates to removing heat at 73 kJ/min (~1219 W). The human body has only ~ 20% efficiency therefore this reported heat loss would support normothermic total energy use of 1520 W. As a result external work rate would be equivalent to ~ 305 W (20% of total energy use). Athletes across a number of social media platforms discuss numbers in the range of 300-350 W for average sustainable power during the cycling portion of an IronMan, meaning that in ideal conditions these numbers are perfectly reasonable and heat gain can be controlled (being mindful of dehydration of course).

Post race edit: Sam Laidlow beat the bike course record with a time of 4 hr 4 min and reported average power ~315 W. source: https://www.youtube.com/watch?v=njUjiu_AOeA].

However, the big problem in Kona, like we have said, is the humidity. Kona may see humidity in the range of 80-90% (30 ^oC air temp at 90% RH = WBGT ~ 28.6 ^oC) meaning the air contains a greater amount of water vapor thus reducing the gradient for evaporative heat transfer. This means our ideal scenario no longer holds true and the ability to dissipate heat decreases. It is the efficiency of sweating, defined as the ratio between secreted and evaporated sweat that is reduced as humidity increases, with some studies indicating that efficiency can decrease by ~35 % when humidity increases from 50 to 70% (Alber-Wallerstron & Homer, 1985; Frye & Kamon 1983). Clearly if humidity tops 90% the athlete’s sweat efficiency will be further reduced. As a result, athletes gain heat more quickly, core temperature increases more rapidly reaching critical limits facilitating a drop in exercise intensity and potentially leading to hyperthermia or more serious consequences. Indeed, Jan Frodeno, arguably the best IronMan athlete of all time, famously said that his rule of thumb is to take 15-20% off his normal wattage on the bike to account for the extreme heat stress in Kona.

So, what are the anticipated conditions in Kona?

Over the past 3 days humidity has ranged from 65 to 94% relative humidity, with temperatures ranging from 25-30 ^oC during the approximate times the professional athletes will race (6am-3pm) (https://w1.weather.gov/data/obhistory/PHKO.html – accessed 5/10/22 23:00). Whilst athletes and coaches are much more aware of the impact of heat stress and humidity in Kona, we will probably still see the breakdowns and collapses in the professional field that we are so accustomed to seeing at Kona. Science and technology, with respect to maximising heat tolerance, has pervaded the sport in recent years with the Norwegians taking the game to another level and other professionals following suit. It will be fascinating to see who has prepared the best, what strategies they adopt and who’s body can tolerate the conditions best. It will be a great race to watch! My money is on Daniela Ryf or Lucy Charles-Barclay in todays race and in the men’s race on saturday its the Big Blu although really hope Sanders has the race he capable of.

Updated 06/10/22 18:00 – Women’s environmental conditions at start of swim – as predicted 24 ^oC and 88% humidity.

Updated 08/10/22 – Men’s environmental conditions at start of swim (~6:00am left) and at the start of the run (~10:44am right) – as predicted temps increased from 24 to 28 ^oC and humidity remained stable around 85%.

Written by Owen Jeffries

On 19^th-20^th June 2023, the inaugural Eatwell Guide Forum was hosted at the Human Nutrition and Exercise Research Centre (HNERC) at Newcastle University. The event was funded by Rank Prize, following application from a project team of UK-based researchers. Dr. Oliver Shannon led the application as principal investigator, supported by co-investigators; Dr. Fiona Malcomson and Dr. Rebecca Townsend (of Newcastle University), Dr. Sarah Gregory (Edinburgh University), Dr. Jamie Matu and Dr. Alex Griffiths (both of Leeds Beckett University), Dr. Amy Jennings and Ms. Nicola Ward (both of Queen’s University Belfast).

This application followed previous work conducted by the project team, which investigated associations between adherence to the Eatwell Guide and outcomes of cardiometabolic and cognitive health, including neuroimaging measures in the PREVENT Dementia cohort. This work was funded by the NuBrain Consortium led by Prof. Emma Stevenson, and contributes toward the limited number of studies which evaluates adherence to recommendations within the Eatwell Guide in relation to health outcomes. Acknowledging this, the project team believed it would be invaluable to host an event which aimed to both consolidate existing knowledge, and set the agenda for future work, surrounding the Eatwell Guide and outcomes of human and planetary health.

The Forum was attended by twenty-one researchers/professionals who travelled to Newcastle-upon-Tyne by train, plane, and van, from across all corners of the UK. A further three individuals attended the event virtually, including colleagues from international locations.

The event kicked off with an introduction to the Forum from the organising committee, who welcomed attendees and set out the agenda for the day. Prof. Louis Levy then gave an engaging keynote talk about the evolution of the Eatwell Guide and the extensive research which underpinned this process, spanning from idea conception to testing and validation of the tool. After a much-needed coffee-break (some attendees had 3am starts!), the first original research session began. This session explored how adherence to the Eatwell guide could impact population health, including outcomes of mortality (Dr. Keren Papier), adiposity (Dr. Nicola Best) cognitive function/brain health (Dr. Sarah Gregory) and risk of falls (Ms. Chloe French).

Following a plentiful lunch break packed with networking and further introductions, the second session began. This session was angled toward exploring the impact of the Eatwell Guide on planetary health. Dr. Pauline Scheelbeek highlighted the potentially beneficial influence of the Eatwell Guide on greenhouse gas emissions, and Dr. Curie Kim reviewed the evidence surrounding the Eat-Lancet Reference Diet (a diet developed to promote environmental sustainability) in relation to cognitive function. After further discussions and an afternoon break, the third and final session of the day commenced. Prof. Bertha Ochieng and Fareeha Jay presented the work they have each undertaken to culturally adapt the Eatwell Guide, in order to improve representation across various communities living within the UK. This included the co-creation of an African Heritage Eatwell Guide and the development of a South Asian Eatwell Guide. The first day of the Forum ended with a stimulating audience discussion surrounding the past, present, and future opportunities in relation to the Eatwell Guide. Event attendees then had a taste of the Newcastle dining scene to complete the first day of the Forum and enjoyed further networking opportunities.

The second day of the Forum opened with a recap of day one from the organising committee, followed by commencement of the fourth original research session. Presenters discussed the potential application of the Eatwell Guide within future clinical trials (Dr. Amy Jennings) and outlined the development of new methods to determine adherence toward recommendations within clinical and public health settings (Ms. Kaydee Shepherd).

Event attendees then participated in a world café-style activity to highlight gaps in current knowledge and outline future opportunities for further research. Discussions were had about the overall paucity of research which investigates adherence to the Eatwell Guide, in relation to both human and planetary health outcomes, especially within specific sub-group populations at increased risk of diet-related diseases. Attendees also commented on the methods to assess the level of implementation of the Eatwell Guide at population-level, including examination of understanding among both the public and healthcare professionals. Following conclusion of the activity, the Forum ended with a general discussion surrounding key principles to consider when conducting future research. The importance of input from patient and public involvement (PPI) panels was highlighted, to promote acceptability, understanding and enhance usability of the Eatwell Guide. Ultimately, the need to develop cross-disciplinary relationships which span outside of academia, including relevant governmental departments and industry partners (e.g., consumer data panels) was acknowledged.

Overall, the event was a great success and helped many to develop new connections and acted as a catalyst for the initiation of novel and exciting ideas surrounding the Eatwell Guide. The event was also live scribed by Beka Haigh, who expertly sketched the final graphic shown below to neatly summarise the content of the Forum. Finally, the organising committee and event attendees intend to write a formal summary of the Forum, for submission to the Nutrition Bulletin – so keep an eye out for this!

A new project outline with Dr. Sam Orange (reposted with permission from Breastcancernow.org)

The challenge

More women are living with and beyond breast cancer than ever before. But they often experience long-lasting low mood or extreme tiredness (fatigue), even after their treatment has ended. It can dramatically affect their quality of life.

Leading a healthy lifestyle after a breast cancer diagnosis and treatment can help with this. And it could lower the risk of breast cancer coming back. Despite this, there’s little support available to help women maintain regular physical activity and a healthy diet.

The science behind the project

Dr Sam Orange, from Newcastle University, wants to improve women’s access to diet and physical activity support after their breast cancer treatment. There are many barriers that prevent women from getting this support in the National Healthcare System (NHS), such as limited resources, no referral pathway, and there being no support services to refer them to at all.

Sam’s creating a referral pathway so that healthcare professionals can refer women to community support services. And he’s developing a training package to help community services adapt their health and lifestyle programmes to specifically support women after breast cancer treatment.

To do this, the researchers will first identify existing diet and physical activity services in the community that could be adapted. They’ll look at how they’re accessed, funded and how well they work.

Then they’ll hold 4 focus groups to explore different people’s experiences of accessing and giving support. These focus groups will include women who have finished treatment for early-stage breast cancer, healthcare professionals, dieticians and exercise specialists, and community practitioners.

The third stage of the project will involve 4 workshops based on the results of earlier stages. They’ll bring women who have finished treatment for breast cancer and healthcare professionals together to talk about how community services could be adapted. And how the referrals could work.

Finally, the researchers will test how well the new programme works. They’ll ask healthcare professionals to refer 40 women to the adapted diet and physical activity service. They’ll see how women feel about the service and get perspectives from community practitioners and healthcare professionals as well.

What difference will this project make?

If this project is successful, the researchers will carry out a larger study to directly measure if this programme leads to better quality of life for women living with and beyond breast cancer. And it may also help to reduce their risk of a second breast cancer diagnosis.

How many people could this project help?

55,000 women are diagnosed with breast cancer each year in the UK. This project has the potential to help all of them to maintain healthy diet and physical habits. But it could especially help the 1/3 of women that experience persistent fatigue after treatment, as well as the 48% of women that experience depression and anxiety.

For the original post, see: Breast Cancer Now

Dr. Oliver M Shannon, Human Nutrition & Exercise Research Centre, Newcastle University

When I was young, I loved to spend time with my grandad.  He was full of energy, had a wicked sense of humour, and was always there when you needed him.  He was in great health throughout most of his life, and he was still running half marathons well into his 70’s. However, when he was 85, my grandad had a stroke.  Shortly after, he was diagnosed with dementia and his short-term memory began to decline. Over time, other bodily functions did too, and he sadly passed away in January of this year. 

This is a short-hand version of my own personal experience of dementia.  Millions of other people have a similar story.  You may do too.  Indeed, right now there are over 55 million people in the world living with dementia, placing a huge and unsustainable burden on individuals, their families and society at large.

Although promising findings are starting to emerge, at present, there are very few options available for treating dementia.  As such, many researchers are focused on identifying ways to help people reduce their risk of developing this condition. 

The 2020 Lancet Commission Report on dementia prevention outlined 12 modifiable risk factors, which collectively account for around 40% of dementia cases worldwide, and could be targeted by policy makers and individuals to help reduce dementia risk.  These risk factors include low education levels, hearing loss, brain injury, high blood pressure, high intake of alcohol, obesity, smoking, depression, social isolation, physical inactivity, air pollution, and diabetes. 

Although this report identifies a high intake of alcohol (a dietary factor) and conditions such as obesity and diabetes (which may be linked with diet) as key dementia risk factors, it is notable that consumption of an unhealthy diet as a whole is absent from the list of modifiable risk factor for dementia.  This is despite mounting evidence that what we eat can impact brain health throughout the life course. 

There are a few reasons why diet might not play a more prominent role in the Lancet Commission report.  This includes the difficulties in defining what a healthy/unhealthy diet looks like, and the fact that not all studies have shown convincing links between diet and brain health.    There is therefore a need for more research to help us understand whether what we eat can have a meaningful effect on dementia risk.  Likewise, it is important to identify whether there are certain people who might benefit more or less from making changes to their diet. 

For some time, we (and many others) have been interested in the potential health benefits of eating a Mediterranean-like diet, which is rich in healthy plant-based foods like fruits and vegetables, pulses, nuts, olive oil and also includes plenty of fish.  Numerous studies, including the influential PREDIMED trial in Spain, have shown that eating a Mediterranean diet can improve cognitive (brain) function in older adults.  Similarly, a handful of studies have suggested that eating a Mediterranean diet could help reduce the risk of developing dementia.  However, the links between a Mediterranean diet and dementia risk are far from conclusive.  Moreover, most studies to date have been fairly small and have provided limited insight into whether certain individuals (for example, those with different genetics) might respond differently to consumption of a Mediterranean diet. 

To address some of these issues, we recently explored the associations between adherence to a Mediterranean diet and dementia risk in over 60,000 participants from the UK Biobank.  Using dietary data from the participants, we were able to give each individual a score ranging from 0 to 15 to define how closely their diet matched the key features of a Mediterranean diet (those with higher scores had a more Mediterranean-like diet).  We then used a statistical technique known as Cox proportional hazard regression to explore associations between the level of Mediterranean diet adherence and risk of developing dementia over a ~9 year period, whilst controlling for potential differences in factors such the education level and physical activity status of participants. 

We found that individuals with higher adherence to the Mediterranean diet, as defined by one of the Mediterranean diet scores known as the MEDAS continuous score, had a 23% lower risk of developing dementia than those with lower adherence to a Mediterranean diet. 

Interestingly, there were similar associations between Mediterranean diet adherence and dementia risk in individuals with higher and lower genetic risk for this condition.  This suggests that, even for those with higher genetic risk, having a more Mediterranean-like diet could help reduce the likelihood of developing dementia. 

Our study has a number of strengths, not least it’s size and the comprehensive way in which we defined genetic risk for dementia (using an approach called a polygenic risk score).  However, no study is without limitations. Most notably, as this was an observational study, we cannot infer cause and effect from our findings. 

Much more research is needed to identify the best diet that people could follow to try and reduce their risk of dementia.  However, the findings from our study contribute towards a growing body of evidence to suggest that following a more Mediterranean-like diet could be an effective way to help ‘oil your cogs’ and reduce your risk of developing dementia.