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Sugar content of yogurt products in the UK: A comparison between 2016 and 2019
- Eimear Sutton, Neil Hancock, J. Bernadette Moore
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- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E568
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Yogurt is a staple part of children's diets and is perceived as a nutrient dense food for adults and children. However, yogurts are also a significant source of free sugars for children and are a target of the UK government's sugar reduction programme, which has recommended a 20% reduction in the sugar content of yogurt and fromage frais products by 2020. With this in mind, in November 2016, we undertook a comprehensive survey of the nutrient contents of yogurt products in UK supermarkets (Moore et al. 2018). The aim of this work was to reassess the UK supermarkets yogurt products in 2019 and determine whether the sugar contents of yogurt products have been reduced. Product data was collected from the UK's top five online supermarkets in January 2019 using the search terms ‘yogurt’ and ‘yoghurt’. Products were placed systematically into the same 8 categories used in 2016: children's, drinks, dairy alternatives, organic, natural/Greek, fruit, flavoured, desserts. Products lists were collected, refined and compared to the 2016 database. All data was double-checked independently and 5% of all entries were randomly selected and verified. GraphPad Prism V/7.0c was used for statistical analysis. After de-duplication of products found in multiple supermarkets, the 2019 database contained 893 unique products in line with the 898 surveyed in 2016. Of these, 539 (60.4%) yogurts were in common (same brand and name) with the 2016 products and 354 were new, demonstrating dynamic turnover in available yogurt products during the 26 months between surveys. In comparing the total sugar contents of the 539 paired products, notably the median [range] of total sugar contents in 2019 was significantly lower than in 2016 (10.8g/100 g [0.4, 29.5] versus 11.8g/100 g [0.1, 31.8]; P < 0.0001, Wilcoxon matched-pairs signed rank test). Indeed, when all products were compared there was a significant reduction in the median total sugar in 2019 compared to 2016 (10.4g/100 g [0–32.9] versus 11.9g/100 g [0.1–32.6]; P < 0.0001, Mann-Whitney test). Categories showing the most improvements were children's, drinks and fruit yogurts. Fifteen percent of the 2019 products contained less than or equal to 5g/100 g sugars, considered a ‘low sugar’ product, an improvement over the 9% identified in 2016. We conclude the sugar content of UK yogurt products has reduced since the sugar reduction program was put into place in 2016. However, a larger reduction in most categories is needed in order to reach the required 20% reduction by 2020.
Sugar Content in UK Breakfast Cereals: A Market Survey
- Tom J. Butler, Evelyn S. Birman, Neil Hancock, J. Bernadette Moore
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- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E174
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Breakfast cereals are known to provide a nutrient-dense meal and are a useful source of carbohydrate, fibre and micronutrients. However, in the UK cereal products are the primary contributor of free sugars in the diets of children aged 1.5 to 10 years; and are the second leading source of free sugars in children aged 11 to 18 years and adults aged 19 to 64 years. For this reason, breakfast cereals were included among food items recommended by the UK government for a 20% reduction in sugar by 2020 for childhood obesity prevention. Therefore, this study aimed to investigate the nutrient contents, including sugars, of breakfast cereals sold in the UK, in particular those marketed to children. Nutritional information and ingredients of cereal products available in five major online supermarkets in the UK, in 2018, were collected into a comprehensive database for analysis. A systematic process flow approach was utilised to separate products into nine distinct categories. Children's products were stratified both on being wholegrain rich (≥ 50%, WG) or not (NWG), and on total sugar content; with > 12.3g/100 g defined as ‘highly flavoured and sweetened’ (HFS) versus ‘plain’ containing ≤ 12.3g/100 g (the target set by the UK for industry sugar reduction). Of the 757 unique products surveyed, 97 cereals were categorised as children's. Cereals not explicitly marketed to children were categorised as either ‘family favourites’ (containing < 50% wholegrains), ‘free-from and organic’, ‘porridge and oats’, ‘healthier with dried fruits’, or ‘healthier without dried fruits’ (healthier defined as wholegrain rich, ≥ 50%). Children's HFS products (n = 78) contained by far the highest sugar contents of all cereals examined. While there was no difference in total sugar between NWG/HFS (n = 69, median [range]: 29.0g/100 g [12.4, 41.0]) and WG/HFS (n = 9, 22.0g/100 g [13.6, 26.0]) cereals; these were much higher (P < 0.01) than the median sugar contents (8.8–19.0g/100g) observed in the other seven product categories. Children's NWG cereals contained dramatically lower fibre (NWG/HFS: 3.5 [0, 8.7], NWG/Plain: 1.6g/100 g [1.3, 7.2]) than all other product categories (7.3–9.1g/100 g; P < 0.001). Similarly, NWG/HFS cereals were lower in protein content (7.4/100 g [3.6, 17.2]) than the non-children's cereals (8.8–11g/100 g; P < 0.05). In conclusion, children's categories of cereal contain significantly greater amounts of sugar and lower amounts of fibre and protein than other cereal categories. Despite their fortification with vitamins and minerals, reformulation of this food category should be a priority alongside additional sugar-reducing strategies.
Healthy dietary patterns from food diaries and FFQ are not associated with colorectal cancer risk: results from the UKWCS
- Petra Jones, Janet Cade, Charlotte Evans, Neil Hancock, Darren Greenwood
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- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E86
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Dietary pattern analyses have most commonly used food frequency questionnaire (FFQ) data for large population studies, whilst food diaries (FD) tend to be used with smaller datasets and followed up for shorter terms, restricting the possibility of a direct comparison. Studies comparing dietary patterns derived from two different assessment methods, in relation to diet and disease are limited. The aims of this study are to assess the agreement between dietary patterns derived from FFQ and FDs and to compare the associations between the Mediterranean dietary pattern and the World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) dietary pattern in relation to colorectal cancer incidence.
The study population included 2276 healthy middle-aged women – participants of the UK Women's Cohort Study. Energy and nutrient intakes, derived from 4-day FDs and from a 217-item FFQ were compared. A 10 and an 8-component score indicating adherence to the Mediterranean diet and to the 2007 WCRF/AICR cancer prevention recommendations respectively were generated. Agreement was assessed by weighted Kappa statistics and the Bland-Altman method. Cox regression was used to estimate hazard ratios (HRs) for colorectal cancer risk for both the FD and the FFQ patterns, for each score separately.
The Bland-Altman method showed that the FFQ gave a higher energy intake compared to the FD with a bias of -525 kcal (95% CI -556, -493) between the two methods. Agreement was slight for the Mediterranean diet score (Κ = 0.15; 95% CI: 0.14, 0.16) and fair for the WCRF/AICR score (Κ = 0.38; 95% CI: 0.37, 0.39). A total of 173 incident cases of colorectal cancer were documented. In the multi-variable adjusted models, the estimates for an association with colorectal cancer were weak: HR = 0.94 (95% CI: 0.83 to 1.06) for a 1-unit increment in the Mediterranean diet score using FD and HR = 1.01 (95% CI: 0.83 to 1.24) for a 1-unit increment in the WCRF/AICR score using FD. For scores derived from the FFQ, estimates were inverse, but weak (HR = 0.80 (95% CI: 0.90 to 1.00) for a 1-unit increment in the Mediterranean diet score using FFQ and HR = 0.84 (95% CI: 0.67 to 1.05) for a 1-unit increment in the WCRF/AICR score using FFQ.
There is insufficient evidence of an association of colorectal cancer risk with the Mediterranean dietary pattern or with the WCRF/AICR cancer prevention recommendations, irrespective of the dietary assessment method in this sample. Further studies with larger sample sizes, using FD for diet assessment are warranted.
Validation of an automated online 24-hour recall (myfood24) using nutrient biomarkers provides similar results to a traditional interviewer administered recall
- Janet Cade, Petra Wark, Gary Frost, Nisreen Alwan, Michelle Carter, Paul Elliott, Heather Ford, Neil Hancock, Michelle Morris, Zeinab Mulla, Essra Noorwali, Aikaterini Petropoulou, Greg Potter, Elio Riboli, Laura Hardie, Darren Greenwood
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- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E391
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Online dietary assessment tools can reduce administrative costs and facilitate repeated dietary assessment during follow-up in large-scale prospective studies. We developed an online 24-h recall (myfood24) with automated estimation of associated nutrient intake, and assessed validity against reference recovery, predictive and concentration biomarkers. Validity of the online tool was then compared with that of traditional interviewer-administered multiple-pass 24-h recalls and presented as the expected attenuation of any diet-disease associations estimated with the tool.
Metabolically stable adults were recruited and completed the new online dietary recall, a traditional interviewer-based multiple-pass recall and provided samples of blood and urine for a range of reference biomarkers. Longer-term dietary intake was estimated from up to three recalls taken two weeks apart. Estimated intakes of protein, total sugars, potassium and sodium were compared with urinary biomarker concentrations. Estimated energy intake was compared with energy expenditure measured by three-plane accelerometry and open-circuit indirect calorimetry. Validity against these biomarkers was also compared to that estimated for traditional interviewer-administered multiple-pass 24-hour recalls.
At least one biomarker sample was received from each of 212 participants. Compared to reference biomarkers, both the online 24-hour recall and interviewer-based recall led to attenuation of diet-disease associations. The online tool resulted in attenuation factors of around 0.2–0.3 which could have important effects on estimated risks. For example, if the true relative risk of a diet-disease association was 2.0, an attenuation factor of 0.3 would reduce the relative risk to 1.23. Ranking using intakes against repeated biomarkers as an estimate of truth, resulted in higher attenuation factors of approximately 0.3–0.4, with a smaller impact on risk estimates. Attenuation improved substantially on repeated application of the tool. Validity of the interviewer-based recall found similar attenuation factors, but it was more administratively burdensome and expensive to implement. The online tool typically provided 10–20% lower nutrient estimates compared to the interviewer-administered tool.
Our findings show that, whilst results from both automated online and traditional interviewer-based dietary recalls are attenuated compared to objective biomarker measures, the myfood24 online 24-hour recall is comparable to the more time-consuming and costly traditional interviewer-based 24-hour recall across a wide range of measures. The less burdensome implementation of the online tool, with automated nutrient coding and easy replication over a longer time period with associated gains in precision, makes it well-placed for repeated use in large-scale prospective studies.
3236 Identification of exhaustive markers in cytotoxic T-cells to guide immune modulation in hepatocellular carcinoma ex vivo
- Lauren Norell Krumeich, Tatiana Akimova, Jason Stadanlick, Abhishek Rao, Neil Sullivan, Seth Concors, Paul Hernandez, David Aufhauser, Jr, Evgeniy Eruslanov, Wayne Hancock, Matthew Levine
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- Journal of Clinical and Translational Science / Volume 3 / Issue s1 / March 2019
- Published online by Cambridge University Press:
- 26 March 2019, p. 13
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OBJECTIVES/SPECIFIC AIMS: Objective: apply checkpoint inhibitors that are specific to the exhaustive markers expressed on tumor CD8+ T-cells ex vivo in order to improve cytokine release and cytotoxic function in comparison to two control groups: (1.) T-cells that receive no antibodies; (2.) T-cells that receive standard inhibition with PD-1 and CTLA-4 antibodies only. Long-term objective: provide personalized medicine in the treatment of HCC by using checkpoint inhibitors that are specific to the receptors expressed by an individual tumor. METHODS/STUDY POPULATION: The study population includes patients undergoing liver transplantation or surgical resection for HCC. Two grams of tumor, two grams of healthy liver tissue at least one centimeter from the tumor margin, and 50 milliliters of blood will be obtained. Solid tissue will be mechanically and enzymatically disrupted and CD8+ T-cells will be isolated from all sites. Using flow cytometry, the expression of surface receptors PD-1, CTLA-4, LAG-3, TIM-3, BTLA, CD244, and CD160 will be categorized in each tissue to identify which receptors are upregulated in the tumor microenvironment. Up to three antibodies specific to the upregulated receptor(s) on the tumor T-cells will be applied per specimen. The experimental arm will receive these antibodies and co-stimulation with CD3/CD28 and will be compared to two controls. One control will receive only CD3/CD28, and the other will receive CD3/CD28 in addition to the standard combination of PD-1 and CTLA-4 inhibitors. From each condition, flow cytometry will be used to assess the mean production of interleukin-2, tumor necrosis factor-α, interferon-γ, granzyme B, and perforin expression as an assessment of T-cell function. RESULTS/ANTICIPATED RESULTS: Preliminary data from the peripheral blood of healthy controls confirms that the developed flow cytometry panels effectively identify the surface receptors and cytokine production of CD8+ T-cells. Two patients have successfully been enrolled in this study. It is predicted that T-cells extracted from the tumor will express more inhibitory receptors than normal liver or peripheral blood and will have increased function after they are targeted with checkpoint inhibitors that are specific to the inhibitory surface receptors they express. DISCUSSION/SIGNIFICANCE OF IMPACT: HCC is the second leading cause of cancer-related death worldwide and therapeutic options are limited for patients who are not surgical candidates. T-cells are a critical component of the anti-tumor response to HCC. However, T-cells can develop an exhausted phenotype characterized by up-regulated inhibitory receptors (PD-1, CTLA-4, LAG-3, TIM-3, CD-244, CD-160, BTLA) and decreased function, allowing for immune escape. Clinical trials using combined checkpoint inhibition with PD-L1 and CTLA-4 antibodies have been considered a breakthrough for patients with advanced HCC, as up to 25% show an objective tumor response. The explanation for the varied susceptibility to checkpoint inhibition remains unknown and is hypothesized to be secondary to inconsistencies in the expression of surface inhibitory receptors. Although inhibitory receptor expression has been shown to be upregulated under conditions of hepatitis and/or HCC, there has been no single study to effectively investigate the expression of all known inhibitors in order to better explore the interplay between them. It will be of great academic interest and clinical purpose to evaluate individual receptor expression and engage the correlating antibodies given the possibility of synergism between receptors and the need for a more profound anti-tumor T-cell response in HCC.
Does adherence to the World Cancer Research Fund/American Institute of Cancer Research cancer prevention guidelines reduce risk of colorectal cancer in the UK Women’s Cohort Study?
- Petra Jones, Janet E. Cade, Charlotte E. L. Evans, Neil Hancock, Darren C. Greenwood
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- British Journal of Nutrition / Volume 119 / Issue 3 / 14 February 2018
- Published online by Cambridge University Press:
- 21 January 2018, pp. 340-348
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- 14 February 2018
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Evidence on adherence to diet-related cancer prevention guidelines and associations with colorectal cancer (CRC) risk is limited and conflicting. The aim of this cohort analysis is to evaluate associations between adherence to the World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) 2007 recommendations and incident CRC. The UK Women’s Cohort Study comprises over 35 372 women who filled in a FFQ at baseline in 1995. They were followed up for CRC incidence for a median of 17·4 years, an individual score linking adherence to eight of the WCRF/AICR recommendations was constructed. Cox proportional hazards regression provided hazard ratios (HR) and 95 % CI for the estimation of CRC risk, adjusting for confounders. Following exclusions, 444 CRC cases were identified. In the multivariate-adjusted model, women within the second and third (highest) categories of the WRCF/AICR score had HR of 0·79 (95 % CI 0·62, 1·00) and 0·73 (95 % CI 0·48, 1·10), respectively, for CRC compared with those in the lowest, reference category. The overall linear trend across the categories was not significant (P=0·17). No significant associations were observed between the WCRF/AICR score and proximal colon, distal colon and rectal cancers separately. Of the individual score components, a BMI within the normal weight range was borderline significantly protective only for rectal cancer in the fully adjusted model. In view of the likely different causes of CRC subtypes, further research is needed to identify the optimal dietary patterns associated with reducing colon and rectal cancer risk, respectively.
Indexed containers
- Part of
- THORSTEN ALTENKIRCH, NEIL GHANI, PETER HANCOCK, CONOR MCBRIDE, PETER MORRIS
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- Journal of Functional Programming / Volume 25 / 2015
- Published online by Cambridge University Press:
- 20 May 2015, e5
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We show that the syntactically rich notion of strictly positive families can be reduced to a core type theory with a fixed number of type constructors exploiting the novel notion of indexed containers. As a result, we show indexed containers provide normal forms for strictly positive families in much the same way that containers provide normal forms for strictly positive types. Interestingly, this step from containers to indexed containers is achieved without having to extend the core type theory. Most of the construction presented here has been formalized using the Agda system.
Containers, monads and induction recursion
- NEIL GHANI, PETER HANCOCK
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- Mathematical Structures in Computer Science / Volume 26 / Issue 1 / January 2016
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- 20 November 2014, pp. 89-113
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Induction recursion offers the possibility of a clean, simple and yet powerful meta-language for the type system of a dependently typed programming language. At its crux, induction recursion allows us to define a universe, that is a set U of codes and a decoding function T : U → D which assigns to every code u : U, a value T, u of some type D, e.g. the large type Set of small types or sets. The name induction recursion refers to the build-up of codes in U using inductive clauses, simultaneously with the definition of the function T, by structural recursion on codes.
Our contribution is to (i) bring out explicitly algebraic structure which is less visible in the original type-theoretic presentation – in particular showing how containers and monads play a pivotal role within induction recursion; and (ii) use these structures to present a clean and high level definition of induction recursion suitable for use in functional programming.
Cardiac findings and long-term thromboembolic outcomes following pulmonary embolism in children: a combined retrospective-prospective inception cohort study
- Hayley S. Hancock, Michael Wang, Katja M. Gist, Elizabeth Gibson, Shelley D. Miyamoto, Peter M. Mourani, Marilyn J. Manco-Johnson, Neil A. Goldenberg
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- Cardiology in the Young / Volume 23 / Issue 3 / June 2013
- Published online by Cambridge University Press:
- 22 October 2012, pp. 344-352
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In paediatric pulmonary embolism, cardiac findings and thromboembolic outcomes are poorly defined. We conducted a mixed retrospective-prospective cohort study of paediatric pulmonary embolism at the Children's Hospital Colorado between March, 2006 and January, 2011. A total of 58 consecutive children – age less than or equal to 21 years – with acute pulmonary embolism were enrolled. Data collection included clinical and laboratory characteristics, treatments, serial echocardiographic and electrocardiographic findings, and outcomes of pulmonary embolism non-resolution and recurrence. The median age was 16.5 years ranging from 0 to 21 years. The most prevalent clinical risk factors were oral contraceptive pill use (52% of female patients), presence of a non-infectious inflammatory condition (21%), and trauma (21%). Thrombophilias included heterozygous factor V Leiden in 21%; antiphospholipid antibody syndrome was established in 31% overall. Proximal pulmonary artery involvement was present in 34%. At presentation, nearly half of the patients had hypoxaemia and 37% had tachycardia. The classic electrocardiographic finding of S1Q3T3 was present in 12% acutely; tricuspid regurgitation greater than 3 metres per second, septal flattening, and right ventricular dilation were each present on acute echocardiogram in 25%. Nearly all patients received therapeutic anticoagulation, with initial systemic tissue plasminogen activator administered in 16% for occlusive iliofemoral deep venous thrombosis and/or massive pulmonary embolism. Pulmonary embolism resolution was observed in 82% by 6 months. Recurrent pulmonary embolism occurred in 9%. There were no pulmonary embolism-related deaths. Right ventricular dysfunction was rare in follow-up. These data indicate that acute heart strain is common, but chronic cardiac dysfunction is rare, following aggressive management of acute pulmonary embolism in children.