Microbiome composition may differ according to menopause status, which may be partially mediated by diet (1). Peri- and post-menopausal symptom burden is associated with diet quality (2), however, knowledge on the association between menopause symptoms and gut microbiome composition is limited (3). This study investigates the associations between gut microbiome composition and menopause symptoms.

Data was analysed from 70,399 peri- (N = 27,926) and post-menopausal women (N = 42,473) from the PREDICT 3 cohort (NCT04735835), examining the gut microbiome composition (using metagenomic sequencing) and diet quality using Healthy Eating Index (HEI) scores derived from the PREDICT Food Frequency Questionnaire. Data was also collected on menopause symptoms, grouped into vasomotor, sexual, psychological and somatic domains. A Menopause Symptom Tracker Score (MSTS) (0-100) was used to capture symptom prevalence (out of 20 symptoms) and impact on quality of life (0-not at all, 1-a little, 3-quite a bit and 5-extremely), with higher score values reflecting greater symptom burden (4).

Using random forest machine learning (ML) models, we found that microbiome composition was predictive of the MSTS (AUCall = 0.70; AUCperi = 0.66; AUCpost = 0.65), as well as physical (e.g., fatigue, weight gain and slowed metabolism, thinning hair) and psychological (e.g., low mood or depression, anxiety and mood changes) domain scores (AUCall = 0.70; AUCperi = 0.66; AUCpost = 0.68 and AUCall = 0.70; AUCperi = 0.65; AUCpost = 0.66 respectively). Microbiome was also predictive of diet quality (HEI; AUCall = 0.77; AUCperi = 0.77; AUCpost = 0.75). Subsequently, we compared the top 50 species predictive for the HEI and MSTS respectively, and identified 32 common predictive species. Notably, the top predictive species for both HEI and MSTS was the not-yet-characterised Lachnospiraceae species-level genome bin SGB4964.

To the best of our knowledge, this is the first time associations between menopause symptoms and the gut microbiome have been identified. Further work is needed to unravel diet-microbiome-symptom interrelationships and investigate a potential causal role of microbiome in menopause symptom burden. This knowledge could ultimately lead to novel, microbiome-based strategies for improving the quality of life for women during and after the menopausal transition.

The average age of menopause (cessation of menstruation for minimum 12 months) is 51 years, accounting for over one-third of a woman’s lifespan (1, 2). The transitional period known as perimenopause, characterised by menstrual irregularities due to female sex hormone deficiency, occurs from around 45 years. Menopausal changes significantly impact health, increasing prevalence of metabolic syndrome, cardiovascular risk factors, cognitive decline, and cause wide-ranging burdensome symptoms such as mood changes and sleep disturbances (1). Considering the recognised influence of nutrition on these health variables, a specific, reliable tool to assess menopausal symptoms would enable further research into potential lifestyle interventions, such as diet, for effective symptom management. The Kupperman Index, Menopause Rating Scale, Menopause Specific Quality of Life questionnaire and the Greene Climacteric Scale are the most widely recognised instruments for assessing menopausal symptoms (3). However, these scales were published between 1950 and 1996, when large-scale studies of menopausal experiences were lacking. This study examined menopause symptoms using the new MenoScale questionnaire, completed by peri- and postmenopausal women within two weeks of its launch on 4th September 2024, at https://zoe.com/menoscale.

The MenoScale, developed with support from the British Menopause Society, considers 20 symptoms across four domains (vasomotor, sexual, psychological, somatic) and subjective impact on quality of life (QoL). The MenoScale score ranges from 0 to 100. It improves on existing tools by uniquely combining prevalence-informed symptoms, modern language, assessing QoL, and offering open online access. Descriptive statistical analysis was performed on the collected responses.

The questionnaire was completed by 61,866 individuals. Average scores were 35.8 (95% CI 35.6, 36.0) for perimenopausal (N = 21,695) and 35.2 (95% CI 35.0, 35.4) for postmenopausal (N = 20,228) respondents. Nearly all (99.9%) peri- and post-menopausal women reported experiencing at least one symptom, with most reporting up to 10 symptoms (89.5% peri-, 87.0% postmenopausal). Furthermore, 8.6% of peri- and 9.5% of postmenopausal women reported all 20 symptoms. Most common symptoms for perimenopausal women were “tiredness and fatigue” (93.3%), “irritability” (88.4%), and “memory problems” (87.2%), and for postmenopausal women “tiredness and fatigue” (89.5%), “loss of interest in sex” (87.5%) and “sleep problems” (87.2%).

As all stages of menopause involve various fluctuating symptoms and subjective experiences, reliable and accessible monitoring methods are essential for establishing dietary, lifestyle and pharmacological interventions that alleviate symptom burden. This open-access and online questionnaire allows real-time symptom monitoring and periodic reassessment to increase understanding of menopause, empowering women to track and manage their menopause experience, and facilitate data-backed conversations with healthcare providers. Investigations into the validity and reliability of the MenoScale in comparison to existing widely used tools is currently underway. Future research should include collecting dietary data alongside the MenoScale to investigate how adherence to dietary guidelines is related to menopausal symptom experiences.

Psoriasis is a chronic debilitating skin disease affecting 2 % of the UK population. The aetiopathogenesis of psoriasis arises from a combination of genetic susceptibly and lifestyle patterns including stress, infections, alcohol misuse, lack of physical activity and adiposity. This unfavourable gene-lifestyle pairing triggers a series of inflammatory responses resulting in the uncontrolled proliferation of skin cells characteristic of psoriasis, which at present is an incurable disease. Concurrent with the systemic nature of the condition, psoriasis has effects beyond the skin with concomitant cardiometabolic complications, arthritis, gastrointestinal diseases and depression, emphasising the need for other strategies beyond pharmaceutical therapies to support psoriasis treatments. The role of diet in psoriasis management has not been clearly established and only two evidence-based recommendations are available for people with psoriasis. This review aims to critically appraise the research examining dietary patterns in psoriasis populations, highlight the gaps in the evidence-base, and present directions for future research.

Psoriasis is a chronic immune-inflammatory skin disease. Cross-sectional research examining diet quality indices in psoriasis has focused on the Mediterranean diet and is confined to Mediterranean populations, thereby lacking generalisability to other populations. We explored associations between diet quality indices and the likelihood of reporting a higher psoriasis severity. This was an online cross-sectional study recruiting adult volunteers with psoriasis (n 257). A 147-item FFQ evaluated adherence to the Mediterranean diet score, the Dietary Approaches to Stop Hypertension score and the Plant-based Diet Index (PDI), including its original (oPDI), healthy (hPDI) and unhealthy (uPDI) subtypes. Psoriasis severity was determined with the self-assessed Simplified Psoriasis Index. When adjusted for age, sex, smoking, alcohol overconsumption, energy intake and psychological morbidity, multinomial logistic regression analyses revealed an increased likelihood of reporting a higher psoriasis severity in participants with a very low adherence to Dietary Approaches to Stop Hypertension (OR = 3·75; 95 % CI 1·313, 10·700; P = 0·01) and hPDI (OR = 4·04; 95 % CI 1·251, 13·064; P = 0·02) patterns. A reduced likelihood of reporting a higher psoriasis severity was shown in participants with low adherence to the uPDI (OR = 0·25; 95 % CI 0·085, 0·716; P = 0·01). With further adjustment for BMI, a very low adherence to the oPDI was significantly associated with an increased likelihood of reporting a higher psoriasis severity (OR = 3·46; 95 % CI 1·029, 11·656; P = 0·05). Dietary interventions and assessment should be introduced in the care pathway for psoriasis management.

As obesity rates rise globally, addressing modifiable lifestyle factors, such as sleep, presents an opportunity for public health interventions. This review explores the growing evidence linking sleep duration, quality and timing with weight management and dietary behaviours throughout the life course. Observational studies associate short or irregular sleep with increased obesity risk, poor diet quality and metabolic disturbances. Plausible mechanisms include decreased physical activity, heightened hedonic and/or emotional eating, dysregulated appetite signals and circadian misalignment of metabolism, which contribute to a positive energy balance. Unravelling the bidirectional relationship between sleep and weight is challenging; poor sleep exacerbates weight gain, while obesity-related comorbidities such as obstructive sleep apnoea further impair sleep. Despite promising evidence from sleep-restriction studies showing increased energy intake, long-term randomised controlled trials (RCTs) examining interventions designed to improve sleep with weight management as an outcome are lacking. A handful of short-term interventions suggest benefits in reducing energy intake or improving dietary quality, but their effects on weight loss remain inconclusive. This review calls for robust, well-powered RCTs that integrate sleep, diet and physical activity interventions to evaluate the potential of sleep as a core component of obesity prevention and treatment strategies. Currently, there is insufficient evidence to support sleep-focused interventions as a mandatory element in clinical weight-management programmes.

Psoriasis is a chronic inflammatory skin condition arising from gene-environment interactions(1). The role of diet in individuals living with psoriasis is poorly understood with research to date confined to relationships with Mediterranean diet adherence in southern European populations(2). Studies are yet to explore the role of dietary patterns in relation to psoriasis severity within a UKbased population. The Asking People with Psoriasis about Lifestyle and Eating (APPLE) study investigated associations between four diet quality indices and psoriasis severity, hypothesising that individuals with more severe psoriasis would report lower diet quality scores.

The APPLE study is an online cross-sectional study (King’s College London Research Ethics Committee LRS/DP-21/22-29257; NCT05448352). Eligible participants included adults residing in the UK with diagnosed psoriasis. Participants were recruited using social media (June 2022January 2024). Validated questionnaires were used to evaluate: 1) psoriasis severity, by the selfassessed simplified psoriasis index, and 2) diet quality, using a 147-item food frequency questionnaire (FFQ) to calculate the Mediterranean Diet Score (MDS), the Dietary Approaches to Stop Hypertension (DASH) score, the Healthy Diet Score (HDS) and the Plant-based Diet Indices (PDIs). Diet-psoriasis associations were adjusted for age, sex, smoking status, energy intake, alcohol use, anxiety/depression diagnosis, and body mass index (BMI)

A total of 270 participants completed the study, of which 82% were female, 85% of White-British ethnicity, with a median (interquartile range (IQR)) age of 40 years (20.0), and a median BMI of 25 kg/m2 (8.2). Univariate regression analyses revealed significant negative associations between the HDS, DASH, healthy PDI, original PDI and MDS and psoriasis severity following adjustment for all covariates except BMI (β =−0.179 to −0.254, P<0.05). Only the HDS remained statistically associated with psoriasis severity when adjusted including BMI (β = −0.152, P<0.05). Stepwise multiple linear regressions identified meat and poultry from the MDS as predictors for psoriasis severity (β =0.158, P<0.05), whilst fruits and nuts (β =−0.140, P<0.05) and legumes (β =−0.130, P<0.05) were negatively associated with disease severity.

Participants with lower diet quality scores report more severe psoriasis, with meat/poultry and fruit/nuts revealed as key dietary components that merit further investigation. Previous findings showed that olive oil and fish were independent predictors for psoriasis severity in a smaller Italian sample population(3), which were not replicated in this population, possibly due to very low fish intakes in the UK population(4).

This study contributes to the evidence examining the diet-psoriasis relationships. Randomised controlled trials are required to evaluate causal inferences in relation to the effect of dietary patterns on psoriasis severity.

Psoriasis is a chronic dermatological disease often linked with systemic conditions such as cardiovascular disease, obesity, and type 2 diabetes(1). Unlike many other systemic diseases, psoriasis lacks specific dietary recommendations for its management(2). To develop evidencebased dietary advice, profiling dietary intakes in this population group is paramount. As part of the Asking People with Psoriasis about Lifestyle and Eating (APPLE) study, we aimed to quantify macronutrient intakes and their food group sources and assess associations with psoriasis severity.

The APPLE study is a web-based cross-sectional survey recruiting UK-based adult volunteers with psoriasis (King’s College London Research Ethics Committee LRS/DP-21/22-29257; NCT05448352). Recruitment was between June 2022 and January 2024 through social media. Participants self-reported age, weight, height, and alcohol use, depression or anxiety diagnosis, as well as psoriasis severity by responding to the self-assessed Simplified Psoriasis Index (possible score range 0-70 points). Diet was self-reported with a validated 147-item food frequency questionnaire. Nutritional composition was determined using the Composition of Food Integrated Dataset(3).Linear models tested associations between food groups sources and psoriasis severity.

The final sample (n = 270) primarily constituted mid-life (median (IQR) 40 (20) years), White-British (85%), female participants (82%) with psoriasis, of which 51% were living with overweight or obesity. Protein intake from animal sources (processed meat, poultry, and red meat) was significantly positively associated with psoriasis severity, adjusted for age, gender, smoking, alcohol use, energy intake, and diagnosed depression/anxiety (β between 0.133 and 0.225, P<0.05). Plant-based (excluding tree nuts) and tree nut sources of protein were inversely associated with psoriasis severity (adjusted β between −0.145 and −0.131, P<0.05). Protein from red meat and plant-based protein remained significantly associated with psoriasis when adjusting for BMI. Poultry and processed meat sources of n-6 polyunsaturated fatty acids were also positively associated with psoriasis severity (βbetween 0.125 and 0.133, P<0.05), whilst tree-nut sources were inversely associated with disease severity (β =−0.144, P<0.05), but associations were no longer significant when adjusting for BMI.

Our findings highlight that associations between psoriasis severity and protein and n-6 polyunsaturated fatty acids intakes depend on their source, suggesting that healthy plant-based diets warrant further investigation by randomised controlled trials for the dietary management of psoriasis.

Psoriasis is a chronic debilitating skin disease driven by pro-inflammatory immunological pathways. Research examining the effect of micronutrient supplementation on the severity of psoriasis has extensively focused on vitamin D and magnesium, yielding conflicting findings(1). As part of the Asking People with Psoriasis about Lifestyle and Eating (APPLE) study; micronutrients intakes were estimated in people with psoriasis for comparison with Reference Nutrient Intakes (RNIs) and to examine associations with psoriasis severity.

The APPLE study was a cross-sectional internet-based survey recruiting adult volunteers with psoriasis residing in the United Kingdom (King’s College London Research Ethics Committee LRS/DP-21/22-29257; NCT05448352). Volunteers were recruited between June 2022-January 2024 through social media. Psoriasis severity and diet were self-reported with validated tools, the self-assessed Simplified Psoriasis Index and a 147-item food frequency questionnaire. Micronutrient constituents were determined using the Composition of Foods Integrated Dataset (https://www.gov.uk/government/publications/composition-of-foods-integrated-datasetcofid).

The demographic characteristics of the study population (n = 270) comprised of a White-British (88%), middle-aged (median (IQR) age of 40 (20.0) years), female majority (82%), reporting a median body mass index (BMI) of 25.8 (8.2) kg/m2. Two-thirds (66%) of both males and females reported intakes below sex-specific RNIs for calcium. Approximately 80% of both males and females reported an iodine intake below 140 µg/day and more than 90% did not meet the 10 µg/day dietary recommendation for vitamin D. Most males (93%) and females (80%) did not meet the RNI for selenium intake. Two-thirds of women aged 18-50 years reported dietary iron intakes below the RNI of 14.8 mg/day. Intakes for other vitamin and minerals met dietary requirements. Magnesium (β = −0.197, P<0.01), copper (β = −0.174, P<0.01) and iron (β = −0.127, P<0.05) were significantly inversely associated with psoriasis severity, adjusted for age, sex, smoking, alcohol use, and diagnosed depression/anxiety. These associations with psoriasis severity were no longer significant when additionally adjusted for BMI.

There is a lack of studies examining dietary mineral intakes in populations with psoriasis, although some reports suggest people with psoriasis have a lower iron and magnesium status compared with control groups(2,3). Our preliminary data suggests that dietary screening of micronutrient intakes as part of routine care may be beneficial in people with psoriasis. Additional research is warranted to explore the effects of mineral intakes and physiological mineral status in people living with psoriasis. Minerals are key regulators of cellular and immunological responses which is of relevance to population groups with underlying immune-mediated conditions such as psoriasis.

Cardiovascular diseases (CVDs) are a major health concern for women. Historically there has been a misconception that men are at greater risk because CVD tends to occur earlier in life compared to women. Clinical guidelines for prevention of heart disease are currently the same for both sexes, but accumulating evidence demonstrates that risk profiles diverge. In fact, several CVD risk factors confer an even greater risk in women relative to men, including high blood pressure, obesity, diabetes and raised triglycerides. Furthermore, many female-specific CVD risk factors exist, including early menarche, pregnancy complications, polycystic ovary syndrome, reproductive hormonal treatments and menopause. Little is known about how diet interacts with CVD risk factors at various stages of a woman’s life. Long chain (LC) n-3 polyunsaturated fatty acid (PUFA) intakes are a key dietary factor that may impact risk of CVD throughout the life course differentially in men and women. Oestrogen enhances conversion of the plant n-3 PUFA, alpha-linolenic acid, to LCn-3 PUFA. Increasing the frequency of oily fish consumption or LCn-3 PUFA supplementation may be important for reducing coronary risk during the menopausal transition, during which time oestrogen levels decline and the increase in CVD risk factors is accelerated. Women are under-represented in the evidence base for CVD prevention following LC n-3 PUFA supplementation. Therefore it is not clear whether there are sex differences in response to treatment. Furthermore, there is a lack of evidence on optimal intakes of LC n-3 PUFA across the lifespan for CVD prevention in women.

With increasing numbers of persons living with dementia and their higher rates of hospitalizations, it is necessary to ensure they receive appropriate and effective acute care; yet, acute care environments are often harmful for persons with dementia. There is a lack of dementia education for acute health care providers in Canada. Scotland presently delivers a dementia education program for health care providers, known as the Scottish National Dementia Champions Programme. The objective of this Policy and Practice Note is to present the collaborative work of Scottish experts and Canadian stakeholders to adapt the Dementia Champions Programme for use in Canada. This work to date includes: (a) an environmental scan of Canadian dementia education for acute health care providers; (b) key informant interviews; and, (c) findings from a two-day planning meeting. The results of this collaborative work can and are being used to inform the next steps to develop and pilot a Canadian dementia education program.

Trustworthiness is typically regarded as a desirable feature of national identification systems (NISs); but the variegated nature of the trustor communities associated with such systems makes it difficult to see how a single system could be equally trustworthy to all actual and potential trustors. This worry is accentuated by common theoretical accounts of trustworthiness. According to such accounts, trustworthiness is relativized to particular individuals and particular areas of activity, such that one can be trustworthy with regard to some individuals in respect of certain matters, but not trustworthy with regard to all trustors in respect of every matter. The present article challenges this relativistic approach to trustworthiness by outlining a new account of trustworthiness, dubbed the expectation-oriented account. This account allows for the possibility of an absolutist (or one-place) approach to trustworthiness. Such an account, we suggest, is the approach that best supports the effort to develop NISs. To be trustworthy, we suggest, is to minimize the error associated with trustor expectations in situations of social dependency (commonly referred to as trust situations), and to be trustworthy in an absolute sense is to assign equal value to all expectation-related errors in all trust situations. In addition to outlining the features of the expectation-oriented account, we describe some of the implications of this account for the design, development, and management of trustworthy NISs.

Sleep habits are directly related to risk of obesity, and this relationship may be partly mediated through food choices and eating behaviour. Short sleep duration, impaired sleep quality and suboptimal sleep timing are all implicated in weight gain and adverse cardiometabolic health, at least partly mediated through their associations with diet quality. Short-term sleep restriction leads to increased energy intake, and habitually short sleepers report dietary intakes that indicate a less healthy diet compared with adequate sleepers. Evidence is emerging that sleep extension interventions in short sleepers may reduce intake of sugars and overall energy intake. Poor sleep quality, night shift work patterns and social jetlag are also associated with lower diet quality and consumption of energy-dense foods. Incorporating sleep advice into weight management interventions may be more effective than energy-restricted diets and exercise advice alone. However, there are a lack of intervention studies that aim to lengthen sleep, improve sleep quality or adjust irregular sleep timing to investigate the impact on dietary intakes and eating behaviour in participants aiming to lose weight or maintain weight loss. Finally, future research should take account of individual characteristics such as age, sex, life stage and changing working practices when designing combined lifestyle interventions including sleep behaviour change for health and well-being.

Turning the wealth of health and social data into insights to promote better public health, while enabling more effective personalized care, is critically important for society. In particular, social determinants of health have a significant impact on individual health, well-being, and inequalities in health. However, concerns around accessing and processing such sensitive data, and linking different datasets, involve significant challenges, not least to demonstrate trustworthiness to all stakeholders. Emerging datatrust services provide an opportunity to address key barriers to health and social care data linkage schemes, specifically a loss of control experienced by data providers, including the difficulty to maintain a remote reidentification risk over time, and the challenge of establishing and maintaining a social license. Datatrust services are a sociotechnical evolution that advances databases and data management systems, and brings together stakeholder-sensitive data governance mechanisms with data services to create a trusted research environment. In this article, we explore the requirements for datatrust services, a proposed implementation—the Social Data Foundation, and an illustrative test case. Moving forward, such an approach would help incentivize, accelerate, and join up the sharing of regulated data, and the use of generated outputs safely amongst stakeholders, including healthcare providers, social care providers, researchers, public health authorities, and citizens.

The Winter Conference 2021 focused on the theme of obesity and the brain, with symposia on the consequences of obesity on brain function, developments in behavioural change interventions, neurobiology of appetite regulation and obesity treatment, and personalised medicine for obesity prevention and treatment. The first plenary lecture discussed sweetness perceptions and how non-nutritive sweeteners may lead to a mismatch between metabolic signals and reward systems in the brain, and the second plenary lecture presented novel approaches to the treatment of binge-eating disorders. This short report summarises the content of these scientific sessions.

New occurrences of flask-shaped and envelope-bearing microfossils, including the predominantly Cambrian taxon Granomarginata, are reported from new localities, as well as from earlier in time (Ediacaran) than previously known. The stratigraphic range of Granomarginata extends into the Cambrian System, where it had a cosmopolitan distribution. This newly reported Ediacaran record includes areas from Norway (Baltica), Newfoundland (Avalonia) and Namibia (adjacent to the Kalahari Craton), and puts the oldest global occurrence of Granomarginata in the Indreelva Member (< 563 Ma) of the Stáhpogieddi Formation on the Digermulen Peninsula, Arctic Norway. Although Granomarginata is rare within the assemblage, these new occurrences together with previously reported occurrences from India and Poland, suggest a potentially widespread palaeogeographic distribution of Granomarginata through the middle–late Ediacaran interval. A new flask-shaped microfossil Lagoenaforma collaris gen. et sp. nov. is also reported in horizons containing Granomarginata from the Stáhpogieddi Formation in Norway and the Dabis Formation in Namibia, and flask-shaped fossils are also found in the Gibbett Hill Formation in Newfoundland. The Granomarginata–Lagoenaforma association, in addition to a low-diversity organic-walled microfossil assemblage, occurs in the strata postdating the Shuram carbon isotope excursion, and may eventually be of use in terminal Ediacaran biostratigraphy. These older occurrences of Granomarginata add to a growing record of body fossil taxa spanning the Ediacaran–Cambrian boundary.

Strong associations between neural tube defects (NTDs) and monozygotic (MZ) twinning have long been noted, and it has been suggested that NTD cases who do not present as MZ twins may be the survivors of MZ twinning events. We have recently shown that MZ twins carry a strong, distinctive DNA methylation signature and have developed an algorithm based on genomewide DNA methylation array data that distinguishes MZ twins from dizygotic twins and other relatives at well above chance level. We have applied this algorithm to published methylation data from five fetal tissues (placental chorionic villi, kidney, spinal cord, brain and muscle) collected from spina bifida cases (n = 22), anencephalic cases (n = 15) and controls (n = 19). We see no difference in signature between cases and controls, providing no support for a common etiological role of MZ twinning in NTDs. The strong associations therefore continue to await elucidation.

The risk of sudden cardiac death (SCD) is doubled when a patient with chronic kidney disease (CKD) stage 5 starts haemodialysis. Low heart rate variability (HRV) has been reported to be independently associated with increased risk of SCD and all cardiac death in haemodialysis patients. Long chain n-3 polyunsaturated fatty acids (LC n-3 PUFA; 20:5n-3, EPA and 22:6n-3, DHA) may exert anti-arrhythmic effects on cardiac myocytes. Haemodialysis patients have lower serum LC n-3 PUFA levels compared to populations without CKD. Few studies have investigated the relationship between LC n-3 PUFA and HRV in patients with CKD. This study aimed to characterise the variability of LC n-3 PUFA status in patients who recently commenced haemodialysis, and to investigate relationships between LC n-3 PUFA status and HRV. A cross-sectional study was conducted in adults aged 40–80 years with CKD commencing haemodialysis (within 6–10 weeks) (NRES research ethics committee ref: 14/LO/0186). At 2 separate study days, pre-dialysis blood samples were taken to measure fatty acid composition by GC, and HRV monitors (Actiheart, CamNtech Ltd, UK) were fitted after dialysis had started to monitor parameters of cardiac autonomic function during dialysis, during the night, and for a total of 24 h. Forty-five patients (mean age 58 y, SD 9, 20 females/25 males) completed data collection at least once; 91% presented hypertension and 39% had type 2 diabetes. Sample mean omega-3 index (O3I; EPA + DHA as a % of fatty acids in erythrocyte membranes) was very low (3.45%, SD 1.25; median 3.26 %, IQR 1.32); only 2 individuals had O3I > 5%. Variability in erythrocyte EPA (median 0.66 %, IQR 0.42) and DHA (median 2.40 %, IQR 1.32) was limited. Most HRV parameters did not significantly correlate with O3I following adjustment (e.g. age, BMI, β-blockers). Plasma EPA significantly positively correlated with overall and longer phase components of HRV and significantly negatively correlated with beat-to-beat variability over 24 h after full adjustment for confounders. This suggests that although higher circulating EPA concentrations were associated with better cardiac responsivity to environmental stimulations over 24 h, they were also associated with poorer parasympathetic tone (the predominant influence on beat-to-beat HRV). No correlations were observed between plasma DHA and HRV. The divergent pattern of relationships between plasma EPA versus DHA and HRV raises the theory that patients commencing haemodialysis may have compromised conversion of EPA to DHA which may impair vagally-mediated regulation of cardiac autonomic function, a potential mechanism for high risk of SCD.

Diets with a high-glycaemic load may increase the risk of type 2 diabetes. Food and beverages containing large amounts of highly bioaccessible starch and sugars induce pronounced postprandial blood glucose concentrations. Chronic exposure to sharp blood glucose peaks can lead to oxidative stress and pancreatic beta-cell dysfunction. Fruit polyphenols may help to limit the glucose excursion following a high-carbohydrate meal.

Our previous research showed that 1.8 g polyphenol-rich apple extract (AE) mixed into a drink consumed before a high starch + sucrose meal, inhibited the incremental area under the curve of plasma glucose during the early absorption-driven postprandial phase (0–30 min) by 52% relative to a placebo drink and meal. Our latest dose-response trial showed that the glycaemic response to starch and sucrose was modified by 0.9 g AE. Possible mechanisms include activity inhibition of carbohydrate digestive enzymes and/or glucose absorption (SGLT1/GLUT2 transport). The AE is uniquely high in phlorizin (10.6%) – a strong inhibitor of SGLT1. However, evidence shows that other apple polyphenols may also inhibit SGLT1.

The primary aim of our work was to explore the effect of different mixtures of apple polyphenols on gut transporters involved in glucose uptake. Acute dose-response effect of the AE and three fractions of AE (20%, 40% and 80% methanol elution during fractionation) on total glucose transport were investigated in Caco-2/TC7 cells. Uptake media (10min) contained, except for controls, increasing concentrations of AE/fractions (0–4.5mg/ml) incorporating the physiological range estimated to be present in the small intestine after ingestion of clinical trial test drinks. Glucose transport under sodium-dependent conditions was determined by radiochemical detection of Glucose D-[14C(U)] and Glucose L-[1-14C].A 47% decrease in total glucose uptake was observed with 1.12mg/ml AE (i.e. clinical trial highest physiological dose) v control (P = 0.03). Dose-response experiments showed IC50were: 1.29 mg/ml, 0.31 mg/ml and 0.88 mg/ml for AE (mg/g: 79 phlorizin; 26 epicatechin; 4 quercetin), 80% fraction (mg/g: 101 phlorizin; 26 epicatechin; 38 quercetin), 40% fraction (mg/g: 83 phlorizin; 20 epicatechin; 7 quercetin), respectively. The 20% fraction (mg/g: 4 phlorizin; 12 epicatechin; 2 quercetin) had no effect on glucose transport.

We have gained greater understanding of a potential mechanism for the anti-hyperglycaemic properties of apple polyphenols, supporting potential applications of the AE in functional foods/beverages. Our in vitro data suggest that a combination of higher amounts of phlorizin and quercetin may be important to maximise intestinal glucose uptake inhibition.