Dr Kathryn Hart


Senior Lecturer in Nutrition and Dietetics
PhD (Nutrition), BSc (Hons) Nutrition & Dietetics
+44 (0)1483 686438
40 AY 03
Weds, Thurs, Friday

Biography

Areas of specialism

Nutrition in early life; Dietary assessment

University roles and responsibilities

  • Level 4 co-ordinator
  • Personal tutor across all UG and PGT levels
  • Academic representative on Dietetic Stakeholder Committee

    My qualifications

    2013
    Advanced Nutrition Leadership
    European Nutrition Leadership Platform
    2008
    Diploma in Advanced Dietetic Practice
    British Dietetic Association
    2007
    Postgraduate Certificate in Academic Practice
    University of Surrey
    2003
    PhD (Nutrition)
    University of Surrey
    1999
    BSc (Hons) Nutrition & Dietetics
    University of Surrey

    Affiliations and memberships

    British Dietetic Association
    Full member
    Member of the Paediatric and Freelance Specialist groups
    Health and Care Professions Council
    Registered Dietitian
    Nutrition Society
    Full member
    Member of the Training and Education Committee

    Academic networks

      Research projects

      Research collaborations

      Supervision

      Postgraduate research supervision

      My teaching

      Courses I teach on

      Undergraduate

      Postgraduate taught

      My publications

      Highlights

      Tripkovic L, Wilson LR, Hart K, Johnsen S, de Lusignan S, Smith CP, Bucca G, Penson S, Chope G, Elliott R, Hyppönen E, Berry JL, Lanham-New SA (2017) Daily supplementation with 15 μg vitamin D2 compared with vitamin D3 to increase wintertime 25-hydroxyvitamin D status in healthy South Asian and white European women: a 12-wk randomized, placebo-controlled food-fortification trial. Am J Clin Nutr. doi: 10.3945/ajcn.116.138693.

      Smith TJ. Tripkovic L, Damsgaard CT, Mølgaard C, Ritz C, Wilson-Barnes SL, Hart KH (2016) Estimation of the dietary requirement for vitamin D in adolescents aged 14-18 years: a dose-response, double-blind, randomized placebo-controlled trial. Am J Clin Nutr, 104(5), 1301-1309.

      Tripkovic L, Lambert H, Hart K, Smith CP, Bucca G, Penson S, Chope G, Hyppönen E, Berry J, Vieth R, Lanham-New S (2012) Comparison of vitamin D2 and vitamin D3 supplementation in raising serum 25-hydroxyvitamin D status: a systematic review and meta-analysis. Am J Clin Nutr;95(6):1357-64.

      Publications

      M Champion, M Hayward, K Hart (2006)Interprofessional education: Even clinical psychologists can do it, In: Clinical Psychology Forum(167)pp. 38-41

      Clinical psychology trainees and dietetic students came together to learn from and with each other. This article reports some of the experiences of those involved.

      OA Hakim, A Darling, S Starkey, M Wong, F Shojaee-Moradie, K Hart, L Morgan, J Berry, A Umpleby, B Griffin, S Lanham-New (2010)POOR BONE HEALTH AND INCREASED CARDIOVASCULAR DISEASE RISK: EVIDENCE OF A LINK IN THE D-FINES STUDY POPULATION, In: OSTEOPOROSIS INTERNATIONAL21pp. 96-97
      M Mendes, Kath Hart, Susan Lanham-New, Patricia B. Botelho (2020)Suppression of Parathyroid Hormone as a Proxy for Optimal Vitamin D Status: Further Analysis of Two Parallel Studies in Opposite Latitudes, In: Nutrients12(4)942 MDPI

      Optimal vitamin D status has commonly been defined as the level of 25-hydroxyvitamin D (25(OH)D) at which parathyroid hormone (PTH) concentrations would be maximally suppressed, represented by an observed minimum plateau. Previous findings indicate a large variation in this plateau, with values ranging from

      There is still limited data on the association between 25-hydroxyvitamin D (25(OH)D), parathyroid hormone (PTH), and bone health in healthy younger adults, particularly in Latin America. This cross-sectional analysis aimed to investigate the associations of 25(OH)D and plasma PTH concentrations with bone parameters, and potential confounders, in women living in a high (England) or low (Brazil) latitude country. Bone was assessed by either peripheral quantitative computed tomography (pQCT) (England) or dual-energy x-ray absorptiometry (DXA) scan (Brazil), serum 25(OH)D concentrations by high performance liquid chromatography tandem mass spectrometry (HPLC-MS) and PTH by the chemiluminescent method. In participants living in England, total volumetric bone mineral density (vBMD) was significantly higher in women

      Marcela M. Mendes, Andrea L. Darling, Kathryn H. Hart, Stephen Morse, Richard Murphy, Susan A. Lanham-New (2019)Impact of high latitude, urban living and ethnicity on 25-hydroxyvitamin D status: A need for multidisciplinary action?, In: The Journal of Steroid Biochemistry and Molecular Biology188pp. pp 95-102 Elsevier

      The effects of urban living on health are becoming increasingly important, due to an increasing global population residing in urban areas. Concomitantly, due to immigration, there is a growing number of ethnic minority individuals (African, Asian or Middle Eastern descent) living in westernised Higher Latitude Countries (HLC) (e.g. Europe, Canada, New Zealand). Of concern is the fact that there is already a clear vitamin D deficiency epidemic in HLC, a problem which is likely to grow as the ethnic minority population in these countries increases. This is because 25-hydroxyvitamin D (25(OH)D) status of ethnic groups is significantly lower compared to native populations. Environmental factors contribute to a high prevalence of vitamin D deficiency in HLC, particularly during the winter months when there is no sunlight of appropriate wavelength for vitamin D synthesis via the skin. Also, climatic factors such as cloud cover may reduce vitamin D status even in the summer. This may be further worsened by factors related to urban living, including air pollution, which reduces UVB exposure to the skin, and less occupational sun exposure (may vary by individual HLC). Tall building height may reduce sun exposure by making areas more shaded. In addition, there are ethnicity-specific factors which further worsen vitamin D status in HLC urban dwellers, such as low dietary intake of vitamin D from foods, lower production of vitamin D in the skin due to increased melanin and reduced skin exposure to UVB due to cultural dress style and sun avoidance. A multidisciplinary approach applying knowledge from engineering, skin photobiology, nutrition, town planning and social science is required to prevent vitamin D deficiency in urban areas. Such an approach could include reduction of air pollution, modification of sun exposure advice to emphasise spending time each day in non-shaded urban areas (e.g. parks, away from tall buildings), and advice to ethnic minority groups to increase sun exposure, take vitamin D supplements and/or increase consumption of vitamin D rich foods in a way that is safe and culturally acceptable. This review hopes to stimulate further research to assess the impact of high latitude, urban environment and ethnicity on the risk of vitamin D deficiency.

      AL Darling, OA Hakim, KH Hart, SA Lanham-New (2011)Vitamin D intakes in UK South Asian and Caucasian postmenopausal women: a novel longitudinal analysis from 2006-2010, In: PROCEEDINGS OF THE NUTRITION SOCIETY70(OCE6)pp. E349-E349
      KH Hart, J Power (2007)Disorders of the colon, In: Manual of dietetic practicepp. 486-495 Wiley-Blackwell
      L Tripkovic, L Wilson, K Hart, S Lanham-New (2012)Comparison of vitamin D-2 and vitamin D-3 supplementation in increasing serum 25-hydroxyvitamin D status: a systematic review and meta-analysis Reply, In: AMERICAN JOURNAL OF CLINICAL NUTRITION96(5)pp. 1153-1154 AMER SOC NUTRITION-ASN
      A.L. Darling, K.H. Hart, S. Arber, J.L. Berry, P.L. Morgan, B.A. Middleton, S. Lanham-New, D.J. Skene (2019)25-Hydroxyvitamin D status, light exposure and sleep quality in UK dwelling South Asian and Caucasian postmenopausal women, In: The Journal of Steroid Biochemistry and Molecular Biology189pp. pp 265-273 Elsevier

      There is a lack of research into 25-hydroxyvitamin D (25(OH)D) status, light exposure and sleep patterns in South Asian populations. In addition, results of research studies are conflicting as to whether there is an association between 25(OH)D status and sleep quality. We investigated 25(OH)D status, self-reported and actigraphic sleep quality in n = 35 UK dwelling postmenopausal women (n = 13 South Asians, n = 22 Caucasians), who kept daily sleep diaries and wore wrist-worn actiwatch (AWL-L) devices for 14 days. A subset of n = 27 women (n = 11 South Asian and n = 16 Caucasian) also wore a neck-worn AWL-L device to measure their light exposure. For 25(OH)D concentration, South Asians had a median ± IQR of 43.8 ± 28.2 nmol/L, which was significantly lower than Caucasians (68.7 ± 37.4 nmol/L)(P = 0.001). Similarly, there was a higher sleep fragmentation in the South Asians (mean ± SD 36.9 ± 8.9) compared with the Caucasians (24.7 ± 7.1)(P = 0.002). Non-parametric circadian rhythm analysis of rest/activity patterns showed a higher night-time activity (L5) (22.6 ± 14.0 vs. 10.5 ± 4.4; P = 0.0008) and lower relative amplitude (0.85 ± 0.07 vs. 0.94 ± 0.02; P ˂ 0.0001) in the South Asian compared with the Caucasian women. More South Asians (50%) met the criteria for sleep disorders (PSQI score ˃5) than did Caucasians (27%) (P = 0.001, Fishers Exact Test). However, there was no association between 25(OH)D concentration and any sleep parameter measured (P ˃ 0.05) in either ethnic group. South Asians spent significantly less time in illuminance levels over 200 lx (P = 0.009) than did Caucasians. Overall, our results show that postmenopausal South Asian women have lower 25(OH)D concentration than Caucasian women. They also have higher sleep fragmentation, as well as a lower light exposure across the day. This may have detrimental implications for their general health and further research into sleep quality and light exposure in the South Asian ethnic group is warranted.

      Kaitlin Day, Alastair Kwok, Alison Evans, Fernanda Mata, Antonio Verdejo-Garcia, Kath Hart, Leigh Ward, Helen Truby (2018)Comparison of a Bioelectrical Impedance Device against the Reference Method Dual Energy X-Ray Absorptiometry and Anthropometry for the Evaluation of Body Composition in Adults, In: Nutrients10(10)1469 MDPI

      This study aimed to compare the use of the bioelectrical impedance device (BIA) seca® mBCA 515 using dual X-ray absorptiometry (DXA) as a reference method, for body composition assessment in adults across the spectrum of body mass indices. It explores the utility of simple anthropometric measures (the waist height ratio (WHtR) and waist circumference (WC)) for the assessment of obesity. In the morning after an overnight fast (10 h), 30 participants underwent a body composition DXA (GE iDXA) scan, BIA (seca 515), and anthropometric measures. Compared to the DXA reference measure, the BIA underestimated fat mass (FM) by 0.32 kg (limits of agreement

      O Hakim, S Lanham-New, F Shojaee-Moradie, L Morgan, A Umpleby, B Griffin, J Berry, R Eastell, F Gossiel, R Hannon, K Hart (2010)POORER LIPID PROFILE ARE ASSOCIATED WITH INCREASED BONE RESORPTION AND PARATHYROID HORMONE: PRELIMINARY RESULTS OF THE D-FINES STUDY, In: OSTEOPOROSIS INTERNATIONAL21(Suppl)pp. S506-S507
      L Tripkovic, NC Muirhead, KH Hart, GS Frost, JK Lodge (2015)The effects of a diet rich in inulin or wheat fibre on markers of cardiovascular disease in overweight male subjects, In: JOURNAL OF HUMAN NUTRITION AND DIETETICS28(5)pp. 476-485 WILEY-BLACKWELL
      Andrea Darling, Kathryn Hart, HM Macdonald, K Horton, AR Kang’ombe, JL Berry, Susan Lanham-New (2012)Vitamin D deficiency in UK South Asian Women of childbearing age: a comparative longitudinal investigation with UK Caucasian women, In: Osteoporosis International Springer Verlag

      This is the first 1-year longitudinal study which assesses vitamin D deficiency in young UK-dwelling South Asian women. The findings are that vitamin D deficiency is extremely common in this group of women and that it persists all year around, representing a significant public health concern. Introduction There is a lack of longitudinal data assessing seasonal variation in vitamin D status in young South Asian women living in northern latitudes. Studies of postmenopausal South Asian women suggest a lack of seasonal change in 25-hydroxy vitamin D [25(OH)D], although it is unclear whether this is prevalent among premenopausal South Asians. We aimed to evaluate, longitudinally, seasonal changes in 25(OH)D and prevalence of vitamin D deficiency in young UK-dwelling South Asian women as compared with Caucasians. We also aimed to establish the relative contributions of dietary vitamin D and sun exposure in explaining serum 25(OH)D. Methods This is a 1-year prospective cohort study assessing South Asian (n = 35) and Caucasian (n = 105) premenopausal women living in Surrey, UK (51° N), aged 20–55 years. The main outcome measured was serum 25(OH)D concentration. Secondary outcomes were serum parathyroid hormone, self-reported dietary vitamin D intake and UVB exposure by personal dosimetry. Results Serum 25(OH)D 

      R Hollingdale, D Sutton, K Hart (2008)Facilitating dietary change in renal disease: investigating patients' perspectives., In: J Ren Care34(3)pp. 136-142

      BACKGROUND: Renal diets are arguably the most restrictive for any patient group, and many of the restrictions contradict current recommendations for healthy eating. OBJECTIVES. This study aims to explore the knowledge and beliefs of chronic kidney disease (CKD) patients about the role of diet in their disease presentation and management. METHODS: Focus groups (FG) with nephrology and dialysis patients informed the development of a questionnaire. Patient experiences and knowledge of diet-disease links and their education needs were explored. RESULTS: Renal diets were not always perceived as compatible with other dietary advice, and often difficult to integrate with family and social occasions. Eighty percent respondents said they would like to receive dietary advice as soon as they know they have renal damage. Renal dietitians were identified as the most reliable and trustworthy source of dietary information, followed by renal specialist doctors. CONCLUSION: Early dietetic intervention would be welcomed by patients, with group work and 'expert patient' assistance offering one means of delivering this service in a patient-centred way.

      Philippa S. Gibson, Alberto Quaglia, Anil Dhawan, Huihai Wu, Sue Lanham-New, Kath Hart, Emer Fitzpatrick, J. Bernadette Moore (2018)Vitamin D status and associated genetic polymorphisms in a cohort of UK children with non-alcoholic fatty liver disease, In: Pediatric Obesity13(7)pp. 433-441 Wiley

      Background: Vitamin D deficiency has been associated with non-alcoholic fatty liver disease (NAFLD). However, the role of polymorphisms determining vitamin D status remains unknown. Objectives: To determine in UK children with biopsy-proven NAFLD: (i) vitamin D status throughout a 12-month period; (ii) interactions between key vitamin D-related genetic variants (NADSYN1/DHCR7, VDR, GC, CYP2R1) and disease severity. Methods: In 103 pediatric patients with NAFLD, serum 25-hydroxyvitamin D (25OHD) levels and genotypes were determined contemporaneously to liver biopsy and examined in relation to NAFLD activity score and fibrosis stage. Results: Only 19.2% of children had adequate vitamin D status; most had mean 25OHD levels considered deficient (

      HM Macdonald, A Mavroeidi, WD Fraser, AL Darling, AJ Black, L Aucott, F O'Neill, K Hart, JL Berry, SA Lanham-New, DM Reid (2011)Sunlight and dietary contributions to the seasonal vitamin D status of cohorts of healthy postmenopausal women living at northerly latitudes: a major cause for concern?, In: Osteoporos Int22(9)pp. 2461-2472

      We assessed sunlight and dietary contributions to vitamin D status in British postmenopausal women. Our true longitudinal 25-hydroxyvitamin D (25(OH)D) measurements varied seasonally, being lower in the north compared to the south and lower in Asian women. Sunlight exposure in summer and spring provided 80% total annual intake of vitamin D.

      L Tripkovic, L Wilson, K Hart, S Lanham-New (2013)Associations between dietary intake and volumetric bone mineral density in South Asian and Caucasian women: preliminary analysis of the D2-D3 Study, In: PROCEEDINGS OF THE NUTRITION SOCIETY72(OCE4)pp. E216-E216 CAMBRIDGE UNIV PRESS
      PS Gibson, E Fitzpatrick, A Quaglia, A Dhawan, H Wu, K Hart, S Lanham-New, JB Moore (2014)Association of NADSYN1, DHCR7, GC and VDR Genotypes With Steatosis And Liver Inflammation in UK Paediatric Non-Alcoholic Fatty Liver Disease Patients, In: HEPATOLOGY60pp. 967A-967A
      L Tripkovic, H Lambert, K Hart, CP Smith, G Bucca, S Penson, G Chope, E Hyppönen, J Berry, R Vieth, S Lanham-New (2012)Comparison of vitamin D2 and vitamin D3 supplementation in raising serum 25-hydroxyvitamin D status: a systematic review and meta-analysis., In: Am J Clin Nutr95(6)pp. 1357-1364 American Society for Nutrition

      Currently, there is a lack of clarity in the literature as to whether there is a definitive difference between the effects of vitamins D(2) and D(3) in the raising of serum 25-hydroxyvitamin D [25(OH)D].

      Taryn J Smith, Laura Tripkovic, Hanne Hauger, Camilla T Damsgaard, Christian Mølgaard, Susan Lanham-New, Kathryn H Hart (2018)Winter Cholecalciferol Supplementation at 51°N Has No Effect on Markers of Cardiometabolic Risk in Healthy Adolescents Aged 14-18 Years, In: The Journal of Nutrition148(8)pp. 1269-1275 American Society for Nutrition

      Background: Epidemiological studies have supported inverse associations between low serum 25-hydroxyvitamin D [25(OH)D] and cardiometabolic risk markers, but few randomized trials have investigated the effect of vitamin D supplementation on these markers in adolescents. Objective: The objective of this study was to investigate the effect of winter-time cholecalciferol (vitamin D3) supplementation on cardiometabolic risk markers in white, healthy 14-18 year-old adolescents in the UK (51°N) as part of the ODIN Project. Methods: In a dose-response trial, 110 adolescents (15.9±1.4 years; 43% male; 81% normal weight) were randomly assigned to receive 0, 10 or 20 μg/day vitamin D3 for 20 weeks (October-March). Cardiometabolic risk markers including BMI-for-age z-score (BMIz), waist circumference, systolic and diastolic blood pressure, fasting plasma triglycerides, cholesterol (total, HDL, LDL and total:HDL) and glucose were measured at baseline and endpoint as secondary outcomes, together with serum 25(OH)D. Intervention effects were evaluated in linear regression models as between-group differences at endpoint, adjusted for the baseline value of the outcome variable and additionally for age, sex, Tanner stage, BMIz and baseline serum 25(OH)D. Results: Mean±SD baseline serum 25(OH)D was 49.1±12.3 nmol/L and differed between groups at endpoint with concentrations of 30.7±8.6, 56.6±12.4 and 63.9±10.6 nmol/L in the 0, 10 and 20 μg/day groups respectively (P≤0.001). Vitamin D3 supplementation had no effect on any of the cardiometabolic risk markers (all P>0.05), except for lower HDL (-0.12 mmol/L, 95% CI -0.21, 0.04, P=0.003) and total cholesterol (-0.21 mmol/L, 95% CI -0.42, 0.00, P=0.05) in the 20 compared to the 10 μg/day group, which disappeared in the fully adjusted analysis (P=0.27 and P=0.30 respectively). Conclusions: Supplementation with vitamin D3 at 10 and 20 μg/25 day, which increased serum 25(OH)D concentrations during the winter-time, had no effect on markers of cardiometabolic risk in healthy 14-18 year-old adolescents. This trial was registered at clinicaltrials.gov as NCT02150122.

      Philippa Gibson, Sarah Lang, Anil Dhawan, Emer Fitzpatrick, Michelle L Blumfield, Helen Truby, Kath Hart, Jennifer Moore (2017)Systematic Review: Nutrition and Physical Activity in the Management of Paediatric Non-alcoholic Fatty Liver Disease, In: Journal of Pediatric Gastroenterology and Nutrition65(2)pp. 141-149 Lippincott, Williams & Wilkins [

      OBJECTIVES: The aim of the study was to evaluate efficacy of nutrition and physical activity interventions in the clinical management of paediatric nonalcoholic fatty liver disease. The prevalence of paediatric nonalcoholic fatty liver disease continues to rise alongside childhood obesity. Weight loss through lifestyle modification is currently first-line treatment, although supplementation of specific dietary components may be beneficial. METHODS: Medline, CINAHL, EMBASE, Scopus, and Cochrane Libraries were systematically searched to identify randomized controlled trials assessing nutritional and physical activity interventions. Primary outcome measures were changes to liver biomarkers assessed by imaging, histology, or serum liver function tests. Study quality was evaluated using the American Dietetic Association Quality Criteria Checklist. RESULTS: Fifteen articles met eligibility criteria investigating nutritional supplementation (vitamin E [n = 6], probiotics [n = 2], omega-3 fatty acids [n = 5]), dietary modification (low glycaemic load [n = 1] and reducing fructose intake [n = 1]). No randomized controlled trials examining physical activity interventions were identified. Vitamin E was ineffective at improving alanine transaminase levels, whereas omega-3 fatty acids decreased hepatic fat content. Probiotics gave mixed results, whereas reduced fructose consumption did not improve primary outcome measures. A low glycaemic load diet and a low-fat diet appeared equally effective in decreasing hepatic fat content and transaminases. Most studies were deemed neutral as assessed by the American Dietetic Association Quality Criteria Checklist. CONCLUSIONS: The limited evidence base inhibits the prescription of specific dietary and/or lifestyle strategies for clinical practice. General healthy eating and physical activity guidelines, promoting weight loss, should remain first-line treatment until high-quality evidence emerges that support specific interventions that offer additional clinical benefit.

      S Barr, K Hart, S Reeves, Y Jeanes (2007)Dietary composition of UK women with Polycystic Ovary Syndrome, In: ANNALS OF NUTRITION AND METABOLISM51pp. 345-346 KARGER
      Taryn Smith, Laura Tripkovic, Susan Lanham-New, Kathryn Hart (2017)Vitamin D in adolescence: evidence-based dietary requirements and implications for public health policy, In: Proceedings of the Nutrition Society.77(3)pp. 292-301 Cambridge University Press

      Vitamin D is a unique nutrient. Firstly, it acts as a pro-hormone and secondly, the requirement for vitamin D can be met by both endogenous synthesis from sunlight and by dietary sources. This complicates the determination of dietary requirements for vitamin D, which along with the definition of optimal vitamin D status, have been highly controversial and much debated over recent years. Adolescents are a population group at high risk of low vitamin D status, which is concerning given the important role of vitamin D, and calcium, in promoting normal bone mineralisation and attainment of peak bone mass during this rapid growth phase. Dietary vitamin D recommendations are important from a public health perspective in helping to avoid deficiency and optimise vitamin D status for health. However limited experimental data from winter-based dose-response randomised trials in adolescents has hindered the development of evidence-based dietary requirements for vitamin D in this population group. This review will highlight how specifically designed randomised trials and the approach adopted for estimating such requirements can lead to improved recommendations. Such data indicates that vitamin D intakes of between 10 and ~30 µg/day may be required to avoid deficiency and ensure adequacy in adolescents, considerably greater than the current recommendations of 10-15 µg/day. Finally this review will consider the implications of this on public health policy, in terms of future refinements of vitamin D requirement recommendations and prioritisation of public health strategies to help prevent vitamin D deficiency

      CG Mountford, NP Thompson, K Hart (2013)Can a community-based nutritional screening and intervention programme improve clinical outcomes in Newcastle elderly care home residents?, In: PROCEEDINGS OF THE NUTRITION SOCIETY72(OCE4)pp. E250-E250 CAMBRIDGE UNIV PRESS
      AL Darling, OA Hakim, K Horton, MA Gibbs, L Cui, JL Berry, SA Lanham-New, KH Hart (2013)Adaptations in tibial cortical thickness and total volumetric bone density in postmenopausal South Asian women with small bone size., In: Bone55(1)pp. 36-43

      There is some evidence that South Asian women may have an increased risk of osteoporosis compared with Caucasian women, although whether South Asians are at increased risk of fracture is not clear. It is unknown whether older South Asian women differ from Caucasian women in bone geometry. This is the first study, to the authors' knowledge, to use peripheral Quantitative Computed Tomography (pQCT) to measure radial and tibial bone geometry in postmenopausal South Asian women. In comparison to Caucasian women, Asian women had smaller bone size at the 4% (-18% p

      Taryn J Smith, Susan Lanham-New, Kath Hart (2017)Vitamin D in adolescents: Are current recommendations enough?, In: The Journal of Steroid Biochemistry and Molecular Biology173pp. 265-272 Elsevier

      Vitamin D is essential for bone development during adolescence and low vitamin D status during this critical period of growth may impact bone mineralization, potentially reducing peak bone mass and consequently increasing the risk of osteoporosis in adulthood. Therefore, the high prevalence of vitamin D inadequacy and deficiency in adolescent populations is of great concern. However, there is currently a lack of consensus on the 25-hydroxyvitamin D [25(OH)D] concentration, the widely accepted biomarker of vitamin D status, that defines adequacy, and the vitamin D intake requirements to maintain various 25(OH)D thresholds are not well established. While the current intake recommendations of 10–15 μg/day may be sufficient to prevent vitamin D deficiency (25(OH)D < 25–30 nmol/l), greater intakes may be needed to achieve the higher threshold levels proposed to represent adequacy (25(OH)D > 50 nmol/l). This review will address these concerns and consider if the current dietary recommendations for vitamin D in adolescents are sufficient.

      Louise Wilson, Laura Tripkovic, Kath Hart, Susan Lanham-New (2017)Vitamin D deficiency as a public health issue: using vitamin D2 or vitamin D3 in future fortification strategies, In: Proceedings of the Nutrition Society76(3)pp. 392-399 Cambridge University Press

      The role of vitamin D in supporting the growth and maintenance of the skeleton is robust; with recent research also suggesting a beneficial link between vitamin D and other nonskeletal health outcomes, including immune function, cardiovascular health and cancer. Despite this, vitamin D deficiency remains a global public health issue, with a renewed focus in the UK following the publication of Public Health England’s new Dietary Vitamin D Requirements. Natural sources of vitamin D (dietary and UVB exposure) are limited, and thus mechanisms are needed to allow individuals to achieve the new dietary recommendations. Mandatory or voluntary vitamin D food fortification may be one of the mechanisms to increase dietary vitamin D intakes and subsequently improve vitamin D status. However, for the food industry and public to make informed decisions, clarity is needed as to whether vitamins D2 and D3 are equally effective at raising total 25-hydroxyvitamin D (25(OH)D) concentrations as the evidence thus far is inconsistent. This review summarises the evidence to date behind the comparative efficacy of vitamins D2 and D3 at raising 25(OH)D concentrations, and the potential role of vitamin D food fortification as a public health policy to support attainment of dietary recommendations in the UK. The comparative efficacy of vitamins D2 and D3 has been investigated in several intervention trials, with most indicating that vitamin D3 is more effective at raising 25(OH)D concentrations. However, flaws in study designs (predominantly under powering) mean there remains a need for a large, robust randomised-controlled trial to provide conclusive evidence, which the future publication of the D2–D3 Study should provide (BBSRC DRINC funded: BB/ I006192/1). This review also highlights outstanding questions and gaps in the research that need to be addressed to ensure the most efficacious and safe vitamin D food fortification practices are put in place. This further research, alongside cost, availability and ethical considerations (vitamin D3 is not suitable for vegans), will be instrumental in supporting government, decision-makers, industry and consumers in making informed choices about potential future vitamin D policy and practice.

      Andrea Darling, Kathryn Hart, Susan Lanham-New, HM MacDonald, K Horton, AR Kang'Ombe, JL Berry (2013)Vitamin D deficiency in UK South Asian Women of childbearing age: A comparative longitudinal investigation with UK Caucasian women, In: Osteoporosis International24(2)pp. 477-488 Springer Verlag

      This is the first 1-year longitudinal study which assesses vitamin D deficiency in young UK-dwelling South Asian women. The findings are that vitamin D deficiency is extremely common in this group of women and that it persists all year around, representing a significant public health concern. Introduction: There is a lack of longitudinal data assessing seasonal variation in vitamin D status in young South Asian women living in northern latitudes. Studies of postmenopausal South Asian women suggest a lack of seasonal change in 25-hydroxy vitamin D [25(OH)D], although it is unclear whether this is prevalent among premenopausal South Asians. We aimed to evaluate, longitudinally, seasonal changes in 25(OH)D and prevalence of vitamin D deficiency in young UK-dwelling South Asian women as compared with Caucasians. We also aimed to establish the relative contributions of dietary vitamin D and sun exposure in explaining serum 25(OH)D. Methods: This is a 1-year prospective cohort study assessing South Asian (n = 35) and Caucasian (n = 105) premenopausal women living in Surrey, UK (51 N), aged 20-55 years. The main outcome measured was serum 25(OH)D concentration. Secondary outcomes were serum parathyroid hormone, self-reported dietary vitamin D intake and UVB exposure by personal dosimetry. Results: Serum 25(OH)D

      Jill Shawe, Kathryn Hart, Ann Robinson (2020)Lifestyle: Substance Use—Nicotine, Alcohol and Drugs, In: Preconception Health and Care: A Life Course Approachpp. 129-158 Springer

      Use of substances including alcohol, tobacco and drugs is common in people of reproductive age, can lead to dependence and is a major global health concern. Despite targeted public health policies and campaigns, population surveys (National Institute on Drug Abuse (NIH) 2020; European Drug Report 2019) continue to highlight widespread use of substances, often in combination, which have substantial negative implications for health in general and the potential to harm future generations (Stephenson et al. 2018). Healthcare professionals need to be aware of the complex psychological, physiological and social factors that may be linked to substance use and be prepared to offer counselling and referral for specialist services. Pregnancy, however, can be a ‘window of opportunity’ and a motivating factor for women and their partners to change their behaviour and minimise risk with help to quit or cut down on substance use (Solomon and Quinn 2004). Preconception care offers the opportunity to further reduce risk by helping to modify consumption prior to pregnancy.

      KH Hart (2007)Malabsorption, In: Manual of dietetic practicepp. 455-460 Wiley-Blackwell
      AL Darling, OA Hakim, KH Hart, JL Berry, SA Lanham-New (2012)POSTMENOPAUSAL SOUTH ASIAN WOMEN SHOW ADAPTATIONS IN TIBIAL CORTICAL THICKNESS AND VOLUMETRIC BONE MINERAL DENSITY TO COMPENSATE FOR SMALL OVERALL BONE SIZE, In: OSTEOPOROSIS INTERNATIONAL23pp. S584-S584
      K Hart, Y Nicolaidou, AO Musaiger, SM Alqallaf, F Al-Haddad (2013)Type 1 Diabetes in Children: The Bahraini Dilemma, In: PROCEEDINGS OF THE NUTRITION SOCIETY72(OCE4)pp. E298-E298 CAMBRIDGE UNIV PRESS
      AL Darling, KH Hart, DJ Skene, S Arber, SA Lanham-New (2014)Vitamin D status, functional ability and muscle strength in older South Asian and Caucasian women in the UK, In: PROCEEDINGS OF THE NUTRITION SOCIETY73(OCE1)pp. E23-E23
      Nicolas Farina, Fredrik Jernerén, Cheryl Turner, Kathryn Hart, Naji Tabet (2017)Homocysteine concentrations in the cognitive progression of Alzheimer's disease, In: Experimental Gerontology99pp. 146-150 Elsevier

      Objectives: Hyperhomocysteinemia in Alzheimer’s disease (AD) is widely reported and appears to worsen as the disease progresses. While active dietary intervention with vitamins B12 and folate decreases homocysteine blood levels, with promising clinical outcomes in Mild Cognitive Impairment (MCI), this so far has not been replicated in established AD populations. The aim of the study is to explore the relationship between hyperhomocystenemia and relevant vitamins as the disease progresses. Methods: In this longitudinal cohort study, 38 participants with mild to moderate AD were followed for an average period of 13 months. Plasma folate, vitamin B12 and homocysteine concentrations were measured at baseline and at follow-up. Dietary intake of B vitamins was also measured. Spearman’s correlations were conducted by homocysteine and B vitamin status. Results: As expected, cognitive status significantly declined over the follow-up period and this was paralleled by a significant increase in homocysteine concentrations (p=0.006). However, during this follow-up period there was no significant decline in neither dietary intake, nor the corresponding blood concentrations of vitamin B12/folate, with both remaining within normal values. Changes in blood concentrations of B vitamins were not associated with changes in homocysteine levels (p>0.05). Conclusion: In this study, the increase in homocysteine observed in AD patients as the disease progresses cannot be solely explained by dietary and blood levels of folate and vitamin B12. Other dietary and non-dietary factors may contribute to hyperhomocysteinemia and its toxic effect in AD, which needs to be explored to optimise timely intervention strategies.

      L Wilson, K Hart, S Lanham-New, L Tripkovic (2013)Vitamin D intakes and blood pressure in Caucasian and South Asian women aged 20-64 years - baseline analysis of the D2-D3 study, In: PROCEEDINGS OF THE NUTRITION SOCIETY72(OCE4)pp. E189-E189 CAMBRIDGE UNIV PRESS
      PS Gibson, S Lang, M Gilbert, D Kamat, S Bansal, ME Ford-Adams, AP Desai, A Dhawan, E Fitzpatrick, JB Moore, KH Hart (2015)Assessment of Diet and Physical Activity in Paediatric Non-Alcoholic Fatty Liver Disease Patients: A United Kingdom Case Control Study, In: NUTRIENTS7(12)pp. 9721-9733 MDPI AG

      Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in children, with prevalence rising alongside childhood obesity rates. This study aimed to characterise the habitual diet and activity behaviours of children with NAFLD compared to obese children without liver disease in the United Kingdom (UK). Twenty-four biopsy-proven paediatric NAFLD cases and eight obese controls without biochemical or radiological evidence of NAFLD completed a 24-h dietary recall, a Physical Activity Questionnaire (PAQ), a Dutch Eating Behavior Questionnaire (DEBQ) and a 7-day food and activity diary (FAD), in conjunction with wearing a pedometer. Groups were well matched for age and gender. Obese children had higher BMI z-scores (p = 0.006) and BMI centiles (p = 0.002) than participants with NAFLD. After adjusting for multiple hypotheses testing and controlling for differences in BMI, no differences in macro- or micronutrient intake were observed as assessed using either 24-h recall or 7-day FAD (p > 0.001). Under-reporting was prevalent (NAFLD 75%, Obese Control 87%: p = 0.15). Restrained eating behaviours were significantly higher in the NAFLD group (p = 0.005), who also recorded more steps per day than the obese controls (p = 0.01). In conclusion, this is the first study to assess dietary and activity patterns in a UK paediatric NAFLD population. Only a minority of cases and controls were meeting current dietary and physical activity recommendations. Our findings do not support development of specific dietary/ physical activity guidelines for children with NAFLD; promoting adherence with current general paediatric recommendations for health should remain the focus of clinical management.

      CA Hartwick, L Moreno, M Fisberg, K Hart, B Fielding, S Lenham-New, Z Richards (2014)An international study of food behavior and nutritional status of children from 21 countries, In: FASEB JOURNAL28(1)
      SJ Long, K Hart, LM Morgan (2002)The ability of habitual exercise to influence appetite and food intake in response to high- and low-energy preloads in man, In: BRITISH JOURNAL OF NUTRITION87(5)pp. 517-523 C A B I PUBLISHING
      O Hakim, A Darling, L Tripkovic, L Wilson, K Hart, J Berry, S Lanham-New (2015)DIFFERENCES IN VITAMIN D STATUS AND VOLUMETRIC BONE MINERAL DENSITY (VBMD) AT THE RADIUS AND TIBIA IN PREMENOPAUSAL CAUCASIAN, SOUTH ASIAN, AND ARAB FEMALES LIVING IN UK, In: OSTEOPOROSIS INTERNATIONAL26pp. S474-S474

      BACKGROUND: The number of children being diagnosed with type 1 diabetes mellitus (T1DM) is on the rise and has more than doubled in the past 10 years in Bahrain. Some studies have linked low vitamin D levels with an increased risk of diabetes. There are concerns regarding the variations in circulating 25(OH)D levels measured by different laboratories and by using different analytical techniques. OBJECTIVE: The aim of this study was to evaluate the vitamin D levels of newly diagnosed children with T1DM using the "gold standard method" with high-pressure liquid chromatography-tandem mass spectrometry methods compared to the chemiluminescence micro-particle immunoassay (CMIA) used in a hospital laboratory. SUBJECTS: Eighteen children, aged 6-12 years, who received a confirmed diagnosis of T1DM in 2014 were chosen as subjects. METHODS: Serum vitamin D levels were assessed in a hospital, while an extra aliquot of blood collected during routine blood collection after acquiring informed written consents from the subjects, and sent to Princess Al-Jawhara Center for Molecular Medicine and Inherited Disorders to be analyzed by ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). RESULTS: The mean age of the study group was 9±2 years. The mean total of 25(OH)D levels (D3 and D2) assessed by UPLC-MS/MS was 49.7±18.8, whereas the mean total of 25(OH)D levels obtained from the CMIA assay was 44.60±13.20. The difference in classification between the two methods was found to be statistically significant (P=0.004). A Bland-Altman plot showed a poor level of agreement between the two assay methods. The CMIA overestimated insufficient values and underestimated deficiency, when compared to UPLC-MS/MS. CONCLUSION: There was a statistically significant difference between the two assay methods with CMIA overestimating vitamin D insufficiency. Clinicians should be prudent in their assessment of a single vitamin D reading, when the gold standard method is not available or feasible.

      S Barr, K Hart, S Reeves, K Sharp, YM Jeanes (2011)Habitual dietary intake, eating pattern and physical activity of women with polycystic ovary syndrome, In: EUROPEAN JOURNAL OF CLINICAL NUTRITION65(10)pp. 1126-1132 NATURE PUBLISHING GROUP
      P Gibson, E Fitzpatrick, A Quaglia, A Dhawan, H Wu, K Hart, S Lanham-New, JB Moore (2015)Assessment of vitamin D status and genetic variation in vitamin-D related genes: key findings from a UK paediatric non-alcoholic fatty liver disease population, In: PROCEEDINGS OF THE NUTRITION SOCIETY74(OCE1)pp. E12-E12
      L Wilson, K Hart, R Elliott, CP Smith, G Bucca, S Penson, G Chope, E Hypponen, J Berry, S Lanham-New, L Tripkovic (2015)The D2-D3 Study: comparing the efficacy of 15 mu g/d vitamin D2 vs. D3 in raising vitamin D status in both South Asian and Caucasian women, and the ethical implications of placebo treatment, In: PROCEEDINGS OF THE NUTRITION SOCIETY74(OCE1)pp. E116-E116 CAMBRIDGE UNIV PRESS
      H Sanders, L Tripkovic, L Wilson, K Hart, S Lanham-New (2015)Comparison of reported dietary intakes between Caucasian and South Asian women and extent of under-reporting, In: PROCEEDINGS OF THE NUTRITION SOCIETY74(OCE1)pp. E148-E148 CAMBRIDGE UNIV PRESS
      C Sibbons, L Boyle, GC Burdge, M Umpleby, KA Lilycrop, CA Hartwick, S Lanham-New, K Hart, BA Fielding (2015)Evaluation of fatty acid status in children of different nationalities, In: PROCEEDINGS OF THE NUTRITION SOCIETY74(OCE1)pp. E94-E94 CAMBRIDGE UNIV PRESS
      YM Jeanes, S Barr, K Smith, KH Hart (2009)Dietary management of women with polycystic ovary syndrome in the United Kingdom: the role of dietitians, In: JOURNAL OF HUMAN NUTRITION AND DIETETICS22(6)pp. 551-558 WILEY-BLACKWELL PUBLISHING, INC
      KH Hart (2007)Dietary Fibre, In: Manual of dietetic practice(2.5)pp. 180-186 Wiley-Blackwell
      L Tripkovic, L Wilson, K Hart, R Elliott, CP Smith, G Bucca, S Penson, G Chope, E Hypponen, J Berry, S Lanham-New (2015)The D2-D3 Study: a randomised, double-blind, placebo-controlled food-fortification trial in women, comparing the efficacy of 15ug/d vitamin D2 vs vitamin D3 in raising serum 25OHD levels, In: PROCEEDINGS OF THE NUTRITION SOCIETY74(OCE1)pp. E16-E16 CAMBRIDGE UNIV PRESS
      Andrea Darling, Kath Hart, MA Gibbs, Susan Lanham-New, F Gossiel, R Eastell, T Kantermann, K Horton, Sigurd Johnsen, JL Berry, DJ Skene, R Vieth (2014)Greater seasonal cycling of 25-hydroxyvitamin D is associated with increased parathyroid hormone and bone resorption, In: Osteoporosis International25(3)pp. 933-941

      This analysis assessed whether seasonal change in 25-hydroxyvitamin D concentration was associated with bone resorption, as evidenced by serum parathyroid hormone and C-terminal telopeptide concentrations. The main finding was that increased seasonal fluctuation in 25-hydroxyvitamin D was associated with increased levels of parathyroid hormone and C-terminal telopeptide. Introduction: It is established that adequate 25-hydroxyvitamin D (25(OH)D, vitamin D) concentration is required for healthy bone mineralisation. It is unknown whether seasonal fluctuations in 25(OH)D also impact on bone health. If large seasonal fluctuations in 25(OH)D were associated with increased bone resorption, this would suggest a detriment to bone health. Therefore, this analysis assessed whether there is an association between seasonal variation in 25(OH)D and bone resorption. Methods: The participants were (n = 279) Caucasian and (n = 88) South Asian women (mean (±SD); age 48.2 years (14.4)) who participated in the longitudinal Diet, Food Intake, Nutrition and Exposure to the Sun in Southern England study (2006-2007). The main outcomes were serum 25(OH)D, serum parathyroid hormone (sPTH) and serum C-terminal telopeptide of collagen (sCTX), sampled once per season for each participant. Results: Non-linear mixed modelling showed the (amplitude/mesor) ratio for seasonal change in log 25(OH)D to be predictive of log sPTH (estimate = 0.057, 95 % CI (0.051, 0.063), p < 0.0001). Therefore, individuals with a higher seasonal change in log 25(OH)D, adjusted for overall log 25(OH)D concentration, showed increased levels of log sPTH. There was a corresponding significant ability to predict the range of seasonal change in log 25(OH)D through the level of sCTX. Here, the corresponding parameter statistics were estimate = 0.528, 95 % CI (0.418, 0.638) and p ≤ 0.0001. Conclusions: These findings suggest a possible detriment to bone health via increased levels of sPTH and sCTX in individuals with a larger seasonal change in 25(OH)D concentration. Further larger cohort studies are required to further investigate these preliminary findings. © 2013 International Osteoporosis Foundation and National Osteoporosis Foundation.

      HM Macdonald, A Mavroeidi, WD Fraser, AL Darling, AJ Black, L Aucott, F O'Neill, K Hart, JL Berry, SA Lanham-New, DM Reid (2011)Erratum to: Sunlight and dietary contributions to the seasonal vitamin D status of cohorts of healthy postmenopausal women living at northerly latitudes: a major cause for concern?, In: Osteoporos Int
      Christina Rachel Sadler, Terri Grassby, Kathryn Hart, Monique Raats, Milka Sokolović, Lada Timotijevic (2021)Processed food classification: Conceptualisation and challenges, In: Trends in Food Science and Technology112pp. 149-162 Elsevier Ltd

      Processed foods are typically praised/revered for their convenience, palatability, and novelty; however, their healthfulness has increasingly come under scrutiny. Classification systems that categorise foods according to their “level of processing” have been used to predict diet quality and health outcomes and inform dietary guidelines and product development. However, the classification criteria used are ambiguous, inconsistent and often give less weight to existing scientific evidence on nutrition and food processing effects; critical analysis of these criteria creates conflict amongst researchers. We examine the underlying basis of food classification systems and provide a critical analysis of their purpose, scientific basis, and distinguishing features by thematic analysis of the category definitions. These classification systems were mostly created to study the relationship between industrial products and health. There is no consensus on what factors determine the level of food processing. We identified four defining themes underlying the classification systems: 1. Extent of change (from natural state); 2. Nature of change (properties, adding ingredients); 3. Place of processing (where/by whom); and 4. Purpose of processing (why, essential/cosmetic). The classification systems embody socio-cultural elements and subjective terms, including home cooking and naturalness. Hence, “processing” is a chaotic conception, not only concerned with technical processes. Most classification systems do not include quantitative measures but, instead, imply correlation between “processing” and nutrition. The concept of “whole food” and the role of the food matrix in relation to healthy diets needs further clarification; the risk assessment/management of food additives also needs debate. •Classifications were created to link processed foods to nutrition and health outcomes.•There is no consensus on what determines the level of food processing.•Classification includes the extent, nature of change, place and purpose of processing.•Processed food concepts relate to naturalness, additives, convenience, home cooking.•Food classifications embody social and cultural elements and subjective terms.

      NICOLA JOHNSTONE, Chiara Milesi, Olivia Burn, Bartholomeus van den Bogert, Arjen Nauta, KATHRYN HAYLEY HART, Paul T. Sowden, Philip W J Burnet, KATHRIN COHEN KADOSH (2021)Anxiolytic effects of a galacto-oligosaccharides prebiotic in healthy females (18-25 years) with corresponding changes in gut bacterial composition, In: Scientific reports11(1)pp. 8302-8302

      Current research implicates pre- and probiotic supplementation as a potential tool for improving symptomology in physical and mental ailments, which makes it an attractive concept for clinicians and consumers alike. Here we focus on the transitional period of late adolescence and early adulthood during which effective interventions, such as nutritional supplementation to influence the gut microbiota, have the potential to offset health-related costs in later life. We examined multiple indices of mood and well-being in 64 healthy females in a 4-week double blind, placebo controlled galacto-oligosaccharides (GOS) prebiotic supplement intervention and obtained stool samples at baseline and follow-up for gut microbiota sequencing and analyses. We report effects of the GOS intervention on self-reported high trait anxiety, attentional bias, and bacterial abundance, suggesting that dietary supplementation with a GOS prebiotic may improve indices of pre-clinical anxiety. Gut microbiota research has captured the imagination of the scientific and lay community alike, yet we are now at a stage where this early enthusiasm will need to be met with rigorous research in humans. Our work makes an important contribution to this effort by combining a psychobiotic intervention in a human sample with comprehensive behavioural and gut microbiota measures.

      S Wilson‐Barnes, L. P Gymnopoulos, K Dimitropoulos, V Solachidis, K Rouskas, D Russell, Y Oikonomidis, S Hadjidimitriou, J María Botana, B Brkic, E Mantovani, S Gravina, G Telo, E Lalama, R Buys, M Hassapidou, S Balula Dias, A Batista, L Perone, S Bryant, S Maas, S Cobello, P Bacelar, S. A Lanham‐New, K Hart (2021)PeRsOnalised nutriTion for hEalthy livINg: The PROTEIN project, In: Nutrition bulletin46(1)pp. 77-87

      Personalised nutrition is a novel public health strategy aiming to promote positive diet and lifestyle changes. Tailored dietary and physical activity advice may be more appropriate than a generalised ‘one‐size‐fits‐all’ approach as it is more biologically relevant to the individual. Information and computing technology, smartphones and mobile applications have become an integral part of modern life and thereby present the opportunity for novel methods to encourage individuals to lead a healthier lifestyle. This article introduces the European Union‐funded PROTEIN project (PeRsOnalised nutriTion for hEalthy livINg) consortium and introduces the associated work packages. The primary objective of the PROTEIN project is to produce a novel adaptable mobile application suite based on sound nutrition and physical activity advice from experts in their field, accessible to all population groups, with differing health outcomes, whose behaviour can be tracked with a variety of sensors and health hazard perception. The mobile application ‘ecosystem’ that will be developed by the consortium includes a platform, mobile suite, cloud services, artificial intelligence advisor, game suite, modelling of expert’s knowledge, users’ behaviour data collection, data analysis and a dashboard for healthcare professionals. It is proposed that users will find the provision of personalised nutrition advice and real‐time data capture through a smartphone application useful, and importantly, will be encouraged by this to make positive health behaviour changes.

      Andrea Darling, Kathryn Hart, F Gossiel, F Robertson, Julie Hunt, TR Hill, Sigurd Johnsen, JL Berry, R Eastell, R Vieth, Susan Lanham-New (2017)Higher bone resorption excretion in South Asian women vs White Caucasians and increased bone loss with higher seasonal cycling of vitamin D:  results from the D-FINES cohort study, In: Bone98pp. 47-53 Elsevier

      Few data exist on bone turnover in South Asian women and it is not well elucidated as to whether Western dwelling South Asian women have different bone resorption levels to that of women from European ethnic backgrounds. This study assessed bone resorption levels in UK dwelling South Asian and Caucasian women as well as evaluating whether seasonal variation in 25-hydroxyvitamin D [25(OH)D] is associated with bone resorption in either ethnic group. Data for seasonal measures of urinary N-telopeptide of collagen (uNTX) and serum 25(OH)D were analysed from n=373 women (four groups; South Asian postmenopausal n=44, South Asian premenopausal n=50, Caucasian postmenopausal n=144, Caucasian premenopausal n =135) (mean (± SD) age 48 (14) years; age range 18-79 years) who participated in the longitudinal D-FINES (Diet, Food Intake, Nutrition and Exposure to the Sun in Southern England) cohort study (2006-2007). A mixed between-within subjects ANOVA (n=192) showed a between subjects effect of the four groups (P

      MARGARET DENISE ROBERTSON, MARY ELIZABETH PHILLIPS, KATHRYN HAYLEY HART, R. Kumar, T Pencavel (2021)Long-term changes in nutritional status and body composition in patients with malignant pancreatic disease - a systematic review, In: Clinical Nutrition ESPEN Elsevier

      Background and aims Patients with pancreatic cancer often experience significant deterioration in nutritional status over time. Malnutrition is complex and multifactorial, with malabsorption, pain, toxic dependencies, co-morbidities and malignant processes all playing a role. The aims of this systematic review were to assess nutritional changes over time and identify tolerance of nutritional intervention, thus identifying potential areas for further research to improve patient outcomes. Materials and methods A systematic review of MEDLINE, EMBASE and PubMed was carried out in February 2020, identifying 2620 articles. After screening to exclude those reporting short-term measures, with only one data point, or in the wrong population, thirteen papers were selected for analysis (four trials in neo-adjuvant treatment, five in populations undergoing palliative treatment for pancreatic cancer, and four in mixed populations undergoing pancreatic resection). Results Overall, studies were limited by predominantly retrospective designs, and poor control of potentially confounding variables. Meta-analysis could not be performed due to heterogenicity in study design and reporting methods. Surgery in mixed cohorts did not appear to result in weight loss. Only one small intervention study was identified. Patients with pancreatic cancer experienced a decline in nutritional status, with 44-63% of patients undergoing neoadjuvant chemotherapy having low muscle mass prior to starting treatment. Conclusion There is a paucity of data regarding nutritional intervention in pancreatic cancer. Future work should include the use of validated functional and clinical assessment tools to further explore the impact of nutritional intervention, and the relationship between nutritional status and outcome.

      (2021)Processed food classification: Conceptualisation and challenges, In: Trends in food science & technology Elsevier

      Background: Processed foods are typically praised/revered for their convenience, palatability, and novelty; however, their healthfulness has increasingly come under scrutiny. Classification systems that categorise foods according to their “level of processing” have been used to predict diet quality and health outcomes and inform dietary guidelines and product development. However, the classification criteria used are ambiguous, inconsistent and often give less weight to existing scientific evidence on nutrition and food processing effects; critical analysis of these criteria creates conflict amongst researchers. Scope and approach: We examine the underlying basis of food classification systems and provide a critical analysis of their purpose, scientific basis, and distinguishing features by thematic analysis of the category definitions. Key findings and conclusions: These classification systems were mostly created to study the relationship between industrial products and health. There is no consensus on what factors determine the level of food processing. We identified four defining themes underlying the classification systems: 1. Extent of change (from natural state); 2. Nature of change (properties, adding ingredients); 3. Place of processing (where/by whom); and 4. Purpose of processing (why, essential/cosmetic). The classification systems embody socio-cultural elements and subjective terms, including home cooking and naturalness. Hence, “processing” is a chaotic conception, not only concerned with technical processes. Most classification systems do not include quantitative measures but, instead, imply correlation between “processing” and nutrition. The concept of “whole food” and the role of the food matrix in relation to healthy diets needs further clarification; the risk assessment/management of food additives also needs debate.

      KATHRYN HAYLEY HART, REBECCA MICHALA VEARING, ANDREA L DARLING, Yasmine Probst, Aminat S Olayinka, JEEWAKA MENDIS, Helena Ribeiro, Siddhartha Thakur, MARCELA MORAES MENDES, Karen Charlton, SUSAN ALEXANDRA LANHAM-NEW (2021)Global Perspective of the Vitamin D Status of African-Caribbean Populations: A Systematic Review and Meta-analysis, In: European Journal of Clinical Nutrition Springer Nature

      Objectives: Vitamin D deficiency remains a global public health issue, particularly in minority ethnic groups. This review investigates the vitamin D status (as measured by 25(OH)D and dietary intake) of the African-Caribbean population globally. Methods: A systematic review was conducted by searching key databases (PUBMED, Web of Science, Scopus) from inception until October 2019. Search terms included ‘Vitamin D status’ and ‘African-Caribbean’. A random effects and fixed effects meta-analysis was performed by combining means and standard error of the mean. Results: The search yielded 19 papers that included n=5,670 African-Caribbean participants from six countries. A meta-analysis found this population to have sufficient (>50 nmol/L) 25(OH)D levels at 67.8 nmol/L, 95% CI (57.9, 7.6) but poor dietary intake of vitamin D at only 3.0µg/day, 95% CI (1.67,4.31). For those living at low latitudes ‘insufficient’ (as defined by study authors) 25(OH)D levels were found only in participants with type 2 diabetes and in those undergoing haemodialysis. Suboptimal dietary vitamin D intake (according to the UK recommended nutrient intake of 10µg/day) was reported in all studies at high latitudes. Studies at lower latitudes, with lower recommended dietary intakes (Caribbean recommended dietary intake: 2.5µg/day) found ’sufficient’ intake in two out of three studies. Conclusions: 25(OH)D sufficiency was found in African-Caribbean populations at lower latitudes. However, at higher latitudes, 25(OH)D deficiency and low dietary vitamin D intake was prevalent. Trial registration: PROSPERO registration number: CRD42019158108.

      AL Darling, KH Hart, F Gossiel, R Eastell, JL Berry, SA Lanham-New (2015)Bone resorption levels are related to diet in UK dwelling South Asian but not Caucasian women, In: PROCEEDINGS OF THE NUTRITION SOCIETY74(OCE1)pp. E43-E43
      J Shawe, D Cooke, K Hart, BM McGowan, C Pring, D Subramanian, M Whyte (2014)Pregnancy after diabetes obesity surgery (PADOS): Qualitative study of pre-pregnancy care, In: Pregnancy Hypertension4(3)pp. 238-238 Elsevier

      Half of all bariatric surgical procedures are in women of childbearing age. Surgery may improve fertility yet exacerbate nutritional deficiencies, that may be disadvantageous to the fetus. A frequently encountered subgroup of obese women have type 2 diabetes. The health risks, to both mother and child, of diabetes in pregnancy are well described including 4.7× risk of stillbirth and 2× risk of congenital abnormality. What is not clear is whether bariatric surgery mitigates or complicates the health consequences of women with obesity and diabetes in pregnancy. In addition the influence of the type of surgery, the optimal interval between surgery and conception and evidence based preconception recommendations are unknown. This study complements wider research aiming to inform optimal management of this patient population. Obese diabetic women require clear guidance regarding pregnancy planning after surgery. This study will develop an understanding of the barriers and facilitators (psychological, behavioural, attitudinal and nutritional) to achieving effective pre-pregnancy health and care in women with type 2 diabetes who have undergone metabolic surgery. Currently women's perception of fertility issues and risks after bariatric surgery is unknown and thus a qualitative interpretive paradigm was chosen. Interviews with the target population will explore decision-making processes; experience regarding metabolic surgery and perceived pregnancy risk. Interviews with a broad range of health professionals involved in bariatric care will include rationale for selected surgical procedure and post surgery referral processes e.g. contraceptive care. This will advance understanding of how to provide targeted support and monitoring.

      D Sutton, T Davey, G VenkatRaman, K Hart (2009)Can a functional food exert a cholesterol lowering effect in renal transplant patients?, In: Journal of Renal Care35(1)pp. 42-47
      O Hakim, F Shojaee-Moradie, K Hart, J Berry, R Eastell, F Gossiel, R Hannon, M Umpleby, B Griffin, S Lanham-New (2011)Evidence of a link between poor bone health, low vitamin D status and CVD risk in caucasian and asian women, In: BONE48pp. S197-S198
      KH Hart, L Boyle, CA Hartwick, L Moreno, SA Lanham-New, B Fielding (2015)Live, eat, sleep football? Body size and composition and beliefs about physical activity in an international cohort of school-aged boys participating in regular team sport, In: PROCEEDINGS OF THE NUTRITION SOCIETY74(OCE1)pp. E97-E97 CAMBRIDGE UNIV PRESS
      M Whyte, C Pring, D Cooke, K Hart, BM McGowan, D Subramanian, J Shawe (2014)Pregnancy after diabetes obesity surgery (PADOS): Incidence and outcomes, In: Pregnancy Hypertension4(3)pp. 239-239

      Half of all bariatric surgical procedures are in women of childbearing age but it remains unclear whether surgery is suitable for women who subsequently conceive: specifically the relative risks and benefits of potential nutrient deficiencies versus weight reduction. We will present data collected from Clinical Practice Research Databases on the maternal and fetal outcomes of pregnancies complicated either by obesity or previous bariatric surgery (BS). Two groups, matched to obese controls for BMI pre-BS and post-BS (at the time of ante-natal booking) will be compared. In this way, the effect of BS on pregnancy outcomes may be examined, independent of its effect on weight. A sub-group of women with antecedent Type 2 diabetes (T2DM) will allow for investigation of the additional impact and persistence of this co-morbidity. This builds upon pilot data collected from a retrospective cohort of women (18-45years) undergoing laparoscopic roux-en-Y (RYGB) surgery over a 24-month period (n=218). After exclusions and loss to follow up, data from 111 patients were analysed; 81 (73%) had conceived prior to RYGB, 20 (18%) became pregnant post RYGB and a further 22 patients (20%) were trying to conceive at the time of data collection. Three women had T2DM which resolved post BS. A suggestion of greater miscarriage risk prior to surgery in this sub-group will be confirmed as more women are recruited. Pregnancy is a frequent desire/occurrence after BS. This database study will advance understanding of the maternal and fetal outcomes of such pregnancies and inform antenatal care.

      FA Al-Haddad, A Musaiger, M Al-Qallaf, K Hart (2015)Children with Type 1 Diabetes, In: Bahrain Medical Bulletin37(1)

      © 2015, Bahrain Medical Bulletin. All Rights Reserved.Background: The prevalence of diabetes in the Middle East is amongst the highest worldwide; Bahrain ranks amongst the top 10 countries. In particular, increasing number of children are being diagnosed with type 1 diabetes mellitus (T1DM) posing a significant public health concern. Objective: To evaluate the magnitude of type 1 diabetes in Bahrain. Design: A Case-Control Retrospective Study. Setting: Pediatric Diabetes and Endocrine Clinic and Local Health Centers (LHC). Method: Fifty-nine cases and 53 controls were included in the study. Data from the Diabetes Registry were recorded for subjects meeting the inclusion criteria and questionnaire was administered to healthy controls. Chi Square or Student’s t-test was used as appropriate. Logistic regression analysis was used to evaluate independent predictors of T1DM. Result: Fifty-nine children aged 6-12 years diagnosed with T1DM in the years 2009 and 2010 were compared to 53 healthy controls. Children with T1DM were more likely to have suffered from a pre-diabetes illness such as tonsillitis 32 (54.2%) compared to controls 3 (5.7%), and have undergone a surgery prior to diagnosis 14 (23.7%), and to have mothers with T2DM or family history of GDM. No significant difference in infant-feeding practices was observed between children with type 1 diabetes and the healthy controls. Conclusion: Children with T1DM were more likely to have suffered from other infectious illnesses before the diagnosis was established. Whilst unable to fully investigate any potential genetic differences between cases and controls, this study provides support for the theoretical role of infections as a trigger for T1DM.

      F Koidis, F Makinwa, K Hart, M Gibbs, S Hampton (2015)Assessment of the use of earplugs effectiveness on a slow eating rate protocol, In: PROCEEDINGS OF THE NUTRITION SOCIETY74(OCE4)pp. E273-E273 CAMBRIDGE UNIV PRESS
      N Omar, M Gibbs, K Hart (2011)Nutritional status and food-related quality of life in hospitalised older adults, In: PROCEEDINGS OF THE NUTRITION SOCIETY70(OCE4)pp. E130-E130 CAMBRIDGE UNIV PRESS
      N Omar, M Gibbs, K Hart (2011)Nutritional status in older adults across care settings, In: PROCEEDINGS OF THE NUTRITION SOCIETY70(OCE6)pp. E390-E390 CAMBRIDGE UNIV PRESS
      L Tripkovic, LR Wilson, K Hart, R Elliott, CP Smith, G Bucca, S Penson, G Chope, E Hypponen, J Berry, S Lanham-New (2014)DAILY SUPPLEMENTATION WITH VITAMIN D3 IS COMPREHENSIVELY MORE EFFECTIVE THAN VITAMIN D2 IN RAISING 25OHD STATUS AND CONCOMITANTLY REDUCING PARATHYROID HORMONE LEVELS: IMPLICATIONS FOR BONE HEALTH, In: OSTEOPOROSIS INTERNATIONAL25pp. S665-S665
      PS Gibson, E Fitzpatrick, A Quaglia, A Dhawan, K Hart, S Lanham-New, JB Moore (2014)VITAMIN D STATUS, PNPLA3 GENOTYPE AND RISK OF NON-ALCOHOLIC FATTY LIVER DISEASE SEVERITY IN A UK PAEDIATRIC POPULATION, In: JOURNAL OF HEPATOLOGY60(1)pp. S512-S512
      T Smith, L Tripkovic, K Hart, S Lanham-New (2015)Associations between maternal-child dietary vitamin D and calcium intakes in UK male and female adolescents aged 14-18 years, In: PROCEEDINGS OF THE NUTRITION SOCIETY74(OCE5)pp. E329-E329 CAMBRIDGE UNIV PRESS
      PS Gibson, E Fitzpatrick, D Kamat, A Dhawan, ME Ford-Adams, A Desai, K Hart, JB Moore (2015)ASSESSMENT OF DIET AND PHYSICAL ACTIVITY IN PAEDIATRIC NON-ALCOHOLIC FATTY LIVER DISEASE PATIENTS: A UK CASE CONTROL STUDY, In: JOURNAL OF HEPATOLOGY62pp. S821-S822
      KH Hart, R Hiscutt, H Truby (2007)A pilot investigation into body composition change and dietary intake during an 8-week low-carbohydrate diet in free-living obese women., In: International Journal of Body Composition Research5(1)pp. 41-44
      PS Gibson, E Fitzpatrick, D Kamat, A Dhawan, ME Ford-Adams, A Desai, K Hart, JB Moore (2015)Assessment of diet and lifestyle factors associated with non-alcoholic fatty liver disease in a UK paediatric population, In: PROCEEDINGS OF THE NUTRITION SOCIETY74(OCE5)pp. E324-E324
      KH Hart, JA Bishop, H Truby (2002)An investigation into school children's knowledge and awareness of food and nutrition, In: JOURNAL OF HUMAN NUTRITION AND DIETETICS15(2)pp. 129-140 BLACKWELL PUBLISHING LTD
      Taryn Smith, Laura Tripkovic, CT Damsgaard,, C Mølgaard, C Ritz, Saskia Wilson-Barnes, KG Dowling, A Hennessy, KD Cashman, M Kiely, Susan Lanham-New, Kathryn Hart (2016)Estimation of the dietary requirement for vitamin D in adolescents aged 14-18 years: a dose-response, double-blind, randomized placebo-controlled trial, In: The American Journal of Clinical Nutrition104(5)138065pp. 1301-1309 American Society for Nutrition

      Background Adolescents are a population group at high risk of low vitamin D status, yet the evidence base for establishing dietary vitamin D requirements to ensure adequacy remains weak. Objective To establish the distribution of vitamin D intakes required to maintain serum 25- hydroxyvitamin D [25(OH)D] concentrations above proposed cut-offs (25, 30, 40 and 50 nmol/L) during the winter-time in white males and females (14-18 years) in the UK (51o 9 N). Design In a dose-response trial, 110 adolescents (age 15.9 ± 1.4 years; 43% male) were randomizedto receive daily 0, 10 or 20 µg vitamin D3 supplements for 20 weeks during the winter-time. A non-linear regression model was fit to the total vitamin D intake (diet plus supplemental) and post-intervention serum 25(OH)D concentrations, and regression predicted values were used to estimate the vitamin D intakes required to maintain serum 25(OH)D concentrations above specific cut-offs. Results Mean (± SD) serum 25(OH)D concentrations increased from 49.2 ± 12.0 to 56.6 ± 12.4 nmol/L and from 51.7 ± 13.4 to 63.9 ± 10.6 nmol/L in the 10 and 20 µg/day groups respectively, and decreased in the placebo group from 46.8 ± 11.4 to 30.7 ± 8.6 nmol/L (all p ≤ 0.001). Vitamin D intakes required to maintain post-intervention 25(OH)D concentrations > 25 and > 30 nmol/L in 97.5% of adolescents were estimated as 10.1 and 13.1 µg/day respectively, and 6.6 µg/day to maintain 50% of adolescents > 40 nmol/L. As the response of 25(OH)D plateaued at 46 nmol/L, there is uncertainty in estimating the vitamin D intake required to maintain 25(OH)D > 50 nmol/L in 97.5% of adolescents, but it did exceed 30 µg/day Conclusions Vitamin D intakes of between 10 and ~30 µg/day are required by white adolescents during the winter-time in order to maintain serum 25(OH)D concentrations > 25 – 50 nmol/L, depending on the serum 25(OH)D threshold chosen.

      Laura Tripkovic, LR Wilson, Kathryn Hart, Sigurd Johnsen, Simon de Lusignan, CP Smith, G Bucca, S Penson, G Chope, Ruan Elliott, E Hypponen, J L Berry, Susan Lanham-New (2017)Daily supplementation with 15 mg vitamin D2 compared with vitamin D3 to increase wintertime 25-hydroxyvitamin D status in healthy South Asian and white European women: a 12-wk randomized, placebo-controlled food-fortification trial, In: American Journal of Clinical Nutrition106(2)pp. 481-490 American Society for Nutrition

      Background: There are conflicting views in the literature as to whether vitamin D2 and vitamin D3 are equally effective in increasing and maintaining serum concentrations of 25-hydroxyvitamin D [25(OH)D], particularly at lower doses of vitamin D. Objective: We aimed to investigate whether vitamin D2 or vitamin D3 fortified in juice or food, at a relatively low dose of 15 μg/d, was effective in increasing serum total 25(OH)D and to compare their respective efficacy in South Asian and white European women over the winter months within the setting of a large randomized controlled trial. Design: A randomized, double-blind, placebo-controlled food-fortification trial was conducted in healthy South Asian and white European women aged 20–64 y (n = 335; Surrey, United Kingdom) who consumed placebo, juice supplemented with 15 μg vitamin D2, biscuit supplemented with 15 μg vitamin D2, juice supplemented with 15 μg vitamin D3, or biscuit supplemented with 15 μg vitamin D3 daily for 12 wk. Serum 25(OH)D was measured by liquid chromatography–tandem mass spectrometry at baseline and at weeks 6 and 12 of the study. Results: Postintervention in the 2 ethnic groups combined, both the vitamin D3 biscuit and the vitamin D3 juice groups showed a significantly greater absolute incremental change (Δ) in total 25(OH)D when compared with the vitamin D2 biscuit group [Δ (95% CI): 15.3 nmol/L (7.4, 23.3 nmol/L) (P < 0.0003) and 16.0 nmol/L (8.0, 23.9 nmol/L) ( P < 0.0001)], the vitamin D2 juice group [Δ (95% CI): 16.3 nmol/L (8.4, 24.2 nmol/L) (P < 0.0001) and 16.9 nmol/L (9.0, 24.8 nmol/L) (P < 0.0001)], and the placebo group [Δ (95% CI): 42.3 nmol/L (34.4, 50.2 nmol/L) (P < 0.0001) and 42.9 nmol/L (35.0, 50.8 nmol/L) (P < 0.0002)]. Conclusions: With the use of a daily dose of vitamin D relevant to public health recommendations (15 μg) and in vehicles relevant to food-fortification strategies, vitamin D3 was more effective than vitamin D2 in increasing serum 25(OH)D in the wintertime. Vitamin D3 may therefore be a preferential form to optimize vitamin D status within the general population. This trial was registered at www.controlled-trials.com as ISRCTN23421591.

      OA Hakim, K Hart, AL Darling, F Shojaee-Moradie, JL Berry, AM Umpleby, BA Griffin, SA Lanham-New (2012)Homeostatic model assessment (HOMA) in relation to lipid profiles and vitamin D status in South Asian and Caucasian women: preliminary results from D-FINES, In: PROCEEDINGS OF THE NUTRITION SOCIETY71(OCE2)pp. E70-E70
      AL Darling, OA Hakim, K Horton, MA Gibbs, L Cui, JL Berry, SA Lanham-New, KH Hart (2012)Associations between vitamin D status and radial bone geometry in older South Asian and Caucasian women, In: PROCEEDINGS OF THE NUTRITION SOCIETY71(OCE3)pp. E230-E230 CAMBRIDGE UNIV PRESS
      K Hart, S Barr, S Reeves, K Sharp, Y Jeanes (2016)Suboptimal dietary intake is associated with cardiometabolic risk factors in women with polycystic ovary syndrome, In: NUTRITION & DIETETICS73(2)pp. 177-183 WILEY-BLACKWELL
      YM Jeanes, S Reeves, EL Gibson, C Piggott, VA May, Kathryn Hart (2017)Binge eating behaviours and food cravings in women with Polycystic Ovary Syndrome, In: Appetite109(Feb)pp. 24-32 Elsevier

      Polycystic Ovary Syndrome (PCOS), the most common endocrine condition in women, is often anecdotally associated with binge eating behaviours and food cravings; however there is a paucity of research. This study aimed to report the prevalence of binge eating and food cravings and their relation to obesity risk in women with PCOS. Participants completed an online survey including the Bulimia Investigatory Test, Edinburgh, Food Cravings-Trait Questionnaire and the Three Factor Eating Questionnaire revised-18. The study included obese (n = 340), overweight (n = 70) and lean (n = 45) women with PCOS and lean healthy women (n = 40). Sixty percent of obese women with PCOS were categorised with binge-eating behaviour, with 39% presenting with clinically significant behaviour. Obese women with PCOS presented with high mean food cravings-trait scores (131.6 ± 28.9) that were significantly greater compared with lean (114.0 ± 34.9) and overweight women with PCOS (120.1 ± 29.5; p < 0.001). Multiple regression exploring relations between eating styles and adiposity explained 59% of the variance in binge eating symptom scores in women with PCOS (F = 173.8; p < 0.001, n = 463): significant predictors were food cravings total score (beta = 0.52; p < 0.001), emotional eating score (beta = 0.16; p < 0.001), BMI (beta = 0.13; p < 0.001) and uncontrolled eating score (beta = 0.10; p < 0.01). Compared with lean healthy women, lean women with PCOS exhibited significantly higher binge eating symptom scores (10.9 ± 7.8 versus 7.4 ± 6.0; p < 0.05), though similar total food craving scores (114.0 ± 34.9 versus 105.6 ± 26.6: NS). This study is the largest, to date, to robustly report that a high proportion of women with PCOS exhibit binge eating behaviours. We recommend screening women with PCOS for binge eating behaviours to help inform the choice of weight management approach for this clinical population.

      LR Wilson, L Tripkovic, K Hart, R Elliott, CP Smith, G Bucca, S Penson, G Chope, E Hypponen, J Berry, S Lanham-New (2014)IS VITAMIN D3 MORE EFFECTIVE THAN VITAMIN D2 IN RAISING 25OHD STATUS IN WOMEN WITH OSTEOPOROSIS AND OSTEOPENIA?, In: OSTEOPOROSIS INTERNATIONAL25pp. S687-S687
      OA Hakim, A Darling, K Hart, JL Berry, SA Lanham-New (2012)VOLUMETRIC BONE MINERAL DENSITY (VBMD) AT RADIUS SITE AND VITAMIN D STATUS IN PREMENOPAUSAL SOUTH ASIAN AND CAUCASIAN WOMEN, In: OSTEOPOROSIS INTERNATIONAL23pp. S336-S337
      OA Hakim, F Shojaee-Moradie, K Hart, JL Berry, R Eastell, F Gossiel, R Hannon, AM Umpleby, BA Griffin, SA Lanham-New (2011)Vitamin D deficiency, poor bone health and the risk of CVD in Caucasian and South Asian women: analysis from the D-FINES study, In: PROCEEDINGS OF THE NUTRITION SOCIETY70(OCE3)pp. E100-E100 CAMBRIDGE UNIV PRESS
      SJ Long, KH Hart, LM Morgan (2000)The effects of habitual exercise level upon appetite response and food intake following high and low energy preloads., In: PROCEEDINGS OF THE NUTRITION SOCIETY59pp. 123A-123A C A B INTERNATIONAL
      KH Hart, A Herriot, JA Bishop, H Truby (2003)Promoting healthy diet and exercise patterns amongst primary school children: a qualitative investigation of parental perspectives, In: JOURNAL OF HUMAN NUTRITION AND DIETETICS16(2)pp. 89-96 BLACKWELL PUBLISHING LTD
      R Boley, K Hart, H Truby (2005)Influence of different high-protein meals on subsequent food intake, In: PROCEEDINGS OF THE NUTRITION SOCIETY64pp. 51A-51A CAMBRIDGE UNIV PRESS
      K Hart, E Cave, B Conroy, N Farina, J Young, J Rusted, N Tabet (2013)Nutritional status of older adults with and without dementia, In: PROCEEDINGS OF THE NUTRITION SOCIETY72(OCE4)pp. E247-E247 CAMBRIDGE UNIV PRESS
      O Hakim, K Hart, L Morgan, B Griffin, S Lanham-New, F Shojaee-Moradie, A Umpleby, J Berry (2010)(PREMIER POSTER-AWARD CANDIDATE) EVIDENCE OF A LINK BETWEEN OSTEOPOROSIS RISK AND CVD IN CAUCASIAN BUT NOT ASIAN WOMEN: RESULTS OF THE D-FINES STUDY, In: OSTEOPOROSIS INTERNATIONAL21pp. S466-S467
      SA Lanham-New, H Lambert, L Tripkovic, CP Smith, G Bucca, K Hart, S Penson, G Chope, E Hyppoenen, JL Berry, R Vieth (2011)Vitamin D-2 v. vitamin D-3 supplementation in raising 25OHD status: preliminary findings of a meta-analysis, In: PROCEEDINGS OF THE NUTRITION SOCIETY70(OCE3)pp. E94-E94 CAMBRIDGE UNIV PRESS
      L Wilson, E Hall, K Hart, S Lanham-New, L Tripkovic (2012)Association between dietary vitamin D intakes and blood pressure in Caucasian and South Asian females: preliminary analysis of the D2-D3 Study, In: PROCEEDINGS OF THE NUTRITION SOCIETY71(OCE3)pp. E235-E235 CAMBRIDGE UNIV PRESS
      Hanne Hauger, Christian Mølgaard, Charlotte Mortensen, Christian Ritz, Hanne Frøkiær, Taryn J Smith, Kath Hart, Susan Lanham-New, Camilla T Damsgaard (2018)Winter Cholecalciferol Supplementation at 55°N Has No Effect on Markers of Cardiometabolic Risk in Healthy Children Aged 4–8 Years, In: The Journal of Nutrition148(8)pp. 1261-1268 Oxford University Press

      Background: Low serum 25-hydroxyvitamin D [25(OH)D] has been associated with unfavorable cardiometabolic risk profiles in many observational studies in children, but very few randomized controlled trials have investigated this. Objective: We explored the effect of winter-time cholecalciferol (vitamin D3) supplementation on cardiometabolic risk markers in young, white, 4- to 8-y-old healthy Danish children (55°N) as part of the pan-European ODIN project. Methods: In the ODIN Junior double-blind, placebo-controlled, dose-response trial, 119 children (mean ± SD age: 6.7 ± 1.5 y; 36% male; 82% normal weight) were randomly allocated to 0, 10 or 20 μg/d of vitamin D3 for 20 wk (October–March). Cardiometabolic risk markers including BMI-for-age z score (BMIz), waist circumference, systolic and diastolic blood pressure, serum triglycerides and cholesterol (total, LDL, HDL, and total:HDL), plasma glucose and insulin, and whole-blood glycated hemoglobin were measured at baseline and endpoint as secondary outcomes together with serum 25(OH)D. Intervention effects were evaluated in linear regression models as between-group differences at endpoint adjusted for baseline value of the outcome, and additionally for age, sex, baseline serum 25(OH)D, BMIz, time since breakfast, and breakfast content. Results: Mean ± SD serum 25(OH)D was 56.7 ± 12.3 nmol/L at baseline and differed between groups at endpoint with concentrations of 31.1 ± 7.5, 61.8 ± 10.6, and 75.8 ± 11.5 nmol/L in the 0-, 10-, and 20 μg/d groups, respectively (P < 0.0001). Vitamin D3 supplementation had no effect on any of the cardiometabolic risk markers in analyses adjusted for baseline value of the outcome (all P ≥ 0.05), and additional covariate adjustment did not change the results notably. Conclusions: Preventing the winter decline in serum 25(OH)D with daily vitamin D3 supplementation of 10 or 20 μg had no cardiometabolic effects in healthy 4- to 8-y-old Danish children. This trial was registered at www.clinicaltrials.gov as NCT02145195.

      AL Darling, F Gossiel, R Hannon, DJ Skene, KH Hart, JL Berry, R Eastell, SA Lanham-New (2011)An association between seasonal fluctuation 'cycling' of 25(OH)D and increased bone resorption but not BMD or BMC in UK South Asian and Caucasian women living at 51on, In: BONE48pp. S187-S187

      It has been hypothesised that the U shaped association between 25(OH)D and some health outcomes may be due to large seasonal fluctuations of 25(OH)D1. It is unknown whether such fluctuation of 25(OH)D (‘cycling’) influences bone health. This is an important issue, because if ‘cycling’ is detrimental for bone, then winter only rather than year round vitamin D supplementation may be useful for bone health to ‘blunt’ the rhythm. In the D-FINES study, n = 373 women (South Asian/Caucasian) had repeated measurements in four seasons for serum 25(OH)D and PTH, as well as a DXA scan in autumn and spring. Serum C-telopeptide (sCTX) was also measured in a random subset (n = 66). Cosinor regression analysis was used to identify individuals showing a significant rhythm (p < 0.10) (‘cyclers’) and those not showing a significant seasonal rhythm (‘non-cyclers’). Potential differences in bone indices between the two groups were assessed within ethnicity. Dependent variables analysed were absolute values for autumn femoral neck and lumbar spine BMD, BMC and bone area, and absolute sCTX and sPTH in each season. Also, change in sCTX and sPTH from summer to winter and change in DXA bone indices from autumn to spring were analysed. ANCOVA was run, adjusting for summer and winter 25(OH)D status, age, socioeconomic status, physical activity, and dietary calcium. BMI was also controlled for in the analysis due to its negative correlation with seasonal change in 25(OH)D. There was no statistically significant difference (p>0.05) between ‘cyclers’ and ‘non-cyclers’ for any of the bone indices in either ethnic group. However, there were trends for a higher CTX and PTH in ‘cyclers’ versus ‘non-cyclers’ in both ethnic groups in every season, but no differences for BMD or BMC (Figs. 1–4). This suggests tentatively that ‘cycling’ could be associated with changes in bone metabolism but may not translate into structural changes. In summary, there is no clear evidence here to suggest that ‘cycling’ is detrimental to bone health, although there are trends in PTH and CTX that warrant further investigation with a larger sample.

      O Hakim, A Darling, K Hart, J Berry, S Lanham-New (2012)25(OH)D CONCENTRATION AND MUSCLE FUNCTION IN PREMENOPAUSAL SOUTH ASIAN AND CAUCASIAN WOMEN, In: OSTEOPOROSIS INTERNATIONAL23pp. S578-S579
      YM Jeanes, J Hodgson, N Saunders, L Gibson, K Hart (2012)Eating behaviours in obese and lean women with polycystic ovary syndrome, In: PROCEEDINGS OF THE NUTRITION SOCIETY71(OCE3)pp. E237-E237 CAMBRIDGE UNIV PRESS
      CG Mountford, AC Okonkwo, K Hart, NP Thompson (2016)Managing Malnutrition in Older Persons Residing in Care Homes: Nutritional and Clinical Outcomes Following a Screening and Intervention Program., In: Journal of nutrition in gerontology and geriatrics35(1)pp. 52-66 Taylor & Francis

      This study aimed to establish prevalence of malnutrition in older adult care home residents and investigate whether a nutritional screening and intervention program could improve nutritional and clinical outcomes. A community-based cohort study was conducted in five Newcastle care homes. 205 participants entered; 175 were followed up. Residents already taking oral nutritional supplements (ONS) were excluded from interventions. Those with Malnutrition Universal Screening Tool (MUST) score of 1 received dietetic advice and ≥2 received dietetic advice and were prescribed ONS (220 ml, 1.5 kcal/ml) twice daily for 12 weeks. Body mass index (BMI), MUST, mini nutritional assessment score (MNA)®, mid upper arm muscle circumference (MAMC), and Geriatric Depression Scale (GDS) were recorded at baseline and 12 weeks. Malnutrition prevalence was 36.6% ± 6.6 (95% CI). A higher MUST was associated with greater mortality (p = 0.004). Type of intervention received was significantly associated with change in MUST score (p < 0.001); dietetic advice resulting in the greatest improvement. There were no significant changes in BMI (p = 0.445), MAMC (p = 0.256), or GDS (p = 0.385) following the interventions. Dietitian advice may slow the progression of nutritional decline. In this study oral nutritional supplements over a 3-month period did not significantly improve nutritional status in malnourished care home residents.

      OA Hakim, K Hart, P McCabe, J Berry, L Rhodes, N Spyrou, A Alfuraih, S Lanham-New (2012)VITAMIN D SYNTHESIS IN CAUCASIAN AND SOUTH ASIAN WOMEN FOLLOWING ULTRAVIOLET RADIATION, In: OSTEOPOROSIS INTERNATIONAL23pp. 669-669
      L Wilson, S Lanham-New, K Hart, L Tripkovic (2012)The influence of habitual dietary intake on bone density in pre-menopausal women, In: PROCEEDINGS OF THE NUTRITION SOCIETY71(OCE2)pp. E127-E127 CAMBRIDGE UNIV PRESS
      OA Hakim, Kath Hart, P McCabe, J Berry, R Francesca, LE Rhodes, N Spyrou, A Alfuraih, S Lanham-New (2016)VITAMIN D PRODUCTION IN UK CAUCASIAN AND SOUTH ASIAN WOMEN FOLLOWING UVR EXPOSURE., In: The Journal of steroid biochemistry and molecular biology164pp. 223-229 Elsevier

      It is known that skin pigmentation reduces the penetration of ultraviolet radiation (UVR) and thus photosynthesis of 25-hydroxvitamin D (25(OH)D). However ethnic differences in 25(OH)D production remain to be elucidated.The aim of this study was to investigate differences in vitamin D production between UK South Asian and Caucasian postmenopausal women, in response to a defined and controlled exposure to UVR.Seventeen women; 9 white Caucasian (skin phototype II and III), 8 South Asian women (skin phototype IV and V) participated in the study, acting as their own controls. Three blood samples were taken for the measurement of vitamin D status during the run in period (9 days, no sunbed exposure) after which, all subjects underwent an identical UVR exposure protocol irrespective of skin colour (9 days, 3 sun bed sessions, 6, 8 and 8minutes respectively with approximately 80% body surface exposed). Skin tone was measured four times during the study.Despite consistently lower 25(OH)D levels in South Asian women, they were shown to synthesise vitamin D as efficiently as Caucasians when exposed to the same dose of UVR. Interestingly, the baseline level of vitamin D rather than ethnicity and skin tone influenced the amount of vitamin D synthesised.This study have found no ethnic differences in the synthesis of 25(OH)D, possibly due to the baseline differences in 25(OH)D concentration or due to the small population size used in this study. Applying mixed linear model, findings indicated no effect of ethnicity and skin tone on the production of vitamin D; baseline level and length of exposure were the critical factors. To confirm that ethnicity and skin tone has no effect on 25(OH)D production, a larger sample size study is required that considers other ethnic groups with highly pigmented skin. Initial vitamin D status influences the amount of UVB needed to reach equal serum concentrations.

      L Tripkovic, KH Hart, GS Frost, JK Lodge (2014)Interindividual and intraindividual variation in pulse wave velocity measurements in a male population, In: BLOOD PRESSURE MONITORING19(4)pp. 233-241 LIPPINCOTT WILLIAMS & WILKINS

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