Dr Shelly Coe
Senior Lecturer in Nutrition
School of Sport, Nutrition and Allied Health Professions
Role
I am a Senior Lecturer in Nutrition Science and am actively engaged in diet and health research (see below for details).
I received a first class BSc honours degree in Nutrition from Oxford Brookes and have completed my PhD entitled 'The role of polyphenols on sugar release from carbohydrate rich foods, and the consequent impact on metabolic risk factors associated with type 2 diabetes.'
Areas of expertise
Nutrition in vulnerable groups, including neurological and autoimmune conditions, flavonoids, polyphenols, cognitive function, nutrition in children and young people, large nutrition cohorts.
Teaching and supervision
Courses
Modules taught
I am teaching on a number of modules on the Nutrition BSc and MSc courses. I am currently supervising BSc dissertation students, MSc students during their summer research projects and multiple PhD students.
Supervision
I am currently on the supervisory team for 6 PhD students, and I have had 4 students complete their PhD successfully to date. I am available to receive applications to supervise relevant self-funded or externally funded PhD studentships. Some of the PhD projects currently on-going are under the 'projects' section below.
Research Students
Name | Thesis title | Completed |
---|---|---|
Francesca Tabacchi | Nutritional support in cancer patients during treatment. | Active |
Matt Poulter | Diet, Nutrition, and Health in UK prisons | 2024 |
Research
I am interested in how the diet quality of people with neurological conditions can influence the severity of disease associated symptoms.
I have been involved in many clinical trials to date and have worked with large cohorts including collaboration with the MRC and Multiple Sclerosis Register UK. One of my current interests includes the role of flavonoid rich sources for fatigue management in people with Multiple Sclerosis and Cancer.
I am currently working on projects looking at diet quality and/ or metabolic parameters in vulnerable groups such as those with Parkinson's, Cerebral Palsy, UK Prisoners, and paediatric patients with neurological and autoimmune conditions.
Research impact
Centres and institutes
- Oxford Institute of Applied Health Research
- Centre for Movement, Occupational and Rehabilitation Sciences (MOReS)
- Oxford Brookes Centre for Nutrition and Health
Groups
- Health Innovation and Technology Trials (HITT)
- Movement Sciences
- Rehabilitation Sciences
- Clinical Applied Nutrition (CAN)
Projects
- Association of diet and other lifestyle factors on non-motor symptoms in Parkinson’s
- Exploration of lifestyle including dietary patterns on later life quality of movement
- Flavonoid-rich pure cocoa to reduce fatigue in people with Multiple Sclerosis
- Nutrient intake and association with symptom severity in a Multiple Sclerosis Registry cohort
Projects as Principal Investigator, or Lead Academic if project is led by another Institution
- Banking on Health: a co-created nutrition cooking workshop initiative for young people in Oxfordshire. (01/05/2024 - 30/04/2025), funded by: Economic & Social Research Council (ESRC), funding amount received by Brookes: £14,769
- Exploring the prospective relationships of Dietary Inflammatory Index scores on clinical progression in people with multiple sclerosis. (09/05/2023 - 31/07/2024), funded by: Multiple Sclerosis Society, funding amount received by Brookes: £47,870
- Exploring the prospective relationships of diet pattern and diet index scores on health outcomes in people with multiple sclerosis (led by The University of Melbourne) (01/01/2023 - 31/12/2025), funded by: Multiple Sclerosis Australia (MS Australia), funding amount received by Brookes: £3,002
Projects as Co-investigator
- KTP with the Institute for Food, Brain and Behaviour(29/01/2024 - 28/09/2026), funded by: Technology Strategy Board (Innovate UK), funding amount received by Brookes: £309,913, funded by: Technology Strategy Board (Innovate UK)
- A lifestyle weight management program for paediatric patients with demyelinating conditions(01/07/2020 - 30/08/2024), funded by: Great Ormond Street Hospital Childrens Charity, funding amount received by Brookes: £92,409, funded by: Great Ormond Street Hospital Childrens Charity
Publications
Journal articles
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Graham A-M. C3,5, Bystrom L4, Rogers O1, Berwick Z1, Akrane O1, Field A1, Zdrava D1, Coe S1,2*.
, 'The impact of Covid-19 lockdown on lifestyle and dietary habits in people with neurological conditions, and the impact on their health: a cross-sectional survey study.'
Clinical Nutrition Open Science 57 (2024) pp.109-125
ISSN: 2667-2685 eISSN: 2667-2685AbstractPublished hereIntroduction: Research has shown that the Covid-19 pandemic may have had negative effects on lifestyle factors of people in the UK, however research is limited in terms of the impact on people living with neurological conditions such as Multiple Sclerosis (MS), Parkinson’s (PD) and spinal cord injury (SCI). This study explores the impact that the pandemic had on mental health and lifestyle factors such as dietary habits, supplement use and exercise in those with MS, PD and SCI.
Methods: A cross-sectional, online, questionnaire study was carried out on a cohort of 134 people in the United Kingdom during the Covid-19 pandemic. Participants completed the questionnaire between June 2021–February 2022. Eligibility criteria included being over the age of 18 years, and declaring having been formally diagnosed with either MS (n=27, female=81%), PD (n=84, female=35%), SCI (n=23, female=61%).
Results: 33% of participants reported an increased consumption of alcohol and 29% a decreased consumption of fruit and vegetables. However, 64% of participants reported no change in diet (p
Conclusion: This study suggests that the impact Covid-19 has had on people with neurological conditions is complex and individual, yet the negative effects may be more pronounced than the general public. Overall, there were changes in lifestyle behaviours, some which may be detrimental to health and life quality in these already vulnerable groups. Therefore, these changes need to be considered in the aftermath of the pandemic.
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Esmaeil Yousefi Rad, Somayeh Saboori, Thanasis G. Tektonidis, Steve Simpson-Yap, Jeanette Reece, James R. Hebert, Richard Nicholas, Rod Middleton, Jonathan Tammam, Lucinda Black, Shelly Coe, 'A systematic review and meta-analysis of Dietary Inflammatory Index and the likelihood of multiple sclerosis/ demyelinating autoimmune disease'
Clinical Nutrition ESPEN 62 (2024) pp.108-114
ISSN: 2405-4577 eISSN: 2405-4577AbstractPublished hereDiet and inflammation may contribute to the development of multiple sclerosis (MS). The aim of this systematic review and meta-analysis was to assess the association between proinflammatory diet, as estimated by the Dietary Inflammatory Index (DII®), and the likelihood of developing MS or other demyelinating autoimmune diseases. A systematic search was performed of search engines and databases (PubMed, ISI Web of Sciences, Scopus, and Embase) to identify relevant studies before 10th June 2023. The search identified 182 potential studies, from which 39 full-text articles were screened for relevance. Five articles with case-control design (n=4,322, intervention group: 1714; control group: 2608) met the study inclusion criteria. The exposure variable was DII, with studies using two distinct models: quartile-based comparisons of DII and assessment of continuous DII. The meta-analysis of high versus low quartiles of DII with four effect sizes showed a significant association with MS/ demyelinating autoimmune disease likelihood, with an odds ratio (OR) of 3.26 (95% confidence interval (CI) 1.16, 9.10). The meta-analysis of four studies with DII fit as a continuous variable showed a 31% increased likelihood of MS per unit increment; which was not statistically significant at the nominal alpha equals 0.05 (OR 1.31; 95% CI 0.95, 1.81). In conclusion, this systematic review and meta-analysis provides evidence of a positive association between higher DII scores with the likelihood of developing MS, highlighting that diet-induced inflammation could play a role in MS or other demyelinating autoimmune diseases risk.
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Yousefi Rad E, Saboori S, Tammam J, Thondre PS, Coe S
, 'The effect of Niacin on inflammatory markers and adipokines: A systematic review and meta-analysis of interventional studies'
European Journal of Nutrition 63 (2024) pp.2011-2024
ISSN: 1436-6207 eISSN: 1436-6215AbstractPublished here Open Access on RADARPurpose.
Niacin (Nicotinic acid), known for its lipid-modifying effects, has been explored for its potential anti-inflammatory properties and potential to affect adipokines secretion from adipose tissue. The aim of this systematic review and meta-analysis was to assess the effects of Niacin on inflammatory markers and adipokines.
Methods.
A comprehensive search was conducted across five databases: PubMed, Scopus, Cochrane Library, Embase, and ISI Web of Science. Randomized controlled trials exploring the effects of Niacin on inflammatory markers (CRP, IL-6, TNF-α) and adipokines (adiponectin, leptin) were included. Pooled effect sizes were analysed using a random-effects model, and additional procedures including subgroup analyses, sensitivity analysis and dose-response analysis were also performed.
Results.
From an initial 1279 articles, fifteen randomized controlled trials (RCTs) were included. Niacin administration demonstrated a notable reduction in CRP levels (SMD: -0.88, 95% CI: -1.46 to -0.30, p = 0.003). Subgroup analyses confirmed CRP reductions in trials with intervention durations ≤24 weeks, doses ≤1000 mg/day, and elevated baseline CRP levels (>3mg/l). The meta-analysis of IL-6 and TNF-α revealed significant TNF-α reductions, while IL-6 reduction did not reach statistical significance. Niacin administration also substantially elevated adiponectin (SMD: 3.52, 95% CI: 0.95 to 6.1, p = 0.007) and leptin (SMD: 1.90, 95% CI: 0.03 to 3.77, p = 0.04) levels.
Conclusion.
Niacin treatment is associated with significant reductions in CRP and TNF-α levels, suggesting potential anti-inflammatory effects. Additionally, Niacin positively influences adipokines, increasing adiponectin and leptin levels. These findings provide insights for future research and clinical applications targeting inflammation and metabolic dysregulation.
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Poulter M, Coe S, Graham CA-M, Leach B, Tammam J, 'A Systematic Review of the effect of Dietary and Nutritional Interventions on the Behaviours and Mental Health of Prisoners'
British Journal of Nutrition [online first] (2024)
ISSN: 0007-1145 eISSN: 1475-2662AbstractPublished here Open Access on RADARPrisoners experience a higher burden of poor health, aggressive behaviours and worsening mental health than the general population. This systematic review aimed to identify research that used nutrition-based interventions in prisons, focusing on outcomes of mental health and behaviours. The systematic review was registered with PROSPERO on the 26th of January 2022: CRD42022293370. Inclusion criteria comprised of current prisoners with no limit on time, location, age, sex, or ethnicity. Only quantitative research in the English language was included. PubMed/Medline, Web of Science, EMBASE, PsycINFO, and CINAHL were searched, retrieving 933 results, with 11 included for qualitative synthesis. Studies were checked for quality using the ROB 2 or ROBINS-I tool. Of the included studies, seven used nutritional supplements, three included diet changes, and one used education. Of the seven supplement-based studies, six included rule violations as an outcome, and only three demonstrated significant improvements. One study included mental health as an outcome, however, results did not reach significance. Of the three diet change studies, two investigated cognitive function as an outcome, with both reaching significance. Anxiety was included in one diet change study, which found a significant improvement through consuming oily fish. One study using diet education did not find a significant improvement in overall mental resilience. Overall, results are mixed, with the included studies presenting several limitations and heterogeneity. Future research should aim to consider increased homogeneity in research design, allowing for a higher quality of evidence to assess the role nutrition can play in improving the health of prisoners.
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Eduard Martinez Solsona, Thanasis Tektonidis, Jeanette C. Reece, Steve Simpson-Yap, Lucinda J. Black, Esmaeil Yousefi Rad, Shelly Coe,, 'Associations between diet and disease progression and symptomatology in multiple sclerosis: A systematic review of observational studies.'
Multiple Sclerosis and Related Disorders 87 (2024)
ISSN: 2211-0348 eISSN: 2211-0356AbstractPublished here Open Access on RADARBackground
Although many people with MS (pwMS) modify their diet after diagnosis, there is still no consensus on dietary recommendations for pwMS. A number of observational studies have explored associations of diet and MS progression, but no studies have systematically reviewed the evidence. This systematic review aimed to provide an objective synthesis of the evidence for associations between diet and MS progression, including symptoms and clinical outcomes from observational studies.
Methods
We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic database searches were performed for studies completed up to 26 July 2023 using PubMed (Medline), Web of Science, CINAHL, Embase (Ovid), and Scopus, followed by citation and reference list checking. We included studies using diet quality scores or dietary indices. Studies assessing individual foods, nutrients, or dietary supplements were excluded. We used the Newcastle-Ottawa Scale to assess the risk of bias of included studies.
Results
Thirty-two studies met the inclusion criteria. Of these, 20 were cross-sectional and 12 prospective. The most frequent outcomes assessed were disability (n=19), quality of life (n=12), fatigue (n=12), depression (n=9), relapse (n=8), anxiety (n=3), and magnetic resonance imaging (MRI) outcomes (n=4). Based on prospective studies, this review suggests that diet might be associated with quality of life and disability. There were also potential effects of higher diet quality scores on improved fatigue, disability, depression, anxiety, and MRI outcomes but more evidence is needed from prospective studies.
Conclusions
Observational studies show some evidence for an association between diet and MS symptoms, particularly quality of life and disability. However, the impact of diet on other MS outcomes remains inconclusive. Ultimately, our findings suggest more evidence is needed from prospective studies and well-designed tailored intervention studies to confirm associations.
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Coe, S, Cossington, J, Collett, J, Meaney, A, Mavrommati F, Ng, Y, Izadi, H, Wade, W, Pindus, DM, Bushnell, O, Whaymand, L, Theologis, T, Swift, E, Akgul, E, Allen, S, Dawes, H, 'The effect of breaking sitting time with physical activity breaks on cognitive performance in young people with Cerebral Palsy: an exposure response cross-over feasibility design.'
Translational Exercise Biomechanics 1 (1) (2024) pp.32-42
ISSN: 2942-6812AbstractPublished here Open Access on RADARAim: To assess the feasibility of methods and estimate the potential effect of interrupting sedentary behaviour, with intermittent or continuous physical activity breaks, on cognitive performance in young people with Cerebral Palsy.
Methods: A randomised three-arm exposure response cross-over design with process evaluation. Participants were recruited throughout the Thames Valley, UK between 01/11/2018 to 31/03/2020. The three 2-hour activity exposure visits included: i) sitting only (controls), ii) sitting plus 20 minutes of moderate-to-vigorous activity burst, or iii) 4 x 5 minutes of moderate-to-vigorous activity bursts, during a 2.5-hour sedentary session. Measures of feasibility were sought. Cognitive performance outcomes (using the Eriksen Flanker task and Forward and Backward Digit Span) were delivered before and after the 2-hour testing period.
Results: 36 participants were randomised (age 13.2 ± 2.7, Gross-Motor Functional Classification System 1-3). Study retention was 83% across all three interventions and overall missing data for measures was 4%. A small intervention effect was found in reaction time in the 4 x 5-minute physical activity exposure session compared to the sedentary control condition (0.42; 95% CI 0.40 to 0.79). There were two research-related minor adverse effects, an allergic reaction to the FreeStyle Libre and feeling faint and vomiting after consumption of glucose solution. Both events were resolved and participants continued with the study.
Conclusion: The study design and intervention implementing short bursts of physical activity was feasible and indicated a potential effect on reaction time as a measure of cognitive performance in young people with cerebral palsy.
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Mousavi SN, Nouri M, Rad EY, Kazemi R, Birjandi M, Coe S, Saboori S, 'Association between Dietary Phytochemical Index and risk of benign prostatic hyperplasia: a case-control study'
Journal of Health, Population and Nutrition 43 (2024)
ISSN: 1606-0997 eISSN: 2072-1315AbstractPublished hereBackground Dietary intake of phytochemicals has been associated with a reduced risk of chronic diseases, but research on their relationship with benign prostatic hyperplasia (BPH) is limited. This case-control study aimed to investigate the association between a Dietary Phytochemical Index (DPI) and BPH risk in a Middle-Eastern population.
Methods The study recruited 112 BPH patients and 112 age-matched healthy controls (40-75 years) from Al-Zahra Hospital Clinic in Isfahan, Iran between 2021 and 2022. Dietary intake was assessed using a validated food-frequency questionnaire, and DPI was calculated as the ratio of energy intake from phytochemical-rich foods to total daily energy intake. Logistic regression analysis was performed, adjusting for potential confounders.
Results In the crude model, participants in the highest DPI tertile had a 70% lower odds of BPH compared to those in the lowest tertile (OR:0.3, 95% CI 0.15-0.61, P-trend=0.001). After adjusting for confounders, this inverse association remained significant (OR:0.23, 95% CI 0.15-0.63, P-trend=0.001). Participants with higher DPI consumed more whole grains (p=0.02), nuts (p
Conclusions This study demonstrates a protective association between DPI and BPH risk in the Middle-Eastern population. Encouraging higher intake of phytochemical-rich foods may help reduce the risk of BPH, highlighting the relevance of nutritional science in promoting prostate health.
Background Dietary intake of phytochemicals has been associated with a reduced risk of chronic diseases, but research on their relationship with benign prostatic hyperplasia (BPH) is limited. This case-control study aimed to investigate the association between a Dietary Phytochemical Index (DPI) and BPH risk in a Middle-Eastern population.
Methods The study recruited 112 BPH patients and 112 age-matched healthy controls (40-75 years) from Al-Zahra Hospital Clinic in Isfahan, Iran between 2021 and 2022. Dietary intake was assessed using a validated food-frequency questionnaire, and DPI was calculated as the ratio of energy intake from phytochemical-rich foods to total daily energy intake. Logistic regression analysis was performed, adjusting for potential confounders.
Results In the crude model, participants in the highest DPI tertile had a 70% lower odds of BPH compared to those in the lowest tertile (OR:0.3, 95% CI 0.15-0.61, P-trend=0.001). After adjusting for confounders, this inverse association remained significant (OR:0.23, 95% CI 0.15-0.63, P-trend=0.001). Participants with higher DPI consumed more whole grains (p=0.02), nuts (p
Conclusions This study demonstrates a protective association between DPI and BPH risk in the Middle-Eastern population. Encouraging higher intake of phytochemical-rich foods may help reduce the risk of BPH, highlighting the relevance of nutritional science in promoting prostate health.
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F. Tabacchi, V. Iatridi, J. Tammam, E. Watson & S. Coe, 'Case report on a multidisciplinary approach to address malnutrition and improve a patient’s fitness for treatment'
Nutrition and Cancer [online first] (2024)
ISSN: 0163-5581 eISSN: 1532-7914AbstractPublished here Open Access on RADARApproximately 5,700 people are diagnosed with myeloma each year in the UK. The standard of care is to receive an autologous stem cell transplant after completion of induction therapy. There are no specific dietary recommendations for people with myeloma, however they are at risk of malnutrition due to symptoms and side effects of treatments. This report describes the journey of a 73-year-old male diagnosed with immunoglobulin A (IgA) lambda myeloma in April 2021. The patient lost 23% of his body weight during 6 months of systemic anti-cancer treatment (SACT), resulting in postponing his transplant twice due to reduced fitness. This report describes an effective, although late, multidisciplinary intervention which was successful for the patient who managed to reestablish a healthy weight and good quality of life. The patient received his transplant in January 2023. This case highlights two important aspects of patient care that should not be underestimated in dietetic clinical practice: early screening and multidisciplinary collaboration. Monitoring the nutritional status of patients and providing early nutrition support can prevent hospital admissions, treatment delays and reduce the associated costs. Multidisciplinary teamwork can improve patient care and clinical outcomes, and it is fundamental to strengthen communication and collaboration among clinical disciplines.
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Poulter M, Coe S, Graham CA-M, Leach B, Tammam J, 'Menu Provision in a Young Offenders Institution, Comparison with Dietary Guidelines, and Previous Menu Allocation: A cross sectional Nutritional Analysis.'
Journal of Nutritional Science [in press] (2024)
ISSN: 2048-6790 eISSN: 2048-6790AbstractOpen Access on RADARObjective: This study aimed to assess and comparatively analyse two menus from a Young Offenders Institution (YOI), one from 2019 and 2022, identifying any improvements in meeting dietary guidelines. Design: Cross-sectional and comparative analysis. Setting: United Kingdom, a YOI in Northern England. Participants: YOI Menus. Results: A total of 30 dietary components were analysed, of these, 25 were exceeding the dietary guidelines (pConclusion: The 2022 menu has demonstrated progress towards meeting dietary guidelines and particularly with reducing calories, fat, saturated fat, salt, sodium, and chloride, as well as increasing vitamin D. Though improvements are seen, calories, free sugars, salt, saturated fat, sodium, and chloride are still exceeding dietary guidelines, posing as potential health risks.
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Somayeh Saboori, Esmaeil Yousefi Rad, Jonathan Tammam, Pariyarath Sangeetha Thondre, Shelly Coe, 'Effects of Niacin on apolipoprotein A1 and B levels: A systematic review and meta-analysis of Randomised Controlled Trials'
British Journal of Nutrition [online first] (2023)
ISSN: 0007-1145 eISSN: 1475-2662AbstractPublished here Open Access on RADARNiacin has been investigated for its potential impact on lipid metabolism and cardiovascular health. This meta-analysis aims to systematically evaluate the effects of Niacin interventions on apolipoprotein A1 (Apo A1) and apolipoprotein B (Apo B) levels, key regulators of lipoprotein metabolism and markers of cardiovascular risk. A comprehensive search of the literature was performed on five databases of PubMed, Scopus, Web of Science, Embase and Cochrane library, from inception up to 15 July 2023. This search identified 1452 publications, from which 12 randomized controlled trials (RCTs) met the inclusion criteria. The intervention dosages ranged from 500 to 3000 mg/day, and the study durations spanned 6 to 102.8 weeks. The Niacin intervention demonstrated a significant reduction in Apo B levels (WMD: -24.37 mg/dl, p = 0.01). Subgroup analyses indicated that intervention duration played a role, with trials of ≤16 weeks showing a greater reduction in Apo B. Regarding Apo A1, Niacin significantly increased its levels (WMD: 8.23 mg/dl, p 1500 mg/day (p
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Collett J, Lawrie S, Bromley S, Harling P, Reed A, Brusco N, Coe S, Coebergh J, Carroll C, Roberts HC, Hu MT, Dawes H, 'A programme evaluation of ‘First Steps’: A peer-conceived, developed and led self-management intervention for people after a Parkinson's diagnosis'
Clinical Rehabilitation Online first (2023)
ISSN: 0269-2155 eISSN: 1477-0873AbstractPublished hereObjective
A diagnosis of Parkinson's often leads to uncertainty about the future and loss of perceived control. Peer support may offer a means to address these concerns and promote self-management.Design
A programme evaluation of the feasibility and potential effects of ‘First Steps’, utilising a pragmatic step wedge approach. Comparing First Steps (intervention) to (control) conditions.
Setting: In the community at four sites in southern England.
Participants: Newly diagnosed (≤ 12months) people with Parkinson's.
Intervention: First Steps was a 2-day peer-conceived, developed and led intervention to support self-management.
Main measures: At 0, 12 and 24 weeks anxiety and depression (Hospital, Anxiety and Depression Scale, HADS), daily functioning (World Health Organisation Disability Assessment Schedule, WHODAS), physical activity, quality of life (EQ5D), carer strain and service utilisation were assessed.Results
Between February 2018 and July 2019, 36 participants were enrolled into intervention and 21 to control conditions, all were included in statistical analysis. Lost to follow up was n = 1 (intervention) and n = 1 adverse event was reported (control, unrelated). Of the 36 allocated to the intervention n = 22 participants completed both days of First Steps during the study period. Completion of outcome measures was >95% at 24 weeks. Small effects favouring the intervention were found for HADS (odds ratio (OR) = 2.06, 95% confidence interval (CI) 0.24:17.84), Carer Strain Index (OR = 2.22, 95% CI 0.5:9.76) and vigorous (d = 0.42, 95% CI −0.12:0.97) and total physical activity (d = 0.41, 95% CI −0.13:0.95). EQ5D, WHOSDAS and service utilisation, was similar between groups.Conclusions
First Steps was feasible and safe and we found potential to benefit physical activity, mental health and carer strain. Further research with longer-term follow up is warranted. -
Soleymani Majd N, Coe S, Lightowler H and Thondre PS, 'The Effect Of High-Polyphenol Sumac (Rhus coriaria) On Food Intake Using Sensory And Appetite Analysis In Younger And Older Adults: A Randomized Controlled Trial '
Food Science & Nutrition 11 (7) (2023) pp.3833-3843
eISSN: 2048-7177AbstractPublished here Open Access on RADARAging is accompanied by a decline in appetite and food intake with associated deficiencies in both macronutrients and micronutrients. The aim of this study was to investigate the impact of adding Iranian brown sumac (Rhus coriaria) (CIBS) into butternut squash soup on sensory evaluation and food intake among older adults (n = 20; >65 years old) and younger adults (n = 20; 18–35 years old). To evaluate the polyphenol content and antioxidant activity of the sumac samples, a Folin–Ciocalteu assay (FCR) and ferric ion reducing antioxidant power (FRAP) assay were used, respectively. L-glutamic acid was assessed using a Megazyme L-glutamic acid assay. Compusense software was used to assess the sensory evaluation attributes of free-living older adults and younger adults receiving different doses of sumac in butternut squash soup. Nutritics software was used to assess food intake following the addition of 0.37 g of sumac to soup. CIBS was selected based on a preliminary assessment in vitro for L-glutamic acid, antioxidant, and polyphenol content of six varieties of sumac. Sensory evaluation results revealed that the difference in perceived intensity of brown color between the soup samples with different doses of CIBS was greater in the younger adults' group (p = .001) than in older adults (p = .037). In addition, the food intake study found that during the ad libitum lunch, older adults consumed more energy (kcal; p = .014), protein (g; p = .025), carbohydrate (g; p = .013), and fat (g; p = .002) after soup with sumac compared to control soup. The overall findings of this study suggest that the addition of sumac to food may have a potential benefit in enhancing ad libitum lunch intake in older adults leading to effective management of malnutrition. This may promote healthy aging and minimize the burden and the consequences of anorexia of aging as main public health concerns.
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Zare N, Mansoubi M, Coe S, Najafi A, Bailey K, Harrison K, Sheehan J, Dawes H, Barker K, 'An investigation into the relationship between nutritional status, dietary intake, symptoms and health-related quality of life in children and young people with juvenile idiopathic arthritis: A systematic review and meta-analysis'
BMC Pediatrics 23 (1) (2023)
ISSN: 1471-2431 eISSN: 1471-2431AbstractPublished here Open Access on RADARBackground.
The association between diet, symptoms and health related quality of life in children and young people with Juvenile idiopathic arthritis (JIA) is not clearly understood. The objectives of this systematic review and meta-analysis were to explore the evidence for a relationship between nutritional status, dietary intake, arthritis symptoms, disease activity and health-related quality of life in children and young people with JIA considering both observational and interventional studies separately.Method.
The databases PubMed, CINAHL, PsycINFO, Web of Science and Cochrane were searched in October 2019, updated in September 2020 and October 2021. Searches were restricted to English language, human and age (2–18 years old). Studies were included if they measured the effect of dietary supplements, vitamins or minerals, or diet in general, on quality of life and/ or arthritis symptom management. Two researchers independently screened titles and abstracts. Full texts were sourced for relevant articles. PRISMA guidelines were used for extracting data. For variables (vitamin D and disease activity), a random-effects meta-analysis model was performed. Two authors using a standardized data extraction form, extracted data independently.Results.
11,793 papers were identified through database searching, 26 studies met our inclusion criteria with 1621 participants. Overall studies quality were fair to good. Results from controlled trial and case control studies with total 146 JIA patients, found that Ɯ-3 PUFA improved the mean active joint count (pConclusions.
We were only able to include small studies, of lower design hierarchy, mainly pilot studies. We found some evidence of lower height and weight across studies in JIA, but were unable to confirm an association between diet, symptoms and health-related quality of life in children and young people with JIA. Well-designed, carefully measured and controlled interventional studies of dietary patterns in combination with important contributing factors such as medication and lifestyle behaviours, including physical activity, are required to determine the impact of diet in improving symptoms and growth patterns in children and young people with JIA, with an aim to improve the quality of their life. -
Tabacchi F, Iatridi V, Tammam J, Watson E, Coe S, 'Under-identification of cancer outpatients at risk of malnutrition: are we making the most of anthropometric data?'
Future Healthcare Journal 9 (3) (2022)
ISSN: 2055-3323 eISSN: 2055-3331AbstractPublished here Open Access on RADARIn oncological outpatient settings, patients often require nutritional support after they have developed malnutrition. A delayed dietetic referral can lead to increased difficulties in providing therapies and surgery, and to poorer patient outcomes. The audit described in this article aimed to assess the frequency and completeness of patient record documentation of anthropometric measurements in a day treatment unit (DTU) in a single cancer centre in the UK. The underlying goal was to improve anthropometry monitoring procedures to ensure that documentation is sufficient to indicate weight loss and, hence, allow timely referrals for nutrition support. The results show that, for over 80% of patients, it was not possible to identify a weight trend between the latest two treatments received at the hospital. The audit findings highlight the need to improve malnutrition monitoring and to ensure patient records contain updated and accurate anthropometric measurements in order to facilitate medical staff to recognise early malnutrition risk and refer for appropriate nutritional support when needed.
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Almaski A, Coe S, Lightowler H, Clegg ME, Thondre PS , 'Finger millet based-muffin decreases insulin response in individuals with prediabetes in a randomised controlled trial'
British Journal of Nutrition 129 (4) (2022) pp.650-659
ISSN: 0007-1145 eISSN: 1475-2662AbstractPublished here Open Access on RADARMillet is a grain high in polyphenols and antioxidants, which are bioactive compounds known to influence blood glucose response. The aim of this study was to compare the effect of finger millet muffin and wheat muffin on glycaemic response (GR), insulin response (IR), gastric emptying (GE) and satiety in healthy individuals and people with prediabetes. In a single blind randomised controlled crossover trial at Oxford Brookes Centre for Nutrition and Health, 15 healthy individuals and 14 individuals with prediabetes were recruited between May and December 2017. The participants’ GR (3 hours), IR (3 hours), GE (4 hours) and satiety (4 hours) were measured before and after the consumption of muffins. A mixed method analysis of variance was used to compare GE and the incremental area under the curve (iAUC) for GR and IR between the participant groups and muffins. There was a significant interaction between participants and muffins on IR iAUC at 180 min (p = 0.042). A significant effect of muffins was found on the GR peak (p = 0.013). The millet muffin decreased the GR peak and IR iAUC compared with the wheat muffin in participants with prediabetes. A significant interaction between participants and muffins for GE ascension time Tasc (p = 0.017) was observed; with no effect of muffins on satiety AUC in the participant groups. This study suggested that polyphenol and fibre-rich finger millet may have the potential to influence the management of prediabetes.
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Lawrie S, Coe S, Mansoubi M, Welch J, Razzaque J, Hu MT, Dawes H, 'Dietary patterns and non-motor symptoms in Parkinson’s: a cross-sectional analysis '
Journal of the American Nutrition Association 42 (4) (2022) pp.393-402
ISSN: 2769-7061 eISSN: 2769-707XAbstractPublished here Open Access on RADARObjective: Evidence-based treatment for non-motor symptoms in Parkinson’s (PD) is limited. Lifestyle-based improvements including dietary changes may be a potential management strategy. To investigate the extent to which three dietary indices (Mediterranean-DASH Diet Intervention for Neurodegenerative Delay (MIND), Dietary Inflammation Index (DII), and Healthy Diet Indicator (HDI-2020) are associated with overall and individual non-motor symptom severity amongst individuals with Parkinson’s.
Methods: An exploratory cross-sectional analysis of dietary (food frequency questionnaire) and clinical data, including measures of overall non-motor symptom severity, including fatigue, depression, anxiety, apathy, sleep problems, daytime sleepiness, and cognitive impairment. The relationship between each dietary score and symptom outcome were assessed by linear regression for continuous variables and through general linear model analysis for tertiles of dietary adherence.
Results: None of the dietary indices significantly predicted the total non-motor symptom severity score. The HDI predicted a significant decrease in fatigue scores as measured by the NeuroQol fatigue item (standardised β= - .19, p= .022), after adjusting for age, gender, energy intake, years diagnosed, physical activity level, education, and smoking. Self-reported depression symptoms reduced by .17 (standardised β) for each unit increase in HDI score (p= .035), after controlling for age, gender, energy intake and years diagnosed. No other significant associations were evident between dietary scores and any other non-motor symptoms.
Conclusion: Our results indicate that fatigue and depression in Parkinson’s may be modified by diet; however more research is needed using a larger sample to replicate these findings.
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Collett J, Brusco N, Cordell N, Cockroft A, Lawrie S, Coe S, Reed A, Dawes H , 'Lost employment potential and supporting people with Parkinson’s to stay in work: Insights from a Pan European cross-sectional survey.'
Disability and Rehabilitation 45 (5) (2022) pp.832-839
ISSN: 0963-8288 eISSN: 1464-5165AbstractPublished here Open Access on RADARPurpose.
To explore, in a European cohort of people living with Parkinson’s (PD), issues affecting employment and economic consequences, considering age at diagnosis.Materials and methods.
A cross-sectional survey (European convenience sample). Inclusion criteria were ≥18 years, a PD diagnosis and in work when diagnosed. Data were collected online on demographics, employment status, occupation, and perceived health. For those no longer in paid work, time from diagnosis until loss of employment, reasons for leaving and enablers to stay in work were ascertained.Results.
Between April and November 2019, n = 692 enrolled and n = 560 were eligible. Those who had lost paid work (n = 190, 34%) reported worse fatigue, sleep, and general health than those still in work (pConclusions.
This study confirms lost productivity after a PD diagnosis, especially in those with many years of potential employment ahead. The study also identified potential targets for interventions. Clinical trial registration: Clincaltrials.gov (NCT03905954).Implications for rehabilitation.
* People with Parkinson’s diagnosed at career establishment or at mid working age risk losing many years of potential employment.
* Most people with Parkinson’s do not receive early intervention to support self-management of problems identified with leaving work early, such as fatigue.
* Adaptations to the work environment and more flexible working patterns were identified factors that may help people remain in work.
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Coe S, Andreoli D, George M, Collett J, Reed A, Cossington J, Izadi H, Dixon A, Mansoubi M, Dawes H, 'A feasibility study to determine whether the daily consumption of flavonoid-rich pure cocoa has the potential to reduce fatigue and fatigability in people with Parkinson’s (pwP).'
Clinical Nutrition ESPEN 48 (2022) pp.68-73
ISSN: 2405-4577 eISSN: 2405-4577AbstractPublished here Open Access on RADARFlavonoids, plant compounds found in certain foods, may have the ability to improve fatigue and fatigability. However, to date, no well-designed intervention studies assessing the role of flavonoid consumption for fatigue management in people with Parkinson’s (pwP) have been performed.
Objectives: To determine the feasibility and estimate potential effect of flavonoid-rich cocoa on fatigue and fatigability in pwP.
Methods: This was a randomised (1:1) double-blind placebo controlled feasibility study in which 30 pwP were recruited from the European Parkinson Therapy Centre, Italy (trial registration: NCT03288155). During a six day intervention participants consumed a high (10.79mg/g) or low flavonoid cocoa (1.02mg/g) beverage (18 grams Cocoa with 200ml Rice milk) once daily. Potential effect on fatigue and fatigability was measured (baseline to day 6). Feasibility and fidelity were assessed through recruitment and retention, adherence and a process evaluation.
Results: From July 2017 to May 2018, 30 pwP were recruited and randomised and allocated to high (n=15) or low (n=15) flavonoid groups and included in analysis. Missing data was less than 5% and adherence to intervention of all allocated individuals was 97%. There was a small effect on fatigability (six minute walk test: ES 0.11 (95%CI=-0.11-0.26); Z=0.81).There were 2 adverse events (one in the control and one in the intervention group).
Conclusion: The consumption of cocoa is feasible and well received in pwP, and further investigation on the effect on fatigability is warranted.
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Mansoubi M, Coe S, Cossington J, Collet J, Clegg M, Palace J, Cavey A, DeLuca GC, Ovington M, Dawes H, 'Physical activity and fatigue in Multiple Sclerosis: secondary outcomes from a double-blinded randomized controlled trial of a cocoa flavonoid drink'
Translational Medicine and Exercise Prescription 1 (1) (2021) pp.53-61
AbstractPublished hereFatigue is a common and pervasive symptom reducing physical activity in people with multiple sclerosis (pwMS). Exercise may reduce fatigue, although evidence to guide optimal prescription is limited. Specifically, supportive evidence for the timing of exercise for fatigue management or the impact of dietary supplements is unavailable. We performed intensive phenotyping of the interrelation of time of day, physical activity levels, and fatigue to evidence exercise prescription in 40 pwMS participating in a six week randomized controlled trial of morning flavonoid intake (n=19) or a control (n=21). Physical activity was measured over seven days by using an accelerometer at baseline, week three and week six. Participants self-reported their fatigue on a 1–10 rating scale at 10 am, 3 pm, and 8 pm daily. Physical activity levels were calculated for 2.5 h before and after fatigue was reported. Generalized estimating equations were used to explore the time of day fatigue profiles, the relationship of physical activity to fatigue, and the effect of morning flavonoids on this relationship. Participants experienced higher fatigue at 8 pm (4.64±2.29) than at 3 pm (4.39±2.28) and 10 am (3.90±2.10) (P0.05). Morning flavonoid cocoa consumption reduced the relationship of fatigue to physical activity (P=0.049) and fatigue to time of the day (P
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Saltaourasa, G, Lightowler H, Coe S, Horne A, Matthews S, Caulfieldc L, Watson EK, 'Diet and nutrition in patients who have received pelvic radiotherapy: A mixed-methods study to explore dietary habits, nutritional awareness and experiences of nutritional care'
Nutrition: The International Journal of Applied and Basic Nutritional Sciences 89 (2021)
ISSN: 0899-9007AbstractPublished hereObjectives
Individuals who have survived cancer may benefit from dietary modifications to improve quality of life and future health outcomes. The aim of this study was to explore dietary habits and experiences of nutritional support in patients with a cancer diagnosis who have received radiotherapy to the pelvic area.Methods
A mixed-methods approach was used. Individuals diagnosed with a pelvic cancer (anal, bladder, rectal, and cancers of the reproductive organs), either undergoing or having completed pelvic radiotherapy 6 to 24 mo previously, were invited to participate in a postal survey. A purposive subsample was also invited to take part in telephone interviews. Thematic analysis of interview data was undertaken and integrated with data from quantitative analysis.Results
The survey was completed by 254 (38%) respondents. Two-thirds of respondents (170) reported dietary changes since diagnosis; most notable changes were reduction of sugary foods (48%) and alcohol (41%). Receipt of support from the health care team was significantly associated with dietary change (odds ratio, 3.26; 95% confidence interval, 1.58–6.75); however, only 43% (108) had received dietary support from the health care team. Of the respondents, 68% (171) said they would like to receive additional dietary support. The effect of the condition on diet was highlighted in the theme “Impact of diagnosis and treatments on dietary choices.” Self-management of disease was influenced by personal resources, social resources, comorbidities and disabilities, influence of work, regaining normality, and barriers to dietary changes.Conclusion
Lack of routine provision of nutritional care to patients after a cancer diagnosis and patient interest in this area highlighted unmet needs in managing diet-related problems and leading a healthy future lifestyle. -
Grace Bennett, Elysia Young, Isabel Butler, Shelly Coe, 'The impact of lockdown during the COVID-19 outbreak on dietary habits in various population groups: a scoping review'
Frontiers in Nutrition 8 (2021)
ISSN: 2296-861X eISSN: 2296-861XAbstractPublished here Open Access on RADARBackground: Since the beginning of the COVID-19 pandemic, access to fresh food has been restricted, and people are spending more time inside and have limited their physical activity. However, more time at home may have resulted in some positive habits including an increase in cooking. The aim of this review was to assess dietary changes during the first lockdown. Themes and patterns were considered and associations with other lifestyle factors were assessed.
Methods: Between June and July 2020, the PubMed, Google Scholar, and Science Direct databases were searched, and results were screened for eligibility based on title, abstract, and full text. The inclusion criteria of this search included: papers published (or in pre-print) in the year 2020; studies that investigated the impact of COVID-19 lockdown on diet; papers published in English. Exclusion criteria were as follows: papers examining dietary changes in those following a structured diet based on diagnosed conditions or dietetic advice; literature, systematic, or narrative studies reviewing previous research. Researchers agreed on the study characteristics for extraction from final papers.
Results: Four thousand three hundred and twenty-two studies were originally considered with 23 final full-text papers included. Four themes were identified: dietary patterns, dietary habits (favorable), dietary habits (unfavorable), and other (includes physical activity levels, weight gain). A total of 10 studies reported an increase in the number of snacks consumed, while six studies found that participants increased their meal number and frequency during quarantine. Eleven studies reported favorable changes in dietary habits with an increase in fresh produce and home cooking and reductions in comfort food and alcohol consumption. However, nine studies found a reduction in fresh produce, with a further six reporting an increase in comfort foods including sweets, fried food, snack foods, and processed foods. Two studies reported an increase in alcohol consumption. In eight studies participants reported weight gain with seven studies reporting a reduction in physical exercise.
Conclusion: The effect of COVID-19 lockdown both negatively and positively impacted dietary practices throughout Europe and globally, and negative diet habits were associated with other poor lifestyle outcomes including weight gain, mental health issues, and limited physical activity. Both in the short term and if sustained in the long term, these changes may have significant impacts on the health of the population.
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Coe S, Tektonidis TG, Coverdale C, Penny , Collett J, Chu BTY, Izadi H, Middleton R, and Dawes H, 'A cross sectional assessment of nutrient intake and the association of the inflammatory properties of nutrients and foods with symptom severity, in a large cohort from the UK Multiple Sclerosis Registry.'
Nutrition Research 85 (2020) pp.31-39
ISSN: 0271-5317AbstractPublished here Open Access on RADARTo assess the intake of nutrients in people with multiple sclerosis (pwMS) compared to a control population, and to assess the pro/ anti-inflammatory properties of nutrients/ foods and their relationships with fatigue and quality of life. This was a cross sectional study in which 2410 pwMS (686 men; 1721 women, 3 n/a, mean age 53 (11 years)) provided dietary data using a food frequency questionnaire that was hosted on the MS Register for a period of 3 months and this was compared to a cohort of 24,852 controls (11,250 male, 13,602 female, mean age 59 years). Consent was implied by anonymously filling out the questionnaire. A Wilcoxon test was used to compare intake between pwMS and controls, and a bivariate analyses followed by chi2 test were undertaken to identify significance and the strength of the relationship between pro/anti-inflammatory dietary factors and fatigue and EQ-5D. Compared to controls, all nutrients were significantly lower in the MS group (P
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Saltaouras G, Coe S, Lightowler H, Watson E, 'Diet and nutrition information and support needs in pelvic radiotherapy: a systematic, mixed-methods review.'
European Journal of Cancer Care 29 (6) (2020)
ISSN: 0961-5423 eISSN: 1365-2354AbstractPublished here Open Access on RADARIntroduction: This study aimed to review diet and nutrition information and support needs of cancer patients who receive pelvic radiotherapy to inform the development of interventions to improve this area of care.
Methods: The systematic review followed the PRISMA guidelines. Six electronic databases were searched for peer-reviewed studies of any design that assessed diet and nutrition needs after a pelvic cancer diagnosis. Narrative synthesis was used to integrate findings. Results: Thirty studies (12 quantitative, 15 qualitative, 3 mixed-methods) were included. Four themes, “content of dietary information”; “sources of information”. “sustaining dietary change”; and “views on the role of diet post-treatment”, summarised evidence about provision of nutritional guidance following diagnosis, but also contrasting views about the role of diet post diagnosis. Qualitative studies contributed considerably more to the synthesis, compared to quantitative studies. Included studies were of moderate to good quality; selection bias in quantitative studies and poor evidence of credibility and dependability in qualitative studies were highlighted. Conclusion: There is some evidence of lack of nutrition support in pelvic cancer survivors, but methodological limitations of included studies may have had an impact on the findings. Future, prospective studies that focus on diet and nutrition needs post-diagnosis are warranted to improve care. -
Tektonidis T, Coe S, Esser P, Maddock J, Buchanan S, Mavrommati F, Izadi H, Schott JM, Richards M, Dawes H, 'Longitudinal Changes in Diet Quality over Adulthood and Physical Function in Older Life: Findings from a British Birth Cohort'
Current Developments in Nutrition 4 (2020)
ISSN: 2475-2991 eISSN: 2475-2991AbstractPublished hereObjectives: A healthy diet has been linked to better physical function in older adults but evidence on the role of cumulative dietary exposure is scarce. Sex differences in the relationship are also underexplored. The objective was to explore the longitudinal association of diet quality in adulthood (from 36–64 y), in line with dietary guidelines, and walking speed as an objective measure of later life physical function.
Methods: Study sample was derived from the Insight 46 (n = 502), a neuroscience sub-study of the longitudinal National Survey of Health and Development, UK. Diet was assessed four times, at age 36 y, 43 y, 53 y and 60–64 y using five-day food diaries, from which the Healthy Eating Index-2015 (HEI) was calculated (0 - low quality, 100 - high quality). Walking speed was estimated in a 10-meter walk test at self-selected pace, using an inertial measurement unit at age 69–71 y. Linear mixed models with random effects and group-based trajectory modeling were used to assess individual and group changes in HEI in adulthood. Multivariable linear regression models with sex as modifier, controlling for multiple characteristics assessed the association between adulthood HEI trajectories and walking speed at 71 y. The final sample was 226 women and 230 men.
Results: Men and women improved diet quality linearly in adulthood (β: 0.6 HEI/y, 95% CI: 0.5, 0.7). Three linear HEI trajectories were identified (21% “Low” βo: 33, β: 3.6; 59% “Medium” βο: 38, β: 6.1; 20% “High” βο: 52, β: 5.5, P rates, higher HEI at each age (β: 4 HEI points, 95% CI: 3, 6) and were
more likely to belong to the “High” HEI trajectory than men (β: 1.97, P increase in predicted HEI trajectory and membership in the “High” vs “Medium”-“Low” HEI trajectories were associated with faster walking speed (β: 0.04 m/s, 95% CI: 0.01, 0.08, β: 0.06 m/s, 95% CI: 0.01, 0.11, respectively). Association was attenuated in multivariable models. No association was observed in men.
Conclusions: In women, higher diet quality in adulthood was associated with faster walking speed in later life. Achieving and maintaining high diet quality in adulthood is likely of importance to yield benefits in physical function.
Funding Sources: Medical Research Council UK Alzheimer’s Research UK Dementias Platform UK Wolfson Foundation UK CLOSER UK.
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Cossington J, Coe S, Liu Y, Dawes H, 'Potential benefits of a ketogenic diet to improve response and recovery from physical exertion in people with Myalgic encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): A feasibility study'
International Journal of Sport, Exercise and Health Research 3 (2) (2019) pp.33-39
ISSN: 2581-4923AbstractPublished here Open Access on RADARBackground. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) affects approximately 250,000 people in the UK. The condition varies in severity causing long-term physical and cognitive fatigue which is not alleviated by rest. Whilst the pathology is not understood, recent evidence suggests metabolic abnormalities may be associated with the manifestation of symptoms, particularly involving the metabolism of glucose and energy production. The use of ketone bodies as an alternative energy substrate may be beneficial to people with ME/CFS, in order to by-pass the glycolytic pathway, enhance energy production and reduce fatiguing outcomes.
Study Design and Methods. Using a pragmatic collective case study with repeated measures methodology we investigated the feasibility of following a ketogenic diet and potential effects of the high fat, low carbohydrate diet on response to physical activity in people with ME/CFS (n=3) and healthy controls (n=3) using a submaximal exercise stress test both with and without dietary intervention. Exercise tolerance (mins), rate of oxygen consumption (VO2) to workload (75W), respiratory exchange ratio (RER), rate of perceived effort (RPE) and lactate response were measured throughout and descriptive statistics performed.
Results. We found that the ketogenic diet was followed, with compliance higher in the pwME/CFS. Variations in response following the ketogenic diet was observed across individuals in minutes performed, VO2, HR, RER, and RPE post diet but the KD only limited exercise capacity in the control individuals. Individuals responded differently to the KD but group trends have been reported as means and standard deviation. The KD resulted in a decrease in RER at submax in the controls with a mean change of 0.07 from baseline (0.86 ± 0.1) to post intervention (0.79 ± 0.1) compared to a mean change of 0.02 in the ME/CFS from baseline (1.03 ± 0.1) to post intervention (1.01 ± 0.1). A decrease in VO2 (L/min) at submax showed a mean change of 0.06 (L/min) in the pwME/CFS at baseline (1.34 ± 0.1) to post intervention (1.27 ± 0.2) compared to a mean change of 0.07 (L/min) in the controls at baseline (1.40 ± 0.3) to post intervention (1.33 ± 0.2). HR (bpm) at submax decreased in all individuals, with a mean change of 4 (bpm), with pwME/CFS at baseline (139 ± 8.2) to post intervention (135 ± 14) and control individuals at baseline (107 ± 7.8) to intervention (103 ± 3.2). RPE at submax decreased in the pwME/CFS from baseline (6 ± 1.0) to post intervention (5 ± 2.1) whereas the controls increased from baseline (2 ± 1.0) to post intervention (3 ± 1.5).
Conclusion. Our observations suggest individualised but metabolic flexibility in healthy individuals is achievable via dietary manipulation showing the ability to switch from glucose to fats under controlled conditions. The different response in substrate utilisation in individuals with ME/CFS suggests that potential metabolic abnormalities may be present in ME/CFS. Further investigation is now warranted in order to assess whether the KD is beneficial for people with ME/CFS.
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Tektonidis TG, Coe S, Esser P, Maddock J, Buchanan S, Mavrommati F, Schott JM, Izadi H, Richards M, Dawes H, 'Diet quality in late midlife is associated with faster walking speed in later life in women, but not men: findings from a prospective British birth cohort'
British Journal of Nutrition 123 (8) (2019) pp.913-921
ISSN: 0007-1145 eISSN: 1475-2662AbstractPublished here Open Access on RADARHealthy diet has been linked to better age-related physical functioning, but evidence on the relationship of overall diet quality in late midlife and clinically relevant measures of physical functioning in later life is limited. Research on potential sex differences in this relationship is scarce. The aim was to investigate the prospective association between overall diet quality, as assessed by the Healthy Eating Index-2015 at age 60-64y and measures of walking speed seven years later, among men and women from the Insight46, a neuroscience sub-study of the Medical Research Council National Survey of Health and Development. Diet was assessed at age 60-64y using five-day food diaries, from which total HEI-2015 was calculated. At age 69-71y, walking speed was estimated during four 10-meter walks at self-selected pace, using inertial measurement units. Multivariable linear regression models with sex as modifier, controlling for age, follow-up, lifestyle, health, social variables and physical performance were used. The final sample was 164 women and 167 men (n=331). Women had higher HEI-2015 scores and slower walking speed than men. A 10 point increase in HEI-2015 was associated with faster walking speed seven years later among women (B: 0.024, 95% CI: 0.006, 0.043), but not men. The association remained significant in the multivariable model (B: 0.021, 95% CI: 0.003, 0.040). In women in late midlife higher diet quality is associated with faster walking speed. A healthy diet in late midlife is likely to contribute towards better age-related physical capability and sex differences are likely to affect this relationship.
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Dias da Silva T, Cardoso Ribeiro-Papa D, Coe S, Regina Pinheiro Malheiros S, Massetti T, de Miranda Meira Junior C, Hervaldo Nicolai Ré A, Collett J, Bandeira de Mello Monteiro C, Dawes H, 'Evaluation of speed-accuracy trade-off in a computer task to identify motor difficulties in individuals with Duchenne Muscular Dystrophy - a cross-sectional study'
Research in Developmental Disabilities 96 (2019)
ISSN: 0891-4222 eISSN: 1873-3379AbstractPublished here Open Access on RADARIntroduction: Individuals with Duchenne Muscular Dystrophy (DMD) present with progressive loss of motor function which can impair both control of speed and accuracy of movement. Aim: to evaluate movement time during a task at various levels of difficulty and to verify whether the level of difficulty affects the speed and/ or accuracy during the task. Methods: the DMD group comprised of 17 individuals age matched with 17 individuals with typical development (TD group). The task evaluates the relationship between speed and accuracy, consisting of the execution of manual movements (using the mouse of the computer) aimed at a target at three different levels of difficulty (ID). Results: A MANOVA demonstrated statistically significant differences in dispersion data and intercept values between the groups with greater movement time in the DMD group. An ANOVA indicated differences between groups for ID, except for when there was a higher accuracy demand (higher ID). In the other IDs that required lower accuracy demand, individuals in the DMD group had significantly longer movement time when compared to the TD group. Conclusion: These results show that the TD and DMD did not differ in the higher ID, therefore it can be concluded that for those with DMD, motor performance is more affected by speed than accuracy of movement.
What this paper adds?
It is known that individuals with DMD have considerable motor deficits, however this paper shows that when the task involves higher accuracy compared with speed, people with DMD have performance similar to typically developed peers. This insight is a novel finding and can inform the rehabilitation team, to focus on training of speed, whilst maintaining accuracy for better execution of daily life tasks. -
Soundy A, Collett J, Lawrie S, Coe S, Roberts HC, Hu MT, Bromley S, Harling P, Reed A, Coebergh J, Carroll C, Dawes H, 'A qualitative study on the impact of First Steps: A peer-led, educational intervention for people newly diagnosed with Parkinson’s Disease.'
Behavioral Sciences 9 (10) (2019)
ISSN: 2076-328XAbstractPublished here Open Access on RADARAim. The dual aim of this research is to consider the impact of providing the First Steps program on the stories of people with Parkinson’s Disease (PD) and investigate the psychosocial and emotional mechanisms which may explain this impact.
Methods. A qualitative study using a subtle realist paradigm and hermeneutic phenomenological methodology was undertaken. A single semi-structured interview was used to consider the impact and experiences of people with PD who completed either the intervention (2-day peer-led behavior intervention using storytelling 6-8 weeks apart) or received telephone support calls as part of the active control group. Descriptive statistics and narrative analysis were undertaken on the results.
Results. Forty-two participants were invited to participate of whom forty completed the interview. This included 18 from the intervention group and 22 from the active control group. The intervention group identified the value of the program as worth-while, demonstrating improved exercise behavior and coping mechanisms following the intervention. Three major stories (the affirmed, the validated and the transformed story) identified the impact of the intervention. Three internal mechanisms (perceived control, hope and action, and the individual’s mind set) alongside three social mechanisms (social comparison, social control and the first opportunity to share with peers) appeared to explain the impact.
Conclusion. This study provides exciting and novel evidence for the impact of a peer led psycho-educational intervention for people newly diagnosed with PD. Further research is needed to consider the impact of stories-based approaches on participants and consider a critical evaluation of the mechanisms which may explain changes in stories and self-reported behaviour. -
Peña de Moraes IA, Bandeira de Mello Monteiro C, Dias da Silva T, Massetti T, Brusque Crocetta T, Del Ciello de Menezes L, Pena de Rezende Andrade G, Hervaldo Nicolai Ré A, Dawes H, Coe S, Henrique Magalhães F, 'Motor learning and transfer between real and virtual environments in young people with autism spectrum disorder: a prospective randomized cross over controlled trial'
Autism Research 13 (2) (2019) pp.307-319
ISSN: 1939-3792AbstractPublished here Open Access on RADARAutism spectrum disorder (ASD) is associated with persistent deficits in social communication and social interaction, including impaired multisensory integration which might negatively impact cognitive and motor skill performance, and hence negatively affect learning of tasks. Considering that tasks in virtual environment may provide an engaging tool as adjuncts to conventional therapies, we set out to compare motor performance between young people with ASD and a typically developing (TD) control group that underwent coincident timing tasks based on Kinect (no physical contact) and on Keyboard (with physical contact) environments. Using a randomized repeated cross-over controlled trial design, fifty young people with ASD and fifty with TD, matched by age and sex were divided into subgroups of 25 people that performed the two first phases of the study (acquisition and retention) on the same device – real or virtual – and then switched to the other device to repeat acquisition and retention phases and finally switched on to a touch screen (transfer phase). Results showed that practice in the virtual task was more difficult (producing more errors), but led to a better performance in the subsequent practice in the real task, with more pronounced improvement in the ASD as compared to the TD group. It can be concluded that the ASD group managed to transfer the practice from a virtual to a real environment, indicating that virtual methods may enhance learning of motor and cognitive skills. A need for further exploration of its effect across a number of tasks and activities is warranted.
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Almaski A, Coe S, Lightowler H, Thondre S, 'Millet Intake and Risk Factors of Type 2 Diabetes: A Systematic Review'
Journal of Food and Nutritional Disorders 8 (3) (2019)
ISSN: 2573-3664AbstractPublished here Open Access on RADARDaily consumption of millet-based foods is associated with a reduced risk of type-2 diabetes. The aim of the present study was to systematically review the literature describing intervention studies that have investigated the effects of consuming different types and forms of millet on the risk factors for type-2 diabetes. A literature search was conducted, using five databases, from May 2016 to January 2017, which identified 57 articles. Search terms included ‘millet’ AND healthy, pre-diabetic or type-2 diabetes AND fasting blood glucose or glycaemic or glycemic response or insulin response or glucose tolerance or insulin sensitivity. Nineteen
studies met the inclusion criteria. Although glycemic and insulin responses differ depending on the millet type and cooking method used, overall, millet has a beneficial effect on fasting and postprandial blood glucose and the plasma-insulin response in healthy individuals and those with type-2 diabetes. It can be concluded that millets do have the potential to play a protective role in the management of type-2 diabetes. -
Kenyon J, Coe S, Izadi H, 'A retrospective outcomes study 42 patients with chronic fatigue syndrome, 30 of whom who had irritable bowel syndrome. Half were treated with oral approaches, and half were treated with Faecal Microbiome Transplantation'
Human Microbiome Journal 13 (2019)
ISSN: 2452-2317AbstractPublished here Open Access on RADARThe gut microbiome comprises the community of microorganisms in the intestinal tract. Research suggests that an altered microbiome may play a role in a wide range of disorders including myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).
Methods. 42 participants with ME/CFS with Irritable Bowel Syndrome (IBS) were allocated into one of two groups, 21 were treated with standard oral approaches, which centred around various nutritional remedies, probiotics, prebiotics, dietary advice and lifestyle advice. The second group who had mostly failed using oral approaches, were treated with Faecal Microbiome Transplantation (FMT). Each patient received 10 Implants, each from a different screened donor, and the Implants were processed under anaerobic conditions. The transplant is delivered via a paediatric rectal catheter, which is inserted through the anus to reach the lower part of the sigmoid colon.
The results were assessed on a percentage basis before and after treatment, 0% being no improvement, 100% being maximum improvement. An exact non-parametric Mann-Whitney (one-tailed) test was used to compare medians from those on FMT compared with those receiving oral approaches only. On clinical experience over many years, the only way to judge improvement in Chronic Fatigue Syndrome as there is no test for Chronic Fatigue Syndrome, is my clinical assessment.
Results. The median for the FMT group was found to be significantly higher compared to the oral treatment group (Mann-Whitney U = 111.5, p = .003). Therefore, the FMT group improved to a greater extent (z = −2.761).
Conclusion. This study shows that FMT is a safe and a promising treatment for CFS associated with IBS. Adequately powered randomised controlled trials should be carried out to assess the effectiveness of FMT in patients with CFS and IBS.
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Coe S, Spruzen SL, Sanchez C, Izadi H, Dawes H, 'A cross-sectional feasibility study of nutrient intake patterns in people with Parkinson’s compared to government nutrition guidelines'
Journal of the American College of Nutrition 30 (3) (2019) pp.187-191
ISSN: 0731-5724 eISSN: 1541-1087AbstractPublished here Open Access on RADARBackground: Diet could have implications for disease progression and management in people with Parkinson’s disease (PwP). However, the knowledge of diet intake patterns in PwP is limited.
Objectives: We set out to assess the feasibility of collecting diet data in PwP to determine food and nutrient intake, in order to compare to national nutrition guidelines and thus understand the habits in this population. Methods: In this cross-sectional feasibility study, PwP were approached through local support groups throughout the Thames Valley and were asked to complete a Food Frequency Questionnaire. Eligibility criteria included a self-reported neurologist confirmed diagnosis of Parkinson’s disease. Completeness of questionnaires was reported and 80% was considered appropriate for each measure including demographic information. Results: Response rate was 61% and missing data rate for the 121 returned questionnaires was 74%; however, of the 90 used for analysis there was 100% completion of the questionnaires. Compared to the UK government guidelines, protein was significantly higher for both males and females and fluid intake was lower for both genders (p -
Saltaouras G, Lightowler H, Coe S, Brett J, Watson E, 'Availability and quality assessment of online nutrition information materials for pelvic cancer patients in the UK'
European Journal of Cancer Care 28 (4) (2019)
ISSN: 0961-5423 eISSN: 1365-2354AbstractPublished here Open Access on RADARWritten information can be an essential source of support in the promotion of lifestyle changes after a cancer diagnosis. This study aimed to identify and assess the quality of available online Patient Information Materials (PIMs) in relation to diet and nutrition for pelvic cancer patients. The online sources of the National Health Service, cancer centres and charitable organisations throughout the UK were searched. Content was assessed using an evidence-based checklist, and readability with two validated formulas. Consumer feedback was sought through Patient and Public Involvement (PPI) groups. Forty PIMs were identified; four were designed specifically for pelvic cancers (bladder, bowel, prostate) and 36 were generic (relevant for all cancers). Most PIMs had a good content score, with PIMs from charities scoring higher overall than PIMs from cancer centres [32 (4) Vs 23 (11), P
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Berezowska M, Coe S, Dawes H, 'Effectiveness of Vitamin D Supplementation in the Management of Multiple Sclerosis: A Systematic Review'
International Journal of Molecular Sciences 20 (6) (2019)
ISSN: 1661-6596 eISSN: 1422-0067AbstractPublished here Open Access on RADARObjective: to examine the extent of effect vitamin D in MS on pathology and symptoms. Methods: A literature search was performed in November 2017 (CRD42018103615). Eligibility criteria: randomised control trials in English from 2012 to 2018; a clinical diagnosis of MS; interventions containing vitamin D supplementation (vitamin D3 or calcitriol) in disease activity compared to a control/ placebo; improvement in: serum 25(OH)D, relapse rates, disability status by EDSS scores, cytokine profile, quality of life, mobility, T2 lesion load and new T2 or T1 Gd enhancing lesions, safety and adverse effects. Risk of bias was evaluated. Results: Ten studies were selected. The study size ranged from 40 to 94 people. All studies evaluated the use of vitamin D supplementation (ranging from 10 IU to 98,000 IU), comparing to a placebo or low dose vitamin D. The duration of the intervention ranged from 12 to 96 weeks. One trial found a significant effect on EDSS score, three demonstrated a significant change in serum cytokines level, one found benefits to current enhancing lesions and three studies evaluating the safety and tolerability of vitamin D reported no serious adverse events. Disease measures improved to a great extent overall in those with higher serum 25(OH)D levels. Conclusions: Improvement in disease measures may be more apparent in those with lower baseline vitamin D levels.
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Coe S, Cossington J, Collett J, Soundy A, Izadi H, Ovington M, Durkin L, Kirsten M, Clegg M, Cavey A, Wade DT, Palace J, DeLuca G, Chapman K, Harrison JM, Buckingham E, Dawes H, 'A randomised double blind placebo-controlled feasibility trial of flavonoid-rich cocoa for fatigue in people with Relapsing and Remitting Multiple Sclerosis'
Journal of Neurology, Neurosurgery and Psychiatry 90 (5) (2019) pp.507-513
ISSN: 0022-3050 eISSN: 1468-330XAbstractPublished here Open Access on RADARThe impact of flavonoids on fatigue has not been investigated in Relapsing and Remitting Multiple Sclerosis (RRMS). Objective. To determine the feasibility and estimate the potential effect of flavonoid-rich cocoa on fatigue and fatigability in RRMS. Methods. A randomised double-blind placebo-controlled feasibility study in people recently diagnosed with RRMS and fatigue, throughout the Thames Valley (ISRCTN: 69897291). During a six week intervention participants consumed a high or low flavonoid cocoa beverage daily. Fatigue and fatigability were measured at three visits (weeks 0, 3 and 6). Feasibility and fidelity were assessed through recruitment and retention, adherence and a process evaluation. Results. 40 pwMS (10 men, 30 women, age 44 ± 10 yrs) were randomised and allocated to high (n=19) or low (n=21) flavonoid groups and included in analysis. Missing data was 75%. There was a small effect on fatigue (Neuro-QoL: effect size {ES} 0.04; confidence interval {CI} -0.40-0.48) and a moderate effect on fatigability (six-minute walk test: ES 0.45; CI -0.18 - 1.07). There were seven adverse events (four control, three intervention), only one of which was possibly related and it was resolved. Conclusion. A flavonoid beverage demonstrates the potential to improve fatigue and fatigability in RRMS.
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Bruna Leal Freitas, Talita Dias Silva, Tânia Brusque Crocetta, Thais Massetti, Luciano Vieira Araújo, Shelly Coe, Helen Dawes, Fatima Aparecida Caromano, Carlos Bandeira de Mello Monteiro, 'Analysis of different device interactions in a virtual reality task in individuals with Duchenne Muscular Dystrophy – a randomized controlled trial'
Frontiers in Neurology 10 (2019)
ISSN: 1664-2295AbstractPublished here Open Access on RADARThere is a need to support individuals with Duchenne Muscular Dystrophy (DMD) to achieve optimal functionality in everyday life and with meaningful tasks and activities, throughout stages of the disease progression. Thus, technological developments have created an exciting opportunity for the use of affordable virtual reality (VR) systems with different kinds of interaction devices, providing an efficient and fun tool for enabling improvement in motor performance. Objective. To compare performance on a virtual task using interfaces with and without physical contact in order to identify functionality by using different devices in individuals with DMD. Methods. One hundred and twenty male individuals took part on this study: 60 with DMD with a mean age of 16 ± 5 (range 9–34 years old) and 60 without DMD in the control group (CG) matched by age. Participants were divided into three groups of 20 individuals each which performed a virtual task in three different interfaces: Kinect®, computer Touch Screen and Leap Motion®, in a cross over design in which all participants used all devices. Motor impairment in the DMD group was measured by using the Motor Function Measurement and Vignos scales. Results. All participants improved performance through practice, regardless of the interface used, although the DMD group had a continuous lower performance compared to the CG. In addition, the DMD group obtained a significant better performance with Leap Motion interface compared to the other interfaces, while the CG presented better performance on Touch Screen interface. Conclusion. Leap Motion provided better performance for individuals with DMD due to enablement of distal muscle function and ease of instrument adjustment using the virtual interface. Therefore, this type of interface should be encouraged for promoting functionality on general tasks using computer systems. Clinical Trial register number: NCT02891434.
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Dawes H, Coe S, 'Efficacy of different interaction devices using non-immersive virtual tasks in individuals with Amyotrophic Lateral Sclerosis: a cross-sectional randomized trial'
BMC Neurology 18 (2018)
ISSN: 1471-2377AbstractPublished here Open Access on RADARBackground. Amyotrophic Lateral Sclerosis (ALS) is a rapid progressive neurodegenerative disease, characterized by a selective loss of motor neurons, brain stem and spinal cord which leads to deterioration of motor abilities. Devices that promote interaction with tasks on computers can enhance performance and lead to greater independence and utilization of technology. Objective. To evaluate performance on a computer task in individuals with ALS using three different commonly used non-immersive devices. Method. Thirty individuals with ALS (18 men and 12 women, mean age 59 years, range 44–74 years) with a mean score of 26, (minimum score of 14 and maximum 41) on the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) and 30 healthy controls matched for age and gender, participated. All participants were randomly divided into three groups, each using a different device system (motion tracking, finger motion control or touchscreen) to perform three task phases (acquisition, retention and transfer). Results. Both the ALS and control group (CG) showed better performance on the computer task when using the touchscreen device, but there was limited transfer of performance onto the task performed on the Finger Motion control or motion tracking. However, we found that using the motion tracking device led to transfer of performance to the touchscreen. Conclusion. This study presents novel and important findings when selecting interaction devices for individuals with ALS to access technology by demonstrating immediate performance benefits of using a touchscreen device, such as improvement of motor skills. There were possible transferable skills obtained when using virtual systems which may allow flexibility and enable individuals to maintain performance overtime.
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Soundy A, Dawes H, Collett J, Coe S, Rosewilliam S, 'Understanding the importance of illness narratives in people with Multiple Sclerosis who participated in an exercise rehabilitation trial; a qualitative study'
Archives of Physical Medicine and Rehabilitation 1 (1) (2018) pp.1-20
ISSN: 0003-9993 eISSN: 1532-821XPublished here Open Access on RADAR -
Coe S, Franssen M, Collett J, Boyle D, Meaney A, Chantry R, Esser P, Izadi H, Dawes H, 'Physical activity, fatigue and sleep in people with Parkinson’s: a secondary per protocol analysis from an intervention trial.'
Parkinson's Disease 2018 (2018)
ISSN: 2090-8083 eISSN: 2090-8083AbstractPublished here Open Access on RADARSymptoms of Parkinson’s can result in low physical activity and poor sleep patterns which can have a detrimental effect on a person’s quality of life. To date, studies looking into exercise interventions for people with Parkinson’s (PwP) for symptom management are promising but inconclusive. The aim of this study is to estimate the effect of a clearly defined exercise prescription on general physical activity levels, fatigue, sleep, and quality of life in PwP. Method. PwP randomised into either an exercise group (29; 16 males, 13 females; mean age 67 years (7.12)) or a control handwriting group (36; 19 males; 17 females; mean age 67 years (5.88)) as part of a larger trial were included in this substudy if they had completed a 6-month weekly exercise programme (intervention group) and had complete objective physical activity data (intervention and control group). Sleep and fatigue were recorded from self-reported measures, and physical activity levels measured through the use of accelerometers worn 24 hours/day over a seven-day testing period at baseline and following the 24-week intervention. A Wilcoxon’s test followed by a Mann–Whitney post hoc analysis was used, and effect sizes were calculated. Results. Participants showed a significant increase in time spent in sedentary and light activities during the overnight period postintervention in both exercise and handwriting groups (p
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Coe S, Philip O, Cossington J, Collett J, Izadi H, Dawes H, 'A Cross-Sectional Pilot Study Assessing Dietary Intake in People with Multiple Sclerosis and the Relationships with National Diet Guidelines'
Enliven: Journal of Dietetics Research and Nutrition 5 (1) (2018)
ISSN: 2378-5438AbstractPeople with the Multiple Sclerosis (PwMS) modify their diet, however their knowledge of diet is unknown and dietary modifications may have long term health implications. We set out to assess the feasibility of a study to determine diet patterns compared to national nutritional guidelines in PwMS, and in those with and without fatigue. Methods: In this cross sectional study four MS support groups were attended throughout the Thames Valley area, with approximately 20 to 25 people attending each group at any one point in time. Measures of feasibility were sought. Descriptive statistics were used to determine inconsistencies in nutrient intake in PwMS with and without fatigue compared to the Scientific Advisory Committee on Nutrition guidelines. Results: 31 PwMS provided dietary data using a Food Frequency Questionnaire, alongside the Fatigue Severity Scale, Barthel Index activities of daily living and demographic data. One third of participants were on a modified diet. Compared to the UK nutrition guidelines, several nutrients were ±1 standard deviation in PwMS, and PwMS tended to miss targets for diet guidelines. Those who were fatigued showed further differences in nutrient intake compared to those who were non-fatigued, and women tended to have healthier diets than men. Missing data was low and response rate was high Conclusion: For the first time data is provided that shows PwMS may have altered dietary intake compared to national guidelines. Furthermore, those who were fatigued show further differences compared to non-fatigued PwMS. Considering the high incidence of modified diets in this group, more substantial investigation of diet is required.Published here Open Access on RADAR -
Coe S, Collett J, Izadi H, Wade D, Clegg M, Harrison JM, Buckingham E, Cavey A, De Luca G, Palace J, Dawes H, 'A protocol for a randomised double blind placebo-controlled feasibility study to determine whether the daily consumption of flavonoid-rich pure cocoa has the potential to reduce fatigue in people with relapsing and remitting multiple sclerosis (RRMS)'
Pilot and Feasibility Studies 4 (2018)
ISSN: 2055-5784AbstractBackground. Dietary interventions including consumption of flavonoids, plant compounds found in certain foods, may have the ability to improve fatigue. However, to date, no well-designed intervention studies assessing the role of flavonoid consumption for fatigue management in people with MS (pwMS) have been performed. The hypothesis is that the consumption of a flavonoid-rich pure cocoa beverage will reduce fatigue in pwMS. The aim of this study is to determine the feasibility and potential outcome of running a trial to evaluate this hypothesis.Published here Open Access on RADAR
Methods. Using a randomised (1:1) double-blind placebo-controlled feasibility study, 40 men and women (20 in each trial arm) with a recent diagnosis (< 10 years) of relapsing and remitting MS (RRMS) and who are over 18 years of age will be recruited from neurology clinics and throughout the Thames Valley community. During a 6-week nutrition intervention period, participants will consume the cocoa beverage, high flavonoid or low flavonoid content, at breakfast daily. At baseline, demographic factors and disease-related factors will be assessed. Fatigue, activity and quality of life, in addition to other measures, will be taken at three visits (baseline, week 3 and week 6) in a university setting by a researcher blinded to group membership. Feasibility and fidelity will be assessed through recruitment and retention, adherence and a quantitative process evaluation at the end of the trial. We will describe demographic factors (age, gender, level of education) as well as disease-related factors (disease burden scores, length of time diagnosed with MS) and cognitive assessment, depression and quality of life and general physical activity in order to characterise participants and determine possible mediators to identify the processes by which the intervention may bring about change. Feasibility (recruitment, safety, feasibility of implementation of the intervention and evaluation, protocol adherence and data completion) and potential for benefit (estimates of effect size and variability) will be determined to inform future planned studies. Results will be presented using point estimates, 95% confidence intervals and p values. Primary statistical analysis will be on an intention-to-treat basis and will use the complete case data set. Discussion. We propose that a flavonoid-enriched cocoa beverage for the management of fatigue will be well received by participants. Further, if it is implemented early in the disease course of people diagnosed with RRMS, it will improve mobility and functioning by modifying fatigue. Trial registration: Registered with ISRCTN Registry. Trial registration No: ISRCTN69897291; Date April 2016. -
Godsiff DT, Coe S, Elsworth-Edelsten C, Collett J, Howells K, Morris M, Dawes H, 'Exploring the metabolic and perceptual correlates of self-selected walking speed under constrained and un-constrained conditions'
Journal of Sports Science and Medicine 17 (2018) pp.1-6
ISSN: 1303-2968AbstractMechanisms underpinning self-selected walking speed (SSWS) are poorly understood. The present study investigated the extent to which SSWS is related to metabolism, energy cost, and/or perceptual parameters during both normal and artificially constrained walking. Fourteen participants with no pathology affecting gait were tested under standard conditions. Subjects walked on a motorized treadmill at speeds derived from their SSWS as a continuous protocol. RPE scores (CR10) and expired air to calculate energy cost (J.kg-1.m-1) and carbohydrate (CHO) oxidation rate (J.kg-1.min-1) were collected during minutes 3-4 at each speed. Eight individuals were re-tested under the same conditions within one week with a hip and knee-brace to immobilize their right leg. Deflection in RPE scores (CR10) and CHO oxidation rate (J.kg-1.min-1) were not related to SSWS (five and three people had deflections in the defined range of SSWS in constrained and unconstrained conditions, respectively) (p > 0.05). Constrained walking elicited a higher energy cost (J.kg-1.m-1) and slower SSWS (p < 0.05) versus normal walking. RPE (CR10) was not significantly different between walking conditions or at SSWS (p > 0.05). SSWS did not occur at a minimum energy cost (J.kg-1.m-1) in either condition, however, the size of the minimum energy cost to SSWS disparity was the same (Froude {Fr} = 0.09) in both conditions (p = 0.36). Perceptions of exertion can modify walking patterns and therefore SSWS and metabolism/ energy cost are not directly related. Strategies which minimize perceived exertion may enable faster walking in people with altered gait as our findings indicate they should self-optimize to the same extent under different conditions.Open Access on RADAR -
Coe S.*, Axelsson E., Murphy V., Santos M., Collett J., Clegg M., Izadi H., Harrison JM., Buckingham, E. & Dawes H., 'Flavonoid rich dark cocoa may improve fatigue in people with Multiple Sclerosis, yet has no effect on glycaemic response: an exploratory trial'
Clinical Nutrition ESPEN 21 (2017) pp.20-25
ISSN: 2405-4577 eISSN: 2405-4577AbstractPublished here Open Access on RADARContext. Current research suggests that dark cocoa may reduce fatigue; however, the effect on fatigue in people with MS (pwMS) has never been established. The objective of this feasibility study was to explore the acute effect of high flavonoid cocoa on measures of fatigue and glycaemic response. Methods. This was a randomised crossover participant blind exploratory study in 12 participants (2 male and 10 female) with MS-related fatigue (>4 on the Fatigue Severity Scale; FSS). After fasting overnight, participants consumed the high flavonoid cocoa drink (350 mg gallic acid equivalents {GAE}/g) or a low flavonoid cocoa control (120 mg GAE/g), consuming the alternative drink on the next visit. Fatigue was self-reported on a 100 mm visual analogue scale at 30-min time intervals for 2 h post cocoa consumption and every 2 h for the rest of the day. Fatigability was monitored using a 6 min walk test (6MWT) at the end of the visit (2 h), and activity monitors worn for 24 h commencing at 12 noon on the day of testing. The feasibility of performing the trial including outcome measures was documented. Results. A moderate effect was found in self-reported fatigue throughout the day in favour of the high flavonoid group (Cohen's d 0.32, 95% non-central t CI −0.57 to 1.20). Fatigability measures did not change. Participants consumed and enjoyed the cocoa, all participants completed the study and outcome measures were accepted. Conclusion. The results of this study support further trials to investigate the feasibility and efficacy of pure cocoa as a dietary supplement for fatigue in pwMS.
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Garvey R, Clegg M, Coe S, 'The acute effects of baobab fruit (Adansonia digitata) on satiety in healthy adults.'
Nutrition and Health 23 (2) (2017) pp.83-86
ISSN: 0260-1060AbstractBackground: The baobab fruit is high in both dietary fibre and polyphenols and therefore may increase satiety. The aim of the study was to measure the effects of baobab fruit extract on satiety.Published here Open Access on RADARMethods: The study was conducted on 20 healthy participants. The study was a one day single blind crossover design. Participants were randomised to either a test smoothie consisting of 15g of baobab extract or a control smoothie without the addition of baobab. Subjective ratings of satiety were taken on visual analogue scales immediately pre consumption and then post consumption, and energy intake at a post ad libitum meal was recorded.
Results: Subjective measures of hunger were reduced following the test smoothie compared to the control (p
Conclusions: This research has positive implications for the use of baobab for reducing hunger, possibly having a positive effect on weight maintenance.
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Almaski A, Thondre S, Lightowler H, Coe S, 'Determination of the polyphenol and antioxidant activity of different types and forms of millet'
Proceedings of the Nutrition Society 76 (OCE1) (2017)
ISSN: 0029-6651AbstractMeeting abstractPublished here -
Bycroft A, Coe S, 'The acute effect of a baobab fruit (Adansonia digitata) smoothie on cognitive function in healthy adults.'
Proceedings of the Nutrition Society 76 (OCE1) (2017) pp.E16-
ISSN: 0029-6651 eISSN: 1475-2719AbstractMeeting abstractPublished here Open Access on RADAR -
Coe S, Ryan L, 'Impact of polyphenol-rich sources on acute postprandial glycaemia: a systematic review'
Journal of Nutritional Science 5 (2016)
ISSN: 2048-6790 eISSN: 2048-6790AbstractIncreasingly, evidence suggests a role for polyphenols in blood glucose control. The objective of this systematic review was to evaluate the effect of polyphenol-rich sources in combination with carbohydrate sources on resulting postprandial glycaemic and insulin responses. A literature search was conducted using Medline, CINHAL and Web of Science databases. Selected studies included randomised controlled trials in which the association of polyphenol-containing food or beverage consumption with a carbohydrate source and effect on acute postprandial glycaemia and/or insulin was reported. A total of thirteen full articles were included in the review. Polyphenol sources included coffee, black tea, fruit juice, plant extracts, berries and different rye breads, and carbohydrate sources included bread, pancakes and simple sugars such as sucrose, glucose and fructose. Although glycaemic and insulin responses differed depending on the polyphenol-carbohydrate combination, overall, polyphenol sources were shown to reduce the peak and early-phase glycaemic response and maintain the glycaemic response in the later stages of digestion. To a lesser extent, polyphenol sources were also shown to reduce peak insulin response and sustain the insulin response, especially when consumed with bread. This review supports epidemiological data suggesting that polyphenols in foods and beverages may have a beneficial effect on reducing the risk of type 2 diabetes. However, the extent of this effect is variable depending on the polyphenol and carbohydrate source.Published here Open Access on RADAR -
Santos M, Coe S, 'The total polyphenol content of various commercial cocoa beverages, with and without the addition of cow’s milk'
Proceedings of the Nutrition Society 75 (OCE1) (2016) pp.E22-
ISSN: 0029-6651Published here -
Coe S, Ryan L, 'Investigation of polyphenol synergism for reducing sugar release from white bread'
Proceedings of the Nutrition Society 74 (OCE1) (2015)
ISSN: 0029-6651Published here -
Coe S, Ryan L, 'White bread enriched with polyphenol extracts shows no effect on glycemic response or satiety, yet may increase postprandial insulin economy in healthy participants'
Nutrition Research 36 (2) (2015) pp.193-200
ISSN: 0271-5317AbstractPublished hereExtracts from different plant sources have been shown to modify starch digestion from carbohydrate-rich foods and lower resulting glycemia. It was hypothesized that extracts rich in polyphenols, added to white bread, would improve the glycemic response and insulin response and increase satiety in healthy participants. An in vitro dose-response analysis was performed to determine the optimal dose of a variety of extracts (baobab fruit extract, green tea extract, grape seed extract, and resveratrol) for reducing rapidly digestible starch in white bread. The 2 extracts with the greatest sugar reducing potential were then used for the human study in which 13 volunteers (9 female and 4 male) were recruited for a crossover trial of 3 different meals. On separate days, participants consumed a control white bread, white bread with green tea extract (0.4%), and white bread with baobab fruit extract (1.88%). Glycemic response, insulin response, and satiety were measured 3 hours postprandially. Although enriched breads did not reduce glycemic response or hunger, white bread with added baobab fruit extract significantly (P
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Coe S, Oni BT, Collett J, Clegg M, Dawes H, 'Increased carbohydrate and energy consumption in people with Multiple Sclerosis compared to healthy controls'
Proceedings of the Nutrition Society 74 (OCE1) (2015)
ISSN: 0029-6651Published here -
Coe S, Fraser A, Ryan L, 'Polyphenol Bioaccessibility and Sugar Reducing Capacity of Black, Green, and White Teas'
International Journal of Food Science 2013 (2013) pp.1-6
ISSN: 2356-7015AbstractTea (Camellia sinensis) is a widely consumed beverage and recognised for its potential enhancing effect on human health due to its rich polyphenol content. While a number of studies have investigated the quantity and type of polyphenols present in different tea samples, no study has reported the potential effect of digestive enzymes on the availability of tea polyphenols for human absorption or the subsequent impact on glycaemic response. The objectives of the present study were to assess the total polyphenol content of different teas, to assess the bioaccessibility of polyphenols in whole and bagged teas, and to determine the effect of black, white, and green tea infusions on sugar release. All of the teas were a significant source of polyphenols (10–116 mg Gallic acid equivalents/g). There was an overall increase in the release of polyphenols from both the bagged and the whole teas following in vitro digestion. Bagged green tea significantly (P<0.05) reduced rapidly digestible starch from white bread samples compared to control and black and white bagged teas. The present study confirms that tea is a rich source of polyphenols and highlights the potential benefits it may have on modulating glycaemic response in humans.Published here -
Coe S, Ryan L, 'Sugar release from various starch rich foods with added polyphenol extracts'
Proceedings of the Nutrition Society 72 (OCE4) (2013)
ISSN: 0029-6651 eISSN: 1475-2719Published here -
Coe SA, Clegg M, Armengol M, Ryan L, 'The polyphenol-rich baobab fruit (Adansonia digitata L.) reduces starch digestion and glycemic response in humans'
Nutrition Research 33 (11) (2013) pp.888-896
ISSN: 0271-5317AbstractThe baobab fruit (Adansonia digitata L.) is found throughout regions of Africa and is becoming increasingly recognized for its high nutrient and polyphenol content. Polyphenols have been beneficial for their effects on reducing the glycemic response (GR) and for improving various other metabolic parameters. Based on previous research, it was hypothesized that the baobab fruit extract would reduce starch digestion in vitro and would show potential for reducing the GR and for increasing satiety and diet-induced thermogenesis in humans. Six extracts of baobab from 6 different locations in Africa were measured for their antioxidant and polyphenol content using the ferric ion–reducing antioxidant power and the Folin-Ciocalteu methods, respectively. Baobab extract was baked into white bread at different doses to determine the optimal dose for reducing starch breakdown and sugar release from white bread after an in vitro digestion procedure. In vivo, baobab extract was consumed in solution at both a low-dose (18.5 g) and a high-dose (37 g) aqueous drink in 250 mL of water along with white bread, and resulting GR, satiety, and postprandial energy expenditure were measured. All extracts in this study were shown to be good sources of polyphenols. Baobab fruit extract added to white bread at 1.88 % significantly (P < .05) reduced rapidly digestible starch from white bread samples. In vivo, the baobab fruit extract at both low and high doses significantly (P < .05) reduced GR, although there was no significant effect on satiety or on energy expenditure.Published here -
Coe S, Ryan L, 'Polyphenol content and in vitro bioaccessibility of six baobab fruit extracts'
Proceedings of the Nutrition Society 71 (OCE2) (2012) pp.E26-
ISSN: 0029-6651Published here
Conference papers
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Poulter M, Coe S, Graham C-AM, Stein J, Tammam J, 'Nutritional assessment of the diets of prisoners in Young Offender Institutions'
83 (OCE2) (2024) pp.E240-
ISSN: 0029-6651 eISSN: 1475-2719AbstractPublished hereAdequate nutrition is necessary for overall health and development(1). Prisoners in general lack autonomy over their diet, in addition to being a population with a high risk of poor health outcomes(2, 3). It is important therefore that prisons are offered menus which meet dietary reference values (DRVs), as set by the UK government, aiming for equity with the general population, and that prisoners choose food options that are beneficial for their health. The aim of this study was to conduct a nutritional analysis of prisoners’ food diaries to determine whether dietary recommendations were being met.
Seven-day food diaries were collected from prisoners eating the normal food supplied by three young offender institutions in 2009. Food eaten was analysed using DietPlan6 version 6.0 (Forestfield Software Ltd). Individual nutrient data were tested for normality and compared against the UK DRVs and NDNS data from 2008/9 using either the one-sample T-test, or one-sample Wilcoxon Signed Rank Test. Data in the results is presented as (Mean ± SD).
There were n=466 diaries analysed, from male participants aged between 16 to 24 years. Twenty- eight nutrients were compared with their respective DRVs by age categories: 16-18y (n=156), 19-24y (n=310), and 16-24y (n=466).
For ages 16-24y, chloride (5556 ± 1692mg), folate (302 ± 112ug), iodine (195 ± 81ug), monounsaturated fat (35 ± 10g), potassium (3667 ± 1161mg), sodium (3899 ± 1392mg), sugar (136 ± 73g), riboflavin (2 ± 1mg), vitamin B12 (6 ± 4ug), vitamin C (92 ± 63mg), and zinc (11 ± 3mg) exceeded DRV requirements (P
For 16-18, and 19-24 respectively, calcium (1286 ± 928mg; 1337 ± 489mg), copper (1 ± 0.6mg; 2 ± 0.6mg), iron (14 ± 5mg; 15 ± 6mg), niacin (19 ± 7mg; 21 ± 7mg), phosphorus (1545 ± 381mg; 1620 ± 493mg), protein (96 ± 24g; 100 ± 29g), thiamine (2 ± 0.6mg; 2 ± 0.7mg), and vitamin B6 (2.3 ± 0.7ug; 3 ± 0.9ug) exceeded their DRV (P
This study represents the largest assessment of dietary intake of prisoners and demonstrates that the prison catering, for the most part, met the DRVs. However, sugar, fat, and energy intake exceeded their DRV target, posing clear risks to health by possibly contributing to later obesity, hypertension, Type 2 diabetes and heart disease.
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Flores-Verastegui MIM, El-Chab A, Coe S, Thondre PS, 'Investigating the sensory acceptance of tropical fruit based products'
81 (OCE4) (2022) pp.E101-
AbstractPublished here Open Access on RADARFruits have been used to design functional foods due to the presence of bioactive compounds and their antioxidant capacity. Hylocereus polyrhizus (dragon fruit) and Averrhoa carambola (star fruit) are tropical fruits that have been used to control diseases such as hypertension and type 2 diabetes in the traditional medicine of different countries (1, 2). Due to their high water content and their short shelf life, different preservation methods, such freezing and drying have been used to maintain their properties as much as possible and to allow their transport and storage to different regions (3). However, several factors such as the effect of the food matrix, the release of nutrients, the design of products and their sensory perception (4) need to be determined in products formulated with preserved fruit. The aim of this study was to establish the sensory acceptance of beverages based on fresh, frozen and dried dragon fruit and star fruit.
Six tropical fruit based beverages were prepared. Three were formulated using dragon fruit in fresh, frozen and dried forms to contain 290 micrograms (mg) of Gallic acid equivalents (GAE) per millilitre (mL) of total phenolic content; three more based on fresh, frozen and dried star fruit were formulated with 490 mg GAE/mL total phenolic content.
A hedonic test was conducted using Compusense Cloud software to determine the overall acceptance of the six beverages in order to evaluate five different attributes using a 9-point scale (9= ‘like extremely’, 1= ‘dislike extremely’): appearance, colour, taste, viscosity and mouthfeel. Ethical approval was obtained from the University Research Ethics Committee (Reg. No. UREC 201379). IBM SPSS Statistics software, version 27, was used to carry out a Friedman non-parametric test and Wilcoxon post hoc test with a Bonferroni correction to compare the sensory acceptance of beverages.
26 participants (8 males and 18 females) between 18 and 50 years were recruited. The overall acceptance was significantly different between tested products, Χ2 (5) = 20.276, p = 0.001. Post hoc tests showed a significant difference (p=0.003) between dried and fresh star fruit based products. Fresh and frozen dragon fruit based beverages as well as the fresh star fruit product were the most preferred, ranking between ‘like slightly’ and ‘like moderately’ for overall acceptance. Attributes such as appearance, colour and taste influenced the like-dislike response. The results of this study provide valuable data to consider hedonic test as a tool to determine the attributes linked to acceptability, and to establish the influence of food matrix on sensory attributes. Fresh and frozen dragon fruit and fresh star fruit based products could be used in in vivo studies to evaluate the effect of polyphenols on health biomarkers.
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Tektonidis TG, Esser P, Coe S, Maddock J, Buchanan S, Mavrommati F, Schott JM, Izadi H, Richards M, Dawes H, 'DIET QUALITY IN LATE MIDLIFE IS ASSOCIATED WITH FASTER WALKING SPEED IN LATER LIFE IN WOMEN, BUT NOT MEN: FINDINGS FROM A BRITISH BIRTH COHORT'
38 (S1) (2019) pp.S316-S317
Published here Open Access on RADAR -
Almaski A, Coe S, Lightowler H, Thondre S, 'Sensory evaluation of polyphenol-rich millet-based muffins and their effect on in vitro starch digestion'
76 (OCE4) (2017) pp.E227-
ISSN: 0029-6651 eISSN: 1475-2719Published here Open Access on RADAR -
Soleymani Majd N, Coe S, Thondre S and Lightowler H, 'Determination of the antioxidant activity and polyphenol content of different types of Rhus coriaria Linn (sumac) from different regions'
76 (OCE4) (2017) pp.E137-
ISSN: 0029-6651 eISSN: 1475-2719Published here Open Access on RADAR
Professional information
Memberships of professional bodies
- Registered Nutritionist of the Association for Nutrition
- Member of the Nutrition Society