Publications
17 results found
Da Silva A, Bussey S, Macdougall C, et al., 2023, How to … grow a team in clinical education research, The Clinical Teacher, ISSN: 1743-4971
<jats:title>Abstract</jats:title><jats:p>The Incubator for Clinical Education Research (ClinEdR) is a UK‐wide network, established with support from the National Institute for Health and Care Research (NIHR), to lead initiatives to build capacity in the field. Our lived experiences as members of the NIHR ClinEdR Incubator and wider literature are woven into this ‘How to …’ paper, which outlines what to consider as you seek to grow and develop a ClinEdR team. This paper sets out pragmatic steps to grow an effective ClinEdR team that has a wider impact and mutual benefits for its members and their institution(s). Growing a ClinEdR team requires more than a dynamic character to bring people together. In our view, you can grow a ClinEdR team with other people through a structured, well‐thought‐out approach, in which its members develop through collaborative work to achieve a shared objective.</jats:p>
Unsworth R, Avari P, Lett AM, et al., 2023, Adaptive bolus calculators for people with type 1 diabetes: A systematic review, DIABETES OBESITY & METABOLISM, ISSN: 1462-8902
Kasprzak MM, Berski W, Krystyjan M, et al., 2023, Effects of fibre addition and processing on the stability, rheology and in vitro gastric digestion of whey protein-xanthan gum stabilised emulsions with high oil phase, LWT, Vol: 178, Pages: 114465-114465, ISSN: 0023-6438
Gardiner B, Wardill H, O'Connor G, et al., 2022, THE EFFICACY OF FIBRE AND PREBIOTIC INTERVENTIONS ON CLINICAL OUTCOMES IN CANCER AND HAEMATOPOIETIC STEM CELL THERAPIES: SYSTEMATIC LITERATURE REVIEW, Publisher: WILEY, Pages: S350-S350, ISSN: 1545-5009
Thomas MG, Avari P, Godsland IF, et al., 2021, Optimizing type 1 diabetes after multiple daily injections and capillary blood monitoring: Pump or sensor first? A meta-analysis using pooled differences in outcome measures, DIABETES OBESITY & METABOLISM, Vol: 23, Pages: 2521-2528, ISSN: 1462-8902
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Cai M, Dou B, Pugh J, et al., 2021, The impact of starchy food structure on postprandial glycemic response and appetite: a systematic review with meta-analysis of randomized crossover trials, American Journal of Clinical Nutrition, Vol: 114, Pages: 472-487, ISSN: 0002-9165
BackgroundStarchy foods can have a profound effect on metabolism. The structural properties of starchy foods can affect their digestibility and postprandial metabolic responses, which in the long term may be associated with the risk of type 2 diabetes and obesity.ObjectivesThis systematic review sought to evaluate the clinical evidence regarding the impact of the microstructures within starchy foods on postprandial glucose and insulin responses alongside appetite regulation.MethodsA systematic search was performed in the PUBMED, Ovid Medicine, EMBASE, and Google Scholar databases for data published up to 18 January 2021. Data were extracted by 3 independent reviewers from randomized crossover trials (RCTs) that investigated the effect of microstructural factors on postprandial glucose, insulin, appetite-regulating hormone responses, and subjective satiety scores in healthy participants.ResultsWe identified 745 potential articles, and 25 RCTs (n = 369 participants) met our inclusion criteria: 6 evaluated the amylose-to-amylopectin ratio, 6 evaluated the degree of starch gelatinization, 2 evaluated the degree of starch retrogradation, 1 studied starch–protein interactions, and 12 investigated cell and tissue structures. Meta-analyses showed that significant reductions in postprandial glucose and insulin levels was caused by starch with a high amylose content [standardized mean difference (SMD) = −0.64 mmol/L*min (95% CI: −0.83 to −0.46) and SMD = −0.81 pmol/L*min (95% CI: −1.07 to −0.55), respectively], less-gelatinized starch [SMD = −0.54 mmol/L*min (95% CI: −0.75 to −0.34) and SMD = −0.48 pmol/L*min (95% CI: −0.75 to −0.21), respectively], retrograded starch (for glucose incremental AUC; SMD = −0.46 pmol/L*min; 95% CI: −0.80 to −0.12), and intact and large particles [SMD = −0.43 mmol/L*min (95% CI: −0.58 to −0.28) and SMD = −0.63 pmol/L*min (95% CI
Lett A, Lim A, Skinner C, et al., 2021, Rapid, non-invasive measurement of gastric emptying rate using transcutaneous fluorescence spectroscopy, Biomedical Optics Express, Vol: 12, Pages: 4249-4264, ISSN: 2156-7085
Gastric emptying rate (GER) signifies the rate at which the stomach empties following ingestion of a meal and is relevant to a wide range of clinical conditions. GER also represents a rate limiting step in small intestinal absorption and so is widely assessed for research purposes. Despite the clinical and physiological importance of gastric emptying, methods used to measure GER possess a series of limitations (including being invasive, slow or unsuitable for certain patient populations). Here, we present a new technique based on transcutaneous (through-the-skin) fluorescence spectroscopy that is fast, non-invasive, and does not require the collection of samples or laboratory-based analysis. Thus, this approach has the potential to allow immediate reporting of clinical results. Using this new method, participants receive an oral dose of a fluorescent contrast agent and a wearable probe detects the uptake of the agent from the gut into the blood stream. Analysis of the resulting data then permits the calculation of GER. We compared our spectroscopic technique to the paracetamol absorption test (a clinically approved GER test) in a clinical study of 20 participants. Results demonstrated good agreement between the two approaches and, hence, the clear potential of transcutaneous fluorescence spectroscopy for clinical assessment of GER.
Dagbasi A, Lett A, Murphy K, et al., 2020, Understanding the interplay between food structure, intestinal bacterial fermentation and appetite control, Proceedings of the Nutrition Society, Vol: 79, Pages: 514-530, ISSN: 0029-6651
Epidemiological and clinical evidence highlight the benefit of dietary fibre consumption on body weight. This benefit is partly attributed to the interaction of dietary fibre with the gut microbiota. Dietary fibre possesses a complex food structure which resists digestion in the upper gut and therefore reaches the distal gut where it becomes available for bacterial fermentation. This process yields short chain fatty acids (SCFAs) which stimulate the release of appetite suppressing hormones Glucagon-like peptide-1 (GLP-1) and peptide YY (PYY). Food structures can further enhance the delivery of fermentable substrates to the distal gut by protecting the intracellular nutrients during upper gastro intestinal digestion. Domestic and industrial processing can disturb these food structures that act like barriers towards digestive enzymes. This leads to more digestible products that are better absorbed in the upper gut. As a result, less resistant material (fibre) and intracellular nutrients may reach the distal gut, thus reducing substrates for bacterial fermentation and its subsequent benefits on the host metabolism including appetite suppression. Understanding this link is essential for the design of diets and food products that can promote appetite suppression and act as a successful strategy towards obesity management. This article reviews the current evidence in the interplay between food structure, bacterial fermentation and appetite control.
Maurice J, Lett A, Skinner C, et al., 2020, Transcutaneous fluorescence spectroscopy as a tool for non-invasive monitoring of gut function: first clinical experiences, Scientific Reports, Vol: 10, ISSN: 2045-2322
Gastro-intestinal function plays a vital role in conditions ranging from inflammatory bowel disease and HIV through to sepsis and malnutrition. However, the techniques that are currently used to assess gut function are either highly invasive or unreliable. Here we present an alternative, non-invasive sensing modality for assessment of gut function based on fluorescence spectroscopy. In this approach, patients receive an oral dose of a fluorescent contrast agent and a fibre-optic probe is used to make fluorescence measurements through the skin. This provides a readout of the degree to which fluorescent dyes have permeated from the gut into the blood stream. We present preliminary results from our first measurements in human volunteers demonstrating the potential of the technique for non-invasive monitoring of multiple aspects of gastro-intestinal health.
Cherta-Murillo A, Lett AM, Frampton J, et al., 2020, Effects of mycoprotein on glycaemic control and energy intake in humans: a systematic review, British Journal of Nutrition, Vol: 123, Pages: 1321-1332, ISSN: 0007-1145
Mycoprotein is a food high in both dietary fibre and non-animal derived protein. Global mycoprotein consumption is increasing although its effect on human health has not yet been systematically reviewed. This study aims to systematically review the effects of mycoprotein on glycaemic control and energy intake in humans. A literature search of randomised controlled trials was performed in Pubmed, EMBASE, Web of Science, Google Scholar and hand search. A total of 21 studies were identified of which only 5 studies, totalling 122 participants, met the inclusion criteria. All 5 studies were acute studies of which 1 reported outcomes on glycaemia and insulinaemia, 2 reported on energy intake and 2 reported on all of these outcomes. Data were extracted and risk-of-bias assessment was then conducted. The results did not show a clear effect of acute mycoprotein on blood glucose levels but it showed a decrease in insulin levels. Acute mycoprotein intake also showed to decrease energy intake at an <jats:italic>ad libitum</jats:italic> meal and post-24h in healthy lean, overweight and obese humans. In conclusion, the acute ingestion of mycoprotein reduces energy intake and insulinaemia whereas its impact on glycaemia is currently unclear. However, evidence comes from a very limited number of heterogeneous studies. Further well-controlled studies are needed to elucidate the short- and long-term effects of mycoprotein intake on glycaemic control and energy intake, as well as the mechanisms underpinning these effects.
Walther B, Lett AM, Bordoni A, et al., 2019, GutSelf: interindividual variability in the processing of dietary compounds by the human gastrointestinal tract, Molecular Nutrition & Food Research, Vol: 63, Pages: 1-28, ISSN: 1613-4125
Nutritional research is currently entering the field of personalized nutrition, to a large extent driven by major technological breakthroughs in analytical sciences and biocomputing. An efficient launching of the personalized approach depends on the ability of researchers to comprehensively monitor and characterize interindividual variability in the activity of the human gastrointestinal tract. This information is currently not available in such a form. This review therefore aims at identifying and discussing published data, providing evidence on interindividual variability in the processing of the major nutrients, i.e., protein, fat, carbohydrates, vitamins, and minerals, along the gastrointestinal tract, including oral processing, intestinal digestion, and absorption. Although interindividual variability is not a primary endpoint of most studies identified, a significant number of publications provides a wealth of information on this topic for each category of nutrients. This knowledge remains fragmented, however, and understanding the clinical relevance of most of the interindividual responses to food ingestion described in this review remains unclear. In that regard, this review has identified a gap and sets the base for future research addressing the issue of the interindividual variability in the response of the human organism to the ingestion of foods.
Sukkar A, Lett A, Frost G, et al., 2019, Regulation of energy expenditure and substrate oxidation by short chain fatty acids, Journal of Endocrinology, Vol: 242, Pages: R1-R8, ISSN: 1479-6805
Short-chain fatty acids (SCFAs) are metabolites produced from the fermentation of dietary fibre by the gut microbiota. High-fibre diets have been associated with lower weight gain and a number of reports have therefore investigated if these positive effects of a dietary fibre on body weight can be replicated through the direct administration of SCFAs. Many of these studies have reported that SCFAs can prevent or attenuate long-term body weight gain by increasing energy expenditure through increased lipid oxidation. The aim of the present review is to therefore evaluate the current evidence for an effect of SCFAs on whole-body energy expenditure and to assess the potential underlying mechanisms. The available data highlights that SCFAs can exert multiple effects at various organ and tissue sites that would cumulatively raise energy expenditure via a promotion of lipid oxidation. In conclusion, the present review proposes that dietary interventions and other therapies that augment gut-derived SCFAs and systemic availability may present an effective strategy to improve long-term energy balance and body weight management.
Consortium H, Drake L, Frost G, et al., 2019, Health outcomes in Undernutrition: the role of Nutrients, Gut dysfunction and the gut microbiome (HUNGer), Health outcomes in Undernutrition: the role of Nutrients, Gut dysfunction and the gut microbiome (HUNGer), Publisher: Imperial College London
The HUNGer consortium is comprised of a multi-disciplinary, multi-national consortium of world leading researchers, with expertise in physiology and nutrition, through to clinical research, public health and agriculture in LMIC settings. The HUNGer consortium was awarded the MRC Confidence in Global Nutrition and Health award in 2018.The HUNGer consortium is developing a programme of work that will directly address United Nations Sustainable Development Goal 2 (SDG-2): End hunger, achieve food security and improve nutrition, and promote sustainable agriculture. We believe there are a number of critical unanswered questions regarding the role of the gut in undernutrition, which if answered could significantly improve the effective management and prevention of undernutrition.The following document represents the consensus opinion of the HUNGer consortium concerning the key challenges that currently limit the effective management and prevention of undernutrition and the most promising potential solutions.
Lett AM, Norton J, 2017, Engineering Satiety, Flavor, Satiety and Food Intake, Editors: Tepper, Yeomans, Publisher: John Wiley & Sons Ltd and the Institute of Food Technologists, ISBN: 9781119044895
This chapter explains two food systems, emulsions and polysaccharides, as case studies, in relation to their microstructural design and use to achieve the function of satiety enhancement. Emulsions are therefore classified as oil‐in‐water (O/W) emulsions, in which the dispersed phase consists of oil droplets and the continuous phase is water, or conversely, water‐in‐oil (W/O) emulsions, where the dispersed phase is water droplets and the continuous phase is oil. The chapter discusses how microstructural engineering approaches in emulsions can, or could, be used to enhance satiety via pre‐ingestive and post‐ingestive mechanisms. Post‐ingestive approaches have considered two forms of gastric structuring for satiety: intra‐gastric layering; and controlling lipolysis. The chapter highlights three mechanisms by which carbohydrates can impact on satiation and/or satiety: viscosity, gelation and fermentability. For positive impacts on satiety to be realised within commercial foods, it is crucial that engineering approaches are considered in order to develop the next generation of satiating foods.
Lett AM, Norton JE, Yeomans MR, 2016, Emulsion oil droplet size significantly affects satiety: A pre-ingestive approach, Appetite, Vol: 96, Pages: 18-24, ISSN: 0195-6663
Lett AM, Yeomans MR, Norton IT, et al., 2016, Enhancing expected food intake behaviour, hedonics and sensory characteristics of oil-in-water emulsion systems through microstructural properties, oil droplet size and flavour, Food Quality and Preference, Vol: 47, Pages: 148-155, ISSN: 0950-3293
Lett AM, Thondre PS, Rosenthal AJ, 2013, Yellow mustard bran attenuates glycaemic response of a semi-solid food in young healthy men, International Journal of Food Sciences and Nutrition, Vol: 64, Pages: 140-146, ISSN: 0963-7486
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