Annie S. Anderson

Situational effects on meal intake: A comparison of eating alone and eating with others

Eating in competition with other tasks has been shown to increase food intake, particularly when tasks are cognitively demanding. To test the hypothesis that social facilitation of eating occurs, in part, as a function of distraction which impairs the ability to self-monitor, eating with others was compared with eating alone or in front of the television. Using a repeated measure within-subjects design, thirty-seven participants (21 males) visited the laboratory 4 times to eat a buffet-style lunch ad libitum. All eating episodes were filmed. Energy intake (EI) was measured when participants ate alone (A), ate alone while watching TV (B), ate with two same sex strangers (C), and ate with two same sex friends (D) in a counterbalanced order. EI was significantly enhanced by presence of familiar others (D: 4565+/-272 kJ, p < 0.001) and watching TV (B: 4350+/-252 kJ, p < 0.05) compared to baseline (A: 3861+/-200 kJ). Length of eating episode correlated significantly (p < 0.05) with EI, however, amount of time spent eating and looking at food differed by condition with a greater percentage of time focussed on food during baseline (p < 0.001). Eating with friends increased EI by 18% and eating in front of the TV increased EI by 14% relative to baseline. Engaging in conversation or watching TV draws attention away from the eaten food and can stimulate food intake. However, since eating with strangers also drew attention away from food but did not result in increased intake, social facilitation effects are not simply due to distraction. Thus food intake can be enhanced when attention to food and self-monitoring are impaired during distraction, however, this effect is moderated when eating with strangers.

Does area of residence affect body size and shape

OBJECTIVE: To examine whether neighbourhood or residence is associated with body size and shape (height, weight, BMI, waist circumference and waist-hip ratio). DESIGN: Analysis of data collected in fact to face interviews at the second wave of longitudinal health survey of two adult age cohorts in the West of Scotland. SETTING: Four socially contrasting urban neighbourhoods in Glasgow City, Scotland. SUBJECTS: A total of 691 subjects: 142 males and 176 females aged 40 at interview; and 167 males and 206 females aged 60 at interview. All had been resident in their current neighbourhood for at least four years. MEASUREMENTS: height, weight, BMI, waist circumference and waist-hip ratio. RESULTS: Neighbourhood of residence was significantly associated with height, BMI, waist circumference and waist-hip ratio after controlling for individual characteristics such as gender, age, social class, smoking behaviour and material deprivation (an index comprising income, housing tenure and car ownership). Individuals living in the most deprived neighbourhood were significantly shorter, and had bigger waist circumferences, waist-hip ratios and BMIs. CONCLUSIONS: If Health of the Nation targets on reducing the proportion of overweight individuals in the population are to be met, public health policy should focus on places as well as people.

Critical research gaps and translational priorities for the successful prevention and treatment of breast cancer

IntroductionBreast cancer remains a significant scientific, clinical and societal challenge. This gap analysis has reviewed and critically assessed enduring issues and new challenges emerging from recent research, and proposes strategies for translating solutions into practice.MethodsMore than 100 internationally recognised specialist breast cancer scientists, clinicians and healthcare professionals collaborated to address nine thematic areas: genetics, epigenetics and epidemiology; molecular pathology and cell biology; hormonal influences and endocrine therapy; imaging, detection and screening; current/novel therapies and biomarkers; drug resistance; metastasis, angiogenesis, circulating tumour cells, cancer ‘stem’ cells; risk and prevention; living with and managing breast cancer and its treatment. The groups developed summary papers through an iterative process which, following further appraisal from experts and patients, were melded into this summary account.ResultsThe 10 major gaps identified were: (1) understanding the functions and contextual interactions of genetic and epigenetic changes in normal breast development and during malignant transformation; (2) how to implement sustainable lifestyle changes (diet, exercise and weight) and chemopreventive strategies; (3) the need for tailored screening approaches including clinically actionable tests; (4) enhancing knowledge of molecular drivers behind breast cancer subtypes, progression and metastasis; (5) understanding the molecular mechanisms of tumour heterogeneity, dormancy, de novo or acquired resistance and how to target key nodes in these dynamic processes; (6) developing validated markers for chemosensitivity and radiosensitivity; (7) understanding the optimal duration, sequencing and rational combinations of treatment for improved personalised therapy; (8) validating multimodality imaging biomarkers for minimally invasive diagnosis and monitoring of responses in primary and metastatic disease; (9) developing interventions and support to improve the survivorship experience; (10) a continuing need for clinical material for translational research derived from normal breast, blood, primary, relapsed, metastatic and drug-resistant cancers with expert bioinformatics support to maximise its utility. The proposed infrastructural enablers include enhanced resources to support clinically relevant in vitro and in vivo tumour models; improved access to appropriate, fully annotated clinical samples; extended biomarker discovery, validation and standardisation; and facilitated cross-discipline working.ConclusionsWith resources to conduct further high-quality targeted research focusing on the gaps identified, increased knowledge translating into improved clinical care should be achievable within five years.

A gender-sensitised weight loss and healthy living programme for overweight and obese men delivered by Scottish Premier League football clubs (FFIT): a pragmatic randomised controlled trial

BACKGROUND The prevalence of male obesity is increasing but few men take part in weight loss programmes. We assessed the effect of a weight loss and healthy living programme on weight loss in football (soccer) fans. METHODS We did a two-group, pragmatic, randomised controlled trial of 747 male football fans aged 35-65 years with a body-mass index (BMI) of 28 kg/m(2) or higher from 13 Scottish professional football clubs. Participants were randomly assigned with SAS (version 9·2, block size 2-9) in a 1:1 ratio, stratified by club, to a weight loss programme delivered by community coaching staff in 12 sessions held every week. The intervention group started a weight loss programme within 3 weeks, and the comparison group were put on a 12 month waiting list. All participants received a weight management booklet. Primary outcome was mean difference in weight loss between groups at 12 months, expressed as absolute weight and a percentage of their baseline weight. Primary outcome assessment was masked. Analyses were based on intention to treat. The trial is registered with Current Controlled Trials, number ISRCTN32677491. FINDINGS 374 men were allocated to the intervention group and 374 to the comparison group. 333 (89%) of the intervention group and 355 (95%) of the comparison group completed 12 month assessments. At 12 months the mean difference in weight loss between groups, adjusted for baseline weight and club, was 4·94 kg (95% CI 3·95-5·94) and percentage weight loss, similarly adjusted, was 4·36% (3·64-5·08), both in favour of the intervention (p<0·0001). Eight serious adverse events were reported, five in the intervention group (lost consciousness due to drugs for pre-existing angina, gallbladder removal, hospital admission with suspected heart attack, ruptured gut, and ruptured Achilles tendon) and three in the comparison group (transient ischaemic attack, and two deaths). Of these, two adverse events were reported as related to participation in the programme (gallbladder removal and ruptured Achilles tendon). INTERPRETATION The FFIT programme can help a large proportion of men to lose a clinically important amount of weight; it offers one effective strategy to challenge male obesity. FUNDING Scottish Government and The UK Football Pools funded delivery of the programme through a grant to the Scottish Premier League Trust. The National Institute for Health Research Public Health Research Programme funded the assessment (09/3010/06).

The impact of a community-based food skills intervention on cooking confidence, food preparation methods and dietary choices – an exploratory trial

OBJECTIVE To evaluate the feasibility of undertaking a food skills intervention study in areas of social deprivation aimed at altering cooking confidence, food preparation methods and dietary choices. DESIGN A standardised skills programme was implemented in community-based settings. Pre- (T1) and post-intervention (T2) and 6-month follow-up (T3) measures (7-day diaries and self-administered questionnaires) were undertaken in intervention and comparison groups. SETTING Eight urban communities in Scotland. SUBJECTS One hundred and thirteen adults living in areas of social deprivation. RESULTS It was clear that many subjects led fragmented lives and found commitment to intervention classes problematic. Sixty-three subjects completed the final (T3) assessments. The response to each component varied due to inability to attend sessions, illness, study requirements, employment, moving out of the area, change in circumstances, loss of interest and loss of postal questionnaires. At baseline, reported consumption of fruit and vegetables was low (mean frequency 8.1 +/- 4.78 times per week). Fruit intake increased significantly (P < 0.05) between T1 and T2 in the intervention group (1.7 +/- 2.36 to 2.7 +/- 3.28 times per week) only. Between T1 and T3, there was a significant increase (P < 0.05) in intervention subjects who reported confidence in following a recipe (67-90%,). CONCLUSIONS This exploratory trial shows that a food skills intervention is likely to have a small but positive effect on food choice and confidence in food preparation. A full-scale randomised controlled trial in this hard-to-reach group would require a range of flexible approaches rather than a fully defined intervention, and presents challenges for trial design.

The impact of a school-based nutrition education intervention on dietary intake and cognitive and attitudinal variables relating to fruits and vegetables

OBJECTIVE To assess the impact of a school-based nutrition education intervention aimed at increasing the consumption of fruits and vegetables. DESIGN The intervention programme increased the provision of fruits and vegetables in schools and provided a range of point-of-purchase marketing materials, newsletters for children and parents, and teacher information. Curriculum materials at age 6-7 and 10-11 years were also developed and utilised. Evaluation was undertaken with groups of younger (aged 6-7 years) and older (aged 10-11 years) children. Methods included 3-day dietary records with interview and cognitive and attitudinal measures at baseline, with follow-up at 9 months, in intervention and control schools. SETTING The work was undertaken in primary schools in Dundee, Scotland. SUBJECTS Subjects comprised 511 children in two intervention schools with a further 464 children from two schools acting as controls. RESULTS Children (n=64) in the intervention schools had an average increase in fruit intake (133+/-1.9 to 183+/-17.0 g day(-1)) that was significantly (P<0.05) greater than the increase (100+/-11.7 to 107+/-14.2 g day(-1)) estimated in children (n=65) in control schools. No other changes in food or nutrient intake were detected. Increases in scores for variables relating to knowledge about fruits and vegetables and subjective norms were also greater in the intervention than in the control group, although taste preferences for fruits and vegetables were unchanged. CONCLUSIONS It is concluded that a whole school approach to increasing intakes of fruits and vegetables has a modest but significant effect on cognitive and attitudinal variables and on fruit intake.

Understanding variety: Tasting different foods delays satiation

Variety stimulates intake by as much as 40% following both simultaneous and sequential presentations. Varying sensory and other characteristics of foods could sustain interest in eating and delay the development of satiation. Two experiments set out to explore this by investigating the effect of introducing different foods to taste and rate during intake of a snack. In Experiment 1, 33 participants (23 female) attended the lab on four occasions, to eat sweet or salted popcorn (depending on preference). In a counterbalanced order participants ate ad libitum (control), or were interrupted during eating to taste and rate either the food they were eating (same condition: SC), another food with shared taste characteristics (congruent condition: CC) or a food with a different taste (incongruent condition: IC). Overall participants consumed significantly more in CC and IC than in SC [F(3,90) = 2.74, p<0.05], and pleasantness ratings of the eaten food during CC and IC remained high relative to SC, demonstrating a delay in the normal decline in pleasantness associated with satiation. In Experiment 2, 47 participants (31 female) were allocated to either a food focus (FF) or food distraction (FD) condition, in which intake of chocolate was interrupted during eating to taste and rate chocolate only (FF) or this food and a cheese cracker (FD). FD (94 +/- 9.3 g) participants ate significantly more than FF (68 +/- 9.5 g) and in support of findings from Experiment 1 pleasantness ratings during eating declined more rapidly during FF than FD. Variety may stimulate food intake, in part, by delaying the development of satiation which extends eating and therefore amount consumed. Encouraging consumers to focus on eating should facilitate the normal decline in pleasantness of the food and serve to limit intake.

Risk determination and prevention of breast cancer

Breast cancer is an increasing public health problem. Substantial advances have been made in the treatment of breast cancer, but the introduction of methods to predict women at elevated risk and prevent the disease has been less successful. Here, we summarize recent data on newer approaches to risk prediction, available approaches to prevention, how new approaches may be made, and the difficult problem of using what we already know to prevent breast cancer in populations. During 2012, the Breast Cancer Campaign facilitated a series of workshops, each covering a specialty area of breast cancer to identify gaps in our knowledge. The risk-and-prevention panel involved in this exercise was asked to expand and update its report and review recent relevant peer-reviewed literature. The enlarged position paper presented here highlights the key gaps in risk-and-prevention research that were identified, together with recommendations for action. The panel estimated from the relevant literature that potentially 50% of breast cancer could be prevented in the subgroup of women at high and moderate risk of breast cancer by using current chemoprevention (tamoxifen, raloxifene, exemestane, and anastrozole) and that, in all women, lifestyle measures, including weight control, exercise, and moderating alcohol intake, could reduce breast cancer risk by about 30%. Risk may be estimated by standard models potentially with the addition of, for example, mammographic density and appropriate single-nucleotide polymorphisms. This review expands on four areas: (a) the prediction of breast cancer risk, (b) the evidence for the effectiveness of preventive therapy and lifestyle approaches to prevention, (c) how understanding the biology of the breast may lead to new targets for prevention, and (d) a summary of published guidelines for preventive approaches and measures required for their implementation. We hope that efforts to fill these and other gaps will lead to considerable advances in our efforts to predict risk and prevent breast cancer over the next 10 years.

Volume and variety: Relative effects on food intake

Volume has been shown to be an important direct control of food intake, since larger volumes of food consumed prior to a meal can inhibit subsequent intake. Variety of food is known to stimulate food intake. The present study was designed to examine the relative effects of manipulating the volume of a soup preload in the context of providing either a single or a variety of sandwich fillings. Thirty participants (15 females; 15 males) attended the laboratory on 4 occasions to receive a low (f=240 ml, 3.6 kJ/g; m=300 ml, 3.6 kJ/g) or high (f=480 ml, 1.8 kJ/g; m=600 ml, 1.8 kJ/g) volume tomato soup preload 30 min before a sandwich lunch with either single or a variety of fillings. Overall, subjects reported significant differences in hunger and fullness as a function of volume manipulations but the satiety quotient (SQ: change in ratings divided by weight of soup) calculated just before lunch indicated a smaller SQ for high than for the low volume soup. Therefore, although subjective ratings were influenced by volume this was not sufficient to affect intake at lunch. Variety (2344+/-200 kJ) increased food intake at lunch compared to the single filling condition (2062+/-171 kJ), an enhancement by variety of 14%. In conclusion, lowering energy density and increasing volume by adding water failed to reduce intake at lunch. Clearly volume effects on intake rely both on amount consumed and energy density. As predicted, variety stimulated food intake and this occurred across volume conditions.

Variations in fresh fruit and vegetable quality by store type, urban–rural setting and neighbourhood deprivation in Scotland

OBJECTIVE Neighbourhood differences in access to fresh fruit and vegetables may explain social inequalities in diet. Investigations have focused on variations in cost and availability as barriers to the purchase and consumption of fresh produce; investigations of quality have been neglected. Here we investigate whether produce quality systematically varies by food store type, rural-urban location and neighbourhood deprivation in a selection of communities across Scotland. DESIGN Cross-sectional survey of twelve fresh fruit and vegetable items in 288 food stores in ten communities across Scotland. Communities were selected to reflect a range of urban-rural settings and a food retail census was conducted in each location. The quality of twelve fruit and vegetable items within each food store was evaluated. Data from the Scottish Executive were used to characterise each small area by deprivation and urban-rural classification. SETTING Scotland. RESULTS Quality of fruit and vegetables within the surveyed stores was high. Medium-sized stores, stores in small town and rural areas, and stores in more affluent areas tended to have the highest-quality fresh fruit and vegetables. Stores where food is secondary, stores in urban settings and stores in more deprived areas tended have the lowest-quality fresh produce. Although differences in quality were not always statistically significant, patterns were consistent for the majority of fruit and vegetable items. CONCLUSIONS The study provides evidence that variations in food quality may plausibly be a micro-environmental mediating variable in food purchase and consumption and help partially explain neighbourhood differences in food consumption patterns.