Explore the vast range of titles available.

Dietary patterns high in meat compromise both planetary and human health. Meat alternatives may help to facilitate meat reduction; however, the nutritional implications of displacing meat with meat alternatives does not appear to have been evaluated. Here, the ninth cycle of the National Diet and Nutrition Survey was used as the basis of models to assess the effect of meat substitution on nutritional intake. We implemented three models; model 1 replaced 25 %, 50 %, 75 % or 100 % of the current meat intake with a weighted mean of meat alternatives within the UK market. Model 2 compared different ingredient categories of meat alternative; vegetable, mycoprotein, a combination of bean and pea, tofu, nut and soya. Model 3 compared fortified v. unfortified meat alternatives. The models elicited significant shifts in nutrients. Overall, carbohydrate, fibre, sugars and Na increased, whereas reductions were found for protein, total and saturated fat, Fe and B12. Greatest effects were seen for vegetable-based (+24·63g/d carbohydrates), mycoprotein-based (–6·12g/d total fat), nut-based (–19·79g/d protein, +10·23g/d fibre; −4·80g/d saturated fat, +7·44g/d sugars), soya-based (+495·98mg/d Na) and tofu-based (+7·63mg/d Fe, −2·02μg/d B12). Our results suggest that meat alternatives can be a healthful replacement for meat if chosen correctly. Consumers should choose meat alternatives low in Na and sugar, high in fibre, protein and with high micronutrient density, to avoid compromising nutritional intake if reducing meat intake. Manufacturers and policy makers should consider fortification of meat alternatives with nutrients such as Fe and B12 and focus on reducing Na and sugar content.

Fermented foods (FFs) are part of the cultural heritage of several populations, and their production dates back 8000 years. Over the last ~150 years, the microbial consortia of many of the most widespread FFs have been characterised, leading in some instances to the standardisation of their production. Nevertheless, limited knowledge exists about the microbial communities of local and traditional FFs and their possible effects on human health. Recent findings suggest they might be a valuable source of novel probiotic strains, enriched in nutrients and highly sustainable for the environment. Despite the increasing number of observational studies and randomised controlled trials, it still remains unclear whether and how regular FF consumption is linked with health outcomes and enrichment of the gut microbiome in health‐associated species. This review aims to sum up the knowledge about traditional FFs and their associated microbiomes, outlining the role of fermentation with respect to boosting nutritional profiles and attempting to establish a link between FF consumption and health‐beneficial outcomes. Mechanism for γ‐PGA electrofermentation (left); charge output and γ‐PGA production in electrofermentation (center, top); SEM of γ‐PGA‐containing EPS on carbon fiber in electrofermentation and conventional ferementation (center, bottom); (1H)‐NMR of γ‐PGA‐enriched EPS in electrofermentation (right).

PurposeThe high-meat, low-fibre Western diet is strongly associated with colorectal cancer risk. Mycoprotein, produced from Fusarium venanatum, has been sold as a high-fibre alternative to meat for decades. Hitherto, the effects of mycoprotein in the human bowel have not been well considered. Here, we explored the effects of replacing a high red and processed meat intake with mycoprotein on markers of intestinal genotoxicity and gut health.MethodsMycomeat (clinicaltrials.gov NCT03944421) was an investigator-blind, randomised, crossover dietary intervention trial. Twenty healthy male adults were randomised to consume 240 g day−1 red and processed meat for 2 weeks, with crossover to 2 weeks 240 g day−1 mycoprotein, separated by a 4-week washout period. Primary end points were faecal genotoxicity and genotoxins, while secondary end points comprised changes in gut microbiome composition and activity.ResultsThe meat diet increased faecal genotoxicity and nitroso compound excretion, whereas the weight-matched consumption of mycoprotein decreased faecal genotoxicity and nitroso compounds. In addition, meat intake increased the abundance of Oscillobacter and Alistipes, whereas mycoprotein consumption increased Lactobacilli, Roseburia and Akkermansia, as well as the excretion of short chain fatty acids.ConclusionReplacing red and processed meat with the Fusarium-based meat alternative, mycoprotein, significantly reduces faecal genotoxicity and genotoxin excretion and increases the abundance of microbial genera with putative health benefits in the gut. This work demonstrates that mycoprotein may be a beneficial alternative to meat within the context of gut health and colorectal cancer prevention.

PurposeMycoprotein is a relatively novel food source produced from the biomass of Fusarium venenatum. It has previously been shown to improve CVD risk markers in intervention trials when it is compared against total meat. It has not hitherto been assessed specifically for benefits relative to red and processed meat.MethodsWe leveraged samples from Mycomeat, an investigator-blind randomised crossover controlled trial in metabolically healthy male adults (n = 20), randomised to consume 240 g/day of red and processed meat for 14 days followed by mycoprotein, or vice versa. Blood biochemical indices were a priori defined secondary endpoints.ResultsMycoprotein consumption led to a 6.74% reduction in total cholesterol (P = 0.02) and 12.3% reduction in LDL cholesterol (P = 0.02) from baseline values. Change in fasted triglycerides was not significantly different between diets (+ 0.19 ± 0.11 mmol/l with mycoprotein, P = 0.09). There was a small but significant reduction in waist circumference for mycoprotein relative to meat (− 0.95 ± 0.42 cm, P = 0.04). Following the mycoprotein diet, mean systolic (− 2.41 ± 1.89 mmHg, P = 0.23) and diastolic blood pressure (− 0.80 ± 1.23 mmHg, P = 0.43) were reduced from baseline. There were no statistically significant effects of the intervention on urinary sodium, nitrite or TMAO; while urinary potassium (+ 126.12 ± 50.30 mmol/l, P = 0.02) and nitrate (+ 2.12 ± 0.90 mmol/l, P = 0.04) were both significantly higher with mycoprotein relative to meat. The study population comprised metabolically healthy adults, therefore, changes in plasma lipids had little effect on cardiovascular risk scores (− 0.34% FRS for mycoprotein P = 0.24).ConclusionsThese results confirm potential cardiovascular benefits when displacing red and processed meat with mycoprotein in the diet. Longer trials in higher risk study populations are needed to fully elucidate suggested benefits for blood pressure and body composition.ClinicalTrials.gov Identifier: NCT03944421.

IntroductionChronic constipation is a common gastrointestinal (GI) disorder that impacts quality of life and has high levels of treatment dissatisfaction. Fruits containing sorbitol are recommended in clinical guidelines to manage chronic constipation despite few clinical trials. It is proposed that fruit fibre reduces gut transit time and increases stool weight, while sorbitol has osmotic effects in the gut. However, there is limited evidence on the contribution of fibre or sorbitol from food sources (alone or in combination) on constipation. Therefore, we tested the impact of dried fruit (containing fibre and sorbitol), fruit juice (sorbitol but no fibre), and a fruit-flavoured placebo (no fibre or sorbitol) on symptoms of constipation (NCT: 04086134).MethodsParticipants meeting Rome IV criteria for functional constipation were randomised to one of three arms: (1) 90 g/d dried fruit (30g each of prunes, raisins, apricots); (2) fruit juices from the same fruits (plums, grapes, apricots; volumes matched to dried fruits for sorbitol and energy); or (3) fruit cordial placebo (water/sugar with the same fruit flavourings; volumes matched for energy to other arms). The primary outcome was change in stool weight measured from 7-day total stool collection. Clinical outcomes included stool consistency/frequency, GI symptoms, constipation symptoms (PAC-SYM, CCCS) and quality of life (PAC-QOL). Differences between groups were analysed by ANCOVA (absolute endpoint values) or ANOVA (change) with Tukey post-hoc tests corrected for multiple comparisons.Results150 people with Rome IV functional constipation were recruited (88% female; mean age 33.9 y, SD ± 12.7). The primary outcome of change in stool weight was significantly different between groups (p=0.027): dried fruit (mean +21.2, SD ± 38.7 g/d), fruit juice (+13.2 ± 40.2 g/d) and placebo (+1.6 ± 25.8 g/d), with significantly greater increases following dried fruit than placebo (p=0.021). There were no significant differences in complete and/or spontaneous bowel movements or clinical scores between groups. The change in PAC-QOL satisfaction subscale scores (a lower score indicating improved quality of life) was different between groups (p=0.034): dried fruit (mean -5.8 ± 5.2); fruit juice (-5.1 ± 6.4); and placebo (-2.8 ± 6.2), with greater improvement in dried fruit vs. placebo (p=0.034). Dried fruits did not induce significant GI side effects, while change in severity of borborygmi was greater in juice (+0.1 ± 0.6) than dried fruit (-0.2 ± 0.5; p=0.016).ConclusionsThis is the largest clinical trial testing the impact of fruit in chronic constipation, indicating dried fruits (containing fibre and sorbitol) were more effective, than fruit juices (containing sorbitol alone). Analysis of gut microbiome and transit time (SmartPill™) data is currently underway.

Mycoprotein is a meat alternative made from Fusarium venenatum. Mycoprotein, as well as other meat alternatives, are used to replace meat by health and environmental conscious consumers, however these products are not direct nutritional replacements for meat, and their health effects are not fully understood. Mycoprotein is high in protein, fibre and low in saturated fat, which make it an interesting meat alternative with potential benefits to health beyond meat displacement. The work in this thesis compares the effects of substituting a high red and processed meat diet with mycoprotein on gut and cardiometabolic health. The original aim was to investigate whether the putative mechanisms linking red and processed meat consumption to colorectal cancer risk might be attenuated by replacing meat with mycoprotein. In a dietary intervention study in healthy male adults, I show that substituting red and processed meat with mycoprotein positively influences gut health, by lowering intestinal genotoxicity, and by increasing the relative abundance of beneficial gut bacteria. In a secondary analysis of the dietary intervention study data, I also show that mycoprotein consumption may improve cardiometabolic disease risk related endpoints. Finally, using nationally representative data, I show that at a population level, displacement of meat with mycoprotein and other meat alternatives would influence nutritional intake and potentially nutritional status in the UK population. Notably, it would allow consumers to achieve the dietary guidelines around fibre but raises addressable concerns about certain nutrients. This work is timely, given the current focus on agricultural systems in the context of climate change. My data supports arguments around the potential healthfulness of choosing mycoprotein, which may help reduce uncertainty amongst potential consumers and thereby increase public confidence in mycoprotein as a replacement for meat. The findings may be of interest to the nutrition and public health community who have struggled to increase fibre consumption in the population and have concerns about the high meat content of the western diet. The findings may also be of interest to those working in the burgeoning meat alternative space. Mycoprotein has considerable potential as part of a healthier, greener food future.

The outcome of sarcoma has been suggested in retrospective and non-exhaustive studies to be better through management by a multidisciplinary team of experts and adherence to clinical practice guidelines (CPGs). The aim of this prospective and exhaustive population based study was to confirm the impact of adherence to CPGs on survival in patients with localized sarcoma. Between 2005 and 2007, all evaluable adult patients with a newly diagnosis of localized sarcoma located in Rhone Alpes region (n = 634), including 472 cases of soft-tissue sarcoma (STS), were enrolled. The prognostic impact of adherence to CPGs on progression-free survival (PFS) and overall survival (OS) was assessed by multivariate Cox model in this cohort. The median age was 61 years (range 16-92). The most common subtypes were liposarcoma (n = 133, 28%), unclassified sarcoma (n = 98, 20.7%) and leiomyosarcoma (n = 69, 14.6%). In the initial management phase, from diagnosis to adjuvant treatment, the adherence to CPGs for patients with localized STS was 36% overall, corresponding to 56%, 85%, 96% and 84% for initial surgery, radiation therapy, chemotherapy and follow-up, respectively. Adherence to CPGs for surgery was the strongest independent prognostic factor of PFS, along with age, gender, grade, and tumor size. For OS, multivariate analysis adherence to CPGs for surgery was a strong independent prognostic factor, with an important interaction with a management in the regional expert centers. This study demonstrates impact of CPGs and treatment within an expert center on survival for STS patients in a whole population-based cohort.

The scale and quality of the global scientific response to the COVID-19 pandemic have unquestionably saved lives. However, the COVID-19 pandemic has also triggered an unprecedented \"infodemic\"; the velocity and volume of data production have overwhelmed many key stakeholders such as clinicians and policy makers, as they have been unable to process structured and unstructured data for evidence-based decision making. Solutions that aim to alleviate this data synthesis-related challenge are unable to capture heterogeneous web data in real time for the production of concomitant answers and are not based on the high-quality information in responses to a free-text query. The main objective of this project is to build a generic, real-time, continuously updating curation platform that can support the data synthesis and analysis of a scientific literature framework. Our secondary objective is to validate this platform and the curation methodology for COVID-19-related medical literature by expanding the COVID-19 Open Research Dataset via the addition of new, unstructured data. To create an infrastructure that addresses our objectives, the PanSurg Collaborative at Imperial College London has developed a unique data pipeline based on a web crawler extraction methodology. This data pipeline uses a novel curation methodology that adopts a human-in-the-loop approach for the characterization of quality, relevance, and key evidence across a range of scientific literature sources. REDASA (Realtime Data Synthesis and Analysis) is now one of the world's largest and most up-to-date sources of COVID-19-related evidence; it consists of 104,000 documents. By capturing curators' critical appraisal methodologies through the discrete labeling and rating of information, REDASA rapidly developed a foundational, pooled, data science data set of over 1400 articles in under 2 weeks. These articles provide COVID-19-related information and represent around 10% of all papers about COVID-19. This data set can act as ground truth for the future implementation of a live, automated systematic review. The three benefits of REDASA's design are as follows: (1) it adopts a user-friendly, human-in-the-loop methodology by embedding an efficient, user-friendly curation platform into a natural language processing search engine; (2) it provides a curated data set in the JavaScript Object Notation format for experienced academic reviewers' critical appraisal choices and decision-making methodologies; and (3) due to the wide scope and depth of its web crawling method, REDASA has already captured one of the world's largest COVID-19-related data corpora for searches and curation.

Background Sarcomas are rare cancers with great variability in clinical and histopathological presentation. The main objective of clinical practice guidelines (CPGs) is to standardize diagnosis and treatment. Methods From March 2005 to February 2007, all patients diagnosed with localized sarcoma in the Rhône-Alpes region were included in a cohort-based study, to evaluate the compliance of sarcoma management with French guidelines in routine practice and to identify predictive factors for compliance with CGPs. Results 634 (71 %) patients with localized sarcoma satisfying the inclusion criteria were included out of 891 newly diagnosed sarcomas. Taking into account initial diagnosis until follow-up, overall conformity to CPGs was only 40 % [95 % confidence interval (CI) = 36–44], ranging from 54 % for gastrointestinal stromal tumor to 36 % for soft tissue sarcoma and 42 % for bone sarcoma. In multivariate analysis, primary tumor type [relative risk (RR) = 4.42, 95 % CI = 2.79–6.99, p  < 0.001], dedicated multidisciplinary staff before surgery (RR = 4.19, 95 % CI = 2.39–7.35, p  < 0.001) and management in specialized hospitals (RR = 3.71, 95 % CI = 2.43–5.66, p  < 0.001) were identified as unique independent risk factors for conformity to CPGs for overall treatment sequence. Conclusions With only 40 % of total conformity to CPGs, the conclusions support the improvement of initial sarcoma management and its performance in specialized centres or within specialized dedicated networks.

Background The transferability of economic evaluation in health care is of increasing interest in today’s globalized environment. Here, we propose a methodology for assessing the variability of data elements in cost evaluations in oncology. This method was tested in the context of the European Network of Excellence “Connective Tissues Cancers Network”. Methods Using a database that was previously aimed at exploring sarcoma management practices in Rhône-Alpes (France) and Veneto (Italy), we developed a model to assess the transferability of health cost evaluation across different locations. A nested data structure with 60 final factors of variability (e.g., unit cost of chest radiograph) within 16 variability areas (e.g., unit cost of imaging) within 12 objects (e.g., diagnoses) was produced in Italy and France, separately. Distances between objects were measured by Euclidean distance, Mahalanobis distance, and city-block metric. A hierarchical structure using cluster analysis (CA) was constructed. The objects were also represented by their projections and area of variability through correlation studies using principal component analysis (PCA). Finally, a hierarchical clustering based on principal components was performed. Results CA suggested four clusters of objects: chemotherapy in France; follow-up with relapse in Italy; diagnosis, surgery, radiotherapy, chemotherapy, and follow-up without relapse in Italy; and diagnosis, surgery, and follow-up with or without relapse in France. The variability between clusters was high, suggesting a lower transferability of results. Also, PCA showed a high variability (i.e. lower transferability) for diagnosis between both countries with regard to the quantities and unit costs of biopsies. Conclusion CA and PCA were found to be useful for assessing the variability of cost evaluations across countries. In future studies, regression methods could be applied after these methods to elucidate the determinants of the differences found in these analyses.