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AbstractBackground: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 < 0.001). There were several other differences in nutrient intake compared to guidelines.Conclusion:We observed high levels of engagement from PwP and found that assessing food and nutrient patterns in PwP was feasible. Importantly, the diet was generally healthy overall, yet there were specific nutrients that may affect medication metabolism in PwP that were found to be high. Therefore further research into this emerging and important area is warranted.

The impact of flavonoids on fatigue has not been investigated in relapsing and remitting multiple sclerosis (RRMS).ObjectiveTo determine the feasibility and estimate the potential effect of flavonoid-rich cocoa on fatigue and fatigability in RRMS.MethodsA randomised double-blind placebo-controlled feasibility study in people recently diagnosed with RRMS and fatigue, throughout the Thames Valley, UK (ISRCTN69897291). During a 6-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.Results40 people with multiple sclerosis (10 men, 30 women, age 44±10 years) were randomised and allocated to high (n=19) or low (n=21) flavonoid groups and included in analysis. Missing data were <20% and adherence to intervention of allocated individuals was >75%. There was a small effect on fatigue (Neuro-QoL: effect size (ES) 0.04, 95% CI −0.40 to 0.48) and a moderate effect on fatigability (6 min walk test: ES 0.45, 95% CI −0.18 to 1.07). There were seven adverse events (four control, three intervention), only one of which was possibly related and it was resolved.ConclusionA flavonoid beverage demonstrates the potential to improve fatigue and fatigability in RRMS.

Vitamin C, vitamin E, and carotenoids are potent dietary antioxidants that have been shown to attenuate ethanol‐induced harm in animal models of fetal alcohol spectrum disorders. A diet low in antioxidant‐rich foods may induce a state of oxidative stress in the context of maternal alcohol consumption during pregnancy, potentially causing growth restriction in the developing fetus. We conducted a secondary analysis of a longitudinal U.K. birth cohort. The sample comprised 9,699 women and their babies in Avon, U.K., with an estimated delivery date between April 1, 1991 and December 31, 1992. Alcohol consumption data were self‐reported at 18 weeks’ gestation via a postal questionnaire. Women reported any binge drinking (≥4 U.K. units/occasion) during the past month. Dietary data were self‐reported at 32 weeks’ gestation using a food frequency questionnaire. Estimated intakes of vitamins C and E and carotenoids were categorized into quartiles. Logistic regression models with interaction terms were used to investigate relationships between maternal binge drinking, dietary antioxidants, and fetal growth. Models were adjusted for maternal sociodemographic and lifestyle characteristics. Small for gestational age (SGA; <10th percentile) was defined using customized birth centiles. In the unadjusted models, binge drinking was associated with higher risk of SGA birth (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.10, 1.72, p= 0.005), and higher maternal intakes of vitamin C (OR = 0.90, 95% CI 0.84, 0.96, p= 0.002) and vitamin E (OR = 0.90, 95% CI 0.84, 0.95, p< 0.0001) were associated with lower risk of SGA birth. However, addition of potentially confounding variables attenuated these relationships. Likelihood ratio tests indicated that interaction terms were not significant for vitamin C (p= 0.116), vitamin E (p= 0.059), or carotenoid intakes (p= 0.174). There was no evidence of maternal intake of dietary antioxidants modifying the relationship between maternal binge drinking and SGA birth. Dietary antioxidants have been shown to attenuate ethanol‐induced harm in animal models of fetal alcohol spectrum disorder. We conducted a secondary analysis of a longitudinal birth cohort to explore whether vitamin C, vitamin E and carotenoids modified the relationship between maternal binge drinking during pregnancy and small for gestational age (SGA). However, we found no evidence of effect modification and associations between binge drinking, dietary antioxidants and SGAwere attenuated once potential confounders were added to the model.

BackgroundEvidence for longer term exercise delivery for people with Parkinson's disease (PwP) is deficient.AimEvaluate safety and adherence to a minimally supported community exercise intervention and estimate effect sizes (ES).Methods2-arm parallel phase II randomised controlled trial with blind assessment. PwP able to walk ≥100 m and with no contraindication to exercise were recruited from the Thames valley, UK, and randomised (1:1) to intervention (exercise) or control (handwriting) groups, via a concealed computer-generated list. Groups received a 6-month, twice weekly programme. Exercise was undertaken in community facilities (30 min aerobic and 30 min resistance) and handwriting at home, both were delivered through workbooks with monthly support visits. Primary outcome was a 2 min walk, with motor symptoms (Movement Disorder Society Unified Parkinson's Disease Rating Scale, MDS-UPDRS III), fitness, health and well-being measured.ResultsBetween December 2011 and August 2013, n=53 (n=54 analysed) were allocated to exercise and n=52 (n=51 analysed) to handwriting. N=37 adhered to the exercise, most attending ≥1 session/week. Aerobic exercise was performed in 99% of attended sessions and resistance in 95%. Attrition and adverse events (AEs) were similar between groups, no serious AEs (n=2 exercise, n=3 handwriting) were related, exercise group-related AEs (n=2) did not discontinue intervention. Largest effects were for motor symptoms (2 min walk ES=0.20 (95% CI −0.44 to 0.45) and MDS-UPDRS III ES=−0.30 (95% CI 0.07 to 0.54)) in favour of exercise over the 12-month follow-up period. Some small effects were observed in fitness and well-being measures (ES>0.1).ConclusionsPwP exercised safely and the possible long-term benefits observed support a substantive evaluation of this community programme.Trial registration numberNCT01439022.

This article examines the evolution and spatial variation in economic development policies adopted by nonmetropolitan district councils in England and Wales. Results from a recent survey reveal four distinct clusters of development strategies that range from activist to non-activist. Areas have tended to become more interventionist over time, with most district councils simply adding new programs to previous initiatives rather than starting over from scratch.