Associate Professor Surinder Baines

Objectives: The aim of this study was to systematically review the literature concerning proton magnetic resonance spectroscopy (H-MRS) measured glutamate levels in specific brain regions of fibromyalgia (FM) patients to determine if there is a correlation between raised glutamate levels and the presentation of FM. Materials and Methods: The electronic databases-MEDLINE, EMBASE Classic+Embase, PsychINFO, Cochrane Database of Systematic Reviews, Cochrane Database of Abstracts of Reviews of Effect, Cochrane Central Register of Controlled Trials-were searched to find original studies that used H-MRS to measure glutamate concentrations in the brains of FM patients. Results: Nine studies with a total of 482 participants were selected for inclusion in the review. Seven of the 8 studies that investigated an association between cerebral glutamate levels and FM, showed a positive association. Brain regions identified as having increased glutamate levels include the posterior cingulate gyrus, posterior insula, ventrolateral prefrontal cortex, and amygdala. One study reported a decrease in glutamate levels in the hippocampus of FM patients compared with healthy controls. Seven of the 8 studies that analyzed the correlations between cerebral glutamate levels and FM symptoms, found a significant positive correlation. Discussion: Although the cause of FM remains inconclusive, there is converging data in favor of a dysregulation of pain processing in the central nervous system of FM patients, particularly associated with an increase in cerebral glutamate levels. Furthermore, there is evidence to support an association between increased glutamate levels and an increase in FM symptoms.

Ruminal acidosis is a prevalent disorder among dairy cows and feedlot cattle, which can significantly impair their health and productivity. This study, involving seven different strains of dairy propionibacteria, represents an in vitro investigation of the feasibility of using these organisms as direct-fed microbials to control lactic acid acumulation in the rumen. Interactions between the propionibacteria, Streptococcus bovis and Megasphaera elsdenii were evaluated in terms of effects on lactic, acetic and propionic acid metabolism, following co-incubation. Spot resistance tests showed slight but varying degrees of growth inhibition by S. bovis among the propionibacteria, while no inhibition was observed between M. elsdenii and the different strains of dairy propionibacteria. In the co-culture experiments comprising S. bovis in nutrient broth, significant differences in pH and the levels of production of lactic, acetic and propionic acid, were observed between treatments following inoculation with various propionibacteria and/or M. elsdenii. In general, lactic acid concentrations at the end of the incubation were significantly lower in the cultures containing propionibacteria compared with cultures comprising either S. bovis only or S. bovis + M. elsdenii, although efficacy of lactate metabolism varied between species and strains. Moreover,the accumulation of acetic and propionic acid in the combined cultures, but not in the solo S. bovis culture, indicated that these compounds were produced as a result of the metabolism of lactic acid by the propionibacteria and M. elsdenii.

Seven different types of fermented drinking milk were made from goats' milk using various culture compositions of Lactobacillus acidophilus LA-5, Bifidobacterium animalis subsp. lactis BB-12 and novel putative probiotic Propionibacterium jensenii 702. Probiotic viability, physico-chemical and sensory properties of fermented milk were measured during 3 weeks of storage at 4 °C. All three probiotics were able to maintain high viability (>10 cfu mL ) during fermentation and subsequent storage regardless of the culture composition in goats' milk without major antagonistic effects. Acidity of all fermented milk samples increased during storage, however there were no significant differences among preparations for organoleptic properties. Generally, lower sensory acceptability was recorded for the samples stored for 3 weeks than the respective fresh products. 7 -1

Background/Objectives Non-alcoholic fatty liver disease (NAFLD) is highly prevalent in older people but currently no specific drugs are available for its treatment. Omega-3 polyunsaturated fatty acids (n-3PUFA), known for their lipid-lowering, anti-inflammatory and anti-hypertensive properties, may have therapeutic potential for the management of NAFLD. The aim of this study was to determine whether n-3PUFA levels are associated with the prevalence of NAFLD in older adults. Methods A cross-sectional sample of older adults aged 65¿95 years (n¿=¿620) from the Retirement Health and Lifestyle Study (RHLS) was analysed. Fatty Liver Index (FLI) scores, used as an indicator of NAFLD risk, were calculated using a validated algorithm that incorporates body mass index, waist circumference, plasma triglycerides and ¿-glutamyl transferase. Omega-3 index scores (O3I, %eicosapentaenoic acid plus %docosahexaenoic acid) were determined by analysing the fatty acid composition of erythrocyte membranes by gas chromatography. Results Following application of exclusion criteria, 475 participants were included in the analysis (age 77.9¿±¿7.0 years; 60.4% females). Of these, 216 participants had FLI scores (=60) suggestive of NAFLD (age 77.0¿±¿6.6 years; 49.1% females). O3I was significantly lower in participants with NAFLD compared to those without NAFLD (p¿<¿0.01). A significant inverse relationship was found between O3I and FLI (r¿=¿-0.165; p¿<¿0.001). This relationship was gender specific with women, but not men, showing a significant association (r¿=¿-0.206; p¿<¿0.001). Conclusions The current study demonstrated a sex-dependent inverse relationship between erythrocyte n-3PUFA concentrations and NAFLD in older adults. The finding supports the proposal for sex-stratified n-3PUFA intervention trials in this high-risk age group.

Objectives: To determine population attributable risks (PARs) estimates for factors associated with non-use of postnatal care (PNC) in Nigeria. Design, setting and participants: The most recent Nigeria Demographic and Health Survey (NDHS, 2013) was examined. The study consisted of 20 467 mothers aged 15-49 years. Non-use of PNC services was examined against a set of demographic, health knowledge and social structure factors, using multilevel regression analysis. PARs estimates were obtained for each factor associated with non-use of PNC in the final multivariate logistic regression model. Main outcome: PNC services. Results: Non-use of PNC services was attributed to 68% (95% CI 56% to 76%) of mothers who delivered at home, 61% (95% CI 55% to 75%) of those who delivered with the help of non-health professionals and 37% (95% CI 31% to 45%) of those who lacked knowledge of delivery complications in the study population. Multiple variable analyses revealed that non-use of PNC services among mothers was significantly associated with rural residence, household poverty, no or low levels of mothers' formal education, small perceived size of neonate, poor knowledge of delivery-related complications, and limited or no access to the mass media. Conclusions: PAR estimates for factors associated with non-use of PNC in Nigeria highlight the need for community-based interventions regarding maternal education and services that focus on mothers who delivered their babies at home. Our study also recommends financial support from the Nigerian government for mothers from low socioeconomic settings, so as to minimise the inequitable access to pregnancy and delivery healthcare services with trained healthcare personnel.

A mixture of probiotic Lactobacillus acidophilus LA-5, Bifidobacterium animalis subsp. lactis BB-12 and novel potential probiotic Propionibacterium jensenii 702 was resuspended in reconstituted (20% w/v) goat's milk, spray dried in a mini spray dryer (inlet temperature=195°C and outlet temperature=85°C) and the spray dried powder was stored in air tight glass jars at 4°C and 30°C for 24 weeks. Powder quality and probiotic viability after spray drying and subsequent storage were measured. Spray drying probiotics in reconstituted goat's milk resulted in a significant reduction in the viability of all three probiotics. However, all three probiotics were able to maintain satisfactory viability levels (10 -10 cfu/g) after spray drying. While storage temperature did not appear to have a significant effect on moisture content, the viability of all three strains declined dramatically when stored at 30°C but lactobacilli and propionibacteria remained virtually unaffected under storage at 4°C, satisfying recommendations regarding the level of viable cells in probiotic foods. 6 8

The purpose of this study was to investigate the reliability of tongue and handgrip strength and endurance measurements in healthy adults using the Iowa Oral Performance Instrument. Fifty-one healthy participants (21 males, 30 females; age range = 19-57 years) were tested on four occasions 1 week apart to determine test-retest reliability. The primary outcome measures were isometric tongue and handgrip strength (best of three trials) and sustained isometric endurance. Small increases (changes in group mean) in both anterior (1.7 %) and posterior (2.5 %) tongue strength and handgrip strength (5 %) between weeks 1 and 2 were observed with no change in subsequent weeks, suggesting that there is only a small learning effect for these measurements. The within-subject variation (mean-typical error expressed as a coefficient of variation [CV]) indicated higher than desirable initial variation for anterior (CV 10.8 %) and posterior (CV 11.8 %) tongue strength and handgrip strength (CV 15.2 %) but this was reduced in weeks 2-4. Intraclass correlation coefficients (ICC) indicated acceptable and improved reliability for both anterior (ICC 0.77-0.90) and posterior (ICC 0.79-0.86) tongue strength and handgrip strength (ICC 0.69-0.91) after week 1. Additional exploratory analyses were conducted with a subset of data to determine whether two values within 5 kPa (tongue) or 15 kPa (handgrip) provide superior strength reliability. Neither tongue nor hand endurance measurements were sufficiently reliable. These findings suggest that tongue and handgrip strength values demonstrate acceptable reliability, especially if familiarization is provided. Further investigation is needed to reduce sources of variability in tongue endurance measurements. © 2013 Springer Science+Business Media New York.

Inappropriate complementary feeding is one of the major causes of undernutrition among young children in Tanzania. Prevalence of newly developed World Health Organization complementary feeding indicators and their associated factors were determined among 2402 children aged 6-23 months in Tanzania using data from the 2010 Tanzania Demographic and Health Survey. The survey used a multistage cluster sample of 10300 households from the eight geographical zones in the country. The prevalence of the introduction of soft, semi-solid or solid foods among infants aged 6-8 months was 92.3%. Of all the children aged 6-23 months, the prevalence of minimum dietary diversity, meal frequency and acceptable diet were 38.2%, 38.6% and 15.9%, respectively. Results from multivariate analyses indicated that the main risk factors for inappropriate complementary feeding practices in Tanzania include young child's age (6-11 months), lower level of paternal/maternal education, limited access to mass media, lack of post-natal check-ups, and poor economic status. Overall, complementary feeding practices in Tanzania, as measured by dietary diversity, meal frequency and acceptable diet, are not adequately met, and there is a need for interventions to improve the nutritional status of young children in Tanzania.

Gastrointestinal tolerance, adhesion to intestinal epithelium and immunomodulation are critical factors in maintaining probiotic efficacy. Seven different types of fermented milk were made from goat's milk using various culture compositions of three probiotics: Lactobacillus acidophilus LA-5, Bifidobacterium animalis subsp. lactis BB-12 and Propionibacterium jensenii 702 and in vitro gastrointestinal tolerance, adhesion ability and stimulation of cytokine production by probiotics were evaluated. All probiotics and combinations demonstrated significantly lower viability after exposure to simulated gastric (pH 2.0) and intestinal (with 0.3% bile, pH 8.0) fluids (p < 0.05). The ability of probiotics to adhere to Caco-2 cells appeared to be influenced by the specific probiotic strains with which they were combined in the manufacturing of fermented milk. Only monocultures of lactobacilli and bifidobacteria and their co-cultures were able to induce low levels of IL-6 and TNF-a production from Caco-2 cells. It seems likely that co-cultures of various probiotics may affect their functional properties. © 2014 Elsevier Ltd.

A vegetarian diet can easily meet human dietary protein requirements as long as energy needs are met and a variety of foods are eaten. Vegetarians should obtain protein from a variety of plant sources, including legumes, soy products, grains, nuts and seeds. Eggs and dairy products also provide protein for those following a lacto-ovo-vegetarian diet. There is no need to consciously combine different plant proteins at each meal as long as a variety of foods are eaten from day to day, because the human body maintains a pool of amino acids which can be used to complement dietary protein. The consumption of plant proteins rather than animal proteins by vegetarians may contribute to their reduced risk of chronic diseases such as diabetes and heart disease.

Surveys over the past 10 years have shown that Australians are increasingly consuming more plant-based vegetarian meals. Many studies demonstrate the health benefits of vegetarian diets. As with any type of eating plan, vegetarian diets must be well planned to ensure nutritional needs are being met. This clinical focus project shows that well planned vegetarian diets can meet almost all the nutritional needs of children and adults of all ages. Sample single-day lacto-ovo-vegetarian meal plans were developed to comply with the nutrient reference values - including the increased requirements for iron and zinc at 180% and 150%, respectively, for vegetarians - for both sexes and all age groups set by Australia's National Health and Medical Research Council and the New Zealand Ministry of Health. With the exception of vitamin D, long-chain omega-3 fatty acids and extended iron requirements in pregnancy for vegetarians, the meal plans meet key requirements with respect to energy; protein; carbohydrate; total fat; saturated, poly- and monounsaturated fats; a-linolenic acid; fibre; iron; zinc; calcium; folate; and vitamins A, C, E and B12.

Background: This study aimed to describe eating behaviors, food tolerance, and dietary intake after laparoscopic adjustable gastric banding (LAGB); explore associations between these variables; and examine the relationship between diet-related factors and percentage weight loss and quality of life after surgery. Methods: A cross-sectional survey was mailed to subjects who had previously undergone LAGB in Newcastle, Australia. Results: Sixty-seven subjects responded (55 females; mean age 49±11.5 years; postoperative body mass index [BMI] 34.5±5.4 kg/m ). Reported average weight loss since surgery was 20.5±9.2% (26.6±13.0 kg). Restraint (including flexible and rigid control) and disinhibition were higher than community norms and hunger trended toward being lower. The majority of respondents rated their eating ability as good (n=27, 40.3%) or excellent (n=15, 22.4%). Median reported energy intake was 4,833 kJ (3,823-5,961) per day. Protein and fat intake as a percentage of daily energy intake was within acceptable distribution ranges, although saturated fat intake exceeded recommendations. Fiber and several micronutrients were below estimated average requirements. BMI at time of surgery and satisfaction with eating ability were significantly associated with reported weight loss after surgery (adjusted R =0.32, p<0.001), and satisfaction with eating ability and rigid control were significantly associated with physical well-being (adjusted R =0.19, p=0.001). Conclusions: This study highlights that potential remains to improve aspects of eating behavior, food tolerance, and diet quality in some individuals who have undergone LAGB, and endorses the need for further development of multifactorial interventions to help optimize a range of diet-related factors after LAGB. © 2013 Mary Ann Liebert, Inc. 2 2 2