Hypertension is a major cause of cardiovascular disease and overall mortality. High dietary salt intake is one of the key risk factors for hypertension and in 2017, it was one of the three leading dietary risk factors for death and disability adjusted life years globally. Despite the efforts to change this behaviour, salt consumption still exceeds the recommendations. One of the main determinants of food intake, and potentially salt, is taste. Taste perception may be genetically determined, however research exploring the associations between genetics, salt taste perception and salt intake is scarce. This may be of special importance in younger adult populations where increased preference for salt is suggested. Therefore, the aim of this study was to explore the associations between genetics, salt taste perception (taste threshold and preference) and salt intake in young adults.

This study was approved by the St Mary's University Ethics Sub-Committee. Forty-two participants (18–35 years, 67% female and 33% male) completed the study. Salt taste thresholds were identified using the British Standards Institution sensory analysis method (BS ISO 3972:2011) and preference for salty taste by asking participants how salty they usually prefer to eat their food using a Likert scale. Salt intake, expressed as mg sodium/1000 kcal, was measured using a five-step multiple pass 24-hour recall for one day of the week and one weekend day. Participants were genotyped for two genetic variants in the SCNN1B and TRPV1 genes, which code for ion channels expressed in taste cells. Multiple regression analysis was performed including SCNN1B and TRPV1 variants, salt taste threshold and preference as predictor variables and sodium intake (mg/1000 kcal) as the dependent variable. Statistical significance was set at p < 0.05.

Participants were normal weight (Body Mass Index 23.8 ± 3.7 kg/m2), predominantly Caucasian with salt intake 7.5 ± 2.7 g per day, reflecting current intakes in the UK. Regression model including genetics, thresholds and preference for salty taste explained 54% of the variance (p = 0.028). In this model, TRPV1 variant rs8065080 [β = 422, confidence interval (50, 794), p = 0.030] and salt preference [β = 618, confidence interval (258, 978), p = 0.004] were indicated as predictors of sodium intake. These findings suggest that genetics and preference for salty taste may be drivers of salt intake in younger populations. If replicated, this information may in the future be used in designing more personalised approaches in changing this behaviour.

As the primary risk factor for cardiovascular disease (CVD), hypertension is the leading cause of preventable, premature mortality globally. Hypertension, or elevated blood pressure (BP), has a number of well-established risk factors, including genetics. A common C677T polymorphism in the gene encoding the folate metabolising enzyme methylenetetrahydrofolate reductase (MTHFR) affects 10–12% of UK and Irish populations and has been linked with 24–87% increased risk of hypertension globally. Evidence from randomised controlled trials (RCTs) conducted at this Centre has shown BP to be highly responsive (by 5–13 mmHg) to supplementation with riboflavin (MTHFR co-factor), an effect confined to homozygous individuals (TT genotype). To date, our trials have focused on peripheral BP; however, additional measures of vascular health such as central pressure are reported to be more closely correlated with CVD risk. Investigation of central BP, augmentation index (AIx) and pulse pressure amplification (PPA) may thus offer further insight into the role of this gene-nutrient interaction in blood pressure. The present study aims to investigate BP, and measures of vascular health in healthy adults stratified by MTHFR 677 genotype. Apparently healthy adults aged 18–60 years were recruited from workplaces across Northern Ireland and screened for MTHFR genotype via buccal swab. Clinic BP, anthropometry and blood sample were measured in TT individuals (n 209) and age and sex-matched CC (n 98) and CT (n 102) controls. AIx and central BP were assessed using SphygmoCor® (AtCor Medical, Australia). Preliminary results demonstrate higher BP in individuals with the MTHFR 677TT genotype compared to non-TT controls (systolic BP 134.7 ± 13.8 mmHg vs 129.7 ± 12.4 mmHg, P < 0.001; diastolic BP 81.6 ± 9.5 mmHg vs 79.7 mmHg ± 8.9 mmHg, P = 0.023, respectively). The MTHFR 677TT genotype group had significantly higher central systolic BP (119.4 ± 11.8 vs 116.7 ± 10.9 mmHg, P = 0.018), central pulse pressure (P = 0.006) and central mean pressure (P = 0.011) compared to the non-TT group. No significant differences for central diastolic BP, pulse pressure amplification, pulse pressure ratio and augmentation index were observed. This study confirms the phenotype of elevated BP in individuals with the C677T polymorphism in the gene encoding MTHFR. For the first time, this study reports that individuals with the MTHFR 677TT genotype have higher central systolic BP, central mean pressure and pulse pressure. Further investigations through RCTs investigating the effect of the MTHFR cofactor, riboflavin, on central blood pressure in these genetically at-risk adults are warranted.

Meta-analyses of epidemiological data report that adults who carry a common polymorphism, the MTHFR 677C→T, in the gene encoding the folate-metabolising enzyme methylenetetrahydrofolate reductase (MTHFR) have a 40% increased risk of CVD and an 87% increased risk of hypertension. Riboflavin (vitamin B2), in its co-enzymatic form flavin adenine nucleotide (FAD), is required as a co-factor by MTHFR and previous trials in hypertensive patients have shown a blood pressure lowering response to riboflavin supplementation that is specific to individuals homozygous for this polymorphism (TT genotype). Low folate status is commonly reported in adults with the TT genotype however the effect of this genetic variant on riboflavin status has not previously been investigated. The aim of this study, therefore, was to investigate dietary intake and biomarker status of riboflavin by MTHFR genotype in Irish adults using data from the National Adult Nutrition Survey (2008–2010) (www.iuna.net).

A 4-day semi-weighed food record was used to collect food and beverage intake data from a representative sample of 1500 Irish adults (18–90 years). Dietary intake data were analysed using WISP© based on UK food composition tables (modified to include recipes of composite dishes, nutritional supplements, fortified foods and generic Irish foods that were commonly consumed). Usual intakes were calculated via the NCI-method using SAS© Enterprise Guide. Blood samples (n = 1126) were collected by venepuncture by a trained professional and were processed and analysed using standard operating procedures. Biomarker status of riboflavin was determined by erthyrocyte gluthathione reductase activation coefficient (EGRac), a functional assay that measures the activity of the enzyme glutathione reductase before and after in vitro activation with its prosthetic group FAD; a lower value indicates better status.

It was found that 12% of the population had the TT genotype. As expected, there was no significant difference in riboflavin intake across the genotype (CC, CT or TT) groups. Similarly, no significant genotype differences in riboflavin status (EGRac) were observed (1.36 vs 1.37 vs 1.38 respectively). Overall, 61% of the total population had EGRac values > 1.3, indicative of low/deficient status with no significant difference observed between the genotype groups (60%,61% and 61%, respectively).

These data suggest that riboflavin status is not influenced by the C677T polymorphism in MTHFR in this cohort of nationally representative Irish adults. Further research is needed to see the impact of riboflavin status on blood pressure across the genotype groups in this nationally representative cohort of Irish adults.

Gestational diabetes (GDM) is a serious condition predisposing both the mother and child to health complications. Key means for treatment are lifestyle related, primarily adherence to a healthy diet and increase in physical activity. The aim of the study was to evaluate dietary quality and physical activity in early pregnancy of women reporting history of GDM compared to healthy women participating in a population-based study. Pregnant women were enrolled to the study by announcements in social media. The interested women (n = 1034) filled in an electronic questionnaire on their background data, validated Index of Diet Quality (IDQ) and index of leisure-time physical activity (MET-index) in early pregnancy. The protocol was approved by the Ethics Committee of the University of Turku, Finland. The study population characteristics were representative of the Finnish pregnant women as compared with values reported in national perinatal statistics, except for overrepresentation of primiparas (54% compared to 41%) and underrepresentation of smokers during pregnancy (2.2% compared to 13%). Of the multiparas, 18.3% reported having been diagnosed with GDM in a previous pregnancy, which is in accordance to that in the general population (19%). Having a history of GDM was not reflected in the dietary quality in the present pregnancy. The IDQ score of the women with history of GDM (adj. mean 9.5) did not differ from those with no history (adj. mean 9.3, NS). When evaluating the categorized values, 45.8% of the women with the history of GDM and 45.4% of those without had a good dietary quality (IDQ score 10 or above). Similarly, the MET-index of the women with history of GDM (4.8 hrs/wk) did not differ from that of the women with no history (4.8 hrs/wk). Also, the categorized MET-index did not differ between the groups. The physical activity level of the women with history of GDM was light in the majority (52%) of the women, moderate in 41% and vigorous in 7%. Despite the known risks that GDM induces to health of the pregnant women and their babies, the dietary quality and physical activity of the women with a history of GDM did not differ from that of the women who were not previously affected. The results indicate that new means are needed alongside with the traditional counselling practices to motivate healthy lifestyle changes in pregnant women, particularly those at risk for recurrent GDM.

In the UK 21% of pregnant women are categorised as obese(1). Women who enter pregnancy with a high body mass index (BMI) are at greater risk of gestational weight gain (GWG) above that recommended by the Institute of Medicine (IOM) and are less likely to return to their pre-pregnancy weight compared to women with a healthy BMI(2). Pregnancy can therefore alter a woman's weight gain trajectory across the life course, through retention of gestational weight gained. Given the increase in prevalence of obesity among women of reproductive age, the aim of this study was to identify antenatal and postnatal modifiable determinants associated with successful postpartum weight loss in women who participated in UPBEAT; a multi-centre randomised controlled trial comparing a lifestyle intervention of diet and physical activity to standard care during pregnancy.

710 women completed the 6-month postpartum follow-up visit, 464 (65%) of which provided complete data for the analysis. Using regression analysis, we examined the relationship between postpartum weight retention (PPWR; calculated by subtracting pre-pregnancy weight from six-month postpartum weight) and modifiable determinants including: reported glycaemic index and smoking status at baseline (15–18 weeks’ gestation), GWG within the IOM recommendations, self-reported postpartum physical activity (categorised as low, moderate or high) and mode of infant feeding (breastfed, formula or mixed). Women were excluded if they gave birth < 37 weeks gestation or they were pregnant at the 6-month visit. Results were adjusted for age, BMI, ethnicity, socio-economic status, parity and randomisation arm.

In this cohort of obese women 52% were at or below their pre-pregnancy weight by 6 months postpartum. Overall, there was a reduction in PPWR of -0.23 ± 6.7 kg [-23.5 to 23.0 kg]. In an adjusted multiple regression model, women who breastfed for ≥ 4months, had moderate or high levels of physical activity and appropriate GWG, were more likely to be at or below their pre-pregnancy weight by 6-months postpartum (all p < 0.02). In a mutually-adjusted multivariate model, for each additional factor women lost a further -1.5 kg (95%CI -2.3 to -0.68; p < 0.001) compared to their pre-pregnancy weight.

This study has shown that there is an incremental association with postpartum weight loss and the identified modifiable determinants. These findings support initiatives which target any or all these factors during the antenatal and postnatal periods to help support women with returning to their pre-pregnancy weight.

The high prevalence of maternal deficiency and the low vitamin D content of breastmilk places newborns and infants at particular risk of vitamin D deficiency. In response to an increase in the incidence of nutritional rickets, the Food Safety Authority of Ireland published an interim infant vitamin D supplementation policy in 2007, which was implemented by the Health Service Executive in Ireland in May 2010. This recommends that all infants be given a 5μg exclusive vitamin D3 supplement daily from birth to 12 months. As adherence is not monitored nationally and the policy has not been evaluated, the aim of this study was to conduct a detailed evaluation of supplementation practices across two maternal-infant cohort studies. Data from the prospective BASELINE (recruited 2008–2011) and COMBINE (recruited 2015–2017) birth cohorts, based in Cork, Ireland, were used to examine supplementation practices. After supplementation policy implementation, BASELINE collected vitamin D supplement use data (n = 1528) at 2, 6 and 12 months. In COMBINE, 7 study visits from birth to 12 months allowed continuous collection of detailed longitudinal supplementation data in 364 participants. Use of supplemental vitamin D was higher in COMBINE than BASELINE at 2 (93 vs. 49%), 6 (89 vs. 64%) and 12 (72 vs. 44%) months (all P < 0.001). In COMBINE, 92% initiated vitamin D supplementation at birth and the median supplementation duration was 51 (40, 52) weeks, although there was a wide range (3–52 weeks). 94% of COMBINE parents used a vitamin D3 only supplement and 88% used the recommended 5μg dose. Half (51%) always supplemented daily; a further 33% supplemented at least 3–6 times/week. Full policy adherence was defined as the provision of a 5μg vitamin D3 supplement daily from birth; 64% adhered fully to 2 months and 52% did so to 6 months. By 12 months, 30% had adhered fully to the policy and a further 16% gave 5μg frequently for the full 12 months. This data indicates a high level of awareness of the supplementation policy amongst new mothers, with substantially higher rates of supplementation in our current cohort compared with BASELINE. While most parents gave an exclusive 5μg vitamin D3 supplement, frequency and duration were the key barriers to full policy adherence. Given the lack of a maternal vitamin D supplementation policy in Ireland and high prevalence of low vitamin D status at birth, supplementation of infants with vitamin D remains a vital public health policy.

A longstanding issue in the field of nutrition is the potential inaccuracy of methods traditionally used for dietary assessment (i.e. food diaries and food frequency questionnaires). It is possible to overcome the limitations and biases of these techniques by combining them with analytical measurements in human biofluids. Metabolomic technologies are gaining popularity as nutritional tools due to their capacity to measure metabolic responses to external stimuli, such as the ingestion of certain foods. This project performed both LC-MS and 1H-NMR metabolomic profiling on serum samples collected as part of the NICOLA study (Northern Irish Cohort for the Longitudinal Study of Aging) in order to discover novel dietary biomarkers. A dietary validation cohort (NIDAS) was incorporated within NICOLA, involving 45 males and 50 females, aged 50 years and over. Participants provided detailed dietary data (4-day food diary) and blood samples at two time-points, six months apart. Serum samples were processed on two analytical platforms. 1H-NMR spectra were acquired using a Bruker 600 MHz Ascent coupled to a TCI cryoprobe and processed using Bayesil (University of Alberta, Canada). A Waters TQ-S coupled with an Acquity I-class UPLC was used in combination with a targeted commercially available kit (AbsoluteIDQ p180 kit, Biocrates). Mass spectra obtained were processed with MetIDQ and verified using MassLynx (v4.1). Data were tested for normality, and metabolite concentrations were correlated with recorded dietary intake of each food type using SPSS. Additional tests (PCA, PLS-DA, ROC Curves) were performed on MetaboAnalyst 4.0 (University of Alberta, Canada). More than 50 statistically significant (P < 0.05) food-metabolite correlations were detected, 15 of which remained significant after eliminating potential confounding from sex, age and BMI. The strongest correlations were between fruit consumption and acetic acid, and between dairy consumption and certain glycerophospholipids (e.g. LysoPC aa C20:3). Stratifying the cohort by gender yielded further correlations, including PC ae C38:2 (dairy; males), PC aa C34:4 (dairy; females), PC aa C36:4 (dairy; females) and trans-4-Hydroxyproline (meat; males). A number of potential blood-based food biomarkers were detected, many of which are gender-specific, and some are corroborated by previously published studies. However, further validation work is required. For example, biological plausibility needs to be established, and the findings need to be reproduced in other cohorts to demonstrate their applicability in larger and more diverse populations. These results contribute greatly to the ongoing efforts to discover and validate reliable nutritional biomarkers as an objective and unbiased measurement of food intake.

Elderly patients are at risk of malnutrition and need an appropriate assessment of energy requirements. In the clinical setting, predictive equations are widely used to estimate the Resting Energy Expenditure (REE). Although easy to use, these equations are not always validated in the elderly and, even if validated, they often provide different outputs of energy requirements for the same subject. The aim of the present work is to develop a web-based application helping clinicians in finding out the most appropriate equation for estimating the REE for each subject. The web-based application is based on a systematic review of the equations for the estimation of REE in the elderly. The systematic review was carried out on PubMed and Scopus following the PRISMA guidelines. Studies in subjects older than 65 years of age that tested the performance of a predictive equation for the estimation of REE vs. a gold standard (indirect calorimetry or doubly labeled water) were included in the review. Studies performed in critically ill elderly patients were excluded. The initial search identified 2035 studies. The final review included 50 studies. Included studies were mainly observational, conducted in healthy elderly subjects enrolled in the outpatient setting, and using indirect calorimetry as the gold standard. The 50 studies included in the review corresponded to 189 different equations. Several parameters were included in the equations, and they can be divided as following: anthropometric characteristics, body composition parameters, environmental measures, laboratory tests, the presence of comorbidities, and physical activity frequency. The equations retrieved were tested on a sample of 88 subjects aged > 65 years enrolled in an Italian nursing home. Based on the systematic review and the pilot testing of the equations, it has been developed a web application (http://r-ubesp.dctv.unipd.it:3838/equationer) that allows for the estimation of REE using the equation most appropriate according to the subject's characteristic and parameters available. The assessment of the energy requirements in the elderly is crucial for the management of nutritional problems in this population group since nutritional problems are related to worse health outcomes. The present study showed a wide use of different type of equations for the estimation of REE in the elderly highlighting the need of choosing the most appropriate predictive equation according to the subject characteristics and health status. The web application will help clinicians in doing that.

Approximately one quarter of children living in Northern Ireland are overweight or obese. Intelligent personal systems (IPS) such as Amazon Echo and Google Home have become increasingly integrated into the home setting and therefore, may facilitate behaviour change via novel interactions or as an adjunct to conventional interventions. However, little is currently known about their potential role in this context; therefore, the aim of this feasibility study is to assess the effect of a home-based technology intervention (delivered using Amazon Echo) on physical activity (PA) and dietary habits in families attending the Safe Wellbeing Eating & Exercise Together (SWEET) project, a community-based health promotion programme. Recruitment to the study is ongoing with the aim of recruiting up to 16 families. Families are randomly assigned to receive an IPS (n = 8) or assigned to control (n = 8) i.e. attend the SWEET project as usual, for 12 weeks. Individualised prompts and reminders, aligned with the content of the SWEET project, are regularly delivered to families via the IPS and normal interaction with the device is also encouraged. The primary outcome measure is PA, which will be objectively measured using an Actigraph accelerometer, and secondary outcome measures include body mass index (BMI) and family eating and activity habits. Process evaluation data from focus groups and device interaction will be used to determine the feasibility of using IPS to promote healthy behaviours within the home setting. To date, 11 families have been recruited (11 adults, 90.9% F; 16 children, 56.3% F), mean age 40.4 ± 5.5 years and BMI 34.9 ± 6.7 kg/m2 for adults and 8.9 ± 2.1 years and BMI z-score 2.61 ± 1.23 for children. Average moderate-to-vigorous intensity physical activity (MVPA) was dichotomised to determine the percentage of adults and children meeting the UK (2011) PA guidelines for health. In total, 62.5% of adults reached the recommended level of 150 minutes MVPA per week before the intervention (n = 8;191.50 ± 81.10 minutes), with 40% of children reaching the recommended level of 60 minutes MVPA each day of the week (n = 10; M = 52.83 ± 31.07 minutes). Follow-up measurements will be taken at the end of the intervention and acceptability and usability of such devices within the context of promoting healthy behaviours will be assessed. The findings from this feasibility study will demonstrate whether the use of IPS can increase PA in adults and children, as well as provide novel insights into the feasibility of using these devices to facilitate behaviour change.

Smartphone technology has the potential to facilitate dietary assessment in epidemiological studies. Measurement error might be reduced by real time recording being more feasible with mobile methods. Our aim was to develop NutriDiary, a smartphone app for conducting three-day weighed dietary records. It provides a digital version of the established pen-and-paper method in the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study, an open cohort study from infancy to adulthood. NutriDiary was developed as a text-based app including brand specific recording of food products. Usability of the beta version of NutriDiary was evaluated in the DONALD study. Participants or their parents were offered to test the app for the annual dietary record and were asked to fill in an app-integrated evaluation questionnaire. Usability was assessed by the System Usability Scale (SUS) and in-app behavior recordings. In the beta version of NutriDiary, a consumed food item is selected using a free-text search from the integrated in-house database LEBTAB. To ease the process of recording, NutriDiary offers some usability features such as a recipe editor, an integrated help mode and a photo function for collecting information on branded food products. In total, 32 mostly female participants (69%) used the app with 21 subjects recording their own dietary intake and 11 subjects conducting a record for their child. However, a relatively large proportion of DONALD participants also refused using the app because they preferred the traditional pen-and-paper method as being easier. Among participants of the feasibility study, subjective usability of NutriDiary was “good” but considerable differences in individual ratings were observed (median SUS = 80, IQR = 23.75, minimum = 45). Although 38% of participants reported technical issues, 88% stated they would use the app again. Technical problems included issues related to setting the time, editing of entered food items and the photo function. In-app behavior recordings showed that the help mode and recipe function were well-used (72% and 63%, respectively). Feedback from the study staff revealed that the post-processing of the dietary data obtained with NutriDiary was still time-consuming. Overall, the beta version of the NutriDiary app was well-received by most participants. Some aspects for improvement such as a barcode scanning function and extension of the database were identified. Moreover, NutriDiary will be further optimized by implementing an automated recipe simulation function.

We describe a novel dietary assessment strategy to estimate usual food intake in the ongoing large-scale multi-center German National Cohort (GNC). The dietary assessment is based on three 24 h food lists (24h-FL) and a food frequency questionnaire (FFQ) enriched by information from the representative German National Nutrition Survey II (NVS II). The novelty of this dietary assessment strategy is based on separating the probability of food intake from daily consumption amounts. The probability of consumption is estimated from 24h-FLs used in the GNC. To estimate daily consumption amounts, the already collected data of the NVS II are used. The 24h-FL simplifies the question on food consumption for all foods asked to consumption or not and so the questionnaire can be completed in about 10 minutes, reducing the burden on study participants. As proof of concept, we applied the assessment strategy to pretest data collected in 2012 to 2013 to assess the feasibility of the instruments. In brief, the novel dietary assessment strategy comprises three steps. First, the individuals’ consumption probability is estimated by three 24h-FLs and one FFQ applying a logistic linear mixed model adjusted for characteristics of the participants. Second, person-specific daily consumption amounts are estimated from the NVS II applying a linear mixed model taking the characteristics of the participants into account. Third, usual food intake is estimated by the consumption probability multiplied by person-specific daily amounts. Usual intake of 41 food groups in 318 men and 377 women were estimated. Of those participants who completed the first 24h-FL, 84.4, and 68.5% completed the second and third 24h-FL, respectively. No associations were observed between probability to participate and lifestyle factors. The estimated usual food intake distributions were in a plausible range as shown by comparing the estimated energy intake to the energy needs approximated by estimated total energy expenditure. Total energy was estimated to be 2,707 kcal/day for men and 2,103 kcal/day for women. With a few exceptions, the estimated food-based consumption probabilities did not differ considerably between men and women. The differences in energy intake between men and women were mainly due to their differences in the estimated person-specific daily amounts. As a conclusion, plausible but not validated values for usual food intake were derived in the pretest study, so that the combination of three repeated 24h-FLs, an FFQ and person-specific daily amounts from an external source is a feasible strategy for dietary assessment.

Dietary pattern analyses have most commonly used food frequency questionnaire (FFQ) data for large population studies, whilst food diaries (FD) tend to be used with smaller datasets and followed up for shorter terms, restricting the possibility of a direct comparison. Studies comparing dietary patterns derived from two different assessment methods, in relation to diet and disease are limited. The aims of this study are to assess the agreement between dietary patterns derived from FFQ and FDs and to compare the associations between the Mediterranean dietary pattern and the World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) dietary pattern in relation to colorectal cancer incidence.

The study population included 2276 healthy middle-aged women – participants of the UK Women's Cohort Study. Energy and nutrient intakes, derived from 4-day FDs and from a 217-item FFQ were compared. A 10 and an 8-component score indicating adherence to the Mediterranean diet and to the 2007 WCRF/AICR cancer prevention recommendations respectively were generated. Agreement was assessed by weighted Kappa statistics and the Bland-Altman method. Cox regression was used to estimate hazard ratios (HRs) for colorectal cancer risk for both the FD and the FFQ patterns, for each score separately.

The Bland-Altman method showed that the FFQ gave a higher energy intake compared to the FD with a bias of -525 kcal (95% CI -556, -493) between the two methods. Agreement was slight for the Mediterranean diet score (Κ = 0.15; 95% CI: 0.14, 0.16) and fair for the WCRF/AICR score (Κ = 0.38; 95% CI: 0.37, 0.39). A total of 173 incident cases of colorectal cancer were documented. In the multi-variable adjusted models, the estimates for an association with colorectal cancer were weak: HR = 0.94 (95% CI: 0.83 to 1.06) for a 1-unit increment in the Mediterranean diet score using FD and HR = 1.01 (95% CI: 0.83 to 1.24) for a 1-unit increment in the WCRF/AICR score using FD. For scores derived from the FFQ, estimates were inverse, but weak (HR = 0.80 (95% CI: 0.90 to 1.00) for a 1-unit increment in the Mediterranean diet score using FFQ and HR = 0.84 (95% CI: 0.67 to 1.05) for a 1-unit increment in the WCRF/AICR score using FFQ.

There is insufficient evidence of an association of colorectal cancer risk with the Mediterranean dietary pattern or with the WCRF/AICR cancer prevention recommendations, irrespective of the dietary assessment method in this sample. Further studies with larger sample sizes, using FD for diet assessment are warranted.

Introduction: Postpartum weight management is difficult for many mothers due to the demands of parenthood. Women have highlighted a need for support but experience barriers to engaging with lifestyle interventions hence more adaptable approaches are required. This work examined participants’ engagement with a 12-month, theory-based, automated, text message (SMS) delivered, intervention supporting postpartum weight management.

Methods: SMS content was informed by: 1) the ‘Health Action Process Approach’ (HAPA)1; 2) behaviour change techniques associated with effectiveness in weight management interventions2; 3) women's accounts of postpartum weight-related experiences; and 4) personal and public involvement. A two-arm pilot RCT recruited women within two years postpartum, with a BMI ≥ 25 kg/m2, through community sources and social media. Women were randomised via a secure remote system to receive the intervention or an active control delivering child development messages. Participants received 353 messages during the 12 month intervention. Two-way messages were used to assess engagement: 50 messages prompted women to respond with their weight; 36 interactive messages requested participants’ to respond ‘Yes/No’ to a question which then triggered a feedback message. Participant engagement with two-way messages was calculated as a percentage of replies sent by women and was categorised as ‘high’ or ‘low’ according to the median number of replies sent. Weight was measured at 0, 3, 6, 9 and 12 months.

Results: 51 of 100 women recruited were randomised to receive the intervention. In months 0–6, (47%) and (95%) of participants responded to the weight messages and the ‘Yes/No’ messages respectively. In months 7–12, the responses were (77%) and (86%) respectively. Participants who were high engagers with weight messages had greater mean weight loss compared with low engagers at all time points: at 12 months high engagers (n = 18) lost -2.66 kg and had a reduction in waist circumference at 12 months of -8.9 cm, compared to changes in low engagers (n = 18) of -0.84 kg and -3.6 cm. Likewise, high engagers with ‘Yes/No’ messages had greater mean weight loss compared with low engagers at all time points: at 12 months high engagers (n = 16) lost -2.87 kg and had a reduction in waist circumference of -9.4 cm, compared to changes in low engagers (n = 20) of -0.86 kg and -3.6 cm.

Discussion: The use of two-way text messages was a useful way to encourage engagement with this SMS-delivered intervention. Higher engagement resulted in more weight loss compared to low engagement.