James Lyons

Sample Web & Print Article Portfolio JA MES H . LYONS , NUTRITIONIS T & EX P ERT HE ALTH WRITE R - ja m e s l yo nsnutr-© J a m e s H. Lyons- Table of Contents WEB & PRINT WRITING SAMPLES How Nicotine Affects Sleep p3 Best Vegan Omega-3 Supplements p8 Causes & Symptoms of Serious Vitamin D Deficiency p 14 TECHNICAL WRITING SAMPLE Biochemical and Metabolic Role of B Vitamins in Energy Metabolism (Excerpt) (2017) p 21 POLICY REVIEW SAMPLE Major determinants of poor dietary choices in childhood obesity in Australia & the effectiveness of individual behavioural change strategies vs. social-ecological health promotion (Excerpt) (2016) p 24 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 © James H. Lyons, 2017 Web & Print Writing Sample NOT TO BE REPRODUCED BIOCHEMICAL AND METABOLIC ROLE OF B VITAMINS IN ENERGY METABOLISM (EXCERPT) The tricarboxylic acid cycle (TCA cycle) is a series of oxidative reactions within the mitochondrial matrix. Reactions within the cycle produce NADH and FADH2 and these reduced nucleotides have the redox potential to drive ATP synthesis via the respiratory chain, supplying cellular energy in aerobic conditions (Hames & Hooper, 2011, p. 393; Mailloux et al., 2007, p. e690). Certain B vitamins are essential cofactors for enzymes within the TCA cycle (Gropper & Smith, 2013, p. 87), the formation of nucleotides (Magni et al., 2004, p. 20), and the transfer of hydrides within the respiratory chain (Sun et al., 2006, p. 1054). Thiamin (B1) is required for the function of pyruvate dehydrogenase complex (PDHC) and a-ketoglutarate dehydrogenase complex (aKGDH) (Londsdale, 2006, p. 51; Tretter & Adam-Vizi, 2005, p. 2335). Riboflavin (B2) is essential for the formation of flavin mononucleotide (FMN) and avin adenine di-nucleotide (FAD) which participate in the transport of electrons in reactions catalysed by PDHC, aKGDH, and succinate dehydrogenase (Patel & Korotchkina, 2006, p. 7; Shi et al., 2005, p. 10888; Horse eld et al., 2005, p. 7309). Niacin (B3) is a precursor for nicotinamide adenine nucleotide (NAD), the oxidising agent that accepts electrons in reactions catalysed by PDHC, isocitrate dehydrogenase, aKGDH, and malate dehydrogenase, then carries them to complex I (Kickoff, 2011) of the electron transport chain to produce ATP (Mailloux et al., 2007, p. e690). Pantothenic acid (B5) is a precursor to coenzyme A, an essential component of the intermediates acetyl-CoA and succinyl-CoA (Leonardi et al., 2010, p. e11107). Ultimately, the role of these B group vitamins in the TCA cycle and respiratory chain is to ensure 21 proper function of these pathways which supply ATP and metabolic intermediates that are essential for biological processes. THIAMIN (B1) Form: Thiamin, phosphorylated as thiamin diphosphate (TDP) also known as thiamin pyrophosphate (TPP). ACTIONS: 1. Pyruvate Dehydrogenase (E1) forms one-third of the pyruvate dehydrogenase complex (PDHC) and uses TPP as a coenzyme in the catabolism of pyruvate to acetylCoA (Londsdale, 2006, p. 51; Patel & Korotchkina, 2006, p. 6; Thomson, Guerrini & Marshall, 2012, p. 85). Mechanism of Action: To move its reactive state, TPP forms a hydrogen bond with the glutamate residue (Glu59) within pyruvate dehydrogenase and loses a hydride, creating a negatively charged carbanion located between the nitrogen and sulphur atoms of its thiazole ring (Ciszak et al., 2003, p. 21241; Patel & Korotchkina, 2006, p. 6; Jordon & Patel, 2004, p. 58). This carbanion readily bonds with pyruvate, holding it in place while pyruvate dehydrogenase removes the substrate’s carbonyl group, releasing CO2 and yielding hydroxyethyl-TDP (Gropper & Smith, 2013, p. 323; Jordon & Patel, 2004, p. 58). This is then metabolised by two additional enzymes in PDHC which require riboflavin and niacin. (University of Illinois, 2004) 22 2. a-Ketoglutarate Dehydrogenase Complex (aKGDH) is a collection of three enzymes which convert a-ketoglutarate into succinyl-CoA, and TPP is a cofactor for its rst subunit, (E1) a-ketoglutarate dehydrogenase (Londsdale, 2006, p. 50; Reed, 2001, p. 38330; Tretter & Adam-Vizi, 2005, p. 2335). Mechanism of Action: As with PDHC, the thiazole ring of TPP loses a hydride and creates a reactive carbanion which bonds to and holds a-ketoglutarate in place while the enzyme, a-ketoglutarate dehydrogenase, removes the carbonyl group from the substrate (Gropper & Smith, 2013, p. 323; Reed, 2001, p. 38330). RECOMMENDED DAILY INTAKE OF THIAMIN: AGE FEMALE MALE 1–3 years 0.5mg/d 0.5 mg/d 4–8 0.6 mg/d 0.6 mg/d 9–13 0.9 mg/d 0.9 mg/d 14–18 1.0 mg/d 1.2 mg/d 19–30 1.1 mg/d 1.2 mg/d 30> 1.1 mg/d 1.2 mg/d Pregnancy & Lactation 1.4 mg/d 1.4 mg/d (NHMRC, 2006, pp. 68 - 69) 23 © James H. Lyons, 2017 Web & Print Writing Sample NOT TO BE REPRODUCED MAJOR DETERMINANTS OF POOR DIETARY CHOICES IN CHILDHOOD OBESITY IN AUSTRALIA & THE EFFECTIVENESS OF INDIVIDUAL BEHAVIOURAL CHANGE STRATEGIES VS. SOCIAL-ECOLOGICAL HEALTH PROMOTION (EXCERPT) INDIVIDUAL CHANGE STRATEGIES VERSUS SOCIO-ECOLOGICAL HEALTH PROMOTION INDIVIDUAL BEHAVIOURAL CHANGE STRATEGIES The transtheoretical model (TTM) of behavioural change is a common framework for individual behaviour change strategy, and is readily applied to weight loss. It involves six steps for understanding behaviour, and where individual intervention can occur: (i) pre-contemplation, (ii) contemplation, (iii) preparation, (iv) action, (v) maintenance, and (vi) termination(Prochaska & Velicer, 1997, p. 38). Health education and behavioural therapy are the most common individual behavioural change strategies and take a downstream approach to encourage the individual to change their eating behaviour (Bray, 2012, p. 1). The reach of individual behavioural change strategies are highly limited as they, by their nature, only impact the individual. Success has been shown to be limited and short-lived, with relapse is common (Tuah et al., 2011, p. 1). As such, intervention of individual-level determinants has little impact on long-term weight-loss obesity, and any short-term success was shown to have little impact at a larger scale (Jeffery, Drewnowski, Epstein, Stunkard, Wilson, Wing & Hill, 2000; Lakerveld et al., 2012, p. 2). An ACE (Assessing Cost Effectiveness) study of Australian interventions aiming to reduce childhood obesity found that strategies targeting individual determinants had a much higher cost and lower reach than socio-ecological health promotion campaigns (Carter, Moodie, Markwick, Magnus, Vos, Swinburn & Haby, 2009, pp. 4 – 5): 24 TABLE 1 COST OF INDIVIDUAL BEHAVIOURAL CHANGE STRATEGIES: Family-based G.P. Intervention modelled on the Live $650 per child Eat and Play (LEAP) program involving multiple GP $6.3m total consultations with the aim to identify and modify be- havioural determinants of the child/family’s physical activity and nutrition. Reach: 9, 685 children Active After School Community Program involving eight weeks of out-of-school hours organised physical activity, education, and a nutritious snack. $407 per child $40.3m total Reach: ~ 99, 000 children dfg School-Based Peer-Led Program involving a twelve week intervention in- volving peer counselling, 15 minutes of guidance by a psychologist weekly, weekly weigh-ins with incentives for >0.25kg loss- es, and 15-minute exercise classes. $129 per child (due to reduced cost by enrolling peer volunteers) $2.2m total Reach: ~ 17, 000 children SOCIO-ECOLOGICAL HEALTH PROMOTION CAMPAIGNS: Reduction of TV advertising of high fat and/or high sugar foods & drinks to chil- dren Reach: 268,600 children TravelSmart Schools involving community wide information ses- sions, professional development for teach- ers, and community promotion. $103 per child $27.7 million total $50 per child $13.3 million total Reach: 267,700 (Carter, Moodie, Markwick, Magnus, Vos, Swinburn & Haby, 2009, pp. 4 – 5) 25 Within individual intervention programs, parent-only group-based intervention involving just the parent has shown comparable effectiveness to family-based or child-withparent intervention, at a signi cantly lower cost ($13,546 versus $20,928 respectively) (Janicke, Sallinen, Perri, Lutes, Silverstein & Brumback, 2013, p. 329). Further considerations include accessibility as the cost of clinic-based weight-control programs can be prohibitive for many families, especially those with low SES who, as already discussed, are more susceptible to determinants for childhood obesity (Tuah et al., 2011, p. 1). SOCIO-ECOLOGICAL HEALTH PROMOTION The socio-ecological framework promotes whole-system interventions where multiple levels of in uence must be considered: (i) individual lifestyle factors; (ii) social and community networks; (iii) living and working conditions; and (iv) socio-economic, cultural and environmental conditions (Whitehead, 2007, p. 478). The ACE study found that socio-ecological health promotion interventions were more cost effective than those focussed on individual determinants (see: table 1). Given children’s position in society and their reliance on environmental factors to guide their food choices (parents, family, school and social supports), it follows that socioecological factors are key targets for intervention to change determinants of childhood obesity (Lawrence & Worsley, 2007, p. 106; Mitchell, Catenacci, Wyatt, & Hill, 2012, pp. 720-721). Children are especially at risk of weight gain during times of changing circumstances, particularly entry into primary school, thereby making schools a useful target for intervention (Langley-Evans, 2009, p. 153). The limited effectiveness of behavioural and educational interventions has led to a greater focus on legislation and policy around nutritional content of school food (Moore, Silva-Sanigorski & Moore, 2013, p. 1001). However, health promotion initiatives within schools have rarely encompassed all levels of influence – either by focussing on proximal environments (home, school and classroom) but excluding the level of policy, or by creating policy that doesn’t consider the in uence of proximal environments (Moore, Silva-Sanigorski & Moore, 2013, p. 1001). Therefore, the full capacity for socio-ecological health promotion has rarely been explored within schools. The Be Active Eat Well (BAEW) project was a community-wide initiative in rural Victoria from 2003 – 2006 which successfully decreased the average childhood BMI by following a framework that took into consideration social determinants of health, community participation, community capacity building and the socio-ecological framework (Moore, Silva-Sanigorski & Moore, 2013, p. 1002 ; Sanigorski, Bell, Kremer, Cuttler & Swinburn, 2008, pp-). Interventions were implemented in multiple settings and involved whole-family education, reduced access to energy-dense snacks, increased fruit intake, and improved activity (Lawrence & Worsley, 2007, p. 209). A top-down approach was taken by engaging stakeholders during development, 26 implementing an extensive social media campaign, changing school food policies, supplying professional development for canteen staff, and holding promotional events at local food stores, in conjunction with individual behavioural change strategies such as “taste tests” and changed curriculum to provide food education and promote healthier food choices by children (Moore, Silva-Sanigorski & Moore, 2013, p. 1002). The success of the project continued beyond the intervention and a 2013 review found that surrounding communities had also experienced benefit, suggesting that well-designed obesity prevention strategies are highly sustainable and can “spread” (Lawrence & Worsley, 2007, p. 209). The BAEW project proved to be affordable and cost effective, with substantial spin-off effects beyond funding levels. It cost $0.34M annually, and saved an estimated 10.2 Disability Adjusted Life Years (DALYs) and 547 BMI units (Moodie, Herbert, SilvaSanigorski, Mavoa, Keating, Carter, Waters, Gibbs & Swinburn, 2013, p. 2079). In comparison, the NSW Go4Fun program was a large scale bi-weekly after school program attended by family or parent-and-child. Go4Fun was designed on a single level to change individual behavioural determinants of childhood obesity by engaging participants in weight loss via education, skills training and motivational enhancement, and half an hour of organised physical activity (Welsby, Nguyen, O’Hara, InnesHughes, Bauman & Hardy, 2014, p. 2). Outcome of lowered BMI was not reported, and the program showed poor attendance particularly by those from socially disadvantaged backgrounds and low SES (ibid., p. 6). Cost effectiveness was not reported. In conclusion, the greatest impact on improving dietary choices in children is through socio-ecological health promotion that includes individual behavioural change strategies. Individual interventions tend to be costly and only effective short-term, while socio-ecological health promotion is most successful when involving multiple levels of in uence. There is a need for increased policy, both at community and national levels, to compliment the current behavioural intervention programs. 27 28 29 30