The current study assesses the impact on appetite and food intake of a novel co-processed ingredient containing a viscous fibre and whole-grain high-amylose corn flour, a source of type 1 and type 2 resistant starch (HAM-RS). Ninety adults completed a crossover, placebo-controlled study comparing two doses of the ingredient (20 and 30 g) to a maltodextrin control in a fruit-based smoothie served with breakfast. Ad libitum food intake was measured over the day and visual analogue scales were used to assess subjective appetite sensations. Subjects consumed 7% less energy intake at dinner following the 30 g dose (p = 0.02) compared to control. In addition, a trend for lower lunch intake (5% less weight of food) was observed for the 20 g dose (p = 0.10). Reductions were also observed for the two meals combined, with 3% lower energy intake for the 20 g dose (p = 0.04) and 5% less weight of food consumed for the 30 g dose (p = 0.04). Lower ratings of hunger were reported at 3 h after breakfast for both doses and also at 2 and 3 h after lunch for the 30 g dose. With ratings combined to compute an overall appetite score, a trend for lower appetite scores at 3 h after breakfast was found for both doses. Consistent with this, significant reductions in AUC hunger and prospective consumption were identified in the 30 g condition. A similar pattern of results was observed for fullness and desire to eat. The results of this study show that a new composite satiety ingredient comprised of a viscous fibre and whole-grain corn flour can affect acute satiety responses in men and women.

Systemic lupus erythematosus (SLE) is a multi-system inflammatory disease where genetic susceptibility coupled with largely undefined environmental factors is reported to underlie the aetiology of the disease. One such factor is low vitamin D status. The primary source of vitamin D is endogenous synthesis following exposure of the skin to UVB light. Photosensitivity, sunlight avoidance and the use of sun protection factor in combination with medications prescribed to treat the symptoms of the disease, puts SLE patients at increased risk of vitamin D deficiency. Decreased conversion of 25-hydroxyvitamin D to the metabolically active form, 1,25-dihydroxyvitamin D 3 , is possible, due to renal impairment common in SLE putting additional stress on vitamin D metabolism. The majority of studies have identified low 25-hydroxyvitamin D in SLE patients, albeit using varying cut-offs ( < 25 to < 80 nmol/l). Of these studies, fifteen have investigated a link between status and disease activity with conflicting results. Variation with disease activity index measures used alongside methodological limitations within the study design may partially explain these findings. This review discusses the importance of optimal vitamin D status in SLE, critically evaluates research carried out to date that has investigated vitamin D in SLE, and highlights the need for a well-designed observational study that controls for diet, medication use, dietary supplements, UV exposure and seasonality, that uses sensitive methods for measuring vitamin D status and disease activity in SLE to conclusively establish the role of vitamin D in SLE.

Background Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease in which fatigue and impaired quality of life (QoL) commonly manifest. Fatigue has been associated with increased disease activity in SLE1-3 and both fatigue and disease activity are considered predictors of impaired QoL2-4, although some studies have not reported any association between disease activity and QoL5-6. Objectives The aim of this study was twofold, firstly to determine whether vitamin D is associated with fatigue and QoL in SLE patients during the winter when status would be expected to be lowest and again during summer when vitamin D levels are thought to be highest and secondly to examine for any relationship between fatigue, QoL and disease activity. Methods SLE patients were recruited from November to March (winter) (n=52) and followed up during June and July (summer) (n=50). Serum 25-hydroxyvitamin D (25(OH)D) was measured by liquid chromatography mass spectrometry. Fatigue was assessed using the fatigue severity score (FSS) and QoL was examined using the 36-item short form questionnaire (SF-36). Disease activity and damage were scored using versions of Systemic Lupus Activity Measure, Systemic Lupus Erythematosus Disease Activity Index, British Isles Lupus Assessment Group and Systemic Lupus International Collaborative Clinics/American College of Rheumatology. Primary statistical analysis included Spearman’s rho correlation and two tailed paired t-test. Multivariate and logistic regression analysis was employed to investigate potential predictors of fatigue and QoL. To investigate whether vitamin D was associated with fatigue and QoL, data from the serial winter and summer measurements were combined to give a larger sample (n=102) with greater power and regression analysis was reapplied. Results During the winter and summer months respectively 47 (96%) and 49 (98%) SLE patients reported fatigue (FSS ≥ 3) and 98% of the cohort presented with vitamin D inadequacy (25(OH)D < 75 nmol/L) throughout the year. The mental component score (MCS) (95% CI 0.02, 5.42, P=0.049) and social functioning (SF) (95% CI 1.01, 13.27 P=0.023) subscales of the SF-36 were reduced during the summer. Analysis from the serial winter and summer data, reported vitamin D status to be reduced in those with fatigue (n=96) (95% CI -39.46, -2.03, P=0.030) and FSS and SF-36 significantly correlated with all disease activity measures. Conclusions Vitamin D inadequacy, fatigue and poor QoL were prevalent in this cohort of Northern Irish SLE patients. Given the observation of reduced vitamin D in those with fatigue and the association between vitamin D and disease activity, it is plausible that improvements in fatigue mediated via increasing 25(OH)D may indirectly improve disease activity and possibly enhance QoL. Further research such as placebo controlled vitamin D intervention trials are warranted to investigate this hypothesis before any firm conclusions can be made. References Zonana-Nacach et al. Lupus 2000; 9(2):101-9. Kozora E et al. Arth...

Background Vitamin D has the potential to modulate the immune system for patients with systemic lupus erythematosus (SLE)1, and which could potentially lead to improved clinical outcomes. Observational data have suggested a relationship between vitamin D and disease activity2. This observation has been confirmed by vitamin D3 supplementation studies, where positive immunological effects were reported in SLE patients3. Additionally a placebo controlled trial supplementing SLE patients with vitamin D3 identified a positive effect on inflammation and haemostatic markers as well as improvements in disease activity4. Research examining the relationship between vitamin D and bone mineral density (BMD) in SLE patients is limited, albeit a study has suggested a link between disease activity and BMD in SLE patients5 and thereby suggesting flares in disease activity has a negative effect on BMD. Objectives To examine for relationships between vitamin D and disease activity, damage and BMD. Methods A total of 52 SLE patients were recruited onto an observational study during the winter (November-March) and followed up during the summer months (June-July) (n=50). Total 25-hydroxyvitamin D (25(OH)D) concentration was measured using the liquid chromatography mass spectrometry method (MassChrom®, Chromsystems Gmbh, Heimburgstrasse, Germany) and BMD was measured at the lumbar spine and femur by dual energy X-ray absorptiometry (Lunar iDXA™, UK). Disease activity and damage were assessed using Systemic Lupus Activity Measure (SLAM), British Isles Lupus Assessment Group (BILAG), Systemic Lupus Erythematosus Disease Activity Index (SELENA SLEDAI) and Systemic Lupus International Collaborative Clinics/American College of Rheumatology (SLICC/ACR). Results Mean (SD) 25(OH)D concentrations in winter (26.9 (16.2) nmol/L) and summer (28.7 (16.7) nmol/L) were not different (P=0.439), nor were differences observed between disease activity and damage. During the winter, but not during the summer, vitamin D was a significant predictor of BILAG (r=-0.307; P=0.027) and SELENA SLEDAI (β=-0.074; SE=0.036; P=0.044), controlling for age, BMI and medications. Osteoporosis and osteopenia was present in some 4 (8%) and 21 (45%) SLE patients respectively and there were no relationships observed between disease activity and BMD. Conclusions Vitamin D inadequacy was prevalent throughout the year and undiagnosed osteoporosis was apparent in this cohort, and, therefore, suggesting routine screening of both is warranted. Wintertime vitamin D status was a predictor of disease activity at that time of year. There was no relationship, however, observed between disease activity and BMD. The lack of seasonal variability in vitamin D status might suggest sun avoidance by the SLE patients; emphasising the importance of obtaining adequate vitamin D intake from the diet and supplements for SLE patients. References Marques et al. Revista Brasileira de Reumatologia. 2010;50(1):67-80. Breslin, et al. Proceedings of the Nutrition Society. 2011 Nov;70(4):399-407. T...