Papers by Margaret Ashwell
British Journal of Nutrition
The regulation of health claims for foods by the Nutrition and Health Claims Regulation is intend... more The regulation of health claims for foods by the Nutrition and Health Claims Regulation is intended, primarily, to protect consumers from unscrupulous claims by ensuring claims are accurate and substantiated with high quality scientific evidence. In this position paper, the Academy of Nutrition Sciences uniquely recognises the strengths of the transparent, rigorous scientific assessment by independent scientists of the evidence underpinning claims in Europe, an approach now independently adopted in UK. Further strengths are the separation of risk assessment from risk management, and the extensive guidance for those submitting claims. Nevertheless, four main challenges in assessing the scientific evidence and context remain: (i) defining a healthy population, (ii) undertaking efficacy trials for foods, (iii) developing clearly defined biomarkers for some trial outcomes and (iv) ensuring the composition of a food bearing a health claim is consistent with generally accepted nutrition p...
Public Health Nutrition, 2006
ObjectiveThe National Diet and Nutrition Surveys (NDNS) are a series of government-funded surveys... more ObjectiveThe National Diet and Nutrition Surveys (NDNS) are a series of government-funded surveys of food intake, nutrient intake and nutritional status of individuals, undertaken to support nutritional policy and risk assessment. This paper summarises a review that considered the extent to which NDNS met the needs of users and suggested options for the future. The Food Standards Agency has since progressed favoured options. This paper aims to help others wishing to obtain this type of information within their own populations.DesignA detailed questionnaire was used to probe use of data and gather opinions from users, producers and managers of the NDNS. It asked about general information needs from NDNS and changes that might be made. This was followed by a two-day workshop which included discussion of the main issues and the generation of 19 possible future options for consideration by the Agency.ResultsOptions to improve effectiveness included methods to prioritise breadth and dept...
Advances in Obesity, Weight Management & Control
This systematic review collated seventy-eight studies exploring waist-to-height ratio (WHtR) and ... more This systematic review collated seventy-eight studies exploring waist-to-height ratio (WHtR) and waist circumference (WC) or BMI as predictors of diabetes and CVD, published in English between 1950 and 2008. Twenty-two prospective analyses showed that WHtR and WC were significant predictors of these cardiometabolic outcomes more often than BMI, with similar OR, sometimes being significant predictors after adjustment for BMI. Observations from crosssectional analyses, forty-four in adults, thirteen in children, supported these predictions. Receiver operator characteristic (ROC) analysis revealed mean area under ROC (AUROC) values of 0·704, 0·693 and 0·671 for WHtR, WC and BMI, respectively. Mean boundary values for WHtR, covering all cardiometabolic outcomes, from studies in fourteen different countries and including Caucasian, Asian and Central American subjects, were 0·50 for men and 0·50 for women. WHtR and WC are therefore similar predictors of diabetes and CVD, both being strong...
The Proceedings of the Nutrition Society, 1979
European Journal of Clinical Nutrition, 2010
Objectives: The EURRECA Network of Excellence is developing standardized methods that will guide ... more Objectives: The EURRECA Network of Excellence is developing standardized methods that will guide the alignment of micronutrient reference values (RVs) across Europe. A consultation process to identify and prioritize the best practice, 'tools' or guidance for EURRECA was undertaken. Subjects/Methods: A questionnaire was sent to 90 individuals with experience of setting or using RVs. Respondents were asked to rank the usefulness of each type of possible guidance. Results: In all, 52% of individuals returned completed questionnaires. For the planning process, the most needed guidance was on the best way to assess the 'status quo' of RVs; what to cover, setting priorities, how to take into consideration the diverse needs of the users; and making the whole process transparent. The most needed guidance for the active stage of development was how to obtain valid and robust data on intakes and status to use as a base for RVs; how to account for food-related factors; how to incorporate results of systematic reviews; how to identify unbiased and independent reviews and make decisions if evidence is conflicting; methods to 'weight' the evidence; and formats or concepts to convert scientific requirements into RVs. Users of RVs required guidance on communication, codes of practice to raise professional and public awareness, making them easy to use in the intended way. Conclusions: The questionnaire responses provided views from a wide range of experts on the most needed 'tools' and standardized methodologies for the process of reviewing micronutrient RVs. This will help the EURRECA Network of Excellence to prioritize resources.
Nutrition Research Reviews
A consensus workshop on low-calorie sweeteners (LCS) was held in November 2018 where seventeen ex... more A consensus workshop on low-calorie sweeteners (LCS) was held in November 2018 where seventeen experts (the panel) discussed three themes identified as key to the science and policy of LCS: (1) weight management and glucose control; (2) consumption, safety and perception; (3) nutrition policy. The aims were to identify the reliable facts on LCS, suggest research gaps and propose future actions. The panel agreed that the safety of LCS is demonstrated by a substantial body of evidence reviewed by regulatory experts and current levels of consumption, even for high users, are within agreed safety margins. However, better risk communication is needed. More emphasis is required on the role of LCS in helping individuals reduce their sugar and energy intake, which is a public health priority. Based on reviews of clinical evidence to date, the panel concluded that LCS can be beneficial for weight management when they are used to replace sugar in products consumed in the diet (without energy ...
British Journal of Nutrition
The National Institute for Health and Care Excellence (NICE) has acknowledged the value of waist-... more The National Institute for Health and Care Excellence (NICE) has acknowledged the value of waist-to-height ratio (WHtR) as an indicator for ‘early health risk’. We used recent UK data to explore whether classification based on WHtR identifies more adults at cardiometabolic risk than the ‘matrix’ based on BMI and waist circumference, currently used for screening. Data from the Health Survey for England (4112 adults aged 18y+) were used to identify cardiometabolic risk, indicated by raised glycated haemoglobin, dyslipidaemia and hypertension. HbA1c, total/HDL cholesterol and SBP were more strongly associated with WHtR than the ‘matrix’. In logistic regression models for HbA1c>=48mmol/mol, total/HDL cholesterol>4 and hypertension (BP>140/90mmHg or on medication), WHtR had a higher predictive value than the ‘matrix. Area under the ROC curve was significantly greater for WHtR than the ‘matrix’ for raised HbA1c and hypertension. Fifteen percent of adults with raised HbA1c would b...
Obesity research & clinical practice, Jan 15, 2017
Waist-to-height ratio (WHtR) is a simple anthropometric proxy for central body fat; it is easy to... more Waist-to-height ratio (WHtR) is a simple anthropometric proxy for central body fat; it is easy to use from a health education perspective. A WHtR value >0.5 has been proposed as a first level indicator of health risk. The first aim of this study was to compare WHtR with values based on body mass index (BMI) in their prediction of the percentage of body fat (%BF) in a multi-ethnic population of adolescents from New-Caledonia (age 11-16year). Secondly, to see whether WHtR >0.5 could be used to detect overfat subjects whose BMI was in the normal range. Body fat percentage (%BF, based on skinfold measurements), BMI and WHtR were calculated for New Caledonian adolescents from different ethnic backgrounds. The relationship between %BF, BMI and WHtR was determined using quadratic models and from linear regression equations. The sensitivity and specificity of WHtR for detecting overfat adolescents (%BF >25% in boys and >30% in girls) were assessed and compared with those from th...
Nutrition Bulletin
The Food Standards Agency's Optimal Nutrition Research Programme (N05) has been in existence sinc... more The Food Standards Agency's Optimal Nutrition Research Programme (N05) has been in existence since 1993 and a review was undertaken of its achievements over the last 5 years in order to determine its future direction. An independent panel of experts agreed that the Programme as a whole represented a sustained effort and has resulted in an excellent body of nutrition research within the UK. The Programme is large and mainly covers work on micronutrient status (i.e. markers of exposure to dietary intake and functional markers) and bioavailability of micronutrients. It also covers projects on the effect of several nutrients on bone health, cognitive function and life-course events. With respect to these health outcomes, the Programme has expanded beyond its original remit for research on micronutrients. It now covers aspects of bioavailability and function of macronutrients and other bioactive dietary factors, such as n-3 fatty acids. However, the experts agreed there is no advantage to be gained in re-focusing onto micronutrients or for splitting the Programme into smaller units. Priorities were reconfirmed and suggestions were made for future directions of the Programme.
Nutrition research reviews, Jan 18, 2017
The role of mindfulness, mindful eating and a newer concept of intuitive eating in modulating eat... more The role of mindfulness, mindful eating and a newer concept of intuitive eating in modulating eating habits is an area of increasing interest. In this structured literature review, a summary of the current evidence is presented, together with details of interventions undertaken and the tools to measure outcomes. It is broad in scope given the emerging evidence base in this area. The review yielded sixty-eight publications: twenty-three interventions in obese/overweight populations; twenty-nine interventions in normal-weight populations; sixteen observational studies, three of which were carried out in overweight/obese populations. Mindfulness-based approaches appear most effective in addressing binge eating, emotional eating and eating in response to external cues. There is a lack of compelling evidence for the effectiveness of mindfulness and mindful eating in weight management. Mindfulness-based approaches may prevent weight gain. Reduced food intake was seen in some of the studie...
Perspectives in public health, 2017
To contribute evidence and make recommendations to assist in achieving free sugars reduction, wit... more To contribute evidence and make recommendations to assist in achieving free sugars reduction, with due consideration to the broader picture of weight management and dietary quality. An expert workshop in July 2016 addressed options outlined in the Public Health England report 'Sugar reduction: The evidence for action' that related directly to the food industry. Panel members contributed expertise in food technology, public heath nutrition, marketing, communications, psychology and behaviour. Recommendations were directed towards reformulation, reduced portion sizes, labelling and consumer education. These were evaluated based on their feasibility, likely consumer acceptability, efficacy and cost. The panel agreed that the 5% target for energy from free sugars is unlikely to be achievable by the UK population in the near future, but a gradual reduction from average current level of intake is feasible. Progress requires collaborations between government, food industry, non-gov...
Nutrition Food Science, 1977
European Journal of Nutrition, 2008
Background Nowadays most countries in Europe have established their own nutrient recommendations ... more Background Nowadays most countries in Europe have established their own nutrient recommendations to assess the adequacy of dietary intakes and to plan desirable dietary intakes. As yet there is no standard approach for deriving nutrient recommen
Nutrition Food Science, 1976
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Papers by Margaret Ashwell