title: Novel nutritional intervention in health and chronic disease
Creators: name: Mullan, Adam William Francis
Publisher: name: University of Glasgow
Year: 2012
Subjects: subject: chronic obstructive pulmonary disease, COPD, COPD exacerbation, COPD cachexia, creatine, ergogenic aid, lean body mass, cardiovascular risk, vascular function, microvascular function, cardiovascular risk biomarker, laser doppler iontophoresis, pulse wave tonometry, polyphenol, flavonoid, endothelial function

description: Nutrition, or malnutrition, is an inescapable facet of human health and disease. Fuelling the human body with calories is essential; a bewildering range of micro and macro-nutrients, vitamins and essential trace elements are also necessary to maintain the physiological milieu; and are implicated in disease states when lacking or present to excess. 

A perceived awareness of ‘healthy’ nutrition is ubiquitous in modern society; claims made by manufacturers of specific foods or supplements are usually driven by commercial concerns and rarely backed by sound scientific evaluation. 

Nutritional modification is a highly attractive option to potentially alter health status or reduce the risk of future disease. Vast sums of money are spent by Western Governments on promotion of healthy eating, in an attempt to reduce future spending on pharmacotherapy - usually for type-2 diabetes, cardiovascular disease and other complications of obesity. Improvements in population health and reduced dependency on health-care resources provide major stimuli for this interest in what we consume. 

Nutrition also plays a central role in the management of many chronic disease states. Dialysis dependent end-stage renal failure may be one of the most extreme examples where adherence to fluid restrictions and dietary regulation of potassium and phosphate can make the difference between a swift demise on dialysis and survival to renal transplantation. Other chronic conditions are being increasingly recognised as having nutritional components, particular in the field of respiratory medicine. 

This thesis examines two different approaches to nutritional intervention in subjects healthy but at risk of future disease, and in those already burdened by a chronic disease state. 

Part A involves patients with Chronic Obstructive Pulmonary Disease (COPD), and evaluates creatine, an ergogenic aid used in athletes to improve performance. Low body mass index is common in COPD and heralds a poor prognosis. Further evaluation of body composition reveals significant losses of skeletal muscle mass in COPD and this is likely to play a major role in the progression of disease. There is some evidence pointing to beneficial effects of creatine on lean body mass creatine in patients with stable COPD. This study assesses creatine in a novel setting, not previously researched. Patients hospitalised with an exacerbation of COPD were recruited to a randomised, double blind, placebo controlled clinical trial and followed up after receiving 2 weeks of nutritional supplementation with either creatine or placebo. 

Part B involves healthy, overweight subjects, potentially at risk of future cardiovascular disease. This randomised, double blind, placebo controlled clinical trial assessed established risk markers for cardiovascular disease along with novel risk markers. These included novel plasma biomarkers, non-invasive measurements of vascular elasticity using pulse wave tonometry and assessment of cutaneous microvascular and endothelial function using laser doppler iontophoresis. Subjects were randomised to 4 weeks of either a polyphenol rich juice beverage or placebo and were assessed at baseline, mid-point and