Dietary patterns and the progression of type 2 diabetes

Main supervisor: Dr Laura Johnson, University of Bristol [email protected]

Co-supervisors: Dr Clare England (University of Bristol); Dr Rob Andrews (University of Exeter Medical School) and Dr Angus Jones (University of Exeter)

MRC GW4 BIOMED DOCTORAL TRAINING PARTNERSHIP http://www.gw4biomed.ac.uk/ brings together the Universities of Bath, Bristol, Cardiff and Exeter to develop the next generation of biomedical researchers. Students have access to the combined research strengths, training expertise and resources of the four research-intensive universities with opportunities to participate in interdisciplinarity and ‘team science’. Many of the PhD projects supported by the DTP are co-supervised across at least two of the partner universities, allowing students to join existing and emerging research partnerships.

This project is a unique opportunity for a student with strong quantitative skills to investigate the role dietary patterns in modifying the progression of type 2 diabetes, responsiveness to diabetes medication and development of diabetes complications. Findings will inform the development of individualised approaches to treatment of Type 2 diabetes.

Currently 3.3 million people in the UK have Type 2 diabetes (T2DM) with this figure expected to rise to 4.6 million by 2030. T2DM can result in loss of vision, kidney failure, and cardiovascular disease and uses 10% of the NHS budget.

In patients with T2DM, randomised trials targeting different nutrients for weight loss and prevention of cardiovascular complications have shown no single approach to dietary change is superior [1]. Dietary patterns, derived through data-driven techniques such as reduced rank regression can identify food combinations that explain maximal variation in multiple nutrient mechanisms simultaneously [2]. Dietary patterns, offer a more precise method for tracking changes in diet and may better predict the progression of T2DM. To date there have been no longitudinal studies of whether such dietary patterns are associated with progression of T2DM (worsening of HbA1c), the development of diabetes complications or responsiveness to diabetes medication.

This project brings together Bristol epidemiologist (Johnson) and dietician (England) with expertise in T2DM and multivariate dietary pattern analysis together with an Exeter clinical scientists (Andrews and Jones), who have conducted a large (593 patients) trial in newly-diagnosed patients with T2DM (Early ACTID [3]) and have access to a large cohort (1000 patients) of newly-diagnosed patients tracked for their progression of T2DM and to identify predictive factors (DIRECT [4]). ACTID and DIRECT have extensively characterised patients, including detailed dietary data (5 food diaries in ACTID and 24 hour recalls in DIRECT), blood samples and medical history at follow ups over 6 and 3 years in ACTID and DIRECT respectively.

The student will develop practical skills in coding dietary data; processing raw data to generate variables on food groups, nutrients, dietary patterns and eating habits e.g. meal size, timing and frequency. Starting with the ACTID dataset the project will investigate: 1. Within-person variation in dietary patterns and eating habits over a 6 year period 2. Associations of changes in dietary patterns with progression of diabetes, time to development of complications or responsiveness to medication. 3. Prediction of progression of diabetes, time to the development of complications and responsiveness to medication from dietary pattern variation over time.

Initial work in ACTID can be extended to the DIRECT cohort to replicate findings across Europe and in a more diverse ethnic group. The project will reveal the role that dietary patterns play in the progression of T2DM and could inform guidelines for first-line diabetes medication among patients with different dietary patterns.

1. Emadian A, Andrews, RC, England, CY. et al. BJN (2015), 114, 1656-66; 2. Johnson, L, Mander, AP., Jones, LR., et al. AJCN (2008) 87(4):846-54 3. Andrews RC et al. Lancet. 2011 Jul 9;378(9786):129-39 4. Koivula RW et al .Diabetologia. 2014 Jun;57(6):1132-42 Funding

This studentship is funded through GW4BioMed MRC Doctoral Training Partnership. It consists of full UK/EU tuition fees, as well as a Doctoral Stipend matching UK Research Council National Minimum (£14,553 p.a. for 2017/18, updated each year).

Additional research and training funding is available over the course of the programme. This will covers costs such as research consumables, courses, conferences and travel. Additional competitive funds are available for high-cost training/research.

The research project listed are in competition with 40 other studentship projects available across the GW4 BioMed MRC Doctoral Training Partnership. Up to 8 studentships will be awarded to the best applicants for an Oct 2017 start. You are encouraged to apply for up to 3 projects.

Eligibility

Residency: The Doctoral Training Partnership welcomes applications from both UK and EU applicants; however, as a consequence of the EU referendum result, final award decisions will depend on the outcomes of the UK/EU negotiations.

All EU applicants must have been ordinarily resident in the EU for at least 3 years prior to the start of their proposed programme of study. Due to funding regulations there are fewer studentships available for EU students who have not been resident in the UK for at least 3 years prior to the start of this course. By using a mixture of MRC and University funding all studentships will be fully funded.

Academic criteria: Applicants for a studentship must have obtained, or be about to obtain, a First or Upper Second Class UK Honours degree, or the equivalent qualifications gained outside the UK, in an appropriate area of medical sciences. The DTP welcomes students from non-medical backgrounds, especially in areas of computing, mathematics and the physical sciences, and can fund additional training, including Masters to assist discipline conversion. Applicants with a Lower Second Class degree will be considered if they also have a Master’s degree or have significant relevant non-academic experience.

English requirements: If English is not your first language you will need to meet the English language requirements of the university that will host your PhD by the start of the programme. This will be at least 6.5 in IELTS or an acceptable equivalent. Please refer to the relevant university for further information.

Applicants who are classed as International for tuition fee purposes are not eligible for funding.

How to apply

Please complete an application to the GW4 BioMed MRC DTP for an ‘offer of funding’. For applicants to the Universities of Bristol and Exeter only those with an ‘offer of funding’ from the DTP will be invited to make an application to the University for an ‘offer of study’. Please complete the online application form. Applications close on 8th June at 0930.

Selection process • First round interviews with lead supervisors (in person or via phone/video call) between 9-16th June; • Selected candidates for individual projects will be informed if they have been shortlisted for interview on 26th June and will be required to provide academic transcripts and two references to the DTP by 29th June; • Interviews will take place in Cardiff on Friday 30 June.

Further details will be included in the shortlisting letter.

For informal enquiries, please contact [email protected] For project related queries, please contact [email protected]