University of Wollongong Research Online University of Wollongong Thesis Collection University of Wollongong Thesis Collections 2012 Food or nutrients? a comparison of the effectiveness and efficacy of increased fish and long chain omega-3 polyunsaturated fatty acid supplement consumption in the context of metabolic health Elizabeth Phillipa Neale University of Wollongong Recommended Citation Neale, Elizabeth Phillipa, Food or nutrients? a comparison of the effectiveness and efficacy of increased fish and long chain omega-3 polyunsaturated fatty acid supplement consumption in the context of metabolic health, Doctor of Philosophy thesis, School of Health Sciences, University of Wollongong, 2012. http://ro.uow.edu.au/theses/3585 Research Online is the open access institutional repository for the University of Wollongong. For further information contact the UOW Library: [email protected] FOOD OR NUTRIENTS? A COMPARISON OF THE EFFECTIVENESS AND EFFICACY OF INCREASED FISH AND LONG CHAIN OMEGA-3 POLYUNSATURATED FATTY ACID SUPPLEMENT CONSUMPTION IN THE CONTEXT OF METABOLIC HEALTH A thesis submitted in fulfilment of the requirements for the award of the degree DOCTOR OF PHILOSOPHY from UNIVERSITY OF WOLLONGONG by Elizabeth Phillipa Neale BND (Hons.), APD Smart Foods Centre, School of Health Sciences 2012 1 2 DEDICATION To Col, Mum and Dad 3 ACKNOWLEDGEMENTS I would like to acknowledge all of my supervisors for all of their help over the last three years. My primary supervisor Professor Linda Tapsell has been instrumental in supporting and encouraging me to pursue my research ideas, whilst also contributing her breadth of knowledge to my work. Linda’s involvement and insight has helped me to become a much stronger researcher and dietitian. I would also like to thank my co- supervisors Dr Yasmine Probst, for her advice, insight and friendship, and Dr Marijka Batterham, for all of her help, particularly in the statistical areas of this thesis. I would like to thank the members of the Smart Foods Centre clinical trials team, past and present, who I have worked with on the clinical trials utilised in my thesis, particularly Jane O’Shea, Beck Thorne, Kiefer Zhang and Holley Jones. I would also like to express my deepest gratitude to my ‘PhD buddies’ Deborah Nolan-Clark and Sayne Dalton, who were also members of the clinical trials team, for their continual support, encouragement and friendship. You have both been of so much help to me, from both a research and motivation perspective, have answered innumerable questions, and have made this experience a very enjoyable and fun one. I would also like to acknowledge Amanda Cossey and Vivien Tsang, who have contributed to my research as part of their Nutrition and Dietetics major projects. I would like to thank Dr Beverley Muhlhausler for improving my understanding of adiponectin, and for her advice in designing the BHEeP study. Thank you also to Dr Francesca Fernandez for conducting the genetic analysis for the BHEeP study, and to Anne McMahon and A/Professor Alexandra McManus for their assistance in designing the focus group questions. 4 I would also like to express my deepest gratitude to the participants of the Smart and BHEeP studies, and the focus groups utilised in this thesis. Thank you for giving up your time and effort (and for the BHEeP participants – thank you for eating so much fish!), I would not have been able to conduct this research without you. I would also like to acknowledge Simplot Australia and Blackmores for contributing fish and supplements to the BHEeP study, and would like to personally thank Jocelyn Midgley and Chris Oliver, who were my respective contacts at each company. Thank you to my parents, Vicky and Wayne Neale, for their continual support and love, in this and all areas of my life. Thank you also to my sister Dr Peta Neale, for her advice on completing a PhD. Finally, I would like to thank my husband Col for all of his help with this thesis. From a professional perspective, thank you for your invaluable help in teaching someone with minimal lab experience how to do the ELISAs for the BHEeP study, it could not have been easy but I appreciated your time and patience more than I can say. More importantly, however, thank you for your never ending support, love and encouragement, and for always being there to listen to my problems and confusing thesis explanations. You have helped me remain motivated and positive about this experience and I can only hope I am as much help to you while you complete your PhD. 5 LIST OF ABBREVIATIONS AA – Arachidonic acid ALA – Alpha-linolenic acid AMPK - 5' adenosine monophosphate-activated protein kinase AUSNUT - Australian Food and Nutrient Database BHEeP – Building Healthy Eating Practices study BMI – Body mass index CRP – C-reactive protein DH – Diet history DHA - Docosahexaenoic acid DNC – Deborah Nolan-Clark ELISA - Enzyme linked immunoassay EN – Elizabeth Neale EPA - Eicosapentaenoic acid FR – Food record FSANZ – Food Standards Australia and New Zealand FTO - Fat mass and obesity-associated gene HDL – High density lipoprotein HMW – High molecular weight IQR – Interquartile range LC n-3 PUFA – Long chain omega-3 polyunsaturated fatty acids LDL – Low density lipoprotein LT – Linda Tapsell MJ - Megajoule 6 n-6 PUFA – Omega-6 polyunsaturated fatty acids NFS – Not further specified NHMRC – National Health and Medical Research Council NNS – National nutrition survey NS – Not specified NUTTAB - NUTrient Data TABle for Use in Australia PPAR - Peroxisome proliferator-activated receptor RCT – Randomised controlled trial SD – Standard deviation SNP – Single nucleotide polymorphism SPSS – Statistical Package for Social Sciences SREBP - Sterol regulatory element binding protein TNF-α – Tumour necrosis factor-alpha USDA – United States Department of Agriculture VLDL – Very low density lipoprotein 7 GLOSSARY OF TERMS Adipocyte – A fat storage cell which makes up adipose tissue Adiponectin – a hormone secreted by fat cells with anti-inflammatory, insulin sensitising and anti-obesity effects BHEeP study – a six week dietary intervention comparing the impact of fish and LC n- 3 PUFA supplement consumption, carried out at the Smart Foods Centre, University of Wollongong Biomarker – biological samples which can be measured objectively to provide information on normal biological or pathological processes. Biomarkers are often used in nutrition as indictors of dietary intake or of the biological responses to dietary interventions Effectiveness – the likely outcome of an intervention in the ‘free-living’ environment, taking into account factors such as long-term adherence and participant satisfaction with the intervention Efficacy – the impact of an intervention (for example dietary change) under ideal or experimental conditions ELISA – a type of analytical biochemistry assay which allows for the measurement of the presence of an antigen in a sample Food synergy – the concept that a whole food has greater value than its single constituent nutrients LC n-3 PUFA supplements – dietary supplements containing the marine LC n-3 PUFA EPA and DHA, also known as fish oil 8 Metabolic health – a general term for a state of health encompassing metabolic domains, for example weight management, insulin sensitivity and blood pressure and lipids within set parameters Metabolic Syndrome – a condition defined as a cluster of risk factors for cardiovascular disease and type II diabetes, including abdominal obesity, raised blood pressure, insulin resistance and dyslipidaemia Smart study – a 12 month dietary randomised controlled trial examining the impact of LC n-3 PUFA consumption on weight loss, carried out at the Smart Foods Centre, University of Wollongong SNPs - nucleotide alterations in the DNA sequence of a gene which occur in more than 1% of the population and can result in substantial variations in the functioning of a gene 9 PUBLICATIONS Peer-reviewed publications 1. Neale EP, Probst YC, Batterham, MJ, Tapsell, LC. Development and validation of an Australian database for estimating the seafood content in canned products. Food and Nutrition Sciences. 2011; 2: 759 - 763 2. Neale EP, Nolan DJ, Probst YC, Batterham MJ, Tapsell LC. Comparing attitudes to fish consumption between clinical trial participants and non-trial participants. Nutrition and Dietetics. 2012; 69: 124 - 129 3. Neale EP, Probst YC, Thorne R, Zhang Q, O’Shea J, Batterham MJ, Tapsell LC. Conversion of Australian food composition data from AUSNUT1999 to 2007 in the clinical trial context. Journal of Food Science and Engineering. 2012; 2: 65 - 71 4. Neale EP, Cossey A, Probst YC, Batterham MJ, Tapsell LC. Effectiveness of dietary advice to increase fish consumption over a 12 month period. Food and Nutrition Sciences. 2012; 3: 455 - 460 Manuscripts in preparation 1. Neale EP, Muhlhausler B, Probst YC, Batterham MJ, Fernandez F, Tapsell LC. Short-term effects of fish and fish oil consumption on total and high molecular weight adiponectin levels in overweight adults (in preparation) 10 Abstracts 1. Neale E, Tapsell L, Batterham M. Relationship between habitual fish consumption and markers of the metabolic syndrome in a sample of overweight volunteers for a dietary intervention. World Congress on Oils and Fats and 28th ISF Congress, Sydney. 2009 (oral presentation) 2. Neale EP, Tapsell LC, Batterham MJ & Charlton KE. Baseline fish consumption patterns in overweight volunteers participating in a trial examining dietary fat and weight loss. Australasian Medical Journal. 2010; 1 (1): 61(oral presentation) 3. Neale E, Tapsell L, Probst Y, Batterham M. Baseline relationships between fish intakes and metabolic profiles appear different for male and female participants in a dietary intervention trial. Proceedings of the 28th National Dietitians of Australia Conference, Melbourne. Nutrition and Dietetics. 2010; 67 (S1): 52-52 (poster presentation) 4. Neale E, Nolan-Clark D, Tapsell L, Probst Y, Batterham M. Motivators and barriers to fish and seafood consumption within participants of a clinical weight loss trial and university staff members. International Seafood and Health Conference, Melbourne. 2010 (oral presentation) 5. Neale E, Cossey A, Tapsell L, Probst Y, Batterham M.