A Southampton-led study has shown customers bought healthier foods with a new supermarket layout. Dr Christina Vogel and Prof Janis Baird led the study, in partnership with the national supermarket chain Iceland Foods Ltd. Promoting healthy choices The new layout positioned an expanded fruit and vegetables section near the entrance. They also removed sweets and chocolate from checkouts and at the end of the opposite aisles, replacing these with non-food items and water. They monitored store sales in a selection of Iceland stores in England, as well as the purchasing and dietary patterns of a sample of regular customers. They found the new layout prompted customers to make healthier food purchases, with more fruit and vegetables. The study results are published in the open-access journal PLOS Medicine. When talking about the results of the study, Dr Vogel said: “Altering the layouts of supermarkets could help people make healthier food choices and shift population diet towards the government’s dietary recommendations." "The findings of our study suggest that a healthier store layout could lead to nearly 10,000 extra portions of fruit and vegetables and approximately 1,500 fewer portions of confectionery being sold on a weekly basis in each store.” Informing UK government decisions This research is more comprehensive than previous studies testing whether placement strategies can promote healthier food purchasing, which have been limited in scope, for example including only a single location (i.e. checkouts) or placing healthy and unhealthy products together. This study went further, aiming to reduce customers exposure to calorie opportunities by placing non-food items at checkouts and the ends of the opposite aisles and measuring effects on store sales, customer loyalty card purchasing patterns and the diets of more than one household member. Matt Downes, Head of Format Development at Iceland, said: “We have been pleased to support this long-term study and the evaluation of how product placement in supermarkets can affect the diets of our customers. We know that childhood obesity is a growing issue and the retail industry has its part to play in tackling this. We hope that the outcomes of the study provide insights for the wider retail industry and policy makers about the impact of store merchandising on purchasing decisions.” Prof Baird added: “These results provide novel evidence to suggest that the intended UK government ban on prominent placement of unhealthy foods across retail outlets could be beneficial for population diet, and that effects may be further enhanced if requirements for a produce section near supermarket entrances were incorporated into the regulation."

A world-first trial has shown that nose drops of modified 'friendly' bacteria protect against meningitis. Led by Professor Robert Read and Dr Jay Laver from the NIHR Southampton Biomedical Research Centre, the work is the first of its kind. Together they inserted a gene into a harmless type of a bacteria, that allows it to remain in the nose and trigger an immune response. They then introduced these bacteria into the noses of healthy volunteers via nose drops. The results showed a strong immune response against bacteria that cause meningitis. Published in Science Translational Medicine, those data also show long-lasting protection. Protecting against meningitis Meningitis occurs in people of all age groups but affects mainly infants, young children and the elderly. Meningococcal meningitis, is a bacterial form of the disease, causing 1,500 cases a year in the UK. It can lead to death in as little as four hours after symptoms start. Around 10% of adults carry N. meningitidis in the back of their nose and throat with no signs or symptoms. However, in some people it can invade the bloodstream. That can lead to life-threatening conditions including meningitis and blood poisoning (‘septicaemia). The ‘friendly’ bacteria Neisseria lactamica (N. lactamica) also lives in some people’s noses naturally. By occupying the nose, it protects from a severe type of meningitis. It does so by denying a foothold to its close cousin Neisseria meningitidis (N. meningitidis). Enhanced immune response The new data build on the team's previous work aiming to exploit this natural phenomenon. That study showed nose drops of N. lactamica prevented N. meningitidis from settling in 60% of participants. For those people, N. lactamica had locked out its deadly cousin. That drove work to make N. lactamica even more effective in displacing N. meningitidis. The team did so by handing it one of N. meningitidis' key weapons; a 'sticky' surface protein that grips the cells lining the nose. By inserting a copy of the gene for this protein into N. lactamica's DNA, it could produce it too - levelling the playing field. As well as inducing a stronger immune response, those modified bacteria stayed longer. Present for at least 28 days, with most participants (86%) still carrying it at 90 days, it caused no adverse symptoms. The results of the study, which was funded by the Medical Research Council, are promising for this new way of preventing life-threatening infections, without drugs. It's an approach that could be critical in the face of growing antimicrobial resistance. Dr Jay Laver, Senior Research Fellow in Molecular Microbiology, commented: “Although this study has identified the potential of our recombinant N. lactamica technology for protecting people against meningococcal disease, the underlying platform technology has broader applications. “It is theoretically possible to express any antigen in our bacteria, which means we can potentially adapt them to combat a multitude of infections that enter the body through the upper respiratory tract. In addition to the delivery of vaccine antigens, advances in synthetic biology mean we might also use genetically modified bacteria to manufacture and deliver therapeutics molecules in the near future.” Prof Read, Director of the NIHR Southampton Biomedical Research Centre said: “This work has shown that it is possible to protect people from severe diseases by using nose drops containing genetically modified friendly bacteria. We think this is likely to be a very successful and popular way of protecting people against a range of diseases in the future.”

Researchers in Southampton are investigating a new early detection test for cancer, following the opening of a new trial. The SYMPLIFY study, supported by the National Institute for Health Research (NIHR) and launching at University Hospital Southampton NHS Foundation Trust (UHS), aims to demonstrate how a new multi-cancer early detection (MCED) test, known as Galleri, could be used to increase cancer detection rates and improve diagnostic pathways. Detecting cancer earlier Galleri is a blood test developed by healthcare company GRAIL that can detect over 50 different types of cancers with a low false positive rate of less than one percent. Over 47 of these cancer types lack recommended screening in the UK today. Using revolutionary next-generation sequencing technology, Galleri has the potential to identify multiple types of cancers at earlier stages of disease compared with traditional diagnostic methods, which should increase the chance of successful treatment and improve outcomes for patients. The study will recruit patients with early signs and symptoms that may be a result of cancer. Patients taking part in the study will have their diagnostic tests in the normal way, but they will also have a Galleri blood sample taken and give permission for their health records to be checked to see if they were later diagnosed with cancer. Transforming cancer diagnosis The SYMPLIFY study is one of the UK-based clinical trials that GRAIL is supporting, alongside the recently announced NHS-Galleri trial, which is evaluating the Galleri test in primary care settings. Successful results may see this technology radically revolutionising how cancer is identified in the future. The study, sponsored by the University of Oxford and funded by GRAIL, hopes to have recruited around 6,000 participants by the end of October 2021. Other local sites include Basingstoke, Bournemouth, Dorchester, the Isle of Wight, Poole and Winchester. Mr Zaed Hamady, Consultant General Surgeon at UHS and local lead for the trial, said: “We are pleased to be able to offer patients in Southampton the opportunity to take part in this landmark trial, which could help transform the way that some cancers are diagnosed in the future. By diagnosing cancers earlier, we hope to improve outcomes for people affected by cancer and ultimately save lives.”

Southampton researchers are looking for pregnant volunteers to join a study investigating how ‘good bacteria’ may protect babies from meningitis and other infections. A team of scientists, led by Dr Anastasia Theodosiou, will give nose drops containing Neisseria lactamica to pregnant women and see if it can be detected in the nose or mouth of their babies after birth. The research will build understanding of how bacteria move from mothers to their babies. ‘Good’ vs ‘bad’ bacteria Neisseria lactamica is a type of ‘good bacteria’ that is harmless and is found in over 40% of one- to two-year-old children, but is uncommon in newborns and adults. It can prevent the ‘bad bacteria’ Neisseria meningitidis, which sometimes causes pneumonia and meningitis, from living in the nose and throat. Eventually, the researchers want to find out if bacterial nose drops given in pregnancy can prevent infections in newborn babies. They have tested these nose drops in over 400 healthy adults; they are safe and effective (they decrease Neisseria meningitidis in the nose and throat). Taking part The study involves five research visits (from 34 weeks pregnant until one month after birth) at University Hospital Southampton or in your own home. Nose, throat and saliva swabs will be collected from you, and nose and saliva swabs from your baby. You will receive up to £100 compensation for your time and the inconvenience. For more information, please contact the study team at uhs.recruitmentCRF@nhs.net or call 023 8120 4989 and ask about the Lactamica 9 study.

Southampton researchers have found that the antibiotic amoxicillin is only slightly more effective at treating chest infections in children than taking no medication. The largest trial of amoxicillin in children identified only a small difference in the length of symptoms. The findings, published in The Lancet, have prompted further warnings about the overuse of antibiotics in primary care. The NIHR-funded study was led by researchers from Southampton. It was supported by centres at the Universities of Bristol, Oxford and Cardiff. Small difference in symptoms Chest infections in children are one of the most common acute illnesses treated in primary care in developed countries. Research in adults has shown that antibiotics are not effective for uncomplicated chest infections. Until now, there has not been the same level of research in children. The new trial recruited 432 children aged six months to twelve years old with acute uncomplicated chest infections from primary care practices in England and Wales. Participants were randomly assigned to receive either amoxicillin or a placebo three times a day for seven days. Children given the placebo had symptoms that were rated moderately bad or worse for around six days on average after seeing the doctor, and those given antibiotics got better only 13 percent quicker. Increasing antibiotic resistance Just four children in the placebo group and five in the antibiotic group required further assessment at hospital. The costs to parents, such as the time needed to be off work or the cost of over-the-counter remedies, was very similar in both groups. Paul Little, Professor of Primary Care Research at the University of Southampton and the study’s lead author, said: “Children given amoxicillin for chest infections where the doctor does not think the child has pneumonia do not recover much more quickly. Indeed, using amoxicillin to treat chest infections in children not suspected of having pneumonia is not likely to help and could be harmful. “Overuse of antibiotics, which is dominated by prescribing of antibiotics in primary care, particularly when they are ineffective, can lead to side effects and the development of antibiotic resistance. Antibiotic resistance is one of the biggest threats to the health of the public, and in future could make much of what is currently routine medical practice very difficult or impossible - such having surgical operations or supporting people who are being treated for cancer.”

Southampton researchers are exploring the effects of antioxidant supplements on the immune system A new study is recruiting healthy volunteers in the Southampton area to assess two different supplements on 50- to 65-year-old adults. The research, led by Dr Caroline Childs, will shine new light on the immune system, metabolism and gut bacteria. The findings will join Southampton’s wider nutrition research as it helps people make healthier life choices and prevent diseases. Healthy and balanced diets Though currently dietary guidelines advise eating five portions of fruits and vegetables per day, recent surveys reveal that fewer than 30% of adults achieve this. Taxifolin and Ergothioneine are antioxidants that are found in foods such as apples, onions, and mushrooms. In this study these will be provided in capsules that are suitable for vegetarians and vegans. Dr Childs, Lecturer in Nutritional Sciences at the University of Southampton, said: “Antioxidants found within fruits and vegetables are understood to be one of the important aspects by which our diet can influence health. It is important to investigate the effects of such antioxidants through well-designed and conducted human trials.” Complex immune function The immune system is highly responsive to environmental influences, including the diet. Our diets provide the energy required to mount a strong and protective immune response. They can also indirectly affect immune function through changes in the gut microbiome. Immune function varies across a lifetime. It is well understood to decline with age. This results in reduced vaccination responses and an increased risk from common diseases such as influenza. Impaired immunity with ageing is known as immunosenescence. This latest study will specifically assess immune function in healthy adults aged 50-65 years old. Healthy volunteers needed Researchers will use a variety of samples to assess the volunteers’ immune systems and any changes in gut bacteria. Participants will be reimbursed for their time in the study and for reasonable local travel expenses. They will also be invited to an event at the end of the study to hear the findings. If you are interested in taking part or finding out more about what is involved in the study, please contact the study team at taxer@soton.ac.uk, 07553 718907 or click here to register your interest.

Professor Keith Godfrey has urged the Government to place children’s health “at the heart of new policies” as part of a major early years health report. The Southampton NIHR BRC Theme Lead for Nutrition, Lifestyle & Metabolism is one of several key contributors to The Health and Wellbeing of Children in the Early Years report. The report, published by The Children’s Alliance, identifies nutrition as a significant area for the Government to reverse what it describes as serious decline in the health and wellbeing of children in the UK. It is estimated that over 8.4 million in the UK have limited access to healthy food choices. Millions of children under four years do not meet the dietary standard of eating at least five portions of fruit and vegetables per day. Worsened by COVID-19 The report says the impact of COVID-19 has worsened the food security challenge already affecting UK children. It highlights a rise in nutritional problems linked with food insecurity such as under-nourishment, nutrient deficiencies and mental health problems such as anxiety, low self-worth, and depression. Statistics show that 14% of families with children in the UK experienced food insecurity during the first six months of the pandemic as opposed to 11.5% beforehand. The earlier the better It is hoped that by paying greater attention to children’s nutrition from early years, the UK Government can improve future health and wellbeing, avoiding ill-health in later years. As part of its recommendations, the report calls for a national strategy dedicated to improving preconception, pregnancy and post-natal diets and the feeding of infants and young children. Professor Godfrey said: “A child’s early years are critical in how their future is shaped. This report brings together a range of evidence to document the challenges and inequalities that our children face. We must ensure that children and their future children are placed at the heart of new policies that will make a real and positive impact on their lives.” The Children’s Alliance report included contributions from 31 academics, voluntary sector and childcare professionals.

A Southampton dietitian has been honoured with a research impact award for her novel work to support babies with congenital heart disease (CHD). Luise Marino has spearheaded a team of doctors and researchers at Southampton Children’s Hospital who developed an effective ‘nutrition pathway’. The guidance improves infant growth and reduces time spent in intensive care for babies who undergo major heart surgery. Dr Marino is the research impact winner of the Chief Allied Health Professions Officer (CAHPO) Awards 2021. Supporting babies with heart disease Around 4,000 babies a year in the UK are born with CHD and many need more than one heart operation during the first year of life. Most of these babies have a normal weight at birth but suffer from poor growth in the coming months. This can increase the risk of complications following surgery. There is currently no standard guidance or information available on how to improve growth for babies with CHD in the months leading up to surgery. Southampton researchers have developed and trialled a new way of supporting babies pre-surgery. This included introducing a weekly dietitian review and a nutrient-packed formula. The Southampton team have produced a series of recipe books funded by Southampton Hospital Charity. The books are widely used by healthcare workers and parents in the UK, as well as Australia, New Zealand and South Africa. They are currently being translated into Portuguese for use in Brazil and in China. Pathway to positive outcomes To date, the team have supported around 500 infants using the pathway. They have also helped other centres adapt their own pathways, such as Great Ormond Street Children’s Hospital. The results of the NIHR-funded work, published in the journal Clinical Nutrition, showed babies on this nutrition pathway had grown better by their first birthday compared to past patients. The number of babies who failed to grow well was reduced by 14% and they spent an average 10 days less in intensive care. Parents also reported feeling supported, informed and able to seek help for feeding problems. In the last NHS England Paediatric Cardiology review the pathway was recognised as an exemplar of good practice. ‘Massive team effort’ This autumn’s CAHPO research impact prize was awarded by the National Institute for Health Research (NIHR), Clinical Research Network and Council for Allied Health Professions Research. The success follows the British Dietetic Association (BDA) Dame Barbara Clayton Award in 2020. Dr Marino said: “This is a massive team effort and would not be possible without input from UHS R&D, SoAR, NIHR Academy, co-authors, collaborators, health care professionals at Southampton Children’s Hospital and the BDA Paediatric Cardiology Interest Group. Lastly, I would like to thank all of the parents for their time and invaluable contributions. “We hope the results to date will be replicated to enable this model to be rolled out nationally and, potentially, internationally.” Image at top: Dr Luise Marino (top left) launches a recipe book for infants with congenital heart disease.

New research with cancer patients has shown being fit before surgery influences outcomes more than muscle-wastage associated with cancer treatments. The study assessed patients with cancer of the upper gastrointestinal tract, which runs from the mouth to the top of the small intestine. It found that physical fitness before surgery is a key factor in survival. This adds support for the existing Fit-4-Surgery programme running in Southampton, where cancer patients are enrolled in research studies investigating the utility of tailored exercise programmes before surgery. Is the patient fit enough? Overall, 160 patients with upper gastrointestinal cancer took part. They were all undergoing chemotherapy or chemoradiotherapy and surgery as part of their treatment. The research team analysed the results of cardiopulmonary exercise tests – a measure of fitness – for 100 of these patients. They found fitness before starting any treatment was an indicator of how well the patient recovered from surgery. There was an association between poor fitness and survival a year after the operation. By comparing CT scans before and after chemotherapy, the researchers also found a reduction in chest wall muscle structure and function was associated with a lower chance of survival. Their results are published in NIHR Open Research and more the Journal of Surgical Oncology. Southampton’s Mr Malcolm West, who was part of the research team, says this shows doctors should consider whether patients are fit enough to withstand the known drop in fitness caused by cancer treatments before recommending these treatments or surgery. What is Fit-4-Surgery? The Fit-4-Surgery programme, led by our critical care research team, offers ‘prehabilitation’ for cancer patients. Prehabilitation is like rehabilitation, in that it helps patients recover from surgery - but instead of happening after their operation, prehabilitation happens before. They are trialling specific multimodality programmes that include exercise, nutrition and psychology interventions in the run up to surgery, as well as a ‘surgery school’, to improve outcomes through the Fit-4-Surgery programme. If found to be suitable for patients with cancer of the upper gastrointestinal tract, this could help to increase their fitness and improve outcomes from surgery.

Southampton researchers are looking for healthy people between 40 and 75 years of age to take part in a study seeking to improve care for those with chronic obstructive pulmonary disease (COPD). It aims to better understand the disease to inform new treatments. Fighting lung disease COPD is a chronic lung condition which affects around three million people in the UK, causing coughing, wheezing and breathing difficulties. It is made worse – often life threatening – by infections and illness. The Microbiology & Immunology of the Chronically-Inflamed Airway II (MICA II) study aims to enhance our understanding of the role of small airways disease in COPD exacerbations, by comparing people with COPD and those who have no diagnosed lung conditions. It forms part of our wider programme of COPD research, all aimed at improving care and quality of life for those with the condition. Taking part The COPD research team are keen to hear from healthy people interested in taking part in studies like MICA II, to contribute to better COPD care. Typically these studies involve a number of respiratory tests and assessments at University Hospital Southampton. We want to hear from you if you can spare the time for four to five visits and are: Aged 40 to 75 years and in good health Either an ex-smoker or current smoker Have no diagnosed respiratory conditions All travel expenses you incur will be remunerated, together with payment for your time. To find out more, please email Elisabeth Marouzet at elisabeth.marouzet@uhs.nhs.uk or Alex Kong at alex.kong@uhs.nhs.uk, or call us on 023 8120 4479.

Southampton researchers are calling for more studies into the effect of nutrition during adolescence. In a series of papers published in the Lancet, the nutrition experts also encourage greater involvement from young people in driving health policy in the UK and internationally. Adolescence is a time of rapid changes. Nutrition has a formative role in the timing and pattern of puberty, with consequences for adult height, muscle, and fat mass. It is also a factor for the risk of non-communicable diseases in later life. Research has shown that the lifestyle choices teenagers make can have an effect of the health of their future children. A neglected age group The Lancet series underlines the effect of nutrition on adolescent growth and development. It discusses the role the food environment has on food choices and which strategies and interventions might lead to healthy adolescent nutrition and growth. Professor Mary Barker, Professor of Psychology and Behavioural Science at the University of Southampton, said: “There has been a lot of emphasis on early childhood nutrition research and rightly so. However, adolescence is an additional important phase of life that has direct consequences on health in later life and the health of their children. “Yet this important age group is neglected in national and global policies that aim to improve health and wellbeing.” Drivers for food choices The first paper in the series was led by Professor Shane Norris with Professor Caroline Fall and Dr Kate Ward. It examines the context for the current generation of teenagers during their “nutrition-sensitive phase for growth”. The second paper provides large analysis of pooled qualitative data on the drivers of young people’s food choices. The data is drawn from studies in eight settings around the world. The paper reflects on how teenagers have a lot to say about why they eat what they eat, and therefore must be active partners in shaping local and global actions that support healthy eating patterns. The findings included contributions from Southampton’s Drs Polly Hardy-Johnson, Sofia Strommer and Susie Weller with Professor Barker.

Having contracted COVID-19 is early 2020, and unable to shake off symptoms, Dr Nisreen Alwan found her interest in long-COVID becoming both personal and professional. “People were posting on social media that they were having similar experiences but it wasn’t being talked about by policy makers. No-one was defining it or counting it,” she says. It prompted Nisreen to write an article on the topic in the British Medical Journal, followed by articles for science and medical journals such as Nature and The Lancet. She started a social media campaign #countinglongcovid to continue to raise awareness of the need for countries to measure and address not only mortality, but long-term ill health from the virus. “Policy decisions were being made without taking account of morbidity. The focus was on overloading the NHS, hospitalisations and death, so people who were not classed as high risk, but who were not recovering, were not counted anywhere. We needed to know the size of the problem in terms of productivity, long-term recovery and impact on health care use so that we could make appropriate public health and policy decisions,” says Nisreen. National recognition for pandemic response Her efforts have paid off. In addition to raising global awareness of the problem, as part of a group of experts, she persuaded the All Parliamentary Group on Coronavirus to include the need to count long-COVID as one of its demands to government. The Office for National Statistics has similarly taken the issue onboard, providing monthly updates on counting long-COVID, and the UK is now leading on trying to estimate the ongoing burden caused by the virus. In recognition of her campaigning and her work on the Southampton Saliva Testing Programme, Nisreen received an MBE and was heralded as one of BBC’s 100 Women of 2020, alongside the likes of Sanna Marin, the Prime Minister of Finland, NASA astronaut Kathy Sullivan, and British vaccinologist Professor Sarah Gilbert. “The massive achievements of those women is really inspirational and to be counted among them was amazing. Both awards felt like a very big honour,” Nisreen says. A passion for women and ethnic minorities Nisreen is an Associate Professor in Public Health at the University of Southampton and an Honorary Consultant in Public Health at University Hospital Southampton NHS Foundation Trust. She is a key researcher in the Nutrition, Lifestyle and Metabolism theme for the NIHR Southampton Biomedical Research Centre. Part of her current research focuses on the link between long-COVID and social and demographic inequalities. This feeds into her passion for supporting women and ethnic minorities. “I saw common themes in terms of recognition of less well-known conditions like long-COVID and around inequalities for women and ethnic minorities. If people’s experiences are not understood, the tendency is to ignore them,” she says. Nisreen also leads an intersectionality mentoring scheme, focused on supporting women from ethnic minorities in their career in medicine. Under the scheme, Southampton will work with other medical schools to provide mentoring scheme for this cohort across the UK. Meanwhile, Nisreen’s other research interests continue. She is conducting work around the prevention of childhood obesity, and undertaking a project looking at the indirect effect of the pandemic on the food security of families with young children. Far from easing up post-COVID, there’s little space to be found on the desk of this award-winning scientist. Nisreen was speaking to Hartley News, the University of Southampton Alumni and Supporter Magazine.