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The incidence of paediatric coeliac disease (CD) is rising globally. It is uncertain whether this is attributed to improved case ascertainment or signifies a true rise in numbers. Geographical variation in incidence has also been reported in some European countries, although it is not known whether regional differences present in Scotland. Furthermore, data on the management of children diagnosed with CD in Scotland is lacking. The cornerstone of CD treatment is a strict gluten-free diet (GFD). Adherence may reduce risk of future complications including osteoporosis, malignancy and fertility difficulties. Nonetheless, the GFD is known to be particularly challenging during adolescence and may be nutritionally inadequate. Limited adolescent research addresses factors associated with adherence to the GFD, the diet’s nutritional quality or effect on health-related quality of life (HRQoL). Retrospective longitudinal and prospective regional trends in age-sex standardised incidence of childhood CD (≤16 years) in Scotland were determined. Data on case presentation, reasons for diagnosis and the management of newly diagnosed children were collected. A cross-sectional study was undertaken to identify adherence to the GFD in Scottish adolescents with CD (11-18 years) using a short validated questionnaire. A further questionnaire was developed to identify factors associated with adherence to the GFD. Teenagers’ energy and nutrient intakes were compared to Dietary Reference Values (DRVs) and a healthy, age-matched control group. Generic and disease-specific HRQoL indices were compared between adherent teenagers, non-adherent teenagers and age-matched controls. The incidence of paediatric CD in Scotland between 01.09.09 and 31.08.10 was 10.0/100,000/yr. Incidence in the East was 16.3, West 8.1 and North 7.7. More than twice the incidence of cases were diagnosed due to active screening in the East (4.6) compared to the West (2.0) and North (1.3), as was the incidence of classical cases. Significantly more CD diagnostic antibody tests were performed per head of population in the East compared to the West (OR 1.65, 95% CI 1.57-1.73) and North (OR 1.81 95% CI 1.70-1.92). The incidence of childhood CD rose from 1.8 (95% CI 1.1-2.7) to 11.7 (95% CI 9.8-13.9) per 100,000 from 1990-1994 to 2005-2009, respectively (p<0.0001). The incidence of non-classical and actively screened cases increased 1467% (p<0.05) and 1100% (p<0.001) from 1990-1999 to 2000-2009, respectively. A significant rise in the incidence of Oslo classical cases from 1.51 (95% CI 0.91-2.38) in 1990-1994 to 5.22 (95% CI 3.98-6.75) in 2005-2009 (p<0.01) remained. A number of differences in the dietetic management of newly diagnosed children were observed between a regional (multidisciplinary team) and a district general (dietetic-led) clinic. Differences in the management of dietary concerns as well as the type of education and resources provided were reported. Sixteen participants were categorised as non-adherent to the GFD in the adolescent study (41%; 0/7 boys, 16/32 girls). Male gender, being a member of a CD support group, ability to follow a GFD on holiday, when traveling and at social and special events were associated with better adherence to the GFD (p<0.05). Never checking food labels was associated with poorer adherence. Compared to controls, boys and girls with CD had higher median energy intakes (p<0.05). Mean percentage energy intake from protein, saturated fat and non-milk extrinsic sugar was significantly higher in the CD group compared to controls and DRVs (p<0.05). Ten (34%) girls with CD II had estimated iron intakes below the Lower Reference Nutrient Intake (LRNI). This was not significantly different compared to NDNS data (44% <LRNI) (p>0.05). Adherent adolescents had significantly better generic HRQoL scores for the domains ‘physical health’ and ‘self perception’ compared to non-adherent teenagers and controls (p<0.05). Evidence of more actively screened cases and more antibody tests performed in the East suggests the higher incidence observed may be due to a lower threshold to test. An environmental influence cannot be dismissed since more classic cases were also captured. The incidence of pediatric CD increased 6.4-fold over the 20 years studied. This rise is significant for classic CD, indicating a true rise in incidence. Further research is needed to highlight the role of exogenous factors in CD development and whether differences in management affect disease outcomes. A number of factors appear to be associated with adherence to the GFD in Scottish adolescents and dietary intakes were of concern regarding the distribution from different macronutrients. The results imply that HRQoL should be monitored alongside adherence in this population. Further studies are required to identify independent predictors of adherence, the nutritional status of teenagers following a GFD and to ascertain whether poor HRQoL is a cause or effect of non-adherence.

Polyphenols are phytochemicals widely available in plants. Dark chocolate (DC) is a high source of polyphenols, particularly flavanols. Studies previously reported a beneficial effect of polyphenol-rich dark chocolate (PRDC) on insulin sensitivity and oxidative stress, while its effects on blood pressure, serum lipid levels and inflammation remain unclear. In addition, a research area regarding the effect of PRDC on body weight control emerged recently. Two investigations were carried out. Study I (61 participants) looked at the effect of PRDC on insulin sensitivity in normal weight and overweight adults, while Study II (14 participants) investigated the effect of PRDC on body weight in overweight individuals. Volunteers received 20g of either PRDC (500mg of polyphenols) or placebo DC (low in polyphenols) daily for 4 weeks (Study I) or 12 weeks (Study II). Anthropometric measures and blood, saliva and urine samples were taken. Results showed that 4 weeks of PRDC supplementation decreased insulin levels (p<0.001) and HOMA-IR (p=0.003), and increased QUICKI (p<0.001), but had no significant impact on glucose levels (p=0.16). However, participants administered placebo DC showed an increase in insulin (p=0.014), HOMA-IR (p=0.003), TG (p= 0.008), glucose (p=0.041) and BMI (p=0.007) levels and a decrease in QUICKI (p=0.013). No significant changes in blood pressure, other serum lipid levels or glucocorticoid hormones were noted in both groups. In study II, there was an increase in BMI in the whole study population (p=0.046) with no significant difference between groups. Results indicate a potential implication of PRDC in the prevention of risk factors for cardiovascular diseases. Findings also highlight the detrimental effects of placebo DC, and propose the analysis of polyphenol content of different DC brands in the market. The increase in BMI and other markers only in the placebo group after four weeks, suggests that PRDC may counteract the adverse effects of fat and energy in the diet. However, the increase in BMI in both groups after 12 weeks implies further investigations to test the counteracting effect of PRDC over the long term.

Introduction: Scotland has an ageing population which has significant implications for health and social care services. Encouraging older people to engage in healthy lifestyle behaviours has the potential to maintain a person’s functional ability, increase healthy life years and thus has the potential to enable older people to live at home independently for longer. Recommendations for levels of activity have been produced for older adults but whether these are being achieved is currently unknown. Levels of activity are influenced by many factors including nutritional and functional status, dietary intake and fatigue but as yet the relationship between these parameters and habitual activity has not been established. Therefore the aims of this study were 1) to determine the relationship between levels of habitual activity and nutritional status, functional ability, dietary intake, and levels of fatigue in older adults and 2) to inform physical activity targets for the aging population. Methods: Older adults were recruited from a range of social and leisure facilities across central Scotland. Habitual activity was measured continuously for seven consecutive days using an activPALTM accelerometer. Nutritional status (BMI, waist circumference (WC), tricep skinfold and mid arm muscle circumference) was measured using ISAK methodology. Functional status (handgrip dynamometry, sit to stand (STS), six minute walk (6MW) and gait speed (m/s)) was measured along with dietary intake using a seven day unweighed diet diary. In addition levels of fatigue were measured using the Multi-dimensional Fatigue Inventory. Pearson’s correlation coefficient analysis was utilised to establish relationships between levels of habitual activity and markers of nutritional status, functional status and dietary intake. Spearman’s rho correlation analysis was utilised to establish the relationship between levels of habitual activity and levels of fatigue. Partial correlation analysis was used to establish the influence of age and gender on these relationships. Results: Forty four (21m, 23f) healthy older adults were recruited and completed the study. Participants were found to spend a mean±sd 551 ± 88 min in sedentary behaviour daily which equates to 61±10% awake time being sedentary. They took 8721 ± 3585 steps daily and spent 108±38 min stepping, 253±78 min standing and 1080±103 min sitting or lying each day. Percent time in sedentary behaviour was positively associated with BMI (r=.302, p=.049), WC (cm) (r=.302, p=.049), percent energy intake from fat (r=.535, p<.001) and saturated fat (r=.381, p=.011) and was negatively associated with 6MW (m) (r=-.445, p=.002) and % energy from non-milk extrinsic sugar (r=-.314, p=.038). Total weekly time in moderate intensity activity accumulated in blocks of at least 10 minutes was positively associated with 6MW (r=0.321, p=.041), daily protein intake (g) (r=.350, p=.025) and mean daily vitamin D intake (μg) (r=.404, p=.009) and was negatively associated with STS (r=-.321, p=.041). Age but not gender influenced the relationships. Conclusion: This is the first study to report objectively measured levels of sedentary behaviour where habitual activity was measured continuously over seven days and sedentary behaviour was considered during waking hours only in a Scottish older adult population. Recommendations for physical activity were not consistently met and there is therefore some indication that current recommendations for sedentary behaviour and physical activity should be reviewed. However activity cannot be considered in isolation as many factors influence this including nutritional status, functional status, dietary intake and levels of fatigue.

Good nutrition is essential for optimal growth and functional development in children. Research indicates that the preschool years are essential for encouraging children to develop a taste for healthy food. Scotland’s obesity rates are amongst the highest in the world, and in areas of low socio-economic status, obesity and related conditions are considered to be most prevalent. It is also widely reported that areas of deprivation are related to poor dietary intake. In 2004, Edinburgh Community Food Initiative (ECFI) was responsible for initiatives that were based on ECFI’s ‘provide and promote’ philosophy, combining health promotion activities with the provision of fresh fruit and vegetables to schools, child and family centres and community centres in the most disadvantaged communities of Edinburgh. Funding was acquired from the Big Lottery Fund to initiate a citywide health initiative in the nursery school setting called ‘the Pip Project’. The aim of this research was to identify dietary intake at baseline in pre-school children and their parents from council sector nurseries, and to observe changes in dietary intake and behaviour over a period of 20 months, comparing dietary intake of children and their parents from areas of lower socio-economic status who received the Pip project interventions to those from areas of higher socio-economic status, who did not. Dietary intake was recorded using a 5 day diet diary at three time points; prior to nursery school attendance (August 2005), at completion of year one (June 2006), and two months prior to leaving nursery (April 2007). A questionnaire was also completed to determine knowledge and dietary behaviour at baseline (August 2005) and at the end of the research period (April 2007). Baseline intake was compared to the National Diet and Nutrition Surveys for adults and for children aged 1.5 to 4.5 years, the Payne and Belton Edinburgh preschool dietary survey, the Food Standards Agency Low Income Diet and Nutrition Survey, and the standards devised by UK Scientific Advisory Committee for Nutrition (SACN). Results at baseline were comparable to results from other national surveys. Research indicated that all adults were aware of the 5 a day message and 80 % thought that 400 g was ‘just right’ or ‘not enough’. Adults, and particularly those from the lower SES group, had clear knowledge of what constituted one portion of fruit or vegetables and did not report any barriers to healthy eating, however at baseline fruit and vegetable intake was 260 g/d, which was significantly lower (p = < 0.05) than the recommended 400 g/d and intakes were significantly less (p = < 0.05) in the lower SES group (219.5 g/d compared with 297.5 g/d in the higher SES group). Minimal increase was seen in fruit and vegetable intake of adults from the lower SES group, who consumed significantly less (p = < 0.05) than adults from the higher SES group by the end of the 20 month research period; children from the lower SES increased their intake by 1 portion (82 g) per day but still consumed less than the children from the higher SES group by stage 3 (203 g/d compared to 253 g/d). At baseline, the diet was balanced for adults and children in terms of % energy from CHO and fat, but mean intakes of both NME sugar and saturated fat were greater than the recommended maximum intake of 11 % total food energy. Mean intake NME sugar in children was 17.9 %; intakes were greater in the higher SES group (19.5 % compared to 16.6 %). Mean intakes were also significantly greater (p = < 0.05) in the parents from the higher SES group (15.2 % compared to 11 %). Mean intakes of NME sugar in parents decreased in both groups over the 18-month duration of the study but mean intakes in children remained high throughout the research period. Saturated fat intakes increased in adults from both SES groups, but were higher in the lower SES group at all stages. There was no change in mean saturated fat intake over time in children from the higher SES group, but mean intake decreased in children from the lower SES group (from 16.2 % to 14.1 %). Mean intake of NSP increased in both parents and children, but remained below the recommended 18 g/d throughout the study. With the exception of iron, mean intakes of all micronutrients for parents were greater than the RNI in both groups. Iron intake was lower than the RNI (14.8 mg/d) at all stages. At baseline intakes were lowest in the lower SES group (9.3 mg/d compared to 11.4 mg/d); 11 participants consumed less than the LRNI (8 mg/d), eight of whom from the lower SES group (73 % of participants). Mean intakes increased in the lower SES group by 3.7 mg/d over the duration of the study but neither group reached the RNI at any stage. At baseline, children met the RNI for all micronutrients, and there were no significant differences between groups. Overall the diet of children, particularly from the lower SES group, improved over the duration of the study, although salt and NME sugar intake did not decrease over time. Further research is required to investigate the best methods to improve diet in families with young children, with particular emphasis on reducing % energy from NME sugar and saturated fat, reducing salt intake and increasing fruit, vegetable and NSP intake.

Background: Texture and energy density are two physical properties of foods known to impact on eating behaviour. For those with mastication and/or deglutition disorders; diets which have their texture altered are prescribed. Further these texture modified diets may be energy enriched in an effort to optimise the opportunity for individuals prescribed them to meet their required energy intakes. However there is insufficient evidence supporting this strategy. No well controlled studies have been conducted evaluating these alterations (made in line with clinical guidelines), which specifically investigates their impact on eating behaviour. As such despite their intention to facilitate food and energy intakes it is unknown if these diets are in fact fit for purpose. Objective: To investigate the effect of texture modification, and/or energy enrichment of a standard meal developed to meet current recommendations for meal provision in hospitals on appetite parameters and food and energy intakes at a single eating occasion, in healthy adults. Design: A single blind, randomised crossover within-subjects design, where on four occasions 33 healthy adults consumed a test meal at lunch until satiation (i.e. meal termination) was reached whilst rating their appetite parameters. The meal had its texture and/or energy density altered to compare the effects of food form and energy density on appetite and satiation. The quantity of meal consumed was calculated using a plate wastage method. Subsequent intakes were recorded in a food diary to determine the effect of the treatments on satiety and identify any evidence of energy compensation. Food (g) and energy intakes (kcal) consumed during the feeding session were analysed using repeated measures ANOVA. Results: Test meal energy intakes (kcal) were significantly higher with energy enrichment of both meals (standard texture (ST); 315 kcal and texture modified (TM); 303 kcal (p=0.001)). Area under the curve (AUC) did not differ between meals for hunger, fullness, or desire to eat however palatability was significantly reduced with texture modification. Regardless of the composition and quantity consumed at the test meal, post-meal energy and macronutrient intakes remained the same across all days. Evidence of partial energy compensation was revealed (15 % (ST) and 22% (TM)) thus energy intakes remained higher over the day for both (260 kcal and 225 kcal respectively) (p<0.05). Conclusions: Enriching a meal, suitable for provision in a hospital setting results in significantly greater energy content without impacting on rated palatability. In a well-controlled, healthy sample, this enriched meal was sufficient to increase energy intakes (kcal) at an individual eating occasion for both ST and TM meals without affecting absolute food intake (g) or appetite responses (between meals) at the testing session. Incomplete subsequent energy compensation resulted in daily energy intakes remaining significantly higher with consumption of the enriched meals. Thus energy enrichment at a single meal, appropriate for provision for patients requiring a “Texture C” diet appears to be a suitable method to optimise short term energy intakes, in a healthy sample not confounded by disease state. Further investigation into enrichment of these meals in a clinical setting is justified.

In the UK, dietary fibre intake is below the recommended level of 30 g/day. The manipulation of behavioural change is challenging, hence finding alternative ways to improve diet is important. The development of functional foods such as bread with added functional ingredients such as β-glucan and black tea may be more feasible and acceptable than changing to a new eating pattern. β-Glucan and black tea are often eaten separately, however there may be a food-matrix interaction between starch, protein (gluten), tea (poly)phenols and β-glucan when added together in a bread. We hypothesise that β-glucan and black tea will be digested slowly and display a blunted postprandial glycaemia. Some undigested residues will reach the colon, where it will be metabolised to short chain fatty acids (SCFA). SCFA, particularly propionate, have the potential to increase satiety by stimulating G protein receptors, however the effects on food intake need to be tested. This project described: i) development of a functional bread containing black tea, BT; β- glucan, βG; β-Glucan and black tea, βGBT) and compare it to normal white bread (WB) (study 1); ii) determination of bread palatability, perceived satiety and subsequent energy intake following ingestion (study 2); iii) determination of postprandial glucose and insulin responses, and appetite hormones (CCK, PYY and GLP-1) among healthy volunteers (study 3 – in vivo study). In study 1, the breads were developed and tested for starch functionality, antioxidant potential and in vitro fermentability mimicking human colonic fermentation. βG and βGBT breads reduced early (10-min) in vitro starch hydrolysis and this could be due to action of β-glucan that ‘protected’ some of the starch granules (microscopic study) against amylolysis. Digestion with α-amylase increased antioxidant potential and total (poly)phenols content of BT and βGBT breads compared with WB. In vitro propionate concentration did not increase significantly when fermented with β-glucan. High inter- individual variation was observed for individual SCFA production. The addition of black tea had no apparent effect on SCFA production. Study 2 is a randomised, crossover study design conducted in healthy volunteers. Breads were given as breakfast and perceived satiety (perceived fullness, hunger, satiety, desire to eat and prospective food intake) was measured postprandially for 3 h. Ad libitum lunch was given after 3 h and energy intake estimated. BT bread was the most acceptable among all breads. βG and βGBT breads showed adverse taste, texture and palatability but showed similar overall acceptability as WB and BT breads. Female subjects showed lower preference for taste, texture and palatability of βG and βGBT compared with WB. βG and βGBT had positive effects on perceived satiety as follows: 1) decreased hunger; 2) increased fullness; and 3) decreased desire to eat. However, eating βG and βGBT at breakfast did not reduce energy intake at lunch compared with WB. Study 3 was similar to study 2. Only βG bread showed significantly lower glucose TAUC0-180 min compared with BT and βGBT but has no apparent effect on insulin response. No significant changes were observed for CCK and GLP-1 responses for all breads. However, βG and βGBT showed lower PYY TAUC0-180 min compared with BT. In vitro starch hydrolysis did not correlate with in vivo postprandial glycaemic responses. In conclusion, these studies suggest that breads with β-glucan and/or black tea have positive effects on perceived satiety in vivo and show good overall acceptability. However, there is no clear evidence that they affect appetite regulation. Breads containing 7 g β- glucan per 50 g of available carbohydrate reduced in vivo glucose response without altering insulin responses. There was no additional effect of adding black tea together with β-glucan to bread on the in vivo postprandial glycaemic response. It is too early to generalise the results from in vitro batch fermentation and starch hydrolysis and this needs to be considered when planning future dietary interventions looking at both in vitro and in vivo studies. Overall this study concluded that adding soluble dietary fibre to bread is feasible in controlling glycaemic responses and may help increase daily dietary fibre intake.

Extreme physical exertion is commonly associated with acute physiological changes in immune variables known to disturb host defences. Likely induced by the production of stress hormones (e.g., cortisol), partaking in ultra-endurance events with accompanying physiological stressors (e.g., environmental extremes, sleep deprivation and compromised hydration and (or) nutritional status) may amplify stress hormone responses and compromise immune status to a greater extent. To date, research investigating the impact of extreme physical exertion (e.g., ultra-marathon events) on physiological variables is extremely limited. More recently, the potential use of probiotics with known immunomodulatory effects may be considered an appropriate nutritional strategy to improve host defences and minimise and (or) prevent sub-clinical or clinically significant outcomes in active populations.

Background: Black Africans in developed countries have a higher prevalence of diet-related chronic diseases. However, dietary and anthropometry data is limited, particularly on sub-groups such as Ghanaians in the UK. Objectives: To determine the habitual diet and body composition of first generation Ghanaian migrants, to validate a food frequency questionnaire specific for Ghanaians, find the ideal body image of Ghanaians and the body size most attractive to Ghanaian males and to conduct a nutrition intervention programme using the Black Churches as a setting. Methodology: Cross-sectional survey. Participants were volunteers and first generation Ghanaian migrant who were congregants of Black Churches in London (n=288). Information on dietary intake was obtained from multiple repeated 24-hour recalls in a sub-sample (n=68) of the survey participants. The food frequency questionnaire was developed using the most commonly reported foods and portion sizes, field tested, shortened and then validated with multiple 24hr recalls (n=68). Information was also collected on height, weight, waist circumference, waist to hip ratio and percentage body fat which was measured using a portable bioelectric impedance analyzer (n=212). Participants from London (n=45) and Ghana (n=79) completed questionnaires to collect information on their ideal size and other body-shape related questions using the Figure Rating Scale (FRS). The nutrition intervention programme (n=76) was developed with input from participants through focus groups and the Obesity Clinic at the London Metropolitan University. Participants were assigned to either the intervention or control group and information on socio-demography, dietary intake and anthropometric measurements were taken at baseline, 6 weeks and at 3 months to evaluate the effectiveness of the intervention programme. Results: Energy and the percentage energy from fat intake of Ghanaian migrants (1987 kcal, fat 35.3%) was similar to that of the host population (1972kcal, fat 35.4%) but carbohydrate and fibre intake was different (carbohydrate 50.1%, fibre 16.4g vs 48.1%, 13.9g) for migrant Ghanaians and host population respectively. Energy under-reporting was 31% for this survey and was associated with gender and body mass index. The food frequency questionnaire performed well relative to 7 multiple 24-hour recalls with correlations increasing after adjusting for energy (protein r= 0.71, fat r=0.69, carbohydrate r=0.54, fibre r=0.69). Participants were correctly classified in the same (34%) or adjacent quartile (54%) for most nutrients with only 3% to 9% of participants mis-classified into opposite quartiles. Bland-Altman plots were within limits of agreement for all the macro-nutrients. The prevalence of overweight and obesity was higher in female migrant Ghanaians using body mass index (67%) compared to the host population (58%) but prevalence was lower when percentage body fat was used (female 40%). There was a cultural shift in acceptability of overweight and obese body sizes and shapes among Ghanaians with 60% of Ghanaian males preferring Ghanaian females with a normal body size. The nutrition intervention programme was conducted over 6 weeks and changes were observed in energy (intervention - 250kcal vs -135kcal (NS)) and fat intake (intervention -3.8g (p=0.04) vs control -2.1g (NS). Waist circumference decreased by 2.2cm (p=0.05) for the intervention group after 6 weeks. After 3 months fat intake decreased by 7.3g (p=0.000) for the intervention group and 10.4g (p=0.04) for the control group. Changes in anthropometry still persisted after 3 months for body weight (-2.3kg, p=0.001), body mass index (-1.4kg/m², p=0.001) waist circumference (-3.3cm, p=0.04) and % body fat (-2.0%, p=0.01) for the intervention group. Changes in anthropometry were also observed in the control group for weight (-0.9kg, p=0.05), waist circumference (-1.9cm, p=0.006) and waist-hip ratio (-0.1, p=0.03). Conclusion: The dietary intake of Ghanaian migrants in the UK is similar to the host population. The food frequency questionnaire developed specifically for this population is an adequate dietary assessment tool. Ghanaian males preferred females with normal body sizes. The prevalence of overweight and obesity is higher in female migrant Ghanaians compared to the host population and the Black Churches are an effective setting for the delivery of nutrition intervention programmes.

Background: The prevalence of obesity is higher in adults with intellectual disabilities (ID) than in the general population, with increased rates of secondary health risks and increased mortality rates. Multi-component weight loss interventions have been advocated by current UK clinical guidelines for all adults without ID. Such interventions incorporate dietary changes that produce an energy deficit, increased levels of physical activity and the use of behavioural approaches to promote and sustain changes in physical activity and dietary patterns, followed by a weight maintenance intervention. However, UK clinical guidelines have reported that the evidence base for the treatment of obesity in adults with ID is minimal. New evidence in this area of research could be used for the development of accessible weight management interventions for adults with ID and lead to a sustainable clinically significant weight loss. Methods: Study 1: A systematic review aiming to evaluate the clinical effectiveness of weight management interventions in adults with ID and obesity using recommendations from current clinical guidelines for the management of obesity in adults. Full text papers published between 1982 to 2011 were sought by searching the Medline, Embase, PsycINFO and CINAHL databases. Studies were evaluated based on 1) intervention components, 2) methodology, 3) attrition rate 4) reported weight loss and 5) duration of follow up. The assessment of the quality of the studies and interventions was based on the criteria of the Centre for Reviews and Dissemination (CRD) (University of York) and the PRISMA checklist. Study 2: The evidence base for the development of weight maintenance interventions in adults with ID is limited. This study presents the findings of the second phase of a multi-component weight management programme for adults with ID and obesity (TAKE 5). A total of 31 completers of the 16 week weight loss intervention of the TAKE 5 programme were invited to participate in a 12 month weight maintenance intervention. The TAKE 5 weight maintenance intervention included monthly one to one sessions and monthly phone calls, using the recommendations of the Glasgow and Clyde Weight Management Service (GCWMS) and of the National Weight Control Registry. The intervention provided a dietary advice based on the estimated energy requirements of each participant, advice to improve physical activity and behavioural approach techniques to facilitate changes in physical and dietary patterns. Participants’ body weight, BMI, waist circumference (WC) and levels of physical activity were measured before and after the intervention. Paired t tests were used to assess differences in anthropometric and physical activity measurements. Study 3: 52 participants of the TAKE 5 weight loss programme were individually matched by baseline characteristics (gender, age and BMI) with two participants without ID of the GCWMS programme. Non parametric significance tests were used for comparisons between groups in terms of weight and BMI change and rate of weight loss. In addition, data from the 52 completers with ID of the TAKE 5 weight loss intervention were used to perform a univariate logistic regression analysis for the identification of socio-biological predictors for absolute weight loss and clinically significant weight loss at 16 weeks. Study 4: Semi-structured interviews were used to explore the experiences of 24 carers that supported participants of the TAKE 5 weight loss programme. The transcripts were analysed qualitatively using the qualitative data software analysis package, ATLAS ti 5.2 software. Thematic analysis was used to examine potential themes within data. Results: Study 1: Twenty two studies met the inclusion criteria. The interventions were classified according to inclusion of the following components: behaviour change alone, behaviour change plus physical activity, dietary advice or physical activity alone, dietary plus physical activity advice and multi-component (all three components). The majority of the studies had the same methodological limitations: no sample size justification, small heterogeneous samples, no information on randomisation methodologies. Eight studies were classified as multi-component interventions, of which one study used a 600 kilocalorie (2510 kilojoule) daily energy deficit diet. Study durations were mostly below the duration recommended in clinical guidelines and varied widely. No study included an exercise program promoting 225-300 minutes or more of moderate intensity physical activity per week but the majority of the studies used the same behaviour change techniques. Three studies reported clinically significant weight loss (≥ 5%) at six months post intervention. Study 2: 28 participants completed the TAKE 5 weight maintenance intervention. Most of the participants (50.4%) maintained their weight (mean weight change=-0.5kg; SD= 2.2) within ± 3% from initial body weight at the end of the weight maintenance intervention. There was no statistically significant change in BMI and WC at 12 months from BMI and WC at the end of the 16 week weight loss intervention. There was no statistically significant decrease in the time spent in sedentary behaviour and no statistically significant increase in the time spent in light and in moderate to vigorous physical activity. At the end of the weight maintenance intervention participants spent less days walking (at least 10 minutes) than at the end of the end of the weight loss intervention (P<0.05). Study 3: There were no significant differences between participants with ID and participants without ID in the amount of weight loss (median:-3.6 vs. -3.8, respectively, P=0.4), change in BMI (median: -1.5 vs. -1.4, P=0.9), success of achieving 5% weight loss (41.3% vs. 36.8%, P=0.9) and rate of weight loss across the 16 week intervention. Only, initial weight loss at four weeks was positively correlated with absolute weight loss at 16 weeks (P<0.05). Study 4: Three themes emerged from the analysis: Carers’ perceptions of participants’ health; barriers and facilitators to weight loss; and carers’ perceptions of the weight loss intervention. Data analysis showed similarities between the experiences reported by the carers who supported participants who lost weight and participants who did not. Lack of sufficient support from people from the internal and external environment of individuals with ID and poor communication among carers, were identified as being barriers to change. The need for accessible resources tailored to aid weight loss among adults with ID was also highlighted. Conclusions: Study 1: Weight management interventions in adults with ID differ from recommended practice and further studies to examine the effectiveness of multi-component weight management interventions for adults with ID and obesity are justified. Study 2: The TAKE 5 weight maintenance intervention can effectively support adults with ID maintain their weight. Assessment of the cost effectiveness of the TAKE 5 weight management programme is justified. Study 3: The TAKE 5 multi-component weight loss intervention in its current structure can be equally effective for adults with ID as in adults without ID and obesity. A study with a larger sample could facilitate the identification of sociological and biological predictors for weight loss in adults with ID. Study 4: This study identified specific facilitators and barriers experienced by carers during the process of supporting obese adults with ID to lose weight. Future research could utilise these findings to inform appropriate and effective weight management interventions for individuals with ID.