scholarly journals Nutrient composition of commercially available compared with prescription only gluten-free bread and flour mixes in England

2020 ◽  
Vol 79 (OCE2) ◽  
Author(s):  
Yvonne Jeanes ◽  
Rawan Rasheid ◽  
Camilla Hovland ◽  
Adele Costabile
Keyword(s):  
Calcium Intake ◽  
Saturated Fat ◽  
Calcium Content ◽  
Gluten Free ◽  
Bread Making ◽  
Nutritional Information ◽  
Increased Risk ◽  
Online Stores ◽  
The Uk ◽  
Nutrient Data

AbstractThere has been a global increase in gluten-free foods market and perceived health benefits are portrayed in the media. UK legislation requires wheat flour to be fortified with calcium, this is not the case for gluten-free (GF) flours. Calcium intake has been reported to be low in those consuming a GF diet. The only treatment for people with coeliac disease is a GF diet and they have a greater risk of osteoporosis. There is variable access to GF foods on prescription for this patient population in the UK. The study aimed to compare the nutrient profile of commercially available and prescribable GF breads and flour mixes.Nutrient data were collated from the nutritional information and ingredients lists from manufacturers and online stores; 122 GF breads and 17 GF flour mixes. White GF breads (n = 52), GF brown and multi-seeded GF breads (n = 70). Data collated from 17 GF flour mixes (12 white and 5 brown/wholemeal). Nutrient data from the nutritional information and ingredients lists were collated. Data is presented as mean ± standard deviation.The energy and macronutrient composition of commercially available (CA) compared with prescribable (P) white GF breads was similar. Fifty-three percent of prescribable GF white breads were fortified with calcium (8 out of15), whereas only 16 % of CA (6 out of 37). Calcium content were similar in fortified GF white breads (CA: 178 ± 91mg/100 g and P:181 ± 142mg/100 g; NS). Only 4 of the 12 white flour mixes, for bread making, were fortified with calcium. Commercially available brown and multi-seeded breads had significantly less saturated fat and sugar compared with prescribable (saturated fat: CA: 0.6 ± 0.3g/100 g and P: 0.9 ± 0.4g/100 g, p = 0.02; sugar: CA: 2.2 ± 2.3g/100 g and P: 3.8 ± 1.8g/100 g, p = 0.01). Sixty-seven percent of prescribable brown and multi-seeded breads were fortified with calcium (10 out of15), whereas only 13% of CA (7 out of 55) and calcium values were similar in those fortified (CA: 215 ± 178mg/100 g and P: 194 ± 136mg/100 g; NS).This study highlights an inadequate proportion of commercially available GF breads fortified with calcium. There is a need for more GF breads to have their calcium content presented within the nutritional information on the food labels to enable people following a gluten free diet to make informed decisions. We recommend mandatory calcium fortification of GF flours to improve calcium intake in a population with an increased risk of fractures.

scholarly journals Calcium, diet and fracture risk: a prospective study of 1898 incident fractures among 34 696 British women and men

2007 ◽  
Vol 10 (11) ◽  
pp. 1314-1320 ◽  
Author(s):  
Timothy J Key ◽  
Paul N Appleby ◽  
Elizabeth A Spencer ◽  
Andrew W Roddam ◽  
Rachel E Neale ◽  
...  
Keyword(s):  
Fracture Risk ◽  
Calcium Intake ◽  
Linear Trend ◽  
Dietary Calcium ◽  
Dietary Calcium Intake ◽  
Younger Women ◽  
Increased Risk ◽  
Outstanding Question ◽  
The Uk ◽  
A Prospective Study

AbstractObjectiveThe risk factors for fractures are incompletely understood. An outstanding question concerns the optimal amount of dietary calcium needed to minimise the risk of fracture.DesignWe examined the associations of dietary calcium and other nutrients with self-reported fracture risk in a prospective cohort study. Nutrient intakes were estimated using a semi-quantitative food-frequency questionnaire administered at recruitment.SettingThe UK.ParticipantsA total of 26 749 women and 7947 men aged 20–89 years.ResultsOver an average of 5.2 years of follow-up, 1555 women and 343 men reported one or more fractures, 72% of these resulting from a fall. Among women, fracture risk was higher at lower calcium intakes, with a relative risk of 1.75 (95% confidence interval (CI) 1.33–2.29) among women with a calcium intake of < 525 mg day− 1 compared with women with a calcium intake of at least 1200 mg day− 1 (test for linear trend, P < 0.001). The association of dietary calcium with fracture risk was stronger among women aged under 50 years at recruitment than among women aged 50 and above. Dietary calcium intake was not associated with fracture risk in men. Fracture risk was not related to the dietary intake of any other nutrient examined.ConclusionIn this population, women with a low dietary calcium intake had an increased risk of bone fracture, and this association was more marked among younger women than among older women.

scholarly journals Nutritional adequacy of meals from an independent catering facility versus chain restaurants for young adults

2017 ◽  
Vol 23 (1) ◽  
pp. 51-56 ◽  
Author(s):  
Charoula Konstantia Nikolaou ◽  
Catherine Ruth Hankey ◽  
Michael Ernest John Lean
Keyword(s):  
Young Adults ◽  
G Protein ◽  
Saturated Fat ◽  
Nutritional Content ◽  
Nutritional Adequacy ◽  
Nutritional Information ◽  
Prevalence Of Obesity ◽  
Eating Out ◽  
The Uk ◽  
One Way Anova

Background: Eating out of home has been associated with the increasing prevalence of obesity. While some chain restaurants provide nutritional information for their products, smaller independent catering facilities may not provide such information. The aim of this study was to assess the nutritional adequacy of meals provided to young adults at an independent catering facility and compare them with meals provided by chain restaurants. Methods: Meals were analysed in 2014 in the UK in relation of nutrient provision to targets for macro- and micro-nutrients. One-way ANOVA was performed to compare menus between the restaurants included in the analyses. Results: 2056 meal combinations were analysed, 210 from the student accommodation and 1,846 from five largest national chain restaurants. Mean (SD) nutritional content was: student accommodation: 1193(269)kcal, fat 52.0(22)g, saturated fat 24.5(14.5)g, protein 42.4(28.5)g, carbohydrate 117.0(30)g; chain restaurants: 922(160)kcal, fat 40.0(9.7)g, saturated fat 14.5(5.8)g, protein 31.2(6.5)g, carbohydrate 104.2(16.6)g. Meals from the student accommodation presented significantly more calories than the meals in all five chain restaurants ( p = 0.0015). Conclusions: Meal provision in the student accommodation was in excess of energy requirements and higher than the meals offered in chain restaurants. Regulating or setting nutritional standards for all places that provide food is essential as current food provision may favour unwanted weight gain and diet-related diseases.

scholarly journals Associations between dietary patterns and the incidence of total and fatal cardiovascular disease and all-cause mortality in 116,806 individuals from the UK Biobank: a prospective cohort study

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Min Gao ◽  
Susan A. Jebb ◽  
Paul Aveyard ◽  
Gina L. Ambrosini ◽  
Aurora Perez-Cornago ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Energy Density ◽  
Dietary Patterns ◽  
Dietary Pattern ◽  
Saturated Fat ◽  
Dietary Advice ◽  
Free Sugars ◽  
Linear Association ◽  
Increased Risk ◽  
All Cause Mortality

Abstract Background Traditionally, studies investigating diet and health associations have focused on single nutrients. However, key nutrients co-exist in many common foods, and studies focusing solely on individual nutrients may obscure their combined effects on cardiovascular disease (CVD) and all-cause mortality. We aimed to identify food-based dietary patterns which operate through excess energy intake and explain high variability in energy density, free sugars, saturated fat, and fiber intakes and to investigate their association with total and fatal CVD and all-cause mortality. Methods Detailed dietary data was collected using a 24-h online dietary assessment on two or more occasions (n = 116,806). We used reduced rank regression to derive dietary patterns explaining the maximum variance. Multivariable Cox-proportional hazards models were used to investigate prospective associations with all-cause mortality and fatal and non-fatal CVD. Results Over an average of 4.9 years of follow-up, 4245 cases of total CVD, 838 cases of fatal CVD, and 3629 cases of all-cause mortality occurred. Two dietary patterns were retained that jointly explained 63% of variation in energy density, free sugars, saturated fat, and fiber intakes in total. The main dietary pattern was characterized by high intakes of chocolate and confectionery, butter and low-fiber bread, and low intakes of fresh fruit and vegetables. There was a positive linear association between the dietary pattern and total CVD [hazard ratio (HR) per z-score 1.07, 95% confidence interval (CI) 1.04–1.09; HRtotal CVD 1.40, 95% CI 1.31–1.50, and HRall-cause mortality 1.37, 95% CI 1.27–1.47 in highest quintile]. A second dietary pattern was characterized by a higher intakes of sugar-sweetened beverages, fruit juice, and table sugar/preserves. There was a non-linear association with total CVD risk and all-cause mortality, with increased risk in the highest quintile [HRtotal CVD 1.14, 95% CI 1.07–1.22; HRall-cause mortality 1.11, 95% CI 1.03–1.19]. Conclusions We identified dietary patterns which are associated with increased risk of CVD and all-cause mortality. These results help identify specific foods and beverages which are major contributors to unhealthy dietary patterns and provide evidence to underpin food-based dietary advice to reduce health risks.

scholarly journals Socioeconomic Inequalities and Ethnicity Are Associated with a Positive COVID-19 Test among Cancer Patients in the UK Biobank Cohort

Cancers ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 1514
Author(s):  
Shing Fung Lee ◽  
Maja Nikšić ◽  
Bernard Rachet ◽  
Maria-Jose Sanchez ◽  
Miguel Angel Luque-Fernandez
Keyword(s):  
Cancer Patients ◽  
Socioeconomic Inequalities ◽  
Uk Biobank ◽  
Incident Cancer ◽  
Increased Risk ◽  
Exposure Variable ◽  
Independent Risk Factors ◽  
The Uk ◽  
Deprived Areas

We explored the role of socioeconomic inequalities in COVID-19 incidence among cancer patients during the first wave of the pandemic. We conducted a case-control study within the UK Biobank cohort linked to the COVID-19 tests results available from 16 March 2020 until 23 August 2020. The main exposure variable was socioeconomic status, assessed using the Townsend Deprivation Index. Among 18,917 participants with an incident malignancy in the UK Biobank cohort, 89 tested positive for COVID-19. The overall COVID-19 incidence was 4.7 cases per 1000 incident cancer patients (95%CI 3.8–5.8). Compared with the least deprived cancer patients, those living in the most deprived areas had an almost three times higher risk of testing positive (RR 2.6, 95%CI 1.1–5.8). Other independent risk factors were ethnic minority background, obesity, unemployment, smoking, and being diagnosed with a haematological cancer for less than five years. A consistent pattern of socioeconomic inequalities in COVID-19 among incident cancer patients in the UK highlights the need to prioritise the cancer patients living in the most deprived areas in vaccination planning. This socio-demographic profiling of vulnerable cancer patients at increased risk of infection can inform prevention strategies and policy improvements for the coming pandemic waves.

scholarly journals Paediatric rotavirus vaccination, coeliac disease and type 1 diabetes in children: a population-based cohort study

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Thomas Inns ◽  
Kate M. Fleming ◽  
Miren Iturriza-Gomara ◽  
Daniel Hungerford
Keyword(s):  
Type 1 Diabetes ◽  
Cohort Study ◽  
Coeliac Disease ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Rotavirus Vaccine ◽  
Rotavirus Vaccination ◽  
Increased Risk ◽  
The Uk

Abstract Background Rotavirus infection has been proposed as a risk factor for coeliac disease (CD) and type 1 diabetes (T1D). The UK introduced infant rotavirus vaccination in 2013. We have previously shown that rotavirus vaccination can have beneficial off-target effects on syndromes, such as hospitalised seizures. We therefore investigated whether rotavirus vaccination prevents CD and T1D in the UK. Methods A cohort study of children born between 2010 and 2015 was conducted using primary care records from the Clinical Practice Research Datalink. Children were followed up from 6 months to 7 years old, with censoring for outcome, death or leaving the practice. CD was defined as diagnosis of CD or the prescription of gluten-free goods. T1D was defined as a T1D diagnosis. The exposure was rotavirus vaccination, defined as one or more doses. Mixed-effects Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CIs). Models were adjusted for potential confounders and included random intercepts for general practices. Results There were 880,629 children in the cohort (48.8% female). A total of 343,113 (39.0%) participants received rotavirus vaccine; among those born after the introduction of rotavirus vaccination, 93.4% were vaccinated. Study participants contributed 4,388,355 person-years, with median follow-up 5.66 person-years. There were 1657 CD cases, an incidence of 38.0 cases per 100,000 person-years. Compared with unvaccinated children, the adjusted HR for a CD was 1.05 (95% CI 0.86–1.28) for vaccinated children. Females had a 40% higher hazard than males. T1D was recorded for 733 participants, an incidence of 17.1 cases per 100,000 person-years. In adjusted analysis, rotavirus vaccination was not associated with risk of T1D (HR = 0.89, 95% CI 0.68–1.19). Conclusions Rotavirus vaccination has reduced diarrhoeal disease morbidity and mortality substantial since licencing in 2006. Our finding from this large cohort study did not provide evidence that rotavirus vaccination prevents CD or T1D, nor is it associated with increased risk, delivering further evidence of rotavirus vaccine safety.

scholarly journals The Level of Processing, Nutritional Composition and Prices of Canadian Packaged Foods and Beverages with and without Gluten-Free Claims

Nutrients ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 1183
Author(s):  
Laura Vergeer ◽  
Beatriz Franco-Arellano ◽  
Gabriel B. Tjong ◽  
Jodi T. Bernstein ◽  
Mary R. L’Abbé
Keyword(s):  
Linear Models ◽  
Saturated Fat ◽  
Nutritional Composition ◽  
Gluten Free ◽  
Food Label ◽  
Nutrient Contents ◽  
Logistic Regression Models ◽  
University Of Toronto ◽  
Information Program ◽  
Label Information

Little is known about the healthfulness and cost of gluten-free (GF) foods, relative to non-GF alternatives, in Canada. This study compared the extent of processing, nutritional composition and prices of Canadian products with and without GF claims. Data were sourced from the University of Toronto Food Label Information Program (FLIP) 2013 (n = 15,285) and 2017 (n = 17,337) databases. Logistic regression models examined the association of NOVA processing category with GF claims. Calorie/nutrient contents per 100 g (or mL) were compared between GF and non-GF products. Generalized linear models compared adjusted mean prices per 100 g (or mL) of products with and without GF claims. The prevalence of GF claims increased from 7.1% in 2013 to 15.0% in 2017. GF claims appeared on 17.0% of ultra-processed foods, which were more likely to bear GF claims products than less-processed categories. Median calories and sodium were significantly higher in GF products; no significant differences were observed for saturated fat or sugars. Compared to non-GF products, adjusted mean prices of GF products were higher for 10 food categories, lower for six categories and not significantly different for six categories. Overall, GF claims are becoming increasingly prevalent in Canada; however, they are often less healthful and more expensive than non-GF alternatives, disadvantaging consumers following GF diets.

scholarly journals Routine use of immunosuppressants is associated with mortality in hospitalised patients with COVID-19

2021 ◽  
Vol 12 ◽  
pp. 204209862098569
Author(s):  
Phyo K. Myint ◽  
Ben Carter ◽  
Fenella Barlow-Pay ◽  
Roxanna Short ◽  
Alice G. Einarsson ◽  
...  
Keyword(s):  
Medical Attention ◽  
Close Monitoring ◽  
Plain Language ◽  
Discharge Data ◽  
Specific Patient ◽  
Risk Of Death ◽  
Hospitalised Patients ◽  
Increased Risk ◽  
The Uk ◽  
The Impact

Background: Whilst there is literature on the impact of SARS viruses in the severely immunosuppressed, less is known about the link between routine immunosuppressant use and outcome in COVID-19. Consequently, guidelines on their use vary depending on specific patient populations. Methods: The study population was drawn from the COPE Study (COVID-19 in Older People), a multicentre observational cohort study, across the UK and Italy. Data were collected between 27 February and 28 April 2020 by trained data-collectors and included all unselected consecutive admissions with COVID-19. Load (name/number of medications) and dosage of immunosuppressant were collected along with other covariate data. Primary outcome was time-to-mortality from the date of admission (or) date of diagnosis, if diagnosis was five or more days after admission. Secondary outcomes were Day-14 mortality and time-to-discharge. Data were analysed with mixed-effects, Cox proportional hazards and logistic regression models using non-users of immunosuppressants as the reference group. Results: In total 1184 patients were eligible for inclusion. The median (IQR) age was 74 (62–83), 676 (57%) were male, and 299 (25.3%) died in hospital (total person follow-up 15,540 days). Most patients exhibited at least one comorbidity, and 113 (~10%) were on immunosuppressants. Any immunosuppressant use was associated with increased mortality: aHR 1.87, 95% CI: 1.30, 2.69 (time to mortality) and aOR 1.71, 95% CI: 1.01–2.88 (14-day mortality). There also appeared to be a dose–response relationship. Conclusion: Despite possible indication bias, until further evidence emerges we recommend adhering to public health measures, a low threshold to seek medical advice and close monitoring of symptoms in those who take immunosuppressants routinely regardless of their indication. However, it should be noted that the inability to control for the underlying condition requiring immunosuppressants is a major limitation, and hence caution should be exercised in interpretation of the results. Plain Language Summary Regular Use of Immune Suppressing Drugs is Associated with Increased Risk of Death in Hospitalised Patients with COVID-19 Background: We do not have much information on how the COVID-19 virus affects patients who use immunosuppressants, drugs which inhibit or reduce the activity of the immune system. There are various conflicting views on whether immune-suppressing drugs are beneficial or detrimental in patients with the disease. Methods: This study collected data from 10 hospitals in the UK and one in Italy between February and April 2020 in order to identify any association between the regular use of immunosuppressant medicines and survival in patients who were admitted to hospital with COVID-19. Results: 1184 patients were included in the study, and 10% of them were using immunosuppressants. Any immunosuppressant use was associated with increased risk of death, and the risk appeared to increase if the dose of the medicine was higher. Conclusion: We therefore recommend that patients who take immunosuppressant medicines routinely should carefully adhere to social distancing measures, and seek medical attention early during the COVID-19 pandemic.

scholarly journals Nutrition as a Key Modifiable Factor for Periodontitis and Main Chronic Diseases

2021 ◽  
Vol 10 (2) ◽  
pp. 197
Author(s):  
Prescilla Martinon ◽  
Laurie Fraticelli ◽  
Agnes Giboreau ◽  
Claude Dussart ◽  
Denis Bourgeois ◽  
...  
Keyword(s):  
Cardiovascular Diseases ◽  
Chronic Diseases ◽  
Periodontal Diseases ◽  
Saturated Fat ◽  
Warning Signal ◽  
Dietary Quality ◽  
Omega 3 ◽  
Periodontal Health ◽  
High Fiber ◽  
Increased Risk

Nutrition is recognized as an essential component in the prevention of a number of chronic diseases, including periodontal disease. Based on these considerations, a better understanding is required regarding how the diet, and more particularly the intake of macronutrients and micronutrients, could impact the potential relationship between nutrition and periodontal diseases, periodontal diseases and chronic diseases, nutrition and chronic diseases. To overcome this complexity, an up-to-date literature review on the nutriments related to periodontal and chronic diseases was performed. High-sugar, high-saturated fat, low-polyols, low-fiber and low-polyunsaturated-fat intake causes an increased risk of periodontal diseases. This pattern of nutrients is classically found in the Western diet, which is considered as an ‘unhealthy’ diet that causes cardiovascular diseases, diabetes and cancers. Conversely, low-sugar, high-fiber and high-omega-6-to-omega-3 fatty acid ratio intake reduces the risk of periodontal diseases. The Mediterranean, DASH, vegetarian and Okinawa diets that correspond to these nutritional intakes are considered as ‘healthy’ diets, reducing this risk of cardiovascular diseases, diabetes and cancers. The role of micronutrients, such as vitamin D, E, K and magnesium, remains unclear, while others, such as vitamin A, B, C, calcium, zinc and polyphenols have been shown to prevent PDs. Some evidence suggests that probiotics and prebiotics could promote periodontal health. Periodontal and chronic diseases share, with a time delay, nutrition as a risk factor. Thus, any change in periodontal health should be considered as a warning signal to control the dietary quality of patients and thus reduce the risk of developing chronic diseases later on.

scholarly journals Estimating the burden of hyperkalaemia in the UK in high-risk patient populations

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P McEwan ◽  
L Hoskin ◽  
K Badora ◽  
D Sugrue ◽  
G James ◽  
...  
Keyword(s):  
Clinical Practice ◽  
High Risk ◽  
Patient Outcomes ◽  
Real World ◽  
High Risk Patient ◽  
Incidence Rates ◽  
Funding Source ◽  
Eligible Population ◽  
Increased Risk ◽  
The Uk

Abstract Background Patients with chronic kidney disease (CKD), heart failure (HF), resistant hypertension (RHTN) and diabetes are at an increased risk of hyperkalaemia (HK) which can be potentially life-threatening, as a result of cardiac arrhythmias, cardiac arrest leading to sudden death. In these patients, renin-angiotensin-aldosterone system inhibitors (RAASi), are used to manage several cardiovascular and renal conditions, and are associated with an increased risk of HK. Assessing the burden of HK in real-world clinical practice may concentrate relevant care on those patients most in need, potentially improving patient outcomes and efficiency of the healthcare system. Purpose To assess the burden of HK in a real-world population of UK patients with at least one of: RHTN, Type I or II diabetes, CKD stage 3+, dialysis, HF, or in receipt of a prescription for RAASi. Methods Primary and secondary care data for this retrospective study were obtained from the UK Clinical Practice Research Datalink (CPRD) and linked Hospital Episode Statistics (HES). Eligible patients were identified using READ codes defining the relevant diagnosis, receipt of indication-specific medication, or, in the case of CKD, an estimated glomerular filtration rate (eGFR) ≤60 ml/min/1.73m2 within the study period (01 January 2008 to 30 June 2018) or in the five-year lookback period (2003–2007). The index date was defined as 01 January 2008 or first diagnosis of an eligible condition or RAASi prescription, whichever occurred latest. HK was defined as K+ ≥5.0 mmol/L; thresholds of ≥5.5 mmol/L and ≥6.0 mmol/L were explored as sensitivity analyses. Incidence rates of HK were calculated with 95% confidence intervals (CI). Results The total eligible population across all cohorts was 931,460 patients. RHTN was the most prevalent comorbidity (n=317,135; 34.0%) and dialysis the least prevalent (n=4,415; 0.5%). The majority of the eligible population were prescribed RAASi during follow-up (n=754,523; 81.0%). At a K+ threshold of ≥5.0 mmol/L, the dialysis cohort had the highest rate of HK (501.0 events per 1,000 patient-years), followed by HF (490.9), CKD (410.9), diabetes (355.0), RHTN (261.4) and the RAASi cohort (211.2) (Figure 1). This pattern was still observed at alternative threshold definitions of HK. Conclusion This large real-world study of UK patients demonstrates the burden of hyperkalaemia in high-risk patient populations from the UK. There is a need for effective prevention and treatment of HK, particularly in patients with CKD, dialysis or HF where increased incidence rates are observed which in turn will improve patient outcomes and healthcare resource usage. Figure 1. Rates of HK by condition Funding Acknowledgement Type of funding source: Private company. Main funding source(s): AstraZeneca

scholarly journals The development of a digital intervention to increase influenza vaccination amongst pregnant women

2021 ◽  
Vol 7 ◽  
pp. 205520762110121
Author(s):  
Joanne E Parsons ◽  
Katie V Newby ◽  
David P French ◽  
Elizabeth Bailey ◽  
Nadia Inglis
Keyword(s):  
Pregnant Women ◽  
Qualitative Methodology ◽  
Intervention Mapping ◽  
Vaccine Uptake ◽  
Flu Vaccination ◽  
Increased Risk ◽  
Diverse Area ◽  
Seasonal Flu ◽  
Flu Vaccine ◽  
The Uk

Objective Pregnant women and unborn babies are at increased risk of complications from influenza, including pneumonia, yet in the UK, uptake of flu vaccination amongst this population remains <50%. Pregnant women hold beliefs about risks of flu and efficacy of vaccination that consistently predict them to decline vaccination. This study aimed to develop a theory and evidence-based intervention addressing these beliefs to promote flu vaccine uptake. Methods The intervention was developed by behavioural scientists, pregnant women, midwives, clinicians and Public Health professionals, informed by Intervention Mapping. Six predefined steps were performed in line with Intervention Mapping. Results The intervention is an animation addressing beliefs about risks of flu and efficacy of vaccination. Preliminary testing using qualitative methodology indicates the information within the animation is appropriate, and the animation is acceptable to pregnant women. Conclusions This is the first known intervention for pregnant women, aiming to increase flu vaccination through addressing risk and efficacy appraisals. It has been implemented within seasonal flu vaccination campaigns during 2018/19 and 2019/20 within one geographically and ethnically diverse area of the UK.

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