ABSTRACT
Understanding the lag time between land management and impacts on riverine nitrate-nitrogen (N) loads is critical to understand when action to mitigate nitrate-N leaching losses from the soil profile may start improving water quality. These lags occur due to leaching of nitrate-N through the subsurface (soil and groundwater). Actions to mitigate nitrate-N losses have been mandated in New Zealand policy to start showing improvements in water quality within five years. We estimated annual rates of nitrate-N leaching and annual nitrate-N loads for 77 river catchments from 1990 to 2018. Lag times between these losses and riverine loads were determined for 34 catchments but could not be determined in other catchments because they exhibited little change in nitrate-N leaching losses or loads. Lag times varied from 1 to 12 years according to factors like catchment size (Strahler stream order and altitude) and slope. For eight catchments where additional isotope and modelling data were available, the mean transit time for surface water at baseflow to pass through the catchment was on average 2.1 years less than, and never greater than, the mean lag time for nitrate-N, inferring our lag time estimates were robust. The median lag time for nitrate-N across the 34 catchments was 4.5 years, meaning that nearly half of these catchments wouldn't exhibit decreases in nitrate-N because of practice change within the five years outlined in policy.
ABSTRACT
BACKGROUND: Many centres across the UK and Ireland anecdotally report using a 'modified ketogenic diet' (MKD) as a treatment for refractory epilepsy. Although a MKD is within the spectrum of ketogenic diets (KDs), there is little literature reporting upon its definition, use or clinical effectiveness. We aimed to understand the core principles of MKD practice and to assess whether and how the MKD differs from other KD protocols. METHODS: An online survey, designed by a consensus group of ketogenic dietitians, was circulated to 39 KD centres across the UK and Ireland. It consisted of 35 questions regarding dietetic practice when providing MKD. RESULTS: Eighteen centres completed the questionnaire: 13 paediatric, three adult and two combined centres. All dietitians based MKD 'prescriptions' on estimated total energy requirements. The average macronutrient profile was 75% fat and 5% carbohydrate, with protein ad libitum. Carbohydrate and fat targets were implemented via weighed portions (carbohydrate lists n = 18; fat lists n = 13) and 'household measures' (carbohydrate lists n = 2; fat lists n = 3). Of the centres, 94% (n = 17) adjusted macronutrients over time; these decisions were based on ketone levels and seizures in most cases (83%; n = 14). Ketogenic nutritional products available on prescription were used by 10 centres (56%) when initiating and by all centres when 'fine-tuning' the MKD. CONCLUSIONS: A modified ketogenic diet in the UK and Ireland is a hybrid KD, adopting principles from other established KD protocols and defining new elements unique to the MKD. Further research into the clinical and cost-effectiveness of MKD would be of benefit.
