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Atkins LA, Spence AC, Szymlek-Gay EA. Iron Nutrition of Pre-Schoolers in High-Income Countries: A Review. Nutrients 2023; 15:nu15112616. [PMID: 37299582 DOI: 10.3390/nu15112616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Pre-schoolers are vulnerable to iron deficiency, which, in high-resource countries, is mainly caused by suboptimal or poorly absorbable iron intakes. This review examines the prevalence of inadequate iron intakes and status, and the non-dietary factors associated with these, among children aged between 2 and 5 years within high-income countries. It then considers the quality of the pre-schooler diet in terms of dietary factors, dietary patterns, and iron intakes. Additionally, it discusses the assessment of iron bioavailability and examines the various methods used to estimate the amount of absorbable iron in pre-schooler diets. Knowledge of the adequacy of iron intakes and bioavailability of iron intakes, and dietary patterns associated with iron intakes can facilitate the design and implementation of effectively targeted community-based intervention studies to improve iron intakes and iron bioavailability to minimise the risk of iron deficiency.
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Affiliation(s)
- Linda A Atkins
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220, Australia
| | - Alison C Spence
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220, Australia
| | - Ewa A Szymlek-Gay
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220, Australia
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Nutri-Score: Its Benefits and Limitations in Children's Feeding. J Pediatr Gastroenterol Nutr 2023; 76:e46-e60. [PMID: 36399776 DOI: 10.1097/mpg.0000000000003657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Reducing the burden of noncommunicable diseases (NCDs) is one of the top priorities of public health policies worldwide. One of the recognized means of achieving this objective is to improve the diet quality. The Nutri-Score (N-S) is a [five-color-A, B, C, D, E letters] front-of-pack labeling logo intended to help consumers quickly identify the healthier prepackaged foods within a food category. Available studies have shown that the N-S is an efficient tool to achieve this aim in terms of consumers' awareness, perception, understanding, and purchasing and that its use may help to reduce the prevalence of NCDs. The N-S is currently implemented on a voluntary basis in 7 European countries and a discussion is underway within the European Commission to achieve a harmonized mandatory label. However, no study on the putative impact of the N-S on children's dietary patterns and health is available. The N-S is not applicable to infants' and young children's formulas and to specific baby foods, the compositions of which are already laid down in European Union regulations. The N-S does not replace age-appropriate dietary guidelines. As children consume an increasing number of adult type and processed foods, the relevance of the N-S for children should be evaluated considering the children's high specific requirements, especially in younger children. This is especially necessary for fitting fat and iron requirements, whereas protein-rich foods should be better framed. Moreover, efforts should be made to inform on how to use the N-S and in education on healthy diets.
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Ofori KF, Antoniello S, English MM, Aryee ANA. Improving nutrition through biofortification-A systematic review. Front Nutr 2022; 9:1043655. [PMID: 36570169 PMCID: PMC9784929 DOI: 10.3389/fnut.2022.1043655] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/30/2022] [Indexed: 12/14/2022] Open
Abstract
Nutritious foods are essential for human health and development. However, malnutrition and hidden hunger continue to be a challenge globally. In most developing countries, access to adequate and nutritious food continues to be a challenge. Although hidden hunger is less prevalent in developed countries compared to developing countries where iron (Fe) and zinc (Zn) deficiencies are common. The United Nations (UN) 2nd Sustainable Development Goal was set to eradicate malnutrition and hidden hunger. Hidden hunger has led to numerous cases of infant and maternal mortalities, and has greatly impacted growth, development, cognitive ability, and physical working capacity. This has influenced several countries to develop interventions that could help combat malnutrition and hidden hunger. Interventions such as dietary diversification and food supplementation are being adopted. However, fortification but mainly biofortification has been projected to be the most sustainable solution to malnutrition and hidden hunger. Plant-based foods (PBFs) form a greater proportion of diets in certain populations; hence, fortification of PBFs is relevant in combating malnutrition and hidden hunger. Agronomic biofortification, plant breeding, and transgenic approaches are some currently used strategies in food crops. Crops such as cereals, legumes, oilseeds, vegetables, and fruits have been biofortified through all these three strategies. The transgenic approach is sustainable, efficient, and rapid, making it suitable for biofortification programs. Omics technology has also been introduced to improve the efficiency of the transgenic approach.
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Affiliation(s)
- Kelvin F. Ofori
- Department of Human Ecology, Delaware State University, Dover, DE, United States
| | - Sophia Antoniello
- Department Human Nutrition, Saint Francis Xavier University, Antigonish, NS, Canada
| | - Marcia M. English
- Department Human Nutrition, Saint Francis Xavier University, Antigonish, NS, Canada
| | - Alberta N. A. Aryee
- Department of Human Ecology, Delaware State University, Dover, DE, United States,*Correspondence: Alberta N. A. Aryee,
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Madrigal C, Soto-Méndez MJ, Hernández-Ruiz Á, Ruiz-López MD, Samaniego-Vaesken MDL, Partearroyo T, Varela-Moreiras G, Gil Á. Dietary Intake, Nutritional Adequacy, and Food Sources of Selected Antioxidant Minerals and Vitamins; and Their Relationship with Personal and Family Factors in Spanish Children Aged 1 to <10 Years: Results from the EsNuPI Study. Nutrients 2022; 14:nu14194132. [PMID: 36235784 PMCID: PMC9573671 DOI: 10.3390/nu14194132] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/28/2022] [Accepted: 10/01/2022] [Indexed: 11/23/2022] Open
Abstract
Minerals and vitamins involved in the antioxidant defense system are essential for healthy growth and proper development during infancy. Milk and dairy products are of particular importance for improving the supply of these nutrients to children. Indeed, the present study aimed to evaluate the nutrient intake and food sources of zinc (Zn), selenium (Se), retinol and carotenoids (sources of vitamin A), and vitamins C and E, and to analyze their relationships with personal and familiar factors in Spanish children from the EsNuPI study. One subpopulation representative of the Spanish population from 1 to <10 years old (n = 707) (reference group, REF) who reported consuming all types of milk over the last year, and another subpopulation of the same age who reported consuming fortified milk formulas (FMFs) (including follow-on formula, young child formula, growing up milk, toddler’s milk, and enriched and fortified milk) (n = 741) (fortified milk consumers, FMCs) completed two 24 h dietary recalls used to estimate their nutrient intakes and to compare them to the European Food Safety Authority (EFSA) Dietary Reference Values (DRVs). The REF reported higher median intakes than FMCs for Se (61 µg/kg vs. 51 µg/kg) and carotenoids (1079 µg/day vs. 998 µg/day). Oppositely, FMCs reported higher intakes than REF for Zn (7.9 mg/day vs. 6.9 mg/day), vitamin A (636 µg/day vs. 481 µg/day), vitamin E (8.9 mg/day vs. 4.5 mg/day), vitamin C (113 mg/day vs. 71 mg/day), and retinol (376 µg/day vs. 233 µg/day). In the REF group, more than 50% of the children met the EFSA recommendations for Zn (79.6%), Se (87.1%), vitamin A (71.3%), and vitamin C (96.7%), respectively. On the other hand, 92.2% were below the EFSA recommendations for vitamin E. In the FMC group, more than 50% of the children met the EFSA recommendations for Zn (55.2%), Se (90.8%), vitamin A (75.7%), vitamin E (66.7%), and vitamin C (100%). We found statistically significant differences between subpopulations for all cases except for Se. In both subpopulations, the main sources of all antioxidant nutrients were milk and dairy products. For carotenoids, the main sources were vegetables and fruits followed by milk and dairy products. A high percentage of children had vitamins A and E intakes below the recommendations, information of great importance to stakeholders. More studies using intakes and biomarkers are needed, however, to determine an association with diverse factors of oxidative damage.
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Affiliation(s)
- Casandra Madrigal
- Department of Nutrition and Food Science, Faculty of Pharmacy, University of Granada, 18071 Granada, Spain
- Iberoamerican Nutrition Foundation (FINUT), 18016 Granada, Spain
| | | | | | - María Dolores Ruiz-López
- Department of Nutrition and Food Science, Faculty of Pharmacy, University of Granada, 18071 Granada, Spain
- Iberoamerican Nutrition Foundation (FINUT), 18016 Granada, Spain
- Biomedical Research Center, Institute of Nutrition and Food Technology “José Mataix”, University of Granada, 18011 Granada, Spain
- Correspondence:
| | - María de Lourdes Samaniego-Vaesken
- Grupo USP-CEU de Excelencia “Nutrición Para la Vida (Nutrition for Life)”, Ref: E02/0720, Departamento de Ciencias Farmacéuticas y de la Salud, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, 28660 Boadilla del Monte, Spain
| | - Teresa Partearroyo
- Grupo USP-CEU de Excelencia “Nutrición Para la Vida (Nutrition for Life)”, Ref: E02/0720, Departamento de Ciencias Farmacéuticas y de la Salud, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, 28660 Boadilla del Monte, Spain
| | - Gregorio Varela-Moreiras
- Grupo USP-CEU de Excelencia “Nutrición Para la Vida (Nutrition for Life)”, Ref: E02/0720, Departamento de Ciencias Farmacéuticas y de la Salud, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, 28660 Boadilla del Monte, Spain
| | - Ángel Gil
- Iberoamerican Nutrition Foundation (FINUT), 18016 Granada, Spain
- Biomedical Research Center, Institute of Nutrition and Food Technology “José Mataix”, University of Granada, 18011 Granada, Spain
- Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Department of Biochemistry and Molecular Biology II, University of Granada, 18071 Granada, Spain
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Abstract
Hydration is a particular concern for infants and young children due to their greater risk of dehydration. However, studies on their water intakes are scarce. The current survey aimed to analyse total water intake (TWI) in non-breastfed children aged 0·5-35 months compared with the adequate intake (AI) for the same age group set by the European Food Safety Authority and to examine the different contributors to TWI as well as beverage consumption patterns. Nationally representative data from the Nutri-Bébé cross-sectional survey were used to assess food, beverage and plain water consumption by age group over three non-consecutive days. With age, median TWI in 1035 children increased from 732 to 1010 ml/d, without differences between sexes, but with a great inter-individual variation, and the percentage of children who did not meet the AI increased from 10 to 88 %. Median weight-related TWI decreased from 136·6 to 69·0 ml/kg per d. Among infants, 90 % had a ratio of water:energy below the AI, similarly for about 75 % of toddlers. Milk and milk products were the main contributors to TWI, while the part of plain water increased gradually to be 25 % in the older toddlers, half of which was tap water. The beverage consumption pattern varied in types and timing, with little consumption of juices and sweetened beverages. Vegetables and fruits accounted for 20 % of TWI after the age of 6 months. These initial results, showing strong discrepancies between actual and recommended water intakes in young children, should help identify ways to increase children's water consumption.
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Jomaa L, Hwalla N, Chokor FAZ, Naja F, O’Neill L, Nasreddine L. Food consumption patterns and nutrient intakes of infants and young children amidst the nutrition transition: the case of Lebanon. Nutr J 2022; 21:34. [PMID: 35599326 PMCID: PMC9125916 DOI: 10.1186/s12937-022-00779-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 04/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background This is the first study on dietary intakes of infants and young children in the Eastern Mediterranean Region, a region that is currently witnessing the nutrition transition. It aims at characterizing food consumption patterns amongst 0–4 year old children in Lebanon, evaluating their macro- and micronutrient intakes and assessing adherence to dietary recommendations. Methods Based on a national cross-sectional survey in 2012 (n = 866), the study collected data on sociodemographic and anthropometric characteristics, and one 24-hour dietary recall was administered. Nutrient intakes were compared with reference values: Estimated Average Requirement (EAR), Adequate Intake (AI) and Acceptable Macronutrient Distribution Range (AMDR). Results Milk was the highest contributor to energy intake (EI) in infants (95.8 and 56.5% in 0–5.9 months and 6–11.9 months old infants, respectively), while its intake was lower among toddlers and preschoolers (35.4 and 15.1%, respectively). In contrast, intakes of sweets and sweetened beverages were the highest in preschoolers compared to younger children, contributing 18.5% EI in preschoolers. Compared to dietary guidelines, the lowest dietary adherence was found for vegetables (17.8–20.7%) and fruits (14.4–34.3%). Protein intake was within the recommendations for the vast majority of children. Although total fat intake was lower in toddlers and preschoolers compared to infants, more than 40% of toddlers and preschoolers exceeded the AMDR for fat and 87.3% of preschoolers exceeded the upper limit for saturated fat. Only 3.6% of toddlers and 11.5% of preschoolers exceeded the AI level for dietary fiber. Micronutrient intake assessment showed that mean intakes in infants exceeded the AI for all micronutrients, except for vitamin D and magnesium. In toddlers, vitamin D and calcium were below the EAR among 84.7, and 44.6%, respectively. In preschoolers, most of the children (91.9%) had inadequate intakes of vitamin D, and a third had inadequate intakes of folate, calcium and vitamin A. Conclusions This study identified priority issues for nutrition intervention in infants and young children in Lebanon. Concerted multi-stakeholder efforts are needed to instill heathier food consumption and nutrient intake patterns early in life. Supplementary Information The online version contains supplementary material available at 10.1186/s12937-022-00779-9.
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De Sousa DR, França AKTDC, Cavalcante MCV, Pereira NO, Fonseca P, Filho FL. Early weaning and family characteristics are associated with greater sodium intake in children between 13 and 35 months: BRISA birth cohort. Br J Nutr 2022; 129:1-8. [PMID: 35466891 DOI: 10.1017/s0007114522001258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Children are consuming less healthy foods, and this eating behaviour exposes the child to greater Na intake. The association between family, maternal and child characteristics with Na intake by children aged 13-35 months was evaluated. A study carried out with retrospective data on 1,185 children from the Brisa cohort. The children's dietary Na intake was assessed by a 24-h diet recall survey. Values ≥ 1200 mg were considered excessive intake. The association between Na intake and independent variables was assessed by a three-level logistic hierarchical regression model. Variables with P-value < 0·05 were retained in the model. Most children were male (51·2 %), eutrophic (63·2 %) and not exclusively breast-feeding (EBF) for 6 months (58·4 %). The average Na intake was 925 mg (±410·4). The prevalence of excessive Na intake was 18·5 % and was associated with the variables children of younger mothers (< 20 years old OR = 4·04, 95 % CI 1·64, 9·99; ≥ 20 to < 35 years old OR = 2·48, 95 % CI 1·10, 5·63), having four or more children (OR = 2·51, 95 % CI 1·29, 4·89), lower family income (≥ 1 and < 3 minimum wages OR = 0·60, 95 % CI 0·39, 0·93; ≥ 3 minimum wages OR = 0·50, 95 % CI 0·30, 0·82) and not being EBF until 6 months (OR = 1·64, 95 % CI 1·14, 2·34). The average Na intake of children was higher than the recommendation for adequate intake, pointing to a high consumption of this micronutrient in the first years of life. Excessive Na intake seems to be linked to unfavourable socio-economic conditions. Avoiding early weaning is the only possible intervention in this scenario.
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Affiliation(s)
- Dinamara Rodrigues De Sousa
- Public Health Department, Biological and Health Sciences Center, Post-graduate Program in Collective Health, Federal University of Maranhão, São Luís, MA65020-070, Brazil
| | - Ana Karina Teixeira da Cunha França
- Public Health Department, Biological and Health Sciences Center, Post-graduate Program in Collective Health, Federal University of Maranhão, São Luís, MA65020-070, Brazil
| | - Milady Cutrim Vieira Cavalcante
- University Hospital Federal University of Maranhão, Post-graduate Program in Collective Health, Federal University of Maranhão, São Luís, MA65020-070, Brazil
| | - Natália Oliveira Pereira
- Public Health Department, Biological and Health Sciences Center, Post-graduate Program in Collective Health, Federal University of Maranhão, São Luís, MA65020-070, Brazil
| | - Poliana Fonseca
- Nutrition Department, Federal University of Piauí, Teresina, PI64049-550, Brazil
| | - Fernando Lamy Filho
- Public Health Department, Biological and Health Sciences Center, Post-graduate Program in Collective Health, Federal University of Maranhão, São Luís, MA65020-070, Brazil
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Chouraqui JP. Dietary Approaches to Iron Deficiency Prevention in Childhood—A Critical Public Health Issue. Nutrients 2022; 14:nu14081604. [PMID: 35458166 PMCID: PMC9026685 DOI: 10.3390/nu14081604] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/03/2022] [Accepted: 04/08/2022] [Indexed: 12/15/2022] Open
Abstract
Iron is an essential nutrient, and individual iron status is determined by the regulation of iron absorption, which is driven by iron requirements. Iron deficiency (ID) disproportionately affects infants, children, and adolescents, particularly those who live in areas with unfavorable socioeconomic conditions. The main reason for this is that diet provides insufficient bioavailable iron to meet their needs. The consequences of ID include poor immune function and response to vaccination, and moderate ID anemia is associated with depressed neurodevelopment and impaired cognitive and academic performances. The persistently high prevalence of ID worldwide leads to the need for effective measures of ID prevention. The main strategies include the dietary diversification of foods with more bioavailable iron and/or the use of iron-fortified staple foods such as formula or cereals. However, this strategy may be limited due to its cost, especially in low-income countries where biofortification is a promising approach. Another option is iron supplementation. In terms of health policy, the choice between mass and targeted ID prevention depends on local conditions. In any case, this remains a critical public health issue in many countries that must be taken into consideration, especially in children under 5 years of age.
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Affiliation(s)
- Jean-Pierre Chouraqui
- Pediatric Nutrition and Gastroenterology Unit, Woman, Mother and Child Department, University Hospital of Lausanne, 1011 Lausanne, Switzerland
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Milešević J, Vranić D, Gurinović M, Korićanac V, Borović B, Zeković M, Šarac I, Milićević DR, Glibetić M. The Intake of Phosphorus and Nitrites through Meat Products: A Health Risk Assessment of Children Aged 1 to 9 Years Old in Serbia. Nutrients 2022; 14:242. [PMID: 35057423 PMCID: PMC8781619 DOI: 10.3390/nu14020242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 12/27/2021] [Accepted: 12/30/2021] [Indexed: 01/02/2023] Open
Abstract
This study provides the data on dietary exposure of Serbian children to nitrites and phosphorus from meat products by combining individual consumption data with available analytical data of meat products. A total of 2603 and 1900 commercially available meat products were categorized into seven groups and analysed for nitrite and phosphorous content. The highest mean levels of nitrite content, expressed as NaNO2, were found in finely minced cooked sausages (40.25 ± 20.37 mg/kg), followed by canned meat (34.95 ± 22.12 mg/kg) and coarsely minced cooked sausages (32.85 ± 23.25 mg/kg). The EDI (estimated daily intake) of nitrites from meat products, calculated from a National Food Consumption Survey in 576 children aged 1-9 years, indicated that the Serbian children population exceeded the nitrite ADI (acceptable daily intake) proposed by EFSA (European Food Safety Authority) in 6.4% of children, with a higher proportion in 1-3-year-old participants. The mean phosphorus concentration varied from 2.71 ± 1.05 g/kg to 6.12 ± 1.33 g/kg in liver sausage and pate and smoked meat products, respectively. The EDI of phosphorus from meat products was far below the ADI proposed by EFSA, indicating that the use of phosphorus additives in Serbian meat products is generally in line with legislation.
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Affiliation(s)
- Jelena Milešević
- Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, National Institute of Republic of Serbia, University of Belgrade, Tadeusa Koscuska, 111000 Belgrade, Serbia; (J.M.); (M.G.); (M.Z.); (I.Š.); (M.G.)
| | - Danijela Vranić
- Institute of Meat Hygiene and Technology, Kaćanskog 13, 11040 Belgrade, Serbia; (D.V.); (V.K.); (B.B.)
| | - Mirjana Gurinović
- Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, National Institute of Republic of Serbia, University of Belgrade, Tadeusa Koscuska, 111000 Belgrade, Serbia; (J.M.); (M.G.); (M.Z.); (I.Š.); (M.G.)
| | - Vladimir Korićanac
- Institute of Meat Hygiene and Technology, Kaćanskog 13, 11040 Belgrade, Serbia; (D.V.); (V.K.); (B.B.)
| | - Branka Borović
- Institute of Meat Hygiene and Technology, Kaćanskog 13, 11040 Belgrade, Serbia; (D.V.); (V.K.); (B.B.)
| | - Milica Zeković
- Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, National Institute of Republic of Serbia, University of Belgrade, Tadeusa Koscuska, 111000 Belgrade, Serbia; (J.M.); (M.G.); (M.Z.); (I.Š.); (M.G.)
| | - Ivana Šarac
- Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, National Institute of Republic of Serbia, University of Belgrade, Tadeusa Koscuska, 111000 Belgrade, Serbia; (J.M.); (M.G.); (M.Z.); (I.Š.); (M.G.)
| | - Dragan R. Milićević
- Institute of Meat Hygiene and Technology, Kaćanskog 13, 11040 Belgrade, Serbia; (D.V.); (V.K.); (B.B.)
| | - Maria Glibetić
- Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, National Institute of Republic of Serbia, University of Belgrade, Tadeusa Koscuska, 111000 Belgrade, Serbia; (J.M.); (M.G.); (M.Z.); (I.Š.); (M.G.)
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Chouraqui JP, Darmaun D, Salmon-Legagneur A, Shamir R. Protein intake pattern in non-breastfed infants and toddlers: A survey in a nationally representative sample of French children. Clin Nutr 2021; 41:269-278. [PMID: 34998033 DOI: 10.1016/j.clnu.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/30/2021] [Accepted: 12/04/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND AIMS Protein intake plays a key role in infants and children's growth, but high protein intake may have adverse long-term effects. Data on actual intakes in various populations are scarce. The aims of this study were (i) to assess daily protein intake (DPI) in non-breastfed infants and children aged 0.5-35 months in comparison with the population reference intake (PRI) set by the European Food Safety Authority, and to examine (ii) the various sources of this intake and their consumption patterns, and (iii) time-related changes in DPI over the last 4 decades. METHODS Data from the Nutri-Bébé cross-sectional survey were used to assess DPI, DPI/kg BW and the protein-energy ratio (E%) by age group. The amounts and quality of each food consumed were recorded over three non-consecutive days and validated by two face-to-face interviews. RESULTS Overall, this study included 1035 children. Median DPI were consistently above the PRI, reaching 4 times PRI in the older toddlers (41.4 g/d; range 15.1-64.0). Regardless of age, more than 95% of children had a DPI/kg BW above the PRI. Protein intake remained below 14 E% until 6 months of age and increased thereafter from 10% to 75% in children older than one year. Overall, DPI gradually decreased from 1981 to 2013. Milk and dairy products were the main contributors to DPI up to 2 years, while the share of other animal sources became predominant later. Plant contribution remained below 25% of DPI. CONCLUSION Despite a gradual decrease over the last few decades, DPI have remained well above the PRI. As the predominant contributors to these intakes are animal sources, the potential long term health consequences of such high intake deserve consideration. CLINICAL TRIAL REGISTRY NUMBER NCT03327415 on ClinicalTrials.gov.
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Affiliation(s)
- Jean-Pierre Chouraqui
- Paediatric Nutrition and Gastroenterology, Division of Pediatrics, Woman, Mother and Child Department, Pediatric Nutrition and Gastroenterology Unit, University Hospital of Lausanne, Lausanne, Switzerland.
| | - Dominique Darmaun
- Nantes University, INRAE, IMAD, CRNH-Ouest, UMR 1280, (PhAN), & Nutrition Support Team, University Hospital, Nantes, France.
| | - Aurée Salmon-Legagneur
- CREDOC (Centre de Recherche pour L'Étude et L'Observation des Conditions de Vie), 75013 Paris, France.
| | - Raanan Shamir
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Israel.
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Lyons OC, Kerr MA, McNulty H, Ward F, Walton J, Livingstone MBE, McNulty BA, Kehoe L, Byrne PA, Saul I, Flynn MAT. Addressing nutrient shortfalls in 1- to 5-year-old Irish children using diet modeling: development of a protocol for use in country-specific population health. Am J Clin Nutr 2021; 115:105-117. [PMID: 34718385 PMCID: PMC8755081 DOI: 10.1093/ajcn/nqab311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/10/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Dietary habits formed in early childhood can track into later life with important impacts on health. Food-based dietary guidelines (FBDGs) may have a role in improving population health but are lacking for young children. OBJECTIVES We aimed to establish a protocol for addressing nutrient shortfalls in 1- to 5-y-old children (12-60 mo) using diet modeling in a population-based sample. METHODS Secondary analysis of 2010-2011 Irish National Pre-School Nutrition Survey data (n = 500) was conducted to identify typical food consumption patterns in 1- to 5-y-olds. Nutrient intakes were assessed against dietary reference values [European Food Safety Authority (EFSA) and Institute of Medicine (IOM)]. To address nutrient shortfalls using diet modeling, 4-d food patterns were developed to assess different milk-feeding scenarios (human milk, whole or low-fat cow milk, and fortified milks) within energy requirement ranges aligned with the WHO growth standards. FBDGs to address nutrient shortfalls were established based on 120 food patterns. RESULTS Current mean dietary intakes for the majority of 1- to 5-y-olds failed to meet reference values (EFSA) for vitamin D (≤100%), vitamin E (≤88%), DHA (22:6n-3) + EPA (20:5n-3) (IOM; ≤82%), and fiber (≤63%), whereas free sugars intakes exceeded recommendations of <10% energy (E) for 48% of 1- to 3-y-olds and 75% of 4- to 5-y-olds. "Human milk + Cow milk" was the only milk-feeding scenario modeled that predicted sufficient DHA + EPA among 1- to 3-y-olds. Vitamin D shortfalls were not correctable in any milk-feeding scenario, even with supplementation (5 µg/d), apart from the "Follow-up Formula + Fortified drink" scenario in 1- to 3-y-olds (albeit free sugars intakes were estimated at 12%E compared with ≤5%E as provided by other scenarios). Iron and vitamin E shortfalls were most prevalent in scenarios for 1- to 3-y-olds at ≤25th growth percentile. CONCLUSIONS Using WHO growth standards and international reference values, this study provides a protocol for addressing nutrient shortfalls among 1- to 5-y-olds, which could be applied in country-specific population health.
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Affiliation(s)
- Oonagh C Lyons
- Food Safety Authority of Ireland, Dublin, Ireland,Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, United Kingdom
| | - Maeve A Kerr
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, United Kingdom
| | - Helene McNulty
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, United Kingdom
| | - Fiona Ward
- Clinical Nutrition and Dietetics, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Janette Walton
- Department of Biological Sciences, Munster Technological University, Cork, Ireland
| | - M Barbara E Livingstone
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, United Kingdom
| | - Breige A McNulty
- UCD Institute of Food and Health, School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
| | - Laura Kehoe
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | | | - Ita Saul
- Clinical Nutrition and Dietetics, Children's Health Ireland at Crumlin, Dublin, Ireland
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12
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Taylor SN. Vitamin D in Toddlers, Preschool Children, and Adolescents. ANNALS OF NUTRITION AND METABOLISM 2020; 76 Suppl 2:30-41. [PMID: 33232959 DOI: 10.1159/000505635] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 12/14/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Vitamin D supplementation is known to both prevent and treat rickets, a disease of hypomineralized bone. Childhood is a period of great bone development and, therefore, attention to the vitamin D needed to optimize bone health in childhood is imperative. SUMMARY Observational studies have pointed to a vitamin D status, as indicated by a 25-hydroxyvitamin D concentration, of 50 nmol/L to ensure avoidance of rickets and of 75 nmol/L to optimize health. However, the benefits of achieving these levels of vitamin D status are less evident when pediatric randomized, controlled trials are performed. In fact, no specific pediatric vitamin D supplementation has been established by the existing evidence. Yet, study of vitamin D physiology continues to uncover further potential benefits to vitamin D sufficiency. This disconnection between vitamin D function and trials of supplementation has led to new paths of investigation, including establishment of the best method to measure vitamin D status, examination of genetic variation in vitamin D metabolism, and consideration that vitamin D status is a marker of another variable, such as physical activity, and its association with bone health. Nevertheless, vitamin D supplementation in the range of 10-50 μg/day appears to be safe for children and remains a promising intervention that may yet be supported by clinical trials as a method to optimize pediatric health. Key Message: Pediatric vitamin D status is associated with avoidance of rickets. Randomized, controlled trials of vitamin D supplementation for pediatric bone health are limited and equivocal in their results. Beyond bone, decreased risk for autoimmune, infectious, and allergic diseases has been associated with higher vitamin D status. The specific vitamin D supplementation to optimize toddler, child, and adolescent outcomes is unknown, but doses 10-50 μg/day are safe and may be beneficial.
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Affiliation(s)
- Sarah N Taylor
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA,
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13
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Bocquet A, Briend A, Chouraqui JP, Darmaun D, Feillet F, Frelut ML, Guimber D, Hankard R, Lapillonne A, Peretti N, Roze JC, Simeoni U, Turck D, Dupont C. The new European regulatory framework for infant and follow-on formulas: Comments from the Committee of Nutrition of the French Society of Pediatrics (CN-SFP). Arch Pediatr 2020; 27:351-353. [PMID: 33023722 DOI: 10.1016/j.arcped.2020.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- A Bocquet
- Université de Franche-Comté, 25000 Besançon, France; Association française de pédiatrie ambulatoire, 30, rue Émile-Zola, 45000 Orléans, France.
| | - A Briend
- Institut de recherche pour le développement, 13002 Marseille, France
| | - J-P Chouraqui
- Gastroentérologie et nutrition pédiatriques DMCP - CHUV, rue du Bugnon, 46, 1011 Lausanne, Switzerland
| | - D Darmaun
- Inra UMR1280, université Nantes-Atlantique, 44300 Nantes, France
| | - F Feillet
- Université de Lorraine, 54000 Nancy, France
| | - M-L Frelut
- Cabinet de pédiatrie, 16, rue Septfonds, 81000 Albi, France; Association française de pédiatrie ambulatoire, 30, rue Émile-Zola, 45000 Orléans, France
| | - D Guimber
- Université de Lille, 59000 Lille, France
| | - R Hankard
- Inserm U 1069, université de Tours, 37000 Tours, France
| | - A Lapillonne
- Hôpital Necker-Enfants-Malades, université de Paris-Descartes, 75006 Paris, France
| | - N Peretti
- CaRMEN, hospices civils de Lyon, université de Lyon, 69000 Lyon, France
| | - J-C Roze
- Inra UMR1280, université Nantes-Atlantique, 44300 Nantes, France
| | - U Simeoni
- Université of Lausanne, CHUV, 1011 Lausanne, Switzerland
| | - D Turck
- LIRIC-Inserm U995, université de Lille 2, 59037 Lille, France
| | - C Dupont
- Hôpital Necker-Enfants-Malades, université de Paris-Descartes, 75006 Paris, France; Clinique Marcel Sembat, 92100 Boulogne-Billancourt, France
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14
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Chouraqui JP, Tavoularis G, Turck D, Ferry C, Feillet F. Mineral and vitamin intake of infants and young children: the Nutri-Bébé 2013 survey. Eur J Nutr 2019; 59:2463-2480. [PMID: 31555975 DOI: 10.1007/s00394-019-02093-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 09/11/2019] [Indexed: 01/16/2023]
Abstract
PURPOSE Minerals and vitamins are essential for optimal growth and development, particularly during the first years of life. Therefore, regularly evaluating their intake makes sense. For this purpose, we report the data from the Nutri-Bébé 2013 survey in comparison with the European Food Safety Authority Adequate Intake (AI), or Average Requirement, (AR) according to age. METHODS This observational, nationally representative, cross-sectional survey was conducted in 1035 non-breastfed French children aged 0.5-35 months. Dietary intake was recorded using a food diary on three non-consecutive days, framed by two face-to-face interviews. RESULTS The intake of zinc, magnesium and water-soluble vitamins most of the time met the recommendations. From the first weeks of life, sodium intake exceeded the AI, with a maximum median intake of 1137 mg/day after the age of 30 months. However, it has decreased since 2005. Calcium median intake often exceeded the AI or AR, reaching a maximum of 780 mg/day between 18 and 23 months. Median vitamin A intake always exceeded the AI or AR but exceeded the recommended upper limit in only a few cases. After 2 years, median iron intake was clearly below the AR, i.e. lower than 6.0 mg/day. Dietary vitamin D intake was below the AI, thereby justifying adequate supplementation. Vitamin E intake was below the AI in 50-75% of toddlers. CONCLUSION This survey highlights excessive sodium intake as well as a shortfall of iron, vitamin D, and vitamin E intakes. The potential consequences of these discrepancies with respect to health outcomes remain to be assessed.
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Affiliation(s)
- Jean-Pierre Chouraqui
- Paediatric Nutrition and Gastroenterology, Medical and Surgical Department of Paediatrics, Centre Hospitalier Universitaire Vaudois, 21 rue du Bugnon, 1011, Lausanne, Switzerland.
| | - Gabriel Tavoularis
- CREDOC (Centre de Recherche pour l'Etude et l'Observation des Conditions de Vie), 142 rue du Chevaleret, 75013, Paris, France
| | - Dominique Turck
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Lille University Jeanne de Flandre Children's Hospital and Faculty of Medicine, University of Lille, INSERM U995, 59037, Lille, France
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15
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Chouraqui JP, Turck D, Tavoularis G, Ferry C, Dupont C. The Role of Young Child Formula in Ensuring a Balanced Diet in Young Children (1-3 Years Old). Nutrients 2019; 11:nu11092213. [PMID: 31540250 PMCID: PMC6770074 DOI: 10.3390/nu11092213] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 09/06/2019] [Accepted: 09/09/2019] [Indexed: 12/20/2022] Open
Abstract
During the nutritional vulnerable period of 1–3 years of age, nutrient intake is often inadequate due to an unbalanced diet. Young child formula (YCF) has been proposed as a means of improving nutrition in this age group. We compared the food consumption and nutrient intake of 241 YCF consumers (YCF-C) to those of 206 non-consumers (YCF-NC), selected from among the children enrolled in the Nutri-Bébé survey, an observational cross-sectional survey, conducted from 3 January to 21 April 2013. Food consumption and nutrient intake were analyzed from a three-day dietary record. The YCF-C < 2 years group had a protein (−8 g/d; p < 0.0001) and sodium (−18%; p = 0.0003) intake that was lower than that of YCF-NC, but still above the respective EFSA (European Food Safety Authority) Average Requirement (AR) or Adequate Intake (AI). At all ages, the YCF-C group had higher intakes of essential fatty acids (p < 0.0001), vitamins C (p < 0.0001), A, D, and E (p < 0.0001), all B vitamins (p < 0.001) except B12, iron (9 vs. 5 mg/d, p < 0.0001), reaching the Dietary Reference Values (DRVs, AR or AI), but similar DHA and ARA intakes. Getting closer to the reference values proposed by EFSA required at least 360 mL/d of YCF. The consumption of YCF may help infants and children at risk of nutrient deficiencies to meet their nutritional requirements. However, protein, sodium, and vitamin A intakes remained above the EFSA DRVs, and DHA, ARA, and vitamin D remained below.
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Affiliation(s)
- Jean-Pierre Chouraqui
- Paediatric Nutrition and Gastroenterology, Division of Pediatrics, Woman, Mother and Child Department, Centre Hospitalier Universitaire Vaudois (CHUV), 21 rue du Bugnon, 1011 Lausanne, Switzerland.
| | - Dominique Turck
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Lille University, 59037 Lille, France.
- Jeanne de Flandre Children's Hospital and Faculty of Medicine, University of Lille; INSERM U995, 59037 Lille, France .
| | - Gabriel Tavoularis
- CREDOC (Centre de Recherche pour l'Etude et l'Observation des Conditions de Vie), 142 rue du Chevaleret, 75013 Paris, France.
| | | | - Christophe Dupont
- Pediatric gastroenterology department, Necker Enfants-Malades Hospital, Paris Descartes University, 75015 Paris, France.
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