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Cozer AWD, Souza FCV, Santiago LD, Lima MR, Pimenta SJ, Fernandes BL, Enes BN, Gama RS, Gomides TAR. Effects of Iron-Fortified Foods on the Nutritional Status of Children Residing in Regions Vulnerable to Parasitic Diseases: A Systematic Review. Prev Nutr Food Sci 2024; 29:8-17. [PMID: 38576884 PMCID: PMC10987379 DOI: 10.3746/pnf.2024.29.1.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/09/2024] [Accepted: 02/22/2024] [Indexed: 04/06/2024] Open
Abstract
Parasitic infections (PIs) remain a public health concern among school-age children living in areas of greater socioeconomic vulnerability, especially in Brazil, Russia, India, China, and South Africa. PIs can promote nutritional deficiencies, increasing the risk of anemia and impaired physical and cognitive development. Thus, fortified foods have been considered as a promising strategy for improving the nutritional status of children and preventing PI complications. This systematic review aimed to present the effects of iron-fortified foods for deworming and improving blood parameters in schoolchildren residing in areas that are vulnerable to PIs. This review is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines of randomized clinical trials addressing the use of fortified foods and micronutrients in children living in areas endemic for PIs. The PubMed, LILACS, Scopus, and Cochrane databases were searched to identify articles published between 2000 and 2020. A total of 153 records were retrieved from the databases, 10 of which were considered eligible for this study. On the basis of our analysis, most of the selected studies showed that the inclusion of fortified foods in the diet improved blood and infectious parameters. Therefore, fortified foods can be used as an important tool for controlling the adverse outcomes of PIs among children living in areas of greater vulnerability. However, more studies on this topic are needed to provide more evidence and consolidate strategies using iron-fortified food.
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Affiliation(s)
| | | | | | - Marlucy Rodrigues Lima
- Department of Pharmacy, Vale do Rio Doce University, Governador Valadares - MG 35020-220, Brazil
| | - Sabrina Julie Pimenta
- Department of Dentistry, Vale do Rio Doce University, Governador Valadares - MG 35020-220, Brazil
| | - Bárbara Leles Fernandes
- Department of Pharmacy, Vale do Rio Doce University, Governador Valadares - MG 35020-220, Brazil
| | - Barbara Nery Enes
- Department of Nutrition, Vale do Rio Doce University, Governador Valadares - MG 35020-220, Brazil
| | - Rafael Silva Gama
- Department of Pharmacy, Vale do Rio Doce University, Governador Valadares - MG 35020-220, Brazil
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Azupogo F, Abizari AR, Feskens EJM, Verhoef H, Brouwer ID. Ten2Twenty-Ghana: a randomised controlled trial on the efficacy of multiple micronutrient-fortified biscuits on the micronutrient status of adolescent girls. Br J Nutr 2024; 131:707-719. [PMID: 37795629 PMCID: PMC10803820 DOI: 10.1017/s0007114523002234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/23/2023] [Accepted: 10/02/2023] [Indexed: 10/06/2023]
Abstract
Adolescent girls are an important target group for micronutrient interventions particularly in Sub-Saharan Africa where adolescent pregnancy and micronutrient deficiencies are common. When consumed in sufficient amounts and at levels appropriate for the population, fortified foods may be a useful strategy for this group, but little is known about their effectiveness and timing (regarding menarche), particularly in resource-poor environments. We evaluated the effect of consuming multiple micronutrient-fortified biscuits (MMB), sold in the Ghanaian market, 5 d/week for 26 weeks compared with unfortified biscuits (UB) on the micronutrient status of female adolescents. We also explored to what extent the intervention effect varied before or after menarche. Ten2Twenty-Ghana was a 26-week double-blind, randomised controlled trial among adolescent girls aged 10-17 years (n 621) in the Mion District, Ghana. Biomarkers of micronutrient status included concentrations of Hb, plasma ferritin (PF), soluble transferrin receptor (TfR) and retinol-binding protein (RBP), including body-iron stores. Intention-to-treat analysis was supplemented by protocol-specific analysis. We found no effect of the intervention on PF, TfR and RBP. MMB consumption did not affect anaemia and micronutrient deficiencies at the population level. MMB consumption increased the prevalence of vitamin A deficiency by 6·2 % (95 % CI (0·7, 11·6)) among pre-menarche girls when adjusted for baseline micronutrient status, age and height-for-age Z-score, but it decreased the prevalence of deficient/low vitamin A status by -9·6 % (95 % CI (-18·9, -0·3)) among post-menarche girls. Consuming MMB available in the market did not increase iron status in our study, but reduced the prevalence of deficient/low vitamin A status in post-menarcheal girls.
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Affiliation(s)
- Fusta Azupogo
- Department of Family and Consumer Sciences, Faculty of Agriculture, Food and Consumer Sciences, University for Development Studies, Tamale, 1882, Ghana
- Institute for Global Nutrition, University of California, Davis, USA
| | - Abdul-Razak Abizari
- Formerly of the Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Edith J. M. Feskens
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Hans Verhoef
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Inge D. Brouwer
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
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Vítolo MR, Baratto PS, Sangalli CN, Leffa PDS, Valmorbida JL. [The use of ultra-processed foods as a source of micronutrients for children: risk of toxicity?]. CAD SAUDE PUBLICA 2024; 39:e00203323. [PMID: 38198365 PMCID: PMC10775964 DOI: 10.1590/0102-311xpt203323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/24/2023] [Indexed: 01/12/2024] Open
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Kotnik KZ, Seljak BK, Gregorič M, Jurak G, Golja P. Questionable advisability of vitamin and mineral dietary supplement use in adolescents. BMC Nutr 2023; 9:110. [PMID: 37770942 PMCID: PMC10537492 DOI: 10.1186/s40795-023-00768-z] [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: 02/03/2023] [Accepted: 09/19/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVE Present study aimed to assess potential health risk in Slovenian adolescents due to inadequate diet and/or dietary supplement (DS) use. METHODS Data on DS use, micronutrient intake (24-h recall), eating habits (FFQ), body height and mass were collected within ACDSi (Analysis of Children's Development in Slovenia) cross-sectional study conducted in 2014. Adolescents enrolled in first year of 15 secondary schools (average (SD) age: 15.4 (0.7) years, N = 342) were included in the sample. RESULTS Adolescents' use of DS (especially multivitamins ingested as a popular drink (60%), magnesium (16%), and vitamin C (10%)) significantly contributed to their absolute intake of vitamins/minerals, resulting in higher percentage of DS users meeting reference values proposed by the nutrition societies of Germany, Austria, and Switzerland (D-A-CH recommendation). Simultaneously, DS users did not exceed the upper tolerable level proposed by the European Food Safety Authority for daily intake. With diet alone, adolescents consumed less than recommended amounts of the following vitamins/minerals: the intake was lowest for fat-soluble vitamins A, D, and E; water-soluble vitamins folate, biotin, and pantothenic acid; and minerals fluoride, iodine, chromium, and molybdenum. Suboptimal intake was due to the fact that around ¾ of adolescents consumed less than 54% of the recommended amounts (according to Optimized Mixed Diet (OMD) recommendations) for fruits, vegetables, milk/dairy products, fish, and cereals/cereal products. In contrast, the diet contributed to the consumption of 200-300% of D-A-CH minimum value for sodium. Furthermore, almost ¾ of adolescents exceeded the recommended amount for meat/meat products (320% of OMD) and sweet/salty snacks (453% of OMD). CONCLUSIONS Although DS use improved micronutrient intake in adolescents (especially vitamin C and magnesium), activities on public-health interventions should be focus to improve their diets, especially to achieve increased intakes of fruits, vegetables, cereals/cereal products and milk/dairy products, and to reduce consumption of sweet/salty snacks and meat products.
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Affiliation(s)
- Katja Zdešar Kotnik
- Biotechnical Faculty, Department of Biology, University of Ljubljana, Vecna pot 111, Ljubljana, SI-1000 Slovenia
| | | | - Matej Gregorič
- National Institute of Public Health, Ljubljana, Slovenia
| | - Gregor Jurak
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Petra Golja
- Biotechnical Faculty, Department of Biology, University of Ljubljana, Vecna pot 111, Ljubljana, SI-1000 Slovenia
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O'Connor LE, Martinez-Steele E, Wang L, Zhang FF, Herrick KA. Food Processing, According to the Nova Classification System, and Dietary Intake of US Infants and Toddlers. J Nutr 2023; 153:2413-2420. [PMID: 37343626 PMCID: PMC10447614 DOI: 10.1016/j.tjnut.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/25/2023] [Accepted: 06/16/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND High intake of ultra-processed foods (UPFs) is associated with increased risk of chronic disease; thus, it is important to understand how UPFs influence diet quality early in life. OBJECTIVES We describe complementary foods and beverages (CFBs) according to the Nova Classification System of Food Processing for infants and toddlers in the United States and estimate how Nova groups and subgroups contribute to energy and select nutrients and food groups. METHODS We used day 1 24-h recall from infants and toddlers aged 6-23 mo from the cross-sectional, nationally representative 2013-18 National Health and Nutrition Examination Survey (n = 1140). We estimated contributions of Nova groups and subgroups to energy and select nutrients and food groups consumed as CFBs (excluding human milk and formula) using the population ratio with weighted survey commands in SAS. RESULTS For infants and toddlers in the United States, 42 ± 0.9% (mean ± standard error of the mean) of energy intake from CFBs came from unprocessed/minimally processed foods (U/MPFs) and 45 ± 0.8% from UPFs. U/MPFs contributed most to nutrient intakes (except iron, zinc, and sodium); ≥20% of all selected nutrients was from UPFs. UPFs contributed most to iron (75 ± 1.0%) and zinc (48 ± 1.3%); breakfast cereals were the top source. Most fruit, vegetables, and dairy were from U/MPFs. More than 80% of total grains, whole grains, refined grains, and added sugars were UPFs. CONCLUSIONS U/MPFs support healthy dietary intake of infants and toddlers in the United States, whereas UPFs contribute meaningfully to nutrients and food groups to be encouraged (iron, zinc, and whole grains), as well as some that should be limited (added sugars and sodium). More research is needed to better understand the utility and sensitivities of using Nova for providing dietary guidance for infants and toddlers in the United States.
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Affiliation(s)
- Lauren E O'Connor
- Beltsville Human Nutrition Research Center, Agricultural Research Service, United States Department of Agriculture, Beltsville, MD, United States; Division of Cancer Control and Population Sciences, Risk Factors Assessment Branch, National Cancer Institute, National Institutes of Health, Rockville, MD, United States.
| | | | - Lu Wang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Kirsten A Herrick
- Division of Cancer Control and Population Sciences, Risk Factors Assessment Branch, National Cancer Institute, National Institutes of Health, Rockville, MD, United States
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Van Hoorn M, Feuling MB, Allen K, Berry R, Brown S, Sullivan CM, Goday PS. Evaluation and Management of Reduced Dietary Diversity in Children with Pediatric Feeding Disorder. J Autism Dev Disord 2023; 53:1290-1297. [PMID: 35996036 DOI: 10.1007/s10803-022-05715-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2022] [Indexed: 11/25/2022]
Abstract
Pediatric Feeding Disorder, a common problem in children, is commoner in children with various developmental disorders. Children with pediatric feeding disorder can have food selectivity and lack dietary diversity (DD). In this paper, an understanding of DD in these children is provided along with a dietary diversity index that can be helpful in measuring and understanding the risks posed by this lack of DD. An overview of a management strategy to address decreased DD is proposed. In these children, improving DD can improve growth, micronutrient status, long-term metabolic health, and potentially quality of life.
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Affiliation(s)
- Megan Van Hoorn
- Children's Wisconsin, 9000 W Wisconsin Ave, MS B610, Milwaukee, WI, 53226, USA
| | - Mary Beth Feuling
- Research and Technology, Children's Wisconsin, 9000 W Wisconsin Ave, MS B610, Milwaukee, WI, 53226, USA
| | - Kim Allen
- Peyton Manning Children's Hospital Center, 3900 Washington Ave, Evansville, IN, 47714, USA
| | - Rashelle Berry
- Children's Healthcare of Atlanta, 1400 Tullie Road, Atlanta, GA, 30329, USA
| | - Shonda Brown
- CHOC Children's, 27700 Medical Center Road, 5th Floor, Mission Viejo, CA, 92691, USA
| | - Christine M Sullivan
- Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Praveen S Goday
- Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
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Calvo MS, Whiting SJ. Perspective: School Meal Programs Require Higher Vitamin D Fortification Levels in Milk Products and Plant-Based Alternatives-Evidence from the National Health and Nutrition Examination Surveys (NHANES 2001-2018). Adv Nutr 2022; 13:1440-1449. [PMID: 35671093 PMCID: PMC9526833 DOI: 10.1093/advances/nmac068] [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: 03/02/2022] [Revised: 05/25/2022] [Accepted: 06/02/2022] [Indexed: 01/28/2023] Open
Abstract
Poor vitamin D status impairs bone growth and immune defense in school-aged children and adolescents, particularly in minorities. Vitamin D insufficiency/deficiency increases the risk of acute viral respiratory infection, underscoring the need for adequate vitamin D intakes during school sessions when viral exposure may be greatest. We studied available vitamin D-related survey data and published findings based on NHANES (2001-2018) to assess the dependency of vitamin D status {25-hydroxyvitamin D [25(OH)D]; in nmol/L} on vitamin D intake (μg/d) in elementary school-aged children (4-8 y), middle school children (9-13 y), and high school adolescents (14-18 y). We sought evidence supporting the need for school programs to facilitate vitamin D adequacy. Usual vitamin D intakes from food and beverages by children/adolescents (NHANES 2015-2018) examined at the 50th percentile intake by race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic) showed all age groups consumed less than half of the Estimated Average Requirement (EAR) for vitamin D (10 μg/d), independent of race/ethnicity. NHANES (2001-2010) analyses show evidence of lower vitamin D status in school-aged children that is linked to lower intakes of fortified milk varying over race/ethnicity and age. Adolescents had lower vitamin D status and milk intake than younger children. A total of 22-44% of vitamin D intakes occurred away from home, with larger percentages of total intakes at breakfast and lunch, at times consistent with school meals. Ever-present inadequate vitamin D intakes with a large percentage consumed away from home together with well-established benefits to growth, bone, and immune defense from enriched vitamin D-fortified milk in school intervention trials provide strong justification to require enriched vitamin D-fortified foods in school meals. An easy to implement plan for improving vitamin D intakes is possible through the FDA's amendment allowing higher vitamin D fortification levels of dairy and plant-based milk alternatives that could increase vitamin D intakes beyond the EAR with just 2 daily servings.
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Affiliation(s)
- Mona S Calvo
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Animal board invited review: Animal source foods in healthy, sustainable, and ethical diets - An argument against drastic limitation of livestock in the food system. Animal 2022; 16:100457. [PMID: 35158307 DOI: 10.1016/j.animal.2022.100457] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 02/07/2023] Open
Abstract
Animal source foods are evolutionarily appropriate foods for humans. It is therefore remarkable that they are now presented by some as unhealthy, unsustainable, and unethical, particularly in the urban West. The benefits of consuming them are nonetheless substantial, as they offer a wide spectrum of nutrients that are needed for cell and tissue development, function, and survival. They play a role in proper physical and cognitive development of infants, children, and adolescents, and help promote maintenance of physical function with ageing. While high-red meat consumption in the West is associated with several forms of chronic disease, these associations remain uncertain in other cultural contexts or when consumption is part of wholesome diets. Besides health concerns, there is also widespread anxiety about the environmental impacts of animal source foods. Although several production methods are detrimental (intensive cropping for feed, overgrazing, deforestation, water pollution, etc.) and require substantial mitigation, damaging impacts are not intrinsic to animal husbandry. When well-managed, livestock farming contributes to ecosystem management and soil health, while delivering high-quality foodstuffs through the upcycling of resources that are otherwise non-suitable for food production, making use of marginal land and inedible materials (forage, by-products, etc.), integrating livestock and crop farming where possible has the potential to benefit plant food production through enhanced nutrient recycling, while minimising external input needs such as fertilisers and pesticides. Moreover, the impacts on land use, water wastage, and greenhouse gas emissions are highly contextual, and their estimation is often erroneous due to a reductionist use of metrics. Similarly, whether animal husbandry is ethical or not depends on practical specificities, not on the fact that animals are involved. Such discussions also need to factor in that animal husbandry plays an important role in culture, societal well-being, food security, and the provision of livelihoods. We seize this opportunity to argue for less preconceived assumptions about alleged effects of animal source foods on the health of the planet and the humans and animals involved, for less top-down planning based on isolated metrics or (Western) technocratic perspectives, and for more holistic and circumstantial approaches to the food system.
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Applicability of Food Grade Modified Starches as a Carrier of Microelements. Processes (Basel) 2022. [DOI: 10.3390/pr10020235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Growth in the human population and intensive, large-scale farming results in a lowering in the quality of nutrition. An oversupply of food energy is often accompanied with a deficiency in micronutrients. To address this problem, the food industry provides products enriched with bioactive substances. The main challenge of this technology is the even distribution of micronutrients in the matrix of the fortified food. A possible solution to this challenge is to use stable and effective carriers. The aim of this work was to verify the applicability of native potato starch and modified starches (commonly used in the food industry) as carriers for microelements. Adsorptions were carried out in starch suspensions at a temperature below gelatinisation. The native potato starch and the modified starches (E 1404, E 1412, E 1420, and E 1422) were assessed for their effectiveness in adsorbing copper, iron, and zinc sulphates or gluconates. Pasting characteristics were analysed using a Brabender viscograph and light microscopy. Furthermore, texture profile analysis of starch-based desserts was carried out with the use of the tested carriers. Starch in both its native and modified forms was able to effectively adsorb copper, iron, and zinc ions. Adsorption was more efficient when using modified starches containing hydrophilic carboxyl groups. The effectiveness of adsorption with oxidised starches increased with an increase in the degree of substitution. Starches containing more hydrophobic acetyl groups were less effective as adsorbents of microelements. The cation adsorption efficiency decreased in the order copper > iron > zinc, and sulphates were better adsorbed than gluconates. Copper ions influenced the pasting characteristics of the oxidised starches, and these effects were dependent on the degree of substitution with carboxyl groups. As observed by light microscopy, the presence of copper ions changes the interaction between the starch macromolecules and water. However, the above-mentioned changes did not significantly affect the texture of traditional sweet desserts. Starch, particularly its oxidised derivatives containing hydrophilic oxidised groups, can be recommended as a carrier of microelements for food fortification. The use of modified starches containing relatively hydrophobic acetyl groups is not appropriate because they absorb microelements less efficiently than native starch.
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Biological Properties of Vitamins of the B-Complex, Part 1: Vitamins B1, B2, B3, and B5. Nutrients 2022; 14:nu14030484. [PMID: 35276844 PMCID: PMC8839250 DOI: 10.3390/nu14030484] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/16/2022] [Accepted: 01/17/2022] [Indexed: 02/06/2023] Open
Abstract
This review summarizes the current knowledge on essential vitamins B1, B2, B3, and B5. These B-complex vitamins must be taken from diet, with the exception of vitamin B3, that can also be synthetized from amino acid tryptophan. All of these vitamins are water soluble, which determines their main properties, namely: they are partly lost when food is washed or boiled since they migrate to the water; the requirement of membrane transporters for their permeation into the cells; and their safety since any excess is rapidly eliminated via the kidney. The therapeutic use of B-complex vitamins is mostly limited to hypovitaminoses or similar conditions, but, as they are generally very safe, they have also been examined in other pathological conditions. Nicotinic acid, a form of vitamin B3, is the only exception because it is a known hypolipidemic agent in gram doses. The article also sums up: (i) the current methods for detection of the vitamins of the B-complex in biological fluids; (ii) the food and other sources of these vitamins including the effect of common processing and storage methods on their content; and (iii) their physiological function.
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de Jong MH, Nawijn EL, Verkaik-Kloosterman J. Contribution of voluntary fortified foods to micronutrient intake in The Netherlands. Eur J Nutr 2022; 61:1649-1663. [PMID: 34973066 PMCID: PMC8921121 DOI: 10.1007/s00394-021-02728-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/27/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE In the Netherlands, voluntary fortification of foods with micronutrients is allowed under strict regulations. This study investigates the impact of voluntary food fortification practices in the Netherlands on the frequency and type of fortified food consumption and on the micronutrient intakes of the Dutch population. METHODS Data of the Dutch National Food Consumption Survey (2012-2016; N = 4314; 1-79 year) and the Dutch Food Composition Database (NEVO version 2016) was used. To determine if voluntary fortified foods could be classified as healthy foods, criteria of the Dutch Wheel of Five were used. Habitual intakes of users and non-users of voluntary food fortification were calculated using Statistical Program to Assess Dietary Exposure (SPADE) and compared. RESULTS Within the Dutch population, 75% could be classified as user of voluntary fortified foods. Consumed voluntary fortified foods were mostly within food groups 'Fats and Oils', 'Non-alcoholic Beverages' and 'Dairy products and Substitutes' and fell mostly outside the Wheel of Five. Voluntary foods contributed between 9 and 78% to total micronutrient intake of users. Users had up to 64% higher habitual micronutrient intakes, compared to non-users. These higher intakes resulted into lower risks on inadequate intakes, and did not contribute to increased risks of excessive intakes. CONCLUSION Although voluntary fortified foods increased micronutrient intakes, most of these foods cannot be classified as healthy foods. Future studies should study the association between higher micronutrient intakes and (potential) excessive intakes of e.g. saturated fat and sugar to better understand the role of voluntary fortified foods in a healthy food pattern.
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Affiliation(s)
- Marjolein H de Jong
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
| | - Eline L Nawijn
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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Chopra AS, Lordan R, Horbańczuk OK, Atanasov AG, Chopra I, Horbańczuk JO, Jóźwik A, Huang L, Pirgozliev V, Banach M, Battino M, Arkells N. The current use and evolving landscape of nutraceuticals. Pharmacol Res 2021; 175:106001. [PMID: 34826602 DOI: 10.1016/j.phrs.2021.106001] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 12/13/2022]
Abstract
The nutraceutical market is currently a high-impact multi-billion-dollar industry, and it is anticipated to grow rapidly over the next decade. Nutraceuticals comprise diverse food-derived product categories that have become widespread due to increased consumer awareness of potential health benefits and the need for improved wellness. This targeted review is designed to identify the current global trends, market opportunities, and regulations that drive the nutraceutical industry. Safety and efficacy concerns are also explored with a view to highlighting areas that necessitate further research and oversight. Key drivers of the nutraceutical market include aging populations, consumer awareness, consumer lifestyle, increasing cost of healthcare, and marketing channels. Although some nutraceuticals hold promising preventive and therapeutic opportunities, there is a lack of a universal definition and regulatory framework among countries. Moreover, there is a lack of adequate evidence for their efficacy, safety, and effectiveness, which was even further highlighted during the ongoing coronavirus pandemic. Future prospective epidemiological studies can delineate the health impact of nutraceuticals and help set the scientific basis and rationale foundation for clinical trials, reducing the time and cost of trials themselves. Together, an understanding of the key drivers of the nutraceutical market alongside a consistent and well-defined regulatory framework will provide further opportunities for growth, expansion, and segmentation of nutraceuticals applications.
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Affiliation(s)
| | - Ronan Lordan
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
| | - Olaf K Horbańczuk
- Warsaw University of Life Sciences, Faculty of Human Nutrition, Nowoursynowska 159 C, 02-776 Warsaw, Poland.
| | - Atanas G Atanasov
- Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, 05-552 Jastrzebiec, Poland; Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria.
| | | | - Jarosław O Horbańczuk
- Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, 05-552 Jastrzebiec, Poland
| | - Artur Jóźwik
- Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, 05-552 Jastrzebiec, Poland
| | - Linfang Huang
- Institute of Medicinal Plant Development (IMPLAD), Peking Union Medical College, Chinese Academy of Medical Sciences (CAMS), Beijing, PR China
| | - Vasil Pirgozliev
- National Institute of Poultry Husbandry, Harper Adams University, Shropshire TF10 8NB, UK
| | - Maciej Banach
- Department of Preventative Cardiology and Lipidology, Medical University of Lodz, Lodz, Poland
| | - Maurizio Battino
- Department of Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy; International Research Center for Food Nutrition and Safety, Jiangsu University, Zhenjiang, PR China
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Tarasuk V, Brassard D. The effect of consuming voluntarily fortified food and beverages on usual nutrient intakes in the Canadian population. Food Nutr Res 2021; 65:5256. [PMID: 34650396 PMCID: PMC8494267 DOI: 10.29219/fnr.v65.5256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 03/31/2021] [Accepted: 08/30/2021] [Indexed: 11/20/2022] Open
Abstract
Background In Canada, regulatory changes have expanded marketing opportunities for voluntarily fortified products (VFPs), with micronutrient additions permitted at levels well in excess of human requirements. Objective To examine how the consumption of VFPs relates to usual nutrient intakes in the Canadian population. Design The 2015 Canadian Community Health Survey comprises single 24-h dietary intake recalls on a population-representative sample of 20,487 individuals aged 1 year and older, with second recalls on a subset of 7,608. The intake data included 15 food codes denoting VFP (e.g. energy drinks, fortified beverages, cereals, and bars). We assessed VFP consumption and estimated usual intake distributions for riboflavin, niacin, zinc, and vitamins A, B6, B12, and C for VFP consumers and non-consumers 14–50 years old (n = 8,442) using the National Cancer Institute method. We applied the ‘shrink and add’ method to estimate usual intakes among supplement users and assessed apparent benefits and risks by comparing usual intake distributions to EARs and ULs. Results Only 2.4% of the population reported any consumption of VFP on the first 24-h recall. VFP consumers were overrepresented in the upper quartile of population intake distributions for niacin, riboflavin, vitamin B6, vitamin B12, and zinc. The median usual intakes of VFP consumers were 24–111% higher than the median usual intakes of non-consumers, and VFP consumers had significantly lower prevalence of inadequacy for riboflavin and vitamins A, B6, B12, and C. Irrespective of VFP consumption, usual intake distributions reached the ULs for vitamin A and zinc with the addition of supplement intakes. Discussion Given the limited differentiation of VFP in this survey, we have likely underestimated nutrient exposure levels. Conclusions VFP consumption was associated with elevated usual nutrient intakes, but we found limited evidence that it protected consumers from nutrient inadequacies or propelled intakes above tolerable upper levels.
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Affiliation(s)
- Valerie Tarasuk
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
| | - Didier Brassard
- Centre Nutrition, santé et société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, Canada
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Jun S, Cowan AE, Dodd KW, Tooze JA, Gahche JJ, Eicher-Miller HA, Guenther PM, Dwyer JT, Potischman N, Bhadra A, Forman MR, Bailey RL. Association of food insecurity with dietary intakes and nutritional biomarkers among US children, National Health and Nutrition Examination Survey (NHANES) 2011-2016. Am J Clin Nutr 2021; 114:1059-1069. [PMID: 33964856 PMCID: PMC8408856 DOI: 10.1093/ajcn/nqab113] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/16/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Food insecurity is associated with poorer nutrient intakes from food sources and lower dietary supplement use. However, its association with total usual nutrient intakes, inclusive of dietary supplements, and biomarkers of nutritional status among US children remains unknown. OBJECTIVE The objective was to assess total usual nutrient intakes, Healthy Eating Index-2015 (HEI-2015) scores, and nutritional biomarkers by food security status, sex, and age among US children. METHODS Cross-sectional data from 9147 children aged 1-18 y from the 2011-2016 NHANES were analyzed. Usual energy and total nutrient intakes and HEI-2015 scores were estimated using the National Cancer Institute method from 24-h dietary recalls. RESULTS Overall diet quality was poor, and intakes of sodium, added sugars, and saturated fat were higher than recommended limits, regardless of food security status. Food-insecure girls and boys were at higher risk of inadequate intakes for vitamin D and magnesium, and girls also had higher risk for inadequate calcium intakes compared with their food-secure counterparts, when total intakes were examined. Choline intakes of food-insecure children were less likely to meet the adequate intake than those of their food-secure peers. No differences by food security status were noted for folate, vitamin C, iron, zinc, potassium, and sodium intakes. Food-insecure adolescent girls aged 14-18 y were at higher risk of micronutrient inadequacies than any other subgroup, with 92.8% (SE: 3.6%) at risk of inadequate intakes for vitamin D. No differences in biomarkers for vitamin D, folate, iron, and zinc were observed by food security status. The prevalence of iron deficiency was 12.7% in food-secure and 12.0% in food-insecure adolescent girls. CONCLUSIONS Food insecurity was associated with compromised intake of some micronutrients, especially among adolescent girls. These results highlight a need for targeted interventions to improve children's overall diet quality, including the reduction of specific nutrient inadequacies, especially among food-insecure children. This study was registered at clinicaltrials.gov as NCT03400436.
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Affiliation(s)
- Shinyoung Jun
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - Alexandra E Cowan
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - Kevin W Dodd
- National Cancer Institute, NIH, Bethesda, MD, USA
| | - Janet A Tooze
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | | | - Patricia M Guenther
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, USA
| | - Johanna T Dwyer
- Office of Dietary Supplements, NIH, Bethesda, MD, USA
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | | | - Anindya Bhadra
- Department of Statistics, Purdue University, West Lafayette, IN, USA
| | - Michele R Forman
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - Regan L Bailey
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
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15
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Gomes F, Bergeron G, Bourassa MW, Fischer PR. Thiamine deficiency unrelated to alcohol consumption in high-income countries: a literature review. Ann N Y Acad Sci 2021; 1498:46-56. [PMID: 33576090 PMCID: PMC8451800 DOI: 10.1111/nyas.14569] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/08/2021] [Accepted: 01/19/2021] [Indexed: 12/12/2022]
Abstract
Thiamine deficiency has been typically associated with alcoholism or as a prevalent problem in low‐ and middle‐income countries (LMICs) whose populations rely on staple foods with a low content of thiamine. We conducted a literature review of published and unpublished data to identify relevant adult cases with confirmed thiamine deficiency of nonalcoholic cause in developed countries. We selected 17 reports with 81 adult cases of confirmed thiamine deficiency affecting adult patients with a wide range of ages and underlying conditions (e.g., cancer, gastrointestinal diseases, heart failure, and obesity). Thiamine deficiency may have been caused by disease‐related malnutrition, bariatric surgery, chronic use of diuretics, repeated vomiting, lack of thiamine in parenteral nutrition formulas, food insecurity, and reliance on monotonous or restrictive diets. Treatment with intravenous thiamine resulted in partial or complete recovery from the symptoms (cardiac, neurologic, and metabolic disorders) for most patients. The number and variety of symptomatic thiamine‐deficient adults identified in this review demonstrates that thiamine deficiency is not exclusive to LMICs and, in high‐income settings, is not exclusive to alcoholic patients. In developed countries, this serious but treatable condition can be expected in patients suffering from various medical conditions or following certain dietary patterns.
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Affiliation(s)
| | | | | | - Philip R Fischer
- Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota.,Department of Pediatrics, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
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16
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Azupogo F, Abizari AR, Osendarp SJM, Feskens EJ, Brouwer ID. Ten2Twenty-Ghana: Study Design and Methods for an Innovative Randomized Controlled Trial with Multiple-Micronutrient-Fortified Biscuits among Adolescent Girls in Northeastern Ghana. Curr Dev Nutr 2021; 5:nzaa184. [PMID: 33604499 PMCID: PMC7880270 DOI: 10.1093/cdn/nzaa184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/24/2020] [Accepted: 12/30/2020] [Indexed: 02/04/2023] Open
Abstract
Investing in adolescent girls' nutrition is vital for health and for breaking the intergenerational cycle of malnutrition and deprivation, but limited knowledge on the type, timing, and efficacy of interventions delays progress. We describe the design of a 26-wk randomized placebo-controlled trial with multiple-micronutrient-fortified biscuits (MMBs) among adolescent girls in northeastern Ghana. Apparently healthy, premenarche (n = 312) and postmenarche (n = 309) girls (10-17 y) were randomly assigned to receive the following for 5 d/wk: 1) MMBs (fortified with 11 vitamins and 7 minerals) or 2) unfortified biscuits. Data included plasma micronutrient status, anthropometry, body composition, cognitive function, psychosocial health, fertility, dietary intake, and sociodemographic and socioeconomic covariates, complemented with in-depth interviews (n = 30) and 4 focus group discussions. We hypothesized an increase in plasma ferritin and retinol-binding protein with a resultant increase in hemoglobin, cognition, vertical height, and psychosocial health. Our study seeks to investigate the efficacy and optimal timing of a multiple-micronutrient food intervention program for adolescent girls. The RCT was registered prospectively with the Netherlands Clinical Trials Register (NL7487).
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Affiliation(s)
- Fusta Azupogo
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
- Department of Family and Consumer Sciences, Faculty of Agriculture, Food, and Consumer Sciences, University for Development Studies, Tamale, Ghana
| | - Abdul-Razak Abizari
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Saskia J M Osendarp
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
- Micronutrient Forum, Washington, DC, USA
| | - Edith J Feskens
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Inge D Brouwer
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
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17
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Smith TJ, Hess SY. Infantile thiamine deficiency in South and Southeast Asia: An age-old problem needing new solutions. NUTR BULL 2021; 46:12-25. [PMID: 33776582 PMCID: PMC7986856 DOI: 10.1111/nbu.12481] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/23/2020] [Accepted: 12/22/2020] [Indexed: 12/29/2022]
Abstract
Infantile beriberi, a potentially fatal disorder caused by thiamine deficiency, is often viewed as a disease confined to history in regions of the world with predominant white rice consumption. Recent case reports have, however, highlighted the persistence of thiamine deficiency as a cause of infant mortality in South and Southeast Asia. Low infant thiamine status and incidence of beriberi is attributable to maternal thiamine deficiency and insufficient breast milk thiamine. Poor dietary diversity, food preparation and cooking practices and traditional post‐partum food restrictions likely play a role in these high‐risk regions. Given the contribution of thiamine deficiency to infant mortality and emerging evidence of long‐lasting neurodevelopmental deficits of severe and even subclinical deficiency in early life, public health strategies to prevent thiamine deficiency are urgently needed. However, efforts are hampered by uncertainties surrounding the identification and assessment of thiamine deficiency, due to the broad non‐specific clinical manifestations, commonly referred to as thiamine deficiency disorders (TDD), that overlap with other conditions resulting in frequent misdiagnosis and missed treatment opportunities, and secondly the lack of readily available and agreed upon biomarker analysis and cut‐off thresholds. This review will discuss the key challenges and limitations in the current understanding of TDD and explore how ongoing initiatives plan to fill persistent knowledge gaps, namely in the development of a standardised case definition to help more accurately diagnose and treat TDD in low‐resource settings. Given more attention and ensuring greater recognition of TDD will support the design and implementation of treatment and prevention programmes, and ensure beriberi can truly be considered ‘the forgotten disease of Asia’.
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Affiliation(s)
- T J Smith
- Institute for Global Nutrition University of California Davis Davis CA USA
| | - S Y Hess
- Institute for Global Nutrition University of California Davis Davis CA USA
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18
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The diets of children: Overview of available data for children and adolescents. GLOBAL FOOD SECURITY 2020. [DOI: 10.1016/j.gfs.2020.100442] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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19
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Sicińska E, Pietruszka B, Januszko O, Jakubowski S, Kielak-Biskupska K, Rolf K, Kaluza J. Intake of Vitamins and Minerals From Voluntarily Fortified Foods and/or Dietary Supplements in School Adolescents in Central-Eastern Poland. Front Public Health 2020; 8:504015. [PMID: 33163469 PMCID: PMC7581890 DOI: 10.3389/fpubh.2020.504015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 09/08/2020] [Indexed: 11/16/2022] Open
Abstract
Background: The key issue is whether voluntarily fortified foods and vitamin/mineral supplements available on the market serve public health needs. The study aim was to estimate nutrient intakes from voluntarily fortified foods and vitamin/mineral supplements in relation to the Dietary Reference Intake (DRI) in adolescents (n = 759) aged 13–19 who attended public secondary schools in Central-Eastern Poland. Methods: Data on the consumption of voluntarily fortified foods were collected using a semi-quantitative food frequency questionnaire containing 58 food items. Data on the use of dietary supplements were assessed via an open-ended question. The content of nutrients was estimated using the producer's labeling declaration. The distribution of nutrient intakes according to the percentage of DRI categories (<20%, 20–39.9%, 40–59.9%, 60–79.9%, 80–99.9%, 100–119%, or >120%) was estimated. Results: Consumption of voluntarily fortified foods was a common behavior in adolescents (86.7% of participants), while vitamin/mineral supplements were used by less than one-fifth of them (17.7%). The amounts of nutrient intakes from fortified foods and/or supplements were at different levels: (I) vitamins A, D, calcium, magnesium (>50% of adolescents did not exceed 20% of DRI); (II) vitamins E, B12, iron (>50% of respondents consumed at least 20% of DRI); (III) niacin and pantothenic acid (>50% of respondents consumed at least 40% of DRI); IV) vitamins C, B1, B2, B6, folate, biotin (>50% of participants consumed at least 60% of DRI). In a subgroup of respondents who used fortified foods and supplements simultaneously (n = 126), some nutrients (i.e., vitamins C, B1, B2, B6, niacin, and biotin) were consumed in amounts ≥150% of DRI. Intake above the Tolerable Upper Intake Levels was observed for niacin, vitamin A, B6 and folic acid in individual cases (up to 1.1% of respondents); a higher risk of overconsumption was associated with using vitamin/mineral supplements than voluntarily fortified foods. Conclusion: Adolescents should be educated on how to reasonably use fortified foods and dietary supplements to help to overcome the potential deficiency of nutrients without causing excessive consumption.
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Affiliation(s)
- Ewa Sicińska
- Department of Human Nutrition, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), Warsaw, Poland
| | - Barbara Pietruszka
- Department of Human Nutrition, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), Warsaw, Poland
| | - Olga Januszko
- Department of Human Nutrition, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), Warsaw, Poland
| | - Sebastian Jakubowski
- Department of Human Nutrition, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), Warsaw, Poland
| | - Kamila Kielak-Biskupska
- Department of Human Nutrition, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), Warsaw, Poland
| | - Katarzyna Rolf
- Department of Human Nutrition, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), Warsaw, Poland
| | - Joanna Kaluza
- Department of Human Nutrition, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), Warsaw, Poland
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20
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Kołbuc M, Leßmeier L, Salamon-Słowińska D, Małecka I, Pawlaczyk K, Walkowiak J, Wysocki J, Beck BB, Zaniew M. Hypomagnesemia is underestimated in children with HNF1B mutations. Pediatr Nephrol 2020; 35:1877-1886. [PMID: 32388583 DOI: 10.1007/s00467-020-04576-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 04/05/2020] [Accepted: 04/15/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Hypomagnesemia in patients with congenital anomalies of the kidneys and urinary tract or autosomal dominant tubulointerstitial kidney disease is highly suggestive of HNF1B-associated disease. Intriguingly, the frequency of low serum Mg2+ (sMg) level varies and is lower in children than in adults with HNF1B mutations that could be partially due to application of inaccurate normal limit of sMg, irrespective of age and gender. We aimed to re-assess cross-sectionally and longitudinally the frequency of hypomagnesemia in HNF1B disease by using locally derived reference values of sMg. METHODS Fourteen children with HNF1B-associated kidney disease were included. Control group comprising 110 subjects served to generate 2.5th percentiles of sMg as the lower limits of normal. RESULTS In both controls and patients, sMg correlated with age, gender, and fractional excretion of Mg2+. In girls, sMg concentration was higher than in boys when analyzed in the entire age spectrum (p < 0.05). In HNF1B patients, mean sMg was lower than in controls as compared with respective gender- and age-specific interval (p < 0.001). Low sMg levels (< 0.7 mmol/l) were found in 21.4% of patients at diagnosis and 36.4% at last visit, which rose to 85.7% and 72.7% respectively when using the age- and gender-adjusted reference data. Similarly, in the longitudinal observation, 23% of sMg measurements were < 0.7 mmol/l versus 79.7% when applying respective references. CONCLUSIONS Hypomagnesemia is underdiagnosed in children with HNF1B disease. sMg levels are age- and gender-dependent; thus, the use of appropriate reference data is crucial to hypomagnesemia in children.
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Affiliation(s)
- Marcin Kołbuc
- Department of Pediatrics, University of Zielona Góra, Zielona Góra, Poland.
| | - Lennart Leßmeier
- Institute of Human Genetics and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | | | - Ilona Małecka
- Children's Hospital, Poznań, Poland
- Department of Preventive Medicine, Poznań University of Medical Sciences, Poznań, Poland
| | - Krzysztof Pawlaczyk
- Department of Nephrology, Transplantology and Internal Medicine, Poznań University of Medical Sciences, Poznań, Poland
- Department of Nephrology, University of Zielona Góra, Zielona Góra, Poland
| | - Jarosław Walkowiak
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznań University of Medical Sciences, Poznań, Poland
| | - Jacek Wysocki
- Children's Hospital, Poznań, Poland
- Department of Preventive Medicine, Poznań University of Medical Sciences, Poznań, Poland
| | - Bodo B Beck
- Institute of Human Genetics and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Marcin Zaniew
- Department of Pediatrics, University of Zielona Góra, Zielona Góra, Poland.
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Pacei F, Tesone A, Laudi N, Laudi E, Cretti A, Pnini S, Varesco F, Colombo C. The Relevance of Thiamine Evaluation in a Practical Setting. Nutrients 2020; 12:nu12092810. [PMID: 32933220 PMCID: PMC7551939 DOI: 10.3390/nu12092810] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/03/2020] [Accepted: 09/05/2020] [Indexed: 02/07/2023] Open
Abstract
Thiamine is a crucial cofactor involved in the maintenance of carbohydrate metabolism and participates in multiple cellular metabolic processes. Although thiamine can be obtained from various food sources, some common food groups are deficient in thiamine, and it can be denatured by high temperature and pH. Additionally, different drugs can alter thiamine metabolism. In addition, the half-life of thiamine in the body is between 1 and 3 weeks. All these factors could provide an explanation for the relatively short period needed to develop thiamine deficiency and observe the consequent clinical symptoms. Thiamine deficiency could lead to neurological and cardiological problems. These clinical conditions could be severe or even fatal. Marginal deficiency too may promote weaker symptoms that might be overlooked. Patients undergoing upper gastrointestinal or pancreatic surgery could have or develop thiamine deficiency for many different reasons. To achieve the best outcome for these patients, we strongly recommend the execution of both an adequate preoperative nutritional assessment, which includes thiamine evaluation, and a close nutritional follow up to avoid a nutrient deficit in the postoperative period.
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Affiliation(s)
- Federico Pacei
- ASST Nord Milano, UOC Neurologia, Ospedale Bassini, 20092 Cinisello Balsamo, Italy
- Department of Physical Rehabilitation, Casa di Cura Bonvicini, Via Michael Pacher 12, 39100 Bolzano, Italy; (A.T.); (E.L.); (A.C.); (S.P.); (F.V.)
- Correspondence:
| | - Antonella Tesone
- Department of Physical Rehabilitation, Casa di Cura Bonvicini, Via Michael Pacher 12, 39100 Bolzano, Italy; (A.T.); (E.L.); (A.C.); (S.P.); (F.V.)
| | - Nazzareno Laudi
- Faculty of Medicine and Surgery, Medizinische Universitat Innsbruck, Christoph-Probst-Platz 1, Innrain 52 A, 6020 Innsbruck, Austria;
| | - Emanuele Laudi
- Department of Physical Rehabilitation, Casa di Cura Bonvicini, Via Michael Pacher 12, 39100 Bolzano, Italy; (A.T.); (E.L.); (A.C.); (S.P.); (F.V.)
| | - Anna Cretti
- Department of Physical Rehabilitation, Casa di Cura Bonvicini, Via Michael Pacher 12, 39100 Bolzano, Italy; (A.T.); (E.L.); (A.C.); (S.P.); (F.V.)
| | - Shira Pnini
- Department of Physical Rehabilitation, Casa di Cura Bonvicini, Via Michael Pacher 12, 39100 Bolzano, Italy; (A.T.); (E.L.); (A.C.); (S.P.); (F.V.)
| | - Fabio Varesco
- Department of Physical Rehabilitation, Casa di Cura Bonvicini, Via Michael Pacher 12, 39100 Bolzano, Italy; (A.T.); (E.L.); (A.C.); (S.P.); (F.V.)
| | - Chiara Colombo
- Lombardy Regional Course for General Practitioner, PoliS-Lombardia, Via Taramelli 12/F, 20100 Milano, Italy;
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Pereira JL, de Castro MA, Crispim SP, Fisberg RM, Isasi CR, Mossavar-Rahmani Y, Van Horn L, Carnethon MR, Daviglus ML, Perreira KM, Gallo LC, Sotres-Alvarez D, Mattei J. Comparing Methods from the National Cancer Institute vs Multiple Source Method for Estimating Usual Intake of Nutrients in the Hispanic Community Health Study/Study of Latino Youth. J Acad Nutr Diet 2020; 121:59-73.e16. [PMID: 32773213 DOI: 10.1016/j.jand.2020.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 03/11/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Multiple Source Method (MSM) and the National Cancer Institute (NCI) method estimate usual dietary intake from short-term dietary assessment instruments, such as 24-hour recalls. Their performance varies according to sample size and nutrients distribution. A comparison of these methods among a multiethnic youth population, for which nutrient composition and dietary variability may differ from adults, is a gap in the literature. OBJECTIVE To compare the performance of the NCI method relative to MSM in estimating usual dietary intakes in Hispanic/Latino adolescents. DESIGN Data derived from the cross-sectional population-based Hispanic Community Health Study/Study of Latino Youth, an ancillary study of offspring of participants in the adult Hispanic Community Health Study/Study of Latino Youth cohort. Dietary data were obtained by two 24-hour recalls. PARTICIPANTS/SETTING One thousand four hundred fifty-three Hispanic/Latino youth (aged 8 to 16 years) living in four urban US communities (Bronx, NY; Chicago, IL; Miami, FL; and San Diego, CA) during 2012 through 2014. MAIN OUTCOME MEASURES The NCI method and the MSM were applied to estimate usual intake of total energy, macronutrients, minerals and vitamins, added sugar, and caffeine. STATISTICAL ANALYSES Mean, standard deviation, minimum and maximum values, coefficient of variation, variance ratio, and differences between NCI and MSM methods and the 2-day mean were estimated in several percentiles of the distribution, as well as concordance correlation coefficients and Bland-Altman plot analysis. RESULTS The distributions of all nutrients studied were very similar between NCI and MSM. The correlation between NCI and MSM was >0.80 for all nutrients (P<0.001), except dietary cholesterol, vitamin C, and n-3 fatty acids. In individual estimations, NCI method predicted higher estimates and lower variance than the MSM. The lowest level of agreement was observed in the values at the tails of the distribution, and for nutrients with high variance ratio. CONCLUSIONS Overall, both MSM and NCI method provided acceptable estimates of the usual intake distribution using 24-hour recall, and they better represented the usual intake compared with 2-day mean, correcting for intraindividual variability.
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Friesen VM, Mbuya MNN, Aaron GJ, Pachón H, Adegoke O, Noor RA, Swart R, Kaaya A, Wieringa FT, Neufeld LM. Fortified Foods Are Major Contributors to Apparent Intakes of Vitamin A and Iodine, but Not Iron, in Diets of Women of Reproductive Age in 4 African Countries. J Nutr 2020; 150:2183-2190. [PMID: 32534454 PMCID: PMC7398785 DOI: 10.1093/jn/nxaa167] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/16/2020] [Accepted: 05/19/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Food fortification is implemented to increase intakes of specific nutrients in the diet, but contributions of fortified foods to nutrient intakes are rarely quantified. OBJECTIVES We quantified iron, vitamin A, and iodine intakes from fortified staple foods and condiments among women of reproductive age (WRA). METHODS In subnational (Nigeria, South Africa) and national (Tanzania, Uganda) cross-sectional, clustered household surveys, we assessed fortifiable food consumption. We estimated daily nutrient intakes from fortified foods among WRA by multiplying the daily apparent fortifiable food consumption (by adult male equivalent method) by a fortification content for the food. Two fortification contents were used: measured, based on the median amount quantified from individual food samples collected from households; and potential, based on the targeted amount in national fortification standards. Results for both approaches are reported as percentages of the estimated average requirement (EAR) and recommended nutrient intake (RNI). RESULTS Fortified foods made modest contributions to measured iron intakes (0%-13% RNI); potential intakes if standards are met were generally higher (0%-65% RNI). Fortified foods contributed substantially to measured vitamin A and iodine intakes (20%-125% and 88%-253% EAR, respectively); potential intakes were higher (53%-655% and 115%-377% EAR, respectively) and would exceed the tolerable upper intake level among 18%-56% of WRA for vitamin A in Nigeria and 1%-8% of WRA for iodine in Nigeria, Tanzania, and Uganda. CONCLUSIONS Fortified foods are major contributors to apparent intakes of vitamin A and iodine, but not iron, among WRA. Contributions to vitamin A and iodine are observed despite fortification standards not consistently being met and, if constraints to meeting standards are addressed, there is risk of excessive intakes in some countries. For all programs assessed, nutrient intakes from all dietary sources and fortification standards should be reviewed to inform adjustments where needed to avoid risk of low or excessive intakes.
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Affiliation(s)
- Valerie M Friesen
- Global Alliance for Improved Nutrition, Geneva, Switzerland,UMR204 Nutripass, Institut de Recherche pour le Développement (IRD), IRD/Université de Montpellier/SupAgro, Montpellier, France,Address correspondence to VMF (e-mail: )
| | | | - Grant J Aaron
- Global Alliance for Improved Nutrition, Geneva, Switzerland
| | - Helena Pachón
- Rollins School of Public Health, Emory University, Atlanta, GA, USA,Food Fortification Initiative, Atlanta, GA, USA
| | | | - Ramadhani A Noor
- Africa Academy for Public Health, Dar es Salaam, Tanzania,Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Rina Swart
- Department of Dietetics and Nutrition, University of the Western Cape, Cape Town, South Africa
| | - Archileo Kaaya
- Department of Food Technology and Nutrition, College of Agricultural and Environmental Sciences, Makerere University, Kampala, Uganda
| | - Frank T Wieringa
- UMR204 Nutripass, Institut de Recherche pour le Développement (IRD), IRD/Université de Montpellier/SupAgro, Montpellier, France
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Abstract
OBJECTIVE To assess the usual dietary intake of twenty micronutrients and to identify their food sources in a representative sample of Greek children and adolescents. DESIGN Cross-sectional data from the Hellenic National Nutrition and Health Survey (HNNHS). Vitamin and mineral intakes were estimated from two 24 h dietary recalls by sex and age groups. Estimates were calculated using the National Research Council method and the statistical software package Stata13 to account for within- and between-person variations. The prevalence of nutrients' inadequacy among sample was estimated using the estimated average requirement (EAR) cut-point method. The contribution of food groups to nutrient intake was estimated to identify micronutrients food sources. SETTING Greece. PARTICIPANTS Children and adolescents aged 1-19 years (n 577) who provided sufficient and plausible 24-h recalls. RESULTS A substantial percentage of children and adolescents had insufficient intakes of numerous micronutrients. Usual intake of vitamins D, K and potassium was inadequate in practically all individuals. Vitamin A, folate, Ca and Mg were also insufficient to a considerable percentage, especially in girls aged 14-18 years. Pantothenic acid was highlighted as nutrient of interest since only one out of ten boys 9-13 years and girls 14-19 years had intake above the EAR. Data demonstrated that food groups highly ranked in energy contribution were not necessarily important sources of micronutrients. CONCLUSIONS Results suggest that micronutrient density of Greek children and adolescents' diet should be improved. These findings might be used by public health policy-makers to help young people optimise their food choices in Greece.
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Ready-to-eat cereal fortification: a modelling study on the impact of changing ready-to-eat cereal fortification levels on population intake of nutrients. Public Health Nutr 2020; 23:2165-2178. [PMID: 31957633 DOI: 10.1017/s1368980019003690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Ready-to-eat (RTE) cereal is an important source of nutrients in the American diet. Recent regulatory changes to labelling requirements may impact the fortification of RTE cereal. We used an evidence-based approach to optimize the fortification of RTE cereal considering current dietary patterns and nutrition policy. DESIGN A US modelling study of cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2013-2014. The percentage of the population below the Estimated Average Requirement (EAR) and above the Upper Tolerable Intake Level (UL) was modelled under three scenarios: baseline, zero fortification and optimized fortification. SETTING USA. PARTICIPANTS Toddlers aged 1-3 years, n 559; children aged 4-12 years, n 1540; adolescents aged 13-18 years, n 992; and adults aged ≥19 years, n 576. RESULTS Comparing current with optimized fortification, nutrient/100 g RTE cereal decreased for vitamin A, thiamin, riboflavin, niacin, vitamin B6, folic acid, vitamin B12, Ca and Fe (by 2-82 %). The amount of vitamins C and D increased (by 13 and 50 %, respectively). Among RTE cereal eaters, these changes resulted in modest increases in the percentage of the population aged ≥1 year below the EAR (+0·5 to +11·5 percentage points). Decreases were observed in the percentage of the population above the UL. CONCLUSIONS Fortification of RTE cereal can be optimized to provide key nutrients and minimize the percentage of the population below the EAR and above the UL. Dietary intake modelling is useful to ensure that RTE cereal continues to help the population meet their nutrient needs.
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Newman JC, McBurney MI, Hunt KJ, Malek AM, Marriott BP. Modeling Possible Outcomes of Updated Daily Values on Nutrient Intakes of the United States Adult Population. Nutrients 2020; 12:E210. [PMID: 31941154 PMCID: PMC7019904 DOI: 10.3390/nu12010210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 01/08/2020] [Indexed: 11/17/2022] Open
Abstract
The United States (US) Food and Drug Administration has updated the Daily Values (DVs) for the Nutrition Facts Label on packaged foods. We used the National Health and Nutrition Examination Survey 2009-2012 data with the International Life Sciences Institute, North America Fortification Database, which identifies intrinsic, mandatory enriched, and fortified sources of nutrients in foods and beverages, to model the new DVs' potential impact on adult (≥19 years of age) intake. We assumed that manufacturers will adjust voluntary fortification to maintain percent DV claims. We assessed the percent of the US population whose usual intake (UI) was < the Estimated Average Requirement (EAR), and ≥ the Upper Limit (UL) based on the current DVs, and modeled estimated UI and %
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Affiliation(s)
- Jill C. Newman
- Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Michael I. McBurney
- Human Health & Nutritional Sciences, University of Guelph, Guelph, ON N1G 2W1, Canada;
| | - Kelly J. Hunt
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (K.J.H.); (A.M.M.)
| | - Angela M. Malek
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (K.J.H.); (A.M.M.)
| | - Bernadette P. Marriott
- Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA;
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
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Leme AC, Baranowski T, Thompson D, Philippi S, OʼNeil CE, Fulgoni VL, Nicklas TA. Food Sources of Shortfall Nutrients Among US Adolescents: National Health and Nutrition Examination Survey (NHANES) 2011-2014. FAMILY & COMMUNITY HEALTH 2020; 43:59-73. [PMID: 31764307 DOI: 10.1097/fch.0000000000000243] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
To identify food sources of shortfall nutrients consumed by adolescents (n = 3156), data from the National Health and Nutrition Examination Survey (NHANES) (2011-2014) were used. Some of the food groups commonly consumed by adolescents made a significant contribution to shortfall nutrient intakes in the diet. Many food sources that provided significant amounts of shortfall nutrients were from foods that also provided nutrients to limit. Awareness of nutrient intakes and food sources is essential to establish dietary guidance in a practical context. Efforts to continue monitoring the food sources of nutrients consumed by adolescents will be important to improve the current knowledge on this topic of research.
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Affiliation(s)
- Ana Carolina Leme
- School of Public Health, University of São Paulo, Sao Paulo, Brazil (Drs Leme and Philippi); Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas (Drs Baranowski, Thompson, and Nicklas); School of Nutrition and Food Sciences, Emeritus Louisiana State University, Baton Rouge (Dr O'Neil); and Nutrition Impact, LLC, Battle Creek, Michigan (Dr Fulgoni)
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Lonsdale D, Marrs C. The potential of lipid soluble thiamine in the treatment of cancer. AIMS BIOPHYSICS 2020. [DOI: 10.3934/biophy.2020002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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State-of-the-Science Review of Non-Chemical Stressors Found in a Child's Social Environment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224417. [PMID: 31718056 PMCID: PMC6888402 DOI: 10.3390/ijerph16224417] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/07/2019] [Accepted: 11/08/2019] [Indexed: 12/14/2022]
Abstract
Background: Children are exposed to chemical and non-chemical stressors from their built, natural, and social environments. Research is needed to advance our scientific understanding of non-chemical stressors, evaluate how they alter the biological response to a chemical stressor, and determine how they impact children’s health and well-being. To do this, we conducted a state-of-the-science review of non-chemical stressors found in a child’s social environment. Methods: Studies eligible for inclusion in this review were identified through a search of the peer-reviewed literature using PubMed and PsycINFO. Combinations of words associated with non-chemical stressors and children were used to form search strings. Filters were used to limit the search to studies published in peer-reviewed journals from 2000–2016 and written in English. Publications found using the search strings and filters went through two rounds of screening. Results: A total of 146 studies met the inclusion criteria. From these studies, 245 non-chemical stressors were evaluated. The non-chemical stressors were then organized into 13 general topic areas: acculturation, adverse childhood experiences, economic, education, family dynamics, food, greenspace, neighborhood, social, stress, urbanicity, violence, and other. Additional information on health outcomes, studies evaluating both chemical and non-chemical stressors, and animal studies are provided. This review provides evidence that non-chemical stressors found in a child’s social environment do influence their health and well-being in both beneficial (e.g., salutatory effects of greenspace and social support) and adverse (e.g., poor relationships between health and selected non-chemical stressors such as economics, educational attainment, exposure to violence, stress) ways. Conclusions: This literature review identified a paucity of studies addressing the combined effects of chemical and non-chemical stressors and children’s health and well-being. This literature review was further complicated by inconsistencies in terminology, methodologies, and the value of non-chemical stressor research in different scientific disciplines. Despite these limitations, this review showed the importance of considering non-chemical stressors from a child’s social environment when addressing children’s environmental health considerations.
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Cardoso RV, Fernandes Â, Gonzaléz-Paramás AM, Barros L, Ferreira IC. Flour fortification for nutritional and health improvement: A review. Food Res Int 2019; 125:108576. [DOI: 10.1016/j.foodres.2019.108576] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/17/2019] [Accepted: 07/21/2019] [Indexed: 12/19/2022]
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31
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Cuadrado-Soto E, Risica PM, Gans KM, Mena NZ, Ellis C, Araujo CD, Lofgren IE, Stowers KC, Tovar A. Micronutrient Adequacy in Preschool Children Attending Family Child Care Homes. Nutrients 2019; 11:nu11092134. [PMID: 31500153 PMCID: PMC6770721 DOI: 10.3390/nu11092134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 08/28/2019] [Accepted: 09/02/2019] [Indexed: 01/09/2023] Open
Abstract
Limited data is available on the micronutrient intake and adequacy in preschool children enrolled in family child care homes (FCCH). The goal of this paper is to describe the micronutrient adequacy relative to age-specific recommendations of preschool-aged children (aged 2-5 years) attending FCCH in Rhode Island (RI). Dietary data among younger preschoolers (aged 2-3 years), n = 245) and older preschoolers (aged 4-5 years), n = 121) in 118 RI FCCH (N = 366 children) were analyzed. Nutrient adequacy was assessed as the amount of nutrient per 1000 kcal of the diet that would meet the Institute of Medicine nutrient requirements (critical nutrient density), and it was compared to the observed nutrient densities of the children. The sodium:potassium ratio was also calculated. For most micronutrients, the observed density met or exceeded the recommendation, meaning the children's intake was adequate. However, a high proportion of children had nutrient densities under the recommendation for vitamins D, E, K, and potassium (86.1%, 89.1%, 70.8%, and 99.2% of children, respectively). The mean vitamin B12, potassium, and zinc densities were statistically higher in younger vs. older preschoolers (p < 0.05 for all). Low densities in calcium and vitamins K and B5 were more frequent in older children vs. younger children (p < 0.05). In addition, older preschoolers had a higher sodium:potassium ratio than younger children (p < 0.05). The micronutrient intake density was adequate for most nutrients. However, intake of some nutrients was of concern. Further attention to training and compliance in FCCH may improve the diet quality of those cared for in these settings.
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Affiliation(s)
- Esther Cuadrado-Soto
- Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, Plaza Ramón y Cajal S/N, 28040 Madrid, Spain;
| | - Patricia Markham Risica
- Center for Health Equity Research, Brown School of Public Health, Providence, RI 02912, USA; (P.M.R.)
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI 02912, USA
| | - Kim M. Gans
- Center for Health Equity Research, Brown School of Public Health, Providence, RI 02912, USA; (P.M.R.)
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI 02912, USA
- Department of Human Development and Family Studies, University of Connecticut, Storrs, CT 06269, USA
- Institute for Collaboration in Health, Interventions and Policy, University of Connecticut, Storrs, CT 06269, USA;
| | - Noereem Z. Mena
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI 02881, USA; (N.Z.M.); (C.E.); (C.D.A.); (I.E.L.)
| | - Carolyn Ellis
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI 02881, USA; (N.Z.M.); (C.E.); (C.D.A.); (I.E.L.)
| | - Carolina D. Araujo
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI 02881, USA; (N.Z.M.); (C.E.); (C.D.A.); (I.E.L.)
| | - Ingrid E. Lofgren
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI 02881, USA; (N.Z.M.); (C.E.); (C.D.A.); (I.E.L.)
| | - Kristen Cooksey Stowers
- Institute for Collaboration in Health, Interventions and Policy, University of Connecticut, Storrs, CT 06269, USA;
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Alison Tovar
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI 02881, USA; (N.Z.M.); (C.E.); (C.D.A.); (I.E.L.)
- Correspondence: ; Tel.: +401-874-9855
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Hosseini SH, Jones JM, Vatanparast H. Association between Grain Intake, Nutrient Intake, and Diet Quality of Canadians: Evidence from the Canadian Community Health Survey-Nutrition 2015. Nutrients 2019; 11:nu11081937. [PMID: 31426505 PMCID: PMC6722608 DOI: 10.3390/nu11081937] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/14/2019] [Accepted: 08/14/2019] [Indexed: 12/27/2022] Open
Abstract
The new Canada's Food Guide (CFG) recommends whole grains foods as the primary choice of grain products in the daily diet. This study examined whether higher shares of whole-grain consumption, beyond the recommended levels (i.e., above half) of the daily grain intake, are linked with optimal diet quality and intakes of some key nutrients, for both children and adolescents and adults in Canada. To meet the objective of this study, we used the Canadian Community Health Survey (CCHS)-Nutrition 2015, which is a nationally representative data. We employed the propensity score matching (PSM) method in this study. PSM estimates the exposure effect when a set of individuals are exposed to a specific treatment (food group intake in this study) in a non-experimental setting. The results of our analyses implied that a high consumption of whole grains is associated with a good diet quality. However, after a certain level of whole-grain consumption, no significant differences can be observed in diet quality scores of children and adolescents and adults. Moreover, it was observed that the proportion of obese and overweight individuals was significantly lower among adults that had balanced intakes of whole and non-whole grains. The results of logistic regression analyses also showed the probability of being obese and overweight is significantly lower in the case of adults with balanced intakes of grains. However, no significant differences were observed in the prevalence of obesity and overweight across whole grains consumption patterns for children and adolescents.
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Affiliation(s)
- Seyed H Hosseini
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 2Z4, Canada
| | - Julie M Jones
- Professor Emerita of Foods Nutrition, St. Catherine University, St. Paul, MN 55105, USA
| | - Hassan Vatanparast
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 2Z4, Canada.
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Newman JC, Malek AM, Hunt KJ, Marriott BP. Nutrients in the US Diet: Naturally Occurring or Enriched/Fortified Food and Beverage Sources, Plus Dietary Supplements: NHANES 2009-2012. J Nutr 2019; 149:1404-1412. [PMID: 31132112 PMCID: PMC6686054 DOI: 10.1093/jn/nxz066] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 01/25/2019] [Accepted: 03/18/2019] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Nutrients are added to the diet through fortification/enrichment and dietary supplements (DSs). Meeting the US Dietary Reference Intakes (DRIs) varies by nutrient and population subsegments. OBJECTIVE The aim of this study was to assess the relative role of naturally occurring, enriched/fortified, and DS sources of 15 micronutrients with reference to the DRIs. METHODS We used the NHANES 2009-2012 (≥2 y old, n = 16,975) data, the ILSI North America Fortification database, and the National Cancer Institute usual intake method. RESULTS Prevalence of nutrient intake from naturally occurring sources below the Estimated Average Requirement (EAR) varied from 5% for vitamin B-12 to 100% for vitamin D, with ≥40% of the population below the EAR for 8 of the 14 nutrients (ages ≥2 y). With enrichment/fortification, the percentage below the EAR decreased to the following for vitamins A (35%), C (34%), and B-6 (7%), folate (8%), thiamin (5%), riboflavin (3%), niacin (1%), and iron (2%). Nutrients from DSs further improved intakes related to the EAR for 12 nutrients (ages ≥2 y). For 9-18-y-olds, the percentages of nutrient intakes below the EAR were 14-50% higher than for 2-8-y-olds. The Tolerable Upper Intake Level (UL) was exceeded among children aged 2-8 y for folate (41.7%), niacin (10.1%), and zinc (39.9%), whereas among ages ≥2 y and 9-18 y no prevalence of intakes over the UL exceeded 10%. CONCLUSIONS Fortification/enrichment constitutes a meaningful contribution to reducing the percentage of individuals with less than the EAR for their demographic. These data underscore the need to encourage better dietary patterns to improve the intake of nutrients at risk of low intake.
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Affiliation(s)
| | | | | | - Bernadette P Marriott
- Department of Medicine,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC,Address correspondence to BPM (e-mail: )
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Race/Ethnicity, Enrichment/Fortification, and Dietary Supplementation in the U.S. Population, NHANES 2009⁻2012. Nutrients 2019; 11:nu11051005. [PMID: 31052522 PMCID: PMC6567168 DOI: 10.3390/nu11051005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/19/2019] [Accepted: 04/25/2019] [Indexed: 12/31/2022] Open
Abstract
In the United States (U.S.), food fortification and/or enrichment and dietary supplement (DS) use impacts nutrient intakes. Our aim was to examine race/ethnicity and income (Poverty Income Ratio, PIR) differences in meeting the Dietary Reference Intakes based on estimated dietary intakes among the U.S. population age ≥2 years (n = 16,975). Two 24-hour recalls from the National Health and Nutrition Examination Survey (NHANES) cycles 2009–2012 were used to estimate the intake of 15 nutrients as naturally occurring, enriched/fortified, and plus DSs. Across racial/ethnic groups and within PIR categories, significant differences were observed in the %< Estimated Average Requirement (EAR) for vitamin A following enrichment/fortification (E/F) and for vitamin B12 and riboflavin following both E/F and DS use when comparing non-Hispanic blacks, Hispanics, and the other race/ethnicity group to non-Hispanic whites. The %<EAR for iron and calcium also differed depending on race/ethnicity within PIR category (p < 0.05). The %<EAR was significantly lower for vitamin D after E/F for Hispanics, and after E/F combined with DS use for vitamins C and B6 for Hispanics and the other race/ethnicity group than non-Hispanic whites. Non-Hispanic blacks were inadequate in all nutrients examined except vitamin C based on the %<EAR than individuals of other races/ethnicities. Differences in the tolerable upper intake level (UL) of nutrients, especially folate and zinc, also varied by race/ethnicity and PIR category.
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Mitsopoulou AV, Magriplis E, Dimakopoulos I, Karageorgou D, Bakogianni I, Micha R, Michas G, Chourdakis M, Ntouroupi T, Tsaniklidou SM, Argyri K, Panagiotakos DB, Zampelas A. Association of meal and snack patterns with micronutrient intakes among Greek children and adolescents: data from the Hellenic National Nutrition and Health Survey. J Hum Nutr Diet 2019; 32:455-467. [PMID: 31020750 DOI: 10.1111/jhn.12639] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The present study aimed to examine how different meal and snack patterns are associated with micronutrient intakes and diet quality among a nationally representative sample of Greek children and adolescents aged 1-19 years from the cross-sectional Hellenic National Nutrition and Health Survey (n = 598). METHODS Meal and snack patterns were derived using 24-h dietary recalls. Mean adequacy ratio (MAR) was used as an overall measure of diet quality. Multiple linear regression adjusted for covariates was conducted to examine associations between eating patterns, nutrient intakes and MAR. RESULTS Four most frequently reported eating schemes were identified including breakfast (B), lunch (L), dinner (D) and two snacks (S) (20.9%); B, L, D and 1S (16.2%); B, L, D and 3S (10.8%); and B, L and D (7.9%). Based on these schemes, the daily consumption of all main meals from the majority of the sample was highlighted. In children and adolescents aged 4-19 years, increasing snack frequency was positively associated with intakes of vitamin D, vitamin K, riboflavin, niacin, pantothenic acid, folate, magnesium, copper and selenium. An inverse association was recorded for vitamin E, vitamin B6 , calcium and iron. Among children aged 1-3 years, only niacin and copper were significantly associated with number of snacks, with the group of 'B-L-D-2S' presenting the highest intake. As for the overall diet quality, among all participants, there was no significant association of MAR with the type of meal and snack pattern, and thus the snack frequency. CONCLUSIONS Snacking behaviour is a common practice among children and adolescents. Modifying current snack foods with nutrient-rich choices could lead to an improvement of their diet's nutritional quality.
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Affiliation(s)
- A-V Mitsopoulou
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - E Magriplis
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - I Dimakopoulos
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - D Karageorgou
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - I Bakogianni
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - R Micha
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - G Michas
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece.,Department of Cardiology, 'Elpis' General Hospital of Athens, Athens, Greece
| | - M Chourdakis
- Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - T Ntouroupi
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - S-M Tsaniklidou
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - K Argyri
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - D B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - A Zampelas
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
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Abstract
Vitamin D is a prohormone that is essential to good health. As very few foods (fish, egg yolks, milk) are rich in vitamin D, the main source of the vitamin is synthesized in the skin in the presence of ultraviolet B rays from sunlight. However, due to Canada's northern latitude, sufficient amounts of vitamin D cannot be synthesized using sunlight during the fall and winter months and, consequently, there is a concern that many Canadians are not achieving adequate levels of vitamin D. A wide array of inconsistent evidence derived from serum and dietary assessments has been published and the results are inconclusive. This paper serves to outline the issues and challenges regarding nationwide intervention strategies such as fortification to increase vitamin D intake in the Canadian population. Given the potential for excessive intakes and the lack of informed Canadian data, implementing an intervention to increase vitamin D intake in the entire population may be irresponsible; however, further investigation of vitamin D intakes in certain subgroups of the Canadian population is warranted.
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Affiliation(s)
- Meghan McGee
- Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
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Potential interventions targeting adolescent nutrition in Indonesia: a literature review. Public Health Nutr 2018; 22:15-27. [DOI: 10.1017/s1368980018002215] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveThe present study aimed to take stock of nutrition interventions that warrant consideration as a minimum package of interventions in Indonesia to improve four key nutrition indicators for adolescents: stunting, thinness, overweight and anaemia.DesignWe conducted a review of the peer-reviewed literature published between 1995 and 2017 on nutrition-specific and nutrition-sensitive interventions that target adolescents in Indonesia. The search to identify studies was conducted in PubMed, Google Scholar and EMBASE, using key search terms. We also explored programmatic and policy documents from the grey literature as they related to adolescents and/or Indonesia. Our search yielded thirty-five peer-reviewed articles and programmatic documents.SettingIndonesia.SubjectsAdolescent girls and boys.ResultsThere is very limited evidence on the impact of interventions specifically among adolescents in Indonesia. Nevertheless, findings from our review suggest the minimum package of interventions in Indonesia could include the following nutrition-specifc interventions: (i) iron–folic acid supplements, paired with antihelminths delivered at scale via school-based platforms and through health centres; and (ii) diet counselling and nutrition education provided through school-based platforms, adolescent youth centres/peer education and technology-based platforms. The minimum package could also include the following nutrition-sensitive interventions: (i) improving access to reproductive health services; and (ii) increasing the coverage of interventions designed to increase school attendance.ConclusionsProgrammes and policies targeting adolescent nutrition are relatively new and coverage is low. To improve the nutritional status of this vulnerable population, additional evaluations of adolescent programming and surveillance data on adolescents are needed.
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Whitfield KC, Bourassa MW, Adamolekun B, Bergeron G, Bettendorff L, Brown KH, Cox L, Fattal‐Valevski A, Fischer PR, Frank EL, Hiffler L, Hlaing LM, Jefferds ME, Kapner H, Kounnavong S, Mousavi MP, Roth DE, Tsaloglou M, Wieringa F, Combs GF. Thiamine deficiency disorders: diagnosis, prevalence, and a roadmap for global control programs. Ann N Y Acad Sci 2018; 1430:3-43. [PMID: 30151974 PMCID: PMC6392124 DOI: 10.1111/nyas.13919] [Citation(s) in RCA: 151] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 06/05/2018] [Indexed: 12/20/2022]
Abstract
Thiamine is an essential micronutrient that plays a key role in energy metabolism. Many populations worldwide may be at risk of clinical or subclinical thiamine deficiencies, due to famine, reliance on staple crops with low thiamine content, or food preparation practices, such as milling grains and washing milled rice. Clinical manifestations of thiamine deficiency are variable; this, along with the lack of a readily accessible and widely agreed upon biomarker of thiamine status, complicates efforts to diagnose thiamine deficiency and assess its global prevalence. Strategies to identify regions at risk of thiamine deficiency through proxy measures, such as analysis of food balance sheet data and month-specific infant mortality rates, may be valuable for understanding the scope of thiamine deficiency. Urgent public health responses are warranted in high-risk regions, considering the contribution of thiamine deficiency to infant mortality and research suggesting that even subclinical thiamine deficiency in childhood may have lifelong neurodevelopmental consequences. Food fortification and maternal and/or infant thiamine supplementation have proven effective in raising thiamine status and reducing the incidence of infantile beriberi in regions where thiamine deficiency is prevalent, but trial data are limited. Efforts to determine culturally and environmentally appropriate food vehicles for thiamine fortification are ongoing.
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Affiliation(s)
- Kyly C. Whitfield
- Department of Applied Human NutritionMount Saint Vincent UniversityHalifaxNova ScotiaCanada
| | - Megan W. Bourassa
- The Sackler Institute for Nutrition ScienceThe New York Academy of SciencesNew YorkNew York
| | - Bola Adamolekun
- University of Tennessee Health Science CenterMemphisTennessee
| | - Gilles Bergeron
- The Sackler Institute for Nutrition ScienceThe New York Academy of SciencesNew YorkNew York
| | - Lucien Bettendorff
- Laboratory of Neurophysiology, GIGA‐NeurosciencesUniversity of LiègeLiègeBelgium
| | | | - Lorna Cox
- Medical Research Council Elsie Widdowson LaboratoryCambridgeUnited Kingdom
| | - Aviva Fattal‐Valevski
- Tel Aviv Medical Center, Dana‐Dwek Children's Hospital, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | | | | | | | - Lwin Mar Hlaing
- National Nutrition Center, Ministry of Health and SportsMyanmar
| | | | | | - Sengchanh Kounnavong
- The Lao Tropical and Public Health Institute, Ministry of HealthVientianeLao PDR
| | - Maral P.S. Mousavi
- Department of Chemistry and Chemical BiologyHarvard UniversityCambridgeMassachusetts
| | - Daniel E. Roth
- Hospital for Sick Children and University of TorontoTorontoOntarioCanada
| | | | - Frank Wieringa
- Institut de Recherche pour le DeveloppmentMontpellierFrance
| | - Gerald F. Combs
- Jean Mayer USDA Human Nutrition Research CenterTufts UniversityBostonMassachusetts
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AbuKhader MM. Comparative assessment and suitability of iron and the nutritional composition of fortified foods for young children. Nutr Health 2018; 24:103-109. [PMID: 29665730 DOI: 10.1177/0260106018767686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM To assess the suitability of iron content and the nutritional benefits of selected fortified food products marketed for 4-8 year old children in Oman. METHODS Forty-five fortified foods, which are available in Omani markets, were classified into four groups based on food type and composition: ready-to-eat (RTE) breakfast cereals (two groups), malted milk drinks and milk powder formulas. The nutrition panel displayed on the products' outer package was used as a source of content values for iron and other nutrients. RESULTS Among the selected products, malted milk drinks contain a significant ( p < 0.001) amount of iron that is 6.2±3.1 mg per 30 g serving (recommended daily intake for children 4-8 years old is 10 mg). The way selected products are served, with milk or water, could have a significant impact on the iron absorption and bioavailability, which is influenced by the presence of calcium and vitamin C. The values recorded from malted milk drinks and milk powder formulas were shown to have vitamin C to iron ratios of 3:1 and 8:1, respectively. Such ratios are reportedly effective in reversing the negative effect of calcium on iron absorption. Iron-fortified foods contain low to moderate amount of iron per serving and are considered more nutritious when compared to iron supplements. CONCLUSION Iron-fortified foods can be conditionally useful to prevent or restore iron deficiency but not be relied on as an only source of iron. Hence these products must be consumed as a part of a healthy diet plan.
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Best CM, Pressman EK, Queenan RA, Cooper E, Vermeylen F, O'Brien KO. Gestational Age and Maternal Serum 25-hydroxyvitamin D Concentration Interact to Affect the 24,25-dihydroxyvitamin D Concentration in Pregnant Adolescents. J Nutr 2018; 148:868-875. [PMID: 29796622 PMCID: PMC6014295 DOI: 10.1093/jn/nxy043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 02/13/2018] [Indexed: 11/13/2022] Open
Abstract
Background Interpretation of serum vitamin D biomarkers across pregnancy is complex due to limited understanding of pregnancy adaptations in vitamin D metabolism. During pregnancy, both gestational age and serum 25-hydroxyvitamin D [25(OH)D] concentrations may influence the concentrations of 1,25-dihydroxyvitamin D [1,25(OH)2D], 24,25-dihydroxyvitamin D [24,25(OH)2D], and parathyroid hormone (PTH). Objective We aimed to identify predictors of change in serum 25(OH)D across gestation in pregnant adolescents and to assess the contribution made by cholecalciferol (vitamin D3) supplementation. We sought to determine whether gestational age and 25(OH)D concentration interacted to affect serum 1,25(OH)2D, 24,25(OH)2D, or PTH. Methods Pregnant adolescents (n = 78, 59% African American, mean ± SD age: 17 ± 1 y) living in Rochester, NY (latitude 43°N) were supplemented with 200 IU or 2000 IU vitamin D3/d and allowed to continue their daily prenatal supplement that contained 400 IU vitamin D3. Serum was collected at study entry (18 ± 5 wk of gestation), halfway through study participation, and at delivery (40 ± 2 wk). Serum concentrations of the biochemical markers were modeled with linear mixed-effects regression models. Results Vitamin D3 supplement intake and season of delivery determined change in 25(OH)D across pregnancy. Fall-winter delivery was associated with a decline in 25(OH)D unless vitamin D3 supplement intake was >872 IU/d. The interaction of gestational age and 25(OH)D affected 24,25(OH)2D concentrations. For a given 25(OH)D concentration, model-predicted serum 24,25(OH)2D increased across gestation except when 25(OH)D was <13 ng/mL. Below this threshold, 24,25(OH)2D was predicted to decline over time. Mean serum 1,25(OH)2D was elevated (>100 pg/mL) throughout the study. Conclusion Our results suggest that when maternal serum 25(OH)D was low, its catabolism into 24,25(OH)2D decreased or remained stable as pregnancy progressed in order to maintain persistently elevated serum 1,25(OH)2D. Furthermore, in adolescents living at latitude 43°N, standard prenatal supplementation did not prevent a seasonal decline in 25(OH)D during pregnancy. This study was registered at clinicaltrials.gov as NCT01815047.
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Affiliation(s)
- Cora M Best
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
| | - Eva K Pressman
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Ruth Anne Queenan
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Elizabeth Cooper
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | | | - Kimberly O O'Brien
- Division of Nutritional Sciences, Cornell University, Ithaca, NY,Address correspondence to KOO (e-mail: )
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Dwyer JT, Coates PM, Smith MJ. Dietary Supplements: Regulatory Challenges and Research Resources. Nutrients 2018; 10:nu10010041. [PMID: 29300341 PMCID: PMC5793269 DOI: 10.3390/nu10010041] [Citation(s) in RCA: 184] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 12/05/2017] [Accepted: 12/12/2017] [Indexed: 01/14/2023] Open
Abstract
Many of the scientific and regulatory challenges that exist in research on the safety, quality and efficacy of dietary supplements are common to all countries as the marketplace for them becomes increasingly global. This article summarizes some of the challenges in supplement science and provides a case study of research at the Office of Dietary Supplements at the National Institutes of Health, USA, along with some resources it has developed that are available to all scientists. It includes examples of some of the regulatory challenges faced and some resources for those who wish to learn more about them.
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Affiliation(s)
- Johanna T Dwyer
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD 20892-7517, USA.
| | - Paul M Coates
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD 20892-7517, USA.
| | - Michael J Smith
- National Center for Natural Products Research, University of Mississippi, MS 38677, USA.
- National Institute of Complementary Medicine, Western Sydney University, Penrith, NSW 2751, Australia.
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Dietary Supplements for Insomnia. CURRENT SLEEP MEDICINE REPORTS 2017. [DOI: 10.1007/s40675-017-0091-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Moyersoen I, Devleesschauwer B, Dekkers A, de Ridder K, Tafforeau J, van Camp J, van Oyen H, Lachat C. Intake of Fat-Soluble Vitamins in the Belgian Population: Adequacy and Contribution of Foods, Fortified Foods and Supplements. Nutrients 2017; 9:E860. [PMID: 28800115 PMCID: PMC5579653 DOI: 10.3390/nu9080860] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 07/27/2017] [Accepted: 08/02/2017] [Indexed: 11/22/2022] Open
Abstract
A key challenge of public health nutrition is to provide the majority of the population with a sufficient level of micronutrients while preventing high-consumers from exceeding the tolerable upper intake level. Data of the 2014 Belgian food consumption survey (n = 3200) were used to assess fat-soluble vitamin (vitamins A, D, E and K) intake from the consumption of foods, fortified foods and supplements. This study revealed inadequate intakes for vitamin A, from all sources, in the entire Belgian population and possible inadequacies for vitamin D. The prevalence of inadequate intake of vitamin A was lowest in children aged 3-6 (6-7%) and highest in adolescents (girls, 26%; boys, 34-37%). Except for women aged 60-64 years, more than 95% of the subjects had vitamin D intake from all sources below the adequate intake (AI) of 15 μg/day. The risk for inadequate intake of vitamins K and E was low (median > AI). Belgian fortification and supplementation practices are currently inadequate to eradicate suboptimal intakes of vitamins A and D, but increase median vitamin E intake close to the adequate intake. For vitamin A, a small proportion (1-4%) of young children were at risk of exceeding the upper intake level (UL), while for vitamin D, inclusion of supplements slightly increased the risk for excessive intakes (% > UL) in adult women and young children. The results may guide health authorities when developing population health interventions and regulations to ensure adequate intake of fat-soluble vitamins in Belgium.
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Affiliation(s)
- Isabelle Moyersoen
- Department of Public Health and Surveillance, Scientific Institute of Public Health (WIV-ISP), Juliette Wytsmanstraat 14, 1050 Brussels, Belgium.
- Department of Food Safety and Food Quality, Ghent University, Coupure links 653, 9000 Ghent, Belgium.
| | - Brecht Devleesschauwer
- Department of Public Health and Surveillance, Scientific Institute of Public Health (WIV-ISP), Juliette Wytsmanstraat 14, 1050 Brussels, Belgium.
| | - Arnold Dekkers
- Department for Statistics, Informatics and Modelling, National Institute for Public Health and the Environment (RIVM), P.O. BOX 1, 3720 BA Bilthoven, The Netherlands.
| | - Karin de Ridder
- Department of Public Health and Surveillance, Scientific Institute of Public Health (WIV-ISP), Juliette Wytsmanstraat 14, 1050 Brussels, Belgium.
| | - Jean Tafforeau
- Department of Public Health and Surveillance, Scientific Institute of Public Health (WIV-ISP), Juliette Wytsmanstraat 14, 1050 Brussels, Belgium.
| | - John van Camp
- Department of Food Safety and Food Quality, Ghent University, Coupure links 653, 9000 Ghent, Belgium.
| | - Herman van Oyen
- Department of Public Health and Surveillance, Scientific Institute of Public Health (WIV-ISP), Juliette Wytsmanstraat 14, 1050 Brussels, Belgium.
- Department of Public Health, Ghent University, De Pintelaan 185, 9000 Gent, Belgium.
| | - Carl Lachat
- Department of Food Safety and Food Quality, Ghent University, Coupure links 653, 9000 Ghent, Belgium.
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Byrd-Bredbenner C, Ferruzzi MG, Fulgoni VL, Murray R, Pivonka E, Wallace TC. Satisfying America's Fruit Gap: Summary of an Expert Roundtable on the Role of 100% Fruit Juice. J Food Sci 2017; 82:1523-1534. [PMID: 28585690 DOI: 10.1111/1750-3841.13754] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 04/21/2017] [Accepted: 04/25/2017] [Indexed: 01/12/2023]
Abstract
The 2015 to 2020 Dietary Guidelines for Americans (DGAs) recognize the role of 100% fruit juice in health and in helping people meet daily fruit recommendations and state that 100% fruit juice is a nutrient-dense beverage that should be a primary choice, along with water and low-fat/fat-free milk. The DGAs note that children are consuming 100% fruit juice within recommendations (that is, 120 to 180 mL/d for children aged 1 to 6 y and 236 to 355 mL/d for children aged 7 to 18 y). Evidence shows that compared to nonconsumers, those who consume 100% fruit juice come closer to meeting daily fruit needs and have better diet quality. In children, 100% fruit juice is associated with increased intakes of nutrients such as vitamin C, folate, and potassium. When consumed within the DGA recommendations, 100% fruit juice is not associated with overweight/obesity or childhood dental caries and does not compromise fiber intake. Preliminary data suggest that polyphenols in some 100% fruit juices may inhibit absorption of naturally occurring sugars. Given its role in promoting health and in helping people meet fruit needs, experts participating in a roundtable discussion agreed that there is no science-based reason to restrict access to 100% fruit juice in public health nutrition policy and programs such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Reducing or eliminating 100% fruit juice could lead to unintended consequences such as reduced daily fruit intake and increased consumption of less nutritious beverages (for example, sugar-sweetened beverages).
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Affiliation(s)
- Carol Byrd-Bredbenner
- Dept. of Nutritional Sciences, Rutgers Univ., 65 Dudley Rd., New Brunswick, N.J., 08901, U.S.A
| | - Mario G Ferruzzi
- Dept. Food, Bioprocessing and Nutrition, North Carolina State Univ., 600 Laureate Way, Kannapolis, N.C., 28081, U.S.A
| | - Victor L Fulgoni
- Nutrition Impact, LLC, 9725 D Drive North, Battle Creek, Mich., 49014, U.S.A
| | - Robert Murray
- Dept. of Human Sciences, The Ohio State Univ., 1945 North High Street, Columbus, Ohio, 43210, U.S.A
| | - Elizabeth Pivonka
- Produce for Better Health Foundation, 7465 Lancaster Pike, Suite J (2nd Floor), Hockessin, Del., 19707, U.S.A
| | - Taylor C Wallace
- Dept. of Nutrition and Food Studies, George Mason Univ., 10340 Democracy Lane, Suite 306, Fairfax, Va., 22030, U.S.A.,Think Healthy Group, LLC, 127 U Street NW, Wash., DC, 20001, U.S.A
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McBurney MI, Hartunian-Sowa S, Matusheski NV. Implications of US Nutrition Facts Label Changes on Micronutrient Density of Fortified Foods and Supplements. J Nutr 2017; 147:1025-1030. [PMID: 28490678 DOI: 10.3945/jn.117.247585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 02/02/2017] [Accepted: 04/11/2017] [Indexed: 11/14/2022] Open
Abstract
The US FDA published new nutrition-labeling regulations in May 2016. For the first time since the implementation of the Nutrition Labeling and Education Act of 1990, the Daily Value (DV) for most vitamins will change, as will the units of measurement used in nutrition labeling for some vitamins. For some food categories, the Reference Amounts Customarily Consumed (RACCs) will increase to reflect portions commonly consumed on a single occasion. These regulatory changes are now effective, and product label changes will be mandatory beginning 26 July 2018. This commentary considers the potential impact of these regulatory changes on the vitamin and mineral contents of foods and dietary supplements. Case studies examined potential effects on food fortification and nutrient density. The updated DVs may lead to a reduction in the nutrient density of foods and dietary supplements with respect to 8 vitamins (vitamin A, thiamin, riboflavin, niacin, vitamin B-6, vitamin B-12, biotin, and pantothenic acid) and 6 minerals (zinc, selenium, copper, chromium, molybdenum, and chloride), and have mixed effects on 2 vitamins where the amount required per serving is affected by chemical structure (i.e., form) (natural vitamin E compared with synthetic vitamin E and folic acid compared with folate). Despite an increased DV for vitamin D, regulations limit food fortification. The adoption of Dietary Folate Equivalents for folate labeling may lead to reductions in the quantity of folic acid voluntarily added per RACC. Finally, because of increased RACCs in some food categories to reflect portions that people typically eat at one time, the vitamin and mineral density of these foods may be affected adversely. In totality, the United States is entering an era in which the need to monitor dietary intake patterns and nutritional status is unprecedented.
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An overview of folate status in a population-based study from São Paulo, Brazil and the potential impact of 10 years of national folic acid fortification policy. Eur J Clin Nutr 2017; 71:1173-1178. [DOI: 10.1038/ejcn.2017.60] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 03/29/2017] [Accepted: 03/31/2017] [Indexed: 01/21/2023]
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Sliwa SA, Miller GF, Brener ND, Park S, Merlo CL. District Policies and Practices Vary in Their Association With Adolescents' Consumption of Milk and 100% Fruit Juice. J Adolesc Health 2017; 60:577-583. [PMID: 28073617 PMCID: PMC5401778 DOI: 10.1016/j.jadohealth.2016.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/11/2016] [Accepted: 11/30/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE Researchers previously examined the relationship between school beverage policies and sugar-sweetened beverage (SSB) consumption. This study addressed a research gap by examining cross-sectional associations between district-level policies and practices and U.S. high school students' consumption of milk and 100% fruit juice. METHODS Data from the 2012 School Health Policies and Practices Study and 2013 Youth Risk Behavior Surveillance System were linked for 12 large urban school districts. Outcome variables were daily milk consumption (≥1 glass/day) and 100% fruit juice consumption (≥1 time/day). Exposure variables were five district policies (i.e., restrict SSB sales, maintain closed campuses, offer/sell healthful alternatives, restrict promotional products, and require nutrition education). Logistic regression models estimated the odds of consuming milk or 100% fruit juice daily, conditional on the policies and adjusting for sex, race/ethnicity, grade level, weight status, and district free/reduced-price lunch eligibility (n = 23,173). RESULTS Students in districts that required/recommended restricting the times of SSB sales had 55% higher (adjusted odds ratio [AOR], 1.55; 95% confidence interval [CI], 1.28-1.87) odds of consuming ≥1 glass/day of milk than students in districts without this policy. Closed campus policies were associated with lower odds of consuming milk (AOR, .72; 95% CI, .63-.82) and higher odds of consuming juice (AOR, 1.27; 95% CI, 1.07-1.50). Policies requiring/recommending that districts offer/sell healthful alternatives were associated with lower odds of consuming 100% fruit juice daily. CONCLUSIONS Results suggest that restricting SSB sales may support adolescents' milk consumption. Future studies should assess whether the implementation of federal standards that further restrict SSB sales in school leads to increased milk consumption.
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Affiliation(s)
- Sarah A Sliwa
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia.
| | - Gabrielle F Miller
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia; Division of Analysis, Research, and Practice Integration, National Center for Injury Prevention and Control, CDC, Atlanta, Georgia
| | - Nancy D Brener
- Division of Adolescent and School Health, National Center for HIV/Aids, Viral Hepatitis, STD, & TB Prevention, CDC, Atlanta, Georgia
| | - Sohyun Park
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Caitlin L Merlo
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
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Papanikolaou Y, Jones JM, Fulgoni VL. Several grain dietary patterns are associated with better diet quality and improved shortfall nutrient intakes in US children and adolescents: a study focusing on the 2015-2020 Dietary Guidelines for Americans. Nutr J 2017; 16:13. [PMID: 28219433 PMCID: PMC5319115 DOI: 10.1186/s12937-017-0230-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 01/17/2017] [Indexed: 12/14/2022] Open
Abstract
Background The present study identified the most commonly consumed grain food patterns in US children and adolescents (2–18 years-old; N = 8,367) relative to those not consuming grains and compared diet quality and nutrient intakes, with focus on 2015–2020 Dietary Guidelines for Americans (2015–2020 DGA) shortfall nutrients. Methods Cluster analysis using data from the National Health and Nutrition Examination Survey 2005–2010, identified 8 unique grain food patterns: a) no consumption of main grain groups, b) cakes, cookies and pies, c) yeast bread and rolls, d) cereals, e) pasta, cooked cereals and rice, f) crackers and salty snacks, g) pancakes, waffles and French toast and other grains, and h) quick breads. Results Energy intake was higher for all grain cluster patterns examined, except ‘cereals’, compared to no grains. Children and adolescents in the ‘yeast bread and rolls’, ‘cereals’, ‘pasta, cooked cereals and rice’, and ‘crackers and salty snacks’ patterns had a higher diet quality relative to no grains (all p < 0.01). Energy adjusted (EA) dietary fiber intake was greater in five of the seven grain patterns, ranging from 1.8 – 2.8 g more per day (all p < 0.01), as compared to those consuming no grains. All grain patterns, except cakes, cookies and pies had higher EA daily folate relative to children in the no grains pattern (all p < 0.0001). EA total fat was lower in ‘cereals’, ‘pasta, cooked cereals and rice’, and ‘pancakes, waffles, French toast and other grains’ in comparison to the no grains food pattern (all p < 0.01). EA magnesium intakes were greater in children and adolescents consuming ‘yeast bread and rolls’, ‘pasta, cooked cereals and rice’, and ‘quick breads’, while EA iron was higher in all grain patterns relative to no grains (all p < 0.01). EA vitamin D intake was higher only in children consuming ‘cereals’ vs. no grain group (p < 0.0001). There were no significant differences in total or added sugar intake across all grain clusters as compared to no grains. Conclusions Consumption of several, but not all, grain food patterns in children and adolescents were associated with improved 2015–2020 DGA shortfall nutrient intakes and diet quality as compared to those consuming no grains.
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Affiliation(s)
- Yanni Papanikolaou
- Nutritional Strategies Inc., 59 Marriott Place, Paris, ON, N3L 0A3, Canada.
| | - Julie Miller Jones
- Distinguished Scholar and Professor Emerita of Food and Nutrition, Department of Foods and Nutrition, St. Catherine University, 4030 Valentine Ct. Arden Hills, Minnesota, MN, 55112, USA
| | - Victor L Fulgoni
- Nutrition Impact, LLC, 9725 D Drive North, Battle Creek, MI, USA
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Romo-Palafox MJ, Ranjit N, Sweitzer SJ, Roberts-Gray C, Byrd-Williams CE, Briley ME, Hoelscher DM. Adequacy of Parent-Packed Lunches and Preschooler's Consumption Compared to Dietary Reference Intake Recommendations. J Am Coll Nutr 2017; 36:169-176. [DOI: 10.1080/07315724.2016.1240634] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Maria Jose Romo-Palafox
- Michael & Susan Dell Center for Health Living, University of Texas Health Science Center, School of Public Health, Austin Regional Campus, Austin, Texas
| | - Nalini Ranjit
- Department of Health Promotion/Behavioral Sciences Austin, Texas
| | - Sara J. Sweitzer
- Nutritional Sciences, School of Human Ecology, The University of Texas at Austin, Austin, Texas
| | | | | | - Margaret E. Briley
- Nutritional Sciences, School of Human Ecology, The University of Texas at Austin, Austin, Texas
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Effect of fortified milk on growth and nutritional status in young children: a systematic review and meta-analysis. Public Health Nutr 2016; 20:1214-1225. [DOI: 10.1017/s1368980016003189] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
AbstractObjectiveAdequate nutrition is critical for optimal growth and development. However, young children may be at risk of nutrient deficiencies when transitioning to weaning foods for a variety of reasons. Supplementation with fortified milk may provide potentially lacking essential nutrients, but effects on growth and nutritional status are yet to be established.DesignFive databases were searched for randomised controlled trials using fortified milk against control milk in young children. Outcomes were growth, body composition and/or biochemical markers. Pooled differences in means were calculated for continuous outcomes and odds ratios for binary outcomes.SettingRandomised controlled trials set in any country.SubjectsOtherwise healthy children aged 6–47 months.ResultsFifteen articles met the eligibility criteria. Fortification varied from Fe, Zn, vitamins, essential fatty acids, to pre- and/or probiotics. Frequently reported outcomes were weight, height and Fe status. Studies varied in geographical location, sample size and duration. Fortified milk had minimal effects on weight gain (mean difference=0·17 kg; 95 % CI 0·02, 0·31 kg) compared with control milk. The risk of anaemia was reduced in fortified milk groups (OR=0·32; 95 % CI 0·15, 0·66) compared with control groups. There were no significant effects on height gain, changes in body composition or Hb concentration.ConclusionsFortified milk is an effective source of complementary nutrition to supplement children in need when consumed in appropriate amounts in addition to a normal diet. Due to compositional differences, further research on fortified milk is warranted before making global recommendations on benefits for growth and nutritional outcomes in young children.
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