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De Cosmi V, Mazzocchi A, Agostoni C, Visioli F. Fructooligosaccharides: From Breast Milk Components to Potential Supplements. A Systematic Review. Adv Nutr 2022; 13:318-327. [PMID: 34555852 PMCID: PMC8803487 DOI: 10.1093/advances/nmab102] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/12/2021] [Accepted: 08/25/2021] [Indexed: 12/30/2022] Open
Abstract
Breast milk is the optimal food choice for infant growth and development. Among breast milk components, fructooligosaccharides (FOSs) are being actively studied because of their role in microbiota development. In particular, 2'-fucosyllactose is being proposed as a potential supplement/nutraceutical or component of infant formula. In this systematic review, we critically summarize the available information on FOSs and we discuss their future use in infant nutrition. We searched the main electronic databases (PubMed, Embase, and Scopus), with a final check in May 2021. Search terms were inserted individually and using the Boolean tools AND and OR. Relevant articles were identified using the following words: ("fructooligosaccharides" OR "FOS") AND ("human milk" OR "breast milk" OR "donor milk" OR "bank milk"). The search retrieved 1814 articles. After removal of duplicates, we screened 1591 articles based on title, abstract, and exclusive use of the English language. We included articles describing the concentration of FOSs in human milk and assessed the relevant ones. We excluded reviews, studies on animals, and studies exclusively carried out on adults. Also, we excluded studies that have not reported evidence either on FOSs or on galactooligosaccharides from human milk. The resulting publications were reviewed, and 10 studies were included in the systematic review. We conclude that human milk FOSs are, indeed, crucial to infant gut development and their addition to infant formula is safe, well-tolerated, and might provide immune benefits to newborns. However, we would like to underscore the scantiness of human data and the need to avoid the immediate translation of infant research to the commercialization of supplements marketed to adults.
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Affiliation(s)
- Valentina De Cosmi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Alessandra Mazzocchi
- Pediatric Intermediate Care Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Carlo Agostoni
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Pediatric Intermediate Care Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
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López Mas R, Luján JL. The essentiality of nutrients: a challenge to methodological monism in the scientific substantiation of health claims. Int J Food Sci Nutr 2021; 73:149-153. [PMID: 34225529 DOI: 10.1080/09637486.2021.1948508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This paper analyzes the way in which the EFSA has addressed the limitations that the essentiality of nutrients presents to the requirement of obtaining evidence from RCTs for the scientific substantiation of health claims. By redefining the requirements to affirm causality in the case of essentiality of nutrients, the EFSA has constrained the debate on the relevance of different methodologies in the field of nutrition research. However, avoiding this methodological debate does not settle the controversy as to whether the EFSA's evidentiary hierarchy is the best for both investigating causal relationships in nutrition and for achieving social objectives such as fostering innovation and public health.
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Affiliation(s)
- Roberto López Mas
- Department of Philosophy, University of the Balearic Islands, Palma de Mallorca, Spain
| | - José Luis Luján
- Department of Philosophy, University of the Balearic Islands, Palma de Mallorca, Spain
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3
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Abstract
Food is the primary source of nutrients to keep us nourished and healthy. Poor and unhealthy diets implicated with the increase of several non-communicable diseases (NCDs) require a food-based approach to reduce the ongoing rise. Traditional knowledge and science behind food-related health benefits became evident in the last three decades. Active ingredients, bioactive molecules and conventionally used herbs were clinically researched and proven to have beneficial outcomes. In the Indian scenario, the multiplicity of food products, including medicinal type formats, such as health supplements, containing plant, herbs or novel ingredients, brings in a new complexity to regulations. Several of these ingredients are pharmacologically active substances and could overlap with drug regulations. The data generated on the nutritional and health benefit of a supplement should be reproducible, outcomes measurable and disease risk reduction shown by well-designed research studies. Regulatory challenges occur at several levels, namely, harmonization of law, fair trade practice, population exposures to chemicals and contaminants, food borne illness, rise in NCD's, novel ingredients, new technologies and a legacy of regulatory practice. While regulatory and legal challenges will always exist, reliance on the role of scientific research in the regulatory context becomes significant.>.
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Affiliation(s)
| | - Joseph I Lewis
- Regulatory Affairs Committee, Protein Foods Nutrition Development Association of India, Mumbai, India
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Luján JL, Todt O. Standards of evidence and causality in regulatory science: Risk and benefit assessment. STUDIES IN HISTORY AND PHILOSOPHY OF SCIENCE 2020; 80:82-89. [PMID: 32383676 DOI: 10.1016/j.shpsa.2019.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 04/05/2019] [Accepted: 05/08/2019] [Indexed: 06/11/2023]
Abstract
In this paper we analyze the Russo-Williamson Thesis (RWT) as a standard of evidence in regulatory science, in risk as well as benefit assessment. In our analysis we take account of the recent controversies that have taken place in regulation with respect to the evidentiary requirements necessary for regulatory decision making. RWT's main point is that not only probabilistic but also mechanistic evidence is necessary for being able to infer the existence of causal links. We ask in which way RWT could have an impact upon current decision making about subjecting to regulation (or, to the contrary, leaving them unregulated) certain chemical substances, food stuffs, health claims, and other typical objects of regulation. We show that the application of RWT resolves some of the problems posed by current standards of evidence. RWT makes it possible to determine with higher accuracy if a particular substance should be subjected to regulation or not, even though under certain circumstances RWT itself may turn into a source of regulatory error. The adequacy of RWT as a standard of evidence depends on the precise manner of its application to regulation (particularly the consideration of mechanistic evidence as a complementary or necessary requirement), as well as the assessment of its non-epistemic consequences.
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Affiliation(s)
- José Luis Luján
- Department of Philosophy, University of the Balearic Islands (UIB), Carretera de Valldemossa, Km. 7,5, 07071, Palma de Mallorca, Spain.
| | - Oliver Todt
- Department of Philosophy, University of the Balearic Islands (UIB), Carretera de Valldemossa, Km. 7,5, 07071, Palma de Mallorca, Spain
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González-Díaz C, Gil-González D, Álvarez-Dardet C. Scientific Evidence on Functional Food and Its Commercial Communication: A Review of Legislation in Europe and the USA. J Food Sci 2018; 83:2710-2717. [DOI: 10.1111/1750-3841.14359] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 08/27/2018] [Accepted: 08/29/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Cristina González-Díaz
- Dept. of Communication and Social Psychology; Univ. of Alicante; Carretera San Vicente del Raspeig s/n, 03690 San Vicente del Raspeig Alicante Spain
| | - Diana Gil-González
- Dept. of Community Nursing, Preventive Medicine and Public Health and the History of Science; Univ. of Alicante; Carretera San Vicente del Raspeig s/n, 03690 San Vicente del Raspeig Alicante Spain
- Public Health Research Group; Univ. of Alicante; Alicante Spain
- CIBER Epidemiología y Salud Pública (CIBERESP); Spain
| | - Carlos Álvarez-Dardet
- Dept. of Community Nursing, Preventive Medicine and Public Health and the History of Science; Univ. of Alicante; Carretera San Vicente del Raspeig s/n, 03690 San Vicente del Raspeig Alicante Spain
- Public Health Research Group; Univ. of Alicante; Alicante Spain
- CIBER Epidemiología y Salud Pública (CIBERESP); Spain
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De Devitiis B, Carlucci D, Nocella G, Viscecchia R, Bimbo F, Nardone G. Insights for the Development of a Functional Fish Product: Drivers and Barriers, Acceptance, and Communication of Health Benefits. JOURNAL OF AQUATIC FOOD PRODUCT TECHNOLOGY 2018. [DOI: 10.1080/10498850.2018.1447059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Biagia De Devitiis
- Department of Agricultural, Food and Environmental Sciences, University of Foggia, Foggia, Italy
| | - Domenico Carlucci
- Department of Agricultural and Environmental Sciences, University of Bari “Aldo Moro”, Bari, Italy
| | - Giuseppe Nocella
- School of Agriculture, Policy and Development, University of Reading, Reading, UK
| | - Rosaria Viscecchia
- Department of Agricultural, Food and Environmental Sciences, University of Foggia, Foggia, Italy
| | - Francesco Bimbo
- Business Economics Group, Department of Social Sciences, Wageningen University, Wageningen, The Netherlands
| | - Gianluca Nardone
- Department of Agricultural, Food and Environmental Sciences, University of Foggia, Foggia, Italy
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7
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Luján JL, Todt O. The dilemmas of science for policy: Scientific evidence and the consequences of regulatory options in risk and benefit assessment. EMBO Rep 2018; 19:194-196. [PMID: 29305516 DOI: 10.15252/embr.201744795] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- José Luis Luján
- Department of Philosophy University of the Balearic Islands, Palma, Spain
| | - Oliver Todt
- Department of Philosophy University of the Balearic Islands, Palma, Spain
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Todt O, Luján JL. Health Claims and Methodological Controversy in Nutrition Science. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2017; 37:958-968. [PMID: 28106272 DOI: 10.1111/risa.12665] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 06/10/2016] [Accepted: 06/11/2016] [Indexed: 06/06/2023]
Abstract
This article analyzes the debate about data acquisition and assessment in health claims regulation by identifying the underlying controversies on methodological choice. Regulation in the European Union imposes the need for a scientific substantiation of all health claims (claims about a relationship between consumption of certain food ingredients and positive health effects). Randomized controlled trials (RCTs) are the method that generally is considered to provide the highest quality data for decision making in claims regulation because they allow for establishing cause-effect relationships. The latter are demanded in European regulatory practice for authorization of a claim. This requirement has contributed to a debate about the advantages and limitations of the RCT methodology in nutrition research and regulation. Our analysis identifies five types of tensions that underlie the controversy, with respect to evidence, cognitive values, standards of proof, future lines of research, as well as expert judgment. We conclude that there is a direct and mutual interaction between methodological decisions in nutrition science, and different strategies in health claims regulation. The latter have social and public health consequences because not only may they affect the European market for functional foods, as well as concomitant consumption patterns, but also the generation of future regulation-relevant evidence in nutrition.
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Affiliation(s)
- Oliver Todt
- Department for Philosophy, University of the Balearic Islands, Palma, Spain
| | - José Luis Luján
- Department for Philosophy, University of the Balearic Islands, Palma, Spain
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9
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Verhagen H, van Loveren H. Status of nutrition and health claims in Europe by mid 2015. Trends Food Sci Technol 2016. [DOI: 10.1016/j.tifs.2016.07.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Tan KYM, van der Beek EM, Chan MY, Zhao X, Stevenson L. Health claims on food products in Southeast Asia: regulatory frameworks, barriers, and opportunities. Nutr Rev 2016; 73:634-41. [PMID: 26269489 DOI: 10.1093/nutrit/nuv029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Association of Southeast Asian Nations aims to act as a single market and allow free movement of goods, services, and manpower. The purpose of this article is to present an overview of the current regulatory framework for health claims in Southeast Asia and to highlight the current barriers and opportunities in the regulatory frameworks in the Association of Southeast Asian Nations. To date, 5 countries in Southeast Asia, i.e., Indonesia, Malaysia, the Philippines, Singapore, and Thailand, have regulations and guidelines to permit the use of health claims on food products. There are inconsistencies in the regulations and the types of evidence required for health claim applications in these countries. A clear understanding of the regulatory frameworks in these countries may help to increase trade in this fast-growing region and to provide direction for the food industry and the regulatory community to develop and market food products with better nutritional quality tailored to the needs of Southeast Asian consumers.
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Affiliation(s)
- Karin Y M Tan
- K.Y.M. Tan and M.Y. Chan are with the Human Nutrition Research Centre, Newcastle University, Singapore, Republic of Singapore. E.M.v.d.Beek is with Nutricia Research, Danone-Nutricia Early Life Nutrition, Singapore, Republic of Singapore. X.J. Zhao is with Nutricia Early Life Nutrition (Shanghai) Co., Ltd, Pudong, Shanghai, People's Republic of China. L. Stevenson is with the Nutrition & Health Research Group, Liverpool John Moores University, Aigburth, Liverpool, United Kingdom.
| | - Eline M van der Beek
- K.Y.M. Tan and M.Y. Chan are with the Human Nutrition Research Centre, Newcastle University, Singapore, Republic of Singapore. E.M.v.d.Beek is with Nutricia Research, Danone-Nutricia Early Life Nutrition, Singapore, Republic of Singapore. X.J. Zhao is with Nutricia Early Life Nutrition (Shanghai) Co., Ltd, Pudong, Shanghai, People's Republic of China. L. Stevenson is with the Nutrition & Health Research Group, Liverpool John Moores University, Aigburth, Liverpool, United Kingdom
| | - M Y Chan
- K.Y.M. Tan and M.Y. Chan are with the Human Nutrition Research Centre, Newcastle University, Singapore, Republic of Singapore. E.M.v.d.Beek is with Nutricia Research, Danone-Nutricia Early Life Nutrition, Singapore, Republic of Singapore. X.J. Zhao is with Nutricia Early Life Nutrition (Shanghai) Co., Ltd, Pudong, Shanghai, People's Republic of China. L. Stevenson is with the Nutrition & Health Research Group, Liverpool John Moores University, Aigburth, Liverpool, United Kingdom
| | - Xuejun Zhao
- K.Y.M. Tan and M.Y. Chan are with the Human Nutrition Research Centre, Newcastle University, Singapore, Republic of Singapore. E.M.v.d.Beek is with Nutricia Research, Danone-Nutricia Early Life Nutrition, Singapore, Republic of Singapore. X.J. Zhao is with Nutricia Early Life Nutrition (Shanghai) Co., Ltd, Pudong, Shanghai, People's Republic of China. L. Stevenson is with the Nutrition & Health Research Group, Liverpool John Moores University, Aigburth, Liverpool, United Kingdom
| | - Leo Stevenson
- K.Y.M. Tan and M.Y. Chan are with the Human Nutrition Research Centre, Newcastle University, Singapore, Republic of Singapore. E.M.v.d.Beek is with Nutricia Research, Danone-Nutricia Early Life Nutrition, Singapore, Republic of Singapore. X.J. Zhao is with Nutricia Early Life Nutrition (Shanghai) Co., Ltd, Pudong, Shanghai, People's Republic of China. L. Stevenson is with the Nutrition & Health Research Group, Liverpool John Moores University, Aigburth, Liverpool, United Kingdom
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11
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Raats MM, Malcolm RN, Lähteenmäki L, Pravst I, Gage H, Cleary A, Klopčič M. Understanding the impact of European Regulation on the substantiation and use of claims on food and drinks: Design of the REDICLAIM project and initial results. NUTR BULL 2015. [DOI: 10.1111/nbu.12179] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | - I. Pravst
- Nutrition Institute; Ljubljana Slovenia
| | - H. Gage
- University of Surrey; Guildford UK
| | | | - M. Klopčič
- University of Ljubljana; Ljubljana Slovenia
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12
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Richardson DP, Eggersdorfer M. Opportunities for product innovation using authorised European Union health claims. Int J Food Sci Technol 2014. [DOI: 10.1111/ijfs.12574] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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van der Kamp JW, Poutanen K, Seal CJ, Richardson DP. The HEALTHGRAIN definition of 'whole grain'. Food Nutr Res 2014; 58:22100. [PMID: 24505218 PMCID: PMC3915794 DOI: 10.3402/fnr.v58.22100] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 12/06/2013] [Accepted: 12/12/2013] [Indexed: 12/17/2022] Open
Abstract
Most cereal products, like white bread, pasta, and biscuits, are based on flour after removal of bran and germ, the two parts of grain kernels containing most of the dietary fibre and other bioactive components. In the past decade, consumers have been rediscovering whole grain-based products and the number of wholegrain products has increased rapidly. In most countries in Europe and worldwide, however, no legally endorsed definition of wholegrain flour and products exists. Current definitions are often incomplete, lacking descriptions of the included grains and the permitted flour manufacturing processes. The consortium of the HEALTHGRAIN EU project (FP6-514008, 2005-2010) identified the need for developing a definition of whole grain with the following scope: 1) more comprehensive than current definitions in most EU countries; 2) one definition for Europe - when possible equal to definitions outside Europe; 3) reflecting current industrial practices for production of flours and consumer products; 4) useful in the context of nutritional guidelines and for labelling purposes. The definition was developed in a range of discussion meetings and consultations and was launched in 2010 at the end of the HEALTHGRAIN project. The grains included are specified: a wide range of cereal grains from the Poaceae family, and the pseudo-cereals amaranth, buckwheat, quinoa, and wild rice. The definition also describes manufacturing processes allowed for producing wholegrain flours. This paper compares the HEALTHGRAIN definition with previous definitions, provides more comprehensive explanations than in the definition itself regarding the inclusion of specific grains, and sets out the permitted flour manufacturing processes.
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Affiliation(s)
| | - Kaisa Poutanen
- VTT, Espoo, Finland
- Department of Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Chris J. Seal
- Human Nutrition Research Centre, School of Agriculture, Food & Rural Development, Newcastle University, Newcastle upon Tyne, UK
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Abstract
Consumer understanding of nutrition and health claims is a key aspect of current regulations in the European Union (EU). In view of this, qualitative and quantitative research techniques were used to investigate consumer awareness and understanding of product claims in the UK, focusing particularly on nutrition claims relating to sugars. Both research methods identified a good awareness of product claims. No added sugars claims were generally preferred to reduced sugars claims, and there was a general assumption that sweeteners and other ingredients would be added in place of sugars. However, there was little awareness of the level of sugar reduction and the associated calorie reduction in products when reduced sugars claims were made on pack. In focus groups, participants felt deceived if sugar reduction claims were being made without a significant reduction in calories. This was reinforced in the quantitative research which showed that respondents expected a similar and meaningful level of calorie reduction to the level of sugar reduction. The research also identified consumer confusion around the calorie content of different nutrients, including over-estimation of the calorie content of sugars. This is crucial to consumers' expectations as they clearly link sugar to calories and therefore expect a reduction in sugar content to deliver a reduction in calorie content.
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