Human protein requirement: policy issues

Challenges in Harmonizing Energy and Nutrient Recommendations in Europe

At the present time, there is considerable diversity in the dietary reference values and recommendations used across Europe, both in terms of terminology and guideline values. Harmonization of dietary reference values would be beneficial in simplifying nutritional policy, trade, and public understanding of diet and health issues. However, this is not a simple task because of the differences in methodological approaches adopted and the assumptions made. In addition, there are genuine differences in diet, lifestyle and geography that may necessitate retaining variation in some dietary reference values between European nations. The complexities of harmonization were discussed at a recent symposium held under the auspices of the Federation of European Nutrition Societies (FENS). This provided overviews of the different terminologies currently in use, of the variations in reference values for children and adolescents, and of the disparities between different groups of countries in Europe. The symposium hosted by FENS provided a forum to exchange views and to consider the steps that will be needed if harmonization is to be realized in the future. A summary of the presentations and conclusions is presented here.

A simple prediction of total body water to aid quality control in isotope dilution studies in subjects 3-87 years of age

The principal method of measuring total body water (TBW) is by isotope dilution. Also, the doubly labelled water method, which is the method of choice for measuring total energy expenditure (TEE) in free-living individuals, includes calculation of TBW as the dilution space of the tracer. TBW was measured in 261 subjects (135 males and 126 females), aged 3-87, including healthy children, children with HIV and adults with non-insulin dependent diabetes mellitus (type 2 diabetes), mild hypertension, pancreatic cancer and lung cancer, either in studies of body composition or TEE. A linear relationship was found between TBW and height in all subjects. When TBW is plotted against height cubed (Ht3, m3) the regression line can be forced through the origin. Considering only adults with 18.5>body mass index <29.9 and all children (n=220), this yielded TBW (l)=7.40 x Ht3, R2=0.95. This simple linear relationship between measured TBW and Ht3 compared favourably with other prediction methods, assuming TBW is a constant proportion (55%) of body weight and TBW predicted from height and weight (mean difference between measured and predicted TBW 0.55 l compared with -1.95 and -1.20 l, respectively). Absolute errors were greater at higher TBW, but use of a log10 transformation reduced this effect. This simple relationship of TBW with Ht3 is too crude to be used as a body composition predictor in individual subjects as it ignores, for instance, body shape. However, it can be used as a quality control tool. Here, use of a log10 transformation and residual plot can serve to identify outliers, which can be checked for gross errors in data input and if necessary samples are re-analysed.

Incidence of endemic ataxic polyneuropathy and its relation to exposure to cyanide in a Nigerian community

BACKGROUND

The occurrence of ataxic polyneuropathy in an endemic area in south west Nigeria has been attributed to exposure to cyanide from cassava foods. However, it has been shown that the prevalence of ataxic polyneuropathy is not high in several communities in the tropics where exposure to cyanide from cassava foods is high.

OBJECTIVES

To determine the incidence of ataxic polyneuropathy in an endemic community, and to compare the intake of cassava foods, exposure to cyanide, and levels of thiols in cases and controls.

METHODS

A cohort of 3167 healthy subjects aged 10 years and over in Ososa, Nigeria, was followed for two years, screened, and examined neurologically. Ataxic polyneuropathy was diagnosed if sensory polyneuropathy and sensory gait ataxia were both present. Controls were selected randomly within 10 year age groups of subjects who screened negative. Intake of cassava foods, exposure to cyanide, concentrations of thiols (glutathione, cysteine, and gamma glutamylcysteine) in plasma, and visual evoked potentials were measured.

RESULTS

Person-years of follow up were 6246 for 1469 male and 1698 female subjects in the cohort. The incidence of ataxic polyneuropathy was 64 per 10,000 person-years (31 for male and 93 for female subjects). Multivariate odd ratios were 0.78 (95% CI 0.23 to 2.61) for intake of the commonest cassava food, and 1.64 (0.56 to 5.09) for concentration of thiocyanate in plasma. The concentration of thiols was less than the reference limits in two controls, but in none of the cases. The latency of P100 was prolonged in 20 cases (69%) compared with 14 controls (42%) (p<0.05).

CONCLUSIONS

The incidence of ataxic polyneuropathy is high in Ososa, Nigeria, but the intake of cassava foods, exposure to cyanide, and levels of thiols, are not related to the occurrence. These findings do not suggest that cyanide is the cause of endemic ataxic polyneuropathy.