EURRECA-Principles and future for deriving micronutrient recommendations

The science of micronutrients in clinical practice - Report on the ESPEN symposium

BACKGROUND & AIMS

The European Society for Clinical Nutrition and Metabolism published its first clinical guidelines for use of micronutrients (MNs) in 2022. A two-day web symposium was organized in November 2022 discussing how to apply the guidelines in clinical practice. The present paper reports the main findings of this symposium.

METHODS

Current evidence was discussed, the first day being devoted to clarifying the biology underlying the guidelines, especially regarding the definition of deficiency, the impact of inflammation, and the roles in antioxidant defences and immunity. The second day focused on clinical situations with high prevalence of MN depletion and deficiency.

RESULTS

The importance of the determination of MN status in patients at risk and diagnosis of deficiencies is still insufficiently perceived, considering the essential role of MNs in immune and antioxidant defences. Epidemiological data show that deficiencies of several MNs (iron, iodine, vitamin D) are a global problem that affects human health and well-being including immune responses such as to vaccination. Clinical conditions frequently associated with MN deficiencies were discussed including cancer, obesity with impact of bariatric surgery, diseases of the gastrointestinal tract, critical illness, and aging. In all these conditions, MN deficiency is associated with worsening of outcomes. The recurrent problem of shortage of MN products, but also lack of individual MN-products is a worldwide problem.

CONCLUSION

Despite important progress in epidemiology and clinical nutrition, numerous gaps in practice persist. MN depletion and deficiency are frequently insufficiently searched for in clinical conditions, leading to inadequate treatment. The symposium concluded that more research and continued education are required to improve patient outcome.

Decomposition of Socioeconomic Changes in the Consumption of Micronutrients in Pakistan between 2006 and 2016

This study is conducted to decompose inequality in four important micronutrient intakes, i.e. calcium, iodine, iron, and zinc due to socioeconomic factors during 2006-2016. For this purpose, data were taken from national-level surveys, i.e. HIES-2006 and HIICS-2016. We applied a recently proposed decomposition method based on copula function to decompose between year changes in the consumption of micronutrients into structure and composition effect. The results show that average calcium and iron intakes increased by 518.54 (mg) and 0.962 (mg), respectively, while average iodine and zinc intakes decreased by 2.009 (mg) and 3.411 (mg), respectively, during the decade. Estimates of structure effect show that calcium, iodine, and iron consumption increased on average, i.e. 525.316 (mg), 14.615 (mg), and 2.15 (mg), respectively, while zinc intake decreased by 2.735 (mg). The composition effect is negative for all the four micronutrients, implying that consumption of calcium, iodine, iron, and zinc decreased as 6.7766 (mg), 16.624 (mg), 1.189 (mg), and 0.677 (mg), respectively. The main factors of this change are household income, urbanization, provinces, and household size. The policymakers need to know the importance of socioeconomic factors to improve hidden hunger in terms of micronutrient intakes.

Eco-friendly synthesis of phytochemical-capped iron oxide nanoparticles as nano-priming agent for boosting seed germination in rice (Oryza sativa L.)

Recently the applications of engineered nanoparticles in the agricultural sector is increased as nano-pesticides, nano-fertilizers, nanocarrier for macro- or micronutrients, nano-sensors, etc. In this study, biocompatible iron oxide nanoparticles (FeO NPs) have been synthesized through an environment-friendly route using Cassia occidentalis L. flower extract to act as nano-priming agent for promoting germination of Pusa basmati rice seeds. Different characterization methods, viz. X-ray diffraction, particle size analyser, zeta potential and scanning electron microscopy, were used to show efficacious synthesis of FeO NPs capped with phytochemicals. Rice seeds primed with FeO NPs at 20 and 40 mg/L efficiently enhanced germination and seedling vigour compared to ferrous sulphate (FeSO₄) priming and hydro-primed control. The seeds primed with 20 mg/L FeO NPs showed up to 50% stimulation in biophysical parameters such as root length and dry weight. Substantial stimulation of sugar and amylase content was also reported at the same concentration. The antioxidant enzyme activity was significantly increased as compared to FeSO₄ priming and control. Inductively coupled plasma mass spectroscopy (ICP-MS) study was also done for analysis of Fe, Zn, K, Ca, and Mn concentration in seeds. The seed priming technique signifies a comprehensible and innovative approach that could enhance α-amylase activity, iron acquisition, and ROS production, ensuing elevated soluble sugar levels for supporting seedling growth and enhancing seed germination rate, respectively. In this report, phytochemical-capped FeO NPs are presented as a capable nano-priming agent for stimulating the germination of naturally aged rice seeds.

Genetic test for the prescription of diets in support of physical activity

Owing to the fields of nutrigenetics and nutrigenomics today we can think of devising approaches to optimize health, delay onset of diseases and reduce its severity according to our genetic blue print. However this requires a deep understanding of nutritional impact on expression of genes that may result in a specific phenotype. The extensive research and observational studies during last two decades reporting interactions between genes, diet and physical activity suggest a cross talk between various genetic and environmental factors and lifestyle interventions. Although considerable efforts have been made in unraveling the mechanisms of gene-diet interactions the scientific evidences behind developing commercial genetic tests for providing personalized nutrition recommendations are still scarce. In this scenario the current mini-review aims to provide useful insights into salient feature of nutrition based genetic research and its commercial application and the ethical issue and concerns related to its outcome.

Proposed guidelines to evaluate scientific validity and evidence for genotype-based dietary advice

Nutrigenetic research examines the effects of inter-individual differences in genotype on responses to nutrients and other food components, in the context of health and of nutrient requirements. A practical application of nutrigenetics is the use of personal genetic information to guide recommendations for dietary choices that are more efficacious at the individual or genetic subgroup level relative to generic dietary advice. Nutrigenetics is unregulated, with no defined standards, beyond some commercially adopted codes of practice. Only a few official nutrition-related professional bodies have embraced the subject, and, consequently, there is a lack of educational resources or guidance for implementation of the outcomes of nutrigenetic research. To avoid misuse and to protect the public, personalised nutrigenetic advice and information should be based on clear evidence of validity grounded in a careful and defensible interpretation of outcomes from nutrigenetic research studies. Evidence requirements are clearly stated and assessed within the context of state-of-the-art 'evidence-based nutrition'. We have developed and present here a draft framework that can be used to assess the strength of the evidence for scientific validity of nutrigenetic knowledge and whether 'actionable'. In addition, we propose that this framework be used as the basis for developing transparent and scientifically sound advice to the public based on nutrigenetic tests. We feel that although this area is still in its infancy, minimal guidelines are required. Though these guidelines are based on semi-quantitative data, they should stimulate debate on their utility. This framework will be revised biennially, as knowledge on the subject increases.

Beneficial changes in food consumption and nutrient intake after 10 years of follow-up in a Mediterranean cohort: the SUN project

Background

The assessment of changes in dietary habits provides interesting information on whether or not the observed trends are in line with accepted nutritional guidelines. The objective was to evaluate within-subject longitudinal changes in food consumption and nutrient intake and in a 10-year follow-up study.

Methods

The SUN (Seguimiento Universidad de Navarra) project is a prospective Spanish cohort study. Diet was assessed using a 136-item food-frequency questionnaire (FFQ), previously validated in Spain. The participants were 3036 university graduates (55.8 % women) of Spain and the main outcome measures the changes in dietary quality and in food consumption and nutrient intake. Paired t-tests and conditional logistic regression models were used to evaluate within-subject longitudinal dietary changes and the risk of inadequacy respectively, after 10 years of follow-up.

Results

During follow-up, participants showed a relevant and significant increase (p < 0.001) in the consumption of fruits (7.4 %), vegetables (8.6 %), low-fat dairy products (35.2 %), lean meat (12.4 %), fish (2.9 %), whole grains (53.2 %), nuts (52.4 %) and a significant decrease in legumes (−7.4 %), whole-fat dairy products (−44.2 %), red meat (−17.6 %), sugar-sweetened beverages (−58.7 %) and wine (−11.9 %). With respect to nutrients, we found a higher proportion of carbohydrates (3.6 %) and fiber (7.4 %) and a decrease in total energy intake (2.7 %), total fat (−4.5 %), SFA (−9.4 %), MUFA (−4.9 %), PUFA (−12.7 %), w-3 and w-6 fatty acids (−9.1 and −20.5 % respectively) and cholesterol (−9.6 %).

Conclusions

In this Mediterranean cohort study, mainly beneficial changes in the consumption of most foods and macronutrients were observed after 10 years of follow-up.

Nutrient Status Assessment in Individuals and Populations for Healthy Aging-Statement from an Expert Workshop

A workshop organized by the University Medical Center Groningen addressed various current issues regarding nutrient status of individuals and populations, tools and strategies for its assessment, and opportunities to intervene. The importance of nutrient deficiencies and information on nutrient status for health has been illustrated, in particular for elderly and specific patient groups. The nutrient profile of individuals can be connected to phenotypes, like hypertension or obesity, as well as to socio-economic data. This approach provides information on the relationship between nutrition (nutrient intake and status) and health outcomes and, for instance, allows us to use the findings to communicate and advocate a healthy lifestyle. Nutrition is complex: a broader profile of nutrients should be considered rather than focusing solely on a single nutrient. Evaluating food patterns instead of intake of individual nutrients provides better insight into relationships between nutrition and health and disease. This approach would allow us to provide feedback to individuals about their status and ways to improve their nutritional habits. In addition, it would provide tools for scientists and health authorities to update and develop public health recommendations.

EURRECA-Evidence-based methodology for deriving micronutrient recommendations

The EURopean micronutrient RECommendations Aligned (EURRECA) Network of Excellence explored the process of setting micronutrient recommendations to address the variance in recommendations across Europe. Work centered upon the transparent assessment of nutritional requirements via a series of systematic literature reviews and meta-analyses. In addition, the necessity of assessing nutritional requirements and the policy context of setting micronutrient recommendations was investigated. Findings have been presented in a framework that covers nine activities clustered into four stages: stage one "Defining the problem" describes Activities 1 and 2: "Identifying the nutrition-related health problem" and "Defining the process"; stage two "Monitoring and evaluating" describes Activities 3 and 7: "Establishing appropriate methods," and "Nutrient intake and status of population groups"; stage three "Deriving dietary reference values" describes Activities 4, 5, and 6: "Collating sources of evidence," "Appraisal of the evidence," and "Integrating the evidence"; stage four "Using dietary reference values in policy making" describes Activities 8 and 9: "Identifying policy options," and "Evaluating policy implementation." These activities provide guidance on how to resolve various issues when deriving micronutrient requirements and address the methodological and policy decisions, which may explain the current variation in recommendations across Europe. [Supplementary materials are available for this article. Go to the publisher's online edition of Critical Reviews in Food Science and Nutrition for the following free supplemental files: Additional text, tables, and figures.].

EURRECA-Framework for Aligning Micronutrient Recommendations

There is currently no standard approach for deriving micronutrient recommendations, and large variations exist across Europe, causing confusion among consumers, food producers, and policy makers. More aligned information could influence dietary behaviors and potentially lead to a healthier population. Funded by the European Commission, EURRECA (EURopean micronutrient RECommendations Aligned) has developed methods and applications to guide Nutrient Recommendation Setting Bodies through the process of setting micronutrient reference values. The EURRECA approach is crystallized into its framework that outlines a standard process for deriving and using dietary reference values for micronutrients in a transparent, systematic, and scientific way. The 9 activities of the framework can be clustered into four stages (i) defining the problem, (ii) monitoring and evaluating, (iii) deriving dietary reference values, and (iv) using dietary reference values in policy making. The EURRECA framework should not be interpreted as a prescriptive description of a linear process, but as a structured guide for checking that all issues essential for deriving requirements have at least been considered.