Grains Contribute Shortfall Nutrients and Nutrient Density to Older US Adults: Data from the National Health and Nutrition Examination Survey, 2011⁻2014

Nutritional Health in Premenopausal Women: A Cross-Sectional Study from Turkey

Background

The aim of this study was to evaluate the nutritional habits of premenopausal women using the Food Consumption Frequency Questionnaire (FCFQ) and to evaluate the relationship between anthropometric measurements, lipid parameters, and the presence of anemia with the findings obtained.

Methods

This study was carried out in the internal medicine outpatient clinics of the Health Sciences University Bursa Yüksek İhtisas Training Research Hospital (located in Yıldırım districts) and Gürsu State Hospital (located in Gürsu districts) of Bursa province between 1 June-31 August 2019. We used clustered sampling in patient selection. One hundred seventy-one premenopausal participants aged between 18 and 55 who were known to be healthy and who came for routine control to the internal medicine outpatient clinics were included in the study. The FCFQ was used to determine how often the participants consumed different food groups in the last 1 month.

Results

Overweight participants were 29.20% and 17% were obese. 43.90% of the women had anemia and 65.50% of the women had iron deficiency. The milk-dairy products nutrition score of the group with triglycerides (TG) <150 mg/dL was higher than the group with TG ≥150 mg/dL (P = 0.029). The meat-egg-legumes nutrition score (2.11 ± 0.57) of the group with high density lipoprotein (HDL) ≥50 mg/dL was higher than the group with HDL <50 mg/dL (1.91 ± 0.58) (P = 0.04).

Conclusions

Anemia and obesity are high in premenopausal women. Community-based screening programs are needed to evaluate premenopausal women for anemia and obesity. Scales to assess the nutritional habits of the population are also needed in screening programs.

Fortification of grain foods and NOVA: the potential for altered nutrient intakes while avoiding ultra-processed foods

PURPOSE

NOVA is a food classification system describing a hierarchy from minimally processed to ultra-processed foods (UPF). Research has associated intake of UPF with chronic diseases. In Australia, the primary sources of grains, both refined and whole, are breads and breakfast cereals, which are typically fortified. Most are classified as UPF, yet are recommended core foods according to the Australian Dietary Guidelines (ADG). This research aimed to identify if avoidance of ultra-processed grain foods would alter nutrient intakes in an Australian population and whether sample diets using substitute (non-UPF) foods would be likely to meet nutrient requirements.

METHODS

Quantitative analysis of usual nutrient intake from the National Nutrition and Physical Activity Survey 2011-12 (n = 12,153) for all foods including and excluding UPF. Dietary modelling examined the nutritional adequacy of sample diets aligned with the ADG and another containing replacements for UPF. We particularly focused on grain foods and meeting whole-grain intake targets.

RESULTS

There was a significant decrease (all p < 0.05) in modelled intake of key nutrients when UPF were excluded, specifically, thiamin, folate and iodine, as substitutions are rarely fortified. Diets with no UPF, where substitutes are carefully chosen, have the potential to meet Nutrient Reference Values, but deviation from customary food choices may mean adoption of substitutes is unlikely.

CONCLUSIONS

Exclusion of UPF may result in lowered intakes of key nutrients of particular concern for at risk groups (including women of child-bearing age), negating gains made by public health policy of fortification. Substitutions may not be realistic in these at-risk populations.

Home-delivered meal programme participants may be at greater risk of malnutrition without the meal programme

OBJECTIVES

(1) To examine total quality of foods consumed on the day a home-delivered meal (HDM) of the Older Americans Act Nutrition Program (OAANSP) was served, and when a HDM was not served; and (2) to estimate proportion of HDM participants and non-participants meeting the daily average recommendations for guidance-based foods and nutrients.

DESIGN

Cross-sectional study.

SETTING

Data were obtained from the national 2015-2017 Outcomes Evaluation Study of HDM participants in the USA.

PARTICIPANTS

Adults aged 67 years and older (n 1227), 620 HDM recipients and 607 matching non-participants examined in three groups: (1) meal recipients who received a HDM on the day of the 24-h dietary recall; (2) no-meal recipients who did not receive a HDM on the day of the recall and (3) matching HDM non-participants.

RESULTS

Healthy Eating Index (HEI)-2010 scores of HDM participants were significantly lower on the day the meal was not received compared with when a meal was received (52·5 v. 63·4, P < 0·0001). There was no significant difference in the total HEI-2010 scores of HDM meal recipients and HDM non-participants. Despite the meal, less than 20 % of HDM participants and non-participants met the 2010-Diet Guidelines for Americans recommended average daily intake for fruit, vegetables, dairy, protein foods and solid fats.

CONCLUSION

HDM participants' diet quality is poorer when they do not receive a meal putting them at increased risk of malnutrition. Expanding the OAANSP to offer meals on weekends and/or to include more than one meal/d is recommended to improve the diet of this vulnerable population.

The Role of Fortified and Enriched Refined Grains in the US Dietary Pattern: A NHANES 2009-2016 Modeling Analysis to Examine Nutrient Adequacy

Background: While dietary recommendations call for greater whole-grain intake and reduced refined grain consumption, there are limited peer-reviewed studies examining the influence of fortified/enriched refined grains on nutrient adequacy. Methods: A modeling analysis using data from National Health and Nutrition Examination Survey (NHANES) 2009-2016 estimated usual daily intake of shortfall nutrients for Dietary Guidelines for Americans (DGA) in the current dietary pattern and when specific percentages of fortified/enriched refined grain foods (bread, ready-to-eat cereals, and all-grained foods) were removed from the diet (19-50-year-old adults, N = 11,169; 51-99-year-old adults, N = 9,641). Results: While American adults are currently falling short of nutrient recommendations, eliminating 25, 50, and 100% of all grains consumed in the US dietary pattern resulted in a greater percentage of adults not meeting recommendations for several shortfall nutrients, including dietary fiber, folate DFE, iron, and magnesium. Removal of all grains led to a reduced energy intake by ~10% in both age groups examined. Currently, ~3.8% of 19-50-year-old adults meet the adequate intake (AI) for dietary fiber. Removal of 25, 50, and 100% of grains from the diet resulted in 2.6 ± 0.3, 1.8 ± 0.2, and 0.7 ± 0.1% of adults exceeded the AI for dietary fiber, respectively. Similarly, 11.0 and 13.8% of younger and older adults, respectively, fall short of folate, DFE recommendations with the current diet. Following the removal of 100% of grains from the diet, 43.4 ± 1.1 and 56.2 ± 1.0%, respectively, were below the estimated average requirement (EAR) for folate DFE. For iron, current dietary pattern consumption shows 8.4% and 0.8% of younger and older adults, respectively, are not meeting iron recommendations, however, removal of 100% of grains from the diet results in nearly 10 and 22% falling short of the EAR. Currently, about 51 and 54% of younger and older adults are below the EAR for magnesium; however, with the removal of 100% of grains, 68 and 73%, respectively, fall below the EAR. Conclusion: Removal of specific refined grains led to an increased percentage of Americans not meeting recommendations for several shortfall nutrients, including dietary fiber, folate, iron, and magnesium.

[Low intake of dietary fibers among the elderly: 2014/2015 ISACAMP population-based study]

The scope of this article is to evaluate the prevalence of inadequate dietary fiber intake and associated factors among elderly adults. A cross-sectional population-based study evaluating participants from the Health Survey of the City of Campinas (ISACAMP) was conducted in 2014/2015, with 1,074 elderly individuals (≥60 years). Dietary fiber intake was obtained using a 24-hour recall, and the prevalence of inadequate fibers was estimated according to the cut-off point of the Institute of Medicine (30 g/day for men and 21 g/day for women). The factors evaluated were sociodemographic conditions (sex, age, schooling, income, marital status), health (number of reported diseases) and lifestyle (physical activity, smoking and alcohol consumption). The prevalence of inadequate dietary fiber intake was 86.6%, being higher in men (RP=1.10), single or divorced (RP=1.09) and physically inactive (PR=1.07). Elderly adults with higher incomes and who reported having 1 to 2 chronic non-communicable diseases had a higher intake of fibers. The high prevalence of inadequate dietary fiber intake in the elderly adults indicates that health and nutrition actions should be developed to ensure adequate dietary intake of these compounds.

Nutritional Significance of Fruit and Fruit Products in the Average Polish Diet

The aim of the present study was to analyze the supply of energy, 19 nutrients, free sugars, and dietary fiber in the average Polish diet from fruit and fruit products. Our analysis is based on 2016 data from the national representative household budget survey conducted on a sample of 36,886 households, yielding a population of 99,230 individuals. Fruit and fruit products provided 3.12% of energy to the average diet in Poland with the highest share of bananas and apples. The highest significance of this food group was found for vitamin C (23.65%), including citrus fruits providing 8.03% of vitamin C, berries (5.97%), other fruits (3.45%), and apples (3.13%). The share of fruit and their products in the supply of free sugars is equally high and amounts to 23.52%. This means that apples provide 6.34% of free sugars, while other fruits also have a high supply of free sugars, including berries 3.68%, stone fruits 3.06%, bananas 2.56%, and citrus fruits 2.54%. The proportion of supply exceeding the percentage of energy (which was 3.12%) was obtained for carbohydrate (5.79%), and fiber (13.66%). The food group studied was particularly important (more than 5% share) in providing four minerals: potassium (8.59%), iron (5.07%), magnesium (5.51%), copper (8.81%), and three vitamins: vitamin C (23.65%), vitamin B6 (5.74%), and vitamin E (5.53%). The influence of sociodemographic and economic characteristics of households on the structure of energy and nutrient supply from fruit and fruit products was assessed using cluster analysis. There were four clusters characterized by different energy, nutrient, and fiber supply. The factors with the highest statistical significance on the supply of energy, nutrients, and fiber from fruit and fruit products were month of study, income, degree of urbanization, education, size of town, and land use. The obtained results concerning energy and nutrient supply from fruits and fruit products are important for the Polish society from the public health point of view, as indicated in the discussion of results and conclusions.

Vegetables, Potatoes and Their Products as Sources of Energy and Nutrients to the Average Diet in Poland

The aim of our study was to analyse vegetables, potatoes and their products as sources of energy and nutrients in the average diet in Poland. Representative data of the 2016 Household Budget Survey from 36,886 households were used. This is the largest study sample in Poland, so we generalized the conclusions to the whole population using the statement ‘average diet’. We analysed three main product groups: vegetables, vegetable products, and potatoes and potatoes products, dividing them into 14 subgroups (e.g., tomatoes, cabbage, carrots, other vegetables, and mushrooms). The percentages of energy, protein, carbohydrates, total fat, nine vitamins (thiamine, riboflavin, niacin, vitamin B6, folate, vitamin C, vitamin A, vitamin D, and vitamin E), seven minerals (calcium, phosphorus, sodium, potassium, iron, magnesium and zinc), and fibre from the analysed food subgroups are presented. Additionally, the influence of household characteristics on the supply of energy and nutrients from each subgroup of vegetables, potatoes, and their products was evaluated using cluster analysis. In the analysis, R programme and Kohonen neural networks were applied. Our study showed that vegetables, potatoes, and their products provide 7.3% of daily dietary energy supply. Vegetables contribute more than 20% of the supply of six nutrients: vitamin C (51.8%), potassium (32.5%), folate (31.0%), vitamin A (30.6%), vitamin B6 (27.8%), and magnesium (20.2%), as well as fibre (31.8%). Cluster analysis distinguished three clusters that differed in nutritional supply from vegetables, potatoes, and their products. Educational level, income measured by quintile groups, village size, socio-economic characteristics, urbanization degree, and land use were the most important factors determining differences between clusters.

Do Refined Grains Have a Place in a Healthy Dietary Pattern: Perspectives from an Expert Panel Consensus Meeting

Although dietary guidance recommends increasing consumption of whole grains and concurrently limiting consumption of refined and/or enriched grain foods, emerging research suggests that certain refined grains may be part of a healthy dietary pattern. A scientific expert panel was convened to review published data since the release of 2015 dietary guidance in defined areas of grain research, which included nutrient intakes, diet quality, enrichment/fortification, and associations with weight-related outcomes. Based on a 1-d roundtable discussion, the expert panel reached consensus that 1) whole grains and refined grains can make meaningful nutrient contributions to dietary patterns, 2) whole and refined grain foods contribute nutrient density, 3) fortification and enrichment of grains remain vital in delivering nutrient adequacy in the American diet, 4) there is inconclusive scientific evidence that refined grain foods are linked to overweight and obesity, and 5) gaps exist in the scientific literature with regard to grain foods and health.

Status and trends in consumption of grains and dietary fiber among Chinese adults (1982-2015)

The objectives of this review were to investigate the status and characteristics of national grain consumption and dietary fiber intake among Chinese adults (aged ≥20 years) and to examine trends in consumption from 1982 to 2015. Data from 5 national surveys that collected dietary information using a household food weighing method and 24-hour dietary recall over 3 consecutive days were analyzed. In 2015, mean grain consumption was 281.1 g/per capita/d (rice 145.6 g, wheat flour 120.7 g, other grains 14.8 g). Total dietary fiber intake was 9.7 g/per capita/d, of which 3.8 g/per capita/d came from grains and accounted for nearly 40% of total dietary fiber intake for adults. The other major sources of dietary fiber were vegetables and fruits. The data indicates consumption of grains and dietary fiber in the Chinese population has been continuously declining since 1982 and the consumption of refined grains has increased. In order for the Chinese population to meet dietary recommendations for whole grain and dietary fiber intake, increasing the availability of more appealing whole grain products and public education are recommended.

Perspective: Whole and Refined Grains and Health-Evidence Supporting "Make Half Your Grains Whole"

Research-based dietary guidelines suggest that consumers "make half their grains whole." Yet some advocate ingesting only whole-grain foods (WGFs) and avoiding all refined-grain foods (RGFs). Some even recommend avoiding all grain-based foods (GBFs). This article will provide arguments to counter negative deductions about GBFs and RGFs, especially staple ones, and to support dietary guidance recommending a balance of GBFs-achieved through the right mix, type, and quantity of WGFs and RGFs. Studies looking at early mortality, body weight, and glucose tolerance and diabetes will be used as examples to characterize the literature about GBFs. The following issues are highlighted: 1) inconsistent findings between epidemiological and interventional studies and impacts of GBFs on health outcomes, and the underreporting of findings showing RGFs neither raise nor lower health risks; 2) multiple confounding and potential interactions make adequate statistical adjustment difficult; 3) nonuniform WGF definitions among studies make comparison of results challenging, especially because some WGFs may contain 49-74% refined grain (RG); 4) binary categorization of GBFs creates bias because nearly all categories of WGFs are recommended, but nearly half the RGF categories are not; 5) ingestion of >5 (30-g) servings RGFs/d and <1 serving WFGs/d creates dietary imbalance; 6) pattern names (e.g., "white bread") may impugn RGFs, when names such as "unbalanced" or "few fruits and vegetables" may more fairly characterize the dietary imbalance; 7) avoidance of all enriched RGs may not only impair status of folate and other B vitamins and certain minerals such as iron and zinc but also decrease acceptability of WGFs; 8) extrapolation beyond median documented intakes in high-WGF consumers (∼48 g whole grain/d) in most cohorts is speculative; 9) recommended dietary patterns such as the Mediterranean diet demonstrate that the right mix of WGFs and RGFs contributes to positive health outcomes.

Circulating Ionized Magnesium as a Measure of Supplement Bioavailability: Results from a Pilot Study for Randomized Clinical Trial

Oral supplementation may improve the dietary intake of magnesium, which has been identified as a shortfall nutrient. We conducted a pilot study to evaluate appropriate methods for assessing responses to the ingestion of oral magnesium supplements, including ionized magnesium in whole blood (iMg²⁺) concentration, serum total magnesium concentration, and total urinary magnesium content. In a single-blinded crossover study, 17 healthy adults were randomly assigned to consume 300 mg of magnesium from MgCl₂ (ReMag^®, a picosized magnesium formulation) or placebo, while having a low-magnesium breakfast. Blood and urine samples were obtained for the measurement of iMg²⁺, serum total magnesium, and total urine magnesium, during 24 h following the magnesium supplement or placebo dosing. Bioavailability was assessed using area-under-the-curve (AUC) as well as maximum (C_max) and time-to-maximum (T_max) concentration. Depending on normality, data were expressed as the mean ± standard deviation or median (range), and differences between responses to MgCl₂ or placebo were measured using the paired t-test or Wilcoxon signed-rank test. Following MgCl₂ administration versus placebo administration, we observed significantly greater increases in iMg²⁺ concentrations (AUC = 1.51 ± 0.96 vs. 0.84 ± 0.82 mg/dL•24h; C_max = 1.38 ± 0.13 vs. 1.32 ± 0.07 mg/dL, respectively; both p < 0.05) but not in serum total magnesium (AUC = 27.00 [0, 172.93] vs. 14.55 [0, 91.18] mg/dL•24h; C_max = 2.38 [1.97, 4.01] vs. 2.24 [1.98, 4.31] mg/dL) or in urinary magnesium (AUC = 201.74 ± 161.63 vs. 139.30 ± 92.84 mg•24h; C_max = 26.12 [12.91, 88.63] vs. 24.38 [13.51, 81.51] mg/dL; p > 0.05). Whole blood iMg²⁺ may be a more sensitive measure of acute oral intake of magnesium compared to serum and urinary magnesium and may be preferred for assessing supplement bioavailability.

Milk and Dairy Products and Their Nutritional Contribution to the Average Polish Diet

The main aim of this study was to identify the dairy sources of energy and 44 nutrients in the average Polish diet. Our research included: carbohydrates, protein, total fat, saturated fatty acids (SFA), monounsaturated fatty acids (MUFA), polyunsaturated fatty acids (PUFA), cholesterol, 18 amino acids, 9 minerals, and 10 vitamins. The analysis was conducted based on the data from the 2016 Household Budget Survey, a representative sample of the Polish population (i.e., 36,886 households). The category of milk and dairy products was divided into three main groups (i.e., milk, cheeses, and yoghurts, milk drinks and other dairy products) and seven sub-groups (i.e., whole milk, reduced fat milk, condensed and powdered milk, ripened and melted cheese, cottage cheese, yoghurts, milk drinks and other dairy products). Milk and dairy products provided 9.1% of the total energy supply. A high share (above 20%) in the supply of nutrients was noted in the case of calcium (54.7%), riboflavin (28.1%), vitamin B12 (26.1%), and phosphorus (24.6%). Supply at the level of 10-20% was observed for protein, SFA, zinc, total fat, cholesterol, potassium, magnesium, and vitamin A. Of the amino acids, the share above 20% from dairy category was recorded in the case of 6 amino acids (proline, tyrosine, serine, lysine, valine, and leucine) and at the level of 10-20% for 10 amino acids (isoleucine, histidine, threonine, tryptophan, phenylalanine, methionine, glutamic acid, aspartic acid, alanine, and arginine).

Consumption of Ready-to-Eat Cereal in Canada and Its Contribution to Nutrient Intake and Nutrient Density among Canadians

In recent years, ready-to-eat cereal (RTEC) has become a common breakfast option in Canada and worldwide. This study used the nationally representative cross-sectional data from the Canadian Community Health Survey (CCHS) 2015-Nutrition to determine patterns of RTEC consumption in Canada and the contribution to nutrient intake among Canadians who were ≥2 years, of whom 22 ± 0.6% consumed RTEC on any given day. The prevalence of RTEC consumption was highest in children aged two to 12 years (37.6 ± 1.2%), followed by adolescents aged 13 to 18 years (28.8 ± 1.4%), and then by adults ≥19 years (18.9 ± 0.6%). RTEC consumers had higher intakes of "nutrients to encourage" compared to the RTEC non-consumers. More than 15% of the daily intake of some nutrients, such as folic acid, iron, thiamin, and vitamin B₆, were contributed by RTEC. It was noted that nearly 66% of milk consumption was co-consumed with RTEC among RTEC consumers. The nutrient density of the diet, as defined by Nutrient-Rich Food Index (NRF 9.3), was significantly higher among RTEC consumers compared to non-consumers. RTEC consumption was not associated with overweight/obesity. RTEC consumption considerably contributed to the intake of some key nutrients among all age groups in Canada.

Perspective: Refined Grains and Health: Genuine Risk, or Guilt by Association?

Refined grain intake is widely assumed to be associated with adverse health outcomes, including increased risk for cardiovascular disease (CVD), type 2 diabetes (T2D), and obesity. The 2015 Dietary Guidelines Advisory Committee recommended that to improve dietary quality, the US population should replace most refined grains with whole grains. This recommendation was based largely on results from studies that examined dietary patterns, not separate food groups. A Western dietary pattern typically includes red and processed meat, sugar-sweetened foods and beverages, French fries, and high-fat dairy products, as well as refined grains, and has been linked to increased risk of many chronic diseases. However, when evaluated as a distinct food category, 11 meta-analyses of prospective cohort studies, which included a total of 32 publications with data from 24 distinct cohorts, demonstrated that refined grain intake was not associated with all-cause mortality, T2D, CVD, coronary heart disease (CHD), stroke, hypertension, or cancer. By contrast, consumption of red and processed meat was consistently associated with increased risk of these same health outcomes. Refined grain consumption up to 6-7 servings/d (1 serving = 30 g) was not associated with higher risk of CHD, T2D, hypertension, or all-cause mortality. Moreover, total grain intake was not associated with risk of CVD, CHD, stroke, or cancer, but was associated with lower risk of all-cause mortality. Consequently, the recommendation to reduce refined grain intake based on results from studies linking a Western dietary pattern to numerous adverse health outcomes is contrary to a substantial body of published scientific evidence. Future research needs to better define refined grain intake to distinguish between staple grain foods and indulgent grain foods, and to better design randomized controlled trials to resolve discrepancies between results from observational studies and such trials with regard to determining the benefits of whole grains compared with refined grains.

How Important are Cereals and Cereal Products in the Average Polish Diet?

The main aim of this study was to identify the food sources of energy and 28 nutrients from cereals and cereal products in the average Polish diet based on data from a nationally representative sample of the Polish population attending in 2016 Household Budget Survey (i.e., 36,886 households). The contribution of energy and nutrients from cereals and cereal products were compared with reference values. The detailded analysis included five main groups and nine sub-groups of cereal food category. Our findings indicated that cereals and cereal products contributed 30.4% of total dietary energy supply, providing a significant percentage of six nutrients to the average Polish diet (i.e., 64.1% of manganese, 51% of carbohydrates, 48.5% of dietary fibre, 34.1% of iron, 33.6% of folate, and 31.3% of copper). Supply at the level of 20⁻30% was observed for protein, thiamin, phosphorus and zinc, and at 10⁻20% for polyunsaturated fatty acids (PUFA), sodium, potassium, calcium, riboflavin, niacin, and vitamin B6. For other nutrients i.e., total fat, saturated fatty acids (SFA), monounsaturated fatty acids (MUFA), cholesterol, iodine, vitamins: A, D, B12, and C, the share of cereals and cereal products contribution was below 10%. Cereals and cereal products were the major food category in meeting the reference values for the Polish population in case of manganese, carbohydrates (approximately100%), and sodium (50%). The reference values was reached at the level of 30⁻40% for dietary fibre, protein, iron, copper, zinc, phosphorus and thiamin, and 20⁻30% for energy, magnesium, folate, niacin, riboflavin, vitamins B6 and E. For such nutrients as total fat, SFA, and potassium, the fulfillment of the reference values amounted to 10⁻20%. Our results document the importance of cereals and cereal products in the Polish diet, which should be emphasized from a nutritional and health point of view.

Meat, Meat Products and Seafood as Sources of Energy and Nutrients in the Average Polish Diet

The aim of this study was to identify the share of meat, meat products and seafood in the contribution of energy and 22 nutrients to the average Polish diet. Data from the nationally representative sample of Polish population (2016 Household Budget Survey) on meat and seafood product consumption from 38,886 households (n = 99,230) were calculated into one person per month. The analyses were conducted for seven food groups (e.g., red meat, poultry) and 16 products (e.g., beef, chicken). Approximately 18.5% of energy is delivered from the sources such as meat, meat products and seafood, providing a higher percentage of 18 nutrients to the diet (e.g., 56.0% of vitamin B12, 52.3% of niacin, 44.9% of cholesterol, 41.5% of protein, 41.4%of vitamin D, 37.6% of monounsaturated fatty acids (MUFA), 37.4% of thiamin, 33.8% of zinc, 32.0% of total fats, 30.3% of saturated fatty acids (SFA), 29.6% of vitamin B6, 25.3% of riboflavin, 24.9% of phosphorus, 24.8% of iron, 22.5% of vitamin A, 21.6% of polyunsaturated fatty acids (PUFA) and 20.3% of sodium). For the contribution of 18 nutrients and energy, processed meat products were ranked first. These results should be taken into consideration in order to compose diets with adequate energy and nutrient contribution and also to analyze benefits and risk resulting from the current level of consumption of red and processed meat, fish and other seafood.