Nutritional interventions in prison settings: a scoping review

BACKGROUND

Mounting evidence has shown that incarceration can affect the health and well-being of individuals and increase the risk of noncommunicable diseases (NCDs). Diet quality is known to be one of the main determinants of risk of NCDs, and dietary changes are the first approach used in primary care to reduce the incidence of NCDs.

OBJECTIVE

This scoping review aimed to summarize the evidence for (1) the diet quality of inmates, and (2) the effect of nutritional intervention in prison systems. In addition, we aimed to describe limitations in the current literature and to suggest potential future research areas.

METHOD

A systematic search was performed in 2 databases (PubMed and Web of Science) using predefined search terms and covering the period May 2023 to June 2023. Additionally, reference lists from the retrieved studies were hand-searched to identify any additional relevant publications. The identified literature was screened based on defined search strategies, criteria, and research questions defined using the PICo (population or problem, interest, and context) framework. The review was conducted referring to the PRISMA-ScR and the PICo framework.

RESULTS

A total of 19 studies out of 63 initially identified records were included in this review (11 cross-sectional evaluations and 9 intervention-based studies). In almost all studies, assessment of the diet quality of menus showed the menus to be nutritionally adequate, except for having a higher-than-recommended intake of total energy, saturated fatty acids, sodium, cholesterol, and sugar. In addition, some studies reported a lower-than-recommended intake of fiber, magnesium, potassium, vitamins D, E, and A, and omega-3 fatty acids. Nutritional interventions were mainly planned in the form of workshops, seminars, and written material to deliver information on healthy dietary choices. Although no significant changes in inmates' dietary choices were observed in any of the studies, a high participation rate was detected.

CONCLUSION

Inmates might require additional prevention intervention to reduce their susceptibility to cardiometabolic diseases by virtue of their isolation from community facilities. Interventions should be tailored to the characteristics of prison settings and inmates to increase adherence to nutritional recommendations.

A three-component Breakfast Quality Score (BQS) to evaluate the nutrient density of breakfast meals

Background

Nutrient profiling methods can be applied to individual foods or to composite meals. This article introduces a new method to assess the nutrient density of breakfast meals.

Objective

This study aimed to develop a new breakfast quality score (BQS), based on the nutrient standards previously published by the International Breakfast Research Initiative (IBRI) consortium.

Methods

BQS was composed of three sub-scores derived from the weighted arithmetic mean of corresponding nutrient adequacy: an eLIMf sub-score (energy, saturated fat, free sugars, and sodium), a PF (protein and fiber) sub-score, and a VMn1 - 14 micronutrient sub-score, where n varied from 0 to 14. The effects of assigning different weights to the eLIMf, PF, and VMn were explored in four alternative models. The micronutrients were calcium, iron, potassium, magnesium, zinc, vitamin A, thiamin, riboflavin, niacin, vitamin B5, vitamin B6, vitamin B12, vitamin C, and vitamin D. Micronutrient permutations were used to develop alternate VMn1 - 14 sub-scores. The breakfast database used in this study came from all breakfasts declared as consumed by adults (>18 years old) in the French dietary survey INCA3. All models were tested with respect to the Nutrient Rich Food Index (NRF9.3). BQS sensitivity was tested using three prototype French breakfasts, for which improvements were made.

Results

The correlations of the models with NRF9.3 improved when the VMn>3 sub-score (n > 3) was included alongside the PF and eLIMf sub-scores. The model with (PF+VMn) and eLIMf each accounting for 50% of the total score showed the highest correlations with NRF9.3 and was the preferred final score (i.e., BQS). BQS was sensitive to the changing quality of three prototype breakfasts defined as tartine, sandwich, and cereal.

Conclusion

The proposed BQS was shown to valuably rank the nutritional density of breakfast meals against a set of nutrient recommendations. It includes nutrients to limit along with protein, fiber, and a variable number of micronutrients to encourage. The flexible VMn sub-score allows for the evaluation of breakfast quality even when nutrient composition data are limited.

Nutritional Recommendations for Type 2 Diabetes: An International Review of 15 Guidelines

OBJECTIVES

Recommendations from clinical practice guidelines (CPGs) for individuals with type 2 diabetes mellitus (T2DM) may be inconsistent, and little is known about their quality. Our aim in this study was to systematically review the consistency of globally available CPGs containing nutritional recommendations for T2DM and to assess the quality of their methodology and reporting.

METHODS

PubMed, China Biology Medicine and 4 main guideline websites were searched. Four researchers independently assessed quality of the methodology and reporting using the Appraisal of Guidelines for Research and Evaluation, second edition (AGREE II) instrument and the Reporting Items for Practice Guidelines in HealThcare (RIGHT) checklist.

RESULTS

Fifteen CPGs include 65 nutritional recommendations with 6 sections: 1) body weight and energy balance; 2) dietary eating patterns; 3) macronutrients; 4) micronutrients and supplements; 5) alcohol; and 6) specific, functional foods. Current nutritional recommendations for individuals with T2DM on specific elements and amounts are not completely consistent in different CPGs and fail to assign the specific supporting evidence and strength of recommendations. To use nutritional recommendations to guide and manage individuals with T2DM, it is important to address the current challenges by establishing a solid evidence base and indicating the strength of recommendations. Overall, 8 CPGs classified as recommended for clinical practice used AGREE II. Fifteen CPGs adhere to <60% of RIGHT checklist items.

CONCLUSIONS

High-quality evidence is needed to potentially close knowledge gaps and strengthen the recommendation. The AGREE II instrument, along with the RIGHT checklist, should be endorsed and used by CPG developers to ensure higher quality and adequate use of their products.

Differences in Cost-Effectiveness of Adherence to Nutritional Recommendations: Why, Where, and What?

Cost-effectiveness analysis of diets may comprise an important tool to promote food security; however, studies show divergent evidence regarding the relationship between diet quality and cost in diverse populations. Thus, this study assesses differences in cost-effectiveness ratios regarding adherence to nutritional recommendations using data representative of the population level in Sao Paulo municipality, Brazil. Information from adolescents and adult individuals (n = 1742) was used to estimate diet quality and cost in 2015. Differences in cost-effectiveness ratios were investigated through application of two diet quality indexes and exploration of individuals' personal and contextual characteristics. Results indicated that higher diet cost was associated with higher adherence to nutritional recommendations at the national level and inversely associated with adherence to international recommendations. Purchasing foods in street markets was linked to healthier diets at lower costs, and protein consumption was associated with higher diet cost regardless of diet quality; however, diet quality was linked to type of protein consumed by individuals. Differences in cost-effectiveness ratios were attributable to methodological choices in measuring dietary quality (why); individuals' personal and contextual characteristics, in particular, access to retail equipment (where); and certain food choices (what). Therefore, cost-effectiveness analyses should be tailored to policy goals and local environments to ensure proper assessment of nutrition programs and to foster improvements in nutritional diet quality at lower cost.

Energy and Macronutrients Intake in Indoor Sport Team Athletes: Systematic Review

Indoor team sports are characterized by matches that are shorter in duration and with frequent substitution (high-intensity intermittent). The main goal of teams is to best cover athletes' physiological demands, while meeting their dietary intake needs is critical. The aim of this study is to conduct a systematic review of the dietary intake of indoor team sports athletes and to analyze whether they comply with nutritional recommendations. A search of PubMed-MEDLINE, Web of Science, and Scopus databases from 2008 to July 2022 was conducted and 2727 documents were identified. The studies focused on adult professional or semi-professional volleyball, basketball, handball, or futsal athletes. Two independent researchers screened and extracted the data, with 20 documents included after they met the inclusion criteria. Most of the athletes, both men and women, did not meet the official recommendations based on under-consumption (energy and carbohydrates) or over-consumption (fats). In relation to protein, 28.6% of studies met the recommendations, with 50% of those who did not meet it being due to under-consumption. Although there are references on athletes' dietary intakes, there are no references considering sexes or types of sport. More adapted recommendations are needed in order to more precisely evaluate athletes' intake to know if they meet their real nutritional requirements.

The 2018 Revision of Italian Dietary Guidelines: Development Process, Novelties, Main Recommendations, and Policy Implications

The fourth edition of the Italian Dietary Guidelines (IDGs) for Healthy Eating was published in 2019. The objective of this paper is to describe the developmental process of IDGs, the main recommendations, the differences with previous revisions, and the concordance and differences with international guidance on a healthy diet. A National Commission oversaw IDG development. A Scientific Dossier (SD), including analysis on nutrition, health, and risk factors status in Italy, was the reference for IDGs preparation. The IDGs are based on the principles of the Mediterranean Diet and are mainly aimed to prevent obesity and nutrition-related non-communicable diseases. The IDGs included 13 directives that were divided into four conceptual blocks: i) how to balance weight; ii) foods to be promoted; iii) foods to be limited; and iv) how to ensure a varied and sustainable diet. Each directive has a box summarizing the key recommendation, myths lists, and false beliefs to be dispelled. The topics of sustainability and the correct approach to food supplementation and weight-loss diet were introduced in the present edition of IDGs. This paper contributes to the debate on the complexity of derivation of Dietary Guidelines and their adaptation to the national context.

How Does the Dietary Intake of Female Field-Based Team Sport Athletes Compare to Dietary Recommendations for Health and Performance? A Systematic Literature Review

Field-based team sports present large energetic demands given their intermittent high-intensity nature. Current evidence suggests that the dietary intake of female athletes may be insufficient to meet such demands, resulting in negative consequences for athletic performance and health. The primary aim of this review was to therefore assess the adequacy of dietary intake of female field-based team sport athletes when compared to dietary recommendations. A systematic search of databases, including PubMed, Web of Science, SPORTDiscus, and OpenGrey, was performed from the earliest record available until July 2020, obtaining an initial total of 2588 articles. To be included within the final review, articles were required to provide a quantitative assessment of baseline dietary intake specific to the target population. A total of 20 studies (n = 462) met the full eligibility criteria. A majority reported that the dietary intake of female field-based team sport athletes was insufficient in overall energy (2064 ± 309 kcal·day^-1), carbohydrate (4.3 ± 1.2 g·kg·day^-1), and iron intake (13.6 ± 6.2 mg·day^-1) when compared to recommendations. Future research is required to establish why female team sport athletes consistently demonstrate deficient dietary practices, and to explore the potential negative consequences of this.

Case Study: Free Lunch Meals Provision during the Remote Learning Conditions

School meals for grade 1 to 4 pupils in Latvia are financed by the government, but with the onset of the COVID-19 pandemic in March 2020, and following the remote learning process, there were problems related to the delivery of these meals for pupils. The current situation in Latvia has been exacerbated again due to the spread of the pandemic; there is a great necessity to find well-thought-out solutions to ensure school lunches outside the school. The aim of this study was to develop recommendation-based one-week food packs for grade 1 to 4 pupils, providing the necessary amount of nutrients and energy. Four food packs were designed to provide five-day lunch meals for pupils, preparing a warm lunch at home. Protein, fat, saturated fatty acids, carbohydrates, sugar, dietary fiber, sodium, salt and calcium content of meals were analyzed according to standard methods. During the project, the most appropriate solution for food packs was explored. The four designed food packs will provide support to municipalities, because the composition of food packs complies with the nutrition and energy value regulation and does not exceed the planned budget. Parents will receive the developed recipe book in addition to a one-week food pack.

Selenium and Dogs: A Systematic Review

The intent of this review is to summarize the knowledge about selenium and its function in a dog's body. For this purpose, systematic literature search was conducted. For mammals, including dogs, a balanced diet and sufficient intake of selenium are important for correct function of metabolism. As for selenium poisoning, there are no naturally occurring cases known. Nowadays, we do not encounter clinical signs of its deficiency either, but it can be subclinical. For now, the most reliable method of assessing selenium status of a dog is measuring serum or plasma levels. Levels in full blood can be measured too, but there are no reference values. The use of glutathione peroxidase as an indirect assay is questionable in canines. Commercial dog food manufactures follow recommendations for minimal and maximal selenium levels and so dogs fed commercial diets should have balanced intake of selenium. For dogs fed home-made diets, complex data are missing. However, subclinical deficiency seems to affect, for example, male fertility or recovery from parasitical diseases. Very interesting is the role of selenium in prevention and treatment of cancer.

A Review of Nutritional Requirements of Adults Aged ≥65 Years in the UK

Appropriate dietary choices in later life may reduce the risk of chronic diseases and rate of functional decline, however, there is little well-evidenced age-specific nutritional guidance in the UK for older adults, making it challenging to provide nutritional advice. Therefore, the aim of this critical review was to propose evidence-based nutritional recommendations for older adults (aged ≥65 y). Nutrients with important physiological functions in older adults were selected for inclusion in the recommendations. For these nutrients: 1) recommendations from the UK Scientific Advisory Committee for Nutrition (SACN) reports were reviewed and guidance retained if recent and age-specific, and 2) a literature search conducted where SACN guidance was not sufficient to set or confirm recommendations for older adults, searching Web of Science up to March 2020. Data extracted from a total of 190 selected publications provided evidence to support age-specific UK recommendations for protein (1.2 g·kg-1·d-1), calcium (1000 mg·d-1), folate (400 μg·d-1), vitamin B-12 (2.4 μg·d-1), and fluid (1.6 L·d-1 women, 2.0 L·d-1 men) for those ≥65 y. UK recommendations for carbohydrates, free sugars, dietary fiber, dietary fat and fatty acids, sodium, and alcohol for the general population are likely appropriate for older adults. Insufficient evidence was identified to confirm or change recommendations for all other selected nutrients. In general, significant gaps in current nutritional research among older adults existed, which should be addressed to support delivery of tailored nutritional guidance to this age group to promote healthy aging.

Could Dietary Goals and Climate Change Mitigation Be Achieved Through Optimized Diet? The Experience of Modeling the National Food Consumption Data in Italy

Objective: The aim of this study is to define a healthy and sustainable diet model with low GHGE, fulfilling dietary requirements, and considering current Italian food consumption patterns. Design: A duly designed database was developed, linking food nutritional composition and GHGE based on 921 food items consumed in Italy according to the last national food consumption survey (INRAN-SCAI 2005-2006). Linear programming was used to develop new diet plans separately for males and females, aged 18-60 years (n = 2,098 subjects), in order to minimize GHGE. The program is based on dietary goals and acceptability constraints as well as on 13 nutrient requirement constraints aiming to reach a healthy and acceptable diet for the Italian population. Results: Diet optimization resulted in a nutritionally adequate pattern minimizing GHGE values (4.0 vs. 1.9 kg CO2e/day for males and 3.2 vs. 1.6 kg CO2e/day for females). In both sexes, the nutrient intake of the optimized diet was at the established lower bound for cholesterol and calcium and at the established upper bound for free sugar and fiber. In males, intake of zinc was at the established lower bound whereas iron was at the established upper bound. Consumption of red meat and fruit and vegetables was at the established lower and upper bound, respectively, in both males and females. Despite the decrease in meat consumption, especially red meat, in the optimized diet with respect to the observed diet, levels of iron intake in females increased by 10% (10.3 vs. 11.3 mg/day) but remained below the adequate intake established in Italian national DRIs. Conclusions: An attainable healthy dietary pattern was developed that would lead to the reduction of GHGE by 48% for males and by 50% for females with respect to current food consumption in the Italian adult population. Health-promoting dietary patterns can substantially contribute to achieve related Sustainable Development Goals.

Performance of the Front-of-Pack Nutrition Label Nutri-Score to Discriminate the Nutritional Quality of Foods Products: A Comparative Study across 8 European Countries

Abstract: In Europe, discussions are currently ongoing to harmonize front-of-pack nutritional labelling, while some countries have adopted or are considering implementing the Nutri-Score. However, its adaptability to multiple nutritional contexts in Europe requires further investigation. This study aimed to evaluate the applicability of the Nutri-Score in various European countries, regarding its ability to discriminate the nutritional quality of foods and its consistency with national dietary recommendations. The European Food Information Resource (EUROFIR) nutritional composition databases from eight European countries (Finland, France, Norway, Poland, Portugal, Slovakia, Sweden, and Switzerland) were used. The distribution of foods across the Nutri-Score classes within food groups was assessed, as well as the discriminating performance of the label, and the adequacy of nutritional recommendations. The Nutri-Score demonstrated high discriminating ability for all food groups, with similar trends in the eight countries, and consistency with nutritional recommendations. For instance, fruit and vegetable products were mainly classified in the two healthiest Nutri-Score categories, while sugar and animal fat products were mainly classified in the two less healthy categories of the Nutri-Score. Our results support the fact that the Nutri-Score would be a relevant tool to discriminate the nutritional quality of products within and across relevant food groups in different European countries, with consistency with nutritional recommendations.

A Clinical Review on Nutritional Requirements and Assessment for Type 2 Diabetes Mellitus with Chronic Renal Disease

BACKGROUND

A significant correlation exists between type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD), where up to 40% of diabetic patients suffer from CKD as a direct result of diabetic complications. The management of diabetes in CKD patients can be challenging due to their need for disease-specific diets, as well as increased risks of complications due to malnutrition, which is why their dietary needs and nutritional requirements require attention to detail, and have to be assessed and tailored according to the patient's needs.

OBJECTIVES

This systematic review aimed to assess nutritional requirements for type 2 diabetes mellitus patients with chronic renal failure.

METHODS

In this review, 85 articles were screened, and 22 articles were then analyzed and selected as per the study criteria. PRISMA guidelines were used to select and screen the articles. Data search included a PubMed search using MeSH terms, and a literature review through the Cochrane library and the British Medical Journal.

RESULTS

The study highlighted the important nutrients and minerals needed to be maintained within a specified range in accordance with the patient's needs and conditions. In addition, dietary restrictions must be set to prevent disease progression and deterioration. Dietary intake in hemodialysis patients must be carefully calculated based on their needs, with tight monitoring of their blood glucose. Protein intake in hemodialysis patients should be determined based on risk-to-benefit ratios.

CONCLUSION

Dietary requirements should be individualized based on the patient's disease severity and progression. Assessment of the patient's previous and current diet, as well as matching it with their dietary requirements and preferences is crucial.

Food and nutrient intake and adherence to dietary recommendations during pregnancy: a Nordic mother-child population-based cohort

Background

A woman's food intake during pregnancy has important implications not only for herself but also for the future health and well-being of her child. Suboptimal dietary quality has been consistently reported in many high-income countries, reflecting poor adherence to dietary guidelines.

Objective

This study aimed to explore the intake of food and nutrients in a cohort of pregnant women in Norway and their adherence to Nordic Nutrition Recommendations (NNR) and Norwegian food-based guidelines (NFG).

Design

We investigated the dietary intake in 1,674 pregnant women from the mother-child birth cohort, PreventADALL, recruited at approximately 18-week gestational age. Dietary intake was assessed by an electronic validated food frequency questionnaire (PrevFFQ) in the first half of pregnancy.

Results

Total fat intake was within the recommended intake (RI) range in most women; however, the contribution of saturated fatty acids to the total energy intake was above RI in the majority (85.2%) of women. Carbohydrate intake was below RI in 43.9% of the women, and 69.5% exceeded the RI of salt. Intakes of fiber, vegetables, and fish were high in a large part of the population. Many women had a high probability of inadequate intakes of the following key micronutrients during pregnancy: folate (54.4%), iron (49.6%), calcium (36.2%), vitamin D (28.7%), iodine (24.4%), and selenium (41.3%). A total of 22.8% women reported an alcohol intake of >1 g/day, and 4.4% reported an alcohol intake of >10 g/day. Women with higher educational levels showed a tendency towards healthier eating habits, except for higher intakes of alcohol and coffee, compared to women with lower educational level.

Discussion

Excessive saturated fat intake and limited intake of many important micronutrients during pregnancy were common, potentially increasing the risk for adverse pregnancy and birth outcomes.

Conclusions

This study highlights the need for improved nutritional guidance to pregnant women across all educational levels.

Dietary Intakes of Professional and Semi-Professional Team Sport Athletes Do Not Meet Sport Nutrition Recommendations-A Systematic Literature Review

Background: to develop sport-specific and effective dietary advice, it is important to understand the dietary intakes of team sport athletes. This systematic literature review aims to (1) assess the dietary intakes of professional and semi-professional team sport athletes and (2) to identify priority areas for dietetic intervention. Methods: an extensive search of MEDLINE, Sports DISCUS, CINAHL, Web of Science, and Scopus databases in April–May 2018 was conducted and identified 646 studies. Included studies recruited team sport, competitive (i.e., professional or semi-professional) athletes over the age of 18 years. An assessment of dietary intake in studies was required and due to the variability of data (i.e., nutrient and food group data) a meta-analysis was not undertaken. Two independent authors extracted data using a standardised process. Results: 21 (n = 511) studies that assessed dietary intake of team sport athletes met the inclusion criteria. Most reported that professional and semi-professional athletes’ dietary intakes met or exceeded recommendations during training and competition for protein and/or fat, but not energy and carbohydrate. Limitations in articles include small sample sizes, heterogeneity of data and existence of underreporting. Conclusions: this review highlights the need for sport-specific dietary recommendations that focus on energy and carbohydrate intake. Further exploration of factors influencing athletes’ dietary intakes including why athletes’ dietary intakes do not meet energy and/or carbohydrate recommendations is required.

Nutritional Intake, Sports Nutrition Knowledge and Energy Availability in Female Australian Rules Football Players

This study aimed to assess nutritional intake, sports nutrition knowledge and risk of Low Energy Availability (LEA) in female Australian rules football players. Victorian Football League Women’s competition (VFLW) players (n = 30) aged 18–35 (weight: 64.5 kg ± 8.0; height: 168.2 cm ± 7.6) were recruited from Victoria, Australia. Nutritional intake was quantified on training days using the Automated 24 h Dietary Assessment Tool (ASA24-Australia), and sports nutrition knowledge was measured by the 88-item Sports Nutrition Knowledge Questionnaire (SNKQ). The risk of LEA was assessed using the Low Energy Availability in Females Questionnaire (LEAF-Q). Daily mean carbohydrate intake in the current investigation was 3 g⋅kg⁻¹⋅d⁻¹, therefore, below the minimum carbohydrate recommendation for moderate exercise of approximately one hour per day (5–7 g⋅kg⁻¹⋅d⁻¹) and for moderate to intense exercise for 1–3 h per day (6–10 g⋅kg⁻¹⋅d⁻¹) for 96.3% and 100% of players, respectively. Daily mean protein intake was 1.5 g⋅kg⁻¹⋅d⁻¹, therefore, consistent with recommendations (1.2–2.0 g⋅kg⁻¹⋅d⁻¹) for 77.8% of players. Daily mean calcium intake was 924.8 mg⋅d⁻¹, therefore, below recommendations (1000 mg⋅d⁻¹) for 65.5% of players, while mean iron intake was 12.2 mg⋅d⁻¹, also below recommendations (18 mg⋅d⁻¹) for 100% of players. Players answered 54.5% of SNKQ questions correctly, with the lowest scores observed in the section on supplements. Risk of LEA was evident in 30% of players, with no differences in carbohydrate (p = 0.238), protein (p = 0.296), fat (p = 0.490) or energy (p = 0.971) intakes between players at risk of LEA and those not at risk. The results suggest that female Australian rules football players have an inadequate intake of carbohydrate and calcium and low sports nutrition knowledge. Further investigation to assess the risk of LEA using direct measures is required.

Dietary Intakes and Dietary Quality during Pregnancy in Women with and without Gestational Diabetes Mellitus-A Norwegian Longitudinal Study

Gestational diabetes mellitus (GDM) is associated with maternal diet, however, findings are inconsistent. The aims of the present study were to assess whether intakes of foods and beverages during pregnancy differed between women who developed GDM and non-GDM women, and to compare dietary intakes with dietary recommendations of pregnancy. This is a longitudinal study using participants of a randomized controlled trial. Women with complete measurements of a 75 g oral glucose tolerance test (OGTT) at 18–22 and 32–36 weeks gestation were included in the cohort (n = 702). Women were diagnosed for GDM according to the simplified International Association of Diabetes and Pregnancy Study Group criteria at 32–36 weeks (GDM women: n = 40; non-GDM women: n = 662). Dietary data (food frequency questionnaire) was collected at both time points and compared between GDM and non-GDM women. Variability in OGTT values was assessed in a general linear model. Marginal differences between GDM and non-GDM women in intakes of food groups were found. No associations were found between dietary variables and OGTT values. Not all dietary recommendations were followed in the cohort, with frequently reported alcohol consumption giving largest cause for concern. This study did not find dietary differences that could help explain why 40 women developed GDM.

Nutritional Requirements of Lung Transplant Recipients: Challenges and Considerations

An optimal nutritional status is associated with better post-transplant outcomes and survival. Post-lung transplant nutrition management is however particularly challenging as lung recipients represent a very heterogeneous group of patients in terms of age, underlying diseases, weight status and presence of comorbidities. Furthermore, the post-transplant period encompasses several stages characterized by physiological and pathophysiological changes that affect nutritional status of patients and necessitate tailored nutrition management. We provide an overview of the current state of knowledge regarding nutritional requirements in the post-lung transplant period from the immediate post-operative phase to long-term follow-up. In the immediate post-transplantation phase, the high doses of immunosuppressants and corticosteroids, the goal of maintaining hemodynamic stability, the presence of a catabolic state, and the wound healing process increase nutritional demands and lead to metabolic perturbations that necessitate nutritional interventions. As time from transplantation increases, complications such as obesity, osteoporosis, cancer, diabetes, and kidney disease, may develop and require adjustments to nutrition management. Until specific nutritional guidelines for lung recipients are elaborated, recommendations regarding nutrient requirements are formulated to provide guidance for clinicians caring for these patients. Finally, the management of recipients with special considerations is also briefly addressed.

Has it become increasingly expensive to follow a nutritious diet? Insights from a new price index for nutritious diets in Sweden 1980-2012

Background

Health-related illnesses such as obesity and diabetes continue to increase, particularly in groups of low socioeconomic status. The increasing cost of nutritious food has been suggested as an explanation.

Objective

To construct a price index describing the cost of a diet adhering to nutritional recommendations for a rational and knowledgeable consumer and, furthermore, to investigate which nutrients have become more expensive to obtain over time.

Methods

Linear programming and goal programming were used to calculate two optimal and nutritious diets for each year in the interval under different assumptions. The first model describes the rational choice of a cost-minimizing consumer; the second, the choice of a consumer trying to deviate as little as possible from average consumption. Shadow price analysis was used to investigate how nutrients contribute to the diet cost.

Results

The cost of a diet adhering to nutritional recommendations has not increased more than general food prices in Sweden between 1980 and 2012. However, following nutrient recommendations increases the diet cost even for a rational consumer, particularly for vitamin D, iron, and selenium. The cost of adhering to the vitamin D recommendation has increased faster than the general food prices.

Conclusions

Not adhering to recommendations (especially those for vitamin D) offers an opportunity for consumers to lower the diet cost. However, the cost of nutritious diets has not increased more than the cost of food in general between 1980 and 2012 in Sweden.