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Diabetes management relies on effective evidence-based advice that informs and empowers individuals to manage their health. Alongside other cornerstones of diabetes management, dietary advice has the potential to improve glycaemic levels, reduce risk of diabetes complications and improve health-related quality of life. We have updated the 2004 recommendations for the nutritional management of diabetes to provide health professionals with evidence-based guidelines to inform discussions with patients on diabetes management, including type 2 diabetes prevention and remission. To provide this update we commissioned new systematic reviews and meta-analyses on key topics, and drew on the broader evidence available. We have strengthened and expanded on the previous recommendations to include advice relating to dietary patterns, environmental sustainability, food processing, patient support and remission of type 2 diabetes. We have used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach to determine the certainty of evidence for each recommendation based on findings from the commissioned and identified systematic reviews. Our findings indicate that a range of foods and dietary patterns are suitable for diabetes management, with key recommendations for people with diabetes being largely similar for those for the general population. Important messages are to consume minimally processed plant foods, such as whole grains, vegetables, whole fruit, legumes, nuts, seeds and non-hydrogenated non-tropical vegetable oils, while minimising the consumption of red and processed meats, sodium, sugar-sweetened beverages and refined grains. The updated recommendations reflect the current evidence base and, if adhered to, will improve patient outcomes. Refereed/Peer-reviewed

Dried fruits contain many bioactive compounds broadly classified as phytochemicals includingphenolics, flavonoids, carotenoids, proanthocyanidins, stilbenes, chalcones/dihydrochalcones,and phytoestrogens. These compounds have antioxidant effects that may benefit health. Dried fruitsare also a diverse group of foods with varying fibre contents. The evaluation of the biological activityof these bioactive compounds, including their bioaccessibility and bioavailability, may contributeto the understanding of the health effects of dried fruits. Limited evidence suggests that driedfruits (raisins, cranberries, dates, and prunes) affect human gut microbiota composition in a potentiallybeneficial manner (in terms of effects on Bifidobacteria, Faecalibacterium prausnitzii, Lactobacillus,Ruminococcaceae, Klebsiella spp., and Prevotella spp.). There is little epidemiological evidence about theassociation of dried fruit consumption with cardiovascular disease incidence and mortality, as well asthe risk of type 2 diabetes or obesity. Clinical trial evidence for the effects of dried fruit consumptionon cardiovascular risk factors, including glycaemic control, is mixed. Clinical trial evidence suggestsprunes might preserve bone mineral density in postmenopausal women. Consumption of driedfruits is associated with higher-quality diets. Studies are needed to increase our understanding of thehealth effects of dried fruits and the underlying biological mechanisms. Dried fruits contain many bioactive compounds broadly classified as phytochemicals including phenolics, flavonoids, carotenoids, proanthocyanidins, stilbenes, chalcones/dihydrochalcones, and phytoestrogens. These compounds have antioxidant effects that may benefit health. Dried fruits are also a diverse group of foods with varying fibre contents. The evaluation of the biological activity of these bioactive compounds, including their bioaccessibility and bioavailability, may contribute to the understanding of the health effects of dried fruits. Limited evidence suggests that dried fruits (raisins, cranberries, dates, and prunes) affect human gut microbiota composition in a potentially beneficial manner (in terms of effects on Bifidobacteria, Faecalibacterium prausnitzii, Lactobacillus, Ruminococcaceae, Klebsiella spp., and Prevotella spp.). There is little epidemiological evidence about the association of dried fruit consumption with cardiovascular disease incidence and mortality, as well as the risk of type 2 diabetes or obesity. Clinical trial evidence for the effects of dried fruit consumption on cardiovascular risk factors, including glycaemic control, is mixed. Clinical trial evidence suggests prunes might preserve bone mineral density in postmenopausal women. Consumption of dried fruits is associated with higher-quality diets. Studies are needed to increase our understanding of the health effects of dried fruits and the underlying biological mechanisms.

Background Diet, as a modifiable factor, plays an important role in cognitive function. However, the association between adherence to the 2015–2020 Dietary Guidelines for Americans (DGA), measured by Healthy Eating Index (HEI)-2015, and cognitive function remains unclear. This study aims to explore whether HEI-2015 is associated with various cognitive domains and whether such association is modified by age, gender, or ethnicity in the US adults aged 60 years or older using data from the National Health and Nutrition Examination Survey (NHANES) 2011–2014. Methods HEI-2015 scores were calculated from 24-h dietary recall interviews. Cognitive function was evaluated by Digit Symbol Substitution Test (DSST, a measure of processing speed), Animal Fluency Test (AFT, a measure of executive function), a subtest from Consortium to Establish a Registry for Alzheimer’s disease (CERAD, a measure of memory), and a composite-z score calculated by summing z scores of individual tests. The associations between HEI-2015 scores and cognitive performance were explored using multiple linear regression models. Results A total of 2450 participants aged 60 years or older were included. Participants with higher HEI-2015 scores were more likely to have higher DSST, AFT as well as composite-z scores (PPinteractionP Conclusion Higher adherence to DGA is associated with better cognitive performance, especially regarding processing speed and executive function among the US adults aged 60 years or older.

The purpose of this study was to investigate Healthy Eating Index 2015 (HEI-2015) and Energy-Adjusted Dietary Inflammatory Index (E-DIITM) scores in women’s cancer survivors and to examine socio-economic (SES) characteristics associated with these two diet indices. In this cross-sectional study, survivors of women’s cancers completed a demographic questionnaire and up to three 24-h dietary recalls. HEI-2015 and E-DII scores were calculated from average intakes. One-way ANOVA was used to examine the association of various demographic factors on HEI-2015 and E-DII scores. Pearson Correlation was used to calculate the correlation between the two scores. The average HEI-2015 score was 55.0 ± 13.5, lower than the national average, and average E-DII was −1.14 ± 2.24, with 29% of women having a more pro-inflammatory and 71% a more anti-inflammatory diet. Diets with higher HEI-2015 scores were associated with more anti-inflammatory diets (r = −0.67, p < 0.001). Those having a graduate degree (F(2,49) = 3.6, p = 0.03) and completing cancer treatment > 4 years ago (F(2,49) = 4.8, p = 0.01) had higher HEI-2015 scores. There were no associations between SES and E-DII scores. The diet quality of women’s cancer survivors is comparatively low, but many achieved an anti-inflammatory diet; a promising avenue for preventing recurrence. There is an urgent need to involve health care professionals in the guidance of women’s cancer survivors to improve diet quality and prevent cancer recurrence.

Background: The prevalence of Inflammatory Bowel Disease (IBD) increases rapidly worldwide. Dietary guidance is an important pillar in the follow-up of patients with IBD. To provide patients with efficient dietary guidance, we need more knowledge about how they experience dietary guidance. This aim of this study is to explore how patients with IBD experience dietary guidance provided by different health professionals. Methods: Semi‐structured, individual interviews were conducted with 10 patients (1 male, 9 females) with IBD in the area of Oslo, Norway from October 2020 to December 2020. Participants were diagnosed with IBD for at least 6 months. The analysis of the interviews was guided by thematic analysis. Results: In general, patients expressed a need for more dietary guidance. Participants met various health professionals during their follow-up, such as general practitioners, gastrologists and, sometimes, clinical dietitians. Some patients strived to receive follow-up by a clinical dietitian. They often experienced that health professionals had little knowledge and motivation to provide them with dietary guidance related to IBD. They often felt left alone and self-responsible to find dietary guidance in other informational sources or tried different diets on their own. Conclusions: This study indicated that patients with IBD need more dietary guidance from health professionals. Based on the participants’ responses health professionals meeting patients with IBD should get more motivated and get more knowledge to provide dietary guidance related to IBD.

Background: The 2015–2020 Dietary Guidelines for Americans (DGA) recommends consuming low-fat or fat-free dairy foods due to concerns about energy and saturated fat intake. It also recommends consuming no more than 10% of daily calories from saturated fat. Objective: The objective was to assess the impact of replacing one serving of fat-free dairy foods in the Healthy U.S.-Style Eating Pattern (HUSEP) from the DGA with one serving of whole- or reduced-fat dairy foods. We hypothesized that this replacement would keep the HUSEP within calorie, saturated fat, and sodium limits. Methods: Utilizing the same modeling procedures as the 2015–2020 DGA, we assessed the nutrient composition of seven alternative models of the 2000-calorie HUSEP. These models replaced all three servings of dairy foods in the HUSEP with an updated fat-free dairy composite (Model 1) or one of three fat-free dairy servings in the HUSEP with: a whole-fat dairy food composite, a reduced-fat/low-fat dairy food composite, whole milk, reduced-fat milk, whole-fat cheese, or reduced-fat cheese (Models 2–7). Results: In all models, the amount of saturated fat did not exceed 10% of total calories, but the amount of energy increased by 45–94 calories. While still lower than current average intake (3,440 mg/d), sodium amounts in four of the seven models exceeded the 2,300 mg/d recommended intake level. Conclusions: Some reduced- and whole-fat dairy foods, especially milk, can fit into calorie-balanced healthy eating patterns that also align with saturated fat recommendations. Allowing some flexibility in fat level of dairy food servings aligns with the recommendations that calories from solid fats and added sugars are best used to increase the palatability of nutrient-dense foods.

Visual perception plays a key role in the selection of nutritious and healthy foods. Color, as one of the most important senses of vision, can be used as an indicator of food quality/defects and grade. It is recommended consumers include various colors in their plate to obtain various vitamins and minerals. Color is also thought to be related to antioxidant capacity. Within this regard, this study investigated the relationship between color and antioxidant capacity in various fruits and vegetables. The results indicate the color hues analyzed by computer vision based image analysis can be related with TAC of fruits and vegetables, but with some limitations and can be used as a guide for food selection to increase daily antioxidant intake. Most of fruits and vegetables having hue values above 180° and below 20°, have high antioxidant capacity (>10 mmol TE/kg fresh weight). The results also emphasized the importance of the serving size of fruits and vegetables in terms of their contribution to daily antioxidant intake. Based on these results, fruits and vegetables could be categorized into low-, medium-, and high-antioxidant groups according to their TAC and potential contributions to fulfill the recommended daily antioxidant intake. Finally, daily antioxidant intake was evaluated with a healthier scenario created by doubling vegetable portion and reducing fruit portion by half in the meal., Graphical abstract Image 1, Highlights • Color is related to antioxidant capacity in some fruits and vegetables. • Anthocyanin-rich purple, red, blue fruits and vegetables have more TAC. • Serving size should be considered when evaluating the overall antioxidant contribution of a meal. • Food selection could be guided by color to increase TAC content, while also considering total calorie intake.

Most Americans do not meet dairy food recommendations from the 2015 Dietary Guidelines for Americans (DGA). This study assesses differences in nutrient intake between Americans who meet recommendations for dairy intake and those who do not, using data from the National Health and Nutrition Examination Survey from 2013&ndash, 2014 and 2015&ndash, 2016 (n = 5670 children ages 2&ndash, 18&thinsp, years and n = 10,112 adults ages 19+). Among children and adults, those meeting dairy food recommendations were significantly more likely to have adequate intake (% above Estimated Average Requirement (EAR)) of calcium, magnesium, phosphorus, riboflavin, vitamin A, vitamin B12, and zinc and consume above the Adequate Intake (AI) for potassium and choline than Americans not meeting dairy recommendations, regardless of age, sex, or race/ethnicity. Americans meeting dairy recommendations were also more likely to exceed recommendations for sodium and saturated fat but consume less added sugars. Nearly 60% of Americans 2 years and older not meeting dairy recommendations consumed calcium and magnesium below the EAR. Only about 20% of Americans who did not meet dairy recommendations consumed above the AI for potassium. Dairy foods make important and unique contributions to dietary patterns, and it can be difficult to meet nutrient needs without consuming recommended amounts of dairy foods.

The objective of this study was to inform consumer-facing dietary guidance by (1) adapting the current University of North Carolina at Chapel Hill (UNC) food processing framework to include a home processing (HP) component and (2) pilot testing the adapted version using a nationally representative sample of foods consumed in the U.S. The UNC framework was adapted to include guidelines for categorizing home-prepared (HP) foods. The original UNC and adapted HP frameworks were used to code dietary recalls from a random sample of National Health and Nutrition Examination Survey (2015&ndash, 2016 cycle) participants (n = 100, ages 2&ndash, 80 years). Percent changes between the UNC and HP adapted frameworks for each processing category were calculated using Microsoft Excel, version 16.23. Participants were 56% female, 35% non-Hispanic white (mean age = 31.3 &plusmn, 23.8). There were 1,376 foods with 651 unique foods reported. Using the HP compared to the UNC framework, unprocessed/minimally processed foods declined by 11.7% (UNC: 31.0% vs. HP: 27.4%), basic processed foods increased by 116.8% (UNC: 8.2% vs. HP: 17.8%), moderately processed foods increased by 16.3% (UNC: 14.2% vs. HP: 16.6%), and highly processed foods decreased by 17.8% (UNC: 46.5% vs. HP: 38.2%). Home-prepared foods should be considered as distinct from industrially produced foods when coding dietary data by processing category. This has implications for consumer-facing dietary guidance that incorporates processing level as an indicator of diet quality.

As part of the revision of the 2007 Eating Well with Canada’s Food Guide, a literature scan on statistical modeling approaches used in developing healthy eating patterns for national food guides was conducted. The scan included relevant literature and online searches, primarily since the 2007 Canada’s Food Guide was released. Eight countries were identified as utilizing a statistical model or analysis to help inform their healthy eating pattern, defined as the amounts and types of food recommended, with many common characteristics noted. Detail on international modeling approaches is presented, highlighting similarities and differences as well as strengths and challenges.

This thesis approaches dietary guidance as socio-culturally produced and comprised in a specific historical context. The work is premised on the position that ideas and understandings of healthy eating are discursively constructed, and that we form our understandings of the world, ourselves and others through discourse. The theoretical approach builds on the Foucauldian notion of governing, which includes how the state governs people through strategic techniques and individuals’ self-governing in relation to discursive norms related to official institutions. The four studies included in the thesis therefore explore how healthy eating and official dietary guidance are negotiated and constructed from stakeholder, lay and policy perspectives. Paper I takes a stakeholder perspective on “appropriate” national dietary advice by exploring 40 written responses to updated official dietary guidelines. Paper II and III focus on lay people’s discourses on dietary guidance and healthy eating by examining their written correspondences (727 and 60 digital messages, respectively) with the Swedish Food Agency. Paper IV examines how the Swedish Food Agency’s official dietary guidelines frame the interplay of public health concerns and environmental concerns in making food choices. The findings demonstrate the dominance of a nutrient-centered and scientific discourse in communication (arguments, statements, instructions and questions) related to official dietary guidance in the Swedish context, even among non-professionals (in stakeholder responses, lay messages and the official dietary guidelines). In lay people´s communication with the Swedish Food Agency, both resistance to and internalization of official dietary advice are expressed within this dominating discourse. Resistance is additionally expressed through emotional language and by referring to alternative authorities, including personal experiences. The nutrient-centered and scientific discourse builds on the basic assumption of individual responsibility for health and the taken-for-granted nature of the primacy of physical health. Environmental perspectives come secondary to nutrition, which is demonstrated by their subordinate status in the official dietary guidelines and limited presence in lay people´s correspondences. Most socio-cultural, emotional and structural aspects on eating are made invisible by these discourses, in which food figures as scientifically quantifiable or functional in relation to physical health. However, in the official dietary guidelines from 2015, an additional discourse of cultivating certain tastes as a key to a sustainable diet constructs an ‘ideal eater’ with ‘middle-class’ aspirations.

Adherence to healthy eating patterns (HEPs) is often short-lived and can lead to repetitive attempts of adopting&mdash, but not maintaining&mdash, HEPs. We assessed effects of adopting, abandoning, and readopting HEPs (HEP cycling) on cardiovascular disease risk factors (CVD-RF). We hypothesized that HEP cycling would improve, worsen, and again improve CVD-RF. Data were retrospectively pooled for secondary analyses from two randomized, crossover, controlled feeding trials (n = 60, 52 &plusmn, 2 years, 30.6 &plusmn, 0.6 kg/m2) which included two 5&ndash, 6 week HEP interventions (Dietary Approaches to Stop Hypertension-style or Mediterranean-style) separated by a four-week unrestricted eating period. Ambulatory and fasting blood pressures (BP), fasting serum lipids, lipoproteins, glucose, and insulin were measured before and during the last week of HEP interventions. Fasting systolic BP and total cholesterol decreased (&minus, 6 &plusmn, 1 mm Hg and &minus, 19 &plusmn, 3 mg/dL, respectively, p &lt, 0.05), returned to baseline, then decreased again (&minus, 5 &plusmn, 13 &plusmn, 0.05) when adopting, abandoning, and readopting a HEP, magnitude of changes did not differ. Ambulatory and fasting diastolic BP and high-density lipoprotein cholesterol concentrations followed similar patterns, glucose and insulin remained unchanged. Low-density lipoprotein cholesterol concentrations decreased with initial adoption but not readoption (&minus, 3 and &minus, 3, respectively, interaction p = 0.020). Healthcare professionals should encourage individuals to consistently consume a HEP for cardiovascular health but also encourage them to try again if a first attempt is unsuccessful or short-lived.

ObjectiveTo test whether diets achieving recommendations from the UK’s Scientific Advisory Committee on Nutrition (SACN) were associated with higher monetary costs in a nationally representative sample of UK adults.DesignA cross-sectional study linking 4 d diet diaries in the National Diet and Nutrition Survey (NDNS) to contemporaneous food price data from a market research firm. The monetary cost of diets was assessed in relation to whether or not they met eight food- and nutrient-based recommendations from SACN. Regression models adjusted for potential confounding factors. The primary outcome measure was individual dietary cost per day and per 2000 kcal (8368 kJ).SettingUK.SubjectsAdults (n 2045) sampled between 2008 and 2012 in the NDNS.ResultsOn an isoenergetic basis, diets that met the recommendations for fruit and vegetables, oily fish, non-milk extrinsic sugars, fat, saturated fat and salt were estimated to be between 3 and 17 % more expensive. Diets meeting the recommendation for red and processed meats were 4 % less expensive, while meeting the recommendation for fibre was cost-neutral. Meeting multiple targets was also associated with higher costs; on average, diets meeting six or more SACN recommendations were estimated to be 29 % more costly than isoenergetic diets that met no recommendations.ConclusionsFood costs may be a population-level barrier limiting the adoption of dietary recommendations in the UK. Future research should focus on identifying systems- and individual-level strategies to enable consumers achieve dietary recommendations without increasing food costs. Such strategies may improve the uptake of healthy eating in the population.

BackgroundThe significance of periconceptional nutrition for optimizing offspring and maternal health and reducing social inequalities warrants greater understanding of diet quality among US women.ObjectiveOur objective was to evaluate racial or ethnic and education inequalities in periconceptional diet quality and sources of energy and micronutrients.DesignCross-sectional analysis of data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be cohort.Participants and settingNulliparous women (N=7,511) were enrolled across eight US medical centers from 2010 to2013.Main outcome measuresA semiquantitative food frequency questionnaire assessing usual dietary intake during the 3 months around conception was self-administered during the first trimester. Diet quality, measured using the Healthy Eating Index-2010 (HEI-2010), and sources of energy and micronutrients were the outcomes.Statistical analysesDifferences in diet quality were tested across maternal racial or ethnic and education groups using F tests associated with analysis of variance and χ2 tests.ResultsHEI-2010 score increased with higher education, but the increase among non-Hispanic black women was smaller than among non-Hispanic whites and Hispanics (interaction P value

BackgroundFederal dietary guidance for consumers in the United States includes three pillars: the Dietary Guidelines for Americans; the Dietary Reference Intakes (DRIs); and the information on food packages (including the Nutrition Facts Label). Food composition tables (FCT) should include information that is relevant to these types of dietary guidance. Objective: To review food composition variables that are meaningful in this public health context. Description: New dietary guidance focuses on three public health concerns: (1) achieving nutrient adequacy; (2) maintaining a healthy body weight; and (3) reducing risk of chronic diseases. To evaluate nutrient adequacy, nutrients with a DRI should be included on a FCT, and the units in which the recommendations are expressed should match those on the FCT. New ways to describe diets that promote a healthy weight have been suggested with an emphasis on decreasing intakes of empty calories (e.g., solid fats and added sugars) and choosing foods with a high nutrient density and a low energy density. To reduce risk of chronic diseases, dietary variables of interest are sodium and potassium, fatty acids, and descriptors of carbohydrate quality. Some of these themes are also seen in the recent recommendations by an Institute of Medicine Committee on front of package labelling. Conclusions: These types of variables are desirable in FCTs that will be accessed by consumers, or used to evaluate consumers’ adherence with dietary guidance. Developers of FCTs should ensure that their tables align with the latest developments in consumer guidance.

Fruit and vegetables (FV) have long been considered a panacea against major chronic diseases, including cancer. However, there is no convincing epidemiological, clinical or experimental evidence supporting FV chemopreventive ability. A daily mono-supplementation of lyophilized onion, tomato, peach, black grape or lettuce was compared with the daily combined administration of the same FV (5 a day-like diet). Ten days post-treatment, the phase-I/II xenobiotic metabolizing and antioxidant enzyme activities, protein and mRNA levels were investigated. As a marker of oxidative stress, the level of hydroperoxides was measured in rat serum samples. Here we show that a blend of FV orally administered to rats not only potentially manipulates metabolism but also disrupts systemic oxidative homeostasis. A daily combination of the five servings remarkably down-regulates the catalytic activity, protein and mRNA levels of a cohort of hepatic metabolizing enzymes, suggesting a possible depressed clearance upon exposure to ubiquitous carcinogens. Strikingly, we observed an impairment of antioxidant enzymes with a boost in systemic hydroperoxide levels. Our study identifies new potential factors of cancer risk connected with the persistent consumption of fixed servings of FV, suggesting that dietary guidance should rely on a "daily diversification" of FV.

Formulating dietary guidance involves navigating a large volume of substantive, conflicting evidence. Canada's guidance is determined after periodic evidence reviews. Health Canada identified the need for a more formal and systematic process to gather, assess, and analyze evidence. This led to the development of the Evidence Review Cycle model for Canada's dietary guidance. The Evidence Review Cycle consists of 5 steps that form a dynamic, iterative process to promote evidence-based, transparent, and proactive decision making. Resulting actions may include enhancing the implementation of guidance, revising guidance, or developing new guidance. Here, the development of this model is described, including considerations for implementation.

In my over three decades of work in the field of food and nutrition, I have participated in many efforts that seek new policy initiatives in the hopes that these programs can curb rates of obesity and chronic disease and help consumers make healthier dietary choices. Because of the profound effect that many of these policies have on consumers, the food environment, federal nutrition assistance programs and subsequent policy and regulatory recommendations, it is imperative that only the strongest, best available evidence is used to set policy. This review evaluates methods by which current nutrition policies use scientific research as well as provides recommendations for how best to ensure future nutrition policies are truly science-based and likely to have a meaningful impact on public health. Specifically, this review will: Describe the current food and nutrition policy environment in the US Examine how science is used in federal food and nutrition policymaking efforts, using the Dietary Guidelines for Americans (DGA) as an example Describe strong versus weak science as well as what types of studies are most appropriate for use in policymaking Discuss the potential effects and consequences of making policy recommendations in the absence of scientific consensus or agreement Make recommendations to support the present and ongoing development of science-based policy likely to positively impact public health.

Ca intake raises bone mineral density (BMD) in adolescence. The present study aimed at improving BMD in adolescent girls by increasing Ca intake from foods, and developing a supportive method for keeping this eating habit. In July of 1997 and 1998, BMD of the left os calcis was measured by ultrasound bone densitometry in 55 college girls respectively in the 1st and 2nd grades by calculating levels of stiffness which served as the index for BMD. We told them the analyzed results both times, giving instruction in life-style for preventing osteoporosis in 1997 and explanation about Ca-rich foods in 1998. After the measurement in 1998, we selected 11 girls with low BMD for the following intervention in diet (intervention group): i) kind and amount of Ca-rich foods were daily recorded for 4 weeks; ii) difference between the calculated intake and necessary level was told; and iii) subjects were continually encouraged to take daily necessary level from foods. Then, BMD of the intervention group was measured 12 weeks after. Further, in 1999, we measured BMD for the intervention group and 10 selected students with normal BMD in the 2nd grade (non-intervention group). Mean stiffness was significantly lower (P < 0.01) in the 2nd grade than in the 1st. In the 2nd grade, the intervention group showed a significantly higher mean 12 weeks after than in July. In the 3rd grade, the decrease in stiffness was stopped in both groups. The longitudinal measurements of BMD over a 2-year period made adolescent girls recognize the decreasing tendency of BMD. We conclude that adolescent girls can maintain BMD by utilizing their knowledge of preventing osteoporosis and by taking ample Ca from foods.

蓚酸の経口摂取による尿中蓚酸およびカルシウム(Ca)排泄量の測定結果と尿路結石患者への食事指導に関するアンケート結果を報告し, 尿路結石患者への食事指導法について述べた.尿路結石症の既往のない男性健康成人6名を対象に, ほうれん草100g摂取時, およびほうれん草100g+小魚30g摂取時それぞれ2時間後の尿中蓚酸, Ca, クレアチニンを測定し, 摂取前と比較した.その結果, 尿中蓚酸はほうれん草摂取およびほうれん草+小魚摂取2時間後にそれぞれ摂取前より増加していたが, 後者の方が増加の程度は低かった.尿路結石患者が食べてはいけないものはないが, バランスの取れた食事を適量摂る指導が大切である, Urolithiasis is a disease that has a high recurrence rate. We think that dietary guidance is necessary for the prevention of urolithiasis. It is important that stone formers eat a well-balanced diet and proper quantity of foods.

Lifestyle - change. How can use of pictures be an expedient tool in communicating dietary guidance towards non- ethnical Norwegian illiterates?Background: In an increasingly globalized world, service providers experience multicultural challenges within most areas of society. In order to reach their recipients with adequate information and guidance it is imperative to communicate in a way that enables the parties to understand each other. With limited access to interpreter services, the challenges are particularly vast for the group of non- ethnical Norwegian illiterates. Purpose: In this study we have examined to which degree facilitating for the use of pictures can be an expedient tool in communicating dietary guidance. The study was conducted at a family shelter where the majority of the clients were non- ethnical Norwegian illiterates.Method: Pictures of various food and beverages from different suppliers were downloaded from the internet. They were categorized and laminated in an appropriate scale for guidance use. Results: The results are uplifting in regards to usefulness value and increase of competence. The study points to a need of additional empirical research on the use of pictures within different areas of life where language barriers and illiteracy obstructs communication. Further research could also contribute to an answer to whether expedient use of pictures could enhance and strengthen the use of the Norwegian spoken language.

A review of the literature indicated a need for nutrition education materials to be current with prevailing scientific knowledge, using advanced instructional technology. Individuals need help in applying nutrition principles to their dietary practices. A nutrition education program utilizing the nutrient density concept and the dietary guidelines for use on videodisc with microcomputer interface was developed and evaluated. The evaluation of the program did not prove to be effective statistically but learners did show an interest in the program and had positive feedback in regard to the information presented and the technology used.