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Background: Fermentation is a widely used method of natural food preservation that has consequences on the nutritional value of the transformed food. Fermented dairy products are increasingly investigated in view of their ability to exert health benefits beyond their nutritional qualities.Objective: To explore the mechanisms underpinning the health benefits of fermented dairy intake, the present study followed the effects of milk fermentation, from changes in the product metabolome to consequences on the human serum metabolome after its ingestion.Methods: A randomized crossover study design was conducted in 14 healthy men [mean age: 24.6 y; mean body mass index (in kg/m2): 21.8]. At the beginning of each test phase, serum samples were taken 6 h postprandially after the ingestion of 800 g of a nonfermented milk or a probiotic yogurt. During the 2-wk test phases, subjects consumed 400 g of the assigned test product daily (200 g, 2 times/d). Serum samples were taken from fasting participants at the end of each test phase. The serum metabolome was assessed through the use of LC-MS-based untargeted metabolomics.Results: Postprandial serum metabolomes after milk or yogurt intake could be differentiated [orthogonal projections to latent structures discriminant analysis (OPLS-DA) Q2 = 0.74]. Yogurt intake was characterized by higher concentrations of 7 free amino acids (including proline, P = 0.03), reduced concentrations of 5 bile acids (including glycocholic acid, P = 0.04), and modulation of 4 indole derivative compounds (including indole lactic acid, P = 0.01). Fasting serum samples after 2 wk of daily intake of milk or yogurt could also be differentiated based on their metabolic profiles (OPLS-DA Q2 = 0.56) and were discussed in light of the postprandial results.Conclusion: Metabolic pathways related to amino acids, indole derivatives, and bile acids were modulated in healthy men by the intake of yogurt. Further investigation to explore novel health effects of fermented dairy products is warranted.This trial was registered at clinicaltrials.gov as NCT02230345. [ABSTRACT FROM AUTHOR]

Iron deficiency is the most common micronutrient deficiency worldwide, and transferrin receptor (TfR) level has been identified as an important measure of iron status that is not confounded by inflammation. However, logistical constraints associated with sample collection and processing have limited efforts to measure TfR, particularly at the community level. Standardized filter paper provides a relatively convenient and minimally invasive means for collecting and transporting samples of whole blood from simple finger pricks, and we present results of our validation of an improved method for quantifying TfR in dried blood spots. The method is based on commercially available reagents and uses capillary blood that is applied directly from the finger to filter paper, eliminating the need for premeasurement at the collection site. The blood spot TfR assay is precise and reliable, agrees well with plasma TfR, and can be performed at any facility with a microplate reader and basic laboratory equipment. Concentrations of TfR remain stable for at least 4 wk when blood spots are stored at room temperature, but begin to deteriorate after 3 d of exposure to higher temperatures. The advantages and disadvantages of the blood spot TfR method are discussed, as well as its potential contribution to future field-based studies of iron deficiency. [ABSTRACT FROM AUTHOR]

Functional foods can be considered to be those whole, fortified, enriched or enhanced foods that provide health benefits beyond the provision of essential nutrients (e.g., vitamins and minerals), when they are consumed at efficacious levels as part of a varied diet on a regular basis. Linking the consumption of functional foods or food ingredients with health claims should be based on sound scientific evidence, with the "gold standard" being replicated, randomized, placebo-controlled, intervention trials in human subjects. However, not all foods on the market today that are claimed to be functional foods are supported by enough solid data to merit such claims. This review categorizes a variety of functional foods according to the type of evidence supporting their functionality, the strength of that evidence and the recommended intakes. Functional foods represent one of the most intensively investigated and widely promoted areas in the food and nutrition sciences today. However, it must be emphasized that these foods and ingredients are not magic bullets or panaceas for poor health habits. Diet is only one aspect of a comprehensive approach to good health. [ABSTRACT FROM AUTHOR]

Background: Conflicting findings on the effects of garlic supplementation on inflammatory biomarkers have been observed in randomized clinical trials (RCTs).Objectives: The aim of this study was to summarize study results regarding the effects of garlic supplementation on serum inflammatory biomarkers in adults.Methods: We searched Scopus, PubMed, Google Scholar and Cochrane library databases for relevant papers published until April 2018, using keywords such as "garlic" and "inflammatory biomarker." We included RCTs that 1) were conducted in adults, 2) examined the effects of garlic supplementation on inflammatory biomarkers compared to a control group, and 3) reported sufficient data on inflammatory biomarkers. Results were reported as weighted mean differences (WMD) with 95% CI using random effects models. Cochrane's Q and I-squared (I2) tests were used to determine heterogeneity among studies. Funnel plots and Egger's regression test were used to assess publication bias.Results: Sixteen RCTs were included. Garlic doses ranged from 12 to 3600 mg/d, and intervention duration ranged from 2 to 52 wk. Garlic administration significantly reduced serum C-reactive protein (CRP) (n = 13) (WMD: -0.61 mg/L, 95% CI: -1.12, -0.11, P = 0.018, I2 = 76.9%), IL-6 (n = 5) (WMD: -0.73 ng/L, 95% CI: -1.06, -0.40, P < 0.001, I2 = 0%), and TNF (n = 7) (WMD: -0.26 ng/L, 95% CI: -0.41, -0.12, P < 0.001, I2 = 0.0%), compared to controls. However, the effect of garlic supplementation on serum adiponectin (n = 3) (WMD: 0.18 µg/L, 95% CI: -0.21, 0.57, P = 0.35, I2 = 60.7%) and leptin (n = 2) (WMD: -1.25 µg/L, 95% CI: -2.64, 0.14, P = 0.07, I2 = 0.0%) concentrations were not significant.Conclusion: In this meta-analysis of RCTs, we found that garlic supplementation reduced serum concentrations of CRP, TNF, IL-6, but did not affect serum adiponectin and leptin in adults. More RCTs are needed to test the effects of garlic supplementation on inflammation. [ABSTRACT FROM AUTHOR]

Iron deficiency anemia (IDA) depresses human productivity, but policymakers do not generally view this effect as an impediment to sustained economic growth. Economic logic should be enfolded in public advocacy for increased investment in the prevention and control of IDA. This paper argues that integrated strategies are required, with each intervention clearly related to particular groups at risk, and benefits carefully calibrated with costs. Protecting women's lives through supplementation has the first call on public resources, but the most productive investments reduce population prevalence at least cost, and these lie with food-based approaches within the competence of the processed food and seed industries. The public and private sectors must embark on modernization of the food industry in developing countries and reorientation of the international agricultural research complex so that iron-enriched essential foods will be affordable and accessible to the poor, especially children. The costs of IDA, the availability of cost-effective strategies and the benefits of sustained iron nutrition improvement to individuals, families and nations are reviewed. The roles of iron supplementation, food fortification, plant breeding and biotechnology, both actual and imminent, are described. The paper concludes that a recast Green Revolution directed toward dietary quality may be the key to enhancing the learning and earning capacity of young people in the developing world. [ABSTRACT FROM AUTHOR]

We describe an improved method for the measurement of retinol in dried blood spots (DBS) on filter paper. Retinol in human DBS on filter paper was analyzed by normal phase HPLC after a simple extraction method. Retinol associated with its binding protein was eluted from the paper into aqueous solution facilitated by ultrasonic agitation. Retinol associated with retinol binding protein was denatured with acetonitrile, and then retinol was isolated in a single hexane extract and analyzed directly by HPLC. When analyzing DBS, the individual plasma volume of the spots was calculated by measuring the sodium content or by weighing the blood spots. The described method yielded low intra- and interassay variability (<6%), with sufficient sensitivity (detection limit, 0.1 micromol/L) and good recovery (97% spike). Compared with matching plasma samples, DBS retinol consistently decreased 18-23% during the 1st wk of storage. After 1 wk, retinol remained stable in the blood spots at 23 degrees C for >3 mo. In conclusion, the analysis of retinol in DBS by HPLC is comparable to retinol analysis in serum. The variability of the method was reduced by using sodium concentration to estimate sample volume. Collection of DBS for retinol analysis is appropriate under field conditions, where it is difficult to centrifuge or freeze blood samples. [ABSTRACT FROM AUTHOR]

Background: Consumption of small, frequent meals is suggested as an effective approach to control appetite and food intake and might be a strategy for weight loss or healthy weight maintenance. Despite much speculation on the topic, scientific evidence is limited to support such a relation in the absence of changes to diet composition.Objective: We examined the effects of high compared with low eating frequency (EF) on self-reported appetite as a secondary outcome in a controlled trial.Methods: We conducted a randomized, crossover intervention trial in 12 participants (4 men, 8 women) who completed 2 isocaloric 3-wk intervention phases of low EF (3 eating occasions/d) compared with high EF (8 eating occasions/d). On the last morning of each study phase, participants completed a 4-h appetite testing session. During the appetite testing session, participants completing the low EF phase consumed a meal at 0800. Participants completing the high EF intervention consumed the same meal spread evenly over 2 eating occasions at 0800 and 1030. Standardized ratings of hunger, desire to eat, fullness, thirst, and nausea were completed every 30 min with the use of paper-and-pencil semianchored 100-mm visual analog scales. A composite appetite score was calculated as the mean of hunger, desire to eat, and the inverse of fullness (calculated as 100-fullness rating). Linear regression analysis compared ratings between low EF and high EF conditions.Results: The mean composite appetite score was higher in the high EF condition for the total testing period (baseline through 1200) (P < 0.05) and for the time period from baseline through 1030 (P < 0.001).Conclusion: The results from this study in 12 healthy adults do not support the popularized notion that small, frequent meals help to decrease overall appetite. This trial was registered at clinicaltrials.gov as NCT02548026. [ABSTRACT FROM AUTHOR]

Dietary fish oil has immunomodulatory effects that are partly mediated by its effects on cytokine secretion. In this paper, we examine whether dietary fish oil has different effects on cytokine secretion by T cells and macrophages. Female BalbC mice were fed diets supplemented with 18% fish oil + 2% corn oil or 20% corn oil. Concanavalin A (ConA)- and LPS-induced TNF-alpha and IL-10 secretion by splenocytes was examined using ELISA. Dietary fish oil decreased ConA induced-, but increased LPS-induced, TNF-alpha and IL-10 secretion by total murine splenocytes. Dietary fish oil increased the number of splenocytes secreting TNF-alpha and IL-10, following stimulation with LPS, by 123 and 38%, respectively, but did not affect cytokine secretion by each cell, as determined using enzyme-linked immunospot. Spleens from mice fed the fish oil diet had over 2-fold higher proportion of macrophages with high expression of CD11b than spleens from mice fed the corn oil diet. In addition, fish oil increased the proportion of total and CD11b(+) splenocytes that expressed the LPS receptor complex molecules, CD14 and toll-like receptor (TLR)4/myeloid differentiation factor-2 (MD-2), by 85 and 28%, respectively. The increased proportion of macrophages expressing the LPS receptor complex molecules, CD14 and TLR4/MD-2, in spleens from mice fed the fish oil diet may explain the increased number of cells that secreted the cytokines after LPS stimulation. [ABSTRACT FROM AUTHOR]

This paper compares a qualitative and a quantitative (Rasch) method of item assessment for developing the content of a food insecurity scale for Bangladesh. Data are derived from the Bangladesh Food Insecurity Measurement and Validation Study, in which researchers collected 2 rounds of ethnographic information and 3 rounds of conventional household survey data between 2001 and 2003. The qualitative method of scale development relied on content experts and respondents themselves to evaluate household food insecurity items generated through ethnographic research. The quantitative method applied the Rasch model to assess the fit of the same items using representative survey data. The Rasch model was then used to test for differential item functioning (DIF) across diverse demographic and geographic subgroups. The qualitative assessment flagged and discarded 10 items, leaving 13. The Rasch assessment of infit and outfit flagged 3 items, and the Rasch DIF test discarded another 10 items, leaving a total of 10 items in the Rasch-derived scale. The 2 scales contained 8 of the same items. The qualitatively and quantitatively derived scales were highly correlated (r = 0.96, P < 0.01), and the 2 methods located 90% of households in the same food insecurity tercile. This convergence lends added confidence to the use of either scale for identifying food-insecure households in different regions of Bangladesh. Multiple methods should continue to be applied in a systematic and transparent way to lend additional credence to the results when they converge and to pinpoint directions for further clarification where they do not. [ABSTRACT FROM AUTHOR]

Previous research using longitudinal data has found a positive and significant relationship between Food Stamp Program (FSP) participation and overweight in young girls and obesity in low-income women. This paper examined whether these relationships occurred simultaneously for members of the same family using longitudinal data on young (aged 4.5-11.5 y) girls and their mothers from the National Longitudinal Survey of Youth 1979. The results of ordinary least squares models that included detailed measures of individual, family, and environment characteristics and daughter or mother fixed effects indicated that all of the positive association between long-term FSP participation and overweight in daughters was accounted for by the association between long-term FSP participation and simultaneous overweight in daughters and obesity in mothers. Similarly, all of the positive association between long-term FSP participation and obesity in mothers was accounted for by the association between long-term FSP participation and simultaneous obesity in mothers and overweight in at least 1 young daughter. These results suggest that the relationship between long-term FSP participation and weight is a family phenomenon. [ABSTRACT FROM AUTHOR]

Calcium and dairy consumption are documented to be low among African Americans and have demonstrated benefits to bone growth, overall nutritional status, and health throughout the life cycle. There is also an emerging relationship to the prevention of obesity. This low consumption has been attributed to both cultural and community/environmental barriers. Using a life course construct and an ecological model of health behavior, this paper will illustrate why nutrition education and food consumption behavior at one stage of the life cycle may influence health status at that stage as well as influence health and consumption of calcium and dairy products at subsequent stages. The life course construct recognizes that both past and present behavior and experiences (in this case food and nutrient intake) are shaped by the wider social, economic, and cultural context and therefore may provide clues to current patterns of health and disease. The ecological model, concerned with constructs of environmental change, behavior, and policies that may help people make choices in their daily life, complements the life course approach when examining the potential influence of nutrition education provided by federally funded food and nutrition programs on calcium and dairy consumption behavior across the life cycle. The "critical period model" within the life course construct is operative for calcium, a nutrient for which adequate intake is critically important during adolescence when peak bone density development, necessary for later protection against osteoporosis, is important. [ABSTRACT FROM AUTHOR]

Food insecurity has been associated with overweight status in women. A number of hypotheses have been proposed to explain this association, some of which assume that household food insecurity is a cause of overweight. Similar to food insecurity, Food Stamp Program (FSP) participation has been associated with overweight status in women. One longitudinal study has also found a small effect of program participation on obesity status in women. Modeling FSP participation without accounting for the effect of need to participate in the program, as estimated by household food insecurity status, may lead to confounded findings. To estimate the direction and timing of the relation between food insecurity, this study reports on recently available longitudinal data from the Panel Study of Income Dynamics. The major finding of this paper is that persistent food insecurity was associated with a smaller weight change, controlling for other income and health-related risk factors for weight change. Among persistently food-insecure women, full participation in the FSP offset the weight change. There were no significant associations between change in food insecurity status and weight change in these data. [ABSTRACT FROM AUTHOR]

Hypercholesterolemia is a major risk factor for atherosclerosis, and lowering cholesterol can significantly reduce the risk for cardiovascular diseases. Oxidation of LDL has recently been recognized as playing an important role in the initiation and progression of atherosclerosis. Oxidized LDL, but not native LDL, promotes vascular dysfunction by exerting direct cytotoxicity to endothelial cells, by increasing chemotactic properties of monocytes, by transforming macrophages to foam cells, and by enhancing the proliferation of endothelial cells, monocytes, and muscle cells. All these events are recognized as contributors to cardiovascular diseases. This paper presents experimental evidence showing that several garlic compounds can suppress LDL oxidation in vitro. Short-term supplementation of garlic in human subjects has demonstrated an increased resistance of LDL to oxidation. These data suggest that suppressed LDL oxidation may be one of the mechanisms that accounts for the beneficial effects of garlic in cardiovascular health. [ABSTRACT FROM AUTHOR]

Dietary energy density [kcal/g (kJ/g)] influences energy intake under controlled laboratory conditions. Little is known about the energy density of the diets of free-living persons. Because energy density investigations are a relatively new endeavor, there are neither standard calculation methods nor published nationally representative values. This paper examines the calculation of energy density based on systematic exclusion of beverage categories, presents data on variability, and compares values by sex, age, and race/ethnicity in a representative sample of U.S. adults. Mean daily dietary energy density values for adults (aged >19 y) were calculated using two 24-h recalls from the Continuing Survey of Food Intakes by Individuals 1994-1996 based on food, food and liquid meal replacements, food and alcohol, food and juice, food and milk, food and juice and milk, food and energy-containing beverages, and food and all beverages. Energy density varied by calculation method, ranging from 0.94 to 1.85 kcal/g (3.93-7.74 kJ/g). Intraindividual-to-interindividual CV ratios were highest for the food and energy-containing beverages calculation. Men reported diets with a higher energy density than women for all calculation methods (P < 0.0001). There were differences by race/ethnicity and an inverse linear trend for age. These data indicate that beverage inclusion schemes should be clearly defined when reporting energy density values. In epidemiologic studies, calculations based on food and all beverages and food and energy-containing beverages may diminish associations with outcome variables. These nationally representative data, which provide an important frame of reference for other studies, indicate that dietary energy density differs by sex, age, and race/ethnicity. [ABSTRACT FROM AUTHOR]

Cancer is the second leading cause of death in the United States, and mortality due to colorectal cancer is only surpassed by lung cancer. Epidemiological studies demonstrate that dietary polyunsaturated fats can have a profound effect on colorectal cancer risk. Experimental data indicate that modulation of cellular (n-6) PUFA metabolism can affect the progression of the disease. This paper discusses the role (n-6) PUFA play in promoting intestinal tumorigenesis and how dietary PUFA from different families interact to modify the neoplastic process. Dietary PUFA that attenuate arachidonic acid metabolism [such as (n-3) PUFA] have antineoplastic properties, whereas those that augment arachidonic acid metabolism, such as linoleic, gamma-linolenic, and arachidonic acids do not appear to enhance tumorigenesis when added to the Western diet but may diminish the beneficial effects of other dietary lipids. It is the relative contributions of the different dietary PUFA that may determine overall risk for and progression of the disease. [ABSTRACT FROM AUTHOR]

Indigenous Peoples globally are part of the nutrition transition. They may be among the most extreme for the extent of dietary change experienced in the last few decades. In this paper, we report survey data from 44 representative communities from 3 large cultural areas of the Canadian Arctic: the Yukon First Nations, Dene/Métis, and Inuit communities. Dietary change was represented in 2 ways: 1) considering the current proportion of traditional food (TF) in contrast to the precontact period (100% TF); and 2) the amount of TF consumed by older vs. younger generations. Total diet, TF, and BMI data from adults were investigated. On days when TF was consumed, there was significantly less (P < 0.01) fat, carbohydrate, and sugar in the diet, and more protein, vitamin A, vitamin D, vitamin E, riboflavin, vitamin B-6, iron, zinc, copper, magnesium, manganese, phosphorus, potassium, and selenium. Vitamin C and folate, provided mainly by fortified food, and fiber were higher (P < 0.01) on days without TF for Inuit. Only 10-36% of energy was derived from TF; adults > 40 y old consistently consumed more (P < 0.05) TF than those younger. Overall obesity (BMI > or = 30 kg/m(2)) of Arctic adults exceeded all-Canadian rates. Measures to improve nutrient-dense market food (MF) availability and use are called for, as are ways to maintain or increase TF use. [ABSTRACT FROM AUTHOR]

The WHO recently conducted, within its Global Burden of Disease 2000 Study, a Comparative Risk Assessment (CRA) to estimate the global health effect of low fruit and vegetable intake. This paper summarizes the methods used to obtain exposure data for the CRA and provides estimates of worldwide fruit and vegetable intakes. Intakes were derived from 26 national population-based surveys, complemented with food supply statistics. Estimates were stratified by 14 subregions, 8 age groups, and gender. Subregions were categorized on the bases of child mortality under age 5 y and 15- to 59-y-old male mortality (A: very low child and adult mortality; B: low child and adult mortality; C: low child, high adult mortality; D: high child and adult mortality; E: high child, very high adult mortality). Mean intakes were highest in Europe A [median = 449 g/(person.d)] and the Western Pacific Region A. They were lowest in America B [median = 192 g/(person.d)], and low in Europe C, the South East Asian Regions B and D, and Africa E. Children and elderly individuals generally had lower intakes than middle-aged adults. SDs varied considerably by region, gender, and age [overall median = 223 g/(person.d)]. Assessing exposure levels for the CRA had major methodological limitations, particularly due to the lack of nationally representative intake data. The results showed mean intakes generally lower than current recommendations, with large variations among subregions. If the burden of disease attributable to dietary factors is to be assessed more accurately, more countries will have to assess the dietary intake of their populations using comparable methods. [ABSTRACT FROM AUTHOR]

This paper examines the relation between long-term Food Stamp Program (FSP) participation and overweight in children using data on children from the National Longitudinal Survey of Youth 1979 Child Sample. A child was categorized as overweight if his or her BMI was >/= the 95th percentile of sex- and age-specific BMI. The data were arranged as a panel with multiple observations per child, and the preferred models of overweight included long-term FSP participation, additional demographic, socioeconomic, and environmental characteristics, and child fixed effects. Child fixed effects were used to take into account unobserved differences across children that did not vary over time. The models were estimated separately for younger (5-11 y old) and older (12-18 y old) children. In Ordinary Least Squares models, long-term FSP participation was positively and significantly related to overweight in young girls (P = 0.048), and negatively and significantly related to overweight in young boys (P = 0.100). Compared with girls and boys whose families did not participate in the FSP during the previous 5 y, FSP participation during all of the previous 5 y was associated with a 42.8% increase for young girls and a 28.8% decrease for young boys in the predicted probability of overweight. Long-term FSP participation was not significantly related to overweight in older children. Although these models did not control for food insecurity, the potential role of food insecurity in FSP participation was considered in the interpretation of the relation between FSP participation and child weight. [ABSTRACT FROM AUTHOR]

Older people have different eating patterns than their younger counterparts, although in most nutritional studies of older populations, food frequency questionnaires (FFQ) that were developed and validated for the general adult population are used. In this paper, we present the advantages of developing an FFQ for an older population based on a population survey. A random sample of the Negev's (Southern Israel) Jewish population > or = 35 y old was recruited and interviewed for their dietary intake using 24-h recalls. Foods eaten were aggregated into conceptually similar groups and entered into stepwise regression models to predict variation in nutrient intake. We interviewed 796 people age 35-64 y and 377 people > or = 65 y old for the study. Significantly more items were required to reach 80% between-person variability for zinc, magnesium, vitamin E and protein for the elderly compared with the younger age group. Portion sizes of most items consumed by the elderly were smaller compared with the Israeli Ministry of Health portion sizes booklet and the younger age group's intake estimates. The nutrient values assigned for each line based on a weighted mean of the intake of the elderly were different from those using the most frequently used item. The above findings highlight some of the advantages of developing an FFQ for an older population based on a population survey. Further studies are required to compare the validity of existing tools adapted for the elderly to those developed on the basis of population surveys. [ABSTRACT FROM AUTHOR]

Garlic is proposed to have immunomodulatory and anti-inflammatory properties. This paper shows that garlic powder extracts (GPE) and single garlic metabolites modulate lipopolysaccharide (LPS)-induced cytokine levels in human whole blood. GPE-altered cytokine levels in human blood sample supernatants reduced nuclear factor (NF)-kappaB activity in human cells exposed to these samples. Pretreatment with GPE (100 mg/L) reduced LPS-induced production of proinflammatory cytokines interleukin (IL)-1beta from 15.7 +/- 5.1 to 6.2 +/- 1.2 micro g/L and tumor necrosis factor (TNF)-alpha from 8.8 +/- 2.4 to 3.9 +/- 0.8 micro g/L, respectively, whereas the expression of the anti-inflammatory cytokine IL-10 was unchanged. The garlic metabolite diallydisulfide (1-100 micro mol/L) also significantly reduced IL-1beta and TNF-alpha. Interestingly, exposure of human embryonic kidney cell line (HEK293) cells to GPE-treated blood sample supernatants (10 or 100 mg/L) reduced NF-kappaB activity compared with cells exposed to untreated blood supernatants as measured by a NF-kappaB-driven luciferase reporter gene assay. Blood samples treated with extract obtained from unfertilized garlic (100 mg/L) reduced NF-kappaB activity by 25%, whereas blood samples treated with sulfur-fertilized garlic extracts (100 mg/L) lowered NF-kappaB activity by 41%. In summary, garlic may indeed promote an anti-inflammatory environment by cytokine modulation in human blood that leads to an overall inhibition of NF-kappaB activity in the surrounding tissue. [ABSTRACT FROM AUTHOR]

Primary care physicians have the potential to decrease morbidity and mortality for many chronic diseases if they provide effective nutrition counseling. Given the time constraints of primary care practice, nutrition counseling needs to be brief, be part of an organized office system and refer appropriate patients to qualified nutrition professionals to be effective. This paper reviews a system of primary care nutrition counseling using the 5A's of patient-centered counseling, the elements necessary to develop an office-based system and some successful tools developed by nutrition researchers for the primary care setting to be used in an office-based system. [ABSTRACT FROM AUTHOR]

Although obesity has multiple etiologies, an overlooked possibility is an infectious origin. We previously identified two viruses, SMAM-1, an avian adenovirus (Ad), and Ad-36, a human adenovirus, that produce a syndrome of visceral obesity, with paradoxically decreased serum cholesterol and triglycerides in chickens and mice. In the two studies presented in this paper, we used nonhuman primates to investigate the adiposity-promoting potential of Ad-36. In study 1, we observed spontaneously occurring Ad-36 antibodies in 15 male rhesus monkeys, and a significant longitudinal association of positive antibody status with weight gain and plasma cholesterol lowering during the 18 mo after viral antibody appearance. In study 2, which was a randomized controlled experiment, three male marmosets inoculated with Ad-36 had a threefold body weight gain, a greater fat gain and lower serum cholesterol relative to baseline (P <0.05) than three uninfected controls at 28 wk postinoculation. These studies illustrate that the adiposity-promoting effect of Ad-36 occurs in two nonhuman primate species and demonstrates the usefulness of nonhuman primates for further evaluation of Ad-36-induced adiposity. [ABSTRACT FROM AUTHOR]

This paper describes usual intakes of vitamin A from diet plus low dose supplements, reviews methods for assessing vitamin A toxicity and applies a kinetic analysis of vitamin A turnover to estimate the effect of high dose supplements on vitamin A liver stores in infants and young children. In the United States, the 95th percentile of intake by preschoolers from foods and supplements exceeds the tolerable upper level (UL) but is below the no-observed-adverse-effect level (NOAEL). The 95th percentile of vitamin A intake from foods and supplements for nonpregnant, nonlactating women aged 19-30 y also exceeds the UL but is below the NOAEL for women of reproductive age. In low income populations in developing countries, vitamin A intakes of preschoolers and women consuming foods plus low dose supplements can also exceed the UL but are unlikely to exceed the NOAEL. There are few data on which to establish thresholds for excessive vitamin A intake or vitamin A concentrations in tissues. To assess the potential toxicity of the new recommendations (see article by Ross in this issue) for high dose vitamin A supplements for infants and children, we used a kinetic approach to estimate accumulation of the vitamin in liver. The new recommendations are unlikely to result in toxic levels (>300 microg per gram of liver) even if high dose supplements are inadvertently given monthly. The kinetic analysis also illustrates that a constant supply of vitamin A from breast milk (and/or complementary foods) is vital for preventing depletion of liver vitamin A stores between high dose supplements. [ABSTRACT FROM AUTHOR]

Night blindness during pregnancy caused by vitamin A deficiency is associated with an increased risk of morbidity and mortality among women. Because a history of maternal night blindness is simple and reliable to use, it is recommended as a population-based indicator of vitamin A deficiency. Furthermore, a maternal night blindness prevalence of >/=5% is recommended as a cut-off at which vitamin A deficiency may be considered to be a problem of public health significance within the community. This paper provides the justification for these recommendations. Night blindness during pregnancy is strongly associated with low serum and breast milk vitamin A concentration, abnormal conjunctival impression cytology and impaired dark adaptation, which suggests that it is a valid indicator of vitamin A deficiency. The prevalence of night blindness during pregnancy tends to be high in countries where the prevalence of xerophthalmia in children is high and in countries where interventions are in place to reduce childhood vitamin A deficiency. Existing data suggest that misclassification of self-reported maternal night blindness may account for a prevalence of up to 3%. The suggested cut-off, 5%, is set higher than this potential level of false-positive prevalence (3%). Illustrative data from India and Cambodia on childhood xerophthalmia and maternal night blindness rates are used to demonstrate the validity of using a 5% prevalence of maternal night blindness as indicative of a community vitamin A deficiency problem. Finally, it is recommended that night blindness history be elicited for a previous pregnancy that ended in a live birth in the past 3 y, using the local term for night blindness whenever possible. [ABSTRACT FROM AUTHOR]

Physiologic indicators reflect the functional consequences of vitamin A deficiency and may be particularly useful for detecting early perturbations in vitamin A status. In conjunctival impression cytology (CIC), epithelial morphology and the presence or absence of mucin spots and goblet cells allow samples, obtained by applying filter paper to the temporal conjunctiva, to be characterized as normal or typical of vitamin A-deficient keratinizing metaplasia. The validity of CIC has been established with reference to other indicators of vitamin A status, and a prevalence of > or =20% abnormal results has been suggested as indicative of a public health problem. However, interpretation of specimens requires considerable training, and nonresponsiveness to supplementation is a frequent problem, which limits the utility of CIC as a method for evaluating the impact of intervention programs. Several simplified field protocols for dark adaptation have been developed, including one in which dark adaptation is assessed by the responsiveness of the pupil to light. Night blind subjects have consistently shown abnormal results on this test, and a significant response to placebo-controlled dosing has been demonstrated for children and pregnant women. Scores have correlated significantly with serum retinol and relative dose response. Pupillary dark adaptation testing is acceptable to most children as young as 2 y old. Limitations of this technique include a time course for recovery after dosing as long as 4-6 wk, a testing time of 20 min, and the need for 1-3 d of training. Given its low cost, noninvasive nature, and lack of the need to transport samples, pupillary dark adaptation offers advantages over other techniques for assessing a population's vitamin A status. [ABSTRACT FROM AUTHOR]

The dietary supply of folates and their measurement are both affected, potentially, by the instability of some folates. Labile folates appear to be stabilized by binding to folate-binding protein (FBP); this paper reports measurements of that stabilization. The degradation rates of the very labile tetrahydrofolate (H(4)folate) and moderately labile 5-methyltetrahydrofolate (5-CH(3)H(4)folate) were measured with the compounds free or bound to either soluble or immobilized bovine milk FBP. Complexation increased stability from 2- to > 1000-fold, depending on buffer and temperature conditions. H(4)folate at 4 degrees C and pH 6.7 appeared to be quite stable for > 100 d when bound to soluble FBP but had a half-life of < 1 h when free. Stabilization of milk folates may be a role of FBP and would improve the bioavailability of milk folate to newborns and other consumers. [ABSTRACT FROM AUTHOR]

This paper provides a synopsis of the experience in combating iron deficiency in industrialized countries and identifies the reasons for the considerable success and future challenges. Significant progress has been made over the last century in reducing and even eliminating iron deficiency in many industrialized countries. Current estimates are that the prevalence of iron deficiency has declined to <20% in many of these countries, even among women and young children, compared with 30 to 70% in many developing countries. The reasons for this success cannot be attributed solely to a single approach but rather to a range of factors that have occurred over time as a result of both economic development and the implementation of specific policies. Several factors have contributed to improving both iron intakes and reducing iron losses; these include fortification, supplementation, dietary diversification and public health measures. For example, the decline in anemia in infants can be attributed to the introduction of iron-fortified formula and complementary foods in the 1960s to 1970s. Similarly, the enrichment and fortification of cereals with iron that began during World War II in North America and Europe is a result of effective public-private partnerships. Despite these successes, iron deficiency remains a public health concern in industrialized countries for selected subgroups such as women of reproductive age with excess menstrual losses and pregnant women who cannot meet increased requirements from the diet alone. Constant vigilance and innovative approaches for screening and combating this problem are thus still required even in developed countries. [ABSTRACT FROM AUTHOR]

Since the pioneering work of Windmueller and Spaeth, the importance of glutamine to the support of intestinal mucosal metabolic function has become generally accepted. Nevertheless, the mechanisms underlying this role still remain obscure. This paper explores a number of questions: 1) Is glutamine essential for intestinal function? 2) To what extent does this relate to its intermediary metabolism? 3) What is the importance of glutamine as a biosynthetic precursor? 4) Is glutamine supplementation of the nutrient mixture presented to patients of any metabolic or clinical benefit? As a result of this exploratory exercise, the following general conclusions were reached: 1) Much suggestive biochemical and physiologic evidence exists that implies that glutamine, especially systemic glutamine, supports the function of the intestinal mucosal system. 2) Despite the extensive metabolism of this amino acid by the intestinal tissues, most evidence suggests that if glutamine does play a physiologic role in the bowel, it is not compellingly related to its intermediary metabolism. 3) There is, on the other hand, evidence that the mucosal cells not only utilize extracellular glutamine but synthesize the amino acid. Given that inhibition of glutamine synthesis inhibits both proliferation and differentiation of mucosal cell cultures, this suggests some more subtle regulatory role. This notion is supported by the demonstration that glutamine will activate a number of genes associated with cell cycle progression in the mucosa. 4) Despite the accumulated evidence, the mechanisms underlying glutamine's function and the question whether glutamine supplementation uniformly benefits mucosal health remain equivocal at best. [ABSTRACT FROM AUTHOR]

Foods containing provitamin A carotenoids are the primary source of vitamin A in many countries, despite the poor bioavailability of carotenoids. In addition, epidemiologic studies suggest that dietary intake of carotenoids influences the risk for certain types of cancer, cardiovascular disease and other chronic diseases. Although it would be ideal to use humans directly to answer critical questions regarding carotenoid absorption, metabolism and effects on disease progression, appropriate animal models offer many advantages. This paper will review recent progress in the development of animal models with which to study this class of nutrients. Each potential model has strengths and weaknesses. Like humans, gerbils, ferrets and preruminant calves all absorb beta-carotene (betaC) intact, but only gerbils and calves convert betaC to vitamin A with efficiency similar to that of humans. Mice and rats efficiently convert betaC to vitamin A but absorb carotenoids intact only when they are provided in the diet at supraphysiologic levels. Mice, rats and ferrets can be used to study cancer, whereas primates and gerbils are probably more appropriate for studies on biomarkers of heart disease. No one animal model completely mimics human absorption and metabolism of carotenoids; thus the best model must be chosen with consideration of the specific application being studied, characteristics of the model, and the available funding and facilities. [ABSTRACT FROM AUTHOR]

The volume of human extracellular water (ECW) may be estimated from the sulfate space (SS). Although it may better approximate ECW volume than the bromide space, a common alternative, SS measurement is limited by the need to administer a radioactive substance, sodium [35S]sulfate. In this paper, we demonstrate the measurement of the SS using the stable isotope, sodium [34S]sulfate. Eight healthy nonobese men ingested 0.50-0.78 mg (3.47-5.42 micromol) Na234SO4/kg body weight and 30 mg NaBr/kg body weight. Sulfate concentrations and 34SO4 enrichments were measured by electrospray tandem mass spectrometry before and during the 5 h after tracer administration. SS was calculated by linear extrapolation of the natural logarithm of serum 34SO4 concentrations obtained at h 2, 3 and 4 compared with h 3, 4 and 5. The SS obtained using values between h 3 and 5 (187 +/- 17 mL/kg) was similar to published determinations using intravenous or oral radiosulfate, and was 80% of the simultaneously measured corrected bromide space (234 +/- 10 mL/kg, P = 0.01). Oral sodium [34S]sulfate administration is a suitable technique for measuring ECW and avoids radiation exposure. [ABSTRACT FROM AUTHOR]

A previous study showed that the marginal efficiency of utilization of digestible nitrogen for deposition in the body in preruminant calves is only approximately 30%. The study consisted of two similar experiments that were performed in two live weight ranges: 80-160 and 160-240 kg. In each experiment, 36 calves were allotted to one of twelve dietary treatments, consisting of six protein intake levels at each of two protein-free energy intake levels. This paper presents amino acid analyses of dietary and body proteins of these experiments with the following goals: 1) to identify possible limiting indispensable amino acids, and 2) to quantify the effect of protein and energy intake on the amino acid composition of deposited body proteins. The marginal efficiency of utilization of ileal digestible amino acids for deposition in the body did not exceed 30% for any of the indispensable amino acids. Increasing protein intake increased the ratio of indispensable to dispensable amino acids in deposited body proteins, likely caused by an increase in muscle-to-bone ratio in the carcass with a concomitant decrease in the proportion of collagen protein. It was concluded that the low marginal efficiency of utilization of digestible milk proteins for growth in preruminant calves of this weight range was not caused primarily by a severe limitation of a single indispensable amino acid in the diet. [ABSTRACT FROM AUTHOR]

Little is known concerning obesity patterns of ethnic subpopulations in the U.S. and the effects of acculturation on these patterns. Adolescent obesity, a major public health problem, has important health, social and economic consequences for the adolescent. The National Longitudinal Study of Adolescent Health survey is unique in the size of the adolescent sample and in its ability to provide large representative samples of Anglo, African-American, Hispanic and Asian-American adolescents. A nationally representative sample of 13,783 adolescents was studied. Measurements of weight and height collected in the second wave of the survey were used to study adolescent obesity. Multivariate logit techniques were used to provide an understanding of the ethnic, age, gender and intergenerational patterns of adolescent obesity. Comparisons are presented between the NHANES III results and those from the Adolescent Health Survey. The smoothed version of the NHANES I 85th percentile cut-off was used for the measure of obesity in this paper. For the total sample, 26.5% were obese. The rates were as follows: white non-Hispanics, 24.2%; black non-Hispanics, 30.9%; all Hispanics, 30.4%; and all Asian-Americans, 20.6%. Important variations within the Hispanic and Asian-American subpopulations are presented. The Chinese (15.3%) and Filipino (18.5%) samples showed substantially lower obesity than non-Hispanic whites. All groups showed more obesity among males than among females, except for blacks (27.4% for males and 34.0% for females). Asian-American and Hispanic adolescents born in the U.S. are more than twice as likely to be obese as are first generation residents of the 50 states. [ABSTRACT FROM AUTHOR]

From 1969 to 1977 a supplementation trial was conducted in Guatemala to ascertain the effects on physical and behavioral outcomes of improved nutrition in pregnant women and in preschool children. This paper reviews different strategies to analyze the effect of the intervention on physical growth. One strategy compares outcomes in two villages that were randomly allocated to receive Atole, a supplement containing high amounts of protein and energy, with values in two other villages that received Fresco, a beverage containing no protein and little energy. Both supplements contained micronutrients. This comparison of village means gives a probability significance statement (P < 0.005) that the difference in growth was because of the supplement intervention, although it does not specify the aspect of the intervention that caused the effect. Complementary strategies increase the credibility that the effect of the supplement was nutritional. Thus, analysis of the dose response with increasing supplement intake within the villages excludes the possibility that the above findings were the result of knowing which villages received which supplement (i.e., measuring biases). A greater effect in those most likely to respond nutritionally also increases the credibility that the mechanism was nutritional. In studying other behavioral and biomedical impacts of this supplementation intervention, analyses for credibility should always be included. [ABSTRACT FROM AUTHOR]

This paper examines the evidence that connects calcium intake and vitamin D status to bone fragility, hypertension, colon cancer, and breast cancer. Human calcium physiology, with an intestinal absorptive barrier and inefficient conservation, reflects the abundance of calcium in the primordial human food supply. The calcium intake of stone-age adults is estimated at 50 to 75 mmol/d, three to five times the median calcium intake of present-day U.S. adults. Long-term calcium restriction and/or insufficient vitamin D may promote the development of bone fragility, high blood pressure, colon cancer, and breast cancer in susceptible individuals. Conversely, improvement in calcium intake and/or in vitamin D status may help to prevent these serious health problems. At least 12 intervention studies have established the skeletal benefit of increased calcium intake among women in the late postmenopause. Other reports suggest that adequate calcium may protect against salt-sensitive and pregnancy-associated hypertension. High intakes of both dietary calcium and vitamin D are associated with reduced development of precancerous changes in colonic mucosa. Preliminary findings also suggest that vitamin D has a protective effect against breast cancer. [ABSTRACT FROM AUTHOR]

The intestine is the major route of excretion of endogenous zinc (Zn) and has a key role in maintaining Zn homeostasis. The principal objective of this paper is to provide an interpretative report of quantities of endogenous fecal Zn (EFZ) excreted by rural Guatemalan school children fed either normal or low phytate maize as their principal food staple. EFZ was measured by a Zn stable isotope technique. EFZ did not differ between control and low phytate maize groups. The overall EFZ (n = 53) was (mean +/- SD) 1.56 +/- 0.69 mg Zn/d or 0.07 +/- 0.03 mg Zn x kg body wt(-1) x d(-1). EFZ was not correlated with the quantity of Zn absorbed. The estimated EFZ at the level of absorption that matched the physiologic requirement (EFZ(PR)) did not differ from the above mean value. The EFZ(PR) of 0.07 +/- 0.03 mg Zn/kg body wt is twice the value currently used in the estimation of Dietary Reference Intakes. Supported by other recent childhood data, these results suggest that the current estimates of EFZ(PR) used in the calculation of Zn requirements for children are misleadingly low. [ABSTRACT FROM AUTHOR]

The Shandong Intervention Trial was a factorial, double-blind, placebo-controlled trial to determine whether any of 3 interventions, alone or in combination, could reduce the prevalence of precancerous gastric lesions in Linqu County, Shandong Province, China, a region with high gastric cancer mortality rates and a prevalence in adults of Helicobacter pylori of approximately 67%. The 3 interventions were one-time treatment with amoxicillin and omeprazole for Helicobacter pylori infection, and long-term administration of a garlic supplement (aged garlic extract and steam-distilled garlic oil) and a vitamin supplement (vitamins E and C and selenium). This paper describes the design and initial findings on treatment compliance, completeness of follow-up data, and eradication of Helicobacter pylori. [ABSTRACT FROM AUTHOR]

The article presents information about several papers discussed at a symposium on the role of branched-chain amino acids (BCAA) in exercise. Sports nutritionists are always interested in the determining the impact of protein and amino acids on muscle mass and physical performance in athletes. The symposium featured several nutritionists including Robert Wolfe, Yoshiharu Shimomura, Robert Layman, John Fernstrom, Masaru Ohtani, Kunio Torii, and Eva Blomstrand. Wolfe focused on the impact of exercise and intake of amino acids on muscle protein accretion in response to resistance exercise. Shimomura looked into the role of branched-chain alpha-keto-acid debydrogenase complex in the metabolism of BCAA in muscle. Layman discussed the role played by leucine in the stimulation of the synthesis of muscle protein through activation of the mammalian target of rapamycin protein kinase pathway. Blomstrand focused on the concept of central fatigue. Amino Vital Sports Science Foundation was the financial sponsor of the symposium.