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Background Children with congenital heart disease (CHD) frequently become malnourished due to many factors including hypermetabolic state, inadequate caloric intake, malabsorption, and fluid restriction as part of the hemodynamic intervention. The abnormal nutritional status may affect early outcome after pediatric cardiac surgery; we aim to prove the importance of nutritional assessment and patient nutritional preparation before performing pediatric cardiac surgery. Results We conducted a prospective observational cohort study from March 2013 till January 2015. All children from birth until 14 years of age admitted to the pediatric cardiac intensive care unit (PCICU) after cardiac surgery. Nutritional status was assessed preoperatively and prognostic nutritional index (PNI) was calculated. All post-operative outcome parameters, PCICU and hospital length of stay (LOS), ventilation time, the rate of infection, and ICU mortality were recorded. Two hundred fifty-nine children were evaluated. At admission, 179 patients (69%) had intake less than 50% of the recommended daily allowance (RDA) of calories intake. There was a statistically significant relationship between pre-admission RDA and the infection rate (P value 0.018). Severely malnourished patients had significantly longer ICU length of stay (LOS) (P value = 0.049). Similarly, weight and height percentiles have a significant effect on ICU LOS (P value 0.009 and 0.045) respectively. There was a significant relation between PNI ≥ 55 and the ICU LOS (P < 0.05), and ventilation time (P = 0.036). Delay in feeding postoperatively was associated with a higher risk of infection (P = 0.005), and higher mortality (P = 0.03). Conclusions Children with CHD were significantly malnourished preoperatively and had further weight loss postoperatively. Preoperative nutritional status and delayed postoperative enteral feeding were associated with a higher infection rate and mortality.

BACKGROUND Developing food-based dietary guidelines (FBDGs) for infants and toddlers is a complex task that few countries have attempted. OBJECTIVES Our objectives are to describe the process of food pattern modeling (FPM) conducted to develop FBDGs for the Dietary Guidelines for Americans, 2020-2025 for infants 6 to

BACKGROUND Americans are underconsuming essential nutrients while overconsuming several nutrients, including sodium, saturated fat, and added sugars. Suboptimal nutrition may be linked with mortality risk; however, few studies have evaluated the associations of underconsumed and overconsumed nutrients in a comprehensive manner among the US population. OBJECTIVES This study investigated the association between nutrient intake through diet and mortality focusing on adequacy, moderation, and macronutrient quality in US adults. METHODS Based on the 1999-2010 NHANES, 20,602 adults aged ≥30 y were followed up until December 2015. Nutrient intake was assessed using a 1-d 24-h dietary recall. Adequacy of major underconsumed nutrients in the United States was evaluated using the RDA (percent of RDA) or Adequate Intake (percent of AI). Overconsumed nutrients for which moderation is needed were assessed based on various dietary recommendations. Macronutrient quality was evaluated using the ratio of carbohydrates to dietary fiber, essential amino acids, and EPA + DHA. The association between nutrient intake and mortality was evaluated using Cox proportional hazards regression analysis. RESULTS Higher intakes of vitamin E, magnesium, iron, dietary fiber, and potassium relative to the RDA/AI were associated with lower all-cause mortality. High intake of vitamin A (tertile 3: ≥80.1% of RDA) was associated with lower mortality from cardiovascular disease (CVD; HR: 0.75; 95% CI: 0.57, 0.99) and cancer (HR: 0.76; 95% CI: 0.62, 0.94), and high intake of calcium (tertile 3: ≥87.8% of RDA) was inversely associated with cancer mortality (HR: 0.72; 95% CI: 0.56, 0.93). Higher intakes of essential amino acids and EPA + DHA evaluated as quartiles were inversely associated with all-cause and CVD mortality. CONCLUSIONS These findings suggest that higher intakes of underconsumed nutrients and improving macronutrient quality are associated with lower risk of CVD and cancer deaths in US adults.

The associations between selenium and liver stiffness and steatosis remain uncertain. This study aimed to explore the clinical relevance of selenium with liver stiffness and steatosis in adults from the 2017-2018 National Health and Nutrition Examination Survey. Subjects with excessive alcohol consumption and hepatitis B or C infection were excluded. Liver stiffness and steatosis were detected by transient elastography. Dietary selenium intakes and blood selenium concentrations were included as exposures. In multivariate analysis without adjustment for obesity, higher dietary selenium intakes (tertile 3 vs. tertile 1) were positively associated with liver stiffness in females (odds ratio (95% confidence interval): 2.64 (1.88-3.70)), and were positively associated with liver steatosis overall (1.54 (1.20-1.97)) and also in males (1.55 (1.06-2.26)). In multivariate analysis without adjustment for obesity, higher blood selenium concentrations (tertile 3 vs. tertile 1) were positively associated with liver steatosis overall (1.33 (1.02-1.76)) and also in males (1.56 (1.13-2.16)). After further adjustment for obesity, the abovementioned associations remain significant between dietary selenium intakes and liver stiffness in females (2.29 (1.69-3.12)) and liver steatosis overall (1.37 (1.01-1.86)), and between blood selenium concentrations and liver steatosis in males (1.67 (1.25-2.21)). Dose-response analysis showed that the abovementioned associations were linear. However, dietary selenium intakes meeting the recommended daily allowance (≥ 55 µg/day) were not associated with liver stiffness (0.99 (0.62-1.55)) and steatosis (1.01 (0.69-1.49)). In conclusion, higher dietary selenium intakes and blood selenium concentrations were positively associated with liver stiffness and steatosis, and obesity may partially account for the observed associations.

Purpose The aim of this study was to evaluate the nutrient content consumed by children and adolescents on home-prepared versus chef-prepared specific carbohydrate diets (SCD) as therapy for inflammatory bowel disease (IBD). Methods Dietary intake of two cohorts with active IBD initiating the SCD over 12 weeks was assessed. The home-prepared cohort received detailed guidance from dietitians on implementation of the SCD. The chef in the other cohort was knowledgeable in the SCD and prepared meals from a fixed set of recipes. Data from 3-day diet diaries at 4 different time points were collected. US Recommended Daily Allowances (RDA) were calculated for macronutrients, vitamins, and minerals. Results Eight participants on the homemade SCD and 5 participants on the chef-prepared SCD were included in analysis. Mean % RDA for energy intake was 115% and 87% for homemade and chef-prepared groups (p

Side effects of nutritional supplements, Edited by F. Anselmo, M.S. Driscoll Where on earth did the copy editor decide to do this?Abstract Vitamin and mineral supplement consumption is widespread. They are taken for a variety of conditions, including dermatologic disorders. Although consumers often assume these supplements are safe, excessive consumption of supplements may have deleterious effects. Such vitamin supplements include vitamin A, niacin, biotin, vitamin D, and vitamin E, and specific mineral supplements include zinc, copper, and iron. These supplements may have a number of potential adverse effects.

PURPOSE To explore whether there is an association between dietary choline intake and odds of diabetic retinopathy (DR) in the US diabetic population. METHODS A cross-sectional study was conducted using the combined data of the National Health and Nutrition Examination Survey (NHANES) 2005-2008 of a complex, multistage, and probability-sampling design. Energy-adjusted choline intake was calculated separately for men and women using the residual method. Binary logistic regression adjusting for covariates was used to identify the variables associated with DR. RESULTS We included 644 male and 628 female diabetic subjects, which were equivalent to a weighted survey sample of 9,339,124 for males and 10,109,553 for females respectively. Female DR patients consumed more choline than non-DR patients (268.6 mg/d vs 250.9 mg/d; p = .046). The estimated prevalence of DR was 17.4%, 21.9%, and 29.7% across three levels of dietary choline intake in females, respectively. In multivariable logistic-regression models, the odds ratio (OR) of DR for female patients in the highest choline intake group was 2.14 (95% confidence interval [CI], 1.38-3.31; p = .001) compared with those in the lowest intake group. This association was positive but not statistically significant in males. CONCLUSION Higher intake of dietary choline is associated with increased odds of DR in females, but not in males. Further studies are warranted to investigate the direct role of choline in DR development and determine the recommended daily intake of choline for diabetic patients weighing the pros and cons of dietary choline consumption.

Background Emerging evidence suggests that a dietary protein intake higher than the current recommended dietary allowance of 0.8 g/kg body weight (BW)/d may be needed to maintain optimal muscle mass, strength, and function in older adults. However, defining optimal protein intake in this age group remains a challenge. Objective In this study we sought to describe the dietary protein intake in frail, prefrail, and robust older Taiwanese adults. Methods Data for 1920 older adults were collected from the Nutrition and Health Survey in Taiwan from 2014 to 2017. Dietary intake was assessed using the 24-h recall method. Frailty was determined using the modified Fried's criteria. Body composition was assessed using DXA. Sex-specific dietary protein intakes, measured as values/kg of BW, fat-free mass (FFM), and lean mass (LM), were estimated for the 3 age groups (65-69, 70-79, and ≥80y) and the 3 frailty levels. Results In both males (P for trend = 0.034) and females (P for trend = 0.015), there were significant downward trends for protein intake/kg of BW with the severity of frailty. The age-adjusted protein intake/kg of BW was still significant in males (P for trend = 0.009), but no longer in females. This phenomenon was also seen for protein intake at lunch and dinner but not at breakfast. Age-adjusted trends for protein intake/kg FFM or LM were not significant in either sex. The median protein intake in robust older males and females was 1.21 and 1.19 g/kg BW/d, respectively, and the mean intakes were even higher. Conclusion Median protein intake in robust Taiwanese older adults was approximately 1.2 g/kg BW/d, with higher mean values. The protein adequate intake in Taiwanese older adults was higher than the current recommended daily allowance (RDA) level but within the RDA range derived from the state-of art indicator amino acid oxidation technique.

The paper examined the incidence, depth and severity of food insecurity among farming household in Sokoto, Nigeria. Data was collected with aid of questionnaire from a total of 440 farming households comprising of (220 beneficiaries and 220 non-beneficiaries of BOA) were randomly selected using four multistage sampling techniques. The data generated was analysed using FGT index. The result for the incidences of food insecurity as indicated by head count ratio shows that 39.55% and 48.18% of food insecure farming households beneficiary and nonbeneficiary respectively were not able to meet their recommended daily allowance (RDAs) which is 2,250 kcal valued at N278.40/person equivalent to 0.87 USD. The coefficient of food insecurity depth (gap) shows that 19% of beneficiary and 44% of non-beneficiary food insecure farming households are below the recommended daily calorie requirement. The severity of food insecurity shows that 3.6% of beneficiaries’ food insecure farming households are most food insecure in the study area as compared with 19% non-beneficiaries’ food insecure farming households. High incidence, depth and severity of food insecurity among non-beneficiary food insecure farming households, indicated that BOA has impacted on beneficiary farming households by increasing their food security status. Therefore, this study recommends financial policies that ensure financial support to farming households most especially non-beneficiary in the study area.

Introduction: Obesity is associated with nonalcoholic fatty liver disease (NAFLD) in children. Our aim was to analyze the association of dietary and sociodemographic factors with NAFLD in obese children and adolescents. Materials and methods: Thirty-three obese patients from 6-16 years of age were included in the present analytic cross-sectional study. Obesity was diagnosed with a body mass index z-score > 2 SD. NAFLD was estimated by liver ultrasound, serum amino transferases, and elastography. The sociodemographic variables were evaluated using validated questionnaires. Diet was estimated through two 24-h recall dietary surveys focused on the quantity of food energy, simple sugars, polyunsaturated fatty acids (PUFAs), and antioxidants. Results: Hepatic steatosis was identified by abdominal ultrasound in 13 patients (39.4%) and the serum alanine aminotransferase level was above the upper reference value in 54.2%. A higher educational level in both parents, greater monthly food expenditure, and a higher socioeconomic level were associated with NAFLD. Overall, simple sugar and saturated fat consumption was above the recommended daily intake, whereas vitamin E and PUFA consumption was below those parameters. Conclusions: NAFLD was identified in one-third of the cases. There was an association between NAFLD and sociodemographic variables. Both groups had an increased intake of simple sugars and a reduced intake of PUFAs. The selective occurrence of NAFLD could be related to a genetic predisposition that has been demonstrated in a Mexican population. Resumen: Introducción y objetivo: La obesidad se asocia con el hígado graso no alcohólico (HGNA) en niños. El objetivo fue explorar la asociación de factores dietéticos y sociodemográficos con el HGNA en niños y adolescentes obesos. Material y métodos: Treinta y tres pacientes obesos de 6-16 años fueron incluidos en este estudio transversal analítico. El diagnóstico de obesidad se realizó con puntuación z del índice de masa corporal > 2 DE. El HGNA se estimó con ultrasonido hepático, aminotransferasas séricas y elastografía. Las variables sociodemográficas se evaluaron con cuestionarios validados. La dieta se estimó mediante dos encuestas dietéticas por recordatorio de 24 horas enfocadas a la cantidad de energía, azúcares simples, ácidos grasos poliinsaturados (PUFAS) y antioxidantes. Resultados: En 13 pacientes (39.4%) se identificó esteatosis hepática por ultrasonido abdominal; 54.2% tuvieron una concentración sérica de alanina aminotransferasa por arriba de la referencia. El nivel educativo superior de ambos padres, el mayor gasto familiar mensual en alimentos y el mayor nivel socioeconómico se asociaron con HGNA. En el grupo total, el consumo de azúcares simples y grasas saturadas fue excesivo y el consumo de vitamina E y PUFAS estuvo por debajo del parámetro. Conclusiones: Se identificó HGNA en un tercio de los casos. Se demostró asociación entre HGNA y variables sociodemográficas. Ambos grupos tuvieron una ingesta aumentada de azúcares simples y disminuida de PUFAs. La ocurrencia selectiva de HGNA se podría relacionar a predisposición genética demostrada en población mexicana.

Docosahexaenoic acid (DHA) is the predominant omega‐3 long‐chain polyunsaturated fatty acid found in human brain and eyes. There are a number of studies in the literature showing the health benefits of DHA. It is critical throughout all life stages from the need for fetal development, the prevention of preterm birth, and the prevention of cardiovascular disease to the improvements in the cognitive function and the eye health of adults and elderly. These benefits might be related to the modulation of gut microbiota by DHA. In addition, there are some discrepancies in the literature regarding certain health benefits of DHA, and this review is intended to explore and understand these discrepancies. Besides the variations in the DHA contents of different supplement sources, bioavailability is crucial for the efficacy of DHA supplements, which depends on several factors. For example, DHA in phospholipid and triglyceride forms are more readily to be absorbed by the body than that in ethyl ester form. In addition, dietary lipids in meals and emulsification of DHA oil can increase the bioavailability of DHA. Estrogens stimulated the biosynthesis of DHA, whereas testosterone stimulus induced a decrease in DHA. The roles of DHA through human lifespan, the sources, and its recommended daily intake in different countries are also discussed to provide a better understanding of the importance of this review., DHA is critical for all life stages from fetal development to elderly health. The recommended intake of DHA depends on many factors, such as regions, age groups, and genders. DHA supplements are mainly from fish, krill, and algal oils, and the bioavailability of DHA depends on its chemical structure and matrix.

In July 2018, the Brazilian National Health Surveillance Agency (Agência Nacional de Vigilância Sanitária, ANVISA, in Portuguese) published new regulations for food supplements, leading to changes both in the sales denomination and labeling statements, and in the composition of these products. Among dietary supplements, those containing vitamins are the most consumed by the population. The objective of the present work is to discuss the changes in the parameters established for the products containing vitamins, mainly in relation to the required and allowed concentrations of micronutrients, and to verify the impact of these changes for the population since the publication of the new standards. Until July 2018, vitamin-based products containing between 15% and 100% of the recommended daily intake (RDI) of these micronutrients were classified as vitamin supplements; above this dosage, they were considered medicines. The new legislation changed the minimum and maximum limits allowed for vitamin food supplements. Taking into account the maximum vitamin limits established for adults, the most relevant differences were the increase in these limits in a proportion of 100, 76 and 43 times in regarding vitamins E, B6 and C respectively, when compared to those previously established. For the required minimum limits, the major difference was observed for vitamin D, with a four-fold increase in its concentration. In conclusion, changes in legislation can influence the health of the population, so the ideal amounts of vitamin in supplements and the recommendation to consume these products require extensive discussion and reflection.

Food and nutrition security interventions have struggled to supply sustainable protein-rich animal source foods in refugee camps due to high costs required and limited resources. Therefore, crickets farming was extended to refugee settings in Kenya as a potential source of protein and income. This paper discusses how cricket farming was introduced in Kakuma refugee camp and the utilization of crickets as food or feed. A thriving cricket colony was established in a site managed by DanChurchAid (DCA) in Kakuma refugee camp. The cricket colony was used to produce and supply cricket eggs to recruited and trained households who belonged to seven different nationalities. The project beneficiaries were selected using purposive sampling based on a set of predefined characteristics. Each household was provided with a cricket-rearing starter kit consisting of wooden pens, hides (carton egg trays), pin-head crickets, feed and water dispenser (cotton wool). Each household harvested 0.5 – 3.0 kg of fresh cricket per cycle of 1–2 months which was used as food (55.65%) or feed (44.35%). The crickets were processed by either sun drying, blanching or frying. The most dominant processing method was the combination of sun drying and frying that constituted 52.17% of the total processing. There was a significant correlation (P 30% of the recommended daily intake of protein and other micronutrients for women and children of different ages. Crickets showed a huge potential in mitigating food and nutrition insecurity in the camp although further efforts are required to strengthen the crickets value chain as food or feed.

Background and objective: Methylmalonic acidemia (MMA) and propionic acidemia (PA) are inborn errors of metabolism. While survival of MMA and PA patients has improved in recent decades, long-term outcome is still unsatisfactory. A protein restricted diet is the mainstay for treatment. Additional amino acid mixtures (AAM) can be prescribed if natural protein is insufficient. It is unknown if dietary treatment can have an impact on outcome. Design: We performed a nationwide retrospective cohort study and evaluated both longitudinal dietary treatment and clinical course of Dutch MMA and PA patients. Protein prescription was compared to the recommended daily allowances (RDA); the safe level of protein intake as provided by the World Health Organization. The association of longitudinal dietary treatment with long-term outcome was evaluated. Results: The cohort included 76 patients with a median retrospective follow-up period of 15 years (min -max: 0-48 years) and a total of 1063 patient years on a protein restricted diet. Natural protein prescription exceeded the RDA in 37% (470/1287) of all prescriptions and due to AAM prescription, the total protein prescription exceeded RDA in 84% (1070/1277). Higher protein prescriptions were associated with adverse outcomes in severely affected patients. In PA early onset patients a higher natural protein prescription was associated with more frequent AMD. In MMA vitamin B12 unresponsive patients, both a higher total protein prescription and AAM protein prescription were associated with more mitochondrial complications. A higher AAM protein prescription was associated with an increased frequency of cognitive impairment in the entire. Conclusion: Protein intake in excess of recommendations is frequent and is associated with poor outcome. 0 2021 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Summary Background & aims Dietary minerals have significant effects on the risk of cardiovascular disease. However, the results of previous studies were not uniform across different countries. The current study aims to determine the causal effects of dietary calcium, zinc, and iron intakes on coronary artery disease (CAD) among Nepalese men. Methods A matched case–control study was carried out at Shahid Gangalal National Heart Center. Dietary intakes of 466 male participants over the past 12 months were evaluated using a semi-quantitative customized food frequency questionnaire. G-estimation and inverse probability treatment weighting (IPTW) analyses were performed to determine the causal odds of CAD due to dietary calcium, zinc, and iron intakes. Results Daily dietary calcium, zinc, and iron intakes were categorized into two groups: less than versus more than the median value and less than versus equal or more than recommended daily allowance (RDA). In G-estimation, dietary calcium intake was inversely associated with CAD in both medians (OR: 91; 91%CI: 0.86, 95) and RDA categories (OR: 0.88: 95%CI: 0.84, 0.97). However, in IPTW analysis, only median calcium intake was significantly associated with CAD (OR: 7; 91%CI: 0.5, 98). We observed a significant inverse association of equal or more than RDA of dietary zinc intake with CAD (OR: 0.91: 95%CI: 0.87, 0.96 in G-estimation, OR: 0.73: 95%CI: 0.66, 0.82 in IPTW); however, more than median dietary zinc intake showed inverse but not significant association with CAD in both analyses. Dietary iron intake was inversely but not significantly associated with CAD in G-estimation in both groups. Nevertheless, in IPTW analysis, equal or more than RDA iron intake was significantly positively (OR: 1.4; 95%CI: 1.14, 1.73) related to CAD. Conclusions A significant inverse association of dietary zinc intake above RDA indicates the potential protective effect of higher dietary zinc against CAD. However, causal odds of CAD are inconsistent across the median or RDA of calcium and iron intakes. Therefore, cohort and randomized clinical trial studies with a large sample size are recommended to substantiate these nutrients’ causal link with CAD development in the Nepalese population.

Adequate magnesium intakes are associated with lower diabetes, hypertension, and cardiovascular disease (CVD) risk but are low in modern diets. Magnesium DRIs, estimated using standard reference body weights (SRBWs) lower than current mean US adult body weights (BWs), need revision. Magnesium DRIs assume variance at 10% CV, whereas balance study data suggests 20–30% CV. Here, estimated average requirements (EARs), the DRI measure estimating average magnesium requirements for healthy adults, were corrected using 2011–2014 mean US adult BWs. Magnesium EARs (in mg magnesium/d) increased 17% for men (330–350 to 386–409) and 25% for women (255–265 to 319–332). RDAs, the DRI measure meant to cover the magnesium needs of 98% of healthy adults, were calculated using BW-corrected EARs given 3 CV levels: 1) 10% (assumed in 1997 DRIs), 2) 20% (model-derived variance from USDA magnesium studies), and 3) 30% (using USDA plus older human magnesium balance data). BW-corrected magnesium RDAs (in mg magnesium/d) rose from 400–420 and 310–320 for men and women, respectively, to 1) 463–491 and 383–398 (16.5% and 23.5% increases), 2) 540–573 and 447–465 (35.5% and 44.5% increases), and 3) 617–654 and 511–531 (55% and 65.5% increases). These recalculations move magnesium intakes estimated to prevent disease into ranges found in traditional diets and to intake levels shown to lower hypertension, diabetes, and CVD risk. In conclusion, mean BW rises over the last ≥20 y and data-driven estimates of CV indicate that reliable US adult magnesium RDAs are ≥60–235 and 70–210 mg magnesium/d higher for men and women, respectively, than the current 1997 RDAs. US adult BMIs are 25 with actual mean BWs. Adjustments for rising BW are necessary for magnesium DRIs to remain useful tools for defining magnesium intake adequacy/deficiency.

Introduction 1 in 2 women and 1 in 5 men will suffer a fragility fracture. Research into calcium and vitamin D supplements has found no consistent evidence to suggest that they reduce the risk of osteoporotic fractures. There has been little research to suggest that dietary calcium is effective at reducing the risk osteoporotic fractures, but supplements have been linked to increased risk of cardiovascular disease and urinary stones. Bisphosphonates have been shown to reduce the risk of osteoporotic fractures and are usually taken in combination with calcium and vitamin D supplements given that deficiencies must be corrected prior to starting. This study set out to assess the dietary calcium intake of patients who attend the falls clinic and explore their attitudes towards dietary change, as an alternative or adjunct to a calcium and vitamin D tablet. Methods Data was collected during private interviews conducted with patients who attended the falls clinic. The Edinburgh University Centre for Genomic and Experimental research (CGEM) food frequency calculator was used to calculate dietary calcium intake. Microsoft Excel was used to collate and analyse the data. Results No association was found between dietary calcium intake, age and sex. We did find that mean dietary calcium intake was significantly less than the recommended daily amount for adults with osteoporosis, with 80% not getting their recommended daily intake (p Conclusion This study has identified a group of patients who will hopefully benefit from a leaflet on sources of dietary calcium and as result improve their bone health.

Background Clinical practice guidelines of dietary management are designed to promote a balanced diet and maintain health in patients undergoing haemodialysis but they may not reflect patients’ preferences. We aimed to investigate the consistency between the dietary intake of patients on maintenance haemodialysis and guideline recommendations. Methods Cross-sectional analysis of the DIET-HD study, which included 6,906 adults undergoing haemodialysis in 10 European countries. Dietary intake was determined using the Global Allergy and Asthma European Network (GA2LEN) Food Frequency Questionnaire (FFQ), and compared with the European Best Practice Guidelines. Consistency with guidelines was defined as achieving the minimum daily recommended intake for energy (≥ 30 kcal/kg) and protein (≥ 1.1 g/kg), and not exceeding the maximum recommended daily intake for phosphate (≤ 1000 mg), potassium (≤ 2730 mg), sodium (≤ 2300 mg) and calcium (≤ 800 mg). Results Overall, patients’ dietary intakes of phosphate and potassium were infrequently consistent with guidelines (consistent in 25% and 25% of patients, respectively). Almost half of the patients reported that energy (45%) and calcium intake (53%) was consistent with the guidelines, while the recommended intake of sodium and protein was consistent in 85% and 67% of patients, respectively. Results were similar across all participating countries. Intake was consistent with all six guideline recommendations in only 1% of patients. Conclusion Patients on maintenance haemodialysis usually have a dietary intake which is inconsistent with current recommendations, especially for phosphate and potassium.

Background Maternal malnutrition is a global concern whose consequences for newborns are intrauterine growth retardation, fetal hypotrophy and exposure to risks of pathologies in adulthood. Objective The aim of this study was to assess and compare the diet quality and nutritional status of pregnant women at the time of childbirth while assessing their newborn's weight at birth. Materials and methods The study involved 400 parturient, divided into two groups of 200 each, the controls who have just given birth to newborns of normal weight and the cases who have just given birth to babies of low birth weight (LBW). Information on food intakes and dietary habits were collected using questionnaires and anthropometric parameters were measured. Results The mean body mass index (BMI) of the cases was 25.93 ± 2.64 kg/m2 vs. 28.25 ± 2.75 kg/m2 in the controls. The dietary diversity and variety scores were higher in the controls than in the cases. Indeed means were 6.87 ± 1.30 vs. 8.88 ± 1.35 food groups for the diversity scores and 11.77 ± 1.57 vs. 15.90 ± 2.09 food items for the variety scores in the cases and the controls respectively. The average daily intakes of folates, calcium, iron and zinc were lower than the Recommended Daily Allowances (RDA) for both groups. The daily calcium intake represents only 1/5th of the RDI for the cases and 1/3 for the controls. Average dietary iron intake was insufficient at only 49% of the daily requirement for cases vs. 66.88% for controls while folates accounts for 64.33% of the RDA for the cases. Conclusion Data from this study shows that the diets of women who have given birth to low birth weight infants are poorly diversified, poorly varied, and poor in certain nutrients essential for a successful pregnancy and childbirth.

In recent years, significant progress has been made at the global level in eliminating of iodine deficiency. However, until recently, there has been a gap in methods for estimating iodine intake with industrially processed foods (IPF) produced with iodized salt (IS). The aim of this work was to study the iodine consumption with IPF and kitchen salt by the adult population and pregnant women in Armenia and Moldova. Material and methods. For modeling iodine consumption, a special matrix based on MS Excel spreadsheets was used, into which data on the average per capita daily consumption of the main IPF, salt content in IPF, the share of IPF produced with IS in the total volume of their consumption, percentage of households using IS, and the iodine content in salt according to the national standard were entered. Results and discussion. The estimated average daily salt consumption per capita of the adult population of Armenia was 10.6 g. Due to the use of IS in 93% of households and in the production of 82% of bakery products, 7% of cheese, 83% of meat products, 44% of canned vegetables and 5% of pasta, iodine intake in adults was 149% of the recommended daily allowance (RDA). Bakery products and iodized kitchen salt were the main sources of iodine (66 and 70% of the RDA respectively), and the share of other IPF did not exceed 13%. In Moldova, salt consumption was 11.9 g per day. Due to the use of IS for the production of 50% bakery products, 12% of canned vegetables and 20% of pasta, iodine consumption in adults in Moldova amounted to 74% of RDA almost entirely due to bakery products and kitchen salt (37 and 35% of the RDA respectively). The median urinary iodine concentration indicated adequate iodine intake in both countries and was significantly higher in Armenia (242 μg/L) than in Moldova (136 μg/L). A planned 30% reduction in salt intake may lead to an inadequate reduction in iodine intake in pregnant women. Conclusion. Adequate iodine intake among the adult population of Armenia and Moldova is ensured mainly through the use of IS in households and in the production of bakery products.

Improving the quality of nutrition for children with gluten intolerance in preschool institutions is an important state task. Relevant adjustment of the diet enables to reduce the risk of the celiac syndrome. Balanced nutrient composition of diet is necessary for the harmonious growth and development of a child. The aim of the research was to develop specialized diet for children with gluten intolerance and celiac desease in municipal preschool educational institutions. Material and methods. A study of the 10-days full-day menu of children aged 3 to 7 years was carried out. To compose the specialized menu, we used the computational program "MDOU Calculate menu. Universal program for kindergarten". Technological maps of dishes in municipal preschool educational institutions were used. The calculation of the supply of the diet with vitamins, minerals and trace elements and the deviation of the nutritional and energy value of the diet from the recommended daily intake was made. Results. The necessity of developing a specialized diet for children 3-7 years old with a confirmed diagnosis of celiac disease, as well as for children on a gluten-free diet has been substantiated. A specialized daily food ration has been developed, consisting of four meals. Analysis of the nutritional and energy value of the dishes offered in the menu showed the minimum deviation of the obtained indicators from recommended daily intake. The necessity of introducing the developed diet into the system of specialized nutrition in preschool educational institutions has been substantiated. Conclusion. The results of the work indicate that under the conditions of state funding, there is a possibility of adjusting the existing food rations for the full-fledged socialization of children with various diseases.

Introduction The purpose of this study was to demonstrate the feasibility of a phototherapy kiosk (PK) to engage community adults in health promotion and to stimulate production of circulating 25-hydroxyvitamin (OH)D as effectively as a vitamin D3 oral supplement (OS). Although optimal production of vitamin D comes from sun exposure, ultraviolet B radiation with a wavelength of 290 to 320 nm penetrates exposed skin and may produce vitamin D3 using a PK. Materials and Methods A prospective study was conducted with adults randomized to either six PK treatments or D3 OS for 10 weeks. Serum 25(OH)D was drawn at baseline, 10 weeks, and 14 weeks. Primary outcome was serum 25(OH)D level. Mann–Whitney test was used to assess continuous data and Chi squared test for pairwise comparisons of categorical data. Significance was set at P Results With 18% attrition, final sample size was 88; OS, n = 45, PK, n = 43. Sample was mostly female (60%), median age 35 years, with no differences observed between groups for age, race/ethnicity, marital status, military affiliation, or season of enrollment. Median daily intake of calcium and vitamin D was well below the recommended daily allowance for each nutrient, and group. Baseline median serum 25(OH)D levels were similar. By 10 weeks, PK median level was 30 ng/mL (interquartile range [IQR] 25.8-37.0) and OS was 26 ng/mL (IQR 21.5-30.5), P = .02. The difference in 25(OH)D levels persisted at 14 weeks; the PK group returned to baseline, 27 ng/mL (IQR 22.0-32.5), and OS group declined to 21 ng/mL (IQR 17.0-30.0), P = .02. Conclusion Programmed ultraviolet B phototherapy appears to be an efficacious alternative to oral vitamin D supplementation with consistent use.

Vitamin A is a fat-soluble vitamin. It is essential for vision, especially dark adaptation, immunity, bone growth and reproduction, maintain surface of cornea and sclera, and epithelial integrity of respiratory, urinary and gastro intestinal tract. Vitamin A also has a role in gene expression. Recommended daily allowance for children ranges from 400 to 700 μg. Normal plasma retinol levels are 20–50 μg/dL. Deficiency results in problems in the eye and vision, cellular differentiation, and functionality of the humoral and cell mediated immune system.World Health Organization recommends supplementation approaches in children between 6 and 59 months of age in certain populations at risk of deficiency.

The collective findings from human microbiome research, randomized controlled trials on specific microbes (i.e., probiotics), and associative studies of fermented dairy consumption provide evidence for the beneficial effects of the regular consumption of safe live microbes. To test the hypothesis that the inclusion of safe, live microbes in the diet supports and improves health, we propose assessment of the types and evidentiary quality of the data available on microbe intake, including the assembly and evaluation of evidence available from dietary databases. Such an analysis would help to identify gaps in the evidence needed to test this hypothesis, which can then be used to formulate and direct initiatives focused on prospective and randomized controlled trials on live microbe consumption. Outcomes will establish whether or not the evidence exists, or can be generated, to support the establishment of dietary recommendations for live microbes.

Summary Background & aims Children on long-term tube-feeding often need special treatment for oral feeding transitioning. Rapid tube-weaning programs usually result in short-term reductions in food intake and weight loss. This study examined the long-term effects of a “Graz-model” based weaning program on nutritional status and growth. Methods Children aged 0.5–13.0 years on long-term enteral nutritional support (ENS) participated in a three-week multidisciplinary weaning treatment. Data were collected at baseline, after completing the program, and at six and 12 months. Height/length, weight and BMI z-scores were determined according to the WHO growth standards. Energy and protein intake were assessed and presented as % of recommended daily allowance (RDA) values. Results Study participants (n = 58) were 64% male. Four children did not complete the three-week program due to acute illnesses. Complete weaning (from 100% ENS to 100% oral) was achieved in 22 children and partial weaning (at least 80% reduction of ENS) in 23 children. No demographic or clinical success predictors were identified. Thirty of the 45 weaned children completed the 12-month follow-up. A significant reduction in energy intake was observed at the three-week time-point [mean (SE): 56 (5.8)% versus 80 (4.7)%, p = 0.001]. This was followed by improvements in eating skills leading to energy intake at 12 months which did not significantly differ from baseline (p = 0.392). Mean (SE) baseline protein intake was 187 (13.0) %RDA. No significant difference from baseline were noted at 12 months (p = 0.301). Estimated mean (SD) height-, weight- and BMI z-scores at baseline were −2.11(0.28), −1.48(0.25), −0.13(0.31), respectively. No significant differences in growth data were observed over time. Conclusions Short-term reductions in nutritional intake and body weight observed after an intensive weaning program were reversible, and growth patterns were stable over 12 months. Further follow-up is recommended to ensure continued positive development in these children.

Physiological changes that occur after spinal cord injury (SCI) are profound and affect almost every organ system in the human body. Energy balance is significantly altered due to motor paralysis, spasticity or flaccidity, neurogenic sarcopenia, neurogenic osteopenia, sympathetic nervous system disruption, and blunted anabolism. Energy expenditure is markedly reduced, whereas hypothalamic control of appetite and satiety is diminished, resulting in discordant energy intake. Ultimately, neurogenic obesity ensues as the result of a positive energy balance. Even though nutritional guidelines for persons with SCI have been available since 2009, the necessity for body composition assessment and total daily energy expenditure was insufficiently addressed such that most individuals with SCI continued in positive energy balance despite “adherence” to the guidelines. Macronutrients must be carefully assessed to optimize caloric intake, while micronutrient consumption may need to be supplemented in order to meet recommended daily allowances. Such a diet would emphasize foods with low caloric yet high nutrient density. This article reviews current literature regarding nutritional requirements for SCI and provides a straightforward plan for implementing more rigorous dietary interventions meant to address the obesity crisis in this especially vulnerable population.

Over the last few decades, there have been significant dietary and lifestyle changes worldwide. In Morocco, these changes have led to serious nutritional disorders and increased risk of morbidity and mortality particularly among vulnerable groups such as women of childbearing age. We aimed to assess the average daily energy and macronutrient intakes and to investigate their association with socioeconomic factors and weight status among women aged 19–49 years in urban areas. A total of 542 women attending public health centers were recruited. Socioeconomic and demographic data were collected using a questionnaire. Anthropometric measurements were taken using standardized equipment. Food consumption data were obtained through the 24-hour dietary recall method, and the macronutrient composition of foods was estimated based on the Moroccan food composition table and the Nutrilog software. The average daily energy intake among the study population was 1591 kcal, composed of 56% from carbohydrates, 28% from fats, and 16% from protein. Reported energy intake by the majority of women (81.5%) was lower than recommended daily allowances for energy. There was a significant positive correlation between educational level and energy (p=0.001), carbohydrates (p=0.001), proteins (p=0.004), and fats intakes (p=0.032), respectively. A significant negative association of household size with protein intakes was also observed (p=0.034). Carbohydrates, proteins, and fats intakes tended to decrease; however, these associations were not statistically significant. Further studies and appropriate interventions are needed to address the trends in energy and macronutrients intakes in the development of policy initiatives aimed at nutrition education and chronic disease prevention among childbearing age women.

BACKGROUND: Only a limited number of studies have examined the vascular and postprandial effects of α-linolenic acid (ALA, C18:3n-3). Therefore, we performed a well-controlled trial focusing specifically on the effects of ALA on vascular function and metabolic risk markers during the fasting and postprandial phase in untreated (pre-)hypertensive individuals.METHODS: In a double-blind randomized, placebo-controlled parallel study, 59 overweight and obese adults (40 men and 19 women, aged 60 ± 8 years) with a high-normal blood pressure or mild (stage I) hypertension consumed daily either 10 g of refined cold-pressed flaxseed oil, providing 4.7 g ALA (n = 29), or 10 g of high-oleic sunflower (control) oil (n = 30) for 12 weeks.RESULTS: As compared with the high-oleic oil control, intake of flaxseed oil did not change brachial artery flow-mediated vasodilation, carotid-to-femoral pulse wave velocity, retinal microvascular calibers and plasma markers of microvascular endothelial function during the fasting and postprandial phase. Fasting plasma concentrations of free fatty acid (FFA) and TNF-α decreased by 58 μmol/L (P = 0.02) and 0.14 pg/mL (P = 0.03), respectively. No differences were found in other fasting markers of lipid and glucose metabolism, and low-grade systemic inflammation. In addition, dietary ALA did not affect postprandial changes in glucose, insulin, triacylglycerol, FFA and plasma inflammatory markers after meal intake.CONCLUSION: A high intake of ALA, about 3-5 times the recommended daily intake, for 12 weeks decreased fasting FFA and TNF-α plasma concentrations. No effects were found on other metabolic risk markers and vascular function during the fasting and postprandial phase in untreated high-normal and stage I hypertensive individuals.

Objective High calorie foods and beverages, which often contain caffeine, contribute to child overweight/obesity. We evaluated the results of an educational intervention to promote healthy growth in very young children. Secondarily, we used detailed diet data to explore the association of nutrient intake with the early development of overweight and obesity. Methods Mothers were obese Latina women, enrolled prenatally, and their infants. Specially trained community health workers provided breastfeeding support and nutrition education during 10 home visits, birth to 24 months. At follow-up, age 18 to 36 months, we measured growth and completed detailed diet recalls (1–7 recall days/child). Results Of 174 infants randomized, 106 children were followed for 24 to 36 months. The educational intervention did not prevent overweight/obesity. Forty-two percent of children became overweight or obese. Fifty-eight percent of children consumed caffeine on at least 1 recall day. Mean intake was 0.48 mg/kg/day. Caffeine correlated with higher consumption of calories, and added sugar and decreased intake of protein, fiber and dairy. Compared with days without caffeine, on days when caffeine was consumed, children ingested 121 more calories and 3.8 gm less protein. Children frequently consumed less than the recommended daily intake of key nutrients such as fiber, vegetables, whole fruit, and vitamins. Conclusions Caffeine was a marker for increased intake of calories and decreased intake of key nutrients. When discussing dietary intake in early childhood, practitioners should screen for nutrient deficiency in young children and recommend limiting the intake of caffeinated foods and beverages.

Purpose The purpose of this paper aims to assess the intake of dietary selenium among Jordanian adults in Madaba Governorate. Design/methodology/approach The authors conducted a cross-sectional study in Madaba Governorate. Convenience sampling was done at Madaba Governorate for this study. The subjects comprised 500 subjects (325 women and 175 men) aged from 18 to 60 years. A 24-h recall (24-HR) and Food Frequency Questionnaire (FFQ) were used to estimate the selenium intake in the studied population. Findings Mean of dietary selenium was more than the recommended amount by at least 2.5-fold in both methods FFQ and 24-HR (p = 0.004), while no significant difference was observed in selenium consumption per day for women and men respectively using FFQ. The results indicated that selenium consumption is higher than the RDA among Madaba population. A moderate correlation was found between both methods for all subjects, women and men, respectively (p < 0.05). Originality/value The authors conclude that the selenium intake in Jordanian population is significantly above the RDA. However, future studies are required to correlate this high intake with health benefits and exclude toxic effects of Selenium.

The DRIs define a range of acceptable dietary intakes for each nutrient. The range is defined from the minimum intake to avoid risk of inadequacy (i.e., the RDA) up to an upper limit (UL) based on a detectable risk of adverse effects. For most nutrients, the minimum RDA is based on alleviating a clear deficiency condition, whereas higher intakes are often recommended to optimize specific health outcomes. Evidence is accumulating that similar logic should be applied to dietary recommendations for protein. Although the RDA for protein of 0.8 g/kg body weight is adequate to avoid obvious inadequacies, multiple studies provide evidence that many adults may benefit from protein quantity, quality, and distribution beyond guidelines currently defined by the RDA. Further, the dietary requirement for protein is a surrogate for the constituent amino acids and, in particular, the 9 considered to be indispensable. Leucine provides an important example of an essential amino acid where the RDA of 42 mg/kg body weight is significantly less than the 100-110 mg/kg required to optimize metabolic regulation and skeletal muscle protein synthesis. This review will highlight the benefits of higher protein diets to optimize health during aging, inactivity, bed rest, or metabolic dysfunction such as type 2 diabetes.

Living in a digital era when most women can enjoy the benefits of easy access to a wealth of online information does not guarantee that mothers-to-bear aware of healthy dietary and nutrition recommendations for pregnancy and the lactation period. Our study aimed to survey the awareness of pregnant women from urban and rural North Eastern Romania in order to identify potential knowledge gaps or misconceptions and suggest solutions to achieve adequate information. A cross-sectional study was conducted among 100 women in the third trimester of pregnancy from both rural and urban parts of NE Romania. A questionnaire was designed to collect data on general socio-demographic characteristics and the women's ability to recognize relevant recommendations for diet and nutrition during pregnancy and lactation. The survey was conducted in 2018 and the data was analysed with SPSS version 16. The mean age of the respondents was 29.8. Overall, they were not entirely aware of the appropriate weight gain during pregnancy, the role of iodine or vitamin D in fetus development, the recommended daily intake of dairy products, or the food sources for iron, folic acid, and fatty acids. Moreover, urban women (51%) seemed better informed overall than those from the countryside (49%) (p

96 Normal 0 false false false EN-US ZH-CN AR-SA Background: Recent studies have suggested the relationship between diet and acne, and zinc plays a role through its anti-inflammatory mechanism. This study aimed to determine the association between zinc intake and serum zinc levels with acne severity. Methods: A comparative cross-sectional study was conducted to assess the difference in zinc intake and serum zinc levels with acne severity based on Indonesian Acne Expert Meeting (IAEM) criteria. Sixty patients with acne in Dr. Cipto Mangunkusumo General Hospital were selected. The effect of zinc intake on acne severity was analyzed via unpaired T test, whereas the effect of serum zinc levels on acne severity was examined with Mann–Whitney test. Data were further evaluated using SPSS 20.0. Results: Zinc intake in all the subjects was below the Indonesian recommended daily allowance, and the mean of zinc intake and serum zinc levels in the mild acne group was higher than that of the moderate–severe acne group. The zinc intake significantly differed between the mild and moderate–severe acne groups (p < 0.01). Likewise, serum zinc levels significantly varied between mild and moderate–severe acne group (p = 0.048). Conclusion: Although this study showed a significant difference between zinc intake and serum zinc levels with the severity of acne vulgaris, further follow-up studies should be performed to assess zinc for acne vulgaris therapy. Keywords: zinc intake, serum zinc level, acne severity

The aim of this study is to evaluate the elemental composition of six food supplements of plant origin, commonly sold in the Portuguese market, by energy dispersive X-ray fluorescence. The presence of arsenic in all the Maca, Ashwagandha, Camu-Camu and Hemp protein samples (except the generic form) is a reason of concern due to the long-term effects of As mainly in its inorganic form. Thus, great caution must be taken on some food supplements, particularly the cases of Moringa from Egypt and Yellow/Xpresso Maca, whose inorganic As concentrations are in line with the upper bound concentration for the 95th dietary exposure according to the European Food Safety Authority which is 0.64 μg/kg bw/day. In what regards Hemp protein, if the supplier’s daily intake recommendation (30 g) is followed, values as high as 1.75 μg/kg bw/day of inorganic As will be consumed, which are dangerously above the upper bound. In this case this specific supplement lot should be removed from the market. Also the consumption of Hemp protein leads to a daily intake of Mn above the Daily Reference Intake (DRI) and Adequate Intakes (AIs) for adults. The contamination of Goji berries by Pb is a reason for concern—organic berries contained 11.3 μg/g while berries derived from conventional agriculture 11.6 μg/g, leading to daily intake doses of 315.3 μg and 324.8 μg, respectively, if the recommended daily intake of 28 g is followed. Our findings point out to an inadequacy of the recommended intakes by the supplier vis a vis the concentrations observed, greatly increasing the risk for public health.

Objective This study aims to look at the relationship between food intake and infectious diseases with the incidence of malnutrition in rural toddlers. Methods The study was conducted using a cross-sectional study design. Daily food intake was collected using the Food Frequency Questionnaire (FFQ) method. Measurement of body weight and body length is done by enumerators who have been trained. Results This study found that there was a significant relationship between food intake and nutritional status of children under five years because p-value Conclusion Food intake among malnutrition children was much lower than the recommended daily allowance. Infectious diseases are found prevalent among malnutrition children.

We analyzed the differences in fat-free mass (FFM) according to serum vitamin D level (VitD) and daily calcium intake (Ca) in 14,444 adults aged over 19 years. We used data from the 4th and 5th Korea National Health and Nutrition Examination Surveys (2008–2011). FFM was measured using dual-energy X-ray absorptiometry. VitD was classified as insufficient or sufficient (cutoff: 20 ng/mL). Ca was classified as unsatisfactory or satisfactory (recommended daily intake: 700 mg). In men, the FFM of group 2 (VitD ≥ 20 ng/mL, Ca &lt, 700 mg), group 3 (VitD &lt, 20 ng/mL, Ca ≥ 700 mg) and group 4 (VitD ≥ 20 ng/mL, Ca ≥ 700 mg) was 0.50 kg (95% confidence interval (CI), 0.084–0.92), 0.78 kg (95% CI, 0.26–1.29) and 1.58 kg (95% CI, 0.95–2.21) higher than that of group 1 (VitD &lt, 700 mg), respectively. In women, a 1 ng/mL increase in VitD was associated with a 0.023 kg increase in FFM (95% CI, 0.003–0.043) and a 1 g increase in Ca was associated with a 0.62 kg increase in FFM (95% CI, 0.067–1.16). High VitD and Ca were associated with a high FFM.

The mammalian lactoperoxidase system, consisting of lactoperoxidase and the H2O2‐producing enzyme duox, is our first line of defence against airborne microbes. This system catalyses the production of hypoiodite and hypoiodous acid in the presence of sufficient iodine. These products are highly efficient at destroying the H1N1 virus and the respiratory syncytial virus (RSV). Japan has not been affected as much as other nations during the COVID‐19 pandemic (death rate about 10% of the United States), and we think this is due to a diet high in iodine. With this in mind, we suggest four actions to prevent SARS‐CoV‐2 infections. First, health professionals should study the preventative effect of increasing iodine in the diets of the aged, institutionalized, diabetics andsmokers. Second, the recommended daily intake (RDI) for iodine should be significantly increased, to at least double, the current RDI. Governments should encourage the use and distribution of cheap iodized salts, kelp and seaweed. Third, more research should be done around the physiology and the protective effects of the lactoperoxidase system. Finally, the degradation products of the SARS‐CoV‐2 viral particle by hypoiodite and hypoiodous acid should be characterized; portions of the damaged particle are likely to elicit stronger immunity and better vaccines.

Background India suffers from a double burden of malnutrition and anaemia. The Karnataka anaemia project indicated that a counselling intervention delivered by community health workers improved anaemia cure rates. Objective To evaluate the effect of maternal counselling on nutritional aspects of anaemia prevention. Methods Secondary analysis of a cluster randomised controlled trial (55 simultaneously randomised villages using random number generator in Chamrajnagar district, Northern India). In the intervention group mothers of anaemic children received five monthly counselling sessions plus usual care (iron and folic acid supplements), while mothers of anaemic children in the control group received usual care alone. Daily intake of nutrients related to anaemia prevention, i.e. iron (mg) and vitamin C (mg), was estimated using the 24-h dietary recall method at baseline and 6 months follow-up. Linear and logistic mixed regression models were used to assess between-groups difference in changes in nutrients intake from baseline to end of follow-up. Data collectors and analysts were blinded to the group assignment. Results Participants were 534 (intervention n = 303; usual treatment n = 231) anaemic children, aged 1 to 5 years and their caregivers, of whom 521(intervention n = 299 from 28 villages; usual treatment n = 222 from 27 villages) were retained at 6 months follow-up and included in the analysis. This study provides inconclusive evidence of improvement in the intake of nutrients that prevent anaemia from baseline to follow-up among the intervention compared to the control group; increase in iron intake was 0.24 mg/day (95% CI -0.67; 1.15) and increase in vitamin C intake was 4.61 mg/day (95% CI -0.69, 9.91). Although encouraging, it is notable that the overall intake of nutrients that prevent anaemia remained well below the national recommended daily allowance. Conclusion This study provides inconclusive evidence of the effect of parental counselling on nutritional aspects of anaemia prevention. The results highlight the need to devise multi-component anaemia-prevention interventions that include facilitators of the availability of nutritious food and should be evaluated in studies that are adequately powered to detect nutritional changes. Trial registration International Standard Randomized Controlled Trial Number ISRCTN68413407, prospectively registered on 17/12/2013.

Raksaworn Jaisaard,1 Tipaporn Kanjanarach,2 Sutin Chanaboon,3 Borey Ban4 1Pharmacy and Health System Graduate Program, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, 40002, Thailand; 2Department of Social and Administrative Pharmacy and Center for Research and Development of Herbal Health Product, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, 40002, Thailand; 3Department of Community Health, Sirindhorn College of Public Health Khon Kaen, Khon Kaen, 40000, Thailand; 4Technical School for Medical Care, University of Health Sciences, Phnom Penh, CambodiaCorrespondence: Tipaporn KanjanarachDepartment of Social and Administrative Pharmacy and Center for Research and Development of Herbal Health Product, Faculty of Pharmaceutical Sciences, Khon Kaen University, 123 Moo 16, Mittraphap Road, Nai Mueang Subdistrict, Mueang District, Khon Kaen, 40002, ThailandTel +66 81 739 2822Fax +66 043 202 379Email otipkan@kku.ac.thBorey BanTechnical School for Medical Care, University of Health Sciences, Phnom Penh, CambodiaTel +855 17 436 496Email boreyban89@gmail.comObjective: A three study research program was conducted to identify high calcium products available in the market (study I), identify high calcium products that were known or consumed by lower secondary school students in the last three months (study II), and identify the amount and sources of calcium that students had consumed in the prior 24 hours, their knowledge about sources of high calcium and how to interpret calcium information on nutrition labels of food packages (study III).Methods: In study I, a cross-sectional market survey was employed. In studies II and III, a school-based cross-sectional survey was employed. The survey population was students enrolled in grades 7– 9 (11– 14 years old) in a medium-sized lower secondary school in semi-urban Khon Kaen, Thailand. A total of 309 students were invited, with 168 and 209 students participating in studies II and III, respectively. Data were collected with self-administered questionnaires.Results: Ninety-three high calcium products were identified. Only 49 were known or consumed by students in the last three months. The median amount of calcium consumed in the previous 24 hours was 410 mg (IQR: 160, 983). Only 31.1% of students (65/209) consumed more than the Thai recommended daily intake (TRDI) of calcium (800mg) in the previous 24 hours. Their main source of calcium was milk. Other high calcium items that were consumed were malt drink, minnow, canned fish, calcium fortified soy milk and Chinese kale. The overall average knowledge score was 6.5± 2.4 out of a maximum of 17. The average knowledge scores for high calcium food sources and for interpreting the calcium information on a sample nutrition label were 4.6+1.8 (out of 12), and 1.9± 1.2 (out of 5), respectively.Discussion: Students should be introduced to high calcium products in their community such as hard tofu, minnow, and small freshwater shrimp. Educational programs on nutrition label interpretation are needed.Keywords: calcium intake, adolescent, calcium-rich food, calcium knowledge, source of calcium, nutrition fact

BACKGROUND The links between nutrition and chronic disease are well established, but consumption of fruits and vegetables is low among young adult childhood cancer survivors (YACS) worldwide. Ensuring equitable access to fresh produce is a significant, persistent public health challenge. OBJECTIVE The purposes of this report are to describe patterns of access to fresh produce, daily intake of fruits/vegetables, and nutrition education preferences among a sample of YACS and to highlight early development of a mentored gardening intervention. METHODS A cross-sectional descriptive study design was used to assess dietary intake, access to fruits/vegetables, and preferences for nutrition education among 124 YACS through a comprehensive cancer survivorship program in a large pediatric cancer center. RESULTS Most participants (71.8%) live more than 10 minutes' walking distance from a supermarket, and 88.7% do not meet the recommended daily intake of 5 or more servings of fruit and vegetables. A total of 91% of participants express that nutrition is important, and 81.5% desire dietary improvement. Most (78.2%) are likely to use either their computer or cell phone for nutrition content. To establish healthy nutrition habits, many seek the support of a nutritionist (63.7%) or another survivor (41.9%). CONCLUSIONS Study findings underscore the need for advocacy to support equitable access to fresh produce and technology-enhanced nutrition education among YACS. IMPLICATIONS FOR PRACTICE To improve access to fresh produce and food literacy among YACS, providers can collaborate with community stakeholders to build capacity for sustainable, technology-enhanced, and mentored gardening interventions at the individual, family, and community level.

Background Dietary intake of antioxidative vitamin C plays a protective role in the prevention of oxidative damage in diabetics, demanding increased requirement of vitamin C. Hyperglycemia results in impaired uptake of vitamin C in the cell. The present study was conducted to compare the plasma ascorbate levels in type 2 diabetic patients and controls consuming adequate dietary vitamin C. Methodology Fifty consented type 2 diabetes mellitus (T2DM) patients who were on treatment with oral hypoglycemic drugs and consuming adequate vitamin C in diet were taken in the study and 50 healthy controls equitably matched for age, gender between 40 and 70 years, and dietary intake of vitamin C were compared. Dietary intake of vitamin C was estimated by a food frequency questionnaire. Subjects consuming more than 35 mg/d of vitamin C were included in the study. Fasting blood sugar was estimated by glucose oxidase and peroxidase method and estimation of ascorbic acid was done by using 2, 4 dinitro phenyl hydrazine method. Result The mean ± standard deviation levels of plasma ascorbate levels in diabetic subjects were 0.22 ± 0.12 mg/dL, which were significantly lower as compared with controls with plasma ascorbate level of 0.47 ± 0.15 mg/dL. In diabetic subjects, insignificant positive correlation was observed between these parameters with r-value 0.168 and p-value 0.245. Conclusion This study concludes that even with the recommended dietary intake of vitamin C low plasma ascorbate levels were found among T2DM patients, which necessitates increased demand and dietary advice to diabetic patients on consuming foods rich in vitamin C more than the recommended daily allowance.

Introduction: For the prevention of symptoms of deficiency and to maintain satisfactory level of the nutrient in the body, consumption of nutrients as par Recommended Daily Allowance (RDA) is very important. Aims and Objectives: To evaluate the level of micro and macro nutrients consumption among the study participants and their comparison with the current RDA recommendation. Materials and Methods: Five hundred and two patients and their attendants visiting the OPD of Diabetes, Obesity & Thyroid Center, Gwalior, Madhya Pradesh for their routine follow ups were studied. Sociodemographic details including age, sex, height and weight were recorded. Dietary recall of two days was taken on a predesigned proforma. Details of the intake of various macronutrients and micronutrients were estimated by Dietcal software. Results: Mean age of study participants was 44.51±12.53 years with male preponderance (51.8%). Females were found to consume less macronutrients (p Conclusion: Present study population had lower amount of protein, higher amount of fats and carbohydrates intake; micronutrients intake was also very low as compared to RDA. Keywords: Recommended daily allowance, Nutritional deficiency, India, macronutrients, Micronutrients.

Ketogenic diet is a high-fat, low-carbohydrate, and adequate-protein diet. It is well-established as a treatment option for drug-resistant childhood epilepsies. Our study aimed to evaluate Selenium levels and oxidative stress in children receiving ketogenic diet for intractable seizures for 6 months. This is a comparative case-control study included 90 children under 6 years age. They were subdivided into three groups. Group I: Thirty patients with drug-resistant epilepsy under antiepileptic drugs only. Group II: Thirty patients with drug-resistant epilepsy under treatment with ketogenic diet for 6 months and antiepileptic drugs. Group III: Thirty age and sex-matched healthy children as controls. Full history taking with special emphasis on severity and frequency of seizures, neurological examination, anthropometric measurements and laboratory analysis for serum Malonaldehyde, and total antioxidant capacity and Selenium were done for all participants. The frequency and severity of seizures were significantly lower in group II receiving ketogenic diet than group I on antiepileptic drugs only. Selenium levels were significantly lower in epileptic patients in comparison to controls. However, it was markedly lower in the ketogenic diet group. Malonaldehyde levels were significantly higher in epileptic children in comparison to controls, with lower values among ketogenic diet group when compared to patients on antiepileptic drugs only. Total antioxidant capacity levels were significantly lower in epileptic patients in comparison to controls, with higher values among ketogenic diet group as compared to epileptic patients on pharmacological treatment. Ketogenic diet is an effective treatment for refractory epilepsy for its anti-epileptic mechanism. It also may exert antioxidant effects. The nutrient content of the ketogenic diet may not meet the recommended daily allowance for selenium. So, this should be taken into consideration for supplementation of minerals in adequate amounts for patients receiving this diet.

Omega 3 fatty acids are long-chain polyunsaturated fatty acids (LC-PUFAs). The basic molecule is the Alpha-linolenic acid (ALA) from which LC-PUFAs are formed: eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). DHA is the predominant fatty acid in the brain especially in synaptic membranes, astrocytes, myelin and organelle membranes. LC-PUFAs lead to increased membrane fluidity and permeability, and most of the positive effects depend on immunomodulatory activities, via mechanisms of gene expression, cell signaling, and membrane organization. Previous studies in animal models have shown that LC-PUFAs are essential for normal dopaminergic, glutamatergic and serotonergic neurotransmission. Preclinical and clinical studies have demonstrated the role of PUFAs as an effective adjuvant therapy for unipolar and bipolar depression. Lack of omega 3 fatty acids plays a role in the onset of anxiety and aggression. Low omega 3 fatty acids in the prefrontal cortex of people with schizophrenia reduce dopaminergic neurotransmission, contributing to negative and neurocognitive symptoms, while subsequent disinhibition in the limbic system causes positive symptoms. Some evidence suggests that LC-PUFA may delay or even prevent the progression of particular psychotic disorders in high-risk children and adolescents. Epidemiological studies have shown a positive correlation between the relatively high intake of DHA and EPA and the lower relative risk of mild cognitive impairment and dementia or their progression. The recommended daily intake of EPA and DHA varies significantly: 300-500 mg/day as recommended by the World Health Organization (WHO), up to 1-2 grams/day in Norway. Daily intakes of EPA and DHA up to 3 grams are generally recognized as safe. EPA and DHA at doses greater than 3 grams per day can have side effects: an increase in bleeding frequency, oxidation of n-3PUFAs with the formation of biologically active oxidation products, and more.

Aging is associated with cognitive declines leading to mild cognitive impairments or Alzheimer disease. Nutrition appear to protect from aging. Some dietary factors could either increase or protect against cognitive declines. This article aimed to provide GRADE recommendations related to nutrition aspects able to prevent or to treat cognitive impairments. A comprehensive literature review was performed using Medline database. The GRADE approach was used to classify quality of the existing evidence (systematic review or meta-analysis).The GRADE process led us to formulate seven key nutritional recommendations to manage cognitive declines, but did not allow us to do it for protein, vitamin B or antioxidants. Thus, 1) adherence to a Mediterranean diet (GRADE 1B); 2) high-level of consumption of mono- or poly- unsaturated fatty acids combined to a low consumption of saturated fatty acids (GRADE 1B); 3) high consumption of fruits and vegetables (GRADE 1B); 4) higher vitamin D intake (GRADE 1C) than the recommended daily allowance. In addition, a ketogenic diet, a low consumption of whole-fat dairy products or a caloric restriction are promising nutritional habits although the evidence does not yet support widespread uptake (GRADE 2C). In conclusion, nutrition is an important modifiable factor to prevent or protect against cognitive decline. Nevertheless, more studies are required to determine specific guidelines such as duration and amounts of nutrients to help older adult to maintain a healthy cognitive life.

Protein is important for growth, maintenance and protection of the body. Both adequacy of protein quantity and protein quality in the diet are important to guarantee obtaining all the essential amino acids. Protein–energy malnutrition is widely present in developing countries such as Nigeria and might result in stunting and wasting. Needs for protein differ depending on age and physiological status and are higher during growth, pregnancy and lactation. The present review assessed protein quantity and quality in diets of Nigerian infants, children, adolescents, and pregnant and lactating women. Literature reviews and calculations were performed to assess adequacy of Nigerian protein intake and to examine the Nigerian diet. The digestible indispensable amino acid score was used to calculate protein quality of nine Nigerian staple foods and of a mixture of foods. The Nigerian population had mostly adequate protein intake when compared with the most recent protein recommendations by the FAO (2013) and WHO/FAO/UNU (2007). An important exception was the protein intake of adolescent girls and pregnant and lactating women. Most of the assessed Nigerian plant-based staple foods were of low protein quality and predominantly lacked the amino acid lysine. The addition of animal-source foods can bridge the protein quality gap created by predominance of plant-based foods in the Nigerian diet. The methodology of this review can be applied to other low- and middle-income countries where diets are often plant-based and lack variety, which might influence protein intake adequacy.

Introduction: Hypertension is a condition which represents one of the main risk factors for the development of cardiovascular diseases. High sodium intake contributes to occurrence of hypertension, increasing the volume of extracellular fluid. Therefore, World Health Organization (WHO) and other associations involved with hypertension research advise to decrease intake of sodium. Effervescent dosage forms usually contain high levels of sodium which could lead to above mentioned health issues. Aim: The aim of this study was to evaluate the levels of sodium in the effervescent dosage forms available in the Serbian drug market. Methods: Data about sodium levels, and excipients was obtained from Summary of Product Characteristics from website of Medicines and Medical Devices Agency of Serbia (ALIMS). Maximum daily doses recommended by the manufacturer and approved by ALIMS were observed. Exposure to sodium through consumption of maximum daily doses was calculated as percentages of the adequate daily intake given by Food and Nutrition Board (Institute of Medicine, National Academies, Washington D.C., USA), and also as percentage of recommended daily intake of sodium given by WHO. Results: There are five formulations with exposure to sodium through consumption of maximum daily doses higher than 100% of the adequate daily intake (2 g), all of which are effervescent tablet formulations. The highest exposure to sodium was found in effervescent tablets containing acetylsalycic acid (500 mg) as active pharmaceutical ingredient: 250.62 % for people aged 51 to 70 years; 271.50 % for people aged 70 and older. Conclusion: In effervescent dosage forms available on Serbian market, level of sodium can be very high, even up to 271.50% of adequate daily intake when maximum daily doses are consumed. Major cause for concern is for vascular patients who use effervescents for chronic therapy. This data should be considered during prescribing and dispensing this category of medicines as well as during analyzing pharmacovigilance.

Background: Geophagy is the consumption of earth materials which occurs across several cultures. For several reasons, pregnant women in many parts of West Africa including Nigeria frequently consume kaolin. This study was carried out to determine the influence of kaolin consumption on serum electrolytes, glucose and amylase levels of pregnant women attending antenatal clinic in a Teaching Hospital in the south east Nigeria. Methods: A total of eighty pregnant women recruited for this study were grouped as follows; Group 1, (30 geophagic pregnant women in the first trimester), Group 2 (30 geophagic pregnant women in the second trimester) and Group 3 (20 non-geophagic pregnant women that served as control). Subjects in Groups 1 and 2 were subdivided into three based on the quantity of kaolin consumed per week: group A (100 g/week), group B (150 g/week) and group C (200 g/week). Preliminary analysis of the calcium content of kaolin was carried out. Serum levels of potassium, sodium, chloride, bicarbonate, glucose and amylase of the subjects were determined. Results: Calcium level in kaolin was below the recommended daily intake in food. The concentrations of potassium in geophagic pregnant women who consumed 150 g and 200 g of kaolin per week were significantly (p st and 2nd trimester groups., There was a significant (p nd trimester pregnant women that consumed 200 g of kaolin per week. The concentrations of chloride and bicarbonate were not significantly (p > 0.05) affected in all the groups. Serum amylase concentration decreased significantly (p st and 2nd trimester pregnant women on 150 g and 200 g of kaolin per week, while the plasma glucose concentration was significantly (p < 0.05) elevated in the same groups. Conclusion: This study concludes that kaolin consumption in pregnant women may predispose to gestational diabetes, electrolytes imbalance and reduced intestinal enzymes activities.

The first positive genome-wide association study on gestational length and preterm delivery showed the involvement of an Se metabolism gene. In the present study, we examine the association between maternal intake of Se and Se status with gestational length and preterm delivery in 72 025 women with singleton live births from the population-based, prospective Norwegian Mother, Father and Child Cohort Study (MoBa). A self-reported, semi-quantitative FFQ answered in pregnancy week 22 was used to estimate Se intake during the first half of pregnancy. Associations were analysed with adjusted linear and Cox regressions. Se status was assessed in whole blood collected in gestational week 17 (n 2637). Median dietary Se intake was 53 (interquartile range (IQR) 44–62) µg/d, supplements provided additionally 50 (IQR 30–75) µg/d for supplement users (n 23 409). Maternal dietary Se intake was significantly associated with prolonged gestational length (β per sd = 0·25, 95 % CI, 0·07, 0·43) and decreased risk of preterm delivery (n 3618, hazard ratio per sd = 0·92, 95 % CI, 0·87, 0·98). Neither Se intake from supplements nor maternal blood Se status was associated with gestational length or preterm delivery. Hence, the present study showed that maternal dietary Se intake but not intake of Se-containing supplements, during the first half of pregnancy was significantly associated with decreased risk of preterm delivery. Further investigations, preferably in the form of a large randomised controlled trial, are needed to elucidate the impact of Se on pregnancy duration.

BACKGROUND: Mothers who feed their children with infant food have increased have over the years leaving a large percentage of children who consume other types of liquid food for supplementation or as alternatives. AIM: Determining the levels of essential trace metals in these formulae with the aim of ascertain their appropriateness is considered important. METHODS: Iron, zinc, manganese, chromium and cobalt in 26 infant formulae purchased from Port Harcourt city, Nigeria were determined by Atomic Absorption Spectrophotometry. The estimated daily intake EDI and percentage of EDI to the recommended daily allowance of these essential trace metals were used in the exposure assessment. RESULTS: The highest mean concentration of Mn, Cr and Co was found in the milk based (0.15 ± 0.09 mg/kg), (0.61 ± 0.70 mg/kg), (0.12 ± 0.32 mg/kg) compared to the cereal based and cereal mix based but the differences was also not significant. The EDI of chromium in the infant formulae exceeded the RDA. CONCLUSION: Infant formulae may add to the chromium body burden of infants in Nigeria.