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Background: Follicular lymphoma (FL) is one of the most common lymphoid malignancies in the western world. FL cases are stratified into three histological grades based on the average centroblast count per high power field (HPF). The centroblast count is performed manually by the pathologist using an optical microscope and hematoxylin and eosin (H&E) stained tissue section. Although this is the current clinical practice, it suffers from high inter- and intra-observer variability and is vulnerable to sampling bias., Methods: In this paper, we present a system, called Follicular Lymphoma Grading System (FLAGS), to assist the pathologist in grading FL cases. We also assess the effect of FLAGS on accuracy of expert and inexperienced readers. FLAGS automatically identifies possible HPFs for examination by analyzing H&E and CD20 stains, before classifying them into low or high risk categories. The pathologist is first asked to review the slides according to the current routine clinical practice, before being presented with FLAGS classification via color-coded map. The accuracy of the readers with and without FLAGS assistance is measured., Results: FLAGS was used by four experts (board-certified hematopathologists) and seven pathology residents on 20 FL slides. Access to FLAGS improved overall reader accuracy with the biggest improvement seen among residents. An average AUC value of 0.75 was observed which generally indicates "acceptable" diagnostic performance., Conclusions: The results of this study show that FLAGS can be useful in increasing the pathologists' accuracy in grading the tissue. To the best of our knowledge, this study measure, for the first time, the effect of computerized image analysis on pathologists' grading of follicular lymphoma. When fully developed, such systems have the potential to reduce sampling bias by examining an increased proportion of HPFs within follicle regions, as well as to reduce inter- and intra-reader variability.

Tumors tissues house a diverse array of cell types, requiring powerful cell-based analysis methods to characterize cellular heterogeneity and identify rare cells. Tumor tissue is dissociated into single cells by treatment with proteolytic enzymes, followed by mechanical disruption using vortexing or pipetting. These procedures can be incomplete and require significant time, and the latter mechanical treatments are poorly defined and controlled. Here, we present a novel microfluidic device to improve mechanical dissociation of digested tissue and cell aggregates into single cells. The device design includes a network of branching channels that range in size from millimeters down to hundreds of microns. The channels also contain flow constrictions that generate well-defined regions of high shear force, which we refer to as "hydrodynamic micro-scalpels", to progressively disaggregate tissue fragments and clusters into single cells. We show using in vitro cancer cell models that the microfluidic device significantly enhances cell recovery in comparison to mechanical disruption by pipetting and vortexing after digestion with trypsin or incubation with EDTA. Notably, the device enabled superior results to be obtained after shorter proteolytic digestion times, resulting in fully viable cells in less than ten minutes. The device could also be operated under enzyme-free conditions that could better maintain expression of certain surface markers. The microfluidic format is advantageous because it enables application of well-defined mechanical forces and rapid processing times. Furthermore, it may be possible to directly integrate downstream processing and detection operations to create integrated cell-based analysis platforms. The enhanced capabilities enabled by our novel device may help promote applications of single cell detection and purification techniques to tumor tissue specimens, advancing the current understanding of cancer biology and enabling molecular diagnostics in clinical settings.

To date, no study has evaluated the short- and long-term effects air pollution exposure on emphysematous subjects who have undergone lung volume reduction surgery (LVRS). Data from the National Emphysema Treatment Trial study (1998-2003) included 1,218 subjects, aged 39 to 84. Daily values of ambient fine particulate matter (aerodynamic diameter < 2.5 μm; PM2.5) and ozone were obtained. Mixed-effects models tested the association between short- and long-term pollutant concentrations and changes in pulmonary function. Cumulative air pollution exposure was strongly associated with worsened respiratory function and symptoms. Mean PM2.5 was associated with poorer lung function. Lagged exposures were poorly associated with respiratory health outcomes. There were detrimental respiratory and pulmonary effects observed in response to even low levels of ambient air pollutants among study participants. These results are indicative that exposures even below those of air quality standards may still pose significant risks to severe chronic obstructive pulmonary disease (COPD) subjects.

Background: Low-fat and low-carbohydrate weight-loss diets can have a beneficial effect on longitudinal measures of blood pressure and blood lipids. We aimed to assess longitudinal changes in blood pressure and blood lipids in a population of premenopausal women. We hypothesized that results may differ by level of adherence to the respective diet protocol and baseline presence of hypertension or hyperlipidemia., Methods: Overweight or obese premenopausal women were randomized to a low-fat (n=41) or low-carbohydrate (n=38) diet. As part of the 52-week Lifestyle Eating and Fitness (LEAF) intervention trial, we fit linear mixed models to determine whether a change in outcome differed by treatment arm., Results: Within-group trends in blood pressure and blood lipids did not differ (p>0.30). Across study arms, there was a significant decrease in systolic blood pressure (SBP, 3 mm Hg, p=0.01) over time, but diastolic blood pressure (DBP) did not change significantly over the course of the study. Blood lipids (total cholesterol [TC], low-density lipoproteins [LDL], and high-density lipoproteins [HDL]) all exhibited nonlinear trends over time (p<0.01); each decreased initially but returned to levels comparable to baseline by study conclusion (p>0.20). We observed a decline in SBP among women who were hypertensive at baseline (p<0.01), but hypercholesterolemia at baseline did not affect trends in blood lipids (p>0.40)., Conclusions: Our results support that dietary interventions may be efficacious for lowering blood pressure and blood lipids among overweight or obese premenopausal women. However, a decrease in SBP was the only favorable change that was sustained in this study population. These changes can be maintained over the course of a 1-year intervention, yet changes in blood lipids may be less sustainable.

Purpose: Associations have been found between trusting patient-physician relationships and use of preventive care and a greater adherence to prescribed care. The objectives of this study were to assess the level of trust rural Medicaid smokers have in their physicians and whether trust was related to patient characteristics or physician behavior., Methods: This was a cross-sectional study of smokers who were enrolled in a tobacco-dependence treatment program. Participants were rural Medicaid-enrolled adults, age 18 and older, who were current smokers. Participants were enrolled from 8 primary care clinics as they came in for an appointment with their physician. The Trust in Physician Scale was completed at the baseline visit. One week later, an interview was conducted with the smoker to determine whether the physician provided tobacco-dependence treatment counseling at the visit. Mixed models were used to model the relationship between trust and participant characteristics and physician behaviors., Findings: Medicaid smokers in this study exhibited a high level of trust in their health care provider, as levels were similar to those reported in the general population of patients. Trust was significantly higher among individuals with better self-reported health., Conclusions: Rural Medicaid smokers appeared to have similar levels of trust in their physician as other patients. Future research should explore the role trust plays in shaping interactions between underserved populations and physicians within the context of smoking cessation counseling., (© 2013 National Rural Health Association.)

Context: Pathologists grade follicular lymphoma (FL) cases by selecting 10, random high power fields (HPFs), counting the number of centroblasts (CBs) in these HPFs under the microscope and then calculating the average CB count for the whole slide. Previous studies have demonstrated that there is high inter-reader variability among pathologists using this methodology in grading., Aims: The objective of this study was to explore if newly available digital reading technologies can reduce inter-reader variability., Settings and Design: IN THIS STUDY, WE CONSIDERED THREE DIFFERENT READING CONDITIONS (RCS) IN GRADING FL: (1) Conventional (glass-slide based) to establish the baseline, (2) digital whole slide viewing, (3) digital whole slide viewing with selected HPFs. Six board-certified pathologists from five different institutions read 17 FL slides in these three different RCs., Results: Although there was relative poor consensus in conventional reading, with lack of consensus in 41.2% of cases, which was similar to previously reported studies; we found that digital reading with pre-selected fields improved the inter-reader agreement, with only 5.9% lacking consensus among pathologists., Conclusions: Digital whole slide RC resulted in the worst concordance among pathologists while digital whole slide reading selected HPFs improved the concordance. Further studies are underway to determine if this performance can be sustained with a larger dataset and our automated HPF and CB detection algorithms can be employed to further improve the concordance.

Background: The receptor kinase inhibitor toceranib phosphate (Palladia) was approved for use in dogs in 2009 using a dose of 3.25 mg/kg administered every other day. Preliminary data suggests that lower doses of toeceranib may be associated with a reduced adverse event profile while maintaining sufficient drug exposure to provide biologic activity. The purpose of this study was to determine the Cmax of toceranib in dogs with solid tumors receiving 2.5-2.75 mg/kg every other day and to document the adverse events associated with this dose rate. Secondary objectives included determination of plasma VEGF concentrations in treated dogs and response to therapy., Results: Dogs with solid tumors were administered toceranib at an intended target dose ranging from 2.5-2.75 mg/kg every other day and plasma samples were obtained for analysis of toceranib and VEGF plasma concentrations on days 0, 7, 14 and 30 of the study at 6 and 8 hours post drug administration. Additionally, plasma samples were obtained at 0, 1, 2, 6, 8, and 12 hours from dogs on day 30 for confirmation of Cmax. Response to therapy was assessed using standard RECIST criteria and adverse events were characterized using the VCOG-CTCAE. Toceranib administered at doses between 2.4-2.9 mg/kg every other day resulted in an average 6-8 hr plasma concentration ranging from 100-120 ng/ml, well above the 40 ng/ml concentration associated with target inhibition. Plasma VEGF concentrations increased significantly over the 30 day treatment period indicating that VEGFR2 inhibition was likely achieved in the majority of dogs. The lower doses of toceranib used in this study were associated with a substantially reduced adverse event profile compared to the established label dose of 3.25 mg/kg EOD., Conclusions: Doses of toceranib ranging from 2.4-2.9 mg/kg every other day provide drug exposure considered sufficient for target inhibition while resulting in an adverse event profile substantially reduced from that associated with the label dose of toceranib. This lower dose range of toceranib should be considered for future use in dogs with cancer.

Background: Methicillin-resistant Staphylococcus spp (MRS), such as methicillin-resistant Staphylococcus aureus (MRSA), is a nosocomial pathogen of significant concern. This study evaluates the prevalence and determinants of airborne MRS and methicillin-susceptible Staphylococcus spp (MSS) in a veterinary teaching hospital during periods of no known active clinical cases of Staphylococci infections., Methods: Airborne MRS and MRSA were sampled from 10 areas on 3 days each over 3 consecutive months in a veterinary teaching hospital. Each location was sampled twice each day (daytime and evening). Hospital clinical personnel were surveyed for activity levels across the areas sampled., Results: Airborne MSS was detected in 52% (25/48) of samples and mecA-confirmed airborne MRS in 12.5% (6/48) of samples. Among daytime air samples, Staphylococcus spp varied by functional area (P < .001), and airborne MRS varied by human activity level (P = .011) with the hallway posing the greatest risk for both., Conclusion: Our results indicate that (1) Staphylococcus spp is present in air in clinical environments during periods of no known clinical Staphylococci cases and (2) levels of airborne Staphylococcus spp are associated with functional space and human activity level. Applying these findings to MRSA surveillance creates opportunities for improving the accuracy and precision of exposure classification and risk mitigation., (Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.)

Background: Docosahexaenoic acid (DHA) is a long-chain polyunsaturated fatty acid important for neonatal neurodevelopment and immune homeostasis. Preterm infants fed donor milk from a Midwestern source receive only 20% of the intrauterine accretion of DHA. We tested the hypothesis that DHA supplementation of donor mothers would provide preterm infants with DHA intake equivalent to fetal accretion., Subjects and Methods: After Institutional Review Board approval and informed consent, human milk donors to the Mother's Milk Bank of Ohio were randomized to receive 1 g of DHA (Martek(®) [now DSM Nutritional Lipids, Columbia, MD]) or placebo soy oil. Dietary intake data were collected and analyzed by a registered dietitian. Fatty acids were measured by gas chromatography/flame ionization detection. Statistical analysis used linear mixed models., Results: Twenty-one mothers were randomly assigned to either the DHA group (n=10) or the placebo group (n=11). Donor age was a median of 31 years in both groups with a mean lactational stage of 19 weeks. Dietary intake of DHA at baseline in both groups was a median of 23 mg/day (range, 0-194 mg), significantly (p<0.0001) less than the minimum recommended intake of 200 mg/day. The DHA content of milk increased in the DHA-supplemented group (p<0.05)., Conclusions: The women enrolled in this study had low dietary DHA intake. Supplementation with preformed DHA at 1 g/day resulted in increased DHA concentrations in the donor milk with no adverse outcomes. Infants fed donor milk from supplemented women receive dietary DHA levels that closely mimic normal intrauterine accretion during the third trimester.

Previous work [1] on the HPLC analysis of artemisinin tentatively identified the two impurities present above trace levels. This identification was based on LC-MS results and NMR of impurities isolated from artemisinin. In this work the impurities have been synthesized allowing verification of their identity by LC-MS. It is found that the previously suggested elution order is incorrect. A determination of relative response factors strongly impacts suggested limits on impurity levels and explains the erroneous peak assignment. The fates of the identified impurities are explored in the transformation of artemisinin to its derivative active pharmaceutical ingredients. A survey of a wide variety of artemisinin samples isolated from different geographical regions, different growing seasons, different plant backgrounds and using different extraction and purification approaches showed that artemisinin has sufficient purity for its intended use as a raw material for anti-malarial drug products., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Gene expression microarray experiments with few replications lead to great variability in estimates of gene variances. Several Bayesian methods have been developed to reduce this variability and to increase power. Thus far, moderated t methods assumed a constant coefficient of variation (CV) for the gene variances. We provide evidence against this assumption, and extend the method by allowing the CV to vary with gene expression. Our CV varying method, which we refer to as the fully moderated t-statistic, was compared to three other methods (ordinary t, and two moderated t predecessors). A simulation study and a familiar spike-in data set were used to assess the performance of the testing methods. The results showed that our CV varying method had higher power than the other three methods, identified a greater number of true positives in spike-in data, fit simulated data under varying assumptions very well, and in a real data set better identified higher expressing genes that were consistent with functional pathways associated with the experiments.

DHA is a long-chain fatty acid that has potent antiinflammatory properties. Whereas maternal DHA dietary supplementation has been shown to improve cognitive development in infants fed DHA-supplemented milk, the antiinflammatory effects of maternal DHA supplementation on the developing fetus and neonate have not been extensively explored. Pregnant C3H/HeN dams were fed purified control or DHA-supplemented diets (~0.25% of total fat) at embryonic d 16 and consumed these diets throughout the study. At birth, the nursing mouse pups were placed in room air (RA; 21% O(2)) or >95% O(2) (hyperoxia) for up to 7 d. These studies tested the hypothesis that maternal DHA supplementation would decrease inflammation and improve alveolarization in the lungs of newborn mouse pups exposed to hyperoxia. Survival, inflammatory responses, and lung growth were compared among control diet/RA, DHA/RA, control/O(2), and DHA/O(2) pups. There were fewer neutrophils and macrophages in lung tissues from pups nursed by DHA-supplemented dams than in those nursed by dams fed the control diet at 7 d of hyperoxia exposure (P < 0.015). Although differences due to hyperoxia exposure were observed, maternal diet did not affect keratinocyte-derived chemokine, macrophage inflammatory protein-2, IL-1β, or TNFα mRNA levels in pup tissues. Hyperoxia also induced NF-κB activity, but maternal diet did not affect NF-κB or PPARγ activities. In mice, DHA supplementation decreases leukocyte infiltration in the offspring exposed to hyperoxia, suggesting a potential role for DHA supplementation as a therapy to reduce inflammation in preterm infants.

This study seeks to investigate changes in iron homeostasis and carotid arteries in women at risk of atherosclerosis, addressing a relatively unexplored hypothesis explaining why women have a 5-10 year lag in initial atherosclerotic events. Recent evidence points to hepcidin, the key regulator of macrophage iron uptake and release, as a potential mediator of risk. Furthermore, iron catalyzes the generation of free radicals that oxidize cholesterol stimulating atheroma formation. Magnetic resonance imaging (MRI) is ideally suited to study iron because of iron's local effects on magnetic susceptibility that can be quantified using a relaxation parameter called T2* ('T2-star'), as well as the ability to noninvasively characterize and quantify atherosclerotic plaque with MRI. This work outlines the rationale and study design to provide critical evidence related to the iron hypothesis, such that novel diagnostics and therapeutics to attenuate risk may be derived from a better understanding of iron's role in atherosclerosis.

Objective: To distinguish centroblast cells from non-centroblast cells using a novel automated method in follicular lymphoma cases and measure its performance on cases obtained by a consensus of six pathologists., Study Design: Geometric and color texture features were used in the training and testing of the supervised quadratic discriminant analysis classifier. The technique was trained and tested on a data set composed of 218 centroblast images and 218 non-centroblast images. Computer performance was tested by measuring sensitivity and specificity among cells classified as centroblast and non-centroblast by consensus of six board-certified hematopathologists., Results: Automated classification distinguished centroblast from non-centroblast cells with a classification accuracy of 82.56% and sensitivity and specificity of 86.67% and 86.96%, respectively, when the approach was tested., Conclusion: The novelty of our approach is the identification of the centroblast cells with prior information and the introduction of the principal component analysis in the spectral domain to extract texture color features.

Objectives: We sought to quantitatively examine the pattern of, and socioeconomic factors associated with, adoption of clean indoor air ordinances in Appalachia., Methods: We collected and reviewed clean indoor air ordinances in Appalachian communities in 6 states and rated the ordinances for completeness of coverage in workplaces, restaurants, and bars. Additionally, we computed a strength score to measure coverage in 7 locations. We fit mixed-effects models to determine whether the presence of a comprehensive ordinance and the ordinance strength were related to community socioeconomic disadvantage., Results: Of the 332 communities included in the analysis, fewer than 20% had adopted a comprehensive workplace, restaurant, or bar ordinance. Most ordinances were weak, achieving on average only 43% of the total possible points. Communities with a higher unemployment rate were less likely and those with a higher education level were more likely to have a strong ordinance., Conclusions: The majority of residents in these communities are not protected from secondhand smoke. Efforts to pass strong statewide clean indoor air laws should take priority over local initiatives in these states.

We review design and analytic methods available for multilevel interventions in cancer research with particular attention to study design, sample size requirements, and potential to provide statistical evidence for causal inference. The most appropriate methods will depend on the stage of development of the research and whether randomization is possible. Early on, fractional factorial designs may be used to screen intervention components, particularly when randomization of individuals is possible. Quasi-experimental designs, including time-series and multiple baseline designs, can be useful once the intervention is designed because they require few sites and can provide the preliminary evidence to plan efficacy studies. In efficacy and effectiveness studies, group-randomized trials are preferred when randomization is possible and regression discontinuity designs are preferred otherwise if assignment based on a quantitative score is possible. Quasi-experimental designs may be used, especially when combined with recent developments in analytic methods to reduce bias in effect estimates.

In this paper we develop a fully automated method for the segmentation of the femur in axial MR images and its use in the analysis of imaging biomarkers for osteoarthritis (OA). The proposed method is based on anatomical constraints implemented using morphological operations to extract the femur medulla and a level set evolution to extract the femur cortex. The average agreement of the automated segmentation algorithm with ground truth manual segmentations was 0.94 +/- 0.03 calculated using the Zijdenbos similarity index (ZSI). A pooled variance t-test analysis found significant associations between the KL grade, a clinical measure of OA severity, and both the cross-sectional area (CSA) of the femur medulla (p = 0.02) and the ratio of the femur medulla CSA to the femur cortex CSA (p = 0.04) for women. No significant association between femur measurements and KL grade was found for men.

In this paper we explore a method of segmentation of muscle interstitial adipose tissue (IAT) in MR images of the thigh. The objective is to apply the method towards research into biomarkers of osteoarthritis (OA). T1-weighted images of the thigh are intensity standardized through bias field correction and intensity normalization. IAT within the thigh muscles is then segmented using a threshold combined with morphological constraints applied on connected regions in the thresholded image. The morphological constraints can be adjusted to allow for highly sensitive or highly specific IAT segmentation. The use of the morphological constraints improved the specificity of IAT segmentation over a threshold segmentation method from 0.54 to 0.67, while retaining a nearly equivalent sensitivity of 0.82 compared to 0.84. We then present a preliminary statistical analysis to demonstrate the application of the automated IAT segmentation. Finally, we specify a protocol for further exploration of IAT by leveraging the massive imaging dataset of the Osteoarthritis Initiative (OAI).

A cross-sectional survey of an age-stratified random sample of 619 independently-living adults (307 males, 312 females) aged 60 years and over, living in Toronto was conducted. Detailed dietary data was collected from three sets of 3-day food records. The mean energy and nutrient intakes appeared to be adequate. However the energy intake of many participants was low, while their fat intake was high. The nutrients of concern for inadequate intakes were calcium, vitamin D and vitamin A. Intakes of zinc, vitamin C and protein were low for a smaller group. Nutrition education is recommended to provide guidance for choosing healthy diets.

The contribution of the various food groups to the nutrient intakes of a group of independently-living elderly individuals in Toronto is described. The pattern of meal and food intakes generally provided enough of the nutrients, excepting calcium, to meet the Recommended Nutrient Intakes for Canadians. Mean energy intake was low. It is suggested that if relatively small amounts of the foods ingested at the different meals are raised, it will likely provide enough energy and all the nutrients to satisfy the recommended levels of intake.

Fourteen experiments were concluded on the effect of protein and carbohydrate sources in the assay diets on the relative biological values (RBV) of food grade sodium iron pyrophosphate (NaFePP) and ferric orthophosphate (FePO4) vs. ferrous sulfate (FeSO4) for rats and chicks, using the response in blood hemoglobin to graded levels of supplemental iron as the assay criterion. Two trials were made with volunteers to estimate the RBV of NaFePP and FePO4 for humans, based on the increase in plasma iron 2 hours after ingestion of 100 mg of iron of a test dose following an overnight fast. The RBV of iron from NaFePP and FePO4 for rats were consistently lower when the basal diet contained nonfat dried milk (9 to 16 and 28, respectively, vs. FeSO4=100) than when casein was used (25 to 28 and 49, respectively). The addition of 22% beta-lactose, replacing sucrose in a diet containing casein fed to rats, significantly reduced the RBV of iron from NaFePP from 25 to 15; the addition of 22% alpha-lactose or 40% glucose in place of sucrose had no effect on the RBV of this iron source. The RBV of iron from NaFePP and FePO4 for chicks were 4 to 6 and 4, respectively, with the source of dietary protein having no effect. Very low RBV of iron from NaFePP and FePO4 (4.3 and 5.9, respectively, vs. FeSO4=100) were also obtained with human subjects.

The daily sodium content in the diets of infants was determined. Milk and milk products were the main contributor of sodium during early infancy. Commercial baby foods contributed little sodium. As table foods were introduced, the daily sodium intake of the infants rose dramatically. The main sources of sodium in table foods were salt-containing canned foods and added table salt.

In recent years, bottle feeding and the early introduction of solid foods in infants' diets have been proposed as factors contributing to overweight in infancy that might continue into childhood. These hypotheses were examined in a longitudinal survey of 403 infants from birth to 18 months of age. Results from this survey do not support either (a) a relationship between type of milk feeding or time of introduction of solid food and fatness at 6 months of age or (b) the hypothesis that fat infants remain fat.

A sample of reduced iron was separated by air elutriation into several fractions based on particle size; and the relative biological values (RBVs) of 3 fractions containing fine, medium, and coarse particles were determined with rats and chicks, using diets containing either skim milk powder or casein as the major source of protein. The RBV of reduced iron for rats was shown to be dependent on particle size by curative and prophylactic assay procedures, with the source of protein having no marked effect. In contrast to rats, chicks utilized reduced iron to a higher degree, especially the iron from coarse particles. Prophylactic assays with rats indicated that a 3-4 week feeding period from weaning at 21 days of age gave RBVs which were not significantly different from those obtained by repletion of hemoglobin of anemic animals. After 5 weeks on the test diets, however, the rats lost their ability to distinguish between coarse and medium particles of reduced iron when fed with a diet containing casein as the source of protein.

Between 1977 and 1979, the H.J. Heinz Company of Canada Ltd conducted a longitudinal survey of infant nutrition from birth to 18 months. In 1980, 189 of the original 403 infants were recruited in a follow-up study. The age of the children in the follow-up study was 3.5 to 4 years. This article describes the food and nutrient intakes of the preschool children. Food intake information was obtained by the 4-day dietary record method. The mean energy intake of the children was adequate to support normal growth. The mean nutrient intakes were above the recommended daily intakes of the Canadian Dietary Standard. All children ate three regular meals and at least one in-between meal snack. Milk was the primary source of energy, protein, fat, calcium, phosphorus, sodium, potassium, and riboflavin. Meat contributed a substantial amount of protein, fat, and niacin. Cereal and cereal products were the primary source of iron and were good sources of carbohydrates, sodium, and the B vitamins. Fruit and fruit juices were the primary sources of carbohydrate and vitamin C. Vitamin supplements provided large amounts of vitamin A and the B vitamins. Since foods alone included sufficient nutrients to provide the recommended daily nutrient intakes, vitamin supplements were largely unnecessary.

Since 1976 many baby foods have been reformulated and the iron used to fortify infant cereals has been changed to a more bioavailable form. Therefore, the dietary intake of iron by infants from 1 to 18 months of age was assessed in a longitudinal survey conducted in Toronto and Montreal between 1977 and 1979. Except in the 1st and 18th months the mean daily iron consumption of the infants was above that recommended in the Dietary Standard for Canada. The main source of this nutrient was infant cereals. Examination of the diets of the infants who did not have the recommended daily intake of iron showed that they did not consume sufficient amounts of infant cereals and other iron-rich foods. These results indicate that without such cereals it is difficult to provide infants with the amount of iron they need. Therefore, infants should receive these cereals during the first 2 years of life.