bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of food industry reformulation, innovation and consumer preference on dietary intakes in Ireland: a probabilistic intake model
Authors: Cushen Maeve , Rogers Noel , Barron Rebecca , Wonik Jasmin , Stanek Beata , Pigat Sandrine , Doherty Dermot , Sturat-Trainor Linda , McNamara Cronan
Published: June 2020

Strong evidence exists linking poor diet to increased risk of overweight, obesity and non-communicable diseases. Reformulation initiatives, whereby the food industry gradually reduces energy, sodium, sugar, fat and saturated fat content of their products, are identified as important strategies to improve dietary intakes. The analysis aimed to examine the impact of voluntary reformulation, changes to products on the market and changes in consumer preferences on dietary intakes in Ireland from 2005 to 2017. Data on composition and volume sales (kg/ year) of products available on the market in 2005 and 2017 were collected from 15 Food Drink Ireland (FDI) member companies via online templates. These products were assigned to appropriate food and beverage groups identified in four Irish University Nutrition Alliance (IUNA) surveys of preschool children (1–4 years), children (5–12 years), teenagers (13–17 years) and adults (18–90 years). Assignment of FDI products to IUNA foods and beverages was carried out using weighted distributions for a given group of foods. The weightings were taken from the sales volumes of similar products relative to one another in a given category in a given year. Monte Carlo simulations were used to run the IUNA survey consumption data with both sets of weighted composition data from 2005 and 2017. The Creme Global intake model was used to estimate daily energy and nutrient intakes for all four populations during 2005 and 2017. The Wilcoxon-signed rank test was used to test for differences between the two years. Changes in both the products available on the market and market share of these products were observed from 2005 to 2017. The nutrient with the greatest intake reduction between the two years for all ages was sugar. Children and teens were the most affected, where total sugar intakes reduced by 3.2g/d and 2.7g/d, respectively. This reduction was primarily driven by the beverage category. There were modest saturated fat intake reductions observed for teens and adults (0.2g/d and 0.5g/d, respectively). Energy, total fat and sodium intakes for all ages remained relatively stable between the two years. This analysis highlights the impact of not only food industry efforts but also consumer choices on nutrient intakes in Ireland. It is worth noting that the data collected predates the sugar tax on sugar-sweetened beverages in Ireland. Reductions in sugar intakes were not compensated by total fat or energy increases.
Investigating the impact of the HSE Healthier Vending Policy on unit sales of snack items
Authors: McVey Marco , Stanley Isobel , Lawless Agatha , O'Brien Sarah , Murrin Celine
Published: June 2020

Vending machines provide quick and easy access to snacks and, in general, provide few healthy options to consumers. Given this high availability of unhealthy foods in vending machines, consumers are likely to purchase and consume a less healthy option. The aim of this study was to investigate the impact of a Healthier Vending policy in all Health Service Executive (HSE) premises across the Republic of Ireland on unit sales of vending machine snacks. Under the policy, the contents of vending machines were altered so that healthier, Better Choice (BC), snacks would constitute a majority of the vending machine stock (minimum 60%) in comparison to the less healthy, Other Choice (OC), snacks. Snacks were defined as BC if they contained: ≤ 150kcals/packet, ≤ 20g/100 g total fat, ≤ 5g/100 g saturated fat, ≤ 15g/100 g sugar, and ≤ 1.5g/100 g salt/sodium. Products stocked as OC should be ≤ 250kcals/packet. BC snacks were placed in prime slots and at eye-level in order to prompt the consumer towards buying a BC snack, with OC snacks being placed to incentivise the choice of BC snacks. Consumers were also incentivised to purchase BC snacks through written cues that appear on the vending machines. Sales data was provided by vending companies for 2015 (baseline) and 2016 (year 1). Unit sales of all snack types increased between the two time points, with the exception of dried fruit and nuts. The proportion of OC products purchased relative to total unit sales decreased following the intervention, as did the proportion of gum and mints and dried fruit and nuts sales. While the proportion of BC crisps purchased relative to total unit sales increased post-intervention, an increase in the proportion of OC bars purchased relative to total unit sales was also seen. Sales of both BC and OC dried fruit/nuts relative to total unit sales decreased. Our results indicate that policies aiming to improve the nutrition environment in health care settings, through increasing the availability of healthy products in vending machines and promoting their purchase, could be an effective method of reducing the amount of unhealthy products purchased overall. These policies can alter consumers’ purchasing patterns and prompt consumers towards purchasing a healthier/unhealthier version of the same product, as seen with crisps and bars in this study.
Measuring phenolic compounds in Mankai: a novel polyphenol and amino rich plant protein source
Authors: Diotallevi Camilla , Angeli Andrea , Vrhovsek Urska , Gobbetti Marco , Shai Iris , Lapidot Miri , Tuohy Kieran
Published: June 2020

Mankai is a cultivated strain of Wolffia globose, an aquatic plant, one of the smallest plants on earth, belonging to the family Lemnaceae, known commonly as Duckweeds. Mankai is being considered as a high-quality substitute for animal protein, and a potential source of vitamin B12(1). In fact, it contains all 9 essential amino acids and its protein profile is extremely close to that of egg. Recently, it has been granted GRAS status, and chosen as a test food in a long-term intervention DIRECT-PLUS (ClinicalTrials.gov identifier (NCT number): NCT03020186) which aims to compare the effect of green-Mediterranean diet (composed with polyphenol enriched food including Mankai) + physical activity (PA) vs. Mediterranen diet + PA vs in 300 volunteers suffering from cardiometabolic disease. Mankai is also rich in iron and has been shown in humans to maintain Iron-Homeostasis and to reverse Anemia in Rats(2). However, molecular characterization of phenolic composition of Mankai plant has not previously been reported. Our initial measurements of total phenolic content determined by Folin-Ciocalteu assay classifies Mankai amongst the foods highest in polyphenols content (8606.7 mg/kg)(3). This poster presents the characterization of Mankai polyphenols according to Vrhovsek et al. 2012 [4] using UHPLC-ESI-MS/MS system, identifying 26 different polyphenols. One of the main advantages of Mankai is its hydroponic cultivation that optimizes yield throughout the year. Light source, water and mineral management can influence the composition of phenolic content. We quantified Mankai polyphenols in 30 different plant batches and 52 different treatments to assess how quality of light may play a major role in the accumulation of secondary plant compounds. Notably, led light seems to enhance the glycated form of luteolin and quercetin compared to sunlight and the aglycone form of luteolin and quercetin are higher in sunlight treatment. The present analysis confirms the high polyphenol status of Mankai, profiles its major polyphenol components and provides new information on how production process in terms of light quality determines polyphenol content.
Nutrient composition of commercially available compared with prescription only gluten-free bread and flour mixes in England
Authors: Jeanes Yvonne , Rasheid Rawan , Hovland Camilla , Costabile Adele
Published: June 2020

There has been a global increase in gluten-free foods market and perceived health benefits are portrayed in the media. UK legislation requires wheat flour to be fortified with calcium, this is not the case for gluten-free (GF) flours. Calcium intake has been reported to be low in those consuming a GF diet. The only treatment for people with coeliac disease is a GF diet and they have a greater risk of osteoporosis. There is variable access to GF foods on prescription for this patient population in the UK. The study aimed to compare the nutrient profile of commercially available and prescribable GF breads and flour mixes.

Nutrient data were collated from the nutritional information and ingredients lists from manufacturers and online stores; 122 GF breads and 17 GF flour mixes. White GF breads (n = 52), GF brown and multi-seeded GF breads (n = 70). Data collated from 17 GF flour mixes (12 white and 5 brown/wholemeal). Nutrient data from the nutritional information and ingredients lists were collated. Data is presented as mean ± standard deviation.

The energy and macronutrient composition of commercially available (CA) compared with prescribable (P) white GF breads was similar. Fifty-three percent of prescribable GF white breads were fortified with calcium (8 out of15), whereas only 16 % of CA (6 out of 37). Calcium content were similar in fortified GF white breads (CA: 178 ± 91mg/100 g and P:181 ± 142mg/100 g; NS). Only 4 of the 12 white flour mixes, for bread making, were fortified with calcium. Commercially available brown and multi-seeded breads had significantly less saturated fat and sugar compared with prescribable (saturated fat: CA: 0.6 ± 0.3g/100 g and P: 0.9 ± 0.4g/100 g, p = 0.02; sugar: CA: 2.2 ± 2.3g/100 g and P: 3.8 ± 1.8g/100 g, p = 0.01). Sixty-seven percent of prescribable brown and multi-seeded breads were fortified with calcium (10 out of15), whereas only 13% of CA (7 out of 55) and calcium values were similar in those fortified (CA: 215 ± 178mg/100 g and P: 194 ± 136mg/100 g; NS).

This study highlights an inadequate proportion of commercially available GF breads fortified with calcium. There is a need for more GF breads to have their calcium content presented within the nutritional information on the food labels to enable people following a gluten free diet to make informed decisions. We recommend mandatory calcium fortification of GF flours to improve calcium intake in a population with an increased risk of fractures.
Assessing water intake of adults during consultation: the striking discrepancy between a prospective record, an open and a frequency question
Authors: Guelinckx Isabelle , Morin Clémentine , Moreno Luis A. , Kavouras Stavros A. , Martinez Homero , Salas-Salvadó Jordi , Gandy Joan
Published: June 2020

Health care professionals often ask their patients questions about their water intake, or water drinking frequency. The aim of the present analysis was to compare 3 questions (prospective 7-day fluid record, an open question (OQ) and a frequency question (FQ)) used to record the volumes of water drank.

8159 participants (18–65 years) from Argentina, Brazil, China, Indonesia, Mexico and Uruguay completed a validated 7-day fluid intake record. For each drinking event, the volume consumed was recorded. On day 8, participants answered the following questions: “On average, what is your daily intake of water? (Tap water, bottled still and/or sparkling water)” and “How often do you consume drinking water (tap water, bottled still and sparking water): at least once a day or several times a day?”.

When asked about the amount of water consumed, 63–76% of participants in all countries, except for Uruguay and Indonesia, estimated their water intake to be 1–2L to 2–3 L/day, 75–88% of participants reported drinking less than 1L of water/day in the record. In Uruguay, 74% of participants reported in the OQ drinking less than 0.4 L/day and 8% drinking 2–3 L/day, while the 7-day record showed that 56% drank less than 0.4 L/day, 2% drank 2–3 L/day and 32% drank 0.4 L/day. In Indonesia, 17% of participants didn't know how much they drank when asked the OQ. Moreover, 7% estimated drinking ≥ 3 L/day when asked the OQ while only 21% recorded this amount. When comparing water intake reported through the FQ and the 7-day record, 34–75% of participants accurately reported drinking water at least once a day. Nevertheless, in Indonesia, where the mean water intake was high (2.16 L/day), only 1% of participants reported drinking water at least once a day but actually drank water less frequently. In the other countries, where the mean water intake was lower (0.49–0.76L/day in Uruguay and Brazil respectively), 20–42% of participants reported drinking water at least once a day but actually drank water less frequently.

Despite recently recording their water intake for 7 days, it was still difficult for adults to estimate how much and how often they drank when asked a single question. These results suggest a lack of awareness in adults of frequency and volume of water intake and illustrate the need for quick, valid methods that health care professionals can use to assess water intake.
Maternal iron absorption and iron transfer to the fetus during pregnancy in normal- weight and overweight/obese women
Authors: Stoffel Nicole U. , Zimmermann Michael B. , Zeder Christophe , Loetscher Katharina Quack , Lopze Ana Carla Cepeda , Gowachirapant Sueppong , Herter-Aeberli Isabelle
Published: June 2020

Overweight/obesity (owob) causes low-grad systemic inflammation and thereby an up-regulation of hepcidin and a reduction in fractional iron absorption (FIA) even with low iron stores. Pregnancy increases iron needs because of the expansion of maternal blood volume and fetal needs. It is unclear to what extent owob pregnancy influences FIA, iron supply of the fetus and risk of iron deficiency. Therefore, the main aim of this study was to determine the effect of maternal owob on iron absorption during pregnancy and on the iron transfer to the fetus. Secondary objectives were to investigate the development of hepcidin, plasma ferritin and inflammatory markers over the course of pregnancy dependent on weight status. In this multicenter case-control study we included 44 normal weight (nw) and 36 owob women around pregnancy week (PW) 12. We administered 57Fe or 58Fe labeled FeSO4 to women during the 2nd and 3rd trimester of pregnancy. We measured FIA determining erythrocyte incorporation of iron stable isotopes 14 days after administration. From PW 12 until PW 36 iron-, inflammation and hepcidin were monitored. Iron transfer to the fetus was determined as iron stable isotope concentration in cord blood. Sample analysis is currently ongoing, all results will be available in October. Subject characteristics in PW 12 for the nw (n = 26) and owob (n = 10) were: mean BMI: 21.4 ± 2.2 and 36.7 ± 6.8 kg/m2, mean hemoglobin: 12.4 ± 1.2 and 12.4 ± 0.9 g/dL and median plasma ferritin: 41.3 (29.6–83.6) and 61.6 (24.3–119.0) μg/L. Preliminary results indicate FIA increased by 2.4 fold in the nw and by 1.3 fold in the owob women between the 2nd and the 3rd trimester of pregnancy. Iron stores decreased in both groups over the course of pregnancy. Hepcidin was still significantly higher in the owob women in the 3rd trimester. Inflammation tended to be higher in owob women throughout pregnancy. Iron isotopes were highly detectable in cord blood. The 58Fe:57Fe-ratio determined in cord blood corresponded to the 58Fe:57Fe-ratio determined in the mother in the 3rd trimester. Thus, in owob women, the increase in FIA throughout pregnancy to support iron needs of mother and fetus is blunted compared to nw women. This is consistent with elevated hepcidin in the 3rd trimester and higher inflammation throughout pregnancy. Thus, even though iron demands are strongly increased, owob may prohibit an adequate iron supply to the expecting mother and the fetus due to persistent subclinical inflammation.
Breakfast characteristics and its association with daily micronutrients intake – A systematic review and meta-analysis
Authors: Giménez-Legarre Natalia , Miguel-Berges María Luisa , Flores-Barrantes Paloma , Santaliestra-Pasías Alba María , Moreno Luis A
Published: June 2020

Introduction

Breakfast (BF) is widely recognized as an important component of a healthy lifestyle and represents an important source of key nutrients in the diet for both adults and children. Furthermore, BF consumption seems to be associated with a better intake of vitamins and minerals in both, children and adolescents.

The aim of this study was to investigate the associations between frequency and characteristics of BF consumption and its relation with micronutrients intake.

Material and Methods

An exhaustive search was carried out in three datasets in March 2019. The search strategy used to identify the articles was as follow: breakfast, food beverages appetite regulation, child nutritional physiological phenomena, diet, digestion, eating, feeding behavior, gastrointestinal absorption, hunger, nutritional requirements, nutritional status, nutritive value, breakfast skipping, meal skipping, fasting, food preferences, diet therapy, child, preschool, adolescent, breakfast skipping and meal skipping. Two independent reviewers performed the data extraction and assessed their quality and risk of bias following the PRISMA methodology and using the Cochrane risk of bias tool. Meta-analysis was performed comparing results based on type of BF: skip BF, Ready To Eat Cereal (RTEC) BF and other types of BF. DerSimonian and Laird estimators using random effects models were applied for continuous data. Effect sizes were calculated for each outcome.

Results

Out of 3105 articles, we selected 30 full-text articles for inclusion and 7 were considered for meta-analysis.. Children who usually skip BF had significantly lower daily intake of vitamin A (SMD, -10.407; 95%CI: -14.147, -6.667) and vitamin C (SMD, -4.127; 95%CI: -5.091, -3.162) than BF consumers. The intake of vitamin B1 (SMD, -16.378; 95%CI: -29.110, -3.647) and vitamin B2 [SMD, -14.757; 95%CI: -20.247, -9.268] was lower in skippers than RTEC BF consumers.

Regarding to minerals, children who usually consume BF had significantly higher daily consumption of Calcium (SMD, -7.034; 95%CI: -9.029, -5.040), Iron (SMD, -6.552; 95%CI: -9.242, -3.861) and Sodium (SMD, -3.395; 95%CI: -5.554, -1.236) than BF skippers. The intake of Magnesium (SMD, -10.903; 95%CI: -18.078, -3.729) and Potassium (SMD, -6.972; 95%CI: -10.689, -3.254) was higher in RTEC BF consumers than BF skippers.

Discussion

Evidence suggested that BF consumption and RTEC breakfast consumption seems to be associated with better micronutrient intake
Meat consumption and risk of ischemic heart disease and stroke: results from the UK Biobank
Authors: Papier Keren , Fensom Georgina , Knuppel Anika , Key Timothy , Perez-Cornago Aurora
Published: June 2020

Introduction

Meat consumption may be associated with a higher risk of cardiovascular diseases, but the evidence remains inconclusive. We prospectively examined the association between meat (total meat, red and processed meat, red meat, processed meat and poultry) intake and risk of ischemic heart disease (IHD) and stroke, including ischemic and haemorrhagic subtypes, in a large British cohort.

Materials and methods

Data were from UK Biobank participants who were free of IHD, stroke and cancer at recruitment (2006–2010), with available information on meat intake in the baseline touchscreen survey, and linked hospital admissions and death data for IHD, stroke, and stroke subtypes over follow-up (n = 441,700). We used multivariable Cox proportional hazards models to assess associations between meat consumption and risk of IHD, total stroke and ischemic and haemorrhagic stroke subtypes.

Results

Over a mean of 8.1 years of follow-up, 13,590 incident cases of IHD, 5,441 cases of total stroke, 2,258, cases of ischaemic stroke, and 949 cases of haemorrhagic stroke occurred. The risk of IHD was positively associated with intakes of total meat (Hazard ratio (HR) = 1.18, 95% Confidence Interval (CI) 1.09, 1.27 per 100 g/day higher intake), red and processed meat (HR = 1.15, 95% CI 1.08, 1.24 per 70 g/day higher intake), red meat (HR = 1.15, 95%, CI 1.07–1.24 per 50 g/day higher intake), processed meat (HR = 1.11, 95% CI 1.05, 1.16 per 20 g/day higher intake), and poultry (HR = 1.07, 95% CI 1.01, 1.13 per 30 g/day higher intake). The risk of total stroke was positively associated with intakes of total meat (HR = 1.15, 95% CI 1.02–1.29 per 100 g/day higher intake) and red and processed meat (HR = 1.14, 95% CI 1.03–1.27 per 70 g/day higher intake). Meat intake was not associated with ischaemic or haemorrhagic stroke.

Discussion

This large prospective study found that any meat consumption was associated with an increased risk of IHD and that red and processed meat consumption was associated with an increased risk of total stroke. Our findings for IHD and total stroke in relation to red and processed meat are in line with previous studies but our positive findings for poultry and IHD and null findings for red meat and ischaemic stroke are not, thus warranting further study.
Determination of serum vitamin D status of mothers and newborns and related outcomes
Authors: Ayşe Kepkep Ufuk , Pekcan Ayla Gulden
Published: June 2020

Vitamin D deficiency (VDD) has been associated with severe adverse health outcomes during pregnancy is increasingly recognised as a public health concern and maternal and infant VDD is closely associated. The aim of this study was to evaluate the magnitude of VDD and associated factors in pregnant women and newborns in the postpartum period. A cross-sectional study was carried out in a total of 66 pregnant women at > 37 weeks of gestation and newborns at the Gaziantep University Faculty of Medicine, Department of Obstetrics and Gynecology in Gaziantep, Turkey. Demographic characteristics, 24-h dietary recalls, intake of food supplements were determined in pregnant women, maternal and newborn anthropometric measurements and serum (25-OHD) levels were assessed. Mean age (± SD) of pregnant women was 28.8 ± 6.9 years. Although Turkey has “National Vitamin D Supplementation Programme for Pregnant Women” only 33.3% of women had VD supplementation during pregnancy, not all in the recommended levels (1200 IU/day). Mean (± SD) serum 25(OH)D levels in pregnant women and cord blood of newborns were 17.3 ± 9.0 ng/mL [non-supplemented women (NSW): 16.5 ± 7.9 ng/mL; supplemented women (SW): 18.8 ± 11.0 ng/mL] and 16.6 ± 9.9 ng/mL [newborns of non-supplemented women (NNSW): 13.9 ± 8.7 ng/mL and newborns of supplemented women (NSW): 22.1 ± 10.1 ng/mL], respectively. Vitamin D severe deficiency (< 10 ng/dL) was noted in 22.7%, deficiency (11–19 ng/mL) 51.5%, insufficiency (20–29 ng/mL) 15.2% and sufficiency (≥ 30 ng/mL) 10.6% of the women whereas severe deficiency, deficiency, insufficiency and sufficiency respectively, were determined in 33.3%, 39.5%, 13.6% and 13.6% of newborns (NNSW vs NSW, p = 006, p < 0.05). Median serum VD levels of NSW were statistically higher than NNSW (p = 0.000, p < 0.05). Out of total, 86.4% of women were dressing traditionally covered, and had lower serum VD level (p = 0.049, p > 0.05). SW had higher median body weight (p = 0.026) and body mass index (BMI) (p = 0.036) levels than NSW (p < 0.05). No statistically significant differences were found between anthropometric measurements of NNSW and NSW groups, although birth weights of NNSW and NSW groups were determined as 3005.1 ± 456.1 g and 3153 ± 422.5 g (p > 0.05), respectively. Maternal serum vitamin D levels strongly were correlated with newborn levels. Maternal vitamin D deficiency is a great problem and “National Vitamin D Supplementation Programme for Pregnant Women and Infants” should be effectively implemented and monitored. Also fortification programme should be a national policy.
The association between a priori and a posterior dietary patterns with perceived stress in women of childbearing age
Authors: Khaled Karim , Almilaji Orouba , Köppen Mareike , Hundley Vanora , Tsofliou Fotini
Published: June 2020

More than half of women in developed countries are overweight or obese. Studies show that 20–25% of women in the UK enter pregnancy as obese. Healthy diet patterns such as the Mediterranean diet (MD) are linked with lower adiposity among women of childbearing age. However there is evidence that maternal diet in the UK is poor and stress increases the consumption of saturated-fat, sweets, and energy-dense foods. There is limited evidence on dietary patterns and stress among women of childbearing age, therefore this study aimed to investigate the association.

This was an anonymous online survey of female university students. The survey included: socio-demographic characteristics, physical activity, self-reported BMI and waist circumference. Dietary assessment was done via a validated 100-food item food frequency questionnaire and perceived stress via the Perceived Stress Scale (PSS). The dietary data were compared to the a priori defined Mediterranean Diet Score (MDS) and scored according to eight components (vegetables, legumes, fruit and nuts, cereals, fish, dairy products, meat and meat products, and the ratio of unsaturated to saturated fat). The scores ranged from 0 to 8 with MDS adherence groups being 0–3 low, 4–5 medium, and 6–8 high. Factor analysis was also applied on 11 food components (g/d) (the eight above plus eggs, potatoes, sweets and drinks) to reveal the latent major dietary patterns (DP) in the studied cohort.Negative binomial regression was used to examine the association between stress and the diet patterns, controlling for the socioeconomic factors, physical activity, marital status, BMI, and waist.

One hundred twenty-three students (mean age 27.7 (SD 7.3)) participated. Participants had medium (n = 49) or low MD adherence (n = 48), with fewer participants having high adherence (n = 26). Stress was not significantly associated with MD adherence, but was positively associated with sweets intake (p = 0.03). The scree plot of Factor analysis showed that the number of factors generated by the analysis is three.

Using minimum loading cut-off of 0.4, factor analysis revealed three latent diet patterns; the first (DP-1) contained: cereals, sweets and potatoes (comfort foods), DP-2 consisted: eggs, fish and meat (high protein) and DP-3 consisted of: vegetables, fruits, nuts, and legumes (vegan). Results showed a significant positive association between stress and DP-1 (p < 0.01). No association was found between other diet patterns and any other psychosocial and physical variables.

Future well designed randomised controlled trials are needed to investigate further the relationship between perceived stress and dietary patterns in women of childbearing age.
Anemia, nutritional status, and breastfeeding practices among mother-child pairs in vulnerable areas of Greater Beirut, Lebanon
Authors: Abou-Rizk Joana , Jeremias Theresa , Nasreddine Lara , Jomaa Lamis , Hwalla Nahla , Frank Jan , Scherbaum Veronika
Published: June 2020

Introduction: Micronutrient deficiencies and malnutrition during the first 1000 days of life can have lifelong effects on the physical and cognitive development of the child. Lebanon, host of the world's highest per capita number of refugees, is becoming increasingly vulnerable to micronutrient deficiencies and facing a protracted crisis. Up-to-date, there is a lack of studies assessing hidden hunger, such as anemia and its determinants, particularly in a fragile setting.

Material and methods: A cross-sectional survey was applied to 539 mother-child pairs of Syrian refugees and Lebanese host communities attending primary health care centers in 6 vulnerable areas of Greater Beirut, Lebanon between July and September 2018. The interview was completed by 476 pairs consisting of women of reproductive age (15–49 years) and children (0–59 months). The questionnaire gathered data on socio-economic characteristics, infant and young child feeding practices, and nutritional status. Hemoglobin concentrations were measured using the HemoCue Hb301 + analyzer. Data analysis used descriptive statistics, t-test, and chi-square test.

Results: Overall, 45.4% of the women were lactating (LW), 16.6% pregnant (PW), and 38.0% non-pregnant non-lactating (NP/NL). The vast majority of the infants were ever breastfed (96.6%) and received colostrum (90.5%); however, more than half of the infants were offered pre-lacteal feedings (55.0%) and only one third were breastfed within the first hour after birth (35.2%). The rate of exclusive breastfeeding under six months was 22.2%. About half of the children were predominantly breastfed under six months (50.4%). Long-term breastfeeding up to the age of 1 year (47.2%), or even 2 years (19.2%), was practiced in line with the WHO recommendations. Anemia rates among mothers were significantly higher among NP/NL compared to PW and LW (26.1%, 17.7%, 18.8%, respectively, p < 0.05). Whereas, anemia rates among children were significantly higher in LW compared to NP/NL and PW (43.0%, 30.0%, 21,5%, respectively, p < 0.01). Among breastfed children, maternal anemia was significantly higher among anemic children (25.8%) compared to non-anemic children (14.0%, p < 0.05). Mild anemia of children under six months was significantly higher among overweight and obese mothers compared to mothers with a healthy BMI (67.7% vs 32.3%, p < 0.05).

Conclusions: Despite an almost universal initiation of breastfeeding, early onset and exclusive breastfeeding under six months were low. Higher anemia rates were found among breastfed children and this was significantly associated to the maternal nutritional- and anemia status. Further analysis is required to examine the determinants of anemia and breastfeeding in this setting.
Barriers and facilitators to nutritional risk screening of older adults in primary care
Authors: Mills Christine
Published: June 2020

Introduction:

Over one-third of these community-dwelling older adults in Canada are at increased nutritional risk. Worldwide, two-thirds of older adults are at increased nutritional risk, although this figure includes those who are hospitalized or in long term care. Nutritional risk can lead to malnutrition; this occurs when an individual's food intake has an imbalance of energy, protein, or other nutrients. Nutritional risk and malnutrition are associated with poor quality of life, increased hospitalization, and premature mortality. Since malnutrition starts in the community, primary care is the ideal location for nutritional risk screening. If nutritional risk is identified early, before it progresses to malnutrition, it can be more easily treated. It is therefore important to understand barriers and facilitators to nutritional risk screening in primary care.

Materials and Methods:

The peer-reviewed and grey literature were searched. The databases CINAHL, Embase, Medline, and Google Scholar were used to identify articles related to barriers and facilitators to nutritional risk screening of older adults in primary care. A Google search identified publications from the grey literature related to nutritional risk screening of older adults. Key informants consisting of health care professionals working in primary care were asked to identify additional barriers. The Theoretical Domains Framework (TDF) was used to classify the barriers and facilitators.

Results:

Nine barriers and nine facilitators relating to nutritional risk screening of older adults in primary care were identified. These barriers and facilitators were located within the following domains of the TDF: knowledge; skills; social/professional role and identity; beliefs about capabilities; beliefs about consequences; motivation and goals; memory, attention and decision processes; environmental context and resources; social influences; emotions; behavioural regulation; and nature of the behaviours.

Discussion:

The TDF can be used to examine the barriers and facilitators to nutritional risk screening of older adults in primary care. Identification and classification of these barriers and facilitators can aid in the development and implementation of interventions designed to improve rates of nutritional risk screening in primary care. Identifying older adults at nutritional risk can help to prevent malnutrition, by intervening early when poor dietary intake may still be relatively easy and inexpensive to address. Screening is the first step in this identification.
Sex differences in association of protein intake with loss of appendicular lean mass in older adults
Authors: Elstgeest Liset , Schaap Laura , Heymans Martijn , Hengeveld Linda , Houston Denise , Naumann Elke , Simonsick Eleanor , Visser Marjolein , Wijnhoven Hanneke
Published: June 2020

A lower dietary protein intake has been associated with muscle mass loss, a decline in physical performance and more mobility limitations over time in old age. Current guidelines for protein intake advise ≥ 0.8 g/kg body weight (BW)/d, while experts propose a higher intake for older adults (1.0–1.2 g/kg BW/d), irrespective of sex. It is unknown whether the association between protein intake and loss of muscle mass is different for men and women, and whether there is an optimal protein intake to prevent this loss. Therefore, we investigated the shape of the association between protein intake and change in appendicular lean mass (aLM) over 3 years in community-dwelling older adults, separately for men and women. Data of men (n = 935) and women (n = 1061) aged 70–81 years and participating in the Health, Aging and Body Composition study were used. Dietary protein intake, measured in 1998/1999 using a food frequency questionnaire, was expressed in daily grams of protein per kg adjusted BW (g/kg aBW/d) by using healthy instead of actual BW. aLM was assessed by dual-energy X-ray absorptiometry at baseline and after 3 years. Restricted cubic spline functions with 3 knots in linear regression models were used as well as linear regression analyses. The fit of both models was compared using the likelihood ratio test. All analyses were stratified by sex and adjusted for demographics, lifestyle factors, chronic conditions, height and baseline aLM. Mean (SD) protein intake was 70.8 (26.2) g in men and 61.0 (22.5) g in women, or 0.93 (0.36) and 0.95 (0.36) g/kg aBW/d, respectively. Over 3 years, mean loss of aLM was 0.61 (1.16) kg in men and 0.35 (0.95) kg in women. In both men and women, the likelihood ratio was not significant (P = 0.57 and 0.67, respectively), indicating that the spline regression model did not fit the data better than the linear regression model. In men, the linear model showed no association between protein intake and change in aLM (adjusted B per 0.1 g/kg aBW/d = 18.1, P = 0.34). In women, a higher protein intake was associated with a smaller loss of aLM (adjusted B per 0.1 g/kg aBW/d = 34.5, P = 0.017). This study suggests a linear association between protein intake and 3-year loss of aLM in older women; however, no association was found in older men. Future studies into sex differences in associations with other physical outcomes are needed. For both sexes, an optimal protein intake could not be detected.
Effectiveness and acceptance of commercially available protein-rich meals and dairy products in increasing protein intake of community-dwelling older adults
Authors: Linschooten Joost O. , Beelen Janne , Borkent Jos , de van der Schueren Marian A. E. , Roodenburg Annet J. C.
Published: June 2020

Introduction

Home-delivered hot meals and dairy could possibly prevent community-dwelling (CD) older adults from becoming malnourished when they are no longer able to cook themselves. Ideally, these products contribute to an intake of 1.2 grams of protein per kg bodyweight per day (g/kg BW/d) and ≥ 25 grams of protein per main meal. This study evaluated the effectiveness of these products on protein intake and explored the acceptance of these products.

Methods

The study was a single-blind RCT with CD older adults switching from self-prepared to commercially-available home-delivered hot meals and dairy products during 28 days. The intervention group (I) received meals and dairy products high in (≥ 20EN%) protein; the control group (C) received standard meals and dairy products low(er) in protein. Dietary intake was measured at baseline, two weeks (T1) and four weeks (T2) by a three-day food diary. After study completion, 25 participants (aged > 80y, 16 female/9 male) participated in focus groups discussing information on healthy eating, attitude towards high protein products, product acceptance.

Results

Ninety-eight CD older adults (mean age: 80.4 years ± 6.8). Baseline protein intake was 1.09 (SE 0.05) (I) and 0.99 (SE 0.05) (C) g/kg BW/d. During the trial, protein intake of I remained stable at 1.12 g/kg BW/d (SE 0.05) while intake decreased in C to 0.87 (SE 0.03). More I participants reached the threshold of ≥ 25 grams protein at dinner compared to C but not at breakfast and lunch. In the focus groups, participants indicated to be aware of the importance of healthy eating (less salt and less fat). However, knowledge on high-protein products was low and participants did not know why intake of protein should be increased. Less social interaction was indicated as one of the main causes of deterioration of eating behaviour. Further, participants indicated that they primarily would like to enjoy eating instead of focusing on functionality. The ready-made meals were generally considered to be too large and low in vegetables.

Conclusions

Switching from self-prepared meals to ready-made meals carries the risk of a decreasing protein intake in CD older adults. To stimulate a healthy dietary pattern, focus should be on behavioural change and knowledge improvement. Besides awareness for healthy eating, food enjoyment is essential. Finally, meal composition could be improved to enhance acceptance.
Endocannabinoids and endocannabinoid-like molecules are present in foods, blood and ileal fluids from ileostomy subjects: insight into possible metabolic implications
Authors: Tagliamonte Silvia , Gill Chris I R. , Pourshahidi Laura Kirsty , Slevin Mary , Lawther Roger , O'Connor Gloria , Ferracane Rosalia , Vitaglione Paola
Published: June 2020

The endocannabinoid system is a lipid signalling system with several regulatory functions throughout the body including regulation of appetite, food intake, macronutrient metabolism, pain sensation, blood pressure, mood, cognition and immunity. It consists of endocannabinoids (ECs), their receptors and enzymes involved in their synthesis and degradation. The two best-characterized endocannabinoids are N-arachidonoylethanolamide (AEA) and 2-arachidonoylglycerol (2-AG). They are ligands of cannabinoid receptors CB1 and CB2 which are located in the central nervous system (CNS) but also in in the enteric nervous system, in the liver and in the adipose tissue.

Several structural congeners of ECs including N-acylethanolamines (NAEs) such as oleoylethanolamine (OEA), linoleyethanolamine (LEA), and palmitoyletahanolamine (PEA), show similar mechanisms of action, tissue distribution as well as pathways of formation and breakdown. They are considered “endocannabinoid-like” molecules acting through receptors that are located both in CNS and in the gastro-intestinal tract mucosa such as the G-protein coupled receptor 119 (GPR119) and peroxisome proliferator-activated receptors (PPARs). NAEs display EC50 values for human GPR119 and PPAR-α between 65 ng/mL and 1000 ng/mL. Some evidence indicated that NAEs, their phosphorylated precursors N-acylphosphatidylethanolamines (NAPEs) and ECs are also present in food. Thus, we developed a food database of these molecules and we calculated the daily dietary intake in a healthy population.

This study aimed to evaluate whether the concentrations of NAPEs, NAEs and ECs in the human intestinal lumen may support their activity through the receptors lining in the gastro-intestinal tract and if they correlated with those in plasma.

The observational study (16/NI/0267, Ulster University) involved 35 ileostomists (18F/17M, aged 18–70 y, BMI 17–40 kg/m2) who collected overnight fasting samples of ileal fluid and plasma. The concentrations of NAEs, NAPEs and ECs in biological samples were determined by LC-HRMS.

Data showed that NAEs and NAPEs were present in ileal fluids and plasma from all subjects ranging between 46851.0–104742.8 ng/mL and 0.3–59.6 ng/mL in ileal samples and 1159.4–3985.7 ng/mL and 0.19–1.24 ng/mL in plasma, respectively. Contrarily, no ECs in ileal fluids were found except 2-AG in two ileal samples whereas they ranged between 1.6–22.3 ng/mL in plasma. Differences between genders and associations of plasma levels with individual energy intakes were found.

Altogether, the data demonstrated that NAEs in the intestinal lumen are sufficient to elicit metabolic responses through the gastro-intestinal receptors.
The impact of chronic stress and eating types on active ghrelin levels in response to acute stress
Authors: Fahrngruber Christine , Duszka Kalina , König Jürgen
Published: June 2020

Chronic stress is associated with impacting eating behavior, namely food choice and energy intake, with a shift towards more palatable and energy dense foods. Additionally, eating behavior is influenced by other psychological factors like mood and emotions. The categorization of people into eating types such as restrained, emotional, and external eaters has gained attraction. Reported changes in eating behavior due to psychological stress are only occasionally accompanied by measures of physiological hunger through ghrelin. The primary objective of this study was to investigate how chronic stress and acute cortisol reactivity affect active ghrelin secretion and how these outcomes account for different eating types. 16 healthy, young males (age: 23 ± 3 years, BMI: 22.5 ± 1.3kg/m2) with low (n = 8) and average-to-high (n = 8) chronic stress level were subjected to the Trier Social Stress Test (TSST) and a control version on two separate days. Active ghrelin, cortisol, glucose, and heart rate were measured throughout the test. Subjects rated their hunger by means of visual analog scale and current mood was assessed with the Positive and Negative Affect Scale (PANAS). In addition, participants filled out the Dutch Eating Behavior Questionnaire (DEBQ) to account for their subjective eating behavior. Overall ghrelin values where higher on the test day compared to the control day. Ghrelin values were also higher during the time leading up to the stress or control test (TSST) than during the conclusion of said tests. On both days, mean values for active ghrelin where higher in individuals with low chronic stress exposure compare to those with average-to-high chronic stress exposure. While values from test to control day decreased for lower stressed participants, they slightly increased for higher stressed participants. Cortisol responders displayed higher ghrelin values on test day than cortisol non-responders, but this association inverted for the control day. Results indicate that chronic stress influences acute stress response and further alters active ghrelin production, which in turn can influence eating behavior. Replication in a greater group of participants of differing weight and sex could yield a greater understanding of stress induced eating. Factors such as relaxation techniques and coping mechanisms could further improve our knowledge and evaluate treatment possibilities.
A high content of Slowly Digestible Starch decreases glycemic and insulinemic responses similarly in Asians and Caucasians
Authors: Goux Aurélie , Neufcourt Lola , Brack Olivier , Atkinson Fiona , Vinoy Sophie
Published: June 2020

Introduction

Glucose intolerance and type 2 diabetes are increasing worldwide. Current scientific evidence tends to demonstrate that people with an Asian phenotype have a lower glucose tolerance compared to Caucasian phenotype. In addition, in Caucasian population, consumption of products with a high content of Slowly Digestible Starch (SDS) significantly decreases postprandial glycemic and insulinemic responses compared to products with a low-SDS content. The aim of this study was to evaluate the effect of consuming products with varying levels of SDS on postprandial glycemic and insulinemic responses, both in Asian and Caucasian populations.

Materials and methods

Five products with varying starch digestibility profiles (determined by the SDS method developed by Englyst) and one glucose solution were tested. A randomized cross-over controlled study was set up in the University of Sydney to study the products’ Glycemic and Insulinemic Indexes (GI and II) and postprandial responses over 2 hours. 12 Caucasian and 12 Asian participants were recruited and consumed 50 g of available carbohydrates from each product (norm ISO-26642(2010)).

Results

Asian participants were 28.0 ± 2.6 yo with a body mass index (BMI) of 21.4 ± 0.3 kg/m2 and Caucasians were 26.0 ± 1.1 yo with a BMI of 22.4 ± 0.5 kg/m2 (no difference between groups). Among the products tested, 3 had a high-SDS content (26 to 28 g SDS / 100g) and 2 had a low-SDS content (0 to 2 g SDS / 100g). GI values for Asian participants ranged between 44 and 54 for high-SDS products (low GI) and were medium (64) or high (90) for low-SDS products. GI values for Caucasian participants ranged between 40 and 48 for high-SDS products (low GI) and between 60 and 79 for low-SDS products. In a statistical model including product effect, ethnicity effect, session effect, and the interaction term product*ethnicity, the product effect was the only significant parameter and products were split according to their SDS content. Furthermore, products with a high-SDS content decrease the glycemic peak value by about 1 mM, both in Asian and Caucasian participants. Consumption of high-SDS products also decreases the insulin demand by 29% and 32% in Asians and Caucasians respectively compared to low-SDS products.

Discussion

Our study demonstrates that consumption of products with a high-SDS content similarly decreases the glycemic and insulinemic responses in both Asian and Caucasian participants. This decrease may be beneficial in the long term to prevent metabolic diseases.
Pre and postoperative deficiencies in iron, ferritin and B12 vitamin among portuguese patients undergoing bariatric surgery
Authors: Lopes Mariana Santos , Oliveira Bruno M. P. M. , Neves Olga , Melim Diva , Freitas Paula ,   AMTCO Group, Correia Flora
Published: June 2020

Introduction:

According to the World Health Organization obesity it's the result of an abnormal or excessive body fat accumulation, which presents a high risk for the health. Bariatric surgery appears as an alternative to the conventional treatment for the morbid obese individuals. However, this type of intervention causes changes in the anatomy and physiology of the gastrointestinal tract, which may lead to the development of nutritional deficiencies in patients, in particular anemia.

Aim:

To evaluate micronutrient deficiencies in patients submitted to bariatric surgery in preoperative and postoperative periods, in particular iron, ferritin, and B12 vitamin.

Methods:

In this longitudinal study, we evaluated, retrospectively and prospectively, patients who attended the nutrition appointment at a central hospital. We completed a preexisting database containing anthropometric and biochemical data, adding biochemical data, at various periods: pre at 6th, 12th, 18th, 24th, 30th and 36th months post-surgery.

Results:

from the 121 patients submitted to bariatric surgery, 79,3% were female. The prevalence or iron deficiency reached 15%, ferritin deficiency reached almost 10% and B12 vitamin deficiency reached 18%. Furthermore there were deficiencies in other nutrients, e.g., vitamin D, magnesium and zinc. There was more than 85% adhesion to take the multivitamin supplementation and frequent use of specific supplementation.

Conclusion:

The prevalence of nutritional deficiencies is high, with a tendency to persist over time even with use of multivitamin supplementation, leading to the need for complementary supplementation, in particular to prevent the risk of anemia. Hence, periodic and long term monitoring is fundamental.