bluuebunny/crossref_metadata_2025 huggingface dataset:
Salt trends in breakfast cereals from 2003 to 2015: An examination of the impact of reformulation by the food industry
Authors: O'Donovan C.B. , McDonald K. , O'Mahony S. , Lyons O.C. , Quinn S.F. , Creane R.J. , Anderson W. , Flynn M.A.T. , Collins N.A.
Published: June 2020

Breakfast cereals are widely consumed in Ireland with over 80% of adults choosing ready-to-eat cereals or porridge. In terms of healthy eating, breakfast cereals are considered a nutritious choice and are not expected to contribute significantly to daily salt intakes. Since 2003, the Food Safety Authority of Ireland has coordinated a salt reduction programme to achieve voluntary reduction by the food industry in the salt content of processed foods available in Ireland. This study aims to examine whether salt levels of breakfast cereals are decreasing due to reformulation practices.

A random selection of breakfast cereals on the Irish market were sampled using the following categories: rice-based, bran-based, cornflake-type, biscuit-based, multigrain, muesli and no added salt/low salt varieties in 2003, 2007, 2011 and 2015 (muesli and no added salt/low salt varieties were not sampled again in 2015) (n687). Samples were analysed for sodium content using atomic emission spectrophotometry and converted to salt (g) per 100 g of the food product by multiplying by 2.54. Results were analysed using IBM SPSS (version 25). As data was not normally distributed, median values (minimum and maximum) were investigated across breakfast cereal categories at the different time-points. Differences between the time-points were assessed using Krusal-Wallis test and Mann-Whitney U tests.

In 2003, salt levels were found to be highest in cornflake-type cereals and lowest in no added salt/low salt cereals (2.02 g (0.20–2.31) and 0.01 g (0.0–0.03) per 100 g respectively). The salt content of rice-based, bran-based, cornflake-type, biscuit-based and multigrain varieties significantly decreased (up to 65% in cornflake-type cereals) until 2011. No further reduction was achieved for rice-based, bran-based and cornflake-type varieties in 2015 and a significant increase in salt was observed for biscuit-based (p = 0.001) and multigrain products (p = 0.007). Between 2003 and 2011, no reduction in salt levels was observed for muesli or no added salt/low salt products.

This study revealed there has been a significant reduction in the salt content of breakfast cereals since 2003 – an important finding considering breakfast cereals are recommended for healthy eating. However, this work also shows that continuous salt monitoring is necessary to ensure this reduction in breakfast cereals is maintained. Future FSAI reformulation work will examine a range of nutrients in food products as the food industry have committed to achieve a gradual reduction in fat, saturated fat and sugar, as well as salt, as part of the National Obesity Policy and Action Plan.
In women, central obesity predicts higher inflammation, higher serum hepcidin, lower absorption and hypoferremia
Authors: Stoffel Nicole , Mallah Carla El , Obeid Omar , Zeder Christophe , Herter-Aeberli Isabelle , Zimmermann Michael
Published: June 2020

Obesity is characterized by chronic low-grade inflammation. Visceral adipose tissue (VAT) is heavily infiltrated by macrophages producing pro-inflammatory cytokines (IL-6), therefore VAT predicts greater systemic inflammation compared to peripheral fat. Thus, central adiposity may cause increased serum hepcidin (SHep) and may affect iron metabolism more than peripheral adiposity. Although increased total body fat (BF) is linked to disordered iron homeostasis, the potential effects of body fat distribution on iron metabolism have not been studied. Therefore, the aim of this study was to assess the effect of BF distribution on iron and inflammation parameters, SHep and iron metabolism.

We enrolled 37 normal-weight women and 81 overweight/obese women in this cross-sectional study. Body composition was assessed using DXA and iron- and inflammation parameters and SHep were measured. The overweight/obese women were assigned to a peripheral (n = 54) and a central (n = 27) fat deposit group, according to their android fat percentage. All women received 100 mg oral iron as ferrous citrate and the change in serum iron was assessed after 2 h to determine iron absorption.

The three groups differed significantly in body weight, BMI, waist circumference, android fat, gynoid fat, total fat, android/gynoid ratio and VAT (for all p < 0.001). Hemoglobin, serum ferritin, body iron stores (BIS), serum iron and transferrin saturation (TSAT) were lowest and transferrin receptor was highest in central obesity. CRP was higher in central obesity compared to both, peripheral obesity (p < 0.05) and normal-weight (p < 0.001). SHep was higher in central and peripheral obesity compared to normal-weight (both p < 0.01), with no difference between the two overweight/obese groups. Δserum iron was ≈30% and ≈20% lower in central obesity compared to normal-weight and peripheral obesity. We performed linear regression analysis on SHep, CRP, TSAT and Δserum iron: Android fat and BIS were positive predictors of SHep (p < 0.05, p < 0.001), android fat was a positive predictor of CRP (p < 0.001), BIS was a positive, android fat was a negative predictor of TSAT (p < 0.001, p < 0.05) and TSAT and android fat were both negative predictors of Δserum iron (p < 0.001, p < 0.05).

Controlling for iron status, inflammation and SHep are increased in women with central obesity and predict lower iron absorption and hypoferremia compared to women with more peripheral fat distribution. Thus, women with central fat distribution may be at increased risk for iron deficiency and anemia.
Salivary amylase gene copy number and its association with fasting and postprandial glucose response
Authors: Farrell Mary , Sonestedt Emily , Raben Anne , Tovar Juscelino , Ramne Stina , Gouinguenet Phébée
Published: June 2020

Introduction

When compared to other primates, humans elicit a large variation in the copy number for the salivary amylase gene, AMY1. This variation can range from 2 to 17 copies. The AMY1 gene is responsible for coding for salivary amylase, an enzyme needed to catalyze the hydrolysis of starch molecules into smaller sugars. AMY1 copy number correlates with the amount and activity of salivary amylase. Few studies have investigated the effect of amylase copy number on fasting and postprandial glucose levels. The aim was first to investigate the association between AMY1 copy numbers and fasting glucose in an observational study, and secondly to investigate the difference in postprandial effect of high-starch meals in individuals with either high or low AMY1 copy numbers.

Materials and methods

For the observational study, we used data from 436 participants from the Malmö Offspring Study (MOS) cohort whom have been genotyped for AMY1. For the meal study (conducted during May 2019), we used genotype-based-recall to recruit 24 participants from the observational study of the MOS cohort: 12 with low AMY1 copy number (from the lowest 20%) and 12 with high AMY1 copy numbers (from the highest 20%). Each subject will be served a breakfast meal of white wheat bread on two separate test days: one containing 40 g and the other containing 80 g of carbohydrates (mainly starch). Blood samples will then be taken at various time points to investigate postprandial glucose and insulin responses.

Results

When using linear regression analyses adjusting for age and sex, no significant association between AMY1 copy number and fasting glucose was observed (p = 0.23). However, there was a difference (p = 0.05) in fasting glucose levels between the lowest (2–4 copy numbers: 5.31 mmol/L; 95% CI: 5.13–5.50) and highest (10–16 copy numbers: 5.57 mmol/L; 95% CI: 5.39–5.75) copy number groups. The results for the meal study will be obtained in June 2019 and be presented at the conference.

Discussion

Our findings of higher fasting glucose among the group with more than 10 AMY1 copy numbers is the first study to find this and needs to be replicated in other populations.
Considerations for the adoption of a Mediterranean diet beyond the Mediterranean Sea: lessons from Australian trials
Authors: Murphy Karen , Dyer Kathryn , Hyde Belinda , Davis Courtney , Hodgson Jonathan , Woodman Richard
Published: June 2020

The Blue Zones are known for healthy longevity and low rates of chronic disease. Common denominators between blue zones include social, environmental and spiritual foundations for good health, however there are key dietary contributors including mindful eating and a predominantly plant-based diet. the Mediterranean diet (MedDiet) is a plant-based diet and is reported to reduce the risk of overall mortality and cancer incidence, diabetes, neurodegenerative disease, heart attack and cardiovascular disease (CVD). Populations have enjoyed the health benefits of a MedDiet, for years, which could offer better health to Western countries which suffer from lifestyle diseases like obesity and heart disease. But how feasible is it to implement such a pattern beyond the Mediterranean sea? The MedLey study explored whether a MedDiet could be adhered to for 6 months and would improve CVD risk factors compared with habitual diet (HabDiet) in a population of older Australian adults. Volunteers were assessed at 3 points during the study (0, 3, 6 months) and12 months after the intervention had finished (18 months). 137 volunteers completed the trial and 128 volunteers completed the follow-up study. Participants completed a food frequency questionnaire and a 15-point MedDiet adherence score (MDAS; greater score = greater adherence) was calculated. Home BP was measured over 6 days, and cardiometabolic health outcomes were assessed. Data were analysed using intention-to-treat LMEM with a group x time interaction term comparing data at 0, 3, 6 and 18-months (12-months post-trial). At baseline the MedDiet score was 6.7 ± 0.2, 9.6 ± 0.2 at 4 months and 7.9 ± 0.3 at 18-months (p < .0001 to baseline and 4 months). The MedDiet resulted in improved systolic BP, endothelial dilatation, oxidative stress and plasma triglycerides in comparison with HabDiet, after 6 months (p < .05). These changes were not sustained at 18-months but did not completely return to baseline values. Principles of the MedDiet appeared to be somewhat maintained. Consumption of olive oil, legumes, fish and vegetables (p < .01) remained higher and discretionary food consumption (p = .02) remained lower at 18-months than baseline in the MedDiet group. We have shown that following a MedDiet for 6-months is feasible and results improvements in markers of CVD risk. Some principles of the MedDiet were maintained following trial completion, but ongoing support may be helpful in maintaining MedDiet adherence and improved health. To implement such a pattern on a population level, several considerations are required including provision of resources and information, ongoing support, creating supportive environments through a multi-settings approach.
Consumption of dairy products and cardiovascular disease risk: results from the French prospective cohort NutriNet-Santé
Authors: Sellem Laury , Srour Bernard , Jackson Kim , Hercberg Serge , Galan Pilar , Kesse-Guyot Emmanuelle , Julia Chantal , Fezeu Léopold , Deschasaux Mélanie , Lovegrove Julie , Touvier Mathilde
Published: June 2020

Current French National Health and Nutrition Plan (PNNS) recommends 2 servings of dairy products per day for adults. However, dairy contributes to dietary saturated fat intake, of which reduced consumption is often recommended for cardiovascular disease (CVD) prevention. Epidemiological evidence on the association between dairy product consumption and CVD risk remains unclear, with findings from recent prospective cohorts suggesting either null or inverse associations between dairy intake and CVD risk(1,2). This study aimed to investigate the associations between intakes of dairy products (overall and specific types) and CVD risk in a large cohort of French adults.

This prospective study included self-selected participants aged ≥ 18 years from the NutriNet-Santé cohort (2009–2019). Dietary data were collected every 6 months using 24 h-dietary records, averaged in daily intakes and coded as sex-specific quartiles. Dairy foods were classified according the PNNS dairy groups: milk, cheese, and yogurts (i.e. yogurts, curd cheese and petit-suisses). Total, fermented and low-fat dairy intakes were also investigated. CVD cases (n = 1,952) included cerebrovascular (i.e. stroke and transient ischemic attack, n = 878 cases) and coronary heart diseases (i.e. myocardial infarction, angina, acute coronary syndrome and angioplasty, n = 1,219 cases). Multivariable Cox models were performed to characterize associations and were adjusted for age, gender, without-alcohol energy intake, number of 24h-dietary records, smoking status, educational level, physical activity, BMI, alcohol intake and family history of CVD.

This analysis included n = 104,805 French adults with a mean age 42.8 (SD 14.6) years and the mean number of dietary records per subject was 5.7 (SD 3.1). There was no association between total or specific dairy intakes and total CVD or coronary heart disease risks. However, consumption of fermented dairy, such as cheese and yogurts, was associated with a 19% reduction in the risk of cerebrovascular disease (HRQ4 vs. Q1 = 0.81 [0.66–0.98], p trend = 0.01).

Despite being important dietary sources of saturated fat, dairy product consumption was not associated with total CVD or coronary heart disease risks in a large cohort of French adults. However, fermented dairy products may be associated with a lower risk of cerebrovascular diseases. Further observational and interventional studies may be needed to further assess the impact of dairy on CVD risk and to identify potential mechanisms underlying the beneficial effects of fermented dairy products on cerebrovascular disease risk.
Gender inequalities in diet quality and their socioeconomic patterning in a nutrition transition context in the MENA region
Authors: Abassi Mohamed Mehdi , Ati Jalila El , Sassi Sonia , Gharbia Houda Ben , Delpeuch Francis , Traissac Pierre
Published: June 2020

Introduction: The Middle East and North Africa region features marked gender excess adiposity inequalities detrimental to women in a context of nutrition transition with major shifts in lifestyle and diet. We assessed gender inequalities in dietary intake with a focus on diet quality. Sociodemographic patterning of these gender dietary inequalities was explored.

Methods: A cross-sectional study in the Greater Tunis region (Tunisia) in 2009–2010 surveyed 20–49 y old adults of both genders (women n = 1689, men n = 930) using a stratified, two-stage cluster sample. Dietary intake was assessed using a 3-day food record. We assessed diet quality by the Diet Quality Index-International (DQI-I) /100 and sub-components (variety, adequacy, moderation, balance); DQI-I > 60 defined good diet quality. Gender inequalities measures were women vs. men differences of means for interval variables and odds-ratios (OR) for DQI-I > 60. Their variation with sociodemographic characteristics were estimated by models featuring gender x covariate interactions.

Results: Mean energy intake in kcal was 2300 ± 15 for women vs. 2859 ± 32 for men. By 1000 g/kcal/day women consumed more fruits and sweets but less red meat and soft drinks than men. Mean DQI-I was lower among women vs. men (58.6 ± 0.3 vs. 60.4 ± 0.3, diff = -1.8[-2.6;-1.0], P < 0.0001) as well as proportion of DQI-I > 60 (45.2% vs. 55.7%, OR = 0.7[0.5;0.8], P < 0.0001). Gender differences varied with the 4 sub-components: women vs. men had lower mean variety (10.1 ± 0.1 vs. 12.1 ± 0.2, diff = -2.0[-2.3;-1.6], P < 0.0001) and adequacy scores (30.8 ± 0.1 vs. 32.5 ± 0.1, diff = -1.8[-2.0;-1.5], P < 0.0001) (for the latter they scored a little better than men for the fruit item, but had much lower scores than men for iron and also calcium). But women scored better than men on the moderation score (14.2 ± 0.2 vs. 12.3 ± 0.2, diff = + 1.8[1.4;2.2], P < 0.0001), mostly due to their better score on the cholesterol and sodium items. There was no difference for the balance subcomponent. Adjusted gender inequalities in DQI-I decreased with age, were higher in larger households and were also higher in the extreme categories of education i.e. no-schooling and university vs. the middle categories.

Conclusions: Diet quality was overall average. It was lower for women than men. Women vs. men differences in diet quality varied somewhat according to sociodemographic indicators linked to different gender roles. We also showed that gender contrasts depend on which dimension of diet quality is considered (better moderation but worse adequacy and variety for women). That maybe a pathway for gender specific prevention.
Sugar Content in UK Breakfast Cereals: A Market Survey
Authors: Butler Tom J. , Birman Evelyn S. , Hancock Neil , Moore J. Bernadette
Published: June 2020

Breakfast cereals are known to provide a nutrient-dense meal and are a useful source of carbohydrate, fibre and micronutrients. However, in the UK cereal products are the primary contributor of free sugars in the diets of children aged 1.5 to 10 years; and are the second leading source of free sugars in children aged 11 to 18 years and adults aged 19 to 64 years. For this reason, breakfast cereals were included among food items recommended by the UK government for a 20% reduction in sugar by 2020 for childhood obesity prevention. Therefore, this study aimed to investigate the nutrient contents, including sugars, of breakfast cereals sold in the UK, in particular those marketed to children. Nutritional information and ingredients of cereal products available in five major online supermarkets in the UK, in 2018, were collected into a comprehensive database for analysis. A systematic process flow approach was utilised to separate products into nine distinct categories. Children's products were stratified both on being wholegrain rich (≥ 50%, WG) or not (NWG), and on total sugar content; with > 12.3g/100 g defined as ‘highly flavoured and sweetened’ (HFS) versus ‘plain’ containing ≤ 12.3g/100 g (the target set by the UK for industry sugar reduction). Of the 757 unique products surveyed, 97 cereals were categorised as children's. Cereals not explicitly marketed to children were categorised as either ‘family favourites’ (containing < 50% wholegrains), ‘free-from and organic’, ‘porridge and oats’, ‘healthier with dried fruits’, or ‘healthier without dried fruits’ (healthier defined as wholegrain rich, ≥ 50%). Children's HFS products (n = 78) contained by far the highest sugar contents of all cereals examined. While there was no difference in total sugar between NWG/HFS (n = 69, median [range]: 29.0g/100 g [12.4, 41.0]) and WG/HFS (n = 9, 22.0g/100 g [13.6, 26.0]) cereals; these were much higher (P < 0.01) than the median sugar contents (8.8–19.0g/100g) observed in the other seven product categories. Children's NWG cereals contained dramatically lower fibre (NWG/HFS: 3.5 [0, 8.7], NWG/Plain: 1.6g/100 g [1.3, 7.2]) than all other product categories (7.3–9.1g/100 g; P < 0.001). Similarly, NWG/HFS cereals were lower in protein content (7.4/100 g [3.6, 17.2]) than the non-children's cereals (8.8–11g/100 g; P < 0.05). In conclusion, children's categories of cereal contain significantly greater amounts of sugar and lower amounts of fibre and protein than other cereal categories. Despite their fortification with vitamins and minerals, reformulation of this food category should be a priority alongside additional sugar-reducing strategies.
Sustainable values of the 2017 French food-based dietary Guidelines:Findings from the BioNutriNet project
Authors: Kesse-guyot Emmanuelle , Chaltiel Dan , Allès Benjamin , Pointereau Philippe , Rebouillat Pauline , Lairon Denis , Vidal Rodolphe , Mariotti François , Egnell Manon , Touvier Mathilde , Julia Chantal , Baudry Julia , Hercberg Serge
Published: June 2020

Background

Recently, Food-Based Dietary Guidelines (FBDG) have introduced the sustainability concept relying on health and environmental issues related diet. In 2017, the French FBDG were updated including, beyond healthy diet for human, environmental protection and the promotion of organic food.

Objectives

The aim of the present analysis was to describe sustainable indicators (nutrition, environment, economic, sanitary exposure and long-term) according to adherence to the 2017 FBDG.

Material and Methods

The sample included a total of 28,240 from the NutriNet-Santé cohort having completed an, in the framework of the BioNutriNet project, an organic food frequency questionnaire allowing to estimate organic and conventional food consumption for 264 items. After matching, several databases were compiled to evaluate environmental impacts (greenhouse gas emissions, cumulative energy demand and land occupation and the pReCiPe score aggregating the three individual indicators), purchase costs of the diet and dietary exposure to pesticides, all data accounting for farming systems. A recently validated adherence score estimating compliance with the 2017 FBDG (programme national nutrition santé guidelines-score, PNNS-GS 2) was used and the quintiles were computed for comparison purpose of multiple sustainable. Numbers of averted or avoided deaths by adhering to the FBDG were also estimated using the PRIME.

Results

A higher PNNS-GS2 scores is positively correlated to a high plant-based diet, a lower energy intake and a higher cost (+ 0.91€/d). It was associated with lower environmental impacts (ΔQ5vsQ1pReCiPe: -50% for PNNS-GS2). Higher PNNS-GS2 was associated with lower exposure to all pesticides except those used in organic farming and led to a reduction of about 20,000 averted or delayed deaths.

Conclusion

Our results suggest that 2017 FBDG are in line with the sustainable despite a slight higher cost. Such dietary guidelines, if largely adopted, may help in health promotion and reducing environmental protection in a context of an alarming climatic change.
Ultra-processed food consumption and breast cancer risk
Authors: Huybrechts Inge , Romieu Isabelle , Kandpur Neha , Katsikari Katerina , Torres-Mejia Gabriela , Sanchez Gloria I. , Garmendia Maria Luisa , Porras Carolina , Biessy Carine , Gunter Marc J. , Monteiro Carlos Augusto , Rinaldi Sabina
Published: June 2020

Objectives

The consumption of ultra-processed foods (UPF) has been linked to an increased risk of cancer in western populations, particularly for breast cancer (BC). Although the consumption of UPF is increasing rapidly in Latin American (LA) populations too, there has been no evaluation of its association with BC among LA women, where 20% of the BC cases present at ages younger than 45 years. We therefore evaluated the role of UPF intake on BC risk in young women participating in the Latin American PRECAMA study.

Methods

The PRECAMA study is an ongoing study coordinated by the International Agency for Research on Cancer (IARC) and involves scientific teams in four LA countries (Chile, Colombia, Costa Rica and Mexico); 406 incident BC cases and population based controls aged 20–45 years are recruited. Trained nurses administered a lifestyle and food frequency questionnaires (FFQ), conducted anthropometric measurements and collected biological samples. Tumour receptor status are determined in a centralized laboratory. UPF consumption was estimated by applying the NOVA classification to the dietary consumption data obtained via the FFQs. The association of the consumption of UPF and BC was determined using conditional logistic regression analysis adjusting for potential confounding factors.

Results

The median age at recruitment was 40 years. The median percentage of calories from UPF was 24% (10th to 90th percentile: 9 to 43%). UPF intake was positively associated with BC risk (OR for tertiles 2 and 3 in comparison with tertile 1 were 1.84 (95% CI 1.21 -2.81) and 1.69 (95% CI 0.99 -2.89) respectively). Among the UPF most strongly associated with BC, we identified the intake of industrial bread, packaged sweet and savoury snacks, breakfast cereals, cakes and desserts, and ready-eat/fast food. Comparing the 3rd with the 1st tertile of energy intake from the UPF group “fast food” the OR for BC risk was 1.93 (95% CI 1.23–3.04).

Discussion

Our results show positive associations between the consumption of UPF and BC risk in young women in LA. Therefore, global actions to decrease UPF intakes are urgently needed to address the cancer burden. In addition, further studies are needed to disentangle mechanisms relating UPF intake and carcinogenic processes in the breast. The European Prospective Investigation into Cancer and Nutrition (EPIC) study, a large-scale cohort including ~500,000 participants and 18,814 BC cases will be used to unravel the mechanistic pathways underlying these positive associations between the consumption of UPF and BC risk.
Food and health related characteristics of active home-living elderly in Norway
Authors: Ueland Øydis , Grini Ida Synnøve
Published: June 2020

Background

The large increase in the elderly population in the Western world is challenging traditional social and welfare structures. Health issues following a natural aging process increase the load on health and welfare services, making it imperative to reduce negative effects of aging and enabling elderly to stay active and live home longer. The aim of this study was to investigate food-related characteristics of active home-living elderly that can provide advice for strategic health promoting measures for this group.

Material and methods

A quantitative web-based survey measuring food and health related behaviour, was administered to a sample of elderly, 67 years and older, in Norway. 1005 elderly participated in the study, 50/50 male/female, age distribution 67–74 years (70%), 75–79 years (19%), and 80 + (11%). In addition, two focus groups and 12 in-depth interviews were conducted.

Results

Women showed higher general health interest than men and enjoyed food more (p < 0,001). Almost everyone consumed at least three regular meals, following fixed routines. They reported dietary practices and knowledge that closely fit the dietary advice from the Health Authorities. 25% reported avoiding certain foods, and 65% took daily dietary supplements. Only 4% reported no physical activity at all. These respondents had higher BMI and age distribution than the rest of the sample. In general, reported health status of the sample was good, and they scored high (7,8) on a scale from 1–10 for how satisfied they were with life. With increasing age, the respondents expressed needs for more dietary advice and special foods as well as a decrease in appetite and fruit and vegetable consumption. The seniors indicated that eating with others was important for food enjoyment and appetite. The qualitative studies confirmed this, but that the advantage of social meals did not include eating with strangers.

Discussion

In order to provide knowledge that can promote and uphold a better life in the future for elderly consumers, active, home-living elderly in generally good health were recruited for this study. Characteristics of this group involved healthy daily meal routines, an active lifestyle and a social life. These activities improve appetite and feelings of well-being. Strategies enabling elderly to adapt and uphold these activities are necessary to avoid severe decline in food intake and activity as the aging process progresses.
Relationship between body composition and eating disorder risk in adolescents. UP& DOWN follow-up substudy
Authors: Rodriguez-Laprast J.A. , Gomez-Martinez S. , Hernandez A. , Cabanas-Sanchez V. , Veiga O.L. , Marcos A.
Published: June 2020

Adolescence is a decisive and characteristic period for overall development throughout the life-span in which Eating Disorders (ED) are among the most common mental health problems in young population. Different factors might be related to the risk of ED such as sex and body composition, but literature about hydration status is still very scarce. This study was aimed to assess possible relationships between ED risk and body composition, including hydration status. A 2-year follow-up substudy from the UP&DOWN Study was performed in a sample of 77 adolescents at baseline (n = 74 after the follow-up; 13.87 ± 1.54 years old at baseline). Subjects were grouped by sex. ED risk was measured by the SCOFF questionnaire, a validated screening tool for ED. Risk of ED criterion is considered when SCOFF score is equal or higher than 2.0. Body composition, particularly Fat Mass (FM%) and hydration [Total Body Water (TBW in liters) regarding the weight of individuals and its range (low, within, high)] were determined by bioimpedance. Data analysis was conducted using version 25.0; SPSS Inc., Chicago, IL, USA, software. A logistic regression was made to select the variables [sex, TBW (L), FM%] that could be more related to ED risk, considered as a dependent variable. Crosstabs and chi-square test were used to establish the relationships between the categorical variables. Almost 30% girls and 10% boys were at risk of ED at baseline (P = 0.036). Furthermore, almost 39% girls and none of the boys were at ED risk after the follow-up (P = 0.000). All the subjects at ED risk showed a low TBW range at both points (baseline, P = 0.04; after the follow-up, P = 0.039). A probit binary model of repeated measures (151 healthy adolescent values were obtained considering every subject in both points of the study) was made to study the influence of sex, TBW (L), FM% on the ED risk. Positive associations between Sex-TBW interaction and ED risk (P = 0.000) as well as between FM% and ED risk (P = 0.020) were observed. These findings show that body composition, not only fat mass but also hydration status is related to ED risk, although it is well known that boys and girls show different hydration and fat patterns. The fact of being a female adolescent with low TBW and FM% values may predispose to a high ED risk. Therefore, sex-hydration interaction together with body composition should be further investigated for ED in adolescence.
Involvement of dietitians in diabetes care, results from a secondary care hospital in Greece
Authors: Pafili Zoe , Samara Sophia , Dimosthenopoulos Charilaos , Gkortzi Olga
Published: June 2020

Introduction

According to diabetes care standards nutrition therapy should be an integral part of diabetes management, and all individuals with diabetes should be referred to a registered dietitian for nutrition therapy at—or soon after—diagnosis and for ongoing follow-up. There is limited international data that indicate that a large percentage of people with diabetes have not received structured diabetes education and have not visited a dietitian. The aim of this study was to assess the involvement of dietitians in diabetes care in Greece.

Materials and Methods

All adult diabetic patients admitted to a secondary care general hospital in Greece during 30 consecutive days were included in the study. Patients admitted in the ICU, CICU, day clinics and hemodialysis patients were excluded. Data were obtained by personal interviews using a 40 item questionnaire which included 10 questions regarding number of visits to dietitians for diabetes management, whether patients were referred by their doctors or sought dietary advice by their own, reasons for visiting a dietitian, goal achievement and patient satisfaction.

Results

In total 124 patients (68 males and 56 females) with diabetes were admitted to the hospital during the study period (4 type 1, 114 type 2 and 6 pregnancy diabetes). Data were obtained from 3 (22.8 ± 6 yrs, 26.1 ± 5.7kg/m2,8.3 ± 5.9 yrs with diabetes),105 (76.6 ± 11.3 yrs, 28.0 ± 5.3 kg/m2, 12.8 ± 9.3 yrs with diabetes), and 5 (32.6 ± 4.4 yrs, 28.5 ± 4.0 kg/m2) patients with type 1, type 2 and pregnancy diabetes respectively. Two out of 3 type 1 diabetes and 1 out of 5 patients with pregnancy diabetes interviewed reported to have been referred to a dietitian by their doctor. Only 5.7% (6 patients) of type 2 diabetes patients reported to have been referred to a dietitian by their doctor and another 5.7% have visited a dietitian on their own initiative. Five out of 6 referrals were at diabetes diagnosis. The number of encounters with a dietitian ranged from 1 to 24 with patients seeking to loose weight having the greater number of encounters. Of type 2 diabetes patients 94.3% did not receive lifestyle advice before commencing diabetes medication whereas 25% did not receive any dietary advice by any health professional even after starting medication.

Conclusions

In our cohort the majority of diabetes patients had not received dietary counseling by a dietitian, whereas about one fourth of type 2 diabetes patients had not received any dietary advice.
Fluid intake in children
Authors: Tláskal Petr , Baliková Marieta
Published: June 2020

Introduction

We monitored fluid intake in children. The hydration of children during morning school classes and on consumption of high-calorie drinks. Subclinical dehydration, expressed as urine osmolarity above 800 mmol / kg, may result in lack of concentration and less effective listening.

Population and methodology

The population included 3,360 children aged as follows: a) 6–35 months, b) 4–6 years, c) 7–10 years d) 11–14 years. 103 children aged 10.3 ± 1 years were included in the study regarding body hydration. The evaluation looked at the intake of food and fluids consumed by children in full-day diet over a period of 3 to 5 days and recorded by the Nutridan program. Child hydration was assessed using three urine osmolarity samples taken at bedtime, in the morning and just before lunch break. The data was evaluated statistically against the reference values for nutrient intake of DACH.

Results and discussion

The median water intake in children was 101–103% of the Dietary Reference Values (DRV). In the b, c, d groups, the median was 81% - 82%, i.e 75% of DRV. 10% of 4 to 6-year-old children had water intake below 49% of DRV, 10% of 7 to 10 year-olds less than 54% of DRV and 10% of 11 to 14-year-olds less than 50% of DRV. A study regarding school children has showed that only 70% of the children drink at breakfast. 27% of the children do not consume any fluids in the morning. The mean urine osmolarity was 724 in the morning and 738 mmol / kg just before lunch. Children who had drunk less than 250 ml of water during breakfast or less than 400 ml of water during breakfast and second breakfast had a urine osmolarity of 910 and 850 mmol / kg respectively just before lunch. In school children, the proportion of sugars received from sweetened beverages accounted for 19.1% of their total calorie intake. 10% of the children in groups c) and d) had this value higher than 28.2 and 30.4% respectively. The results based on full-day diet show that sweetened drinks account for 79% of fluids consumed by children at school, whereas only for 72% at home.

The results of our studies have identified the areas where it is necessary to provide education regarding nutrition of children, to raise awareness of the importance of fluid intake, particularly focusing on the systematic approach and the choice of appropriate beverages ensuring adequate fluid intake.
Screen-use, active-play and sleep behaviours in a nationally representative sample of infants, toddlers and pre-school children from the U.S.
Authors: Jacquier Emma , Lenighan Yvonne , Anater Andrea , Kinneman Brian
Published: June 2020

Introduction

Inadequate sleep, excessive screen-use and low-levels of physical activity may lead to an increased risk of childhood obesity. Caregivers during early childhood should limit screen-time, encourage active play and establish bedtime routines to ensure adequate sleep. The benefits of such may also extend to improved attention, learning, memory, psycho-social development and other factors. There is limited data on such lifestyle behaviours in infants and children in the U.S. Therefore, this analysis describes findings from the Feeding Infants and Toddlers Study (FITS) 2016.

Methods

FITS 2016 is a national, cross-sectional survey of caregivers of children aged 0–3.9 y in the U.S. Demographic data and information on feeding practices, sleep, physical activity and screen-use were collected using a questionnaire (n = 4380). Differences in behaviours across age groups were assessed using a one-way ANOVA or chi-squared tests.

Results

Children older than 12 months slept for an average of 9.6 (sd = 2.0) hours per night, which was significantly higher than infants (0–11.9mo) who slept for 8.9 (sd = 2.1) hours per night (P < 0.001). All children slept for approximately one hour during the day. There were no significant difference in the weekly hours spent in active play (mean = 20.8,sd = 16.5) between younger and older children, while participation in sports was higher among older versus younger children. However, time spent playing video games, watching TV videos/DVDs and using a screen was significantly higher in older versus younger children (P < 0.001). For example, infants spent 7.8 hours per week watching TV, compared to 9.4 hours in 3 year old children (P < 0.001). Approximately 65% of caregivers reported that they did not allow electronics in the bedroom, however this decreased with increasing age (P = 0.036). Consequently, 5% of infants (0–11.9mo) viewed a tablet or smartphone in their bedroom, compared to 26% of 3 year old children (P < 0.001).

Discussion

Recent guidelines from the American Academy for Pediatrics (AAP) recommend that children younger than 18 months avoid use of screen media, and that children aged 2–5 should limit screen-time to one hour per day. This data from the US FITS suggests that children are exceeding these recommendations. However, the current population are meeting the AAP physical activity recommendation of minimum 60 minutes/day. Furthermore, infants and children in this population are also failing to meet the AAP sleep recommendations. Therefore, further emphasis needs to be placed on the importance of limiting screen-time and promoting physical activity and positive sleep behaviours in this young population.
Daily consumption of 100% orange juice does not increase body weight in adults: a meta-analysis of randomised controlled trials
Authors: Ruxton Carrie , Horgan Graham , De Rycker Johan
Published: June 2020

There is convincing evidence that sugar-sweetened beverages increase the risk of body weight (BW) gain and higher body mass index. In contrast, observational studies on regular consumption of 100% fruit juice provide conflicting results, with most indicating a neutral impact on BW and body mass index, while others suggest positive or even inverse associations. The lack of agreement may be due to confounding factors, or studies incorrectly grouping sugar-sweetened juice drinks with 100% fruit juice, which by law does not contain added sugars.

Intervention studies provide an opportunity to investigate the short-to-medium term impact of daily 100% orange juice (OJ) on BW. From 17 available studies (none of which individually reported statistically significant BW gain following OJ consumption), 6 randomised controlled trials in adults (n = 236) were selected for a meta-analysis. Inclusion criteria were an OJ intervention group and a non-OJ control group. Comparison with a control group was essential as some were weight loss studies with additional BW loss components, and for consistency this comparison between groups was used for all studies.

The meta-analysis focussed on the differences in BW change between OJ and control arms of each study. Where the standard deviation (SD) or standard error (SE) of the change was not reported and could not be obtained from the authors, it was imputed by using the mean SD from studies where it was available. The combined effect estimate was obtained from a random effects model using the DerSimonian-Laird estimator. Cochran's Q statistic was used to test for study heterogeneity.

The resulting forest plot revealed no statistically significant change in BW following OJ intakes of 250–500 ml per day for 4 to 12 weeks (which would theoretically provide 102–205 kcal on average). The Q statistic was 10.6 (I2 = 53%, p = 0.059) while the combined effect estimate was -0.34 kg (95% CI -1.11, 0.43). Interestingly, a similar finding was noted in a meta-analysis (Onakpoya et al. 2017) investigating BW change and daily grapefruit juice consumption from 3 intervention studies (n = 233); mean difference -0.45 kg [95% CI:-1.06 to 0.16; I2 = 53%].

In conclusion, daily consumption of OJ does not appear to have an adverse impact on BW. This may be due to dietary energy compensation (conscious or unconscious) or a satiety effect linked with the low glycemic index of OJ (GI = 50).

Onakpoya I et al. (2017) Crit Rev Food Sci Nutr 57: 602–612.
Eating and lifestyle habits of overweight and obese teenagers in Thulamela municipality, South Africa
Authors: Mbhenyane Xikombiso , Ayuk Tambe Betrand , Ligege Ntovhedzeni
Published: June 2020

A survey made worldwide (including South Africa) revealed that most teenagers are overweight and obese and that they eat little nutritious food. Obesity and overweight are public health problems and need to be addressed from a community perspective. The reason for exploring this problem in this study was that South Africa has one of the highest rates of overweight and obesity in the world among urban and rural black women. The objective was to investigate the eating and lifestyle habits of overweight and obese female teenagers in Thulamela Local Municipality, Limpopo province, South Africa. This was an exploratory, descriptive study conducted amongst 125 female teenagers aged 13 to 18 years from rural schools in Thulamela Local Municipality. Eating and lifestyle habits, physical activity, meaning of healthy and unhealthy dietary habits, weight, height and body mass index were measured. A hundred and twenty-five questionnaires were completed and data were gathered on the demographics, anthropometry, social and lifestyle habits, nutrition-related problems, dietary patterns and dietary history of the participants. The BMI revealed that 34.4% were of normal weight, 39.2% overweight and 26.4 obese. Seventy percent of the respondents actively consumed meals in a day, 83% consumed starchy snacks, whilst 72% of the respondents carried lunchboxes to school. Regarding lifestyle habits, 88% of the respondents slept more hours than recommended (8 hours) while 88% performed sedentary activities and 66% did physical activities such as walking. The results pointed out unhealthy eating and lifestyle habits influencing teenagers’ weight and provided information on which of these must be considered in order to develop tailored nutrition interventions, improving teenagers’ consciousness about s adopting a healthy lifestyle.
Food and nutrient intake of children and adolescents living in Germany: results from EsKiMo II
Authors: Barbosa Clarissa Lage , Brettschneider Anna-Kristin , Haftenberger Marjolein , Lehmann Franziska , Richter Almut , Mensink Gert B.M.
Published: June 2020

Introduction

An appropriate diet is particularly important for development, growth and health of children and adolescents. The living and social environments, as well as the food market and dietary habits have changed in recent decades. The second “Eating Study as a KiGGS Module” EsKiMo II (2015–2017) provides a current overview of the food and nutrient intake of children and adolescents living in Germany.

Material and Methods

About ten years after EsKiMo I (2006; N = 2,506), EsKiMo II (2015–2017) investigated the dietary behavior of 2,644 children and adolescents aged six to 17 years who previously participated in the second wave of the “German Health Interview and Examination Survey for Children and Adolescents” (KiGGS Wave 2) of the Robert Koch Institute. Food intake of the 6–11 year-olds was assessed by weighted food records on three consecutive days and one independent day. Adolescents (12–17 years) were interviewed about their food intake during the past four weeks using the Dietary Interview Software for Health Examination Studies (DISHES). Individual food group intake was compared with the food based dietary guidelines for children and adolescents in Germany. Energy and nutrient intake was calculated using the German Nutrient Database (BLS 3.02); intake from supplements was included. Individual intakes were compared with the Estimated Average Requirements (EAR) for Nordic countries.

Results

Most children and adolescents do not achieve the recommendation for fruits, vegetables, and milk/dairy products, whereas the maximal recommended intake of meat and “tolerated foods”, such as sweets and soft-drinks, is exceeded by almost all children and adolescents.

The mean energy intake proportions (En%) for macronutrients correspond to the reference values. The majority of children and adolescents have intakes above the EAR for most micronutrients, except for iodine and vitamin D for all age groups and gender, and iron for the 12–17-year-old girls.

Discussion

EsKiMo II observed that the majority of the 6–17-year-olds is adequately supplied with macronutrients and most vitamins and minerals. Vitamin D and iodine supply are critical for all age groups and gender. However, there is much potential to improve food consumption patterns. These results are relevant for decision-making, and evaluation of nutrition, consumer and health policies.
How achievable are free sugar recommendations in healthy dietary patterns for 1–5 year olds in Ireland?
Authors: Quinn S.F. , Creane R.J. , O'Donovan C.B. , O'Mahony S. , Collins N.A. , Lyons O.C. , Flynn M.A.T.
Published: June 2020

The World Health Organisation (WHO) strongly recommends reducing free sugar intake to < 10% energy, and suggests a further conditional reduction to < 5% energy. This study aims to assess how achievable these free sugar intake recommendations are in healthy diets of 1–5 year olds in Ireland and to identify the main food contributors.

Using minimal added sugar, fat and no added salt, four-day food intake patterns were developed for 1–5 year old children (n30 girls; n30 boys) representing different percentile levels on the WHO growth charts. These food intake patterns were based on foods commonly consumed in the Irish National Pre-school Nutrition Survey and adjusted to meet energy, macronutrient and micronutrient requirements. The free sugar content of each food used was identified according to the WHO definition and estimated using food composition tables. Free sugar content of the four-day patterns was assessed against the two WHO recommendations. Subjects were compared depending on recommendations achieved. Where necessary, nutrients were estimated per 500kcal to control for energy.

Food intake patterns of all subjects (n60) achieved the WHO recommendation of < 10% energy, with 50% (n30) meeting the further recommendation of < 5% energy. Subjects with free sugar intakes < 5% energy compared with those not meeting this recommendation, were younger (2 years vs. 3.5 years, p < 0.001), had lower energy intakes (946kcal vs. 1263.8kcal, p < 0.001), higher fat intakes (37% vs. 29%, p < 0.001), higher saturated fat intakes (18% vs. 13%, p < 0.001) and lower carbohydrate intakes (46% vs. 53%, p < 0.001). When estimated per 500kcal they had lower intakes of fibre (5.0 g vs. 6.2 g, p < 0.001) and vitamin D (5.9μg vs. 6.3μg, p < 0.001) and higher intakes of vitamin A (177.3μg vs. 108.5μg, p < 0.001) and DHA and EPA (0.3 g vs. 0.2 g, p < 0.001). The main foods contributing to free sugar intakes in these subjects were cereals (29% of free sugar intake), yoghurts (27%), breads (5%) and ice cream (4%). By comparison the main foods contributing to free sugar in subjects whose intakes exceeded 5% energy included yoghurts (22%), stewed apples (9%) and puddings (6%).

This analysis demonstrates the WHO strong recommendation of < 10% energy for free sugar was easily achievable, but the further conditional recommendation (< 5%) was more difficult. This was only achieved at younger ages and was associated with increased intakes of fat and saturated fat and lower intakes of fibre and vitamin D. The main food contributors to free sugar in healthy diets for 1–5 year olds are important sources of nutrients.