Comparison of the Nutritional Adequacy of Current Food-Based Very Low Energy Diets: A Review and Nutritional Analysis.

Very low energy diets (VLEDs) contain <800 kcal/day and typically comprise formulated meal replacement products with adequate protein and micronutrients. Food-based VLEDs are an alternative approach, but it is uncertain whether they can provide adequate nutrition within an 800 kcal/day restriction. This analysis aimed to assess the nutritional adequacy of food-based VLEDs compared with formula VLEDs. A systematized literature review was conducted to identify balanced food-based VLEDs by searching five scientific databases from inception to 23 March 2023 and online sources between 1 and 7 May 2023. Ultimately, nine diets were analyzed for nutritional content and compared with Codex Alimentarius standards for formula foods, and Australian estimated average requirement and adequate intake (AI) for adults 19-50 years. Optifast® was used as a comparator. None of the VLEDs met all nutritional benchmarks. Three food-based diets had nutrient profiles similar to formula VLEDs, with one being adequate for all nutrients except thiamine, magnesium and zinc in men and iron in women. All VLEDs, including Optifast®, did not meet AI for dietary fiber, except one. In general, food-based VLEDs offered more fiber than Optifast®. In conclusion, food-based VLEDs were inadequate in certain micronutrients but offered more dietary fiber than formula VLEDs. These nutritional deficits do not preclude food-based VLEDs from being recommended, provided they are addressed.

Contemporary Themes in Dietary Intake in Rugby Union Players: A Narrative Review.

Rugby union is an intermittent team sport with variability in body composition and match-play demands between positions which requires careful consideration for individual dietary requirements. While previous reviews have detailed the macronutrient intake in rugby players, none have discussed the further determinants of dietary intake in this population. Therefore, the purpose of the current review was to summarise the current evidence detailing dietary intake in rugby union players, report on contemporary nutritional research themes, and provide recommendations for athletes, nutritionists, and other stakeholders. In total, eighteen articles report on dietary intake in rugby players, with only one of these detailing dietary intake in female athletes. Recent studies have reported on both protein and carbohydrate periodisation practices in rugby union players; however, there is currently limited evidence as to the influence of these on performance, recovery, and well-being. Factors influencing eating patterns, the impact of sports nutritionists on dietary intake, and food consumption in catered and non-catered environments has been explored in isolated studies. Nutrition knowledge levels in rugby players have been reported in several studies; however, the influence this has on dietary intake in rugby players is unknown. Collectively, despite new contemporary themes emerging in the literature concerning dietary intake in rugby players, the studies are isolated; as such, there is limited scope to the translatability of information due to heterogeneity in sex, level of play, and location of participants. Given this, future research should aim to build upon the themes identified in this review in combination to support practitioners working within their specific environments. This will subsequently build towards the generation of rugby-specific recommendations.

Can micronutrient requirements be met by diets from sustainable sources: outcomes of dietary modelling studies using diet optimization.

BACKGROUND: Consumption of diets from sustainable sources is required for planetary health, however, large sections of the population, including females of reproductive age and children, will be at risk of not meeting their micronutrient (MN) requirements in a complete transition to plant-based foods. Constrained diet optimization methods use mathematical programming to construct diets that meet predefined parameters and may contribute towards modelling dietary solutions that meet nutritional and planetary targets. OBJECTIVE: Review the evidence from diet optimization studies proposing solutions to ensure MN availability in the context of a transition to diets from sustainable sources. APPROACH: Narrative review focusing on literature published over the last five years. RESULTS: Dietary modelling using diet optimization can design a range of omnivorous and plant-based diets that meet individual MN requirements, have reduced environmental impacts, and minimize deviation from culturally acceptable dietary practices. Using data from large-scale dietary surveys, diet optimization can support development of food-based dietary guidelines; identify limiting MNs in a particular context or a conflict between constraints e.g. nutrition and environment; explore food-based strategies to increase nutrient supply, such as fortification; and support trial design. Methods used and outcomes reported are sources of variability. Individual-level dietary data and MN requirements for population sub-groups such as females of reproductive age and children are important requirements. Although maintaining iron and zinc intakes are regularly reported to present challenges in diets from sustainable sources, few studies have considered bioavailability, which reduces with increased dietary phytate. These and other data gaps including acceptability and affordability must be addressed to improve the applicability of modelling outcomes in population recommendations. CONCLUSIONS: Dietary modelling using diet optimization can be useful in the design of more sustainable diets that meet MN requirements, however, translation of outcomes into dietary intervention studies is required to test real-world application and adoption into dietary guidelines.

A widespread shift towards plant-based diets could increase the risk of inadequate intakes of micronutrients typically sourced in foods of animal origin, particularly among females of reproductive age and children.Modelling of dietary intake data collected among individuals using techniques such as diet optimization could be helpful in guiding recommendations and intervention strategies; translation into intervention studies is required.Representative data in different population groups and settings, with methods incorporated to address data gaps on bioavailability of micronutrients, food fortification, and affordability, will improve the applicability of modelling outcomes.

Contemporary educational and behavior change strategies improve dietary practices around a match in professional soccer players.

BACKGROUND: The importance of nutrition in optimizing the health and performance of professional soccer players has been well established. Despite published practical recommendations for the dietary requirements for professional soccer players, many players fail to meet these guidelines. Thus, the primary purpose of this study was to assess the impact of targeted nutritional education and behavior change interventions on dietary intake in professional football players. Additionally, previous research within this population has reported elevations in resting metabolic rate (RMR) following match-play. Therefore, a further aim of this study was to examine whether any changes in dietary intake would influence RMR following match-play. METHODS: Twenty players from the professional development phase in an English Premier League club (age: 18.4 ± 1.0 years; body mass: 76.1 ± 6.0 kg; stature: 1.80 ± 0.07 m) were randomly assigned to an "Intervention" (INT) group (n = 10), who received numerous nutritional education and behavior change interventions, or a "Control" (CON) group (n = 10), who received no nutrition support. Dietary intake was assessed daily throughout the match-week (Match Day (MD)-2, MD-1, MD, MD + 1, and MD + 2), whilst RMR was assessed on MD-1, MD + 1, and MD + 2. Statistical analyses on the intervention effects on dietary intake and RMR were carried out using a two factor (group and day) analysis of variance (ANOVA) with a subsequent Bonferroni post-hoc test. RESULTS: Mean energy (3393 ± 852 vs. 2572 ± 577 kcal · day-1) and CHO (5.36 ± 1.9 vs. 3.47 ± 1.1 g · kg-1 BW · day-1) intake was significantly higher (p < 0.001) in the INT vs. CON group. Furthermore, the INT group implemented nutrition periodization practices as CHO intake was significantly increased on MD-1 (7.0 ± 1.7 g · kg-1 BM · day-1), MD (7.1 ± 1.4 g · kg-1 BM · day-1) and MD + 1 (5.1 ± 0.8 g · kg-1 BM · day-1). However, the CON group did not periodize their CHO intake and failed to meet the CHO recommendations on MD-1, MD, and MD + 1 (<4 g · kg-1 BM · day-1). Compared to MD-1, the RMR increased on MD + 1 and MD + 2 in both groups, although it was only statistically significant for the INT group (MD + 1 = +243 kcal · day-1; MD + 2 = +179 kcal · day-1). CONCLUSIONS: The implementation of targeted nutritional education and behavior change interventions resulted in improved dietary practices in professional football players and enabled better adherence to recommended guidelines. However, despite this, RMR was still elevated in the 24-48 h following match play. Thus, in order to optimize recovery, this finding further reinforces the need for professional football players to adopt strategies to meet energy, and particularly CHO, requirements in the acute period following a match in order to account for this increase in energy requirement.

Dietary Quality and Nutrient Intakes of Elite Paracyclists.

Nutrient requirements for para-athletes will be influenced by a variety of factors secondary to their impairment and, therefore, recommendations for para-athletes cannot be drawn directly from that of able-bodied athletes. Information on the dietary intakes of para-athletes is lacking and therefore needs to be examined. This study assessed the nutrient intakes and diet quality of 31 paracyclists via food frequency questionnaires. Based on the dietary reference intakes, most paracyclists consumed intakes above the recommended dietary allowance (RDA) or adequate intake (AI). Recommendations were not met for iodine (males = 87% RDA; females = 62% RDA) or fibre in males (84% AI). A 26% risk of inadequacy was noted for vitamins D and E in females. A total of 42% of females and 75% of males did not meet fibre recommendations (14 g/1000 kcal), and only three athletes (all females) consumed fatty acids in the recommended omega-6 to omega-3 ratio of 4:1 or less. Athletes consumed grains, fruits, and vegetables frequently, though whole grains, pulses, and oily fish were generally consumed less often. Paracyclists appear to be consuming intakes at or above recommendations for most nutrients, though several nutrients were consumed below the recommended amounts; therefore, increasing the variety of foods consumed is suggested.

An Evaluation of the Nutritional and Promotional Profile of Commercial Foods for Infants and Toddlers in the United States.

Despite growing concerns over the increasing popularity and health impact of commercial foods for infants and toddlers, no nutrition or promotional guidelines currently exist for the United States. In 2022, the WHO Regional Office for Europe published a nutrient and promotion profile model (NPPM) to provide guidance and regulation for commercially produced infant and toddler foods. This study assessed the nutritional and promotional profile of infant and toddler foods (6-36 months of age) collected from the top 10 grocery chains in 2023. Products were assessed against the WHO NPPM nutritional and promotional requirements. The type and number of claims across packaging type were also assessed. Of the 651 products examined, 60% failed to meet the nutritional requirements of the NPPM, and 0% met the promotional requirements. Almost 100% of products had at least 1 claim on-pack that was prohibited under the NPPM, with some products displaying up to 11 prohibited claims. Snack-size packages had the lowest compliance with nutrient requirements. These findings highlight that urgent work is needed to improve the nutritional quality of commercially produced infant and toddler foods in the United States. The high use of prohibited claims also suggests the need to regulate the type and number of claims allowed on-pack.

Nutrition for Children and Adolescents Who Practice Sport: A Narrative Review.

At a developmental age, adequate physical activity is fundamental to overall health and well-being and preventing obesity. Moreover, establishing active behavior can help children and adolescents meet their growth and neurodevelopmental goals. Nutritional requirements vary according to intensity, frequency, and practiced physical activity or sport; therefore, pediatricians should give children and adolescents and their families adequate counseling, avoiding both nutrient deficiencies and excessive or inadequate supplement intake. The focus should be not only on sports performance but also on the child's well-being, growth, and neurodevelopment. Our narrative review aims to discuss the nutritional needs of children and adolescents who practice physical activity, non-competitive sports activity, and elite sports activity while also analyzing the role of food supplements and the risk of eating disorders within this category of subjects.

ESPEN practical guideline on clinical nutrition in hospitalized patients with acute or chronic kidney disease.

BACKGROUND AND AIMS: Hospitalized patients often have acute kidney disease (AKD) or chronic kidney disease (CKD), with important metabolic and nutritional consequences. Moreover, in case kidney replacement therapy (KRT) is started, the possible impact on nutritional requirements cannot be neglected. On this regard, the present guideline aims to provide evidence-based recommendations for clinical nutrition in hospitalized patients with KD. METHODS: The standard operating procedure for ESPEN guidelines was used. Clinical questions were defined in both the PICO format, and organized in subtopics when needed, and in non-PICO questions for the more general topics. The literature search was from January 1st, 1999 until January 1st, 2020. Each question led to one or more recommendation/statement and related commentaries. Existing evidence was graded, as well as recommendations and statements were developed and agreed upon in a multistage consensus process. RESULTS: The present guideline provides 32 evidence-based recommendations and 8 statements, defining how to assess nutritional status, how to define patients at risk, how to choose the route of feeding, and how to integrate nutrition with KRT. In the final online voting, a strong consensus was reached in 84% at least of recommendations and 100% of statements. CONCLUSION: The presence of KD in hospitalized patients identifies a highly heterogeneous group of subjects with widely varying nutrient needs and intakes. Considering the high nutritional risk related with this clinical condition, an individualized approach consisting of nutritional status evaluation and monitoring, frequent evaluation of nutritional requirements, and careful integration with KRT should be planned to avoid both underfeeding and overfeeding. Practical recommendations and statements were developed, aiming at defining suggestions for everyday clinical practice in the individualization of nutritional support in this patient setting. Literature areas with scarce or without evidence were also identified, thus requiring further basic or clinical research.

Evaluating predictive equations for energy requirements throughout breast cancer trajectory: A comparative study.

BACKGROUND & AIMS: Accurately estimating resting energy requirements is crucial for optimizing energy intake, particularly in the context of patients with varying energy needs, such as individuals with cancer. We sought to evaluate the agreement between resting energy expenditure (REE) predicted by 40 equations and that measured by reference methods in women undergoing active breast cancer treatment stage (I-IV) and post-completion (i.e., survivors). METHODS: Data from 4 studies were combined. REE values estimated from 40 predictive equations identified by a systematic search were compared with REE assessed by indirect calorimetry (IC) using a metabolic cart (MC-REE N = 46) or a whole-room indirect calorimeter (WRIC-REE N = 44). Agreement between methods was evaluated using Bland-Altman and Lin's concordance coefficient correlation (Lin's CCC). RESULTS: Ninety participants (24 % survivors, 61.1% had early-stage breast cancer I or II, mean age: 56.8 ± 11 years; body mass index: 28.7 ± 6.4 kg/m2) were included in this analysis. Mean MC-REE and WRIC-REE values were 1389 ± 199 kcal/day and 1506 ± 247 kcal/day, respectively. Limits of agreement were wide for all equations compared to both MC and WRIC (∼300 kcal for both methods), including the most commonly used ones, such as Harris-Benedict and Mifflin ST. Jeor equations; none had a bias within ±10% of measured REE, and all had low agreement per Lin's CCC analysis (<0.90). The Korth equation exhibited the best performance against WRIC and the Lvingston-Kohlstadt equation against MC. Similar patterns of bias were observed between survivors and patients and between patients with stages I-III versus IV cancer. CONCLUSION: Most equations failed to accurately predict REE at the group level, and none were effective at the individual level. This inaccuracy has significant implications for women with or surviving breast cancer, who may experience weight gain, maintenance, or loss due to inaccurate energy needs estimations. Therefore, our research underscores the need for further efforts to improve REE estimation.

Hydroelectrolytic and nutritional needs of infants with epidermolysis bullosa during the first month of life.

Dehydration and malnutrition are common in infants with severe epidermolysis bullosa (EB), but their nutritional needs have been poorly studied. The principal aim was to assess the nutritional status, fluid and electrolyte balance, and nutritional intake of newborns with EB during the first month of life and estimate their needs during this period. This was a retrospective study over an eight-year period. Inclusion criteria were neonates with confirmed EB admitted to our neonatal referral unit during the first month of life. Exclusion criteria were hospitalisations <7 days. Twenty-seven patients with EB (mean [min-max] gestational age = 39 weeks [33; 41]; birth weight = 2986 g [1982; 4150]), were included. Four patients (15%) had hyponatraemia < 135 mmol/L at admission (age at admission = 4.8 days +/- 2.6 [2; 7]). Sixteen patients (59%) had a sodium deficit -requiring fluid and sodium intake well above recommendations from the World Health Organisation (WHO). The risk of hyponatraemia was significantly higher in infants with the greatest body surface area affected but did not appear to be related to EB subtype. Caloric and protein intake were well above the WHO's recommendations, preventing acquired growth restriction. The rate of sodium deficit in neonates with EB is high and related to the significance of skin exudate. The administration of nutrient intake greater than that recommended helps to prevent acquired growth restriction. We propose recommendations for nutritional intake and monitoring in neonates with EB in the first month of life.

A new system of phosphorus and calcium requirements for lactating dairy cows.

Accurately predicting phosphorous (P) and calcium (Ca) dietary requirements is critical for optimizing dairy cattle performance, and minimizing mineral excretions and ecosystems eutrophication. This study provides a new factorial system to determine net and dietary P and Ca requirements for maintenance and lactation, derived from a meta-regression of mineral trials involving lactating dairy cows. A comprehensive global database was constructed from 57 peer-reviewed articles of mineral balance trials, with a wide range of dietary and animal performance data. We estimated the net requirements for maintenance from the intercept of a nonlinear equation between mineral intake and the sum of total fecal and urinary excretions, which is an estimate of endogenous mineral loss. Mineral secreted in milk was used to obtain net requirements for lactation. The mineral metabolizable coefficient was quantified through observed (treatment means) mineral intake and total fecal and urinary excretions, discounting the estimated endogenous excretions from our proposed models. The nonlinear models of total fecal and urinary mineral excretion were evaluated (observed versus predicted values) using a 5-fold cross validation approach. The models to estimate the sum of endogenous fecal and urinary excretions of P (0.135±0.043 g P/kg BW0.75) and Ca (0.360±0.144 g Ca/kg BW0.75) exhibited suitable precision and accuracy; r = 0.89 and 0.79, concordance correlation coefficient = 0.85 and 0.77, and root mean square prediction error = 24.1 and 20.5% observed means, respectively. Dietary variables (forage level, fiber, starch, crude protein, and ether extract) did not affect the metabolizable coefficient (MC) of P and Ca; therefore, an overall dietary MC of P (0.69±0.01) and Ca (0.65±0.02) were proposed. Our new system estimates lower net and dietary P requirements for lactating dairy cows compared to the NASEM-2021 and NRC-2001 models, but slightly higher Ca requirements than NASEM-2021.This proposed system holds potential to reduce the use of phosphorus in diets for dairy cows, and thus to enhance economic efficiency and environmental sustainability of the dairy industry.

Differences in adult nutritional requirements impact the population growth and survival of two related species of rice leaffolders to produce interspecific differentiation.

Nutrition is a limiting feature of species evolution. The differences in nutritional requirements are the evolutionary result of differential adaptations to environmental changes, explaining differences in their ecological traits. Cnaphalocrocis medinalis and Cnaphalocrocis exigua, two related species of rice leaffolders, have similar morphology and feeding properties but different migration and overwintering behaviors. However, it is unclear whether they have evolved adult nutritional differentiation traits to coexist. To explore this issue, this study examined the effects of carbohydrates and amino acids on their reproductive and demographic parameters. The findings indicate that carbohydrate intake prolonged the longevity and population growth of two rice leaffolders, but amino acid intake promoted egg hatching only. However, nutrient deficiency made it impossible for C. medinalis to reproduce successfully and survive, but it did not affect C. exigua. The population expansion and survival of migratory C. medinalis relied on adult nutritional intake. Conversely, the nutrients necessary for C. exigua overwintering activity mostly came from the storage of larvae. The difference in nutritional requirements for population growth and survival between the two rice leaffolders partially explained their differences in migration and overwintering.

The potential contributions of bouillon fortification to meeting micronutrient requirements among women and preschool children in Senegal: A modeling study using household consumption and expenditure survey data.

To reduce micronutrient deficiencies, Senegal mandates the fortification of refined oil with vitamin A and wheat flour with iron and folic acid. Expanding Senegal's large-scale food fortification programs to include fortified bouillon could help fill the remaining gaps in dietary micronutrient requirements. Using 7-day household food consumption data collected between 2018 and 2019, we assessed the potential contributions of bouillon fortified with vitamin A (40-250 µg/g bouillon), folic acid (20-120 µg/g), vitamin B12 (0.2-2 µg/g), iron (0.6-5 mg/g), and zinc (0.6-5 mg/g) for meeting micronutrient requirements of women of reproductive age (WRA; 15-49 years old) and children (6-59 months old). Most households (90%) reported consuming bouillon, including poor and rural households. At modeled fortification levels, bouillon fortification reduced the national prevalence of inadequacy by up to ∼20 percentage points (pp) for vitamin A, 34 pp (WRA) and 20 pp (children) for folate, 20 pp for vitamin B12, 38 pp (WRA) and 30 pp (children) for zinc, and ∼8 pp for iron. Predicted reductions in inadequacy were generally larger among poor and rural populations, especially for vitamins A and B12. Our modeling suggests that bouillon fortification has the potential to substantially reduce dietary inadequacy of multiple micronutrients and could also help address inequities in dietary micronutrient inadequacies in Senegal.

Methods of Determining Energy Expenditure in Individuals with Prader-Willi Syndrome: A Systematic Literature Review.

Prader-Willi syndrome (PWS) is a rare disorder characterised by varying nutritional phases that occur throughout the lifespan, ranging from failure to thrive to hyperphagia. If uncontrolled, the imbalance between energy intake and expenditure results in obesity development and increased morbidity and mortality risk. Although measures of energy requirements for accurate nutrition assessment are vital, the evidence appears sparse and heterogeneous; hence, the aim of this review was to examine the available literature on energy expenditure predicted or measured using various methods in individuals with PWS. Studies were sought that presented methods and results on resting energy expenditure or basal metabolic rate. A narrative synthesis was completed to present the study characteristics and results. Methods of determining energy requirements included predictive equations and indirect calorimetry. Differences amongst ages, growth hormone therapy, fasting status, and measures in which results were presented were limitations to appropriately summarising and identifying trends in energy expenditure. Indirect calorimetry was identified as the most accurate method; however, it is not widely available in all settings. Further research is encouraged to support the development of valid and reliable predictive equations that will better inform and improve the efficiency of clinical practice in supporting people with PWS.

Organic Food in Athletes Diet-Narrative Review of Alternative Products in Sports Nutrition.

Athletes are characterized by special nutritional needs. Meeting their dietary needs associated with intensive exercise is a prerequisite for effective training and success in sports competitions. Hence, it is important to supply key performance nutrients, such as macronutrients, antioxidants, calcium, vitamin D, or iron, in adequate quantities. The increased need for these nutrients makes it necessary to look for food products on the market that more fully cover these needs. Such products may include organic foods. According to research, they have unique properties and are richer in selected nutrients, such as antioxidants. Hence, the aim of this review was to analyze the available literature as to whether organic foods have the potential to more fully cover the increased nutritional requirements of athletes for selected nutrients compared to conventionally produced foods. A narrative review of current literature was carried out. As the analysis showed, organic foods are characterized by a higher content of antioxidant bioactive compounds, a higher content of n-3 fatty acids, a better n:3/n:6 ratio, and a more optimal amino acid composition, which may result in an appropriate dietary ration design for athletes. In conclusion, organic food appears to be an interesting alternative to meet the special nutritional needs of professional and amateur athletes.

[Review of nutrition and hydration in relation to physical exercise during pregnancy]. / Revisión de la nutrición e hidratación con relación al ejercicio físico en el embarazo.

Introduction: Studies on nutritional recommendations for pregnant women who exercise are scarce. The objective of this article is not to focus on the diet of pregnant women as a whole, but to review those aspects of it that may be related to physical exercise. To this end, the nutritional and hydration recommendations contained in the main clinical practice guides on physical exercise during pregnancy are collected, including the first Spanish guides. Likewise, the energy requirements required by pregnant women who perform physical exercise during pregnancy for adequate gestational weight gain are addressed, aspects related to macronutrients in the aforementioned population group, and two specific topics, such as nutritional needs in the adolescent who practices physical exercise during pregnancy and eating disorders in pregnant athletes It is concluded by stating that pregnant women who exercise regularly should eat a varied and balanced diet, such as the Mediterranean diet, avoid long periods of fasting to avoid the appearance of hypoglycemia and maintain adequate fluid intake before, during and after physical exercise. Pregnant adolescents who engage in physical exercise require nutritional supervision to achieve adequate gestational weight gain. The pregnant athlete with an eating disorder has a higher risk of complications during pregnancy and childbirth, gynecological, fetal and neonatal, and, therefore, requires close monitoring by specialists in maternal-fetal medicine.

Introducción: Los estudios sobre recomendaciones nutricionales para la embarazada que realiza ejercicio físico son escasos. El objetivo de este artículo no es centrarnos en la dieta de la embarazada de forma global, sino revisar aquellos aspectos de la misma que pueden tener relación con el ejercicio físico. Para ello, se recogen las recomendaciones nutricionales y sobre hidratación contenidas en las principales guías de práctica clínica sobre ejercicio físico durante el embarazo, incluyendo las primeras guías españolas. Así mismo, se abordan los requerimientos energéticos que precisan las gestantes que realizan ejercicio físico durante el embarazo para una ganancia de peso gestacional adecuada, aspectos relacionados con los macronutrientes en el citado grupo de población, y dos temas específicos, como son las necesidades nutricionales en la adolescente que practica ejercicio físico durante su embarazo y los trastornos de la conducta alimentaria en deportistas embarazadas. Se concluye afirmando que las embarazadas que realizan ejercicio físico de forma regular deben llevar una dieta variada y equilibrada, como es la dieta mediterránea, eludir períodos largos de ayuno para evitar la aparición de hipoglucemias y mantener una adecuada ingesta de líquidos antes, durante y después del ejercicio físico. Las adolescentes embarazadas que realizan ejercicio físico requieren una supervisión nutricional para que alcancen una ganancia de peso gestacional adecuada. La deportista embarazada con un trastorno de la conducta alimentaria tiene un mayor riesgo de complicaciones durante el embarazo y parto, ginecológicas, fetales y neonatales, y, por tanto, requiere un estrecho seguimiento por especialistas en medicina maternofetal.

An error in concept and definition of recommended dietary allowance developed in 1941: Time to create new ones.

The recommended dietary allowance (RDA) for vitamin C differs greatly (40-110 mg/d) across countries. In addition, vitamin D deficiency is, effectively, a pandemic, with a prevalence of approximately 25% to 80% across countries according to the findings in the recent scientific literature. However, these phenomena are attributable to a serious error in the concept and definition of RDA, which was developed in 1941. The current definition of RDA is the average daily dietary nutrient intake level that is deemed sufficient to meet the nutrient requirements of almost all (97-98%) healthy individuals. This is an extremely high intake level for a specific nutrient affecting only a few individuals (the upper 2.5%) of the generally healthy population. The RDA should be redefined by investigating at which intake level of a specific nutrient the incidence of a specific disease or mortality increases or decreases based on prospective cohort studies.

Review: Update of nutritional requirements of goats for growth and pregnancy in hot environments.

Goats play an important role in the agricultural business, providing valuable income sources through producing high-quality animal protein. They are widespread livestock for rural households due to their inherent resiliency, adaptability to many environments, and suitability in sustainable production systems. While goats are reared in highly diverse environments, a great portion of their population is reared in hot environments. Heat stress is known to affect goats' productive and reproductive performance negatively. However, goats can remarkably thrive in harsh conditions due to physiological, metabolic, and molecular adaptive mechanisms. In the face of it, in the last decades, the nutrition of goats, particularly their nutritional requirements, has received special attention. Research groups worldwide have dedicated their efforts to updating feeding systems for goats. Our objective was to present the recent findings on the energy and nutrient requirements of growing and pregnant goats in hot environments. Energy and protein requirements for the maintenance and growth of goats are influenced by sex and genotype only when mature weight is not considered in the models. Sex and genotype affect the efficiency of energy use for growth but do not affect the efficiency of protein use. Major mineral requirements for maintenance and growth are not affected by sex, except for magnesium. However, the phosphorus, sodium, and potassium requirements of goats raised in hot environments differ from those in the feeding systems. This difference may be related to the adaptation mechanisms goats employ to cope with the hot environmental conditions. Regarding requirements for pregnancy, there was no effect of days of pregnancy on the energy or protein requirements. The efficiency of metabolizable energy utilization for pregnancy increased with the progress of pregnancy. Mineral accretion for pregnancy differs between single and twin pregnancies and, irrespective of pregnancy type, the mineral requirements increase as pregnancy progresses. The differences between the estimated dietary requirements of goats raised in hot environments and the most widely adopted feeding systems suggest that these goats may be using energy and nutrients to cope with heat stress and other stressors associated with hot environments. The recent findings on energy, protein, and mineral requirements of growing and pregnant goats can be an important resource of information for enhancing feeding systems worldwide.

Fortifying Micronutrient Supplementation in India: Indian Expert consensus.

Micronutrients play a key role in human health, being involved in energy metabolism, immunity, cellular functioning, growth, and development. Deficiencies in micronutrients occur in individuals of all ages due to several factors, including inadequate diets, disease states, and overweight/obesity. Guidelines from the Indian Council of Medical Research (ICMR) National Institute of Nutrition (NIN) Expert Group on Nutrient Requirements for Indians (2023) have specified the Recommended Dietary Allowances (RDA) for macronutrients and micronutrients. In addition, a healthy diet is crucial for overall health and should be the first step toward addressing micronutrient deficiencies. When diet is inadequate, micronutrient supplements can be provided to compensate. An expert panel of Indian doctors was convened to develop a pathway toward micronutrient supplementation among the Indian population. This Consensus Statement recognizes that different populations have varying needs for specific micronutrients, and ensuring adequate intake of such micronutrients can improve health outcomes. The panel provided recommendations for dietary practices and micronutrient supplementation when diet is inadequate. Addressing micronutrient deficiencies at the primary care level can prevent chronic deficiencies and their consequences. This Consensus Statement can serve as a primer for physicians to monitor and address deficiencies and thus help individuals maintain their health.

The art of establishing mineral tolerances of dogs and cats.

For over six decades, nutritional science has provided well-developed, peer-reviewed nutrient recommendations to support the health of dogs and cats. These guidelines are updated based on new scientifically valid research and appropriate peer-review. Recent regulatory and scientific positions around health issues have resulted in strong opinions and desires for rapid regulatory action surrounding mineral nutrition, but with limited and conflicting scientific evidence. Pet Food Institute nutrition experts have come together to jointly author an article on the complexities of establishing mineral tolerances of dogs and cats to illustrate the limitations in defining mineral tolerances. This discussion covers how mineral requirements were determined, including the opportunities and pitfalls encountered. Scientific councils must review and clarify any proposed changes in conducting mineral nutrition research that might impact complete and balanced foods and surrounding regulations. It is important to clarify the multiple issues in mineral nutrition research and the necessity for thorough evaluation of data while avoiding arbitrary and potentially harmful guidelines.

Dogs and cats are living longer and healthier lives due, in part, to the scientific development of nutritional information. This information has allowed the building of many new types of foods, treats, and supplements that promote life, health, and enjoyment by the pet. There are several organizations that have provided helpful reviews of nutritional data through scientific councils that help identify safe and healthy criteria for all pet food products. These are readily available for those who want to learn more about pet nutrition. For many nutrients, there is a large database of information to help build products. Nutrients that are called macro- or micro-/trace minerals (e.g., sodium, potassium, zinc, copper, etc.) often have more limited information. Recently, strong opinions about pet health as related to mineral nutrition have been shared and robustly communicated without adequate scientific research to support the hypotheses. This has led to misinformation, concerns, and fear. To safeguard the health of companion animals and provide assistance to regulatory bodies regarding the nutritional welfare of dogs and cats, scientific panels have come together from industry, government, and academia to review, approve, and challenge nutritional guidelines. This overview provides the reader context into the rigor needed to establish safe mineral tolerances for dogs and cats.