The Nutrient Balance Concept: A New Quality Metric for Composite Meals and Diets.

BACKGROUND: Combinations of foods that provide suitable levels of nutrients and energy are required for optimum health. Currently, however, it is difficult to define numerically what are 'suitable levels'. OBJECTIVE: To develop new metrics based on energy considerations-the Nutrient Balance Concept (NBC)-for assessing overall nutrition quality when combining foods and meals. METHOD: The NBC was developed using the USDA Food Composition Database (Release 27) and illustrated with their MyPlate 7-day sample menus for a 2000 calorie food pattern. The NBC concept is centered on three specific metrics for a given food, meal or diet-a Qualifying Index (QI), a Disqualifying Index (DI) and a Nutrient Balance (NB). The QI and DI were determined, respectively, from the content of 27 essential nutrients and 6 nutrients associated with negative health outcomes. The third metric, the Nutrient Balance (NB), was derived from the Qualifying Index (QI) and provided key information on the relative content of qualifying nutrients in the food. Because the Qualifying and Disqualifying Indices (QI and DI) were standardized to energy content, both become constants for a given food/meal/diet and a particular consumer age group, making it possible to develop algorithms for predicting nutrition quality when combining different foods. RESULTS: Combining different foods into composite meals and daily diets led to improved nutrition quality as seen by QI values closer to unity (indicating nutrient density was better equilibrated with energy density), DI values below 1.0 (denoting an acceptable level of consumption of disqualifying nutrients) and increased NB values (signifying complementarity of foods and better provision of qualifying nutrients). CONCLUSION: The Nutrient Balance Concept (NBC) represents a new approach to nutrient profiling and the first step in the progression from the nutrient evaluation of individual foods to that of multiple foods in the context of meals and total diets.

Safety of supplementing infant formula with long-chain polyunsaturated fatty acids and Bifidobacterium lactis in term infants: a randomised controlled trial.

Probiotics and long-chain PUFA (LC-PUFA) may be beneficial supplements for infants who are not breast-fed. The aim of the present study is to evaluate the safety of an infant formula containing the LC-PUFA DHA and arachidonic acid (AA) and the probiotic Bifidobacterium lactis by comparing the growth rate of infants fed the supplemented and unsupplemented formulas. One hundred and forty-two healthy, term infants were enrolled in a single-centre, randomised, double-blind, controlled, parallel-group trial, and allocated to receive either standard or probiotic and LC-PUFA-containing experimental formulas. The infants were fed with their assigned formulas for 7 months. The primary outcome (weight gain) and the secondary outcomes (length, head circumference and formula tolerance) were measured throughout the study. LC-PUFA status was assessed at 4 months of age and immune response to childhood vaccines was measured at 7 months of age. There was no significant difference in growth between the two groups. The 90 % CI for the difference in mean weight gain was - 0.08, 3.1 g in the intention-to-treat population and 0.1-3.8 g in the per protocol population, which lay within the predefined boundaries of equivalence, - 3.9-3.9. There were no significant differences in mean length and head circumference. DHA and AA concentrations were higher in infants in the experimental formula group compared with the control formula group. No influence of the supplements on the response to vaccines was observed. Growth characteristics of term infants fed the starter formula containing a probiotic and LC-PUFA were similar to standard formula-fed infants.

Gastric emptying in healthy newborns fed an intact protein formula, a partially and an extensively hydrolysed formula.

BACKGROUND & AIMS: Gastric emptying (GE) is influenced by the type of nutrition. The objective of this study was to compare GE in infants fed an intact protein formula (IPF), a partially hydrolysed formula (PHF), and an extensively hydrolysed formula (EHF). METHODS: This was a double-blind, randomized, cross-over study. Following a fasting period of > or = 3 h, 20 healthy newborns were fed IPF, PHF, and EHF containing 50 microl (13)C-octanoic acid (OA). Breath samples were taken before feeding and every 15 min for 4 h thereafter. (13)C-OA breath test was assessed by isotope-ratio mass spectrometry, and GE half-times (t(1/2)) were determined. RESULTS: Seventeen infants with a mean gestational age of 37 wk (range 28-40 wk) and birth weight of 2698 g (range 720-3690 g) completed the study. At study initiation, the mean age was 31 d (range 6 d-13 wk) and the mean weight was 3466 g (range 2100-5700 g). EHF emptied significantly faster than IPF and PHF (medians 46 vs. 55 and 53 min, respectively, Wilcoxon, P<0.05 for both). There was no significant difference between GE of PHF and IPF (Wilcoxon, P=0.2). CONCLUSIONS: EHF may be better tolerated by infants with GE problems.

Does maternal docosahexaenoic acid supplementation during pregnancy and lactation lower BMI in late infancy?

We compared growth of infants whose mothers either did or did not receive docosahexaenoic acid (DHA) supplements during pregnancy and lactation. At 21 weeks' gestation, 144 women were enrolled into a randomized, double-blind clinical trial receiving: (1) a basic supplement consisting of vitamins and minerals (BS), or (2) BS plus 4.5 g fructooligosaccharide (BSF), or (3) BSF plus fish oil DHA (200 mg) until the end of the third month of lactation. Infants' length, weight and head circumference were measured at birth and at 1, 3 and 21 months. A total of 51 mothers/infants were lost to follow-up by the third month and 24 at 21 months. The two groups not receiving DHA were combined into a control group. Analysis with mixed models adjusted for confounding factors showed a significant time dependent effect for the DHA group on the development of the body mass index (BMI) (P=0.037), and of weight (P=0.046), but no effect on the development of length (P=0.537), or of head circumference (P=0.267). At 21 months, weight of the DHA group was lower by -601 g (95% CI -171; -1030 g) and BMI was lower by -0.76 kg/m(2) (95% CI -0.07; -1.46) compared to controls. The results indicate that DHA taken by pregnant and lactating mothers may reduce BMI in late infancy.

Comparison of the effects of zinc alone and zinc associated with selenium and vitamin E on insulin sensitivity and oxidative stress in high-fructose-fed rats.

PURPOSE: In the present study, we investigated the effect of an association of micronutrients (zinc (Zn), selenium (Se) and vitamin E (vit E)) on insulin activity and antioxidant status in an animal model of insulin resistance, the high-fructose-fed rat. PROCEDURES: Five experimental groups were compared: a control group (C) receiving a standard diet, a high-fructose-fed group (F) where 58% of the diet carbohydrate was fructose, a high-fructose-fed group supplemented with Zn alone (FZn group), a high-fructose-fed group supplemented micronutrients (Zn, Se and vit E) (FMicro group). A fifth group consumed a high-fructose diet and received metformin in the drinking water (200mg/day/rat) (FMet group). Insulin sensitivity was measured using the euglycemic hyperinsulinic glucose clamp technique. Metabolic parameters, trace elements and antioxidant parameters were measured in blood samples from all groups. RESULTS: High-fructose-fed rats were resistant to insulin as indicated by the lower glucose infusion rate. The insulin sensitivity of FZn, FMicro and FMet groups was higher than that of F group, with the highest insulin sensitivity for the FMicro group. No statistically significant difference in glycemia between the groups was observed. The ratio of reduced to oxidized glutathione was higher in FZn and FMicro groups than in all other groups, as a consequence of decreased oxidized glutathione. CONCLUSION: Our results provide direct evidence that micronutrients have a beneficial effect on insulin sensitivity and some components of the antioxidant defense system in an animal model of insulin resistance.

Substitution of casein by beta-casein or of whey protein isolate by alpha-lactalbumin does not affect mineral balance in growing rats.

Bovine milk protein fractions that enable modification of the protein composition and amino acid profile of infant formulas to mimic those of human milk have recently become available. To determine the effects on protein quality and mineral bioavailability of replacing casein by beta-casein and of whey protein isolate by alpha-lactalbumin, 4 groups of growing rats were fed for 3 wk diets containing 10% protein as 1) casein (control); 2) beta-casein; 3) casein:whey (40:60); or 4) beta-casein:alpha-lactalbumin (40:60). Protein quality, determined as protein efficiency ratio (PER), net protein utilization (NPU), biological value (BV) and protein digestibility (PD), as well as body weight gain, were higher (P < 0.05) with consumption of the whey-adapted diets [casein:whey (40:60); beta-casein:alpha-lactalbumin (40:60)] compared with the casein diets (casein; beta-casein); however, there were no differences between the 2 casein diets or between the 2 whey-adapted diets. Apparent absorption of minerals (Ca, P, Fe, Zn) from the whey-adapted diets was higher than that from the casein diets (P < 0.05); but again, no differences were observed when casein or whey protein isolate were replaced by beta-casein or alpha-lactalbumin, respectively. Thus, substitution of casein by beta-casein or of whey protein isolate by alpha-lactalbumin does not affect protein quality or mineral bioavailability as determined in growing rats.

Water and food consumption patterns of U.S. adults from 1999 to 2001.

OBJECTIVE: High water consumption has been proposed as an aid to weight control and as a means of reducing the energy density of the diet. This study examines the relationship between water consumption and other drinking and eating patterns. RESEARCH METHODS AND PROCEDURES: The National Health and Nutrition Examination Survey 1999 to 2001, with responses from 4755 individuals > or =18 years of age, provides the data for this cross-sectional analysis. A cluster analysis was performed using z-scores of specific food and beverage consumption to examine patterns. A multinomial logit analysis was used to examine sociodemographic characteristics of each dietary pattern and to examine the effects of water consumption on the likelihood of consuming a non-dairy caloric beverage. All results were weighted to be nationally representative and controlled for design effects. RESULTS: Within the sample, 87% consumed water, with an average daily consumption of 51.9 oz (1.53 liters) per consumer. Water consumers drank fewer soft/fruit drinks and consumed 194 fewer calories per day. Water consumers (potentially a self-selected sample) consumed more fruits, vegetables, and low- and medium-fat dairy products. Four distinct unhealthy dietary patterns were found that included little or no water consumption. Older and more educated persons used healthier food patterns. Mexican dietary patterns were much healthier than dietary patterns of blacks. DISCUSSION: Water consumption potentially is a dietary component to be promoted, but much more must be understood about its role in a healthy diet. Because high water consumption is linked with healthier eating patterns-patterns more likely to be followed by higher-educated, older adults-the target of water promotion and healthy diet options should focus on younger and less educated adults.

Stable isotope-enriched selenite and selenate tracers for human metabolic studies: a fast and accurate method for their preparation from elemental selenium and their identification and quantification using hydride generation atomic absorption spectrometry.

Stable isotope tracers are safe and nutritionally relevant tools for the investigation of mineral metabolism in man. Increased research into the functional role of selenium has resulted in a need for well-characterised, isotopically enriched solutions of the element in order to determine the nutritional relevance of selenium fortification of foods. A simple method for the conversion of isotopically enriched elemental selenium (2.5-10 mg) into selenite and selenate, and their accurate characterisation and quantification is described. Analysis of selenite and selenate tracers using continuous-flow hydride generation-atomic absorption spectrometry technique was based on the specificity of the selenium hydride reaction and allowed their precise (RSD<2.5%) and accurate determination in aqueous solutions. The detection and determination limits were at 0.13 and 0.36 microg Se/l, respectively. Isotopically enriched elemental selenium was converted into selenite and selenate by a nitric acid and a combined nitric acid/hydrogen peroxide oxidation, respectively. The conversion was quantitative (>95%) and specific for both inorganic selenocompounds. Selenite and selenate labels were stable in 0.1 mol/l nitric acid for at least 18 months, i.e. making them ideally suitable for use in long-term metabolic studies. An overview of data relating to the absorption and retention of selenium by humans obtained using the two, well-characterised, tracers is presented and indicates that selenite and selenate are equally well retained in adult men and infants, despite differences in their absorption and urinary excretion characteristics.

Dephytinisation of soyabean protein isolate with low native phytic acid content has limited impact on mineral and trace element absorption in healthy infants.

Infant formulas based on soyabean protein isolate are often used as an alternative to cows'-based formulas. However, the presence of phytic acid in soya formulas has raised concern about the absorption of trace elements and minerals from these products. The aim of the present study was to evaluate mineral and trace element absorption from regular and dephytinised soya formula in healthy infants. Soyabean protein isolate with a relatively low native content of phytic acid was used for production of a regular soya formula (300 mg phytic acid/kg liquid formula) and an experimental formula was based on dephytinised soya protein isolate (<6 mg phytic acid/kg liquid formula). Using a crossover study design, apparent mineral and trace element absorptions were measured by a stable isotope technique based on 72 h faecal excretion of non-absorbed stable isotopes (Zn, Fe, Cu and Ca) and by the chemical balance technique (Mn, Zn, Cu and Ca) in nine infants (69-191 d old). Fe absorption was also measured by erythrocyte incorporation 14 d after intake. The results from the present study demonstrated that Zn absorption, measured by a stable isotope technique, was significantly greater after dephytinisation (mean value 16.7 v. 22.6 %; P=0.03). No other statistically significant differences between the two formulas were observed. The nutritional benefit of dephytinisation was marginal in the present study. Based on these results, the use of soyabean protein isolate with low native content of phytic acid should be promoted for production of soya formulas and adequate addition of ascorbic acid to enhance Fe absorption should be ensured in the products.

The DASH diet and sodium reduction improve markers of bone turnover and calcium metabolism in adults.

Dietary strategies to prevent and treat osteoporosis focus on increased intake of calcium and vitamin D. Modification of whole dietary patterns and sodium reduction may also be effective. We examined the effects of two dietary patterns and three sodium levels on bone and calcium metabolism in a randomized feeding study. A total of 186 adults, aged 23-76 y, participated. After a 2-wk run-in period, participants were assigned randomly to diets containing three levels of sodium (50, 100 and 150 mmol/d) to be consumed for 30 d in random order. Serum osteocalcin (OC), C-terminal telopeptide of type I collagen (CTX), fasting serum parathyroid hormone (PTH), urinary sodium, potassium, calcium and cAMP were measured at baseline and at the end of each sodium period. The Dietary Approaches to Stop Hypertension (DASH) diet reduced serum OC by 8-11% and CTX by 16-18% (both P < 0.001). Urinary calcium excretion did not differ between subjects that consumed the DASH and control diets. Reducing sodium from the high to the low level significantly decreased serum OC 0.6 microg/L in subjects that consumed the DASH diet, fasting serum PTH 2.66 ng/L in control subjects and urinary calcium 0.5 mmol/24 h in both groups. There were no consistent effects of the diets or sodium levels on urinary cAMP. In conclusion, the DASH diet significantly reduced bone turnover, which if sustained may improve bone mineral status. A reduced sodium intake reduced calcium excretion in both diet groups and serum OC in the DASH group. The DASH diet and reduced sodium intake may have complementary, beneficial effects on bone health.

[A study on absorption and utilization of calcium, iron and zinc in mineral-fortified and dephytinized soy milk powder consumed by boys aged 12 to 14 years].

OBJECTIVES: In order to understand the absorption and utilization of calcium, iron and zinc in cow milk, soy milk powder and dephytinized soy milk powder in the children and adolescents, and to lay a foundation for the improvement of protein and mineral nutrition in Chinese residents with popularizing consumption of soy milk powder. METHODS: Totally, 57 boys aged 12 to 14 years were selected and divided into three groups, matched by age, hemoglobin concentration, height and weight. The boys were given 220 ml of fortified and dephytinized soy milk, soy milk or cow milk, respectively, containing calcium 270 mg, iron 4 mg and zinc 4 mg, which were labeled with stable isotopes (44)Ca, (58)Fe and (70)Zn in a single serving size, and their feces were labeled with brilliant blue and dysprosium. Feces specimens were collected for all the subjects and absorption rate of calcium, iron and zinc were measured for all the children who took fortified and dephytinized soy milk, soy milk or cow milk, respectively. Calcium in feces was measured with heat ionized mass spectrometry, and recovery of (58)Fe and (70)Zn in feces and content of dysprosium were measured with induction coupling iso-ionic mass spectrometry, and then absorption rates of iron and zinc were calculated and adjusted by the recovery rate of dysprosium. RESULTS: Iron absorption rate was (6.7 +/- 3.8)% in soy milk powder group, (15.5 +/- 9.2)% in the cow milk group and (20.6 +/- 7.3)% in dephytinized soy milk powder group, respectively. Calcium absorption rate was (43.5 +/- 10.7)%, (64.2 +/- 11.4)%, and (50.9 +/- 6.6)% in the three groups, respectively. Absorption rate of zinc was (11.3 +/- 6.5)%, (31.2 +/- 10.4)% and (20.1 +/- 7.4)%, respectively. Significant increase in absorption of calcium, iron and zinc was observed in the groups with fortified and dephytinized soy milk powder, as compared with those consuming nondephytinized soy milk powder. Absorption rate of calcium and zinc was significantly higher in the group with cow milk than that in the group with dephytinized and fortified soy milk powder, and iron bioavailability was lower in the group with cow milk than that with dephytinized soy milk powder, with no significant difference. Absorption rates of calcium, iron and zinc were higher in children of China due to their long term adaptation to dietary intake of lower mineral and protein, and higher fiber. CONCLUSIONS: Bioavailability of calcium, iron and zinc in soy milk powder could be increased by dephytinized treatment for it.

[Effect of long term supplementation of mineral-fortified dephytinized soy milk powder on biomarkers of bone turnover in boys aged 12 to 14 years].

OBJECTIVES: In order to understand the effect of long term consumption of mineral-fortified dephytinized soy milk powder on skeletal health in children, biological effects of mineral-fortified dephytinized soy milk powder, dephytinized mineral-unfortified soy milk powder and fresh mineral-fortified cow milk were compared. METHODS: Totally, 90 boys aged 12 to 14 years were involved in the study and were given daily with mineral-fortified dephytinized soy milk powder, dephytinized soy milk powder and fresh fortified cow milk, respectively, for two months. The blood samples were collected from all the subjects for measuring activity of serum bone specific alkaline phosphatase and serum level of oesteocalcin, and the urine samples were collected for determining urine C-terminal telopeptides of type I collagen (CTx). RESULTS: After two-month intervention, serum level of oesteocalcin increased significantly in the all groups, (16.42 +/- 11.25) micro g/L for the group with fortified soy milk powder, (18.86 +/- 11.57) microg/L for the group with unfortified soy milk powder and (13.81 +/- 10.06) microg/L for the group with fortified cow milk, respectively. The activity of bone specific alkaline phosphatase significantly decreased in the all groups, by (0.28 +/- 0.40) micromol x s(-1) x L(-1) for the group with fortified soy milk powder, (0.26 +/- 0.35) micromol x s(-1) x L(-1) for the group with unfortified soy milk powder, and (0.17 +/- 0.28) micromol x s(-1) x L(-1) for the group with fortified cow milk, respectively. As well as, urine level of CTx decreased significantly, by (349.1 +/- 380.3) mg/L for the group with fortified soy milk powder, (260.4 +/- 412.4) mg/L for the group with unfortified soy milk powder, and (354.4 +/- 404.7) mg/L for the group with fortified cow milk, respectively. CONCLUSIONS: Long term consumption of mineral-fortified and dephytinized soy milk powder could improve bone mass retention and calcium nutrition status efficiently in children.

Comparison of selenite and selenate apparent absorption and retention in infants using stable isotope methodology.

The inorganic selenium compounds selenite and selenate are used for selenium fortification of infant formulas. However, information on absorption and retention of selenium from these compounds is lacking. The purpose of this study was therefore to determine apparent absorption and retention of selenium from selenate and selenite added to a milk-based infant formula in healthy infants. Labeled test meals were prepared by addition of 10 microg Se as (76)Se-selenate or (74)Se-selenite to 500 mL formula. The two batches of labeled formulas were fed as alternate feeds during the first day of the balance period, followed by unlabeled formula. Selenium isotopes were determined in feces collected for 72h after intake and in 3 consecutive 24h collections of urine. Mean apparent absorption was 97.1% for (76)Se-selenate and 73.4% for (74)Se-selenite; mean difference 23.7% (range: 13.8%-35.7%; SD 6.8%, p < 0.001). Mean urinary excretion (% of ingested dose) was 36.4% ((76)Se-selenate) and 9.7% ((74)Se-selenite); mean difference 26.7% (range: 13.9%-36.5%; SD 5.9%, p < 0.001). Mean apparent retention of selenium from (76)Se-selenate and (74)Se-selenite was not significantly different, 60.7% ((76)Se-selenate) versus 63.7% (for (74)Se-selenite). The average difference was -3.01% (range: -14.0%-12.0%; SD 9.4%, p = 0.36). Although apparent selenium absorption and urinary excretion differed for selenite and selenate, selenium was equally well retained by infants from both selenium compounds. We therefore concluded that Se fortification of infant formulas with selenate or selenite can be expected to have similar impact on the selenium nutritional status of term infants.

Meal effect on magnesium bioavailability from mineral water in healthy women.

BACKGROUND: Magnesium intakes in many industrialized countries are below recommended daily allowances. Magnesium-rich mineral water may contribute to coverage of magnesium requirements by providing significant amounts of natural, energy-free, bioavailable magnesium. OBJECTIVE: The objectives were to determine magnesium bioavailability from magnesium-rich (110 mg/L) mineral water in healthy subjects when consumed alone and to evaluate the effect of simultaneous meal consumption. DESIGN: Magnesium bioavailability was measured in 10 healthy women with the use of a crossover design. Stable magnesium isotopes ((25)Mg and (26)Mg) were administered orally with mineral water, which was consumed with or without a meal. Apparent magnesium absorption was determined by fecal monitoring, and magnesium retention was determined from urinary excretion of magnesium isotopes. RESULTS: The mean (+/-SD) magnesium absorption from mineral water consumed alone was 45.7 +/- 4.6% (range: 40.2-55.5%) and was significantly greater (P = 0.0001) when it was consumed with a meal (52.3 +/- 3.9%; 46.2-60.2%), a relative difference of 14.4%. Magnesium retention also was significantly greater (P = 0.0004) when mineral water was consumed with a meal (41.5 +/- 4.2%; 35.2-50.6%) than when consumed alone (37.4 +/- 4.0%; 33.1-47.0%), a relative difference of 11.0%. CONCLUSIONS: In healthy young women, approximately 50% of the magnesium from magnesium-rich mineral water was absorbed when consumed alone. Magnesium bioavailability from mineral water is enhanced when the water is consumed with a meal, perhaps because of a slower gastrointestinal transit time, the presence of digestion products from the meal, or both. Regular consumption of magnesium-rich mineral water could make a valuable contribution to magnesium requirements.

Nutritional status of institutionalised elderly in Ecuador / Estado nutricional de ancianos institucionalizados en el Ecuador

The nutritional status of 111 elderly men and women aget 60 to 99 years in two institutions in the Ecuadorian Andes was evaluated using dietary, anthropometric and biochemical measurement. Mean daily energy intakes of men and women were 1720 and 1650 Kcal, respectively (7,2 and 6.9 MJ), corresponding to 1.5 times the calculated basal metabolic rate (BMR). 6 por ciento of subjects had intakes less tham 1.2 x BMR and 40 por ciento less than 1.5 x BMR. Body mass index (BMI) was below 20 kg/m2 in 21 por ciento of subjects; 45 por ciento were between 20 and 24. Only one subject had a BMI over 29. Intakes of protein, calcium, iron, riboflavin and vitamin C were satisfactory, in contrast to those of zinc, vitamin A, niacin and thiamin. Using sex-and altitude-specific cutoffs for hemoglobin, anemia was observed in 11 por ciento of subjects. Nutritional status, evaluated using biochemical indicators, was satisfactory with respect to riboflavin, vitamin A, vitamin E and copper. 14 por ciento of subjects had low serum zinc levels and 17 por ciento had serum albumin values below 35 g/L. Low physical activity was associated with low energy intake and low serum albumin levels