Development and validation of a computerized web-based quantitative food frequency questionnaire.

BACKGROUND & AIMS: Epidemiological research is progressing towards digital data collection. This study aimed to evaluate the validity and reproducibility of our new computerized, and easy-to-use Food Frequency Questionnaire (FFQ). METHODS: Participants' dietary intake was assessed using 24-h Dietary Recalls (DRs) and our FFQ, consisting of 133 food items and beverages. The software allows users to choose between three visualized portion sizes, categorizes the selections into food groups with three degrees of food processing levels, and produces a visualized output of the results. The reproducibility of the FFQ was evaluated based on two user submissions, and its validity was measured by comparing its calculated caloric intake and macro and micro-nutrient consumption to the equivalent mean values from three 24-h DRs. Thirty-nine women of fertility age [18-45] were recruited to the study, of whom twenty-six qualified for reproducibility testing and thirty-one qualified for validity testing. RESULTS: For most nutrient intakes, the FFQs yielded higher scores than the 24-h DRs, resulting in a less satisfactory agreement between them due to FFQs overestimation. The Intra Class Correlation (ICC) coefficient between the two FFQs ranged from moderate for calcium (0.55) to high for magnesium (0.83) (p < 0.05), indicating good reproducibility. Evaluation of food groups and processed food reproducibility scores yielded ICC coefficients ranging from moderate (0.53; super-processed foods) to high (0.83; non-processed foods) (p < 0.05). Spearman's correlation coefficient showed a moderate (sugar-sweetened beverages) to strong (non-processed foods) correlation (p < 0.05). CONCLUSIONS: The FFQ we developed and validated in this study showed moderate to high reproducibility and acceptable validity in a group of thirty-nine women of fertility age. Moreover, it is highly adjustable and easy to use, and its digital-based delivery enables large-scale, multilingual nutritional research.

Pregnancy after bariatric surgery: Effects of personalized nutrition counseling on pregnancy outcomes.

BACKGROUND & AIMS: Nutritional challenges following bariatric surgery can be intensified during pregnancy and may have crucial effects on the fetus, including lower birth weight. To the best of our knowledge, the effect of nutritional counseling during post-bariatric pregnancy to improve maternal diet quality and eating habits on neonatal outcome has not been evaluated. The aim of this research was to examine the effects of personal nutritional counseling during post-bariatric pregnancy on nutritional intake and neonatal outcomes. METHODS: We performed a non-randomized, intervention-control clinical trial. Women (n = 61) were divided into three groups; two prospective, and one retrospective: 1. An Intervention Bariatric Prospective group 2. A Control Prospective group without surgery, and 3. A Control Bariatric Retrospective group. Patient enrollment was performed from April 2016 to March 2018. The intervention program included biweekly visits with a pregnancy nutrition certified bariatric dietitian. Data collection was performed four times during pregnancy, and included demographic and eating habits questionnaires, 24 h dietary recall, and information about delivery outcomes. In the retrospective group delivery outcomes and Food Frequency Questionnaire was collected once, after delivery. RESULTS: There were no differences between groups at baseline except for a higher pre-pregnancy BMI in the post-bariatric groups. In the prospective groups, dietary protein, energy, and iron were found to be consumed in higher amounts in the Control-Prospective group than in the Intervention Bariatric-Prospective group (p < 0.05), without the addition of supplements. On the other hand, iron and calcium calculated from diet with supplements, were found to be significantly higher in the Intervention Bariatric Prospective group than in the Control Prospective group. In addition, consumption of saturated fats, oil, and salty snacks was lower in both prospective groups compared to the retrospective group (p < 0.05), suggesting better food quality habits for the bariatric group with nutritional counseling. Mean birth weight was significantly lower in the Control Bariatric Retrospective group than in the Control-Prospective group (3074 ± 368 g vs. 3396 ± 502 g, respectively. p = 0.023). In the Intervention Bariatric Prospective group, mean birth weight was 3168 ± 412 g, and no significant difference was observed from the Control Prospective group. Birth percentiles were also significantly lower in the Control Bariatric Retrospective group compared to the Control Prospective group (27th vs. 42nd, respectively. p < 0.05). In the Intervention Bariatric Prospective group, mean birth percentile was 35th, and no significant difference was observed from the Control Prospective group. As for the weight change of the woman during pregnancy, the highest variability was noted among the Control Bariatric Retrospective group with cases of weight loss up to 37 kg, due to conception close to the bariatric operation. Nevertheless, this variable was controlled, and showed no significant impact on birth weight results. CONCLUSIONS: Our results suggest that personalized nutritional counseling care during post bariatric pregnancy improved nutrient intake of mothers and may contribute to higher birth weight of offspring. Further research is needed to examine the effects of prenatal nutrition care intervention, in addition to repeating this trial with a larger sample size, to allow for clearer findings. CLINICAL TRIAL REGISTRATION: IRB number: 0310-15-RMB. IDENTIFICATION NIH NUMBER: NCT02697981 URL: https://www.nih.gov.

Sleep, screen time and behaviour problems in preschool children: an actigraphy study.

Inadequate sleep and excessive exposure to media screens have both been linked to poorer mental health in youth. However, the ways in which these interact to predict behaviour problems have yet to be examined using objective sleep measurement. The lack of objective evidence for these relationships in young children has recently been defined by the World Health Organization (2019) as a gap in the field. We thus aimed to test the interacting effects of screen exposure and objectively measured sleep on behaviour problems in the preschool age. A total of 145 children aged 3-to-6-years participated in this cross-sectional study. Sleep was assessed objectively using actigraphy for 1-week, and subjectively using parent-reported daily sleep diaries. Parents reported the child's daily duration of screen exposure, and completed the Strengths and Difficulties Questionnaire. Results showed that actigraphic sleep duration, timing and efficiency were associated with screen exposure. The link between screen time and behaviour problems was moderated by sleep duration, as it was significant only for children with sleep duration of 9.88 h or less per night. Sleep duration also moderated the relation between screen time and externalizing-but not internalizing-problems. Hence, the combination of increased screen exposure and decreased sleep duration may be particularly adverse for child mental health. While these key relationships should be further examined in longitudinal and experimental investigations, our findings shed light on their complexity, underscoring the importance of the moderating role of sleep.

Understanding the interplay between factors that influence bone mineral density in CF.

BACKGROUND AND OBJECTIVES: Multiple factors affect bone mineral density (BMD) in cystic fibrosis (CF). Our aim was to perform comprehensive analyses of parameters potentially contributing to BMD. METHODS: A prospective single-center study assessing BMD, and correlations with multiple parameters including pancreatic status, lung functions, 6-minute walk test (6MWT), clinical score (modified Shwachman-Kulczycki [SK] score), vitamin D, nutritional intake, hand grip strength (HGS), habitual physical activity (smart watches), and quality of life (SF-36 questionnaire). RESULTS: Forty CF patients, mean age 18.3 ± 8.1 years, forced expiratory volume in 1 second 74.7% ± 17.9% predicted. Fifteen (37.5%) and 11 (27.5%) had osteopenia and osteoporosis, respectively. BMD was similar in pancreatic sufficient (pancreatic sufficient [PS], n = 15) and insufficient (pancreatic insufficient [PI], n = 25); median hip z score -1.5 ((-2.7)-(+0.2)) vs -1.5 ((-3.5)-(+0.7)), P = .79; spine -0.8 ((-2.2)-(+2)) vs -1.2 ((-4.4)-(+1.5)), P = .39 in PS vs PI, respectively. BMD correlated with HGS (r = .72, P < .001 hip; r = .52, P = .001 spine) and fat-free mass index (r = .81, P < .001 hip; r = .63, P < .001 spine). BMD z score correlated weakly with SK score and moderately with SF-36 general health. Data from smart watches, nutrition questionnaires, and 6MWT did not correlate with BMD. In a multivariate model, age and SK score predicted spine z score BMD. CONCLUSIONS: A substantial number of CF patients have low BMD. Similar rates in PS and PI suggest that other factors, such as disease severity, may contribute to low BMD. SK and age, which can easily be obtained even with limited resources, were the best predictors of low BMD. Further larger multicenter studies are warranted to evaluate the contribution of multifactorial etiologies to low BMD in CF.

Reply to the Comment on "Revisiting the carrageenan controversy: do we really understand the digestive fate and safety of carrageenan in our foods?" by M. Weiner and J. McKim, Food Funct., 2019, 10: DOI: 10.1039/C8FO01282B.

This commentary re-emphasizes the aim of our recent review (David et al., 2018) and addresses some of the points raised in the adjacent commentary by M. Weiner and J. McKim, Food Funct., 2019, 10, DOI: 10.1039/C8FO01282B. In agreement with the commentary, the discussed review highlights the need to adequately understand the complex physicochemistry of the food additive carrageenan (CGN) and its fate in the alimentary canal. In fact, there is a realm of scientific findings that justify the continuation of an open discussion of CGN safety. This response emphasizes that there is sparse information on [i] the physicochemical properties of commercial CGN, [ii] human levels of exposure to CGN from foods, [iii] the role of CGN in gut microbiome dysbiosis and inflammation, and [iv] the effects of CGN on susceptible populations. As long as the determinants of the increased prevalence of chronic and autoimmune diseases are not identified, we must continue to explore the possible beneficial or deleterious effects that may arise from extrinsic factors, including food additives, and do so in meticulous independent studies.

Effects of Early Parent Training on Mother-Infant Feeding Interactions.

OBJECTIVE: This study examined whether professional behavioral and nutritional training for first-time mothers can improve feeding interaction at age 12 months. METHODS: Participants were 128 mother-infant dyads: 86 in the intervention group and 42 in the control group. The mean mothers' age was 30 years (±2.6). The intervention group received Mother-Infant Feeding Interaction (MI-FI) training: 4 weekly workshops for mothers when infants were aged 4 to 6 months old, followed by internet-based support by a dietitian and social worker until infants reached age 12 months. The control group received municipal well-baby clinic's standard mother-infant support. We assessed the mothers' tolerance to ambiguity and feeding-related reports. Blinded coders evaluated videotaped home mealtime interactions (age 12 months) using the Chatoor Feeding Scale (CFS). RESULTS: Significant intergroup differences emerged in mealtime interactions for 4 of the 5 CFS dimensions: dyadic conflict (MI-FI = 4.69 vs control = 8.38), talk and distraction (3.75 vs 4.90), struggle for control (2.30 vs 4.88), and maternal noncontingency (1.61 vs 2.75). Findings indicated significantly more positive mother-infant mealtime interactions and maternal responses to infant cues in the MI-FI group than in the control group. CONCLUSION: Very early maternal training may support the development of more positive mother-infant feeding interactions. This may contribute to preserved internal hunger and satiety cues and improved eating habits.

Digestive fate of dietary carrageenan: Evidence of interference with digestive proteolysis and disruption of gut epithelial function.

SCOPE: The objective of this study was to interrogate two mechanisms by which commercial Carrageenans (E407) (CGN) may adversely affect human health: (i) Through modification of gastric proteolysis and (ii) Through affecting gut epithelial structure and function. METHODS AND RESULTS: Three commercial CGN samples with distinct zeta-potentials (stable at the pH range of 3-7 and varied with physiological levels of CaCl2 ) were mixed with milk, soy or egg protein isolates, then subjected to a semi-dynamic in vitro digestion model and analyzed by SDS-PAGE. This revealed varying levels of interference with gastric digestive proteolysis and a significant decrease in pepsin activity. Further, a Caco-2 cell model was used to explore various effects of physiologically digested CGN (pdCGN) on various epithelial cell functions and characteristics. Samples of pdCGN (0.005-0.5 mg/mL) affected the epithelial barrier function, including redistribution of the tight-junction protein Zonula Occludens (Zo)-1, changes in cellular F-actin architecture and increased monolayer permeability to the transfer of macromolecules. Moreover, pdCGN induced elevation in the levels of the pro-inflammatory IL-8 receptor CXCR1. CONCLUSION: This work raises the possibility that CGN may reduce protein and peptide bioaccessibility, disrupt normal epithelial function, promote intestinal inflammation, and consequently compromise consumer health.

Vitamin D status in young HIV infected women of various ethnic origins: incidence of vitamin D deficiency and possible impact on bone density.

BACKGROUND: Decreased bone mineral density (BMD) was reported in HIV infected patients. Mechanisms leading to this decrease are poorly understood. AIMS: To assess factors relating to BMD in young HIV infected Israeli women of Ethiopian and Caucasian origin. PATIENTS AND METHODS: 75 young HIV infected women aged 34.5 ± 8.5 followed up at the Institute of Allergy, Clinical Immunology & AIDS filled a questionnaire about sun exposure, daily calcium intake and dress habits. Data about HIV status and treatment regimens were collected from the patients' charts. Serum hydroxyvitamin D [25(OH)D] levels, bone turnover markers and bone densitometry were evaluated. RESULTS: 28 (65%) of Ethiopians and 2 (6.25%) of Caucasians had 25(OH)D serum levels <10 ng/ml (vitamin D deficiency), p = 0.001. 21 (67.7%) Ethiopians and 16 (39%) Caucasians avoided sun exposure, p = 0.019. Mean daily calcium intake was 491 ± 268.6 mg and 279 ± 252.6 mg, respectively, p = 0.001. Z scores < -1 found at Lumbar spine in 26 (89.7%), at Femoral neck in 20 (69%) at Total hip in 17 (58.6%) of vitamin D deficient patients compared to 20 (48.8%), 17 (41.5%), 9 (22%), in patients with 25(OH)D > 10 ng/ml, p < 0.01, <0.03, <0.001, respectively. Significantly more Ethiopian than Caucasian women covered their face (32.3% and 9.5%, p = 0.003) and hands (58.1% and 30.9%, p = 0.03). There was no difference in bone turnover markers levels. CONCLUSION: Poorer vitamin D status was observed in Ethiopian women might be one of the important factors related to lower BMD in this group.

Standardized versus individualized parenteral nutrition in very low birth weight infants: a comparative study.

BACKGROUND: Parenteral nutrition (PN) improves the growth and outcome of very low birth weight (VLBW) infants. Optimal PN composition, standard (STD-PN) or individualized (IND-PN), is still controversial. AIM: To compare IND-PN and STD-PN as to nutritional and growth parameters, complications and cost. PATIENTS AND METHODS: 140 VLBW infants were studied. Each of the 70 neonates from the IND-PN group was matched with a neonate of similar gestational age (GA; +/-4 days) on STD-PN. Data collection included demographic, maternal, intrapartum, neonatal, interventional, growth and nutritional data. RESULTS: Compared to STD-PN infants, IND-PN infants had a significantly lower mean birth weight, greater need for resuscitation at birth and interventions thereafter. Nevertheless, IND-PN infants showed significantly greater weight gain SDS during the 1st week (p = 0.036) and the 1st month of life (p = 0.0004), and higher discharge weight SDS (p = 0.012) and head circumference SDS (p = 0.006). IND-PN infants received higher mean daily caloric intakes. They also had significantly shorter durations of exclusive PN and needed less electrolyte corrections. CONCLUSIONS: Compared to STD-PN infants, IND-PN infants achieved significantly better growth without added clinical or laboratory complications, had a shorter period of exclusive PN and less electrolyte corrections. IND-PN, in accordance with the current more aggressive nutritional approach, appears optimal for PN of VLBW infants. Yet, STD-PN with adequate composition is an appropriate alternative.

Physical activity and bone mineral density in adolescents with vitamin D deficiency.

INTRODUCTION: Studies have shown that physical activity (PA) is superior to many other environmental factors in determining bone mineral density (BMD), but none has examined the independent relationship between PA and vitamin D status. PURPOSE: The aim of this study was to assess the relationship among amount of PA, vitamin D (25(OH)D), and BMD. METHODS: A total of 166 female ballet dancers and sedentary adolescents were divided by tertiles of serum levels of 25(OH)D (< 11.3, 11.3-14.9, and > or = 15 ng·mL(-1)). Diet, PA, and menstruation were assessed by questionnaires; BMD was measured in three sites by dual-energy x-ray absorptiometry. RESULTS: Across 25(OH)D tertiles, there were no differences in mean participant age, weight, height, PA, calcium and energy intake, BMD, or parathyroid hormone. PA was positively associated with BMD in participants with vitamin D deficiency. Multivariable regression analysis, controlling for age, body mass index, parathyroid hormone, and bone turnover markers, showed that total body, femoral neck, and lumbar spine BMD were all positively related to PA, with regression coefficients increasing as vitamin D levels dropped across tertiles. CONCLUSIONS: PA is positively related to BMD in vitamin D-deficient female adolescents and with increasing magnitude as serum vitamin D levels drop. These findings suggest that PA may counteract the detrimental effect of marked vitamin D deficiency on bone mass.

A controlled intervention study of changing health-providers' attitudes toward personal lifestyle habits and health-promotion skills.

OBJECTIVE: Data regarding health providers' personal lifestyle and the differential effect of a short-term personal lifestyle experience intervention program on health providers are limited. METHODS: We conducted a controlled study aimed at changing personal attitudes toward lifestyle habits among 323 health professionals: 136 (42%) physicians, 140 (43%) dietitians, and 47 (15%) nurses and health promoters. In the intervention group (n = 209) individuals participated in a 2-d intensive self-experience workshop in an isolated location emphasizing healthy lifestyle and behavior-modifying techniques. Intervention and control groups were followed for 6 mo. RESULTS: At baseline, avoidance of salt, trans-fatty acids, saturated fats, and processed meat was more frequent among dietitians (P < 0.05 versus physicians). The physicians reported a lower intake of olive/canola oil, nuts/almonds, dietary fibers, vegetables, and fruits (P < 0.05). Furthermore, physicians reported lower confidence in lifestyle primary prevention and felt less useful engaging in health-promotion activities (P < 0.05 versus other health professionals). After 6 mo, waist circumference decreased in the intervention group (-1.3 versus +1.8 cm in control group, P < 0.01). The effect was more prominent among physicians. A modest differential effect of the intervention program was shown in health-promotion activities. CONCLUSION: Approaches toward primary prevention can be improved by an intervention program focusing on personal changes of health care providers. Physicians who are less likely to personally adhere to and believe in lifestyle primary prevention are more likely to benefit from this platform.

Dietary intake of carotenoid isomers in Israel.

Controversy exists regarding the possible protective role of carotenoids against cancer. Evidence is mainly against all-E-beta-carotene, while there is no evidence against other carotenoids or against mixtures of beta-carotene stereoisomers. Carotenoid isomers could account for the variability in study results but are rarely estimated, and reference to the degree of their consumption is lacking. The aim of our study was to create a comprehensive database of carotenoid isomers content in food items commonly consumed in Israel. Food items were analyzed using a liquid chromatography system to determine the content of carotenoid isomers in Israeli food. The main sources of carotenoids detected in Israeli foods were tomato juice, tomato, watermelon, parsley, coriander, spinach, carrot, sweet potato, banana, zucchini, mango, loquat, pepper, eggplant, and chickpeas. Data were used to measure consumption in healthy participants of a case-control study, using a semi-quantitative food-frequency 187-item questionnaire. Compared to reference studies, the median carotenoid isomers intake in 712 Israeli healthy controls (age range 23-95 years, mean 71 +/- 10.9 years, median 73 years) was higher for beta-carotene, alpha-carotene, beta-cryptoxanthin, and zeaxanthin, while the intake of lycopene was lower. Major differences in consumption were noticed between ethnic groups consuming Mediterranean diets and those consuming Western-type diets. Population consumption patterns of carotenoid isomers using a comprehensive database are used to improve our understanding in disease prevention. Consumption in Israel seems to be generally higher than that reported in studies conducted elsewhere, and varies by ethnic group.

Sustained effect of short-term calcium supplementation on bone mass in adolescent girls with low calcium intake.

BACKGROUND: The effect of short-term calcium supplementation on peak bone mass in adolescent girls is not completely defined. In our previous double-blind, placebo-controlled, calcium-supplementation study (1000 mg calcium carbonate/d), we showed that calcium supplementation of postmenarcheal girls with low calcium intakes enhances bone mineral acquisition. OBJECTIVE: The objective of this follow-up study, conducted 3.5 y after the end of calcium supplementation, was to investigate the sustained effect of calcium supplementation on bone mineral mass. DESIGN: Anthropometric data, nutrient intakes, and bone variables were reassessed in 96 of the 100 adolescent girls whose data had been studied at the end of the supplementation period. Bone mineral content and bone mineral density (BMD) of the total body, lumbar spine, and femoral neck were determined by dual-energy X-ray absorptiometry. RESULTS: The calcium-supplemented group tended to have a greater accretion of total-body BMD (TBBMD) than did the control group 3.5 y after the end of supplementation. The finding was statistically significant in the active-treatment cohort (n = 17 in the calcium-supplemented group and 28 in the placebo group), who had a compliance rate of > or =75% during the intervention study. In a multivariate linear-regression analysis, TBBMD accretion from the beginning of the intervention study to the follow-up study in the active-treatment cohort was attributed to calcium supplementation and to the time since inclusion in the initial study. CONCLUSION: Calcium supplementation for 1 y in postmenarcheal girls with low calcium intakes may provide a sustained effect on the basis of TBBMD measurements in participants with compliance rates of > or =75%.

Calcium supplementation provides an extended window of opportunity for bone mass accretion after menarche.

BACKGROUND: High calcium intakes during adolescence may increase bone acquisition. The magnitude of the effect of dietary calcium supplementation and the timing of its administration to achieve significant effects on bone health are still incompletely defined. OBJECTIVE: The objective of this study was to assess the effect of calcium supplementation on bone mass accretion in postmenarcheal adolescent girls with low calcium intakes. DESIGN: A double-blind, placebo-controlled calcium supplementation study was implemented. One hundred girls with a mean (+/- SD) age of 14 +/- 0.5 y with habitual calcium intakes < 800 mg/d completed a 12-mo protocol. The treatment group received a daily supplement containing 1000 mg elemental calcium. Bone mineral density (BMD) and bone mineral content (BMC) of the total body, lumbar spine, and femoral neck were determined at inclusion, 6 mo, and 12 mo. Also measured were serum concentrations of biochemical markers of bone turnover (osteocalcin and deoxypyridinoline), parathyroid hormone, and vitamin D. RESULTS: The calcium-supplemented group had greater accretion of total-body BMD and lumbar spine BMD but not BMC than did the control group. Calcium supplementation appeared selectively beneficial for girls who were 2 y postmenarcheal. Calcium supplementation significantly decreased bone turnover and decreased serum parathyroid hormone concentrations. CONCLUSION: Calcium supplementation of postmenarcheal girls with low calcium intakes enhances bone mineral acquisition, especially in girls > 2 y past the onset of menarche.

Bone density in axial and appendicular skeleton in patients with lactose intolerance: influence of calcium intake and vitamin D status.

BACKGROUND: Lactose intolerance (LI) is a common enzymatic insufficiency, manifesting by poor tolerance of dairy products, leading to low calcium intake and poor calcium absorption from dairy products. These changes might lead to an impairment of bone metabolism [1]. OBJECTIVES: To evaluate the impact of LI on quantitative bone parameters in axial and appendicular skeletal sites. To assess the impact of calcium intake from dairy and non-dairy nutritional sources, calcium regulating hormones and bone turnover on quantitative bone parameters in LI patients. METHODS: We evaluated calcium intake and bone status in sixty-six patients with LI, 49 women and 17 men, aged 20 to 78. Bone mass was assessed at the lumbar spine (LS), total hip (TH) and femoral neck (FN) by dual-energy x-ray absorptiometry (DEXA) and at the radius, tibia, phalanx by quantitative ultrasound. Serum calcium, albumin, inorganic phosphate, calcium regulating hormones and markers of bone turnover were evaluated. RESULTS: Total daily calcium intake was below the recommended by the American Dietetic Association [2] in all study participants (mean 692 mg/day +/- 162). Elevated level of urinary deoxypyridinoline crosslinks (DPD) was observed in 63 (96%) patients and was negatively correlated with total daily calcium intake (r = -0.998, p = 0.025) and with nondairy calcium intake (r = -0.34, p = 0.015). Parathyroid hormone (PTH) level in the upper third of normal range (45-65 ng/L) was observed in 11 (17%) patients. Parathyroid hormone (PTH) was inversely correlated with total calcium intake (r = -0.4, p = 0.001), dairy calcium intake (r = -0.83, p = 0.05), non-dairy calcium intake (r = -0.29, p = 0.043), 25OHD(3) serum level (r = -0.3, p = 0.007) and positively correlated with bone turnover markers (deoxypyridinoline crosslinks [DPD], r = 0.36, p = 0.01 and bone specific alkaline phosphatase [BSAP] r = 0.36, p = 0.01). Decrease in quantitative bone parameters compared to age-matched controls was observed in the axial and in the appendicular skeleton in men and in postmenopausal women: mean z-score for LS -0.87 +/- 0.22 and -1.32 +/- 0.65, p = 0.004 and 0.015, tibia -1.15 +/- 0.53 and -0.44 +/- 0.044, p < 0.001 and 0.27, phalanx -0.98 +/- 0.22 and -0.52 +/- 0.98, p < 0.001. We observed decrease in bone mass in patients with serum PTH in the upper tertile of normal range in the FN (z-score -0.57 +/- 0.6 versus -0.03 +/- 0.9, p = 0.025), TH (-0.51 +/- 0.96 versus 0.04 +/- 0.9, p = 0.05) and radius (-1.84 +/- 0.27 versus -0.07 +/- 1.61, p = 0.025, respectively). z-scores in FN and TH positively correlated with serum 25OHD(3) level (r = 0.31, 0.29; p = 0.014, 0.019). In postmenopausal women serum 25OHD(3) level correlated also with LS z-scores (r = 0.52, p = 0.004); FN and TH z-scores negatively correlated with DPD level (r = -0.51, p = 0.02 and r = -0.55, p = 0.04). CONCLUSION: LI state may lead to increased bone turnover and decreased bone mass especially in men and postmenopausal women. Impaired vitamin D status and low calcium intake may be deleterious to bone in this condition.

[Consumption of soy and phytoestrogens--is there a place for dietary guidelines?].

Phytoestrogens (PE), and soy protein consumption are suggested to be associated with reduced risk of developing breast and prostate cancer, slowing the progression of renal failure, improved bone density, reduced serum lipid levels, and reduction in the risk of developing coronary artery disease. In infants, breast milk is the feeding of choice in the first months of life, and soy-based formulas should only be given to infants with intolerance of cows milk protein. In adults, except for reduced serum lipid levels, there is a lack of scientific evidence for health claims related to high phytoestrogen consumption.