Underutilized plants increase biodiversity, improve food and nutrition security, reduce malnutrition, and enhance human health and well-being. Let's put them back on the plate!

The global food system depends on a limited number of plant species. Plants with unsatisfactory nutritional value are overproduced, whereas the wide variety of nutrient-rich plant species used in earlier times remains neglected. Basing our diet on a few crops has wide-ranging negative consequences on nutrition and food security. Although still under-researched, underutilized plants are slowly starting to receive increased recognition. These plants have superior nutritional content and immense potential to contribute to food and nutrition security and increased sustainability. This narrative review provides evidence to encourage the promotion, domestication, and commercialization of underutilized plants. The anti-inflammatory, antidiabetic, and anticancer effects of some of underutilized plants are presented in this review. The outstanding ability of forgotten plants to increase food and nutrition security, boost dietary diversity, reduce malnutrition, and enhance human health and well-being is demonstrated. The main barriers and obstacles to reintroducing underutilized foods are reviewed and recommendations for overcoming nutrition and dietary-related challenges for re-establishing underutilized plants into the global food system are presented. The expansion of underutilized plants for human use is of paramount importance. The exceptional nutritional properties, bioactive potential, and proven health benefits of underutilized plants indicate that increased promotion, domestication, and commercialization of these plants should be strongly supported. Besides health benefits, marginalized plants have the potential to enhance human well-being and improve people's lives in many ways, retain biodiversity, and develop local economies. Therefore, underutilized plants should be used in the broader context of well-balanced and healthy diets.

Exposure to Phosphates and Nitrites through Meat Products: Estimation of the Potential Risk to Pregnant Women.

Diet during pregnancy is one of the most important nutritional challenges associated with some risks for the mother and the fetus. For the first time, the study aims to estimate long-term (2018-2022) exposure to nitrate and phosphates in Serbian pregnant women, based on individual consumption data and accurate values measured in frequently consumed meat products. For this purpose, seven types of meat products, consisting of 3047 and 1943 samples, were collected from retail markets across Serbia, to analyze nitrites and phosphorus content, respectively. These data were combined with meat product consumption data from the Serbian National Food Consumption Survey to assess dietary intake of nitrites and phosphate. The results were compared with the acceptable daily intake (ADI) proposed by the European Food Safety Authority. The average dietary exposure (EDI) to phosphorus ranged from 0.733 mg/kg bw/day (liver sausage and pate) to 2.441 mg/kg bw/day (finely minced cooked sausages). Considering nitrite intake, the major sources were bacon (0.030 mg/kg bw/day) and coarsely minced cooked sausages (0.0189 mg/kg bw/day). In our study, average nitrite and phosphorus exposure in the Serbian pregnant women population are far below the EFSA recommendations (ADI 0.07 mg/kg bw/day and 40 mg/kg bw/day, respectively).

Evaluation of Dietary Intake and Anthropometric Status in 1-9-Year-Old Children Living in Serbia: National Food Consumption Survey according to the EU Menu Methodology.

The Serbian Food Consumption Survey among 1-9-year-old-children was conceptualized and conducted in compliance with the principles, established protocols, and guidelines of the EU Menu project between 2017 and 2021. Valid data were collected for 576 individuals (290 1-3-year-old toddlers and 276 3-9-year-old children). Regardless of age and gender category, the majority (68.80%) of children had normal weights according to the Body Mass Index-for-age classification system. The median daily energy intake was 1406.71 kcal with no differences between the settlement types. The overall median contributions of carbohydrates, protein, and fat to the total energy intake were 47.54%, 14.06%, and 37.88%, respectively. The proportions of the macronutrient intake deviated from the dietary reference values with compliance to the recommendations being particularly poor for fat and fiber. The consumption of energy-dense food groups such as meat and meat products, fat and oil, sugar, and confections was more pronounced among older children. The survey results provide a valuable insight into the nutritional status and dietary habits of toddlers and children 1-9 years old living in Serbia. They may serve as an evidence platform for public health programs, a valuable asset for decision-makers, and a reliable reference to guide nutritional policies, diet monitoring, and interventions targeting this population group in the future.

Trans fatty acids in frequently consumed products from Serbian and Slovenian market.

OBJECTIVES: Industrially produced trans fatty acid (iTFA) have adverse health effects and thus their consumption should be limited. The aim of this study was to determine and compare the iTFA content in frequently consumed food products by young adults from the Serbian and Slovenian market with supposedly elevated iTFA content in 2015. At the time of this study, there was no recommended limit of iTFA in both countries, and reduction of iTFA in foods was on voluntary basis. METHODS: We determined iTFA content in food products, 19 from the Serbian and 22 from the Slovenian market, blinded and analysed in the same analytical run. Contents of fatty acids (FA) methyl esters were analysed by capillary gas chromatography with a flame ionisation detector. Heptadecanoic acid was used as internal standard. Individual FA along with TFA were expressed as percentages of total measured FA. The amount of each FA in the sample was then calculated from the response factor and the transformation factor of the FA from the FA methyl ester content. RESULTS: Elaidic acid (C18:1t) was found as the most abundant TFA in analysed products, ranging from 0.52 g/100 g of total FA in chocolate candy up to 60.4 g/100 g in a salami from Serbian market. In Slovenian products, the values for elaidic acid were lower, 0.04-3.95 g/100 g of total FA, except in one type of wafers (24.3 g/100 g). CONCLUSIONS: The majority of analysed products from the Serbian and three from Slovenian market exceeded the recommended WHO and EU limit of 2% iTFA of total fat in foods. Samples of frequently consumed salami, wafers, tea biscuits, and snacks were identified as products with potentially higher burden of iTFA in diets of young adults in Serbia.

The Intake of Phosphorus and Nitrites through Meat Products: A Health Risk Assessment of Children Aged 1 to 9 Years Old in Serbia.

This study provides the data on dietary exposure of Serbian children to nitrites and phosphorus from meat products by combining individual consumption data with available analytical data of meat products. A total of 2603 and 1900 commercially available meat products were categorized into seven groups and analysed for nitrite and phosphorous content. The highest mean levels of nitrite content, expressed as NaNO2, were found in finely minced cooked sausages (40.25 ± 20.37 mg/kg), followed by canned meat (34.95 ± 22.12 mg/kg) and coarsely minced cooked sausages (32.85 ± 23.25 mg/kg). The EDI (estimated daily intake) of nitrites from meat products, calculated from a National Food Consumption Survey in 576 children aged 1-9 years, indicated that the Serbian children population exceeded the nitrite ADI (acceptable daily intake) proposed by EFSA (European Food Safety Authority) in 6.4% of children, with a higher proportion in 1-3-year-old participants. The mean phosphorus concentration varied from 2.71 ± 1.05 g/kg to 6.12 ± 1.33 g/kg in liver sausage and pate and smoked meat products, respectively. The EDI of phosphorus from meat products was far below the ADI proposed by EFSA, indicating that the use of phosphorus additives in Serbian meat products is generally in line with legislation.

Dietary Exposure and Risk Assessment of Aflatoxin M1 for Children Aged 1 to 9 Years Old in Serbia.

The present study was conducted to estimate the exposure and characterize the risk for the child population of Serbia to Aflatoxin M1 (AFM1) from milk and milk-based food. A total of 3404 samples comprising milk and different milk-based food samples were collected from various regions of Serbia from 2017 to 2019. Evaluation of AFM1 exposure was carried out using the deterministic method, whereas risk characterization was evaluated using the margin of exposure (MOE) and the risk of hepatocellular carcinoma (HCC). Detection rates for AFM1 in milk and milk-based food samples ranged between 2% and 79%, with the highest incidence (79%) and mean level (22.34 ± 0.018 ng kg-1) of AFM1 being detected in pasteurized and UHT milk. According to the three consumption estimates, the values of estimated daily intake (EDI) were higher for toddlers as compared with children aged 3-9 years. Children aged 1-3 years had the highest risk of exposure to AFM1 in milk, with an estimated daily intake of 0.164 and 0.193 ng kg-1 bw day-1 using lower bound (LB) and upper bound (UB) exposure scenarios, respectively. Such difference could result from the higher consumption to weight in younger children. Based on the estimated daily intake (EDI) found in this study, the risk of AFM1 exposure due to consumption of milk and milk-based food was low since the MOE values obtained were >10,000. In addition, the risk of HCC cases/year/105 individuals of different age groups showed that the value of HCC, using potency estimates of 0.0017 (mean), was maximum (0.00034) in the age group 1-3 years, which indicates no health risk for the evaluated groups. The present study revealed the importance of controlling and preventing AFM1 contamination in milk through continuous monitoring and regular inspection to reduce the risk of AFM1 exposure, especially in children.

Vitamin D Status and Its Correlation With Anthropometric and Biochemical Indicators of Cardiometabolic Risk in Serbian Underground Coal Miners in 2016.

The status of vitamin D in underground working coal miners and its association with their cardiometabolic health is rarely studied. This study aimed to examine vitamin D (VitD) status in Serbian underground coal miners and to correlate it with anthropometric and laboratory indicators of cardiometabolic risk. Nutritional data (food frequency questionnaire, FFQ, and two times repeated 24 h recall), anthropometric data (including segmental analysis by bio-impedance analyzer TANITA BC-545N), arterial tension, and biochemical and hematological data of 103 coal miners (aged 22-63 years) were correlated with their late summer (early September) serum 25 (OH)D levels (measured by HPLC). 68.9% of the studied coal miners were overweight/obese, and 48.5% had metabolic syndrome. Their mean VitD nutritional intakes were low: 5.3 ± 3.8 µg/day (FFQ) and 4.9 ± 8 µg/day (24 h recalls), but their mean serum 25 (OH)D levels were surprisingly high (143.7 ± 41.4 nmol/L). Only 2.9% of the coal miners had 25(OH)D levels lower than 75 nmol/L (indicating an insufficient/deficient status), while 63.2% had values above 125 nmol/L (upper optimal limit), and even 10.7% had values above 200 nmol/L. There were no statistical differences in 25 (OH)D levels in the coal miners with or without metabolic syndrome (or overweight/obesity). Interestingly, 25(OH)D levels had significant positive correlations with body mass index (BMI), fat mass (FM), fat mass percentage (FM%), limbs FM%, serum triglycerides, GGT, AST, ALT, and ALT/AST ratio, and had significant negative correlations with serum HDL-cholesterol and age. All these correlations were lost after corrections for age, FM, FM%, and legs FM%. In Serbian coal miners, high levels of early September VitD levels were observed, indicating sufficient non-working-hour sun exposure during the summer period. Furthermore, the unexpected positive correlations of VitD levels with anthropometric and biochemical parameters indicative of obesity, metabolic syndrome, and fatty liver disease were found. More research is needed on the VitD status of coal miners (particularly in the winter period) and its relationship with their cardiometabolic status.

Implementation of Harmonized Food Consumption Data Collection in the Balkan Region According to the EFSA EU Menu Methodology Standards.

Initiatives in the Capacity Development in Nutrition Research in the Balkan region in the last decade have been toward the creation of contemporary, harmonized Research Infrastructure (RI) compliant with European standards. This study describes the process of creation and implementation of the European Food Safety Authority (EFSA) EU Menu methodology in the Balkan region during the EFSA support projects for food consumption data collection in four countries (Serbia, Montenegro, Bosnia and Herzegovina, and North Macedonia). This process entailed the application and improvement of an innovative tool, the DIET ASSESS and PLAN (DAP), a platform for standardized food consumption data collection and dietary intake assessment. DAP comprises computerized food consumption, anthropometric measurements, and physical activity questionnaires, validated food picture book, and FoodEx2 exposure hierarchy with sets of facet descriptors of the interest. It hosts the Balkan food platform with a Serbian food composition database (FCDB) and Regional FCDB, compliant with European Food Information Resource (EuroFIR™) standards. The implementation of the DAP platform in national dietary surveys conducted with the support of the EFSA EU Menu project in Balkan countries enabled harmonized food consumption data compilation and reporting. Application of the methodology entailed the development of study protocol and extensive education and training of study personnel. The entire data collection process was managed by internal and external survey coordinators. A pilot study was conducted to test the entire data collection and control process and was afterward used to make necessary improvements and adjustments to meet EU Menu requirements. Data collected are internationally comparable with food consumption data in other European countries within the framework of the EU Menu program. The existence of such data in the Balkan region will catalyze research activities in emerging topics, such as identification of dietary patterns, the establishment of national nutrient reference values and food-based dietary guidelines (not only in Serbia, but in the whole Balkan region), dietary exposure assessments, the endorsement and evaluation of new food legislations, the environmental and other effects of diet on the food system. The developed and implemented methodology underpins evidence-based policy-making processes lacking in the field of public health nutrition in the region.

Sustainable food systems for healthy diets in Europe and Central Asia: Introduction to the special issue.

This Special Issue highlights various good practices and food policy discussion in relation to the transformation of current food systems toward their social, environmental and economical sustainability. The papers describe policies, programmes and initiatives in developing and advanced economies of Europe and Central Asia that refer to the core elements of food systems, such as food supply, food environments, and consumers. The shared opinions, analyses, studies and approaches, experiences and insights contribute to a better understanding of regional specificities and support the efforts to guide the complex food systems' transformation for their improved capacity to deliver healthy diets.

Energy, macronutrients and dietary fibre intake among adults in North Macedonia.

OBJECTIVE: The present research aimed to estimate macronutrients intake among adults in North Macedonia and to identify their predominant food sources. METHODS: Within this cross-sectional study dietary data were collected using repeated 24h recall interviews. Nationwide, adults aged 18+ were recruited. Dietary data, anthropometric measures and socio-demographic characteristics were available for 496 participants. Nutrient intake was analyzed using the Balkan Food Composition Database and Diet Assess and Plan platform. Macedonian dietary guidelines were used for estimation of inadequacy. RESULTS: Significant differences in macronutrients intake are noticed between age groups within certain socio-demographic factors. Total sugar intake was significantly higher among young adult females comparing with those older than 25 years (p = 0.049). Young urban females have significantly higher fats intake than older participants (p = 0.038). Higher total daily energy, proteins, fats and carbohydrates intake (p = 0.033, p = 0.043, p = 0.032, p = 0.042, respectively) was noticed among young urban males when compared to older ones. Only dietary fibre intake was higher among older urban males (p = 0.030). Univariate linear regression models showed that obese participants had significantly higher relative proteins intake comparing with those having BMI within recommended range (p = 0.024, ß = 1.21). Relative carbohydrates intake was significantly lower among males (p = 0.018, ß = -2.077) and among highly educated participants (p = 0.018, ß = -4.304). Participants with tertiary education had higher relative fats intake (p = 0.012, ß = 4.213). CONCLUSION: Macronutrients intake of adults should be improved. There is higher intake of dietary fats and need for an increase of complex carbohydrates intake, particularly dietary fibre. Findings of this survey should be used in shaping, fine-tuning and implementing food and nutrition policies that will stimulate healthier diets for prevention of diet related non-communicable diseases.

Fueling an epidemic of non-communicable disease in the Balkans: a nutritional survey of Bosnian adults.

OBJECTIVES: Dietary surveys are essential for guiding national efforts to reduce the burden of non-communicable disease, but individual-level dietary data are lacking in many low- and middle-income countries. We aimed to estimate the prevalence of inadequate and excessive intakes of specific nutrients in Bosnia and Herzegovina. METHODS: A dietary survey among 853 adults using two 24-h recalls. RESULTS: The majority of men (73%) and women (66%) were overweight/obese, and > 50% of participants had elevated blood pressure. Low intakes of N-3 polyunsaturated fatty acids, specifically α-linolenic acid (men: 94.4 mg/day among, women: 96.6 mg/day) and DHA + EPA (men: 18.2 mg/day, women: 16.0 mg/day), low fiber intake (women: 21.5 g/day), and high sodium (men: 3244 mg/day, women: 2291 mg/) and saturated fatty acids intakes (men: 29.2 g/day) were reported. There was also a suggestion of low intakes of vitamins A, B6, C and D (in both sexes), and of riboflavin, folate, B12 and calcium (in women). CONCLUSIONS: Our findings provide initial evidence on the Bosnian population's dietary habits and identify aspects that need attention. As the survey evolves into a continuing surveillance system, it will allow evaluation of dietary changes over time.

Investigation of Variations in the Human Urine Metabolome amongst European Populations: An Exploratory Search for Biomarkers of People at Risk-of-Poverty.

SCOPE: According to Eurostat 2016, approximately 119 million European citizens live at-risk-of-poverty (ROP). This subpopulation is highly diverse by ethnicity, age, and culture in the different EU states, but they all have in common a low income that could represent an increased risk of nutrient deficiencies due to poor nutritional habits. This study aims to investigate the human urine metabolome in the search of common biomarkers representing dietary deficiencies amongst European populations at ROP. METHODS AND RESULTS: 2732 urine samples were collected from 1391 subjects across five different European countries, including the United Kingdom, Finland, Italy, Lithuania, and Serbia, and analyzed using 1 H-NMR spectroscopy. The resulting urine metabolome data were explored according to study design factors including economic status, country, and gender. CONCLUSION: Partitioning of the effects derived from the study design factors using ANOVA-simultaneous component analysis (ASCA) revealed that country and gender effects were responsible for most of the systematic variation. The effect of economic status was, as expected, much weaker than country and gender, but more pronounced in Lithuania than in other countries. Citrate and hippurate were among the most powerful ROP biomarkers. The possible relationship between these markers and nutritional deficiencies amongst the ROP population is discussed.

The Development and Validation of Food Atlas for Portion Size Estimation in the Balkan Region.

Assessment of portion sizes is an important factor for the accuracy of food consumption surveys. The objective of this study was to develop and validate a food atlas of commonly consumed foods in the Balkan region in order to improve the accuracy of portion size estimation for food consumption surveys. A list of 135 foods and their portion sizes was based on previously conducted food consumption surveys in this region. Food was cooked, measured and served in three or four portion sizes right before being photographed. A validation study was conducted through the visual perception method. Without receiving training on usage of the food picture book, participants were asked to evaluate two portion sizes of 20 selected foods by comparison with a photo series of each food. Portion sizes were evaluated by 18 nutrition professionals and 17 lay individuals who had no nutritional education. Mean differences and the standard deviations of the mean differences (SD) between the portions estimated by each participant and the served portion were calculated. The percentages of participants who selected the correct, adjacent or distant portion size also were calculated. The number of food items that were quantified within the predefined acceptable range (i.e., mean difference < ∣ 0·7 ∣ and SD < 1) was 16 (80%) among lay individuals and 17 (85%) among nutritional professionals. Among 16 photo series that were assessed as "acceptable," the percentage of all participants, who selected the correct picture, was between 44.3 and 82.9%, with an average of 60.2%. Only three foods were assessed correctly by <50% participants. The percentage of participants who selected the correct or adjacent serving size was above 98% for both lay and professional evaluators. This is the first food atlas containing representative foods and recipes commonly consumed in the Balkan region. However, further adjustments of the methodology should include larger number of food items to be tested, involvement of more participants and provision of training for the users of the food atlas. This food atlas could be used in food consumption surveys in the Balkan region after further testing and validation.

Assessment of vitamin D intake among Libyan women - adaptation and validation of specific food frequency questionnaire.

Vitamin D deficiency (VDD) has pandemic proportions worldwide. Numerous studies report on high prevalence of VDD in sunny regions like Near East and North Africa (NENA). Previous studies indicated that Libyan population was at risk of VDD. To contribute to the body of evidence, measurement of vitamin D status on children, adults, in Misurata region was conducted, and confirmed with validated dietary intake study. Serum 25(OH)D was analysed using electrochemiluminescence protein binding assay. Existing Food Frequency Questionnaires (FFQ) were adapted to Libyan Women Food Frequency Questionnaire (LW-FFQ). Repeated 24 h dietary recalls and LW-FFQ were employed in vitamin D intake evaluation. LW-FFQ was validated using 24 h dietary recall and vitamin D status as referent methods. The questionnaires included anthropometry and lifestyle information. Vitamin D status assessment revealed inadequate levels (25(OH)D < 50 nmol/l) in almost 80% of participants. Women (25-64 y) were identified as the most vulnerable group with vitamin D inadequacy present in 82% (61.6% had 25(OH)D < 25 nmol/l, and 20.2% had 25-50 nmol/l 25(OH)D). Average Vitamin D intake within the study sample (n = 316) was 3.9 ± 7.9 µg/d, with 92% participants below both Institute of Medicine (IOM) (10 µg/d) and European Food Safety Authority (15 µg/d) recommendations. Measured vitamin D status, in 13% of this group, correlated significantly (p = 0.015) with intake estimates. Based on self-report, consumption of vitamin D supplements does not exist among study participants. Additional lifestyle factors influencing vitamin D status were analysed. Only 2% of study participants spend approximately 11 min on the sun daily, 60.4% were obese, 23.1% were overweight and 71.2% reported low physical activity. These findings confirm previous reports on high prevalence of VDD in women across NENA, and in Libya. The situation calls for multi-sectoral actions and public health initiatives to address dietary and lifestyle habits.

Systematic Review of Observational Studies with Dose-Response Meta-Analysis between Folate Intake and Status Biomarkers in Adults and the Elderly.

BACKGROUND: Dietary reference values for folate intake vary widely across Europe. METHODS: MEDLINE and Embase through November 2016 were searched for data on the association between folate intake and biomarkers (serum/plasma folate, red blood cell [RBC] folate, plasma homocysteine) from observational studies in healthy adults and elderly. The regression coefficient of biomarkers on intake (ß) was extracted from each study, and the overall and stratified pooled ß and SE (ß) were obtained by random effects meta-analysis on a double log scale. These dose-response estimates may be used to derive folate intake reference values. RESULTS: For every doubling in folate intake, the changes in serum/plasma folate, RBC folate and plasma homocysteine were +22, +21, and -16% respectively. The overall pooled regression coefficients were ß = 0.29 (95% CI 0.21-0.37) for serum/plasma folate (26 estimates from 17 studies), ß = 0.28 (95% CI 0.21-0.36) for RBC (13 estimates from 11 studies), and ß = -0.21 (95% CI -0.31 to -0.11) for plasma homocysteine (10 estimates from 6 studies). CONCLUSION: These estimates along with those from randomized controlled trials can be used for underpinning dietary recommendations for folate in adults and elderly.

Evaluation of New Technology-Based Tools for Dietary Intake Assessment-An ILSI Europe Dietary Intake and Exposure Task Force Evaluation.

BACKGROUND: New technology-based dietary assessment tools, including Web-based programs, mobile applications, and wearable devices, may improve accuracy and reduce costs of dietary data collection and processing. The International Life Sciences Institute (ILSI) Europe Dietary Intake and Exposure Task Force launched this project to evaluate new tools in order to recommend general quality standards for future applications. METHODS: A comprehensive literature search identified technology-based dietary assessment tools, including those published in English from 01/2011 to 09/2017, and providing details on tool features, functions and uses. Each of the 43 tools identified (33 for research and 10 designed for consumer use) was rated on 25 attributes. RESULTS: Most of the tools identified (79%) relied on self-reported dietary intakes. Most (91%) used text entry and 33% used digital images to help identify foods. Only 65% had integrated databases for estimating energy or nutrients. Fewer than 50% contained any features of customization and about half generated automatic reports. Most tools reported on usability or reported validity compared with another assessment method (77%). A set of Best Practice Guidelines was developed for reporting dietary assessment tools using new technology. CONCLUSIONS: Dietary assessment methods that utilize technology offer many advantages for research and are often preferable to consumers over more traditional methods. In order to meet general quality standards, new technology tools require detailed publications describing tool development, food identification and quantification, customization, outputs, food composition tables used, and usability/validity testing.

Development, features and application of DIET ASSESS & PLAN (DAP) software in supporting public health nutrition research in Central Eastern European Countries (CEEC).

In order to meet growing public health nutrition challenges in Central Eastern European Countries (CEEC) and Balkan countries, development of a Research Infrastructure (RI) and availability of an effective nutrition surveillance system are a prerequisite. The building block of this RI is an innovative tool called DIET ASSESS & PLAN (DAP), which is a platform for standardized and harmonized food consumption collection, comprehensive dietary intake assessment and nutrition planning. Its unique structure enables application of national food composition databases (FCDBs) from the European food composition exchange platform (28 national FCDBs) developed by EuroFIR (http://www.eurofir.org/) and in addition allows communication with other tools. DAP is used for daily menu and/or long-term diet planning in diverse public sector settings, foods design/reformulation, food labelling, nutrient intake assessment and calculation of the dietary diversity indicator, Minimum Dietary Diversity-Women (MDD-W). As a validated tool in different national and international projects, DAP represents an important RI in public health nutrition epidemiology in the CEEC region.