Ellisras Longitudinal Study 2017: Childhood underweight and blood pressure status in a rural black population of South Africa (ELS 26).

AIM: Childhood underweight is a problem being faced by rural black South African populations but little is known about its risk factors. The aim of this study was to investigate the risk factors related to childhood underweight in rural black South African children within the area known as Ellisras. METHODS: A cross-sectional study was conducted as part of the ongoing Ellisras Longitudinal Study. The current study comprised a total of 1 811 pre-primary and primary school children (934 males and 877 females) aged between five and 16 years. The chi-squared automatic interaction detection (CHAID) decision tree model was used to identify factors and determine their relationships with childhood underweight. RESULTS: A total of 1 811 children were involved in the study, of whom about 81% were severely underweight. The CHAID model showed that the variables: nutrition, age group, gender and school level were the four main predicting variables affecting childhood underweight. Hypertension was not significantly associated with childhood underweight. CONCLUSIONS: The prevalence of childhood underweight was found to be high in children aged between five and 16 years. To address this problem, well-thought-out intervention systems are need.

Racial Disparities in Obesity Treatment.

PURPOSE OF REVIEW: Obesity rates in the USA have reached pandemic levels with one third of the population with obesity in 2015-2016 (39.8% of adults and 18.5% of youth). It is a major public health concern, and it is prudent to understand the factors which contribute. Racial and ethnic disparities are pronounced in both the prevalence and treatment of obesity and must be addressed in the efforts to combat obesity. RECENT FINDINGS: Disparities in prevalence of obesity in racial/ethnic minorities are apparent as early as the preschool years and factors including genetics, diet, physical activity, psychological factors, stress, income, and discrimination, among others, must be taken into consideration. A multidisciplinary team optimizes lifestyle and behavioral interventions, pharmacologic therapy, and access to bariatric surgery to develop the most beneficial and equitable treatment plans. The reviewed studies outline disparities that exist and the impact that race/ethnicity have on disease prevalence and treatment response. Higher prevalence and reduced treatment response to lifestyle, behavior, pharmacotherapy, and surgery, are observed in racial and ethnic minorities. Increased research, diagnosis, and access to treatment in the pediatric and adult populations of racial and ethnic minorities are proposed to combat the burgeoning obesity epidemic and to prevent increasing disparity.

Randomised Controlled Trial Comparing Daily Versus Depot Vitamin D3 Therapy in 0-16-Year-Old Newly Settled Refugees in Western Australia Over a Period of 40 Weeks.

Vitamin D deficiency is highly prevalent in newly settled refugees in Western Australia (WA). If adherence to daily vitamin D therapy is problematic, depot therapy is a therapeutic alternative. The aim of this study was to compare daily versus depot treatment and factors influencing the therapeutic outcome. Newly settled refugees (n = 151) with 25(OH)D levels less than 78 nmol/L were randomised to receive daily or depot vitamin D therapy with eight weekly interval follow up to 40 weeks. Biochemical and clinical parameters were collected at each visit. Generalized Linear Mixed Models (GLMM) examined the longitudinal changes over time controlling for confounders including age, gender, treatment arm, season, country of refuge/origin and sun exposure score. Participants were aged 5.5 months to 16.0 years (75 males, 83 females). Both treatment groups achieved vitamin D sufficiency. The daily treatment group had significantly higher 25(OH)D levels at each visit post baseline and a higher proportion of participants with levels above 50 nmol/L at all time points. Time, treatment group, calcium and sun exposure score were significant predictors of 25(OH)D serum levels. Depot vitamin D therapy is an alternative to daily treatment in this at-risk group of children and adolescents in whom treatment adherence is problematic.

Community approval required for periconceptional adolescent adherence to weekly iron and/or folic acid supplementation: a qualitative study in rural Burkina Faso.

BACKGROUND: Iron deficiency remains a prevalent adolescent health problem in low income countries. Iron supplementation is recommended but improvement of iron status requires good adherence. OBJECTIVES: We explored factors affecting adolescent adherence to weekly iron and/or folic acid supplements in a setting of low secondary school attendance. METHODS: Taped in-depth interviews were conducted with participants in a randomised, controlled, periconceptional iron supplementation trial for young nulliparous women living in a rural, malaria endemic region of Burkina Faso. Participants with good, medium or poor adherence were selected. Interviews were transcribed and analysed thematically. RESULTS: Thirty-nine interviews were conducted. The community initially thought supplements were contraceptives. The potential benefits of giving iron supplementation to unmarried "girls" ahead of pregnancy were not recognised. Trial participation, which required parental consent, remained high but was not openly admitted because iron supplements were thought to be contraceptives. Unmarried non-school attenders, being mobile, were often sent to provide domestic labour in varied locations. This interrupted adherence - as did movement of school girls during vacations and at marriage. Field workers tracked participants and trial provision of free treatment encouraged adherence. Most interviewees did not identify health benefits from taking supplements. CONCLUSIONS: For success, communities must be convinced of the value of an adolescent intervention. During this safety trial, benefits not routinely available in iron supplementation programmes were important to this low income community, ensuring adolescent participation. Nevertheless, adolescents were obliged to fulfil cultural duties and roles that interfered with regular adherence to the iron supplementation regime. TRIAL REGISTRATION: Trial Registration at clinicaltrials.gov : NCT01210040.

Validation of the Brazilian Healthy Eating Index-Revised Using Biomarkers in Children and Adolescents.

The Brazilian Healthy Eating Index-Revised (BHEI-R) can be used to determine overall dietary patterns. We assessed the BHEI-R scores in children and adolescents, aged from 9 to 13 years old, and associated its component scores with biomarkers of health and dietary exposure. Three 24-h recalls were used to generate BHEI-R. Biomarkers were analyzed in plasma and red blood cells. Correlation tests, agreement, and covariance analyses were used to associate BHEI-R components with biomarkers. Data from 167 subjects were used. The strongest correlations were between fruits, vegetables and legumes with omega-6 and omega-3 fatty acids, and ß-carotene intakes. Milk and dairy correlated with plasma retinol and pyridoxine. All components rich in vegetable and animal protein sources correlated with plasma creatine. Total BHEI-R scores were positively associated with intakes of omega-6, omega-3, fiber and vitamin C, and inversely associated with energy and saturated fat intakes of individuals. Plasma ß-carotene and riboflavin biomarkers were positively associated with total BHEI-R. An inadequate food consumption pattern was captured by both biomarkers of health and dietary exposure. BHEI-R was validated for the above dietary components and can be associated with metabolomics and nutritional epidemiological data in future pediatric studies.

Association of sodium intake with insulin resistance in Korean children and adolescents: the Korea National Health and Nutrition Examination Survey 2010.

BACKGROUND: This study aimed to evaluate the relationship between sodium intake and insulin resistance indices. METHODS: A total of 718 Korean children and adolescents (411 boys) aged 10-18 years who participated in the Korea National Health and Nutrition Examination Survey (KNHANES) were included in the study. The urinary sodium to urinary creatinine ratio was used as a surrogate for sodium intake. The homeostatic model assessment of insulin resistance (HOMA-IR) and the quantitative insulin sensitivity check index (QUICKI) were used as indices of insulin resistance. RESULTS: The mean urinary sodium to urinary creatinine ratio was 11.34 in males and 10.17 in females. The urinary sodium to urinary creatinine ratio was significantly positively correlated with HOMA-IR (r=0.165, p<0.001) and inversely correlated with QUICKI (r=-0.181, p<0.001) in Pearson's correlation analyses. In a multivariate linear regression analysis, the urinary sodium to urinary creatinine ratio was independently and significantly positively associated with HOMA-IR (ß=0.073, p=0.018) and significantly inversely associated with QUICKI (ß=-0.080, p=0.007) after adjustment for possible confounders. HOMA-IR was independently and significantly positively associated with the urinary sodium to urinary creatinine ratio (ß=0.087, p=0.018), whereas QUICKI was independently and significantly negatively associated with the urinary sodium to urinary creatinine ratio (ß=-0.097, p=0.009) after controlling for confounders. CONCLUSIONS: Our results suggest that sodium intake, as estimated by the urinary sodium to urinary creatinine ratio, may be independently associated with insulin resistance in children and adolescents.

Food patterns and nutritional assessment in Galician university students.

The access of the young people to the university marks a fundamental break in their lives that may also result in a substantial change in their dietary habits. The aim of this study was to characterize the food patterns, body composition and biochemical profiles of Galician university students from the University of Santiago de Compostela (Campus de Lugo). A total of 62 students participated in this survey. For each individual, anthropometric parameters, blood pressure, blood glucose and lipid profile were measured. Also, the participants filled questionnaires of dietary habits, Mediterranean and Atlantic diet adherence, risk of type II diabetes and physical activity, lifestyle and personal and family histories. A BMI within the normal range was shown by 72% of students. Eight volunteers (12.90%) presented high levels of total cholesterol (>200 mg/dL), and 54.55% of women had levels of HDL-cholesterol above 60 mg/dL. Five students had levels of glucose above 100 mg/dL, being four men and one woman. None of the participants presented high blood pressure, but 11.29% were in pre-hypertension status. The intake of carbohydrates was below the recommendations, while protein and lipids were above. There was an excessive consumption of bakery, alcohol beverages, sausages and ready-made food. The students showed medium adherence to Atlantic and Mediterranean diet and low risk of type II diabetes mellitus and a sedentary lifestyle. Since university students are a group especially prone to poor dietary habits, it seems necessary to promote changes towards healthier meals and rescue the Mediterranean-like dietary pattern.

Mediation of psychosocial determinants in the relation between socio-economic status and adolescents' diet quality.

PURPOSE: To examine the underlying reasons for the positive relation between socio-economic status (SES) and the diet quality of adolescents. METHODS: In 2081 adolescents (12.5-17.5 years) of the European HELENA study, a continuous variable on diet quality via 2-day 24-h recalls was available. SES was reflected by parental education, parental occupation and family affluence. Mediation by several psychosocial determinants was tested: self-efficacy, availability at school and home, social support, barriers, benefits, awareness and some self-reported influencers (parents, school, taste, health, friends, food readily available, easy preparation, hunger, price and habits). Multiple mediation analyses were adjusted for age, sex and country. RESULTS: The availability of soft drinks and fruit at home, social support, parental influence, barriers, price influence, taste influence, health influence and food being readily available were significant mediators. The multiple mediation indirect effect accounted for 23-64% of the total effect. Both occupation and education and both maternal and paternal factors could be explained by the mediation. The unavailability of soft drinks was the strongest mediator (17-44% of the total effect). CONCLUSION: Up to 64% of the positive relation between SES and the diet quality in adolescence could be explained by several healthy eating determinants. Focusing on these factors in low-SES populations can minimize social inequalities in diet and health by improving the diet of these specific adolescents.

Dietary patterns, cost and compliance with low-protein diet of phenylketonuria and other inherited metabolic diseases.

BACKGROUND/OBJECTIVES: Phenylketonuria (PKU) and several other inherited metabolic diseases (IMD) require a lifelong low-protein diet (LPD), otherwise they lead to many health complications. LPDs, however, carry a significant economic burden for patients and their families. The objective of this study was to explore the costs of low-protein foods (LPFs) necessary for LPD as well as dietary patterns and compliance towards an LPD. SUBJECTS/METHODS: A detailed questionnaire was created in cooperation with National Association of PKU and other IMD (NSPKU), and consequently sent to all NSPKU members treated with an LPD (n=303). A total of 184 respondents from the Czech Republic were included in the study (174 had PKU, 10 had other IMD). RESULTS: The average daily consumption of LPF was equal to 411.7 g (PKU) and 345.6 g (other IMD), which corresponds to energy value of 5558 kJ and 4438 kJ, respectively, per patient per day. Patients mostly consumed low-protein flour (≈30% of energy intake), pasta (≈18%), basic pastry (≈15%) and sweets (≈10%). The average monthly costs of LPDs were equal to [euro ]130 (PKU) and [euro ]129 (other IMD) per patient per month. The compliance with LPD was decreasing with increasing age (P<0.0001). CONCLUSIONS: This is the largest study examining costs and dietary patterns of LPDs in patients with PKU and the first study of this kind in other IMD patients requiring an LPD. The study clearly showed that an LPD carries a very high economic burden for families, which may lead to less LPD compliance and potential severe health consequences.

Dietary sources of sugars in adolescents' diet: the HELENA study.

OBJECTIVE: To report dietary sugars consumption and their different types and food sources, in European adolescents. METHODS: Food consumption data of selected groups were obtained from 1630 adolescents (45.6% males, 12.5-17.5 years) from the HELENA study using two nonconsecutive 24-h recalls. Energy intake, total sugars and free sugars were assessed using the HELENA-DIAT software. Multiple regression analyses were performed adjusting for relevant confounders. RESULTS: Total sugars intake (137.5 g/day) represented 23.6% and free sugars (110.1 g/day), 19% of energy intake. Girls had significantly lower intakes of energy, carbohydrates, total sugars and free sugars. 94% of adolescents had a consumption of free sugars above 10% of total energy intake. The main food contributor to free sugars was 'carbonated, soft and isotonic drinks,' followed by 'non-chocolate confectionary' and 'sugar, honey, jam and syrup.' Older boys and girls had significantly higher intakes of free sugars from 'cakes, pies and biscuits.' Free sugars intake was negatively associated with low socioeconomic status for 'non-chocolate confectionary' and 'sugar, honey and jam' groups; with low maternal educational level for carbonated and 'soft drinks,' 'sugar, honey and jam,' 'cakes and pies' and 'breakfast cereals' groups; and with high paternal educational level for 'carbonated and soft drinks' and 'chocolates' group. CONCLUSIONS: The majority (94%) of studied adolescents consumed free sugars above 10% of daily energy intake. Our data indicate a broad variety in foods providing free sugars. Continued efforts are required at different levels to reduce the intake of free sugars, especially in families with a low educational level.

The school environment and sugar-sweetened beverage consumption among Guatemalan adolescents.

OBJECTIVE: The current study sought to examine Guatemalan adolescents' consumption of sugar-sweetened beverages (SSB), identify which individual-level characteristics are associated with SSB consumption and describe school characteristics that may influence students' SSB consumption. DESIGN: Within this observational pilot study, a questionnaire was used to assess students' consumption of three varieties of SSB (soft drinks, energy drinks, sweetened coffees/teas), as well as a variety of sociodemographic and behavioural characteristics. We collected built environment data to examine aspects of the school food environment. We developed Poisson regression models for each SSB variety and used descriptive analyses to characterize the sample. SETTING: Guatemala City, Guatemala. SUBJECTS: Guatemalan adolescents (n 1042) from four (two public, two private) secondary schools. RESULTS: Built environment data revealed that students from the two public schools lacked access to water fountains/coolers. The SSB industry had a presence in the schools through advertisements, sponsored food kiosks and products available for sale. Common correlates of SSB consumption included school type, sedentary behaviour, frequency of purchasing lunch in the cafeteria, and frequency of purchasing snacks from vending machines in school and off school property. CONCLUSIONS: Guatemalan adolescents frequently consume SSB, which may be encouraged by aspects of the school environment. Schools represent a viable setting for equitable population health interventions designed to reduce SSB consumption, including increasing access to clean drinking-water, reducing access to SSB, restricting SSB marketing and greater enforcement of existing food policies.

Impact of Age and Race on Outcomes of a Program to Prevent Excess Weight Gain and Disordered Eating in Adolescent Girls.

Interpersonal psychotherapy (IPT) prevents weight gain and reduces loss-of-control (LOC)-eating in adults. However, IPT was not superior to health-education (HE) for preventing excess weight gain and reducing LOC-eating over 1-year in adolescent girls at risk for excess weight gain and eating disorders. Limited data suggest that older and non-White youth may be especially responsive to IPT. In secondary analyses, we examined if age or race moderated weight and LOC-eating outcomes. The 113 participants (12-17 years; 56.6% White) from the original trial were re-contacted 3 years later for assessment. At baseline and follow-up visits through 3 years, we assessed BMI, adiposity by dual energy X-ray absorptiometry, and LOC-eating presence. In linear mixed models, baseline age moderated 3-year BMI outcome; older girls in IPT had the lowest 3-year BMI gain compared to younger girls in IPT and all girls in HE, p = 0.04. A similar pattern was observed for adiposity. Race moderated 3-year LOC-eating; non-White girls in IPT were most likely to abstain from LOC-eating at 3 years compared to all other girls, p = 0.04. This hypothesis-generating analysis suggests future studies should determine if IPT is especially efficacious at reducing LOC-eating in older, non-White adolescents.

Reciprocal relationships between emotion regulation and motives for eating palatable foods in African American adolescents.

This study examines possible bidirectional relationships between emotion regulation and motives related to consuming palatable foods during adolescence. Participants included 79 adolescents (96% African American) who took part in Waves 2 and 3 of the Coping with Violence Study. The youth were recruited from four public middle schools serving low income, urban communities in Birmingham, AL. Participants completed self-report measures of emotion regulation and indicated different motives for consuming tasty foods and drinks at both waves. Results demonstrate that poorer emotion regulation at Wave 2 predicted more frequent endorsement of eating motives related to coping and conforming at Wave 3. Eating motives at Wave 2 were not associated with changes in emotion regulation at Wave 3. The results suggest that emotion regulation problems in adolescence may contribute to obesity and related negative outcomes through greater consumption of unhealthy food for coping and social conformity reasons.

Decreased, but still sufficient, iodine intake of children and adults in the Netherlands.

Sufficient I intake is important for the synthesis of thyroid hormones, which play an important role in normal growth and development. Our aim was to estimate habitual I intake for the Dutch population and the risk of inadequate or excessive intakes. Further, we aimed to provide an insight into the dietary sources of I and the association with socio-demographic factors. Data from the Dutch National Food Consumption Survey 2007-2010 (n 3819; 7-69 years), and from the Dutch food and supplement composition tables were used to estimate habitual I intake with a calculation model. Contribution of food groups to I intake were computed and multiple linear regression was used to examine associations of intakes with socio-demographic factors. A total of ≤2 % of the population had an intake below the estimated average requirement or above the upper level. The main sources of I were bread containing iodised salt (39 %), dairy products (14 %) and non-alcoholic drinks (6 %). I intake (natural sources only, excluding iodised salt and supplements) was positively associated with (parental) education, which could at least partly be attributed to a higher consumption of dairy products. Among children, the consumption of bread, often containing iodised bakery salt, was positively associated with parental education. The I intake of the Dutch population (7-69 years) seems adequate, although it has decreased since the period before 2008. With the current effort to reduce salt intake and changing dietary patterns (i.e. less bread, more organic foods) it is important to keep a close track on the I status, important sources and potential risk groups.

High prevalence of cardiovascular risk factors in Peruvian adolescents living in a peri-urban shantytown: a cross-sectional study.

BACKGROUND: Adults of the peri-urban Peruvian shantytown of Lomas de Zapallal have a high prevalence of risk factors for developing cardiovascular disease (CVD)-likely due to behavioral choices established during childhood and adolescence. To guide the development of community-based risk reduction programs, we assessed the prevalence of risk factors for developing CVD among adolescents. METHODS: We collected cross sectional data from adolescents of Peruvian peri-urban shantytown to evaluate four domains of CVD risk factors: (1) clinical (blood pressure, fasting blood glucose, and blood lipids), (2) anthropometric (height, weight, and waist circumference), (3) behavioral (physical activity, diet, and substance abuse), and (4) psychosocial (mental health and violence). RESULTS: We enrolled 275 adolescents (56.4% female, mean age 14 years). Prevalence of overweight or obese status was 27.8%. High blood pressure was more common in males (37.4%) than females (20.5%) (p = 0.002). Total cholesterol was elevated (>170 mg/dL) in nearly half (45.5%) of the adolescents, and 71% had impaired fasting blood glucose (>100 mg/dL). Females were less likely to exercise daily (95.4%) than males (84.2%) (p = 0.002) but reported higher rates of depression (66.4%), anhedonia (67.6%), and self-harm behavior (37.9%) (all p < 0.01). CONCLUSIONS: Adolescents living in the peri-urban population of Puente Piedra had high prevalence of risk factors for future development of CVD; preventative efforts focused on improving nutrition, increasing physical inactivity, and addressing mental health conditions could reduce such risk factors.

Dual Burden of Malnutrition Among Adolescents of Smallholder Coffee Farming Households of Jimma Zone, Southwest Ethiopia.

BACKGROUND: Substantial evidence is emerging on the coexistence of double burden of malnutrition on adolescents of low-income countries, shaping the health challenges of the upcoming adult generation for the worst. Whether nutritional status markers of adolescents in the cash crop setting are on par with economic gains remains uncertain. Thus, we investigated the nutritional outcomes of adolescents and their determinants in coffee farming households. METHODS: The survey was carried out in 3 top coffee-producing districts of Jimma Zone, Ethiopia. Five hundred fifty mothers/caregivers and their respective adolescents were selected using multistage random sampling. Anthropometric data were converted into height-for-age and body-mass-index-for-age Z scores using WHO Anthroplus software and analyzed by SPSS for windows. RESULTS: Prevalence of thinness, stunting, and overweight/obesity were 11.6%, 15.6%, and 7.1%, respectively. The odds of stunting among adolescents in households in the lowest wealth tertile was nearly 6-fold higher compared to the highest tertile (adjusted odds ratio [AOR] = 5.6 [2.6-12]). Conversely, the odds of overweight/obesity was higher among adolescents in the households in the middle wealth tertile (AOR = 2.72 [1.08-6.86]) compared to the highest tertile. Adolescents living in households with low-dependent age-groups were more than twice likely to be overweight/obese (AOR = 2.58 [1.06-6.24]). CONCLUSION: The current study revealed the presence of substantial dual burden of malnutrition. In such a setting, it is critical to draw a fine line and trade-off for eliminating morbidity and mortality of undernutrition, without triggering the risk of overweight/obesity.

Perceptions and Knowledge of Caffeinated Energy Drinks: Results of Focus Groups With Canadian Youth.

OBJECTIVE: To examine use, knowledge, and perceptions of caffeinated energy drinks (CEDs) among youth. DESIGN: Qualitative research using focus group discussions (n = 4). SETTING: Two Canadian cities (Toronto and Montreal). PARTICIPANTS: Youth aged 12-18 years (n = 41). PHENOMENON OF INTEREST: Perceived definitions of CEDs, reasons for use, knowledge of health effects, use with alcohol, marketing perceptions, and use and understanding of cautionary statements on packaging. ANALYSIS: Data were analyzed using a modified grounded-theory approach. RESULTS: Youth identified CEDs as products that provide energy and contain caffeine and sugar. Compared with mainstream CED brands and energy shots, youth were less likely to perceive Gatorade, Coca-Cola, and a Starbucks beverage as energy drinks, despite some ambiguity. The majority of participants believed that CEDs, including mixed with alcohol, were not necessarily harmful in moderation and that marketing was targeted toward older youth and young adults. Awareness of cautionary statements on CEDs was low; cautionary statements were perceived as difficult to find and read owing to the design and small font. CONCLUSIONS AND IMPLICATIONS: Findings suggest a need to increase public education regarding the potential risks of CED consumption, including enhancements to the mandated cautionary statements, with greater attention to the impact of CED marketing on youth.

Factors associated with high consumption of soft drinks among Australian secondary-school students.

OBJECTIVE: To examine demographic and behavioural correlates of high consumption of soft drinks (non-alcoholic sugar-sweetened carbonated drinks excluding energy drinks) among Australian adolescents and to explore the associations between high consumption and soft drink perceptions and accessibility. DESIGN: Cross-sectional self-completion survey and height and weight measurements. SETTING: Australian secondary schools. SUBJECTS: Students aged 12-17 years participating in the 2012-13 National Secondary Students' Diet and Activity (NaSSDA) survey (n 7835). RESULTS: Overall, 14 % of students reported consuming four or more cups (≥1 litres) of soft drinks each week ('high soft drink consumers'). Demographic factors associated with high soft drink consumption were being male and having at least $AU 40 in weekly spending money. Behavioural factors associated with high soft drink consumption were low fruit intake, consuming energy drinks on a weekly basis, eating fast foods at least once weekly, eating snack foods ≥14 times/week, watching television for >2 h/d and sleeping for <8 h/school night. Students who perceived soft drinks to be usually available in their home, convenient to buy and good value for money were more likely to be high soft drink consumers, as were students who reported usually buying these drinks when making a beverage purchase from the school canteen/vending machine. CONCLUSIONS: High soft drink consumption clusters with other unhealthy lifestyle behaviours among Australian secondary-school students. Interventions focused on reducing the availability of soft drinks (e.g. increased taxes, restricting their sale in schools) as well as improved education on their harms are needed to lower adolescents' soft drink intake.

Dietary recommendations for the prevention of depression.

BACKGROUND: Major depressive disorder is a common, chronic condition that imposes a substantial burden of disability globally. As current treatments are estimated to address only one-third of the disease burden of depressive disorders, there is a need for new approaches to prevent depression or to delay its progression. While in its early stages, converging evidence from laboratory, population research, and clinical trials now suggests that dietary patterns and specific dietary factors may influence the risk for depression. However, largely as a result of the recency of the nutritional psychiatry field, there are currently no dietary recommendations for depression. AIM: The aim of this paper is to provide a set of practical dietary recommendations for the prevention of depression, based on the best available current evidence, in order to inform public health and clinical recommendations. RESULTS: Five key dietary recommendations for the prevention of depression emerged from current published evidence. These comprise: (1) follow 'traditional' dietary patterns, such as the Mediterranean, Norwegian, or Japanese diet; (2) increase consumption of fruits, vegetables, legumes, wholegrain cereals, nuts, and seeds; (3) include a high consumption of foods rich in omega-3 polyunsaturated fatty acids; (4) replace unhealthy foods with wholesome nutritious foods; (5) limit your intake of processed-foods, 'fast' foods, commercial bakery goods, and sweets. CONCLUSION: Although there are a number of gaps in the scientific literature to date, existing evidence suggests that a combination of healthful dietary practices may reduce the risk of developing depression. It is imperative to remain mindful of any protective effects that are likely to come from the cumulative and synergic effect of nutrients that comprise the whole-diet, rather than from the effects of individual nutrients or single foods. As the body of evidence grows from controlled intervention studies on dietary patterns and depression, these recommendations should be modified accordingly.

Relative validation of 24-h urinary hippuric acid excretion as a biomarker for dietary flavonoid intake from fruit and vegetables in healthy adolescents.

PURPOSE: A biomarker for dietary flavonoid intake from fruit and vegetables (FlavFV) is needed to elucidate the relevance of flavonoids from these sources for the prevention of chronic diseases. Urinary hippuric acid (HA)-a major metabolite of flavonoids-is promising in this respect as it was shown to satisfyingly indicate fruit and vegetable consumption in different age groups. Therefore, we validated urinary HA as a biomarker for intake of FlavFV. METHODS: Analyses included data from 287 healthy adolescents of the DONALD Study (aged 9-16 years) for whom a minimum of two pairs of HA measurements from 24-h urine samples (test method) and FlavFV intake estimated from 3-day weighed dietary records (reference method) existed. Agreement between both methods was assessed by Spearman correlation and cross-classification analyses. Possible confounders of the association were identified by linear regression models. Analyses were performed using a split-sample approach allowing for consecutive exploration (n = 192) and confirmation (n = 95) of results. RESULTS: Agreement between urinary HA excretion and FlavFV intake was moderate according to correlation analysis in the exploratory sample (r unadjusted = 0.47, P < 0.0001). Yet, 79 % of the subjects were classified into same/adjacent quartiles, and only 5 % were misclassified into opposite quartiles. These findings were corroborated by analyses in the confirmatory sample (r unadjusted = 0.64; 88 % in same/adjacent vs. 4 % in opposite quartiles). Body surface area (BSA) was the only relevant covariate in the exploratory sample, and its adjustment improved cross-classification estimates in both subsamples. CONCLUSIONS: BSA-adjusted 24-h urinary HA excretion represents a suitable biomarker of habitual FlavFV intake in healthy adolescents.