Age-specific burden of cervical cancer associated with HIV: A global analysis with a focus on sub-Saharan Africa.

HIV substantially worsens human papillomavirus (HPV) carcinogenicity and contributes to an important population excess of cervical cancer, particularly in sub-Saharan Africa (SSA). We estimated HIV- and age-stratified cervical cancer burden at a country, regional and global level in 2020. Proportions of cervical cancer (a) diagnosed in women living with HIV (WLHIV), and (b) attributable to HIV, were calculated using age-specific estimates of HIV prevalence (UNAIDS) and relative risk. These proportions were validated against empirical data and applied to age-specific cervical cancer incidence (GLOBOCAN 2020). HIV was most important in SSA, where 24.9% of cervical cancers were diagnosed in WLHIV, and 20.4% were attributable to HIV (vs 1.3% and 1.1%, respectively, in the rest of the world). In all world regions, contribution of HIV to cervical cancer was far higher in younger women (as seen also in empirical series). For example, in Southern Africa, where more than half of cervical cancers were diagnosed in WLHIV, the HIV-attributable fraction decreased from 86% in women ≤34 years to only 12% in women ≥55 years. The absolute burden of HIV-attributable cervical cancer (approximately 28 000 cases globally) also shifted toward younger women: in Southern Africa, 63% of 5341 HIV-attributable cervical cancer occurred in women <45 years old, compared to only 17% of 6901 non-HIV-attributable cervical cancer. Improved quantification of cervical cancer burden by age and HIV status can inform cervical cancer prevention efforts in SSA, including prediction of the impact of WLHIV-targeted vs general population approaches to cervical screening, and impact of HIV prevention.

Systematic development of a mobile preconception lifestyle programme for couples undergoing IVF: the PreLiFe-programme.

STUDY QUESTION: Can we develop a preconception lifestyle programme for couples undergoing IVF that is in line with their needs. SUMMARY ANSWER: A mobile preconception lifestyle programme was systematically developed based on expert opinion, literature and needs of IVF-patients. WHAT IS KNOWN ALREADY: A healthy lifestyle prior to conception is not only beneficial for the general health of couples, but evidence on its importance for their reproductive health and the health of their children is also emerging. So far, the vast majority of fertility clinics do not offer a lifestyle programme for couples undergoing IVF. Therefore, the present study aimed to develop a lifestyle programme for IVF-couples. STUDY DESIGN, SIZE, DURATION: The development of the PreLiFe-programme was guided by the steps of the Medical Research Council (MRC) framework for developing complex interventions, a systematic approach for developing theory- and evidence-based health promotion interventions. PARTICIPANTS/MATERIALS, SETTINGS, METHODS: First, the evidence base on lifestyle programmes for IVF-couples was reviewed. Second, several iterations between an expert panel, the literature, and quantitative and qualitative data from IVF-patients identified the content, the format, behaviour change techniques and theory of the programme. Third, the PreLiFe-programme was produced and the expected process and outcomes of a randomized controlled trial assessing it were modelled. Finally, user tests among experts and patients and pilot tests among patients were conducted. MAIN RESULTS AND ROLE OF CHANCE: The finally developed PreLiFe-programme is a mobile application to be used autonomously by both partners of IVF-couples during the first year of IVF, in combination with motivational interviewing over the telephone every three months (i.e. blended care). The PreLiFe-programme provides advice and skills training on physical activity, diet and mindfulness based stress reduction and is in part tailored based on monitoring and tracking the lifestyle of patients. Based on the literature the expert panel considers it plausible that all three components contribute to IVF-success rates. The PreLiFe-programme is likely to be acceptable to patients as it meets the need of patients for lifestyle advice and treatment information. LIMITATIONS, REASON FOR CAUTION: The pilot in IVF-couples had a 3-month duration. The feasibility of the PreLiFe-programme in other infertile populations and/or upon longer use is yet to be examined. Whether the PreLiFe-programme effectively improves lifestyle and IVF-success rates is currently being examined in a trial randomizing heterosexual couples starting IVF to the PreLiFe-programme or an attention-control group for 12 months. WIDER IMPLICATIONS OF THE FINDINGS: If the PreLiFe-programme improves lifestyle and the chance of IVF-success, it will be a powerful tool and provide guidance for implementing lifestyle programmes in fertility clinics. STUDY FUNDING/COMPETING INTEREST(S): Funded by the Research Foundation Flanders (FWO-TBM (Applied Biomedical Research with a Primary Social finality); reference: T005417N). The authors have no conflict of interest to report. TRIAL REGISTRATION NUMBER: NCT03790449.

Effect of obesity on gastrointestinal transit, pressure and pH using a wireless motility capsule.

BACKGROUND: Despite the increasing prevalence and medical burden of obesity, the understanding of gastrointestinal physiology in obesity is scarce, which hampers drug development. AIM: To investigate the effect of obesity and food intake on gastrointestinal transit, pressure and pH. MATERIAL AND METHODS: An exploratory cross-sectional study using a wireless motility capsule (SmartPill©) was performed in 11 participants with obesity and 11 age- and gender-matched participants with normal weight (group) in fasted and fed state (visit). During the first visit, the capsule was ingested after an overnight fast. During a second visit, the capsule was ingested after a nutritional drink to simulate fed state. Linear mixed models were constructed to compare segmental gastrointestinal transit, pressure and pH between groups (obesity or control) and within every group (fasted or fed). RESULTS: Food intake slowed gastric emptying in both groups (both P < 0.0001), though food-induced gastric contractility was higher in participants with obesity compared to controls (P = 0.02). In the small intestine, a higher contractility (P = 0.001), shorter transit (P = 0.04) and lower median pH (P = 0.002) was observed in participants with obesity compared to controls. No differences were observed for colonic measurements. CONCLUSION: Obesity has a profound impact on gastrointestinal physiology, which should be taken into account for drug development.

A feasibility study of using a diet optimization approach in a web-based computer-tailoring intervention for adolescents.

OBJECTIVE: Adolescents are an interesting but neglected target group in obesity prevention. We assessed the feasibility of using a diet optimization approach for computer-tailored nutrition interventions for adolescents. METHOD: Development of an optimization model based on the public health approach to diet optimization. On the basis of food frequency questionnaires (FFQ) of 48 adolescents (14-17 years) optimized diets were calculated. RESULTS: The optimization calculations for all cases resulted in individual advice. On a total of 137 items included in the FFQ, the individualized advice included changes in a minimum of 36 and a maximum of 88 items (mean: 61 items), recommendations for changes in the food items ranged from less than 1 g day(-1) up to 1660 g day(-1). In almost all cases a higher intake of fruit and vegetables was recommended; some unexpected advice was also generated (for example, to decrease the consumption of brown bread and to increase the consumption of pizza). The strengths and weaknesses of the optimized diets are discussed. CONCLUSION: Using the optimization approach is a step forward in nutrition tailoring interventions but the model used in the present feasibility study still needs to be refined.

Development and evaluation of a self-administered computerized 24-h dietary recall method for adolescents in Europe.

OBJECTIVE: To describe the development of a European computerized 24-h dietary recall method for adolescents, and to investigate the feasibility of self-administration (self report) by comparison with administration by a dietician (interview). METHODS: Two hundred and thirty-six adolescents (mean age 14.6 years (s.d.=1.7)) of eight European cities completed the 24-h recall (Young Adolescents Nutrition Assessment on Computer (YANA-C)) twice (once by self-report and once by interview). RESULTS: A small but significant underestimate in energy (61 (s.e.=31) kcal) and fat (4.2 (s.e.=1.7) g) intake was found in the self-reports in comparison with the interviews; no significant differences were found for the intake of carbohydrates, proteins, fibre, calcium, iron and ascorbic acid. Spearman's correlations were highly significant for all nutrients and energy ranging between 0.86 and 0.91. Agreement in categorizing the respondents as consumers and non-consumers for the 29 food groups was high (kappa statistics >or=0.73). Percentage omissions were on average 3.7%; percentage intrusions: 2.0%. Spearman's correlations between both modes were high for all food groups, for the total sample (>or=0.76) as well as for the consumers only (>or=0.72). Analysing the consumer only, on an average 54% of the consumed amounts were exactly the same; nevertheless, only for one group 'rice and pasta' a significant difference in consumption was found. CONCLUSION: Adaptation, translation and standardization of YANA-C make it possible to assess the dietary intake of adolescents in a broad international context. In general, good agreement between the administration modes was found, the latter offering significant potential for large-scale surveys where the amount of resources to gather data is limited.

Evaluation of a 2-day food record to determine iron, calcium and vitamin C intake in young Belgian women.

OBJECTIVE: Evaluation of a 2-day food record (FR) for the assessment of iron, calcium and vitamin C intake. DESIGN: In a subsample of a large-scale epidemiological study, iron, calcium and vitamin C intake were estimated using a 2-day FR and compared to the nutrient intakes assessed by an 11-day FR (reference method). SETTING: City of Ghent, Dutch speaking part of Belgium. SUBJECTS: A number of 51 non-pregnant women (18-39 years). RESULTS: Mean iron, calcium and vitamin C intakes were not significantly different between the reference method and 2-day FR. Correlation coefficients of 0.63 (iron) and 0.76 (calcium, vitamin C) were reached. The iron intake of 95% of the individuals assessed by the 2-day FR varied between 5 mg above or below the reference intake. Over 50% of the women were correctly classified and 4% or fewer were extremely misclassified by the 2-day FR. Mean 11-day FR intakes increased progressively over the tertiles defined by the 2-day FR. The 11-day energy intake was under-reported by 28% of the women; no over-reporters were identified. CONCLUSIONS: The 2-day FR is able to estimate mean iron, calcium and vitamin C intake and to rank individuals along the distribution of intakes.

Simulated impact of a fish based shift in the population n--3 fatty acids intake on exposure to dioxins and dioxin-like compounds.

Due to the favourable health effects of LC n-3 PUFAs, marine products have been recognised as a food group of special importance in the human diet. However, seafood is susceptible to contamination by lipophilic organic pollutants. The objective of this study was to evaluate intake levels of PCDDs, PCDFs and dioxin-like PCBs, by a probabilistic Monte Carlo procedure, in relation to the recommendation on LC n-3 PUFAs given by Belgian Federal Health Council. Regarding the recommendation, two scenarios were developed differing in LC n-3 PUFAs intake: a 0.3 E% and a 0.46 E% scenario. Total exposure to dioxins and dioxin-like substances in the 0.3 E% LC n-3 PUFAs scenario ranges from 2.31 pg TEQ/kg bw/day at the 5th percentile, over 4.37 pg TEQ/kgbw/day at the 50th percentile to 8.41 pg TEQ/kgbw/day at the 95th percentile. In the 0.46 E% LC n-3 PUFAs scenario, 5, 50 and 95th percentile are exposed to 2.74, 5.52 and 9.98 pg TEQ/kgbw/day, respectively. Therefore, if the recommended LC n-3 PUFAs intake would be based on fish consumption as the only extra source, the majority of the study population would exceed the proposed health based guidance values for dioxins and dioxin-like substances.

Selection of women at risk for cervical cancer in an HIV-infected South African population.

OBJECTIVE: Cervical cancer is the leading cause of cancer-related death in women in South Africa. This study evaluates DNA methylation levels in cervical (pre)cancer and aims to assess the value of high-risk human papillomavirus (hrHPV) testing and methylation analysis, alone or in combination, on physician-taken cervical scrapes to detect cervical cancer, and cervical intraepithelial neoplasia grade 3 (CIN3) in an HIV-infected South African population. DESIGN: Prospective observational multicentre cohort study. METHODS: Women from a cohort of women living with HIV (n = 355) and a referral cohort (n = 109, 60% HIV seropositive) were included. Cervical scrapes were collected for hrHPV testing and methylation analysis of cell adhesion molecule 1, T-lymphocyte maturation-associated protein, and microRNA124-2 genes. Histologic endpoints were available for all participants. Performance for detection of CIN3 or worse (CIN3+) was determined in the cohort of women living with HIV and different testing strategies were compared. RESULTS: HrHPV and methylation positivity rates increased with severity of cervical disease in the two study cohorts, each reaching 100% in samples of women with carcinoma. HrHPV testing showed a sensitivity for CIN3+ of 83.6%, at a specificity of 67.7%. Methylation analysis showed a comparable CIN3+ sensitivity of 85.2%, but a significantly lower specificity of 49.6%. HrHPV testing with reflex methylation analysis showed a CIN3+ sensitivity of 73.8%, at a specificity of 81.5%. CONCLUSION: In this HIV-infected South African population, stratifying hrHPV-positive women with reflex methylation analysis detects all cervical carcinomas and yields an acceptable sensitivity and specificity for CIN3+.

[A review of the nutritional management plans in the member states of the European Union]. / Een overzicht van de nutritionele beleidsplannen in de lidstaten van de Europese Unie.

Obesity has reached epidemiological proportions in Europe and the burden of diseases attributable to nutrition is substantial. Under the impetus of the World Health Organisation (WHO), member states have been urged to develop national action plans for nutrition and physical activity. This study describes what has been done in terms of nutrition policy at national level in the member states of the European Union right before its enlargement in 2004. It is a critical review of publicly available policy documents on nutrition and physical activity. The background idea was to assist the initiative of the Belgian food industry to play a proactive role in the development of a Belgian nutrition action plan. At the time of writing, in total six out of the fifteen EU member states namely Sweden, Finland, Denmark, France, the Netherlands and the United Kingdom, reported to have an operational national nutrition plan. By the end of the year 2004, another four countries are expected to have their plan finalised. In line with WHO guidelines, all nutrition plans in this study acknowledge the importance of a multidisciplinary approach and promote stakeholder involvement at some point. Most of the plans however, do not elaborate on their specific role and strategies that will be used to do so. It seems that stakeholder mobilisation is largely restricted to the implementation phases. All operational nutrition plans envisage reducing social disparities. Long-established vulnerable groups in society such as pregnant women, children and elderly are targeted. Considerable variability was observed for nutritional objectives and dietary recommendations between the different countries. Nutrition surveillance and monitoring activities seem to vary considerably between the different action plans. None of the countries except Denmark documents the theoretical foundations and development process of their nutritional surveillance system. National nutrition policy in Europe is clearly in a state of flux and the centre of gravity seems to move away from Scandinavia. Although the importance of nutritional surveillance, comprehensive approach to nutritional problems and stakeholder involvement is recognised by the action plans, the rationale, justification and mechanisms for it is vaguely described. Our findings call for increased efforts to strengthen the evidence base of public health nutrition policy. To achieve this however, systematic evaluations and proper reporting of which health and nutrition promotion strategies work in the different countries in the EU are urgently needed.

Young adolescents' nutrition assessment on computer (YANA-C).

OBJECTIVE: To assess the relative validity and acceptability of the computerised 24-h recall 'Young Adolescent's Nutrition Assessment on Computer (YANA-C)'. DESIGN: Food and nutrient intakes assessed with YANA-C were compared with food records (study 1) and 24-h dietary recall interviews (study 2). MAIN OUTCOME MEASURES: Intakes of food groups (fruit, fruit juice, vegetables, potatoes, bread, cereals, milk, cheese, other milk products, soft drinks, diet soft drinks, sugar/sweets, pastry/cookies, savoury snacks, butter/sauces, eggs, fish, meat) and nutrients (energy, carbohydrates, protein, fat, fiber, calcium, vitamin C and iron). SUBJECTS AND SETTING: A total of 237 pupils (11-14 y) from two primary and four secondary schools (study 1: n = 136; study 2: n = 101) in Belgium-Flanders. RESULTS: YANA-C proved to agree well with both standard methods in categorizing subjects in consumers and nonconsumers (kappa(study 1) = 0.48-0.92; kappa(study 2) = 0.38-0.90). Spearman's correlations for energy and nutrient intakes ranged between 0.44 and 0.79 for study 1 and between 0.44 and 0.86 for study 2. Nutrient and energy intakes were in general (excluding calcium) significantly higher in YANA-C in comparison with the food record, but not in comparison with the interview (only fiber). Statistics used to investigate whether YANA-C agreed with the other methods in ranking portions/amounts in consumers only were fair to moderate for most of the food groups (weighted kappa study 1 = 0.11-0.55; study 2 = 0.04-0.73); amounts in consumers only, were significantly lower in YANA-C against both standards for cereals; amounts were significantly higher in YANA-C against the food record for milk, soft drinks, sugar/sweets and savoury snacks and against the interview for potatoes. Only a few pupils evaluated the program negatively. CONCLUSION: YANA-C is a promising method to collect detailed dietary information from young adolescents with relatively low staff resources, useful in many nutrition research applications.

Iron intake and dietary sources of iron in Flemish adolescents.

OBJECTIVE: To investigate the dietary iron intake and food sources of iron in Flemish adolescents. DESIGN: Cross-sectional survey; dietary assessment method: a 7-day estimated food record. SETTING: Private and public secondary schools in Ghent, a city in the Dutch-speaking part of Belgium. SUBJECTS: A total of 341 adolescents (129 boys and 212 girls), 13-18 y, randomly selected by a multistage clustered sampling technique. RESULTS: The mean total iron intake (s.d.) for boys was 13.4 (+/- 2.91) mg/day and for girls 10.1 (+/- 2.79) mg/day. A proportion of 38.8% of the boys and 99.5% of the girls had a mean total iron intake below the Belgian Recommended Dietary Allowance and 3.1% of the boys and 71.2% of the girls below the British Estimated Average Requirement. When bioavailable iron intake is considered, 84.5% of the boys and only 16.5% of the girls met the age-specific requirement. The food groups with the highest mean proportional contribution to total iron intake in both males and females were bread, meat and meat products, cereals and potatoes. A comparison of adolescents from the highest tertile of iron intake (mg/day) with adolescents from the lowest tertile showed a significantly higher energy-adjusted intake of brown bread and a significantly lower intake of soft drinks in the former group in both boys and girls. A significantly higher energy-adjusted intake of breakfast cereals in adolescents of the highest tertile than those of the lowest tertile was seen in girls only. Analyses in consumers only did not change this overall picture. CONCLUSIONS: One can conclude that the mean iron intake of Flemish girls is considerably lower than the current recommendations. An increased iron intake in this subgroup of the population is therefore advisable.

Risk assessment of dietary acrylamide intake in Flemish adolescents.

Acrylamide has recently been found in a range of heat treated food items. As it is a neurotoxic agent and a probable, human carcinogen (IARC 2A), human exposure to this chemical might constitute an important public health issue. The purpose of the study was to estimate the acrylamide intake in Flemish adolescents (based on 7-day food record) and to evaluate the possible health risks due to the exposure. The Belgian Federal Agency for the Safety of the Food Chain collected 150 food items from different supermarkets and restaurants to analyse the acrylamide level. The limit of quantitation was 30 microg acrylamide/kg foodstuffs. Exposure modelling was based on Monte Carlo simulations. The estimated dietary intake of acrylamide per person given as the 5th, 50th and 95th percentile were 0.19, 0.51 and 1.09 mircog/kg bw/d. Bread, despite its low acrylamide content, is relevant as a source of acrylamide exposure at the lower percentiles. At higher percentiles the contribution of French fries and crisps is more important. It must be emphasised that the exposure assessment has several limitations. Risk of neurotoxicity seems negligible. The relevance of current intake levels in terms of cancer risk remains a subject of debate.

Maternal and umbilical fatty acid status in relation to maternal diet.

The aim of this study was to describe the dietary fat intake during pregnancy and to study the relationship between the intake of polyunsaturated fatty acids (PUFAs) and the fatty acid composition of maternal and umbilical plasma phospholipids (PLs) and cholesterol esters (CEs) at delivery. In addition, the contribution of food groups to the intake of total fat and fatty acids in the diet was quantified.Maternal and umbilical blood samples were collected at delivery from 30 healthy pregnant women. The women completed a food frequency questionnaire during the first and third trimesters. The total fat intake during pregnancy is 85 (SD 24) g/day. The mean intake of saturated fatty acids (SFAs) is 33.4 g/day, of monounsaturated fatty acids (MUFAs) 28.6 g/day and of PUFA 15.2 g/day. Major sources of fat, MUFA and PUFA are fats, oils and sauces. Major sources of SFA are meat and poultry followed by cheese and eggs. Meat and poultry contribute the most to the intake of 20:4n-6 whereas fish is the major source of 20:5n-3 (EPA) and 22:6n-3 (docosahexaenoic acid (DHA)) in the diet. Linoleic acid, EPA and DHA (w%) in PL of maternal plasma are positively related to the intake of these fatty acids during pregnancy. No association is found between the maternal intake of the two parent essential fatty acids (18:2n-6 and 18:3n-3) and their fraction in umbilical PL or CE. EPA and the sum of n-6 fatty acids (w%) in umbilical plasma PL are positively correlated with the dietary intake of these fatty acids.

Estimated energy intake, macronutrient intake and meal pattern of Flemish adolescents.

OBJECTIVE: To describe the energy and macronutrient intake and the meal patterns of Flemish adolescents, aged 13-18 y. METHODS: A 7 day estimated food record was administered to the whole sample. SETTING: Secondary schools in the city of Ghent, Belgium. SUBJECTS: A total of 341 adolescents (13-18 y) selected by a multistage clustered sampling (participation: 72.7%). MAIN RESULTS: A significant increase with age was observed in total energy intake in adolescent boys (P<0.01), but not in girls. The energy distribution over the macronutrients showed no significant difference between boys and girls. On average, 35.7% (s.d. 4.81%) of energy came from total fat and 15.4% (s.d. 2.46%) from saturated fatty acids; 49.0% (s.d. 5.28%) from total carbohydrates with 25.1% (s.d. 4.49%) from complex carbohydrates and 23.9% (s.d. 5.86%) from free sugars. The energy contribution of alcohol in the 16-18 y-old-group was significantly higher as compared with the 13-15 y-old-group, for both boys and girls. Snacks between meals accounted for almost 20% of the total energy intake. Lunch and dinner were characterized by high total fat content. CONCLUSION: These students consumed a diet high in total fat and in saturated fatty acids and also high in mono- and disaccharides. Observed mean intakes deviate considerably from the Belgian dietary guidelines. A low energy intake at breakfast was observed, while a higher proportion of energy was derived from snacks.

Validity and reproducibility of a computerised tool for assessing the iron, calcium and vitamin C intake of Belgian women.

OBJECTIVE: To determine the relative validity of a newly developed iron intake assessment tool, designed specifically to assess iron, calcium and vitamin C intake. DESIGN: Estimates of iron, calcium and vitamin C intake from a computerised iron intake assessment tool compared with those from 11-day estimated dietary records. SETTING: Region of Ghent (N= +/- 225,000), a city in Flanders, the Dutch-speaking part of Belgium. SUBJECTS: In all, 50 women aged 18-39 y, participating in a large-scale epidemiological study on iron intake and iron status. MAIN RESULTS: Mean dietary iron intake from the 11-day food record, the unadjusted dietary iron intake assessment tool and the adjusted tool was, respectively, 10.5 +/- 2.7, 10.4 +/- 4.3 and 9.6 +/- 2.9 mg. For the different nutrients, the correlation coefficients vary from 0.45 to 0.60 for adjusted intake. The mean difference of iron intake by the two methods (0.8 +/- 2.9 mg) did not differ significantly from zero. The new method correctly classified 38% (iron), 38% (calcium) and 58% (vitamin C) of the subjects to the correct tertile. The correlation coefficients ranged from 0.48 for adjusted vitamin C intake to 0.73 for adjusted calcium intake between two administrations. CONCLUSION: The newly developed instrument can be used to assess mean group intakes of iron, calcium and vitamin C in women consuming a Western diet. However, since the ranking capability of the new tool is rather weak, further refinement of the tool is required to produce a robust method for assessing iron, calcium and vitamin C intakes of individuals. SPONSORSHIP: This research was supported by the Belgian National Fund for Scientific Research/Flemish Division (Fund No G.0152.01).

Ten-year changes in anthropometric characteristics of elderly Europeans.

OBJECTIVE: Assess longitudinal (10-y) changes in height, body weight and circumferences in elderly Europeans. DESIGN: Longitudinal assessments including baseline measurements taken in 1988/1989 which were repeated in 1993 (follow-up) and in 1999 (Finale). SETTING: Longitudinal data were collected in nine European research towns: Hamme/Belgium (H/B), Roskilde/Denmark (R/DK), Haguenau/France (H/F), Romans/France (R/F), Padua/Italy (P/I), Culemborg/the Netherlands (C/NL), Vila Franca de Xira/Portugal (V/P), Betanzos/Spain (B/E), Yverdon/Switzerland (Y/CH). SUBJECTS: Using standardised methodologies data were collected from a random stratified sample of elderly men and women born between 1913 and 1918 including a total of 662 subjects in 1999. RESULTS: On average stature had decreased by 1,5-2 cm. Mean weight changed by -2.6 kg to - 4.2 kg in only three towns. An increase of at least 5 kg of body weight had taken place in 13 % of both men and women whereas 23 % of men and 27 % women had lost at least 5 kg of their baseline weight. Such weight loss over the first 4 years of follow-up was associated with higher mortality rates in men (crude RR 2.2, p<0.0001). Serial changes in arm circumference were small but waist circumference had increased by 3-4 cm. CONCLUSIONS: Whilst small-to-modest average changes in height, body weight and circumferences emerged over SENECA's 10-year follow-up period, considerable gains and losses of body weight had occurred in a significant proportion of the SENECA populations, whereby early weight loss might be predictive of subsequent survival.

Five year changes in mental health and associations with vitamin B12/folate status of elderly Europeans.

OBJECTIVE: To describe 5-year changes of mental health in SENECA participants, and to examine whether mental health is associated with the status of vitamin B12 and folate. DESIGN: A longitudinal, multicentre study including a Baseline study, a Follow-up study, and a Finale study. SUBJECTS: Inhabitants of 11 European towns, born between 1913 and 1918, were randomly selected at baseline to participate in the SENECA study. Of the 1099 enrolled subjects in the Follow-up study, 586 participated in the Finale study. INTERVENTION: Mental health status was assessed by the Mini-Mental State Examination (MMSE, cognitive impairment defined as MMSE<23) and the 15-item Geriatric Depression Scale (GDS, depression defined as GDS>5). RESULTS: In the Finale study, mean overall MMSE score was 26.1 for men and 25.6 for women, while mean overall GDS score was 3.1 for men and 4.1 for women. Among subjects that participated in both the Follow-up and the Finale study, MMSE scores decreased with 0.9 points (P<0.0001) and 1.0 points (P<0.0001) among men and women respectively. The GDS scores decreased with 0.7 points (P<0.0001) for men and 0.8 points (P<0.0001) for women. Among subjects that participated in the Finale study, no significant correlations have been observed between mental health and vitamin B12/folate status. CONCLUSION: In the Finale study, mental health of the majority of the SENECA participants remained intact. In contrast to the Follow-up study, no associations between mental health and vitamin B12/folate status were emerged.

The role and requirements of digestible dietary carbohydrates in infants and toddlers.

Digestible carbohydrates are one of the main sources of dietary energy in infancy and childhood and are essential for growth and development. The aim of this narrative review is to outline the intakes of digestible carbohydrates and their role in health and disease, including the development of food preferences, as well the consequences of excess carbohydrate. Key experts in these fields provided up-to-date reviews of the literature. A search of available information on dietary intakes of children below the age of 4 years was conducted from 1985 up to 2010. Articles and reports including information about sugars and/or starch intakes were selected. A number of factors limit the ability to obtain an overall picture of carbohydrate intakes and food sources in this age group. These include small numbers of intake studies, differing approaches to analysing carbohydrate, a variety of terms used to describe sugars intakes and a dearth of information about starch intakes. Data suggest that sweet taste is preferred in infancy and later food choices. There are few established adverse consequences of high intakes of digestible carbohydrate for young children. The greatest evidence is for dental caries, although this is influenced by high intake frequency and poor oral hygiene. Evidence for detrimental effects on nutrient dilution, obesity, diabetes or cognition is limited. In infants, minimum carbohydrate (mainly lactose) intake should be 40% of total energy, gradually increasing to 55% energy by the age of 2 years.

Impact of fixed implant prosthetics using the 'all-on-four' treatment concept on speech intelligibility, articulation and oromyofunctional behaviour.

The purpose of this case control study is to determine the impact of screw-retained fixed cross-arch prostheses, supported by four osseointegrated implants, on articulation and oromyofunctional behaviour. Objective (acoustic analysis) and subjective assessment techniques were used to determine the overall intelligibility, phonetic characteristics and oromyofunctional behaviour at an average period of 7.3 months after placement of the fixed implant prosthesis in 15 patients and 9 age-matched controls with intact dentition and without prosthetic appliances. Overall satisfaction with the prosthesis was 87%, but 53% of the subjects mentioned an impact on speech. 87% of the subjects presented with one or more distortions of the consonants. The most common distortions were distortions of the sound /s/ (sigmatismus simplex, 40% and sigmatismus stridens, 33%), simplex /z/ (27%), insufficient frication of /f/ (20%), /[symbol in text]/ (20%), addental production of /d/ (20%), /t/ (20%) or /s/ sound (13%) and devoiced /d/ (7%). In the control group, no articulation disorders were noted. Oromyofunctional behaviour in both groups was normal. To what extent motor-oriented speech therapy (with focus on tongue function) immediately after periodontal treatment (after wound healing) would decrease the persistent phonetic distortions is a subject for further research.

Intake and dietary sources of haem and non-haem iron in Flemish preschoolers.

BACKGROUND/OBJECTIVES: In the absence of biochemical data on iron status in preschoolers, data on the adequacy of iron intake may be used to assess the possible risk of iron deficiency in this population group. Therefore, this study aims to investigate iron intake and its food sources in Flemish preschoolers. SUBJECTS/METHODS: A total of 661 Flemish preschoolers 2.5-6.5 years old were recruited via a random cluster sampling design, using schools as primary sampling units. Three-day estimated diet records were used to assess dietary intakes. The contribution to iron intake (haem and non-haem) of 57 food groups was computed by summing the amount provided by the food group for all individuals divided by the total intake for all individuals. RESULTS: Mean total iron intake (s.d.) was 7.4 (±2.3) and 6.7 (±2.8) mg/day for boys and girls, respectively. In all 65% of the children <4 years old and 45% of those 4-6.5 years old presented adequate iron intakes. The food groups with the highest mean proportional contribution to total iron intake were bread, meat and meat products, breakfast cereals and sweet snacks (in that order). Children from small families whose mother had a low educational level had higher iron intakes. CONCLUSION: Iron intakes were similar for boys and girls and almost half of the Flemish preschoolers do not comply with the dietary iron recommendations.