Nutritional, environmental and economic implications of children plate waste at school: a comparison between two Italian case studies.

OBJECTIVE: This study aims at comparing two Italian case studies in relation to schoolchildren's plate waste and its implications, in terms of nutritional loss, economic cost and carbon footprint. DESIGN: Plate waste was collected through an aggregate selective weighting method for 39 d. SETTING: Children from the first to the fifth grade from four primary schools, two in each case study (Parma and Lucca), were involved. RESULTS: With respect to the served food, in Parma, the plate waste percentage was lower than in Lucca (P < 0·001). Fruit and side dishes were highly wasted, mostly in Lucca (>50 %). The energy loss of the lunch meals accounted for 26 % (Parma) and 36 % (Lucca). Among nutrients, dietary fibre, folate and vitamin C, Ca and K were lost at most (26-45 %). Overall, after adjusting for plate waste data, most of the lunch menus fell below the national recommendations for energy (50 %, Parma; 79 %, Lucca) and nutrients, particularly for fat (85 %, Parma; 89 %, Lucca). Plate waste was responsible for 19 % (Parma) and 28 % (Lucca) of the carbon footprint associated with the food supplied by the catering service, with starchy food being the most important contributor (52 %, Parma; 47 %, Lucca). Overall, the average cost of plate waste was 1·8 €/kg (Parma) and 2·7 €/kg (Lucca), accounting respectively for 4 % and 10 % of the meal full price. CONCLUSION: A re-planning of the school meals service organisation and priorities is needed to decrease the inefficiency of the current system and reduce food waste and its negative consequences.

Are increased symptoms of orthorexia nervosa linked to self-perceived body image and nutritional adequacy of Turkish adults?

This cross-sectional study, conducted on 4003 participants aged between 18 and 45, aims to contribute to orthorexia nervosa (ON) research by examining the relationship between ON, body image and nutritional adequacy. The Orthorexia Nervosa-11 scale (ORTO-11) and body perception scale were applied to individuals, and food consumption records were taken with a 24-hour dietary recall method. The study found that more individuals with orthorexia nervosa (ON) considered themselves overweight compared to non-ON individuals. Evaluating diet quality, the mean adequacy ratio was significantly higher in ON individuals. Nutrient adequacy ratios for total fiber, magnesium, zinc, thiamine, folic acid, and vitamin C were higher, while those for carbohydrate and iron were lower in ON individuals. Additionally, increasing the number of snacks, protein, and total fiber adequacy decreased the ORTO-11 score. Distorted body image perception may be a risk factor for ON, but healthy eating fixation does not lead to nutrient inadequacy unless it involves progressive food restriction.

Nutritional adequacy of commercial food products targeted at 0-36-month-old children: a study in Brazil and Portugal.

In the context of the global childhood obesity, it is essential to monitor the nutrition value of commercial foods. A cross-sectional study (November 2018 to April 2019) aimed to evaluate the nutritional adequacy of processed/ultra-processed food products targeted at 0-36-month-old children in Portugal and in Brazil. The nutrient profiling model developed by the Pan American Health Organization was used. A total of food 171 products were assessed (123 in Portugal and forty eight in Brazil). From the fifteen available meat- or fish-based meals in Brazil, 60 % exceeded the amount of Na and 100 % exceeded the target for total fat. Given the lack of specification of sugars within carbohydrates in the label of the foods in Brazil, it was not possible to calculate free sugars. In Portugal, from the seventeen fruit and vegetable purees and the six juice/smoothie/tea/drinks available, 82 % and 67 %, respectively, surpassed the level of free sugar, while total and saturated fat was excessive in all yogurt and yogurt-related products (n 21), 40 % of biscuit/wafer/crisps (two out of five) and 13 % meat- or fish-based meals (two out of sixteen). These findings demonstrate the relevance of improving the nutritional profile of some food products targeted to young children.

Environmental and nutritional assessment of young children's diets in Norway: comparing the current diet with national dietary guidelines and the EAT-Lancet reference diet.

PURPOSE: Introducing healthy and sustainable diets early in life can promote lifelong healthy dietary patterns with a low environmental impact. Therefore, we aimed to estimate the environmental and nutritional consequences of a dietary change for 2-year-old children in Norway towards healthier dietary patterns. METHODS: Environmental impacts of the current habitual diet among 2-year-olds (n = 1413) were estimated for six impact categories and compared with scenario diets based on the Norwegian food-based dietary guidelines (FBDG) and the EAT-Lancet Commission reference diet. Last, we evaluated the nutritional adequacy of the diets against the Norwegian nutrition recommendations for children aged 2-5 years. The current diet was assessed by an FFQ. RESULTS: Environmental impacts of the current habitual diet were up to two times higher than those of the scenario diets. Compared with the current diet, impacts from the FBDG scenario diet were reduced by 35% for water use and 18% for terrestrial acidification, whereas impacts from the EAT-Lancet scenario diet were reduced by 51% for water use, 57% for terrestrial acidification, 36% for global warming potential and 27% for freshwater eutrophication. Milk and dairy products were the main contributors to environmental impacts in both the current diet and the FBDG scenario diet. The scenario diets were nutritionally adequate and improved the dietary quality among Norwegian 2-year-olds. CONCLUSION: Compared to current diets among young children, more plant-based dietary patterns in line with national FBDG or the EAT-Lancet Commission reference diet can improve the nutritional adequacy of diets and simultaneously reduce environmental impacts.

Prognostic values of modified NUTRIC score to assess outcomes in critically ill patients admitted to the intensive care units: prospective observational study.

PURPOSE: Modified Nutrition Risk in the Critically Ill (NUTRIC) score (mNUTRIC score) have been validated as screening tool for quantifying risk of adverse outcome critically ill patients admitted to the intensive care units (ICUs). The aim of this study was to evaluate the prognostic value of mNUTRIC score to assess outcomes in this population. MATERIALS AND METHODS: This prospective, observational study was conducted on adult patients admitted to the general ICUs of two university affiliated hospital in northwest of Iran. The association between the mNUTRIC score and outcomes was assessed using the univariate and multivariate binary logistic regression. The performance of mNUTRIC score to predict outcomes was assessed using the receiver operating characteristic (ROC)-curve. RESULTS: In total 445 ICU patients were enrolled. Based on mNUTRIC score, 62 (13.9%) and 383 (86.1%) individuals were identified at high and low nutritional risk, respectively. The area under the curve (AUC) for predicting ICU mortality, using vasopressor, duration of vasopressor, and mechanical ventilation (MV) duration were (AUC: 0.973, 95% CI: 0.954-0.986, P < 0.001), (AUC: 0.807, 95% CI: 0.767-0.843, P < 0.001), (AUC: 0.726, 95% CI: 0.680-0.769, P < 0.001) and (AUC: 0.710, 95% CI: 0.666-0.752, P < 0.001), respectively. CONCLUSIONS: An excellent and good predictive performance of the mNUTRIC score was found regarding ICU mortality and using vasopressor, respectively. However, this predictive was fair for MV and vasopressor duration and poor for ICU and hospital length of stay.

Approximately Half of Total Protein Intake by Adults Must be Animal-Based to Meet Nonprotein, Nutrient-Based Recommendations, With Variations Due to Age and Sex.

BACKGROUND: Shifting towards a more plant-based diet, as promoted in Western countries, will reduce the animal protein contribution to total proteins. Such a reduction may not only impair protein adequacy, but also the adequacy in other nutrients. OBJECTIVES: We determined, for different adult subpopulations, the minimum total protein levels and the minimum animal protein contributions to total proteins that are compatible with the fulfillment of all nonprotein nutrient-based recommendations. METHODS: Mean nutritional contents and mean diet costs were estimated using a French, cross-sectional, representative survey for 5 French subpopulations: 1) women < 50 y; 2) women 50-64 y; 3) women ≥ 65 y; 4) men < 65 y; and 5) men ≥ 65 y. For each subpopulation, linear programming optimization was used to assess the minimum protein level (model set #1) and the minimum animal protein contribution to total proteins (model set #2) that are compatible with the fulfillment of all nutrient-based recommendations (except proteins, for which levels were analyzed as outputs). Total diet costs were not allowed to increase. Eating habits were considered in model set #2 only. RESULTS: The minimum amount of protein that was theoretically compatible with the fulfillment of nutrient-based recommendations (model set #1) was below the minimum recommended protein intake for all subpopulations except women < 50 y. In model set #2, for women and men ≥ 65 y, decreasing animal protein contributions to total proteins below 55% and 60%, respectively, led to protein levels below recommended levels. For the other subpopulations (women < 50 y, women 50-64 y, and men < 65 y), the lowest animal protein contributions to total proteins compatible with a nutritionally adequate diet (including protein adequacy) were 55%, 50%, and 45%, respectively. CONCLUSIONS: This study provides factual information about the animal protein contributions to total proteins compatible with meeting all nutrient-based recommendations at no additional cost, and shows that they vary between 45% and 60% depending on the group of adults considered.

Meeting nutritional adequacy in the Brazilian population increases pesticide intake without exceeding chronic safe levels.

Achieving nutritional adequacy requires an increase in fresh foods consumption, which may increase pesticide intakes. This study aimed to identify required dietary modifications to achieve nutritional adequacy without exceeding the acceptable daily intake (ADI) for pesticides. Data from the National Dietary Survey 2017-2018 were linked to the pesticide database from the Program on Pesticide Residue Analysis in Food. We performed linear programming models to design nutritionally adequate diets constrained by food preferences for different constraints on pesticide intake at the least cost increment. Nutritional adequacy led to an increase in pesticide intakes without exceeding their ADI. Modifications in diets varied according to the model, but, in general, consisted in an increase in fruits and vegetables, dairy, and seafood, and a reduction in rice, red meat, and sugar-sweetened beverages quantities. In conclusion, meeting nutritional adequacy increases pesticide intake compared to the observed diets, without representing a health concern to consumers.

Assessment of diet quality in children and adolescents with type 1 diabetes.

Background: Micronutrient malnutrition is a serious public health problem in most developing countries, including Morocco, due to poor and therefore lower quality diets that lack dietary diversity. Objective: The present study aimed to assess dietary diversity and variety and their relationship with micronutrient adequacy in children and adolescents with type 1 diabetes (T1D). Materials and methods: A cross-sectional study was carried among 240 children and adolescents with T1D. Weight and height were measured and BMI was calculated. Dietary intake data were obtained from two 24-h recalls. A Dietary diversity (DDS) and dietary variety scores (DVS) and mean adequacy ratio (MAR) and nutritional adequacy ratios (NARs) were calculated and compared according to sociodemographic/anthropometric categories. Results: 52.1% of the patients were female. The mean age of the patients was 8.49 ± 4.1 years. The mean BMI was 19.44 ± 5.24 kg/m2; the mean DDS was 4.62±1.20 and the mean MAR was 0.66 ± 0.11. Older children living in rural areas have a low DDS/DVS. Parental education and income level are associated with DDS/DVS. General and central obesity were significantly elevated in children with high DDS. In addition, a high intake of vegetables, eggs, fiber and micronutrients (Magnesium, Calcium, Potassium, Zinc, Phosphorus and Vit B1) is associated with a high DDS; however, high DVS is associated with high consumption of dairy products, carbohydrates and low intake of protein and fat. There are also positive correlations between DDS/DVS and NARs for various nutrients. Conclusion: The quality of the respondents' diets are moderately diversified. DDS or DVS can be used as indicators of micronutrient adequacy in Moroccan T1D children. Nutritional education needs to be strengthened to improve dietary diversity in children, especially in rural areas.

Nutrient and Food Intake of Participants in a Whole-Food Plant-Based Lifestyle Program.

OBJECTIVE: We evaluated the nutrient adequacy of a well-planned supplemented whole-food plant-based (WFPB) diet as a component of an ongoing community lifestyle optimization program. We investigated the contributions of nutrients from foods and supplements and plant-based meal replacement (SMR) separately (foods, SMR) and combined (vs recommendations) as well as food group intake, both according to sex. METHOD: Our cross-sectional study included 151 healthy, active participants (aged 39.6 years) who were on a Western-type diet when they voluntarily joined our WFPB lifestyle program (0.5-10 years ago). We assessed diet using 3-day weighed dietary records (foods, S, and MR). After we standardized nutrient intake to 2000 kcal/d, we calculated the contribution of macro- and micronutrients from foods and SMR separately and combined (foods + SMR) (vs central European Recommendations), as well as food group intake, both according to sex. RESULTS: All macro- and micronutrient intake (total: from foods plus SMR) exceeded the reference values, except for calcium (95% and 82% in females and males) and vitamin D (both sexes, in summertime). Compared with male participants, female participants consumed (i.e., from foods and SMR together) significantly larger amounts of 23 (/25) micronutrients (8 [/25] from foods and 22 [/25] from SMR). The diet was primarily composed of the following (by mass in descending order): unprocessed vegetables/fruits, whole grains, legumes, potatoes, nuts/seeds, MR, and spices/herbs. CONCLUSIONS: Participants in our WFPB lifestyle program ingested a nutrient-rich WFPB diet and targeted supplementation. The presented ongoing community WFPB lifestyle program ensures a healthy, balanced, and environment-friendly dietary pattern for participants who are compliant.

Snacking in Japanese nursery school children aged 3-6 years: its characteristics and contribution to overall dietary intake.

OBJECTIVE: This cross-sectional study evaluated the dietary characteristics of snacks, the contribution of snacks to daily nutrient intake and the association of energy intake (EI) from snacks with the prevalence of nutritional inadequacy in Japanese nursery school children. DESIGN: Foods and nutrients consumed in each eating occasion were assessed by 3-d dietary records. The prevalence of inadequate intake of twenty nutrients assessed by the age- and sex-specific reference values in the Japanese Dietary Reference Intakes was compared according to tertile categories of EI from snacks. SETTING: A multi-regional dietary survey based on nursery schools in Japan. PARTICIPANTS: A total of 187 boys and 191 girls aged 3-6 years. RESULTS: EI from snacks accounted for 19·5 % (sd 6·9) of total daily EI. Confectionaries accounted for the largest part of EI from snacks (35·3 %), followed by milk (19·5 %). Relative to their energy contribution, snacks accounted for a small proportion for all nutrients examined, except for free sugar, calcium, SFA and riboflavin. Although a higher EI from snacks was associated with favourable profiles for intakes of calcium, iron, thiamine and riboflavin, excessive intakes of free sugar and Na were more prevalent among children with a higher EI from snacks. CONCLUSIONS: Although snacks are effective in meeting the requirement of some nutrients among Japanese nursery school children, snacks are generally not nutrient-dense and have an impact on excessive intake of some nutrients. There is hence room for improvement in food choices at snack time.

The development of food portion sizes suitable for 4-18-year-old children used in a theoretical meal plan meeting energy and nutrient requirements.

BACKGROUND: Healthy eating guidelines for school-aged children are available but without advice on portion sizes. This is a concern because consuming large portions is associated with an increased risk of overweight/obesity. The present study aimed to calculate recommended portion sizes for school-aged children based on weight for age and use them to develop a meal plan to meet nutritional needs within energy requirements. METHODS: Portion size data on foods consumed by school-aged children (4-18 years) were extracted from two sources: (i) British National Diet and Nutrition Survey (1997) and (ii) Avon Longitudinal Study of Parents and Children (1997-2006). Foods were allocated to groups based on the UK Eatwell Guide and the US My Plate Model. Portion sizes were developed for a variety of foods. A meal plan that included portion size guidance and met healthy eating guidelines was developed based on the number of portions of each food group needed to meet dietary requirements. RESULTS: Portion sizes were developed for 131 foods that were commonly eaten by children in age groups 4-6, 7-10, 11-14 and 15-18 years. The meal plan met requirements for energy and nutrients as specified by UK dietary reference values, except for vitamin D for which there are few dietary sources. CONCLUSIONS: Food portion sizes informed by usual intake in UK children can help inform dietary advice for a range of childhood settings and for parents. The meal plan included a wide variety of foods to encourage dietary diversity and meet energy and nutrient needs for school-aged children.

The use of extensively hydrolysed and amino acid feeds beyond cow's milk allergy: a national survey.

BACKGROUND: Extensively hydrolysed formulas (EHFs) and amino acid formulas (AAFs) with proven hypoallergenicity are used for children suffering from cow's milk allergy, when breast milk is not available. However, these feeds are often used in other medical conditions where tolerance and absorption of whole protein is affected, frequently without assessment of efficacy. This practice survey assessed the use of these feeds in paediatric conditions other than cow's milk allergy; aiming to describe the population, growth parameters and micronutrient status. METHODS: Four National Health Service tertiary paediatric centres participated in this practice survey. Inclusion: children between 0 and 18 years, consuming >25% of their estimated energy requirements of an EHF/AAF for any condition other than allergic disease. Anonymised data were collected: (i) descriptive information; (ii) indications; (iii) type and route of feeding; (iv) growth status and nutritional deficiencies; and (v) medication and vitamin and mineral supplementation. RESULTS: One hundred-and-ninety-one children were included with a median age of 19 months (interquartile range 4-63]. Seventeen percent (33/191) were on AAFs and 83% (158/191) were on EHFs. The feeds were commonly used in cancer for 26% and in critical illness for 31%. The majority (73%) of children had enteral feeds via a nasogastric tube. Nutritional biomarkers were performed in 29% of children and 83% were on a vitamin or mineral supplement. CONCLUSIONS: This practice survey found that EHFs and AAFs were used in a variety of medical conditions. Indications for feed choice varied, and evidence-based research supporting the use was scarce. Awaiting further research, children on these types of feeds should have regular nutritional monitoring.

A Multicenter Study of Nutritional Adequacy in Neonatal and Pediatric Extracorporeal Life Support.

BACKGROUND: Malnutrition in critically ill patients is common in neonates and children, including those that receive extracorporeal life support (ECLS). We hypothesize that nutritional adequacy is highly variable, overall nutritional adequacy is poor, and enteral nutrition is underutilized in this population. MATERIALS AND METHODS: A retrospective study of neonates and children (age<18 y) receiving ECLS at 5 centers from 2012 to 2014 was performed. Demographic, clinical, and outcome data were analyzed. Continuous variables are presented as median [IQR]. Adequate nutrition was defined as meeting 66% of daily caloric goals during ECLS support. RESULTS: Two hundred and eighty three patients received ECLS; the median age was 12 d [3 d, 16.4 y] and 47% were male. ECLS categories were neonatal pulmonary 33.9%, neonatal cardiac 25.1%, pediatric pulmonary 17.7%, and pediatric cardiac 23.3%. The predominant mode was venoarterial (70%). Mortality was 41%. Pre-ECLS enteral and parenteral nutrition was present in 80% and 71.5% of patients, respectively. The median percentage days of adequate caloric and protein nutrition were 50% [0, 78] and 67% [22, 86], respectively. The median percentage days with adequate caloric and protein nutrition by the enteral route alone was 22% [0, 65] and 0 [0, 50], respectively. Gastrointestinal complications occurred in 19.7% of patients including hemorrhage (4.2%), enterocolitis (2.5%), intra-abdominal hypertension or compartment syndrome (0.7%), and perforation (0.4%). CONCLUSIONS: Although nutritional delivery during ECLS is adequate, the use of enteral nutrition is low despite relatively infrequent observed gastrointestinal complications.

Equity implications of rice fortification: a modelling study from Nepal.

OBJECTIVE: To model the potential impact and equity impact of fortifying rice on nutritional adequacy of different subpopulations in Nepal. DESIGN: Using 24-h dietary recall data and a household consumption survey, we estimated: rice intakes; probability of adequacy (PA) of eight micronutrients commonly fortified in rice (vitamin A, niacin (B3), pyridoxine (B6), cobalamin (B12), thiamin (B1), folate (B9), Fe and Zn) plus riboflavin (B2), vitamin C and Ca and mean probability of adequacy (MPA) of these micronutrients. We modelled: no fortification; fortification of purchased rice, averaged across all households and in rice-buying households only. We compared adequacy increases between population subgroups. SETTING: (i) Dhanusha and Mahottari districts of Nepal (24-h recall) and (ii) all agro-ecological zones of Nepal (consumption data). PARTICIPANTS: (i) Pregnant women (n 128), mothers-in-law and male household heads; (ii) households (n 4360). RESULTS: Unfortified diets were especially inadequate in vitamins B12, A, B9, Zn and Fe. Fortification of purchased rice in rice-purchasing households increased PA > 0·9 for thiamin, niacin, B6, folate and Zn, but B12 and Fe remained inadequate even after fortification (PA range 0·3-0·9). Pregnant women's increases exceeded men's for thiamin, niacin, B6, folate and MPA; men had larger gains in vitamin A, B12 and Zn. Adequacy improved more in the hills (coefficient 0·08 (95 % CI 0·05, 0·10)) and mountains (coefficient 0·07 (95 % CI 0·01, 0·14)) but less in rural areas (coefficient -0·05 (95 % CI -0·09, -0·01)). CONCLUSIONS: Consumption of purchased fortified rice improves adequacy and gender equity of nutrient intake, especially in non-rice-growing areas.

Nutritional adequacy and content of food bank parcels in Oxfordshire, UK: a comparative analysis of independent and organisational provision.

BACKGROUND: Food bank use has increased significantly in the UK. With the rise in demand, it is imperative that users are receiving food parcels that meet their requirements. The present study aimed to explore whether typical food parcels, supplied by The Trussell Trust and independent food banks, were meeting the daily nutrient and energy requirements of an adult user. METHODS: The Trussell Trust (n = 2) and independent food banks (n = 9) were surveyed in Oxfordshire, UK. Data were collected on food bank use, resources, donations and parcel content. The energy and nutrient contents of a representative parcel were compared with the average dietary reference values (DRVs) for an adult. Additional comparisons were made between The Trussell Trust and independent provision. RESULTS: Parcels provided energy, carbohydrate, sugar, protein and fibre contents that significantly exceeded the DRVs. In total, 62.2% of energy was provided as carbohydrate and 569% of the DRV was provided by sugars. The vitamin D and retinol content of the parcels was significantly lower than the DRVs, meeting 25% and 27% of users' needs respectively; provision of all other micronutrients exceeded the DRVs. The Trussell Trust's parcels provided significantly less vitamin D and copper than independent parcels. CONCLUSIONS: Food bank parcels distributed in Oxfordshire, UK, exceeded energy requirements and provided disproportionately high sugar and carbohydrate and inadequate vitamin A and vitamin D compared to the UK guidelines. Improved links with distributors and access to cold food storage facilities would help to address these issues, via increased fresh food provision.

The impact of removing gastric residual volume monitoring and enteral nutrition rate titration in adults receiving mechanical ventilation.

BACKGROUND: Monitoring gastric residual volume (GRV) and titrating enteral nutrition (EN) towards goal rate are common practices in the intensive care unit (ICU) despite limited supportive evidence. We investigated the effect of removal of GRV monitoring and commencing EN at goal rate had on EN provision in mechanically ventilated ICU patients. METHODS: We conducted a single-centre, pre-post implementation study, in a 10-bed ICU comprising 181 patients with ventilation ≥48 h and given EN within 24 h of intubation. EN adequacy, expressed as the proportion of patients receiving ≥90% of the prescribed volume during the first 24 h of feeding, was compared before and after implementation. Secondary outcomes included EN adequacy over entire ICU stay; incidence of gastrointestinal intolerance in terms of vomiting, abdominal distension, and GRV >200 ml; prokinetic use; onset of a ventilator-associated condition; ventilation duration; length of stay; and mortality. RESULTS: After intervention, the proportion of patients meeting ≥90% of their prescribed EN volume within the first 24 h of feeding increased by 38.1% (pre: 46.4%, 95% confidence interval [CI]: 36.7-56.3; post: 84.5%, 95% CI: 75.8-91.2; p < 0.001). Over their entire ICU stay, the proportion of patients meeting ≥90% of their prescribed EN volume increased by 21.4% (pre: 61.9%, 95% CI: 52.0-71.1; post: 83.3%, 95% CI: 74.4-90.2; p = 0.001). Gastrointestinal intolerance reduced by 34.0% (pre: 80.4%, 95% CI: 71.8-87.5; post: 46.4%, 95% CI: 36.0-57.1; p < 0.001) and fewer prescribed prokinetic agents (pre: 57.7%, 95% CI: 47.8-67.3; post: 23.8%, 95% CI: 15.6-33.6; p < 0.001). CONCLUSIONS: Removal of GRV monitoring and commencing EN at goal resulted in significantly increased EN provision during the first 24 h of feeding and entire ICU stay with reduced prokinetic use and gastrointestinal complications.

Maternal nutritional adequacy and gestational weight gain and their associations with birth outcomes among Vietnamese women.

BACKGROUND: During pregnancy, a mother's nutritional needs increase to meet the added nutrient demands for fetal growth and development. An enhanced understanding of adequate nutrition and sufficient weight gain during pregnancy can guide development of policies and strategies for maternal nutrition care, actions that will ultimately promote better pregnancy outcomes. In a sample of pregnant women in Vietnam, this study characterized maternal nutrition status and gestational weight gain at a mid-pregnancy baseline, then examined the association of these variables with specific birth outcomes. METHODS: The study used baseline data from a randomized, controlled trial that compared pregnant Vietnamese women who received a nutritional intervention group with those who received only standard dietary counseling (control group). At baseline (26-29 weeks gestation), mothers' dietary reports were collected, and intake of 10 macro- and micronutrients was estimated; data for baseline gestational weight gain was collected for all pregnant women enrolled into the study (n = 228). This analysis also used weights, lengths, and head circumferences at birth for infants of mothers in the control group. RESULTS: At baseline, 95% of the pregnant women had concurrent inadequacies for more than five nutrients, and nearly half had concurrent inadequacies for more than ten nutrients. Almost two-thirds of the pregnant women did not meet recommendations for gestational weight gain. We found a significant, inverse association between the number of nutrient inadequacies and gestational weight gain (overall p ≤ 0.045). After adjusting for potential confounders, gestational weight gain was positively associated with birth weight, length at birth, birth weight-for-age z-score and length-for-age z-score (all p ≤ 0.006). CONCLUSIONS: Our findings raise concern over the high proportion of pregnant women in Vietnam who have multiple concurrent nutrient inadequacies and who fall short of meeting recommended gestational weight gain standards. To ensure better birth outcomes in this population, policies and strategies to improve the status of maternal nutrition are greatly needed. TRIAL REGISTRATION: The trial was retrospectively registered at clinicaltrials.gov on December 20, 2013, registration identifier: NCT02016586.

Micronutrient intake adequacy and depression risk in the SUN cohort study.

PURPOSE: The aim of the study was to prospectively assess the association between micronutrient intake adequacy and risk of depression. METHODS: This dynamic cohort study involves Spanish university graduates (SUN Project). Dietary intake was assessed at baseline and after 10 years of follow-up with a semi-quantitative food frequency questionnaire. Micronutrient intake adequacy for vitamins B1, B2, B3, B6, B12, C, A, D, E, folic acid, zinc, iodine, selenium, iron, calcium, potassium, phosphorus, magnesium and chrome was estimated. Inadequate intake for each nutrient was defined when the intake of the nutrient was below the estimated average requirements (EAR) if available or the adequate intake levels, if EARs were not available. We compared participants with inadequate intake for ≥4 nutrients vs. those with one nutrient. Participants were classified as having incident depression if they had no previous history of depression or antidepressants use at baseline, but they reported during follow-up a new clinical diagnosis of depression by a physician, use of antidepressant drugs, or both. Time-dependent multivariable Cox regression models were fitted. RESULTS: After a median follow-up of 8.5 years, 953 new cases of depression were observed among 13,983 participants. Participants with inadequate intake for ≥4 nutrients showed a significantly higher risk of depression [multivariable hazard ratio (HR) = 1.37; 95% confidence interval (CI) 1.01-1.85]. When the analyses were updated with repeated assessments of intakes, the association was attenuated and it was no longer statistically significant (Multivariable HR = 1.11; 95% CI 0.82-1.51). CONCLUSIONS: Micronutrient inadequacy in four or more micronutrients could exert a moderate role in the development of depression.

Use of chicken eggshell to improve dietary calcium intake in rural sub-Saharan Africa.

Undernutrition resulting from inadequate access to high-quality, nutritious food is a widespread issue in sub-Saharan Africa impacting the health and survival of mothers and their children. Inadequate dietary intake leads to a deficiency in nutrients including calcium, required for growth and physiological functioning. This study investigated the potential of increasing dietary calcium intake by the addition of heat-treated ground eggshell to locally prepared food. A mixed methods approach of literature review, Delphi expert survey and focus group discussions with women of childbearing age in rural Tanzania, were used to assess the practicality, safety, and acceptability of consumption of ground eggshell. Chicken eggshell has high calcium content (380 mg of calcium/gram) and bioavailability comparable to calcium carbonate (~39%) with 1 g sufficient to provide one half of a sub-Saharan African adult female's dietary calcium needs. Salmonella was indicated as the most likely threat to human health through eggshell consumption. Experts agreed that eggshells boiled for 10 min when preparing hard-boiled eggs with a further 20 min cooking of crushed eggshell in staple foods would eliminate identified egg-associated pathogens. Five focus groups (n = 46) indicated eggshells were perceived as waste. However, there was an indication of general acceptance of the approach and a willingness to consider the incorporation of ground eggshells into their diets. Development of suitable communication methods are required to convey benefits and safe preparation methods. Ground eggshell could be a highly equitable method of increasing calcium intakes across rural sub-Saharan Africa where calcium intake is low and village poultry ownership common.

When the low FODMAP diet does not work.

Irritable bowel syndrome (IBS) is heterogeneous. Patients need proper assessment and explanation of IBS pathophysiology and appropriate therapies. A low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet effectively reduces symptoms in 75% of patients. Best treatment for those nonresponsive will depend on the pathophysiological basis for symptom genesis, with the following possible abnormalities: (i) Visceral hypersensitivity and/or enhanced gut-brain communication: a low FODMAP diet is mainly targeted for this patient group. A dietitian may also recommend antispasmodic agents, including peppermint oil. Another dietary treatment is a low food chemical diet, although this diet is often extremely limited, and therefore, not suited for some populations. Psychological therapies are also clinically beneficial. (ii) Altered motility: in patients with fast transit, a dietitian may recommend a reduction in all FODMAPs or targeted monosaccharides and disaccharides, which are more osmotic in nature. If not effective, patients may benefit from psyllium, which has an exceptional water-holding capacity aimed to promote more formed stools. Patients with slow or uncoordinated transit are often more difficult to treat. Dietary interventions have some success and usually comprise a combination of adequate fiber and fluid, osmotic laxatives, and stimulating agents such as caffeine, senna, and exercise. (iii) Altered microbiome: supplementary probiotics and prebiotics have weak evidence of efficacy with some notable exceptions. A dietitian may trial supplementary Bifidobacterium infantis or oligosaccharides, usually as an adjunct therapy. Guidance from a dietitian will encompass dietary methods to treat IBS but additionally identify where dietary treatment is not indicated to ensure that diet is correctly used and patients are not nutritionally or psychologically compromised.