Prevalence and risk factors of food insecurity among Syrian refugees in Türkiye.

BACKGROUND: Although Türkiye (Turkey) hosts the largest number of Syrian refugees, studies on food insecurity are limited. This study examined the prevalence and risk factors of food insecurity among Syrian refugees living in Istanbul, which has the highest number of refugees in Türkiye. METHODS: A cross-sectional survey was conducted among Syrian refugees in Istanbul between September 2021 and March 2022. The main income earners of 103 households were interviewed by a research dietitian, with the assistance of an Arabic speaking interpreter through hour-long face-to-face. Data on sociodemographic characteristics (age, gender, nationality, marital status, educational status, the family income, the major source of family income, and the number of family members living in the household etc.) and household food insecurity status were collected. Household food insecurity status was assessed with the eighteen-item Household Food Security Survey Module. RESULTS: The household food insecurity rate was 90.3%, and those of adults and children were 88.4% and 84.8%, respectively. It was observed that family income level was significantly associated with food insecurity. A one-unit increase in monthly income increased food security by 0.02 times (p < 0.001). The number of employed refugees in the food security group was higher than that in the food insecurity group (p = 0.018). A significant difference was found in the rate of occupation type of the major income earner between the groups (p = 0.046). CONCLUSIONS: High rates of food insecurity, particularly severe food insecurity, were found among Syrian refugees living in Istanbul. While more research is warranted to explore the root causes and efficacy of the current support system, it requires the immediate attention of policymakers at the national and international levels to implement effective policies and interventions.

Linking Immigrants with Nutrition Knowledge (Project LINK): An Innovative Approach to Improve Cultural Competence in Dietetic Education.

Linking Immigrants with Nutrition Knowledge (Project LINK) was a service-learning cultural competence training programme completed by undergraduate dietetic students enrolled in the University of Saskatchewan's (USASK) nutrition and dietetic programme.This paper evaluates the impact of participation in the programme on students' cultural competence. We conducted a cross-sectional survey and qualitative analysis of reflective essays of 107 participants of Project LINK from 2011 to 2014. Cumulative logistic regression models assessed the impact of the intervention on students' cultural competencies. The Akaike information criterion compared models and Spearman correlation coefficient identified possible correlation among pre- and post-intervention data points. Student reflective essays were analyzed by inductive thematic analysis.All cultural competencies improved comparing pre- and post-participation in Project LINK. Odds of increasing one level of student knowledge were 110 times of that prior to Project LINK. Comparing student competencies before and after Project LINK, the odds of increasing one level of students' skills were six times greater, five times greater for increasing one level of students' ability to interact or encounter, and 2.8 times greater for increasing one level of students' attitude.The results of this study indicate Project LINK has successfully increased cultural competence and underscores the importance of combining opportunities for practical experience in addition to classroom-based training on cultural competence.

The association of the quality of life with Afghan households' food insecurity before and after the recent political change in Afghanistan: a comparative analysis.

The overreaching objective of the current study is to investigate the association of quality of life with Afghan households' food insecurity. The data was collected immediately after the Taliban took control of a large part of Afghanistan. About a total of 555 households' heads participated in a face-to-face interview, using the HFIAS and WHOQOL-100 questionnaires along with some questions related to their socioeconomic characteristics at two different times, before and after the Taliban's takeover. The comparative analysis showed that 98% of Afghan households were food insecure after the Taliban takeover, while 70% of them faced food insecurity before the Taliban's takeover. The quality of life in the Taliban era is worse than before the Taliban. All dimensions of quality of life have decreased, and this decrease was more pronounced for the psychological, environmental, and physical domains. It is recommended that international organizations, NGOs, and local agents focus on these dimensions of the quality of life to improve food security.

Food Security Among Syrian Refugee Families in Quebec, Canada.

This study aims to understand how socioeconomic, geographic and cultural factors affect the food security status of Syrian refugee households in Quebec, Canada. Using a mixed methods study design, 49 households were assessed for their food security and socioeconomic status, followed by structured interviews with 35 households and 9 service providers. 52% of refugee households were food insecure, and although not significantly different, food insecurity was higher among privately sponsored refugee households in the Montreal area. Food insecurity appears mainly due to food access issues. Syrian refugees possess agricultural and cooking skills that could be beneficial in promoting community food security.

The assessment of an extended set of socio-economic determinants to explain anxiety and uncertainty, insufficient quality and food intake of Afghan refugees.

OBJECTIVES: In this study, socio-economic factors associated with Afghan refugee households' food insecurity, anxiety and uncertainty, insufficient quality and food intake were determined. DESIGN: Household Food Insecurity Assess Scale measurement was applied to assess food insecurity, anxiety and uncertainty, insufficient quality and insufficient food intake. Descriptive analysis and multivariable regression models were used to determine the associated factors. SETTING: The study was carried out in urban areas of Tehran province in Iran. PARTICIPANTS: To collect data, interviews were conducted among 317 Afghan households. The questionnaire was administered via face-to-face interviews to either the breadwinner of the selected households or a member who could respond on behalf of the household. RESULTS: About 11·3 % of Afghan households who resettled in Tehran province were food secure, while 11·7 % were marginally, 40·7 % moderately and 36·3 % severely food insecure. Economic and financial factors were inversely and significantly associated with food insecurity. Employment, income, distance from the central market and personal saving were inversely associated with food insecurity, while other determinants, including the length of living time in Tehran, house type and the number of male and female children, had a direct association with food insecurity. CONCLUSIONS: The associations of socio-economic factors with three categories of food insecurity differed. Elimination of occupation bans that the Iranian government imposes on refugees provides simple access to financial supports like long-term loans, and opening a bank account for refugees will benefit both Iranians and refugees.

Trends in the consumption of conventional dairy milk and plant-based beverages and their contribution to nutrient intake among Canadians.

BACKGROUND: Current evidence suggests a shift from conventional dairy milk to plant-based beverages (PBBs) for a number of lifestyles and perceived health-related reasons. METHODS: Using nationally representative cross-sectional data from the 2004 and 2015 Canadian Community Healthy Surveys, the main objectives of the present study were to (i) examine the trend in the proportion of Canadians (≥ 2 years) consuming plain milk and PBBs and (ii) determine the percentage contribution of plain milk and PBBs to daily energy and nutrient intakes. RESULTS: From 2004 to 2015, the percentage of Canadians consuming plain milk significantly decreased from 70.2% to 56.1%, whereas the percentage of PBBs consumers significantly increased from 1.8% to 3.0%. In 2015, plain milk provided almost 50% of the daily vitamin D intake, over 30% of calcium and vitamin B12, and over 20% of vitamin A and riboflavin among plain milk consumers. The top five nutrients provided by PBBs among PBBs consumers were vitamin D, calcium, vitamin B12, vitamin A and riboflavin. Although plain milk was a major contributor to saturated fat (14.5%) and protein (12.5%) intake among plain milk consumers, PBBs provided only 0.2% of saturated fat and 1.4% of protein intake in the diet of PBBs consumers. CONCLUSIONS: The consumption of plain milk by Canadians has declined and the consumption of PBBs has increased, which may differentially affect the nutritional profile of the diet.

The short-term effects of COVID-19 outbreak on dietary diversity and food security status of Iranian households (A case study in Tehran province).

Currently, the COVID-19 outbreak is spreading fast in 185 countries and has engaged most people around the world. COVID-19 imposes severe and tragic consequences on people's health due to the high rate of spread and potentially fatal impacts. In this study, the association of socio-economic factors with food security and dietary diversity is assessed before and during the COVID-19 pandemic. Data from 299 respondents were collected by an online standard questionnaire. Household Dietary Diversity Score (HDDS) and Household Food Insecurity Access Scale (HFIAS) were calculated. A multinomial regression model was applied to determine factors associated with HDDS and HFIAS before and during COVID-19 outbreak. Food security of Iranian households improved during the initial COVID-19 pandemic period (P < 0.001). Households reduced consumption of some food groups during the COVID-19 pandemic compared to the pre-COVID-19 period. Key socio-economic factors associated with food insecurity during the COVID-19 pandemic included personal savings, household income, employment status of head of household, and nutrition knowledge of head of household. During the COVID-19 outbreak, household size, head of household's occupation, personal savings, and number of male children were significantly associated with dietary diversity. Distributing free food baskets to poor households, extending e-marketing, providing nutrition consultations, and organizing donations to support infected households may increase household dietary diversity and improve food security status during a pandemic such as COVID-19. Vulnerable populations in countries experiencing food insecurity, such as Iran, should be supported - not just by providing medical care and personal protective equipment, but also with flexible safety nets and food-based intervention programs to respond to population needs.

Calcium Intake from Food and Supplemental Sources Decreased in the Canadian Population from 2004 to 2015.

BACKGROUND: In light of the publications (2008-2014) linking calcium intake, mainly from supplements, to the elevated risk of cardiovascular events, there is a need to determine if there have been any changes in usual intakes of calcium among Canadians. OBJECTIVE: We aimed to examine changes in dietary and total usual intake of calcium among Canadians aged ≥1 y over the period 2004-2015. METHODS: We used nutrition data from 2 nationally representative surveys conducted in 2004 and 2015 (CCHS 2004 Cycle 2.2 and CCHS-Nutrition 2015). This study included all the Canadians across 10 provinces, and the analyses were performed across different age/sex groups. We used the National Cancer Institute (NCI) method to estimate the usual intake of calcium and the prevalence of calcium inadequacy. Multiple logistic regression was performed to assess the relation between supplement uses and sociodemographic variables. RESULTS: From 2004 to 2015, the usual intake of calcium from food sources significantly decreased in calcium supplement nonusers (from 872 ± 18.2 mg/d to 754 ± 18.0 mg/d), but not in calcium supplement users. The contribution of calcium from the Milk and alternatives food group significantly decreased by 7.5% and 6.1% in calcium supplement users and nonusers, respectively. The prevalence of calcium supplement use significantly decreased from 2004 to 2015 in the Canadian population, from 27.5% to 22.0%. During this time, the percentage contribution of calcium from supplemental sources significantly decreased among Canadians, especially women. The prevalence of calcium inadequacy increased from 58.0% to 68.0% in supplement nonusers; however, among users of calcium supplements, the prevalence of calcium inadequacy remained at ∼31%. CONCLUSIONS: Calcium intake from both food and supplemental sources decreased in the Canadian population over an 11-y period, which must be addressed by policy-makers in their efforts to decrease the high prevalence of calcium inadequacy.

Vitamin D Intake from Supplemental Sources but Not from Food Sources Has Increased in the Canadian Population Over Time.

BACKGROUND: Evidence is lacking to determine whether there have been any changes in dietary or total usual intakes of vitamin D among Canadians, in the light of recent evidence of beneficial health effects beyond bone. OBJECTIVE: We aimed to examine trends in dietary and total usual intake of vitamin D among Canadians aged ≥1 y. METHODS: This study used nationally representative nutrition data from the Canadian Community Health Survey Cycle 2.2 (CCHS 2004) and CCHS Nutrition in 2015. Dietary intake data were collected with use of two 24-h dietary recalls and dietary supplement use was determined by questionnaire. The National Cancer Institute method was used to estimate the usual intake of vitamin D as well as the prevalence of vitamin D inadequacy among Canadians aged ≥1 y. RESULTS: From 2004 to 2015, the usual intake of vitamin D from food significantly decreased (P < 0.05) by 1 µg/d only in vitamin D supplement nonusers. The contribution of Milk and Alternatives food group (i.e., fluid milk, fortified soy beverages, powdered milk, and other milk alternatives) to dietary vitamin D intake significantly decreased (P < 0.05) in both supplement users (by 7.1%) and nonusers (by 5.8%). Prevalence of vitamin D supplement use and percentage contribution of vitamin D from supplemental sources significantly increased (P < 0.05) by 5.0% and 14.9%, respectively, from 2004 to 2015. Total usual intake of vitamin D (food + supplement) significantly increased (P < 0.05) from 15.1 ± 0.3 µg/d in 2004 to 31.5 ± 1.8 µg/d in 2015 in vitamin D supplement users. In contrast to vitamin D supplement nonusers, the prevalence of vitamin D inadequacy significantly decreased (P < 0.05) from 20.6% to 14.1% among users of vitamin D supplements. CONCLUSIONS: The prevalence of vitamin D supplement use and the percentage contribution of vitamin D from supplemental sources has increased in the Canadian population over an 11-y period.

Time, location and frequency of snack consumption in different age groups of Canadians.

BACKGROUND: The location and time of snack consumption may influence the composition, nutrient content and portion sizes of snacks. In this study, we aimed to determine and compare the time, location and frequency of snack consumption among different age groups of Canadians. METHODS: Nationally representative dietary data from the 2015 Canadian Community Health Survey (CCHS) were used (19,677 participants aged ≥2 years). Dietary data were obtained using 24-h dietary recalls. Participants were categorized according to the frequency of snack consumption (1 time, 2-3 times, ≥4 times). The snack consumption over 24 h was divided into four time periods: before 10 am, 10 am to 3 pm, 3 pm to 8 pm and 8 pm to 12 am. Meal and snack location was categorized as at home; someone else's home; restaurants; and other. RESULTS: Snacking 2-3 times per day was the most common reported frequency (53.0%). Snacking at home (73.0%) was more prevalent than snacking away from home (27.0%). The most frequently reported time for snacking among Canadians was 3 pm to 8 pm (36.3%), and the least frequently reported time was before 10 am (8.1%). Snacking contributed to a high proportion of Milk and Alternatives (23.7%) and Vegetables and Fruit (23.4%) food groups and lesser proportions of Grain Products (15.4%) and Meat & Alternatives (9.4%) food groups among Canadians. CONCLUSIONS: Home is the main location, 3 pm to 8 pm is the main time, and 2-3 times per day is the most common reported frequency for snacking. A full understanding of snacking behaviors is needed in order to develop targeted strategies to improve the quality of snack food choices.

Effectiveness of the Healthy Start-Départ Santé approach on physical activity, healthy eating and fundamental movement skills of preschoolers attending childcare centres: a randomized controlled trial.

BACKGROUND: Since young children spend approximately 30 h per week in early childcare centres (ECC), this setting is ideal to foster healthy behaviours. This study aimed to assess the effectiveness of the Healthy Start-Départ Santé (HSDS) randomized controlled trial in increasing physical activity (PA) levels and improving healthy eating and fundamental movement skills in preschoolers attending ECC. METHODS: Sixty-one ECC were randomly selected and allocated to either the usual practice (n = 30; n = 433 children) or intervention group (n = 31; n = 464 children). The HSDS intervention group was provided a 3-h on-site training for childcare educators which aimed to increase their knowledge and self-efficacy in promoting healthy eating, PA and development of fundamental movement skills in preschoolers. PA was measured during childcare hours for five consecutive days using the Actical accelerometer. Preschoolers' fundamental movement skills were assessed using the standard TGMD-II protocol and POMP scores. Food intake was evaluated using digital photography-assisted weighted plate waste at lunch, over two consecutive days. All data were collected prior to the HSDS intervention and again 9 months later. Mixed-effect models were used to analyse the effectiveness of the HSDS intervention on all outcome measures. RESULTS: Total number of children who provided valid data at baseline and endpoint for PA, food intake and fundamental movement skills were 259, 670 and 492, respectively. Children in the HSDS intervention group had, on average, a 3.33 greater point increase in their locomotor motor skills scores than children in the control group (ß = 3.33, p = 0.009). No significant differences in effects were observed for object control, PA and food intake. However, results demonstrated a marginal increase in portions of fruits and vegetables served in the intervention group compared to control group (ß = 0.06, p = 0.05). CONCLUSION: Of the 12 outcome variables investigated in this study, 10 were not different between the study groups and two of them (locomotor skills and vegetables and fruits servings) showed a significant improvement. This suggests that HSDS is an effective intervention for the promotion of some healthy behaviours among preschoolers attending ECC. TRIAL REGISTRATION: Clinical Trials NCT02375490. Registered on February 24, 2015; 77 retrospectively registered.

Validity and Reliability of the Persian Version of Nutrition Screening Tool for Every Preschooler (NutriSTEP®) in Iranian Preschool Children.

BACKGROUNDS: To assess the validity and reliability of the Persian version of Nutrition Screening Tool for Every Preschooler (NutriSTEP®), a community-based nutrition screening tool in preschool children. DESIGN AND METHODS: A cross-cultural validation study was conducted on 192 Iranian preschool children in Mashhad, Iran. Forward and backward translation and face validity was assessed. Criterion validity was confirmed by nutritionist risk score which was determined by an expert physician. Content validity, construct validity and reliability of the Persian version was assessed as well. Receiver operating characteristic (ROC) curve was used to detect the reasonable cut-points for the Persian version. FINDINGS: Content validity index and ratio ranged between 0.9 and 1 and 0.63-1, which both were acceptable. NutriSTEP® scores were significantly different in the three categories of nutritionist risk scores (p = .007). Item-to-scale correlation analysis shows significant correlation between each item and the total score. A significant correlation was seen between test-retest scores of NutriSTEP® (r = 0.68, p < .001). In Persian NutriSTEP®, scores 27 and 31 seems to better reflect the nutrition risk in Iranian preschool children population and are suggested as cut-points; Therefore, scores lower or equal to 27 are determined as mild risk and 28-31 as moderate risk, while scores higher than 31 are categorized as high risk. CONCLUSION: The Persian NutriSTEP® questionnaire is both valid and reliable for the screening of nutrition risk in preschool children of the Iranian population. PRACTICE IMPLICATIONS: Health care professionals may use the NutriSTSP® tool to find nutritionally high risk children as an important step to prevent childhood obesity.

Dietary habits of newcomer children in Canada.

OBJECTIVE: To explore the dietary habits, nutrient adequacies and dietary change experiences of immigrant and refugee children. DESIGN: Mixed-methods cross-sectional design. Children completed three 24 h dietary recalls to determine nutrient inadequacies. Parents and service providers were interviewed to capture dietary practices. SETTING: Healthy Immigrant Children study, Saskatchewan, Canada. PARTICIPANTS: Three hundred immigrant and refugee children aged 3-13 years and twenty-two parents who lived in Regina or Saskatoon for less than 5 years; twenty-four newcomer services providers. RESULTS: Immigrant children had higher mean intakes of meat and alternatives, milk and alternatives, and whole grains; and consumed more vitamin B12, folate, Ca, vitamin D, Fe and Zn compared with refugee children. Refugee children were at higher risk of having inadequate intakes of folate (37 %) and Fe (18 %). Both immigrant and refugee children were at high risk of inadequate vitamin D (87 and 93 %, respectively) and Ca intakes (79 and 80 %), and a substantial portion were at risk for inadequate Zn intake (21 and 31 %). Participants mentioned challenges with maintaining a healthy traditional diet in the midst of a busy schedule, while responding to their children's demands for foods high in fat and sugar. CONCLUSIONS: Newcomer children are at risk for inadequate intakes of vitamin D, Ca and Zn, while refugee children are at additional risk for inadequate folate and Fe intakes. Newcomers to Canada may experience subtle or drastic changes in their food environment leading to dietary acculturation that includes increased consumption of foods high in sugar, salt and fat.

Evidence for the Validity of the Children's Attraction to Physical Activity (CAPA) Scale in Iranian Preschool Children.

PURPOSE: The escalating trend of overweight and obesity is a major global health challenge and needs particular attention. There are a number of reasons for this increase, but the dominant one appears to be the pandemic of physical inactivity. It is now clear that children's attraction to physical activity is an important promising factor in children's physical activity involvement. In this study, we aimed to cross-validate the long version of children's attraction to physical activity (CAPA) scale in Iranian preschool children. DESIGN AND METHODS: Evidence for the validity of the scale was based on face validity, content validity, and internal consistency. The scale was translated into Persian and underwent forward translation, synthesis of the translation and backward translation. Face and content validity were subsequently assessed on individuals and expert panels. A sample of 30 preschool children (5-6 years of age) were randomly selected from three kindergartens. Children were interviewed by their kindergarten teachers. RESULTS: Internal consistency for each of the five subscales of the CAPA scale was evaluated through Cronbach's alpha. The internal consistency was acceptable for most of the subscales when negative statements were excluded from the analyses. CONCLUSIONS: The results supported the use of modified version of Persian-language long CAPA scale for Iranian preschool children, with the deletion of negatively worded items. PRACTICE IMPLICATIONS: Health care professionals may use the CAPA when assessing the attraction of children toward physical activity and its potential involvement in childhood obesity.

Facilitators and Barriers toward Food Security of Afghan Refugees Residing in Karachi, Pakistan.

The present study comparatively assesses how Afghan refugees in Pakistan understand both the factors and barriers affecting their food security status before and after refuge. Through qualitative in-depth interviews with 25 Afghan refugee families, we assess how quality of life, together with perceptions of a balanced meal, food environments both pre- and post-migration and push and pull factors of migration, impact food security and food choices for refugee families. Furthermore, our results reveal that regardless of the length of protracted status for Afghan refugees, food insecurity remains as a consistent condition for refugee families.

Vegetarian-style dietary pattern during adolescence has long-term positive impact on bone from adolescence to young adulthood: a longitudinal study.

BACKGROUND: The amount of bone accrued during adolescence is an important determinant of later osteoporosis risk. Little is known about the influence of dietary patterns (DPs) on the bone during adolescence and their potential long-term implications into adulthood. We examined the role of adolescent DPs on adolescent and young adult bone and change in DPs from adolescence to young adulthood. METHODS: We recruited participants from the Saskatchewan Pediatric Bone Mineral Accrual Study (1991-2011). Data from 125 participants (53 females) for adolescent analysis (age 12.7 ± 2 years) and 115 participants (51 females) for adult analysis (age 28.2 ± 3 years) were included. Bone mineral content (BMC) and areal bone mineral density (aBMD) of total body (TB), femoral neck (FN) and lumbar spine (LS) were measured using dual-energy X-ray absorptiometry. Adolescent dietary intake data from multiple 24-h recalls were summarized into 25 food group intakes and were used in the principal component analysis to derive DPs during adolescence. Associations between adolescent DPs and adolescent or adult BMC/BMD were analyzed using multiple linear regression and multivariate analysis of covariance while adjusting for sex, age, the age of peak height velocity, height, weight, physical activity and total energy intake. Generalized estimating equations were used for tracking DPs. RESULTS: We derived five DPs including "Vegetarian-style", "Western-like", "High-fat, high-protein", "Mixed" and "Snack" DPs. The "Vegetarian-style" DP was a positive independent predictor of adolescent TBBMC, and adult TBBMC, TBaBMD (P < 0.05). Mean adolescent TBaBMD and young adult TBBMC, TBaBMD, FNBMC and FNaBMD were 5%, 8.5%, 6%, 10.6% and 9% higher, respectively, in third quartile of "Vegetarian-style" DP compared to first quartile (P < 0.05). We found a moderate tracking (0.47-0.63, P < 0.001) in DP scores at individual levels from adolescence to adulthood. There were an upward trend in adherence to "Vegetarian-style" DP and an downward trend in adherence to "High-fat, high-protein" DP from adolescence to young adulthood (P < 0.01). CONCLUSION: A "Vegetarian-style" DP rich in dark green vegetables, eggs, non-refined grains, 100% fruit juice, legumes/nuts/seeds, added fats, fruits and low-fat milk during adolescence is positively associated with bone health.

Association of dietary patterns of American adults with bone mineral density and fracture.

OBJECTIVE: In a representative sample of US adults, we investigated the associations of nutrient patterns (NP) with bone mineral density (BMD) and fractures. DESIGN: Cross-sectional. SETTING: US community-based National Health and Nutrition Examination Survey (NHANES). SUBJECTS: Participants with measured data on dietary intake and BMD from 2005 to 2010 were included. Principal components analysis was used to identify NP. BMD was measured using dual-energy X-ray absorptiometry. ANCOVA, adjusted logistic and linear regression models were employed, accounting for the complex survey design and sample weights. RESULTS: We included a total of 18 318 participants, with 47·0 % (n 8607) being men. The mean age was 45·8 years with no sex difference. Three NP emerged, explaining 55·9 % of the variance in nutrient consumption. Multivariable-adjusted linear regressions revealed significant inverse associations between the 'high-energy' NP (rich in carbohydrates and sugar, total fat and saturated fat) and total femur, femoral neck, trochanter and intertrochanter BMD (ß coefficient: -0·029, -0·025, -0·034 and -0·021, respectively, all P<0·001), while there were significant associations between the 'nutrient-dense' NP (rich in vitamins, minerals and fibre) and 'healthy fat' NP (high dietary PUFA and MUFA) and BMD at total femur, femoral neck, trochanter and intertrochanter (all P<0·001). In adjusted logistic regression models, the odds of hip, wrist or spine fractures did not vary significantly across NP quartiles. CONCLUSIONS: Nutrient-dense and healthy fat NP are associated with higher BMD at various bone sites, while the high-energy NP is inversely associated with BMD measures.

Effect of statins on serum vitamin D concentrations: a systematic review and meta-analysis.

BACKGROUND: We conducted a systematic review and meta-analysis to assess the effects of statin therapy on serum vitamin D concentrations. MATERIALS AND METHODS: We searched multiple databases including PubMed, MEDLINE, Web of Science and Google Scholar from inception to May 2016, for studies on the effects of statin treatment on serum vitamin D concentration. Quantitative data synthesis used random-effects models meta-analysis, with sensitivity analysis conducted using the leave-one-out method. Heterogeneity was quantitatively assessed using the I2 index. The systematic review's registration number was CRD42016035974. RESULTS: In all, seven of 644 studies met our selection criteria including three randomized controlled trials (RCT), three observational cohort studies and one case-control study. Across RCTs, treatment with statins was associated a significant increase in serum vitamin D concentrations [weighted mean difference (WMD) 2·71 ng/mL, 95% CI 0·19-5·24, I2 62·1%). Across studies of non-RCT design, statins treatment was associated with a decrease in vitamin D concentrations (WMD -0·70 ng/mL, 95% CI -1·20 to -0·20, I2 56·3%). These findings were robust in sensitivity analyses. CONCLUSIONS: This meta-analysis was inconclusive on the effects of statins on vitamin D, with conflicting directions of the effects from interventional and observational studies. The suggested favourable effects from RCTs need to be confirmed in larger studies with extended follow-up in order to determine the possible health benefits.

"Monkey see, monkey do": Peers' behaviors predict preschoolers' physical activity and dietary intake in childcare centers.

Preschoolers observe and imitate the behaviors of those who are similar to them. Therefore, peers may be role models for preschoolers' dietary intake and physical activity in childcare centers. This study examined whether peers' behaviors predict change in preschoolers' dietary intake and physical activity in childcare centers over 9months. A total of 238 preschoolers (3 to 5years old) from 23 childcare centers in two Canadian provinces provided data at the beginning (October 2013 and 2014) and the end (June 2014 and 2015) of a 9-month period for this longitudinal study. Dietary intake was collected at lunch using weighed plate waste and digital photography on two consecutive weekdays. Physical activity was assessed using accelerometers over five days. Multilevel linear regressions were used to estimate the influence of peers' behaviors on preschoolers' change in dietary intake and physical activity over 9months. Results showed that preschoolers whose dietary intake or physical activity level deviated the most from those of their peers at the beginning of the year demonstrated greater change in their intakes and activity levels over 9months, which enabled them to become more similar to their peers (all ß 95% CI ranged from -0.835 to -0.074). This study suggests that preschoolers' dietary intake and physical activity may be influenced by the behaviors of their peers in childcare centers. Since peers could play an important role in promoting healthy eating behaviors and physical activity in childcare centers, future studies should test interventions based on positive role modeling by children.

Both high and low plasma levels of 25-hydroxy vitamin D increase blood pressure in a normal rat model.

The lower threshold plasma 25-hydroxy vitamin D (25(OH)D) level for optimal cardiovascular health is unclear, whereas the toxicity threshold is less clear. The aim of this study was to examine the cardiovascular-vitamin D dose-response curve in a normal rat model. Doses of cholecalciferol ranged from deficiency to toxic levels (equivalent to human doses of 0, 0·015, 0·25 and 3·75mg/d) for 4 weeks, and then cardiovascular health was examined using blood pressure telemetry and high-resolution ultrasound in normal male rats (n 16/group, 64 rats total). After 1 month, only the 0·25mg/d group had plasma 25(OH)D that was within current recommended range (100-125 nmol/l), and all groups failed to change plasma Ca or phosphate. Systolic blood pressure increased significantly (10-15 mmHg) in the rat groups with plasma 25(OH)D levels at both 30 and 561 nmol/l (groups fed 0 and 3·75mg/d) compared with the group fed the equivalent to 0·015mg/d (43 nmol/l 25(OH)D). Although not significant, the group fed the equivalent to 0·25mg/d (108 nmol/l 25(OH)D) also showed a 10 mmHg increase in systolic blood pressure. Carotid artery diameter was significantly smaller and wall thickness was larger, leading to higher peak carotid systolic blood velocity in these two groups. Despite these vascular changes, cardiac function did not differ among treatment groups. The key finding in this study is that arterial stiffness and systolic blood pressure both showed a U-shaped dose-response for vitamin D, with lowest values (best cardiovascular health) observed when plasma 25(OH)D levels were 43 nmol/l in normal male rats.