LLL 44 - Module 3: Micronutrients in Chronic disease.

Micronutrients (MN), i.e. trace elements and vitamins, are essential organic molecules, which are required in the diet in relatively small amounts in any form of nutrition (oral, enteral, parenteral). The probability of MN depletion or deficiencies should be considered in all chronic illnesses, especially in those that can interfere with intake, digestion, or intestinal absorption. Low socio-economic status and food deprivation are recognized as the most prevalent reasons for MN deficiencies world-wide. Elderly multimorbid patients with multimodal therapy, as well as patients with long-lasting menu restrictions, are at high risk for both disease related malnutrition as well as multiple MN deficiencies, needing careful specific follow-up. The importance of monitoring MN blood levels along with CRP is essential for optimal care. Drug interactions are also highlighted. In patients with chronic conditions depending on medical nutrition therapy, the provision of adequate dietary reference intakes (DRI) of MN doses and monitoring of their adequacy belongs to standard of care.

Beef Consumption Is Associated with Higher Intakes and Adequacy of Key Nutrients in Older Adults Age 60+ Years: National Health and Nutrition Examination Survey 2011-2018 Analysis.

Beef is an important source of high-quality protein and several micronutrients, including iron, zinc, and B vitamins. We determined beef intake and its relationship with intakes of nutrients and their adequacy using 24 h dietary recall data from 5868 older adults. Usual intakes from foods were determined using the National Cancer Institute method, and the percent of the population below the estimated average requirement or above adequate intake was estimated. A high percentage of older adults did not meet nutrient recommendations for vitamin D (96%), choline (96%), vitamin E (84%), potassium (70%), calcium (63%), magnesium (60%), vitamin C (46%), vitamin A (39%), zinc (21%), vitamin B6 (19%), and folate (15%). About 68% of older adults were beef consumers with a mean intake of 56 g/day. Beef consumers had higher (p < 0.05) intakes of energy, protein, calcium, iron, phosphorus, selenium, sodium, zinc, thiamin, riboflavin, niacin, vitamin B12, and choline, and a higher (p < 0.05) proportion met nutrient recommendations for protein, calcium, copper, zinc, thiamin, folate, and vitamin B12 than non-consumers. Consumers of fresh, ground, and processed beef also had generally higher intakes and lower inadequacies of many nutrients depending on the beef type. In conclusion, older adults generally had poor nutrient adequacy from their diets, while beef consumers had higher nutrient intakes and adequacy for certain key nutrients, which are inherently generally available from beef or from foods consumed with beef.

The development of an EU-wide nutrition and physical activity expert knowledge base to support a personalised mobile application across various EU population groups.

A healthy lifestyle comprising regular physical activity and an adequate diet is imperative for the prevention of non-communicable diseases such as hypertension and some cancers. Advances in information computer technology offer the opportunity to provide personalised lifestyle advice directly to the individual through devices such as smartphones or tablets. The overall aim of the PROTEIN project (Wilson-Barnes et al., 2021) was to develop a smartphone application that could provide tailored and dynamic nutrition and physical activity advice directly to the individual in real time. However, to create this mobile health (m-health) smartphone application, a knowledge base of reference ranges for macro-/micronutrient intake, anthropometry, biochemical, physiological and sleep parameters was required to underpin the parameters of the recommender systems. Therefore, the principal aim of this emerging research paper is to describe the process by which experts in nutrition and physiology from the PROTEIN consortium collaborated to develop the nutritional and physical activity requirements, based upon existing recommendations, for 10 separate population groups living within the EU including, but not limited to healthy adults, adults with type 2 diabetes mellitus, cardiovascular disease, excess weight, obesity and iron deficiency anaemia. A secondary aim is to describe the development of a library of 24-h meal plans appropriate for the same groups and also encompassing various dietary preferences and allergies. Overall, the consortium devised an extensive nutrition and physical activity knowledge base that is pertinent to 10 separate EU user groups, is available in 7 different languages and is practically implemented via a library of culturally appropriate, 24-h meal plans.

Assessment of the prevalence of inadequate iron intakes in premenopausal females based on the reference values of the European Food Safety Authority using cross-sectional food consumption data.

BACKGROUND: The iron intake requirement distribution for premenopausal females is not symmetric, which invalidates the EAR cut-point approach for assessing the prevalence of iron inadequacy. Therefore, Beaton's Full Probability Approach (PA) must be used. Although the PA requires information on the entire iron intake requirement distribution, the European Food Safety Authority (EFSA) only provided the EAR (50th percentile), 90th, 95th (population reference intake), and 97.5th percentiles. OBJECTIVES: This study aimed to reliably estimate the prevalence of iron inadequacy in premenopausal females using the PA, based on the intake requirements established by EFSA, and compare the results with those obtained from the EAR cut-point method. METHODS: Habitual iron intakes were calculated using the statistical program to assess dietary exposure with data from 484 females (20-45 y) from the Dutch National Food Consumption Survey 2012-2016. Iron requirements of EFSA (including additionally obtained information) were applied. Results from the PA were compared to results obtained with the EAR cut-point method. Sensitivity analyses examined the impact of lower iron intake distributions on differences in estimated inadequate intakes between PA and EAR cut-point methods. RESULTS: A 2-fold higher prevalence of iron inadequacy among Dutch premenopausal females was observed when employing the PA compared to the EAR cut-point method, using EFSA's reference values. Sensitivity analysis showed that the EAR cut-point method could also result in large overestimations for populations with lower intake distributions. CONCLUSIONS: This study provided an example of using the PA method by using additionally derived information on the full requirement distribution underlying EFSA's reference values. Results showed once more the unsuitability of the EAR cut-point method to calculate the prevalence of iron inadequacy in premenopausal females. Hence, we recommend that institutions deriving dietary reference values provide all the information needed to use the correct method to determine inadequate intakes in the population.

[Influence of individualized dietary adaptation in patients undergoing hematopoietic stem cell transplantation. The ADITRAS study]. / Influencia de la adaptación dietética individualizada en pacientes sometidos a trasplante de precursores hematopoyéticos. Estudio ADITRAS.

Introduction: Introduction: the objective of the study was to assess the efficacy of an individualized dietary adaptation to achieve nutritional requirements in patients undergoing hematopoietic stem cell transplantation (HSCT). Methodology: a pilot study of a nutritional intervention in patients undergoing HSCT. A nutritional assessment was performed the first 24 hours of admission and every 48-72 hours until discharge, or + 40 days after the transplant, making dietary adaptations. Results: 25 patients were recruited. According to MUST, 92.0 % (n = 23) were well nourished at the initial visit, with a loss of 2.1 (3.8) kg and a BMI of 26.4 kg/m2 (4.2). Before HSCT, there was already a decrease in intake of 15.4 (23.5) % and in body weight of 0.2 (3.2) kg; after the HSCT, the weight loss was 3.4 (5.0) kg and the decrease in intake was 6.5 (30.4) %. The predominant symptoms were mucositis (60 %), nausea (60 %), and diarrhea (44 %). The diet was adapted in 100 % of the patients, 52 % received oral nutritional support (ONS) (n = 13); enteral nutrition (EN) and parenteral nutrition (PN) were used only once. Conclusion: the nutritional status of patients undergoing HSCT is normal on admission but deteriorates during transplantation and prior conditioning. Dietary intervention is key to maintaining oral intake and reducing the risk of malnutrition.

Introducción: Introducción: el objetivo del estudio fue valorar la eficacia de una adaptación dietética individualizada para conseguir los requerimientos nutricionales en pacientes sometidos a trasplante de precursores hematopoyéticos (TPH). Metodología: estudio piloto de intervención nutricional con pacientes sometidos a TPH. Se realizó una valoración nutricional en las primeras 24 horas de ingreso y cada 48 a 72 horas hasta el alta, o + 40 días del trasplante, realizando adaptaciones dietéticas. Resultados: se reclutaron 25 pacientes. Según el MUST, el 92,0 % (n = 23) se encontraban bien nutridos en la visita inicial, con una pérdida de 2,1 (3,8) kg y un IMC de 26,4 kg/m2 (4,2). Antes del TPH ya hubo una disminución de la ingesta del 15,4 (23,5) % y del peso corporal de 0,2 (3,2) kg; tras el TPH, la pérdida de peso fue de 3,4 (5,0) kg y la disminución de la ingesta del 6,5 (30,4) %. Los síntomas predominantes fueron mucositis (60 %), náuseas (60 %) y diarrea (44 %). Se adaptó la dieta en el 100 % de los pacientes y el 52 % recibieron soporte nutricional oral (SNO) (n = 13), mientras que la nutrición enteral (NE) y la nutrición parenteral (NP) se utilizaron solo 1 vez. Conclusión: el estado nutricional de los pacientes sometidos a TPH es normal al ingreso pero se deteriora durante la realización del trasplante y su acondicionamiento previo. La intervención dietética es clave para mantener la ingesta oral y disminuir el riesgo de desnutrición.

Development and validation of age-specific predictive equations for total energy expenditure and physical activity levels for older adults.

BACKGROUND: Predicting energy requirements for older adults is compromised by the underpinning data being extrapolated from younger adults. OBJECTIVES: To generate and validate new total energy expenditure (TEE) predictive equations specifically for older adults using readily available measures (age, weight, height) and to generate and test new physical activity level (PAL) values derived from 1) reference method of indirect calorimetry and 2) predictive equations in adults aged ≥65 y. METHODS: TEE derived from "gold standard" methods from n = 1657 (n = 1019 females, age range 65-90 y), was used to generate PAL values. PAL ranged 1.28-2.05 for males and 1.26-2.06 for females. Physical activity (PA) coefficients were also estimated and categorized (inactive to very active) from population means. Nonlinear regression was used to develop prediction equations for estimating TEE. Double cross-validation in a randomized, sex-stratified, age-matched 50:50 split, and leave one out cross-validation were performed. Comparisons were made with existing equations. RESULTS: Equations predicting TEE using the Institute of Medicine method are as follows: For males, TEE = -5680.17 - 17.50 × age (years) + PA coefficient × (6.96 × weight [kilograms] + 44.21 × height [centimeters]) + 1.13 × resting metabolic rate (RMR) (kilojoule/day). For females, TEE = -5290.72 - 8.38 × age (years) + PA coefficient × (9.77 × weight [kilograms] + 41.51 × height [centimeters]) + 1.05 × RMR (kilojoule/day), where PA coefficient values range from 1 (inactive) to 1.51 (highly active) in males and 1 to 1.44 in females respectively. Predictive performance for TEE from anthropometric variables and population mean PA was moderate with limits of agreement approximately ±30%. This improved to ±20% if PA was adjusted for activity category (inactive, low active, active, and very active). Where RMR was included as a predictor variable, the performance improved further to ±10% with a median absolute prediction error of approximately 4%. CONCLUSIONS: These new TEE prediction equations require only simple anthropometric data and are accurate and reproducible at a group level while performing better than existing equations. Substantial individual variability in PAL in older adults is the major source of variation when applied at an individual level.

Iron homeostasis in older adults: balancing nutritional requirements and health risks.

Iron plays a crucial role in many physiological processes, including oxygen transport, bioenergetics, and immune function. Iron is assimilated from food and also recycled from senescent red blood cells. Iron exists in two dietary forms: heme (animal based) and non-heme (mostly plant based). The body uses iron for metabolic purposes, and stores the excess mainly in splenic and hepatic macrophages. Physiologically, iron excretion in humans is inefficient and not highly regulated, so regulation of intestinal absorption maintains iron homeostasis. Iron losses occur at a steady rate via turnover of the intestinal epithelium, blood loss, and exfoliation of dead skin cells, but overall iron homeostasis is tightly controlled at cellular and systemic levels. Aging can have a profound impact on iron homeostasis and induce a dyshomeostasis where iron deficiency or overload (sometimes both simultaneously) can occur, potentially leading to several disorders and pathologies. To maintain physiologically balanced iron levels, reduce risk of disease, and promote healthy aging, it is advisable for older adults to follow recommended daily intake guidelines and periodically assess iron levels. Clinicians can evaluate body iron status using different techniques but selecting an assessment method primarily depends on the condition being examined. This review provides a comprehensive overview of the forms, sources, and metabolism of dietary iron, associated disorders of iron dyshomeostasis, assessment of iron levels in older adults, and nutritional guidelines and strategies to maintain iron balance in older adults.

Nutritional management during critical illness in those with previous obesity surgery.

PURPOSE OF REVIEW: The prevalence of overweight and obesity in our society is a pressing concern that has demanded immediate attention. Traditional treatments have proven ineffective for many individuals, leading to a surge in bariatric surgery as a last resort. While the rate of early and late postoperative complications may be low, when they occur, they place these patients at higher risk of requiring intensive care treatment. Therefore, it is our aim to discuss the nutritional care of these individuals. RECENT FINDINGS: Nutritional management of critically ill postbariatric surgical patients is related to the difficulty of providing an adequate nutritional assessment, calculating the macro and micronutrient requirements, choosing the right therapy, and defining the timely moment to initiate it. The anatomic changes related to the bariatric operation pose a high risk for a nonfunctional gastrointestinal tract both in the early postoperative and late postoperative. Therefore, the route of nutrition will greatly rely on the absorptive capacity, as well as on the nutritional status, with parenteral nutrition being an early option, especially for those with high critical care severity scores. Also, these patients are known to have an altered microbiota which may influence the absorptive capacity. Immunonutrition, prebiotics, probiotics, and symbiotics may represent potential options, but there is currently little support for 'one size fits all'. SUMMARY: The nutritional care of critically ill patients postbariatric surgery is a complex and nuanced process requiring a multifaceted precision approach. The distinct nutritional challenges of early and late postoperative patients necessitate a thorough nutritional assessment and a highly individualized nutritional care plan.

Diet and Nutritional Supplementation in Patients With Cancer: Is More Necessarily Better?

This editorial and the accompanying article summarize evidence-based guidelines that can inform dietary recommendations in oncology practices.

Minimum methionine requirement in adult cats as determined by indicator amino acid oxidation.

There is a lack of empirical data on the dietary Met requirement, in the presence of Cys or cystine, in adult cats. Thus, the aim of this study was to determine the Met requirement, in the presence of excess Cys, in adult cats at maintenance using the indicator amino acid oxidation (IAAO) technique. Six adult neutered male cats were initially selected and started the study. Cats were adapted to the basal diet sufficient in Met (0.24% dry matter, DM) for 14 d prior to being randomly allocated to one of eight dietary levels of Met (0.10%, 0.13%, 0.17%, 0.22%, 0.27%, 0.33%, 0.38%, and 0.43% DM). Different dietary Met concentrations were achieved by supplementing the basal diet with Met solutions. Alanine was additionally included in the solutions to produce isonitrogenous and isoenergetic diets. Cats underwent a 2-d adaptation period to each experimental diet prior to each IAAO study day. On IAAO study days, 13 meals were offered corresponding to 75% of each cat's daily food allowance. The remaining 25% of their daily food intake was offered after each IAAO study. A bolus dose of NaH13CO3 (0.44 mg kg-1) and l-[1-13C]-phenylalanine (13C-Phe; 4.8 mg kg-1) were provided in fifth and sixth meals, respectively, followed by a constant dose of 13C-Phe (1.04 mg kg-1) in the next meals. Breath samples were collected and total production of 13CO2 was measured every 25 min through respiration calorimetry chambers. Steady state of 13CO2 achieved over at least three breath collections was used to calculate oxidation of 13C-Phe (F13CO2). Competing models were applied using the NLMIXED procedure in SAS to determine the effects of dietary Met on 13CO2. Two cats were removed from the study as they did not eat all meals, which is required to achieve isotopic steady. A breakpoint for the mean Met requirement, with excess of Cys, was identified at 0.24% DM (22.63 mg kg-1) with an upper 95% confidence limit of 0.40% DM (37.71 mg·kg-1), on an energy density of 4,164 kcal of metabolizable energy/kg DM calculated using the modified Atwater factors. The estimated Met requirement, in the presence of excess of Cys, is higher than the current recommendations proposed by the National Research Council's Nutrient Requirement of Dogs and Cats, the Association of American Feed Control Officials, and the European Pet Food Industry Federation.

The objective of this study was to determine the minimum Met requirement, when Cys was provided in excess, of adult cats using a highly sensitive and noninvasive technique, the indicator amino acid oxidation (IAAO). Six adult cats were fed experimental diets with varying levels of methionine (0.10%, 0.13%, 0.17%, 0.22%, 0.27%, 0.33%, 0.38%, and 0.43% on a dry matter [DM] basis) for 2 d prior to each IAAO study day. Although not all cats completed the study, a breakpoint was still defined in the statistical models applied, resulting in an estimated minimum Met requirement of 0.40% DM (37.71 mg kg−1), on an energy density of 4,164 kcal of metabolizable energy/kg DM calculated using the modified Atwater factors. The Met requirement, in the presence of excess of Cys, estimated in our study is higher than the current recommendations proposed by the National Research Council's Nutrient Requirement of Dogs and Cats, the Association of American Feed Control Officials, and the European Pet Food Industry Federation.

Protein intake affects erythrocyte glutathione synthesis in young healthy adults in a repeated-measures trial.

BACKGROUND: In 2005, the Institute of Medicine advised using methods other than nitrogen balance (NB) for determining protein requirements. Since then, protein requirements using indicator amino acid oxidation (IAAO) have been published and are higher than NB. Glutathione (GSH), a tripeptide of cysteine, glutamate, and glycine, is a principal antioxidant that can be used as a functional indicator of protein adequacy. OBJECTIVES: The aim of this study was to measure changes in erythrocyte GSH kinetics [fractional synthesis rate (FSR) and absolute synthesis rate (ASR)] in healthy adults following a range of protein intakes at and above the current recommendations. METHODS: Sixteen healthy adults [8 males and 8 females, aged 25.6 ± 0.9 y (mean ± SEM)] were studied at 4 of 6 protein intakes ranging from 0.6 to 1.5 g⋅kg-1⋅d-1. Erythrocyte GSH kinetics were assessed during a 7-h infusion of [U-13C2-15N]glycine following 2 d of adaptation to each protein intake. Blood and urine tests were performed to measure oxidative stress markers, plasma homocysteine, triglycerides, plasma amino acid concentrations, 5-L-oxoproline (5-OP), and urinary sulfate. The protein intake that maximized GSH synthesis was determined using mixed-effect change-point regression in R. Primary and secondary outcomes were analyzed using linear mixed-effects and repeated-measures analysis of variance with Tukey's post hoc test. RESULTS: The protein intake that maximized GSH FSR at 78%⋅d-1 was 1.0 g⋅kg-1⋅d-1 (95% confidence interval: 0.63, 1.39). GSH ASR was significantly lower at 0.6 and 0.8 g⋅kg-1⋅d-1 than at 1.5 g⋅kg-1⋅d-1 (2.03 and 2.17, respectively, compared with 3.71 mmol⋅L-1⋅d-1). Increasing the protein intake led to increased urinary sulfate but did not affect erythrocyte GSH concentration, plasma oxidative stress markers, triglycerides, homocysteine, or 5-OP. CONCLUSIONS: A protein intake of 1.0 g⋅kg-1⋅d-1 maximized GSH synthesis, which is in agreement with earlier IAAO-derived protein requirements of 0.93 to 1.2 g⋅kg-1⋅d-1. These findings suggest that recommendations based on NB (0.66 g⋅kg-1⋅d-1) may underestimate protein needs for adequate health. This trial was registered at clinicaltrials.gov as NCT02971046.

Aminoácidos essenciais em suínos: explorando as demandas nutricionais para um crescimento saudável / Amino acids essenciais em suínos: exploring nutritional demands for healthy growth / Aminoácidos esenciales en cerdos: explorando las demandas nutricionales para un crecimiento saludable

O objetivo desta revisão bibliográfica é elucidar os principais avanços relacionados à utilização de aminoácidos na nutrição de suínos e sua relação com o desempenho animal. Essa revisão foi realizada a partir de uma busca bibliográfica embasada em diferentes publicações encontradas em banco de dados. A busca por artigos foi realizada nas seguintes bases de pesquisa literária eletrônica: Web of Science e Google Scholar, utilizando termos de busca associados ou não, no plural ou singular, em inglês e em português, como: "aminoacids" and "swine" and "needs". Foram selecionados 45 arquivos, após o teste de relevância para uso no estudo, os mesmos foram tabulados em planilha do Excel® com as informações relevantes, para exploração na revisão. As exigências de aminoácidos devem ser atendidas em todas as fases desde o nascimento, seguindo recomendações por idade e sexo e categoria produtiva, visando a expressão máxima do seu potencial de produção, atendendo as exigências de aminoácidos para garantir a sanidade, potencial produtivo, reprodutivo e índices zootécnicos de interesse.

The objective of this literature review is to elucidate the main advances related to the use of amino acids in swine nutrition and its relationship with animal performance. This review was carried out from a bibliographic search based on different publications found in the database. The search for articles was carried out in the following electronic literary research bases: Web of Science and Google Scholar, using search terms associated or not, in the plural or singular, in English and Portuguese, such as: "aminoacids" and "swine" and "needs". 45 files were selected, after the relevance test for use in the study, they were tabulated in an Excel® spreadsheet with the information that is relevant, for exploration in the review. Amino acid requirements must be met at all stages of life following recommendations by age and sex and productive category, aiming at the maximum expression of its production potential, meeting the amino acid requirements guarantees health, productive and reproductive potential and zootechnical indices of interest.

El objetivo de esta revisión bibliográfica es dilucidar los principales avances relacionados con el uso de aminoácidos en la nutrición porcina y su relación con el rendimiento animal. Esta revisión se realizó a partir de una búsqueda bibliográfica a partir de diferentes publicaciones encontradas en la base de datos. La búsqueda de artículos se realizó en las siguientes bases de datos de búsqueda literaria electrónica: Web of Science y Google Scholar, utilizando términos de búsqueda asociados o no, en plural o singular, en inglés y portugués, tales como: "aminoácidos" y "swine" y "necesidades". Se seleccionaron 45 archivos, luego de la prueba de pertinencia para su uso en el estudio, se tabularon en una planilla de Excel® con la información que sea relevante, para exploración en la revisión de recomendaciones por edad y sexo y categoría productiva, visando al máximo expresión de su potencial productivo, el cumplimiento de los requerimientos de aminoácidos garantiza sanidad, potencial productivo y reproductivo e índices zootécnicos de interés.

The Minimum Methionine Requirement for Adults Aged ≥60 Years Is the Same in Males and Females.

The minimum methionine requirement in the presence of excess dietary cysteine has not been determined in older adults. This study aimed to determine the minimum methionine requirement in healthy older adults using the indicator amino acid oxidation (IAAO) method. Fifteen healthy adults ≥ 60 years of age received seven methionine intakes (0 to 20 mg/kg/d) plus excess dietary cysteine (40 mg/kg/d). Oxidation of the indicator, L-[1-13C]phenylalanine (F13CO2), was used to estimate the mean minimum methionine requirement using a change-point mixed-effect model. There was no statistical difference between male and female requirement estimates, so the data were pooled to generate a mean of 5.1 mg/kg/d (Rm2 = 0.46, Rc2 = 0.77; p < 0.01; 95% CI: 3.67, 6.53 mg/kg/d). This is the first study to estimate the minimum methionine requirement in healthy older adults, which is the same between the sexes and as our lab's previous estimate in young adults. The findings are relevant considering current recommendations for increased consumption of plant foods, which will help to establish the appropriate balance of methionine and cysteine intake required to satisfy the sulphur amino acid requirements of older adults.

Virgin Olive Oil Ranks First in a New Nutritional Quality Score Due to Its Compositional Profile.

Dietary oils play a crucial role in maintaining a healthy diet. However, with the increasing number of oils available, it became a challenging task for food producers and consumers to select the best oil for their needs. In this work, an easy-to-understand nutrition quality score was created, using a model that included beneficial lipid compounds criteria according to the dietary recommendations published by international food and health organizations. The algorithm assigned points for each component of the model considering their content in each particular oil. The points were added up and the fats and oils were classified by the corresponding percentile. As a result, among the 32 edible oils that were evaluated, virgin olive oil ranked first with a score of 100. All plant oils, except for margarine and coconut oil, ranked above the 50th percentile. Receiver-operator curves and regression models showed that saturated fatty acids may be able to predict the score, and thus, the nutritional quality of the oils. In conclusion, the proposed nutritional quality score would promote healthy and nutritious food options for consumers and would provide food producers with a valuable tool to select high-quality oils for their products, ensuring that they meet the nutritional requirements.

Exploring the physiological plasticity of giant grouper (Epinephelus lanceolatus) to dietary sulfur amino acids and taurine to measure dietary requirements and essentiality.

Giant grouper (Epinephelus lanceolatus) is an economically important yet under-researched species, still reliant on 'trash fish' or generic aquafeeds. The transition toward sustainable formulations is contingent on establishing requirements of target species for limiting nutrients, among which the sulfur amino acids (methionine and cysteine) commonly limit fish growth. Further, there remains significant conjecture around the role of the sulfonic acid taurine in marine aquafeed formulation and its relationship to sulfur amino acids. To develop a species-specific feed formulation for giant grouper, dietary methionine was modulated in a dose-response experiment to achieve five graded levels from 9.5 to 21.5 g/kg, including an additional diet with methionine at 18.6 g/kg supplemented with 8 g/kg taurine. The mean (±SD) cysteine level of the diets was 4.5 ± 0.3 g/kg. Each diet was randomly allocated to triplicate tanks of 14 fish (83.9 ± 8.4 g). The best-fit regression for growth showed that the optimal dietary methionine content was 15.8 g/kg and the total sulfur amino acid content was 20.3 g/kg. Inadequate dietary methionine content triggered physiological responses, including hepatic hyperplasia and hypoplasia at 9.5 and 21.5 g/kg, respectively, and high aspartate transaminase levels at 18.9 g/kg. Moreover, inadequate dietary methionine contents resulted in higher densities of mixed goblet cell mucin and reduced absorptive surface area of posterior intestinal villi. Our results suggest that adequate levels of methionine, but not taurine, improved posterior intestinal conditions and liver homeostasis. These findings may aid in formulating aquafeeds to optimize gastrointestinal and liver functions in juvenile giant grouper.

Iron Nutrition of Pre-Schoolers in High-Income Countries: A Review.

Pre-schoolers are vulnerable to iron deficiency, which, in high-resource countries, is mainly caused by suboptimal or poorly absorbable iron intakes. This review examines the prevalence of inadequate iron intakes and status, and the non-dietary factors associated with these, among children aged between 2 and 5 years within high-income countries. It then considers the quality of the pre-schooler diet in terms of dietary factors, dietary patterns, and iron intakes. Additionally, it discusses the assessment of iron bioavailability and examines the various methods used to estimate the amount of absorbable iron in pre-schooler diets. Knowledge of the adequacy of iron intakes and bioavailability of iron intakes, and dietary patterns associated with iron intakes can facilitate the design and implementation of effectively targeted community-based intervention studies to improve iron intakes and iron bioavailability to minimise the risk of iron deficiency.

The dietary requirement for total sulfur amino acids in adults aged ≥60 years appears to be higher in males than in females.

BACKGROUND: The total sulfur amino acid (TSAA) recommendation in older adults is based on data from young adults. Physiological evidence suggests that older adults have a higher requirement than young adults. OBJECTIVES: The objective of this study was to determine the TSAA requirement in healthy men and women aged ≥60 y. METHODS: The TSAA requirement was determined using the indicator amino acid oxidation method with L-[1-13C]phenylalanine as the indicator. At recruitment, 15 older adults (n = 7 men and n = 8 women; BMI < 30 kg/m2) were assigned to receive 7 methionine intakes (5, 10, 15, 19, 25, 35, and 40 mg/kg/d) without dietary cysteine. Intake levels were randomly assigned to each subject. Following enrollment, 2 subjects completed 2 intakes and 3 completed 3, while the remainder completed all 7. Mean TSAA requirement was determined from oxidation of L-[1-13C]phenylalanine using a mixed-effect change-point model. The 95% CI was calculated using parametric bootstrap. To test whether breakpoints were different between men and women, the overlap in the 95% CI was calculated. RESULTS: The mean TSAA requirement was 26.2 (Rm2 = 0.39, Rc2 = 0.89; P < 0.001) and 17.1 mg/kg/d (Rm2 = 0.22, Rc2 = 0.79; P < 0.001) for men and women, respectively. The requirement was significantly higher in men than in women (difference in CI: 9.1 ± 8.85). CONCLUSIONS: To our knowledge, this is the first study to determine the TSAA requirement in older adults. The requirement in older women is similar to current recommendations but is 75% higher in older men. These findings are important given recommendations for increased plant protein consumption. They will help in the assessment of diet quality and provide the basis of dietary guidelines for older adults consuming a plant-based diet. This trial was registered at clinicaltrials.gov as NCT04595188.

Iron and DHA in Infant Formula Purchased in the US Fails to Meet European Nutrition Requirements.

Requirements for iron and docosahexaenoic acid (DHA) content of infant formula varies by country. Powdered full-term infant formula purchase data from all major physical stores in the US between 2017-2019 were obtained from CIRCANA, Inc. Iron and DHA composition and scoop sizes for each formula were obtained from manufacturers. The equivalent liquid ounces of prepared formula were calculated. Average iron and DHA content were compared between formula types and to both US and European formula composition requirements. These data represent 55.8 billion ounces of formula. The average iron content of all formula purchased was: 1.80 mg/100 kcal. This iron concentration is within the FDA regulations. However, it exceeds the maximum allowable iron concentration of infant formula (Stage 1) set by the European Commission of 1.3 mg/100 kcal. A total of 96% of formula purchased had an iron concentration of >1.3 mg/100 kcal. DHA is not a required ingredient in US formulas. The average DHA content of all formula purchased was: 12.6 mg/100 kcal. This DHA concentration is far below the minimum required DHA concentrations of infant formula (Stage 1) and follow-on formula (Stage 2) set by the European Commission of 20 mg/100 kcal. These are novel insights into the iron and DHA intake of formula-fed infants in the US. As international infant formulas have entered the US market due to the formula shortage, parents and providers need to be aware of regulatory differences in formula nutrient composition.

The impact of voluntary folate fortification of corn masa flour on US pregnancies complicated by neural tube defects.

INTRODUCTION: In 1996, the US Food and Drug Administration (FDA) mandated folic acid fortification for all enriched cereal grains. This resulted in a reduction of neural tube defect (NTD)-affected pregnancies. However, Hispanic women continued to be twice as likely to give birth to a child affected by NTD compared to non-Hispanic White women. Some hypotheses explaining this difference focus on cultural variation in dietary intake of cereal grains. In 2016, the FDA approved voluntary folic acid fortification for corn masa flour products to focus on the Hispanic diet staple. This study investigates rates of NTDs in predominantly Hispanic-populated zip codes before and after the voluntary fortification of corn masa flour with folic acid. METHODS: Normal pregnancies and those complicated by NTDs between 1/1/2016 and 9/30/2020 were identified using ICD-9 and ICD-10 codes in an all-payor claims database. The post-fortification period began 12 months after the fortification recommendation. The US Census data was used to stratify pregnancies in predominantly Hispanic zip codes (≥ 75% of households) vs. non-Hispanic zip codes. The causal impact of the FDA's recommendation was assessed by means of a Bayesian structural time series model. RESULTS: A total of 2,584,366 pregnancies were identified among females aged 15-50 years. Of these, 365,983 took place in predominantly Hispanic zip codes. Mean quarterly NTDs per 100,000 pregnancies did not significantly differ between predominantly Hispanic zip codes and predominantly non-Hispanic zip codes pre-FDA recommendation (184.5 vs. 175.6; p = 0.427), nor post-recommendation (188.2 vs. 185.9; p = 0.713). Rates of NTDs predicted to occur if no FDA recommendation had been made were compared to the actual rate post-recommendation: no significant difference was observed in predominantly Hispanic zip codes (p = 0.245) or overall (p = 0.116). CONCLUSIONS: Rates of neural tube defects were not significantly reduced in predominantly Hispanic zip codes following the 2016 FDA approval of voluntary folic acid fortification of corn masa flour. Further research and implementation of comprehensive approaches to advocacy, policy, and public health are necessary to decrease preventable congenital disease rates. Mandatory rather than voluntary fortification of corn masa flour products may achieve more substantial prevention of neural tube defects in at-risk US populations.

Nutritional Care in Children with Cystic Fibrosis.

Patients with cystic fibrosis (CF) are prone to malnutrition and growth failure, mostly due to malabsorption caused by the derangement in the chloride transport across epithelial surfaces. Thus, optimal nutritional care and support should be an integral part of the management of the disease, with the aim of ameliorating clinical outcomes and life expectancy. In this report, we analyzed the nutrition support across the different ages, in patients with CF, with a focus on the relationships with growth, nutritional status, disease outcomes and the use of the CF transmembrane conductance regulator (CFTR) modulators. The nutrition support goal in CF care should begin as early as possible after diagnosis and include the achievement of an optimal nutritional status to support the growth stages and puberty development in children, that will further support the maintenance of an optimal nutritional status in adult life. The cornerstone of nutrition in patients with CF is a high calorie, high-fat diet, in conjunction with a better control of malabsorption due to pancreatic enzyme replacement therapy, and attention to the adequate supplementation of fat-soluble vitamins. When the oral caloric intake is not enough for reaching the anthropometric nutritional goals, supplemental enteral feeding should be initiated to improve growth and the nutritional status. In the last decade, the therapeutic possibilities towards CF have grown in a consistent way. The positive effects of CFTR modulators on nutritional status mainly consist in the improvement in weight gain and BMI, both in children and adults, and in an amelioration in terms of the pulmonary function and reduction of exacerbations. Several challenges need to be overcome with the development of new drugs, to transform CF from a fatal disease to a treatable chronic disease with specialized multidisciplinary care.