Assessment of energy availability and associated risk factors in professional female soccer players.

This study aimed to assess energy availability (EA), alongside possible risk factors of reduced or low EA of professional female soccer players during a competitive season. Thirteen players (age: 23.7 ± 3.4 y, stature: 1.69 ± 0.08 m, body mass: 63.7 ± 7.0 kg) engaged in a 5-day (two rest days, one light training, heavy training and match day) monitoring period. Energy intake (EI) and expenditure during exercise (EEE) were measured. EA was calculated and categorised as optimal, reduced or low (>45, 30-45, <30 kcal·kg FFM-1·day-1, respectively). Relationships between EA and bone mineral density, resting metabolic rate (RMR), plasma micronutrient status, biochemical markers and survey data were assessed. EA was optimal for 15%, reduced for 62% and low for 23% of players. Higher EA was observed on rest days compared to others (P<0.05). EA was higher for the light compared to the heavy training day (P<0.001). EEE differed significantly between days (P<0.05). EI (2124 ± 444 kcal), carbohydrate (3.31 ± 0.64 g·kg·day-1) and protein (1.83 ± 0.41 g·kg·day-1) intake remained similar (P>0.05). Survey data revealed 23% scored ≥8 on the Low Energy Availability in Females Questionnaire and met criteria for low RMR (ratio <0.90). Relationships between EA and risk factors were inconclusive. Most players displayed reduced EA and did not alter EI or carbohydrate intake according to training or match demands. Although cases of low EA were identified, further work is needed to investigate possible long-term effects and risk factors of low and reduced EA separately to inform player recommendations.

Vitamin Status and Diet in Elderly with Low and High Socioeconomic Status: The Lifelines-MINUTHE Study.

Socioeconomic health inequalities are an important global public health problem. However, it is not well known to what extent socioeconomic inequalities culminate in impaired vitamin status and whether this is mediated by diet. We, therefore, aimed to assess vitamin status in a population already at increased risk of micronutrient deficiency, i.e., elderly with high and low socioeconomic status (SES), and to investigate whether potential differences therein were mediated by diet quality. Vitamin status in 1605 individuals (60-75 years) from the Lifelines- Micronutrients and Health inequalities in Elderly (MINUTHE) Study was assessed by measuring folic acid and the vitamins B6, B12, D, A, E, and K. Multinomial logistic and linear regression analyses were applied to test the associations between SES and vitamin status. Mediation analysis was used to explore the interrelationship between SES, diet quality, and vitamin status. Low SES was associated with poorer status of vitamin B6, vitamin B12, and, notably, folic acid. Moreover, multivitamin deficiencies were more prevalent in the low SES group. Diet quality was found to mediate the associations of SES with folic acid (for 39.1%), vitamin B6 (for 37.1%), and vitamin B12 (for 37.2%). We conclude that low SES is a risk factor for a spectrum of vitamin deficiencies. Diet quality can partially explain the socioeconomic differences in vitamin status, suggesting that policymakers can mitigate socioeconomic inequality in nutritional status through improving diet quality.

Measuring socioeconomic gaps in nutrition and early child development in Bolivia.

BACKGROUND: A large body of evidence shows that socioeconomic status (SES) is strongly associated to children's early development, health and nutrition. Few studies have looked at within sample differences across multiple measures of child nutrition and development. This paper examines SES gaps in child nutritional status and development in Bolivia using a representative sample of children 0-59 months old and a rich set of outcomes, including micronutrient deficiencies, anthropometic measures, and gross motor and communicative development. METHODS: We construct direct and proxy measures of living standards based on household expenditures and on ownership of assets combined with access to services and dwelling characteristics. The data for this study come from a nationally representative household survey in Bolivia that contains information on health, nutrition, and child development tests. We used a regression framework to assess the adjusted associations between child development outcomes and socioeconomic status, after controlling for other demographic factors that might affect child's development. The SES gap in child development was estimated by OLS. To explore when the development gaps between children in different socioeconomic groups start and how they change for children at different ages, we analyze the differences in outcomes between the poorest (Q1) and richest (Q5) quintiles by child's age by estimating kernel weighted local polynomial regressions of standardized scores for all child development indicators. RESULTS: There are large and statistically significant differences in all anthropometrics z-scores between children in Q5 and children in Q1: height for age (0.95 SD), weight for age (0.70 SD), and weight for height (0.21 SD). When we divide the sample into children at the bottom and top consumption quintiles the results show that 68.6% of children in the poorest quintile are anemic. While this percentage falls to 40.9% for children in the richest quintile, it remains high compared to other countries in the region. The prevalence of vitamin A deficiency is 29.9% for children in the richest quintile and almost 10 percentage points higher for those at the bottom quintile (39.0%); the prevalence of Iron deficiency for children in the top and bottom quintiles is 16.4% and 23.8%, respectively. Compared to the most deprived quintile, children in the wealthiest quintile are less likely to have iron deficiency, anemia, to be stunted, and to have a risk of delays in gross motor and communicative development. At age three, most of these gaps have increased substantially. Our findings are robust to the choice of socioeconomic measurement and highlight the need for targeted policies to reduce developmental gaps. CONCLUSION: These findings highlight the need for targeted public policies that invest in multiple dimensions of child development as early as possible, including health, nutrition and cognitive and verbal stimulation. From a policy perspective, the large socioeconomic gaps in nutrition outcomes documented here reinforce the need to strengthen efforts that tackle the multiple causes of malnutrition for the poorest.

Nutritional Deficiencies in Patients with Severe Obesity before Bariatric Surgery: What Should Be the Focus During the Preoperative Assessment?

BACKGROUND: Nutritional deficiencies are a well-recognized long-term complication following bariatric surgery. The presence of preoperative deficiencies has been shown to be predictive of postoperative deficiencies. OBJECTIVE: The aim of the study was to investigate the prevalence of micronutrient deficiency in a large sample of patients with severe obesity preoperatively, and to determine whether such deficiencies may be related to patient's sex, body mass index, or ethnic subgroup. DESIGN: A cross-sectional study of data collected at the time of the preoperative evaluation. PARTICIPANTS/SETTING: Data were collected during the preoperative evaluation of 872 bariatric surgery candidates in a university hospital in Israel between 2011 and 2018. The patients were 72.9% women, with a mean age of 37.9±12.1 years and mean body mass index of 42.4±4.7 MAIN OUTCOME MEASURES: Nutritional deficiencies according to blood assays. Data on anthropometrics, comorbidities, and demographic characteristics was also collected. STATISTICAL ANALYSES: Baseline differences between patient subgroups were analyzed using independent-samples t test, analysis of variance, or χ2 test. RESULTS: Deficiencies of vitamin D, iron, folate, vitamin B-12, elevated parathyroid hormone and low transferrin saturation were present in 75.2%, 42.6%, 28.5%, 8.5%, 35.5%, and 70% of patients, respectively. Nutritional deficiencies were significantly more common among women compared with men for iron (45.9% vs 33.5%; P=0.002), low transferrin saturation (77.7% vs 44.6%; P<0.001), vitamin D (77.5% vs 69.2%; P=0.019) and elevated parathyroid hormone level (39.5% vs 22.9%; P=0.002). Iron, transferrin saturation, and vitamin D deficiencies were more prevalent in Arab patients compared with Jewish patients: 59.6% vs 36%; P<0.001, 80.2% vs 62.8%; P=0.003, and 85.1% vs 71.6%; P<0.001, respectively. Vitamin D and iron deficiency were more common among higher body mass index subgroups (P=0.004 and P=0.040, respectively). CONCLUSIONS: The results indicate a high prevalence of nutritional deficiencies, mainly of iron and vitamin D in bariatric surgery candidates. Patients at higher risk for nutritional deficiencies include those with higher body mass index, women, and Arabs.

Nutrition Assessment in Crohn's Disease using Anthropometric, Biochemical, and Dietary Indexes: A Narrative Review.

Malnutrition is common in patients with Crohn's disease and negatively influences immunity and quality of life. The optimal tools for nutrition assessment in patients with Crohn's disease are not clearly defined and lead to variations in practice. With this review, we aimed to appraise the existing evidence for nutrition assessment of patients with Crohn's disease compared with healthy controls and provide a comprehensive guide with relevant measures applicable to clinical practice. A literature search using Medline, Embase, and Scopus from inception to October 1, 2018, was conducted. Forty-one articles that assessed body composition, muscle strength, micronutrient status and/or dietary intake in adults with Crohn's disease compared with an age- and sex-matched healthy individuals were included. There were heterogeneous findings on nutritional status in patients with Crohn's disease compared with healthy controls. Only one article reported a clinically significant difference for body mass index; however, significant deficits in fat mass, fat-free mass, and muscle strength were observed in patients with Crohn's disease compared with healthy controls, with more pronounced differences with increasing disease activity and length of diagnosis. Most research reported significantly lower serum micronutrients in patients with Crohn's disease compared with healthy controls. Half of studies measuring micronutrient intake reported lower intakes in patients with Crohn's disease compared with healthy controls. Fruit and vegetable intake was also lower in patients with Crohn's disease. Difficulties characterizing the type and prevalence of malnutrition exist due to the heterogeneous nature of Crohn's disease and warrants continued investigation. As a result of this review, we advocate that a nutrition assessment should include more parameters than weight and body mass index.

Assessment of micronutrients in a 12-wk ketogenic diet in obese adults.

OBJECTIVE: A 12-wk ketogenic diet was found to have many beneficial effects in healthy obese adults, but it is not clear if the supply of micronutrients is adequate. METHODS: In 35 adult individuals with body mass index >30, the intakes of minerals and their serum levels were analyzed at baseline and at weeks 4 and 12 of the ketogenic diet intervention. The intake of vitamins and serum antioxidative potential were also investigated. RESULTS: Throughout the diet the intakes of magnesium, calcium, iron, phosphorus, and potassium were less than recommended values, but serum levels always remained within the reference range. Nevertheless, the level of calcium decreased significantly (from 2.52 ± 0.10 mmol/L at baseline to 2.36 ± 0.07 mmol/L at week 12, P < 0.001), which could be due to the omission of legumes and reduced dairy intake or because of the high fat intake alone. The levels of phosphate increased concomitantly. Calcium serum levels were negatively associated with ω-6 but not with ω-3 unsaturated fatty acid intake. The intakes of water-soluble vitamins were also too low. However, the antioxidative potential of serum did not change during intervention. CONCLUSIONS: Careful choice of foods that will provide the necessary micronutrients is of utmost importance when consuming ketogenic diet. In the 12 wk study the decreased intakes were not reflected in serum values, but special attention to calcium should be advised if such diet is recommended for longer periods.

Food-basket intervention to reduce micronutrient deficiencies among Maasai-pregnant women in Tanzania: a quasi-experimental study.

BACKGROUND: Micronutrients comprised of vitamin and mineral nutrients that are needed during pregnancy for foetal growth, development and maturation, as well as for reducing/preventing maternal complications. However, micronutrient-rich foods (vegetables and fruits) are lacking in the Ngorongoro Conservation Area as a result of restrictions on cultivation in conservation areas and the unavailability of vegetables and fruits in local markets. The present study introduced a food basket intervention and assessed the effectiveness of the food baskets with respect to addressing anaemia, vitamin A and iron deficiencies among pregnant Maasai women within the Ngorongoro Conservation Area. METHODS: The quasi-experimental study included Misigiyo ward as a control group (provided education only) and Olbalbal ward as an intervention group (provided food baskets and education). The study assessed haemoglobin, serum ferritin and retinol at baseline and during follow-up. Haemoglobin, serum ferritin and retinol were quantitatively (duplicate) measured with HemoCue™ (HemoCue AB, Ängelholm, Sweden), Maglumi 800 (Snibe Diagnostic, Shenzhen, China) and vitamin A enzyme-linked immunosorbent assay, respectively. Dependent and independent t-tests were used to compare the micronutrient blood levels between and within the groups. RESULTS: The present study found a statistically significant increase in serum retinol (P < 0.001) in the intervention group compared to the control group; moreover, baseline serum retinol was positively associated with the follow-up serum retinol, whereas baseline haemoglobin and serum ferritin were negatively associated. CONCLUSIONS: The food basket intervention holds promise with repect to reducing micronutrient deficiency, especially in communities where micronutrient-rich foods are scarce.

Assessment of the Effect of Dietary Modifications and Bioenteric Intragastric Balloon Treatment on the Changes of Some Morphological and Biochemical Parameters in Obese Patients.

Obesity is the most common disease of affluence of the XXI century. According to WHO (World Health Organization), it is defined as a chronic metabolic disorder manifested by excessive accumulation of adipose tissue with high tendency for familial occurrence. According to WHO, obesity reaches epidemic proportions in many countries. High BMI (Body Mass Index) correlates with coexisting diseases. Traditional dietetic treatment often does not bring any results. A form of conservative (non-surgical) support for patients in fighting with obesity is the reduction of stomach volume by bioenteric intragastric balloon (BIB) treatment. The aim of the work was to develop a diet with anti-inflammatory properties, well-tolerated by the patients after BIB treatment. An American diet was modified by changing the composition of fatty acids, increasing anti-oxidative potential and adding synbiotics for patients treated with BIB. Chemical analysis of reconstructed food ratios of recommended diet was performed, analysing the content of micronutrients, composition of fatty acids, antioxidative capacity, reducing power and the content of polyphenols. Improvement in anthropometric measurement results and satisfying body weight loss were obtained, while preserving fat-free body mass. Improvement in the parameters of lipid metabolism was also observed, that is, decrease in total CH (cholesterol) and TG (triglycerides), and normalized concentration of HDL (high density lipoproteins) and LDL (low density lipoproteins) fractions. Reduced concentration of glucose in blood and lower blood pressure was also noted. Performed study confirms the effectiveness of complex treatment with BIB and properly adjusted individualized diet. Observations and own experience allow to deduce that patients who resign from systematic contact with a dietician cannot maintain reduced body weight. Abandoning previous habits is the only way to maintain the effect of weight loss. Most importantly, the change in patients' awareness and consequent behaviour in the future are crucial. Even though genes may contribute to obesity, environmental factors mainly determine the possibility of the disease to occur. Therefore, the change of patients' lifestyle after body weight reduction will decide on their fate.

Micronutrient status in middle childhood and age at menarche: results from the Bogotá School Children Cohort.

Childhood intake of animal foods is associated with age at first menstrual period (menarche). It is unknown whether the micronutrients present in these foods could explain this association. Our objective was to investigate the associations of micronutrient status biomarkers in middle childhood with age at menarche. We quantified circulating Hb, ferritin, mean corpuscular volume, Zn, vitamin B12, erythrocyte folate and retinol in 1464 pre-menarcheal girls aged 5-12 years in Bogotá, Colombia, and followed them for a median 5·7 years for the occurrence and date of menarche. We estimated median age at menarche and hazard ratios (HR) with 95 % CI by levels of each biomarker with use of Kaplan-Meier survival probabilities and Cox regression, respectively. Median age at menarche was 12·4 years. Middle childhood Hb was inversely related to age at menarche whereas plasma ferritin was positively associated with this outcome in a linear manner. HR of menarche for every 1 sd of Hb (11 g/l) and ferritin (23·2 µg/l) were 1·11 (95 % CI 1·04, 1·18; P=0·001) and 0·94 (95 % CI 0·88, 0·99; P=0·02), respectively, after adjustment for baseline age, C-reactive protein concentration, maternal age at menarche and parity and socioeconomic status. The association with ferritin was stronger in girls aged 9-10 years at baseline. Additional adjustment for baseline height- and BMI-for-age did not change the results. We conclude that higher Fe status in middle childhood is related to later age at menarche whereas Hb concentrations are inversely associated with age at onset of menses.

Assessment of Micronutrient Status in Critically Ill Children: Challenges and Opportunities.

Micronutrients refer to a group of organic vitamins and inorganic trace elements that serve many functions in metabolism. Assessment of micronutrient status in critically ill children is challenging due to many complicating factors, such as evolving metabolic demands, immature organ function, and varying methods of feeding that affect nutritional dietary intake. Determination of micronutrient status, especially in children, usually relies on a combination of biomarkers, with only a few having been established as a gold standard. Almost all micronutrients display a decrease in their serum levels in critically ill children, resulting in an increased risk of deficiency in this setting. While vitamin D deficiency is a well-known phenomenon in critical illness and can predict a higher need for intensive care, serum concentrations of many trace elements such as iron, zinc, and selenium decrease as a result of tissue redistribution in response to systemic inflammation. Despite a decrease in their levels, supplementation of micronutrients during times of severe illness has not demonstrated clear benefits in either survival advantage or reduction of adverse outcomes. For many micronutrients, the lack of large and randomized studies remains a major hindrance to critically evaluating their status and clinical significance.

Estimated Nutritive Value of Low-Price Model Lunch Sets Provided to Garment Workers in Cambodia.

BACKGROUND: The establishment of staff canteens is expected to improve the nutritional situation of Cambodian garment workers. The objective of this study is to assess the nutritive value of low-price model lunch sets provided at a garment factory in Phnom Penh, Cambodia. METHODS: Exemplary lunch sets were served to female workers through a temporary canteen at a garment factory in Phnom Penh. Dish samples were collected repeatedly to examine mean serving sizes of individual ingredients. Food composition tables and NutriSurvey software were used to assess mean amounts and contributions to recommended dietary allowances (RDAs) or adequate intake of energy, macronutrients, dietary fiber, vitamin C (VitC), iron, vitamin A (VitA), folate and vitamin B12 (VitB12). RESULTS: On average, lunch sets provided roughly one third of RDA or adequate intake of energy, carbohydrates, fat and dietary fiber. Contribution to RDA of protein was high (46% RDA). The sets contained a high mean share of VitC (159% RDA), VitA (66% RDA), and folate (44% RDA), but were low in VitB12 (29% RDA) and iron (20% RDA). CONCLUSIONS: Overall, lunches satisfied recommendations of caloric content and macronutrient composition. Sets on average contained a beneficial amount of VitC, VitA and folate. Adjustments are needed for a higher iron content. Alternative iron-rich foods are expected to be better suited, compared to increasing portions of costly meat/fish components. Lunch provision at Cambodian garment factories holds the potential to improve food security of workers, approximately at costs of <1 USD/person/day at large scale. Data on quantitative total dietary intake as well as physical activity among workers are needed to further optimize the concept of staff canteens.

Associations between Red Meat Intakes and the Micronutrient Intake and Status of UK Females: A Secondary Analysis of the UK National Diet and Nutrition Survey.

Blanket health messages to lower red meat intakes are being communicated at present. These could have adverse implications on the micronutrient quality of women's diets. The current paper evaluates the nutritional impact of lower red meat intakes on British women's micronutrient intakes and status. A secondary analysis of the UK National Diet and Nutrition Survey was undertaken using data from years 2008/2009 to 2011/2012. This was comprised of dietary and blood analyte data from 1384 and 641 females aged 11 to 64 years. Females consuming less than 40 g total red meat daily were more likely to have micronutrient intakes below the Lower Reference Nutrient Intake (LRNI) for zinc, iron, vitamin B12 and potassium and have lower habitual vitamin D intakes than females consuming between 40 and 69 g daily. After adjusting data for energy intake, zinc (% below the LRNI) and vitamin D (µg/day) remained statistically significant (p < 0.001). No significant differences were observed for blood biomarkers. Females consuming diets lower in red meat, i.e., <40 g daily, appear to have reduced micronutrient intakes, especially in the case of zinc and vitamin D. This should be considered when giving blanket advice for whole populations to reduce red meat intakes.

Organic food consumption during pregnancy and its association with health-related characteristics: the KOALA Birth Cohort Study.

OBJECTIVE: To investigate the associations of organic food consumption with maternal pre-pregnancy BMI, hypertension and diabetes in pregnancy, and several blood biomarkers of pregnant women. DESIGN: Prospective cohort study. SETTING: Pregnant women were recruited at midwives' practices and through channels related to consumption of food from organic origin. SUBJECTS: Pregnant women who filled in FFQ and donated a blood sample (n 1339). Participant groups were defined based on the share of consumed organic products; to discriminate between effects of food origin and food patterns, healthy diet indicators were considered in some statistical models. RESULTS: Consumption of organic food was associated with a more favourable pre-pregnancy BMI and lower prevalence of gestational diabetes. Compared with participants consuming no organic food (reference group), a marker of dairy products intake (pentadecanoic acid) and trans-fatty acids from natural origin (vaccenic and rumenic acids) were higher among participants consuming organic food (organic groups), whereas elaidic acid, a marker of the intake of trans-fatty acids found in industrially hydrogenated fats, was lower. Plasma levels of homocysteine and 25-hydroxyvitamin D were lower in the organic groups than in the reference group. Differences in pentadecanoic acid, vaccenic acid and vitamin D retained statistical significance when correcting for indicators of the healthy diet pattern associated with the consumption of organic food. CONCLUSIONS: Consumption of organic food during pregnancy is associated with several health-related characteristics and blood biomarkers. Part of the observed associations is explained by food patterns accompanying the consumption of organic food.

The influence of food consumption and socio-economic factors on the relationship between zinc and iron intake and status in a healthy population.

OBJECTIVE: To examine Zn and Fe nutritional status of a healthy population by means of anthropometric, dietary and biochemical measurements and to investigate the relationship of usual Zn and Fe dietary intakes to Zn and Fe status. In addition, to examine the impact of food choices and socio-economic factors on Fe and Zn dietary intakes and status with the aim to identify groups at risk of dietary deficiency and suggest factors that may influence the status of these nutrients. DESIGN: Food consumption was assessed by 24 h recall questionnaires. Twenty biochemical parameters were measured, of which Hb, haematocrit, erythrocyte count and plasma concentrations of Fe and Zn were directly related to Fe and Zn nutrition. The prevalence of study participants with inadequate micronutrient intakes was calculated using the Estimated Average Requirement cut-point method. SETTING: Serbia, Europe. SUBJECTS: Apparently healthy adults (25-65 years of age). RESULTS: Mean daily Zn and Fe intakes were 9·1 mg and 11·6 mg for males and 7·3 mg and 9·4 mg for females, respectively. Five per cent of the study population had inadequate dietary Fe intake and 15-25 % had inadequate Zn intake. Lower Hb concentrations were measured in women with lower Zn intakes. No differences in Fe and Zn intakes and status among various socio-economic groups were observed, except for Fe intake between the low-income and affluent groups. CONCLUSIONS: Regular follow-ups are needed to ensure that potential deficiencies of Zn and Fe do get recognized and addressed in a timely manner.

Development of a Healthy Dietary Habits Index for New Zealand Adults.

Healthful dietary habits are individually associated with better nutrient intake and positive health outcomes; however, this information is rarely examined together to validate an indicator of diet quality. This study developed a 15-item Healthy Dietary Habits Index (HDHI) based on self-reported dietary habits information collected in the 2008/09 New Zealand Adult Nutrition Survey. The validity of HDHI as a diet quality index was examined in relation to sociodemographic factors, 24-diet recall derived nutrient intakes, and nutritional biomarkers in a representative sample of adults aged 19 years and above. Linear regression models were employed to determine associations between HDHI quintiles and energy-adjusted nutrient data and nutritional biomarkers. Significantly higher HDHI scores were found among women, older age groups, Non-Maori or Pacific ethnic groups, and less socioeconomically-deprived groups (all p < 0.001). Increasing quintiles of HDHI were associated with higher intakes of dietary fibre and seven micronutrients including calcium, iron, and vitamin C, and lower intakes of energy, macronutrients, sodium, zinc, vitamins B6 and B12. Associations in the expected directions were also found for urinary sodium, whole blood folate, serum and red blood cell folate, and plasma selenium (all p < 0.001). The present findings suggest that the HDHI is a valid measure of diet quality as it is capable of discerning quality of diets of subgroups and ranking nutrient intakes among NZ adults.

Adequacy of Usual Vitamin and Mineral Intake in Spanish Children and Adolescents: ENALIA Study.

Background: The National Dietary Survey on the Child and Adolescent Population in Spain (ENALIA) provides data to assess the usual micronutrient intake among Spanish infants, children, and adolescents. Methods: Cross-sectional survey (November 2012-July 2014) of a representative sample of Spanish children and adolescents (six months-17 years) (n = 1862). Dietary information was collected using two non-consecutive one-day food diaries (six months-10 years old) or two 24 h dietary recalls (11 years and older) separated by at least 14 days. Estimates were calculated using the Iowa State University method and PC-SIDE software (version 1.0, department of statistics, center for agricultural and rural development, Ames, IA, USA) to account for within- and between-person variation. Results: Usual intake of vitamin D was insufficient in practically all individuals. Vitamin E, folate, and calcium were insufficient, especially from nine years of age, and magnesium and iodine from 14 years of age. The percentage of subjects with insufficient intakes was higher among females. Sodium intake was excessive in a considerable percentage of the population, especially in males, and it increased with age. Finally, over half of children under four years of age had zinc usual intakes that exceeded the Tolerable Upper Level. Conclusion: Vitamin and mineral intake in Spain should be improved, especially in late childhood and adolescence. Nutritional intervention and educational strategies are needed to promote healthy eating habits and correct micronutrient inadequacies in Spanish children and adolescents.

Non-enzymatic antioxidant capacity (NEAC) estimated by two different dietary assessment methods and its relationship with NEAC plasma levels.

PURPOSE: We aimed to quantify and compare dietary non-enzymatic antioxidant capacity (NEAC), estimated using two dietary assessment methods, and to explore its relationship with plasma NEAC. METHODS: Fifty healthy subjects volunteer to participate in this study. Two dietary assessment methods [a food frequency questionnaire (FFQ) and a 24-hour recall (24-HR)] were used to collect dietary information. Dietary NEAC, including oxygen radical absorbance capacity (ORAC), total polyphenols, ferric-reducing antioxidant power (FRAP) and trolox equivalent antioxidant capacity, was estimated using several data sources of NEAC content in food. NEAC status was measured in fasting blood samples using the same assays. We performed nonparametric Spearman's correlation analysis between pairs of dietary NEAC (FFQ and 24-HR) and diet-plasma NEAC, with and without the contribution of coffee's NEAC. Partial correlation analysis was used to estimate correlations regardless of variables potentially influencing these relationships. RESULTS: FFQ-based NEAC and 24-HR-based NEAC were moderately correlated, with correlation coefficients ranging from 0.54 to 0.71, after controlling for energy intake, age and sex. Statistically significant positive correlations were found for dietary FRAP, either derived from the FFQ or the 24-HR, with plasma FRAP (r ~ 0.30). This weak, albeit statistically significant, correlation for FRAP was mostly present in the fruits and vegetables food groups. Plasma ORAC without proteins and 24-HR-based total ORAC were also positively correlated (r = 0.35). CONCLUSION: The relationship between dietary NEAC and plasma FRAP and ORAC suggests the dietary NEAC may reflect antioxidant status despite its weak in vivo potential, supporting further its use in oxidative stress-related disease epidemiology.

Dietary intakes in children born small for gestational age and appropriate for gestational age: A longitudinal study.

Children born small for gestational age (SGA) have an increased risk of cardiovascular disease (CVD) and associated risk factors in later life; however, little is known about their dietary intakes. The objective of this study was to assess dietary intakes in SGA and appropriate for gestational age (AGA) at 3.5, 7, and 11 years. The Auckland Birthweight Collaborative Study is a longitudinal case-control study of children born at term (n = 871). Children were assessed at 3.5 (n = 550), 7 (n = 591), and 11 (n = 620) years of age. Diet was assessed using a 24-hr record-assisted recall. Reported dietary intakes were analyzed and compared with the Australian and New Zealand Nutrient Reference Values. Compared with AGA, median energy intakes were significantly lower in SGA at 3.5 years (4.2 MJ [IQR, 3.0 to 5.8] vs. 5.4 MJ [IQR, 3.9 to 6.5]; p < .0001) but not at 7 and 11 years. Inadequate dietary intakes of micronutrients were more prevalent among SGA at 3.5 years and 11 years of age. A large proportion of SGA and AGA children consumed more than the recommended amounts of saturated fats, sugars, and sodium. There was no association of dietary intake and socio-demographic factors. This study reveals that dietary intake in 3.5-year-old children born SGA is lower in energy and a variety of micronutrients compared with dietary intake in AGA. These intakes may however be appropriate given their BMI z-scores. High intakes of sodium, saturated fat, and sugars are a concern for all children in this cohort.

Micronutrient Adequacy and Dietary Diversity Exert Positive and Distinct Effects on Linear Growth in Urban Zambian Infants.

BACKGROUND: In the monitoring of infant and young child feeding, dietary diversity is used as an indicator of micronutrient adequacy; however, their relation may have weakened with the increasing use of fortified complementary foods. OBJECTIVE: The objectives were to assess the relation between dietary diversity and micronutrient adequacy in an urban infant population with a high consumption of fortified foods and to investigate whether dietary diversity and micronutrient adequacy were independently associated with subsequent growth. METHODS: We used longitudinal data on 811 infants in the Chilenje Infant Growth, Nutrition, and Infection Study conducted in Lusaka, Zambia. The relation between mean micronutrient adequacies and dietary diversity scores derived from 24-h diet recalls at 6 mo of age was investigated with the use of Spearman rank correlation. Multiple linear regression was used to assess the association between micronutrient adequacy, dietary diversity, and subsequent growth to 18 mo of age. RESULTS: Overall mean micronutrient density adequacy (MMDA) and MMDA of "problem micronutrients," defined as those micronutrients (calcium, iron, zinc) with mean density adequacies less than half of estimated needs, were correlated with dietary diversity scores (ρ = 0.36 and 0.30, respectively, both P < 0.0001). Consumption of "sentinel foods" (iron rich, fortified, animal source, dairy) showed better correlation with MMDA than with dietary diversity (ρ = 0.58-0.69, all P < 0.0001). In fully adjusted analyses, MMDA calcium, iron, zinc, and dietary diversity, but not overall MMDA, were associated with linear growth to 18 mo (both P ≤ 0.028). CONCLUSIONS: Micronutrient adequacy in infants consuming fortified foods may be more accurately assessed using locally specific sentinel food indicators rather than dietary diversity scores. Nonetheless, dietary diversity has a positive effect on subsequent linear growth apart from that of micronutrient adequacy, warranting its continued monitoring and further investigation into the mechanisms underlying this finding. This trial was registered at www.controlled-trials.com as ISRCTN37460449.

Maximizing the benefits and minimizing the risks of intervention programs to address micronutrient malnutrition: symposium report.

Interventions to address micronutrient deficiencies have large potential to reduce the related disease and economic burden. However, the potential risks of excessive micronutrient intakes are often not well determined. During the Global Summit on Food Fortification, 9-11 September 2015, in Arusha, a symposium was organized on micronutrient risk-benefit assessments. Using case studies on folic acid, iodine and vitamin A, the presenters discussed how to maximize the benefits and minimize the risks of intervention programs to address micronutrient malnutrition. Pre-implementation assessment of dietary intake, and/or biomarkers of micronutrient exposure, status and morbidity/mortality is critical in identifying the population segments at risk of inadequate and excessive intake. Dietary intake models allow to predict the effect of micronutrient interventions and their combinations, e.g. fortified food and supplements, on the proportion of the population with intakes below adequate and above safe thresholds. Continuous monitoring of micronutrient intake and biomarkers is critical to identify whether the target population is actually reached, whether subgroups receive excessive amounts, and inform program adjustments. However, the relation between regular high intake and adverse health consequences is neither well understood for many micronutrients, nor do biomarkers exist that can detect them. More accurate and reliable biomarkers predictive of micronutrient exposure, status and function are needed to ensure effective and safe intake ranges for vulnerable population groups such as young children and pregnant women. Modelling tools that integrate information on program coverage, dietary intake distribution and biomarkers will further enable program makers to design effective, efficient and safe programs.