Effect of zinc and vitamin A supplementation on immune responses in Indonesian pre-schoolers.

BACKGROUND AND OBJECTIVES: Vitamin A and zinc are interrelated, but the effects of zinc on vitamin A supplementation on morbidity are inconsistent and not well understood. We investigated the effects of zinc and vitamin A supplementation on immune responses in Indonesian pre-schoolers. METHODS AND STUDY DESIGN: In a twostage study design, 826 children (2-5year old) were randomly assigned to receive daily zinc supplement (10 mg) or placebo for 4 months. At 2 months, both groups received a 200,000 IU vitamin A capsules through national vitamin A program. Data were collected at baseline, two and four months, resulting in 4 groups for comparisons: - no zinc no vitamin A (Placebo), zinc only, vitamin A only, and zinc plus vitamin A. Hair, blood and saliva samples were collected to measure hair zinc and serum retinol (vitamin A) concentration, ex-vivo IFN-γ, serum IgG and salivary IgA from 81 children selected randomly from each group. RESULTS: At baseline, there were no differences between treatment groups. Zinc supplementation increased ex-vivo IFN-γ production, greatest amongst boys, younger (<3.5 years), normal weight and children with low baseline retinol concentration. Vitamin A supplementation increased IFN-γ only in those with low baseline retinol, with no effect on serum IgG and salivary IgA. After vitamin A supplementation, zinc had an effect on salivary IgA among younger and underweight children. CONCLUSIONS: Zinc supplementation increased IFN-γ (cellular immune responses) and modified the effect of vitamin A supplementation on salivary IgA (mucosal innate immune response) in younger and underweight children.

Non-farmed fish contribute to greater micronutrient intakes than farmed fish: results from an intra-household survey in rural Bangladesh.

OBJECTIVE: Fish is the most important animal-source food (ASF) in Bangladesh, produced from capture fisheries (non-farmed) and aquaculture (farmed) sub-sectors. Large differences in micronutrient content of fish species from these sub-sectors exist. The importance of fish in diets of vulnerable groups compared with other ASF; contribution from non-farmed and farmed species to nutrient intakes; and differences in fish consumption among age, gender, wealth groups and geographic regions were analysed, using quantitative intra-household fish consumption data, focusing on the first 1000 d of life. DESIGN: Two-stage stratified sample. SETTING: Nationally representative of rural Bangladesh. SUBJECTS: Households (n 5503) and individuals (n 24 198). RESULTS: Fish consumption in poor households was almost half that in wealthiest households; and lower in females than males in all groups, except the wealthiest, and for those aged ≥15 years (P<0·01). In infants of complementary feeding age, 56 % did not consume ASF on the survey day, despite 78 % of mothers knowing this was recommended. Non-farmed fish made a larger contribution to Fe, Zn, Ca, vitamin A and vitamin B12 intakes than farmed fish (P<0·0001). CONCLUSIONS: Policies and programmes aimed to increase fish consumption as a means to improve nutrition in rural Bangladesh should focus on women and young children, and on the poorest households. Aquaculture plays an important role in increasing availability and affordability of fish; however, non-farmed fish species are better placed to contribute to greater micronutrient intakes. This presents an opportunity for aquaculture to contribute to improved nutrition, utilising diverse production technologies and fish species, including small fish.

Estimated effects of white rice consumption and rice variety selection on incidence of type 2 diabetes in Cambodia.

OBJECTIVE: Rice consumption patterns are considered an important risk factor for diabetes in many countries. The present study aimed to model the impact of a shift in consumption of white rice from current to appropriately reduced levels and a shift in rice variety from one with a high glycaemic index to one with a low glycaemic index, on the burden of type 2 diabetes in Cambodia. DESIGN: Prevent Plus software was used to model the impact of selected changes to white rice consumption on the burden of type 2 diabetes. Data used for modelling included: demographic projections, relative risk estimates for white rice consumption and diabetes, diabetes incidence, rice type and quantities consumed. The 10-year projections were based on different scenarios of changes in risk factors. RESULTS: With no intervention, 10-year projections showed that total new diabetes cases will increase from 11 315 (9·1 per 10 000 person-years) for the year 2011 to 14 852 new cases (12·4 per 10 000 person-years) in 2020. However, this increase will be reduced by 27 % (average across 10 years) with a change in rice variety from Phka Rumdual to IR66 and by 26 % (average across 10 years) with a 25 % reduction in quantity from current consumption levels. CONCLUSIONS: Changing rice consumption patterns has potential for an important impact on diabetes risk, with a change of rice variety having a similar impact on the burden of diabetes in communities consuming rice with a high glycaemic index as a 25 % reduction in the quantity of rice consumed. Similar effects are likely for other countries with rice as a staple food, diversity in rice varieties and high incidence of diabetes.

Effects of decentralisation and health system reform on health workforce and quality-of-care in Indonesia, 1993-2007.

The impact of decentralisation, socioeconomic changes and healthcare reforms in Indonesia on type and distribution of healthcare providers and quality-of-care has been unclear. We examined workforce trends for healthcare facilities from 1993 to 2007 using the Indonesian Family Life Surveys. Each included a sample of public and private healthcare facilities, used standardised interviews for numbers and composition of staffing, and quality-of-care vignettes. There was an increase in multiprovider facilities and shift in profile of solo providers-increasing proportions of midwives and drop in doctors in rural areas (including facilities with doctors) and nurses in urban areas. Quality-of-care scores were low, particularly for nurses as solo providers. Despite increased numbers of healthcare workers and growth of the private sector, outer Java-Bali and rural areas continued to be disadvantaged in workforce capacity and quality-of-care. The results have implications for accreditation and in-service training requirements, the legal status of nurses and private sector regulation.

Inclusion of Small Indigenous Fish Improves Nutritional Quality During the First 1000 Days.

BACKGROUND: Within food-based approaches to improve nutrition during the first 1000 days of life, improved formulations of food products and the use of animal source foods, such as fish, are 2 widely cited strategies; however, there are few examples where the 2 strategies are combined. Furthermore, although small indigenous fish are highly nutritious and available to the poor in many regions of the world, their importance is often overlooked. OBJECTIVE: To document the development of 2 nutritious fish-based food products in Bangladesh: a chutney for pregnant and lactating women (PLW) and a complementary food (CF) for infants and young children (6-23 months), including potential contributions to recommended or desirable nutrient intakes in the first 1000 days, processing methods, and nutrient composition. METHODS: Local nutrient-rich ingredients and simple processing methods based on traditional knowledge (for the chutney), and a literature review (for the CF), were selected and trial batches produced. Products were analyzed for nutrient composition using standard analytical procedures and results compared with recommended or desirable nutrient intakes for women and children. RESULTS: Both products could contribute significantly to micronutrient intakes of PLW (24% of iron and 35% of calcium recommended intakes) and macro- and micronutrient intake of infants and young children (≥ 65% of vitamin A, ≥ 61% of zinc, and 41% of iron desirable intakes) when consumed in the proposed serving size. CONCLUSION: Inclusion of small indigenous fish as an underutilized animal source food in combination with other local nutrient-rich ingredients in food products represents a promising food-based strategy to improve nutrition, with many additional potential benefits for communities involved in production, and therefore warrants further investigation.

Low serum vitamin B-12 and folate concentrations and low thiamin and riboflavin intakes are inversely associated with greater adiposity in Mexican American children.

BACKGROUND: Micronutrient status may be a contributing factor to the development of childhood obesity in many industrializing countries passing the nutritional transition. The few studies investigating associations between serum concentrations of vitamin B and intake of B vitamins with adiposity, however, have reported inconsistent findings. OBJECTIVE: The aim of the study was to examine associations between serum vitamin B-12 and folate concentrations and intakes of B vitamins with body fat by using data on 1131 Mexican American children 8-15 y of age included in NHANES 2001-2004. METHODS: Children's body mass index (BMI), trunk fat mass (TrFM), and total body fat mass (TBFM) were used as body adiposity (BA) measures. Serum concentrations of folate and vitamin B-12 were measured in blood samples collected from children. Intake of B vitamins was collected according to 24-h dietary recall. Associations of BA with serum concentrations of vitamin B-12 and folate and intake of B vitamins were determined by using linear and multinomial regression models. RESULTS: Serum concentrations of vitamin B-12 and folate were inversely associated with BMI (ß: -2.68, P < 0.01; ß = -1.33, P < 0.01), TrFM (ß:-3.32, P < 0.01; ß: -0.14, P < 0.05), and TBFM (ß:-1.93, P < 0.01; ß: -3.19; P < 0.01). Higher serum concentrations of vitamin B-12 were associated with a reduced risk of obesity (OR: 0.48; 95% CI: 0.31, 0.77; P < 0.001). Thiamin and riboflavin intakes were inversely associated with BMI (ß:-1.35, P < 0.05; ß: -1.11, P < 0.05) and TrFM (ß:-1.26, P < 0.05; ß: -1.37, P < 0.05). CONCLUSION: Similar inverse associations between BA and status of both vitamin B-12 and folate and intake of thiamin and riboflavin suggest that these micronutrients may play a role in adipogenesis and risk of childhood obesity.

Low serum concentrations of carotenoids and vitamin E are associated with high adiposity in Mexican-American children.

Mexican-American children have a high prevalence of overweight/obesity. Micronutrient deficiencies may be contributing to the development of greater adiposity in these children. This study investigated the relations between adiposity and serum concentrations of carotenoids, retinol, and vitamin E among Mexican-American children 8-15 y of age included in the 2001-2004 U.S. NHANES. Associations of the outcomes of children's body mass index (BMI), truncal fat mass (TrFM), and total body fat mass (TBFM) with serum concentrations of α-carotene, cis-ß-carotene, trans-ß-carotene, retinol, and α-tocopherol were determined by using linear, quantile, and multinomial regression models. BMI was inversely associated with serum concentrations of α-carotene (ß = -0.88, P < 0.05), trans-ß-carotene (ß = -2.21, P < 0.01), cis-ß-carotene (ß = -2.10, P < 0.01), and α-tocopherol adjusted for total cholesterol ratio (ß = -3.66, P < 0.01), respectively. Similar inverse associations were found with TrFM and TBFM. Higher cis-ß-carotene and α-tocopherol serum concentrations were associated with reduced probability of overweight (OR: 0.57; 95% CI: 0.37, 0.89; P < 0.05; and OR: 0.56; 95% CI: 0.37, 0.86; P < 0.05; respectively) and obesity (OR: 0.39; 95% CI: 0.26, 0.58; P < 0.01; and OR: 0.38; 95% CI: 0.24, 0.60; P < 0.01; respectively). Higher retinol serum concentrations were associated with increased probability of overweight and obesity (OR: 2.01; 95% CI: 1.26, 3.22; P < 0.01; and OR: 2.90; 95% CI: 1.65, 5.09; P < 0.01; respectively). Significant inverse associations were found between serum concentrations of carotenoids and vitamin E and adiposity among Mexican-American children, but serum retinol concentrations were positively associated with adiposity. Future research is needed to understand the causes and consequences of micronutrient status on adiposity and comorbidities.

Nutrition capacity development: a practice framework.

OBJECTIVE: To outline a framework and a process for assessing the needs for capacity development to achieve nutrition objectives, particularly those targeting maternal and child undernutrition. DESIGN: Commentary and conceptual framework. SETTING: Low- and middle-income countries. Result A global movement to invest in a package of essential nutrition interventions to reduce maternal and child undernutrition in low- and middle-income countries is building momentum. Capacity to act in nutrition is known to be minimal in most low- and middle-income countries, and there is a need for conceptual clarity about capacity development as a strategic construct and the processes required to realise the ability to achieve population nutrition and health objectives. The framework for nutrition capacity development proposed recognises capacity to be determined by a range of factors across at least four levels, including system, organisational, workforce and community levels. This framework provides a scaffolding to guide systematic assessment of capacity development needs which serves to inform strategic planning for capacity development. CONCLUSIONS: Capacity development is a critical prerequisite for achieving nutrition and health objectives, but is currently constrained by ambiguous and superficial conceptualisations of what capacity development involves and how it can be realised. The current paper provides a framework to assist this conceptualisation, encourage debate and ongoing refinement, and progress capacity development efforts.

Quality of physical resources of health facilities in Indonesia: a panel study 1993-2007.

OBJECTIVE: The merits of mixed public and private health systems are debated. Although private providers have become increasingly important in the Indonesian health system, there is no comprehensive assessment of the quality of private facilities. This study examined the quality of physical resources of public and private facilities in Indonesia from 1993 to 2007. DESIGN AND SETTING: Data from the Indonesian Family Life Surveys in 1993, 1997, 2000 and 2007 were used to evaluate trends in the quality of physical resources for public and private facilities, stratified by urban/rural areas and Java-Bali/outer Java-Bali regions. MAIN OUTCOME MEASURES: The quality of six categories of resources was measured using an adapted MEASURE Evaluation framework. RESULTS: Overall quality was moderate, but higher in public than in private health facilities in all years regardless of the region. The higher proportion of nurses and midwives in private practice was a determinant of scope of services and facilities available. There was little improvement in quality of physical resources following decentralization. CONCLUSIONS: Despite significant increases in public investment in health between 2000 and 2006 and the potential benefits of decentralization (2001), the quality of both public and private health facilities in Indonesia did not improve significantly between 1993 and 2007. As consumers commonly believe the quality is better in private facilities and are increasingly using them, it is essential to improve quality in both private and public facilities. Implementation of minimum standards and effective partnerships with private practice are considered important.

Zinc combined with vitamin A reduces upper respiratory tract infection morbidity in a randomised trial in preschool children in Indonesia.

Zn supplementation has shown inconsistent effects on respiratory morbidity in young children in developing countries. Few studies have focused on upper respiratory tract infection (URTI), a frequent cause of morbidity in this group, and potential benefit from Zn supplementation or factors that influence its efficacy. We investigated the effects of Zn supplementation on URTI before and after vitamin A supplementation. This randomised double-blinded controlled Zn supplementation study was conducted on 826 children aged 2-5 years. Placebo or Zn (10 mg/d) was given in syrup daily for 4 months, with 200 000 IU vitamin A (60 mg retinol) given to all children at 2 months. Health workers visited children every 3 d for compliance and morbidity information. We found that 84 % of children experienced URTI during the study. Zn supplementation reduced the percentage of days with URTI (12 % reduction; P = 0·09), with greater impact following vitamin A supplementation (20 % reduction; P = 0·01). Vitamin A supplementation was associated with a decreased number but an increased duration of URTI episodes. We conclude that Zn combined with vitamin A supplementation significantly reduced the percentage of days with URTI in a population of preschool Indonesian children with marginal nutritional status. The results suggest that vitamin A status modifies the efficacy of Zn supplementation on URTI.

Diet quality and change in anthropometric measures: 15-year longitudinal study in Australian adults.

Evidence from longitudinal studies on the association between diet quality and change in anthropometric measures is scarce. We therefore investigated the relationship between a recently developed food-based dietary index and change in measured BMI and waist circumference (WC) in Australian adults (1992-2007). We used data from the Australian population-based Nambour Skin Cancer Study comprising 1231 adults aged 25-75 years at baseline (1992). We applied generalised estimating equations (GEE) to examine the association between diet quality and change in anthropometric measures. Dietary intake was assessed by an FFQ in 1992, 1996 and 2007. Diet quality was estimated using the dietary guideline index (DGI), developed to reflect the dietary guidelines for Australian adults; a higher score indicating increased compliance. Multivariable models, stratified by sex, were adjusted for sociodemographic and lifestyle characteristics. We show that men with higher diet quality had a lower gain in BMI as compared to those with low diet quality during the 15-year follow-up. In a multivariable adjusted model, as compared to men in quartile 1 (reference), those in the highest quartile had the lowest gain in BMI (mean (95 % CI): 0.05 (0.00, 0.09) v. 0.11 (0.06, 0.16) kg/m2 per year, P =0.01). Diet quality was inversely, but non-significantly associated with change in WC. In women, DGI score was unrelated to change in any body measure. Energy underreporting did not explain the lack of association. We conclude that adherence to a high-quality diet according to Australian dietary guidelines leads to lower gain in BMI and WC in middle-aged men, but not in women.

Longitudinal change in diet quality in Australian adults varies by demographic, socio-economic, and lifestyle characteristics.

Knowledge of determinants of change in diet quality is needed, but it is relatively limited to date and mostly available from cross-sectional studies. We investigated longitudinal change in diet quality and its associations with period of birth (birth cohort) and socio-demographic and lifestyle characteristics. We used dietary intake data collected by FFQ in 1992, 1996, and 2007 from a population-based random sample of adults comprising 1511 men and women aged 25-75 y at baseline and applied generalized estimating equations to examine determinants of long-term change in diet quality, calculated using a diet quality index reflecting dietary guidelines for Australian adults. Information on socio-demographic and lifestyle factors was derived from self-reported questionnaires. Multivariable models, stratified by sex, were adjusted for confounders. We showed that there was an overall increase in diet quality in both men and women, but scores related to intake of fruit (men only), cereals, and food variety decreased during a 15-y follow-up. Younger age, higher occupational level (men only), and low to medium level of physical activity and hormone replacement therapy use in women were independently associated with greater improvement in diet quality over time (P < 0.05). In conclusion, despite an overall improvement in diet quality over time, this study suggests that efforts to further improve diet quality in Australia should focus on increasing consumption of fruit, cereals, and a greater variety of foods. More evidence from studies that assess change in dietary quality in longitudinal studies is needed to corroborate these findings.

Dietary fat intake and risk of skin cancer: a prospective study in Australian adults.

Although intakes of dietary fat have been associated with both basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the skin, the evidence is sparse and inconsistent. This study prospectively investigated the association between total dietary fat; saturated, polyunsaturated and monounsaturated fatty acids; and percent energy from fat in relation to BCC and SCC of the skin. At baseline in 1992, total fat intake and intake of fatty acids were assessed in an Australian community-based longitudinal study, using a validated semi-quantitative food frequency questionnaire in 1,057 adult residents (aged 25-75 years) in Nambour, Queensland. Information on demography, sun-sensitivity history and sun exposure factors were obtained using self-administered questionnaires. Associations with BCC and SCC in terms of persons newly affected and of tumor counts were assessed using Poisson and negative binomial regression models, respectively, based on incident, histologically-confirmed tumors occurring between 1992 and 2002. No significant linear trends were observed in overall risk of BCC or SCC of the skin with increasing total fat intake. However, in participants with a history of skin cancer, total fat intake (multivariable adjusted RR = 2.42, 95% CI = 1.20-4.88; p for trend = 0.01) was associated with increased numbers of SCC tumors comparing the highest to lowest tertile. In conclusion, SCC tumor risk increased as total fat intake increased in people with a history of skin cancer. Dietary fats were not associated with BCC occurrence.

Serum antioxidants and skin cancer risk: an 8-year community-based follow-up study.

BACKGROUND: Antioxidant nutrients can help prevent skin damage caused by ultraviolet radiation from sunlight, but it is not clear whether serum concentrations of such nutrients influence skin cancer risk. METHODS: We carried out a prospective study of the associations between serum concentrations of antioxidant nutrients and incidence (person-based and tumor-based) of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the skin among a random subsample of 485 adults from an Australian community. Participants were divided into thirds, ranked according to their serum concentrations of carotenoids, alpha-tocopherol, and selenium measured in 1996 and were monitored for incident, histologically confirmed BCC and SCC tumors until 2004. RESULTS: Although there were no associations between baseline serum carotenoids or alpha-tocopherol concentrations and incidence of BCC or SCC, baseline serum selenium concentrations showed strong inverse associations with both BCC and SCC tumor incidence. Compared with participants with lowest selenium concentrations at baseline (0.4-1.0 micromol/L), those with the highest serum selenium concentrations (1.3-2.8 micromol/L) had a decreased incidence of BCC tumors (multivariate relative risk, 0.43; 95% confidence interval, 0.21-0.86; P(trend) = 0.02) and SCC tumors (multivariate relative risk, 0.36; 95% confidence interval, 0.15-0.82; P(trend) = 0.02). CONCLUSION: Relatively high serum selenium concentrations are associated with an approximately 60% decrease in subsequent tumor incidence of both BCC and SCC, whereas serum concentrations of carotenoids or alpha-tocopherol are not associated with later skin cancer incidence. A possible U-shaped association between serum selenium concentrations and SCC of the skin needs confirmation.

Cash transfer programmes in lower-income and middle-income countries: understanding pathways to nutritional change-a realist review protocol.

INTRODUCTION: Child malnutrition continues to be a significant global public health concern. Nutrition-related interventions have changed and diversified over the last two decades, with increasing emphasis on nutrition-sensitive programmes that address underlying determinants of child malnutrition. Cash transfer programmes (CTPs) are used with increasing popularity in lower-income and middle-income countries to improve both food/nutrition insecurity and resilience. Available studies, however, provide mixed findings on the outcomes of CTPs for child nutritional status. This review is the first stage of a research project to develop evidence-informed theories of how CTPs affect child malnutrition. These will be empirically tested in the field and contribute to a better understanding of how, why, for whom and in what circumstances CTPs can be implemented to optimise impacts on child nutritional status. METHODS AND ANALYSIS: This realist review is informed by available standards for realist reviews and follows a five-step process. In step 1, an initial scoping of literature identified potential contextual factors and underlying mechanisms that influence nutritional outcomes, and potential theories developed to address our research question. In step 2, a systematic literature search using multiple databases will be undertaken with papers screened using defined inclusion/exclusion criteria. In step 3, included studies will be appraised, data extracted into a bespoke data extraction tool and used to test and further refine our explanatory framework. The fourth step will synthesise, using a mix of inductive and deductive analytical processes to identify patterns, link chains of inference and tracking and linking of articles. The final step involves dissemination of a preliminary theory for feedback prior to empirically testing it in Kenya and Ethiopia where large-scale CTPs are being implemented. ETHICS AND DISSEMINATION: This review will not involve primary data collection. Findings will be presented in accordance with Realist and Meta-Narrative Evidence Synthesis: Evolving Standards guidelines and published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: CRD42018110735.

Dietary pattern in association with squamous cell carcinoma of the skin: a prospective study.

BACKGROUND: The role of diet in the development of skin cancer is inconclusive, and the effect of the combined consumption of foods has never been reported. OBJECTIVE: We prospectively investigated the association between dietary patterns and cutaneous basal cell (BCC) and squamous cell (SCC) carcinoma. DESIGN: Principal components analysis of 38 food groups was used to identify dietary patterns in 1360 adults aged 25-75 y who participated in a community-based skin cancer study in Nambour, Australia, between 1992 and 2002. We obtained baseline information about diet, skin color, and sun exposure factors. Multivariate-adjusted relative risks (RRs) for BCC and SCC tumors were estimated by using negative binomial regression modeling. RESULTS: Two major dietary patterns were identified: a meat and fat pattern and a vegetable and fruit pattern. The meat and fat pattern was positively associated with development of SCC tumors (RR=1.83; 95% CI: 1.00, 3.37; P for trend=0.05) after adjustment for confounders and even more strongly associated in participants with a skin cancer history (RR=3.77; 95% CI: 1.65, 8.63; P for trend = 0.002) when the third and first tertiles were compared. A higher consumption of the vegetable and fruit dietary pattern appeared to decrease SCC tumor risk by 54% (P for trend = 0.02), but this protective effect was mostly explained by the association with green leafy vegetables. There was no association between the dietary patterns and BCC tumors. CONCLUSION: A dietary pattern characterized by high meat and fat intakes increases SCC tumor risk, particularly in persons with a skin cancer history.

Intake of antioxidant nutrients and the risk of skin cancer.

To investigate the associations between intake of antioxidant nutrients and risk of basal cell (BCC) and squamous cell carcinomas (SCC) of the skin, we carried out a prospective study among 1001 randomly selected adults living in an Australian community. Intake of antioxidants was estimated in 1996. Incident, histologically-confirmed BCC and SCC were recorded between 1996 and 2004. High dietary intake of lutein and zeaxanthin was associated with a reduced incidence of SCC in persons who had a history of skin cancer at baseline (highest versus lowest tertile, multivariable adjusted relative risk (RR)=0.47, 95% confidence interval (CI): 0.25-0.89; P for trend=0.02). In persons without a history of skin cancer at baseline, development of BCC was positively associated with intake of vitamins C and E from foods plus supplements (RR=3.1, 95% CI: 1.1-8.6; P for trend=0.03 and RR=2.6, 95% CI: 1.1-6.3; P for trend=0.02, respectively). In those with a skin cancer history at baseline, dietary intake in the second tertile for beta-carotene (multivariable adjusted RR=2.2, 95% CI: 1.2-4.1) and for vitamin E (multivariable adjusted RR=2.1, 95% CI: 1.1-3.9) was associated with increased BCC risk, with no trend, and similar results were seen in those with a specific history of BCC. These data suggest quite different associations between antioxidant intake and SCC compared with BCC, consistent with other evidence of their different causal pathways.

Higher fish but lower micronutrient intakes: Temporal changes in fish consumption from capture fisheries and aquaculture in Bangladesh.

Malnutrition is one of the biggest challenges of the 21st century, with one in three people in the world malnourished, combined with poor diets being the leading cause of the global burden of disease. Fish is an under-recognised and undervalued source of micronutrients, which could play a more significant role in addressing this global challenge. With rising pressures on capture fisheries, demand is increasingly being met from aquaculture. However, aquaculture systems are designed to maximise productivity, with little consideration for nutritional quality of fish produced. A global shift away from diverse capture species towards consumption of few farmed species, has implications for diet quality that are yet to be fully explored. Bangladesh provides a useful case study of this transition, as fish is the most important animal-source food in diets, and is increasingly supplied from aquaculture. We conducted a temporal analysis of fish consumption and nutrient intakes from fish in Bangladesh, using nationally representative household expenditure surveys from 1991, 2000 and 2010 (n = 25,425 households), combined with detailed species-level nutrient composition data. Fish consumption increased by 30% from 1991-2010. Consumption of non-farmed species declined by 33% over this period, compensated (in terms of quantity) by large increases in consumption of farmed species. Despite increased total fish consumption, there were significant decreases in iron and calcium intakes from fish (P<0.01); and no significant change in intakes of zinc, vitamin A and vitamin B12 from fish, reflecting lower overall nutritional quality of fish available for consumption over time. Our results challenge the conventional narrative that increases in food supply lead to improvements in diet and nutrition. As aquaculture becomes an increasingly important food source, it must embrace a nutrition-sensitive approach, moving beyond maximising productivity to also consider nutritional quality. Doing so will optimise the complementary role that aquaculture and capture fisheries play in improving nutrition and health.

Role of dietary factors in the development of basal cell cancer and squamous cell cancer of the skin.

The role of dietary factors in the development of skin cancer has been investigated for many years; however, the results of epidemiologic studies have not been systematically reviewed. This article reviews human studies of basal cell cancer (BCC) and squamous cell cancer (SCC) and includes all studies identified in the published scientific literature investigating dietary exposure to fats, retinol, carotenoids, vitamin E, vitamin C, and selenium. A total of 26 studies were critically reviewed according to study design and quality of the epidemiologic evidence. Overall, the evidence suggests a positive relationship between fat intake and BCC and SCC, an inconsistent association for retinol, and little relation between beta-carotene and BCC or SCC development. There is insufficient evidence on which to make a judgment about an association of other carotenoids with skin cancer. The evidence for associations between vitamin E, vitamin C, and selenium and both BCC and SCC is weak. Many of the existing studies contain limitations, however, and further well-designed and implemented studies are required to clarify the role of diet in skin cancer. Additionally, the role of other dietary factors, such as flavonoids and other polyphenols, which have been implicated in skin cancer development in animal models, needs to be investigated.

Acute cadmium chloride administration induces hepatic and renal CYP2A5 mRNA, protein and activity in the mouse: involvement of transcription factor NRF2.

Modulation of the cytochrome P450 (CYP) monooxygenase system by cadmium was investigated in male, adult DBA/2J mice treated with a single dose (16 micromol/kg body weight, i.p.) of cadmium chloride (CdCl2). Total CYP content of liver and kidney microsomes decreased maximally (56% and 85%, respectively) 24 and 18 h, respectively, after CdCl2 treatment. Progressive increases of hepatic coumarin 7-hydroxylase (COH) activity; indicative of CYP2A5 activity, relative to the total CYP content were seen at 8 h (2-fold), 12 h (3-fold), 18 h (12-fold), and 24 h (15-fold). Similar changes were seen in the kidney. Liver and kidney CYP2A5 mRNA levels increased maximally 12 and 4 h after treatment and decreased to almost half 6 h later. In contrast, kidney and liver CYP2A5 protein levels increased maximally at 18 and 24 h. The CYP2A5 mRNA levels in the kidney and liver increased after Cd treatment in Nrf2 +/+ but not in Nrf2 -/- mouse. This study demonstrates that hepatic and kidney CYP2A5 is upregulated by cadmium with a somewhat faster response in the kidney than the liver. The strong upregulation of the CYP2A5 both at mRNA and enzyme activity levels, with a simultaneous decrease in the total CYP concentration suggest an unusual mode of regulation of CYP2A5 in response to cadmium exposure, amongst the CYP enzymes. The observed decrease in the mRNA but not in protein levels after maximal induction may suggest involvement of post-transcriptional mechanisms in the regulation. Upregulation of CYP2A5 by cadmium in the Nrf2 +/+ mice but not in the Nrf2-/- mice indicates a role for this transcription factor in the regulation.