Nutritional Approaches as a Treatment for Impaired Bone Growth and Quality Following the Consumption of Ultra-Processed Food.

The severe impairment of bone development and quality was recently described as a new target for unbalanced ultra-processed food (UPF). Here, we describe nutritional approaches to repair this skeletal impairment in rats: supplementation with micro-nutrients and a rescue approach and switching the UPF to balanced nutrition during the growth period. The positive effect of supplementation with multi-vitamins and minerals on bone growth and quality was followed by the formation of mineral deposits on the rats' kidneys and modifications in the expression of genes involved in inflammation and vitamin-D metabolism, demonstrating the cost of supplementation. Short and prolonged rescue improved trabecular parameters but incompletely improved the cortical parameters and the mechanical performance of the femur. Cortical porosity and cartilaginous lesions in the growth-plate were still detected one week after rescue and were reduced to normal levels 3 weeks after rescue. These findings highlight bone as a target for the effect of UPF and emphasize the importance of a balanced diet, especially during growth.

Beneficial effects of a plant-fish oil, slow carbohydrate diet on cardio-metabolic health exceed the correcting effects of metformin-pioglitazone in diabetic pigs fed a fast-food diet.

BACKGROUND: Lifestyle influences endocrine, metabolic and cardiovascular homeostasis. This study investigated the impact of diet and oral anti-diabetic medication on cardio-metabolic health in human-sized diabetic pigs. METHODS: After a growing pre-phase from ~30 to ~69 kg during which domestic pigs were fed either a low fat, low sucrose diet (group A) or a fast food-type diet elevated in lard (15%) and sucrose (40%) (group B), the pigs were subdivided in 5 groups (n = 7-8 pigs per group). Group 1, normal pigs from group A on a low fat, low sugar (L) pig diet and group 2, normal pigs from group B on a high lard (25%), sucrose-fructose (40%), cholesterol (1%) fast food-type (F) diet. Diabetes (D) was induced in group B pigs by streptozotocin and group 3 received the F diet (DF), group 4 received the F diet with Anti-diabetic medication metformin (2 g.day-1)-pioglitazone (40 mg.day-1) (DFA) and group 5 switched to a Plant-Fish oil (25%), Slowly digestible starch (40%) diet (DPFS). The F and PFS diets were identical for fat, carbohydrate and protein content but only differed in fat and carbohydrate composition. The 5 pig groups were followed up for 7 weeks until reaching ~120 kg. RESULTS: In normal pigs, the F diet predisposed to several abnormalities related to metabolic syndrome. Diabetes amplified the inflammatory and cardiometabolic abnormalities of the F diet, but both oral FA medication and the PFS diet partially corrected these abnormalities (mean±SEM) as follows: Fasting plasma TNF-ɑ (pg.ml-1) and NEFA (mmol.l-1) concentrations were high (p<0.02) in DF (193±55 and 0.79±0.16), intermediate in DFA (136±40 and 0.57±012) and low in DPFS pigs (107±31 and 0.48±0.19). Meal intolerance (response over fasting) for glucose and triglycerides (area under the curve, mmol.h-1) and for lactate (3-h postprandial, mmol.l-1) was high (p<0.03) in DF (489±131, 8.6±4.8 and 2.2±0.6), intermediate in DFA (276±145, 1.4±1.1 and 1.6±0.4) and low in DPFS (184±62, 0.7±1.8 and 0.1±0.1). Insulin-mediated glucose disposal (mg.kg-1.min-1) showed a numerical trend (p = NS): low in DF (6.9±2.2), intermediate in DFA (8.2±1.3) and high in DPFS pigs (10.4±2.7). Liver weight (g.kg-1 body weight) and liver triglyceride concentration (g.kg-1 liver) were high (p<0.001) in DF (23.8±2.0 and 69±14), intermediate in DFA (21.1±2.0 and 49±15) and low in DPFS pigs (16.4±0.7 and 13±2.0). Aorta fatty streaks were high (p<0.01) in DF (16.4±5.7%), intermediate in DFA (7.4±4.5%) and low in DPFS pigs (0.05±0.02%). CONCLUSION: This translational study using pigs with induced type 2 diabetes provides evidence that a change in nutritional life style from fast food to a plant-fish oil, slowly digestible starch diet can be more effective than sole anti-diabetic medication.

Ginseng Saponin Enriched in Rh1 and Rg2 Ameliorates Nonalcoholic Fatty Liver Disease by Inhibiting Inflammasome Activation.

Nonalcoholic fatty liver disease (NAFLD) is becoming one of the most common chronic liver diseases in the world. One of the features of NAFLD is hepatic fat accumulation, which further causes hepatic steatosis, fibrosis, and inflammation. Saponins, the major pharmacologically active ingredients isolated from Panax notoginseng, contain several ginsenosides, which have various pharmacological and therapeutic functions. However, the ginsenoside-specific molecular mechanism of saponins in NAFLD remains unknown. This study aimed to elucidate the effects of ginseng saponin extract and its ginsenosides on hepatic steatosis, fibrosis, and inflammation and their underlying action mechanism in NAFLD. Mice were fed a fast food diet (FFD) for 16 weeks to induce NAFLD and then treated with saponin extract (50 or 150 mg/kg) for the remaining nine weeks to determine the effects of saponin on NAFLD. Saponin extract administration significantly alleviated FFD-induced hepatic steatosis, fibrosis, and inflammation. Particularly, saponin extract, compared with conventional red ginseng, contained significantly increased amounts of ginsenosides (Rh1 (10.34-fold) and Rg2 (7.1-fold)). In vitro Rh1 and Rg2 treatments exerted an anti-steatotic effect in primary hepatocytes, an antifibrotic effect in hepatic stellate cells, and anti-inflammatory and pro-mitophagy effects in immortalized mouse Kupffer cells. Mechanistically, saponin extract alleviated lipopolysaccharide-induced NLRP3 inflammasome activation by promoting mitophagy. In conclusion, saponin extract inhibited inflammation-mediated pathological inflammasome activation in macrophages, thereby preventing NAFLD development. Thus, saponin extract administration may be an alternative method for NAFLD prevention.

Lower Postprandial Thermogenic Response to an Unprocessed Whole Food Meal Compared to an Iso-Energetic/Macronutrient Meal Replacement in Young Women: A Single-Blind Randomized Cross-Over Trial.

In contrast to ultra-processed foods that are associated with increased weight gain and obesity risk, nutritionally engineered dietary supplements, including meal replacement (MR) bars and shakes, are generally promoted as healthy. Limited data is available comparing the metabolic and hunger responses of whole food (WF) versus MR meals. The purpose of this study was to directly compare the thermic effect (TEM), respiratory exchange ratio (RER), hunger/taste ratings, and glucose response of two different breakfast meals containing MR and WF products in young healthy women. Eight volunteers completed two iso-caloric (529 kcals)/macronutrient (50% carbohydrates; 26% fat; 24% protein) test meals in a single-blind, randomized crossover design: (1) whole food meal; or (2) meal replacement. TEM was significantly higher following MR compared with WF (percent mean difference: 7.76 ± 3.78%; absolute mean difference: 0.053 ± 0.026 kcal/minute, p = 0.048), whereas WF substrate utilization demonstrated lower carbohydrate oxidation (RER) than MR (mean difference: -0.024 ± 0.008, p = 0.005). No differences existed for blood glucose response and feelings of hunger, desire to eat, and satiety among trials. Consumption of an MR meal increases postprandial thermogenesis and RER compared to a WF meal, which may impact weight control and obesity risk over the long-term.

Acute Epigallocatechin-3-Gallate Supplementation Alters Postprandial Lipids after a Fast-Food Meal in Healthy Young Women: A Randomized, Double-Blind, Placebo-Controlled Crossover Study.

A high-fat fast-food meal negatively impacts postprandial metabolism even in healthy young people. In experimental studies, epigallocatechin-3-gallate (EGCG), a bioactive compound present in green tea, has been described as a potent natural inhibitor of fatty acid synthase. Thus, we sought to evaluate the effects of acute EGCG supplementation on postprandial lipid profile, glucose, and insulin levels following a high-fat fast-food meal. Fourteen healthy young women 21 ± 1 years and body mass index 21.4 ± 0.41 kg/m2 were enrolled in a randomized, double-blind, placebo-controlled crossover study. Participants ingested capsules containing 800 mg EGCG or placebo immediately before a typical fast-food meal rich in saturated fatty acids. Blood samples were collected at baseline and then at 90 and 120 min after the meal. The EGCG treatment attenuated postprandial triglycerides (p = 0.029) and decreased high-density lipoprotein cholesterol (HDL-c) (p = 0.016) at 120 min. No treatment × time interaction was found for total cholesterol, low-density lipoprotein (LDL-c), and glucose or insulin levels. The incremental area under the curve (iAUC) for glucose was decreased by EGCG treatment (p < 0.05). No difference was observed in the iAUC for triglycerides and HDL-c. In healthy young women, acute EGCG supplementation attenuated postprandial triglycerides and glucose but negatively impacted HDL-c following a fast-food meal.

Ultra-Processed Food Consumption Is Associated with Abdominal Obesity: A Prospective Cohort Study in Older Adults.

INTRODUCTION AND OBJECTIVES: Ultra-processed food (UPF) consumption has been associated with increased incidence of cardiovascular disease and its risk factors. The aim of this study was to assess, for the first time in the literature, the prospective association between UPF consumption and the incidence of abdominal obesity (AO) in older adults. METHODS: The study sample consists of 652 participants in the Seniors Study on Nutrition and Cardiovascular Risk in Spain: Seniors-ENRICA-1 study, (mean age 67, 44% women). At baseline, standardized anthropometric measurements were collected (including abdominal circumference). After a median follow-up of six years, the abdominal circumference was measured again, and the incidence of abdominal obesity (AO) was calculated, defined as an abdominal perimeter ≥102 cm in men and ≥88 cm in women. At baseline, dietary information was collected using a computerized and validated dietary history. Information was obtained on the usual diet in the previous year. A total number of 880 foods were classified according to their degree of processing following the NOVA classification. Foods or drinks formulated mostly or entirely from substances derived from foods, with little or no presence of the unaltered original food were classified as UPF. For each participant, the percentage of energy from UPF was derived and sex-specific tertiles were calculated. Logistic regression models were built and adjusted for sociodemographic, lifestyle, morbidity, and drug treatment variables. RESULTS: Among those participants without AO at baseline, 177 developed AO during follow-up. The average consumption of UPF was 17% of total energy (7% in the first tertile; 29% in the third tertile). The odds ratio (95% confidence interval) for incident AO risk when compared to the lowest tertile was: 1.55 (0.99-2.44) for the second tertile of UPF consumption and 1.62 (1.04-2.54) for the third tertile; p for linear trend: 0.037. Results remained statistically significant after adjusting for potential dietary confounding factors such as fiber consumption, the intake of very long chain omega-3 fatty acids and adherence to the Mediterranean diet. CONCLUSIONS: A higher UPF consumption is positively associated with incident AO in older adults in Spain. These findings extend the current evidence of the detrimental effect of UPF consumption on cardiometabolic health.

The Pediatric Obesity Encounter: Literature and Resources to Help with 4 Common Issues.

PURPOSE OF REVIEW: We review here best practices and resources for pediatricians providing pediatric obesity management in 4 key areas: how to assess all of the relevant factors contributing to obesity, how to provide nutrition education, how to counsel families who eat out regularly, and what to do with patients who frequently make poor eating choices. RECENT FINDINGS: While there are many resources indicating recommendations for the physical exam and laboratory tests, there are very few resources that give pragmatic advice on the counseling aspects of the pediatric obesity encounter. We note new nutrition research showing the importance of avoiding ultra-processed foods. Most importantly, we list several resources regarding useful questionnaires, nutrition guidance, and even further training for pediatricians. There is a need for more curation of resources in different aspects of obesity care. We hope that this review and list of resources are helpful for pediatricians and will empower families and can be expanded in the future.

Processed and ultra-processed foods are associated with high prevalence of inadequate selenium intake and low prevalence of vitamin B1 and zinc inadequacy in adolescents from public schools in an urban area of northeastern Brazil.

Changes in eating behavior of adolescents are associated with high consumption of processed and ultra-processed foods. This study evaluated the association between these foods and the prevalence of inadequate micronutrient intake in adolescents. A cross-sectional study was conducted with 444 adolescents from public schools in the city of Natal, northeastern Brazil. The adolescents' habitual food consumption was evaluated using two 24-hour dietary recalls. Foods were categorized according to the degree of processing (processed and ultra-processed) and distributed into energy quartiles, using the NOVA classification system. Inadequacies in micronutrient intake were assessed using the estimated average requirement (EAR) as the cutoff point. Multivariate logistic regression models were used to estimate the relationship between energy percentage from processed and ultra-processed foods and prevalence of inadequate micronutrient intake. The mean (Standard Deviation (SD)) consumption of total energy from processed foods ranged from 5.8% (1.7%) in Q1 to 20.6% (2.9%) in Q4, while the mean consumption of total energy from ultra-processed foods ranged from 21.4% (4.9%) in Q1 to 61.5% (11.7%) in Q4. The rates of inadequate intake of vitamin D, vitamin E, folate, calcium, and selenium were above 80% for both sexes across all age groups. Energy consumption from processed foods was associated with higher prevalence of inadequate selenium intake (p < 0.01) and lower prevalence of inadequate vitamin B1 intake (p = 0.04). Energy consumption from ultra-processed foods was associated with lower prevalence of inadequate zinc and vitamin B1 intake (p < 0.01 and p = 0.03, respectively). An increase in the proportion of energy obtained from processed and ultra-processed foods may reflect higher prevalence of inadequate selenium intake and lower prevalence of vitamin B1 and zinc inadequacy.

Mechanistic insights into the aetiology of post-prandial decline in testosterone in reproductive-aged men.

Obesity is known to be associated with impaired testicular function potentially resulting in androgen deficiency and subfertility. While the underlying cause of obesity-related male hypogonadism is multi-factorial, here, we investigated the impact of dietary fat on testicular endocrine function. Ingestion of a high-fat "fast food" mixed meal, a common practice for obese men, produced a 25% fall in serum testosterone within an hour of eating, with levels remaining suppressed below fasting baseline for up to 4 hr. These changes in serum testosterone were not associated with any significant changes in serum gonadotrophins. The nadir in serum testosterone preceded the post-prandial increase in serum IL-6/IL-17 by several hours, suggesting that inflammation was unlikely the cause. Furthermore, intravenous administration of fat (Intralipid) had no impact on testosterone levels, while an identical oral dose of fat did suppress testosterone. These results suggest that fat does not directly impair Leydig cell function, but rather the passage of fat through the intestinal tract elicits a response that indirectly elicits a post-prandial fall in testosterone.

Growth of Clostridium perfringens in sous vide cooked ground beef with added grape seed extract.

The growth of Clostridium perfringens from spore inocula was studied in sous vide cooked ground beef with added 0 to 3% grape seed extract (GSE). C. perfringens did not grow at 4 °C with or without GSE present. Lag time (LT) was 95 h in control samples at 15 °C, whereas 1-3% GSE addition significantly (p < .05) extended LT to 244 h or longer. Generation time (GT) in 3% GSE added beef was similar to that of control (19 h, 3% GSE versus 18 h, control) at 15 °C. At 20 °C, GT was 1.5 h in samples without GSE; however, 1-3% GSE addition extended GT about 2-3 folds (p < .05). Lag time at 20 °C was 23 h in control samples, while LT was 40-59 h in samples containing GSE. Interestingly, GSE did not affect LT at 25 °C; however, significantly (p < .05) longer GT was observed in 3% GSE added samples than the other sample groups. Additionally, GSE from 1 to 3% in beef extended the period needed to reach 6 log cfu/g at 15 or 20 °C, while 3% GSE was required at 25 °C. The findings suggest that GSE exhibits concentration and temperature dependent inhibitory effect on growth of C. perfringens in sous vide cooked ground beef. Grape seed extract can be used to extend the shelf-life and ensure the microbiological safety of sous vide cooked meat products.

Limiting trans Fats in Foods: Use of Partially Hydrogenated Vegetable Oils in Prepacked Foods in Slovenia.

Consumption of industrially produced trans-fatty acids (TFAs) is a well-established health risk factor that correlates with the increased risk of developing cardiovascular disease. The recommended TFA intake is as low as possible, within the context of a nutritionally adequate diet. Different countries have introduced different measures to minimize the exposure of their population to TFAs. Previous data have shown that TFA content has significantly decreased in Western European countries, while this was not the case in many Central-Eastern European countries, including Slovenia. In the absence of regulatory requirements, a number of awareness campaigns were launched in Slovenia since 2015, with the common goal of lowering the use of partially hydrogenated oils (PHO), which are considered a major source of TFAs. To determine if this goal had been reached, we performed an assessment of the exposure of the population to prepacked foods containing PHOs in years 2015 and 2017. Altogether, data on the composition of 22,629 prepacked foods was collected from food labels, using a specifically developed smartphone application. Furthermore, the food categories with the most frequent use of PHOs were identified. The proportion of PHO-containing products was determined for each specific food category, and adjusted with the market share data. The results showed that in 2015, vegetable cream substitutes, soups, and biscuits were the categories with the highest penetration of declared PHO content. In 2017, the proportion of products with PHO decreased considerably. In vegetable cream substitutes the percentage of PHO containing items dropped from 30 down to 4%, in soups it decreased from 21 to 5%, in biscuits from 17 to 8%, and in crisps and snacks from 10 to 4%. However, PHO content remained notable among cakes, muffins, pastries, and biscuits. We can conclude that the voluntary guidelines and regular public communication of the risks related to the TFA consumption has had a considerable effect on the food supply, but did not result in sufficient removal of PHOs from foods.

Dietary recommendations for the prevention of depression.

BACKGROUND: Major depressive disorder is a common, chronic condition that imposes a substantial burden of disability globally. As current treatments are estimated to address only one-third of the disease burden of depressive disorders, there is a need for new approaches to prevent depression or to delay its progression. While in its early stages, converging evidence from laboratory, population research, and clinical trials now suggests that dietary patterns and specific dietary factors may influence the risk for depression. However, largely as a result of the recency of the nutritional psychiatry field, there are currently no dietary recommendations for depression. AIM: The aim of this paper is to provide a set of practical dietary recommendations for the prevention of depression, based on the best available current evidence, in order to inform public health and clinical recommendations. RESULTS: Five key dietary recommendations for the prevention of depression emerged from current published evidence. These comprise: (1) follow 'traditional' dietary patterns, such as the Mediterranean, Norwegian, or Japanese diet; (2) increase consumption of fruits, vegetables, legumes, wholegrain cereals, nuts, and seeds; (3) include a high consumption of foods rich in omega-3 polyunsaturated fatty acids; (4) replace unhealthy foods with wholesome nutritious foods; (5) limit your intake of processed-foods, 'fast' foods, commercial bakery goods, and sweets. CONCLUSION: Although there are a number of gaps in the scientific literature to date, existing evidence suggests that a combination of healthful dietary practices may reduce the risk of developing depression. It is imperative to remain mindful of any protective effects that are likely to come from the cumulative and synergic effect of nutrients that comprise the whole-diet, rather than from the effects of individual nutrients or single foods. As the body of evidence grows from controlled intervention studies on dietary patterns and depression, these recommendations should be modified accordingly.

Modification of aftertaste with a menthol mouthwash reduces food wanting, liking, and ad libitum intake of potato crisps.

This research investigated the effect of modifying the aftertaste of potato crisps on (1) temporal sensory perception and (2) appetite using three mouthwash conditions (no mouthwash, a water mouthwash, and a menthol mouthwash). For the sensory study, 17 screened female subjects were trained on the Temporal Dominance of Sensations (TDS) methodology. Subjects undertook TDS to monitor all sensory attributes during the mastication of a 2 g crisp until swallowing (at 20s), then conducted the mouthwash, and then continued the TDS task to monitor aftertaste until 90s. For the appetite study, 36 subjects (18 male, 18 female) completed 100 mm Visual Analogue Scales (VAS) for desire, liking, hunger, and thirst, followed by an ad libitum eating task. For the VAS scales testing, subjects chewed and swallowed a 2 g crisp, and then immediately conducted the mouthwash before completing the VAS scales. For the ad libitum task, subjects were given 12 min to consume as many crisps as they desired on a plate (up to 50 g). Every three minutes they were required to conduct a mouthwash. TDS results showed that in comparison with no mouthwash, the water mouthwash significantly reduced aftertaste attributes such as savoury, salty, and fatty mouthcoating, and the menthol mouthwash significantly increased aftertaste attributes of cooling, minty, and tingly. The water mouthwash did not influence desire and liking of crisps, or hunger and thirst. The water mouthwash did not influence ad libitum intake of the crisps over a 12 min period. The menthol mouthwash significantly reduced desire and liking of the crisps, as well as hunger and thirst. Furthermore, the menthol mouthwash significantly reduced ad libitum crisp intake by 29% over the 12 min period.

Instant noodles, processed food intake, and dietary pattern are associated with atopic dermatitis in an adult population (KNHANES 2009-2011).

BACKGROUND AND OBJECTIVES: The incidence of atopic dermatitis (AD) is continuously increasing in industrialized countries, possibly due to dietary and lifestyle changes. However, the association between processed food intake and AD has not been studied in a large adult population. METHODS AND STUDY DESIGN: We investigated the association between dietary habits and AD in 17,497 adults in the 2009-2011 Korean National Health and Nutrition Examination Survey (KNHANES). RESULTS: We identified 4 dietary patterns using principal components analysis of a 63-item food frequency questionnaire: the "traditional dietary pattern", rich in rice and kimchi; the "processed food pattern", with more meat, instant noodles, soda, and processed foods; the "healthy dietary pattern", high in grains, vegetables, fruits, and seaweeds; and the "drinking dietary pattern", mainly drinking coffee and alcohol. Adjusted odds ratios (ORs) for AD were calculated according to dietary patterns after adjusting for potential confounders with incorporation of sample weights for the complex sample design. The "meat and processed food" pattern was associated with a significant 1.57 fold higher OR for atopic dermatitis than the low consumption group. Further analysis revealed that the increased atopic dermatitis was most closely associated with instant noodles. In contrast, the groups with high intake of rice and kimchi exhibited lower ORs, 0.38 and 0.43 folds, compared to the low intake group. CONCLUSION: Consuming instant noodles, meat and processed foods was associated with increased prevalence of atopic dermatitis, whereas consuming rice and kimchi, and coffee was associated with decreased prevalence of atopic dermatitis.

Infant and young child feeding practices among children under 2 years of age and maternal exposure to infant and young child feeding messages and promotions in Dar es Salaam, Tanzania.

There are limited data describing infant and young child feeding practices (IYCF) in urban Tanzania. This study assessed the types of foods consumed by children under 2 years of age and maternal exposure to promotions of these foods in Dar es Salaam, Tanzania. A cross-sectional survey was conducted among 305 mothers of children less than 24 months of age who attended child health services in October and November, 2014. Among infants less than 6 months of age, rates of exclusive breastfeeding were low (40.8%) and a high proportion (38.2%) received semi-solid foods. Continued breastfeeding among 20-23-month-olds was only 33.3%. Consumption of breastmilk substitutes was not prevalent, and only 3.9% of infants less than 6 months of age and 4.8% of 6-23 month-olds were fed formula. Among 6-23-month-olds, only 38.4% consumed a minimum acceptable diet (using a modified definition). The homemade complementary foods consumed by the majority of 6-23-month-olds (85.2%) were cereal-dominated and infrequently contained micronutrient-rich ingredients. Only 3.1% of 6-23-month-olds consumed commercially produced infant cereal on the day preceding the interview. In contrast, commercially produced snack foods were consumed by 23.1% of 6-23-month-olds. Maternal exposure to commercial promotions of breastmilk substitutes and commercially produced complementary foods was low (10.5% and 1.0%, respectively), while exposure to promotions of commercially produced snack foods was high (45.9%). Strategies are needed to improve IYCF practices, particularly with regard to exclusive and continued breastfeeding, increased dietary diversity and consumption of micronutrient-rich foods, and avoidance of feeding commercially produced snack foods.

Scurvy in the present times: vitamin C allergy leading to strict fast food diet.

Scurvy results from a deficiency of vitamin C, a nutrient otherwise known as ascorbic acid. Today, scurvy is rare yet emerges in select patients. The patient reported herein developed scurvy secondary to deliberate avoidance of vitamin C-rich foods. Classic cutaneous manifestations of scurvy include follicular hyperkeratosis and perifollicular hemorrhage encompassing coiled "corkscrew" hairs and hairs bent into "swan-neck" deformities. Ecchymoses, purpura, and petechiae are also characteristically prominent. Classic oral abnormalities include erythematous, swollen gingivae that hemorrhage from subtle microtrauma.Subungual linear splinter hemorrhages may also manifest as a sign of the disease. To establish the diagnosis requirements include characteristic physical exam findings, evidence of inadequate dietary intake, and rapid reversal of symptoms upon supplementation. Although unnecessary for diagnosis, histological findings demonstrate perifollicular inflammation and hemorrhage, fibrosis, and hyperkeratosis, amongst dilated hair follicles and keratin plugging. Although citrus fruit allergies have been historically documented, ascorbic acid has not been previously reported as an allergen. Although lacking absolute certainty, this report suggests a presumed case of ascorbic acid allergy based on patient history and favorable response to ascorbic acid desensitization therapy.

Consumption of highly processed snacks, sugar-sweetened beverages and child feeding practices in a rural area of Nicaragua.

Appropriate feeding behaviours are important for child growth and development. In societies undergoing nutrition transition, new food items are introduced that may be unfavourable for child health. Set in rural Nicaragua, the aim of this study was to describe the infant and young child feeding (IYCF) practices as well as the consumption of highly processed snack foods (HP snacks) and sugar-sweetened beverages (SSBs). All households with at least one child 0- to 35-month-old (n = 1371) were visited to collect information on current IYCF practices in the youngest child as well as consumption of SSBs and HP snacks. Breastfeeding was dominant (98%) among 0- to 1-month-olds and continued to be prevalent (60%) in the second year, while only 34% of the 0- to 5-month-olds were exclusively breastfed. Complementary feeding practices were deemed acceptable for only 59% of the 6- to 11-month-old infants, with low dietary diversity reported for 50% and inadequate meal frequency reported for 30%. Consumption of HP snacks and SSBs was frequent and started early; among 6- to 8-month-olds, 42% and 32% had consumed HP snacks and SSBs, respectively. The difference between the observed IYCF behaviours and World Health Organization recommendations raises concern of increased risk of infections and insufficient intake of micronutrients that may impair linear growth. The concurrent high consumption of SSBs and HP snacks may increase the risk of displacing the recommended feeding behaviours. To promote immediate and long-term health, growth and development, there is a need to both promote recommended IYCF practices as well as discourage unfavourable feeding behaviours.

Most consumed processed foods by patients on hemodialysis: Alert for phosphate-containing additives and the phosphate-to-protein ratio.

BACKGROUND AND AIMS: Hyperphosphatemia is common in patients with chronic kidney disease (CKD) stages IV and V because of decreased phosphorus excretion. Phosphatemia is closely related to dietary intake. Thus, a better understanding of sources of dietary phosphate consumption, absorption and restriction, particularly inorganic phosphate found in food additives, is key to prevent consequences of this complication. Our aims were to investigate the most commonly consumed processed foods by patients with CKD on hemodialysis, to analyze phosphate and protein content of these foods using chemical analysis and to compare these processed foods with fresh foods. METHODS: We performed a cross-sectional descriptive analytical study using food frequency questionnaires to rank the most consumed industrialized foods and beverages. Total phosphate content was determined by metavanadate colorimetry, and nitrogen content was determined by the Kjeldahl method. Protein amounts were estimated from nitrogen content. The phosphate-to-protein ratio (mg/g) was then calculated. Processed meat protein and phosphate content were compared with the nutritional composition of fresh foods using the Brazilian Food Composition Table. Phosphate measurement results were compared with data from the Food Composition Table - Support for Nutritional Decisions. An α level of 5% was considered significant. RESULTS: Food frequency questionnaires were performed on 100 patients (mean age, 59 ± 14 years; 57% male). Phosphate additives were mentioned on 70% of the product labels analyzed. Proteins with phosphate-containing additives provided approximately twice as much phosphate per gram of protein compared with that of fresh foods (p < 0.0001). CONCLUSIONS: Protein and phosphate content of processed foods are higher than those of fresh foods, as well as phosphate-to-protein ratio. A better understanding of phosphate content in foods, particularly processed foods, may contribute to better control of phosphatemia in patients with CKD.

Dietary fat intake and risk of cardiovascular disease and all-cause mortality in a population at high risk of cardiovascular disease.

BACKGROUND: Dietary fat quality and fat replacement are more important for cardiovascular disease (CVD) prevention than is total dietary fat intake. OBJECTIVE: The aim was to evaluate the association between total fat intake and fat subtypes with the risk of CVD (myocardial infarction, stroke, or death from cardiovascular causes) and cardiovascular and all-cause death. We also examined the hypothetical effect of the isocaloric substitution of one macronutrient for another. DESIGN: We prospectively studied 7038 participants at high CVD risk from the PREvención con DIeta MEDiterránea (PREDIMED) study. The trial was conducted from 2003 to 2010, but the present analysis was based on an expanded follow-up until 2012. At baseline and yearly thereafter, total and specific fat subtypes were repeatedly measured by using validated food-frequency questionnaires. Time-dependent Cox proportional hazards models were used. RESULTS: After 6 y of follow-up, we documented 336 CVD cases and 414 total deaths. HRs (95% CIs) for CVD for those in the highest quintile of total fat, monounsaturated fatty acid (MUFA), and polyunsaturated fatty acid (PUFA) intake compared with those in the lowest quintile were 0.58 (0.39, 0.86), 0.50 (0.31, 0.81), and 0.68 (0.48, 0.96), respectively. In the comparison between extreme quintiles, higher saturated fatty acid (SFA) and trans-fat intakes were associated with 81% (HR: 1.81; 95% CI: 1.05, 3.13) and 67% (HR: 1.67; 95% CI: 1.09, 2.57) higher risk of CVD. Inverse associations with all-cause death were also observed for PUFA and MUFA intakes. Isocaloric replacements of SFAs with MUFAs and PUFAs or trans fat with MUFAs were associated with a lower risk of CVD. SFAs from pastries and processed foods were associated with a higher risk of CVD. CONCLUSIONS: Intakes of MUFAs and PUFAs were associated with a lower risk of CVD and death, whereas SFA and trans-fat intakes were associated with a higher risk of CVD. The replacement of SFAs with MUFAs and PUFAs or of trans fat with MUFAs was inversely associated with CVD. This trial was registered at www.controlled-trials.com as ISRCTN 35739639.