Hidden multiple comparisons increase forensic error rates.

When wires are cut, the tool produces striations on the cut surface; as in other forms of forensic analysis, these striation marks are used to connect the evidence to the source that created them. Here, we argue that the practice of comparing two wire cut surfaces introduces complexities not present in better-investigated forensic examination of toolmarks such as those observed on bullets, as wire comparisons inherently require multiple distinct comparisons, increasing the expected false discovery rate. We call attention to the multiple comparison problem in wire examination and relate it to other situations in forensics that involve multiple comparisons, such as database searches.

An Ex-Ante Analysis of the Impact of Biofortified Zinc Rice on Dietary Zinc Inadequacy: Evidence from Bangladesh, Indonesia, and the Philippines.

BACKGROUND: South, East and Southeast Asia are among regions of the world with the highest estimated prevalence of inadequate zinc intake. Because populations in those regions eat rice as their main staple, zinc biofortification of rice has the potential to improve zinc intake especially among the most vulnerable OBJECTIVE: We modeled the impact of consumption of zinc-biofortified rice on zinc intake and inadequacy among women of childbearing age and young children nationally in Indonesia, and the Philippines, and at a sub-national level in Bangladesh METHODS: We conducted an ex-ante analysis by applying increments of zinc content in rice, from a baseline level of 16 parts per million (ppm) to 100 ppm, and based on rice consumption data to substitute levels of conventional rice with zinc-biofortified rice varying between 10% and 70% RESULTS: Among all datasets evaluated from these three countries, the prevalence of dietary zinc inadequacy at baseline was 94 to 99% among women of childbearing age, 77 to 100% among children 4-5 years old and 27 to 78% among children 1-3 years old. At the current breeding target of 28 ppm, zinc-biofortified rice has the potential to decrease zinc inadequacy by up to 50 percent among women and children in rural Bangladesh and among children in the Philippines where consumption of rice is higher compared to Indonesia CONCLUSIONS: Our analysis shows that increasing zinc content in rice up to 45 ppm reduces the burden of zinc inadequacy substantially, after which we encourage programs to increase coverage to reach the highest number of beneficiaries.

Hierarchical Bayesian non-response models for error rates in forensic black-box studies.

Forensic science plays a critical role in the United States criminal legal system. Historically, however, most feature-based fields of forensic science, including firearms examination and latent print analysis, have not been shown to be scientifically valid. Recently, black-box studies have been proposed as a means of assessing whether these feature-based disciplines are valid, at least in terms of accuracy, reproducibility and repeatability. In these studies, forensic examiners frequently either do not respond to every test item or select an answer equivalent to 'don't know'. Current black-box studies do not account for these high levels of missingness in statistical analyses. Unfortunately, the authors of black-box studies typically do not share the data necessary to meaningfully adjust estimates for the high proportion of missing responses. Borrowing from work in the context of small area estimation, we propose the use of hierarchical Bayesian models that do not require auxiliary data to adjust for non-response. Using these models, we offer the first formal exploration of the impact that missingness is playing in error rate estimations reported in black-box studies. We show that error rates currently reported as low as 0.4% could actually be at least 8.4% in models accounting for non-response where inconclusive decisions are counted as correct, and over 28% when inconclusives are counted as missing responses. These proposed models are not the answer to the missingness problem in black-box studies. But with the release of auxiliary information, they can be the foundation for new methodologies to adjust for missingness in error rate estimations. This article is part of the theme issue 'Bayesian inference: challenges, perspectives, and prospects'.

[Processed and ultra-processed products and their relationship to quality of diet in childrenProdutos processados e ultraprocessados e sua relação com a qualidade da dieta em crianças]. / Productos procesados y ultraprocesados y su relación con la calidad de la dieta en niños.

Objective: Estimate the impact on quality in the early childhood diet (ages 2 to 4 years) in Uruguay, resulting from consumption of products containing excessive amounts of critical nutrients associated with noncommunicable diseases (NCDs) (free sugars, total fats, saturated fats, and sodium), according to the Pan American Health Organization (PAHO) Nutrient Profile Model. Methods: A 24-hour dietary recall survey was used with a representative sample of 401 participants from the 2018 Nutrition, Child Development, and Health Survey. The NOVA classification system was used to categorize foods according to the nature and purposes of the industrial processes they undergo. Foods were then analyzed using the PAHO Nutrient Profile Model, enabling identification of products with excessive amounts of these nutrients. Results: Fifty percent of children consumed three or more products with an excess of some of the nutrients linked to NCDs. About 9 out of 10 children consume products with an excess of at least one of the critical nutrients studied. Conclusion: Diets that do not contain ultra-processed and processed products with excess free sugars, total fats, saturated fats, or sodium were the best choice for children aged 2 to 4 years. Based on PAHO criteria, the consumption of products with excess critical nutrients (and of each additional gram of these products) significantly worsens diet quality, and impedes adherence to World Health Organization recommendations.

Objetivo: Estimar o efeito do consumo de produtos que contêm quantidades excessivas de nutrientes críticos associados a doenças não transmissíveis (DCNTs) ­ açúcares livres, gorduras totais, gorduras saturadas e sódio ­, de acordo com o modelo de perfil nutricional da Organização Pan-Americana da Saúde (OPAS), na qualidade da dieta da primeira infância uruguaia (crianças de 2 a 4 anos). Métodos: Um recordatório alimentar de 24 horas foi aplicado a uma amostra representativa de 401 participantes da Pesquisa de Nutrição, Desenvolvimento Infantil e Saúde de 2018. Foi utilizada a classificação proposta pelo sistema NOVA para categorizar os alimentos de acordo com sua natureza e os processos industriais a que são submetidos. A análise foi feita com base no modelo de perfil nutricional da OPAS, que possibilitou identificar os produtos com teor excessivo dos nutrientes supracitados. Resultados: Das crianças avaliadas, 50% consumiram três ou mais produtos com excesso de algum dos nutrientes vinculados às DCNT. Aproximadamente 9 em cada 10 crianças consomem produtos com excesso de pelo menos um dos nutrientes críticos estudados. Conclusão: As dietas que não contêm produtos ultraprocessados e processados com excesso de açúcares livres, gordura total, gordura saturada e sódio foram a melhor opção para crianças de 2 a 4 anos. A ingestão de produtos com excesso de nutrientes críticos segundo a OPAS (e cada grama adicional consumido desses produtos) piora significativamente a qualidade da dieta e impede o cumprimento das recomendações da Organização Mundial da Saúde.

Food sources, energy and nutrient intakes of adults: 2013 Philippines National Nutrition Survey.

BACKGROUND: Comprehensive assessment of dietary intakes of foods and nutrients in Filipino adults are lacking. This study evaluated energy and nutrient intakes and food sources of key nutrients consumed by Filipino adults. METHODS: The participants were from the 2013 National Nutrition Survey wherein food intake of young adults aged 19-49 years (n = 12,896) and older adults aged 50 years and above (n = 7853) were collected using 24-h recalls. Usual nutrient intakes were estimated using PC-SIDE program. The Philippines Dietary Reference Intakes were used to calculate proportions of inadequate intake using Estimated Average Requirement (EAR) and Acceptable Macronutrient Distribution Ranges (AMDR). Energy adequacy was evaluated using the Institute of Medicine (IOM) equation for Estimated Energy Requirements (EER). RESULTS: The nutrient intakes with the highest prevalence of inadequacy (> 50%) were: iron (97-99%), vitamin C (96-98%), calcium (95-98%), riboflavin (86-91%), folate (89-90%), thiamine (73-89%), energy (67-70%), total fat (55-67%), and vitamin A (54-56%). Refined rice, pork and breads contributed most to daily intakes of energy, protein, carbohydrates, thiamine, riboflavin, and iron. Low intake of vegetables, fruits and dairy was common in both age groups. CONCLUSIONS: This study demonstrated that intakes of many nutrients were markedly inadequate among adults in the Philippines, due to the rice-dominant dietary pattern with few nutrient-dense foods. These results can be used to support the development of specific interventions to improve the shortfalls in nutrient intakes.

Energy Intake Derived from an Energy Balance Equation, Validated Activity Monitors, and Dual X-Ray Absorptiometry Can Provide Acceptable Caloric Intake Data among Young Adults.

Background: Assessments of energy intake (EI) are frequently affected by measurement error. Recently, a simple equation was developed and validated to estimate EI on the basis of the energy balance equation [EI = changed body energy stores + energy expenditure (EE)]. Objective: The purpose of this study was to compare multiple estimates of EI, including 2 calculated from the energy balance equation by using doubly labeled water (DLW) or activity monitors, in free-living adults. Methods: The body composition of participants (n = 195; mean age: 27.9 y; 46% women) was measured at the beginning and end of a 2-wk assessment period with the use of dual-energy X-ray absorptiometry. Resting metabolic rate (RMR) was calculated through indirect calorimetry. EE was assessed with the use of the DLW technique and an arm-based activity monitor [Sensewear Mini Armband (SWA); BodyMedia, Inc.]. Self-reported EI was calculated by using dietitian-administered 24-h dietary recalls. Two estimates of EI were calculated with the use of a validated equation: quantity of energy stores estimated from the changes in fat mass and fat-free mass occurring over the assessment period plus EE from either DLW or the SWA. To compare estimates of EI, reporting bias (estimated EI/EE from DLW × 100) and Goldberg ratios (estimated EI/RMR) were calculated. Results: Mean ± SD EEs from DLW and SWA were 2731 ± 494 and 2729 ± 559 kcal/d, respectively. Self-reported EI was 2113 ± 638 kcal/d, EI derived from DLW was 2723 ± 469 kcal/d, and EI derived from the SWA was 2720 ± 730 kcal/d. Reporting biases for self-reported EI, DLW-derived EI, and SWA-derived EI are as follows: -21.5% ± 22.2%, -0.7% ± 18.5%, and 0.2% ± 20.8%, respectively. Goldberg cutoffs for self-reported EI, DLW EI, and SWA EI are as follows: 1.39 ± 0.39, 1.77 ± 0.38, and 1.77 ± 0.38 kcal/d, respectively. Conclusions: These results indicate that estimates of EI based on the energy balance equation can provide reasonable estimates of group mean EI in young adults. The findings suggest that, when EE derived from DLW is not feasible, an activity monitor that provides a valid estimate of EE can be substituted for EE from DLW.

Higher dietary magnesium intake is associated with lower body mass index, waist circumference and serum glucose in Mexican adults.

BACKGROUND: Obesity and diabetes mellitus (DM) are public health concerns in Mexico of top-level priority due to their high prevalence and their growth rate in recent decades. The accumulation of adipose tissue leads to an unbalanced release of pro-oxidant factors, which causes cellular damage and favors the development of comorbidities. Recent evidence suggests that oxidative stress also promotes the accumulation of adipose tissue and the development of insulin resistance. The objective of this study is to evaluate the association between usual intake of antioxidant nutrients, specifically vitamins A, C, E and magnesium with body mass index (BMI), waist circumference (WC) and serum glucose concentrations in a representative sample of Mexican adults. METHODOLOGY: We analyzed data on diet, BMI, WC and serum glucose from the Mexican National Health and Nutrition Survey 2012. Analysis included 20- to 65-year-old adults without a known diagnosis of DM (n = 1573). Dietary information was obtained using the five-step multiple-pass method developed by the United States Department of Agriculture and adapted to the Mexican context. Nutrient usual intake distributions were estimated using the Iowa State University method, through the "Software for Intake Distribution Estimation" (PC-Side) v.1.02. Associations were analyzed using multivariate regression models. RESULTS: Higher dietary magnesium intake was associated with lower markers of adiposity, so that an increase in 10 mg per 1000 kcal/day of magnesium was associated with an average decrease in BMI of 0.72% (95% CI: -1.36, - 0.08) and 0.49 cm (95% CI: -0.92, - 0.07) of WC. Additionally, in women with normal glucose concentrations, an increase in magnesium intake was associated with an average decrease in serum glucose by 0.59% (95% CI: -1.08, - 0.09). CONCLUSION: The results suggest that magnesium intake is associated with lower BMI, WC and serum glucose in Mexican population. However, more studies are required to elucidate the nature of this association.

Three 24-Hour Recalls in Comparison with One Improve the Estimates of Energy and Nutrient Intakes in an Urban Mexican Population.

BACKGROUND: Population surveys often collect dietary intake data by using one or two 24-h recalls (24HR), mainly to minimize cost and respondent burden. However, in order to increase accuracy in estimating usual intake distributions, a larger number of 24HRs may be advisable. OBJECTIVE: The purpose of this study was to identify whether estimates of the intake and prevalence of nutrient inadequacy based on 3 d are better than those that are based on 1 d of information. METHODS: We conducted a national survey in 31 cities in Mexico using a sample that included 1073 individuals of both sexes, from birth through 79 y of age. Dietary information was collected by using 3 multiple-pass 24HRs (on nonconsecutive days). We estimated intake, adequacy, and prevalence of energy and nutrient inadequacy using information from 1 d and also from 3 d, adjusted for day-to-day variability, using PC-SIDE software. The prevalence of inadequacy was estimated by using the reference values proposed by the US Institute of Medicine. RESULTS: We found high prevalences of inadequacy for fiber (73-99%), iron (31-94%), calcium (2-85%), vitamin A (0.1-61%), and folates (2-80%) among various age and sex groups. Energy intake results showed that the variance in the estimated usual 3-d intake distribution was smaller than the variance of distribution estimated from a single daily intake. We observed bigger differences in prevalence of inadequacy between 1 and 3 d for several nutrients. For example, in preschool children, the prevalence of inadequacy of folate and calcium was 30% and 43%, respectively, with 1-d recalls and 3.7% and 4.6%, respectively, with 3-d recalls. CONCLUSIONS: We conclude that the adjusting-by-variance method using 3 d of 24HR allows for a more accurate estimation of usual intake, dietary adequacy, and prevalence of inadequacy, thereby reducing the measurement error that could compromise the results and conclusions of surveys.

Usual Intake of Added Sugars and Saturated Fats Is High while Dietary Fiber Is Low in the Mexican Population.

BACKGROUND: The Mexican National Health and Nutrition Survey (ENSANUT) was carried out in 2012. Information from the survey is used to design and evaluate food and nutrition policies in Mexico. OBJECTIVE: The objective of this study was to estimate the usual intake of energy and macronutrients in the Mexican population by using the ENSANUT 2012. METHODS: Twenty-four-hour recall interviews were administered to a nationally representative subsample of 10,096 individuals aged ≥1 y from the ENSANUT 2012. Usual intake distributions and the prevalence of inadequate intakes were estimated by using the Iowa State University method. Student's t tests and tests on the equality of proportions were used to compare usual intakes and prevalence of inadequacy across socioeconomic status, area (rural or urban), and region of residence (North, Center, or South). RESULTS: Energy and macronutrient intakes and indicators of dietary adequacy are presented for children (ages 1-4 y and 5-11 y), adolescents (12-19 y), and adults (≥20 y). At the national level, the estimated mean fiber intake was below the Adequate Intake for all population subgroups, suggesting inadequacies. The estimated proportion with a usual added sugars intake of >10% of total energy intake was >64% in all age groups. The proportion with a usual saturated fat intake of >10% of total energy intake was estimated to be >78% in children, >66% in adolescents, and >50% in adults. Overall, fiber intake was lower and intakes of saturated fat and added sugars were higher in urban compared with rural areas, in the North compared with South regions, and among those with high compared with low socioeconomic status (P < 0.05). CONCLUSIONS: Fiber intake is lower and added sugar and saturated fat intakes are higher than recommended for >50% of the Mexican population aged ≥1 y. These results highlight the importance of improving the diets of the overall population to reduce the risk of noncommunicable chronic diseases.

High Prevalence of Inadequate Calcium and Iron Intakes by Mexican Population Groups as Assessed by 24-Hour Recalls.

BACKGROUND: A National Health and Nutrition Survey (ENSANUT) conducted in Mexico in 1999 identified a high prevalence of inadequate mineral intakes in the population by using 24-h recall questionnaires. However, the 1999 survey did not adjust for within-person variance. The 2012 ENSANUT implemented a more up-to-date 24-h recall methodology to estimate usual intake distributions and prevalence of inadequate intakes. OBJECTIVE: We examined the distribution of usual intakes and prevalences of inadequate intakes of calcium, iron, magnesium, and zinc in the Mexican population in groups defined according to sex, rural or urban area, geographic region of residence, and socioeconomic status (SES). METHODS: We used dietary intake data obtained through the 24-h recall automated multiple-pass method for 10,886 subjects as part of ENSANUT 2012. A second measurement on a nonconsecutive day was obtained for 9% of the sample. Distributions of usual intakes of the 4 minerals were obtained by using the Iowa State University method, and the prevalence of inadequacy was estimated by using the Institute of Medicine's Estimated Average Requirement cutoff. RESULTS: Calcium inadequacy was 25.6% in children aged 1-4 y and 54.5-88.1% in subjects >5 y old. More than 45% of subjects >5 y old had an inadequate intake of iron. Less than 5% of children aged <12 y and 25-35% of subjects aged >12 y had inadequate intakes of magnesium, whereas zinc inadequacy ranged from <10% in children aged <12 y to 21.6% in men aged ≥20 y. Few differences were found between rural and urban areas, regions, and tertiles of SES. CONCLUSIONS: Intakes of calcium, iron, magnesium, and zinc are inadequate in the Mexican population, especially among adolescents and adults. These results suggest a public health concern that must be addressed.

Usual Vitamin Intakes by Mexican Populations.

BACKGROUND: In the past several years, the consumption of high-energy, nutrient-poor foods has increased globally. Dietary intake data collected by the National Health and Nutrition Survey (ENSANUT) 2012 provide information to assess the quality of the Mexican diet and to guide food and nutrition policy. OBJECTIVE: The aim was to describe the usual intake and the prevalence of inadequate intakes of vitamins for the overall Mexican population and by subgroups defined by sex, age, region, urban or rural areas, and socioeconomic status (SES). METHODS: ENSANUT 2012 is a cross-sectional probabilistic survey representative of the Mexican population. Dietary information was collected by using the 24-h recall automated multiple-pass method (n = 10,096) with a repeated measurement on a subsample (n = 889) to permit adjustment for intraindividual variability with the use of the Iowa State University method. Mean usual intakes and the prevalence of inadequate intakes of thiamin, riboflavin, niacin, folate, and vitamins A, D, E, C, B-6, and B-12 were calculated for children aged 1-4 y (CH1-4y), children aged 5-11 y (CH5-11y), adolescents aged 12-19 y, and adults aged ≥20 y. RESULTS: In all of the age groups, prevalences of inadequate intakes of vitamins D and E were the highest (77-99% of adults and adolescents and 53-95% of CH5-11y and CH1-4y) and those of folate and vitamin A were intermediate (47-70% of adults and adolescents, 15-23% of CH5-11y and 8-13% of CH1-4y), whereas those of thiamin, riboflavin, niacin, and vitamins B-6, B-12, and C were the lowest (0-37% of adults, 1-27% of adolescents, and 0-2.4% of CH5-11y and CH1-4y). With few exceptions, the highest prevalences of inadequate intakes for vitamins were observed in the poorest populations (rural South region and the lowest tertile of SES). CONCLUSIONS: The intake of vitamins among Mexicans is inadequate overall. Information collected by ENSANUT can help target food assistance programs and develop strategies to prevent vitamin deficiencies.

Estimation of the Prevalence of Inadequate and Excessive Iodine Intakes in School-Age Children from the Adjusted Distribution of Urinary Iodine Concentrations from Population Surveys.

BACKGROUND: The urinary iodine concentration (UIC), a biomarker of iodine intake, is used to assess population iodine status by deriving the median UIC, but this does not quantify the percentage of individuals with habitually deficient or excess iodine intakes. Individuals with a UIC <100 µg/L or ≥300 µg/L are often incorrectly classified as having deficient or excess intakes, but this likely overestimates the true prevalence. OBJECTIVE: Our aim was to estimate the prevalence of inadequate and excess iodine intake in children (aged 4-14 y) with the distribution of spot UIC from iodine surveys. METHODS: With the use of data from national iodine studies (Kuwait, Oman, Thailand, and Qatar) and a regional study (China) in children (n = 6117) in which a repeat UIC was obtained in a subsample (n = 1060), we calculated daily iodine intake from spot UICs from the relation between body weight and 24-h urine volume and within-person variation by using the repeat UIC. We also estimated pooled external within-person proportion of total variances by region. We used within-person variance proportions to obtain the prevalence of inadequate or excess usual iodine intake by using the Estimated Average Requirement (EAR)/Tolerable Upper Intake Level (UL) cutoff method. RESULTS: Median UICs in Kuwait, Oman, China, Thailand, and Qatar were 132, 192, 199, 262, and 333 µg/L, respectively. Internal within-person variance proportions ranged from 25.0% to 80.0%, and pooled regional external estimates ranged from 40.4% to 77.5%. The prevalence of inadequate and excess intakes as defined by the adjusted EAR/UL cutoff method was ∼45-99% lower than those defined by a spot UIC <100 µg/L or ≥300 µg/L (P < 0.01). CONCLUSIONS: Applying the EAR/UL cutoff method to iodine intakes from adjusted UIC distributions is a promising approach to estimate the number of individuals with deficient or excess iodine intakes.

Total Iron Bioavailability from the US Diet Is Lower Than the Current Estimate.

BACKGROUND: Total (heme and nonheme) iron bioavailability from the US diet has been estimated to be 18% based on a single human absorption study. New data, however, suggest that it may be time to revisit this estimate. OBJECTIVE: We estimated total iron bioavailability from the US diet with the use of our recently reported algorithm that estimates nonheme iron absorption and a conservative value for heme iron absorption. METHODS: We used dietary intake and biomarker information from the NHANES 2001-2002, MyPyramid Equivalents Database, and Food and Nutrient Database for Dietary Studies. The survey package in R software was used to estimate means and CIs, taking into account the strata, primary sampling units, and appropriate survey weight. We implemented 2 different approaches to estimate total iron absorption. In the first approach, we included all survey participants but adjusted the geometric mean of nonheme iron absorption to 15 µg ferritin/L serum to mimic values of individuals with no iron stores; in the second approach, absorption was estimated for only nonanemic subjects with no iron stores. A total sample size of 6631 was used based on availability of dietary and iron status biomarker data and C-reactive protein concentration ≤ 6 mg/L. RESULTS: The geometric mean (95% CI) of unadjusted nonheme iron absorption for all subjects was 3.7% (3.6%, 3.8%), higher in female subjects [5.6% (5.4%, 5.7%)] than male subjects [2.6% (2.5%, 2.7%)] (P < 0.0001). Nonheme iron absorption was lower in non-Hispanic whites [3.5% (3.4%, 3.6%)] than Mexican Americans [4.5% (4.2%, 4.8%)] and non-Hispanic blacks [4.4% (4.1%, 4.7%)]. Estimated total iron absorption was 15.5% or 15.1%, depending on which approach was used to carry out the calculations. CONCLUSION: This study provides useful data for evaluating the current value of iron bioavailability from the US diet.

Use of Folate-Based and Other Fortification Scenarios Illustrates Different Shifts for Tails of the Distribution of Serum 25-Hydroxyvitamin D Concentrations.

BACKGROUND: The purpose of food fortification is to affect those at the lower end of the distribution curve for nutrient status while avoiding unintended consequences for those at the high end of the distribution. Vitamin D presents challenges in this regard. OBJECTIVES: We used scenarios to model changes in concentrations of serum 25-hydroxyvitamin D [25(OH)D] based on increases made because of assumptions about fortification. We then examined the outcomes for balance between improving serum 25(OH)D status for those at risk of inadequacy while avoiding high concentrations for those not at risk. METHODS: Data from NHANES 2001-2006 served as baseline serum 25(OH)D concentrations and were used to model shifts in serum 25(OH)D distribution after application of 3 fortification scenarios, including conceptual scenarios and an experiential predictive scenario we developed with the use of statistical modeling of changes in NHANES serum folate concentrations between prefortification and postfortification time periods. RESULTS: All scenarios suggested the possibility of increasing serum 25(OH)D above 125 nmol/L among the proportion of the population at the high end of baseline serum 25(OH)D distribution. The scenario based on serum folate change struck a middle ground between the 2 conceptual scenarios. It predicted a prevalence of 11% <40 nmol/L serum 25(OH)D compared with 17% currently (study baseline), and 8% prevalence of serum 25(OH)D >125 nmol/L compared with <1% currently (study baseline). It also confirmed that fortification affects those at the low end of the status distribution curve differently from those at the high end. CONCLUSIONS: Nutrient inadequacy of the type demonstrated by vitamin D--in which the risk is not universal--requires a thorough exploration of the unintended consequences of the overall shift in the distribution of serum 25(OH)D if efforts are made to use fortification to increase the status of persons at risk of deficiency. Fortification is at best a blunt instrument that must be implemented with caution. Moreover, fortification must be preceded by more research to elucidate the dose-response relation between intake and changes in serum 25(OH)D.

Usual Dietary Energy Density Distribution Is Positively Associated with Excess Body Weight in Mexican Children.

BACKGROUND: Studies suggest a positive association between dietary energy density (DED) and body weight in adults, but evidence in children is inconclusive. OBJECTIVE: The objective of this study was to compare usual DED distributions of nonoverweight vs. overweight or obese (OW/O) Mexican children. METHODS: The study used 24-h recall (24HR) data from 2367 children aged 5-11 y from the 2012 Mexican National Health and Nutrition Survey (ENSANUT 2012). Repeated 24HR measures were obtained in a random sample (∼10%) to estimate usual intake distributions by using the Iowa State University (PC-Side) method. Implausible dietary reports were identified. Multivariate linear regression models were used to evaluate the relation between DED and body mass index status and to compare results with and without PC-Side adjustment and restriction to plausible reporters. RESULTS: A total of 35.1% of the children in the sample were OW/O. The usual DED mean was ∼175 kcal/100 g in both the complete sample and the plausible reporters subsample. Regression models adjusted by PC-Side and for potential confounders showed higher DED in OW/O relative to nonoverweight children for both plausible reporters (9.7 kcal/100 g; n = 1452, P < 0.0001) and the complete sample (7.9 kcal/100 g; n = 2367, P < 0.0001). The DED difference in plausible reporters translates into 88 additional kilocalories in daily energy intake of OW/O children. In the absence of PC-side adjustment, the difference was significant for plausible reporters (P < 0.05) but not for the complete sample (P > 0.10). CONCLUSIONS: A positive association between usual DED and OW/O was found in Mexican children. The association was stronger when only plausible reporters were considered. This suggests that there is a need for strategies to reduce energy density in the diet of Mexican children.

Estimating the population distribution of usual 24-hour sodium excretion from timed urine void specimens using a statistical approach accounting for correlated measurement errors.

BACKGROUND: High US sodium intake and national reduction efforts necessitate developing a feasible and valid monitoring method across the distribution of low-to-high sodium intake. OBJECTIVE: We examined a statistical approach using timed urine voids to estimate the population distribution of usual 24-h sodium excretion. METHODS: A sample of 407 adults, aged 18-39 y (54% female, 48% black), collected each void in a separate container for 24 h; 133 repeated the procedure 4-11 d later. Four timed voids (morning, afternoon, evening, overnight) were selected from each 24-h collection. We developed gender-specific equations to calibrate total sodium excreted in each of the one-void (e.g., morning) and combined two-void (e.g., morning + afternoon) urines to 24-h sodium excretion. The calibrated sodium excretions were used to estimate the population distribution of usual 24-h sodium excretion. Participants were then randomly assigned to modeling (n = 160) or validation (n = 247) groups to examine the bias in estimated population percentiles. RESULTS: Median bias in predicting selected percentiles (5th, 25th, 50th, 75th, 95th) of usual 24-h sodium excretion with one-void urines ranged from -367 to 284 mg (-7.7 to 12.2% of the observed usual excretions) for men and -604 to 486 mg (-14.6 to 23.7%) for women, and with two-void urines from -338 to 263 mg (-6.9 to 10.4%) and -166 to 153 mg (-4.1 to 8.1%), respectively. Four of the 6 two-void urine combinations produced no significant bias in predicting selected percentiles. CONCLUSIONS: Our approach to estimate the population usual 24-h sodium excretion, which uses calibrated timed-void sodium to account for day-to-day variation and covariance between measurement errors, produced percentile estimates with relatively low biases across low-to-high sodium excretions. This may provide a low-burden, low-cost alternative to 24-h collections in monitoring population sodium intake among healthy young adults and merits further investigation in other population subgroups.

Predicted efficacy of the Palestinian wheat flour fortification programme: complementary analysis of biochemical and dietary data.

OBJECTIVE: To utilize complementary biochemical and dietary data collected before the initiation of national flour fortification to (i) identify micronutrient insufficiencies or deficiencies and dietary inadequacies in Palestinian women and children in vulnerable communities and (ii) assess the suitability of the current wheat flour fortification formula. DESIGN: Quantitative dietary intake questionnaires were administered and fasting venous blood samples collected in randomly selected households in Gaza City and Hebron. The impact of fortification was simulated by estimating the additional micronutrient content of fortified wheat flour. SETTING: Households in Gaza City and Hebron that were not receiving food aid from social programmes. SUBJECTS: Non-pregnant women (18-49 years) and children aged 36-83 months. RESULTS: The micronutrients with highest prevalence of insufficiency were vitamin D in women (84-97 % with serum 25-hydroxyvitamin D <50 nmol/l) and vitamin B12 in women and children (43-82 % with serum B12 <221 pmol/l). Deficiencies of vitamin A, Fe and Zn were also of public health concern. Current levels of wheat flour fortificants were predicted to improve, but not eliminate, micronutrient intake inadequacies. Modification of fortificant concentrations of vitamin D, thiamin, vitamin B12, Zn and folic acid may be indicated. CONCLUSIONS: Micronutrient insufficiencies or deficiencies and intake inadequacies were prevalent based on either biochemical or dietary intake criteria. Adjustments to the current fortification formula for wheat flour are necessary to better meet the nutrient needs of Palestinian women and children.

Selecting desirable micronutrient fortificants for plant-based complementary foods for infants and young children in low-income countries.

The World Health Organization (WHO) recommends that both breast-fed and non-breast-fed children are fed micronutrient fortified complementary foods designed to meet their high nutrient requirements from aged 6 to 23 months of age. This paper summarises the steps recommended by WHO/FAO to identify the country-specific micronutrient shortfalls in complementary diets and establish desirable levels of bioavailable fortificants for centrally processed plant-based complementary foods for infant and young child feeding. The goal of the WHO/FAO guidelines is to achieve a desirably low prevalence of inadequate micronutrient intakes in the target group whilst simultaneously ensuring minimal risk of excessive intakes.

Establishing desirable fortificant levels for calcium, iron and zinc in foods for infant and young child feeding: examples from three Asian countries.

We used the World Health Organization's recommended procedures to establish desirable fortificant levels for three problem micronutrients in children's diets, based on dietary data collected earlier from Filipino (n = 1374; 6-36 months), Mongolian (n = 179; 12-36 months) and Cambodian (n = 177; 12-36 months) children. Prevalence of inadequate and excessive intakes of calcium and zinc (via cut-point method) and iron (via full-probability approach) was assessed after adjusting usual intake distributions with pc-side using internal or external within-person variances from Filipino (calcium and iron) and US National Health And Nutrition Examination Survey III (zinc) national surveys. Fortificant levels were determined by repositioning usual intake distributions so that the 2.5th percentile of the targeted populations equalled the estimated average requirement (calcium, zinc) or so that full-probability prevalence was no larger than 2.5% (iron). Prevalence of inadequate intakes was ≥70% for calcium and iron, except Filipino infants (30% for Ca) and Cambodian toddlers (41% for Fe); but <1% for zinc for toddlers in Mongolia and 20% in Cambodia. Prevalence of excessive intakes was <1% for zinc, calcium and iron, except for Mongolian toddlers (11% for Zn). Desirable fortificant levels, although apparently negligible for zinc, were 530-783 mg for calcium and 10.8-22.8 mg for iron (per 100 g). Fortificant levels can be estimated from 24-h recalls, preferably by applying internal within-person variances. Fortification with calcium and iron was necessary, but seemingly not for zinc, despite a high prevalence of low serum zinc, suggesting the need for better defined cut-offs for population risk of zinc deficiency based on dietary zinc intake and/or serum zinc.