Bronchiolitis: evidence-based management in high-risk infants in the intensive care setting.

AIM: Systematically review the management of infants with severe bronchiolitis in a paediatric intensive care unit (PICU) setting with a focus on high-risk infants to identify gaps in evidence-based knowledge. METHODS: This systematic review utilised Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) to examine the literature on the PICU management of bronchiolitis in infants <24 months old. Three databases, Embase, PubMed and Medline, were searched and higher levels of evidence I, II and III were included. RESULTS: There were 455 papers reviewed and 26 met the inclusion criteria. Furthermore, 19 of these studied respiratory interventions such as positive airway pressure and oxygen delivery. The remaining 7 examined: erythropoietin, caffeine, dexamethasone, protein supplementation, ribavirin, respiratory syncytial virus immune globulin, or diuretic therapy. Of the 26 studies, 20 excluded infants with high-risk conditions. Therapies showing favourable outcomes included Heliox, prophylactic dexamethasone pre-extubation, protein supplementation, and diuretic use. CONCLUSIONS: Clinical trials for bronchiolitis management frequently exclude high-risk children. Innovative study design in the future may improve access to clinical trials for the management of bronchiolitis in high-risk infants in a PICU setting. IMPACT: Clinical trials for bronchiolitis management frequently exclude high-risk children. We review the evidence base for the management of an under-investigated patient demographic in the setting of acute bronchiolitis. Randomised controlled trials are needed to determine the efficacy of management strategies for bronchiolitis in high-risk infants in a paediatric intensive care setting.

Current perspectives and challenges in the estimation of fruit juice consumption across the lifecycle in Europe.

Fruit juice (FJ) is typically low in energy, contains natural sugars, important amounts of micronutrients and is not permitted to have added sugars/sweeteners. However, its role in a healthy diet is under scrutiny partly due to the wider adoption of the definition for free sugars in nutrition policy. This review aimed to identify data on FJ consumption from national food consumption surveys across Europe, to examine current intakes, percent consumers and its contribution to intakes of energy, total sugars, free sugars, vitamin C, folate and potassium. Data were extracted on the population mean intake of FJ and its contribution to nutrient intakes across the lifecycle and crude estimates of population mean intakes across countries were reported for the total population and for consumers only. This review highlighted significant gaps/challenges regarding the availability of country-specific national food consumption surveys across Europe and specifically data on FJ consumption (including complexities surrounding categorisations). Nonetheless, using a comparable/homogenous definition, the mean intake of FJ among consumers was approximately 1 × 150 ml glass/day for adults/older adults, with lower intakes among infants (86 g/d), children (108 g/d) and teenagers (112 g/d). FJ made important contributions to intakes of vitamin C while making little contribution to energy intakes but also contributed 2-14 % of free sugars intake (which may be considered modest compared to other sources). The complexity of collating and interpreting data on FJ intake as elucidated in this review raises questions surrounding the categorisation of FJ in research and presents significant challenges for policymakers with respect to dietary guidance for FJ.

A food-exchange model for achieving the recommended dietary intakes for saturated fat in Irish children: analysis from the cross-sectional National Children's Food Survey II.

OBJECTIVE: To identify the main foods determining saturated fatty acid (SFA) intakes and model the impact of food exchanges to improve compliance with dietary fat recommendations in Irish children. DESIGN: Estimated food and nutrient intakes were obtained from a cross-sectional study, the National Children's Food Survey II. Participants were categorised into low, medium, and high SFA consumers, and the contribution of food categories to SFA intakes were compared. A food-exchange model was developed, whereby a selected range of high SFA foods were exchanged with lower SFA or unsaturated fat alternatives. SETTING: Participants were randomly selected from primary schools throughout the Republic of Ireland. PARTICIPANTS: A representative sample of 600 Irish children (5-12 years). RESULTS: The main determinants of low and high SFA consumers were milk, cheese, and butter. These foods, including snack foods, and meat and meat products, were considered exchangeable foods within the model. Compared with baseline data, modelled intakes for total fat, SFA, monounsaturated fatty acids (MUFA) and trans-fat presented decreases of 3.2, 2.7, 1.6 and <0.1% of total energy (% TE), respectively. Polyunsaturated fatty acid (PUFA), omega 6, omega 3 and alpha-linolenic acid showed increases of 1.0, 0.8, 0.2 and 0.1% TE, respectively. Compliance with total fat, MUFA and trans-fat recommendations remained adequate (100%). Adherence to SFA and PUFA recommendations improved from 18 to 63%, and 80 to 100%, respectively. CONCLUSION: The food-exchange model decreased SFA intakes and increased PUFA intakes, suggesting modest dietary changes to children's diets can effectively improve their overall dietary fat profile.

Food and nutrient intakes and compliance with recommendations in school-aged children in Ireland: findings from the National Children's Food Survey II (2017-2018) and changes since 2003-2004.

The childhood years represent a period of increased nutrient requirements during which a balanced diet is important to ensure optimal growth and development. The aim of this study was to examine food and nutrient intakes and compliance with recommendations in school-aged children in Ireland and to examine changes over time. Analyses were based on two National Children's Food Surveys; NCFS (2003-2004) (n 594) and NCFS II (2017-2018) (n 600) which estimated food and nutrient intakes in nationally representative samples of children (5-12 years) using weighed food records (NCFS: 7-d; NCFS II: 4-d). This study found that nutrient intakes among school-aged children in Ireland are generally in compliance with recommendations; however, this population group have higher intakes of saturated fat, free sugars and salt, and lower intakes of dietary fibre than recommended. Furthermore, significant proportions have inadequate intakes of vitamin D, Ca, Fe and folate. Some of the key dietary changes that have occurred since the NCFS (2003-2004) include decreased intakes of sugar-sweetened beverages, fruit juice, milk and potatoes, and increased intakes of wholemeal/brown bread, high-fibre ready-to-eat breakfast cereals, porridge, pasta and whole fruit. Future strategies to address the nutrient gaps identified among this population group could include the continued promotion of healthy food choices (including education around 'healthy' lifestyles and food marketing restrictions), improvements of the food supply through reformulation (fat, sugar, salt, dietary fibre), food fortification for micronutrients of concern (voluntary or mandatory) and/or nutritional supplement recommendations (for nutrients unlikely to be sufficient from food intake alone).

The patterns and position of snacking in children in aged 2-12 years: A scoping review.

BACKGROUND: Childhood obesity is associated with serious comorbidities during childhood and into adulthood. One potential risk factor for childhood obesity is consumption of unhealthy, energy-dense foods. This scoping review examines evidence on snacking in children aged 2-12 years of age and presents the patterns and position of snacking in children's diets. METHODS: A search of electronic databases (MEDLINE, Web of Science, PubMed, Embase) for articles published from March 2011 to November 2022 was conducted. Articles providing insight into the position of snacking (e.g., energy contribution), or patterns (e.g., location, timing), in children aged 2-12 years were included. A quality assessment was conducted and data was synthesised according to data source (nationally representative or other). RESULTS: Twenty-one articles were included, most (n = 13) reporting nationally representative data. The average number of daily snacks was 3, with 92.9-100.0% of children consuming snacks. Most were consumed in the afternoon (75.2-84.0%) and at home (46.5-67.3%). Snacks frequently consumed were 'fruits and vegetables', 'baked desserts', 'sweets, candy and confectionery', and 'dairy products'. Snacks contributed 231-565 kcal daily, up to a third of daily carbohydrate intake, a quarter of fat intake, and a fifth of protein intake. Snacks provided up to one third of vitamin C intake, one quarter of vitamin E, potassium and magnesium intake, and a fifth of calcium, folic acid, vitamins D and B12, iron and sodium intake. DISCUSSION: This scoping review provides insight into patterns and position of snacking within children's diets. Snacking plays a significant role in children's diets with multiple snacking occasions occurring throughout a child's day, the overconsumption of which has the potential to increase risk of childhood obesity. Further research is required into the role of snacking, particularly specific foods playing a role in micronutrient intake, and clear guidance for snacking intake in children.

Determining the food choice motivations of Irish teens and their association with dietary intakes, using the Food Choice Questionnaire.

During adolescence, teens start making their own food choices. While health and nutrition are important, practical and social concerns are also influential. This study aims to determine factors that motivate the food choices of Irish teens (using Food Choice Questionnaire), using data from the National Teens' Food Survey II (N = 428, 50% male, 13-18 years), and to identify how these motivations relate to dietary intakes (4-day semi-weighed food diaries). Data analysis used PCA to determine the food choice motivation subscales, and correlation and comparative statistical tests (t-test, ANOVA). Eight motivating factors were identified for Irish teens: Sensory Appeal, Price & Availability, Health & Natural Content, Familiarity, Ease of Preparation, Mood, Weight Control, and Ethical Concerns. Health and practical aspects to food choice (Price, Availability, Ease of Preparation) are important for teens, but taste (Sensory Appeal) remains a key influence. Food choice motivations vary by sex and by age, BMI status and weight perception, where girls were more motivated by health, weight control, mood and ethical concerns, and older teens were more influenced by mood and ease of preparation. Both those classified as overweight and those who perceived they were overweight were motivated more by weight control and mood for their food choices, whereas those who perceived their weight to be correct placed more importance on health and natural content. Those motivated by weight control had lower energy and higher protein intakes, and those motivated by health and natural content had more health promoting behaviours, with higher physical activity, lower screen time, and higher protein intakes. Understanding the motivations of teens' food choice can help understand why they struggle to meet dietary recommendations, and help to develop more effective health promotion messages by capitalising on the key motivations in the population.

Perceived impact of the COVID-19 pandemic on child and adolescent psychiatric services after 1 year (February/March 2021): ESCAP CovCAP survey.

In April 2020, the European Society for Child and Adolescent Psychiatry (ESCAP) Research Academy and the ESCAP Board launched the first questionnaire of the CovCAP longitudinal survey to estimate the impact of COVID-19 on child and adolescent psychiatry (CAP) services in Europe. In this brief report, we present the main findings from the second questionnaire of the survey, one year after the COVID-19 pandemic began to hit Europe (i.e., February/March 2021). While service delivery to patients and their families was affected in a major way (reported by 68%) at the beginning of the pandemic, the majority of respondents (59%) in this second survey only reported a minor impact on care delivery. The use of telemedicine remained widespread (91%) but the proportion of CAP services partially closed or transformed to accommodate COVID-19 patients (59% in 2020) dropped to 20%. On the other hand, the perceived impact on the mental health and psychopathology of children and adolescents dramatically increased from "medium" (> 50%) in 2020 to "strong" or "extreme" (80%) in 2021. Four nosographic entities were particularly impacted: suicidal crises, anxiety disorders, eating disorders and major depressive episodes. Accordingly, this was associated with a substantial increase in the number of referrals or requests for assessments (91% reported an increase in 2021 while 61% reported a decrease in 2020). Finally, heads of the CAP departments expressed strong concerns regarding the management of the long-term consequences of this crisis, especially regarding the provision of care in light of the perceived increase in referrals.

Effectiveness of subtemporal decompression for the management of slit ventricle syndrome.

OBJECTIVES: To assess the effectiveness of subtemporal decompression in the management of slit ventricle syndrome. METHODS: We conducted a retrospective review of all patients with slit ventricle syndrome (SVS) who underwent subtemporal decompression (STD) at our centre between 2010 and 2021. Cases were identified using the hospital database. Medical records for each patient were reviewed, including operative and radiological reports. RESULTS: Fifteen patients underwent STD for the management of SVS. Median age at time of STD was 9.18 years. Aetiology of hydrocephalus consisted of spinal dysraphism (5), idiopathic (4), post-infectious (1), post-haemorrhagic (3), secondary to tumour (1), and craniofacial anomalies (1). Median age at first shunt insertion was 3.4 months. Median pre-operative period assessed, from initial shunt insertion to STD, was 4.54 (interquartile range [IQR] 3.12-10.47) years. Twelve patients underwent ≥1 shunt revision prior to STD. All patients had a diagnosis of SVS at time of STD. Presenting symptoms, for the admission in which STD was performed, included nausea (9), vomiting (8), lethargy (8), headache (12), irritability (5), and visual disturbances (6). One third underwent shunt revision at the time of STD. Two patients developed post-operative complications requiring further surgery (meningitis requiring shunt revision: 1; wound debridement: 1). Three patients developed uncomplicated post-operative pyrexia, which was managed with antibiotics. Median duration of post-operative follow-up was 5.4 (IQR 1.73-8.54) years. Eleven patients underwent ≥1 shunt related procedure following STD. Wilcoxon signed-rank test demonstrated a significant difference in number of shunt related procedures before (median = 5, IQR 1-8) and after (median = 3, IQR 0-5) STD (Z = -2.083, p = .037). All patients reported subjective symptom improvement post-operatively. Thirteen patients experienced symptom recurrence at a median duration of 10 months post-operatively. CONCLUSIONS: STD was associated with a reduction in the amount of shunt related procedures required in this group of patients with SVS. Further study is required to confirm this association.

Attitudes Toward Injection Practices Among People Who Inject Drugs Utilizing Medical Services: Opportunities for Harm Reduction Counseling in Health Care Settings.

Hospitals are an important setting to provide harm reduction services to people who inject drugs (PWID). This study aimed to characterize PWID's injection practices, the perceived risk and benefits of those practices, and the immediate IDU risk environment among individuals seeking medical care. Surveys were administered to 120 PWID seeking medical services at an urban hospital. Poisson regression was used to examine the effect of perceived risk or importance of injection practices on the rate of engaging in those practices. The mean participant reported "often" reusing syringes and "occasionally" cleaning their hands or skin prior to injection. 78% of participants reported that syringes were extremely risky to share, which was associated with lower likelihood of sharing them (ARR: 0.59; 95% CI: 0.36-0.95). 38% of participants reported it was extremely important to use a new syringe for each injection, and these participants were more likely to report never reusing syringes >5 times (ARR: 1.62, 95% CI: 1.11-2.35). Other factors that may influence injection practices-including fear of arrest, withdrawal, lack of access to supplies, and injecting outdoors-were common among participants. In conclusion, practices that place PWID at risk of injury and infection are common, and risk-benefit perception is associated with some, but not all, injection practices. Injecting in challenging environments and conditions is common. Therefore, harm reduction counseling in medical settings must be accompanied by other strategies to reduce risk, including facilitating access to supplies. Ultimately, structural interventions, such as affordable housing, are needed to address the risk environment.

Adequacy of calcium and vitamin D nutritional status in a nationally representative sample of Irish teenagers aged 13-18 years.

CONTEXT AND PURPOSE: In light of the key roles of vitamin D and calcium in adolescent bone health, there is a critical need for representative data on nutritional status for both micronutrients in teenagers. The present work used data from the recent representative National Teens' Food Survey II (2019-2020) to assess calcium and vitamin D intakes of teenagers in Ireland, including adequacy of such intakes, as well as, for the first time, to characterise serum 25-hydroxyvitamin D (25(OH)D) concentrations and their determinants. METHODS: Usual calcium and vitamin D intake estimates were generated using food intake data (via 4-day weighed food records) from a nationally representative sample of teenagers aged 13-18 years in Ireland (n 428). Serum 25(OH)D was measured (via LC-MS/MS) in the 57.5% (n 246) who provided a blood sample. RESULTS: Sixty-seven and 94% of Irish teenagers had intakes of calcium and vitamin D below the respective Estimated Average Requirements values, reflecting a high degree of inadequacy of intake for both micronutrients (and higher in girls than boys; P < 0.001). In addition, 21.7% and 33.1% of teenagers had serum 25(OH)D < 30 nmol/L (risk of vitamin D deficiency) and 30-49.9 nmol/L (inadequacy), respectively. Extended winter sampling, being aged 16-18 years, low total vitamin D intake, being overweight/obese or being of non-white skin type were significant (P < 0.05) predictors of serum 25(OH)D < 30 nmol/L. CONCLUSIONS: There was a high prevalence of inadequacy of intake of calcium and vitamin D in Irish teenagers, and a fifth were at increased risk of vitamin D deficiency.

ESCAP CovCAP survey of heads of academic departments to assess the perceived initial (April/May 2020) impact of the COVID-19 pandemic on child and adolescent psychiatry services.

In April 2020, the European Society for Child and Adolescent Psychiatry (ESCAP) Research Academy and the ESCAP Board launched the first of three scheduled surveys to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on child and adolescent psychiatry (CAP) services in Europe and to assess the abilities of CAP centers to meet the new challenges brought on by the crisis. The survey was a self-report questionnaire, using a multistage process, which was sent to 168 heads of academic CAP services in 24 European countries. Eighty-two responses (56 complete) from 20 countries, representing the subjective judgement of heads of CAP centers, were received between mid-April and mid-May 2020. Most respondents judged the impact of the crisis on the mental health of their patients as medium (52%) or strong (33%). A large majority of CAP services reported no COVID-19 positive cases among their inpatients and most respondents declared no or limited sick leaves in their team due to COVID-19. Outpatient, daycare, and inpatient units experienced closures or reductions in the number of treated patients throughout Europe. In addition, a lower referral rate was observed in most countries. Respondents considered that they were well equipped to handle COVID-19 patients despite a lack of protective equipment. Telemedicine was adopted by almost every team despite its sparse use prior to the crisis. Overall, these first results were surprisingly homogeneous, showing a substantially reduced patient load and a moderate effect of the COVID-19 crisis on psychopathology. The effect on the organization of CAP services appears profound. COVID-19 crisis has accelerated the adoption of new technologies, including telepsychiatry.

Dietary fat intakes in Irish children: changes between 2005 and 2019.

OBJECTIVE: To examine current dietary fat intakes and compliance in Irish children and to examine changes in intakes from 2005 to 2019. DESIGN: Analyses were based on data from the Irish National Children's Food Survey (NCFS) and the NSFS II, two cross-sectional studies that collected detailed food and beverage intake data through 7-day and 4-day weighed food diaries, respectively. SETTING: NCFS and NCFS II, Republic of Ireland. PARTICIPANTS: A nationally representative sample of 594 (NCFS) and 600 (NCFS II) children aged 5-12 years. Current intakes from the NCFS II were compared with those previously reported in the NCFS (www.iuna.net). RESULTS: Current intakes of total fat, SFA, MUFA, PUFA and trans fat as a percentage of total energy are 33·3, 14·0, 13·6, 5·6 and 0·5 %, respectively. Total fat, SFA and trans fat intakes since 2005 remained largely stable over time with all displaying minor decreases of <1 %. Adherence to SFA recommendations remains inadequate, with only 7 % of the population complying. Insufficient compliance with PUFA (71 %) and EPA and DHA (DHA; 16 %) recommendations was also noted. CONCLUSION: Children in Ireland continue to meet the total fat and trans fat target goals. Adherence to MUFA and PUFA recommendations has also significantly improved. However, deviations for some fats remain, in particular SFA. These findings are useful for the development of dietary strategies to improve compliance with current recommendations.

A hospital-wide initiative to redesign substance use disorder care: Impact on pharmacotherapy initiation.

Background: Substance use disorder (SUD) treatment in general medical settings remains underutilized. We evaluated 5 years of a hospital-wide SUD initiative which included an inpatient addiction consult team (ACT), low-threshold Bridge Clinic, recovery coaches, and office-based addiction treatment (OBAT) nurses. Methods: Naturalistic registry study. We calculated frequencies of patient contacts, types of substance use diagnoses, and medication treatment initiation and duration. Results: From 2014 to 2019, 7,036 unique patients were seen, including 4,959 by ACT, 1,197 in Bridge Clinic, 2,250 by a recovery coach, and 979 by an OBAT nurse. The median age was 47, 31% were women, 80% were white, 7% were black, 6% were Hispanic/Latinx, and 25% were experiencing homelessness. Alcohol use disorder was seen in 62%, opioid use disorder in 54%, cocaine use disorder in 29%, benzodiazepine use disorder in 14%, and stimulant use disorder in 7%. Co-occurring medical and psychiatric illnesses were common; 35% had hepatitis C, 59% depression, 66% anxiety, and 13% schizophrenia. 1,623 patients received a prescription for buprenorphine during the study period (42% of patients with OUD), 877 for oral naltrexone, and 163 for extended-release naltrexone. The mean length of continuous treatment was 178.4 days for buprenorphine, 47.7 days for oral naltrexone, and 1.29 injections for extended-release naltrexone. Conclusion: A hospital SUD initiative effectively initiated SUD pharmacotherapy with naltrexone and buprenorphine. Medication treatment episodes were longer with buprenorphine.

Modelling the impact of mandatory folic acid fortification of bread or flour in Ireland on the risk of occurrence of NTD-affected pregnancies in women of childbearing age and on risk of masking vitamin B12 deficiency in older adults.

PURPOSE: The rate of neural tube defects (NTDs) in Europe has remained similar since the 1990s despite folic acid supplement recommendations (400 µg/day) for women of childbearing age. Mandatory folic acid fortification of staple foods has proved effective for reducing the prevalence of NTDs in over 80 countries. This study estimated the impact of addition of folic acid to bread or flour in the Republic of Ireland on reducing the risk of occurrence of NTD-affected pregnancies and the possible risk of masking (undiagnosed) vitamin B12 deficiency in older adults. METHODS: Analyses were based on the Irish National Adult Nutrition Survey (2008-2010). Folic acid fortification was modelled using DaDiet© software. Estimates were made of the increase in average daily folic acid intake in women (18-50 years) and the risk of exceeding the tolerable upper intake level (UL) of 1000 µg for folic acid in adults over 50 years of age. RESULTS: The fortification scenarios examined would reduce the risk of NTD-affected pregnancies by 8-32%, corresponding to an increase of 39-152 µg in the mean daily folic acid intake of WCBA. The risk of masking anaemia associated with vitamin B12 deficiency in older adults would be negligible as the probability of exceeding the UL for folic acid, even by a small amount, is very low (≤ 0.2%). CONCLUSIONS: These levels of addition of folic acid to bread or flour would effectively reduce the risk of NTDs while allowing safe consumption of folic acid at current levels from other fortified foods and supplements.

The role of meat in the European diet: current state of knowledge on dietary recommendations, intakes and contribution to energy and nutrient intakes and status.

The role of meat in the diet has come under scrutiny recently due to an increased public emphasis on providing healthy diets from sustainable food systems and due to health concerns relating to the consumption of red and processed meat. The present review aimed to summarise dietary guidelines relating to meat, actual meat intakes and the contribution of meat to energy and nutrient intakes of children, teenagers and adults in Europe. The available literature has shown that food-based dietary guidelines for most countries recommend consuming lean meat in moderation and many recommend limiting red and processed meat consumption. Mean intakes of total meat in Europe range from 40 to 160 g/d in children and teenagers and from 75 to 233 g/d in adults. Meat contributes to important nutrients such as protein, PUFA, B vitamins, vitamin D and essential minerals such as Fe and Zn; however, processed meat contributes to significant proportions of saturated fat and Na across population groups. While few data are available on diaggregated intakes of red and processed meat, where data are available, mean intakes in adults are higher than the upper limits recommended by the UK Scientific Advisory Committee on Nutrition (70 g/d) and the World Cancer Research Fund (500 g/week). While there are no recommendations for red and processed meat consumption in children and teenagers, intakes currently range from 30 to 76 g/d. The present review provides a comprehensive overview of the role of meat in the European diet which may be of use to stakeholders including researchers, policy makers and the agri-food sector.

The prevalence of overweight and obesity in Irish children between 1990 and 2019.

OBJECTIVE: The present study aimed to examine the temporal prevalence of overweight and obesity in Irish children through different methodologies and evaluate the change in rates between 1990 and 2019. DESIGN: Anthropometric data from three Irish national food consumption surveys were used to examine the change in the prevalence of BMI and waist circumference-derived overweight and obesity levels. SETTING: Three cross-sectional food consumption surveys from the Republic of Ireland: the Irish National Nutrition Survey (1990), the National Children's Food Survey (2005) and The Second National Children's Food Survey (2019). PARTICIPANTS: A demographically representative sample of Irish children aged 5-12 years: 1990 (n 148), 2005 (n 594) and 2019 (n 596). RESULTS: Twelve percentage of children had overweight/obesity in 1990, which was significantly higher in 2005 at 25 % and significantly lower in 2019 at 16 % (P = 0·003). In 2019, more girls had overweight/obesity in comparison with boys (19 v. 14 %), whilst children from the lowest social class group had the highest levels of overweight/obesity (P = 0·019). Overall, the proportion of children with abdominal overweight/obesity was significantly lower in 2019 in comparison with 2005 (P ≤ 0·001). CONCLUSIONS: Evidence from the most recent national survey suggests that overweight and obesity levels are plateauing and in some cases reducing in children in Ireland. Despite this, rates remain high, with the highest prevalence in 2019 observed in girls and in those from the lowest social class group. Thus, overweight/obesity prevention and intervention policies are necessary and should be continued.

Pasture intensification is insufficient to relieve pressure on conservation priority areas in open agricultural markets.

Agricultural expansion is a leading driver of biodiversity loss across the world, but little is known on how future land-use change may encroach on remaining natural vegetation. This uncertainty is, in part, due to unknown levels of future agricultural intensification and international trade. Using an economic land-use model, we assessed potential future losses of natural vegetation with a focus on how these may threaten biodiversity hotspots and intact forest landscapes. We analysed agricultural expansion under proactive and reactive biodiversity protection scenarios, and for different rates of pasture intensification. We found growing food demand to lead to a significant expansion of cropland at the expense of pastures and natural vegetation. In our reference scenario, global cropland area increased by more than 400 Mha between 2015 and 2050, mostly in Africa and Latin America. Grazing intensification was a main determinant of future land-use change. In Africa, higher rates of pasture intensification resulted in smaller losses of natural vegetation, and reduced pressure on biodiversity hotspots and intact forest landscapes. Investments into raising pasture productivity in conjunction with proactive land-use planning appear essential in Africa to reduce further losses of areas with high conservation value. In Latin America, in contrast, higher pasture productivity resulted in increased livestock exports, highlighting that unchecked trade can reduce the land savings of pasture intensification. Reactive protection of sensitive areas significantly reduced the conversion of natural ecosystems in Latin America. We conclude that protection strategies need to adapt to region-specific trade positions. In regions with a high involvement in international trade, area-based conservation measures should be preferred over strategies aimed at increasing pasture productivity, which by themselves might not be sufficient to protect biodiversity effectively.

Estimating safe maximum levels of vitamins and minerals in fortified foods and food supplements.

PURPOSE: To show how safe maximum levels (SML) of vitamins and minerals in fortified foods and supplements may be estimated in population subgroups. METHODS: SML were estimated for adults and 7- to 10-year-old children for six nutrients (retinol, vitamins B6, D and E, folic acid, iron and calcium) using data on usual daily nutrient intakes from Irish national nutrition surveys. RESULTS: SML of nutrients in supplements were lower for children than for adults, except for calcium and iron. Daily energy intake from fortified foods in high consumers (95th percentile) varied by nutrient from 138 to 342 kcal in adults and 40-309 kcal in children. SML (/100 kcal) of nutrients in fortified food were lower for children than adults for vitamins B6 and D, higher for vitamin E, with little difference for other nutrients. Including 25 % 'overage' for nutrients in fortified foods and supplements had little effect on SML. Nutritionally significant amounts of these nutrients can be added safely to supplements and fortified foods for these population subgroups. The estimated SML of nutrients in fortified foods and supplements may be considered safe for these population subgroups over the long term given the food composition and dietary patterns prevailing in the respective dietary surveys. CONCLUSIONS: This risk assessment approach shows how nutrient intake data may be used to estimate, for population subgroups, the SML for vitamins and minerals in both fortified foods and supplements, separately, each taking into account the intake from other dietary sources.

The Development, Validation, and User Evaluation of Foodbook24: A Web-Based Dietary Assessment Tool Developed for the Irish Adult Population.

BACKGROUND: The application of technology in the area of dietary assessment has resulted in the development of an array of tools, which are often specifically designed for a particular country or region. OBJECTIVE: The aim of this study was to describe the development, validation, and user evaluation of a Web-based dietary assessment tool "Foodbook24." METHODS: Foodbook24 is a Web-based, dietary assessment tool consisting of a 24-hour dietary recall (24HDR) and food frequency questionnaire (FFQ) alongside supplementary questionnaires. Validity of the 24HDR component was assessed by 40 participants, who completed 3 nonconsecutive, self-administered 24HDR using Foodbook24 and a 4-day semi-weighed food diary at separate time points. Participants also provided fasted blood samples and 24-hour urine collections for the identification of biomarkers of nutrient and food group intake during each recording period. Statistical analyses on the nutrient and food group intake data derived from each method were performed in SPSS version 20.0 (SPSS Inc). Mean nutrient intakes (and standard deviations) recorded using each method of dietary assessment were calculated. Spearman and Pearson correlations, Wilcoxon Signed Rank and Paired t test were used to investigate the agreement and differences between the nutritional output from Foodbook24 (test method) and the 4-day semi-weighed food diary (reference method). Urinary and plasma biomarkers of nutrient intake were used as an objective validation of Foodbook24. To investigate the user acceptability of Foodbook24, participants from different studies involved with Foodbook24 were asked to complete an evaluation questionnaire. RESULTS: For nutrient intake, correlations between the dietary assessment methods were acceptable to very good in strength and statistically significant (range r=.32 to .75). There were some significant differences between reported mean intakes of micronutrients recorded by both methods; however, with the exception of protein (P=.03), there were no significant differences in the reporting of energy or macronutrient intake. Of the 19 food groups investigated in this analysis, there were significant differences between 6 food groups reported by both methods. Spearman correlations for biomarkers of nutrient and food group intake and reported intake were similar for both methods. A total of 118 participants evaluated the acceptability of Foodbook24. The tool was well-received and the majority, 67.8% (80/118), opted for Foodbook24 as the preferred method for future dietary intake assessment when compared against a traditional interviewer led recall and semi-weighed food diary. CONCLUSIONS: The results of this study demonstrate the validity and user acceptability of Foodbook24. The results also highlight the potential of Foodbook24, a Web-based dietary assessment method, and present a viable alternative to nutritional surveillance in Ireland.