Bowel habits, faecal microbiota and faecal bile acid composition of healthy adults consuming fruit pomace fibres: two-arm, randomised, double-blinded, placebo-controlled trials.

Dietary fibre modulates gastrointestinal (GI) health and function, providing laxation, shifting microbiota, and altering bile acid (BA) metabolism. Fruit juice production removes the polyphenol- and fibre-rich pomace fraction. The effects of orange and apple pomaces on GI outcomes were investigated in healthy, free-living adults. Healthy adults were enrolled in two double-blinded, crossover trials, being randomised by baseline bowel movement (BM) frequency. In the first trial, subjects (n 91) received orange juice (OJ, 0 g fibre/d) or OJ + orange pomace (OJ + P, 10 g fibre/d) for 4 weeks, separated by a 3-week washout. Similarly, in the second trial, subjects (n 90) received apple juice (AJ, 0 g fibre/d) or AJ + apple pomace (AJ + P, 10 g fibre/d). Bowel habit diaries, GI tolerance surveys and 3-d diet records were collected throughout. Fresh faecal samples were collected from a participant subset for microbiota and BA analyses in each study. Neither pomace interventions influenced BM frequency. At Week 4, OJ + P tended to increase (P = 0·066) GI symptom occurrence compared with OJ, while AJ + P tended (P = 0·089) to increase flatulence compared with AJ. Faecalibacterium (P = 0·038) and Negativibacillus (P = 0·043) were differentially abundant between pre- and post-interventions in the apple trial but were no longer significant after false discovery rate (FDR) correction. Baseline fibre intake was independently associated with several microbial genera in both trials. Orange or apple pomace supplementation was insufficient to elicit changes in bowel habits, microbiota diversity or BA of free-living adults with healthy baseline BM. Future studies should consider baseline BM frequency and habitual fibre intake.

Cost-effective options for increasing consumption of under-consumed food groups and nutrients in the USA.

OBJECTIVE: To identify the most cost-effective options/contributors of under-consumed food groups and nutrients in the USA. DESIGN: Twenty-four-hour dietary recall data were used for the dietary sources of under-consumed food groups and nutrients. Costs were estimated using USDA National Food Price Database 2001-2004 after adjustments for inflation using Consumer Price Index. SETTING: National Health and Nutrition Examination Survey, 2013-2016. PARTICIPANTS: A total of 10 112 adults aged 19+ years. RESULTS: Top five cost-effective options for food groups were apple and citrus juice, bananas, apples, and melons for fruit; baked/boiled white potatoes, mixtures of mashed potatoes, lettuce, carrots and string beans for vegetables; oatmeal, popcorn, rice, yeast breads and pasta/noodles/cooked grains for whole grain; and reduced-fat, low-fat milk, flavoured milk and cheese for dairy. Top five cost-effective sources of under-consumed nutrients were rice, tortillas, pasta/noodles/cooked grains, rolls and buns, and peanut butter-jelly sandwiches for Mg; grits/cooked cereals, low- and high-sugar ready-to-eat (RTE) cereal, rolls and buns, and rice for Fe; low- and high-sugar RTE cereals, rice, protein and nutritional powders, and rolls and buns for Zn; carrots, margarine, other red and orange vegetables, liver and organ meats, butter and animal fats for vitamin A; and citrus juice, other fruit juice, vegetable juice, mustard and other condiments, and apple juice for vitamin C. CONCLUSIONS: Apple/citrus juice, white potatoes/carrots, oatmeal, RTE cereals and milk were the most cost-effective food sources of multiple under-consumed food groups and nutrients and can help promote healthy eating habits at minimal cost.

Association of whole-grain and dietary fiber intake with cardiometabolic risk in children and adolescents.

BACKGROUND: Diet is known to affect many risk factors of cardiovascular disease (CVD), a leading cause of mortality and morbidity. AIM: The objective of this study was to explore the potential association between whole grain and dietary fiber with CVD risk factors, including metabolic syndrome (MetS) in children and adolescents using National Health and Nutrition Examination Survey (NHANES) 2003-2014. METHODS: Two days of 24-hour recall data from 16,507 children and adolescents age 2-18 years were used to estimate dietary intakes. Continuous MetS scores (cMetS) were computed by aggregating age/sex regressed z-scores of waist circumference, mean arterial blood pressure, high-density lipoprotein-cholesterol, triglycerides, and glucose. Regression analyses were used to assess association of fiber and whole grain intake with cardiometabolic markers including MetS after adjusting for demographic factors. RESULTS: Increasing tertiles of fiber intake were significantly associated with 3% lowered risk MetS in adolescents age 13-18 years. Additionally, increasing intake tertiles of fiber were associated with reduced risk elevated cholesterol (5-11% reduction), elevated diastolic blood pressure (10-23% reduction) in adolescents age 13-18 years, and risk of obesity (3-5% reduction) in children and adolescent age 2-18 years. Increasing tertiles of whole grain intake were only associated with reduced risk of elevated triglycerides (52% risk reduction) in adolescents age 13-18 years. CONCLUSION: The results suggest that intake of dietary fiber was inversely associated with several markers of cardiovascular disease risk including MetS.

High-Protein and High-Dietary Fiber Breakfasts Result in Equal Feelings of Fullness and Better Diet Quality in Low-Income Preschoolers Compared with Their Usual Breakfast.

Background: In the United States, 17% of children are currently obese. Increasing feelings of fullness may prevent excessive energy intake, lead to better diet quality, and promote long-term maintenance of healthy weight.Objective: The purpose of this study was to develop a fullness-rating tool (aim 1) and to determine whether a high-protein (HP), high-fiber (HF), and combined HP and HF (HPHF) breakfast increases preschoolers' feelings of fullness before (pre) and after (post) breakfast and pre-lunch, as well as their diet quality, as measured by using a composite diet quality assessment tool, the Revised Children's Diet Quality Index (aim 2).Methods: Children aged 4 and 5 y (n = 41; 22 girls and 19 boys) from local Head Start centers participated in this randomized intervention trial. Sixteen percent of boys and 32% of girls were overweight or obese. After the baseline week, children rotated through four 1-wk periods of consuming ad libitum HP (19-20 g protein), HF (10-11 g fiber), HPHF (19-21 g protein, 10-12 g fiber), or usual (control) breakfasts. Food intake at breakfast was estimated daily, and for breakfast, lunch, and snack on day 3 of each study week Student's t tests and ANOVA were used to determine statistical differences.Results: Children's post-breakfast and pre-lunch fullness ratings were ≥1 point higher than those of pre-breakfast (aim 1). Although children consumed, on average, 65 kcal less energy during the intervention breakfasts (P < 0.007) than during the control breakfast, fullness ratings did not differ (P = 0.76). Relative to the control breakfast, improved diet quality (12%) was calculated for the HP and HF breakfasts (P < 0.027) but not for the HPHF breakfast (aim 2).Conclusions: Post-breakfast fullness ratings were not affected by the intervention breakfasts relative to the control breakfast. HP and HF breakfasts resulted in higher diet quality. Serving HP or HF breakfasts may be valuable in improving diet quality without lowering feelings of satiation or satiety. This trial was registered at clinicaltrials.gov as NCT02122224.

The effect of high fiber snacks on digestive function and diet quality in a sample of school-age children.

BACKGROUND: Dietary fiber (DF) intake in American children is suboptimal, increasing the risk of GI distress and contributing to poor diet quality. The objective of this study was to determine the effect of introducing two high-fiber snacks per day on gastrointestinal function as well as nutrient and food group intake in healthy children ages 7-11 years old. METHODS: This study was a randomized controlled prospective intervention study of children 7-11 years of age (n = 81) attending a rural Midwestern elementary school. Children were randomized by classroom to consume two high-fiber snacks per day (total of 10-12 g DF) or their usual snacks for 8 weeks. Participants completed two 24-hour dietary recalls and a questionnaire about their GI health at baseline, mid-intervention (week 4), and post-intervention. Dietary data was entered into NDSR 2011 and t-tests utilized to assess changes. Analyses were completed in SAS 9.2. RESULTS: Children consumed at least half their snack 94% of the time when a snack was chosen (89% of time). Participants in both the intervention and control group had healthy scores on the GI health questionnaire at all time points. The intervention group increased DF (P = 0.0138) and whole grain (WG) intake (P = 0.0010) at mid-intervention but after the intervention returned to their baseline DF intake (P = 0.2205) and decreased their WG intake (P = 0.0420) compared to baseline. Eating high-fiber snacks increased DF intake by 2.5 g per day (21% increase), suggesting displacement of other fiber-rich foods. CONCLUSIONS: Study results indicate that children accept high-fiber foods, thus making these high-fiber foods and snacks consistently available will increase DF intake.

Trends in Vitamin C Consumption in the United States: 1999-2018.

Low intakes of fruits and vegetables have resulted in suboptimal intakes of several micronutrients, including vitamin C. This cross-sectional study used data from 84,902 children/adults (≥1 y) who completed a 24-h dietary recall as part of the United States National Health and Nutrition Examination Survey (1999-2018). Mean vitamin C intakes from foods/beverages were calculated as were trends in major food/beverage sources of vitamin C. Percentages below the Estimated Average Requirement (EAR) were estimated. Overall, mean vitamin C consumption declined by 23% (97-75 mg/d; p-value for trend < 0.001). 100% fruit juice was the leading source of vitamin C (25.6% of total or 21.7mg/d), but this declined by 48% (25-13 mg/d; p-value for trend < 0.001). Whole fruit increased among children/adolescents (+75.8%;10-17 mg/d; p-value for trend < 0.001), but not adults, while the vegetable contribution was generally unchanged. The proportion of the population below the EAR increased by 23.8% on a relative scale or 9 percentage points on an absolute scale (38.3-47.4%). Declines in vitamin C intake is driven largely by decreases in fruit juice coupled with modest increases in whole fruit. Due to associations between vitamin C intake and numerous health outcomes these trends warrant careful monitoring moving forward.

BH(4) therapy impacts the nutrition status and intake in children with phenylketonuria: 2-year follow-up.

The impact of tetrahydrobiopterin (BH(4)) treatment on phenylalanine tolerance, medical-food consumption, and nutrition status in patients with phenylketonuria (PKU) was investigated. Six children (5-12 years) with well-controlled PKU, responding to a BH(4) dose of 20 mg/kg per day, were assessed for 24 months. Mean dietary phenylalanine tolerance increased from 421 ± 128 to 1470 ± 455 mg/day. Height Z scores significantly improved from 0.25 ± 0.99 at baseline to 0.53 ± 1.16 at 24 months (p for trend < 0.001). Patients tolerated more phenylalanine and more intact protein and required less medical food (protein supplement). Improved linear growth and nutrition status was seen over the course of the 24-month follow-up. Due to the variation in phenylalanine tolerance, dietary recommendations should be tailored to the patient's individual requirements.

Oatmeal-Containing Breakfast is Associated with Better Diet Quality and Higher Intake of Key Food Groups and Nutrients Compared to Other Breakfasts in Children.

Oatmeal is a whole grain (WG) food rich in fiber and other nutrients. The study objective was to compare diet quality and nutrient intake of children consuming oatmeal breakfasts to those of children consuming other breakfasts using the National Health and Nutrition Examination Survey (NHANES) 2011-2014. Dietary intake data from 5876 children aged 2-18 years were divided by breakfast food consumption: oatmeal breakfasts, "Doughnuts, sweet rolls, pastries", "Pancakes, waffles, French toast", "Eggs and omelets", "Ready-to-eat cereal, lower sugar", and "Ready-to-eat cereal, higher sugar" were used to assess diet quality and intake of food groups and nutrients using the USDA Healthy Eating Index-2015 (HEI-2015), Food Patterns Equivalents Database, and Food and Nutrient Database for Dietary Studies, respectively. As compared to consumers of other breakfasts or breakfast skippers, oatmeal consumers had consistently higher diet quality (4-16 points higher HEI 2015 total score, p < 0.05), higher WG intake (0.6-1.6 oz eq. higher, p < 0.05), and higher fiber and magnesium intakes compared to consumers of most other breakfasts or breakfast skippers. The results show that children consuming oatmeal breakfasts have better diet quality and increased intake of key nutrients compared to breakfast skippers and other breakfast consumers and suggest oatmeal may represent an important component of a healthy childhood diet.

What do we know about dietary fiber intake in children and health? The effects of fiber intake on constipation, obesity, and diabetes in children.

The effect of dietary fiber intake on chronic diseases has been explored in adults but is largely unknown in children. This paper summarizes the currently existing evidence on the implications of dietary fiber intake on constipation, obesity, and diabetes in children. Current intake studies suggest that all efforts to increase children's dietary fiber consumption should be encouraged. Available data, predominantly from adult studies, indicate significantly lower risks for obesity, diabetes, and constipation could be expected with higher dietary fiber consumption. However, there is a lack of data from clinical studies in children of various ages consuming different levels of dietary fiber to support such assumptions. The existing fiber recommendations for children are conflicting, a surprising situation, because the health benefits associated with higher dietary fiber intake are well established in adults. Data providing conclusive evidence to either support or refute some, if not all, of the current pediatric fiber intake recommendations are lacking. The opportunity to improve children's health should be a priority, because it also relates to their health later in life. The known health benefits of dietary fiber intake, as summarized in this paper, call for increased awareness of the need to examine the potential benefits to children's health through increased dietary fiber.

Sources of Dietary Fiber and the Association of Fiber Intake with Childhood Obesity Risk (in 2-18 Year Olds) and Diabetes Risk of Adolescents 12-18 Year Olds: NHANES 2003-2006.

Increased fiber intake has been linked with lower risk of overweight and obesity in adults, but data are sparse for children. To address this issue, NHANES 2003-2006 data was used to evaluate (1) the food sources of fiber in children, (2) the dietary fiber density levels and risk of being classified as overweight/obese, and (3) the association between fiber intake level and impaired glucose metabolism in children. Analyses were restricted to the subsample of children with biological plausible diet reports (N = 4,667) and stratified by 2-11 year olds (n = 2072) and 12-18 year olds (n = 2595). Results showed that the food sources are predominantly foods that are low in dietary fiber, but are consumed at high levels. In 2-18 year old plausible reporters, the risk for overweight/obesity decreased by 17% from children in the medium tertile of fiber density intake compared to the lowest tertile (OR = 0.83, P value = 0.043) and by 21% between the highest compared to the lowest tertile (OR = 0.79, P value = 0.031). There was a protective effect of being in the medium tertile of dietary fiber density (OR = 0.68, P value <0.001) on impaired glucose metabolism. These results indicate a beneficial effect of higher fiber density in children's diets.