Frailty syndrome: A target for functional nutrients?

Frailty is a late life phenotype characterized by a decline in physiological reserve across several organ systems, resulting in the increased susceptibility to endogenous and/or exogenous stressors. Although the etiology of frailty remains poorly understood, an interconnected network of putative mechanisms linked to the ageing process has been proposed. However, frailty is a dynamic process that may be prevented, delayed, or even reversed. The syndromic nature of frailty requires a multidomain approach, such as proper nutrition, as part of modifiable environmental factors, and represents one of the most promising and least costly ways to prevent and reduce frailty among older adults. Nutrient deficiencies have been consistently associated with frailty; however, mounting evidence also supports the hypothesis that beyond the traditional nutritional value, specific dietary components may exert function-enhancing effects and mitigate the extent of frailty. Thus, further mechanistic studies, along with large clinical trials, are imperative to establish the exact role of functional nutrients in the clinical management of frailty. Here, we provide a contemporary discussion of how emerging functional nutrients may contribute to modify the trajectory of the frailty syndrome.

Micronutrient intake in children with cystic fibrosis in Sydney, Australia.

BACKGROUND: Children with CF have been reported to consume significantly more energy-dense, nutrient-poor foods than controls where there are now concerns of inadequate micronutrient intake. There are no current or comprehensive dietary studies assessing micronutrient intake in CF children. OBJECTIVES: To evaluate micronutrient intake in children with CF compared to recommended dietary intakes (RDIs). METHODS: Dietary intake of 13 micronutrients was measured in CF children aged 2-18 years and age- and sex-matched controls using a validated food frequency questionnaire (The Australian Child and Adolescent Eating Survey). RESULTS: CF children (n = 82) consumed significantly more energy than controls (n = 82) [3142(2531-3822) kcal vs 2216(1660-2941) kcal; p < .001]. Absolute intake in CF children was significantly higher in all micronutrients except vitamin C and folate, however energy-adjusted intake was significantly lower for all micronutrients except vitamin A, sodium, calcium and phosphorous. Energy-adjusted intake in primary school CF children was significantly less than controls in 8/13 micronutrients. Overall, median intakes exceeded the RDIs for all micronutrients however CF children fell short of the RDIs for folate (26.8%), iron (15.9%) and calcium (9.8%). In pre-school, 50% of CF children and 91.7% of controls did not meet the iron RDI. High school CF and control children failed to meet RDIs for 7/13 and 9/13 micronutrients respectively. CONCLUSION: Increased intake of most micronutrients in CF children was largely attributed to higher energy consumption. However, micronutrient density of the diet declined with increasing age, where high school children failed to meet RDIs for most key micronutrients.

A Comprehensive Review on Chemical and Pharmacological Potential of Viola betonicifolia: A Plant with Multiple Benefits.

Viola betonicifolia (Violaceae) is commonly recognized as "Banafsha" and widely distributed throughout the globe. This plant is of great interest because of its traditional, pharmacological uses. This review mainly emphases on morphology, nutritional composition, and several therapeutic uses, along with pharmacological properties of different parts of this multipurpose plant. Different vegetative parts of this plant (roots, leaves, petioles, and flowers) contained a good profile of essential micro- and macronutrients and are rich source of fat, protein, carbohydrates, and vitamin C. The plant is well known for its pharmacological properties, e.g., antioxidant, antihelminthic, antidepressant, anti-inflammatory, analgesic, and has been reported in the treatment of various neurological diseases. This plant is of high economic value. The plant has potential role in cosmetic industry. This review suggests that V. betonicifolia is a promising source of pharmaceutical agents. This plant is also of significance as ornamental plant, however further studies needed to explore its phytoconstituents and their pharmacological potential. Furthermore, clinical studies are needed to use this plant for benefits of human beings.

Assessment of Nutritional Intakes in Individuals with Obesity under Medical Supervision. A Cross-Sectional Study.

People with obesity in Romania are often under medical supervision, which is aimed to decrease body weight and treat accompanying metabolic disorders and cardiovascular implications. However, there is limited information regarding the implementation of dietary recommendations in adults with obesity. We aimed to evaluate the prevalence of reaching the recommended intakes of macro- and micro-nutrients in adults with obesity under medical supervision. Individuals with obesity, recruited in the context of a study with a larger scope (NutriGen ClinicalTrials.gov NCT02837367), who were under medical supervision underwent four 24 h recalls in order to assess daily food intakes. Macro- and micro-nutrient intakes were computed, and the prevalence of reaching recommended dietary allowances (RDAs) for each nutrient was calculated. The majority of subjects did not meet the recommended intakes for most nutrients. Energy from fat exceeded the threshold of 35% recommended intake, even in the lowest quartile of energy intake. The micronutrients with less than 5% of individuals reaching the RDAs were vitamin D, vitamin E, fluoride, and omega-3 fatty acids for both males and females, and choline, magnesium, and potassium in females. The burden of inadequate nutrition in individuals with obesity should be acknowledged and properly addressed within efforts to reduce obesity rates and associated disorders.

Prevention of Micronutrient Deficiencies in Young Children: Consensus Statement from Infant and Young Child Feeding Chapter of Indian Academy of Pediatrics.

JUSTIFICATION: Micronutrient deficiencies have significant impact on the overall health and well-being of society and potential targets for supplementations. It is important to formulate a consensus statement in view of current evidence, and put in place strategies to meet targets. OBJECTIVE: To formulate by endorsement or adoption and disseminate a consensus statement for prevention of micronutrients deficiencies in young children for office practices from an Indian perspective. PROCESS: A National Consultative Meeting was convened by Infant and Young Child Feeding Chapter (IYCF) of Indian Academy of Pediatrics (IAP) on 17 December, 2016 at Mumbai. IYCF chapter, IAP, United Nations Children Fund, National Institute of Nutrition and Government of India were the participating agencies; and participants representing different parts of India were included. CONCLUSIONS: Micronutrient deficiencies are widespread. For its prevention proper maternal and infant-young child feeding strategies need to be practiced. Encourage delayed cord clamping, dietary diversification, germinated foods, soaking and fermentation processes. Existing Iron, Vitamin A, Zinc supplementation and universal salt iodization programs need to be scaled up, especially in high risk groups. Universal vitamin D supplementation need to be in place; though, the dose needs more research. Vitamin B12 deficiency screening and supplementation should be practiced only in high-risk groups. Availability of appropriately fortified foods needs to be addressed urgently.

Association of dietary intake below recommendations and micronutrient deficiencies during pregnancy and low birthweight.

Background Pregnancy is associated with biochemical changes leading to increased nutritional demands for the developing fetus that result in altered micronutrient status. The Indian dietary pattern is highly diversified and the data about dietary intake patterns, blood micronutrient profiles and their relation to low birthweight (LBW) is scarce. Methods Healthy pregnant women (HPW) were enrolled and followed-up to their assess dietary intake of nutrients, micronutrient profiles and birthweight using a dietary recall method, serum analysis and infant weight measurements, respectively. Results At enrolment, more than 90% of HPW had a dietary intake below the recommended dietary allowance (RDA). A significant change in the dietary intake pattern of energy, protein, fat, vitamin A and vitamin C (P < 0.001) was seen except for iron (Fe) [chi-squared (χ2) = 3.16, P = 0.177]. Zinc (Zn) deficiency, magnesium deficiency (MgDef) and anemia ranged between 54-67%, 18-43% and 33-93% which was aggravated at each follow-up visit (P ≤ 0.05). MgDef was significantly associated with LBW [odds ratio (OR): 4.21; P = 0.01] and the risk exacerbate with the persistence of deficiency along with gestation (OR: 7.34; P = 0.04). Pre-delivery (OR: 0.57; P = 0.04) and postpartum (OR: 0.37; P = 0.05) anemia, and a vitamin A-deficient diet (OR: 3.78; P = 0.04) were significantly associated with LBW. LBW risk was much higher in women consuming a vitamin A-deficient diet throughout gestation compared to vitamin A-sufficient dietary intake (OR: 10.00; P = 0.05). Conclusion The studied population had a dietary intake well below the RDA. MgDef, anemia and a vitamin A-deficient diet were found to be associated with an increased likelihood of LBW. Nutrient enrichment strategies should be used to combat prevalent micronutrient deficiencies and LBW.

Nutrition and Alzheimer Disease.

We gathered some theoretic and practical concepts related to the importance of nutrition in the prevention and management of Alzheimer disease (AD). Besides the role of nutrients in brain development and functioning, some nutrients exert special control in the development of AD, due to their participation in neurotransmitter synthesis, their modulation in epigenetics mechanisms, and as antioxidants. In addition, some non-nutrient food-derived substances have shown potential in the control of neuroinflammation and consequently in the prevention of AD. Finally, it is important to be aware of the nutritional status and food intake patterns of the patient with AD.

Micronutrient status of Indian population.

Micronutrients play an important role in the proper growth and development of the human body and its deficiency affects the health contributing to low productivity and vicious cycle of malnutrition, underdevelopment as well as poverty. Micronutrient deficiency is a public health problem affecting more than one-fourth of the global population. Several programmes have been launched over the years in India to improve nutrition and health status of the population; however, a large portion of the population is still affected by micronutrient deficiency. Anaemia, the most common form of micronutrient deficiency affects almost 50 to 60 per cent preschool children and women, while vitamin A deficiency and iodine-deficiency disorders (IDD) have improved over the years. This review focuses on the current scenario of micronutrient (anaemia, vitamin A, iodine, vitamin B12, folate, ferritin, zinc, copper and vitamin C) status in the country covering national surveys as well as recent studies carried out.

Why US adults use dietary supplements.

BACKGROUND: Dietary supplements are used by more than half of adults, although to our knowledge, the reasons motivating use have not been previously examined in US adults using nationally representative data. The purpose of this analysis was to examine motivations for dietary supplement use, characterize the types of products used for the most commonly reported motivations, and to examine the role of physicians and health care practitioners in guiding choices about dietary supplements. METHODS: Data from adults (≥20 years; n = 11 956) were examined in the 2007-2010 National Health and Nutrition Examination Survey, a nationally representative, cross-sectional, population-based survey. RESULTS: The most commonly reported reasons for using supplements were to "improve" (45%) or "maintain" (33%) overall health. Women used calcium products for "bone health" (36%), whereas men were more likely to report supplement use for "heart health or to lower cholesterol" (18%). Older adults (≥60 years) were more likely than younger individuals to report motivations related to site-specific reasons like heart, bone and joint, and eye health. Only 23% of products were used based on recommendations of a health care provider. Multivitamin-mineral products were the most frequently reported type of supplement taken, followed by calcium and ω-3 or fish oil supplements. Supplement users are more likely to report very good or excellent health, have health insurance, use alcohol moderately, eschew cigarette smoking, and exercise more frequently than nonusers. CONCLUSIONS: Supplement users reported motivations related to overall health more commonly than for supplementing nutrients from food intakes. Use of supplements was related to more favorable health and lifestyle choices. Less than a quarter of supplements used by adults were recommended by a physician or health care provider.

Nutrición parenteral: elementos traza, energía, complicaciones y monitorización / Parenteral nutrition: trace elements, energy, complications and monitoring

En el niño enfermo, una excelente alternativa en caso de no contar con nutrición enteral, es la nutrición parenteral (NP). Los requerimientos de los elementos traza, no están bien definidos. El síndrome de realimentación se puede presentar en niños con desnutrición moderada o grave, con desequilibrio metabólico y electrolítico. Las complicaciones pueden ser infecciosas, metabólicas, mecánicas, hepáticas, gastrointestinales, y psicológicas. En la práctica clínica la monitorización de los parámetros bioquímicos, mecánicos y antropométricos debe ser seguida. La nutrición domiciliaria, debe ser el objetivo fundamental en pacientes que dependen al 100% del apoyo por NP.

In the sick child, an excellent alternative if you do not have enteral nutrition is parenteral nutrition (PN). The requirements of trace elements are not well defined. The refeeding síndrome can occur in children with moderate or severe malnutrition, metabolic and electrolyte imbalance. Complications can be infectious, metabolic, mechannical, hepatic, gastrointestinal, and psychological. In clinical practice the monitoring of biochemical parameters and anthropometric mechanics must be followed. Home nutrition should be the primary goal in patients who dependo n the support 100% of the PN.

Desnutrición aguda severa en niños hospitalizados en el Hospital Pereira Rossell aplicación y evaluación de una pauta de diagnóstico y tratamiento / Severe acute malnutrition in children hospitalized in the Hospital Pereira Rossell: implementation and evaluation of a course of diagnosis and treatment

Introducción:La desnutrición aguda severa requiere el comienzo inmediato de un tratamiento específico. En el Hospital Pereira Rossell se creó y se puso en práctica una pauta de diagnóstico y tratamiento del niño con desnutrición aguda severa, basada en recomendaciones de OMS. Objetivo:evaluar los resultados de la aplicación de dicha pauta. Pacientes y Métodos: estudio prospectivo realizado entre el 1/5 y el 30/9 del 2008, incluyendo todos los niños hospitalizados en la Unidad de Nutrición, con diagnóstico de desnutrición aguda severa. Se aplicó la pauta de diagnóstico y tratamiento.Conclusiones: la desnutrición aguda severa afecta a niños pequeños. Se debe principalmente a fallas en la alimentación. Estos niños pueden ser tratados en forma exitosa con fórmulas de bajo costo y el agregado de electrolitos y micronutrientes. La ausencia decomplicaciones habilita a que el tratamiento nutricional pueda llevarse a cabo en domicilio.

Introduction: Severe acute malnutrition requires the immediate commencement of a specific treatment. Hospital Pereira Rossell was developed and implemented a guideline for diagnosis and treatment of children with severe a c u t e ma l n u t r i t i o n , b a s e d o n WHO recommendations. Objective:To evaluate the results of applying this standard. Patients and Methods: A prospective study between 1/5 and 30/9, 2008, including all children hospitalized in the Nutrition Unit, diagnosed with severe acute malnutrition.We applied the standard of diagnosis and treatment. Conclusions:Severe acute malnutrition affects young children. Is mainly due to power failures. These children can be treated successfully with low-cost formula and the addition of electrolytes and micronutrients. The absence of complications enables that nutritional therapy can be done at home

Zinc en la infancia: rompiendo paradigmas / Zinc in childhood: breaking paradigms

El zinc es un ejemplo de un micronutriente esencial, cuya deficiencia juega un papelimportante en la comprensión de las altas tasas de mortalidad y morbilidad infantil en países en desarrollo. Tanto la deficiencia intermedia de zinc como de vitamina A, pueden pasar inadvertidas clínicamente. Con respecto a la inmunidad, el zinc es fundamental para las funciones de tejidos de alto recambio, especialmente en el sistema inmunitario, y su deficiencia se asocia a alteraciones de la inmunidad innata, la inmunidad humoral y la inmunidad celular. Existe evidencia que avala la s u p l eme n t a c i o n d e z i n c d u r a n t e e inmediatamente después de un episodio de diarrea aguda, con lo que se disminuye su tiempo de duración y la gravedad, con reducción en la incidencia de diarrea en los dos o tres meses siguientes.Aun no se conoce exactamente cuál es el mecanismo que explique por qué se encuentra limitada la proliferación celular ante la deficiencia de zinc.

Zinc is an example of an essential micronutrient whose deficiency plays an important role in understanding the high rates of infant mortality and morbidity in developing countries. Both intermediate zinc deficiency and vitamin A, may go unnoticed clinically.With respect to immunity, zinc is essential for the functions of tissues of high turnover, especially in the immune system, and its deficiency is associated with alterations of innate immunity, humoral immunity and cellular immunity. There is evidence supporting zinc supplementation during and immediately after an episode of acute diarrhea, which shortens their duration and severity, with a reduction in the incidence of diarrhea in the two or three months. Still not known exactly what the mechanism that explains why it is limited to cell proliferation in zinc deficiency.

Impact of the revision of a nutrient database on the validity of a self-administered food frequency questionnaire (FFQ).

BACKGROUND: Revision of the national nutrient database in 2000 had a strong impact on the absolute level of estimated nutrient intake in dietary assessments. However, whether it influenced the ranking of individuals by estimated intake, a more important function in epidemiologic studies, has not been investigated. Here, we investigated the effect of this revision of the nutrient database on the validity of a food frequency questionnaire (FFQ) used to estimate nutrient intake in the Japan Public Health Center-based prospective Study (JPHC Study). METHODS: Subjects were a subsample of the JPHC Study who volunteered to participate in the validation study of the FFQ. Validity of the FFQ was evaluated by reference to the 28-day weighed dietary records as a gold standard. Nutrient intake according to the FFQ was recalculated using the revised database, and the results were compared to those using the previous database. Spearman's rank correlation coefficients (CCs) between intakes estimated by the FFQ and dietary records were computed using the revised database, and were compared to CCs computed using the previous database. RESULTS: For most of the nutrients, mean intake increased or decreased significantly using the revised database. However, no notable change was seen for the CC between estimated intake according to dietary records and FFQ when the revised database was used for calculation. Differences in the point estimates of the CCs ranged from -0.14 to 0.15. Likewise, CCs between biomarkers and estimated intake according to FFQ were similar for the two databases. CONCLUSION: Despite changes in intake levels for many nutrients, the validity of our FFQ using rank correlation by nutrient intake was not influenced by revision of the nutrient database in Japan.

Micronutrientes: consideraciones sobre los factores que influyen en los requerimientos de vitaminas y minerales / Micronutrient: estimation over factor related minerals, trace elements and vitamins requirements

El objetivo de este trabajo es dar una información complementaria, con la finalidad de precisar los conocimientos sobre la mayoría de los nutrientes esenciales. Se revisa el papel fisiológico, metabolismo, deficiencias y los requerimientos de las vitaminas, minerales y oligoelementos. Definir los límites de tolerancias para aquellas vitaminas y minerales en las cuales el exceso es un problema (AU)

La aplicación de las DRI (Dietary Reference Intakes) en la evaluación de la ingesta de micronutrientes en individuos / The application of DRI (Dietary Reference Intakes) in micronutrient intake assessment of individuals

El asesoramiento dietético dentro de la valoración del estado nutricional puede realizarse tanto para grupos como en individuos, difiriendo en ambos casos la metodología estadística a aplicar. En el presente artículo se describe la metodología para analizar la ingesta de micronutrientes en individuos. Para ello, se presupone una distribución normal tanto de las ingestas como de los requerimientos. Siguiendo las "Aplicaciones para el asesoramiento dietético" promulgadas por el Instituto de Medicina de EEUU, se citan ejemplos de cómo realizar el asesoramiento de la ingesta de micronutrientes, tanto en el caso de que tengan definido un Requerimiento Medio Estimado (EAR, Estimated Average Requirement) o una Ingesta Adecuada (AI, Adequate Intake). La aceptación a nivel mundial de estas directrices es un requisito previo para la armonización internacional de la interpretación de datos. En el caso de distribuciones sesgadas, no se pueden aplicar estos métodos y por tanto se deben desarrollar nuevas metodologías en el futuro (AU)

Risk analysis applied to food fortification.

OBJECTIVE: To describe how a risk analysis can be applied to food fortification, with emphasis on voluntary fortification and intake levels that might exceed usual dietary levels. DESIGN: Use of the risk analysis model as a frame to classify nutrients according to the risk of exceeding upper safe intake levels. Furthermore, to apply the model when discussing possible consequences of liberal fortification practices on eating behaviour and disease patterns. SETTING: The discussion on food fortification presently going on internationally. RESULTS: Micronutrients can be classified according to their safety margin, i.e. the size of the interval between the recommended intake and the upper safe level of intake. We suggest that nutrients with a small safety margin, i.e. for which the upper safe level is less than five times the recommended intake, be placed in a category A and should be handled with care (retinol, vitamin D, niacin, folate and all minerals). Category B comprises nutrients with an intermediate safety margin (vitamins E, B6, B12 and C), while nutrients that according to present knowledge are harmless even at 100 times the recommendation (vitamin K, thiamin, riboflavin, pantothenic acid and biotin) are categorised as C. DISCUSSION: The risk analysis model is a useful tool when assessing the risk of both too low and excess intakes of single micronutrients, but can also be applied to analyse the consequences of fortification practices on eating behaviour and disease patterns. Liberal fortification regulations may, for example, distort the conception of what is healthy food, and drive consumption towards a more unhealthy diet, contributing to the plague of overweight and concomitant increased risk of degenerative diseases. CONCLUSION: The impact of fortification practices on the total eating pattern of a population should become an integrated part of the discussions and regulations connected to the issue.

Micronutrient regulation in pregnant and lactating wome from Rio de Janeiro / Regulación de micrnutrientes en embarazadas y mujeres lactantes de Río Janeiro

Studies with low-income pregnant and lactating women from the city of Rio de Janeiro, conceened mainly with the changes in micronutrient homeostasis during pregnancy and lactation in the absence of overt clinical deficiencies, are reported. These studies focused on folate, cobalamin, iron, zinc and vitamin A. Factors that may effect the maternal micronutrient state, such as dietary intakes, use of supplements and interrelationships of micronutrients have been considered, as well as the implications of changes for maternal-fetal transfer and milk composition. Although these studies were not designed to evaluate the prevalence of sub-clinical micronutrient deficiencies in pregnant and women, they indicate that high frequencies of sub-clinical deficiencies of folate, iron, zinc and vitamin A, especially in pregnant women, are expected to be found in Rio de Janeiro

Zinc in urban infants and children from Brasilia / Zinc en infantes y niños urbanos de Brasilia

The substandard living conditions of the poor families in the growing urban population of Brazilian cities puts children in the more vulnerable group of micronutrient deficiency. The chemical analysis of milk diets consumed by infants showed that zinc is insufficiently provided in bottle-fed infants and possibly a first-limiting nutrient in breast-fed babies, at least during the first 6 months of life

Micronutrients and urban life-style: lessons from Guatemala / Micronutrientes y estilo de vida urbana: lección de Guatemala

Guatemala is a nation of 10 million persons, at the northern point of the chain of five Republics derived from Spanish colonies on the Ishmus of Central America. The country is diverse in its ethnicities, its climate and terrain, and its agricultural pursuits. The majority of its population is poor, illiterate, and under-employed. It has had aunique and turbulent political history, and only recently has emerged. The traditional basis of the diet, dating to Mayan times, is maize and beans. Guatemala City, with its population in excess of 2 million inhabitants, having doubled since the Earthquake of 1976, is the only major metropolis. The pattern of dietary selection and the format of eating meals is changing in relationship to the size, congestion, economic evolution, and modernization of the capital city. A wider selection of foods is consumed in the city, but preparation follows the traditions of the cuisine. Street vendors play an ever larger role in the feeding of the urban poor. Quantitative data are only available for vitamin A and zinc, and only in certain subsegment of the population. The vitamin A in fortified foods, notably table sugar which is fortified with retinyl palmitate by legal mandate, makes up over one-third of the intake. The maize tortilla is an important sources of calcium, iron, zinc and copper. Average zinc intakes are appropriate, but the biological availability of the metal is low. The intake of iodine is totally dependent upon table salt which is inconsistently fortified. Data on micronutrient status exists for vitamin A, iron, iodine, riboflavin and zinc. With respect to rural areas, no major advantages or disadvantages in the adequacy of micronutrient nutriture can be calimed for the urban population. IT is probable that, in the metropolitan area, vitamin A nutriture is slightly better and riboflavin status somewhat poorer than in the countryside. The prospects for tuture directions in urban lifestyle, in micronutrient status and in their interaction are uncertain. The pressures of growth are straining the ability of the municipal infrastructure and the industrial base to respond with provision of services and employment

Micronutrient deficiency in urban Indonesia / Deficiencia de micronutrientes en area urbana de Indonesia

The economic situation of characterized by a large increase in the gross national product which has been on average 7 por ciento annually during the last ten years. This was accompanied by rapid urbanization. With the economic improvement, "First World" health and nutrition problems are coexisting in Indonesia. In 1992, the most common of death cause was cardiovascular disease whereas tuberculosis was the second ranking. About 40 por ciento of the preschool children are stunted. The main stable food and source is rice, although the urban population has a more diverse food pattern than the rural population. In Jakarta, many children receive too late colostrum feeding and mothers are not aware about the importance of correct breastfeeding practices after delivery. Three studies had shown that about one fidth of preschool children and one fourth of elderly take micronutriens. Nevertheless are prevalent in Jakarta. About one third of women suffer from moderate vitamin A deficiency (plasma retino <0.70 mmol/L) and 50 por ciento of pregnant women are anemic. More information is necessary on other micronutrient deficiencies. For example, a small study revealed that nearly two thirds of non-institutionalized alderly living in Jakarta experience thiamine deficiency. Appropriate interventions to reduce micronutrient deficienies should sensitiza the urban population to the fact that the government should restrict itself no use its resources to assist only the poorest individuals and groups, whereas it must be expected from the middle class to spend more to solve their own problemas